LIBRARY OF CONGRESS. 
 
 Shelf. -_iii&& 
 
 UNITED STATES OF AMERICA. 
 
YELLOW FEVER 
 
 ITS SHIP ORIGIN 
 
 AND 
 
 PREVENTION. 
 
 f *> 
 
 r 
 
 BY ROBERT B. S. HARGIS, M. D. 
 
 PENSACOLA, FLORIDA. 
 
 D. G. BRINTON, M. D., Publisher, 
 
 115 SOUTH SEVENTH STREET, 
 PHILADELPHIA. 
 
Q> 
 
 CONTENTS. 
 
 Introduction 3 
 
 The Ship Origin of Yellow Fever 9 
 
 Practical Hints Relating to Yellow Fever 42 
 
 The Most Recent Utterances -on Acclimatization and 
 
 Endemicity 54 
 
 The Origin op the Poison op Yellow Fever 65 
 
 Letter by Prop. John Gamgee to the Author 66 
 
 Letter by Prop. John Gamgee to Rear-Admiral Daniel 
 Ammen on the Inter-Oceanic Canal and Yellow Fever 
 
 Zone 68 
 
 INDEX , , 77 
 
 Entered, according to the Act of Congress, in the year 1880, 
 
 By ROBERT B. S. HARGIS, M. D., 
 
 In the office of the Librarian of Congress, at Washington. 
 
INTRODUCTION. 
 
 The dangerous and irrational proceedings, constantly ad- 
 vocated, in relation to the prevention of yellow fever, induce 
 me to reprint three articles, which have recently appeared in 
 medical journals, and which, if I may judge from kind let- 
 ters received, have met with approval on the part of many 
 of my professional brethren. Twenty-two years have so 
 familiarized me with the idea, based on many facts, of the 
 naval genesis of this disease, that I am much in the posi- 
 tion of all who acquire positive knowledge on any question, 
 and who become intolerant of error. A man who insists 
 to-day that the earth is flat is simply regarded as an idiot, 
 whereas Columbus, when leading that immortal expedition 
 which was the forerunner of our new world life, and of all 
 yellow fever epidemics, had great difficulty in convincing 
 his adversaries and followers that he was not going to the 
 edge of the earth's broad plane, thence to drop into un- 
 fathomable space. 
 
 I plead guilty to a charge which may be made against 
 many who acquire firm convictions, viz., that I did not 
 take time — which, in truth, I could ill afford — to publish in 
 book form, such evidence as had converted me from being 
 a believer in the land origin of the disease. Evidence of 
 this character was brought together, last year, by Professor 
 John Gamgee in his work on " Yellow Fever a Kautical 
 Disease," which was in the press when my views were first 
 made known to him. A careful study of the question en- 
 abled him to define the geographical limits of the disease, 
 its probable origin in the calm belts, the exemption of all 
 other seas except the tropical Atlantic, and that it never 
 
Introduction. 
 
 had penetrated continents, but had confined its ravages to 
 seaports and places in direct communication with seaports. 
 He was as impatient, as I was, at the insinuations that yel- 
 low fever was a disease of the American continent, as ex- 
 pressed by a German author, and failed to conceive how 
 any one could imagine that it developed spontaneously in 
 New Orleans or any of the Antilles. 
 
 From the publication of my first paper, in the New Or- 
 leans Medical News and Hospital Gazette, in 1858, occasional 
 newspaper articles and discussions had led some physic- 
 ians to understand my views ; but the necessity for wide 
 and repeated statement of the simplest truth is indicated 
 by that admirably edited work, Parkes' Practical Hygi- 
 ene. Both Professor Parkes and Doctor De Chaumont. 
 who are responsible for this work, have long been con- 
 nected with an army medical school ; and it is matter 
 of history how seriously the British soldiers and sail- 
 ors have, until within recent years, been afflicted with yel- 
 low fever in the West Indies. Turning to the chapter 
 on the prevention of some important and common dis- 
 eases, we find that " the question of the origin of yellow 
 fever is one which cannot be considered in this volume, 
 and at present no preventive rules of importance can be 
 drawn from the discussion." 
 
 Is it possible to acknowledge impotence in stronger lan- 
 guage, when a studious review, of the cause and develop- 
 ment of jrellow fever, could scarcely lead to any other con- 
 clusion, than that which Copland found himself conquered 
 by, viz., that, after all, no opinion could be sustained with 
 more irrefragable evidence than that yellow fever originated 
 in foul ships ? 
 
 To those who know what the inhalation of nitrous acid 
 fumes implies, and who have experience of the slender 
 touch that kicks the beam, in the balance between life and 
 death, in yellow fever, the following sentence must sound 
 
Introduction. 
 
 absolutely inexplicable : u In all buildings where sick are, or 
 where yellow fever prevails, there should be constant fumi- 
 gation with nitrous acid, which seems to be, as far as we 
 know, the best disinfectant for this disease." 
 
 The only possible and sufficient purifier is an unlimited 
 supply of wholesome air, and when adequate ventilation, 
 without the poisonous contamination of adjoining rooms, 
 houses, or streets, may be secured, the irritating, killing, and 
 worse than useless, vapors, so abundantly prescribed, will 
 fall into disuse. Bearing on the influence of pure or 
 impure air as the cause of yellow fever, I desire to quote the 
 words ofan excellent observer, for whom I entertain a great 
 respect, and who was commissioned, in consequence of a sug- 
 gestion of mine, to investigate yellow fever. In the second vol- 
 ume of the public health reports and papers, published by the 
 American Public Health Association, Dr. Harvey E. Brown, 
 Surgeon United States Army, has a paper on Yellow Fever 
 in the Dry Tortugas. In concluding it he says : 
 
 " I desire to offer a few remarks concerning the question 
 of the transfer or isolation of population from infected lo- 
 calities. This, to be sure, is no longer an open question. 
 Its advisability has been proved in so many instances, that 
 it is only on the ground of accumulating testimony on its 
 advantage that it is worth while to mention it. 
 
 ' ; It is a curious fact in the history of yellow fever (and, 
 perhaps, of other infectious diseases) that a community al- 
 ready infected may be moved from the locality where the 
 disease first appeared ; and that in its new and healthy lo- 
 cation, no new cases will occur, except among those who were 
 passing through the period of incubation at the time of such 
 removal. In July, 1867, yellow fever was carried by a sick 
 man from the town of Indianola, Texas, to the permanent 
 military camp, distant a mile from town. Twenty-two 
 cases and twelve deaths occurred, after which the command 
 was moved to Green Lake, a healthy country locality some 
 
6 Introduction. 
 
 twenty miles distant. But two cases occurred after the 
 removal, the remainder of the command keeping perfectly 
 well, while a few soldiers, who had been left behind at the 
 old post, all had the disease. 
 
 " In the epidemic of 1873, at Fort Jefferson, the troops 
 were removed to Loggerhead, Ky., on the 28th August, a 
 week after the disease had become epidemic. After re- 
 moval, one man was taken at Loggerhead on the 29th, one 
 on the 31st, and two on the 2d of September, all of whom 
 were promptly returned to the post, after which the disease 
 ceased at Loggerhead, and the command remained perfectly 
 healthy. When the troops moved, several men remained 
 behind at the fort ; all but one of these took the disease, 
 and that one was the ordnance sergeant, who lived in a 
 distant part of the work, and held no communication with 
 the other parts of the fort. 
 
 " The removal of the sick to a distance, leaving those 
 who have not been attacked behind, was shown to be of no 
 value in the epidemic of 1870, on Governor's Island, New 
 York harbor — cases of the disease continuing to occur for a 
 month after the sick had been so removed. This absence 
 of disposition to spread (as we may call it) has always been 
 used as a strong point in favor of the non-infectious nature 
 of the disease, but a little consideration will show the fal- 
 lacious character of the argument. The conditions in the 
 two localities are entirely different. When the fever breaks 
 out among troops or permanent barracks, its generating prin- 
 ciple quickly infects the walls, wood work, and furniture 
 of the quarters. Moreover, within the walls of a fort or in 
 barracks, there is always a certain amount of residual air, 
 which the ordinary wind-currents are not sufficient to en- 
 tirely remove. This speedily becomes charged with the 
 poison, and thus resembles that contained in the infected hold 
 of a ship, producing the disease in all susceptible persons who 
 respire it. Let, however, the population of such an infect" 
 
Introduction. 
 
 ed locality be removed into tents in an open country, and 
 all these deleterious conditions disappear. The tents should 
 be so arranged as to afford a frequent and complete renewal 
 of the atmosphere ; if they become infected, they and their 
 contents should be immediately destroyed. 
 
 " We may lay it down as an established fact that the 
 cessation of yellow fever, and its inability to spread after re- 
 moval of the well people from a locality where it exists, so 
 far from its being any argument against its infectiousness, is 
 really one in favor of it, for this reason : where the sick are 
 moved instead of the well, as at Governor's Island, in 1870, 
 the epidemic continues, all the conditions for its propaga- 
 tion being still present." 
 
 Would that observers had always been as precise and 
 reporters as logical as Dr. Harvey E. Brown. We should 
 then not have to criticize the excellent compilations which 
 are mixing "chaff with the wheat" offered to medical 
 students and sanitary officers. Can anything be more pre- 
 posterous than the plan adopted in the British Navy, en- 
 dorsed by Parkes, who says, "as a matter of precaution, the 
 present plan of three or five years' Mediterranean service 
 before passing to the West Indies seems desirable." 
 
 In his New Orleans lectures, Mr. Gamgee showed that the 
 enclosed seas, though the hottest, such as the Mediterranean 
 and the Red sea, have always been exempt from yellow 
 fever. It only penetrated, by importation, to Minorca, 
 Leghorn, Malta and Egypt early this century, carried by 
 contaminated vessels, infected directly or indirectly in the 
 West Indian Archipelago. It is this scrutiny of history 
 which arms us with facts, such as no authority has been 
 able to adduce in relation to the spontaneous origin of the 
 yellow fever on land. Mr. Gamgee has ransacked every 
 source of information, as I have done for over a quarter of 
 a century, and, apart the interesting manifestations of Oroya 
 Fever in the Andes, nothing which could in any way be 
 
8 Introduction. 
 
 confounded with Yellow Fever has been traced to specific 
 land influences. History, accurate knowledge of genuine 
 endemics, the geographical distribution of disease and the 
 overwhelming evidence of outbreaks of yellow fever in 
 ships without contact with infected lands, may be relied on 
 to confront and confound the " opinions" of those Port Phy- 
 sicians who indulge in catastrophic etiology. Noah Web- 
 ster — a great man, but a bad pathologist — is really their 
 luminary, and no one since his day has equalled him in 
 marshalling all facts, but those right ones, on which, justly 
 interpreted, now is woven an indelible generalization — that 
 Yellow Fever is the Ship Fever of the Tropical Atlantic. 
 
THE SHIP ORIGIN OF YELLOW FEVER. 
 
 X 
 
 America may well be proud of the attitude assumed, and 
 successfully maintained, by its medical men, on the great 
 question of Public Hygiene. State Boards of Health, the 
 American Public Health Association, and last, but not least, 
 the National Board of Health, represent the vigorous ef- 
 forts of practical Sanitarians for the permanent advance- 
 ment of the country's welfare. A boon beyond all price 
 to the New World is to result from efforts aimed mainly 
 at the prevention of Yellow Fever. Whatever conflicts 
 of opinioD or errors in practice may retard the work, I am 
 confident, as I said years since, that under an adequate cen- 
 tral administration by a Medical Board, the plague of 
 American commerce, more especially of Atlantic sea ports, 
 can be stayed and extinguished for all future time from the 
 bloody annals of controllable epidemics. 
 
 One year's experience of the operations of the National 
 Board of Health satisfies me that the disease is being at- 
 tacked locally on land as a contagion, whatever the precise 
 method of transmission may be, and that special centres 
 for the isolation and purification of shipping are to liberate 
 commerce of unnecessary inter-State obstructions. The 
 practical difficulties encountered will suggest the details of 
 a preventive system. The land will be cleared of the mal- 
 ady and its threatened invasion in shipping will be met ra- 
 tionally. If I know anything in medicine — if there be 
 any medical truth which I have grasped by searching meth- 
 ods of careful study — it is that, year by year, a fresh crop 
 
 ^Reprinted from G-aillard's Medical Journal for June, 1880. 
 
10 The Ship Origin of Yellow Fever. 
 
 of poison springs from foul vessels sailing in the tropical 
 Atlantic, and from such infected ships, or their contents, 
 and others infected directly or indirectly by them, the 
 country can be protected without onerous restrictions on 
 commerce. 
 
 As physicians we must never forget that prosperity is 
 the surest key to national vigor and individual health. Ob- 
 noxious quarantines and schemes of non-intercourse imply 
 an acknowledgement of our impotence. Happily we are 
 far from being driven to this extremity. The meaningless 
 term, quarantine, should be made obsolete. It is odious 
 to all and its use excites more enmity than the most tedious 
 safeguards we have to impose. Professor John Gamgee, 
 whose work on "Yellow Fever, a Nautical Disease," should 
 be studied by every medical man, has suggested to me the 
 expression "Sanitation," instead of "Quarantine Station." 
 The word sanistation refers to the practical preventive or 
 purifying measure to be applied on land or ships. Why 
 not speak of "Ship Island Sanistation" instead of "Ship Is- 
 land Quarantine"? 
 
 An unexpected incident has induced me to direct the 
 attention of my professional brethren to a correspondence 
 which has appeared in the Pensacola and other papers. 
 In reply to a circular issued by Dr. J. C. LeHardy, of Sa- 
 vannah, relating to proposed Congressional action affecting 
 the National Board of Health, whilst strongly advocating 
 that the powers of the Board should be increased rather 
 than curtailed, I remarked as follows : 
 
 " The National Board of Health has been unfortunate in 
 favoring the view that Yellow Fever is endemic in Cuba. 
 The report of the Havana Commission must, before another 
 decade is past, meet, as it deserves, with the strongest con- 
 demnation. Such is my opinion on this point. It is diffi- 
 cult enough to get the Spanish Government to do its duty, 
 towards this country, by purifying the Pearl of the Antilles, 
 
The Ship Origin of Yellow Fever. 11 
 
 and how can we hope for their energetic action when an 
 American Physician, clothed with all the prestige of au- 
 thority, assures the world that Yellow Fever in Havana is 
 inevitable ? 
 
 " In this most healthy region, (Pensacola, Ma.,) singularly 
 free from contagious maladies, where climatic seasonal con- 
 ditions only rarely favor the propagation of imported yellow 
 fever, and where the winter hibernation of the malady has 
 been proved impossible over a period, to my knowledge, of 
 30 years, how can we throw open our Port to commerce, in 
 summer and autumn, when a single ship from Cuba having 
 one case of the disease on board, will close all inland com- 
 munication ? 
 
 " It is, I confess, with absolute impatience that I learn of 
 the continued advocacy of the local origin of yellow fever, 
 either on this Continent or in the West Indian Islands. 
 The blunders of the Profession are still in striking contrast 
 to the common sense of the people, on the one vital ques- 
 tion of the communicability of this disease. The eloquent 
 teachings of shot-guns quarantine — detestable as every form 
 of real or apparant inhumanity must be — may yet drive 
 home the substantial truths, in relation to the transmissi- 
 bility of the malady by Eailroads and Kefugees." 
 
 This provoked an answer from Dr. Chaille, which tends 
 to remove any doubt as to the tendency of the Report, 
 which so far as I am aware has not been discussed in the 
 Medical Journals. That such discussion is urgently called 
 for, I trust to prove by comments intended to avert mis- 
 chief if they fail to elicit truth. 
 
 New Orleans, March 19, 1880. 
 Editor of the Pensacola Advance : 
 
 Dear Sir : My attention has been called, this day, to the letter of 
 Dr. Hargis on yellow fever, published in your issue of March 10, 1880, 
 and I respectfully submit that in opening your colurns to a denuncia- 
 tory attack, common j ustice requires that equal publicity should be 
 given to the defence. 
 
12 The Ship Origin of Yellow Fever. 
 
 Dr. Hargis, whom I know, and have had reason to regard Math 
 friendship and respect, states: "The National Board of Health has 
 been unfortunate in favoring the view that yellow fever is endemic in 
 Cuba. The report of the Havana commission must, before another dec- 
 ade, meet, as it deserves, the 'strongest condemnation. Such is my 
 opinion on this point. " 
 
 Dr. Hargis would confer a favor by stating when and where the 
 National Board of Health "unfortunately favored" any such view. 
 This board did instruct its Havana committee to investigate "the so- 
 called endemicity of yellow fever in Cuba." I am not aware that it 
 has ever said or done more than this to unfortunately favor a view, in 
 opposition to which Dr. Hargis will find it difficult to cite one single 
 Cuban authority, of any weight in medicine. In Cuba yellow fever is 
 very certainly a "so-called endemic." 
 
 While this is the non-committal position of the National Board of 
 Health, the Havana yellow fever commission calls attention to the in- 
 definiteness of the signification of the word " endemic," and then states 
 that if the word is accepted as signifying an habitual annual prevalence 
 of a disease, and the existence of causes favoring its propagation, then 
 the facts prove that yellow fever is endemic in certain localities in Cuba. 
 The facts, on which this conclusion is based, are stated, so that no man 
 can be led astray either by the indefiniteness of the word endemic, or 
 by the theories and fancies of the commission, which, under the cir- 
 cumstances, will await with great equanimity the expiration of Dr. 
 Hargis' fatal decade. So much for "this one point." 
 
 Dr. H. also writes: "It is difficult enough to get the Spanish Gov- 
 ernment to do its duty towards this country by purifying the Pearl of 
 the Antilles, and how can we hope for this energetic action when an 
 American physician, clothed with all the prestige of authority, assures 
 the world that yellow fever in Havana is inevitable?" I, Mr. Editor, 
 am this unfortunate unrepentant " American physician." Here, again, 
 as everywhere, the facts were first given, in order that "the world" 
 might correctly judge the validity of the conclusion. Those facts are, 
 briefly, that since 1761 yellow fever has annually prevailed in Havana; 
 that all the favoring conditions during the past one hundred and 
 twenty-eight years persist; that there were no evidence that these con- 
 ditions would be arrested, and that as long as these conditions persisted 
 it was inevitable that the effect would persist. The Havana commis- 
 sion is well assured of the correctness" of the premises of this syllo- 
 gism, and submits the conclusion with great confidence to the test of logic. 
 
