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The History Of Yellow Fever In West Africa Author(s): Rubert Boyce Source: The British Medical Journal, Vol. 1, No. 2613 (Jan. 28, 1911), pp. 181-185 Published by: BMJ Publishing Group Stable URL: http://www.jstor.org/stable/25285236 Accessed: 24/02/2010 14:20
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Jan.

28, ion.]

YELLOW

FEVER

IN WEST

AFRICA.

[m^S?SKa*

i81

THE HISTORY YELLOW OF IX FEVER

WEST AFRICA. BY
SIE HUBERT BOYCE, F.R.S.,
PROFESSOB OP PATHOLOGY, LIVERPOOL UNIVERSITY

patients suffering from the fever. The tables were turned when Grenada accused Bui am in West Africa for having introduced the "nova pestis" as they termed it, into the West Indies. The story is instructive? because it shows that at that bas persisted to the present period inWest Africa. Dr. Chisholm maintained that up to 1793 yellow fever was a miasm and sot therefore but in that fever, contagious, that year the ship Harikey introduced a " new plague," as he called it, into Grenada for ihe first time, from whence it spread to the other islands, and from them to America and
Europe. great period yellowfaver confusion had was contagious already or not; arisen this as to whether same confusion

INTRODUCTION. Now that West Africa is beginning in earnest to open op to mining and industrial enterprises of all kinds, I wish to lay before the medical profession, through the medium of
the British Medical Journal, a review of than is usually In fact, is far more prevalent supposed. in my that yellow observations fever is prove, my opinion, the natives of the coast endemic towns, amongst to-day as it was amongst the Creoles, the yellow-skins of precisely If the mining etc. Rio, Santos, Para, Vera Cruz, Havana, will and merchants forearm themselves managers by of rational and the precautions adopting segregation on the West destruction not Coast, Stegomyia tthey need set backs to commercial fear the awful which the progress from yellow towns above named fever. experienced I have of reference For convenience summarized the

yellow fever inWest Africa, which shows that yellow fever

the history

of

In the eighteenth century the slave ship was no doubt one of the most powerful factors in the distribution not only of yellow fever, but of all other racial and endemic
and have of the insect the carriers virus of peculiar to fever, them. Not been malaria, etc. plague,

diseases might sleeping various might

only did the slave ship carry human beings in whose blood
sickness,

it equally well

served as the means

relapsing

fever,

yellow filariasis,

of mosquito, species on have taken been

know, could have developed on board ship, for in all taken on board at a probability every cask of water
was station infected with ova the or tropical already of the Stegomyia, larvae a The "slaver" was floating in which native the worst features of the native village,

Some of these fly, or flea. board infected ; others', we

of transport of the

history of yellow fever under the following heads :

1. General. 2. Yellow 3. Yellow fever fever fever fever fever fever fever fever in Sierra Leone. in Southern Nigeria. Senega). and Bonavista. Ascension the Gold Coast. the Ivory Coasi. Togoland. Dahomey. I.

4. Yellow
5. 6. 7. 8. 9. 10. Yellow Yellow Yellow Yellow Yellow Yellow

fever in the Gambia.

in in on on in in

village were reproduced, white and blacks living jammed together in hot stifling quarters, providing the ideal con ditions for tbe multiplication of the Stegomyia and the spread of yellow fever. The slave ship justly earned its reputation of being tbe great cause of the dissemination
of diseases, we more and strongly now in than of the of modern discoveries light ever realize the truth of this following records of outbreaks statement. The consideration

the

and

of yellow fever in West Africa shows how often history repeats itself. If the early settlements in the West Indies
in Central America were

HISTORY
. . . The

OF YELLOW
arrived

FEVER

IN AFRICA.
the question

so precisely

on the West

Coast of Africa the foundation of

or the arrival of new of course by outbreaks the same disease. regiments cf what

hampered

by

yellow

fever,

conclusion

whether

was or in Central and Southern that yellow fever America, was the early inhabitants of both places. endemic amongst of yellow When the even more fever fragmentary history we will, I thick, come in West Africa is examined, to a as regards the West African conclusion similar continent, a disease in all probability that yellow fever was namely, races of the coast. to the native West Africa did endemial or missionary, or even attract not commercial military as did the more at so early a date attractive expeditions

yellow fever was first endemic in the West

at concerning

Indies

settlements missionary as a matter were heralded was in every probability

It is New World. information begins fevers of the coast: of "Fernando Po";

etc. Amongst the

earliest

not until the eighteenth century that to filter home of the deadly African of " Bulam Fever" (1793); of the fever of the "fever of the Bight of Benin,"
records are those relating to the

