USA > Tennessee > Shelby County > Memphis > A history of the yellow fever : the yellow fever epidemic of 1878, in Memphis, Tenn., embracing a complete list of the dead, the names of the doctors and nurses employed, names of all who contributed money or means, and the names and history of the Howards, together with other data, and lists of the dead elsewhere > Part 3
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A HISTORY OF THE YELLOW FEVER :.
about forty feet a day. Dr. Stone used to compare its course and mode of travel to a tax-collector-from house to house along a street before it diverges. It is most active in its operations near the surface of the earth. attacking a larger proportion of persons on the ground floor; it is more active at night than in the day-time; it may attack a single block or district in a city, as, for instance, in 1870, New Orleans suffered from yellow fever. It was con- fined to a portion of the second district. twelve blocks by four. In 1872 it was in the fourth district. In 1873 it appeared in all the districts in the city, and was epidemic, but disinfectants so modified the disease that it did not become a general epidemic, whilst higher up the river, Shreveport and Memphis passed through the terrors of a fatal epidemic. In 1874, New Orleans again escaped, while Pascagoula and Pensacola suffered. Walls may stop the progress of yellow fever; as, for instance, the inmates of the cala- boose in New Orleans generally escape; even a partition of boards may inter- vene, as reported by Dr. Nott, from Governor's Island, in 1867. Dr. Parkes says that in the West Indies it has repeatedly attacked a barrack, while no other place on the island was affected. At Lisbon, Cadiz, and many other places, it has attacked only one side of a street. In the West Indies it has repeatedly commenced in the same part of a barrack. It has been known to attack every house in a neighborhood save one; to attack all the sailors in the berths on one side of a man-of-war before reaching over on the opposite side."
Dr. W. A. MeCully, of Independence, Mo., a very intelligent physician. who volunteered and was devoted to the work in Memphis in 1878, writes of his ex- perience during that epidemic, and one that prevailed at Key West, Florida, in 1864, while he was a surgeon of volunteers in the Federal army. It will be seen, from what he says, that notwithstanding a strict quarantine, enforced by an ade- quate military force, there were some seemingly spontaneous cases of fever in 1865. He says : " In the winter of 1864 and 1865 stringent sanitary regulations were enforced on the island of Key West and Fort Taylor. In March, 1865, a strict quarantine was ordered by Brig .- Gen. John Newton, which I enforced with the assistance of the army and navy. A number of cases occurred during the sum- mer of that year, but all of a mild type, the mortality being hut two per cent. The local conditions were such that the germs could not propagate, and in my opinion to them we must generally ascribe the malignancy of the disease. I left Key West in 1866, and never saw yellow fever again until the recent epi- demic at Memphis, Tenn. The disease there exhibited the same phenomena as at Key West and Havana, except that it was frequently complicated with malarial fever. Patient, sometimes would have intermittent fever precede, and at others follow yellow fever. Relapses were more frequent. A failure to treat the miasmatic complications was the cause of considerable mortality. I thought, at Memphis. I made thirty autopsies at Key West, and a number at Memphis, with almost identical results. The same lesions were observed in all, modified by malaria, suppression of urine, or some other compliestion. The observations made at these places lead me to the following conclusions :
" Ist. That yellow fever is produced by a specifie germ.
"2d. That the impression on the individual organization is as specific as
27
A HISTORY OF THE YELLOW FEVER.
that produced by typhoid or the eruptive fever, and protects it from subse- quent attacks.
"Bd. That race or acclimation affords no protection against contracting the disease. That the African rare suffered less with small mortality, while the white race, especially those of sanguine temperament, suffered severely with heavy mor- tality. Being accustomed to the climate certainly diminished the mortality.
"4th. That the germs propagate within and without the body ; the spread of the disease depending on cess-pools, sewers, filth and personal contact, the temperature and other meteorological conditions being favorable.
"5. That a temperature below 70° is unfavorable to the propagation of the germs, and if continuous will destroy them.
" 6. That where the temperature produces frost sufficient to exterminate the germs it is probably a preventable disease by quarantine alone: but should it be introduced, its benign or malignant type will depend entirely upon the sanitary condition of our villages, towns and cities.
"7. I believe the disease may be introduced into any part of our country where there is a continuous daily temperature above 72º for two months."
