94 
lasted for about six or seven weeks, during which time the sore slowly 
increased in size, he consulted a native physician, who first poulticed the 
area and then treated it with antiseptic dressings. About two weeks 
later he came to Manila for treatment, a diagnosis. of tropical ulcer 
having been made, and he was referred by the Civil Hospital to the 
laboratory for examination. The lesion revealed the condition shown 
by fig. 14. There was no longer any scab covering the entire area, 
though here and there, over the surface of the lesion, there were a few 
hardened crusts, and in other places small patches of a pseudomembrane 
of a grayish color. These patches may be distinguished in the figure. In 
general, the surface of the ulcer was moist and covered with a yellowish- 
gray, purulent exudate. The base was very uneven and was covered 
with areas of necrotic tissue or with fresh granulations. ‘The edges were 
undermined. In depth, the lesion extended through the entire skin and 
into the subcutaneous tissue and in places the muscle was just exposed. 
Dr. Cook, of the Civil Hospital, has kindly informed me that after 
curetting and antiseptic treatment, this ulcer, finally, after three months, 
healed and the patient was discharged, cured. 
The lesion, in this case, when first observed by me, seemed to cor- 
respond very well with the description of “tropical sloughing phag- 
edena,” as it is described by Manson, although the physical condition 
of the patient was otherwise good and the development of the ulcer did 
not occur exactly as Manson describes it. It is perhaps unnecessary 
to add that the lesion in this case was not syphilitic. 
Film preparations from various portions of the uleer were made on 
cover glasses, and these were examined both in a fresh condition and 
after drying and staining. While numerous, short, thick bacilli and a 
few cocci were found to be present in these films, nothing which sug- 
gested protoza or other parasites was observed. No tubercle bacilli were 
present. Portions of the tissues were excised for histological study, and 
agar plate cultures and bouillon tubes were prepared from the lesion, the 
oese being pushed through the soft granulations and also beneath the 
overhanging margins of the skin. After twenty-four hours the plate 
cultures developed numerous colonies, the great majority of which closely 
resembled one another. In fact, the cultures were almost pure. Colonies 
occurred on the surface and in the depth of the media. Usually most 
of those on the surface were round, whitish-gray, and moist. Under a 
low magnification they were often nucleated and their margins were 
frequently uneven. ‘There was little which was characteristic about them. 
Microscopical preparations, which were made from a number of colonies, 
showed the organism to be a short bacillus, measuring about 1.5 » in 
length and about 0.6 » in breadth. Its motility was only moderate, 
although later, numerous flagella were demonstrated. When inoculated 
in gelatin, rapid liquefaction of the medium occurred, with hair-like pro- 
jections in the line of the stab. Litmus milk was very slowly coagulated. 
