STUDY OF TSUTSUGAMUSHI DISEASE. 3 



expert workers, and it is therefore unnecessary, and it would be futile, 

 in a paper of this kind, to attempt the thorough consideration of them 

 which the)' deserve and will receive later. 



III. HISTORY OF THE TWO DISEASES. 



According to Tanaka the name tsutsugamushi has been known since 

 the earliest historical times, while the designation shashitsu occurs in 

 Chinese writings more than a thousand years old. A quotation from one 

 of these indicates that at the time the disease was recognized as a 

 distinct affection and was ascribed to the bite of a mite, which occurred 

 in summer time in certain districts which had been flooded by the spring 

 rains: The bite was described and the statement made that after three 

 days a high fever developed and a pustule appeared at the site of the 

 injury. It was also recognized that only certain regions of the country 

 harbored the infection and that the disease only appeared in persons 

 entering them. 



Tsutsugamushi was brought to the attention of the Western World by 

 Palm in 1878 and by Balz in 1879, and since that time it has been the 

 subject of much painstaking work by Japanese medical men. Numerous 

 articles have appeared in Japanese journals and a certain number of 

 European ones; many microorganisms, including cocci, bacilli and pro- 

 tozoa, have been described as the cause of the disease, and several investi- 

 gators are working at the present time, each with what he considers to be 

 the causative factor. It can not be said that any one of these workers has 

 as yet established his claim. Three hypotheses at present divide those 

 actively engaged in the study of the disease and rule the work of 

 investigation : 



1. That the disease is caused by a bacterium, a belief favored by the 

 workers of the Institute for Infectious Diseases. 



2. That it is a protozoal infection. Professor Ogata is the leading 

 exponent of this idea. 



3. Tanaka thinks it is due to a toxin contained in the body of the red 

 mite. 



Spotted fever of Montana has been recognized for only a few years, 

 twenty-five at the most, while the literature relating to it has practically 

 all been written since 1902. Wilson and Chowning in 1902 published 

 their first account of the fever and gave their ideas as to its cause and the 

 method of its transmission in a preliminary report to the Montana State 

 board of health, which appeared in the Journal of the American Medical 

 Association. It is true that Major Wood, in" 1896, and Maxey in 1899 

 had reported a similar, or the same disease in Idaho, but the form oc- 

 curring in the latter territory presents such points of difference, partic- 

 ularly in regard to mortality, that it is not considered in this paper. 



