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I'O M ! i ! ! d 'OJ-j'Ci I'd i i i t o g?d id j i • > j o g o i o j j j j 1 •d 'u oo ; o j | j j '3 >.<« >, i >» i i i i J2 a> fe I'&lJloojo SqSoP j jo ! 8 o be o o o ooooo •d •d«d f f O 'O 'C^ ^ 3 O g . i i i i i i i i i s 1 i i i i i i I "3 j « j | { j j { 1 'nd £ ! ! j ! ! ! ! ! 6 j j | j j ; j j &b o o goo cd o o o o 3 3 o o o ooooo g'd'd'd'g'd'd'd'd o ! j ! w ! ! ! ! is •d nd-d 'd *d 'd 'd 'd & iii i i i i a i i i i i i i i t i | N N || 1 1 !2 ' i i i i i 6 3 i i i i i i < i i d be 'o ! o3 i d be i i i i i £o|f|oo&o s c o3 ^3 d "3 3 j 100 j O S5 >^ ill!! « ,0 « JS O * J3 t> iCiO "O CO fc {Z5 ^ Tfl ■^rji "^ ^ Th Tf^ d bo 5 O J-CT3 S be 0Q I ."So S S« d 03 O T( 21 d A o3 ft R 44 be •-) 'd o o d oi o> !>! d 0) ft V a ->, 5 -^ a -d "3 o o §s +3,d o o 03 O O M M»d ,d.d "^.bc •d d $1 CO * ^5 ^i -*■" o— i -a^ +» d O 03 ^^ 5 « d£ d9 5| ^d Z! d .2 S Or. 33 A fuller discussion of the variations of B. bovisepticus, especially as regards pathogenicity, must be left for further study. From the few facts at the present time available we are not willing to draw conclusions. REFERENCES TO LITERATURE. Diekerhoff. Lehrbuch der speciellen Pathologie imd Therapie. Berlin, 1892. Schneidmuhl. Vergleichende Pathologie und Therapie. Leipzig, 1898. Moore. The Pathology and Differential Diagnosis of Infectious Diseases of Animals. Ithaca, N. Y., 1902. Woolley and Jobling. Hemorrhagic Septicaemia in Animals in the Philip- pine Islands. Bulletin No. 9, Biological Laboratory, Bureau of Gov- ernment Laboratories. Manila, 1904. Woolley. Pulmonary Lesions Produced by the Bacillus of Hemorrhagic Septicemia. Bulletin No. 12, Ibid. Manila, P. L, 1904. 23394 3 Part III. REPORT ON PINTO (PAnO BLANCO). By Paul G. Woolley, M. T>., Director of the Serum Laboratory. Under the terms pano bianco, pinta, pinto, carate, mal pintado, mal de los pintos, mal del pinto, peint, cute, cativi, quirica, pannus, carateus, and the spotted disease of Central America, is included a group dermatomycoses, characterized by peculiar nonpigmented patches on the skin, in the scales from which hyphse or spores or both, of a mold-like fungus are found, which resemble in some cases Penicilium, in others Aspergillus, in still others Monilia. Heretofore this epiphytic disorder has been reported from Mexico and Central and South America; another disease resembling it in some respects has been observed by Legrain in North Africa, and by Sandwith in Egypt, but, so far as I know, no previous report has come from the Philippine Islands. The case which I wish to record is not the only one which I have seen in Manila, but it is the only one from which I have been able to obtain specimens for examination. All of the affected persons whom I have noticed have shown only the white variety, of which the following case is an example. The history of the case is as follows : The patient was a Filipino laundryman, 15 years old, and in good health. There was no similar disease in any of his immediate family. Upon inspection it was noticed that there were pinkish white patches, irregular in size and shape, on the ankles, dorsa of the feet, shins, knees, elbows, hands, wrists, and one on the right shoulder. This last-mentioned lesion the boy says was the one first noticed. The largest ones were over the external malleoli of the 35 ankles. These, the boy says, appeared after the one on the shoulder. The patches on the knees and elbows occurred later. None of these patches were of the same shape or size, nor were they definitely defined, but they shaded from their clear white centers to the normal brown of the skin. Neither were the lines of extension regular, so that the outlines of the patches were irregular and crenated. About the larger areas were smaller ones, some barely visible and of a faint pinkish white or very light-brown color. On palpation it was evident that the skin over the larger patches was slightly rougher than the normal and that it felt somewhat thicker. The palpating finger could detect no abnormal variation in the covering of the smaller spots. There was but a minimum amount of scaling, and there was some itching. The rate of extension had been extremely slow, for in three years the largest patch had a diameter of but 7 by 5 centimeters. When asked regarding the cause, the boy said that the first spot came from carrying laundry baskets on his shoulder, and that the other ones followed traumata of one kind or another. There were no lesions on the palms of the hands or soles of the feet. From one of the larger lesions on the ankle scrapings were made and examined in a solution of caustic potash (25 per cent) . Among the epithelial cells branching, segmented hyphge were seen forming a coarse mesh work. The mycelium was somewhat finer than that of Trichophyton; it was in general evenly refrangent, but in places beaded or granular. The