Identifier: medicaldiagnosi00gree (find matches)
Title: Medical diagnosis for the student and practitioner
Year: 1922 (1920s)
Authors: Greene, Charles Lyman, 1862-
Subjects: Diagnosis
Publisher: Philadelphia, Blakiston
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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fractile membrane. Mode of Entrance.—It seems probable that inhalation implants thepathogenic organism. Symptoms.—The first effect is pulmonary, a bronchopneumonia develop- Misleadinging with a history of pain in the chest, perhaps chill, and evidences of severe symptoms-or primary bronchitis with blood-stained sputa. 1128 MEDICAL DIAGNOSIS Fever is present and with the coming of subcutaneous nodules, abscesses,single and successive or in crops, chiefly on the face and neck, together,usually, with ulceration, secondary, or even primary and independent ofabscess sites, a chronic infection becomes established, which may assume theclinical form of an excessively chronic septicemia or pyemia. Ulceratingareas by fusion may cause large sluggish fungating areas. The joints maybecome very much enlarged in certain cases. The blood shows a moderateor high leucocytosis, but is otherwise not greatly affected unless the invasionof the medullary substance of the bones produces myelocytic forms.
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Fig. 544.—Disseminated, polymorphous, ulcerative sporotrichosis, simulating syphilis,tuberculosis, ecthyma, and furunculosis. (After C. H. Plant.) Diagnosis.—This depends primarily upon the physicians recollection thatsuch a disease as systemic and dermal blastomycosis (oidiomycosis) exists;secondly, upon the recovery of the fungus from the pus or, in some instances,from the sputum or urine, or even the blood. The spores are easily recognized if the pus is heated with 20 per cent,sodium hydrate solution or even with no preliminary mixing. A stain isneither necessary nor desirable. These cases are mistaken for other ailments and especially for tuberculosisof the skin, lung and bones unless the disease is held in mind as a possibility. The direct diagnosis is then so easy as to make unnecessary the specifictests for syphilis and tuberculosis. Coccidioidal granuloma must be excluded by examination of the funguspresent in the discharges or tissues. COCCIDIOIDAL GRANULOMA—THE NOCARDO

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