Vegetable Parasites, 
AND THE 
D r s e a s e s c a u s e d b y their g r o w t h 
UPON MAN. 
[From the Third Annual Report of the State Board of Health 
of Massachusetts.] 
BY 
JAMES C. WHITE, MJD,,. 
/ (■ ’ a. 
Pkofessok ok Dermatology in Ha tJv a«/ U n i ~\*Ti- k's i t v>v 
BOSTON: 
Wright & Potter, State Printers, 
79 Milk Street (Corner of Federal). 
1872. VEGETABLE PARASITES 
AND THE 
DISEASES CAUSED BY THEIR GROWTH UPON MAN. 
L 
By James C.' White, M. D. 1. The Nature of Vegetable Parasites. 
2. The Diseases to which they give Rise upon Man. 
3. Pseudo-Parasites. 
4. Their Growth upon the Domestic Animals. 
6. Their Supposed Identity, and their Relations to Common 
Moulds. 
6. Common Sources of Contagion, and Precautions to be Used 
Against Them. VEGETABLE -PARASITES. 
1. The Nature of Vegetable Parasites. 
The question of the occurrence of low forms of vegetable life 
upon the external surface of man at times, and of alterations in 
the tissues of the skin and its appendages in connection with, or 
in consequence of, their presence there, is no longer a matter for 
discussion ; it is a fact as well demonstrated as the growth of the 
lichen upon tree and rock. Concerning the botanical position of 
these forms, however, their absolute connection with some of the 
affections in which they are found, the identity of the different 
varieties, and their relations to the common moulds of decay 
and fermentation, there still exists a great difference of opinion 
in consequence of lack of knowledge on these points. The pur- 
pose of this paper is to present some account of what is known 
about vegetable parasites and their effects upon the exterior of 
man and other animals, and of the present state of information 
in relation to that part of the subject which is still a matter of 
theory and under investigation. 
At the foot of the vegetable kingdom there exists a large 
family of so-called cryptogamous or flowerless plants, the fungi, 
among which the forms under consideration are generally 
placed, although there are recent writers who would give them 
a still lower rank in the scale of creation, and, on account of 
their marked dissimilarity to plants in most respects, would 
make of them an entirely independent group of organisms. 
Like many of the moulds, nothing can be learned of their 
structure by the unaided eye, and in some cases even their 
existence can only be determined by the high powers of the 
microscope. 
Examined by this instrument, the growths in question are 4 
found to consist of elongated, extremely slender, thread-like cells 
or tubes, more or less branched or intertwined, and divided trans- 
versely by partition walls here and there. This, the nutritive 
or vegetative part of the fungus, is called mycelium It may 
increase directly by subdivision into cells which have also the 
power of branching and self-multiplication, or by the produc- 
tion of innumerable, minute spherical or ovoid cells at the ends 
of certain of its branches, either enclosed in capsules called 
sporangia, or growing in bunches or bead-like chains, when they 
are called conidia or spores. These conidia, when detached, 
may be found single, united in rows, or divided into compound 
cells, and each of these is capable of reproducing the mycelium 
in turn. If these cells or the mycelium be placed in a liquid 
under proper conditions, their substance, or plasma, as it is 
called, becomes cloudy and subdivided into innumerable and 
infinitely small, free cells, which have the power of multiplying 
by self-division again, and which are either motionless or ex- 
hibit peculiar movements among themselves. One of these forms 
is called micrococcus, a term applied not only to what is really 
known to be the most minute and elementary form of fungus 
growth, but to much else of indefinite character in the shape of 
granules detected universally in matter under certain conditions 
by the highest powers of the microscope. The term is strictly 
applied to the more or less spherical cells or points,—those 
which are somewhat elongated and swollen at one or both ends 
being called bacteria; while those united in minute chains are 
called vibriones. These are supposed to be the primitive forms 
of organic life, and are of late much and loosely referred to in 
the discussions upon the germ-theory of disease. As a phase in 
the life of the parasitic fungi they claim our attention here. 
Placed in suitable fluids these infinitely small cells develop 
into other and much larger cells of various shapes, which are 
found either single or united in rows with lateral branches, 
which increase by budding, and may assume an elongated form 
like mycelium. They are the submerged form of fungus life, 
and are known as ferment cells, of which the beer or yeast 
plant, the wine and vinegar plants, and the milk ferment are 
well-known examples. This form is capable of reversion to the 
micrococcus, or under more favorable circumstances probably 
of attaining to the higher mycelial and conidial development 5 
above described. It is a form of special interest from its close 
resemblance in shape and size and manner of growth to the 
spores which form by far the greater portion of the fungus 
growths parasitic upon man, but which are regarded rather as 
sterile mycelial elements. The forms which demand our atten- 
tion, therefore, are, to repeat, the cell-like spores or conidia, 
the tube-like mycelium, and the mycrococcus granules. 
These are the forms which make up the structure of the 
moulds, and the varying predominance of some one or more 
of these elements, their shape and size, constitute the only dis- 
tinguishing features formerly recognized among them. Such 
variations were generally regarded as specific characters, and 
upon such views mycological systems have hitherto been based, 
but recent observation has shown that such a system of classifi- 
cation is wholly wrong ; that moulds assume a great variety of 
forms according to the nature of the soil and the atmospheric 
condition under which they grow ; and that many of the most 
common of those formerly recognized as distinct species are but 
varieties of some one well-known individual, prevented from 
attaining their perfect development by the circumstances of 
their position. Such tendency to variation has been termed 
Pleomorphism, and must be farther considered in connection 
with some of the questions above referred to. It is enough for 
our present purpose to recognize the possibility that the simple 
spores and mycelium, which make up almost wholly the growth 
of the vegetable parasites under consideration, are not the only 
or highest phase of development of which they are severally 
capable, and that under other conditions they might present 
appearances so unlike these as to have no apparent connection 
with them. 
The important part which these humble forms of vegetation 
play in the economy of nature may only be briefly alluded to 
here. The processes of fermentation by which fruits and 
cereals are converted into wines and beer, and these in turn 
into vinegar, by which the sugar of milk is changed to lactic 
acid, and many other transformations by which new chemical 
products are obtained, are exhibitions of their influence over 
the metamorphosis of matter. They are the active agents, too, 
in those less obvious changes by which dead matter, so called,, 6 
is resolved into its ultimate elements and converted into a state 
best fitted for the support of future vegetation. 
But it is not wholly upon decaying, or at the expense of in- 
animate objects, that fungi flourish, nor are the results of their 
operations always as beneficial as those just mentioned. The 
existence of the destructive wheat bunt and rust, and of the 
poisonous ergot of rye, the disastrous disease of the vine, the 
potato rot, and the dry rot of the hardest oaks, show how such 
insignificant creations may change the destiny and destroy the 
health of nations. They prove too that fungi may attach them- 
selves to, and live at the expense of, the living tissues of other 
plants, and, as Berkeley says, although they may not prey 
upon cells full of vital energy, life is so depressed by the pres- 
ence and contact of tissues already diseased, that the healthiest 
soon fall victims to the deadly encroachment of the spreading 
mycelium. Upon the higher organization of animal life, too, 
we find the same destructive agencies at work. The domestic 
fly glued to the window-pane, and surrounded by its pall of 
white spore dust, oftenest calls our attention to this fact, and 
the muscadine of the silkworm has been as destructive to large 
manufacturing districts in France as the oidium to the cele- 
brated vineyards of Madeira. The well-known spheriae of New 
Zealand, objects apparently dried plant at one end, dried cater 
pillar at the other, furnish another instance of the mastery of 
their living host by fungi. Such victories of the vegetable over 
animal life, and the seeming metamorphosis, are foreshadowed 
by the fabulous transformations of Clytie and Daphne. 
The effects which fungi produce by their presence upon the 
surface of man are never fatal in character or in any way inju- 
rious to his constitution ; they are, however, the cause of serious 
deformity and discomfort, as will appear in the following ac- 
count of the several affections in which they occur. The num- 
ber of these diseases has been constantly changing since 
Schoenlein in 1839 first recognized the cryptogamic character 
of the crusts of Favus, according to the discoveries of observers 
and the varying views which writers on these subjects have 
expressed from time to time. There are those who profess to 
believe in the impossibility of a plant’s attaching itself to ani- 
mal tissues under any circumstances ; but such an opinion, as 
stated at the beginning, requires no notice, as this part of the question is settled. There are others who, from the fact that 
the spores of various fungi are occasionally detected in the 
effete scales of Psoriasis, the crusts of Eczema, and in other 
cutaneous diseases, the non-parasitic nature of which no one 
questions, claim that their presence in all other cases is equally 
insignificant. Such a conclusion is as unsound as would be 
that of a botanist who should deny the cryptogamic nature of 
the various parasitic growths upon the forest tree, because the 
crevices of its bark catch and retain the scattered spores which 
the wind is always sweeping through the air. Then there are 
certain affections in which fungi have been discovered by some, 
and not recognized by other reliable observers ; the former 
maintaining that the plant is the cause of the abnormal appear- 
ances which constitute the disease, the latter that it is only oc- 
casionally and accidentally present. Great difference of opinion 
prevails therefore with regard to the position of several of these 
affections, not only as to whether they are to be considered of 
parasitic origin, but as to their mutual relations among those 
who claim the latter. 
On the other hand, there are three well-marked and important 
affections of the skin and its appendages which reliable author- 
ity universally admits to be produced by the presence of fungi 
upon and within their tissues, and these will be first considered. 
They are called Favus, Herpes tonsurans, and Pityriasis ver- 
sicolor. 
2. The Diseases to which they give Rise. 
FAYUS. 
The first of these, Favus, is the one in which, as already stated, 
the existence of a vegetable parasite was first recognized. It may 
be briefly described as an affection of the scalp and external cover- 
ing, characterized by the formation of large, yellow crusts. The 
shape of these crusts is peculiar, being concave upon their upper 
and exposed surface, circular or ovoid in outline, and presenting 
concentric rings rising like the seats of an amphitheatre from the 
central depression towards the elevated margin as they increase by 
peripheral growth. In size they vary from a minute point scarcely 
discernible by the naked eye to flattened masses a half inch in 
diameter when separate, and an eighth of an inch or more in eleva- 
tion above the surface of the skin at their edges. Distinct crusts 
may by confluence, however, form large patches in which their 8 
characteristic concavities may be more or less blended and lost. 
These peculiarities of shape are caused by their seat and the method 
of their growth. The minute elements of the fungus gain entrance 
to the tissues of the skin upon which they thrive through the open- 
ing of the hair follicle, and from this as a central point extend down- 
wards into the hair canal, and outwards in all directions into the 
epidermis. At first a minute globular mass is formed, but as the 
growth increases peripherally it is held down at its centre by the 
clinging of the hair-sheath to the hair, while in the free epidermal 
tissues around it is allowed an upward growth. It is the presence 
of the hair in the centre of each crust, therefore, which mainly 
causes the concavity of the crusts. Upon the scalp where the hairs 
are best developed this shape is longest retained, while upon the 
general surface of the body, where it is much less frequently met 
with, the crusts when large wholly lose this peculiarity and form 
irregular-shaped masses projecting to a much greater elevation 
above the surface. If we remove one of the small and perfect 
crusts, which is easily done by the nails, or a blunt instrument, we 
shall find its under surface convex, and that it is seated upon a 
smooth and shining depressed surface, which soon rises again to the 
level of the surrounding skin, and reproduces the crust. The color 
of the crusts when young is bright orange, fading to a pale lemon 
color when older. The odor is disagreeable, resembling, as it is 
thought, somewhat that of mice, a significant fact in connection 
with its frequent occurrence upon these animals. These appear- 
ances may be modified by the bursting of the crusts by rough hand- 
ling and the discharge of their contents, or inflammation may arise 
beneath them from the same cause, and the pus and blood mingling 
with them give rise to the formation of large scabs. 
There is a stage, however, in Favus, preceding the appearance of 
the crusts, which is generally overlooked, and which strongly re- 
sembles the appearances peculiar to the disease next to be described. 
This is best studied by observing the effects of inoculation upon 
portions of skin not covered with hair. This is most successfully 
accomplished by enlarging the openings of hair-follicles by a needle, 
and applying to the punctures a drop of water containing favus par- 
ticles. In a few days a red spot is noticed which is somewhat scaly 
upon the surface, and increases in size, apparently healing in the 
centre, as it spreads outwards. Sometimes groups of small vesicles 
or pajDules may be seen within the patch. These appearances, so 
strongly resembling ringworm, may last three or four weeks, and 
disappear without the production of a true favus crust, if the 
growth should not chance to enter the canal of the hair follicles 9 
seated within its border; but generally minute masses of the charac- 
teristic yellow color may be seen, or characteristic favus cups are 
formed after a while. This early stage is rarely noticed upon the 
scalp for two reasons: it is concealed by the hairs when present, 
and the larger development of hair there leads to the more easy and 
rapid formation of the crusts which obscure it. Favus is so rarely 
seen upon other parts than the scalp, that this stage is little under- 
stood, and when observed has been without doubt mistaken for 
ringworm in many instances. This error, or an occasional chance 
coincidence of the two affections upon the same portion of the skin, 
has given rise to the opinion, held by some dermatologists, that the 
fungus is the same in both diseases. This is a question, however, 
which will be considered further on.* 
* During the preparation of this paper I have been watching upon my own arm the 
growth of the favus fungus, inoculated according to the method of Peyritsch. 
