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 46
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be compared with the blood of those who lived in an atmosphere unquestiona- bly pure, Dr. Potter selected an equal number of persons who dwelt on the hills, in Baltimore County, and drew from each of them ten ounces of blood. The contrast was mo-t manifest. The serum was neither of a yellow nor of an orange color; there was no red precipitate; the appearances were such as are found in the blood of persons in perfect health. A young gentleman having returned to the city from the western part of Pennsylvania, on the 10th of September, in a state of sound health, Dr. Potter drew a few ounces of blood from a vein on the day of his arrival ; it exhibited no deviation from that of a healthy person. He remained in the family until the 26th of the month, that is, sixteen days. On the sixteenth day the bleeding was repeated. The serum had assumed a deep yellow hue, and a copious precipitation of red globules had likewi-e fallen to the bottom of the vessel. In these experiment-, the blood in six persous indicated the operation of the morbid cause, while each remained in a state of apparent health. Of these six persons, four were art- ually seized with yellow fever during the prevalence of the epidemic ; and the other two, though they escaped any formal attack, did not escape indisposition. They were atleeted with headache, nausea, and other indications of disease, like hundreds besides, who were never absolutely confined to the house, and who never took any medicine, but who still experienced, in nausea, giddiness. head- ache, pain in the extremities, and so on, abundant intimations of the presence of the poison. These examples may suffice to show how the exciting may itself become a most powerful predisposing cause. The predisposition to sub- sequent attacks, after the system has once suffered from the disease, is very remarkable ; that predisposition remains for a considerable period after conva- lescence and apparent recovery. Of this, striking examples continually occur. both with regard to intermittent and to continued fever. In fact, the disposi- tion to relapse remains until the constitution has recovered its previous strength and vigor, however distant that period may be. The influence of cold, moist- ure, fatigue, intemperance, constipation, anxiety. fear, and all the depressing passions, are likewise extremely powerful predisposing causes. They enable a less dose of the poison to produce fever, and they increase the intensity of the fever when it is established. They all act by weakening the resisting power inherent in the constitution, that is, by enfcebling the powers of life."
Dr. Drake, of Nashville, thus formulates his views as to quarantine :
1. The danger of attacks from yellow fever is in proportion to the amount of the poison taken into the system.
2. There is a systemic toleration of the poison varying with the vital resist- ance of each individual, and zymotic action is mainly concerned in the process of sporulation and fructifieation without the body, and not within, until the line of vital resistance is broken down, when this process may come into act- ive operation as in other effete matter without the body; otherwise it would seem impossible for a single human being to escape .*
* In Coleridge's "Table Talk," under date of April 7, 1832, and the heading " Epi- demic Diseases-Quarantine " the following views are expressed: "Quarantine can
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3. In the midst of an epidemic, depopulation of rooms and avoidance of con- fined areas of stagnant air afford the safest personal prophylaxis.
4. Quarantine of the ordinary landing of vessels, cars, and other vehicles, and of the baggage and clothing of travelers from infected districts, should be rigidly enforced until disinfection is thoroughly consummated. Cities and towns should quarantine against infected districts, but the open country need not be put under restriction, as the fuets in the case of the refugee camp near Mem- phis abundantly prove. Camps of refuge should be provided at convenient- distances from a city or town infected, and the entire population exposed to danger should abandon all inclosures, and live in the open air.
