396 PHALEN AND NICHOLS. 



kindness of Doctors Saleeby and Winsor we have been able to study 

 a number of patients at the Dispensary and usually have been able 

 to find without previous arrangement one or more cases. The physicians 

 in charge say that at least one new case of this form of disease applies 

 for treatment each week. Among 50 natives examined on one morning 

 we found 5 cases. In the last eight months we have seen 7 officers with 

 various degrees of the disease and have ceased to keep track of the exact 

 number of enlisted men affected. The infection has been seen in Min- 

 danao, Jolo, Cebu, Panay, Samar, and Luzon, and there is every reason 

 to believe it to be widespread throughout the group of Islands. This is 

 somewhat surprising because among skin diseases common in the Tropics, 

 no mention is made of this condition by Manson, Scheube, Mense, 

 Macleod in Albutt's System or Jackson, nor is the term found in special 

 articles on the skin diseases of different tropical countries. The only 

 account of this form of infection in the Tropics, which we have found, 

 is by Ashburn and Craig. They had a white patient, age 40, with 

 five lesions of two years' duration on his face, resembling ring-worm. 

 Scrapings stained by the modified Gram method showed round, double- 

 contoured bodies lying in and between the epithelial cells. The patient 

 stated that the disease was common among natives, but rare among 

 whites.- He improved under potassium iodide internally. No cultures 

 were obtained. There are several references to blastomycotic ulcerations 

 in the East by Sakurane and Okugawa, Japan, 1905 ; Lukis, India, 1907 ; 

 Strong, Philippine Islands, 1906, and Shattuck, Philipjnne Islands, 

 1907, but the lesions described seem to be different from those with 

 which we are now concerned. 



III. DIFFERENT FORMS. 



Clinically the disease appears in three distinct forms, although there 

 are intermediate types from the mildest to the most severe. 



A. The mild cases somewhat resemble the commonly observed skin 

 infections with ordinary fungi. The lesions are elevated little, if at 

 all, above the surrounding skin, are irregular in outline, and the surface 

 when freed from scales presents a smooth, reddish surface. The lesions 

 itch considerably, but otherwise give no discomfort. The couse is toward 

 a progressive extension of the patches, with marked induration of the 

 affected skin. The tendency to appear in unusual locations, and the 

 frequency of a symmetrical distribution are the features which distinguish 

 it clinically from ring-worm, with which it has many features in common. 

 It has been observed to occur on the back of the hands, the forearm, 

 shoulder, face, front of the leg, and the toes. 



Case I. — In fig. 1 is given an illustration of a lesion of this class. This 

 patient, a sergeant of an Infantry regiment, first came to the Philippine Islands 

 in 1904 and went to Camp Jossman, Island of Guimaras, for station. In the 

 spring of 1905, while cutting a clump of bamboo at that post, he scratched his 