On November 2d, material from a favus crust, removed from a patient in the skin ward 
of the Massachusetts General Hospital was rubbed up with a little water so as to form a 
thin paste. This was smeared over a portion of the fore-arm, where the openings of four 
contiguous hair-follicles had been just previously enlarged by drilling into them with a 
needle. An inch above this spot a needle loaded with the same moistened favus matter 
was bored into three hair follicles also. The parts were then covered with a piece of 
cotton cloth, and sticking plaster was applied over all. 
November 4th.—The follicles thus treated were red and slightly elevated. 
November 7th.—Appearances as on 4th. 
November 13th.—Follicles of the upper patch much more swollen than those of the 
lower, and the skin surrounding both points of insertion reddened. 
November 20th.—Follicles of upper patch still more prominent than the others, and the 
skin surrounding them, half an inch in diameter, considerably swollen. 
December 7th.—The dressings, which up to this time had been only momentarily re- 
moved for inspection, were not replaced, and the parts were covered simply by the ordi- 
nary clothing. Both patches were red and covered with yellow, scaly matter, the borders 
being somewhat elevated and papular. Some of this matter was scraped off, and the 
parts were then washed for the first time. 
December 11th, four days after washing.—The surfaces of both patches have become 
covered again with yellowish-white scales, and two of the follicles in the upper patch 
are quite prominent. 
The scaly matter removed from the surface was examined by the microscope, and pre- 
sented the following appearances: The epithelial cells, of which it mainly consisted, were 
filled with groups of fungus cells, resembling in all respects those of achorion, and quite 
unlike those of the parasite of Tinea tonsurans. A very abundant growth of mycelium was 
also seen running through the masses of epithelium in all directions. One of the lanugo 
hairs from the patch was also removed, and, after maceration in a solution of potash, was 
found to be permeated by favus cells throughout. 
December 27th.—The parts are still unchanged, except that they are less red beneath 
the scaly surface, and the elevated margin has flattened down to the general level of the 
skin. The spots have not enlarged, and no true, characteristic favus cup has formed. 
They would not be generally considered as favus, if seen without the above knowledge of 
their history, and they might easily have been mistaken for ringworm. 
February 20th.—The skin of the above parts has returned to its natural appearance. 
The fungus did not succeed in establishing a permanent hold upon the tissues. 10 
Such are the appearances produced by the growth of the favus 
plant upon the human skin; the effects and symptoms to which it 
gives rise need but a brief mention. Upon the general surface of 
the body it causes various degrees of irritation, sometimes sufficient 
to excite an eczematous condition of the surrounding skin if 
scratched, or some immobility of the joints of the limbs, if there 
seated; but generally its presence is productive of little inconven- 
ience. Upon the scalp, however, its effects are of a more serious 
nature. The hairs soon begin to change in color, becoming gray or 
white, lustreless, stiff and brittle, and after a while break off at the 
surface, or are discharged by suppuration with the surrounding 
favus masses. In this way the disease spreads over the whole scalp 
in time, the baldness beginning generally at the front and lateral 
portions, while the hair upon the occiput may retain its position for 
years. The baldness may be temporary only, in case the hair fol- 
licles are not destroyed, but the presence of so much foreign matter 
within them may give rise to so violent an inflammation that they 
and the hair-growth are forever destroyed. In this way the firm, 
white and atrophied condition of the scalp is produced so charac- 
teristic of old cases of favus. In some instances atrophy of the 
bones of the skull even, has been observed. It will be easily un- 
derstood how, by combing and scratching, or by self-rupture of the 
crusts, and by the changes of position in the bandages worn to con- 
ceal its presence, favus-matter may be transplanted from one part 
of the scalp to another. 
Upon the constitution and health generally favus has little or no 
effect. It is often seen upon sickly-looking and consumptive chil- 
dren, but such coincidence indicates only neglect most favorable to 
the progress of both the local and general affection. It may pos- 
sibly thrive more vigorously upon the devitalized tissues of a per- 
son debilitated by consumption, but its alleged connection with this 
disease or dependence upon hereditary or constitutional predispo- 
sition, rests upon no proper foundation. 
Favus affects the nails too occasionally; generally in persons 
either carrying the growth in some other position, or having charge 
of those affected by it. Their substance, which is only modified 
epidermal tissue, becomes yellow and opaque, their longitudinal 
striae are more marked, and their surface has a rough and tubercu- 
lated appearance. The external layers of cells are easily detached, 
and are found filled with the parasitic growth, while sometimes a 
well-defined favus mass perforates the nail from below. 
If now we examine by the microscope the matter of which the 11 
favus crust is composed, upon whatever part of the body it may be 
growing, we shall find in addition to more or less epithelium, 1st, 
innumerable, minute cells of an irregular ovoid shape, attached to 
each other in groups or rows, of about the of an inch in 
diameter; 2d, others more or less swollen at one end, or divided or 
branched; 3d, long and very slender tubes extending from the 
masses of cells, and more or less subdivided by partition-walls and 
branched ; and 4th, granular matter so small as to be withoiit defi- 
nite form, even when examined by the highest powers. These ob- 
jects constitute, it scarcely need be said, the elements of a fungus as 
already described. The first two forms are the spores or conidia, 
the third is the mycelium, and the last the micrococcus. They are 
not distributed evenly throughout the favus mass. The spores pre- 
dominate in the centre of the cup, while the micrococcus and myce- 
lium are found more largely at its cii’cumference and extending into 
the surrounding epidermis, which holds it encapsuled. The cells of 
the skin, in the earlier stage of the disease above described, and 
likewise the outlying portions in the neighborhood of the crust 
when formed, will also be found to contain the same elements, 
although the spores are in much smaller proportion. If we remove 
the hair which pierces the centre of one of the cups, with its 
sheath attached, we shall find the walls of the latter distended with 
innumerable spores and mycelium shooting out into the surround- 
ing tissues. If the hair be one sufiiciently long affected to present 
to the eye the appearances already described, it will be found when 
examined by the microscope, after maceration in a solution of pot- 
ash, to be permeated by hollow canals running lengthwise between 
its fibres, and by beaded tubes extending longitudinally throughout 
its substance. Rows of conidia may also be seen encircling the 
shaft of the hair. These appearances are to be traced from the 
atrophied bulb for a considerable distance after the hair emerges 
from the skin. 
The fungus growth in the nail is the same in all respects as in 
the epidermal tissues elsewhere. The fungus in favus has always 
hitherto been called achorion schoenleinii, in honor of its discov- 
erer. Whether it is still to be looked upon as a species peculiar to 
this disease, as identical with those found in the other parasitic af- 
fections of the human skin, or as only a modified form of some 
common mould, are points to be considered farther on. 
Favus is a rare disease in comparison with the affections remain- 
ing to be considered. It is mostly met with upon the heads of 
poor children, for its elements seldom succeed in developing upon 
surfaces frequently washed or brushed. Although positively con- 12 
tagious, it is so in far lower degree than some of the varieties of 
ringworm to be described, and it seldom if ever runs through 
schools and asylums like the latter. It is frequently observed upon 
sevei’al members of the same family, however, and to be developed 
successively and only after long periods of daily contact amongst 
its individuals. Its artificial transmission by inoculation is also a 
matter of difficulty, although recent attempts performed by punct- 
uring the hair follicles for the admission of the fungus have been 
much more successful than when other methods were used. It 
affects children more frequently than adults, and is comparatively 
more common in the country than in cities. Its course is always 
slow ; left to itself it may last a life-time upon the scalp, or until it 
has entirely destroyed the hair, in which case a spontaneous cure is 
possible. Upon other portions of the body its duration is by no 
means so chronic, and its eradication by treatment, compared -with 
its seat upon the scalp, a simple matter. The same happy result 
might be obtained there, did not the hairs which pierce the crusts 
retain them in position, and also contain a store of seed which con- 
tinually gives rise to new life. It is on this account that favus upon 
the scalp is one of the most obstinate affections known. 
Under this general name will be described certain diseased condi- 
tions of the skin of various parts of the body, so unlike in their 
appearance as to have been considered distinct affections up to very 
recent date, and to be still called by different names, and to be the 
subject of more animated discussion at present, perhaps, than any 
other point in dermatology. Ringworm of the scalp, called herpes 
tonsurans or tinea tonsurans; ringworm of the general surface of 
the body, called herpes circinatus; ringworm of the beard and syco- 
sis, both called “ barber’s itch ” at times, as well as by other names; 
eczema marginatum, a peculiar affection of certain parts of the 
body, so called by Ilebra in his original description ; and the major- 
ity of the cases of parasitic disease of the nails, called onychomy- 
kosis, are all caused by the growth of one and the same fungus, 
hitherto generally entitled trichophyton tonsurans. The great dis- 
similarity in the appearances of these affections is due, as we shall 
see, mostly to peculiarities in the seat and stages of the parasitic 
growth. 
RINGWORM. 
Ringworm of the general surface of the body is familiar to all. 
It begins as a red spot, slightly elevated above the surrounding 
skin, which is covered in a few days with minute papules or vesicles 
of very short duration, or with little white scales. It increases 13 
rapidly in size, flattening down in the centre as it expands, so as to 
form a circular patch, the elevated border of which consists of a 
ring, an eighth or a quarter of an inch in width, of the same pap- 
ules, vesicles, or scales, while the central portion appears red and 
scaly. Thus it goes on sweeping outwards like the cryptogamic 
fairy ring upon the soil, and forming complete circles sometimes six 
inches or more in diameter, which then appear as rings simply, as 
the redness and scaliness of the enclosed skin disappear after a 
while. Sometimes, however, the disease starts up afresh within the 
district already swept over, and rings within rings may be formed. 
Generally, after reaching any considerable size the disease dies out 
at certain portions of the border or rim, for want of proper nour- 
ishment or suitable soil, and segments more or less broken are left 
to advance over the uninvaded regions of the skin. Generally, too, 
new spots appear before the disease has lasted long, the result of 
self-inoculation, which run the same course. Their seat is most 
commonly the neck and face, or these are the parts generally the 
first to be affected from their greater exposure, but the whole sur- 
face of the body may be more or less successively swept over before 
the disease is exterminated, or may exhibit simultaneously the char- 
acteristic marks of its presence. When about the face and neck in 
children it may extend its march to the scalp, and thus give rise to 
one of the other varieties already mentioned ; or in a man it may 
run through the beard and cause there similar appearances to those 
upon the scalp of children, or terminate finally in another form, 
sycosis. It may, however, affect the hairy portions of the face or 
scalp and for a considerable time, and yet manifest itself in no other 
way than by the formation of the rings already described. In the 
latter case the hair follicles have not become implicated, and thus 
the appearances and course of the disease remain the same as upon 
non-hairy portions of the body. Occasionally these varieties may 
be seen simultaneously upon one person and their conversion into one 
another satisfactorily observed. The sensations which accompany 
them are more or less itching and burning. 
If some of the scaly matter be removed from any portion of the 
skin affected by ringworm and examined by the microscope, there 
will be seen mixed with epidermal cells innumerable round bodies 
7T»V<r °f an inch i*1 diameter arranged in groups and rows, or single, 
and, sparingly interspersed, long and branching tubes. These are 
the unmistakable elements of a fungus, and they differ from those 
found in favus, already described, in the shape and size of the spores 
or conidia, and the much smaller quantity of the mycelium. 14 
Eczema Marginatum. 
There is occasionally observed upon the central portions of the 
trunk, especially about the inner surface of the thighs and lower 
abdomen a diseased condition of the skin of peculiar appearance, 
which Prof. Hebra was the first to particularly describe under the 
name eczema marginatum. It begins as a small round patch of 
papules and vesicles, which itches excessively and excites scratching. 
As it spreads it heals in the centre, sinking down and leaving a 
dark red, scaly condition of the skin, while the advancing border 
presents constantly an elevated ridge of papules, vesicles, and other 
lesions of eczema, upon an inflamed base. The scratching aggra- 
vates the severity of the symptoms and tissue-changes, and gives a 
markedly eczematous appearance to the part. The affection differs 
from eczema, however, in the central retrogression and the concen- 
tration of its activity at the advancing edges. It may extend thus 
over large and continuous portions of the trunk and limbs, but the 
appeai’ances never vary from the type of the raised and narrow 
margin of papules, vesicles, excoriations and crusts, and the dark 
red and scaly state of the parts earlier affected. New centres of 
the disease may be developed simultaneously on neighboring parts, 
and occasionally the same process is repeated within the bor- 
ders of the old patch; the whole then exhibiting concentric rings 
of the character already described upon a general field of a dark 
red color. 
