\ / HISTORY OF YELLOW FEVER. QUITMAN KOHNKE, M. D. BoRX IX 1857, AT Natchez, IMiss. Died June 26, 1909, at Covington, La. Dr. Kohnke was one of the pioneers and most forci- ble expounders of the modern doctrine of the transmission of yellow fever by the Stegoniyia Caljpus. He com- menced teaching this do'fi ne in Louisiana and illustrated his lectures by lantern slides immediately after the report of the Reed Commission had been given publicity. Had his indefatigable labors in this direction to educate public opinion in the South received fuller recognition at the time, the experience of 1905 would have been an impos- sibility. He lived long enough to see the universal ac- ceptance of this doctrine and quarantine practices modi- fled in obedience to its teachings. Requiescat in Pace. HISTORY OF YELLOW FEVER BY GEORGE AUGUSTIN. Assistant Secretary Louisiana State Medical Society; Assistant Secretary-Librarian Or- leans Parish Medical Society, New Orleans; Author of "Romances of Xew Orleans" and other Creole Stories. TO WHICH ARK ADDED THE FOLLOWING ARTICLES: MEDICAL. KTIOLOCiV — (i. EARRAR PATTOX, Ex-Secretary Louisiana State Board of Health. I'Rl>:VENTIOX— QVITMAX KOHXKE, Ex-President Xew Orleans Board of Health. P.\THOLOGY— O. L, POTHIF;r, Pathologist to Charity Hospital, Xew Orleans. DIAOXOSIS— HAMILTOX P. JOXES, Ph.\ sician-in-Chief Xew Orleans Yellow Pever Hospital, Epidemic of 1V05. TREATMEXT— LVCIEX F. SALOMON', Ex-Secretary Louisiana State Board of Health PROGNOSIS— CHARLES CHASS.\IGNAC, Dean New Orleans Polyclinic. THE LOUISIANA SYSTEM OF HYGIENIC EDUCATION— FRED. J. MAYER, Secre- tary Louisiana Sanitary Commission. history .vni) statistics, the panama canal and yellow fever- col. w. c. gorgas, v. s. army. pu'idemic of 190.5. henry dickson bruxs, m. d. cii.\rlf;s chass.\ignac, m. d. LOUIS G. LeBEUF, M. D. JULES LAZARD, M. D. SIDNEY L. THEARD. M. D. NEW ()RLP:.ANS: Published for the .\uthor by SEARCY & PFAFF Ltd., 724-728 Perdido Street. 1909. A Copyright, 1909, By GEORGE AUGUSTIN, New Orleans, La. Biomedical Library TO THAT CHIVALROUS SOUTHERN GENTLEMAN, DR. CHARLES CHASSAIGNAC, OK NEW ORLEANS, THLS VOLUME LS DEDICATED, As a Testimonial of the high esteem in which he is held in ,this com- munity, and in recognition of valuable assistance rendered in the compilation and classification of the INIedical Part of this Work to THE AUTHOR. ? ACKNOWLEDGEMENTS. I specially desire to thank Major Walter D. McCaw, Sur- geon, U. S. A., Librarian Surgeon-General's Office, for his un- faltering courtesy in placing at my disposal the works contained in the Surgeon-General's Library. During the long years con- sumed in the compilation of this work, Dr. McCaw's promptness in lending me books necessary for research work has greatly facilitated my labors, and I desire to signify my heartfelt appre- ciation of his kindness. I desire also to thank Drs. W. C. Gorges, Henry Dickson Bruns, Charles Chassaignac, Quitman Kohnke, Hamilton P. Jones, Jules Lazard, Louis G. Le Beuf, Fred. J. Mayer, G. Farrar Patton, Oliver L. Pothier, Lucien F. Salomon and Sidney L. Theard for the valuable articles contributed to this volume. THE AUTHOR. June 30, 1909. REMARKS BY THE AUTHOR. The original intention of the writer was to pubhsh a bro- chure on "The History of Yellow Fever in Louisiana," the idea suggesting itself to him while acting as special stenographer in the olhce of the United States Marine Hospital Service at New Orleans during the Yellow Fever outbreak of 1897. The duty of copying the reports made by the medical staff under Surgeon Carter devolving upon him, the thought occurred to him that a statistical and historical compilation of the many epidemics of yellow fever which have afflicted our State would prove inter- esting. With this end in view, the work of collecting data was begun shortly after the mild epidemic of 1898. Such was the nucleus of this work. During the decade which has elapsed since the collection of data for this volume was begun, the original scope was en- larged, and as the years rolled by and the magnitude of the task became more and more evident, the author found himself con- strained to dodge around corners whenever he spied a medical friend who had been assured that the book would be out "by the end of December" the year previous; and the patient, good- natured people of New Orleans, who had been told by compli- mentary articles in the public press, from time to time, that the work would "soon be issued," naturally reached the conclusion that the end would arrive simultaneously with the Millennium. No apology is made for the long-deferred appearance of this volume. A glance is sufficient to show that it is a work of love, for no amount of financial gain (should it meet with public favor) could be adequate compensation for the time consumed in its compilation. Not being possessed of independent means, the author had to steal moments out of the busy work-a-day life to complete his task, aided by his devoted wife, to whose valu- able assistance is chiefly due the completion of a work whi:h, until very recently, seemed unending. It was the author's intentions also to include within these pages a history of the ravages of Yellow Fever in the West Indies and South America, but, judging by the time which has been consumed in the compilation of what is included in this volume, he has concluded that the span of life is too short for the accomplishment of such a task, and humbly submits the re- sult of his labors to the cynical public and to the judgment of indulgent friends. GEORGE AUGUSTIN. New Orleans, June 30, 1909. CONTENTS. PART FIRST. GENERAI, OBSERVATIONS. CHAPTER I. THINGS EVERYBODY OUGHT TO KNOW. Definition of Teclinical Terms: Epidemic 1 Endemic 2 Sporadic 2 What Fomites Are 2 The Difference Between Infection and Contagion 3 What a Pandemic Is 4 Brief Remarl^s on Quarantine 6 CHAPTER II. THE RAVAGES OP PESTILENTIIAL DISEASE. The Peculiar Pranlcs of Epidemics 7 Ancient Notions About the Origin of Pestilential Disease 9 Odd Beliefs and Practices of Superstitious Ages 10 An Extraordinary Historical Document 14 Historic Mortalities Caused by Pestilences in Ancient and Medieval Times 17 The Great Plagues of London 21 CHAPTER III. THE GREAT EPIDEMICS OF THE MIDDLE AGES. The Inguinal Pestilence of the Sixth Century 22 The Black Plague 27 Le Mai des Ardents 30 The Eruptive Fevers of the Sixt'h Century — Variola, Measles, Scarlatina 35 The Sweating Sickness 36 Scurvy 38 Xicprosy 39 CHAPTER 'IV. INSECTS AS PROPAGATORS OF DISEASE. How Pestilence is Spread by Flies, Mosquitoes, Fleas and Other Insects. — Instances Where Disease Was Conveyed by Bed- Bugs and Ants. — The Role Played by the Cattle-Tick and the Tsetse-Fly. — ^Summary of the Mosquito Doctrine 44 IBibliography of Transmission of Disease by Insects 52 PART SECOND. PRELIMINARY OBSERVATIONS ON YELLOW FEVER. CHAPTER I. PERTINENT POINTS ABOUT YELLOW FEVER. Geographical Limits 62 Mortality in September, as Compared with Other Months 64 Historic Mortalities Caused by Yellow Fever 66 CHAPTER II. NOMENCLATURE OF YELLOW FEVER. Peculiar Names Giren the Disease by Medical Writers. — A List Con- taining One Hundred and Fifty-two Synonyms 70 CHAPTER III. HISTORICAL SUMMARY. Wiere was the Cradle of Yellow Fever? 85 Critical Examinations of the Literature on the Origin of Yellow Fever: American Origin 87 African Origin 100 Asiatic Origin 105 The Gulf Stream Theory 10& First Recorded Outbreaks Ill PART THIRD. HISTORY OF YEI/I.OW F^VBR BY I,OCAI,ITI^S. ASIA. The Effect that the Completion of the Panama Canal will have upon the Probable Extension of Yellow Fever to Asia — W. C. Gorgas, U. S. A 135 Alleged Yellow Fever in Syria 144 AFRICA. History cf Yellow Fever in Africa, Arranged Alphabetically, by Localities 150 to 343 Chronology of Yellow Fever in Africa and the Islands off the Coast thereof, from 1494 to 1997 344 Summary of Yellow Fever Years and Periods of Immunity 350 Chronology, by Localities 352 EUROPE. Austria. Trieste 356 Azores. Historical Summary 357 Ponta Delgado 358 France. Historical Summary 359 Chronology, 1694 to 1908 360 Aix 363 Bordeaux 364 Brest 370 Dunkirk 372 Havre 373 La Rochelle 375 Marseilles 375 Mindin 388 Montoirde-Bretagne 389 Montpellier 389 Nantes 390 Paris 390 Rochefort 396 Saint-Nazaire 400 Toulon 412 AIGISTIN S HISTORY UF YELLOW KKVER. Great Britain. Historical Summary 415 Chronology, 1713 to 1878 416 Cork 430 Dover 419 Dublin 430 Falmouth 419 Isle of Wright 419 Llanelly 432 London 420 Motherbank. (See Isle of Wight). Newcastle-on-Tyne 421 Portsmouth 422 Salcombe 423 Southampton 423 Swansea 432 Woolwich 443 Italy. Chronology, 1804 to 1883 447 Genoa 447 Leghorn 448 Naples 452 Pisa 453 Torre Annunziata 454 Varignana 456 Portugal. Chronology, 1718 to 1880 460 Belem 460 Bom Successo 462 Ericeira 462 Lisbon 463 Olivaes 475 Oporto 475 Peniche 480 Spain. Historical Summary 483 Geographical Description of Localities in Spain Where Yellow- Fever has been Observed 484 Chronology, 1649 to 1S90 491 Summary of Yellow Fever Epidemics, by localities : Aguilas 499 CONTENTS. 5 Alberca, Alcala de los Gazules, Alcala de los Panderos 500 Alcantarilla, Algerziras 501 Alhaurin-el-Grande, Alicante 502 Antequera 504 Arahal, Arcos de la Frontera 506 Avriata, Ayamonte 508 Badalona 509 Balearic Islands 509 Barcelona 516 Barcelonette 522 Barrios, Benaocaz 523 Borncs 524 Cadiz 524 Caneta-de-Mar 544 Caneta-la-Real, Carmona, Carraca, Carrana 545- Cartagena 54& Catalan Bay 548- Chiclana, Chipiona 549' Churriana, Coin 550 Conil, Cordova , 551 Coria, Cortes de la Frontera, Corunna, Dos Hermanos 552 Ecija 553 El Arahal, El Borge, El Palo, El Passajes, Eprezalena 554 Espejo 555 Espera, Estepa 556 Ferrol, Fraga 557 Gibraltar 557 Granada, Guardamar 566 Huelva, Isla de Leon 567 Jesus, Jiimilla 568 La Charlotta, La Rambla 569 Las Cabezas de San Juan, Las Palacios, Lebrixa 571 Lorca 573 Loyola 574 Madrid 574 Mairena del Alcor 576 Malaga 577 Malgrat 598 Mazarron, Medina-Sidonia 599 Mequinenza 600 Mijas, Monte Alegre, Montejague 601 Montilla 602 Mora, Moron de la Frontera, Murcia 603 Nonaspe, Ojos, Ol'.vera 604 Olot 605 AUGUSTIN S HISTORY OF YELI.OVV FEVER, Palma (See Balearic Islands). Palmar, Pasajes 605 Paterna de la Ribiera, Pedrara 607 Pedroches, Penacerrada 608 Port Mahon. (See Balearic Islands). Puerto de Santa Maria 608 Puerto Real 609 Regans, Ricote 610- Ronda 611 Roquetas, Rota, Saint Eloy 612 San Andero, Salou 613 San Gervaiso, San Juan del Porto, San Lucar de Baramaeda 614 San Roque, Sans, Sarria 615 Seville 618 Sitges 621 Tabarca, Tobarra, Torre del Mar, Torre Molino 622 Tortosa 623 Totana, Tribujena 625 Turriano, Ubrique, Utrera 626 Valencia, Vejer, Velez Malaga 627 Vera, Vigo 628 Villa Martin 629 Villanueva del Ariscal, Villaseca de la Sagua 630 Xeres de la Frontera 630 Ximena de la Frontera 633 Yecla, Zieza 634 HISTORY OF YEI.I.OW FEVER IN NORTH AMERICA. Proofs tliat Yellow Fever is an American Product and was Unknown to Europeans before the time of Columbus QZB^ CANADA. Historical Resume 650 Chronology, 1805 to 1880 652 Summary of Yellow Fever Outbreaks, by Localities: Nova Scotia. Halifax 652 Prince Edward Island. Charlottetown 656 Quebec. Quebec 656 Saint Pierre and IVIiquelon. Saint-Pierre-deMiquelon 658 Bibliography of Yellow Fever in Canada 659 CENTRAL AlVIERICA. Historical Resume 660 Chronology, 1596 to 1908 661 Summary of Yellow Fever Outbreaks, by Localities: British Honduras. Belize 666 Costa Rica. Alajuela 668 Heredia, Liberia, Matina 669 Port Limon 670 Punta Arena. San Jose 678 San Juan 679 Zent 680 Guatemala. Champerico, Chiquimula, Gualan 681 Livingston, Puerto Barrios 682 Tucara, Zucapa 683 Honduras. Ceiba, Chamelicon 685 Cholona, Cienaguita, El Pariso, Nacaome, Pimenta 686 Puerto Cortez 687 San Pedro 689 Nicaragua. Bluefields, Corinto 690 Granada, Jucunapa, Leon 691 Managua, San Francisco 692 Salvador. Acajitla, La Libertad 693 San Salvador 693 Santiago de Maria " 696 Bibliography of Yellow Fever in Central America 696 O AUGUSTIN S HISTORY OF YELLOW KEVER. MEXICO. Historical Summary of Yellow Fever in Mexico: Endemic Foci 700 Along the Pacific 'Coast 702 General Retrospect 705 The General Epidemic of 1883 707 Summary of Yellow Fever Epidemics in Mexico, by Localities: Acapulco, Acayucan, Altata, Altamera 708 Alvardo, Amalco, Atai, Camarga, Campeche 709 Cardenas, Chilpanzingo 710 Cilas, Cinchapa, Clinidas, Coatzacoalcos, Colina 711 Caraco 712 Concordia 712 Cordova 715 Corrientes 715 Cosmaloapam, Cosala, Culican, Dofia Cecilia, El Higo, Equador, Frontera 71& Gualian, Guaymas, Guerrera, Guietihicori, Hermosilo 717 Hidalgo, Huachinango, Huimanguillo, Ixcallan, Jalapa, Jicaltepec, Jico, Jiminez 718 Joltipan, Juchitan. Laguna del Carmen, La Junta, Lampasas, La Paz 71i> Las Animas, Linares, Mazanillo 720 Matamoras 720 Mazatlan 721 Merida 721 Mexico City — Experiments Demonstrating that the Yellow Fever Mosquito can Breed in Mexico City 723 Summary of Yellow Fever Importations to Mexico City 728 Micaltepec, Mier 728 Minatilpan, Misantla, Monclava, Monterey 729 Motul, Montzorongo, Naulta 730 Nicayuca, Xeuva Laredo, Ocus, Omealca 731 Orizaba 731 Papantla, Paraje Nuevo, Paso de Ovijas, Pinchucalco, Presidio 734 Progreso Peublo Vejo, jr^eurto Angel, Quantana Roo, Reata 735 Reynosa, Rosario, Salina Cruz, San Antonio, San Benito, San Bias.. 736 San Fernando, San Geromino, San Ignacio, San Juan Batista, San Lorenzo, San Luis Potosi 737 Santa Cruz de los Rosales, Santa Lucretia. Santiago Acapemeta, Soconusco 738 Tampico 738 CONTENTS. & Tamuin, Tapachula, Tepee, Tehuantep.ee 74L Teran, Texistopec 742 Tezonapa, Tierra Blanca, Tapona, Tlacoltipan, Tpislan, Tonala, Tuxpan 743 Tuxtepee, Valladolid 744r Vera Cruz (1509 to 1909) 744 Victoria, Xumpich, Yuki, Zonogolica, Zucatula 750 Bibliography of Yellow Fever in Mex'co, by Localities 750 UNITED STATES. General Summary 767 Table Showing Years in which Yellow Fever has Invaded the Sea board Cities of the United States. 1668 to 1893 769 to 78(> History of Yellow Fever in the United States, by Localities: A'abama 781 Arkansas 792 California 7E5- Connecticut 798 Delaware 801 District of Columbia 804 Florida 805- Georgia 821 Illinois 833 Indiana 838 Indian Territory 838^ Kentucky 839 Louisiana 844 to 902 Maine 915 Maryland 917 Massachusetts 5iJ& Michigan 936 Mississippi 937 to 954 MisEouri 957 New Hampshire 962 New Jersey 96 J New York 96& North Carolini 982 Ohio 934 Pennsylvania ^^^ Rhode Island ^^^ South Carolina ^^^ Tennessee Texas .... .1001 .1009 Virginia ^"^^ Vermont .1022 Washington 1^^"^ West Virginia .1024 10 PART FOURTH HISTORY OF YELLOW FEVER EPIDEMIC OF 1S05. I. EXPERIENCES DURING THE YELLOW FEVER EPIDEMIC OF 1905.— HENRY DICKSON BRUNS, M. D 1027 II. SOME LESSONS TAUGHT BY THE EPIDEMIC OF 1905.— CHARLES CHASSAIGNAC, M. D. I. Truth of Mosquito Propagation 1049 II. Infection in Proportion to Number of Bites 1052 III. Virulence Diminishes Pari Passu witli the Destruction of Mosquitoes 1053 IV. Susceptibility of Negroes 1054 V. Quarantines Unintelligent 1055 VI. Prophylaxis in Place 1056 VII. Prophylaxis in Person 1057 VIII. Depopulation of Infected Places 1057 IX. Detention Camps 1058 X. The Great Lesson 1058 III. THE WORK OF THE MEDICAL PROFESSION OF NEW OR- LEANS DURING THE EPIDEMIC OF 1905.— LOUIS G. LeBEUF, M. D. I. Preliminary Remarks; Local Medical Organization. . .1060 II. Appeal for Early Notification 1069 III. Appeal for Immediate Screening of Suspected Cases, and Fumigation 1071 IV. Appeal for an Educational Campaign lOTi; V. A Warning to Beware of the Danger of Overlooking the Less Obvious Breeding Places of the Stegomyia 1073 VI. Appeal for a More Skilled Medical Body to Conduct the Campaign 1074 VII. Letter Warning Medical Men not to Overlook the Mild Type of Yellow Fever which may be Found in the Native-Born lO'^S VIII. Appeal to Householders to Delay "Moving Day" on Account of Danger of Spreading Infection 1076 IX. Danger of Removal of Temporary Cistern Screens 1076 X. Concluding Remarks 10"7 CONTENTS, 1 1 . . IV. STATISTICAL REVIEW OF THE YELLOW FEVER EPIDEMIC OF 1905, NEW ORLEANS.— JULES LAZARD, M. D. I. General Remarks 1078 II. "Suspicious" Deaths, 1905, Previous to Epidemic Period 1079 III. Daily Record nf Cases and Deaths and Cases Under Treatment 1081 IV. Deaths Classified According to Age 1083 V. Deaths by Months 1084 VI. Deaths According to Nationality 1084 VII. Comparative Mortality, 1904, 1905, 1906 1085 V. ilEQUIREMENTS OF THE MOSQUITO DOCTRINE— S. L. THEARD, M. D 1086 VI. ISTEW ORLEANS YELLOW FEVER IN 1905.— S. L. THEARD, M. D 1093 VII. AiNTI-MOSQUITO ORDINANCES ADOPTED BY THE CITY COUNCIL OF NEW ORLEANS IN 1905 1100 12 PART FIFTH THE ACCEPTED MODERN THEORIES CONCERNING YELLOW- FEVER. ETIOLOGY OF YELLOW FEVER— G. FARRAR PATTON, M. D. L First Definite Suggestion of the Truth liOT The Yellow Fever Germ 1103 II. Views Formerly Held 1111 III. Tyranny of a False Doctrine 1116 IV. Convincing Object Lessons of 1905 1117 V. Etiological Role of the Mosquito 1118 VI. The Bacillus Icteroides 1124 VII. Dengue and Yellow Fever 112(> II. THE SANITARY PREVENTION OF YELLOW FEVER— QUITMAN KOHNKE, M. D. I. The Yellow Fever Mosquito 1127 II. Moral Responsibility for Epidemics 11 2S in. The Sanitary Creed 1125^ IV. Mortality Statistics 1131 V. Destruction of Stegomyiae 1133 VI. Conditions Obtaining in New Orleans in 1905 llo4 VII. Conclusions 1136 Bibliography of Transmission of Yellow Fever by Mosquitoes 113S III. PATHOLOGY OF YELLOW FEVER.— O. L. POTHIER, M. D. I. Difficulty of Pathc!ogical Diagno&Is 1147 II. Yellow Coior 1147 III. Hemorrhagic Spots 1148 IV. The Lungs 1148 V. The Heart 1148' VI. The Liver 1149 VII. The Spleen 1149 VIII. The Kidneys 1150 IX. The Adrenals, Thyroids and Pancreas 1150- CONTENTS. 13 X. The Stomach 125 ) XI. The Intestines 1151 XII. The Blood 1151 XIII. The Nervous System 1151 XIV. Adults More Susceptib'.e 1152 XV. General Steatosis the only Special Characteristic Lesion 1152 IV. DIAGNOSIS OF YELLOW FEVER.— HAMILTON P. JONES, M. D. I. Preliminary Remarks 1154 II. First Stage 1156 III. Second Stage 1156 IV. The Blood 1157 V. Urine 1157 VI. Facial Expression •. 