O22 REPORT OF THE HARVARD AFRICAN EXPEDITION 
and legs they consisted of more or less circular patches measuring from about 
1 cm. to 7-8 cm. in diameter. Here again the smaller ones were roughly circular 
while the larger ones had irregular, indefinite margins. The patches on the 
trunk, arms and legs were not raised and were smooth to the touch. They were 
distinctly lighter in appearance than the surrounding skin and of a cinnamon or 
copper color. Examined with a hand lens, the surface of the lesions on the face 
appeared uneven, apparently due to protrusion of the closely-placed papillae, 
while those on the body were even. The lesions, particularly those on the fore- 
head and face, suggested leprosy. 
After scrubbing the skin over a lesion on the cheeks with gauze and alcohol, 
it was scraped with a scalpel, and film preparations made with the material thus 
obtained which were stained for acid-fast bacilli. No leprosy bacilli were dis- 
covered but many oval and budding forms of Cryptococcus or Blastomyces were 
found lying both free and within the epithelial cells. In view of the fact that no 
leprosy bacilli were found in several such examinations, the skin over the cheeks 
was again scrubbed with gauze and alcohol and an alcohol dressing applied for 
five minutes, after which a small piece of the skin with the subcutaneous tissue 
was removed. Microscopical preparations made from the cut surfaces of this 
tissue showed only blastomyces and again no leprosy bacilli. The tissue was 
placed in Zenker’s solution. Cultures were taken on Sabourraud’s medium from 
the cut surfaces of the piece of tissue removed. The following day after a similar 
cleaning with alcohol six microscopical preparations were made from the maculae 
on the chest, and these were studied with similar results. An examination of the 
patient’s blood was negative for parasites, but there was apparently a moderate 
increase in eosinophils. On the third day, a distinct growth was visible in the 
culture, and on microscopical examination a few budding yeast cells were seen, 
but a large, coarse bacillus, very probably a contamination from the air, was 
present in large numbers. The latter organism rapidly overgrew the whole sur- 
face of the culture. Four days later another examination of scrapings of portions 
of other lesions was made for leprosy bacilli, but only the yeast cells were en- 
countered. Cultures also were again made from the lesions. At this time the 
following clinical note was made: 
The diagnosis of the case is frankly a puzzle. Without any microscopical examination, it 
would have been regarded as one of leprosy. It must, however, be admitted that the lesions on 
the skin of the face are not tubercular in character and they are not indurated to the touch. On the 
body, the patches of cinnamon red color are paler than the brown normal skin surrounding them, 
and are smooth. Upon the face, some of the patches are even lighter in color. There are no lesions 
in the nose or mouth or about the ears, and no anesthesia can be detected. 
After a few days, the cultures in Sabourraud’s medium revealed a white, 
porcelain-like growth which showed upon microscopical examination many oval 
and budding or dumb-bell-shaped forms and also chains of three or four budding 
segments, but with no mycelium. These yeast cells did not show a distinct 
double contour and also there were very few granules within them, and these 
were of small size. The organism was apparently a Cryptococcus, but obviously 
quite different from the Cryptococcus farciminosus, which was first described in a 
