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 44
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3. I believe that the disease is transmissible, and that it is not-that is, that when carried from one point to another, it must find the conditions or surround- ings necessary to its propagation, or it will not spread. Therefore, the disease has at times been brought to New Orleans, and to other places, and has not spread. In illustration of this point, I cited the case I carried to Cooper's Well, in 1853 (not willfully), the case that bought its way through General Butler's boasted military quarantine, in September, 1862, and the case carried from Memphis or Shreveport into New York city, by rail, in September, 1873; as well as cases known to have been carried into New York, by rail, during the past summer-1878.
4. In view of the foregoing, it is difficult to establish the fact that a given ship or person spreads yellow fever. Yet all the probabilities of the ship or person having done so may be strong, and even satisfactory, to many minds.
5. I believe that it is most probable that yellow fever was originally brought to New Orleans; but I also believe that it has long ago become engrafted on us, and that it has appeared here in summers, and will appear again, inde- pendent of importation from abroad. I am satisfied that I saw the first case
# Illustrating the absurdity of the doctrine of contagion, Dowler mentions that Carlos, King of Spain, by proclamation, in 1805, conferred on Don Cabanellas and his two children an annuity of $1,200, making the Don phy-ician to the royal househoki, bestowing other privileges on him, for having slept one night with his children in the bed whereon yellow fever victims had died in the lazaretto. A number of galley convicts, in chains, who vol- untarily accompanied the Don for the night, had one year's punishment remitted from their penalties. The party consisted of fifty persons, who suffered no harm. Great was the astonishment of His Catholic Majesty and his doctors.
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that appeared here in 1867 -- the young English servant man of Mr. J. O. Nixon, living on St. Charles Street, between Julia and Girod, the central and granite paved portion of our city. The most careful inquiry revealed no con- nection of this man with any ship, or passengers of a ship; the city was per- feetly healthy at the time, and I only saw the patient after the fever had passed off. I predicted an epidemic on the strength of the case, and it came speedily.
The late Dr. Stone, of New Orleans, does not believe in the contagion theory. He also sustains Dowler. He said, in his Bellevue Hospital lecture, delivered in 1867, after the epidemic of that year: "If the dis- ease were contagious once, it would always be so, for it is the same dis- case in all places. It is a specific disease, and the same person has it but once. Acclimation is perpetual, but it is very hard to convince the human understanding of that. There are, however, exceptions to these rules, as to every rule, and as there is to the rule governing small-pox, for in- stance. I have observed, honestly at least, if not closely, and the result of my observations has led me to believe yellow fever non-contagious. In 1833 I arrived in New Orleans, and went into the Charity Hospital on duty. The hospital became full, and as there was great scarcity of help, it became filthy. The passages (halls) were often filled with bed-sacks covered with excrement and black vomit, so that a sort of typhoid fever was generated, yet the persons employed there escaped yellow fever, and I did not have it myself until late in the season, after these conditions had been remedied. In 1853, I had an infirmary in which there were 300 cases of yellow fever, treated by ten or twelve sisters of charity, all of whom were unacclimated, yet the atmospheric influence did not prevail where the hospital was situated. In 1847, in 1853. in 1854, and in 1859, my experience had been substantially the same. In 1859, some forty cases of yellow fever were placed in the Charity Hospital, among a number of other patients, who were unacelimated, and although a large number of the forty died, not a solitary new case occurred in the house. Cases were constantly occurring of persons who went into infected districts, took the disease, were taken to uninfected districts, treated and nursed, and yet no one took the disease from them. In 1856 and 1857, yellow fever of a severe character prevailed in New Orleans, but was strictly confined to six squares. No intercourse with vessels had taken place, and it was evident the disease had originated there. In the country, I made diligent inquiries, with the same result. It did not spread from person to person. It was quite possible that a quantity of the poisoned atmosphere might be conveyed in the hold of a ship to distant places, and that persons breathing that atmosphere might have dis- ease, but they could not impart it to others. Just how much air would suffice to render the fever portable, it was impossible to ascertain. The question of its contagiousness is of great importance, and ought to be settled, both for the interest of sufferers from the disease, and as a guidance' in the matter of quar- antine. I am perfectly convinced, beyond all doubt or hesitation, that per- somally it is not contagious ; I know that it is not!"
