HM 34- Febre amarela. Benfeitores e mártires

Neste início de 2018 a febre amarela ocupa as manchetes e provoca filas para vacinação. É oportunidade para lembrar e homenagear 5 médicos  que trabalhando em Cuba ao final do século XIX tiveram papel fundamental na elucidação da transmissão da doença.

O epidemiologista cubano Carlos Juan Finlay  (1833- 1915) publicou evidências, em 1886, que a febre amarela era transmitida por um vetor – um mosquito infectado- e não fomites como pretendiam alguns estudiosos, mas  a observação ficou ignorada por anos.

O patologista e bacteriologista norte-americano Walter Reed (1851-1902), coordenador da Comissão constituída para investigar um surto de febre amarela em acampamento americano em Havana e que, alertado por Finlay, decidiu que o objetivo maior da Comissão era  avaliar a participação de um mosquito na transmissão da doença e desenvolveu as experiências que comprovaram o papel transmissor da picada do Aëdes aegypti, em 1900.

O cirurgião norte-americano Jesse William Lazear (1866-1900), que fez parte da Comissão, aceitou ser picado pelo mosquito infectado para testar a teoria e morreu de febre amarela.

O clínico norte-americano James Carroll (1854- 1907), que fez parte da Comissão, aceitou ser picado pelo mosquito infectado para testar a teoria, contraiu a febre amarela e sobreviveu à doença.

O patologista e bacteriologista cubano Aristides Agramonte y Simoni, (1868-1931), que fez parte da Comissão pela experiência como pesquisador adquirida nos Estados Unidos da America.

 

 

iewly established Army Medical School. During the Spanish-American War of 1898 he was appointed chairman of a committee to investigate the spread of typhoid fever in military camps. Its report, not published until 1904, revealed new facts regarding this disease. On the completion of the committee’s work in 1899, he returned to his duties in Washington. Almost immediately he became involved in the problem of yellow fever. The result was a brilliant investigation in epidemiology.

During most of the 19th century it had been widely held that yellow fever was spread by fomites—i.e., articles such as bedding and clothing that had been used by a yellow-fever patient. As late as 1898 a U.S. official report ascribed the spread to this cause. Meanwhile, other methods of transmission had been suggested. In 1881 the Cuban physician and epidemiologist Carlos Juan Finlay began to formulate a theory of insect transmission. In succeeding years he maintained and developed the theory but did not succeed in proving it. In 1896 an Italian bacteriologist, Giuseppe Sanarelli, claimed that he had isolated from yellow-fever patients an organism he called Bacillus icteroides. The U.S. Army now appointed Reed and army physician James Carroll to investigate Sanarelli’s bacillus. It also sent Aristides Agramonte, an assistant surgeon in the U.S. Army, to investigate the yellow-fever cases in Cuba. Agramonte isolated Sanarelli’s bacillus not only from one-third of the yellow-fever patients but also from persons suffering from other diseases. Reed and Carroll published their first report in April 1899 and in February 1900 submitted a complete report for publication. It showed that Sanarelli’s bacillus belonged to the group of the hog-cholera bacillus and was in yellow fever a secondary invader.

Before this report had actually been published, an outbreak of yellow fever occurred in the U.S. garrison at Havana, and a commission was appointed to investigate it. The members of the commission were Reed, who was to act as chairman, Carroll, Agramonte, and a bacteriologist, Jesse W. Lazear. In the summer of 1900, when the commission investigated an outbreak of what had been diagnosed as malaria in barracks 200 miles (300 kilometres) from Havana, Reed found that the disease was actually yellow fever. Of the nine prisoners in the prison cell of the post, one contracted yellow fever and died, but none of the other eight was affected. Reed and his colleagues thought it possible that this patient, and only he, might have been bitten by some insect. Reed therefore decided that the main work of the commission would be to prove or disprove the agency of an insect intermediate host.

On August 27, 1900, an infected mosquito was allowed to feed on Carroll, and he developed a severe attack of yellow fever. Shortly afterward Lazear was bitten, developed yellow fever, and died. In November 1900 a small hutted camp was established, and controlled experiments were performed on volunteers. Reed proved that an attack of yellow fever was caused by the bite of an infected mosquito, Stegomyia fasciata (later renamed Aedes aegypti), and that the same result could be obtained by injecting into a volunteer blood drawn from a patient suffering from yellow fever. Reed found no evidence that yellow fever could be conveyed by fomites, and he showed that a house became infected only by the presence of infected mosquitoes. In February 1901 official action in Cuba was begun by U.S. military engineers under Major W.C. Gorgas on the basis of Reed’s findings, and within 90 days Havana was freed from yellow fever.

On his return to Washington in February 1901, Reed continued his teaching duties. He died following an operation for appendicitis the next year.

 

James Carroll (June 5, 1854 – September 16, 1907)[1] was a US Army physician.

Carroll was born in England. He moved to Canada in 1874, and enlisted in the U.S. Army in 1874. He graduated with an M.D. from the University of Maryland in 1891. After graduating Carroll studied bacteriology under Dr. William H. Welch at Johns Hopkins Hospital and assisted Walter Reed in pathology laboratories. Carroll and Reed later worked together at the Army Medical Museum in Washington and the Columbia University Medical School.[2] In 1900 he served as an American physician and a member of the Yellow Fever Commission in Cuba, along with Walter ReedJesse William Lazear, and Aristides Agramonte. He and Lazear subjected themselves to the bite of infectious mosquitoes to test the theory that mosquitoes were carriers of yellow fever. Lazear died, but Carroll recovered and completed the last, official experiments of the Yellow Fever Commission. After a trip to Washington D.C., Carroll returned to Cuba for additional studies in which he proved that blood from active cases of yellow fever contained sub-microscopic infective agents.[3] In 1904, with permission from Army Surgeon-General Robert Maitland O’Reilly, Carroll tested an oral typhoid fever vaccine on himself and 12 other volunteers from the military. Due to faulty vaccine preparation by lab personnel, seven men came down with the disease. They all survived, but the Office of the Surgeon General did not publicize the results. [4] The yellow fever infection Carroll contracted eventually killed him. [5]

Aristides Agramonte y Simoni, (born June 3, 1868, Camagüey, Cuba—died Aug. 19, 1931, New Orleans, La., U.S.), physician, pathologist, and bacteriologist, a member of the Reed Yellow Fever Board of the U.S. Army that discovered (1901) the role of the mosquito in the transmission of yellow fever.Agramonte was the son of a prominent physician who had been killed while serving in the Cuban Army of Liberation. Brought up in New York City, Agramonte received his M.D. in 1892 from the College of Physicians and Surgeons of Columbia University. After he had served his internship, he conducted research in pathology and bacteriology at Bellevue Hospital and with the New York City Department of Health. He was appointed an assistant surgeon with the U.S. Army from 1898 to 1902.As professor of bacteriology and experimental pathology at the University of Havana (from 1900), member of the government board of infectious diseases, Cabinet secretary of health and charities, and medical practitioner for many of the Americans who lived in Havana, Agramonte was an influential leader of scientific medicine in Cuba. In 1931 he was appointed to head the new department of tropical medicine at a medical school in Louisiana, but he died while preparing to assume the position.

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