564 DISEASES OF UNKNOWN ETIOLOGY 



not obtained in artificial media heavily inoculated with blood from 

 patients, shown by experiment to contain the virus. 



Buccal and nasal secretions contain virus of measles which passes 

 a Berkefeld filter. 1 



Scarlet Fever. The etiology of scarlet fever is unknown. The 

 very common occurrence of streptococci in this disease has led many 

 observers to attribute to the streptococcus an etiological relationship. 

 No satisfactory evidence in support of the view that any type of 

 streptococcus is the causative agent has been brought forward. 



Dohle 2 described small oval, round and rod-shaped bodies measur- 

 ing about 1 micron in diameter, lying within the cytoplasm of poly- 

 morphonuclear leukocytes in a series of cases of scarlet fever. It was 

 assumed at first that these inclusion bodies were fragments of a 

 spirochete (the hypothetical inciting agent of scarlet fever) which had 

 been phagocytized and disintegrated by the polymorphonuclear 

 leukocytes. This view is now discredited. Numerous investigations, 

 especially that of Hill, 3 indicated that the Dohle bodies are fragments 

 of the nucleus of the leukocyte, presumably a reaction to injury by 

 bacterial toxins. They are present, however, in a majority of cases of 

 scarlet fever up to the tenth day and especially numerous during 

 the first four days of the clinical disease, as the following table by 

 Hill shows. The Poppenheim stain (two parts of a saturated aqueous 

 solution of pyrosin and four parts of a saturated aqueous solution of 

 methyl green) is especially recommended for the demonstration of the 

 inclusion bodies of Dohle. The nuclei of the cell are colored greenish 

 blue, the Dohle bodies bright red. 



Hill concludes that the Dohle inclusion bodies are present in a 

 majority of cases of scarlet fever up to the tenth day, but they are not 



1 Goldberger and Anderson, Jour. Am. Med. Assn., 1911, Ivii, 476, 971. 



2 Centralbl. f. Bakt., Orig., 1911, Ixi, 63. 



3 L. W. Hill, Boston Med. and Surg. Jour., 1914, clxx, 792; excellent summary of 

 literature. 



4 25 cases examined before tenth day; 18 after tenth day; latest case forty-fifth day. 



5 All except 6 cases after tenth day ; remaining 6 cases had normal temperature and 

 very slight rash. 