 In fine it seems that Dr. Hargis is an earnest advocate for the origin 
 of yellow fever on ships — a view which the Havana yellow fever com- 
 mission earnestly condemns, and here, I imagine, is the great cause 
 
The Ship Origin of Yellow Fever. 13 
 
 of his offence against, and condemnation of, the commission. But the 
 commission was careful to state the facts on which its opinion was 
 founded, and feels very confident that however false this may be, all 
 just and generous men will view with liberal charity any such con- 
 clusion when preceded by and accompanied with the very facts from 
 which it was deduced. 
 
 In conclusion, Mr. Editor, permit me to make a prophecy about 
 that "next decade " with which Dr. Hargisso unmercifully threatens 
 the Havana yellow fever commission. This prophecy is, that at its 
 expiration many more doctors than at present (though they are nu- 
 merous) will think it as idle a waste of words to discuss the origin of 
 yellow fever as to discuss the origin of a cat or of a dog. The great 
 practical question is with yellow fever (as with all vegetables, ani- 
 mals, and epidemic diseases), how is it propagated? For rny own 
 part, I have even less hope of determining the origin of yellow fever 
 than the origin of small -pox, scarlatina, typhoid fever, cholera, trichina, 
 tape worm, etc. Now, if Dr. Hargis will inform us how the causes 
 of any of these originate, while handling with so much confidence the 
 origin of yellow fever, he will confer an inestimable favor on science 
 and mankind. In order that the correctness of my statements may be 
 tested, I forward you a copy of the report of the Havana yellow fever 
 commission. Yours, very truly, 
 
 STAFFORD E. CHAILLE, M. D., 
 President of Havana Yellow Fever Commission 
 
 of the U. 8. National Board of Health. 
 
 To which I replied as follows : 
 
 Editor Pensacola Advance : 
 
 Sir: Grateful am I for the publication this day of my friend Dr. 
 Chaille's remarks on my letter which appeared on the 10th inst. I 
 have known Dr. Chaille for many years. It is the privilege and duty 
 of professional men to discuss scientific questions, with ardor and 
 force, based on intelligent conviction, whilst avoiding personalities. 
 You, sir, have enabled Dr. Chaille to define his position, and to stand 
 in self-defense in the most manly attitude, not sheltered behind the 
 titles of the Havana Commission and the National Board of Health. I 
 accept his challenge only for truth's victory and the demolition of 
 specious argument or theory based on false premises. 
 
 Dr. Chaille holds himself responsible for "a concise preliminary re- 
 port, stating the general results accomplished " by the Havana com- 
 mission, so far, at all events, as the question in dispute, and which 
 refer to the endemicity of yellow fever in Cuba and the origin of the 
 disease in ships and harbors. 
 
14 The Ship Origin of Yellow Fever. 
 
 Whatever mystery there might have been as to his interpretation of 
 the word endemic it is dispelled. It is used by the Havana yellow 
 fever commission to signify the "habitual prevalence of a disease and 
 the existence of causes favoring its propagation." The "facts are, 
 briefly, that since 1761 the yellow fever has annually prevailed in 
 Havana; that all the favoring conditions during the past one hundred 
 and twenty-eight years persist; that there were no evidences that 
 these conditions would be arrested, and that as long as these conditions 
 persisted it was inevitable that the effects would persist." 
 
 Words in diplomacy may be used to conceal man's thoughts; the 
 language of science should be precise. Webster, after Hoblyn, de- 
 fines endemial or endemic as signifying "peculiar to a people or a na- 
 tion, and endemization as equivalent to naturalization, to indicate an 
 indigenous growth. We speak of ague as an endemic of the marshes. 
 It is an autocthonous disease springing from the soil — from local con- 
 ditions. Cholera is the endemic of Hindostan, and only known to us 
 in America like yellow fever, as an imported plague, pestilence, or 
 epidemic; and, at most, medical men have spoken of sporadic cases, 
 to indicate isolated attacks, before or after epidemics, or as casual ac- 
 cidents. When the Havana commission, in its report, speaks of small- 
 pox as endemic in Havana, it confounds yellow fever with the purely 
 contagious maladies, and classes it where it cannot for one moment 
 be placed by an enlightened pathologist. That Dr. Chaille commits 
 this serious error is shown by the important conclusion, that "it is as 
 idle a waste of words to discuss the origin of yellow fever as to discuss 
 the origin of a cat or dog" — "for my own part," he adds: "I have 
 even less hope of determining the origin of yellow fever than the 
 origin of small -pox, scarlatina, typhoid fever, trichina, tapeworm, etc." 
 The fact, sir, that yellow fever is totally unlike any of these diseases, 
 that it is entirely specific and distinct, and, unlike any other known 
 plague, invades land rather than springing and spreading from land, 
 stamps it with peculiarities which enable us to determine its origin. 
 There is no more interesting truth in pathology, nor one better estab- 
 lished to those who are not blind or deaf to the clearest evidence, that 
 the yellow fever poison, engendered and reproduced outside the hu- 
 man system, is the active cause of an infection and malignant pesti- 
 lence which may travel under favorable conditions wherever man 
 may go, even as far north as Quebec. The correct history of yellow 
 fever places it indisputably amongst the localized diseases of the globe, 
 and its habitat since the discovery of the new world, and not before, 
 has been the tropical Atlantic. It has not originated in the Pacific, 
 nor in the Indian Ocean; in the Mediterranean, nor in the Red Sea. 
 But within the tropical Atlantic belt the records of all islands and 
 
The Ship Origin of Yellow Fever. 15 
 
 cities, including Havana, is the record of every American city such as ' 
 New Orleans and Pensacola. 
 
 Since, therefore, yellow fever has unquestionably its centre of de- 
 velopment on ships in the tropical Atlantic, and is transmissible 
 from the ship to the port and from the port back to the ship again, 
 many intelligent and trustworthy observers, without prejudice and 
 sophistry, have recorded the spontaneous development of the disease 
 on the broad ocean. If the vast array of facts, carefully studied, indi- 
 cate this to be possible and frequent, the acknowledged impossibility 
 of tracing its land origin anywhere, indicates that I am fully justified 
 in considering the disease in its inception as a. ship fever. 
 
 Dr. Chaille did not hesitate in his concise report to devote ample 
 space to the denunciation of this view and of those who entertained it. 
 He said "there were formerly many, and there are still some few, 
 who, without personal experience or extensive knowledge of the spec- 
 ial subject, look upon it in a much simpler light. They pronounce 
 yellow fever a "nautical disease." Until the publication last October 
 of Prof. Gamgee's work, entitled " Yellow Fever, a Nautical Disease," 
 I was practically the only person who had since 1858 adopted and 
 propagated the idea that yellow fever was a disease of ships at sea; 
 and since 1839 I have been an active observer of six great epidemics 
 in Mobile, New Orleans, Pensacola and Milton, besides an annual ex- 
 perience with many sporadic cases amongst the shipping in this bay 
 and the United States marine hospital. 
 
 But Dr. Chaille thinks naval surgeons best entitled to credence, and 
 quotes Dutroulau, who was compelled to publish in 1851 that in not 
 a single instance of many infected vessels did the disease "originate 
 onboard." This is a sample of the authorities and facts given "in 
 order that the world might correctly judge the validity of the conclu- 
 sions," and the Havana commission submits this "with great confi- 
 dence to the test of logic." 
 
 There are not many physicians in this country who have access to 
 French medical libraries, and Dr. Chaille has not sought the refer- 
 ences, numerous enough in the English language. His champion is 
 Dutroulau, whose recorded facts and main conclusions Dr. Chaille 
 passes over in profound silence, with the object, I suppose, to use his 
 own words, that "all just and generous men will view with liberal 
 charity any such conclusions when preceded by and accompanied 
 with ' ' his own selection of data. ' ' I have not read Dutroulau' s works, 
 but I have before me the very able lecture delivered by Prof. Gamgee 
 on the 16th of December, in New Orleans, on the possible extinction 
 of yellow fever, and from which it appears that Auguste Frederic Du- 
 troulau said in bis thesis, published in 1842, that an indispensable con- 
 
The Ship Origin of Yellow Fever. 16 
 
 dition of the focus of development {foyer d' emanation) is its mari- 
 time attribute." Nay, more, the examples are not rare of vessels in 
 which yellow fever has declared itself spontaneously in the open sea 
 (en pleine mer), and without having communicated with any infected 
 land." He then reports a typical case, too long to be quoted, which 
 occurred in 1833 in the brig Cuirassier, aboard of which Dutroulau was 
 the surgeon in charge. 
 
 In 1853, in the Archives Generates de Medicine, Dutroulau distin- 
 guished the endemic or land miasms from the yellow fever poison 
 which shuns the marshes. He said, yellow fever is limited to a very 
 short distance from the sea-shore, whereas paludal fevers are ob- 
 served wherever marsh miasm occurs, and authorizes the conclusion 
 that the miasma of yellow fever derives one of its essential characters 
 from the influence of the sea. More recently still, and in the very 
 work quoted by Dr. Chaille in his report, Dutroulau declares that the 
 essential and primary cause of yellow feveris localized on the sea — "an 
 infection proper to certain maritime localities." 
 
 I am now actively engaged in the preparation of my work to be 
 entitled "The Tropical Atlantic Plague, Yellow Fever," wherein I 
 shall show how simple and grand the truth is, as revealed hy history, 
 coupled with a wide experience in several cities of numerous epidemics. 
 The science of pathology is not so hopelessly without basis, as Dr. 
 Chaille indicated when he confounds plagues proper, the pure con- 
 tagia ever propagated from pre-existing cases, such as small-pox, 
 with diseases like yellow fever of localized origin. Anxious as I am 
 to see the work of the National Board of Health flourish for the 
 salvation of our country, I trust to show yellow fever is an endemic 
 of no land, in the sense in which the word endemic is defined by the 
 profession at large. Once this is acknowledged, and the mercantile 
 marine purified, yellow fever must become extinct. 
 
 I am, sir, your obedient servant, 
 
 EOBT. B. S. HARGIS, M. D. 
 
 This was succeeded by the two following letters : 
 
 New Orleans, March 31, 1880. 
 Editor op the Pensacola Advance: 
 
 Dear Sir — Permit me to furnish Dr. Hargis a brief reply, which will 
 be final, because if I had time and inclination, which I have not, to 
 engage in a newspaper controversy on the problem of yellow fever, 
 I despair of either receiving or conferring benefit by controverting an 
 opponent who so much misunderstands, and, apparently for this 
 reason, misrepresents me. This is not the less discouraging because 
 
The Ship Origin of Yellow Fever. 17 
 
 of my friendly and firm conviction that the misrepresentations are 
 without intention or bad purpose. 
 
 My first letter was designed to show how groundless was Dr. Har- 
 gis' charge against the National Board of Health, to indicate how lit- 
 tle provocation he had for denouncing with strongest condemnation 
 and consigning to the vengeance of "the next decade " his brother 
 physicians, — animated by scientific zeal, integrity and knowledge, pos- 
 sibly as great as his own, and to intimate that he had misrepresented 
 his true cause for his "strongest condemnation." His last letter, of 
 March 27, fully confirms my positions in reference to these three points, 
 and L very much regret that additional misrepresentations, some im- 
 plied others clearly expressed, should tempt me again to weary your 
 readers. 
 
 For my own credit, and the honor of the position held, it is to be 
 hoped that there has been misrepresentation (implied) as to my ''di- 
 plomacy" and "lack of precision in the use of scientific language, "as 
 to my "specious arguments based on false premises," as to my ignor- 
 ance of the yellow fever literature of the English language, as to my 
 being "blind or deaf to the clearest evidence, " and as to my woeful de- 
 ficiencies as an "enlightened pathologist." I have long taken an 
 humble part in medical literature, but am unaccustomed, and intend 
 to remain unaccustomed, if silence will assure it, to such implications. 
 
 Dr. Hargis persists in misrepresenting my views as to that ill-de- 
 fined word "endemic," and upbraids me for the use of it with " mys- 
 tery," but if used in a manner mysterious to him alone, am I respon- 
 sible ? He misrepresents the value I attach to Dutroulau's evidence, 
 and he misrepresents — apparently misled by another — that evidence it- 
 self. He misrepresents my views as to the relationship between yel- 
 low fever and such diseases as small-pox, failing here, as elsewhere, 
 to understand even in what particulars I agree with him. Finally, he 
 misrepresents my own and the correct signification of the word "ori- 
 gin." 
 
 Even should he accomplish the Herculean feat of convincing others 
 than himself ' ' how simple and grand the truth is revealed by history, 
 coupled with a wide experience in several cities of numerous epidemics 
 (whatever this may mean) and that yellow fever originates on 
 ships, he would then have done no more than prove where the disease 
 originates, not how it originates, nor what the poison is, and would be 
 just as far from the true origin of the disease as he would be from the 
 true origin of a cat, — after having conclusively demonstrated that some 
 cats have made their first appearance in his stable. Would any one 
 discussing the "origin of man" deem himself answered by even the 
 most conclusive proofs as to the mere place where man made his first 
 
18 The Ship Origin of Yellow Fever. 
 
 appearance ? In such sense did I very manifestly use the word origin, 
 and not in the sense misrepresented by Dr. Hargis. 
 
 If having thus specified the more important misrepresentations, Dr. 
 Hargis should fail to appreciate them, then one of two things : Either 
 this failure to appreciate will be his misfortune and not my fault, or 
 my ignorance of the English language is so dense that I ought to re- 
 frain from abusing it further, to the vexation of Dr. H. and of your 
 readers. Therefore I decline to enter into long and tedious explana- 
 tions for the purpose of exposing in detail the misrepresentations which 
 have been specified. Should any of your readers desire such explan- 
 ations, they can find those most essential by a perusal, more critical 
 and thoughtful than Dr. Hargis has given, of that very report which, 
 in his opinion, "deserves the strongest condemnation." On the other 
 hand, since the majority of your readers do not probably care a button 
 about either the subject or misrepresentations, or explanations, they 
 will rejoice that I hasten to subscribe myself, 
 
 Yours, very truly, 
 
 STANFORD E. CHAILLE, M. D. 
 
 To the Editor of the Pensacola Advance : 
 
 Sir — Dr. Chaille has anticipated a resolve which I had formed, that 
 any technical discussion between us should cease in the public press. 
 The medical profession shall judge who it is that "misunderstands" 
 or "misrepresents." Argument and evidence can only be fairly met 
 by argument and counter-evidence. I seek enlightenment, whilst 
 standing firm by the knowledge so far gained. 
 
 Dr. Chaille attempts to fasten on me some charge against the Na- 
 tional Board of Health. So much depends on comprehensive and uni- 
 form sanitary measures, that the influence of the medical profession 
 should stand pre-eminent in the nation's councils, and no one shall 
 excel me in fostering a just confidence in its chosen representatives. 
 
 Fortunately, Dr. Chaille assumes the personal responsibility of de- 
 fending views which I condemned, and data which I rejected as with- 
 out foundation. Pie defines our relative position. I do not condemn 
 the entire Havana Commission. Far from it ; — the researches of Dr. 
 Sternberg promise to result in great good. 
 
 When refusing to hamper the operations of the National Board, by 
 opposition before Congress, it was desirable to indicate that my action 
 was not dictated by personal preference, but simply by a sense of pub- 
 lic duty. In my letter to Dr. Le Hardy I held myself free to take ex- 
 ception to that which I deemed pernicious, whilst supporting the ex- 
 
Endemicity of Yellow Fever in Cuba. 19 
 
 cellent general work of the Board. My Pensacola friends must have 
 thought, for many years past, that I was fighting the winds, so con- 
 stant and earnest have been my utterings on the subj ect of yellow fever, 
 and its possible exclusion, not only from America, but all other lands - 
 The time has come to show whether the opportunities enjoyed have 
 been wasted, or whether another century must witness periodical out- 
 bursts of malignant pestilence, owing to some agency which mysteri- 
 ously haunts the minds of Dr. Chaille and others, as beyond the ken 
 and grasp of man. 
 
 Dr. Chaille requires, as the only measure of safety, non-intercourse 
 as absolute as possible. He declares the ships are primarily contami- 
 nated from the shore, catch the disease from land, whereas all yellow 
 fever history points unmistakably the other way. 
 
 I have a higher regard for your readers than to think, with Dr. Chaille, 
 that the majority "do not care a button " about this subject. Attempt 
 to fence in the Gulf or other ports, by impenetrable barriers, and then 
 we may see what the non-intercourse programme implies. Our mer- 
 chants care not less for Pensacola than the New Orleans citizens for 
 their port. In the last they are raising one hundred thousand dollars 
 this year for sanitary purposes to avoid the inconvenience of useless 
 quarantine and non-intercourse. They are led in this by an experi- 
 enced physician, Dr. C, B. White, whose influence in such a com- 
 munity does honor to the profession, of which he has long been an 
 energetic member. 
 
 I shall in due course announce in which of the medical journals my 
 views as to Dr. Chaille 's writings are to be amplified, and meanwhile 
 I subscribe mj^self, 
 
 Your obedient servant, 
 
 ROB'T B. S. HARGIS, M. D. 
 
 The charges and declarations made by Dr. Chaille, in the 
 foregoing letters, are of far too serious importance not to be 
 fairly and fully met by arguments and statements, which I 
 respectfully submit to the judgment of the profession. In 
 the first place I shall speak of the 
 
 ENDEMICITY OF YELLOW FEVER IN CUBA. 
 
 Dr. Chaille says it would be difficult " to cite a single 
 Cuban authority of any weight in medicine," in opposition 
 to the view of the endemicity of yellow fever. To speak 
 more plainly, Cuban physicians advocate "local origin," 
 
20 Endemicity of Yellow Fever in Cuba. 
 
 and being in this, in my estimation, a quarter of a century 
 behind the time, it is essential that the National Board of 
 Health be informed of the actual and substantial grounds 
 for entertaining such an opinion. 
 
