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Contents

Contributors  xi
Preface  xxi

I. General Considerations

1. Tuberculosis in History: Did It Change the Way We Live?   3

Thomas M. Daniel

2. Epidemiology and Host Factors   11

Jay B. Mehta and Asim K. Dutt

3. Perspectives for Developing New Tuberculosis Vaccines Derived

from the Pathogenesis of Tuberculosis   33
Arthur M. Dannenberg, Jr. and Bappaditya Dey

4. Laboratory Diagnosis and Susceptibility Testing for

Mycobacterium tuberculosis  45
Gary W. Procop

5. Diagnosis of Latent Tuberculosis Infection   59

Alfred A. Lardizabal and Lee B. Reichman

6. Treatment of Latent Tuberculosis Infection   67

Connie A. Haley

7. Chemotherapy of Tuberculosis   101

Thomas E. Dobbs and Risa M. Webb

vii
viii Contents

8. The Role of Therapeutic Drug Monitoring in Mycobacterial

Infections  119
Charles Peloquin

9. Therapy of Multidrug-Resistant and Extensively Drug-Resistant

Tuberculosis  129
Barbara J. Seaworth and David E. Griffith

10. Role of Surgery in the Diagnosis and Management

of Tuberculosis  159
Alan D. L. Sihoe

11. Mycobacterium bovis BCG and New Vaccines for the Prevention
of Tuberculosis  187
Timothy Lahey and C. Fordham Von Reyn

12. Tuberculosis—a World Health Organization

Perspective  211
Giovanni Sotgiu, Giorgia Sulis, and Alberto Matteelli

13. Crisis-Affected Populations and Tuberculosis   229

Dominik Zenner

14. Tuberculosis in Enclosed Populations   237

Sorana Segal-Maurer

15. Role of the Health Department in Tuberculosis

Prevention and Control—Legal and Public Health
Considerations  261
Carla Jeffries, Phil LoBue, Terence Chorba, Beverly Metchock,
and Ijaz Kashef

II. Clinical Syndromes

16. Pulmonary Tuberculosis  285

Sarah M. Lyon and Milton D. Rossman

17. Upper Respiratory Tract Tuberculosis   299

Surinder K. Jindal, Aditya Jindal, and Ritesh Agarwal

18. Tuberculous Otomastoiditis  309

Jonathan M. Hand and George A. Pankey

19. Ocular Tuberculosis  313

Daniel M. Albert and Meisha L. Raven

20. Central Nervous System Tuberculosis   331

John M. Leonard

21. Tuberculous Lymphadenitis and Parotitis   343

Juan Carlos Cataño and Jaime Robledo
Contents ix

22. Urogenital Tuberculosis  355

André A. Figueiredo, Antônio M. Lucon, and Miguel Srougi

23. Musculoskeletal Tuberculosis  371

Michael K. Leonard, Jr. and Henry M. Blumberg

24. Cardiovascular Tuberculosis  393

John A. Crocco

25. Gastrointestinal Tuberculosis  411

Eric H. Choi and Walter J. Coyle

26. Tuberculous Peritonitis  433

Urvashi Vaid and Gregory C. Kane

27. Tuberculosis of the Liver, Biliary Tract, and Pancreas   439

G. Shelton McMullan and James H. Lewis

28. Cutaneous Tuberculosis  483

Michael K. Hill and Charles V. Sanders

29. Miliary Tuberculosis  491

Surendra K. Sharma and Alladi Mohan

30. Endocrine and Metabolic Aspects of Tuberculosis   515

Christopher Vinnard and Emily A. Blumberg

31. Hematologic Complications of Tuberculosis    529

Shyam S. Balepur and David Schlossberg

32. Tuberculosis in Infants and Children   541

Gabriella S. Lamb and Jeffrey R. Starke

33. Tuberculosis and Pregnancy—Maternal, Fetal, and Neonatal

Considerations  571
Jane M. Gould and Stephen C. Aronoff

34. Tuberculosis Associated with HIV Infection   577

Jeffrey A. Tornheim and Kelly E. Dooley

35. Diabetes and Tuberculosis   595

Blanca I. Restrepo

36. Tuberculosis and Transplantation   607

José M. Aguado, José Tiago Silva, Palash Samanta, and Nina Singh

37. Biologic Agents and Tuberculosis   623

Claudia C. Dobler

38. Paradoxical Reactions and the Immune Reconstitution

Inflammatory Syndrome  637
L. W. Preston Church, Amit Chopra, and Marc A. Judson
x Contents

