LIBRARY OF CONGRESS ill::'' mm: N'tirn: Qass. Book. COPYRIGHT DEPOSIT '^- *^ HISTORY OF YELLOW FEVER. Jj QUITMAN KOHNKE, M. D. Born ix 1S57, at Xatchez, ]Miss. Died June 26, 1909, at Covixgtox, La. Dr. Kohnke was one of the pioneers and most forci- ble expounders of the modern doctrine of the transmission of yellow fever by the Stegomyia Calopus. He com- menced teaching this doctrine in Louisiana and illustrated his lectures by lantern slides immediately after the report of the Reed Commission had been given publicity. Had his indefatigable labors in this direction to educate public opinion in the South received fuller recognition at the time, the experience of 1905 would have been an impos- sibility. He lived long enough to see the universal ac- ceptance of this doctrine and quarantine practices modi- fied in obedience to its teachings. Requiescat in Pace. HISTORY OF YELLOW FEVER By GEORGE AUGUSTIN. Assistant Secretary Louisiana State Medical Society; Assistant Secretary-Librarian Or- leans Parish Medical Society, New Orleans; Author of "Romances of New Orleans" and other Creole Stories. TO WHICH ARE ADDED THE FOLLOWING ARTICLES: MEDICAL. ETIOLOGY— G. FARRAR PATTON, Ex-Secretary Louisiana State Board of Health. PREVENTION— QUITMAX KOHNKE, Ex-President New Orleans Board of Health. PATHOLOGY— O. L, POTHIER, Pathologrist to Charity Hospital, New Orleans. DIAGNOSIS— HAMILTON P. JONES, Physician-in-Chief New Orleans Yellow Fever Hospital, Epidemic of 1905. TREATMENT— LUCIEN F. SALOMON, Ex-Secretary Louisiana State Board of Health PROGNOSIS— CHARLES CHASSAIGNAC, Dean New Orleans Polyclinic. THE LOUISIANA SYSTEM OF HYGIENIC EDUCATION— FRED. J. MAYER, Secre- tary Louisiana Sanitary Commission. HISTORY AND STATISTICS. THE PANAMA CANAL AND YELLOW FEVER— COL. W. C. GORGAS, U. S. Army. EPIDEMIC OF 1905. HENRY DICKSON BRUNS, M. D. CHARLES CHASSAIGNAC, M. D. LOUIS G. LeBEUF, M. D. JULES LAZARD, M. D. SIDNEY L. THEARD, M. D. NEW ORLEANS: Published for the Author by SE-ARCY & PFAFF Ltd., 724-728 Perdido Street. 1909. A ^ - v^?' Copyright, 1909, By GEORGE AUGUSTIX, Xew Orleans. La. ?^JI. A 2 o 1 2 1 AUG 3 1909 TO THAT CHIVAI.ROUS SOUTHERN GENTLEMAN, DR. CHARI.es CHASSAIGNAC, OF NEW ORLEANS, THIS VOLUME IS DEDICATED, As a Testimonial of the high esteem in which he is held in ^this com- munity, and in recognition of valuable assistance rendered in the compilation and classification of the Medical Part of this Work to THE AUTHOR. ACKNOWLEDGEMENTS. I specially desire to thank Major Walter D. McCaw, Sur- geon, U. S. A., Librarian Surgeon-General's Office, for his un- faltering courtesy in placing at my disposal the works contained in the Surgeon-General's Library. During the long years con- sumed in the compilation of this work. Dr. McCaw's promptness in lending me books necessary for research work has greatly facilitated my labors, and I desire to signify my heartfelt appre- ciation of his kindness. I desire also to thank Drs. W. C. Gorgas, Henry Dickson Bruns, Charles Chassaignac, Quitman Kohnke, Hamilton P. Jones, Jules Lazard, Louis G. Le Beuf, Fred. J. Mayer, G. Farrar Patton, Oliver L. Pothier, Lucien F. Salomon and Sidney L. Theard for the valuable articles contributed to this volume. THE AUTHOR. June 30, 1909. REMARKS BY THE AUTHOR. The original intention of the writer was to publish a bro- chure on "The History of Yellow Fever in Louisiana," the idea suggesting itself to him while acting as special stenographer in the office of the United States Marine Hospital Service at New Orleans during the Yellow Fever outbreak of 1897. The duty of copying the reports made by the medical staff under Surgeon Carter devolving upon him, the thought occurred to him that a statistical and historical compilation of the many epidemics of yellow fever which have afflicted our State would prove inter- esting. With this end in view, the work of collecting data was begun shortly after the mild epidemic of 1898. Such was the nucleus of this work. During the decade which has elapsed since the collection of data for this volume was begun, the original scope was en- larged, and as the years rolled by and the magnitude of the task became more and more evident, the author found himself con- strained to dodge around corners whenever he co'^'l « medical friend who had been assured that the book would be out "by the end of December" the year previous; and the patient, good- natured people of New Orleans, who had been told by cpmnl'- mentary articles in the public press, from time to time, that the work would "soon be issued," naturally reached the conclusion that the end would arrive simultaneously with the Millennium. No apology is made for the long-deferred appearance of this volume. A glance is sufficient to show that it is a work of love, for no aniount of financial gain (should it meet with public favor) could be adequate compensation for the time consumed in its compilation. Not being possessed of independent means, the author had to steal moments out of the busy work-a-day Hfe to complete his task, aided by his devoted wife, to whose valu- able assistance is chiefly due the completion of a work whioh, until very recently, seemed unending. It was the author's intentions also to include within these pages a history of the ravages of Yellow Fever in the West Indies and South America, but, judging by the time which has been consumed in the compilation of what is included in this volume, he has concluded that the span of life is too short for the accomplishment of such a task, and humbly submits the re- sult of his labors to the cynical public and to the judgment of indulgent friends. GEORGE AUGUSTIN. New Orleans, June 30. 1909. CONTENTS. PART FIRST. GBNERAI, OBSERVATIONS. CHAPTER I. THINGS EVERYBODY OUGHT TO KNOW. .X)efinition of Technical Terms: Epidemic 1 Endemic ; 2 Sporadic 2 What Fomites Are 2 The Difference Between Infection and Contagion 3 What a Pandemic Is 4 Brief Remarks on Quarantine 6 CHAPTER II. THE RAVAGES OF PESTILENTIAL DISEASE. The Peculiar Pranks of Epidemics 7 .Ancient Notions About the Origin of Pestilential Disease . . . ^ 9 Odd Beliefs and Practices of Superstitious Ages 10 An Extraordinary Historical Document 14 Historic Mortalities Caused by Pestilences in Ancient and Medieval Times 17 The Great Plagues of London 21 CHAPTER III. THE GREAT EPIDEMICS OF THE MIDDLE AGES. The Inguinal Pestilence of the Sixth Century 22 The Black Plague 27 Le Mai des Ardents 30 The Eruptive Fevers of the Sixth Century — ^Variola, Measles, S'Carlatina 35 The Sweating Sickness 36 Scurvy 38 Xieprosy 39 CHAPTER ilV. INSECTS AS PROPAGATORS OF DISEASE. How Pestilence is Spread by Flies, Mosquitoes, Fleas and Other Insects. — Instances Where Disease Was Conveyed by Bed- Bugs a-id Ants. — The Role Played by the CattleTick and the Tsetse-Fly. — ^Summary of the Mosquito Doctrine 44 IBibliography of Transmission of Disease by Insects 52 PART SECOND PRELIMINARY OBSERVATIONS ON YELLOW FEVER. CHAPTER 1. PERTINENT POINTS ABOUT YELLOW FEVER. Geographical Limits 63 Mortality in September, as Compared with. Other Months 64 Historic Mortalities Caused by Yellow Fever 66- CHAPTER II. NOMENCLATURE OF YELLOW FEVER. Peculiar Names Giren the Disease by Medical Writers. — A List Con- taining One Hundred and Fifty-two Synonyms 70- CHAPTER III. HISTORICAL SUMMARY.. Where was the Cradle of Yellow Fever? 85 Critical Examinations of the Literature on the Origin of Yellow Fever: American Origin 87 African Origin 100 Asiatic Origin 105- The Gulf Stream Theory 10& First Recorded Outbreaks Ill PART THIRD. HISTORY OF Y^lvIvOW FBVBR BY I,OCAI,ITi:eS. ASIA. The Effect that the Completion of the Panama Canal will have upon . the Probable Extension of Yellow Fever to Asia — W. C. Gorgas, U. S. A ..135 Alleged Yellow Fever in Syria 144 AFRICA. History of Yellow Fever in Africa, Arranged Alphabetically, by Localities 150 to 343 Chronology of Yellow Fever in Africa and the Islands off the Coast thereof, from 1494 to 1907 344 Summary of Yellow Fever Years and Periods of Xmmunity 350 Chronology, by Localities 352 EUROPE. Austria. Trieste 356 Azores. Historical Summary 357 Ponta Delgado 358 France. Historical Summary 359 Chronology, 1694 to 1908 360 Aix 363 Bordeaux 364 Brest 370 Dunkirk 372 Havre 373 La Rochelle 375 Marseilles 375 Mindin 388 Montoir- de-Bretagne 389 Montpellier 389 Nantes 390 Paris 390 Rochefort 396 Saint-Nazaire 400 Toulon 412 AUGCSTIN S HISTORY OF YELLOW FEVER. Great Britain. Historical Summary 415 Chronology, 1713 to 1878 416 Cork 430 Dover 419 Dublin 430 Falmouth 419 Isle of Wright 419 Llanelly 432 London 42a Motherbank. (See Isle of Wight). Newca3tle-on-Tyne 421 Portsmouth 422 Salcombe 423 Southampton 423 Swansea 432 Woolwich 44a Italy. Chronology, 1804 to 1883 447 Genoa 447 Leghorn 448 Naples 452 Pisa 453 Torre Annunziata 454 Varignana 456 Portugal. Chronology, 1718 to 1880 460 Belem 460 Bom Successo 462 Ericeira 462 Lisbon 463 Olivaes 475 Oporto 475 Peniche 480 Spain. Historical Summary 483 Geographical Description of Localities in Spain Where Yellow Fever has been Observed 484 Chronology, 1649 to 1890 491 Summary of Yellow Fever Epidemics, by localities: Aguilas 499 CONTENTS, 5 Alberca, Alcala de los Gazules, Alcala de los Panderos 500 Alcantarilla, Algerziras 501 Alliaurin-el-Grande, Alicante 502 Antequera 504 Arahal, Arcos de la Frontera 506 Avriata, Ayamonte 508 Badalona 509 Balearic Islands 509 Barcelona 516 Barcelonette 522 Barrios, Benaocaz ; 523 Bornos 524 Cadiz 524 Caneta-de-Mar 544 Caneta-la-Real, Carmona, Carraca, Carrana 545 Cartagena , 546 Catalan Bay 548 Chiclana, Chipiona 549 Churriana, Coin 550 Conil, Cordova 551 Coria, Cortes de la Frontera, Corunna, Dos Hermano3 552 Ecija 553 El Arahal, El Borge, El Palo, El Passajes, Eprezalena 554 Espejo 555 Espera, Estepa 556 Ferrol, Fraga 557 Gibraltar 557 Granada, Guardamar 566 Huelva, Isla de Leon 567 Jesus, Jumilla 568 La Charlotta, La Rambla 669 Las Cabezas de San Juan, Las Palacios, Lebrixa 571 Lorca 573 Loyola 574 Madrid 574 Mairena del Alcor 576 Malaga 577 Malgrat 598 Mazarron, Medina-Sidonia 599 Mequinenza 600 Mijas, Monte Alegre, Montejugue 601 Montilla 602 Mora, Moron de la Frontera, Murcia 603 Nonaspe, Ojos, Olivera 604 Olot 605 AUGUSTIN S HISTORY OF YELLOW FEVER, Palma (See Balearic Islands). Palmar, Pasajes 605 Paterna de la Ribiera, Pedrara 607 PedroctLes, Penacerrada 608 Port Malion. (See Balearic Islands). Puerto de Santa Maria 608 Puerto Real 609 Regens, Ricote 610 Ronda 611 Roquetas, Rota, Saint Eloy 612 San Andero, Salou 613 San Gervaiso, San Juan del Porto, San Lucar de Baramaeda 614 San Roque, Sans, Sarria 615 Seville 618 Sitges 621 Tabarca, Tobarra, Torre del Mar, Torre Molino 622 Tortosa 623 Totana, Tribujena 625 Turriano, Ubrique, Utrera 626 Valencia, Vejer, Velez Malaga 627 Vera, Vigo 628 Villa Martin 629 Villanueva del Ariscal, Villaseca de la Sagua 630 Xeres de la Frontera 630 Ximena de la Frontera 633 Yecla, Zieza 634 HISTORY OF YBI^lyOW FEVER IN NORTH AMERICA. Proofs that Yellow Fever is an American Product and was Unknown to Europeans before the time of Columbus 639 CANADA. Historical Resume 650 Chronology, 1805 to 1880 652 Summary of Yellow Fever Outbreaks, by Localities: Nova Scotia. Halifax 652 Prince Edward Island. Charlottetown 656 Quebec. Quebec 656 Saint Pierre and Miquelon. Saint-Pierre-deMiquelon 658 Bibliography of Yellow Fever in Canada 659 CENTRAL AMERICA. Historical Resume 660 Chronology, 1596 to 1908 661 Summary of Yellow Fever Outbreaks, by Localities: Britisli Honduras. Belize 666 Costa Rica. Alajuela 668 Heredia, Liberia, Matina 669 Port Limon 670 Punta Arena. San Jose 678 San Juan 679 Zent 680 Guatemala. Champerico, Chiquimula, Gualan 681 Livingston, Puerto Barrios 682 Tucara, Zucapa 683 Honduras. Ceiba, Chamelicon 685 Cholona, Cienaguita, El Pariso, Nacaome, Pimenta 686 Puerto Cortez 687 San Pedro 689 Nicaragua. Bluefields, Corinto 690 Granada, Jucunapa, Leon 691 Managua, San Francisco 692 Salvador. Acajitla, La Libertad 693 San Salvador 693 Santiago de Maria 696 Bibliography of Yellow Fever in Central America 696 8 AUGUSTIN S HISTORY OF YELLOW FE^ER. MEXICO. Historical Summarr of Yellow Fever in Mexico: Endemic Foci 70(^ Along tlie Pacific Coast TO^' G-eneral Retrospect 70S The General Epidemic of 1883 707 Summary of Yellow Fever Epidemics in Mexico, by Localities: Acapulco, Acayucan, Altata, Altamera 708 Alvardo, Amalco, Atai, Camarga, Campeclie 709 Cardenas. Chilpanzingo 710- Cilas, Cinchapa, Clinidas, Coatzacoalcos, Colina 711 Caraco 71? Concordia 713^ Cordova 713 Corrientes 115 Cosmaloapam, Cosala, Culican, Dofia Cecilia, El Higo, Equador, Frontera 71& Gualian, Guaymas, Guerrera, Guie-c'Mcori, Hermosilo 71T Hidalgo, HuacMnango, Huimangnillo, Ixcallan, Jalapa, Jicaltepec, Jico, Jiminez 718^ Joltipan, Juchitan, Laguna del Carmen, La Ju.nta, Lampasas, La Paz 119 Las Animas, Linares, Mazanillo 720 Matamoras 720 Mazatlan 721 Merida 721 Mexico City — Experiments Demonstrating that the Yellow Fever Mosquito can Breed in Mexico City 723" Summary of Yellow Fever Importations to Mexico City 728 Micaltepec, Mier 72& Minatilpan, Misantla, Monclava, Monterey 729 Motul, Montzorongo, Xaulta IZO Xicayuca, Xeuva Laredo, Ocus. Omealca 731 Orizaba 731 Papantla, Paraje Xuevo, Paso de Ovijas, Pinchucalco, Presidio 734 Progreso Peublo Vejo, r'eurto Angel, Quantana Roo, Reata 735 Reynosa. Rosario, Salina Craz. San Antonio, (San Benito, San Bias. .736 San Fernando, San Geromino, San Ignacio, San Juan Batista, San Lorenzo, San Luis Potosi 737 Santa Cruz de los Rosales, Santa Lucretia, Santiago Acapemeta, Soconusco 738 Tampico 73S CONTENTS. ^ Tamuin, Tapacliula, Tepee, Tehuantep.ee 74L Teran, Texistopee 742 Tezonapa, Tierra Blanea, Tapona, Tlacoltipan, Tpislan, Tonala, Tuxpan 743 Tuxtepee, Valladolid 744 Vera Cruz (1509 to 1909) 744, Victoria, Xumpich, Yuki, Zonogolica, Zueatula 750 Bibliography of Yellow Fever in Mexieo, by Localities 750 UNITED STATES. General Summary 767 Table Showing Years in which Yellow Fever has Invaded the Sea board Cities of the United States, 1668 to 1893 769 to 780 History of Yellow Fever in the United States, by Localities: A abama 781 Arkansas 792 California 725. Connecticut 798 Delaware 801 District of Columbia 804 Florida 805. Georgia 821 Illinois 833 Indiana 838 Indian Territory 838' Kentucky .839 Louisiana 844 to 902: Maine 915 Maryland 917 Massachusetts 525 Michigan 936^ Mississippi 937 to 954 Missouri 957 New Hampshire 962 New Jersey 96o New York 965 North Carolina 982 Ohio . . . 9S4 Pennsylvania 986 Rhode Island 993" South Carolina ^^^ Tennessee l^^l Texas 1«^9 Virginia 1^^^' Vermont 1^^^ Washington 1^^'^ West Virginia l^^'^ 10 PART FOURTH HISTORY OF YELLOW FEVER EPIDEMIC OF 1S05. EXPERIENCES DERIXG THE YELLOW FEVER EPIDEMIC OF 1905.— KEXRY DICKSON BRUNS. M. D 1027 SOME LESSONS TArGHI EY THZ: EPIDE:\nC OF 1505.— CHARLES CHASSAIGNAC : I L Truth of Mosqniio P :;: 3^ :- 1049 n. Infection in Proportion to Nnmber of Bites 1052 m. Timlence Diminishes Pari Passu with the Destruction of Mosquimes 1053 IT. Susceptibility of Negroes 1054 V. Quarantines Unintelligent 1055 VI. Prophylsxis in Place 1056 Vn. Prophylaxis in Person 1057 VUL Depopulation of Infected Places 1057 IX. Detention Camps 1"5S X. The Great Lesson lOcS m. THE WORK OF THE MEDICAL PROFESSION OF NEW OR- LEANS DURING THE EPIDE:\nC OF 1905.— LOUIS G. LeBEUF, M. D. I. Preliminary Remarks; Local Medical Organizstion . . . 1060 IL Appeal for Early Notification 1069 in. Appeal for Immediate Screening of Suspected Cases, and Fnmigation 1071 rv. Appeal for an Educational Campaign 1072s V. A Warning to Beware of the Danger of OTerlooking the Less Obvious Breeding Places of the Stegomyia 1073 Yl. Appeal for a More Skilled Medical Body to Conduct the Campaign 1074 VII. Letter Warning Medical Men not to Overlook the Mild Type of Yellow Fever which may be Found in the N2tive-Bom 1075 Yin. Appeal to Householders to Delay "Moving Day" on Account of Danger of Spreading Infection 1076 rx. Danger of Removal of Temporary Cistern Screens 1076 X. Concluding Remarks 1077 CONTENTS. 1 1 IV. STATISTICAL REVIEW OF THE YELLOW FEVER EPIDEMIC OF 1905, NEW ORLEANS.— JULES LAZARD, M. D. I. General Remarks 1078 II. "Suspicious" Deaths, 1905, Previous to Epidemic Period 1079 III. Daily Record of Cases and Deaths and Cases Under Treatment 1081 IV. Deaths Classified According to Age 1083 V. Deaths by Months 1084 VI. Deaths According to Nationality 1084 VII. Comparative Mortality, 1904, 1905, 1906 1085 V. ilEQUIREMENTS OF THE MOSQUITO DOCTRINE— S. L. THEARD, M. D 1086 VI. :NEW ORLEANS YELLOW FEVER IN 1905.— S. L. THEARD, M. D 1093 VII. AiNTI-MOSQUITO ORDINANCES ADOPTED BY THE CITY COUNCIL OF NEW ORLEANS IN 1905 1100 12 PART FIFTH. THE ACCEPTED MODERN THEORIES CONCERNING YELLOW FEVER. ETIOLOGY OF YELLOW FE\'ER— G. FARRAR PATTON, M. D. L First Definite Suggestion of tlie Truth HOT The Yellow Fever Germ 1109 n. Views Formerly Held IIIL m. Tyranny of a False Doctrine 1116 rv. Convincing Object Lessons cf 1905 1117 V. Etiological Role of the Mosquito 1118 VI. The Bacillus Icteroides 1124r \TI. Dengue and Yellow Fever 112(> 11. THE SANITARY PREVENTION OF YELLOW FEVER— QUIT ]VL\N KOHNKE, M. D. L The Yellow Fever Mosquito 112T n. Moral Responsibility for Epidemics 112S IIL The Sanitary Creed 112^ IV. Mortality Statistics 1131 V. Destruction of Stegomyiae 1133 VI. Conditions Obtaining in New Orleans in 1905 1134 yy^. Conclusions 1136 BitlJGgraphy of Transmission of Yellow Fever by Mosquitoes 1138" III. PATHOLOGY OF YELLOW FEVER.— O. L. POTKIER, M. D. L Difficulty of Pathc^xOgical Diagnosis 114T IL Yellow Coior 1147 III. Hemorrhs gic Spots 1148 IV. The Lungs 1148 V. The Heart 1148- YJ. The Liver 1149 VII. The Spleen 1149 VIII. The Kidneys HSO" IX. The Adrenals, Thyroids and Pancreas 1151> CONTENTS. 13 X. The Stomach 115J XL The Intestines 1151 XIL The Blood 1151 XIII. The Nervous System 1151 XIV. Adults More Susceptible 1152 XV. General Steatosis the only Special Characteristic Lesion 1152 IV. DIAGNOSIS OP YELLOW FEVER.— HAMILTON P. JONES, M. D. I. Preliminary Remarks 1154 11. First Stage 1156 IIL Second Stage 1156 IV. The Blood 1157 V. Urine 1157 VI. Facial Expression 1157 VII. Jaundice 1158 VIII. Circulation 1158 IX. Temperature 1158 X. Pulse 1158 XL Respiration 1159 XII. Blood Pressure 1159 XIII. Differential Diagnosis Malaria 1160 Hemoglobinuric Fever 1161 Dengue 1161 La Grippe 1161 Typhoid Fever 1161 Acute Yellow Atrophy of the Liver 1162 Weil's Disease 1162 Catarrhal Jaundice 1162 Acute Peritonitis 1162 XIV. General Summary 1162 PROGNOSIS OF YELLOW FEVER— CHARLES CHASSAIGNAC, M. D. I. Preliminary Remarks 1164 IL Age 1165 III. Condition of the Vital Organs 1166 IV. Habits 11^^ V. Amount of Poison 1166 14 AUGUSTIN's history of yellow F£VER. VI. Surroundings 1167 VII. Race 1167 VIII. Treatment 1167 IX. Temperature 116& X. Icterus 1168 XI. Urine 1168 XII. Hemorrhage 1169 VI. TREATMENT OF YELLOW FEVER— LUCIEN F. SOLOMON, M. D 1171 VII. THE LOUISIANA SYSTEM OF HYGIENIC EDUCATION— FRED. J. MAYER, M. D 1176 PART I GENERAL OBSERVATIONS. PART FIRST. CHAPTER I. TPIINGS EVERYBODY OUGHT TO KNOW. Definition of Technical Terms. — What is Meant by Epidemic, Endemic and Sporadic. — What Fomites Are. — The Difference Between Contagion and Infection. — What a Pandemic Is. — Brief Remarks on Quarantine. As this work is not solely for the use of physicians, but also for the information and guidance of the public, we wUl give a brief synopsis of the meaning of certain words which have be^n used quite freely by the lay and medical press recently, so that anyone who reads these pages will be perfectly familiar with technical terms which might otherwise seem confusing. Epidemic. The term Epidemic is applied to any disease which at- tacks a great many persons in a locality at any particular period and spreads rapidly in every direction, although every conceivable effort to check it or stamp it out is resorted to. The popular belief prevails among tJie laity that a disease is epidemic when the deaths from any cause exceed those from all other diseases occurring simultaneously in any locality. Such is not the case. A disease may be epidemic without having an unusual rate of mortality. This was illustrated by the epidemic of jaundice (some say it was yellow fever in its mildest form) which pre- vailed in Eotherham, England, in 1862. There were over three hundred cashes, with only one death. And yet the disease was decidedly epidemic. iIISTORY OF YELLOW FEVER. Endemic. A disease is said to be Endemic when it is permanently established or is ordinarily prevalent in a locality, and dependent on local conditions. Sporadic. SpGradic means that a disease manifests itself by the occurence of scattered or isolated cases, croi)ping out here and there, at irregular interyals, and easily amenable to remedial measures. FOMITES. The word Fomites has been juggled with so much by non-medical writers and by physicians who ought to ha^re knoAvn better, but who made use of the expression in a hap-hazard way, that we desire to call specie, 1 attention to its true etymology. Fomites is the plural of Fomes, and is derived from the Latin fomes, meaning touch-wood or tinder, or something which spreads quickly. It is ap- IDlied to any substance capable of absorbing, retaining and transmitting contagious or infectious germs. Such things as Avoolen clothes, moss, etc., are decidedly active Fomites, but it is impossible for wood, stone, iron, cork, books, newspapers or anything which does not retain germs, to propagate them. As yellow fever can only be transmitted by a certain species of mosquito, it cannot, under any con- dition whatsoever, be propagated by Fomites. Even if one T\'ears the garments of a person who has died of yellow fever, he can never contract the disease and vaW never be susceptible to it, unless he is bitten by a female Stegomyia Fasciata wliicli has bitten a yellow fever sufferer during the first three days of the attack. The only diseases believed to be capable of being trans- mitted by Fomites are cholera, typhoid fever, smallpox, scarlatina, diphtheria, tuberculosis, measles and eruptive and venereal affections. Prof. Beyer admirably sums up the question in the New THINGS EVCRYBODY OUGHT TO KNOW. 3 Orleans Harlequin as follows:^ "A quarantine against any kind of freight is stupid. It is as silly as the disin- fecting of crude carbolic acid and pig-iron which occurred in Galveston during the last fever panic. Only the house mosquito conveys the disease. You can take a thousand people, all ill of yellow fever, into the most populous city, and if there are no mosquitoes in that city not one case will develop. With those thousand cases, the disease will end. * * * The genius of the world cannot take any article of freight and make it the transmitting agent of the disease." Further comment is unnecessary. In conclusion, we echo Prof. Beyer's sentiment, that this fact should be driven home to the intelligence of every community. The Difference Betaveen Infection and Contagion. Infectious. The pathological definition of Infectious is a disease capable of being communicated by contact, or through the medium of air, water or fomites. Contagious. Transmissible by contact. Infection is frequently confounded with Contagion, not only by the laity, but even by medical men. The best usage now limits Contagion to diseaises that are trans- mitted by contact with the diseased person, either directly by touch or indirectly by use of the same articles, by breath, or by eating or drinking after a diseased person. Infection is applied to diseases produced by no known or definite influence of one person upon another, but where common climatic, malarious or other widespread condi- tions are believed to be chiefly instrumental in their dis- semination. Yellow fever is neither contagious nor infectious. There are only two ways in which it can be transmitted : 1. By the bite of the female mosquito of the genus Stegomyia Fasciata, which has previously fed upon the blood of a person suffering from yellow fever during the first three days of the attack. 2. By inoculation with the blood of a yellow fever ^August 3, 1905. HISTORY OF YELLOW FEVER. sufferer during the first three days of the attack ; after the third day, the disease cannot possibly be communicated. Pandemic. A Pandemic is an ei3idemic which attacks the whole or a greater part of the population of the world. It generally follows the routes of commerce, but has been known to ignore the by-ways of travel and to proceed by leaps and bounds, crossing wastes of waters and covering miles and miles of territory to reach a certain fated spot, without leaving a trace of its influence between the point of de- pai'ture and the locality it was destined to ravage. One of the most noteAvorthy pandemic waves of modern times began at the Cape of Good Hope in 1S22 and ended in the frigid zone seven years later, after having covered nearly the entire globe. Starting at the Cape, it traveled along the southern coast of Madagascar and reached the Island of Matiritius, in the Indian Ocean, in 1823. It was next felt in Ceylon, India and in some parts of Eastern Asia, after which it seems to have "doubled upon its ti^acks," for it stopped when it reached China and travelled A\'estward, skirting the sotithern coast of Asia and enter- ing the Mediterranean by way of Asia Minor, in the fall of 1821. It then successively invaded Malta, Gibraltar ajid some of the islands off the west coast of Africa. It next sojourned towards the north, reaching Great Britain the same year. Observers have recorded the fact that dur- ing the visitation of this pandemic, the admissions into the fever hospitals of London, Dublin, Glasgow and Edin- burg increased to an abnormal extent. The wave then crossed the Atlantic and was felt in the West Indies in the Autumn of 1821, where it caused a high rate of mortal- ity. Its influence seems to have lingered in that locality, for in 1825, Jamaica, in which had taken place the preced- ing year a slight advance in the death rate, experienced a terrible epidemic. By one of those strange and unaccount- able A'agaries which often characterize the phenomena of Nature, Ners^ Orleans was the only locality in the United States A^hich felt the influence of the wave; the mortality, THINGS EVERYBODY OUGHT TO KNOW. 5 however, was not very great, the deaths froin yellow fever in 1824 aggregating 108, against 808 in 1822. The paudeniic then jumped, as it were, from the Gulf of IMexico to Canada,, where it caused much sickness and mortality in 1825, especially in Nova Scotia and the eastern provinces. The wave seems to have been loth to leave the British Isles, for its baneful influence was felt now and then throughout the United Kingdom from 1825 to 1828, during which manifestatioins the death-rate rose to a notewo] thy degree. This remarkable pandemic finally spent itself on the frozen shores of Iceland in 1829, leaving in its wake throughout the island a series of epidemic diseases, in which typhus played a prominent role. liawson, \Aiio minutely noted the occurrence and in- fluences of pandemics, says:- ''These waves occupy about two years in passing over a given station ; the mortality from fever, of whatever de- scription it may be, increases during their passage, subsiding again as they move onwards. They follow each other at intervals of a few years, and may be traced from the Cape of Good Hope, where they first become sensible, to Iceland. Some embrace Ceylon, in 80^ E. longitude, and New Orleans, in 90^ W. longitude, or nearly half the circumference of the earth. Were information for other places available, no doubt their passage might be demon- strated still more extensively.'- x\gain :^ ^'The occurrences in the Mediterranean in 1828 are extremely interesting and important. There, under the same pandemic wave, while yellow fever was causing such mortality at Gibraltar as to induce many to think it an imported disease, the remittent fever, the und<)ubted pro- duct of the locality, was causing a much higher one at Santa Maura, and other forms of febrile disease^ — petechial typhus at Naples, and plague in Albania, — were prevailing on either side the latter. It must, therefore, be concluded ^Lawson: Trans. Epidemiological Society of London, Vol li, 1862. '' Ibid. HISTORY OF YELLOW FEVER. that though the pandemic cause determines the occurrence of febrile disease in places over which it passes, the peculiar form, and eren the frequency, of the disease is determined rather by the circumstances, whether meteo-o- logical, malarial, hygienic, or social, to which each popula- tion is subjected. The same local circumstances may exist in other years, and, so far as can be estimated, to an equal extent, but fevers do not become rife; but no sooner is the pandemic cause added, than these seem to acquire a potency which is almost inexplicable." Quarantine. Quarantine is derived from the Italian word quaranfina, which means a space of forty days, the period (originally forty days) during which a ship having a contagious disease on board, or coming from a port suspected of being infected Avith pestilential disease, is forbidden in- tercourse with the place at which she arrives. The period of quarantine in this country is generally from six to twenty days. Quarantine is practically abolished in England and its dependencies. If there is evidence or suspicion of in- fectious disease on board a vessel arriving in a British port, tlie customs oificers report the occurrence to the sanitary authorities of the port, whose decision in such matters is final. In the United States, by act of Congxess passed in 1888, national quarantine stations were established. This statute makes it a misdemeanor, i^unishable by fine or im- prisonment, or both, for the master, pilot or o\\'ner of any vessel entering a port of the United States, without first presenting a clean bill of health. Pratique is permission given to a vessel to unload with- out hindrance from quarantine laws. To do this, the vessel must present a clean bill of health. A comprehensive history of quarantine, from its earliest enforcement to the present day, will be found in the medical part of this volume. CHAPTER II. THE RAVAGES OF PESTILENTIAL DISEASE. The Peculiar Pranks of Epidemics. — Ancient Notions about the Origin of Pestilences. — Full Text of the Extraordinary Document Promulgated hy the College of Physicians of Paris in 1665. — An Out- line of the Appalling Mortality caused by Pandemics in Ancient and Medieval Times. — The Great Plagues of London. The Peculiar Pranks of Epidemics. Fortunately for the human race, it is seldom that two diseases are epidemic at the same time in the same locality. When yellow fever raged with such violence at Gibraltar in 1804, it Avas remarked that all other diseases declined ; and T^'ell they might, for in that great epidemic, out of a civil population of 14,000, only 28 escaped an attack. A similar retreat of inferior diseases has been observed to take plaee during the prevaJence of the plague in London, Holland and Germany, according to histories of that disease by Sydenham, Diemer brock, Sennertus and Hildamus. A modern instance of the malignity of yellovf fever took place at Yv^oodville, Miss., in 1844. When the fever broke out, all those ^^'ho could get away fled, and out of a total remaining population of 500 some 495 were attacked by the fever. There liave been notable exceptions to the rule that only one epidemic can rage at the same time. In 1889, both smallpox and measles were epidemic in England and Wales. Smallpox and scarlet fever were both epidemic in New York in 1840, 1841, 1842 and 1843; and in 1840 and 1841, measles Avas also epidemic, so that the three diseases were epidemic at the same time in the last mentioned years. In the year 1802, Charleston, S. C., was affected with four epidemics — smallpox, measles, yellow fever and influenza. It was a common occurrence, during the prevalence of cholera at New Orleans in the autumn of 1832, for a O HISTORY OF YELLOW FCVER. person to be attacked with yellow fever, and before, or as soon as the febrile excitement ceased, for the patient to be destroyed by the cholera in its most marked and malig- nant form. The cholera which was imported to^ New Orleans in 1866 maintained its existence throughout the yellow fever epidemic of 1867, diminishing in its intensity as the fever advanced, and again becoming more malignant as the fever subsided. But it was never entirely absent. In November of that y^r, 234 deaths occurred from cholera and 103 from yellow fever; in December, when the fever had almost disappeared the mortalitv from cholera was 210. In 1853, according to Fenner,^ there was a remark- able series of ei3idemic disease. We cull the following from his report, p. 1 : '^During the past year,^ two of the most terrible epidemic diseases that ever afflicted man- kind have prevailed, to a greater or less extent, in parts of the extensive region assigned to my notice.^ I mean cholera and yellow fever. Smallpox has also appeared in several i)laces; and other epidemics^ such as measles, scarlatina and whoo]3ing cough, have made us their cus- tomary annual visitations. '- ^leasles and smallj)ox were also ei3idemic in Philadel- phia in 1823 and 1824, and in 1835 and 1845, smallpox, measles and scarlet fever were all epidemic. Measles and scarlet fever were both epidemic in Balti- more in 1837, and smallpox and scarlet fever in 1838, and again in 1845. In 1868, smallpox, cholera and yellow fever i^revailed in Cienfuegos, Cuba. Other instances could be cited, but these suffice for the purpose in view. P^pidemic diseases seem to be more fatal among the un- civilized than the civilized. In an epidemic of rubeola ^Fenner: Report of the Epidemics of Louisiana, Mississippi, Arkansas and Texas in the Year 1853, by E. D. Fenner, 1853. = 1853. •' The four States mentioned in above title. THE RAVAGES OF PESTILENTIAL DISEASE. y among the Crees (a tribe of North American Indians) in the summer of 1846, as reported by Dr. Smellie in the Monthly Journal of Medical Science for December, 1846, of 145 cases treated in his camp, 40 were fatal. Smallpox has sometimes swept off an entire tribe of Indians, as ^\'as the case with the Mandans (another North American tribe), and has generally proved abnormally fatal when it attacked the Ked Eace. It has been obseaved by Gregory^ that epidemics are usually severe when they first appear in a country or are renewed after any long intervals of time. When cholera first invaded India in 1817, it raged with an intensity which may have been equalled, but never has been sur- passed. When smallpox first made its appearance in America (Mexico) in 1518 and gangrenous sorethroat (diphtheria) first visited Naples in 1618, America in 1735 and London in 1747, the ravages of each disorder were terrific. It seems, then, to be the law of animal economy that the susceptibility to any morbid poison is great in proportion as it has been little accustomed to the impres- sion. Ancient Notions about the Origin of Pestilential Disease. The works of Tlipocrates contain many interesting ob- servations upon the origin and nature of epidemics. He states that disease, in general, may be said to arise either from the food we eat or the air we breathe. When, there- fore, a disease seizes upon a multitude of persons of dif- ferent sexes, ages and habits, he infers that it must arise from the latter cause. ^ In his first book, fourteen cases of diseaise are related, and in the beginning of the third book, twelve, and sixteen in the end, thus making forty- two in all. It is worthy of remark that in twenty- five of these the result was fatal. There is every reason then to suppose that they were selected for a purpose, but what that purpose was cannot now be easily determined. * Gregory: A Treatise on Eruptive Fevers (1851), p. 35. ^Paulus Egineta (Adams' translation). Vol, 1, p. 274. ]0 HISTORY OF YELLOW FEVER. The most natural result would no doubt have been to illustrate the different pestilential diseases which are described as occurring at the time.^ Galen also attributes the origin of epidemics to the state of tlie atmosphere, but holds that the nature of the country may contribute. Lucretius accounts for the prevalence of epidemics upon similar principles, and Silius Italicus refers an epidemical fever to the same cause. The purif ving of the afmosphere as a means of prevent- ing or liiniting the spread of disease, is as old as the world itself. It is reported of Hippocrates that he changed the morbific state of the atmosphere of Athens by kindling fires. Plutarch also makes mention of one Acron, of Athens, wlien the great plague visited that city at the commencement of the Pelo-ponesian war, and attributes to him the advice that was given to the Athenians to kindle large fires throtighout the streets, with the view of purify- ing the air, which is the same i^lan as was adopted by the priests of Egypt." Pliny also speaks of fires as a corrective of the state of the atmosphere, and Herodotus relates that fumigation with aromatics were recommended as a preventive of the plague.^ Odd Beliefs and Practices of Supekstitious Ages. The ancients attributed to their gods the authorship of epidemics, and tinder this belief, religious sacrifices were made to ajDpease their anger. Terror-stricken and demoralized, they abandoned all measures calculated to give them protection and relief and relied solely upon their offerings and theii* prayers at the foot of the altai* for preservation. Cardan and Valesco de Tarente did not fear to attribute the origin of disease to the in- fluence of certain planets, while Xat. Webster, an Ameri- can physician, gives also more than fifty instances of the concurrence of an epidemic Avith some commotion of '^Hippocrates (Adams' translation), Vol. 1, p. 342. 'Histoire de Medecine (Leclerc), Vol. 1, p. 57. •* Paulus Egineta, Vol. 1, p. 174. THE RAVAGES OF PESTILENTIAL DISEASE. 1 1 nature, such as earthquakes, volcanic eruptions and the appearance of comets, Jackson, Joubert and others, liave dwelt ui)on the influence of the moon upon epidemic disease; and during the plague that nearly depopulated Paris in 1580, Asiien forty thousand people were swept away, the sky was so clear and serene, that the stars were looked to as the cause A^hicli could not be found in the atmosphere.^ According to researches made by Eager,^^ in the earliest period, superstition and stellar influence took the principal place in the confused ideas of etiology. Ill- ordered doctrines led to all sorts of irrational practices. Among the Greeks, in the rites of Esculapius, the sick were not pcj-mitted to enter the temples, where they un- derAvent ti eatment, Avithont first being purified by various baths, frictions, and fumigations. All this was accom- panied by ceremonies similar to those practiced within the temples, namely, magical performances and fervent prayers recited in a loud voice, often with musical ac- companiment. As an accessory to the purification prelim- inary to being admitted, the patient was required to pass the night sta^etched on the skin of a sheep that had been offered as a sacrifice. Here he was ordered to compose his mind for sleep and await the arrival of the physician. Throughout these ages as Avell as in more recent times a fanciful association between the phenomena of the material world and the destinies of mankind closely linked the doctrine of etiology with aistrology. Thcii per- sistent belief of learned men in the relation of stellar con- ditions to epidemics is in part explained by the fact that astrologers Avho predicted epidemics wrought charms against the impending pestilence, thus saving their credit, in event the disaster did not materialize, by claiming that it had been averted through their elTorts. These primitive views of the origin of epidemics did not necessarily place the cause of the disease outside the earth and its immediate surroundings. Winds, thunder and •'Chastant: Observations on Yellow Fever, 1879, p. 5. ^•^ Eager: The Early History of Quarantine (Yellow Fever Bulletin No. 12, U. S. Treasury Dept), 1903, page 7. 12 HISTORY OF YELLOW FEVER. lightning, fogs, and even meteors were blamed for caus- ing pestilence, and the flight of birds and insects were supposed to be dependent phenomena. Xanaphanes, Ave hundred or six hundred years before Christ, expounded an idea that the sun was a torch and tlie stars candles that were put out from time to time. According to his notion, which was seriously accepted, the stars were not heavenly bodies in the wider sense, but meteors thrown off from the earth. So a belief in stellar influence did not carry the mind outside worldly ranges. For this reason other practices than j^rayers and sacrifices were belicA'ed to be effective. They consisted chiefly in efforts to dissipate the meteors, such as huge and numer- ous fires, and to avoid meteoric influence by confinement in closed or otherwise protected places. ^'During the period under consideration," concludes Dr. Eager, ^'the promptings of superstition were para- mount and the epidemiologists of the times confined them- selves principally to interpreting the signs of the heavens. More advanced views came as the result of reasoning, but the path of discovery by experimental science was not entered upon until after many centuries." It Avas a common practice among the Phenicians to immolate their children during the prevalence of epi- demics, ho]3ing thereby to appease the anger of the gods and put a stop to the pestilence. Plutarch relates the manner of Esop's death, B. C. 581. The famous fabulist went to Delphi with a great quantity of gold and silver to offer, in the name of Cresus, a great sacrifice to Apollo, and to give each inhabitant a con- siderable sum. A quarrel arose between Esop and the people of Delphi, occasioning hini afterwards to send back the money to Cresus. The people of Delphi caused him to be condemned as guilty of sacrilege, and to be thrown from the top of a rock. The god, offended by this action, punished them with a plague and famine, so' that, to put an end to these e^ils, the terrorized Delphians offered to make reparation to any of the relatives of Esop. ^'At the third generation," continues Plutarch, ^'a man presented himself from Samos. The Delphians made this man re- THE RAVAGES OF PESTILENTIAL DISEASE. 13 paration or satisfaction, and thereby delivered themselves from pestilence and famine which distressed tliem."^^ Epidemic disease was frequent in Greece before the Christian Era. The Athenians were wont to make annual sacrifices to Toxaris, '^the foreign physician," because their city Imd been delivered from the plague by his means, or rather by a woman Avho had dreamed that Toxaris, who dwelt at Athens, had told her that the pestilence would cease if they washed the streets with wine, "which they did, and the plague ceased immediately." In the year 665 B. 0., Thaletes, the Milesian, is reputed to have put a stop to an epidemic which had baffled the skill of the most renowned physicians of the time, by the influence of music. Had Thaletes lived in the present age, he Avould undoubtedly have amassed a princely fortune by stating what particular make of instrument he used. Un- fortunately, history is silent on this point. In the year B. C. 534, a terrible plague raged at Car- thage. The devastation was soi great, that the people sac- rificed their children to appease the gods. According to Niebuhr/^ the eruption of Mount Etna, which took place in the 81st. Olympiad, coincided exactly with the pestilence which devastated Rome about that period. The same authority says that in the year 301, the Nortliern Lights could be distinctly seen in Italy and were -'eminently connected with the fermcmt in the bowels of the earth." In the year 290, and also 295, the firma- ment seemed to be on fire, ''broken by flashes of lightning; armies and the tumults of battles were seen in the sky and sounds were heard which heightened the terror of this phenomenon." Dr. Howe (quoting Mebuhr) also speaks of another phenomenon which is said to have occurred in the year 295, and observes that, however incredible it may seem, "it ought not to be rejected as an idle tale." The para- graph referred to reads as follows : ^^Howe: Epidemic Diseases, 1865, p. 21. ^'Niebuhr: Lectures on Roman Historie (Howe, loc. cit, p. 85). 14 HISTORY OF YELLOW FEVER. '^There fell, we are told, a shower of flakes like flesh, T^'hlch the birds devoured. What remained on the ground did not rot." No explanation is made of this alleged phenomenon, except in metaphors, which, when carefully sifted, ex- plain nothing, as is usually the case with metaphors. In the Year of Kome 300, a plan was adopted to cause the cessation of the plague which had afflicted Kome 350 years from its foundation. The Komansi, by the advice of their oracle, sent ten deputies to Epidaurus, a town in ancient Greece, in the Peloponesus, celebrated for its magnificent temple of Esculapius. Thei delegatiou was headed by Quinctus Ogulnius, and the object was to bring the statue of Esculapius to Kome, as a means of stopping the ravages of the pest. On their arrival at Epidaurus, and while they were admiring the statute of Esculapius for its extraordinary size, the Komans perceived, emerg- ing from the base of the statue, a serpent. This unexpect- ed apparition, instead of causing dread and consternation, Avas regarded as a good omen by those present and im- pressed upon their minds feelings of awe and veneration. The serjjent glided through the crowd, sped swiftly through the streets of the town — followed by the populace — and betook itself to the vessels of the Komans and went straight to the apartment of Ogulnius. The Komans im- mediately erected a temple to Apollo, and the pestilence ceased.^^ An Extraordinary Historical Document. One of the most remarkable theories concerning the origin of epidemic disease was solemnly promulgated by the Faculty of Paris in 1665, to account for the ravages of the Black Plague, which was then devastating Europe. The pestilence commenced in December, 1664, and ended in January, 1666, a period of thirteen months. The learned medical men of France assembled at Paris in June, 1665, in order to discover the cause of the epidemic and devise " Leclerc : Histoire de Medecine. THE RAVAGES OF PESTILENTIAL DISEASE. l5 sanitary measures to arrest its progress. After much deliberation, the conclaye finally evolved the extraordin- ary document copied below, which, at this day, would be vieAved in the light of a burlesque, but which was looked upon as an oracular pronunciamento by the superstitious people of the time. We think the document possesses feuch an element of quaintness and absurdity, that we pub- lish it in full : ''We, the Members of the College of Physicians, of Paris, have, after mature consideration and consultation on the present mortality, collected the advice of our old masters in the art, and intend to make known the cause of this pestilence, more clearly than could be done ac- cording to the rules and principles of astrology and natural sciences; we, thereifore, declare as follows: ''It is known that in India, and the vicinity of the Great Sea, the constellations which combated the rays of the sun, and the warmth of the heavenly fire, exerted their power especially against that sea,, and struggled violently with its waters. ( Hence, vapours often originate which en- velope the sun, and convert his light into darkness.) These vapours alternately rose and fell for twenty-eiglit days; but at last, sun and fire acted so powerfully upon the sea, that they attracted a great portion of it to them- selves, and the waters of the ocean arose in the form of vapour; thereby the waters were, in some part, so cor- rupted, that the fish which they contained, died. These- corrupted waters, however, the heat of the sun could not consume ; neither could other wholesome water, hail or snow, and dcAV, originate therefrom. On the contrary, this A apour spread itself through the air in many places on the earth, and enveloped them in fog. "Such was the case all over Arabia; in a part of India; in Crete; in the plains and valleys of Macedonia; in Hungary, Albania and Sicily. Should the same thing occur in Sardinia, not a man will be left alive; and the like will continue, so' long as the sun remains in the sign of Leo, on all the islands and adjoining countries to which this corrupted sea-wind extends, or has already extended from India. If the inhabitants of those parts do not HISTORY OF YELLOW FEVER. employ and adhere to the folloAving, or similar means and precepts, we announce to them inevitahle death, except the grace of Christ preserve their lives : ^'We are of opinion, that the constellations, with the aid of Nature, strive, by virtue of their divine might, to protect and heal the human race; and to this end, in union with the rays of the sun, acting through the power of fire, endeavor to break through the mist. Accordingly, within the next ten days, and until the 17th of this ensuing month of July, this mist will be converted into a stinking deleterious rain, whereby the air Avill be much purified. Now, as soon as the rain shall announce itself, by thunder, or hail, every one of you should protect himself from the air; and, as well before as after the rain, kindle a large fire of vijie-wood, gTeen laurel or other green wood ; worm- wood and chamomile should also be burnt in great quanti- ty in the market places, in other densely inhabited locali- ties, and in the houses. Until the earth is again com- pletely dry, and for three days afterwards, no one ought to go abroad in the fields. During this time, the diet should be simple, and people should be cautious in avoid- ing (Exposure in the cool of the evening, at night, and in the morning. Poultry, and water fowl, young pork, old beef, and fat meat, in general, should not be eaten; but on the contrary, meat of a proper age, of a warm and dry, but on no account of a heating and exciting nature. Broth should be taken, seasoned with ground pepper, ginger and cloves, especially by those Avho are accustomed to' live temperately, and are yet choice in their diet. Sleep in the day-time is detrimental; it should be taken at night until sunrise, or some^vhat longer. At breakfast, one should drink little; supper should be taken an hour before sun- set, when more may be drunk than in the morning. Clear light wine, mixed wdth a fifth or a sixth part of water, should be used as a beverage. Dried or fresh fruits, with wine, are not injurious; but highly so without it. Beet root or other vegetables, whether eaten pickled or fresh, are hurtful ; on the contrary spicy pot-herbs, ais sage and rosemary, or wholesome. Cold, moist, watery food is in general prejudicial. Going out at night, and even until THE RAVAGES OF PESTILENTIAL DISEASE. 17 three o'clock in the morning, is dangerous, on acconnt of the dew. Only small river fish should be used. Too much exercise is hurtful. The body should be kept warmer than usual, and thus protected from moisture and cold. Kain water must not be employed in cooking, and every one should guard against exposure to wet weather. If it rain, a little fine treacle should be taken after dinner. Fat people should not sit in the sunshine. Good clear wine should be selected and drunk often, but in small quanti- ties, by day. Olive oil as an article of food is fatal. Equally injurious are fasting and excessive abstemious- ness, anxiety of mind, anger, and immoderate drinking. Young people, in autumn especially, must abstain from all these things, if they do not wish to run a risk of dying of dysentery. In order to keep the body properly opened, an enema, or some other simple means, should be employed, when necessary. Bathing is injurious. Men must pre- serve chastity as they value their lives. Everyone should impress this on his reicollection, but especially those who reside on the coast, or upon an island into which the noxious wind has penetrated." Htstortc Mortalities Caused by Pestilence in Ancient AND Medieval Times. If we were to compute the total mortality from pestilen- tial disease from the earlist times to the present day, the figure would be appalling and almost beyond credulity. Pandemics have played havoc with the human race. At times, half the pop|ilation of the world was swept away before an epidemic had run its course; it spared neither man nor beast, but surged like an overcharged torrent over leagues and leagues of country, overleaping the highest mountain summits, swirling over miles of desert land, crossing rivers, lakes and even seas, and finally, like a huge beast that has gorged itself to suffocation, ceasing its awful carnage for want of new material. We shall cite only the most notable examples of great mortality. 18 ' HISTORY OF YKLLOW FEVER. The greatest mortality caused by a single pestilence took place in Egypt in 1792/when 800,000 persons are reported to have perished. The next greatest mortality on record occurred in ^^aples and vicinity in 1656, where, in six months, 400,000 perished, almost depopulating that section of Italy. From December, 1664, to January, 1666, a period of thirteen months, the ''Great Plague" of Loudon caused a mortality of 69,000. Even ''Bonnie Scotland" comes in for a niche in the cinnals of epidemiology, for it is of record that a pestilence carried off 40,000 of her sons in A. D. 954. Let us now take a peep into antiquity. In the 1017 B. C, ''David, being elated with success, God sends a grievous pestilence, of which 70,000 died in less than three days." in 594 B. C. a third of the inhabitants of Jerusalem perished by pestilence. In 480 B. C, while the army of Xerxes Avas retreating into Asia, after the battle of Salamis, 150,000 died from pestilential disease. In 395 B. C, a terrible plague attacked Himilco's army, which was on its way to sack and destroy Swacuse; 50,000 died. In 378 B. C, according to Howe,^^ immediately after the arrival of the troops from Italy, Carthage had a most ten-ible calamity to struggle with. "The plague broke out afresh there and swept away an infinite number of in- habitants. This seems to have raged with gTeater violence than any distemper the city was ever visited with before, for such vast multitudes were carried off by it, that the country was, in a manner, depopulated." In B. C. 188, a great plague raged in the Greek Islands, Egypt and Syria, and destroyed 2,000 persons daily. In the reign of the Echeopean king, Micipsa (B. G. 125), according to Orosius, a great part of Africa was covered with locusts, which died by billions, causing a plague, which swept away an incredible number of people. In "Howe, loc. cit, p. 57. THE RAVAGES OF PESTILENTIAL DISEASE. 19 Kuinidia alone perished 800,000 persons, and in Africa proper 200,000, and also 30,000 Roman soldiers quartered about Ulica. At Utiea, particularly, the mortality raged to such a degree that 1500 dead bodies were carried out by one gate in one day. In B. C. 22, Rome was about depopulated by plague and famine. In A. D. 77 and 78 a most appalling pestilence raged in Southern Europe; 10,000 persos perished daily. In A. D. 717 an epidemic carried off 50,000 of the inhabitants 6t the then known world. In the Year of Rome 666, ^'all of a sudden the plague manifested itself, but with such violence, that in a few da^^s it carried off eleven thousand men." In the year of Rome 540, during the siege of Syracuse by Marcellus (according to Catrou and Rouille, Histoire Romaine, vol. 8, p. 152), it appears that Heaven took pleasure to combine all the scourges of its anger against unfortunate Syracuse. In addition to other calamities, a pestilence supervened to afflict the city. At first, the contagion commenced in the coiuntry. The heat, of the climate and the season had corrupted the air, and the filth which the sea ordinarily leaves upom the shore when the waters retire, had still further deteriorated it. The two camps of Himilco and Crispinus were first attacked. Then the malady communicated itself to the army of Marcellus, from the intercourse with that of Crispinus. Soon after Acredina was attacked by the pestilence. Thus aro^und the city, and in the interior of it, nothing was seen but the dead and dying. From the fear of catching the infec- tion by approaching the dead bodiesi, they were left with- out burial, to poison the place where they lay decompos- ing. Hippocrates and HimilcO' died of the scourge. The plague which broke out in the army of Sennacherib (B. C. 709), is said to have caused a mortality of 185,- 000. This was regarded by the Jews as a punishment of Divine Providence, meted out to Sennacherib for having invaded Judea. During the plague of Rome (A. D. 256), 2,000 persons were buried daily. In the year 89 B. 0., while Pompeius, a Roman general, 20 HISTORY OF YELLOW FEVER. was leading an army against Marius, the Carthaigenian, a plague broke out among the soldiers, which carried away 11,000 men in a feAV days. From A. D. 716 raged the great plagnie of Constanti- nople, which destroyed nearh^ 300,000 people in that historic city. In 1611, after a j)eriod of eight hundred and fifty-two years, occurred the second ''great plague" of Constantinople, when 200,000 persons are said to have perished. In A. D. 772, an epidemic carried off 31,000 of the popu- lation of Chichester, England. In 1545, the "Trousse Galante" swept away 10,000 of the foreign population of Boulogne, France. The fatali- ties among the natives could not be ascertained. ''In 1115,'- says Sauvel, "from the month of August to St. Andre's Day (NoYember 30), 6,000 infants died in Paris from smallpox. "^^ The "Black Plague" of the fourteenth century was one of the most appalling iDestilences which swept the earth. In the space of four years, 12,836,186 persons died. Asia, exclusive of China, lost 10,810,000. China alone lost 13,- 000,000 inhabitants. In Europe, the mortality reached the appalling figure of 18,916,186, Germanv alone losing 12,000,000 souls.16 In 1773, Persia was devastated by an awful pestilence. In the City of Bussorah alone, 80,000 perished. In 1799, the city of Fez, Africa,, lost 217,000 of her population by pestilence. In 1799, 3,000 persons died daily in Bombay, India. The fever which swept over the Coromandel Coast, India, in 1809, 1810 and 1811, caused the loss of 106,789 out of a population of 1,828,610. The ravages of the glandulas plague were enormous. In London, in 1625, it carried off not less than 35,117 indi- viduals; at Lyons, in 1628-29, in a population of 200,000, it is reported that 50,000 died ; at Marseilles, in 1720, the morta lity was 40,000 ; at Cyprus, in 1760, the deaths were '' Sauvel : Histoire et Recherches des Antiquitees de la Vilie de Paris. '^Ozanam: Histoire Medicale, etc., des Maladies Epidemiques, 1835, vol. 4, p. SG. THE RAVAGES OF PESTILENTML DISEASE. 