1884 



DISEASES OF THE RESPIRATORY ORGANS 



Experimental Reproduction. — Chalmers and O'Farrell have suc- 

 ceeded in reproducing the disease in monkeys. Cases of human 

 laboratory infections have been recorded by some authorities. 

 Attempts to infect guinea-pigs and rabbits have failed. 



Method of Infection. — Infection takes place from infected to healthy 

 persons, the spray exhaled in coughing, etc., being contaminated 

 with the spirochaetes or, more probably, according to Fantham, 

 with the resistant coccoid bodies produced by S. bronchialis. It 

 is also probable that a certain number of persons may harbour 

 S. bronchialis, and that a chill or any cause decreasing their organic 

 resistance may induce an increase in its virulence in the same way 

 that a chill may act on the pneumococcus. To this latter possi- 

 bility Violle and others have called attention. 



Symptomatology. — Three types of the disease may be distinguished 

 — -the acute type, the subacute type, the chronic type. 



Acute Bronchospirochcetosis. — In the acute type the patient 

 feels chilly and develops fever, which generally is not very high, 

 rarely exceeding 103° F. The fever may last between two and eight 

 days. The patient coughs a great deal, and may have rheumatoid 

 pains all over the body. The expectoration is scanty, muco- 

 purulent, very seldom containing traces of blood. In most cases 

 the general condition of the patient is not much affected; in others 

 the patient feels very tired and ill. 



Subacute Bronchospirochcstosis. — The attack begins suddenly or 

 gradually, and lasfs between two and several weeks; in many cases 

 there is very little or no fever, and the general condition of the patient 

 may be fairly satisfactory. The cough is frequent and there is often 

 expectoration of pink jelly-like mucus, and true haemoptysis may 

 take place. The physical examination of the chest may reveal 

 nothing at all, or only signs of simple bronchitis ; but at times patches 

 of slight dulness with crepitations may be observed. The blood may 

 show a slight degree of anaemia, but the number of leucocytes is 

 normal, and so is the differential leucocytic count. 



Chronic Bronchospirochcetosis. — Chronic bronchial spirocha^tosis 

 may follow on an acute or subacute attack or several such attacks, 

 but frequently the onset is quite insidious and slow. The patient has 

 a chronic cough, which is in certain cases more severe in the morning. 

 The expectoration is not very abundant, and may be muco-purulent 

 in character, but in many cases for periods of two or three days, and 

 even much longer, the expectoration contains blood. Sometimes 

 attacks of genuine haemoptysis occur, one or two teaspoonfuls or 

 much more of blood being expectorated. In some cases there is no 

 fever; in others a true hectic-like fever may be present. In some 

 cases, however, the rise of temperature takes place in the morning, 

 and not in the afternoon; in others the fever is present only occa- 

 sionally, and is very irregular. The physical examination of the 

 chest reveals in many cases very little except a few dry or coarse 

 moist rales. In others there may be signs of consolidation. The 

 general condition may remain fairly good for a long time, though a 



