USA > Alabama > Memorial record of Alabama. A concise account of the state's political, military, professional and industrial progress, together with the personal memoirs of many of its people. Volume II pt 1 > Part 13
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"The early settlers came mostly from Georgia, Tennessee, Virginia and the Carolinas. They usually settled in communities at convenient distances from one another. Owing to the fact these immigrants brought but few laborers with them. they chose for their homes the uplands and hammocks rather than encounter, with feeble forces, the rich and heav- ily timbered alluvial lands of the river bottoms."-Lewis.
This accounts to some extent for the comparative mildness of the malarial diseases from which they suffered. When, at a later day, the advancing tide of immigration began to invade the river bottoms, fevers of a much more severe type. but still of malarial origin, were developed amongst them. It is an important consideration, however, that much of the work of clearing these richer lands was done by negroes, who are much less vulnerable to malarial influences than the whites. In these early settlements the houses were built of green logs, often with the bark on; the trees in the clearings were killed by belting, and left standing until they fell through the slow agency of decay: and the virgin soil, filled with vegetable matter. was turned up by the plough. The protecting shade of the green trees and the thick undergrowth being withdrawn, and with nothing to intercept the fervent rays of the sun, the natural consequence was the abundant generation of the malarial poison. Along with the malarial fevers, the pioneers suffered from pneumonias and pleurisies, and sometimes from dysenteries.
"In the treatment of malrial diseases, tartar emetic was much used. as was also the lancet. A favorite domestic remedy was tea made of bone- set-Eupatorium perfoliatum. But perhaps the most common remedies were calomel. to act on the liver, and peruvian bark. to prevent the re- currence of the paroxysms.
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"Between the years 1812 and 1818, the town of St. Stephens, situated on the lower part of the Bigbee river, had a large accession of popula- tion, attended with a corresponding increase of houses in the town, and of agricultural improvements in the vicinity. Fever of a severe and malignant type prevailed in this place during the summers o 1818-19-20-21. During the two latter years, however. the town began to decline, and sank with a rapidity even greater than that which marked its rise.
"Fort Claiborne, situated on the most elevated bluff on the Alabama river, was an unimportant place until about 1818, at which time it began to improve. and in 1:22 the population had increased to 3.000. This high and elevated plain has a gradual declivity, as it recedes from the bank of the river, until it reaches a few low marshy ponds. In 1819 fever pre- vailed in this town with great severity, with subsequent annual visita- tions, and every summer an increasing mortality, until the population be- gan to decline about 1825.
"About 1817 -- 18 -- 19. the town of Cahaba, on the Alabama river, in Dallas county, increased very rapidly in population, and at the same time a vast extent of that fertile region of country was brought into cultiva- tion. In the year 1821, a year memorable in Alabama for a late inunda- tion of the rivers, great destruction of crops, and widespread disease. the people of Cahaba experienced their first epidemic visitation. They were so tenacious of the reputation of their town, then the seat of gov- ernment. that they held a public meeting in the midst of the epidemic. resolved that the fears of those who had retired into the country were not well founded. and forced the public officers to return to the city and resume their various duties. The mortality was not less than twelve per cent. of the entire population."-Lewis.
About 1830, the settlement of the prairies was begun. They were found to be very fertile, and the population rapidly increased. Very soon these prairie settlements became subject to a very severe form of mala- rial fever, which was commonly known as congestive fever. in reference to which Dr. Lewis used this graphic language: "To ascertain that malady, which from its malignancy constitutes the principal outlet of human life in this section during the summer and autumn. that malady which most excites the fears of the people and absorbs the attention of the medical man, it is only necessary to be brought to the bedside of one laboring under congestive fever. and the search is at once ended." The type of this fever in the prairies became modified in a few years, as the result, probably, of the thorough cultivation of the lands and improved drainage. In connection with this congestive fever, and other malarial fevers of less maligant type. the people in the prairies suffered from pneu- monia, pleurisy, dysentery, etc. Pneumonia by the local doctors was divided into two classes, bilious pneumonia and typhoid pneumonia. The bilious pneumonia was an acute febrile malady, in which malarial influ- ences complicated the pneumonities; while typhoid pneumonia ordinarily supervened upon some protracted case of fever, and was characterized by adynamic symptoms.
