GREASE f I3ST j YELLOW FEVER URINE BY jSrnzzi delmanri a physician and surgeon form Havana’s University, rewarded by the same in oppositions, a physician of the “Charity Dispensary” withont pay, and also of the reconcentrados people in the calamitous times of General Weyler, asistant surgeon of Dr. Mone Lasser in Lee’s Asylum, a member of honor of the revolutionary Clubs of Juan Delgado and Fitzhurgh Lee. Incorporated at the Board of Sanity of Tampa-Fla. HAVANA Printing “La Moderna Poesia” 133 and 135 Obispo street. 1899 GREASE * 11ST j YELLOW FEVER URINE BY <5?delmanri a physician and surgeon form Havana’s University, rewarded by the same in oppositions, a physician of the “Charity Dispensary” withont pay, and also of the reconcentrados people in the calamitous times of General Weyler, asistant surgeon of Dr. Mone Lasser in Lee’s Asylum, a member of honor of the revolutionary Clubs of Juan Delgado and Fitzhurgh Lee. Incorporated at the Board of Sanity of Tampa-Fla. HAVANA Printing “La Moderna Poesia” 133 and 135 Obispo street. 1899 Ulinjf 1 Samucf IvUuiie! pear poster: $ beg you to accept in friendly correspondance this extract of- one of my worlds; made come of they with, you, in yours laboratory, at number 2 ffospU taU'HCedadc. yours truly attentive (§4n€4/ (Qt/e/mann- Havana June of 1899 Grease in XJellow {Giver XIrine The last war betwen Spain and Cuba obilged me and my family to go to Tampa, Fla—Ibor City—Their I made acquaintance with whoom that is today my dear freind, Dr. Charles Barthlet, he leaved their by his pro- fession, and that he was so kaind in his manner of thin- king, that he served to 25 companions as interpreter without salary, that had run away from Cuba, his dear and loving country. Make so free, so handsome, so riche, by the hands of the Lord, and made so unfortunate, by the men’s will. Dr. Barthlet’s example to serve without interest, to one or severals enemies perhaps, made me now the truly interpretetion of the liberty, that is desirous to open the doors to all the men that want to lives in its free country. How much free and happy are the men that think in inglish! How great is the United-States, the must free country in the world, that as soon as its was free, 6 opened quikly all its door to the emigrants, without as- king them for theirs titles, bnt with the sight open to them for seeing theirs manner of behaving them selves. Having finished the Ith ediccion of my pamphlet on the grease in yellow fever mine, I give the 2th edic- cion, increased and corrected. I am going now frist to refer here to one letter, that came from Washington, and that was addresed, to the Medical society of this city, and also, to severals doctors. In this letter they want to know onrs manner of thin- king abont infeccious fever, pernicious fever, typhus fever, and what is the difference between the typical typhus of this country with that of other country. I praise with all my heart the just wishes of the chief of the sanity departement of the Americans Army, uf General Stenberg, because he wants to know well enough the germens of death, that this ground enclosured. What relecions are their between the typical typhus of this country and that of others country’s? now with the mo- dern medical nosologic, what means to us the term fever? Wheather fever is the product of the infeccious of the body by the toxinas produced by infeccions illness we understand the illness that is owed to one micro orga- mism that penetrates since from exterior to the interior of the body and multiplav them selves theiring. But we dont know about the micro-orgamism, if we dont know nothing abont the toxinas and if we only know that their is a great dose of poison that acts in only one time, and that we have given the name of intoxication. We know also that yellow fever had been classifed some ti- mes between the infeccious illness and in other times between the typhus illness, now whilst it micro-orgamism is discoverd, we can classifed this illness between the typhus illness, knowned by the name typhus not only the stupor, but the intoxication or poison produced by morbus human poison, and substituted by the bad name of yellow fever, because their are many cases that we 7 have not jaundice; by the name of kindneys typhus, ty- pical of this country. The acting of the poison in the kindneys, is the sinptoms more salient, the severs paints in the kindneys, call from the beginnings the attention to this orgams, the want of prodoms, show us that the intoxication is rapid, brutal and dangerous it seemes that it dont need to wait, the multiplication of the germs it appear that they have not to sustain a strugle, frist into the livers cellules, and afterwards with the fago- citos. The frist orgams that overcomes at the strenth of the illness is the kindney, that is to say the door of escape of the poison elaborated by the life of the celules, both phisiologic and patholpgical. In the cours of 3 days the kindneys runes over all the phasis of the Bright’s illness and the albumen accuses frist the severe congestion of the glomerul and its death by the degenerancy by the graise granulation, afterwards, process that killed so quikly the kindney’s cellules repercussion open the liver, and