and plants. They appear to be especially abundant in tropical countries. Doubtless they get access to the tissues through some wound or breach of surface. A number of species, distinguishable perhaps by the mycologists, have been described; for the clinician it suffices to know that in the morbid discharges and tissues they occur and are recognizable as yeast-like cells. In some instances the parasites are limited to one particular spot; in others they are more diffuse, and may attack almost any organ or tissue. The following clinical types have been recognized:—
1. The cutaneous.— Patches of various dimensions of small warty excrescences with minute abscesses or encrusted ulcers, especially at the periphery of the patch.
2. Oral.— Lesions resembling the foregoing, which develop in or spread to the mucosa of the mouth and throat, and eventuate in deep ulceration and perhaps fatal destruction of the part.
3. Coccidial.— The skin lesions are similar to type -1, but usually larger and coarser. The viscera becoming involved, death ensues. In the affected tissues peculiar round bodies, 3 to 80 μ in diameter, many of them containing a multitude of spores, are a feature.
4. Gluteal.— There is extensive brawny thickening of one or both gluteal regions, the superjacent skin being thickened and coarse and perforated with the openings of many communicating sinuses. The condition is apt to be regarded as an aggravated form of fistula in ano.
5. Sporotrichosis.— Gumma-like swellings in limbs or trunk, which enlarge and ultimately break down, leaving deep ulcers. The lymphatics, oral cavity, periosteum, muscles, or viscera may become involved. In the discharges and tissues the parasites are scanty, so that the niycotic nature of the disease can be made out only from cultures in glucose-agar tubes.
Diagnosis.— Usually these lesions in the first instance suggest syphilis or tuberculosis. Specific treatment and absence of reaction to tuberculin and of the bacillus of tubercle should lead to a careful