The Homeopathic Commission, whose investigation was thorough, and whose recommendations are of the most sensible and practical character, in relation to quarantine, recommend the creation of a permanent sanitary commission, ably constituted, well salaried, and invested by the government with large powers, to be composed of medical men, yellow fever experts, and of professed scientists; which sanitary commission shall devote itself exclusively to mat- ters of public hygiene. The measures they recommend to prevent the in- portation and spread of yellow fever are the following:
1. An intelligent over-ight of all the tropical ports during the summer months. The sanitary commission should have agents in all those ports con-
not keep out an atmospheric disease, but it can, and does always, increase the predispos- ing causes of its reception." And this: "There are two grand divisions under which all contagious di-eases may be classed, Ist. Those which spring from organized living beings. and from the life in them, and which enter. as it were, into the life of those in whom they reproduce themselves-such as small-pox and measles. These become >o domesticated with the habit and system that they are rarely received twice. 2d. Those which spring from dead, organized, or nnorganized, matter, and which may be comprehended under the wide term, malaria. You may have passed a stagnant pond a hundred times without injury, you happen to pass it again, in low spirits and chilled, precisely at the moment of the explosion of the gas, the malaria strikes on the cutaneous or veno-glandular sys- tem and drives the blood from the surface, the shivering fit comes on, till the muscuio- arterial irritability reacts, and then the hot fit succeeds, and, unless bark or arsenic- particularly bark, because it is bitter as well as tonic-be applied to strengthen the veno- glandular, and to moderate the musculo-arterial system, a man may have the agne for thirty years together. But it. instead of being exposed to the solitary malaria of a pond. a man, traveling through the Pontine marshes, permits his animal energies to play, and surrenders himself to the drowsiness which generally attacks him, then blast upon blast strikes upon the cutaneous system. and passes through it to the musculo-arterial, and so completely overpowers the latter that it can not react, and the man dies at once, instead of only catching an ague. There are three factors of the operation of an epidemic, or atmospheric disease. The first anl principal one is the predisposed state of the body. Secondly, the specific virus in the atmosphere; and, thirdly, the accidental circumstances of weather, locality, food, occupation. etc. Against the second of these we are powerless ; its nature, canses, and sympathies are too subtle for our senses to find data to go upon. Against the first, medicine may act profitably; against the third, a wise and sagacious medical police ought to be adopted; but above all. let every man act like a Christian, in all charity and love, and brotherly kindness, and sincere reliance on God's merciful provi dence."
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nected either with our consulates or with responsible commercial houses. It should be their business to keep the commission regularly and frequently ad- vised of the sanitary condition of every locality, to report the appearance and progress of the fever, the sailing of every suspicious or infected vessel, and to furnish all information the commission may require.
2. The declaration of a discriminating quarantine only against ports notori- ously infected, regulated in character and duration by the actual facts obtained by the commission.
3. The thorough cleansing, disinfecting, and refrigeration of every yessel arriving from yellow fever ports during the summer months. The character, mode, and extent of the disinfection will be determined by the studies and experiments of the commission in that special direction. We call attention to the refrigeration of vessels suggested to us by Dr. Bushrod W. James, of Phil- adelphia. From the recent inventions and improvements in the way of fitting up refrigerating rooms and ice-making machines, he is convinced that all diffi- eulties can be easily overcome, and the hold, cargoes, and passengers of vessels can be subjected for two or three days to a low temperature, say ten or fifteen degrees below the freezing-point-a temperature quite destructive of the yellow fever germ, but entirely compatible with human comfort.
4. The . sanitary surveillance for thirty days after landing of all persons coming from tropical ports and remaining in the city. Physicians should be compelled, under heavy penalties, to report the slightest sickness among such passengers, and as soon as yellow fever is diagnosed by experts, measures for the immediate suppression of the disease should be adopted.
Dr. A. N. Bell, editor of the Sanitariun, perhaps the highest authority in this country on quarantine and sanitation, concluding a very able article on this subject in the number of his magazine for February of this year (1879), says, in regard to yellow fever : "This epidemic, more than any other, concerns the commercial prosperity of the southern ports of the United States. It is of little consequence whether it was originally indigenous or exotic. It is a disease of communities, rarely or never originating or spreading in a scattered popula- tion. It has been common to the cities of the Gulf coast of America, and in the West Indies, as far back as we have any authentic history of their diseases, and has recurred sufficiently often to maintain a potential activity whenever favored by local conditions and protracted periods of prevailing high tempera- ture. But every place where yellow fever arises spontaneously, is epidemic, or is capable of being introduced, must have, in addition to localizing causes, a prevailing temperature for several weeks above 75°, a condition comparatively rare in our sea- ports north of Charleston. It is apparent, therefore, that quar- antine restrictions necessary to southern ports may be unnecessarily oppressive to northern ones, that a low temperature is ordinarily an effeetnal quarantine against the introduction of yellow fever. The portability of yellow fever is a settled question ; but no matter what the differences of opinion in regard to the essential nature of the cause of the disease, the relations of yellow fever to con- merce, wherever brought in contact with it, have shown that vessels are liable to become infected, and to convey it from port to port in proportion to their
E
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over-crowded state, want of cleanliness, and want of ventilation. And no measures are more imperatively necessary for the prevention of the spread of yellow fever and other epidemics by commerce than those which will effectually enforce room, cleanliness, and ventilation in the naval, mercantile marine, lake, and river services. Finally, no quarantine can ever be made successful without coordinate internal sanitary measures for both ports and vessels of every class. The remarks of John Simon, in his Report to the Commissioners of Sewers of London, 1854, in regard to cholera, are equally applicable to yellow fever: 'The specific migrating power, whatever its nature, has the faculty of infecting dis- triets in a manner detrimental to life only when their atmosphere is fraught with certain products susceptible, under its influence, of undergoing poisonous transforma- tion. . .. . Through the unpolluted atmosphere of cleanly districts it mi- grates silently, without a blow; that which it can kindle into poison lies not there. To the foul, damp breath of low-lying cities it comes like a spark to powder. Here is contained that which it can quickly make destructive -- soaked into soil, stagnant in water, grimming the pavenient, tainting the air-the slow rottenness of unremoved exerement, to which the first contact of this foreign ferment brings the occasion of changing into new and more deadly com- binations.'"
