484 MUSGRAVE, CLEGG, AND POLK. 



type of Streptothricosis pedis, because it may be caused by several if not 

 any of the species of this genus and the clinical manifestations are 

 practically the same in all cases. The special symptoms of this. type are 

 well known and have already been discussed in this report. 



Miscellaneous types of streptothricosis may be mentioned, such as in- 

 volvement of the conjunctiva, bones, ear, nose, intercostal spaces, etc. 

 Their only peculiarities are in the anatomical locations of the lesions. 



Diagnosis. — The diagnosis of Streptothrix infections is made clinically 

 by the character of the exposed lesions and discharges and by laboratory 

 methods. Obviously, the common and frequent involvement of internal 

 organs is rarely recognized except by microscopic examinations at opera- 

 tions or at autopsy. The thoracic types may be determined by microscopic 

 and bacteriologic studies of the sputum or aspirated fluid from the pleural 

 cavities. It is generally stated by competent observers that these types 

 are frequently overlooked, even in sputum examinations and it is not 

 improbable because of the acid-fast properties of some of the organisms 

 that they may occasionally be mistaken for the tubercle bacilli. The 

 resemblance may, at times, be quite close. In some of our experimental 

 lesions the similarity has been striking. The microscopic examination of 

 material from exposed lesions often requires some patience and care to 

 enable the observer to find the organisms ; unless a granule is encountered, 

 when, of course, the determination is easy. Inasmuch as some other 

 closely related organisms such as Oidia, Leptothrix, and Cladothrix may 

 cause somewhat similar lesions, Strcptothricce should not be diagnosed 

 positively without careful microscopic study of the organisms present in 

 the lesions. 



Prophylaxis. — From what we know of the distribution of the organ- 

 isms of this disease and the mode of transmission and the prevalence of 

 certain anatomical types, prophylaxis should consist in guarding against 

 wound infection and generally by care in food and drink. In the 

 Tropics most of the types consist in local foot or other skin wound 

 infections, which should be guarded against by wearing shoes and by 

 promptly treating skin wounds and abrasions according to antiseptic 

 methods. 



Prognosis. — The prognosis depends to a considerable extent upon 

 the location and extent of the lesions. The general infections and those 

 of the internal organs almost always end fatally. The external types 

 are much more amenable to treatment and 'the mortality is small. 



According to the statistics of Duvan, and Poncet and Berard who 

 analyzed 257 cases, the mortality was as follows: Skin, 2.3 per cent; face 

 and neck, 10; jaw and temporal region, 30; abdominal cavity and 

 intestine, 65; thoracic, 85; liver, 100, and brain and spinal cord, 100 

 per cent. The mortality in mycetoma, under proper treatment, is very 

 small. The course of the disease is usually chronic, but it may be general 