A few years after the war a form of fever, known amongst southern writers as hemorrhagic malarial fever, made its appearance in the ma-
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larious regions of the state. This is a profoundly adynamic disease, with sudden and intense yellow discoloration of the skin, and abundant dis- charge of red urine, surcharged with the coloring matter of the disor- ganized red blood corpuscles. The mortality attending was very great. Occasional cases of this fever occurred before the war, but it was not then of common occurrence. Many papers in regard to this disease are to be found in the volumes of the Transactions of the State Medical as- sociation, between 1870 and 1880. It has not entirely disappeared, but is now very much less common than in the decade mentioned. It does not yield to quinine and the ordinary anti-malarial treatment.
:Typhoid fever is occasionally mentioned as far back as 1835, but it is doubtful if the cases were really of the specific typhoid type. About 1850, genuine typhoid fever became prevalent in many parts of the state, in some sections a little earlier than 1850, and in some a little later. . This was distinctly a new epidemic invasion. It fell under the observation of the writer in the adjacent state of Mississippi, and for several years was very destructive, especially among the negroes-so much so that the writer knew the fortunes of many farmers to be seriously crippled in a single season by its ravages. At first the doctors did not know how to manage it and treated it very much as they were accustomed to treat the malarial fevers, with which they had long been familiar. Experience fin- ally taught them the danger of heroic medication, and the percentage of mortality was greatly diminished. In the mean time, also, its infectious character was recognized, and under the influence of this knowledge very - effective measures of prevention were employed. When one of the little villages on a plantation-one of the negro quarters as they were called-was invaded, the wells were condemned and new sources of water supply provided: and not infrequently the entire slave community was moved into new quarters at a safe distance from the old ones. This fever diminished greatly in prevalence in a few years. and by 1860, it had ceased to be an important factor in the mortality of the people of the state. It lingering longest in the prairies.
After the war, beginning about 1870, another continued fever invaded Alabama. It was first observed in the northern part of the state and slowly made its way sonthward. This fever is known by several names, such as typho malarial fever, continued malarial fever and typhoid fever. There has been much discussion amongst the doctors as to its true character. Its duration is from two to four weeks, and often , longer the thermometer curve is not that of specific typhoid as described in the books. The rose spots have been very rarely observed; there is not much disposition to diarrhea: as a rule the tongue is flat and moist; and there is very little muttering delirium. It is not controlled by quinine. It ap- pears indifferently in the city and country; it has not been recognized as infectious, and is not known to have any dependence on the water supply. In the few post mortems that have been made, the same lesions of Pey-
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ers patches have been found that are found in typhoid fever. Notwith- standing its want of conformity to the classic descriptions of typhoid fever, the doctors of the state are more and more coming to regard it as a form of that fever modified by the influence of our southern climate. The mortality in it is not very great.
"In this section of the Union, scarlatina does not seem to be attended with the same degree of malignancy as in the older states: neither has it been noticed that it presents the same epidemic character as marks its prevalence elsewhere. As a general rule, it may be said to be sporadic in its nature, some few cases appearing in various sections of the country every year, but generally mild and easily controlled by remedies. There are, however, some exceptions in different localities, where the disease has assumed a malginant type, but its fatality has usually been confined to a limited space, and but few years have been noted when this form prevailed. It is likely to be milder in spring and summer and more severe in winter."-Lewis.
Diphtheria either did not prevail before the war, or else it was not recognized. Since the war there have been localized outbreaks of it occa- sionally, but no widespread epidemic. Like scarlet fever, sporadic cases of it appear here and there every year, but something in our climatic con- ditions seems to stand in the way of its dissemination.
