XXIII 
DISEASES AFFECTING THE SKIN 
SPOROTRICHOSIS 
In Liberia a case of sporotrichosis was observed. The patient was a member 
of the Jarquellis tribe, about 45 years of age. The duration of the disease was said 
to be one year and to have started on the finger and spread up the arm. No sim- 
ilar cases were said to have occurred in his house. The general condition of the 
patient was good. The right forefinger was much swollen, especially around the 
phalanx. On the dorsal surface was an ulcer about three centimeters in diameter. 
The base of the ulcer was formed of granulomatous tissue in which there were 
depressions covered with a thin grayish slough. There was a similar lesion 
of smaller size between the thumb and forefinger and still smaller ones over 
the first and second metacarpal bones. Distributed along the radial surface of the 
forearm were four more somewhat larger lesions and there were also three on the 
inner aspect of the forearm. These ulcers were crater-shaped and had elevated 
margins. All the lesions were covered with a crust which was easily washed or 
picked off. There were no lesions of this nature elsewhere on the body and no 
sears which suggested that a similar process had existed elsewhere. There was, 
however, an old scar with keloidal thickening on the right hip, and another scar 
over the head of the right fibula. The skin sensation was apparently normal on 
the arms and back. The lesions are well illustrated in No. 257 (Case 186). 
An examination of the peripheral blood proved to be negative. At the first 
examination of the patient, three pieces of tissue were excised from the lesions 
of the finger and three pieces from the lesions on the forearm. These were placed 
in Zenker’s solution or ten per cent formalin. Later on, two other pieces of tissue 
were also excised and hardened in a similar manner. Many film preparations 
were made of the lesions and after they were hardened in absolute methyl alcohol, 
they were stained by Giemsa’s solution and by Ziehl-Neelsen-Gabbett’s method. 
The film preparations made from different parts of the lesions both suppurating, 
and granulating or healing areas, naturally varied somewhat in appearance. 
In the suppurative lesions many bacteria, particularly cocci, were found. Many 
of the leucocytes were also crowded with cocci. 
In some of the areas in the preparations made from the granulating lesions, 
many round disks staining deeply but without distinct double contour were ob- 
served, suggesting the spores of fungi. Some of these occurred in clumps and 
occasionally in the protoplasm in a degenerating cell. No acid-fast bacilli were 
found. <A piece of granulation tissue was removed and cut up and rubbed up in 
saline solution in a mortar and injected subcutaneously into a monkey. Films 
made from the cut surface of the piece of tissue showed no micro-organisms. 
331 
