7/29/2019 Investigations Into Yellow Fever Mexico

1/3

BMJ Publishing Group

Investigations Into Yellow Fever In MexicoSource: The British Medical Journal, Vol. 1, No. 3141 (Mar. 12, 1921), pp. 396-397Published by: BMJ Publishing GroupStable URL: http://www.jstor.org/stable/20426854

Accessed: 24/02/2010 14:20

Your use of the JSTOR archive indicates your acceptance of JSTOR's Terms and Conditions of Use, available at

http://www.jstor.org/page/info/about/policies/terms.jsp. JSTOR's Terms and Conditions of Use provides, in part, that unless

you have obtained prior permission, you may not download an entire issue of a journal or multiple copies of articles, and you

may use content in the JSTOR archive only for your personal, non-commercial use.

Please contact the publisher regarding any further use of this work. Publisher contact information may be obtained athttp://www.jstor.org/action/showPublisher?publisherCode=bmj.

Each copy of any part of a JSTOR transmission must contain the same copyright notice that appears on the screen or printed

page of such transmission.

JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of

content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms

of scholarship. For more information about JSTOR, please contact support@jstor.org.

Digitization of the British Medical Journal and its forerunners (1840-1996) was completed by the U.S. NationalLibrary of Medicine (NLM) in partnership with The Wellcome Trust and the Joint Information SystemsCommittee (JISC) in the UK. This content is also freely available on PubMed Central.

BMJ Publishing Group is collaborating with JSTOR to digitize, preserve and extend access to The British

Medical Journal.

http://www.jstor.org

http://www.jstor.org/stable/20426854?origin=JSTOR-pdfhttp://www.jstor.org/page/info/about/policies/terms.jsphttp://www.jstor.org/action/showPublisher?publisherCode=bmjhttp://www.jstor.org/action/showPublisher?publisherCode=bmjhttp://www.jstor.org/page/info/about/policies/terms.jsphttp://www.jstor.org/stable/20426854?origin=JSTOR-pdf

7/29/2019 Investigations Into Yellow Fever Mexico

2/3

396 MARCH I2, 1921] 8. WBIA MITCHELL.?N'T. in the human body, and Dr. H. M. Turubullmade very complete histological studies of the ehangesin the Organs from cases, in man and animals. Thejaundice appeared to be a true toxic jaundlbe dueto detruction of 1iver by the poison and not to be of

haemolytic on gin. The aplastic anaemia-the rarestand most fatal of- the complications-was found tobe due to a direct action of the poison on the bloodforming, cells which thts caused a grew reduction ofthe blood-forining marrow. It was not due primarilyto haemolysis, though thisoccur in the laesagof the anaemia. The blood picte was that of aprogressive primary anaemia with high colour itThe interesting question was considered as towhether progressive changes in the liver werGe & upin T.N.T. workers after their removal from the influence, of the poison. In the severe cases of liverpoisoning there was clear evidence of the occurrenceof fatal toxic jaundice many' months after removalfrom the influence of the poison, pointing to progressive degeneration of the liver. Where only munorliver damage occurred such evidence as was available suggested that this was recoverable and notprogressive.

S. WEIR MITCHELLAiER his death in 1914 the College of Phyukia_ atPhiladelphia, forwhich the late Dr. Silas Weo itdid more than any other man of his gention, fondin his name and memory a triennial oration to deal with" the life and work of Weir Mitchell in their variousaspects, or the relation of the physician to public life. orthe physician in science or letters, or broad consideraiosof psychiatry and neurology, or surgery and militarysurgery in relation to morbid condiions and wounds andinjuries of the brain and nervous system, or of seientihioresearch, ormedical books and libraries, ormdical historyand biography, and shall be, as far as possible, at generalas well as professional interest" This long list wellepitomizes the many-sided activities of his remarkablepersonality. The first oration, delayed by the war until1919,was happily entrusted to Dr. C. W. Burr,' who revealsa literary gift of a Wigh order, tinged with an atractiveturn of gentle satire for the asing foibles of theyounger generation. To Weir Mitchell and SirWiiam,Osler the orator gracefully aekiowledgc his debt forinfluencing his intellectual life, and fot teachinf himthe paramount necessity for intellectual honesty; it isaccordingly with a pupil's reverence that be deTote thefirst oration to a description of Weir Mitchell as thephysician, the man of science, the man of letters and