Bibliography. on Quarantine, Dr.: fciecond Report Chi8hoIm, Dr., and Gillkrest, Yellow Fever. 1852. London, sur Ja topographie m?dicale Essai Charlea: Stormont, de la c?te occidentale de VAfrique et particuli?rement sur celle de la colonie de Sierra Leone. 1882. Account ?f the Coast of Africa. Boyle, James : Medico-historical London, 1831. J. A. B. :The Diseases Horton, of Tropical Climates and their Treat ment. 1874. Edinburgh, Medical Reports of Troops serving on the Wes o Quarterly Coa ?frica. ? Report by Colonel Ord upon the Condition of the British Settlenien on the West Coast of Africa. 1865. :Trait? de la fi?vre jaune. Paris, 1890. B?renger-F?raud II.

me

presence of jellow fever in St. Louis in 1778. The fact that yellow fever has persisted in unbroken line from the eighteenth century to the present day appears to
in favour evidence of the essentially to be the strongest of the disease. character Also of tbe endemial many on yellow writers fever adopted this view. earlier military we do not dis In the case of the sister disease, malaria,

HISTORY

OF YELLOW FEVER LEONE.

IN SIERRA
appears out made occurred by

cuss whether
ili was endemic

it was imported intoWest Africa or whether

The foundation and of Freetown settlement from the commencement to have been impeded of yellow are breaks fever. References constantly on yellow writers to an epidemic fever which by

or endemic whether question imported still are countries, that there We know

duced, bat introduced at such an early period in which

has

We it as a disease endemic. regard essentially those to peoples living amongst AnopheUnes; to the very widespread distribution having regard similarly, we may in Africa, assume of the Stegomyia that reasonably so fever has existed be long that it may yellow reasonably as endemic. in the case so in As of malaria regarded infection the of course have been intro fever, may jellow

in 1815. According to Johnson, in that epidemic 26 out of 50 died, the symptoms being jaundice, pain in the loins, stupidity in the head, black discharge or black vomit, fol lowed soon by death. He states farther that the Nova
" break to a bone vessel fever." which The fever arrived in

settlers called Scotia it was at the time attributed was genuine yellow fever.

January, 1815. There can be little doubt that the disease This epidemic is also referred
it and FerguEscn. Barry writers have taken Fiench was the home Leone of yellow

that

the

the Stegomyia
been

abounds, but in which

is beside the mark. as the East Indies,

to by Staff

Surgeons
Sierra Coast,

the disease

for granted that on the West fever

so far not

We also know that in the eighteenth century ships could have readily at any time introduced the disease into West Africa, for in those days the ships were exceedingly few which did not regularly carry infected Stegomyia and

signalled.

on the very natural

and had wider also contended

ground

that

it was more

peopled, Pym

with relations the outside world. that Sierra was Leone the home

thickly
of

yellow fever inWest Africa. Griesinger believed that it had early become endemic. s

[2613]

*82

kSSiS?^S^] the disease

of the coast. refers to this

YELLOW

FEVER

IN WEST

AFRICA.

[JAN.

28, 1911.

From Freetown
to the other parts 1817. Johnston

is supposed to have spread

year as an

and states that three missionaries

illness.

died after five days'

epidemic

year,

In 1821 a missionary died from yellow fever accompanied by black vomit. From 1822 to 1824 a considerable number of cases
occurred. Sta?

break, states that it broke out in December, 1822, and that the first case was that of a sailor ;previously, however, the crews of several ships in the harbour had been attacked with what he describes as the endemial remittent fever of the locality. It was also a matter of much speculation whether the disease was imported or endemic. Some held that it was an imported contagious disease; others that it was local in origin, and that the endemial remittent fever
of had the a

Surgeon

Barry,

who

described

the

out

in July, when, as the writer the yellow states, succeeded the common remittent of fever by and was once more confidence restored; but, to every one's the fever writer, astonishment,

viously occupied by the crew of the Mary, were infected, and 4 died in January, 1837. Deaths occurred in March and April, and the fever was at its height in May and June ; the last case was recorded
fever was Freetown adds the broke out

afresh before the end of the year. The first to succumb were the crews of three ships which had arrived during
the autumn, and Staff

amongst the white residents between November, 1837, and February, 1838 ; 2 ended fatally. In 1839, 6 officers of the garrison, 7 officers of the Boyal
Navy, Table and many soldiers and sailors died of yellow fever. from Showing the Number February, Occupation. Navy Army ... ... ... ... ... ... ... 11 5... and 272 107 of Cases Treated by Fergusson 1838. 1837, to March, Cases. 25 43 Deaths.

