328 BURT RANSOM RICKARDS 



Potato. Grows well, but is invisible. 



Blood serum. Growth as described under agar stroke, except that it grows 

 more luxuriantly, spreads slightly, and is faintly flesh-colored. Typical appearance. 



Agar stab. Filiform, spreading slightly on surface. 



Gelatin stab. Filiform; no liquefaction; slight growth on surface. 



Broth. Surface growth, none; tubidity, slight; sediment, considerable, granular 

 adhering to glass. 



Milk. Coagulation, none; consistency, unchanged. 



Agar colonies. Punctiform; edge entire; finely granular. 



Relative growth at 20 and 37. Grows well at 37 C.; very slow growth at 20 C. 



Fermentation of dextrose* No gas production; no growth in closed arm; acidi- 

 fying coefficient: i day, ^; 2 days, |^; 4 days, ^~; 6 days, |^; 8 days, ^; 



10 days, . 

 y ' 0.5 

 Fermentation of lactose* No acid or gas production. 



Fermentation of saccharose.* No acid or gas production. 



Indol production. Very slight. 



Patho genesis. Very slight. A guinea-pig inoculated with i per cent of his 

 body-weight of a 0.2 per cent dextrose broth grown 10 days at 37 C. showed a 

 very slight edema at site of inoculation and slight injection of suprarenals in two days. 



For the following clinical history the writer is indebted to Dr. 

 A. H. Bassett the attending physician : 



Patient, Miss H S . Age, 32 years; medium height; sandy complexion; 

 slightly stoop-shouldered; weight, 112 pounds. Occupation, clerk. First consulted 

 physician on December 30, 1905. Symptoms: loss of flesh, pain in upper chest 

 and right shoulder, loss of appetite. 



Present illness dates back five years, previous to which patient said she had no 

 sickness since childhood. No history of diphtheria. First symptoms were decided 

 hoarseness, aggravated by dampness or by becoming over-tired. For past two years 

 the amount of perspiration has been over normal. Regular night sweats eight months 

 ago; not as profuse at present time. Took care of consumptive sister one year ago. 

 Symptoms gradually growing worse since then. Some expectoration, but not abun- 

 dant. Within the past year urine has at times contained some blood. This condi- 

 tion lasts for some time and" then passes off. The patient's urine was examined by 

 one physician who reported "nothing pathologic." No urine analysis by writer. 



Physical examination (reported by Dr. H. C. Clapp): "Small area of dulness 

 in apex of right lung, heard more posteriorily; broncho-vesicular respiration; bron- 

 chophony; normal temperature. Clinically, tuberculosis." 



On February 26, six weeks after the last previous sputum was 

 examined, a third specimen was requested and obtained, in order 

 to demonstrate the continued presence of the diphtheria-like organ- 

 ism. No tubercle bacilli were found, but the above organism 

 was present in undiminished numbers. 



* o . 2 per cent, in sugar free-broth. 



