REFERENCES 



ance somewhat resembling the tubercle bacillus. Other species of nocardia, 

 also found in sputum, may not be acid -fast, and these are more easily recognized. 



Morbid Anatomy. — As a rule the appearances found post-mortem are not 

 unlike that of tuberculosis. There is consolidation, necrosis, and cavity 

 formation in the lung, with or without the signs of caseous pneumonia or of 

 calcareous deposition, or there may be small cirrhotic nodules scattered 

 through the lung. There may also be nodules in the liver, spleen, peritoneum, 

 and lymph glands, and there may be chocolate-coloured exudate into the 

 pleural or peritoneal cavities. This exudate may be odourless or foetid in 

 odour. The fungus can be easily found in these pseudo-tubercles. 



Symptomatology. — In general it may be stated that the symptoms resemble 

 those of phthisis, and as such the disease is usually recognized. Usually there 

 is fever, cough, a muco-purulent sputum containing blood at times and showing 

 acid -fast rods resembling theBacillus tuberculosis, but careful search may reveal 

 a few elongate or branching forms. The physical signs are those of chronic 

 broncho-pneumonia, with or without cavity formation, and with or without 

 those of pleural effusion. The liver and spleen are often enlarged. The cases 

 usually go from bad to worse, and end in death. 



Diagnosis. — Many of these cases are diagnosed as pulmonary tuberculosis 

 at the present time. The correct diagnosis can only be established by a 

 careful examination of the sputum, by microscopical and bacteriological 

 methods, including the culture of the organism. 



The differential diagnosis has to be made from phthisis and liver abscess. 



It may be distinguished from phthisis by the recognition of the beaded 

 branched organism in the sputum and the culture of it therefrom. 



In cases giving a history of dysentery and exhibiting enlargement of the 

 liver, fever, and a purulent chocolate-coloured effusion into the pleural cavity, 

 the diagnosis can only be effected by finding the fungus and by the absence of 

 any pus in the liver. In such cases the dysenteric amoeba may be present in 

 the fasces. 



For the morphological and cultural characters of the species of nocardia 

 see Chapter XXXIX., p. 1040. 



Prognosis. — So far the prognosis is very bad, as all known cases have died. 



Treatment. — Iodide of potash in large doses may be tried or a vaccine made 

 from the patient's causal organism. 



Prophylaxis. — Nothing whatever can be said on this part of the subject. 



REFERENCES. 



Bronchial Spirochaetoses. 



Alcock (1918). Communication by letter. 

 Barbary (1918). Bull. Ac. de Med. 



Beau, Dide, and Ribereau (1918). Societe Med. des Hopiteaux. 

 Branch (1907), British Medical Journal. 



British Medical Journal. Bronchospirochaetosis. Leader, p. 727, De- 

 cember 28, 1918, 



Castellani (1906). Lancet, May 19. (1906-13). Ceylon Medical Reports, 

 (1909) . British Medical Joarnal, September 1 8 (Tropical Diseases Section) . 

 (191 7), Presse Medicale, No. 37, and also Journal of Tropical Medicine, 

 August and September. 



Chalmers and O'Farrell (1913), Journ. of Trop. Med. 



CoRVETTO (1918). Espiroquetosis bronco-pulmonar de Castellani. An, 



Facult. Med. de Lima., vol. v.. No, 5. 

 Dalimier (1919), A propos de la broncho-spirochetose de Castellani. Presse 



Medicale, No. 14, p. 124. 

 Delamare (1919). Soc. de Biologic. 



Derrien (1918), Reunion Medico-Chirurgicale de la i5ieme Region. 

 Fantham (1915). Annals Trop. Med. and Paras. 



Galli- Valeric (1915). Centr. f. Bakt, (1917)- Correspondenzblatt f. 



Schweizer-Aerzte. 

 Hallenberger (1916). Arch. f. Schiffs-u. Tropen-Hygiene. 