Surgeon

Fergusson

attended

20 caseB

again, held that the endemial remittent

common parent. the One

place

was

another

form

of thing

the

disease;

and yellow
is clear, fever.

others,

fever

from
from their It

the description
that the wives, was out disease; 10 died. noticed,

of the symptoms
was yellow 12 the of a party of that

and postmortem
with

however,

appearance,

disease

The white population, and especially

however, Bann sailed

the sailors, suffered

schoolmasters, blacks remained

resident merchants European seamen

healthy,

with

the exception

of

the Croomen.

H.M.S. the outbreak She then attacked.

crew and her arrived, for Ascension, some and

During
were affirm

Total

326 137 the

introduced the disease for the first time into that in 1823. (See Ascension Island.) The mortality is given as follows (Walker)
1822 December, 1823 January, 1823 February, 1823 March, 1823. April, 1823. May, 1823. June, ... ... ... ... ... ... ... ... ... ... . 7 2 9 11 12 24 12 deaths. deaths. deaths. deaths. deaths. deaths. deaths. deaths.

island

During arrived

sailed for the Gambia; during her voyage the crew are stated to have suffered from an outbreak of the dis
ease. time. Freetown was in

the prevalence one and stayed

of week

epidemic in Freetown

H.M.S. Harbour,

Curlew and

introduced

yellow

fever

consequence

blamed

for

into that colony

for the first

having

As in the previous epidemic, so also in this one, the relationship of the endemial remittent fever to yellow
fever was much discussed.

Total.77

opinion
was only

that yellow
the malignant

fever or malignant
form of the

Fergusson

put

forward " endemial

the

remittent

fever

common

According
remittent occurred imported

to Burnett, a disease differing from the usual

the character not contagious, of fever yellow and was not

In 1825 an epidemic is described with of 263.

There was also a considerable outbreak

and possessing It was in 1823. Caroline. by H.M.S.

a total mortality
in 1826, for, out

remittent" fever, and he thought that if cases of the simple endemial remittent type were transported by ship to other localities they might give rise to the malignant form. Fergusson firmly believed that " yellow fever was a product of the colony itself," but that both the Gambia
and Ascension were infected from Sierra Leone.

of a garrison of August 24th. Major Crofts remittent fever ?tated to have

yellow fever.

535 soldiers, 115 died from June

14th to

Sierra

In 1837 Burton described an outbreak of yellow fever in the island of St. Mary, situated off the north-west coast of
Leone. of

gives a table showing the mortality from in July, 1826 ; 53 men and 3 officers are died. In all probability the disease was case of black vomit was
occurred. ; 11 deaths 1829 the outbreak states that

From
reports "

1837 to 1839
the garrison remittent

inclusive
and fever." town

the quarterly
show

medical

fatal cases of yellow

malignant

fever entered under the heading of

with often severe severely

unquestionably

In 1827 a typical
12 cases were in commenting by

recorded

{Fergusson). whites Boyle,

In 1829 an epidemic broke out, and in the garrison of 130

reported upon in Free

period " endemial the remittent sometimes fever," fatal crews were and symptoms. Ships' affected.

In the

1840 to 1845 there is a yearly record of

town, and refuting the idea tbat the fever was

into Freetown H.M.S. Eden,

imported
occasional

cases of yellow
Freetown. disease the memorandum

fever are to be met with

every year in

tagious was drawn up in Freetown on May 27th, 1829, and ?igned by J. Boyle (Colonial Surgeon), M. Sweeny, M.D.,
Inspector, Deputy In 1835 a case from Fernando and W. Fergusson, Surgeon vomit is recorded. of black R.A.M.C.

also Violent controversy or not. was contagious that yellow to the effect

as to whether arose a In consequence, not con fever was

on the at anchor River. The squadron Roquelle sym are unmistakable, recorded and are confirmed ptoms by the post-mortem accounts In this year aleo (Fergusson). some evidence there was that Bonavista infeoted appears

In 1845 a case of malignant remittent or yellow fever appeared ; the fever broke out amongst the crews of the

The origin of the outbreak was

Po, and by others

ascribed
to the town

to importation
of Zangara,

it was seriously proposed to build a 400 miles distant; was high wall to keep out the pestilential breeze which, it
came from this town. alleged, in the years occurred The next large epidemic out broke fever In December, 1836, a malignant 1836-38. amongst

In 1847 an epidemic is chronicled by Staff Surgeon The resident white civilian population is put Lawson. down at 100, and of these 12 died from yellow fever.
were also There on H.M.S. and cases

severe the newly arrived and amongst symptoms sailors, so amongst the native least soldiers. At this period, also, " " the expressions bilious remittent of the country fever " ,l fever and occur?other no names, inflammatory for the same disease. doubt,

from Freetown by H.M.S. Eclair. It is also stated that in this year cases occurred frequently and with the most

the the on who

young

crew of the barque Mary whilst in Freetown ; 15 of crew were attacked and 5 died. Cases then appeared shore, one of those who died being a mulatto lady another was had come from the United States;
man who had only been one month in the colony.

cases,

3 of which

Syren,

the in the sailors amongst on which there were ship

port 17

developed

black vomit

ten days after

embarkation.

