The jaundice, which occurred among coal- miners
working in certain collieries in East Lothian, was
diagnosed clinically by Professor G. Lovell Gulland,
and proved bacteriologically by the writer, to be
of spirochaetal origin (January 1924).
Wild rats and field mice from. the infected
mining area were incriminated as carriers of the
causal organism in Scotland for the first time
The diagnosis in 22 cases of the disease was
based on the combined clinical, laboratory and
experimental observations described.
In 22, jaundice was a feature.
In 1T7, haemorrhage, mainly epistaxis, occurred.
In 17, spïrochaetes were found in the urine.
Spirochaetal jaundice was produced in two guinea -pigs
inoculated with urine from two of the patients, and
in eight "spotted" lung haemorrhages were the only
signs of infection.
The figure for the death rate among coal -miners
approximates very closely that reported by Inada in
Japan, viz. - 50.6 per cent.
The establishment of a diagnosis by means of
,bacteriological procedure was attempted. Blood
examination for the spirochaete proved negative in all
cases, as did guinea pig inoculations with suspected
1. blood. The urinary examination for the .presence of
the spirochaete proved more helpful, but the organism;
was never observed under the dark- ground microscope
or in stained films in typical form. The results, of
guinea pig inoculation with suspected urine containing
spirochaetes were very uncertain. The writer is of
the opinion, however, that in cases of jaundice in
which the clinical signs point to the spirochaetal
form,and in the urine of which granular spirochaetes
are found, the chain of evidence is strong enough to
justify the diagnosis of spirochaetal jaundice.
As an aid in diagnosis, serological methods were
applied in several cases but without very definite
results. No agglutination of the spirochaete was
observed when tested with the blood serum of four
patients during convalescence, but a lytic action of
the serum on the spirochaete was demonstrated in a few instances. The serological aspect of human
infection was not studied to any extent owing to the
difficulty of obtaining material for this purpose.
The writer was instrumental in effecting the pr-eparration of a specific anti-serum from the local strain
of the organism. The number of human cases in which
it has been used, is too few, however, to state an
opinion regarding its efficacy.
The chief prophylactic measure is agreed to be
rat extermination as far as possible,- and moreover
in infected coal-mines, improved drainage7as Inada
found that this measure was responsible for a decrease in the incidence of the disease in certain
wet mines in Japan. The usual precautions applied
to other infectious diseases should also be put into
force. Active immunization was established by the
Japanese who administered spirochaetal vaccines with
very satisfactory results.