21 70,000 ; at Meppo, 1761-62, the plague carried off 21,800 and in 1796-97, in the same city, the mortality amounted to 60,000. In 1720-21, in the space of seven months, 60,000 persons died of the plague at Marseilles, France. The Great Plagues of London. London shares the palm with Rome for having been the nidus of the plague from nebulous times. As early as 207 A. D., when Severus invated Britian, 50,000 of his soldiers perished from a pestilence which was then ravaging the island. Not counting the lesser epidemics, in which the mortality amonnted ''only to a few thousands," the follow- ing table will show the appaling havoc wrought by pestil- ence in London, without counting the balance of Britain, in the short period of forty-four years : Table of Deaths from all Diseases and from Pestilence in London, England ^ from 1592 to 1636. Year. Mortality from Mortality from All Diseases. Plague Alone. 1592 .. 25,886 11,503 1603 37,294 30,561 1625 51,758 35,403 1630 10,545 1,317 1636 23,359 10,400 Total mortality during forty-four years 119,042 89,184 It is thus seen that out of a total mortality of 119,042 from all diseases, the plague carried off 89,184. In December, 1664, twenty-eight years after the terrible visitation of 1636, began what is known to history as the ^'Great Plague of London." From its inception to January, 1666, a period of only thirteen months, it caused a mortality of 69,000. Some historians place the figures as high as 100,000. In 1666, also occurred the "Great Fire," which spread over 396 acresi, destroying over 13,2000 houses, ninety churches and many public buildings. CHAPTER III. THE GREAT EPIDEMICS OF THE MIDDLE AGES. The lugiiinal Pestilence of the Sixth Century. — The Black Plague or the Fourteenth Century. — Le Mai des Ardents. — The Eruptive Fevers of the Sixth Century. — The Sweating Sickness. — Notable Epidemics of Scurvy. — Leprosy and its Attendant Horrors. THE IXGUIXAL PESTILENCE OF THE SIXTH CENTURY. (Up to the year 1831, when the •'Fragments" of Ruffus were published, the prevailing opinion had been that Procopius, the Greek historian, was the first to give a description of the Glandular Plague of the East. Even after the publication of this remarkable work, such distinguished historians as Hecker, Rosenbaum, Fariset and Navman still gave the honor to Procopius, claiming that the newly-discovered manuscript was spurious. The passage referred to reads as follow^s: '"The buboes called pestilential are most fatal and acute, especially those which are seen occurring about Lybia, Egj^pt and Syria, and which are mentioned by Dionysius Curtus. Dioscorides and Posidonius make much mention of the plague which occurred in their time in Lybia; they saw it was accompanied by acute fever, pain and prostration of the whole body, delirium, and the appearance of large and hard buboes, w^hich did not suppurate, not only in the accustomed parts, but also in the groins and armpits." According to Adams, the only thing which detracts from the value of this paragraph is the diflBculty of determining exactly who the authorities are which are referred to in it. Of Dionysius Surtus nothing is known; indeed, it is more than probable that there is some mistake in the name. There are several medical authors by the name of Dioscorides and Posidomius, and it is diflacult to determine to which of them reference is made. Still, Adams finds no reason for questioning the authenticity of the passage. Ruffus flourished in the reign of Trajan, in the beginning of the second Century. The graphic description of this terrible pestilence and other epidemics of the Middle Ages, has been abstracted from the masterly translation of Dr. Dupuy's "Le Moyen Age Medical," by Dr. Thomas C Minor of Cincinnati These articles were originally pub- lished in the Cicinnati "Lancet- Clinic," of which Dr. Minor is associate editor, and an abstract is published in this volume by special p.ermis sion. — G. A.) In the sixth century after Christ, occurred the terrible epidemic known bj the name of the ''Inguinal Pestilence," THE GREAT EPIDEMICS OF THE MIDDLE AGES. 2S which, after ravaging Constantinople spread into Liguria, then into France and Spain. According to Procopius/ it attacked the entire earth, striking every race of people, sparing neither age nor sex ; differences in habitation, diet, temperament or occupa- tion of any nature did not stop its ravages; it prevailed in summer and in winter — in fact, at every season of the year. It commenced at the town of Pelusa, in Egypt, whence it spread by two routes, one through Alexandria and the rest of Egypt, the other through Palestine. After this it covered the whole world, progressing always by regular intervals of time and force. In the springtime of 543 it broke out in Constantinople and announced itself in the following manner : Many victims believed they saw the spirits of the de- parted rehabilitated in human form. It appeared as though these spirits appeared before the subject about to be attacked and struck him on certain portions of the body. These apparitions heralded the onset of the malady. The commencement of the disease was not the same in all cases. Some victims did not see the apparitions, but only dreamed of them; but all believed they heard a ghostly voice announcing their inscription on the list of those who were going to die. The fever at the onset of the attack came on suddenly, — some while sleeping, some while waking, some while at work. Their bodies exhibited nO' change of color, and the temperature was not very high. Some indications of fever were perceptible, but no signs of acute inflammation. In the morning and at night the fever was slight, and in- dicated nothing severe either to the patient or to the ^ Procopius, the Greek Historian, born at Caesarea in the year 500, left behind him numerous works, among which may be enumerated L'Histoire de Son Temps, in eight volumes (Procopii Caesariensis Historian sui temporibus). This history of the times by Procopius gives a full description of the plague, and is one of the chef d'oeuvres of medical literature, one that will never be excelled. In this work, nothing being omitted, not even the diiferent clinical forms, it is truly classical. 2i HISTORY OF YELlOW FEVER. physician who counted the pulse. Most of those who presented such symptoms showed no indications of ap- proaching dissolution; but the first day among some, the second day in others, and after several days in many cases, a bubo was observed on the lower portion of the abdomen, in the groin, or in the folds of the axilla, and sometimes back of the ears or on the thighs. Some patients were plunged into a condition of pro- found drowsiness ; others were victims to furious delirium. Those who' were drowsy remained in a passive state, seem- ing to have lost all memory of the things of ordinary life. If they had any one to nurse them they took food when offered from time to time, and if they had no care, soon died of inanition. The delirious patients, deprived of sleep, were eternally pursued by their hallcinations ; they imagined themselves haunted by men ready to slay them, and they sought flight from such fancied foes, uttering dreadful screams. A(S nothing was known of this strange disease, certain physicians thought its origin was due tO' some source of evil hidden in the buboes, and they accordingly opened these glandular bodies. The dissection of the bubo showed sub-adjacent carbuncles, Avhose rapid malignity brought on sudden death or an illness of but. few days' duration. In some instances the entire body was covered by black spots the size of a bean. Such unfortunates rarely lived a day, and generally expired in an houlr. many cases died suddenly, vomiting blood. As to treatment, the effects were variable, following the condition of the victim. Procopius states that, as a fact, no efficacious remedies were discovered that could either prevent the onset of the disease or shorten its dura- tion. The victims could not tell why they were attacked, nor how they were cured. The epidemic at Constantinople lasted four months, three months of which time it raged with gxeat violence. As the epidemic progressed the mortality rate increased from day to day, until it reached the point of 5,000 deaths per day, and on several occasions ran up to as high as 10,000 deaths in the twenty-four hours. Evagre, the scholastic, another Greek historian of the THE GREAT EJt'IDEMICS OF THE MIDDLE AGES. 25 sixth century, recounts in hs works the story of the plague at Constantinople. He states that he frequently observed that persons recovering from a. first and- second attack subsequently died of a third attack ; also that persons flying from an infected locality were often taken sick after many days of an incubating period, falling ill in their places of refuge in the midst of populations, free, up to that time, from the pestilence. In following the progress of this epidemic from the Orient to the Occident, it was noticed that it always com- menced at the sea-ports, and then traveled inland. The disease was carried much more easily by ships than it could be at the present time, inasmuch as there were no quarantines and no pest houses for isolating patients. It entered France by the Mediterranean Sea. It was in 549 that the plague struck Gaul. ''During this time," says Gregory of Tours, ''the malady known as the inguinal disease ravaged many sections; the province of Aries was cruelly depopulated."^ This illustrious historian wrote, in another passage: "We learned this year that the town of Narbonne was devasted by the groin disease, of so deadly a type that when one was atacked he generally succumbed. Felix, the Bishop of Nantes, was stricken down and appeared to be desperately ill. The fever having ceased, the humor broke out on his limbs, which were covered with pustules. It was after the application of a plaster covered with cantharides that his limbs rotted off, and he ceased to live in the seventieth year of his age. "Before the plague reached Auvergne it had involved most all the rest of the country. Here the epidemic at- tacked the people in 567, and so great was the mortality that it is utterly impossible to give even the approximate number of deaths. Populations perished en masse. On a single Sunday morning three hundred bodies were counted in St. Peter's Chapel, at Clermont, aAvaiting funeral service. Death came suddenly; it struck the axilla or the groin, forming a sore like a serpent that bit ^ Georgius Florentinus Gregorius, Historia Francorum, de 417 a 591 A. D. 26 HISTORY OF YELLOW FLVER. SO cruelly that men rendered up their souls to God on the second or third day of the attack, many being so violent as to lose their senses. At this time Lyons, Bourges, Chalons, and Dijon were almost depopulated by the pestilence." In 590, the towns of Ayignon and Viviers were cruelly ravaged by the Inguinal Disease. The plague reached Marseilles, however, in 587, being carried there by a merchant vessel from Spain, which entered the port as a center of infection. Eight persons who bought goods from this trading vessel, and who all lived in the same house, were carried off by this plague. The spark of the epidemic did not burn very rapidly at first, but after a certain time the smouldering fire of the pest burst out in a blaze that almost consumed Marseilles. Bishop Theodorus isolated himself in a wing of the cloister of Saint Victor, with a small number of persons, who remained with him during the plague, and in the midst of their general desolation continued to implore Almighty God for mercy, with fasting until the end of the epidemic. After two months of calm, the population of the city commenced to drift back, but the plague reap- peared anew and most of those who returned died. Anglada,^ who derives most of his citations from Gregory of Tours, thinks that the plague that devasted Strasbourg in 591 Avas only the same inguinal disease that ravaged Christendom. He cites, in support of his asser- tion, that passage from the historian-poet Kleinlande, translated by Dr. Boersch : "In 591 there was a great mortality throughout our country, so that men fell down dying in the streets, ex- piring suddenly in their houses, or even at business. When a person sneezed his soul was apt to fiy the body; hence the expression on sneezing, ^God hless you/ And when a person yawned they made the sign of the cross be- fore their mouths." Such are the documents we possess on the great epidemic of Inguinal Plague of the fourth century, docu- ments furnished by historians, to whom medical history ^Anglada: Etude sur les Maladies Eteintes et les Maladies Nouvelles. THE GREAT EPIDEMICS OF THE MIDDLE AGES. J7 is indebted, and not from medical authors, who left no records of the pestilences of that period. The Black Plague. The Black Plague of the fourteenth century was more destructive even than the bubonic pest of the sixth century, and all other epidemics observed up tO' the present day. In the space of four years, more than twenty-five millions of human beings perished — one-half the population of the world. Like all other pestilences, the Black Plague came from the Orient — from India, and, perhaps, from China. Europe was invaded from East to West, from South to North. After Constantinople, all the islands and shores of the Mediterranean were attacked, and successively became so many foci of disease, from which the pestilence radiated inland. Constantinople lost two-thirds of its population. Cyprus and Cairo counted 15,000 deaths. Florence paid an awful tribute to the disease, so great being the mor- tality, that the epidemic has often been called Peste de Florence. According to Boccacio, 100,000 persons per- ished. Venice lost 20,000 victims, Naples 60,000, Sicily 53,000 and Genoa 40,000. In Rome, the dead were innu- merable. In Spain, Germany, England, Poland and Russia, the malady was as fatal as in Italy. In London they buried 100,000 persons. It was the same in France. Avignon lost 150,000 citizens in seven months, among whom (1348) was the beautiful Laura de Noves, immortalized by Petrarch. At Marseilles, 56,000 people died in one month; at Montpellier, three-quarters of the population, including all the physicians, went dcwn in the epidemic. Narbonne had 30,000 deaths and Strasbourg 16,000 in the first year of the outbreak. Paris was not spared. The Chronique de St. Denis in- forms us that, '^in the year of Grace 1348, commenced the aforesaid mortality in the Realms of France, the same lasting about a year and a half, increasing more and more, until Paris lost each day 800 inhabitants; so that the 28 HISTORY OF YELLOW FEVER. number who died there amounted to more than 500,000, while in the town of St. Denis the number reached 16,000." Among the yictims were Jeanne de Bourgogne, wife of Philip YI; Jeanne II, Queen of Navarre and grandchild of Philip the Beautiful. In Spain, died Alphonso XL, of Castille. Happily for the human race, during the years which followed the plague, the births were greatly in excess of the deaths, as though Nature desired to repair the ravages wrought by the pestilence. According to the records of that time, many persons died the first day of their illness. These bad cases were announced by a violent fever, with headache, vertigo, drowsiness, incoherency in ideas, and loss of memory; the tongue and palate were black and browned, exhaling an almost insupportable fetidity. Others were attacked by violent inflammation of the lungs, with hemorrhage; also gangrene, which manifested itself in black spots all over the body; if, to the contrary, the body was covered by abscesses, the patients seemed to have some chance for recovery. Medicines were powerless, all remedies seeming to be useless. The disease attacked rich and poor indiscrimin- ately; it overpowered the robust and debilitated; the young and the old were its victims. On the first symptom the patients fell into a profound melancholy and seemed to abandon all hope of recovery. Ths moral prostration aggTavated their physical condition, and mental depres- sion hastened the time of death. The fear of contagion was so great that but few persons attended the sick. The clergy, encouraged by the Pope, visited the bed- sides of the dying who bequeathed all their wealth to the Church. The plague was considered on all sides as a pun- ishment inflicted by God, and it was this idea that in- duced armies of penitents to assemble on the public streets to do penance for their sins. Men and women went half naked along the highways, flagellating each other with whips, and, growing desperate with the fall of night, they committed scandalous crimes. In certain places the Jews were accused of being the authors of the plague by pois- oning the wells; hence the Hebrews were prosecuted. THE GREAT EPIDEMICS OF THE MIDDLE AGES. 29 sometimes burned alive by the fanatical sects known as Flagellants, Begardes and Turlupins, who were encour- aged in their acts of violence by the priests, notwithstand- ing the intervention of Clement VI. Physicians were not only convinced of the cantagious nature of the disease, but also believed that it could be transmitted by look and word of mouth. Such doctors obliged their patients to cover their eyes and mouth with a piece of cloth whenever the priest or physician visited the bedside. Guillaume de Machant, poet and valet de cliaiiibre of Philip the Beautiful, mentions this fact in one of his poems : ■'They did not. dare, in open air To even speak by stealth, Lest each one's breath might carry death By poisoning the other's health." And, in the preface of the ''Decameron," Boccacio re- marks in his turn : ''The plague communicated direct, as fire to combustible matter. They were often attacked from simply touching the sick; indeed it was not even necessary to touch them. The danger was the same when you listened to their words or even if they gazed at you." One thing is certain — those who nursed the patients surely contracted the disease. All the authorities of the Middle Ages concur in their statements as to the contagious nature of the plague. The rules and regulations enforced against the afflicted were barbarous and inhuman. "Persons sick and well, of one family, when the pest developed," says Black^, were held, without distinction, in close confinement in their home, while on the house-door, .a red cross was traced, bearing the sad and desperate epitaph : Dieu, ayez pitie ne nous!* "No one was permitted to leave or enter the plague- stricken house, save the physician and nurse, or other persons who might be authorized by the Government." * Black: Histoire de la Medecine et da la Chirurgie. * Lord, have mercy on us! 30 HISTORY OF YELLOW FEVER. We can well judge of the terror inspired by the pestil- ence by the precautions which the physicians who attend- ed the sick took. In his treatise on the plague, Mauget describes the costumes worn by those who approached the bedsides of patients : ''The costumes worn were of Levant morocco, the mask haying crystal eyes and a long nose filled with subtle per- fumes. The nose was in the form of a snout, with an opening on each side. These openings served as respira- tory passages and were well-filled at the anterior portion with drugs, so that at each breath they contained a medi- cated air. Under a cloak, the doctor also wore buskin made of morocco; closely-sewed breeches were attached to the bottines above the ankles ; the shirt, the hat and the gloves were also of soft morocco.'' Thus accountered, the doctor resembled a modern diver clad in a suit of leather. All this sounds ridiculous at the present age, but it must be understood that the great epidemics of plague were of a nature to terrify ignorant populations. The nar- ratives of historians of that epoch show them to be im- bued with the superstitious ideas of antiquity. This at- tack of an invisible enemy, whose blows fell right and left, paralyzed and terrified every one. ''In the midst of this orgy of death," remarks Angiada, "the thought of self- preservation absorbed every other sentiment. Dominated by this selfish instinct the human mind shamelessly dis- played its cowardice, egotism and superstition. Social ties were rudely sundered, the affections of the heart laid aside. The sick were deserted by their relatives; all flew with horror from the plague-breathing air and contact with the dreadful disease. The corpses of the victims of the epidemic, abandoned without sepulture, exhaled a hor- ribly putrid odor, and became the starting point of new infectious centres. The worse disorder overthrew^ all con- ditions of existence. Human passions raged uncontrolled ; the voice of authority was no longer respected ; the wheels of civilization ceased to revolve." LE MAL DES ARDENTS. Towards the end of the tenth century a new epidemic appeared in Europe, the ravages of which spread terror THE GREAT EPIDEMICS OF THE MIDDLE AGES. 31 among the people of the Occident ; this disease was known by the name of Mai des Ardents^ Sacred Fire, St. An- thony's Fire, St. MarcelFs Fire, and Hell Fire. This great epidemic of the Middle Ages is considered by many modern writers as one of the forms of ergotism, notwithstanding the contrary conclusions arrived at by the Commission of 1776, composed of such men as Jussieu, Paulet, Saillant, and Teissier, who were ordered to report as to the nature of the disease by the Royal Society. Ac- cording to the Avork of this Commission the Mai des Ar- dents Avas a variety of plague, Avith buboes, carbuncles and petechial spots, while St. Anthony's fire was only gangrenous ergotism. This is a remarkable example of the confusion into which scientific facts were allowed to fall through the fault of careless authors. It is in such instances that Ave may estimate the importance of history. We find in the ''Chronicles of Frodoard," in the year 945, the following : "The year 945, in the history of Paris and its numerous suburban Adllages, a disease called Ignis Plaga attacked the limbs of many persons, and consumed them entirely, so that death soon finished their sufferings. Some few survived, thanks be to the intercession of the Saints; and CA^en a considerable number were cured in the Church of Notre Dame de Paris.. Some of these, believing them- selves out of danger, left the church; but the fires of the plague were soon relighted, and they were only saved by returning to Notre Dame." Sauvel, the translator of Frodoard, remarks that at this epoch the Church of Notre Dame served as a hospital for the sick attacked by the epidemic, and sometimes con- tained as high as six hundred patients. Another historian of the time was Raoul Glaber,^ who mentions that ''in 993 a murderous malady prevailed among men. This was a sort of hidden fire, Ignis Oc- cultus, Avhich attacked the limbs i^nd detached them, from the trunk after having consumed the members. ^ The "Chronique de Raoul Glaber," Benedictine of Cluny, covers the period between the year 900 and 1046. It may be found translated in the collection of memoirs on the History of France by Guizot. 32 HISTORY OF YELLOW FEVER. Among some the deToiiring effect of this fire took place in a single night.** "In 1039," continues onr atithor, "diyine vengeance again descended on the human race with fearful effect and destroyed many inhabitants of the world, striking alike the rich and the poor, the aristocrat and the peasant. Many persons lost their limbs and dragged themselves around as an example to those who came after them." In the Chrouiele of France, from the commencement of the Monarchy up to 1029,^ the monk Adhemar speaks of the epidemic in the following terms : "In these times a pestilential fire [pestilential ignis) attacked the popula- tion of Limousin; an infinite number of persons of both sexes, were consumed by an invisible fire." Michael Felibien, a Benedictinee friar of Saint Maur, also left notes on the epidemic of gangTcne. He states in his History of Paris : "In the same year, 1129, Paris, as the rest of France, was afflicted by the maladie cles a relents. This disease, although known from the morality it caused in the years 915 and 1011, was all the more ter- rible inasmuch as it api^eared to have no remedy. The mass of blood, already corrtipted by internal heat which devoured the entire body, pushed its fluids outwards into ttimors, which degenerated into incurable ulcers and thus killed oft' thotisands of people." We cotild make many more citations, derived from ancient writers, but we think we have quoted enough to prove that the Mai des Ardent s was only the plague con- founded with the symptoms known as gangrenous ergot- ism. Cotild it not have been a i)liigtie of a gangrenous type? We cannot positively aflirm, however, that it had no connection with poisoning by the sphaceJia developed in grain, particularly on rye. Its onset was sudden and often very rapidly followed by a fatal termination. The Eruptive Fevers of the Sixth Century — Variola, Measles, Scarlatina. Before the sixth century, the terrible j^eriod of the plague, one never heard of the eruptive fevers. Small- " Xouvelle Bibiiotheque des Manuscripts. THE GREAT EPIDEMICS OF THE MIDDLE AGES. S3 pox, measles and scarlet fever were unknown to the an- cients. Neither Hippocrates nor Galen nor any of the Greek physicians Avho practiced in Kome make mention of these diseases. The historians and poets of Greece and Italy who have written largely on medical subjects remain mute on these three great questions in pathology. Some authors have endeavored to torture texts for the purpose of throwing light on the contagious exanthemata, but they have not been repaid for their fresh imagination.'^ It is admitted to-day that the eruptive fevers are compara- tiveh^ new diseases, which made their appearance in the Middle Ages. The first document that the history of medicine pos- sesses on this point is that left by Marius, Bishop of Aventicum, in Switzerland, who says, in his chronicle, ^^Anno 570, morl>us validus cum profluvio ventris et vari- ola, Italiam GaUiamque valde affecit/^^ Ten years later, Gregory of Tours described the symp- toms of the new disease in the following terms :^ ''The fifth year of the reign of Childebert, 580, the re- gion of Auvergne was inundated by a flood and numerous weather disasters, which were followed by a terrible epi- demic that invaded the whole of Gaul. Those attacked had violent fevers, accompanied by vomiting, great pain in the neighborhood of the kidneys, and a heaviness in the head and neck. Matter rejected by the stomach looked yellowish and even green, many deeming this to be some* secret poison. The peasants called the pustules corals.^^ Sometimes, after the application of cups to the shoulders ^ Satirical writers would not have failed to have spoken of the marks left by sraall-pox. Such authors as Martial, who frequented the public baths in order to write up the physical infirmities of his fellow-townsmen, to the end of divulging their deformities in biting epigram, would only have been too happy to have mocked the faces of con- temporaries marked by the cicatrices of small-pox. *In the year 570, a violent disease, with running of the belly and variola, cruelly afflicted Italy and France. ® Gregorii Turonensis, Opera Omnia, Liber V. ^•^ Latin corallum, which signifies heart, lung, intestines, and by extension of meaning, the interior of the body. $^ HISTORY OF YELIOW FEVER. or limbs, blisters were raised, which, when broken, gave issue to sanious matter, which oftentimes saved the pa- tient. Drinks composed of simples to combat the effects of the poison were also very efficacious. ''This disease, which commenced in the month of Au- gust, attacked all the very young children and carried them off. "In those days Chilperic was also seriously aflaicted, and as the King commenced to convalesce his youngest son was taken with the malady, and when his extremity was perceived he Avas given baptism. Shortly afterwards he was better, and his eldest brother, named Chlodobert, was attacked in his turn. They placed the prince in a lit- ter and carried him to Soissons, in the chapel of Saint Medard; there he was placed in contact with the good Saint's tomb, and made vows to him for recovery, but, very weak and almost without breath, he rendered his soul to God in the middle of the night. ''In those days, Austrechilde, wife of King Gontra, also died of the disease ; while Nantin, Count of Angouleme, succumbed to the same malady, his body becoming so black that it appeared as though calcined charcoal." It will thus be seen that smallpox came from the Orient — that eternal centre of pestilence and curses. From the seventh century the Saracen armies spread the malady wherever they passed — in Sja^a, Egypt and Spain: in their turn, the Crusaders, in returning from the Holy Land, brought the disease into France, England and Ger- many; from these foci spread the great epidemics of the twelfth and thirteenth centuries, after which smallpox be- came periodically epidemic, appearing and disappearing without causation, but alwaj^s destroying myriads of vic- tims. "In 1445," says Sauvel, "from the month of August to St. Andre's Day (November 30) over 6,000 infants died in Paris from smallpox."^^ The physicians knew neither the nature nor the treatment of the disease. The measles was first noted at the same time as the -^ Sauvel : Histoire et Recherches des Antiquites de la Ville de Paris. THE GREAT EPIDEMICS OF THE MIDDLE AGES. 35 small-pox, making its first appearance as an epidemic in the sixth century. It is more than probable that the measles originated in Egypt, and, according to Borsieri, it had such an extension throughout Western Europe that there were but few per- sons who had not suffered attacks. The history of measles, however, is less clearly defined than that of small-pox, although Anglada says that it figured among the spotted diseases, of which Gregory of Tours speaks. But it was only in the sixteenth cCiitury that Prosper Martian exactly describes the disease. Says Martian, '^It is a disease of a special type, peculiar to children. It commences with a yiolent fever, followed, towards the third day, by an eruption of small red spots, which become elevated by degrees, making the skin feel rough to the touch. The fever lasts until the fifth day, and when it has ceased, the papules commence to disap- pear.-' Measles was designated in the middle ages under the name MorhiUi, which signified a petty plague, the same that Morbus meant a special plague. It is then fair to presume that the type of disease was no more serious than it is at the present day. It is probable that the measles of the sixth century in- cluded at the same time small-pox, measles and scarlet fever, of which the ancients made no differential diag- nosis. Anglada affirms the co-existence of all forms of eruptive fevers and gives the following reasons : ''The contemporaneous appearance of variola and rube- ola represents the first manifestation of an epidemic con- stitution, resulting from a collection of unknown influ- ences as to their nature, but manifest by their effects. The earth was thence prepared to receive scarlatina, and it soon came to bear its baleful fruits. We do meet some mention of scarlet fever in the writings of the Ara- bian School, but it is merely suspected and only vaguely indicated. But when we remember how difficult it often is to diagnose at first between variola and measles, we are not astonished at the indecision manifested in adding an- other exanthematous affection to the medical incognito. It was onlv after innumerable observations and the ex- 36 HISTORY OF YELLOW FEVER. perience of several centuries that the third new disease received its nosological baptism. There is nothing to prove that it did not co-operate with earlier epidemics of variola and rubeola, remaining undistinguished as to type, however." What clearly proves that there was confusion between the various fevers of exanthemata is that Ingrassias de- scribes scarlatina in 1510, under the name of rosaUia, add- ing, "Some think the measles and rosaUia are the same malady; as for me, I have determined their differences on many occasions.'' These facts appear conclusive enough to admit that measles and scarlet fever are,, like variola, the products cf the epidemic constitution developed during the sixth century, as contemporaries of the bubonic plague, all these maladies representing the medical constitution of the first centuries of the Middle Ases. "»' The Sweating SickxeSc. The name of Sweating Sickness was given to the gTcat epidemic of fever that appeared in England in the fifteenth century, and thence extended over Continental Europe. This ej)idemic broke out in the month of Septem- ber, 1186, in the army of Henry YIL, encamped in Wales, and soon reached London, extending over the British Isles with frightful rapidity. Its appearance was alarming and while it lasted, which was only a month, it made a considerable number of victims. ^'It was so terrible and so acute that within the memory of man none had seen its like." This epidemic reappeared in England in 1513, 1517, and 1551. It was preceded by very moist weather and violent winds. The mortality was great, patients often dying in the space of two hours ; in some instances half the popula- tion of a town being carried off. The epidemic of 1529 was surely murderous; King Henry VIII was attacked and narrowly escaped death. Although flying from vil- lage to village the nobility of England paid an enormous tribute to the King of Terrors. The Ambassador from France to London, L. du Bellay, writing on the 21st of THE GREAT EPIDEMICS OF THE MIDDLE AGES. Si July, 1529, remarks: ''The day I visited the Bishop of Canterbury eighteen of the household died in a few hours. I was about the only one left to tell the tale, and am far from recovered 3^et." This same year the sweating sickness spread all over Europe. It made terrible ravages in Holland, Germany, and Poland. At the famous synod of Luther and Zwingie, held at Marburg, the Reformed ministers seized by fear of death prayed for relief from the pestilence. At Augusburg in three months eighteen thousand people were attacked and fourteen hundred died. This epidemic did not extend as far as Paris, but it de- veloped in the north of France and Belgium. Fernel, physician to Henry II., who practiced in Paris, likewise speaks- of this sudorific sickness in one of his works. ^^ It prevailed generally in summer and autumn, especial- ly when the weather was moist and foggy. Contrary to what is seen in other epidemics, it was observed that the weak and poor and the old and infants were not attacked as often as robust persons and those in affluent circum- stances. The symptoms noted hj physicians, such as Kaye and Bacon, may be classed into three distinct periods : 1. The period of chill, characterized by pains and itching in the limbs, an extraordinary prostration of the physical forces — a tremulous, shaky period. 2. The period of sweat, preceded by a burning heat all over the body and an unquenchable feverish thirst. The patient was agitated, disquieted b}^ terror and despair. Many complained of spasms in the stomach, followed sometimes by nausea and vomiting, suffocation and lum- bar pains, headache, with palpitation of the heart and proecardial anxiety. This period was announced by a high delirium, sometimes muttering, sometimes loqua- cious; a fetid sweaty odor, irregular pulse, coma, and, in the last named condition, death always occured. 3. The duration of the disease was most frequently but a few hours, rarely exceedingly a day, whether the termin- ation was favorable or fatal. '- Ferneli : Universa Medico S8 HISTORY OF YELLOW FEVER. Convalescence was always long, often being complicated by diarrhoea or dropsy. It has been remarked in this con- nection that the malady might be confounded with the miliary sweat observed in Picardy and central France, but in the first named disease no cutaneous eruption was observed. Fernel clearly affirms this statement, as he says: ''In this affection there is no carbuncle, bubo, ex- anthema or eczema, but simply a hypersecretion of sweat." Such was the sweating sickness of the sixteenth cen- tury, which made so few victims in France, but which de- stroyed so many people in England and Germany.^^ The origin of this disease has been often discussed, and also its nature ; but all theories expounded by various authors partake of the doctrines of other days and are too anti- quated to be revamped. The Scurvy. It has been supposed by many that Hippocrates de- scribed scurvy under the name of Enlarged Spleen, an af- fection attributed to the use of stagnant water and char- acterized by tumefaction of the gums, foul breath, pale face, and ulceration of the lower limbs. But the study of the Hippocratic passage leads us to think that these symp- toms were more of the character of scrofula than of scurvy. The recital by Pliny of the disease of the Eoman soldiers while on an expedition to Germany seems to in- dicate scurvy, which Coelius Aurelianus, and after him the Arabian physicians, claims presented only a slight analogy to that affection. Springer thinks that we may find the first traces of scurvy in the expedition of the Normans to Wineland, in ^^ According to the Climatologist, vol. 1, p. 63, 1888, the "Sweat- ing Sickness" appeared in epidemic form in 1887. It broke out in the Department of Vienne, Haute Vienne, in March of that year. The French Government prompt- ly sent .a commission of prominent sanitarions, with Prof. Brouardel at their head, into the infected districts, with power to take measures for the restriction of the disease. Strict isolation and disinfection soon brought the out- break to an end. — G. A, THE GREAT EPIDEMICS OF THE MIDDLE AGES. 39 the first years of the eleventh century. In admitting that the men commanded by Eric Thorstein were obliged to winter on the western shores of Wineland and almost all succombed to an epidemic malady of that country, proves that it Avas nothing but scurvy, although the word's only signification, in Danish, is ulceration of the mouth. We have, besides, another document, which has great authentic value, a proof transmitted to us by our earliest and best chronicler of the Middle Ages, Joinville, the friend and companion of Saint Louis in his Crusade into Palestine. In his memoirs he gives a very succinct re- cital of the epidemic of famine and scurvy which attacked the French army on the banks of the Nile in 1248, just after the battles of Mansourah.^^ The relation of Joinville leaves no doubt as to the na- ture of the epidemic that attacked the Crusaders. He gives a minute pen picture of the debility, and hem- orrhages, the livid ecchymosis of the skin, the fungous tumefaction and bleeding of the gums, which character- ize the disease known as scurvy. According to the writings of some German physicians of the fifteenth century, this malady was endemic in the septentrional portions of Europe upon the shores of the Baltic Sea. In Holland numerous epidemics of scurvy were observed among the lower classes of the population, coinciding with bad conditions of public hygiene, such as food consisting of salt and smoked meats, dwellings lo- cated on marshy ground, cold atmospheres charged with fogs, etc. This was the same infection that attacked our colonies in Canada, but at that time we had no knowledge of the therapeutic indications in such emergencies. A proof of this remarkable observation is inscribed on the registers of Cartier on his vessels during his sojourn in Canada. ^^ Leprosy. Leprosy is a disease originating in the Orient; Egypt and Judea were formerly the principal infected centres. ^* Joinville: Histoire de Saint Louis. ^'Cartier: Bref Recit et Succincte Narration de la Navigation Faite aux Ysles de Canada. Paris, 1545. 40 HISTORY OF YELLOW FEVER. It was the return of an expedition to Palestine, under Ponipey, that imported the malady to Italy. In the first years of the Christian Era it is mentioned by Celsus, who advised that it should be treated by sweating, aided by vapor baths. Some years later Areteus used hellebore, sulphur baths, and the flesh of vipers taken as food, a treatment adopted by others, as, for instance, Musa and Archigenes. In the second century the disease was in Gaul ; Soranus treated the lepers of Aquitaine, who were numerous. ^^ According to Yelley, leprosy was common in France in the middle of the eighth century, when Nicholas, Abbot of Corbeil. constructed a leper hospital, which was never much frequented until after the Crusades of the eleventh and fctirteenth centuries. At this period the number of lepers, or lad res, a name given to the unfortunates in re- membrance of their patron saint, St. Lazarus, became so gTeat that every town and village was obliged to build a leper house in order to isolate the afflicted. Under Louis VIII. there were 2,000 of these hosiDitals; later the num- ber of such asylums reached 19,000. According to the historians of this time, when a man was suspected to be a leper he cotild have no social rela- tions without making full declaration as to what the real nature of his complaint might be. Without this j)recau- tion his acts were void, from the caxDitiilary of Pepin, which dissolved all marriage contracts with lepers, to the law of Charlemagne, that forbade their associating with healthy persons. The fear of contagion was such that in places where no leprosy existed they built small houses for any one who might be attacked ; these houses were called fto/r/ev.^" A gray mantle, a hat and wallet, were ^^^ Gregory of Tours says that in Paris they had a place ol reiuge, where they cleaned their bodies and dressed their sores " Tbey designated by the name of borde, bordeau, bordell, bordette, bourde, or boiirdeau, a small house or cabin built on the edge of town; a cabin intended to contain lepers. The word bordell. a house of ill-fame, as used even in modern days, takes its origin from borde, an asylum for lepers THE GREAT EPIDEMICS OF THE MIDDLE AGES. 41 also supplied the victims, also a tartarelle, a species of rattle, or a small bell, with which they warned all passers near not to approach. They also had a cup placed on the far side of the road, in which all persons might drop alms without going near the leper. Leper houses were enriched, little by little, by the liber- ality of kings and nobles and the people, and to be a leper became less inhuman and horrible than at the be- ginning. After entering a leper house the victim was considered as dead under the civil law, and in order to make the pa- tients better understand their position the clergy accom- panied them to their asjdum, the same as to their funeral, throwing the cemetery dust on them while saying: '^En- ter no house save your asylum. When you speak to an outsider, stand to the windward. When you ask alms, sound your rattle. . You must not go far from the asylum without your leper's robe. You must drink from no well or spring save on your own grounds. You must pass no plates or cups without first putting on your gloves. You must not go barefofted, nor walk in narrow streets, nor lean against Avails, trees, or doors, nor sleep on the edge of the road," etc. When dead they were interred in the lepers' cemetery by their fellow-sufferers. It is true that each time that sanitary measures were relaxed by the authorities — such, for instance, as the per- fect isolation of the patients — an increase in the number of lepers was noticeable. When this was observed the old-time ordinances were enforced again with vigor. It was thus in 1371 the Provost of Paris issued an edict enjoining the lepers to leave the Capital within fifteen days, under heavy corporal and pecuniary penalties; and in. 1388, all lepers were forbidden to enter Paris without special permission; in 1402 this restriction was renewed, ^'under penalty of being taken \)j the executioner and his deputies and detained for a month on a diet of bread and water, and afterwards perpetual banishment from the kingdom." Finally, in April, 1488, it was announced ^^all persons attacked by that abominable, very dangerous and contagious malady known as leprosy, must leave Paris 42 HISTORY OF YELLOW FEVER. before Easter and retire to their hospitals from the date of issuance of this edict, under penalty of imprisonment for a month on bread and water ; and, where they had property, the sequestration of their houses and jewels and arbitrary corporal punishment; it was permitted them, howeyer, to send things to them by servants, the latter being in health." We can understand from this how these poor wretches, at different epochs, were accused of horrible crimes, among other things, poisoning rivers, wells, and fountains. As regards this accusation, says the author of the Distion- naire des Moeurs des Francais^ Philip le Long burned a certain number of these poor wretches at the stake and confiscated their wealth, giving it to the Order of Malta and St. Lazare. A minute description of this disease will be found in the works of Barbarin.^^ The physicians of leper hospitals have left behind a great number of medical documents bearing on the char- acteristics of the disease, but their observations are so confused that we can only conclude that they considered all cutaneous maladies as belonging to the same constitu- tional vice. In 1543, leprosy was so widespread in France, as to be beyond sanitary control, and the edict of Francois I., re- establishing leper hospitals, amounted to nothing. There were too many affected people. The Hospital of Lour- cine, which was sf»ecially devoted to these cases at Paris, contained 600 patients in 1540, and in the wards of Trinity Hospital and the Hotel Dieu there were many more. It was the same in the Provinces, notably at Tou- louse, which had the merit of creating the first hospital of its kind ever instituted. Finally, fifty years later, in 1606, for want of lepers, the leper asylums were offlcially ^'^ Etienne Barbazin, erudite and historian, born in 1696, author of a number of works on the History of France: "Recueil Alphabetique de Pieces Historiques"; "Tableaux et Contes Francais, des XII., XIIL, XIV., et XV., Siecles"; "The Orders of Chivalry, etc." He also left numerous manuscripts on the origin of the French language. See "Bibliotheque de TArsenal." THE GREAT EPIDEMICS OF THE MIDDLE AGES. 43 closed. Henry IV., in a proclamation, gave those remain- ing ''to poor gentlemen and crippled soldiers." Thus ended the epidemic of leprosy in France, which had prevailed from the second century, observing the same progress in other countries of Western Europe dur- ing the same period of time. CHAPTEK lY. INSECTS AS PROPAGATORS OF DISEASE. How Pestilence is Spread by Flies, Mosquitoes, Fleas and Other Insects. — Instances Where Disease Was Conveyed by Bed-Bugs and Ants. — The Role played by the Cattle-Tick and the Tsetse-Fly. — Sum- marj' of the Mosquito Doctrine. — Bibliography. In the medical part of this Tolume will be found a de- tailed scientific account of the mosquito theory. For the benefit of the lay reader, however, who is either too busy to digest the riews expressed in these instructive observa- tions, or who does not care to tussle with medical phrase- olooy, we will give a short talk regarding the role played by insects in the propagation of disease. There is no novelty in the doctrine of insect or animal- cular origin of disease. Many of the older writers, most conspicuous amongst whom are Linnaeus, Kircher and Lyander, have promulgated such an opinion, and it has been vaguely presented to the notice of the medical pro- fession in the past ; but it was not until after the publica- tion of Ebrenberg's great work on Infusoria (1838) that its bearings were fully appreciated. It will no doubt be ncAvs to many to learn that the mos- quito theory of the transmission of yellow fever came very nearly being expounded over half a century ago. Dr. Xott, of Mobile, in a paper published in 1848,^ reviews the situation in a scholarly manner and attributes the speci- fic cause of yellow fever to ''some form of insect life." He does not mention the mosquito as the active agent of transmission, but, in a long and carefully-prepared paper, dwells upon the fact that "certain insects'' are capable of transmitting the disease. Among other things. Dr. 'Nott makes the following as- sertion (loc. cit. p. 40), which certainly is prophetic of the theory fathered by Dr. Finlay: "It would certainly be quite as philosophical (as the malarial theory) to suppose that some insect or an animal- cule, hatched in the lowlands, like the mosquito,- after ^Nott: New Orleans Medical and Surgical Journal. 1848, vol. 4, p. 563. - The emphasy is ours. G. A. INSECTS AS PROPAGATORS OF DISEASE. 45 passing- through its metamorphoses, takes flight, and either by preference for a different atmosphere, or im- pelled by one of those extraordinary instincts which many are known to possess, wings its way to the hill top to ful- fil its appointed destiny." Twenty-two years later (1870), Dr. Nott was commis- sioned by the Board of Health of the City of New York to prepare and present to the Board a report upon the out- break of yellow fever at Governor's Island that year. In an elaborate paper, in which thie Doctor touches upon the causes of the outbreak and its progress, he comments at length upon the insect hypothesis. The following extract from Dr. Nott's paper is the nearest approach to the pres- ent accepted doctrine of transmission we have yet seen in opinions of the past :^ "It is possible," observes Dr. Nott, ''that even insects may exist a million times smaller than any the microscope has yet reached. While the slow and steady progression of yellow fever from a point, as I have described it, should be received as an indis]3utable fact, on the other hand we confess that the fact is at present inexplicable ; it must be some form of living organism, Avhich multiplies and ex- tends by organic laws. If in insects form, it is easy to understand its progress, and, if a fungus, we are not with- out examples in the larger fungi, of a manner of progres- sion from a given spot more rapid than that of yellow fever. Moreover, it is the business of some insects to dis- tribute certain seeds of plants far and wide ; to carry the pollen of one plant to another to fructify it; and it may be the duty of others to disseminate diseases. It is well known, on the authority of Murchison and others, that the malignant pustule is taken by gnats from the animal and communicated to man by its bite. So there are many ways that diseases might be carried and communicated by insects or fungi. "I will here mention a fact which I have often noticed myself with regard to mosquitoes/ but have never seen it alluded to by others. These insects are so abundant in 'Nott: Annual Report of the Board of Health of the Health Department of the City of New York, 1870, p. 363. *The emphasy is ours. G. A. 46 HISTORY OF YELLOW FEVER. Mobile, New Orleans, and other Southern cities, that it is impossible to sleep at night without the j)rotection of mos- quito nets. Fair-skinned persons from more northern climates, and particularly Toung children recently intro- duced, suffer greatly from the bites of this insect, the bites often inflaming, and even making tedious, troublesome sores; whereas the children of i^arents who have lived a generation or two in the climate suffer comi3aratiTely little; they seem to become acclimatized against the poison of these insects as they do against the i)oison of yellow fever. On rising from my own bed in the morning I have many times seen my little children lying in a trun- dle-bed covered by mosquitoes, after, as Mrs. Jackson said, 'kicking the kiver off.' The insects had been biting at them for hours, and yet by breakfast-time every mark had disappeared. Such would not be the case with children of fair-skinned i3arents recently brought into the clime. Some Southern children, it is true, are more susceptible to the i^oison of mosquitoes than others, and so it is with regard to suscej)tibility to yellow fever." If Dr. Nott had simj)ly gone a little further and directly accused the mosquito of being the active agent of trans- mission, yellow fever would have been eradicated from the American Continent years ago and the illustrious South- erner would have occupied a place in the annals of fame which would have endured for all time to come. Tiktine, in an article entitled '^'Contagion through the Infltience of Insects,"'^ relates facts of great interest. In a review of this j)aper made in the Bulletin of the Pasteur Institute for April, 1897, mention is made of an epidemic of relapsing fever which occurred in Odessa, Russia, where the disease is almost unknown.^' It seems that a sailor who came from Jaffa was suffering from this mal- ady and was admitted to the hospital. A week later an- other patient was admitted, and soon after a tremendous epidemic occurred, which affected more than ten thousand individuals. Most of these were sailors, living about the harbor, who ustially applied for admission after a de- = Bulletin Medical (Paris), Februarj^ 3, 1S97. ^ This disease is exceedingly rare in the United States, but is quite prevalent in Great Britain. INSECTS AS PROPAGATORS OF DISEASE. 4? bauch. Dr. Tiktine went to see a number of them, and was struck by the enormous number of bed-bugs, lice and fleas with Avhich they were covered. He then thought that the contagion might have arisen from these parasites going from one indiyidual to the other. One of these in- sects, passing from a sick man to a healthy one, might inoculate the latter hj its sting, still smeared with blood, or else the sleeper, abrading his skin by scratching, might become infected by crushing the parasite, full of septic blood, over the sore places. The Doctor collected some bed-bugs and allowed them to fast, after Avhicli he placed them upon the skin of pa- tients suffer ino- from an attack of relapsing fever. They rapidlv filled themselves with blood which, upon micro- scropic examination, was found to contain large numbers of spirilli s^^■'ll in motion. He was able to show that their vitality persisted, wiinin the insect, for more than eighteen hrurs. Besides this, bed-bu,2S were fed upon the blood of a monkey that had been inoculated with spiril- lum fever. They were then placed upon a health}^ monkey, and the latter soon had a characteristic attack of the dis- ease. ''We can therefore see what a preponderating place is taken by insects in the spreading of contagious diseases," concludes the reviewer. ''We knoAv that flies often carry about the bacilli of tuberculosis, of cholera, of purulent ophthalmia, and of anthrax. Finlay of Havana, believes that flies are the principal agents in the dissemination of yellow fever, and Hammond shares this view. Texas fever, according to Smith and Kilborne, is propagated by ticks which spread about a hgematozoa, belonging, like that of the malarial infection, to the class of protozoa." Howard, whose great work on the natural life of the mosquito is a standard, thus describes how typhoid fever is propagated by the common house-fly -J "The principal insect agent in this spread is the com mon house fly and this insect is especially abundant in country houses in the vicinity of stables in which horses are kept. The reason for this is that the preferred food of ^Howard: Farmers' Bulletin No. 155, U. S. Department of Agriculture, 1902, p. 12. 48 HISTORY OF YELLOW FEVER. tlie larvae of house flies is horse manure. House flies breed in incredible numbers in a manure pile largely de- rived from horses. Twelve hundred house flies, and per- haps more, will issue from a pound of horse manure. Ten days completes a generation of house flies in the summer. The number of eggs laid by each female fly averages 120. Thus, under favorable conditions, the offspring of a single over- wintering house fly may in the course of a summer reach a flgure almost beyond belief. With an uncared-for pile of horse manure in the vicinity of a house, therefore, flies are sure to swarm. Their number practically Avill be limited only by breeding opportunities. They are at- tracted to, and will lay their eggs in, human excrement. Under favorable conditions they will breed, to some ex- tent, in this excrement. They swarm in kitchens and dining rooms where food supplies are exposed. They are found commonly in box privies, which sometimes are not distant from the kitchens and dining rooms. Therefore, with an abundance of flies, with a box privy near by, or with excremental desposit in the neighborhood, and with a perhaps unsuspected or not yet fully developed case of typhoid in the immediate neighborhood, there is no reason why, through the agency of contaminated flies alighting upon food supplies, the disease should not be spread to healthy individuals. That it is so spread is not to be questioned. That under the unusual conditions of the army concentration camps in the summer of 1898 it was so spread to a shocking extent has been demonstrated by the army typhoid fever commission. And the remedy is plain. It consists of two courses of procedure: (1) Pro- per care of excereta; (2) the destruction of flies." The same authority says,^ that while in malaria and typhoid we have the two princii)al diseases common to the United States which may be conveyed by insects, the agency of these little creatures in the transfer of disease germs is much more widespread in warm countries, and it is by no means confined to human beings. In Egypt and in the Fiji Islands there is a destructive eye disease of human beings the germs of which are carried by the com- «Loc. cit., p. 17. INSECTS AS PROPAGATORS OF DISEASE. 