RICKETTSIA BODIES 641 
period varying from four or five days to twelve days ; it may be as long 
as three weeks. There is a developing febrile reaction which persists 
typically for about two weeks, followed by crisis, or rapid lysis, and an 
extensive erythematous eruption, maculo-papular in character which 
appears usually within three or four days after the onset, and persists 
for ten to fourteen days. Complications, especially inflammations of 
the head adnexa, are very common. The disease pathologically may 
be regarded as an hemorrhagic septicemia; the lesions are located 
chiefly in the bloodvessels of the skin, striped muscles, central nervous 
system, and to a lesser degree the viscera and parenchymatous organs. 
The lesions correspond closely with the distribution of the parasite 
within the body. Death occurs frequently with extensive involvement 
of the brain and proliferati^'e changes therein.^ 
The mortality varies greatly; in the eastern- and southern^ parts of 
the United States the disease is mild in character, so mild in fact that 
the malady is spoken of as Brill's disease, in honor of Dr. Nathan Brill, 
who described this somewhat atypical form in great clinical detail. 
The mortality in pAU-ope, Central and South America, where the disease 
is very prevalent in certain areas, is usually high. 
The disease was first transmitted experimentally to an anthropoid 
ape by Nicolle,"* and by Nicolle, Conor and Conseil,^ through the blood 
from a case of human typhus; and similarly to Macacus rhesus and 
Capuchin monkeys by Anderson and Goldberger.*^ These results have 
been confirmed by Ricketts and Wilder^ and others. Human trans- 
mission is, so far as is known, exclusively through lice. 
Anderson,^ Wolbach, Todd and Palfrey^ and others have shown that 
the disease may be transmitted also to guinea-pigs. 
Etiology of Typhus.— The etiology of typhus is not universally agreed 
upon. Various bacteria, protozoa, and filterable viruses have been 
advanced from time to time as causative agents, but the consensus of 
opinion, with much experimental evidence as a background, points to 
the Rickettsia bodies"' as the probable inciting factor. 
Plotz" isolated a small Gram-positive bacillus from the blood of a 
series of cases of Brill's disease, and from severe cases of typhus which 
seemed to possess antigenic properties, and Olitsky, Denzer and Husk^- 
found the organism both in cases of typhus, and in infected lice. 
' Wolbach, Todd and Palfrey: The Etiology and Pathology of Typhus, 1922, p. 200. 
This is an excellent monograph. 
2 Brill: Am. Jour. Med. Sci., 1910, 139, 4S4; 1911, 142, 196. 
3 Sinclair: Public Health Reports, 1925, 40, 241. Maxcy: Ibid., 1926, 41, 1213. 
4 Ann. Inst. Pasteur, 1910, 24, 243; 1911, 25, 1. 
6 Compt. rend. Acad. Sci., 1910, 150, 1772; 1910, 151, 258, 454, 685. 
6 Pubhc Health Reports, 1909, 24, 1861, 1941; 1910, 25, 177; 1912, 27, No. 22. 
' Jour. Am. Med. Assn., 1910, 54, 463, 1304, 1373. 
8 Pubhc Health Reports, 1915, 30, 1303. 
9 The Etiology and Pathology of Typhus, 1922. 
1" Da Rocha-Lima: Deutsch. med. Wchnschr., 1916, 42, 1353. Toepfer and Schussler: 
Deutsch. med. Wchnschr., 1916, 42, 1157. 
1' Jour. Am. Med. Assn., 1914, 62, 1556. 
'■- .Jour. Infec. Dis., 1916, 19, Sll. 
41 