 Dr. Chaille insists on the great value of experience on 
 this question. No one doubts it ; but the most skillful hy- 
 gienists and epidemiologists are not the busiest practition- 
 ers who visit the sick. I have been familiar with yellow 
 fever for forty years, but have learnt that sanitarians who 
 have never witnessed an epidemic can grasp the practical 
 questions better than I can. An episode in the history of 
 American medicine may prove instructive and a warning 
 to writers who belittle their adversaries. When Philadel- 
 phia was scourged by yellow fever in 1793, Dr. Chas. Cald- 
 well was a truly brilliant student of medicine. He was the 
 first and last in charge of the city hospital and has described, 
 in a graphic manner, the dread of contagion which caused 
 medical men and students to fly, thus rendering assistance 
 scarce. The nurses were few and inexperienced. The pro- 
 visions and arrangements of the hurriedly prepared asylum 
 were in all respects limited, ciude and insufficient. In fact 
 the whole establishment being the product of but two or 
 three days labor " was a likeness in miniature of the city 
 and the time, a scene of deep confusion and distress, not to 
 say of utter desolation." " No apartments being yet pre- 
 pared for the use and accommodation of the medical assist- 
 ants, I was obliged," says Dr. Caldwell, " to eat, drink and 
 sleep (when indeed I was permitted to sleep) in the same 
 room in which I ministered to the wants of the sick. And 
 not only did I sleep in the same room with my patients 
 but also at times on the same bed," receiving occasionally 
 " on some part of my apparel a portion of the matter of 
 black vomit, and I was inhaling the breath of the sick, and 
 immersed in the matter which exhaled from their systems, 
 every hour of the day and night." He often woke to find 
 
Endemicity of Yellow Fever in Cuba. 21 
 
 his patient dead beside him. Under these circumstances 
 Dr. Caldwell abandoned his belief in the contagiousness of 
 yellow fever and published the fact. At a meeting of the 
 Philadelphia Medical Society, in the fall of the year, he re- 
 deemed a promise made to Dr. Eush and read a paper on 
 the domestic origin of the disease. He was opposed by 
 several who had left during the epidemic, and in the most 
 dexterous manner he said, " Yellow fever has but just dis- 
 appeared, the miasm productive of it having been distroyed, 
 as it will always be, by the occurrence of cold weather. 
 My wish, therefore, sir" (addressing the Chairman), "is to 
 hear from the gentlemen arguments in favor of its foreign 
 origin, drawn from what they have learned by their recent 
 intercourse with it, in the way of observation as men of 
 science, and of experience as physicians engaged in the 
 treatment of it." 
 
 " This I knew," says Caldwell in his autobiography, 
 " would be sail and wormwood; because not a single indi- 
 vidual who, as yet, had contended, in the present debate, 
 that yellow fever was an imported complaint, had ever seen 
 a case of it. They had all hurried into the country on its 
 first appearance in Philadelphia, and had now but just re- 
 turned, to instruct the community, including those who had 
 met it, contended with it, and studied it, as the mystery of 
 its origin." 
 
 Dr. Caldwell has, and many since his time have, overlooked 
 the fact that, as with a statesman defending a nation, who 
 controls generals, or distant fields of battles, though himself 
 not a warrior, so in epidemic times the calm and broad 
 views of the events at many points, in a country so vast as 
 this, give, the skillful scientific pathologists, a clearer per- 
 ception than the local observer of the adverse influence he 
 has to antagonize in order to limit the spread of disease. 
 It is thus also with the logical mind building up a sound 
 conception of the nature of plagues. He cannot afford to 
 
22 Endemicity of Yellow Fever in Cuba. 
 
 overlook anything, or any one in the past, and, with far 
 greater justice can we to-day, than ever before, apportion 
 to Chisholm and Bancroft, Hosack and Kush, Chervin and 
 LaKoche, the praise or the blame for the truths or errors 
 they promulgated. Who more than Caldwell and Eush 
 could vaunt a practical experience, and being trusted by all 
 in the afflicted city, they imposed on the stricken a course 
 of blood-letting and the famous " ten and ten dose of calo- 
 mel and jalap? " Perhaps there is no living American 
 who has seen more yellow fever than I have since 1859, so 
 that I am entitled to encourage our unprotected hygienists, 
 especially in the North, not to risk their lives, to add 
 weight to their opinions, whilst engaged in the laborious 
 duty of culling, for the common good, from the experience 
 of centuries. Nay, more, the events recorded by unsophisti- 
 cated minds, by young physicians, when careful note takers, 
 rather than burdened with years and theories, will often be 
 found to bear the impress of the most solid fact. • This is 
 conspicuously the case with the greatest of the authorities 
 quoted by Dr. Chaille, viz., Dutroulau. 
 
 We can look back to-day with composure and compe- 
 tent perception to the many fruitless efforts made to indi- 
 cate the localities and circumstances charged with the 
 " domestic origin " of yellow fever on American soil. The 
 question, settled early by Tully and others of the broad line 
 of separation between endemics, or malarial fevers of marshes, 
 and the pestilence carried North annually right into the 
 ports on the Connecticut, is still feebly agitated and periodi- 
 cally demolished. Land malaria and filth on land are 
 charged with the local production of yellow fever only by 
 those who do not read and cannot observe. 
 
 The " exotic origin " of the malady may be said to per- 
 vade the American medical mind as the fashionable opinion 
 of the day. So far so good ; but some land must be charged 
 with the odium of developing this pestilence, since its local- 
 
Endemicity of Yellow Fever in Cuba. 23 
 
 ized character is too striking to be ignored, and hence the 
 importance of Dr. Chaille's remarks concerning Cuba. 
 
 A very common, and amply justified, opinion is that yel- 
 low fever poison developes and propagates outside the hu- 
 man body, and it has been declared by such authorities as 
 Jewell that " there is no adequate reason whatever for be- 
 lieving that it attaches especially to, or is multiplied in, the 
 bodies of the sick." The latest views promulgated tend to 
 oppose the idea of the spontaneous origin of yellow fever 
 anywhere. In a clinical study by S. M. B., in the April 
 number of the American Journal of the Medical Sciences, it 
 is stated that yellow fever "is reproduced chiefly, if not 
 wholly, within the body." The indispensable " germ " 
 spreading from man to man is at the root of this opinion, 
 but I agree with Mr. Gamgee that "there is no foundation 
 in fact for the plausible explanation of the propagation of 
 the disease by the reproduction of the lowest organisms." 
 
 With all these conflicting declarations before them, the 
 National Board of Health very naturally sought to deter- 
 mine whether Cuba constituted a primary and permanent 
 home of yellow fever. In other words whether it is en- 
 demic there as it was once supposed to be in New York. 
 In attempting to settle this question Dr. Chaille, who has 
 acknowledged his responsibility for this portion of the 
 Havana Commission Eeport, neglects the common signifi- 
 cation given by medical writers to the words endemic and 
 endemicity. He says that " the word endemic will not be 
 used to imply that either this, or any other disease, which 
 there may be occasion to thus designate, owes its origin 
 necessarily to local causes." Then why use the word at all, 
 other than to indicate a disease peculiar to the people or 
 the nation? That endemicity in Cuba in relation to yel- 
 low fever is in a temporary or controllable condition is in- 
 dicated by the statement that " the day may come when 
 the people of the United States will demand whether their 
 
24 Endernicity of Yellow Fever in- Cuba. 
 
 welfare would not be best promoted by suspension of inter- 
 course with Cuba during certain months of the year." 
 Since small-pox would probably be found " as exception- 
 ally and almost as severely prevalent as yellow fever, it 
 has also become endemic in Cuba," and to fix beyond perad- 
 venture Dr. Chaille's position, the following statement may 
 be noted : " It should not be forgotten that while none of 
 the causes referred to suffice to always explain all the vari- 
 ations in the prevalence of yellow fever, during certain 
 seasons and years, yet that this terra incognita of this dis- 
 ease is also a terra incognita for small-pox, malarial, and 
 other diseases. Science has no right to expect explana- 
 tions of the mysteries of the one, while still unable to solve 
 the similar mysteries of other much more familiar and 
 widely prevalent diseases." 
 
 Small-pox has its home wherever man can live and be 
 approached by other men. Malaria has a strictly defined 
 boundary, as its source, as much as a river has in a moun- 
 tain. Drain the land within these limits and malaria dis- 
 appears. Kelapsing fever originated during the great Irish 
 famine, and travelled across the Atlantic. The geographi- 
 cal distribution of yellow fever and its relations to com- 
 merce, wars and revolutions, are illustrated by an array of 
 facts not to be surpassed in epidemiology and only equalled 
 by the abundant data possessed regarding Asiatic cholera. 
 
 Dr. Chaille has but sought to justify the utter confusion 
 in which, to say the least, an irregular use of the words en- 
 demic and endemicitv, has created in the minds of readers 
 of his preliminary report. Since he objects to Webster's 
 definition after Hoblyn, I have searched a few of the prin- 
 cipal authorities whose works I possess. Dr. C. B. Wil- 
 liams in his Principles of Medicine settles the question as 
 understood by the whole profession. He avoids the ex- 
 pression by certain causes " inasmuch as this involves a hy- 
 pothetical signification of their modes of action." Endem- 
 
Endemicity of Yelloic F'ever in Cuba. 25 
 
 ics he says " are instances of disease which may be said to 
 dwell among the residents in particular spots ; hence they 
 are called endemic in the people." His examples are ague 
 and goitre. Other diseases are not confined to particular 
 localities '*' although they infest some more than others." 
 * * * * " They attack a whole district, a 
 whole country — nay, almost a whole hemisphere These 
 are called epidemics, like a blight or pernicious influence 
 blowing on the people." 
 
 Dr. Aitkin says, in his Science and Practice of Medicine, 
 li endemic influences result from those conditions or agen- 
 cies peculiar to a locality which favor the development of 
 various miasmatic diseases, and may thus account for their 
 s udden origin. Such diseases are then said to be endemic. 1 ' 
 
 Dr. Koger S. Tracy, in Dr. Buck's Hygiene, speaking of 
 endemic diseases, says : " The type and exampler of such 
 diseases is the malarial fever, which takes upon itself so 
 many forms and causes so much misery and so many broken 
 constitutions in the West and South-west, and which shows 
 itself with something less of intensity at various points along 
 the Atlantic coast. Typhoid fever can almost be called 
 endemic in the beautiful valley of the Connecticut, and 
 tetanus in a certain district of Long Island. These diseases 
 are due to local causes, and it is altogether probable that 
 these causes will at some time be ascertained ; and when 
 they are once known, means can be adopted for their ex- 
 tinction." 
 
 Dr. Dunglison, in his Dictionary on Medical Science, says 
 " an endemic is owing to some peculiarity in a situation or 
 locality. Thus ague is endemic in marshy countries ; goitre 
 at the base of lofty mountains, etc. Some authors use the 
 term in the same sense as epidemic." 
 
 Dr. Daniel Drake, than whom it is not easy to quote a 
 more precise author, whatever opinion we may form of his 
 conclusions, anticipated, many years since, in his aetiological 
 
26 Endemicity of Yellow Fever in Cuba. 
 
 deductions, all that Dr. Chaille implies when speaking of 
 the endemicity of yellow fever in Cuba. Dr. Drake said, 
 " whether the yellow fever of Havana originated there, or 
 was introduced from abroad, we may speak and treat of it 
 as a disease of that city ; seeing thata, lthough it is not ex- 
 tensively prevalent every summer, it is never absent, and 
 thus, if not a native, is a naturalized endemic" 
 
 Now what influence has Dr. Drake exercised on the Pro- 
 fession in relation to yellow fever? The hopeless confusion 
 he launched the subject in, after the sound teachings of 
 Tully and others, may be gleaned by the following. He 
 said : " Is yellow fever, then, it may be asked, merely the 
 remittent autumnal fever with which we are all familiar? 
 The answer, according to these views of its origin is, that 
 it is one of the varieties, as a tertian fever is another." 
 That is where alone endemicity leads us, and the National 
 Board of Health undoubtedly wished to know if the West 
 Indian Islands were the plague spots whence yellow fever 
 sprang, and was annually propagated. In other words, 
 whether the source of the great stream of yellow fever, like 
 the source of a river in a mountain, was not absolutely re- 
 stricted to islands, of which Cuba is a type. 
 
 Dr. Chaille has favored us with many useful facts and 
 inferences relating to yellow fever. Every one of these may 
 be cited as evidence against the domestic origin of yellow 
 fever in Cuba, in plain medical language, against its 
 endemicity in that Island. He says that " knowledge of na- 
 ture's laws, of disease, of yellow fever particularly, and of 
 other subjects relating to the present topic, convert the 
 suspicion, justified by scanty historical records, into an abso- 
 lute conviction that yellow fever was at least worse, in some 
 of the West Indies with their first settlement by Europeans." 
 No record or tradition lends the slightest support to the 
 view that yellow fever reached the West Indies Islands be- 
 fore the ships of Columbus and his followers. Indeed, the 
 
Endemicity of Yellow Fever in Cuba. 27 
 
 first epidemic of yellow fever, that probably ever occurred 
 in this world, was that carried to Barcelona in 1497 by 
 sailors returning to that port from the second expedition to 
 the " Indies." The second epidemic of which we have any 
 approximately reliable notice, was that recognized as a 
 "new disease" which was named " coup de barre" from the 
 intense rachialgia, and which was introduced into the Antil- 
 les by the ship Le Boeuf, from Rochelle, in France. Neither 
 the West Indies in the Barcelona epidemic, nor Rochelle in 
 the first invasions of the New World, had anything to do 
 with the probable development of these epidemics, which, 
 like so many others, in my opinion, emanated from the 
 tropical Atlantic. 
 
 But we may pass from inferences and suppositions which^ 
 however interesting, have only a very limited scientific 
 value, and truly does Dr. Chaille remark that, " though 
 Spanish literature is unusually rich in valuable histories of 
 Cuba, no allusion has been found justifying even a suspicion 
 that yellow fever was known in the Island from 1655 to 
 1761. On the contrary, repeated references are made to the 
 remarkable salubrity of Havana, and the non-existence of 
 any exceptional or devastating diseases during this in- 
 terval." 
 
 That Cuba is naturally a most healthy Island is proved by 
 Dr. Charlie's statistics, which indicate, in the special case of 
 Havana, a salubrity equal to the finest European and Ameri- 
 can cities, if " endemic yellow fever," " endemic small-pox," 
 and phthisis in people seeking a warm climate, are excluded. 
 Not all the filth, so forcibly described, nor a tropical climate 
 of the most definite character engender any plague there. 
 As to yellow fever, it " habitually prevails in every place in 
 Cuba from which reports were received, provided these 
 places are of any size or commercial importance, and contain 
 any considerable number of unacclimated persons to furnish 
 food for the wide-spread poison." 
 
28 On Acclimation. 
 
 No epidemiologist can miscontrue the meaning of the 
 sentence I have marked in italics. An endemic attacks the 
 few or the many which are subjected to the evil influences 
 engendering such a disease. The very spot mentioned by 
 Lind, in his Diseases of Hot Climates, as having proved fatal 
 in the summer and autumn of 1766 to French settlers on 
 the Escambia River is well-kuown to me, and frequently 
 since, attempts at peopling that place have ended in the 
 sickness and death of all who dared to sleep one night in 
 that locality, in August or September. 
 
 ON ACCLIMATION. 
 
 I must also object jnost strenuously, especially when speak- 
 ing of yellow-fever, to the use of the words acclimation, ac- 
 climated and unacclimated. All persons with slight dif- 
 ferences of race predispositions are liable to yellow fever, 
 however long they may have resided anywhere on land- 
 Protection is only absolutely gained by an attack of the dis- 
 ease, which in some cases may be slight and barely percep- 
 tible. My objection to the word acclimation extends also 
 to the true endemic, for a wide experience of these maladies 
 has proved to me that people inhabiting malarious regions 
 suffer more the longer they remain there, and the fatal form 
 of yellow disease, a malignant paludal fever, as in the cane 
 brakes of Alabama, ultimately develops. 
 
 Dr. Chaille " proves how erroneous is the idea that yellow 
 fever is especially and exceptionally severe in the shipping 
 and harbor of Havana. He has not stated what my own 
 extensive and very precise inquiries have indicated, viz.: 
 that the crews of ships frequenting all West Indian and 
 Gulf Ports are protected to the extent of full 50 per cent. 
 Besides this, many a healthy ship escapes the disease just 
 like a large number of even " unacclimated " people pass 
 into Havana, and even Vera Cruz, every year without con- 
 tracting the disease. 
 
On Acclimation. 29 
 
 The subjoined remarks, indicating that yellow fever de- 
 pends on something more than local filth, are instructive, 
 and indicate that the yellow fever poison is an element su- 
 peradded to defective hygienic conditions : 
 
 " There has been no intention to convey the idea that 
 houses may not be found in New York and other American 
 cities as foul as they can be, and, therefore, as foul as they 
 are found in Cuba ; but in the former these evil conditions 
 are seen as exceptions, confined to narrow, disreputable 
 limits, while in Havana these conditions in the ' homes of 
 the poor n are widespread and general. Moist, foul, stag- 
 nant air, confined low to the ground, is found everywhere, 
 so everywhere can be seen the refuse of fruits and vegetable 
 substances, furnishing abundant materials for decomposition, 
 while numerous turkey-buzzards, roosting on the trees and 
 house-tops of populous cities, sufficiently testify to ample 
 supplies for animal putrefaction. These gross insanitary 
 evils are as abundant in Havana, where yellow-fever always 
 prevails, as in Canton and Bombay, where this disease never 
 occurs." 
 
 " There is one more subject which deserves brief notice in 
 connection with air- polluting causes and with theories main- 
 tained as to yellow fever. Sanitarians were greatly offended 
 by the burial ol the dead of Havana in its churches until 
 1806, when the "cemetery of Espada " was established out- 
 side the walls. In the course of years the growing city 
 surrounded this cemetery, and to this was again attributed, 
 among other insanitary evils, a bad influence on yellow- 
 fever. Overcrowded with more than three hundred thou- 
 sand dead bodies it was closed in 1871, since when all the 
 dead of Havana have been interred in the new " cemetery 
 of Colon," which is admirably located and too distant from 
 the population to exercise upon it any evil influence. It is 
 noteworthy that there has apparently been no abatement 
 in the prevalence of yellow fever." 
 
30 The Ship Origin of Yellow Fever. 
 
 THE SHIP ORIGIN OF YELLOW FEVER. 
 
 Failing to determine the causes of endemicity and noting 
 the perplexity as to what measure may be advocated for 
 the benefit of Cuban Ports and the world trading with them, 
 Dr. Chaille tells us " that the people must be provided with 
 means to become intelligent, enlightened (especially in hy- 
 giene.) prosperous, and sufficiently numerous to eventually 
 gain both the knowledge and the power necessary to cor- 
 rect their insanitary evils. This is not only the best, but 
 the only means. Until their accomplishment (which the 
 present generation will not live to witness) Havana will con- 
 tinue to be a source of constant danger to every vessel within 
 its harbor, and to every southern^ port which these vessels 
 may sail to during the warm season." 
 
 " While these are the conclusions of this Commission, 
 there were formerly many, and there are still some few, 
 who, without personal experience or extensive knowledge 
 of this special subject, look upon it in a much simpler light. 
 They pronounce yellow fever " a nautical disease," and 
 seem to believe that if means were adopted to rid ships and 
 harbors of the poison generated, as is alleged, and contained 
 in them, there would be an end to it. Since this view 
 leads to practical results of great sanitary importance the 
 facts in the matter have been carefully examined in Cuba, 
 and also the records of the facts in other of the West In- 
 dies." 
 