49 mon house fly. In our Southern States an eye disease knoAvn as pink-eye is carried by certain very minute flies of the genus Hippelates. In certain tropical countries a disease known as filariasis, which somewhat resembles cer- tain forms of leprosy, is transferred among human beings by certain mosquitoes. There is good reason to suppose that the germs of the bubonic plague may be transferred from sick people to healthy people by the bites of fleas. The so-called Texas fever of cattle is unquestionably transferred by the common cattle tick and this was the earliest of the clearly demonstrated cases of the transfer of disease by insects. In A^frica a similar disease of cattle is trasferred by the bite of the famous biting fly known as the tsetse fly. The germs of the disease of cattle known as anthrax are carried by gadflies, or horse flies, and when these flies subsequently bite human beings malignant pus- tules may result; and other discoveries of this nature are constantly being made. Even the common bedbug is strongly suspected in this connection. Jelliffe, in speaking of flies as carriers of disease, gives the following example :^ To prove that flies as well as men and animals were able to contract the plague, a certain number of insects were allowed to feed on the crushed organs of an animal that had died of it, while an equal number of flies were fed on similar organs of a healthy animal. In several repeti- tions of this experiment all the infected flies were dead at the end of six or seven days, while nearly all the other flies were alive. All the dead flies had the living germs of the plague in their intestines. In plague stricken countries where there are no sewers, no garbage laws, and no sani- tation, where dead animals lie unburied, where families live and eat and sleep in the same room, it is logical to conclude that the flies, the only natural scavengers, should become infected, and should, in the few days that elapse before they die, infect all the food they light on. The following experiment is also related by Jeliffe: ''Flies are not the only insects that carry the plague. Ants and fleas are just as dangerous. In India, when a » Jeliffe: Munsey's Magazine, 1901, Vol. 25, p. 707. 50 HISTORY OF YELLOW FEVER. rat dies of the jjlagiie. Ms body is promptly eaten by ants. To i)rove that the insects contract the infection, an exj^eri- nienter dipped the point of a needle in their excreta, and with it x^ricked some living rats and mice, which he kei:)t carefully in cages. They in turn died of the j)lagne. That such a slight thing as a pin prick is enough to allow the germs to enter the body of a human being is shown by the case of the two Jax^anese physicians who scratched themselres with the jjoints of their instruments while making autopsies on plague patients^ and immediately took the disease.-' It will thus be seen that not only flies and mosquitoes, but **all insects that bite" should be looked uj)on with sus- picion and destroyed. The earliest reference to mosquitoes in connection with yellow fever that we have been able to discover, is made by Benjamin Bush in his Medical Itiqniries and 0]bserva- tions. I Vol. 5, p. IS I, edition of 179S. In speaking of the yellow fever epidemic at Philadelphia in 1797, he says : "In addition to the register of the weather, it may not be improper to add, that mosquitoes were more numerous during the prevalence of the fever than in 1793. An un- usual number of ants and cockroaches were also observed : and it was said that the martins and swallows disap- peared from the city an<;l its neighborhood." The presence of mosquitoes during the prevalence of yellow fever was also noted by an early wi^iter. Dr. John Vaughan,^'^ in his observations on the epidemic at Wil- mington. Delaware, in 1S02. ''Myriads of mosquitoes,'' says this wiiter, "infested the lower parts of the town from July until frost, having gradually diffused them- selves over the borough in September. The eldest of our inhabitants do not recollect this insect being so trouble- some here in any previous season: while the unanimous report of persons from the fenny counties of Kent and Su>?sex. the annual haunts of these winged pests, was that they were unusually free from them." It is also worthy of note that the fever did not spread '^Vaughan: Medical Repository, X. Y., 1803, vol. 6, p. 299. INSECTS AS PROPAGATORS OF DISEASE. 51 to Kent and Sussex counties, but spent all its virulence in the district where the mosquito was more abundant. ^^ The idea that yellow fever could be transmitted by mos- quitoes originated with Dr. Carlos Finlay, of Havana, in 1881. The doctor noticed a correspondence between the abundance of mosquitoes and a period of increase of yel- low fever in the autumn, while during the summer yellow fever had not prevailed to any extent and mosquitoes had also been less numerous. This set the doctor to thinking and a suspicion lurked in his mind that these pestiferous insects were probably responsible for the spread of the dsease. He immediately began a series of experiments, which resulted in the great discovery which has revodu- tionized the antiquated theories concerning the propaga- tion of yellow fever and which are detailed in the medical part of this volume. We will end this summary by giving the conclusions of Reed, Carroll and Agramonte, taken from their mas^terly essay on the etiology of yellow fever, which sums up the whole situation in a nutshell '}^ 1. The mosquito^ — C. fasciatus — serves as the inter- mediate host for the parasite of yellow fever. 2. Yellow^ fever is transmitted to the non-immune in- dividual by means of the bite of the mosquito that has pre- viously fed on the blood of those sick with this disease. 3. An interval of about twelve days or more after con- tamination appears to be necessary before the mosquito is capable of conveying the infection. 4. The bite of the mosquito at an earlier period after contamination does not appear to confer any immunity against a subsequent attack. 5. Yellow fever can also be experimentally produced by the subcutaneous injection of blood taken from the general circulation during the first and second days of this disease. 6. An attack of yellow fever, produced by the bite of the mosquito, confers immunity against the subsequent " See Chapter on "Yellow Fever in Maine," in this volume, ^ The Etiology of Yellow Fever, By Walter Reed, James Carroll and Aristides Agramonte, 1901. 52 HISTORY OF YELLOW FEVER. injection of the blood of an individual suffering from the non-experimental form of this disease. 7. The period of-^incubation in thirteen cases of ex- perimental yellow fever has varied from forty-one hours , to ^Ye days and seventeen hours. 8. Yellow fever is not conveyed by fomites, and hence disinfection of articles of clothing, bedding, or merchan- dise, supposedly contaminated by contact with those sick with this disease, is unnecessary. 9. A house may be said to be infected with yellow^ fever only Avhen there are present within its walls contamin- ated mosquitoes capable of conveying the parasite of this disease. 10. The spread of yellow fever can be most effectually controlled by measures directed to the destruction of mos- quitoes and the protection of the sick against the bites of these insects. 11. While the mode of propagation of yellow fever has now been definitely determined, the specific cause of this disease remains to be discovered. BIBLIOGRAPHY ON TRANSMISSION Or OISP^ASE BY INS»=CTS. NOTE BY THE AUTHOR. As this work treats principally of yellow fpver, we give below only a partial bibliography of the transmissioT» of disease by insects. The literature on the relation between the transmission of malaria and the mosquito is enormous and can be foupd in the Index Medicus, the Index Catalogue of the Surgeon-H ''nopal's Office and medical journals. The bibliography of the transmissio '^ c* yellow fever by the mos- quito will be found in another part c* t] '-^x volume. BOOKS AND MO>TOaRAPHS. CORNOLDI (G. M.). La Mosca et il Colera. (Octavo.) Venice 1884. HOAVARD (L. O.). How insects affect health in rural districts. U. S, Dept. of Agriculture: Farmers' Bulletin No. 155, 1902. HEISE (J. G.). De insectorum noxio effectu in corpus humanunL Halae Magdeb., 1757. INSECTS AS PROPAGATORS OF DISEASE. 53 JOLY (R. A. P.). Importance du role des insectes dans la trans- mission des maladies infectieuses et parasitaires. Du formol comme insecticide. (Octavo.) Bordeaux, 1898. Also Abstract. LAVERAN (A,). Traite du Paladisme. (Octavo.) Paris, 1898. (See pages 123; 129.) LEVRIER. (Translation into French of Nuttall's work below cited.) 2 vols. (Octavo.) Bordeaux, 1900. MUHLING (P.). Die Uebertragung von Krankheitserregern durch Wanze und Blutegel. (Octavo.) Konigsberg, i. p., 1899. NUTTALL (G. H. F.). On the role of insects, arachnids, and myriapods as carriers in the spread of bacterial and parasitic diseases of man and animals; a critical and historical study.. (Octavo.) Balti- more (no date). JOURNALS. ABEL (R.). Einige Fraganzungen zu der in No. 5-12 dieser Zeit- schrift Erschienenen Abhandlung von Nuttal uber die Rolle der In- sekten u. se. w. bei der, etc. Thiere. Hyg. Rundschau, Berl., 1899, Vol. 9, p. 1065.. ANOTHER tick-borne disease. Interstate M. J., St. Louis, 1902, Vol. 9, p. 443. BASTIANELLI (G.) and BIGNAMI (A.). Sullo sviluppo del para- sitti della ternaza nell' Anopheles claviger. Bull. d. r. Acad Med. di Roma, 1899, vol. 25, p. 277. Ibid. Ann. d'Ig. Sper., Rome, 1899, vol. 9, p, 272. Ibid. Malaria and Mosquitoes. Lancet, London, 1900, vol. 1, p. 79. (See also other articles by the above authors, published in European medical journals from 1896 to 1900.) BEACH (C. C). Insects as etiological factors in disease. Proc. Connect. M. Soc, Bridgeport, Conn., 1899, p. 95. BEALE (A.). Cholera, a fly-borne disease. Indian M. Rec, Cal- cutta, 1897, Vol. 12, 76. BRENNAN (T.). La mouche comme agent de propagation des maladies et comme milieu de metamorphose microbienne. Rev. med. du Canada, Montreal, 1902-3, Vol. 6, p. 33. 54 HISTORY OF YELLOW FEVSR. BUCHANAN (W. J.). Cholera diffusion by flies. Indian M. Gaz., Calcutta, 1897, Vol. 32, p. 86. Also: Dietet. & Hyg. Gaz., N. Y,. 1897, Vol. 13, 377. BURRAGE (S.). The transmission of disease by flies and other in- sects. Proc. Indiana M. Soc, Indianap., 1900, p. 182. CALMETTB (E.). Del rol de los insectos en la propogacion de las enfermedades de los paises calidos. Rev. med. de Sevilla, 1899, Vol. 23, p. 35. CAMPBELL (C). House flies and disease. Brit. M. J., Lond., 1901, Vol. 2, p. 980, CARTAZ (A.). La transmission des maladies par les Insectes. Nature, Par., 1898-9, Vol. 27, p. 10. CHAPMAN (C.) and JOHNSTON (J.). House flies and disease. Brit. M. J., London, 1901, Vol. 2, p. 1267. CHASSAIGNAC (CHARLES). The Role of the Mosquito in the Propagation of Disease, Especially Malaria. (Annual Address, etc.). N. O. Med. & Surg. Jl,, 1905-06, vol. 58, p. 33. CIAURI (R.). Gli insettinella transmissione delle malattie infettive. Riforma med., Palermo, 1898, vol. 14, pt. 4, p. 565. CLEAVER (EMMA O.). The role of insects in transmission of dis- ease; a resume. Penn. M. J., Pittsburg, 19()0-1901, Vol. 4, p. 457. COPLIN (W. M. L.). The propagation of disease by means of in- sects, with special consideration of the common domestic types. Pennsylvania Med. JL, 1899-1900, Vol. 3, p. 241. Phila. M. J., 1899, Vol. 3, p. 1303. Reprint. CORREA (A.). Breve nocion de la perniciosa influencia que ejercen los insectos en determinadas enfermedades. Siglo med. Madrid, 1892, Vol. 39, pp. 386; 402. CRAIG (C. F.). The transmission of disease by certain insects; ticks, bedbugs, ants, etc. N. York M. J., 1898, Vol. 68, p. 593. CRAIG (T. C). The transmission of the cholera spirillum by the alimentary contents and intestinal dejecto of the common house-fly. Med. Rec, N. Y., 1894, Vol. 46, p. 38. INSECTS AS PROPAGATORS OF DISEASE. 55 DAWSON (C. F.). The dissemination of infectious diseases by in- sects. Am. Vet. Rev., N. Y., 1901-2, Vol. 25, p. 266. DESFOSSES (P.). Du role de certains insectes dans la transmis- sion de quelques maladies. Presse med., Par., 1898, Vol. 2, annexes, 182. ' ELLIS (A. G.). Insects as a means of spreading infectious dis- eases. Medical Age. Detroit, 1899, Vol. 17, p. 641. FINLAY (C. J.). Mosquitoes considered as transmitters of yellow fever and malaria. Medical Record, N. Y., 1899, Vol. 55, p. 737. FLIES as agents in the New York cholera epidemic. Boston M. & S. J., 1893, Vol. 128, p. 170. FLY (The) as a propagator of typhoid fever. Medical Record, N. Y., 1898, Vol. 54, p. 486. FRANCIS (C. R.). Cholera caused by a fly (?). Brit. M. J., Lond., 1893, Vol. 2, p. 65. FURNARI (S.). Insectes producteurs du cholera. J. d. conn. Med. prat. Par., 1836-7, Vol. 4, p. 25. GALIPPE (V.). Transport par un insecte de parasites infectieux. Compt. rend. Soc. de biol.. Par., 1889, 9. s., Vol. 1, p. 558.. GOODALL (T. B.). On entomology as a sanitary science. Tr. San. Inst., 1892, Lond., 1893, Vol. 13, p. 272. H. (J.). Les punaises et les moustiques comme agents de contagion. Riv. sclent, Par., 1897, 4. s.. Vol. 7, p. 110. Also, Translation: Med. Press & Circ, Lond., 1898, n.. s.. Vol. 65, p. 6. GRASSI (B.). La malaria propagee par le moyen de certain in- sectes particuliers. Arch. Ital, de Biologic, Turin, 1899, Vol. 31, p. 143. HEIM (F.). Du role de quelques coleopteres dans la dissemination de certains cas de charbon. Comptes Rendu de la Societe Biologique de Paris, 1894, Vol. 6, p. 58. HELBIG. Kerbthiere als Krankheitsverbreiter. Pharm. Central- halle, Dresd., 1901, n. F., Vol. 22, p. 729. 56 HISTORY OF YELLOW FEVER. HELLER (C). Ueber septische Infection wahrscheinlich durch Insecten vermittelt. Mitth. a. d. Tubing. Poliklin., Stuttgart, 1886, 1. Hft, p. 1. HERICOURT (J.). El contagio por medio de los insectos. Habana med., 1900, Vol. 3, p. 33. HOMAN (G.). Insect agency in the spread of disease. St. Louis M. Gaz., 1898, Vol. 1, p. 133. HOMAN (G.). On the agency of parasitic vermin and other insect pests in the spread of disease. Am. Med., Phila., 1901, Vol. 2, p. 536. HOWARD (L. O.). Insects as carriers and spreaders of disease. Yearbook U. S. Dep. Agric. 1901, Wash., 1902, p. 177. HOWARD (L. O.). Experimental work with fungous diseases of grasshoppers. Ibid., p. 459. HUTCHINSON (J.). On flies, fleas, etc., as agents in the produc- tion of disease. Arch. Surg., Lond., 1895, Vol. 6, p. 386. JELLIFFE (S. E.). Insects as Carriers of Disease. Munsey's Maga- zine, N. Y., 1901, Vol 25, p. 707. JOLY (R. A. P.). Importance du role des insectes dans la trans- mission des maladies infectueuses. (Abstract.) Gazette des Hopi- taux, Paris, 1898, Vol. 71, p., 1202. KELLY (H. A.). A historical note upon Diptera as carriers of dis- eases; Pare; Declat. Johns Hopkins Hosp. Bull., Bait., 1901, Vol. 12, p. 240. Also, reprint. LAVERAN (A.). Comment prend-on le paludisme? Revue d'Hy- giene, Paris 1896, Vol. 18, p. 1049. Ibid. Des mesures a prendre contre les moustiques. Revue G«n. de Clin, et de Therap., Paris, 1899, Vol. 13, p. 257. Ibid. Sur um anopheles provenant de Madagascar. Compte Rendu. Soc. de Biologic, Paris, 1900, II. Series, Vol. 2, p. 109. LEIDY (J.). The common fly as a factor in the transmission of disease germs. Phila. M. J., 1901, Vol. 7, p. 49. MACRAE (R.). Flies and cholera diffusion. Indian M. Gaz., Cal- cutta, 1894, Vol. 29, p, 407. 1 pi. Also, Reprint. INSECTS AS PROPAGATORS OF DISEASE. 57 MADDOX (R. L.). Further experiments on feeding insects with the curved or "comma" bacillus. J. Roy.. Micr. Soc, Lond., 1885, 2d s.. Vol. 5, p. 941. MALARIA (A) conference in Rome. British Med. Jl., 1900, Vol. 1, p. 323. MALARIA (The) expedition to Sierra Leone. British Med. Jl., London, 1, 1899, Vol. 2, pp. 675; 746; 869; 1033. MALARIA (The) expedition to West Africa. Lancet, London, 1899, Vol. 2, p. 1041. MANSON (PATRICK). The Goulstonian Lectures on the life- history of the malaria germ outside the human body. British Med. JL, London, 1896, Vol. 1, pp. 641; 712; 774. Ibid. The mosquito and the malarial parasite. British Med. Jl., 1898, Vol. 2, p. 849. Ibid. Surgeon-Major Donald Ross' recent investigations on the mosquito-malarial theory. British Med. Jl., 1898, Vol. 1, p. 1575. Ibid. The role of the mosquito in the evolution of the malarial parasite; the recent research of Surgeon-Major Ronald Ross. Lancet, London, 1898, Vol. 2, p. 488. Ibid. An exposition of the mosquito-malaria theory and its recent developments. Jl. Tropical Med., London, 1898-99, Vol. 1, p. 4.. MARCHOUX. Au sujet de la transmission du paludisme par les moustiques. Annals d'Hygiene et de Medecine Colonial, Paris, 1899, Vol. 2, p. 22. McCOLLOM (J. H.). The role of insects in the propagation of disease. Am. J. Nursing, Phila., 1901-2, Vol. 2, p. 181. McFARLAND (J.). Relation of insects to the spread of disease. Medicine, Detroit, 1902, Vol. 8, p. 1. MACKAIG (A.). Insects and cholera. Edinb. M. J., 1902, n. s., Vol. 12, p. 137. MADDOX (R. L.). Experiments in feeding some insects with cul- tures of comma or cholera bacilli. Tr. Am. Micr. Soc. 1898, Lincoln, Neb., 1899, Vol. 20, p. 75. (1 Plate.) 58 HISTORY OF YELLOW FEVER. MANNING (J.). A preliminary report on the transmission of pathogenic germs by the common house-fly. Am. J. Nursing, Phila., 1901-2, Vol. 2, p. 920. Also: J. Am. M. Ass., Chicago, 1902, Vol. 38, 1291. MARPMANN (G.). Ueber d'e Vernichtung von Bakterien durch Fliegen und stechende Insekten und uber den Zusammenhang von epidemischen Krankheiten mit dem Auftreten und der Entwicklung von Stechfliegen, Mucken, etc., in den insektenreichen und insekten- armen Jahren. Apoth. Ztg., Berl., 1897, Vol. 12, p. 616. MARPMANN (G.). Ueber den Zusammenhang von pathogenen Bakterien mit Fliegen. Centralbl, f. Bakteriol., etc. 1. Abt, Jena, 1897, Vol. 22, p. 127. MONNIER (U.). Du role des insectes dans la propagation des maladies infectieuses Gaz. med. de Nantes, 1898-9, Vol. 17, p. 179. MUHLING (P.). Die Uebertragung von Krankheitserregern durch Wanze und Blutegel. Centralbl. f. Bakteriol,, etc. 1. Abt., Jena, 1899, Vol. 25, 703. NOTES on the part played by insects as carriers of infection. Brit. M. J., Lond., 1900, Vol. 1, p. 328. NUTTALL (G. H. F.). Zur Aufklarung der Rolle, welche stechende Insekten bei der Verbreitung von Infektionskrankheiten spielen. Cen tralbl. f. Bakteriol, etc. 1. Abt., Jena, 1898, Vol. 23, p. 625. NUTTALL (G. H. F.). Remarks upon a paper by Dr.. Calmette en- titled: "Intertropical medicine; on the part played by insects in the dissemination of the diseases of hot countries." J. Trop. M., Lond., 1899-1900, Vol. 2, p. 182. NUTTALL (G. H. F.). Die Mosquito-Malaria Theorie. Centralbl. f. Bacteriol, 1. Abt., Jena 1899, vol. 25, pp. 161; 200; 245; 285; 387. NUTTALL (G. H. F.). On the role of insects * * * in the spread of bacterial and parasitical diseases. Johns Hopkins Hospital Re- ports, Baltimore, 1890, Vol. 8, p. 1. (3 plates.) Ibid. (Abstract.) British Med. Jl., London, 1899, Vol. 2, p. 642. Ibid. (Abstract.) Journal of Tropical Medicine, London, 1899-1900, Vol. 2, p. 107. Ibid. (Abstract.) Lancet, London, 1899, Vol. 2, p. 775. Ibid. (Translation.) Hyg. Rundschau, Berlin, 1899, Vol. 9, pp. 209; 289; 393; 503; 606. INSECTS AS IROPAGATORS OF DISEASE. 59 PAULLINUS (C. F.). Musca dysenteriae genitrix. Acad. nat. curios, ephem. 1687, Norimb., 1707, decuria 2, vi (ap.p.), 30-34. Also, trans. Abstr. Collect. Acad. d. mem., etc., Dijon, 1766, Vol. 7, 510. RAMIREZ (R.). The diptera from a hygienic point of view. Am. Pub. Health Ass. Rep., Columbus, 1898, Vol. 24, p. 257. Discussion, p. 356. RASAIL (F. v.). Sur les maladies qui peuvent etre I'oeuvre des insectes, et sur leur traitement. Experience, Par., 1838, Vol. 1, pp. 425-429. Also: Ann. d med. beige, Brux., 1838, Vol. 2, 1-5. RENDER. Curious instances of pestiferous insects. Boston M. & S. J., 1832, Vol. 6, 53-56. ROSS (RONALD). Some observations on the crescent sphere- flagella metamorphosis of the malarial parasite within the mosquito. Transactions South Indian Branch British Med. Ass'n, Madras, 1895, Vol. 6, p. 334. Ibid. Indian Lancet, Calcutta, 1896, Vol. 7, p. 227. Ibid. Life-history of the parasites of malaria. Nature, London, 1899, Vol. 60, p. 322. (Dr. Ross also published numerous articles on this subject, which will be found in the scientific journals from 1896 to 1900.) S. (A. H.). Typhoid fever and flies. Medical Record, N. Y., 1898, Vol. 44, p. 537. SALISBURY-SHARPE (W.). The influence of dust and flies in the contamination of food and the dissemination of disease. Lancet, Lond., 1900, Vol. 1, 1613. SANGREE (E, B.). Flies and typhoid fever. Medical Record, N. Y., 1899, Vol. 55, p. 88. SAUNDERS (J.). Is there a cholera fly, sui generis? Texas Health J., Dallas, 1889-90, Vol. 2, p. 397. SAVCHENKO (I.. G.). Materiali k etiologii choler'i; rol mukh v rasprostranenii choler'noi zarazi. (Data on the etiology of cholera; the role of flies in the diffusion of the contagion of cholera.) Vrach, St. Petersb., 1892, Vol. 13, p. 1131. Also, transl.: Centra Ibl. f. Bakteriol. u. Parasitenk,, Jena, 1892, Vol. 12, p.. 893. 60 HISTORY OF YELLOW FEVER. SHEWAN (M.). Insects and infection. Indian M. Rec, Calcutta, 1897, Vol. 12, p. 203. STILES (C. W.). Insects as disseminators of disease. Sanitarian, N. Y., 1901, Vol. 47, p. 3. Also: Virginia M. Semi-Month., Richmond, 1901-2, Vol. 6, p. 53. SUTTON (R. S,). Typhoid Fever and Flies. Medical Record, N. Y., 1898, Vol. 44, p. 610. TRANSMISSION (La) des maladies infectieuses par les insectes, les arachnides et les myriapodes. Med. Mod., Par., 1899, Vol. 10, 579. VEEDER (M. A.). The relative importance of flies and water sup- ply in spreading disease. Buffalo M. J., 1898-9, n, s.. Vol. 38, p. 663. Also: Med. Rec, N. Y., 1899, Vol. 55, p. 10. Also, Reprint. VEEDER (M. A.). Flies as spreaders of sickness in camps. Med. Rec, N. Y., 1898, Vol. 54, p. 429. Also, Reprint. VEEDER (M. A.). The spread of typhoid and dysenteric diseases by flies. American Public Health Ass'n Reports, Columbus, 1898, Vol. 24, p. 260. (Discussion, p. 356.) VON HOLUB (C). Insekten als lebendes Substrat fur Kultivierung ansteckender Krankheiten des Menschen und der Tiere. Centralbl. f. Bakteriol. (etc) 1. Abt, Jena, 1901, Vol. 30, p. 284. WEBER (L. W.). Die Stubenflige als Uebertragerin ansteckender Krankheiten. Irrenpflege, Halle, a. S., 1898, Vol. 2, p. 191. WIESNER (A.). O prenaseni zarodku nakazlivych chorob lidskych i zvirecich cizopasniky koznimi, zejmena hmyzem. (The conveyance of the germs of contagious diseases of man and animals by insects.) Lek. rozhledy, Praha, 1899, Vol. 7, .p. 129. WILLIAMSON (G. A.). Contribution a I'etude du role pathogenique des insectes dans les pays chauds. (Transl.) Ann. Soc. de med. de Gand, 1901, Vol. 80, p. 248. WILLIAMSON (G. A.). The Cyprus sphalangi and its connection with anthrax (called locally sphalangi bite). J. Trop.. M., 1901, Vol. 4, pp. 34; 44. PART SECOND YELLOW FEVER PRELIMINARY OBSERVATIONS. CHAPTER I. PERTINENT POINTS ABOUT YELLOW FEVER. Geographical Limits of Yellow Fever and Other Pestilential Dis- eases. — Mortality of Yellow Fever in September, Compared with Other Months. — Historic Mortalities from Yellow Fever. Geographical Limits of Yellow Fever. No disease possessing such pestiferous proclivities as yelloAv fever is confined within such restricted limits. In America, it has never prevailed further north than Quebec (latitude 46° 50') nor has it been noticed further south than Montevideo (latitude 34° 54\). In the Eastern Hemisphere, Swansea, in Wales (latitude 51° 37') has been its northernmost limit, while St. Paul de Loanda, in Africa (about 9° S.) has been the southernmost habitat. Its western limits have been the shores of the Pacific from Montevideo to Lower California, except on one occasion (1883) when an imported case died in San Francisco, Cal. In Europe, it has never been seen further East than Leghorn, in Italy (7° 56'). In Africa, Egypt and Mada- gascar are said to have been invaded by the disease, but the report lacks authenticity^ The same may be said of the alleged prevalence in Asia Minor during the cam- paigns of Napoleon. The present foci of yellow fever are still more restricted than formerly. Juan Guiteras recognizes the following three areas of infection : 1. The Focal Tjone, in which the diseases is never ab- sent, including Havana, Vera Cruz, Kio Janeiro and other South American ports. 2. The Perifocal Zone, or region of periodic epidemics, including the ports of the tropical Atlantic in America and Africa. 64 HISTORY OF YELLOW FEVER. 3. The Zone of Accidental Epidemics, between the parallels of 43° north and 35° south. To better understand the meaning of this eminent authority, the reader is referred to the map of the world, where he will observe three great regions of pestilential disease: First, of the plague; secondly, of cholera; thirdly, of yellow feyer. These regions are distributed as follows : From the equator to 20° North may be regarded as the true yellow feyer region. This includes the West Indies, the coast towns of Mexico, the Isthmus of Panama, Col- umbia, Venezuela, the eastern shores of South America as far south as the Kio de la Plata, and the western coast of Africa, embracing Sierra Leone and the Gold Coast. From 30° to 40° North, in the Eastern Hemisphere, is the region of the plague, including Arabia, Egypt, Turkey and Asia Minor. From 20° to 40° North, in the Eastern Hemisphere, is theValley of the Ganges, the principal centre of the cholera Mortality of Yellov^^ Fever in September. A study of the statistics of yellow fever demonstrates the peculiar fact that the disease is connected in its epi- demic appearance with certain seasons of the year. The months of July, August and September are those in which epidemics are more prevalent and the disease seems to at- tain its greatest mortality in the latter month. A resume of nine epidemics in New Orleans, made by Chaille, and completed (so far as 1905 is concerned) by the compiler of this work, shows that in six of these visitations, the mortality was greatest in September, viz : ^ Some Yellow Fever Data, by S. E. Chaille, New Orleans Medical and Surgical Journal, 1905, vol. 58, p. 191. PERTINENT POINTS ABOUT YELLOW FEVER. 65 Mortality in Xine Notable Epidemics in New Orleans. 1 5 1848 1853 1854 'O QO 1 QO 00 May June July August SEPTEMBER. October ; November December fflontnsDjRDOWQ..- 74 965 1000 198 12 10 445 33 200 467 126 20 22 31 1521 5133 982 147 28 4 2 29 53-2 1234 490 131 7 5 382 1286 874 97 19 7 2 132 1140 2204 1137 224 15 3 255 1637 1072 103 26 26 1025 1780 1065 147 3 42 217 III 61 6 total 1 • 2804 872 7848 2425 j 2670 4854 1 3107 4046 A glance at the above figures proves that in only three instances (1853, 1858 and 1905) August proved more fatal than September. In 1853, the mortality reached the appalling aggregate of 5133 in August, against 892 in September and a grand total of 7848 for the entire year. A search into the records of nearly every place where yellow fever has been epidemic reveals the same state of affairs, with the exception of Havana, where July seems to be the most fatal month. Even as far back as 1793, Currie,^ in speaking of the gTeat epidemic at Philadelphia that year, says : ''In September, the disease increased amazingly. In the course of the month, about 1400 citizens were added to the list of mortality; towards its close, from 50 to 90 were buried of a day, though the mercury uoav seldom rose above 80°." ''After the first of September, there was no disease to be seen but yellow fever."^ -a Treatise on the Synochus Icterodes, etc., by William Cuirie (1794), p. 15. •'Epidemic at Philadelphia of 1797, Rush, vol. 5, p. 19. 66 HISTORY OF YELLOW FEVER. In 1822, when New York was visited by the disease, the deaths in September monnted up to 110, against 58 in August and 90 in October.^ The excess in mortality in September over the other months during the prevalence of yellow fever, has also been noted in the following epidemics: New York, 1799 ; Providence, K. I., 1797; Baltimore, 1819; Wilmington, (Del.) 1798; Charleston, (S. C.) 1807, 1817, 1819, 1824, 1827 and 1838; Natchez, 1823 and 1825; Mobile, 1839; New Haven, (Conn.), 1794; Ncav Orleans, 1819, 1820, 1824 and 1833. La Koche^ notes that the mortality has occasionally been greatest in August, as was the case in Charleston in 1838 and in New Orleans in 1817, 1839 and 1853. But these were isolated exceptions. The apparent reason for the greater mortality in Sep- tember seems to be that the disease, beginning early in summer, has had time to spread and to attack a larger number of persons; also, the virulence is greater because by that period the infected mosquitoes are more numerous and, everything else equal, exposed persons receive more bites and consequently a larger dose of poison.^ This did not follow in 1905, because by September the effect of the active anti-mosquito campaign was showing itself by diminishing number of cases as well as by lower mortality. Historic Mortalities From Yellov^ Fever. Whenever yellow fever has spread its sombre mantle over a community, it has left in its wake countless heca- tombs. ^'The reader need scarcely be informed," saj^s LaBoche, in his monumental work on yellow fever, "that the yellow fever, wherever it has assumed the epidemic form, has fully established its claims to being classed among the * Proceedings Board of Health of the City of New York (1823), p. 123. '^Vol. 1, p. 545. " See Article by Dr. Chassaignac, in the medical part of this volume. PERTINENT POINTS ABOUT YELLOW FEVER. " 6? most formidable diseases to wliicli the human body is liable." The island of St. Lucia, in the West Indies, furnishes the earliest authentic example of great mortality from yel- low fever. In 1664, according to Keating,' it killed 1,411 out of a population of 1,500 soldiers, being in the ratio of 1.06 of the whole number. In 1665, in the same locali^ ty, out of 500 sailors, 200 died, being one in 2:5; and again, in 1666, the unfortunate island was invaded by the disease, when every man, woman and child, 5,000 in all, died. In 1793^ in Grenada, West Indies, yellow fever appeared among the sailors, the proportion of deaths in cases amounting to 1 in 3 ; and of a total of 1,130 soldiers, 630 died. In 1794, the disease attacked Sir Charles Gray's Army, in the Windward and Leeward Islands, and of an esti- mated population of 12,000, there was a mortality of 6,012. In Guadeloupe, in 1796, out of an estimated population of 20,000, there was a mortality of 13,807. That same year, out or 367 artillerymen stationed at the island, 129 died. In 1802, Guadeloupe was again decimated, 5,057 deaths occurring in a iDopulation of 16,363. In 1802, at San Domingo, in a population estimated at 40,000 (principally soldiers), there were 27,000 cases and 20,000 deaths. The mortality among French troops in the West Indies in 1802 amounted to 57 per cent. Quebec, Canada, was invaded by yellow fever for the first and last time in 1805. Of one company of 55, be- longing to an English regiment, all but six died. The greatest mortality ever recorded in Havana was in 1819, when 5,162 died. As yellow fever had visited Havana almost every year since 1620, this mortality is especially worthy of note. In 1852, at Barbadoes, West Indies, out of 1,380 sol- diers, there were 879 cases and 173 deaths. At Martinique, during a period of five years, 1802 to ^Keating: History of the Yellow Fever of 1878, p. 77. 68 HISTORY OF YELLOW FEVER. 1807, in a population of 11,085 soldiers, there were 8,673 cases and 2,891 deaths. According to Joseph Jones,^ 'the total deaths from all diseases in New Orleans from 1838 to 1883, a period of forty-five years, amounted to 272,619, of which 31,207 were from yellow fever, 10,009 from cholera and 6,436 from smallpox. It will thus be seen that of the 47,642 deaths from contagious and infectious disease, the mor- tality from yellow fever reached the appalling figure of 31,207, or a 3^early average of 693 for the period above mentioned. The greatest mortality from yellow fever in a single year in New Orleans took place in 1853, when 7,848 died. From 1853 to 1858, a period of six years, the mortality Avas as follows : 1853 7,848 1854 2,425 1855 2,670 1856 74 1857 200 1858 4,845 Total for six years '....... 18,062 Since 1858, there have been only two great epidemics in New Orleans: 1867, when 3,107 died, and- 1878, when the pestilence made 4,046 victims. The North also presents a melancholy record. In his sumnmry of the epidemics which devastated Philadelphia in the past. La Roche states that during the visitation of 1699, Avhen the city was only 17 years old and the population did not exceed 3,800, the mortality from yellow fever Avas 220, or one in 17.3 of the entire number of residents. Ninety- four years later (1793), when the population of Philadelphia'^ amounted to 60,000, occurred the '^gTcat epidemic," commencing in August and ending in December, and causing a fearful total of 4,041 deaths. Four years later (1797), a severe epidemic "Jones: "Medical and Surgical Memoirs, vol. 3, part 2, Table PERTINENT POINTS ABOUT YELLOW FEVER. 69 visited the city, the mortality amounting to 1,300. The year following (1798), j^ellow fever again assumed a virulence which caused such a widespread terror, that nearly the whole population fled. The epidemic of that 3'ear made 3,645 victims. It will thus be seen that in the short space of five years (1793 to 1798), yelloAv fever made the melancholy record of 8,986 victims in that scourge-ridden city. In New York, Boston, Baltimore, Portsmouth (Va. ) and on the North Atlantic seaboard, the disease has at times assumed pestilential proportions, the details of which will be found in that part of this volume devoted to the history of yellow fever. Europe furnishes an appalling list of mortalities. Ac- cording to LaRoche, Spain has been the principal sufferer on occasions of this kind, experiencing, in the course of nine epidemics— 1800, 1801, 1803, 1804, 1810, 1813, 1818, 1819 and 1821 — the immense loss, by yellow fever, of up- wards of 130,000 individuals. During one single season — that of 1800 — not less than thirty places in Andalusia were visited, and in them the loss amounted to 61,363. The year 1804, according to LaRoche, was another of great calamity. On that occasion, twenty-five places in Spain, with a combined population of 427,228, lost 52,559 souls, or one in 8.12. The disease also prevailed epidemically in some parts of France, England, Italy and Portugal during the eighteenth and nineteenth centuries, but Spain seems to have been the most fertile spot for the propagation of yellow fever in the Old World. 70 HISTORY OF ^"ELLOW FETER. CHAPTEK II. NOMENXLAl URE OF YELLOW FEATR. Peculiar Names given the Disease by Medical Writers. — A List con- taining One liundred and Fifty-two Synonyms. Xames IX Vogue at the Present Day. English: Yellow Fever. French : Fievre Jaime. Spanish : Fiebre Amarilla. Portugese: Febre Amarella. Oerman : Gelbes Fieber. Italian : Febbre Gialla. Latin : Febris Flava. Synonyms. Xo disease under heaven has had more synonyms than yellow fever. Beginning witli 14:91, when it was generally designated by the name of Contagion, and ending with the Year of Grace 1907, when the term Mosquito Fever seemed decidedly appropriate, the nomenclature of the dis- ease has been stuxjendoiis. The subjoined list, which has been carefully prepai'ed from the wi^itings of American, English, Spanish, Italian, Portugese and Spanish chron- iclers, will convey an idea of the peculiar names which were used in former times to designates the yellow scourge, the nature and origin of which we are no wiser to-day than were those worthy and illustrious observers. 1. American Bilious Malignant Fever. Moultrie, 1719. 2. American Fever. Ceresa, 1S29. 3. American Pestilence. Haygai;th, in a work published in 1801, theorizes on the "prevention of infectious fever, especially the American Pestilence." 'synonyms of yellow fever. 71 4. American Typhus. Term used by the disciples of the school of Bally. 5. American Yellow Fever. Lining, in his ''Essays and Observations;" also Jolivet, 1831, and others. 6. Ardent Fever. Fermin thus mentions it in his work on "Traite des Maladies les Plus Frequentes a Surinam,'^ published in 1763. 7. Ardent Summer Fever. English writers, middle of Eighteenth Century. 8. Ataxic Typhus. Bally and his followers. 9. Autumnal Endemial Epidemic Fever. Davidge, in a work published at Baltimore, in 1798. 10. Autumnal Epidemic Fever. Shaw, 1804. 11. Autumnal Fever. Yaughan, in his ''Concise History," etc., 1802. 12. Barbadoes Distemper. American and English writers, in the beginning of the Eighteenth Century. 13. Barbadoes Fever. Philadelphia, in 1699, because the pestilence of that year was imported from Barbadoes, West Indies. 14. Barcelona Fever. Kochoux, 1822, and those who advocated the theory that the epidemics Avhich ravaged Spain in the beginning of the last century, were endemic to that country. 72 HISTORY OF YELLOW FEVER. 15. Bilious Fever. Gamble, Kocliefort, Hughes, Chanvalon, Bajon and Fermin. 16. Bilious Epidemic Fever. Yates, 1813. 17. Bilious Fever of Warm Climates. English and American writers in the middle of tlie last century. 18. Bilious Malignant Fever. Joseph Brown, 1797. 19. Bilious Putrid Fever. Hillary. 20. Bilious Kemittent Fever. Arnold. 21. Bilious Kemittent Putrid Fever. Rush and his disciples. 22. Bilious Remittent Yellow Fever. Rush and his school. 23. Bilious Remitting Fever. Rush, 1793. 24. Bilious Yellow Fever. Williams. 25. Black Vomit. Popular name adopted by old English writers and derived from the Spanish Vomito Negro. 26. Bronze John. Chambers' Encyclopedia, article on ^^Y^ellow Fever." 27. Bulam Fever. Pym, Chisolm, and their disciples, who propagated the visionary doctrine that the fever had been imported from the Island of Bulam, West Africa. SYNONYMS OF YELLOW FEVER. , 3 28. Calentura. This name had its origin in the dogma that heat was the prime cause of yellow fever. It was only in the beginning of the nineteenth century that this designation was abandoned by the Spaniards, who substituted '^Fiebre Amarilla," a term which is used to this day in Spain and in Central and South America. 29. Calentura Amarilla. Cibat, 1803. 30. Calentura Maligna Contagiosa. Gonzales, in his dissertation on the yellow fever in Cadiz, published in 1801. 31. Calentura Amarilla De America. Jose Fernandez de Madrid, 1821. 32. Calenturas Putridos y Maligna. Masterall, 1797. 33. Calenturas Tifoideas. Burdin, 1820. 34. Calenturas Thermo-Adynamica y Therjmo- Ataxia. Jose Fernando de Madrid, 1821. 35. Cardite Amarille. Mentioned by Berenger-Feraud. 36. Causos or Ardent Fever. Desperriere, Gillespie. 37. Causus. Name used by Fermin, in his work above quoted, and by Miller, McArthur and others. 38. Cxvusus Malin D'Amerique. Berenger-Feraud is authority for this expression. 74 HISTORY OF YELLOW FEVER. 39. Causus Tropicus Endemicus. Moseley, in his '^Treatise on Tropical Diseases/' etc., 1795. 40. Chapetonada. Coreal and Ulloa. This name, which signihes '^brigand" in the Peruvian language, was origin- ally given to the followers of Pizarro by the na- tives and was subsequently adopted by the in- habitants of Martinique to mean all Europeans who landed on their shores. These unfortunate colonists dying by the thousands from the endemic fever of the country, the name was finally apiilied to the disease itself. 41. COCOLITZLE. Herrera, in his famous work published in 1601, says that this name was given by the Carib In- dians to the disease. 42. Concentrated Endemic Fever. Jackson, in a work published in Edinburg, 1789. 43. Contagion. This name is quite prevalent in the writings of early Spanish and French authors from 1494 to 1634. After that date and up to the end of the Seven- teenth Century, the diseas was designated as Coup de Bar re by the French and Cedent lira by the Spanish. 44. Continua Putrida Icterodes Caroliniensis. Macbride. 45. Contagious Fever. Rochedort, Bajon, Fermin, Chanvalon, Hughes, Schotte. SYNONYMS OF YELLOW FEVER. 75 46. Coup De Barre. Labat and other early Antillian chroniclers. The literal meaning of the word is: "I am struck with a whip-stock," and is expressive of the suddenness of the onset of the malady and the muscular pains Avhich accompany it. 47. Elodbs Icterodes. Vogel. 48. Endemial Causus, or Burning Fever. Mentioned by Moseley in his treatise on Tropical Diseases. 49. Epauctus Malignus Flavus. Goode. 50. Epidemic. Sahagun, Salgado, Salamanca and other early writers. 51. Epidemical Distemper. Sandiford. 52. EXAMTHEMA EXTERNUM CONTAGIOSA. According to Jackson (1821), this name was ap- IDlied to the disease by Spanish physicians during the great epidemics in Andalusia in the begin- ning of the last century. 53. Febbre Gialla Pestilenziale D'Amerique. Palloni and other Italian writers, in the beginning of the nineteenth century. 54. Febbre Livorno. Palloni and Tomasini, in their descriptions of the epidemic at Leighorn in 1804. 55. Febre Endemica Indiarum Occidentalum. Latin writers. 6 HISTORY OF TEIXOW FE\:ER. 56. Febee Flata Indiae Occidextales. Cnllen, 177'^. 57. Febre Flava Regiorum Calidaefm. Fisher. 1705. 58. Febre Hlspanae Flava. Fago, ISIS. 59. Febre Ixdiae Occtdextams. MackitTTick. 1766. 60. Febris Arlens Aestiva. Roiippe. 177:^. 61. Febris Arbens BiuasA. Towne, 1726. 62. Febris Cum Xigeo To]iiito. Same adopted by DoweU. 63. Febels Flavae Ameeicaxae Causis. Ferrello, 1825. 61. Febels Icterodes. General term adapted br medical men from 1701 to 1815. 65. Febris Maugxa Biliosa, Moultrie. 66. Febris Putrid a C<::LLOQrATivA. Ronppe, 1772. 67. Febels Typhus Icterodes. Dowell. 68. FiEBRE Amarilla Hispaxorum Et Hispaxo- Americaxum. Early Spanish writers. SYNONYMS OF YELLOW FEVER. 77 69. FiEVRE Des Lacs. Berenger-Feraud. ro. FiEYRE Gastro-Adynamique. Pinel. 71. FlEYRE JaUXE. Modern French writers. 72. FlEVRE Jaune D'Amerique. Valentin. 73. FlEVRE Matelotte. Earlj' French writers. This exjDression owed its origin to the belief that seamen were especially susceptible to yellow fever. 74. FlEYRE PUTRIDE CONTINUE. Pugnet. 75. FlEYRE Spasmodico-Lypirienne Des Pays Chauda. Chabert, 1821. 76. Flaya Febre Tropica. Bartholomaei, 1822. 77. Flaya Indiarum Febre. Hunter, 1798. 78. Gastro-Cephalite. Vatable, 1828. 79. Gastro-Enteritis. LeRiYcraud. . 80. Gelbe Fieber. Longermann, 1804, and German writers to the present day. 81. Gibraltar Feyer. Term used by medical writers in the beginning of the Nineteenth Century. 78 HISTORY OF YELLOW FEVER. 82. Haemagastkic Pestilence. Copland, "DictionarT of Practical Medicine." 83. Haemelitic Epidemic. Nicholson. 84. Inflammatory Endemic. Dickson, 1819. 85. Jail Feyer. So called by the inhabitants of the island of Ber- muda, West Indies, in 1779, because the fever first manifested itself among the jjrisoners of war. 86. Kendal's Fever. Humboldt and Hughes. 87. Maladie De La Saison. Earlv Antillian writers, who propagated the theory that the disease only occurred at certain seasons of the year. 88. Maladie Dr Diable. Falligant. The word which means '*The Devil's Illness," was inspired by the terror it created. 89. Maladie Du Pays. Early Antillian Chroniclers. This signifies, liter- ally, ^'endemic disease," and is, in our opinion, decidedly apj^ropriate. 90. Maladie Matelotte. Early French writers. Companion expression of ''Fievre Matelotte." 91. Maladie Speciale Du Foie. Berenger-Feraud. SYNONYMS OF YELLOW FEVER. 79 92. Mal De Siam. So called because of the general belief in early col- onial days that the disease had been imported from Siam. It is mentioned by Labat, Chavalon, Desportes, Moreau de Saint-Mery, and other chroniclers of the period and Avas known by this name in Martinique and San Domingo near the close of the seventeenth century. It is found designated by this name in the old Government and local records of these islands. 93. Maladie Spasmodico-Lyperienne Des Pays Chauds. Chabert. 94. Malignant Fever. Walsh. 95. Malignant Ataxic Fever. Disciples of the School of Bally. 96. Malignant Contagious Fever. Cathrall. 97. Malignant Fever. Warren, 1740; Blanchini, 1750. 98. Malignant and Nervous Fever. Berenger-Feraud. 99. Malignant Pestilential Fever. Chisolm, 1795. 100. Malignant Putrid Pestilential Fever. Berenger-Feraud. 101. Malignant Kemittent Fever. McDiarmid, London Med. Gaz., vol. 2, p. 444. 102. Malignant Yellow Fever. Berenger-Feraud. 80 HISTORY OF YELLOW FEVER. 103. Matlazahuatl. Humboldt says that the Aztecs thus called the dis- ease and claims that their records speak of the j)estileuce as ravaging Mexico eren as far back as the Eleventh Century. 104. Meditteeaxeax Fever. . Burnett, 1816. 105. Mexixgo-Cephalo-Gast;rite. Maher. lOG. Mosquito Fever. This expression was first used by Xew Orleans newspapers in 1905, to commemorate the most glorious victory over pestilential diseases which has ever been achieved. 107. ZS^AUTiGAL Typhus. Adouard, Faget, Gamgee, and adherents of the ship origin of yellow fever. 108. Novae Pestis Americae. Eisner, 1805. 109. ]S^ERvous Gastric Fever. Berenger-Feraud. 110. New Distemper of 1791. American writers, beginning of Nineteenth Cen- tury. 111. Occidental Pestilence. Berenger-Feraud. 112. Oghropyra. From ''Ochre," yellow, and "Pyra,-' fire, meaning, literall}', a burning or ardent fever. SYNONYMS OF YELLOW FEVER. 81 113. Palatine Fever. Name originally given to the pestilence which reigned at Philadelphia in 1741, owing to the popular notion that it had been brought to the City by some German euiigrants from the Pala- tinate. 114. Peste or Pestilencia. Early Spanish chroniclers. 115. Peste Caraibe. Early French and Spanish waiters. 116. Pestilential Fever. Eochefort, Bajon, Hughes, Fermin, Chanvalon, Chirac. 117. Pestis Tropicus. Hosack. 118. POULICANTINA. Carib Indians. 119. Putrid Inflammatory Synocope. Berenger-Feraud. 120. Putrid Fever. ; Hughes, 1750. 121. Putrid Malignant Fever. Berenger-Feraud. 122. Putrid Synocope. ' Berenger-Feraud. 123. Ship Fever. Audouard and his school. 124. Spanish Fever. Cadet, 1822. _ , 82 HISTORY OF YELLOW FEVER. 125. Strangers* Fever. Simons, 1S39. So called in Charleston. S. C, as the disease was thought to attack only new- comers, 126. Synochus, Young. 127. SYxocHrs Atrabiliosji. Schotte, 17S2. 128. Syxochus Icterodes. Currie, 1794. 129. Syxochus Maligna. Cathrall, 1791. 130. Tanardilla. Moreau de Saint-Mery says this designation was quite prevalent in San Domingo and Spanish America. It is derived from the Sj)anish and means a febrile illness followed by jaundice. 131. TiFUs Icterodes, Flores, 1813. 132. Tritopheia Americana, Sauvages. 133. Tropical Fever. Berenger-Feraud. 131. Tropical Continued Fever. Lemprierre. 135. Tropical Endemic Fever. Dickson: Belcher. 130. Typho-Icterode Animadversiones. Leiblin, 1815. SYNONYMS OF YELLOW FEVER. 83 137. Typhus. According to Laroche, yellow fever has been re- garded as a hybrid form of typhus by such emi- nent authorities as Blane, Lempriere, Dickson and Chisolm. 138. Typhus Acgidentel Ou Icterique. Savaresy. 139. Typhus Amarilla. This term came into general use shortly after the War of 1812. It was then that the great discus- sion about the contagiousness of yellow fever reached its zenith. 140. Typhus Icterodes Padecido. Moreno, 1813. 141. Typhus Cum Flavedine Cutis. Cullen. 142. Typhus D'Amerique. Bally. 143. Typhus Icterodes. Sauvages. 144. Typhus Tropicus. Qgiish a century. English and American writers, beginning of last 145. Typhus Miasmatique Ataxique Putride Jaune. Bally. 146. VOMITO. From 1709 to 1790, Yellow Fever was popularly known as ''Vomito." 147. VoMiTO Amarilla. According to Chambers' Encyclopedia, article on Yelloiv Fever, the disease is designated by the above name in Central America. 84 HISTORY OF YELLOW FEVER 148. VoMiTO Negro Epidemico. Gastiblondo, 1755. 149. VoMiTO Xegro. Early colonial writers. The word is Spanish and means ''Black Yomit.'' 150. YOMITO Prieto. Spanish writers. Same meaning as ''Vomito Xe- gro." 151. Yellow Fever. At the present day the name Tellow Fever and translations is used by all writers, to the exclu- sion of all other names. The term was first used by Griffith Hughes in 1750, in Ms ^'Xatura: His- tory of Barbadoes." 152. Yellow Jack. A popular name for the disease in England and the United States. CHAPTER III. HISTORICAL SUMMARY. Where was the Cradle of Yellow Fever? — The Theory of American Origin. — The African Theory. — The Asiatic Theory. — The Gulf Stream Theory. — Observations by the Author on the above Theories. Where was the Cradle of Yellow Fever? There is no subject in medicine upon which there has been such a diversity of opinion as the origin of yellow fever. From the time of Bally, in the seventeenth century, when the controversy can really be said to have begun, to the present day, medical writers and historians have been theorizing and conjecturing on the matter, but nothing has been adduced which can, in the remotest way, be said to have thrown any new light on the vexed and seemingly unending question. As soon as one w^riter would launch a doctrine which, in his opinion, was plausible and in- contestable, another would come to the front and adroitly dissect it,' laying bare its imperfections to the glaring light of logic, and inaugurate a theory of his own, which, in turn, would be mercilessly denuded of every semblance of common sense by a third disputant, who would bring columns of statistics and page after page of denuci- atory arguments to prove that no one but himself was on the right track and that every previous writer hold- ing a contrary view had either erred owing to gross ignor- ance of what he was proclaiming or had intentionally juggled with the facts. Some authors assert that yellow fever has affected man- kind from pre-Christian times, citing in support of their contention the waitings of ancient observers and philoso- phers ; others claim that it is a purely American product and deny its existence before the discovery of America, laying the blame for its importation into Europe and Africa to the slave trade and indiscriminate commerce of colonial days. A careful search into the voluminous literature on the origin of yellow fever naturally leads to the query: Where was the cradle of yellow fever? 86 HISTORY OF YELLOW FIVER. The problem is as difficult of solution as the SyUogismus Crocodilus of Aristotle. After centuries of discussion, we are no nearer the truth than our forefathers were. Such eminent observers as Bancroft. Cornilliac, Bally, Moreau de Jonnes, Physick, Chaille, Toner, ^aint-Merv, Finlav, Cullen, Sternberg, Ferreira, Kochefort, Audotiard, Ber- anger-Feraud, Valdez, Bush, La Koche, Jones, Faget and others, have conjectured ah libitum upon the origin of the disease, but their conclusions have only left us a diver- gence of opinion which no amount of conjecture can bridge and which defies the most abstruse laws of com- mon sense and logic. That great American philosopher. Humbolt,^ admir- ably sums up the situation in the following words : "In all climates men appear to find some consolation in the idea that a disease considered pestilential is of for- eign origin. As malignant fevers easily originate in a numerous crew cooped up in dirty vessels, the beginning of an epidemic may be frequently traced to the period of the arrival of a squadron; and then, instead of atribut- ing the disease to the vitiated air contained in vessels de- prived of ventilation, or to the elfects of an ardent and unhealthy climate on sailors newly landed, they affirm that it was imported from a neighboring port, where a squadron or convoy touched at during its navigation from Europe to America. Thus we frequently hear in Mexico that the ship-of-war which brotight such-or-such a viceroy to Vera Cruz has introduced the yellow fever which for several years had not prevailed here; and in this manner during the season of greatest heat the Havana, Vera Cruz, and the ports of the United States mutually accuse one another of communicating the germ of the contagion. It is with the yellow fever as with the mortal typhus known by the name of 'Oriental pest,' which the inhabitants of Egypt attribute to the arrival of Greek vessels, while in Greece and Constantinople the same pest is considered as coming from Eosetta or Alexandi-ia." Let us noAv consider these theories seriatim. ' Humboidt: Poltical Essay on the Kingdom of New Spain, vol. I, ]). 219. HISTORICAL SUMMARY. 87 1. The Origin of Yellow Fever. A search through musty archives, time-yellowed tomes and worm-eaten volumes two or more centuries old, re- veals the fact that the first epidemic of yellow fever in the New World, took place in the West Indies in 1647, the de- tails of which are faithfully chronicled in Ligon's History of Barbadoes. Outbreaks of the fever are noted by other observers as having caused much mortality before this, among which is the pestilence which mowed doAvn the fol- lowers of Columbus in 1494 and the series of epidemics in Brazil which lasted from 1688 to 1694.- We shall now proceed to give the views of the best authorities upon the subject, believing with Quintilian that ^'searching into every particular, we sometimes discover truth where we least expected to find it.-' The earliest authentic description of yellow fever is that of the Portuguese pln^sician Ferreira da Rosa, who observed the epidemics which prevailed at Olinda, in Brazil, from 1687 to 1694, shortly after the Portuguese army had made the conquest of Pernambuco. Humboldt notes the fact that it is known with certainty that in 1691 yellow fever manifested itself at the Island of Bar- badoes, West Indies, where it went by the name of ''Ken- dal's Fever," without the slightest proof that it was brought there by vessels from Pernambuco. The natural conclusion is that the disease must have been epidemic in the locality at that time. Ulloa,^ siDcaking of the Chapetonadas, or fevers to which Europeans were exposed on their arrival in the West Indies, relates that according to the opinion of the people of the country, the vomit o prieto was unknown at Santa Martha before 1729 and at Carthagena previous to 1740. The first epidemic at Santa Martha is described by de Gastilbondi,"^ a Spanish physician. Since that time, the inroads of yellow fever have been almost universal -Ferreyra da Rosa: Traitado da Constitucion Pestilencial de Peniambuco, by Joam Ferreira da Rosa (1694), "Ulloa; Voyage, etc., pp. 41 and 149. *Gastiblondi: Lazuriaga de la Calentura Biliosa, p. 7. 88 HISTORY OF YILLOW FEVER. and are given in detail under proper classifications in other portions of this yolume. The Twentieth Century Practice, a work which occu- pies a foremost place in medical literature, in an article on the history of yellow fever, says \^ ''It would afford the student of the disease a great deal of satisfaction if he could locate its first habitat, but that privilege is denied him. As far as we moderns are con- cerned, ,we date the disease from the time of Columbus and his followers. The disease, no doubt, existed in pre- historic times, and is buried in that nebulous past that envelopes so many infectious and contagious diseases." La Eoche^ adheres to the belief that the West Indies, and part of the coast of North and South America, con- stitute the proper soil of yellow fever. Herrera, Oviedo and other early Spanish writers, relate that shortly after the arrival of the Europeans in Ameri- ca, they were decimated by a sudden and very fatal pestil- ence, which committed fearful ravages. Columbus him- self was stricken by the malady on his second voyage while at the island of Mona, West Indies, and ts as in great danger, escaping death by immediately sailing for the high seas. Berenger-Feraud,^ one of the ablest and most conscien- tious authorities on the subject, tells us that the first at- tempts to colonize Porto Eico were frustrated by the pre- valence of this unknown pestilence and notes"^ the fact that of the 1500 men which had been left by Columbus at Monte Cristo in 1493, there remained, two years after- wards, only two hundred foot soldiers and twenty cavalry- men. The attempts to colonize St. Domingo (1191 and 1501), Porto Eico (1508 and 1513), the Isthmus of Darien (1509 and 1511), were also retarded by the rav- ages of the same disease. So fatal was this malady, es- pecially in Saint Domingo, that the Spanish Government, loth to lose this coveted possession, but not wishing to ex- pose its soldiers to annihilation, sent as colonists to the "Page 401. "La Roche: Vol. 1, p. 219. 'Gazette des Hapitaux, 1884, vol. 57, p. 660. HISTORICAL SUMMARY. 89 island two hundred convicts. These criminals can be said to have b^en the pioneer settlers of the island. At Darien, in 1509, the expedition commanded by Da- vila lost seven hundred men in a single month. Panama had the same experience.^ Fathers Breton and Dutertre,^ who describe the epi- demic of 1635, in Guadeloupe, says that it was known among the Caribs b}^ the name of Poulicantlna, a word which signifies ''I am struck with a switch," which meant to describe the suddenness which characterized the onset of the fever. These same observers say that the disease was considered so infectious b}^ the natives, that those stricken were often abandoned to their fate and whole villages were deserted when the first cases appeared, the torch being applied by the terror-stricken Caribs, so as to prevent the further spread of the infection. Ziemssen's Cyclopedia of the Practice of Medicine^^ that wonderful storehouse of medical lore, which is edited with that careful attention to accuracy and to the minutest details which characterize the German mind, has the following observations on the subject: ^'We are entirely without trustworthy information re- garding the first appearance of yellow fever. It is highly probable, that the communication of various authors, which inform us of the prevalence of the disease in the Antilles since the memory of man, really refer to yellow fever. The theory is much more tenable that the disease was first developed after the immigration of Europeans into the West India Islands; at least, it agrees better with many facts, which have been since observed, to con- sider yellow fever as an acclimation disease (of the tropics), to which immigrants are liable, than to assume that it originally prevailed as an epidemic disease among the natives, and afterwards underwent a complete altera- tion of its character. The Antilles were probably the cradle of yellow fever; at least, accurate observations of the disease in question were first made here." The Board of Experts authorized by Congress to in- ®Du Tertre: Histoire General des Antilles, vol. 1, p. 30. ^•^Vol. 1 (1874), p. 489. 