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 5
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A HISTORY OF THE YELLOW FEVER.
of the State denominated the epidemic district.
be but one opinion, so far as I have been able to extend my inquiries, There seems to
as respects the putrid state of the atmosphere in all the localities attacked by the fever. The odor, which was broadcast in the atmosphere of the cities and towns where the epidemic raged, was offensive in the extreme. This is an odor so peculiar as that, to be appreciated, it must be experienced. It is not confined to houses, but often pervades the atmosphere of certain districts of the infected locality, where it most seemingly concentrated; then a larger proportion of the susceptible are attacked and the disease is most malignant. Is this one of the sensible properties of yellow fever poison, or does the poison determine certain chemical laws with an atmosphere reeking with almost every imaginable impurity consequent on active decomposition and exhalation of animal and vegetable matter, that result in the produc- tion of this odor ? Is this the subtle and mysterious influence which, while it casts a death-like torpor over the vaso-nervous system, determines the most intense hyperæesthesia of the nerves of common sensation ? Time and
future observation must resolve the problem. I infer a relatively small amount of ozone to exist in such an atmosphere." Dr. R. H. Harrison, in his account of the epidemic at Columbus, Texas, in 1873, says: "The health of the town was much worse than usual. During June, July, and August the wind was steady from the south, sweeping whatever of malarial or other poison might have been developed along the river away from the town. Intermittent, remittent, and bilious fevers prevailed, with nothing
unusual to mark their course. In one or two instances there was a marked hemorrhagic tendency. One such case ended in black vomit. Cases after
this continued to multiply, aggravating, perhaps, the cause of the visitation. The low lands near the river had been overflowed four or five times between the months of April and November. One of these, occurring about the 25th of
August, was remarkable for the enormous quantity of dead fish which floated down stream. The column of floating putridity was scarcely broken for two
days and nights. and, the current being strong, the quantity which passed is altogether beyond computation. Occasionally they were floated away from the main current and lodged in the drift-wood of the overflowed land, where,
coated with a thin sediment from the midday flood, vast quantities of them were left to swelter and decay. The source from whence they came and
the cause of their death are questions that, up to the present time, have
defied scrutiny. On the 2d of October the last of these overflows occurred. The weather was hot and sultry, and although there was no dead fish to
be seen in the turbid waters, the stench from it was intolerably nauseating- the odor of rotting fish and weeds combined. Occasionally the skeleton of
a fish with fragments of flesh in an advanced state of decomposition might
be seen floating just beneath the surface. Other carcasses were also floating
down the muddy torrent in abundance, some in advanced states of decompo- sition, and others but recently dead. The condition of affairs was now cal-
culated to excite the most alarming apprehensions in all reflecting minds. Surrounded by a flood of filthy, stinking waters; the streets and vacant lots
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A HISTORY OF THE YELLOW FEVER.
of the town covered with a rank growth of matured weeds, which were falling down and rotting rapidly under the influence of repeated rains and a high temperature; numbers of carcasses of dead hogs and dogs were found decaying in various parts of the town; privies were unpoliced; and, to aggra- vate this multitude of evils, a city government that, whenever it was addressed upon the subject of a sanitary police, insisted upon establishing quarantine against some place that it imagined had yellow fever. And, as if intent to precipitate us into an epidemic, at this juncture this government passed an ordinance requiring the hogs, our only scavengers, to be removed from the streets, thus leaving the offal from our kitchens to add its noisome effluvia to the mass already on hand. The result is not difficult to imagine. While the city government continued from time to time to adopt quarantine ordinances, the health of the town grew gradually worse, the number of cases increased, and the attacks were more violent. frequently terminating on the seventh or ninth day. By the 7th of October every member of the faculty was busy. and, by the 18th, yellow fever was announced, and the usual de- moralization of the whole population set in. Calvert was prepared for the vellow fever in 1873 by the prevalence. during July and August, of malarial fever of an obstinate and unyieldling character. While in this condition a young man named Hughes arrived from Shreveport, who was taken down with the yellow fever a few nights after his arrival, and in a few days died. Dr. Coleman, who attended him, made an attempt to have his bedding burned and the room fumigated, but the bedding, instead of being burned, was thrown upon the roof of a little house almost at the foot of Main Street, and left there three weeks in the sun. The prevailing wind blowing up the street, the whole town soon became impregnated with the poison." Dr. McCraven insists that the yellow fever which prevailed epidemically in Houston in 1848 originated there; that the city was badly drained and filthy, and there was not much rain during the latter part of summer, making it remarkably dry. He he- lieves that no one had a second attack, as did Dr. Stone, of New Orleans; and he believes that animal filth is the food of the yellow fever, and that it will not spread in a clean city. Dr. Bennett Dowler declares that, from 1796 to 1853. it is almost certain that several cases of yellow fever have occurred every year in New Orleans, often only four or five. Baron de Ca- rondelet, in 1801. recommended that the stagnant waters of the city be drained into Canal Carondelet : he regarded them the cause of much mortality from fatal fevers, among which he included yellow fever. Dr. Cartright and Dr. Merrill (lately of Memphis) state that, in their opinion. the epidemic of 1823 originated in Natchez, and was not imported. In 1853, according to Dowler, the heavy frosts at the close of October and beginning of No. vember did not appear to have any marked influence upon the epidemic. He also says that about the 25th of October-and until frost appeared for a few nights at many of the interior towns of Louisiana, but which did not in a marked degres arrest the march of the epidemic- warm weather, how- ever, soon returned, but this did not revive the epidemic in places where it had declined,-as in New Orleans and many other places, where the return
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A HISTORY OF THE YELLOW FEVER.