The Commission of Allopathic Physicians# appointed by the Congressional Committee to investigate and report upon the origin and causes of the yellow fever epidemic of 1878, state that " the concurrence of local conditions favorable to the evolution of the yellow fever poi-on seems to be necessary to the evolu- tion of yellow fever epidemies; but, as to the nature of these favorable local con- ditions, we have no positive knowledge. In a negative way, we know that yellow fever often fails to swell into epidemie prevalence when high summer heat, at- mospheric moisture, marsh malaria, and abundant filth are all present ; so that there must be some conditio sine qua non other than any or all of these. The discovery of this unknown factor in the generation of yellow fever epidemics would be a great boon to humanity." Dr. P. V. Schenck. of St. Louis, who, in a well-prepared paper -- from which one quotation has already been made -- shows that yellow fever has a home lacking in sanitary conditions; it mi- grates; it is carried in baggage and in the hold of ships, and by a wave power; and that it requires humidity and a continuously high temperature. But these are not causes. He says: "It is not generated by bilge-water : un- sanitary conditions won't produce it. Constantinople has filth and the plague, but no yellow fever : India, heat and cholera, but no yellow fever. Heat and humidity exist without the disease. Mauritius, in the Eastern, compared with Jamaica in the Western, Seas, has a mean annual temperature (80º Fahrenheit) alnost the same: the fluctuations and undulations are not ex- ressive, and the humidity nearly the same. The rain-fall (sixty-six to seventy- six inches) is similar: the geological formations not dissimilar. Yet, with al twee points of similarity, the diseases are very different. At Jamaica the
# The following are the names of the gentlemen composing the Commission : John M. Woodworth. M. D., President : Stanford E Chaille. M. D., Secretary ; S. M. Bemiss, M D .: Jerome Cochran. M. D .: M S. C. M. D .: S A. G, M. D .: Tomas S. Hardee. C. E. ; R. W. Mitchell, M. D .: Jacob S. Mosher. M. D .; W. HI. Randle, M. D .; Loni- A. Falligant, M. D. ; R. M. Swearingen, M. D.
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28
A HISTORY OF THE YELLOW FEVER.
yellow fever is often epidemic, at Mauritius it is unknown. The ground is not tenable, therefore, that has been taken by some of the most eminent English practitioners in the West Indies, as well as prominent men in this country, that the yellow fever may be occasioned through the agency of a tropical sun, independent of any other cause. Dr. Bryson, who has studied this question, thinks that yellow fever is not a distinct disease, but ouly an exaggerated bilious fever, and quotes the celebrated case of the ship Bann, where there was no fever when they left-the first case was nothing but malarial fever. The cases after this assumed the type of yellow fever, which became so bad that they were compelled to abandon the cruise and go to As- cension Island for relief. He also quotes the Leclair case; and he accounts for these cases, that the disease, owing to local cause, changed its type. Dr. Fenner says that, in regard to yellow fever in New Orleans, the fevers there are intermittent, remittent, and continued, alternating in type, and running into each other. In summer and autumn they have a decided tendency to crisis by hemorrhage; this makes yellow fever. Dr. Hanson has observed that often malignant intermittent fevers precede the outbreaks of yellow fever epidemics .* The cause of miasmatic diseases is a specific excitant of disease, known as miasm, which propagates outside of, and is disconnected from, a pre- viously diseased organism. But this disease does not occur, like marsh fevers, at regular periods; it occurs where there is the least malaria; it avoids the country, with its marshes, and seeks the city. In Charleston the people flee to the marsh lands in order to avoid the disease. Others contend it is owing to decomposing animal or vegetable matter; in other words, to an unsanitary condition of our large cities. Under such circumstances the disease could be produced at will, but we find that sanitary measures, in the ordinary accepta- tion of the term, have no power to arrest an epidemic wave. Besides these migrations of yellow fever have not occurred when the most unsanitary con- ditions would tempt it. During the whole of the war of the Revolution, and of the late war, when the military and naval operations on our coast, and the communication with the West Indies, were greater than at any other time; when, during the Revolution, large bodies of troops were accumulated in the Antilles and landed in our country direct from there, and every circumstance seemed combined that could generate and propagate disease, still during that time yellow fever was a disease entirely unknown, and unknown at points where it previously and has since prevailed with terrific force. When we state that yellow fever will attack the healthy villages equally with the dirty alleys of cities, the palace with the hovel, do not understand that a person placed un- der superior hygienic conditions is as liable to receive disease and that he will not recover from it sooner than one otherwise placed. From the earliest cul- tivation of medical science, certain states or conditions of the atmosphere have been recognized as powerfully influencing the production of the cause of disease. Hippocrates and Galen attributed to change in the air, though the
* This was the cause in Memphis in 1873 and 1878. In the first named year cholera and small-pox a'so prevailed.
