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Clinical Mycology 1st Edition William E. Dismukes Digital
Instant Download
Author(s): William E. Dismukes, Peter G. Pappas, Jack D. Sobel
ISBN(s): 9781423745808, 1423745809
Edition: 1
File Details: PDF, 5.21 MB
Year: 2003
Language: english
Clinical Mycology
This page intentionally left blank
 CLINICAL
MYCOLOGY

Edited by

WILLIAM E. DISMUKES, M.D.

PETER G. PAPPAS, M.D.
JACK D. SOBEL, M.D.

1
2003
 1
Oxford New York
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Copyright © 2003 by Oxford University Press, Inc.

Published by Oxford University Press, Inc.
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Oxford is a registered trademark of Oxford University Press

All rights reserved. No part of this publication may be reproduced,

stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of Oxford University Press.

Materials appearing in this book prepared by individuals as part of their official duties
as United States government employees are not covered by the above-mentioned copyright,
and any view expressed therein do not necessarily represent
the views of the United States government. Such individuals’ participation in
the Work is not meant to serve as an official endorsement of
any statement to the extent that such statement may
conflict with any official position of the United States government.

Library of Congress Cataloging-in-Publication Data

Clinical mycology / edited by William E. Dismukes, Peter G. Pappas, Jack D. Sobel.
p. ; cm. Includes bibliographical references and index.ISBN 0-19-514809-6 (cloth)
1. Medical mycology.
I. Dismukes, William E. II. Pappas, Peter G. III. Sobel, Jack D.
[DNLM: 1. Mycoses—etiology.
2. Antifungal Agents.
WC 450 C6411 2003] QR245.C566 2003
616
015—dc21 2002193100

2 4 6 8 9 7 5 3 1
Printed in the United States of America
on acid-free paper
 Preface

Systemic fungal infections (systemic mycoses) have pro- distinctive sections. The Introduction (Section I) provides
gressively emerged over the past 50 years as causes of an overview of laboratory aspects of medical mycology,
human disease in normal hosts and, more importantly, which are pertinent to all fungi. Similarly, an overview
in the ever expanding population of immunocompro- of the epidemiology of systemic fungal diseases addresses
mised hosts. Over this same period of time, much has the complex interactions of the many host and environ-
been learned about the causative fungal organisms, in- mental factors that predispose to systemic mycoses.
cluding their molecular biology and ecologic niches. Systemic Antifungal Drugs (II), which is the largest
Moreover, we now have a clearer understanding of the section in the book and contains 8 chapters, addresses
epidemiology, pathogenesis, and the broad array of both classes of drugs and specific old and new agents
clinical syndromes associated with the various systemic in each class. Drug structure, mechanisms of action,
mycoses. Most importantly for our patients, major ad- pharmacologic features, drug–drug interactions, ad-
vances have been achieved in the area of antifungal verse events, clinical indications, and major clinical tri-
therapy, namely, development of new classes of drugs als are discussed in detail. In addition, two special
with unique fungal targets, (e.g., echinocandins), and chapters provide extensive and valuable reviews of im-
modifications of existing classes of drugs to enhance portant and rapidly evolving areas, namely, resistance
spectrum of activity and improve the therapeutic: toxic to antifungal drugs and adjunctive therapy.
ratio (e.g., azoles and polyenes). In addition to the The five sections that follow are organized into the
availability of several new drugs, many Phase III and mycotic diseases caused by various type of fungi:
Phase IV clinical trials over the past 25 years have Yeasts(III), Moulds(IV), Dimorphic Fungi(V), Skin and
taught us how to use these drugs appropriately to Subcutaneous Pathogens(VI), and other mycoses (VII).
provide more creative and effective management ap- Within these sections, each chapter on a specific fungal
proaches for prophylaxis, empirical therapy, induction disease consists of comprehensive discussions of perti-
and consolidation therapy, and chronic suppressive nent topics including organism, epidemiology, patho-
(maintenance) therapy of systemic fungal diseases. The genesis, clinical syndromes, diagnosis and management.
editors feel there is a need for a comprehensive and up- The final section—Special Patient Populations (VIII)—
to-date textbook that not only addresses the many ad- addresses those groups at high risk for opportunistic fun-
vances alluded to above, but also provides detailed in- gal diseases including neutropenic patients, hematopoi-
formation about the current status of diagnosis and etic stem cell and bone marrow as well as solid organ
treatment. We believe our book fills this need. transplant recipients, and patients with HIV/AIDS.
The 32 chapters are written by many of the leading The editors express their deep gratitude to the many
authorities in the field of clinical mycology. These au- authors for their scholarly contributions to this book,
thors, who are distinguished clinicians as well as inves- to Lee Hoke and Windell Ross, our assistants, as well
tigators, both basic and translational, have performed as the staff at Oxford University Press for their in-
many of the key studies that have transformed our un- valuable support in the preparation of this work, and
derstanding and management of fungal diseases. The to our wives, Pidgie, Alexis, and Audrey, for their con-
book also contains numerous color and black-and-white tinued encouragement and enduring patience. Without
photos and illustrations, plus tables and algorithms, these individuals, the existence and timely completion
which help to convey essential information quickly and of this book would not have been possible.
easily. In addition, the references cited in each chapter
represent the latest and most significant publications on Birmingham, Alabama W.E.D.
each disease, drug, or management strategy. Birmingham, Alabama P.G.P.
To facilitate its use, the book is organized into eight Detroit, Michigan J.D.S.

v
This page intentionally left blank
 Contents

Contributors, xi

PART I INTRODUCTION, 1
1. Laboratory Aspects of Medical Mycology, 3
Mary E. Brandt and David W. Warnock
2. Epidemiology of Systemic Fungal Diseases: Overview, 23
Rana A. Hajjeh and David W. Warnock

PART II SYSTEMIC ANTIFUNGAL DRUGS, 31

3. Amphotericin B, 33
Stanley W. Chapman, John D. Cleary, and P. David Rogers
4. Liposomal Nystatin, 49
Richard J. Hamill
5. Flucytosine, 59
Robert A. Larsen
6. Azole Antifungal Drugs, 64
Jackson Como and William E. Dismukes
7. Cell Wall Synthesis Inhibitors: Echinocandins and Nikkomycins, 88
Andreas H. Groll and Thomas J. Walsh
8. Terbinafine, 104
Peter G. Pappas
9. Resistance to Antifungal Drugs, 111
Dominique Sanglard
10. Adjunctive Antifungal Therapy, 125
Emmanuel Roilides, John Dotis, Joanna Filioti, and Elias Anaissie

PART III MYCOSES CAUSED BY YEASTS, 141

11. Candidiasis, 143
Jose A. Vazquez and Jack D. Sobel
12. Cryptococcosis, 188
John W. Baddley and William E. Dismukes
13. Rhodotorula, Malassezia, Trichosporon, and Other Yeast-Like Fungi, 206
Jose A. Vazquez

vii
 viii CONTENTS

PART IV MYCOSES CAUSED BY MOULDS, 219

14. Aspergillosis, 221
Thomas F. Patterson
15. Zygomycoses, 241
Ashraf S. Ibrahim, John E. Edwards Jr., and Scott G. Filler
16. Hyalohyphomycoses (other than Aspergillosis and Penicilliosis), 252
Harrys A. Torres and Dimitrios P. Kontoyiannis
17. Phaeohyphomycoses, 271
John R. Perfect, Wiley A. Schell, and Gary M. Cox

PART V MYCOSES CAUSED BY DIMORPHIC FUNGI, 283

18. Histoplasmosis, 285
Carol A. Kauffman
19. Blastomycosis, 299
Robert W. Bradsher
20. Coccidioidomycosis, 311
Neil M. Ampel
21. Paracoccidioidomycosis, 328
Angela Restrepo-Moreno
22. Sporotrichosis, 346
Peter G. Pappas
23. Penicilliosis, 355
Kenrad E. Nelson and Thira Sirisanthana