1157 VII. Jsundice 1158 VIII. Circulation 1158 IX. Temperature 1158 X. Pulse 1158 XI. Respiration 1159 XIL Blood Pressure 1159 XIII. Differential Diagnosis Malaria 1160 Hemoglobinuric Fever 1161 Dengue 1161 La Grippe 1161 Typhoid Fever 1161 Acute Yellow Atrophy of the Liver 1162 Weil's Disease 1162 Catarrhal Jaundice 1162 Acute Peritonitis 1162 XIV. General Summary 1162 V. PROGNOSIS OF YELLOW FEVER— CHARLES CHASSAIGNAC. M. D. I. Preliminary Remarks 1164 IL Age 1165 III. Condition of the Vital Organs 1166 IV. Habits 1166 V. Amount of Poison 1166 14 augustin's history of yellow fever. VI. Surroundings 1167 VII. Race 116? VIII. Treatment 1167 IX. Temperature 1165^ X. Icterus 1168 XI. Urine 1165^ XII. Hemorrhage 1169 VI. TREATMENT OF YELLOW FEVER— LUCIEX F. SOLOMON, M. D 1171 VIL THE LOUISIANA SYSTEM OF HYGIENIC EDUCATION— FRED. J. MAYER, M. D 1176 PART I. GENERAL OBSERVATIONS. PART FIRST. CHAPTER I. THINGS EVERYBODY OUGHT TO KNOW. Definition of Technical Terms.— What is Meant by Epidemic, Endemic and Sporadic— What Fomites Are.— The Difference Between Contagion and Infection.— What a Pandemic Is.— Brief Remarlvs on Quarantine. As this work is not soldy for the use of physicians, but also for the information and guidance of the public, we wiU give a brief synopsis of the meaning of certain words wluch have been used quite freely by the lay and medical press recently, so that anyone who reads these pages will be perfectly familiar Avith technical terms Avhich might otherwise seem confusing. Epidemic. Tlie term Epidemic is applied to any disease which at- taclcs a great many persons in a locality at any particular period and spreads rapidly in every direction, although every conceivable effort to check it or stamp it out is resorted to. The popular belief prevails among the laity that a disease is epidemic when the deaths from any cause exceed those from all other diseases occurring simultaneously in any locality. Such is not the case. A disease may be epidemic Avithout having an unusual rate of mortality. This was illustrated by the epidemic of jaundice (some say it was yellow fever in its mildest form) which pre- vailed in Ifotherham, England, in 1862. There were over three hundred cases, with only one death. And yet the disease was decidedly epidemic. WISTORY OF VELLOW FEVER. Endemic. A diseiise is said to be Endemic when it is permanently established or is ordinarily i>revalent in a locality, and dependent on local conditions. Sporadic. Sporadic means that a disease manifests itself by the occurence of scattered or isolated cases, cropping- out here and there, at irregular intervals, and easily amenable to remedial measures. FOMITES. The word Fomitcs has been juggled with so much by non-medical writers and by physicians who ought to have known better, but who made use of the expression in a hap-haxard way, that we desire to call special attention to its true etymology. Fomitcs is the plural of Fames, and is derived fi'om the ]>atin fomes, meaning touch-wood or tinder, or something which spreads quickly. It is ap- plied to any substance capable of absorbing, retaining and transmitting contagicms or infectious germs. Such things as woolen clotbes, mos.s, etc., are decidedly active Fomites, but it is impossible for wood, stone, iron, cork, books, newspapers or anything which does not retain germs, to propagate them. As yellow fever can only be transmitted by a certain species of mosfpiito, it cannot, under any con- dition whatsoever, be propagated by Fomites. Even if one wears the gannents of a person who has died of yellow fever, he can never contract the disease and will never be susceptilde to it, uidess he is bitten by a female Stcgomijia Fasciata which has bitten a yellow fever sufferer during the first three days of the attack. Tlie only di.sea.ses believed to be capable of l^eing trans- mitteoint of de- pai'ture and the locality it was destined to ravage. One of the most noteworthy pandemic waves of modern times began at the Cape of Good Hope in 1822 and ended in the frigid zone seven yiars later, after luning covered nearly the entire globe. Starting at the Cape, it traveled along the southern coast of jMadagascar and ]-eached the Island of ^Mauritius, in the Indian Ocean, in 1823. It was next felt in Ceylon, India and in some parts of Eastern Asia, after which it seems to have "doubled upon its tracks," for it stopped when it reached China and travelled >\x^tward, skirting the southern coast of Asia and enter- ing tbe ^Mediterranean by Avay of Asia ■Minor, in the fall of 1^21. It then successively invaded ^Malta, Cibraltar and some of the islands off tlie west coast of Afri(*a. It next sojourned towards the north, reaching Great Britain the same year. 0)»servers have recorded tlu^ fact that dur- ing the visitation of this ])aiid( iiiic, tlie admissions into the fever hospitals of London, Dublin, (Jlasgow and Edin- burg increased to an abnormal extent. Tlie wave then crossed the Atlantic and was felt in the West Indies in the Autumn of 1824, Avhere it caused a high rate (►f nnu'tal- ity. Its influence seems to have lingwed in that locality, for in 1825, Jamaica, in which had taken place the preced- ing year a slight advances in the death rate, expe^rienced a terrible epidemic. By one of those strange and unaccount- able vagaries which often chiu-acterize the phenomena of Nature, New Orleans was the only locality in the United States ^^I)ich felt the influence of the wave; the mortality, THINGS EVERYBODY OUGHT TO KNOW. 5 hoAve\'ea', Avas not very great, the deaths from yellow fever in 1824 aggregatino- io8, against 808 in 1822. Tlie pandemic then jumped, as it were, from the Gulf of Mexico to Canada, where it caused much sickness and mortality in 1825, especially in Nova Scotia and the eastern provinces. The wave seems tO' have been loth to leave the T^ritish Isles, for its baneful influence was felt now and then throughout the United Kingdom from 1825 to 1828, during which manifestations the death-rate rose to a noteworthy degree. This remarkable pandemic finally spent itself on the frozen shores of Iceland in 1829, leaving in its wake throughout the island a series of epidemic diseases, in which typhus played a prominent role. LaAN'son, anIio minutely noted the occurrence and in- fluences of pandemics, says:- "These waves oecupy about two years in passing over a given station; the mortality froiu fever, of Axhatever de- scription it ma^^ be, increases during their passage, subsiding again as they move onwards. They follow each other at intervals of a few years, and may be traced from the Cape of Good Hope, where tliey first iK^conie sensible, to Iceland. Some embrace Ceyhm, in 80^ E. longitude, and New Orleans, in 90^ W. longitude, or nearly half the circumference of the earth. Were information for other places aA'ailable, no doubt their passage might be demon- strated still more extensive]}'." xVgain :^ "The occurrences in the ]Medi terra nean in 1828 are extremely int/ resting and im]iorlaut. There, under the same pandemic wave, while yellow fever was causing such mortality at Gibraltar as to induce many to think it an imported disease, the remittent fever, the undoubted pro- duct of (he locality, was causing a mncli higlier one at Santa ]\faura, and other forms of i'ebrib' disease — petechial typhus at Naples, and plague in Albania^ — were prevailing on either side the latter. It must, therefore, be concluded -Lawson: Trans. Epidemiological Society of London. Vol '^. 1862. '' Ibid. HISTORY OF YELLOW FEVER. that tlioiijrh the pandemic cause determines the occurrence of febi'ih^ disease in places over whicli it passes, the peculi.'ir form, and even the frequency, of the disease is determined rather by the circumstances, whether motfo u- log-ical, malarial, livgienic, or social, to Avhich each popula- tion is snhjectetl. Tlie same local circumstanci s may exis^t in other years, and, so far as can be estimated, to an equal extent, but fevers do not become rife; but no sooner is the pandemic cause added, than these seem to acquire a potency which is almost inexplicable." Quarantine. Quarantine is derived from the Italian word quaruutUui. which means a space of forty days, the period (originally forty days) during wliicli a ship liavinii' a contagious disease on boar% medical part of this volume. '% CHAPTER II. THE RAVAGES OF PESTILENTIAL DISEASE. The Peculiar Pranks of Epidemics. — Ancient Notions about the Origin of Pestilences. — Full Text of the Extraordinary Document Promulgated by the College of Physicians of Paris in 1665. — An Out- line of the Appalling Mortality caused by Pandemics in Ancient and Medieval Times. — The Great Plagues of London. The Peculiar Pranks of Epidemics. Fortiinatelj for the human race, it is seldom that two diseases are epidemic at the same time in the same locality. "When yellow fever raged with such violence at Gibraltar in 1S04, it was remarked that all other diseases declined ; and ^^'ell they might, for in that great epidemic, out of a civil population of 14,000, only 28 escaped an attack. A similar retreat of inferior diseases has been observed to take place dui'ing the prevalence of the plague in London, Holland and Germany, according to histories of that disease by Sydenham, Diemerbrock, Sennertus and Hildamus. A modern instance of the malignity of yellow fever took place at V»^oodvi]le, Miss., in 1844. When the fever broke out, all those who could get away fled, and out of a total remaining population of 500 some 495 were attacked by the fever. There have been notable exceptions to the rule that only one epidemic can rage at the same time. In 1830, both smallpox and measles were epidemic in England and Wales. Smallpox and scarlet fever were both epidemic in New York in 1840, 1841, 1842 and 1843; and in 1840 and 1841, measles was also epidemic, so that the three diseases were epidemic at the same time in the last mentioned years. In the year 1802, Charleston, S. C, was affected with four epidemics — smallpox, measles^ yellow fever and influenza. It A^'as a common oecurrence, during the prevalence of cholera at "New Orleans in the autumn of 1832, for a O HISTORY OF YKLLOW FKVER. person to be attacked with yellow fever, and before, or as soon as the febrile excitement ceased, for the patient to be destroyed by the cholera in its most marked and malig- nant form. The cholera Avhich was imported to New Orleans in 186G maintained its existence throughont the yellow fever epidemic of 1807, diminishing in its intensity as the fever advanced, and again becoming more malignant as the fever subsided. Pint it was never entirely absent. In Xovemlte]* of that year, 234 deaths occurred from choleja and 103 from yellow fever; in December, Avhen the fever had almost disappeared the mortalitv from cholera was 210. In 1853, according to Fenner,^ there was a remark- able series of epidemic disease. We call the following from his report, p. 1 : "During the past 3'ear,- two of the most terrible epidemic diseases that ever afflicted man- kind have prevailed, to a greater or less extent, in parts of the extensive region assigned to my notice.^ I mean cholera and yellow fever. Smallpox has also appeared in several places; and other epidemics, such as measles, scarlatina and whooping cough, have made us their cus- tomary annual visitations.'' ^leasles and smallpox were also epidemic in Philadel- phia in 1823 and 1824, and in 1835 and 1845, smallpox, measles and scarlet fever were all epidemic. Measles and scarlet fever were both epidemic in Balti- more in 1837, and smallpox and scarlet fever in 1838, and again in 1845. In 1808, smallpox, cholera and yellow fever prevailed in Cienfuegos, Cuba. Other instances could be cited, but these suffice for the purpose in view. Epidemic diseases seem to be more fatal among the un- civilized than the civilized. In an epidemic of rubeola Tenner: Report of the Epidemics of Louisiana, Mississippi, Arkansas and Texas in the Year 1853, by E. D. Fenner, 1853. = 1S53. ' The four Slates mentioned in above title. THE RAVAGES OF PESTrLKNTIAL DISEASE. 9 among the Crees (a tribe of North American Indians) in the summer of 1846, as reported by Dr. Smellie in the Monthly Journal of Medical Science for December, 1846, of 145 cases treated in his camp, 40 were fatal. Smallpox has sometimes swept off an entire tribe of Indians, as A\'as the case with the Mandans (another North American tribe), and has generally proved abnormally fatal A\'hen it attacked the Ked Ilace. It has been obseived by Oregory* that epidemics are usually severe when they first appear in a country or are reneAved after any long intervals of time. AA'hen cholera first invaded India in 1817, it raged with an intensity which may Imve been equalled, but never has been sur- passed. When smallpox first nmde its appearance in America (Mexico) in 1518 and gangrenous sorethroat (diphtheria) first visited Naples in 1618, America in 1735 and London in 1747, the ravages of each disorder were terrific. It seems, tlien, to be the law of animal economy that the susceptibility to any morbid poison is great in proportion as it has been little accustomed to the impres- sion. Ancient Notions about the Origin of Pestilential Disease. The works of Hipocrates contain many interesting ob- servations upon the origin and nature of epidemics. He states that disease, in general, nmy be said to arise either from the food we oat or the air we breathe. AMien, tlu^re- fore, a disease seizes upon a multitude of persons of dif- ferent sexes, ages and habits, he infers that it must arise from the latter cause.'' In his first book, fourteen cases of disease are related, and in the beginning of the third book, tAvelve, and sixteen in the end, thus making forty-t\\o in all. It is worthy of remark that in twenty- five of these the result was fatal. There is every reason tlien to suppose that they Avere selected for a pur])ose, but what that purpose was cannot now be easily deterndned. ^Gregory: A Treatise on Eruptive Fevers (1851), p. 35. ^Paulus Egineta (Adams' translation). Vol. 1, p. 274. 10 HISTORY OF YELLOW KEVER, Tlie most natural result ^vould no doubt have bten to illustrate the dififerent pestilential diseases which are described as oecurriuj:: at the tiiue.^ (ialeu also attiibutes the orijiin of epidemics to the stiite of the atmosphere, but holds that the nature of the country may contribute. Lucretius accounts for the prevalence of epidemics u[H)n similar principles, and Silius Italicus refers au e])idemical fever to the same cause. The purifyiui;- of the atmosi)here as a means of prevent- inji' or limitini*' the spread of disease, is as old as the world itself. It is reported of Hipi)Ocrates that he changed the morbific state of the atmosphere of Athens by kindlinjr fires. I'lu larch also makes mention of one Acron, of Athens, a\ hen the great plague visited that city at the commencement of the PeloponCvsiau war, and attrilmtes to him the advice that was given to the Athenians to kindle large fires throughout the streets, Avith the view of purify- ing the air, which is the same plan as was adopted l)y the priests of l"]gyj)t.' Pliny also speaks of fires as a corrective of the state of the atinos])here, and Herodotus relates that fumigation with aromatics were recommended as a preventive of the plague.^ Odd Beliefs and Practices of Supeustitious Ages. The ancients attributed t/) their gods the authorship of ejtidemics, and under this Itclief, religious sacrifices were made to appease their anger. Terror-stricken and demoralized, they abandoned all measures calculated to give them ]»r<>te(tion and rdicf and relied solely upon their offerings and their i)rayers at the f(M)t of the altar for presei-vation. Cai'dan and Valesco de Tarente did not fear to attribute the origin of disease to the in- fluence of certain planets, while Xat. Webster, an Ameri- can ])hysi(ia.n, gives also iiion* than fifty instances of the concurrence of an e])idemic with some comnujtion of "Hippocrates (Adams' translation). Vol. 1, p. 342. • Histoire de Medecine (Leclerc), Vol. 1, p. 57. * Paulus Egineta, Vol. 1, p. 174. THE RAVAGES OF PESTILENTIAL DISEASE. 1 1 nature, such as earthquakes, volcanic eruptions and the appearance of comets. Jackson, Joubert and others, have dwelt upon tJie influence of tlie moon upon epidemic disease; and during the plague that nearly depopulated Paris in 1580, ^^'hen forty thousand people Avere swept away, the sky was so clear and serene, that the stars were looked to as the cause which could no-t be found in the atmosphere.^ According to researches made by Eager,^" in the earliest period, superstition and stellar influence took the principal place in the confused ideas of etiology. Ill- ordei^ed doctrines led to all sorts of irrational practices. Among the Greeks, in the rites of Esculapius, the sick wei'e not j)cj'mitted to enter the temples, where they un- derwent tieatment, without first being purified by various baths, frictions, and fumigations. All this was accom- panied by ceremonies similar to those practiced within the temples, namely, nmgical perfornmnces autl fervent prayers recited in a loud voice, often with musical ac- companiment. As an accessory to the purification prelim- inary to being admitted, the ])atient was required to pass the night sti'etched on the skin of a sheep that had been offered as a sacrilice. Here he was ordered to eompose his mind for sleep and await the arrival of the physician. Throughout these ages as we^ll as in more recent times a fanciful association between the phenomena of the material world and the destinies of mankind closeh* linked the doctrine of etiology \\iih astrology. Th-, fop;s, and even meteors were blamed for caus- ing pestileuce, and the Hii>ht of l)irds and injects were supposed to be dependent plienomena. Xanaphanes, five hundred or six hundred years before Clirist, expounded an idea that the sun was a torch and tJie stars candles that were put out from time to time. Accord iufj to his notion, which was seriously accepted, the stars were not heavenly l)odies in tJie wider sense, but meteors thrown off from the earth. So a belief in stellar influence did not carry the mind (;utside Avorldly ranjies. For this reason other practices than prayc^rs and sacrifices were believed to be effective. They consisted cliiefly in efforts to dissijiate the meteors, such as huiie and numer- ous fires, and to avoid meteoric influence by confinement in closed or oth.erwise protected places. "Durinii the pe^riod under consideration/' concludes Dr. Ea- the Phenicians to immolate their children durini^- the ])revalence of epi- d( lilies, ho])infi tliereby to a]>pease the anj^er of the gods and put a stop to the pestilence. Plutarch relates the manneM* of Esop's death. B. C. 581. The famous fabulist went to Delphi with a great quantity of gold and silver to offer, in the name of Cresus, a great sacrifice to Apollo, and to give each inhabitant a con- siderable sum. xV quarrel arose l>et.ween Eso]) and the people of Del])hi, occasioning him afterwards to send back the money to C'resus. The iK'ojjle of Del])lii caused him to be condemned as guilty of sacrilege, and to be thrown froui the loj) of a rock. The god, (tft'ended by this action, punished them with a jjlague and famine, so that, to put an end to these e^ils, the terrorizeel Delphians offered to make reparation to any of the i-elatives of Esop. "At the third generation,-' continues Plutarch, "a man presented himself from Samos. The Delphians made this man re- THE RAVAGES OF PESTILENTIAL DISEASE. 