29
A HISTORY OF THE YELLOW FEVER.
former speaks of unknown divine principle, to the operation of which he supposed pestilential diseases might be owing. Some attribute to an electric operation; others speak of the epidemic constitution of the air; others, to sothe hidden or occult qualities derived from exhalations of the bowels of the earth. But now these ideas are, since the discovery of germs, put down among the curiosities of our literature."
The Homeopathic Commission, whose expenses were borne by that philan- thropic lady, Mrs. Thompson, of New York-who also paid the expenses of the Woodworth (or Allopathic) Commission-after some weeks of personal in- vestigation at the principal points affected by the fever in 1878, made a report of fifty-six pages, which contains matter of great value, but which unfortu- nately is interwoven with much of aggressive criticism of allopathic treatment which, in the eyes of those at least who are attached to the old school, is repre- hensible especially in view of the importance of the subject under investigation. Treating of the causes of yellow fever this Homeopathic Commission * reports that it is a specific disease, entirely independent of malaria, occurring rarely a second time in the same person, infectious and capable of transmission to any distance by means of fomites or infected material. The yellow fever germs-for we accept provisionally the germ theory of the disease -- are indige- nous to the West Indies and perhaps to the west coast of Africa, and have been thoroughly naturalized in many localities in the southern portion of the United States. They were imported into New Orleans during the last quarter of the eighteenth century, and have existed in the soil or atmosphere of that place ever since, either in a latent or an active condition. They may lie dormant for many years consecutively, and they require a concurrence of causes to develop them into a state of disease-producing activity. Some of the factors which seem to be favorable to the excitation of the yellow fever germ are the following :
Low, swampy ground, near the level of a tropical sea.
Long continuance of very high temperature, following heavy rains.
Long continuance of south and east winds.
Aggregations of human beings with the excreta of their bodies in small spaces. A crowded and dirty ship may be a nidus for yellow fever, as well as a crowded and dirty city.
Long continuance of calm weather, unbroken by thunder-storms.
Exposure of decaying vegetable and animal matter to a burning sun.
Inefficient drainage and the general accumulation of filth, especially the city garbage.
Deficiency of ozone in the atmosphere.
Pestilential exhalations from an upturned soil.
* This Commission was composed of the following named gentlemen: Wm. H. H.1- combe, M. D., of New Orleans, Chairman; T. S. Verdi, M. D., of Washington City, Sed'y : Bushrod W. James, M. D., of Philadelphia, Penn .; W. L. Breyfogle, M. D., of Louis- ville, Ky .; J. P. Dake, M. D., of Nashville, Tenn .; E. H. Price, M. D., of Chattanooga, Tenn .; F. IT. Orme, M. D., of Atlanta, Ga .; L. A. Falligant, M. D., of Savannah, Ga .; Lucius D. Morse, M. D., of Memphis, Tenn .; W. J. Murrell, M. D., of Mobile, Alabama; Thomas J. Harper, M. D., of Vicksburg, Miss.
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A HISTORY OF THE YELLOW FEVER.
When the yellow fever germ has been walked into activity by these Games, it may be transported to places where none of them exist. It seems that a certain concurrence of several of the above factors is necessary to the genera- tion of yellow fever. There is probably one combination in one epi lemie, and a somewhat different combination in the next epidemic. An epilewie nity be mild or severe according to the number and force of the concurring alice. There may also be other unknown but discoverable factors, which may In- necessary at one time to produce an epidemic and not necessary at another. No one of the above suggested causes could excite an epidemic by it-elf. and it i- not probable that they all ever concurred equally to the formation of the disease. The most extensive collections and comparison of fact- are necessary to illumine the very great darkness which lies upon these complex que't is. The naturalized yellow fever germs may receive so slight a stimulus a- to produce only a few sporadic cases. Or they may be vitalized in certain bewal- ities to such a degree as to occasion quite an outbreak in those localities. but easily communicated to other quarters. Or, thirdly, the disseminated Cera .- may be vivified in all directions, and a general epidemie excited. Or. lastly. the naturalizol germs may lie entirely quiescent until fresh and active germs are brought in from foreign ports, which then act a- sparks to ignite the in- flammable material already existing. We thus have four shades or de_fers of yellow fever visitation: sporadic cases, local and limited outbursts. epi- demics from naturalized germs, and epidemics from importation. In -paradic cases and limited outbreaks the specific nature of the fever is not charly brought to light, and it is sometimes difficult to diagnose it from the dominant malarial or bilious diseases. The imported epidemic, whether from Havana to New Orleans or from New Orleans to Memphis, ete., ete., is always a more quick-spreading and malignant disease than that arising from our naturalized germs. The comparative mildness of the late epidemie in New Orleans is one out of several reasons for believing that the disease was of local origin. The yellow fever of domestic origin can only be prevented by local sanitary measures. So long as the public authorities ignore the crying evils at home. and watch only for the enemy at the sea-side, we shall continue to be scourged with repeated epidemics of yellow fever. Quarantine may or may not keep out the tropical foe, but our utmost energies should be concentrated again-t the enemy which has been domiciliated in our households for nearly a century. Is there any personal prophylactic against yellow fever? None which has the least scientifie value. Quinine is probably serviceable when malarial fevers are simultaneously prevailing, not because it has any power against vel- low fever, but because an attack of malarial fever, preventable by quinine. might, if allowed to occur, precipitate an attack of yellow fever. Quin !! : for intermittents, belladonna for scarlet fever, and vaccination for stal- pox, are the only prophylactics which have commanded even the part'al belief of the profession. They are all confessedly homeopathie in their ac- tions: and we confidently believe, if prophylacties for yellow fever, or any other disease, exist, that they will be fand only by study and experiment in that direction. The poison of the rattlesnake produces an artificial dis-
31
A HISTORY OF THE YELLOW FEVER.
