PATHOLOGY OF BLASTOMYCOSIS. 637 



the disease. The organisms which have been cul- 

 tivated from the cases in California grow as molds, 

 and they differ from those described by Gilchrist, 

 Hektoen, Eicketts and others in that they form 

 endospores and apparently do not bud in the tis- 

 sues of the host (Ophiils, Wolbach). This feature 

 is so constant that it would seem to constitute a 

 specific difference between these organisms and 

 those found in blastomycosis. There are reasons 

 for believing, however, that endospore formation 

 is a facultative property of at least some of the 

 organisms of blastomycosis (LeCount and Myers), 

 and if this proves to be true, the two groups are 

 brought very close together biologically as well 

 as morphologically. Ophiils cal]s this parasite 

 Oidium coccidiades, agreeing with Eicketts as to 

 the generic character of the group, and the cor- 

 responding disease bears the name of coccidiodal 

 granuloma. 



The skin infection in both diseases usually ap- Pathology. 

 pears as a coarse warty and ulcerative lesion, in 

 which the large papilla and cutaneous areola are 

 beset with minute abscesses; the process extends 

 gradually and eventually may involve large areas. 

 Microscopically, the tissue shows an enormous epi- 

 thelial hyperplasia with intraepithelial abscesses, 

 and a richly cellular, granulomatous condition of 

 the subepithelial tissue, in which giant cells and 

 small abscesses are found. When the disease is 

 systemic, various organs, especially the lungs, 

 spleen and kidneys, skin and joints, are the seats 

 of abscesses and nodules which contain the para- 

 sites in immense numbers, and many giant cells 



