236 REPORT OF THE HARVARD AFRICAN EXPEDITION 
tissue there are evidences of chronic hyperplasia. There is. endothelial pro- 
liferation about most of the vessels and the lymph spaces are sometimes almost 
occluded. However, in other areas hyperplasia of the lymph vessels has been 
brought about, giving an alveolar oedematous appearance to the tissue. Ap- 
parently the micro-organisms invading the surface of the skin are of a low grade 
of virulence that do not produce toxins capable of giving rise to a more acute 
inflammatory process which might result in the formation of abscesses. No 
doubt the inflammatory condition of the tissues resulting from the presence 
in or the blocking of the larger lymph vessels by the filaria primarily produces 
a condition, which together with the irritation resulting from scratching, is 
very favorable for the invsion of the deeper tissues with micro-organisms from 
the surface of the skin. 
This case recalls particularly one of our Brazilian patients in which there 
was elephantiasis and ‘“‘verrucous dermatitis’? and in which no fungi but only 
coecl were found in the deeper lesions. The subject of the etiology of mossy 
foot and verrucous dermatitis was fully discussed in the report of the Amazon 
Expedition ! in which it was noted that fungi had in some instances been culti- 
vated from such lesions and that in other cases no fungi had been encountered. 
The opinion of Rojas ? was concurred in to the effect that mossy foot and ver- 
rucous dermatitis as it has been described, is not a distinct morbid entity and 
constitutes an elephantoid condition of the skin which may arise from one or 
more of several causes. 
In this same report ® we have also called attention to the frequent secondary 
infection in filariasis with cocci and noted especially the attention which has 
been called by Stephens and Yorke* and Anderson’ to the importance and 
the frequency of such bacterial infections in cases of elephantiasis. The impor- 
tance of bacterial infection especially haemolytic streptococci in the production 
of elephantiasis has recently been emphasized by Acton and Rao,°® and Grace.’ 
Under the term dermatitis verrucosa (chromoblastomycosis), Mayer § illus- 
trates a case with lesions of the foot and leg, reported by Rocha Lima in which 
Blastomyces were encountered in the tissues. The parasites were round, re- 
fractile and brown in color, hence the name chromoblastomycosis has been given 
to the condition. Apparently Mayer also considers that Phialophora verru- 
cosa and Acrotheca pedrosiana which have been found by other observers in some 
cases termed dermatitis verrucosa are not yeasts. Castellani in his monograph 
of Fungi and Fungus Diseases *® does not refer to Phialaphora verrucosa and 
Acrotheca pedrosiana or to the subject of chromoblastomycosis. 
1 Loc cit., pp. 40-47. 
2 Rojas: Chronica Med. Lima, (1923), XL, 361. 
3 Loc cit., p. 123. 
* Stephens and Yorke: “Practice of Medicine in the Tropics,” ed. by Byam and Archibald (1923), 
III, 1922. 
6 Anderson: London School of Trop. Med., Research Memoirs (1924), Vol. V. Mem. 7. 
6 Acton and Rao: Indian Med. Gazette (1929), LXIV, 631. 
7 Grace: Proc. Royal Soc. (still unpublished), 
8 Mayer: ‘‘Exotische Krankheiten”’ (1929), p. 325. 
® Castellani: Arch. of Derm. and Syph. (1927-1928). 
