748 Blastomycosis 



from a generalization of the blastomycetic infection, which not in- 

 frequently happens. 



After the work of Gilchrist had made clear the symptomatology 

 and parasitology of the disease, a numberof other 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. An- 

 other very interesting paper by Montgomery,! 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 granuloma. 

 It seems to have been first observed by Posadas and Wernickef 

 and has been carefully studied by Ophuls.§ In this form of the 

 disease the lesions are in the internal organs, macroscopically and 



Fig. jii. — Cutaneous blastomycosis (Montgomery). 



microscopically resemble tubercles, and can only be differentiated 

 from them by the presence of the blastomyces and the absence 

 of tubercle bacilli. The lungs may be affected, and Walker and 

 Montgomery 1 1 mistook a case for miliary tuberculosis of the lungs. 

 According to Evans** the disease seems to have a predilection for 

 the central nervous system. 



There seems to be httle reason for beUeving that there is any 

 other difference than that of distribution between the blastomycetic 

 dermatitis and the blastomycetic granuloma, or that they are caused 

 by different micro-organisms. Regarding the organisms, however, 

 we are by no means sure that there are not several species. 



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

 t "Jour. Amer. Med. Assoc," June 7, 1902, i, i486. . 

 t "Jour, de Micro-organismen," 1891, xv, 14. 



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

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



"Jour. Amer. Med. Assoc," 1902, xxxvra, 867. 

 ' "Jour, of Infectious Diseases," 1909, vi, 535. 