III. Nontuberculous Mycobacteria

39. Nontuberculous Mycobacteria—Overview  655

Won-Jung Koh

40. Mycobacterium avium Complex Disease   663

Charles L. Daley

41. Rapidly Growing Mycobacteria   703

Barbara A. Brown-Elliott and Julie V. Philley

42. Mycobacterium kansasii  725

James C. Johnston, Leslie Chiang, and Kevin Elwood

43. Mycobacterium marinum  735

Alexandra Aubry, Faiza Mougari, Florence Reibel, and
Emmanuelle Cambau

44. Mycobacterium bovis and Other Uncommon Members of the

Mycobacterium tuberculosis Complex  753
Jaime Esteban and Maria-Carmen Muñoz-Egea

45. Other Slow-Growing Nontuberculous Mycobacteria   767

Marvin J. Bittner and Laurel C. Preheim

Index  777
Contributors

Ritesh Agarwal
Department of Pulmonary Medicine
Postgraduate Institute of Medical Education & Research
Chandigarh, India
José M. Aguado
University Hospital 12 de Octubre
Unit of Infectious Diseases
Madrid, Spain
Daniel M. Albert
Department of Ophthalmology and Visual Sciences
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin
Stephen C. Aronoff
Department of Pediatrics
Lewis Katz School of Medicine
Temple University
Philadelphia, Pennsylvania
Alexandra Aubry
Centre National de Référence pour la résistance des Mycobactéries aux
antituberculeux
Sorbonne Université
Université Pierre et Marie Curie
AP-HP Hôpital Pitié-Salpêtrière
Centre d’Immunologie et des Maladies Infectieuses, Team 13, INSERM U1135
Paris, France

xi
xii Contributors

Shyam S. Balepur
ABBCI, Division of Hematology & Oncology
Penn Medicine/Lancaster General Health
Lancaster, Pennsylvania
Marvin J. Bittner
Infectious Diseases Section
VA Medical Center
Departments of Medicine and of Medical Microbiology and Immunology
Creighton University School of Medicine
Omaha, Nebraska
Emily A. Blumberg
Division of Infectious Diseases
Department of Medicine
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania
Henry M. Blumberg
Division of Infectious Diseases
Emory University School of Medicine
Atlanta, Georgia
Barbara A. Brown-Elliott
Department of Microbiology
The University of Texas Health Science Center
Tyler, Texas
Emmanuelle Cambau
Centre National de Référence pour la résistance des Mycobactéries aux
antituberculeux
Laboratoire de Bactériologie, AP-HP Hôpital Lariboisière
Université Paris Diderot, IAME UMR 1137 INSERM
Paris, France
Juan Carlos Cataño
Section of Infectious Diseases
University of Antioquia Medical School
Medellín, Colombia
Leslie Chiang
Division of Tuberculosis Control
British Columbia Centre for Disease Control
Vancouver, British Columbia, Canada
Eric H. Choi
University of California Riverside School of Medicine and
Riverside Medical Clinic
Riverside, California
Amit Chopra
Division of Pulmonary and Critical Care Medicine
Albany Medical College
Albany, New York
Contributors xiii