This affection has been the subject of much discussion within the 
last few years. As early as 1864 Kobner of Breslau in his Mittheil- 
ungen demonstrated its parasitic nature and the identity of the 
fungus found in it with that of ringworm of other parts of the 
body, and maintained that the two diseases were the same. His 
statements were not received, however, with all the consideration 
they deserved, and it was not until Dr. Pick of Prag, three years 
ago, again opened the question with still more positive proofs of 
the correctness of Kobner’s views, that they were generally adopted 
by dermatologists. But why is it, it may be asked, if eczema mar- 
ginatum is identical with ringworm, a very common affection, that 
there has ever been this doubt as to its nature and this reluctance 
still on the part of Prof. Hebra to regard the fungus found in it as 
the essential agent in its production, although obliged at last to 
admit its existence there ? How does it differ from ordinary ring- 
worm of the skin ? Only in the more eczematous character of the 
lesions which compose the outer and active rim, and the greater 
amount of congestion and pigmentation which remain behind en- 
closed within it. The parasite in ordinary ringworm creates a cer- 15 
tain amount of irritation of the skin, expressed by the formation 
mainly of papules, vesicles, and scales. In eczema marginatum the 
inflammatory process is aggravated, as shown by the addition to the 
lesions just mentioned of pustules and crusts, and greater exudation 
beneath where the source of the irritation is most actively at work, 
namely, at the edge. The deeper color within indicates only a 
higher grade of chronic inflammation. How therefore can we ac- 
count for this difference in the degree of inflammation, the exciting 
cause being the same in both affections ? It is evident that it must 
be due either to peculiarity in position or in the temperament or 
tendencies of the persons affected. The former, no doubt, is the 
reason why ringworm of the parts specified should assume the pe- 
culiarities described as eczema marginatum, for they are specially 
liable to a form of eczematous inflammation, and its chronic charac- 
ter will explain why a true eczema of the same parts might at times 
be converted into this form of disease. No doubt, however, that 
both position and individual tendencies operate in its production, 
for we may have ordinary ringworm of the same parts presenting 
none of the peculiarities of the eczema marginatum form, and on 
the other hand true eczema may affect them indefinitely as such 
without becoming accidentally inoculated with the fungus of, and 
converted into, ringworm. Eczema marginatum, then, is to be re- 
garded either as ringworm of certain parts exciting an eczematous 
inflammation in addition to the lesions ordinarily produced by itself, 
or as ordinary eczema modified by the subsequent development upon 
it of the parasitic elements of ringworm. 
Of the real nature of the affection, however started, there can be 
no doubt. Removing some of the epidermal cells from the border 
we shall find by the microscope precisely the same fungoid ele- 
ments that we found in the scales of ringworm, conidia, mycelium, 
and micrococcus, although after the disease has existed for a long 
time they are often difficult of detection. Were this not sufficiently 
conclusive both as to its parasitic nature, and its identity with ring- 
worm, we have in addition the experiments of Kobner and Pick, 
both of whom succeeded in producing unmistakable ringworm upon 
their own skins by transplanting some of the scales from cases of 
eczema marginatum, and the observation of many that ordinary 
ringworm has been seen to become converted into eczema margina- 
tum after existing some time. 
This disease is not of very frequent occurrence. It has been 
observed by Hebra to affect especially shoemakers and horse- 
soldiers, occupations most likely to add an eczematous character to 
a ringworm existing upon the thighs, or to generate a local eczema 16 
of the parts for the later engrafting of parasitic elements. The 
disease occurs also upon other parts than those already mentioned ; 
in and about the axillae, for example, and upon the female breast. 
In India it is of not unfrequent occurrence, and is there called Bur- 
mese ringworm. The subjective symptoms are an exaggeration 
only of those above attributed to ringworm of other parts. 
The third variety of ringworm to be described is that seated 
upon the scalp, and, owing to the presence there of the hairs, its 
appearance and course differ greatly from those belonging to the 
forms affecting the non-hairy portions of the skin already men- 
tioned. It is called Herpes tonsurans or Herpes tondens by the 
various writers on skin diseases, just as ringworm of the skin is 
called Herpes tonsurans or H. circinatus, although in no way allied 
to true Herpes. It would be better to adopt the title Tinea ton- 
dens or tonsurans, to correspond to Tinea favosa, the most accept- 
able title for favus. The terms tonsurcnis and tondens suggest the 
most striking feature of ringworm of the scalp, as the disease first 
manifests itself by the falling of the hair in circular spots, although 
not close to the skin as if shaven, as in alopecia areata, an affection 
to be described below, but by breaking off one or two lines from 
the surface and leaving the irregular stumps to project. The sur- 
face of these circumscribed patches is harsh, owing to the pro- 
jection of the hair follicles as well as of the stumps, and from the 
thick coating of dry and diseased epidermal cells and the parasitic 
elements present. This, however, is not the first stage of the dis- 
ease, although that which first attracts notice. It is preceded 
generally by the same appearance of circles of erythema, spreading 
outwards and healing at the centre as in ringworm of the skin, but 
without as markedly elevated a rim as in the latter. These, being 
concealed by the hairs, generally escape observation, and it is only 
by watching the development of new points of inoculation, as 
the disease progresses, that its early stages may be generally stu- 
died. After gaining a hold upon the epidermal cells, as shown by 
these manifestations, with which we are already familiar, the fun- 
gus soon affects the hairs; they become dry, lustreless and brittle, 
and break very easily, leaving the stumps projecting from the 
prominent follicles, as already described. As the disease spreads 
outwards from its central starting point, large, bare spots are formed, 
several inches in diameter, which may coalesce and thus give rise 
to a very large and continuous patch; or many separate points 
scattered over the scalp may give a spotted appearance to the 
Ringworm of the Scalp. 17 
whole head. Thus the outlines of the affection are constantly 
changing in every case, but the minute and surface appearances of 
every spot are always the same, viz.: the stumps of hair, the white 
scaly matter, and the prominent follicles resembling shagreen, or 
the skin of a plucked fowl, as variously described by writers. 
If the patches increase in size sufficiently to run down upon the 
neck or forehead, Where there are no large hairs, the appearances 
change abruptly to those of ringworm of the skin; and on the 
other hand should, in a case of the latter, the affection sweep from 
the face on to the scalp, there are at once developed the character- 
istic features we are describing. It is by no means uncommon to 
observe both forms of the affection upon the same child; that is, the 
tonsurans upon the scalp and the circinatus upon the face forming 
continuous parts of one large ring, or to find in one child of a fam- 
ily the scalp affected, and xipon the skin of another child or of the 
parent well-marked circles of ringworm. 
Occasionally, however, other appearances are observed, which 
must be referred to individual temperament. When the irritation 
produced by the parasite, generally of slight character, is excessive, 
vesicles and pustules of considerable size may arise upon the 
affected parts, which terminate in thick crusts; or in other cases 
large nodules or tumors may be developed from the inflammation 
of the hair follicles, sub-epidermal abscesses, which open by sev- 
eral mouths and for a long time discharge a glutinous matter; a 
condition similar to that observed at times when the beard is 
affected, as will be seen below. Such cases may give rise to par- 
tial and permanent baldness, but fortunately they are rare. 
Left to itself ringworm of the scalp, like favus, tends to per- 
petuate itself indefinitely. The hairs repeatedly fall and are 
reproduced, until the soil contains no more nutriment for the plant, 
or the follicles are obliterated by inflammation, in both of which 
conditions a local spontaneous cure of the disease results. It will 
sometimes apparently disappear more or less entirely, but almost 
always acquires new life, and thus may go on for years unless 
arrested by treatment. 
If we pull out one of the hairs changed as described, and 
examine it by the microscope, we shall find the bulb much changed 
in appearance, flattened and distorted or, perhaps, wholly destroyed; 
the shaft, or all that remains of it, irregular in outline, and its 
free end splintered and jagged, like the uncut portion of the stump 
of a tree. The various structures of the hair are scarcely distin- 
guishable, and the longitudinal fibres are distended and forced 
apart by the parasitic growth. This is seen to consist of an innu- 18 
merable number of spores or conidia, covering the outside of the 
hair, and penetrating its tissues throughout its length. But little 
of the myceloid growth is seen. The epidermal cells surrounding 
it, and those which make the scaly matter covering the general 
surface of the bald patch, are likewise filled with the same elements. 
These are identical in appearance with those already described as 
discovered in the other varieties of the disease. 
Ringworm of the scalp is a frequent affection among children, 
and often occurs upon the same individual and at the same time 
with ringworm of the general surface. The one may readily give 
rise to the other upon another person. In adults, however, it 
very rarely affects the scalp, and it may exist for months upon the 
hairy portions of the face, and extend from these parts over large 
portions of the body without appearing upon the head. Indeed, I 
have never seen but one adult thus affected, while the beard in 
gentlemen, as will be explained in another connection, is very 
frequently the seat of ordinary ringworm. Unlike favus, it is of 
more frequent occurrence in cities than in the country. It is in 
orphan asylums that it is most commonly found, and the introduction 
of a child affected with it is often the cause of an outbreak which 
may spread among scores of the inmates and last for months, before 
it can be exterminated. It causes some degree of itching, and, as 
just stated, occasionally a circumscribed inflammation sufficient to 
destroy the hair follicles, and thus produce partial baldness, but it 
does not affect the health in any way. 
Ringworm of the beard presents very unlike appearances at dif- 
ferent times, so dissimilar in fact as to pass generally for entirely 
distinct diseases. As just stated, it is in one form a very common 
affection among young men, and its real nature is then readily 
recognized even by the patient. The latter appearances are those 
of ordinary ringworm of the chin and those of the scalp affection 
just described, more or less combined, and are called simply ring- 
worm. They may be designated as the 
Ringworm of the Beard.—Sycosis.—Barber’s Itch. 
First Stage.—It begins, as upon the non-hairy portions of the 
face or body, in the form of small points, which generally attain the 
size of a pea or a cent, before they attract much attention. They 
spread rapidly in a circular form, flattening down in the centre as 
the elevated margin of papules or vesicles enlarges, and are accom- 
panied by a considerable degree of itching and burning. The 
centi’es of the patches remain more or less x-eddened and scaly, but 
seldom present the white, branny look, so characteristic of their 19 
seat upon the scalp; probably because the parts are so much more 
frequently washed. The sides of the face are its most common 
starting-point, from which the rings may spread in every direction, 
or new ones may be started from these upon other parts by self- 
inoculation ; the itching causing frequent rubbing with the hands, 
and in this way transference of the parasitic elements elsewhere. 
When the circle spreads beyond the beard, the appearances of such 
portions of the patch are identical with those of ringworm origi- 
nally started upon the general surface of the skin. The disease may 
thus run on for some time in the beard without any apparent 
change in the hairs, but sooner or later, the period varying greatly 
in different cases, the hairs begin to fall from the parts affected, 
thus defining the patches more conspicuously than before. The 
hairs break off a short distance above the surface, and leave ragged 
stumps, as on the scalp. Ringworm of the beard primarily occurs 
generally upon those parts of the face which are shaven, or in other 
words upon those persons who are shaved; much less frequently 
upon others, for reasons to be hereafter given. On this account it 
seldom exists long without attracting attention, and its effects and 
changing phases may be carefully studied. It may extend from the 
shaven portion of the face into parts of the beard worn long, or, 
beginning in the form of herpes circinatus upon the neck, spread 
upwards into the long hairs of the face, but it seldom primarily gets 
a seat in a full beard. The fashions of wearing the beard, or the 
methods of shaving practised by the barbers in different countries, 
may have much to do with the comparative frequency of occur- 
rence of this stage of ringworm of the hairy portions of the face 
among various nations, certainly a great difference in this respect 
exists ; German writers, including Prof. Hebra, saying that simple 
tinea tonsurans of the beard seldom if ever occurs in their large 
cities. In France, on the other hand, it is spoken of as more preva- 
lent. Here at any rate it is of very common occurrence, as will be 
shown in connection with the subject of the causes of the parasitic 
affections of the skin. It often apparently disappears, to revive again 
and again, and thus may run on indefinitely even for years, when 
left to itself, or when unsuccessfully treated. Occasionally, how- 
ever, other appearances are added to the typical symptoms of the 
aflection above given. After existing thus for months, possibly 
for a year or more, the beginning of those lesions of the skin be- 
comes manifest, which characterize the second stage of the disease. 
Simple ringworm of the beard becomes in other words, 
Sycosis. Second Stage.—This is an affection about which there 
has been even more difference of opinion expressed among derma- 20 
tologists than in the case of eczema marginatum and its relations to 
ringworm. This has arisen from the circumstance that there are 
two affections of the beard closely resembling each other in appear- 
ance, but due to different causes, which are confounded with each 
other, and which bear no distinguishing titles. Sycosis may be 
defined in general terms as a chronic inflammation of the hair 
follicles of the face. It begins in the form of a small nodule about 
the insertion of the hair, which slowly enlarges and, if the inflam- 
mation runs high enough, discharges pus from its summit, which 
dries and forms a crust about the hair. This process is repeated in 
the individual follicles several times generally, the nodules varying 
in size and prominence according to the degree of inflammation. 
In later stages the nodules and pustules may be converted into 
hard and large, prominent tubercles, giving rise to thicker crusts 
upon their surfaces as they suppurate, or forming large, raw indu- 
rations. The tissues beneath the skin may in time become involved 
and large abscesses be formed. Thus the disease may go on for 
months or years, spreading gradually over the hairy portions of the 
face, and affecting sometimes the eyelashes and eyebrows. When 
the inflammation is excessive, the hair follicles thus affected are de- 
stroyed and permanent baldness results. Great disfigurement and 
local distress are often caused by it. It forms one of those chronic 
affections of the beard known as barber’s itch. 
