292 REPORT OF THE HARVARD AFRICAN EXPEDITION 
situated over the malleolus of the right ankle. The ankle, especially in its 
outer aspect, and the dorsum of the foot were swollen. The ulcer itself was 
very irregular in outline, indurated and with elevated margins. A portion of 
its base was composed of granulation tissue and another part covered with 
yellowish slough. In the vicinity of the ulcer were whitish, elevated scars. 
Cases 187, 203, 217, 385, 402-404, 553, and 579, will serve to illustrate 
very well other features of the condition. Case 187 (No. 216) illustrates both 
confluent and circumscribed, suppurating, as well as healing, lesions. The 
patient was a member of the Jarquellis tribe in Liberia, a woman about thirty 
years of age, who stated that the duration of the condition was three years, 
and that it began on the back of the wrist. There were no other cases in the 
family. Scarring was extensive on the distal two-thirds of the right forearm, 
part of the scar being depigmented and part hyperpigmented. On the under 
side of the elbow and forearm there were situated a number of ulcers varying 
from 2 to about 4 em. in diameter. Their bases were usually covered with 
yellowish slough. There was a similar ulcer, about 5 cm. in diameter on 
the dorsum of the wrist, and other ulcers on the proximal phalanx of the little 
finger and the knuckle of the right finger. These ulcerations were surrounded 
by depigmented scars. The little and ring fingers were stiff and useless, the 
middle finger more flexible. The subcutaneous tissues of the fingers were slightly 
swollen and indurated. There was no tenderness except near the margins of the 
ulcers. Over the lower part of the tibia on the right side was a superficially 
encrusted lesion. There was no general glandular enlargement. The skin sensa- 
tion on the arms was apparently normal. The ulnar nerve on the left side was 
not thickened, while that on the right was beneath an ulcer. In some of the 
sections of the tissues from this case the papillae are lengthened, and extend 
well into the mucous layer almost to the granular layer. There is marked in- 
filtration with plasma cells and a few leucocytes at the base of the papillae, but 
the infiltration does not extend to any great extent into the papillae toward the 
surface. Other portions of the sections show a more extensive infiltration of the 
corium with endothelial cells, leucocytes, plasma cells, and fibroblasts. There 
is much endothelial proliferation about the walls of the vessels. In No. 217 
is illustrated the more or less zonal character of the infiltration with a central 
area of necrosis. 
Case 553 (Nos. 208-210) represents a stage in which the disease has apparently 
run its course. This patient, an old negress observed near Stanleyville, was well 
nourished and apparently in good general health. There was very extensive 
scarring over the cheeks, bridge of the nose, backs of the hands, thighs and legs. 
Over the third and fourth metacarpals of the left hand the scars were adherent 
to the bones, indicating the previous existence of a destructive process beneath 
the skin. There were similar scars on the right patella and on the dorsum of the 
foot. The fresh sears on the right calf and marked shrinkage of the muscles in- 
dicated a deep destructive process. <A resulting contracture on this side had 
drawn the heel up so that the patient was obliged to walk on the ball of the foot 
and the movements of the ankle were limited. The toes also were involved in 
