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
Catalogue details

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.

    51/108 (page 35)
    The conclusion which we thought probable was that they were the local lesion caused by the introduction and local development of the parasite of yellow fever, and that the condition found in the lymphatic glands was of the same nature. The mode of proof by watching the progress of the bite of an infected gnat upon an experi¬ mental case could not be made, and unfortunately the Commission under Major Reed do not refer to the matter.1 Another mode of proof was by determining the presence of the yellow fever parasite in the locality. After scrubbing the skin with lysol and then with spirit, the spots were stabbed with a lancet, and the blood, which freely exudes, was taken directly into a fine sterile capillary without touching the skin. Examination of specimens thus taken were examined in the fresh state, and also stained with carbol fuchsin. In the stained condition a few small, fine bacilli from 2 to 6 /u in length were found in scanty numbers, sometimes in tiny groups of four or five, sometimes singly ; besides these bacillary forms sometimes small coccoid bodies in pairs or singly could be found. It was suggestive that these might be the spherical shape assumed by the bacilli in consequence of the bactericidal action of the blood, especially from the specimen of a late case (P.-M. ii), who had many typical bites when admitted on the fifteenth day ; in these some little groups contained, apparently, stages between the complete bacilli and the coccoid forms. Here there is, of course, a risk of contamination with skin microbes. At a later date after my illness I examined some bites (which were rather swollen and due to the entrance of several C. fatigans during one night through neglect of closing the mosquito net) ; the blood obtained contained many ‘ polynuclear’ leucocytes, in some of which ingested bacilli, similar to our small bacillus, were found, as also in the salivary sacs of the gnats themselves ; this was very suggestive of an introduction of bacilli by the gnats (Fig. 2). B. Lymphatic Glands Since it appeared likely that the infection of yellow fever was introduced by some such agency as the gnat, it was possible that, the infection being local and superficial, there might be some signs of lesion about the corresponding super¬ ficial lymphatic glands. Our attention was more particularly attracted to this point by the marked enlargement, deep congestion, and juiciness of the axillary glands in our fourth autopsy, on October 29, 1900. After this, the investigation of the axilla became a constant feature of the clinical examination of patients; in some cases the inguinal and femoral regions were also felt, but comparatively little attention was paid to these owing to the obvious source of fallacy during life. In forty-four cases of undoubted yellow fever, palpable and marked enlargement of the axillary glands is noted thirty-nine times, questionable enlargement three times, 1. It is obvious that if a single bite has caused the disease, the lesion, even it ‘typical,’ might be overlooked. I must frankly own that I should have anticipated finding the small bacillus in greater numbers in the axillary glands.