13 paration or satisfaction, and thereby delivered themselves from pestilence and famine which distressed tliem."^^ Epidenjjc disease was frequent in Greece before the Christian Era, The Athenians were wont to make annual sacrilices to Toxaris, "the foreign physician," because their city liad been delivered from the plague by his means, or rather by a a\ oman who had dreamed that Toxaris, who dwelt at Atliens, had told her that the pestilence would cease if they ^^ ashed the streets with wine, "which they did, and the plague ceased immediately." In the year 665 B. C, T'haletes, the Milesian, is reputed to have put a stop to an epidemic which had baffled the skill of the most renowned physicians of the time, by the influence of music. Had Thah tes lived in the present age, he would uudouI)tedly have amassed a princely fortune by stating what particular Diake of instrument he used. Un- fortunately, history is silent on this point. Tn the year B. C. 534, a terrible plague raged at Car- thage. The devastation was so great, that the people sac- rificed their children to appease the gods. According to Xiebuhr,^- the eruption of Mount Etna, which took jdace in the 81st. Olympiad, coincided exactly with the ]iest Hence which devastated Rome about that period. The same authority says that in the year 301, the Northern Lights could be distinctly seen in Italy and were •'•'eminently connected with the ferment in the bowels of the earth." in the year 2IJ0, and also 295, the firma- ment seemed to be on fire, "broken by flashes of lightning; armies and tbe tumults of battles were seen in the sky and Siounds A>ere heard which heightened the terror of this phenomenon.'- ])r. Howe (quoting Nicbuhr) also speaks of another phenomenon which is said t(^ have occurred iu the year 295, and observes that, however incredible it nmy seem, "it ought not to be rejected as an idle tale." The para- graph referred to reads as follows : ^'irlowe: Epidemic Diseases, 186-5, p. 21. '-Niebuhr: Lectures on Roman Historic (Howe, loc. cit., p. So). !♦ HISTORY OF YEI^LOW FEVER. "There fell, we are told, a shower of flakes like flesh, ^^ilich the birds devoured. W'liat remained on the ground did not rot." No explanation is made of this alleged phenomenon, except in meta])lu)r.s, which, when carefully sifted, ex- plain nothing, as is usually the case with metaphors. In the Year of Eome 300, a ])lan was adopted to cause the cessation of the plague which had alHicted Kome 350 years from its foundation. The Romans, by the advice of their oracle, sent ten deputies to Epidaurus, a town in ancient Greece, in the Peloponesus, celebrated for its magniflcent temple of Esculapius. The delegation was headed by (^uinctus Ogulnius, and the object was to bring the statue of Esculapius to Kome, as a means of stopping the ravages of the pest. On tlunr arrival at Ei)idaurus, and A\hi]e they ^^'ere admiring the statute of Esculapius for its extraordinary size, the Uomans perceived, emerg- ing from the base of the statue, a serpent. This unexpect- ed {ip])aritioi). instead of causing dread and consternation, \\as regarded as a good omen by those present and im- pressed upon their minds feelings of awe and veneration. The ser[ient glided through the cix)wd, sped swiftly through the streets of the town — followed by the populace — and betook itself to the vessels of the Romans and went straight to the.apai'tment of Ogulnius. The Romans im- mediately erected a temple to Apollo, and the pestilence ceased.^^ Ax ExTItAORDINAKY IIlSTOKICAL DOCI'MENT. One of the most remarkable theories concerning the origin of epidemic disease was solemnly promulgated by the Faculty of Paris in 16G5, to account for the ravages of the Black Plague, which was then devastating Europe. The pestilence commenced in December, 1004, and ended in January, 1G(>0, a period of thirteen months. The learned medical men of France assembled at Paris in June, 1665, in order to discover the cause of the epidemic and devise "Leclerc: Histoire de Medecine. THE RAVAGES OF PESTILENTIAL DISEASE. 15 sanitary measures to arrest its progress. After much deliberation, the conchive tinallj- evolved the extraordin- ary document copied below, whicli, at this day, would be viewed in the light of a burlesque, but which was looked upon as an oracular pronuuciamento by the superstitious people of the time. We think the document possesses &uch an element of quaintness and absurdity, that we pub- lish it in full : "We, the Members of the College of Physicians, of Paris, have, after mature consideration and consultation on the present mortality, collected the advice of our old inasters in the art, and intend to make known the cause of this pestilence, more clearly than could be done ac- cording tp the rules and principles of astrology and natural sciences ; we, therefore, declare as follows : "It is known that in India, and the vicinity of the Great Sea^, the constellations wliich combated the rays of the sun, and the warmth of the heavenly fire, exerted their power especially against that sea, and struggled violently with its waters. ( Hence, vapours often originate which en- velope the sun, and convert his light into darkness.) These vapours alternately rose and fell for twenty-eight days; but at last, sun and fire acted so powerfully upon the sea, that they attracted a great portion of it to them- selves, and the waters of the ocean arose in the form of vapour; thereby the waters were, in some part, so cor- rupted, that tlie fish which they contained, died. These corrupted waters, however, the heat of the sun could not consume; neither could other wholesome water, hail or snow, and dew, originate therefrom. On the contrary, this vapour spread itself through the air in many places on the eartl), and enveloped them in fog. "Such was the case all over Arabia ; in a part of India ; in Crete; in the plains and valleys of ]Macedonia ; in Hungary, Albania and Sicily. Slionld the same thing occur in Sardinia, not a man will be left alive; and the like will continue, so long as the sun remains in the sign of Leo, on all the islands and adjoining countries to which this corrupted sea-wind extends, or has already extendi^l from India. If the inhabitants of those parts do nor 16 HISTORY OF YELLOW FEVER. employ and adhere to the following, or similar means and precej)t«, we announce to them inevitable death, except the grace of Clirist ])reserve thc-ir lives: "^\'e are of opinion, that the constellations, with the aid of Nature, strive, by virtue of their divine might, to protect and heal the human race; and to this end, in union with the rays of the sun, acting through the power of fire, endeavor to break through the mist. Accordingly, within tlie next ten days, and until the 17th of this ensuing month of July, this mist will be converted into a stinking deleterious rain, Avhereby the air will be much purified. Xow, as soon as the rain shall announce itself, by thunder, or hail, every one of you should protect himself from the air; and, as well before as after the rain, kindle a large fire of vi]ie-\\-ood, gTeen laurel or other gi'een wood ; worm- wood and chamomile should also be burnt in great quanti- ty' in the market places, in other densely inhabited locali- ties, and in the houses. lentil the earth is again com- pletely dry, and for three days afterwards, no one ought Lo go abroad in the fields. During this time, the diet should be simple, and people should be cautious in avoid- ing ex])osure in the cool of the evening, at night, and in the morning. ]*oultry, and water foAvl, young pork, old beef, and fat meat, in general, should not be eaten; but on the contrary, meat of a proper age, of a warm and dry, but on no account of a heating and exciting nature. Broth should be taken, seasoned Avith ground pepper, ginger and cloves, especially by those who are accustomcni to live temperately, and ai'e yet choice in their diet. Sleep in the day-time is detrimental ; it should be taken at night until sunrise, or someA\hat longer. At breakfast, one should drink little; supper should be taken an hour before sun- set, when more may be drunk than in the morning. Clear light Avine, mixed with a fifth or a sixth part of water, should be used as a l)everage. Dried or fresh fruits, with wine, are not injurious; but highly so without it. Beet root or other vegetables, whether eaten pickled or fresh, are hurtful; on the contrary S]»icy pot-herbs, as sage and rosemary-, or wholesome. Cold, moist, watery food is in general prejudicial. Going out at night, and even until THE RAVAGES OF PESTILENTIAL DISEASE. 17 three o'clock iu the moruiug", is dangerous, on account of tlie dew. Only small river fish should be used. Too much exercise is hurtful. The body should be kept warmer than usual, and thus protected from moisture and cold. Bain water must not be emplo^-ed in cooking, and every one should guard against exposure to wet weather. If it rain, a little fine treacle should be taken after dinner. Fat peO'i)le should not sit in the sunshine. Good clear wine should be selected and drunk often, but in small quanti- ties, by day. Olive oil as an article of food is fatal. Equally injurious are fasting and excessive abstemious- ness, anxiety of mind, anger, and immoderate drinking. Young people, in autumn especially, must abstain from all these things, if the,y do not wish to run a risk of dying of dysentery. In order to keep the body properly opened, an enejna, or some other simple means, should be employed, wlien necessary. Bathing is injurious. Men must pre- serve chastity as they value their lives. Everyone should impress this on his recollection, but especially those who reside on the coast, or upon an island into which the noxious wind has penetrated." Historic ^Iortalities Caused by Pestilence in Ancient AND Medieval Times. If ^^•e were to compute the total mortality from pestilen- tial disease from the earlist times to the present day, the figure would be appalling and almost beyond credulity. Pandemics have played havoc; with the human race. At times, half the population of the world was swept a,way before an epidemic had run its course; it spared neither man nor beast, but surged like an overcharged torrent o^er leagues and leagues of country, overleaping the highest mountain summits, swirling over miles of desert laud, crossing rivers, lakes and i ven seas, and finally, like a huge beast that has gorged itst^lf to suffocation, ceasing its aA\ ful carnage for want of new material. We shall cite only the most notable examples of gi-eat mortality. 18 HISTORY OF VILLOW FEVER. The greatest inortalitv caused by a single pestilence took place in Egyiit in 1792, when 800,000 persons are reported to liaA'e perished. Tlie next greatest mortality on record occurred in Naples and vicinity in 1656, where, in six months, 400,000 perished, almost depopulating that section of Italy. From December, 1664, to January, 1666, a period of thirteen months, the "Great Plague" of London caused a mortality of 60,000. Even "lionnie Scotland" comes in for a niche in the iinnals of ei)idemiology, for it is of record that a pestilence carried off 40,000 of liei' sons in A. D. 954. Let us now take a peep into antiquity. In the 1017 B. C, "David, being elated with success, God sends a grievous pestilence, of which 70,000 died in less than tliree days." In 594 B. (\ a third of the inhabitants of Jerusalem peri sliced by pestilence. In 480 B. C, while the army of Xerxes was retreating into Asia, after the battle of Salamis, 150,000 died from jK'stileutial disease. In 395 B. C., a terrible plague attacked Ilimilco's army, which was on its Avav to sack and destrov S\Tacuse; 50,000 died. In 878 B. C, according to Howe,^* immediately after the arrival of the troops from Italy, Carthage had a most terrible calamity to struggle with. "The plague broke out afresh there and swept away an infinite number of in- habitajits. 1'his seems to have raged with gTeater violence than any distemper the city was ever visited with before, for such vast multitudes were carried off b^- it, that the counti'v A\as, in a manner, de:i)(ti)ulated." In B. C. 188, a great plague raged in the Greek Islands, Egypt and Syria, and destroyed 2,000 persons daily. In the reign of the Echeopean king, ^licipsa (B. C. 125), according to Orosius, a great part of Africa was covered with locusts, which died by billions, causing a plague, which swej)t away an incredible number of people. In "Howe, loc. cit, p. 57. THE RAVAGES OF PESTILENTIAL DISEASE. 19 Nuinidia alone perished. 800,000 persons, and in Africa proper 200,000, and also 30,000 Roman soldiers quartered about Utica. x\t Utica, particularly, the mortality raged to such a degree that 1500 dead bodies were carried out by one gate in one day. In B. C. 22, Ivome was about depopulated by plague and famine. In A. D. 77 and 78 a most appalling pestilence raged in Southern Europe; 10,000 persos perished daily. In A. I). 717 an epidemic carried off 50,000 of the inhabitants of the then known world. In the Year of Eonie 066, ''all of a sudden the plague manifested itself, but with such violence, that in a few days it carried otf eleven thousand men." In the year of Ivome 510, during the siege of Syracuse by Marcellus (according to Catrou and Rouille, Histoire Romaine, vol. 8, p. 152), it appears that Heaven took pleasure to combine all the scourges of its anger against unfortunate Syracuse. In addition to other calamities, a pestilence supervened to afflict the city. At first, the contagion commenced in the country, The heat of the clinmte and the season had corrupted the air, and the filth which the sea ordinarily leaves upon the shore when the waters retire, had still further deteriorated it. The two camps of Himilco and Crispiuusi were first attacked. Then the malady communicated itself to the army of Marcellus, from the inteixourse with that of Crispinus. So(m after Acredina was attacked by the pestilence. Thus around the city, and in the interior of it, nothing was seen but the dead and dying. From the fear of catching the infec- • tion by approaching the dead bodies, they a> ere left with- out burial, to poison the place where they lay decompos- ing. Hippocrates and Himilco died of the scourge. The plague which broke out in the army of Sennacherib (B. C. 709), is said to have caused a mortality of 185,- 000. This was regarded by the Jews as a punishment of Divine Providence, meted out toi Sennacherib for having invaded Judea. During the plague of Rome (A. D. 256), 2,000 persons were buried daily. In the year 89 B. C, while Pompeius, a Roman general, 20 HISTORY OF YELLOW FEVER. was k'adiii;; an army a. 74(1 rai»ed the great plagiie of Constanti- nople, which destroyed nt^arly .*)00,()00 jjcople in that historic city. In 1011, after a period of eight hundred and fifty-two years, occurred the second "gTeat plague" of Constantinople, when 200,000 persons are said to haye perished. In A. D. 772, an epidemic carried off 34,000 of the popu- lation of Chichester, England. In 1545, the "Trousse (Talante"' swept away 10,000 of the fciieign population of Kcuilogne, France. The fatali- ties among the uatiyes could not be ascertained. "In 1445," says Sauyel, "from the month of August to St. Andre's Day (Xoyember 30), 0,000 infants died in, Paris from smallpox."^"' The "Black I*lague" of the fourteenth century was one of the most appalling pestilences which swept the earth. In the space of four years, 42,83(),48() persons died. Asia, exclusiyc ulation of 20(),000, it is reported' that 50,000 died; at :Mai-seilles, in 1720, the nuH'tiility was 40,000; at Cyprus, in 17(>0, the deaths were "Sauvel: Histolre et Recherches des Antiquitees de la Ville de Paris. "Ozanam: Histoire Medicale, etc., des Maladies Epidemiques, 1883, vol. 4, p. 8(;. THE RAVAGES OF PESTILENTIAL D.SEASE. 21 70,000; at Aleppo, 17Gl-()2, the plague carried off 21,800 and in 1790-97, in the same city, the mortality amounted to 00,000. In 1720-21, in the space of seven months, 60,000 persons died of the plague at Marseilles, France. The Great Plagues of London. London shares the palm with Konie for having been the nidus of the plague from nebulous times. As early as 207 A. D., when Severus invated Britian, 50,000 of his soldiers perished from a pestilence which was then ravaging the island. Not counting the lesser epidemics, in which the mortality amounted ''only to a few thousands," the follow- ing table will show the appal ing havoc wrought by pestil- ence in London, without counting the balance of Britain, in the short period of forty-four years : Tabic of Deaths from\iU Diseases; and from Pestilence in London, EnfjJand, from 1592 to 1030. Year. Mortality from ^Mortality from All Diseases. Plague Alone. 1592 25,886 11,503 1603 37,294 30,561 1625 51,758 35,403 1630 10,545 1,317 1636 23,359 10,400 Total mortalitv during forty-four years. . . . 