Remarks ON A CASE OF SPOROTRICHOSIS
Authors: N. Walker, J. Ritchie
Journal: BMJ (1911)

asliing me to admit to rny ward a patient-stsffering from peculiar ulcerative growtlhs on the arm, wlho was steadily getting worse in spite of assiduous treatmeent.The patient wXi-s admitted on January 14th, and the cast, wlhich is reprodu-ed in the colotured plate, was taken two days later by my secretary, Miss Rae.With the exception of an unbroken lesion just above tlhe elbow, tile cast slhows the whlole extent of the disease.Rtobert B., aged 46, a strong, healtlhy man, married, seven healthy children, is a native of the Isle of Man, and ilis father an(d motlier are botli hale and hearty at the age of "about " 83.HIe worlis eight hours a day in the open air, and his work qconsists in mixing iron ore with lime and coke, filling the mix- ture into barrows, and wheeling these to a lift which raises them and tips the contents into the furnaces.On August 3rd last, when working on night duty, instead of shovelling the ore as usual, he was packing his barrow, by hand, with large pieces of ore, and accidenltally bruised the knuckle of his right forefinger with a piece of.limestone.He took no notice of the trifling bruise until three or four days later, when it commenced to fester.He applied domestic remedies, including soap and sugar, but no improvement resulted, and about a fortnight later a number of little pimples appeared on his forearm.These did not interfere with his working capacity, and it was only their persistence and steady increase in size which sent him, ten weeks after the injury, to cznsult Dr. McKerrow.Dr. McKerrow painted the spots with iodine and ordered him to stop work.The spots seemed to ' go back," and he resumed work a week later.But with the resumption of work the spots again began to enlarge, and pou1ltices were ordered.Several of the lesions were incised and (dressed with lint; to others ointment was applied.But no treatment seemed to do any good.The lesions simply stood still; they got neither better nor worse.During the three weeks prior to his admission to hospital the lesions did, if anything, somewhat diminish.Although I had never seen a case-this is, indeed, the first reported in this country-the appearances so closely resembled those shown in a plhotograplh in Stellwagon's latest edition, that I at once suspected that we had to do with a case of sporotrichosis.One of the lesions-tlhe only one not shown in the plate had not broken down, and from it cultures and inoculations were made, which are described later by Dr. Ritchie.It suffices lhere to state that they confirmed the suspicion.The credit of first recognizing this disease belongs to Dr. Schenk, who published in the Johns Hopkins Bulletin of December, 1898,' a paper on " Refractory Subcutaneous Abscesses caused by a Fungus probably related to the Sporotricha."The case was that of a male who, on November 30th, 1896, presented bimself at the Surgical, Clinic ,of the Johns Hopkins Hospital with an infection of an unusual nature of the right hand and arm.The disease first showed on the index tinger, extended up the radial side of the arm, and gave rise to several circumscribed indurations.Three months pre- viously the patient had scratched his finger with a nail while reaching into a red lead keg.The lesions were treated with antiseptic solutions, but were very refractory to treatment.On examination there was evidence of extensive tuberculosis of tthe lungs and there were bacilli in the sputum.The fungus was cultivated from the pus.Another ease was published by Hektoen and Perkins in the Journal of Exp)erimental Medicine, 1900 (page 77).aA boy of 5 suffered from a sore on thaleft index finger, where he liad struck himself with a hammer.The injury did not heal up, anid, as in Schenk's case, a chain of nodules developed up the line of the lymphatics.The pus from the lesions was of a malogany colour, thick and tenacious.