220 REPORT OF THE HARVARD AFRICAN EXPEDITION 
two hundred spleens obtained by operation or autopsy. Twenty-four of them 
were found to have mycotic infection and contain the Gandy-Gamna nodules 
shown to be of mycotic origin by Nanta and others. In ten of these cases, the 
mycelium was calcified and degenerate and in the remaining fourteen the my- 
celium was well preserved. In all of the four cases of Banti’s disease, mycotic 
nodules were found. Such nodules were also found in different forms of cirrhosis 
of the spleen, as well as in Algerian splenomegaly. In view of the fact that the 
mycotic infection was encountered in a great variety of pathological conditions, 
he concludes that it is probably only secondary in nature and occurs in a spleen 
which has already been injured in some manner. He thinks that the mycotic in- 
fection may follow one of two courses, either that the mycosis develops for a time 
and then retrogresses and the lesions undergo cicatrization or, in other cases, the 
mycosis develops rapidly and infiltrates the spleen with mycotic nodules. 
Gamna,! however, has deplored the manner in which certain authorities, in 
conformity with the work of Nanta and Pinoy, have accepted the presence of 
Gamna nodules as being diagnostic of splenic mycosis and have regarded these 
nodules as mycotic tubercules. He points out that he has described these nodules 
in many different diseases of the spleen and states that there is as yet no decisive 
evidence that they are specifically mycotic. He also believes that it has not 
been proved that the filaments in the spleens examined are really of mycelian 
origin and that in only three or four cases have cultures of a fungus been isolated, 
and further, that the pathogenicity of this fungus has not yet been demonstrated. 
Langeron ” also, after a review of the literature upon the subject and from 
the study of certain cultures isolated from cases of splenic mycosis, as well as of a 
number of the spleens which were considered to be infected, concludes that there 
is no justification for considering that there is a mycotic form of splenomegaly. 
He believes that the fungi which have been obtained in cultures from such spleens 
are accidental contaminations of non-pathogenic forms and that the filaments 
and conidial structures described as mycelial in character in the spleens consti- 
tute pathological changes in fibrin and collagen in haemorrhagic areas. 
In still later papers, however, Nanta, Emile-Weil, and Pinoy ? firmly maintain 
the existence of this mycotic form of splenomegaly. Nanta and Pinoy point out 
as evidence of the pathogenesis of the organism that intravenous injections of a 
culture of Aspergillus fumigatus in a rabbit proved fatal after eight days and 
produced lesions comparable to those of human splenomegaly, though much 
more acute in character. 
The question has been studied more recently in Brazil by Fonseca and Leao 4 
who have examined the specimens of splenomegaly in the Institute Oswaldo 
Cruz at Rio de Janeiro in some of which siderotic nodular lesions have been 
observed. ‘They conclude from the study of this material that the aspect. of 
certain structures and filamentous elements described may at first sight impress 
1 Gamna, C.: Presse Méd. (1928), XX XVI, 357. 
? Langeron, M.: Ann. Parasit. Humaine et Comparée (1928), VI, 211; Reprint from La Presse 
Médicale (May 9, 1928), No. 37. 
3 Nanta, Emile-Weil and Pinoy: Presse Méd. (1928), XXXVI, 579. 
* da Fonseca and de Area Leao: Inst. Oswaldo Cruz. Sup. das Memorias, No. 1 (Aug. 31, 1928). 