 " The only means " seem to me as indefinite and unat- 
 tainable as any ever proposed, and Dr. Chaille" s declaration 
 concerning the former, " many " and " still some few " who 
 " without experience or extensive knowledge of this special 
 subject," pronounce yellow fever a nautical disease, is in 
 direct and flagrant defiance of all history. 
 
 For twenty-five years I have sought allies and supporters 
 for this truth from amongst writers of the past and my con- 
 
The Ship Origin of Yellow Fever. 31 
 
 temporaries. I left the Medi cal School of Louisiana a believer 
 in " local origin " on land like every disciple of Stone. The 
 Northampton, direct from England, infected New Orleans in 
 1853, and I purposely visited that ship to satisfy myself as 
 to its condition. A new light dawned on me, but it was 
 five years before I felt warranted in declaring, in direct op- 
 position to every authority I could consult, that yellow 
 fever was never a land malady, but always localized in its 
 source on sea in the tropics. The few who have hinted at the 
 nautical origin of yellow fever, have been men of excep- 
 tionalty large experience. The individual cases of ships in 
 which disease has been unmistakably developed are, as a 
 'rule, singularly well recorded. They offer a striking contrast 
 to the many, but utterly baseless assertions concerning the 
 sites and circumstances of local origin on land. They have 
 been recorded by contagionists and non-contagionists alike — 
 though we must admit that many of the earliest and most 
 instructive examples, relating to local origin in ships, were 
 published by physicians who believed the malady would 
 originate anywhere, under definite conditions of heat, moist- 
 ure and foul effluvia. 
 
 Those who have written with fairness and learning on 
 yellow fever, have not ventured to explain away the pre- 
 cise facts which abound, but which somehow failed to create 
 the impression needed to formulate the law that " yellow 
 fever is a naval malady of the tropical Atlantic, communi- 
 cable to, and capable of, persistence on shore, but never pre- 
 senting the feature of a land plague like cholera." It was 
 most disappointing to me, at first, to notice that the ablest 
 authors, in discussing the source of yellow fever, failed to 
 appreciate this one fundamental idea, an adequate statement 
 and demonstration of which was never in print until Mr. 
 Gamgee treated the question last summer with learning and 
 thoroughness. When he first broached the matter to friends, 
 and before he knew of my writings, he was met by expres- 
 
32 The Ship Origin of Yellow Fever. 
 
 sions of astonishment, precisely as I have been, even as late 
 as at the Nashville meeting of the American Public Health 
 Association. It is, therefore, a little surprising to find an 
 attempt made to discredit the originality of this conception, 
 and to overlook its important bearings on the present med- 
 ical era. 
 
 It is true that towards the close of the last century Dr. Grif- 
 fiths of Philadelphia, in a letter to Dr. David Hosack, used 
 the following words : " The disease called yellow fever — 
 but which I call the ship fever of the tropical climates." 
 It is not clear that he did not ascribe some influence in its 
 production to the West Indies where, according to La Poche, 
 Dr. Griffiths believed the fever was not apparently conta- 
 gious, " but he thought it became so during the passage 
 from the Antilles to the United States." Hosack, of all 
 men, came nearest the truth, for he considered yellow fever 
 to be the disease of northern men removed to the tropics, 
 but he had not the data before him to limit its precise cen- 
 tre of development. He classed it with plague, typhus, 
 etc., apart from the pure contagia, " which are communi- 
 cated exclusively by contact and under all circumstances ; 
 the diseases of this separate class, which includes yellow fe- 
 ver, he points out as ' specific," 1 but only in general communi- 
 cable, through the medium of an impure atmosphere." 
 
 Though Dr. Push ascribed the fever of 1797, at Philadel- 
 phia, to a foul ship, direct from Marseilles, and an out- 
 break at Kensington to a ship from Hamburg (both very 
 possible occurrences in the days of sailing ships striking a 
 southern course), he did not suspect that the disease was a 
 pure ship fever. Dr. Caldwell's report of the sloop Mary, 
 which had visited no sickly port, and produced yellow fever 
 amongst several persons exposed to the effluvia of the hold 
 after opening ports and hatches, was one of the earliest, fol- 
 lowed at various intervals by carefully noted cases, a pe- 
 rusal of which, as La Poche asserted, " willfully sustain the 
 
The Ship Origin of Yellow Fever. 33 
 
 opinion of those who ascribe, in very many instances, the 
 appearance and spread of the disease to morbid effluvia 
 generated in the vessels themselves." Dr. Ferguson, of 
 Demerara, Audouard, Dickson and Alison have spoken of 
 the occasional origination of the fever on board of ships. 
 Copland saw it on a slave ship and thought it might be 
 produced where masses of human beings were congregated 
 in the hold of a vessel. He said : " If this opinion as to the 
 probable origin of the infectious poison be not admitted there 
 is certainly no other deserving greater confidence." 
 
 Dr. J. C. Faget of New Orleans, in his Memoirs on Yel- 
 low Fever, published in 1859, accepts as most reasonable, 
 Audouard's views concerning the outbreak of yellow fever 
 in ships at sea (meme en pleine rner) as Dutroulau had de- 
 clared in 1842. In the New Orleans Medical News and 
 Hospital Gazette for January, 1859, will be found a letter 
 in which I say, for the first time, that " yellow fever is 
 neither indigenous to this country nor a native of any for- 
 eign clime," and " that it is in the holds of vessels within 
 the tropics a certain period of time, that are to be found the 
 nidus in which the germs of yellow fever are engendered, 
 developed and propagated, and from them, under favorable 
 circumstances, disseminated on reaching inhabited shores, 
 within certain degrees of latitude." 
 
 Last year Professor Gam gee entered into greater de- 
 tails and pointed to the conditions which localized the dis- 
 ease, in its origin de novo, in the calm belts of the Atlantic, 
 mainly on the western half, the originally infected ships in- 
 fecting land and other ships, until the full sway of malig- 
 nant epidemics might be witnessed under similar conditions 
 in the West Indies and in our sea ports. In his first New 
 Orleans lecture he defined the malady as a pelagic or ocean 
 malady confined within definite limits in the Equatorial 
 Atlantic, and whilst communicable to points most accessible 
 to maritime commerce, never penetrating as a plague in or 
 
34 Dr. Chaille's Evidence . 
 
 across continents. He likewise indicated how utterly with- 
 out basis was the " germ " theory of the disease. The sap- 
 posed vital cause, demanding progressive generation 
 throughout time and restricted to reproduction like animal 
 and vegetable forms is not only hypothetical, but at the 
 root of a new hypothesis which represents the latest fancies 
 of yellow fever pathologists, who refuse to acknowledge the 
 possibility of the spontaneous development of any disease. 
 
 They endow with life the essential elements of all trans- 
 missible maladies. In this I believe them to be in error. 
 
 Dr. Chaille must kindly enlighten us as to the many or 
 few who, inexperienced or " without extensive knowledge 
 of this special subject," have pronounced yellow lever "a 
 nautical disease." I challenge him to support this state- 
 ment by anything like adequate proof. 
 
 DE. CHAILLE' S EVIDENCE. 
 
 Three columns of the concise Eeport are devoted by Dr. 
 Chaille to the origin of yellow fever in ships and harbors, 
 in order to state the " facts " at variance with the view. 
 The vast importance of setting this point at rest is indicated 
 in a very peculiar way by Dr. Chaille. He says : 
 
 " There is a final deduction of much scientific importance 
 derivable from the conclusion that yellow fever never origi- 
 nates on ships. This deduction will be better understood 
 if preceded by the statement that the facts occurring within 
 an infected place, and. bearing upon the questioned trans- 
 mission of yellow fever, can be as well explained by infec- 
 tion of locality as by infection through the movable things 
 and persons in such locality ; and that therefore these facts 
 as they occur outside of infected localities must be more 
 particularly relied on to solve the question. Now, vessels 
 — because of their restricted limits and of their small and 
 more readily observed contents and population — are the 
 
Dr. Chaille'' s Evidence. 
 
 places which present the most numerous and favorable op- 
 portunities for the solution of all questions which relate to 
 the modes by which the poison is conveyed to such places, 
 as well as from thence to other places, and also to the con- 
 ditions necessary for the propagation of the poison." 
 
 It is clear from this and all other statements that Dr. 
 Chaille considers " the facts now presented "*--** 
 " tend to prove beyond question that the poison of yellow 
 fever is on the shore, and not in the waters of the harbor P 
 
 Now what are these convincing facts ? The reader is re- 
 quested to peruse the three columns of evidence and to as- 
 sure himself that my summary or criticism as follows, is 
 justified. Dr. Chaille begins like many recent writers on 
 yellow fever, vaguely discrediting inexperienced writers 
 and observers, without enabling his readers to determine 
 whom he is hitting at, or for what reason an invisible enemy 
 is demolished. 
 
 " Naval surgeons, and especially those among them 
 charged with marine sanitation, are, of all other medical 
 men, best entitled to credence and confidence in this matter. 
 Evidence from two such French witnesses will first be sub- 
 mitted, one of these being A. F. Dutroulau, ' premier medicin 
 en chef de la marine,' who had more than twenty years' 
 personal experience of yellow fever, particularly in Martin- 
 ique, and the other being Beranger Feraud, who held the 
 same high post in the French navy, and also had extensive 
 personal experience. Each of them was charged at differ- 
 ent epochs with the duty of preventing yellow fever on 
 ships and in seaports ; and while surrounded for years by 
 special opportunities for observation, was required by im- 
 perative official duty to study particularly the causation 
 and prevention of yellow fever." 
 
 The evidence of Dutroulau, as given in my first reply to 
 Dr. Chaille, is conclusive that this authority considered 
 the essential element in the development of the yellow 
 
36 Dr. Chaille' s Evidence. 
 
 fever poison as of maritime origin. And if Dutroulau's 
 facts, as well as some later theory, had been quoted by Dr. 
 Chaille, the readers of the concise report would have had 
 some means of independent judgment. To choose what 
 suits a simple hypothesis from the pages of a voluminous 
 author, is not quoting " facts " as the fair premises of a syl- 
 logism. 
 
 This is not all. Beranger Feraud's " facts " are not cited 
 for he has none ; he does not deem it necessary to specially 
 consider the subject. Dr. Chaille quotes him as insisting 
 on the isolation of ships from land, and states a fact that 
 " the common experience of mariners in the ports of the 
 West Indies teaches them especially to avoid the shore." 
 It is truly astonishing to find such a statement, which I am 
 almost tempted to style puerile, published in disproof of 
 the ocean origin of yellow fever. Is it not certain that for 
 one ship, in which the disease springs de novo, scores are 
 infected, 'in epidemic times, in the same way as houses are 
 in seaports ? 
 
 Dr. Chaille does not say that he personally visited the 
 shipping and acquired a knowledge of the striking differ- 
 ences between foul ships carrying disease to Havana from 
 the ocean/and the recently infected ships smitten in the har- 
 bor. Had he done this, he might have had some facts the 
 nature of which I shall specially detail in my work to be 
 shortly published. 
 
 The next authority, quoted by Dr. Chaille, counts for 
 another authority but, so far as the report is concerned, 
 not for another fact against the position I hold. Dr. Chaille 
 says : 
 
 " Dr. Fuzier, a French army surgeon in high official po- 
 sition during that most favorable period for observation, 
 1861 to 1865, when France occupied Mexico, and at that 
 most favorable place for observation, Vera Cruz, denies ab- 
 solutely the spontaneous origin of yellow fever on ships." 
 
Dr. Chaille 1 s Evidence. 37 
 
 " Such, is the evidence derived from the highest French, 
 authorities." 
 
 Intending to analyze all these facts, the abundance oi 
 quotations is to avoid the slightest chance of misinterpre- 
 tation. " The experience in the Spanish navy is not less 
 emphatic " than the French. Dr. de Caneda has " fre- 
 quently " observed the first cases on board ships amongst 
 " persons whose duty calls them oftenest to the shore." 
 Could he have said " always " instead of " frequently," he 
 might have been of some use to Dr. Chaille. Dr. de Can- 
 eda and a special commission appointed to report on the 
 questions propounded by Dr. Chaille, could, in truth, only de- 
 clare what every tyro in a busy seaport in the tropics knows, 
 where navies congregate, that those most liable to contract 
 yellow fever are those who inhabit the arsenal, and who 
 frequent the wharves. Dr. Chaille does not seem to have 
 heard of the speed with which any prudent Commander in 
 the American navy clears out of a port when an epidemic 
 is threatened. That the shipping in harbor forms part, and 
 a most dangerous part, of an infected seaport has been well 
 and widely known for over three-quarters of a century. 
 Did not Lind show that healthy ships put to sea might 
 save those who boarded them, and that "during the sick- 
 ness at Cadiz and Pensacola, the removal of the sick into 
 ships which lay at anchor, in a pure air, produced the same 
 happy effects? " 
 
 Has it not often happened that a ship has crossed the At- 
 lantic with a healthy crew, notwithstanding a protracted 
 sail in the tropics, and yellow fever breaking out when the 
 ship was being unloaded, the " vile " climate of the port 
 has been charged with engendering a poison which had 
 been days and weeks in process of development within the 
 vessels ? As Humboldt (one of the despised philosophers, 
 if we are to shun the teachings of those who have not stud- 
 ied yellow fever clinically), said, " as malignant fevers are 
 
38 Dr Chaille' s Evidence. 
 
 easily engendered, amid a large crew, crowded together in 
 filthy vessels, the commencement of an epidemic dates 
 pretty often from the arrival of a squadron." The people 
 affirm that the disease has been imported from a neighbor- 
 ing port, as it often, but far from invariably, has been. 
 
 Reverting again to Dr. de Caneda's commission, Dr. 
 Chaille tells us they had " not sufficient time to collect sta- 
 tistical data in detail," for a " demonstration beyond ques- 
 tion" of that which needed no demonstration, for it did 
 not in the least bear on the naval origin of yellow fever i n 
 the tropical Atlantic. 
 
 " Fortunately, however," says Dr. Chaille, "that able and 
 zealous officer of the United States, Dr. D. M. Burgess, 
 * * * was enabled to collect statistical 
 
 facts in detail, and to present a very valuable tabular state- 
 ment of these tacts." The table is reserved for the final re- 
 port, but Dr. Burgess asserts "that those vessels which lie 
 at wharves suffer incomparably the most. Of 81 vessels 
 discharging at wharves, in July, August and September ? 
 1879, only one in lo escaped infection. " The liability to 
 infection in this harbor is in an inverse ratio to the dis- 
 tance at which a vessel lies from wharves and habita- 
 tions." Moreover, there " is a striking difference in the 
 chances of infection, when making comparison between the 
 wharves and the open bay." Dr. Burgess has " no hesita- 
 tion in saying that the nearer the vessel is to wharves 
 and to habitations, the more it is exposed to infection,' ' 
 and with a caution, which ma}~ be commended to Dr. 
 Chaille's special attention, he concludes by saying that 
 " statistical records are very desirable on all these points." 
 
 Such is the evidence (?) — the whole evidence — every fact and. 
 opinion — enumerated, which precedes the extraordinary 
 conclusion of Dr. Chaille, which he states as follows : 
 " While all freely admit that yellow fever finds a favor- 
 able medium on vessels, especially in the parts where air is 
 
Dr. ChaUUs Evidence. 39 
 
 confined, for the propagation of its poison, the facts now 
 presented are totally irreconcilable with the theory of the 
 spontaneous origin of this poison on ships." It is quite im- 
 possible to give adequate expression to my astonishment 
 at the complete misconception manifested by Dr. Chaille, 
 of the ordinary meaning of the words " facts " and " evi- 
 dence" He has simply ignored anything and everything 
 bearing, even incidentally, on the possible origin of yellow 
 fever in ships. Going out of his way to quote French 
 Naval Surgeons, could he not find ample material ready at 
 hand in the Annals of our Navy Medical Department ? I 
 happen, by chance, to have on my table the Sanitary and 
 Medical Eeports for 1873-4, by officers of the IT. S. Navy, 
 in which Dr. Thomas N. Penrose reports on the yellow 
 fever on board the U. S. S. Ticonderoga, at Key West, Fla., 
 August, 18 7-A. This is one of many cases which will fur- 
 nish food for reflection. 
 
 That the Profession may distinctly understand the prac- 
 tical result which I anticipate from proving that yellow 
 fever is the ship lever of the tropics, I may at once state 
 that its malignancy, when first introduced under circum- 
 stances favorable to a high mortality, has a natural tend- 
 ency to diminish. In a warm climate and in warm dwell- 
 ings, it may remain over one, two or three years, but, as 
 with cholera, its known tendency, even in the West Indian 
 Islands, is to extinction. Fresh poison and fresh people are 
 indispensable to its permanence. According to Dr. Chaille 
 the endemicity in Cuba will insure the persistence of the 
 disease, whatever measures might be adopted with the 
 shipping. I do not agree with him, and believe that the 
 exclusion of newly-introduced yellow fever poison could re- 
 store Havana to the condition in which it was prior to 
 1761, and that, at the worst, the local developments would 
 admit of sanitarv control. The history of Jamaica, Marti- 
 
40 Dr. Chaille's Evidence. 
 
 nique, Guadaloupe, and the Bermudas teaches this, if it 
 teaches anything. 
 
 Fierce in his attacks on the exotic origin of yellow fever, 
 La Roche, armed at all points by evidence which he repro- 
 duced fairly, whilst attempting to bend it in support of his 
 views, admitted the absolutely incontestable character of 
 the records of vessels "in which the yellow fever has truly 
 originated and prevailed." I ask Dr. Chaille to analyze the 
 numerous cases quoted by La Roche and explain how they 
 can possibly be erased from the pages of reliable history. 
 In the light of augmenting experience, apparently incom- 
 prehensible and irreconcilable facts came to be understood 
 and we now know how it has often happened that an epi- 
 demic, in an American or European port, has succeeded the 
 arrival of a vessel, with a clean bill of health, from a port 
 which could not possibly be infected. Even taking such a 
 case as that of the ship Eliza accused of carrying yellow fe- 
 ver into Philadelphia in 1799, La Roche was not justified 
 in dismissing all that was said, " inasmuch as she came from 
 Leghorn, where the disease did not exist at the time, and 
 has as yet never occurred." Hundreds of cases prove that 
 she might develope the disease on the voyage as the Nor- 
 wegian ship Skebladna did in 1877 on a passage of sixty- 
 three days, laden with sweepings from the streets of Lon- 
 don and long becalmed in the latitude and heat of Fer- 
 
 nandina. 
 
