TRENCH FEVER 673 



is thermolabile. On the other hand, agglutinin formed 

 (by inoculation of Proteus X 19 into man or animals is 

 thermostable, and also agglutinates ordinary races of 

 Proteus. Weil and Felix assume, therefore, the existence 

 of two types of receptors in X 19 strains, viz. a " specific " 

 receptor for the typhus agglutinins, and a " substance " 

 receptor, corresponding to the receptors of saprophytic 

 Proteus strains. 



Various hypotheses have been advanced to explain 

 the Weil-Felix reaction, but none is satisfactory. 



2. Trench fever is a disease characterised by recurring 

 attacks of fever at intervals of seven to ten days, bone 

 pains, particularly in the shins, and affection of the 

 cardiac muscle, leading to tachycardia. It was very 

 prevalent on the Western front during the War. The 

 disease is transmitted by the louse, both by its bite and 

 by its excreta if these be rubbed into abrasions. The 

 virus is filterable and exists in the blood and urine. It is 

 destroyed at a temperature of 70 C., but not below this. 

 Rickettsia bodies are present in the blood and also in 

 infected lice. Sundell and Nankivell noted the presence 

 of spirochaetes in the urine of trench fever cases, but 

 they are probably saprophytic forms. 



Volhynia fever is probably a form of trench fever. 

 Trench fever does not seem to be a form of any other 

 disease and was apparently unknown before the War. 



3. Rocky Mountain spotted fever is a typhus-like disease 

 occurring in limited areas in North America. Years ago, 

 Wilson and Chowning ascribed the disease to a Piroplasma, 

 but subsequent research failed to confirm this. Ricketts 

 believed that the disease is caused by a small bacillus, 

 and Wolbach agrees with this view. Wolbach * describes 

 the bacillus as occurring in the blood, vascular walls, 

 testicle and skin. The characteristic form of the organism 



1 Journ. Med. Research, vol. xxiv, 1916, pp. 121 et seq, 

 M.B. 43 



