492 CHAMBERLAIN. ■ 



Fusiform bacilli and spirochsetge were not detected in any of the 4 

 cases where the Klebs-Loeffler bacilli were found by cultural methods. 

 Prom 44 others of the 106 cases studied, cultures on blood serum were 

 made with negative results as far as the diphtheria bacillus was con- 

 cerned. Many of these lesions showed in smears the presence of large 

 numbers of spirochgetse and fusiform bacilli. In some of them the local 

 appearances were strongly suggestive of diphtheritic infection. 



Nearly all of our positive cases were young adult males, for the most 

 part American soldiers. A few throat lesions among Filipinos were 

 examined. Only one of these had any of the organisms and in this 

 lesion they were not present in preponderating numbers. 



In the patients showing fusifoi-m bacilli and spirochsetse in prepon- 

 derating numbers the clinical appearances and symjDtoms were so variable 

 that no diagnosis based on them could have been of value. As shown in 

 the table the localities affected were diverse. The "ulcers were covered 

 with white exudate in 2 and with soft grayish membranes in 8 cases. 

 Fever was present in 6 of the cases of throat involvement, dysphagia in 

 16 and prostration in 1. Of the lesions on the gums 3 were very painful 

 and 2 were painless. Most of the cases were acute, but 7 were chronic, 

 some having had ulcers for several months. 



On the assumption that carious teeth might be the cause of the fre- 

 quent presence of spirochsetse and fusiform bacilli in the mouth, an 

 examination was made of the material from the interior of the carious 

 teeth of 10 individuals. In the smears from 3 individuals an occasional 

 spirochgeta was found, but "no fusiform bacilli were seen in any instance. 

 We also examined a number of smears from apparently normal tonsils. 

 Most of these were negative, but in some there were a few spirochfetse 

 and very rarely a small fusifonn bacillus. 



PRESENCE OF THE ORGANISMS IN LESIONS OF THE SKIN IN THE TROPICS. 



Tn speaking of tropical ulcer Castellani and Chalmers say: (10) "Vincent 

 believes the affection ( Ulcus tropicum ) to be due to the association of spirochaetes 

 and fusiform bacilli so frequently found in such ulcers. Vincent's observations 

 have been confirmed by Smith and Peil in Sierra Leone, Patton in Aden, and 

 many other observers in various parts of the tTopics." In 1907 Shattuck(6) 

 working in the Philippines reported that of 34 ulcers of the skin examined by him 

 5 contained spirochsetse in the exudate. He states that some resembled Spirochceta 

 refringens and that others appeared intermediate between that organism and 

 Treponema pallidum. He concluded that the spirochsetse were not of etiologic 

 significance because of their absence in sections. He makes no mention of having 

 found fusiform bacilli in the smears from the ulcers, but in his photomicrographs 

 there are some large not very clearly defined, bacilli which somewhat resemble 

 Bacillus fusiformis. 



Howard (13) reports spirochsetae, generally in company with Bacillus fusiformis, 

 to be common in various types of ulceration in Nyasaland, and states that in 

 sections the spirochsetse can be seen spreading into the healthy tissue in advance 

 oi other micro-organisms. He also says they may be found in nearly all foul- 

 smelling neglected ulcers. 