the, man of affairs. The son of a scientific physician,he grew up in a medical atmosphere; otherwise it isprobable that his natural inclination would have me himpurely a man of letters. His early profeonal lifewasa struggle, for financial success was slow inarrivng, buthe filled in this probationary period by scientific researchand. did pioneer work on snake venom The iviit warprovided him with opportunities for an exltensive study ofnerve injuries, and his great work, Gunishot Wountt8 andoher Injuries of Nerve8 (1864), gave him a lasting reputation. Among his minor discoveries were the cremastericreflex and erytliromeklagia. His name became widelyknown in connexion with the rest cure ;. but, as Dr.Burr points out, it became too popular, and incompetentpractitioners adopted it for patients who really were inneed of a work cure. The first of. his fifteen novels,Itephzibah `Guinness, did not appear until he was 50, inddference to Oliver Wendell, Holmes's advice not tojeopardize his professional prospects; and on this incidentthe orator remarks that " little-minded people are oi the,

fixed opinion that no one sa have denough to dQwwthan one thing." The medicalma and thezeurlagistahOwup but littlein WeoMitrbas wves6, save for the acptions of really disb chrsers, togh oome ofhis writings, such as beo, ds and double perse.ality. form a concglink beween e and litureDrABurr suggests, tbt ,. reas wby no medical man oflettels has ever suceeei in a doctor isathat itinanalogous towriting his tobiogap or ting hisow; picture from a mror; preudi mkes him seewhAhe wants to see. He agrees with Weir ill thaGeorge Eliot's Dr. Lydgae is thee best descriptiox inmodern English literatmr., and Dickea's doctorsas either were ricat or illy, timen, goody.goody men; he does not Tackeray's Dr. Good.enough, generally regarded as a portrait of Elliotson, butperhaps this is too shadowy a sotch. As a post WeirMitchell was eminently ful for special occasions,and wrote charmwing verses on the country. Alwaysinterested in, physio-therapy he advanced its applictionad rescued it from the hands of charlatans; he also tooka, active part in instituting schools for traaning nursesand in numerous other -publicmovements. He died in his85thyear when stifl at work, and almost had the boon thatall men should pray for-namely, sudden death. Dr.Burr's tribute may recall Sir William Osler's obituaryremarks,2 in the course of which he applied to WeirMitchell the remark made by Samuel Johnson aboutMead: "No man ever lived more in the sunshine of life."

1The; S. Weir Mitchell Oration, delivered before the College ofPhysicians of Philadelphia on November 19th? 19?9, by Charle? W.Burr, M.D. ; pages 31. Published by the College. 1920.2British Mbdical Journal. 1914, i. 120

