A STUDY OF PSITTACOSIS
Authors: R. Hutchison, R. A. Rowlands, S. L. Simpson
Journal: BMJ (1930)

\WE desc;ribe below 27 cases of psittacosis that ]]ave conme to o011 liotice dutiing the last few montlis.Of this number, 18 occurred in the London area, and the parrots associated witlh the renmaininig 9 cases were purchased from bird- slhop)s in Lond(lon.The majority of the cases lhave been seen bv one or other of us, and several have be-en observed thlrouglhout the greater part of their illness in the wards of tlhe Lonidon Hospital.Of the 27 patients 5 died.Thlree of these deatlhs, however, occurr ed in one virisleiit famiiily -epideml-lic.involving five people.Prior to the present epidemic of 1929-30 psittacosis was alinost iuniknown in this country except for a few sporadic .cases.It lhas, lhowever, been recognizecl as a disease, and tle association with parrots noted, for.fifty years.Its raritv in receiit times has tended to cause it to h>e forgotten, and thiis fact, coupled with an uncertain bacteriology, resulted in a sceeptical attitude in the diagnlosis of the.cases that occurred early-in the recent epidenmic.In fact, many of these w-ere nlot unnaturally thought to be atypicaltyphoid, or in)fluenzal pneumonta, and it was only tlhrough a letter inserted by one of us in the miedical pr ess that many of tile cases came to our knowledge.Tfhe hiistory of psittacost's constittites an instructive epideiiniiological study, and has helped in the appireciation of many features of the present epidemic. EPIDEMIOLOGY.In 1880 Ritter' described.a small el)idemic ill Ulster, Switzerland(l.Seveni persons wsvere affectel, of whlom four lived in the lhouse, one came (lailv, anIi th-e reemainiing two camiie to clean or repair, bird-cages.The owner of the houise was a bird col-lector, anid-parrots anid otlhev exotic birds had nrrive(l a few weeks previously fr om nHamburg, .andalso from Vtienna.Somlle of the bir(ds died, and the remiainder.were killed as susp-ect.Thlree of the seven patienits died.Sn)all ouitbreaks were observed by Ost2 in Berie (1882), an(l Wagner3 in Leipzig (1882 anld 1885).The Leipzig butbreaks arie of great interest, for althouglh some of the cases were caused by sick parrots, three cases in one house- hold were appare.ntlydue to a sick dog bought from tlle parrot shop.lThe dog died.lThe first extensive outbreak occurred in Paris in 1891492.Tlhere were 50 cases, with 16 deaths in the first year.Smaller outbreaks occurred in the next few years.The Paris epidcemic was investigated by several workers: Dujardlin-Beaumetz,4 Dubief,4 Nocard,4 Sicard,5 Gilbert .andFournier,6 7 8etc.M. Dujardin-Beaumetz4 made the first report to the Council of Hygiene.Two Frenchmen, Dubois and Marion, brought a consignment of parrots fromii Buenos Aires to Havre.Of 500 birds, 300 died on tlhe voyage.The two men fell ill, and the surviving parrots were distributed.All the subsequent cases except three could be (lefinitelv traced to contact with this batch of pairots.It is a matter of historical interest, however, that Dujardih-Beaaumetz, in his first report, sutggested that this was mlierely coincidenee, and -that-they were dealing with ani epidemi;ic. of influenza, anid not a newv illness imported iiito the couintry by parrots.In January, 1893, DubiefP described two small epidemics originating from such parrots in different quiart-ers of Paris, and Dujardin-Beauiiietz was so impressed by the evidlence that lie asked leave to with- draw his originial opinion, and to state, " I think, on the cointrary, that the lreturn of these epidemics alid their identic'al course p('l'lit mle to affilm that there is a relation of cauise and effect.")SIS.THx BiRiTisN 633 L MEDICAL JOUXRNA Onie of tlie house epidemics studlieI by Dr. Duibief is ' 634 APRIL 5, 1930] PSITTACOSIS.of contact witlh the sick parrots, eithler at the store or at lhome. . .Some people touclied the parrots, but,in the majority of instanices the inispir atioii of tle air of this zoine was the conmmon factor. . . .Tlher e were a niumber of lhuiman cases in wlhiclh the disease in its cpidemic form must have beeni contracted from sick paliots, after th-e birds had beeni takiin to the bomes."In tllis countr y Beddoes' 4 described two e:s>es, aunt and niece, that occur-red in 1914.A saileoi relative brouiglht lhome a sick parrot froim-l his ship.Several of the sailors AAere uniwell, anid oine w as taken to hospital at Liverpool wi-ith suppose(l typhoid.In 1924 Gullai(I5 reportedl two eases in this countrY, anid in 1927 Stolkiind'6 recor(led a fuirtlher two cases.In.July, 1929, Thom so01 17jeStitcI a smiiall outbreak of four eases occurrincg ini Birmiinghami.It is of great initeiest to note that psittacosis in the sumilzmer of 1929 occurred in epidemic formii in the Argentine.This suggests that the mode of transit of the ptarrots froml the Argentine to Europe is nlot necessarily responsible for the iiiitiation of the disease, buit ratlher for its spread amlionlg the birds.Weekly Bulletin No. 48 of the Healthl Section of the League of Nation,s, dated Novemiiber 28th, 1929, states that according to uniofficial information received fr oiii the Argenitine there was an outbreak of psittacosis in October, and cases of this disease weie-reported from various lpalts of the country.The epidemic is said to have begunii at Cordova, among, a thleatrical comllpany pos,S,Wessing a parri'ot which was sufferiing fromii the disease.The Epidemuiological Record of the League of N ationis, December 5th, 1929, states: " Argentine medical journals contain some details concelriing the epidemic of psittacosis which broke out in that counity at the end of the summer.Duriing July ahd August the town of Cordova reported many cases.Psittacosis was only diagniosed a consider- able time after it had made its appearance, wheni the source of the contagion was traced to a disease of parrots.A few days after the epidemic started at Cordova there was another outbreak at Alta Gracia, a watering place 35 kilometres from Cordova.Another epidemic was niotified in the towun of Tucuman, also situated in the interior of the Argentine wlhere the Andes rise.This town is directly conniiected by rail witlh Cordova.Lastly, cases have been recorded at Buenos Aires.Altogether several huniidreds of cases-all coninected with sick parrots-have beeni recorded in the Ar genitine.Accordiingly this seenms to be the GROUP B. (BarkiIng, Lond(on.)In this group five people wcere affected--two sisters, two brothers, and the motlher, all belonging to onie familyv.Apart fromi onie of the sisters, whlio was married, they ill lived in the same house.It is ilntelesting, to note thlat whereas all these people wrere pleviously in good healtlh two remaininlg members of thle familv, brothecr and sistec, sulffering from plithisis an1d living in the s 1ame house, gave nio evidence of infection witls psittacosis.Two otlier sisters, lhowever, also escaped infection.J. R. bouglit a green AmI1azoni l)arrot froml a hawker in Spitalfields Market oii Xanuary 10th.Altlhouiglh showing no gross signs of illness, it fell off its perch (lead on January 21st.The patients at fiirst conisidered that they hbad hiad no intimate contact witlh the bird, buit it su-b- sequienltlv appeared tlhat, except for the married sister, they lbad in all probability puit thleir fingers in-side the cage and stroked the parrot's head.L. R. fell ill on Jaiiuary 23rd, E. R. on Jantuary 25th,