90 HISTORY OF YELLOW FLYER. vestigate the yellow fever epidemic of ISTS. after thorough and minute i-uTestigations. reached the following conclu- sions :^^ ••Yellow fever was not known to the people of the East- ern Hemis])here until after the discoyerv of America by Columbtis. The earliest epidemics of which we have any historical information occtirred during the first half of the seventeenth century, in the West India islands." Joseph Jones, one of Louisiana's most distinguished physicians, whose works on fevers are acknowledged atithorities. makes the following observations :^- ••After a critical examination of the works of Herod- otus^, Strabo, Jtistin, Cornelius, Xepos, Eutropius, Plti- tarch, Tittis, Linus, Thucidides, Homer, Salhist. Virgil, Flores. Vallerius, Particulus, C»sar, Horace, Cicero, Xencphon; and Tacittis. we have failed to recognize the disease now calleel yellow fever, in any descriptions of l)articular plagues or allusions to any pestilence; and in like manner, while in the writings of the middle ages we have descriptions of wide-spread and mortal plagties, amongst which may be recognized the oriental giandtilar plague, small-pox, measles, tyi^htis and typhoid fevers, the sweating sickness, elephantiasis or leprosy, cholera, dysentery, and cerebro-spinal meningitis: yellow fever finds no place in these annals of general history, or of medicine, previous tr> the discovery of America by Colum- bus. As we have failed to find any history or record of yellow fever before the voyage of Christopher Columbus, the first question of importance which presents itvSelf is, whether yellow fever had ever prevailed among the aboriginal inhaV)itants of North and South America and the We.vt Indies previous to the discovery of America and the explorations of the Spanish adventurers, and the es- tablishment of the Spanish. French. Portuguese, Dutch and English colonies?" Dr. Jones then goes on to say that the West India Islands and certain portions of Xorth and South Ameri- ca, as the Valley of the Mississippi. Mexico, Central " See Report, p. — "JoDes: Proceedings Louisiana State Medical Society. 1879, p. 54. HISTORICAL SUMMARY. 91 America and Peru, appear to have been, at the time of their discovery by Europeans, peopled with a sufficiently dense population for the existence of those conditions upon Avliich the origin and spread of certain diseases de- pend. The Avholesale destruction of the native popula- tion by cruel Avars, and by still more cruel slavery, and by the introduction of certain diseases, as the small-pox, as well as the Avanton destruction of the pictorial Avorks by which the hieroglyphics of the more adA^anced nations of America might liaAe been deciphered, and the sudden and utter subA^ersion of the systems of religion and science peculiar to these people, and the rapid disappearance of the royal families and priests who Avere, as in ancient Egyi3t, tlie custodians of the national science and art, have involA-^ed in obscurity many subjects of great and lasting interest to the medical historian. The medical historian has only imperfect and doubtful data upon which to found an^^ opinion as to the nature of the epidemic and contagious diseases which afflicted the aborigines previous to the discovery of the AVestern Hemisphere. That the more populous nations of America Avere not exempt from diseases of an epidemic and jDestilential na- ture, has been Avell established. The pestilence called by the Mexicans ''Matlazahuatr' desolated the cities of the Toltecs in the eleventh century, and forced them to abandon Mexico, and to continue their migrations soutliAvard, and to the Avest and northAvest; it iuA^aded the populous cities of Central America, and a similar disease committed great raA^ages amongst the In- dian tribes which occupied the country between the mountains and the Atlantic coast a fcAV years before the landing of the Pilgrim Fathers. The Matlazahuatl, a disease closely resembling yelloAV fever, but Avhich is said to be peculiar to the Indian race of America, has seldom appeared more than once in a century; it raged in the elcA^enth century amongst the Toltecs, it made great raA^ages amongst the Mexicans in 1545, 1576, 1736,^1737, 1761 and 1763, and amongst the Indians of the Atlantic coast in 1618 and 1619. According to Alexander Humboldt, the Matlazahuatl, 9£ HISTORY OF YELLOW FEVER. altliougli pestilential in iis naTiire. and at^H-nded wirli hiemorrliage from the n'j>e and si'^marh. was distinLT from the Vomito Prieto, and was peculiar to the alMii^ines of America. The Spanish authors call this disease a plagtie. The following passage from Htimlx>ldt's • -Politi- cal Essay on ^N'ew Spain" appears tLi ernhndy all that is known with reference to the nature of the Matlazahuatl of the Mexicans : -The Matlazahuatl. a disease peculiar to the Indian race, seldom a^^pears more than once in a centui^y. It raged in a particular manner in 154:5. 1576 and 173'j. It is called a plague by the Spanish authors. As the latest epidemic tcK>k j^lace at a time when medicine was not con- sidered as a science, even in the capital, we have no exact data as to the Matlazahuatl. It bears certainly some analogy to* the yellow fever or black vomiting ; but it never attacks white people, whether Europeans or de- scendants from the natives. The individuals of the race of Caucasus do not appeal* subject to this mortal typhus, while, on the other hand, the yellow fever or black vomit- ing very seldom attacks the Mexican Indians. The i)rin- cipal site of the Vomito Prieto is the maritime region, of which the climate is excessively warm and humid : but the Matlazahuatl carries terror and destruction into the very interior of the country, to the central table-land, and the coldest and the most arid regions of the kingdom. "Father Forribio, a Franciscan, better known by his Mexican name of Motolina, asserts that the small-pox at its introduction in 1520, by a negro slave of Xarvaez, car- ried off half the inhabitants of Mexico. Toquemada ad- vances the hazardous r»pinicin that in the two Matlaza- huatl epidemics of 1515 and 1576, SOO.fioo Indians died in the former, and 2,000,000 in the latter. But when we reflect on the difficulty with which we can at this day estimate in the eastern i>arts of Europe the number of those whr» fall victims to the plague, we shall very reas- onably be inclined to doubt if the Viceroys Mendoza and Almanaza, governors of a recently conquered country, were able to procure an enumeration of the Indians cut off by the Matlazahuatl. I do not accuse the two monkish hi.storians of want of veracity^ but there is very little HISTORICAL SUMMARY. 93 probability that their calculation is founded on exact data. ^'A very interesting problem remains to be resolved. Was the pest which is said to have desolated from time to time the Atlantic regions of the United States before the arrival of the Europeans, and which the celebrated Rush and his followers look upon as the principle of the yellow fever, identical with the Matlazahuatl of the Mexican Indians? We may hope that this last disease, should it ever reappear in Xew Spain, will be hereafter carefully observed by the physicians. "^^ Humboldt further states that long before the arrival of Cortez there had almost periodically prevailed in New Spain an epidemical disease called by the natives Matlaza- huatl, which several authors have confounded with the Yomito or yellow fever. This plague was probabh^ the same as that which in the eleventh century forced the Toltecs to continue their • emigrations southwards. It made great ravages amongst the Mexicans in 1545, 1576, 1736, 1737, 1761, and 1763; but as has already been ob- served, it differed essentially from the Yomito of Vera Cruz. It attacked few except the Indians or copper-col- ored race, and raged in the interior of the country on the central table-land, at twelve or thirteen hundred feet above the level of the sea. It is true, no doubt, that the Indians of the valley of Mexico who perished by the thou- sands in 1761 of the Matlazahuatl, vomited blood at the nose and mouth; but these hsematemeses frequently oc- curred under the tropics, accompanying bilious ataxical {ata.riqitcs} fevers; and they were also observed in the epidemical disease which in 1759 prevailed over all South America, from Potosi and Oraso to Quito and Popazan, and which, from the incomplete description of Ulloa, was a typhus peculiar to the elevated regions of the Cordil- leras. In summing up the result of his investigations. Dr. Jones says : "It is evident, therefore, that the origin of the American plague or typhus (vomito prietOy fievre jaune, yellow "Humboldt: Political Essay in the Kingdom of New Spain, vol. 1, p. 1j7. 94 HISTORV OF YELLOW FEVER. fever) is involved in doubt, on account of the prevalence in the tropical and sub-tropical regions and temperate zones, both amongst the natives and foreigners, of some forms of malarial fever, often attended with jaundice, passive haemorrhages, and black vomit. If it could be de- termined at what time this terrible disease was clearly recognized bv the medical profession and historical writers as distinct from paroxsvmal malarial fever, and as dependent upon a specific catise or upon a combination of causes peculiar to itself, a firm ground for the discus- sion of its origin and of its relations to the native popula- tion, as well as to the foreign elements, would be estab- lished. But it is well known that many of the descrip- tions given by various authors will apply as well to the severer forms of paroxysmal malarial fever as to yellow fever, and also that the distinction of the one from the other has been the result of comparatively recent labors, and even at the present time there are not a few physi- cians who hold to the identity of both diseases in their origin and essential nature." Clemow^^ says that so far as a somewhat imperfect knowledge of the history of the disease enables us to judge, it seems certain that originally yellow fever was essentially an American disorder, and that though the in- fection has to some extent become domiciled on the African shores, it is more than probable it was originally brought there from South America or the West Indies. ' ''It is to be noted,'- continues this atithor, "that some writers have held exactly the contrary vicAv and believed that yellow fever was originally imported to the West Indies by means of infected negroes from Africa.^-^ The facts of history are, however, against this view, and there is much evi- dence to show that this fever was known in those part of America where it still prevails, even before the discovery of the continent by Europeans, and long before the trans- "Clemow: The Geography of Disease, by Frank J. Clemow, (3 903), p 520. "^ In 1699 an English vessel carrying slaves transported > ellow fever to Mexico from the Atlantic coast of Africa. Bat the disease was already endemic along the shore of the Gulf of Mexico G A. HISTORICAL SUMMARY. 95 port of negroes from Africa to the West Indies began to be practised." Toner believes that the conceded home of yellow fever is the West Indies. ^^ Stille^" asserts that yellow fever unquestionably ori- ginated in the W>st Indies, where it was observed at St. Domingo at the end of the fifteenth century. It was then carried to Mexico and other localities bordering on the Gulf of Mexico, where it prevailed to a great extent in the seventeenth century. Finlay,^^ in commenting on the history of the disease, asserts that the remotest records about epidemic disease in the Old World fail to show that yellow fever, or any other malady presenting similar epidemiological features, had ever been observed previous to the discovery of America in 1492; while in the newly-discovered lands it soon became apparent that every expedition of European settlers that came to the Antilles or to the Spanish Main had to pay a heavy tribute to an unknown pestilence, dur- ing the first summers of their residence, suffering there- after no further trouble from the climate. About fifteen years ago, Drs. Finlay and Berenger- Feraud,^^ independently of each other, undertook minute historical researches regarding this ''unknown pestilence," and came to the conclusion that the disease mentioned in the old Spanish chronicles as the "peste," "contagio" or "epidemia," was no other than our modern yellow fever. They also reached the conclusion that at the time of the discovery of America the disease was endemic on the coast of Mexico, at the present site of Vera Cruz, as well as on the Atlantic site of the Isthmus of Panama, and on the Spanish Main along the coast of Colombia and Ven- ezuela, inhabited by the Carib Indians. ^•^ The Distribution and Natural History of Yellow Fever in the United States, by J. M. Toner. American Public Health Association Reports, 1873, vol. 1, p. 359. " Stille: Medical Record, N. Y., 1879, vol. 15, p. 193. "Finlay: Reference Handbook of the Medical Sciences, Vol. 8, p. 322. '' Ibid. 96 HISTORY OF YELLOW FEVER. This view is also concurred in by Anders,-*^ who states that yellow fever first appeared at Barbadoes (West In- dies) in 1647 and was subsequently conveyed along the channels of commerce, until it became widely dissemin- ated. Even the old stand-by of every American school-boy, the venerated and verbcse ^^oah Yv^ebster,-^ has something to say on the subject. He tells us in all seriousness that yelloAv fever jDrevailed among the Indians of Canada and 'Xew England in 1618, was again epidemic in 1716 and made spasmodic appearances among the noble sons of the forest at various stated periods. According to the report of Beyer, Parker and Pothier,-^ yellow fever has been endemic in Vera Cruz since 1509. Manson, whose work on Tropical Diseases is one of the classics of medical literature, does not consider the mat- ter of mtich importance, summing up the situation in a few words, simply stating that it is impossible to deter- mine from existing records whether it was originally an African or a West Indian disease.-'^ One of the strange freaks of yellow fever visitations is recorded by Stille,-^ who claims that the disease was in- troduced into Dutch Guiana in 1793 from the West In- dies. For a period of 37 years after this, it never invaded that province. At the end of this long period of immunity the colony sttffered from a new importation of the disease, which visited it anntially thereaft-er for ten sticcessive years, when it ceased and for the six following years failed to occur. It was then reintroduced by an infected vessel and spread more widely than before. At the time spoken of by Stille, Spain possessed by far the best and largest portion of the American continent, extending from the north of California to the Straits of Magellan — a space between 6,000 and 7,000 miles — and -'Practice of Medicine, by James M. Anders, (1899) p. 119. ^ History of Epidemic and Pestilential Diseases, by NoaH Webster, vol. 1, p. 177. -Report of Yellow Fever Party No. 1, Yellow Fever Institute, p. 12. ==* Tropical Diseases, by Patrick Manson (1903), p. 187. =' Medical Record, N. Y., 1879, vol. 15, p. 193. HISTORICAL SUMMARY. 97 the system of commerce which prevailed then appeared to be eminently favorable to the origin and spread of yel- low fever. The Spanish galleons dotted the seas and, during times of peace (which were not frequent in that age of buccaneering and aggressive colonization) visited the principal ports of the Spanish Empire, where they were ahvays royally entertained. It was therefore easy for them to cavvj disease from one port to another, a fact which is attested by the melancholic record of the fearful epidemics which visited the New World in the early days of its history. Joseph Jones^^ thus interestingly describes the usual programme followed by the galleons : . ''They sailed from Cadiz to the Canaries, thence for the Antilles, and after reaching this longitude the}' bore away for Carthagena. . As soon as they came in sight be- fore the mouth of Eio de la Hacha, after haying doubled Cape de la Vela, advice of their arrival was sent to all parts, that everything might be prepared for their recep- tion. They remained a month in the harbor of Cartha- gena, and landed there whatever was designed for terra firma. They then sailed to Puerto Velo, where, having stayed during the fair, which lasted five or six weeks, they landed the merchandise intended for Peru, and re- ceived the treasures and commodities sent from thence. The galleons then sailed back to Carthagena, and re- mained there till their return to Spain, which usually hap- pened Avithin the space of two years. When orders for re- turning home arrived, they sailed first to the Havana, and having joined the flota, and what other ships were bound to Europe, tliey steered nortliAvard as far as Caro- lina, and then, taking the westerly winds, they shaped their course to the Azores, when, having watered and victualed afresh at Terceira, they thence continued their voyage to Cadiz.-' What a glamour of romance and interest invariably surrounds the writings of this great son of Louisiana! The paragraph above cited almost carries one back to the good old days when men lived only to fight, eat, drink -''Jones: Transaction Louisiana State Medical Society, 1879, p. 64. 98 HISTORY OF YELLOW FEVER. and write sonnets toi their lady-loves and cared naught for the morrow. But my enthusiasm makes me forget my task. Let us return to our mutton. In an interesting paper read by LeBeuf before the Or- leans Parish Medical Society, and published in the Transactions of that Society for 1905 and also in the New Orleans Medical and Surgical Journal for December, 1905, a thorough review of the history of yellow fever is given. In commenting on the probable origin of the dis- ease, the doctor says : ^'The Aztecs called the disease Matlazahuatl and Hum- boldt tells us that it existed as early as the eleventh cen- tury. In 1545, 1576, 1736, 1737, 1761 and 1777, it greatly deciminated the native Mexican race in a number of places. Before the advent of the white colonists it was not general. The natives travelled very little, on account of the lack of roads and the high mountain ranges. They had no vessels large enough to make the voyage to the West Indies and did not have free communication with outsiders. When the white colonists came, they were more susceptible to the dangers of the disease, as they were unacclimated, and were quickly the transmitting agent of it through all the low austral regions. It was also more fatal to them than to the natives, and it re- tarded the settlement of many calonies on account of the panics it caused." The same writer, quoting Prescott, says that it seems that European civilization carried with it the germ of the poison. The moment a town was founded or a com- mercial centre created, it was certain to cause the ex- plosion of the latent malignity of this poison in the air. We will conclude this resume of the American origin of yellow fever by quoting from that inexhaustible source of information. Dr. Joseph Jones :^^ ''If it were possible to determine with accuracy the na- ture of the severe and fatal forms of fever which afflicted the first explorers and colonists of the tropical and sub- tropical regions of America, and even the very compan- ions of Columbus, the question of the origin of yellow ^« Trans. La. State Med. Society, 1879, p. 63. HISTORICAL SUMMARY. 99 fever would be relieved of much uncertainty and doubt. If we are to credit the accounts of some authors, the first trace of yellow fever was observed at the end of the fif- teenth and beginning of the sixteenth century at San Domingo and Porto Kico, in the Continent of South America, and in the Gulf of Darien, at which latter place it is said to have prevented the Spaniards from settling. In November, 1493, Columbus landed at San Domingo with 1500 Spaniards, in order to found the city of Isa- bella. A severe and fatal fever carried off the greater part of them within a year after their arrival, and the disease is described as being 'yellow as saffron or gold.' From 1544 to 1568 there is no record of the disease having pre- vailed as an epidemic until 1635, when it appeared in Guadeloupe, and thenceforward it occurred at regular in- tervals. Tn the seventeenth century it spread along the Continent of South America to latitude 8° south, and in North America to latitude 42°, but only on the eastern coast of both. The first appearance of the disease in the United States was at Boston in 1693, and in Charleston and Philadelphia in 1699. It is said first to have appeared in the Gulf of Mexico, at Biloxi Bay in 1702, and Mobile in 1705; but Humboldt held that it had prevailed from the ver}^ foundation of Yera Cruz, and was indigenous to this city. It prevailed at Pensacola and Mobile in 1765. ''In the eighteenth century it appeared on the west coast of South America in latitude 2° south. On the North American Continent it spread to latitude 42"; it extended even to Europe, and reached the Pacific and Madagascar. At the beginning of the nineteenth century it penetrated deeper into the North American Contin- ent than formerly, reaching as high as latitude 47° north, and in Europe it extended to latitude 48°, and prevailed in the Canary Islands and Leghorn. "Ever since yellow fever attracted attention it was recognizeci as a distinct disease from the remitent autum- nal fevers of the temperate zone. It has prevailed as an endemic in Havana, raging epidemically from April to December, and occurring sporadically during the rest of the year. From time immemorial it has been endemic at Vera Cruz, in the Gulf of Mexico, where its chief victims 100 HISTORY OF YELLOW FEVER. are strangers who come from cold regions during the hot season, as well as Europeans and those native who ex- change the more elevated and cool regions of Mexico for the coast." African Origin of Yellow Fever. The doctrine that Africa was the original home of yel- low fever has been promulgated by many writers. As early as X815, Pym, in his ^'Observations on Bulam, or Yellow Fever," propagated the doctrine that yellow fever was endemic to Africa, had always existed there and that the world was indebted to that continent for the spread of the disease to the four points of the compass. This theory was warmly espoused by Audouard in the Revue Medicale (Paris, 1825), Avho thickened the plot by fastening the onus on the slave trade of colonial days and asserting that the disease also developed spontaneously in the holds of ships packed with living cargoes of slaves, reeking with filth and germ-propagating material. These views were seriously championed by many writers, one of them being that distinguished Louisiana authority on yel- low fever, Faget, who, in his work entitled Etudes Medi- cales de Questions Importantes pour la Louisiane, pub- lished in 1859, speaks in eulogistic terms of the views of Pym and Audouard and gives as his opinion that the theory advanced by these famous contagionists is the only rational solution of the problem. In support of his contention. Dr. Faget claims that when the traffic in slaves Avas interfered with by the United States government and the channels of this com- merce changed to sub-tropical ports, yellow fever, for the first time, broke out in Brazil. The learned doctor, in making this assertion, evidently overlooked the great epi- demic which broke out in Pernambuco in 1688 (according to Ferreira da Rosa) and which ravaged the Brazilian coast for several years afterAvards. In an interesting little book published in 1898, Cole- man (History of YelloAV Fever, etc.) revives the doctrine enunciated by Audouard, citing many examples in an ef- fort to prove that the French observer Avas correct, but advances nothing decidedly noA^el or couAdncinu'. HISTORICAL SUMMARY. 101 According to Byrd,^^ the disease was introduced into Southern Europe, the West India Islands and the con- tinent of North and South America from the West coast of Africa, ''AYhere it originally flourished." This author blames the importation of the disease into Europe upon the ambition for extended territory which dominated the Caucasian race in the Middle Ages and holds the view that if the avarice and cupidity of the New England slave- trader had not tempted him to invade the jungles of West Africa, to kidnap the unwary and guileless aborigines, there is reason to believe that the hecatombs which have marked the visitations of the pestilence in the West In- dies and the shores of the American Continent, would never have been known. The natives of those lands knew nothing of the disease until brought to them by ships en- gaged in a most unholy commerce. Kochefort, one of the earliest writers on the subject, al- luding to the West Indies, says : ''This noxious air was brought by vessels coming from the African Coast. "^^ Another disciple of the African origin of the disease is found in Turpinseed,^^ who says that the great difference of temperature between day and night in the great desert, the air being 174° by day and 24° by night, undoubtedly had an influence in furnishing the embryonic conditions necessar}^ to the origin and propagation of the disease. The infection was then carried by the desert winds to the coast towns of West Africa and thence scattered to sus- ceptible foci throughout the world. Strobel,^^ who also blames Africa for having been the original source of infection, furnishes considerable in- formation concerning the origin and spread of yellow fever, but his views are, unfortunately, too biased to be of any reliable historical value. The learned essayist cites only events which lend color to his rabid views on conta- gion and he eludes facts Avhich prove the contrary in such -•Philadelphia Medical Times, 1872, vol. 3, p. 726. -® Ce mauvais air y avait ete apporte par des navires qui venoient de la Coste d'Afrique. Histoire Naturelle et Morale des Isles Antilles d'Amerique (1658), vol. 1, p. 3 ^^''Turpinseed: Medical Record, N. Y., 1878, vol. 14, p. 304. •■"Strobel: An Essay on the Subject of Yellow Fever, 1840. 102 HISTORY OF YELLOW F£VER. a tactfnl and unconcerned way. that it is a pity Ms efforts should not have been directed to a better purpose. He deplores the fact that the French Academy awarded 3Ion- sieur Chervin a premium of 10.000 francs for his admir- able I this is our word, not Strobel's ) treatise on the non- contagiousness of yellow fever, and holds up Dr. Bahi as a martyr because the latter was chased out of Barcelona for having propagated the doctrine that the fever which prevailed in that city in 1S21 was contagious. -They ex- ecratel and threatened with death those physicians suffi- ciently well-informed to recognize this character of the disease," continues Strobel ; "'they called them, by way of insult and derision, the aiitJtors of yellow fever."'^^ i The italics are Strobel's. i But it is not our purpose to quarrel with the views of the respected and departed disciple of Bally, who was, we feel certain, honest in his opinion. TTe simi)ly desire to say. en passant, that Monsieur Chervin earned those 10.000 francs by a large mai*gin, for it is of record that he not only put on the linen of patients that had died of yellow fever and slept in their beds, but that he also ate of the black vomit and inoculated himself with it. in order to prove the non-contagiousness of the disease. '^- Dowell-^^ speaks in positive terms concerning the source of yellow fever, giving Afi^ca as the undoubted origiQal focus. He also states that it exLsted in Africa, Eastern Asia, and Southern Europe, long before the establishment of the Greek and Eoman Empires, even running back a thousand years before Christ. Chisolm was an advocate of the African importation of the disease, as will appear by a perusal of his work pub- lished in 1799.^^ =»Ibid, p. 8. - Lancet, 1849, vol. 2, p. 433. *^Doweli: Yellow Fever and Malarial Diseases, etc.. 1S76. p. 13- ** Chisolm; An Essay on the Malignant Pestilential Fever in- troduced into the West India Island from BouUam, etc, 1799. HISTORICAL SUMMARY. 103 Sternberg^^ says that the early history of the disease is involved in obscurity and it is not possible to determine whether, as maintained by some, it was endemic at certain points on the shores of the Gulf of Mexico at the time of the discovery of the New World, or whether it was im- ported to the West Indies from the African coast, as ad- vanced by others. In commenting on the African theory of the origin of the disease, Sternberg adds that it seems very probable that the pestilential malady which prevailed for a time in these usually healthy islands (the West Indies) and then disappeared, was in fact yellow fever, and that it was in- troduced by ships from the west coast of Africa is not at all incredible. ^'Indeed," continues this authority, ''it al- most seems necessary to look for an endemic of the dis- ease outside of the West Indies, for the reason that in the comparatively few places in which it is now endemic, there is historical evidence to show that there was first im- portation and a previous period of exemption; while, on the other hand, the conditions upon which endemicity at the present day seems mainly to depend, were formerly unknown — conditions arising from the aggTegate of popu- lation at seaport cities, as in Havana, Vera Cruz and Kio Janeiro. "^^ Elliott,^'^ in commenting on the endemic diseases of West Africa, says : ''There is an old doctrine that yellow fever had its original home on the West African coast, and that its existence in the tropical regions of the American continent and in the West Indies is the result of the slave trafiic. On the other hand, certain French authors, notably Berenger-Feraud, contend that the disease was first imported into Africa from America. However this may be, there is no doubt about the fact that yellow fever has frequently shown itself in epidemic form in Senegam- bia, and that the British possessions on the West African littoral are liable to outbreaks of a peculiar malignant ^^ Sternberg: Reference Handbook of the Medical Sciences, vol, 8, p. 583. 3« Ibid, p. 584. "Elliott: Journal of Tropical Medicine, London, 1899, vol. 1, p. 317. 104 illSTORY OF YELLOW FEVER. form of fever which is confined to the European residents, and which, after thinning their numbers to an appalling degTce, and within a brief period, suddenly disappears." It is a matter of history, and cannot therefore be contra- dicted with any degree of safety, that in December, 1493, when Columbus reached St. Domingo, bringing with him the first Europeans who had ever set foot on American soil (about fifteen hundred, according to Cornilliac^^) that a pestilential disease broke out in the Tillage of Ysabella (then in process of construction), and nearly annihilated the venturesome little band that had braved the terrors of a long voyage through unknown seas to colonize a strange and wonderful land, where, according to the fabulous stories then current, ^'gold grew on trees and diamonds strewed the ground." Pouppe-Des-Portes,^^ a French surgeon, who practiced at St. Domingo from 1732 to 1748, says that yellow fever was quite prevalent in the West Indies at that time and was called Mai cle Siam, from the tradition that it had first been observed at St. Domingo during the visit of a French man-of-war coming from the kingdom of Siam in the seventeenth century. No one who has read the works of Bally will dispute the fact that he is generally reliable and accurate in his statements, but his unalterable belief in the doctrine of contagion and importation made him blind to the true state of affairs in this particular instance. Even such an eminent authority as LaRoche criticizes the great apostle of contagion, observing that the course he pursued in the controversies about his pet theory was assuredly not com- mendable.^9 In this connection, it is opportune to remark that up to 1793, a majority of American physicians were believers in the contagiousness of yellow fever, but during the epi- demics occurring between that date and 1825, the practi- cal experience so changed the mind of the medical world, that, while five hundred and sixty-seven were against the ^' Pierre Martyr, in his "Decades/' says the number was 1200. ■•" Histoire des Maladies de A, St. Domingue, vol, 1, p. 191. "Americ*\n Journal of the Medical Sciences, April, 1853, p. 317. HISTORICAL SUMMARY. 105 doctrine of contagion, twenty-eight only remained in fa- vor of it."^^ The phj^sicians of two hundred years ago Avere just as bitter and acrimonous when it came to discussing the subject of 3'ellow fever as those of our present enlightened age. A glance over the pages of the Medical Repository, the Edlnhiirg Medical Revieio, the British and Foreign Medico-Chirurgical Revieto, and other old-time medical journals, reveals page after page of decidedly personal re- marks directed by some venerable Esculapius against a brother who held a contrary view to those which were, in his opinion, the only tenable way of explaining certain things. The amount of vituperative ammunition which those ancient disputants possessed certainly puts all mod- ern efforts in that line in the shade. The terms ''medical buccaneers," ''malignant drivelers," "inexperienced and transient practitioners," etc., were among the lukewarm expressions used in these amiable diatribes. Sometimes, finding discussions through the medical press too tame or monotonous, the disputants abandoned the quill for more strenuous modes of clinching an argu- ment and we find mention here and there of violent per- sonal encounters between opponents of contending theo- ries. One of the most remarkable ways of settling a dis- pute concerning the diagnosis of yellow fever, took place at Kingston, Jamaica, between Drs. Williams and Ben- nett, who met on the field of honor on the 29th of Decem- ber, 1750, and fought so ferociously that they finally suc- ceeded in killing each other.^^ Asiatic Origin of Yellow Fever. An anonymous writer, more audacious and original than his contemporaries or those who lived before him, and whose identiy, unfortunately, we have been unable to unravel, asserts that the ancient and malodorous city of Smyrna, in Asia Minor, was the original focus whence yellow fever infected the world, and cites in support of his theory certain passages of history referring to the re- " Dowell, p. 107. *- Medical Repository, N. Y., 1805-06, vol. 9, p. 187. 106 HISTORY OF YELLOW FEVER. mittent fevers which devastated the Grecian Archipelago and the shores of Asia Minor as far back as the age of Pericles. French writers of the seventeenth century adhered to the theory that the Typhus miasmatiqiie ataxique putride jaune, the name by which the disciples of Bally desig- nated yellow fever, had its origin in Siam. Bally^^ as- sures us that the disease was brought to the island of Martinique by the ship of war VOriflamme in 1682, in which year *'the French people who had settled in Siam fled from the insurrection in that country and established themselves at Fort Eoyal/' Bally also states that the Oriflamme stopped at some Brazilian port on its way to Martinique. According to Ferreira and others, yellow fever was epidemic in Brazil at the time spoken of by Bal- ly, and if such was the case, how could the disease have been imported from Siam, when it was already implanted on American soil? There is certainly a historical faux- pas somewhere. Moreau de Saint-Mery, one of the most reliable and learned chroniclers of his time, in commenting on the al- leged Siamese importation, makes certain observations which leave no doubt that the disease brought to Martin- ique by the Oriflamme was yellow fever, no matter where the original infection of the vessel took place. Accord- ing to this authority, the ship was a hotbed of disease when it reached Martinique. Spotted fever {le pourpre, to use his exact expression) and an unknown pestilen- tial fever had committed fearful ravages among the ofift- cers and crews of the ill-fated Oriflamme, the mortality exceeding one hundred souls, among the victims being McRisieur de Lestrille, the commandant of the expedition. Saint-:\Iery also speaks of the bloody uprising which took place in the Siamese Empire and the flight of the French settlers on board the ships VOriflamme, Le Loiitre and the aS7. Nicholas, which set sail for France with all possi- ble haste. When the miniature flotilla entered the Atlan- •^ Description Topographique, Physique, etc., de I'lle de St. Domingue, by Victor Bally (1814), p. 700. ** The distinguished contagionist evidently got his dates mixed, as the insurrection in Siara took place in 1688. G. A. HISTORICAL SUMMARY. 107 tic Ocean, it was diverted from its course by storms, com- pelling the ships to make for the west. The Oriflamme arrived safely at Fort Koyal, Martinique, but the fate of her sister ships is left in doubt. Nowhere does Saint- Mery speak of the vessel having touched at any port in Brazil, as asserted by Bally and those cited by him. The date given by Saint-Mery (1690) is certainly more accu- rate than that stated by Bally (1682), as a reference to the political history of Siam, reveals the fact that the mas- sacre of the handful of Englishmen in the factory at Ayuthia, then capital of the kingdom, which was the sig- nal for the anti-foreign demonstration which put an end to the intrigues of the French court, took place in 1688. Cornilliac^^ gives 1690 as the date of the arrival of the Oriflamme at Martinique. Father Labat, a Dominican friar, who arrived in Mar- tinique in January, 1594,^^ tells of the ravages of the dis- ease, which he claims was imported by the warship VOriflamme, which had touched at a Brazilian port on its way from Siam. What led additional color to the story of the disease having been imported from Siam, was the fact that, in 1691, two vessels arriving from Pondichery, capital of the French East Indian settlement of that name, in Siam, were found to be nests of yellow fever, Avhich caused an appalling mortality among the crews of both vessels. It was afterwards proved, however, that the infection had been contracted at Fort Royal. Whether or not the disease was imported to the West Indies from Siam, or vice versa^ is a point which we will leave for others to dispute and theorize upon; but the importation, if it ever happened, certainly did not take place for the first time either in 1682 or 1690, as the reli- able and unassailable records of such historians as Oviedo y Valdez, Gomora, Coreal, Humboldt, Ulloa, Cor- nilliac, and Rochefort, give details of epidemics which de- vastated the West India Islands as far back as the ^'' Recherches Chronologiques et Historiques sur TOrigine et la Propagation de la Fievre Jaune dans les Antilles, by Cornilliac (1867), vol. 2, p. 72. «Ibid., p. 73. J 08 HISTORY OF YELLOW FEVER. fifteenth century. We are more inclined to lean to the theory that the disease was first brought to the East from the tropical coasts of America. Moseley^^ speaks at length of the ravages committed by the fever at Martinique in 1665 and the majority of authors of the time concur in saying that, although yellow fever prevailed in the West Indies ever since the voyages of Columbus, there is no authentic instance of the disease having been noticed on vessels previous to 1690, when the Oriflamme incident set the whole medical world agog. On the contrary, these ancient writers agree in the opin- ion that yellow fever prevailed as an endemic in the sev- enteenth century in all the localities in the New World bordering on the Gulf of Mexico and the Atlantic shores of South America, almost as far South as the Rio de la Plata. We will conclude by quoting from Hillary (Observa- tions on the Changes of the Air, etc., London, 1759), p. 144 : ''We observe no trace of this scourge in the descrip- tions given by ancient writers, not even by the Arabian observers, who practiced in warm climates." So far as history informs us, yellow ^fever has never been observed in Asia, although this vast continent is studded with regions which possess all the requirements for engendering and spreading the disease, including the Stegomyia. Let the Panama Canal be pierced, however, thus reducing time of commercial intercourse between the West Indies and the East to a fcAV days, and we shall, in all probability, see yellow fever transplanted to these ancient shores and commit fearful ravages among its bil- lions of souls. This is not a fanciful flight of the imagination, but simply a ''look forward," a calm, dispassionate prophecy, based upon experiences of the past and whose ultimate truth will thrill humanity with horror and despair when the mists which veil the future have melted away. The Gulf Stream Theory. Professor P. Stille, of Mobile, differs from all the pre- ceding authorities, and advances a novel theory to ac- -^A Treatise on Tropical Diseases, p. 421. HISTORICAL SUMMARY. 109 count for the origin of yellow fever. He attributes it to the Gulf Stream. Calling attention to the equable atmos- pheric conditions of the tropical lands of both hemi- spheres, he says : ''Coming up the south-east, across the torrid zone, is an ocean current which, where it sweeps around the north coast of South America, is called the Guiana Current. It makes its way directly into the Gulf of Mexico, where it takes the name of the Gulf Stream. After washing the smaller islands of the West Indies, it forces itself with great strength through the narrow chan- nel between Cuba and Yucatan, and rushes all around the shores of the gulf, taking its turn towards the east, and quitting the land immediately after passing the southern point of Florida. Within the gulf its tempera- ture stands at from 85° to 89°, but soon after having passed Florida its temperature goes suddenly clown to 65°, and finally to 54°, and 50°. Now, if we examine every part of the sea we shall find no other spot where a warm current washes the land at an^^thing like so high a tem- perature as is exhibited in the Gulf of Mexico. A; goodly portion of the time the temperature of the water stands entirely above that of the air, consequently a heavy mist is taken up. In other words, the atmosphere is com- pletely saturated with moisture to such an extent as to render it too heavy to rise in obedience to the usual laws governing evaporation, the high temperature of the land preventing condensation. As a result, there lies upon the surface of the low country a thin stratum of air so heavy and so damp as to tempt us strongly into coining suba- queos as a designation by which to represent its condi- tion. For proof that such conditions do arise in all cases where the Avater stands at a temperature higher than that of the air, we refer you to Fitches' Physical Geography, page 152 ; and for proof that they exist in the West India Islands, see Humboldt's Island of Cuba, page 172. And here, in my humble judgment, we have arrived at a knowledge of the main conditions necessary to the propagation of the yellow fever: ^A stratum of atmos- phere saturated with moisture to such an extent as can only occur urder like circumstances as exist in the West Indies, and a tropical clime such as prevails there, and is 110 HISTORY OF YELLOW FEVER. every now and then, as I contended, carried into regions far above its natural lines. This thin stratum of heavy atmosphere is carried from the ocean equator and thrown upon our shores from the gulf breezes, so called, but in ordinary seasons the low temperature of the earth con- denses the moisture permanently before it has passed far inland. In seasons like the present, however, when there have been two summers together, as it were, the earth with us is too warm to admit of permanent condensation. A portion of the moisture may fall as heavy as dew, but the rising temperature of the morning will take it up again, and hence it will be carried on, wave after wave, as it were, until it has reached its final stopping place, possibly many degrees above the shore of the Gulf of Mexico. The immediate agent working in yellow fever (be it living atom or fungus) is semi-aquatic in its nature, perhaps, and therefore always finds itself a home in this peculiar character of heavy and wet atmosphere; hence it flour- ishes wherever a footing can be secured in it; and fattens upon its human victims the more the further it gets from its nursery bed and finds them the less acclimated against its effects. This heavy atmosphere theory would explain whv vellow fever is mainlv confined to the low errounds — in all cases waves of heavy atmosphere, like currents of water, find their ways through the depressions upon the surface of the earth. If our Gulf breezes should drive them inland, they would very naturally roll up the valleys of our rivers.'' Prof. Stille was without doubt one of the South's fa- mous sons and a scholar of recognized ability, but his theory is decidedly untenable, especially when viewed through twentieth century spectacles. A reference to the medical part of this volume, where will be found practi- cal and scientific arguments concerning the origin and spread of yellow fever, will be sufficient to remove any doubt which the skeptical reader may entertain in the premises. We have given a place in this work to Prof. Stille's theory, not because we endorse or admire it, but simply to put it on record among the many odd views ad- vanced concerning the oric^in of vellow fever. It is a HISTORICAL SUMMARY. Ill close second to the views of the College of Physicians of Paris, published in a preceding chapter. Observations by the Author. Emerging from the heterogenous avalanche of opinions promulgated by sedate and learned chroniclers of ages past and present, bewildered by the positiveness of each and every argument advanced to prove that yellow fever originated anywhere except in the natal land of the ob- server, we pause for a moment on the threshold of trepi- dation before making a digest of the theories advanced in the foregoing pages. We stop just to take a breath, rivet the wobbling places in our armor, and then rush into the fray with the satisfaction that we will at least make the situation still more unintelligible. The West Indian Theory. — We are free to confess that we see much to admire and theorize upon in the doc- trine that yellow fever is a West Indian product. Look into the history of every notable epidemic and you will see that ''a ship from the West Indies" carried the infec- tion. Of course there are exceptions, but they are few. A search through the works of Oviedo, Pierre Martyr d'Anghiera, Fernand Columbus (a son of the great dis- coverer), Herrera and other early writers, reveals the fact that yellow fever attacked the Spaniards, English, French, Dutch and Portugese wherever they tried to es- tablish themselves in the New World. In the following table, we give the first four historic outbreaks of yellow fever in the West Indies. We have purposely selected ex- amples where the scourge manifested itself within a few months after the landing of the colonists, as this is all that is needed to illustrate the point we wish to em- phasize : 112 HISTORY OF YELLOW FEVER. First Eecorded Outbreaks of Yellow Fever in the West Indies. Island Locality U5 *J c ^^\ ^ G a ^ s s "^2 ^ cZ-S REMARKS San Domingo Porto Rico Capara Ysabella, 1493 Jamaica Sei'illa llMelilla HOristan 1508 1509 Gaude- St. Pierre 1635 loupeJUGrande j Ansel 1493 1508 1635 Ysabella was the first town established in the Western Hemisphere by Europeans, being- found- ed by Christopher Columbus in December 1493, fourteen months after the discovery of America. That same month the colonists were attacked by a pestilential disease (now known as yellow fever) which raged until 1496, when the town was aban- doned. Capara, founded by Ponce de Leon in 1508, Was abandoned the same year, owing to the ravages of the *' unknown pestilence." Sevilla was founded by Diego, a son of Colum- bus, in 1509. The Yellow Spectre soon invaded the place and the inhabitants fled in terror to the north of the island, where they built the town of Melilla. The pestilence pursued the colonists into their new abode and they again fled, this time to the southern p rt of the island, where, for a third time, they launched a new town lOristan). Like its predecessors. Oristan was soon laid waste by the same terrible disease which has to this day been the curse of the Antilles. In 1635, L'Olive and Duplessis, agents of the French Government, with a following of 550, founded the towns of St. Pierre and Grande Anse. Three months after the arrival of the colonists, yellow fever made its appearance, Duplessis him- self dying of the scourge. The epidemic devasted the island from 1635 to 1652, a period of seventeen years. Some doubtful Thomas will probably shrug his shoulders and ironically ask us to explain how it is that Columbus and his intrepid sailors Avere not attacked bv yellow fever when they set foot on the Island of San Sal- vador, if the theory of Antillian endemicity of the dis- ease is correct. It is not necessary to call into action Eooseveltian pow- ers of reasoning to explain this. The discoverer of the New World and his followers es- caped an attack on their first voyage for the reason that they landed on the Island of San Salvador during the cool season (October 12, 1492), at a time when mosquitoes ^ HISTORICAL SUMMARY. 113 were inactive ; tliat they did not mingle much with the na- tives and, finally, that they confined their explorations to the coasts and did not venture into the interior of the "unknown country" which was destined to change the whole political aspect of the then known world. On the second voyage of Columbus things were differ- ent. The Europeans landed hundreds of miles further South (San Domingo), at a place where the breath of Boreas is never felt, and found all the conditions neces- sary to contract the disease, including the Stegomyia Calopus. Frequent intercourse with the natives, fatigues, privations and exposure, rendered the new- comers easily susceptible to the germs which were only awaiting new fuel to kindle the fires of pestilence anew. And, from that date, wherever the Spaniards went, the jaundiced handmaiden of death — yellow fever — was awaiting their arrival. The African Theory. — It does not require a profuse waste of gray matter to relegate the African theory of the origin of yellow fever to the oblivion it richly deserves. In looking over the literature on the subject, we notice that even such a learned author as Berenger-Feraud was nearly converted to the doctrine of African endemicity, being somewhat inclined to believe that the epidemics in Senegal Avere of spontaneous origin. But he guarded his views with the statement that he was not totally convinced and, in a later article, showed the absurdity of this doc- trine. We believe, like Berenger-Feraud, that the African theory is untenable and easily disproved. The West Coast of Africa has been known to Europeans ever since the sixth century Before Christ, when, Hammo, a Car- thagenian, made a voyage along that coast and is said to have got as far as the Bight of Benin. The Portugese, however, were the first people of modern times to under- take the exploration of the Dark Continent. In 1433, they doubled Cape Bojador, in 1441 reached Cape Blanco, in 1442, Cape de Terde, and in 1462 discovered Sierra Leone. In 1484, Diego Cam, an audacious Portugese navigator, discovered the mouth of the Congo. That same nation established the first European settlement in I 14 HISTORY OF YELLOW Fi:VER. Africa at Angola about the year 1500, eight years after the discovery of America by Columbus. From the inception of its colonization, the commerce between Africa and Europe was an active one, and had yellow fever been endemic in the Dark Continent at the time it Avas first visited by Europeans, the disease would certainly have been imported by the ill- ventilated and un- sanitary craft engaged in this primitive intercourse and would have caused memorable epidemics in Europe, which would have been noted by the historians of the period, who had a knack of writing about everything and every- body, no matter how trivial or private. It is a matter of history, chronicled by many w^riters, that it was only after the discovery of America that yellow fever was observed in Africa. The first authentic account is that of the voy- agers Windham and Pinteado, who speak of having ob- served yellow fever on vessels off the coast of Benin in 1558. This is not at all improbable, as slave-hunters from the Spanish colonies in the New World frequented, the coast of Africa as early as the middle of the sixteenth century, to replace with negroes the dearth of labor caused by their massacres of the Indians in Cuba, Mexico and South America. After stealing the gold which the Aztecs and Incas had taken centuries to amass, the Spaniards forced their victims to work their mines and till their plantations. Unused to such toil, which was rendered still more onerous by the cruelties practiced upon them by their conquerors, the Indians perished by millions. His- torians tells us that more than half the population of Peru were consumed in the mines. AVafer, an English surgeon (according to Moseley^^), says that he and some others landed at Vermejo, in Peru, in 1687, and marched four miles up a sandy bay, ''all of which," he says, 'Sve found covered with bodies of men^ women and children, which lay so thick, that a man might, if he would, have Avalked half a mile and never trod a step off a dead human body. These bodies, to appear- ance, seemed as if they had not been above a week dead ; but if you handled them, they proved as dry and light as a sponge, or piece of cork." The voyagers soon came upon ^' Moseley: A Treatise on Tropical Diseases, 1792, p. 155^ HISTORICAL SUMMARY. 115 a Spanish Indian, who was picking up dried soa-weed, and asked him how those dead bodies came there? To which he answered that, in his father's time the soil, 'Svhich now yielded nothing, was green, well-cultivated and fruit- ful; that the city of Wgrniia had been well inhabited by Indians; and that they were so numerous, that they could have handed a fish, from hand to hand, twenty leagues from the sea, until it had come to the Inca's hands; and that the reason of those dead bodies was, that when the Spaniards came and blocked up and laid seige to the city, the Indians, rather than lie at the Spaniards' mercy, dug holes in the sand and buried them- selves alive." When the Spaniards saw that the natives were about to become extinct, and that the majority of those that were left had fled to caverns and mountain fastnesses, they had recourse to Africa, and negroes were imported by the thousands to take the places of the Mexicans, Peru- vians and West Indians. This Avas the beginning of the slave trade, and the constant voyages to and from Africa in quest of new victims, gave a semblance of truth to the theory that yelloAV fever had been imported from Africa to America. Let us now juggle with dates and obtain some poignant conclusions : A glance at the table on page 112 will show that the first epidemic of yellow fever in the world of which there is any record took place at Ysabella, San Domingo, in De- cember, 1193, fourteen months after the discovery of America. According to Lind, the first outbreak of yellow fever on the mainland of Africa took place in Senegal in 1759, two hundred and sixty-six years after the Ysabella incident. As the mainland of Africa was colonized hy Europeans about the year 1500, and yellow fever was never observed prior to 1759, or two hundred and fifty- nine years after its colonization, it is not necessary to in- dicate with a i^ointer on the map of the world where the natural home of yellow fever was, is and will continue to be for all time to come— unless our Southern neighbors stop long enough launching new revolutions and attend to 116 HISTORY OF YELLOW FEVER. intelligent preventive measures against a disease which science has proved can be conquered. Ainother noteworthy fact before we conclude: The epidemics of yellow fever in the West Indies fol- lowed one another in rapid succession and hardly a year has jDassed since 1493 without the disease manifesting itself, either sporadically or as an epidemic, in one of the Antilles. In Africa, the record is different. Let us take Senegal to illustrate our point : From 1759 to 1882, a period of one hundred and twenty- three years, there were six epidemics in Senegal. Be- tween the first and second epidemics (1759-1778), nine- teen years elapsed; between the second and third (1778- 1830), fifty-two years; between the third and fourth (1830-1867), thirty-seven years; between the fourth and fifth (1867-1878), eleven years; between the fifth and sixth (1878-1882), four years. By reference to the chronological tables in another part of this volume, it will be seen that during this same period of one hundred and twenty-three years, there is a record of nearly two hundred outbreaks of yellow fcA^r in the West Indies. A soil which can produce yellow fever will do so annu- ally; the long intervals between the epidemics in Africa gives the palm to the West Indies. The Ship Theory. — The theory that yellow fever originates on shipboard was based on the fact that, in sev- eral notcAvorthy instances — such as the outbreaks at St. Nazaire, Brest, Falmouth, etc. — it Avas noticed that so long as the hatches remained -closed, the disease did not manifest itself, but as soon as the scuttles and hatches Avere opened, the fever invaded the A^essel and often spread to the port Avhere she Avas riding at anchor. This is easily explained: The infected mosquitoes, Avhich had fed on yelloAv fcA^er patients at the port of sail- ing, had been imprisoned in the hatches during the long voyage across the seas, Avith no chance of gaining access to the upper parts of the ship. When the vessel reached her destination and the hatches were opened, the insects were liberated and SAvarmed with famished haste all OA^er the vessel, inoculating Avith the poison of yellow fever HISTORICAL SUMMARY. 