MTIOLOGY 



1679 



intoxication may produce peripheral neuritis, but the epidemics of the 

 disease are quite against a theory of auto-intoxication. 



0. Parasitic Causes. — -A great many observers are in favour of a parasitic 

 cause for the disease, without committing themselves as to whether it is 

 animal or A'-egetal. Among these may be mentioned Sambon, who con- 

 siders that the specific agent lives in the patient's body, Scheube considers 

 that it is an infectious, but not a contagious, disease, and says that the 

 analogy with malaria is in some respects striking, and that it is spread by 

 mechanical transmission of the disease by human intercourse in some way 

 or another. This is quite true, because there are numerous instances of 

 disease being imported by human beings into a fresh place and spreading, 

 but the curious point is that it generally sticks to one race. 



Thus, in Malaya it is a common disease among imported Chinese, and 

 hardly known among the natives. In the Bilibid Prison, mentioned above, 

 the prisoners included Filipinos, Spaniards, Chinese, Japanese, Indians, 

 American negroes, Americans, and Europeans, but the disease fell most 

 severely on the Filipinos, the Chinese being almost exempt, only one or two 

 contracting the disease, while the Americans were immune. Van der Scheer 

 suggested that perhaps insects, such as cockroaches, might be the spreaders of 

 the disease, but Durham's investigations are contrary to this. It would seem 

 as though the causal agent was spread by some parasite, for Daniels has 

 carefully considered the question of infection, and does not find any evidence 

 in favour of it being conveyed by the excreta of persons suffering from the 

 disease, especially the fa2ces. 



Further, he points out that infection b}^ air and water can be excluded, as in 

 Kwala Lumpur all races drink the same v/ater, but only Chinese are attacked, 

 even though they drink little unboiled water: and the immunity of prison 

 officials from the disease while an epilemic rages among the prisoners 

 excludes air. Disinfection appears, from Durham's results on Christmas 

 Island, to be useless. As regards parasites, Durham and Daniels are both 

 against mosquitoes as being the cause — and, indeed, this is hardly likely — and 

 also against bugs. 



On the other hand, there appears to be some evidence in favour oiPediculus 

 capitis, which is apt to cling to one race, and this is, according to Daniels, a 

 plausible theory in explaining the racial selection of the disease. Experi- 

 ments on an orang-outang with pediculi from a beri-beri case were negative, 

 the lice rapidly disappearing. Daniels could not exclude fomites as a carrier 

 of the disease in his observations. Only one observer, Taylor, is said to have 

 produced the disease in animals by the inoculation of the blood from patients. 



Having thus briefly considered the general question of contagium vivum, and 

 its method of entry into the body, it is necessary to review the various 

 organisms which have been held to be the cause of the disease. 



They may be classified into : — 



Animal Parasites: — 

 {a) Protozoa. 



1. Plasmodium in the blood (Glogner). 



2. Protozoon in the urine (Hewlett and Korte). 



3. Haematozoa in the blood (Fajardo and Voorthuis). 

 [h) N emathelminthes . 



1 . Some form of Trichinella (Gelpke) . 



2. Trichuris trichiura (Erni and Kynsey). 



3. Ancylosloma duodenale (Erni and Kynsey). 



Vegetal Parasites-t-Fungi : — 

 [a] Coccacece. 



1 . Cocci in the alimentary canal, etc, (Dangerfield) . 



2. Diplococcus in the urine (Tsuzuki). 



3. Diplococcus from the blood and urine or organs post mortem 



(Okata and Kokubo). 



4. Four kinds of cocci (Musso and Morelli). 



