HISTOPATHOLOGY— SYMPTOMATOLOGY 



1541 



cytes, large and small mononuclear leucocytes, eosinophiles, plasma 

 cells, mast cells, connective-tissue cells, and some extravasated 

 erythrocytes. In the older nodules the plasma cells are present 

 in such enormous numbers as to dominate all the others. Macleod 

 has shown that there is no perivascular mononuclear infiltration 

 so characteristic of syphilis, nor 

 any endothelial proliferation in 

 the vessel walls. The framboetic 

 lesion also differs from that of 

 syphilis in affecting the epithelium 

 rather than the cutis, in the more 

 considerable oedema, and in the 

 absence, as a rule, of the giant 

 cells. 



When the framboetic granulo- 

 mata have reached a certain stage, 

 a very well-marked hyperkera- 

 tosis is noticeable. One of us has 

 called attention to the appearance 

 of the films taken in the usual 

 way from the granulomata, and 

 stained according to Leishman's 

 method. In such films it is inter- 

 esting to note the presence of a 

 large number of polychromatic 

 red blood cells of very different 

 sizes, some much larger than the 

 normal erythrocytes, some much 

 smaller. They are stained deep 

 or light blue instead of pink, and 

 sometimes have a granular appear- 

 ance. The leucocytes present in 

 the films frequently contain in 

 their protoplasm, and sometimes 

 in their nuclei, roundish or oval, 

 more or less deeply blue stained 

 bodies, which are probably poly- 

 chromatic micro-erythrocytes en- 

 gulfed by phagocytes. Some of 

 these bodies present peculiar 

 chromatin dots. In such films 

 the Treponemata are almost con- 

 stantly found. The Treponemata 



may be put in evidence also in sections by using the Volpino- 

 Bertarelli or Levaditi's silver staining, as used by Spronk, Shennan, 

 and Schiiffner. The examination of sections so stained shows that 

 the parasite is mostly found in the epithelial layers. 



Symptomatology. — ^l^he course of framboesia may be divided into 

 three periods — a primary stage, comprising the development of the 



Fig. 687. — Frambcesia: Primary 

 Stage, showing the Primary 

 Lesion OR Frambcesoma below 

 THE Right Knee. 