ease bearing a remarkable resemblance to yellow fever, and it has proved a remedy of considerable value in the malignant forms of that affection. Inoculation with this poison was used extensively at Havana many years ago, under the auspices of an erratic genius who, it is said, assumed the vener- able name of Humboldt. The results are differently stated by the friends and enemies of the experiment, but, as the quantity inoculated was entirely too great, and large doses of antidotal remedies were simultaneously adminis- tered, it may be fairly presumed that such an experiment had no real scien- tifie value. Whether the poison, cautiously used, either hypodermically or in small doses by the mouth, may not produce a substitutive di-ease, which. for that season at least, might prevent an attack of yellow fever, is a ques- tion certain to command further consideration." It will thus be seen that the homeopathists do not believe in prophylacties, as little do the allo- pathists, who have had a wider and more extended experience with the fever. Beyond the reach of successful contradiction. it may be asserted that there is no known preventive of yellow fever. This has been proven in every epidemie: but especially in the last, that of 1878 in Memphis, and so strongly as to set the question at rest forever. Those who re- sorted to lime-water, to, sulphur in the boots, shoes or stockings. to sulphur and gin, to regulated quantities of gin, to liver-pads, to garlic, to onions. to quinine, to cathartic pills, calomel, chlorinated lime, or any thing el-e. invariably proved easy victims, and died rapidly. The system was, by means of these poisons-for such they proved -- either diseased or depleted: every additional dose or every additional effort only increasing or intensity- ing the fear which induces a resort to prophylactics. One case of many such within the author's knowledge may he mentioned. It was that of a man who ordinarily cujoyed good health, who left the city at the outset of the fever, but returned for the purpose of transacting some business. Br the time this was accomplished, shot-gun quarantines were established, and he was compelled to remain. Demoralized by this enforced imprisonment in the doomed city, he had recourse to garlic and onions, which he used three times each day; and to sulphur, which he used in his stockings; and to sulphur and gin, of which he drank as his fears prompted. He was taken with the fever and died on the fourth day. All the physicians of experience advised against prophylacties, though there were not wanting a few of the faculty who had a pet preventive. Dr. Luke P. Blackburn, writ- ing of his experiences in Hickman, in 1878, says that " those who had been taking quinine as a preventive also fell an easy prey. Quinine was an irritant, and usually opened the system to the attack of the disease. In my opinion much of the mortality of Memphis, Grenada, and other cities was due to the extravagant use of quinine and the saturation of the air with carbolic acid. Instead of the latter assisting in the suppression of the disease, it but increased the effect of the poison and made the fever more dea liy. Those who had escaped easiest were those who lived temperately. were not frightened. and did not take 'preventives' too often recommended." A clergyman, who writes as if he had had some experience, says what every 3
32
A HISTORY OF THE YELLOW FEVER.
sensible layman as well as physician must endorse, as follows: "For indi- viduals who are obliged to remain in an infected locality, there is no pre- ventive so effectual as keeping the system in a general state of good health. Let a man breathe fresh air as much as possible, eat nutritious food mod- erately and regularly, take plenty of sleep at seasonable hours, bathe freely, and above all avoid the use of stimulants; by so doing he will reduce the danger to a minimum and he likely to escape, while strong men of irreg- ular habits are stricken down by his side. An equable mind, which comes of a firm trust in God and an implicit reliance on His providence, is not the least valuable preventive of this as of every other disease."
