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The Epidemiology of Relapsing Fever in the Anglo-Egyptian Sudan, including an Experimental Study of the Abyssinian Louse-Borne Strain

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THE EPIDEMIOLOGY OF RELAPSING FEVER IN THE ANGLO-EGYPTIAN
SUDAN, INCLUDING AIT EXPERIMENTAL STUDY OF THE ABYSSINIAN
LOUSE-BORNE STRAIN.
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2-
I N T R O D U C T I O N
The o b s e r v a t i o n s r e c o r d e d i n t h i s p a p e r w e r e
o r i g i n a l l y u n d ertak en w ith a s t r i c t l y
p r a c t i c a l end i n view .
The g r a v e e p i d e m i c o f r e l a p s i n g f e v e r w h i c h d e c i m a t e d t h e
p o p u l a t i o n o f D a r f u r i n 1 9 26-1927 was f o r t h e Sudan a
c a l a m i t y s t i l l w e l l w i t h i n t h e me mo ry o f m o s t o f t h e p r e s e n t
in h ab itan ts.
When t h e d i s e a s e
re a p p e a re d i n 1936, and in
1 93 7 s e e m e d t o b e s p r i n g i n g u p a l l o v e r t h e
p o ssib ility
c o u n try the
o f a n o t h e r m a j o r e p i d e m i c was r e g a r d e d w i t h more
th an a l i t t l e
app reh en sio n .
to o b ta in a l l p o s sib le
It
beca me a m a t t e r o f u r g e n c y
in fo rm a tio n about the
i n f e c t i o n so
t h a t p r e v e n t i v e m e a s u re s m ig h t be i n s t i t u t e d a l o n g th e
most e f f i c i e n t l i n e s .
I t h a d t o be e x p l a i n e d wh y t h e d i s e a s e
was a p p e a r i n g s i m u l t a n e o u s l y i n d i f f e r e n t p a r t s
country:
w hether i t
had a s in g le
o f the
o r i g i n o r many.
At th e
same t i m e i t w a s o f p r i m e i m p o r t a n c e
t o make c e r t a i n t h a t
t h e v e c t o r was a s i n p r e v i o u s y e a r s ,
the lo u s e ,
was d e c i d e d a t
the
o u ts e t to re g a rd the
although i t
disease as lo u se-b o rn e,
pending i n v e s t i g a t i o n s .
At a c o m p a r a t i v e l y e a r l y s t a g e o f th e p r e s e n t
in v estig atio n ,
the v e c to r ,
it
and i t
was p o s s i b l e
to in crim in ate
so o n became e v i d e n t t h a t
d i s e a s e was from E r i t r e a
and A b y ssin ia.
th e lo u se as
th e o r i g i n o f the
R elativ ely l i t t l e
i s k now n o f t h e m e d i c a l c o n d i t i o n s e x i s t i n g i n t h e s e r e g i o n s .
A lth o u g h l o u s e - b o r n e r e l a p s i n g f e v e r h a s b e e n r e p o r t e d from
th e se a re a s d u rin g the l a s t
reference
few y e a r s ,
t o a t i c k —b o r n e s t r a i n
r e c o r d s , w hich a re
literatu re.
that
it
is
o n ly w ith
sca n ty experim ental
in a d d itio n confusing,
WENYON ( 1 9 2 6 ) f o r i n s t a n c e ,
c a n be f o u n d i n t h e
states
that
O rnithodorus sa v ig n y i i s
the v e c to r o f r e la p s in g
fever in
A b y s s i n i a , w h i l e BRUMPT ( 1 9 3 6 a ) p o i n t s o u t t h a t t h i s
although e a s ily
in fected
in the
lab o rato ry ,
tick ,
has n e v e r been
found n a t u r a l l y i n f e c t e d i n any c o u n try .
O w in g t o
such u n c e r ta in t y ,
be c o n s id e re d t h a t
the p o s s i b i l i t y had to
i n t h i s A b y s s i n i a n r e l a p s i n g f e v e r one
m ig h t be d e a l i n g w i t h a s t r a i n
of sp iro chaete
d i f f e r i n g from
any o f th o s e w hich had a l r e a d y been s t u d i e d .
w h e th e r o r n o t t h i s was th e
v iru le n c e and o th e r f e a tu r e s
case
To d e t e r m i n e
a l a b o r a t o r y s tu d y o f the
o f the
s t r a i n was u n d e r t a k e n .
F o r r e a s o n s w hich a re l a t e r g iv e n f u l l y ,
a t t e n t i o n was p a i d t o t h e p o s s i b i l i t y
p articu lar
o f tr a n s m is s io n o f the
f e v e r by t i c k s a s w e l l a s by l i c e .
The p o s s i b i l i t y
o f tick -b o rn e
in fectio n s
i n the
S u d a n w a s o ne w h i c h h a d i n t e r e s t e d t h e w r i t e r f o r some t i m e .
But th e com plete ab sence
a ctiv ities
of cases had r e s t r i c t e d h is
d u rin g t h e p re v io u s th r e e y e a r s to th e
c o l l e c t i o n o f the
tic k s th em selves.
w ith o u t advantage.
When t h e
clin ical
T h i s was n o t h o w e v e r
cases d id ooour,
a l r e a d y h a d f r o m o n e ' s own o b s e r v a t i o n s ,
com p reh en siv e know ledge o f th e
to
of tic k tran sm issio n .
o f view a l s o
o btain tic k s
it
of
T h i s e n a b l e d one a t t h e
o u ts e t to d e f in e , w ith in f a i r l y narrow l i m i t s ,
point
one
a fa irly
d i s t r i b u t i o n and h a b i t s
the t i c k s o f the N o rth e rn Sudan.
p o ssib ilities
s tu d y and
the
From t h e p r a c t i c a l
g a v e on e t h e a d v a n t a g e
o f know ing where
f o r e x p e r im e n ta l p u rp o s e s , alm o st a t any
mome n t .
From t h e c o n c l u s i o n s o f t h e s e e x p e r i m e n t s a s w e l l
a s from o t h e r i n f o r m a t i o n w h ic h was b r o u g h t t o l i g h t
th is
in v estig atio n ,
it
became a p p a r e n t t h a t
during
the h i s t o r y o f
-
r e la p s in g fe v e r in the
o f unique
in terest,
4-
Sudan p r o v id e d a n e p i d e m i o l o g i c a l s tu d y
w hich h ad r e f e r e n c e , m oreover,
la rg e a re a o f the A fric a n c o n tin e n t.
The S u d a n i s
surrounded by c o u n trie s
is
from w h ich i t
to a very
separated
p h y s i o g r a p h i c a l l y , and i n w hich r e l a p s i n g f e v e r i s en d em ic.
W ith t h e
years,
o p e n in g up o f com m unications d u r i n g th e
it
has been invaded by th e
fever,
last
a t d i f f e r e n t tim es
fr o m t h e N o r t h , fr o m t h e S o u t h , a n d fr o m t h e West
A lthough d e v a s ta tin g ep id em ics have r e s u l t e d ,
evidence s u g g e sts
th a t the
(see F ig .2 ) .
a l l the
d i s e a s e h a s n e v e r become
e s t a b l i s h e d i n endem ic form i n t h e
is
fifty
Sudan.
I n how f a r t h i s
due t o t h e e n e r g e t i c p r e v e n t i v e m e a s u r e s w h ic h h av e b e e n
undertaken i s
d ifficu lt
to e s tim a te .
m i l i t a r y u p h eav als in E a s t A fric a the
in v a d e d by r e l a p s i n g f e v e r ,
fu tu re
is
th is
W ith t h e r e c e n t
Sudan h a s a g a i n b een
tim e from th e E a s t .
l i k e l y to see a f u r th e r in c re a s e
The
o f com m unication
a c r o s s A f r i c a from E a s t t o W est, a n d w h e t h e r o r n o t i t w i l l
be p o s s i b l e
to p rev en t the d ise a se
becom ing e s t a b l i s h e d in
en d em ic form i n t h e Sudan r e m a in s t o be s e e n .
ACKNOWLEDGMENTS.
The w r i t e r g l a d l y a c k n o w l e d g e s h i s g r a t i t u d e
t h o s e who h a v e a s s i s t e d h i m d u r i n g t h e
to th e D i r e c t o r , Sudan M edical S e r v ic e ,
d u rin g the
th is
to
study, e s p e c ia lly
fo r every f a c i l i t y
co u rse o f the w ork, an d f o r p e r m is s io n to p r e s e n t
th esis:
problem s e a s y :
t o t h e S u d a n R a i l w a y s , who made h i s t r a n s p o r t
to th e G overnor and s t a f f o f K a ss a la
p r o v i n c e who g a v e h i m e v e r y a i d i n t h e
o bservation of ro u tes
o f im m ig r a tio n and m ethods o f f r o n t i e r c o n t r o l :
not le ast
to h is
co lleagues
in charge o f h o s p ita ls
who r e a d i l y a f f o r d e d h i m a c c e s s t o
to
the
in the
affected, a re a s ,
cases under th e ir care:
th e M e d ic a l O f f i c e r o f H e a l t h , K hartoum , f o r c o - o p e r a t i o n
i n s e v e r a l i n s t a n c e s a n d t o M r. N. M a c d o n a l d , o f t h e Stack.
L a b o r a t o r i e s , who c a r r i e d o u t d a i l y e x a m i n a t i o n s o f t h e
b l o o d o f o n e o f t h e e x p e r i m e n t a l a n i m a l s f o r some t i m e a f t e r
th e w r i t e r h a d gone on l e a v e .
TABLE
(A)
OF
CONTENTS
INTRODUCTION
GEOGRAPHICAL AND ETHNOLOGICAL DATA.
CLIMATIC FACTORS.
THE GEZIRA.
THE POPULATION.
MOVEMENTS OF THE WESTERN PEOPLES.
(B)
(C)
HISTORICAL SURVEY.
RE-INFECTION OF THE SUDAN FROM ABYSSINIA.
RECRUDESCENCE OF THE DISEASE IN 1 9 3 6 a n d 1937'.
RELAPSING FEVER IN ABYSSINIA.
FACTORS LEADING TO THE INFECTION OF THE SUDAN.
(D)
LABORATORY STUDIES.
MORPHOLOGY AND MOVEMENTS OF THE ABYSSINIAN
RELAPSING FEVER SPIROCHAETES.
APPEARANCES IN FROZEN BLOOD.
CULTURE
Y ua n P o ' s E g g M e d iu m :
C i t r a t e d Human B l o o d s
D i l u t e d Homan S e r u m :
D i l u t e d H o rs e Serum:
M o d i f i e d N o g u c h i ’ s Medium.
ANIMAL INOCULATION:V arious R odents:
G erb illes:
W hite M ice:
M onkeys.
IMMUNITY: E v id e n c e o f Imm unity:
E r r a t i c N ature
o f th e Im m unity:
Presence o f
S ev eral A ntigenic S tr a in s .
-
7-
(6)
THE EFFECT OF SPLENECTOMY IN MICE AND MONKEYS•
(7)
RESIDUAL AND LATENT INFECTIONS.
APPENDIX.
(E )
(1)
CASS HISTORIES OF THE MONKEYS.
TRANSMISSION OF INFECTION
TRANSMISSION BY THE LOUSE: S p iro c h a e te s found in l i c e :
No i n f e c t e d n i t s f o u n d :
T r a n s m i s s i o n to a monkey.
(2)
TRANSMISSION EXPERIMENTS WITH TICKS.
(3)
DISTRIBUTION AND HABITS OF ORNITHODORUS SAVIGNYI
IN THE SUDAN.
(4)
METHODS.
(5)
RESULTS: EXPERIMENTS WITH ARGAS AND PEDICINUS.
GENERAL CONCLUSIONS.
(F)
(1)
OBSERVATIONS ON THE HUMAN DISEASE.
EPIDEMIOLOGY.
In cid en ce;-
Sex:
Age:
Race:
Season.
(2)
RELATION TO MALARIA, TYPHUS AND PLAGUE.
(3)
CLINICAL FEATURES AND COURSE OF THE DISEASE.
(4)
PATHOLOGY.
(5)
PREVENTION.
(G)
SUMMARY.
(H)
BIBLIOGRAPHY.
(K)
ILLUSTRATIONS.
(A)
INTRODUCTION
GEOGRAPHICAL AND ETHNOLOGICAL DATA
The A n g l o - E g y p t i a n S u d a n l i e s
N orth l a t i t u d e s .
v ariety ,
It
is
o f v a s t e x te n t, and i n f i n i t e
so t h a t a b r i e f r e f e r e n c e
s a lie n t featu res
b e tw e e n 23° a n d 3°
to
in
certain of its
is .n e c e s s a r y in order to
o rien tate
mo re
some o f
th e o b s e r v a t i o n s w hich f o l l o w .
The S u d a n i s b o u n d e d o n t h e N o r t h b y E g y p t , o n
t h e E a s t b y t h e Red S e a , E r i t r e a ,
and A b y ssin ia ,
on th e
S o u t h b y K e n y a, U g a n d a , a n d t h e B e l g i a n Congo, a n d on t h e
West by F r e n c h E q u a t o r i a l A f r i c a .
m ain p r o v i n c e s
P h y sio g rap h io ally five
c a n be r e c o g n i s e d : -
(1)
The d e s e r t i n t h e N o r t h , e x t e n d i n g f r o m t h e
E g y p tia n b o rd e r n e a r ly a s f a r South a s
K hartoum .
(2)
The R e d S e a H i l l s , w h i c h e x t e n d b e t w e e n t h e
E g y p t i a n and E r i t r e a n b o r d e r s and mark th e
E a s t e r n f l a n k o f the G reat R i f t V a lle y i n t h i s
p art of A frica.
(3)
The r e d s a n d r e g i o n s l i e S o u t h o f K h a r t o u m ,
an d e x t e n d W estw ards t h r o u g h K o r d o f a n , D a r f u r ,
and beyond.
The v e g e t a t i o n o f t h i s r e g i o n i s
enough to f i x th e s o i l , and co m p rises s h o r t
g r a s s a n d t r e e s , i n c l u d i n g t h e gum A r a b i c
acacia.
There i s good g r a z i n g , an d e x c e l l e n t
crops are r a is e d over la rg e a re a s .
(4)
South o f the san d b e l t , th e p l a i n s o f d a rk s o i l
e x t e n d f r o m t h e S o u t h e r n p a r t s o f t h e R ed S e a
H i l l s W estwards a c r o s s th e S o u t h e r n Sudan t o
S outhern D a rfu r.
They e x t e n d t o a l m o s t 6° N o r t h .
The s u r f a c e i s c o v e r e d w i t h g r a s s o r s a v a n n a
fo rest.
Wide t r a c t s a r e c u l t i v a t e d , a n d i t a f f o r d s
w ide a r e a s o f g r a z i n g .
The c o n t o u r o f t h e p l a i n s
i s b r o k e n o c c a s i o n a l l y by g r o u p s o f h i l l s w hich
ris e lik e islan d s in a sea.
Perm anent w a te r
su p p lie s are a s s o c ia te d w ith these h i l l groups,
and the w e ll d ra in e d s lo p e s a f f o r d fa v o u ra b le s i t e s
for v illa g e s.
(5)
In th e A n g lo -E gyptian Sudan th e d a rk s o i l i n the
S o u th m e rg e s i n t o t h e r e d s o i l o f th e hum id
tro p ics.
The t r a n s i t i o n i s g r a d u a l , a n d n o f i x e d
l i m i t s c a n be d ra w n .
I n th e W estern Sudan,
N i g e r i a , e t c . , t h e r e i s no b e l t o f d a r k s o i l , and
th e r e d san d m erges d i r e c t l y in t o th e r e d s o i l o f
t h e hum id t r o p i c s .
B o r d e r in g th e Sudan on th e
E a s t a r e t h e h i g h l a n d s o f A b y s s i n i a , where
d iff e r e n t co n d itio n s p re v a il.
C o n se q u e n tly , the
ty p es o f c o u n try o f the Sudan p l a i n s a re
p r a c t i c a l l y l i m i t e d by the boundary.
CLIMATIC FACTORS.
R ainfall is
the d o m in a tin g f a c t o r .
s e e n from F i g . 3 t h a t th e
in to
two p o r t i o n s .
r o u g h ly from t h e
I t w i l l be
r a i n b e l t i n t h e S u d a n ma y b e d i v i d e d
The m ore N o r t h e r l y b e l t
20th p a r a l l e l to the
stretch es
13th p a r a l l e l ,
and has
a n a n n u a l r a i n f a l l o f f r o m 25 mm. i n t h e N o r t h t o 4 0 0 mm.
in th e S outh.
p a r a l l e l to
The S o u t h e r n b e l t s t r e t c h e s
from th e
th e S o u th e rn boundary o f th e Sudan, i t s
r a n g i n g f r o m 6 0 0 mm. t o 1 , 2 0 0 mm. p e r a n n u m .
13th
rain fall
K hartoum i s
a t th e N o r th e r n b o r d e r o f r a i n c u l t i v a t i o n , where r e s u l t s
a re u n c e r t a i n , w h ile S inga i s
in the h e a r t
of i t ,
w here good
c r o p s c a n a l w a y s be r e l i e d o n .
T em perature in the d e s e r t re a c h e s ex trem es
(30° - 126° F . ), w h ile
i n t h e mo re h u m i d S o u t h t h e r a n g e i s
less.
R e l a t i v e H um idity o f th e N o rth e rn and C e n tr a l
Sudan i s e x t r e m e l y low .
F i g u r e s a s low a s 5 p e r c e n t , a r e
o c c a s i o n a l l y r e c o r d e d even a s f a r S o u th a s K hartoum .
The S e q u e n c e o f W e a t h e r may b e f o l l o w e d i n t h e
b e l t c o n t a i n i n g K a s s a l a , M edani, E l O beid, and F a s h e r ,
w h i c h o u r o b s e r v a t i o n s mo re e s p e c i a l l y a p p l y .
to
The g e n e r a l
m a r c h o f t h e s e a s o n s may be r e g a r d e d a s b e g i n n i n g w i t h t h e
rain s.
The NNE. t r a d e w i n d s g i v e p l a c e
in A p ril,
is
to S o u t h e r l y w inds
a n d t h e r e ma y b e s m a l l s h o w e r s o f r a i n .
u s u a lly f a i r l y d ry , b u t the w eather is
d ust storm s,
show ers,
or
'h u b o o b s* ,
May
u n s e t t l e d by-
I n June t h e r e
may b e h e a v y
b u t t h e r a i n s c a n o n l y be r e g a r d e d a s commencing
in earnest
i n J u l y , w he n ' h u b o o b s 1 c e a s e .
co n d itio n s,
R ainy
w i t h c lo u d y s k i e s a n d hum id a tm o s p h e re
co n tin u e th ro u g h o u t J u ly , August and S eptem ber.
o c c a s i o n a l s h o w e r may f a l l
An
i n O c t o b e r , b u t t h i s m onth
m a rk s t h e p e r i o d known t o t h e
people a s th e
'd u ra t* , - a
few w eeks o f h o t , r a t h e r hum id w e a t h e r b e tw e e n t h e
and the
onset o f the
t r a d e w ind i n November.
rain s
T his
w i n d (NNE) i s v e r y d r y , a n d w i t h t h e
in crease
i n the
d e c l i n a t i o n and f a i l i n g power o f th e
sun, b r in g s the
dry
V
days and co o l n ig h ts
o f th e w i n t e r m onths.
v e g e ta tio n soon d r i e s up,
crops r ip e n and are h a rv e s te d .
T h e r e i s mu ch v a r i a t i o n i n t h e
t h a t i n th e Sudan th e r e
The N i l e
y ears and i t
p lain s.
has been s a id
i s seldom a norm al s e a s o n .
f l o o d i s m a in ly d e r iv e d from r a i n s t h a t
f a l l on th e A b y s s in ia n p l a t e a u .
fo r th ere
The a n n u a l
t o be l i t t l e
T h is i s rem ote enough
r e l a t i o n betw een i t
I t does not follow
that
because
and th e Sudan
th ere
are
fa v o u ra b le r a i n s and good cro p s i n th e Sudan th e r e
is
n e c e s s a r i l y a h ig h flo o d i n the N ile .
THE GEZIRA
The G e z i r a i s a f l a t b a r e p l a i n , w h i c h l i e s
i n the t r i a n g l e
fo rm e d b y t h e B lue a n d W hite N i l e s b e f o r e
t h e y j o i n a t K hartoum .
It
c o n ta in s about 5 ,000,000 a c r e s ,
-
11-
o f w h i c h some 5 0 5 , 0 0 0 a c r e s a r e i r r i g a t e d w i t h N i l e w a t e r s
fro m S e n n a r dam.
On t h i s
crops in th e w orld a re
centre
o f th e Sudan.
g r o u n d some o f t h e f i n e s t
produced.
Fr om i t s
Sudan Government d e r i v e s
T his i s the
share
tru e
the
p a r t o f the
re v e n u e s from w hich th e v a r i o u s s o c i a l s e r v i c e s
the G e z ira are
econom ic
of co tto n p r o f its
d ire c tly a large
country are m ain tain ed :
cotton
of the
a c c o r d i n g l y econom ic c o n d i t i o n s in
to a la rg e
e x te n t r e f l e c t e d by those
i n the
c o u n try a s a w hole.
THE POPULATION
From t h e p o i n t o f v i e w o f i t s
S u d a n may b e d i v i d e d i n t o
N o r th e r n Sudan and t h e
d iv isio n
in h ab itan ts,
two d i s t i n c t e n t i t i e s ,
S o u th e rn Sudan.
The l i n e
f o l l o w s a p p r o x i m a t e l y t h e 4 0 0 mm. l i n e
the
the
of
on t h e
r a i n f a l l map.
The N o r t h e r n S u d a n m i g h t a l m o s t be r e g a r d e d
c u ltu r a lly as p a rt of A sia.
Its
o r i g i n a l p e o p l e s seem to
have b een o f m ixed C a u o a s ia n -n e g ro s t o c k , b u t from the
s e v e n th c e n t u r y onwards A rab i n v a s i o n i n t r o d u c e d a l a r g e
m easure o f A s i a t i c b lo o d and c u l t u r e .
A rabic r a c e ,
lan g u ag e,
whole N o r t h e r n S u d a n .
A common b a s i s
and r e l i g i o n e x i s t
of
th ro u g h o u t the
The n e g r o i s a f a m i l i a r e n o u g h t y p e ,
b u t he i s A r a b i c i s e d a n d I s l a m i c i s e d .
The S o u t h e r n S u d a n , o n t h e o t h e r h a n d ,
negroid A fric a .
In place
we f i n d t h e e l a b o r a t e
a sh -sm eared D inka.
o f the w hite ro b es
co iffu re
b ew ildering in th e ir v a rie ty ,
n eg ro id :
n o t the
o f th e N orth
of the S h il lu k ,
A lthough th e
is tru e
o r the
ra c e s o f th e South ap p ea r
th e y are e s s e n t i a l l y a l l
I s l a m ic is e d n e g ro id o f th e N o rth , b u t the
-
12 -
n e g ro id c o m p a ra tiv e ly u n to u c h e d , naked an d unashamed,
l i v i n g i n h i s own n a t u r a l c o n d i t i o n s ,
so p rim itiv e
some c a s e s t h a t i n h i m we c a n v i s u a l i s e
o f m ankind.
It
is
of p ra c tica l
th e ir nakedness th ese
a g a in s t louse
its
tra in .
im portance
e a rly an cesto rs
to note
th a t in
p eo p le have a n e f f i c i e n t p r o t e c t i o n
in festatio n ,
and th e
C o n seq u en tly the
d iseases
th a t follow in
s p re a d S outhw ards o f
lou se-b o rn e re la p s in g fe v e r is
by the h a b i t s
the
in
to a la rg e
extent lim ite d
o f these p e o p les.
MOVEMENTS OF THE WESTERN PEOPLES.
The e x t r e m e West o f t h e N o r t h e r n S u d a n i s
i n h a b i t e d by r a c e s o f n e g r o i d o r i g i n .
A lthough t h e y have
adopted Islam th e se p e o p les rem ain c o m p a ra tiv e ly untouched
by th e
in flu en ce
o f A rabic language and c u l t u r e ,
indigenous d i a l e c t s and fo lk b e l i e f s
still
and t h e i r
su rvive.
R a c i a l l y t h e y a r e mo re a k i n t o t h e p e o p l e s o f F r e n c h W est
A frica th an to
the
W ith th e p e o p le
in h ab itan ts
o f th e N o rth e rn Sudan p r o p e r .
o f F r e n c h West A f r i c a t h e y a r e o f t e n
c o l l e c t i v e l y grouped under the
term
’ W e s te r n e r s * , and
c o n f o r m t o a common p h y s i c a l t y p e , w h i c h c a n be r e a d i l y
d i s t i n g u i s h e d from th e
o th er r a c ia l
ty p es o f the N orthern
Sudan.
The e p i d e m i o l o g y o f r e l a p s i n g f e v e r i n t h e S u d a n
d u rin g the
last
tw elve y e a rs has been v e ry l a r g e l y
d e t e r m i n e d b y th e h a b i t s and movements o f t h e s e p e o p l e s .
In fo rm e r y e a r s t h e y w ere r e g u l a r l y r a i d e d by
t h e Arab s l a v e - t r a d e r s ,
im portant source
t o whom t h e y c o n s t i t u t e d a n
o f w e a lth and man-pow er.
Now t h e y t r a v e l
long d is ta n c e s a c r o s s the A fric a n c o n tin e n t i n s e a rc h o f
-
13-
p a i d w o rk , w hich w i l l e n a b le them t o a c c u m u la te enough
money t o b u y c a t t l e
a n d a w ife when t h e y s e t t l e
down i n
t h e i r own d i s t r i c t s .
Every y e a r th e r e
W esterners in to
the
G ezira f o r the
November a n d D ecem ber.
o f the A rab,
w ages.
co tto n h arv est
l a c k i n g the
co tto n p ick in g is
own c o u n t r y ,
A few s e t t l e
H ere,
in f lu x o f these
t h e y maxe b e t t e r l a b o u r e r s ,
A fte r the
to th e ir
is a larg e
if
in
so p h isticatio n
a n d e a r n good
o v e r t h e y ma y r e t u r n
t h e y have a c c u m u l a t e d enough money.
in v arious p a rts
of th e Sudan.
O thers d r i f t
f u r t h e r E a s t w a r d s i n s e a r c h o f w o r k , t h e i r m ovem ents from
p l a c e t o p l a c e b e i n g a f f e c t e d b y t h e demand f o r c a s u a l
labour.
Large num bers o f them c o n t i n u e t h e i r E a s tw a r d
jo u r n e y on t h e p i l g r i m a g e t o M ecca.
The p i l g r i m a g e
to
the W estern ers to
urge.
is
leav e
p robably as b ig an in c e n tiv e
t h e i r homes a s t h e econom ic
T h e i r Mohammedan r e l i g i o n i s
w ith the
c u r i o u s l y m ix e d up
innum erable A fric a n s u p e r s t i t i o n s
has only r e c e n t l y been g r a f te d , and i s
credulous and f a n a t i c a l
type.
on t o w h ic h i t
consequently of a
M o s t o f t h o s e who l e a v e
t h e i r ho m e s do s o w i t h t h e h o p e o f u l t i m a t e l y r e a c h i n g
Mecca a n d l a t e r r e t u r n i n g .
The p i l g r i m a g e
l i v e l i h o o d by th e way.
i s l o n g f o r one who m u s t f i n d a
I t may b e a q u e s t o f y e a r s ,
even o f a l i f e t i m e , w ith perhaps d eath en r o u t e .
pilg rim s s e t t l e
i n the
Some
e i t h e r perm an en tly , o r fo r long p e rio d s ,
c o u n t r i e s th r o u g h w hich t h e y p a s s .
m o ne y q u i c k l y ,
or
O thers, g ain in g
r e t u r n to buy a w i f e , l e a v i n g the
pilgrim age fo r a fu tu re
occasio n .
-
The r e s u l t
im p ercep tib le,
14-
is a slow ,
irreg u lar,
alm ost
yet co n tinuous i n f i l t r a t i n g m ig ra tio n of
W e s te r n e r s .E astw ards a c r o s s t h e S udan, a n d a s m a l l e r
W estw ard r e t u r n i n g m ovem ent.
is d iffic u lt
co n sid erab le.
to e stim a te ,
The m a g n i t u d e o f t h i s m i g r a t i o n
but i t
i s p robably q u ite
I t may be t e m p o r a r i l y d e f l e c t e d ,
o r d e la y e d by i r r e g u l a r changes i n th e
by o th e r p o l i t i c a l
o r econom ic e v e n t s .
accelerated ,
labour m arkets,
or
-
(B)
:
r
15 -
HISTORICAL SURVEY,
n
■
.... .
... •:.»
***&■
Xjjr. r u n . ? : " V h i r
-
i.
-
i r fit.
-
16-
HISTORICAL SURVEY.
A ccording to a l l a c c o u n ts c o n d itio n s
before
in the
t h e B r i t i s h o c c u p a t i o n were e m i n e n t l y s u i t a b l e
r e l a p s i n g f e v e r - the
o ld
’ fam ine
appeared t y p i c a l l y in tim es
for
f e v e r ’ o f E u ro p e , w hich
of u n re s t and d e p re ssio n .
From 1 8 8 4 w h e n t h e M a h d i d r o v e o u t t h e
ex p lo iters
Sudan
o f the c o u n try , to
T urco-E gyptian
the
A bdullahi a t
d e fe a t o f the K h a lifa
e
Omdurman i n 1 8 9 8 , t h e r e s t r e t c h f o u r t e n y e a r s
o f m assacre,
fam ine,
and p e s t i l e n c e .
But t h e s e were o n ly
the
cu lm in atio n o f a rem o ter and lo n g er p e rio d ,
its
consequence.
From 1 8 2 1 , w he n Mahommed A l i
as fo u l as
the G reat
s u b j u g a t e d f p r h i s o v e r l o r d t h e S u l t a n t h e p e o p l e s he
c a l l e d th e Sudan -
’the
c o u n tr y o f the b l a c k s ’ - th e
c o n q u e r o rs r a n th e l a n d p u r e l y a s an enormous s l a v e
farm .
What t h e T u r c o - E g y p t i a n r e g i m e m e a n t t o t h e p o p u l a t i o n c a n
be r o u g h ly e s ti m a te d by th e r e s u l t - i n s i x t y y e a r s
d w in d le d from t h i r t e e n m i l l i o n s
starv ed ,
to a plague
and in c o n ce iv a b ly m ise rab le
three
it
strick en ,
m illio n s
(KEUH, 1 9 3 0 ) .
From o l d d e s c r i p t i o n s ,
the b e st
o f w hich a re
t h o s e g i v e n b y BRUCE ( 1 8 1 0 ) , a n d BURCKHARDT ( 1 8 2 2 ) , t h e
p r i n c i p a l d i s e a s e s w h ic h r a v a g e d t h e p o p u l a t i o n seem t o
have been m a l a r i a ,
m en in g itis,
the
d y sen teries,
and sm allpox.
have been p r e s e n t
d e sc rip tio n s are
in th is
cereb ro -sp in al
P o s s i b l y r e l a p s i n g f e v e r may
p eriod,
in d efin ite.
b u t the o r i g i n a l
BURCKHARDT ( 1 8 2 2 ) ,
how t h e M a m e l u k e s , a f t e r t h e i r f l i g h t
relates
from E g y p t t o D ongola
’ d ie d o f a p u t r i d f e v e r w hich r e g u l a r l y p r e v a i l s i n
Dongola d u r i n g th e h o t w e a t h e r ’ .
the
PONCET ( 1 7 0 9 ) d e s c r i b e s
d e p o p u l a t i o n ojf D ongola b y p la g u e so t h a t
he fo u n d
-
17 -
*t o w n s a n d v i l l a g e s w i t h o u t i n h a b i t a n t s ,
p ro v in ces,
a t o th e r tim es v ery f e r t i l e ,
and e n t i r e l y abandoned’ .
It
is
CRAGG ( 1 9 2 2 ) p l a g u e
is
the
qu ite
l a i d w aste
i n t e r e s t i n g to n o te
plague has n e v e r b een found i n th e
to
and la rg e
Sudan, w hile a c c o rd in g
d isease
w hich i s most
co m m o n ly c o n f u s e d w i t h e p i d e m i c r e l a p s i n g f e v e r .
d e s c r i p t i o n s may p o s s i b l y r e f e r t o
relap sin g fev er,
was i n the
esp ecially as at
th roes
These
o ld epidem ics o f
th e tim e th e
o f wars betw een th e
and the S h a ik iy a , b u t t h i s
th at
country
Fung Icings o f S e n n a r
c a n o n l y be a s p e c u l a t i o n .
D r . H a s s a n Z a k i who s e r v e d w i t h t h e E g y p t i a n
M e d ic a l Corps i n th e Sudan d u r i n g th e
tim e
o f G ordon, and
a s a c a p t i v e w a s t h e M a h d i ’ s p h y s i c i a n i n Omdurman, s t i l l
liv es
i n K hartoum .
He t e l l s me t h a t t h e d i s e a s e w a s n o t
recognised during th a t
period.
A p p a ren tly the f i r s t
cases
of rela p sin g fever
r e c o r d e d f r o m t h e S u d a n w e r e s e e n b y CUMMINS ( 1 9 1 0 ) i n
E l O beid i n 1908.
T h e s e w e r e two E g y p t i a n s o l d i e r s , who
h ad j u s t r e t u r n e d from le a v e
i n E g y p t , where t h e d i s e a s e
h a d a l r e a d y b e e n f u l l y d e s c r i b e d c l i n i c a l l y b y SANDWITH
( 1 9 0 5 ) , a n d s t u d i e d e x p e r i m e n t a l l y b y GRAHAM-SMITH ( 1 9 0 9 )
a n d DREYER ( 1 9 1 0 ) ,
presence
A c c o r d i n g t o RUSSELL ( 1 9 3 2 ) t h e
of r e la p s in g fe v e r in Egypt had been s u sp e c te d as
l o n g a g o a s 1 8 5 7 b y GRESSINGER, o n c l i n i c a l g r o u n d s .
D u r i n g t h e n e x t tw o y e a r s BOUSEFIELD ( 1 9 1 1 )
r e p o r t e d s i x c a s e s s e e n i n K hartoum — a l s o E g y p t ia n s o l d i e r s
r e c e n t l y a r r i v e d from E g y p t.
W r i t i n g w ith a know ledge o f
the m edical c o n d itio n s in the
country a t
BOUSEFIELD m a k e s t h e
•sp iro eh aeto sis is
th e tim e
i n t e r e s t i n g rem ark t h a t
’ huma n
p ro b a b ly n o t endem ic i n th e N o rth e rn
-
Sudan,
oth erw ise
it
18-
seems s c a r c e l y p o s s i b l e
have m is se d r e c o g n i t i o n ' .
BALFOUR ( 1 9 1 1 ) c a r r i e d
some e x p e r i m e n t a l w o r k w i t h t h e
from t h e s e
cases,
sp iro ch aetes
b u t was u n a b le t o
a l t h o u g h he a t t e m p t e d t o
th at i t
w ould
out
o btained
i d e n t i f y the v e c to r ,
in fect tic k s,
lice,
and bed-bugs.
I n 1 9 1 3 one c a s e w a s f o u n d a t Wadi H a i f a on
the E g y p tian b o rd e r,
and one i n K h a rto u m .
was a s m a l l o u t b r e a k a t H a i f a - 112 c a s e s
o rig in of th is
i n a l l - b u t the
i n f e c t i o n was once more t r a c e d t o E g y p t .
