Pathogenesis 437 



The staining is intense, but is rarely uniform, the substance usually 

 being interrupted by vacuoles or fractures, reminding one of those 

 seen in the diphtheria and tubercle bacilli. The organism forms en- 

 dospores sometimes situated at the center, but more frequently to- 

 ward one end. In twenty-four to forty-eight hours filaments are 

 seen. These are of the same diameter throughout, and usually con- 

 tain deeply staining bodies, sometimes round, oftener in bands. 

 ■ Most of the filaments are made up of strings of bacilli, but some 

 stain uniformly. Tunnicliff found that about the fourth or fifth 

 day the spirals made their appearance, sometimes in enormous 

 numbers. As a rule, they stained uniformly, some showed the 

 dark bodies seen in the bacilli and filaments. They had from one 

 to twenty turns, which were not uniform. The spirals were flexible, 

 the ends pointed. The spirals persisted in the cultures, at times 

 for fifty-five days. 



Neither the bacilli nor the spirals showed any progressive move- 

 ment, though with the dark-field illuminator they showed a slight 

 vibratile and rotary movement. No flagella were observed. 



Pathogenesis. — Pure cultures of the organisms were inoculated 

 into guinea-pigs. without result. As in Vincent's angina the throat 

 always contains staphylococci and streptococci, and not infrequently 

 diphtheria bacilli, it is thought by many that Bacillus fusiformis does 

 not initiate the morbid process, but is a secondary invader, by which 

 simpler inflammations are intensified and made necrotic. 



This seems to be particularly true of diphtheria, and may account 

 for the occurrence of noma, in which gangrenous condition of the 

 mouth and genitals the organisms have been found in great numbers. 



Bacillus fusiformis, with the associated spirals are not confined to 

 Vincent's angina, but are found in a variety of other necrotic and 

 gangrenous affections. Vincent* himself found them in all cases of 

 hospital gangrene; Veillon and Zuber,t found them in certain cases 

 of appendicitis; Bernheim and PopischellJ in gangrenous laryngitis; 

 Silberschmidt§ in fetid brochitis; Freejmuth and Petruschky,|| 

 Seiner** and others in noma; Wolbachft in certain chronic ulcers of 

 the legs in Gambia. 



The complete literature of the subject collected by Beitzke, is 

 published in the Centralbl. fiir Bakt. u. Parasitenk. (Referata) 1904, 



XXXV, p. I. 



* "Ann. de I'lnst. Pasteur, 1896, x, 488. 



t "Archiv. de med. Exp.," i8g8, p. 517. 



t " Jahresb. fiir Kinderheilkunde," 1898, xlv. 



§ "Centralbl. f. Bakt, etc.," 1901, Orig., xxx, 159. 



I "Deutsche med. Wochenschrift," 1898, p. 232. 

 ** "Wiener klin. Wochenschrift," 1899, No 2. 

 tt "Journal of Medical Research," 1912-13 xxvii, 27. 



