194 



REVIEW — TEOX'ICAL MEDICINE, ETC. 



Spirochetes 

 and Spiro- 

 chxtosis — 

 continual 



The following are the conclusions of Oppenheimer,' from work performed on 

 S. uhermeieri in New York. They are interesting as comparing the American parasite with 

 S. duttmii and iS. carteri : — 



1. The New York Sjiiivclucta obcrmcieri cannot, yet, as has been attempted, be separated from the i\iri('an 

 spirochaete, upon the following grounds: (1) the length of its stay in the peripheral blood of the rat; (2) the 

 number of relapses in the rat; (3) the lack of figure b aud circular forms ; (4) the absence of several transverse 

 breaks ; for the length of stay in the peripheral blood probably varies with the method of passage, relapses are an 

 uncertain quantity, since it is, perhaps, not positively estsiblished that they occur at all, figure 8 forms and circles 

 aud finally several division zones exist in the New York spirillum as well as in H. diUtoni and in the spirillum 

 of Bombay. 



2. As far as our work is concerned, the parasite merely holds its own in vitro ; we cannot say that we had 

 a culture. 



3. It is not unlikely that the tangles and interwindings, seen during attempts at cultivation on artificial 

 media, are due to the concentration or coagulation of the blood on standing, or the interwindings to fusion or 

 conjugation. 



4. The Spirochete obcrmcieri probably increases by transverse fission and fragmentation. 



5. We have seen no evidence of sporulation (no .spore stain was used) or of a cycle of development, unless 

 the particularly slender forms, short forms, " bands," and interwindings be considered such evidence. The only 

 host studied was the rat. 



6. The variations in the description of the motility are in all likelihood due to differences in the 

 conditions under which the jiarasites are watched. As observed by us, its motility is almo.st precisely like that 

 described by Hoffmann for Hpirochccla pallida. 



7. Perhaps the undulations that pass over the organism are merely an appearance, and the spiral is in truth 

 rigid except for the lateral swayings. 



8. The indication of an undulating membrane in the hanging-drop is the only sign of a definite structure 

 which we have seen, except a deeply stained grain (granules). The absence of a complicated structure, the 

 apparent multiplication by transverse division and fragmentation, the rapidity of multiplication, the length of 

 viability outside of the body, and the persistence of the spiral form in death, point to a bacterium ; whereas the 

 flexibility of the parasite, the indication of an undulating membrane, the inability to cultivate the organism on 

 artificial media, and the death at incubator temperature suggest that the New York Spirochuila obernicicri may 

 be protozoan. 



According to Schaudinn, Spirochceta pallida is not a spirochaete aud not a spirillum, but a treponema. It is not 

 a spirochaete, because of the permanency of its coils, because of its terminal cilium, and because it has not more or 

 less blunted ends. It is not a spirillum, because its spirals are flexible, because it has a single cilium instead of a 

 terminal tuft, and because it apparently divides longitudiually. The New York Spirillicm. obermeicri is certainly 

 flexible and has permanent coils. If against our better judgment we grant in addition that each of its two ends 

 represents a cilium and that the parasite divides longitudiually, then the New York Spirochw-ta oberineieri must 

 be classed with Spirochieta pallida as a treponema. 



Sprue. One has never heard of genuine sprue arising in the Sudan, but I understand 

 that cases of somewhat intractable diarrhoea occur, so that some papers on this interesting 

 condition may be noted. Moreover, the disease has been reported from some parts of 

 tropical Africa, as Cantlie- records in a paper, wherein he also points out that it may attack 

 old residents in the tropics or sub-tropics long after they have permanently taken up 

 residence in Britain. He mentions also that sprue is associated with a diminution in 

 size — an atrophy and atony — of the liver, which would appear more physiological than 

 pathological in character. He believes the disease to be due to fermentative changes of 

 micro-organisiiial or parasitic origin set up in the alimentary tracts of those who have 

 been long resident in hot climates and are therefore debilitated. No definite organism has, 

 however, been isolated. 



The appearance of thrush in the mouth is a fatal sign (but vide infra). Cantlie has 

 never seen a patient recover from sprue after thrush appeared. He condemns the milk 

 treatment and commends the " meat " treatment, which he describes fully as follows : — 



(1) The patient is put to bed, at any rate for a few days ; (2) a wet pack is applied — 

 a towel, or double layer of flannel large enough to reach from nipples to groins, and 

 sufficiently wide to reach half-way round either loin — is wrung out in warm water and laid 

 upon the abdomen. Round the body a large bath towel is wrapped, pulled tight and fixed 

 by safety pins. The wet pack is kept on for two hours at a time, and is to be applied 

 morning and evening ; (3) the patient (unless very ill) is given 5 oz. pounded beef, lightly 

 cooked, for breakfast, luncheon and dinner, with salt to taste, unless the mouth soreness 

 prohibits its use. Every two hours the patient is given jellied beef-tea, beef-jelly, calves'- 

 foot jelly, a plain jelly, all home-made ; the jelly is given also during the night should the 

 patient wake ; (4) dr. 1^ castor oil every morning for first three mornings ; (5) gr. 3 



' Ojjpenheimer, A. (1906), "Laboratory Notes on Spirochaeta Obcrmcieri found in New York." 

 Studies from the Research Laboratory Department of Health, New York, Vol. II. 



= Cantlie, J. (November '2nd, 1905), "Sprue." Uritish Medical Journal, p. 1282, Vol. II. 



Collected 



