The etiology of yellow fever : a preliminary note / by Walter Reed [and others].

Date:
1900
Catalogue details

Licence: Public Domain Mark

Credit: The etiology of yellow fever : a preliminary note / by Walter Reed [and others]. Source: Wellcome Collection.

    3/16 (page 790)
    \»di.b ©riginal Articles. THE ETIOLOGY OF YELLOW FEVER. A Preliminary Note.1 By WALTER REED, M.D., Surgeon, U. S. A., AND JAMES CARROLL, M.D., A. AGRAMONTE, M.D., JESSE W. LAZEAR, M.D.,2 Acting Assistant Surgeons, U. S. A. The writers, constituting a board of medical officers, convened “ for the purpose of pursuing scientific investigations with reference to the acute infectious diseases prevalent on the Island of Cuba,” arrived at our station, Columbia Barracks, Quemados, Cuba, on June 25 of the present year, and proceeded under written instructions from the Surgeon-General of the Army, to “ give special attention to questions relating to the etiology and prevention of yellow fever.” Two of its members (Agramonte and Lazear) were stationed on the Island of Cuba, the former in Havana, and the latter at Columbia Barracks, and were already pursuing investigations relating to the etiology of this disease. Fortunately for the purposes of this board, an epi¬ demic of yellow fever was prevailing in the adjacent town of Quemados, Cuba, at the time of our arrival, thus furnishing us an opportunity for clinical observa¬ tions and for bacteriologic and pathologic work. The results already obtained, we believe, warrant the pub¬ lication, at this time, of a Preliminary Note. A more detailed account of our observations will be submitted to Surgeon-General Sternberg in a future report. The first part of this Preliminary Note will deal with the results of blood-cultures during life and of cultures taken from yellow-fever cadavers; reserving for the second part a consideration of the mosquito as instru¬ mental in the propagation of yellow fever; with observa¬ tions based on the biting of nonimmune human beings by mosquitos which had fed on patients sick with yellow fever, at various intervals prior to the biting. In prosecuting the first part of our work, we isolated d variety of bacteria, but of this we do not purpose to speak at present. It will suffice for our purpose if we state the results as regards the finding of Bacillus icte- roides, leaving the mention of other bacteria to our detailed report. The cases studied during the Quemados epidemic had been diagnosed by a board of physicians, selected largely by reason of their familiarity with yellow fever. This board consisted of Drs. Nicolo Silverio, Manuel Herera, Eduardo Angles, and Acting Assistant Surgeon Roger P. Ames, and Jesse W. Lazear, U. S. Army. Those studied in Havana were patients in Las Animas Hospital, and had been diagnosed as such by a board of distinguished practitioners of that city. An examination of Table I will show the character of the attacks. The milder cases studied, few in number, were attended by jaundice and albumin in the urine. I. Bacillus Icteroides (Sanarelli) as the Cause of Yellow Fez 'err.—The claim of Sanarelli for the specific character of B. icteroides as the causative agent in yellow fever, has excited such wide attention, since the publication 1 Read at the Meeting of the American Public Health Association, held in Indianapolis, Ind., October 22-26, 1900. 2 Died of yellow fever at Camp Columbia, Cuba, September 25, 1900, of his observations, that it seemed to us of the first importance to give our undivided attention to the isola¬ tion of this microorganism from the blood of those sick with yellow fever, and from the blood and organs of yellow-fever cadavers. A. Cultures taken from the Blood during Life.—The method followed was that ordinarily used in an attempt to isolate bacteria from the circulating blood ; viz., from a vein at the bend of the elbow, a sufficient quantity of blood was taken with an hypodermic syringe, made sterile by boiling, and after careful cleansing of the skin with soap and water, followed by equal parts of absolute alcohol and ether, and 1:2000 bichlorid solu¬ tion. Exceptionally the blood withdrawn was plated on agar, but, as a rule, it was immediately transferred to sterile bouillon tubes (10 ccm.) in quantities of 0.5 ccm. to each of several tubes. These were then incubated at from 35° to 37° C. for a period of one week. They were examined daily and if growth was observed, plates in agar or gelatin, or both, were made and the colonies carefully studied by transference to ordinary labora¬ tory media. Eighteen cases have thus been carefully studied; of these 11 were designated as “severe” cases of yellow fever with 4 deaths; three as “ wTell-marked ” cases with no deaths, and 4 as “ mild ” case3 with no deaths. From these 18 cases, blood-cultures were made, as shown in the following table : Table I. BLOOD-CULTURES DURING LIFE. DAY OF DISEASE. CHARACTER OF ATTACK. NO. OF CULTURES. NO. OF BOUILLON TUBES INOCULATED. ! 1 BACILLUS ICTEROIDES. 1st Severe. 3 < 4 (3 agar plates.) Negative. ti Well marked. 1 4 tt it Mild. 1 3 it 2d Severe. 6 18 . < it Well-marked. 1 2 tt It Mild. 1 3 (6 agar plates.) (t 3d ■ Severe. 7 18 (6 agar plates.) ft ti Mild. 2 4 tt 4th Severe. 5 14 it “ Well-marked. 2 6 it i l Mild. 1 1 tt 5th Severe. 5 12 (3 agar plates.) a << Well marked. 1 3 n « Mild. 1 1 it 6th Severe. J 4 6 it it Well-marked. 1 2 tt 7th Severe. 1 2 tt < i Well-marked. 1 2 il 8th Severe. 0 m 6 tt <1 Well marked. 1 2 tt 9th Severe. 1 2 it Number of cultures.48 Number of bouillon tubes inoculated.Ho Number of agar plates.18 Number of cultures.48 Number of bouillon tubes inoculated.115 Number of agar plates.18 It will be seen that of 48 separate cultures made from the blood on various days of the disease and repre¬ senting 115 bouillon inoculations and 18 agar plates.