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 45
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2. The virus, if not indigenous, was imported at an early period in the his- tory of New Orleans, and is ever present with us, requiring only a concurrence of certain conditions to call it forth, all of which conditions or factors are not known.
3. That the climate of New Orleans is sufficiently tropical to call into activity the virus of yellow fever without importation, and that New Orleans is allied to the cities of Havana and Vera Cruz in the power of developing the poison at certain seasons; which powers depend upon the fact that these cities are within the geographical arca of development of this particular contagion. Why it is not developed at all times in places apparently under the same conditions, is unknown, because we are not acquainted with all of the essential factors of its development.
4. To prevail as an epidemic, there must exist certain favorable conditions. Such states or conditions of fitness prevailing, the early importation of the
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virus will insure an epidemic, the magnitude of which will be determined by the number of persons unacelimated.
5. The specific virus of yellow fever, whether pre-existing as a dormant germ, or even as a germ at all, requires, among factors of its development, a certain geographical area of the earth, a long-continued high temperature, and the congregation in dense community of a large number of people, as in large towns and cities.
6. That it is not the simple fact of people living together in large numbers which furnishes this last factor, but the violation of hygienic law likely to re- sult from such massing of humanity in the accumulation of their filth.
7. The contagion is readily transplanted through fomites, as in the gar- ments of the sick, as well as in the recognized methods along the highways of commerce by ships and other carriers of merchandise. In regard to the transmission of yellow fever, it is almost impossible to determine the boundary line, in some instances, between infection strictly speaking and contagion.
8. Quarantine established with such vigor as to assure absolute non-intercourse with infected ports, can furnish the only crucial test of its own efficacy. Two formidable difficulties stand in the way. Evasion, that is, running the block- ade-a performance at one time so common in the face of the artillery of the whole United States navy-and the established fact that ships once infected, and after that subjected to repeated cleansings, and even changing the erews, years afterward, coming into the yellow fever regions, have developed the dis- ease, even on the high seas, without having touched at a tropical port .* In the history of New Orleans, quarantine has failed utterly to afford protection against yellow fever. We can only hope that its value may be discovered in its thoroughness.
9. The greatest good which may be reasonably expected of quarantine is in the prevention of the early introduction of the specific poison. Inasmuch as long-continued heat is required for its spontaneous manifestation, the disease is likely; therefore, to appear very late in the warm season, at a time when the cold weather may easily overtake it and prevent epidemic prevalence. That the specific poison, however, which has given rise to our great epidemics has invariably been imported, is by no means proven. In regard to some of them there is abundant evidence to the contrary.
10. Another great benefit which may be derived from quarantine, is prob- ably in the fact that unless New Orleans shows a determined effort to furnish a guarantee to all inland and coast cities and towns by endeavoring to prevent the importation of the yellow fever poison, the whole country will be ready. upon the slightest provocation or idle rumor, to establish a shot-gun quarantine against New Orleans.
Dr. Southwood Smith, of the London Fever Hospital, in a "Treatise on Fever," published at London, in 1829, in a chapter on the causes of fever. explains clearly that under known conditions the yellow fever, like other
$ As in the case of the United States steam-hip Plymouth, an account of which is given at length on pp. 97 and 98 of the chronology of yellow fever in this book.
