ASSOCIATED SPIROCH^T^ AND FUSIFORM BACILLI. 495 



Case II. — Cassas, civilian employee, age 25. Tribe, Tagalog. Admitted to 

 liospital October 31, 1910. Family history unknown. No previous illness. 

 During last two months has had slight chills and fever at irregular intervals. 

 Since shortly before entry had a cough with muco-purulent expectoration. Some 

 headache, no diarrhoea. Fairly well nourished, nothing abnormal found on 

 physical examination except fever which pursued a typical typhoid course for a 

 period of twenty-seven days when the temperature became normal for one week 

 since which time (three weeks) it has been subject to irregular and unaiccountable 

 elevations. The Widal reaction was partial November 1, and positive November 3. 

 On November 1, Bacillus typhosus was obtained from a blood culture. On 

 November 22 a stool culture for the same organism was positive. 



This patient became very ill as his disease progressed. On November 4 he 

 vomited a great deal. The spleen became palpable. Subsequently pulse became 

 dicrotifc and weak and tympanites developed. On November 14 complained of 

 sore throat and a patch of exudate appeared on the left tonsil. This was negative 

 for diphtheria and did not shoto the spirochcetce and fusiform bacilli associated 

 loith Vincent's angina. On November 17 the throat symptoms had disappeared. 

 On November 20 patient was verj^ weak and began to cough up bloody sputum. 

 This bloody expectoration lasted for several days and was quite profuse. After 

 the temperature reached normal the patient gradually impi'oved and the cough 

 disappeared. 



In this case the blood was negative for malaria. The leucocytes ranged from 

 8,500 to 12,800. The differential count showed nothing of interest; polymorpho- 

 nuclears 68 per cent, small lymphocytes 30 per cent, and large mononuclears 

 2 per cent. The urine during the height of the fever showed a trace of albumin 

 and a few hyaline casts. The stools showed ova of Tricocephalus dispar, and 

 Cercomonas intestinalis, but no amcebffi. 



After the appearance of bloody sputum an examination on nine occasions was 

 negative for tubercle bacilli and on one occasion an acid-fast bacillus shorter and 

 thicker than the tubercle bacillus was found. This specimen was inoculated into 

 a guinea pig and at the end of eight weeks the animal was alive and well. At 

 autopsy it showed no indications of tviberculosis. 



On one occasion motile amnebre and a flagellate resembling a cercomonas were 

 found in the sputum. 



The character of the sputum was the same as in the preceding case except 

 that it was blood-stained at times. It was found to contain large numbers of 

 spirochaetse associated with many masses of bacilli and cocci. An occasional large 

 fusiform haoillus loas seen. The spirochsetse were found constantly present for a 

 period of two weeks. After a lapse of nearly two weeks more (December 31, 

 1910), the patient meanwhile having greatly improved in condition and the blood 

 having disappeared from the sputum, spiroehsetse were still present in considerable 

 numbers though not as numerous as at the time of the hsemorrhage. The sputum 

 at this time, obtained only after forced coughing, was thin and watery with great 

 nimibers of the small, gray flakes described in Case I. There were no blood 

 corpuscles. 



The spiroch^tse in both cases were similar in motility, shape and size, 

 averaging about 15 /i, in length. They were thin and delicate and 

 resembled the thir4 class described by Castellani except that none having 

 one blunt point were noticed. (lO) In one of the patients (jSTumber II) 

 there were found a few fusiform hacilli similar to those which are seen 



