YELLOW FEVER EXPEDITION 
533 
S.S. 'A M.' arrived at Para, October 8, 1900. The vessel lay close to the 
wharf, on the mud at low tide ; the proximity to the city and the fact that the men 
went on shore prevents any direct information. The chief engineer died of an 'access 
of pernicious fever ; ' this occurred after about six or seven days of illness, and 
patient was very jaundiced at death as I was subsequently informed. The boatswain 
had a well marked severe attack of yellow fever, and a week later the third engineer 
was taken ill and died also of well marked yellow fever ; it may be remarked that 
the diagnosis of ' pernicious access ' is a not uncommon means of reducing the 
yellow fever mortality and increasing the apparent danger of the city. 
Whilst isolated cases recognized as yellow fever occurred occasionally on the 
ships which do not approach close to the cities (Para and Manaos), occasionally cases 
of slight fever occur, the nature of which is not clear from the accounts which can 
be obtained of them. One case, which was seen a week after being taken ill, may be 
cited. S.S. ' L.,' steward taken suddenly ill with a rigor, the thermometer shewing 
1 03° F. ; he was treated with a purge and quinine ; the next day there was still fever, 
and the hands and up to the elbows were described to have become swollen, ' like 
dropsy ; ' on the third day this swelling went down, and patient was feeling much 
better, but very weak ; at the end of a week the only complaint is of weakness ; there 
are no objective symptoms, e.g., icterus (unfortunately there was no means of testing 
the urine for albumin), except that the right axillary glands were palpably enlarged, and 
there were signs of many old bites about the hands. 