119,042 89,184 It is thus seen that out of a total mortality of 119,042 from all diseases, the ])lague carried off 89,184. In December, 1664, twt nty-eight years after the terrible visitation of 1636, began what is known to history as the "(iT-eat Plague of London." From its inception to January, 166(), a i)eriod of (vuly thirteen months, it caused a mortality of 69,000. Some historians place the figures as high as' 100,000. In 16(56, also occurred the "Great Fire," A\hich spread over 396 acres, destroying ovei- 13,2000 houses, ninety churches and many public buildings. CHAPTER III. THE GREAT EPIDEMICS OF THE MIDDLE AGES. The Inguinal Pestilence of the Sixth Century. — The Black Plague ot the Fourteenth Century. — Le Mai des Ardents. — The Eruptive Fevers of the Sixth Century. — The Sweating Sickness. — Notable Epidemics of Scurvy. — Leprosy and its Attendant Horrors. THE IXGUIXAL PESTILENCE OF THE SIXTH CENTURY. (Up to the year 1831, when the "Fragments" of Ruff us were published, the prevailing opinion had been that Procopius, the Greek historian, was the first to give a description of the Glandular Plague of the East. Even after the publication of this remarkable work, such distinguished historians as Hecker, Rosenbaum, Fariset and Navman still gave the honor to Procopius, claiming that the newly-discovered manuscript was spurious. The passage referred to reads as follows: "The buboes called pestilential are most fatal and acute, especially those which are seen occurring about Lybia, Egypt and Syria, and which are mentioned by Dionysius Curtus. Dioscorides and Posidonius make much mention of the plague which occurred in their time in Lybia; they saw it was accompanied by acute fever, pain and prostration o£ the whole body, delirium, and the appearance of large and hard buboes, which did not suppurate, not only in the accustomed parts, but also in the groins and armpits." According to Adams, the only thing which detracts from the value of this paragraph is the difficulty of determining exactly who the authorities are which are referred to in it. Of Dionysius Surtus nothing is known; indeed, it is more than probable that there is some mistake in the name. There are several medical authors by the name of Dioscorides and Posidomius, and it is difficult to determine to which of them reference is made. Still, Adams finds no reason lor questioning the authenticity of the passage. Ruffus flourished in the reign of Trajan, in the beginning of the second Century. The graphic description of this terrible pestilence and other epidemics of the Middle Ages, has been abstracted from the masterly translation of Dr. Dupuy's "Le Moyen Age Medical," by Dr. Thomas C Minor of Cincinnati These articles were originally pub- lished in the Cicinnati "Lancet Clinic," of which Dr. Minor is associate editor, and an abstract is published in this volume by special permis sion. — G. A.) In the sixth centiirT after Christ, occurred the terrible epidemic known by the name of the ''Inj>ninal Pestilence," THE GREAT EPIDEMICS OF THE MIDDLE AGES. SS which, after ravaging ^Constantinople spread into Liguria, then into France and Spain. According to I'rocopius/ it attacked the entire earth, striking every race of people, sparing neither age nor sex ; differences in habitation, diet, temperament or occupa- tion of any nature did not stop its ravages; it prevailed in summer and in winter — in fact, at every season of the yeai'. It commenced at the town of Pelusa, in Egypt, whence it spread by two routes, one through Alexandria and the rest of Eg^^pt, the other through Palestine. After this it covered the whole world, progressing always by regular intervals of time and force. In the springtime of 543 it broke out in Constantinople and announced itself in the following manner : Many victims believed they saw the spirits of the de- parted rehabilitated in human form. It appeared as though these spirits appeared before the subject about to be attacked and struck him on certain portions of the body. These apparitions heralded the onset of the malady. The commencement of the disease was not the same in all cases. Some victims did not see the apparitions, but only dreamed of them ; but all believed they heard a ghostly voice announcing their inscription on the list of those who were going to die. The fever at the onset of the attack came on suddenly, — some while sleeping, some Avhile waking, some while at work. Their bodies exhibited no change of color, and the temperature was not very high. Some indications of fewer were perceptible, but no signs of acute inflammation. In the morning and at night the fever was slight, and in- .dicated nothing severe either to the patient or to the ^ Procopius, the Greek Historian, born at Caesarea in the year 500, left behind him numerous works, among which may be enumerated L'Histoire de Son Temps, in eight volumes (Procopii Caesariensis .Historian sui temporibus). This history of the times by Procopius gives a full description of the plague, and is one of the chef d'oeuyres of medical literature, one that will never be excelled. In this work, nothing being omitted, not even the different clinical forms, it is truly classical. 24 HISTORY OF YELlOW FEVER. ])hysiciaii who eoiuitcMl the ]»nlso. .Most of those who l)reseutiHl siicli symptoius showed uo iudicatioiis of ap- proachiii«»- dissolution; but the first day ainonj'- some, the second day in others, and after several days in many cases, a bubo was observed on the lower portion of the alxlomen, in the groin, or in the folds of the axilla, and sometimes back of the ears or on the thighs. Some ])atients were plunged into a condition of pro- found drowsiness; others were victims to furious delirium. Those who were drowsy remained in a. passive state, seem- ing to have lost all memory of the things of ordinary life. If they had any one to nurse them they took food when ottered from time to time, and if they had no care, soon died of inanition. The delirious ])atients, deprived of sleep, Avere eternally pursued by their hallcinations; they imagined themselves haunted by men ready to slay them, and they sought flight from such fancied foes, uttering dreadful screams. A« nothing was known of this strange disease, certain physicians tliought its origin was due to some source of evil liidden in the buboes, and they accordingly opened these glandular bodies. The dissection of the bubo showed sub-adjaqent carbuncles, whose rapid malignity brought on sudden death or an illness of but few days' duration. In some instances the entire body was covered by black spots the size of a bean. Such unfortunates rarely lived a day, and generally expired in an houl'. many cases died suddenly, vomiting blood. As to treatment, the ett'ects weic variable, following the condition of the victim. Procopius states that, as a fact, no etticacious remedies were discovered that could either prevent the onset of the disease or sliorten its dura- tion. The victims could not tell why they were attacked, nor how they wei*e cured. The epidemic at C(mstantinople lasted four months, I three months of which time it raged with gTcat violence. * As the epidemic progrosed th(^ mortality rate increased ( from day to day, until it reached tlve ])oint of 5,(MK) deaths ? per day, and on several occasions ran up to as high an ^ 10,000 deaths in the twenty- four hours. ] Evagre, the scholastic, ancither (Ji'cek historian of the . < THE GREAT El'IDEMICS OF THE MIDDLE AGES. 25 sixth centni\v, recounts in lis works the story of the phijiiie at Constantinople. He states that he frecinently observed that persons recoverin,ii from a tirst and second attaek subseiring suddenly in their houses, or even at business. When a person sneezed his soul was apt to fly the body; hence the exi)rcssion on sneezing, 'Y/or/ hlrss j/oh.' And wh(^n a ])('rson yawned tliey made the sign of the cross be- fore their mouths.'' Such are the documents we possess on the great epidemic of Inguinal Plague of the fourth century, docu- ments furnished l»y historians, to whom nu'dical history 'Anglada: Etude sur les Maladies Eteintes et les Maladies NouYelles. THE GRKAT EPIDEMICS OF THE MIDDLE AGES. S7 is indebted, and not from medical authors, who left no records of the pestilences of that period. The Black Plague. The Black Plague of the fourteenth century was more destructive even than the bubonic pest of the sixth century, and all other epidemics observed up to the present day. In the space of four years, more than twenty-five millions of human beings perished — one-half the population of the Avorld. Like all other pestilences, the Black Plague came from the Orient — from India, and, perhaps, from China. Europe was invaded from East to West, from South to North. After Constantinople, all the islands and shores of the Mediterranean were attacked, and successively became so many foci of disease, from which the pestilence radiated inland. Constantinople lost two-thirds of its population. Cyprus and Cairo counted 15,000 deaths. Florence paid an awful tribute to the disease, so great being the mor- tality, that the epidemic has often been called Peste de Florence. According to Boccacio, 100,000 persons per- ished. Venice lost 20,000 victims, Naples 60,000, Sicily 53,000 and Genoa 40,000. In Eome, the dead were innu- merable. In Spain, German}^, England, Poland and Russia, the malady was as fatal as in Italy. In London they buried 100,000 persons. It was the same in I'rance. Avignon lost 150,000 citizens in seven months, among whom (1318) was the beautiful Laura de Noves, immortalized by Petrarch. At Marseilles, 56,000 people died in one month; at Montpellier, three-quarters of the population, including all the physicians, went dcAvn in the epidemic. Narbonne had 30,000 deaths and Strasbourg 16,000 in the first year of the outbreak. Paris was not spared. The Chronique de *S'f. Dviti.s in- forms us that, "in the year of Grace 1318, commenced the aforesaid mortality in the Kealms of France, the same lasting about a year and a half, increasing more and more, until Paris lost each day 800 inhabitants ; so that the 28 HISTORY OF YELLOW FEVER. imiuber who died there amounted to more thau 500,000, while ill the town of St. Denis the niiiiiher readied 1(5,000." Aiuonu the victims were Jeanne de Konruojiiie, wife of rhilii> VI; Jeanne II, (jneeii of Navarre and lirandchild of IMiilip the Beautiful. In Spain, died Alphonso XL, of (^astille. IIai)]»i]\' for tlie human race, diirinji* the years which followed the jihii-ue, the births werc^ lireatly in excess of the deaths, as though Nature desired to repair the ravages wrought by the pestilence. According to the records of that time, many i>ersons died the first da^^ of their illness. These bad cases were announced by a violent fever, with headaehe, vertigo, drowsiness, incoherency in ideas, and loss of memory; the tongue aiul palate were l>lack and browned, exhaling an almost insupportable fetidity. Others were attacked by violent iiitiammation of the lungs, with hemorrhage; also gangrene, which manifested itself in blaek spots all over the body; if, to the contrary, the Ixtdy was covered by abscesses, the patients seemed to have some ehance for recovery. ^Medicines were powerless, all r(Miiedies seeming to be useless. The disease attacked rich and ]»<)or indiscrimin- ately; it overpowered the robust .and (l('l)ilitated ; the young and the old were its victims. On the tirst symptom the jiatients fell into a prof((und melancholy and seemed to abandon all hope of recovery. Ths moral prostration aggravated th(ir i)hysical condition, and mental res- sins attended the sick. The clei-gy, eii<-<)Uraged l>y the T*(»pe, visited the bed- sides of tlie dying who b(M|ueathe(l all their wealth to the Church. The ])lague was considered on all sides as a pun- ishment intlicted by (lod, and it was this idea that in- duced armies of penitents to assemble on the i)ublic streets to do jtenance for their sins. Men and women \\( nt half naked along the highways, tlagellatiiig each other with whips, and, growing desperate with the fall of night, they committed scandalous crimes. In certain ])laces the Jews were accused of l)eing the authors of the plague by pois- oning the wells; hence the Hebrews were prosecuted. THE GREAT EIMDKMICS OF THE MinDLK AGES. 29 sometimes burned alive by the fanatical seets known as Flaj»ellants, Bej;ardes and Turlnpius, who Avere eneonr- a<.;ed in their acts of vioh'nce by the priests, notwithstand- ini^' the intervention of Clement VI. riiysicians were not only convinced of the cantagious nature of the disease, but also believed that it could be transmitted by look and word of mouth. Sucli doctors oblij^ed their patients to cover their eyes and mouth with a piece of cloth whenever the priest or physician visited the bedside. Guillaume de ^lacliant, ])oet and ralct dc cJuunhrc of Philip the Beautiful, mentions this fact in one of his poems : "They did not. dare, in open air To even speak by stealth, Lest each one's breath might carry death Bv poisoning the other's health." And, in the preface of the ''Decameron," Boccacio re- umrks in his turn : "Tlie plajiue communicated direct, as fire to cond)Ustible matter. Tliey were often attacked from simply touching the sick; indeed it was not even necessary to touch them. The danjicr was the same when you listened to their words (»r even if they ^azed at you." One thinji; is certain — those who nursed tlie patients surely contracted the disease. Ali the authcuities of the Middle Ai>es concur in their statements as to the coutaiiious nature of the ])hiiiue. The rules and rei>idati()us enforced ai^aiiist the alllicted were barbarous and inhunuin. "Persons sick and well, of one family, when the pest developed," says Black"*, were held, without distinction, in close confinement in their home, while on the house-door, a red cross was traced, bearing the sad and desperate epitaph: Dien, aijez pitic iic nous!* "No one was permitted to leave or enter the pla.niie- stricken house, save the physician and nurse, or other persons who might be authorized by the Gavernnuuit." 'Black: Histoiie de la Medecine et da la Chirurgie. * Lord, have mercy on us! 30 HISTORY OF VEIXOW FEVER. We can well judge of the terror inspired bv the pestil- ence by the precautions which the physicians who attend- ed the sick took. In his treatise on the plajiue, Mau«;et describes the costumes worn h\ those who approached the bedsides of patients : "The costumes worn Avere of Levant morocco, the mask haviuii ci-ystal eyes and a long- nose filled with subtle per- fumes. The nose was in the form of a snout, with an openinij;' on each side. These openings served as respira- tory passages and were well-filled at the anterior portion with drugs, so that at each breath they contained a medi- cated air. Under a cloak, the doctor also wore buskin made of morocco ; closely-sewed breeches were attached to the bottines above the ankles; the shirt, the hat and the gloves were also of soft morocco." Thus accountered, the doctor resembled a modern diver clad in a suit of leather. All this sounds ridiculous at the present age, but it must be understood that the great epidemics of plague Avere of a nature to terrify ignorant poi)ulati()us. The nar- ratives of historians (►f that epoch show them to be im- bued with the superstitious ideas of antiquity. This at- tack of an invisible enemy, whose blows fell right and left, paralyzed and terrified every one. "In the midst of this orgy of death," remarks Anglada, "the thought of self- preservation absorbed every other sentiment. Dominated l>y this selfish instinct the human mind shamelessly dis- played its cowardice, egotism and superstition. Social ties were rudely sundered, the att'ections of the heart laid aside. The sick were deserted by their relatives; all flew with horror from the plague-breathing air and contact with the dreadful disease. The corpses of the A'ictims of the epidemic, abandoned without sepulture, exhaled a hor- ribly putrid odor, and became the starting point of new infectious centres. The worse disorder overthrew all con- ditions of existence. Human passions raged uncontrolled ; the voice of authority Avas no longer respected; the Avheels of civilization ceased to revohe.'' LE MAL DES ARDENTS. Towards the end of the tenth century a ncAv epidemic appeared in Europe, the ravages of which spread terror I THE GREAT EPIDEMICS OK THE MIDDLE AGES. 31 among the people of the Occident ; this disease was known by the name of Alal des Ardent s, Sacred Fire, St. An- thony's Fire, St. MarcelPs Fire, and Hell Fire. This great epidemic of the Middle Ages is considered by many modern writers as one of the forms of ergotism, notwithstanding the contrary conclusions arrived at by the Commission of ITTO, composed of such men as Jussieu, Paulet, Saillant, and Teissier, who were ordered to report as to the nature of the disease by the Ko^al Societ3\ Ac- cording to the work of this Commission the Mai des Ar- dent s was a variety of plague, Avith buboes, carbuncles and ]3etechial spots, while St. Anthony's lire was only gangrenous ergotism. This is a remarkable example of the confusion into which scientific facts were allowed to fall through the fault of careless authors. It is in such instances that we may estimate the importance of history. We find in the ''Chronicles of Frodoard,'' in the year 945^ the following : "The year 945, in the history of Paris and its numerous suburban villages, a disease called Ignis Phiya attacked the limbs of many persons, and consumed them entirely, so that death soon finished their sufferings. Some few survived, thanks be to the intercession of the Saints; and even a considerable nund)er were cured in the Church of Notre Dame de Paris. Some of these, believing them- selves out of danger, left the church; but the fires of the plague Avere soon relighted, and they were only saved by returning to Notre Dame.^' Sauvel, the translator of Frodoard, remarks that at this epoch the Church of Notre Dame served as a hospital for the sick attacked by the epidemic, and sometimes con- tained as high as six hundred patients. Another historian of the time was liaoul Glaber,^ who mentions that "in 993 a murderous malady ])revailed among men. This was a sort of hidden fire, lulse, coma, and, in the last named condition, death always occured. 3. The duration of the disease was most frequently but a few hours, rarely exceedingly a day, whether the termin- ation was favorable or fatal. '- Ferneli : Universa Medico 38 HISTORY OF YEI,I.OVV FEVER. Convalescence was always lonjj;-, often bcinii" complicated by diarrhoea or dropsy. It lias been remarked in this con- nection that the malady mioht be confounded with the miliary sweat observed in Picardy and central France, but in the lirst named disease no cutaneous eruption was observed. Kernel clearly affirms this statement, as he says: "In this affection there is no carbuncle, bubo, ex- anthema or eczema, Init simply a hypersecretion of sweat." Such was the sweating sickness of the sixteenth cen- tury, which made so few victims in France, but which de- stroyed so many people in Enjjland and Germany.