spores were darker in color than the rest of the organism and less refractile. An occasional fructification was found in the smears, and in these the arrangement of the spores was like that of Penicilium. When treated with dilute fuchsin the spores were stained a very deep red. The hyphse showed an inner segmented arrangement with a continuous inclosing capsule. There w r as nothing in any of the preparations to suggest the description of Gastambide. The mycelial filaments were usually long, branched, and terminated in a bunch of spores. The descrip- tion given by Montoya y Mores seems to apply more accurately to the fungus of this case. There can be no doubt of the nature of the disease. The clear white spots with almost normal looking skin can be confused with no other skin affection with which I am acquainted. Diseases caused by trichophytons are extremely common in Manila and are 37 known generally as "dhobie itch," which is so common in the natives that in thirty cases of skin disease taken at random in Bilibid Prison twenty-four showed trichophyton filaments in caustic potash preparations. It is possible that a brown pinta might be confused with pityriasis versicolor should the small patches occur on the face where it is said that the latter may occur. However, in the present case the clear white color of the irregular patches, the presence of sensation and of itching, together with microscopic findings, are enough to assure a correct diagnosis. REFERENCES TO LITERATURE. Manson. Tropical Diseases. London, 1903. Scheube. Krankheiten der Warmen Lander, 1900. Part IV. NOTES ON ANALYSIS OF THE WATER FROM THE MANILA WATER SUPPLY. By Charles L. Bliss, B. S., Chemist. In December, 1903, it was suggested by the Superintendent of Government Laboratories and the Director of the Biological Labor- atory that a systematic investigation, both from a chemical and bacteriological standpoint, be made of the water supplied the city of Manila. After careful consideration it was decided that this investigaton should consist of the usual sanitary chemical analysis and a count of bacteria, these to be made at regular intervals of one week and to extend over a period of several months. Later it was decided to examine the water for the presence of amebas and also to extend the investigation so as to include samples taken from the course of the watershed. There were several reasons why such examinations were desirable : (1) Up to that time no chemical analysis of the city water had been made at the laboratory, and frequent requests for statements in regard to the water had to be denied. (2) It was supposed the water would vary considerably from time to time — not only from one season to another, but even from day to day. It seemed very probable that during the rainy season especially it would be subject to great changes within the course of a few hours, and that the results would be markedly different from the ones obtained during the dry, hot months preceding. This seemed all the more probable if any conclusions can be reached from the appearance of the water on different days. While ordi- 39 40 narily it is quite clear, a few hours after a rain it shows turbidity, which is very marked after a heavy storm. The watershed contains a quantity of suspended matter in the form of a fine silt, most of which gradually deposits when it is allowed to stand for a short time. This would naturally lead to the supposition that a variation could also he expected in the soluble constituents and in the number of bacteria. (3) Although numerous bacteriological examinations have been made of the city water since the organization of the Biological Laboratory, these had not previously been made at regular intervals, but only at random as opportunity offered; moreover, they were undertaken for different purposes. At times merely a count of bacteria was needed ; at others, a search for certain specific organ- isms was undertaken, so that no continuous record was made of the number of organisms found in the water. (4) Amebas had been frequently found in the water in past times, 1 but it was not definitely known whether or not they were always present. With the prevalence of amebic dysentery in the city it was especially desirable to know whether these organisms were constantly present in the water. The investigation was begun on December 14, 1903, and con- tinued during seven months. It extended over the greater por- tion of the cooler weather, the hot season, and the beginning of the rainy season. At first weekly examinations were made; but after three months, there having been but little variation, examina- tions were made every alternate week. All samples were taken from a tap in the laboratory except on the following days: Feb- ruary 23, from El Deposito; February 29, from the Mariquina Eiver at Santolan, and March 7, four samples. from the Mariquina Kiver (the watershed) at different points. The taking of the samples (with the exception of those from El Deposito and Mariquina Kiver), the methods of manipulation, the apparatus and chemicals were as nearly uniform as possible throughout the entire period, Monday of each week being selected as the day for doing this work. The last sample was analyzed on *Dr. Strong called attention to the presence of amebas in the water and to its unfitness for drinking purposes in his annual . report as Director of the Biological Laboratory in 1902 and 1903. See Report of the Superintendent of Government Laboratories for 1902 and 1903. 