PART VI MYCOLOGY INVOLVING SKIN AND SUBCUTANEOUS TISSUES, 365

24. Superficial Cutaneous Fungal Infections, 367
Jeff Weeks, Stephen A. Moser, and Boni E. Elewski
25. Eumycetoma, 390
Beatriz Bustamante and Pablo E. Campos
26. Chromoblastomycosis, 399
John W. Baddley and William E. Dismukes

PART VII OTHER MYCOSES, 405

27. Pneumocystosis, 407
Catherine F. Decker and Henry Masur
28. Miscellaneous Fungi, 420
John W. Baddley and William E. Dismukes

PART VIII SPECIAL PATIENT POPULATIONS, 425

29. Fungal Infections in Neutropenic Patients, 427
Juan C. Gea-Banacloche, Andreas H. Groll, and Thomas J. Walsh
30. Fungal Infections in Blood or Marrow Transplant Recipients, 456
Kieren A. Marr
 Contents ix

31. Fungal Infections in Solid Organ Transplant Recipients, 470

Peter G. Pappas
32. Fungal Infections among Patients with AIDS, 488
Bertrand Dupont, Peter G. Pappas, and William E. Dismukes
Index, 503
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 Contributors

NEIL M. AMPEL, MD STANLEY W. CHAPMAN, MD

Professor of Medicine Director, Division of Infectious Diseases
Division of Infectious Diseases Professor of Medicine
University of Arizona School of Medicine and Veterans Department of Medicine and Department of Microbiology
Affairs Medical Center University of Mississippi Medical Center and Department
Tucson, AZ of Veterans Affairs Medical Center
Jackson, MS
ELIAS ANAISSIE, MD
Professor of Medicine, Director, Supportive Care JOHN D. CLEARY, PHARMD
Myeloma Institute for Research and Treatment Professor and Vice-Chairman for Research
The Arkansas Cancer Research Center School of Pharmacy
University of Arkansas for Medical Sciences University of Mississippi Medical Center
Little Rock AR Jackson, MS
JOHN W. BADDLEY, MD JACKSON COMO, PHARMD
Assistant Professor, Division of Infectious Diseases
Director, Drug Information
Department of Medicine
Department of Pharmacy
University of Alabama School of Medicine at Birmingham
University of Alabama Hospital
Birmingham, AL
University of Alabama Medical Center
ROBERT W. BRADSHER, MD Birmingham, AL
Richard Ebert Professor of Medicine
Vice Chairman, Department of Medicine GARY M. COX, MD
Director, Division of Infectious Diseases Assistant Professor of Medicine
University of Arkansas for Medical Sciences Division of Infectious Diseases
Central Arkansas Veterans Healthcare System Duke University Medical Center
Little Rock, AR Durham, NC

MARY E. BRANDT, PHD CATHERINE F. DECKER, MD

Research Microbiologist, Mycotic Diseases Branch Division of Infectious Diseases
National Center for Infectious Diseases National Naval Medical Center
Centers for Disease Control and Prevention Bethesda, MD
Atlanta, GA
WILLIAM E. DISMUKES, MD
BEATRIZ BUSTAMANTE, MD Professor and Vice-Chairman
Chief of Mycology Laboratory and Associate Researcher Department of Medicine
Institute of Tropical Medicine “Alexander von Humboldt” Director, Division of Infectious Diseases
Peruana Cayetano Heredia University University of Alabama School of Medicine at Birmingham
Lima, Peru Birmingham, AL

PABLO E. CAMPOS, MD, MPH JOHN DOTIS, MD

Associate Professor Research Fellow
School of Public Health 3rd Department of Pediatrics
Institute of Tropical Medicine “Alexander von Humboldt” Hippokration Hospital
Peruana Cayetano Heredia University Aristotle University
Lima, Peru Thessaloniki, Greece

xi
 xii CONTRIBUTORS

BERTRAND DUPONT, MD ASHRAF S. IBRAHIM, PHD

Professor of Infectious Diseases Assistant Professor
University of Paris V, Hospital Necker UCLA School of Medicine
Paris, France Los Angeles, CA

JOHN E. EDWARDS, JR. CAROL A. KAUFFMAN, MD

Director, Division of Infectious Diseases Chief, Infectious Diseases Division
Professor of Medicine Veterans Affairs Ann Arbor Healthcare System
UCLA School of Medicine Professor of Internal Medicine
Harbor-UCLA Research and Education Institute University of Michigan Medical School
Harbor-UCLA Medical Center Ann Arbor, MI
Torrance, CA

BONI E. ELEWSKI, MD DIMITRIOS P. KONTOYIANNIS, MD

Professor of Dermatology Associate Professor
Department of Dermatology Director of Clinical Mycology
University of Alabama School of Medicine at Birmingham The University of Texas M.D. Anderson Cancer Center
Birmingham, AL Department of Infectious Diseases, Infection Control and
Employee Health
SCOTT G. FILLER, MD Adjunct Associate Professor University of Houston College
Associate Professor of Medicine of Pharmacy
UCLA School of Medicine Houston, TX
Division of Infectious Diseases
Harbor UCLA Medical Center ROBERT A. LARSEN, MD
Torrance, CA Associate Professor of Medicine
Division of Infectious Diseases
JOANNA FILIOTI, MD University of Southern California School of Medicine
Research Fellow Los Angeles, CA
3rd Department of Pediatrics
Hippokration Hospital
KIEREN A. MARR, MD
Aristotle University
Assistant Member
Thessaloniki, Greece
Program in Infectious Diseases
Fred Hutchinson Cancer Research Center
JUAN C. GEA-BANACLOCHE, MD Seattle, WA
Experimental Transplantation and Immunology Branch
National Cancer Institute
National Institutes of Health HENRY MASUR, MD
Bethseda, MD Chief, Critical Care Medicine Department
Warren Magnuson Clinical Center
ANDREAS H. GROLL, MD National Institutes of Health
Infectious Disease Research Program Bethesda, MD
Center for Bone Marrow Transplantation and
Department of Pediatric Hematology/Oncology STEPHEN A. MOSER, PHD
Wilhelms University Medical Center Associate Professor of Pathology and Microbiology
Muenster, Germany University of Alabama School of Medicine at Birmingham
Birmingham, AL
RANA A. HAJJEH, MD
Chief, Epidemiology Unit
KENRAD E. NELSON, MD
Mycotic Diseases Branch
Professor, Department of Epidemiology
Centers for Disease Control and Prevention
Bloomberg School of Public Health
Atlanta, GA
Johns Hopkins University
Baltimore, MD
RICHARD J. HAMILL, MD
Professor, Departments of Medicine and Molecular
Virology and Microbiology PETER G. PAPPAS, MD
Baylor College of Medicine Professor of Medicine
Staff Physician, Infectious Diseases Section Division of Infectious Diseases
Veterans Affairs Medical Center University of Alabama School of Medicine at Birmingham
Houston, TX Birmingham, AL
 Contributors xiii

THOMAS F. PATTERSON, MD THIRA SIRISANTHANA, MD

Professor of Medicine Professor of Medicine
Division of Infectious Diseases Research Institute for Health Sciences
University of Texas Health Sciences Center Chiang Mai University
San Antonio, TX Chiang Mai, Thailand

JOHN R. PERFECT, MD JACK D. SOBEL, MD

Director, Duke University Mycology Research Unit Professor of Internal Medicine
Professor of Medicine Director, Division of Infectious Diseases
Duke University Medical Center Wayne State University School of Medicine
Durham, NC Detroit, MI