^^ The orijiin of this disease has been often discussed, and also its nature; l)ut all theories expounded by various authors partake of the doctrines of other days and are too anti- quated to be revamped. The Scurvy. It has been supposed by many that Hippocrates de- scribed scurvy under the name of Enlarged ^Splcvii, an af- fection attributed to the use of stah the word's only signification, in Danish, is ulceration of the mouth. We have, besides, another document, which has great authentic value, a proof transmitted to us bv our earliest and best chronicler of the Middle Ages, Joinville, the friend and companion of Saint Louis in liis Crusade into Palestine. In liis memoirs he gives a very succinct re- cital of the epidemic of famine and scurvy whicli attacked the French ami}- on the banks of the Nile in 1248, just after the battles of Mausourah.^'^ The relation of Joinville leaves no doubt as to the na- ture of the epidemic that attacked the Crusaders. He gives a minute pen picture of the debility, and hem- orrhages, the livid ecchymosis of the skin, the fungous tunu'faction and bleeding of the gums, which character- ize the disease known as scurvy. According to the writings of some German physicians of the fifteenth century, this malady was endemic in the septentrional portions of Europe upon the shores of the Baltic Sea. In Holland numerous ei)idemics of scurvy were observed among the lower classes of the population, coinciding Avith bad conditions of public hygiene, such as food consisting of salt and smoked meats, dwellings lo- cated on marshy ground, cold atmosi)heres charged with fogs, etc. This was the same infection that attacked our colonies in Canada, but at that time we had no knowledge of the therapeutic indications in such emei-gencies. A proof of this remarkable observation is inscribed on the registers of Cartier on his vessels during his sojourn in Canada. ^^ Lkprosv. Leprosy is a disease originating in the Orient; Egypt and Judea were formerly the principal infected centres. "Joinville: Histoire de Saint Louis. ''Cartier. Bref Recit et Siiccincte Narration de la Navigation Faite aux Ysles de Canada. Paris, 1545. 40 HISTORY OK YELLOW FEVER. It was tlie ri'tiiin of an expedition to Palestine, under I'onipcy, that imported tlie malady to Italy. In tlie first years of the Christian Era it is mentioned by Celsns, who advised that it should be treated by sweating, aided by vapor baths. Some years later Areteus used hellebore, snlidmr baths, and the flesh of vipers taken as food, a triatment adopted by others, as, for instance, ^Musa and Arthiiienes. In the second century tlie disease was in Gaul ; Soranus treated the lepers of Acpiitaine, who were numerous.^^ According to Velley, lci)rosy was common in France in the middle of the eighth century, when Nicholas, Abbot of Corbeil, constructed a leper hospital, which was never much frecpiented until after the Crusades of the eleventh and fourteenth centuries. At this jjeriod the number of lepers, or ladrcs, a name given to the unfortunates in re- membrance of their patron saint, St. Lazarus, became so great that every town and village was obliged to build a le])er h(»use in order to isolate the altiicted. Under Louis VIII. there were 2,000 of these hospitals; later the num- ber of such asylums reached 19,000. According to the historians of this time, when a man was suspected to be a leper he could have no social rela- tions without making full declaration as to what the real nature of his complaint might be. Without this precau- tion his acts were void, from the cai)itulary of Pepin, which dissolved all marriage contracts with lepers, to the law of Charlemagne, that forbade their associating with healthy persons. The fear of contagion was such that in places where no leprosy existed they built small houses for any one who might be attacked; these houses were called hordrs}'' A gray numtle, a hat and wallet, were "Gregory of Tours says that in Paris they had a place ol reluge, where they cleaned their bodies and dressed their sores " They designated by the name of horde, bordeau, bordell, bordette, bourde, or bourdeau, a small house or cabin built on the edge of town; a cabin intended to contain lepers. The word bordell, a house of ill-fame, as used even in modern days, takes its origin from horde, an asyium for lepers 1 THE GREAT EPIDEMICS OF THE MIDDLE AGES. 41 also supplied the yictiiiis, also a tartareUe, a species of rattle, or a small bell, with wliieh they warned all passers near not to approach. The^- also had a cup placed on the far side of the road, in which all persons might drop alms without iioing near the lei)er. Leper houses were enriched, little by little, by the liber- ality of kings and nobles and the people, and to be a leper became less inhuman and horrible than at the be- ginning. After entering a leper house the victim was considered as dead under the civil law, and in order to make the pa- tients better understand their position the clergy accom- panied them to their asylum, the same as to their funeral, throwing the cemetery dust on them while saying: "En- ter no house save your asylum. AVhen you speak to an outsider, stand to the windward. When you ask alms, sound your rattle. You must not go far from the asylum without your leper's robe. You must drink from no Avell or spring save on your own grounds. You must pass no I)lates or cups without first putting on your gloves. You must not go barefotted, nor walk in narrow streets, nor lean against walls, trees, or doors, nor sleep on the edge of the road," etc. When dead they were interred in the lepers' cemetery by their fellow-sulferers. It is true that each time that sanitary measures were relaxed by the authorities — such, for instance, as the per- fect isolation of the patients — an increase in the number of lepers was noticeable, AYhen this was observed the old-time ordinances were enforced again with vigor. It was thus in 1371 the Provost of Paris issued an <'dict enjoining the lepers to leave the Capital within fifteen days, under heavy corporal and pecuniary jx-ualties; and in 138.S, all lejjcrs were forbidden to enter Paris without special permission; in 1102 this restriction was renewed, "under penalty of being taken by the executioner and his deputies and d( tained for a month on a diet of bread and water, and afterwards perjjetual banisliment from the kingdom." Finally, in Ai>ril, 1188, it was announced "all persons attacked by tliat abominable, very dangerous and contagious malady known as leprosy, must leave Paris 42 HISTORY OF YELLOW FEVER. before Easter and retire to tlieir li()si)itals from the date of issuance of this edict, under penalty of imprisonment for a month on bread and water ; and, where they had ]>i()pei-tv, the se(iuestrati(>n of tlieir houses and jewels and arbitrary corporal punishment; it was permitted them, however, to send things to them by servants, the latter being' in health." AVe can understand from this how these poor wretches, at different epochs, were accused of horrible criuies, among other things, poisoning rivers, wells, and fountains. As regards this accusation, says the author of the D'lsUon- tiairc dcs Mociirs dcfs Franaiis, Philip le Long burned a certain nund»er of these poor wretches at the stake aud confiscated their wealth, giving it to tlie Oi-der of Malta and St. Lazare. A minute description of this disease will be found in the works of Barbarin.^^ The i)hysicians of leper hospitals have left hebind a great number of medical documents bearing on the char- acteristics of the disease, but their observations are so confused that we can only c(tnclude that they considered all cutaneous maladies as belonging to the same constitu- tional vice. In 1543, leprosy was so widespread in France, as to be beyond sanitary contnd, and th(» edict of Francois I., re- establisliing leper hospitals, auiountcd to nothing. There were too nuiny affected people. The Hospital of Lour- cine, which was si)ecially devoted to these cases at Paris, contained 000 patients in 1540, and in the wards of Trinity Hospital and the Hotel Dieu there were many more. H was Ihe sauie iu the Pi-ovinces, notably at Tou- louse, which had the merit of creating the first hosjiital of its kind ever instituted. IMnally, fifty years later, in 1000, for want of lepers, the leper asylums were otficially '•^Etienne Barbazin, erudite and historian, born iu 1696, author of a number of works on the History of France: "Recueil Alphabetique de Pieces Historiques"; "Tableaux et Contes Francais, des XII., XIII., XIV., et XV., Siecles"; "The Orders of Chivalry, etc." He also left numerous manuscripts on the origin of the French language. See "Bibliotheque de I'Arsenal." THE GREAT EPIDEMICS OF THE MIDDLE AGES. 4S closed. Henry IV., in a proclamation, gave those remain- ing "to poor gentlemen and crippled soldiers." Thus ended the epidemic of leprosy in France, which had prevailed from the second century, observing the same progress in other countries of Western Europe dur- ing the same period of time. CIIAPTEJ{ IV. INSECTS AS PROPAGATORS OF DISEASE. How Pestilence is Spread by Flies, Mosquitoes, Fleas and Other Insects. — Instances Where Disease Was Conveyed by Bed-Bugs and Ants. — The Role played by the Cattle-Tick and the Tsetse-Fly. — Sum- mary of the Mosquito Doctrine. — Bibliography. In the niedieal part of this vchiiuc will lie found a de- taih^d scientific account of the mosquito tlieory. For the heneflt of the lay reader, h(jwever, who is either too busy to digest the views expressed in these instructive observa- tions, or who does not care to tussle with medical phrase- ology, we will give a short talk regarding the role played by insects in the propagation of disease. There is no novelty in the doctrine of insect or animal- cular origin of disease. Many of the older writers, most cons])icuous amongst whom are Linnaeus, Kircln^r and Lyander, have pr(;mulgated such an oijinion, and it has been vaguely presented to the notice of the medical pro- fession in the past; but it was not until after the publica- tion of Ebrenberg's great work on Infusoria (1S38) that its bearings were fully appreciated. It will no doubt be news to many to learn that the mos- quito theory of the transmission of yellow fever came very nearly being expounded over half a century ago. Dr. Nctt, of .Mobile, in a paper published in 1848,^ reviews the situation in a scholarly manner and attributes the speci- fic cause of yellow fever to "some form of insect life." He does not mention the mos(|uito as the active agent of transmission, l»ut, in a long and caiTfully-prei)ared paper, dwells upon the fact that "certain insects" are capable of transmitting the disease. Anwnig other things. Dr. Nott makes the following as- sertion ( loc. cit. p. 40), which certainly is prophetic of the theory fathered by Dr. I'inlay: "It would certainly be (juite as philosoi)hical (as the nmlarial tlieory) to suppose that some insect or an animal- cule, hatched in the lowlands, like the mosquito,- after *Nott: New Orleans Medical and Surgical Journal. 1848, vol. 4, p. 563. - The emphasy is ours. G. A. INSECTS AS PROPAGATORS OF DISEAj^E. 45 passing' through its iiietainorphoses, takes tlight, aud either by preference for a different atmosphere, or im- pelled b}^ one of those extraordinary instincts which many are known to possess, wings its way to the hill top to ful- fil its appointed destiny." Twenty-two years later (1870), Dr. Nott was commis- sioned by the Board of Health of the City of New York to prepare and present to the Board a report upon the out- break of yellow fever at Governor's Island that year. In an elaborate paper, in which the Doctor touches upon the causes of the outbreak and its progress, he comments at length upon the insect hypothesis. The following extract from Dr. Nott's paper is the nearest approach to the pres- ent accepted doctrine of transmission we have yet seen in opinions of the past:'^ "It is possible/' ol)serves Dr. Nott, "that even insects uia}' exist a million times smaller than any the microscope has yet reached. While the slow and steady progression of yellow fever from a point, as I have described it, should be received as an indisputable fact, on the other hand we confess that the fact is at present inexplicable ; it must be some form of living organism, which multiplies and ex- tends by organic laws. If in insects form, it is easy to understand its progress, and, if a fungus, we are not with- out examples in the larger fungi, of a manner of progres- sion from a given spot more rapid than that of yellow fever. Moreover, it is the business of some insects to dis- tribute certain seeds of plants far and wide; to carry the pollen of one plant to another to fructify it; and it may be the duty of others to disseminate diseases. It is well known, on the authority of Murchison and others, that the nuilignant pustule is taken by gnats from the animal and communicated to man by its bite. So there are many ways that diseases might be carried and communicated by insects or fungi. "I will here mention a fact which 1 have often noticed myscdf with regard to mosquitoks/ but have never seen it alluded to by others. These insects are so abundant in ^Nott: Annual Report of the Board of Health of the Health Department of the City of New York, 1870, p. 363. * The emphasy is ours. G. A. 4G HISTORY OF YELLOW FEVER. :Mobile, New Orleans, and other Southern cities, that it is iiii]»()ssible to sk'e]) at nijiht Avitlioiit the pr(;tectiou of mos- (luito nets. Fair-skinned persons from more northern climates, and particularly .younji; children recently intro- duced, sufTer iireatly from tlie hitfs of this insect, the bites often intiaminjj;, and even makiiiu- tedious, troultksome sores; Avhereas the children of parents who have lived a iicneration or two in the climate suffer comparatively little; they seem To become acclimatized against the jKvison of these insects as they do against the poison of yellow fever. On rising from my own bed in the morning I have many times seen my little children lying in a trun- dle-l)ed covered l)y mosquitoes, after, as Mrs. Jackson said, 'kicking the kivcr off.' The insects had been biting at tliem for hours, and yet by br(ndvfast-time every mark had disai)peartd. Sucli Y\ould not be the case with children of fair-skinned parents recently brought into the clime. Some Southern children, it is true, are more -susceptible to the poison of mosquitoes than others, and so it is with regard to susceptibility to yellow fever." If Dr. Xott had simply gone a little further and directly accused the mosquito of being the active agent of trans- mission, yellow fever would have been eradicated from the American Continent years ago and tlie illustrious Soutli- erner would have occupied a place in the annals of fame which would have endured for all time to come. Tiktine, in an article entitled '^Contagion through the Intluence of Insects, ''•'' relates facts of great interest. In a review of this paper made in the BnUctin of the Pasteur Institute for April, 1897, mention is made of an epidemic of rela])sing fever which occurred in Odessa, Ixussia, where the disease is almost unknown.'"' It seems that a saib)r who came from Jaffa was suffering from this mal- ady and was admitted. to the hospital. A week later an- other patient was admitted, and soon after a tremendous epidemic occurred, which affected more than ten thousand individuals. !Most of these were sailors, living about the harbor, who usually applied for admission after a de- ' Bulletin Medical (Paris), February 3, 1S97. 'This disease is exceedingly rare in the United States, but is quite prevalent in Great Britain. INSECTS AS PROPAGATORS OF DISEASE. 4? baiicli. Dr. Tiktiiie weut to see a number of them, aud was struck by the enormous number of bed-bugs, lice and fleas with whicli they were covered. He tlien thoui»ht tliat tlie {'(nitaiiion miiiht liave arisen from these parasites g-oin<>- from one individual to the other. One of these in- sects, passing from a sick man to a healthy one, might inoculate the latter by its sting, still smeared with Wood, or else the sleeper, abrading his skin by scratcliing, might become infected by crushing the parasite, full of septic blood, over the sore places. The Doctor collected some bed-bugs and allowed them to fast, after whicli he jdaced them upon the skin of pa- tients sutferinu' from an attack of rela^jsing fever. Tliey raiiidlv filled themselves with blood which, upon micro- scropic examination, was found to contain large numbers of spirilli s^'U in motion. He was able to show that tlieir A'italitv persiKted, witiun the insect, for more than eiiihteen In urs. Besides this, bed-bugs were fed u])on the blotkl of a monkey that had been inoculated with s])iril- lun'i fever. They were then placed upon a healthy monkey, and the latter soon had a characteristic attack of the dis- ease. "We can therefore see what a preponderating place is taken by insects in the spreading of contagious diseases," ccnchides the reviewer. ''We know that flies often carry about the bacilli of tuberculosis, of cholera, of puruhuit ophthalnua, and of anthrax. Finlay of Havana, believes that flies are the principal agents in the dissemination of yellow fever, and Hammond shares this view. Texas fever, according to Smith and Kilborne, is i)ropagated by ticks which spread about a h.Tmatozoa, belonging, like that of the malarial infection, to the class of protozoa." Howard, Avhcse great work on the natural life of the mos(iuito is a standard, thus (Uscrilies liow typhoid fever is i)ro])agated by the common house-fly :^ ''The princii)al insect agent in this spread is the com mon house fly and this insect is especially abuii' rats and mice, whicli he kept carefully in cai^es. They in turn died of the plajiue. That such a slight thing as a pin prick is enough to allow the germs to enter the body of a human l)eing is shown by the case of the two Japanese i)hysicians who scratched themselves with the points of their instruments while nuiking autopsies on plague patients, and immediately took the disease.'' It will thus be seen that not only flies and mosquitoes, but ''all insects that bite" should be looked upon with sus- picion and destroyed. The earliest reference to mosquitoes in connection with yellow fever that we have been able to discover, is^ made by Benjamin Rush in his Medical Incpiirics and Observa- tions, (Vol. 5, p. 18), edition of 1T9S. In speaking of the yellow fever epidemic at rhiladeli)hia in 1797, he says: "In addition to the register of the weather, it may not l)e iui]u-op(r to add, that mos<|uitoes were more uuuierous during the prevaleuce of the fcAcr than in 1703. An un- usual number of ants and cockroaches were also observed ; and it was said that the martins and swallows disap- peared froui the city and its neighb()i]i()(;(l."' The presence of mosquitoes during the prevalence of y(^llow fever was also noted by an early writer. Dr. John Vauglian,^** in his observations on the ejjidemic at Wil- nungton, Delaware, in 1S02. "Myriads of mosquitoes," says this wiiter, "infested the lower parts of the town from July until frost, having gradually diffused them- selves over the borough in September.' The eldest of our inhabitants do not recollect this insect being so trouble- some here in any previous season; while the unanimous rci)ort of persons from the fenny counties of Kent and Sussex, the annual haunts of these winged pests, Avas that they were unusually free from theui." It is also worthy of note that the fever did not spread f "Vauglian: Medical Repository, N. Y., 1803, vol. 6, p. 299. INSECTS AS PROPAGATORS OF DISEASE. 