 The question before us stands thus. The old doctrine of 
 "domestic origin" of yellow fever, wherever this occurs on 
 land, has been abandoned by Dr. Chaille, who dared not at- 
 tempt to prove it in Cuba. There the endemicity of yel- 
 low fever — whatever that may mean — is precisely analo- 
 gous to the endemicity of small-pox. Dr. Chaille, without 
 supporting his opinion by facts, nor evidence of the slight- 
 est importance, actually neglects the numerous statements 
 of his leading authority, Dutroulau, that the essential ele- 
 
Dr. Chaille's Evidence. 41 
 
 ments of yellow fever is of maritime origin. He denies 
 that yellow fever ever originated de novo in ships. Where 
 then is its sonrce? ISTo where ? The whole history and the 
 geographical limits of the disease point to this as simply 
 absnrd. 
 
 But for the length of this article I would have commented 
 on Dr. Chaille's extraordinary declaration, as to the im- 
 possibility of defining the sources ot the special diseases he 
 mentions. Resting satisfied with one example — the case of 
 human tapeworms — what more do we require to learn, 
 with a view to limiting their reproduction, than that they 
 are always derived from eating raw meat. Measly pork is 
 the immediate cause of taenia solium, and raw veal of tae- 
 nia mediocannellata. Of all so-called fevers or epidemics, 
 none present more clear and trenchant features than yellow 
 fever, and its recognition, as an ocean pestilence, will contri- 
 bute quite as much to the advancement of pathology as a 
 science, as did the labors of the illustrious Louis in relation 
 to the distinction between typhus and typhoid. 
 
 In conclusion I shall quote a few words from a philo- 
 sophical lecture, just published in the London Lancet, on 
 the History of Mental Medicine, by Ball. He tells us, in 
 the first place, to respect our ancestors. In the second 
 place, to observe well, and in the third, to be sceptical ; 
 and he explains the word scepticism as follows : " I do not 
 mean by that, that morbid frame of mind which makes us 
 receive all new conceptions with a vulgar irony, and which 
 would become, in the long run, more destructive to the true 
 interests of science than the most childish credulity. I 
 mean by scepticism that negative virtue which consists in 
 never accepting a fact without verifying it, an idea with- 
 out discussing it, and which teaches us to yield, only when 
 the laden mind comes to bend beneath the burden of proofs" 
 * * * * "subdued only bv truth." 
 
PRACTICAL HINTS 
 
 RELATING TO YELLOW FEVER PREVENTION* 
 
 The signs of the current season are such as I have known 
 to precede yellow-fever epidemics. The history of the dis- 
 ease in this region is that there are years when the spread 
 seems to be impossible, and there are others when all efforts 
 fail to stem its course. The condition essential to an out- 
 break is the arrival of infected shipping ; but from 1853 to 
 1861, I treated cases annually, in vessels in our bay, and 
 coming ashore — made no disguise of my mission, without 
 exciting surprise, much less fear. The virulent epidemic 
 of 1853 originated in New Orleans on the arrival of the 
 ship " Northampton," direct from Liverpool, with emi- 
 grants. False swearing failed to hide the deaths from yel- 
 low-fever, which occurred in the Carribean sea, or the 
 cases presenting themselves in the gulf, and amongst newly 
 landed passengers. I personally investigated this case and 
 know that the vessel never touched land between Europe 
 and New Orleans, and was protected from any other sources 
 of contamination, than that incidental to traversing the dan- 
 gerous Atlantic calm belts, under conditions favorable to 
 yellow-fever development. The out-break occurred early 
 in the season, in May, and we became the victims of an ex- 
 tensive epidemic, which had been introduced from abroad 
 by an infected vessel. 
 
 It was this case of the "Northampton" and its resultant 
 evils, which made me waver in opinion as to the possible 
 
 *From the Independent Practitioner, July, 1880. 
 
Practical Hints Relating to Yellow Fever Prevention. 43 
 
 land origin of the disease, and which modified the course 
 of my subsequent investigations, observations and thoughts. 
 The lesson was too striking to produce any but the strongest 
 impression, and I soon familiarized myself with the con* 
 trasts exhibited by the numerous ships, exhibiting signs of 
 having been poisoned in infected ports, and of those in 
 which the disease had evidently broken out spontaneously. 
 The many opportunities for study, in the eight years pre- 
 ceding the war, satisfied me, first, that the epidemic of 1853 
 had protected the majority of our people, hence the uncer- 
 tainty of infection from communication with the shipping. 
 Secondly, that the persistent gulf breeze, which renders 
 Pensacola one of the most delightful cities in the South for 
 summer residence, in all probability exercises a marked 
 protective influence against yellow-fever, which revels in 
 stagnant air. Thirdly, that the periods of high tempera- 
 ture are not necessarily the periods of greatest danger to 
 human life ; but cold nights succeeding hot days seem to 
 check the discharge, from the system, of poison which might 
 otherwise be forced out, and develop many case p of an ag- 
 gravated type. 
 
 Fourthly, that in years when an excess of ozone in the 
 atmosphere in spring is attended by almost epidemic and 
 very severe catarrhs, we are apt to have an auturrn with 
 an atmosphere deficient in ozone, well adapted to favor the 
 spread of yellow-fever. No example was more startling 
 than in the condition of matters in 1878, when we escaped 
 the epidemic by rigid quarantine. In no year have I no- 
 ticed' better defined indications, which personal experience 
 causes me to reckon as of special importance. 
 
 We are having a repetition of 1878. I do not attempt 
 to foresee the meteorological features of the succeeding 
 months, but we have had the catarrhal fevers, and now we 
 must look out against disease importation. No one is more 
 conscious than I am of the slight scientific value of these gen- 
 
44 Practical Hints Relating to Yellow Fever Prevention. 
 
 eralities, which, are mentioned to direct inquiries and not to 
 stifle investigation. As practitioners of medicine, we form 
 personal opinions, from local knowledge which helps us ma- 
 terially in our work, and soon we shall have much greater 
 precision and more rational deductions. I can, however, 
 confirm an almost accepted truth in epidemiology, that the 
 careful observer must watch the vital statistics of seasons 
 preceding epidemics, to obtain useful etiological informa- 
 tion. It is this which has inspired me with hope or fear, 
 when witnessing the first instance of yellow-fever in the 
 shipping in our port. In some cases I felt sure of exemp- 
 tion, and, in others, of fatal consequences. 
 
 Western Florida has furnished me with some singularly 
 definite experiences, and whilst at one time witnessing the 
 malady on the cleanest, driest and healthiest regions, as at 
 Milton and Fort Barrancas, I can testify to the virulence 
 of the malady in unwholesome and over-crowded dens. 
 Here we have, fortunately in winter, a congregation of old 
 hulks discarded for all other than the lumber trade ; the many 
 annually lost and reported waterlogged on the broad ocean, 
 were not liable to yellow-fever. When the pumps have to 
 be kept going all the time, it is difficult, bat by no means 
 impossible, to have fever developed. These old and defec- 
 tive vessels have afforded me personal experience, in sum- 
 mer, of the poisonous character of these emanations — for it 
 was by concentrated ship poison I caught yellow-fever in 
 1853, after having past unscathed through a number of ep- 
 idemics. 
 
 The malarial element on the Escambia, distinctly limited 
 now as it was in the days of the French Huguenots, cited 
 by Lind, cannot travel in ships at sea; agues cease and sail- 
 ors improve every day after they leave port ; but it is quite 
 otherwise on vessel? which have either caught or developed 
 yellow-fever. 
 
Ocean-Infected Ships. 45 
 
 OCEAN-INFECTED SHIPS. 
 
 The resident in a Gulf port having daily intercourse with 
 mariners, learns that the suffering at sea in the tropics are 
 beyond description. Hailing from any quarter of the globe, 
 the oppressed crews refuse to go below, and lie about on 
 deck, seeking some means of relief by the working of the 
 ship, in the deathly stillness of the " calms." At times a 
 man ventures below and the foul forecastle seals his fate. 
 He is buried at sea, having died of a nameless disease, which 
 I know from analogous cases, reported by intelligent cap- 
 tains and medical men, to be generally yellow-fever. But 
 such a ship may enter our port, in ballast, without a death, 
 and only an unusual sallowness and sickliness of the crews. 
 They go ashore and arrange for discharging their ships and for 
 cutting ports to load lumber. The laborers and carpenters 
 engaged in these operations are the first to succumb. They 
 are specially susceptible and are often the first and only 
 ones to reach the foul bilge. It is only those who have 
 smelt, the combined sulphuretted hydrogen and fetid am- 
 moniacal odors, who can appreciate the character of this 
 poisonous gas, incapable of supporting combustion and an- 
 imal life. Dead rats and roaches by the bushel are not 
 rarities, and I have seen the active bubbling of gas on the 
 surface of the bilge, supplying a constant quantity of putrid 
 vapor, which effectually displaces or precludes the entrance 
 of fresh air. 
 
 Ocean infected ships usually have rotton timbers, are not 
 very leaky, come in sometimes from Rio with rock ballast, 
 whereas, at others, they have a more dangerous ballast in the 
 shape of coal, which is loaded in Wales to avoid the charge 
 for relieving a vessel of other ballast. 
 
 The merchant ships of the future should have water bal- 
 last in perfectly tight tanks. Every part of the timber 
 should be made impervious to wet and elements of organic 
 decay. 
 
46 Simple Fever Carriers 
 
 A ship may have an infected hold, as the result of infec- 
 tion from land, so that whilst specifying the distinctive fea- 
 tures of the condition of a sickly ship entering our ports, 
 after having left any European port without possible yellow- 
 fever infection, there are cases which may be confounded 
 with it. Above all, we must state our positions fairly and 
 truthfully, not attempting to prove too much, or reckless 
 by disregarding sources of recorded facts, after the manner 
 of recent writers, who declare the spontaneous origin of yel- 
 low-fever in ships impossible. 
 
 SIMPLE FEVER CARRIERS. 
 
 I have vividly before my eyes the " Fair Wind, " a ves- 
 sel now in this port, and which is not a yellow-fever ship, 
 like those in which the disease has originated de novo. 
 She came here in July, 1867, as clean, as pure and well 
 equipped as any vessel I have ever seen of her kind. She 
 brought the yellow-fever, and how ? Amongst her crew, 
 who contracted the disease at Kingston, Jamaica, before 
 sailing for the port of Pensacola. After the discontinuance 
 of the disease on board, and though disinfected in the up- 
 permost deck, cabin, forecastle, &c, she opened her hatches 
 and port holes and proceeded to load ; not a single case oc- 
 curred amongst the steamer's employes that could be traced 
 to that source ; the " Fair Wind " was a carrier, but not a 
 generator of that malady. 
 
 Land infected vessels show signs of the disease usually 
 after leaving an infected port, and rarely beyond the 4th or 
 5th day. When a ship has been ten days at sea or over, 
 the chances are she has a foul bilge and will infect all the 
 susceptible people who enter her. 
 
 Vessels from Eio coming to this port, if infected in Eio, 
 show signs of the disease unmistakably south of the equator, 
 and usually, south of the tropic of Capricorn. If the out- 
 break be delayed until the line is crossed, the permanent 
 infection of the vessel, originating in the ship, is highly prob- 
 
 
The Period of Incubation of Yellow Fever. 47 
 
 able. Nothing but familiarity with this subject and with 
 shipping, can enable a sanitarian to appreciate the sharpness 
 of these distinctions. The most puzzling complications are 
 due to the vast difference between men as to constitutional 
 pre-disposition. In yellow -fever, as in every disease, the 
 study of diathesis, susceptibility, cause of immunity, may 
 be placed in the first rank with a view to intelligent rec- 
 ords. 
 
 Medical men especially connected with Southern ports, 
 should, in tracing the history of a ship, obtain from the log 
 an account of her course. A sailing vessel from Europe 
 making for New Orleans, has to keep far out on the Atlan- 
 tic and strike a southerly course, to avoid the opposing 
 gulf stream, and this is a circumstance which has specially 
 attracted Mr. Gamgee's attention, accounting for the rarer 
 out-breaks on vessels leaving for Europe, than those com- 
 ing from Europe or sailing into the gulf from the southern 
 hemisphere. Every degree north that is past affords a rel- 
 ative protection, but the winds and currents which impel 
 the vessels northward, exert a favorable influence on the 
 health of the crew and passengers of ships at sea. 
 
 Indeed, it is under these circumstances that even suscep- 
 tible crews suffer little, or not at all, in an infected ship, 
 until she reaches a port and is opened out as in the cele- 
 brated case of the "Anne Marie," which left Nantes for Ha- 
 vana on the 12th of May, 1861, started healthy on her re- 
 turn voyage on the 13th of June, and seventeen daj^s after 
 leaving port had a case of yellow-fever on board. The dis- 
 astrous consequences which ensued in and around St. Na- 
 zaire, in the north of France indicated that the northward 
 travel of yellow-fever is not impossible, though ships are 
 much relieved by stiff' trade winds. 
 
 THE PEKIOD OF INCUBATION OF YELLOW- FEVEK. 
 
 Slowly, but surely, have my eyes been opened to the folly 
 of confounding natural phenomena, in relation to disease. 
 
48 The Period of Incubation of Yellow Fever, 
 
 I appeal to medical men to abandon the talk about "germs" 
 until "germs" are proved to exist. I have sinned like my 
 colleagues, but the evils attendant on the use of words 
 which do not implicitly convey a truth, have taught me a 
 lesson. It is a fact that the development of fecundated ova, 
 the embryonic stage of every known organic form, demand 
 specific and invariable periods of time. A female acarus 
 lodging on the human skin, has to produce the germs to 
 induce the general and appreciable signs of itch. This 
 takes time. The poison of small pox requires a definite 
 and almost invariable period of latency or incubation, to 
 overwhelm a healthy person. Not so with yellow-fever. 
 All the statements made in the past must be carefully scan- 
 ned, and it will be found, that where a period of latency ex- 
 ists, between exposure to the poison and manifestation of its 
 effects, this period is usually very brief and extremely un- 
 certain. It varies with the cases and with the epidemics. 
 The simultaneous manifestations of the disease in two or 
 more persons exposed at the same time to the poison, often 
 observed, may be explained on the principle of poison doses. 
 There are many drugs given in like quantities to two simi- 
 lar individuals, at the same time, which produce a defi- 
 nite result at the exact same time. Bat strengthen the 
 dose, and as with yellow-fever, the effect is immediate. 
 From the earliest careful observations of this disease, pro- 
 duced by foul ships, on susceptible people in ports, the in- 
 stant sickness of persons who have breathed the air of the 
 hold has been noticed. I returned to shore from an infected 
 ship in 1853, and remarked to friends who met me, that I 
 was never so sick before in my life, as I was then. They 
 gave me brandy ; I rejected it and took another drink with 
 like effect. All the premonitory signs of fever seized me 
 at once, and next morning I was transferred to Milton, 
 which I reached in an unconscious state, and remained so, 
 more or less, for six days, with marked symptoms of yel- 
 
The Period of Incubation of Yellow Fever. 49 
 
 low -fever. I convalesced on the seventh day from the time 
 of exposure and commencement of sickness. The same 
 season a carpenter, who left Milton as a refugee to escape 
 yellow-fever, went to Coffee County, Alabama, and returned 
 after the first frost. He went straight to the house of his 
 late friend Trammel, who had died in the summer ; the 
 house had been kept warm and, after entering Trammel's 
 bed, he was forthwith seized with the premonitory signs of 
 yellow-fever and I treated him. 
 
 These are not rare though somewhat exceptional cases, 
 and the experience in northern ports that people who have 
 remained healthy five or six days at sea, may be regarded 
 as free from the poison, is to a great extent indicative of 
 the prompt action of the yellow-fever poison. The type of 
 the disease varies within certain limits strikingly, but 
 every time has the same uncertain invasion which is totally 
 unlike the latency and invasion of true fever. The well- 
 marked supra- orbital and other pains, with or without rigors, 
 supervene in one, two, three or four days, and rarely longer. 
 
 These points have a most important bearing on the pre- 
 vention of the disease, and, guided by them, we can readily 
 understand how ship infection, the inevitable precursor to 
 port infection, must be controlled, whilst the people carried 
 are much more easily dealt with, owing to the brevity of 
 the latent stage. In six years we have had no yellow-fever, 
 but quarantine measures have been fairly carried out, and 
 have sufficed in conjunction with natural tendency to ex- 
 ceptional atmospheric purity, thanks to persistent natural 
 winds peculiar to this region of country. 
 
 Pensacola is by no means a model of sanitary arrange- 
 ments. We might easily have efficient drainage, which 
 we lack. We have plenty of space and porous soil, so that 
 until the town is more populous and crowded, we may es- 
 cape the visitations of typhoid and other fevers or great 
 mortality from cholera, should it be introduced. We have 
 
50 Prevention of Yellow Fever. 
 
 probably the healthiest city in the United States, and the 
 infant mortality is exceedingly slight. I may define it a 
 rural port, sheltered by healthy piney woods, and, thanks 
 to the breeze, free from the heat diseases of inland, and of 
 other cities on this and even more northern latitudes. 
 
 Well have I understood, as a resident in Pensacola, the 
 remarks frequently printed on the salubrity of the West 
 Indian Islands, such as Curacoa, and how exactly similar 
 the history of yellow fever here is with that of any other 
 tropical port. 
 
 PKEVENTION OF YELLOW FEVEK. 
 
 Every eye witness of a city, during an epidemic of yel- 
 low fever, has occasion to deplore the absolute helplessness 
 of citizens and physicians in controlling the spread or an- 
 ticipating the course of the plague. The well-founded 
 opinions of the rarity of personal contagion, under certain 
 circumstances, coupled with a large body of protected 
 people, as in New Orleans, may be recognized as having 
 materially favored the congregation of gossiping citizens 
 in infected houses and localities, and thus, even by the well, 
 the disease has been carried into many a house. The time 
 was when, with less sanitary rule than is now enforced, a 
 crop of yellow fever cases led the curious and the charit- 
 able, the friends and the strangers who had no reason to 
 fear an attack, to congregate, especially at the beginning of 
 an outbreak, just like people run to a fire. 
 
 The now acknowledged transmissibility of the disease 
 leads to the imposition of wholesome restrictions. Never- 
 theless, taking a case like that of Memphis, depopulation 
 and isolation failed to arrest the malady before frost. The 
 reason for this is, in all probability, that the impure air, 
 poisoned in almost unlimited masses, in hospital wards and 
 houses, is free to move and passes laden from block to 
 block and street to street, until the sparsely inhabited sub- 
 
Prevention of Yellow Fever. 51 
 
 urbs and open country cut it short by abundant atmo- 
 spheric dilution. 
 
 As a ship fever this malady is ever engendered by vola- 
 tile matter, or matter suspended in moist, warm air, emerg- 
 ing when the hold is opened, to poison the forecastle, the 
 cabins, adjoining ships and houses. A slight breeze hast- 
 ens its transit, but often neutralizes it. It does not go far. 
 A contaminated house on a wharf does not transmit by 
 fomites, "usually carried by man, the disease to a distant 
 point of the port. Its proximate growth and a continuous 
 current are marked in its course and stages by human vic- 
 tims. 
 
