GRANULOMA INGUINALE 



2195 



Symptomatology. — The disease in the male begins on the penis, as 

 a rule, as a papule or small nodule, which extends over skin and 

 mucosa by peripheral growth, which is aided by the formation of new 

 papules and nodules at the growing margin and in the healthy skin. 



It grows into the groins, causing the hair to fall out, and between 

 the scrotum and the thighs, and from thence backwards into the 

 perineum and around the anus, into which it may pass. 



When fully developed, it appears as a mass of nodules or papules, 

 without deep ulceration as a rule, but with 'a thin, offensive dis- 

 charge. In the older regions it shows some attempt at healing in the 

 formation of dense scar tissue. There is very little pain or pruritus. 



In the female the process begins as a papule on the labium minus, 

 and then extends (into the vagina, along the perineum, around the 



Fig. 865. — Granuloma Inguinale. 

 (From a photograph by Sambon.) 



anus, and up the rectum, and into the groins. The growth extends 

 into the tissue between the rectum and the vagina, and may give 

 rise to rectovaginal fistulae. The whole growth is also much more 

 liable to ulcerate in the female than in the male. 



The lesions may become oedematous, and present an appearance 

 analogous to elephantiasis. 



Bonne and Verhagen have described a case in which the disease after a 

 time attacked the upper lip and alas nasi. 



Varieties. — -Daniels lays stress upon the fact that the disease 

 varies much in different races. In negroes it is more granular, and 

 spreads farther; in Indians it is less marked; in Fijians it is softer, 

 and separate areas more common. 



Diagnosis. — It is most likely to |be confused with syphihs, lupus, 

 and epithelioma. From syphilis it can be differentiated by the 