F o r t h e y e a r s 1917 t o 1924 t h e
some f i f t y
I n 1916 t h e r e
records are scan ty ,
c a s e s were o b s e r v e d d u r i n g t h i s
around A tb ara.
p erio d ,
BOUSEFIELD h a d p o i n t e d o u t t h e
E g y p tian im m igrants b e in g ab le
to in tro d u ce
but
i n a nd
danger of
the d is e a s e
i n t o t h e S u d a n , a n d so p e r m a n e n t l y i n f e c t i n g a d i s t r i c t
ap p aren tly free
f r o m human s p i r o c h a e t o s i s .
d is tr ib u tio n o f the
suggested th a t th e
the l i n e s
The
c a s e s from 1908 t o 1924 c e r t a i n l y
d ise a se had a tendency to sp re ad alo n g
o f com m unication betw een Egypt and th e Sudan.
D uring 1925, how ever,
t h e r e were no f u r t h e r
c a s e s i n t h e N o r t h e r n S u d a n , b u t s i x c a s e s were fo u n d i n
M ongalla,
on th e Uganda f r o n t i e r .
Tick-borne
relap sin g
f e v e r i s p r e v a l e n t i n U g a n d a , a n d O r n i t h o d o r u s m o u b a t a was
f o u n d i n some o f t h e r e s t - h o u s e s w h i c h h a d b e e n o c c u p i e d
by th e s e
cases.
o c ca sio n the
It
So i t may be p r e s u m e d t h a t o n t h i s
d i s e a s e was t i c k - b o r n e .
is
probable,
th erefo re,
re la p s in g fe v e r had not e s ta b lis h e d
n o r had i t ,
t h a t u n t i l 1926
i t s e l f in th e Sudan,
a t any r a te under B r itis h a d m in is tra tio n ,
assumed e p id e m ic form .
I n 1926 l o u s e - b o r n e
relap sin g
fe v e r invaded
D a r f u r fro m t h e W est i n e p i d e m i c fo r m .
RIDING a n d MACDOWELL ( 1 9 2 7 ) s u g g e s t t h a t
th is
d isease
o r i g i n a t e d from a n endem ic fo c u s i n th e
M arra m ountains.
A c c o r d i n g t o ATKEY ( 1 9 2 9 ) t h e
was i n t r o d u c e d i n t o
t h e S u d a n by i m m ig r a n t l a b o u r e r s
from th e French S udan.
th is
argum ent.
in fectio n
T h e r e s e e m s more s u p p o r t f o r
Louse-borne r e la p s in g
fever f i r s t
a p p e a r e d i n F r e n c h W est ^ . f r i c a i n 1 9 2 1 , w h e r e , a c c o r d i n g
t o KERREST,
GAMBIER, a n d BOURON ( 1 9 2 2 ) ,
by r e p a t r i a t e d S en eg alese
i t was i n t r o d u c e d
t r o o p s from S y r i a .
O ther
o b s e r v e r s , n o t a b l y RIGOLETT ( 1 9 2 5 ) a n d NOGUE ( 1 9 2 5 )
m aintain th a t t h i s
e p i d e m i c o r i g i n a t e d f r o m some u n k n o w n
e n d e m i c f o c u s i n W est A f r i c a ,
evidence
and produce c o n s id e r a b le
i n su p p o rt o f t h e i r view s.
H o w e v e r i t may h a v e a r i s e n ,
t h i s was u n d o u b t e d l y
one o f t h e g r e a t e s t h i s t o r i c a l e p i d e m i c s o f r e l a p s i n g f e v e r .
It
s p r e a d u n c h e c k e d o v e r B r i t i s h a n d F r e n c h West A f r i c a
i n t o th e Tchad r e g i o n
a p p e a r e d i n W ada i
(LASNET, 1 9 3 0 ) , a n d f i n a l l y
(LE GAC, 1 9 3 1 ) .
The m o r t a l i t y i n t h e s e
a r e a s i s unknown.
1 2 8 , 7 5 0 d e a t h s w e r e e s t i m a t e d i n Kano a l o n e ,
1925),
and i n o th e r d i s t r i c t s
(McCULLOCH,
th e m o r t a l i t y i s s a i d to
have b een h ig h e r s t i l l .
I n S e p te m b e r 1926 th e d i s e a s e
th e most W e s te rly p r o v in c e o f th e Sudan.
from v i l l a g e
Here i t
to v i l l a g e w ith am azing r a p i d i t y ,
th e s p a c e o f s i x m onths h a d k i l l e d
It
reached D arfur,
co m m o n ly s w e p t t h r o u g h a v i l l a g e
spread
and in
o v e r 1 0,000 p e o p le .
and i n f e c t e d h a l f o r
a t h i r d o f the p o p u la tio n , w ith a case m o r t a l i t y of
-
70 p e r c e n t ,
20-
a f t e r w hich i t s
v irulence
abated
(MAURICE, 1 9 3 2 ) .
For f o u r y e a r s the E astw ard sp re a d o f the
in to
the
C e n t r a l S udan was p r e v e n t e d by a v i g o r o u s
cam paign,
the
in c lu d in g the e sta b lis h m e n t of q u aran tin e p o s ts ,
d e s tr u c tio n o f l i c e , and th e
(BEVERIDGE, 1 9 2 8 ) .
G ezira,
d isease
tre a tm e n t o f the
H ad t h i s v i r u l e n t d i s e a s e
th e work i n th e c o t t o n f i e l d s
sick
in v ad ed the
w ould h ave b e e n
s e r i o u s l y d i s o r g a n i s e d , a n d t h e whole Sudan m ig h t have b e en
f a c e d w ith a n econom ic d i s a s t e r o f th e f i r s t m a g n itu d e .
D uring th e se
in fectiv ity
four y e a rs th e
o f the d ise a se
virulence
and
a p p e a re d to d im in is h .
The
w id e s p r e a d e p id e m ic s w hich had d e c im a te d th e p o p u l a t i o n
o f D a r f u r d i e d down, a n d gave p l a c e t o
lo c a l is e d epidem ics,
This decrease
appearance
o f l e s s e r v iru le n c e and i n f e c t i v i t y .
i n v i r u l e n c e was a c c o m p a n i e d b y t h e
o f m ild su b a c u te ,
(ATKEY, 1 9 3 2 ) ,
sm aller,
or am bulatory cases
extrem ely d i f f i c u l t
to d e te c t a t the
q u aran tin es.
I t was i n e v i t a b l e t h a t
some o f t h o s e
c a s e s w ould s l i p
sooner or l a t e r
th ro u g h , and p a s s in the
s tre a m o f im m igrant l a b o u r i n t o th e
irrig a te d areas
of
the G ezira.
T his happened i n 1930.
From A p r i l t i l l A u g u s t
of th a t y ear sporadic cases occurred in v ario u s p a rts
the
of
G e z i r a , a n d on A ugust 3 0 t h s i x c a s e s w e re r e p o r t e d
i n one l o c a l i t y .
From t h a t t i m e o n w a r d s f r e s h c a s e s
continued to o ccu r,
in sp ite
u n t i l J u n e 1 9 3 1 , when t h e
sm all recrudescence
of vig o ro u s c o n tro l m easures,
incidence
took p la ce
was r e a d i l y stam ped o u t .
N o r t h e r n S u d a n was f r e e
f e ll ab ru p tly .
A
i n th e autum n o f 1932, b u t
D uring th e
next
t h r e e y e a r s the
from r e l a p s i n g f e v e r , a l t h o u g h
i n 1 9 3 4 on e i s o l a t e d e a s e w a s f o u n d a t M a l a k a l ,
S outhern Sudan.
th is
No d e f i n i t e
i n f e c t i o n was t i c k - b o r n e
i n v e s t i g a t i o n s w e r e made*
i n the
ev idence e x i s t s a s to w hether
o r l o u s e - b o r n e a s no
(C)
RE-INFECTION OF THE SUDAN FROM ABYSSINIA
(1)
RECRUDESCENCE OF THE DISEASE IN 1 9 3 6 - 1 9 3 7 ,
(2)
RELAPSING FEVER IN ABYSSINIA.
(3)
FACTORS LEADING TO THE INFECTION OF THE SUDAN.
-
23“
HECRUDES CEITCE OF THE DISEASE IN 19-36 a n d 1 9 3 7 .
I n 1936 r e l a p s i n g
the Sudan.
On t h e 2 2 n d A u g u s t o f t h a t y e a r o ne c a s e was
r e p o r t e d from S in g a ,
i n th e Fung d i s t r i c t ,
s l i d e s were s e n t t o t h e
the
f e v e r a p p e a r e d once a g a i n i n
L ab o rato ries
and blood
fo r co n firm atio n of
d iag n o sis.
D uring the rem ain d er o f the y e a r ,
o c c u rre d in the
same d i s t r i c t ,
a fe w c a s e s
th e m onthly in c id e n c e b e in g
as follow s
A u g u s t .......................................
S e p t e m b e r .............................
O c t o b e r .....................................
N o v e m b e r ..................................
D e c e m b e r ..................................
7
15
0
1
1
E n q u i r i e s a b o u t t h e i r movements r e v e a l e d t h a t
the p a t i e n t s had r e c e n t l y
and t h e i r
come f r o m A b y s s i n i a .
The c a s e s
c o n t a c t s w ere p ro m p tly i s o l a t e d and d i s i n f e s t e d .
By t h e e n d o f t h e y e a r i t
appeared th a t
th e s i t u a t i o n was
w e l l i n h a n d , a n d t h a t a n y t e n d e n c y to e p i d e m i c s p r e a d h a d
been scotched.
T h i s , u n f o r t u n a t e l y , was n o t s o .
Odd c a s e s
c o n t i n u e d t o o c c u r d u r i n g t h e e a r l y p a r t o f 1 9 3 7 , a n d by
the end o f M arch, 1937, th e
t h e y e a r was 3 9 .
t o t a l i n th e whole Sudan f o r
I n f e c t i o n s w ere r e p o r t e d from p l a c e s as
f a r a p a rt as K assala
(8 c a s e s )
and F ash er
(2 c a s e s ) .
One
e a s e was f o u n d i n U a h u d , a n d t h e r e m a i n d e r w ere d i s t r i b u t e d
b e tw ee n th e Fung and G e z i r a d i s t r i c t s
o f the C e n tra l Sudan.
CRAGG ( 1 9 2 2 ) d e s c r i b e s how e p i d e m i c r e l a p s i n g f e v e r i n
the
U nited P ro v in ce s o f In d ia fr e q u e n tly appears to take
o rig in
s i m u l t a n e o u s l y from m u l t i p l e
of
the c o u n try ,
and i t
foci in d iffe re n t p arts
l o o k e d a s i f t h e same t h i n g w ere a b o u t
to happen i n th e Sudan.
-
In A ugust the
24-
incidence
rose a b ru p tly .
everyw here n o tic e d t h a t th e d i s e a s e ,
as
was a l m o s t w h o l l y c o n f i n e d to n a t i v e s
a n d F r e n c h West A f r i c a .
in form er y e a r s ,
o f th e W e ste rn Sudan
The p o s s i b i l i t y
e p i d e m i c was d i s q u i e t i n g .
I t was
o f a n o t h e r m ajor
I n O c t o b e r 19 37 t h e w r i t e r w a s
com m issioned by th e D i r e c t o r o f th e
t o make a t o u r o f i n v e s t i g a t i o n ,
Sudan M edical S e rv ic e
a n d r e p o r t on t h e
s p re a d , and any o th e r f e a tu r e s r e l a t i v e
o rig in ,
to p re v e n tio n of
the d is e a s e .
D uring t h i s
in v estig atio n ,
p a r t l y i n K hartoum a n d p a r t l y i n th e
w hich was c a r r i e d
affected d is tr ic ts ,
’la b o ra to ry s a lo o n ’ proved in v a lu a b le .
coach
(F ig .22),
up-to -d ate
the
i n t e r i o r o f w hich i s
lab o rato ry .
s t a t i o n on t h e
It
out
This i s
the
a railw ay
equipped as an
c a n be r e a d i l y t r a n s p o r t e d t o any
railw ay l i n e ,
th u s b r i n g i n g the
facilities
o f a w e l l e q u i p p e d l a b o r a t o r y w i t h i n e a s y r e a c h o f some o f
t h e more o u t l y i n g d i s t r i c t s .
W ithout t h i s m obile l a b o r a t o r y
it
to c a rry out the n ecessary
w ould have b e e n i m p o s s i b l e
in v e s t ig a ti o n s w ith any degree
of ex p ed itio n .
RELAPSING FEVER IK ABYSSIKIA
In s p ite
disease
o f th e a lm o st com plete r e s t r i c t i o n
o f the
t o n a t i v e s o f t h e W e s t e r n S u d a n a n d F r e n c h W est
A f r i c a one o f t h e f i r s t
th e source
o f the
t h i n g s t o become a p p a r e n t was t h a t
i n f e c t i o n was t h i s
tim e from an e n t i r e l y
new q u a r t e r , v i z , A b y s s i n i a a n d t h e o t h e r c o u n t r i e s E a s t o f
the Sudan.
The e x i s t e n c e
o f r e l a p s i n g fe v e r in A byssinia
h a s b e e n known f o r ma ny y e a r s .
The i n f e c t i o n w a s f i r s t
-
r e p o r t e d b y DOREAU ( 1 9 0 8 ) ,
25-
a n d i n t h e s ame y e a r BRUMPT
(1908) r e p o r t e d th a t- he h a d s u c c e s s f u l l y i n f e c t e d a
monkey i n P a r i s b y means o f O r n i t h o d o r u s m o u b a ta s e n t
to
h im b y a m i s s i o n a r y f r o m H a r r a r ,
the
existence
a review ,
of a tick -b o rn e
c a l l e d the
thus e s t a b l i s h i n g
strain .
sp irochaete
MESNIL ( 1 9 0 8 ) i n
S p .. j b o y s i n , 3ERGSMA
( 1 9 2 8 ) g a v e a n a c c o u n t o f some c l i n i c a l
the p re v a len c e
c a se s and n o te d
o f O r n ith o d o r u s m oubata a n d O rn ith o d o r u s
sav ig n y i.
Louse-borne r e l a p s i n g fe v e r has been r e p o r te d
fro m A d d is Abbaba b y SIB ILIA ( 1 9 3 7 ) .
t o be t h e
first
T h is a u th o r claim s
to r e p o r t th e lo u s e - b o r n e
NAGELSBACH ( 1 9 3 4 ) ? t h r e e
d isease,
but
years e a r lie r , had noted th a t in
the h i g h l a n d s o f A b y s s i n i a , where t i c k s were n o t fo u n d ,
lice
a n a r e l a p s i n g f e v e r w e r e b o t h common, a n d c o n c l u d e d
th a t the
l i c e m u s t be t h e v e c t o r s .
It is
i n t e r e s t i n g to note
t h a t de PAOLI ( 1 9 3 0 )
d e s c r i b i n g an e p id e m ic o f r e l a p s i n g f e v e r i n Asmara i n
1 9 2 9 , i n w hich t i c k s were n o t fo u n d b u t l i c e
p len tifu l,
E ritrea
states
t h a t the d isea se
from A b y s s i n i a .
were
was i m p o r t e d i n t o
C o rro b o r a tio n o f h i s view s is
g i v e n b y BRUITS ( 1 9 3 7 ) who r e c o r d s a v e r y f a t a l e p i d e m i c
o f lo u se -b o rn e r e l a p s i n g f e v e r in the D jig d i s t r i c t of
A b y ssin ia i n 1929.
d isease
A c c o r d i n g t o CACCIAPUOTI ( 1 9 3 6 )
the
i s now e n d e m i c i n ma ny t o w n s a n d v i l l a g e s i n
E ritrea.
A c c o r d i n g t o BRUNS ( 1 9 3 7 ) r e l a p s i n g f e v e r i s
e n d e m i c i n many d i s t r i c t s
o f A b y ssin ia , bu t a p t to break
o u t i n e p id e m ic form d u r i n g the r a i n y s e a s o n .
The l o u s e ,
O rn ith o d o r u s m oubata a n d O r n ith o d o r u s s a v i g n y i a re a l l
-
26-
c i t e d as v e c to r s by th is , a u th o r.
I t may be n o t e d t h a t w i t h t h e
exception of
BRUMPT ( 1 9 0 8 ) , t h e s e a u t h o r s r e l y l a r g e l y o n e p i d e m i o l o g i c a l
d a t a f o r t h e i r v iew s on t r a n s m i s s i o n ,
a n d do n o t s u b s t a n t i a t e
them by e x p e r i m e n t a l t r a n s m i s s i o n o f t h e d i s e a s e
by th e
alleg ed v ecto r.
A sim ilar state
of affairs
o b t a i n s i n the
a d j o i n i n g c o u n t r i e s , B r i t i s h a n d I t a l i a n S o m a l i l a n d , where
O rnithodorus
s a v i g n y i , DRAKE-BROCKMAH ( 1 9 1 3 ) ,
O r n ith o d o r u s m oubata
CLARKE ( 1 9 3 6 )
( DONALDS OIT, 1 9 2 5 ) a n d t h e l o u s e
(MODUGNO, 1 9 3 7 ) h a v e a t d i f f e r e n t t i m e s b e e n c i t e d a s t h e
p rin c ip a l v ecto rs.
ep id em io lo g ical,
Here a g a i n ,
and th e re
th e evidence
is a notable
is
larg ely
absence o f
la b o ra to ry confirm ation.
FACTORS LEADING TO THE INFECTION OF THE SUDAN
The f a c t o r s
le a d in g to the
i n f e c t i o n o f t h e Sudan
may i n a g e n e r a l s e n s e , b e d e s c r i b e d a s p a r t o f t h e
a fte rm a th o f the
Ita lo -A b y s s in ia n w ar.
B u t i t may
d e f i n i t e l y be s t a t e d t h a t t h e i n t r o d u c t i o n o f th e d i s e a s e
i n t o t h e Sudan was n o t t h e r e s u l t
refugees.
the
o f an in f lu x o f A b yssinian
I t has a lr e a d y been n o ted t h a t the v ic tim s o f
d i s e a s e were n o t A b y s s i n i a n s o r l o c a l n a t i v e s ,
but
n a t i v e s o f t h e W e s t e r n S u d a n a n d F r e n c h West A f r i c a ,
an aly sis
is
o f th e f a c t o r s w hich l e d up to t h i s s t a t e
a n d an
of a ffa irs
o f some i n t e r e s t .
A fte r th e m i l i t a r y o c c u p a tio n o f A b y ssin ia by
the
Italian s
th ere
s t i l l rem ains th e lo n g e r p ro c e s s o f
p a c i f i c a t i o n a n d d e v e l o p m e n t , r e q u i r i n g m on e y a n d l a b o u r .
-2 7 -
A tte n tio n has a lr e a d y been d i r e c t e d to the m ig ra to ry
movements o f t h e
W esterners a c r o s s A f r i c a , and to
i n w h ich t h e demands o f th e
la b o u r m arket in flu e n c e
m ovem ents.
B eing good l a b o u r e r s ,
co nditions,
th e y w ere th e
i n the
o f a ta s k such as
face
A byssinia.
obvious im m ig ran ts to encourage
confronted
C onsequently la rg e
years,
these
s u ite d to A frican
the
Italian s
in
num bers o f W e s te rn e rs
made t h e i r w a y i n t o A b y s s i n i a a n d E r i t r e a
th re e
t h e way
d u r in g the l a s t
in the reaso n ab le e x p e c ta tio n th a t
there
t h e y w o u l d f i n d a m a r k e t w h e r e l a b o u r w o u l d command a
high p ric e .
E x t r a c t s f r o m a R e p o r t b y me t o t h e D i r e c t o r ,
Sudan M edical S e r v ic e ,
e n c o u n te re d i n the
on th e
in d icate
b riefly
the fo rtu n e
I ta lia n t e r r i t o r i e s and i t s
in tro d u ctio n o f relap sin g fever in to
b earin g
th e Sudan:
(14)
"98 p e r c e n t , o f th e K a s s a la and
B lue N ile e a s e s have been i n m ales o v e r
1 5 y e a r s o f a g e , a n d o v e r 90 p e r c e n t ,
a re W e s te rn e rs o r n a t i v e s o f th e Sudan
r e t u r n i n g from E r i t r e a an d A b y s s in ia "
(15)
' C o n d itio n o f the Im m ig ran ts'
"G e n e ra lly sp e a k in g the c ases a re in d iv id u a ls
who h a v e t r e k k e d a c r o s s A f r i c a t o E r i t r e a a n d
A b y s s i n i a , a t t r a c t e d b y p r o m i s e s o f ample w o rk
and good pay.
15 p i a s t r e s a d a y , a l l f o u n d was
what t h e y were l e d to e x p e c t .
Many h a v e b e e n
12 - 18 m o n t h s o n t h e i r E a s t w a r d t r e k k , . a n d f o r
most th e jo u rn e y h as b e en a rd u o u s enough"
(16)
"Once i n t h e I t a l i a n t e r r i t o r i e s , h o w e v e r ,
th e y found c o n d itio n s d i s a p p o i n t i n g .
T h o s e who
w e r e l u c k y g o t 7 - 8 p i a s t r e s a d a y : ma ny g o t
less.
O f t e n t h e r e w a s n o m one y a v a i l a b l e , a n d
th e y h ad to a c c e p t i n s t e a d c a r p e t s and o t h e r
goods o f I t a l i a n o r i g i n .
T h o s e who w e r e l u c k y
e n o u g h t o o b t a i n m o n e y f o u n d t h a t i t s e x p o r t was
p r o h ib i te d by the a u t h o r i t i e s .
T h e ir food th e y
h a d t o p a y f o r a n d t h e y were u n a b l e t o o b t a i n i t
e x c e p t from a p p o i n t e d c a n t e e n s , where t h e p r i c e
was h i g h a n d t h e q u a l i t y p o o r .
The w o r k ( m o s t l y
r o a d m a k i n g ) was h a r d a n d t h e c o n d i t i o n s
-2 8 -
(16)
ex actin g .
T h o s e who f e l l s i c k b y t h e w ay
had to look a f t e r th e m se lv e s.
No m e d i c a l
a t t e n t i o n was p r o v i d e d f o r m i n o r o r m a j o r
a ilm en ts.
A c c o rd in g to t h e i r r e p o r t s num erous
m in o r A b y s s in ia n i n s u r r e c t i o n s added t o the
g e n e ra l s t r e s s o f l i v i n g , and th ey say t h a t in
t h e i n t e r i o r many p e r s o n s a r e d y i n g o f s m a l l p o x
and fe v e r"
(17)
"T he r e s u l t i s t h a t t h o s e i m m i g r a n t s a r e
now l e a v i n g t h e I t a l i a n t e r r i t o r i e s a s r a p i d l y
a s th e y c a n , an d p o u r in g b a c k i n t o th e Sudan i n
l a r g e n um b ers, h o p in g e i t h e r to f i n d work h e r e ,
o r t o r e t u r n t o t h e i r homes"
(18)
" P h y s ic a lly they are u n d e r-n o u rish e d ,
verm inous, and w eary w ith lo n g jo u r n e y in g .
T heir
s p a re b o d ie s and dry s k in s are ev id en ce o f t h e i r
d e v ita lis e d condition"
"In a d d i t i o n to the epidem ic d is e a s e s ,
r e l a p s i n g f e v e r an d sm allp o x , w hich th e y a re
b r i n g i n g i n , a t t e n t i o n ma y be d r a w n h e r e t o t h e
l a r g e number o f c h r o n i c s e p t i c c o n d i t i o n s and
s lo u g h in g u l c e r s w hich a r e c ro w d in g o u t th e
h o s p i t a l s on th e Sudan b o r d e r .
A ll th e se cases
a r e r e c e n t a r r i v a l s from I t a l i a n t e r r i t o r y "
(19)
" I n s h o r t , we h a v e h e r e a c l a s s i c a l p i c t u r e
o f r e l a p s i n g fe v e r w ith a l l the a s s o c ia te d
c irc u m s ta n c e s w hich have been r e c o g n is e d s in c e
the days o f H ip p o c ra te s - u n r e s t and m ise ry ,
w ar, f a t i g u e , overcrow ding, m a l n u t r i t i o n ,
v erm in o u sn ess, and th e sp re a d o f the d ise a se
a m o ng c o m m u n i t i e s a l o n g t h e m a i n l i n e s o f
trav el"
(21)
"From r e c e n t I t a l i a n m e d i c a l l i t e r a t u r e
(CACCIAPUOTI, 1 9 3 7 ) i t i s e v i d e n t t h a t l o u s e borne r e l a p s i n g fe v e r has been p r e s e n t in
e p i d e m i c form i n E r i t r e a f o r t h e l a s t two y e a r s
at least.
The p o s s i b i l i t y o f i n f e c t e d p e r s o n s ,
e i t h e r in c u b a tin g the d is e a s e or in an
a p y re x ia l p e rio d , having p assed through in to
t h e S u d a n a t v a r i o u s t i m e s c a n n o t be i g n o r e d .
T h i s may b e t h e e x p l a n a t i o n o f t h e s p o r a d i c e a s e s
w hich o c c u r r e d i n d i f f e r e n t p a r t s o f th e c o u n tr y
d u r i n g 1936 a n d th e e a r l i e r p a r t o f 1937"
-2 9 -
(23)
" S i n c e t h e n t h e s i t u a t i o n h a s b e c o m e one
of co n sid e ra b le urgency.
F o r some t i m e now
e a c h W estbound t r a i n p a s s i n g S e n n a r h a s b r o u g h t
i n some 4 0 0 - 5 0 0 p e r s o n s c o m i n g f r o m t h e
h e a v i l y i n f e c t e d c o u n t r i e s on t h e E a s t e r n b o r d e r
o f the Sudan.
A c e r t a i n s m a ll number a re
probably a ls o t r a v e l l i n g through A tb ara.
For
t h e r e a s o n s g i v e n i n p a r a g r a p h s 11 a n d 1 2 ,
n u m b e r s o f t h e s e i n f e c t i o n s may p a s s u n d e t e c t e d
t i l l t h e p e r s o n s c o n c e rn e d have p ro c e e d e d f u r t h e r
on t h e i r W estw ard j o u r n e y , o r i n f i l t r a t e d th e
G e z ira i n t h e i r s e a rc h f o r w ork, th u s s t a r t i n g
new e p i d e m i c f o c i i n t h e s e p a r t s o f t h e
country"
F i g 4 shows th e r o u t e s b y w hich t h e i n f e c t i o n
was i n v a d i n g t h e S u d a n .
P a r tic u la r ly n o ticeab le
is
the
p a r t p lay ed by th e K a ssala-S en n a r ra ilw a y in s h o rte n in g
the
tim e o f t r a v e l and e n a b l i n g p e o p le
d istan ces
from th e
to p ro c e ed long
so u rce o f i n f e c t i o n d u rin g the
in c u b a tio n p e rio d o r in the a p y r e x ia l i n t e r v a l .
The p o p u l a r i t y o f t h e r a i l w a y l i n e
w ith o u t advantage
from th e p u b l i c h e a l t h
was n o t
p o in t o f view .
I t was a p p a r e n t t h a t a s l o n g a s t h e v a s t m a j o r i t y o f
im m igrants chose th e ra ilw a y l i n e
c o n t r o l was p o s s i b l e ,
the b o rd e r to
some m e a s u r e o f s a n i t a r y
e s p e c i a l l y a s t h e m ain r o u t e s from
th e r a i l w a y c o n v erg ed on K a s s a l a , w here the
m a in q u a r a n t i n e s t a t i o n was e s t a b l i s h e d .
s p a r e d to a v o id irksom e
o r s t r i n g e n t c o n t r o l m e a s u r e s on
th e r a i l w a y w hich m ig h t d i v e r t
in to
channels le s s e a s i l y
h e a l t h p o in t of view .
No p a i n s w e r e
the stream
o f im m igrants
c o n t r o l l e d from th e p u b l i c
Even a s i t
w a s, a s m a l l e r number
o f i m m i g r a n t s w e r e f i n d i n g t h e i r way f r o m t h e
th e B lue N ile w ith o u t
t r a v e l l i n g by r a i l .
border in to
Most o f t h o s e
w ere s t r a g g l e r s a c r o s s t h e A b y s s i n i a n b o r d e r whose r o u t e
t o o k t h e m down t o
In t h i s
the ra ilw a y l i n e
somewhere n e a r G e d a r e f .
d i s t r i c t t h e r e was a b r i s k d e m a n d f o r l a b o u r e r s
30-
in c o n n e c tio n w ith the
d u r r a and sim sim f i e l d s .
t r a v e l l i n g by t h i s ro u te
journeyed slo w ly ,
Persons
tak in g
advantage
o f a few d a y ' s e m p lo y m en t h e r e a n d t h e r e
offered.
On t h i s
keep any tr a c e
(i)
account i t
was mu ch m ore d i f f i c u l t
o f them .
7
as i t
tk ti
“T U;
nx
to
-3 1 -
' a ;- :
•
(D)
LABORATORY STUDIES
(1)
MORPHOLOGY AND MOVEMENTS OF THE ABYSSINIAN
RELAPSING FEVER SPIROCHAETES.
(2)
APPEARANCES SEEN IN FROZEN BLOOD.
(3)
CULTURE.
(4 )
ANIMAL INOCULATION: (a)
(b)
RODENTS
MONKEYS
(5)
IMMUNITY.
(6)
THE EFFECT OF SPLENECTOMY.
(7)
RESIDUAL AND LATENT INFECTIONS.
\
-3 2 -
R elap sin g fe v e r o f A byssinian o r ig in has not
p re v io u s ly been e n c o u n te re d in th e Sudan.
w hich e x i s t s
i n the
oth er fe a tu re s
lite ra tu re
of th is
a m atter of i n t e r e s t ,
ab o u t the
The u n c e r t a i n t y
t r a n s m i s s i o n and
s t r a i n has a lre a d y been n o ted .
th e re fo re ,
p r a c t i c a l p o in t o f view , i t
As
a s w e l l a s from th e
seemed d e s i r a b l e
to ta k e
the
o p p o rtu n ity of c a rry in g out a la b o ra to ry stu d y of th is
stra in
of re la p sin g fever.
MORPHOLOGY AND MOVEMENTS OF THE SPIROCHAETE.
T ypical sp iro c h ae te s
(B o r r e l i a ) w e r e
blood d u rin g the p y r e x ia l s ta g e s
o rd in a ry th in blood film s ,
m ethods,
the
found i n the
o f the d i s e a s e .
In the
s t a i n e d by L eish m an ’s o r G iem sa’ s
o rg a n ism s were e x t r e m e l y p o ly m o rp h o u s.
Among
many h u n d r e d s , h a r d l y one was s e e n w h i c h p r e s e n t e d t h e
ch aracteristic
th is
close
w orm -like
corkscrew a rran g em en t.
s p ir a l s tru c tu re and appeared as u n d u la tin g or
f o r m s ,o r th e y w ere t w i s t e d i n t o f i g u r e s
c o n c e n t r i c a l l y wound h o o p s ,
form s
They had e i t h e r l o s t
(F ig .6 ).
and o th e r c o ile d and d i s t o r t e d
Som etim es d i v i d i n g form s w ere s e e n i n w hich
t h e two d a u g h t e r s w e r e i n t e r t w i n e d a n d s t i l l
th in p o rtio n in the cen tre, but th is
in liv in g
a t t a c h e d by a
a p p e a r a n c e was n o t
seen
film s.
O ccasionally,
clear areas
p a rt o f a s p iro c h a e te 's le n g th ,
appearance.
c risis,
of eig h t,
I n one l u c k y s l i d e ,
c o u l d be s e e n a l o n g
g iving i t
taken a t
a beaded
th e tim e o f th e
t h e s p i r o c h a e t e s were s e e n t o have clum ped t o g e t h e r
a n d t o be u n d e r g o i n g a p r o c e s s o f d i s i n t e g r a t i o n b y
b r e a k i n g up i n t o g r a n u le s a lo n g t h e i r l e n g t h .
-3 3 -
Under dark -g ro u n d illu m i n a ti o n ,
e x a m in a tio n o f the
l i v i n g o r g a n i s m s p r o d u c e s an. e n t i r e l y d i f f e r e n t p i c t u r e .
The s p i r o c h a e t e s
rig id
sp irals,
m o tile.
appear as long,
tap erin g s lig h tly
clo sely co iled ,
u su ally
a t b o th ends, and a c t i v e l y
T h r e e t y p e s o f m o v e m e n t c o u l d be c l e a r l y made
o u t:(1)
down t h e
An e x t r e m e l y r a p i d w a v e - l i k e
sp iral
t u r n s , w hich m ight ta k e p la c e w ith o u t the
organism a l t e r i n g
(2)
its
p o sitio n
in space.
A movement o f t r a n s l a t i o n b y w h i c h t h e
swam r a p i d l y a c r o s s t h e
field :
it
by t h e w a v e - l i k e movement i n t h e
(3)
m ovement, p a s s i n g
organism s
was a lw a y s a c c o m p a n ie d
sp iral*
V a rio u s c o n t o r t i o n i s t m ovem ents, r e c a l l i n g
form s se e n i n th e
sta in e d film s,
f r e q u e n t l y b e n d t o on e s i d e
up i n t o hoops o r f i g u r e s
S p i r o c h a e t e s w ould
or the o th e r ,
of e ig h t,
c o i l them selves
from w hich t h e y w ould
u n c o il a g ain w ith alm ost e x p lo siv e v io le n c e .
spirochaete
the
Som etim es a
w o u ld s u d d e n l y c e a s e a l l movements a n d l i e
ab so lu tely s t i l l
f o r a few s e c o n d s ,
i n a rem arkably
r e g u l a r c o r k s c r e w s p i r a l and t h e n a s r a p i d l y s t a r t moving
again*
APPEARANCES NOTED IN FROZEN BLOOD
V a r i a t i o n s i n l e n g t h and i n th e number o f t u r n s i n
th e
s p i r a l were c o n s i d e r a b l e .
I t was fo u n d t h a t by f r e e z i n g
c i t r a t e d blo o d c o n ta in in g s p ir o c h a e te s ,
days in the
f o r a few
i c e - c h e s t , an d t h e r e a f t e r making f i l m s ,
b e a u tifu l p rep aratio n s
c o u l d be o b t a i n e d i n w h i c h t h e
reg u lar s p ira l stru ctu re
(F ig .12).
keeping i t
o f t h e o r g a n i s m s was p r e s e r v e d
-3 4 -
T hese f i l m s were i d e a l
average
f o r m easurem ents.
l e n g t h o f 200 c o n s e c u t i v e
sp iro ch aetes
The
seen in such
a f i l m w a s f o u n d t o b e 1 8 /x t h e e x t r e m e s b e i n g 1 0 m a n d
4 0 ju»
W ider e x t r e m e s w ere o b s e r v e d i n o t h e r f i l m s .
In th ese
film s o f fro z e n b lo o d ,
s w e l l i n g s were f r e q u e n t l y s e e n i n t h e
som etim es t e r m i n a l ,
a lo n g the
length
c o rre s p o n d to the
irreg u lar
globose
sp iro ch aetes,
som etim es s i t u a t e d a t v a r io u s d i s t a n c e s
o f the
sp iro ch aete.
They p ro b a b ly
s w e l l i n g s s e e n b y BUTLER ( 1 9 0 8 )
in
S p . d u t t o n i w h i c h h a d b e e n k e p t f o r some t i m e o u t s i d e
human b o d y .
I n a l l p r o b a b i l i t y t h e y w e r e due t o
degenerative
changes.
In those
film s o f frozen blood,
s t r u c t u r e s c o u l d be s e e n i n s i d e
the
the
to o , v ario u s
re d blood c o r p u s c le s .
Some o f t h e m r e c a l l e d t h e a p p e a r a n c e s f i g u r e d b y BALFOUR
(1911)
i n the developm ent o f th e
o f Treponema a n se rin u m
s e e n b y CARTER ( 1 9 0 8 )
r e a d i l y be i d e n t i f i e d i n t h e
sp iro ch aete,
but the
granules
(S p i r o c h a e t a g r a n u l o s a p e n e t r a n s ) .