II.
SPORADIC or epidemic yellow fever is not always to be attributed to the same causes, notwithstanding Dr. Dowell, of Galveston, says that in nineteen cases out of twenty it will be found to have been introduced or imported. Dr. Bennett Dowler, in his excellent pamphlet, "The Epidemie in New Orleans," tells of an outbreak of it in Gallipolis, Ohio, in 1796, which killed one- half the army and the inhabitants in ten days. This place, which also suffered in 1878, was at that time a new settlement, quite in the wilderness, and isolated from all others, having communication with the Atlantic cities only at long intervals and under favoring conditions of weather and of roads. Mr. A. Elliott, in his journal of a voyage down the Ohio in that year, referred to in the report of the surgeon-general of the army, says the dis- ease raged violently, the fatal cases being generally attended with black vomit. "The fever," he says, "could not have been taken there froin the Atlantic States, as my boat was the first that descended the river in the spring. Neither could it have been taken from New Orleans, as there is no com- munication up the river at that season of the year." In the fall of 1:23, yellow fever of a high grade suddenly appeared at Fort Smith, Arkansas, and prevailed epidemically, without so much as a suspicion of exposure to conta- gion, according to the official report on file in the office of the surgeon-general of the army. The theory here suggested, that this disease, if not localized or indigenous to this country, may originate under favoring conditions, is borne out to some extent by a tabulated statement furnished in an article that ap- peared in De Bow's Review for December, 1853, immediately after what was. until last year's experience in Memphis, considered the most dreadful of its visitations in this country. The table shows the number of cases and deaths. from the year 1822 to 1849, inclusive, which occurred in the Charity Hospital. The figures are perfectly authentic, having been taken from the official ree- ords. These figures bear very significantly upon the proposition with which the writer prefaces his remarks, to wit: "That the yellow fever originates here,
35
18
33
A HISTORY OF THE YELLOW FEVER.
no instance of its ever having been imported being as yet well proved." The table, be it understood, represents only the cases and deaths at the Charity Hospital for the years respectively mentioned :
YEARS.
TOTAL CASES, DEATHS. | YEARS.
TOTAL CASES. DEATHS.
1822%
·
337
239
1836
.
6 993
442
1824
167
108
1838
22
17
1825
99
49
1839#
1,086
452
1826
24
5
1840
3
3
1827
372
109
18419
1,114
594
1828
290
130
1842#
425
211
1830
256
117
1844#
169
83
1831
3
2
1845
1
0
1832ª
18
26
1846
146
96
1833ª
422
210
1847*
2,479
895
1834*
150
95
1848*
1,226
420
1835#
505
284
1849 .
1,055
545
Total,
12,913
6,332
5
1823
.
1
1
1837#
.
1829
436
215
1843ª
1,086
487
It thus appears that during these twenty-eight years there were thirteen epi- demics in New Orleans, and at least five other seasons of heavy mortality from yellow fever when it did not please the authorities to declare an epidemic. It will be seen that there was not a single year in which the yellow fever did not appear at the Charity Hospital, and that the average number of deaths annu- ally from that cause was more than 200. The author of this article in De Bow argues from the statistics of the year 1853, and from those of all the preceding years as far back as 1822, that the yellow fever is indigenous to New Orleans, and that it depends upon purely local conditions from year to year whether or not it will become epidemic. All accounts agree-and he quotes copiously from the contemporaneous press-that the sanitary conditions in 1853 were unusually and unprecedentedly bad; that at no time within the memory of man had the streets been as filthy and the policing of the city as negligently and criminally mismanaged. To these causes is attributed the frightful mortality of 1853 as compared with other years. Strengthening these conclusions, Dr. Simonds, of New Orleans, declared (and gave the figures to prove) that the yellow fever was treated in the Charity Hospital every year for thirty years, up to 1849. "So," as Dowler says, "that the stream of yellow fever, with whatsoever of contagion it may possess, is uninterrupted, no year having been wholly ex- empt in this institution, not to name the city at large." The commission appointed by the Board of Health of New Orleans, in 1853, to inquire into the origin, propagation, or mode of transmission of the then late epidemic of yellow fever,-sewerage, quarantine, and the sanitary condition of that city,-after a long and laborious investigation, reached the same conclusion. They say "that yellow fever is not a disease personally contagious; that its infectious properties are only communicable in a foul or infectious atmosphere ; that is, that a foul vessel or individual with the disease will only propagate it umler atmospherical and local conditions similar to that which furnished its na-
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