1 882 DISEASES OF THE RESPIRATORY ORGANS 



discharge, occasionally a slight cough. The patient may complain 

 of headache, and there may be some slight fever. 



In a few days, as a rule, all the symptoms disappear, but occasion- 

 ally the affection may run a much longer course, and may spread 

 to the larynx, trachea, and bronchi. In two cases of bronchitis 

 following an attack of spirochsetic coryza above described Castellani 

 observed in the expectoration the same type of spirochaete, and 

 it would appear, therefore, that there may be several types of 

 bronchial spirochsetosis. 



Diagnosis. — This is based on the microscopical examination 

 of the nasal and pharyngeal secretion. The beginner should be 

 careful not to recognize as spirochsetes detached cilia and segments 

 of undulating fibrin threads. 



Prognosis. — This appears to be favourable. 



Treatment. — A carbolic cocaine spray (carbolic acid 3 minims, 

 cocaine hydrochloride i grain, water i ounce) will be found useful. 

 Aspirin, pyramidon, and quinine may be administered internally in 

 5 grain doses three or four times daily. In cases running a pro- 

 tracted course arsenic may be tried. 



In a few cases of naso-pharyngitis preceding, at times, typical cases of 

 bronchospirochaetosis the nasal and pharyngeal secretion may contain S. 

 bronchialis, though this is rare. Several aetiological types of nasal spirochaetosis 

 might therefore be, perhaps, distinguished. In the tropics one comes across 

 occasionally ulcerative affections of the nose, with presence of numerous coarse 

 spirochsetes and Bacillus fusiformis, but these conditions have nothing to do 

 with true rhino-pharyngitis spirochsetica. 



BRONCHIAL SPIROCHiETOSIS. 



Synonyms. — Castellani's bronchitis (Galli Valerio), Spirochetose 

 bronchopulmonaire de Castellani (Violle), Bronchite sanglante 

 (Violle). 



Definition. — A type of bronchitis and broncho-alveolitis charac- 

 terized by the presence of enormous numbers of spirochsetes in the 

 expectoration. 



History. — The affection was described by Castellani in 1905 

 and 1906. He named the causative spirochaete S. bronchialis in 1907. 

 Castellani's findings were speedily confirmed by Branch, in 1906 

 and 1907, in Kingstown, St. Vincent, and by Jackson, in 1908, in 

 the Philippine Islands. In 1909 Waters described numerous cases 

 of the disease occurring in India, and Phalen and Kilbourne a case 

 in the Philippine Islands, where, in 1911, Chamberlain recorded two 

 further cases. 



In 1913 Chalmers and O'Farrell carried out an investigation 

 on the malady in the Sudan, and succeeded in reproducing it in 

 a monkey. In 1914 Taylor investigated the condition in Uganda. 

 In 1915 Fantham published a classical paper onSpirocheta bronchialis, 

 studying it completely from a morphological point of view, and de- 

 scribed its granular stage and the intracellular forms of the parasite. 



In the same year Macfie reported cases from West Africa, and 



