NOTES ON HUMAN SPIEOCH-ETOSIS 63 



This man did not occupy the barrack-rooms, but was the pack store-keeper, who 

 issued clean clothes to the troops, taking the dirty ones and placing them in cloth bags 

 ready for the wash. 



It was found that he not only lived, but also slept, in the same room w'ith these 

 bags of dirty linen, prior to their being sent to the wash. 



Every additional item of evidence on the transmission of this disease is of importance, 

 and this last case seems to help to corroborate the view held by Dreyer, Kirton and 

 Graham W. Smith in Egypt, and by Mackie in India, that lice, Pedicnli vestimentoruin, 

 are the usual carriers of the disease from man to man. 



No definite evidence can be adduced from these cases, for, unfortunately, no Pedicnli. Evidence as to 

 capifit:, vestimentorum or Phthirius pubis were found in the infected cases, since, by P™ ^ ^, 



z ' ± J ^ J i< vector 



the time the diagnosis had been made, their clothes had been sterilised and washed, 

 following the general rule on admission to hospital. 



Further, Dr. Andrew Balfour's experiments with I'ediculi vestimentorum taken from 

 other recruits coming up with these cases, failed, owing to the difficulty of keeping the 

 lice alive. 



Nuttall has proved that Giinex lectularius can convey the disease from mouse to 

 mouse, and Schaudinn found spirochaetes persisting in bugs up to 30 days, but it seems 

 probable that the latter are not the usual transmitters of the disease. 



The six Khartoum military cases were undoubtedl}' bitten by bugs in Cairo and in 

 Khartoum, but no other cases occurred amongst the soldiers in Khartoum, though each 

 case went to a separate barrack-room where bugs existed. 



Dr. Balfour failed to find spirochaetes in bed-bugs taken from the crevices in the 

 wall near the bed of one of the cases. 



The flea is considered not to convey the disease, though it is certainly food for 

 thought that the disease is common in Egypt wdiere fleas abound, while unknown in 

 the Sudan, where this pest is, as far as my knowdedge goes, practically never seen, 

 though Cimex lectularius and Pediculus vestimentorum are common to both countries. 



The case of the pack store-keeper seems to implicate Pediculus vestimentorum rather 

 than the flea or the bed-bug. 



A brief summary of the clinical aspect of the disease is given. Clinical picture 



The duration of the first attack varied from 2-8 days, while the relapses varied from 

 4-6 days. 



One case probably had three relapses, one had two relapses, five had one relapse 

 and one had only one attack of fever. 



The fever usually reached its maximum or thereabouts during the first 24 hours 

 wnth subsequent morning remissions. 



The termination of all, except one, was by crisis with marked diaphoresis. 



Between attacks, and subsequent to the last attack, the temperature was subnormal 

 for some days. 



The case having no relapse showed the highest temperature, 107-4" F., and the 

 pyrexia only lasted two days. 



The spleen was palpable in six cases, enlarged to percussion in one and apparently not 

 enlarged in another. 



Increase in size of the spleen was noted on several occasions during a relapse. 



Seven complained of pain in the splenic region and two had spleens tender to 

 palpation. 



The liver was not enlarged in any case, but was tender and painful in two. 