In 1850 a case of fatal yellow fever was reported ; it was said to have been introduced by a sailing ship from
Rio.

Five of the crew of another ship, The Lady Douglas, who bad gone ashore and who had lodged in the house pre

In 1859 an epidemic of the disease.

occurred

in which 100 whites

died

JAN. 28, iQii.]

_BELLOW

FEVEIt

IN WEST
occurred.

AFKICA.
After this date a few more

[*???fSSSLi,
cases occurred,

183
but

In 1865 and 1866 cases were also observed. After this period there is a lull in which no doubt the
disease

in a mild and undiagnosed form, but does not make itself obviously manifest, owing to altered conditions
in the navy, mercantile marine, and in commercial enterprise. The

persists

amongst

the

permanent

residents,

but

of a less virulent type. The final opinion?given the disease was

contagious a noticeable Europeans. surgeon and the other nature." feature The The was natives

on July 17th by the colonial in Freetown?was that practitioners "mild a type of yellow fever of a non
Governor that, as in his report the disease to have

that states a assumed

In 1872 it broke out again and 6 deaths were

colonial surgeon, writing in 1883, states

" : We

recorded.
have

more virulent type, it became more

seemed the

and more restricted not

complete

to
im

had no cases of yellow fever since 1872." It is presumed to have been present in 1878. In 1884 a severe epidemic prevailed in Freetown; the cases appear to have been diagnosed either as yellow and a dispute arose as to the nature of the fever.
annual military returns one soldier is returned fever, severe or pernicious remittent fever, African fever,

munity
authenticated

from

its attacks,'there
case amongst

being
population.

single

In the
having

the acting colonial and Dr. Cole, officer,

To Sir Arthur Havelock's covering dispatch is appended the report of the Special Medical Committee, consisting of
surgeon, a private the senior military medical practitioner.

negro

as

died of yellow fever, and the statement is made under date June 25th, 1884, that yellow fever and a severe type of remittent fever prevailed in the town during this year. There is no doubt that great confusion existed at the time
between in a great yellow fever. remittent fever and yellow " The term " bilious remittent fever has been employed number fever; of some cases have, as another name for however, regarded genuine it as a

From the report it appears that the epidemic was most fatal in Westmorland, Bawdon, and Home Streets (the
quarter). The disease, they state,

European

distinct disease. From the history of yellow fever on the West Coast it certainly appears probable that a very
large proportion of yellow fever. of the When bilious the remittent fevers were a more fever assumed cases severe

remittent resembled fever, or that type of pernicious yellow as its character destructive fever of a malignant type having dark-coloured skin and conjunctivae, of the istics yellowness urine dark-coloured alvine offensive and evacuations, very a quick pulse blood oasts and very obvious albumen, containing from 102? to 105?. and a persisting ranging high temperature in dark to control, and very difficult often persistent Vomiting, cases in some of bile, a large quantity and containing colour black vomit. with distinctly Duration, five to seven days, and, in malignant cases,

represent the mild forms of yellow fever? In this con nexion it is interesting to note that there is some evidence from the MS. notes of the period that the " endemial "
remittent fever of Freetown conferred a certain

long as the cases remittent fever. The question

type and became epidemic

remained therefore

it was
mild arises,

called yellow
they Do were the put remittent

fever ; as
down as fevers

four to five days. The report describes the types of fever prevalent
coast enteric as intermittent or typho-malarial fever fever, or

on the

of immunity against yellow fever, which would show that the remittent fever might be a mild form of yellow fever. Moreover, the fact that the natives escaped the severer form would also tend to show that they had had a milder
form of the disease, probably Lawson states that some medical the "endemial men of the

degree

or yellow fever. They state that the years 1807, 1809,. 1812,1815, and 1819 were marked by great sickness, the nature of which they do not state. They allude to the 1823 yellow fever epidemic, and state that in 1825 oui of 902 persons attacked 263 died. Another epidemic attacked occurred in 1829, when out of 150 Europeans 11 died. In 1837 an outbreak also occurred in April, preceded by state, died down, passing insensibly into the common endemic remittent fever. In 1838 yellow fever appeared in February and ended inMarch. In 1839 6 officers died of yellow fever, and an appalling number of the troops, 7 officers of the Boyal Navy, and
13 seamen H.M. June, died. very suspicious cases in January. The epidemic, they

remittent fever, ague, and pernicious malignant

sidered that the natives did suffer from a mild form, which was capable of inducing the malignant form in the whites. Lawson himself considered that both diseases had a
common A Dr. cause. Davies, practising in Freetown, reported a case

period

remittent." con

of yellow fever on July 15th, 1884. Upon receipt of this report, the acting principal medical officer sent a letter
to Dr. diagnosed Davies, a case

