522 
THOMPSON YATES LABORATORIES REPORT 
Naturally if there is any specific connexion between the glandular enlargement, 
which may be felt clinically, and yellow fever the point might be of diagnostic value. 
In Para it was not possible to make satisfactory control observations ; especially in 
mild cases of fever, in the absence of any distinguishing mark, the discovery of enlarged 
glands did not lead to help — many such not included in the figures given above were 
seen. One question upon which no information was forthcoming is what is the con- 
dition of the palpable glands in malaria ; since being in Para I have asked a number 
of physicians who have had considerable experience of malarial cases, but the axilla 
never appears to have been examined. In respect of this the following quotation may 
be of interest. A. C. Smith 1 says : — ' My attention has been attracted a number of 
times within the past dozen years to a group of symptoms which I have never seen 
described in any text-book . . . The group consists" of inguinal bubo associated with 
malarial fever ; the bubo being most commonly non-suppurating and the fever of the 
aestivo-autumnal type, though not invariably so. The bubo, in the cases which I re- 
port, occurred without suspicion of venereal infection and was clearly secondary to the 
fever and dependent upon it.' It may be remarked that the author speaks of the 
inguinal and not femoral glands. 
Information and observation then is wanted in non-malarial and non-yellow fever 
localities which are mosquito ridden, and also in malarial neighbourhoods which are free 
from yellow fever. 
C. Urine 
In conversation whilst in Cuba, I think Major Reed mentioned to us that they 
had sometimes succeeded in finding tube casts in the urine, although, chemically, the 
presence of albumen was not apparent. We noticed that reaction for albumen could, 
sometimes, be obtained by the use of picric acid when other reagents failed. About 
ten days after my recovery, I found that, although no reaction was obtained with 
nitric acid, boiling, and the like, a distinct precipitate which did not clear up on 
heating was obtainable with picric acid. (When very small traces are tested for I 
fancy that it would be best to heat the urine before, rather than after, the acid has 
been run on, for the agitation prevents the formation of a ring.) Thinking that, 
perhaps, this result might be due to the presence of some proteid of a soluble nature 
such as a proteose, a number of specimens from patients were examined. The 
following are instances of the results obtained : — P. well-marked, rather acute yellow 
fever. Sample of urine boiled with drop or two of acetic acid, coagulum allowed to 
settle. When cool, filtered. Filtrate gives a good ring with superimposed absolute 
alcohol, on shaking this it dissolves. Addition of an equal volume of absolute alcohol 
(ethylic) does not give a permanent precipitate, which only commences when two 
I. A. C. Smith. Inguinal Bubo as a Complication of Malarial Fever . New York Medical Journal, LXXIII, June 22, 1901, 
and American Medicine, vol. II, no. 1, p. 38. 
