This is a peculiar disease, from a geographic standpoint. Its home so far seems to be confined to America, and only in a few localities, largely in the Mississippi valley, if we also include the city of Chicago. The forms on the Pacific coast seem to differ from those found in other localities in the United States and are named protozoic and coccidioidal. In cases of protozoan infection the organism develops by endogenous spore formation and not by budding, while in blastomycosis the only way of development in the tissue is by budding. The cultures also differ somewhat from those obtained in blastomycosis. The first case reported from Boston was in the latter part of 1906. There were no recognized cases in England up to 1903; a doubtful one was reported from Madrid the same year. I have seen three cases in the past eight years, one of them somewhat