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YELLOW FEVER

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Originally appearing in Volume V28, Page 912 of the 1911 Encyclopedia Britannica.
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YELLOW See also:

FEVER , a specific infective tropical fever, the germ of which is transmitted by the Stegomyia fasciata or domestic See also:mosquito, occurring endemically in certain limited areas. The See also:area of See also:distribution includes the See also:West Indies, See also:Mexico, See also:part of Central See also:America, the W. See also:coast of See also:Africa and See also:Brazil. The first See also:authentic See also:account of yellow fever comes from See also:Bridge-See also:town, See also:Barbados, in 1647, where it was recognized as a " nova pestis " that was unaccountable in its origin, except that Ligon, the historian of the See also:colony, who was then on the spot, connected it with the arrival of See also:ships. It was the same new pestilence that Dutertre, See also:writing in 1667, described as having occurred in the See also:French colony of See also:Guadeloupe in 1635 and 1640; it recurred at Guadeloupe in 1648, and See also:broke out in a peculiarly disastrous See also:form at St Kitts the same See also:year, and again in 1652; in 1655 it was at See also:Port Royal, See also:Jamaica; and from those years onwards it became See also:familiar at many harbours in the West Indies and See also:Spanish See also:Main. It appeared at the Brazilian ports in 1849. In 1853 it appeared in See also:Peru and in 1820 on the W. coast of Africa. In See also:Georgetown (See also:British See also:Guiana) 6g% of the See also:garrison died in 184o. During the See also:great See also:period of yellow fever (1793-1805), and for some years afterwards, the disease found its way See also:time after time to various ports of See also:Spain. See also:Cadiz suffered five epidemics in the 18th See also:century, See also:Malaga one and See also:Lisbon one; but from 1800 down to 1821 the disease assumed much more alarming proportions, Cadiz being still its See also:chief seat, while See also:Seville, Malaga, See also:Cartagena, See also:Barcelona, See also:Palma, See also:Gibraltar and other See also:shipping places suffered severely, as well as some of the See also:country districts nearest to the ports. In the severe epidemic at Barcelona in the summer of 1821, 5000 persons died. At Lisbon in 1857 upwards of 6000 died in a few See also:weeks. In New See also:Orleans 7970 See also:people died in 1853, 3093 in 1867, and 4056 in 1878.

In Rio 416o died in 1850, 1943 in 1852, and 1397 in 1886. Certain distinct conditions have seemed to be necessary for an outbreak. Foremost we may See also:

notice a high atmospheric temperature, one of 750 F. or over. As the thermometer sinks, the disease ceases to spread. Moisture favours the spread of yellow fever, and epidemics in the tropics have usually occurred about the See also:rainy See also:season. Seaport towps are most affected. In many instances the elevated See also:airy and hygienic quarters of a town may See also:escape, while the See also:shore districts are decimated. Usually the disease does not spread to villages or sparsely popu lated districts. Certain houses become hotbeds of the disease, See also:case after case occurring in them; and it is usually in houses that the disease is contracted. A See also:house may be said to be infected when it contains infected mosquitoes, whether there be a yellow-fever patient there or not. Ships become infected in the same way, the old wooden trading ships affording an ideal hiding-See also:place to the Stegomyia in a way that the See also:modern and airy steamship does not. The See also:incubation period of yellow fever is generally four or five days, but it may be as See also:short as twenty-four See also:hours.

There are usually three marked stages: (1) the febrile period, (2) the period of remission or See also:

