﻿558 SHATTUCK. 



dressed with an antiseptic. The ulcer when seen again two days later appeared 

 very much better. A piece of tissue was removed from one of the knobs in the 

 base of the ulcer. The patient stopped coming and has not been seen since. 



Smears from scrapings showed blood, with a few polymorphonuclear leucocytes 

 and many cocci and thick bacilli, the latter intra- and extra-cellular. One slide 

 also contained a few blastomyees. A section stained with hematoxylin and eosin 

 showed hypertrophy of the middle and papillary layers of the epidermis. There 

 were a few polymorphonuclear leucocytes and plasma cells in the corium, but 

 no lymphocytes around the vessels and no endarteritis. No necrotic nor ul- 

 cerated areas were seen. The silver stain and that for tubercle bacilli gave 

 negative results. The Gram-Weigert stain showed many diplococci and bacilli in 

 the horny layer (the former were positive and the latter negative to Gram). 



Case VI. — A young native woman. 9 The patient was poor and emaciated, the 

 throat negative and the glands not enlarged. The lesions were confined to the legs 

 and feet, which presented an appearance suggesting elephantiasis. The knees 

 could not be completely straightened. The left foot was firmly held in the posi- 

 tion of equinus by contracted, atrophied muscles. The right foot and ankle were 

 much enlarged and held immovable by the dense, wooden character of the swelling. 

 The skin was pink, unyielding and immovable with a macerated, sealing surface 

 which merged into large ulcers encircling both ankles. There were sloughing, 

 ragged ulcers of varying size and depth on the feet. The great and second toes 

 of the right foot were absent, but the bone was not exposed. On the legs there 

 were many small, round, punehed-out ulcers of equal size, having firm, inverted 

 edges and a yellowish slough at the base from which exuded a sero-purulent, 

 sticky fluid. The legs were bathed in this foul-smelling exudate. They were not 

 anaesthetic. This patient was under observation for a week. The lesions improved 

 under simple washing. 



Smears from the exudate taken on two occasions showed pus and enormous 

 numbers of bacteria of many kinds. Spirochsetae were present in three out of four 

 specimens and were very abundant in two of these. The fourth specimen con- 

 tained blood with a little pus and only a few bacteria. Many of the spirochsta; 

 could fairly be classed as Sp. refringens Schaudinn, but the characteristics of the 

 majority were midway between these of typical refringens and typical Treponema 

 pallidum Schaudinn. No typical examples of pallidum were seen. 



No. 17 (see Table I) is an excellent example of the same sort of hypertrophy 

 and ulceration. The toes on the affected limb were drawn up by contractures. 



These four cases had two important common characters : First, a 

 similar hypertrophic process affecting the skin in the same way; second, 

 punched-out ulcers of the same type. These fundamental resemblances 

 were noticeable at a glance. Stelwagon ( 6 ) in his description of ulcerat- 

 ing gummata says that an "elephantoid" condition with punehed-out 

 ulcers is common, that it has no clear limits and that in a few months 

 it takes on a violaceous hue, softens, and breaks dow r n or is absorbed. 

 The indications are that the hypertrophic condition in the first and 

 third cases has lasted much longer than the limit which this anther has 

 given. The process in the first case was pretty definitely circum- 

 scribed, but its limits in the third case could not be determined. Chronic 



9 No. 4 of Catbalogan series. First seen April 10, 1907. 



