YELLOW FEVER EXPEDITION 
495 
Following Sanarelli came a number of publications dealing with the bacillus ; 
of these, that of Wasdin and Geddings 1 gives positive finding of B. icteroides in 
thirteen out of fourteen cases examined. Whilst they undoubtedly met with the 
bacillus in question, their account, especially of the fermentation reactions, is not 
entirely clear ; it is not possible to summarize their results, for it is not always 
certain whether the cultures mentioned were pure or not ; in several instances it is 
stated that contaminations such as B. co/i were present. 
The much discussed case of P. Smith 2 perhaps gives a clue to the asserted 
frequency of occurrence of B. icteroides, ' the present attack of illness came on 
the 5th of February, 1899 (W. and G.).' On the 10th, i.e., 'on the sixth day of 
the disease,' blood was taken from the ear tip, and with this plates were prepared; 
these ' gave us numerous colonies of B. icteroides ; also of two other organisms, one 
a colon. We offered this evidence as diagnostic on the 12th.' It is not stated whether 
fermentation tests were made to prove the diagnosis of B. icteroides within this space 
of two days, anyhow it would not have been possible to have repeated them. At 
the autopsy ' in twenty-four hours the spleen gave a pure culture of B. icteroides, and 
the blood, a culture but slightly contaminated. Other organs and fluids the same. 
There was observed no B. typhosus.'' 
Agramonte 3 does not regard this as a case of yellow fever at all ; his account of 
it is at variance in several particulars ; thus on February 4, P. Smith had ' felt sick 
for about a week,' or Major Ducker's statement, 'on February 9, 1899 
It was then the eighth day of the soldier's illness.' It is agreed that B. icteroides was 
present; thus, 'We found B. typhosus and B. icteroides in almost pure cultures from 
the spleen ; B. typhosus in pure culture from the kidney ; B. co/i, B. icteroides, and a 
non-motile bacillus from the blood ; pure culture of the bacillus only from the blood 
of the heart.' Both accounts agree that there was malaria, and that there were no typhoid 
intestinal lesions. The evidence on which the recognition of the typhoid bacillus is 
based is not given, but this case is given so much attention here not because of yellow 
fever (Agramonte gives the opinions of six consultants, all of whom considered that 
the case was not yellow fever), but from the point of view of the pathogenic relation 
of the presence of B. icteroides, viz., was it merely an accidental contamination, or had 
it anything to do with the illness ? It becomes of interest to call attention to the 
work of the following observers, and to remark that the bacilli of Gwyn and Cushing 
(vide infra) were extremely typhoid-like when examined by the writer, for which 
without care they might have been mistaken. 
The more exact relationship of the B. icteroides was established by Reed and 
Carroll 4 who found that it belonged to the so-called hog-cholera or ' enteritidis ' 
1. Wasdin and Geddings, Report of U.S. Marine Hospital Service, 1899. 
2. No. 7, Wasdin and Geddings, l.c , and Agramonte, v. infra. 
3. Agramonte, Reprints from the Medical Nenus, February 10-17, 1900. 
4. Reed and Carroll, Medical News, September 9, 1898 