Indeed a l l the ap p earan ces
CARTER r e g a r d e d th e m a s
in tra-co rp u scu lar
co rp u scles o f th ese
stag e s in the
life
cycle
ap p earan ces seen in the
were a l m o s t c e r t a i n l y a r t e f a c t s ,
could
film s.
o f the
fro z e n blood
because
(1)
They were o n ly s e e n i n f r o z e n b l o o d , n e v e r
in fre sh film s.
(2)
The s p i r o c h a e t e s s h o w i n g t h e s e p e c u l i a r i t i e s
were a l w a y s m o t i o n l e s s i n t h e d a r k - f i e I d
and t h e r e f o r e , p re s u m a b ly d e a d .
(3)
O th e r and o b v io u s a r t e f a c t s were o b s e r v e d i n
t h e same f i l m s .
-3 5 -
CULTURE.
I t was f o u n d i m p o s s i b l e t o grow t h e
sp iro ch aetes
i n t h e new e g g m e d iu m d e s c r i b e d b y YUAN-PO ( 1 9 3 3 ,
At t h e
1936).
o u t s e t much t i m e w a s l o s t b y c o n f i n i n g o n e ' s a t t e m p t s
a t cu ltu re
failu res,
to
t h i s m e di um a n d r e f u s i n g t o a c c e p t r e p e a t e d
larg ely
owing t o t h e g l o w i n g r e p o r t s
who c l a i m e d t o h a v e
o b t a i n e d 100 p e r c e n t ,
o f YUAN-PO
su cc e ss w ith
S p . r e c u r r e n t i s i n t h i s medium.
S p ir o c h a e te s c o u ld be found i n th e c u l t u r e s
p e r i o d s up t o
From t h e
for
te n and even tw enty days a f t e r in o c u la tio n .
s e v e n t h day onw ards t h e i r movements u n d e r t h e
d a r k - f i e l d became v e r y f e e b l e .
F i n a l l y th e y s to p p e d and th e
s p i r o c h a e t e s d is a p p e a r e d , though i t
determ ine
was n o t p o s s i b l e
t h e manner o f t h e i r g o i n g .
o f o n l y two o r t h r e e
r e s u l t e d from th e
S h o rt,
t u r n s w ere o b s e r v e d ,
to
im m obile form s
and p ro b ab ly
d i s i n t e g r a t i o n o f dead or dying
sp iro ch aetes.
B a t c h e s o f m e diu m w e r e made up a c c o r d i n g t o t h e
o rig in a l recip e
(YUAN-PO, 1 9 3 3 ) a n d a l s o
m o d if ie d sim p le method
difference
a c c o rd in g to the
(YUAN-PO, 1 9 3 6 ) , b u t t h e r e w a s no
in the r e s u l t .
No e v i d e n c e
c o u l d be a d d u c e d i n e i t h e r m e d i u m .
a u t h o r were f o l l o w e d t o th e l e t t e r
of m u ltip licatio n
The i n s t r u c t i o n s o f t h e
in both c a s e s ,
and the
r e s u l t i n g pH w a s f o u n d t o b e i d e n t i c a l w i t h t h a t o b t a i n e d
by h im , so t h e r e
i s no r e a s o n t o b e l i e v e
that
th e m edia
d i f f e r e d i n a n y way f r o m t h o s e u s e d b y YUAN-PO.
A f t e r ma ny a t t e m p t s t h i s med ium w a s f i n a l l y
d i s c a r d e d , a n d o t h e r m ethods were t r i e d .
C i t r a t e d h u m a n b l o o d , k e p t e i t h e r a t ro o m
t e m p e r a t u r e s 3 7 ° C , was n o t f o u n d s u c c e s s f u l .
The
-3 6 -
s p i r o c h a e t e s d i e d r a p i d l y a s e s t i m a t e d b y t h e i r movements
under d ark ground illu m in a tio n .
They w ere a lw a y s
c o m p le te ly im m obile i n t h r e e
days, and th e re
evidence
It
of m u ltip licatio n .
c o rp u s c le s sedim ented,
in the
lay er
ju s t above
the
was f o u n d t h a t a s t h e
sp iro ch aetes
the
co rp u scles,
i m p r e s s i o n o f m u l t i p l i c a t i o n m i g h t be
from t h i s
w a s no
ten d ed to
settle
and a f a ls e
o btained i f
l a y e r were s e l e c t e d f o r e x a m i n a t i o n .
flu id
I n some
c a s e s a t e n d e n c y t o a u t o - a g g l u t i n a t i o n was o b s e r v e d .
b l o o d u s e d was o f human o r i g i n ,
t a k e n from
the
p a t i e n t s and c o n ta in e d s p iro c h a e te s a t th e
tim e
The
in fected
of
w ith d raw al.
D i l u t e d human s e r u m ,
cu ltu re
flu id ,
f a r from b e in g a s u c c e s s f u l
a p p e a r e d t o h a v e a l e t h a l a c t i o n on t h e
o rg a n is m s w hich were a l l m o t i o n l e s s i n t w e n t y f o u r h o u r s .
D ilu te d horse
s e r u m was s i m i l a r l y f o u n d t o be
u s e l e s s a s a c u l t u r e medium.
A lthough s i x
i n o c u l a t e d fro m two d i f f e r e n t s t r a i n s ,
ad m itte d t h a t the
it
t u b e s were
s h o u l d be
seru m was a l l o b t a i n e d from one h o r s e .
HOELTZER a n d ZABBLOTZKAJA ( 1 9 2 6 ) h a v e s t a t e d t h a t s e r a
from d i f f e r e n t h o r s e s o f t e n v a r y c o n s i d e r a b l y ,
on e g i v i n g
a good g ro w th w h ile a n o t h e r a p p e a r s to h ave a n i n h i b i t o r y
effec t.
E x c e l l e n t c u l t u r e s w ere f i n a l l y
o btained in a
m o d i f i e d N o g u c h i 's medium, p r e p a r e d a s f o l l o w s Under a s e p t i c p r e c a u tio n s \ in ch o f egg
a l b u m e n was p i p e t t e d i n t o t h e b o t t o m o f t e s t t u b e s ,
and th e n c o a g u la te d by p l a c i n g th e tu b e s i n hot
w a te r a t a p p ro x im a te ly 80°C.
T h e r e a f te r the tu b es
were f i l l e d t o w i t h i n a n i n c h a n d a h a l f from th e
to p w i t h f r e s h l y drawn a s c i t i c f l u i d .
The t u b e s w e r e i n o c u l a t e d b y i n t r o d u c i n g
3 - 5
d ro p s o f blood c o n t a i n i n g s p i r o c h a e t e s ,
and in cu b ated
-3 7 -
a t 37°C .
W i t h i n 48 h o u r s
t h e r e was an o b v io u s i n c r e a s e
i n th e e a s e w i t h w hich s p i r o c h a e t e s
c o u ld be fo u n d i n th e
d a r k - f i e l d , and th e h ig h p ro p o r tio n o f lo n g and d iv id in g
f o r m s was e v i d e n c e
day a f t e r
of activ e m u ltip lic a tio n .
in o cu latio n ,
each d a r k - f i e l d
from th e
ly in g j u s t above th e c o a g u la te d eg g -w h ite
to
t h i r t y a c tiv e ly m otile
flu id
c o n ta in e d tw enty
s p ir o c h a e te s , w ith a high
p ro p o rtio n o f d iv id in g form s.
Enorm ously lo n g fila m e n to u s
form s were som etim es e n c o u n t e r e d .
appearance
On t h e t h i r d
I n on e o f t h e s e ,
o f th in n e d p a r t s along i t s
le n g th suggested th a t
i t was i n t h e p r o c e s s o f d i v i d i n g t r a n s v e r s e l y i n t o
four
dau g h ters.
T h i s m e di um n e v e r f a i l e d t o
grow t h e
sp iro ch aetes.
The i m p r e s s i o n was g a i n e d t h a t g r o w t h w a s i m p r o v e d b y t h e
a d d i t i o n o f 5 - 10 d r o p s o f s t e r i l e
b u t i t was d i f f i c u l t
to be c e r t a i n .
50 p e r c e n t ,
g lucose,
The a d d i t i o n o f t h e
g lu c o s e was c e r t a i n l y n o t n e c e s s a r y i n o r d e r t o
o b tain a
good g ro w th .
The a d d i t i o n o f a l a y e r o f l i q u i d p a r a f f i n on
\
th e
top o f th e a s c i t i c
on t h e
grow th.
C ulture
f l u i d was f o u n d t o h a v e n o i n f l u e n c e
t u b e s w i t h o u t t h e p a r a f f i n on t h e
to p a re
indeed p r e f e r a b le a s the o i l te n d s to adhere
p ip ette
w ith w hich sam p les a r e w ith d ra w n f o r e x a m i n a tio n ,
and r e f r a c t i l e
o i l y g lo b u le s ap p ear in the
c o m p a r e d w i t h YUAN-PO*s m e d i u m , w h i c h i s
d eb ris,
the a s c i t i c
d ark -field s
d ark -field .
As
f u l l o f gran u lar
f lu i d gives b e a u tif u lly
a g a i n s t w hich th e
to the
clear
sp iro c h a e te s stan d out
d istin ctly .
S u b c u l t u r e s w e r e r e a d i l y made b y i n t r o d u c i n g
3 - 4
d r o p s from a c u l t u r e
showing p l e n t i f u l s p i r o c h a e t e s
-3 8 -
in to a fresh cu ltu re
p ip e tte ,
adding a t
tu b e by means o f a c a p i l l a r y
t h e sam e t i m e 3 - 4
or fresh ly -d raw n r a b b i t 's blood.
th ro u g h tw elve s u c c e s s iv e
drops o f c i t r a t e d
One s t r a i n w a s p a s s e d
s u b c u ltu r e s a t 3 - 5 day
i n t e r v a l s w ith o u t any a p p a re n t l o s s o f v i t a l i t y ,
p r o c e s s was o n l y g i v e n up b e c a u s e
leave.
o f the
A f t e r nine
cu ltu re
resu lted
s u b c u ltu re s the
o f my d e p a r t u r e
on
i n o c u l a t i o n o f -g c . c .
f l u i d i n t o t h e p e r i t o n e u m o f a mouse
in th e appearance
of sp iro ch aetes
p e r i p h e r a l blood in tw e n ty -fo u r h o u rs.
th is
and the
i n the
The c o u r s e
of
i n f e c t i o n was n o t f o l l o w e d o u t .
A t t e m p t s w e r e made w i t h t h e s e
u tilise
the
"adhesion t e s t "
the s t r a i n s .
cu ltu res
to
a s a m ethod o f d i f f e r e n t i a t i n g
The t e c h n i q u e d e s c r i b e d f o r l e p t o s p i r a
(BROWN a n d DAVIS, 1 9 2 7 ) w a s f o l l o w e d , b u t i n s t e a d o f
B. c o l i a n e m u ls io n o f a s a l m o n e l l a o rg a n is m i s o l a t e d
f r o m a c a s e o f f o o d p o i s o n i n g was u s e d .
u n satisfacto ry .
The r e s u l t s w e r e
W h i l e t h e w r i t e r was o n l e a v e
1 9 3 8 , he d i s c u s s e d t h e
in June,
f i n d i n g s w i t h MAJOR H . C . BROWN,
who s t a t e d t h a t h e h i m s e l f h a d r e c e n t l y b e e n o b t a i n i n g
sim ilarly u n satisfa c to ry re s u lts ,
and th a t the f u r th e r
i n v e s t i g a t i o n o f t h e m a t t e r h a d l e d him to t h e
discovery
o f a h i t h e r t o u n reco g n ised p ro p e rty o f re d blood c e l l s
and b a c t e r i a ,
in d icato rs
as a r e s u l t
o f w h i c h some w e r e s u i t a b l e
f o r a d h e s i o n a n d o t h e r s were n o t .
ANIMAL INOCULATION
RODENTS.
Of l a b o r a t o r y a n i m a l s , w h i t e r a t s ,
r a b b its and g u in e a -p ig s proved in s u s c e p tib le .
So a l s o
-3 9 -
d id o r d i n a r y brown an d b l a c k r a t s
(R a t t u s r a t t u s
and
R a t t u s n o r v e g i c u s ) c a u g h t l o c a l l y by th e K hartoum S a n i t a r y
S erv ice.
T his a t
in fectio n .
rats,
the
to the
notable
the o u ts e t su g g ests a lou se-b o rn e
RIDING a n d MAODOWELL ( 1 9 2 7 )
found t h a t f i e l d
o n ly a n i m a l s th e y h a d a v a i l a b l e , were i n s u s c e p t i b l e
lo u se-b o rn e
stra in
in D a rfu r in 1927, a lth o u g h i t
is
t h a t MATHIS a n d GUILLET ( 1 9 2 5 ) w o r k i n g i n S e n e g a l
w i t h w h a t w a s i n a l l p r o b a b i l i t y t h e s am e s t r a i n ,
t h e l o c a l g r e y mo us e c o u l d b e r e a d i l y
in fected .
found
The W est
A f r i c a n s t r a i n on th e
Gold C o a s t h a s b e e n s u c c e s s f u l l y
in o c u la te d in to w hite
and b la ck r a t s
LE FAUN a n d INGRAM ( 1 9 2 3 ) .
b y SELWYN CLARKE,
Perusal o f th e ir records,
h o w e v e r , showw t h a t i n f e c t i o n w a s s c a n t y ,
u n certain ,
t r a n s i e n t and
and o n l y r e s u l t e d when r e l a t i v e l y enorm ous
d o s e s o f i n f e c t e d b l o o d were i n o c u l a t e d .
P r o b a b l y mo re s i g n i f i c a n c e
the r e s u l t s
c a n be a t t a c h e d t o
of gu in ea-p ig in o c u la tio n .
NICOLLE ( 1 9 3 2 )
recommends g u i n e a - p i g i n o c u l a t i o n a s t h e m o st r e a d y m ethod
o f d i f f e r e n t i a t i n g betw een lo u s e - b o rn e and t i c k - b o r n e
s t r a i n s i n N orthern A fric a ,
and su g g e sts th a t
p r o c e d u r e w e r e r e s o r t e d t o m ore f r e q u e n t l y ,
if
th is
many i n f e c t i o n s
i n E g ypt, A lg e r ia and Lybia a t p r e s e n t r e g a rd e d as
l o u s e - b o r n e , w ould prove by t h e i r v i r u l e n c e
t o be i n r e a l i t y due to t i c k - b o r n e
to g u in e a - p ig s
strain s.
W h i t e m i c e o b t a i n e d o r i g i n a l l y f r o m t h e W el l co m e
B ureau o f S c i e n t i f i c R esearch ,
su scep tib le.
The i n f e c t i o n
ru n a very co n stan t course.
L o n d o n , w e r e f o u n d t o be
in th ese
a n i m a l s was o b s e r v e d t o
As a g e n e r a l r u l e
the
i n t r a p e r i t o n e a l r o u t e was u s e d f o r i n o c u l a t i n g t h e
-4 0 -
sp iro ch aetes.
The t r e p o n e m e s w e r e
p e r i p h e r a l b lo o d i n 12 -
i n v a r i a b l y found i n the
24 h o u r s a f t e r i n o c u l a t i o n .
They
w e r e a l w a y s p r e s e n t 48 h o u r s a f t e r i n o c u l a t i o n , b u t u s u a l l y
d is a p p e a r e d d u rin g th e f o llo w in g tw elve h o u rs .
The i n f e c t i o n
r a n an e x c e e d in g ly m ild course i n th e s e w h ite m ice.
I t was
a p p a r e n tly sym ptom less, and d a i l y e x a m in a tio n o f the blo o d
f o r 20 d a y s a f t e r
failed
the d is a p p e a ra n c e o f th e
i n e v e r y c a s e t o show a n y e v i d e n c e
S ubinoculations
of relap se.
fro m mouse to mouse w e re n o t
e v e n when a l a r g e
su ccessfu l,
i n o c u l u m o f i n f e c t e d m a t e r i a l was g i v e n .
T h i s was e f f e c t e d by b l e e d i n g a mouse t o
citrate
sp iro ch aetes
s o lu tio n t h i r t y hours a f t e r
death in to
sterile
i n o c u l a t i o n , when t h e
b l o o d ^ a s shown by f i l m s t a k e n i m m e d i a t e l y b e f o r e b l e e d i n g ,
c o n t a i n e d numerous s p i r o c h a e t e s .
a c .c.
About t h r e e - q u a r t e r s
of
o f b l o o d was o b t a i n e d i n t h i s way a n d i n o c u l a t e d
im m ediately in to
the
p e r i t o n e u m o f tw o f r e s h m i c e , b u t no
in fectio n re su lted .
N egative r e s u l t s
were l i k e w i s e
o b t a i n e d when th e o r g a n is m s w ere i n o c u l a t e d s u b c u t a n e o u s l y
i n s t e a d o f i n t r a p e r i t o n e a l l y , an d a l s o by th e p e r c u ta n e o u s
m e t h o d , w h i c h TOMOIKA ( 1 9 2 4 ) h a d f o u n d t o g i v e r i s e
to a
much mo re s e v e r e
i n m ice
i n f e c t i o n w ith the European s t r a i n
th a n in tr a p e r ito n e a l in o c u la tio n .
A ccording to
t h e t a b l e s d r a w n u p b y BALFOUR ( 1 9 1 1 )
a n d MANSON-BAHR ( 1 9 3 5 ) , p a s s a g e t h r o u g h m o n k e y s i n c r e a s e s
virulence
o f the European s t r a i n
ro d en ts.
T h i s w a s n o t f o u n d t o be t h e
A byssinian s t r a i n .
R ats,
o f the
a n y th in g , dim inished.
f o r sm all
case w ith the
r a b b i t s and g u i n e a - p i g s were s t i l l
r e f r a c t o r y a f t e r p a ss a g e o f the
and the v i r u l e n c e
o f T. r e c u r r e n t i s
the
s p i r o c h a e t e s t h r o u g h monkeys
o rg a n is m s f o r w h i t e mice w a s, i f
T w enty-four h o u rs a f t e r
in o c u l a t i o n the
s p i r o c h a e t e s were p r e s e n t i n th e p e r i p h e r a l b lo o d o f the
-4 1 -
mouse, b u t a t
f o r t y - e i g h t h o u rs th e y were e x c e e d i n g l y
s c a n ty and d i f f i c u l t
an d no r e l a p s e
to fin d .
took p la c e .
A fter th is
th ey d isappeared
S u b - i n o c u l a t i o n s fro m mouse t o
m ous e w e r e s t i l l u n s u c c e s s f u l .
It
is
i n t e r e s t i n g to note th a t
the
course
o f the
i n f e c t i o n i n t h e s e mice i n o c u l a t e d fro m monkeys d i d n o t v a r y
w ith th e
it
sev erity
seem t o
of the d is e a s e
s i g n i f y w hether th e
splenectom ised or n o t,
by th e
i n th e m onkeys.
o r i g i n a l m o n k e y was
or w h e th e r i t was o r i g i n a l l y
i n o c u l a t i o n o f b lo o d from a c a s e ,
t r a n s m i s s i o n from an i n f e c t e d
Io u s e .
in fectio n
The g e r b i l l e
was a l s o
suscep tib le
I t w i l l be s e e n l a t e r
d ifferen ce
in the
i n th e monkey.
or d e se rt ra t
and in t h i s
i n f e c t i o n was s i m i l a r t o t h a t
som etim es p e r s i s t e d i n the
in fected
o r by ex p erim en tal
t h a t t h e s e v a r i a t i o n s made a c o n s i d e r a b l e
s e v e r ity o f the
Nor d i d
o f th e N o rth e rn Sudan,
anim al th e
in m ice, b u t th e
blood f o r th re e
S u b - i n o c u l a t i o n s from g e r b i l l e
course
to g e r b i l l e
r e s u lte d i n a t r a n s i t o r y appearance
a b o u t 48 h o u r s a f t e r i n o c u l a t i o n .
o f the
p arasites
or even fo u r days.
som etim es
of s c a n ty s p iro c h a e te s
The g e r b i l l e
u n d o u b t e d l y t o be t h e m o s t s u s c e p t i b l e
o f the
seems
rodents a t
o n e ’s d is p o s a l.
An i n t e r e s t i n g o b s e r v a t i o n made i n t h e s e r o d e n t
i n f e c t i o n s was t h a t
i n a s m a l l p e r c e n t a g e o f w h i t e mice th e
s p i r o e h a e t a l i n f e c t i o n was accom panied b y ,
o r m o r e commonly
f o l l o w e d b y , a low g r a d e s e p t i c a e m i a i n w h ic h a m i x t u r e o f
o r g a n is m s were c o n c e r n e d , p r i n c i p a l l y d i p h t h e r o i d s ,
and b a c i l l i .
T h is alw ays p e r s i s t e d
cocci
f o r some t i m e a f t e r t h e
s p i r o c h a e t e s h ad d i s a p p e a r e d from t h e b lo o d a n d g e n e r a l l y
seemed n o t to u p s e t th e h e a l t h of th e a n i m a l s , a lth o u g h i n
42-
two m i c e t h e n u m b e r o f o r g a n i s m s o b s e r v e d i n t h e b l o o d
film s s te a d ily
and f i n a l l y
increased,
succumbed.
and the
a n i m a l s became i l l ,
P o s t - m o r t e m r e v e a l e d no p e r i t o n i t i s
o r a b sc e ss fo rm a tio n , and c l i n i c a l ex am in atio n o f o th e r
a f f e c t e d m ice show ed no e v i d e n c e
reactio n a t
the s i t e
of p e rito n itis
or lo cal
o f in o cu latio n .
A t t h e t i m e n o t mu ch a t t e n t i o n w a s p a i d t o
these
o rg a n is m s w h ic h were s e e n i n t h e b lo o d f i l m s ,
t o e x c l u d e t h e p o s s i b i l i t y o f t h e i r b e i n g due to
t e c h n i q u e when t h e b l o o d f i l m s w e r e t a k e n .
It
except
fau lty
is
d ifficu lt
t o u n d e r s t a n d why t h e i n t r a p e r i t o n e a l i n o c u l a t i o n o f
s p ir o c h a e te s w ithdraw n d i r e c t l y
fro m a human v e i n s h o u l d
cause a se p tic a e m ia w ithout l o c a l r e a c t i o n u n le s s the
o r g a n is m s were o f e x tre m e v i r u l e n c e ,
i n which c a s e th e
s e p t i c a e m i a m ig h t r e a s o n a b l y be e x p e c t e d t o
be r a p i d l y
fatal.
It
is
possible
due t o a n i n c r e a s e
in the
th at
the
c o n d i t i o n may h a v e b e e n
invasive
organism s, brought about by th e
pow ers o f commensual
sp iro ch aetal in fe c tio n .
SARAHELLI ( 1 9 2 7 ) m a i n t a i n s t h a t t h e
i s harm less in i t s e l f ,
increase
the
sp iro ch aetal in fectio n
b u t i n some w a y i s a b l e t o
i n v a s i v e powers o f o t h e r o rg a n is m s a n d t h e s e
are resp o n sib le
f o r the d is t u r b a n c e w hich ta k e s p l a c e .
KULESCHA a n d TITOWA ( 1 9 2 3 ) ,
c i t e d b y RUSSELL ( 1 9 3 2 ) made
o u t t h a t ma n y o f t h e r e l a p s i n g f e v e r f a t a l i t i e s
i n the
R u s s i a n e p i d e m ic o f 1920 - 1921 were due t o s e c o n d a r y
in fectio n ,
a n d p o i n t o u t t h a t from th e l i t e r a t u r e
it
is
a p p a r e n t t h a t ma ny o f t h e p a s t E u r o p e a n e p i d e m i c s h a v e
been c o m p lic a te d by a pyaem ia in th e
Monkeys.
same w a y .
The common g r e y m o n k e y o f t h e S u d a n
( C e r c o p i t h e c u s s e b a e u s ) w a s f o u n d t o be s u s c e p t i b l e
and
-4 3 -
i n th e se anim als th e
d isease.
in fe c tio n is
The s p i r o c h a e t e s
s i m i l a r t o t h e hum a n
co mm only a p p e a r i n t h e
p e r ip h e r a l blood a f t e r an in c u b a tio n p e rio d of 2 - 4 days,
p ersist
from 2 - 5
days,
and th e n , a f t e r
10 d a y s , r e a p p e a r f o r 1 - 3
fu rth er relap se.
days a f t e r w hich t h e r e
Thus,
i s no
one monkey h a d no r e l a p s e ,
a n d a n o t h e r was fo u n d w hich a p p e a r e d to
q u ite
o f some
Some v a r i a t i o n b e t w e e n i n d i v i d u a l
monkeys was e n c o u n t e r e d .
a tte m p ts to
a lap se
be q u i t e
i n f e c t i t w i t h two d i f f e r e n t
strain s
im mu ne :
were
u n su ccessfu l.
I t w as fo u n d t h a t one monkey c o u l d be r e a d i l y
in f e c te d by th e
sp iro ch aetes
in o c u la tio n o f blood c o n ta in in g
from a n o t h e r monkey.
A s t r a i n o b t a i n e d from
i n f e c t e d human b l o o d w a s p a s s e d t h r o u g h
t h i s w ay, a n d one o b t a i n e d d i r e c t l y
p a sse d through th re e
tw o m o n k e y s i n
f r o m a l o u s e was
s u o o e s s iv e monkeys.
No a t t e m p t was
made t o f i n d o u t how many p a s s a g e s c o u l d be e f f e c t e d
t h i s way w i t h o u t t h e
s tra in lo sin g i t s
v iru len ce.
in
I t may
b e r e c a l l e d t h a t SARGENT a n d FOLEY ( 1 9 1 0 ) w e r e u n a b l e t o
p a s s th e A l g e r i a n s t r a i n e v en t o a s e c o n d monkey.
Enlargem ent
d etected in a l l
made t o
of the
l i v e r and s p l e e n were r e a d i l y
t h e i n f e c t e d m o n k e y s , b u t n o a t t e m p t was
fo llo w o u t the c l i n i c a l
course
o f the d i s e a s e
th ese anim als.
E xcept f o r v e ry obvious i l l n e s s ,
was c o n f i n e d t o
the e x a m in a tio n o f
in
atten tio n
the blood fo r
organism s.
In g e n e r a l term s, th e v ir u l e n c e
o f the s t r a i n
f o r l a b o r a t o r y a n i m a l s may be s u m m a r i s e d a s f o l l o w s .
R o d e n t s , w i t h th e e x c e p t i o n o f w h i t e mice a n d g e r b i l l e s ,
were i n s u s c e p t i b l e .
In th e se
two l a t t e r
the i n f e c t i o n
-4 4 -
runs an e x c e e d in g ly m ild c o u rse , ending i n re c o v e ry .
i s no r e l a p s e ,
th e se
an im als.
and th e
stra in
There
c a n n o t be m a i n t a i n e d i n
In monkeys, th e i n f e c t i o n ru n s a m ild
c l i n i c a l c o u r s e w i t h on e r e l a p s e , a n d t e n d s t o r e c o v e r y .
P assage th ro u g h a t
l e a s t t h r e e monkeys i s
These r e s u l t s
p o ssib le.
conform i n th e m ain w ith th o s e
w hich have b e e n fo u n d f a i r l y u n i v e r s a l l y w ith th e
lou se-b o rn e
strain s
N orth A fr ic a n group.
of relap sin g
f e v e r and e s p e c i a l l y the
-4 5 -
IMMUNITY
E vidence
of Im m unity.
On 2 4 / l / 3 8 b l o o d
c o n t a i n i n g num ero u s s p i r o c h a e t e s was i n o c u l a t e d fr o m a
human c a s e
i n K hartoum N o rth d i r e c t l y
in to
two m ice w h ic h
h a d p r e v i o u s l y b e e n i n f e c b e d o n two o c c a s i o n s , a n d a t
s am e t i m e ,
in to
two f r e s h m i c e .
the
I n -t w e n t y - f o u r h o u r s t h e
l a t t e r d e v e l o p e d a t y p i c a l two d a y s ’ i n f e c t i o n , w h i l e
s p i r o c h a e t e s n e v e r a p p e a r e d i n t h e b l o o d o f t h e two
A s i m i l a r r e s u l t was
p re v io u s ly in o c u la te d m ice.
o b t a i n e d on 2 6 / 2 / 3 8 when b l o o d was i n o c u l a t e d fro m a n
i n f e c t e d monkey i n t o
two f r e s h m i c e a n d t w o p r e v i o u s l y
i n o c u la t e d m ice.
Monkey R . ( l )
a n a t t e m p t was made t o
had been tw ice
proved r e s i s t a n t
in fect i t .
M on ke y R . ( 2 ) w h i c h
i n f e c t e d p r e v i o u s l y was i n s u s c e p t i b l e
w h e n a t h i r d a t t e m p t w a s made o n 5 / 3 / 3 8 .
o c c a s io n s i t was p o s s i b l e
in o c u la tio n o f the
monkeys R . ( l )
th e se c o n d tim e
On b o t h t h e s e
t o i n f e c t o t h e r monkeys by
same b l o o d w h i c h f a i l e d t o
and R.(2)
in fect
r e s p e c t i v e l y , show ing t h a t
a b s e n c e o f i n f e c t i o n was n o t d u e t o l o s s
the
of virulence
of the s p ir o c h a e te s .
Evidence e x i s t s
im m unity t o f u r t h e r
previous
th erefo re
of
i n f e c t i o n can be b r o u g h t a b o u t b y a
in fectio n .
E r r a t i c N ature o f th e
of th is
th at a s ta te
im m unity, how ever,
is
Im m unity.
The e v i d e n c e
i n c o n s t a n t and e r r a t i c .
O t h e r a n d m o r e n u m e r o u s e x p e r i m e n t s c a n be c i t e d i n w h i c h
previous in f e c tio n f a ile d
to p r o t e c t
ag ain st
fu rth er
in fectio n .
T h u s , two m i c e i n f e c t e d o n 1 3 / 1 1 / 3 7 w e r e f o u n d
t o be s u s c e p t i b l e
a g a i n o n 1 6 / 1 1 / 3 7 , a n d two m i c e
-4 6 -
i n f e c t e d on l b / l l / 3 7
on 2 5 / 1 1 / 3 7 .
s im ila r to
w ere a s r e a d i l y s u s c e p t i b l e
I n both, c a s e s
the f i r s t
in i t s
t h e second, i n f e o t i o n was
i n t e n s i t y and d u ra tio n .
The c a s e w i t h monkeys was s i m i l a r .
R .( l) ^
was s u s c e p t i b l e
resistan t,
again
M on k ey
on one o c c a s i o n a n d t h e r e a f t e r
w h i l e m o n k e y s . R . ( 2 ) a n d R. ( 3 ) j w e r e r e a d i l y
i n f e c t e d on a se c o n d o c c a s io n .
PRESENCE 0 ? SEVERAL ANTIGENIC STRAINS
T hese d i s c r e p a n c i e s a r e p ro b a b ly due to
a n tig e n ic d if f e r e n c e s i n the v a rio u s
strain s
stu d ied .
3ALTHAZARD ( 1 9 3 6 ) a n d o t h e r w o r k e r s h a v e f o u n d t h a t no
tw o s t r a i n s
of re la p sin g fever are
i n f e c t i o n w i t h on e s t r a i n r e s u l t s
im m unity a g a i n s t
th at s tra in
the same, an d t h a t
in
the d e v elo p m en t of
o n ly and no o t h e r .
CUHinJTGHAM ( 1 9 2 5 ) h a s p o s t u l a t e d t h e
altern atio n
o f two s e r o l o g i c a l v a r i a n t s w i t h s u c c e s s i v e r e l a p s e s .
Some o f o u r e x p e r i m e n t a l r e s u l t s a t l e a s t
(i
relapse
stra in
»
is
d i f f e r e n t from t h a t
suggest
t h a t the
of the f i r s t
paroxysm .
On 2 4 / 1 / 3 8 t w o m o n k e y s a n d tw o m i c e w e re
i n o c u l a t e d w ith b lo o d c o n t a i n i n g num erous s p i r o c h a e t e s
from a c a s e i n K hartoum N o r t h .
o ne o f t h e m o n k e y s , R . ( 2 ) ^ w a s t h e
sp iro ch aetes in i t s
Of t h o s e f o u r a n i m a l s
o n ly one t o
^lood a f t e r w a r d s , a lth o u g h th e y had
a l l b e e n p r e v i o u s l y i n f e c t e d w i t h one s t r a i n .
p revious
ahoy/
o c c a sio n , how ever,
On t h i s
o n e o f t h e m o n k e y s ; R . (1 )^
-4 7 -
r e l a p s e d , w hile
the
o th e r d id n ot, R . ( 2 ) .
both in o c u la te d
from monkey R . (1) d u r i n g t h e
paroxysm , and a g a in d u rin g th e
The m i c e w e r e
relap se.
first
In b o th in s ta n c e s
t h e y were s u s c e p t i b l e .
The f a c t t h a t b o t h m i c e w e r e
r e s i s t a n t on th e t h i r d
i n o c u l a t i o n , a s w e l l a s m on k e y
r
. (1 ),
su g g ests th a t the d iffe re n c e
monkeys was t h i s
v ariatio n s
tim e due t o o t h e r f a c t o r s
in n a tu ra l
It
is
betw een th e
two
th an in d iv id u a l
resistan ce.
reasonable
to assum e t h a t
the r e s i s t a n c e
o f t h e o n e m o n k e y a n d t h e two m i c e w a s du e t o a c q u i r e d
im m unity b ro u g h t a b o u t b y p r e v io u s e x p e r i e n c e
a n tig en ically sim ilar s tra in .
due to t h e
strain
c au sin g the
the s u c c e ss fu l in f e c tio n
also had a f i r s t
first
of the
"relapse
paroxysm i s shown b y
o t h e r mo nkey , R. ( 2 )? w h i c h
the
in fectio n .
im m u n ity i n monkey R . ( l )
two m i c e was d u e t o t h e r e l a p s e
i n monkey R . ( 2 ) .
im m u n ity was n o t
paroxysm i n th e p r e v io u s
Presum ably, t h e r e f o r e ,
th e
That th e
o f an
I f t h i s be s o ,
and
w hich n e v e r a p p e a re d
the
o r i g i n a l and
s t r a i n s " were p r o b a b l y d i f f e r e n t from e a c h
o th er.
The e f f e c t o f t h e K h a r t o u m s t r a i n o n m i c e
i n f e c t e d p r e v io u s ly w ith the
have g iv e n v a lu a b l e
one b e e n a b l e
to
"relapse
s t r a i n " o n l y would
in fo rm atio n in t h i s
foresee
the p o s s i b i l i t y
in stan ce.
o f th ese
Had
two
s t r a i n s b e i n g r e l a t e d a n t i g e n i c a l l y i n t h i s way, t h e
e x p e rim e n ts m ight have been p la n n e d a c c o r d i n g l y , b u t as
it
w a s , t h e c o r r e l a t i o n o n ly became s u g g e s t i v e a f t e r w a r d s ,
when t h e r e s u l t s
o f th e e x p e r im e n t s w ere b e i n g r e v i e w e d .
A n o t h e r m o n k e y , R. ( 3 ) , h a d a r e l a p s e
first
in fectio n ,
during i t s
a n d t h u s p r o b a b l y e x p e r i e n c e d tw o
-4 8 -
d ifferen t v arian ts.
This
did not p rev en t i t
being
s u c c e s s f u l l y i n f e c t e d two m o n t h s l a t e r b y t h e
in o cu latio n
o f i n f e c t e d b lo o d from a n o t h e r monkey.
p robable,
th erefo re,
It
is
t h a t m o r e t h a n tw o a n t i g e n i c v a r i a n t s w e r e
p r e s e n t a m ong t h e s t r a i n s .
There i s
p o ssib ly also
im m unity w h ich i s n o t s p e c i f i c
in fectio n s
to th e
strain s.
Two
s e e m e d a l w a y s t o make o u r a n i m a l s immune t o
fu rth er in fectio n .
relap se
a f a c t o r i n the
I t may be n o t e d ,
too,
th at
the
i s u s u a l l y o f mu ch s h o r t e r d u r a t i o n t h a n t h e
o rig in al a ttack .
