306 MANUAI. OF POISONOUS PLANTS 



located below the left ankle and extended down to the heel. He was obliged to stop work 

 in December. The patient was emaciated, pale, anemic, and weak. Marked oedema was 

 present in the ankles, feet, face and arms. His nails were clubbed; inguinal adenopathy 

 was noted. From the lesions blastomycotic fungus was isolated, the sputum also contain- 

 ing the organism. 



Eisendrath and Ormsby described the cultures as follows : 



On March 22nd pus was removed from a subcutaneous abscess on the left forearm, 

 which was inoculated on various media. Six days later growth was plainly visible, and 

 after this time the cultures grew rapidly. These proved to be pure cultures of blastomy- 



cetes In the pus they occurred as circular forms and budding forms, having a 



double contour and the usual refractile capsule. On media the growth varied. It presented 

 a moist, pasty surface on glycerin-agar, with at times a wormy appearance or else present- 

 ing large folds and depressions. Microscopically, these cultures showed many oval and 

 circular organisms, some budding ones, and much mycelial formation, the latter being both 

 coarse and fine containing sporules. Lateral conidia occurred. On glucose-agar the growth 

 was more dry, white, and presented aerial hyphae; and microscopically there were fewer 

 circular and budding organisms and more fine mycelia. On both glucose and glycerin-agir 

 the media were penetrated to a considerable depth in a semi-circulaP manner. 



Drs. Le Count and J. Myers say, as follows : 



The body was examined a few hours after death and the following anatomical 

 diagnosis made: Blastomycotic bronchopneumonia; blastomycosis of the peribronchial lymph 

 nodes, of the pleura, the subpleural, and retropharyngeal tissue, the liver, the kidneys, 

 the colon, the spinal column (dorsal vertebrae), the external spinal dura, the cerebellum, 

 the left elbow, both knee and ankle joints, and of the skin and subcutaneous tissue with 

 ulcerations, fistulae, and scars. Fibrous pleuritis. Passive hyperemia /of liver and spleen. 

 Serous atrophy of adipose tissue. Emaciation. Adenoma of thyroid and accessory spleen. 



One notable feature of this case is the large conglomerate blastomycotic nodule in the 

 cerebellum. In only one other case of systemic blastomycosis, that of Curtis', is there 

 any record of changes in the nervous system, and the statements in that instance are solely 

 clinical, death being due to meningitis. The reproductipn by a process of sporulation 

 demonstrable in the cerebellar lesion is likewise a new feature of the changes encountered 

 in the lesions of this disease. The idea that in the nervous tissue the fungus may have 

 found favorable or different conditions of nutrition, as an explanation for this method of 

 multiplication, is opposed by the facts that the regions in which it was found were very 

 minute, that it was not generally present in the cerebellar process, and the budding was 

 commonly observed in the "abcesses" in the partitions between necrotic regions. 



Highly interesting is the relationship between this case of blastomycosis and one of 

 coccidioidal disease described by Ophuls. Up to the present two of the chief differences 

 between blastomycosis and coccidioidal granuloma have been the endosporulation observed 

 in the tissues in the latter disease and its tendency to spread by the Imyph channels. Al- 

 though no widespread extension by the Imyphatics was demonstrated in the case reported 

 here, the extension to the tracheobronchial glands and in peribronchial lymph channels is. 

 unmistakable; the endosporulation on the cerebellum in part also resembles the methods of 

 production described for the organism of coccidioidal granuloma. Taken together, these 

 features in this instance of systemic blastomycosis are in accord with the belief expressed 

 by Ophuls of a close relationship of the organisms in the two diseases. 



Ricketts, in an interesting monograph on "Oidiomycosis (Blastomycosis) 

 of the Skin and its Fungi," gives the clinical history, cultural characters and 

 histopathology of a large number of cases. The fungi are divided into three 

 groups, (1) Blastomycetoid or yeast-like. (2) Oidium-like. (3) Hyphomycet- 

 oid. He says : 



There are two histological forms of the disease in the skin, the eosinophilous and the 

 non-eosinophilous, the former being associated with the mould type of the organism. Aside 

 from the infections considered in this communication, certain cases which have been 

 described in the literature from time to time indicate that oidium-like organisms may cause 

 other severe pathological conditions in man. 



