178 The Philippine Journal of Science ms 



flammatory tissue. On the inner surface of the foot was a firm swelling 3 

 by 5 centimeters, evidently a developing focus, covered by intact skin; this 

 was of several months' duration. Material for cultures and smears was 

 removed from open ulcers, but incision of the unopened mass was not 

 permitted. 



On November 18 the lesion over the ankle had lost its fungating character 

 (figs. 4 and 5), the mass on the inside of the foot was represented by 

 irregular ulcers, and those on the leg (fig. 4) had enlarged and were more 

 fused. The condition, as a whole, seemed more active. Small fragments of 

 superficial tissue were again secured. 



On August 17 material from three different lesions was 

 planted on nutrient banana agar and banana cylinders. The 

 cultures became overgrown with bacteria — B. pyocyaneous and 

 Staphylococcus aureus chiefly — and molds and were discarded. 



On November 17 other tissue fragments were obtained from 

 two active ulcers, though not sufficiently deep for satisfactory 

 cultivation work, and plants were made on various media. On 

 November 25 numbers of forms approaching the basic were 

 found in several cultures, few in others. On January 2, 1917, 

 there was apparently no increase of these bodies where they 

 were to be found. From three of the possibly favorable cultures 

 the material was transferred to plain banana agar slants. On 

 February 10 a very few basic forms were found in one of the 

 subcultures. Subplants from these to special media, and a gui- 

 nea pig (G. P. 110) inoculated intradermally, gave no results. 



Comment. — Though the lesions in this case were fairly active, 

 satisfactory material was not obtained. The lesions seemed very 

 sensitive, and the patient was unusually timorous. Being ig- 

 norant and careless, she had neglected the lesions, and contam- 

 inating organisms were particularly numerous. 



CASE IV 



Chronic ulcers of left leg, with deep scars. — The patient, T. P., a Filipino, 

 farmer, aged 19 years, was seen November 17, 1916. He was somewhat 

 undersized and not robust. The condition had begun eight years before as 

 a small sore at the knee. This had spread, evidently superficially, down- 

 ward over the entire inner surface and much of the outer, leaving a soft, 

 thin, parchmentlike skin extending to the inner malleolus. 



On the inner surface of the lower half of the leg were three irregular 

 ulcers (two shown in fig. 6) in an area of marked tissue loss. This is 

 poorly seen from the angle at which the photograph was taken. Fibrosis 

 was extensive and involved the muscular tissue, with some limitation of 

 motion. 



The ulcers were fairly typical, extending outward in the more or less 

 fibrotic tissue, with slow undermining of the epidermis (fig. 8) and indura- 

 tion of the overlying layer. Healing occurred centrally as the lesions 

 progressed outwardly, leaving scar tissue (fig. 6). These lesions were said 

 to have been active for two years, but it could not be determined positively 