lull, (3) in severe cases, the period of reaction. The illness usually starts with languor, chilliness, headache, and See also:muscular pains, which might be the precursors of any febrile attack. These are followed by a See also:peculiar look of the eyes and See also:face, which is characteristic: the face is flushed, and the eyes suffused at first and then congested or ferrety, the nostrils and lips red, and the See also:tongue See also:scarlet-these being the most obvious signs of universal congestion of the skin, mucous membranes and See also:organs. Meanwhile the temperature has risen to fever See also:heat, and may reach a very high figure (maximum of 110° Fahr., it is said) ; the See also:pulse is See also:quick, strong and full, but may not keep up in these characters with the high temperature throughout. There are all the usual accompaniments of high fever, including hot skin, failure of appetite, thirst, See also:nausea, restlessness and See also:delirium (which may or may not be violent); albumen will nearly always be found in the urine. The fever is continued; but the febrile excitement comes to an end after two or three days. In a certain class of See also:ambulatory or masked cases the febrile reaction may never come out, and the See also:shock of the infection after a brief See also:interval may See also:lead unexpectedly and directly to prostration and See also:death. The cessation of the See also:paroxysm makes the See also:stadium, or lull, characteristic of yellow fever. The hitherto militant or violent symptoms cease, and prostration or collapse ensues. The See also:internal heat falls below the normal; the See also:action of the See also:heart (pulse) becomes slow and feeble, the skin See also:cold and of a See also:lemon-yellow tint, the See also:act of vomiting effortless, like that of an See also:infant, the first vomit being clear fluid, but afterwards See also:black from an admixture of See also:blood. It is at this period that the prospect of recovery or of a fatal issue declares itself. The prostration following the paroxysm of fever may be no more than the weakness of commencing recovery, with copious flow of urine, which even then is very dark-coloured from the presence of blood.

The prostration will be all the more profound according to the height reached by the temperature during the acute paroxysm. Much blood in the vomit and in the stools, together with all other haemorrhagic signs, is of evil See also:

omen. Death may also be ushered in by suppression of urine, See also:coma and See also:convulsions, or by fainting from failure of the heart. In severe types of the disease an apoplectic, an algid and a choleraic form have been described. The case mortality averages from 12 to 8o%. In Rio in 1898 it reached the appalling height of 94'5%. In cities where it is endemic the case mortality is usually See also:lower. In 269 cases observed by See also:Sternberg, the mean mortality was 27.7 %. In 158 cases of yellow fever in See also:Vera Cruz in 1905 there were 91 deaths. The death-See also:rate, however, tends to vary in different epidemics. In the epidemic occurring in Zacapa, Mexico, in 1905 in a See also:population of 600o there were 700 cases, and the mortality among the infected was 40%. Treatment.—The patient should be removed from the See also:focus of infection and nursed in a well-ventilated See also:room, screened from mosquitoes.

The further treatment is symtomatic. A purgative, followed by hot See also:

baths, is useful in the See also:early stages to relieve congestion, high temperature may be controlled by sponging; vomiting, by See also:ice; or, if haemorrhagic, by See also:ergot, perchloride of See also:iron or other styptics; and See also:pilocarpine may be given if the urine be scanty. Sternberg has introduced a See also:system of treatment by alkalis to counteract the hyperacidity of the intestinal contents and increase the flow of urine. Of 301 whites treated by this method only 7.3 % died, and of 72 blacks all recovered. See also:Causation.--The See also:pathology of the disease is discussed in the See also:article PARASITIC DISEASES. In 1881 Dr See also:Charles See also:Finlay, of See also:Havana, propounded the theory that mosquitoes were the See also:carriers of the infection. Numerous theories had previously been brought forward, notably that of the Bacillus icteroides, described by Sanarelli; but it is now certain that this organism is not the cause. Other authorities held that the disease was spread by contagion, by miasmata, or some other of the vague agencies which have always been put forward in the See also:absence of exact knowledge. Finlay's mosquito theory remained in See also:abeyance until See also:attention was again See also:drawn to it by the demonstration in See also:recent years of the part played by these See also:insects in the causation of other tropical diseases. The mosquito selected by Finlay was the Stegomyia fasciata, a black See also:insect with silvery markings on the See also:thorax, which is exceedingly See also:common in the endemic area. It frequents towns, and breeds in any stagnant See also:water about houses. Specimens were caught, fed upon yellow-fever patients, kept for a fortnight, and then allowed to bite susceptible persons established in a See also:special See also:camp with other susceptible persons as a See also:control.