No doubt smallpox sometimes prevailed epidemically in Alabama in the early decades of her history; but of such outbreaks no records are known to the author. Immediately after the war it was spread by Federal troops through most of the towns garrisoned by them, and notably in Mobile, Montgomery and Selma. In 1874-5 a neglected outbreak in Mobile spread to the extent of 990 cases. and 262 deaths. This is the last epidemic that has occurred in the state. It has broken out since a number of times, but has always been promptly suppressed.
Cholera has visited Alabama on several occasions. There were some cases and some deaths in Mobile and Montgomery in 1834; and a small outbreak of a dozen or fifteen cases, with five deaths, in Sumter county. In 1849 cholera again visited Mobile; number of cases not known, number of deaths, seventy-six. It began its ravages in December. In February and March, 1854, there were a few cases of cholera in Mobile, some of them very malignant, with death in ten or twelve hours. In Huntsville, in 1873, there was an outbreak of cholera-cases about 150, deaths 51. It was brought from Memphis in June. An interesting account of this epidemic, written by Dr. J. J. Dement, is to be found in the Transactions of the Alabama State Medical association for 1874. . In June, 1873, cholera broke out in Birmingham. It is believed to have been brought from Huntsville. Birmingham was then in the beginning of its career. and was not a populous city. After the disease began to spread. many of the people left the place; but amongst those who remained there was a sweep- ing epidemic-number of cases and number of deaths not known. An account of this outbreak was contributed by Dr. M. H. Jordan, to the transactions of the State Medical association for 1574. In this same
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summer of 1573, there were about fifteen or twenty cases of cholera in Mobile, of whom about one-third died.
Yellow fever has occurred in Mobile in the following years: 1705, 1765, 1819, 1824, 1825, 1827, 1829, 1837, 1839, 1842. 1843. 1844, 1847, 1849, 1851, 1853, 1854. 1567, 1870. 1873, 1878; and in Mobile county, at the villages of Spring Hill, Dog River Factory, Fulton, and Citronelle, in 1853: at Whistler, Bon Secours, and Fish River-the two last in Baldwin county. in 1878; at Selma. in 1853: - at Grove Hill. in Clarke county, in 1853; at Montgomery. in 1854 and 1873, while in 1878 it prevailed along the line of the Memphis & Charleston railroad at Tuscumbia, Florence, Town Creek, Decatur and Stevenson. In 1883. there was another outbreak at Brewton, in Escambia county; and in 1888 at Decatur.
The limits of this sketch will not permit of separate accounts of these various epidemics, but a few facts in regard to some of the more notable of them may not be without interest:
"Previous to 1817. the population of Mobile did not exceed 500 souls. consisting principally of French. Spaniards, and free negroes: but after this period the place rapidly improved, and in 1819 the accession of Europeans and of whites from the adjacent states had increased the num- ber nearly three-fold in two years. The deathis in 1819 were estimated at 400, being nearly one-third of the population. Such was the consterna- tion produced by this epidemic that public attention was directed to a location on the opposite side of the bay, and the alarmed inhabitants began rapidly to improve the small village of Blakely, which for a time increased in population. while Mobile seemed sinking to decay. But in 1822 Blakely was visited by an epidemic as fatal in proportion to the . population as that of 1819 in Mobile. This confounded the hopes of its people, and it passed out of existence as a place of commercial impor- tance. The yellow fever of 1842 was confined to the southern portion of the city, whilst that of 1843 was confined mostly to the northern section. and did not invade the district infected the preceding autumn. The epideme of 1843 lasted from the 20th of August to the 10th of November. The population of the city was about 14.000, number of cases 1.352, num- ber of deaths 240."-Condensed from Lewis.
The history of the great epidemic of 1853, the most widespread and destructive epidemic ever known in the south before the war, requires special notice. It began its ravages in Mobile in August. The first eight or ten cases were amongst persons who came from New Orleans. In this way a number of infectious centers were established, and the fever spread with unexampled rapidity. Panic took possession of the public mind. How many persons fled it is impossible to ascertain, but it was estimated that in three weeks not more than 10,000 or 12.000 were left in the city. and of this number it is probable that 4,000 or 5.000 were attacked in less than a month after the disease appeared. The epidemic reached its height about the first week in September. In the suburbs north, west and south, and wherever there were settlements within six or eight miles. it raged with almost as much violence as in the city. Amongst other places it prevailed at Spring Hill, at Dog River Factory,
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at Fulton, and at Citronelle-all in Mobile county, but Citronelle at a distance of sixty miles. About the middle of November there were sev- eral sharp frosts, which promptly checked it progress. A very interest- ing account of this epidemic, as it occurred in Mobile, was contributed by Dr. W. H. Anderson to the proceedings of the State Medical association for 1854.