51 to Kent and Sussex counties, but spent all its virulence in the district where the mosquito was more abundant.^ ^ The idea that yellow fever could be transmitted by mos- quitoes originated with Dr. Carlos Finla^', of Havana, in 1881. The doctor noticed a correspondence between the abundance of mosquitoes and a period of increase of yel- low fever in the autumn, while during the summer yellow fever had not prevailed to any extent and mosquitoes had also been less numerous. This set the doctor to thinking and a suspicion lurked in his mind that these pestiferous insects were probably responsible for the spread of the dsease. He immediately began a series of experiments, which resulted in the great discovery which has revcilu- tionized the antiquated theories concerning the propaga- tion of yellow fever and which are detailed in the medical part of this volume. We will end this summary' by giving the conclusions of Keed, Carroll and Agramonte, taken from their masterly essay on the etiology of yelloAV fever, which sums up the whole situation in a nutshell '}^ 1. The mosquito^ — C. fasciatus — serves as the inter- mediate host for the parasite of yellow fever. 2. Yellow fever is transmitted to the non-immune in- dividual by means of the bite of the mosquito that lias pre- viously fed on the blood of those sick with this disease. • 3. An interval of about twelve days or more after con- tamination appears to be necessary before the mosquito is capable of conveying the infection. 4. The bite of the mosquito at an earlier period after contamination does not appear to confer any immunity against a subsequent attack. 5. Yellow fever can also be experinu^ntally produced by the subcutaneous injection of blood taken from the general circulation during the first and second days of this disease, 6. An attack of yellow fever, produced by the bite of the mosquito, confers immunity against the subsequent " See Chapter on "Yellow Fever in Maine," in this volufhe. '- The Etiology of Yellow Fever, By Walter Reed, James Carroll and Aristides Agramonte, 1901. 52 HISTORY OF YELLOW FEVER. iujection of the blood of au individual suffering from the uon-experiniental form of this disease. 7. The period of incubation in thirteen cases of ex- perimental yellow fever has varied from forty-one hours to five days and seventeen hours. 8. Yellow fever is not conveyed by fomites, and hence disinfection of articles of clothing, bedding, or merchan- dise, supposedly contaminated by contact with those sick with this disease, is unnecessary. 9. A house may be said to be infected with yellow fever only when there are present within its walls contamin- ated mos(]uitoes capable of conveying the parasite of this disease. 10. The spread of yellow fever can be most effectually controlled by measures directed to the destruction of mos- quitoes and the protection of the sick against the bites of these insects. 11. While the mode of propagation of yellow fever has now been definiteh' determined, the specific cause of this disease remains to be discovered. BIBLIOGRAPHY ON TRANSMISSION O** OIS«=ASE BY INS«^CTS. NOTE BY THE AUTHOR. As this work treats principally of yellow fpver, we give below only a partial bibliography of the trausmissioT> of disease by insects. The literature on the relation between the transmission of malaria and the mosquito is enormous and can be found in the Index Medicus, the Index Catalogue of the Surgeon-n'° 50\) nor has it heen noticed further south than Montevideo (latitude 34° 54'). In the Eastern Hemisphere, Swansea, in Wales (latitude 51° 37') has been its northernmost limit, while St. Paul de Loanda, in Africa (about 9° S. ) has been the southernnu)st habitat. Its western limits have been the shores of the Pacific from ]Montevideo to Lower California, except on one occasion (1883) when an imported case died in San Francisco, Cal. In Europe, it has never been seen fui-ther East than Leghorn, in Italy (7° 5G'). In Africa, Egypt and ]Mada- gascar are said to have been invaded by the disease, but the report lacks authenticity. Tlie same may be said of the alleged prevalence in Asia Elinor during the . cam- paigns of Napoleon. , The present foci of yello^\' fever are still more restricted than fonuerly. Juan Guiteras recognizes the following three areas of infection : 1. The Focal Vjjuc, in which the diseases is never ab- sent, including Havana, Vera Cruz, Rio Janeiro and other South American ports. 2. The Perifocal Zo»r. or region of periodic epidemics, including the ports of the troi)ical Atlantic in America and Africa. 64 HISTORY OK YELLOW FEVER. 3. The VjOuc of Accidental Epidemics^ between the parallels of 43° uortli aud 35° south. To better understand the meaning of this eminent authority, the reader is referred to the map of the world, where he will observe three great regions of pestilential disease: First, of the plague; secondly, of cholera; thirdly, of yellow feyer. These regions are distributed as follows : From the equator to 20° North may be regarded as the true yellow feyer region. This includes the West Indies, the coast towns of Mexico, the Isthmus of Panama, Col- umbia, Venezuela, the eastern shores of South America as far south as the Eio de la Plata, and the western coast of Africa, embracing Sierra Leone aud the Gold Coast. From 30° to 40° North, in the Eastern Hemisphere, is the region of the plague, including Arabia, Egypt, Turkey and Asia Minor. From 20° to 40° North, in the Eastern Hemisphere, is theValky of the Ganges, the principal centre of the cholera region. Mortality of Yellow Fevkr in September. A study of the statistics of yellow feyer demonstrates the peculiar fact that the disease is connected in its epi- demic appearance with certain seasons of the year. The months of July, August and September are those in which epidemics are more prevalent and the disease seems to at- tain its greatest mortality in the latter month. A resume of nine epidemics in New Orleans, made by Chaille, and completed (so far as 1905 is concerned) bj' the compiler of this work, shows that in six of these visitations, the mortality was greatest in September, viz : * Some Yellow Fever Data, by S. E. Chaille, New Orleans Medical and Surgical Journal, 1905, vol. 58, p. 191. PERTINENT POINTS ABOUT YELLOW FEVER. 65 Mortality in Nine Notable Epidemics in New Orleans. May June July August SEPTEMBER October November December MODtHsOaKDOWD.. 74 965 laoo 198 12 10 445 4 33 200 467 126 20 22 31 2 1521 29 5:33 53 J 982 1234 147 490 28 131 4 7 5 382 1286 2 132 1140 3 II 26 255 1025 42 217 874 2204 1837 1780 III 97 19 137 1072 1065 61 224 103 147 6 15 26 3 TOTAL 2804 872 7848 24«5 2670 4854 3107 , 4046 A glance at the above figures proves that in only three instances (1853, 1858 and 1905) August proved more fatal than September. In 1853, the mortality reached the appalling aggregate of 5133 in August, against 892 in September and a grand total of 7848 for the entire year. A search into the records of nearly every place where yellow fever has been epidemic reveals the same state of affairs, with the exception of Havana, wliere July seems to be the most fatal montli. Even as far back as 1793,'Currie,- in speaking of the great epidemic at Philadelphia that year, sa^s : ''In September, the disease increased amazingly. In the course of the month, about 1100 citizens were added to the list of mortality; towards its close, from 50 to 90 were buried of a day, though the mercury now seldom rose above 80°.'' "After the first of September, there was no disease to be seen but yellow fever."^ -A Treatise on the Synochus Icterodes, etc., by William Currie (1794), p. 15. •'Epidemic at Philadelphia of 1797, Rush, vol. 5, p. 19. 66 HISTORY OF YELLOW FEVER. In 1822, when New York was visited by the disease, the deaths in September mounted up to 110, against 58 in Aufiust and 1)0 in October.^ The excess in moitalit^^ in September over the other months during the prevalence of yellow fever, has also been noted in the following epidemics: New York, 1799; Providence, 1\. I., 1797; Baltimore, 1819; AVilmiuoton, ( Del. I 1798; Charleston, ( S. C.) 1807, 1817, 1819, 1821, 1827 and 1838 ; Natchez, 1823 and 1825 ; Mobile, 1839; New Haven, (Conn.), 1791; Xew Orleans, 1819, 1820, 1821 and 1833. La Roche'' notes that the mortality has occasionally been greatest in August, as was the case in Charleston in 1838 and in New Orleans in 1817, 1839 and 1853. But these were isolated exceptions. The apparent reason for the greater mortality in Sep- tember seems to l)e that the disease, beginning early in summer, has had time to spread and to attack a larger number of persons; also, the virulence is greater because by that period the infected mosquitoes are more numerous and, everything else e(]ual, exposed persons receive more bites and consequently a larger dose of poison.'' This did not follow in 1905, because by September the effect of the active anti-mosquito campaign was showing itself by diminishing number of cases as well as by lower mortality. lIisTouic MouTALiTiE.s Fuo:m Ykllow Fever. Whenever yellow fever has spread its sombre nmntle over a community, it has left in its wake countless heca- tombs. "The reack'r need scarcely be informed,"" says Lalv(jche, in his monumental work on yellow fever, ''that the yellow fever, wherever it has assumed the epidemic form, has fully estaldished its claims to being classed among the ♦Proceedings Board of Health of the City of New York (1823), p. 123. ' Vol. i, p. 545. " See Article by Dr. Chassaignac, in the medical part of this volume. PERTINENT POINTS ABOUT YELLOW FEVER. 67 most formidable diseases to which tlie human body is liable." The island of St. Lueia, in the West Indies, furnishes the earliest authentic example of iii-eat mortality from yel- low fever. In 1(164, accordino to Keatingy it killed 1,411 out of a population of 1,500 soldiers, being- in the ratio of 1.06 of the whole number. In 1665, in the same locali- ty, out of 500 sailors, 200 died, being one in 2:5; and again, in ir>66, the unfortunate island was invaded by the disease, when every man, wonmn and child, 5,000 in all, died. In 1703^ in Grenada, West Indies, yellow fever appeared among the sailors, the proportion of deaths in cases amounting to 1 in 3 ; and of a total of 1,130 soldiers, 630 died. In 1791, the disease attacked Sir Charles Gray's Army, in the Windward and Leeward Islands, and of an esti- mated population of 12,000, there was a mortalitv of 6,012. In Guadeloupe, in 1796, out of an estimated population of 20,000, there was a mortality of 13,807. That same year, out or 367 artillerymen stationed jit the island, 129 died. In 1802, Guadeloupe was again decimated, 5,057 deaths occurring in a population of 16,363. In 1802, at San Domingo, in a population estimated at 40,000 (principally soldiers), there were 27,000 cases and 20,000 deaths. The mortality among French troops in the West Indies in 1802 amounted to 57 per cent. Quebec, Canada, Avas invaded by yellow fever for the first and last time in 1805. Of one company of 55, be- longing to an English regiment, all but six died. The greatest mortality ever recorded in Havana was in 1819, when 5,162 died. As yellow fever had visited Havana almost every year since 1620, this mortality is especially worthy of note. In 1852, at Barbadoes, West Indies, out of 1,380 sol- diers, there were 879 cases and 173 deaths. At Martinique, during a period of five years, 1802 to Keating: History of the Yellow Fever of 1878, p. 77. 68 HISTOKY OF YELLOW FKVER. 1807, ill a poi»iilati(»ii of 11,085 soldiers, there were 8,673 eases and 2,891 deaths. Aecordiui' to Joseph eJones,^ the total deaths from all diseases iu New Orleans from 1838 to 1883, a period of fort3'-five years, amoniited to 272,619, of Avhich 31,207 were from yellow fever, 10,009 from cholera aud (),136 from smallpox. It will thus he seen that of the 17,612 deaths from eontagii.ns aud infectious disease, the mor- tality from yellow fever reached the appalliii, that the Spanish Government, loth to lose this coveted possession, but not wishing to ex- pose its soldiers to annihilation, sent as colonists to the "Page 401, "La Roche: Vol. 1, p. 219. ' Gazette des Hapitaux, 1S84, vol. 57, p. 660. HISTORICAL SUMMARY. 89 island two hundred convicts. These criminals can be said to have been the i)ioneer settlers of the island. At Darien, in 1509, the expedition commanded by Da- vila lost seven hundred men in a single month. Panama had the same experience.*^ Fathers Breton and Dutertre,^ who describe the epi- demic of 1635, in Guadeloupe, sa3^s that it was known among the Caribs b^' the name of Poulicantlna, a word which signifies "I am struck vdih. a switch," which meant to describe the suddenness which characterized the onset of the fever. These same observers say that the disease was considered so infectious by the natives, that those stricken were often abandoned to their fate and whole villages were deserted when the first cases appeared, the torch being applied by the terror-stricken Caribs, so as to prevent the further spread of the infection. Ziemssen's Cyclopedia of the Practice of Medicine ^^ that wonderful storehouse of medical lore, which is edited with that careful attention to accuracy and to the minutest details which characterize the German mind, has the following observations on the subject: "We are entirely without trustworthy information re- garding the first appearance of yellow fever. It is highly probable, that the communication of various authors, which inform us of the prevalence of the disease in the Antilles since the memory of man, really refer to yellow fever. The theory is much more tenable that the disease was first developed after the immigTation of Europeans into the West India Islands; at least, it agrees better with many facts, which have been since observed, to con- sider yellow fever as an acclimation disease (of the tropics), to which immigrants are liable, tlian to assume that it originally prevailed as an epidemic disease among the natives, and afterwards underwent a complete altera- tion of its character. The Antilles were probably the cradle of yellow fever; at least, accurate observations of the disease in question were first made here." The Board of Experts authorized by Congress to in- Mbid. ^Du Teitre: Histoire General des Antilles, vol. 1, p. 30. ^"Vol. 1 (1S74,), p. 489. 90 HISTORY OF YELLOW FLVKR. vestigate the ygIIow fever epidemic of 1878, after tliorough and minute investigations, reached the following conclu- sions :^^ "Yellow fever was not known to the people of the East- ern Hemisphere until after the discovery of America by Columbus. The earliest epidemics of which we have any historical information occurred during the first half of the seventeenth century, in the West India islands." Joseph Jones, one of Louisiana's most distinguished physicians, whose works on fevers are acknowledged authorities, makes the following observations:^^ "After a critical examination of the works of Herod- otus, Strabo, Justin, Cornelius, Nepos, Eutropius, Plu- tarch, Titus, Linus, Thucidides, Homer, Sallust, Virgil, Flores, Vallerius, Particulus, Caesar, Horace, Cicero, Xenophon, and Tacitus, we have failed to recognize the disease now called yellow fever, in any descriptions of particular plagues or allusions to any pestilence; and in like manner, while in the writings of the middle ages we have descriptions of wide-spread and mortal plagues, amongst which may be recognized the oriental glandular plague, small-])ox, measles, typhus and typlioid fevers, the sweating sickness, elephantiasis or leprosy, cholera, dysentery, and cerebro-si)inal meningitis; yellow fever finds no place in these annals of general history, or of nu'dicine, previous to the discovery of Anuu-ica l)y Colum- bus. As we have failed to find any history or record of 3'ellow fever before the voyage of Christopher Columbus, the first question of importance which presents itself is, whether yellow fever had ever prevailed among the aboriginal inhabitants of North and South America and the West Indies previous to the discovery of America and the explorations of the Spanish adventurers, and the es- tablishment of the Spanish, French, Portuguese, Dutch and English colonies?" Dr. Jones then goes on to say that the West India Islands and certain portions of North and South Ajueri- ca, as the Valley of the Mississippi, Mexico, Central " See Report, p. — "Jones: Proceedings Louisiana State Medical Society, 1879, p. 54. HISTORICAL SUMMARY. 