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fevers, may originate spontaneously in any place, and the immediate or exciting cause may become the predisposing cause, the fever being thus propagated to the extent of an epidemic. He says : "The immediate, or the exciting cause of fever, is a poison formed by the corruption or the decomposition of organic matter. Vegetable and animal matter, dur- ing the process of putrefaction, give off a principle, or give origin to a new compound, which, when applied to the human body, produces the phe- nomena constituting fever. What this principle or compound is, whether it be one of the constituent substances which enter into the composition of organized matter, or whether the primary clements of organized matter, as they are disengaged in the process of putrefaction, enter into some new com- bination, and thus generate a new product, we are wholly ignorant. Of the com- position of the poison, of the laws which regulate its formation, and of its prop- erties when generated, we know nothing beyond its power to strike the human being with sickness or death. We know that, under certain circumstances, veg- etable and animal substances will putrefy ; we know that a poison capable of pro- ducing fever will result from this putrefactive process, and we know nothing more. Of the conditions which are ascertained to be essential to the putrefactive process of dead organic substance, whether vegetable or animal, those of heat and moisture are the most certain, and as far as we yet know, the most powerful. Accordingly, in every situation in which circumstances concur to produce great moisture, while the heat is maintained with some steadiness within a certain range, there the febrile poison is invariably generated in large quantity, and in great potency. Wherever generated, we have no means of ascertaining its existence but by the effects it produces on the human body. Now and then circumstances arise which illustrate these effects in an exceed- ingly striking manner. This is the case when large numbers of men. previously in a state of sound health, are simultaneously exposed to it. Examples of such oc- currences, as numero:s and as complete as can be desired, were long since recorded. The suddenness with which fever sometimes attacks individuals on board a ship, or even an entire ship's crew, on the approach of the vessel to a shore where this poison is generated in large quantity, and in a high state of coneen- tration, illustrates its operation, perhaps, in a still more striking manner. Dr. McCulloch, who has labored with great ability and zeal to recall attention to the most important and long-forgotten subject of malaria, relates an instance of some men on board a ship, who were seized, while the vessel was five miles from shore, with fatal cholera, the very instant the land smell first became perceptible. Several of these men, who were unavoidably employed on deck, died of the disease in a few hours. The armorer of the ship, who, before he could protect himself from the noxious blast, was accidently delayed on deck a few minutes to clear an obstruction in the chain cable, was seized with the malady while in that act, and was dead in a few hours. Dr. Potter states% that he witnessed the rise of a most malignant yellow
* See a Memoir on Contagion, more especially as it respects the yellow fever, etc., by N. Potter, M. D., Baltimore.
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fever, in a valley in Pennsylvania, which contained numerous ponds of fresh water, and which, from the heat and dryness of the season, emitted a most offensive smell ; that the fever prevailed most, and with the greatest degree of malignity, among the people who lived nearest these ponds ; and adds an ex- ceedingly instructive case, illustrative of the generation and operation of the cause of fever, recorded by Major Prior, in his account of a fever which attacked the army of the United States, at Gallipolis [1796]. The source of the malady was clearly traced to a large pond near the cantonment. When the dis- ease was most severe, it assumed the continued form, and was accompanied with yellowness of the skin; when proper means were taken to destroy the pond, the fever immediately lost its continued form, and became first remittent, then intermittent, and ultimately disappeared. . The fever,' says this intelli- gent officer, ' was, I think, justly charged to a large pond near the cantonment. An attempt had been made two or three years before to fill it up, by felling a number of large trees that grew on and near its margin, and by covering the wood thus fallen with earth. This intention had not been fulfilled. In August, the weather was extremely hot, and uncommonly dry ; the water had evapor- ated considerably, leaving a great quantity of muddy water, with a thick, slimy mixture of putrefying vegetables, which emitted a stench almost intolerable. The inhabitants of the village, principally French, and very poor, as well as filthy in their mode of living, began to suffer first, and died so rapidly, that a general consternation seized the whole settlement. The garrison continued healthy for some days, and we began to console ourselves with the hope that we should escape altogether ; we were, however, -oon undeceived, and the reason of our exemption heretofore was soon discovered. The wind had