Blastomycosis 819 



and begins to heal, but at the periphery new and usually mi- 

 nute foci of suppuration occur, so that while the original 

 lesion tends to heal very slowly, with much cicatricial for- 

 mation, it is always spreading. The progress is usually 

 slow, and Gilchrist's first case spread only two inches in four 

 years. 



Though the progress is slow, it is sure, and there is no tend- 

 ency to spontaneous recovery in most cases, nor is the condi- 

 tion modified by treatment. The patients may die from in- 

 tercurrent disease or from a generalization of the blastomy- 

 cetic infection, which not infrequently happens. 



After the work of Gilchrist had made clear the symptoma- 

 tology and parasitology of the disease, a number of other 



Fig. 275. Cutaneous blastomycosis (Montgomery). 



cases were reported, and Ricketts* published an excellent 

 and lengthy summary of all the cases with references to all 

 of the literature up to that date. Another very interesting 

 paper by Montgomery , f published in 1902, contains a splendid 

 atlas of photographs of the various lesions and of the cultures. 

 In addition to the cutaneous blastomycosis, a second form 

 is also occasionally seen, and is known as Coccidioidal granu- 

 loma. It seems to have been first reported by Posadas and 

 WernickeJ and has been carefully studied by Ophiils. In 



* "Jour. Med. Research," 1901, i, 373. 

 t "Jour. Amer. Med. Assoc.," June 7, 1902, i, 1486. 

 J "Jour, de Microorganismen," 1891, xv, 14. 



"Jour. Experimental Medicine," 1905, vi, 443. Ophiils and Moffit, 

 "Phila, Med. Jour.," 1900, v, 1471. 



