YELLOW FEVER 121 



result in liability to haemorrhages, congestion of viscera, 

 and extreme fatty degeneration of the cells in the liver, 

 kidneys and elsewhere. The fatty degeneration in the 

 liver is most marked at the periphery of the lobules. The 

 changes somewhat resemble those in phosphorus poison- 

 ing and are less like those in acute yellow atrophy. This 

 fatty degeneration is so marked that the liver and kidneys 

 are pale yellow in colour, almost like boxwood, and ex- 

 tremely friable. The tubules of the kidneys may become 

 blocked as the epithelium is detached and there is a 

 coagulable exudate. Suppression is from mechanical 

 obstruction of the tubules by this epithelium and exudate. 

 There will be no malarial pigment unless there have been 

 previous attacks of malaria. The stomach is always 

 congested, submucous haemorrhages are common, and 

 the contents of the stomach and alimentary canal are 

 black and tarry, even when there has been no black 

 vomit. Subserous haemorrhages are always present, and 

 the serous membranes are stained with bile. 



All attempts at isolating an organism that can be 

 regarded as the cause of the disease have failed. From 

 time to time organisms have been described, and the 

 one that for some years attracted considerable attention 

 was a bacillus described by Sanarelli. This organism, 

 one of the coli group, has been shown to be that of 

 hog-cholera. Seidelin describes bodies that he found in 

 the blood, in cases of yellow fever, as protozoal organisms. 

 These bodies are either in red corpuscles or free in the 

 plasma. They consist of a chromatin nodule either 

 alone or surrounded by a variable amount of cytoplasm- 

 Seidelin finds them not only during the first three days 

 of the disease but later, and names them Paraplasnia 

 flavigenum. The protozoal or parasitic nature of these 

 bodies is not universally admitted, and it is difficult to 

 state to what group of protozoa they belong, if they are 

 protozoa. Some absolute method of diagnosis in the 

 mild forms of yellow fever is much to be desired, as some 

 observers consider ailments to be yellow fever which 

 others consider to be mere trivial digestive disturbances. 