41 July 15, for the reason that there had been an excessively heavy rainfall on the four days preceding, during twenty-seven hours of which time 17 ■£■ inches of rain had fallen, the city and outlying districts having been completely under water from the evening of the 12th till a day or so later. A few weeks earlier an examina- tion made eight or nine days after a rather severe typhoon showed results very nearly the same as those which had been obtained throughout the series ; it was therefore thought best to take a sample very soon after the flood, rather than wait until the following week. It might be remarked "that even in this instance there was but very little variation from the usual results. Two samples were taken from one of the laboratory taps each Monday morning, after the water had been allowed to run for at least one-half hour; one was retained for chemical analysis, the other, with the usual precautions to prevent contamination, was sent to the Biological Laboratory. 1 Both examinations were begun immediately. The sample for chemical analysis was collected in a 3-liter, glass-stoppered bottle, which was first rinsed thoroughly, filled and emptied two or three times, and then filled to the neck; the stopper was well rinsed and immediately inserted. This bottle was used for no other purpose throughout the series. The deter- minations of nitrites, nitrates, ammonia, and oxygen consumed were started at once so as to obtain results representing the true condition of the water before any changes due to oxidation, reduc- tion, or bacterial action could vitiate it, all necessary precau- tions to prevent contamination by laboratory fumes being taken. As the results in chlorine and hardness would not be affected by any changes which might take place in the water, and as the residues would be but very little if at all altered, these determina- tions were deferred until opportunity to make them was at hand; but in every instance they were undertaken before the end of the week. In order to represent the water as it actually came from the pipes, all analyses were made with the unfiltered liquid. The chemical analysis consisted of the determination of total residue; fixed residue; loss on ignition; nitrogen in the forms of 1 The counting of the bacteria was done by Mr. Clegg, of the Biological Laboratory, and the determination of the presence of amebas was also done by Mr. Clegg in conjunction with Dr. Musgrave, who has compiled his results in Bulletin No. 18, Bureau of Government Laboratories, Biological Laboratory. 42 nitrites, nitrates, free and albuminoid ammonia ; oxygen consumed ; chlorine; also hardness. As some of the methods of manipulation were different from those usually employed, a brief description is given. Total residue was determined in a platinum dish easily holding 100 cubic centimeters, by evaporation on the water bath, and heating for thirty minutes at 95° after drying. The dish, after the weighing of the total residue, was heated uniformly to low redness for three or four minutes. It was then placed in the desiccator and weighed as soon as cold. " There was practically no change in the appearance in any sample on heating ; at most only a very slight darkening and but little odor were perceptible, indicating the presence of only small amounts of organic matter. The loss on ignition was therefore due largely to decomposition of carbonate, as the heat was not sufficient to volatilize any chlorides. Nitrites.— The reagents were prepared as follows: (a) Eight grams of naphthylamine hydrochloride were dissolved in water, 8 cubic centimeters of concentrated hydrochloric acid added, and the solution diluted to one liter. (6) Sulphanilic acid, a saturated solution in water containing 5 per cent concentrated hydrochloric acid. The test was made by placing 50 cubic centimeters of the water in a Nessler tube, adding 1 cubic centimeter of each of the above solutions, and mixing well by gently shaking. After thirty minutes the color was noted. In no instance did the depth of color indicate more than a very faint trace of nitrites, and very frequently none developed. There- fore a quantitative estimation could not be made. Nitrates. — The aluminum reduction method was employed. After a few hours, when the reaction