346 Ulcerative Granuloma of the Pudenda 
So far as I am aware, Cleland is the first to supply this proof of the 
connexion of spirochaetes with the malady. 
In the specimens which I examined, the spirochaetes were ac¬ 
companied by large numbers of bacterial forms. These were found 
wherever the spirochaetes lay, and were absent where the latter were 
absent. The bacteria were very irregular in shape and size, ranging 
from granules about \—\p in diameter and slender rods (2 or 3p by \p) 
to large rod-shaped organisms, often pretty sharply curved, some 6/j, in 
length and about \p in thickness (Fig. 5). The question of the 
relationship of the bacteria to the spirochaetes is of importance in 
connexion with that of the aetiology of the disease. Both organisms 
lay deeply in the tissues and were present in large numbers. The 
bacteria did not resemble, so far as I could judge, any of the known 
agents of infective disease: at the same time it seems unlikely that 
mere saprophytes could establish themselves in such numbers at a point 
so far from the surface. Hence there is a probability that either the 
spirochaetes or the bacteria are the causal agents of the ulceration. If 
this be so, the coexistence of the two forms might be explained either as 
an example of symbiosis or on the ground that they represent different 
stages in the development of the same organism. On the latter 
hypothesis transitional stages might be seen either in the small slender 
bacterial forms, corresponding as they do with the spirochaetes in 
thickness and possibly representing the results of transverse division, or 
in the spherical granules which resemble bacterial spores and may be 
the granules seen at the extremities and occasionally in the substance of 
the spirochaetes. 
In this connexion it is interesting to recall that in Vincent’s angina 
fusiform bacilli and spirochaetes invariably coexist, and that Ruth 
Tunnicliffe believed that the latter developed in cultures of the former; 
that rod-like bodies were found along with spirochaetes on the surfaces 
of ulcerated cancers by Hoffmann and by Loewenthal; that bacteria 
and spirochaetes were found together in onychia by Dutton, Todd and 
Tobey; that Levaditi states that vibrio-forms develop from spirilla in 
E. African tick-fever; and that Castellani in yaws and Leuriaux and 
v. Geets in syphilis found oval forms, which the latter authors regard as 
spores from which the Treponema develops. In several of these cases, 
the question of symbiosis or of varying forms of the same organism is 
undecided. Markham Carter regards the bacteria present along with 
the parasites (Helcosoma tropicum ) in Oriental Sore as symbiotic. The 
need for such partnership might constitute one of the difficulties in 