Now it is about the cause of this affection that the difference of 
opinion above mentioned has arisen. Gruby was the first to sug- 
gest its cryptogamic character, and called the parasitic elements 
found microsporon mentagrophytes, mentagra being another name 
for the disease. Hebra and other distinguished German observers 
failed to discover the presence of a parasite except in very rare 
instances, and therefore consider its occurrence purely accidental, 
and in no way connected with its production. They regard the dis- 
ease, therefore, as simple acne of the beard. The French observers, 
on the other hand, insist upon its parasitic character, but regard the 
fungus found as the trichophyton tonsurans, the same as that com- 
mon to all the varieties of ringworm we have described, or in other 
words that sycosis is merely Herpes tonsurans of the beard, its final 
stage. There can be no doubt of the accuracy of this latter view 
in part, nor are the opinions of Hebra and others wholly wrong. 
There is a parasitic form of sycosis, there is a non-parasitic form of 
sycosis. Kobner, who has done so much to clear up the doubts 
concerning this class of affections and this disease in particular, 
calls the former Folliculitis barbae, the latter Sycosis parasitaria, 
and his investigations show that the latter form is by no means so 21 
uncommon in Germany as the statements of other observers teach, 
although there can be no doubt that it is much more prevalent in 
Paris and Boston than in Vienna; a fact, taken in connection with 
the more frequent occurrence in the two former places of simple 
ringworm of the beard, of important bearing upon its relations to 
the latter. Kobner bases his opinion, that parasitic sycosis is 
only the worst and most advanced stage of Herpes tonsurans, upon 
the following observations, stated in brief: 1st, the fungus found in 
both is identical in form, size and distribution; 2d, the transfer of 
the crusts of sycosis to the skin of the same or of another individual 
produces Herpes circinatus and on the other hand, of material from 
this, or from the head in ringworm of the scalp, to the beard of 
another person causes sycosis; and 3d, parasitic sycosis generally 
begins with ringworm of the beard. 
The latest study of the disease has been made by Prof. Tanturri, 
whose observations may be found at length in the Italian and Ger- 
man journals of dermatology. His conclusions are stated in abstract 
in the latter as follows : 1. Herpes tonsurans generally precedes the 
development of phytosycosis. 2. Phytosycosis is not an accidental 
symptom, but the direct consequence of Herpes tonsurans. 3. Phy- 
tosycosis is still contagious, even when Herpes tonsurans no longer 
exists. 4. The parasite of phytosycosis is found in the hair which 
penetrates the nodules and pustules, and also around it; and, 5, is 
identical with that of Herpes tonsurans. 6. Phytosycosis is dis- 
tinguished from the idiopathic sycosis by its morphological, clinical 
and anatomical characters. These important points of distinction 
cannot be given here in detail, but may be found in the journals re- 
ferred to, and are also minutely discussed by Kobner in his valuable 
work. It must be said, however, that in many cases the mere ap- 
pearances at some periods would be insufficient to distinguish the 
parasitic from the non-parasitic inflamation of the hair-follicles, and 
that the clinical history and, most important of all, the microscopic 
examination, are aids in diagnosis never to be discarded, sometimes 
indispensable. That parasitic sycosis is the latest stage of ringworm 
in the beard, I have no doubt remaining, for I have watched the 
conversion of the one into the other in several cases. 
Ringworm of the Nail. 
The last form remaining to be described is ringworm of the nails. 
Occasionally some one or more of the nails of persons affected with 
any of the varieties above described, or of those having the daily 
and long-continued care of such patients, lose their transparency, 
become opaque and dry, and gradually thicken. Their surface ap- 22 
pears rough, and cracks easily, and their free edge is blunted. 
Their substance is brittle, and flakes off superficially in the form of 
scales. If these be examined by the microscope, the flattened cells 
of which they are composed will be found filled with a parasitic 
growth, consisting of long chains of conidia, more or less branched, 
of a few slender myceloid tubes without septa, and of small round 
cells or spores. Such a condition continues for years or perpetually, 
unless the plant is destroyed by treatment. Such cases form one of 
the varieties of so-called onychomykosis, a name applied to all the 
parasitic affections of the nails, of which, also, the favus form, al- 
ready described, is another. Whether there be in fact other varie- 
ties than these two, dependent upon the growth of other fungi than 
those found in Tinea tonsurans and T. favosa, is a matter much 
discussed, but not easy of solution, because the growth of the plant 
in nail substance is very unlike its modes of development in the 
other cutaneous structures; so much so, that without the clinical 
history, it is often impossible to say to which of these varieties any 
case shall be referred. 
PITYRIASIS VERSICOLOR. 
The other remaining parasitic affection of the human skin, con- 
cerning the cryptogamic nature of which no doubt exists, bears the 
above name. It is also called by some writers Tinea versicolor. It 
is characterized by the formation upon the surface of yellowish or 
buff-brown spots of irregular outline, but slightly elevated, and 
covered with fine scales, which are easily scratched up by the nails, 
or removed by scraping with a knife. They vary in size from mi- 
nute points to confluent patches of sufficient extent to cover large 
portions of the chest or abdomen. They chiefly affect the front 
trunk, beginning generally upon the chest, and may extend down- 
ward so as to cover more or less wholly the abdomen, hips, and 
upper thighs, and upwards to the shoulders, and thence down to 
the forearms, or creep around the chest to the back. They rarely 
appear below the knees and elbows, or ascend upwards upon the 
neck, and never affect the face. In other words, they do not gen- 
erally grow upon those parts of the skin which are exposed to .the 
air and light, finding rather upon those parts protected by clothing 
the warmth, and possibly the absence of light, essential to the de- 
velopment of the plant. It seldom, if ever, occurs upon children, 
which may be explained, perhaps, by the choice the parasite shows 
for the dry and outer cells of the epidermis, those of adult life be- 
ing probably better adapted in this respect to its needs. It is said, 
also, to occur less frequently upon women than upon men; but it 23 
is not unfrequently communicated from husband to wife, and 
flourishes as vigorously upon the female skin, when once started, as 
upon the male. When once established, it seldom disappears spon- 
taneously, but may go on for years, perhaps dying out largely dur- 
ing the winter, to revive and extend over wider areas during the 
summer. It often gives rise to great itching of the parts affected, 
although in some cases the patient is not conscious of its presence 
through any sensations it may cause. It is often mistaken for, and 
confounded with, the pigment stains, upon the skin called moth, 
liver-spots, or chloasma, an affection differing from it in position, 
anatomical seat, course, and clinical history. 
An examination by the microscope of a few of the scales, so 
easily removed, from a patch of pityriasis versicolor, will readily es- 
tablish its nature. We see lying between the upper layers of epi- 
demal cells countless numbers of round conidia or spores, grouped 
in clusters, of high refractive power, and resembling minute oil 
globules. Associated with these are fine tubes of mycelium run- 
ning in a net-work of endless intricacy. About the opening of a 
hair follicle the parasite may be seen reaching down the canal, and 
possibly it may run over the surface of the hair; but it never pen- 
etrates it deeply or alters its structure. This plant has been gener- 
ally called microsporon furfur. Its relations to the other parasitic 
fungi will be spoken of in another place. 
The disease is of not unfrequent occurrence here, although* its 
presence is frequently overlooked by its host, and is only discovered 
by the physician when’examining the naked chest for other reasons. 
It is on this account that it has been said to affect consumptive pa- 
tients especially. There is no other ground, however, for such an 
opinion. Its growth is entirely independent of, and unconnected 
with, the general condition of the person it affects, nor does it exert 
any injurious influence upon the same, save the itching it occasions. 
It is positively contagious,—husbands giving it to their wives, as 
above stated, and as also proved by direct experiment. The spread 
of the disease from one portion of the body to another is likewise 
affected by the transplanting of the spores in the furrows ploughed 
up in the healthy epidermis by the nails while scratching. Still it 
is not by any means so easily communicated to new hosts as the 
tricophyton tonsurans, nor is it so easy to trace the source of con- 
tagion in any particular case. The color it imparts to the skin is a 
property of the fungus, as much as the yellowness of the favus 
crust belongs to the achorion. 24 
Thus far in our subject there has been either no doubt as to 
the cryptogamic nature of the affections considered, or, if differ- 
ence of opinion upon this point does exist with regard to some 
of them, the weight of evidence is such as to overrule such dif- 
ference in the direction already stated. But we now have to 
refer to an affection, which is still one of undecided position, and 
concerning the nature of which dermatologists differ widely in 
opinion. 
ALOPECIA AREATA. 
Alopecia circumscripta. Area celsi. Porrigo decalvans. Tinea decalvans. 
These are the names given by different writers to this singu- 
lar affection, which is characterized by the existence of circular, 
bald spots, of a smooth and shaven appearance upon the scalp, 
apparently whiter than the surrounding skin. Before it is dis- 
covered the disease has generally attained considerable head- 
way, and one or several bald spots, the size of a dime or larger, 
first attract the attention of the patient or of other members of 
tbe family. These increase more or less rapidly and may 
coalesce, forming large bald patches many inches in diameter, 
or even in time spread over the whole scalp. The eyelashes 
may be lost in the same way, and in rare cases all the hairs upon 
the body are destroyed. The baldness thus produced is not 
always permanent, and the hair may be reproduced spon- 
taneously even in part, but generally the new growth becomes 
affected in the same way and falls again. If we examine the 
surface of one of the patches in its early stage, we shall find 
no vestige of the hair upon it, and its limits sharply defined by 
apparently sound hairs. Sometimes the scalp feels thickened or 
oedematous over the bald spot and somewhat beyond and around 
it, and occasionally with this is associated a slight erythematous 
blush. In later stages there is often a partial restoration of the 
activity of the hair follicles, and in place of the normal growth 
of the part, lanugo, or short and colorless, downy hairs are pro- 
duced. When the disease has existed for a long time, years it 
may be, these in turn may disappear, and the scalp may pre- 
sent over its whole surface that bald and shining, alabaster 
whiteness and smoothness, so characteristic of senile atrophy of 
the skin, divided off into separate districts, perhaps, by spare 
lines and tufts of hairs untouched by the disease. 25 
What is the cause of this strange affection ? In 1842, Gruby 
discovered in the hairs of a case a fungus which he called mi- 
crosporon audouini; and as the clinical history of the affec- 
tion favored this view, and as the plant was seen and figured 
by other competent observers, it was generally accepted by der- 
matologists that it was of a parasitic nature. Inasmuch, how- 
ever, as observation since then, and especially of late, has failed 
to detect the presence of the fungus in all or in a large propor- 
tion of the cases examined microscopically, doubts have arisen 
as to its parasitic nature, and the recent German writers deny 
it altogether. They base their opinions upon their failure to 
find in cases recently examined any such plant as Gruby de- 
scribed, or as Bazin and other dermatologists have figured; but 
inasmuch as their testimony is wholly of a negative character, 
how is it that they offer it as an offset to the positive observa- 
tions of other and equally competent investigators ? They at- 
tempt to sustain the validity of their position by denying the 
competency of those who hold the opposite opinion. They say 
that in the case where the supposed fungus has been seen, 
either fat globules have been mistaken for spores, or, if the 
appearances seen were really due to the presence of parasitic 
elements, the case must have been one of ringworm. In other 
words, that the authorities in question were not sufficiently 
good microscopists to distinguish the cells of a fungus from se- 
baceous matter, or sufficiently careful clinical observers to know 
tinea tonsurans from alopecia areata. Now when this style of 
argument is applied to such men as Bazin and Fox on the one 
hand, who have seen and figured the plant, and to Hardy, 
McCall Anderson and many others, who believe in its parasitic 
and contagious nature, its absurdity becomes apparent.* 
* Is it to be supposed that one who gives such precautions as the following would him- 
self fall into the errors he is warning against? “ The greatest care must be taken on 
every occasion to distinguish between fatty cells and spores. * * * * If we suspect 
the presence of much fat, it is advisable to allow the hair or other object to soak for some 
time in ether if any doubt exists as to the nature of any particles, cells or granules. The 
fat cells always exhibit a wide variation as regards size, and have a duller aspect; the 
cells of the fungus, on the other hand, are uniform in size in any particular case, refract 
the light very perfectly, and their outline is more defined and contoured; they are not af- 
fected by ether. In old standing cases of tinea, the epithelial cells take on a kind of fatty 
degeneration, and look very like cells invaded by sporules. When the mycelium is well 
developed no mistake can well arise, but there are one or two foreign matters and modifi- 
cations of normal structure that offer appearances similar in aspect to some of the less 
flourishing examples of mycelial threads. I have known the fibres from handkerchiefs or 26 
If we pull out the hairs bordering upon the bald patch in 
the early stages, we shall find scarcely any root present, the 
ends tapering to a slender point from atrophy. The spores or 
conidia, which occur both in the substance of the hairs and on 
their exterior, vary considerably in size, and the scanty myce- 
loid growth which accompanies them is very small. According 
to Fox the hairs contain also a large quantity of the minute 
stromal form of the plant which generally escapes detection, 
and from which the distinct sporular form may be artificially 
developed. 
