168 The Philippine Journal of Science i9i» 



mined, sometimes punched out. Deep scrapings showed no 

 pyogenic organisms and practically no polymorphonuclear leuco- 

 cytes. Lymphocytes predominated with many large cells, 20 

 to 30 microns in diameter, some cf which looked as if they were 

 full of small circular bodies, which, however, showed no chro- 

 matin staining after Giemsa's stain. Healing was very slow, 

 and treatment was unsatisfactory. The second type was charac- 

 terized by an acute exudate with a dirty membrane and irregular- 

 staining diphtheroid bacilli. 



Shattuck, 4 at the same meeting, reported a series of 35 cases 

 of chronic Philippine ulcers, none of which was a typical "tro- 

 pical ulcer" (phagedenic) ; all were of obscure causation. On 

 clinical grounds solely, microscopic findings being negative or 

 ambiguous, he concluded that there were four types. Syphilis 

 was probably a factor in a few cases and possibly so in the 

 great majority; others were not diagnosed. The diagnosis of 

 probable syphilis was arrived at by exclusion, not by positive 

 findings, and in spite of atypical features. In the group of 19 

 cases from Catbalogan, Samar, the resemblance between the 

 different individual cases was very striking and pointed to a 

 common etiology, although the lesions ranged from simple ulcers 

 to contractures and loss of toes and bone destruction. The pos- 

 sibility that any of these may have represented late yaws was 

 not discussed. 



GENERAL DESCRIPTION 



The present report includes six cases that were seen in the 

 clinic of the Sanitary Survey Commission No. 2 of the Philip- 

 pine Health Service, during its survey of Hagonoy, Rizal, by 

 Dr. T. P. Corpus, the Commission surgeon, acting under instruc- 

 tions to note particularly all cases suggestive of blastomycosis 

 or any allied condition. Some were seen by me once, others 

 twice. Material for study was collected each time, and on the 

 second occasion photographs of four of them were obtained. 

 More extensive study of the cases themselves was prevented 

 by prevailing circumstances. 



GROSS LESIONS 



The lesions varied greatly in duration, extent, and activity, yet 

 presented features that suggest a common etiology. However, 

 they possessed no peculiarity that could differentiate them dis- 

 tinctly as a clinical entity. They developed subcutaneously, 

 sometimes as a pustule, usually as a firm nodule that broke 



4 Shattuck, R. R., This Journal, Sec. B (1907), 2, 551. 



