FILARIASIS 239 
Anderson! in his report on filariasis in British Guiana, in describing the 
clinical aspects of filariasis, states that a fourth type is the variety known as 
“filariasis verrucosa,’ on account of the very coarse, warty appearance of the 
skin. The warts and small bosses appear in greatest profusion around the 
lower part of the calf and the dorsum of the foot. 
Breinl * working in Australia, reported two cases of elephantiasis of this 
nature. ‘These we have discussed in our previous report of the Amazon Ex- 
pedition.* 
In one of our cases observed in the Belgian Congo (Case 580) the foot was 
covered with bristle-like, closely placed papillomata. The patient was a negro 
about twenty-two years of age with a skin otherwise clear. The abdomen was 
prominent, but the liver and spleen were not palpable. The lower legs and 
especially the ankles were moderately oedematous, and the dorsa of the feet 
were much swollen. The skin about the ankles was deeply folded and covered 
with fine, bristle-like papillomata. The upper surface of the foot, the ends of the 
toes, the sides and back of the foot showed similar changes. The toenails were 
thickened, irregular and cracked and the soles of the feet were thickened and 
oedematous. A note was made at the time that the appearance of the foot 
resembled that described by Breinl under the term “‘mossy foot.” Pieces of 
the tissue were excised and, after washing them in 95 per cent alcohol for 
three minutes, were cut into with a sterile knife and cultures made from the 
cut surface on Sabourraud’s media. A number of white and lightly yellow- 
tinged colonies developed on the surface of the media. These were found to con- 
sist of cocci, some small and others considerably larger in diameter. Other pieces 
of tissue were hardened in Zenker’s solution and in ten per cent formalin, and 
later sectioned and stained. Histological study of the tissues shows that there 
is great thickening of the stratum corneum and in places there are large num- 
bers of cocci and a few blastomycetic forms lying both above and between the 
layers of cells. They are particularly abundant where the cells are pressed 
apart from the oedematous condition. There is also a marked hyperplasia 
of the stratum mucosum. The corium in a number of areas shows marked 
infiltration of endothelial and polymorphonuclear leucocytes. There is also 
marked infiltration about the sweat glands. In places, between the individual 
papillomata, fissures and breaks have occurred, extending from the surface of 
the corneal layer downward through the epithelial layer and into the papillary 
layer of the corium. Within and along the margins of these channels, lying 
in the albuminous material containing a few red blood cells and fair numbers 
of leucocytes, are seen large numbers of cocci and a few torulae. These organ- 
isms have also infected the corium for some distance away from the margins 
of the fissures and in the tissue about them there is much proliferation of 
the endothelial leucocytes and polymorphonuclear cells. Many other degen- 
erating connective tissue cells are seen in and about these areas. In the deeper 
1 Anderson: London School Trop. Med., Research Memoir Series (1924), vol. V. Mem. 7, p. 14. 
2 Breinl: Report of Australian Inst. of Trop. Med. (1910). 
3 Strong and Shattuck: Loc. cit., p. 40. 