III.
Disagreeing upon nearly every other point, the doctors are almost a unit as to the necessity for thorough sanitation, in order to ward off or mitigate at- tacks of yellow fever. They all declare that filth, especially decaying animal matter and human excrement, is a prime, if not the potent, cause of the se- verity of the attacks of this curse to the people of the Mississippi Valley. The specific poison may be in the air, but its propagation depends upon con- ditions, the destruction of which are within the reach of all classes in the South. Dr. Joseph Holt, in a paper read before the Congressional Yellow Fever Commission of 1878, while sitting in New Orleans, declares that, " while we can not trace a direct causative relation between the filth of a city, town, or ship* and the first appearance of this disease, it invariably develops itself,
# A writer, in the Nashville Banner, of the 19th of March, 1879. gives the filth attend- ant upon the Middle Passage as the source and origin of this disease, which, like a dire- ful retribution, he thinks, continues to plague all the slave-cursed countries of North and South America. He paints the horrifying picture graphically. He says: "As for the origin and birth-place of the yellow fever, there can be bat little doubt, no matter how much ink has been used on the subject. It is ocean born. I have seen more sides of the world than one, and spent more than one Saturday night at 'sea,' in the forecastle vi a
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primarily associated with a bad sanitary condition of the community. In cer- tain cities-Philadelphia and New York especially-formerly devastated by this pestilence, the scourge has ceased coincidently with an improved sanitary system.
ship, among seamen of all nations, hearing them tell of all their voyages and the voyages of their fathers, in plain, unmistakable language. The horrors of the Middle Pas-age. sometimes called High Latirades, have been related by some bronzed fellow, an eye- wit- ness from the Gulf of Guinea, a deadhead, in such language as none other dare to use or could use. That fever about which there has been, and still is, much discussion and dif- ference of opinion among landsmen and philanthropists, is the fruit of this Middle Pus: sage, in my belief. Here hundreds, sometimes a thousand, human beings, torn from their rude yet happy homes, were haddled together between the upper and lower decks of a floating hell, commanded by a demon in human shape, and managed by the offscouring of God's earth, to be carried to a Christian land and sold, ' slaves for life.' My God ! could you be with them-mad, naked, hopeless, forlorn !-- as a squall strikes the ship and hurls to leeward a raving mass, you would see what the Middle Passage micans, Conl you hear them in a dead caini. not even : cat's paw of wind on the rolling deep, the ther- mometer 110º Fahrenheit, the pitch boiling from the seams in the black sides of the ship. the white deck so hot with a vertical sun that you could not tread on it with a bare foot, and then hear the wild anguish beneath you, and smell! Could you stand on that deck. again, of a dark, murky night-a night of the tropic-and feel it rain in torrents, such as you never saw, decks full of port-sills, a heavy ground -- well on, ship rolling and tum- bling abont, her unfilled sails slashing, and dashing, and crashing against the mast with a noise like thunder, the deck load of water hurled from side to side, while beneath is un- told misery for want of some of that dashing water, you would see the origin of the dread pestilence. Wait for the morning after such a night, look at your mast beats, your canon, your hatchways, your lower mast, your pumps; they are all covered with a lead-colored, silver-looking coat, and large drops of black dew. This is the emanation- the poison gas from the catacomb beneath you. Dreadful ! Ain't it dreadful? Hark! The bell strikes one; 'tis death ! The gratings are off, and from that dark, concentrated misery below is passed up thirty or more nude forms. Their white, blearing eyes, their open mouths, their fallen chins, their bluish-looking skin, wrinkled and parboiled with the heat of the damp ship, and their last agonies-ain't it dreadful ! Then they are tumbled into the sea, food for the sharks, with a Coast of Guineaman's prayer. 