The Houston daily post. [volume] (Houston, Tex.) 1886-1903, 1897-11-17
REPORT OF DR.. GUITERAS.

From the OFFICIAL report Vi thS ~
States marine horpital service py II
John Guiteras, Dir fessor Of general pain
ology and morbid anatomy, University oi
Pennsylvania and temporary acting as
sls,hnt surgeon, United States marine
hospital service.
when ordered by the government TO IN
spect points in the South as yeilow
fever expert, have assumed 1t to be my
duty, not solely to report upon the dag
nosis Of Individual cnses. but to form an
opinion as to the actual state OF the out
break, whether 1t DO possible to locaiize
II and stamp 1t out; or on the other hand,
whether the outbreak is beyond the con-
troll Of our means Of sanitation. ! have
even deemed 1t pcssiblss when yellow fever
was not found in oas Of the Southern
States, 10 predict whether 1t was likely
to break out or not duriig the summer
The diagnosis, then, from my point OF
view. Is OF two kinds, namely, as to the
epidemic status Of the locality. and as 70
the Individual cases.
| careful study Of the conditions exist
ing In Cuba during the earlier part OF the
present summer made 1t very probable
that yellow fever would extend from that
island to this country. There prooaDiy
has never been so much yellow fever in
| CUBA as there has been during the pres
ent season.
| rist, as to the epidemic status: There
are several features characteristic OF the
community where yellow fever is prevail
| ing that make the fact known to an ex-
perieneed observer, even when willfuliy or
otherwise its presence Is denied by the
| physicians and local authorities. Without
seeing single case OF the disease ! have
often made up my mind as to the exist
ence Of yellow fever from the reports OF
prevailing sickness given by the physi-
clans.
| In the first place, many cases OF acute
| febrle attacks OF mild character are re-
| ported and an attempt Is made to show
why they can not be cases OF yellow fever.
They are usually ascribed to an epidemic
OF dengue or to prevailing malarial in
| lection. The report that some Of these
! cases have shown albumin in the urine
! becomes extremely suspicious. Fatal cases
| are reported, but some intercurrent disease
| or previously existing condition Is supposed
I to be tho cause of the fatul termination.
On investigation it is found that most Of
these cases are OF young people. Very
OFTEN one or two physicians are found in a
locality who positively declare that they
have seen extremely suspicious cases or
| positively diagnosed such cases OF yellow
fever. These physicians are generally
younger members Of the profession who
have never seen the disease. 1t Is mat
ter OF experience that usually the older
physicians acquainted with the disease in
former epidemcs fail to recognize these
early cases and are the last to become con-
WINGED OF the existence of the disease.
| Convaescents from yellow fever may be
discovered also on the streets An icteroid
hue of the eye persists usually for some
tfNa Of tnH and hnI inpA .nf
rarely shows itself also as premonitory
symptom OF an attack.
Another aid toward forming an opinion
Is found in the study of the mortuary
records. comparison should be made
between the present time and the preced-
Ing year. Sometimes this investigation Is
in itself enough to give strong presumptlve
evidence one way or the other The char
acterlstlc feature of the mortuary records
is the increase in the number OF deaths
| among the white population. he class Of
the white population especially affected
varies according to the manner of intro
duction of the disease. 1t may affect es-
pecially the sailors, or children, or rail-
road people. Even when there is no
marked Increase OF the death rate OF whits
people we may find cause of death that
are suspicious. For instance, young adults
dying Of congestion of the stomach. con-
gestion Of the brain, purpura, hemorrhagi-
mittent fcvers
The diagnosis OF individual cases OF yell
low fever Is, in My opinion, very easy.
There is no acute febrile disease in which
there are as many signs that may be called
pathogncmonic. The diagnosis of tn, DIS
ease rests upon three sueh symptoms,
namely, the facies, the alpuminuria, and
tho want Of correlation between the pulse
and the temperature l rely mainly for my
diagnosis upon the faCies, which / con-
slider extremely characteristic. However.
as consider 1t my duty to convince the To-
cal practitioners Of the existence of the
disease. make 1t rule not to announce
officially the existence CT yel,oS fever UNI
I'll l have been able to show the presence
OF albumin in the urine. My own mind,
however, IS generally made up by the
simple inspection of The patient and | al
most invariably find my opinion confirmed
ON the second, third OF fourth day by the
appearance Of the albuminura.
The appearance OK The i.ice is that OF ty-
phus fever during the first forty-eight
hours of this disease. or like that OF nies-
sles before the eruption breaks out with
more or less pronounced icteroid hue, It is
the latter feature, 1 believe, which gives
the face its characteristic appearances. In
the first twenty four hours. or forty-eight,
II Is by no means distinct jaundice The
physician to whom AM showing the signs
Of the disease usually expresses surprise
when / state that jaundice is present. 1t
Is, OF course, best noted in The sclerotics.
II Is hidden, however. by the marked injec-
ion OF the enaller vessels Tho icterold
hue is often better seen at some distance
from the patient than when the eye is
closely inspected. 1t seems 10 show itself
in waves with the different movements OF
the eve. Possibly this is the result Oh
transient contraction Of the vessels OF the
conjunctlva or OF the different angles Of re-
Election Of the light upon the cyeball. In
severe cases and on The second and third
day Of the disease the iaundlce becomes
more prominent II will show Itself In dis
tinet waves as the capillues OF the skin
| contract with the movements OF the facial
muscles, or 1t may be brought out by TAX
Ing up a fold of the skin between the fin
gers. when the contrast between the yell
lowish anemic skin and the surrounding
congested areas Will become well marked.
Later On there may be we'll marked jaun-
dice BY this time usually the florid color
OF the face has bean replaced by more
dusky hue. In the later stages Of the dis
ease Their are also characteristic features OF