117 every susceptible person they bit. These persons, in turn, were so many new foci of infection and served to spread the disease. In the present light of the mosquito transmission of yellow fever, nothing can be more simple; but, when we come to think over the matter, we can hardly blame Audouard and his dintinguished champions for having blundered, as they were groping in the dark and launched the theory which seemed, under the circumstances, the most plausible and intelligent. The Gulf Stream Theory. — This doctrine cannot for a moment be seriously entertained and does not need to be dissected here to lay bare its imperfections. It ex- plains nothing and is dismissed without further comment. The Asiatic Theory. There is a theory, however, which takes our fancy and which we are prone to espouse — the opinion that yellow fever originated on the western shores of Asia centuries before the advent of Christianity. The city of Smyrna, in Asia Minor, is just the sort of place where a pestiferous disease could originate cle novo. Since the date of its foundation, in pre-historic times, it has been renowned for its filthiness and pestilences, a fame which clings to it to this day. Smyrna occupies the unique position in history of being the only great city of the west coast of Asia Minor which has survived to the present day. Unlike good wine, however, it does not seem to have improved with age, from a sanitarian point of view. It is as insalubrious to-day as it was in distant past, when it cradled Homer and was the glorious capital of Antigonus. The appearance of the city at the present day is very attractive when viewed from the harbor, but a closer inspection dispels the illu- sion. The houses, mostly built of wood, are mean and fragile looking; the streets v:lose and filthy and filled with intolerable stenches, proceeding from illy-constructed sewers and drains. Having thus all the necessary condi- tions present to harbor and propagate pestilence, it is within the reasonable bounds of probability that it could 118 HISTORY OF YELLOW FEVER, have been the original nidus of yellow fever. How yellow fever was engendered there, what special atmosphere con- stitutions precipitated its origin or how it sprung spon- taneously into existence, our feeble powers of imagination cannot conjecture, but, for the purpose of propping up the doctrine we advance, we shall admit that it did spring from somewhere within the walls of the malodorous ori- ental town — in fact, grew, like the immortal Tops}^^ — and was thence disseminated by the mosquito-infected vessels of the Phenicians and other ancient adventurers through- out the then known world. The immigration of the Phenicians to the Mediter- ranean coast of Asia took place in remote antiquity. When the Children of Israel settled in Canaan, they found the Phenicians already established in the country, and history tells us that the tribes of Naphtali, Asher and Dan, to which that section of Syria was assigned, did not conquer Phenicia, but occu]3ied only a small portion of it. The Phenicians were a commercial and not a war- like race and their policy from the onset towards the Chosen People was one of conciliation and the two races afterwards became stalwart friends. From the earliest period the Phenicians occupied them- selves in distant voyages and their skill in shipbuilding is a matter of history. Lebanon supj)lied them with abun- dance of timber and Cyprus gave them all necessary naval equipments, from the keel to the topsails. In the reign of Pharaoh-Xecho, these daring navigators even circum- navigated Africa. The commerce of Tyre extended all over the ancient world, from India to England, and the maritime knowledge and experience of the Phenicians led to the founding of numerous colonies in Cyprus, Rhodes, Sicily, Sardinia and even in distant Spain, where they founded the famous city of Gaddier, now -known as Cadiz, eleven centuries before the Christian Era. With Smyrna as a nidus, yelloAV fever could thus easily have been imported to the seaports of the Mediterranean by the active commerce in which these remarkable people were engaged in. Mosquitoes .are plentiful in Western Asia and Southern Europe and the great plagues which history recounts as having almost depopulated the world HISTORICAL SUMMARY. 119 at certain epochs in the distant past, were possibly yellow fever epidemics, spread far and wide through the medium of mosquito-infected ships, which sailed from infected points to countries free from the disease. These countries, in their turn, proved so many foci of infection, whence yel- low fever radiated to susceptible localities. In course of time, the disease Avas imported to A^merica by the early voyagers who visited this country centuries before the time of Columbus and gradually spread over the con- tinent, until it found a home suited to its permanent hibernation in what is now known as the yellow fever zone. Simple, is it not? We shall undoubtedly find scof- fers and unbelievers, but we advance the theory with the same assurance that all previous theories have been pro- mulgated and can safely challenge anyone to prove the contrary. This is the beauty of theories. You may not be able to prove what you say by what lawyers call '^docu- mentary evidence," but the burden of proving the con- trary is on the other fellow, and he is generally in the same fix when it comes to trotting out facts to prove that you are talking through your cliapeau. ^'Admitting your theory to be correct," observes my astute friend, Mr. Doubting Thomas, ''why has yellow fever ceased to visit Smyrna?" For the same reason that it is no longer prevalent in Spain, Philadelphia, Boston, New York,* and scores of other places where it was, at some time or other, consid- ered endemic. What has brought about this change? "The disappear- ance of the Stegomijia Calojms from these' localities," would be the logical answer. But such is not the case. The yellow fever mosquito has been banished from New York, Boston, Philadelphia and other Northern places, * See the very interesting theory advanced by Col. W. C. Gorgas concerning the disappearance of the Stegomyia from Philadelphia, New York and other Northern locali- ties, published in another part of this volume, under the caption "The Effect that the Completion of the Panama Canal Will Have Upon the Probable Extension of Yellow Fever to Asia." 120 HISTORY OF YELLOW FEVER. but, according to Theobald,^^ these insects are still to be found in Spain at the present day. And yet, yellow fever, except in a few isolated instances, has been unknown in that kingdom since the great epidemics which ravaged it in the beginning of the last century. Theobald does not designate Smyrna as one of the habi- tats of the Stegomyia Calopus, but mentions the tact that the insects are prevalent in Tyre, Sidon and Palestine, neighboring localities. ''Where the climate is not too dry," observes Howard,^^ '^Stegomyia Fasciata will, with little doubt, upon close search, be found." The climate of Smyrna is an ideal one for the propagation of the insect under discussion and it has no doubt been domiciliated there from time immemorial. But here comes the clincher : ''If Stegomyiae flourished in Smyrna ages past and yellow fever was an endemic, how is it that, with all the conditions which were then present existing at the present day, the disease no longer manifests itself?" The only way to get rid of this Gordian Knot is to treat it a-la- Alexander : Let us suppose that the great pestilences which devas- tated Europe, Asia and Africa centuries before the Chris- tian Era were yellow fever epidemics. History tells us that these outbreaks caused fearful mortalities and that at times "nearly half the population of the world" was swept away. As the years went by, new generations were attacked by the disease, which became milder and less murderous for want of fresh material, until it came to pass that those who remained became immune through acclimatization or because they had withstood a previous attack, and the disease gradually disappeared from its old-time haunts. Immigration, one of the most fertile feeders of endemic disease, was no longer a factor in the Old World after the twelfth century of the Christian Era, for the nomads of that period had penetrated as far as they dared to go, and with the whole population of the "=* Theobald: A Monograph of the Cu'licidae of the World, 1891. ''"Howard: Concerning the 'Geographic Distribution of the Yellow Fever Mosquito, 1905. HISTORICAL SUMMARY. 121 Avorld immune from ^^ellow fever, it is natural that the scourge should cease to manifest itself. It is a remarkable truth that persons born in a com- munity where a disease is endemic, seldom, if ever, experi- ence an attack. Humboldt notes the fact that a person born and brought up in Vera Cruz is not subject to the disease. The same observation has been made in regard to Havana. And yet, the natives of Havana are often at- tacked with yellow fever when they visit Vera Cruz in August and September; while, on the contrary, natives of Vera Cruz, who were known to have passed unscathed through violent epidemics in their natal place, have died of yellow fever in Havana, Jamaica and the United States. '^New sources of disease are developed by civilization," observes Gouverneur Smith,^^ ^'new measures of prophy- laxis germinate simultaneously with each genesis. Many of the poisons with which we are familiar, and which were known to our ancestors, are not as yet to be extinguished, but are to continue to harass posterity. Posterity will en- counter ills which have not afflicted us, and the medical literature of future centuries will relate the outcrops of novel disorders, and record the successful means by which they were held in abeyance. If the chemists are capable of producing new compounds, it can be inferred by anal- ogy, and even inferred from a study of past ages, that in the mutations of society new forms of aerial contamina- tions and new zymotic affections will be developed by reason of the overcrowdings of population, by the influ- ences of new occupations and of new relations of life. The opening of new territories to civilization will be at- tended with its dangers. Indigenous germs of disease may exist in unexplored Africa and in other secluded parts of the globe, which are in time to be conveyed to marts of commerce, and thence to be still more widely diffused." Gouverneur Smith's observations, made thirty years ago, upholds the point we wish to elucidate. What has kept alive the fires of pestilence in the West Indies? War and the Spanish soldiery. For hundreds of years, Spain was engaged in putting down insurrections in ^1 Trans. N. Y. Academy of Medicine, vol. 2, 1876, p. 362. 122 HISTORY OF YELLOW FEVER. Cuba, and for hundreds of years has yellow fever mowed down her soldiers by the thousands. During the period of ten years, from 1870 to 1879, there arrived, at the port of Havana, 151,123 Spanish sol- diers. During that same period, out of a total death-rate of 92,231 from all diseases in Havana, there were 11,837 fatalities from yellow fever alone, of which 1,139 were newly-arrived soldiers, or nearly half the total mortality from yellow fever. Look over the long list of epidemics in the West Indies since the beginning of the last century, and you will see that in almost every instance the disease was either im- ported or attacked the newly-arrived. The natives (that is, descendants of the original settlers of the islands), if they had not been contaminated by this -susceptible ele- ment from a foreign clime, would never have contracted the disease. According to the views of the Havana Yellow Fever Commission,-^- the pure-blooded American red Indian an- nually proves at Vera Cruz his present susceptibility to yellow fever; hence there is no reason to disbelieve that the aborigines of San Domingo and other A,ntilles were susceptible, but had, in 1192, acquired immunity from the disease by the same process and to the same general extent now enjoyed by the white, black, and yellow or red natives of habitually infected localities in Cuba and elsewhere. The same reasoning holds good for Smyrna, Spain and other old-world localities. Natives of susceptible climes not having emigrated to these countries for centuries past, the occasional visitor of to-day is safe from attack, as the infected mosquitoes and their immediate posterity have long since ''passed in their checks'' and their descendants content themselves in disseminating malaria and kindred transmissible diseases. But let a single case of yellow fever be imported into the heart of Spain, Smyrna or any presumably former habitat of the disease, and the world will witness a repetition of the terrible ravages of the past. Previous to 1793 yellow fever was unknown in Dem- '- Annual Report National Board of Health, 1880. HISTORICAL SUMMARY. 12S erara, British Guiana, which is noted for its low, swampy soil, abounding in vegetable matter in a state of decom- position, the whole constituting a true hot-bed of pollu- tion, where Stegoinylae breed by millions. Yellow fever could not, and never would have, developed itself in that region; but, according to Ball}^,^^ it was introduced by the schooner Fanfaii in the year above mentioned, and finding an habitat suited for its propagation, became es- tablished there, and Demerara is to-day one of its focal points. Diseases, like fashions, have their whims. A locality may for years — aye, even centuries — be afflicted with a certain ailment and then, sometimes suddenly, sometimes with such gradual decadence as to be scarcely noticeable, the endemic disappears, to manifest itself in places where it was unknoAvn before and create the same havoc, inspire the same terrors and display the identical idiosj^ncrasies which characterized it in its old habitat. According to Muhry,^"^ if we except the admirable and accurate descriptions of diseases contained in the writings of the Arabian physicians, we have scarcely any of an earlier date than the beginning of the sixteenth century, sufficiently full and correct to enable us, by comparing the phenomena of the diseases which now prevail with those by which the same diseases were accompanied at former periods, to detect their points of resemblance or discrepancy^ Judging, however, from the few and imper- fect details furnished us by medical writings of former days, we believe that there are good reasons for conclud- ing that the more prominent diseases to which the human organism is now liable, are essentially the same, in all their leading features, with those to Avhich it was subject as far back as medical history leads us. Muhry further asks if it is true, however, that diseases which formerly prevailed have entirely disappeared? This is by no means improbable. The history of endemics proves very clearly that certain forms of disease depend upon cases of a strictly local character, and no longer occur when these local causes are removed. It is equally ^* Bally: Typhus d'Amerique, p. 60. ^* Muhry: Historical Immutability of Nature and Disease, 1844. 1?4 HISTORY OF YELLOW FEVER. reasonable to suppose that morbific causes of wider extent may become extinct either spontaneously or through the agency of man, and with their extinction would, of course, cease the diseases produced by them. But it is not so yery certain, that among the diseases to which the human or- ganism is still subject, some at least of those which are presumed to haye disapeared are not to be included, but in a form so far modified that the resemblance between them and their prototypes is oyerlooked. It is, also, prob- able that diseases which formerly preyailed as endemics or epidemics, still occur sporadically; isolated cases ap- pearing occasionally and at long interyals, and hence at- tracting little attention, being yiewed as anomalous forms of some one of the more preyalent affections. Muhry-s masterly diagnosis is admirably suited to the subject under discussion in these pages. Take away the Stegomyia Calopus and you take away yellow feyer. The experience of New Orleans in 1905 is incontestible proof of the truth of this assertion. Although all the conditions which preyailed in 1905 existed in 1906 (with the excep- tion, of course, of the millions of Stegomyia), not a case of yelllow feyer occurred among the yast cosmopolitan population of the Metropolis of the South, and only a single case, undoubtedly imported, is known to haye oc- curred throughout the entire State of Louisiana. And this, thanks to the untiring work of the eminent sanitari- ans in whose hands were the destinies of the State and City Boards of Health, was soon rendered inocuous. Let us again look into the fascinating question of Asiatic origin of yellow feyer. Without desiring to be irreyerent to the shades of Audouard, Bally, Chisolm and others, we think that there is more in the theory of Asiatic origin than appears on the surface, when one comes to weigh it in the balance of conjecture. How do we know that the pestilential ardent feyers, or causi, of which repeated mention is made in the works of ancient writers, were not yellow feyer mani- festations? In reading descriptions or the cmisi, not only in the Epidemics of Hippocrates, but also in the writings of his contemporaries, Thucydides and Isocrates, one is struck by the similarity of the diagnosis g:iyen and the HISTORICAL SUMMARY. 125 present accepted symptoms of yellow fever. The writings of Galen, Paulus Egineta, Aretus, Avicenna, Hippocrates ( First and Third Books on Epidemics ) , Procopius ( VHis- toire de Son Temps), Gregorius (Histora Francorum^ de 417 a 591 A. D.), Anglada {Etudes siw les Maladies Eteintes et les Maladies NouveUes) , Black {Histoire de la Medicine et de la Chirurgie) , and others, also lead to the presumption that a disease posessing all the peculiari- ties of yellow fever was epidemical long before the Chris- tian Era. "In the works attributed to Hipprocates," says Ban- croft, "mention is made of violent febrile disorders, which sometimes proved fatal on the fourth day, and even sooner,^^ and were attended with incessant vomiting, sometimes of black matters, yelloAvness of skin, and other affections so similar to those which are frequently ob- served in the Yellow Fever, that I am disposed to believe that they could be no other disease." Lyons,^^ commenting on the above, says : "At what his- toric period yelloAv fever became an established epidemic, it may perhaps be not possible now to determine. Some writers, and amongst them Bancroft, seem to think that certain of the fevers described by Hippocrates as being attended with black vomiting and yellowness of the skin, were of the same nature a^ the yellow fever of later times. I doubt much that the question admits of absolute solu- tion, so meagre are the accounts left us in the fragments of the works of the great Father of Medicine." Had Hippocrates any knowledge of yellow fever? At first thought, this looks like a startling and foolhardy question, but a careful perusal of the works of the Father of Medicine certainly leads to the conclusion that yellow fever, or some distemper possessing almost the identical symptoms of the disease, prevailed among the Greeks and their neighbors in the nebulous past. According to that learned and well-posted observer. Dr. Samuel Latham Mitchel, who edited the New York Medical Repository in the beginning of the last century, this inference is readily '^ This fact is rioted by Alcee Chastant, of New Orleans, in his Observations on Yellow Fever, published in 1878. ^« Lyons: A Treatise on Fever, 1861, p. 249. 126 HISTORY OF YELLOW FEVER. , drawn from the observations which Hippocrates makes of the pestilential distempers of Persia and Greece. Dr. Mitchell holds the opinion that it is much to be lamented that the Grecian sage has not left to posterity an account of this distemper, and of the methods he took to guard against it. We might, in all probability, have derived some information that would be of priceless value to us at the present time. However, although he has not left us the history of the disease which afflicted the Persian army ,and which gave so much concern to the Greeks, there are several passages in his works which show that the southern parts of Europe and the western countries of Asia were visited by disorders marked by yellow skin and black vomiting, at least four hundred years before the Christian era. One cannot help noticing that the writings of Hippocrates contain evidence enough of mor- bid yellowness; and that, although the different kinds are meant by the same word, the yellow suffusion incidental to fevers is clearly distinguishable from the yellow^ tinc- ture caused by an absorption of bile when the liver is obstructed. Black vomit is also alluded to in the works of the Father of Plwsics. In the tAvelfth section of his Prog- nostics, he affirms that if the matter vomited be of a livid or black color, it betokens ill. In the first section of the first book of his Coan Progiiostico, he enumerates black vomiting among a number of the most desperate symp- toms. In the fourth section of the same book, he considers leek-green, livid and black vomiting as omens of sad im- port. The passage in the eleventh paragraph of the first book of his Predictions, indicates strongly the unfavorable issue of a fever after black vomiting. The connection be- tween black vomiting and deatli is noticed likewise in the third paragraph of the second section of the Coan Prog- no stico. The same symptom is mentioned in the first paragraph of the first section of the same book. And the like will be found to recur in the fourth paragraph of the third section of the same book. From the above, it will be seen that this alarming symp- tom was frequent among the ancient Greeks laborincr un- HISTORICAL SUMMARY. 127 der fevers, Avas well-kuown to their physicians, and was noticed by Hippocrates as a familiar occurrence. It must not be forgotten, however, that this symptom frequently occurs in the late stages of other dangerous septic conditions. Littre, whose famous work is one of the classics of medical literature, denies- that Hipi)ocrates had any knowledge of yellow fever and asserts that the caitsi were merely remittent fevers, the same as is observed in our days in the countries bordering on the Mediterranean. But Littre, in our humble opinion, is not infallible. It is a matter of history that yellow fever was unknown by that name previous to 1694, when Ferreira da Eosa pub- lished his admirable treatise on the pestilential diseases of Pernambuco. The fact that the disease Avas not men- tioned in ancient times by the name we now knoAV it, hoAV- ever, does not mean that it did not prevail throughout the world then or at any other time. The Avorks of noted chroniclers, from the time of Aretus'^^ to Guyzot,^^ abound Avith accounts of pestilences which ravaged Europe, Asia and Africa at specified epochs, depopulating cities, deci- mating armies and creating widespread terror and demor- alization. Even as far l3ack as 1184 B. C, during the Trojan war, it is said that Podalirius, a son of Esculapius, Avas iuAdted bA^ the Greeks to their camp "to stop a pestilence Avhich had baffled the skill of the physicians."^^ This disease is said to have resembled yelloAv fever. Certain authors, among them Marius de Bamberg, as- sert that the plague of Athens described b}^ Thucidides and Lucretius, was nothing less than yelloAV fcA^er. Ber- enger-Feraud tries to dispose of this tlieorj^ by saying that although the malady Avhich afflicted the ancient Greeks during the Peloponesean Avars Avas characterized by a sudden onset, great pain in the head, injection of the eyes, rapid respiration, etc., symptoms which may appear to denote yellow fever, it is also worthy of notice that Thucydides speaks of the red appearance of the facies of those affected, black and putrid ulcers, gangrene of the ex- " Adams' translation. ^^See his "History of France.' ^^ Lepriere's Classical Dictionary, p. 543. 128 HISTORY OF YELLOW FEVER. tremities and the cicatrices which remained after the pa- tients had been cured. These latter characteristics seem to indicate that the Greeks were either attacked by the plao'ue or by malignant smallpox, or, at all events, a. malady totally different from yellow fever. Sydenham, the greatest epidemiologist of modern times, describes the Plague of London, in the summer and autumn of 1665, as havino- been ushered in by a malignant fever, and also alludes to a disease similar to yellow fever which prevailed in Moscow in 1771, where it destroyed 80,000 persons. Aiccording to Mertins, one of the physi- cians appointed by the Empress of Kussia to attend the infected, the pestilence was introduced in Moscow by Turkish prisoners. In Hume- & Histori/ of England (page 33), occurs the following passage: ^'The reign of Oswy was rendered memorable by a most destructive pestilence called the Yellow Plague, which, commencing in 664, ravaged the whole island during twenty years, with the exception of the Highlands of Scotland." A fever similar to yellow fever has been observed in England and Ireland. Dr. Hamilton describes its appear- ance at Norfolk and Drs. Graves and Stokes*^^ speak of its prevalence in Dublin in 1826, though the latter ex- presses some doubts as to the disease being yellow fever. Dr. Graves, however, avers that the symptoms and ana- tomical characters were the same as those laid down in cases of yellow fever by the best authorities. Anstie,^^ in comparing English epidemical disease with yellow fever, says : ''In truth, it is difficult to read care- fully the histories of AVest Indian epidemics of yellow fever without being tempted to believe that the disease has strong affinities with our English typhus; and the pecu- liar symptoms (jaundice and black vomit) of which so much has been made, are in truth phenomena which are not infrequently witnessed in typhus and relapsing fever ""Lectures on Fever, by Wm. Stokes (1876), p. 37. ''^ Notes on Epidemics, by Francis Edmund Anstie (1866), p. 86. HISTORICAL SUMMARY. ] 29 in Britain.^^ So often lias this been the case, that one can hardly avoid thinking that, were these latter fevers trans- ported to the peculiar tropical regions which have been mentioned, they would develop these features with con- stancy, instead of occasionally, and would then be indis- tinguishable from true yellow fever." The great American historian and philosopher. Hum- bolt, makes the following observations: ''It is certain that the vomito, which is endemic at Vera Cruz, Cartha- gena, and Havana, is the same disease as the yellow fever, which, since the year 1793, has never ceased to afflict the people of the United States. This identity, against which a very small number of physicians in Europe have started doubts, is generallv acknowledged by those of the Faculty who have visited the Island of Cuba and Vera Cruz, as well as the coast of the United States, and by those who have carefully studied the excellent nosological descrip- tions of M. M. Makittrick, Rush, Valentin, and Luzuriaga. We shall not decide whether the yellow fever is percepti- ble in the causus of Hippocrates, which is followed, like several remittent bilious fevers, by a vomiting of black matter ; but we think that the yellow fever has been spor- adical in the two continents since men born under a cold zone have exposed themselves in the low regions of the torrid zone to an air infected with miasmata. Wherever the exciting causes and the irritability of the organs are the same, the disorders which originate from a disorder in the vital functions ought to assume the same appear- CONCLUSION. As previously observed, we lean to the doctrine of Asiatic origin of yellow fever, but we are in no wise unal- terably wedded to the hypothesis. We have tried hard to be convinced, but the bewildering mass of evidence, jjro et con, has raised a lingering doubt in our mind, which no amount of reasoning has been able to eradicate. ®- The differential diagnosis between typhus and yellow fever in this country is too well. established to need comment- ing upon. — G. A. ISO HISTORY OF YELLOW FEVER. We now bring this historical summarY to an end^ think- ing it unnecessary to burden these pages with further quotations and observatioiis. We feel we have proved nothing new concerning the origin of yellow fever and^ taking Tou into our confidence, patient reader, we must confess Ve never had the remotest idea of launching a new theory. We simply culled from the best observers and trust to the intelligence of the reader to make whatever deductions may seem proi>er or reasonable in the premises. So far as we are j)ersonally concerned, we beg to express- our opinion of the whole business by the following quota- tion from Peisse, taken from his great work, La Jledecine et Les Aledecins : ^^Quand, par I'oljservaiion directe du regne animal^ etudie dans son organization intericure la plus delicate^ Olivier eut fini son travail, il troiiva qwil etait arrive a pen pres aiix menies divisions qwAristote avait etahlies^ il y a plus de deux mille ans:^ To paraphrase the above : After caref tilly sifting the opinions of the most noted writers on the origin of yellow fever, we have arrived at the same conclusions reached by all of them — that the disease either was endemic in America centuries before the arrival of Columbus, or was imported from some transatlantic country by the hordes of nondescript personages who swarmed to the Xew World in search of riches and adventure. But where the invaders primarily contracted the disease, is a question which reminds us of the immortal question of the small boy. propounded ages ago to his preceptor: ''Which was born first, the >egg or the chicken?*' We find no record of the learned gentleman's explana- tion, and the problem will undoubtedly remain forever unsolved. We cheerfully relegate the yellow fever brain- racker to the same fate. PART THIRD. HISTORY OF YELLOW FEVER, BY LOCALITIES. YELLOW FEVER AS IT CONCERNS ASIA THE EFFECT THAT THE COMPLETION OF THE PANAMA CANAL WILL HAVE UPON THE PEOBABLE EXTENSION OF YELLOW FEVER TO ASIA. By Col. W. C. Gorgas. Assistant Surgeon-General^ U. S. Army; Chief Sanitary Officer^ Panama Canal Zo7ie. To get a basis for the discussion as to what will be the probable effect of commerce through the Panama Canal upon the introduction of yellow fever into Asia, it will be necessary to review roughly the past and present habitat of yelloAV fever, and its method of extension in the past. Yellow fever has only been recognized as a disease since the discovery of America, and its principal habitat since that time has been the West India Islands, and the main lands of both North and South America bordering the Gulf of Mexico and the Caribbean Sea. It has, however, extended at time very widely from these localities, on the eastern and western coast of North and South America, and the western coast of Africa, and the southwestern coast of Europe. It seems to have had its widest exten- sion during the latter part of the eighteenth century and the earlier part of the nineteenth. It has been as far North as Quebec in North America and as far South as Montevideo in South America. There have been several epidemics in Spain, and minor epidemics in France and Wales. In Europe a few cases have originated as far east as Genoa, Italy. It has never extended farther east in Europe than Genoa, nor has it at any time affected Asia, or the islands of the Pacific. With our present knowledge of its means of propaga- tion one can readily understand why it has not spread beyond these limits. The great road of travel during the old days of sailing ships, between Europe and America on the one hand, and Asia on the other, was around the Cape of Good Hope. This took four or five months. The only possibility of such a ship transmitting yellow fever would be that the ship itself would become infected, and 1S6 HISTORY OF YELLOW FEVER. continue to have a succession of cases, and thus keep alive infected mosquitoes during the whole Torage. She would have to be breeding stegomyia mosqtiitoes aboard and have a case of yellow fever introduced, and infect these mosquitoes, and then have a succession of cases of yellow fever among her non-immunes that would keep up the dis- ease for several months. The probabilities are greatly against this. The probabilities are that within the first two months all the non-immunes aboard would contract the fever, and at the end of a couple of months, we would have a ship peopled by immunes. Every probability is that the infected mosquitoes left at the end of two months would die from natural causes within the following three months, and by the time the ship reached India, she would be entirely free from infection. Another gTcat means of protection was the fact that the vessel was exposed to freezing weather for several weeks in passing the Cape. Before the days of the Suez Canal there was not a great deal of traffic through the Mediterranean Sea to Asia, and what there was, was carried on by means of x)ack trains of various kinds. One can readily understand the im- probability of transmitting yellow fever in this way. I think our experience points to the fact that yellow fever is nearly always transmitted from place to place by a sick person going from an infected point, and infecting the mosquitoes in an uninfected place. It apparently takes pretty frequent communication to transmit the disease. In the earlier days of yellow fever in the United States it was almost entirely confined to the littoral and was looked upon as a disease of the sea coast. As the country became settled up and river traffic became great, it was found that it would spread up the rivers, but it was still looked upon as a disease confined to the sea coast and large rivers. When railroads were introduced, it was found that it spread with equal facility along railroad routes. The small amotmt of commerce and the great length of time that it took for a sailing vessel to cross the Pacific would readily account for yellow fever not having spread across the Pacific. With the introduction of steam ves- sels one would have expected that yellow fever would ASIA. 1S7 have been more likely to spread to Asia, but a steam ves- sel breeds many less mosquitoes than a sailing vessel. The sailing vessel, for her long voyage, had to carry large quan- tities of fresh water, which were prolific breeding places for the stegomyia. A| steam vessel, while she can and does breed mosquitoes, does not do so to anywhere near the ex- tent that the sailing vessel does. Her expenses being large, she cannot afford to spend such length of time in port as the sailing vessel does, and is, therefore, less likely to become infected. And then again, the routes of com- merce do not extend directly from infected ports to Asia. It is very seldom that a vessel goes directly from Havana or Kio de Janeiro to Asia. The exchange is almost en- tirely carried on by means of London or Hamburg, or some other Eurojiean port. The effect that the Suez Canal has had as a means of the introduction of infectious and contagious diseases from Asia to Europe, would be some indication of what effect the Panama Canal will have upon the introduction of such diseases from America to Asia. The probability, while remote, of the introduction of yellow fever from America to Asia, was certainly increased by the opening of the Suez Canal, The city of Para, in Brazil, is the port in America nearest to Asia going east by the Suez Canal, which is at present permanently infected witli yellow fever. The time by steamer from Para to India has been reduced by the Suez Canal more than half. The whole route via the Suez Canal lays in tropical and subtropical latitudes. The likelihood of the introduction of yellow fever from Para to India via the Suez Canal is at present just about the same as it is for the transfer of the same disease from Guayaquil to Hong Kong. Both Guayaquil and Para are permanently infected with yellow fever and have been for years. The steaming distance from Para east through the Suez Canal to India is about the same as that west from Guayaquil over the Pacific to Hong Kong. While we would have to acknowledge the possibility of the conveyance of yellow fever to Asia by either of these routes, it is evidently extremely improbable. The Suez route has been in use for a generation, and the Pacific route for some three centuries, with never a single in- 138 HISTORY OF YELLOW FEVER. stance of yellow fever getting to Asia. But it is probable that in that time there has never been a single instance of a vessel going directly from either Para or Guayaquil to Asia. As commerce goes on increasing they may, how- ever, occur. A very good example of a large commerce between ports infected with yellow fever, without the transmission of the disease, is that between the ports of Rio de Janeiro and Para, infected ports on the eastern coast of South America, and England. Also that between Guayaquil, an infected port on the west coast of South America and San Francisco. Commerce is very intimate between these infected ports south of the equator and the non-infected regions .mentioned north of the equator. Vessels sail between these ports oftener than weekly, and the steam- ing time is less than a month, yet, to my knowledge, yel- low fever has never been carried either to England or San Francisco from these sources.* But, before the open- ing of the Suez Canal, one, in discussing the probable dangers, would have thought that plague and cholera would be much more likely to be introduced from Asia to Europe than yellow fever from Europe to Asia. The com- merce is large and the trip not more than three weeks, infection from this source. Europe has, however, taken Yet there has been little, if any, trouble in Europe with the precaution to establish an International Board of Health which has sanitary supervision over the Canal and guards this route very carefully. I think the above fairly satisfactory reasons why yel- low fever in the past has not spread to Asia. It is inter- esting here to note the fact that the yellow fever zone had greatly decreased before we knew that it was transmitted *In one isolated instance (1883), yellow fever was imported into San Frapcisco, but did not spread. In 1897, 1898, 1902 and 1903, vessels coming from South American ports infected with yellow fever, or on which cases had had developed, died or convalesced, were detained at the San Francisco Quarantine Station, but no new cases developed while the ships were in the harbor. For full particulars, see detailed account under "California," in another part of this volume. G. A. ASIA. 139 bv the mosquito, and before any general measures of any kind vrere taken for its extinction. It extended most widely about the beginning of the nineteenth century. At this time, Philadelphia, New York, Boston, Baltimore and Charleston were all liable to yellow fever and had fre- quent epidemics. From this time it has become less and less frequent on the Atlantic Seaboard of the United States and in the United States itself. At present, I do not think the stegomyia is found farther north than Nor- folk, and she probably had the same habitat a hundred years ago, and it is hard to understand how New Yorl^ and Philadelphia could have ever had yellow fever. But the probable explanation is that before they had water supplies they used wells and cisterns generally as a means of storing water and thus had excellent means of breeding stegomyia. Sailing vessels frequently came in with num- bers of stegomyia aboard. When these arrived in the summer time, the ships continued to breed mosquitoes for weeks at a time while they were tied up to the wharves. Many of these mosquitoes wandered off to the neighboring houses where they found ready means of breeding, and thus, in a few weeks, the town became well stocked with stegomyia. Quarantines were very lax and a case would be introduced from an infected ship and find a good ground for spreading the disease through the city. As the cold weather came on all the stegomyia would be killed, but in some other year the same thing would occur over again. At present in Philadelphia thev have no tanks or cisterns and very few places where the stegomym would breed, but communication with ports where stegomyia breed is almost altogether through steamers which are not likely to bring many stegomyia, and she has a good quarantine which stops the large majority of yellow fever cases. These are the causes, I think, that have led to the contraction of the zone of yellow fever. The same statements would apply to Spain and Eng- land. They are not countries where the stegomyia breed, and these mosquitoes could only flourish there when in- troduced during the summer time, and when the condi- 140 HISTORY OF YELLOW FEVER. tions as to water receptacles were favorable to their breed- ing* In our Southern Gulf States the stegomyia has its natural habitat. The weather during the winter is not sufficiently cold to kill off all the adults, so that we are still liable to an occasional epidemic when the disease is introduced from the neighboring West Indian ports. But even in these localities the winters are so cold that the mosquito becomes dormant and yellow fever disappears, even no sanitary measures are taken. As we go farther south and get into the tropics we find that the stegomyia breeds as well, as far as temperature is concerned, in one season as in another, and varies principally according to rain fall, or conditions that give more or less numerous breeding places. Now let us consider a moment the distribution of yel- low fever at the present time and the possibility of its transmission to Asia. It is at present in Cuba, Mexico, Central America, and on the east and west coast of South America. At present I do not think there is any direct communication between an infected port and Asia. The West Indies and the eastern coast of South America ex- change their wealth with the wealth of Asia principally through the European ports, and Guayaquil, which is the only infected port of any consequence on the west coast, carries on w^hatever commerce she has with Asia through San Francisco. In Southern Asia and the Philippines the stegomyia is a very common mosquito. The population in China and India is very dense and non-immune; the Chinaman and Coolie being just as liable to yellow fever as the European, and as far as we can see, it will only require the introduc- tion of a case of yellow fever to cause a very devastating epidemic, which, in the state of civilization existing in Asia, w^ould be entirely uncontrollable. If the Canal were opened to-morrow I do not think the chances of carrying yellow fever to Asia would be one whit increased over what they are to-day. At the present ♦According to Theobald (Monograph of the Culicidae of the World, published in 1891), stegomyia have been found in Spain. G. A. ASIA. 141 time such danger is very remote. It is onl}' a possibility. On the Pacific side ^ye have only one infected port, Guaya- quil. It is within the bounds of possibility for a steamer to sail directly from Guayaquil to an Asiatic port, be- come infected at the time of leaving Guayaquil, continue the infection by means of a succession of cases during the two months it would take her to reach an Asiatic port and implant the infection at such port. But it is extremely improbable. If a weekly steamer sailed from Guayaquil to a tropical Asiatic port the probabilities would be in- creased. The chances of a ship remaining infected for two months are small. Take, for instance, the relations between Cuba and Spain. For the twentj^ years before the American occupation of Cuba frequent steamers sailed from Havana to the ports of Spain. They were crowded with passengers, civil and military. Havana, during these years, always had yellow fever, summer and winter. Spain, as previous history has shown, was capable of be- coming infected. But such intimate commerce could go on for twenty years without establishing yelloAv fever in the country. SmalJh local epidemics have been established two or three times in Spain by this commerce since the in- troduction of the steamship. But it is rare. Now if the time of transit were made eight weeks, instead of two, the probabilities of carrying the disease Avould be greatly de- creased. I think that if such had been the case, Europe would have remained as free from yellow fever as has Asia. The Commission which was appointed by the United States to examine and report upon routes across the Isthmus, and which finally recommendied the Panama route, discussed at considerable length as to what would be the probable amount of commerce through the Canal and as to where it would come from. They quote the commerce of the great canals of the world at present in operation and its rate of increase yearl}^ from the open- ing of these canals. From this data they conclude that ten millions tons per year, will be a large tonage for the first ten years. Assuming that commerce Avill always follow the short- est and quickest routes between two points, they show 142 HISTORY OF YELLOW FEVER. that almost all European ports are nearer Asiatic ports via the Suez Canal than via the Panama Canal, and that, therefore, Panama will get very little trade from Europe. They conclude that the traffic through the Suez Canal will not be interfered with by the Panama Canal; that this traffic will come principally from the United States; some from the West Indies and South America and a very little from England. Accepting this as a basis for discus- sion, we see, that, if yellow fever . infection is distributed, at the time of the opening of the Canal, as it is at present, ships passing through the Canal and going to Asia from Vera Cruz, Havana and Kio de Janeiro, would be the only ones which could possibly carry infection. A half a dozen ships a year would be a large average for these ports. The other ports at present infected will probably never send a ship through the Canal to Asia. How will the opening of the Panama Canal affect the ^chances of this introduction? It will, no doubt, increase somewhat the commerce between infected ports and Asia, and vastly increase the commerce between North America and Europe, on the one hand, with Asia on the other. Ships in passing through the Canal will touch at Panama and Colon and be some twelve or fifteen hours crossing the Isthmus. If this territory is infected with yellow fever at this time it will greatly increase the chances of some of these numerous vessels becoming infected, and therefore, the possibility of yellow fever spreading to Asia. If we could bring about such conditions, therefore, that no vessel in passing through the Isthmus would be liable to become infected with yellow fever, and so that no ves- sel from an infected port would be allowed to go through the Canal, with any possibility of her carrying infection, Asia would be no more liable to get yellow fever from us than she is at present. To bring this happy condition about, we would have to keep the Isthmus itself free from yellow fever, and to guarantee, by means of rigid quarantines, that no infect- ed vessel passed through the Canal. Both these things are possible of accomplishment. Modern sanitary meas- ures have demonstrated the fact that even in the tropics it i;: possible to rid a locality of yellow fever and keep it ASIA. 143 free. This has already been done at Panama. It has been over a year since a ease of yellow fever has occurred in the city of Panama, and only one case has occurred on the Isthmus in the year 1906. There is a much larger non- immune population on the Isthmus at present that was ever here before, and that iDrobably ever will be here after the construction of the Canal. The same system of quarantine that has kept yellow fever for the past three years from being introduced by shipping from the neighboring infected ports, into the Zone, will also in the future prevent an infected ship from passing through the Canal. Whether the Panama Canal, when completed, will be a menace to the health of Asia all depends upon the effi- ciency of the government which controls the Zone through which it passes. If the Zone remains an endemic focus, as in years past, the probabilities of transmittino- yellow fever to Asia, by the largely increased direct traffic, will be augmented. If the Zone is kept free from yellow fever, and the last three years of sanitary work by the United States Government at Panama has shown that this is entirely possible, then the liability of the introduction of yellow fever into A-sia will not be at all increased by the opening of the Canal. SYRIA. Geographical and Historical. Syria forms part of Asiatic Turkey, south and south- east of Arabia and borders on the Mediterranean. It has a population of about 1,500,000, and area of about 70,000 square miles. In ancient times, Syria formed a part of the Byzantine Empire, and was successively conquered by the Persians, the Greeks and the Komans. Since then, its political history has been varied and sensational. It was taken by the Arabs in 636 A. D., by the Sedjuk Turks in 1078, by the Crusaders, by the Mamelukes and by the Ottoman Turks, AA^ho added it to their empire in 1517. In 1833, it was conquered by Mehemet Ali and annexed to Egypt, but was restored to Turkey in 1840 by the interven- tion of the great powers of Euroj)e. Bethlehem, the birth- place of our Savior, is located in Syria. Alleged Outhrealv of Yellow Fever in 1800. Yellow fever has never invaded Asia, so far as history informs us. The probability of the disease being carried to the Ancient Continent is ably and comprehensively dis- cussed by Col. Gorgas in the preceding Chapter. We do not believe that the incident related below was an out- break of yellow fever, but give it a place in this volume to complete our records of reported eruptions of the disease. According to Dr. Larrey, Avho was Surgeon-in-Chief in the Army of Napoleon during the campaigns in Egypt and Syria, yellow fever prevailed in Western Asia among the troops under General Kochler, in the summer and autumn of 1800. Dr. Larrey gathered his facts from the medical journal of Dr. Witman, a physician who was with the English military commission. We cull the following from Dr. Larrey's observations:^ Dr. Witman relates that, in the autumn of 1800, while ^Memoirs of Military Surgery and Campaigns of the French Armies, etc., by D. J. Larrey (Hall's Translation), 1814, p. 234. SYRIA 145 the military commission remained on the coast of Jaffa — a maritime town of Palestine, 31 miles northwest of Jeru- salem — where it was encamped with the army of the Grand Vizier, a malignant bilious remittent fever made its appearance. It commenced about the middle of Au- gust, and continued with much severity through the months of SeiJtember and October, lasting until Decem- ber. The weather was foggy, and very warm, the tempera- ture ranging from 90° to 98°. The nights, however, were cool and moist. The first victims of this disease were two of the artificers attached to the English forces ; the malady soon extended to the camp of the Turks, w^here it caused great mortality. The symptoms that appeared in this disease, according to Dr. Witman, were at first chilliness, pains in the head and prostration of strength ; after these a burning pain of the stomach and abdomen, nausea, a bitter taste in the mouth, and copious vomiting of bloody and bilious matter, with a diarrhea, of the same appearance; the tongue of a yellowish black, an ardent thirst, the pulse quick and strong, the skin yellow and hot, the respiration hurried. When the fever assumed an unfavorable character, it was attended by delirium ; the eyes were inflamed, and the skin often affected with dark colored spots. This disease ad- vanced with more or less rapidity, according to the state of the mind and body, age, and particular regiment; also with many circumstances connected with the place and the atmosphere. The wife of General Kochler, commandant of the Eng- lish forces, was the first to be stricken with the disease after the artificers had been attacked, and died on the seventh day. The general, wiio had faithfully nursed his consort during her illness, also contracted the disease. He died on the third day after being taken ill. The disease caused much mortality among the soldiers. In the months of November and December it subsided and was replaced by the plague, which was brought into Egypt by the invading armies and raged with unusual violence in that already much afflicted country. It is to be regretted that Dr. Larrey could not collect 146 HISTORY OF YELLOW FEVER. more circumstantial details relatire to tliis outbreak, es- pecially as regrards tlie pathology of the disease. The results of the dissections which were undoubtedly made by Dr. Witman and his fellow j)hysicians would have proved a Valuable addition to the history of this epidemic. HISTORY OF YELLOW FEVER IN AFRICA. ANGOLA. .Description. Angola is a Portugese colony on the '»7est coast of Africa, south of the Congo Free State. It consists of four dis- tricts — Congo, Loanda, Benguela and Mossamedos. An- gola was for a long time the radiating point of the slave- trade. Capital, St. Paul de Loanda. YELLOW FEVER YEAES. 1860; 1862; 1863; 1865. SUMMAEY OF EPIDEMICS. ISoO. Although the coast of Angola was discoyerei by the Portugese in 1186 and colonized soon after, we find no mention of yellow fever having prevailed in that locality previous to 1860. As Angola was the most active centre of the slave-trade in the past, there is no doubt thiit the dis- ease was imported and flourished there often^ although official confirmation is lacking on this score But we come across the same hiatus almost everywhere iu Africa. All the colonies along the Atlantic seaboard are controlled by European governments, whose policy of concealment and suppression has been instrumental in closing every avenue of research in that direction, so as to throw dust in the eyes of their own people and put down the bars to immigration. The outbreak of 1860, according to Berenger-Feraud* (page 136) was quite severe; but, beyond the mere men- tion of this fact, the noted epidemiologist is as silent as the proverbial bivalve. *Berenger-Feraud: Traite Theoriquo et Clinique de la Fievre Jaune, Paris, 1891. ANGOLA. 151 1862. St. Paul de Loanda was again visited by yellow fever in 1862 (Berenger-Feraud, page 139). No details are ob- tainable. 18G3. The epidemic which had its inception in 1862^ continued in 1863 (Berenger-Feraud, page 140). It was brought that year from Angola to Grand Bassam (q. v.). 1865. The year 1865 furnishes the last record of yellow fever in Angola. According to Mackay (cited by Berenger- Feraud, page 141), it was quite severe at St Paul de Loanda. ASCENSION ISLAND. Description. The Island of Ascension is a mere speck near the middle of the South Atlantic Ocean, about 750 miles northwest of the historic Island of St. Helena, and belongs to Great Britain. It is only 36 miles in circumference, 8 miles at its widest part, is of volcanic origin, and is chiefly cele- brated for its turtle, which are the finest in the world. The capital, George Town, located on the west side, has a population of about 150, and is gorerned under the admir- alty by a nayal officer. The total population of the colony is about 400. YELLOW FEVER YEARS. 1818; 1823; 1838; 1817; 1859; 1873. SUMMARY OF EPIDEMICS. 1818. According to the Second Report on Quarantine?- page 197, a feyer called ''bilious remittent,'' .but which was, no doubt, yellow feyer, prevailed on the Island of Ascension in 1818. The fever attacked "every man on the island," but the mortality was small. In the journal kept by Mr. Robert Malcolm, who was stationed at George Town in 1818, appears the history of a case of the disease, which commenced on the first day of June and was terminated by death the next day, ''with all the symjjtoms of yellow ruffusion and black vomit." The fever was, no doubt, imported from America by ^ Second Report on Quarantine : Yellow Fever, with Appen- dixes, by the General Board of Health; Presented to Both Houses of Parliament by Command of Her Majesty. London, 1852. The First Report is a general treatise on epidemic disease's; the Second Report deals principally with yellow fever. ASCENSION ISLAND. 