o12 REPORT OF THE HARVARD AFRICAN EXPEDITION 
time. This Philippine case was some years later reported by one observer as 
a case of leprosy, and by another one as representing a tertiary lesion of yaws 
because the Wassermann reaction was positive. While in many cases of leprosy a 
positive Wassermann reaction is an evidence of existing syphilitic infection, 
unquestionably the Wassermann reaction occurs in a certain percentage of cases 
of leprosy in which the reaction cannot be rendered negative by antisyphilitic 
treatment. Hence in leprosy a positive Wassermann reaction may not necessarily 
be conclusive of syphilis or yaws. The recent work of DeVera ! gives further con- 
firmatory evidence of this statement. On the other hand, it is recognized that 
syphilis and leprosy may sometimes exist as concomitant infections. 
Film preparations were made from Case 531 from the suppurative lesions on 
the arms, and portions of the diseased tissues and skin were removed and placed 
in Zenker’s solution and ten per cent formalin. Sections were stained by the 
Ziehl-Neelsen-Gabbett method for acid-fast bacilli, by haematoxylin and eosin, 
Giemsa’s solution and by Levaditi’s silver impregnation method. 
The three portions of tissue removed show some variations which, ead, 
are not very marked. In the first portion of tissue, where the epidermis is pre- 
served, the corneal layer is somewhat thin, while the stratum mucosum shows 
moderate proliferation. The papillae are irregularly placed but are, in many 
areas, still preserved. There is a marked cellular infiltration of the corium, in 
some instances extending into the papillae, but more marked in the deeper layers 
of the corium. ‘The corium also is occupied particularly by proliferating fibrous 
tissue in which fibroblasts are numerous. The cellular infiltration is composed 
particularly of plasma cells and there are zones or islands made up almost entirely 
of these cells surrounded by fibrous tissue. Fair numbers of round cells are else- 
where scattered through the tissue but there are comparatively few polymorpho- 
nuclear leucocytes. The corium is rich in blood vessels and newly-formed vessels, 
and capillaries are plentiful. About some of the blood vessels there is moderate 
proliferation of the endothelial cells. The great majority of the vessels, however, 
appear normal. There is no marked evidence of endarteritis or thickening of the 
coats. In the areas where the epidermis has been destroyed, many round cells 
are present, but the polymorphonuclear leucocytes are not very numerous. 
In the second portion of tissue, where the epidermis is intact, the corium be- 
neath is represented by areolar connective tissue containing considerable fat. 
This tissue is very vascular. In these parts of the section there is no infiltration 
about the vessel walls and no evidence of either endarteritis or thickening of the 
coats. In many of these areas there is comparatively little infiltration with 
plasma cells. Near the areas where the epidermis is destroyed, the stratum muco- 
sum shows hyperplasia and extensive downgrowths of the epithelium, almost 
suggesting conditions seen in early malignancy. These downgrowths of epithe- 
lium are surrounded by tissue densely infiltrated with plasma cells. In the area 
where the corium is exposed, the overlying tissues having been destroyed, coagula- 
tion necrosis has occurred. There are amorphous amalgamated areas of exudate 
staining red with eosin, in which there are cocci and the remains of a few degener- 
1 DeVera: Jour. Philippine Islands Med. Assoe. (1929), IX, 318. 
