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 days, 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 1 there was justification for the popular view 

 that it was associated with the bite of the dipterous fly, phlebo- 

 tomus pappatasii. This was borne out by the fact that on feed- 

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

 free from the disease and allowing them to bite healthy in- 

 dividuals, 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 con- 

 firmed 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. This last fact 

 would indicate that the causal organism passes through a 

 developmental cycle in the fly. The disease also occurs in 

 Northern Africa, in Corsica, in Calabria, and probably generally 

 throughout Italy, in Portugal, and in Arabia. 



These results are of importance themselves, as throwing light 

 on the etiology of a troublesome disease of the Mediterranean 

 littoral, but they are also interesting as having a possible 