Terence Chorba
Division of Tuberculosis Elimination
Centers for Disease Control and Prevention
Atlanta, Georgia
L. W. Preston Church
Ralph H. Johnson VA Medical Center
Charleston, South Carolina
Walter J. Coyle
Scripps Clinic Torrey Pines
La Jolla, California
John A. Crocco
UMDNJ—Robert Wood Johnson Medical School
New Brunswick, New Jersey
Charles L. Daley
Division of Mycobacterial and Respiratory Infections
National Jewish Health
Denver, Colorado
Thomas M. Daniel
Department of Medicine
Case Western Reserve University
University Hospitals Case Medical Center
Cleveland, Ohio
Arthur M. Dannenberg, Jr.
Department of Environmental Health Sciences
Department of Molecular Microbiology and Immunology
Department of Epidemiology
Johns Hopkins Bloomberg School of Public Health
Department of Pathology
Center for Tuberculosis Research
Johns Hopkins School of Medicine
Baltimore, Maryland
Bappaditya Dey
Center for Tuberculosis Research
Johns Hopkins School of Medicine
Baltimore, Maryland
Howard Hughes Medical Institute
Chevy Chase, Maryland
Thomas E. Dobbs
Mississippi State Department of Health
University of Mississippi Medical Center
Jackson, Mississippi
Claudia C. Dobler
Liverpool Hospital and South Western Sydney Clinical School
University of New South Wales
Woolcock Institute of Medical Research
xiv Contributors

University of Sydney
Sydney, New South Wales, Australia
Kelly E. Dooley
Johns Hopkins University School of Medicine
Divisions of Clinical Pharmacology & Infectious Diseases
Center for Tuberculosis Research
Baltimore, Maryland
Asim K. Dutt
Department of Medicine
Meharry Medical College
Nashville, Tennessee
Kevin Elwood
Division of Tuberculosis Control
British Columbia Centre for Disease Control
Vancouver, British Columbia, Canada
Jaime Esteban
Department of Clinical Microbiology
IIS-Fundación Jiménez Díaz, UAM
Madrid, Spain
André A. Figueiredo
Núcleo Interdisciplinar de Pesquisa em Urologia and Department of Surgery/Urology
Federal University of Juiz de Fora
Minas Gerais, Brazil
Jane M. Gould
Department of Pediatrics
Drexel University College of Medicine
Philadelphia, Pennsylvania
David E. Griffith
Heartland National TB Center
University of Texas Health Science Center-UT Health Northeast
San Antonio, Texas
Connie A. Haley
Division of Infectious Diseases and Southeast National Tuberculosis Center
University of Florida
Gainesville, Florida
Jonathan M. Hand
Department of Infectious Diseases
Ochsner Clinic Foundation
The University of Queensland School of Medicine
Ochsner Clinical School
New Orleans, Louisiana
Michael K. Hill
Saint Tammany Parish Hospital
Covington, Louisiana
Contributors xv

Carla Jeffries
Division of Tuberculosis Elimination
Centers for Disease Control and Prevention
Atlanta, Georgia
Aditya Jindal
Jindal Clinics
Chandigarh, India
Surinder K. Jindal
Department of Pulmonary Medicine
Postgraduate Institute of Medical Education & Research
Jindal Clinics
Chandigarh, India
James C. Johnston
Division of Tuberculosis Control
British Columbia Centre for Disease Control
Vancouver, British Columbia, Canada
Marc A. Judson
Division of Pulmonary and Critical Care Medicine
Albany Medical College
Albany, New York
Gregory C. Kane
Department of Medicine
Sidney Kimmel Medical College
The Korman Lung Center
Thomas Jefferson University
Philadelphia, Pennsylvania
Ijaz Kashef
Division of Global Health Protection
Centers for Disease Control and Prevention
Atlanta, Georgia
Won-Jung Koh
Division of Pulmonary and Critical Care Medicine
Department of Medicine
Samsung Medical Center
Sungkyunkwan University School of Medicine
Seoul, South Korea
Timothy Lahey
Dartmouth’s Geisel School of Medicine
Section of Infectious Diseases and International Health
Dartmouth-Hitchcock Medical Center
The Dartmouth Institute for Clinical Practice & Health Policy
Lebanon, New Hampshire
Gabriella S. Lamb
Baylor College of Medicine
Houston, Texas
xvi Contributors

