CASE OF APPARENT PULMONARY TUBERCULOSIS 329 



Three separate examinations have thus been made on three samples 

 of sputum submitted at intervals, and in each case no tubercle bacilli 

 were found after an exhaustive search. This fact in itself does 

 not, of course, rule out the possibility, but lessens by so much the 

 probability, of their presence in the lung tissue. On each of these 

 examinations an organism resembling B. diphtheriae both morpho- 

 logically and culturally has been present in large numbers. 



The fact of the continued presence of this organism raises a 

 suspicion in the mind of the writer as to whether the organism, 

 if not the primary, may not at least be a contributing factor in 

 producing the symptoms above described. 



Dr. Louis Hoag, of the Danvers, Mass., State Hospital, has 

 in a number of cases isolated diphtheria-like organisms from the 

 lungs of patients who had died of broncho-pneumonia. Dr. Hoag 

 agrees with the writer that these organisms differ in many respects 

 from the one here described. 



The writer is unaware of any previous descriptions in the liter- 

 ature analogous to the above. Dr. W. H. Smith, of this city, has, 

 however, very kindly submitted notes on a case which came under 

 his care at the Massachusetts General Hospital in 1904. The 

 clinical history bears a most decided resemblance, including a family 

 history of tuberculosis, tubercular symptoms, cough four years 

 moist rales, apex of right lung, etc. Sputum examinations show no 

 bacilli of tuberculosis, but the constant presence of an organism 

 resembling the diphtheria bacillus morphologically, but of very 

 low virulence. 



It is the intention of the writer to follow the two cases cited, if 

 circumstances permit, with a view to determining, if possible, the 

 role played by the diphtheria-like organisms. 



The writer wishes to acknowledge his indebtedness to Dr. F. H. 

 Slack, Assistant Bacteriologist, for help in isolating and identifying 

 the organism. 



DESCRIPTION OF PLATE 3. 



Pure culture, diptheria-like, organism isolated from sputum. Twenty-four-hour 

 growth in serum. Methylene blue. X 1500. 



