024 REPORT OF THE HARVARD AFRICAN EXPEDITION 
human lesion of the skin in a case in the Philippine Islands.t. It obviously is 
also different from the Cryptococcus dermatitis of Gilchrist and Stokes, as is 
evident from its morphology (Nos. 252-255). It evidently is a parasite of 
epithelial cells and is not present in endothelial phagocytes. It was not possible 
to identify further the species at the time in the field, and in the later months 
of the Expedition the tubes became extensively contaminated with other fungi 
from the air, from which it could not be recovered. 
Castellani,? in his excellent monograph upon “‘ Fungi and Fungous Diseases” — 
has fully discussed the etiology and clinical varieties of blastomycosis and gives — 
descriptions of twelve species and also mentions fifteen other less known ones. 
The organism in the present case is perhaps identical or closely related to Blasto- 
myces or Cryptococcus epidermidis which was isolated and described by Castellani 
some years ago in Ceylon, and later cultivated by him from small, roundish, 
dirty yellow or brown patches of skin on the arms and, more rarely, on the chest 
or neck. In Castellani’s cases the invasion of the epidermis by the micro- 
organism was apparently more superficial. 
Our case could not be studied further since unfortunately the patient did not 
reappear. At the last examination, additional portions of tissue were removed 
and these, as well as the other pieces previously taken, were hardened in Zenker’s 
solution and in formalin, and upon our return to the United States were sec- 
tioned. The sections were stained by different methods, including Giemsa’s and 
the Ziehl-Neelsen-Gabbett method for acid-fast bacilli. In the study of the 
sections, while the cryptococci were still encountered in the cells in the epidermis, 
being found in all layers of the stratum corneum and in portions of the stratum 
mucosum, deeper in the corium, leprosy bacilli were found in fair numbers 
(No. 256). Although in some portions of the tissue leprosy bacilli were easily 
demonstrable, in other parts of it they were not discovered. Both the clinical 
and histological examinations of this case suggest that the leprosy infection 
was making very slow progress; also, there had been evidently superimposed 
upon it the epidermal infection with Cryptococcus. Whether the alterations in 
the skin produced as a result of leprosy, predispose it in such areas to secondary 
infection with Cryptococcus, it is not possible to say. 
Several other instances of somewhat similar nature presenting yellowish- 
brown or copper-colored maculae or spots, usually upon the trunk, were later 
observed in Liberia. In two cases (183 and 219) the maculae were observed 
both upon the face and trunk. The patches were usually slightly elevated, espe- 
cially at the margins, the skin over them being smooth. No anaesthesia could 
be detected. In one of the cases (219) on the under surface of the great toe an 
ulcer was present having a base of relatively healthy granulation tissue. The tip. 
of the toe was entirely gone. There was no anaesthesia of the skin of the toes, 
no enlargement of the ulna nerve, and the lobes of the ears were normal. There 
were also no nodules in the skin. ‘The lesions on the trunk in this case are well 
























1 Strong: Publications, Dept. of the Interior, Bureau of Govt. Laboratories (1902), No. 1; Trans. 
Assoc. Amer. Physicians (1905), XX, 383. : 
2 Castellani: Arch. Derm. and Syph. (1927), pp. 388, 571, 714; (1928), pp. 61, 194, 354. 
