ANTENATAL CLINICS AND PREMATERNITY PRACTICE AT THE EDINBURGH ROYAL MATERNITY HOSPITAL IN THE YEARS 1909-1915
Authors: J. W. Ballantyne
Journal: BMJ (1916)

AND CONCLUSIONS. 1.The disease is a definite entity, and of infective nature, as is proved by its ready transmission from one person to anotlher by the blood.2. There are two clinical types of the disease: (a) A short fever of about a week's duration, followed frequently after a few days by a short single relapse; (b) a longer illness characterized above all by the number, sharpness, and periodicity of the relapses.3. .The symptoms of botlh types are clininally identical, the most constant and characteristic being headaclhe, and pain in the legs and small of the back.4. The two types described are, in ouir opinion, merely varieties of one and the same disease.In addition to the identity of symptoms, the experimental evidence for this is strong, a typical " short" variety lhaving been shown capable of giving rise to a typical " long " one.5. The incubation period varies, possibly withl the dose of the infective virus introduced.Thle shortest incubation period in otur experimental transmissions was six days, and the longest twenty-two days.6.The disease is transmiissible in every case by the -whole blood, whether iiujectced intravenously or intra- mnuscularly.7. The disease is not transmissible by the serum.In the one instance in whliclh the serum proved infective, haemo- lysis of corpuscles had occurred before injection.8. It follows as a corollary to the preceding statement tllat the virus is not a "filter passer" ill tlhe serum, as we tlhought from alnalogy tllat it miglht be.All our experiments with filtered seruLm were negative.9.The plasma was infective in one experiment, but haemolysis of red cells lhad occurred, so that the plasma was haemoglobin-tinted.The filtered plasma in anothler test was not infective.10.The above results secemed to poilnt to the virus beina contained within tlto blood co')pUSClC8 thlemselvcs, wvhether leucocytes or red cells.11. 13lood corpuscles, after washing five timies in saline to remove the plasma, were still fotiud to be infective.This further supports otur view that tlle virus is intra- corpuscular.12. Very many blood filns at all stages of the disease 1have been examined without a parasite beilng detected.The blood lhas been examined fresh, under dark-ground illumination, and dlied films hlave been stained in varying ways, witlhout result.13. Blood corpuscles vwere brokeln (lown, and the laemo- globin-tinted fluid passed tlhrouglh a filter in an attempt to prove the virus an ultna-microscopic one confined to tlle corpuscles.Tlhe fluiid when injected, lowever, was not found to be infective.14.The only constant m*orphological change in the blood is the presence of punictate basophilia.This was so uarlked in some cases as to require very careful investigation to differentiate it from.aIn intracellular parasite.The blood counts, differential and orclinary, did not yield any important results.15.As regards the means by whicll tlle disease is trans- mitted in nature we have as yet no evidence to offer.The fact that only two classes of m:en are affected-those from the trench zone and men of the Royal Army MZedical Corps-is, lhowever, sucggestive.Thle disease is either contagious from man to man or, what seems miiuclh more likely, is carried by one of the common flies or parasites found in tlle trenches.During the past summer lice, mosquitos, midges, and flies of otlher kinds have all been common in the Flaniders war zone.