War Surgery and Medicine
A DISEASE regarded before the war as a medical curiosity with localised distribution, Q fever came to be recognised during the war as of world-wide incidence. In 1937 Derrick described the clinical features, diagnosis, and laboratory findings of a new fever entity which he named ‘Q’ fever. The original cases occurred among workers in a large meat works in Brisbane. Derrick was able to transmit the infective agent to guinea pigs by the injection of blood or urine from the cases in the acute stage of the disease. The study of the infective agent was taken up by Burnet and Freeman, who established the disease in mice and isolated the infective agent which proved to be a rickettsia, subsequently named by Derrick ‘the rickettsia burneti’. The clinical picture in the human cases was quite characteristic. The incubation period was fifteen days or less, and the clinical features were constant. It is noteworthy that in the original cases described by Derrick no pulmonary lesions were noted. Between September 1935 and August 1942, 176 cases were recognised. All but two occurred in males, and the ages ranged from 10 to 64 years; 129 of the cases occurred among urban dwellers and 47 in country people. All but six occurred in men connected with the cattle industry in some way or other.
Serological surveys of men working in abattoirs in Brisbane showed that the infection was very prevalent among this group of workers, many of whom had evidence in the blood of Q fever but who had had no notable illness to suggest a Q fever attack. The first record of the so-called atypical pneumonia syndrome occurring in cases with Q fever was in an epidemic described by Hornibrook and Nelson which occurred in 1940 among employees of the National Institute of Health, Washington DC.