I t may be o b s e r v e d f u r t h e r ,
th e number o f o u r e x p e r i m e n t s on t h i s
although
p o in t i s sm all,
t h a t w he n p r e v i o u s l y i n f e c t e d m o n k e y s a r e s p l e n e c t o m i s e d ,
and t h e n i n o c u l a t e d w ith a s t r a i n to w hich t h e y a re
su scep tib le,
the e f fe c t
o f t h e s p l e n e c t o m y on th e
i n f e c t i o n i s d i f f e r e n t f r o m t h a t w h i c h r e s u l t s w he n
splenectom y i s
done b e f o r e t h e
first
in fectio n .
EFIECT OF SPLENECTOMY
A c c o r d i n g t o MELENEY ( 1 9 2 7 ) , KRITSCHEWSKI a n d
RUBINSTEIN ( 1 9 2 7 ) , a n d KALAJE7/ ( 1 9 3 1 ) , t h e i n c r e a s e d
s u s c e p t i b i l i t y o f e x p e r im e n ta l anim als
f e v e r w hich r e s u l t s
to r e la p s in g
from sp le n e c to m y i s e v id e n c e d by a
much h e a v i e r i n f e c t i o n o f t h e b l o o d w i t h s p i r o c h a e t e s ,
and an in c re a se
in the d e a th r a t e
o f in o c u la te d anim als.
On t h e o t h e r h a n d BRIFNL a n d KINGHORN ( 1 9 0 b ) f o u n d t h a t
s p l e n e c t o m y h a d no e f f e c t w h a t e v e r on t h e c o u r s e
of
A f r i c a n r e l a p s i n g f e v e r ; a n d VELU, BALOZET a n d ZOTTNER
(1931) h av e r e a c h e d a s i m i l a r c o n c l u s i o n w i t h r e g a r d to
-4 9 -
T. h ispanicum i n f e c t i o n s .
RUSSELL ( 1 9 3 1 ) f o u n d w i t h t h e
West A f r i c a n s t r a i n t h a t s p l e n e c t o m y m i g h t r e s u l t
s lig h tly h ig h e r d eath ra te
in a
b u t o th e rw is e h a d no e f f e c t
on t h e i n f e c t i o n *
I n e x p e r i m e n t a l work w i t h o rg a n is m s o f
r e l a t i v e l y low v i r u l e n c e
such as t h i s A b yssinian s t r a i n ,
a n y th in g w hich w i l l in c r e a s e
h o s t s a n d make t h e
in fectio n s
i s a p r a c t i c a l advantage.
reason that
sq u irrels
the
su scep tib ility
a little
o f the
m ore d e f i n i t e ,
P r e s u m a b ly i t was f o r t h i s
FENG a n d CHUNG ( 1 9 3 7 ) u s e d s p l e n e c t o m i s e d
in t h e i r tra n s m is s io n experim ents w ith th e
C hinese s t r a i n .
A few e x p e r i m e n t s c a r r i e d o u t b y t h e
w r i t e r u n d e r t h i s h e a d i n g were u n d e r t a k e n p r i m a r i l y
to
d e t e r m i n e w h e t h e r a n y a d v a n t a g e w o u l d be g a i n e d b y t h e
use
o f splenectom ised r a th e r
tra n sm issio n experim ents,
than norm al an im als f o r
although in p o in t o f fa c t
the
experim ents had a lr e a d y been u n d e rta k en w ith sp len e c to m ised
anim als*
M ice.
Two m i c e ,
splenectom ised fiv e
days
p r e v i o u s l y were i n o c u l a t e d i n t r a p e r i t o n e a l l y w i t h
approxim ately 0 ,2 c.c*
a m o nk e y o n 2 6 / l / 3 8 .
o f i n f e c t e d b lo o d w ith d raw n from
Two n o r m a l m i c e w e r e i n o c u l a t e d a t
t h e same t i m e , a s c o n t r o l s *
d ise a se pursued a s im ila r
c o u rse, s p iro c h a e te s being
fo u n d i n the b lo o d d u r in g th e
in o cu latio n ,
In a l l fo u r an im als the
first
two d a y s f o l l o w i n g
a f t e r w hich th e y d i s a p p e a r e d and d i d n o t
retu rn .
S ix days a f t e r th e
d isap p e a ra n ce o f the
s p i r o c h a e t e s t h e two c o n t r o l m i c e w e r e s p l e n e c t o m i s e d ,
but th is
did not r e s u l t
sp iro ch aetes.
in th e reappearance
o f the
-5 0 -
Two o f t h e s e
f o u r m ice w ere i n f e c t e d
seco n d o c c a s io n on 5 / 3 / 3 8 and th e
coarse, ex actly
s im ila r to th a t
i n o c u l a t e d a t t h e same t i m e .
on a
in fectio n ran a ty p ic a l
i n tw o f r e s h m i c e
A th ir d attem pt to
in fect
t h e m some d a y s l a t e r w a s n o t s u c c e s s f u l *
The e f f e c t
o f sp le n e c to m y on th e c o u rs e
i n f e c t i o n i n m ice a p p e a r s t o
be n e g l i g i b l e ,
o f the
although i t
is
r e a d i l y a d m i t t e d t h a t th e number o f t h e s e e x p e r im e n t s
is
t o o s m a l l t o a l l o w o f a n y t h i n g more t h a n t e n t a t i v e
c o n c l u s i o n s b e i n g made.
M onkeys.
I n monkeys t h e r e s u l t s w ere d i f f e r e n t .
The n u m b e r o f o b s e r v a t i o n s we w e r e a b l e t o make w a s
restricted ,
but even th ese
does m odify the co u rse
and does in c re a se
fe w i n d i c a t e d t h a t
o f the d is e a s e
splenectom y
in th e se anim als
th eir su scep tib ility
to the
in fectio n .
On 5 / 3 / 3 8 tw o s p l e n e c t o m i s e d a n d one n o r m a l
monkey w ere i n o c u l a t e d w i t h b l o o d c o n t a i n i n g a b u n d a n t
sp iro ch aetes.
I n th e n o r m a l monkey, R . ( 8 ) , t h e i n f e c t i o n
ran a f a i r l y ty p ic a l course.
m o n k e y s ,R .(7) and R . ( 6 ) ,
In the
no s t r i k i n g d e p a r t u r e
n o r m a l was n o t i c e d i n t h e f i r s t
appeared e a r l i e r ,
splenectom ised
from th e
paroxysm , b u t th e r e l a p s e s
l a s t e d l o n g e r , a n d s h o w e d a much h e a v i e r
i n f e c t i o n o f the b lo o d w ith s p i r o c h a e t e s
com parable i n t h i s
r e s p e c t to the
- alm ost
fa ta l in fectio n of
m on k e y R . ( 4 ) w h i c h was i n f e c t e d d i r e c t l y f r o m a l o u s e
(see l a t e r ,
p . 64).
I n one o f t h e
a s e c o n d r e l a p s e was o b s e r v e d .
died.
Owing t o my d e p a r t u r e
to follow out th e se
s p l e n e c t o m i s e d monkeys
The o t h e r s u b s e q u e n t l y
on l e a v e
in fectio n s fu lly ,
i t was n o t p o s s i b l e
s o t h e r e may h a v e
b e e n f u r t h e r r e l a p s e s w h ic h were n o t o b s e r v e d .
-5 1 -
It
is h a rd ly p erm issib le
bo i n c l u d e
in th is
c o m p a r i s o n t h e m o n k e y w h i c h was f o u n d i m m u n e , n o r
was i n f e c t e d d i r e c t l y
the
series
from a l o u s e , b u t t h e i r i n c l u s i o n i n
gives a very s t r i k i n g p ic tu re
splenectom y,
one w h i c h
of th e e f f e c t
of
thus -
C h aracter
of
D isease
Four
S plenectom ised
M onkeys
Five
Normal
Monkeys
Immune
1
-
Ho r e l a p s e
1
-
1 relapse
3
1
E relap ses
-
1
D eath r a t e
N il
50 p e r c e n t .
N o t e O n e s p l e n e c t o m i s e d monkey d i e d d u r i n g t h e f i r s t
paroxysm , and a n o t h e r , w h ich u l t i m a t e l y d i e d ,
p r o b a b l y h a d more t h a n one r e l a p s e .
Splenectom y had n o t th e
same e f f e c t o n p r e v i o u s l y
i n f e c t e d an im a ls, w hether u n d e rta k en b e fo re
course o f the second i n f e c t i o n .
Thus,
the
o r d u rin g the
course
o f the
s e c o n d i n f e c t i o n w a s n o m ore s e v e r e i n m o n k e y R .( -3 ) t h a n
i n monkeys R . ( l )
and R . ( £ ) , w hich had b e en s p l e n e c t o m i s e d .
E v e n m ore s t r i k i n g e v i d e n c e
o f t h i s was o b t a i n e d on
5 / 3 / 3 8 w he n one s p l e n e c t o m i s e d m on k e y w h i c h h a d b e e n
in fected
t w i c e p r e v i o u s l y was i n o c u l a t e d w i t h t h e same
b l o o d a s a n o r m a l m on k e y w h i c h h a d b e e n i n f e c t e d o n c e .
The l a t t e r w a s f o u n d s u s c e p t i b l e ,
t h e f o r m e r imm un e.
KRITSCHEWSKI a n d RUBINSTEIN ( 1 9 3 1 ) f o u n d t h a t w h i l e
-5 2 -
s p le n e c to m y had no e f f e c t
cause the re a p p ea ra n ce
on a c q u i r e d im m u n ity i t m i g h t
o f the
sp iro ch aetes
in the blo o d .
T h i s was n o t f o u n d i n o u r a n i m a l s .
A possible
e x p l a n a t i o n why t h e e f f e c t s
of
s p l e n e c t o m y were more a p p a r e n t i n monkeys t h a n i n m ice
is
s u g g e s t e d b y a n e x p e r i m e n t o f RUBINSTEIN ( 1 9 3 0 ) .
This
a u t h o r fo u n d t h a t w hen s p l e n e c t o m i s e d r a b b i t s were
i n o c u la te d w ith the
m aterial
o r d in a r y d o ses o f the
the d e a th r a t e
g iv en the
same d o s e s .
however, th e d e a t h r a t e
w a s t h e sam e a s i n c o n t r o l r a b b i t s
When a much l a r g e r d o s e w a s u s e d ,
o f the
sp len ecto m ised as
w i t h t h e n o rm a l a n i m a l s was s t r i k i n g l y
effect
in fectiv e
in creased .
norm al an im al: w ith v e ry m ild
in fectio n s
course
any e f f e c t s
course
o f the
o f the
splenectom y.
In the
i n the
the r e s e r v e s
the r e t i c u l o - e n d o t h e l i a l system a re s u f f i c i e n t
severe
The
o f t h e s p l e n e c t o m y was a p p a r e n t o n l y i n a n
i n f e c t i o n which was l i k e l y t o r u n a s e v e r e
the
compared
of
t o mask
c a s e o f o u r mice
i n f e c t i o n was v e r y m i l d .
The m ore
i n f e c t i o n i n t h e m on k e y p r e s u m a b l y e n t a i l e d a
g r e a t e r t a x o n t h e r e t i c u l o - e n d o t h e l i a l s y s t e m , w h i c h was
then l e s s ab le to w ith s ta n d rem oval o f a la rg e
part of its
su bstance.
RUBINSTEIN a n d GOLOBEWA ( 1 9 3 0 ) h a v e s h o w n t h a t
i n Trypanosoma eq u ip erd u m i n f e c t i o n s
splenectom y i s
in v e rs e ly p ro p o rtio n a l to
tim e w hich e l a p s e s betw een th e
in fectio n .
the e f f e c t
In th is
observe t h a t the
the
of
len g th of
splenectom y and subsequent
connection i t
is
in terestin g
to
o n l y one o f o u r m o n k e y s i n w h i c h t h e
in o c u la tio n o f i n f e c te d blood r e s u l t e d in a f a t a l issu e
w a s one w h i c h h a d b e e n r e c e n t l y s p l e n e c t o m i s e d .
The o t h e r s
had undergone t h e o p e r a t i o n s e v e r a l m onths p r e v i o u s l y and
-5 3 -
i n t h e m eantim e h a d r e c e i v e d num erous i n o c u l a t i o n s
fo reig n m a te ria l,
of
a p r o c e s s w h i c h m i g h t r e a s o n a b l y be
e x p e c te d to induce
some d e g r e e
o f com pensatory h y p e rtro p h y
i n th e re m a in d e r o f the r e t i c u l o - e n d o t h e l i a l system .
LATENT INFE CTIOUS.
WENYON ( 1 9 2 6 ) a n d ANZAR ( 1 9 2 6 ) h a v e r e c o r d e d
t h a t when m i c e , p r e v i o u s l y i n o c u l a t e d w i t h s p i r o c h a e t e s ,
were i n f e c t e d w i t h t r y p a n o s o m e s s e v e r a l m onths a f t e r th e
a p p aren t disappearance
th is
of th e s p iro c h a e te s
r e s u l t e d i n the re a p p ea ra n ce
the b lo o d s tre a m ,
th e
sp iro ch aetes
in
BUSCHKE a n d KROO ( 1 9 2 3 ) a n d o t h e r
w o r k e r s have shown t h a t t h e
disappearance
o f the
from th e b lo o d ,
sp iro ch aetes,
from th e b l o o d ,
settle
after
in the
th eir
tissu e s
of
c e n t r a l n e r v o u s s y s t e m , w h e r e t h e y may r e m a i n v i a b l e
fo r long p e rio d s .
The i m p o r t a n c e
point
o f th ese
o b s e r v a tio n s from the
o f v i e w o f t h e hu m a n i n f e c t i o n
is th a t they suggest
th e p o s s i b i l i t y o f s p i r o c h a e t e s l y i n g dorm ant i n th e
t i s s u e s o f r e c o v e r e d p a t i e n t s and i n v a d i n g t h e b lo o d
s tre a m as a r e s u l t
f o r exam ple.
start
o f some d e b i l i t a t i n g i n f e c t i o n , m a l a r i a ,
T h is m ight l e a d to
in fectio n of lic e
a new o u t b r e a k .
On 1 3 / l / 3 8
w ith sp iro c h a e te s a t
t h r e e mice w hich h a d b e e n i n f e c t e d
differen t
p e rio d s d u rin g the p re v io u s
two m o n th s w ere i n o c u l a t e d w i t h T ry p an o so m a e v a n s i .
th is
and
I am i n d e b t e d t o D r . S . C . J .
For
BENNETT, S e n i o r V e t e r i n a r y
R e s e a r c h O f f i c e r o f th e Sudan G overnm ent.
A f t e r an
'i n c u b a t i o n p e r io d o f s i x days th e trypanosom es a p p e a re d
-5 4 -
i n th e blood stre am .
In exam inations
They p e r s i s t e d
of the
fo r fo u r days only.
blood c a r r i e d
o u t f o r the
f o llo w in g tw enty days n e i t h e r trypanosom es n o r s p ir o c h a e te s
w ere s e e n .
On a n o t h e r o c c a s i o n 12 w h i t e m i c e , w h i c h h a d
b e e n i n f e c t e d on one o r more o c c a s i o n s a t p e r i o d s v a r y i n g
f r o m tw o t o e i g h t w e e k s p r e v i o u s l y , w e r e k i l l e d .
E m u l s i o n s w e r e made o f t h e i r b r a i n s a n d i n o c u l a t e d
subeutaneously in to
s ix g e r b ille s , each g e rb ille
m a t e r i a l f r o m two m o u s e b r a i n s .
f o l l o w i n g 12 d a y s none
D uring the
o f the g e r b i l l e s
receiv in g
course
o f the
developed an
i n f e c t i o n , a f t e r w hich t h e i r b lo o d was n o t e x am in ed .
G e r b i l l e s w e re c h o s e n a s t h e y h a d shown
t h e m s e l v e s t o be t h e m o s t s u s c e p t i b l e
of
to the
was n o t h o p e f u l l y
in f e c tio n , b u t th e experim ent
undertaken.
rich
the
sm all ro d e n ts
I f p a s s a g e s were n o t s u c c e s s f u l when b l o o d
i n s p i r o c h a e t e s was i n o c u l a t e d ,
t h e y were h a r d l y
l i k e l y to succeed w ith b r a in em ulsions c o n ta in in g p o s s ib ly
a few o r g a n i s m s .
N egative r e s u l t s
in th is
instance
can
h a v e no s i g n i f i c a n c e .
P r o b a b l y t h e o n l y s u c c e s s f u l way t o
in v estig ate
t h i s a s p e c t o f th e A b y s s in ia n s t r a i n w ould have b e en to
u s e monkeys o n l y .
proof of la te n t
of the s t r a i n
The i m p o r t a n t p o i n t i s n o t s o much t h e
in f e c tio n , but to e stim a te
to cause such i n f e c t i o n ,
alo n g these
tendency
a s shown b y t h e
p r o p o r t i o n o f o r d i n a r y i n f e c t i o n s w hich a r e
la te n t in fectio n .
the
f o l l o w e d by
U n f o r t u n a t e l y a n y s a t i s f a c t o r y work
l i n e s w o u ld h a v e r e q u i r e d more monkeys t h a n
were a t d i s p o s a l .
-5 5 -
CASE HISTORIES OF THE SSPBRIKSNT a L M0HEEY5
These
case h i s t o r i e s
chronological ta b u la tio n s
the
a re presented, as
of e v e n ts ,
w ith th e view t h a t
f a c t s a r e more r e a d i l y a p p r e c i a b l e
in th is
form .
KOIfoSY T.O,
16/ 11/ 3 7 .
17/ 11/ 3 7 .
16/ 11/ 3 7 .
19/ 11/ 3 7 .
20/11/3 7 .
21/ 1 1 / 3 7 .
22/ 11/ 3 7 .
23/ 11/ 3 7 .
24/ 11/ 3 7 .
25/ 11/ 3 7 .
26/11/37.
27/11/37.
23/11/37.
29/11/37.
30/11/37.
1 /12/37.
2/12/37.
3/12/3 7 .
4/ 12/ 3 7 .
5/ 12/ 3 7 .
6/ 12/ 3 7 .
7/ 12/ 3 7 .
At S e n n a r , i n o c u l a t e d i n t r a p e r i t o n e a l l y
w i t h 1 c . c . b l o o d f r o m a hu m a n c a s e , s h o w i n g
abundant s p iro c h a e te s in the b lo o d .
B lood n e g a t i v e .
B lood n e g a ti v e .
B lood n e g a t i v e .
B lood n e g a t i v e .
B lood n e g a t i v e .
Blood n e g a t i v e .
B lood n e g a t i v e .
B lood n e g a t i v e .
Blood n e g a t i v e .
At K a ssa lu .
Inocu lated in tr a p e rito n e a lly
w i t h 1 c . c . b l o o d f r o m a hu m a n c a s e , s h o w i n g
abundant s p iro c h a e te s .
Blood n e g a t i v e .
Bloou n e g a t i v e .
Blood n e g a t i v e .
Blood n e g a t i v e .
Blood n e g a t i v e .
B lood n e g a t i v e .
Blood n e g a t i v e .
B lood n e g a t i v e .
B lood n e g a t i v e .
B lood n e g a t i v e .
B lood n e g a t i v e .
Blood n e g a t i v e .
As t h i s m o n k e y s e e m e d t o b e i n s u s c e p t i b l e ,
f u r t h e r a t t e m p t s v/ere made t o
two m o n t h s l a t e r ,
in feo t
it.
w ithout app aren t cause.
f i n d i n g s were n e g a t i v e .
no
The a n i m a l d i e d
P ost-m ortem
-5 6 -
MOHKEY R.(1).
23/12/37.
24/ 12/ 3 7 .
25/ 12/ 3 7 .
At S e n n a r .
In o c u la te d i n t r a p e r i t o n e a l l y w ith
1 c . c . b l o o d f r o m a hu m a n c a s e s h o w i n g
abundant sp iro c h a e te s.
B lood n e g a ti v e .
B lood p o s i t i v e , i n f e c t i o n o f m o d erate s e v e r i t y .
H eart puncture perform ed under e th e r a n a e s th e s ia
and 5 c .c . blood w ithdraw n.
One h a l f c . c .
i n o c u l a t e d d i r e c t l y i n t o e ac h o f the f o ll o w i n g ,
i n t o the p e rito n e u m :2
2
2
1
1
1
26/12/37,
27/12/37.
2 8/12/37.
4 /1/33.
5/1/38.
20/1/38.
24/1/38,
25/1/38,
w h i t e mice
g erb illes
w hite r a t s
guinea p ig
rab b it
monkey R . ( 3 ) .
Blood p o s i t i v e .
B lood p o s i t i v e .
R em ained n e g a t i v e u n t i l
Blood n e g a t i v e .
4/1/38.
Blood p o s i t i v e .
The two w h i t e m i c e i n o c u l a t e d
on 2 5 / 1 2 / 3 7 w e re i n o c u l a t e d o n c e a g a i n w i t h
b lo o d from th e e a r , d i l u t e d w ith c i t r a t e .
B lood n e g a t i v e .
A f t e r t h i s date s p ir o c h a e te s
were n e v e r fo u n d a g a i n i n t h e b l o o d o f t h i s
monkey.
U n d e r e t h e r a n a e s t h e s i a , s p l e n e c t o m y was
c a r rie d out.
Ho s p i r o c h a e t e s w e r e s e e n i n
s m e a r s made a t o n c e f r o m t h e s p l e e n , n o r i n
p a r a f f i n s e c t i o n s o f t h e s p l e e n , s t a i n e d by
L e v a d i t i ’s m ethod.
Splenectom y d id n o t cause
a re a p p e a ra n c e o f th e s p ir o c h a e t e s in the blood
d u rin g the n e x t fo u r d a y s.
At K hartoum N o r t h .
Inoculated in tr a p e rito n e a lly
w i t h 1 c . c . b l o o d f r o m a huma n c a s e , s h o w i n g
abundant s p ir o c h a e te s in the p e r ip h e r a l b lo o d .
B lood n e g a t i v e , a n d re m a in ed n e g a t i v e d u r i n g the
n e x t t w e l v e d a y s a f t e r w h i c h no f u r t h e r
e x a m i n a t i o n s were c a r r i e d o u t .
Monkey i s s t i l l u n d e r o b s e r v a t i o n fro m t h e p o i n t
o f view o f K a la A z ar.
It
is
in te r e s tin g - to n o te
th a t in fre s h spleen
s m e a r s L e ish m an -D o n o v an b o d i e s were d i s c o v e r e d ,
though th e re
was n o h i s t o r y o f a t t e m p t e d i n f e c t i o n w i t h K a l a A z a r , a n d
no c l i n i c a l symptoms o f t h i s
t h i s monkey i s a l i v e
K ala Azar a r e a .
d isease.
and w e l l .
It
Up t o d a t e
(23/5/38)
came o r i g i n a l l y f r o m a
T h e r e was n o e v i d e n c e
of K ala Azar i n the
p a t i e n t f r o m whom t h e mon ke y was i n o c u l a t e d , a n d no
L e i s h m a n i a f o u n d i n t h e s p l e e n o f t h e o t h e r mon ke y i n o c u l a t e d
-5 7 -
from th e
sam e p a t i e n t .
T his is
the
o ccu rrin g n a tu ra lly
f i r s t record
i n a monkey.
seem t o h a v e b e e n s u b c l i n i c a l ,
o n ly the
d eb ilitatin g
in fectio n .
of le is h m a n ia
Its
p r e s e n c e w ould
p e r h a p s made o b v i o u s b y
e f f e c t o f the
sp iro ch aetal
T h i s o b s e r v a t i o n h a s b e e n more f u l l y e x p l o r e d
in a separate
study.
MONKEY R . ( 2 ) .
23/12/37.
24/12/37.
25/12/37.
26/12/37.
27/12/37.
24/1/38.
25/1/38.
2 6 /l/3 8 .
2 7 /1/38.
2 8 /l/3 8 .
2 9/1/38.
3 0 /l/3 8 .
3 1 /1/38.
1 /2/38.
5 /3/38.
6 /3/38.
At S en n ar.
Inoculatedin tr a p e r ito n e a lly
w i t h 1 c . c . b l o o d f r o m t h e same c a s e a s
monkey R . ( 1 ) .
B lood n e g a tiv e .
Blood
p o s i t i v e , i n f e c t i o n of m oderate
sev erity .
B lood p o s i t i v e .
B lood
neg ativ e.
T h e r e was no r e l a p s e i n
t h i s monkey.
The b l o o d r e m a i n e d
c o n s is te n tly negative u n t i l
At K hartoum N o r th .
Inoculated in tr a p e rito n e a lly
w i t h 1 c . c . b l o o d f r o m t h e same c a s e a s
monkey R . ( l ) .
B lood n e g a t i v e .
B lood n e g a t i v e .
B lood p o s i t i v e , i n f e c t i o n of m oderate s e v e r i t y .
U nder e t h e r a n a e s t h e s i a s p l e n e c t o m y done and
about 0 .2 c . c . o f blood in o c u la te d d i r e c t l y
in to th e peritoneum o f : 2 s p l e n e c t o m i s e d mice ( T y p i c a l
in fectio n ).
B lood p o s i t i v e .
B lood p o s i t i v e .
B lood p o s i t i v e .
C risis.
A g g l u t i n a t i n g and f r a g m e n tin g form s
only seen i n th e b lo o d , and very s c a r c e .
Blood n e g a t i v e .
No r e l a p s e .
B lood rem ained
n e g a tiv e fo r the next fo u r te e n days.
At K hartoum .
Inoculated in tr a p e r ito n e a lly _
w i t h -g c . c . b l o o d f r o m m o n k e y R- ( 4 ) a t a t i m e
when s p i r o c h a e t e s w e r e a b u n d a n t i n t h e b l o o d .
B l o o d n e g a t i v e , a n d c o n t i n u e d t o be s o f o r
the n e x t f o u r te e n d a y s.
-5 8 -
iIOEKEY R . ( 3 ) .
2& /12/37.
//
27/12/37.
2& /12/37.
29/12/37.
30/12/37.
31/12/37.
8/1 /3 8 .
9/1/38.
1 0 /l/3 8 .
11 /1 /3 8 .
' I
’
5/3/38.
6/3/33.
7/3/38.
8/3/38•
9/3/38.
10/3/38.
At K h a rto u m .
Inoculated in tr a p e r ito n e a lly
w i t h -g c . c . "blood c o n t a i n i n g n u m e r o u s
s p i r o c h a e t e s from monkey R . C l ) •
B lood n e g a t i v e .
B lood p o s i t i v e , i n f e c t i o n o f m o d erate s e v e r i t y .
U nder e t h e r a n a e s t h e s i a b lo o d w ith d r a w n from
the h e a r t and ab o u t 0 .2 c . c . i n o c u la te d i n t o : 1 mouse:
1 guinea p ig :
1 rab b it.
B lood p o s i t i v e .
B lood p o s i t i v e .
B lood n e g a t i v e .
C ontinued n e g a tiv e u n t i l 8 /l/3 8
B lood p o s i t i v e , i n f e c t i o n o f m oderate s e v e r i t y .
Blood p o s i t i v e - s c a n t y i n f e c t i o n .
B lood n e g a t i v e .
B lood n e g a t i v e an d c o n tin u e d n e g a t i v e f o r the
follow ing e ig h te en days.
In o c u la te d i n t r a p e r i t o n e a l l y w ith g c . c . blood
c o n t a i n i n g a b u n d a n t s r i r o c h a e t e s f r o m m on k e y
R .(4 ).
Blood n e g a t i v e .
B lood p o s i t i v e , i n f e c t i o n o f 'm o d e r a te s e v e r i t y .
Blood p o s i t i v e .
B lood p o s i t i v e .
Blood n e g a t i v e .
Wo f u r t h e r r e l a p s e d u r i n g t h e
follow ing e ig h te en days.
MONKEY R . ( 4 ) .
a/12/37.
3/1 2 /3 7 .
14/12/37.
20/12/37.
24/1/38.
2 8 /2/38.
2 7 /2/38.
28/2/38.
1/3/38.
2/3/38.
3/3/38.
4 /3/33.
5/3/38.
6/3/38.
Splenectom y un d er e th e r a n a e s t h e s i a .
B i t t e n by e i g h t t i c k s , b a t c h e s
. and 3 . and
tic k coxal f lu id in o cu lated su b cu tan eo u sly .
B i t t e n by fiv e t i c k s , and coxal f l u i d
in o c u la te d subcutaneously.
B i t t e n by s i x t i c k s a n d t h e c o x a l f l u i d
in o c u la te d subcutaneously.
Wo i n f e c t i o n r e s u l t e d f r o m t h e s e t i c k b i t e s .
In o c u la te d p e rc u ta n e o u sly w ith an em u lsio n of
e i g h t l i c e t a x e n from a c ase i n K hartoum W orth.
Wo i n f e c t i o n r e s u l t e d f r o m t h i s : l i c e n e g a t i v e
f o r s p i r o c h a e t e s on m i c r o s c o p i c a l e x a m i n a t i o n .
I n o c u la te d p e r c u ta n e o u s ly w ith a r o r t i o n o f the
haenocoele f l u i d o f a lo u se tak en "fro m a case
i n Omdurman.
Blood n e g a t i v e .
Bipod n e g a t i v e .
Blood n e g a t i v e .
B lood p o s i t i v e , heav y i n f e c t i o n .
Blood p o s i t i v e .
B lood p o s i t i v e .
Blood p o s i t i v e , i n f e c t i o n v e r y h e a v y , a lm o s t
a s ma ny s p i r o c h a e t e s a s r e d b l o o d c e l l s ,
3 1 o o d p o s i t i v e : m o n k e y v e r y d u l l , a n d a t e no
food to d a y .
-5 9 -
M onkey c o n tin u e d , t o h a v e a h e a v y b l o o d i n f e c t i o n ,
lo st fle sh rap id ly t i l l
on th e m o rn in g o f 1 0 /3 /3 8
u n c o n sc io u s and m oribund.
it
was
The a n i m a l d i e d t h a t e v e n i n g .
MONKEY R . ( 5 ) .
5/12/37.
14/12/37.
2 0/12/37)
2 6/12/37)
1 2/1/38)
2 5/1/38)
2 /2/38)
8 /2/38)
5 /3 /3 8 .
7 /3 /3 8 .
10 /3 /3 8 .
15 /3 /3 8 .
2 1 /3/38.
2 4 /8/38.
25 /3 /3 8 .
26/3/38.
27 /3 /3 8 .
2 8 /3/38.
Splenectom y, u n der e t h e r a n a e s t h e s i a .
In o c u la tio n subcutaneously of t i c k c o n te n ts .
V a r i o u s a t t e m p t s w e r e made o n t h e s e d a t e s t o
i n f e c t t h e monkey by s u b c u t a n e o u s i n o c u l a t i o n
o f m a t e r i a l from t i c k s , b u t no i n f e c t i o n
resu lted .
In o c u la te d i n t r a p e r i t o n e a l l y . % c . c . blood
r i c h i n s p i r o c h a e t e s f r o m m on k e y R . ( 4 ) .
B l o o d p o s i t i v e a n d c o n t i n u e d t o be p o s i t i v e_ u n t i l
Blood n e g a t i v e
C ontinued n e g a tiv e u n t i l 1 5 /3 /3 8 ,
B lood p o s i t i v e , h eav y i n f e c t i o n .
C ontinued
p o sitiv e u n til
31ood n e g a t i v e ,
C ontinued n e g a tiv e d u r in g the
n e x t t h r e e days u nt i l
B lood p o s i t i v e , heavy i n f e c t i o n .
B lood n e g a t i v e .
B lood n e g a t i v e .
B lood n e g a ti v e .
B lood n e g a t i v e .
I t was n o t p o s s i b l e
any f u r t h e r .
to
follow out t h i s
in fectio n
No f u r t h e r b l o o d e x a m i n a t i o n s w e r e m a d e .
MONKEY R . ( 6 ) .
24/12/37.
26/12/37)
12/1/38)
25/1/38)
30/1/38)
2 /2/38)
8 /2/38)
2 0 /2/38.
2 0 /3/38.
2 3 /3/38.
Splenectom y under e t h e r a n a e s t h e s i a .
V a r i o u s a t t e m p t s made o n t h e s e d a t e s t o i n f e c t
t h e monkey by s u b c u t a n e o u s i n o c u l a t i o n o f
m a t e r i a l from t i c k s b u t no i n f e c t i o n r e s u l t e d .
In o c u la te d p e rc u ta n e o u s ly w ith em ulsion of
e i g h t P e d i c i n u s c o l l e c t e d f r o m m on k e y R . ( 2 )
tw enty days a f t e r the d is a p p e a ra n c e o f th e
s p i r o c h a e t e s from i t s b l o o d .
No i n f e c t i o n
resu lted .
I n o c u l a t e d w i t h about 0 . 2 c . c . b lo o d from
monkey R . ( 7 ) .
B lood p o s i t i v e .
-6 0 -
T h i s i n f e c t i o n was n o t f o l l o w e d o a t .
p ro v ed , how ever, t h a t
It
t h e monkey was s n s c e p t i b l e .
MONKEY R . ( 7 ) .
1 /3 /3 8 .
5 /3 /3 8 .
6/3 /3 8 .
7 /3 /3 8 .
1 2/3/38.
13/3/38.
14/3/38.
1 5/3 /3 8 .
1 6/3/38.
25 /3 /3 8 .
26/3/38.
27/3/38.
23/3/33.
Splenectom y under e t h e r a n a e s t h e s i a .
In o c u la ted in tr a p e r ito n e a lly w ith \ c .c .
b lo o d r i c h i n s p i r o c h a e t e s from monkey R . ( 4 ) .
Blood n e g a t i v e .
B lood p o s i t i v e , i n f e c t i o n o f m o d erate s e v e r i t y .
C ontinued p o s i t i v e f o r f iv e days u n t i l
B lood n e g a t i v e .
B lood n e g a t i v e .
B lood n e g a t i v e .
B lood n e g a t i v e .
B lood p o s i t i v e , heav y i n f e c t i o n .
C ontinued
p o s i t i v e , w ith a heavy i n f e c t i o n f o r the
fo llo w in g n in e days u n t i l
B lood n e g a t i v e .
B lood n e g a t i v e .
B lood n e g a ti v e .
Blood n e g a t i v e .
I t was n o t p o s s i b l e
i n f e c t i o n any f u r t h e r .
carried
to
fo llo w out t h i s
No f u r t h e r b l o o d e x a m i n a t i o n s w e r e
out.
MONKEY R . ( 8 ) .
5/3/38.
6/3/38.
7/3/38.
8/3/38.
9/3 /3 8 .
10/3/38.
18/3/38.
19/3/38.
I n o c u l a t e d i n t r a p e r i t o n e a l l y w i t h -g c . c . b l o o d
r i c h i n s p i r o c h a e t e s fro m monkey R . ( 4 ) .
Blood n e g a t i v e .
B lood p o s i t i v e , i n f e c t i o n o f m o d erate s e v e r i t y .
Blood p o s i t i v e .
Blood p o s i t i v e .
Blood n e g a t i v e .
C ontinued n e g a tiv e u n t i l
B lood p o s i t i v e , heavy i n f e c t i o n .
Blood n e g a t i v e .
No f u r t h e r r e l a p s e w a s r e c o r d e d .
B l o o d was
e x a m i n e d u n t i l 2 8 / 3 / 3 8 b y me a n d f o r a f u r t h e r t e n d a y s
by a n o t h e r .
(E)
I.
II.
III.
IV.
V.
TRASSMISSION OF INFECTION
TRANSMISSION BY THE LOUSE.
TRANSMISSION EXPERIMENTS WITH TI CKS .
DISTRIBUTION AND HABITS OF ORNITHODORUS SAVIGNYI IN
THE SUDAN.
METHODS.
RESULTS
EXPERIMENTS WITH ^RGAS AND PEDICINUS.
-6 2 -
TRANSMIS S 10 N BY THE LOUSE.
