YELLOW FEVER EXPEDITION 
497 
conclusively shew that the course of the disease was essentially modified by the injec- 
tions, although the scheme is by no means without hope. 1 
The nett result of Agramonte's work is that B. icteroides has nothing to do with 
yellow fever, and presumably appeared solely as a contamination. The relationship of 
the B. icteroides with yellow fever has been carefully questioned by the American 
Commission (Reed, Carroll, Lazear, and Agramonte 1 ) ; at first is recorded the 
examination of blood of eighteen patients withdrawn on different days of the fever 
(first to ninth) by means of a syringe from a vein at the elbow ; the blood was put, 
in quantities of J c.c. into 10 c.c. broth. As a rule these blood cultures were sterile 
of all growth, in none did B. icteroides appear. 
Further, eleven autopsies were made on yellow fever cadavers ; in all of these 
Sanarelli's bacillus failed to appear in the cultures. No information concerning 
other organisms occurring in the cultures is given. 
Next, in four cases blood was transferred from yellow fever patients to non- 
immunes ; at the same time cultures were made in broth, three of these remained 
sterile, the fourth yielding staphylococci. Since in each of these cases yellow fever 
resulted as a consequence of the inoculation of the same blood into man, the authors 
argue that the exclusion of Sanarelli's bacillus as the cause of the fever is conclusively 
determined ; the only apparent sources of fallacy in this conclusion would be (i) that 
the bacillus was so scanty that it happened to be solely in the samples injected ; this, 
I think, may be fairly discounted ; (2) that the broth used was insufficiently favourable 
for the growth of the bacillus ; and (3) that the bactericidial power of the blood before 
transference to broth or of the resulting mixture of blood and broth was sufficiently 
high to kill, or to inhibit the growth of, the bacillus ; the recognition of this last 
factor has been used in the cultivation of typhoid bacilli from living patients ; but 
it probably has no effect upon cultivations made from organs to autopsies. 
In summary in the three communications' these authors consider that the bacillus 
of Sanarelli can be definitely excluded from the etiology of yellow fever. 
Our own observations at Para are in accordance with this conclusion, as will be 
seen. The inoculation upon culture media of blood taken directly from veins (second, 
sixth, and seventh day) of different patients during life was only carried out on three 
occasions ; in each case the broth used remained sterile (aerobic and anaerobic) ; 
cultures from blood from the ear-lobe were only made on two occasions ; one of these 
yielded diplococci and tetrads aerobically, the other remained sterile. It did not 
seem to be a very profitable mode of research in the light of Agramonte's experience. 4 
1. Finlay (Elstein and Schwalbe, Handbuch d. practl. med.) commenced this as a mode of prophylactic and therapeutic treat- 
ment in 1893. 
2. Reed, Carroll, Lazear, and Agramonte, preliminary note, Philadelphia Medical Journal, October 27, 1900, 
3. Preliminary note, Philadelphia Medical News, October 27, 1900, additional note, Journal American Medical Association, 
February 16, 1901, and experimental yellow fever, American Medical, July 6, 1901. 
4. A number of flasks containing large quantities of broth were got ready, but owing to other observations they were left 
for a short time, and consequently became full of moulds and unusable. 
