﻿YELLOW 
  FEVER 
  — 
  SAWYER 
  579 
  

  

  results 
  only 
  in 
  young 
  children 
  could 
  not 
  be 
  accepted 
  as 
  fully 
  conclu- 
  

   sive 
  evidence 
  of 
  the 
  absence 
  of 
  yellow 
  fever, 
  and 
  this 
  was 
  the 
  only 
  

   evidence 
  available 
  in 
  some 
  countries. 
  The 
  disease 
  had 
  been 
  present 
  

   in 
  El 
  Salvador 
  in 
  the 
  form 
  of 
  a 
  sudden 
  epidemic 
  of 
  unknown 
  origin 
  

   as 
  late 
  as 
  1924 
  and 
  had 
  been 
  widespread 
  in 
  Central 
  America 
  and 
  

   Mexico 
  in 
  1921, 
  and 
  consequently 
  many 
  adult 
  immunes 
  were 
  discovered. 
  

   The 
  results 
  of 
  the 
  survey 
  were 
  in 
  general 
  consistent 
  with 
  the 
  complete 
  

   disappearance 
  of 
  yellow 
  fever 
  from 
  the 
  entire 
  region, 
  including 
  North 
  

   America, 
  Central 
  America, 
  and 
  the 
  West 
  Indies, 
  but 
  the 
  finding 
  of 
  

   three 
  protective 
  sera 
  among 
  those 
  from 
  321 
  Mexican 
  children 
  under 
  

   10 
  years 
  of 
  age 
  made 
  it 
  seem 
  probable 
  that 
  unrecognized 
  yellow 
  fever 
  

   infection 
  had 
  existed 
  in 
  that 
  country 
  as 
  late 
  as 
  1925, 
  when 
  the 
  youngest 
  

   of 
  the 
  three 
  immune 
  children 
  was 
  born. 
  It 
  was 
  apparent 
  that 
  yellow 
  

   fever 
  might 
  still 
  be 
  lingering 
  in 
  Mexico 
  or 
  some 
  one 
  of 
  the 
  Central 
  

   American 
  countries 
  or 
  West 
  Indian 
  islands, 
  and 
  it 
  was 
  decided 
  to 
  

   watch 
  the 
  situation 
  over 
  a 
  period 
  of 
  years 
  and 
  investigate 
  all 
  suspicious 
  

   reports. 
  Canada 
  and 
  the 
  United 
  States 
  seemed 
  definitely 
  free 
  of 
  in- 
  

   fection. 
  In 
  the 
  absence 
  of 
  any 
  suspicion 
  of 
  the 
  reintroduction 
  of 
  the 
  

   disease, 
  no 
  further 
  investigation 
  of 
  these 
  two 
  countries 
  was 
  made. 
  

   In 
  Mexico, 
  the 
  West 
  Indies, 
  and 
  all 
  but 
  two 
  of 
  the 
  countries 
  of 
  Cen- 
  

   tral 
  America, 
  there 
  have 
  been 
  neither 
  observations 
  nor 
  rumors 
  sug- 
  

   gesting 
  the 
  reappearance 
  of 
  yellow 
  fever. 
  Accordingly, 
  the 
  tenta- 
  

   tive 
  opinion 
  that 
  they 
  are 
  free 
  from 
  yellow 
  fever, 
  as 
  published 
  in 
  1937, 
  

   seems 
  to 
  have 
  been 
  strengthened 
  by 
  the 
  lapse 
  of 
  time. 
  

  

  CASES 
  RESEMBLING 
  YELLOW 
  FEVER 
  IN 
  COSTA 
  RICA 
  

  

  Eeports 
  of 
  two 
  fatal 
  illnesses 
  in 
  Costa 
  Rica 
  aroused 
  apprehension 
  

   lest 
  jungle 
  yellow 
  fever 
  might 
  be 
  present 
  there. 
  The 
  first 
  case 
  origi- 
  

   nated 
  early 
  in 
  October 
  1938 
  in 
  the 
  town 
  of 
  Parrita 
  at 
  about 
  the 
  mid- 
  

   dle 
  of 
  the 
  southwestern 
  coast 
  of 
  that 
  country, 
  and 
  the 
  patient 
  died 
  

   in 
  a 
  hospital 
  in 
  the 
  town 
  of 
  Puntarenas. 
  Parrita 
  is 
  in 
  a 
  region 
  being 
  

   developed 
  for 
  banana 
  culture 
  by 
  the 
  clearance 
  of 
  virgin 
  jungle, 
  exactly 
  

   the 
  kind 
  of 
  situation 
  which 
  would 
  bring 
  jungle 
  yellow 
  fever 
  to 
  light 
  

   if 
  it 
  were 
  present. 
  The 
  symptoms 
  of 
  the 
  patient 
  included 
  pro- 
  

   nounced 
  jaundice, 
  high 
  fever, 
  slow 
  pulse, 
  albuminuria, 
  and 
  vomiting 
  

   of 
  blood. 
  There 
  was 
  no 
  necropsy. 
  

  

  The 
  second 
  case 
  was 
  in 
  a 
  man 
  26 
  years 
  old. 
  It 
  originated 
  in 
  Sierpe, 
  

   on 
  the 
  seacoast 
  near 
  the 
  southwestern 
  end 
  of 
  the 
  Pacific 
  slope 
  of 
  Costa 
  

   Rica. 
  Here 
  too, 
  there 
  is 
  a 
  banana 
  development 
  and 
  forest 
  clearance. 
  

   This 
  patient 
  had 
  fever, 
  a 
  pulse 
  rate 
  of 
  120, 
  albuminuria, 
  acute 
  epigas- 
  

   tric 
  pain, 
  slight 
  jaundice, 
  and 
  persistent 
  vomiting. 
  There 
  were 
  no 
  

   malaria 
  parasites 
  in 
  his 
  blood. 
  The 
  patient 
  died 
  on 
  the 
  fourth 
  day 
  

   after 
  admission 
  to 
  hospital 
  at 
  Puntarenas. 
  At 
  autopsy 
  the 
  stomach 
  

   was 
  found 
  to 
  contain 
  a 
  dark 
  fluid, 
  and 
  there 
  were 
  hemorrhagic 
  spots 
  

  

  