18 
patient.  The  x-rays,  however,  are  decisive 
(Radiograph  N.  1.  Tracheo-bronchial  adenopa¬ 
thy  caused  by  Oidium  brasiliense).  However, 
we  did  not  find  the  abundant  symptomato- 
logy,  attributed  by  some  authors  to  the  tra¬ 
cheo-bronchial  adenopathies.  Even  when,  as 
in  patient  506  (ward  of  Dr.  SAMUEL  LIBA- 
NiO),  the  lymphadenitis  was  remarkable 
during  life-time,  it  little  helped  the  diagnosis. 
There  was  no  thoracic  deformation,  nor  cir¬ 
culation  of  the  higher  prethoracic  or  the 
middle  thoracic  (CARRY)  or  interme¬ 
diary  type,  nor  signs  of  FERNET,  etc.,  shortly, 
none  of  the  signs  indicated  as  expression  of 
these  adenopathies.  They  must  be  carefully 
searched  for  by  watching  attentively  the  sub¬ 
jective  signs,  revealed  by  the  patient.  Once 
diagnosed,  the  process  must  be  distinguished 
from  similar  affections.  Here  the  clinical 
observation  is  not  sufficient  ;  we  must  study 
the  particular  and  specific  biological  reactions, 
giving  more  reliable  indication  for  diagnosis. 
In  this  way  we  discard  the  neoplasms  of  the 
lymph  glands,  which  principally  produce  a 
striking  symptomatology,  the  hypertiophy  of 
the  thymus  (children)  with  almost  exclusively 
respiratory  symptoms,  the  hooping-cough 
with  similar  coughing,  though  with  more 
marked  inspirations,  mucosities  and  dif¬ 
ferent  evolution,  and,  specially,  syphilitic, 
mycotic,  tuberculous  and  various  post-infec¬ 
tious  forms  of  adenopathy  and  mediastinitis. 
The  latter  group  is  of  the  highest  importance 
on  account  of  the  manyfold  clinical  aspects, 
possibly  present. 
Here  we  have  COMBY's  chronic  medi¬ 
astinitis,  which  imitates  the  tracheo-bronchial 
adenopathies,  denouncing  itself,  however,  by 
the  participation  of  the  pericardium  (with  a 
series  of  consequences  of  increasing  gravity) 
or  a  syphilitic  adenopathy,  not  common,  slow, 
insidious,  due  to  intense  generalised  infec¬ 
tion  or  pulmonary  lesion,  or  a  tubercular 
gland  lesion,  also  slow  and  insidious,  not 
rarely  multiple  and  forming  by  fusion  large 
tracheo-bronchial  masses  ;  there  are,  moreover, 
various  and  complicated  mycotic  adenites,  of 
which  the  sporotrichotic  adenitis  is  a  perfect 
type.  This  is  the  reason  why  we  resort  to 
the  immunity  reactions.  The  suspected  patient, 
after  the  clinical  examination,  was  submitted 
to  cuti-reaction,  to  ophthalmo-reaction  (KOCH) 
WASSERMANN’s  reaction  (classic),  to  dired 
researches  on  the  glands  of  annexed  systems 
(neck)  and  principally  to  intradermal  reaction 
and  to  the  specific  fixation  test  of  Oidium 
brasiliense. 
The  two  latter  reactions,  though  still 
in  the  period  of  comparative  researches,  gave 
us  already  some  information  on  this  difficult 
chapter  of  the  disease  (vide  Diagnosis). 
As  a  last  recourse  remains,  for  many 
cases,  the  treatment  with  iodides.  The  amyg¬ 
dalitis  has  been  confounded  with  many 
other  kinds.  We  isolated  pure  cultures  of  the 
fungus  from  many  cases.  The  local  treat¬ 
ment  (iodine  water)  cures  rapidly.  These  le¬ 
sions  are  of  some  importance  for  the  etio¬ 
logy  of  the  disease. 
After  overcoming  the  barrier  of  the 
lymph  glands  and  passing  through  the  mu¬ 
cosa  of  the  tonsils,  the  fungus  invades  the 
organism  through  the  circulation.  This  is 
the  beginning  of  the  “manifest  disease”. 
Inflammation  of  serous  membranes. 
The  lesion  of  the  serosae  must  begin 
on  this  occasion.  Experiments,  assisting  cli¬ 
nical  observation,  fully  prove  this  point. 
The  serosae  (sometimes  all  of  them)  resent 
the  attack  of  the  germ  already  a  few  hours 
after  the  inoculation  of  the  fungus. 
It  has  not  yet  been  possible  to  detect 
the  beginning  of  this  serositis.  Perhaps 
continual  observation  of  this  point  may  give 
us  soon  the  decisive  proof.  However, 
we  can  already  state,  that,  until  now,  no 
case  of  the  disease  with  integrity  of  the 
serosas  has  been  observed  in  man,  even  when, 
as  in  some  of  our  patients,  the  clinical  exa¬ 
mination  finds  little  or  nothing  at  all  during 
life-time.  The  post-mortem  shows  residues 
of  old  lesions.  The  very  age  of  these  le¬ 
sions  explains  the  absence  of  any  constant 
clinical  sign  indicating  serositis. 