Those bitten See also:

developed the fever, theothers did not. An See also:American See also:commission was appointed in 1900, consisting of See also:Walter See also:Reed, See also:James See also:Carroll, A. Agramonte and Lazear, and its conclusions were: that the Stegomyia fasciata is the See also:agent of infection, that the See also:virus of yellow fever is See also:present in the blood during the first three days of the fever, and is generally absent on the See also:fourth; that the germ is so small that it can pass through a Chamberland See also:porcelain See also:filter; that the bite of all infected Stegomyia does not produce yellow fever (about 35% of the experiments proving negative); that mosquitoes fed on yellow-fever blood were not capable of giving rise to infection until after a See also:lapse of twelve or fourteen days, but the insects retained their infective See also:power for at least fifty-seven days. It can therefore be concluded that the virus of yellow fever is a See also:parasite, requiring as in See also:malaria an alternate passage through a vertebrate and an insect See also:host, the See also:analogy to malaria being very See also:complete. E. Marchoux and P. L. Simond, of the French Yellow Fever Commission to Rio de Janeiro, 1906, have observed an interesting fact in connexion with the S. fasciata. In See also:order to See also:lay her eggs she must first have a feed of blood, three days after which she See also:lays them. Before she lays her eggs she strikes both See also:day and See also:night, after that period at night only. Persons bitten in the day-time, therefore, do not develop yellow fever, while those bitten at night do. This may explain the impunity with which Europeans may visit an infected See also:district in the day-time provided that they are careful not to See also:sleep there at night.

It was stated by Marchoux and Simond that an infected mosquito transmits the parasite to her eggs, the progeny proving infective. Prophylaxis.—Following on the publication of these experi: ments there was instituted a vigorous See also:

campaign against See also:moss quitoes in Havana in 19or, based on the methods applied to the suppression of malaria, and carried out under the direction of See also:Major W. C. Gorgas of the See also:United States See also:army, chief sanitary officer of Havana. The See also:work was begun on the 27th of See also:February 1901. An order was issued that all receptacles containing water were to be kept mosquito-See also:proof; sanitary inspectors were told off for each district to maintain a See also:constant house-to-house inspection, and to treat all puddles, &c., with oil; receptacles found to contain larvae were destroyed and their owners fined; breeding-grounds near the town were treated by draining and oil; hospitals and houses containing yellow-fever patients were screened; infected and adjacent buildings were fumigated with See also:pyrethrum See also:powder. The results exceeded all expectation, and after See also:January 1902 the disease entirely ceased to originate in Havana. Cases occasionally now come into Havana from Mexican ports, but are treated under screens with impunity in See also:ordinary See also:city hospitals and never at any time infect the city. Thus in 1907 there was one death from yellow fever, and the See also:general death-rate of Havana from all diseases was 17 per thousand. In the Bulletin of Public See also:Health and Charities of See also:Cuba it is stated there only occurred between 1905–9 a See also:total of 345 cases of yellow fever in all Cuba, where formerly they numbered many thousands, and in See also:April igio the See also:republic was declared to be entirely See also:free from the disease. Among other modern outbreaks in which sanitary See also:measures have triumphed in the suppression of yellow fever were the outbreak in New Orleans in 1905, in which a medical See also:staff of 5o with sub-ordinates to the number of 1203 started immediately on the outbreak to clean up the city; the outbreak in See also:Belize, British See also:Honduras, in 1905; the See also:anti-yellow-fever campaign undertaken in the British W. Indies in 1906-9.

As soon as the Isthmian See also:

Canal commissioners took over the See also:administration of the See also:Panama Canal See also:Zone they undertook a vigorous campaign against the mosquito, as the result of which yellow fever was successfully banished. See also:Colonel Gorgas in his 1908 See also:report wrote: " It is now three years since a case of yellow fever has developed in the See also:Isthmus, the last being in See also:November 1905." Rio de Janeiro, which had lost 28,078 inhabitants in 13 years by yellow fever, and Santo, have also waged See also:war against the disease; as a result of the anti-Stegomyia policy the deaths from yellow fever in Rio See also:fell to 42 in 1906, 39 in 1907, 4 in 1908, and 0 in 1909. See See also:Sir P. See also:Manson, Tropical Diseases (1907) ; article" Yellow Fever " in Allbutt and Rolleston's System of See also:Medicine; Sir R. See also:Boyce, Report on Yellow Fever in Honduras (1906), and Health and Administration in the West Indies (1910) ; Bulletins of the U.S. Yellow Fever See also:Institute; Annales de l'lnstitut See also:Pasteur (January 1906).

End of Article: YELLOW FEVER

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