In 1845 yellow
squadron July,

fever broke out amongst

in the Boquelle River.

the crew of during.

at anchor

case of yellow fever which he had had in his practice to be the principal medical officer stated that, in his opinion, Dr. Davies had made a grievous mistake in his diagnosis as showing the attitude of mind at the time as regards the nature and diagnosis of yellow fever. Yellow fever in
the same year to have broken appears another part of the colony. In 1884 the evidence shows that there out was at Rufisque, a considerable in of yellow fever. This correspondence is of great interest, contagious or not." In a subsequent letter to the Governor,

him what he upon asking " grounds of yellow he considered and if fever,

had the

In 1847 yellow fever was

and August.

epidemic

in Freetown

In 1859 also an epidemic broke out, when 100 European? Cases also occurred in 1865 and died of yellow fever. 1866. In 1872 there was an epidemic, and 6 deaths occurred in December of yellow fever. The total mortality from this disease may have been 250. Dr. Lamprey, describing the cases of yellow fever in the Journal, 1885, 1884 epidemic in the British Medical states that the outbreak of yellow fever in Sierra Leone and that all attempts to trace its origin to a non-sporadic
source had failed. sporadic in origin, the undoubted product of Freetown,

was

reluctance to notify the outbreak as yellow fever, and oases which terminated fatally and with the classical
symptoms remittent of black

were

"enteric fever." The year 1884 showed a mortality of 50 amongst the whites; probably the majority of these
yellow fever.

fever,"

were vomit "African

entered fever,"

"pernicious and "typhoid,"

as

In a report sent in July 30 th, 1884, to the then Secretary of State?the Earl of Derby?by Sir Arthur Havelock, the
Governor described the months of Sierra Leone, as " typho-malarial of May and June a is stated that fever, fever," was prevalent during arrived ; recently Europeans it

between the He notes the difficulty of distinguishing bilious remittent fever and yellow fever. He states that in 1853 yellow fever was present, and that an epidemic occurred in 1825. He states that also in the years 1829,. were 1837, 1838, 1839, 1845, 1865, 1866, and 1872 there
very many cases

amongst

In the 1884 epidemic he notes that the total death-rate was 35 per 1,000, and amongst the native population The month.
the Europeans 6

of yellow

fever.

suffered most

disease became was the disease on the borderland

severely?

The malignant

symptoms

of the

epidemic commenced He then describes

of cases.

inMay and lasted until August. in detail the symptoms of a large

can be no doubt, therefore, thai

per

cent,

per

more On June marked 27th every day. " as a fever remittent described pernicious a same At time fever." the of yellow

private
disease

practitioner
was yellow

had

already
and the

concluded

that

the

had actually reported a case of yellow fever. On June 28th a European died of black vomit. On July 2nd two Europeans died of yellow fever, diagnosed as such by the colonial surgeon; on July 6th another fatal case

fever,

military

medical

officer

there existed a severe yellow fever epidemic in 1884. this year (1910) of the scanty medical Examination of Freetown shows that in the year 1893,4 death? reports fever. malarial from pernicious occurred In 1894 the statement is made that there were 16 deaths amongst the Europeans, of which 13 were stated fever and to be due to bilious remittent haemorrhagic fever. Three of the cases 1 from malignant malarial I

number

There

184

mS?J?jotonai.] thirty-six hours of their

YELLOW

FEVER the

IN WEST

AFRICA._

[JAN. 28, 1911.

died within

rivers. now Of course, it is no !? to be certain possible cases or whether there were of black water fever them ware not genuine fever cases. yellow

landing from

whether some of

and numerous outbreaks the very into account Taking been described have fever which cases of yellow sporadic in Sierra Leone the nineteenth up to date, century daring or sporadic no epidemic after in mind that and bearing

case was

In 1899 there were of bilious remittent

records. there were 2 cases

17 cases of remittent and 6 cases in the hospital fever entered is made

fever

any town

fumigated

to destroy

the

infected

In 1900 the statement

of

in th9 annual report that

in the six years from

we may Stegomyia, cases fever, yellow When these years. are in possession

be certain that, following occurred of the disease in mind, facts are borne of facts which, in my

laws of in intervening and the same the place it

reasoning applied to the other colonies

of Africa. one fever, of the especially

inWest Africa, we
opinion,

1885 to 1891. In 1903 a Syrian

yellow

died with

was officer in attendance medical who regarded now time as a case of gastric ulcer. He thinks have been a case of yellow fever. very well might