To the list of those who have been fortunate enough to see 
the fungus in cases of Alopecia areata, I may add myself. In 
two young gentlemen, aged seventeen and twenty-four, com- 
panions, and presenting all the striking and unmistakable char- 
acteristics of the disease, all the parasitic elements were found 
to be abundantly present. The relationship existing between 
them, points to the support afforded to the questioned parasitic 
nature of the affection by its clinical history in general, as 
above stated. It is as fair to suppose the one case to have been 
taken from the other, as if they had both been cases of ordi- 
nary ringworm. The evidence in favor of its contagiousness 
as furnished by many dermatologists, is conclusive, although it 
is by no means eminently so. Compared with the other para- 
sitic affections in this respect, it should be ranked as follows in 
a descending scale: Tinea tonsurans, T. favosa, T. versicolor, 
T. decalvans. 
If then we accept as established the parasitic nature of the 
disease, how shall we on the other hand account for the oppo- 
site view held by German and other authorities, who fail to 
discover grounds for such belief, and at the same time not be 
open to the charge of tacitly accusing them also of incompe- 
towels which have been used to cleanse the object-glass to be recognized as mycelial fila- 
ments. Sometimes some of the fibres of the hair will be stripped off the shaft and curl 
back like mycelium. The safeguard is to get the mycelium free from surroundings, and 
then no error can arise. The imbrication of the epithelium is sometimes irregular, and 
the edges of the scales present exactly the appearance of mycelium running transversely 
through and across the shaft, of the hair, and it is really difficult to imagine that filaments 
are not present, more especially if there happen to be a few sporules scattered throughout 
the interior of the hair.” This extract is from Dr. Tilbury Fox’s recent work on Skin 
Diseases, and it is given here at length to show the errors to be avoided in the study of 
the parasitic affections, and that he at least may not be considered capable of the mistakes 
in question. tency ? Were there no other solution of such entire discrep- 
ancy in the views of equally competent observers, than which 
were most likely to be right or least likely to be wrong, it would 
still be easy to decide upon which side of the question to range 
ourselves, for in such cases the negative evidence of twenty 
good observers cannot be set against the weight of one good 
positive observation. But it is not necessary to resort to such 
an invidious method of solution. The evidence of both 
parties may be received with credence, and is consistent, when 
properly interpreted. There is a parasitic and a non-parasitic 
form of alopecia areata, just as there is a parasitic and a non- 
parasitic sycosis. In other words, the hair may fall in circum- 
scribed patches from the growth of a parasite in its tissues, and 
it may fall apparently in the same way from atrophy of the 
bulb due to other causes There may be hereafter material dif- 
ference observed in the clinical history of the two forms, possi- 
bly in their; gross appearances also, so that they may be 
distinguished the one from the other, without the aid of the 
microscope ; but at present this is impossible. When we recall 
the history of sycosis and of eczema marginatum, we need not 
fear that authority, however eminent, can prevent the elucida- 
tion of truth by any amount of dogmatic assertion. Such 
matters are to be settled by the quiet researches of a Kobner, 
not by international controversies. Positive and reliable evi- 
dence has demonstrated the existence of a parasitic alopecia. 
Negative evidence on the other hand has as fully shown that a 
large proportion of the cases so called are not of the parasitic 
form. It may be that the former is much more common in 
England and France than in Germany, just as parasitic sycosis 
is more prevalent in the former countries, and this may help 
explain the discrepancy in the views of the authorities in dif- 
ferent parts of Europe. Amongst ourselves, the parasitic form 
is, according to my own observations, rare, whereas cases of the 
disease collectively, are not very uncommon. That there are 
very marked differences in the course and appearances of the 
various cases that occur here, there can be no question ; their 
aetiological significance remains to be determined by future 
observation. 28 
MYRINGOMYCOSIS. 
This is a term applied to an affection of the ear, caused by 
the growth within the outer cavity of one or more species of a 
fungus. The symptoms, according to Wreden, from whose 
work on the subject the following account is mostly taken, are 
a more or less complete deafness, generally sudden in its onset, 
accompanied by ringing sounds and pulsation, with sensations 
of pain and pressure varying in intensity, in the ear affected. 
On washing out the organ with a jet of water, in such cases 
there comes away a flocculent sort of membrane or mass, vary- 
ing in color from white to dark brown, the microscopic appear- 
ances of which will be described below. With its removal 
disappear the pain, and temporarily the other symptoms more 
or less, to return as the fungus grows again. The tympanum 
will be found of a dark red color, swollen and deprived of its 
epithelium, and this hyperaemia and swelling of the parts, to- 
gether with the mechanical pressure exerted by the vegetable 
growth upon the tympanum, will account for the symptoms. 
Examined in the early stages the tympanum and parts adjoin- 
ing are found to be covered with a fine, white, powdery sub- 
stance (the leptothrix and mycelium stage), which cannot be 
washed away, and which soon develops into the thick and 
velvety mass of the perfect plant. The course of the disease 
may be acute or chronic. It may attain its fullest develop- 
ment in a few days, but left to itself or improperly treated, it 
may last months. After the removal of the mass by mechani- 
cal means, it may be completely renewed in a week. 
Examined by the microscope this mass, large enough perhaps 
to cover the nail of the little finger, will be found to present 
some elements with which we are already familiar, but others 
also which we have not yet met with in the examination of the 
parasitic fungi thus far considered. The mycelium, which is 
much larger than in the fungi found in the other parasitic af- 
fections of the skin, is colorless, divided by cross partitions into 
joints, and at its ends filled with granular matter. Branching 
off at right angles from these filaments or rootlets, are the hy- 
phens or stems, which bear at their summits the receptacles or 
fruit-heads. They are also transparent and colorless, more or 
less bulging, jointed and branched, and of considerably greater 
diameter than the mycelium from which they spring. At their upper and free extremities they dilate into oval or spherical 
heads, sporangia, from the top of which at first a few elongated, 
hairlike cells shoot out, which increase in number and length 
rapidly, and cover the whole surface in the form of a head, like 
the pappus or down of the dandelion when expanded. Finally, 
minute round cells are seen to be developed upon the ends of 
these slender filaments, or basides, which are pushed perpen- 
dicularly outwards in turn by the formation or budding of new 
spores beneath them, one after the other, until each little stem 
bears a chain of perhaps twenty spores united in this way, and 
the whole forms a head of spore-chains or conidia, composed of 
countless spores. The diameter of the largest receptacles va- 
ries from 0.024 to 0.03 Mm., and of the spores from 0.002 to 
0.003 Mm. The spores are round, and finally, when fully 
mature, fall off, either singly or in chains of various lengths, and 
form dense groups, more or less mixed with mycelium and the 
hyphens, and undergo farther development. In color they 
are yellowish brown or black, and this difference in shade, with 
a corresponding difference in the shape of the sporangia, has 
given rise to the opinion that the fungus, which the above char- 
acteristics show to be an aspergillus, presents two species, A. 
flavescens and A. nigricans, in the cases observed. Wreden, 
however, has shown by cultivation that both forms, although 
preserving their distinctly individual peculiarities when grow- 
ing in the ear, are only varieties of the common aspergillus 
glaucus, the spores of which may be found almost omnipresent, 
and that such variation in growth is due solely to the differences 
in the soil upon which they grow. 
That the fungus found in myringomycosis is the cause of the 
disease, that is, that it is not merely an accidental occurrence 
in certain morbid conditions of the ear, there can be no doubt, 
but whether the spores can take root within ail ear quite healthy 
at the time, is a matter of uncertainty. Wreden is inclined 
to the hypothesis that some diseased state of the epithelium of 
the tympanum is requisite for their permanent attachment and 
development. That aspergillus is one of our most common 
moulds, so that its spores are ever ready to enter the ears, and 
on the other hand that the disease they produce there is com- 
paratively rare, would seem to favor this view. With regard 
to the relations of aspergillus to penicillium, and the occur- 30 
rence of other fungi in the ear, it may be said in this connec- 
tion that Wreden has never detected the latter in the ear, nor 
has he been able to produce it from the former by cultivation, 
although Karsten and others believe in their botanical identity. 
Other forms of fungus growth have been occasionally found 
associated with aspergillus in the ear, but their presence is gen- 
erally looked upon as an accidental occurrence. 
As already stated various affections of the skin and its append- 
ages have at times been considered to be of a parasitic nature, 
which closer observation has shown to be erroneous, while in 
certain of them fungi have been from time to time discovered, 
their presence at such times being only accidental. Among the 
instances of parasitic growth more intimately connected with 
our subject than such, is the so-called Chignon-fungus. Some 
degree of alarm was not long ago created among ladies by stories 
of the occurrence of various sorts of parasitic growths upon the 
false hair so generally worn by them, and the writer has seen 
not a few cases of disease of the scalp supposed by the patients 
to have been “ caught ” from some impurity attached to the 
chignon worn. Such fears are groundless. There have been 
often observed little globular masses upon the shafts of the hairs 
before cleansing, and, in cases where such cleansing is not 
properly done, also upon the hairs after being manufactured 
into shapes for wear. These masses are composed of the 
elements of a fungus, which has received the name Pleurococcus 
Beigeli; Dr. Beigel being among the first to investigate their 
nature. Hallier considers it a sclerotium, another stage of 
penicillium, but this opinion, like many of those advanced by 
him, needs confirmation. There is no reason to suppose it 
capable of attaching itself to living tissue or of creating any 
disease of the parts with which it might be brought in contact. 
3. Pseudo-Parasites. 
The possibility of receiving animal parasites through the 
false hair worn, is a question of course foreign to our subject; 
but it may be added in this connection that the dried sebaceous 
concretions, which form at times upon the shafts of the hair, 
and are popularly called hair-eaters, and supposed to be a cause 
of loss of hair, are not to be confounded with anything of a 
parasitic nature. 4. Parasitic Plants upon Animals. 
Favus. 
But it is not upon man alone that the forms we have been 
considering grow; they are found likewise upon domestic 
animals, and may be communicated from the latter to persons 
brought in contact with them. I have before me, while I write, 
the body of a young mouse, one of a family of several caught in 
a seed store in this city, all of which presented similar appear- 
ances. Its head resembles a kernel of popped corn more than 
anything else, its form and features being concealed by an exuber- 
ant growth of dry, yellow matter. Examined by the microscope 
this is seen to be composed of fungus elements identical with 
those of the achorion schoenleinii found in favus of the human 
subject. Upon the mouse, too, well marked and characteristic 
favus-shaped crusts are to be detected. Such cases are occasionally 
met with. 'Cats catching mice marked in this way have ex- 
hibited well-formed favus crusts upon their paws, and have 
communicated the disease to their kittens. Dogs, too, that 
have caught mice similarly affected have had favus crusts de- 
veloped upon their fore-paws. In the same way the disease 
may extend from any of these domestic animals to man, cases 
of which are cited in abundance. Both mice and cats have 
repeatedly communicated favus to children playing with them, 
and St. Cyr in some recent experiments received it himself from 
a dog, to which animal he had transferred it from a cat. Arti- 
ficially it has been again and again cultivated upon rabbits with 
material from the human subject, and even upon the heads of 
hens it has been observed in two instances. Upon all these 
animals, either about the hairs or feathers, the unmistakable 
form of the favus crust was developed, preceded in the carefully 
watched cases of artificial inoculation by the herpetic or ring- 
worm-like earlier manifestations, precisely as on the skin of man. 
The presence of favus, therefore, upon such animals may be 
easily recognized, and by proper precautions its farther trans- 
mission may be prevented. As it occurs upon mice more com- 
monly than upon other animals, and upon such others mainly 
as come in contact with them, it is possible that they are to be 
regarded as the original or favorite host of this parasite, through 
which it has been introduced upon man. 32 
Tinea tonsurans. 
Bingworm, too, has been observed upon some of the domestic 
animals, presenting the same characteristic appearances, the 
circular patches with elevated and advancing borders, the 
scaly central portion, and the stumps of hair projecting from 
the parts long affected, as upon the skin of man ; and in the 
epidermal scales and the hairs removed from them precisely the 
same parasitic elements are detected by the microscope as in 
the various forms of ringworm upon man. The animals most 
commonly affected in this way are the cow and the horse, and 
Gerlach has succeeded in transplanting it from oxen to calves 
and horses, and from these to his own arm and to the skin of 
his pupils. In these, and in similar cases of inoculation con- 
ducted by other observers, the transfer of parasitic matter from 
the animal to man has in every instance given rise to true ring- 
worm. Upon the sheep and the pig the plant has not yet been 
made to grow. But artificial inoculation is by no means essen- 
tial to the communication of the disease from the animal to the 
human subject. Numerous cases are on 'record of cow-keepers 
and milkmaids taking it from their four-footed charge, of chil- 
dren from calves, and of grooms and cavalry soldiers from their 
horses. I have myself seen three children with well-marked 
ringworm of the hands and face taken from the family cat, 
which was similarly affected. Upon these animals it constitutes 
one of several affections called mange. 
Tinea versicolor. 
With regard to this affection no instance of its natural occur- 
rence upon animals, so far as I am aware, has been observed, 
although Kobner has succeeded in producing upon the rabbit 
by inoculation a well defined scaliness of the skin lasting from 
five to seven weeks, in which abundant conidia and slender 
fungoid threads were found. 
5. On the supposed identity of the Vegetable Parasites, and 
their relations to the Common Moulds. 
