HIDEYO NOGUCHI 479 



organism appears more like a spirillum than a treponema or leptospira. It looks, in 

 fact, very much like the spirillum of rat-bite fever (S. morsusmiiris). It is described 

 by Kuhn and Steiner as being moderately active, somewhat wormlike, seldom rota- 

 tory, and as having a short, straight flagellum at either end. 



The treponemas causing relapsing fevers {Figs. 48-^6). — Relapsing fever was rec- 

 ognized as an independent febrile disease by the British observers of the eighteenth 

 century and the early part of the nineteenth. William Jenner' and others differentiated 

 it from typhus and typhoid fever, and many recognized its existence in various parts 

 of the world. It was Obermeier,^ however, who provided the requisite criterion for 

 recognition of sporadic cases and variant types of the disease by finding the organism, 

 which was named S pirochaeta recurrentis by Lebert-' in 1874. The discovery was made 

 in 1868 and announced in 1873. Carter^ had confirmed Obermeier's finding in India 

 and established the etiological relation of the organism to relapsing fever by repro- 

 ducing the disease in the monkey {Macacus radiatus). Relapsing fever is of wide- 

 spread occurrence, and it appears to be the same disease no matter where it occurs. 

 The only difference which has come to be recognized is in the intermediate hosts of 

 the parasites. The so-called "tick fever" of Africa is transmitted by Ornithodoros 

 monbata,^ the European and East Indian relapsing fevers'^' are transmitted by lice and 

 perhaps also by bedbugs. The mild type of relapsing fever occurring on the American 

 continent is carried by the tick Ornithodoros talajeJ In the fowl relapsing fever an- 

 other tick, Argas persicus, is the vector.* 



All forms of relapsing fever are clinically identical. The incubation period is usually 

 about a week. Onset is sudden, with chills, followed by febrile paroxysms and intense 

 headache. Muscular and leg pains are very characteristic, and arthritic pains with- 

 out any inflammatory or other joint symptoms not infrequently occur. There is a 

 moderate enlargement and tenderness of the spleen. The fever suddenly ends by 

 crisis. The duration of the initial paroxysm is variable, usually three to four days, and 

 the intermission lasts from four to fourteen days. The period of relapse may be as 

 short as a few hours or longer than the primary fever. The number of relapses varies. 

 The pulse rate is usually high during the paroxysms (90-110). Nausea and vomiting 

 are among the most common symptoms. In severe cases slight jaundice may be 

 noticed after each paroxysm. Epistaxis may occur. Spirochetes are usually present 

 during the paroxysm. 



The infection is transmissible to monkeys and rats or mice. Rats usually show no 

 signs of illness. All the strains of pathogenic blood spirochetes are maintained in the 



'Jenner, W.: Lectures and Essays, i84Q-i8yQ. London, 1873. 



' Obermeier, O. : Berl. klin. Wchnschr., 10, 152. 1873. 



^Lebert: Ziemsscn's Handb., 2, 267. 1874. 



■• Carter, H. V.: Deutsche tned. Wchnschr., 5, 189. 1879. 



s Button, J. E., and Todd, J. L.: loc. cit. 



^Nicolle, C, Blaizot, L., and Conseil, E.: loc. cit.; Sergent, E., and Foley, H.: Ann. del' lusl. 

 Pasteur, 24, ^^y. 1910; Schellack, C: Arh. a. d. kaiserl. Gesundheitsamle, ^o, ^$1. 1909; Centralbl.f. 

 Bakteriol., 46, 486. 1908. 



'Bates, L. B., Dunn, L., and St. John, J. H.: Am. J. Trap. Med., i, 183. 1921. 

 * Marchoux, J*;., and Salembeni, A.: loc. cit. 



