﻿412 MIURA. 



the epidemic spreading of the infection may be attributed to obscure 

 psychic influences. David suggested adulterated alcoholic beverages, or 

 a poisoning by bread or lentils. Other physicians in Japan and in 

 Europe believe that latent malaria is the cause, but the clinical picture 

 and the blood examination are against this view. G-erlier was the first 

 who emphasized the close connection between this disease and those who 

 work in horse's and cow's stables. After he had excluded the possible 

 etiologic factors, one by one, he emphasized that it appears most frequently 

 in peasants, day laborers, or persons who are occupied with the care of 

 cows and horses, whereas landowners and women are free from endemic 

 paralytic vertigo. Kubisagari also is general in those regions of Japan 

 where a portion of the dwelling is used as a stable for horses or cows and 

 when there is no idea of cleanliness. If we compare the region in 

 Switzerland, where endemic paralytic vertigo is frequently encountered, 

 with Aomori and Iwate, where kubisagari is endemic, we observe great 

 differences in the geological structure of the region and the food of the 

 peasants. Only one point is in common — in Switzerland the custom of 

 sleeping in the stable and in Japan the imperfect separation of stable and 

 dwelling. 



Gerlier maintains "dans le bassin de Leman, il est d'usage qu'on coiiche 

 a l'etable, ce qui n'est pas admis dans les cantons de Berne et de Tribourg 

 ou la maladie est inconnue." With lis in Japan the region of Aomori 

 and Iwate is the territory where agriculture and the raising of cattle 

 take place side by side, so that in each peasant's cottage, horses or cattle 

 are maintained and cared for more carefully than the children. The 

 inhabitants of this region generally have the barn so arranged that a 

 part is used as a stable, and onl} r an incomplete partition exists between 

 the two spaces, so that not only the air but also insects have free access 

 to all parts. The structure of the houses is planned for the winter 

 months. The stable, however, is the place where throughout the year, 

 processes of decomposition are going on and where there is a certain 

 degree of heat in conjunction with imperfect lighting, a true incubator 

 of micro-organisms, for the manure is only cleaned out twice a year. 



At this point our knowledge ends. Is the etiologic factor an animal 

 or a vegetable micro-parasite? Is the disease transferred by air, food, 

 insects or domestic animals? The answer to these questions must be 

 left to the future. Horses and cattle seem to resist this disease, but cats 

 and chickens have been observed to be attacked by it, but much more 

 rarely than human beings. 



Prophylactic measures are the removal from the neighborhood of horse's 

 or cow's stables and the avoidance of such places for the midday or night 

 sleep. No great hope can be entertained from the use of medicaments, 

 the best results are obtained from a combination of potassium iodide 

 and arsenic. So far as is now known, no deaths have resulted from this 

 disease, although it runs a course with bulbar appearances. 