Alfred A. Lardizabal
New Jersey Medical School Global Tuberculosis Institute
Rutgers University
Newark, New Jersey
John M. Leonard
Department of Medicine—Infectious Disease
Vanderbilt University Medical Center
Nashville, Tennessee
Michael K. Leonard, Jr.
Division of Infectious Diseases
Carolinas HealthCare System
Charlotte, North Carolina
James H. Lewis
Division of Hepatology
Department of Medicine
Georgetown University Hospital
Washington, DC
Phil LoBue
Division of Tuberculosis Elimination
Centers for Disease Control and Prevention
Atlanta, Georgia
Antônio M. Lucon
Division of Urology
University of São Paulo Medical School
São Paulo, Brazil
Sarah M. Lyon
Pulmonary, Allergy and Critical Care Division
Department of Medicine
Perelman School of Medicine
University of Pennsylvania
Philadelphia, Pennsylvania
Alberto Matteelli
Department of Infectious and Tropical Diseases
WHO Collaborating Centre for TB/HIV and TB Elimination
University of Brescia
Brescia, Italy
G. Shelton McMullan
Division of Gastroenterology
Georgetown University Hospital
Washington, DC
Jay B. Mehta
Department of Medicine
East Tennessee State University
James H. Quillen College of Medicine
Johnson City, Tennessee
Contributors xvii

Beverly Metchock
Division of Tuberculosis Elimination
Centers for Disease Control and Prevention
Atlanta, Georgia
Alladi Mohan
Division of Pulmonary and Critical Care Medicine
Department of Medicine
Sri Venkateswara Institute of Medical Sciences
Tirupati, India
Faiza Mougari
Centre National de Référence pour la résistance des Mycobactéries aux
antituberculeux
Laboratoire de Bactériologie, AP-HP Hôpital Lariboisière
Université Paris Diderot, IAME UMR 1137 INSERM
Paris, France
Maria-Carmen Muñoz-Egea
Department of Clinical Microbiology
IIS-Fundación Jiménez Díaz, UAM
Madrid, Spain
George A. Pankey
Department of Infectious Diseases
Ochsner Clinic Foundation
New Orleans, Louisiana
Charles Peloquin
Infectious Disease Pharmacokinetics Lab
College of Pharmacy
Emerging Pathogens Institute
University of Florida
Gainesville, Florida
Julie V. Philley
Department of Medicine
The University of Texas Health Science Center
Tyler, Texas
Laurel C. Preheim
Infectious Diseases Section
VA Medical Center
Departments of Medicine and of Medical Microbiology and Immunology
Creighton University School of Medicine
Omaha, Nebraska
Gary W. Procop
Department of Laboratory Medicine
Cleveland Clinic
Cleveland, Ohio
Meisha L. Raven
Department of Ophthalmology and Visual Sciences
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin
xviii Contributors

Florence Reibel
Centre National de Référence pour la résistance des Mycobactéries aux
antituberculeux
Sorbonne Université
Université Pierre et Marie Curie
AP-HP Hôpital Pitié-Salpêtrière
Centre d’Immunologie et des Maladies Infectieuses, Team 13, INSERM U1135
Paris, France
Lee B. Reichman
New Jersey Medical School Global Tuberculosis Institute
Rutgers University
Newark, New Jersey
Blanca I. Restrepo
UT Health Houston
School of Public Health at Brownsville
Brownsville, Texas
Jaime Robledo
Section of Mycobacteria Research
Corporación para Investigaciones Biológicas
Universidad Pontificia Bolivariana
Medellín, Colombia
Milton D. Rossman
Pulmonary, Allergy and Critical Care Division
Department of Medicine
Perelman School of Medicine
University of Pennsylvania
Philadelphia, Pennsylvania
Palash Samanta
University of Pittsburgh Medical Center
Infectious Diseases Section
Pittsburgh, Pennsylvania
Charles V. Sanders
Department of Medicine
Louisiana State University School of Medicine
New Orleans, Louisiana
David Schlossberg
The Lewis Katz School of Medicine at Temple University
The Perelman School of Medicine at the University of Pennsylvania
Philadelphia Department of Public Health
Philadelphia, Pennsylvania
Barbara J. Seaworth
Heartland National TB Center
University of Texas Health Science Center-UT Health Northeast
San Antonio, Texas
Contributors xix

