Obrázky stránek

whether this is the organism, we can only determine that by future investigations. It makes us a little skeptical when good men have reported finding organisms which they believe to be the specific organism of the disease. We are always skeptical when a new organism is brought to our attention. This is of more value than the changes which have been reported by other observers, from the fact that, for instance, in the changes we find reported by Van Gehutchten in the perivascular infiltration, which he considered diagnostic of the disease, but which has been found by others not to be present. Then Nelis and others reported a multiplication of the epithelial cells lining the capsule of the ganglionic cells, reporting them as constant in the disease. This was found in other diseases, and was, therefore, not constant. Ravanel and others maintain that it is fairly diagnostic; from the symptoms and changes together a diagnosis can be made. The fact, however, that this body is always constant, whatever it is, in the disease, indicates that it is really of positive diagnostic value, and is, therefore, superior as a causative factor to any of the others that have been recorded in the past.

Dr. Brawner (in closing): It is unnecessary for me to say anything further. In reference to Dr. Smith's. remarks as to the organism passing through a porcelain filter, I will say that it has been proven positively that the organism of rabies will pass through a Berkfield filter, and that this organism passes through two cycles of development, which a great many of the protozoan organisms do, and the Negri body has never been found in the saliva. It is eliminated in the saliva probably, and is of different form, and when it gets in the tissues it undergoes another cycle of development.



For a number of years there has been ascribed to various micro-organisms the specific etiologic role in the production of syphilis, but until quite recently the finding of no organisms has been confirmed a sufficient number of times to justify its acceptance as the specific cause. Experimental inoculations have been made on a number of different animals by a large number of workers, the results of whom, however, have been conflicting and not corroborated by other investigations.

In 1903 Metchnikoff & Roux successfully inoculated a chimpanzee with syphilitic virus from a human being and this was followed by the successful repetition of this experiment on a large number of monkeys. In regard to the susceptibility of the different species of monkeys, Neisser concludes from his experiments on inoculation as follows: "The lower monkeys react with local syphilides, the highest monkeys, namely the chimpanzee, gorilla and orang-outang, react with primary lesions, while the gibbon, which occupies an intermediate position, develops less characteristic primary lesions and fails to show the typical secondary ones.'

Klingmuller and Baermann diluted syphilitic virus with normal salt solution and filtered it by means of the Berk

feld filter. With the filtrate they inoculated themselves, the results being that no lesion of any kind was produced.

Prior to the announcement of the discovery of the parasites which occurred in the lesions of syphilis, Metchnikoff & Roux passed the syphilitic virus through a Berkfeld filter, and with the filtrate inoculated a chimpanzee with a negative result, while inoculating with the unfiltered virus produced a chancre, thus showing whatever the contagion might be it did not pass through the Berkfeld filter, and consequently must be microscopic in size. In addition they have shown that if heated to a temperature of 51 degrees C. the syphilitic virus loses its virulency.

In April, 1905, Schaudinn & Hoffman announced what in all probability appears to be the specific organism of syphilis. This they describe as a thin filamentous spiral· which could only be seen in a living state by the high powers of the best apochromatic lenses. This organism. Schaudinn classified as a spirochetæ, a species which according to Schaudinn belongs to the class of protozoa. These organisms he demonstrated in the superficial secretions of the syphilitic lesions and in the depths of the diseased tissues, and in the superficial enlarged inguinal glands. A few weeks later Schaudinn & Hoffman described another species of spirochetæ, namely, the spirocheta referingens. This organism is larger than the spirochetæ pallida,. is more wavy than corkscrew-like, more refractile and stain with great facility; the spirals are also larger. It was found by him with the pallida in three out of four cases of syphilis.

To discover these exceedingly delicate spirochetæ it is best to use cover-glass preparations made directly from the fresh material taken from the lesions. In the primary lesions, which have been excised, the papules, or condy

lomata, press out as much fluid as is possible from their centers spread on cover-glass, dry and examine. In glands which have been extirpated entirely, simply make a section and press out some of the glandular fluid from the center. If no excision, however, is made and the examination is to be made directly from the chancre or secondary syphilide, curette its surface lightly, and if it is possible squeeze out some of the serum and smear thinly on cover-glass. From a number of measurements I obtained the following results: the length of these organisms vary from 4 to 14 m. averaging about 7 and being somewhat smaller than the other varieties of spirochetæ (Sp. Obermeiri, anseina, ziemanni, buccalis). The width varies from an immeasurable thinness up to about 1⁄2 m. The number of spirals vary from three to twelve and the distance between them was from 34 to 2 m. The movements of these organisms are very characteristic and quite different from those of other spirochetæ. There is first rotation on a long axis, moving forward and backward and undulations of the entire body. There is occasionally suggestions of an undulating membrane but no flagella have ever been demonstrated. The poles are sharply pointed. Practically nothing is known of the finer structure of these organisms, particularly of the nuclei on account of the great difficulty which presents itself in studying such minute structures. These spirochetæ continue to live if the tissue fluid be diluted with normal salt solution and are sometimes motile for six hours after such dilution is made. They behave differently, however, toward concentrated glycerine solution, becoming immotile in five to ten minutes. They then assume many different shapes and often becoming stiff; in one to two hours they lose their spiral shape and may again take back their spiral shape even while under ob

servation, and finally often disappear. Others may gradually draw up into a sort of spiral spindle-shaped structure similar to the malarial sporozoites: this shortening may finally result in short oval figures which may persist for twenty-four hours in a glycerine solution. Similar structures together with typical spirochetæ are sometimes found in stained preparations. All attempts to artificially cultivate these organisms have proved failures.

When this discovery was announced, Schaudin & Hoffman very modestly did not claim to have discovered unquestionably the specific agent of syphilis, but such great interest has been manifested by this discovery which has led to so much work and so many contributions to the subject that the force of so many and so constant findings of this organism in syphilitic disease seems almost to have precluded the possibility of doubt. This work has been greatly added to by the brilliant work of Metchnikoff & Roux. These investigators inoculated twenty-two chimpanzees with the virus from human syphilides and in no case failed to produce the disease. Eight of this number presented secondary lesions, three others presented mucous patches. Small, dry or necrotic papules on seven other chimpanzees, and others showed irregular lesions over the body. The periods of inoculation in these experiments varied from nineteen to sixty-one days. Found sp. p. in seventy-four per cent. of these cases. Buschke & Fischer found spirochetæ in the liver and spleen of a child with congenital syphilis. Levaditi found them in the fluid from a bullæ in a child eight days old. These did not come from secondary infection, as the blisters were not ruptured and the spirochetæ were also found in primary papules.

Levaditi has also succeeded in finding them in the lungs, spleen and liver of congenitally syphilitic children.

« PředchozíPokračovat »