S p ir o c h a e te s found i n l i c e .
to dem o n strate t h a t the lo u se
is th e
th e r e l a p s i n g fe v e r u n der s tu d y .
100 p e r c e n t ,
I t has been possib le
in term ed iate
host
I t may be s a i d t h a t
o f t h e r e t u r n i n g i m m i g r a n t s were l o u s y ,
minimum o f e i g h t l i c e
of
and a
c o u ld r e a d i l y be o b t a i n e d from any
one o f them.
M e ta c y c li c form s o f th e
th e haem ocoele f l u i d o f l i c e
Compared w i t h th e
are sm aller,
sp iro ch aete
were fo u n d i n
from i n f e c t e d p e r s o n s .
organism s found i n th e b lo o d th e se
fin er,
a n d mo re r e g u l a r l y s p i r a l
in s tru c tu re .
S t a i n e d b y L e i s h m a n ’ s m e t h o d t h e y do n o t show t h e
te n d e n c y to t w i s t th e m s e lv e s i n t o f i g u r e s
o th e r c o i l e d o r i r r e g u l a r form 3.
foun d i n enorm ous num oers,
the haem ocoele o f the lo u s e
same
o f e i g h t and
They were
form ing la r g e
forms
freq u en tly
ta n g le d m asses in
(F ig .1 4 ).
The b e s t m e t h o d o f d e m o n s t r a t i n g t h e
sp iro ch aetes
i n t h e l o u s e w a s f o u n d t o oe t h a t d e s c r i b e d by RIDING a n d
MACDOHELL ( 1 9 2 7 ) .
The l o u s e w a s s e i z e d w i t h f i n e
forceps,
a n d l a i d o n i t s b a c k i n a s m a l l d r o p o f d i s t i l l e d w a t e r on
a clean s lid e .
lateral
The a b d o m e n w a s t r a n s f i x e d b y a n e e u l e ,
to the g u t ,
and th e haem ocoele f l u i d a llo w e d to
e s c a p e from th e p u n c t u r e ,
t h e movements o f th e l o u s e ' s
legs
a s s i s t i n g th e m ix in g o f th e haem ocoele f l u i d an d th e w a te r
o n -h e slide.
The f l u i d c o u l d t h e n be e x a m i n e d b y d a r k
g r o u n d i l l u m i n a t i o n o r a l l o w e d bo d r y i n t h e a i r a n d
3 t a i n e d oy L eishm ar..
T h i s m ethod was i n f i n i t e l y s u p e r i o r
to m aking sm ears o f c ru s h e d l i c e ,
prep aratio n s,
test-tu o e
f r e e from d e b r is *
and gave ad m irab le
T h e 1-ioe w e r e k e p t i n a
f o r t w e n t y - f o u r hQiirs b e tw e e n r e m o v a l f r o m th e
-6 3 -
p a t i e n t and e x a m in a tio n f o r s p i r o c h a e t e s .
The p e r c e n t a g e
d ifferen t cases,
the
of in fected lic e
presum ably a c c o rd in g to th e
d i s e a s e , a l t h o u g h i t was n o t p o s s i b l e
as h isto rie s
s h o r t the
were u n r e l i a b l e ,
d u ratio n of
to
v erify th is
a n d s t e p s w ere t a k e n to
d ise a se w ith tre a tm e n t as soon as th e
was v e r i f i e d u n d e r t h e m i c r o s c o p e .
per cent,
v a rie d in
o f the l i c e
were
o f c a s e s no i n f e c t e d l i c e
cut
d iagnosis
M o s t c omm only 1 5 — 20
found i n f e c t e d .
w ere f o u n d .
I n 30 p e r c e n t ,
I n on e c a s e w h i c h
was i n v e s t i g a t e d i n K a s s a l a t h e i n f e c t i o n r a t e was a s h i g h
a s 60 p e r c e n t ,
(six in fe c te d out of a t o t a l of te n lic e
o b ta in e d from th e p a t i e n t ' s
No i n f e c t e d n i t s
clo th in g ).
found.
l i c e w e r e f o u n d t o be i n f e c t e d .
B o th m ale a n d fe m a le
No e v i d e n c e
of h ered itary
t r a n s m i s s i o n i n th e l o u s e was f o u n d , a l t h o u g h l a r g e
num bers o f n i t s were e x a m in e d , i n c l u d i n g a num ber a c t u a l l y
d e p o site d i n c a p t i v i t y by in f e c te d l i c e .
e x a m i n a t i o n a l o n e was m ade: t h e n i t s
M icro sco p ical
w ere c r u s h e d on a
s l i d e an d exam ined u n d e r th e h i g h pow er, s t a i n e d by
L e i s h m a n . . No a n i m a l i n o c u l a t i o n e x p e r i m e n t s w e r e c a r r i e d
out,
so t h a t th e p o s s i b i l i t y o f h e r e d i t a r y
in v isib le
granule
s t a g e was n o t
T ran sm issio n o f the
The s p i r o c h a e t e s i n t h e l i c e
illu m in atio n ,
i n monkeys.
i n f e c t i o n by an
in v e stig ate d .
d isease
t o monkey from l o u s e .
were m o t i l e u n d e r d a r k g ro u n d
a n d t h e y were a b l e
to re p ro d u c e
the d is e a s e
O n l y on e s u c c e s s f u l t r a n s m i s s i o n e x p e r i m e n t
was c a r r i e d o u t , b u t t h i s
to o k p l a c e u n d e r somewhat d r a m a t i c
circum stances,
A blood s l i d e
from a p a t i e n t a d m i t t e d to t h e
C h u r c h M i s s i o n a r y H o s p i t a l i n Omdurman o n 2 4 / 2 / 1 9 3 8 was
-6 4 -
fo u n d t o be p o s i t i v e
for relap sin g fever.
was i n f o r m e d , a n d i t was r e q u e s t e d t h a t
The h o s p i t a l
the
lic e
from t h i s p a t i e n t be c o l l e c t e d a n d t r a n s m i t t e d
U nfo rtu n ately , i t
tr a n s p ir e d th a t the
been washed an d h i s
sin g le
to me.
p a tie n t had a lre a d y
c l o t h e s removed f o r d i s i n f e s t a t i o n .
The f o l l o w i n g d a y , h o w e v e r ,
v ig ilan ce
( i f any)
ow ing t o th e
o f th e M e d ic a l O f f i c e r o f H e a l t h , K hartoum , a
l o u s e was f o u n d on a p a i r
o f p a n t s w hich m ust
somehow h a v e e s c a p e d t h e d e l o u s i n g p r o c e s s ,
removed from th e p a t i e n t .
although
T h i s l o u s e was g i v e n a f e e d
from th e w r i t e r ’ s arm , and k e p t f o r a n o t h e r day a t
On 2 6 / 2 / 1 9 3 8 t h i s
slid e
and i t s
l o u s e was t r a n s f i x e d on a
h a e m o c o e le f l u i d was a l l o w e d t o m ix w i t h
d i s t i l l e d w a te r i n th e manner d e s c r ib e d ab o v e.
th is
37°C.
Some o f
f l u i d was r u b b e d i n t o a s m a l l s c a r i f i e d a r e a o n t h e
s h a v e d abdomen o f a s p l e n e c t o m i s e d monkey, a n d a l l o w e d
to dry, as in a v a c c in a tio n .
The r e s i d u e
on t h e
slid e
was s t a i n e d b y L e i s h m a n ’ s m e t h o d , a n d e x a m i n e d
m icro sco p ically .
I t was f o u n d t o c o n t a i n s p i r o c h a e t e s .
A f t e r an i n c u b a t i o n p e r i o d o f f o u r days
s p i r o c h a e t e s a p p e a re d i n th e monkey’ s b l o o d .
D uring the
n e x t e i g h t d a y s t h e y b e ca m e p r o g r e s s i v e l y m o r e n u m e r o u s ,
u n til
t h e r e a p p e a r e d t o be a s many o r g a n i s m s a s r e d b l o o d
cells.
The mon ke y b e ca m e o b v i o u s l y i l l
d i e d on 1 0 / 3 / 1 9 3 8 , e i g h t d a y s a f t e r t h e
o f the s p ir o c h a e te s
in the
A ccording to
a c q u i r e d from th e lo u s e
resu lts
from t h e
th is
on 6 / 3 / 1 9 3 8 and
first
appearance
blood.
o b serv atio n the d isease
i s m ore v i r u l e n t t h a n t h a t w h i c h
in o c u la tio n of blood c o n tain in g sp iro c h a e te s,
I n no o t h e r e x p e r i m e n t a l a n i m a l s were t h e s p i r o c h a e t e s
o b s e r v e d i n the p e r i p h e r a l b lo o d i n s u c h enorm ous numbers
a s i n t h i s monkey, w hich w as, m o re o v e r, t h e o n l y a n im a l
to
die
fever.
i n the
first
paroxysm o f e x p e r i m e n t a l r e l a p s i n g
A lthough t h i s
is
findings in tick -b o rn e
i n a c c o rd w ith
relap sin g
fever,
w orking w ith S. n o v y i , found t h a t
from l i c e
the
the ex p erim en tal
the
was a l w a y s b e n i g n , w h i l e
LI PST EH I
(1936)
in fe c tio n deriv ed
t h a t w hich f o ll o w e d
i n o c u l a t i o n o f i n f e c t e d b l o o d was a l w a y s f a t a l .
The w r i t e r d i d n o t d e v e l o p r e l a p s i n g f e v e r ,
d i d he e x p e c t t o
do s o .
to fe e d in f e c te d l i c e
On two o c c a s i o n s i t
was n e c e s s a r y
o n my own b l o o d i n o r d e r t o k e e p
them a l i v e u n t i l s u c h tim e a s i t
them .
nor
I was w e l l aware
was p o s s i b l e
t o examine
o f 1JTC0LLE, BLAIZOT a n d COIJSEIL’ S
(1913) w ork on t h e m echanism o f t r a n s m i s s i o n ,
a n d was
c o n f i d e n t t h a t t h e r i s k w a s n e g l i g i b l e , p r o v i d e d c a r e was
ta k e n n o t to
crush or in ju re
the l i c e .
A s i m i l a r a t t e m p t h a d p r e v i o u s l y b e e n made t o
in fe c t th is
monkey by means o f l i c e ,
b u t was u n s u c c e s s f u l .
In t h i s
th irty
days e a r l i e r ,
i n s t a n c e , how ever,
e x a m in a tio n o f s t a i n e d sm ears of th e haem ocoele f l u i d
o f the l i c e
showed t h a t
th e l a t t e r were n o t
I t was c o n s i d e r e d t h a t
to g e th e r w ith the r e s u l t s
th ese ex p erim en ts,
o f anim al
d em onstration o f in fe c te d lio e
in fected .
i n o c u l a t i o n , a n d the
in a large
p ro p o rtio n of
t h e huma n c a s e s w e r e s u f f i c i e n t t o i n c r i m i n a t e
as the v e c to r ,
the
louse
a n d no f u r t h e r e x p e r i m e n t s were c a r r i e d
out along th ese l in e s .
-6 6 -
TRANSMISSION EXPERIMENTS WITH CERTAIN TICKS.
I t w a s s u g g e s t e d ma ny y e a r s a g o b y NICOLLE a n d
ANDERSON ( 1 9 2 6 ) t h a t
th e epidem iology o f lo u se-b o rn e
r e l a p s i n g f e v e r w o u l d u l t i m a t e l y be c l a r i f i e d b y t h e
d i s c o v e r y o f some r e s e r v o i r , m o s t p r o b a b l y a t i c k ,
t h e v i r u s was a b l e
o f th e human h o s t .
stren g th en ed i f
louse-b o rn e
it
to
p ersist
f o r long p e rio d s
i n w hich
independently
T h i s h y o p t h e s i s w o uld o b v i o u s l y be
c o u l d be shown e x p e r i m e n t a l l y t h a t t h e
s t r a i n s w ere a b l e
to p e r s i s t
be t r a n s m i t t e d o n c e m o r e t o s u s c e p t i b l e
medium o f t h e s e a r t h r o p o d s .
in tic k s ,
an d to
an im als th ro u g h the
But th e c a r e f u l l y d e v is e d
e x p e r i m e n t s o f NICOLLE, BLAIZOT, a n d CONSEIL ( 1 9 1 3 )
tran sm it
the T u n is ia n lo u s e - b o rn e
O r n i t h o d o r u s s a v i g n y i gave
to
s t r a i n by means o f
only n e g a ti v e
r e s u l t s , and
o th er
w orkers have r e c o r d e d s i m i l a r f a i l u r e s .
SARGENT a n d FOLEY ( 1 9 1 0 ) f a i l e d
A lgerian s t r a i n
to
by means o f A rg a s p e r s i c u s .
a l s o was
unable
to tra n sm it e ith e r th i s
A m erican
stra in
by O r n i t h o d o r u s m o u b a ta .
tr a n s m it the
BRIMPT ( 1 9 0 8 )
strain
orth e
BALFOUR ( 1 9 1 1 )
recorded n e g a tiv e a tte m p ts w ith the E g y p tian s t r a i n ,
O r n i t h o d o r u s s a v i g n y i , a n d INGRAM ( 1 9 2 4 ) was u n a b l e
tra n sm it the
and
to
Gold C o a s t s t r a i n by O r n i t h o d o r u s m o u b a ta .
r e c e n t l y BRTJMPT ( 1 9 3 6 a )
More
a n d FENG a n d CHUNG ( 1 93 7 ) f a i l e d
independently to tra n s m it
the C hinese lo u s e -b o rn e
s t r a i n by
O rn ith o d o ru s m oubata.
On t h e
o t h e r hand th e
MANTEUFEL ( 1 9 0 8 ) , NEUMAN ( 1 9 0 9 ) ,
text-bouks a l l reco rd th a t
a n d SCHUBERG a n d MANTEUFEL
(1909) s u c c e e d e d i n t r a n s m i t t i n g th e R u s s i a n a n d A m erican
strain s
by m e a n s o f O r n i t h o d o r u s m o u b a t a .
to c o n s u lt the
I have b e en unable
o r i g i n a l p a p e r s o f t h e s e a u t h o r s , b u t BRTJMPT
(1936a) c r i t i c i s i n g t h i s
work p o i n t s
out
that n o th in g is
kn ow n o f t h e
carried
c o n d i t i o n s u n d e r w h ich t h e s e e x p e r i m e n t s were
o u t.
The i n c u b a t i o n p e r i o d s i n t h e r a t s
in fected
by t i c k b i t e s w ere a p p a r e n t l y u n d u ly lo n g a n d , a s th e
s p i r o c h a e t e s w ere shown to be r e a d i l y t r a n s m i s s i b l e
lice,BRUMPT s u g g e s t s t h a t t h e
r e a l i t y by th e s e
O rnithodorus
p arasites,
i n f e c t i o n was t r a n s m i t t e d i n
and n o t by the b i t e s
may be made o f t h e e x p e r i m e n t s
o f NEUMAN a n d MANTEUFEL i n t h a t t h e r e
to
o f the
tick s.
A fu rth e r c riticism
doubt as
by r a t
the
o r i g i n o f the
The ’ R u s s i a n s t r a i n *
the s o - c a l l e d
s t r a i n s u s e d by th e s e a u t h o r s .
s t u d i e d b y th e m w a s i n a l l p r o b a b i l i t y
’F r a n k f u r t s tr a in *
i n Germany i n r a t s
s e e m s t o b e some
since
o f which h a s b e e n l o s t .
which h a s b e e n m a i n t a i n e d
1907, and th e o r i g i n a l h i s t o r y
More r e c e n t l y BRUMET ( 1 9 3 6 b )
c o n clu d ed from a n e x p e r im e n t a l s t u d y o f t h i s
i t was n o t a t r u e S .
strain
th at
r e c u r r e n t i s , bub a s t r a i n o f S. d u t t o n i
w h i c h h a d b e c o m e m o d i f i e d i n v a r i o u s i n t e r e s t i n g w a y s by
the c o n tin u e d p a ssa g e th ro u g h
rats.
The c o n f u s i o n w h i c h may a r i s e
of la b o ra to ry s t r a i n s
the
from t h e em ployment
o r i g i n o f w hich i s
i n a n y w ay
d o u b t f u l h a s b e e n e m p h a s i z e d i n a s p e c i a l p a p e r b y NICOLLE
a n d ANDERSON ( 1 9 2 9 ) , who r e c o m m e n d t h a t s u c h d o u b t f u l s t r a i n s
s h o u l d be d i s c a r d e d .
In s p ite
tran sm it
the
l o u s e - ’o o r n e s t r a i n s b y t h e i n t e r m e d i a r y o f t i c k s
the
p o ssib ility
still
o f th ese
ex ists
failu res
t h a t i n some c o u n t r y s t r a i n s may be
found h a v in g th e s p e c i a l a p t i t u d e
ju st as th ere
f r o m man t o
to
of surv iv in g in tic k s ,
a r e some s t r a i n s w h i c h a r e r e a d i l y i n o c u l a b l e
o t h e r a n i m a l s a n d some w h i c h a r e n o t .
A s t h i s A b y s s i n i a n s t r a i n h a d n o t t o my k n o w l e d g e ,
p r e v io u s ly been s tu d ie d ,
it
seemed o f i n t e r e s t
to a s c e r t a i n
-6 8 -
w hether i t
was a b l e
to p e r s is t
in tick s
or n o t.
T his
a p p e a r e d , m o r e o v e r t o be a m a t t e r o f n o s m a l l p r a c t i c a l
im portance
from th e p o i n t o f view o f p r e v e n t i o n ,
w ould e n a b le
one t o e s t i m a t e how f a r i n t e n s i v e m e a s u r e s
d ire c te d ag ain st
e rad icatin g
as i t
lice
m ig h t hope t o be s u c c e s s f u l in
the d is e a s e
from th e S u d an .
E x p e rim e n ts w ere
th erefo re
c a r r i e d o u t to
I
determ ine w hether t h i s
sav ig n y i.
stra in
This p a r t i c u l a r
.
co u ld p e r s i s t i n O rn0thadorus
t i d e was c h o s e n f o r num e ro u s
reasons.
REASONS FOR SELECTING ORNITHODORUS SAVIGNYI.
In the f i r s t
in s u ffic ie n t
p lace
th is
t i d e was r e a d i l y a v a i l a b l e
numbers f o r e x p e r i m e n t a l p u r p o s e s .
Some
e x p e r im e n ts w ith O rn ith o d o r u s m oubata a l s o w ould have been
ad m itted ly d e sira b le ,
but t h i s
t i d e was q u i t e u n o b t a i n a b l e .
I t h a s b e e n s h o w n b y NICOLLE, ANDERSON a n d ,
COLAS-BELCOTTR ( 1 9 2 8 ) , a n d 3RUMPT ( 1 9 0 3 )
th a t under
e x p e r im e n ta l c o n d itio n s O rn ith o d o ru s s a v ig n y i can tr a n s m i t
a l l the v a r i e t i e s
of re la p sin g
O rn ith o d o ru s m oubata.
in tid e s
th ere
Thus i f
i s no a p r i o r i
fever tran sm issib le
t h i s A byssinian^can survive
reason to b eliev e
experim ents w ith O rnithodorus sav ig n y i are
be s u c c e s s f u l t h a n t h o s e
by
carried
that
l e s s l i l c e l y to
out w ith o th e r t i c k s .
I t w i l l b e s e e n f r o m t h e map i n F i g . 5 t h a t i f
any O rnithodorus t i c k p la y s a p a rt
in the ep idem iology of
r e l a p s i n g f e v e r i n t h e N o r th e r n Sudan i t
be 0 .
i s most l i k e l y to
savignyi.
A t t e n t i o n h a s a l r e a d y b e e n drawn to t h e
the r e la p s in g
fe v e r concerned is a p p a r e n tly being
fact
that
-6 9 -
i n t r o d u c e d from th e
th e Sudan.
the
co u n tries
O rnithodorus
p rin c ip a l vecto rs
A byssinia
on th e E a s t e r n b o r d e r o f
s a v i g n y i h a s b e e n c i t e d a s one
in a t le a s t
tw o o f t h o s e
(BRUNS, 1 9 3 7 ) a n d S o m a l i l a n d
of
co u n tries,
( DRAKE-BROCKMAN,
1 9 1 5 , CLARKE, 1 9 3 6 ) .
C ertain f u r th e r ep id em io lo g ical fe a tu re s
d isease
tic k .
o f the
i n t h e S u d a n seem ed to th ro w s u s p i c i o n on t h i s
These a r e ,
incidence
of the
firstly ,
d isease
a f t e r the
our o b s e r v a tio n s s u g g e s t,
more a c t i v e .
the w ell-m a rk e d s e a s o n a l
th is
rain ,
a t w hich p e r i o d ,
t i c k i s more p r e v a l e n t a n d
CLARKE ( 1 9 3 6 ) h a s d r a w n a t t e n t i o n t o
s t r i k i n g seaso n al incidence
the
o f the S o m a lila n d d i s e a s e ,
w hich i s r a t h e r an u n u s u a l f e a t u r e
in the tic k -b o rn e
in fectio n .
Even more s u g g e s t i v e
s a v ig n y i i s n o t a house t i c k ,
is
the
fact
th a t O rnithodorus
but occurs t y p i c a l l y under
t r e e s and in o th e r s im ila r s i t u a t i o n s
out of doors.
The
r e l a p s i n g f e v e r i n th e Sudan o c c u rs a lm o s t e x c l u s i v e l y
i n p e r s o n s who do n o t l i v e
fr o m t h e W e s t , who t a k e
camping g ro u n d s f o r
in houses v i z , w andering n e g ro id s
t h e i r m i d - d a y r e s t a n d make t h e i r
the n i g h t i n j u s t
such p la ce s as are
freq u e n te d by O rnithodorus s a v ig n y i.
DISTRIBUTION AND BIONOMICS OF ORNITHODORUS SAVIGNYI IN THE
SUDAN.
DISTRIBUTION.
O r n ith o d o r u s s a v i g n y i r e s e m b le s 0 . m oubata v e r y
clo sely but d iffe rs
from i t by the p o s s e s s i o n o f e y e s and
i n c e r t a i n o t h e r m inor a n a to m ic a l d e t a i l s .
x e r o p h ilic o f the
O rnithodorus
tick s.
It
is
th e most
In A fric a i t s
g e o g r a p h i c a l d i s t r i b u t i o n o v e r l a p s t o some e x t e n t t h a t
of
-7 0 -
0 . m oubata.
In th e Sudan i t
i s w idely d i s t r i b u t e d
throughout
t h e a r i d K o r t h , b u t a b s e n t fr o m t h e more h um id S o u t h .
O rn ith o d o r u s m o u b ata, on th e o t h e r h a n d , does n o t
n o rth e rn Sudan, though i t
province,
tid es
in the S o u th .
i n th e Sudan i s
has
occur in
been o o se rv ed i n M ongalla
The d i s t r i b u t i o n o f O r n i t h o d o r u s
i l l u s t r a t e d b y t h e map i n F i g . 5 ,
t h e names u n d e r l i n e d b e i n g
those
has p e rs o n a lly i d e n t i f i e d 0.
o f p l a c e s where th e w r i t e r
sav ig n y i.
BIONOMICS.
0 . m o u b a t a i s e x c l u s i v e l y a hum a n t i c k ,
and is
found t y p i c a l l y i n h o u s e s , r e s t h o u ses an d o t h e r d w e llin g s .
The h o s t s o f 0 .
s a v i g n y i , on th e
other hand, are v a rio u s,
i n c l u d i n g man a n d m o s t o f t h e d o m e s t i c a n i m a l s , s u c h a s
sheep,
cam els, h o rs e s an d dogs.
found t h i s
One h a s o c c a s i o n a l l y
t i c k i n t h e compounds o f n a t i v e
p a r t i c u l a r l y those
houses,
o f t h e m ore p r o s p e r o u s i n d i v i d u a l s ,
whose num e ro u s s t o c k a n i m a l s a r e h e r d e d i n t o
at n ig h t.
M ost commonly, h o w e v e r,
it
is
t h e compounds
found i n o u td o o r
s i t u a t i o n s , where a n i m a l s a r e f r e q u e n t l y t i e d up o r c o n f i n e d ,
or in th e san d u n d er th e
Here t h e t i c k s
trees
surrounding d e se rt w e lls.
c o n ce a l th em selv es under the
may b e no i n d i c a t i o n o f t h e i r p r e s e n c e
host seeks re s t
sand, and th e re
u n t i l some u n s u s p e c t i n g
in the shade o f a n e arb y t r e e .
unknown means th e t i c k s
oecome a w a r e
o n l y a few m i n u t e s e l a p s e u n t i l t h e
By some
o f t h e new a r r i v a l ,
first
and
t i c k w orks i t s
wa y o u t o f t h e s a n d a n d p r o c e e d s t o w a r d s i t s
prospective
h o st.
A few m o m e n ts l a t e r a n o t h e r a p p e a r s a n d y e t a n o t h e r ,
u n til,
w i t h i n h a l f an h o u r or s o , upw ards o f a h u n d re d t i c k s
may be a d v a n c i n g u p o n t h e h o s t o r a c t u a l l y
in s itu
feeding.
The way i n v / h i c h e a c h t i c k o n e m e r g i n g f r o m t h e s a n d s t a r t s
-7 1 -
at
once i n t h e
s tra ig h te st lin e
i s alm ost uncanny.
The b i t e
is
for its
pro sp ectiv e host
d is tin c tly p ercep tib le,
a n d r a i s e s a w h e a l w h i c h may r e m a i n u n c o m f o r t a b l e
We h a v e
seen a horse
t i e d up under a tr e e
where t h e s e
t i c k s were a b u n d a n t become l i t e r a l l y
fran tic
o f th e num erous b i t e s .
cam els t i e d
In K ordofan,
fo r days.
as a r e s u lt
b a r r a c k e d i n compounds h e a v i l y i n f e s t e d w i t h t h e s e t i c k s
h a v e b e e n known t o d i e w i t h i n a few d a y s a s a r e s u l t
the m assed a t t a c k to w hich t h e y a r e
The e g g s o f 0 .
d e p o s ite d in the san d ,
six -leg g ed larvae
3 - 4
b ite
sav ig n y i,
of
su b jected .
few i n n u m b e r , a r e
and h a tc h in a b o u t t e n d a y s .
c a n n o t be i n d u c e d t o
feed,
The
but a f te r
d a y s , m o u l t , a n d be come e i g h t - l e g g e d n y m p h s w h i c h
read ily .
A part from r a r e
accid en ts
it
know w h a t t h e n a t u r a l h a z a r d s o f t h e s e
can r e s i s t
drought and s t a r v a t i o n
poultry,
d ifficu lt
tick s
are.
to
They
f o r ma ny m o n t h s , b u t i n
t h e l a b o r a t o r y we h a v e n e v e r b e e n a b l e
t h a n one y e a r w i t h o u t a f e e d .
is
They a re
t o k e e p them l o n g e r
r e a d i l y e a t e n by
and p e rh a p s a l s o by o t h e r b i r d s .
We h a v e
observed
f u l l y gorged, but o th erw ise h e a lth y t i c k s b eing s u b je c te d
t o a mass a t t a c k by a n t s , w h ich r a p i d l y d e m o lis h them , by
e a ti n g a hole
i n the
cu ticle
in tern al p arts.
W hether t h i s
nature or not i t
is
and th e n e a t i n g
im po ssible
out the
soft
is a freq u e n t occurrence
to s a y .
in
METHODS
The m e t h o d s e m p l o y e d c o n s i s t e d e s s e n t i a l l y i n
allow ing tic k s
T h ereafter,
to b ite
in fe c te d persons or an im als.
a t v a r y i n g p e r i o d s , a t t e m p t s w e r e made t o
i n f e c t s u s c e p t i b l e , a n im a ls by th e b i t e s
by the
in o c u la tio n o f the
i n o c u l a t i o n o f the t o t a l
coxal flu id ,
o f th ese
tick s,
a n d f i n a l l y by the
c o n te n ts of the
tick s,
em u lsified
in sa lin e .
To a v o i d t h e many p i t f a l l s
of th is n atu re,
the
im portance
w hich b e s e t e x p e r im e n ts
p a r t i c u l a r a t t e n t i o n was p a i d t o d e t a i l ,
o f w hich i s
p re v io u s experim ents
The
em phasised by c o n s i d e r a t i o n o f
recorded in
the
common g r e y g r i v e t
literatu re.
monkey o f t h e S udan
(C e r c o p i t h e c u s S e b a c u s ) was c h o s e n a s t h e
t o be i n f e c t e d f r o m t h e t i c k s ,
because,
our d is p o s a l,
it
was u n d o u b t e d l y
the d i s e a s e .
I t was i m p o r t a n t t h a t t h e
as p o ssib le
o r d e r to o b v i a t e
in fectio n ,
or la te n t in fe c tio n s
a n d ZOTTNER ( 1 9 3 0 )
o f the type
in ra b b its .
of th e anim als a t
th e most s u s c e p t i b l e to
s h o u l d be a s s e n s i t i v e
lig h t
anim al most l i k e l y
to
specim ens used
the
in fectio n ,
w h ic h m ig h t be m is s e d ,
f o u n d b y VELU, BALOZET,
W ith t h i s
i n view th e
m o n k e y s w e r e s p l e n e c t o m i s e d , a s o u r own r e s u l t s
and those
o f s e v e r a l o t h e r w o r k e r s h a d shown t h a t t h e e f f e c t
o p eratio n ,
in
i f a n y t h i n g , was t o i n c r e a s e
the
of th is
su scep tib ility
to r e l a p s i n g f e v e r .
The m o n k e y s w e r e o b t a i n e d w i t h t h e h e l p
n atives
of lo cal
from t h e woods o f t h e S e n n a r a n d S i n g a d i s t r i c t s
o f t h e S u d a n , a n d were a l l y oung a n i m a l s .
NICOLLE a n d
ANDERSON ( 1 9 2 7 b ) s a y t h a t n o w i l d a n i m a l s s h o u l d b e u s e d
f o r e x p e r i m e n t a l work w i t h r e l a p s i n g f e v e r ,
a s s o many o f
-7 3 -
t h e m may h a r b o u r . l a t e n t n a t u r a l s p i r o c h a e t a l i n f e c t i o n s .
I t was f u l l y r e a l i s e d
t h a t t h e s e monkeys were i n a l l
p r o b a b i l i t y t h e same s p e c i e s
found s p i r o c h a e te s
in the
i n w h i c h PLIMMER ( 1 9 1 2 )
L o n d o n Z o o , a n d t h a t RANKEN ( 1 9 1 2 )
h a s r e c o r d e d from t h e S o u t h e r n Sudan a n a t u r a l s p i r o c h a e t a l
in fectio n in
the a l l i e d
C ercopithecus ru b e r.
Except fo r
w h i t e m i c e , h o w e v e r , no l a b o r a t o r y a n i m a l s w e r e
su scep tib le.
carried
A few e x p e r i m e n t s w i t h w h i t e m ic e were
out, but i t
is
d o u b tfu l i f even th e se anim als
be r e g a r d e d a s a b s o l u t e l y s a f e ,
'C le a n 1 la b o ra to ry -b re d s t r a i n
w ith trypanosom es.
before
can
s i n c e VINZENT ( 1 9 2 7 ) h a s
re c o rd e d the sp o n tan e o u s a p p earan ce
sp iro ch aetes,
found
of a sp iro ch aete
o f m ice a f t e r
in a
in o cu latio n
To e x c l u d e a n y w h i c h s h o w e d o b v i o u s
the b lo o d of a l l
o u r monkeys was e x a m i n e d
t h e y w ere u s e d f o r e x p e r i m e n t b u t was i n v a r i a b l y
neg ativ e.
At a n e a r l y s t a g e
of th is
f o u n d w h i c h a p p e a r e d t o be q u i t e
sp iro ch aetal in fe c tio n .
work a
m o n k e y was
in su scep tib le
Because o f t h i s ,
the
to the
fu rth er
p r e c a u t i o n was t a k e n o f p r o v i n g t h a t t h e a n i m a l s u s e d f o r
th e t r a n s m i s s i o n e x p e r im e n t s w ere s u s c e p t i b l e
n e g a t i v e r e s u l t s were a c c e p t e d .
before
T h is was done by i n o c u l a t i n g
them d i r e c t l y w i t h b l o o d c o n t a i n i n g s p i r o c h a e t e s ,
a f t e r the
c o n c lu s io n o f the tr a n s m i s s io n e x p e rim e n ts.
A l l t h e monkeys w ere fo u n d n a t u r a l l y i n f e s t e d
w ith lic e
(P e d i c i n u s s p . ) .
A lthough a tte m p ts to tr a n s m it
th e s p i r o c h a e t e s e x p e r i m e n t a l l y by th e s e l i c e
were
u n s u c c e s s f u l , p r e c a u t i o n s were t a k e n to s e g r e g a t e monkeys
w hich h ad been i n f e c t e d to e x c lu d e
transference
monkeys.
of e cto p a ra sites
the p o s s i b i l i t y
o f any
from i n f e c t e d t o h e a l t h y
I t may b e r e c a l l e d t h a t BRUMPT ( 1 9 3 6 b ) h a s
-7 4 -
d iscred ited
the
experim ents
the g ro u n d s t h a t
o f NEUMAN a n d MANTEUFEL o n
t h i s p r e c a u t i o n was p r o b a b l y o m i t t e d .
The a n i m a l h o u s e s i n K h a r t o u m a r e m o s q u i t o p r o o f ,
o b v ia tin g the p o s s i b i l i t y
Stom oxys
are
thus
o f m echanical tr a n s m is s io n by
(SCHUBERG a n d KUHN, 1 9 1 1 ) a n d t a b a n i d s , w h i c h
common e n o u g h i n t h e v i c i n i t y .
As HINDLE ( 1 9 1 1 ) , SCHUBERG a n d MANTEUFEL ( 1 9 1 0 )
a n d KLEINE a n d KRAUSE ( 1 9 3 2 ) h a v e s h o w n t h a t a c e r t a i n
p r o p o r t i o n o f O r n i t h o d o r u s s e e m t o be i n s u s c e p t i b l e
spiro ch aetal
in fectio n ,
number o f t i c k s
care
to exclude
to
was t a k e n t o u s e a s u f f i c i e n t
f a l l a c y a r i s i n g from t h i s
cause.
NICOLLE, ANDERSON a n d C0LAS-3ELC0UR ( 1 9 2 8 )
m aintain th a t
t h e nymphs o f a v i c a r i o u s v e c t o r c a n o f t e n
be i n f e c t e d w h e n t h e a d u l t s
cannot,
and s t r e s s
n e c e s s i t y f o r u s i n g nymphs a s w e l l a s a d u l t s
experim ents.
and a l s o
This i s
in tran sm issio n
d e n i e d b y KLEINE a n d KRAUSE ( 1 9 3 2 )
by KRIT3CHEV7SKI a n d DVGLAITSKAYA-3ARIS CHEWA ( 1 9 3 1 ) ,
b u t i n o r d e r to e n s u r e
fo r the
the
in fectio n
t h a t the
optimum p o s s i b l e
co n d itio n s
o f th e t i c k s w ere p r e s e n t e d a c e r t a i n
p r o p o r t i o n o f n y m p h s was u s e d i n t h e
tra n sm issio n experim ents.
As t h e e x p e r i m e n t s w e r e d e s i g n e d t o
w h eth er 0. s a v ig n y i
could a c t as a tr u e
fin d out
v e c t o r and n o t
w h e t h e r m e re m e c h a n i c a l t r a n s m i s s i o n w a s p o s s i b l e , - i t was
n e c e s s a r y to e n s u r e t h a t
in fe c tiv e
su fficien t
f e e d a n d a n y a t t e m p t to t r a n s m i t
t o a new h o s t b y m e a n s o f t h e
th at
tick .
s p i r o c h a e t e s may p e r s i s t u p t o
a lim e n ta ry can a l of the t i c k a f t e r
m o n t h was a l l o w e d t h e r e f o r e ,
first
tim e e l a p s e d b e tw e e n the
two b a t c h e s o f t i c k s ,
the s p ir o c h a e te
KINDLE ( 1 9 1 1 ) h a s s h o w n
f o u r weeks i n th e
a feed.
e x c e p t i n the
At l e a s t
on e
case o f the
when f e e d i n g e x p e r i m e n t s
only
“ 75-
were c a r r i e d
out a f t e r a lap se
o f l e s s t h a n a m onth.
e m u ls io n from t h e
t i c k s were n o t i n o c u l a t e d i n an y
in stan ce u n t i l
l e a s t a m onth h a d e l a p s e d from t h e
o f the
at
in fectiv e
T issue
date
feed.
