2o86 



TROPICAL DERMATOMYCOSES 



disease by the massive diffuse induration, and absence of tuber- 

 cular cutireaction. 



Prognosis. — The disease very rarely heals spontaneously. The 

 general health in the common type of the malady is not much 

 affected, but the patients complain of the disfigurement. Occa- 

 sionally the organisms from the skin lesions enter the general cir- 

 culation, and a condition similar to pyaemia develops. Cases of 

 systemic blastomycosis terminating fatally, without any skin lesion, 

 have also been described. The prognosis of blastomycosis cocci- 

 dioides and oral blastomycosis is bad, while blastomycosis glu- 

 tealis is most persistent, though the general health is not much 

 affected. 



Treatment.- — Potassium iodide, given in large doses (gr. xv. to xx. 

 three or four times daily), has a beneficial effect, though it is not 

 so efficacious as in sporotrichosis. The application of Rontgen rays 

 to the lesions is useful. In mild cases the local application of various 

 disinfectants — e.g., perchloride of mercury (i in i,ooo), diluted 

 tincture of iodine, etc., may bring about a cure. The following 

 ointment is useful, especially in the localization to the upper lip: 

 Ichthyol, gr. xv. ; ung. belladonnse, 3ii. ; vaselini, ad §i. No 

 treatment is apparently of much use in blastomycosis cocci- 

 dioides, in oropharyngeal blastomycosis, or in blastomycosis 

 glutealis. 



Dermatosis Hyphomycetica Indica. — This term has been used by Castellani 

 to indicate a peculiar hyphomycetic condition he has once seen in Ceylon. 

 The patient had a number of gummatous swelHngs and indurated patches, 

 but no warty lesions were present anywhere. A fungus was isolated which 

 in various sugar broths and ordinary broth produced very long filaments, 

 but owing to an accident could not be further studied. 



SPOROTRICHOSIS. 



Schenk, in 1898, described a case of multiple chronic abscesses in 

 the pus of which a Sporotrichum was found. Hektoen and Perkins 

 reported two similar cases also in the United States in 1900. De 

 Beurmann published in 1903 a case of similar nature in France. 

 De Beurmann and Gougerot, from 1906 onwards, have pubhshed 

 many cases, and have completely investigated the subject of human 

 sporotrichosis bacteriologically and histologically, as well as 

 clinically. Their researches have been confirmed by Gaucher 

 and Monier-Vinard, Duval and Fago, Vaquez, Bonnot, Lambry, 

 Adamson, Esmeni, and many others. Cases have been reported 

 from the tropics by Lutz and Splendore in Brazil, and by us in 

 Ceylon. Clair has observed the disease in Arab stokers on board 

 some steamers of the Messageries Maritimes Company. 



.ffitiology. — ^The fungi causing the disease belong to the genus 

 Sporotrichum Link, 1809, of which nine species have been so far 

 described in man : — 



