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REVIEW — TROPICAL MEDICINE, ETC. 



Spirochaetes 

 and Spiro- 

 chaetosis — 



canlinued 



majority of wliich arc phagocytosed by the spleen. Sonic of tbem become encysted and 

 break up into very small bodies out of which the new generation of spirochaetes is evolved." 

 A coloured plato illustrates the various appearances mentioned. 



Loghem,' following up this work, and using Levaditi's method for the organs of 

 infected rats, found at the height of infection atypical forms in the liver and spleen. 

 These can bo recognised only by their staining reactions, by the conditions under which 

 they are found, and by the presence of intermediate stiges. They occur as small, 

 circular, or oval, tightly-coiled spirals, about half the size of a red blood cell. These are 

 the encysted forms of Breinl and Kinghorn, the " agony forms " of Levaditi, preceding 

 further stages of degeneration and disintegration, the " resting stages " of Prowazek, who 

 takes quite a different view of them. They were most commonly seen in the liver, and 

 usually within the phagocytes, not in the lumen of the capillaries. Loghem thinks Levaditi is 

 correct in his supposition that these forms are due to the influence of phagocytosis. 

 A French paper by Levaditi and Manouelian- deals with much the same questions, and 

 may be consulted with advantage. 



Carter' investigated the presence of S. duttoni in the ova of Ornithodoros wouhata, 

 and concludes that the ticks infected by spirochaetes lay infected eggs, that multiplication 

 of the spirochaetes probably takes place in the eggs, and that morphological changes in the 

 spirochaetes also occur in the eggs. Illustrations of the curious banded and swollen forms 

 met with in the eggs of the tick are given. Moller's work (Berlin, 1907), with monkeys, has 

 shown that a tick may remain infective for one and-a-half years and that the infection may 

 be conveyed to the third generation of ticks. 



Eogers'' describes the Indian form and mentions that Sandwith has observed the 

 disease in Egypt. The latter author,^ indeed, describes Egyptian relapsing fever at 

 considerable length, noting that it is more common in the Delta than in Upper Egypt 

 or the Sudan, and mentioning its tendency to occur along with typhus. The symptoms 

 of the Indian fever are given very fully by Eogers, and amongst special symptoms one 

 notes slight enlargement of the liver and of the spleen, jaundice, and a rash which occurs 

 in about 10 per cent, of the cases. The rash appears on the front or sides of the chest 

 or abdomen, or on the arms and more rarely on the legs, and is in the form of clusters 

 of minute red blotches or stains. 



Atypical forms of the fever occur, simulating malaria and typhus fever. The latter, 

 constituting usually fatal forms, have been described by Carter as " Icteric Fever," 

 owing to the presence of intense jaundice. Such cases might be mistaken for yellow 

 fever and Weil's disease. Lowenthal's reaction is mentioned as an aid to diagnosis during 

 the intervals when there are no spirilla in the blood. A drop of blood from the suspected 

 case is mixed with another drop containing spirilla from a case in the febrile stage, sealed 

 under a cover glass and incubated at 37° C. for at least half an hour. Clumping and loss 

 of motility indicate relapsing fever, provided a control is negative after not more than two and 

 a half hours. 



The work of Mackie on bed-bugs as carriers of the disease is quoted as follows : — 



Quite recently the question of the mode of infection of relapsing fever in Bombay has been investigated 

 by P. Percival Mackie, I.M.S. On examining bed-bugs at various intervals after being fed on monkeys infected 

 with the disease, the spirilla was found up to the fourth and seventh days respectively in two series of 

 experiments in the upper part of the alimentary tract only, together with fi-esh blood. Out of fifty-three bugs 

 from the relapsing fever ward, spirilla were only found in the stomach of one. Of six monkeys, into whose 

 cages bed-bugs were frequently placed, only one contracted the disease. Dr. Mackie also informs me that the 

 disease can be transmitted by the punctures of a grooved needle carrying a trace of fresh blood, so that it 

 appears to be not unlikely that mosquitoes might thus convey it from one patient to another, which would 

 account for the infection in wards not being most commonly between neighbouring beds, as Vandkye Carter 

 pointed out. For this reason mosquitoes may be a more likely carrying agent than ijed-bugs, and are worthy of 

 close attention. The disease was also transmitted by oral feeding with slightly larger quantities of blood, the 

 incubation stage being prolonged to four or five days. Blood drawn during an apyretic interval, with no spirilla 

 in the blood, also infected monkeys, the fever developing late at the same time that a relapse occurred in the man 

 from whom it had been taken." 



' Loghem, J. Q. van (February 29th, 1908), " Some Notes on the Morphology of S. duttoni in the Organs of 

 Rats." Annals of Tropical Medicine ami Parasiloloyy. Series T.JI., Vol. I., No. 4. 



= Levaditi, C, and Manouelian, Y. (April 25tli, 1907), " Recherchcs sur I'infection provoqut-e par le Spirilla 

 de la Tick-fever." Ann. de I'InstitiU Pasteur, t. XXI., No. 4. 



= Carter, R. M. (February Ist, 1907), " The presence of .S'. duttoni in the Ova of Ornithodorus moubata." 

 Annals of Tropical Medicine and Parasitology. Series T.M., Vol. I., No. 1. 



* Rogers, L. (1908), " Fevers in the Tropics." 



• Sandwith, F. M. (1905), " The Medical Diseases of Egypt." Part I. 