153 some of the many trading ships which stopped at Ascen- sion on their Avay to African ports, but the framers of tlie **Second Eeport" vehemently deny this, claiming that the fever was en_gendered ''by an unusually wet turtle season, when the men are much exposed by watching at night to turn these animals." This explanation seems amusing and absurd when viewed in the light of our present knowledge of the trans- mission of yellow fever, but the statement was undoubted- ly accepted as gospel truth by the learned men of the period. It must also be remembered that the ''Second Re- port" was written under direction of the British Govern- ment, and as England's merchant marine dotted the seas at that time, the interests of her vast commerce demanded that the theory of importation be tabooed and ridiculed, even at the sacrifice of truth. According to an old saying of the ante-bellum Louisiana negro, Ravet pa gaignin raison divan poiile^ and the astute and narrow-minded compilers of this "Report" resort to all sorts of ingenious metaphors in their attempt to refute every proved instance of importation of yellow fever, twisting facts with amaz- ing cold-bloodedness and striving with every fiber of their prejudiced minds to prove that everybody but themselves are falsifiers. We regret not being able to gi\e a detailed account of this outbreak, the first on record in the eijidemiological history of Ascension. Even our old reliable friend, Ber- enger-Feraud, disposes of the subject with barely two lines, referring the reader to the unsatisfactory account con- tained in the "Second Report on Quarantine," v/hich, as we have seen, is historically incompu te. 1823. An Heirloom in the Annals of Medicine. — The Case of the ' ''BannJ' In 1823, the diminutive islet of Ascension^ which looks like a pin-head in the vast wastes of wf^ters which surround ^ The roach, has no voice in an argument with chickens. 154 HlSTOaY OF YELL W FKWa.. ir, assumed the magnitude of a eont-nent in the imag^na- lion of the hoarr-headed chroniclers who catered to public opinion in the beginning of the last century- This anomal- ous state of things was brought about by an occurrence which led the medical men of the period into a renewal of the acrimonious and endless controTersies conc-erning the c-ontagiousness or non-contagiousness of yellow fever — a war of words which had been waged witL more or less fierceness since 1793, and which furnished material for dis- cussion in the lay and medical jiress for fifty years after- wards. This noteworthy event was the arrival, on April 25, 1823, of the British ioop Bann in the harbor of George Town, the lava-fringed capital of the Islai^d. The case of the Bann is an heirloom in the annals of ej>ideniiology. To jjublish all that has been said, dis- cussed and written about this '^celebrated case,-' would take, at least, half a dozen volumes of several hundred pages each ; so we will merely confine ourselves to a recital of the incidents which led to the infection of the Island of Ascension, as abstracted from the report of Sir Wdliani Burnett, in his comx^rehensive work published in 1819.^ Owing to the universal interest which was evinced in the case of the Bann during the last century, we have seen fit to go into details which will doubtless seem unimpor- tant — and, mayhap, tiresome — ^to the * lay reader, but which are absolutely essential to a faithful narration of the historic event. The British sloop Bann anchored in the Sierra Leone river, Wei^t Africa, on the 11th of Jsnuary, 1823, after having cruised in the Bight of Benin. She remained at Sierra Leone until the 25th of March, part of her crew be- ing employed in her tender, the 8an Raplmel. The men were greatly exjxised in refitting the rigging of both ves- sels, and the schooner having been sent up the river to Bounce Island to have her bottom rexmred, she was there laid on the beach, and the men exposed on shore in one of the most unhealthy spots in the colony. On the 1st of March, 3Ir. Higgon was seized with fever Trhile on the San EaphaeL- where he had been for some 'Burnett: A Report upon the Diseases of the African Coast, 1849. ASCENSION ISLAND. 155 days Avitli a party of men actiyely employed getting her ready for sea. On the morning of tlie second lie was better, but became worse in the eyening. He had mo^'e feyer, which increased until the 3rd, when in the eyening he re- mitted. On the 4th and 5th it appears to liaye been moder- ate, and on the 6th he Ayas free from all complaint but de- bility. His. eyes were slightly yellow. On the 10th of March four cases occurred in the same yessel, the San Raphael, while at sea. In only one of the cases, which is detailed at length, there were slight remis- r^ions, as in the preceding. On the 15th the skin assumed a yellow tinge, but the patient recoyered: and was dis- charged to duty on the 24th. On the 25th another man was attacked in the tender, which had returned to the anchorage of Freetown. He had been only three days on board. On the 26th there was a slight remission, followed by an accession of feyer. On the 27th there was a second remission, followed by an accession. On the 29th he be- gan to sink, and died early on the 30th. The integuments, which Ayere slightly yellow, assumed a yery deep color after death. This Ayas the first fatal case that occurred amongst the crcAy of the Bann. Three men, tAyo on the San Raphael and one on the Bann, Ayere attacked on the 26th, but they all recoA^ered. The Bann sailed on the 27th of March, but remained about the mouth of the riyer until the 29th. Three cases occurred on the 27th, but they AA^ere all of an ephemeral nature, the Ayliole of the men haying retarned to duty AAithin a Ayeek. On the 31st there was a case of more seA-erity, the patient haying been on the sick list for nine- teen days. On the 3rd of April, there were four attacks. These, AAdtli one exception, Ayere all slight cases. On the 7th of April, elcA^en days after the Bann left Sierra Leone, there AA'as a scA^ere case, which terminated fatally on the 12th. From this time the disease assumed a greater de- gree of malignity and the deaths became more frequent. Only one of the cases Ayhich occurred about this period is detailed in the surgeon's journal. The patient Ayas at- tacked on the 14th, but had felt unwell for a fcAy days preyiously. He had the usual symptoms of fe^er, which 156 HISTORY OF YELLOW FEVER. were relieved by bleeding. Early on the 15tli, lie suffered less from pain, the skin was hot, but moist and the pulse was full and quick. At 9 a. m. he was again bled, which seemed to relieve him, but at noon the bad symptoms re- turned. The skin became very hot the pulse 120 and strong. There was, in fact, an accession of fever. On the evening of the 16th slight stupor supervened^ and the fever continued to be high. On the ITtli the symptoms were more favorable and there was a decrease of pyrexia, but on the 18th, about noon, the patient became suddenly worse and died almost immediately afterwards. Neither black vomit nor yellowness of skin is mentioned. It was intended to proceed with the vessel to the Island of St. Thomas, in the Bight of Biafra, but on account of the rapid increase of the fever and the bad state of the weather, a run was made for the Island of Ascension, which was reached on the 25tli of April, the Bann having lost thirteen men by fever up to that per'od. The viru- lence of the fever was most marked about the third week in April, a few days after the vessel crossed the equator, and when within a few hundred miles of Ascension. On April 22d eight men were attacked, not one of whom sur- vived ; three died on the 26th, two on the 27th, tAvo on the 29th and one on the third of May. The total number of cases on board the Bann was 99 and the mortality 34. The fever was carried by the offtcers and crew of the Bann to the detachments of Royal Marines stationed at George Town, the capital of Ascension, and spread throughout the island. There were altogether 28 cases and 15 deaths, a mortalitj^ of over fifty per cent. The theory of importation in the above instance is viciously assailed by the ''Second Report on Quarantine," pages 89 and 196, but the arguments advanced are de- cidedly vapid and irreconciliable with strict veracity and common sense. , 1838. • ^ The Case of the ''Etna J' From 1823 to 1838, the Island of Ascension Avas free from yellow fever. In 1837. there was a severe epidemic ASCENSION ISLAND. IS7 in Sierra Leone and the infection was finally brouo:ht to the island in 1838 by one of the many English war vessels which were constantly cruising about the South Atlantic - waters, ready to pounce upon the enemy and annex every- thing reachable. The source of infection was finally traced to three vessels, but which one of the three was the active cause of the epidemic is a mooted question to this day. The facts, according to the literature of the period, are as follows :^ The ship Etna arrived from Gibraltar in the roads off Sierra Leone in November, 1837. The fever at the time was committing great ravages among the prize crews and merchant seamen. On the 3rd of December, the Etna^ having Avatered, and taken on board some African boys and^Kroomen, sailed from Sierra Leone. On the 8th, one of the African boys was taken ill with a slight feverish attack, which did not attract any attentioii. On the 10th (December) two serious cases of yellow fever occurred in two Europeans^ who had been on shore and much exposed. On the 12th two more cases occurred, and of these four cases, three died of black vomit On the 20th two other cases occurred and five on the 21st. The disease then at- tacked officers and men indiscriminately. On the 20th of January, when the vessel anchored at Ascension, 99 cases had occurred and 25 deaths. Only five of the ship's crew entirely escaped. Shortly after the departure of the Etna, the Forester left Sierra Leone for Ascension, with the fever raging on board. On the way to Ascension, she fell in with the Boiietta, bound also for Ascension, and sent on board a prize crew. Immediately after this, yellow fever appeared on board the Bonetta and was extremely fatal. Both ves- sels arrived at Ascension simultaneously and shortly after- wards yellow fever appeared among the residents of the Island. Now, whether the infection was brought by the Etna, the Bonetta, or the Forester, or by all three vessels, which arrived at Ascension about the same time, is a problem which nearly made driveling idiots of the honor- * British and Foreign Medico-Chirurgical Review, 1849, vol. 4, p. 467. 158 HISTORY OF YELLOW FEVER. able medical men who fought orer the momeutous ques- tion, and which the writer is too modest to presume to un- ravel. The evidence further goes to show that the Water wit ch^ arriving at Ascension from a healthy port, with a healthy crew, contracted yellow fever at Ascension and carried it to sea- losing 15 men out of 60 within a period of 40 days. But, to the credit of the astute disputants of the period, the Waterwitch was never accused of having brought the pest to Ascension. 1847. Importation hi/ the ^^ Eclair/' Eight years elapsed Avithout a single case of yellow fever being noticed at Ascension, but an epidemic was nar- rowly averted in the beginning of 1847, when tv>'o cases developed on board the British ship Rosamond, formerly the Eclair, which vessel had played such a sensational role in the transmission of yellow fever to Boa Vista, Cape Verd Islands, in 1845, and to Woolwich, England, the following year (1846). The history of the inception and progTess of the disease on board the Eclair is interesting. To avoid repetition, we refer the reader to the compre- hensive account given elsewhere in this volume of the memorable epidemic which devastated Boa Vista in 1845.''^ The facts of the outbreak of 1847 are as follows : From the account given by the Second Report on Quar- antine, page 98, the Eclair was completely overhauled and fitted out anew at Woolwich, where she was commissioned for the Cape of Good Hope on Xovember 5, 1846, under the new name of Rosamond, as the old name was looked upon as a ''hoodoo." It is of record that during the time of fitting out, four cases of typhus fever occurred on the ship and were sent to the hospital, where two of them died ; but it is also known that typhus prevailed at Woolwich at that time. The steamer left England for the Cape on February 23, 1847. Three days aft^r sailing, one of the men was affected with slight febrile symptoms and he con- tinued more or less indisposed for a number of days, but 'See "Cape Verd Islands." ASCENSION ISLAND. 159 occasionally felt so well that lie returned to his work. After the ship entered the tropics, however, the disease began to assume a new and alarming character; and when off the Island of St. Nicholas, and almost in sight of Boa Vista, the man died, having had for two days previous black vomit and other characteristic symptoms of yellow fever. Within a few days afterwards, the Rosamond ar- rived at Ascension, where two other cases developed. The infection did not spread to the inhabitants of the Island, and no mention is made in the Report of any additional cases on board the ship, so we take it for granted that there were none. The great point of interest, however, is the persistence with which the spectre of yellow fever hovered over the Eclair, and the only explanation which we can make at this latter day^ is that infected mosquitoes were impris- oned in the hold of the vessel and were the active agents in the distribution of the poison which caused the sporadic outbreaks which followed in the wake of the vessel. 1859. Yellow fever was carried to Ascension by the British war vessels Trident and Sharpshooter, in 1859, under the following circumstances :^ Yellow fever was quite severe at Sierra Leone in 1859. In the middle of May, the war-vessel Trident was infected at Freetown. The disease spread rapidly to the officers and men and the ship was put to sea, with a view of ar- resting the progress of the malady, but without the wished- for result. She returned to Sierra Leone on June 10 and sailed for Ascension on June 17, where she arrived on June 27, having lost 17 men since the eruption of the fever. Fifty-two cases were then on the sick list, 31 of which were sent on shore to the garrison hospital, and the remainder to the convalescent hosijital on the Green Moun- tain. The remaining part of the crew way landed and placed under canvass in a small bay about two miles from the garrison, with which all communication was inter- « statistical Report of the Health of the Navy of Great Britain for 1859 (London, 1862), p. 83. 160 HISTORY OF ^-ELLOW FiTVER. dieted. The disease continued to txtend among t3ie ^rew on sliore until tlie middle of JnlT, wMen it entirely ceased. Of 143 of all ranks and ratings on board, namely, 110 Enropeans and 33 Africans, 101* were attacked and 44 died. Eleven cas€^^ of yellow fexer occurred on tlie Sharp- shooter, which lay off Sierra Leone from the 9t3i to tMe 16t!i of December- Disease is said to haTe originated thus : On December 12 the Sharp sliooter was taken a]ongside a schooner for a supply of coal ; in this xessel the body of a seaman, who had died on the Surprise of yellow fever, was deposited previous to interment ; and though the fever was sujjposed to have ceased in the town it was still prevalent in merchant vessels. The Sharpshooter s men, who were employed in the coal vessel, compLiined of the effluvium of bilge water, and said it gave them headache. On De- ceml>er 21 the Sharpshooter sailed, and on that day a boy who had l>een c^cmplaining the day before of severe head- ache was attacked; the fever ran a rapid course, and he died on the morning of the 22nd. Other cases followed rapidly. The ship then stood out to sea for a few days and kept about 90 miles from land. This seemed to check the progTess of the fever. On Dec*eml>er 27 sct ,eral new cases occurred and the ship sailed for the Island of Ascen- sion. In neither of the abore instances was the disease communicated to the inhabitants of Asc^Bsion. 1873. The Case of the ^'Amethyst.-'' For fourteen years, Asc*ension had a respite from yellow fever, and would have enjoyed immunity to this day, had not imjiortation again threatened tc kindle anew the dor- mant fires of pestilence. It does not appear that any cases of yellow fever were observed among the British war ves- sels or the land forces in the vicinity of the Island, yet the ship Amethi/st is accused of having brought the fever to Ascension from Cfij^e Coast, Africa. ASCENSION ISLAND. 161 This war steamer, according to Smart,'^ was despatched from the coast with a large number of invalids, many of whom were from Elmina. After five days at sea, she reached Ascension on the 20th of December, and landed her invalids. Among these there was a case of continued fever with great nervous tremor^ who died on the seventh day after landing. Another case was moribund when sent ashore, djing in thirty-six hours. The symptoms were great anxiety, intense headache vvdth deafness, epigastric pains, dry red cylindrical tongue rapid pulse and respira- tion, injected eyes, a yellow surface, ecchymosed as death approached, relaxed bowels, vomiting of dark tar-like fluid, and suppression of urine — symptoms closely allied to those of yellow fever. On the third day after being landed, one of the. invalids, after a few hours of slight discomfort, fell down almost lifeless, and vomited and purged at the same moment a dark tar-like fluid mixed Avith pure blood; the features were deathlike, the surface cold and of a dirty yellow color, pulse scarcely perceptible, respiration slow and sighing. Under treatment by stimulants, with opiates, he rallied, vomiting ceasing after a few hours, when a typhous state supervened, lasting to the end of the second day, after which he convalesced. Another case was similarly attacked on the fourth day after landing, went through an analogous course of symp- toms, convalescing from the end of the following day. The train of symptoms and events in the above cases, according to Dr. Smart, were sufftciently diagnostic of severe bilious remittent fever of the English nosology, and of the gastroenteric type of algide pernicious fever of the French nosology; from which the Doctor infers that the disease carried from Cape Coast to Ascension in the Amethyst w^as of the remittent, and not of the yellow fever type. Be that as it may, we think the cases sufficiently diagnostic of yellow fever to class them as such and place this outbreak among our records, ^ Smart: Transactions Epidemiological Societv of London, vol. 3, p. 508. BANANA ISLANDS. Description. The Banana Islands are a group of small islands off the coast of Sierra Leone, Africa. Tlney are seldom visited by white men, which no doubt accounts for the fact that only a single outbreak of yellow fever is recorded as having taken place there. YELLOW FEVER YEAR, 1847. SUMMARY OF EPIDEMIC. Our authority^ does not give the source of infection, but relates the following facts : On the 26th of July, 1847, the British brig Syren detached a party of three officers and twenty- seven men to the Banana Islaods, for the purpose of blockading the Sherbo River. On August 14, a case of fever occurred, and, subsequently, scattered cases ap- peared till September 20th, when the blockade was aban- doned. The first cases were said to be of a purely endemi- cal character. The disease then assumed a worse form, until it merged into yellow fever, with its characteristic symptom, black vomit. The number of cases and deaths is not aiven.^ ^Bryson: British and Foreign Medico-Chirurgical Review, 1849, vol. 4, p. 470,. ^ This is unfortunately the case in about every account of yellow fever in Africa. BENIN. Description. Benin is a negro kingdom of West Africa, in Upper Guinea, on the Bight of Benin, extending along the coast on both sides of the Benin River, west of the Lower Niger, and some distance inland. It has no political unity and has no commercial importance. Benin, the principal town, has a population of about 15,000. In the days gone by, it was the great slave emporium of the district. The religion is fetichism. Human sacrifices are numerous and cruelty, in its most atrocious forms, is characteristic of the people. YELLOW FEVER YEARS. 1520; 1553; 1558; 1588; 1828; 1852; 1853; 1854; 1855; 1856; 1857; 1862; 1873. SUMMARY OF EPIDEMICS. 1520. Berenger-Feraud,^^ quoting Valkanaer,^^ gives an ac- count of an epidemic, said to be yellow fever, which at- tacked the crews of the Portugese explorers in the Gulf of Benin in 1520. No information as to the origin of the dis- ease is given. 1553. In August, 1553, an Englishman named Windham and a Portugese, Antoine Pinteado^ sailed from Plymouth, England, for the West Coast of Africa, to explore and colonize the country. The expedite' on consisted of two ships, manned by a crew of 140 men. Shortly after reach- ing: the Gulf of Benin, thewressels were attacked by a malig- nant fever, which proved so fatal that it was found neces- ^^ Berenger-Feraud : Traite Theorique et Pratique de la Fievre Jaune (Paris, 1890), p. 27. "Vol. 1, p. 370. 164 HISTORY OF YELLOW FEVER. sarv to burn tlie ships, there not being enough men left to inan them. Only 39 of these adventurers returned to Plymouth, making a death-rate uf TO per cent. This ''malignant fever" is said to have been yellow fever, but how, where and by what means the infection was contract- ed, our source of information^- does not say. As Wind- ham's vessels originally sailed from a port where fever has never prevailed de novo, commtmication was evidently had with some of the slave-shii^s which then did quite an ex- tensive business between Africa and Cuba^ Mexico and South America — for even at that early period the Span- iards stole negroes by the thousands to work their j)lanta- tions in the New World — and the sturdy sons of a north- ern clime proved easily stisceptible to the bites of the stegomvia. 155S. In 1558. an explorer named Torwson and his compani- ons were stricken with yellow fever while in the Gulf of Benin.^^ The data as to this outbreak are very meagre. 15S8. Bird and XewtoUj^^ intrepid voyagers in search of ad- venture and wealth, and their comi^anions are said to have experienced vellow fever while in the Gulf of Benin in 1588. 1828. From 1588 to 1828, a i)eriod of two htmdred and forty years, there is no record of any yellow fever outbreak in the Gtilf of Benin. This seems almost incredible, btit even such a careful observer as Berenger-Feratid has failed to find any data for these '^silent years.*' In 1828, however, the disease broke out afresh,^-^ being imported from Sierra Leone by the ship La BordeJaise^ and ravaged all the coast *owns from the Gulf of Benin to Gambia. ^' Gazette des Hopitaux, Paris, vol. 57, p. 661. ^^ Berenger-Feraud, loc. cit, p. 27. ^'* Berenger-Feraud, loc. cit. p. 27. ^ Berenger-Feraud, loc. cit., p. 105. BENIN. 165 1852 to 1857. After an interyal of twenty-four years, yellow fever was again imported to the Gulf of Benin in 1852 and cases occurred sporadically every year from that date until 1857. Our authoritv^^ does not sive anv details. &^ 1862. In 1862, yellow fever was imported to Benin and other countries on the West Coast of Africa (presumably from Havana or South America) by some of the nondescript craft engaged in the slave-trade between Africa and the Spanish-American countries. Early in ^lay, the fever broke out among the natives huddled in the towns and hamlets located along the banks of the Bonny Tiiver, and -spread rapidly to the officers and white porticrs of the crews of the palm-oil vessels in the river. The contagion then successively attacked the crews of vessels lying at anchor in the numerous rivers flowing into the Gulf of Biaffra,^^ more especially the Old and New Calabar and Brass rivers. It was particularly fatal at Bonny, then a notorious slave-mart, where it mowed down natives and Europeans alike. The epidemic, although of a vicious and generally fatal type, was of short duration, disappear- ing from all the rivers and bordering villages by the end of June. The source of this epidemic has never been clearly estab- lished. That section of Africa was then one of the most active centres of the slave trade and, although British war vessels blockaded the coast and were on the lookout for slave-traders, the high rate of speed possessed by the ves- sels engaged in this nefarious trade and the thorough knowledge the marauders had of the many inlets where they could find a safe hiding place when the scout-ships were sighted, enabled them to navigate the many rivers of that section almost unmolested. As most of these slave- ships came from Cuba or South America, where yellow ^^ Berenger-Feraud, loc. cit., p. 122, " Statistical Report of tlie Health of the Navy for the Year 1862 (London, 1865), p. 157. 166 HISTORY OF YELLOW FEVER. fever reigns at almost any season of the year, the yellow fever mosquitoes could easily be imported. The only mat- ter of surprise is that the disease has not been more fre- quently propagated by these vessels. 1873. In 1873, yellow fever was imported to the island of Sal, one of the Cape Verds, from Brazil, and thence to Benin. Small vessels, laden with grain from South Ameri- ca were then in the habit of first stopping at the Cape Verd Islands on their way to West Africa, and as yellow fever has been epidemic in Brazil almost every year since 1849, this visitation can surely be attributed to importa- tion from that country. The first knowledge at Cape Coast Castle of the pres- ence of yellow fever in the Bights was late in November, on the arrival of the mail packet Amhriz, having the dis- ease among her crew.^^ The vessel was at once quaran- tined, her mails being put on board the Blafra and both vessels steamed off. The Amhriz lost thirteen of her crew before she reached the Cape Verds^ and the Blafra six. From the meagTe report furnished, this outbreak does not appear to have been either extensive or attended with much mortality. BOA VISTA. {See Cape Verd Inlands.) ^^ Smart: Trans, Epidemiological Society of London, vol, 3, p. 507. BONNY. Description. Bonny is a town of West Africa, on the Bonny River. Jt is surrounded by a pestilential swamp and is inhabited by degraded savages. It does a good exporting business in palm oil. It was once the most notorious slave-port in Africa. YELLOW FEVER YEARS. 1862; 189L SUMMARY OF EPIDEMICS. 1862. The epidemic of 1862 almost deciminated Bonny and was as fatal among the blacks as among the few white settlers of the colony. The fever was original^ y intro- duced by some of the trading vessels plying between Bonny and the Cape Verd Islands. Two-thirds of the inhabitants of Bonny are said to have perished. Out of a population of 140 Europeans, 70 were attacked in the space of a month. In one day, as many as twenty bodies were taken out of the same house. The mortality in the shipping was heavy. The bark Phrenologist lost its captain, pilot, first mate and two sailors. The ship Gran Bonny lost four men. Between April 4 and May 5, there were 62 deaths among the crews of vessels at Bonny. ^^ "Landa: La Espana Medica, 1863, vol. 8, p. 427; also: Statisti- cal Report of the Health of the Navy for the Year 1862 (London, 1865), p. 157.. 168 HISTORY OF YELLOW FEVER. 1891. The second recorded outbreak of yellow fever at Bonny occurred in 1891. The epidemic lasted from February to April. -^ Cases and deaths are not given. As this is the only locality in Africa where the fever prevailed in 1891, it was probably imported from that prolific source of in- fection — Brazil. A glance at the consular reports and re- ports of quarantine officers published in the Weekly Ab- stracts of Sanitary Reports for 1891, brings out the fact that almost every vessel reported as ''infected with yellow fever'- during that year originally sailed either from Bahia, Kio de Janeiro, Santos, Para, Pernambuco, or other in- fected Brazilian ports. It is surprising that, owing to the lax quarantine methods then in vogue in Africa, that the whole coast was not infected. An explanation will no doubt be found in the absence of the festive Calopus from the localities which escaped a visitation. 2° Weekly Abstracts of Sanitary Reports, U. S. P. H. & M. H. S., 1891, vol. 6, pp. 266, 298. BULAM. Description. Bulam or Boullam (now called Bulam or Eolama), is one of the Bisagos, a group of about thirty islands near the west coast of Africa, opposite the mouth of the Kio Grande, between lat. 10° and 12° N. The largest of the archipelago, Orango, is about 25 miles in length, and most of the islets are inhabited by a rude negro race, with whom some desultory trade is carried on. Most of the islands are under native chiefs, nominally vassals of Portugal. At Bulama, once a British settlement, but abandoned as unhealthy in 1793, there is a Portuguese town, a thriving and pleasant place, the seat of government for the Portu- guese possessions in this quarter. The earliest description of Bulam is given by the Che- valier de Marchais, in Father Labat's Voyages du Cheva- lier de Marchais en Guinee et ana; Ties Voisines, vol. 1, p. 68, of which the following is a translation : ''The bed of that river (Sierra Leone) contains a quantity of islands, densely Avooded; the soil is rich and produces all that is necessary to life. The air is very pure and one is not sub- ject to those violent and dangerous diseases which prevail on the Coast of Guinea and which are so fatal to Euro- peans," , Dr. Lind, in his Diseases of Hot Climates^ p. 56, also speaks favorably of these islands. According to Chisolm,^^ the most correct description of the Island of Bulam can be found in the African Plot, a paper published by Capt. Norris in 1796 (or thereabouts), in which it is stated that ''Boullam'' is located in "latitude 11° N. and longitude 3° W. from Farro, almost in the mouth of the Eio Grande, having Hen Island between it and the ocean. It appears to be nearly circular, about 15 miles long and 15 broad; and, consequently^ about 45 round." ^^ An Essay on the Malignant Pestilential Fever introduced into the West India Islands from Boullam, etc., by C. Chisolm (1799), p. 85, 170 HISTORY OF YELLOW FEVER. YELLOW FEVER YEAR. 1792. A VENERABLE MEDICAL HEIRLOOM. The alleged importation of yellow fever by the British ship Hankey from Bulam to the island of Grenada, West Indies, in 1793, is one of the mustiest heirlooms in the annals of medical history. Together with the case of the Bann (Island of Ascension, 1823) and that of the Eclair (Boa Vista, 1845-6), it forms a triumvirate which, for nearly a century, was the cause of most acrimonious con- flicts between medical men and gave rise to controversies which remain unsettled to this day. The believers in the specific nature of yellow fever, headed by Sir William Pym, and the "other side," composed of men who upheld the theory that the disease should be placed in the same category as malarious fevers, wrote books and brochures by the score and burdened the columns of the medical press of the period with articles which are brimful with personalities of the most volcanic type. When, through sheer exhaustion, partisans abandoned the fray, fresh re- cruits would take up the gauntlet and, imbued with seem- ing! v irrepressible hatred, would ''sail in'- with fiendish fury and renew hostilities, scattering vituperation right and left, without the least regard for age, oificial position or facts. A specimen of this mode of warfare will prove interest- ing. According to the British and Foreign Medico-Chir- urgical Revieiu,^^ we find Sir William Pym stating that Sir William Burnett and Dr. Bryson, his antagonists, ''have gone unnecessarily and wantonly out of their way, to make unfounded and malicious statements," and giving utterance to a pious wish that these gentlemen may profit by the information he has given them, and may "pray for- giveness for their inconsistencies and misrepresentations." He informs us that he has been induced to take up the gauntlet again, by the "wanton, false, abusive, and un- founded attack" made by Sir William Burnett upon him ^^Vol. 4, 1849, p. 459! ' BULAM. 171 in reference to the Eclair. On the other side, Dr. Bryson accuses Sir William Pym of attacking him ''in most un- justifiable and unprofessional language;" of making use "of garbled and unfair extracts;" of "disingenuously mix- ing up facts and statements in a confused manner, for the purpose of making out charges of inconsistency;" and he regrets that Sir William Pym's review of his "Ixeport of the Diseases of the African Station" "is written in a style which prevents his replying to it with the respect due to a man of Sir William Pym's age and position in society." Other equally amiable diatribes are of record, but we will pass them by and revert to the fossilized case under discussion. HOW BULAM BECAME FAMOUS- Up to 1792, Bulam was an unknown quantity m the af- fairs of men. It is true that it occupied a place in the charts of the bold, but cautious navigators of the time, but insofar as its climate and the people which inhabited it were concerned, it was as deep a mystery as the North Pole is to us at the present writing. How it suddenly sprang into world-wide prominence and achieved a noto- riety which clings to it to this day, and which gave the name of "Bulam Fever" to the nomenclature of yellow fever, is faithfully chronicled in Dr. Chisolm's immortal work, from which the information which follows is ex- cerpted. SUMMAKY OF EPIDEMIC. According to Dr. Chisolm,^^ the Hankey sailed from England, in company with the Calypso, both chartered by the Sierra Leone Company, loaded with stores and adven- turers for the projected colony at Boullam, about the be- ginning of the month of April, 1792. When these ships sailed, the crews and passengers were all healthy and con- tinued so until they reached their destination. These ad- venturers, who were mostly the well-to-do middle class, had been induced to settle in this "new country" more 23Chisolm: loc. cit., p. 83. 172 HISTORY OF YELLOW VFEER. from the delusive prospect of wealth held out to them and the fanatic enthusiasm for the abolition of the slave trade, than by any deprivation of the means of subsistence in their own country. Boullam had been depicted to them as an ideal place. When the Hankeij arrived off the island, it was found to be unhabitated and lurid tales were told by some of the sailors who had been in the neighbor- hood before concerning the aborigines who inhabited the mainland. They were i)ictured as being ferocious to an extraordinary degree and some were even said to be rabid cannibals. These rumors unnerved the prospective settlers and hindered them from making a permanent landing on the island. For nine months they lived on board the Hankey. '^The rainy season coming on almost immedi- ately after their arrival," observes Dr. Chisolm,-^ ''and the heat being at^he same time excessively great, they en- deavored to shelter themselves from both by raising the sides of the ship several feet, and covering her with a woodtn roof.-' Amid such cramped and unsanitary surroundings, it is not surprising that the worst forms of disease should be engendered. We shall continue the recital of this famous case, as culled from the Second Report on Quara^itine, pages .71 to 83 : According to the estimate of Dr, Chisolm, the settlers and crew, numbered in all upwards of 200 people, includ- ing women and children. These persons, he says, con- fined in a sultry, moist atmosphere, inattentive to cleanli- ness, and neglecting to sweeten the ship and to destroy the clothes, bedding, etc., of those that died, were seized with a malignant fever which produced such havoc among them that when the time for which the Hankey was char- tered had expired, there were no seamen left to navigate the ship; and consequently they were obliged to proceed to sea. having on board only the captain, who was sick, the mate, one of the settlers (Mr. Paiba), and two seamen. It is stated that with much difficulty they arrived at St. Jago, where they found the Charon and Scorpion, ships of war, from each of which they- received two men to as- sist them in navigating their vessel; that with this aid 2'Loc. cit., p. 85. BALUM. 173 they proceeded to the West Indies — a voyage to England being impracticable in their state; and that on the third day after leaving St. Jago, the four men transferred to them from the ships of war, were themsehes seized with the fever, two of whom died, and the remaining two Avere put on shore at Grenada, ''in the most wretched state pos- sible." Dr. Chisolm further states tliat Captain Dodd of the Charon, having occasion about that time to come to Grenada, and hearing of the mischief of which the Hankeij had been the cause, mentioned that several of the Charon^s and Scorpion^s people Avere sent on board the Hankeij at St. Jago to repair her rigging, etc. ; that from this circum- stance and the communication Avhich his barge's crew had with the ship, the pestilence was brought on board both ships; and that of the Gharon^s creAV thirty died; and of the Scorpion's about fifteen. The Hankeij arrived at the port of St. George on the 19tli of February. The first person who visited the ship after her arriA^al in St. George's Bay Avas Captain Eeming- ton an intimate acquaintance of Captain Coxe, the captain of the Hankeij . This person went on board of her in the evening after she anchored, and remained three days, at the end of which time he left St. George's and proceeded in a drogher (a coasting A^essel) to Grenville Bay, where his ship J the Adventure lay. He was seized Avith the pes- tilential fcATr on the passage, and the Adolence of the symptoms increased so rapidly as on the third day to put an end to his existence. The crcAV of the Defiance, in Blythe Port near Newcastle, were the next AA^ho suffered by Aisiting this ship ; the mate, boatsAvain, and four sailors Avent on board the day after her arrival; the mate re- mained either on deck or in the cabin, but the rest went below and stayed all night there. All of them were imme- diately seized with the fever, and died in three days. The mate was also taken ill but recovered. Tlie crew of the ship BailUes Avere the next who suffered; these communi- cated the infection to the ships nearest them, and so it gradually spread from those nearest the mouth of the carenage, where the Hankey for some time lay, to those at 174 HISTORY OF YELLOW FLVER. the bottom of it, not one escaping in succeSvSion whatever means the captains took to prevent it. About the middle of Ax)ril the disease began to appear on shore. The first house it showed itself in was that of Messrs. Stowewood and Co., situated close to the wharf; and the infection was evidently introduced by a negro wench who took in sailor's clothes to wash. The whole of the family were successively afflicted with it ; and by them communicated to all those Avith whom they had any inter- cotirse. All who from friendship, business, or duty, com- municated with the diseased were themselves infected, and no instance occurred wherein the contagion could not be traced to its particular sotirce. A few who sedulously avoided the houses where the infected actually were, es- caped. That part of the garrison quartered nearest to where the Hankeij lay, were the first of this class of men who re- ceived the infection. A barrack containing nearly one-half of the tl:5th regiment, was situated exactly to leeward of the Hankeij and distant from her about 200 yards. One of the officers visited the Hcnikei/, and with two or three soldiers who rowed his boat, remained on board some time. The consequence of this imprudence was fatal to himself almost immediately after, and in a little time, tc many of the men. All the officers and men were successively seized with the disease; but it proved fatal only to recruits who had lately joined. About the beginning of May the disease made its ap- pearance in the detachment of Eoyal Artillery; a circum- stance rather extraordinary, as that corps were quartered in a situation far removed from the focus of infection. It was evidently prodticed. however by the communication which the gunners, doing duty in Fort George, had with the 45th regiment. Of 84 people belonging to the ordin- ance department at that time, about 56 were seized with the disease before the 1st of Jtily, and of these 5 died; a trifling mortality, considering the nature of the complaint. All these men, however, had been about three years in the country, and consequently suffered less from the disease, than about 27 recruits who ioined the artlllerv in Julv. BULAM. 175 Of 26 of these unfortunate men who were infected, 21 died before the middle of August. About the 1st of June, the disease began to appear among the negroes of the estates in the neighborhood of the toAvn, but it did not spread much among them, nor was it marked with the fatality which attended it, when it ap- peared among the whites. About the middle of June, the disease broke out in the 6Tth regiment, and among the artificers and laborers on Eichmond Hill. The infection was communicated by some of the latter, who had visited their friends in town labor- ing under it. All w^ere successively seized with it; but it fell heavier on the officers than the men, several of the former being young men lately arrived from Europe. The disease in the course of the months of May, June, and July, appeared in several distinct and distant part* of the country, W'here the infection was carried by per- sons^^ who had imprudently visited infected houses in town. But the infection was not confined to Grenada alone; from this, as a focus, it spread to the other islands; to Jamaica, St. Domingo, and Philadelphia, by means of ves- sels on board of which the infection was retained by the clothes, more especially the w^oollen jackets of the deceased sailors.-^ Such are the facts of this celebrated legend, on which whole libraries have been written. That the Hankey was ravaged by yellow fever, there is not the slightest doubt; but the disease did not and could not originate at Bulam, for the simple reason that it had never prevailed there be- fore and has never been observed there since. As yellow fever was epidemic at Fernando-Po in 1792^ the Hankey was in all probability visited by the commanders and crews of the innumerable tramp and semi-piratic ships which then infested these waters and, once contaminated, acted as firebrands in propagating the pest. The statement made by the venerable Chisolm that the disease w^hich raged on the Hankey while the ship was in ^ It is needless to add that we dissent from this view. ^ Dr. Chisolm evidently had not been introduced to the Steg'omyia Calopus. G. A. 176 HISTORY OF YELLOW FEVER. the harbor of George Town was ^'anknown in this coun- try"^" is easily refuted by history. A reference to our chronological tables and also to the history of yellow fever at the island of Grenada, will show that the saffron scourge made its first appearance among the inhabitants of that island in 1694, antedating by almost a hundred years the alleged importation so graphically outlined by Chisolm. -'Chisolm: Loc. cit, p. 89, CALABAR. Description. Calabar is a maritime district of West Africa, in Upper Guinea, between the bights of Benin and Biaffra. The native population consists principally of slaves. The cli- mate is extremely unhealthy and, with the exception of missionaries, there are no white men in the district. 1862. YELLOW FEVEE YEAR. SUMMARY OF EPIDEMIC, There is a solitary instance of yellow fever having vis- ited Calabar. In 1862, according to Berenger-Feraud,^^ the disease was introduced into the district, but no details are given. As the fever ravaged the whole African coast that year, from the Congo to Sierra Leone, it was no doubt imported into Calabar by the palm-oil vessels trading along the coast. ^^ Berenger-Feraud, loc. cit., p. 139, CANARY ISLANDS. Description. Canary Islands, or Canaries, are a cluster of islands in the Atlantic Ocean, about 60 milts northwest of the Afri- can coast, and belong to Spain. They are thirteen in num- ber, seven of which are of considerable size, namely, Palma, Ferro, Gomera, Teneriffe, Grand Canary, Fuerteventura and Lancerota. The other six are very small: Graciosa, Roca, Allegranza, Santa Clara, Inferno and Lebos. The population of the islands, which is a mixture of Portugese and Spanish, is estimated at 300,000. Santa Cruz de Ten- eriffC; with a population estimated at 46,000, is tlie capital of the group. Las Palmas, with a population of about 12,512, is the next city in importance. Historica I Nummary. Two years after the discovery of America, or, to be more explicit, in 1494, yellow fever is said to have made its debut in the Canaries. No previous record of the appear- ance of the disease among the Guanches, the mysterious tribe w^hich originally peopled the islands, is in existence. This, of itself, is sufficient to forever set at rest the theory that yellow fever is an African product, for were this the case, the Canaries, which are only about 60 miles from the mainland and directly in the path of vessels plying be- tween Western Africa and Europe, and were no doubt vis- ited by the mediaeval freebooters using this route, would certainly have been infected long before 1494. The Canaries, which are supposed to be the ^^Fortunate Islands" of the ancients, were known to Europeans from time immemorial. ^ The elder Pliny speaks of them, but, by one of these strange freaks which characterize history, they were lost sight of for many centuries and not rediscov- ered until 1313, when they were invaded by the Spaniards, who retained possession of the islands until 1334, when they passed into the hands of the Portugese. In 1402, tlie Norman adventurer, Jean de Bethencourt, fitted out an CANARY ISLANDS. 1 7^ expedition for the purpose of conquering the archipelago. He was assisted by the Spanish Crown and succeeded in mastering four of the group. After his death, his suc- cessor sold all his rights to Spain. In 1477, the King of Spain sent out a large force to subdue the Guanches, but the natives put up such a brave and stubborn fight, that it Avas not until 1495 that the islands were completely sub- jugated. The aborigines were nearly extirpated by the conquerors and have long ceased to exist as a separate people. Of this mysterious race, little is known. They are supposed to have been of Lybian or Berber stock, but this is only a conjecture. They are said to have been a brave, intelligent race, of large stature, and comparatively fair and to have been proficient in the making of pottery ware. Specimens of their craft are preserved in the British museums. It is a significant fact that the first recorded introduc- tion of yellow fever into the Canaries should be coincident with the exodus of the panic-stricken Spaniards from the "New World," fleeing from a 7iova pestis, engendering a dread which even overshadowed their innate greed for gold and conquest. The terror which the new hemisphere in- spired began to be manifest about 1494 and not only caused hundreds of the adventurers to return to their na- tive land, but hindered others from attempting the voyage. "Not a single vessel," says Oviedo,^^ "left Spain during^ the third voyage of Columbus,^^ because the men who had returned with him from San Domingo were of such a sick- ly hue, that they resembled corpses." Such was the curse of God in atonement for the atroci- ties perpetrated by these merciless conquerors upon an in- offensive and peace- abiding race, whose only crime was that they defended their native land. What the poor Guanches could not do, however, was wrought by the pes- tilence, and the countless hecatombs which mark the ad- vent of the Spaniards in the New World, bear silent wit- ness to the merciless work of the avenging spirit. '^Goncalo Oviedo: La Historia General de las Indias, 1547, vol. 2, chap. 4. ^•^ March. 1496. 180 HISTORY OF YELLOW FEVER. YELLOW FEVER YEAES. 1494; 1495; 1496; 1512; 1531; 1582; 1599; 1601; 1606; 1707; 1771; 1772; 1773; 1810; 1811; 1828; 1846; 1847; 1862; 1888; 1905. SUMMARY OF EPIDEMICS. 1494. According to Finlay/^^ a pestileiitial disease, said to be yellow fever, appears to have been carried from Hispanola ( San Domingo ) to tlie Canary Islands in 1494. either by the vessels of Antonio Torres, or, more probably, by the three which returned to Spain after having landed Don Bartolome Colon at Y'sabella, San Domingo. Wliat makes this assertion seem still more plausible, is the faei:, record- ed by Humboldt^- and Bonpland,"^'^ that what remained of the Guanches on the island of Teneriffe perished mostly in 1494, in the terrible epidemic called the '"Mordora.'' 1495. Oviedo'^^ informs us that the island of Tenerifi'e, one of the Canaries, was visited by a great pestilence in 1495, pre- sumed to have been imported from Hispanola b;/ the flee- ing Spaniards, who stopped at the island on their home- ward voyage. This epidemic was undoubtedly yellow fever, for the adATnturers who returned home were of a ^^sickly saffron color"^^ and were so permeated with terror- ^^Finlay: Reference Handbook of the Medical Sciences (New York, 1904), p. 323. '- Ibid. ^Aime Bonpland, French botanist, 1773-1858. While pursuing his studies in Paris, he made the acquaintance of Alex- ander von Humboldt, the famous historian, and agreed to accompany him in his celebrated expedition to the New World. During this expedition, he made many valu- able botanical discoveries. ^'Goncalo Oviedo: La Historia General de las Indian, 1547, vol. 2, chapter 15. ^Oviedo: Loc. cit., vol. 2, chap. 4, CANARY ISLANDS. 18 I that neither promises of gold nor assurances of lordly power in the '^New World" could tempt them to cross the seas again. 1496. Teneriffe seems to have been again infected in 1496, ac- cording to Cornilliac,^^ but whether it was a recrudescence of the epidemic of 1495 or a new importation, is left to conjecture. 1512, Berenger-Feraud is of the oi)inion that the epidemic which reigned in the Canaries in 1512, and which was designated by the name of peste, Avas an invasion of yellow fever. ^^ 1531. This year Avas also characterized by an outbreak of the peste in the archipelago. The authority quoted in the preceding paragraph thinks it was yellow fever. ^^ 1582. Half a century elapsed without yellow fever being ob- serA^ed in the Canaries. It Avas introduced that year, pre- sumably from the West Indies, and is designated by the name of peste by the Spanish chroniclers. Berenger- Feraud, hoAvever, says it Avas undoubtedly yellow fever.^^ 1599. In 1599, a pestilential disease, designated by the Span- iards by the name of ealentura, ravaged the Canaries. Towards the end of 1599,^^ the squadron commanded by ^^ Cornilliac: Reclierches Chronologiques et Historiques sur rOrigine et la Propagation de la Pievre Jaune dans les Antilles (Fort-de-France, 1867). ^'Berenger-Feraud, loc. cit., page 38. ^Ibid. 2'^' Ibid. ^'Cop: Histoire de la Medecine Navale Ho'landai!:e. 182 HISTORY OF YELLOW FEVER. Admiral Van der Does, of the Dutch Navj, consisting of 75 vessels and 8,000 men, made an attack on tho Spanish vessels at Corunna, Spain, but meeting with poor success, set sail for the West Indies. The vessels stopped at the Canaries to harass the Spanish colonists located on the islands and were soon afterwards infected by the disease then raging in the archipelago. On the admiral's flag-ship alone, 15 died. The fever is said to have been brought to the Canaries by Spanish vessels returning from San Domingo.^^ 1601. The year 1601 witnessed another outbreak of pestilential disease in the Canaries. Some chroniclers says it was the plague, but Berenger-Feraud^- is of the opinion that it was yellow fever. 1606. The Canaries were again afflicted in 1606. Opinions are divided as to whether this epidemic was yellow fever or the Oriental plague, but Berenger-Feraud thinks it was yellow fever. ^^ 1701. For nearly one hundred years — 1606 to 1701 — the Canaries were free from yellow fever. Xo explanation of this extraordinary immunity for such a long period is given by historians, even our old stand-by, Berenger- Feraud, whose writings we ahvays consult when "up a tree," being as mum as the proverbial clam. Of course, we could venture an opinion, but as same could not be based upon even a scintilla of fact, it would be valueless. In 1701, yellow fever was epidemic in Havana, Barba- does, Martinique and the English Antilles, and according to Arejula,^* was brought from Havana to the Canaries, " Berenger-Feraud, loc, cit, p. 27. *^ Berenger-Feraud, loc. cit., p. 38. *^ Berenger-Feraud, loc. cit., p. 38. **Arejula: Archives de Medecine Navale, Paris, vol. 7, p. 251. CANARY ISLANDS. ^ 183 where it caused a great mortality. As is the case with every mention of epidemics of yellow fever during colonial days, no details are given. In speaking of this outbreak, Berenger-Feraud informs us that elle fit de grarids ravages^^^ but says nothing of the number of victims nor of the extent of the disease. As will be seen by consulting our Chronology, yellow fever was also present in Spain in 1701 . 1771. Another prolonged lapse of time took place before yel- low fever again visited the Canaries In 1771, a vessel from the West Indies, where yellow fever prevailed, in- fected the islands.^^. The outbreak was attended with much mortality. 1772. A Spanish regiment is said to have brought yellow fever from Havana to the Canaries in 1772. Though not as gen- eral as the year previous, the epidemic was quite severe.^'^ 1773. A mild epidemic of yellow fever prevailed in the Cana- ries in 1773.^^ The source of infection could not be ascer- tained. 1810. The year 1810 witnessed another murderous eruption of yellow fever on the island of Teneritfe. The history of this outbreak is interesting, and goes to show how steadily and treacherous is the advent of this terrible disease. What makes the circumstance ptill more remarkable, is the fact that the Canaries escaped un- scathed during the great epidemics which devastated Spain ^^ "It caused great mortality." *^ Berenger-Feraud, loc. cit, p, 55. *^ Berenger-Feraud, loc. cit., p. 55. ** Berenger-Feraud, loc. cit., p. 56. 184 HISTORV OF YELLOW FEVER. in ISOO and 1804 — an iniuiunirT which one can only ascribe to Divine Providence, for commnnication between the islands and their Mother Country was free and fre- quent during the above mentioned years. To Spain belong^s the credit of having imported the fever to Teneriffe in 1810. The disease was almost general in Andalusia, causing much mortality in Cadiz, Barce- lona. Carthagena. Seville and Gibraltar. In the l>egiiiiimg of October of that year,^^^ a panto ae. or prison-ship, sailed from Cadiz with French prisoners on board and landed at Santa Cruz de Teneriffe. where the human cargo was disembarked and lodged in the town barracks. It is said that the i^rison-shiii was a hot-bed of yellow fever, but this fact was withheld from the port authorities, and as the disease had not been observed on the island since 1773, they were lulled by a false sense of secui'ity. About the middle of C^ctober, the practitioners of Santa Cruz de Teneriffe noticed that there was an unusual number of cases of malignant bilious fever and the fact was reported to the health authorities. The wai-ning was at first un- heeded, but the malady soon liecame so T\idesi)read, that an investigation was ordered and it was found by ex- perts — men who had already gone through epiiemics of yellow fever — that the prevailing sickness presented the identical symj)toms which had characterized the disor- ders of Andalusia in 1800 and 1801. The authorities awoke from their lethargy, but it was too late. The disease had sfjread indiscriminately to several quarters of the town and preventive measui^es were unable to ch^^ck its de- structive progi-ess. To prevent the y^estilence from being carried to the other towns of the island, a sanitary cordon was established around Santa Cruz de Teneriflfe and inti^uctions were sent to the other islands of the archi- pelago to take the necessary precautions to prevent the in- troduction of the fever. These \)V(.mi)t and rigid measiues limited the epidemic to its original *:ite. This is the first ej)idemic in the Canaries vvhere definite details could be obtained. In each of ihe other Id stances, chroniclers speak of *^'the great mortality" caused by the ** Fellowes : Reports of the PestUential Disorders of Andalasia (London, 1S15), p. 230. CANARY ISLANDS. 185 disease or that the inhabitants ''died by thousands," but here we have cold-blooded statistics, carefully compiled, which give an intelligent and comprehensive resume of the visitation. The total number of cases in the epidemic of 1810 at Santa Cruz de Teneriff e is said to have been 5,000 ; deaths, 1,150. The estimated population of the town at the time of the outbreai^ Avas 12,000. 1811. The epidemic of 1811 was still more disastrous than that of 1810. How the disease originated, our ; ources of information (Moreau de Jonnes,^^ Fellowes^^ and Beren- ger-Feraud^^) fail to enlighten us, but the mortality is said to have been great. In San Juan Orotava, on the island of Teneriffe, which had then a population of 3,000, there were 500 fatalities. In the island of Grand Canary, there were over 3,000 deaths. 1828. During the summer of 1828. yellow fever was brought from 'Spain to the Canaries. ^^ The outbreak was not gen- eral, but it claimed many victims. 1847. In 1847, we must look to America for importation of yellow fever to the Canaries. The outbreak does not ap- pear to have been virulent, however, for out of a total of 5,000 cases, a mortality of only 60 i« recorded.^^ We doubt that this was yellow fever. ^''Morea de Jonnes: Monographie Historiqiie et Medicale de la Fievre Jaune des Antilles (Paris, 1820), p.. 342. ^^Fellowes: Loc. cit, *=* Berenger-Feraud : Loc. cit., p. 83. "■^ Berenger-Feraud, loc. cit., p. 106. '^Ibid., p. 116. ISo HISTORY OF YELLOW FIVER. 