Memoirs of Georgia; containing historical accounts of the state's civil, military, industrial and professional interests, and personal sketches of many of its people. Vol. II, Part 18

Author:
Publication date: 1859
Publisher: Atlanta, Ga., The Southern historicl association
Number of Pages: 1166

USA > Georgia > Memoirs of Georgia; containing historical accounts of the state's civil, military, industrial and professional interests, and personal sketches of many of its people. Vol. II > Part 18

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I am indebted for the facts relative to this epidemic, says: "It is positively known that the disease was brought to Darien from Savannah, but whether by steamer or stage I cannot learn, but regular trips twice a week were made between Sa- vannah and Darien by both stage lines and steamers."

NOT AN ENDEMIC DISEASE.

It will be observed that I have not included yellow fever among the endemic diseases of Georgia. In my judgment no greater wrong has ever been done our state than by many of her physicians who have persisted in asserting that yellow fever originates in our climate, i. e., that yellow fever takes its origin in Savannah, for instance, from causes existing within her limits under the influ- ence of peculiar conditions of soil and atmosphere; that it is capable of self- production, whenever these conditions exist, similar to bilious fever in the country whenever vegetation, putrefaction and temperature acquire a certain development. If this were so we would be liable to yellow fever at any time whenever intense malarial poison taints our atmosphere.

I contend that yellow fever never did exist in any portion of the United States except when imported during the heated terms of the year. It is an exotic disease in America. This country is not and never has been its habitat. It is a disease sui generis, is in nowise related to malaria more than is measles to smallpox. An individual exposed to malaria in the swamps or rice fields in the summer or fall prior to a "killing frost" will contract a malignant, even fatal, case of malarial fever, but never under any circumstances yellow fever. Local insani- tary conditions of American cities, be they ever so foul, never did originate one single case of yellow fever. Insanitary conditions, putrefying substances, consti- tute a magnificent hot-bed for breeding yellow fever germs when once introduced from the West Indies or other yellow fever countries. But without importation of the yellow fever germ there has never been developed a case of yellow fever in America. In foreign countries-the West Indies, for instance, yellow fever finds a habitat-the disease is there a perennial. In America it is an annual, lives only during the summer and fall seasons, and is killed by frost. It has never survived the winter season in America. If yellow fever prevails in any part of America in 1894 it will surely be killed out by the cold of winter, and unless im- ported subsequently will never be known again in the United States. It is as thoroughly well demonstrated as any proposition in medical science that the dis- ease has never obtained a permanent abode in any portion of North America, has never become naturalized in our climate, and this is even so of the extreme southern portions of Florida, which are below the frost line. These statements are in perfect accord with the opinions of the overwhelming majority of the ablest sanitarians in America. Yet they are by no means new. The fact is that up to the year 1800 yellow fever was universally considered an exotic to this country. One hundred and fifty years ago Dr. John Lining, of Charleston, S. C., writing to Dr. Whytt, professor of the practice of medicine in the university of Edinburgh, draws this graphic picture of yellow fever in America: "This fever does not seem to take its origin from any particular constitution of the weather, independent of infectious miasmata, as Dr. Warren (of Barbadoes, p. 8th) has formerly well observed. For within these twenty-five years it has been only four times epi- demical in this town, namely, in the autumns of the years 1732, 1739, 1745 and 1748, though none of these (excepting that of 1739, whose summer and autumn were remarkably rainy) was either warmer or more rainy (and some of them less so) than the summers and autumns were in several other years, in which

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we had not one instance of any one being seized with this fever, which is con- trary to what would have happened, if particular constitutions of the weather were productive of it, without infectious miasmata. But that this is really an infectious disease seems plain, not only from this, that almost all the nurses caught. it, and died of it, but likewise as soon as it appeared in town, it soon invaded new- comers, those who never had the disease before, and country people when they came to town, while those who remained in the country escaped it, as likewise did those who had formerly felt its dire effects, though they walked about town, visited the sick in the different stages of the disease, and attended the funerals of those who died of it. And lastly, whenever the disease appeared here, it was easily traced to some persons who had lately arrived from some of the West Indian Islands, where it was epidemical.