INVESTIGATIONS INTO YELLOW FEVER INMEXI1C0.IN continuation of the researches into the etiology ofyellow fever in Guayaquil which have been noted in ourpages from time to time, making it highly probable thatthe causal organism is Leptospira icteroides and alliedto the Leptospira icterokaemorrhagiae responsible for theform of infectious jaundice formerly termedWeil's disease,Noguchi, now in collaboration with I J. Kligler,8- hasinvestigated the disease at Merida, the capital of Yucatan,Mexico. During the four years previous to 191% asystematic anti-stegomyia campaign kept this city freefrom yellow fever, but in that year, as a result of an enormous crop of stegomyias, there was an epidemic of yellowfever from July to November, with 100ases anong newlyarrived troops, and a death rats of about 50 per cent.Arriving in December, Negach-i sad Kligler oundopportunities, in one fatal case, a case that recovered,and in convalescent pabients,- for scientific investigation.Blood drawn from the vein of a patient on the second,and third days of the disease, direetly tansmitthe disease bo guinea-pigs,. and there were indicatiomof abortive or mild leptespira isfection in guineafpigpinoculated with blood draw on thie fifth day of thedisease. Daxk-eI march fr the leptospira in materialfrom the fatal case was negabive, but cultures ofblood taken on the second day. of the diease shbowed, tbleptospiras. The morphological fbatums and cultural properties of the strain of leptospira, isolated from yellow,fever in M~erida were similar to those of the Guayaquilstrains. By means of an antiieteroid seram, preparedby repeatedly injecting a horse with dfereat strains ofLe~ptosipra icteroide fxom Guayaquil, itwas shown thatheMerida strain belongs to the same group as the Guayanuilstrain. Multivalent anti-icteroid immune serum prepared in the horse or univalent anti-icteroid immuneserumprepared in the rabbit had a definite devitalizing action ontheMerida strain, whereas antiserums similarly preparedwith straims of Leptopira icterohaemorrag~i~a did nothave any perceptible effect upon the Merida! strain.This observation is important not only in showing therelation of the Guavaquil and Merida srain. hbt Mlan9H. Noguchi and I, J. Kligler, Journ* Exger. Med., Baltimore. 1920,xxxii, 601-637.

7/29/2019 Investigations Into Yellow Fever Mexico

3/3

MARCH 12, 1921] THE MEDICAL SOCIETY OF LONDON. ICA0U 397in answering the criticism that "the yellow fever" inGuayaquil was really an infection with Leptospiraicterohaemorrhagiae. Anti-icteroides serum protectedguinea-pigs against infection, 0.1 c.cm. preventing fatalinfection against at least 5,000 minimum lethal doses ofthe Merida strain, when given during the incubation periodor at an early stage of the disease (fever and commencingjaundice), but being almost without effect at a later stagewhen the jaundice is deep and the temperature falling.If man's susceptibility to L. icteroidee is comparable tothat of the guinea-pig it may reasonably be assumedthat intravenous injection of the serum at an early stagewould have a similarly beneficial effect. A man weighing80 kg. would require about two hundred times the amountof serum that a guinea-pig weighing 400 grams would,or 20 c.cm., and, if necessary, the injection should berepeated at intervals of four hours.

CIATACLYSMAL HAEMORRHAGE AFTERTONSILLECTOMY.BLEEDINGof great severity is fortunately rare after tonsillectomy, and overwhelming haemorrhage leading to thealmost instant death of the patient is amongst the raritiesof medicine. A brisk arterial spurting from the tonsil-bedis not very uncommon, particularly in those adults whohave a sclerotic, buried, tonsil. In such cases the vesselinvolved is commonly believed to be the ascending pharyngeal, or more rarely one of the other arteries whichsupply the tonsil, but abnormally placed or abnormallylarge. There are, however, in the archives of medicine,records of cases inwhich the haemorrhage was so appallingthat one or other of the carotid vessels was believed tohave been injured, no other regional vessel being thoughtcapable of such violent bleeding. Fear of a disaster of thisnature was well known to our fathers, and forms thebackground to a story told of, Nlaton. A friend metNilaton at some distance from Paris, and askedhim what brought him thither. " I have just done theoperation," he replied, "which takes most out of me.I have removed two tonsils." With this anecdoteM. Sebileaul closes an exceedingly interesting descriptionof an overwhelming and immediately fatal haemorrhagefollowing tonsillectomy. M. Sebileau was not himself theoperator. It was his duty to perform a necropsy on thechild in question with a view to the absolution or arraign.ing of the surgeon. All who prize good writing, andparticularly dramatic writing, may be recommended toreadM. Sebileau's account of the operation and its sequels.The possibility of wounding either of the carotids has beendoubted bymany, and M. Sebileau went to considerable painsto establish beyond doubt the source of the haemorrhage inthis case. He injected the two carotids and the internaljugular severally with three different coloured media andwas able to show beyond all question that a piece had beencut out of the wall of the internal carotid artery. Preciselyhow this had happened, how the surgeon went blindlyafter the upper pole of the tonsil which had escaped removal,and how, hampered by the child's struggles, he cut awaythe posterior faucial pillar instead, is vividly described.The paper is well documented and contains a usefuldescription of the relationships of the various vessels tothe tonsillar fossa. M. Sebileau searched the literature ofthe subject and has found some eight or more recordedexamples. It is not certain that in all of these the carotidwas the vessel injured, but the violence of the haemor.rhage makes this probable. M. Sebileau has collectedalso six cases of injury to the carotid inflicted whilstincising a tonsillar abscess. These accidents, when they