ANGELA RESTREPO-MORENO, PHD HARRYS A. TORRES, MD

Senior Researcher, Corporación para Investigaciones Post Doctoral Research Fellow
Biológicas The University of Texas M.D. Anderson Cancer Center
Medellin, Colombia Department of Infectious Diseases, Infection Control and
Employee Health
Houston, TX
P. DAVID ROGERS, PHARMD, PHD
Assistant Professor of Pharmacy
Pharmaceutical Sciences and Pediatrics
JOSE A. VAZQUEZ, MD
Associate Professor of Medicine
Colleges of Pharmacy and Medicine
Division of Infectious Diseases
University of Tennessee Health Sciences Center
Wayne State University School of Medicine
Memphis, TN
Detroit, MI

EMMANUEL ROILIDES, MD, PHD THOMAS J. WALSH, MD

Assistant Professor Chief, Immunocompromised Host Section
3rd Department of Pediatrics Pediatric Oncology Branch
Hippokration Hospital National Cancer Institute
Aristotle University National Institutes of Health
Thessaloniki, Greece Bethesda, MD

DOMINIQUE SANGLARD, PD, MER DAVID W. WARNOCK, PHD, FRC, PATH

Institute of Microbiology Chief, Mycotic Diseases Branch
University Hospital Lausanne National Center for Infectious Diseases
Lausanne, Switzerland Centers for Disease Control and Prevention
Atlanta, GA
WILEY A. SCHELL, MS
Associate in Research JEFF WEEKS, MD
Department of Medicine Resident in Dermatology
Division of Infectious Diseases Department of Dermatology
Duke University Medical Center University of Alabama School of Medicine at Birmingham
Durham, NC Birmingham, AL
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 I

INTRODUCTION
This page intentionally left blank
 1

Laboratory aspects of medical mycology

MARY E. BRANDT AND DAVID W. WARNOCK

Over the course of time, more than 100,000 species of and increases in length as a result of apical growth. In
fungi have been recognized and described. However, the more primitive fungi, the hyphae remain aseptate
fewer than 500 of these species have been associated (without cross-walls). In the more advanced groups,
with human disease, and no more than 100 are capa- however, the hyphae are septate, with more or less fre-
ble of causing infection in otherwise normal individu- quent cross-walls. Fungi that exist in the form of mi-
als. The remainder are only able to produce disease in croscopic multicellular mycelium are often called
hosts that are debilitated or immunocompromised. moulds.
Many fungi that exist in the form of independent sin-
gle cells propagate by budding out similar cells from
WHAT ARE FUNGI?
their surface. The bud may become detached from the
Fungi are not plants. Fungi form a separate group of parent cell, or it may remain attached and itself pro-
higher organisms, distinct from both plants and ani- duce another bud. In this way, a chain of cells may be
mals, which differ from other groups of organisms in produced. Fungi that do not produce hyphae, but just
several major respects. First, fungal cells are encased consist of a loose arrangement of budding cells are
within a rigid cell wall, mostly composed of chitin and called yeasts. Under certain conditions, continued elon-
glucan. These features contrast with animals, which gation of the parent cell before it buds results in a chain
have no cell walls, and plants, which have cellulose as of elongated cells, termed a pseudohypha.
the major cell wall component. Fourth, fungi reproduce by means of microscopic
Second, fungi are heterotrophic. This means that they propagules called spores. Many fungi produce spores
are lacking in chlorophyll and cannot make their or- that result from an asexual process. Except for the oc-
ganic food as plants can, through photosynthesis. Fungi casional mutation, these spores are identical to the par-
live embedded in a food source or medium, and obtain ent. Asexual spores are generally short-lived propag-
their nourishment by secreting enzymes for external di- ules that are produced in enormous numbers to ensure
gestion and by absorbing the nutrients that are released dispersion to new habitats. Many fungi are also ca-
from the medium. The recognition that fungi possess a pable of sexual reproduction. Some species are ho-
fundamentally different form of nutrition was one of mothallic and able to form sexual structures within in-
the characteristics that led to their being placed in a dividual colonies. Most, however, are heterothallic and
separate kingdom. do not form their sexual structures unless two differ-
Third, fungi are simpler in structure than plants or ent mating strains come into contact. Meiosis then leads
animals. There is no division of cells into organs or tis- to the production of the sexual spores. In some species
sues. The basic structural unit of fungi is either a chain the sexual spores are borne singly on specialized gen-
of tubular, filament-like cells, termed a hypha or hy- erative cells and the whole structure is microscopic in
phae (plural) or an independent single cell. Fungal cell size. In other cases, however, the spores are produced
differentiation is no less sophisticated than is found in in millions in “fruiting bodies” such as mushrooms and
plants or animals, but it is different. Many fungal puffballs. In current mycological parlance, the sexual
pathogens of humans and animals change their growth stage of a fungus is known as the teleomorph, and the
form during the process of tissue invasion. These di- asexual stage as the anamorph.
morphic pathogens usually change from a multicellu-
lar hyphal form in the natural environment to a bud-
CLASSIFICATION OF FUNGI
ding, single-celled form in tissue.
In most multicellular fungi the vegetative stage con- Mycologists are interested in the structure of the re-
sists of a mass of branching hyphae, termed a productive bodies of fungi and the manner in which
mycelium. Each individual hypha has a rigid cell wall these are produced because these features form the ba-

3
 4 INTRODUCTION

sis for the classification and naming of fungi. Most re- Basidiomycota
cently the kingdom Fungi has been divided into four This division contains approximately 22,000 species.
lesser groups, termed divisions, based on differences in The thallus is septate. Asexual reproduction is variable,
their reproductive structures, as follows. with some species producing conidia like those of the
Ascomycota, but many others are not known to pro-
Chytridiomycota duce conidia at all. Sexual reproduction is by fusion of
This division consists of a single class with approxi- nuclei from compatible colonies, followed by meiosis
mately 100 genera and 1000 species, none of which are and production of basidiospores on the outside of a
pathogenic to humans. Most species live in an aqueous generative cell, termed a basidium. The basidia are of-
environment. Sexual reproduction, if it occurs, consists ten produced in macroscopic structures, termed basid-
of fusion of compatible nuclei. Meiosis then occurs and iocarps, and the spores are often forcibly discharged.
motile (swimming) spores, termed zoospores, are pro- Only a few members of this large division are of
duced. medical importance. The most prominent are the ba-
sidiomycetous yeasts of the genera Cryptococcus,
Zygomycota Malassezia, and Trichosporon. Filamentous basid-
This division consists of about 175 genera and 1000 iomycetes of clinical importance include the genus
species. The thallus (vegetative body of a fungus) is Schizophyllum.
aseptate. The asexual spores, or sporangiospores, are
nonmotile and are produced inside a closed sac, termed CLASSIFICATION OF ANAMORPHIC FUNGI
a sporangium, the wall of which ruptures to release
them. Sexual reproduction consists of fusion of nuclei In many fungi asexual reproduction has proved so suc-
from compatible colonies, followed by the formation cessful that the sexual stage (the teleomorph) has dis-
of a single large zygospore with a thickened wall. Meio- appeared, or at least, has not been discovered. Most of
sis occurs on germination and haploid mycelium then these anamorphic fungi are presumed to have (or to have
develops. had) a teleomorph that belonged to the division As-
This division contains two orders of medical impor- comycota; some are presumed to belong to the division
tance, the Entomophthorales and the Mucorales. The Basidiomycota. Even in the absence of the teleomorph
former includes the genera Basidiobolus and Conid- it is now often possible to assign these fungi to one or
iobolus, and the latter includes the genera Absidia, Mu- other of these divisions on the basis of ultrastructural or
cor, Rhizomucor, and Rhizopus. molecular genetic characteristics. In the past, however,
these anamorphic fungi were termed the Fungi Imper-
Ascomycota fecti and were divided into three artificial classes ac-
This division contains at least 3200 genera and ap- cording to their form of growth and production of asex-
proximately 32,000 species. The thallus is septate. ual reproductive structures. Many current mycological
Asexual reproduction consists of the production of texts still employ this system of classification.
spores, termed conidia, from a generative or conidio-
Hyphomycetes
genous cell. In some species the conidiogenous cell is
The mycelium is septate. The conidia are produced di-
not different from the rest of the mycelium. In others,
rectly on the hyphae or on special hyphal branches
the conidiogenous cell is contained in a specialized hy-
termed conidiophores. This class contains a large num-
phal structure, termed a conidiophore. Sexual repro-
ber of anamorphic fungi of medical importance, in-
duction results from fusion of nuclei from compatible
cluding the genera Aspergillus, Cladophialophora,
colonies. After meiosis, haploid spores, termed as-
Fusarium, Microsporum, Phialophora, Scedosporium,
cospores, are produced in a sac-like structure, termed
and Trichophyton.
an ascus. The Ascomycota show a gradual transition
from primitive forms that produce single asci to species Coelomycetes
that produce large structures, termed ascocarps, con- The mycelium is septate. The conidia are produced in
taining numerous asci. structures that are either spherical with an apical open-
This division includes the genus Ajellomyces, the ing (termed pycnidia), or flat and cup-shaped (termed
main teleomorph genus of dimorphic systemic fungal acervuli). Only a few members of this class are of med-
pathogens. Anamorph genera are Blastomyces, Em- ical importance. These include the genera Lasiodiplo-
monsia, and Histoplasma. The Ascomycota also in- dia, and Pyrenochaeta.
clude the genus Pseudallescheria, the teleomorph of the
anamorph genus Scedosporium. This division also in- Blastomycetes
cludes the ascomycetous yeasts, many of which have The thallus consists of loose budding single cells or a
an anamorph stage belonging to the genus Candida. pseudomycelium. These organisms are identified on the
 Laboratory aspects of medical mycology 5