The late Dr. L. Shanks, a physician long resident in Memphis, and well known
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as one of the ablest members of his profession in the Mississippi Valley, utterly scouted the theory of contagion. Giving his experience of yellow fever up to 1855, he says : " Previous to the late epidemie [1855], Memphis has been regarded as being above the yellow fever region in the Mississippi Valley, and secure against its origin and development as an epidemic from any cause. Memphis has heretofore occupied a position on the Mississippi River above the region in which cases of the yellow fever have originated, and though exempt from the disease, the citizens, and especially the physicians, have been familiarized with it, by the number of cases on the boats passing up the river, when it has prevailed as an epidemie in New Orleans, Natchez, Vicksburg, and at other places below. The boats coming from the infected places always landed here, and were freely visited by the citizens and physicians, when either business or the professional call of the physician required it. In this way the sick passengers upon the boats were not only frequently seen and administered to, but, when they desired it, were occasionally removed from the boats to the hotels and boarding-houses in the city, to be better attended to in the way of nursing and having medical aid. No fear ever existed here of the propagation of the disease by cases thus brought from the infected boats on the river into the city; and no instance has occurred in which a single case of the yellow fever has thus been produced here by contact with the sick, the dying, or the dead from the boats. The non-contagiousness of the disease has not only been demonstrated here in that way for many years, but it has been still more largely confirmed by the results at the Memphis Charity Hospital. When the yellow fever has prevailed as an epidemic in New Orleans, there has always been cases occurring on the boats after leaving that city, before their arrival at this port. Many of these cases have been put off at the landing here, and sent through the city to the hospital, in former years. In 1853, about sixty cases ; in 1854, forty cases ; and, in 1855, forty-two cases were thus sent from the boats to the hospital. Of these cases a large proportion died, as they were sent out at an advanced period of the attack; but not a single instance has ever occurred of a nurse, or other patients, or persons in or about the hospital taking the yellow fever from these cases." Dr. W. R. Milner, of New Orleans, writes as positively against contagion and quarantine as Dowler. He says : "The specific action of our common swamp malaria, which produces ordinary chill and fever, is upon the red corpuscles of the blood. It is attracted to these with as uniform certainty as the needle to the pole. This fact is known to every intelligent physician. It is the cause of the anæmic condition which univer- sally follows prostrated intermittents; and this destruction of the red blood is slow or rapid, according to the mildness or severity of the attack. Now I have observed that the same specific destruction of the red-blood corpuscles takes place not only in intermittents, but in remittents, in pernicious fever, in con- gestive chills, in purpura hemorrhagica, in malarial hæmaturia, and in yellow fever. In 1867 I was called to see a boy, the patient of another doctor, who had had the yellow fever for some days, and was then slowly bleeding to death from the gum of a decaved tooth. The red corpuscles had been nearly con- sumed by the poison, and nothing could stop the hemorrhage; he died. Now,
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if there is a point of specific agreement, uniforin, identical, and typical between yellow fever and all other forms of malarial diseases, are we not forced to the logical conclusion that the specific nature of yellow fever is identical with that of our common intermittents? Most assuredly. Then, if it be intrinsically the same, is it not of the utmost importance to commerce and to humanity that the fact be known and obeyed? Does not the wide-spread panic of the present, with its train of evils, not to mention the equally damaging effects of quarantine of past years, appeal to the common sense of an enlightened people to take this question up and compel its solution ? If I have stated a fact, and not an hypothesis, as to the specific and typical quality in the behavior of all of these diseases, what use of quarantine? Certainly none. Is there any intelligent observer of malarial diseases who can deny the fact? Why is quinine, the known specific of common swamp fevers, the specific and prophylactic of yellow fever also, if my premise be not true ?* , Will the advocates of the importation theory explain ? Nay, they can't. We have two great evils to contend with, one is natural, and the other is artificial; one is yellow fever, and the other is quar- antine. Shall we keep both ? Has quarantine ever prevented yellow fever? Tell me where, and when. Let the next legislature abolish the quarantine laws, and I tell you, sir, we shall have less yellow fever than we have ever had. Why? Because attention being thus drawn off from quarantine as a preven- tion, the useless expenditures of time and money in that direction will cease, and time and money will be utilized by concentration upon the only means of prevention-that of thorough drainage and cleanliness. And the work com- meneed in such good earnest would pay so well that in a few years success would be a demonstrated faet. The fires of enterprise would burn out the poisons of our swamps. A salubrious atmosphere would bless the city and State, invigorating and purifying the body, mind, and soul of the people; emi- gration would flow in; our lands would be taken and cultivated by God's noblest yeomanry, and soon Louisiana would become the example and the gar- den spot of the world."