91 America and Peru, appear to have been, at the time of their discovery by Europeans, peopled with a suflflciently dense population for the existence of those conditions upon which the origin and spread of certain diseases de- pend. The wholesale destruction of the native popula- tion b}^ cruel wars, and by still more cruel slavery, and by the introduction of certain diseases, as the small-pox, as well as the wanton destruction of the pictorial works by which the hieroglyphics of the more advanced nations of America might have been deciphered, and the sudden and utter subversion of the systems of religion and science peculiar to these people, and the rapid disappearance of the royal families and priests who were, as in ancient Egypt, the custodians of the national science and art, have involved in obscurity many subjects of gTeat and lasting interest to the medical historian. The medical historian has only imperfect and doubtful data upon which to found any opinion as to the nature of tiie epidemic and contagious diseases which afflicted the aborigines previous to the discovery of the Western Hemisphere. That the more populous nations of America were not exempt from diseases of an epidemic and pestilential na- ture, has been well established. The pestilence called by the Mexicans "Matlazahuatl" desolated the cities of tlie Toltecs in the eleventh century, and forced them to abandon Mexico, and to continue their migrations southward, and to the west and northwest; it invaded the populous cities of Central America, and a similar disease committed great ravages amongst the In- dian tribes which occupied the country between the mountains and the Atlantic coast a few years before the landing of the Pilgrim Fathers. The Matlazahuatl, a disease closely resembling yellow fever, but Avhich is said to be peculiar to the Indian race of America, has seldom appeared more than once in a century; it raged in the eleventh century amongst the Toltecs, it made great ravages amongst the Mexicans in 1545, 157G, 1730, 1737, 17(3i and 1703, and amongst the Indians of the Atlantic coast in 1018 and 1019. According to Alexander Humboldt, the Matlazahuatl, 92 HISTORY OK YELLOW FEVER. although pestilential in its nature, and attended with htTMuorrhaue from the nose and stomach, was distinct from the ^'omito l*iieto, and Avas peculiar to the aborigines of America. The Spanish authors call this disease a plague. The following j)iissage from Humboldt's "Politi- cal Essay on New Spain"' appears to embody all that is known with reference to the nature of the Matlazahuatl of the Mexicans : "The ]Matlazahuatl, a disease peculiar to the Indian race, seldom api)ears more than once in a century'. It raged in a particular manner in 1545, 157G and 1736. It is called a plague by the Spanish authors. As the latest epidemic took place at a time when medicine was not con- sidered as a science, eyen in the cai)ital, we haye no exact data as to the ^Matlazahuatl. It bears certainly some analogy to the yellow feyer or black yomiting; but it neyer attacks white people, whether Europeans or de- scendants from the natiyes. The indiyiduals of the race of Caucasus do not appear subject to this mortal typhus, while, on the other hand, the yellow feyer or black yomit- ing yery seldom attacks the Mexican Indians. The prin- cipal site of the Vomito Prieto is the maritime region, of wliich tlie climate is exeessiye^ly warm and humid; but the Matlazahuatl carries terror and destruction into the yery interior of the country, to the central table-land, and the coldest and the most arid regions of the kingdom. "Father Forribio, a Franciscan, better known by his Mexican name of Motolina, asserts that the small-pox at its introduction in 1520, by a negro slaye of Naryaez, car- ried oft" half tlie inhabitants of ^Fexico. Tixpiemada ad- yances the hazardous ()])iiii(>n that in tlic two Matlaza- huatl epidemics of 1545 and 1576, 800,000 Indians died in the former, and 2,000,000 in the latter. But when we reflect on the difficulty with which we can at this day estimate in tlie eastern parts of Europe the number of those wlio fall yictims to the plague, we shall yery reas- onably be inclined to doubt if the Viceroys Mendoza and Almanaza, goyernors of a recently conquered country, were able to ])ro(ure an enumeration of tTie Indians cut off by the Matlazahuatl. I do not accuse the two monkish historians of want of yeracity, but there is yery little HISTORICAL SUMMARY. 93 probability that their calculation is founded on exact data. "A very interesting" problem remains to be resolved. Was the pest which is said to have desolated from time to time the Atlantic reij;ions of the United States before the arrival of the Europeans, and which the celebrated Kush and his followers look upon as the principle of the yellow fever, identical with the Matlazahuatl of the Mexican Indians? We may hope that this last disease, should it ever reappear in New Spain, will be hereafter carefully observed by the physicians."^-'' Humboldt further states that long before the arrival of Cortez there had almost periodically prevailed in New Spain an epidemical disease called by the natives Matlaza- huatl, which several authors have confounded with the Vomito or yellow fever. This plague was i)robably the same as that which in the eleventh century forced the Toltecs to continue their emigrations southwards. It made great ravages amongst the Mexicans in 1545, 15TG, 1730, 1737, 1761, and 17()3 ; but as has already been ob- served, it differed essentially from the Vomito of Vera Cruz. It attacked few except the Indians or copper-col- ored race, and raged in the interior of the country on the central table-land, at twelve or thirteen hundred feet above the level of the sea. It is true, no doubt, that the Indians of the valley of 3Iexico who ])erished by the thou- sands in 1701 of the Matlazahuatl, vomited blood at the nose and mouth; but these hjenuitemeses frequently oc- curred under the troi)ics, accom])anying bilious ataxical ((if(i.rieared on the west coast of South America in latitude 2° south. On the North American Continent it spread to latitude 42°; it extended even to Eurctpe. and reached the Pacific and Madagascar. At the beginning of the nineteenth century it penetrated deeper into the North American Contin- ent than formerly, reaching as high as latitude 47° north, and in Europe it extended to latitude 48°, and prevailed in the Canary Islands and Leghorn. "Ever since yellow fever attracted attention it was recognized as a distinct disease from the remitent autum- nal fevers of the temperate zone. It 1ms prevailed as an endemic in Havana, raging epidemically from April to December, and occurring sporadically during the rest of the 3^ear. From time immemorial it lias been endemic at Vera Cruz, in the Gulf of Mexico, where its chief victims 100 HISTORY OF YELLOW FEVER. are straugers who come from cold regions during the hot season, as well as Europeans and those native who ex- change the more elevated and cool regions of Mexico for the coast." African Ohkjin of Yellow Fever. The doctrine that Africa was the original home of j'el- low fever has been promulgated by many writers. As early as 1815, Pyni, in his "Observations on Bulam, or Yellow Fever,'' propagated the doctrine that yellow fever was endemic to Africa, had always existed there and that the world was indebted to that continent for the spread of the disease to the four points of the compass. This theory was warmly espoused by Audouard in the Revue Mcdicalc (Paris, 1825), who thickened the plot by fastening the onus on the slave trade of colonial days and asserting that the disease also developed spontaneously in the holds of ships packed with living cargoes of slaves, reeking with tilth and germ-propagating material. These views were seriously championed by many writers, one of them being that distinguished Louisiana authority on yel- low fever, Faget, who, in his work entitled Etudes Medi- cales dc (Jiie.stions 1 iii porta iites pour la Louisianey pub- lished in 1851), speaks in eulogistic terms of the views of Pym and Audouard and gives as his opinion that the theory advanced by these famous contagionists is the only rational solution of the ])roblem. In su]>])(Ht of his contention, Dr. Faget claims that when the traffic in slaves was interfered with by the United States government and the channels of this com- merce changed to sub-troi)ical ports, yellow fever, for the first time, broke out in Prazil. The learned doctor, in making this assertion, evidently overlooked tlie great ei)i- demic which broke out in Pernambuco in 1088 (according to Ferreira da I\osa) and which ravaged the Prazilian coast for several years afterwards. In an interesting little book ])ublished in 181)8, Cole- man (History of Yellow Fever, etc. ) revives the doctrine enunciated by Audouard, citing many examples in an ef- fort to prove that the l^'rench observer was correct, but advances nothing decidedly novel or convincing. HISTORICAL SUMMARY. 101 According to Byrd,-^ the disease was introduced into Soutlierii Europe, the West India Ishinds and the con- tinent of North and South America from the ^^'est coast of Africa, "where it originally flourished." This author blames the importation of the disease into Europe upon the ambition for extended territory which dominated tlie Caucasian race in the Middle Ages and holds the view that if the avarice and cupidity of the New England slave- trader had not tempted him to invade the jungles of West Africa, to kidnap the unwary and guileless aborigines, there is reason to believe that the hecatombs which have marked the visitations of the pestilence in the West In- dies and the shores of the American Continent, would never have been known. The natives of those lands knew nothing of the disease until brought to them by ships en- gaged in a most unholy commerce. Eochefort, one of the earliest writers on the subject, al- luding to the West Indies, says: "This noxious air was brought by vessels coming from the African Coast. "-^ Another disciple of the African origin of the disease is found in Turpinseed,-^ who says that the gTeat difference of temperature between day and night in the great desert, the air being 174° by day and 24° by night, undoubtedly had an influence in furnishing the embryonic conditions necessary to the origin and propagation of the disease. The infection was then carried by the desert winds to the coast towns of W^st Africa and thence scattered to sus- ceptible foci throughout the world. Strobel,'^*^ who also blames Africa for having been the original source of infection, furnishes considerable in- formation concerning the origin and spread of yellow fever, but his views are, unfortunately, too biased to be of any reliable historical value. The learned essayist cites only events which lend color to his rabid views on conta- gion and he eludes facts which prove the contrary in such "Philadelphia Medical Times, 1872, vol. 3, p. 726. -* Ce mauvais air y avait ete apporte par des navires qui venoient de la Coste d'Afrique. Histoire Naturelle et Morale des Isles Antilles d'Amerique (1658), vol. 1, p. 3 ="Turpinseed: Medical Record. N. Y.. 1878, vol. 14, p. 304. '" Strobe! : An Essay on the Subject of Yellow Fever, 1840. 102 HISTORY OF YELLOW FEVER. a tactful and unconcerned way, that it is a pity his efforts should not have been directed to a better purpose. He deplores the fact that the French Academy awarded Mon- sieur Chervin a premium of 10,000 francs for his admir- able (this is our word, not Strobel's) treatise on the non- contagiousness of yellow fever, and holds up Dr. Bahi as a martyr because the latter was chased out of Barcelona for having' propagated the doctrine that the fever which prevailed in that city in 1821 was contagious. "They ex- ecrated and threatened with death those physicians sufli- ciently well-informed to recognize this character of the disease," continues Strobel ; "they called them, by way of insult and derision, the authors of yellow fever: ''^'^ (The italics are SStrobel's. j But it is not our purpose to quarrel with the A'iews of the respected and dei)arted disciple of Bally, who was, Ave feel certain, honest in his opinion. We simply desire to say, en passant, that Monsieur Chervin earned those 10,000 francs by a large margin, for it is of record that he not only put on the linen of patients that had died of yellow fever and slept in their beds, but that he also ate of the black vomit and inoculated himself with it, in order to prove the non-contagiousness of the disease.'^- DowelP^ speaks in positive terms concerning the source of yellow fever, giving Africa as the undoubted original focus. He also states that it existed in Africa, Eastern Asia, and Southern Europe, long before the establishment of the Oreek and Roman Empires, even running back a thousand years before Christ. Chisoliii was an advocate of the African importation of the disease, as will ai)pear by a perusal of his w(u*k pub- lished in 1799."^ "'Ibid, p. 8. "Lancet, 1849, vol. 2, p. 433. "Dowell: Yellow Fever and Malarial Diseases, etc., 1876, p. 13. "'Chisolni. An Essay on the Malignant Pestilential Fever iu- trodiiced into the West India Island from Bouliam, etc., 1799. HISTORICAL SUMMARY. 103 Sternberg^^ saj-s that the early history of the disease is involved in obscurity and it is not possible to determine whether, as maintained by some, it was endemic at certain points on the shores of the Gulf of Mexico at the time of the discovery of the New World, or whether it Avas im- ported to the West Indies from the African coast, as ad- vanced by others. In commenting on the African theory of the origin of the disease, Sternberg adds that it seems very probable that the jjestilential malady which prevailed for a time in these usually healthy islands (the West Indies) and then disappeared, was in fact .yellow fever, and that it was in- troduced by ships from the west coast of Africa is not at all incredible. "Indeed," continues this authority, '4t al- most seems necessary to look for an endemic of the dis- ease outside of the West Indies, for the reason that in the comparativeh' few places in which it is now endemic, there is historical evidence to show that there was first im- portation and a previous period of exemption; while, on the other hand, the conditions upon which endemicitj^ at the present daj^ seems mainly to depend, were formerly unknown — conditions arising from the aggTcgate of ])opu- lation at seaport cities, as in Havana, Vera Cruz and Kio Janeiro."^** Elliott,^^ in commenting on the endemic diseases of West Africa, saj's : "There is an old doctrine that yellow fever had its original home on the West African coast, and that its existence in the tropical regions of the American continent and in the West Indies is the result of the slave traffic. On the other hand, certain French authors, notably Berenger-Feraud, contend that the disease was first imported into Africa from America. However this may be, there is no doubt about the fact that yellow fever has frequently shown itself in epidemic form in Senegam- bia, and that the British possessions on the ^^'est African littoral are liable to outbreaks of a peculiar malignant ^= Sternl)erg: Reference Handbook of the Medical Sciences, vol. 8, p. 5S3. '"Ibid, p. 584. "Elliott: .lournal of Tropical Medicine, London, 1899, vol. 1, p. 317. lO-t ilISTORY OF YELLOW KEVER. form of fever which is confined to the European residents, and which, after thinninj; their numbers to an appalling degree, and within a l)rief period, suddenly disappears." It is a matter of history, and cannot therefore he contra- dicted with any degree of safety, that in December, 1493, when Columbus reached St. Domingo, bringing with him the first Europeans who had eyer set foot on American soil f about fifteen hundred, according to rornilliac'^^) that a pestilential disease broke out in the yillage of Ysabella ( then in process of construction ) , and nearly annihilated the yenturesome little band that had brayed the terrors of a long yoyage through unknown seas to colonize a strange and wonderful land, where, according to the fabulous stories then current, "gold grew on trees and diamonds strewed the ground.'' Pouppe-Des-Portes,"^ a French surgeon, who practiced at 8t. Domingo from 1732 to 1718, says that yellow feyer was quite prevalent in the West Indies at that time and was called Mai dc *S'?Vn//, from the tradition that it had first been observed at St. Domingo during the visit of a French man-of-war coming from the kingdom of Siam in the seventeenth century. No one who has read the works of Bally will dispute the fact that he is generally reliable and accurate in his statements, but his unalterable belief in the doctrine of contagion and importation made him blind to the true state of affairs in this particular instance. Even such an eminent authority as LaKoche criticizes the great apostle of contagion, observing that the course he pursued in the controversies about his ])et theory was assuredly not com- mendable.^'^ In this connection, it is oi>i)ortune to remark that up to 1793, a majority of American i)hjsicians were believers in the contagi(»usness of yellow fever, but during the epi- demics occurring between that date and 1S2."), tlie practi- cal experience so changed the mind of the medical world, that, while five hundred and sixty-seven were against the ** Pierre Martyr, in his "Decades," says the number was 1200. ™ Histoire des Maladies de A. St. Domingue, vol. 1, p. 191. *" Americ«\n Journal of the Medical Sciences, April, 1853, p. 317. HISTORICAL SUMMARY. 105 doctrine of contagion, twenty-eight only remained in fa- vor of it.^^ The physicians of two hundred years ago were just as bitter and acrimonous when it came to discussing the subject of yellow fever as those of our present enlightened age. A glance over the pages of the Medical Repository, the Edbiburg Medical Review, the British and' Foreign Medico-Chirurgical Review, and other old-time medical journals, reveals page after page of decidedly personal re- marks directed by some venerable Esculapius against a brother who held a contrary view to those which were, in his opinion, the only tenable way of explaining certain things. The amount of vituperative ammunition which those ancient disputants possessed certainly puts all mod- ern efforts in that line in the shade. The terms "medical buccaneers," "malignant drivelers," "inexperienced and transient practitioners," etc., were among the lukewarm expressions used in these amiable diatribes. Sometimes, finding discussions through the medical press too tame or monotonous, the disputants abandoned the quill for more strenuous modes of clinching an argu- ment and we find mention here and there of violent per- sonal encounters between opponents of contending theo- ries. One of the most remarkable Avays of settling a dis- pute concerning the diagnosis of yellow fever, took place at Kingston, Jamaica, between Drs. Williams and 1km- nett, who met on the lield of honor on the 29th of Decem- ber, 1750, and fought so ferociously that they finally suc- ceeded in killing each other.