538 Infective Jaundice 



As suggested by Noguchi, blood cultures may be possible and 

 of use in making the diagnosis. 



The finding of spirochsetas in urine subjected to dark field exami- 

 nation should not be relied upon in suspected cases unless supported 

 by guinea-pig inoculation, for Stoddart* has found that spirochastae 

 of various species are not uncommon organisms in the urethra, and 

 could be found in 44 out of 100 cases examined. 



Sources of Infection. — Where the spirochasta comes from and how 

 it finds its way into the body are matters of great practical interest. 

 The escape of the organisms in such great numbers in the urine, 

 at once causes suspicion to center about that excretion as the chief 

 agent. The Japanese writers, so often quoted, observed that epi- 

 demics sometimes occurred in mines and always in wet mines. 

 Stokes, Ryle and Tatler observed that when the disease occurred 

 among soldiers in the trenches, it was always in particular trenches. 

 When the soldiers were removed from there they ceased to have new 

 cases; when new soldiers were placed there, the disease appeared 

 among them. Such trenches were always wet. 



In 1915, Miyajima called the attention of Inada, Ido, Hoki, Ito 

 and Wanif to the fact that he had observed spirochaetas, similar to 

 those of infective jaundice, in the kidney of a field mouse. This 

 led them to begin a study of various rodents, but being occupied 

 with the Spirochaeta icterohemorrhagias, the problem was set aside for 

 future solution. In 1916, Miyajima. made additional mention of 

 having found similar spirochsetae that infected guinea-pigs, and that 

 he believed to be identical with S. icterohemorrhagise, not only on 

 account of the symptoms produced, but because the immune serum 

 of Spirochffita icterohemorrhagiae was capable of destroying them. 

 It was then remembered that cooks working in kitchens frequented 

 by rats frequently suffered from infective jaundice, and at the be- 

 ginning of 191 7 they observed two typical cases following the bites 

 of rats. They were led to the conclusion that rats play an important 

 part in the spread of the disease and therefore undertook an investi- 

 gation of the rats in the city of Fuknaka and its vicinity. They 

 were able to find S. icterohemorrhagiae in the kidneys of 40.2 per cent, 

 of 149 Mus decumanus specimens examined. Their results were 

 soon confirmed by Stokes, Ryle and TatlerJ of the British Army in 

 Flanders and by Noguchi. § This occurrence of the spirochaeta in 

 the kidney of the rat compared with that of the convalescent cases in 

 man. "The behavior of the spirochaeta within the rat is open for 

 further study, but we know that the rats harboring spirochaetae 

 always excrete them in the urine. The organisms thus find their 

 way to the ground where they may infect other rats if opportunity 

 offers. In all probabihty they are disseminated by means of the 



* Brit. Med. Jour., Sept. 20, 1917, p. 416. 



t Jour. Med. Research, 1917, xxv, No. 3, p. :4i. 



t Lancet, 1917, i, 142. 



§ Jour. Exp. Med., 1917, xxv, 755. 



