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Anthrax, Relapsing Fever, and other blood diseases. It is fortunate that with such
marked features of similarity we have also marked points of difference. In Anthrax
the blood contains bacilli, in Relapsing Fever spirilla. In Anthrax the temperature is
persistently high; in Relapsing Fever it is alternately high and low. In nine cases out
of ten Anthrax is acute; in a similar proportion Relapsing Fever is of long duration.
Although the differences between the two disorders are amply sufficient for diagnosis,
yet there is a sufficient family likeness between these two parasitic affections to
determine that they shall be studied by the same methods and to indicate that the
lines of research followed and facts established in this investigation of Relapsing Fever
may in the future suggest new lines of inquiry in cases of Anthrax outbreaks. The
disease of the horse known as KAMRI has long been regarded as of frequent occurrence
in Burma ; it is possible that many cases recorded as such have been Relapsing Fever.
True Kamri is a nervous disorder, having its seat in the spinal cord (unless we may
accept the latest researches on the subject—those of Officiating Inspecting Veterinary
Surgeon Poyser); it is characterized by a sudden or gradual paraplegia persisting
apparently as a local disorder and tending rather to indefinite chronicity than to a fatal
result. We never see an animal affected with Relapsing Fever sitting on his powerless
hind quarters fighting violently with his fore limbs; we never see him, in trotting, roll
his hind limbs in the manner distinctive of his being " gone in the loins." The loss
of power in the fever patient is general; his staggering with the hind limbs is not from
paralysis, but from sheer weakness, imperfect nutrition of their muscles on account of
plugging of the blood-vessels, and impediment to their free action by the gelatinous
effusion between them. Altogether it is evident that, although the two diseases
resemble one another to an extent sufficient to induce some confusion in diagnosis, yet
the differences are well marked and no qualified observer would commit such an error.
13 The spirillum of Relapsing Fever in man very closely, in its form and the
character of its movements, resembles the spirillum plicatilis, which was first described
by Ehrenberg, and is of common occurrence in stagnant water. This at once suggests
the possibility of the two organisms being identical species and is pregnant with
suggestions as to the etiology of Relapsing Fever. I have seen bodies somewhat like
certain phases of the relapsing fever organism in my microscopical examinations of
the stomach contents and of scrapings from the teeth of patients, as well as in the
débris from mouth ulcers, but these bodies were so mixed with minute particles of
food, also bacilli, bacteria, infusorians, and other low forms of life, that I was unable
to derive any special information from examination of them as regards their bearings
on the disease which I was studying. Microscopical examinations of water and marsh
soil also gave no clue to the source whence the parasite gained entry into the organism
of the mule. Examination of the air also gave negative results.
14. In seeking the cause of any disorder, we may advantageously work in two
ways: Firstly, we may take all conditions, in so far as we can ascertain them, which
have been acting on the affected animals and examine each in turn, considering it
guilty of having generated the disorder, until proved otherwise or its harmlessness be
established; or, secondly, we may, from an examination of the symptoms and post-mortem
conditions, determine the pathology of the disease and then seek for all causes which
might bring about such disorder and in our experience of other cases are known
to have done so. In my examination of relapsing fever of mules, I at first could
adopt the former method solely, but am now able to supplement my conclusions by
the latter, since we may reasonably feel assured that the parasite is the actual and
immediate cause of the disease—the materies morbi. We need not here enter further
into the inquiry as to whether its agency is direct (as is most probable) or indirect
through some excretum or other chemical matter or ferment thrown out by it into the
blood. Suffice it that the parasite must enter the system and it must have a source
whence it gains entry into the circulatory system. We know that active spirilloid
organisms introduced into the alimentary canal generate parasites in the blood, and that,
when thrown into the subcutaneous areolar interspaces they are also able, in a still
shorter time, to produce a like effect. Experimental inquiry has also shown us that
blood in which no parasites are detectable under ordinary powers in their ordinary
form will, after a still longer time, generate relapsing fever. It seems that once in the
blood the organisms do not leave it, but in the low stages of fever are still present