CHAPTER XXI 

 INFECTIVE JAUNDICE; WEIL'S DISEASE; 

 SPIROCH^ETOSIS ICTEROHEMORRHAGICA 



SpirochjEta Icterohemorrhagije (Inada and Ido) 



General Characteristics. — A minute, slightly bent, irregularly coiled, inactively 

 motile, flagellated spiral organism, capable of cultivation by special means in 

 special media. It is aerobic, non-chromogenic, non-aerogenic, non-sporogenic, and 

 is pathogenic for guinea-pigs, rats and man. It can be stained by certain meljiods 

 oiiy and not by Gram's method. 



Occasional epidemic outbreaks of jaundice have been noted since 

 the time of Hippocrates, by whom they were mentioned, and have 

 received mention from the pens of many eminent writers. Lance- 

 reaux spoke of the disease as "Ictere grave essentiel;" Landouzy as 

 "Fievre bileuse; " Mathieu as "Ictere febrile a rechutes" on account 

 of the frequency of relapses. In 1886 Mathieu described cases and 

 pointed out that "catarrhal jaundice" was an inadequate name for 

 the affection as the severity of the fever, the severe constitutional 

 symptoms, the enlargement of the spleen and the occurrence of 

 albuminuria justified the name infectious jaundice. In the same 

 year Weil* described four cases, two of which suffered from relapses, 

 and from the time of the appearance of his contribution the disease 

 has been known as Weil's disease. 



The disease is characterized by a sudden onset with occasional 

 vomiting, malaise sometimes amounting to severe prostration, 

 muscular pains sometimes of great severity, fever ranging from 103° 

 to io5°F. and lasting for a number of days during which the tongue 

 becomes dry and brown and herpes hemorrhagica appear about the 

 lips in about haK of the cases. About the fourth day jaundice 

 appears, deepening until its greatest intensity is reached by the ninth 

 day, and continuing until the twelfth day. There is usually consti- 

 pation. Bile-pigments, albumen and tube casts appear in the urine. 

 In severe cases epistaxis, hemoptysis, hematemesis, melsena, and 

 subcutaneous hemorrhages occur. In nearly all cases lymphatic 

 enlargements are present. Hume and Bedsonf point out that jaun- 

 dice is not always present in otherwise t3^ical Weil's disease. Under 

 these conditions it is difficult to recognize and may figure as "Fever 

 of unknown origin," and be one form of what is sometimes called 

 "Trench fever." 



* "Deutsches Archiv. f. Klin. Med.," 1886, xxxix, 209. 

 t "Brit. Med. Jour.," Sept. 15, 1917, P- 34S- 

 532 



