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.

    5/16 (page 791)
    L Medical Journal we failed to find Bacillus icteroides in any of our tubes or plates. The results of cultures taken in 188 cases of unmis¬ takable yellow fever, on various days of the disease, and in some cases on every day from the onset to death or recovery, would seem to exclude the presence of Bacillus icteroides in the blood of these cases during life. It will, therefore, be seen that while Wasdin and Geddings, taking cultures from the ear-lobe (Report on the Cause of Yellow Fever, 1899), record that “ in the blood of yellow fever cases extracted during life Bacillus icteroides has been found in 13 of the 14 cases, with 1 negative,” (92.85%), we, by withdrawing the blood from the veins of 19 patients, have to record 100% of failures. We have already stated that we will reserve for a later report a description of the bacteria isolated from the blood in these cases. We now remark that but few organisms were obtained and that, as a rule, our blood- cultures gave no growth whatever. B. Cultures from Yellow Fever Cadavers.—We tried to obtain autopsies very soon after death, and sometimes succeeded in doing so. Tubes containing about 10 ccm. of flesh-pep4one bouillon were generally used for the first inoculation direct from the blood and organs. As soon as the laboratory was reached, agar plates were made from these inoculated bouillon tubes, the former as well as the latter being then incubated at from 35° to 37° C. In nearly every case gelatin plates were also made from the recently inoculated bouillon tubes and kept at a temperature of 19° to 20° C. If colonies were found in the agar or gelatin plates, on the following days, the corresponding bouillon tubes were also plated on agar and gelatin. The bacteria thus found in our plates were carefully isolated and studied upon the usual nutritive media, so as to enable us to identify them, if possible. We will here content ourselves with giving the results as regards the pres¬ ence of B. icteroides only. much surprised at the absence of this bacillus in cul¬ tures from cadavers sectioned in or near Havana, during the present year. In 2 of the 11 cases we had reason to believe that from the appearance of colonies seen in gelatin plates, we would be able to isolate B. icteroides. These colonies, however, when transferred to other media and carefully studied, did not prove to be this bacillus. We wonder whether other observers have occasionally relied upon the appearance of colo¬ nies in gelatin plates, without further study. We only mention this as a possible explanation of the large per¬ centage of positive results recorded by some observers. Portier, of New Orleans, La., only succeeded, how¬ ever, in isolating B. icteroides in 3 out of 51 autopsies 1 (,Journal of American Medical Association, April 16,1898), and, if we remember correctly, Veazie, of New Orleans, has recently reported that during the epidemic of 1899 in New Orleans a pure culture of B. icteroides was not ! isolated in any case of yellow fever. Lutz (Revista d’lgiene e Sanita Publica, xi, No. 13, I July, 1900, pp. 474-475) says as the result of his ex- i tensive observations on yellow fever that Bacillus icte¬ roides cannot be found by present laboratory methods in more than half of the cases of yellow fever, and that when present, the colonies are few in number. It is possible that our future autopsies may give more favor¬ able results as regards B. icteroides. II. The Mosquito as the Host of the Parasite of Yellow Fever. —Having failed to isolate B. icteroides, either from the blood during life, or from the blood and organs of cada¬ vers, two courses of procedure in our further investiga¬ tions appeared to be deserving of attention, viz., first, a careful study of the intestinal flora in yellow fever in comparison with the bacteria that we might isolate from the intestinal canal of healthy individuals, in this vicinity, or of those sick with other diseases; or, sec¬ ondly, to give our attention to the theory of the propa¬ gation of yellow fever by means of the mosquito—a Table II. NO. OF CASE. DAY OF DISEASE. time of autopsy. SOURCE OF CULTURE. B. ICTEROIDES. 1 Seventh. 2 hours after death. Blood, liver, spleen, kidney. Negative. 2 Sixth. 13 hours after death. Blood, liver, spleen, kidney. 3 Fourth. 8 hours after death. Blood, liver, spleen, kidney. 4 Eighth. 2 hours after death. Abdominal, cavity, blood, liver, spleen, kidney, bile, duo¬ denum. 5 Fourth. 4 hours after death. Blood, liver, spleen, kidney, bile, duodenum. 6 Sixth. 6% hours after death. Abdominal cavity, blood, pericardial fluid, lung, spleen, kid- nev, liver, bile, duodenum. 7 Sixth. 50 minutes after death. Blood, lung, liver, spleen, kidney, bile, jejunum. 8 Sixth. % hour after death. Blood, lung, liver, spleen, kidney, urine, small intestine. 9 Fourth. 2 hours after death. Liver, spleen, small intestine. 10 Fifth. * 7 hours after death. Liver, kidney, spleen, small intestine. 11 Third. % hour after death. Liver, kidney, spleen. Our failure to isolate B. icteroides in these 11 autop¬ sies of yellow-fever patients was a result which we had not anticipated. One of us (Agramonte), who, at Santi¬ ago, Cuba, during the epidemic of 1898, succeeded in finding B. icteroides in 33% of his autopsies, has been 3 Cultures from the blood during life had been taken by Dr. Lazear in 8 other cases of yellow fever, but, owing to the death of our colleague, the necessary data as to the day of the disease on which cultures had been taken cannot be ascer¬ tained. These cultures were negative as regards the finding of Sanarelli’s bacillus. theory first advanced and ingeniously discussed by Dr. Carlos J. Finlay, of Havana, in 188i (Anales de la Real Academia, vol. xviii, 1881, pp. 147-169). We were influenced to take up the second line of in¬ vestigation by reason of the well-known facts connected with the epidemiology of this disease, and, of course, by the brilliant work of Ross and the Italian observers, in connection with the theory of the propagation of malaria by the mosquito.