was completed, the ammonia formed, together with the free ammonia originally present in the water was estimated directly by the Nessler process; the free ammonia (determined in another portion of the sample) was deducted, the remainder being the ammonia formed from the nitrates. In the present series the determination of nitrates was begun within a few minutes after the sample was received, and the ISTesslerizing was done on the following day. If nitrites are present in appreciable amount an allowance should be made for them. A little more than 50 cubic centimeters of the sample were placed 43 in a 250 cubic centimeter glass-stoppered bottle; 2 cubic centimeters of sodium hydroxide of 33 per cent strength and 2 grams of aluminum filings were added, and the loosely stoppered bottle allowed to stand at room temperature until the next day. The solution was then filtered, with all precaution, into a tube, filling it to the 50 cubic centimeter mark. This solution was then Nessler- ized, the necessary correction for free ammonia being made. Free ammonia. — A round-bottom flask of 1 liter- capacity with short neck was connected with a condenser 1 meter in length, the Nessler tube being slipped over the other end. On the day the sample was received the distilling flask was rinsed with distilled water; about 200 cubic centimeters of a solution of distilled water containing 1 gram of sodium carbonate were then added, and the greater part of the water distilled off, until the apparatus was free from ammonia. After cooling, 500 cubic centimeters of the sample were added to the residue, and the distillation continued at such a rate that a ISFessler tube was filled to the 50 cubic centimeter mark in about ten minutes. Three tubes of 50 cubic centimeters each were collected and ISFesslerized. As a matter of fact one tube would usually have been sufficient, at most two; for the third one never showed more than a slight trace of ammonia, and often none at all. Albuminoid ammonia. — Fifty cubic centimeters of alkaline per- manganate (8 grams of permanganate, 200 grams of potassium hydroxide, and 1,100 cubic centimeters of water, evaporated to 1 liter) were now added to the contents of the flask and distilla- tion was continued, four tubes of 50 cubic centimeters each being collected. The distilling apparatus was used for no other purpose throughout the series, and it was always well protected from fumes. Nesslerizing. — The Nessler solution was prepared according to the usual method and the standard solution of ammonium chloride contained (0.03812) gram of pure ammonium chloride in one liter. One cubic centimeter represents 0.00001 gram of nitrogen. The distilled water in the laboratory was found to be free from even the slightest perceptible trace of ammonia; it was tested each time. A number of ISFessler tubes were thoroughly rinsed with this ammonia-free water, then filled to the 50 cubic centimeter mark; portions of the standard ammonium chloride solution were measured in from a normal capillary pipette reading accurately 44 in hundredths of a cubic centimeter. The amounts used were 0.2, 0.4, 0.6, 0.8, 1, 1.2, 1.5, 2, and 2.5 cubic centimeters. Two cubic centimeters of the Nessler reagent were added to each, and also to the tubes containing the ammonia (free, albuminoid, and that from the nitrates), x^fter allowing thirty minutes for develop- ment of the color, the comparisons were made. The results were expressed in terms of nitrogen per million. Oxygen consumed. — The solution of pure potassium perman- ganate contained exactly 0.3953 grams in 1 liter. One cubic centi- meter represented 0.0001 gram available oxygen, and the solution of pure ammonium oxalate was of exactly equivalent strength. These two solutions were kept in a dark closet and were standardized from time to time. One hundred cubic centimeters of the water were measured into a 200 cubic centimeter Erlenmeyer flask from a pipette; 2 cubic centimeters of pure concentrated sulphuric acid were added, and then 10 cubic centimeters of the permanganate solution; the flask was then suspended in a boiling-water bath for thirty minutes. It was then taken out and 10 cubic centimeters of the oxalate solution were immediately added. The solution became colorless within a minute or so, and was then titrated with the permanganate till a faint pink color appeared, which remained permanent for a few moments. This determination was made in duplicate, two flasks being carried through at the same time. In no instance did the two titrations vary more than 0.05 cubic centimeters, and usually they were identical. For convenience, the titrations were made with a very narrow pipette graduated in 0.05 cubic centimeters. Results were expressed as parts of oxygen consumed per million. Chlorine. — A solution of pure, recrystallized and dried silver nitrate was made containing 4.7940 grams in 1 