Page:Tropical Diseases.djvu/948

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890
DISEASES OF THE SKIN
[CHAP.

of finding fructification in one of his attempts at culture, pronounces the fungus to be a lepidophyton and not a trichophyton. Castellani has succeeded in cultivating the true parasite; this he has proved by the reproduction of the characteristic skin lesions by inoculation of his cultures. He considers that in tinea imbricata we have to deal with at least two distinct species, which he has named Endermophyton concentricum and E. indicum. Castellani obtained cultures by immersing imbricata scales in alcohol for five to ten minutes and then placing them in tubes of glucose broth— one scale in each tube. Usually most of the tubes become contaminated with bacteria, but a few remain clear; in the latter, in five to ten days, fine white threads may be seen spreading from the scales. In three to four weeks, if portions of this are transferred to solid agar media, characteristic cultures can be obtained, and are inoculable into the human subject.

Diagnosis.— From ordinary ringworm tinea imbricata is easily distinguished by the absence of marked inflammation or congestion of the rings, by the abundance of the fungus, by the large size of the scales, by the concentric arrangement of the many rings or systems of rings, by the non-implication of the hair, and, according to Baker, by the avoidance of crutch and axillæ. From ichthyosis it is distinguished by the concentric arrangement of the scaling, by the peripheral attachment of the scales, and by the presence of abundant fungus elements.

Treatment.— The best treatment for tinea imbricata in natives is the free application of strong linimentum iodi. Limited patches might be treated with chrysophanic acid ointment (20 gr. to the ounce) or by rubbing with the bruised leaves of Cassia alata. Paranhos and Leme recommend a tepid alkaline bath of sodium bicarbonate (1 kilogramme to 20 litres of water), followed by the application of ocalia perdiceps 50 grm., glacial acetic acid 15 grm., macerated for two days in glycerinated water (10 per cent.) 985 grm., and then filtered. Sulphur ointment, or