REVIEW — TEOPICAL MEDICINE, ETC. 193 



Mackie^ suggests the name Spirillum carteri for the Indian parasite. Spirochaetes 



and Spiro- 



Later work- by the same author is of great interest and importance, for it goes to prove chstosis— 

 that the body-louse, Pediculiis corporis, is probably a transmitter of the disease. He continued 



investigated an outbreak at a mission settlement in India and summarises his investigations 

 and conclusions as follow : — 



1. An epidemic of relapsing fever broke out in a mixed settlement of boys and girls living under similar 

 conditions. 



2. A very high percentage of the boys fell victims to the disease in the course of a few weeks. 



3. A much smaller percentage of girls fell ill and at infrequent intervals extending over three months. 



4. The most notable factor in which the boys differed from the girls was that they were infested with body- 

 lice, from which parasite the girls were almost free. 



5. A well-marked percentage of the lice taken from the infected ward contained living and multiplying 

 spirilla. 



6. The stomach of the louse was the chief scat of multiplication, aud this was carried on in the face of 

 active digestion and after the disappearance of all other cellular elements. Other organs became secondarily 

 infected. The secretion expressed from the mouth of infected lice contained numbers of living spiiuUa, and they 

 also existed in greater or less numbers in the upper alimentary tract. The ovary was frequently infected, but 

 spirilla were not found in deposited ova. 



7. With the increase of the epidemic amongst the girls, body-lice became more in evidence. 



8. With the subsidence of the epidemic amongst the boys, the percentage of infected lice fell. 



9. An attempt to infect a monkey by means of lice failed. 



I think that the above facts are sulEcient to throw grave suspicion on the body-louse as a transmitter of 

 relapsing fever. Many epidemiological facts point to this mode of transmission as being a likely one, and the 

 life-history and habits of body-lice as outlined above show how well these parasites fulfil the necessary conditions 

 for spreading the disease. 



Thus relapsing fever has always been associated with poverty-stricken, overcrowded, and 

 half-starved communities, and it is under just such conditions that lousiness is at its worst. 

 Again, in mixed communities, as in Bombay, the disease attacks the poor, dirty and low- 

 caste living in squalid tenements, to the exclusion of those of cleanly habits and better 

 conditions of life. 



Relapsing fever is a "personal" and not a "place" disease, and among stricken 

 communities the infection spreads from person to person very rapidly after only a few days' 

 exposure, and mere contiguity without contact is not sufficient to carry on the infection. 



It is probable that the infected secretion of the louse's mouth is the medium responsible 

 for transmission during the height of an epidemic, but whether the ovarian infection plays 

 any part in the linking together of epidemics or in the carrying over of the disease during 

 the off season it is at present impossible to say, but the failure to find spirilla in nits is rather 

 against this theory. 



The same epidemic is described by Landon,^ who also mentions the presence of lice, and 

 states that in native circles relapsing fever is called " Lice Plague." He mentions the value 

 of adi-enalin chloride for heart-failure occurring in the course of the fever. It can be given 

 in 1 : 1000 solution, as sold, in doses of 5 to 30 minims. In less urgent cases, 10 minims of 

 1 : 5000 solution every four hours were found to have a remarkable effect. 



Sergent and Foley^ have made observations, clinical and experimental, tending to 

 implicate the clothes-louse, Pediculus vestimenti, in South Oran in Algeria. Their work, so far, 

 is only of a preliminary character and need not be detailed. 



Desai' deals with the clinical features of the Indian disease, which, he says, is 

 frequently mistaken for plague in Bombay. He mentions pains in the calves as a prominent 

 symptom constantly present, and speaks of the "air hunger" respirations which are 

 relieved by quinine. 



1 Maekie, F. P. (September 21st, 1907), "A Preliminary Note on Bombay Spirillum Fever." Lancet,Yol. II. 



- Maekie, P. P. (December 14th, 1907), "The Part played by Pediculus Corporis in the Transmission of 

 Relapsing Fever." British Medical Journal, Vol. II. 



^ Landon, E. (December, 1907), "Some Clinical Observations on Relapsing Fever." Indian Medical Oazette, 

 Vol. XLII. 



■* Sergent, E., and Foley, P. H. (March 2nd, 1908), " Pievre r^currente du End-Orunais et Pediculus 

 vestimentis," note Pr(51iminaire. Bitll. Soc. Path. Exot., Vol. I., No. 3. 



" Desai, V. Q. (July 16th, 1906), "A Clinical Picture of Relapsing Fever." Journal of Tropical Medicine 

 and Hygiene, Vol. IX. 



