5. Rate of Injection.—Operators should pay particular attention to the rate of administration since it is believed that rapidity of injection accounts for more unfavorable results in the use of arsphenamine than any other one thing. In no case should the rate exceed 0.1 gm. of drug (30 cc. of solution) in two minutes, i.e., twelve minutes for the average dose of 0.6 gm.
CHAPTER V
YELLOW FEVER
Definition and Synonyms
Definition.—Yellow fever is an important epidemic disease of the West Coast of Africa and tropical America caused by a spirochaetal organism, Leptospira icteroides. The spirochaete is contained in the peripheral blood only during the first three days of the disease. A mosquito, Stegomyia calopus (Aedes calopus), biting a patient during this period of his illness, takes in the organism which undergoes some developmental cycle of the nature of which we are ignorant, but we do know experimentally that a minimum period of twelve days is requisite for the completion of the cycle which makes the mosquito infectious for man.
When a susceptible individual is bitten by an infected mosquito there develops, after a period of incubation of from two to five days, a rapid rise of fever, with markedly congested face and severe pains of back and head. About the end of the third day the sthenic manifestations are succeeded by asthenic ones in which jaundice, haemorrhages, particularly black vomit, and anuria are the important features.
Faget’s sign of a lack of accordance between pulse and temperature is of great diagnostic importance.
Synonyms.—Febris Flava, Typhus Icteroides. Spanish: Fiebre Amarilla, German: Gelbfieber, French: Fièvre Jaune.
History and Geographical Distribution
History.—It would seem probable that yellow fever was the disease from which those of Columbus’ second expedition suffered in San Domingo, in 1495. At the same time the first definite description of the disease was that of Dutertre, in Guadaloupe, in 1635. There has been much discussion as to whether the West Coast of Africa may not have been the original endemic centre and the importation to the West Indies the result of the slave traffic. While there is very little support given this view the recent recognition of the extent and importance of the African endemic area, as brought out by Boyce, is somewhat suggestive. Spinden advances evidence to show that a devastating epidemic disease, attended with bleeding from the mouth and nose, raged among the Mayas and Aztecs in pre-Columbian periods. One such epidemic is recorded as of 1454. There have been numerous severe outbreaks in the United States, that occurring in Philadelphia, in 1793, being the most celebrated and that centering in Memphis, in 1878, probably the most terrible. Yellow fever has been a scourge in Brazil since its introduction in 1849, until quite recently. Lisbon experienced severe outbreaks of the disease in 1723 and in the next century in 1850 and 1856. Many of the Spanish cities have also suffered from time to time.