BORREL a n d MARCHOUX ( 1 9 0 5 ) a n d l a t e r MARCHOUX
a n d GOUTY' ( 1 9 1 3 ) h a v e s t a t e d
t r a n s m i t fow l s p i r o c h a e t e s
it
after 2 - 3
p ractice
i f kept in
days a t 30° - 35°C.
o f k e e p in g the
about fiv e
t h a t A rgas lo s e s
days before
tick s
in the
t r y i n g to
its
the c o ld ,
hut reg ain s
We t h e r e f o r e
in cu b ato r
power to
made a
(37°C) f o r
i n f e c t a n i m a ls from them .
A l t h o u g h BRUMPT ( 1 9 3 & c ) , a s a r e s u l t o f e x p e r i m e n t s a n d
o b s e r v a t i o n s i n na-ti -v e-s d i s a g r e e s w i t h t h e
fin d in g s
of
BORREL a n d MARCHOUX, HIKDLE ( 1 9 1 1 ) a n d o t h e r w o r k e r s h a v e
sh ow n t h a t t h e p r o c e d u r e
days r e s u l t s
o f the
v isib le
i n an a c t i v e
sp iro ch aetes,
of
’w a r m i n g ’ t h e t i c k s
f o r a few
d e v e lo p m e n t and m u l t i p l i c a t i o n
t h e r e b y m a k in g them more r e a d i l y
in the s e c r e t i o n s of th e
tic k ,
or
in i t s
tissu es
d u ring d is s e c tio n s .
In the e a r l i e r
the s p iro c h a e te
by t i c k s , f e e d i n g e x p e r i m e n t s ,
o f the co x al f l u i d ,
tissu es
a tte m p ts o f the w r i t e r to tr a n s m i t
d i s s e c t i o n s and e x a m i n a tio n s o f th e
o f th e t i c k s were c a r r i e d o u t .
p r o c e s s , a n d s o m etim e s i t was d i f f i c u l t
to
exam ination
T his
to
is a ted io u s
induce
f e e d i n t h e r e q u i r e d numbers a t a g iv e n t i m e .
found t h a t
the
tick s
I t was
th e o n ly s a t i s f a c t o r y method e n t a i l e d h a v in g th e
h o s t a n i m a l s p r e a d - e a g l e d o n a b o a r d a n d f i r m l y t i e d do w n.
I n a n e a r l y e x p e r i m e n t when a t t e m p t s w e r e b e i n g made to
induce t i c k s to b i t e
o f the t i c k s .
a m o u s e , t h e m ous e b i t a n d k i l l e d
two
A f t e r a number o f n e g a ti v e
resu lts
th ese
d etailed
m e th o d s w ere d i s c a r d e d a n d r e l i a n c e was p l a c e d on s im p le
in o c u la tio n o f the
t o t a l c o n te n ts of the t i c k .
o b ta in e d by opening th e
the s o f t t i s s u e s .
for th is
purpose.
t i c k d o r s a l l y , an d gouging out a l l
A salin e
was m ade, G r i f f i t h s '
em u lsio n of these
soft
tissu es
tu b e s b e in g found p a r t i c u l a r l y
The e m u l s i o n w a s f i l t e r e d
wool an d i n o c u l a t e d i n t o
For these
T h i s was
su itab le
through g la s s
the a n im a l.
in o cu latio n s
the
subcutaneous ro u te
was a l w a y s u s e d , _as t h e m a t e r i a l i n o c u l a t e d w a s c e r t a i n t o
be c o n t a m i n a t e d w i t h o r g a n i s m s o f v a r i o u s s o r t s .
No
a b s c e s s e s r e s u l t e d , how ever, a lth o u g h by th e tim e the
e x p e r i m e n t s w e r e c o n c l u d e d two o f t h e m o n k e y s h a d i n d u r a t e d
areas
i n th e s u b c u ta n e o u s t i s s u e s a t s i t e s where s e v e r a l
i n o c u l a t i o n s had been g iv e n .
NICOLLE a n d ANDERSON ( 1 9 2 7 a ) h a v e
in f e c tio n follow ing in o c u la tio n of th e
po in ted out th a t
tissu es
of a
s u p p o se d v e c t o r c a n n o t be r e g a r d e d a s e v id e n c e
th at
vector is
capable o f t r a n s m i t t i n g th e d is e a s e
th is
in n atu re.
T h is o b j e c t i o n w ould have b e e n o f p rim e im p o rta n c e h a d o u r
r e s u l t s been p o s itiv e ,
negative
the
but as th e y w ere c o n s i s t e n t l y
t h i s m ethod p r o v i d e d th e m ost c o m p lete p r o o f t h a t
s p i r o c h a e t e s had d is a p p e a r e d e n t i r e l y from the
tissu es
o f the t i c k s .
.n.n a m p l e s u p p l y o f t i c k s w a s h e l d
in reserv e
be u s e d as c o n t r o l s i n th e e v e n t o f a p o s i t i v e
b e i n g r e c o r d e d , b u t were n o t r e q u i r e d .
from K hartoum , E l O b e id ,
to
tran sm issio n
B atches o f tic k s
and from K a s s a l a were d i s s e c t e d ,
a n d s m e a r s made f r o m t h e i r t i s s u e s ,
s p i r o c h a e t e s was e v e r e n c o u n t e r e d .
b u t no s i g n o f
-7 7 -
The f o l l o w i n g i s a b r i e f r e c o r d o f t h e
tra n s m is sio n ex perim ents c a r r ie d
out w ith O rnithodorus
sav ig n y i:(I)
B a t c h A.
B a t c h B.
FEEDING EXPERIMENTS
13/1 1 /3 7 .
Twelve t i c k s were f e d on a
case o f r e la p s in g fe v e r in S ennar.
Two
t i c k s were f o u n d d e a d t h r e e d a y s a f t e r th e
feed.
13/11/37.
T w elve t i c k s were f e d on a
second case in Sennar.
One t i c k d i e d t h r e e
days a f t e r th e fe e d .
B a t c h C.
£2/11/37.
Twelve t i c k s w ere
in K assala,
One t i c k d i e d .
f e d on a
B a t c h D.
22/11/37.
Twelve t i c k s were
second case in K a ssa la .
f e d on a
B atch E.
25/11/37.
T w elve t i c k s w e re f e d on a t h i r d
case i n K a ssa la.
T h i s c a s e was a d e f i n i t e
relap se.
One t i c k w a s f o u n d d e a d f o u r d a y s
a f t e r the fe e d .
B atch F.
26/12/37.
E i g h t e e n t i c k s a n d t h i r t y ny mp hs
w e re f e d on Monkey R . (£) d u r i n g f i r s t
a t t a c k o f f e v e r a f t e r i n o c u l a t i o n from a
case in Sennar.
Two t i c k s d i e d t h r e e d a y s
a f t e r the feed .
B a t c h G.
27/12/37.
S i x t e e n t i c k s a n d t h i r t y nym phs
w e re f e d on Monkey R . ( l ) , i n o c u l a t e d i n
S e n n a r f r o m t h e same c a s e a s M o n k e y R . ( £ ) .
One t i c k d i e d .
B atch H.
E ight tic k s .
Four’ w e re f e d o n 2 7 / 1 1 / 3 7 on
tw o m i c e i n o c u l a t e d f r o m M o n k e y R . ( 1 ) , t h e
o t h e r f o u r w e r e f e d o n 2 8 / 1 2 / 3 7 f r o m two
m ice i n o c u l a t e d fro m Monkey R . ( 3 ) .
B atch J .
E i g h t e e n t i c k s a n d t w e n t y nymphs w ere f e d
o n m on k e y R . ( £ ) i n o c u l a t e d f r o m a c a s e i n
Sennar.
The m o n k e y r e l a p s e d , a n d t h e t i c k s
o f t h i s b a t c h were fe d d u r i n g th e r e l a p s e .
(II)
1 /1 2 /3 7 .
case
ATTEMPTED TRANSMISSIONS
E i g h t t i c k s , f o u r f r o m B a t c h A. a n d f o u r
f r o m B a t c h B. w e r e a l l o w e d t o b i t e Monkey
R . ( 4 ) , and th e c o x a l f l u i d exuded a t th e
tim e o f th e b i t e was s u c k e d up i n a s y r i n g e
and i n o c u l a t e d s u b c u ta n e o u s ly i n t o the
monkey.
-7 3 -
4 /1 2 /3 7 .
T h ree t i c k s from B atch B. w ere in d u c e d
to b i t e a w hite m ouse, and th e c o x a l f l u i d
was i n o c u l a t e d i n t o t h e mouse.
Two t i c k s
f r o m B a t c h A. w e r e l o s t b y b e i n g k i l l e d b y
th e mouse.
10/12/37.
F o u r t i c k s from B a t c h A. w ere i n d u c e d t o
b i t e tw o w h i t e m i c e , a n d t h e c o x a l f l u i d
i n o c u l a t e d s u b c u t a n e o u s l y . The t i c k s w e re
d i s s e c t e d , a n d s m e a r s made f r o m t h e g u t ,
m a lp ig h ia n t u b e s , and th e haem ocele f l u i d .
F u n g a l b o d i e s o n l y d i s c o v e r e d : no
sp iro ch aetes.
14/12/37.
F iv e t i c k s from 3 a t c h e s A. a n d B. w ere
a l l o w e d t o b i t e Monkey R . ( 4 ) .
Coxal f l u i d
c o l l e c t e d and i n o c u l a t e d s u b c u t a n e o u s l y .
The t i c k s were d i s s e c t e d an d s m e a r s from
g u t, haem ocele, and m a lp ig h ia n tu b e s proved
n e g a tiv e , e x cep t fo r fu n g a l organism s.
T o ta l contents o f tic k s in o c u la te d in to
Monkey R . ( 5 ) .
20/12/37.
S i x t i c k s f r o m B a t c h e s A. a n d B . w e r e
a l l o w e d t o b i t e Monkey R . ( 4 ) .
Coxal f l u i d
was i n o c u l a t e d .
S m e a r s w e r e made f r o m g u t ,
haem ocele and m a lp ig h ia n tu b e s o f f o u r t i c k s .
T o t a l c o n t e n t s o f te n t i c k s w ere i n o c u l a t e d
s u b c u t a n e o u s l y i n t o Monkey R . ( 5 ) .
26 /1/38.
T o t a l c o n t e n t s o f e l e v e n t i c k s ( B a t c h C)
were i n o c u l a t e d i n t o Monkeys R . ( 5 ) a n d R . ( 6 ) .
12/1/38.
T o t a l c o n t e n t s o f t w e l v e t i c k s ( B a t c h D)
i n o c u l a t e d s u b c u t a n e o u s l y i n t o Monkeys
R. ( 5 ) a n d R . ( 6 ) .
25/1/38.
T o t a l c o n t e n t s o f n i n e t e e n t i c k s (B atches
E . a n d H) w e r e i n o c u l a t e d s u b c u t a n e o u s l y
i n t o M o n k e y s R . ( 5 ) a n d R. ( 6 ) .
30/1/38.
T o t a l c o n t e n t s o f s i x t e e n t i c k s ( B a t c h F)
w ere i n o c u l a t e d i n t o Monkeys R . ( 5 ) a n d
R.(6).
Smears from g u t , h aem o cele and
m a l p i g h i a n t u b e s o f two t i c k s f r o m t h i s
b a t c h w e re e x a m i n e d a n d f o u n d n e g a t i v e .
2/2/38.
A l l t h e ny mp hs o f B a t c h e s F . a n d G. w e r e
g r o u n d up i n s a l i n e a n d i n o c u l a t e d i n t o
Monkeys R . ( 5 ) a n d R . ( 6 ) .
8/2/38.
Nymphs a n d c o n t e n t s o f t i c k s ( 1 6 ) o f
B a t c h J . were e m u l s i f i e d i n s a l i n e a n d
i n o c u l a t e d i n t o Monkeys R . ( 5 ) a n d R . ( 6 ) .
RESULTS
The r e s u l t s
n eg ativ e,
ta k en to
o f th ese
e x p e r i m e n t s were e n t i r e l y
a l t h o u g h a v a r i e t y o f s t r a i n s was u s e d .
include re la p se
s t r a i n s as w ell as
C a r e was
those
from th e
o r i g i n a l i n f e c t i o n , an d s t r a i n s w hich had b e e n p a s s e d
t h r o u g h monkeys a n d m ice a s w e l l a s s t r a i n s
f r o m huma n p a t i e n t s .
taken d i r e c t l y
The b l o o d o f t h e a n i m a l s w h o s e i n f e c t i o n
was a t t e m p t e d w a s e x a m i n e d d a i l y d u r i n g t h e c o u r s e
e x p e rim e n ts, and fo r tw enty days a f t e r th e l a s t
made t o
in fect
o f the
a t t e m p t was
them , b u t s p i r o c h a e t e s were n e v e r f o u n d , a l t h o u g h
th e a n i m a l s w ere l a t e r shown t o be s u s c e p t i b l e .
Nor were
s p ir o c h a e te s e v e r found by d a rk -g ro u n d e x a m in a tio n of th e
c o x a l f l u i d exuded by th e
tissu es
o f the
tick s,
n o r i n s t a i n e d sm ears o f th e
tick s.
A c u r i o u s o r g a n i s m was a l m o s t i n v a r i a b l y f o u n d i n
the
tissu es
o f th e t i c k s exam ined,
mo re p a r t i c u l a r l y
in
the
m alpighian tu b es.
Som etim es th e
b a c i l l a r y form s,
o f various le n g th :
filifo rm
a p p e a r a n c e , an d re s e m b le d th e m ycelium o f a
sep tate
f u n g u s more t h a n a n y t h i n g e l s e .
t i c k s w hich had n o t fe d
a n d grow t h e
This
had a
o r g a n i s m was f o u n d i n
o f m a lp ig h ia n tu b e u nder a s e p t i c
in b ro th .
a fungus a p p e a re d i n pure c u l t u r e
th is
it
On t w o o c c a s i o n s a t t e m p t s w e r e
o r g a n is m from i t ,
general featu res
a t o th e r tim es
on i n f e c t e d b l o o d a s w e l l a s i n t h o s e
used in the e x p e rim e n ts.
t o remove a p i e c e
organism a p p e a re d as
co n d itio n s,
In both in s ta n c e s
i n the b r o t h .
In i t s
f u n g u s r e s e m b l e d s o c l o s e l y some o f
the o r d in a r y a ir - b o r n e
fu n g i w hich a re fo u n d everyw here
in the
was d i f f i c u l t
tro p ics th a t i t
t o be s u r e
it
was n o t
a contam ination w ithout
the
m y cologist.
a g o BALFOUR ( 1 9 1 1 b ) o b s e r v e d w h a t
appears
Many y e a r s
o p in io n o f a com petent
t o h a v e b e e n t h e same o r g a n i s m s i n t h e s e
b u t I h a v e fo u n d no o t h e r r e f e r e n c e
to i t .
made
tick s,
-8 0 -
P o ssib ly i t
d escribed
i s a s y m b io tic organism such a s have been
i n a g r e a t number o f o t h e r haem atophagus a n im a ls .
A nother i n t e r e s t i n g f a c t n o tic e d d u rin g
e x p e r i m e n t s was t h a t a c e r t a i n p r o p o r t i o n o f t h e
t ic k s d ied
some 2 t o 3 d a y s a f t e r a m e a l o f i n f e c t e d b l o o d .
alw ays r e v e a le d s p i r o c h a e t e s
a f t e r d eath ,
in the
s i m i l a r in appearance
Smears
gut of th ese
to
those
th ese
tick s
found i n th e
b l o o d , a n d w h e r e d a r k - g r o u n d e x a m i n a t i o n w a s do n e t h e
s p i r o c h a e t e s w ere m o t i l e .
the re a s o n f o r th e s e
i s m erely re c o rd e d ,
No a t t e m p t w a s made t o
d e a t h s among t h e
and i t
ticks*
is not possib le
in v estig ate
The o b s e r v a t i o n
to say at p re sen t
w h e t h e r t h e d e a t h s w ere due t o t h e s p i r o c h a e t e s ,
to the
b l o o d f r o m a n u n u s u a l h o s t o r t o some o t h e r r e a s o n .
EXPERIMENTS >71TH OTHER ARTHROPODS.
A rgas p e r s i c u s .
carried
out w ith A rgas p e r s i c u s ,
a s the v e c to r of r e la p s in g
HAROLD, 1 9 2 0 ) ,
a t i c k w hich h a s b een c i t e d
fever in P e rsia
(WRIGHT a n d
i n Q j a e t t o (BROWSE, 1 9 1 2 ) a n d i n P a l e s t i n e
(NICHOLSON, 1 9 1 9 ) , a l l
on v e r y q u e s t i o n a b l e
t i c k i s w idely d i s t r i b u t e d
where i t
One a t t e m p t e d t r a n s m i s s i o n w a s
This
th ro u g h o u t the N o rth e rn Sudan,
c a n be fo u n d i n a n y v i l l a g e
dom estic p o u ltr y .
evidence.
Like o t h e r t i c k s
in fe stin g p rin cip ally
it
can l i v e
p e r i o d s o e t w e e n m e a l s - we h a v e k e p t some f o r
fo r long
t e n m onths
w it h o u t fo o d o r w a t e r , d u r in g w hich p e r i o d th e y n o t o n ly
s u rv iv e d , b u t produced eg g s,
tick s
c a n u s u a l l y be f o u n d i n t h e
p o u ltr y are
Sudanese
th eir
from which young em erg ed .
s o l d , and a l s o
com monly s h a r e
dom estic an im als.
These
' s u k T o r m a rk e t where
i n most n a t i v e
compounds, a s th e
t h e i r l i v i n g accom m odation w i t h
-8 1 -
On 8 / l / 3 8 ,
e i g h t a d u l t A rg a s were
on a monkey w h ic h h a d nu m e ro u s s p i r o c h a e t e s
blood.
S ix weeks l a t e r
the s o f t
w ere e m u l s i f i e d i n s a l i n e
tissu es
induced to
feed
in the p e rip h e ra l
o f th ese
and in o c u la te d in to
tick s
two w h i t e
m i c e , b u t no i n f e c t i o n r e s u l t e d .
SERGENT ( 1 9 3 3 ) a n d SERGENT a n d LEVY ( 1 9 3 5 ) h a v e
drawn a t t e n t i o n t o t h e p o s s i b l e
ro le
o f the
dog t i c k
(R h ip ic ep h a lu s s a n g u in e o u s ) a s a v e c t o r of r e l a p s i n g
It
i s p e r h a p s t o be r e g r e t t e d
conducted w ith
d istrib u ted
tim e
th is
fever.
t h a t no e x p e r i m e n t s w ere
tic k fo r lik e
A rgas p e r s i c u s
i n th e Sudan and r e a d i l y o b t a i n a b l e .
it
i s w idely
At the
I was u n a w a r e o f SERGENT a n d LEVY’ S w o r k .
At t h e
i n s t i g a t i o n o f MAJOR H . C . BROWN, o f t h e
W e ll c o m e B u r e a u o f S c i e n t i f i c R e s e a r c h , a t t e m p t s w e r e made
to
o b t a i n s p e c i m e n s o f t h e b u g B r a g a d a p i c t a w h i c h he h a d
s u s p e c t e d o f p l a y i n g some p a r t i n t h e
i n o rd e r to
fin d out i f
any l e n g t h o f tim e
tran sm issio n in
the s p ir o c h a e te s
in th is
arth ro p o d .
India,
could p e r s i s t
I was u n a b le
for
to
o b t a i n any specim ens o f t h i s bug.
No e x p e r i m e n t s w e r e c a r r i e d o u t w i t h t h e b e d b u g .
T his p a r a s ite
h a s once a g a i n been b ro u g h t u n d e r s u s p i c i o n
a s a p o s s i b l e r e s e r v o i r b y t h e e x p e r i m e n t s o f ROSENHOLZ
q u o t e d b y HINDLE ( 1 9 3 2 ) .
The b e d b u g i s
th ro u g h o u t the Sudan, bu t a s i t
it
is
w idely d i s t r i b u t e d
stric tly
a h o u se-freq u en ter
i s u n l i k e l y to p l a y an i m p o r t a n t p a r t i n th e e p i d e m i o lo g y
o f the
Sudan d i s e a s e .
In p ra c tic e ,
a c c e p t ROSENHOLZ'3 w o r k a s d e f i n i n g
p o ssib ility
of th is
it
seemed r e a s o n a b le
su fficien tly
to
the
arthropod a c tin g as a v ic a rio u s v e c to r.
Some w o r k w a s c a r r i e d o u t w i t h r e g a r d t o t h e a b i l i t y
o f the l i c e
f o u n d n a t u r a l l y on t h e m o n k e y s
tra n s m it the d is e a s e .
(P e d i c i n u s ) t o
D uring th e e x p e r im e n ts w ith th e
-8 2 -
O rnithodorus i t
possib le
was s t a t e d
that
c a r e was t a k e n t o p r e v e n t
i n f e c t i o n o f one m o n k e y f r o m a n o t h e r b y t h e
agency o f th e se
lice,
a s MANTEUFEL a n d NEUMAN h a d f o u n d t h e
European s t r a i n e a s i l y tr a n s m is s ib le
by th e r a t
FENG a n d CHUNG ( 1 9 3 7 )
th at
found lik e w is e
s t r a i n was t r a n s m i s s i b l e
s q u ir r e l to a n o th e r.
by th e
On 4 / l / 3 8
the C hinese
s q u i r r e l louse
lice
Monkey R . ( l ) w h ic h h a d s p i r o c h a e t e s
louse.
f r o m one
w ere c o l l e c t e d from
in its
b l o o d on t h a t
day, and had had a th re e
d a y a t t a c k some
te n days
prev io u sly .
were
o f w hich s i x
Twelve l i c e
co llected ,
were e x am in ed m i c r o s c o p i c a l l y i n c r u s h e d s m e a r p r e p a r a t i o n s ,
an d s i x g r o u n d up i n s a l i n e
a f t e r a f a s t o f 24 h o u r s .
in fectio n .
and in o c u la te d in to a g e r b i l l e ,
The g e r b i l l e
In the sm ears o f th e l i c e
found i n f a i r n um bers, b u t i n
th e y resem bled those
d i d n o t d e v e l o p an
s p i r o c h a e t e s were
t h e i r shape and d i s p o s i t i o n
seen in the
b lo o d , r a t h e r th a n the
m e ta c y c lic form s,
a l t h o u g h t h e y w e r e r e l a t i v e l y much more
numerous t h a n th e
re d blood c o rp u s c le s ,
w hich h a d p re s u m a b ly
la r g e ly been d ig e s te d .
S ixteen days l a t e r ,
a fu rth er six lic e
were
c o l l e c t e d f r o m t h i s m o n k e y , a n d a n o t h e r a t t e m p t made t o
in fect
th e g e r b i l l e b u t i t was u n s u c c e s s f u l .
n o t e x am in ed on t h i s
were
occasion.
On H 0 / t : / 3 8 e i g h t l i c e
R. ( 2 ) w h i c h h a d h a d s p i r o c h a e t e s
prev io u sly .
The l i c e
w e r e c o l l e c t e d f r o m M onkey
in i t s
blood tw enty days
These were g ro u n d up i n s a l i n e
and in o c u la ted
p e r c u t a n e o u s l y i n t o a s p l e n e c t o m i s e d monkey b u t no i n f e c t i o n
resu lted .
On t h i s
occasion a lso
th e l i c e were n o t exam ined
m icroscopically.
When M on key R . ( 4 )
died a f t e r e ig h t days of
experim ental r e la p s in g fe v e r,
t e n l i c e w ere c o l l e c t e d
from
-8 3 its
body and exam ined.
some o f t h e s e
observed.
lic e ,
A bundant s p i r o c h a e t e s were
found in
e v e n when no b l o o d c o r p u s c l e s w ere
These s p i r o c h a e t e s ,
how ever, re sem b le d th e
form s
s e e n i n human b l o o d i n b e i n g t h i c k e r and more i r r e g u l a r
th a n the
f o r m s co m m o n ly s e e n i n P e d i c u i u s .
As f a r a s
c o u l d make o u t t h e y a p p e a r e d t o b e r e s t r i c t e d
to
one
the
alim en tary c an a l.
I n the
s m e a rs e x a m in e d a p p e a r a n c e s were s e e n
w hich s u g g e s te d t h a t
t h e i r way i n t o
the
the c e l l s
s p i r o c h a e t e s were a c t u a l l y b o r i n g
o f the g u t,
them , an d b r e a k i n g up i n t o
gran u les.
say w h eth er t h i s r e p r e s e n t s
l i v i n g organism s,
c o ilin g u p .in sid e
is
im p o ssib le
in v a sio n o f the
t i s s u e s by
o r m erely p h a g o c y to s is o f the
The n e g a t i v e t r a n s m i s s i o n e x p e r i m e n t s
but th ey a re
to
sp iro ch aetes.
su g g est the
la tte r,
c o m p a r a t i v e l y f e w i n n u m b e r , a n d i t may be
m entioned t h a t
p o sitiv e
It
i t a p p e a r s much m ore d i f f i c u l t
tran sm issio n r e s u l t s w ith lic e
WENYON ( 1 9 2 6 ) r e m a r k s o n t h e
t r a n s m i s s i o n s from t h e
b a c t e r i a were a l s o
to o b ta in
than w ith t i c k s .
s c a r c i t y o f experim ental
louse.
In the
cells
co n stan tly p re se n t.
o f P edicinus
They w ere, how ever,
e a s i l y r e c o g n i s a b l e a s s u c h , a n d n o t l i k e l y t o be c o n f u s e d
w ith d is in te g r a tin g
sp iro ch aetes.
GENERAL CONCLUSIONS.
W o r k i n g w i t h s p i r o c h a e t e s f r o m some o f t h e
E g y p t i a n c a s e s , BALFOUR ( 1 9 1 1 )
concluded t h a t th e lo u se
was t h e v e c t o r : h e w a s u n a b l e , m o r e o v e r ,
to in fe c t
tick s
(O r n ith o d o r u s s a v i g n y i and A rg as p e r s i c u s ) w i t h th e s e
sp iro ch aetes.
RIDING a n d MACDOWELL ( 1 9 2 7 ) s h o w e d t h a t t h e
D a r f u r e p i d e m i c was l o u s e - b o r n e , a n d INGRAM ( 1 9 2 4 ) w o r k i n g
-8 4 -
i n W est . A f r i c a w i t h w h a t w a s p r e s u m a b l y t h e
of sp iro ch aete,
was u n a b l e
to i n f e c t
The p r e s e n t w r i t e r h a s b e e n a b l e
d is e a s e w hich in v a d e d th e
also
louse-borne,
(O rn ith o d o ru s
to
same
stra in
O rn ith o d o ru s m oubata.
sho w t h a t t h e A b y s s i n i a n
Sudan d u r i n g 1936 - 1937 was
a n d was u n a b l e
to i n f e c t
tick s
s a v ig n y i and A rgas p e r s i c u s ).
Mo e x p e r i m e n t a l work, wos c a r r i e d o u t i n
c o n n ec tio n w ith the
few c a s e s w h ic h o c c u r r e d i n t h e
S o u t h e r n Sudan i n 1925 and 1 9 3 4 , so t h a t
t h a t t h e s e may h a v e
b e e n du e
to
it
tick -b o rn e
is
possib le
in fectio n s;
th o s e w hich o c c u r r e d i n M o n g a lla i n 1925 a lm o s t c e r t a i n l y
w ere.
Mo v i e w s c a n be e x p r e s s e d a s t o t h e
o r ig in of the
i n f e c t i o n w h i c h w a s f o u n d b y RAMKEM ( 1 9 1 2 )
i n t h e monkey.
I t has a lr e a d y been p o in te d out t h a t the
southw ard s p re a d o f lo u s e - b o rn e r e l a p s i n g
t o be l i m i t e d b y t h e
is
also th a t tick -b o rn e
in fectio n s
i n th e M orthern Sudan,
It
is u n lik ely
w i l l become e s t a b l i s h e d
o w in g 'to th e absence
of a su itab le
I t w i l l be s e e n f r o m map i n F i g . 5 t h a t
d i s t r i b u t i o n o f O rnithodorus ti c k s
t o be l i m i t e d t o 0 .
i n the South.
lik ely
freedom from l o u s e - i n f e s t a t i o n w h ich
e n jo y e d by th e nak ed S o u th e rn r a c e s .
vecto r.
fever is
the
in th e Sudan ap p ears
s a v i g n y i i n th e M orth a n d 0 . m oubata
A lthough the fo rm er t i c k h a s b een r e g a r d e d
at d ifferen t
tim es as the p ro b ab le v e c to r o f r e l a p s i n g
in A byssinia
(W3SNY0M, 1 9 2 6 ) ,
in 3 r i t i s h Som aliland
(DRAKE-3R0CKMAM, 1 9 1 5 ) a n d i n A n g o l a
these
conclusions are
fever
(WELIMAM, 1 9 0 5 ) ,
b a s e d on g e n e r a l c o n s i d e r a t i o n s
only,
o.nd h a v e no o b e e n s u b s t a n t i a t e d b y l a b o r a t o r y f i n d i n g s .
It
is
true
that
under e x p erim en tal c o n d itio n s O rnithodorus
s a v ig n y i can tr a n s m it a l l the v a r i e t i e s
of r e la p s in g fever
tran sm issib le
But the
by O r n i t h o d o r u s m o u b a t a .
in fectio n
-8 5 -
i s n o t p a s s e d on to
the
O rnithodorus s a v ig n y i,
next g e n e r a t i o n i n the
and i t
case
i s p o ssib ly fo r th is
a s 3 RUMPT ( 1 9 3 6 d ) h a s s u g g e s t e d ,
t h a t the
o f O rn ith o d o r u s s a v ig n y i from v a r i o u s p a r t s
of sp iro eh aetal
in f e c t i o n been found.
n o r t h e r n Sudan can p r o b a b ly t h e r e f o r e
in fe c tio n alo n e.
disease has been in tro d u ced a t
separate
to i n f e c t
o f t h e Sudan
p r e s e n t w r i t e r , b u t on no o c c a s i o n
The e p i d e m i o l o g y o f r e l a p s i n g
th e lo u se -b o rn e
B atches
t i m e s b e e n e x a m i n e d b y ARCHIBALD ( 1 9 1 0 ) ,
BRIJ&PT (193 &d) a n d b y t h e
has any e v id en c e
reason,
l a t t e r tic k has
n o t b een found n a t u r a l l y i n f e c t e d i n any c o u n tr y .
have a t d i f f e r e n t
of
and d i s t i n c t s o u rc e s
f e v e r i n the
be r e g a r d e d a s t h a t
M oreover, a lth o u g h th e
d i f f e r e n t tim e s from t h r e e
of in fe c tio n ,
t i c k s w ith the p a r t i c u l a r s t r a i n
a l l attem p ts
of sp irochaetes
co n cern ed on each o c c a s io n have b een u n s u c c e s s f u l .
a s th e N o rth e rn Sudan i s
As f a r
c o n c e r n e d , t h e r e f o r e , no e v i d e n c e
c a n be f o u n d t h a t t h e s e a r t h r o p o d s h a v e p l a y e d a n y p a r t
w hatsoever i n the ep idem iology o f r e l a p s i n g f e v e r .
of
(F)
I*
II.
III.
IV.
OBSERVATIONS ON THE HUMAN DISEASE.
epidem iology
(a)
GENERAL REMARKS
(b)
INCIDENCE
(c)
RELATION TO OTHER DISEASES.
CLINICAL FEATURES AND TREATMENT.
PATHOLOGY.
PREVENTION,
-8 7 -
EPIDEMIOLOGY.
GENERAL REMARKS.
It
is
stated
1923) t h a t e p id e m ic s
( SELWYN CLARKE, LE FAUN a n d INGRAM,
of relap sin g
f e v e r b e g i n s l o w l y and
in crease
in viru len ce
epidem ic
o f 1926 b e g a n w i t h e x p l o s i v e v i o l e n c e .
the v i r u l e n t d i s e a s e
and i n f e c t i v i t y .
In the Sudan the
3 y 1930
o f 1926 h a d become a r e l a t i v e l y
b e n i g n i n f e c t i o n w i t h a m o r t a l i t y o f 10 p e r c e n t ,
o f 70 p e r c e n t . ,
and the appearance
whose i n f e c t i o n w a s e n t i r e l y
of health y c a rrie rs
su b clin ical,
although
s p i r o c h a e t e s were r e a d i l y fo u n d i n t h e i r b l o o d
It
is
suggested th a t t h i s
in stead
(ATKEY,1 9 3 2 ) .
epidem ic d ie d out d u r in g i t s
p a s s a g e a c r o s s t h e S u d a n , a s e p i d e m i c s f r e q u e n t l y do
(CURRIE, 1 9 2 9 ) ,
There seems to
w ith the
by p r o g r e s s i v e
be n o e v i d e n c e
enfeeC lem ent o f i t s
to
connect
contagium .
t h i s epidem ic
1929 e p i d e m i c i n t h e D j i g r e g i o n o f A b y s s i n i a
(BRUNS, 1 9 3 7 ) , n o r w i t h t h e r e a p p e a r a n c e
of th e d ise a se
in
th e Sudan i n 1936.
It
the d is e a s e
is,
o f course,
t h e o r e t i c a l l y conceivable
th at
o f 1936 m i g h t be m e r e l y a r e a c t i v a t i o n o f th e
1926 d i s e a s e , w h i c h h a d m e a n t i m e l a i n d o r m a n t i n some
reservoir,
or in re sid u a l b rain in fe c tio n s ,
activ e again as a r e s u lt
No e v i d e n c e
w h i c h b e ca m e
o f m a l a r i a o r some o t h e r d i s e a s e .
c a n be o b t a i n e d t o s u p p o r t t h e s e v i e w s .
The way i n w h i c h u n r e c o g n i s e d s p o r a d i c c a s e s
m a in ta in the
i n f e c t i o n i n A lg e r ia d u rin g the p e rio d s
b e t w e e n e p i d e m i c s h a s b e e n d e s c r i b e d b y SERGENT a n d FOLEY
(1S22)•
The p o s s i b i l i t y o f t h i s h a p p e n i n g i n t h e S u d a n i s
d i f f i c u l t t o e x c l u d e , a n d i n c i d e n t a l l y may p r o v i d e a p u b l i c
h e a l t h problem f o r the f u t u r e .
Yet i t
seems c l e a r from our
-8 8 -
stu d ies
at
th at th is
process,
if
it
be a s s u m e d t o o c c u r ,
the p r e s e n t tim e o f acad em ic im p o rtan c e
w ith the
on ly ,
is
compared
obvious heavy i n f l u x o f i n f e c t i o n a c r o s s the
E astern f r o n tie r .
C om parison o f th e r o u t e s t a k e n by th e
im m igrants
( F ig .4) w ith th e
d isease
the Sudan shows
in
invoked to e x p la in
d isease.
of a p p a r e n t o r i g i n o f the
t h a t n o o t h e r f a c t o r n e e d be
th e d i s t r i b u t i o n an d s p r e a d o f the
S im ilarly ,
in the
sp reading a c ro ss A fric a
necessity ,
foci
fa c e of a m ajor e p id e m ic slo w ly
f r o m t h e West , t h e r e
seem s no
in th e absence o f c o n crete evidence,
the p e r s i s t e n c e
of the
old E g y p tian d is e a s e
t o assume
in sporadic
or
endemic form to a c c o u n t f o r th e e p id e m ic o f 1926.