blown the air arising from the pond from the camp; but as soon as it shifted to the reverse point, the soldiers began to sicken ; in five days, half the garrison were on the sick list, and in ten, half of them were dead. They were generally seized with a chill, followed by headache, pains in the back and limbs, red eyes, constant sickness at stomach, or vomiting, and generally, just before death, with a vomit- ing of matter like coffee-grounds. They were often yellow before, but almost always after leath. The sick died generally on the seventh, ninth, and eleventh days, though sometimes on the fifth, and on the third. As some decisive meas- ures became necessary to save the remainder of the troops, I first thought of changing my quarters, but as the station was in every respect more eligible than any other, and had been made so by much labor and expense. I deter- mined to try the experiment of changing the condition of the pond, from which the disease was believed to have arisen. A ditch was accordingly ent ; what little water remained was conveyed off, and the whole surface covered with fresh earth. The effects of this scheme were soon obvious. Not a man was seized with the worst form of the fever after the work was finished. and the sick were not a little benefited. for they generally recovered, though slowly, because the fever became a common remitent, or gradually assumed the inter- mitting form. A few cases of remitting and intermitting fever occurred or- casionally, till frost put an end to it in every form. As soon as the contents of the pond were changed, by cutting the ditch, the cause, whatever it was, seems
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to have been rendered incapable of communicating the disease in its worst form. Dr. Potter further states that, on one occasion, he saw a lady, who had been confined three days only, and whom he found in the agonies of death, with the skin of a deep orange color, the eyes red and prominent, the pulse in- termittent, and ejecting copiously from the stomach every eight or ten minutes the secretion now known by the name of the black vomit; that she expired in a convulsion while he sat at her side; that petechic appeared immediately after death, and that putrefaction succeeded so rapidly, that it was necessary to order immediate interment; that, shortly afterward, he was called to a gentleman, who had been ill five days, and who, having expired in an hour'or two after his visit, was removed into the coffin with the utmost difficulty, the flesh literally dropping from the bones; that, in one family, residing in a house which stood on a level piece of ground, apparently beyond the reach of noxious exhalation, there being no stagnant water, as was supposed, within a mile of it, he found the mother laboring under a bilious remitting fever, which had continued eleven days, the daughter, seventeen years of age, suffering from a similar fever ; two sons, the one between eight and nine, and the other six, ill with dysentery ; and the father on the brink of the grave from a most malignant fever. There be- ing no apparent cause for the condition of this afflicted family, the immediate neighborhood of the house being free from the ordinary sources of malaria, and the adjacent country being not unhealthy, the condition of the house itself was minutely investigated. The cause of the evil was manifest. It appeared that the present funily had resided in the house only about five weeks; that immediately preceding their occupation of it a man had died suddenly in it; that he, him- self (Dr. Potter), was seized with nausea and general lassitude immediately on leaving the house after his first visit; and that a fever, as he supposes, was ar- rested by a strong dose of tartarized antimony, which operated violently by vomiting and purging. On examining the premises, it was found that the cellar contained water about two feet deep, which had remained there from the first week in June, the country having been then inundated by torrents of rain. The cellar being useless, the door had been closed, and the only vent for the postiferous gases was through the floor, which was open in several places. The family being immediately removed, all the sick became convales- cent from the time they ceased to breathe the air of the place. The owner of the house hired two men to empty the cellar. These men having ripped up the floor, and placed a pump in the deepest part of the water, evacuated the cellar to the dregs in one day. On the second day after the execution of this task one of these men was seized with a chillness, sneeceded by an ardent fever, which terminated with the usual symptoms of yellow fever ; namely, hemorrhages, yellow skin and petechice, and proved fatal on the third day from the attack ; the day following the seizure of the first, the second man was attacked with similar symptoms, and died on the seventh day of the disease, with the black vomit, in addition to the ordinary symptoms of the yellow fever. These examples may suffice to illustrate the operation of that febrile poi- son which arises chiefly from the decomposition of vegetable matter. The poi- son derived from the putrefaction of animal matter is still more pernicious ;