To those not familiar with the recent literature of this branch 
of dermatology it may seem surprising that very contradictory 
opinions prevail among authorities upon the subject with regard 
to the mutual relations of the vegetable parasites we have been 33 
considering. As we have described the various affections to 
which they give rise, it will have been observed that they differ 
from each other in external appearance manifestly, and that the 
fungus elements belonging to each have their individuality 
marked with equal distinctness when examined by the micro- 
scope. How then could the question of the possible identity of 
all these forms have arisen, and have become one of the most 
interesting subjects for the investigation of dermatologists and 
mycologists of the present day ? How can it be that such men 
as Hebra and Pick, Fox and Hutchinson, as examples, upon the 
one side, should believe that Favus, Ringworm, and Pityriasis 
versicolor are all forms of disease caused by one and the same 
fungus, exhibiting its variations in growth and external mani- 
festations according to its stage of development, soil, etc., while 
on the other hand Barensprung and Kobner, Anderson and all 
the French authorities, observers equally well known and 
trusted, should maintain as positive a belief in their non- 
identity ? The same difference of opinion exists among the 
mycologists who have investigated the subject from their special 
point of view. It is evident, therefore, that no absolutely posi- 
»tive answer can be given to this important question in our 
present state of knowledge. The data upon which any probable 
conclusion in the matter can be based must be the result of 
three methods of investigation: first, clinical observation; 
second, artificial inoculation ; third, study of the full develop- 
ment of the fungi in question by cultivation. 
First. It was clinical observation which first led Hebra to 
believe in the identity of the parasites found in favus and ring- 
worm. He noticed the occasional development of favus crusts 
in cases of ringworm, and the production of both, alone or in 
combination, upon parts to which poultices were applied. He 
concludes, therefore, that Tinea tonsurans is an earlier stage of 
Tinea favosa, while Tinea versicolor is a still younger phase of 
development of the same plant. 
With regard to the latter affection, it may as well be removed 
from our consideration of the question at once. No good clin- 
ical ground (the opinions of Hebra and Hutchinson to the con- 
trary, notwithstanding), and certainly no sufficient experi- 
mental data, have ever been presented to show its connection 
with either favus or ringworm. Clinically, Tinea versicolor 34 
must be considered a distinct affection, as heretofore by most 
dermatologists. Its mycological relations are yet to be dis- 
covered. 
The question turns, therefore, mainly upon the relationship 
of the two other affections. Fox believes that favus can be di- 
rectly produced from bad cases of ringworm by keeping up a 
proper amount of irritation. There can be no doubt of ihe 
occurrence at times of favus in cases of ringworm, also none of 
the occasional development of both affections (in Germany, at 
least,) upon portions of the skin covered with damp cloths or 
poultices. Such occurrences are rare, however, and by them- 
selves are of little weight in the question of identity, when we 
consider that in one hundred cases of chronic ringworm favus 
may not be developed a single time, and that favus may, and 
generally does, exist for years without any association with any 
of the varieties of true ringworm. The exceptional cases of 
the development of favus upon the latter may well be wholly 
coincidences, and should be fairly so considered when balanced 
against the clinical proofs of the non-identity of the two. In con- 
nection with the other class of cases, in which herpes tonsurans is 
said to be more or less frequently observed accompanying favus,* 
it must be remembered, as already stated, that the early stage 
of the latter very closely resembles ringworm, and has been 
called by Kobner, who has made the subject a special matter of 
investigation, the early herpetic stage (das herpetisches Yorsta 
dium). That such appearances are often mistaken for ring- 
worm, and have largely contributed to the belief in the frequent 
association or identity of the two affections, there can be little 
doubt. Peyritsch, in the most recent investigations upon the 
inoculation of favus, and St. Cyr, in his late experiments upon 
the transmissibility of the affection to animals, and from them 
to man, both speak of the occurrence of this ringworm-like 
stage of favus, and of its liability to be confounded with Tinea 
tonsurans. The latter says that both Rollet and Tripier recog- 
nized, in the appearances upon his own arm, produced by inoc- 
ulation from his dogs affected with favus, appearances which 
offered “ tons les caracteres d'un beV herpes circinS,” “ non un 
herpes circine legitime, mais bienune forme de la teigne faveuse 
veritable.” 
Peyritsch concludes, as the result of his experiments, that “ herpetic eruptions often occur as a vorstadium after inocula- 
tion with favus, but also not infrequently after the develop- 
ment of the cup-shaped crusts, and often not at all; that these 
appearances are the result of irritation, and are not identical 
with Herpes tonsurans circinatus.” Kobner recognizes and de- 
scribes in the external appearances characteristic differences by 
which the true ringworm and the herpetic stage of favus may 
be distinguished from each other, which need not be given here 
in detail, but another means of differential diagnosis is afforded 
by the microscope, by which the fungus elements present in the 
latter are shown to be those belonging to favus, the achorion 
and not trycophyton. Now, without attaching much signifi- 
cance to minute differences in the microscopic appearances of 
parasitic fungi, so far as this bears upon their botanical iden- 
tity, for clinical purposes they are of some degree of import- 
ance, and when these differences are constant and consistent 
only with the theory of the non-identity of these affections, their 
significance must not be disregarded. When, therefore, a case 
occurs in which favus and herpes tonsurans appear to be com- 
bined, and in which fungus elements apparently identical with 
those of the latter are found in the outlying circles, as in the 
case reported by Kolin in the 3d Heft of the Archiv fiir Perma- 
tologie of the present year, we cannot regard it in any other 
light than exceptional, and as an instance of the chance, coin- 
cident occurrence of the two distinct diseases. 
The clinical proofs of their non-identity, as shown by the his- 
tory of thousands of cases of pure tinea tonsurans without any 
development of favus in connection with them ; in the highly 
exceptional simultaneous or subsequent appearance of true 
ringworm in cases of favus ; the frequency of the former, the 
rarity of the latter, in communities, and the varying relations 
of their comparative frequency both in different countries and 
in cities and rural districts ; the prevalence of ringworm of the 
scalp for years continuously in orphan asylums without the pro- 
duction or transmission of any other parasitic affection than 
itself among the inmates ; the ease with which the one, the dif- 
ficulty with which the other, is communicated ; the spontane- 
ous transmissibility of both forms from man to the domestic 
animals and back again through several hosts to the human 
subject, their individual identity being without exception pre- 36 
served the meanwhile,—these and other facts, which might be 
mentioned, would seem to be conclusive. 
Second. The results of inoculation, as practised especially 
to determine this question, point almost without exception to 
the same conclusion. Favus, when transplanted from man to 
man, from man to domestic animals, or from animal to animal, 
produces always favus and nothing but favus, according to the 
experiments of Kobner, St. Cyr, and Peyritsch, above referred 
to, and the same unvarying preservation of individuality has 
been observed with tinea tonsurans. On the other hand, Pick 
believes that he has obtained indifferently both affections by in- 
oculation of the parasitic elements of either one. His results, 
therefore, are directly at variance with those of former observ- 
ers, and as they are of a positive character, while those of the 
others are merely negative, they might seem entitled to the 
greater weight in the question. When we consider, however, 
that all the other observers have obtained results seemingly 
pointing to the same conclusions, but which have been other- 
wise interpreted by them, we think that, in connection with the 
recognized fact of the herpetic stage of favus, Pick’s views may 
be fairly set aside until they are confirmed by other investiga- 
tions and by general clinical observation. 
Third. Another method of studying the question, and one 
which would seem to promise an easy and positive settlement, 
is that by cultivation. That none of the parasitic fungi we 
have been considering attain their normal and perfect forms 
under the conditions of their growth upon the skin, and that 
therefore their true botanical position is to be learned by ob- 
servation of them under circumstances better fitted for their 
complete development, is universally recognized. In accom- 
plishing this, however, it is evident that we should also settle 
definitely this question of their mutual relations, for if the 
fungus of Tinea tonsurans and of T. favosa are in reality iden- 
tical and so seemingly unlike in their microscopic appearances, 
external manifestations, and clinical history from differences in 
soil, in stage, or from any other of the various causes assigned 
to account for their apparent non-identity, it is evident that if 
removed from the skin to conditions favorable to their normal 
growth, we should have a return to their one common parent 
form, and thus have before us the long-sought solution of this 37 
mysterious question. This method of study has therefore been 
eagerly adopted within the last few years, but the results ob- 
tained unfortunately are far more contradictory, and unsatis- 
factory even, than those derived from clinical observation and 
from inoculation. The difficulty has not been in making the 
fungi taken from these cutaneous diseases to grow apparently 
when transferred to other soils, but to convert them always into 
the same fungi, when they have attained their perfect develop- 
ment. Not only do different observers obtain different results, 
but various results at different times. Thus by transplanting 
favus elements to various substances, such as glycerin, albu- 
men, milk-sugar, starch, paste, the surface of fresh fruits, etc., 
or to solutions of certain salts, matters upon which fungi are 
known to thrive, all sorts of moulds are obtained after a while, 
among which of most frequent occurrence are penicillium 
glaucum, mucor mucedo, aspergillus glaucus and torula. 
Hoffman obtained in this way penicillium and mucor, but 
looks upon the former as an accidental occurrence, and upon 
the latter as the real cause of favus, while other mycologists 
regard both as botanically identical. Hallier states that he has 
seen the parasite in favus develop into penicillium; Baumgar- 
ten also obtained penicillium from its cultivation ; and Lowe, 
aspergillus. Pick, too, has obtained from tinea favosa, penicil- 
lium. With regard to the fungus of herpes tonsurans in 
particular, Hallier at first looked upon the tricophyton as peni- 
cillium, but later makes it out to be aspergillus. Pick culti- 
vates it into penicillium, while Neumann sees it developed into 
penicillium and trichothecium. The fungus of pityriasis versi- 
color, too, Hallier finds no difficulty in tracing back to its parent 
stock, making it out to be stemphylium, the achorion form of 
aspergillus. With regard to the ear fungus, both forms,'the 
aspergillus flavescens and A. nigricans, have been seen by Wreden 
to return under cultivation to aspergillus glaucus, while Karsten, 
from his experiments, is inclined to the opinion that penicillium 
is the original source from which they spring. 
On the other hand, Kobner, Peyritsch, Karsten and de Barry, 
in their recent investigations in the same field, while finding no 
difficulty in obtaining penicillium and the like in their cultiva- 
tions of favus matter, regard its presence in their experiments as 38 
merely accidental. The elements of penicillium, aspergillus, 
etc., are omnipresent, awaiting only the proper conditions of 
soil, temperature and moisture for development, so that unless 
their germs are primarily excluded by the most rigorous meas- 
ures from the materials and atmosphere used in these experi- 
ments, their constant appearance under circumstances best 
adapted to their growth, is not surprising, though their absence 
would be. Now such exclusion has been found to be almost 
an impossibility in all the methods of experimental cultivation 
hitherto employed by different observers, but the greater the 
precautions used to keep them out, the less frequent their oc- 
currence. Thus Peyritsch in his experiments with the favus 
plant, generally got penicillium or mucor, but when he used 
extraordinary care no farther fungus development was observed. 
This, with the results of his other experiments, which have 
been, and remain to be mentioned, leads him to the conclusion 
that “ the specific individuality of achorion schoenleinii must, 
in our present state of knowledge, be preserved.” De Barry 
also concludes from his investigations that the plant in favus, 
as well as the other cutaneous fungi, are specific parasites. 
Kobner failed to produce any mature form from the favus plant. 
Karsten in his recent work (Chemismus der Pflanzenzelle), 
states his belief that the achorion from its resemblance to the 
milk fungus may be derived from some common fungus, but 
has been unable to obtain any advanced growth by which its 
connection with such could be established. Neumann, too, in 
his latest published observations (Zur Entwicklungsgeschichte 
des Achorion), withdraws his former statement, that he had 
traced the parentage of favus to penicillium, and as the result 
of more careful methods of cultivation, says that he has been 
unable to obtain the perfect development of the achorion, and 
that the data for determining its connection with any known 
fungus are still wanting. 
Still another method of gaining light upon this supposed con- 
nection between some of these common moulds and the vege- 
table parasitic growths of the skin has been tried. It is 
evident that if favus, and ringworm, and pityriasis versicolor 
were really caused by the attachment to, and subsequent 
growth upon, the skin of some of the elements of penicillium, 39 
aspergillus and the like, to which the fungi found in these 
affections are referred by some of the observers above mention- 
ed, it might be possible to produce these diseases de novo, by 
transplanting such common moulds to the human skin, and 
thus settle the matter. Attempts of this kind have frequently 
been made, and the results are as apparently conflicting as the 
evidence derived from the methods already considered. While 
Hallier asserts that he has produced true favus by transplant- 
ing penicillium to the skin, and Pick thinks that he has seen it 
give rise to the herpetic stage of favus, Peyritsch, and Kobner, 
and many other investigators have repeatedly tried to produce 
some parasitic affection by transplanting this and many of the 
most common moulds to the skin, but always without suc- 
cess ; although they have found no difficulty in producing the 
diseases we have been considering by the same methods of 
transferring parasitic matter directly from them to other sub- 
jects, as already described. 