"Although the infection was spread with great celerity through the town, yet if anyone from the country received it in the town and sickened on his return home, the infection spread no further, not even so much as to one in the same house." In 1800 Dr. Ramsey of South Carolina, writing to Dr. Miller of New York, says: "There is but one opinion among the physicians and inhabitants of Charleston as to the origin of yellow fever here, and that is, that the disease was neither imported nor contagious." Unfortunately for the south this became the accepted doctrine of the medical profession of our section under the domination of Rush and La Roche of Philadelphia, and Barton of New Orleans. Such is the power of authority to trammel research. To even question the local origin theory of yellow fever was regarded as heresy. Convinced of the correctness of the domestic origin of this disease the profession of medicine for decade upon decade made no effort to trace its origin to foreign sources. If a bold, scientific brother pointed out facts which incontestably proved that the fever followed importation of cases from foreign sources he was ridiculed, and his convincing array of facts considered the theory of a crank. To show the predilection men have for preconceived opinions, I cite the fact that even so late as 1876, in so learned a medical profession as Savan- nah-admittedly one of the ablest in the south, all of the physicians of that city who appeared before the state board of health except two, Drs. Duncan and Elliott -- affirmed their conviction that the yellow fever epidemic of that year originated from unsanitary conditions, in and around the city, together with meteorological peculiarities. One of these learned men seriously claimed that "malarial poison and the effects of extraordinary heat produce yellow fever." Other physicians contend that the rice fields produce yellow fever, others attribute it to filthy sew- ers and stagnant filth in canals, on the surface of the streets, lots, etc., while others insist that the disease originates from excavations of the soil of cities, etc., etc.

The reason of all this confusion is the failure to discriminate between origin and propagation. They are as different as day and night. The old theory of causation of yellow fever in America by annual importation from foreign sources has been demonstrated to be true by the researches of modern medicine. The germ theory of disease has thrown a flood of light on this long mooted point. While the germ of yellow fever is to the present hypothetical-no microscopist having ever detected it, or demonstrated its existence, yet the profession of medi- cine of to-day is practically a unit in regarding it a germ disease, i. e., that its origin is due to a specific germ, microbe, as is smallpox, typhoid fever, cholera, etc. One of the fixed certainties of modern microbiology is the inconvertibility of germs, i. e., that every disease germ is the product of a previous germ, and this germ is peculiarly the causative agent only of one disease, and this germ cannot under any condition or conditions cause any other disease. There is no such thing as spontaneous generation of living organisms.

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At the birth of a germ or germs whether development and multiplication will ensue depends upon finding lodgement in a suitable soil. In other words, the environment must be suited to the necessities of that particular seed, germ. But without the parent germ there can be no subsequent one, and the progeny will be identical with the parent. As corn invariably produces corn only, so does the gern of yellow fever, for example, produce yellow fever only. It would be just as easy for the husbandman to grow wheat by planting seed corn, as for the physician to produce yellow fever by sowing the germs or seed of malaria. It never has been done. It never can be. It may be true, as claimed, that the same factors, soil and environment, which favor the growth and multiplication of the germ of malaria, are equally favorable to the growth and multiplication of the yellow fever germ in the city. But this by no means proves their identity. The same factors, soil and environinent, are alike favorable to the growth of wheat and oats, yet they are two separate and distinct entities. It is true that yellow fever usually prevails in localities where malarial fevers exist, but malaria prevails in thousands of localities where yellow fever has never been known. Yellow fever is pre-eminently an urban disease, malaria is pre-eminently a rural disease. The poison of malaria is not portable, that of yellow fever is markedly so. Malaria prevails annually in a malarial locality, yellow fever rarely ever does. One attack of yellow fever is protective against a second manifestation of the disease, one attack of malaria makes the individual more susceptible to a second attack than if he had never had the first one.

Twenty years ago Parkes said: "During the last few years the progress of inquiry has entirely disconnected yellow fever from malaria, though yellowness of the skin is a symptom of malarious fevers. Yellow fever is a disease of cities and parts of cities, being often singularly localized, like cholera. In the West Indies it has repeatedly attacked a barrack (at Bermuda, Trinidad, Barbadoes, Jamaica), while no other place in the whole island was affected. In the same way (at Lisbon, Cadiz, and many other places), it has attacked only one section of a town, and, occasionally, like cholera, only one side of a street. In the West Indies it has repeatedly commenced in the same part of a barrack. In all these points, and in its frequent occurrence in non-malarious places, in the exception of higlily malarious places, in its want of relation to putrifying foecal and other animal matters, its cause differs entirely from malaria. If these points were not sufficient, the fact that the agent or poison which causes yellow fever is portable, can be carried and introduced among a community, and is increased in the bodies of those whom it attacks, indicates that the two agencies of yellow fever and malarial fevers are entirely distinct.