it takes the caracteres of the graissed liver, that every one can see in the liver of the persons that had consumption or that of those that had Bright’s illness. In the liver we can not faind the fatness degenerancy, and the jaundice that appears in this illness have not been cansed by one lesion of the liver tissue, it is not for obstruccion in the bile cours, it is owed by the poison that have broken the natural attraccion of the small ca- nal of the bile by them, and the bile passes to the blood. We well know that the pass of the bile to the blood is nothing if the kindneys can put it ont of the body, but if the reins can not does it the pernicious jaundice is es- tablisch, but this is secondary in yellow fever, in which jaundice it does not causes death; we have faund biliver- dina in the urine as a truly symptom of the good state of the liver’s celules. Dr. Madan has faund urobilina that acording to Ha- yein’s opinion shows us that liver’s cellules suffer but the 8 suffering that urobilina show us is very small because we can see it in the must swift jaundice. We are all agree to Freirchs’s opinion that the lesion of the liver is not of destrued by the fatness process, only the infiltra- tion and impregnation of the cellule by the graisse, but never we have been able to see the destruction and death caused by the greasse process, like we see in the kindneys, its cellules and glomeruls of Malphigio’s is emulsioned and digested by the greasse. The clinical study is according with this painfully of the kindney of the frist moment, and is continued by a painfully head each and vomits, and anxionsly epigastric pain and the breathing smell to urine. Deaths in yellow fever is always the product of the uremia, and the hemorrhage and jaundice is also the product of the intoxication by the urine. The kindney or best saying its lession occupayes the frist place in yellow fever, and in its lighty forms we are always in the doubt wheather its was a case of yellow fever or a case of gastric fever, because the only diferencial symptom, is the albumen, that wants that was a case with ours forefathers have called acclimation fever, because they and us also can not afirmed of that have been or not a truly case of yellow fever, the inmunity that this fever give, is the only that shows us that it was a swift forms of yellow fever. Now we are in the peace and Cuba need to go rapidly to arrive to the 15 or 20 million of white men, that she can support, and the agriculture go to reach the place that she deserve and owes to be in this richer ground. I think it is necesary to show to the Americans, the two dangerons illness that disgustus in Cuba, the malaria fe- ver, and the yellow fever. We know that the paludic manifestation is owed to one protohoos, that is an ameba that had flagelas in num- ber of one to four for each one, that had a voluminous nucleus, that can be seen when me add acetic acid, the 9 membrane that envelopes the ameba is rich in albumen and in another subtance vegetable, insomernn of the vegetable filotium, the flagelas had not in its end ab- sortion. The form of the palndic ameba is spherical when it is big and strong, its reproduces by gems and by seg- mentation, they lives in the waters richer in organic ve- getables subtances, and in alkaline medium, we can make by this way artificial and sterile swam with ten part of boullon alkaline for ico parts of sterile waters sown by some droops of blood that had big forms of the paludic ameba, and puting all in a darke place, and left quiet during 48 hours; if we take then a small droops, by the microscopical examen we can see the Laveran’s amebas. They don not belong to the gregarinas, nor to the coccidens, they are not gregarinas because they have not quitinous in its composition, and they are not cocci- deus, because they have not its ovular phase. They are not simple ameba because they have flagelus and nucleus. Its breathings and its cuculations is owed to the capillarity and osmosis laws, its feed itselfs by a hole. The writters have present to the Academy of Medicine in this city, severals cases belonging to the reconcentrados, that had presented the two forms of beri-beri illness, the atrophic and the swelled forms. I have proved their that beri-beri, is the product of famish and paludic intoxication. The blood of all this poor famished was analyzed by me, all had the paludic ameba. For me the paludic acces, is the result of the struggle between two amebas, the leucosyts, this proto ameba in the normal blood and the paludic ameba, ours duty as a doctor is to help the leucosyts, so that its cau ercome the paludic ameba. Both the leucosyts and the plasinodic has the same composition, life, etc. We ean establishing now that the melanin found in the blood is not a product of the plasmodium but is de- rived from the hematin bred by the plasmodium. Before 10 and during the attack, when the blood is loaded with malarial parasites: and the fever is destroying the red corpuscles, the blood will be found to contain numbers of living and dead plasmodia and melanin free and en- closed in the leucocytes. But of the blood is examined after the attack no parasites will be found nor any leu- cocytes containing