'D-n the nigger,; what ails them? There is thirty more gone.' Ain't it dreadful? Gentlemen. here is the birth-place and canse of our scourge, the yellow fever. It was not known among the Caribbean Islands, nor at Brazil, nor on the western Continent, until the curse of slavery came there. It is a creature of the Middle Passage-the high latitudes of mis- ery, nakedness, want, and filth. Gentlemen, you have heard of these things, but have never seen them. You have heard of a slave-ship, but she has never come with all her horrors before you. It is from her we receive this dread eurse; it is not of western birth-not in- digenous. I's footsteps come up from mid-ocean. Why is it thus? In 1825, I was in Liver- pool. The barque Mollie, from Fernando Po, Gulf of Guinea, was brought into dock, a condemned slaver. She was 'eighty years old,' had been in the west coast of Africa trade most of that time; was a low, black craft with a short shark's head above her ent-water a smoky black, looked as if she had been below. I heard her history from an old sailor. I have given you part of that history. Her name should be changed to Aceldama. Er- ery look about her toll a tale of horror, yet her owner bowed at the name of Jesus. The officers and crews of these slave-ships slept above the slave-decks in the poop or top-gal- lant forvcastle, where the air was pure, were well fed and kept clean, and thus, in most cases, creaped the contagion. But for this no voyage could have been safely made. Con- tlemien, keep clean, stir around out of doors, let the wind feel your skin, and, above all,
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Sanitary negligence in India is punished with cholera; in the Orient, with plagne and leprosy ; in Europe, the British Islands, and the Northern United States, with typhus, typhoid, diphtheria, and scarlatina, in their malignant and epidemie forms; in the West Indies and tropical and semi-tropical Americas with yellow fever. For the disobedience of sanitary law these are among the prices paid by the human race according to its distribution upon the earth." The Board of Health of New Orleans adopting these views of Dr. Holt, in a report to the general council of that city, say that " One duty para- mount to all others confronts the people of New Orleans -- that they shall per- feet the sanitary condition of our city. This can only be done in accordance with a system of the most liberal and enlightened sanitary engineering, and in an absolute obedience to all the laws relating to the public health. By the enforcement of wisely-appointed sanitary measures, we will accomplish a double reformation, the crowning necessity of our time-we will improve by it the health and prosperity of our people, and in equal measure diminish the mis- eries of our poor." The report of the Board of Health of England,# on quarantine and yellow fever, presented to both houses of Parliament, in April, 1852, says: " The means of protection from yellow fever is not in quarantine restrictions and sanitary cordons, but in sanitary works and operations. . . . We believe there is a general belief in the conclusion that the substitution of sanitary hygienic measures for quarantine isolation and restriction would afford more certain and effectual protection." Dr. Louis A. Falligant, who differed on many points from his colleagues of the Allopathic Commission, appointed by the congressional committee, holds the view that yellow fever may be devel- oped by indigenous as well as by imported poison, and that local hygiene is of equal importance with quarantine in checking the spread of the imported fever, and of absolute necessity in the prevention of that of domestic origin. He says, clearly and forcibly, " I can not overlook the fact that, whilst fire will explode powder, the fire may be produced in one locality by electricity, in another by
don't hide dirt. Better let the hot sun lick its poison up, and the winds scatter it, than to turn it into badly-covered sewers, to creep along and ripen, and then cast its breath out with the dews of night through thousands of little openings. There is more safety in this than in all your quarantine, inland. Quarantine ships and foreign travelers as much as you please, but when they have introduced the evil, cleanliness is the best and surest remedy I have seen yet."
