CLINICAL 189 



LITERATURE 



L Almeida, F. P. de, Estudo comparativo do granuloma coccidioidico nos 

 Estados Unidos e no Biasil, Ann. vied. Sao Paulo, 4, 91 (1929). 



2. CoNANT, N. r., and A. Howell, The similarity of the fungi causing South 



American blastomycosis (paracoccidioidal granuloma) and North American 

 blastomycosis (Gilchrist's disease), J. Investigative Dermatol., 5, 353 (1942). 



3. LuTZ, A., Uma mj'cose pseudococcidica localisada na bocca e observada no 



Brasil, Brasil vied., 22, 121, 141 (1908). • 



4. MooRE, M., Blastomycosis, coccidioidal granuloma and paracoccidioidal gran- 



uloma, Arch. Dermatol. Syphilol. (Chicago), 38, 163 (1938). 



5. Splendore, a., Sobre um novo caso de blastomycose generalizada, Rev. soc. 



sci. Sao Paulo, 4, 52 (1909). 



HISTOPLASMOSIS 



From 1906 to 1909 Darling, in a series of papers,-' ^ * reported his 

 discovery of a new disease which he had found while searching the 

 pathological material at the Ancon Hospital, Canal Zone, for kala- 

 azar. He recognized in this material features which differentiated 

 the organism from Leishmania, but he believed it to be a protozoan 

 and he erected for it a new genus, Histoplasma, calling the organism 

 Histoplasma capsulatum and the disease histoplasmosis. As addi- 

 tional material was studied it became apparent that the organism was 

 a fungus rather than a protozoan, but not until 1934 when Dodd and 

 Tompkins ^ observed the fungus in blood smears taken before death 

 and DeMonbreun * isolated it in culture was its complete life cycle 

 known. In the same year Hansmann and Schenken ' also isolated the 

 fungus in culture although, because of certain clinical features of 

 their case, they did not identify it with histoplasmosis. Since these 

 important advances in the knowledge of the fungus several cases have 

 been diagnosed before death and the fungus isolated in culture. A 

 study of this material has demonstrated some variability in the vari- 

 ous strains of the fungus, and considerable variation in the clinical 

 aspects of the disease. 



Clinical. Darling, from his study of preserved material and a 

 review of case records, described the mycosis as one characterized 

 by irregular fever, emaciation, leukopenia, anemia, and splenomegaly. 

 The study of additional cases has demonstrated that some of these 

 features may be lacking in some cases and that there may be other 

 manifestations not at first recognized.^- ^' ^°' ^^' ^- There may be pap- 

 ular or ulcerative skin and mucous membrane lesions, the naso-oral 



' * Literature citations for this section will be found on page 193. 



