Pathogenesis 809 



It would seem as though the rarity of its occurrence as a patho- 

 genic agent signified that it was by no means easy for it to effect the 

 invasion of the animal body. However, de Beurmann mentions a 

 man wounded in the forehead by a coster's awl whom he believed 

 to have been infected by a cap, used to conceal the untreated wound, 

 that usually lay on the fruit and vegetables that filled his barrow; 

 a market woman infected by the salad that she was in the habit of 

 handling all day. Dominici and Duval report a case following a cut 

 inflicted while peehng a potato; Saint-Girons, a case following the 

 prick of a thorn of a barberry bush. A patient of Lutz's was inocu- 

 lated through the bite of a cat; one of Wyse-Lauzun's through the 

 bite of a parrot. Perkins' case was that of a child that had abraded 

 a finger with a hammer, de Beurmann found the organism in the 

 pharynx of healthy persons "carriers," whose saliva might, therefore, 

 ■ be infectious. He beUeves that infection may take place through the 

 hair-follicles; that the healthy skin may be penetrated, and that the 

 healthy gastro-intestinal mucosa may be invaded. 



Lesions. — The primary disturbance is a chronic and destructive 

 ulceration from which the disease spreads to numerous secondary 

 foci chiefly by lymphatic metastasis. Hektoen and Perkins describe 

 the appearance of the primary lesion in Perkins' case of infection 

 by S. schenckii, thus: "the finger from the first to the third joints 

 is swollen to twice its original size, presenting in the center a deep, 

 well-defined, sharp, undermined ulceration, the size of a ten-cent 

 piece. The base of the ulceration is rough and covered with gray- 

 ish-looking pus. This, when sponged away, leaves a bright red 

 sxurface; the ulcer extends through the whole thickness of the skin. 

 Surrounding the ulcer over about one-haK of the infiltrated area, are 

 a large number of vesicles and a few pustules. The dorsal surface 

 of the hand and the extensor surface of the forearm present a chain 

 of swollen lymphatics along which are about twenty nodules from 

 the size of a small pea to a large hazel nut. . . This little patient 

 does not complain of much pain." In the course of two months 

 Perkins opened and treated more than twenty abscesses resulting 

 from the enlargement and softening of the nodes. 



De Beurmann and Gougerot found that the most characteristic 

 lesion of the skin is a nodule in which three processes are found, some- 

 times mixed up in an irregular manner, but most frequently arranged 

 concentrically. "In the center an abscess containing polymorpho- 

 nuclear leukocytes and macrophages; in the intermediate zone an 

 area of degenerated epithelioid giant-cells and tuberculous follicles 

 and at the periphery a proliferation of basophile lymph and con- 

 nective-tissue cells. or a fibro-cellular infiltration." "The structure 

 of the sporotrichoma is, therefore, very closely allied to that of the 

 lesions caused by syphihs, tuberculosis, and by the agents of chronic 

 suppuration, and it resembles sometimes the one, sometimes the 

 other." 



