APPENDIX H. 



PHLEBOTOMUS FEVER. 



IN Dalmatia, Herzegovina, and neighbouring parts of the 

 Adriatic littoral there occurs a disease known as "pappataci," 

 characterised by fever lasting for about three clays, followed 

 by somewhat prolonged prostration, but very rarely having a 

 fatal issue. Doerr, after failing to isolate any organism from 

 the blood, found that the subcutaneous injection of from '5 to 

 1 c.c. of the serum from a case into a healthy individual was 

 followed about eight days later by an attack of the disease. 

 A similar effect was produced with the serum after it had been 

 passed through a Berkefeld filter, all the inoculation experiments 

 being performed at a distance from the original location of the 

 disease. The view is therefore put forward that here we have 

 to deal with another example of an ultra-microscopic virus. The 

 disease has been only observed in the summer season, and Doerr 

 considered there was justification for the popular view that 

 it was associated with the bite of the dipterous fly, phlebotomm 

 pappatasii. This was borne out by the fact that on feeding 

 such flies on a sick person, transporting them to a locality free 

 from the disease and allowing them to bite healthy individuals, 

 the affection was reproduced. An apparently identical disease 

 occurs in Malta and has been investigated by Birt under the 

 name of "Phlebotomus Fever." This observer fully confirmed 

 Doerr's results, the condition again being reproduced by infected 

 flies which, however, were found not to manifest infectivity 

 earlier than seven days after biting. 



These results are of importance of themselves as throwing 

 light on the etiology of a troublesome disease of the Mediter- 

 ranean littoral, but they are also interesting as having a possible 

 bearing on the pathology of a group of similar affections 

 occurring in various parts of the world, chiefly in coastal areas, 

 and going under a variety of names. Examples are dengue, 

 the three-day fever of various regions, Canary fever, Shanghai 



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