If we accept as reliable the statements of those of the 
above observers who claim to have been thus exceptionally 
successful in these experiments, it must be only after due con- 
sideration of the possible fallacies attending them. The neces- 
sary application, for considerable periods, of bandages to pro- 
tect the parts experimented upon, for instance, is one of the 
conditions most apt of itself to favor the accidental develop- 
ment of the diseases in question. The irritation of the skin, 
provoked by the dressings or lesions made, or by the foreign 
matter placed in coijtact with it, might readily be mistaken for 
the early stages of ringworm or favus. There should be no 
mistake, however, in the results obtained. Let there be one 
trustworthy production of well-marked favus by the trans- 
ference, with necessary precautions, of any of the common 
moulds to the skin, and we should then have a piece of evi- 
dence about the character of which there could be no question, 
which could be preserved indefinitely for inspection, and which 
would go far to settle the matter in dispute. As it stands, how- 
ever, this method of investigation, taking the negative and the 
so-claimed positive results together at their worth, has furnished 
no unquestionable proof of a direct connection between the 
well-known moulds and any of the parasitic affections. Indeed, 38 
merely accidental. The elements of penicillium, aspergillus, 
etc., are omnipresent, awaiting only the proper conditions of 
soil, temperature and moisture for development, so that unless 
their germs are primarily excluded by the most rigorous meas- 
ures from the materials and atmosphere used in these experi- 
ments, their constant appearance under circumstances best 
adapted to their growth, is not surprising, though their absence 
would be. Now such exclusion has been found to be almost 
an impossibility in all the methods of experimental cultivation 
hitherto employed by different observers, but the greater the 
precautions used to keep them out, the less frequent their oc- 
currence. Thus Peyritsch in his experiments with the favus 
plant, generally got penicillium or mucor, but when he used 
extraordinary care no farther fungus development was observed. 
This, with the results of his other experiments, which have 
been, and remain to be mentioned, leads him to the conclusion 
that “ the specific individuality of achorion schoenleinii must, 
in our present state of knowledge, be preserved.” De Barry 
also concludes from his investigations that the plant in favus, 
as well as the other cutaneous fungi, are specific parasites. 
Kobner failed to produce any mature form from the favus plant. 
Karsten in his recent work (Chemismus der Pflanzenzelle), 
states his belief that the achorion from its resemblance to the 
milk fungus may be derived from some common fungus, but 
has been unable to obtain any advanced growth by which its 
connection with such could be established. Neumann, too, in 
his latest published observations (Zur Entwicklungsgeschichte 
des Achorion), withdraws his former statement, that he had 
traced the parentage of favus to penicillium, and as the result 
of more careful methods of cultivation, says that he has been 
unable to obtain the perfect development of the achorion, and 
that the data for determining its connection with any known 
fungus are still wanting. 
Still another method of gaining light upon this supposed con- 
nection between some of these common moulds and the vege- 
table parasitic growths of the skin has been tried. It is 
evident that if favus, and ringworm, and pityriasis versicolor 
were really caused by the attachment to, and subsequent 
growth upon, the skin of some of the elements of penicillium, 39 
aspergillus and the like, to which the fungi found in these 
affections are referred by some of the observers above mention- 
ed, it might be possible to produce these diseases de novo, by 
transplanting such common moulds to the human skin, and 
thus settle the matter. Attempts of this kind have frequently 
been made, and the results are as apparently conflicting as the 
evidence derived from the methods already considered. While 
Hallier asserts that he has produced true favus by transplant- 
ing penicillium to the skin, and Pick thinks that he has seen it 
give rise to the herpetic stage of favus, Peyritsch, and Kobner, 
and many other investigators have repeatedly tried to produce 
some parasitic affection by transplanting this and many of the 
most common moulds to the skin, but always without suc- 
cess ; although they have found no difficulty in producing the 
diseases we have been considering by the same methods of 
transferring parasitic matter directly from them to other sub- 
jects, as already described. 
If we accept as reliable the statements of those of the 
above observers who claim to have been thus exceptionally 
successful in these experiments, it must be only after due con- 
sideration of the possible fallacies attending them. The neces- 
sary application, for considerable periods, of bandages to pro- 
tect the parts experimented upon, for instance, is one of the 
conditions most apt of itself to favor the accidental develop- 
ment of the diseases in question. The irritation of the skin, 
provoked by the dressings or lesions made, or by the foreign 
matter placed in contact with it, might readily be mistaken for 
the early stages of ringworm or favus. There should be no 
mistake, however, in the results obtained. Let there be one 
trustworthy production of well-marked favus by the trans- 
ference, with necessary precautions, of any of the common 
moulds to the skin, and we should then have a piece of evi- 
dence about the character of which there could be no question, 
which could be preserved indefinitely for inspection, and which 
would go far to settle the matter in dispute. As it stands, how- 
ever, this method of investigation, taking the negative and the 
so-claimed positive results together at their worth, has furnished 
no unquestionable proof of a direct connection between the 
well-known moulds and any of the parasitic affections. Indeed, 40 
every day chance is offering to the success of such experiment 
the most favorable opportunity in the omnipresence of seed and 
abundance of cutaneous soil, harrowed and fertilized by nail 
and dirt, if these conditions be thought essential to the devel- 
opment of the former. In addition, every possible variation in 
the chemical and physical nature of the skin is offered in its 
multifarious changes in disease. That these diseases are not 
of this every-day production, is sufficient to show that the right 
seed is not at hand for development. That no peculiarity in 
the nature of the soil is requisite, the ease with which ring- 
worm is transferred from one skin to another, even in the 
healthiest state, is a sufficient demonstration. 
With regard to the identity, then, of the fungi found in these 
affections, we must still maintain their specific individuality, be- 
cause clinically they are distinct, notwithstanding the deceptive 
inferences drawn from accidental coincidences, and because 
neither the results of transplanting nor of artificial cultivation 
have been such as to counterbalance even the negative evidence 
drawn from the same sources. With regard to their identity 
with any of the common moulds, the evidence presented is still 
more questionable. 
Too much can scarcely be said in condemnation of the way 
in which experiments have been conducted by certain so-called 
observers to determine the supposed relations of moulds, not 
only to these affections, but to all sorts of internal and consti- 
tutional diseases. One might suppose, from the conclusions 
drawn by them from such investigations, that the cause of all 
diseases had been already determined. The most charitable 
opinion to express concerning much of what has been done or 
written in this country and in Europe, at least of such part of 
it as has claimed most positive results and the easy solution of 
some of the most mysterious questions concerning the causation 
of disease, is to call it boy’s play. Unscientific work and hasty 
conclusions of this sort serve only to throw discredit upon one 
of the most important fields of research open to the pathologist, 
and to turn aside the true student from labor in it. The whole 
study of mycology is as yet in its infancy, and a master-mind is 
needed to clear away the mist and error thrown around it by 
such dabblers. In its present state it is to be feared that it can 
do little to settle even the questions we have been considering, 41 
with reference to the affections universally acknowledged to be 
of a parasitic origin.* 
6. Precautions against Vegetable Parasites. 
Regarding, then, the vegetable parasites of the skin as spe- 
cifically distinct and without established relations to any of the 
well-known and common moulds, (as a due regard to*their 
clinical characteristics compels us in the present chaotic state 
of mycological knowledge respecting the mutual relations of 
the latter), what positive knowledge have we of their distribu- 
tion and occurrence, by which the danger of acquiring the 
diseases they occasion may be prevented ? That the minute 
elements of fungi may be conveyed by the atmosphere, their 
universal presence, as shown by the microscope upon a glass 
slide left for any time “ undusted,” and their unfailing develop- 
ment when suitable soil is provided, are sufficient proof. In the 
experiments conducted so extensively of late in connection with 
the question of spontaneous generation, and in those of arti- 
ficial cultivation above alluded to, it has been found almost im- 
possible to exclude such germs from the substances employed 
in them ; and in this lies the fallacy of most of the conclusions 
drawn from such investigations Pasteur found that the air ad- 
mitted to substances previously freed from such germs gave rise 
to new growths of the same in accordance with the nature of 
the surroundings. Thus, of the flasks deprived of air and 
opened at the foot of the Jura, at a remote distance from hu- 
man habitations, 12 out of 20 remained free from organisms 
subsequently ; at a height of 850 metres, 15 out of 20 remained 
free ; and at a height of 2,000 metres only 1 of 20 showed signs 
of their growth ; while of 13 opened at the inn only 3 failed 
* Those who are especially interested in the question of the relations of low organisms to 
disease, will find in the articles below mentioned criticisms upon the imperfect methods 
of investigation employed, and upon the hasty conclusions drawn therefrom, by some of 
the recent observers and writers in this field of inquiry. 
1. Ueber die pathogenetische Bedeutung der kleinsten Organismen bei Infections-krank- 
heiten. Yon Dr. August E. Vogl.—Archiv fur Dermatol, und Syph., 1870, p. 393. 
2. Les Vegetaux parasites et les nouvelles Recherches sur les Maladies virulentes et con- 
tagieuses. Par Lortet.—Annales de Dermatol, et de Syph. Duxieme Annee, p. 29. 
3. A Review of Dr. Salesbury’s Microscopic Examinations of Blood; and Vegetations 
found in Variola, Vaccina, and Typhoid Fever.—Boston Medical and Surgical Journal, 
18G8, Oct. 1. 
4. Der gegenwartige Standpunkt der Mycologie mit Riicksicht auf die Lehre von den 
Infections-krankheiten. Von Dr. Eduard Eidam. Berlin, 1871. 42 
to exhibit their development. These and similar experiments, 
repeated under varying conditions of locality, although they 
shed no light upon the occurrence or distribution of the par- 
ticular fungi we have been considering, so far as we know, do 
illustrate the universality of similar elements near the habita- 
tions of men, and the ease with which they must be conveyed 
from place to place. Knowing nothing, therefore, of the para- 
sitic fungi beyond that phase of their existence upon the skin 
of man and the domestic animals we have been considering, 
we must fall back upon the clinical history of each of these 
affections for our knowledge of the proper safeguard against 
them. 
Tinea favosa. 
We have already seen that this disease is observed much 
more frequently in the country than in the city, and among 
poor children than upon those who are kept clean. How in- 
frequent its occurrence is in comparison with other cutaneous 
diseases may be judged by the following data. In three succes- 
sive years out of some 10,000 affections of the skin in the Vi- 
enna clinic, only thirty-six cases were noticed. These were of 
course representatives of disease among the poorer classes. 
How much less frequently it occurs among the higher classes and 
a cleaner race, may be seen by examining Mr. Wilson’s “ statis- 
tics of cutaneous disease among the wealthier classes ” in Eng- 
land. In 10,000 consecutive cases it occurred but three times. 
My own experience in this vicinity shows similar results. In 
1,000 consecutive tabulated cases of skin disease among private 
patients, but a single case was seen ; whereas in the same num 
ber of cases among out-patients of the skin department of the 
Massachusetts General Hospital, representing a poorer class of 
persons, there were four cases of the disease. My own obser- 
vation teaches me that favus affects perfectly healthy skins be- 
longing to perfectly healthy bodies; that no predisposition or 
cutaneous idiosyncrasy is essential to its development; that a 
dirty or a wounded epidermis is favorable to the attachment of 
the achorion, but not absolutely requisite; that although by 
no means so contagious as some of the other parasitic affections, 
yet almost every case is connected with others in the same 
family or among the playmates of the patient first affected, in 
the course of its long history ; that nearly every case may be 43 
traced back to its source of infection ; that direct contact there- 
fore with parties affected, either human or animal, is generally 
the cause of the spread of favus ; and that without such com- 
munication there is little danger of acquiring it. 
The following cases will illustrate the contagious nature 
of the disease, and the long time which sometimes elapses 
between inoculation and the development of the character- 
istic appearances. A few years ago I saw a poor girl, fifteen 
years old, of a consumptive family, who had had the disease 
seven years. She had always kept her head well wrapped up, 
and washed the bandages herself. She subsequently died of 
consumption, without having pursued any proper course of 
treatment for the favus. Three years before I first saw her, her 
little cousin, eight years old, had put on her bonnet, while the 
disease was in a very active condition. About a month after- 
wards a little pimple was observed on the crown of her head, 
which disappeared for a week or two at a time after washing it, 
but always returned. It appeared white and scaly. One year 
after the death of her cousin, the child was brought to me with 
a well-marked and large mass of favus situated upon this spot. 
* * * Some time since I was called to see two strong and 
healthy children at ‘the western end nf the city, upon whose 
heads were well developed masses of favus. There were two 
other children in the family, and on examination the disease 
was«found also upon one of these. It had appeared succes- 
sively in all these cases. On going into the street I discovered 
a boy, a playmate of these children, with his head almost 
completely deprived of hair by a favus of long standing. From 
him the former had taken it. 
Tinea tonsurans. 
This, as already stated, is a much more contagious and there- 
fore a much more common affection than favus, and is relative- 
ly of more frequent occurrence in cities than in the country. 
