328 REPORT OF THE HARVARD AFRICAN EXPEDITION 
illustrated in the photographs. The patches over the back and shoulders show 
serpiginous margins, slightly raised, of a reddish copper color, lighter than the 
surrounding skin. In the different cases of similar nature these maculae varied 
in size from 3 to 4 em. up to 15 em. in diameter (see Whitman, page 1052). 
Tissues were taken from the cutaneous lesions and hardened in Zenker’s 
solution and in formalin. Examination of scrapings from the patches showed 
large numbers of eryptococci similar to those already described in Case 110. In 
the study of the sections of three of the cases, however, no leprosy bacilli were 
found in the lesions. Nevertheless, they were almost certainly cases of tro- 
phoneurotic leprosy. Leprosy bacilli are, of course, frequently not found in 
many of the skin lesions of trophoneurotic leprosy, as we have emphasized else- 
where. It may be recalled that in some instances the skin lesions of leprosy 
consist of light or brown maculae in which there is distinct cellular infiltration 
of the skin. Such lesions probably constitute a stage of tubercular leprosy. In 
many of them, however, the pathological process apparently becomes arrested 
and the infiltration of the skin largely disappears. While in the earlier infiltrated 
lesions of the skin in tubercular leprosy, bacilli are usually found without diffi- 
culty, in the older maculae and particularly in the maculae associated with lesions 
of the nerves, the organisms are very frequently not found. In such cases, how- 
ever, they may sometimes be found in the involved nerves supplying the skin 
area. 
Relationship of dermal moniliasis to leprosy. E. C. Smith! has recently de- 
scribed a form of dermal moniliasis in Lagos, Nigeria, which may be similar to the 
condition that we observed in Liberia and have referred to. In his cases, the 
portion of skin most frequently involved was found to be that over the scrotum. 
However, the condition that he found, consisting of scaly maculae over the scro- 
tum was not observed by us. Smith, however, also observed patches scattered 
over the trunk and limbs. These varied in size and shape. Large irregular areas 
had ensued from the confluence of smaller ones. They were usually very scaly 
and tended to become whiter when scraped. A second clinical variety was de- 
seribed in which areas were somewhat shiny and like much-creased silver paper 
with hard and very scaly patches. The condition appeared to him to closely 
resemble that produced by the seborrhoea of temperate climates. Also, the close 
clinical resemblance to the various forms of tinea, in many instances rendered 
the naked eye differentiation of the etiology difficult if not impossible. It is 
the appearances illustrated in the excellent photographs in Smith’s article of the 
lesions of the body, and of the micro-organisms observed, that suggest particu- 
larly that the condition may be similar to the one that we studied in Liberia. 
We, however, did not see lesions which were particularly scaly or psoriasis-like 
in appearance. Possibly, however, the habits of the different tribes with refer- 
ence to bathing and scrubbing the skin may account somewhat for this difference 
in sealiness. Smith describes the organism he encountered as a Monilia. The 
morphology of the yeast cells which he found in his film preparations and in 
sections is similar to that observed in the Liberian cases. 
1 Smith: Trans. Royal Soc. Trop. Med. and Hyg. (1927), X XI, 125. 