The position against quarantine, so strongly taken by Dowler, and the phy- sieians quoted to sustain him, was indorsed by the convention of the Boards of Health, held in New York on April 27-30, 1859. Early in the session Prof. A. H. Stevens, M. D., submitted the following resolution :
Resolved, That in the absence of any evidence establishing the conclusion that yellow fever has ever been conveyed by one person to another, it is the opinion of this convention that personal quarantine of cases of yellow fever may be safely abolished.
This resolution elicited discussion by many members, and some of them the most profound students of this disease that had ever met in debate : such were Drs. R. La Roche and George B. Wood. of Philadelphia ; Drs. A. H. Stevens and John W. Francis, of New York; Drs. John Jeffries and D. H. Storer, of
# The doctor is unfortunate in this question, so far as the experience of 1878 goes. Quinine proved then to be any thing but a specifie or prophylactic for yellow fever. In most instances it was a positive aggravation of the disease.
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Boston; and several younger men, who appeared as living witnesses of modern epidemics. Finally, Dr. Stevens' resolution was amended by A. N. Bell, M. D., by the addition of a proviso, " that fomites of every kind be rigidly restricted," and passed by eighty-five affirmative votes to six negative; two physicians only voting in the negative. Before adjournment a committee was appointed to report at the next convention "specific recommendations of principles and . measures of quarantine, as severally applicable to yellow fever, cholera, typhus fever, and small-pos, having reference also to the variations which different localities require." The committee consisted of Drs. A. N. Bell, Elisha Harris, Wilson Jewell, Isaac 1. Nichols, and D. B. Reid. At the fourth annual con- vention, in Boston, June 14, 1860, this committee reported a " Code of Marine Hygiene," introduced by the following declarations :
1. Every organized government has the right of protecting itself against the introduction of infectious diseases, and of putting any country, place, or thing in quarantine which would introduce infectious diseases; provided, however, that no sanitary measures shall go so far as to exclude or drive from port a vessel, whatever be her condition.
2. The only diseases at present known, against the introduction of which general quarantine regulations should be enforced, are plague, yellow fever, cholera, small-pox. and typhus fever. As regards plague, the European Con- gress at Paris had the right to settle the question for the nations there repre- sented ; and inasmuch as they and the other nations of the Eastern Continent have reason to subject the plague to quarantine restrictions, the States of America yield implicit obedience to that convention.
3. All quarantine regulations, of any place whatever, should bear with equal force against the toleration or propagation of disease as against its introduce- tion ; and authority to prevent the introduction of disease in any place should be equally applicable against its exportation.
4. All quarantinable diseases are chiefly introduced by the material of com- merce ; and it is therefore against it that quarantine restrictions should be in- stituted, and not against the personnel; excepting, however, persons with no evidence of vaccination, and known to have been exposed to small-pox ; such persons shall be vaccinated as soon as possible, and detained until the vaccina shall have taken effect ; otherwise they may be detained fourteen days from the time of the known exposure.
