xiii, b, 5 Wade: Chronic Pulmonary Blastomycosis 273 



fatal and in which pulmonary lesions were found these were 

 comparatively acute and were either small granulomatous nodules 

 or small circumscribed abscesses. Metastasis to the lungs has 

 been almost constant and often very extensive, particularly in 

 the monkeys inoculated peripherally ; metastases in other viscera 

 have, on the contrary, been comparatively uncommon. In a few 

 cases it has happened, in animals that have been subjected to 

 unfavorable influences, that the focus at the point of sub- 

 cutaneous inoculation proved comparatively insignificant, in 

 contrast to the extensive pulmonary involvement. 



In the animal under discussion pulmonary metastases from 

 the original subcutaneous focus developed, possibly after a period 

 of quiescence, in spite of the subsidence of the peripheral lesion. 

 Whether the metastases would have progressed to a fatal issue 

 in an ordinary animal without the physiological responsibilities 

 of maternity cannot be said, though it seems to me likely that, in 

 spite of the fact that the monkey is more susceptible to this 

 infection than any other laboratory animal, the secondary foci 

 might have been overcome as was the subcutaneous lesion. 



The factors that may have influenced the development are for 

 the present discussion incidental to the fact. The point is that 

 had the animal been seen first after the subsidence of the lesion 

 at the point of inoculation, where only a clean, inconspicuous 

 scar remained, there would obviously have been little possibility 

 of recognizing that as the portal of entry of the infection. 



It is evident that should similar pulmonary metastasis from 

 a primary subcutaneous or other focus occur in a human case, 

 with subsequent disappearance of the original peripheral lesion, 

 which need never have been particularly large or striking, the 

 onset of the systemic disease might well appear to coincide with 

 or to follow a cold or other temporary disturbance, as, for 

 example, was the history in the majority of the cases reviewed 

 by Stober. 2 This would serve to concentrate attention unduly 

 upon the respiratory tract as the point of origin. In view of 

 the long latency possible in this infection this exacerbation might, 

 as in pulmonary tuberculosis, be at a date comparatively remote 

 from the time of primary invasion. 



SUMMARY 



A full-grown monkey, later found to be pregnant, was in- 

 oculated subcutaneously with the so-called Blastomyces dermati- 

 tidis, a small abscess resulting. After two and a half months, 



2 Stober, A, M., Arch. Int. Med. (1914), 13, 509. 



