204 MEDICAL MYCOLOGY 



spores appearing late, dimorphous, ovoid or elongate, the latter type predominant, much 

 less numerous than in the preceding genera. Pseudomycelium well developed, higlily branched 

 (suggesting the branching of a fir tree), hyphae ending in a group of blastospores, a short 

 chain, or a single elongate cell. Verticils not developed, the apical portion of a pseudomycelial 

 cell not producing more than two opposite blastospores. Gelatin not liquefied. 



In this work no attempt will be made to cover the pathologic changes in 

 tissues by these organisms, beyond very brief notes in connection with the in- 

 dividual species. The pathogenicity ranges from great severity with a rela- 

 tively high fatality to very mild lesions. Practically all organs may be at- 

 tacked. The majority of the species so far described are evidently saprophytes 

 which have found a suitable substratum for growth and multiplication. This 

 growth may set up a mechanical irritation, often aggravating already existing 

 conditions, or enzymes and toxins secreted may interfere with the normal 

 functions of the organs. 



The bulk of the species quickly divides into those attacking one or more 

 of the following organs: respiratory tract, alimentary tract, genitalia, and 

 skin. Some of those with weaker parasitism may be found on more than one 

 organ, while on weakened hosts they may migrate and invade organs not 

 originally attacked. 



In the respiratory tract, many of the symptoms closely simulate pul- 

 monary tuberculosis, from which they may be differentiated by the absence of 

 Mycohacterium tuherculosis in the sputum and the presence of large numbers 

 of blastospores. A specialized form from the Orient, variously known as "tea 

 factory cough" or "tea taster's cough," is a bronchomycosis, supposed to be 

 spread by the dry tea leaves which are sniffed in determining odor while grading 

 tea. These mycoses usually disappear quite promptly following administration 

 of relatively large doses of potassium iodide. 



In the digestive tract, we find these organisms in the flora of apparently 

 normal persons. "Whether they are the same species as those which are so 

 abundant in the tracts of diseased individuals, is still a disputed point. Too 

 frequently all these organisms have been called Monilia albicans, Soor, sapinho 

 or muguet without a critical study as to specific identities. ' A few morphologic 

 characters, or few fermentation reactions are given, seldom both, usually neither. 

 The two clinical entities which have gradually been differentiated are thrush 

 and sprue. Both these conditions need much further clinical study correlated 

 with a more careful study of the morphology of the organism. 



Thrush is predominantly a disease of the mouth of infants, occasionally 

 also of senile or very anemic persons. With weakened resistance the organism 

 may spread to the lower digestive tract, the vagina, or even the moister por- 

 tions of the skin. Apparently several different species may cause approxi- 

 mately the same symptoms, giving rise to no end of confusion in the litera- 

 ture, for each worker apparently searches for a case of thrush, isolates the 

 organism, considers it as typical for the organism originally described by 

 Robin, and designates it as Monilia albicans or by one of the numerous syno- 

 nyms. A study of the drawings in the numerous doctoral theses on this dis- 

 ease in the last century, will indicate many different organisms which we 