of absentees and the influx of strangers did not reproduce the epidemic. In Clinton, La., where the fever began a month before the frosts above alluded to, the fever did not disappear; on the contrary, after the 10th of December many persons died, among them several negroes. "All the les- sons of philosophy teach." says Dowler, "that yellow fever has a cause or combination of causes, without which it can not appear; with which, it can not fail to appear, being not the less certain because unknown in the present state of science. Its antecedents and sequences must prove when known as invariably connected and simple as any part of physics. Fortu- nately the eouditions if not the causes of yellow fever are to a considerable extent known: for example, it is known to be connected. no matter how. with the warm season of the year; with unacclimated coustitution>: with aggregations of people in towns and village-, and it rarely attack, rural populations unless they crowd together so as to become virtually towns."
And he might have added, that it is subject to a law of periodicity, that it reaches its zenith in a given time and declines without regard to climatic conditions or other influences, such as the continued unsanitary state of the publie highways. In New Orleans, in 1853, the climax was reached on the 53d day of the epidemic; in 1858. on the 56th day: in 1867, on the 55th day; ail in 1878, on the 57th day. In Memphis, in 1867, the fever reached its climax on the 40th day; in 1873, on the 40th day; and in 187s, on the 44th day -in every instance declining in the sume ratio a- it advanced.
That yellow fever can be imported and may be engrafted by conditions which, if they do not originate, certainly promote it, is apparent in the case of Louisville, from which we have this tardy confession in the Age, a weekly paper remarkable for its candor, for its freedom from sectional or political bias. from personal considerations or control, and that is amongst the best of our current publications for fair dealing. truth-telling, and trenchaut, fearless criticism. It says, in the number for February 22, that "Many credulous persons in Louisville, relying implicitly upon the opinions of the doctor and the solemn assurances of newspapers last summer, laughed at the idea that indigenous yellow fever existed in the city. It is we believe with a single exception admitted now. however, that the dreadful disease not only existed here, but proved quite fatal in a number of cases. Fortu- nately it was not developed until late in the season, and the cool weather of September. followed by the frosts of October, retarded its propagation. It is interesting to discover the methods that were adopted to mislead the public. One of our most prominent physicians, writing in a late number of the Medical Nes, frankly discloses how the result was accomplished wenn- dum artem. "W. M.,' says he, . had all of the usual symptoms of yellow fever, well marked, and diel on the fifth day,' but, ' knowing that a pasle announcement of a death from this cause in a citizen would be disastrous a the business interests and social quiet of Louisville, it was decided to call the disease " gastro enteritis.' The death certificate, however, was brought to the physician in charge, ' filled out as madrid ferer' and the physician signed it. The cloud was a camel, a weasel, or a whale, any thing to suit the exigencies
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A HISTORY OF THE YELLOW FEVER.
of the case." And here it is proper to remind all the communities north of Memphis, even so far as St. Paul, that yellow fever has many times prevailed epidemically even in bleak and cold New England; that it only needs condi- tions to prevail again and play havoe among the people of the Northern cities as it has within the past forty years among the people of the Southern. It must be remembered that the conditions necessary for the propagation of the disease one day are not those of another, hence the best doctors, like Chopin, of New Orleans, are not ashamed to confess that they know nothing about it, save as it develops itself in patients.
