1 888 



DISEASES OF THE RESPIRATORY ORGANS 



cough. The expectoration is muco-purulent and very often scanty, 

 and no blood can be seen. The physical examination of the chest 

 will reveal only a few coarse rales or absolutely nothing. The 

 condition may last several weeks or months, and may get cured 

 spontaneously, or, continuing, may turn into the severe type. The 

 severe type closely resembles phthisis; the patient becomes ema- 

 ciated, there is hectic fever, muco-purulent and bloody expectora- 

 tion. Occasionally true haemoptysis occurs, a teaspoonful or more 

 of bright blood being spat up at a time. The physical examination 

 of the chest may show patches of dulness, fine crepitations, and 

 pleural rubbing. This type is often fatal. Betw^een these two 

 extreme types there are of course cases of intermediate severity, 

 apyretic or with subcontinuous and continuous fever, and more or 

 less marked bronchial and broncho-alveolar symptoms. 



Fig. 774. — Sputum in Bronchomoniliasis (Severe Case). 

 (From a preparation stained \\ith methylene blue.) 



Diagnosis. — The diagnosis of moniliasis is based on finding the 

 fungus in the sputum. It is absolutely necessary that this should 

 be collected in sterile petri dishes and examined as soon as possible, 

 as sputum exposed to the air becomes contaminated with all sorts 

 of fungi in the tropics. In fresh preparations of the expectoration 

 spore-like, roundish, or oval cells 4 to 6 are seen, often presenting 

 a double contour, alone or more rarely with some mycelial articles. 

 The fungus is Gram-positive. 



To identify the fungus cultural researches are necessary. A particle of the 

 sputum is smeared on maltose or glucose agar plates; after two or three days 

 white, rather large, roundish colonies appear, easily distinguishable, even 

 macroscopically, with a little practice, from the colonies of cocci and other 

 bacteria. The fungus colonies are further investigated by inoculating maltose 

 agar, ordinary agar, gelatine, serum, and a set of sugar broths. All the 

 species of Monilia found in our cases grow well on ordinary agar, but much 

 more abundantly on maltose and glucose agar, especially if slightly acid. 