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its effects are more powerful in degree, and worse in character; it operates more intensely on the nervous system, and less on the vascular; and the fevers it produces are invariably of the typhoid type, and of the continued form. Without doubt, a febrile poison, purely of animal origin, in a high degree of concentration, would kill instantaneously ; and when not intense enough to strike with instantaneous death, it would produce a continued fever with the typhoid characters, in the greatest possible degree of complete- ness and perfection. And this appears to afford the true solution of the origin of the plague. The more closely the localities are examined of every situation in which the plague prevails, the more abundant the sources of putrefying animal matter will appear, and the more manifest it will become, not only that such matter must be present, but that it must abound. In assigning the reason why Grand Cairo, in Egypt, is [was] the birth-place and the cradle of the plague, Mead states that that city is crowded with vast numbers of inhabitants, who live not only poorly, but nastily ; that the streets are narrow and close: that the city itself is situated in a sandy plain, at the foot of a mountain, which keeps off the winds that might refresh the air : that consequently the heat is rendered extremely stifling ; that a great canal passes through the midst of the city, which, at the overflowing of the Nile, is filled with water ; that on the decrease of the river, this canal is gradually dried up, and the people throw into it all manner of filth, carrion, offal, and so on : that the stench which arises from this, and the mud together, is intolerably offen- sive ; and that, from this source, the plague constantly springing up every year, preys upon the inhabitants, and is stopped only by the return of the Nile, the overflowing of which washes away this load of filth; that in Ethiopia the swarms of locusts are so prodigious that they sometimes cause a famine, by devouring the fruits of the earth, and when they die create a pestilence by the putrefaction of their bodies; that this putrefaction is greatly increased by the dampness of the climate, which, during the sultry heats of July and August, is often excessive ; that the effluvia which arise from this immense quantity of putrefying animal substance, combined with so much heat and moisture, continually generate the plague in its intensest form ; and that the Egyptians of old were so sensible how much the putrefaction of dead animals contributed toward breeding the plague, that they worshiped the bird Ibis, from the services it did in devouring great numbers of serpents, which they observed injured by their stench when dead. as much as by their bite when alive. Nothing can be more striking than the cases recorded by Pringle, and which daily occur- red to him of the production of fever, exquisitely typhoid (according to the language of that day, jail and hospital fever), and of the sudden transition of. intermittent and remittent into the continued and typhoid type, from the presence of a poison clearly and certainly of animal origin. Whenever wounded soldiers, with malignant sores, or mortified limbs, were crowded to- gether, or whenever only a few of such diseased persons were placed in a room with the sick from other di-eases, with those laboring under intermit- tent and remittent, for example, a severe and mortal typhus immediately arose; nay, whenever men, previously in a state of sound health, were too
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much crowded together for any considerabte time, typhus (jail or hospital fever) was sure to be produced. The instances of such occurrences that are de- tailed are too numerous to be cited, but they are so clearly stated, and so strik- ing, that they well deserve to be consulted by whoever is desirous of clearly tracing the operation of this great cause of fever. But by far the most potent febrile poison, derived from an animal origin, is that which is formed by ex- halations given off from the living bodies of those who are affected with fever, especially when such exhalations are pent up in a close and confined apart- ment. The room of a fever-patient, in a small and heated apartment in Lon- don, with no perflation of fresh air, is perfectly analogous to a stagnant pool in Ethiopia, full of the bodies of dead locusts. The poison generated in both cases is the same; the difference is merely in the degree of its potency. Nature, with her burning sun, her still and pent-up wind, her stagnant and teem- ing marsh, manufactures plague on a large and fearful scale : poverty in her hut, covered with her rags, surrounded with her filth, striving with all her might to keep out the pure air, and to increase the heat, imitates nature but too successfully ; the process and the product are the same, the only difference is in the magnitude of the result. Penury and ignorance can thus at any time, and in any place, create a mortal plague. And of this no one has ever doubted. Of the power of the living body, even when in sound health, much more when in disease, and, above all, when that discase is fever, to produce a poison capa- ble of generating fever, no one disputes, and the fact has never been called in question. Thus far the agreement among all medical men, of all sects, and of all ages, is perfect. But it happens that there is another form of animal matter capable of producing fever; namely, a