From the preceding it will be seen that, on the best authorities, every theory advanced touching the birth in Africa and origin in America, or its islands, of yellow fever, has been contradicted, and that the theories of geographical or zone limit, of altitude, of germ or fermentation origin, of development, of contagion or infection, of its naturalization in the United States and the effect of sanitary conditions to increase and intensify it, all have partisans who contend for each with zeal, every one of them furnishing more or less data with which to fortify positions that are taken only to be destroyed by others. It only remains, then, to furnish a case or cases in contradiction of the power of frost to kill it, and the conclusion of Dr. Chopin, of New Orleans, is irresistible, that are really know nothing about yel- low fever; that it is a law unto itself in its tenacity of life as well as in its incep- tion, growth, and progress in development, how long it takes to incubate in the human system and the strength it must reach to prerail epidemicully, to leap, as it did in Memphis in 1878, in three days, from one to one hundred cases. First, we have the case of Mr. Joyner, a well-known merchant of Memphis, who had not been in the city during the epidemic, and who went down to George Hunt's plantation, near Horn Lake. Miss., to look after the estate of a deceased relative, late in December. He slept. it is said, in a bed occupied by a person who had died of the fever during the epidemic. However that may be, he contracted the dis- ease in that place, and died at his home in Memphis, whither he had been re- moved. There had been much cold weather for a month before, the thermom- eter ranging lower than 323, and the house where the disease was contracted, like nearly all houses in the South, was built more with a view to comfort in the heats of summer than to repelling the extreme colds of winter, so that it must have been thoroughly exposed and brought under the influence of the very low temperature which prevailed before his arrival. New Orleans fur- nishes another case that shames the temperature theory (an exceptional case, to be sure, like that of Joyner's), still a case that can not be overlooked. The New Orleans Times made a full report of it, giving names, locality, date, and the temperature of the room of the patient before and after the attack, and during sickness. It said: "Probably the most remarkable case of yellow fever ever recorded, and one which stands seriously in the way of many accepted theorie-, is that which has recently occurred in this city, in the per- son of Nellie, daughter of Mr. S. E. Carey of this city, aged five years. After an absence from the city of seven months, the child left Chicago De- cember 18, when the temperature was 0-2º Fahrenheit, in the sleeping-ear
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A HISTORY OF THE YELLOW FEVER.
'Autocrat,' which, with bedding just washed, had been exposed to the intense coll for fifty-one hours. She arrived in this city at noon, December 21, and was im- mediately conveyed to Mr. Carey's residence, No. 199 Louisiana Avenue. The house had been thoroughly cleaned in the spring, freshly kalsomined and frescoed, and moreover had not had a case of fever in it during the summer. On the 26th, Dr. Joseph Scott was summoned. He found the child suffering from severe supra-orbital, temporal, and epigastric pains; surface of body cool and slightly per-piring; pulse, 120; temperature (between teeth and cheek ;. 1043°. Temperature of the room, 41º. He visited her five times during the next twenty-four hours, pursuing the usual expectant treatment. Shortly after the last of these visits he was hastily resummoned, and found that black vomit had supervened. Dr. Joseph Jones examined the discharge and pronounced it to be from true yellow fever. Dr. Scott speedily checked the vomit. The fever lasted eighty-one hours, with thermal and sphygmie lines horizontal; theu the pulse and temperature gradually declined to normal. On the second and third days albumen was found, and the seleroties were imbued with the usual tint. In fine, every pathognomonic symptom of yellow fever was strongly marked, so much so that this might be regarded as a typical case. The theory that yellow-fever poison is destroyed by a temperature of 32º Faliren- heit is strongly controverted in the fact that the house had been exposed to even greater cold. The view that a temperature of at least 60º is required for its development finds contradiction in that the temperature of the room where the child sickened was only 41º. Surely it can not be urged that the period of incubation extended from May to December; and on the other hand, what might have been the fomites conveying the germ, when it is an assured fact that there had been no fever in the house during the summer. and that neither had the child been outside the house nor had any one visited it. In fact, all accepted etiological and semeiological principles in yellow fever science seem to have been utterly set at defiance in this truly remarkable case. It surely can not be claimed that this was a case of bilious remittent fever, or of malarial type, when every symptom was in perfect accordance with the most marked type of yellow fever in its monoparoxysmal forni. Here we have strong confirmation of the germ theory, and the alleged power of the seeds to hibernate; evidence adverse to the theory that cold will kill the poison, or that a test of 60º is necessary to develop it; and facts strongly pointing to the spontaneous reproduction of the disease at all times. even in cleanly and healthy localities. So clear and easily attainable ar- the circumstances surrounding it, that it is eminently worthy of rigil investigation and of being placed upon the records of science."