 I quite concur with Mr. Gam gee that currents of pure 
 air, driven through and through infected places, constitute 
 the most reliable means to dilute and ultimately to destroy 
 the poison. The only danger is that atmospheric dilution, 
 up to the present time, has implied a city's doom — a whole- 
 sale infection. In grappling with the great difficulties 
 which present themselves, as a believer in the oceanic char- 
 acter of yellow fever, I must first and foremost attend to 
 ship sanitation. Medical men are not engineers and ship- 
 builders. Had they known how to advise, the practices 
 commonly witnessed in gulf ports would long since have 
 ceased. 
 
 The problems relating to ship ventilation and pumping 
 the bilge water are of the highest importance ; but I could 
 not treat these subjects technically, and I desire to restrict 
 my observations to a few reforms and procedures which 
 admit of prompt attention. 
 
 So far as the ship is concerned, it should not be emptied 
 of solid cargo until it is freely exhausted of its gaseous 
 contents. All that is then removed from the ship should 
 be freely aereated by positive currents of air, and in many 
 cases there is no objection to sulphurous acid fumigation. 
 
52 Prevention of Yelloiv Fever. 
 
 The empty ship can then receive in its bilge some fresh 
 burnt lime, and this may be sprinkled with advantage 
 where foul gases may emanate. The word cleanliness im- 
 putes, then, al] that has to be secured ; and by cleanliness 
 and free ventilation, with thorough liming, a vessel can be 
 purified. If, however, a low temperature can be secured, 
 any way below 32° Fahr., and made* to penetrate some- 
 what, the poison can certainly be destroyed. 
 
 Mr. Gamgee has suggested to me a means whereby the 
 foulest timber can be purified by hot drying oils, which 
 destroy all moist organic matter, and render the wood ever 
 after impervious to moisture or elements of decay. The 
 hot varnish could be applied to the whole interior of the 
 ship with great advantage. An impermeable purifying 
 coating may prove a great boon, and this constitutes one 
 of the points which Professor Gamgee intends to carry out 
 in his fever-proof ship. 
 
 The great advantage of having ships carrying skilled 
 men and appliances for disinfection, is that infected vessels 
 need never touch land until they are made safe. It is a 
 bright idea, and could undoubtedly be carried out into prac- 
 tice in our gulf ports. 
 
 Stations, such as the one at Ship Island, may be adopted, 
 but we are threatened, with that great impediment to com- 
 mon sense legislation in sanitary matters, by divided coun- 
 sels within states, and inadequate national administration. 
 A sanistation could easily be provided for Havana by the 
 Cuban government, and seeing how effectually the Spaniards 
 have excluded yellow fever from their European Atlantic 
 ports, it is to be hoped they may disregard the recently 
 uttered statements, that Cuba is to be the permanent hot 
 bed of a naturalized pestilence. 
 
 I shall not attempt much, on this occasion, in relation to 
 prevention of yellow fever on land, but I am happy to have 
 been the first to witness Mr. Gamgee's experiments, whereby 
 
Prevention of Yelloiv Fever. 53 
 
 forced ventilation of rooms, with filtration and effectual 
 disinfecting of air is rendered possible. He has designed 
 an apparatus which he calls the " circlair," which enables 
 us to shut up a room and practically isolate the volume of 
 infected air, which is abundantly purified and displaced 
 by fresh air. 
 
 The poison which seems to travel on the roads and side- 
 walks, with the volume of heavy air dropping from infect- 
 ed houses, can, in my opinion, be better destroyed by hot 
 lime than carbolic acid. I object to this offensive com- 
 pound, and believe, that irritating and fetid vapors have 
 only found favor, because people have been led to suppose 
 they must do good, and that their presence was unmis- 
 takable. 
 
 I do not think the yellow fever poison is difficult to 
 destroy, but we must not be idle when a case indicates its 
 location. Simple means will effect much, and I am in 
 favor of prime attention to the foul gases of ships, the foul 
 air of cities, and notably of the sick room. Control these, 
 and much has been done to control the malady. 
 
THE MOST RECENT UTTERANCES ON ACCLIMATIZA 
 TION AND ENDEMIC1TY 
 
 ON ACCLIMATIZATION. 
 
 The 1880, August number of the New Orleans Medical 
 and Surgical Journal contains an excellent article by Dr. 
 Chaille, on acclimatization, or acquisition of immunity, from 
 yellow-fever. 
 
 Having ventured to take exception to the preliminary 
 report of the Havana Yellow-Fever Commission, and 
 especially to the lack of all, in the nature of true evidence, 
 adduced, in opposition to the nautical origin of yellow-fever, 
 I am all the more anxious to give my hearty approval to an 
 entirely new departure, on the part of Dr. Chaille. It 
 will be seen that I have spoken of immunity from yellow- 
 fever being alone obtained by an attack — mild or severe — 
 of the disease. 
 
 Dr. Chaille, while in Cuba, gathered from eminent phy- 
 sicians a number of yellow-fever cases in Cubans — not only 
 born — but always residing in Cuba. A very intelligent 
 minority of the medical men of the Island regard immu- 
 nity as only acquired by an attack of the disease. 
 
 Heinemann reports, in 1879, " until lately the physicians 
 and people of Vera Cruz, supported, with fanaticism, the 
 dogma that natives were absolutely exempt from yellow- 
 fever. But the fearful epidemics of recent years (1875, 
 1877, 1878,) have worked a change ; for so many native 
 children and adults suffered that the truth could no longer 
 be denied that they do not enjoy an absolute immunity." 
 *From the Louisville Medical Herald, September, 1880. 
 
On Acclimatization. 55 
 
 By far the most interesting and conclusive evidence is 
 afforded by Dr. Chaille's observations in relation to New 
 Orleans. He says: "In 1851, the medical profession of 
 New Orleans was almost unanimous in teaching that thqse 
 born in that city were not liable to yellow-fever. Prof. 
 Warren Stone, my teacher, was one of the very few who 
 taught that Creole children did have yellow-fever, often 
 in a form too mild to justify an absolute diagnosis." 
 
 Dr. Chaille has lived to find that Prof. Stone's view has 
 triumphed, and that the change has been so complete, he 
 attributes "chiefly to the fact that, until 1858, New Orleans 
 was ravaged by almost biennial epidemics, while since 1858, 
 there have been only two serious invasions, in 1867 and in 
 1878. The longer the intervals between epidemics, the 
 larger necessarily must be the number of those who have 
 failed to acquire immunity, and the more glaring becomes 
 their liability to the disease. This is the explanation of 
 the very old observation, that, the longer the absence of an 
 epidemic from a place, the greater the susceptibility of its 
 inhabitants. 
 
 " Wherever yellow-fever occurs only occasionally, as an 
 epidemic, there the Creoles are manifestly liable to the 
 disease ; wherever it prevails habitually, there the Creoles 
 appear to enjoy a very great, if not absolute, immunity ; 
 and the fact that the white natives of a place do enjoy 
 this comparative immunity, is good evidence that the poison 
 of yellow-fever prevails habitually in this place. Hence, 
 the important practical conclusion that the stranger should 
 beware, during the warm season, of every place in Cuba or 
 elsewhere, of which the natives boast, that while the for- 
 eign born habitually, they never suffer with yellow- fever/' 
 
 Neglecting much instructive matter, for which the reader 
 can refer to the original article, it will be seen that Dr. 
 Chaille endorses my statement at page 28, in the follow? 
 
56 On Acclimatization. 
 
 ing words : " The only known mode of acquiring immu- 
 nity from every other non-recurring disease is to have one 
 attack ; and, so far as yellow-fever is concerned, while va- 
 rious modes are claimed this remains the only one so cer- 
 tain that no one whatever disputes it." Susceptibility to 
 the poison is sometimes unaccountably diminished. He 
 says: "facts will now be presented in proof that immunity 
 from yellow-fever is acquired by a large majority of the 
 natives of infected places, in the same manner if is ac- 
 quired by unacclimated immigrants, and in the very same 
 manner that immunity from every other non -recurring 
 disease is acquired." 
 
 Dr. Chaille appends a table, consisting exclusively of 
 official data of population, from the United States census, 
 and of deaths from the Board of Health of New Orleans. 
 A second table consists of results obtained by calculations 
 based on the original data in the first table — calculations 
 designed to facilitate the interpretation of those original 
 data. They date back to 1856 — that is as far back as au- 
 thentic records can now be procured, including those most 
 disastrous epidemics — 1858, 1867 and 1878. 
 
 Until 1858 the great majority of the medical profession 
 of New Orleans taught, with as much vehemence, as some 
 few of them still do, and as nearly all the physicians of 
 Havana and Cuba now teach, that the native-born Creole 
 children and adults enjoyed absolute immunity from yellow- 
 fever. 
 
 Dr. Chaille has classed his conclusions under six heads : 
 First, There is an enormous excess in the deaths of chil- 
 dren, under ten years of age, during every epidemic year ; 
 and this mortality occurs during the very months when 
 yellow-fever devastates the city. 
 
 Second. The statistics turn aside from the simple and 
 reliable tally of the sexton, and become dependent on the 
 di agnostic skill and theories of the doctor, since simul- 
 
On Acclimatization. 57 
 
 taneously with yellow-fever there is always an enormous 
 increase in deaths from "bilious," "congestive," "pernic- 
 ious," malignant," fever, as well as by typhus and typhoid. 
 Not verv nattering to the doctors who have hitherto failed 
 to perceive they were recording a tale of singular inconsis- 
 tency and incompetency, which " the sexton's tally " in Dr. 
 Chaille's hands has just exposed. 
 
 Third. Yellow-fever has not only been confounded with 
 "malarial fever," since all these deaths, added to those of 
 yellow-fever, fail to sum up a total, equal to the excess of 
 deaths, which invariably occurs during epidemic years. 
 Faulty diagnoses seem to include convulsions, cerebral 
 congestions, and that everlasting ghost of mothers — "teeth- 
 ing." With such a confession or exposure of prejudice or 
 downright stupidity, who can be astonished that the aver- 
 age medical man knows nothing of the origin and nature of 
 yellow -fever. 
 
 Fourth. Accepting the excess of children's deaths, in epi- 
 demic years, as due to yellow-fever, the comparative suscep- 
 tibility at different ages, can be calculated. There was an 
 increased mortality, but slight, in children under one year. 
 It was much greater between 1 and 2 years. Enormous in 
 children from 2 to 5 years old. So that there were 89.4 
 deaths in every 1000 of those in 1878, in place of 19.6 deaths 
 in every 1000 in the non-epidemic years of 1877 and 1879. 
 This, more than quadruple increase, is not equalled at any 
 other ages. Dr. Chaille grapples with an anomaly exhib- 
 ited by the epidemic of 1858. 
 
 He says : " When it is known that the population of 
 New Orleans had been subjected, so shortly before, to the 
 three violent epidemics of 1853-'4-'5, and that during this 
 prosperous period of the city's history, unacclimated im- 
 migrants, chiefly from 15 to 40 years old, flowed to it in 
 numbers far greater than subsequently, no one will be sur- 
 prized to find that the mortality in 1858, compared with 
 
58 On Acclimatization. 
 
 1878, was less in those under 15 years, and greater in those 
 from 15 to 40 .years of age." , 
 
 Fifth. "Accepting the conclusion, drawn from the ceme- 
 teries, that the excess of deaths during an epidemic are due 
 to the disease causing the epidemic ; and, again, taking the 
 1878 epidemic as an illustration, we are forced to admit 
 that somewhere between 1406 and 2023 children, under 10 
 years of age, must have been killed by yellow-fever." Dr. 
 Chaille attempts to deduce the number of children protected, 
 having recovered, and these could not be less than 6,000 ; 
 but probably much more, since, the younger the children, 
 the less fatality amongst them from this disease. 
 
 Finally. Dr. Chaille wisely refers to mild, benign, 
 aborted or bastard yellow-fever, granting immunity, and 
 which is recognized by physicians of noted skill. 
 
 I cannot resist quoting a paragragh, which affords me an 
 opportunity of directing attention to the opinions of a very 
 distinguished British physician. Dr. Chaille says : " Blair, 
 the unsurpassed classical student and historian of the epi- 
 demic of British Guiana, 1851'— 4, states that the very first 
 cases occured among little children, and that the attacks of 
 others were numerous and repeated. Infancy was one of 
 the most favoring causes of the action of yellow-fever poi- 
 son. The constitution of the new born or young white 
 Creole was highly susceptible. He or she was truly in the 
 category of new comers. In 1851 yellow fever had been 
 absent from British Guiana for six years — since 1845." 
 
 Dr. Daniel Blair, thus justly eulogized by Dr. Chaille, 
 was Surgeon-General of British Guiana in .1852, when his 
 work reached a third edition. He states that, when the ep- 
 idemic of 1837 occurred, those who had seen the disease in 
 1819, had retired from practice, or were dead, and had left 
 no record of its local peculiarities and treatment. When, 
 in 1852, he attempted to trace the disease to its source he said, 
 
On Endemicity, 59 
 
 "sufficient evidence has been elicited from the last epidemic 
 to show that our inquiries must be directed to the sea-shore." 
 And unable to perceive, in common with many others, that 
 ships had infected the country, his perception was, never- 
 theless, quick enough to make him say " some new element 
 is required in the generation of yellow-fever, beside what 
 is to be found annually within our embankments; and it is 
 in all probability dependent on a sea change." 
 
 II. 
 
 ON ENDEMICITY. 
 
 Dr. S. S. Herrick, one of the editors of the New Orleans 
 Medical and Surgical Journal, in a review at page 142 of 
 the August number, says : " We do not regard the term 
 " endemic " as properly applicable to yellow-fever in New 
 Orleans." * * * "An endemic should prevail in its 
 habitat every year ; not so with yellow-fever at New Or- 
 leans." Further on he remarks that, the doctrine of yel- 
 low-fever endemicity at New Orleans, besides being scientifi- 
 cally unsound, is ruinous to the city's commercial pros- 
 perity.. 
 
 " The suicidal policy of a portion of our citizens in pro- 
 claiming to the world that their soil is incurably plague- 
 stricken, has no parallel in this country, nor probably in the 
 whole world." Dr. Herrick has evidently not read the yel- 
 low-fever literature of his country, if he believes the words we 
 have italicized. The indignant remonstrance of the in- 
 spector of vessels of Philadelphia in 1793, Dr. J. Hutchin- 
 son — who denied that the fever was " an imported disease, 
 is before us. Dr. Rush, we well know concurred, and Cald- 
 well echoed their sentiments. 
 
 As late as 1819 we find Dr. Samuel Emlen producing a 
 statement relating to Philadelphia, "as additional confirma- 
 tion of the disease occuring without the slightest founda- 
 tion for tracing its origin to a foreign source." 
 
60 On Endemicity. 
 
 Dr. Thomas Lawson, Surgeon-General, in his statistical 
 report, during the sickness and mortality in the Army of 
 the United States, in 1840, said : " The experience of sev- 
 eral centuries teaches us, that the cause of tihis fever is 
 perennially present in our Southern cities. Indissolubly con- 
 nected with our soil and climate, it maintains the same re- 
 lation towards the animal system as the malaria of our 
 Southern low lands." 
 
 I allude, casually, to one or two references, which indicate 
 that the people of America have, ever since yellow-fever 
 invaded our ports, blamed their soil for it — so much so that 
 the eloquent words of Dr. Francis before the Third Na- 
 tional Quarantine and Sanitary Convention, held in New 
 York in 1859, never can be forgotten ; there he vindicated 
 the City of New York from the imputation of being the 
 birthplace of yellow-fever. He spoke of it as engendered 
 on ship-board, in healthy vessels sailing from ports diseased 
 of yellow-fever. He complained loudly of those citizens of 
 America who affixed to this noble country the stigma of 
 producing yellow -fever. Nevertheless scores of partial ob- 
 servers, ignoring the past, the experiences of which can 
 only be made available by industry and patient investiga- 
 tion, if the truth be sought, have steadfastly adhered to the 
 local origin of yellow-fever in our ports, and the last strong- 
 hold of this baseless and infamous theory is New Orleans I 
 
 Can we be astonished if Griesinger, in his treatise on in- 
 fectious maladies, published in 1868, should say "yellow- 
 fever develops under the influence of general climacteric 
 conditions ? It is essentially a disease of the Western Hemis- 
 phere, of the West Indies, and of the American Continent." 
 
 The mere quotation of this sentence suffices, I hope, to 
 condemn the unfounded assertions, which, to this day, pass 
 current as worthy of report. 
 
On Enchmicity. 61 
 
 Dr. S. S. Heriick must know that, now the evidence re- 
 lating to the nautical origin of yellow -fever is, in a substan- 
 tial measure, before the world, and no one has dared to 
 produce that which does not exist, counter evidence, to dis- 
 pute it. His clear endorsement of my views as to the en- 
 demicity of yellow-fever, I acknowledge, with thanks. He 
 asks some questions which familiarity with the yellow- 
 fever history would have indicated as entirely irrelevant. 
 
 It is, perhaps, only fair to my case, and certainly fair to 
 
 Dr. Herrick, to quote verbatim the extraordinary questions 
 
 he has proposed. 
 