symptoms

which

the

beyond a doubt that yellow fever is endemic

Coast B?renger-F?raud, on yellow times

on the West
recent that

at the that it

In 1909 a fatal case occurred which, some 10 cases of yellow

recent the experience, now conclude attendance

in the light of
who were in

In 1910
reported, been more

medical officers was fever. yellow

fever have

been

Sierra Leone is the endemic source of yellow fever in West Africa, and compares it to Mexico and Cuba; he further remarks upon the great efforts which the English authorities took to deny the existence of yellow fever.
Bibliography. : The White Man's Grave; or, A Visit to Sierra Rankin, F. Harrison 1836. Leone. 1831. London, Coast of Africa. Boyle, J. : Account of the Western Paris, 1842. Walkenaer: Voyages en Afrique. of : Account of the Origin, Spread, and Decline Bryson, Alexander 1?49. the Epidemic Fevers of Sierra Leone in West of 1816-1823. Church Mission Johnson, W. A. E. :Memoirs 1845. One Hundred Years of the C.M.S. Africa. \ in Sierra Leone. 8. A. : The Church of England Mission Walker, London, 1847. in Sierra Leone; MS. of the Troops Medical Reports Quarterly in Freetown. Reports preserved Letter Book, The Medical of Freetown: Annual Medical Reports Freetown. on the Sir Arthur :The Report of the Special Committee Havelock, Colonial Office, in 1884 in Freetown. Cause of the Mortality 1884. in Sierra Leone, 1884, of Yellow Fever J. J. : Outbreak Lamprey, vol. ii, 1885. Medical Journal, British and their Climates J. A. B. : The Diseases of Tropical Horton, 1874. Treatment. Edinburgh, Paris, 1874. La fi?vrejaune au S?n?gal. B?renger-F?raud:

of historians great in Africa, contends

8 proved of which but there have fatal, may cases and more one fact which is deaths. The

certain is that the disease was yellow fever, and that the Syrians were the first attacked and amongst whom the
greatest mortality and continued May,

From

in Freetown, disease the reader forced is, in my opinion, to bat one conclusion?that as in in the case of Freetown, the case of the towns in Central South America, America, and the West or virulent in a mild fever Indies, yellow a disease form has been common those among living

the preceding history

occurred. The into September.

outbreak

occurred

in

of epidemic and endemic

in the Stegomyia-mtecte?
to the present

town of Freetown

since

its

foundation

In the preceding account yellow fever is diagnosed and carefully described by well-known military and naval of the world, and the descriptions
surgeons fully conversant with the disease in other

day.

which

they have left in YELLOW FEVER

parts

was that their diagnosis correct. prove manuscript is the history there occur annual of the almost Again, rence of outbreaks of black which all disease vomit?a observers new-comers in preference to mention?attacking

m. IN SOUTHERN

NIGERIA.

the indigenous inhabitants. Indeed, authorities were agreed that the permanent black pspulation did not get the
severe yellow fever of the white man. Some authorities

bagan

to discuss

or acclimatizing remittent fever mild, endemial, fever, o1 Freetown, with concluded that fever, and many yellow ?e mild t form could severe fever. into the pass yellow Others concluded that both had a common ; others, parent

the relationship

between

the common

I have in view of the reasons which be strange, It would inWest fever as endemic for regarding yellow put forward the pre where like Southern if a colony Africa, Nigeria, and is the Stegomyia town calopus, mosquito vailing of yellow fever has been the existence which around close

officially chronicled during

exempt however, probability, overlooked be

a^aio, that the remittent fever of the native could give rise to the yellow fever in the white man. Another authority of the time concluded that the
endemial remittent fever a certain of conferred degree are All fever. these points over in discussed been again, are fever is endemic. They for no the doubt observation,

I am of opinion, fever. from endemic yellow in all is endemic, and that fever that yellow has as in other the disease colonies, long been diseases. for other and mistaken Unfortunately

the past fifteen years, should

the medical

records which have been kept in the hospitals

of a very records scanty of the nature, diseases and there prevalent

have been in the past are no careful manuscript been preserved has There

amongst the troops and sailors similar to those which have

in Freetown.

