20 
The  fungus-forms  are  always  present  and 
the  fresher  the  pleural  effusion,  the  greater 
is  the  number  of  parasites. 
The  examination  of  the  abdomen  in  the 
2d  and  chiefly,  in  the  3rd  period  of  the  chro¬ 
nic  form  of  the  human  disease  reveals  nearly 
always  the  presence  of  ascites.  The  peritoneal 
affection  proceeds,  without  much  show,  from 
small  effusions  to  those  of  large  quantities. 
Here  also  we  find  the  fungus.  In  the  expe¬ 
rimental  disease  the  peritoneum  is  one  of 
the  best  places  for  obtaining  culture  mate¬ 
rial.  The  inspection,  the  palpation  and  the 
percussion,  all  together,  furnish  elements  for 
the  diagnosis.  The  palpation  reveals  the 
senation  of  waves,  of  great  value  for  the 
diagnosis  of  the  effusion.  We  sea,  further¬ 
more,  general  symptoms  due  to  effusion,  as 
compression  of  the  abdominal  vessels  (vena 
cava  inferior)  and  subsequent  edema  of 
the  limbs.  Neither  in  the  experimental  disea¬ 
se,  nor  in  the  human  did  we  find  a 
localised  effusion.  The  nature  of  the  abdo¬ 
minal  effusion  is  various;  not  rarely  it  is  he- 
morrhagical.  The  effusion  in  the  serosae, 
either  isolated  or  multiple,  are  constant,  es¬ 
pecially  at  the  second  period  of  the  manifest 
disease  and  afterwards. 
Acute  form. 
In  the  begining  of  1916  a  patient,  sus¬ 
pected  of  pulmonary  mycosis  was  received 
in  the  ward  of  Prof.  SAMUEL  LIBANIO. 
The  microbiological  researches,  made 
by  us,  showed  that  it  was  another  case  of 
this  disease. 
Various  occupations  forced  us  to  leave 
Bello  Horizonte  for  a  rather  long  time. 
The  study  of  the  morbid  symptoms  was 
completed  by  Prof.  SAMUEL  LIBANIO. 
The  patient,  a  young  man,  presented  a 
symptomatology  rather  different  from  the  or¬ 
dinary  type  of  the  disease,  we  were  accom¬ 
panying. 
The  fatal  evolution  of  the  human  disea¬ 
se  within  a  little  more  than  thirty  days,  fully 
justified  the  designation  “acute  form”  and 
so  it  was  already  considered  by  Prof.  SA¬ 
MUEL  LIBANIO  at  the  last  Congress  of 
Medicine  in  Buenos  Aires. 
In  five  years  work  we  collected  several 
dozens  of  cases  of  this  “pulmonary  oidiosis”, 
some  with  sufficient  details,  others  with  as 
many  as  allowed  by  circumstances. 
Only  three  of  those  showed  the  unex¬ 
pected  symptoms,  which  constitute  the  subs¬ 
tratum  of  the  “acute  form”  of  the  human 
disease,  which,  in  fact,  is  excepcional. 
The  first  case  was  seen  in  1913  in  the 
ward  of  Dr.  E.  LOUREIRO;  the  second  in 
1916  in  tbe  ward  of  Prof.  SAMUEL  LIBA¬ 
NIO,  the  third  this  year,  in  the  private  prac¬ 
tice  of  Dr.  MARCELLO  LIBANIO. 
The  obtaining  of  these  clinical  observa¬ 
tions  in  the  hospital  was  a  rare  coincidence. 
The  social  conditions  of  the  interior  of 
Brazil  rarely  allow  the  begining  of  a  disease 
to  coincide  with  the  entry  of  the  patient  in 
the  hospital. 
The  “sertanejo”  only  takes  refuge  to 
charity,  overcoming  the  superstition,  which  de¬ 
ters  him,  when  the  disease  is  already  in  full 
evolution,  serious  and  deep-rooted.  Nor  is 
there  an  anamnesis  worth  mentioning,  as  it 
is  almost  always  wholly  valueless,  deficient 
or  even  absurd. 
The  expression  “acute”  is  used  only 
for  clinical  classification.  It  is  due  to  the 
same  parasite,  which  finds  a  favourable  field 
in  a  sensitive  organism.  Hence  the  violence 
of  the  disease. 
Time  will  show  that  the  transformation 
of  acute  form  into  a  chronic  process,  is  not 
at  all  impossible  and  that  the  acute  exacer¬ 
bation  from  the  marasmus  of  a  chronic 
form  is  not  absurd. 
Our  patient  (M.  N.  1)  fully  proved  that 
at  least  the  latter  hypothesis  is  oossible.  She 
entered  the  Maternity  of  Bello-Horizonte 
showing  a  chronical  form  of  the  disease  and 
on  4-12-16  left  spontaneously  “in  tolera¬ 
ble  condition”,  consideraby  improved  by  the 
treatment  with  iodides,  but  not  cured.  She 
1)  For  this  observation  we  are  Indebted  to  Prof. 
HUGO  WERNECK. 