 He says : " If the fever springs from the tropical seas of America, why- 
 does it not become diffused throughout the warm waters of the Atlan- 
 tic basin, at least, and thus infect all its shores? Having reached the 
 western extremity of the Mediterranean Sea, and the coast of Spain, 
 why should it not have extended eastward its whole length? Why is 
 it not an every day occurrence for vessels, sailing between Europe and 
 New Orleans, to catch the yellow-fever in the infected Gulf of Mexico ? 
 Why does yellow-fever prevail annually ashore at Vera Cruz, and never 
 on the shipping, which has to be a mile distant from shore ? Why are 
 vessels lying in the harbor of Havana, which discharges and receives 
 cargoes by lighters, and whose crews are not allowed to go ashore, so 
 much less likely to become infected than those which lie at the wharves? 
 Until the above inquiries are answered satisfactorily, we ask to be ex- 
 cused from accepting any dropsical theory of the origin of yellow fever. ' ' 
 
 They have been answered repeatedly by the events of 
 past times. The numerous and cogent reasons which ex- 
 plain why certain animals, like the herring, do not increase 
 m numbers to the exclusion of all others, mav be cited in 
 relation to an universal law of limitation of development. 
 Who ever suggested that the Gulf of Mexico was itself in- 
 fected, or that the Atlantic ocean waters themselves, under 
 the benign influence of air, sunlight, and electricity, could 
 produce yellow fever ? Dr. Herrick has erected a house of 
 cards to experience the gratification of its demolition. The 
 sailors on such ships as the Excelsior, so long as they keep 
 above deck, are usually exempt of the products of foulness 
 which arise from the imprisonment of Atlantic Ocean- 
 
62 On Endemicity. 
 
 ivater and products in a ship's bilge, or in rotten timbers. 
 When, in 1840, the General Board of Health met in London 
 to report on quarantine, what did they say : "A foul ship 
 is not only a centre of disease to those on board, but a source 
 of disease to her neighborhood." Whilst condemning the 
 quarantine establishments, the report states " that typhus 
 and other dangerous epidemic diseases are frequent on board 
 merchant seamen vessels at sea and in port, for which no 
 effectual or suitable provision is at present made." Dr. 
 Herrick allies yellow fever with typhoid — the typical land 
 endemic whose periodical development, de novo, in our 
 mountain ranges and elsewhere, is almost demonstrated. 
 The analogy between yellow fever and typhus is universally 
 acknowledged, whilst recognizing some marked and unfail- 
 ing points ol demarcation between them. Surely typhus 
 may be regarded as a specific disease, due to a specific 
 poison in foul, over-crowded habitations, but no modern 
 pathologist can ally typhus or yellow fever with small-pox, 
 the type of the purely contagious diseases. It is its place 
 in nature, which has been, for the first time, defined by the 
 believers in the naval origin of the yellow fever, in the 
 tropical Atlantic, and this has especially, and for the first 
 time, been accomplished by my friend, Mr. Gamgee. It is 
 satisfactory to have lifted Dr. Herrick so far on the fence, as 
 to make him admit that yellow fever is not an endemic 
 disease, " that is attributable to localized causes in any 
 region whatever." As regards land, he is quite correct, and 
 as regards seas, he is technically right — for remove the foul, 
 and often becalmed shipping from the tropical Atlantic 
 ocean, and yellow fever will be found without a habitation, 
 and, for all practical purposes, not needing a name. It is 
 by discussions and experiment that the strength of our posi- 
 tion will be forced on the medical profession, and all we 
 ask is a fair field and ample opportunity to prove our point 
 or be enlightened by the correct interpretations of accumu- 
 
On Endernicity. 63 
 
 lated experience, which no special pleading can now dis- 
 place from the category of reliable human records. Yellow 
 fever history counts some miserable exhibitions of human 
 folly and prejudice, which retarded progress for years, and 
 none more so than the conflict between Bancroft and Chis- 
 holm, in which the latter proved triumphant. In this contro- 
 versy the point was as to the actual importation of the disease 
 into the West Indian Islands, and that most honest, most 
 impartial and pains-taking American physician, Dr. John 
 W. Francis, stated before the 1859 Convention, that " no 
 fact in medical history is better established, in the whole 
 range of historical testimony concerning endemics, notwith- 
 standing the obloquy attempted to be cast on Chisholm by 
 the late Dr. Caldwell and others, and by Bancroft, an 
 equally unscrupulous writer." 
 
 Dr. Herri ck's reference to the ship origin of the yellow 
 fever in the Atlantic " as a dropsical theory of yellow fever" 
 is interesting to me because, hereafter, when the question 
 of priority turns up, in relation to the correct and only 
 possible interpretation of the origin of yellow fever, we 
 shall be able to point to the ridicule so commonly heaped 
 on the promulgators of new truths and of the most im- 
 portant discoveries. 
 
 If Dr. Herrick has any facts to furnish we shall accept 
 them witli as much thankfulness as I now express to Dr. 
 Chaille tor his lucid arguments and convincing statistics, re- 
 lating to the subject of acclimatization. The Northampton 
 case I shall hereafter discuss. The weapons of philosophy 
 are ascertained truths t and the purely empirical method 
 pursued by many of the ablest medical observers of yellow 
 fever in the past, has crushed out the theory of the land 
 origin of the disease— demolished the doctrine of a specific 
 animal virus, like that of small-pox, and traced epidemics 
 of yellow fever to putrefaction in foul ships sailing, or that 
 have sailed, on or near the Atlantic Equator. Directly or 
 indirectly, this is the essential source. 
 
THE ORIGIN OF THE POIS03V OF YELLOW FEVER. 
 
 Having both approved and refuted opinions and state- 
 ments, hitherto made by Doctor Chaille, it is opportune that 
 I should comment on that chapter, of the final report of the 
 Havana Yellow Fever Commission of 1879, which has just 
 made its appearance, in the October number of the New 
 Orleans Medical and Surgical Journal. My greatest diffi- 
 culty, in accomplishing this, is to give an adequate reflex of 
 Doctor Chaille's attempt, since he has laid his case be- 
 fore the medical world, without condescending to analyze 
 the vast array of accumulated evidence. 
 
 We are entirely in accord with our adversary on the re- 
 sults of biological investigation. Spontaneous generation 
 of organic forms, or of the specific virus of diseases propa- 
 gated alone by contagion, cannot be admitted. The brief 
 reference to fungi is entirely unobjectionable, except as 
 bearing in any sense on the untraced lineaments of the yel- 
 low fever poison. The germ theory has been made to do 
 service, after it has been proved as calculated to mislead the 
 world. The systematic labors of the Calcutta Sanitary 
 Commission, in relation to Hallier's cholera fungus, are in 
 striking contrast to the attempts of the Havana Commis- 
 sion to fasten on us the u unknown." 
 
 Pasteur's researches are justly eulogized, but none are in 
 conflict with the opinion, founded on hundreds of carefully 
 recorded cases, that a putrefying bilge-water, proceeding from 
 a definite region and under specific conditions, emits pois- 
 onous elements, destructive to human life and susceptible of 
 increase outside the human body. There is one feature of 
 the deadly bilge which must again be forced on public at- 
 
The origin of Yellow Fever Poison. 65 
 
 tention. It is the exclusion of oxygen, and the continued 
 development of foul emanations almost in proportion to 
 such oxygen exclusion. Every student of biology must 
 recognize that this implies some physical or chemical trans- 
 formation — a death change, in the imprisoned living water 
 of the equatorial Atlantic, when charging the hold with 
 pestiferous miasm. Pasteur's results are incontrovertible, 
 and indicate the pre-eminent mastery of natural law. They 
 add to all previous demonstrations that " like reproduces 
 like," but they would involve us in a confusion Avorse con- 
 founded, if they implied, and they do not, that we must 
 class erysipelas or purulent infection with syphilis and 
 variola. 
 
 One typical characteristic of yellow fever poison is its re- 
 lation to temperature. A change of physical state is abso- 
 lutely essential to its production and destruction. Being a 
 tropical disease, its continuance in a semi-tropical climate 
 depends on protection from climatic influences in ships, 
 houses, boxes, &c. How can a poison carried anywhere on 
 a pin's point be classified with one, peculiar to fomites, 
 always needing encasement for distant fruition and trans- 
 portation ? 
 
 We might have expected a new and faithful picture of 
 this intangible yellow fever poison, culled from Cuban ex- 
 perience and genuine scientific investigation, instead of 
 vague analogies, and the most superficial reference to authors 
 and observers, who avowedly have seen or written on other 
 diseases, knowing nothing of yellow fever. Doctor Chaille 
 remarks that outbreaks of yellow fever on vessels " for 
 the most part are not reported with sufficient precision 
 respecting either dates or other essential details." This 
 is not so ; and if so, why has he neglected those of 
 the minor part ? For one case, in which there is any in- 
 dication of direct dependence of an outbreak on the intra- 
 
66 The origin of Yellow Fever Poison. 
 
 corporeal development of the yellow fever poison, and the 
 direct transmission from the sick to the healthy, as in the 
 case of scarlatina or small pox, there are thousands demon- 
 strating that these exceptions are entirely illusory. There 
 is absolutely no reliable evidence, on the inevitable depend- 
 ence of cases of yellow fever on pre-existing cases. There 
 is an overwhelming amount indicating that the emanations 
 from a ship's hold have killed crews and desolated sea ports. 
 Dr. Chaille has not read, or, if he has read, he has sup- 
 pressed the only evidence in existence. I cannot do better 
 than conclude by two letters from Mr. Gamgee's pen : 
 
 YELLOW FEVER POISON. 
 
 Deae De. Haegis : The battle is won. It was quite im- 
 possible for Dr. Chaille to admit the land origin of yellow 
 fever, and, having condemned, as erroneous, the view that 
 it is the ship fever ol the Tropical Atlantic, lie was com- 
 pelled to class it, as we anticipated, with the pure contagia. 
 Few can be misled by his presumed analogies and pure hy- 
 potheses. Those who read history will find the evidence 
 of ocean origin so strong that they cannot set it aside. The 
 competent medical practitioners, who know yellow fever as 
 it occurs in ships and sea ports, will be unanimous in admit- 
 ting, that the human body is not a necessary factor, in the 
 production and transmission of the poison. Imprisoned air 
 is its vehicle. When concentrated it manifests instant ef- 
 fects. If weakened by dilution a supposed incubation with 
 no definite limits, but always short, conforms to the action 
 of ordinary poisons. 
 
 Had our attempts, at setting fairly before the world the 
 evidence and arguments in favor of the naval origin of yel 
 low fever, not met with counter statements— -for of counter 
 evidence there is none — it might have taken years to instil 
 the truth in the public mind. Dr. Chaille has rendered the 
 cause great service, and by the time we can adequately ex- 
 
 , 
 
The origin of Yellow Fever Poison. 67 
 
 pound the entire question, numerous independent students 
 and reasoners will confirm our teaching. I am seeking in 
 every direction for data against- us, since it is my invaria- 
 ble practice to avoid, by every means at my command, any 
 partial acquisition of truth which, in its blinding influence, 
 is most detrimental. 
 
 You will perceive from the annexed letter, to Kear-Ad- 
 miral Daniel Ammen, United States Navy, that T have ad- 
 vanced in my inquiries, as to the localization and develop- 
 ment of yellow fever, before it ever acquired the precari- 
 ous foothold in the West Indian and American sea ports, 
 which, for over a century, has misled medical observers as 
 to the home of the disease. 
 
 If the Spanish domination of Cuba, with its incessant 
 turmoils, ceased to-day, Havana would again merit Cates- 
 by's eulogium. In his Natural History of Carolina, Flor- 
 ida, and the Bahama Islands, published in 1743, Mark Cat- 
 esby, Fellow of the Eoyal Society, says : 
 
 " The north side of Cuba also enjoys the benefit of the 
 refreshing winds, particularly that part of the island on 
 which the Havana stands. To this, no doubt, is owing 
 the healthiness of the air and good character of that proud 
 emporium, the conquest of which, by British arms, would 
 put us in possession of a country much more agreeable to 
 British constitutions than any of the islands between the 
 Tropics." 
 
 I remain, dear Dr. Hargis, 
 
 very sincerely yours, 
 
 JOHN GAMGEE. 
 
 Washington, October 21, 1880. 
 
LETTER TO REAR-ADIIRAL AIM, U. S. I., 
 
 ON 
 
 THE INTEK-OCEANIC SHIP CANAL 
 
 AND THE 
 
 YELLOW FEYEE ZONE. 
 
 Sir : Captain De Kraft's interesting note on the respect- 
 ive merits, in a nautical point of view, of the Panama and 
 Nicaragua sea approaches, suggests a statement of the rela- 
 tion the equatorial calms bear to yellow fever development. 
 
 Brief reference to the res alts of historical research is es- 
 sential to an understanding of the question. 
 
 Prior to the voyage of Columbus, — and, indeed, for long- 
 before his birth, the records of plagues had acquired clear- 
 ness and precision. No doubt preoccupies the medical his- 
 torian as to the consequences of the Crusades. The source 
 and periodic invasions, in Central and Western Europe, of 
 the Black Death were traced by keenest intellects. Lazza- 
 retti and quarantines had been established. The origin of 
 scurvy and its manifestations, in the days of Yenetian su- 
 premacy, down to Yasco de Gama's voyage to Melinde in 
 1498-99, have been handed down to us in interesting nar- 
 ratives. Columbus crossed the ocean in shallow, small and, 
 in the case of two out of three, deckless vessels. No sign, 
 no trace, no word of yellow fever, till after his first voyage. 
 The native West Indians had no ships and no seaports — 
 ergo, they had no yellow fever. The followers of Colum- 
 bus first perished from it, navigating the Atlantic calms, 
 and some, perhaps many, Indians caught it in the new 
 shore settlements. 
 
 A wide stretch of the imagination has accounted for the 
 depopulation of the islands by yellow fever. Ancient 
 habits were crushed out by sword and torch. Fields re- 
 
Letter to Admiral Ammen, U. S. N. 69 
 
 mained unsown. Famine fever spared neither hill nor 
 dale. It penetrated where yellow fever, as a pestilence, 
 never could prevail. Since then, the islands of the West 
 Indies and likewise this continent afford no trace of yellow 
 fever epidemics, except as seaports grew and sailors multi- 
 plied. Voyages of discovery, Slavers from Africa plying 
 their vile trade since the days of Columbus, Pirates from 
 the North Seas, bore human beings to and through the 
 Torrid Zone, and yellow fever became constant in ships. 
 It was spoken of as " the effects of climate," flux, malignant 
 fever and more specifically " calenture." The Portugese 
 entitled it " morte repentina." 
 
 The first Frenchman who visited the East Indies, Fran- 
 cois Pyrard, relating his voyage of 1601, gives a graphic 
 description of the dangers incurred from " injures de Fair " 
 on reaching within seveu ,or eight degrees of the line and 
 during the passage of the equatorial calm. The uncertain- 
 ties oi navigation until the determinations of longitude, 
 which practically began with Major Holmes' pendulum 
 watches at sea in 1665, led to serious detentions. Dr. 
 Stubbs stated, in the Philosophical Transactions for 1668, 
 that " the change of climate and the effect of it are sensible 
 to our bodies as we approach the tropick. There usually 
 occurred, as you may observe in Purchas' voyages, sick- 
 nesses in our ships about that time ; and as soon as the sea- 
 men pass the tropick they still use expressions of joy by 
 firing guns in testimony of gladness for their safe arrival. 
 * * * * * In our ships two had the disease so 
 
 much talked of called the calenture." 
 
 Queen Elizabeth, whose proudest title was that of " Mis- 
 tress of the Sea," granted a charter to the East India Com- 
 pany in 1600. The first fleet that left lost a third or more 
 of its people in the tropics. The calenture appeared as 
 the}^ approached the line. It passed away as it came, with- 
 out warning, when the vessels reached south of the calm 
 
70 Letter to Admiral Arnmen, U. S. N. 
 
 belt of Capricorn. East Indian commerce confined yellow- 
 fever, mainly, to the east of 30° W. Longitude. The ships 
 left Europe sound, became infected after passing the Tropic 
 of Cancer, and usually in the equatorial calms. The 
 malignancy of the fever disappeared near the Cape of Good 
 Hope, and scurvy commonly succeeded it in the Indian 
 Ocean. This phase of plague history has remained unno- 
 ticed, and my attention was specially directed to it by the 
 well known outbreak of yellow fever on the Busbridge East 
 Indiaman in 1792, which I felt sure could be no isolated in- 
 stance, but must have conformed to a general law.* That 
 the calenture of the equator was yellow fever, commonly 
 affecting European traders with the East Indies, all history 
 confirms. Ships returning from the Indian Ocean, China 
 seas or Australia, suffered inconvenience only when reach- 
 ing north of the calm belt of Capricorn, but especially 
 north of 5° S. latitude. The disease disappeared north of 
 the Tropic of Cancer. 
 
 To the epidemiologist no more interesting subject pre- 
 sents itself, than tracing the early beginnings, the greater 
 developments, and the present decline of yellow fever. 
 Where mystery and chaos reigned before, we find order 
 now. 
 
 * Alexander Stewart, surgeon to the Earl Talbot and General God- 
 darcl, East Indianien, writing in 1798, said. "It is a well-known and 
 melancholy truth, that these voyages when protracted beyond the 
 usual length of time, from one or other reasons have hitherto been 
 very generally attended with great sickness and mortality; the scurvy, 
 fluxes and malignant fevers, having frequently made dreadful ravages 
 amongst the crews " * * * * * * " The foul air that is gene- 
 rating in the well, which is known to be of a very noxious and fatal 
 nature, should be frequently purified by fire." 
 
 "When the bilge water is much corrupted it should not be pumped 
 out before breakfast, as in the morning, with an empty stomach, men 
 in every situation are more liable to be affected with any noxious ef- 
 fluvia." 
 
 "It may be alleged that sickness and mortality in voyages to India 
 are now less frequent than in more early times. It will be found, 
 however, that this results not from a more particular attention to the 
 preservation of health, but is chiefly attributed to the great improve- 
 ments in navigation, which now effects a passage in a quarter or third 
 of the time usual in former periods." 
 
Letter to Admiral Arnmen, U. S. iV 7 . 71 
 
 Bearing in mind the statement just made, it is clear 
 how French ships infected Barbadoes in 1647. In 1671 
 the victorious fleet from the Panama expedition intro- 
 duced the pestilential fever into Jamaica. In the year 
 1690 a bloody revolution took place in the Empire of Siam. 
 The French, established there, embarked for France in the 
 ship Oriflamme. They were forced by stress of weather 
 into Fort Boyal, Martinique, communicating a contagion 
 named the " Mai de Siam," which not only assailed the 
 Port, but all the vessels in the harbor. No one need be 
 told to-day that Siam is beyond the yellow fever zone, nor 
 that the Oriflamme succumbed to the disease in crossing the 
 tropics. She affords an early instance of the practice con- 
 demned by Humboldt. "In all climates," he says, "men 
 imagine they find some consolation in the idea that a dis- 
 ease reputed pestilential is of foreign origin. As malignant 
 fevers are easily engendered amid a large crew crowded to- 
 gether (entasses) in filthy vessels, the commencement of an 
 epidemic dates pretty often from the arrival of a squadron." 
 
 How slowly American sea-ports became occasional cen- 
 tres of devastation I need scarcely recount. Boston, not a 
 Southern city, first imported the disease, in 1693. Six years 
 later Philadelphia was attacked, and in 1702 New York 
 was, for the first time, invaded. Before the Eevolutionary 
 War there was little commerce, and whilst the pure con- 
 tagia — typically belonging to no distinct region, no alti- 
 tude, no latitude nor longitude, such as small-pox — ravaged 
 the country, the so-called West Indian fever had but slen- 
 der chance for more than very limited introduction in the 
 cities of the shore, and never reached inland. The Eevo- 
 lutionary War effectually excluded it. The Siam fever 
 was forgotten, but ports in Spain and France were contam- 
 inated, owing to their trade with the West Indies. These 
 were, however, free at intervals, until a new era was 
 reached, when the ship Hankey, necessarily crossing the line, 
 
72 
 
 Letter to Admiral Ammen, U. S. N. 
 
 arrived from Bulam, early in the year 1793, and started 
 the most virulent plague epoch which ever assailed this 
 country. The massacre of San Domingo added to all its 
 horrors the cruel slaughter, by yellow fever, of the hospi- 
 table succorers of the Creole refugees, who were fortunate 
 enough to reach American ports alive. 
 