"That great point being considered settled, the inquiry into the conditions of spread of yellow fever becomes easier. The points to seize are its frequent and regular localization and its transportation. The localization at once disconnects it with any general atmospheric wave of poison, it is no doubt greatly influenced by temperature, and is worse when the temperature is above 70 degrees Fahrenheit; though it will continue to spread in a colder air than was formerly supposed, it does not spread rapidly, and appears to die out, but even temperature does not cause it to become general in a place."

Meteorological conditions, coupled with unsanitary surroundings, putrefac- tion of vegetable and animal substances vitiate the atmosphere of cities-this atmosphere is impure from a sanitary point of view, but such an atmosphere con- tains no single element, or combination of elements, capable of originating yellow fever. Another element must be added to this impure atmosphere before the disease is generated therein, that element is the germ or seed of this malady. This is the leaven that leaveneth the whole lump. It appears in American cities in only

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three ways, one or all in combination, i. e .: I. An atmosphere charged with yellow fever germs contained in vessels, cars, etc. 2. Yellow fever fomites, i. e., germs, in the baggage of passengers recently arrived from an infected locality. 3. By persons having inibibed the disease in an infectious locality and falling ill of the malady after reaching the non-infected city. In this latter instance the germs multiply in the body of the yellow fever patient, and after leaving the body multi- ply in the atmosphere in sufficient number to make it infectious. It has never been demonstrated how the yellow fever germ finds exit from the body of the patient. The late Dr. Parkes of England, admittedly the highest sanitary authority in the world, was probably correct in calling it "a foecal disease." On this point he says: "The localizing causes are evidently connected with accumulation of excreta round dwellings, and overcrowding. Of the former there are abundant instances, and it is now coming out more and more clearly that, to use a convenient phrase, yellow fever is a foecal disease. And here we find the explanation of its locali- zation in the West Indian barracks in the olden time. Round every barrack there were cesspits open to the sun and air. The evacuations of healthy and sick men were thrown into the same places. Grant that yellow fever was somehow or other introduced, and let us assume (what is highly probable) that the vomit and foecal matters spread the disease, and it is evident why at St. James' barracks at Trinidad, and at St. Ann's barracks at Barbadoes, men were dying by the dozens, while at a little distance there was no disease. The prevalence on board ship is as easily explained; granted that yellow fever is once imported into the ship, then the conditions of spread are probably as favorable as in the most crowded city, planks and cots get impregnated with the discharges, which may even find their way into the hold and bilge. No one who knows how difficult it is to prevent such impreg- nation in the best hospitals on shore, and who remembers the imperfect arrange- ments on board ship for sickness, will doubt this. Then, in many ships, indeed in almost all in unequal degrees, ventilation is most imperfect, and the air is never cleansed."

Thorough drainage, sewerage and scavenging of a city no doubt markedly decrease its liability to infection from yellow fever when the germ of the disease has been introduced. Thorough drainage dries the soil and atmosphere, thereby decreasing the vitality of the yellow fever microbes; perfect sewerage promptly and efficiently removes all liquid household filth beyond the inhabited area, which liquid filth would, in the absence of sewerage, be thrown upon the street or lot surface there to putrefy and furnish pabulum for these microbes. Thorough scav- enging promptly and efficiently removes the solid filth of a community and thereby robs these microbes of food from this source. Yet with all this perfection of sani- tary administration should yellow fever patients be admitted into such a com- munity, even though they had been divested of all fomites before being admitted, there is still marked and unquestionable danger of infection of the atmosphere unless all dejecta of such patients be thoroughly disinfected immediately that they leave the body, for as has already been shown, the microbes of yellow fever grow and multiply in the body of the patient and pass out in the dejecta, to find even more favorable growth and multiplication in media external to the body of the living host. Medical history has, however, indubitably proven the fact that yellow fever does not always infect a city even when a number of persons sick of the disease, and bringing with them yellow fever fomites, are admitted. Indeed, history shows that in the majority of such cases no spread of the malady results. Yet the fact that infection is the exception and non-infection the rule, furnishes no justification for admitting these persons and fomites into a community, for it

