398 PHALBN AND NICHOLS. 



crescentio ridge 3 to 6 millimeters high and 13 to 20 millimeters wide, with a 

 concavity vvpward extending along the lower edge and sides of the patch. This 

 ridge has a number of small pustules opening upon its surface, and is covered by 

 a crust made up of the dried discharge. The center and the upper part of the 

 affected area is occupied by indurated tissue, with a smooth surface covered 

 by fine scales. A smaller area, 4 by 5 centimeters, of a similar character 

 occupies the outer side of the right elbow. This area has a ridge along the 

 posterior border, with some superficial erosion. The rest of the lesion is made 

 up of indurated tissue of a like character to the larger lesion. The scales and 

 crusts show a great quantity of blastomyeetes. 



Case III. — This patient is an officer in a Scout organization, and presents the 

 following history: In the early part of 1904, while stationed at Camp Connell, 

 Samar, he noticed a small papule near the middle of his left cheek. He con- 

 sidered it of no consequence, and so does not remember much of its early 

 characters, except that it itched considerably. He does not recollect any injury 

 or abrasion of the face previously. From this beginning the present lesion has 

 extended, at first downward, then forward and upward ; at first it was quite 

 superficial and the earlier places were healed by the local application of nitrate 

 of silver. As is customary in these cases, the eruption recurred almost 

 immediately and the patient has never been free from it since. 



When first seen by us, in April, 1908, there was present on the left cheek a 

 large, crescentic patch extending parallel to the lower jaw, presenting an 

 indurated ridge along the convexity of the patch and induration of a less 

 degree inside. 



The whole area is red and shining, except where covered with scales. Along 

 the ridge, a number of more indurated spots exist, lighter in color, which upon 

 opening exude a small drop of white pus. There are some crusts covering small 

 cavities also containing pus. Examination of the scales and pus in this case 

 reveals in large numbers the same organisms found in the others. 



Case IV. — C. C, Chinaman, 40 years old, a shopkeeper in the Santa Cruz 

 district of Manila, seen at St. Luke's Dispensary. No history is obtainable, 

 except that the lesions present are of eight months' duration, came on grad- 

 ually and were still extending. This patient has a circular patch, 5 centimeters 

 in diameter, over the center of the back of his neck. This patch has a raised, 

 indurated border and a central portion, indurate, but apparently healed, on 

 the levcjl with the rest of the skin. The surface of the raised border is smooth, 

 glossy and of a dark red color. This patient has also a round, elevated spot, 

 12 millimeters in diameter at each angle of the mouth and on the right side 

 of the lower lip a patch extending laterally from the angle of the mouth to 

 the median line, and reaching downward for about 25 millimeters, the lower 

 border being scalloped and raised in a sharp ridge. The lesions are bright red 

 and glossy. The scales show a large number of organisms which are indis- 

 tinguishable from those found in the other eases ; a culture was obtained from 

 this case, which will be described later. 



A number of other eases of this class have been observed (fig. 2). 

 They all give a history of a long, chronic course, and of resistance to 

 treatment. They have been diagnosed as syphilis, leprosy, tuberculosis 

 and other diseases. However, with the exception of tuberculosis, there 

 is little resemblance to these infections. The case of cutaneous blastomy- 

 cosis, reported by Ashburn and Craig in 1906, belongs to this second 



