VIII. B, 5 Barber: Unusual Disease at Buhi 371 



As to laboratory findings, pus, where obtained from a super- 

 ficial lesion, showed either pure Staphylococcus aureus or Staph- 

 ylococcus aureus with Streptococcus. In pus obtained from 

 a deep abscess avoiding surface contamination, a pure culture 

 of Streptococcus was obtained. Microscopical examinations of 

 blood smears from nonpurulent lesions were negative, and cul- 

 tures from this source and from blood taken from the vein 

 of an affected arm were also negative. All guinea pig inocula- 

 tions of pus or blood were negative. Plague and anthrax could 

 be definitely excluded. 



The duration of the cases was from two or three days to 

 several weeks, and all cases seen by me recovered except one, a 

 woman of 90, who had an abscess on the ankle. 



The people on being questioned maintained that a disease 

 like the one observed by me had not been known in Buhi before, 

 and certainly the occurrence of so many cases in a small popula- 

 tion and the fact that they followed an epidemic of fatal cases 

 would argue something unusual. There is no conclusive evi- 

 dence that the disease seen by me was a milder form of the 

 earlier epidemic ; but the testimony of the people, the similarity 

 in the lesions, and the fact that the one immediately followed 

 the other point to that conclusion. 



The only positive laboratory findings were pyogenic cocci, 

 and it is possible that many of the milder and perhaps of the 

 earlier fatal cases were due to pyogenic infection. The fact 

 that the disease often began at a definite point in the skin, 

 sometimes a minor lesion, and extended from it, would support 

 this view. But one would not expect a pyogenic infection to 

 take an epidemic form, unless in a people whose resistance had 

 been lowered by exceptional hardships. The location of the 

 town of Buhi is healthful, and the physical condition of the 

 people was generally good at the time of my visit; but there 

 had been an extended drought earlier in the season. There was 

 no foundation for the belief that this disease had any connection 

 with that of carabaos. 



Inquiry has been made among persons who have had a wide 

 medical experience in the Philippine Islands, but none have 

 observed a similar epidemic. Dr. A. G. Sison of the Philippine 

 General Hospital mentioned a cellulitis, probably pyogenic in 

 origin, known among the people of Manila and the northwest 

 provinces as "culebra" or "snake," because of its tendency to 

 progress from an extremity upward. There is a slight fever 

 and a vesicular eruption over the lesion. This disease does not 

 occur in an epidemic form. 



