Spirochetal Pulmonary Gangrene

Ever since Obermeier, in 1873, reported the presence of micro- organisms of the genus spirocheta, or spirilla, in the blood of patients with relapsing fever, many diseases have been found to be caused by varieties of this species.The most important disease due to spirochetal infection is, of course, syphilis, to which etiologic rela- tionship of the Spirochaeta pallida was demonstrated by Schaudinn and Hoffman in 1905.Castellani subsequently found that frambesia tropica, or yaws, was caused by the Spirochaeta pertenuis.The eti- ologic relationship of spirochetes to Vincent's angina, Weil's disease, rat bite fever and pyorrhea alveolaris has likewise been demonstrated.It is, however, not so well known that certain pathologic processes in the bronchi and lungs are due to the activity of these micro- organisms.Many years ago, Eichhorst stated that he found spiro- chetes in the sputum of some patients suffering from bronchitis.Bertarelli and Volpino observed Spirochaeta buccalis and Spirochaeta pallida in the sputum of patients affected with heart disease.These observations were not confirmed until Aldo Castellani1 reported two cases of hemorrhagic bronchitis presenting symptoms simulating those of pulmonary tuberculosis, but no tubercle bacilli could be discovered in the sputum either microscopically or by animal inoculation.In these cases large numbers of spirochetes were found in the sputum.Although Castellani pointed out that similar organisms were also found in the saliva and the superficial scrapings of the gums of his patients, he was inclined to ascribe an etiologic relationship of the spirochetes to the pulmonary disease.From a study of his cases Castellani arrived at the conclusion that, at least in Ceylon, there is a form of bronchial and pulmonary dis- ease caused by spirochetes.To this disease he gave the name of bronchial spirochetosis.These findings attracted attention and soon many other observers reported similar cases seen in the tropical world.Jackson, Phalen and Kilbourne 2 and Weston R. Chamberlain 3 reported cases from the From