Mes
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A HISTORY OF THE YELLOW FEVER.
III.
HAVING thus given many, if not all, of the various theories advanced touch- ing the origin, causes, propagation or means of transmission of yellow fever. the diagnosis and treatment of it are next to be considered. Dr. Happoldt, before referred to as a physician of high standing, gives the following as the result of hi- experience in Memphis in 1873: " Most cases." he says, "of whatever nature, were ushered in by a chill. followed by a fever, with a pulse and temperature to which the succeeding phenomena would correspond. The attack was so violent in some cases that death occurred within thirty-ix hours. Great prostration was frequent from the beginning, in serious cases. The eye did not often exhibit the bloodshot, glistening appearance, and inquisitive. anxious stare; but frequently presented a mere suffusion with an expression of apathy; sometimes there was pain in the eye-balls, with intolerance of light. The face was sometimes injected, pale or waxy. The tongue was rarely furred at first; it would become red, cracked, and dry in hemorrhagic cases, and sometimes became darkly discolored, even when black vomit did not ceeur. Headache and rachialgia were generally constant during the first and second days; and pains in the joints common in children; and sometimes in adults they would simulate those of gout, rheumatism or dengue. The skin was most generally moi-t from the beginning, and became more so as the disease progres-ed; in some cases the perspiration was profuse and clammy, emitting a peculiar, disgusting odor; but its abundance afforded no relief to the patient - not apparently affecting the temperature. Insomnia and restlessness were constant during the febrile paroxysm. Delirium -mild or furious- was not uncommon, especially in female and nervous persons. Thirst was frequently an urgent symptom from the first. Anorexia was constantly present throughout the disease; the loathing of food was sometimes so great that liquid nourishment would induce nausea in many instances, even in those which terminated favorably. Pain and tenderness over the region of the stomach were sometimes distressing, even in favorable cases, and occasionally it woald extend to the abdomen. In some cases, chiefly andong adults, nausea and vomiting of bilions matter occurred in the inception of the disease, generally followed by biliary dejections, and accompanied with an icterie hue of the skin ; pain in the region of the spleen usually attended these symptoms. Hemorrhage. occurred, generally, late in the disease, mostly passive, and from the mucous sur- fires. Uterine hemorrhage was constant in menstruating females: many mi-car- riages occurred ; some women were delivered of still-born children at their tull term. The temperature frequently fell during convalescence much below the normal standard. The pulse, whatever may have been its force and frequency,
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A HISTORY OF THE YELLOW FEVER.
after it had declined, generally became weak and slow, sometimes falling be- low forty beats to the minute. In these cases convalescence was protracted ; the appetite was perverted ; and dyspeptic symptoms, with a weak beart. remained for months afterwards. Cutaneous eruptions of various kinds appeared in many cases after the subsidence of the febrile paroxysm, and also during convalescence. In some instances the eruption was confined to partie- ular parts of the boly --- generally to the thorax, back, arms, and thighs: ami sometimes to the brow alone. The urticarous, roscolous, and eczemous wore the most common. The eruptions which appeared during and after convales- cence were the most annoying, continuing longer than a week, and giving rise to intolerable itching ; and in some cases the desquamation of the cuticle was as great as that occurring in a pronounced case of scarlatina. During and after convalescence boils and abscesses frequently made their appearance : they were confined to no particular part, and were sometimes so numer- ons, and gave rise to so much discomfort, as to confine the patient in-doors for several weeks. Swellings of the salivary glands, gums, and tongue were of common occurrence during the latter part of the disease. Suppuration of' one of the parotid glands occurred in several cases; but in one case only, in the practice of Dr. W. J. Armstrong, did ' both of the parotid glands become inflamed quickly after the attack of the fever; and rapidly went on to sup- puration and total destruction of the glandular structure, with sloughing of the parenchymatous tissues, leaving a cavity behind each angle of the lower maxilla an inch deep, by three-fourths of an inch in diameter.' In some cases a typhoid condition substituted convalescence ; in many, an icteric hue of the skin and eyes remained for weeks. Bright's disease and albuminuria were among the sequelæe; generally occurring some weeks after convalescence, and