MEDICAL SURVEY OF THE TOWN OF TAYTAY. 285 



sniiilljjox and yaws are so common that it was difficult to find a child with an 

 entirely normal smooth skin. 



The following diseases were looked for but were not found: Tinea imbricata, 

 Tinea nigra {Castellani) , Pinta, and Tinea tonsurans. Two cases which clinically 

 resembled blastomycetic infection were seen but sections of the skin could not 

 be obtained. 



Puente. — In examining tlie adults, especial!}' the women, one fre- 

 quently meets with circular scars about one inch in diameter, on the 

 arms, legs and thighs which might be mistaken for vaccination marks. 

 These scars result from the healing of running sores called b}^ the natives 

 "Puente" (corruption of the Spanish word fuente^=sin-mg) which have 

 been produced for the purpose of causing counterirritation. The method 

 of their production is as follows : In a small area of inflammation, which 

 has been set up by the application of lime to the skin, an abrasion is made, 

 and upon this a small piece of betel-nut or wax is bound. Plate XVIII 

 fig. 2, shows the binder in place and fig. 1 shows a resulting ulcer with a 

 piece of wax in place. Puente is produced as a counterirritant to any sort 

 of pain or altered sensation and is most frequently used on the legs during 

 pregnancy. Only one case was seen in a man, he having a pad covering 

 an ulcer on his abdomen. 



Fibromata. — S3inmetrical fibromata were seen a number of times in 

 persons over 30, most frequently in females. The distribution of these 

 fibromata is shown in Plate XIX. Two were excised and on section 

 found to be fibroma dura : several felt partly calcified. The tumors 

 spring, apparently, from the subciitaneous tissue and are not painful 

 nor adherent to any particular structure. About one in every thirty 

 women over 30 years of age was found to have them either on one or 

 on both ankles and elbows. 



Yaws. — Tills disease is known in Taytay as "galis pateros," galis 

 being the Tagalog name for scabies, and pateros (Spanish name for duck 

 farm) the name of a town near by where yaws is supposed to be partic- 

 ularly prevalent and is thought to be contracted from a scaly lesion on 

 the head of the ducks. Twenty-one cases were foimd after a special 

 search and it is believed that nearly all the cases in the town were seen. 

 (Plate XX.) Sixteen cases were found in children under 10 j-ears oE 

 age, and, as the number of such children in the town is about 1,650, 

 lience about 1 per cent were infected. Treponema pertenuis was found 

 in three cases examined with the use of Giemsa's stain but the clinical 

 appearance is so characteristic tliat further microscopical examination 

 was considered unnecessary. The circinate, tubercular, ulcerative, and 

 desquamative forms occurred, but no lesions of yaws wei'e seen on the 

 soles of the feet. 



In almost every case the disease Avas attributed to contact with some 

 other case and in all liut one, in spite of very common ghindular enlarge- 

 ment the yaws seemed to develop gradually by aiitoiiioculation from 



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