do occur, are amongst the most painful disasters thatcan befall a surgeon.1"Les art?res carotides et les h?morrhagies cataclysmiques del'aniy gd alec torn ie totale." P- Sebileau, Bull, et M?m. de la Soc. deChir.. Paris, January, 1921,109.

MOTOR FUEL ECONOMY TRIALS.THE Royal Automobile Club has now issued the regu.lations to govern its fuel economy trials to take place onthe afternoon of Saturday, May 7th, with the object ofdemonstrating the possibility of obtaining greater fueleconomy in the use of cars than is now general. Manyprivate motorists claim to have effected noteworthyeconomies in fuel consumption, and it is hoped that thetrials will give wide publicity to such results and themeans by which they are achieved., The Club realizesthat the trial will also afford a good opportunity of testingthe claims made for the very large number of appliancesfor reducing fuel consumption that are on the market andconcerning which, as has often been pointed out in ourmotoring notes, the only way in which they can hope todeserve attention is to submit them to official tests. Thepublic has been invited from time to time to spend largesums ofmoney on devices which, it is claimed, effect fueleconomy, but in connexion with which it is practicallyimpossible to point to any official evidence in confirmationof the alleged gain. It is therefore noteworthy that oneof the regulations wisely allows the judges, when makingthe awards in connexion with the forthcoming R.A.C.trial, to take into consideration the selling price of anyfuel economy device submitted, on the principle that thereis no economic advantage in spending ?5 to save,possibly, ?4 10s. The rules are of a simple character,designed with a view to encouraging the entry ofprivate car owners, who have already shown a considerableinterest in the trial and to whom it makes an obviousappeal. A measure of miles per gallon has been chosenas the basis of award for the reason that it is well under.stood by everyone. In effect, the result will be equivalentto saying that a car of a given make and horse-power, witha complement of passengers, is capable of running efficientlysomany miles on one gallon of spirits. That is preciselywhat the public wants to know. The trial itself willconsist of a series of runs from various centres throughoutthe country, and the date and time have been chosen sothat the trial may appeal to a large number of motoristswho will be free then. In each locality the course will bea short one. The three classes are for cars not exceeding12 h.p.; exceeding 12 but not exceeding 20 h.p.; and forthose exceeding 20 h.p. R.A.C. rating. These tests cannotbe regarded as exhaustive or final. Rather would theirusefulness seem to lie in their serving the purpose ofeliminating trials of fuel economizers. We should learnwhich methods and devices are worthy of submission toreally searching tests.

THE MEDICAL SOCIETY OF LONDON.THE 148th anniversary dinner of the Medical Society ofLondon was held at the Wharneclife Rooms onMarch 8th,with the President, Sir William Hale-White, in the chair.In proposing prosperity to the Society, the President tracedthe origins of medical societies, and remarked on thewidespread desire that showed itself during the eighteenthcentury to form clubs and societies. Of the many medicalsocieties founded in that century for the advancement ofknowledge and the promotion of good fellowship, theMedical Society ofLondon was one of the few that survived.Sir Anthony Bowlby, President of the Royal College ofSurgeons, in proposing the toast of the Imperial Forcesof the Crown, confined himself to the work of the medicalservices, upon whose efficiency the moral and spirit of thenation and of the forces depend somuch in time of war.He told the story of how interference with the FrenchService de Sant4 by politicians early in 1917 causedtemporary demoralization of the French army and nationafter the failure of General Nivelle's offensive. Justbefore the attack the Minister-of War did away withthe central authority of the medical service, and theconsequent breakdown of the arrangements for disposal,transport, and treatment of the wounded gave the