were of the most serious character. Relapses occasionally occurred, and were almost always fatal. Death appeared to be due to feebleness of the heart. The greatest number of fatal cases appeared to be due to the direct sedative action of the poison of the disease. Death by coma and convulsions Was most common in women and children. Uremic poisoning, with or with- out black vomit, was most generally the outlet of life among adults, whose stomachs and kidneys had been impaired in function or structure from habit- ual dietetic indiscretions, from pernicious drugs, or from having undergone super-sudation. Whatever views may have been entertained of the special pathology of individual cases, occurring during the epidemic, it was from the master poison that the greatest danger was to be apprehended, and to which all efforts were to be directed. Every kind and variety of diseased action would wear its livery; and it was folly to burden the mind with use- less distinctions, and attempt to treat any other disease without being ever conscious that the exhibition of special means should not be those inimical to the medical constitution existing at the time. For reasons before stated. a diversified treatment was required, according to the character of the case presented ; and remedies were as varied as the diverse opinions entertained of the nature of the epidemic. Mercury and quinine were relied upon chiefly by some. Dr. Mallory, in his account of the epidemic, states that 4
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A HISTORY OF THE YELLOW FEVER.
he gave a cathartic dose of calomel in the commencement; and that 'after purgation, the remedy was continued in small doses until ptyalism was in- duced.' His patients 'recovered without manifesting any inconvenience, in many instances, from its employment. Suppression of the urine did not appear in a single instance among the eighty-one patients on whom this treatment was employed.' One of those who used quinine in all cases, gave it in one-grain doses, in combination with the same quantity of calomel, every hour, until ten doses had been taken; and then gave the quinine alone every two hours until the fourth day, when stimulants were given as required. Dr. Luke P. Blackburn, of Louisville, who had charge of the Walthall Infirmary, believing yellow fever to be similar to the exanthemata, treated it with warm drinks and foot-baths, with sufficient covering. Neither purgatives nor diuretics were given until convalescence was established ; though the vinous and stronger alcoholic stimulants were freely allowed. He believed that the poison was eliminated by the skin solely; and he looked upon 'the fecal matter, coated over with bile, as being the most soothing coat which the bowels can have in the first stage of the disease.' According to his judgment, quinine was fatal in yellow fever. Some phy- sieians employed neither mercury nor quinine, using gentle purgatives or aperients at first, and enemata when needed later in the disease. During the febrile paroxysm, warm diluents, as orange-leaf tea, etc., were generally resorted to. By some lemonade was preferred, and champagne and other wines allowed. To promote the action of the kidneys, the salts of potash or ammonia, with or without the spts. nitric ether, were commonly used. The effort was made by some to abort or resolve the febrile paroxysm by means of such depressing agents as gelseminum, aconite, digitalis, or veratrum viride; and for irritable stomach, chloroform, creosote, nux vomica, and Fow- ler's Solution of arsenic were prescribed. The hydrate of chloral and bromide of potassium, or morphia, were used to promote sleep. Carbolic acid and the sulpho-carbolate of sodium were tried when black vomit occurred. The spirits of turpentine, acetate of lead, and the preparations of iron were given for the relief of hemorrhages. Vinous, distilled and fermented liquors were almost always used during convalescence. These are among the articles of materia medica asserted to have been prescribed. Hot mustard pediluvia were invariably used by all, and cold sponging of the upper extremities by many. Sinapismis or blisters to the epigastrium to relieve gastric distress were in general use. Dry and wet cups, blisters, and warm fomentations were applied to the region of the kidneys in cases of suppression. My views of the pathology and treatment of yellow fever have undergone no essential change since 1854, when I denied the efficacy of Blair's formula expres-ed by the symbol XX by XXIV; and those of my acquaintances who attempted to carry out his precepts have been forced to abandon it. Quinine in seruple doses, in some epidemics, may do good when it is combined with calomel, but I believe that the beneficial effect is due more to the mercurial than the alkaloid. While rejecting this heroic treatment of Blair's, I also rejected the expectant as well as the sedative, which has not yet gone out of fashion
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