The morning news. [volume] (Savannah, Ga.) 1887-1900, 1897-09-17
From the New York Post.

istics of the Disease-The Cause of
Death.
From the New York Post.
Washington, Sept. 13.-Instructions
having been sent by the Marine Hospital
bureau here to the yellow fever district In
the south that the methods of DR.. sana-
relli of Brazil shall be made the basis of
the study Of the present outbreak, especial
interest attaches TO Sanarellrs discover
les. His report on his researches was for
warded a few weeks ago by DR.. Cleary
OF the Marine Hospital service from Rio
dc Janeiro 1t is too Voluminous to be
copied in full, and much of it is too tech
meal to be understood by the general
reader; but some passages from it deserve
reproductions:
mo one who has followed a case of yell
low fever, and observed the successive de-
Velopment of the symptoms which give
this disease its marked and peculiar char
acter, can doubt for an instant that the
process is due to the action of a microbe
which is absolutely specific, and which
can be easily demonstrated in necropsy
In the majority of cases. however, the
| most complete and minute archaeological
investigation of the cadaver seems calcu-
lated tosniislead the Investigator and turn
him from his purpose.
THE bodies of icteroid-ty phus (yellow
fever) patients will be found TO be invad
ed by certain microbic species, streptococ-
CT, staphylococcus, pyogenes, coli bacillus,
etc, which are in no way responsible for
the disease, or they are invaded by mix
ture of microbes, the classification of
which IS a stupendous undertaking.
The microbe of yellow fever may with all
propriety, be termed the icteroid typhus.
since yellow fever is also termed icteroid
typhus. The icteroid ba-
cillus should be sought in
the blood or tissues, and not in
the gastro-intestinal cavity, contrary TO
what might be presumed a priori in the
premises. In fact in yellow fever, the
digestive canal is the seat, as in typhoid
fever, of an abundant termination of
bacillus coli, which is there found in a
state of absolute purity.
THE result of my Investigations show
that the icteroid bacillus may be isolated
in SO per cent. of the cases of yellow fe-
yer, and in some cases may be found even
during life. The reason why it may not
always be recognized are easy of compre-
hension. In the first place, the icteroid
bacillus multiplies very slowly in the first
stage of the disease very small quanti-
ty of the toxin being sufficient to develop
in the human subject a very grave case
of yellow fever. In the second place, the
toxin, either of its own potency or by
means of the profound LESSONS which it
determines In the digestive fluids and
liver, facilitates to the most extraordinary
degree secondary infections of every sort.
These secondary infections may some
times assume the type of true septicaemia,
due to bacillus coli, to streptococci or
staphylococci, etc. and are sufficient of
themselves to cause death. At other
times they occur in such multiple colonies
as to transform the patient into a verita-
nf al he faG n
microbes. Fjnally,as the result of my OBJ
seFvation that the icterold bacillus always
occurs in the blood and tissues, and not in
the gastro-intestinal contents, we may
conclude, contrary to what has hitherto
been received, that the virus Of yellow
fever does not reside in the intestinal
tube, and that its toxin, instead of being
absorbed by the intestinal walls, is elabo-
rated in the interior of the organs and in
the blood.
'aThis bacillus, morphologically consider
ed never presents marked characteristics
at the first view 1t is a small rod with
rounded extremities, generally united in
pairs in cultures, and in small groups in
the tissues, from two to four thousandths
of a millimeter in size, and generally two
or three times longer than 1t is wide. 1t
is sufficiently pleomorphous.
yellow fever both in man and the low
er animals, represents disease of cyclic
progress. During this period the specific
microbe Is found in the organs in state
of great scarcity, and it is in the morbid
period, or after seven or eight days, that
it suddenly invades the whole organism,
accompanied almost invariably by other
microbes of intestinal origin. 1t is only in
cases that terminate in this way-that Is
TO saw in those which execute regular
cyclic deVelopment-that the specific mi
crobe may be readily found dispersed
throughout the blood and the organs.
when intercurrent septicaemia and
premature uremic poisoning abruptly ter
inmate this morbid period, the isolation
Of the icteroid bacillus is extremely diff
cult If not impossible.
THE icteroid bacillus, once introduced
into the system, not only determines
general infection, but causes specific al
terations, having their favorlte location
In the kidneys, in the digestive canal, and
the liver. In the last named organ a rapid
fatty degeneration takes place, In the d.
gestive canal gastro-enteritis, and in the
kidneys acute jarenchynatous nephrltis
'oThe yellow fever patient is, In fact,
menaced by three imminent dangers, and
examination of the cadaver may determine
the immediate cause of death.
a. Death may be considered due in
great part to specific infection, particular
ly when the icterod bacillus is found in
the body in considerable quantity, and in
cases which complete the full morbid cy-
Gle
%. 1t may be considered as produced by
septicaemias successfully established dur
ing the course of the disease when the
cadaver shows products Of almost pure
culture of other microbes.
20. It may. be due In great part to in
sufficient action of the kidneys, when the
body is found almost sterile with q consid-
erably large quantity of urea in the blood,
death having occurred before the morbid
cycle had completed its evolution.
ut is difficult 10 pronounce during the
life of the patient on the predominance of
specific uremic symptoms, because the
most salient features of yellow fever pois-
oning are easily COMPOUNDED with failure
of the kidneys. This frequent and UNI
avoidable complication is sometimes the
principal cause of the failure Of yellow
fever to take on a distinctly thermic type.
'It is very probable that certain tenn
peratures, which are apparently normal,
and certain low temperatures, which man
ifest themselves very frequently during
the period Of delirium and in full conva-
lescence and some sudden and unexpected
examinations of the morbid process, are
for the most part due not to the action