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is not in the power of the most learned sanitarian in the world to foretell at what introduction it will or will not spread and scatter desolation and death in a city. The portability of the poison being proven, the golden rule of prophylax is non- intercourse with infected localities, persons and materials, i. e., that before persons and materials from a city infected with yellow fever can be safely admitted into a community the period of incubation must have passed and all materials thor- oughly disinfected, as well as ventilation and disinfection of boats, cars, etc., plying between the infected locality and the healthy one. No fact is better established in medical history than that one determining factor in the propagation and dissemi- nation of yellow fever is human intercourse. In the vast majority of epidemics of yellow fever in America infection has been directly traced to arrival of infected boats, cars, fomites or persons. And all of them could be so traced could all the facts be ascertained. It is often impossible to trace the source of the first case of smallpox, scarlet fever, or measles in a community, yet every intelligent physician knows that the poison was imported into the previously non-infected community. The agency of human intercourse in scattering the seeds of this disease is con- clusively demonstrated by the fact that medical history is full of examples wherein monasteries, prisons, etc., in the midst of decimating epidemics, have wholly escaped infection by observing the rule of non-intercourse with those outside of their walls. It has been proven over and over again that winds or atmospheric currents have little or no influence in scattering yellow fever from one section of a city to another. The poison travels as rapidly against as with a wind. Almost every epidemic has shown that a certain district, or districts, of a large city had been the field of a general, decimating prevalence of the disease, and few if any cases occurred outside of the infected locality or localities, except such persons as had visited the infected center. Experience has abundantly demonstrated that yellow fever often remains confined to a single square of a city, or a single street, and that the poison does not cross the square or street unless it be carried across by some person visiting the infected place. The progress of the disease has often been known to be arrested by a stream of water or by a high wall.

SCIENTIFIC QUARANTINE ESSENTIAL.

Freedom from yellow fever in America is to be secured only by the adminis- tration of a thoroughly scientific quarantine, such as the one inaugurated at New Orleans, La., in 1885, by Dr. Joseph Holt, president of the state board of health of Louisiana. Many years ago quarantine meant the detention of passengers from infected places for forty days on ship board or in a lazaretto. In this day quarantine means the detention of such persons in a properly equipped lazaretto or refuge camp until the period of incubation shall have passed, when, after thor- ough disinfection of all fomites, the individuals are allowed to go to their respec- tive destinations. Formerly, indeed so late as 1876 in Georgia, mere detention for forty days was considered sufficient to stamp out infection in a ship, which, by reason of its construction, could not be even ventilated. In very rare instances ignorant and crude efforts were made to disinfect the cabin and forecastle by burning a few pounds of sulphur therein, but the hold, filled with the foreign yellow fever atmosphere and the putrescent bilge, was left unmolested until the vessel was admitted to pratique; to open their hatches at our wharves, there to discharge their long pent-up air, reeking with yellow fever poison, into the atmos- phere of the very heart of the city. Mere detention of a vessel, even for a period of twice forty days, did not divest her of her deadly infection. At the end of

