-  21 
came  back,  some  time  later,  in  a  very  seri¬ 
ous  condition  and  died  in  the  ward  of  Prof. 
BALENA,  on  the  22-12-16. 
The  cases  of  pulmonary  oidiosis,  either 
acute  or  chronic,  are  always  fatal,  if  not 
treated. 
In  acute  or  chronic  cases  one  or  more 
serous  cavities  are  always  attacked. 
In  acute  or  chronic  cases  congestive  pro¬ 
cesses  prevail. 
In  acute  or  chronic  cases  immunoreac- 
tions  are  the  S2me. 
In  acute  or  chronic  cases  treatment  is  the 
same. 
The  general  conditions  of  the  patient  of 
the  acute  form  are,  in  the  begining,  without 
important  characteristics.  They  are  general¬ 
ly  confounded  with  the  initial  stage  of  the 
infectious  diseases,  showing  the  same  pro¬ 
stration,  the  same  accentuated  general  depres¬ 
sion,  the  same  disturbing  sudden  indisposi¬ 
tion,  caused  by  the  attack  of  microbes.  In 
the  begining  fever  rises  to  the  highest  curve 
but,  shortly  afterwards,  it  assumes  a  very  ir¬ 
regular  form  of  rising  and  falling.  The  dif¬ 
ference  shown  by  the  two  processes  (i.  e. 
the  chronic  and  the  acute  forms)  in  their 
irregular  curves  of  fever  is  the  height  of  the 
thermographical  elevation.  While  in  the  acute 
cases  fever  rises,  though  irregularly,  to  39 
and  40°,  in  the  chronic  forms  it  hardly  attains, 
though  also  irregular,  38°  in  the  armpit. 
In  the  acute  forms  fever  may  fall, 
within  24  hours,  from  39  to  36°,  rising  in 
the  next  days  to  39°. 
In  the  chronic  cases  the  curve  goes  up 
and  down  between  35  and  36°,  with  an 
average  of  37°  and  some  tenths. 
Under  treatment  the  temperature  does 
not  fall  immediately,  but  the  decided  effect  of 
the  medicine  is  followed  by  a  gradual  dimi¬ 
nution  of  the  fever.  This  lysis  is  verified  in 
the  acute  as  well,  as  in  the  chronic  form.  In 
the  acute  form  the  pulse  is,  as  a  rule,  full  and 
ample,  the  pulsations  being  between  100  a 
140.  Except  for  this  correlative  tachycardia, 
there  are  no  perceptible  disturbances  of  the 
cardiac  rhythm  ;  what  here  calls  our  attenti¬ 
on,  is  the  respiratory  system. 
In  one  of  the  3  clinical  observations,  we 
made,  the  lesions  of  this  system  looked  like 
those  of  a  true  pleuropneumonia  of  the  right 
lobe  1).  Here  we  find  the  pain  in  the  henii- 
thorax,  high  fever,  intense  prostration,  dysp¬ 
noea,  chills,  dullness,  stertores  with  crepitation, 
tubal  breathing,  pleural  attrition  etc.  What 
we  fail  to  find,  is  the  well  known  evolution 
of  this  pulmonary  disease.  The  sputa  are  he- 
moptoic. 
After  some  30  days  we  begin  to  note 
perceptible  alterations  in  the  condition  oí 
the  lung,  which  till  then  remained  constant  and 
unalterated.  There  is  now  an  accentuation  oí 
the  signs  of  liquid  collection,  variable  accor¬ 
ding  to  the  case.  They  vary  from  a  third  to 
almost  the  totality  of  the  two  hemithoraces, 
though  effusion  is  not  constant.  In  one  or 
in  both  lungs  we  perceive  signs  of  softening 
of  the  parenchyma.  The  apices,  as  a  rule, 
initiate  the  process.  Outside  of  these  regions, 
the  lung  or  the  lungs  appear  as  a  compact 
and  massive  block. 
Abundant  extensive  stertores  are  scat¬ 
tered,  in  various  foci,  all  over  the  lesion. 
Not  rarely  and  especially  at  the  bases  do  we 
find  legions,  where  only  dullness  of  re¬ 
spiration  is  perceived.  Pseudo-cavitary  brea¬ 
thing  is  observed  in  circumscribed  regions 
of  the  organ. 
The  temperature,  rising  and  falling  irre¬ 
gularly,  continues  high,  reaching  39  and  40° 
in  the  sudden  risings  ;  often  it  is  only  in 
this  period  of  pulmonary  affection,  that  the 
patient  goes  to  the  hospital.  Hence  the 
difficulty  of  the  diagnosis.  The  sputa  are 
abundant  and  the  hemoptysis  may  persist. 
By  some  of  the  symptoms  one  is  remin¬ 
ded  of  “caseous  pneumonia”,  by  others  of 
GAUCHER’s  form. 
The  general  condition  becomes  worse  ;  pa¬ 
leness  is  remarkable  and  emaciation  extreme. 
The  bones  seem  to  swell  beneath  the  retrac- 
1)  For  the  first  part  of  an  observation,  which  justies 
some  details  of  this  description,  we  are,  partly  indebted 
to  Dr.  ABEL  TAVARES  DE  LACERDA  (Military  Hos¬ 
pital)  With  Dr.  MARCELLIO  L1BANIO,  we  obtained 
the  second  part  in  the  house  of  the  patient. 