Sorana Segal-Maurer
The Dr. James J. Rahal Jr. Division of Infectious Diseases
NewYork-Presbyterian/Queens
Flushing, New York
Weill Cornell Medicine
New York, New York
Surendra K. Sharma
Division of Infectious Diseases
Department of Medicine
All India Institute of Medical Sciences
New Delhi, India
Alan D.L. Sihoe
Department of Surgery
Li Ka Shing Faculty of Medicine
The University of Hong Kong
Hong Kong SAR, China
José Tiago Silva
University Hospital 12 de Octubre
Unit of Infectious Diseases
Madrid, Spain
Nina Singh
University of Pittsburgh Medical Center
Infectious Diseases Section
VA Pittsburgh Healthcare System and University of Pittsburgh
Pittsburgh, Pennsylvania
Giovanni Sotgiu
Clinical Epidemiology and Medical Statistics Unit
Department of Biomedical Sciences
University of Sassari
Sassari, Italy
Miguel Srougi
Division of Urology
University of São Paulo Medical School
São Paulo, Brazil
Jeffrey R. Starke
Baylor College of Medicine
Houston, Texas
Giorgia Sulis
Department of Infectious and Tropical Diseases
WHO Collaborating Centre for TB/HIV and TB Elimination
University of Brescia
Brescia, Italy
xx Contributors

Jeffrey A. Tornheim
Johns Hopkins University School of Medicine
Division of Infectious Diseases
Baltimore, Maryland
Urvashi Vaid
Department of Pulmonary and Critical Care Medicine
Thomas Jefferson University
Philadelphia, Pennsylvania
Christopher Vinnard
The Public Health Research Institute Center and Department of Medicine
New Jersey Medical School
Rutgers, The State University of New Jersey
Newark, New Jersey
C. Fordham von Reyn
Dartmouth’s Geisel School of Medicine
Section of Infectious Diseases and International Health
Dartmouth-Hitchcock Medical Center
Lebanon, New Hampshire
Risa M. Webb
Division of Infectious Disease
University of Mississippi Medical Center
Mississippi State Department of Health
G.V. “Sonny” Montgomery VA Medical Center
Jackson, Mississippi
Dominik Zenner
Centre for Infectious Disease Surveillance and Control
Public Health England
Institute for Global Health
University College London
London, United Kingdom
Preface

We are pleased to present the Seventh Edition of Tuberculosis and

Nontuberculous Mycobacterial Infections.
Tuberculosis remains epidemic in much of the world, causing several million
deaths each year. Although most of these deaths occur in developing nations,
the developed world continues to struggle with tuberculosis, with evolving chal-
lenges from drug resistance, immigration, immunosuppression, and the expand-
ing awareness of nontuberculous mycobacterial infection.
The previous structure of this book has been maintained. Section I presents
basic concepts of epidemiology, pathophysiology, diagnosis, medical and surgi-
cal therapy, resistant tuberculosis, vaccines, tuberculosis in enclosed populations,
and the role of the health department. Section II describes both classic and more
recently described clinical manifestations of tuberculous infection. Virtually every
organ system is included, as are the endocrinologic and hematologic compli-
cations of tuberculosis. Separate chapters address issues unique to pregnancy,
infants and children, HIV infection, and the immune reconstitution syndrome.
Section III comprises nontuberculous mycobacterial infection, with an overview
of clinical syndromes produced by these organisms as well as individual chapters
on Mycobacterium avium-intracellulare, M. fortuitum and other rapidly growing
mycobacteria, M. kansasii, M. marinum, and additional less common pathogenic
mycobacteria.
Four new chapters have been added. “The Role of Therapeutic Drug
Monitoring in Mycobacterial Infections” explores the vital importance of mon-
itoring serum levels of the antituberculosis drugs; “Crisis-Affected Populations
and Tuberculosis” describes the interrelationship of groups affected by social
upheaval; in “Diabetes and Tuberculosis” we see the growing influence of each
of these afflictions on the other; and “Biologic Agents and Tuberculosis” details
the effect of these increasingly used agents on the incidence of tuberculosis. In