Selma has had but one epidemic of this disease-in 1853. It had been brought into the city twice before and had failed to spread, so that the first few cases excited but little apprehension. The first case occurred on the 17th of September. The subject of it resided near the river, but had not been to Mobile. No other well marked case was witnessed until the 7th of October. The fever soon assumed an epidemic form, and the people, becoming alarmed, fled from their homes, leaving in the city only 1,000 or 1,200 persons out of a population of over 3,000. Only a few negroes were attacked. The whole number of cases was 120. with 32 deaths.
There was no yellow fever in Alabama, nor in any of the gulf states during the war, an immunity undoubtedly due to the efficiency of the blockade of our ports by the federal navy. The blockade did not abso- lutely prevent all intercourse with the outside world, but it was rendered so infrequent and so difficult as to constitute a very rigorous quarantine.
The epidemic of 1873 was more widely distributed than that of 1853, it invaded a considerable number of communities in Louisiana, Texas and Tennessee, and two in Alabama-in Mobile and Montgomery. The out- break in Mobile was comparatively mild. There were 210 cases, with 35 deaths. A very elaborate account of this epidemic was contributed by Dr. J. Cochran to the transactions of the Alabama State Medical associ- ation in 1874. An account of the Montgomery epidemic was contributed to the same volume of transactions by Dr. R. F. Michel. In Montgomery the cases were about 500, and the deaths 102.
The most widely disseminated, the most detructive. and in every way the most remarkable and dreadful epidemic of yellow fever that has ever devastated the states of the gulf and of the Mississippi valley, was that of 1878. It would be out of place here to give even an outline of the history of the epidemic. Suffice to say, that something like 140 cities and towns suffered from its ravages; that the number of cases of sick- ness inflicted on the people of the country reached the grand total of about 125,000; and that the number of deaths for which it was responsi- ble aggregates about 18,000. But these statisties convey to the imagina- tion only the faintest and most inadequate conceptions of the dreadful details of the epidemic. In many of the more sorely afflicted communi- ties the pestilence was king; and panic, and shuddering horror, and the black shadow of death were his ministers. Hope of escape there was none, except by flight: and all the routes of travel leading from the infected localities were populous with fugitives. The times, indeed; were
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times of tribulation, and such as try men's souls. No wonder that even brave men fled; and since all who remained at all, remained to feed the pestilence and increase its horrors, flight became a sort of sacred duty. But universal flight was impossible. Many were too poor in the goods of this world to travel away from home; and many others were constrained to remain, out of sentiments of Christian charity, to minister to the wants of suffering friends and neighbors Amongst those who fought most bravely under the banners of humanity, we may be excused if we single out for special mention the members of the medical profession, who, upon this occasion, acted as they have always done from immemorial ages. They rec- ognized in all its fullness of meaning the truth of the trite maxim, that the epidemic is the battle-field of the physician ; recognized that it was their pe- culiar mission to carry hope to the hopeless, help to the sick, comfort to the dying. None else knew so well as they the character of the danger they were called upon to face; and certainly none else confronted it with such unflinching courage. In the principal centers they knew well that, for them, there was no hope of escape. All of them went surely to beds of sickness; and many of them to beds of death. The immortal charge of the 600 at Balaklava,
Into the valley of death, Into the jaws of hell,
was not so desperate as the warfare waged by the doctors of the south against the invisible armies of the pestilence. In south Alabama there were this year in Mobile about eighty cases; and in proportion to popu- lation quite a number of cases in the villages of Bon Secours and Fish River. These outbreaks were all traceable to New Orleans. In north Alabama it was of much more extended prevalence. It was brought to this section by the Memphis & Charleston railroad, which here runs through the Tennessee valley, and none of the larger towns escaped. There were sweeping epidemics in Tuscumbia. Florence, Decatur and Stevenson; and a few cases in Town Creek, Athens, Huntsville, Opelika and Tuscaloosa.