 The College of Physicians of Philadelphia, whose 1797 
 Memorial, to the Senate and House of Eepresentatives of 
 the Commonwealth of Pennsylvania, saved the honor 
 of medicine at this period, effectually disposed of the 
 opinions of Eush, Caldwell, and other professional advo- 
 cates of the indigenous origin of the disease. That memo- 
 rial rebutted the monstrous proposition that yellow fever 
 was a plague of the American Continent. It traced it "to 
 the infected clothing of persons who died in the West In- 
 dies. In most of the cases where the infection cannot be 
 ascertained, the first appearance of the disease has been, as 
 in the other instances, in the neighborhood of the shipping, 
 or among persons connected with vessels." . . "In most of the 
 instances of the occurrence of the disease in the United 
 States, there has been war in the West Indies." Eeferring 
 to these wars, Burke said : " In these adventures, it is not 
 an enemy we have to vanquish, but a cemetery to acquire." 
 Our gallant British troops, destined to encounter barba- 
 rians, and "most of them in the bloom of youth, were con- 
 veyed," says Bryan Edwards, " with little intermission, from 
 the ship to the hospital, from the hospital to the grave!" 
 Where every advantage was "but a new demand for recruits 
 to the West Indian" tombs, entire regiments being exter- 
 minated, how could America escape the hideous consequences 
 of unwholesome intercourse? 
 
 Napoleon repeated the deluge ol human blood, sacrificed 
 to yellow fever, by his memorable West Indian expedition 
 in 1805. The contest raging in Europe, and the Berlin de- 
 cree of 1806 blockading the British Islands, interrupted the 
 
Letter to Admiral Ammen, U. S. N. 73 
 
 profit America was deriving from the destruction of the 
 ships and commerce of other nations. The President rec- 
 ommended to Congress that the seamen, ships, and mer- 
 chandise of the United States be detained in Port. The 
 embargo was established, and until its removal by Madison 
 on his accession to power in 1809, ocean commerce and 
 yellow fever were alike extinguished. The plague returned 
 in 1811, but the war of 1812-14 again closed the Atlantic 
 sea-ports, and complete immunity reigned till commerce 
 began to revive in 1817. A new factor soon came into op- 
 eration in the shape of emigration to the Southern States, 
 and imperfect quarantine admitted the disease annually, 
 not only into the ocean harbors, but up the rivers acces- 
 sible to the West Indian ships. The most active cause of 
 virulent outbreaks in the Islands was the active, irregular, 
 and barbarous traffic in slaves. 
 
 The events of the late rebellion, sustaining previous his- 
 tory, are too fresh in the people's minds to need exposition 
 here. I need not unduly extend this cursory glance at the 
 invasions of the only genuine ocean pestilence on the Globe. 
 The Equatorial calm belt continued the centre of uncertain 
 and usually prolonged detentions. Steamships then opened 
 a new era of yellow fever decline, and American hydrogra- 
 phers contributed most, by their records and charts, to re- 
 duce the passage of sailing ships from the North to the 
 South Seas. To the latter circumstance must we ascribe 
 the comparitive immunity enjoyed by Australian clippers, 
 which have, however, at times encountered the ship fever of 
 the tropical Atlantic — often escaping with less mor- 
 tality than the old East Indiamen. Had the medical 
 profession of New Orleans followed their great teacher, 
 Carpenter, they might long since have seen that whilst the 
 Mexican Gulf, like all other almost land locked seas, is free 
 from transmissible ship-fever, the annual and, frequently, 
 disastrous importations of the disease by vessels from Eu- 
 
74 Letter to Admiral Ammen, U. S. N. 
 
 rope, was due to the tedious course compelling detention in 
 the calm belts. The passage through the Caribbean Sea 
 is the occasion of its manifestation, and on the north- 
 ward progress to New Orleans the disease acquires epidemic 
 proportions. On leaving the Gulf for Europe a vessel at once 
 enters the Gulf Stream and the trades, and is soon blown 
 beyond harm's reach. Its purification, on the speedier east- 
 ward voyage, is due to similar influences to those which 
 operate South of Capricorn in ships bound for the Indian 
 Ocean. 
 
 To conclude : — the hottest open sea in the World, the 
 western half of the Equatorial Atlantic, is the constant cen- 
 tre of yellow fever development in becalmed ships. The 
 eastern half once was, owing to the peculiar conditions of 
 British East India commerce, the perennial seat of malig- 
 nant naval outbreaks, always commencing and ending in mid - 
 ocean. The opening of the proposed Panama Canal, level 
 with the sea, in the very midst of the Equatorial Calms 
 would, in my opinion, have the following effects, until sail- 
 ing ships and wooden vessels, liable to decay and contami- 
 nation, are abolished. 
 
 In the first place, the long voyage from Europe would 
 often result in sickness by the time a vessel reached the ex- 
 treme west of the tropical Atlantic. Slow towage through 
 the canal would not help it. Its abandonment to six hundred 
 miles of shifting winds and calms in the Pacific would 
 seriously aggravate its ills, and might tend to unprecedented 
 extensions of the disease in that Ocean. 
 
 Secondly. The peculiar properties of Ocean water with its 
 teaming forms of life, which undoubtedly account for the 
 poisonous bilge^emanations of vessels in the equatorial At- 
 lantic, would invade the canal water and probably extend 
 into the Pacific. An argument against this theory, how- 
 ever, may be that the colder waters of the Pacific might op- 
 pose this westward current. It must not be forgotten that 
 
Letter to Admiral Ammen, U. S. N. 75 
 
 the strip of land between the oceans effectually separates 
 their waters, fauna and flora. Antartic ice maintains the 
 high average salubrity and immunity from yellow-fever of 
 the equatorial Pacific, in contrast to the opposite conditions 
 in the equatorial Atlantic. 
 
 Thirdly. Vessels reaching the mouth of the Nicaragua 
 Canal more speedily, and blown across the fresh water lake 
 by the constant breezes which disturb it, would be placed 
 in the best possible sanitary state, by free ventilation as in 
 the OcQan trade winds and by washing out of any putrescent 
 ocean residue. They would pass into the north Pacific 
 current free from the dangers incurred in and beyond Pan- 
 ama Baj^. 
 
 I have not entered on the dangerous land fever which 
 assailed the laborers on the Panama Railroad, since my field 
 of inquiry has been more especially in relation to that 
 equatorial plague, which has been limited in its Pacific ex- 
 tensions by the purifying influences of wind and cold, in the 
 passage round the Horn. 
 
 The localization of } r ellow fever and the limitations by 
 natural conditions, so universally observed during the past 
 four centuries, point to the facility with which this conti- 
 nent may be permanently and unfailingly protected from 
 that disease. All ships from the yellow fever zone, rather 
 than those only from infected ports, should, during the 
 "dangerous months, be purified before contact with land. 
 This demands machinery and disciplined crews afloat, ade- 
 quate to ship purification in any latitude. 
 
 Contact with quarantine grounds leads to outbreaks, 
 such as have caused dangerous medical dissensions in 
 the recent outbreak on the Mississippi. Medical disputants 
 continue their doctrinal defences, whilst the Mississippi 
 Valley lies exposed to the utmost danger. Frost ends the 
 discussion by disappearance of the disease. There is but 
 one method whereby this country can be permanently pro- 
 tected from the scourge. Cold is its only known and 
 
76 Letter to Admiral Amme7i, U. S. N. 
 
 available antidote. Fumigations and fetid disinfectants 
 have all signally failed. The construction of the Kefrigera- 
 ting Ship, approved by Congress, would afford a demonstra- 
 tion surpassing in importance all else attempted in relation 
 to yellow fever prevention. 
 
 Addressing these words to an Admiral of the United 
 States Navy, I feel confident they will not be deemed out 
 of place. 
 
 I remain, Sir, with much respect, 
 
 Your obedient servant, 
 
 JOHN GAMGEE. 
 
 Kiggs House, "Washington, D. C, 
 
 October 18, 1880 
 
I35TDE3:. 
 
 Acclimatization 28, 54 
 
 " in the Mediterranean against yellow fever 7 
 
 Air the best purifier 5 
 
 Alison, Dr., origin of yellow fever in ships 33 
 
 American Continent not the home of yellow fever 72 
 
 Ammen, Letter to, by Prof. Gamgee 68 
 
 Anne Marie infected 47 
 
 Ascertained truths the weapons of philosophy 63 
 
 Audouard, Dr., origin of yellow fever on ships 33 
 
 Ball's, Dr., conclusions 41 
 
 Barcelona epidemic 27 
 
 Black Death 68 
 
 Blair, Dr. Daniel, on yellow fever 58 
 
 Boston epidemic 71 
 
 Breeze favors and sometimes hinders spread 50, 75 
 
 Brown, Dr. Harvey E., on depopulation 5 
 
 Burgess, Dr., on yellow fever in ships 38 
 
 Burke on Wars in the West Indies 72 
 
 Busbridge East Indiaman 70 
 
 Calenture 69 
 
 Caldwell, Dr. Chas., on yellow fever 20, 60 
 
 Calm belts unhealthy 45 
 
 Caneda, Dr. de, on yellow fever 37 
 
 Carpenter, Dr., on yellow fever 73 
 
 Carribbean Sea, yellow fever in 42 
 
 Cemetery of Espada 29 
 
 Chaille, Dr., on acclimatization 54, 57 
 
 " " evidence in opposition to nautical origin 34, 38 
 
 " " letters to Pensacola Advance 11, 16 
 
 Charter, E. India Company's 69 
 
 Chaumont, Dr. de, 4 
 
 Children with yellow fever 57 
 
 Chisholm, Dr., conflict with Bancroft 63 
 
 Circlair 53 
 
 Columbus 3, 68 
 
 Copland origin in ships 4, 33 
 
 Coup de Barre 27 
 
 Course of ships on the Atlantic 47 
 
 Crews of ships often protected 28 
 
 Cuba, naturally healthy. . . . 27, 67 
 
 Cubans suffer from yellow fever 54 
 
 Dickson, Dr., origin of yellow fever in ships 33 
 
 Domestic origin of yellow fever, Dr. Caldwell on 20, 72 
 
 " Dr. Drake on 26 
 
 " Dr. Emlenon 59 
 
 " Dr. Herrick on 59 
 
II 
 
 t 
 
 Domestic origin of Yellow Fever, Dr. Hutchinson on 59 
 
 " Dr. Lawson on 60 
 
 " " Dr. Rush on 59 
 
 Drake, Dr. Daniel, on yellow fever 59 
 
 Dropsical theory of yellow T fever 63 
 
 Dunglison, Dr., on endemic 22 
 
 Dutroulau, Dr. . A F., on yellow fever in ships 15, 36 
 
 Edwards, Bryan, on West India Fever 72 
 
 ' ' Eliza ' ' infected from Leghorn 40 
 
 Elizabeth, Queen, mistress of the sea 69 
 
 Embargo from 1806 to 1809 72 
 
 Emlen, Dr. Samuel, on yellow fever 59 
 
 Endemics, Dr. Aitkin's (definition 25 
 
 " Dr. Dunglison's definition 25 
 
 Dr. Hobfyn's " 24 
 
 " Dr. Roger Tracy's definition 25 
 
 Dr. C. B. Williams' definition 24 
 
 Endemicity, Dr. Herrick on 59 
 
 Dr. Tully on 22 
 
 " of yellow lever and small-pox 40 
 
 " of yellow fever in Cuba 19 
 
 Epidemics of yellow fever continued by removing the sick. . . 7 
 
 Faget, Dr. J. C, on ship origin 33 
 
 "Fair wind " a fever carrier 46 
 
 Fatal endemic on the Escambia in 1776 28 
 
 Feraud, Dr. Berenger, on yellow fever. .......... 36 
 
 Ferguson, Dr., on ship origin 33 
 
 Fever carrying ships 46 
 
 " producing ships 45 
 
 Fort Jeflerson, yellow fever 6 
 
 Foul ships with yellow fever , 4 
 
 Francis, Dr., on Chisholm 63 
 
 " " on yellow fever 60 
 
 French authorities on yellow fever 37 
 
 Fuzier, Dr., on yellow fever 36 
 
 Gamgee, John, on yellow fever in the calm belts 2, 7, 10, 33 
 
 " " on the circlair 53 
 
 " " on course of ships from Europe . . . . 47 
 
 " " on currents of pure air 51 
 
 " " on refrigeration 75 
 
 " "on seas exempt , 7 
 
 " " on ships fever — proof 52 
 
 " " work on j^ellow fever a nautical disease 3,7 
 
 " on the British East Indiaman 69 
 
 " " Inter-Oceanic Canal and yellow fever 67 
 
 " ' on Oroya fever 7 
 
 letter to Dr. Hargis 66 
 
 "" " letter to Admiral Ammen , 68 
 
 Gama's, Vasco de, voyage , 68 
 
 Germ theory of yellow fever without basis in fact 34 
 
 Governor's Island, yellow fever on 6 
 
 Griesinger, Dr., definition of yellow fever 60 
 
 Griffiths, Dr. on ship fever , 32 
 
 Hankey, yellow feVer in 71 
 
 Havana not incurably infected 39, 67 
 
 " sanistation for. 52 
 
in 
 
 Heineuiann, Dr., on Vera Cruz 54 
 
 Herrick, Dr., statement 61 
 
 ' ' " refutation of 61 
 
 Holmes' pendulum watches 69 
 
 Hosack, Dr. David, views on yellow fever . . 32 
 
 Huguenots on the Escambia 44 
 
 Humboldt on ship fever 71 
 
 Immunity of Pensacola in 1878 43 
 
 Incubation, period of 47 
 
 Indianola, yellow fever in 5 
 
 Introduction 3 
 
 Kraft, Captain de, on calms 68 
 
 Land infected vessels 46 
 
 La Roche on ship origin 32, 40 
 
 Lawson, Dr. Thomas, on yellow fever 60 
 
 Le Bceuf, infected 27 
 
 Le Hardy, Dr. J. C, on the National Board of Health 10 
 
 Lime, burnt, as a disinfectant 52 
 
 Lind, Dr., diseases of hot climates 28 
 
 " " on Escambia malaria 44 
 
 " " on removal of sick to ships 37 
 
 Loggerhead, yellow fever at 6 
 
 London, General Board of Health 62 
 
 Mai de Siara I 71 
 
 Marseilles, ship from, infected 32 
 
 " Mary, " sloop, report on 32 
 
 Massacre of St. Domingo 72 
 
 Medical profession in New Orleans believed Creoles exempt... 55 
 
 Memorial of Philadelphia, Col. of Phys 72 
 
 Memphis depopulated, bat not clear ot yellow fever till frost.. 50 
 
 Milton, refugee, with sudden attack 49 
 
 Mortality amongst children 57 
 
 National Board of Health 9 
 
 Naval surgeons on yellow fever 35 
 
 New Orleans, medical men on 59, 73 
 
 Nitrous acid fumes objectionable 4 
 
 Noah Webster, a catastrophic etiologist 8 
 
 Northampton infected in 1853 31, 42 
 
 Operations of the National Board of Health 9 
 
 Oriflamme 71 
 
 Oroya fever 7 
 
 Parkes, Dr., practical hygiene , 41 
 
 " on origin of yellow fever 4 
 
 Penrose, Dr. Thomas N., on Ticonderoga outbreak 39 
 
 Pensacola, Florida, healthy 11 
 
 exempt in 1878 42 
 
 " quarantine successful at 49 
 
 Pyrard's voyage 69 
 
 Rats and roaches dead in bilge 45 
 
 Rebellion stopt yellow fever 73 
 
 Refrigeration a sure antidote 52 
 
 Rio infected ships 46 
 
 Rotten ships, ocean infected 45 
 
 Rush, Dr., on yellow fever 20, 32, 60 
 
 Saint Nazaire outbreak 47 
 
 Sanistation, a substitute for quarantine 10 
 
 ' ' for Havana 52 
 
IV 
 
 Sea shore, yellow fever traced to the 59 
 
 Ship fever of the tropical Atlantic 66 
 
 Ships infected 9, 60 
 
 Dr. Griffiths on. 
 
 Snip poison concentrated 
 
 Small-pox endemic in Cuba 
 
 Source of disease , 
 
 Stewart, Alexander, on sickness in East Indiamen. 
 
 Stone Warren, Prof., on domestic origin 
 
 ' ' " on yellow fever in Creoles 
 
 Stranger oiding places where natives enjoy immunity, 
 
 Stubbs. Dr., on calenture 
 
 Tully, Dr. endemicity 
 
 Quarantine an Sanitary Convention , 
 
 " sue - Hful at Pensacola 
 
 Vera Cruz epidemics 
 
 Water ballast safest 
 
 War of 1812 stopped yellow fever 
 
 West India not depopu ated by yellow fever. 
 Yellow fe 
 
 32 
 44 
 24 
 41 
 70 
 31 
 55 
 56 
 69 
 22 
 60 
 49 
 55 
 45 
 73 
 68 
 3,7 
 33 
 33 
 4,33 
 
 ver a nautical disease, by Prof. John Gamgee 
 
 Alison, Dr. , on 
 
 Audouard, Dr., on 
 
 Copland, Dr., on 
 
 Dickson, Dr., on 
 
 Emlen, Dr., on 33 
 
 Stone, Dr. , on 55 
 
 endemic in Cuba 12, 27 
 
 its place in nature 62 
 
 in ship from Marseilles 32, 40 
 
 31 
 
 47 
 
 40 
 
 6 
 
 6 
 
 5 
 
 6 
 
 6 
 
 6 
 
 ..... 44 
 
 35 
 
 23 
 
 53 
 
 42 
 
 47 
 
 48 
 
 39 
 
 68 
 
 in ship Northampton. 
 
 " Anne Marie 
 
 " Eliza 
 
 in Fort Jefferson in 1873 
 
 " Governor's Island in 1870 
 
 " Indianola in 1867 
 
 " Loggerhead 
 
 " permanent barracks 
 
 " infected hold of ship 
 
 malignant in clean and unclean places. 
 
 naval surgeons on 
 
 poison from outside the human body. . , 
 
 poison surely destroyed 
 
 prevention 
 
 period of incubation not definite 
 
 sometimes instantaneous 
 
 tendency to disappear 
 
 zone