immunity against yellow which over and have, countries where yellow all on based accurate

mild

endemial

remittent

fever

of the

inhabitants

of

by many of the experienced traders, that the disease which has proved rapidly fatal to the white man on several occasions, and which had at the time been
attributed

been,

however,

strong

opinion,

expressed

was in very many Freetown mild instances fever, yellow and it naturally a certain conferred of immunity, degree or perhaps to a subsequent attack complete immunity,

were It was but natural, infested with Stegomyia. itself therefore, that yellow fever should first manifest
them, amongst the infection. as On they the were other most obviously exposed the merchants hand, to and

the final of the essen is, in my opinion, proof in Freetown. endemic of the disease character The tially in recent in numbers have increased in Syrians years are engaged Freetown. in a small and live trade, They with and amongst in the more the natives crowded parts of Freetown. of their and those Their yards neighbours infected,

of yellow fever. The endemial remittent fever of the native was the source from which the Stegomyia obtained its infection. The outbreak which has taken place this year (1910), and in which the Syrians were early

j bability yellow fever. This view is much strengthened by tho outbreak of yellow fever which took place in Bonny
in 1899, and

to a malignant

form

of malaria,

was

in all pro

yellow fever which occurred m 1905. I will now briefly record outbreaks of the disease in Southern Nigeria, in order why I consider yellow fever
at the present Yellow time. Fever

by

the

undoubted

cases,

in Lagos

in 1893-4, and again

in my

opinion,

of

the outbreaks and supposed some of the chief towns of that the student may realize endemic in Southern Nigeria
Nigeria,

in Southern Warri.

The medical
a was there about factories

officer reports that a tradition exists that

fever outbreak yellow 1860-70. the years at the European

officials living in better and less congested quarters suffered to a far less degree, whilst those completely
segregated were not affected at all.* * Sir William upon the origin of yellow fever Pym, in commenting inWest Africa, states the great difficulty of bringing positive proof of its existence amongst the natives, because they have it in so mild a form that it does not kill. Be mentions how the Croomen escaped yellow fever in the West African squadron when the white crews were He concludes that it is reason suffering and dying from the disease.

able to suppose that the Croomen had already had the disease in their I native country. of the acting principal medical officer, Dr. Kennen, I The opinion of 1910 had a local origin and of others was that the epidemic ] and was not This opinion of the endemic origin of the imported. of yellow fever was the view most adopted by frequently epidemic in the past. outbreaks I those who had been called upon to investigate failed in 1910, as in past years, to prove importation. I Investigation of the facts on the spot, with I I concur, as the result of examination | the endemic origin of this outbreak.

JAN. 28, 1911.]

Calabar. An undoubted case occurred Bonny. in the years

PUERPERAL

ECLAMPSIA.

[me^?S**-^

1890-1.

PUERPERAL ECLAMPSIA:
A COMPARISON WITH VENOM POISONING AND A SUGGESTION FOR TREATMENT FOLLOWING
THEREFROM.* By H. LEITH MUKRAY, M.D.Aberd., PATHOLOGIST TO THE DAVID LEWIS NORTHERN HOSPITAL LIVERPOOL. In a recent number of the Journal Obstetrics and

In 1873 several deaths were recorded which might have

been due

In 1883 it is stated

to yellow

fever.

that an outbreak of yellow fever

from Freetown. due to importation occurred, a very is recorded In 1890-1 serious outbreak of what was The medical vello w fever. officer, unquestionably was that it was fever. Dr. certain Parker, genuine yellow

The description
doubt thought as to by

of the symptoms

is such as to leave no
disease and was was attri

buted to the pulling down of an old factory ; others main tained that it was introduced in the straw and litter on
a ship coming not affected. Dr. from There South were was America. 11 cases in Bonny and

of the the nature some to be malignant

disease?the malaria,

I have gone fully Gynaecology of the British Empirel into the pathological lesions found in eclampsia and their interpretation. On this occasion I wish, in the first place,
to summarize some of the evidence

of

the population of 15 white men.

A. J. Brown, headache, who pain,

were natives The 9 deaths amongst the time, informs

at

me
were

that he attended

two of the cases.

The symptoms
albuminuria, at the time,

yellowness, persistent Dr. who Parker,

great prostration, black vomiting. was the medical officer

and especially that part of it which seeks to show that the single, although complex, type of toxin which I take to be the cause of the disease is capable of producing a very definite polymorphism of lesion in such an organ as the liver ; I should then like to add some confirmatory [ come my way since that has which evidence paper was published ; and, finally, to give certain new therapeutic suggestions which are rendered at least plausible by the results I will lay before you. It is very necessary that I should make it absolutely
attack to an acutely toxaemic I am referring that plain state without evidence in the puerperal any occurring Of those convulsive chronic of pre existing nephritis. in pregnancy conditions toxaemic other and occurring

given

in

that

paper,

stated that he was

convinced

that the disease was yellow

the disease fever. He and died. contracted subsequently me with notes Dr. has furnished MacDonald, Bonny, case in 1909, six weeks of a suspicious occurred which The at the time was after in Bonny. arrival diagnosis " No malarial and were, parasites jaundice." gastritis

associated with a chronic kidney I can say nothing. must

work of examining on eclampsia by such cases, the one hand

inflammatory lesion in the I have had no opportunity

exact their to uraemia so vast and to relation on the other

however,

found in the specimens

inquiries which

of blood which
made,

were
can

examined. repeatedly numerous From

and and are

I have

there

at present be difficult to determine.

