﻿NOGUCHI 
  FLEXNER 
  605 
  

  

  solution 
  which 
  he 
  found 
  was 
  undoubtedly 
  aided 
  by 
  the 
  fact, 
  already 
  

   determined 
  in 
  1910, 
  that 
  the 
  warty 
  or 
  verrugous 
  lesions 
  appearing 
  on 
  

   the 
  skin 
  bear 
  a 
  relationship, 
  if 
  a 
  disputed 
  one, 
  to 
  Oroya 
  fever, 
  and 
  they 
  

   had 
  actually 
  been 
  already 
  communicated 
  by 
  inoculation 
  to 
  monkeys. 
  

   It 
  was, 
  indeed, 
  this 
  disputed 
  relationship 
  which 
  led 
  the 
  Peruvian 
  

   medical 
  student. 
  Carrion, 
  in 
  1885 
  to 
  inoculate 
  himself 
  with 
  material 
  

   taken 
  from 
  the 
  warty 
  formations, 
  from 
  which 
  a 
  fatal 
  attack 
  of 
  Oroya 
  

   fever 
  developed. 
  Since 
  this 
  time 
  the 
  composite 
  malady 
  is 
  often 
  called 
  

   Carrion's 
  disease. 
  

  

  The 
  rods 
  yielded 
  to 
  artificial 
  cultivation, 
  and 
  with 
  the 
  cultures 
  

   Noguchi 
  was 
  enabled 
  to 
  reproduce 
  both 
  verruga 
  peruana 
  and 
  the 
  

   equivalent 
  of 
  Oroya 
  fever 
  in 
  monkeys. 
  Moreover, 
  the 
  rods 
  have 
  been 
  

   cultivated 
  repeatedly 
  from 
  verrugous 
  nodules 
  sent 
  to 
  New 
  York 
  from 
  

   Peru. 
  The 
  bacterial 
  incitant 
  of 
  Carrion's 
  disease 
  having 
  been 
  estab- 
  

   lished, 
  Noguchi 
  turned 
  his 
  attention 
  to 
  the 
  manner 
  in 
  which 
  infection 
  

   arises, 
  

  

  A 
  good 
  many 
  acute 
  observations 
  made 
  by 
  Peruvian 
  physicians 
  and 
  

   others 
  had 
  already 
  indicated 
  that 
  direct 
  transmission 
  from 
  person 
  to 
  

   person 
  did 
  not 
  occur. 
  Indirect 
  evidence, 
  indeed, 
  pointed 
  to 
  an 
  insect 
  

   carrier 
  or 
  vector 
  of 
  the 
  microorganism. 
  An 
  American 
  entomologist, 
  

   Charles 
  H. 
  Townsend, 
  who 
  had 
  studied 
  the 
  subject 
  minutely 
  had 
  con- 
  

   cluded 
  that 
  this 
  vector 
  belonged 
  to 
  the 
  phlebotomus 
  class 
  of 
  nocturnal 
  

   blood-sucking 
  insects. 
  He 
  even 
  went 
  so 
  far 
  as 
  to 
  name 
  the 
  supposed 
  

   vector 
  Phlebotomus 
  verrucarum. 
  

  

  Just 
  before 
  sailing 
  for 
  Africa, 
  Noguchi 
  planned 
  a 
  definitive 
  investi- 
  

   gation 
  of 
  this 
  question. 
  Through 
  the 
  cooperation 
  of 
  the 
  Rockefeller 
  

   Foundation, 
  Raymond 
  C. 
  Shannon 
  was 
  sent 
  to 
  Peru 
  to 
  study 
  the 
  insect 
  

   life 
  of 
  the 
  valleys 
  in 
  which 
  verrugas 
  and 
  Oroya 
  fever 
  abound. 
  He 
  was 
  

   to 
  collect 
  and 
  send 
  insects 
  falling 
  under 
  suspicion 
  to 
  New 
  York, 
  where 
  

   the 
  inoculation 
  and 
  culture 
  experiments 
  were 
  to 
  be 
  made. 
  All 
  this 
  

   was 
  carried 
  out 
  precisely 
  as 
  Noguchi 
  had 
  arranged 
  it, 
  with 
  the 
  result 
  

   that 
  the 
  vectors 
  of 
  Carrion's 
  disease 
  have 
  now 
  been 
  determined 
  to 
  be 
  

   insects 
  of 
  the 
  class 
  of 
  phlebotomi, 
  as 
  Townsend 
  believed, 
  and 
  Shannon 
  

   has 
  succeeded 
  in 
  identifying 
  two 
  species, 
  P. 
  verrucarum 
  and 
  P. 
  nogu- 
  

   chii, 
  which 
  certainly 
  carry 
  Bartonella 
  hacillvformis, 
  and 
  a 
  third 
  species, 
  

   P. 
  peruensis, 
  which 
  is 
  in 
  this 
  respect 
  still 
  in 
  doubt. 
  

  

  Noguchi's 
  investigations 
  of 
  trachoma 
  fall 
  into 
  two 
  periods. 
  The 
  

   first 
  one 
  dates 
  from 
  1910 
  to 
  1913, 
  in 
  which 
  he 
  studied 
  cases 
  of 
  the 
  dis- 
  

   ease 
  in 
  New 
  York. 
  Nothing 
  especially 
  significant 
  came 
  from 
  this 
  study. 
  

   But 
  the 
  investigation 
  made 
  in 
  1926 
  of 
  cases 
  of 
  Indian 
  trachoma 
  at 
  

   Albuquerque, 
  N. 
  Mex., 
  led 
  to 
  a 
  wholly 
  different 
  result. 
  This 
  investiga- 
  

   tion 
  was 
  promoted 
  by 
  Dr. 
  F. 
  I. 
  Proctor 
  and 
  Dr, 
  Polk 
  Richards, 
  who 
  

   gave 
  invaluable 
  aid. 
  The 
  plan 
  which 
  Noguchi 
  followed 
  was 
  to 
  make 
  

   cultures 
  on 
  specially 
  prepared 
  media 
  and 
  to 
  isolate 
  and 
  test 
  by 
  inoc- 
  

   ulation 
  into 
  the 
  conjunctiva 
  of 
  the 
  monkey 
  all 
  bacteria 
  growing 
  in 
  the 
  

  

  