PRIMARY CUTANEOUS NORTH AMERICAN BLASTOMYCOSIS

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Abstract
DURING the half century following Gilchrist's delineation of North American blastomycosis as an entity in 1896, it became firmly established by many observers that the disease exists in two widely divergent forms. In one, the skin alone is apparently involved in a chronically progressive, ulcerative, granulomatous, and cicatrizing process, which usually persists over many years without affecting the general health of the patient. In the other, the lungs are the primary focus, from which the disease as a rule soon becomes widely disseminated, usually causing death. Rarely has a combination of these two forms, or a transition from one to the other, been observed. It has been widely accepted that this sharp differentiation occurs because of variation in the portal of entry of the infection, direct inoculation of the organisms into the skin causing the chronic cutaneous type, and inhalation into the lungs resulting in the

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