liter. One cubic centimeter represented 0.001 gram of chlorine. A 5-per cent solution of potassium chromate freed from chlorides by precipitat- ing with silver nitrate was used. The chlorine determinations were made in duplicate. Two portions of 250 cubic centimeters each were measured into casseroles of about 300 cubic centimeters capacity, carefully evaporated to about 50 cubic centimeters, 1 cubic centimeter of the chromate solution added, and the mixture titrated with the silver solution. By using one as a comparison 45 the first change in color from a pure to a reddish yellow was noted very sharply, and the two results never varied by more than 0.05 cubic centimeter; usually they were identical. A pipette similar to the one employed in the titration with permanganate was used. Eesults were expressed in terms of chlorine per million. Hardness. — A solution of pure calcium chloride was diluted so that 1 cubic centimeter contained 0.0002218 grams, or represented the equivalent of 0.0002 gram of calcium carbonate. Fifty cubic centimeters of this solution should require exactly 14.25 cubic centimeters of standard diluted soap solution in order to form a lather which covered the surface of the liquid and persisted for five minutes. The soap solution was standardized each time and the proper value obtained, 50 cubic centimeters of the above calcium chloride being used for this purpose. This was compared with 50 cubic centimeters of the sample treated in the same manner, and the degree of hardness determined by reference to published tables. In the two or three instances, when the results varied from those usually obtained, and in all cases where any doubt as to the exact end-point existed the determinations were repeated. Analyses of the Manila water supply. [Results are given in parts per million.] Labo- ratory No. 1739 1745 1756 1780 1781 1803 1821 1840 1880 1922 1944 1996 2025 2026 2027 2028 2069 2157 2225 2303 2352 2385 2434 2464 2487 2511 Location. Deposito Santolan Mariquina River do do do Date. Dec. 14, Dec. 21, Dec. 28, Jan. 4, Jan. 11, Jan. 18, Jan. 25, Feb. 1, Feb. 8, Feb. 15, Feb. 23, Feb. 29, Mar. 7, do__ do__ do__ Mar. 14, Mar. 28, Apr. 11, Apr. 25, May 9, May 23, June 6, June 20, July 5, July 15, 1903 1903 1903 1904 1904 1904 1904 1904 1904 1904 1904 1904 1904 1904 1904 1904 1904 1904 1904 1904 1904 1904 1904 Total resi due 220 181 188 188 191 179 176 178 162 168 168 164 160 153 174 173 167 173 174 165 180 169 196 174 378 191 Fixed residue. 190 148 152 142 160 148 152 152 142 152 145 138 134 127 147 145 138 147 138 136 145 135 150 138 150 159 Loss on igni- tion. Nitrites. 0) Trace. ( 2 ) ( 2 ) Trace. Trace. ft ( 3 ) Ni- trates. 0. 150 .271 .100 .112 .080 .110 .198 Trace. .100 .138 .274 .292 .124 .139 .112 .136 .220 .220 .158 .200 .158 . 120 .360 .360 .220 Free am- monia. 0. 0079 .0049 .000 .008 .002 .006 .002 Trace. Trace. .002 .006 .028 .036 .021 .028 .024 Trace. Trace. .002 Trace. .004 Trace. Trace. Trace. Trace. Trace: 46 Analyses of the Manila water supply — Continued. [Results are given in parts per million.] Labo- ratory No, 1745 1756 1780 1781 1803 1821 1840 1880 1922 1944 1996 2025 2026 2027 2028 2069 2157 2225 2303 2352 2385 2434 2487 2511 Locati m. ___do_ _„do _ do. Deposito Santolan Mariquina River. Albu- min am- monia. Oxy- gen. Chlo- rine. Hard- ness. Bacte- ria. Ame- bas. 0.078 1.90 2.13 85.7 400 - .073 .031 1.85 .875 2.23 2.60 85.7 90.0 550 600 - .052 .86 2.40 94.3 460 __ .034 .038 .044 .048 .85 .65 .65 .90 3.00 3.04 3.00 3.00 101.5 94.3 87.1 95.0 250 200 200 150 - .048 .044 .052 .086 .100 .90 .95 .95 1.25 1.60 2.60 3.20 3.30 3.40 3.60 104.0 95.0 109.0 97.0 97.0 125 150 120 112 + + ( 4 ) .080 .062 .060 .048 .052 .062 .048 .064 .042 .074 1.50 1.07 1.35 1.00 .82 1.07 1.20 1.20 1.05 1.60 3.20 3.60 3.60 3.88 4.14 3.80 4.40 4.20 4.40 4.20 93.2 93.2 94.8 95.0 101.8 97.8 95.0 98.0 92.0 91.0 208 105 267 120 120 108 125 175 130 206 + -f + + + + T .040 36.0 83.0 135 + .050 1.70 2.80 71.4 450 + .068 2.20 3.16 58.8 ( 5 ) 4- Remarks. Heavy rain dur- ing few days preceding; water very turbid. Do. Water distinctly turbid. Water slightly turbid. Do. Do. Do. Water almost perfectly clear. Do. Do. All contained deposit, appar- ently organic matter and silt. Determi- nations of residue were made with fil- tered water. Each gave slight dark color and odor on ignition. Do. Do. Do. Heavy rains just previous; wa- ter turbid; slight sedi- ment. Slight- ly dark color and odor on ignition. No rain imme- diately pre- ceding. Very turbid. Heavy rains. Very turbid. (Flood.) 1 Very faint trace. 2 Faint trace. 8 Distinct trace. 4 Not sufficient sample. A sample taken following week, bacteria, 100; amebas, 0. 5 Rapid growth over surface prevented count. The counts of bacteria and determinations of the presence of amebas were made by Dr. W. E. Musgrave and Mr. M. T. Clegg, both of the Biological Laboratory . 