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eighty days' detention at the quarantine station she was as capable of infecting the port as if she had never been detained one hour. This fact has been proven over and over again, yet blind adherence to the local origin theory on the part of the port physician caused the niere detention idea to prevail and thus sow the seeds of disease and death in the community. Is it anything strange that yellow fever occasionally visits us? Should we not rather be amazed that we so frequently escaped? Happily all is changed. Modern ship sanitation has eliminated every · vestige of cruelty from quarantine, shortened the period of detention, brought order out of chaos, and supplanted failure with success. Ship sanitation under the Holt system is as scientifically correct and its results as exact as modern antiseptic surgery. Indeed, the system consists of applying to vessels and their contents exactly the same treatment as is applied by modern antiseptic surgery to hospital wards, patients and fomites. If modern quarantine and germicidal treatment of ships, railway cars, houses, fomites, etc., together with detention of suspects until the period of incubation shall have passed, is unnecessary and unscientific in war- fare against yellow fever, admittedly a portable disease, then modern antiseptic surgery is equally as unnecessary and unscientific. Let it always be remembered that the quarantine system of to-day operated against yellow fever is as necessary, and fully as protective against importation of cholera, typhus fever, measles, smallpox, scarlet fever, etc. Inland cities must wage warfare against infection from yellow fever by absolute non-intercourse quarantine, for the reason that no city can be expected to erect and maintain detention camps and disinfection appliances at a station on every railway leading into the place. Unless yellow fever refugees have been detained beyond the period of incubation of the disease, and all fomites thoroughly disinfected before being admitted into a community, it is just as rash and unscientific to admit such refugees and their fomites as it would be for the surgeon to admit a case of erysipelas into a surgical ward. Absolute non-intercourse quarantine operated by inland cities has failed only when the measure was inaugurated after refugees or fomites had gained admittance prior to the inauguration of the measure. Every fair-minded man must admit that in the past the existence of yellow fever in a city was kept a profound secret by the authorities until the disease had become epidemic, and before this event numbers of the citizens had caught on to the state of affairs and fled the place, many of these refugees having imbibed the poison, and developed the disease after arriving in the city of refuge, not only these refugees unknowingly infected, but their baggage likewise. Every city owes it as a duty to its neighbors as well as its citizens to announce the first case of yellow fever immediately that the disease has been diagnosticated. The mere announcement of the first case has no power in itself to cause the disease to extend into an epidemic, but it puts her citizens and neighbors upon notice of impending danger, and enables them to prepare to meet it in their own way. The law should make it a penal offense for the officials of a city to conceal from its citizens the existence of yellow fever within its limits. No city has the right to murder her citizens by forcing them to unknowingly dwell amid pestilence for fear of damaging her commercial interests. The trouble in the past has been that in sanitary matters human life has been held of inferior value to commerce. Whenever it becomes a question of fostering commerce at the expense of human health and life, commerce should be restrained rather than sow the seeds of pestilence among an innocent people. Under the enlightened quarantine system of the present, there is no conflict be- tween quarantine and commerce, and no intelligent commercial body in America

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known to me regard it as a hardship upon commerce. In fact rational quarantine is the ally of commerce.

PUBLIC HEALTH LAWS-SANITATION.

The sanitary laws of Georgia are general in nature and provide: How and by whom hospitals for contagious diseases may be established. Maritime quarantine, how prescribed and regulated. Towns may establish quarantine. Vessels may be removed to quarantine grounds. Persons escaping quarantine; how dealt with. Masters of vessels must deliver bills of health, etc. Inland passengers to perform quarantine when ordered by authorities to do so, if they come from a place infected with a contagious disease. Duty of pilots before entering vessels. Persons on board of an infected vessel shall observe quarantine. Governor empowered to give orders to prevent the spread of contagious diseases within the state, and make such appointments and regulations concerning the same, as deemed proper by him. Violators of quarantine may be indicted. Per- sons concealing smallpox indictable. Fines and forfeitures arising out of violation of quarantine; how disposed of. Performance of quarantine; how certified. Fees of health officer; how paid. Smallpox hospitals may be constructed in towns and counties in which the disease appears. Towns and counties may provide necessary regulations to prevent the spread of smallpox. Governor is required to procure the necessary vaccine virus and have it transmitted to the ordinaries of each county for immediate use. These laws are to be found in the code of Georgia, sections 1375 to 1393 inclusive. Nuisances injurious to the public health may be abated under sections 4090 to 4097 inclusive of the code of Georgia. In addition to these sanitary laws certain towns and cities have special grants from the legislature either in charter provisions, or special sanitary laws, to protect the public health under ordinances enacted by the authorities of these communities.

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Memoirs of Georgia; containing historical accounts of the state's civil, military, industrial and professional interests, and personal sketches of many of its people. Vol. II, Part 18

Author: Publication date: 1859 Publisher: Atlanta, Ga., The Southern historicl association Number of Pages: 1166

Author:
Publication date: 1859
Publisher: Atlanta, Ga., The Southern historicl association
Number of Pages: 1166