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The Weil-Felix Test for the Rickettsioses

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20 Lib. 265, preface, (RML). in Valletta, Rome .. p. 179. Ms. 142 E (a), foJ. 521. (RML). SCICLUNA, H. (1955 b). ibid., pp. 115 & 207. Ms. 142 E (b), fol. 323, (RML). VESALIUS, A. (1543), De humani corporis SCICLUNA, H. (1~55 a). The Church of St. John fabrica, Basilea, p. 164. THE WEIL-FELIX TEST FOR THE RICKETTSIOSES ETHELWALD E. VELLA B.Sc., M.D., F.R.C.Path., D.C.P., D.T.M. & H., M.I.Biol., L./R.A.M.C. r1.ssocia·te Professor of Pathology, RoyaJ Army Medical College, London Prologue patient's serum against this protozoal disease by testing the specimen against - A pathologist's lot is a happy one. of all things - B.C.G. used as a diagnostic Some things he does are to say the least, reagent in his laboratory test! most extraordinary even unbelievable, Now take this Weil-Felix test; the except that they are practical and there­ other day a young Caucasian patient com­ fore useful. Consider the bullock's heart, ing out of Africa developed fever with a freed from fat· and alcohol extracted - rash soon after landing in his native now use the resultant product to diagnose Britannia. One of the possibilities was Syphilis in Switzerland, Pinta in Paraguay obviously a rickettsial fever - so off went or Yaws in Zanzibar. Go down to the local his serum for screening against rickettsial abattoir and collect the dripping blood disease, and one of the tests done was, in from a bleeding sheep, or better still take fact. the Weil-Felix test, that is to say some horse's red blood cells - now mix doubling-up dilutions of the patient's them with the fluid portion of your serum from ]J in 20 to 1 in 10,240 are jaundiced patient's blood and you may placed in a row of test tubes and a drop pontificate that he or she is suffering from of a milky suspension of Proteus bacilli 1S Infectious Mononucleosis (or should it be pipetted into each. The test-tube rack is Infectious Mononucleoses?) then placed in an incubator at 37°C for 2 And this goes on and on; some months hours, stored overnight in the cold room, ago a patient fresh (I speak metaphorically and the results are observed after a with reference to an episode in time and further 2 hours standing on the laboratory not to the patient's actual physical condi­ bench at 22° C. After this cabalistic pro­ tion at that time - perhaps "fresh" is not cedure the pathologist duly reports his the rIght \vcrd) from his Mediterranean findings. holiday was complaining of a P.D.O. (or if It was at this point that I sat up (so you ar.:: a::. Am9rican colleague, an F.D.O.). to speak) and took upon myself the task An a~:~~:lOt portion of a specimen of his of finding out the How and Why and serum was therefore prudently referred Wherefore of this Proteus bacillary sus­ for investigation re leishmaniasis. The pension test to screen for such an exotic pathologist in his ivory tower screened the illness as a spotted-fever-group communic- 21 able disease. the very beginning. But let each reader With these objectives in mind I betook judge for himself. myself to those Herculean Pillars of Bri­ On June 16th, 1917, a month later that tish Medicine, "The Lancet" and the "Bri­ is, the "British Medical Journal" on page tish Medical Journal" optimistically 825, carried an anguished cri du coeur in expecting to get an early answer to the protest against the previous innocuous­ mystery of the W-F and thereby achieve looking and half-hidden announcement. a quick Q.KD. and consequent peace of Here are extracts (somewhat paraphrased) mind. This however was not to be; the of these, which were in the form of a letter Quest for the W-F was not to prove so entitled, easy. "Typhus Fever and the so-called Weil­ Felix Reaction" Section 1. Stadium 1 note the emphasis on the operative words The Qu~st begins ... "so-called" . To set down in correct chronological The letter read as follows, order the sequence of events as the story "Sir, unfolds itself, the first finding that the I read this with great interest, since search threw up was a very inconspicuous it shows that investIgations carried out note right at the bottom of a page in the by me at Belfast some ten years ago are "British Medical Journal" for May 19th, now being confirmed on an extensive 1917, page 649, where it was announced scale. The results of my investigations for the diligent reader who reads medical were published in the "Journal of journals from front page to back page Hygiene" (the writer refers to J. Hyg. (including the adverts) that, for 1909, and 1910). In these publications "The German authorities