COMPLICA TIONS—TREA TMENT 



1885 



certain degree of anaemia is often present. A few cases waste 

 rapidly. 



The course of the disease maybe prolonged, with periods of great 

 improvement and even apparent cure. 



BronchospirochcBtosis in the Lower Animals. — Mendelson in Siam has 

 recently made the interesting observation of the occurrence of a form of 

 bronchopulmonary spirochaetosis in cats. 



Complications. — Pneumonia and bronchopneumonia have been 

 observed. Rhinitis has been noted. The disease may be com- 

 plicated with tuberculosis and bronchomycosis. 



Diagnosis. — This is based on the microscopic examination of the 

 expectoration collected after rinsing the mouth and gargling with 

 sterile water. The sputum may be examined fresh, using the dark 

 ground illumination, or may be stained, using one of the 

 many modifications of the Romanowsky stain, or nitrate of silver 

 staining methods, such as the Fontana-Tribondeau, may be em- 

 ployed. The Spirochceta hronchialis is generally present in large 

 numbers, while bacteria are very few. 



Differential Diagnosis. — The acute type is often mistaken for 

 influenza or malaria. The examination of the sputum, in which no 

 Pfeiffer's bacilli are found, will distinguish the affection from 

 influenza, and the examination of the blood will exclude malaria. 



Cases of the subacute and chronic type presenting blood in the 

 expectoration are generally diagnosed as phthisis. The examination 

 of the sputum for tubercular bacilli will be always negative, and the 

 animal inoculations will remain without effect. The ophthalmo- 

 and cuti-reactions are negative in the great majority of cases. 

 Occasionally, however, cases of mixed infections of tuberculosis and 

 spirochaetosis occur. From bronchomycosis the affection is dis- 

 tinguished by the absence of fungi; cases of double infection, how- 

 ever, bronchospirochsetosis, and bronchomycosis, may at times be 

 observed, though very rarely, 



Spirochaetosis is easily distinguished from endemic haemoptysis 

 by the examination of the sputum, which will show absence of the 

 ova of Paragonimus ringeri Cobbold, and from bronchomycosis by 

 the absence of fungi. 



Prognosis. — The prognosis is favourable quoad vitam, but the 

 disease may take a chronic course with anaemia and wasting. 



Treatment. — In the acute cases all the symptoms as a rule 

 disappear after a few days' rest in bed. Codeine (J grain) and 

 aspirin (5 grains) may be administered when the cough is painful 

 and the patient complains of rheumatoid pains. In the subacute 

 and chronic types of the disease, arsenic, introduced by Castellani in 

 the treatment of the malady since 1906, gives good results. It may 

 be administered by the mouth in the form of liquor arsenicalis or 

 arsenious acid pills, or may be given subcutaneously in the form of 

 cacodylates. Plant and Galli Valerio recommend salvarsan. 

 When the expectoration is profuse, glycerophosphates and balsamics 

 are useful. 