5. The application of quarantine shall be regulated by the official declara- tion of the constituted sanitary authority at the port of departure where the malady exists. The cessation of these measures shall be determined by a like declaration that the malady has ceased after, however, the expiration of a fixed delay of thirty days for the plague, fifteen days for yellow fever, and ten days for cholera.
6. It is obligatory on all vessels to have a bill of health ; this shall consist of two kinds only- clean bill and a gross bill-the first for the attested ab- sence of disease, and the sceond for the attested presence of disease. The bill shall state the hygienic state of the vessel; and a vessel in a bad condition,
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even with a clean bill of health, shall be regarded as a vessel having a gross bill, and shall be submitted to the same regime.
7. The plague, yellow fever, and cholera being the only maladies that entail general measures, and place in quarantine those places whence they procced, the restrictions enforced against these diseases shall not be applied to any other suspected or diseased vessel.
8. The power of applying the general principles of this eode, and of acced- ing to its provisions, is expressly reserved to those nations and governments who consent to accept the obligations which it imposes ; and all the admini- trative measures proceeding from it shall be determined by international sani- tary regulations, or by a convention of the representatives of the governments which have adopted it.
9. This code shall continue in force and vigor among the governments adopting it for five years; and it shall be the duty of any party wishing to withdraw from its observance at the end of that time to officially declare his intention six months before the time expires; if there be no such notice the code shall be regarded as in force one year longer; and thus it shall continue year after year with all the governments accepting it, until after due notice six months before withdrawal. Then follow the provisions in detail : (1) Mens- ures relating to departure; (2) Sanitary measures during the voyage ; (3) Sanitary measures on arrival; (4) Executive arrangements; (5) Sanitary authorities.
This code was accepted by the unanimous vote of the convention, and re- committed to the committee, with instructions to secure its adoption by differ- ent governments.
Dr. Dowell, of Galveston, in the chapter on "quarantine" in his " Yellow Fever," says: "I have stated quarantine, to be effective, must be complete, both as to person and goods. But I do not think this either practicable or possible at the present time in most cities of the United States, as a man may take the seeds of the disease in Rio Janeiro, South America, and come to Gal- veston and pass its quarantine sound and well, and yet have the disease, and infect the whole city, for I have seen such cases-as the revenue cutter Dela- ware, at Galveston, in 1867, where four men came to the city, and eighteen and twenty days afterward these four had the disease, which shows, conclu- sively, that at least twenty days may intervene before the stage of incubation is over. So you see one may go almost around the world before he would have the disease. Hence I contend for quarantine, for cleanliness, and not for prohibition of ingress and egress, and that we must rely on sanitary means and sanitary measures almost exclusively for our protection from yellow fever. All animal filth should be removed-no open privies should be allowed in any town or city where yellow fever can prevail. All low streets or under-houses should be filled up. Better do it in summer than not at all; but hest to be done in winter. For the further discussion of quarantine, we quote from an address by Prof. J. M. Calloway, M. D., before the Galveston Historical So- ciety, which was written at my suggestion, and all of which I indorse, except that part where he says personal contagion can not take place. This I have 20
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fully argued above, and think, if I am wrong, it is at least safest to believe in it,* and in all cases avoid personal contact with any one after the fever rises and until the fever ceases, and all discharges and clothing have been removed. and the room well and completely ventilated or frozen out, and this must be for at least, seven consecutive days-below zero; as it will be seen, from reports, that persons have returned to the city several weeks after a frost, and slept in roomis where it has been, and taken the disease and died. No one should re- turn who leaves, until at least four weeks after the last case, or after a seven days' freeze, the thermometer being below zero, centigrade, at least .? New York was among the first of the States of the Union to establish quarantine. She suffered four epidemies of the yellow fever before. and ten since, its establishment, and had an interval of twenty-two years with- out yellow fever and without quarantine. Philadelphia had quarantine restrictions during all her epidemics. Boston, though the most favored city on the Atlantic coast, in the