402 PHALEN AND NICHOLS. 



V. OTHER FORMS OF BLASTOMYCOSIS. 



This disease of the skin is especially interesting in view of the pres- 

 ence in these Islands of a blastomyeotic disease of horses and of the 

 finding of blastomycetes in ulcers, in sprue and allied diseases. 



Strong, in 1904, identified as blastomyeotic a disease of horses known as 

 pseudo farcy or ulcerative lymphangitis. He obtained only a slight growth at 

 that time. A similar disease has been known for some time in Italy, France, 

 Algiers, Russia, and Japan. It was more prevalent in Manila in 1903 and 1904 

 than at present, but we have seen several good cases. Fig. 14 shows a horse which 

 we observed at the ice plant through the courtesy of Veterinarian Bishop. Veteri- 

 narian McKinnen, quartermaster's department, kindly sent us some sterile pus 

 from a native pony and this after a month on glucose-agar, gave a slight growth. 

 On transplantation this grew more readily on the same medium, but slowly on 

 maltose-agar and potato. Figure 15 shows the convoluted, brown growth on mal- 

 tose-agar. At room temperature the slow, new growth at the edges is pure white. 

 Microscopically (fig. 17) it shows branching, segmented hyphae with rounded ends 

 and a great many free, round forms. The organisms in the ulcerating lymph- 

 glands are oval, and are more uniform in shape and size than those in the skin 

 disease ; the membrane is not as distinct. The cultural characters are also very 

 different. However, in order to determine if possible the question of relation- 

 ship, two horses were inoculated subcutaneously, one with scales of the second 

 form of disease, and one with the culture obtained from the third form; no 

 infection resulted. 



We have seen no general infection with blastomycetes, but think it 

 probable that such cases exist in the Islands. We have had a Scout ser- 

 geant under observation with a good history and who was otherwise 

 healthy, who suffered from gradual loss of weight, with cough, spitting of 

 blood and pain in the chest. No tubercle bacilli could be demonstrated 

 by repeated examinations or by inoculation; no ova were present in the 

 sputum. Blastomycetes, however, were found in large numbers. The 

 patient recovered completely in two months on ascending doses of potas- 

 sium iodide. We have seen several cases like this one, but have not been 

 able to satisfy ourselves entirely that the blastomycetes were pathogenic 

 or to obtain encouraging cultures. However, we believe that lung infec- 

 tion may occur and may explain many obscure cases. 



Dantec has recently stated that sprue is a blastomycosis of the intes- 

 tinal tract and we have found numerous blastomycetes in two cases of 

 sprue seen since reading Dantec's article. In two cases of hill diarrhoea 

 we have encountered large numbers of blastomycetes in the stools and 

 using Dantec's technic have obtained the same culture from each case. 

 The growth is white, powdery, with a pasty center consisting of yeast- 

 like forms and filamentous borders. This subject will be reported upon 

 at length later. The ulcerations as reported by Strong, Sakurane and 

 Okugawa in which blastomycetes have been found were undoubtedly due 

 to these organisms. Those described by Strong resemble more closely 

 the organisms from the horse than those which we have described. No 



