Weil's Disease (Leptospirosis): A Clinical and Bacteriological Study of Nineteen Cases Occurring Chiefly Among Fish Workers

The occurrence in Minorca of an epideinic of jaundice was first described by Cleghorn in 1745.The publication by Weil in 1886 of an account of four cases of infectious jaundice led to the recognition of a symptom-complex of fever, jaundice, enlargement of the liver and spleen, the occurrence of haemorrhages, and, occasionally, febrile relapses under the designation of Weil's disease.Following the discovery of the L. icterohaemorrhagiae in the blood of a patient suffering from the Japanese form of the disease, and the proof of its specificity by Inada and Ido in 1915, the name " spirochaetosis icterohaemor- rhagica" was suggested as a substitute for the many titles applied to this disease.Stokes and Rylel in 1916 obtained bacteriological evidence of the existence of the disease among the British soldiers in Flanders; similar outbreaks were-reported and confirmed among the German, French, and Italian troops on the Westem Front.The occurrence of spirochaetosis in the form of an acute febrile illness, without jaundice, was recognized.2In consequence it has been the practice of European workers to revert to the non-descriptive title of " Weil's disease," in preference to its synonyms laying emphasis on jaundice.Interest in the disease has increased in recent years in Holland, where in the past decade 452 cases have been observed, with a mortality of 10.2 per cent.3Infection occurs by bathing and by accidental or suicidal immer- sion in the canals; a highler occupational incidence is reported among bargemen and workers in abattoirs and other rat-infested premises. Leptospiral Infection in BritainPotential sources of infection irn Britain are known to exist, the carrier rate in rats varying from four out of 101 rats in London4 to thirty out of 100 in different parts of England.5 Buchanan6 found sixty-one infected rats out of a total of 166 from various parts of Scotland.In the light of these figures the reports of leptospiral infection in man are surprisingly' few, and their authenticity-is undoubted only in three outbreaks.Manson-Bahr7 in 1922 described a case in a seaman four days after immer- sion in the Thames, the L. icterohaemarrhagiae being isolated from the blood.An outbreak of epidemic jaundice in 1923, among miners in certain wet pits in East Lothian, was described by Gulland and Buchanan,8 the diagnosis in eighteen cases being based on the clinical features.Investigations by Buchanan resulted in proof * Since this paper -was submitted to the British Medical Joutrnzal four more cases of proved Weil's disease in fish workers have been investigated, making a total of twenty-three.