basis of their physiologic rather than their morphologic to (or caused by) fungus B” (Odds et al, 1992). This
characteristics. This class contains the yeasts of the recommendation was not intended to apply to long-
anamorphic genus Candida. Most of the so-called black established disease names, such as aspergillosis; rather
yeasts are able to produce true mycelium and are there- it was intended to offer a more flexible approach to
fore classified under the Hyphomycetes. nomenclature.
There is also much to be said for the practice of
grouping together mycotic diseases of similar origins
NOMENCLATURE OF FUNGI
under single headings. One of the broadest and most
AND FUNGAL DISEASES
useful of these collective names is the term phaeohy-
As Odds has commented, there are few things more phomycosis, which is used to refer to a range of sub-
frustrating to the clinician than changes in the names cutaneous and deep-seated infections caused by brown-
of diseases or disease agents, particularly when the dis- pigmented moulds that adopt a septate hyphal form in
eases concerned are not very common ones (Odds, tissue (Ajello, 1975). The number of organisms impli-
1996). The scientific names of fungi are subject to the cated as etiologic agents of phaeohyphomycosis has in-
International Botanical Code of Nomenclature. In gen- creased from 16 in 1975 to more than 100 at the pres-
eral the correct name for any organism is the earliest ent time (Matsumoto and Ajello, 1998). Often these
(first) name published in line with the requirements of fungi have been given different names at different times
the Code of Nomenclature. To avoid confusion, how- and the use of the collective disease name has helped
ever, the Code allows for certain exceptions. The most to reduce the confusion in the literature.
significant of these is when an earlier generic name has The term hyalohyphomycosis is another collective
been overlooked, a later name is in general use, and name that is increasing in usage. This term is used to
a reversion to the earlier name would cause much refer to infections caused by colorless (hyaline) moulds
confusion. that adopt a septate hyphal form in tissue (Ajello,
There are two main reasons for renaming. The first 1986). To date, more than 70 different organisms have
is reclassification of a fungus in the light of more de- been implicated. The disease name is reserved as a gen-
tailed investigation of its characteristics. The second is eral name for those infections that are caused by less
the discovery of the teleomorph (sexual stage) of a pre- common moulds, such as species of Fusarium, that are
viously anamorphic fungus. Many fungi bear two not the cause of otherwise-named infections, such as
names, one designating their sexual stage and the other aspergillosis.
their asexual stage. Often there are two names because
the anamorphic and teleomorphic stages were described
LABORATORY PROCEDURES FOR THE
and named at different times without the connection
DIAGNOSIS OF FUNGAL INFECTION
between them being recognized. Both names are valid
under the Code of Nomenclature, but that of the teleo- As with other microbial infections, the diagnosis of fun-
morph should take precedence. In practice, however, it gal infection relies upon a combination of clinical ob-
is more common (and correct) to refer to a fungus by servation and laboratory investigation. Superficial and
its asexual designation because this is the stage that is subcutaneous fungal infections often produce charac-
usually obtained in culture. teristic lesions that suggest the diagnosis, but labora-
Unlike the names of fungi, disease names are not sub- tory input can aid the diagnostic process where this is
ject to strict international control. Their usage tends to not the case, either because several microorganisms
reflect local practice. One popular method has been to and/or noninfectious processes produce similar clinical
derive disease names from the generic names of the pictures, or because the appearance of the lesions has
causal organisms: for example, aspergillosis, candidia- been rendered atypical by previous treatment. In many
sis, sporotrichosis, etc. However, if the fungus changes situations where systemic fungal infection is entertained
its name, then the disease name has to be changed as as a diagnosis, the clinical presentation is nonspecific
well. For example, moniliasis has become candidi- and can be caused by a wide range of infections, un-
asis or candidosis, and pseudallescheriasis has been derlying illnesses, or complications of treatment. The
variously designated monosporiosis, petriellidiosis, definitive diagnosis of these infections is based almost
allescheriasis and now scedosporiosis to match the entirely on the results of laboratory investigation.
changing name of the pathogen. In 1992 a subcom- The successful laboratory diagnosis of fungal infec-
mittee of the International Society for Human and An- tion depends in major part on the collection of ade-
imal Mycology recommended that the practice of form- quate clinical specimens for investigation. Inappropri-
ing disease names from the names of their causes should ate collection or storage of specimens can result in a
be avoided, and that, whenever possible individual dis- missed diagnosis. Moreover, to ensure that the most
eases should be named in the form “pathology A due appropriate laboratory tests are performed, it is essen-
Other documents randomly have
different content
flower the sun and dew, so did he drink in the divine light and life.
In adoration and love he beheld the Saviour, until likeness to Christ
and fellowship with Him became his one desire, and in his character
was reflected the character of his Master.
“Behold,” he said, “what manner of love the Father hath
bestowed upon us, that we should be called the sons of God;
therefore the world knoweth us not, because it knew Him not.
Beloved, now are we the sons of God, and it doth not yet appear
what we shall be; but we know that, when He shall appear, we shall
be like Him; for we shall see Him as He is. And every man that hath
this hope in Him purifieth himself, even as He is pure.”[104]

