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Paterson has a large 5 cm diameter tropical ulcer on his left 
foot which Frangoise opened, cleaned and dressed today and we gave him 
1.2 X 10 units of Bicillin im. He has been walking on the ulcer all 
day and this evening is ill with a fever of 39°C» some headache, and 
his ulcer is painful. I fear a bacteremia resulting from "opening" of 
his ulcer, not covered by the penicillin. We have put him on Aralen 
and Ampicillin and redressed his ulcer. We are leaving him with four 
days of Aralen and one week of oral Ampicillin (1.0 gm/day), and ample 
dressing materials. 
Jim Collin Tawioi has a small right indirect inguinal hernia which 
should be repaired and has an enormous hernia on the right 
(grapefruit size) and smaller one on the left. He has been to Lolowai 
where they decided against surgical repair "because he had had it a 
long time already". I do not find it a fibrosed filarial mass, and think 
that surgery is indicated. Thus, he and Jim should go into Santo for 
further workup and Paterson for grafting and further antibiotic treat- 
ment of his ulcer. The several cases of severe elephantiasis are beyond 
any therapy we can suggest for them. Zacharias is enormously fat, and 
this tends to obscure the fact that he does have elephantiasis of his 
lower limbs. At 13 years of age he is already crippled with the disease. 
He also has a history of several bouts of generalized edema but we see 
nothing suggesting renal disease on his physical examination now. 
One small girl of nine without evidence of elephantiasis, is 
enormously fat, two of the women are similarly obese, as one expects 
to see them in Polynesia but not in Melanesia. What is the reason for 
this? There are two men with enormous elephantiasis of their lower 
extremities. 
From dusk on, five of us worked at sticking fingers for hematocrits, 
hemoglobins and thick and thin smears, completing the whole community 
by 7:30 p.m. We then had a wonderful supper of rice, peas, tinned baked 
ham, and boiled green pawpaw, along with a pot of soup and dessert of 
cooked pawpaw in coconut milk, and hot tea. We have eaten well. All 
day and yesterday our "camp" has been the surrealistic setting of 
Stanley’s nearly destroyed house, with the roof askew, walls gone, cement 
patio open to the sky and a base of packed fine beach coral. In the 
intermittent showers of the day it has leaked' badly, but by shifting supplies 
and activities to dry space, we have manged to use the house. Its open- 
sided quality provides for ample breezes and relatively few mosquitoes. 
During the afternoon, the boys picked up three filled hemoglobin tubes 
with the numbers in the 1200 's on the sand beach of the cove facing southeast. 
Obviously, these have been discarded on the high seas and foolishly just 
off this bay, and some, have reached the sandy shore intact. It is embarraslng 
to have them show up this way, and we have to assure the people that they 
have been studied and used and are now discardable. 
