318 RHINOSCLEROMA 



as large as a pea ; in the earlier stages they are comparatively 

 smooth on the surface, but later they become shrunken and the 

 centre is often retracted. The disease is scarcely ever met with 

 in this country, but is of not uncommon occurrence on the 

 Continent, especially in Austria and Poland. In the granulation 

 tissue of the nodules there are to be found numerous round and 

 rather large cells, which have peculiar characters and are often 

 known as the cells of Mikulicz. Their protoplasm contains a 

 collection of somewhat gelatinous material which may fill the 

 cell and push the' nucleus to the side. Within these cells there 

 is present a characteristic bacillus, occurring in little clumps or 

 masses, chiefly in the gelatinous material. A few bacilli also he 

 free in the lymphatic spaces around. This organism was first 

 observed by Frisch, and is now known as the bacillus of 

 rhinoscleroma. The bacilli have the form of short oval rods, 

 which, when lying separately, can be seen to possess a distinct 

 capsule, and which in all their microscopical characters correspond 

 closely with Friedlander's pneumobacillus. They are usually pre- 

 sent in the lesions in a state of purity. It was at first stated that 

 they could be stained by Gram's method,. but more recent obser- 

 vations show that, like Friedlander's organism, they lose the stain. 



From the affected tissues this bacillus can be easily cultivated 

 by the ordinary methods. In the characters of its growth in 

 the various culture media it presents a close similarity to the 

 pneumobacillus, as it also does in its fermentative action in 

 milk and sugar-containing fluids. The nail-like appearance 

 of the growth on gelatin is said to be less distinct, and the 

 growth on potatoes is more transparent and may show small 

 bubbles of gas ; but it is doubtful whether any distinct line of 

 difference can be drawn between the two organisms so far as 

 their microscopical and cultural characters are concerned. 



The serum of patients suffering from the disease gives fixation 

 of complement when tested with an emulsion of the bacillus, but 

 varying results have been obtained as regards the validity of 

 the test in the differentiation of the bacillus from the allied 

 organisms. 



The evidence that the organisms described are the cause of 

 this disease consists in their constant presence and their special 

 relation to the affected tissues, as already described. From 

 these facts alone it would appear probable that they are the 

 active agents in the production of the lesions. Experimental 

 inoculation has thrown little light on the subject, though one 

 observer has described the production of nodules on the con- 

 junctiva of guinea-pigs. The relation of the rhinoscleroma 



