YELLOW FEVER AND THE LEPTOSPIRA 885 



WEIL'S DISEASE; ICTERO-KflSMORRHAGIC FEVER; 

 (EPIDEMIC JAUNDICE) 



This is a disease which has been known for a very long time. 

 It was described by Larrey as early as 1800 and the probability 

 of its being a clinical entity was recognized by a number of other 

 observers between that time and 1886 when Weil gave an accurate 

 description of a number of cases he observed in Germany. The 

 infectious nature of the disease was suspected from the course and 

 symptoms and many etiological "guesses" were made. For a time 

 it was suspected that the disease was particularly associated with 

 butcher shops and occurred especially in individuals following 

 the butcher's trade. During the recent war the disease occurred 

 in many of the armies at the front, in the trenches. They were 

 first reported from the Italian front and later in the British, German 

 and French armies, occurring at times in almost epidemic-like form. 

 The disease has been relatively mild in European countries, whereas 

 in Japan where it seems to be particularly a disease of mine workers, 

 it is quite virulent and often has a high death rate. It seems to 

 have been particularly a disease of war, since the cases of Larrey 

 came from the Eygptian army of Napoleon. The recent outbreaks 

 were largely among soldiers and it is stated that a considerable 

 number of cases occurred in the South African and the American 

 Civil Wars. It is important to note in connection with what will 

 be said later about yellow fever that Nishi identified Weil's disease 

 with fellow fever some time ago, but was opposed by Ohno. Inada 

 and his co-workers mention this, and emphasize the difference be- 

 tween the two diseases from the epidemiological point of view, 

 though they admit the similarity of the symptoms. Also, transmis- 

 sion seems to be quite different in the two diseases. 



The Disease. Fiedler, 23 whom we quote from Inada 24 divides 

 the disease into three stages, an initial period of two or three days, 

 with fever, followed by a second stage of three days, during which 

 icterus, edema of the liver, enlargement of the spleen and skin 

 hemorrhages occur. The defervescent period starts on the seventh 

 day and initiates convalescence. Inada describes it as follows: The 



"Fiedler, Deut. arch. klin. Med., 1892, 1, 232. 

 "Inada, Jour, exper. Med., 26, 1917, 355. 