xxi
xxii Preface

addition to the new chapters, every chapter has been thoroughly updated. New
clinical data impact our understanding of interferon gamma release assays, the
HIV-tuberculosis interaction, immune reconstitution inflammatory syndrome,
and extremely drug-resistant tuberculosis. The protean presentations of pulmo-
nary and extrapulmonary tuberculosis continue to challenge the clinician, as does
the growing list of nontuberculous mycobacterial pathogens. Epidemiologic is-
sues include airline-associated infection, the explosion of tuberculosis in areas of
the developing world, and the critical roles of the World Health Organization and
departments of public health in tuberculosis control.
We hope that this text continues to provide a complete and user-friendly re-
source for everyone—clinician, scientist, epidemiologist—involved in the diagno-
sis and treatment of tuberculosis and related infections.
I am grateful for the guidance, wisdom, and professionalism of the staff at
ASM Press, particularly Christine Charlip, Megan Angelini, and Greg Payne.

David Schlossberg, MD, FACP

General
Considerations

I
Another random document with
no related content on Scribd:
 Son 42
of Hammedatha
the Agagite

[57]

[Contents]
Puzzle No. 72
 ROUND AND ROUND
By Persephone

The double round of blacks outlines four good corners

and a center which, while bearing an unenviable five-
spot, would have been virtually impossible of
construction without it. The unkeyed letters should not
cause any trouble.
1 2 3 4 5 6 7 8 9 10 11 12
13 14 15 16
17 18 19 20 21 22
23 24 25 26 27 28
29 30 31 32 33 34
35 36 37 38 39 40 41
42 43 44 45 46
47 48 49 50 51 52 53 54
55 56
57 58 59 60 61 62
63 64 65 66 67 68 69
70 71 72 73 74 75 76
77 78 79 80 81 82 83
84 85 86 87 88
89 90 91 92 93 94 95
96 97 98 99
100 101

[56]
HORIZONTAL

Unremittingly
1 Mean 56proportion
Teach7 Augment
57
Smirch
13 Fish58without pelvic fins
Forth14 The 60
entire men
By word
16 of mouth To move
61 to deep
Examine
17 thoroughly reverence
Private
19 instructor Turf 63
Active
21being or quality Official
65 garment of
A writer’s
23 style Jewish high priest
Crafty
24 Said68to be a wise bird
A tuberous
26 root In the
70direction of
A dull
28finish A distinctive
72 doctrine or
Deposits
29 theory
Commanded
31 Pole74having a flat end
Gambling
34 game Personification
75 of Truth
Exist35 in “Faerie Queen”
Long,36fixed bench The 76
man
Wrath38 Worshiped
77 image
Unclose
39 To speak
79 to
Accomplish
41 Close82
Ancient
42 goddess, Dandy84
personifying night Arid 85
Single
43 performances Bronze
86 or copper
Pointed
45 instrument Equipage
88
End 47 Angry89
Animal
49 One91 chosen, or set
Appropriate
51 apart
Terminal
53 Worship
94
Erases
55 Fluid96rock
Period
98
In the
99midst of
To 100
bind with a bandage
Abode;
101 habitation
VERTICAL

