Bacteriological Diagnosis 537 



the 14th day. The distribution differs in guinea-pigs and men in that 

 in the latter the number is smaller, degenerative forms more numer- 

 ous and a greater number inclosed within the cells. 



Lesions. — In animals the chief pathological changes are marked 

 jaundice, hemorrhages into or from the lungs, intestinal walls,, 

 retroperitoneal tissues and the fatty tissues of the inguinal region, 

 and cloudy sWelUng of the organs. The liver shows cloudy swelling 

 of the parenchyma, while the color varies according to the degree 

 of jaundice and the quantity of blood present. ■ Microscopically 

 the precipitation of bile is not marked in spite of the presence of jaun- 

 dice and there is no congestion of bile in the biKary tract. The 

 kidneys show parenchymatous nephritis; the lungs large or small 

 hemorrhagic spots; the intestines hemorrhages in their walls. 



Escape of the Spirochcetce from the Body. — In seven cases studied by 

 Inada, Ido, Hoki,.Kaneko and Ito, many spirochsetse were found in 

 the urine from the loth to the 30th day of the illness. The num- 

 ber was sometimes countless. They were chiefly present in cylin- 

 droids and nubeculae and in small numbers in the cylinders. At 

 the time that the urine contains the micro-organisms it is highly in- 

 fectious. A number of the spirochaetse also seem to leave the body 

 in the faeces. Bloody sputum contains such as have escaped in the 

 blood. 



Bacteriological Diagnosis.- — This can sometimes be made by 

 microscopic examination with dark field illumination but best by the 

 injection of 4 to 5 cc. of the blood of the patient into the abdominal 

 cavity of a guinea-pig. Inada, Ido, Hoki, Kaneko and Ito, however, 

 found that the spirochaetse are present in the blood only during 

 what'may be described as ihe first stage of the lesion. Thus, all blood 

 gave positive results on the 4th and 5th days of the disease; on 

 the 7th day one blood gave a positive, the other a negative result; 

 one blood gave a positive result on the 9th day; no blood gave a 

 positive result on the 12 th day. Guinea-pigs thus inoculated 

 show jaundice by the 7th or 8th day. 



During the second stage of the disease, from the 7 th to the 14th 

 day, no spirochaetae are in the blood, the development of immune 

 bodies having destroyed them, but they remain in heart-muscle 

 and kidneys. During this period, though the chnical signs are 

 striking and characteristic, bacteriological confirmation may be diffi- 

 cult. In the third stage of the disease, from the 14th day to conva- 

 lescence, the spirochagtag appear in large numbers in the urine, 

 and bacteriological confirmation of the clinical findings again be- 

 comes possible, by microscopic examination of the urine, by dark 

 field illumination, India ink staining and by guinea-pig inoculation 

 with the urine. Garnier and Reilly* centrifugalize 50 to 150CC. of 

 the urine and inject the sediment suspended in 5 cc. NaCl 

 solution. 



* C. R. de la Soc. de Biol., 1917, lxxx, p. 38. 