It
is suggested th a t
30USEFIELD ( 1 9 1 1 ) ,
Sudan is
i s probably
concerned.
but has a t various
co u n tries.
the view e x p r e s s e d by
tru e
as f a r as th e N orthern
Human s p i r o c h a e t o s i s
is not
endem ic,
tim e s b e e n i n t r o d u c e d from a d j o i n i n g
D u r in g 1908 - 1925 i t was fr o m E g y p t ,
i n 1926
f r o m F r e n c h W est A f r i c a a n d i n 1 9 3 6 f r o m A b y s s i n i a a n d
E ritrea.
The d i s e a s e
o f 1 9 2 5 may o r may n o t h a v e b e e n a n
i n t r o d u c t i o n from U ganda.
The c l a s s i c a l e p i d e m i o l o g i c a l a s s o c i a t i o n s
r e l a p s i n g fe v e r - w ar,
c iv il u n rest,
h a v e b e e n shown c l e a r l y a t
1936 d i s e a s e .
epidem ics.
T heir
econom ic s t r e s s ,
in flu en ce
is
I t w o u l d be e a s y t o
in e x p lan a tio n o f the d ise a se
doubtful i f
th is
suggests th a t t h i s
etc.
work i n t h e p r o p a g a t i o n o f t h e
less
invoke
c le a r in p revious
th e w orld-w ide
econom ic d e p r e s s i o n o f 1929 - 1930, w h ich h i t
is
of
th e Sudan b a d l y ,
i n th e G e z ir a i n 1930 b u t i t
c o u l d be j u s t i f i e d .
e p i d e m i c was t h e t a i l
The e v i d e n c e a l l
end o f the E a s tw ard
-8 9 -
s p r e a d from D a r f u r o f th e
.Vest A f r i c a i n 1 9 2 1 .
u n d e rly in g the
1926 d i s e a s e ,
A ttem pts to d e fin e
spread of th is
d isease
th ese p a r tic u la r y ears le a d in to
w hich began i n
the
facto rs
a cro ss A fric a during
re a lm s o f pure
sp ecu latio n .
INCIDENCE.
SEX.
As i n I n d i a ,
West A f r i c a an d o t h e r c o u n t r i e s
i n w hich r e l a p s i n g fe v e r i s fo u n d ,
occur in m ales,
the m a jo r ity
th e a c tu a l in c id e n c e i n th e Sudan b ein g
98 p e r c e n t , m a l e s a n d 2 p e r c e n t ,
the
of cases
fem ales.
Except fo r
c a s e s d e s c r i b e d i n . W est A f r i c a b y SELWYN CLARKE,
LE FAUN a n d INGRAM ( 1 9 2 3 ) t h i s
incidence
i n m ales th a n is
T his very la rg e
d e p e n d e n t on the
th is
g e n e ra lly observed.
preponderance
degree of lo u s in e s s
in fe s ta tio n is
women.
i s a much h e a v i e r p e r c e n t a g e
o f m ales i s n o t
o f t h e two s e x e s ,
for
s h a r e d i n e i y u a l m e a s u r e b y b o t h men a n d
I n d e e d , women a r e o f t e n m o r e h e a v i l y i n f e c t e d w i t h
head l i c e
t h a n men o w i n g t o t h e h a b i t o f s h a v i n g t h e s c a l p
a l m o s t u n i v e r s a l am ong t h e l a t t e r , w h i l e e l a b o r a t e
co iffu res
lies
are
i n the
f a v o u r e d b y t h e women.
fact
e x c l u s i v e l y to
th a t the
people
there
It
ex p lan atio n
i n f e c t e d m ales b e lo n g most
im m igrant t r i b e s
f r o m t h e W e s t , who h a d come
o r i g i n a l l y to A b y ssin ia and E r i t r e a
money.
The t r u e
i s c o n t r a r y to th e
in search
o f work and
t r a d i t i o n s and h a b i t s
of these
t o b r i n g t h e i r w o m en -fo lx w i t h them , e s p e c i a l l y i f
i s a n y q u e s t i o n o f p r o c e e d i n g f u r t h e r on th e
p ilgrim age
to M ecca.
AGE.
As t h e m a j o r i t y o f c a s e s
im m ig ra n t m a le s from th e W e s t, i t
o c c u r am ong
f o l l o w s t h a t most
o f the
-9 0 -
c a s e s w i l l be a d u l t s ,
E ritre a
sin ce
the
jo u rn ey a cro ss A fric a
a n d A b y s s i n i a i s n o t a t h i n g t o be u n d e r t a k e n
l i g h t l y by o t h e r t h a n h e a l t h y a d u l t s .
15 -
to
55 y e a r s , b u t
The a g e v a r i e d
from
the g r e a t e r p r o p o r t i o n o f c a s e s
observed f e l l in to
the
20 - 3 5 a g e g r o u p .
Ages w ere
a s s e s s e d a p p r o x i m a t e l y on t h e p h y s i c a l a p p e a r a n c e
o f the
p atien ts.
RACE.
SELWYN CLARICE, LS FAUN a n d INGRAM ( 1 9 2 3 )
r e c o r d e d t h a t 80 p e r c e n t ,
were n a t i v e s
o f t h e i r c a s e s i n West A f r i c a
o f on e p a r t i c u l a r t r i b e ,
s i m i l a r pronounced r a c i a l in c id e n c e
S u d a n w h e r e o v e r 90 p e r c e n t ,
t h e s e r a c e s w hich a r e
term o f
th e Zabram ah.
i s o b serv ed i n the
of the
in fectio n s
grouped to g e th e r under th e
’W e s t e r n e r s ' .
of the
S u d an , and h a s b e e n so e v e r s i n c e
the
racial
V arious f a c to r s
incidence
in
occur in
co llectiv e
T h i s may be d e s c r i b e d a s t h e
p rin c ip a l ep idem iological fe a tu re
D arfur.
A
in stan ce.
th e s e p e o p le b e in g im m ig ran ts from th e
w ould n a t u r a l l y be t h e
first
to
in fected ,
and t r a d i t i o n s ,
in the
1926 e p id e m ic in v a d e d
combine t o p ro d u c e t h i s
the p r e s e n t
th e ir h ab its
disease
strik in g
To b e g i n w i t h ,
in fected co u n tries,
co n tract
the
d isease.
Once
to g e th e r w ith the
c o n d i t i o n s u n d e r w hich th e y have been l i v i n g , w ould e n s u r e
a re a d y sp re a d o f the d is e a s e .
Owing t o t h e s c a r c i t y
d istric ts
of v/ater i n
e x c e p t d u rin g th e wet s e a s o n ,
wash f r e q u e n t l y .
t h e i r home
t h e s e p e o p l e do n o t
T heir standard o f personal c le a n lin e s s
is
much b e l o w t h a t o f t h e r i v e r a i n p e o p l e s o f t h e S u d a n who
h a v e more f r e q u e n t o p p o r t u n i t i e s
th e w hole,
su b ject
fco a much l e s s h e a v y l o u s e
In re s p e c t
these
o f w a s h i n g a n d who a r e ,
in festatio n .
to p h y s ic a l c o n d itio n s th e p l i g h t
i m m i g r a n t s was l i t t l e
d ifferen t
on
from t h a t
of
of re fu g e e s ,
-9 1 -
They w ere d i r t y ,
t i r e d and h a ra s s e d .
T h e i r homes were
in
a n o t h e r land-, a n d t h e y p o s s e s s e d no h o u s e p r o p e r t y o r
r e l a t i v e s w ith s a t i s f a c t o r y l i v i n g accom m odation i n th e
d istric ts
th e y p assed thro u g h .
p ro b ab ly had to liv e
F o r m onths t h e y h a d
on a v e r y
inadequate
d iet:
c o n s ta n t co m p lain t a g a in s t the
co n d itio n s
th ey had s u ffe re d
was
’e l a k l w is h a n ’ SEASON.
the
fo o d was f i l t h .
In th e Sudan a d e f i n i t e
be o b s e r v e d i n t h e i n c i d e n c e
p revalence
the r a i n s .
i.e .
d u r i n g th e h o t hum id
A s im ila r tendency to sea so n al
o f re la p s in g fe v e r has been observed in In d ia
(G IL L, 1 9 2 2 , CRAGG, 1 9 2 2 ) w h e r e i t
h o t hum id w e a t h e r :
where
te n d e n c y can
o f r e l a p s i n g f e v e r to r i s e
a b r u p tly in A ugust and S eptem ber,
w eather a f t e r
th e most
in A lg eria
(SARGENT a n d FOLEY, 1 9 2 2 )
i t has been c o r r e l a t e d w ith
in A byssinia
has been c o r r e l a t e d w ith
th e c o ld w i n t e r m onths:
(3IIUNS, 1 9 3 7 ) w h e r e i t
rain s:
and in o th e r c o u n trie s .
p o in ts
out th a t
the
seem s to d e p e n d on th e
In C hina,
sea so n al incidence
is lia b le
masked o r d i s t u r b e d by e p id e m ic s , and th e
the Sudan.
F i g . 8 shows g r a p h i c a l l y
(SHRBSPTON, 1 9 3 6 )
be
same o c c u r s i n
the r e l a t i o n betw een
r e l a p s i n g f e v e r an d r a i n f a l l i n th e Blue N ile
th e S udan where t h e m ost a c c u r a t e
to
fig u res are
province
of
o b tain ab le,
I t s h o u l d be r e a d i n c o n j u n c t i o n w i t h F i g . 9 w h i c h s h o w s t h e
r e l a t i o n to
the in c id e n c e
of m alarial
fever.
CRAGG ( 1 9 2 2 ) h a s d r a w n a t t e n t i o n
v ariatio n s
probable
to th e e f f e c t
i n t e m p e r a t u r e a n d h u m i d i t y on l i c e ,
that
and i t
of
is
i n I n d i a , and o t h e r p l a c e s where th e d i s e a s e
i s e n d e m i c t h i s may be o n e o f t h e m o s t i m p o r t a n t f a c t o r s
in flu encing i t s
prev alen ce.
I n the
Sudan, how ever,
th ere
a n o t h e r f a c t o r to be c o n s i d e r e d a s w e l l a s m e t e o r o l o g i c a l
v ariatio n s,
v is,
e q u al im p o rtan ce.
im m igration.
It
is probably of a t le a s t
is
-9 2 -
It
o f the
h a s a l r e a d y b e e n d e s c r i b e d how t h e r i p e n i n g
co tto n crop,
b r i n g i n g a n a n n u a l demand f o r l a b o u r e r ^
w i l l cause an im m igration o f W este rn e rs.
h a rv e s t ta k e s place
larg est
in flu x
The a c t u a l
i n N o v e m b e r a n d Dece mbe r*, a n d t h e
occurs th e n .
D u rin g Septem ber and O c to b er,
work b e g in s on a s m a l l e r s c a l e
w ith v a r io u s m inor w eed in g ,
' h i s h i n g 1 and cleaning- o p e r a t i o n s , an d a t t h i s
is
a sm aller p relim inary
c o r r e l a t i o n betw een th e
in flu x
o f W esterners.
tim e th e re
T his
close
s e a s o n a l movements o f im m ig ra n t
la b o u r e r s and the s e a s o n a l in c id e n c e
of relap sin g fever,
in our opinion,
th an any d ir e c t
o f more s i g n i f i c a n c e
is,
r e l a t i o n w ith m eteo ro lo g ical v a r ia tio n s .
RELATION TO OTHER DISEASES.
MALARIA.
incidence
in
The d i a g r a m i n F i g .
9 shows t h e
seasonal
o f r e l a p s i n g f e v e r compared w i t h t h a t o f m a l a r i a
the B lue N ile p r o v i n c e .
is a fa irly
close
axiom atic th a t
I t w i l l be o b s e r v e d t h a t t h e r e
correspondence.
the
It
seaso n al incidence
N o rth e rn Sudan i s d e te rm in e d by th e
is
p ractically
o f m a la r ia i n the
d i s t r i b u t i o n of the
rain s
th ro u g h o u t the y e a r .
TYPHUS.
a t t e n t i o n to th e
SERGENT a n d FOLEY ( 1 9 2 2 ) h a v e d r a w n
c lo s e a s s o c i a t i o n betw een e p id em ics o f
lo u s e -b o rn e r e l a p s i n g f e v e r and lo u s e -b o rn e
A l g e r i a w h e r e t h e two d i s e a s e s h a v e t h e
p rev alen ce,
t h e same g e n e r a l c o u r s e ,
typhus in
same s e a s o n a l
a n d com monly f o l l o w e a c h
o th e r or c o in cid e.
No s i m i l a r a s s o c i a t i o n o c c u r s i n t h e S u d a n .
o fte n a m atter of su rp rise
that c lin ic a l
It
is
typhus has n e v e r
b e e n r e p o r t e d i n t h e S u d a n , a l t h o u g h from tim e
to tim e v a rio u s
-9 3 -
s u s p ic io u s c ase s o f f e v e r have been n o te d .
real
There i s
c l i n i c a l e v id e n c e t h a t any o f t h e s e have
in fectio n s,
and th e
few s e r a w h ich i t
no
been R ic h e tts ia
has been p o ssib le
to
o b t a i n from s a c h c a s e s have b e e n n e g a t i v e .
In o r d e r to
determ ine w hether t h i s
r e a l o r m erely
absence o f typhus
is
a p p a r e n t , amd d u r i n g 19-37 a s u r v e y w a s c a r r i e d o u t o n a
larg e
n u m b er o f human s e r a a n d a l s o
on t h e s e r a o f w i l d
rats.
Human s e r a w e r e o b t a i n e d f r o m a l l p a r t s
Sudan.
A few w ere fro m s u s p i c i o u s c a s e s o f f e v e r ,
were t h e r o u t i n e
sera
f o r Kahn r e a c t i o n ,
some w e r e
of the
some
sera
s e n t i n f o r th e ffid al r e a c t i o n w hich had been n e g a t i v e
the e n t e r i c
group,
o t h e r s were s p e c i a l l y c o l l e c t e d
o f t h e way d i s t r i c t s
Rat s e r a
(R. r a t t u s ,
from th e
in out
o f the Sudan.
were o b t a i n e d t h r o u g h th e
a u th o rities
for
R . a l e x a n d r i n u s , R. n o r v e g i c u s )
c o l l a b o r a t i o n o f the S a n ita r y
la rg e r cen tres
o f po p u latio n in
the
N o rth e rn Sudan.
T h r e e s u s p e n s i o n s o f P r o t e u s w ere u s e d 0X19,
0X2
a n d OXK, o f w h i c h 0X19 a n d 0X2 w e r e a l c o h o l i s e d a g a r c u l t u r e s
a n d OXK a f o r m o l i s e d b r o t h c u l t u r e ,
as fo r
some u n k n o w n
reaso n a l l a lc o h o lic suspensions o f ag ar c u ltu re s
from t h i s
prepared
s t r a i n s h o w e d some s p o n t a n e o u s a g g l u t i n a t i o n .
The r e s u l t s
i n 1 , 0 0 0 huma n s e r a ,
a n d 240 r a t s e r a
were a s f o l l o w s : S train
Human
1
1
1
1
1
1
- 12.5
25
50
125
250
500
98
5
1
0
0
1
OXK
Rats
63
1
0
0
0
-
0X2
0X19
Human
Rats
Human
R ats
4
0
0
0
1
0
3
1
0
0
0
3
0
0
0
0
0
2
0
0
0
0
—
-9 4 -
The r e s u l t s
com plete ab sen ce
are
cut and in d ic a te
of ag g lu tin atio n
i n the m a j o r i t y o f s e r a ,
1 -
clear
w hile
if
(less
p o sitiv e.
showed any s i g n i f i c a n t
OXK.
The f o r m e r c a s e
serum was s e n t
th an 1 - 1 2.5)
t h e more u s u a l d i l u t i o n
25 i s t a k e n a s t h e m i n i m a l t i t r e
o f t h e human s e r a a r e
the
only 0 .8 per c e n t,
O n ly two o f t h e
sera
t i t r e s . * — 1 - 2 5 0 0X2 a n d 1 - 5 0 0
c o u l d n o t be t r a c e d :
in fo r ro u tin e
Kahn t e s t
o f th e m a n 's p r e v i o u s h i s t o r y f a i l e d
the
la tte r
and i n q u i r i e s
to e l i c i t
an y th in g .
Of the r a t s e r a none showed a g g l u t i n a t i o n i n a n y s i g n i f i c a n t
titre
(1-50)
were p o s i t i v e
and in d ilu t i o n s
o f 1 - 2 5 o r o v e r o n l y two
(0 ,8 p e r c e n t) .
The s e r o l o g i c a l r e s u l t s
s e r a thus appear to
f r o m b o t h h um a n a n d r a t
co n firm the e x p e rie n c e
w ith r e g a rd to th e absence o f typhus
PLAGUE.
Like ty p h u s ,
been r e p o r t e d c l i n i c a l l y
p o in te d out the
in v erse
th is
o f the
fe v e r in th e Sudan.
d isease has never
in the Sudan.
GRAGG ( 1 9 2 2 ) h a s
seaso n al prevalence
of plague
r e l a p s i n g fe v e r i n the U n ited P ro v in c e s of I n d i a .
i n v e r s e r e l a t i o n s h i p h e was a b l e
to
th a n an ab n o rm ally h ig h peak in th e
clin ician s
deduce,
and
From t h i s
in re tro s p e c t,
'd e a t h s from fev er*
c u r v e was du e t o a n u n r e c o g n i s e d e p i d e m i c o f r e l a p s i n g f e v e r .
A glance a t the
s how t h e
m onthly m a la r ia in c id e n ce graph
f a l l a c y o f draw ing such c o n c lu s io n s
( F i g . 9) w i l l
in th e Sudan.
NICOLLE a n d ANDERSON ( 1 9 2 7 ) h a v e s u g g e s t e d t h a t
the r e la p s in g fe v e rs o r ig in a te d as in f e c tio n s
It
of sm all ro d en ts.
i s a v e r y s t r i k i n g e p i d e m i o l o g i c a l c o i n c i d e n c e , a n d one
w h i c h h a s i n t e r e s t e d t h e w r i t e r f o r some t i m e ,
o f the p r i n c i p a l i n f e c t i o n s
that
of rodents tra n sm issib le
a r e unknown i n N o r t h e r n S u d a n .
three
t o man
R e f e r e n c e h a s b e e n made a b o v e
-9 5 -
to p lag u e and ty p h u s , and the
elsew here
present w riter
drawn a t t e n t i o n to th e
(1938) h a s
a p p aren t absence
of
lep to sp iro sis.
CLINICAL FEATURES AND COURSE OF THE DISEASE.
The f o l l o w i n g b r i e f s u m m a r y o f t h e m a i n c l i n i c a l
featu res
o f the d is e a s e ,
and t h e i r approxim ate
frequency
i s b a s e d o n 62 c a s e s o b s e r v e d b y t h e w r i t e r .
F e v e r was a n i n v a r i a b l e
fe a tu re , u su ally of
sudden o n s e t, and f r e q u e n tly s e v e r e : te m p e ra tu re s
a n d 1 0 6 ° F . w e r e n o t u n c om m on ,
T h i s f e v e r was a c c o m p a n ie d
b y s e v e r e h e a d a c h e i n 83 p e r c e n t ,
c e r t a i n number o f th e
unaware o f
o f 105°
of cases,
re m a in d er the p a t i e n t s
but in a
seemed q u i t e
th eir fever.
Enlargem ent of th e
spleen,
u s u a l l y accom panied
by p a i n i n t h e l e f t h y p o e h o n d r iu m , was a v e r y c h a r a c t e r i s t i c
s ym pto m a n d o c c u r r e d i n 8 3 p e r c e n t ,
e n l a r g e m e n t was o f m o d e r a t e d e g r e e
below th e
orig in .
of cases.
( 2 - 3
The
fin g ers'
breadth
c o s t a l m argin) and f r e q u e n t l y o f f a i r l y r a p i d
I t u s u a lly su b sid e d r a p i d l y a f t e r the
c o n t r o l l e d by n o v a r s e n o b i l l o n .
Numbers o f t h e s e
had en larg ed sp leen s
due t o
fe v e r - old m a la r ia ,
b ilh a rz ia , etc.
e n l a r g e m e n t s were a s a r u l e
- but th ese
ch ro n ic and p a in le s s .
of cases.
freq u en t.
It
The d e g r e e o f
e n l a r g e m e n t was u s u a l l y a b o u t tw o f i n g e r s '
th e c o s t a l m a rg in and s l i g h t
im m igrants
causes o th er th an re la p s in g
E n l a r g e m e n t o f t h e l i v e r was l e s s
was o b s e r v e d i n 60 p e r c e n t ,
f e v e r was
b re a d th beneath
t e n d e r n e s s was t h e r u l e .
J a u n d i c e w a s uncommon, b e i n g p r o n o u n c e d i n o n l y
10 p e r c e n t ,
of cases.
As t h e p a t i e n t s w e r e b l a c k - s k i n n e d ,
-9 6 -
the
only v i s i b l e
o f the e y e b a l l s .
evidence
o f the
V arious d eg rees o f s u b i c t e r i c
were f r e q u e n t l y met w i t h ,
but i t
how ma ny o f t h e s e w e r e d u e t o
resu lt
j a u n d i c e was y e l l o w n e s s
w ould
be d i f f i c u l t
j a u n d i c e a n d how
ma ny w e r e t h e
in c lu d e d i n the
given.
E v e n when j a u n d i c e was p r e s e n t t h e
rap id .
to say
o f m ild degrees o f x ero p h th alm ia and o th e r c o n d itio n s ,
so o n ly c a s e s o f w e ll-m a rk e d ja u n d ic e are
figure
d isco lo u ratio n
V om iting o c c u r re d i n l e s s
The a p p e t i t e
p u l s e was a l w a y s
t h a n 10 p e r c e n t ,
and c o n d i t i o n o f the ton g u e
of cases.
v aried co n sid erab ly .
E p i s t a x i s was a f r e q u e n t sy m p to m a n d o c c u r r e d i n
50 p e r c e n t ,
of cases.
seen in fiv e
cases.
com plained o f ,
A l b u m i n u r i a was r a r e ,
P ain in the
and a s l i g h t
p r e s e n t i n most o f the
b e in g only
j o i n t s was o c c a s i o n a l l y
g e n e r a l i s e d a d e n i t i s s e e m e d t o be
c a s e s exam ined.
S k in r a s h e s were n e v e r
w ith m e n in g e a l symptoms.
No e y e
seen, n e ith e r
were c a s e s
c o m p l i c a t i o n s w e re
o b s e r v e d , b u t i n a fe w c a s e s w h i c h t h e w r i t e r d i d n o t s e e
p erso n ally i r i t i s
is
s a id to have o c c u rre d .
This
c o m p l i c a t i o n was f r e q u e n t i n t h e e p i d e m i c d e s c r i b e d b y
DRAKE-3R0CKMANN ( 1 5 1 3 ) i n B r i t i s h S o m a l i l a n d , a n d i s
s a id to
have b e en t r a n s m i t t e d by O r n i t h o d o r u s s a v i g n y i .
The c o m m o n e s t a n d m o s t t y p i c a l i j i c t u r e o f t h e
d i s e a s e a s s e e n b y t h e w r i t e r ma y be summed u p i n t h e
c a rd in a l sign s - fe v e r,
three
e p is ta x is and p a in fu l sp le n ic
enlargem ent.
The o n l y c e r t a i n d i a g n o s i s w a s made b y f i n d i n g t h e
s p ir o c h a e te s in the p e r ip h e r a l b lo o d .
The i n f e c t i o n was o f
m oderate s e v e r i t y , a n d , a lth o u g h s e v e r a l f i e l d s had som etim es
t o be e x a m i n e d b e f o r e t h e
n e v e r any r e a l d i f f i c u l t y .
s p i r o c h a e t e s were f o u n d ,
th ere
was
They w ere fo u n d o n l y d u r i n g th e
-9 7 -
p y rex ial stages
o f the
d isease.
The a p y r e x i a l p e r i o d ,
v a r i e d f r o m f o u r up t o
p atien ts
after
the
f i r s t relap se,
f o u r t e e n d a y s , d u r i n g w h ich tim e
f e l t rem arkably f i t ,
the
a n d s p i r o c h a e t e s w ere n e v e r
found i n th e b lo o d .
The o c c u r r e n c e
the
organism s in
of health y c a r r ie r s ,
the b lo o d , as in th e D a rfu r ep id em ic of
1 9 2 6 , was n o t a f e a t u r e
o f the
a t t e n t i o n was d i r e c t e d t o
as a p o ssib le
the
it
harb o u rin g
facto r
th is
in the
1937 d i s e a s e .
P articu lar
on a c c o u n t o f i t s
im portance
sp read o f the d is e a s e .
W ith
c o - o p e r a t i o n o f th e M e d ic a l O f f i c e r o f H e a l t h , K hartoum ,
was p o s s i b l e
to
o b ta in blood s l i d e s
from a l l
w i t h c a s e s o b s e r v e d i n K hartoum d u r i n g th e
und erg o in g the p ro c e ss o f d e lo u s in g .'
tim e
contacts
t h e s e were
Among o v e r 3 0 0
c o n t a c t s w h o s e b l o o d was e x a m i n e d t h e o n l y p o s i t i v e was
found i n a boy, o b v io u s ly ja u n d i c e d ,
o f 101°F.
and w ith a te m p e ratu re
S m a lle r b a tc h e s o f c o n t a c t s exam ined a t G edaref
a n d S e n n a r were a l l n e g a t i v e .
Ho c a s e s w e r e s e e n w h i c h h a d mo re t h a n on e r e l a p s e .
T h i s c a n n o t be t a k e n a s th e n o rm a l c o u r s e
o f the
a s i n no c a s e w a s t h e d i s e a s e a l l o w e d t o r u n i t s
course.
The d i a g n o s i s o f r e l a p s i n g f e v e r ,
d isease,
n atu ral
confirm ed under
t h e m i c r o s c o p e , was a lw a y s a n i n d i c a t i o n f o r t r e a t m e n t a t
the e a r l i e s t
possible
The b l o o d .
m o m e n t.
The p r e s e n c e
o f a polym orphonuclear
l e u c o c y t o s i s was a p r o m i n e n t f e a t u r e
exam ined.
blood s l i d e s
T o t a l b l o o d c o u n t s were n o t c a r r i e d o u t , b u t
d ifferen tial
average
in a l l the
counts gave the
f o l l o w i n g p r o p o r t i o n s a s an
o f t h i r t y blood f il m s :P o l y m o r p h s ...................................... 70
Lym phocytes
19
L a r g e m o n o n u c l e a r s .................... 6
E o s i n o p h i l s . . . . . . .................... . 5
per
per
per
per
cent.
cent.
cent.
cent.
-9 8 -
In th e Sudan, a s compared w ith te m p e ra te
co u n tries,
is
a relativ e
the r u l e ,
in crease
i n the n o n -g r a n u la r c e l l s
even in a p p a re n tly h e a lth y in d iv id u a ls ,
s h o u l d be r e g a r d e d a s n o r m a l b o t h i n n a t i v e s
E u r o p e a n s who h a v e
and i n
s p e n t any l e n g t h o f tim e i n th e c o u n t r y .
T his c o n c lu s io n has been re a c h e d a s the r e s u l t
co n sid erab le ex perience
of
in the e x am in a tio n o f olood in
t h e S u d a n , a n d no e x p l a n a t i o n i s
put forw ard to account fo r
the a l t e r a t i o n .
In the p r e s e n t in s t a n c e
th a t th e average
d i f f e r e n t i a l c o u n t we h a v e q u o t e d
rep resen ts a g re a te r re la tiv e
than is
and
a p p a r e n t when i t
in crease
it
sig n ifies
in the
i s compared w ith t h e
g e n e r a lly a c c e p te d as norm al i n c o ld e r
polym orphs
standards
clim ates.
RIDING a n d MACDOWELL ( 1 9 2 7 ) a n d o t h e r o b s e r v e r s
have s t a t e d
t h a t when th e
d isea se has been p re s e n t
some t i m e t h e g r a n u l a r c e l l s be co m e r e l a t i v e l y
less
pro m in en t and the p o ly m o rp h o n u clear le u c o c y te s i s
succeeded by a ly m p h o cy to sis.
for
is
T h i s was n o t s e e n i n any
case exam ined by the w r i t e r ,
p ro b a b ly because the
was n e v e r a l l o w e d to p e r s i s t
lo n g enough to
in fectio n
reach th is
stag e.
F i f t e e n c a s e s w i t h no h i s t o r y
o f s y p h ilis had t h e i r
w h ic h was p o s i t i v e
or c lin ic a l
signs
s e r a t e s t e d b y t h e Kahn r e a c t i o n ,
in fo u r only,
i s n o t alw ays a f a l l a c y f o r t h i s
so t h a t r e l a p s i n g
te st.
fever
O ther o b s e r v e r s
r e c o r d v a r i o u s f i n d i n g s w ith b lo o d s p i r o c h a e t o s i s and the
serum t e s t s
(1935),
for sy p h ilis.
FAIRLEY, c i t e d b y MANS ON BAHR
f o u n d t h a t 25 p e r c e n t ,
of cases of re la p sin g fever
gave a p o s i t i v e Wasserraan r e a c t i o n .
p o s i t i v e W a s s e r m a n s i n 18 c a s e s ,
tra n sie n t p o sitiv e
ROAF ( 1 9 2 2 ) f o u n d 11
and c o n c lu d e d t h a t a
r e a c t i o n was t h e r u l e
d u rin g the
acute
-9 9 -
stag es,
CHU, DEITRICK a n d CHUNG ( 1 9 3 1 ) o b t a i n e d n e g a t i v e
W a s s e r m a n s i n 25 o u t o f 26 o a s e s .
Kahn a lw a y s n e g a t i v e ,
lu e tic
cases,
p o sitiv e
PAI (1937) fo u n d t h a t
a l t h o u g h 5 o u t o f 13 f e b r i l e
a n d 1 o u t o f 15 a f e b r i l e
non-
ones gave a
vVasserman.
T reatm ent.
N ovarsenobillon,
intrav eno usly,
was t h e o n l y re m e d y u s e d a n d was f o u n d e f f e c t i v e , a l t h o u g h
i n w eaxly o r very to x ic
in d iv id u als
u ndoubtedly d an g ero u s.
The l a r g e r
w ere
later
t h e d r u g was
doses used a t
d isc a rd e d in favour o f sm a ller doses
first
(0 .3 -
0 .4 5 g m . ) , w i t h a view to d i m i n i s h i n g th e r i s k o f t o x i c
effects.
T h e s e s m a l l e r d o s e s a p p e a r e d t o be a s e f f e c t i v e
th e ra p e u tic a lly as
s u ffic ie n t to
the l a r g e r o n e s .
c a u s e d i s a p p e a r a n c e o f th e s p i r o c h a e t e s from
th e b l o o d w i t h i n 43 h o u r s
blood f i l m s ) ,
One d o s e was u s u a l l y
(as o b serv ed in f o u r - h o u r ly
and to reduce
the tem p eratu re
to n o rm a l.
S u t one dose d i d n o t a lw a y s p r e v e n t r e l a p s e .
It
is stated
i n the t e x t books t h a t th e a d m i n i s t r a t i o n o f t h i s
drug
s h o u l d be a v o i d e d j u s t
often is
before
the c r i s i s , . a s
th is
fo llo w e d by a r e l a p s e .
C lin ically i t
t e l l w he n t h e
i m m i n e n t , a n d t h i s may oe t h e
crisis
e x p la n a tio n i n the
a t t e n t i o n to
is
i s by no means e a s y to
few c a s e s w h i c h d i d r e l a p s e .
C areful
th e d i e t i s n e c e s s a r y , p a r t i c u l a r l y i n the
p erio d of reco v ery a f t e r s p e c if ic treatm en t w ith
no v arsen o b illo n .
The a p p e t i t e
a n d i t may be d i f f i c u l t
i s o fte n extrem ely voracious
to p re v e n t the p a t i e n t s g r o s s ly
ov ertax in g t h e i r d ig e stiv e
pow ers.
I t was o u r i m p r e s s i o n t h a t t h e a d m i n i s t r a t i o n o f
novarsenobillon in d e b ilita te d ,
very to x ic ,
p atien ts
the f a t a l i s s u e .
freq u en tly a c c e le ra te s
o r m oribund
But t h i s
i s no i n d i c a t i o n to w i t h h o l d th e d r u g , a s such p e r s o n s w i l l
-1 0 0 -
c ertain ly
die
esp ecially ,
if
l e f t w ithout tre a tm e n t.
In th e se
th e re d u c e d d o ses o f the drug a re to
eases
be
recom m ended, r e p e a t e d i f n e c e s s a r y , an d acco m p an ied by
the a d m i n i s t r a t i o n o f glucose
o f soda
and in tr a v e n o u s th i o s u l p h a t e
( 0 . 6 grn.).
I t may b e r e c a l l e d t h a t i n t h e G e z i r a ,
during
1930 - 19 3 1 , Grey O i l ,
a m ercurial p re p a ra tio n ,
effectiv e
(ATKEY, 1 9 3 2 ) a n d i n T a n g a n y i k a
in treatm ent
was f o u n d
m e r c u r o c h r o m e , i n t r a v e o u s l y , i s r e c o m m e n d e d (MANSON-BAHR) ,
(1935).
Our e x p e r i e n c e was r e s t r i c t e d t o t h e a r s e n i c a l s .
MORTALITY.
The m o r t a l i t y i n t h e
cases observed in Y assala
a nd t h e B l u e N i l e p r o v i n c e s w a s 9 p e r c e n t .
w i t h a m o r t a l i t y o f 12 p e r c e n t ,
G ezira, and a m o rta lity
D arfur.
six ty
It
i n 1930 - 1931 i n the
o f 70 p e r c e n t ,
is notew orthy th a t
T his compares
i n 19 26 - 1927 i n
in a sm all outbreak o f
c a s e s w h i c h o c c u r r e d i n K u t t u m i n N o v e m b e r , 19 37 t h e
m o r t a l i t y was 30 p e r c e n t .
A s i m i l a r d i s c r e p a n c y was n o t e d
i n 1930 - 1931 b e tw e e n c a s e s i n D a r f u r , w here th e
m o r t a l i t y was 40 p e r c e n t ,
It
is
d ifficu lt
and those i n the G e z ira .
t o e x p l a i n t h i s d i s c r e p a n c y on
th e grounds of r a c i a l
or d i e t e t i c d i f f e r e n c e s
provinces
It
concerned.
is
t h e same r a c e s w h i c h a r e a f f e c t e d ,
a n d a c c o r d i n g t o t h e i r own a c c o u n t t h e
on, a t
least
w ith t h a t
in
in the
th eir
Italian
in the
co lo n ies,
fo o d t h e y h ad to l i v e
compared u n fa v o u ra b ly
own c o u n t r i e s i n t h e
We s t .
I t may be s u g g e s t e d t h a t t h e d i f f e r e n c e
m o rtality
in
i s d u e t o t h e way i n w h i c h m e d i c a l a t t e n t i o n i s
h in d e r e d by t r a n s p o r t d i f f i c u l t i e s
in a ru r a l area lik e
D a r f u r a s com pared v/ith the h i g h l y o r g a n is e d G e z ir a and
the p la c e s n e a r th e
railw ay lin e .
P robably, th e re fo re ,
mu ch n e a r e r w h a t t h e
figure
the D a rfu r m o r t a l i t y is
f o r the u n t r e a t e d d is e a s e
w ould b e , a n d s u g g e s t s t h a t i n th e a b se n c e o f p r o p e r
m e d ic a l and s a n i t a r y m easures t h i s
r e p e a t the havoc o f p revious
d is e a s e m ight very w e ll
years.
PATHOLOGY.
Among p r i m i t i v e
peo p les,
s u c h a s we h a d t o
deal w ith ,
post-m ortem ex am in atio n s a r e v i o l e n t l y
resen ted .