United States, regarding yellow fever epidemics. has had the most lax quarantine laws of any city of its size. The quarantine convention of Philadelphia, in 1857, one of the most able and intelligent bodies ever convened on the American continent, announce the opinion that " yellow fever can not become epidemic or endemic, unless there exists in the com- munity the circumstances which are calculated to produce such diseases, inde- pendent of the importation." Dr. Gaillard, of Louisville, Kentucky, is of the same opinion. In a paper on the yellow fever, published during the epidemic of 1878, he says : "That New Orleans should. up to a certain time, have been absolutely free from yellow fever, that a fruit-vessel should land some of her crew sick with this disease, that the fever should at once spread, that it
# Mr. E. M. Avery, a respectable and reliable citizen of Memphis, states, in confirma- tion of the contagion theory, and as part of his experience in 1878, as follows: I was refugeed for exactly eight weeks, at White Haven, a station on the Mississippi and Ten- nessee Railroad, just eight miles south of our city. During that time there were three deaths by yellow fever in my immediate neighborhood -- the first was that of Dr. Raines. who had visited the sick at Camp Joe Williams, contracted the fever, and died at his home, abont a mile from White Haven station : the second was the case of young Bolton, at Camp Burke, located about a quarter of a mile south of the station ; he had been ex- posed to the malaria of the city, and died after a few days' sickness. The third case, and which proves, most conclusively, the contagious nature of the late epidemic, was that of a young girl by the name of Colhouer, ten years of age, a resident with her parents at the station, who had not been away from home in many months, who was living in a pure and healthy atmosphere, but who contracted the disease by sleeping one night with a Mrs. Nicholson, whose husband had died of the fever in Memphis, and whom she had nursed. The little girl died of yellow fever; her mother took the disease the day after the child died, but recovered.
t In opposition to this advice we have the fact that the fever runs its course, and ab- solutely dies ont without the killing effects of frost. This is the case, not only in Rio Janeiro, Vera Cruz, Havana, Kingston, Jamaica, but in all points in the United States. The fever, in 1978, was declared no longer epidemic in Memphis on the 29th of Detaber, when the thermometer stood at 48.7, falling to 39.0 on the 31st, which was its lowest de- cline until December : so that there was no heavy black frost, as was declared by some, and the fever died out in its own good time.
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should infect first those in immediate proximity to it, and subsequently those in remote communication with it, is simply a repetition of the old record. A further addition to the testimony which for generations has demonstrated the fact, clear and indisputable, that yellow fever will exist always in its well- known zone; that it will not originate out of this zone; that carried beyond it, and introduced into foul municipal air-its favorite, if not essential, nidus -- it will spread and decimate ; will bring ruin and desolation in its train. Norfolk and Mobile, and Philadelphia and Quebec, and Marshall, Texas, and St. Louis, and Montgomery, Alabama, and many other places which could be named, have climates and surroundings in every respect different from each other, but they have all been desolated by yellow fever, whenever the germs of the disease have been carried there. The alleged causes of yellow fever are often active in these cities, but the disease prevails only when it is manifestly transported there. The great authorities in all civilized lands believe yellow fever and malarial fevers to be essentially and totally different, while they be- lieve the yellow fever poison to be essentially transportable, and, therefore, conanunicable ; for its communicability is the logical evidence of its trans- portability. The great writers and teachers warn all of the communicability of this terrible plague : and the list is an imposing one-Hosack, Blane, Wistar, Townsend, Dickson, Hartshorne, George Gregory, Flint, Copland, Stevens, and J. W. Monette, Pym, Fellows, Audouard, Lining, Ramsay, Strobel, and a host of distinguished worthies." Hæenisch writes thus: " The dis- ease has been carried and has appeared at elevations of 2,000, and even 4,000, feet above the level of the sea," a fact attributed by Hanisch and Hirsch solely to the transportability and communicability of the disease.
Dr. Joseph Holt, of New Orleans, in a paper read before the congressional commission of 1878, says :
1. I believe that yellow fever is due to a specific poison, the existence of which is known only as manifested in man. Intangible, imponderable, unrecog- mizable to any of the senses, we have no positive knowledge of the essential nature of this poison. Every effort to prevent its appearance and to limit its spread must, therefore, be purely experimental.
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