The greater ease with which it may be transferred from one 
host to another is best seen in large asylums. A case of favus 
may be admitted, and months may pass without transference to 
another child with ordinary care, and when entirely uncared for 
but few other cases will appear; whereas, if a single child with 
ringworm be admitted, the disease will spread rapidly among 44 
the inmates, even before the original case may be detected. The 
same eminent contagiousness marks the spread of the affection in 
the community at large, and no age, no condition, no amount 
of cleanliness will prevent infection. In Mr. Wilson’s statis- 
tics of 10,000 cases of cutaneous disease among the wealthy, 
252 cases are noted, although in this number are not included 
cases of sycosis and eczema marginatum, which are varieties of 
the disease. Among the 1,000 cases of the same class in my 
own practice above quoted, eighty-one instances of all kinds 
are recorded, whereas in the other thousand from the out- 
patients of the Massachusetts General Hospital, only thirty- 
seven cases of all varieties occurred. It will be seen by these 
figures, first, how much more widely prevalent is herpes ton- 
surans than favus amongst all classes ; and second, how much 
more frequent in comparison with the latter is its occurrence 
among the wealthy and cleanly than among the poorer classes. 
I have several times been able to trace the transmission of 
the affection through the different members of several fami- 
lies in succession, all of whom were accustomed to the daily 
use of the bath, and the descendants of what was possibly a 
single spore at the time of its transference to the first case, 
may thus be kept in view for months’ and years, oftentimes 
upon successive hosts. The boy may bring home from school 
a ringworm of the face or hands, which may give rise to other 
ringworms upon any one or many members of the family, 
young and old, and from these may arise upon the former 
herpes tonsurans of the scalp, upon the latter sycosis or eczema 
marginatum. One of the most common starting-points of such 
occurrences in our community, however, is the barber’s shop. 
A large proportion of the cases above enumerated, and many 
more might be added, since recorded, were of such origin. The 
patients were young gentlemen, and the barber’s shops frequent- 
ed by them were the best in Boston. From this it follows that 
the habits of the former in point of cleanliness were unques- 
tionable, and the customs of the “ establishments ” such as are 
least likely to foster and communicate contagion. The danger 
of catching barber’s itch, so called, or other horror usually as- 
sociated with public shaving, is so universally and strongly 
prevalent among gentlemen, that extra precautions against such 
infection are generally taken by them. Such was the case in 45 
most of the instances here referred to. The patients had near- 
ly all had their own mug, soap, brushes and razors, yet with 
all these trusted safeguards, they had acquired the disease. 
It follows, therefore, that with all possible precautions on their 
part, gentlemen who are shaved in public places may there get 
simple ringworm or its later stage, sycosis. 
How this may happen is very easily explained. To these 
shops, (or saloons as they claim to be called,) in addition to the 
regular customers who are not shaved elsewhere, there resort 
an irregular set of residents, who are shaved sometimes in one 
place, sometimes in another, and also a large and ever changing 
multitude of travellers. It is evident that opportunity for the 
entrance to a shop of cases of so common an affection as ring- 
worm, or of one so chronic as sycosis, in all this shifting multi- 
tude, will not be wanting. Were there any doubt upon this 
point it would vanish with the statement of the fact that many 
of the patients here spoken of had continued to be shaved at the 
place where they took the disease after it was fully developed. 
The question is, how it may be communicated from one cus- 
tomer to another, both of whom have their own equipments, 
which we will accept as reserved for their individual use ? The 
operator uses not only the brush, but his hands also, in lather- 
ing a face thus affected. These are not always washed before 
they are applied to the face or apparatus of another; the razor 
is first stropped, without thorough cleansing perhaps, upon the 
common strop, even while the act of shaving is only half finished, 
it may be ; the towel used in wiping the face of the first 
goes not upon a few afterwards; the comb, used upon parts of 
the face not shaven but yet similarly affected, goes directly to 
the beard of the next comer. These are the channels of com- 
munication by which these parasitic cells, so small as to be in- 
visible, and incapable of destruction by the soap, water or washes 
used during the process of shaving, may gain passage from 
one face to another, even when all possible precautions are ob- 
served by the regular patrons ; when the common property and 
apparatus of the shop are employed, the danger of conveyance 
is of course largely increased. There are, however, other ways 
in which the disease may be transferred. The danger of infec- 
tion is not only for the person shaved; the operator himself 
may take the disease. I have treated in several instances ring- worm upon the hands and fingers of barbers. To how many of 
their customers may they in turn not have given it ? 
It will be seen, therefore, how important a part the barber’s 
shop may play in the maintenance and transmission of Tinea 
tonsurans. From it as a starting-point the disease is carried 
home and given to other member family, or even, ands of the 
not unfrequently, taken by young gentlemen into other fami- 
lies. There can be no doubt, too, that herpes tonsurans of the 
scalp may be conveyed from one boy’s head to another in a 
similar way by the hair-cutter; but this is a danger far less to 
be feared than that of the barber’s shop, for the affection of the 
scalp among cleanly children is comparatively rare, while that 
of the face in gentlemen who resort to the latter place, on the 
contrary, is by no means rare. 
The following, among many instances which might be cited, 
will illustrate the contagious and persistent character of some 
of the forms of Tinea tonsurans:— 
• In an asylum for orphans in this city, containing about two 
hundred inmates, ringworm of the scalp had been long preva- 
lent, and the affected children had been allowed to mingle at 
will with the others. The thirty thus affected were subse- 
quently kept in a separate portion of the building, entirely shut 
off from all communication with the other inmates, and sub- 
jected to treatment. The spread of the affection ceased, and 
no new cases occurred, except among the newly-received chil- 
dren who brought it with them, and who were at once placed 
in quarantine. It was hardly possible that so many heads could 
be properly attended to, and consequently the cure was pro- 
longed in some instances for more than a year, and in a few the 
affection reappeared after apparent recovery. Among the lat- 
ter class was one who was put out to service before the disease 
was completely eradicated, and upon whose head it returned 
after entering her new home. In this household were three 
children, all below the age of ten. Several months after her 
arrival, I was called to examine the heads of the two oldest, 
and found upon them well-marked herpes tonsurans. In sev- 
eral weeks the youngest also showed unmistakable signs of the 
same affection, although its progress was at once checked. In 
the course of a few months a little cousin from the country came 
to reside in the family, and in six weeks the disease had also 47 
communicated itself to him. In two of these cases, in addition 
to the affection of the scalp, there were well-marked ringworms 
upon the face and neck. In the asylum, from which the disease 
was brought, it should also be stated, in two of the nurses, 
who had long had charge of the cases there, the nails were greatly 
disorganized by the growth in their substance of the fungus. 
Some time ago I was consulted by a young lady, Miss X., 
who for fifteen months had been treated for ringworm upon the 
face and neck. The disease rapidly yielded to remedies where 
properly applied, but certain portions of the skin, difficult of 
access and hidden from view, were never quite thoroughly at- 
tended to, so that fresh growths of the plant were constantly 
springing up on the arms, neck, shoulders, and other parts, 
which might have been easily and permanently killed by thor- 
ough attention. * * * * A month after Miss X. was first 
seen by me, a lad, Master Y., five years old, who had been 
much with her at the sea-shore, exhibited a circular patch of 
herpes tonsurans upon the scalp some two inches in diameter, 
which soon yielded to treatment, and did not return. In the 
spring of the following year, the mother of Miss X. brought to 
me a younger daughter with a well-defined ringworm as large 
as a silver dollar upon the arm, which at once disappeared un- 
der treatment. * * * * Again, in October of the same 
year, I was called to see Miss Y., the sister of Master Y., just 
mentioned, and the intimate friend of Miss X., the original and 
constant patient, whom she had been lately visiting. In her 
case there were four distinct rings of the disease upon the left 
cheek, which were shortly destroyed by the remedies applied. 
* * * * Here, then, were three persons affected in succes- 
sion by the same patient, all of whom might likewise have 
served as centres for the spread of the disease had they not er- 
ceived prompt treatment. 
The following cases are briefly described in illustration of the 
dangers of public shaving, not only to the persons immediately 
exposed, but to those with whom they associate:— 
A year ago Mr. K. acquired a ringworm of the beard at a 
barber’s shop in a town near this city, which persisted for 
several months under the domestic remedies at first used. Dur- 
ing the past summer his sister consulted me for a ringworm of 
the face, contracted beyond question from her brother. 48 
Mr. G. consulted me last spring for sycosis of the beard of 
many months’ duration, the sequel of a ringworm of the face 
coming on after being shaved, contrary to his usual custom, at 
a barber’s shop. On learning the nature of the affection and 
its contagious character, he informed me that his wife and child 
were possibly affected by the same disease. I subsequently saw 
them, and found several well-marked ringworms on the face 
and arms of the former, and one large ring upon the face of her 
infant. 
Mr. F., after being shaved in Washington, in 1870, brought 
home a ringworm upon his face. In spite of the use of several 
domestic remedies, it lingered and continued to spread. He 
came to see me with his wife. At that time the disease was 
largely scattered through his beard, as well as upon the chin. 
His wife had acquired it also, and presented well-developed 
ringworms of the face. 
Mr. S. acquired a ringworm at a barber’s shop two years ago 
in an adjoining city, in which shop four other gentlemen whom 
I saw, and not a few others, also, according to their statement, 
were similarly infected. Mr. S. had not been affected but a few 
weeks, during which several new rings appeared, before the 
young lady to whom he was engaged to be married applied to 
me also for relief, having a well-defined ringworm upon her 
cheek. The possibility of contact with the face of Mr. S. was 
not denied. 
In these cases, sister, wife, child, and fiancee were secondarily 
infected by the barber’s shop. They represent a multitude of 
similar instances within my own experience, but will serve as 
well as many the purpose for which they are here introduced. 
Tinea tonsurans is to be guarded against, therefore, in the 
school, whenever a child in attendance is known to be affected 
by it in any form; in the barber’s shop, always; at home, when 
brought into it by any one member of the family ; and at times 
upon the skins of the domestic animals. 
Tinea versicolor. 
Pityriasis versicolor is less frequently brought to the notice of 
the dermatologist than herpes tonsurans, but its real prevalence 
cannot be estimated. In the first place, its nature keeps it from 
the light, and therefore out of sight; and secondly, it causes 49 
the patient comparatively little trouble, so that he seldom con- 
sults his physician until it has existed for a long time and 
spread over an extensive surface. It is, in fact, often first dis- 
covered by the latter when the patient’s person is inspected for 
other purposes, as already mentioned. In Mr. Wilson’s 10,000 
cases it occurred 131 times; in my own observation of private 
patients, 13 times in 1,000. Among hospital patients, 14 times 
in 1,000. The ratio it bears to other cutaneous diseases seems 
to be remarkably constant, therefore, in the two countries and 
among all classes of society, although these figures cannot be 
relied upon as to its absolute occurrence, as in the two former 
parasitic affections. It is contagious, but in a low degree, and 
its direct transference from one individual to another is seldom 
observed except among those living upon the closest terms of 
personal intimacy ; even under these conditions it often fails to 
be communicated. How else than in this way it originates 
upon a person, we have no means of knowing. 
With regard to the prevention of the parasitic form of Alo- 
pecia areata we have hardly a word to say, except that it is evi- 
dently a very rare affection, and therefore but little danger from 
it is to be feared. How freely it may be communicated, our 
insufficient data will not allow us to determine. An instance 
of its spread from a single child to some thirty inmates of an 
English school, and the fact that my own two cases occurred 
upon intimate companions, suggest that it may be readily 
transferred from one host to another. 
Tinea decalvans 
Myringomycosis. 
As to the prevalence of this disease our knowledge is scanty 
and of recent date. Dr. J. 0. Green, aurist of the city hos- 
pital, and Dr. C. J. Blake, of the Eye and Ear Infirmary, have 
kindly furnished me with the following information, by which 
it appears that it is by no means a common affection here. 
Dr. Green writes: “In 755 consecutive cases in private prac- 
tice, I have found only four cases of parasitic growth where the 
parasite seemed to me to cause any symptoms. These cases in- 
cluded two of so-called aspergillus glaucus, one of A. nigricans, 
and one of the simplest form, viz., round or oval single cells. In 50 
addition to these, in thirty-three microscopic examinations of 
various masses removed from ears, some in private practice and 
sotne at the hospital, I found in three undoubted vegetable 
growth, which I classified at the time as penicillium.” 
Dr. Blake says: “ I have had, I think, but five cases of my- 
ringomycosis, and of these four occurred in private practice.” 
Several of the other aural surgeons of the city, of whom I 
made similar inquiries, state that they have seen but one or two 
cases each. 
Our knowledge of means of preventing infection is likewise 
very scanty. Of Wreden’s ten cases, the fungus was found in 
both ears in four, and one case narrated by him seems highly 
suggestive. The affection in this patient was obstinate, and the 
relapses were unusually frequent. On examining his sleeping- 
chamber, the window near the head of his bed was found 
covered with the growth of aspergillus. 
There remains to be mentioned only a single rule applicable 
to the management of all these affections before professional 
advice is obtained. 
All articles of clothing which have been worn in contact with 
parts upon which the parasite grows should be purified by im- 
mersion in boiling water, or, where the nature of the material 
does not permit this, by baking. All bed-linen, bandages, 
brushes, combs, and towels, or other articles suspected of simi- 
lar contact, should be treated in the same way, and, of course, 
should be used by no other person until thus purified. The 
patient, if a child, should be kept by itself as far as possible, 
and those having charge of the case should thoroughly wash 
themselves after handling the parts affected. With such pre- 
cautions there is but little danger that the disease will be trans- 
ferred to others, and when proper treatment has been once put 
in operation such danger of infection is far less.