YELLOW FEVER EXPEDITION 
525 
extreme hopelessness of the condition might make it worthy of a trial. At the 
same time free and copious administration of water in the form of large subcutaneous 
or intravenous injections and enemata would be requisite to induce a flushing of the 
tubules if possible, and also vapour baths or ' hot pack.' 
Spleen. The spleen does not appear to have been much examined in yellow fever. 
At all our autopsies with the exception of the four with malarial condition, the spleen 
was plump and turgid, though not enlarged ; on section it was dark and usually much 
blood exuded. Microscopically the marked feature is the large number of large active 
macrophage cells' in the pulp ; some much vacuolated and mostly containing remnants 
of nuclear material. It is clear that some great destruction is proceeding. Another 
feature is the condition of the adenoid tissue around the smaller arteries. I have to 
thank Dr. Glynn for the loan of a normal specimen for comparison, and his kindly 
afforded experience. In many places the small arteries are devoid of any adenoid 
sheath ; in other places where it is retained the borders are more ragged and less well 
marked than in the normal organ ; at the same the lymphoid tissue is much invaded 
by macrophage cells mostly filled with vacuoles, hyaline pieces, and nuclear remains. 
Curiously enough here and there these cells have distinctly ingested lymphocytes, of 
this there can be no doubt where a distinct vacuole surrounds the ingested structure. 
In the normal organ a few relatively small macrophages are to be seen, but they do 
not shew the activity of those of the yellow fever cases. 
Liver. The chief point of interest, beyond the fatty and atrophic changes which 
have already been described, is the frequently large number of leucocytes, especially 
' polynuclear,' in the capillaries of the liver. The same is true of other organs, kidney 
and spleen, but perhaps not so striking. 
Blood. It is stated in many books that there is an early yellowness, which is due to 
the presence of dissolved haemoglobin in the blood plasma. My colleague undertook 
the spectroscopic examination of the numerous serum and citrated plasma samples 
which we obtained in the course of our centrifugalizations for microscopical purposes. 
At no stage of the disease, early or late, was there the slightest indication of the 
oxyhaemoglobin bands. We concluded, therefore, that the so-called ' haemopoietic ' 
icterus was not due to the presence of dissolved haemoglobin. 
Another statement is to the effect that the blood of yellow fever corpses does 
not clot well. We found that the blood taken into test tubes from the heart at 
autopsies made immediately after death clotted perfectly well and firmly ; we supposed 
that, possibly, the statement originated from the observation of blood which had been 
exposed to post-mortem change within the vessels, and to the action of various bac- 
terial invaders. 
With regard to the counts which were made for determining the abundance 
of leucocytes in the peripheral blood, it can only be said that there is a marked 
1. Many of these contain granules giving the blue iron reaction with potassic ferrocyanide ami acid. 
P I 
