368 DOURINE 
Tertiary. Characterized by the formation of lesions in the central 
nervous system, and by nervous disturbance with ultimate paraplegia. 
It was probably on account of these three periods that the older 
writers confounded the disease with syphilis, and it is also possible 
that the ulcerations and chronic enlargements of the sheath and 
penis gave rise to the idea that it was a form of localized glanders. 
The duration of the disease is stated to be from three months to 
several years. The prognosis is unfavorable. 
Morbid anatomy. In the early stages there are phlegmonous or 
edematous swellings of the sheath, scrotum, penis and inguinal glands 
and a yellowish liquid effusion into the scrotal cavity. The skin 
covering the parts may show a papular or vesicular eruption or if 
this has passed a mottling with white spots shows where these lesions 
have been. Later, the inguinal glands shrink and become firm, owing 
to the development of fibrous tissue. The testicles, which are either 
swollen or shrunken, contain in some cases foci of suppuration or 
caseation. The connective tissue of the epididymis and the cord is the 
seat of a gelatinous exudate. The walls of the scrotum may be greatly 
thickened and be the seat of abscesses or of caseous degenerations. 
In advanced cases the testicles are usually abnormally small, even if 
the scrotal mass is enormously distended. The sheath and penis 
may be the seat of more or less numerous ulcers and swellings. Con- 
traction and contortions of the penis are not uncommon. It may, 
however, retain its normal dimensions. 
The walls of the lymphatics in the inguinal region may be the seat 
of hyperplasia; the thickening causes them to stand out like cords as 
in glanders. In the advanced stages the muscles, especially those of 
the hind limbs, become pale and atrophied. 
The nerve centers undergo profound changes which have been 
studied by Thanhoffer. The pia mater in the affected part of the 
spinal cord maybe the seat of active congestion and thickening. The 
central canal of the spinal cord is irregularly dilated, contains more 
than the normal amount of liquid and the neuroglia around it is 
thickened and fibrous. The substances of the cord, both white and 
gray, may show congestion, blood staining, and points of softening 
and of hyperplasia of the neuroglia. The nerve cells are modified in 
various ways, some being granular, some discolored by fine granular 
pigment, some having enlarged and multiple nuclei and some show 
vacuoles. Marek found in chronic cases cellular infiltration, degenera- 
tion and atrophy of some of its nerve fibers, especially of its posterior 
