THE INFECTIOUS DISEASES. 265 



RELAPSING FEVER. (Typhus Recurrens ; Famine Fever ; Spirillum 

 Fever ; Seven Day Fever.) 



The lesions which may be present in this disease are not distinctive. 

 It is characterized, apart from symptoms, by the presence in the blood 

 at certain periods of a spiral bacterium discovered by Obermeier in 1873. 



THE LESIONS OF THE DISEASE. 



There may be albuminous degeneration in the viscera, leucocytosis, 

 catarrhal or croupous inflammation of the mucous membranes of the res- 

 piratory and digestive organs, ecchymoses in th'e skin and in the mucous 

 and serous membranes. There may be pneumonia and pleurisy, degen- 

 eration of the cardiac muscle, hyperplasia of the mesenteric lymph-nodes. 



The Spleen may be large and flabby, this change being so extreme that 

 rupture has occurred during life ; it may also be the seat of infarctions, 

 and these have given rise to peritonitis. 



Characters of the Spirochsete Obermeieri. 



In the blood of all parts of the body during the febrile attacks may be found, ID 

 very large numbers, a long, slender spirillum called from its discoverer SpirocTwete Ober 

 meieri (Fig. 136). The organisms disappear from the blood 

 during the afebrile intervals, and it has been shown that 

 at this time they accumulate in the spleen, where they are 

 destroyed in large numbers, apparently through the action 

 of phagocytic cells. The organism is from 14 to 40 n in 

 length, and performs rapid, undulating movements. 



The inoculation of healthy men and of mon- 

 keys with the blood of relapsing-fever patients 

 which contains the bacteria, induces a similar FIG- ia6 '~ s ^ ITE ' 

 disease. Pure cultures have not as yet been 



made of these bacteria, but for the reasons indicated, and since the or- 

 ganism has never been found except in connection with the disease, there 

 is every reason for believing that the Spirochaete Obermeieri is the exci- 

 tant of relapsing fever. ' 



Malta Fever. 



This disease, which has been most frequently observed along the shores of the 

 Mediterranean and in India, is characterized by prolonged pyrexia with irregular re- 

 missions. In the rather rare fatal cases there may be considerable enlargement of the 

 spleen, albuminous degeneration in the liver and kidneys. Acute nephritis may occur. 



It is said that there are constantly present in the spleen in this disease small cocci 

 stained by Gram, readily cultivated on artificial media. The result of inoculations of 

 pure culture into monkeys and other animals tends to confirm the pathogenic signifi- 

 cance of the organism, which has been called Micrococcm melitenMs. * 



1 For resume and bibl. see Wladimiroff in Kolle and Wassermann's "Handbuch der 

 Mikroorganismen," Bd. iii., p. 75, 1903. 



2 Consult Birtand Lamb, Lancet, 1899, ii., p. 701, bibl. 