1862. The Si)anisl:; frigate Xiraria i^aHed from Havana on June 30, 1862, after being in port thirty clays. The vessel arrivei at Vigo, Spain, in the beginning of July. The authorities were informed that there had been a death from yellow fever on the frigate shortly after her depart- ure from Havana, and as the disease was known to be epi- demic at that port and it was feared that other cases would break otit, the captain was ordered to proceed to the quarantine station, where the vessel was thoroughly ftimigated and retained eight days. She was then per- mitted to proceed to her destination and arrived at Santa Cruz de Teneriffe, where she wa> imprudently admitted to free praHqne. There had been no new cases since the death on the way from Havana and the health authorities of the island thought that all danger vras «^.ver. The crew had hardly started discharging the cargo, when two of them were taken ill and died shortly afterwards, with all the symptoms of yellow fever. Stringent precautions were taken, and, for some time, no other cases manifested them- selves; but on October 2, Valentin Zamora, who had com- municated with the vessel, was stricken and died after an illness of seven days. Cases began to show themselves here and there in the immediate neighborhood of the shipping and then suddenly spread throughout the town. A panic ensued. Almost the entire population fled to the interior of the island, only about 3.000 remaining. The epidemic lasted until th^ beginning of 1863, resulting in 2,600 cases and 380 deaths.^^ The Xivaria was engaged in transporting arms to Cuba. 18G3. The epidemic which began in 1SG2 did not subside until the beginning of 1863, after which the public health re- sumed its normal state. "Landa: Espana Medica, Madrid, 1863, vol. S, pp. 377, 395, 411, 427, 442, 475, 491. CANARY ISLANDS. 187 Interesting accounts of this epidemic are given by Do Valle,'^^ Berenger-Feraud^^ and Landa.^^ 18S8. In 1888, Santa Cruz de las Pabnas, capital of the island of Palma, experienced a stubborn epidemic of yellow fever, which, though not attended with much mortality, caused great uneasiness throughout the archipelago, owing to the difficulty which the authorities encountered in their attemjjts to stamp out the disease. Even as late as De- cember 17, 1888, the island of Palma was still un'^Jer strict quarantine, having been totally isolated from the rest of the group by the Spanish Government. ^^ These precau- tionary measures confined the disease to Palma. We have been unable to obtain more definite details concerning this outbreak. 1905. The melancholy history of yellow fever in the Canaries, extending over a period of four hundred and eleven years, closes with a case of the disease on board the Spanish steamship Montevideo^ June 30; 1905, in the harbor of Santa Cruz de Teneriffe.^^ Fortunately for the islanders, who had paid dearly in the past for neglecting precaution- ary measures, the vessel was not allowed to communicate with the shore, not even her mails being landed, but was remanded to Port Mahon quarantine station, where she remained until all danger of contamination was past. The patient recovered and no other cases developed on board the steamship. The Montevideo had been infected at Colon, Isthmus of Panama, from which port she ori- ginally sailed. '^Do Valle: Echoliaste Medicale, Lisbon, 1864, vol. 15, p. 6. " Berenger-Feraud, p. 139. "^^Landa: Siglo Medical, Madrid, 1863, vol. 10, pp. 339, 375, 403, 418, 434, 451. =" Weekly Abstracts of Sanitary Reports, 1888, vol. 3, p. 296; Ibid., 1889, vol. 4, p. 2. ^° U. S. Public Health Reports, 1905, vol. 20, pp. 1511, 2770. 188 HISTORY OF YELLOW FETER. Another infected vessel arrived at Santa Cruz de Ten- eriffe on November 1, 1905.^^ The captain reported the death from yellow fever of a passenger who had taken passage for Spain at Sabanilla, Colombia^ and who was buried at sea three days after the vessel had left San Juan, Porto Eico. On arrival at Teneriffe. the steamer was not admitted to pratique, but proceeded to Spain for quarantine and fumigation, IS'o other cases occurred on board. «^Ibid., p. 2628.. CAPE VERD ISLANDS. Description. The Cape Verd Islands (Portugese IlJios Yerdes, i, e., ''green islands'-) are a group of fourteen volcanic islands and rocks, situated off the coast of Africa^ in the xAtlantic Ocean, 320 miles west of Cape Verd. The archipelago con- sists of the folloAving islands : Sal, Boa Yista^ Mayo, San- tiago, Fogo, Brava, Grando, Bombo, Sao Mcolao, Santa Luzia, Branco, Razo, Sao Vincente and Santo Antonio; also, several smaller islets. Area, 1680 square miles. The group belongs to Portugal and together with the Portugese possessions on the mainland of Africa, constitute the pro- vince of Cape Yerde, the capital of which is Porto Pra^^a. Historical Sumniari/. The Cape Yerd Islands were discovered in 1441 by the Portugese, who colonized them. The population is quiet and docile, but extremely indolent. The first invasion of yellow fever is said to have taken place in 1510, and to have lasted for several years after that date; but the re- port does not bear the seal of authenticity. Although within the geographical limits of yellow fever, the archi- pelago has been visited by the disease only at infrequent intervals, and but for the epidemic of 1845^ would have been sufficiently disposed of with half a dozen lines. It has been thought very extraordinary by observers that these islands, situated in the direct path of vessels coming from localities where yellow fever is perenialh present, should not have been frequently ravaged by the scourge; but, with the exception of the islands of San lago and Boa Vista, the group has been remarkably free from the disease. YELLOW FEVER YEARS. 1510; 1511; 1512; 1513; 1514; 1515; 1639; 1807; 1821; 1822; 1827; 1837; 1838; 1845; 1847; 1862; 1864; 1868; 1873. 190 HISTORY OF YELLOW FEVER. SUMMAEY OP EPIDEMICS. 1510 to 1515. Berenger-Feraud,^^ quoting Valkenaer (vol. 1, p. 370), says that yellow fever prevailed at the Cape Verd Islands from 1510 to 1514. No details as to how the disease was brought to the islands or the extent of the invasion, could be obtained. The mortality is said to have been consider- able on the vessels stopping at the archipelago during these years, on their way from Europe to the West Indies and vice-versa. 1639. One hundred and twenty-four years elapsed without yel low fever being noticed at the Cape Verd islands. In 1639, the Spanish fleet, on its way to Brazil, stopped at the islands and is said to have been contaminated by a pestil- ential disease, which carried off 3,000 soldiers. (Berenger- Feraud, p. 27.) The disease is said to have been yellow fever, but how it reached the Cape Verds, history does not informs us. It is worthy of note, however, that yellow fever made its initial appearance in Brazil in 1640 and it is plausible to incriminate the Cape Verds in this out- break. 1778. According to Boudin, yellow fever prevailed in the island of Santiago in 1778. He gives the testimony of Dr. Eochard, surgeon of the French frigate Consolante^ who states that his ship stopped for a week at Santiago in the latter part of 1778. He was told by the inhabitants that they were just recovering from an invasion of yellow fever. What gives additional creden:^e to this statement, is the fact that, a few days after leaving the island, yellow fever broke out on board the Consolante, resulting in the death of 150 seamen in the short space of five weeks.^^ ^- Berenger-Feraud, loc. cit., p. 26. ®^ Boudin: Traite de Geographie et de Statistique Medicales d-es Maladies Endemiques, Paris, 1857; Cornilliac, La Fievre Jaune Dans le Antilles, 1886, p. 445. CAPE VERD ISLANDS. 191 The report does not state how and whence the disease came to Santiago, but as yellow fever was epidemic in Senegal, Sierra Leone, the Gold Coast and Gambia in 1778, we can safely incriminate Africa, 1821. From 1778 to 1821 the islands were free from epidemic disease. In 1821, according to M'Williams,^^ an outbreak of the fever took place, but was not attended with much mortality. 1822. In 1822, another mild outbreak took place.^^ No details are obtainable. 1827. YelloAV fever was imported to Santiago in 1827, pre- sumably by a ship from America. The mortality was very great. Among the victims were the British Consul and some of the members of his family. The American Consul, who was then just recovering from an attack of the fever, took charge of both consulates. The British ship Tioeed, which was on its way to the Cape of Good Hope Station, touched at San Jago and a party of junior officers went on shore. These were all attacked with fever and, with one exception, died. The Portugese troops were decemated.^^ 1833. There was a mild outbreak in 1833.^^ 1837. In 1837, yellow fever ravaged the whole coast of Guinea and was imported to the Cape Verds,^^ where H caused much mortalitv. ^* Second Report on Quarantine (1852), p,. 110. ^McWilliams: Second Report on Quarantine, p. 110. *^Ibid.; also: Lancet, London, 1848, vol. 1, p. 52. " Berenger-Feraud, p. 108. ^Ibid., p. 109. 192 HISTORY OF YELLOW FEVER. 1815. The Famous Case of the ^'Eclair /^ The epidemic of 1845 furnishes the first intelligent and comprehensiye report of yellow fever in the Cape Yerd archipelago. This outbreak, which was confined to the island of Boa Vista, was considered at the time the car- dinal point in the discussion of the contagiousness of yel- low fever. All the acrimony which had been smouldering broke out afresh and the honorable and dignified medical men arrayed on both sides renewed the conflict with greater frenzy and venom. The controversy, which had begun with the epidemic of Philadelphia in 1793, had bobbed up again when the Spanish disorders of 1800-1801 took phice, had been once more rejuvenated by the Bann episode at Ascension in 1823, was gone all over again and made still wider the breach between the rabVl contngionists and their opponents. As this is another cause celehre in the annals of epi- demiology, we will give it generous ejjace. The facts are as follows :^^ On July 23, 1815, the British ship Eclair sailed from Sierra Leone, which seems to have been the natural source of infection during the last century, and reached Boa Vista in August of the same year. During the voyage, 60 of the crew died of yellow fever. According to the testi- mony of Dr. Xavier de Almeida, who went to practice medicine in Boa Vista in 1809 and was the only resident physician of the island for thirty-eight years, yellow fever had not been seen in the vicinity for nearly fifty years pre- vious to the arrival of the Eclair. The disease ^as, there- fore, undeniably imi^orteel by the infected ship While at Boa Vista the officers and crew of the Eclair mingled freely with the inhabitants and when the ship finally weighed anchor, she left the nucleus of the epi- demic in the towns of Eabil and Porto Sal Key. Of the three soldiers who constituted the guard at the fort when the vessel left the island, two, a corporal and a private, *' British and Foreign Medico-Chirurgical Review, 184S, vol. 2, p. 164. CAPE VERD ISLANDS. 193 Avere stricken with the disease. They died on September 22d, after an illness of five or six days. The surviving private of this guard, being attacked with a high fever some days after this, was removed, together wirh a sick comrade, to a small hut at Pao de Verelia. Here the stricken men Avere visited and nursed by a Avoman named Anna Galinha, AA'ho also contracted the disease and died on the 16th of October. The scourge subsequently spread through the toAvn and committed much haA'oc. The case of Louis Pathi, a laborer of Eabil, who Avas taken ill after having Avorked for tAvo days on board the Eclair is of pathetic interest, cA^en at this late date, sixty- three years after the occurrence. We quote the folloAving from the report of Dr. McWilliams, Avho Avas sent by the British GoA^ernment to investigate the origin and cause of the epidemic :'*^ Testimony of Louis Pathi. Q. HoAV long Avere you employed on board the Eclair? A. About eight days. Q. What family haA^e you? A. I liaA^e none left.' Q. What family had you? A. I had a aa ife and three children. Q. Did they all die of fever? A. Yes, all of them. Q. Were you attacked? A. Yes; I AA^as first attacked. Q. When Avere you attacked? A. Three days after I went to Rabil from the ship. Q. You were Avith vour family AA-lien you were taken sick? A. Xo ; I was at Moradinha, Q. How long did you stay at Moradinha? A. I Avas there eight days, sick. Q. What did you complain of? A. I had general fcA'^er, headache, pain of back and limbs ; A^ery sick. ^° Report on the Fever at Boa Vista, by J. O. McWilliam, Lon- don, 1847. 194- iIISTORY OF YELLOW FEVER. Q. How long were jou sick after return to your own house? A. Xearly three weeks. Q. Who, after yourself, was first taken ill? A. My daughter, 12 years of age. Q. How long after your return from the Eclair f A. It was in the beginning of October. Q. Who was next attacked? A. Another girl, 7 years of age, four days after the first died. Q. ATho was next? A. My boy, 11 years of age. He was taken ill eight days after the second girl died. Q. And your wife last? A. Yes ; my wife was taken ill the same day as the last of the children died. A melancholy sequel to the above happened in the home of Mauoel Fachina, who lived next door to Pathi' and who, together with his wife, nursed the stricken fami];^ . After the death of Pathi's wife, the Fachinas were taken sick with the fever, but recovered. Their child caught the dis- ease and died in three days. We find the Eclair again j)laying the role of importa- tionist in 1816. After the melancholy experience she had undergone in 1815, the ship was sent to the navy-yard at Plymotith, England, where she was thoroughly cleaned and repainted and given the name of Eosamond.'^ She was put in commission and left England for the Cape of Good Hope in February, 1816. 1817. Yellow fever is said to have prevailed at the Cape Yerds in 1817, but whether it was a recrudescence of the previ- ous visitation or a new importation, our source of informa- '' For fuller details, see notice of epidemic at Island of Ascen- sion in 1846, page 152 of this volume. CAPE VERB ISLANDS. 195 tion'''- does not say. It is claimed that the British ship Grotcler Avas contaminated at the Cape Verds and brought the disease to Barbadoes. 1862. 1862 was a disastrous yellow fever year in Africa. Al- most the entire coast, from Senegal to St. Paul de Loanda and the Cape Yerd and Canary Islands, suffered from the disease. '^^ The outbreak was not very severe at tlie Cape Yerds. 1864. The Cape Yerds were again invaded in 1864,^'* but no details are obtainable. 1868. In 1868, yellow fever was imported to the Cape Yerds from French colonies of the West Coast of Africa, Goree and Senegal, and made its first appearance in Bissam.'^^ The epidemic was most severe in the city of Praia, in the island of Santiago. Commencing in the middle of July, 1868, the disease spread with such rapidity that a very large proportion of the European inhabitants became suc- cessively or simultaneously affected, so much so, that dur- ing the month of August there were received into the Military Hospital at Misericordia no less than 285 cases, of which, by September 1, 41 had proved fatal. During the month of October, there was a considerable decline of the epidemic, the affected persons being those who came from the interior of the island of Santiago or other points. The disease, however, spread to the island of Braza. one of the first victims being the medical officer, Theophilio Joaquim Yieiria. There were also some cases in individuals who had fled from the city of Praia to other '- Berenger-Feraud, p, 118. ^^'Ibid., p. 139. ^*Ibid., p. 141. ^'' Medical Times and Gazette, London, 1869, vol. 1, p. 119. 196 HISTORY OF YELLOW FEVER. points of the island of Santiago. Nearly the whole med- ical staff stationed on the island suffered, Senor Pimenta, of the Pharmaceutical Branch, succumbing from the disease. 1873. In 1873, 3^ellow fever was imported to the Cape Verds, presumably from Brazil.'^^ The invasion was confined_ to the island of Sal, where the fever ran a mild course during the summer months. Sal was put under strict quarantine, the authorities prohibiting any communication whatever with the rest of the archipelago, and to this sanitary pre- caution is no doubt due the small extent of the outbreak. The mortality was small. There is no other record of any invasion of yellOAV fever in the Cape Verd archipelago after 1873. The general use of steam-power and the strict attention given id ventila- tion and hygiene in the construction of vessels at present, has done much to destroy the breeding places of the mos- quitoes in the holds of sea- going craft and thus given a quietus to the importation of the saffron pestilence. ^® Smart: Transactions Epidemiological Society of London, vol. 3, p. 508. CONGO COAST. DescriptiGn. The Congo Coast was formerly under stcod t • embrace all the countries on the West coast of Africa be (ween the equator and latitude 18° South, but is now restricted to the northernmost district of the Portugese colony of An- gola. Cabinda, with a population of 8,000, is the capital. YELLOW FEYEK YEAES. 1816; 1860; 1862; 1900. suMMAKY OF epide::\iicr, 1816. A Memorahle Expedition and its BisaHirou-j End. The history of the first invasion of the Congo by yellow fever reads like a romance. We have been much interested in the quaint account of the famous Tuckey expedition, published in an old hybrid French medical journal long since defunct and forgotten, and give in the following lines a faithful translation.'^'^ In the beginning of 1816, the British Government fitted out an expedition to explore the Congo River, under the leadership of Captain J. K. Tuckey, an experienred navi- gator. Among tho^e who cast their fortunes with the un- dertaking, were Dr. Tudor, Messrs. Smith, Lockhart and Cranch, naturalists, a few less noted gentlemen in search of adventure, and a crew of twenty picked men. The expedition consisted of the schooner Congo and the transport Dorothea, and left England about the middle of March, 1816. On account of contrary winds, slow pro- gress was made. The vessels touched at Porto-Pra^^a, one of the Cape Yerd Islands, where they remained a few " Moreau de Jonnes: Nouveau JourDal de Medecine, Chirurgie, Pharmacie, etc., Paris, 1822, vol. 44, p, 330. 198 HISTORY OF YELLOW FSVER. days, and then proceeded to the mouth of the Congo, where they anchored in the beginning of July, three months and a half after their departure from England. On July 8, 1816, the explorers ente^'ed the Congo. Pro- gress Ayas slow, as the current was rapid and trr mingled with any strangers from the time they left England until they entered the Congo, save the solitary instance of the brief stay at Port:-Praya. As the vessels could possibly not have been infe-^ted at that port, we were at a loss to locate the original focus, when we came across a short account of the epidemic in the scholarly work cf Eerenger- Feraud, which clears the mystery. It is certainly peculiar that such a close observer as Moreau de Jonnes makes no mention of this fact, but as the authorities quoted are un- assailable, it deserves a tardy, but merited place in history. A perusal of the article by Berenger-Feraud^^ reveals the fact that while riding at anchor at the mouth of the Congo, Captain Tuckey's vessels were in frequent com- munication with the officers and crew of a foreign vessel flying the American flag, but which was afterwards found to be a Spanish slave-ship from Brazil. There were some suspicious cases of fever on board the stranger, but, being informed that the craft had come direct from the United States, Captain Tuckey had no suspicion of the nature of the illness prevailing on board and allcvred free com- munication between the complement of the three vessels, as he was anxious to obtain all the information he could about the mysterious river he was about to explore and did not wish to offend the ncAvcomers^ who seemed to be well-versed in the topography of the country. Alas for human short-sightedness and ambition! This want of caution undoubtedly paved the way for the terrible afflic- tion which afterwards annihilated the I'ttle band of ^'^Loc. cit, p. 332. " Berenger-Feraud, loc. cit., p. 87. %02 HISTORY OF YELLOW FEVER. pioneer explorers and deprived science of some of its most enthusiastic devotees. 1860. Yellow fever prevailed quite extensively along the Congo Coast in 1860 and was particularly severe at Angola and St. Paul de Loanda.^^ The source of importation is not given. 1862. In 1862, yellow fever invaded alm.ost the entire African coast from Sierra Leona to Saint Paul de Loanda. (Ber- enger-Feraud, p. 139.) The epidemic, though widespread, was not very severe. 1865. The epidemic of 1865 was mild and was not attended with much mortality. Berenger Feraud (page 141) only makes a brief mention of the incident. 1900. In 1900 yellow fever was imported from Senegal to the French Congo. ^^ On May 26, the steamship Ville de Pernamhuco, plying between France, West Africa and Brazil, stopped at Dakar where yellow fever was prevailing. While riding at anchor, three sisters of charity who were on board the vessel exchanged greetings with members of their order who had come to the wharf to see them. It is claimed that no other communication Avas had with the inhabitants of Dakar, but the statement must be taken cum granis salis. The vessel left Senegal for the usual voyage down the coast and arrived at Loango, one of the ports of the French Congo, on June 15th, where the sisters disembarked. They were all successively taken ill. One of the sisters died on June 20th and another on Julv 2d. The third recovered. *- Berenger-Feraud, p.. 136. ^^Kermorgant: Receuil des Trav. du Com. Con. d'Hyg. Pub. de France, 1901 (Paris, 1903), vol. 33, p. 394. CONGO COAST. 203 Autopsies revealed the fact that the two deaths had been caused by yellow fever. The fourth case at Loani^o manifested itself in the per- son of a young negress aged 16; who had nursed the sister of, charity that recovered. The patient died a few days later, with black vomit. The i)ort physician took extra- ordinary precautions to prevent a spread of the disease, which was confined to the cases above mentioned. A! remarkable feature of this invasion, is that the only person infected by the sisters was a native Af lican and that the few whites in the town escaped an attack. The natives of Western Africa are generally immune and the rare occurrence of a case among them certainly deserves special mention. This is the fifth and last authentic instance of yellow fever on the Congo Coast ; but other visitations of the dis- ease no doubt took place before^ between and after the dates chronicled in this history, for it is a notorious fact that St. Paul de Loanda was one of the most infamous cen- tres of the slave-trade in by-gone days and was frequented by the worst class of trans-oceanic freebooters. DAHOMEY. Description. Dahomey is a negro kingdom of Weste? n Africa, in Guinea, with a coast-line only 35 miles in length, nearly the whole of which is composed of islands and swamps. The natives are all pagans and their worship fetishism. Population, 250,000, of which 230^00 are said to be slaves. YELLOW FEVEE YEAES. 1905; 1906; 1907. SUMMAEY OF EPIDEMICS. 1905. Yellow fever had nev^r been observed in Dahomey pre- vious to 1905. The immunity of this negro kingdom from the disease is easily understood, when one reflects that it is hardly ever visited by white men. How the fever was imported, we were unable to ascertain, owing to the diffi- culty of obtaining information from a region governed by savages and only exploited by white men when in quest of wild animals for circuses and zoological gardens. Com- munication between the European settlements on the coast- line of Dahomey and other African ports are frequent and uninterrupted. The fact that the first cases were observed in the persons of customhouse employes at Grand-Popo, giA^es weight to the Iwpothesis that the disease was con- tracted on shipboard, as the duties of these officers also in- clude the sanitation of vessels coming from foreign ports. They w^re thus compelled to spend much of their time on "suspicious vessels" and were thus exposed to infection. According to the report of the "Gouvernement General de FAfrique Occidentale Francaise," ijublished in the Annalcs d^Hygiene et de Medecine Coloiviales, Paris, 1907, vol. 10, page 449, the first case erupted at Grand-Popo in January, 1905, in the person of an old customhouse in- DAMOHEY. 205 spector. The patient died four days after the onset of the fever. Fifteen days later, another customhouse inspector, a young man aged 28, who had recently arrived from France, was stricken. Death ensued in a few days. The third case, a nun, also ended fatally. The bishop of the colony, Avho had nursed the nun, was next attacked and furnished the fourth victim. His death occurred at Ouidah, where he had gone Avhen he felt indis- posed. In less than a month, nine additional cases erupted in Grand-Popo, six of whom died. Thrown into consternation by the rapid and malignant nature of the fever which Avas decimating their ranks in such a short space of time (six AA^eeks), the handful of Europeans Avliich had been spared by the scourge (about 14), fled to France. Only six or seven Avhites, AAhose offi- cial duties prcA^ented them from deserting their posts re- mained in the toAvn. Great precautions Avere taken by this little band against infection. The Colonial GoA^ernment had their living apartments thoroughl^^ screened and they Avere especially instructed to Avage an incessant Avarfare against mosquitoes. These precautionary measures put an end to the epidemic, as no other cases erupted after the exodus of the colonists. If one takes into cbnsideration the comparatively lim- ited population of Grand-Popo and its environs (30 or 35), the number of cases (13, folloAved by 10 deaths), shows that the fcA^er Avas decidedly malignant and Avould certainly have been more fatal had the segregation of the population not taken place. 1906. One of the strange characteristics of yellow fcA^er is the fact that when an epidemic is especially severe in a locali- ty, it is almost certain to recrudesce the following year. We Avere therefore not surprised to note, in the report aboA^e cited (page 451), that the disease under discussion re-appeared in Dahomey in 1906. The first case erupted at Ouidah, April 12. The patient, 206 HISTORY OF YELLOW FEVER. the wife of a German subject, died a few days after being- attacked. Between April 23 and May 3, 4 deaths were reported from Togo. May 5, 2 cases were obseryed in Grand- Popo. One of the yictims died. The patient recoyering was the husband of the German lady, mentioned aboye. On May 10, a fatal case was obseryed at Ouidah. This was followed, on May 20, by another case, which termin- ated fatally on June 3. May 21. Cotonou, until then immune, became infected. One case, followed bj^ death on the 29th, is recorded. May 29. One case at Grand-Popo. Eecoyered. June 5. One case, a nun, at Ouidah. Died June 8. An- other case at Ouidah on the 5th, imported from Toffo, where unconfirmed cases had been obseryed. Eecoyered. June 16. One death at Ouidah. June 23. One case at Ouidah, followed by death on 25th. This was the last case of the epidemic. There were alto- gether 15 cases, with 12 deaths, distributed as follows : Locality. Cases. Deaths. Cottonou 1 1 Grand-Popo 3 1 Ouidah 7 fi Togo 4 4 Total .... 15 12 The origin of the epidemic is unknown. 1907. In January, 1907,^^ Dahomey was still under the ban of quarantine, yellow feyer haying made its appearance at Grand Popo in the beginning of the year. Up to the time of the closing of this report, no details could be obtained. ** Kermorgant : Annales d'Hygiene et de Medecine Coloniales, 1907, vol. 10, p. 299. EGYPT. Description. Egypt is a country in the northeastern part of Africa, governed by a viceroy (khedive), who pays tribute to the Sultan of Turkey, but is otherwise independent. Egypt is bounded on the north by the Mediterranean Sea, on the east by Arabia and the Ked Sea, on the south by Abyssinia and other unimportant countries; and on Ihe west by tlie Desert of Sahara. Capital, Cairo. "THE PLAGUE SPOT OF THE WOELD." According to the opinion of medical writers, we have to accept Egypt as the country whence pestiknce most fre- quently originated and extended itself. This is why that ancient land has been christ'med "The Plague Spot of the World." From time immemorial, the terrible Oriental Plague and epidemic cholera were, in almost ':very in- stance, first observed in Egypt before they began their journey of death and desolation. Cairo and the villages of the Delta were generally attacked first; thence the whole civilized world was infected. HOW MEHEMET ALT KEDEEMED EGYPT. A little historical causerie, to relieve the mind from the array of cold-blooded statistics which are part and parcel of a work of this kind, will be found refreshing and inter- esting. The Egyptians are the earliest people known to us as a nation. When Abraham entered the Delta from Canaan, they had long been enjoying the advantages of a settled government. They had built cities, invented hieroglyphic signs, and improved them into syllabic writing, and almost into an alphabet. They had invented recordS; and wrote the names of their rulers and their heroic actions on the massive temples which they raised. More than 2000 years B. C, the Egyptians had duodecimal as well as decimal numbers, and weights and measures. The masonry of the 208 HISTORY OF YELLOW FEVER. passages in the Great Pyramid has not been surpassed at any age. In mechanical arts, the carpentei-, boai-builder, potter, leather-cutter, glass-blower and others, are often represented on their ancient monuments. They were also adepts in other arts too numerous to mention. The social and domestic life of the ancient Egyptians is depicted on the walls of their temples and tombs. Cairo, the capital of Modern Egypt, is situated on the right bank of the Xile, 12 miles above the apex of its delta, and 150 miles by rail from Alexandria, and has a popula- tion of 374,838 souls. The character of the town is still mainly Arabic, though in modern times the European style of architecture land ether matters has become more and more prevalent. The city is partly surrounded by a fortified wall, and it is intersected by seven or eight great streets, from Avhich runs a labyrinth of narrow crooked streets and lanes. There are several large squares, or places, the principal being the Ezbekiyeh^ To the south- east of the town is a citadel, on the last spur of the Mo- kattam Hills, overlooking the city. It contains the fine mosque of Mehemet Ali, a well 270 feet deep called •Joseph's Well, cut in the rock, the palace of the Viceroy, and other things of interest to tourists. There are up- wards of 100 mosques. The finest is that of Sultan Has- san. There are also some forty Christian churches, Jew- ish synagogues and other denominations. The tombs in the burying-grounds outside of the city also deserve men- tion, especially those known as the tombs of the Caliphs. The trade of Cairo is large, and the bazaars and markets are numerous. Of these the Khan el Khalilivin the north- east of the town, consists of a series of covered streets and courts in which all kinds of eastern merchandise are dis- played in open stalls. Cairo has railway communication Avith Alexandria, Suez, and Siout. Before the Avatering and sweeping of the streets of EGYPT. 209 Cairo Avas introduced by the Vicevoy, Meliemet Ali,^^ in the beginning of the last century, thej were full of filth. A canal running through the city received all kinds of refuse, and Avas much neglected; its borders had always been considered as most unliealthV;, and most frequented by. the plague. MoreoA^er, Cairo AA^as surrounded AAath an almost comi3lete circle of hills, one hundred and fifty to three hundred feet in height^ and aa here these ceased, by a projection of the Mokattam mountains. Thus purifying AA'inds Avere cut off from the city. The disease alAA^ays ap- peared after the receding AA^aters of the Nile had left much animal and A^egetable matter decaying, producing nias- mata under the combined influence and moisture, and after raging scA^eral months, disappeared AA^th the nucta (a heaA^y dcAv) and the scorching rays of the June sun. Mehemet Ali gaA^e orders to clean the 'city, and to Avater and SAveep the streets cA^ery morning, but the state of health did not materially improve. It had already been "' Mehemet Ali, Viceroy of Egypt, born at Kavala, in Mace- donia, in 1769. He entered the Turkish army, and served in Egypt against the French; rose rapidly in military and political importance; became Pasha of Cairo, Alex- andria, and subsequently of all Egypt. In 1811 he mas- sacred the Mamelukes to the number of 470 in Cairo, and about 1200 over the country. He then commenced, by the orders of the Porte, a war of six years' duration against the AVahabees of Arabia, which was brought to a successful conclusion by his son Ibrahim, and secured him the possession of Hejaz, Ibrahim also aided in bringing a large part of the Soudan under Egyptian rule. By means of a vigorous domestic policy Mehemet re- duced the finances to order; organized an army and a navy; stimulated agriculture, and encouraged manufac- tures. In 1824-27 he assisted the Sultan in endeavoring to reduce the Morea, which led to the destruction of his fleet by the allied European powers at Navarino (1827). Subsequently he turned his arms against the Sultan, and in his efforts to secure dominion over Syria by armed invasion, he was so far successful that the European powers had to interfere and compel him to sign a treaty in 1839, which gave him the hereditary pashalic of Egypt in lieu of Syria, Candia, and Hejaz, This remarkable personage died in 1849 at the age of eighty. 210 HISTORY OF YELLOW FEVER. remarked by physicians of the army, at the time of the French-Egyptian expedition, that the encircled position of the city, combined with other nnfaforablt circum- stances, must be very unhealthy. Advisers of Mehemet Ali repeated the remark, and the Viceroy; who was a tyrant, but seldom shrinking from the extent of an enter- prise, took the bold resolution of carrying down a large portion of the hill into the fields, which, after having suf- ficiently elevated, he intended to water artificially and to convert into beautiful gardens. As once the Pharaohs dragged thousands of men to the erection of temples and pyramids, so Mehemet Ali forced thousands of fellahs (Egyptian peasants) to execute his plans. Many died un- der the excessive labor, but the ranks were filled by others, and the work itself was always advancing. Thus a long chain of hills was carried down, and miasmatic marshes converted into charming olive and fruit gardens. And as the work progressed the health of Cairo improved. The disease, no longer brought from Egypt to other parts of the Turkish Empire, disappeared. Mehemet Ali has proved what can be done, even under the most unfavor- able circumstances, by his grand and energetic measures, in improving the health of one city; and by thus destroy- ing the germ of this most destructive of all diseases, he has unconsciously saved the lives of millions.^^ ALLEGED YELLOW FEVEE YEAE. 1800. SUMMAEY OF EPIDEMIC. With the exception of the alleged epidemic depicted by Dr. Larrey,^^ we fail to find anywhere any menticn of yel- low fever in Egypt. We have ransacked the works of ancient, medieval and modern writers on epidemiology, but only find the solitary instance narrated by Baron Larrey. In our opinion, this was not yellow lever, for *«Dowell: Yellow Fever and Malarial Diseases (1876), p. 25. «^ Larrey: Memoirs of Military Surgery and Campaigns of the French Armies, etc., (Hall's Translation), 1814, p. 230. EGYPT. ^ I 1 that disease could not originate in Egypt, and nowhere in Larrey's account do we find any mention of importation. We would have passed this account by without giving it any attention had the author been an irresponsible or less distinguished personage, but Baron Larrey was one of the most noted surgeons of his day, holding the post of Sur- geon-in-Chief of the Army of Napoleon in his foolhardy invasion of Egypt, and was the author of notable surgical works His post naturally afforded him abundant oppor- tunities for practical study and a careful perusal of his writings shows that he studiously availed himself of his astute powers of observation and deduction by collecting numberless important and interesting facts. Dr. Larrey was a close and intelligent observei, and his descriptions of the several phases of the disease he had to deal with, even if antagonistic to the tenets of this en- lightened -age, are so replete with interesting d^-^ail, that we will quote at length from his views on the cause, path- ology and treatment of the maladv which decimated the army of the great Napoleon in the campaigns which proved so disastrous to the French arms. ^^The fatal consequences which tcok place in a great number of our men who were wounded in the battle of Heliopolis," observes Dr. Larrey, ''and at the siege of Cairo in 1800, led our soldiers to believe that the balls of our enemy were poisoned. It was not difiicult to unde- ceive them; but not so easily could we arrest the progress of the disease." This eminent authority further asserts that the malady presented all the symptoms of the yellow fever observed in America during the campaigns of the French armies in the West Indies and which^ according to the report of Dr. Gilbert, his former colleague, who was physician-general of the army of St. Domingo, reappeared among the French troops during the expedition to that island in the last de- 'cade of the eighteenth century. A peculiarity noted by Dr Larrey in Egypt was that the fever attacked none but the wounded, and more particu- larly those who had been injured in the articulations, or had fractured bones, with injuries of the nerves, of the head, of the abdomen or thorax. The disease appeared 212 HISTORY OF YELLOW FEVER. about the 5tli of April, 1800. and disappeared aloiit the last of May. Dr. Larrey gives the folloAving details of the principal symptoms which the malady presented: "The wounded had scarcely received the lirst assistance, or submitted to an operation, when they fell into a state of faintness and anxiety; rigors were felt over 'ork. But he little dreamed that this information would be of immense value to the compiler of this history and overlooked the impor- tant function. This is only one of the millioi] illiistrations of that trite Americanism, "every little bit helps/- ** Berenger-Feraud, loc. cit., p. 60. "Rey: Archives de Medecine Navale, Paris, 1878, vol. 29, p. 407. FERNANDO-PO. 219 1829. After a lull of fifteen years, yellow fever again made its appearance at Fernando Po. This time, the infection is indisputably traced to Sierra Leone. The facts are as follows :^^ At the inception of the epidemic of yellow fever which decimated Sierra Leone in 1829, the British ship Eden was anchored in the roads, off Freetown, and, as was the usual custom in those days, her officeis were occasionally on shore. On the 3d of May, a man, who two days previ- ously had come aboard the Eden from Freetown, was taken ill with yellow fever and died on the Tth. On May 5, two days after this man had been taken ill, a mid- shipman, Avho had been on board a detained vessel of which he had charge, returned on board the Eden. He had been taken ill on April 29th and died the day following his re- moval to the Eden. On May 12, some other cases occurred among the ship's crew, and on the 201h of May the Eden left for Fernando Po. She arrived at her destination on the lltli of June, having lost during this period 25 officers and men. She was thoroughly cleaned, fumigated, and whitewashed at Fernando Po, and then, re-embarking her convalescents, sailed for Princess Island on the 9th of July. After the departure oi the Eden, the disease broke out at Fernando Po, where it prevailed with great severity. The mortality was not very great. During the voyage from Fernando Po to Princess Island, the fever reappeared aboard the Eden, and the mor- tality was considerable. The fever continued to rage till August, and the Eden lost, between the months of May and December, 110 persons out of a complement iff 160. At the same time that the Eden carried the disease to Fernando Po, the Champion sailed from Sierra Leone with several bad cases of fever on board and arrived at Clarence Town three days after the Eden. As on board the Eden, the fever which was ravaging the Champion was of a most malignant type and the landing of her sick at the little ^-Bryson: Report on the Climate and Principal Diseases of the African Stations, p. 39. 220 HISTORY OF YELLOW FEVER. town added fuel to the dormant fires of pestilence already kindled by the Eden. According to Bryson,^^ from the time it was first occu- pied by Europeans, Fernando Po proved a perpetual hot- bed of disease. Most of the people who were located at Clar- ence Cove during the years 1827 and 1828, were attacked with fever or ulcer, and cut off in the course of a few months after their arrival. But as the medical returns only commence subsequently to the f.rrival of the Eden and Champion, the accounts respecting the fevers which prevailed previoush^, can only be gleaned from other sources, which, although sufficiently authentic as to their fatality, do not give the information requisite to follow them out in full detail. That it had acquired the charac- ter of being a most unhealthy locality, the number of medi- cal officers who accompanied the marines and mechanics sent out in the Champion, sufficiently attests; and it is a melanchol}^ reflection that only two out of the three reached the anchorage in time to have their bones deposited in that desolate grave-yard. 1839. Yellovv' fever was again brought to I'ernando-Po in 1839 and was quite severe.®* 1857. In 1857, yellow fever again invaded Fernando Po.®^ 1860. A ship from the West Indies is incriminated in the in- fection of Fernando-Po in 1860. The epidemic was quite ^^Bryson: Loc. cit., p. 49. ®*Bryson: Loc. cit, p. .. ^Huard: Theses de Montpellier, 1868. "^'Yglesias y Pardo (Rerreo), 1874, p. 12. FERNANDO-PO. 221 1862. In the early days of July, 1862^ yellow fever broke out at Feruando-Po amongst the Spanish population. The disease was first observed in one of two convict hulks in Clarence Ba}- and spread rapidly to the convicts and sail- ors in the other hulk, whence it attacked the soldiers com- posing the small garrison and the mechanics on shore. In a very short time, 76, out of 200 composing tlie entire purely Spanish population, were carried away by the dis- ease. A remarkable phase of this epidemic is that it was confined exclusively to the Spaniards of unmixed blood and did not attack the colored Cuban settlers (einanci- pados), although the latter nursed the sick and visited freely all the foci of infection. This proves conclusively that the disease was the genuine West Indian yellow fever, for the criiancipados, who evidently had experi- enced an attack in their own country, escaped unscathed. The source of importation is dispufed. Some authori- ties claim that the inter-colonial mail steamer Metriever brought the disease from Bonny, Africa, while Bourru, Berenger-Feraud and Ygiesias y Pardo^'^ assert that the English ship Ferrol, which left Havana on June 10, 1862, with 200 emancipados^ should be looked upon as the nidus of infection. The French ship La Ze?ce was infected at Fernando-Po in 1862 and brought the disease to Grand Bassam (q. v.). 1864. Another outbreak of yellow fever occurred at Fernando- Po in 1861. No details are given. ^^ 1806. The epidemic of 1866 continues the chain of importa- tion. On August 2, 1866, the ship Rosa del Ttirla, having on ®^ Bourru: Geographie des Epidemies de Fievre Jaune, p. 7; Berenger-Feraud, p. 139; Ygiesias y Pardo, loc. cit., p. 12. ^^Berenger-Feraud, loc. cit., p. 141. 22 S HISTORY OF YELLOW FEVER. board about 200 convicts, sailed from Havana for Fernan- do-Po, which was then a penal settlement, arriving at her destination on October 3 of the same year. During the two months the vessel took to make the trip, yellow fever prevailed to a more or less extent among her crew and living cargo, but this did not deter those in command of the vessel from landing the 200 convicts on the island. A disastrous epidemic broke out shortly aftervrards, which caused much mortality on the island and lasted until the end of November. Again we find occasion to criticize the excellent and astute Dr. Eey,^^ to whom we are indebted for the above narration of the epidemic of 1866, The genial doctor de- cries the attempts made by certain chroniclers of the period to hide the true nature of this epidemic under the name of bilious pernicious fever, but overlooks the most important information, the statistics ot the outbreak. He informs us that the Perle lost ten of her crew, but is mute as to what happened to the unfortunate inhabitants of the island. 18G8. On September 24, 1868, the ship General Alva arrived at Fernando-Po from Havana.^^ A few days after the vessel'^: arrival, yellow fever broke out on the island, but was not very severe. 1869. On May 22, 1869, the transport San Fraiielsco de Borja arrived at Fernando-Po with 250 men deported from Ha- vana. ^*^'^ Yellow fever prevailed to some extent on board the vessel, but no mention is made of the disease having reached shore. *Rey: Archives de Medecine Navale, Paris, 1878, vol. 29, p. 407. ®'Bourru: Geographie des Epidemics de Fievre Jaune (Bor- deaux, 1883), p. 7. ^""Penard and Boye: Annales d'Hygiene et de Medecine Col- oniales, 1904, vol. 7, p. 509. FRENCH GUINEA. Description. French Guinea, as the name implios, is a French col- onial possession on the west coast of Africa, bounded on the north hj Senegambia, on the east by the Ivory Coast, on the south by Liberia and feierra Leone and on the Avest by the Atlantic Ocean. Capital. Conakry, situated on the Tombo Peninsula. Conakry is of recent origin. It was founded in 1889 and has at present a population of about 12,000, principally natives. The European population is about 350, but is hardly 275 during the sickly season. YELLOW FEYEK YEAR. 1901. SUMMARY. French Guinea was in imminent danoer of being iuA^aded by yellow fever during the epidemics at Senegal in 1900 and 1901 and at Grand Bassam in 1902 and 1903 ; but save for a single case, observed December 21, 1901 at Conakry, the territory seems to have been exempt from tljc disease. It is not known definitely whether or not Sfegomyia Calopus breed at Conakry, as no special observations have been made in that direction, but the fact that this solitary instance of the appearance of yellow fever in the locality did not cause a general eruption, may be taken as a tentative proof of the non-existence of the insect there. The case mentioned above was piobably iinijorled from Senep:al. GAMBIA. Descripticn. Giii.it,ia is a British colony of T\>stern Africr, consist- iMg (,r thc3 island of St. Mary? the town of B-itLiirst (the capita] ) and other minor dependencies. Artil; i)9 square Miles Poptilation about 15,000. YELLOW FEVER YEAES. 17(33; ITIU; 1766; 1768; 1769; 1778; 1825; 1S2S; 1837; 1859; 1860; 1865; 1866; 1878; 1881; 1900. SUMMAEY OF EPIDEMICS. 17C3. The first outbreak of yellow fever in Gambia (1763) is coincident Avith the first appearance of tie di-ease in Sierra Leone and was no doubt imported fr jm tliat colony, which since then has played sucli a notorious role in radi- ating the scourge to the otherwise healthy stations of the West African coast and the near-by insular coF.nies. In nearly every instance, the chain of importation has been the same: Sierra Leone, infected by ships from the West Indies or South America, lias contaminated Gambia; Gambia has sent the disease to Senegal, and the latter colony has. propagated the pestilence to other African set- tlements. It is unfortunate that no detailed accounts exist of these first outbreaks on the African coast. Otir authority^ is deplorably uncommunicative on this score. 1761. Yellow fever again invaded Gambia in 1761. Only a mere mention of the fact is made by our source of in- formation. - ' Berenger-Feraud, p. 53. Mbid., p. 53. GAMBIA. 225 IToo. Anotker eruption in Gambia.^ No details cbtainable. 1TG8. The outbreak of 1768 furnishes us with the first intelli- gent account of yellow fever in Gambia. According to Lind,^ in August, 1768, the British ship Merlin^ while in the Gambia Eiver, lost several of her crew from yellow fever. Lind would have us believe that the fever was caused by effluvia rising from freshl}^ cut timber, but as yellow fever was then reigning at Bathurst, the capital of Gambia, Avhere the ilferZi^i stopped on its voyage up the Gambia, the source of infection is clearly established. How the fever got to Bathurst, is left to conjecture. 17G9. Yellow fever prevailed in Gambia in July. 1769. In the month of August following, the British warships Weasel and Hound were contaminated at Bathurst and Ijst many of their crews. The disease is said to have been severe.^ 1778. In 1778, yellow fever w-as almost general on the western coast of Africa.^ The memorable epidemic of Senegal, about which so much has been written, occurred that year. Gambia was infected by Sierra Leone and sufff^red con- siderablv. 1825. A lull of nearly fifty years took place before yellow fever again manifested itself in Gambia. Although the disease prevailed in Sierra Leone in 1815, 1816 and 1823, it does not appear to have reached Gambia ; but, in 1825, it was no 8 Ibid., p. 54; Schotte. ■•Lind: Diseases of Hot Climates, vol. 1, p. 250. ^ Berenger-Feraud, p. 55. ' Berenger-Feraud, p. 56; Schotte. 226 HISTORY OF YELLOW FEVER. doubt imported from Sierra Leone. The diseasi^ caused much mortality at Bathurst and the surrounding country, three-fourths of the cases terminating fatally.'^ Bryson (page 33) informs us that a detachment of one hundred and eight men landed at Gambia in 1825; in the course of four months seventy-four died of fever, and thirteen of other diseases, leaving only twenty-one alive 1826. The fever re-appeared in Gambia in 1826 and was very severe. xA.s in 1825, the majority of those attacked died.^ 1828. The epidemic of 1828 ravaged the whole African coast from Benin to Gambia.^ It was not severe in Gambia. 1837. After an absence of nearly ten year*;', yePow fever made its appearance with renewed virulence in Gambia in 1837. The epidemic was attended with a high death-rate. ^^ 1859. Yellow fever prevailed at McCarthy Island, in the Gambia Kiver, in 1859, according to Berenser-Feraud (page 136). ISGO. Yellow fever re-appeared in Gambia in 1860. The dis- ease does not seem to have manifested itself on ihe main- land, but prevailed on McCarthy Island,^^ in the Gambia Eiver, 127 miles from its mouth, inhabited iDrincipally b}^ liberated slaves. ' Second Report on Quarantine (1852), p. 288. ^ Second Report on Quarantine, p. 288. ® Berenger-Feraud, p. 105. ^° Berenger-Feraud, p. 105,. ^^ Berenger-Feraud, p. 136. CAMBIA 227 1885. Another outbreak of yellow fever caused much mortality in Gambia in 1865. Our author! ty^^ does not furnish any details. 18o6. Yellow fever reigned with much virulence at Bathurst in 186(3. One-half of the European population perished.^^ No official account of this epidemic exists, as the facts were suppressed by the British Government, for commer- cial reasons, and only reached the public through a private letter published in the London Times. An investigation was demanded by the public, but dilatory measures by the authorities soon caused the exjisode to be forgotten. 1872. In 1872 yellow fever was quite severe at Bathurst. Out of a white population of 31, there were 13 deaths.^^ 1878. The yellow fever epidemic of 1878 may truly be called a pandemic. A reference to our chrorological tables will show that it prevailed on both sides of the Atlantic, on the Pacific coast and, for the first and last time in the history of the disease, a case was imported to London and died. The official records of Gambia are silent regarding the prevalence of yellow fever in that colony in 1878, but Berenger-Feraud^^ claims that the facts were suppressed and that the disease was present that year, in a mild form. The noted author takes issue with Lejemble, who tries to prove that the fever could not have been in Gambia in 1878, because that country maintained a strict quarantine against Senegal and that the official reports do not men- tion yellow fever at all. Berenger-Feraud cites :n refuta- ^ Berenger-Feraud, p. 141. ^^ London Lancet (New York), 1867, p. 60. "Lejemble: Theses de Paris, 1882, No. li, p. 22. ^ Berenger-Feraud, p. 154. 228 HISTORY OF YELLOW FEVER. tion of this assertion the fact that in 1872 yellow fever raged fiercely in Sierra Leone and Garabia, yet the of&cial records of the colony are a perfect blank regarding this outbreak. We can yerily concur with this eminent chron- icler, for, by referring to our own account of the epidemic in Gambia in 1866, it will be seen that the authorities sup- pressed the fact that a virulent eruption of yellow fever was causing great mortality at Bathurst and the sur- rounding country and it was only when the London Times' received private information concerning the state of affairs and gave the matter publicity, that an ''investigation'* was ordered by the British Government. ^^ 1881. In June, 1881, yellow fever was present in Sierz-a Leone ; in August, it invaded Gambia ^" Here we find the same old story of importation from Sierra Leone. The outbreak does not appear to have been severe. 1900. The year 1900 furnishes the last recorded appearance of yellow fever in Gambia. A sporadic otitbreak occurred at Bathurst, but the disease did not gain a very disastrous footing, as the white settlers fied at the first signs of the fever, seeking refuge on board the ca^^go-boats bound for European ports.^^ As usual, no official records of the out- break could be obtained. ^« London Lancet (New York edition), 1867, p. 60. " Berenger-Feraiid, p. 190. ^« U. S. Public Health Reports, 1900, vol. 15, p. 2025. GOLD COAST. Description. Gold Coast is a British crown-colony in West Africa, betAveen the Slave Coast and the Ivory Coast, and com- prises that part of the coast of Guinea which extends from 50° W. to 20° E. longitude, stretching inland to an average distance of fifty miles The climite is very un- healthy. The chief forts and settlements are Cape Coast Castle, Elmina, Accra, Axim, Dixcove and Ai^namabee. Estimated population, 1,500,000, of whom only about 200 are Europeans. YELLOW FEVER YEARS. 1778; 1786; 1822; 1823; 1824; 1852; 1853; 1851; 1855; 1856; 1857; 1862; 1898. SUMMARY OF EPIDEMICS. 1778. Although the Gold Coast was colonized by tie Portu- gese in the early years of the seventeenth century, the first recorded invasion of the territory by yellow fever took place in 1778, when an epidemic wave of the disease swept almost the whole West African coast occupied by Europe- ans. No details of the epidemic are given.^'^ 1786. Another outbreak of yellow fever look place in 1786, but the original source of infection i^ not given. It is stated, however, that the ship Experim.ent, v/hich had been sent by the British Government to assist in the establish- ment of trading places, lost many of her men by a ^'malig- uant fever. "-^ ' Berenger-Feraud, p. 56. ' Berenger-Feraud.p. 58; Valentin, p. 77. 230 HISTORY OF YELLOW FEVER. 1822 to 1824. No mention of yellow fever having prevailed along the Gold Coast is made from 1786 to 1822. Acccrding to Bryson,^^ the mortality was great among the detachments which arrived at Cape Coast Castle in 1822, 1823 and 1824. 1852 to 1857. In 1852 yellow fever was imported to the GoM Coast and sporadic cases were observed every year from 1852 to 1857. The Government records, following the usual cus- tom, give no detail of this series of outbreaks, and Berenger-Feraud^^ disposes of the matter m a few words only. 1862. Yellow fever was almost general along the west coast of Africa in 1862. The Gold Coast suffered considerably. (Berenger-Feraud, page 139.) GOREE. (See Senegal.) GUINEA. {See Benin, Dahomey y French Guinea^ Gold Coast, Grand Basam, Ivory Coast, Lagos, and Sierra Leone.) ^'^Bryson, loc. cit, p. 33. =^Page 122. IVORY COAST. Description. The Ivory Coast is a part of the coast of Gnmea, be- tween Cape Appolonia and Cape Palmas, West Africa, Its western portion belongs to Liberia; its eastern half, now counted as part of the Gold Coast (q. v.)? ?s shared between England and France. The French colony com- prises three fortified centres : Grand Bassam, Assinie and Dabon. The first two are situated at the mouth of the Grand Basam Kiver, on a narrow tongue of land between the sea and a shallow lagoon. Dabou is sixty mUes from Grand Bassam. Since the date of their establish- ment, these colonial towns have been visited nine times by yellow fever. In every instance, the disease was im- ported. YELLOW FEYEE YEARS. 1853; 1857; 1862; 1863; 1899; 1902: 1903; 1904; 1905. SUMMARY OP EPIDEMICS. 1852. In 1852, many localities on the Gulf of Guinea were in- vaded by yellow fever.^^ At Grand Bassam the mortality was over fifty per cent, among the French troops i-tationed at that post. 1857. Grand, Bassam. Sporadic cases of yellof fever began to be observed at Grand Bassam in February, 1857. The disease pursued an uneventful course until April, when it seemed to have died out. About the middle of April, the ^3teamship ==-^ Berenger-Feraud, p. 122. 232 HISTORY OF YELLOW FEVER. Panar,ta arrived froni France, having on board many col- onistib. who had been employed to work at the town factory. One man came on shore on April 15, was taken sick the next day, and died on the 19th. Fifteen days later, three more colonists landed. They were all taken ill and died between the 12th and 16tli of May. At about the same time, a soldier arrived from Dabou, was taken ill and died. These new cases revived the epidemic and many who had previously been spared were attacked and died. During the revival of the epid3mic, the gunboat La Tourmente arrived near Grand Bassam, but could not reach the town on account of shallow water. The Cap- tain was rowed to shore, contracted the disease and died during the first days of June. We have no data concerning the mortality among the natives, but the fatalities among the v\^hite colonists was excessive, for, out of a population of 66, there were 22 deaths.