Report of the yellow fever expedition to Parà of the Liverpool School of Tropical Medicine and Medical Parasitology / by H.E. Durham.

  • Durham, H. E. (Herbert Edward), 1866-1945.
Date:
1902
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Licence: Public Domain Mark

Credit: Report of the yellow fever expedition to Parà of the Liverpool School of Tropical Medicine and Medical Parasitology / by H.E. Durham. Source: Wellcome Collection.

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    Following Sanarelli came a number of publications dealing with the bacillus ; of these, that of Wasdin and Geddings1 gives positive finding of B. icteroides in thirteen out of fourteen cases examined. Whilst they undoubtedly met with the bacillus in question, their account, especially of the fermentation reactions, is not entirely clear; it is not possible to summarize their results, for it is not always certain whether the cultures mentioned were pure or not; in several instances it is stated that contaminations such as B. coli were present. The much discussed case of P. Smith2 3 perhaps gives a clue to the asserted frequency of occurrence of B. icteroides, ‘ the present attack of illness came on the 5th of February, 1899 (W. and G.).’ On the 10th, i.e.> ‘on the sixth day of the disease,’ blood was taken from the ear tip, and with this plates were prepared; these ‘ gave us numerous colonies of B. icteroides ; also of two other organisms, one a colon. We offered this evidence as diagnostic on the 12th.’ It is not stated whether fermentation tests were made to prove the diagnosis of B. icteroides within this space of two days, anyhow it would not have been possible to have repeated them. At the autopsy ‘ in twenty-four hours the spleen gave a pure culture of B. icteroides, and the blood, a culture but slightly contaminated. Other organs and fluids the same. There was observed no B. typhosus.’ Agramonte’ does not regard this as a case of yellow fever at all; his account of it is at variance in several particulars ; thus on February 4, P. Smith had £ felt sick for about a week,’ or Major Ducker’s statement, ‘on February 9, 1899. It was then the eighth day of the soldier’s illness.’ It is agreed that B. icteroides was present; thus, ‘We found B. typhosus and B. icteroides in almost pure cultures from the spleen ; B. typhosus in pure culture from the kidney; B. coli, B. icteroides, and a non-motile bacillus from the blood ; pure culture of the bacillus only from the blood of the heart.’ Both accounts agree that there was malaria, and that there were no typhoid intestinal lesions. The evidence on which the recognition of the typhoid bacillus is based is not given, but this case is given so much attention here not because of yellow fever (Agramonte gives the opinions of six consultants, all of whom considered that the case was not yellow fever), but from the point of view of the pathogenic relation of the presence of B. icteroides, viz., was it merely an accidental contamination, or had it anything to do with the illness ? It becomes of interest to call attention to the work of the following observers, and to remark that the bacilli of Gwyn and Cushing (vide infra) were extremely typhoid-like when examined by the writer, for which without care they might have been mistaken. The more exact relationship of the B. icteroides was established by Reed and Carroll4 who found that it belonged to the so-called hog-cholera or ‘ enteritidis ’ 1. Wasdin and Geddings, Report of U.S. Aiarine Hospital Service, 1899. 2. No. 7, Wasdin and Geddings, l.c., and Agramonte, v. infra. 3. Agramonte, Reprints from the Medical News, February 10-17, 1900. 4. Reed and Carroll, Medical News, September 9, 1898