MEDICAL LEGISLATION.
During the territorial regime in Alabama this writer has not been able to find that any laws were passed bearing on the practice of medicine.
The state of Alabama was organized and admitted into the union in 1819. At that time, in the larger centers of population, there were to be fouud physicans of culture and ability-the graduates of reputable med- ical institutions. But in many portions of the state. in sparsely settled communites, where remuneration for medical services was necessarily of the scantiest character, much of the practice was done by the wise women of the time, and by men who had picked up a few notions of dis- eases and their treatment from some of the popular manuals of domestic medicine then in circulation. Many of these backwoods practitioners
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were exceedingly ignorant, not only of medicine, but also of the very rudiments of English education.
As the population of the state increased in numbers, in wealth, and in intelligence, it was felt that something should be done, and a better qualified class of medical practitioners provided to take charge of the health and lives of the people; and to this end the interference of the legislature was invoked. The first law to regulate the practice of medi- cine was enacted in 1823, when the state was only four years old. Under this law all graduates of all regularly constituted medical institutions within the United States were authorized to practice medicine without further qualification; and all persons, not graduates, who were actually engaged in practice at the time of the passage of the law, were allowed to continue to practice without interference, provided they registered themselves as practitioners before some one of the medical boards created by the law. Having cleared the ground in this way, the law went on to provide that, for the future, no persons except college graduates should be allowed to practice medicine in Alabama, without first having obtained a certificate of qualification from one of the established boards. These boards were at first five in number-one at Huntsville, one at Tuscaloosa, one at Cahaba, one at Claiborne and one at Mobile. Each board was composed of five members elected by the joint vote of the two houses of the general assembly; and two members were to constitute a quorum. In the intervals between the annual sessions, any member of a board could issue a temporary permit to practice. Five dollars was allowed the board for each examination, 85 for each permanent certificate, and 85 for each temporary permit. The boards could grant certificates to practice medi- cine alone, or surgery alone. Each board was left to itself to adopt such standard of qualifications and such methods of examination as seemed good to its members.
In 1826, this law was amended so as to allow all graduates of any regular "medical university" to practice without examination by the state boards. This was probably done because the clause in the original act exempting college graduates from examination had not been clearly expressed. In 1854, another similar amendment was passed. to the effect that all graduates of "reputable medical colleges in the United States" should be exempted from the operations of the law, the intention of this amendment being doubtless to obviate any uncertainty that might be sup- posed to lurk in the awkward phrase. "regular medical university." In 1832, the law was amended so as not to apply to botanic or Thompsonian physicians; provided. they were not to bleed, apply blisters, or give mercury, tartar emetie, opium or laudanum.
This medical law, as here given in outline, remained the law of the state, undergoing only minor modifications, until 1877, when the law to regulate practice at present in force was enacted. This new law will be discussed presently. In the meantime the old law was incorporated in -
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the successive codes of the state. But it was never very rigorously en- forced: the examinations were not such as to maintain a high standard of medical qualifications: prosecutions. if known at all, were very infre- quent, and. easy as it was to get the certificate, a good many engaged in practice without it. The general result was that the law accomplished very little good; and the poorer white sections of the state were largely given over as fields of practice to doctors who were anything but learned in the art and science of medicine. It was not so in the black neighborhoods -that is to say. in the neighborhoods where slaves constituted the major- ity of the population. In these neighborhoods the planter was able to pay good fees; he wanted a doctor of at least a decent show of medical knowledge to treat himself and family; and the money value of his slaves made him equally anxious that they also should have the best medical skill that was to be obtained. The natural consequence was that, throughout the black belt of Alabama. the doctors were nearly always of fair literary culture and graduates of regular medical colleges.
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