^^ The disease did not spread to the other ports of the Ivory Coast, with the exception of two imported cases at Dabou. Dahon. In 1857, two employes of a commercial house at Grand Bassam went on a mission to Dabiai. Shortly after their arrival, the men were almost simultaneously at.acked by yellow fever and died. No new cases resulted. 18G2. The Epidemic on Board the DispatcJi-Boat V Archer , at Grand Bassam. In his account of the epidemic of 1862, Sarrouille gives more elaborate details.^^ A reference to our chronological tables will show that yellow fever was widespread along the west coast of Africa in 1862. Rumors of the existence ^'^Salis: Archives des Hopitaux du Senegal; Sarrouille, Theses de Paris, 1869, No. 150, p. 14. =^ Sarrouille: Theses de Paris, 1869, No. 150, p. 21. IVORY COAST. 233 of the disease reached Grand Bassam as earl}^ as the mid- dle of the year, but it was not until November that the first case was observed in the dependency. On the 16th of that month, the French dispatch boat VArclier. which had been infected at Saint Paul de Loanda, by communicating with the Dialmatli, arrived at Grand Bassam and laiided one white and ten native sailors. The white sailor was taken ill on the ITth and died on the 20th, with unmistakable symptoms of yellow fever. None of the blacks who were put on shore at the same time contracted the disease. The fever did not spread immediately to the mainland, but soon broke out on the vessel. On November 26 the second steersman was stricken. The t'ever spread rapidly, five deaths occurring between November 28 and December 5. Dr. Sarrouille himself was attacked. On December 7 the commandant, thinking that VArcJie/r had been infected at Grand Bassam, took on board all the white inhabitants of the post which could be sj)ared, and sailed for Dabou. But the disease continued to rage on board and by the time the vessel reached Dabou, December 12, three more sailors had succumbed. The men who had been taken on board at Grand Bassam were landed at Dabou and, strange as it may seem, not a single case developed among them, the pestilence being confined exclusively to the sailors. This immunity, in our opinion, can only be explained on the ground that the landsmen slept on d< ck, where the in- fected mosquitoes had no access, while the poor sailors were compelled, in the performance of their duties, to re- main below decks most of the time, A\here they were un- protected from the bites of the insects. On December 12th, when the ship's mechanic died, only three of the eleven men who comprised the complement of V Archer on November 26, when the first case broke out, re- mained, namely, the captain. Dr. Sarrouille and a sailor. It was thought that the epidemic had ceased with the death on the 12th, but on the 18th the heroic captain, who had nursed his comrades throughout the terrible ordeal and had seen them die one after the other, was taken ill and was soon added to the list of victims. It will thus be seen that, out of a crew of eleven^ we have ihe ai)palliiig record of ten attacks and nine deaths. Dr. Sarrouille being the 234 HISTORY OF YELLOW FEVER. only one who survived an attack and tbe sailor above men- tioned being the only member of the crew who proved im- mune to the pestilence. Grand Bassara. Cases begin to appear at Grand Eassam shortly after the death of the sailor landed from F Archer. The outbreak was quite severe, resulting in twelve cases and s*x deaths, out of a white population of eighteen. Assinie. The European population at Assinie in 1S62 consisted of only five persons — the governor, the resident surgeon and three soldiers.-^ About vhe 10th of December, two of the soldiers were taken ill and the symptoms diagnosed as yellow fever. Both died s few davs later. The gov- ernor and the surgeon were then successively attacked, the latter dying on the 27th. The former recovered. The na- tives of the villages contiguous to Assinie suffered severe- ly, but in the town proper there were only four deaths among the blacks, making a total mortality of eight. General Summary of the Epidemic of lS6i. The epidemic which began at Grand Bassam in Novem- ber, 1862, was one of the most virulent on record, for out of 27 Europeans attacked, 18 died. The cases and deaths were as follows : Locality. Cases. Deaths. On board the F Archer 10 9 Grand Bassam 12 6 Assinie (white population only 5) .... . 10 8 32 23 The combined white population of Grand Bassam and Assinie amounted to 23. As will be seen, this small num- ^ Sarrouille, loc. cit., ji. 35. IVORY COAST. 235 ber furnished 17 cases and 9 deaths. The most appalling mortality, however, was on board of V Archer, where ten cases were followed by nine fatalities. The disease did not spread to Dabou.^^ '\ 18G3. Sporadic cases of yellow fever appeared at Assinie and Grand Bassam in 1863, but almost entirely among the natives. We find the record of only one death among the Europeans at Grand Bassam, an agent sent by a French commercial house to establish a factoi-y at this post. He arrived at the '^unhealthy season" and rt^maiuhd three months on board a vessel in the harbor. During the month of February, thinking that aU danger was past, he went on shore. Fifteen days later, he was stricken with yellow fever and died eight days after the onset of the maladv.^^ 1899. Through some source which is not given, yellow fever was brought to Grand Bassam in 1899 and for a time threatened to assume epidemical proportions. Strict sani- tary measures were adopted, however, and the disease was restricted to the vicinity of the original outbreak, re- sulting in six cases and ^nq deaths. The infected terri- tory extended from the Gold Coast up to and including Half Jack on the west.^^ The other African stations were not affected. 1902. The epidemic of 1902 broke out -rnddenly and, although it lasted hardly a month, was characterized by nearly one hundred per cent, mortality. On July 14, 1902, a sergeant of infantry, who had only been at Grand Bassam two or three weeks, was taken ill 2^Huard: Theses de Montpellier, 1868. ^ Sarrouille, loc. cit., p. 41. -»U. S. Public Health Reports, 1899, vol. 14, pp. 1336, 1812; Annales d'Hygiene et de Medecine Coloniales, 1903, vol. 6, p. 325. 236 HISTORY OF YELLOW FEVER. with fever. He died on the l>9th ^ith "suspicious symp- toms/- but as yellow fever had not been observed in the colony since 1899, the case was diagnosed as ''pernicious fever" by the attending physician On July 20, an Australian prospector, aged 30, who, to- gether with three other prospectors, had landed at Grand Bassam June 27, died with black vomit, and the authori- ties concluded that they were face to face with an invasion of yellow fever and cabled the facts to the colonial officials. Orders were received to take immediate sanitary measures and to make war against mosquitoes. The three other pros^Dectors, room-mates of the case above mentioned, were successivelv attacked, on the 23d, 25th, and 26tli of Julv; one recovered, the others died on the 30th. In the four last cases above noted, bla'jk v jmit was present. On July 24, a white servant, aged 34, who had been in the colony two months, died at the infirmary, alter four days' illness. On July 24, a notary's clerk, also a new arrival, died after three days' illness. A young couple wlio occupied the same residence as this young clerk, and Avho nursed him through his illness, proved immune, although they had arrived from France only six weeks x)reviously. Two customhouse officers were taken ill on July 23 ; one died on the 27th and the other on the 2Sth. An Englishman, aged 26, who had arrived at Grand Bassam on June 26, furnished the tenth case. He was taken ill on July 25th. He continued to attend to his duties until the 28th, when he was f iund in a coma by one of liis fellow- clerks. Death, preceded by black vomit, took place shortly afterwards. His companion ^as taken sick in a few days, but suffered only a slight attack, which resulted in an uneventful recovery. The twelfth case was an Alsatian who had arrived at Grand Bassam on June 27. On the morning of July 27 he left town to ''isolate'' himself at th« village of Abidjan, where he died on July 31 with black v.mit. A second death took place outside o^ the town limits, at Eloca, a native village near Grand Bnssam. This was an IVORY COAST. ^37 European, aged 33, who had spent a few hours in tlie house where the Australians had died. He was taken ill a feAV days after his return to Eloca and died on August 2. The fourteenth ease was furnished l^y a priest who had been doing missionary work along the west coast of Africa for six or seven years. He was taken ili August 2 and died on the 12th. ' The last case, a mulatto, had been a resident of Grand Bassam since 1894 and had gone through the epidemic of 1899. He was taken ill on August 12th and died on the 19th. This is one of the te^\ instances in which a person with African blood has died of yellow fever on African soil. The disease is generally fatal among the Avhite col- onists, but the mulattoes are generally immune while the blacks, despite their unsanitary and barbarous mode of living, rarely contract the disease. Such has beer the case in almost every epidemic, not only at Grand Bassam, but along the entire coast of the Dark Continent v*here the saffron scourge has manifested itself. The epidemic of 1902 may be summarized as follows : Grand Bassam, 13 cases; 11 deaths. Abidjah, 1 case, resulting in death. Imported from Grand Bassam. Eloca, 1 case, resulting in death. Imported from Grand Bassam. Grand total, 15 cases; 13 deaths. The source of the ej)idemic has never been definitely es- tablished. Some claim it was imported from the Gold Coast; others incriminate Senegal, Dr. Rousselot- Benaud,-^^ from whose account this resume is made, be- lieves that the disease was not imported, but wa^ due to extensive excavations made in a lagocm where the debris of the epidemic of 1899 had been thrown and left undis- turbed since that time. It is needless to explain why this hypothesis is untenable. 1903. The epidemic of 1903, following so closely upon the out- break of 1902, caused widespread panic throughout the 2<* Rousselot-Beriaud : Annales d'Hygiene et de Medecine Col- oniales, 1903, vol. 6, p. 319. 2S8 HISTORY OF ITELLOW FESTER. colony. According to Gouzien and Le Hardy.^^ the first suspicious cases occurred in January. On the 24th of that month, a Syrian, who had landed at Grand Bassani in De- cember, 1902, and who lived in the natire section of the town with seven or eight of his countrymen, died with black vomit. The corpse was burned by the authorities and the dead man's compatriots were isolated for nine days, during which time a strict watch was kept over them. On January 29 another case was observed, followed by death in a tew days. A third case occurred about the same time in the person of a customhouse emiDloye. The outbreak seemed to subside, no cases being ob- served during February. On 3Iarch 3, a sergeant of in- fantry died at the infirmary. This death was foliowed by another on March 11, in the same room where tht sergeant had succumbed. The reappearance of the disease caused consternation in the town. The cabin where the tv o deaths occurred was burned, as was also the clothes and bed-linen of the unfor- tunates. On March 11, a fatal case was obser^ ed, followed short- ly by two cases, which recovered. On March 15, a sister of charity died. About that time, the Government oidered the isolation of the white inhabitants of Grand Bassam. To avoid spreading the contagion, this was done by groups of two or three, until the town was nearly depopulated. On July 17, only 23 Europeans vrere iDresent. The fever soon began to show itself at the places where the refugees had been sent. On July 19, a death occurred at Adjeo, followed by two fatalities at Tmperie on the 23rd. On the 27th a death was registered at Arriounna. The sixth death at Grand Bassam was furnished by a city official who had been two months in ihe colony. On July 28, a Catholic priest died after an illness of only forty-eight hours. On August 1, the white population amounted to 13. ^^ Gouzien and Le Hardy: Annales d'Hygiene et de Medecine Coloniales, Paris, 1904, vol. 7, p. 558. IVORY COAST. 239 On August 3, case occurred at Schneider Plantation, in the person of a refugee from Grand Bassam, followed by death on the 4th. The last case at Grand Bassam occurred on August 7th, resulting in recovery. The cases and deaths may be summ_arized as follows : Cases. Deaths. Grand Bassam 10 7 Adjeo 1 1 Imperie 2 2 Arriounna 1 1 Schneider 1 1 Total 15 12 The epidemic was probably a recrudesceuce of that of 1902, caused by the renewed activitv of the infected Stegomyia. 1904-1905. Yellow fever was brought to the verv doors of tLe colony in 1904 and 1905. The steamship Tibet arrived at Dabou towards the end of October, 1904. Her physician had just died from an attack of '^pernicious fever," but subsequent events justify the assertion that it was probablv a case of yellow fever. On the next trip of the vessel to the colony, January 26, 1905, while in the harbor of Grand Bassam, a case of '^sus- picious fever" was reported on board. This proved to be the ship's physician, who had taken tlie place left vacant by his comrade's death. The patient was well enough to be on deck that evening, but fell into a coma on the 28th and died on the 29th. He v/as buried on shore. A few daj^s later, while the Tlljet was in the harbor of Cotonou, the hospital steward was attacked by what was pronounced a typical manifestation of yellow fever. The case was a mild one and the patient recovered. The Tihet was then given free pratique and left for Grand Bassam, where she arrived February 24th, and took 240 HISTORY OF ^"ELLOW FEVER. a passenger for France. The man was an inyali'l, of dis- sipated habits, who had been in the hospital foi about a month and was weak from fever. That same night, while at Dabou, he fell into a comatose state and died the day following (February 26th) with black vomit.^- A perplexing qtiestion now presents itself : Where did this man contract yellow fever? Xo '^x^oradlc Oase had been seen at Grand Bassam before the eruption of this fatal one, and none were observed during the balance of the year. The patient came directly from the hosi^ital to the ship, did not communicate with anyone and had not left his room for nearly a month The rapid evolution of the disease precludes the j^ossibility of the patient having been infected on board on the 24th, and as be presented all the symptoms of yellow fever, even the black vomit, there is no gainsaying the fact that he was contaoiinated some- icliere. But to take down the map of the world and point out that '"somewhere" is the piece de resistance. The only loop-hole we see, is the assumption that, when the Tibet was in the harbor of Grand Bassam on her first visit (Jan- uary 2Gthi, the tmfortunate Frenchman was bitten by an infected mosqtiito either at the whs^rf •. r on board the ves- sel and afterward had a mild attack of yellow fe^er. Be- ing convalescent when transferred to the Tibet, the excite- ment incidental to his removal brotiglit on a i elapse, which terminated as above set forth. This circuitous mode of infection may seem a little far- fetched, but it is plausible, and, in the absence of proof to the contrary, is just as good as any other theory. ^Vivie: Annales d'Hygiene et de Medecine Coloniales (Paris), 1907, YOL 10, p. 121. JOHANNA ISLANDS. Description. Johanna is one of the Comore Islands, in the Mozam- bique Channel, between Madagascar and the mainland of Africa. Its capital is the walled town of Johanna. ALLEGED YELLOW FEVER YEAR. 1801. SUMMARY OF ALLEGED OUTBREAK. Bancroft, in his Sequel to An Essay on Yellow Fever (1817, page 132), tells of an outbreak of ^'Bulam Fever" on board a sloop of war which had stopped at Jrhanna in 1801 for provisions, water and fuel. Soon after sailing, symptoms of a fever "of an unusual kind" appeared among those of the crew that had been on the island. The general symptoms were: An oppressed pulse, pungent heat on the surface, bloated countenance, a dull, heavy, inflamed e^^e, violent headache, pain at the epigastric region, and an in- vincible irritability of the stomach; the vomiting, in all cases, being of a bilious nature and a yellow-greenish as- pect, which, towards the fatal termination of the disease, assumed a dark-brown olive or chccolate color. In none of the bad cases were remissions well marked, and in most of those who died, a yellow suffusion of the skin of a lemon hue, was conspicuous only a short time previous to death; in all, however, after death this appearance was common. The discharges by stool manifested a similar variety, but they were so highly corrosive and acid as to excoriate the anus and nates, and to excite the general dread in the patient on the api)roacli of the evacuation. Out of twelve men attacked, six died ; those who recov- ered did not have the dark colored von j ting and fheir con- valescence was extremely tardy. With the exception of the alleged outbreak at Madagas- c^ar (q. v.), this is the only record o^ yellow fever, or a 242 HISTORY OF ^"ELLOW FfVER. disease simulating that scourge, on tlio eastern shores of Africa. Banrr«:>ft says that this sIood of war carje direct from England. ^ hiih jjr^cludes the thfMiry of importation. We ar J prone to believe that it was simjjlv a yirnlent out- break of ijalutlial fever, aggravated by exiiosure and fatisrue. LAGOS. Description. La.Q:os is a British colony in Upper Gninea. on the Gulf of Benin. The capital, Lagos^ the largest port in Western Africa has a population of about 40,000. The population of the colony is about 100,000, mostly negroes. Lagos was once a noted slave mart. YELLOW FEVEE YEAR. 1864. SUMMARY OF EPIDEMIC. There is a solitary record of yellow f< ver having invaded Lagos ( Berenger-Feraud, p. 141). In 1864, the disease was in Sierra Leone and was brought to Lagos by trading vessels. The outbreak does not appear to have been of much consequence, as it is barely mentioned in the official reports. MADAGASCAR. Description. Madagascar, the third largest island in the wor-d, is sit- uated in the Indian Ocean, 210 mi^es from the v^qst coast of Africa, from which it is separated by the Mozambique Channel. It is about 1,000 miles long and has an aver- age breadth of 250 miles. Population, 3,520,000. Capital, Tananarive. Chief port, Tamatave. The island is under French protectorate. YELLOW FEYEE AS IT CONCEKNS MADAGASCAK. Berenger-Feraud, in the Gazette Medical de Nantes^^ and Joseph Jones, in the Transactions of the Louisiana State Medical Society for 1879 (page 63), make brief mention of yellow fever having been observed in Madagascar in 1790, but a search through the literature of that vear and a careful perusal of the principal works on Madagascar, fails to throw any light on the subject. Bancroft, in his Sequel of Yellow Fever (page 135) claims that an English warship contracte^l a pestilential disease at Mtidagascar in 1806, but makes no mention of the alleged outbreak of 1790. Bancroft's account is as follows: In the year 1806, a seventy-four gun ship of tho British navy stopped at Madagascar for the purpose of obtaining fresh beef, vegetables, fruit, wood and water. In conduct- ing these duties it was necessary to « mploy mai-y of the men ; and of all the parties thus employed, none remained on shore during the night, except a guard of marines, sent in the evening on purpose for the protection of watetr casks, etc. ; and it was so arranged thai no man had occa- sion to be out of the ship more than one night. Notwith- standing these precautions, a fever of malignant nature ap- peared among the marines, and of twenty-four attacked in a violent degree, six fell victims to the disease. The symptoms here were not exactly similar to those wit- * 1883-4, vol. 2, p. 6. MADAGASCAR. 245 nessed in Johanna f^ death in several cases was sudden and unexpected, preceded by a violent burning sensation at the epigastrium, which was only a precursor of death by a few hours, and in one case by a fcAV minutes. In these cases neither Avas a ^^ellow suffusion of the skin con- stant, nor the eyes so highly inflamed, nor the countenance so much flushed as in the fever of Johanna : but a sallow, dingy, disagreeable aspect of the countenance prevailed. In some of these cases the ship-s surgeon Avas inclined to think the individuals in a state of intoxication, from the very great degree of vertigo and staggering present; but a short time served to convince him of his error. This variety of appearance in the two diseases this officer ascribed to peculiarity of constitution only, and not to any difference of climate ; those who vvere affected at Johanna were young and recently arrived from their native climate ; whereas the people subjected to the Madagascar fever had been some length of time in India, and had but lately ar- rived from a long cruise of four months, the greater part of which they had subsisted on salt provisions, and symp- toms of scurvy had appeared among them for some time before their arrival at Madagascar. . This outbreak was certainly not yellow fever. Nowhere can we discover in Bancroft's account any mention of previous contamination of the warship, and unless the vessel stopped at some infected port on its way from Eng- land to Madagascar, the contagion which prevailed on board was not, and could not have been, under the wildest stretch of the imagination, yellow fever. The mode of propagation of this disease is now too well established to need elucidation, and, unless the mosquitoes of Mada- gascar were imbued with the venom of infection simply for this special occasion, the incident can positively and for- ever be dismissed as being puerile and chimerical. It is a well known fact, however, that palndial fever reigns with great intensity in the litoral of the island and commits fearful ravages among the whites. In this connection, the historic words of Eadama, King of the Hovas, \shen con- fronted with invasions by the FrcLch, "I have at my ser- vice the great General Tago (fever) and in his hands I'll ^^ See article on Johanna Island, in this volume. 246 HISTORY OF YELLOW FEVER, leave the whites for a while; 1 ha^e no fear of the results,^ proved terribly prophetic, for the shores of the great island are so thickly studded with the gravestones of the invading French, that Madagascar has been christened Le Tomheaii des Franca is. MADEIRA ISLANDS. Description. The Madeiras are located in the Atlantic Ocean, about 440 miles off the west coast of Africa and consist of the islands of Madeira and Porto Santo and three islets called the Desertas. The group belongs to Portugal. Popula- tion, 123,841. Capital, Funchal^ on the island of Madeira. 1738. YELLOW FEVER YEAE. SUMMAPiY OF EPIDEMIC. Although the Madeiras have been known to Europeans for four hundred and seventv-six years, only once has yel- low fever invaded the group. Like the Canary and Cape Verd islands, the Madeiras are directly in the path of com- merce between Europe and Africa and were no doubt the rendezvous of the delightfully unsanitary galeons, buc- caneers, slave-traders and gentlemanly cut-throats of by- gone days; but, strange and inexplicable as the ^otatement may seem, the dreaded peste, although it devastated the other islands off the African coast, only found lodgment once on the shores of this salabrious Portugese possession. This solitary record of the appearance of the ^'Ameri- can Pestilence" in the Madeira Islands may be found in an old Portugese work published nearly two hundred years ago, by Jose Rodriguez de Avreu,^* phvsician to King Juan Y, of Portugal. No details are given of this inva- sion, beyond the statement that it caused much mortality in the city or Funchal. From 1738 to this day, yellow fever has never been ob- served at the Madeira archipelago. How can this immunity be explained? Only by hypothesis, and as hj^potheses are generally concocted of such volatile ingredients that they collapse of their own weight, we shall not indulge in any, but will sum up the ** Jose Rodriquez de Avreu: Historiologia Medica, vol. 1, p. 620- 248 HISTORY OF YELLOW FEVER. whole matter in five little words: TJie tihsenc^ of the Stegoinyia. This, in our opinion^ is the true explanation. It is not a hypothesis, but a fact, that the ^tegomyia Cal- opus, the only active agent in ,the transmission of yellow fever, does not flourish in tlie Madeira group. The insect was imported once to the islands and that solitar}^ instance furnished the delightful little city of Funchal the only epi- demic of yellow fever which has ever invaded that locality ; and, as soon as the climatic conditions i f the island proved hostile to the propagation of the mosquito and the im- ported insects died, the pestilence which they had pro- duced ceased and the old-time health con-litions of the country re-established themselves and have endured to the present day. MOROCCO. Description Morocco is a country occupying' the northwest extremity of Africa. Area, about 200,000 squaro miles. Popuhition, 6,000,000. The empire has three capitals — Fez, with an estimated population of 100,000: Morocco, with 40,000 souls, and Tangier (the diplomatic sea':), estimated to con- tain about 14,200 inhabitants. YELLOW FEVER YFAR>S. 1804 ; 1881. SUMMARY OF EPIDEMICS. 1804. Penon cle Velez. The only recorded epidemic of yellov; fever in northwest Africa took place in 1804, at Penon de Velez, a fortified Spanish fortress situated on a lofty r(.ck in the Mediter- ranean, 80 miles southeast of Ceuta. Morocco. In the last years of the eighteenth century, this islet was used as a prison for refractory presldarios^ or galley slaves. It is now a Spanish penal colony. In 1804, yelloAv fever was epidemic almost throughout Spain and the infection was carried to Penon de Velez by tradespeople and soldiers from Malaga, between which port and Morocco there was constant and uninterrupted communication. No detailed account could be found of this epidemic. Fellowes^^ and Moreau de Jonnes^^ inform us that the disease was imported from, Malaga, and was widespread among the garrison and gallev slavis which formed the sole population of the islet, but give no in- formation regarding the number of cases or the latalities. ^"Fellowes: Reports of the Pestilential Disorders of Andulasia which appeared at Cadiz in the years 1800, 1804, 1810 and 1813(London, 1815), p. 101. ^® Moreau de Jonnes: Monographie Historique et Medicale de la Fievre Jaune des Antilles (Paris. 1817), p. 341. 250 HISTORY OF YELLOW FEVER. 18S1. Tangier. The second and last invasion of Morocco by yellow fever took place in 1881, at Tangier, one of the capitals of the empire, situated at the entrance to the Strait of Gibraltar, which had then an estimated population of 15,000. It is unfortunate that only a bare mention :s made of this out- break in the consular reports. There were onlv a few sporadic cases and no deaths, ■" The source of importation is not given. ^' National Board of Health Bulletin, 1881-1882, vol. 3, p. 337. SAINT HELENA. Description. Saint Helena is a volcanic rock in the South Atlantic Ocean, TOO miles south-east of the Isla/id of Ascension, and 1400 miles west of the west coast of Africa. It is 10 1-2 miles in length, 7 miles in breadth and belongs to Great Britain. Population, 4,116. Capital, James Town, on the north-west shore. Saint Helena i:? famous in history as haying been the living tomb of the Great Napoleon from the date of his banishment, 1815, to his death. 1821. YELLOW FEVEE YEAK. 1830. SUMMARY OF EPIDEMIC. It is surprising that yellow fever has never invaded Saint Helena, for, previous to the cutting of the Suez Canal, the island was a favorite port of call fcr vessels bound to and from India, by way of the Cape of Good Hope and the inhabitants did a large Trade in furnishing these vessels with provisions and other supplies. The only explanation is found in the absence of the Stegomyia Cal- opus from this lonely rock, as vessels infected with yellow fever no doubt stopped long enough a^^ James Town in its palmy days to communicate the disease to the inhabitants. The outbreak of 1830 was solely in the harbor and did not spread to the shore. It took place en board the British ship Sybille, under the follovv^ing circumstances (Bryson, loc. cit, p. 57) : The Syhille was infected by some vessel attached to the British South Atlantic squadron in 1829 and suffered much from the ravages of yellow fever. On September 1, 1829, she arrived at Saint Helena. The epidemic had ceased and no one was on the sick list. She shortly sailed on a cruise and met with the Black Joke^ T\?th which she com- 252 HISTORY OF YELLOW FEVER. municated. This vessel had just recovered from a severe visitation of yellow fever. The disease again broke out on board the Sybille. She returned to Saint Helena and anchored in the harbor of James Town on ]\ larch 22, 1830. The disease was widespread amono- the crew, there being 26 cases and 6 deaths while the ship was at Saint Helena. The fever was confined to the Syhille. SAINT THOMAS. Saint Thomas is an island in the Gulf of Giuinea, belong- ing to Portugal. Area, 145 square mikis. Capit?.l, Chaves. Population, 29,441. YELLOW FEVEE YEAPvS. / 1558; 1588.. SUMMAEY OF EPIDL MICB. 1558. AVe find only two instances of the appearance of yellow fever on the island of Saint Thomas. There is no doubt that the disease has prevailed there o,?. numerous occa- sions, as the Portugese have never been over-strict in en- forcing quarantines in their colonial possessions and the locality has always been a nest-egg of smugglers and lax maritime transactions. But the available sources of in- formation, as is ahvays the case wheij the colonies - of Western Africa are concerned, are either sterile or untrust- worthy, so we shall confine our observations to the two outbreaks herein noted. According to Berenger-Feraud {loc. cit., p. 27), yellow fever was observed among the white settlers of the island in 1558. Beyond this mere mention, iio details are given. 1588. The same authority (p. 27) also informs us that Bird and Newton, English explore .'s, and their crews, were at- tacked by yellow fever at Saint Thomas in 1588. Where the disease was contracted, ^v^hether it was then prevailing on the island or was brouj^ht there by the explorers, our source of information doefe not reveal. SENEGAL. Description. Senegal is a French colonial deijendency in West Afri- ca, in Senegambia, comprising the island and town of Saint-Louis, at the mouth of the Senegal Kiver, the island and town of Goree, Albunda on the Gambia, and other stations south of Cape Yerd. It was first settled by the French in the beginning of 1600, taken by the English in 1756, retaken by the French in 1759 and 1779, and subse- quently held by the English until 1814, when it again came under control of the French, who have retained pos- session to this day. Capital, Saint-Louis. Other towns and stations: Goree, Dakar, Rufisque, Thies. Senegal being one of the most important colonial pos- sessions on the West Coast of Africa, having extensive trade relations with America and Europe, a description of its principal centres of population will not be out of place in this volume. The reader will thus be in a better posi- tion tc understand the radiations of the many epidemics which have ravaged this distant land. Saint-Louis. Saint-Louis, capital of the French possessions in Sene- gambia, was founded in 1626. It is situated on an island of the same name, at the mouth of the Senegal River. It has fine public buildings and mission schools. The white I)opulation occupies the centre of the is 'and, while the huts of the natives are located at both extremities. The streets are large and macadamized in the business section, but the houses, with few exceptions, are of ancient construction. Several bridges over the small arm of the Senegal connect the island with the peninsula of Barbary, a narrow sand- bar, on which are located the native villages of Guet N'Dar and N'dar Toute. The cemeteries are located at Sorb, on the mainland and separated from the island by (he great arm of the Senegal. A single bridge connects Sorb with the capital. SENEGAL. 255 The natives are exceedingly filtlij^ in their Labiis?. Those residing in the European section of the citj^ occupy the basements, where they operate small stores. In the small court-yards attached to these houses, they keep chickens, hogs, sheep and often cows, and when the yards become overcrowded, which is a common occurrence^ tliese ani- mals are often quartered in the living apartments. Under such conditions, it is not surprising that the lieaith of the city is always on the Avrong side of the balance Saint-Louis has a population of 15,758, mostly natives. The white population is transient and generally J eaves for Europe at the beginning of the rainy season. Goree. . The rocky island of Goree, which is entirely occupied by the town of the same name, lic-s in the Atlantic Ocean, south of the Cape Yerd Peninsula It is directly opposite Dakar, with which town it is so closeiy allied that the name Goree-Dakar is now generally used when alluding to the twin cities. It is claimed to be the healthiest place in West Africa. The native quarter is composed of grass; huts, but the houses of the Europeans are of fair construc- tion and decorated with fine flowering plants and shrubs. The elevation of Goree above the sea level varies from 2 metres on the northwest to 34 on the southeast Goree was for years the principal port of the colony, making rapid strides in population i^nd commercial im- portance, but it is now being outstri^^ped by Dakar and Eufisque. Population, 2,452, mostly natis^es. The white mer- chants, as is the case everywhere throughout Senegal, gen- erally sail for Europe every year at the beginning of the warm season. ; Dalcar. . Dakar is situated on the continent, almost at the ex- treme point of Cape Verd, and is 1 1-2 miles from Goree, from which it is separated by an arm of the Atlantic Ocean. Up to very recent years Dakar was an obscure negro village and was simply a vast necrophlle, having ^56 HISTORY OF YELLOW FEVER. been used as a burying ground for the inliabilants of Goree from time immemorial. In the eighties, its natural advantages began to be recognized and European commer- cial houses established agencies there. The building of modern residences followed and to-dav the town occupies a foremost place in the affairs of the colory. It is 163 miles from Saint-Louis, with which it is connected by rail. Population, 3,417, of which only a few hundreds are Europeans. Rufisque. Rufisque, the second city jn Senegal from a point of population, is situated on the Atlantic Ocean, opposite Goree, about ten miles from Dakar, and is the principal station on the Dakar-Saint-Loui^ rat'road. Population. 5,280. YELLOW FEVER YEARS. 1759; 1766; 1769: 1778; 1779; 1828; 1829- 1830; 1837; 1859; 1866; 1867; 1872; 1878; 1879; 1880;. 1881; 1882; 1900 ; 1901 ; 1905. SUMMARY OF EPIDEMICS. 1759. The first appearance of yellow fever on the mainland of Africa, according to Lind,^^ occurred at Senegal in 1759. We can find no details of this inyasicn. It would cer- tainly proye interesting to be able to trace the origin of this outbreak, which planted the seeds of a disease hereto- fore unobseryed on the continent of Africa, and which was destined to commit such fearful ravages among the unfor- tunate pioneers sent to colonize its shujes. 1766. Goree and iSaint-Louis. The second appearance of yellow fever on continental Africa took place in Senegal in 1766, when the towns of ^^Lind: An Essay on Diseases Incidental to Europeans in Hot Climates, vol. 1, p. 51. SENEGAL. 257 Goree and Saint-Louis lost nearly their entire wiiUe popu- lation, composed of French soldiers and traders. No de- tailed accounts of this epidemic aie obtainable, our authorities (Lind and Berenger-Feraiid ) being deplorably uncommunicative on this score. 1709. Berenger-Feraud (page 55) goes into more explicit de- tails concerning the outbreak of 1769, but is certainly not prolix. We could obtain no statistics, but learn from his account that the French troops sent tv capture Galam, on the Senegal Kiver, were so decimated by yellow fever, that there were not enough men left to undertake the task. 1778. Saint-Louis, The epidemic of 1778, which is the first on African soil where details are obtainable, was murderous in its inten- sity and almost depopulated the dependency of its white settlers. Senegal was then in the turmoil of war, the English having wrested the colony from the French. The fever first apiDcared on the Gold Coast, whence it was brought to Sierra Leone, which, in its turn, infected Gam- bia. From Gambia, it spread to Goree and thence, accord- ing to Hirsch,^^ to Saint-Louis. The progress of the disease in the town of Saint-Louis is one of the saddest pages in the history of the colony. We cull our information from an old work published by Schotte in 1782, which gives a comprehensive account of the rise and fall of the epidemic. ^^ Schotte, who was sur- geon-in-chief of the British garrison at Saint-Loui. in 1778, first wrote this treatise in Latin, but was finally prevailed to publish it in English. The work Avas considered of such 2'Hirsch: Handbusch der Historich Georgraphischeii Path- ologie, Stuttgart, 1881.. • *" Schotte: A Treatise on the Synochus Atrabiliosa, Jjondon, 1782. 258 HISTORY OF YELLOW FEVER. importance at the time, that it was translated into French and German. The first case in Saint-Louis was imported from Goree- Dakar and was observed in the hospital on August 3, ter- minating fatally on the 7th. The last death w^as that of Governor Clarke, the commandant of the island, on Sep- tember 18th. Schotte observes that up to the end of July. 1778, the garrison and the inhabitants of Senegal were, for that time of the year, remarkably healthy. Iii the beginning of August, ''a sudden and most dreadful disease broke out," which, raging until the middle of Sejtember, carried off the greatest part of the Europeans and a great number of the native mulattoes and blacks. The whites suffered much more, in proportion, than the mulattoes and the latter much more than the blacks. The few who had es- caped the fury of the pestilence were not attacked after September 18th ; but those who had recovered were seized with relapse during the following month and some died as late as December. The course of the disease was frightfully rapid. There was hardly a day between the 9th of August and the 18th of September without one or two deaths. Out of so small a population as 92 Europeans, we find the melancholy record of four deaths on August 28d, four on the 26th, three on the 27th and five on September 5th. The total number of deaths reached 59. Eight of the convalescents were still too feeble to walk when the French took possession of the island on January 28, 17'^9. Schotte, who was a valorous champion of African ende- micity of yellow fever, believes thet the disease originated spontaneously on the Gold Coast and was then spread by contagion to the localities mentioned iu this account. As 'the French and English were at loggerheads, however, and probably drew on their West IndiVn fieets for transports and blockade runners, it does not require a gigantic stretch of the powers of observation to see how ea•=^ily the disease could have been imported to the west cr.ast of Africa. SENEGAL. 259 Vlid. Saint-Louis. The French, undaunted by the many reverses and the rava«jes of disease which had marked their attempts to colonize Senegal, determined to recapture Saint-Louis, and, in 1779, sent a force of about 200 men, headed by the Due de Lauzun, to dislodge the British. The soldiers were recruited from the crack Walsh Kegiment, the Queen's Kegiment and volunteers and were a fine body of men, vig- orous and healthy. The invading force arrived afc their destination January 29, 1779, in the dead of night, intend- ing to take the garrison by surprise,^ but they found that not even a solitary sentry guarded the place, and the 33 Englishmen who had survived the terrible epidemic which had just come to a close, too weak and disheartened to offer any resistance, surrendered unconditionaUy, and were sent to France as prisoners of war. Two were drowned by the upsetting of a boat at the mouth of the Senegal and three died in transit, so that out of 99 men which originally comprised the. garrison, only 28 reached Europe alive. But the bloodless victory achieved by the French was destined to have a terrible .sequel. The landing of these unacclj mated soldiers in this charnel house of disease acted like oil upon a smoldering fire and ^^be pestilence soon broke out with renewed fury. In the space of a few months, the expedition, which had started out ?o auspi- ciously, was almost annihilated. The exact number of the invading force is not given, bat Lejemble^^ informs us that on the mortuary register of Saint Louis for 1779, kept at th^t time by the parish priest^, appear the names of one hundred and eighty soldiers ! A melancholy record, to be sure, but what of it? Senegal was oncf^ more a French pos- session, and when the news of the capture of the. place from the hated Englishmen reached Pai'is, there was much re- joicing over the glorious deed. Such l^ the egoism of the people. Life is short, glory imperishable, and it mat- tered not if a hundred or so brave men laid down their ^^Lejemble: Theses de Paris, 1882, No. 91, p. 19. 260 HISTORY OF YELLOW FEVER. lives for the honor of their country, so long as their mission was crowned with the laurel of triam}»h. 1828. Goree-Dakar. For liftT years, Senegal was free from yellow fever. In 1828, the French ship La Bordeluise, infected at Sierra Leone, brought the disease to Goree-Dakar (Berenger- Feraud, p. 105). Many soldiers attached to the garrison were attacked, but the outbreak was of short duration and was not followed by much mortality. On the Bordelaise, out of a crew of 50, there resulted 31 cases. The number of fatalities is not stated. 1S29. Goree-Bakar. In the beginning of 1829, a slave-ship and a pirate were captured by the French off the Gold Coast and brought to Goree- Dakar. "^^ The sailors from the pirate ship were taken sick and died at the military hospital at Goree. The disease soon manifested itself in the town. In three months, out of 113 European residents, 11 died. ISSO. Goree-Bakar. The epidemic which radiated from Goree-Dakar in 1830, begaU; withotit any j^revious warning, in a mosc remark- able manner, as will be seen from th*^ account of the out- break given below, taken from the writings of three emi- nent French authors, Berenger-Ferat-d, Duval and Le- jemble.'^-^ The facts are as follows • On Jtme 13, 1830, a religious festival was in progTess at *^ Berenger-Feraud, p. 107. *^ Berenger-Feraud, p. 107; Riival, La Fievre Jaime a Goree (Bordeaux), 1883, p. 16; Lejemble, Theses de Paris, 1882, No. 91, p. 20. SENEGAL— 1830. 261 Goree and a great number of people thronged the streets. AYhile the jollification was at its height, a number of Sis- ters of Charity ^Yeve taken ill and soon gave unmistakable evidences of yellow fever infection. Ti! a few days, the epidemic was in full sway and between its inception and the first days of August, when the last cases were ob- served, out of a white population of 150, there resulted 144 eases and 85 deaths. From Goree, the fever spread to the adjoining negro villages in the Cape Verd peninsula and was especially severe at Gandiole and Guet N'dar. Saint-Loui^. During the first days of August, a white woman resid- ing at Saint-Louis visited the market-x>lace at Guet N'dar, where a fair was in progress, and returned home the same day. On August 4, she was taken ill with fever and died in a few days. A young mulattress vho had nursed this woman was taken ill and succumbed. A notary's clerk, who assisted in taking an inventory of the possessions of the white woman, furnished the next victim. From these cases, the disease propagated itself throughout the town. Saint-Louis, which had a white x>opvilation of 650, suf- fered cruelly, for out of 600 cases, there resulted 328 fatali- ties. Out of ten physicians, eio:ht were attacked and six died.^^ Probable Cause of the EfAdemic. For a long time epidemiologists were at a loss to account for the cause of this fulminating outbreak, which seemed to have sprung from the ground. No suspicious vessels had been observed in the harbor of Goree at that period and the entire colony was in a perfect sanitary condition. Some tried to prove that it was a re -awakening of the "germs" of the epidemic of the previous season and even *^ Berenger-Feraud's statistics say that out of 12 physicians 10 were attacked and 6 died; but Duval and Lejemble attest to the correctness of the figures given in the above ac- count. 262 HISTORY OF YELLOW FEVER. Berenger-Feraud half-heartedly espoused that theory. This view was no doubt plausible year,s ago, but its ludi- crousness at the present age is too apparent to need com- menting upon. The elusive yellow fever germ may be eaten for breakfast, lunch and supper, yet no iH results will follow; you can take it by its caudal appendage and toy with it from sunrise till moonset, smear it all over your body, bite its head off or swallow it in your milk or pousse-cafe — you may do all this and vet remain healthy and frisky. But let a Stegomyia which has taken a draught of blood from a yellow fever sufferer in the first stages of the disease bite you, and if you are not an im- mune^ it's a chance out of a thousand that you will con- tract the disease. The outbreak at Goree in 1830 can easily and satisfac- torily be elucidated. All we have to do, is to take a peep into the past and see what was happening in that far-off" land at the time of the outbreak. As we ha\e already seen, the inhabitants were celebrating a religious feast, and, as is usually the case with celebrations of the Catholic church, the whole zeal of the people was concentrated in making the event as gay as the solemn rites of the Church would permit. Flags, decorations and bunting were used with profusion. Berenger-Feraud anr^ Lejemble inform us that, for some days previous to the <.'elebration, the Sis- ters of Charity were busy making odds and ends with a lot of bunting which had been stored ir* an out-of-the-way room since the epidemic of the year before. The room had never been aired since the rags were placed thert. When the go'od sisters removed the lot, the mosquitoes, which had been hibernating during the wip(er, Avere liberated and, famished after such a' long fast, fed eagerly apon the blood of the populace, propagating the germs of the terri- ble disease far and wide. 1837. Goree-Dakar, The epidemic of 1837 was the result of flagrant neglect on the part of the authorities of Goree-Dakar. Since the beginning of June, rumors of the txisti^nce of yellow fever SENEGAL. 263 at Bathurst, in Gambia, reached the town. In the be- ginning of July, the British Government sent to Goree- Dakar for medical assistance and the surgeon-in-chief of the colony. Dr. Dupuis, was sent to the afflicted locality. He returned on July 21 and reporterl that the fever had subsided at Bathurst, but advised that strict quarantine be maintained. On August 12, a coaster arrived at Goree from Bathurst, having on board three Europeans. In spite of the warning of the colonial surgeon, the vessel was allowed free pratique and two of th.^ white passengers, who were ill, were admitted into the hospital. The third passenger Avas next attacked and a]l tlree died with un- mistakable symptoms of yellow fever. The disease soon manifested itself in the towm and lasted until November 23, during which time, out cf a white population of 160, there were 80 cases and 46 deaths.^- The French ship Malouine,'*^ which Isad been sent by the French Government to found a town ut the mouth of the Casamanza River, in Senegambia, wns contaminated at Goree and experienced a severe epideaiic. Out < f a crew of 57, there were 42 cases. Saint Louis. The fever was introduced from Goree into Saint-Louis late in the year, but did not become epidemic. About a dozen cases were observed.^"^ 1859. For twenty-two years Goree Guarded itself against yel- low fever invasion. On August 9;. 1859, the disx)atch boat Le Ruhis arrived at Goree from Bathurst, where the fever was prevailing, with two sick passengers, the vicai-general and a merchant. The vessel was aH<>wed free pratique and the patients transferred to the liospital. The mer- chant recovered, but the priest died on the 12th. From that date to September 30, no other cases were observed, *'Dupont: Archives de Medecine Navale, 1880, vol. 34, p. 262. *^ Duval: La Fievre Jaune a Goree (Bordeaux, 1883), p. 17. *^ Berenger-Feraud, p. 111. 264 HISTORY OF YELLOW FEVER. when the death of a merchant was recorded. Th's. was fol- lowed by another death on October Irt. The physician who attended these two cases contraried the disease and died on October 12. The disj.ase ther became T\idesj)read and there were 54 deaths in October, 25 in Xoyember and 6 in December. Out of a white i^opnlation of 267, there were in all 244 casese and 162 deaths."*^ Saint-Louis The infection spread from Goree to Saint Louis, result- ing in 41 cases and 11 deaths.^^ 1566. Goree. The epidemic of 1866 is directly traceable to Gambia. Xews of the existence of yellow fever along the coasts of Sierra Leone and Gambia reached Goree early in May and measures were at once taken to i3revent importation of the disease. On August 3, a coastinsr ressel, the Marie Antoinette, arrived from Bathurst and, through false representations, was admitted to pratique. It y, as after- wards discovered that the vessel did n«:t have a clean bill of health. The captain was arrested and fined heavily, but the evil had already been done. On September 15, a case of yellow fever erupted in the town, followed by sporadic cases. The epidemic lasted until January 27, 1867, re- sulting in 249 cases and 110 deaths.''^ The civil population of Goree in 1 866 was as follows : ^^Berenger-Feraud; Duval; Lejemble. ** Berenger-Feraud, p. 135. "•Cedont: Archives de Medecine Navale, Paris, 1868, vol. 9, p. 334. SENEGAL — 1866. 265 Natives (blacks) 2,500 Mulattoes, Males , 335 Mulattoes, Females , . 431 Europeans ( whites ) , Males . 55 Europeans (whites), Females ..... -18 766 103 3,369 Military population (white) ... . . 165 Total 3,534 The cases and deaths were distributed as follows: Cases. Deaths. Whites 242 107 , Mulattoes '..... 4 2 Blacks 3 ' 1 Total - 249 110 It will thus be seen that out of a total white population of 268, there resulted 242 cases and 107 deaths. The mulat- toes, numbering 766, furnished 4 cases, followed by 3 deaths, while the blacks, 2,500 strong, had onlv 3 cases, with 1 death. This remarkable immuiiity has always pre- vailed among the blacks, not only in x\fric?., but through- out the Avorld. Dakar. The proximity of Dakar to Goree and the unrestrained communication between the two towns, could not fail from resulting in the infection of the latter. The first case in Dakar was observed on October 12tli, followed by death on the 14th. Prom that date until the end of the epidemic, there resulted 80 cases and 36 deaths, distributed as f oIIoavs : Cases. Deaths. Civilian population 24 11 Military population 56 25 80 36 266 HEsnmir of teujow ekweo.. The last death at Dakar oeenrred on Jamiaiy 21^ 1867. Oil' f^^^ fsfui'ri'i'fl c-g:^^ The gunboat Surprise was the unij yessel which did not take any jirecantions against infection and it was also the only one to experience a Tisitation of the dis^ise. On Xovember 5th, while in the harbor cf Dakar, the first case manifested itself on board. Nearly the entire crew was attacked, resulting in 14 deaths. Rufisque and Eedhnhm. From Dakar, the f erer spread to Rnfisque and Sedhnion, but was not severe. It will be seen below how the infection was carried from Bnfisqne to Orir^e ihe following Tear (1867). Saint-Louis Thanks to the rigid quarantine observed by the health officers, not a single case was observed at Saint-Louis. 1867. In October, 1866, a derk emplcytd in Bufisque who had gone on a visit to Dakar, was taken ill on his return home and died in a few days. His employer sent to France for a new clerk, who arrived in January 1867. The new-comer was given the same ioom which his predecessor had occu- pied and soon shared the same fate. In April, another clerk arrived from France, was given the same living room as the two employes who had died of fever. A few days after his arrival, he was taker, ill and -died. A third unfortunate shared the same fate. A friend of the latter, who had been his room-mate on b*iarl the ship which brought him from France, visited him while he was in the first stages of the disease, and, taking pity upon his lone- liness, resolved to nurse him. He soon contracted the sick- ness, and, together with his companion^ was transported to the Hospital of Goree, where b«jth »»atie^3ts died a day or two after. The ne^*^ of the reappearance of yellow SENEGAL. 267 fever in the town created profound cousteriiation and the governor ordered the embarkation of all the troops on board the Crocodile and VEtoile and transported them to Saint Louis. Shortly afterwards, the disease broke out in Saint-Louis and lasted until the cool season. The disease spread to Leybar^ Lamj.sar and other mili- tary posts of the colony, where many cases and deaths oc- curred. The cases and deaths in the localities affected by the epi- demic of 1867 are not given by Berenger-Feraud, Lejemble nor Duval, from whose works the above resume is made. 1868. According to the London Medical Times and G-azettey^'^ yellow fever was present in Senegal iii 1868 and was im- ported to the Cape Yerd Islands (q. v.) by trading vessels from Goree-Dakar. The French authors deny thut the dis- ease was in Senegal that year and implicate Sierra Leone in the importation. 1872. Goree-Dal'. The cause of this second outbreak has never been luridlj explained. ISSl. Saint-Louis. The year 1881 witnessed another terrible epitlemic of yellow fever in Senegal. We are indebted to Berenger- Feraud, Duval, de Boisse, Noury and Esclagon for the facts.-^<5 ;The first case Avas obserA^ed on June 26, in a soldier at- tached to the marine infantry of Saint-Louis, who Avas ad- ^^ Berenger-Feraud, p. 169. =« Berenger-Feraud, loc. cit, p. 170; Duval, loc. cit, p, 24; de Boisse: Theses de Paris, 1884, No. 52; Noury: Gazette Medicale de Nantes, 1884, vol. 2, pp. 84; 103; Esclagon; Theses de Paris, 1883. SENEGAL — 1881. 275 mitted into the hospital on the 27th, and died July 2d. On July 20, another soldier entered the hospital and died on the 23d, with unmistakable symptoms of yellow fever. In the interval between these two e:ises, three others, folloAved by death, had broken out in different sections of the town — one on July 5th, which proved fatal on the 10th ; one death on the 14th and another on the 15th. On July 23, several cases suddenly manifested them- selves all over the city and at the barracks. From that date, the epidemic had full sway and Ir.sted until Septem- ber 26th. Out of a population of 1,000 Europeans, there resulted 521 cases and 425 deaths. Malcana. On July 25th and 28th, 108 soldieis were transferred from Saint-Louis to Makana, a village Dear Lampsar. Al- most Immediately after their arrival, eight men were stricken with fever and died in a day or two after the onset of the disease. A ninth case manifested itself and died August 14th. On the 20th another case occurred, followed by death on the 23d. This concluded the outbreak at Makana. Xo cases originated in the village, the attacks being confined to persons wiio had recently arrived from Saint-Louis. This probably saved the balance of the refugees, for every attack resulted in death. Pointe-aux-Cliameaiix. Ninety-three soldiers were sent fr^jm Saint-Louis to Pointe-aux-Chameaux ; 92 to N'Diago and 83 to Kichard- Toll. Not a single case occurred at any of these posts. Bop-Diarra. On July 30th, 215 men from the Saint-Louis barracks were transported to Bop-Diara. From that date to Sep- tember 10th, 21 cases and 13 deaths were recorded in the three camps improvised at this post. '2.0 HISTORY OF YELLOW FEVER, Goree-Dal'ur. The Castor plaTecl a more nnfcrtiiiiate role in tlie chain of infection than any other ressel in llie T^aters of the Seneoial, for it transmitted the dt«ea?c to Gorte-Dakar, which had remained uncontaminatod T\'hil? the ]>esti]ence was being carried in everr direction by refugees from Saint-Louis and other infected i)osts. The Castor will be remembered as one of the dispatcli-boats which lielped in the transi^ortation of the Logo Expedition of 1S7S and which furnished its quota of vir-tims in rhe memorable epidemic of that year.^' In the beginning of the epidemic of ISSl, a case of yel- low fever had been bruught from the Castor to the military hospital at Saint Louis. The yessel was then sent on a mission to the CajDe Verd Islands, with the hope that the trip would proTe sanitary and prevent further ertiptions. Xo further cases occurred. "^Alien the vessel returned to Saiut-Lotiis. it was learned that the disease had assumed grave proportions in the town and she was ordered to Goree. The crew continued healthy and Goree was con- gratulating itself upon having kept the pestileuce away from its doors, when the commandant of the Castor was taken seriotisly ill. On the pretext that it was simj)ly mal- aria, for if yellow fever had been mentioned the patient would have been turned away, the case was admitted into the hospital at Goree. The patient died on September 5th. The attending physician. Dr. Cari^entiu, who had seen the disease at Guadelottpe. unhesitatingly pronounced it yellow fever, but refrained from giving publicity to the fact, fearing a panic and thinking no other cases wotild ensue. A day or so after the death of the officer, a work- man on board the Castor was taken V] and died in a few days. The news of this second case roused the health authorities from their lethargy an