The history of no one of the disciples Peter

better illustrates Christ’s method of training
than does the history of Peter. Bold, aggressive, and self-confident,
quick to perceive and forward to act, prompt in retaliation yet
generous in forgiving, Peter often erred, and often received reproof.
Nor were his warm-hearted loyalty and devotion to Christ the less
decidedly recognized and commended. Patiently, with discriminating
love, the Saviour dealt with His impetuous disciple, seeking to check
his self-confidence, and to teach him humility, obedience, and trust.
But only in part was the lesson learned. Self-assurance was not
uprooted.
Often Jesus, the burden heavy upon His own heart, sought to
open to the disciples the scenes of His trial and suffering. But their
eyes were holden. The knowledge was unwelcome, and they did not
see. Self-pity, that shrank from fellowship with Christ in suffering,
prompted Peter’s remonstrance, “Pity Thyself, Lord; this shall not be
unto Thee.”[105] His words expressed the thought and feeling of the
twelve.
So they went on, the crisis drawing nearer; they, boastful,
contentious, in anticipation apportioning regal honors, and dreaming
not of the cross.
 For them all, Peter’s experience had a Rebuke That
lesson. To self-trust, trial is defeat. The sure Reclaims
outworking of evil still unforsaken, Christ “I Have Prayed for
could not prevent. But as His hand had Thee”
been outstretched to save when the waves were about to sweep
over Peter, so did His love reach out for his rescue when the deep
waters swept over his soul. Over and over again, on the very verge
of ruin, Peter’s words of boasting brought him nearer and still nearer
to the brink. Over and over again was given the warning, “Thou
shalt ... deny that thou knowest Me.”[106] It was the grieved, loving
heart of the disciple that spoke out in the avowal, “Lord, I am ready
to go with Thee, both into prison, and to death;”[107] and He who
reads the heart gave to Peter the message, little valued then, but
that in the swift-falling darkness would shed a ray of hope: “Simon,
Simon, behold, Satan hath desired to have you, that he may sift you
as wheat. But I have prayed for thee, that thy faith fail not; and
when thou art converted, strengthen thy brethren.”[108]
When in the judgment-hall the words “When Thou Art
of denial had been spoken; when Peter’s Converted”
love and loyalty, awakened under the Saviour’s glance of pity and
love and sorrow, had sent him forth to the garden where Christ had
wept and prayed; when his tears of remorse dropped upon the sod
that had been moistened with the blood-drops of His agony,—then
the Saviour’s words, “I have prayed for thee; ... when thou art
converted, strengthen thy brethren,” were a stay to his soul. Christ,
though foreseeing his sin, had not abandoned him to despair.
If the look that Jesus cast upon him had spoken condemnation
instead of pity; if in foretelling the sin He had failed of speaking
hope, how dense would have been the darkness that encompassed
Peter! how reckless the despair of that tortured soul! In that hour of
anguish and self-abhorrence, what could have held him back from
the path trodden by Judas?
He who could not spare His disciple the Not Alone
anguish, left him not alone to its bitterness.
His is a love that fails not nor forsakes.
 Human beings, themselves given to evil, are prone to deal
untenderly with the tempted and the erring. They can not read the
heart, they know not its struggle and pain. Of the rebuke that is
love, of the blow that wounds to heal, of the warning that speaks
hope, they have need to learn.
It was not John, the one who watched “Tell Peter”
with Him in the judgment-hall, who stood
beside His cross, and who of the twelve was first at the tomb,—it
was not John, but Peter, that was mentioned by name in the first
message sent to the disciples by Christ after His resurrection. “Tell
His disciples and Peter,” the angel said, “that He goeth before you
into Galilee; there shall ye see Him.”[109]
At the last meeting of Christ with the disciples by the sea, Peter,
tested by the thrice-given question, “Lovest thou Me?” was restored
to his place among the twelve. His work was appointed him; he was
to feed the Lord’s flock. Then, as His last personal direction, Jesus
bade him, “Follow thou Me.”[110]
Now he could appreciate the words. The Lesson Learned
The lesson Christ had given when He set a
little child in the midst of the disciples and bade them become like
him, Peter could now better understand. Knowing more fully both his
own weakness and Christ’s power, he was ready to trust and to
obey. In His strength he could follow his Master.
And at the close of his experience of labor and sacrifice, the
disciple once so unready to discern the cross, counted it a joy to
yield up his life for the gospel, feeling only that, for him who had
denied the Lord, to die in the same manner as his Master died was
too great an honor.
A miracle of divine tenderness was A Miracle of
Peter’s transformation. It is a life-lesson to Miracles
all who seek to follow in the steps of the Master Teacher.

Jesus reproved His disciples, He warned and cautioned them;

but John and Peter and their brethren did not leave Him.
Notwithstanding the reproofs, they chose to be with Jesus. And the
Saviour did not, because of their errors, withdraw from them. He
takes men as they are, with all their faults and weaknesses, and
trains them for His service, if they will be disciplined and taught by
Him.
But there was one of the twelve to Judas
whom, until very near the close of His work,
Christ spoke no word of direct reproof.
With Judas an element of antagonism An Element of
was introduced among the disciples. In Antagonism
connecting himself with Jesus he had responded to the attraction of
His character and life. He had sincerely desired a change in himself,
and had hoped to experience this through a union with Jesus. But
this desire did not become predominant. That which ruled him was
the hope of selfish benefit in the worldly kingdom which he expected
Christ to establish. Though recognizing the divine power of the love
of Christ, Judas did not yield to its supremacy. He continued to
cherish his own judgment and opinions, his disposition to criticize
and condemn. Christ’s motives and movements, often so far above
his comprehension, excited doubt and disapproval, and his own
questionings and ambitions were insinuated to the disciples. Many of
their contentions for supremacy, much of their dissatisfaction with
Christ’s methods, originated with Judas.
Jesus, seeing that to antagonize was Not Conflict, but
but to harden, refrained from direct conflict. Healing
The narrowing selfishness of Judas’ life, Christ sought to heal
through contact with His own self-sacrificing love. In His teaching He
unfolded principles that struck at the root of the disciple’s self-
centered ambitions. Lesson after lesson was thus given, and many a
time Judas realized that his character had been portrayed, and his
sin pointed out; but he would not yield.
Mercy’s pleading resisted, the impulse of evil bore final sway.
Judas, angered at an implied rebuke, and made desperate by the
disappointment of his ambitious dreams, surrendered his soul to the
demon of greed, and determined upon the betrayal of his Master.
From the Passover chamber, the joy of Christ’s presence, and the
light of immortal hope, he went forth to his evil work,—into the
outer darkness, where hope was not.
“Jesus knew from the beginning who Love Unfailing
they were that believed not, and who
should betray Him.”[111] Yet, knowing all, He had withheld no
pleading of mercy or gift of love.
Seeing the danger of Judas, He had brought him close to
Himself, within the inner circle of His chosen and trusted disciples.
Day after day, when the burden lay heaviest upon His own heart, He
had borne the pain of continual contact with that stubborn,
suspicious, brooding spirit; He had witnessed and labored to
counteract among His disciples that continuous, secret, and subtle
antagonism. And all this that no possible saving influence might be
lacking to that imperiled soul!
“Many waters can not quench love,
Neither can the floods drown it;”
“For love is strong as death.”[112]