Supersede
1 Singular
48
Black2 Consumed
50
A white3 linen vestment A pin52of wood or metal
Performs
4 Of recent
54 origin
That thing
5 Crafty
57device
Yourself
6 Keener
59
Jewish 7 territorial Arising
62 unexpectedly
organization Lubricant
64
Thus 8 A legume
66
Street9car Natural
67 combination of
Tattered
10 fragment metals
A Mohammedan
11 Pale69
college, or body Smell71
composed of imams, To deface
73
muftis and cadis Employ
75
Marked
12 by indelible Hairbreadth
76
coloring matter, pricked Gems 78
in Color80
Wholly
15 Rested
81
A measure
18 of paper To destroy
83 by slow
Teutonic
19 war god disintegration
A grain
20 A god85
Spikenard
22 Identical
87
Inferior
25 Marble
90
Fuss27 Shelter
92
To discover
30 by close Carnivorous
93
search domesticated
God32 (Ital.) quadruped
Make 33of automobile Dull 95
Goes 37beyond the limit In, on,
97 near or by
of One99 or any
A proprietor
40 under old
Dutch governments of
 New York and New
Jersey
Requires
42
Tablet
43
Rescued
44
Lawful
46

[59]

[Contents]
Puzzle No. 73
 MY SECOND AND LAST
By Joseph A. Margolies

“This is my second and last,” writes J. A. M. “Too

absorbing. Leaves no time to read.” We don’t believe
J. A. M. He underestimates the frailty of the human
soul where cross word puzzles are concerned. He’ll be
at it with ruled paper and pencil again, and then he’ll
swear off again.
1 2 3 4 5 6 7 8 9 10 11 12
13 14 15 16
17 18 19 20 21
22 23 24 25 26 27
28 29 30 31
32 33 34 35 36 37
38 39 40 41 42 43
44 45 46 47
48 49
50 51 52 53 54 55 56 57
58 59 60 61
62 63 64 65 66
67 68 69 70 71 72
73 74 75 76 77
78 79 80 81 82 83
84 85 86
87 88 89
[58]

HORIZONTAL

Napkins
1 Leading
49 part (musical)
Director
4 Music50drama
Beach10 Lure53into danger
Photographic
13 Cichlid
55 fish
instrument Leaps58over
Idle 15 Rodent
60
Pronoun
17 Supreme
61 deity of
Mushrooms
19 ancient Minæans
Mental
20 images Do wrong
62
Pronoun
21 Goddess
63 of dawn
Belief
22 Before
65
Wailing
24 Attempt
66
Tyrolian
26 singing Frogs’
67 spawn
Atmosphere
28 Weight
69 for vessels
Genus29 of lily family Unite72
Between
31 Minor73prophet
Poisonous
32 snake Skins75
Dejected
33 Round76 of years
Reckoning
34 of years Pronoun
78
American
36 humorist Ornamental
79 tape
A condiment
38 Uncover
81
Vulgar
40 fellow Pronoun
83
Rings42 Fraud84
Careful
44 observer Trains
85
Stored
45 for future So 87
reference Bedaubed
88
Implant
47 Pigs89
Prepared
48 for combat

VERTICAL
 Lure 1 Soft 40
drink that is
Before2 11 Vertical sometimes hard
Less hazardous
3 Station
41
Males4 Father43 of Methuselah
Debated
5 Nourished
45
Brads6 Arid 46
Deceit7 Talking
51 bird
Bear 8 East52 or southeast wind
Regret9 Heavy 54 rope
Broom10 Garret56
After11
2 Vertical Not frequently
57
German
12 city Sigh59 with sudden
Egyptian
14 goddess heaving of breast
Speak16 Skill 61
Annoyer
18 Specie64 of poisonous
Interfere
21 tree
Biting
23 Ancient
65 Monastic Order
Ordinary
25 First68appearance
Old fashioned
27 clocks Shelf70
Obstruct
29 Kind71 of tree
Wooden
30 ship Characteristic
72 of
Confirm
32 groups
Notch33 Intimate
73
Enliven
35 Part 74
of body
Where37 the tide meets a Vehicle
76
river current Long77fish (pl.)
Gem39 Jewish80 month (pl.)
What82the cow chews
Exclamation
84
Thus86

[61]
[Contents]
Puzzle No. 74
 QUADRICRUCIFEROUS
By A. C. R.

