WEIL'S DISEASE; REPORT OF SIX CASES

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Abstract
The history of the disease is briefly summarized. The disease may be divided into 3 stages: the febrile stage, during which lepto-spirae are circulating in the blood, the toxic stage, during which the organisms are found in the urine, and the convalescent stage during which the agglutination reaction becomes strongly positive and the organisms begin to disappear from the urine. Jaundice occurs only in about 1/2 the cases. A febrile illness exhibiting a sudden onset, with muscular aches, jaundice, gastro-intestinal disturbances, hemorrhagic phenomena, elevated white count, evidences of renal involvement often with elevation of NPN, represents the classical picture. Cases without jaundice are difficult to diagnose. Muscular pains, albuminuria, conjunctivitis, leuko-cytosis and a history suggesting contact with urine of wild rats should lead one to consider the disease in any obscure febrile illness. In any case the diagnosis must be proved by demonstration of the organisms in the blood or urine by direct dark-field examination or by guinea-pig inoculation, or by the agglutination reaction of the blood against a culture of Leptospira icterohaemorrhagiae. Six cases are described, all were jaundiced. A 51-yr.-old colored [female] was the only fatality, death was due to uremia. L. icterohaemorrhagiae were demonstrated in the urine of 4 cases. The other 2 had positive agglutination reactions against L. icterohaemorrhagiae.

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