So far as Judas himself was concerned, Warning to the

Christ’s work of love had been without avail. Eleven
But not so as regards his fellow-disciples. Goal of Worldly
To them it was a lesson of lifelong Wisdom
influence. Ever would its example of tenderness and long-suffering
mould their intercourse with the tempted and the erring. And it had
other lessons. At the ordination of the twelve, the disciples had
greatly desired that Judas should become one of their number; and
they had counted his accession an event of much promise to the
apostolic band. He had come more into contact with the world than
they, he was a man of good address, of discernment and executive
ability, and, having a high estimate of his own qualifications, he had
led the disciples to hold him in the same regard. But the methods he
desired to introduce into Christ’s work were based upon worldly
principles and were controlled by worldly policy. They looked to the
securing of worldly recognition and honor,—to the obtaining of the
kingdom of this world. The working out of these desires in the life of
Judas, helped the disciples to understand the antagonism between
the principle of self-aggrandizement and Christ’s principle of humility
and self-sacrifice,—the principle of the spiritual kingdom. In the fate
of Judas they saw the end to which self-serving tends.
For these disciples the mission of Christ Results of Christ’s
finally accomplished its purpose. Little by Training
little His example and His lessons of self-abnegation moulded their
characters. His death destroyed their hope of worldly greatness. The
fall of Peter, the apostasy of Judas, their own failure in forsaking
Christ in His anguish and peril, swept away their self-sufficiency.
They saw their own weakness; they saw something of the greatness
of the work committed to them; they felt their need of their Master’s
guidance at every step.
They knew that His personal presence Self-Distrust
was no longer to be with them, and they
recognized, as they had never recognized before, the value of the
opportunities that had been theirs to walk and talk with the Sent of
God. Many of His lessons, when spoken, they had not appreciated or
understood; now they longed to recall these lessons, to hear again
His words. With what joy now came back to them His assurance:—
“It is expedient for you that I go away; for if I go not away, the
Comforter will not come unto you; but if I depart, I will send Him.”
“All things that I have heard of My Father I have made known unto
you.” And “the Comforter ... whom the Father will send in My name,
He shall teach you all things, and bring all things to your
remembrance, whatsoever I have said unto you.”[113]
“All things that the Father hath are The Teacher of
Mine.” “When He, the Spirit of truth, is Truth
come, He will guide you into all truth.... He shall receive of Mine,
and shall show it unto you.”[114]
The disciples had seen Christ ascend from among them on the
Mount of Olives. And as the heavens received Him, there had come
back to them His parting promise, “Lo, I am with you alway, even
unto the end of the world.”[115]
They knew that His sympathies were Faith’s Assurance
with them still. They knew that they had a
representative, an advocate, at the throne of God. In the name of
Jesus they presented their petitions, repeating His promise,
“Whatsoever ye shall ask the Father in My name, He will give it
you.”[116]
Higher and higher they extended the hand of faith, with the
mighty argument, “It is Christ that died, yea rather, that is risen
again, who is even at the right hand of God, who also maketh
intercession for us.”[117]
Faithful to His promise, the Divine One, exalted in the heavenly
courts, imparted of His fulness to His followers on earth. His
enthronement at God’s right hand was signalized by the outpouring
of the Spirit upon His disciples.
By the work of Christ these disciples The Final
had been led to feel their need of the Spirit; Preparation
under the Spirit’s teaching they received their final preparation, and
went forth to their life-work.
No longer were they ignorant and uncultured. No longer were
they a collection of independent units or of discordant and
conflicting elements. No longer were their hopes set on worldly
greatness. They were of “one accord,” of “one mind and one soul.”
Christ filled their thoughts. The advancement of His kingdom was
their aim. In mind and character they had become like their Master;
and men “took knowledge of them, that they had been with
Jesus.”[118]
Then was there such a revelation of A Work That Shook
the glory of Christ as had never before the World
been witnessed by mortal man. Multitudes who had reviled His name
and despised His power confessed themselves disciples of the
Crucified. Through the co-operation of the divine Spirit the labors of
the humble men whom Christ had chosen, stirred the world. To
every nation under heaven was the gospel carried in a single
generation.

The same Spirit that in His stead was “I Am with You

sent to be the instructor of His first co- Alway”
workers, Christ has commissioned to be the instructor of His co-
workers to-day. “Lo, I am with you alway, even unto the end of the
world,”[119] is His promise.
The presence of the same Guide in educational work to-day will
produce the same results as of old. This is the end to which true
education tends; this is the work that God designs it to accomplish.
 Nature Teaching

“Consider the wondrous works of Him

who is perfect in knowledge”
 God in Nature
“HIS GLORY COVERS THE HEAVENS;”
“AND THE EARTH IS FULL OF
HIS RICHES”

U pon all created things is seen the The Pervading Life

impress of the Deity. Nature testifies of God. The susceptible
mind, brought in contact with the miracle and mystery of the
universe, can not but recognize the working of infinite power. Not by
its own inherent energy does the earth produce its bounties, and
year by year continue its motion around the sun. An unseen hand
guides the planets in their circuit of the heavens. A mysterious life
pervades all nature,—a life that sustains the unnumbered worlds
throughout immensity; that lives in the insect atom which floats in
the summer breeze; that wings the flight of the swallow, and feeds
the young ravens which cry; that brings the bud to blossom, and the
flower to fruit.
The same power that upholds nature, Universality of Law
is working also in man. The same great
laws that guide alike the star and the atom, control human life. The
laws that govern the heart’s action, regulating the flow of the
current of life to the body, are the laws of the mighty Intelligence
that has the jurisdiction of the soul. From Him all life proceeds. Only
in harmony with Him can be found its true sphere of action. For all
the objects of His creation the condition is the same,—a life
sustained by receiving the life of God, a life exercised in harmony
with the Creator’s will. To transgress His law, physical, mental, or
moral, is to place one’s self out of harmony with the universe, to
introduce discord, anarchy, ruin.
To him who learns thus to interpret its Nature’s Witness
teachings, all nature becomes illuminated;
the world is a lesson-book, life a school. The unity of man with
nature and with God, the universal dominion of law, the results of
transgression, can not fail of impressing the mind and moulding the
character.
These are lessons that our children The Child’s Teacher
need to learn. To the little child, not yet Opportunity for
capable of learning from the printed page Nature Study
or of being introduced to the routine of the schoolroom, nature
presents an unfailing source of instruction and delight. The heart not
yet hardened by contact with evil is quick to recognize the Presence
that pervades all created things. The ear as yet undulled by the
world’s clamor is attentive to the Voice that speaks through nature’s
utterances. And for those of older years, needing continually its
silent reminders of the spiritual and eternal, nature’s teaching will be
no less a source of pleasure and of instruction. As the dwellers in
Eden learned from nature’s pages, as Moses discerned God’s
handwriting on the Arabian plains and mountains, and the Child
Jesus on the hillsides of Nazareth, so the children of to-day may
learn of Him. The unseen is illustrated by the seen. On everything
upon the earth, from the loftiest tree of the forest to the lichen that
clings to the rock, from the boundless ocean to the tiniest shell on
the shore, they may behold the image and superscription of God.
So far as possible, let the child from his earliest years be placed
where this wonderful lesson-book shall be open before him. Let him
behold the glorious scenes painted by the great Master Artist upon
the shifting canvas of the heavens, let him become acquainted with
the wonders of earth and sea, let him watch the unfolding mysteries
of the changing seasons, and, in all His works, learn of the Creator.
In no other way can the foundation of Antagonistic Forces
a true education be so firmly and surely
laid. Yet even the child, as he comes in contact with nature, will see
cause for perplexity. He can not but recognize the working of
antagonistic forces. It is here that nature needs an interpreter.
Looking upon the evil manifest even in the natural world, all have
the same sorrowful lesson to learn,—“An enemy hath done this.”[120]
 Only in the light that shines from The Interpreter of
Calvary can nature’s teaching be read Nature
aright. Through the story of Bethlehem and the cross let it be shown
how good is to conquer evil, and how every blessing that comes to
us is a gift of redemption.
In brier and thorn, in thistle and tare, is represented the evil
that blights and mars. In singing bird and opening blossom, in rain
and sunshine, in summer breeze and gentle dew, in ten thousand
objects in nature, from the oak of the forest to the violet that
blossoms at its root, is seen the love that restores. And nature still
speaks to us of God’s goodness.
“I know the thoughts that I think Thoughts of Peace
toward you, saith the Lord, thoughts of
peace, and not of evil.”[121] This is the message that, in the light from
the cross, may be read upon all the face of nature. The heavens
declare His glory, and the earth is full of His riches.
 Lessons of Life
“SPEAK TO THE EARTH, AND
IT SHALL TEACH THEE”

T he great Teacher brought His hearers in Christ’s Object

Teaching
contact with nature, that they might
listen to the voice which speaks in all created things; and as their
hearts became tender and their minds receptive, He helped them to
interpret the spiritual teaching of the scenes upon which their eyes
rested. The parables, by means of which He loved to teach lessons
of truth, show how open His spirit was to the influences of nature,
and how He delighted to gather the spiritual teaching from the
surroundings of daily life.
The birds of the air, the lilies of the Adapted to Every
field, the sower and the seed, the shepherd Hearer
and the sheep,—with these Christ illustrated immortal truth. He drew
illustrations also from the events of life, facts of experience familiar
to the hearers,—the leaven, the hid treasure, the pearl, the fishing
net, the lost coin, the prodigal son, the houses on the rock and the
sand. In His lessons there was something to interest every mind, to
appeal to every heart. Thus the daily task, instead of being a mere
round of toil, bereft of higher thoughts, was brightened and uplifted
by constant reminders of the spiritual and the unseen.
So we should teach. Let the children learn to see in nature an
expression of the love and the wisdom of God; let the thought of
Him be linked with bird and flower and tree; let all things seen
become to them the interpreters of the unseen, and all the events of
life be a means of divine teaching.
As they learn thus to study the lessons Unity of Law
in all created things, and in all life’s
experiences, show that the same laws which govern the things of
nature and the events of life are to control us; that they are given
for our good; and that only in obedience to them can we find true
happiness and success.