47 On examining the above table the following maxima and minima appear during the period covered by the report : Total residue Fixed residue Loss on ignition Nitrites (N) Nitrates (N) Free ammonia (N) Albuminoid ammonia (N) _ Oxygen consumed (O) — Chlorine (CI) Hardness Minimum. Maximum. 153 220 127 190 16 46 Trace- Trace. .36 .036 .031 .100 .65 2.20 2.13 4.40 58.8 109 As will be seen despite the great variation in the weather condi- tions the differences in analytical results were not very great. At times the chlorine ran as high as 4.40 indicating some contamina- tion, but these maxima were only transitory. However, a water may show a very high degree of purity, so far as this can be deter- mined by chemical analysis, and yet be unfit for drinking purposes because of either the large number of micro-organisms which it contains or because of their nature; so that it may be possible to convey the etiological factor of typhoid fever, cholera, dysentery, etc., by a drinking water which chemically would be pronounced unobjectionable. The chemical analysis may indicate a probable pollution with sewage or with other matter which may be suspicious or dangerous at all times, and it may condemn such a water. How- ever, in the case of the Manila supply the long series of analyses gave such results that no one would be justified, even at the worst, in stating from a chemical standpoint that this water was either injurious or deleterious to the public health. For this reason, as has been repeatedly pointed out by others, a bacteriological examina- tion is essential. However, in glancing over the number of bacteria it will be seen that the maximum, on December 28, was 600, and this large number was quite unusual, the average being below 250 organisms to 1 cubic centimeter and in many cases even below 150. Bacteriolog- ically, therefore, the water may not be regarded as very suspicious, especially since the general series of determinations did not demon- strate pathogenic organisms to be present, and indeed typhoid fever is of but rare occurrence in Manila. During the cholera epidemic it does not seem likely that any of the cases could have been referred to direct infection from the Manila water supply. 48 A factor however, which , apart from the chemical and bacterio- logical analysis, is the most important, is shown in the last column, where it is demonstrated that amebas, whether pathogenic or not, are almost constantly present in the water supply, and Dr. Mus- grave and Mr. Clegg, of the Biological Laboratory, in Bulletin No. 18, "Amebas: Their Cultivation and Etiologic Significance/* have shown that amebic dysentery can be sometimes produced in monkeys by cultures made from the water supply. Neither a chemical analysis nor a bacteria count will demonstrate the presence of these dangerous factors of disease, and consequently, in the Tropics at least, if we wish to obtain a fair idea of the condition of the water, a determination of the presence or absence of amebas is necessary. The ordinary sanitary analysis does not include an examination for substances which in themselves are injurious. The quantities of ammonia, nitrate, chlorine, etc., found in an ordinary water are harmless — they are simply indicative of a possible pollution, but before judgment can be passed in regard to the sanitary analysis, the source of the water, the geological conformation of its sur- roundings, and so forth, must be taken into consideration. An amount of chlorine, for example, which would be perfectly normal in water from one locality might indicate contamination with sewage in that from another. The total residue in this series was always below 200 parts per million excepting on one occasion which was after a heavy rain. Very little darkening of the residue on heating was noted in any sample; sometimes there was none, so that in this respect no criticism can be made of the water. The presence of nitrites in measurable quantity is sufficient ground for condemning a water as a rule, for nitrites indicate bacterial action. However, in this water nitrites were frequently absent altogether, and only on one occasion were there more than a trace, this occurring immediately after a heavy rain. The amount of nitrates was always very low. The highest amount of free ammonia found was 0.008 per million, excepting in five samples taken from the Mariquina Eiver itself where the results varied from 0.0021 to (0.036), so that by the time the water from the river reaches Manila the ammonia has largely become oxidized to nitrate. This is borne out by the fact that the amount of nitrate in those samples which were taken on March 7 was 49 lower than the usual quantity obtained. Albuminoid ammonia, as a rule, was also quite low. None of these factors, therefore, would indicate a contamination of the river water. The same may be said of the amount of oxygen consumed. No figure exceeding 2 was found