98 An Introduction to Medical Mycology 



(tinea manuum), and allergic manifestations, or dermatophytids. Fun- 

 gous infection of the nails (tinea unguium, or onychomycosis), which is 

 caused by the same species of fungi, is usually described as a separate en- 

 tity. The involvement of nails is linked so intimately with that of the 

 feet that we believe it should be included as part of the syndrome. The 

 usual varieties of infection of the nails are discussed in this section. Un- 

 gual and paronychial infections due to M. albicans are described in the 

 section on moniliasis, pp. 145 ff. We agree with Weidman that dermatophy- 

 tosis of the type caused by T. gypseum is essentially an intertriginous con- 

 dition and usually begins as such. Associated, however, are sensitization 

 or the lack of it, secondary infection, acuteness or chronicity and a number 

 of important incidentals. The terms epidermophytosis, epidermomycosis 

 and trichophytosis are also used by some as synonyms for dermatophytosis 

 but would better be reserved for instances of specific infection (as epi- 

 dermophytosis: due to E. inguinale). 



(a) Incidence.— It has been variously estimated that from 50 to 90 per 

 cent of the population of the United States are affected at some time dur- 

 ing their lives. Hulsey and Jordan recorded a clinical incidence for tinea 

 pedis of 67 per cent and a microscopic incidence of 63 per cent in a series 

 of 100 university students. Gilman noted that of 390 new patients with 

 diseases of the skin seen during six months in the Student Health Service 

 of the University of Pennsylvania, 145 (37 per cent) had a mycotic infec- 

 tion. The average age of these patients was 19/2 years. Gilman examined 

 500 students; 297 (60 per cent) had gross evidence of ringworm. Legge, 

 Bonar and Templeton found that 53.3 per cent of the men and 15.3 per cent 

 of the women of the 3,100 freshmen in a university were infected and that 

 at the end of the spring semester 78.6 per cent of the men and 17.3 per 

 cent of the women had tinea pedis. Muskatblit examined 112 medical stu- 

 dents and 100 dispensary patients. Evidence of dermatophytosis was pre- 

 sented by 89 per cent. Andrews and Birkman in a clinical studv of 520 

 public school students between the ages of 14 and 20 noted that 65 (12/2 

 per cent) showed clinical signs of fungous disease. We can substantiate 

 the relative infrequency of Trichophyton infection in adolescents and in 

 children. Prehn found that 88 per cent of 1,500 men examined on 11 ships 

 of the United States Navy showed clinical evidence of ringworm of the 

 feet. In a survey of over 300 patients in a home for the aged we found 

 evidence of residual infection in the skin and nails of over 90 per cent; 

 only a few of the patients complained of the condition. Ajello, Keeney and 

 Broyles stated that 40 per cent of young men entering military life had 

 normal feet, whereas for the troops at Fort Benning, Hopkins and his co- 

 workers reported normal findings in only 20 per cent when the feet were 