melanin in some cases. The question is what has become of them? I can answers by asserting that they have all been imprisioned in the spleen, where the normal number of lymph-cells has been multiplied to protect the organism from the invasion of the parasite. In yellow fever we all think that they are one germs in it cause, but ours means of colouring and of culture can not put out at ours sight it. Freire’s cocus, Finlay’s tetrageneus, Gibier’s cromo- genons Senberg’s X, Sanarelli’s baccilus, has not proved us as the cause of yellow fever. The clinical study in yellow fever is the principal Dr. Faine Mayor of Sanity of the Americans Army has addressed one questionary to the doctors in Havana: one of the cuestion put by his was that. Is their one symptom that can be pathological in ye- llow fever? Yes sir can I anwers and in the urine you can always faund it; it is the grease you know perfectly well that yellow fever has a quickly evolucion in 3 or 4 days, the fever and all the simptom ceased, and the ter- minical periodic begin and by the urine you can see in it the fatness degenerancy of the kindney, and say suret- ly the diagnostic and the prognostic. It is certanly that the orgam more lesioned in yellow fever is the kindney. In this intoxication since the frist day you can see in the urine, mucine, from the second or third days you can see the albumen, and the grease come sooner and make the pathonomonic type in this esencial pirexia, the fatness degenerancy. The appearance of tke grease in the urine, that I am the frist in showing, tell us clair the destruc- tive process by the grease. The analysis of the urine give 11 always a acid reaction, so carectheristic that one urine of alkaline reaction put ours manner of thinking out of yellow fever, the albumen is always in direct relacion of the seriousness of the case. The colour of the urine chan- ges in direct relation of bile pigmentum, and we can see always Gmelin’s reaction in all the case that jaundice is seeing. If we pass now to the microscopic examination we can follow the kindneys destruccion by the fatness pro- cess, day by day and steps by steps, or the disappearance of the grease and the restitucion and integrum of the orgam. Their is in yellow fever 3 penods, frist infeccion se- cond remission, and 3th termination, one times by cure and in other timqs by death. In this last periodic, the analysis of the urine show us with its daily variation the end of the illness. In proof of this I am going to refer you two cases, one was cure, the other died, both having taking bed in angeles Hospital in the 5th day of its illness and after of the characteristics remission, both had the same thermo- meter and pulse curve line, one of them had incoercibles vomits, insoinnious near 48 hours, and cured hersself; the other rested quiet in his bed and only had furions deli- rium a few hour before his death: the frist one that is to say that, that was cured had not jaundice, the other one that was death had a pronounce jaundice. Let us see now the urine, that of the woman, had a yellow colour acid reaction, specific weigth, 1,018 albu- men enough; at the microscope a great deal of grease and also epitelic cellules in fatness degenerancy, leuco- syts, kindney’s cellules and kindney’s cylinders, in fat- ness degenerancy. In the man the urine had a brown yellow colour acid reaction, albumen 30gramesby 1,000 a great deal of pigmentum and bile acid we see the Gmelin’s raction; by the microscope you can see a great deal of kindney’s cellules in fatness degenerancy. 12 This analysis of the urine show us the march of the kindney fatness degenerancy: in the woman we can see the restitution ad integrum of the kindney tissue, till it desappeared all abnormal in the urine and she leaved the hospital in ten days of hers illness, because she was cured. The examination of the urine in the man let us see that death was the natural end of the fatness degenerancy that was increasing every day, in 120 grams of urine obtained by the sound after 24 hours of anurie, I have faund a great deal of kindney’s cellules, that I doubt very much that one can faind more that in this nefritis pa- remquimatous acute, after of this the pacient had been takened by a complete anurie. This urine belongs only to the yellow fever. We have made with Dr. Carvallo and Mayor Kra- mer, director of number 2 Hospital, at the Vedado—Ha- vana—The folowing post mortem examination—Frist and second cases belongs to two Spaniards—Corujo and Quintela—Third case belong to one American, Henry Smith, and the last and four case did not died of yellow fever. Patrick Smith. For proofing the grease we have put the histological cuts of the livers into theaccion of osmic acid; 1 by 100, and to Marchi’s method that showed very well the grease in black colour in a half of an hour, in Patrich Smith case the reaction of the grease, have not had place not- withstanding that the entrails cuts has been put into osmic acid solution for 4 hours. In the livers of the 3 frist cases we can see the grease in all the orgam between and into the cellules: the liver’s cellules are very pale and fully by a great number of granul of grease, and also between the intercellules espace, that