excepting in one instance, and that was three days after the great flood in July. The amount of oxygen consumed seemed to be greater immediately after heavy rains. The low results obtained in the investigation of chlorine are favorable indications as to the quality of the water. One would expect rather higher chlorine values in the waters of the Philip- pine Islands owing to the proximity to the sea, but this is not as a rule the case, as analyses of waters from other localities have demonstrated. After heavy rains more or less insoluble suspended matter, both inorganic and organic, is rinsed into the supply. However the turbidity of the Manila water is generally due to a very fine silt which has its rise in some of the clay beds at the source of the river, and is for this reason harmless. Therefore the analyses made in the Chemical Laboratory show that the water supply of the city of Manila is of a very good quality, but the constant presence of amebas, as demonstrated in the Biological Laboratory, render the water unsafe for drinking purposes unless it is boiled. 23394 4 Part V. FRAMBOESIA: ITS OCCURRENCE IN NATIVES OF THE PHILIPPINE ISLANDS. By Paul G. Woolley, M. D., Director of the Serum Laboratory. In a recent visit to Benguet Province, in the central part of northern Luzon, I became interested in a peculiar disease which was called "Lepra" by the native Igorrotes, this term having been taught them by the Spaniards. Inasmuch as I was entirely unpre- pared for a complete study, and because it is extremely difficult to / obtain any history or to make complete examinations of these people, the following report will be meager, but it is interesting, since I feel certain that the disease is one closely related to if not identical with frambcesia. In Baguio, Benguet, I saw, with Dr. Thomas of the Civil Sanitarium, two cases; one, a woman aged about 35 years, and her son, the latter of some 15 years, both of whom presented small rasp- berry growths upon the face. In the mother, these were situated at the corners of the mouth; in the son, in the nasolabial folds, and they much resembled the growth pictured in the New Sydenham Society's Atlas (F^se. XIV, PL B. fig. 8). Both of these persons showed pigmented scars on the neck and face. At a later time I searched for these two people in their native town of Agno, Ben- guet, but was unable to find them. The case from which I procured the tissue which I will describe below, I saw one niorning as Mr. Barron — the sanitary inspector of the province — and I were returning from a long trip in the mountains. As we stopped to rest at a little native village, we 51 52 noticed that several of the children had peculiar looking, sluggish ulcers on their legs, necks, or bodies, and also showed signs of considerable anemia. We asked concerning this affection and were told that the Spanish called it "Lepra," and that many people had it. This was all we could learn, except that the sores were not painful, though they showed the effects of scratching, and that they eventually healed. One grown person, a woman, was found who had similar lesions on her neck. Whether she had others elsewhere we were unable to discover. One lesion on the neck (see Sydenham Society's Atlas, Fase. XIV, PL LXXXV, upper left-hand corner of lower figure) was a shallow ulcer with a firm grey base, a well-defined, firm margin, a slight yellowish secretion, not surrounded by any appreciable induration, not painful, and situated on the neck just below the angle of the jaw. This was excised and preserved in commercial alcohol. Near it were some pigmented areas, somewhat darker than the normal skin, not appre- ciably thickened, and possessed of sensation, and which the woman said were at the sites of healed ulcers similar to the ones we saw. (New Syden. Soc. Atlas, PL LXXXXV.) An infant which the woman carried had similar lesions on its legs, face, and neck. Another child of the same woman, which, however, we did not see, was said to be afflicted in the same manner. The gross appearance of the lesions would lead one to think of leprosy, tuberculosis, epitheliomia, syphilis, or yaws. Leprosy I think may be excluded. There were no cases of outspoken leprosy among the persons of the pueblo in which these persons lived. There were no anesthesias or leucoplakias in any of the cases examined. The histologic examination was negative. Tuberculosis could be excluded since neither the lesions nor the scars had the classic appearance of lupus, nor was the histologic evidence suf- ficient to support such a diagnosis. Epithelioma could only be excluded by microscopic examination. All in all the cases seemed most like syphilis. None of the people of the pueblo showed out- spoken signs of this disease, although, as stated, a complete examina-. tion could not be obtained. The inhabitants of this region generally are rigidly moral and rigorous