XI. B, 6 Wade: Cultivation of a Pathogenic Fungus 279 



tinguish them by morphology or by staining reactions from the 

 simpler types of body cells does not seem remarkable. It is, 

 however, a fact that has not been generally recognized. 



The clinical features of the described infection cannot be 

 broadly discussed on the basis of a single case. An interesting 

 feature th.it may be noted, however, is the wide distribution of 

 a great number of small lesions, indicating a hematogenous dis- 

 semination. This is emphasized by the histology of the active 

 lesion, in which are large vascular spaces many of which contain 

 parasitic bodies. While tissue sections containing simple para- 

 sitic forms might be easily passed over without remark, the 

 parasite-filled phagocytic cells and the botryoid clusters of var- 

 ious-sized bodies, which in my sections have been found only in 

 the more active areas, are striking. 



While no case clinically similar has been found in the literature, 

 certain descriptions of the condition known as "botryomycosis 

 hominis" and a few of those called, perhaps erroneously, "tropical 

 inguinal granuloma" indicate some similarity of histologic find- 

 ings with those of the present case. 



In the small granulomatous skin tumors, first described 

 by Poncet and Dor, (8) there are often to be seen small 

 groups of bodies apparently like those here described. Whether 

 rightfully or not, this condition has in recent years been classed 

 by many authors as a staphylococcal granuloma. Very different, 

 however, are the extensive lesions described as botryomycotic by 

 Archibald(i) from the Sudan and by Castellani(3) from Ceylon. 

 These are sometimes tumorlike and may even necessitate amputa- 

 tion of entire parts of the body. The former author found in 

 sections groups of large and small bodies, free and in endothelial 

 leucocji;es, and also described and depicted a protoplasmic rim 

 about some of the free bodies. 



The typical "tropical inguinal granuloma" as described by 

 Donovan, (5) Carter, (2) Conyers and Daniels, (4) Wise,(il) Flu, (6) 

 and others is evidently a distinct infection, thought by many to 

 be protozoic. However, certain cases that have been given this 

 diagnosis may be of different nature. Such, for instance, are 

 the three cases in American negroes reported by Grindon, (7) in 

 sections from which the peculiar bodies of Donovan and of Carter 

 were not found. In an illustration accompanying his article 

 (his figure 6) is shown a photomicrograph of a section in which 

 are discernible, both within the epidermis and in the connective 

 tissue, many small, compact bodies and "cells" which, as well 

 as can be made out, seem indistinguishable from any of the 



