Report on the first eighteen months of the fourth yellow fever epidemic of British Guiana / by Daniel Blair.

  • Blair, Daniel.
Date:
[1856]
Catalogue details

Licence: Public Domain Mark

Credit: Report on the first eighteen months of the fourth yellow fever epidemic of British Guiana / by Daniel Blair. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    92/96 (page 90)
    had often seen them formerly in the urine and black vomit, and other fluids eli- minated from the subjects or yeUow fever; but as in most cases they are colour- less and empty when, so foxmd, I was wont to set them down as extraneous bodies, and suspected them to be fibres derived from the linen sheets and towels of the establishment. With this preconceived idea, they were of course overlooked and unrecorded. On turning up some old mounted specimens of caddy stool of the epidemic of 1851, I find these vessels still existmg in them. The fragments of capillaries are found generally in single cylinders ; I have seen, however, a few branched and bifurcated. Their tendency to break off seems to be at the bendinas. The fracture is occasionally clean, but generally the broken end is split into fila- ments. A separation of filaments seems to be the mode in which the fracture occurs; and in many fragments, the length of which wUl occupy three or four times the field of vision of a half-inch object-glass, several partial fractures may be observed in which the tube at such points is split all round longitudinally, and a perfect sub-division is about to occur. At sucn points on the outer angle, and at the open ends of the capillary fragments, the debris of blood corpuscles is to be seen, and these sometimes form a little dossil which is seen connected with the tube of the vessel by fibrillse. In the urine, 1 have seen some of the capillary fragments enveloped in the tube-cast material, but encrusted evidently with flat instead of spheroidal epithelium. I cannot observe in the specimens which I have now sent, any epithelial lining within the capUlaries ; and yet their calibre, I think, is such as would lead us to expect its presence, were they not diseased. In some of the specimens which I have kept of the same expectoration, epithelial matter is visible alongside of the broken capillary vessels, as if it, as well as the blood, had escaped from their cavities. Eindtng that ecchymosis of the conjunctiva, epi- staxis, and some other hsemorrhagic appearances, are common in yellow fever long before the blood has apparently lost any of its fibrine ; and findiirg that even when black vomit is established and the tongue is smeared with blood, the corpuscles are normal in appearance, I carmot but look on the textural lesion of the capillaries as a primary eilect of the yellow fever poison, and as the cause of the congestions, ecchymoses, oozings, and haemorrhages, and all their consecutive mischief. The phenomena of the present minor epidemic also corroborate the view that the poison attaches itself to the mucous membranes in the first instance. Its early effects seem to be local. The system is thereby inoculated, and the poison spreads to all the analogous tissues of the body. A. general impregnation of the circulation in the first instance would be scarcely compatible with the fact of the slow, steady march of the pathogenic influence through the various organs of the body. 1 enclose the case of Thomas Bailly, as reported in our hospital case book. It will be seen how his attack commenced like a common cold—be?an in the bronchi, and how it gradually extended to the conjunctiva, mucous meraDrane of the mouth and fauces, to the liver and kidneys, and its final resolution. I may mention, in reporting progress, that I have detected the glandular cells of the liver to be a common and very large constituent of black vomit. Their shape and size and tint, and the presence of minute oil-globules beside the nucleus in the epithelium, leave no doubt in my mind as to their identity. In the flakes of the black-vomit sediment, also, there'is not much difficulty, with the addition of liquor potassa, in distinguishing the bilc-flakes from the blood-flakes. I remain, my dear Sir, ever faithfidly yours, D. Blaik. Dr Jolm Davy, F.R.S., &c. &c. Relative to the morbid specimens referred to in his letter which my friend has sent me, and which I have examined with some care, I may remark that their appearance under the microscope accords well with his description; and in consequence, that I entertain no doubt that they are really fragmentary portions of vessels. The only substances much resem-