All things both in heaven and in earth The Law of Ministry

declare that the great law of life is a law of
service. The infinite Father ministers to the life of every living thing.
Christ came to the earth “as he that serveth.”[122] The angels are
“ministering spirits, sent forth to minister for them who shall be heirs
of salvation.”[123] The same law of service is written upon all things in
nature. The birds of the air, the beasts of the field, the trees of the
forest, the leaves, the grass, and the flowers, the sun in the heavens
and the stars of light,—all have their ministry. Lake and ocean, river
and water-spring,—each takes to give.
As each thing in nature ministers thus Gaining by Giving
to the world’s life, it also secures its own.
“Give, and it shall be given unto you,”[124] is the lesson written no
less surely in nature than in the pages of Holy Writ.
As the hillsides and the plains open a channel for the mountain
stream to reach the sea, that which they give is repaid a
hundredfold. The stream that goes singing on its way leaves behind
its gift of beauty and fruitfulness. Through the fields, bare and
brown under the summer’s heat, a line of verdure marks the river’s
course; every noble tree, every bud, every blossom, a witness to the
recompense God’s grace decrees to all who become its channels to
the world.

Of the almost innumerable lessons Laws of Growth

taught in the varied processes of growth,
some of the most precious are conveyed in the Saviour’s parable of
the growing seed. It has lessons for old and young.
“So is the kingdom of God, as if a man should cast seed into the
ground; and should sleep, and rise night and day, and the seed
should spring and grow up, he knoweth not how. For the earth
bringeth forth fruit of herself; first the blade, then the ear, after that
the full corn in the ear.”[125]
The seed has in itself a germinating Divine Agency in
principle, a principle that God Himself has Growth
implanted; yet if left to itself the seed would have no power to
spring up. Man has his part to act in promoting the growth of the
grain; but there is a point beyond which he can accomplish nothing.
He must depend upon One who has connected the sowing and the
reaping by wonderful links of His own omnipotent power.
There is life in the seed, there is power in the soil; but unless
infinite power is exercised day and night, the seed will yield no
return. The showers of rain must refresh the thirsty fields; the sun
must impart warmth; electricity must be conveyed to the buried
seed. The life which the Creator has implanted, He alone can call
forth. Every seed grows, every plant develops, by the power of God.
“The seed is the word of God.” “As the earth bringeth forth her
bud, and as the garden causeth the things that are sown in it to
spring forth, so the Lord God will cause righteousness and praise to
spring forth.”[126] As in the natural, so in the spiritual sowing; the
power that alone can produce life is from God.
The work of the sower is a work of Sowing in Faith
faith. The mystery of the germination and
growth of the seed he can not understand; but he has confidence in
the agencies by which God causes vegetation to flourish. He casts
away the seed, expecting to gather it many-fold in an abundant
harvest. So parents and teachers are to labor, expecting a harvest
from the seed they sow.
For a time the good seed may lie God’s Covenant for
unnoticed in the heart, giving no evidence the Harvest
that it has taken root; but afterward, as the Spirit of God breathes
on the soul, the hidden seed springs up, and at last brings forth
fruit. In our life-work we know not which shall prosper, this or that.
This question it is not for us to settle. “In the morning sow thy seed,
and in the evening withhold not thine hand.”[127] God’s great
covenant declares that “while the earth remaineth, seed-time and
harvest ... shall not cease.”[128] In the confidence of this promise the
husbandman tills and sows. Not less confidently are we, in the
spiritual sowing, to labor, trusting His assurance: “So shall My word
be that goeth forth out of My mouth; it shall not return unto Me
void, but it shall accomplish that which I please, and it shall prosper
in the thing whereto I sent it.” “He that goeth forth and weepeth,
bearing precious seed, shall doubtless come again with rejoicing,
bringing his sheaves with him.”[129]
The germination of the seed represents the beginning of
spiritual life, and the development of the plant is a figure of the
development of character. There can be no life without growth. The
plant must either grow or die. As its growth is silent and
imperceptible, but continuous, so is the growth of character. At every
stage of development our life may be perfect; yet if God’s purpose
for us is fulfilled, there will be constant advancement.
The plant grows by receiving that Conditions of
which God has provided to sustain its life. Growth
So spiritual growth is attained through co-operation with divine
agencies. As the plant takes root in the soil, so we are to take root in
Christ. As the plant receives the sunshine, the dew, and the rain, so
are we to receive the Holy Spirit. If our hearts are stayed upon
Christ, He will come unto us “as the rain, as the latter and former
rain unto the earth.” As the Sun of Righteousness, He will arise upon
us “with healing in His wings.” We shall “grow as the lily.” We shall
“revive as the corn, and grow as the vine.”[130]
The wheat develops, “first the blade, Fruit-Bearing
then the ear, after that the full corn in the
ear.”[131] The object of the husbandman in the sowing of the seed
and the culture of the plant, is the production of grain,—bread for
the hungry, and seed for future harvests. So the divine Husbandman
looks for a harvest. He is seeking to reproduce Himself in the hearts
and lives of His followers, that through them He may be reproduced
in other hearts and lives.
 The gradual development of the plant A Lesson in Child-
from the seed is an object-lesson in child- Training
training. There is “first the blade, then the Natural
ear, after that the full corn in the ear.” [131] Development
He who gave this parable created the tiny seed, gave it its vital
properties, and ordained the laws that govern its growth. And the
truths taught by the parable were made a reality in His own life. He,
the Majesty of heaven, the King of glory, became a babe in
Bethlehem, and for a time represented the helpless infant in its
mother’s care. In childhood He spoke and acted as a child, honoring
His parents, and carrying out their wishes in helpful ways. But from
the first dawning of intelligence He was constantly growing in grace
and in a knowledge of truth.
Parents and teachers should aim so to cultivate the tendencies
of the youth that at each stage of life they may represent the beauty
appropriate to that period, unfolding naturally, as do the plants in
the garden.
The little ones should be educated in Simplicity
childlike simplicity. They should be trained
to be content with the small, helpful duties and the pleasures and
experiences natural to their years. Childhood answers to the blade in
the parable, and the blade has a beauty peculiarly its own. Children
should not be forced into a precocious maturity, but as long as
possible should retain the freshness and grace of their early years.
The more quiet and simple the life of the child,—the more free from
artificial excitement and the more in harmony with nature,—the
more favorable it is to physical and mental vigor and to spiritual
strength.

