232 BBVIEW — TROPICAL MEDICINE, ETC. 



Weil's According to Sandwith.i this disorder is undoubtedly a filth disease, engendered by 



Disease— contamination with sewage and putrid meat. In Alexandria it has become more common 



ruiiiinual since the introduction of a bad system of drainage, and the bulk of the patients affected 



came from the lowest parts of the town where the sewers empty into the sea ; while the 



suburbs of the town, which are not drained at all, remain apparently unaffected. 



The cause is still obscure, no microbe having yet been described. There is no direct 

 evidence that the disease is insect-borne. Sandwith' is inclined to think that either 

 Culex fatigaiis or the Stegomi/ia fasciafa is a likely culprit in transmitting it. Taeger 

 and Nauwerk, in Germany, believe that the Bacillus proteus flaorescens is the cause of 

 the disease, owing to the fact that this bacillus was isolated from the urine in cases after 

 death had occurred, and because the bacillus was found in ducks and geese which had died 

 in the same locality from a disease in which jaundice was the chief symptom. 



The symptoms may be divided into three stages : 1. Primary fever, lasting three to five 

 days. 2. Jaundice, about seven to nine days. 3. Secondary fever, lasting about seven to 

 nine days. After an incubation period of one or two days, the disease is ushered in by a 

 rigor, general pains and vomiting and a temperature of 102° to 104°. About the third or 

 fourth day, jaundice begins with great enlargement of the liver and spleen together with 

 tenderness. Albuminuria also is present, together with a certain amount of suppression 

 which may increase till urajmia supervenes. The fever subsides, jaundice and other 

 symptoms disappear, and in the majority of the cases this improvement is followed by a 

 secondary fever. 



The nervous symptoms consist for the most part of headache, giddiness and perhaps 

 delirium, the patient passing more or less into the " typhoid state." Muscular pains, 

 especially in the nape of the neck and the calves of the leg, are intense during the first 

 stage of the disease, and are greatly increased by pressure, this forming a useful diagnostic 

 sign. 



The chief complication is that of hyperpyrexia, and it is observed that the convalescence 

 is invariably a protracted one. 



The mortality occurs chiefly in those above the age of 40, and may vary from 

 10 per cent, to 60 per cent. 



The chief pathological conditions present consist of an enlargement of the liver with 

 fatty degeneration and concomitant cloudy swelling and infiltration of the portal canal with 

 lymphocytes. The spleen is only slightly enlarged. Petechial haemorrhages are frequently 

 present in the pleura, peri- and endo-cardium, and capillary hiemorrhages are present in the 

 stomach and kidneys. Microscopically the kidneys show a lymphocyte infiltration around 

 the glomeruli. 



Formerly there was some difficulty in diagnosing this disease from relapsing fever, 

 but that difficulty no longer exists, owing to the presence in the latter of a spirochaete. It 

 has been suggested that this disease resembles yellow fever, but, as the latter has not been 

 known to exist in Egypt, infectious jaundice can hardly be confused with it, although some 

 observers state that it is a modified form of yellow fever. Its similarity to acute yellow 

 atrophy must also be borne in mind. 



Epidemic jaundice occurred in South Africa during the late war, but Mathias^ 

 considered that it was a distinct variety of febrile jaundice which frequently follows 

 outbreaks of enteric fever, and that it should not come under the category of Weil's disease. 



The treatment is chiefly symptomatic. Bryce-Orme ^ records what appears to have 

 been a fatal case of infectious jaundice in the Federated Malay States, showing therefore 

 that the disease has probably a wider geographical distribution than is supposed, and 

 is not merely confined to the Mediterranean Basin. This observer considered the case to 

 be one of infectious jaundice, the predominating signs and symptoms being intense 

 jaundice, enlarged liver, and albuminuria. There were no indications of the malarial 

 parasite being present in the blood, but there was present a well-marked leucocytosis. 



» Sandwith, F. M. (January 15th, 1904), " Weil's Disease in Egypt." Journal of Tropical Medicine. 

 " Sandwith, F. M. (September 17th, 1904), " Infectious Jaundice." British Uedical Journal. 

 ' Mathias, H. B. (September 17th, 1904), "Jaundice in South Africa." British Medical Joiirnnl. 

 * Bryce-Orme, W. (February 29th, 1908), " A Fatal Case o£ Infectious Jaundice in the Federated Malay 

 States." British Medical Journal. 