uraemia that itself a on record,3 combination of

The problems
complicated, eclampsia and

be no doubt that yellow fever occurred in Lagos virulent form from 1894 to 1895. Thus, I have
reliable authority that seventeen members of

in a it on

presented

as may well be judged from a perusal of the experimental

a mission

arrived from England in Lagos on December 13th, 1893. Of these, five had died by the end of January, 1894. In
addition, another cases At type a resident

the classical symptoms of yellow fever.

were at Lagos reported in 1898-9, there Sapoli fever was recorded

missionary,

missionary, had also

and died.

the The

of child young cases presented

renal disease, with interrelation of the two, is likely to present still greater difficulties for elucidation. You will understand, then, that I limit myself to that
acute which which some clears and usually convulsive toxaemia which tends more

According

to Ott,

particularly
may days up,

to affect previously healthy young primiparae,

develop or weeks and which most quite commonly in a more ingravescent stage), (pre-eclamptic is characterized

in 1896. a considerable were

commences

number

of suspicious deaths, and in 1907 an outbreak of a severe

of at Widah.

but suddenly, form during in the which degenera

event of a favourable

issue very rapidly and completely

by purely

Examination

of the medical

notes

in the hospital

at

Lacros

cases me of well-marked that convinces genuine were 1902-5. There in the years fever occurred yellow cases. also many mild are violent and body headache The recorded symptoms of urine, slow pains, suppression temperature, pulse, high

tive, as opposed to inflammatory, lesions in the kidney. The difference of opinion as to the nature of eclampsia ranging from the view that the disease is indistinguishable from uraemia to the idea that it is a disease as peculiar to
as pathology is not dition is a the ovum is, as your know, extremely marked?the divergence

black vomit, and coma, terminating fatally. In 1905 the symptoms recorded could hardly be those of any other disease but yellow fever, yet the diagnosis made at the
and included "fever cordis"?a diagnosis in Togoland. I am, been gastritis" which therefore, fever. Ott "fever and and was also states of opinion strongly When it it is recol

time morbus made has 60,000

that a bistological evidence goes to prove. I think, too, correct interpretation ot the lesions will show them to be
peculiar to occur nor the puerperal to eclampsia state, neither other natural in certain or in part in whole conditions. experimental consist of eclampsia seen in the liver, the lesions as but and

simple

to pregnancy. the uraemia

That the condi most satisfactory

that in Lagos one of the causes of mortality lected how

native it undoubtedly

in the past the is the

that the is under

of

little
is

is known
not

yellow

of the fevers amongst

and to when assume

three definite and distinct

exception, cases. there is a This

changes.
is usually

First,
change rather

and without
widespread marked

inhabitants

stood that by far the most

Stegomyia,

of Lagos,

abundant mosquito
fever is endemic. contention of this

in different throughout the organ and varying in intensity more

degeneration

degenerative

unreasonable yellow favour

natives

in all probability
that therefore in evidence

suffer from a mild type of yellow

is fur

towards the centre of the lobule, and may

to a little proceed although commonly, the surface towards

in that region

and fever, Further

nished by the admitted frequent presence of yellow fever in Dahomey and Togoland close by (see the paragraphs on these colonies). It must also be recollected that, just as in the case of Sierra Leone, the infected Stegomyia left to were not destroyed by fumigation, but were
propagate the disease. (To be continued.)

of focal necrosis in the periphery of the lobule. This necrosis is strictly limited to the outer zone or to part of it,
and

and very necrosis. Secondly, irregular is seen there no means invariably, by condition liver a very peculiar of the

we In a recent on Cinematographic note Microscopy of 31 and 33, Charing Path? mentioned that Messrs. Fr?res, their films to exhibit were Cross Road, willing always on pre men life to medical of micro-organic illustrative us to now firm The sentation of their cards. requests it has of medical state to the number visitors, that, owing in demonstrations for the set aside afternoons Friday question.

of blood extravasation, a certain amount especially organ, areas. the necrosed with in association the invaii are, first, of greatest The importance points lack the absolute and, secondly, able degenerative change,

in the middle and inner zones. And, thirdly, there is the surface of the frequently seen, particularly towards

does

not

gradually

merge

into

the

degeneration

seen

In of relation which this bears to the focal necrosis. other words, the clinical severity bears no relation to the
amount of necrosis

An explanation of these peculiarities complex nature of the toxin at work.

*Bead at a pathological on December 1st, 1910. meeting of the Liverpool

seen post

mortem.

is found in the It contains both

Medical Institution