" This commission, composed of Lord Shaftsbury and Drs. Edwin Chadwick and I. Southwood Smith, in their report to that government, declare " that the conditions which influence the localization of yellow fever are known, definite, and, to a great extent, remova- ble, and are substantially the same as the localizing causes of cholera and all other epidemic diseases. That, as in the case of all other epidemic diseases, in proportion as there local- izing causes are removed or diminished, yellow fever ceases to appear, or reenrs at more distant intervals, and in milder forms. That there is no evidence to prove that yellow fever has ever been imported. That consequently the means of protection from yellow fever, are not quarantine restrictions and sanitary cordons, but sanitary works and opera- tions, having for their object the removal and prevention of the several localizing condi- tions, and when such permanenit works are impracticable [as they can not be in cities ] the temporary removal, as far as may be possible, of the population from the infected districts.
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the collision of flint and steel, and in still another by striking a match." Dr. Holt, as sanitary inspector for the fourth district, in his report to the New Orleans Board of Health, calls attention to the fact that it " has by no means been satisfactorily . proven that putrefying animal matter and the filth of great communities of human beings has not its position as a factor in the production or first appearance of yellow fever poison. No instance has yet been adduced of yellow fever appearing de novo, except as associated with large communities in a filthy condition, or on ship-board, where the same unsanitary condition exists in a concentrated form. There are precisely the same reasons for declaring yellow fever to be ab initio the product of human filth, as malaria
But so clear a statement of cause and effect, a judgment delivered after the most care- ful examination, has not been allowed to pass unchallenged. Even so respectable a body as the State Medical Society of Tennessee has declared against it-against this so deliberately stated experience. At its last session, and on the 3d of April, 1879, that body resolved : "That we recommend to those in authority a quarantine in its most judicious shape -- national, State, and local-as the only means yet known by which this terrible scourge can be even partially stayed and controlled ; and that all measures now pending in Congress or in any State legislature looking to thisend have the hearty indorsement of this body." And this in the face of the testimony of the most experienced yellow fever physicians, who declare that filth in every form-from the offal of the slaughter- house to human excreta -- is the nidus on which yellow fever feeds and propagates, and by which it is sustained and perpetuated. Quarantine may be one, but it is not " the only" means of prevention of the spread of this awful sconrge. As Dr. McDonald says : "Whatever physical conditions, such as an increase of temperature, moisture, and sub- sequent evaporation, or the common decompositions of cess-pools, or the eflluvia evolved in bad drainage, may be operative on shore, yet, when once communicated to a man-of- war vessel, and isolated on her voyage by far removal from all local land influences, the phenomena are very striking and suggestive. Under such circumstances it is difficult to witness the spread of the disease from one individual to another, and its virulence be- coming more intensitied by the unavoidable crowding of the sick, without recognizing the important part that the emanations and exeretions of the human body must take in the matter. It may be objected that all the most potent of the terrestrial or atmospheric conditions alluded to are fulfilled in the bilge-effluvia of the vessel, but it must be appar- ent to the close observer that the human element far outweighs all other suppositions, al- though bilge-water and all other foulnesses in the vessel may form a nidus for the further development of the disease and its spread. But when the disease is again landed at some new port, this bilge-water is not brought on shore, although it may be communicated to foul doeks. The clothing and effects of the dead, and of the survivors, and even of those who have not been sick, but which have been long exposed to the emanations of the siek, are then brought on shore and taken to near or distant points in the unfortunate town. The more crowded and the more filthy the houses into which these infected things are brought, the greater will be the danger of an outbreak. It is believed that the specific yellow fever poison can not be conveyed directly from the sick to the healthy, but must first be deposited in decomposing animal and vegetable matter. Still, however this may be, it is certainly a portable disease, which can be conveyed from one locality to another by means of clothing, foul merchandise, and in the holds of vessels. If filth is necessary to its propagation, where is that most easily met with but in the unwashed bodies and clothes of the dirty poor, and in their foul rooms, kitchens, privies, yards, streets, gutters, sewers, ete., and even in the hou-es of the slovenly and enreless rich-for not every rich person is a clean person in every part of his house and belongings."
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