HISTORY AND GEOGRAPHICAL DISTRIBUTION.—It is not important to consider here at any length the history of this disease. Allusions to it were made by Strother, 1729, and by Huxham, 1752, but the first reliable account on record is the description of an epidemic in the year 1739 by John Rutty.1 Relapsing fever undoubtedly occurred at different times and at various places during the next hundred years, although the records of it are scanty, and for the most part imperfect, owing chiefly to the want of a clear recognition of its essential difference from typhus and typhoid fevers.
1 A Chronological History of the Weather and Seasons, etc., London, 1770, pp. 75-90.
During the decade from 1842 to 1852 relapsing fever prevailed in a very active and widespread form. Epidemics occurred in England, Scotland, and Ireland, in various parts of Germany, and it was during this time that it was first observed and described in America. In June, 1844, an emigrant ship from Liverpool came to America with eighteen cases on board, which were taken to the Philadelphia and Pennsylvania Hospitals. In 1848 a few cases were imported by emigrants to New York, and in 1850 to Buffalo in the same way.2
2 See Fevers, their Diagnosis, Pathology, and Treatment, Meredith Clymer, Phila., 1846, p. 99; Clinical Reports on Continued Fever, A. Flint, Phila., 1855, p. 364; Dubois 1848.
The next great outbreak of relapsing fever began in Odessa in 1863 and lasted until 1872. It prevailed in various parts of Russia, in Germany, France, and Great Britain, and for the first time occurred extensively in the United States, especially in Philadelphia and New York. The present article is based largely on a study of this epidemic as it presented itself in Philadelphia during the years 1869-70, when the writer, in conjunction with the late Edward Rhoads, had the opportunity of observing about two hundred cases, in the wards of the Philadelphia Hospital. An admirable article on the same epidemic appeared from the pen of the late John S. Parry, in the Amer. Jour. Med. Sciences, N.S., vol. lx., Oct., 1870, p. 336.
Between the years 1877 and 1880 relapsing fever occurred quite extensively at Bombay, and was there studied by Carter3 and Lewis; and during 1879-80 it prevailed in Königsberg, an account of which epidemic has been published by Meschede.4
3 Spirillum Fever, by H. Vandyke Carter, M.D., London, 1882.
4 Virchow's Archiv, Bd. lxxxvii. p. 393.
The geographical distribution of relapsing fever is seen, therefore, to have been very extensive; and not only has it occurred in the above-mentioned localities, but there have also been less extensive outbreaks in France, India, Egypt, Algeria, South America, and elsewhere.
CAUSES.—In all probability the essential cause of relapsing fever is a specific poison, but we know nothing of its real nature nor of the precise conditions under which it originates. Recent investigations have shown that the spirillum discovered by Obermeier is constantly present during the febrile stages of relapsing fever, but it cannot yet be decided whether this minute organism is the actual cause or only an invariable accompaniment of the disease.