M u t i l a t i o n o f th e dead i s anathem a t o
the
Mohammedan, i n a n y s h a p e o r f o r m , a s t h e m u t i l a t i o n g o e s
w ith the
d e a d man t o p a r a d i s e .
relig io u s
secure
because
b eliefs
On a c c o u n t o f t h e f a n a t i c a l
o f the p eo p les
concern ed , a tte m p ts to
p o s t - m o r t e m s w e r e t o be d e p r e c a t e d - p r i n c i p a l l y
the t r u s t and co n fid en ce
o f th e people them selves
were so e s s e n t i a l t o t h e s u c c e s s o f a n y scheme t o r e s t r i c t
th e s p re a d o f the
disease.
The s l i g h t e s t s u g g e s t i o n o f
t e r r o r o r b l a c k m agic a s s o c i a t e d w i t h th e h o s p i t a l s and
quarantine
p o s t s w ould have a r o u s e d su ch f e a r an d d i s t r u s t
i n t h e m inds o f th e p e o p le t h a t t h e s e
have been a v o id ed a l t o g e t h e r .
the
t a s k of c o l l e c t i n g the
i n s t i t u t i o n s would
Under t h e s e
circum stances
im m igrants to g e th e r and
i n d u c i n g them t o s u b m it t o d e l o u s i n g e t c .
would have been
w e ll n igh im p o ssib le.
P rin c ip a lly for
m a t e r i a l was s c a n t y .
these reason s p a th o lo g ic a l
We w e r e f o r t u n a t e h o w e v e r i n
o b t a i n i n g a c o m p l e t e p o s t - m o r t e m o f on e c a s e , a n d s e c t i o n s
from t h e l i v e r and s p l e e n o f a n o t h e r .
-1 0 2 -
The f o r m e r d i e d o f l o b a r p n e u m o n i a ,
the r e l a p s i n g
fever.
com plicating
T h i s pneum onia was n o t o f s p i r o c h a e t a l
o rig in ,
b u t was a s s o c i a t e d w i t h th e pneumococcus i n th e
alv eo li
in larg e
numbers.
A p a rt from th e lu n g s , th e o n ly o t h e r o rg a n to
show a n y d e p a r t u r e
sp leen .
f r o m n o r m a l m a c r o s c o p i c a l l y was t h e
T h i s was e n l a r g e d a n d c o n g e s t e d a n d num erous s m a l l
in farctio n s
c o u l d be s e e n o n t h e o u t e r s u r f a c e
y ellow ish a re as
as
o f ir r e g u la r shape.
P a r a f f i n s e c tio n s o f the l i v e r
showed a t i s s u e
in both cases
t h a t was s u b s t a n t i a l l y n o r m a l .
S e c t i o n s o f t h e k i d n e y s showed e x t e n s i v e
s w e llin g and c a t a r r h a l changes in the tu b u le
cloudy
cells,
am ounting i n p l a c e s to a c t u a l n e c r o s i s o f c e l l s .
In the
c a s e o f t h e s p l e e n , RUSSELL ( 1 9 3 2 ) h a s
d e sc rib e d a c h a r a c t e r i s t i c p a th o lo g ic a l le s io n in
r e l a p s i n g f e v e r - a p e r i p h e r a l n e c r o s i s a f f e c t i n g the
o u ter la y e rs
of cells
in th e m alphighian c o rp u sc le ,
a s s o c ia te d w ith the presen ce
The i l l u s t r a t i o n s
clearly .
o f s p i r o c h a e t e s i n the
in h e r paper d e p ic t t h i s l e s i o n very
RUSSELL c l a i m s t h a t t h i s
ch aracteristic
lesio n is
su fficien tly
o f r e l a p s i n g fe v e r to en ab le a post-m ortem
d i a g n o s i s t o be made f r o m t h e h i s t o l o g y o f t h e
In the
o f the
n ecro sis.
i n the r e g i o n o f th e
C lear-cut ty p ic a l m ilia ry lesio n s
t y p e p i c t u r e d b y RUSSELL w e r e n o t s e e n .
sectio n s
spleen.
two s p l e e n s w h i c h we e x a m i n e d t h e p r i n c i p a l
c h a n g e s were c o n g e s t i o n a n d ,
in farctio n s,
cells.
In the s p l e e n
from t h e c a s e w h ich d i e d o f pneumonia t h e r e c o u ld
o c c a s i o n a l l y b e made o u t a l e s i o n o f t h e
ty p e shown i n
F i g . 19 i n w h i c h t h e m a l p h i g h i a n c o r p u s c l e was much r e d u c e d
i n s i z e , and su rro u n d e d by a l a y e r o f n e c r o s i s and c e l l u l a r
-1 0 3 -
in filtra tio n .
There
c a n be l i t t l e
doubt t h a t th e se
c o r r e s p o n d w i t h t h e m i l i a r y l e s i o n s o f RU SS E LL ,b ut t h e y
w ere much l e s s
c l e a r l y d e f i n e d , a n d i n t h e s e c t i o n s we
e x a m i n e d t h e y w e r e much l e s s f r e q u e n t t h a n t h e f i g u r e s
of th is au th o r.
It
i s d o u b tfu l i f the d is c o v e ry o f such
a l e s i o n a s t h a t shown i n t h e p h o t o g r a p h i n a s p l e e n
s e c t i o n , m o s t o f w h i c h r e s e m b l e d F i g . 18 w o u l d w a r r a n t a
p a th o lo g ic a l diag n o sis of re la p sin g fe v e r,
e s p e c i a l l y as
s p i r o c h a e t e s were n o t s e e n e v e n when t h e s e c t i o n s were
s t a i n e d by L e v a d i t i ' s m ethod.
In the
e x p erim en tal anim als s i n g u l a r l y l i t t l e
c h a n g e c o u l d b e made o u t i n t h e o r g a n s , a l t h o u g h
c l i n i c a l l y enlargem ent
of-the
l i v e r a n d s p l e e n oelow th e
c o s t a l m a r g i n c o u l d be d e t e c t e d .
A ll the organs of
Monkey R . ( 4 ) w h i c h d i e d o f e x p e r i m e n t a l r e l a p s i n g f e v e r ,
and a l l th e
o r g a n s o f a mo us e w h i c h was b l e d t o d e a t h
a t t h e h e i g h t o f th e i n f e c t i o n were e x am in ed m i c r o s c o p i c a l l y
by sm ears an d s e c t i o n s .
The o n l y o r g a n i n w h i c h a n y
a p p r e c i a b l e h i s t o p a t h o l o g i c a l c h a n g e s c o u l d be s e e n was t h e
liv er
o f t h i s m ouse, w h ich showed a m i l d d e g re e o f
g en eralised f a tty
because
it
d eg en eratio n
in d icated th a t,
(F ig .21).
in s p ite
in f e c t i o n does cause tis s u e
A f te r splenectom y,
of its
T h i s was o f i n t e r e s t , !
m ild c o u rs e ,
the
damage.
th e s p l e e n s o f a n i m a l s which
had b e e n i n f e c t e d were a lw a y s ex am in ed f o r s p i r o c h a e t e s
b y f r e s h s m e a r s , a n d s e c t i o n s w e r e made a n d s t a i n e d b y
G iem sa, by h a e m a to x y lin and e o s i n , and by L e v a d i t i ’s s i l v e r
im p r e g n a t io n m ethod.
d u rin g the
and a ls o
feb rile
A lth o u g h t h o s e s p l e e n s were removed
p a ro x y sm , on th e day f o l l o w i n g t h e c r i s i s ,
s e v e r a l d a y s a f t e r r e c o v e r y , no e v i d e n c e c o u l d be
s e e n o f p h a g o c y t o s i s o r p e n e t r a t i o n o f th e c e l l s by the
-1 0 4 -
sp iro ch aetes
su ch a s has been described, by s e v e r a l a u t h o r s .
Nor c o u l d i t
oe s a i d t h a t t h e s e s p l e e n s
d efin ite
h i s t o p a t h o l o g i c a l change.
showed a n y v e r y
F i g . 17 s h o w s a
m i c r o p h o t o g r a p h o f a s p l e e n removed t h e d a y a f t e r th e
crisis.
The p e r i p h e r y o f t h e m a l p i g h i a n c o r p u s c l e s i s
somewhat more p r o m i n e n t t h a n u s u a l , b u t t h e s e c t i o n m ig h t
w e l l p a s s f o r t h a t o f a norm al s p le e n .
PREVENTION.
A l l t h e e v i d e n c e we h a v e b e e n a b l e
in crim in ates
the lo u s e ,
and the
lo u s e a lo n e , a s the
vector of th is
d isease.
is,
d estru ctio n of lic e .
th erefo re,
The i n d i c a t i o n f o r p r e v e n t i o n
T his i s e a s i l y
cases,
but i t s
su b ject
to
o f people
to o b t a i n
enough a c c o m p lish e d i n i n d i v i d u a l
a p p l i c a t i o n to a p o p u l a t i o n which i s
t h e e f f e c t s o f i m m i g r a t i o n a n d t h e m o v e m e n ts
i n s e a r c h o f w o rk i s by no means so e a s y .
d e t a i l e d d is c u s s io n o f the
adm inistrative
and o t h e r
d i f f i c u l t i e s w h ich have to
be o v e r c o m e i s
o u ts id e the
scope
of th is
w ork.
two m a i n p r i n c i p l e s
The f i r s t
A
In g e n e r a l te rm s , how ever, th e r e a re
to be f o l l o w e d .
is
the p re v e n tio n o f f u r t h e r in f e c tio n
from w i t h o u t , by th e e s t a b l i s h m e n t o f q u a r a n t i n e s t a t i o n s
a lo n g the r o u t e s
o f im m ig ratio n ,w h ere
i m m i g r a n t s c a n be
d i s i n f e s t e d before proceeding f u r th e r in to
th e Sudan, o r
detained i f sick .
T h is a l o n e w i l l n o t be s u f f i c i e n t , a s i n f e c t e d
p e rs o n s have p a ss e d i n t o
the c e n t r a l Sudan.
T h e y may s t i l l
p a s s t h r o u g h even the most v i g i l a n t q u a r a n t i n e system i n
-1 0 5 -
s m a l l num bers and th u s l e a d to th e a p p e a ra n c e
d isease
of i t s
i n v a r i o u s p a r t s o f the Sudan.
o f the
The p r e v e n t i o n
f u r t h e r s p r e a d w i l l t h e n d e p en d on s p e e d y
r e c o g n i t i o n an d th e r a p i d i t y w ith w hich e f f e c t i v e
co n tro l
m e a s u r e s c a n be a p p l i e d i n t h e a f f e c t e d d i s t r i c t s .
This
is
the second l i n e
o f defence.
In p r o p o r tio n as the m easures a lo n g the r o u te s
o f i m m i g r a t i o n a r e made e f f e c t i v e ,
so the number of
cases lik e ly
t o p a s s i n t o t h e S u d a n u n n o t i c e d w i l l be
dim inished.
So a l s o
t h e n u m b e r o f p o s s i b l e new e p i d e m i c
f o c i t o w h ic h t h e s e m ight g iv e o r i g i n w i l l be d e c r e a s e d ,
and the
chances c o rre s p o n d in g ly reduced o f th e epidem ic
su d d e n ly assum ing u n c o n t r o l l a b l e p r o p o r t i o n s .
E xperience
i n t h e S u d a n h a s shown t h a t
lo u se-b o rn e re la p s in g fe v e r i s
s u f f i c i e n t „ i s made, and t h a t
is
co n tro llab le,
if
the u ltim a te e f f o r t r e q u ir e d
i n v e r s e l y p r o p o r t i o n a l t o th e r a p i d i t y w i t h which
c o n t r o l m e a s u r e s c a n be made e f f e c t i v e
o f an epidem ic.
th at
the
a t the beginning
Under p r e s e n t c o n d i t i o n s i t
is believed
chances o f any epidem ic su d d en ly assum ing m ajor
p r o p o r tio n s th ro u g h o u t the c o u n try are rem ote:
but a
g r e a t e r r i s k a t t h e p r e s e n t t i m e s e e m s t o be t h a t t h e
d i s e a s e may become e s t a b l i s h e d i n e n d e m i c f o r m .
W ith t h e
f u r t h e r p a c i f i c a t i o n and c o lo n iz a tio n of A byssinia,
the
fu tu re
i s l i k e l y to see a f u r t h e r in c re a s e
across
t h e S u d a n f r o m i n f e c t e d c o u n t r i e s i n t h e West t o
in fe c te d cou n tries
i n the E a s t ,
in t r a f f i c
and v i c e v e r s a .
i t w i l l s t i l l be p o s s i b l e under th e s e
W hether
c i r c u m s t a n c e s to
p r e v e n t t h e d i s e a s e b e c o m i n g e n d e m i c among t h e p o p u l a t i o n
o f t h e S u d a n r e m a i n s t o be s e e n .
(G)
SUMMARY
The h i s t o r y o f r e l a p s i n g f e v e r i n t h e S u d a n
i s sum m arised an d c e r t a i n r e l e v a n t p h y s i o g r a p h i c a l ,
r a c i a l , a n d economic f e a t u r e s o f the c o u n t r y a r e
n o ted .
L o u s e - b o r n e r e l a p s i n g f e v e r was i n t r o d u c e d
i n t o t h e S u d a n d u r i n g 13 08 - 19 24 f r o m E g y p t , i n
1 9 2 6 f r o m F r e n c h West A f r i c a , a n d i n 1936" f r o m
I ta lia n East A frica.
The i n f e c t i o n o f t h e S u d a n i n 1 9 3 6 a n d 1937
f r o m A b y s s i n i a was a c o n s e q u e n c e o f t h e I t a l o - A b y s s i n i a n
w a r , a l t h o u g h i t was n o t e f f e c t e d by A b y s s i n i a n
refugees.
The m o r p h o l o g y , m o v e m e n t s , e t c . o f t h e
A b y ssin ia n s t r a i n o f lo u se-b o rn e r e la p s in g f e v e r are
described.
I t was s u c c e s s f u l l y c u l t u r e d i n a n
S g g - a l b u m e n a s c i t i c f l u i d m e d iu m , b u t n o t I n YUAN
P C ’ S e g g m e diu m a n d o t h e r m e d i a .
G e r b i l l e s , a n d w h i t e mice w ere t h e o n l y
r o d e n t s f o u n d t o be s u s c e p t i b l e .
In th ese anim als
th e d is e a s e runs a very m ild c o u rse .
T h e r e i s no
r e l a p s e , a n d t h e s t r a i n c a n n o t be m a i n t a i n e d i n t h e s e
a n i m a l s , ev en a f t e r p a s s a g e th r o u g h monkeys.
M o n k ey s ( C e r o o p i t h e c u s s e o a e u s ) w e r e
s u s c e p t i b l e , a n d i n them t h e i n f e c t i o n r u n s a c o u r s e
s i m i l a r t o t h e huma n d i s e a s e .
I t a p p e a r s p o s s i b l e to
m a in ta in th e s t r a i n in these anim als f o r a t l e a s t th re e
passages.
E v i d e n c e o f i m m u n i t y was f o u n d i n i n f e c t e d
a n i m a l s , b u t s e v e r a l a n t i g e n i c v a r i a n t s o f the
sp iro eh aete are ap p arently p re se n t.
I n m o n k e y s s p l e n e c t o m y was f o u n d t o i n f l u e n c e
t h e c o u r s e o f t h e f i r s t i n f e c t i o n , b u t h a d no e f f e c t
on a c q u i r e d im m u n ity .
I n m i c e , s p l e n e c t o m y h a d no
effect a t a ll.
A p o s sib le e x p la n a tio n o f these r e s u l t s
i s d iscu ssed .
No e v i d e n c e o f l a t e n t o r r e s i d u a l i n f e c t i o n s
was fo u n d i n r q d e n t s a f t e r r e c o v e r y .
The i n t e r m e d i a t e h o s t i s t h e l o u s e .
V irulent
s p i r o c h a e t e s were fo u n d i n l i c e from i n f e c t e d c a s e s ,
w h ic h were a b le to r e p r o d u c e t h e d i s e a s e i n a monkey.
I n th e monkey, th e i n f e c t i o n d e r i v e d from th e
l o u s e i s m ore s e v e r e t h a n t h a t d e r i v e d f r o m t h e
in o c u la tio n o f in fe c te d blood.
The A b y s s i n i a n s t r a i n o f l o u s e - b o r n e
r e l a p s i n g f e v e r - r e s e m b l e s i n i t s g e n e r a l f e a t u r e s the
o t h e r me m be rs o f t h e N o r t h A f r i c a n g r o u p o f l o u s e - b o r n e
stra in s.
-1 0 7 -
C n )
I t i s n o t t r a n s m i s s i b l e by Q r n i t h o d o r u s
s a v i g n y i , and does not p e r s i s t in th a t t i c k .
(14)
C o n sid e ra tio n of the g e o g ra p h ica l
d i s t r i b u t i o n o f O rn ith o d o ru s t i c k s i n th e Sudan
s h o w s t h a t 0 . s a v i g n y i i s t h e o n l y one l i k e l y t o
p la y any p a r t i n the epidem iology o f r e l a p s i n g
f e v e r i n N o rth e rn Sudan.
(15)
A tte m p ts to t r a n s m i t the s p ir o c h a e te by
m e a n s o f t h e t i c k A r g a s p e r s i c u s a n d t h e m on k e y
l o u s e (P e d i c i n u s ) w e r e n o t s u c c e s s f u l .
(16)
E pidem iological c o n sid e ra tio n s suggest
t h a t r e l a p s i n g fe v e r has no t e s ta b lis h e d i t s e l f
i n endem ic form i n th e N o r th e r n Sudan, a l t h o u g h
i t h a s b e e n i n t r o d u c e d on d i f f e r e n t o c c a s i o n s f r o m
the a d jo in in g c o u n tr ie s .
(17)
D u r i n g t h e l a s t 12 y e a r s t h e i n c i d e n c e
o f th e d is e a s e has been c o n fin e d alm ost e n t i r e l y
t o a d u l t m ale ' W e s t e r n e r s ’ , i . e . n e g r o i d im m ig r a n ts
from th e W estern Sudan a n d French E q u a t o r i a l A f r i c a .
(13)
The d i s e a s e s h o w s a t e n d e n c y t o s e a s o n a l
i n c i d e n c e d u r i n g t h e h o t h u m id w e a t h e r a f t e r t h e
r a i n s , b u t t h i s may be o b s c u r e d b y t h e p r e s e n c e o f
epidem ics.
T his i s c o r r e l a t e d w ith s ea so n al
movements o f im m ig r a n t l a b o u r e r s r a t h e r t h a n w i t h
m eteorological v a ria tio n s .
(19)
A lthough a c lo s e a s s o c i a t i o n has been
o b se rv e d elsew h ere betw een ep id em ics o f lo u se-o o rn e
r e l a p s i n g f e v e r a n d l o u s e - o o r n e t y p h u s , no s u c h
a s s o c i a t i o n e x i s t s i n th e S udan, where e p id e m ic
ty p h u s i s a p p a r e n t l y unknown.
(2
0)
I n f e c t i o n s i n t h e S o u t h e r n S u d a n may be
t i c k - b o r n e , b u t t h e r e i s no e v i d e n c e t h a t t h e s e
a r t h r o p o d s have p la y e d any p a r t i n th e ep id em io lo g y
o f r e l a p s i n g f e v e r i n th e N o rth e rn Sudan.
21)
The m o s t c h a r a c t e r i s t i c c l i n i c a l symptoms
a r e f e v e r , p a i n f u l s p l e n i c e n la rg e m e n t and
ep istax is.
(
(22)
M i l i a r y l e s i o n s a t t h e p e r i p h e r y o f the
m a l p i g h i a n c o r p u s c l e s were s e e n i n s e c t i o n s o f th e
s p l e e n i n f a t a l c a s e s , b u t t h e s e w e re o b s c u r e d b y
o t h e r c h a n g e s , a n d i n th e c a s e s exam ined would n o t
have been s u f f i c i e n t to w a rra n t a d ia g n o s is being
made f r o m p o s t - m o r t e m e x a m i n a t i o n o f s p l e e n s e c t i o n s .
(H)
ANZAR, A.
(1926)
A r c h . I n s t . I n t e r n a t . d 'H y g .d » A lfo n so X I I I
O ct. 4 th .
ARCHIBALD, R . G .
(1910)
ATKSY, O . F . H .
(1929)
ATKSY, O . F . H .
(1932)
BALFOUR, A.
(1911)
BALTHAZARD, M.
BERG3MA, S .
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NOGUE,
(1925)
PA I, S .E .
(1937)
de P A O L I , P .
PLIMMER, H . G .
PONCET, M.
Ann . ' l e d . e t P h a r m . C o l o n .
C h i n e s e M ed . J l .
(1930)
RANKEN, K . S .
(1912)
23, 445.
52, 595.
A rc h .Ita l.S e i.M e d .C o lo n . 11, 303.
(1912)
(1709)
(1913)
P r o c . Z ool.Soc.L ond. I I ,
Voyage t o E t h i o p i a .
406.
London.
B r i t .M e d .J l. 1, 1482.
RIGOLETTE ( 1 9 2 5 )
B u ll.S o c .P a t h .E x o t . 18, 679.
RIDING, D . a n d MACDOWELL, T.W.
ROAF, U . S .
(1922)
RUBINSTEIN, P . L .
(1927)
T r a n s . R .Soc.T rop.M ed.
H yg.20, 524.
B r i t . Jl.E x p er .P a th . 3,
(1930)
59.
Z ts c h r . f .I m m u n ita ts f . 65, 538.
RUBINSTEIN, P . L . a n d GOLOBEWA, E . E . ( 1 9 3 0 )
Z tsch r.f.
Im m unitatsf. 66, 1.
RUSSELL, H.
(1931)
W .A frican M e d .J l. 4, 59.
R'JSSELL, H .
(1932)
T ra n s .R .Soc .Trop.M ed.H yg. 26, 259,
SANDWITH, F .M .
SARANELLI, G.
(1905)
(1927)
The M e d i c a l D i s e a s e s o f E g y p t . V o l . I .
London.
K i m p t o n a n d Co.
Q u o t e d b y HINDLE ( 1 9 3 1 ,
SCHU3ERG, A . a n d KUHN, P .
(1911)
SCHUBERG, A . a n d MANTEUFEL, 3 .
loc.
c it.).
Q u o t e d b y HINDLE ( 1 9 3 1 ,
l o c . c i t . ).
(1910)
q u o t e d b y BRTJMPT
(1936a, l o c . c i t . ) .
SERGENT, Edm. a n d FOLEY, H. ( 1 9 1 0 )
Ann. I n s t . P a s t e u r , 2 4 ,
(1922) T ra n s .R .S o c .T ro p .M e d .H y g . 1 6 , 170.
SELWYN CLARKE, P . S . , LE FAUN, G .H . a n d INGRAM, A.
A n n .T r o p .M e d .P a r a s ito l. 17, 389.
SHRB.'PTON, E . A . G .
(1936)
337.
(1923)
C h i n e s e M e d . J l . Feb . S u p p l e m e n t N o . l
P . 312.
SIBILIA,
D. ( 1 9 3 7 ) P o l i c l i n i c o
TOIvIOIKA,
Y. ( 1 9 2 4 ) C e n t . f . B a k t .
(S ez.P rat).
O rig.
44,
772.
92, 41.
VELU, I I . , BALOZET, L . , a n d ZOTTNER, G.
(1930)
C .R.Soc . B i o l .
103, 381.
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(1931)
C .R .S o c.B io l.
106, 890.
VINZENT,
R. ( 1 9 2 7 ) A n n . I n s t . P a s t e u r . 4 1 , 1 3 1 .
WENYON, C.M.
(1926)
P rotozoology V o l.I I .
T y n d a l l , a n d C ox .
WRIGHT, C .11.H . a n d HAROLD, H . D .
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YUAN-PO,
(1920)
London: B a i l l i e r e ,
J l.R .A r m y M ed.Cps.
35, 203.
K i t a s a t o A r c h iv .E x p e r .M e d . 10 , 78.
L i . ( 1 9 3 6 ) A n n . P a r a s i t . H u m . e t Comp. 1 4 ,
76.
-1 1 --
(K)
ILLUSTRATIONS
(A)
1.
2.
3.
4.
5.
G e n e r a l map o f t h e A n g l o - E g y p t i a n S u d a n .
D iagram show ing th e o r i g i n o f epidem ic r e l a p s i n g
fe v e r a t v a rio u s tim es.
R a i n f a l l map o f t h e A n g l o - E g y p t i a n S u d a n .
Map o f t h e E a s t e r n S u d a n s h o w i n g t h e r o u t e s b y w h i c h
i n f e c t i o n w a s s p r e a d i n g i n 193 6 a n d 1 9 3 7 .
Map s h o w i n g D i s t r i b u t i o n o f O r n i t h o d o r u s t i c k s i n t h e
Sudan.
(3)
6.
7.
8.
9.
10.
19 .
20.
21.
22.
DIAGRAMS
Polym orphous form s assumed by th e s p i r o c h a e t e s i n
s t a i n e d blood film s .
A ppearances seen in film s of f r o z e n blood.
Diagram show ing t h e s e a s o n a l i n c i d e n c e o f r e l a p s i n g
f e v e r in the G e zira.
Diagram show ing th e r e l a t i o n b e tw e e n r e l a p s i n g f e v e r
and m a la ria .
D iagram showing th e b e h a v io u r o f th e s p i r o c h a e t e s in
P edie in u s .
(C)
11.
12.
13.
14.
15.
16.
17.
18.
MAPS
PHOTOGRAPHS
S p iro c h a e te s in blood film .
S p iro c h a e te s in film o f fro zen blood, .
S p i r o c h a e t e s from t h e h a em o c o e le o f th e l o u s e .
Mass o f s p i r o c h a e t e s from a l o u s e .
O rnithodorus sav ig n y i, n a tu r a l s iz e .
Human s p l e e n , s h o w i n g a r e a s o f i n f a r c t i o n .
S p l e e n o f monkey - p h o t o m i c r o g r a p h .
Human s p l e e n - p h o t o m i c r o g r a p h .
Human s p l e e n - m i l i a r y l e s i o n i n m a l i p i g h i a n c o r p u s c l e photom icrograph.
.
Human k i d n e y i n r e l a p s i n g f e v e r - p h o t o m i c r o g r a p h .
M ouse l i v e r i n r e l a p s i n g f e v e r - p h o t o m i c r o g r a p h .
The l a b o r a t o r y s a l o o n .
-1 1 3 -
I L L U S I S A I I O N S
-1 1 4 -
Jl apiTREA
r« .-Q CuFflyieR.
u. •
FRENCH
EQUATORIAL
A FR IC A
IwATwiSr %
BELGIAN
CONGO
FIG. I .
KENYA
GENERAL MAP OF THE ANGLO-EGYPTI AN SUDAN.
S cale
I
: 15,000,000.
I n te r n a tio n a l boundaries
province b o u n d aries.
------------------
-------------- --------
-1 1 5 -
FROM
FRENCH
EQUATORIAL
AFRICA
1926
fr o m
937
Cl o u s e - b o r n e )
F IG .2.
RELAPSING FEVER:
A B Y S S IN IA AND
ERITREA
I9 3 6 -I9 ? 7
(LO USE-BO RN E)
DIAGRAM SHOWING THE SOURCE
OF INFECTION AT VARIOUS TIMES IN THE SUDAN.
-1 1 6 -
Op,
.
F IG .3.
9fg>
RAINFALL MAP OP THE ANGLO-EGYPTIAN
SUDAN, SHOWING THE DIVISION OP THE
COUNTRY INTO NORTHERN SUDAN AND
SOUTHERN SUDAN.
-1 1 7 -
To E&YPT
'K H flR T ouM
MEOflN/
Y»Ufl6 flT
To
FONG
F IG .4.
SKETCH MAP OF THE EASTERN SUDAN, SHOW­
ING THE ROUTE BY WHICH INFECTION WAS
ENTERING DURING 1 9 3 6 - 3 7 .
ROUTE
,
OF INFECTION SHOWN IN RED.
I n t e r n a t i o n a l b o u n d a r i e s im rnrrm nr
R a i l w a y s — —— —
By t r a c i n g t h e p r e v i o u s m o v e m e n ts o f g a s e s f o u n d
i n t n e S udan, a n d f i n a l l y by th e e s t a b l i s h m e n t of
c u a ra n tin e p o s ts along the ro u te of in f e c tio n ,
the
l a t t e r c o u l d be d e f i n e d w i t h c o n s i d e r a b l e a c c u r a c y .
-1 1 8 .
T3fl<A
iMwnaum
V MEDflNl
&ELGIRH
C0N6Q
KENYA
btsRHon
FIG .5.
SKETCH MAP SHOWING THE DISTRIBUTION OF
ORNITHODORUS TICKS IN THE SUDAN.
Names u n d e r l i n e d i n d i c a t e p l a c e s w h e r e t h e w r i t e r
has p e rs o n a lly i d e n t i f i e d O rnithodorus s a v ig n y i.
O r n i t h o d o r u s m o u b a t a . known d i s t r i b u t i o n . . . . . . § | ;
O rn ith o d o ru s m oubata, s u sp e c te d d i s t r i b u t i o n . . !
O r n i t h o d o r u s s a v i g n y i ............................................................... H
-1 1 9 -
FIG. 6 .
POLYMORPHOUS FORMS ASSUMED BY THE
SPIROCHAETES IN STAINED BLOOD FILMS.
D r a w i n g s made u n d e r t h e m i c r o - p r o j e c t o r .
approx.
stain ed film s.
x200Q,
A - E , s h a p e s commonly a s s u m e d i n
F, d i v i d i n g form - d a u g h t e r s s t i l l
a t t a c h e d by t h i n p o r t i o n ,
and i n t e r t w i n e d .
G,
a group o f a g g lu tin a te d and d i s i n t e g r a t i n g s p i r o ­
c h a e te s seen in a b loodfilm taken n ear the c r i s i s .
-1 2 0 -
FIG .7.
APPEARANCES SEEN IN FILMS OF FROZEN
BLOOD.
D r a w i n g s made u n d e r t h e m i c r o - p r o j e c t o r .
approx.
chaete.
x200Q,
A, s w e l l i n g i n m i d d l e o f s p i r o B, t e r m i n a l s w e l l i n g i n s p i r o c h a e t e .
C, g r a n u l e s i n r e d b l o o d c e l l s .
D, B a b e s i a -
l i k e a p p ea ra n ce s i n re d blood c e l l s .
E,
appearances suggesting p e n e tra tio n of re d c e lls
by s p i r o c h a e t e s , fo llo w e d by d i s i n t e g r a t i o n of
the sp iro c h ae te s.
-1 2 1 -
1 30
I2o
600
110
101
500
90
300
200
IoO
JAN
VU'.B
P IG .8.
mar
APR
MAY
JUN
JUL
AUG
SEP
OCT NOV
DEC
GRAPHS SHOWING THE SEASONAL INCIDENCE OP
RELAPSING FEVER IN THE BLUE NILE PROVINCE
(GEZIRA) WITH A HISTOGRAM SHOWING THE AVERAGE
RAINFALL DURING THE YEARS CONCERNED.
The f i g u r e s f o r 193 6 a r e shown on a m a g n i f i e d s c a l e , w h i c h
i s i n d i c a t e d b y t h e r e d f i g u r e s on t h e l e f t s i d e .
R ^IN F^CL
)N
MMS
400
-1 £ £ -
70 00
20C
6000
150
RELAPSING
4000
100
2000
50
1000
F IG .9.
GRAPHS SHOWING THE SEASONAL INCIDENCE OF RELAPS­
ING FEVER COMPARED WITH THAT OF MALARIA.
M a l a r i a shown i n r e d .
The v a l u e s f o r r e l a p s i n g f e v e r a r e
t h e summation o f each J a n u a r y , F e b r u a r y , e t c . , d u r i n g th e
p e rio d 1930-37, and the v a lu e s f o r m a la ria a r e averages
t a k e n o v e r t h e same p e r i o d .
malaria
FEVER
5000
-1 2 3 -
90
IU CLEU S)
BACTERIA
F IG .10.
DRAWINGS MADE UNDER THE MICRO-PROJECTOR
TO SHOW THE FATE OF THE SPIROCHAETES IN
THE CELLS OF PEDICINUS.
x 2,500 approx.
C o ile d up s p i r o c h a e t e s , and s p ir o c h a e te s a p p a r e n tly
u n d e r g o in g d i s i n t e g r a t i o n can be see n i n s i d e th e c e l l s .
-
F IG .II.
124-
SPIROCHAETES IN BLOOD FILM.
S h o w i n g t h e p o l y m o r p h o u s a p p e a r a n c e s commonly
seen in r o u tin e blood f i l m s .
FIG .12.
(x 1 , 9 0 0 )
SPIROCHAETES IN FILM OF FROZEN BLOOD.
The o r g a n i s m s i n t h i s f i l m show t h e r e g u l a r
corkscrew arrangem ent,
(x 1 , 9 0 0 )
seen in th e l i v i n g s t a t e ,
-1 2 5 -
t:
v
.FIG .13.
METACYCIIC SPIROCHAETES
•
FROM TIE HAEMOCELE OF A
LOUSE.
F IG .14.
(x 1 , 9 0 0 )
LARGE TANGLED MASS OF SPIROCHAETES
FROM THE HAEMOCELE OF A LOUSE.
(1 ,9 0 0 ).
-1 2 6 -
•
§ •
• •
§
0
F IG .15.
ORNITHODORUS SAVIGNYI
NATURAL S I Z E .
1
j
1
________________ J
FIG. 16.
PORTION OF HUMAN SPLEEN IN RELAPSING
FEVER, SHOWING INFARCTION.
-1 2 7 -
P IG .17.
MlCROPriOTOGRAPH OP MONKEY'S SPLEEN EXPERIMENTAL RELAPSING PEVER.
x 75.
The a p p e a r a n c e s a r e s u b s t a n t i a l l y t h o s e o f t h e
norm al s p le e n .
-1 2 8 -
F1G .18.
MICROPHOTOGRAPH OF HUMAN SPLEEN IN
RELAPSING FEVER - AREA OF INFARCTION,
x 75.
-1 2 9 -
F IG .19.
MICROPHOTOGRAPH OF HUMAN SPLEEN IN RELAPSING
FEVER, SHOWING MILIARY LESION IN MALPIGHIAN
CORPUSCLE.
x480.
The m a l p i g h i a n c o r p u s c l e i s r e l a t i v e l y much s m a l l e r t h a n
norm al, p ro b a b ly a s th e r e s u l t o f c h ro n ic m a la ria ,
sim ila r condition.
'
S u r ro u n d in g i t can be seen a p o o r ly
d e f i n e d zone o f n e c r o s i s ,
a t a rm 's le n g th .
o r some
b e t t e r seen i f
the p la te
i s viewed
-1 3 0 -
F IG .20.
MICROHiOTOGRAfH OF HUMAN KIDNEY IN RELAPS­
ING FEVER.
x480.
Shows c a t a r r h a l c h a n g e s i n t h e t u b u l e s ,
and cloudy
s w e llin g o f th e tu b u le c e l l s , am ounting to a c t u a l
n ecro sis in p laces.
-1 3 1 -
FIG. 21.
MICROFHOTOGRAFH OF MOUSE LIVER IN
EXPERIMENTAL RELAPSING FEVER.
x 480
-1 3 2 -
LABORATORY
343
F IG .22.
THE LABORATOHY SALOON.
T h i s i s a h a ilw a y c o a c h , equipped, a s a
tra v e llin g lab o rato ry ,
it
by means o f w hich
i s p o s s ib le to provide the n ecessary
f a c i l i t i e s f o r l a b o r a t o r y work a t any
statio n
on t h e r a i l w a y l i n e .
I t was of
im m e ns e v a l u e d u r i n g t h e c o u r s e o f t h e w o r k
recorded in th is paper.
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