36 
Leaving  alone  such  cases,  as  may  be 
considered  secundary  pulmonary  localisati¬ 
ons,  on  account  of  the  more  or  less  genera¬ 
lized  blastomycetic  infection,  there  are  others 
(case  of  ALBERS),  in  which  the  primitive 
infection  seems  to  be  located  in  the  lungs. 
Not  attributing  much  importance  to  the 
exceptional  rarity  of  such  exclusively  pulmo¬ 
nary  diseases,  we  observe,  at  first,  with  the 
development  of  the  infection,  the  rapid  dis¬ 
semination  of  the  fungus  in  the  organism. 
The  cutaneus  or  ganglionic  lesions,  besides 
those  which,  in  these  case,  as  a  rule  appear 
in  other  viscera,  should  always  contain  mate¬ 
rial  for  elucidating  the  diagnosis.  The  clinical 
symptomatoly  also  is  said  to  be  more  com¬ 
plicated.  Besides,  in  all  these  cases,  the 
sputa  furnish  pure,  or  almost  pure,  cultures 
of  blastomvcetes.  The  smears  of  sputum 
show  innumerous  charaeteristical  forms.  A 
motig  the  Hyphomycetes  there  is  the  Asper¬ 
gillus  fumiga  tus ,  capable  to  produce  a  pri¬ 
mary  pulmonary  pseudo-tuberculosis.  The 
fungus  is  characterized  by  smears  and  cul¬ 
tures.  Of  artificial  cultue  media  RAU- 
LlN’s  fluid  is  most  used.  The  Aspergillus 
bronchialis  is  a  species  of  the  same  genus, 
but  of  doubtful  pathogenic  ation.  In  the  fa¬ 
mily  of  the  Mucorini ,  there  are  three  spe¬ 
cies,  Mucor  niucedo  Rhizomucor  parasiticus 
and  Mucor  corymbifer ,  accused  as  parasites  of 
man.  Given  the  great  number  of  fungi  of 
these  species,  it  is  a  wise  rule  to  use  the 
greatest  care  in  these  diagnoses. 
Even  so,  for  our  case  only  the  pulmona¬ 
ry  Rhizomucormycosis  of  LUCET  &  CONS¬ 
TANTIN  is  worth  mentioning.  The  pulmo¬ 
nary  mucormycosis  of  FUERBRINGER  and 
the  lung  manifestations  of  the  generalized 
mucormycosis  of  PALTAUF  deserve,  in  our 
opinion,  well  founded  reservation.  The  diag¬ 
nosis  of  the  species  is  easily  made  by  smears 
of  the  lesions  and  of  the  sputa,  by  cul¬ 
tures,  and,  when  possible,  by  anatomo-pa- 
thological  examinations.  The  tracheo-bron- 
chial  adenopathy  of  adenomycosis  might,  in 
the  begining,  lead  to  eonfusion  with  the  ade¬ 
nopathy  caused  by  Oidium  brasiliense. 
This  adenopathy,  according  to  the  dis¬ 
coverer  of  this  new  mycosis,  has  often  fatal 
tracheo-bronchial  and  nervous  consequences. 
The  phenomena  of  compression  are  in¬ 
dicated  in  some  cases,  not  to  mention  other 
symptoms,  by  a  certain  amount  of  expecto¬ 
ration,  but  here  the  clinical  syndrome  is  cha- 
racteristical.  So  far  as  we  know,  there  are  no 
exclusive  lungsymptoms.  The  glands  of 
the  neck,  the  submaxillary  glands,  etc.  fur¬ 
nish,  by  punction,  sufficient  elements  for  di- 
ferential  diagnosis.  Immediately  after  the 
mycoses,  we  consider  the  malignant  neo¬ 
plasms  of  the  lungs. 
The  primitive  pulmonary  cancer  has,  ac¬ 
cording  to  MENETRIER,  a  pathognomic 
feature:  the  presence  of  neoplastic  cells  in 
the  sputum  or  in  the  liquids,  retired  by 
punction  from  pleura  or  lungs. 
The  adenopathies,  the  external  tumours, 
the  complex  of  clinical  symptoms,  complete  the 
picture  satisfactorily.  There  2re  cases,  though 
rare,  in  which  pulmonary  cancer  may  be  con¬ 
founded  with  tuberculosis,  in  all  its  forms, 
and  with  not  tuberculous  chronic  adenopa¬ 
thies.  Of  course,  confusion  is  also  possible 
with  the  tuberculosis,  caused  by  Oidium 
brasiliense.  If,  however,  in  these  cases,  the 
microbiological  researches  should  prove  in¬ 
sufficient  for  differential  diagnosis,  there 
would  still  be  the  treatment  with  iodides. 
Amongst  many  other  eases,  we  must  call  at¬ 
tention  to  malignant  neoplasms  with  more 
violent  symptoms,  the  different  forms  of  pul¬ 
monary  sarcomas.  In  such  cases  clinical  ob¬ 
servation  may  soon  furnish  sufficient  ele¬ 
ments  for  differential  diagnosis. 
Hydatic  cysts  of  the  lungs  also  have 
caused,  in  adults  as  well,  as  in  children, 
confusions  with  tubercular  lesions  of  the 
pleura  or  the  lung.  The  use  of  x-rays  gives 
a  valuable  help  for  this  diagnosis.  There 
are  also  the  anamnesis  and  the  clini¬ 
cal  examination,  completed  by  laboratory 
methods.  The  diagnosis  is  also  helped  by 
urticaria,  bloodcosinophilia,  expectoration 
containing  membranes  or  embryonic  hooks 
and  the  immunity  reactions. 
The  diagnosis  is  completed  by  the  re¬ 
search  of  the  Oidium  brasiliense  and  treatment 
