H. Baton 
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spirochaetes of Russian relapsing fever and Central African tick-fever 
are identical, the differences in the clinical course of the disease in the 
two countries might be due to the fact that the cases seen in Russia 
may already be partially immunised; the severity of the disease in 
Europeans in Central Africa on the other hand appears to he due to 
their being specially undefended against the spirochaete and to the 
special mode of transmission through the tick. Following up these 
suggestions, I can say that in the dozens of cases which I was able to 
observe in the Bassmannie Bolnitza at Moscow, the symptom complex 
was much less severe than that seen in any European or non- 
immunised African in Central Africa. The great majority of the 
patients in Moscow were able to .stand up and make a few steps even 
at tlie height of the disease. In Africa the excruciating muscular 
and joint pains and the extreme weakness prevent every movement. 
The personal observation of cases of tick-fever in Uganda and of 
relapsing fever in Moscow lead me to believe there exists conclusive 
clinical evidence that the disease runs a much more severe course in 
Africa than in Russia, and to this we can add that a distinct ditference 
from a biological point of view between S. recurrentis and S. duttoni 
has been demonstrated by Uhlenhuth and Haendel, Strong (1908) and 
others, in so far as mice which had undergone an attack due to 
S. recurrentis spirochaetosis could be infected with S. duttoni, but not 
again with S. recurrentis. 
From what I have seen in Moscow I am of the opinion that the 
transmission of relapsing fever in Russia, is commonly effected by 
Pediculus vestimentorum and not by Ciniex. 
Mackie (1907) appears to have been the first to incriminate 
pediculi, later on Manteufel (1908, h), Smith (1910), Sergent and Foley 
(1910), and Fehrmann (1910) have brought forward experimental and 
clinical evidence in support of this view. 
My reasons are so far purely clinical. Having visited the big 
municipal Night Hostels at Mo.scow I soon noticed that they were kept 
with such scrupulous cleanliness, disinfected so lavishly, the beds being 
of iron, the floor cemented, that it was not possible for bed-bugs to 
thrive to any extent on the premises. The people sleeping there were 
allowed, however, to go to sleep in their own clothes. The introduction 
of these model homes had not had any effect on the incidence of 
relapsing fever, for the places were still hotbeds of the disease during 
winter. On the other hand, though I changed my rooms several times 
I found bugs in every successive lodging, and as I was told in Moscow 
V 
