294 REPORT OF THE HARVARD AFRICAN EXPEDITION 
the contracture. Other scars on the backs of both thighs indicated deep destruc- 
tive lesions which had caused much loss of substance in the muscles. A large 
scar over the right shin exhibited complete depigmentation in some places and 
partial in others. The cartilage of the nose was nearly all gone and there was a 
perforation of the septum. The nasal bones and palate were intact. It was 
noted that the apparent good health of the patient, in spite of the extensive 
residual lesions, is a frequent manifestation of these cases of treponemiasis or 
tertiary yaws. Apparently in this patient the disease has run its course. 
In Case 385 (No. 219) there also were no ulcerative or suppurating lesions 
of the skin, the tissues being taken from nodular or infiltrated cutaneous lesions. 
It, therefore, is of interest to refer particularly to the clinical notes regarding 
this case. 
This patient was a Liberian of the Gibi tribe, about forty years of age, well 
nourished and apparently in good health. There were many pitted scars on the 
face, somewhat suggesting old smallpox, but the larger scars on the face were 
apparently due to some other process. On the right upper arm there were two 
infiltrated lesions serpiginous in outline, with the margins elevated for some 3 or 
4 millimeters, and with slight depressions in the center. The lesions themselves 
measured about 2 to 6 cm. in diameter and their color was pinkish-brown. On 
the anterior surface of the thighs there were symmetrical lesions of similar 
character to those just described on the arm. ‘There were also many small 
depigmented spots of skin scattered over the arms, face and chest. Some were 
at the sites of old scars, others seemed to be independent of the scars. In addition 
there were nodular formations in the skin. Several of these, measuring about 
1 cm. in diameter, were present on the posterior surface of the right upper arm; 
the skin over them was scaly. On the right side of the face, from the ear to the 
angle of the jaw, there was a series of nodules 0.5 to 1 cm. in diameter, and there 
was slight thickening and scaling of the epidermis along the edge of the left ear. 
There was also nasopharyngeal disease, with destruction of the cartilage and 
septum of the nose. The nasal palate was nearly all destroyed and there were 
ulcers in the posterior portions of the pharynx. There were also evidences of other 
destructive lesions consisting of an old sear on the terminal phalanx of the right 
thumb and loss of the tip of the middle finger. These were attributed by the 
patient to an injury in childhood. However, the little toe on the right foot 
presented a constricting band, as in ainhum. The lesion on the left foot ap- 
parently was of a similar nature in an earlier stage. Portions of tissue were taken 
from the patient from the different nodular and macular lesions and hardened both 
in Zenker’s solution and formalin and stained as already referred to on page 290. 
The histological study of the three portions of tissue excised reveals some 
changes not observed in those tissues from cases with ulcerative lesions which 
have already been discussed. In places the epidermis is not greatly altered. 
The stratum corneum is not more distinctly thickened than is frequently ob- 
served in a native African skin and there is only a moderate degree of proliferative 
acanthosis. In other areas the stratum mucosum is distinctly thickened without 
there being still any hyperkeratosis. In the more abnormal areas of the skin, 