have arranged I showed that in typhus fever the blood for the systematic testing at the Robert serum often agglutinates intestinal Koch Institute of blood taken from bacilli - for example B. coli, B. typho­ patients suspected of typhus fever. The sus, and espeCially a coliform bacillus Weil-Felix reaction is employed, and isolated from the urine of certain cases. whenever the reaction is negative but I pointed out in the paper dealing with the clinical symptoms remain suspicious the etiology of typhus fever that the a second sample is examined". presence of these agglutinins did not This was indeed only a meagre 5-line necessarily imply that the bacillus in note but it was certainly calculated to question was of etiological significance. arouse the curiosity of an amateur medi­ The whole question of heterologous cal historian such as I am, especially taking agglutinins is fully discussed in my into consideration the fact of my being paper, and before the reaction is cre­ also an army man at that. The reader will dited to W~il-Felix, I think it but fair note the year - this was in fact in the that my work on the subject should be midst of World War I, and I thought to my­ considered. self as I read this notice, that once more It would seem therefore that the our German medical confreres had got in work of Weil, Felix and Dietrich first again - a Ut Wassermann and his (Deutsch. med. Woch. 1916) is a redis­ evergreen venereologic test. covery of what was pointed out by me in This was then the beginning of the the "Journal of Hygien8" many years trail, that kept on opening hitherto unsus­ ago. pected vistas to me, as I coasted along it; very much like those exhilarating and won­ Signed: derful mountain roads in the Tirol. For no Captain W. James Wilson RAMC (TF) sooner had I started along the main high­ No 54 (London) General Hospital way, when my observation was drawn to British Expeditionary Forces, the fact that possibly I had not began at May 25th. 22 cal Corps. These two authors subtitled th;;ir pap2r, 'Observations of a serological test (Weil-Felix Rsaction)' but neverth3- 19S5 acknowledged Wilson's work in their very first introductory paragraph; thus they op3ned up their paper by stating: "The following is a brief account of our experience of the Weil-Felix reaction during the early months of 1918 in Egypt and Palestine. The reaction is an amplifica­ tion of the work done by Dr. Wilson of Belfast who first showed that typhus serum possessed the power of agglutinat­ ing certain intestinal organisms. During th~ past year it has been favourably reported on by Austrian and German workers." Sir Neil Hamilton-Fairley (1891-1966) was one of the most distinguished Austra­ lians of his generation and an outstanding worker in thC) field of tropical medicine. WILLIAM JAMES WILSON (1879-1954) "I showed that in typhus fever the blood serum agglutinates a coliform bacillus iso­ lated from the urine. The work of Weil and Felix is a rediscovery of what was pointed out by me many years ago." William James Wilson (1879-1954) had been Emeritus Professor of Public Heath, QUten's University, Belfast and Consul­ tant Director of Public Health Laboratory Service, Northern Ireland. He was also noted for the Wilson-Blair medium u:~ed especially for Isolation of Salmonella typhi; on this medium the first positive isolations of this dangerous organism from sea water and from River Thames water had been reported. On our side of the barbed-wire fences some of his fdlow war service medical EDMUND WElL (1879-1922) officers gave Capt. Wilson a measure of loyal support; thus late in 1918 (Sept 21) "The Weil-Felix Reaction was one of the "The Lancet" published an article entitled most outstanding medical achievements of "Typhus Fever" by Capt. C.M. Craig, WorId War I, and it was indeed suggested Royal Army Medical Corps, and Major N. that to honour Weil the Proteus X strains Hamilton Fairley, Australian Army Medi- should be called Proteus weilii". 23 He described a new pigment in blood, methaemalbumin, and was elect'od F.R.S. in 1942. His work as Dir2ctor of the Land Headquarters Medical R~search Unit, in World War II in Queensland, Australia led to the Allied Armies prophylactic anti­ malarial regime of daily mepacrine. He was the first holder of the Wellcome Chair of Tropical Medicine at London University in 1946 and a Consultant to the British Army in Tropical Medicine in 1950. In expressing their acknowledgement Capt. Craig and Major Hamilton-Fairley wen in fact reiterating th" sentiments ex­ pressed in an editorial annotation which appeared in the British Medical Journal for Ja~.
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