Page:Tropical Diseases.djvu/723

XXXIX] to inconvenience and perhaps seriously implicating the urethra, vagina, or anus, but not otherwise materially impairing the health. The lymphatic glands do not become affected. The disease continues entirely local. Histologically this disease is allied to rhinoscleroma.

Histology.— On microscopical examination the new growth at the margins of the sore is found to be made up of nodules, or masses of nodules, consisting of round cells having large and, usually, badly staining nuclei. These cells are embedded in a delicate fibrous reticulum. The nodular masses are, for the most part, covered by epithelium, their under surfaces merging gradually into a thick, dense fibrous stroma in which small clusters of similar round cells are here and there embedded. The growths, though very vascular, contain no hæmorrhages; and there are no signs of suppuration or of caseation, no giant cells, and no tubercle bacilli. In vertical section of the small nodules the round-cell mass will be found to be wedge-shaped, the base of the wedge being towards the skin; the deep-lying apex is usually pierced by a hair or two. The growth is found around sebaceous follicles, blood-vessels, lymphatics, and sudoriparous glands; but it is especially abundant, and most deeply situated, around the hair-follicles.

Diagnosis.— Malignant and syphilitic ulcerations of the groin are common enough; the disease under notice, however, differs widely from these— clinically, histologically, and therapeutically. It is characterized by extreme chronicity— ten or more years; by absence of cachexia or of any tendency to cause death; by non-implication of the lymphatic system, and by non-amenability to mercury and iodide of potassium. The disease which it most resembles is lupus vulgaris. From this it differs inasmuch as it is practically confined to the pudendal region; affects mucous as well as cutaneous surfaces; tends to follow in its extension the folds of the skin; is not associated with the tubercle bacillus, giant cells, caseation, or other evidences of tuberculous disease.