is always faind in yellow and this tipical. We could not faund the grease in the liver of Patrick Smith case, but he had very much melanic pigmentum and lesion of hiperplastic caracter, that is to say one infiltration of embrionary cellules 13 round about of the interlobulares veins, that sprung their and extend amonst the intercelulares liver’s espaces, that constitutes a lesion of equal nature that hapen in thy- phus abdominal, and in malaria fever. Niether Kramer, nor Carvallo, nor I can have seen lesion in Peyer’s plates, and his blood examend before diving for Davalos have not given Widal’s serum reac- tion. Patrick Smith blood shows to Kramer and Coro- nado, the aimeba palustre, that is to say the Lave rail’s parasites, we can affirm that he died of a paludic fever. The Kindney lesion in the 3th cases of truly yellow fever show us, two states, the frist congestion, that can go folowyed with the apopelxy of the glomerul and in other part of the orgam; and the last and second state, the fatness degenerancy that can be folowyed by the destruction of the kindney parenquima by the grease; vthe kindney’s tubes had a gray colours, owed to the -emulsion that the grease made by the kindney’s cellules that kills and digests. Their are other two clases of kindney lesion, of one of them the author speaking it, and is the formation of hemorrage focus spread abont and in condition of making purulents absseces: the other lesion is the necrobiosis of the glomerul of malphigio’s by the grease and gives to all the aspect of an homogeneus maters, that ocuppies all the cavity and that it can be coulours by Weigert’s metod (methil violet) in violet maters that is made by the condensed nuclein, spread in the glomeml snared by the death of the orgam, that is one inflamation pheno- menon the lesion more advanced of the inflitratipn and hiperplasie, that also we all have seen in the Bowman’s capsul, bloting out the space that are their in normal state. This lesion we could not see in Patrick smith kindney. As you can see the frist orgam that in yellow fever put out frist day the nine accuse mucine, and in the second and third day the albumen appears and the grease 14 come sooner and vacillate as the illnes fluctuates, and by the microscopic examination we can make surely the diagnossis and the prognostic and follow the kindney destruction by the fatness process day by day and steps by steps. In the fifth day of the illness sometimes jaun- dice appears and the pace of the bile by the kindney filter add more elements to the destruction of the cellule of this orgam, that had been before lesioned. The bacteriologic is for making in yellow fever, we have employeed Sanarelli’s method and we have faind the baccilus in case that do not belongs to yellow fever and in truly case of yellow fever we have not been able in fainding it. I think that I can now affirm that we posses now one sign that always we can faind in yellow fever mine, that is the grease,,that put ont the general degenerancy of the kindney by the grease in yellow fever, and that I am the frist in speaking and in making to be nottied. Two words about the treatment. The pharmaceutical treatment give us one disappointment more, we have not gotten a drug that can act over the poison, the purges are good because they cleansen the bowels, and avoid ferments cause. We dont know nothing about the micro-organism niether its toxine, nor its anti-toxine; but that, that the laboratory can not do, the nature do it. Dr. Finlay propo- sed before the Academy of this city to employed the in- yeccion in the pacient the serum obtain by a cautery in the inmunes. I think that is best, to prepare the serum from the blood of the last inmune. ariother on^inales WORKS Ith Is the paludic diarrhea with or without fever the porter, and propagator of the contagion? 2th Is beri-beri illness the result of famish and pa- ludic intoxication? 3th Hysterical grils. 4th Phsicological destrub produced by the frist evo- lution of teeth growning. 5th Antidifteric serum in serious ulceration of mauth. 6th One case of esphacelum of the feet and amurie, belonged to one boy of the reconcentrado, that had beri- beri. 7th Diarrhea of blood in the chilhood. 8th One case of Pott’s illnes, cured. 9th Paludic dispeptic. ioth Is the paludic acces the result of struggle be- tween two amebas, and is the leucosyts one ameba? nth Biology of Laveran’s parasite. 12th Is phosphoric loss the consecuence of the des- truction of the organism? 16 13th Differencial diagnossis betwen yellow fever ancl bilious malaria fever. 14th Clinical, hisloligical and bacteriological diag- nosis in yellow fever. 15th The grease in yellow fever urine. 16th The yellow fever germs. 17th Is it enough only seen in blood serum the me- tallic pigmentum for making the diagnossis of malaria. 18th Yellow fever treatment. All this works has been read at the Academic of me- dicine and Clinical Study society of this City. Published in the profesional periodic of Havana the Cronica Medi- co-Quirurgica, la Havana medica and in the Archives’s of the both medical society; and I have had the pleasure, to seen its reproduces by severals profesionals periodics of the Unites-States, France, Spain and Mexico.