ASPERGILLOSIS 283 
distance from the borders one could see through the crevices by transmitted light. 
On the surface, the sub-pleural connective tissue was distended by large blebs. Upon 
palpation the lung crackled and numerous hard nodules could be felt. On section 
numerous dark red nodules appeared in the surrounding normal tissue. In each lung 
there were from fifty to sixty of these nodules, from 5 to 12 mm. in diameter. Most 
of them were dark red and closely resembled partially organized blood clots. However, 
on crushing a portion in glycerin between two slides and examining it under the micro- 
scope, they were found to be made up almost entirely of a felted network of mycelial 
threads. Between these large nodules there were numberless smaller areas of much 
the same color, 1 to 2 mm. in diameter, not perceptible to the touch as nodules but 
which were of the same character and were no doubt foci of recent origin. These were 
seen especially well in portions of the lungs which were preserved by Pick’s method, the 
slight bleaching of the tissue bringing them into relief. On opening some of the inter- 
lobular emphysematous spaces, small, whitish, mouldy looking patches were noticed 
which bordered the cavity. Scrapings of these patches were made up entirely of 
perfect fruit hyphae, with myriads of spores. The diagnosis of a mould mycosis was 
in this way made at once and confirmed by cultures and examination of sections. 
Cultures were obtained on glycerinated potato, bouillon and plain agar, by opening a 
nodule with sterile instruments and tearing out a small portion of the center, which 
was transferred to the culture tubes and placed in an incubator at 39° C. A rabbit 
was inoculated in the aural vein with one-half cubic centimeter of a suspension of the 
spores. The animal died in forty-four hours and from the liver and kidneys cultures 
were recovered. All of the organs were examined in sections, but the mycelium was 
detected in two only. 
The histology was studied largely in sections stained with hematoxylin and eosin. 
The bronchial epithelium was normal in places, but, for the most part, the columnar 
cells had been replaced by a sort of membrane, which appears to be made up almost 
entirely of a felt-work of mycelial threads. From this membrane hyphe grew out 
into the lumen of the bronchus, and here, owing no doubt to the supply of air, fruit 
hyphae arose, with perfect sterigmata and spores. There were no cellular nor other 
exudate and very little debris. The under surface of this membrane was of looser 
texture and contained some cellular infiltration made up of round cells, leucocytes, 
proliferated connective tissue cells and red blood corpuscles. The adjacent structures 
were closely filled with a cellular infiltration with a quantity of mycelium of the same 
description, this extended to the neighboring alveoli, which under low power appeared 
to have preserved their outline but with greater amplification were seen to have lost 
all their normal structure, showing clumps of homogeneous, irregular masses which 
stained faintly with eosin and were probably of connective tissue origin. 
In these areas the mycelium followed the alveolar wall as a trellis, the tissue seeming 
to afford no obstacle to its advance. Within the alveoli was a finely granular debris, 
with some coarser particles, probably the remains of cells. In sections stained with 
carbol-thionine large numbers of mast cells were seen in the alveolar walls. Bordering 
these degenerated areas were alveoli which had retained their normal structure and 
were filled with a network of fibrin holding in its meshes a few cells. In other parts 
of the sections were areas resembling those just described, but in which all anatomical 
landmarks had been destroyed, so that it was impossible to tell whether or not the 
spaces seen were bronchi. 