In the Saviour’s miracle of feeding the The Miracle of the

five thousand is illustrated the working of Harvest
God’s power in the production of the harvest. Jesus draws aside the
veil from the world of nature, and reveals the creative energy that is
constantly exercised for our good. In multiplying the seed cast into
the ground, He who multiplied the loaves is working a miracle every
day. It is by a miracle that He constantly feeds millions from earth’s
harvest-fields. Men are called upon to co-operate with Him in the
care of the grain and the preparation of the loaf, and because of this
they lose sight of the divine agency. The working of His power is
ascribed to natural causes or to human instrumentality, and too
often His gifts are perverted to selfish uses, and made a curse
instead of a blessing. God is seeking to change all this. He desires
that our dull senses shall be quickened to discern His merciful
kindness, that His gifts may be to us the blessing that He intended.
It is the word of God, the impartation Partakers of the Life
of His life, that gives life to the seed; and of of God
that life, we, in eating the grain, become partakers. This God desires
us to discern; He desires that even in receiving our daily bread we
may recognize His agency, and may be brought into closer fellowship
with Him.

By the laws of God in nature, effect We Reap What We

follows cause with unvarying certainty. The Sow
reaping testifies to the sowing. Here no Life’s Harvest,
pretense is tolerated. Men may deceive Character
their fellow-men, and may receive praise and compensation for
service which they have not rendered. But in nature there can be no
deception. On the unfaithful husbandman the harvest passes
sentence of condemnation. And in the highest sense this is true also
in the spiritual realm. It is in appearance, not in reality, that evil
succeeds. The child who plays truant from school, the youth who is
slothful in his studies, the clerk or apprentice who fails of serving the
interests of his employer, the man in any business or profession who
is untrue to his highest responsibilities, may flatter himself that, so
long as the wrong is concealed, he is gaining an advantage. But not
so; he is cheating himself. The harvest of life is character, and it is
this that determines destiny, both for this life and for the life to
come.
The harvest is a reproduction of the seed sown. Every seed
yields fruit “after its kind.” So it is with the traits of character we
cherish. Selfishness, self-love, self-esteem, self-indulgence,
reproduce themselves, and the end is wretchedness and ruin. “He
that soweth to his flesh shall of the flesh reap corruption; but he
that soweth to the Spirit shall of the Spirit reap life everlasting.”[132]
Love, sympathy, and kindness yield fruitage of blessing, a harvest
that is imperishable.
In the harvest the seed is multiplied. A Increase from
single grain of wheat, increased by Sowing
repeated sowings, would cover a whole land with golden sheaves.
So widespread may be the influence of a single life, of even a single
act.
What deeds of love the memory of that alabaster box broken for
Christ’s anointing has through the long centuries prompted! What
countless gifts that contribution, by a poor unnamed widow, of “two
mites, which make a farthing,”[133] has brought to the Saviour’s
cause!

The lesson of seed-sowing teaches “Freely Give”

liberality. “He which soweth sparingly shall
reap also sparingly; and he which soweth bountifully shall reap also
bountifully.”[134]
The Lord says, “Blessed are ye that sow beside all waters.”[135]
To sow beside all waters means to give wherever our help is needed.
This will not tend to poverty. “He which soweth bountifully shall reap
also bountifully.” By casting it away the sower multiplies his seed. So
by imparting we increase our blessings. God’s promise assures a
sufficiency, that we may continue to give.
More than this: as we impart the blessings of this life, gratitude
in the recipient prepares the heart to receive spiritual truth, and a
harvest is produced unto life everlasting.

By the casting of grain into the earth, Life through Death

the Saviour represents His sacrifice for us.
“Except a corn of wheat fall into the ground and die,” He says, “it
abideth alone; but if it die, it bringeth forth much fruit.”[136] Only
through the sacrifice of Christ, the Seed, could fruit be brought forth
for the kingdom of God. In accordance with the law of the vegetable
kingdom, life is the result of His death.
So with all who bring forth fruit as workers together with Christ:
self-love, self-interest, must perish; the life must be cast into the
furrow of the world’s need. But the law of self-sacrifice is the law of
self-preservation. The husbandman preserves his grain by casting it
away. So the life that will be preserved is the life that is freely given
in service to God and man.

The seed dies, to spring forth into new A Symbol of the

life. In this we are taught the lesson of the Resurrection
resurrection. Of the human body laid away to moulder in the grave,
God has said: “It is sown in corruption; it is raised in incorruption: it
is sown in dishonor; it is raised in glory: it is sown in weakness; it is
raised in power.”[137]
As parents and teachers try to teach Nature Study Made
these lessons, the work should be made Practical
practical. Let the children themselves prepare the soil and sow the
seed. As they work, the parent or teacher can explain the garden of
the heart, with the good or bad seed sown there, and that as the
garden must be prepared for the natural seed, so the heart must be
prepared for the seed of truth. As the seed is cast into the ground,
they can teach the lesson of Christ’s death; and as the blade springs
up, the truth of the resurrection. As the plant grows, the
correspondence between the natural and the spiritual sowing may
be continued.
The youth should be instructed in a similar way. From the tilling
of the soil, lessons may constantly be learned. No one settles upon a
raw piece of land with the expectation that it will at once yield a
harvest. Diligent, persevering labor must be put forth in the
preparation of the soil, the sowing of the seed, and the culture of
the crop. So it must be in the spiritual sowing. The garden of the
heart must be cultivated. The soil must be broken up by repentance.
The evil growths that choke the good grain must be uprooted. As
soil once overgrown with thorns can be reclaimed only by diligent
labor, so the evil tendencies of the heart can be overcome only by
earnest effort in the name and strength of Christ.

In the cultivation of the soil the Obedience to Law

thoughtful worker will find that treasures Development of
little dreamed of are opening up before Character
him. No one can succeed in agriculture or gardening without
attention to the laws involved. The special needs of every variety of
plant must be studied. Different varieties require different soil and
cultivation, and compliance with the laws governing each is the
condition of success. The attention required in transplanting, that
not even a root-fiber shall be crowded or misplaced, the care of the
young plants, the pruning and watering, the shielding from frost at
night and sun by day, keeping out weeds, disease, and insect-pests,
the training and arranging, not only teach important lessons
concerning the development of character, but the work itself is a
means of development. In cultivating carefulness, patience, attention
to detail, obedience to law, it imparts a most essential training. The
constant contact with the mystery of life and the loveliness of
nature, as well as the tenderness called forth in ministering to these
beautiful objects of God’s creation, tends to quicken the mind and
refine and elevate the character; and the lessons taught prepare the
worker to deal more successfully with other minds.
 Other Object Lessons
“WHOSO IS WISE, AND WILL OBSERVE
THESE THINGS, EVEN THEY SHALL
UNDERSTAND THE LOVING-KINDNESS
OF THE LORD”

G od’s healing power runs all through The Ministry of

Healing
nature. If a tree is cut, if a human
being is wounded or breaks a bone, nature begins at once to repair
the injury. Even before the need exists, the healing agencies are in
readiness; and as soon as a part is wounded, every energy is bent to
the work of restoration. So it is in the spiritual realm. Before sin
created the need, God had provided the remedy. Every soul that
yields to temptation is wounded, bruised, by the adversary; but
wherever there is sin, there is the Saviour. It is Christ’s work “to heal
the broken-hearted, to preach deliverance to the captives, ... to set
at liberty them that are bruised.”[138]
In this work we are to co-operate. “If a A Suggestive Figure
man be overtaken in a fault, ... restore such Only Love Can
[139] Restore
a one.” The word here translated
“restore” means to put in joint, as a dislocated bone. How
suggestive the figure! He who falls into error or sin is thrown out of
relation to everything about him. He may realize his error, and be
filled with remorse; but he can not recover himself. He is in
confusion and perplexity, worsted and helpless. He is to be
reclaimed, healed, re-established. “Ye which are spiritual, restore
such a one.” Only the love that flows from the heart of Christ can
heal. Only he in whom that love flows, even as the sap in the tree or
the blood in the body, can restore the wounded soul.
Love’s agencies have wonderful power, for they are divine. The
soft answer that “turneth away wrath,” the love that “suffereth long,
and is kind,” the charity that “covereth a multitude of sins,”[140]—
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