punishment is inflicted upon any who overstep the bounds. But while they live morally clean lives, their physical surroundings are filthy, which may account for the modification of the frambcesial lesion and the predominance of 53 infection. Treatment, of course, has not been tried, so one can not say what effect mercury or iodides might have, but from the evidence that I have at present I incline to the idea that the cases seen were examples, not of syphilis, but of framboesia. The tissue was embedded in celloidin, and the sections which were made later were stained with hematoxylin and eosin, Unna's polychrome blue, Gram's stain, and by the tubercle bacillus methods. Microscopic examination showed that the lesion con- sisted of a marked hyperplastic acanthosis, with a round-celled infiltration of the underlying, and especially of the perivascular, connective tissues. The first impression was that one was dealing with an epithelioma, but closer examination showed this to be a delusion. The acanthus layer of the skin was thickened and prolonged in strands and columns of bizarre shapes. In many places in this hyperplastic epithelium there were larger or smaller islands of connective tissue, each, apparently, representing the path of a blood vessel. In the centers of such areas and about the vessel were collections of small round and plasma cells, but this small- celled infiltration was most marked in the larger strands of the sub- malpighian connective tissue. Here the increase of these formative elements was remarkably prominent, and there was throughout the sections the same perivascular arrangement. Within these areas there were occasional leucocytes; there were also fibroblasts in varying stages of development, and a number of plasma cells were present within the round cell accumulations. At the site of the ulceration the structure of the lesion was modified by the destructive process. Here all the layers were invaded by a multitude of polymorphonuclear leucocytes, the blood vessels were widely dilated, and there was a certain amount of superficial degeneration, but the structure of the lesion in the not degenerated parts was still per- ceptible. So far as the arrangement of the layers of the skin was concerned there was no distortion. In many parts of the sections a peculiar appearance was seen which gave one the same impression as that produced by the scales of a fish, or by the overlapping of shingles upon the roof of a house. This was apparently due to the fact that certain of the acanthus cells took a more intense stain on one side. In this phenomenon (seen best in polychrome blue specimens), the nucleus did not participate. In none of the sec- tions, and these included the whole of the lesion studied, were there 54 any giant cells, tubercle of lepra bacilli, and no evidence of cell inclusions was seen. As for the occurrence of such lesions in frambcesia, and their distribution, little can be said excepting as quotations from authors who have had considerable experience with the disease. Manson says, in discussing the distribution of the yaws, that they may be scattered over the entire body, or the crop may be limited to one or two growths, or they may be confined to a circumscribed region of the skin. Moreover, there may be successive crops evolved, especially when the person affected is debilitated. Morris remarks that the disease in. adults is more chronic than in children. When the yaw develops normally it does not ulcerate, but Manson says that the tumors instead of being absorbed, may break down and ulcerate, the ulceration usually being confined to the yaw itself, although it may go deeper and give rise to extensive sores. With the develop- ment of the deeper and more extensive forms of ulceration, the typical lesion of f rambcesia may disappear for a time, or perhaps permanently. If such is the case, the ulcerations are said not to be infective and to not communicate the disease, although they may persist for years. Wicholls, quoted by Mason, states that ulcera- tion occurs in about 8 per cent of the cases. There is no histologic description of the variety of the lesion which I have encountered to which I can refer, though from Unna's and Charlouis's descrip- tion of the typical yaw it is but a modification of the latter. These writers speak of the true yaw as a cutaneous plasmoma complicated by epithelial hyperplasia and hyperkeratosis. Except that the lesion described above is not raised it certainly corresponds in many details with Unna's and CharlouisV description. REFERENCES TO LITERATURE. Manson. Tropical Diseases. London, 1903. Morris. Diseases of the Skin. Philadelphia, 1898. Hyde. Diseases of the Skin. Philadelphia, 1900. Unna. Hautkrankheiten. Berlin, 1894. Schetjbe. Die Krankheiten der warmen Lander. Jena, 1900. SECTION STAINED WITH H/EMATOXYLIN AND EOSIN. ..ZEISS COMP. OC, 6, OB,. Missing Page ;1M