Twenty-four unkeyed letters—but no two, and only four

three-letter words and a splendid all-over interlock. Not
more than average difficult, but not more than medium
easy. The long words form splendid spinal clews—if
you get them.
1 2 3 4 5 6 7 8 9 10 11 12
13 14 15
16 17
18 19 20 21
22
23 24 25 26 27 28 29
30 31 32 33
34
35 36 37 38 39
40 41 42 43 44
45
46 47 48 49 50 51 52
53 54
55 56 57
58 59

[60]

HORIZONTAL
 Penetrated
1 Rely35 upon
A fruit7 Wearing
37 apparel
Part 13
of the day Length40 measures
A long
14 spear Carried
41 away
A fleet
15 of ships Sound 44 of voice
Finical
16 One45 (Scot.)
A war17horse Girl’s46name
Tight18fitting caps A natural
49 right
Foreign
19 Run 51away
Soup21herb Steppers
53
India22 Marks 54of distinction
Celtic
23hero Always55
Establishes
26 A liquid
56 compound
Paradise
28 Formerly
57
A roundabout
30 way Allures
58
Plain32 Poisonous
59 insects
Metamorphose
34

VERTICAL

Disposed
1 of contents Irish28
hero
Girl’s 2name Heroine
29 in Scott
Musical3 instrument Vase31
Purposes
4 Metallic
33 mineral
Lohengrin’s
5 bride Groups
35 of ten
Flower 6 Contrived
36
Concur 7 Balkers
38
Laborer8 Clothes
39 again
Japanese
9 ornaments Upper42garments
Waterfall
10 A very
43 small pill
Above11 Architectural
47 term
Despotism
12 A color
48
Urgent
20 A large
49 woody plant
 Inclination
24 Lugs50
Rules25 State51of vexation
Glaziers’
26 tacks Other52
Brief27

[63]

[Contents]
Puzzle No. 75
 LOCKED UP TIGHT
By Gregorian

An all-over double interlock with a triply-locked center

and corners. Probably considerably easier to solve
than to construct. The words are weak in spots, but the
construction passes the few obsoletes.
1 2 3 4 5 6 7 8 9 10
11 12 13
14 15 16 17 18
19 20 21 22
23 24 25 26 27
28 29 30 31
32 33 34 35
36 37
38 39 40 41 42 43
44 45 46 47
48 49 50 51
52 53 54 55 56
57 58 59 60
61 62 63 64
65 66

[62]

HORIZONTAL
 Alternate
1 passage Chemical
37 compound
Incomplete
6 Imbecility
38
Fruity
11nut Sharpshooters
41
Those12 who dry by wind Annual
44 Scottish festival
Cheerfulness
14 Adjusted
45
Capable
15 Consume
47
Midday
17 Ounce48 (abbr.)
Man’s19name Salts49of stearic acid
Mountain
21 in Greece Toward
51
Passage-way
22 Chinese
52 tree
Negative
23 Hobo 54(slang)
Shaped
24 like a bull Pert.55
to Asian people
Prefix,
27 of Jog 57
Character
28 in Peer Gynt Flat 58
part of boat’s
Pits 30 bottom
Prefix,
31 footed Color60
Pert.32
to month Taxes61
Settings
34 Mistaken
63
Plaything
36 Cook65by air and heat
Awe-inspiring
66

VERTICAL

Oil 1 Finished
29
Fuse 2 Active
31volcano of West
Thus 3 Indies
Those4 in power Male33 descendant
Naval5officer Pinch35
Decanters
6 Dejected
38
Furrow7 Famous
39 composer
Abraham’s
8 birthplace Throw40 back
A form9 of colored Knotty
41
cotton Classification
42
God10of Love Lay 43
in a supply
 Form11of sugar European
46 mountain
Fuse13 range
Ash 14
kokos Encounter
49
Entrance
16 Brown
50 pigment
In want
18 Famous
53 Scot
Empower
20 Outer
56coat
Compounds
22 of arsenic Egyptian
58 god
Mineral
25 To make
59 a mistake
Dye 26 Exclamation
62
Concerning
64

[65]

[Contents]
Puzzle No. 76