matter secreted by the living body, constituting not only a poison, but a peculiar and specifie poison. This specifie poison produces not merely fever, but fever with a specific train of symptoms. In the acknowledgment of this fact, also, the agreement among all medical men is equally perfect. But some contend that the poison gener- ated in the first case, and that generated in the second, may both be properly called contagious : others maintain that the application of the same term to two cases so specifically different, destroys a distinction which it is useful to pre- serve, and that it would be more correct, as well as more conducive to clear- ness of conception, to call the poison generated in the first care an infection, and to restrict the term contagion to designate the poison generated in the latter. Vast and immeasurable as the difference appears to be between the contagionists and the anti-contagionists. if regard be had merely to their lan- gnage, yet if attention be paid only to their ideas, to this, and to this only. narrow as the compass is, the whole controversy is reduced. It resolves itself wholly into the question, whether one word shall be used to express two cases which differ from each other in some important circumstances, or whether it may not be more convenient to employ two terms, and strictly to appropri- ate each to designate its own specific class. It must be manifest that, since both sects are perfectly agreed about the facts, the dispute can be only verbal. If the one would consent to restrict their use of the term contagious, for which there is the best authority and ancient custom, to those diseases which arise
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from a specific contagion, and would call those which arise from every other poison infectious, there would be an end to this apparently interminable, and, in many respects, mischievous controversy. Is the febrile poison, whether of veg- etable or animal origin, or whether composed of both, capable of adhering to clothes, apparel, and other substances, in such a manner as truly to infect them, so that when applied to the bodies of the healthy, at any distance of place, and at some distance of time, the specific effects of the poison are produced ? That such substances may be so imbued with the poison of the small-pox, all admit: that the evidence should not be as complete relative to the power, or the inability of such substances to convey and communicate the poison of ordinary continued fever, is alike disgraceful to the state of our science, and injurious to the cause of humanity. There is no reason why the question should not be settled with absolute certainty; there is no manner of diffi- culty in determining it. Experiments the most direct, complete, and decisive, might be performed, which, if observed, during their progress, by competent witnesses, andl duly authenticated, might ascertain the point, with sufficient clear- ness and certainty, to satisfy not only the present age, but future generations. Of all predisposing causes, the most powerful is the continued presence and the slow operation of the immediate or exciting cause. It is a matter of constant observation, that the febrile poison may be present in sufficient inten- sity to affect the health, without being sufficiently potent to produce fever. In this case, the energy of the action of the organs is diminished, their func- tions are languidly performed. the entire system is weakened, and this increases, until at length the power of resistance is less than the power of the poison. When- ever this happens, fever is induced; not that the power of the poison may be at all increased; but the condition of the system is changed, in consequence of which, it is capable of offering to the noxious agent that asssails it less resistance. Dr. Potter performed some experiments, to show that the continual presence of the exciting cau-e not only operates upon the general system, but actually pro- duces a morbid change in the blood before it induces fever. During the prev- alence of an epidemic, it was observed that, in all the cases in which the patients were bled, the general appearance of the blood was precisely the same ; that the coagulum was either of a yellow or of a deep orange color, and that a portion of the red particles was invariably precipitated. It occurred to Dr. Potter that if the cause of the disease were contained in the common atmosphere, the blood of those who had inhaled it a certain time would exhibit similar phenomena; and that should this be the case, it would prove that the cause, before actually producing the disease, brought about a state of the system which predisposed it to be affected by the poison. To ascertain the appearances of the blood in persons who were exposed to the febrile poison, but who still remained appar- ently in perfect health, he drew a quantity of blood from five persons who had lived during the whole epidemic season in the most infected parts of the city. To external appearance and inward feeling, each of these persons was in sound health. Their blood could in no respect be distinguished from the blood of those who labored under the most intense forms of the prevailing fever. As it was necessary to the conclusiveness of the experiment that their blood should
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