^- Asiatic Origin of Yellow Fevkk. An anonymous writer, more audacious and original than his contemporaries or those who lived before him, and whose identiy, unfortunately, we have been unable to unravel, asserts that the ancient and malodorous city of Smyrna, in Asia ^Minor, was the original focus whence yellow fever infected the world, and cites in su])port of his theory certain passages of history referring to the re- " Dowell, p. 107. *■■ Medical Repository, N. Y., 180.5-06, vol. 9, p. 187. 106 HISTORY OF YELLOW FEVER. mittent fevers Avhieli devastated the Grecian Archipelago and the shores of Asia Minor as far back as the age of Pericles. French writers of the seventeenth century^ adhered to the theory that the Typhus miasmatique ataxique putride jaiine, the name by which the disciples of Bally desig- nated yellow fever, had its origin in Siam. Bally^^ as- sures us that the disease was brought to the island of Martinique by the ship of war rOriflaiiiine in 1682, in which year "the French people who had settled in Siam tied from the insurrection in that country and established themselves at Fort Eoyal." Bally also States that the OrifJdinuie stopped at some Brazilian port on its way to Martinique. According to Ferreira and others, yellow fever was epidemic in Brazil at the time spoken of by Bal- ly, and if such was the case, how could the disease have been imported from Siam, when it was already implanted on American soil? There is certainly a historical faux- pas somewhere. Moreau de Saint-Mery, one of the most reliable and learned chroniclers of his time, in commenting on the al- leged Siamese importation, makes certain observations which leave no doubt that the disease brought to Martin- ique by the Onflamme was yellow fever, no matter Avhere the original infection of the vessel took place. Ak^cord- ing to this authority, the ship was a hotbed of disease when it reached Martinique. Spotted fever {le jwiirpre, to use his exact expression) and an unknown "pestilen- tial fever had committed fearful ravages among the offi- cers and crews of the ill-fated Oriflaiuiuc, the mortality exceeding one hundred souls, among the victims being ]\rc«isieur de Lestrille, the commandant of the expedition. Saint-^fery also speaks of the bloody uprising which took place in the Siamese Empire and tlie tiiglit of the French settlers on board the ships VOriflaiinnc, Le Loutrc and the »S7. Nicholas, which set sail for France with all possi- ble haste. When the miniature flotilla entered the Atlan- •' Description Topographlque, Physique, etc., de I'lle de St. Domingue, by Victor Bally (1814), p. 700. ^' The distinguished contagionist evidently got his dates mixed, us the insurrection in Siam took place in 1688. G. A. HISTORICAL SUMMARY'. 107 tic Ocean, it was diverted from its course by storms, com- pelling the ships to make for the west. The OriflanituG arrived safely at Fort Royal, Martinique, but the fate of her sister ships is left in doubt. Nowhere does Saiut- Mery speak of the vessel having touched at any port in Brazil, as asserted by Bally and those cited by him. The date given by Saint-Mery (1090) is certainly more accu- rate than that stated by Bally (1682), as a reference to the political history of Siam, reveals the fact that the mas- sacre of the handful of Englishmen in the factory at Ayuthia, then capital of the kingdom, which was the sig- nal for the anti-foreign demonstration which put an end to the intrigues of the French court, took place in 1G88. Coi-nilliac^^ gives 1G90 as tlie date of the arrival of the Oriflamme at Martinique. Father Labat, a Dominican friar, who arrived in Mar- tinique in January, loOl,^*^ tells of the ravages of the dis- ease, which he claims was imported by the warship VOrifldminc, which had touched at a Brazilian port on its way from Siam. AVhat led additional color to the story of the disease having been imported from Siam, was the fact that, in 1G91, two vessels arriving from Pondichery, capital of the French East Indian settlement of that name, in Siam, were found to be nests of yellow fever, which caused an appalling mortality among the crews of both vessels. It was afterwards proved, however, that the infection had been contracted at Fort Royal. Whether or not the disease was imported to the West Indies from Siam, or vice versa, is a point which we will leave for others to dispute and theorize upon; but the importation, if it ever ha])pened, certainly did not take place for the first time either in 3082 or 1090, as the reli- able and unassailable records of such historians as Oviedo y Valdez, Goniora, Coreal, Humboldt, Ulloa, Cor- nilliac, and Rochefort, give details of epidemics which de- vastated the West India Islands as far back as the « Recherches Chronologiques et Historiques sur I'Orlgine et la Propagation de la Fievre Jaime dans les Antilles, by Cornilliac (1867), vol. 2, p. 72. "Ibid., p. 73. 108 HISTORY OK YELLOW FEVER. fifteenth century. We are more inclined to lean to the theory that the disease was first brought to the East from the tropical coasts of America. Moseley^" speaks at length of the ravages committed by the fever at Martinique in IfiOo and the majority of authors of the time concur in saying that, although yellow fever prevailed in the West Indies ever since the voyages of Columbus, there is no authentic instance of the disease having been noticed on vessels previous to 1690, when the Orifhimine incident set the whole medical world agog. On the contrar}', these ancient writers agree in the opin- ion that yellow fever prevailed as an endemic in the sev- enteenth century in all the localities in the New World bordering on the Gulf of Mexico and the Atlantic shores of South America, almost as far South as the Kio de la Plata. We will conclude by quoting from Hillary (Observa- tions on the Changes of the Air, etc., London, 1759), p. 144 : "We observe no trace of this scourge in the descrip- tions given by ancient Avriters, not even by the Arabian observers, who practiced in warm climates." So far as history- informs us, yellow fever has never been observed in Asia, althougli this vast continent is studded with regions which i)()ssess all the requirements for engendering and spreading the disease, including the Stcgowi/ia. Let the Panama Canal be pierced, however, thus reducing time of commercial intercourse between the AVest Indies and the East to a few days, and we shall, in all probability, see yellow fever transplanted to these ancient shores and commit fearful ravages among its bil- lions of souls. This is not a fanciful fiight of the imagination, but simply a "look forward,'' a calm, dispassionate prophecy, based upon experiences of the past and whose ultimate truth will thrill humanity with horror and despair when the mists which veil the future have melted away. The Gulf Stream Theory. Professor P. Stille, of INIobile, differs from all the pre- ceding authorities, and advances a novel theory to ac- '-'A Treatise on Tropical Diseases, p. 421. HISTORICAL SUMMARY. 109 couDt for the origin of yellow fever. He attributes it to the Gulf Stream. Calling attention to the equable atmoa- pheric conditions of the tropical lands of both hemi- spheres, he says: "Coming up the south-east, across the torrid zone, is an ocean current which, where it sweeps around the north coast of South America, is called the Guiana Current. It makes its way directly into the Gulf of Mexico, where it takes the name of the Gulf Stream. After washing the smaller islands of the West Indies, it forces itself with great strength through the narrow chan- nel between Cuba and Yucatan, and rushes all around the shores of the gulf, taking its turn towards the east, and (juitting the land immediately after passing the soutliern point of Florida. Within the gulf its tempera- ture stands at from 85° to 80°, but soon after having passed Florida its temperature goes suddenly down to G5°, and finally to 54°, and 50°. Now, if we examine every part of. the sea we shall find no other spot where a warm current washes the land at anything like so high a tem- ])erature as is exliil)ited in the (Julf of Mexico. A goodly portion of the time the temperature of the water stands entirely above that of the air, consequently a heavy mist is taken up. In (;ther words, the atmosphere is com- pletely saturated with moisture to such an extent as to render it too heavy to rise in obedience to the usual laws governing evaporation, the high temperature of the laud preventing condensation. As a result, there lies upon tlie surface of tlie low country a thin stratum of air so heavy and so damp as to tempt us strongly into coining suba- (puM)s as a designation by which to represent its condi- tion. For proof that such conditions do arise in all cases where the water stands at a temperature higher than that of the air, we refer you to latches' Physical Geography, page 152 ; and for proof that they exist in the West India Islands, see Ilumboblt's Island of Cuba, page 172. And here, in my humbk^ judgment, we have arrived at a knowledge of the main conditions necessary to the propagation of the yellow fever: A stratum of atmos- pliei-e saturated with moisture to such an extent as can only occur urdtr li':(^ circumstances as exist in the West Indies, and a tropical clime such as prevails there, and is 110 HISTORY OF YELLOW FEVER. every now and then, as I contended, carried into regions far above its natural lines. This thin stratum of heavy atmosphere is carried from the ocean equator and thrown upon our shores from the panish colonies in the Xew AVorld frequented the coast of Africa as early as the middle of the sixteenth century, to replace Avith negroes the dearth of labor caused by their massacres of the Indians in Cuba, ^Mexico and South America. After stealing the gold which the Aztecs and Incas had taken centuries to amass, the Spaniards forced their victims to work their mines and till their ]>lautations. Unused to such toil, Avhicli was rendered still more onerous by the cruelties practiced upon them by their conquerors, the Indians perished by millions. His- torians tells us that more than half the population of Peru were consumed in the mines. A\'afer, an English surgeon (according to Aloseley"*^), says that he and some others landed at Vermejo, in I'eru, in 1()87, and marched four miles up a sandy bay, "all of which,'' he says, "we found covered with bodies of men, women and children, Avhich lay so thick, that a man miglit, if he would, have walked half a mile and never trod a step off a dead human body. These bodies, to appear- ance, seemed as if they had not been above a week dead; but if you handled them, they proved as dry and light as a sponge, or i)iece of cork." The* voyagers soon came upon ''Moseley: A Treatise on Tropical Diseases, 1792, p. 155. HISTORICAL SUMMARY. 115 a Spanish Indian, wlio Avas picking np dried soa-weed, and asked liini how those dead bodies came there? To which he answered that, in his father's time the soil, "which now yielded nothing, was green, well-cultivated and fruit- ful ; that the city of Worniia had been well inbabited by Indians; and that they were so numerous, that they could have handed a tisli, from hand to hand, twenty leagues from the sea, until it had come to the Inca's hands ; and that the reason of those dead bodies was, that when the Spaniards came and blocked up and laid seige to the city, the Indians, rather than lie at the Spaniards' mercy, dug holes in the sand and buried them- selves alive/' AVhen the Spaniards saw that the natives were about to become extinct, and that the majority of those that were left had Hed to caverns and mountain fastnesses, they had recourse to Africa, and negroes Avere imported by the thousands to take the places of the ^Mexicans, Peru- vians and West Indians. This was the beginning of the slave trade, and the constant voyages to and from Africa in (piest of new victims, gave a semblance of truth to the theory that yellow fever had been imported from Africa to America. Let us now juggle with dates and obtain some poignant conclusions : A glance at the table on page 112 will show that the first epid(Miiic of yellow fever in the w(u-ld of which there is any record took place at Ysabella, San Donungo, in De- cember, 1193, fourteen months after the discovery of America. According to Lind, the first outbreak of yellow fever on the mainland of Africa took place in Senegal in 175!!, two hundred and sixty-six years after the Ysabella incident. As the mainland of Africa was colonized b\ Euroi)eans about the year 1500, and yellow fever was never observed i)rior to 1751), or two liundnMl and fifty- nine years after its colonization, it is not necessary to in- dicate with a pointer on the map of the world where the natural home of yellow fever was, is and will continue to be for all time to come — unless our Southern neighbors stop long- enough launching new revolutions and attend to 116 HISTORY OF YELLOW FEVER. intelligent preventive measures against a disease which science has proved can be conquered. A!nother noteworthy fact before we conclude: The ei)ideiiiics of yellow fever in the West Indies fol- lowed one another in rapid succession and hardly a year has passed since 1493 without the disease manifesting itself, either sporadically or as an epidemic, in one of the Antilles. In Africa, the record is different. Let us take Senegal to illustrate our point : From 1759 to 1882, a period of one hundred and twenty- three years, there were six ei)idemics in iSenegal. Be- tween the tirst and second epidemics (1759-1778), nine- teen years elapsed; between the second and third (1778- 1830), fifty-two years; between the third and fourth (1830-1807), thirty-seven years; between the fourth and fifth (1807-1878), eleven years; between the fifth and sixth (1878-1882), four 3'ears. By reference to the chronological tables in another part of this volume, it will be seen that during this same period of one hundred and twenty-three years, there is a record of nearly two hundred outbreaks of yellow fever in the AVest Indies. A soil which can produce yellow fever will do so annu- ally; the long intervals between the epidemics in Africa gives the palm to the West Indies. The Ship Theory. — The theory that yellow fever originates on shipboard was based on the fact that, in sev- eral noteworthy instances — such as the outbreaks at St. Nazaire, ]>i'(^st, Falmoutb, etc. — it was noticed that so long as the hatches remained closed, the disease did not manifest itself, but as soon as the scuttles and hatches were opened, tlu^ fever invaded the vessel and often spread to the port wliere she was riding at anchor. This is easily cx]>lained: The infected mosquitoes, which had fed on yellow fever patients at the port of sail- ing, had been imprisoned in the hatches during the long voyage across the seas, Avith no chance of gaining access to the upper i)arts of the ship. AMieu the vessel reached her destination and the hatches were opened, the insects were liberated and swarmed with famished haste all over the vessel, inoculating with the poison of yellow fever HISTORICAL SUMMARY. 117 every susceptible person they bit. Tliese persons, in turn, were so inan^' new foci of infection and served to spread the disease. In the present liiilit of the mosquito transmission of yellow fever, nothing can be more simple; but, when we come to think over the matter, we can hardly blame Audouard and his dintinguished champions for having blundered, as they were groping in the dark and launched the theory which seemed, under the circumstances, the most plausible and intelligent. The Gulf Stream Theory. — This doctrine cannot for a moment be seriously entertained and does not need to be dissected here to lay bare its imperfections. It ex- plains nothing and is dismissed without further comment. The Asiatic Theory. There is a theory, however, which takes our fancy and which we are prone to espouse — the opinion that yellow fever originated on the western shores of Asia centuries before the advent of Christianity. The city of Smyrna, in Asia Minor, is just the sort of place where a pestiferous disease could originate de iioi^o. Since the date of its foundation, in prehistoric times, it has been renowned for its filthiness and pestilences, a fame which clings to it to tliis day. Smyrna occupies the unique position in history of being the only great city of the west coast of Asia ]Minor which has survived to the present day. Unlike good wine, however, it does not seem to have imi)roved with age, from a sanitarian point of view. It is as insalubrious to-day as it was in distant past, when it cradled Homer and was the glorious capital of Antigonus. The appearance of the city at the present day is very attractive when viewed from the harbor, l)ut a closer inspection dis])els the illu- sion. The houses, mostly built of wood, are mean and fragile looking; the streets Jose and filthy and tilled with intolerable stenches, proceeding from illy-constructed sewers and drains. ITaving thus all the necessary condi- tions present to harl>or and propagate pestilence, it is within the reasonable bounds of probability that it could 118 HISTORY OF YELIOW FKVER. have beeii the original nidus of yellow fever. How yellow fever was engendered there, what special atmosphere con- stitutions precipitated its origin or how it sj^rung spon- taneously into existence, our feeble powers of imagination cannot conjecture, but, for the purpose of propping up the doctrine we advance, we shall admit that it did spring from somewhere within the walls of the malodorous ori- ental town — in fact, grew, like the immortal Topsy — and was thence disseminated by the mosquito-infected vessels of the Pheuicians and other ancient adventurers through- out the then known world. The immigration of the Phenicians to the Mediter- ranean coast of Asia took place in remote antiquity. When the Children of Israel settled in Canaan, they found the Phenicians already established in the country, and history tells us that the tribes of Naphtali, Asher and Dan, to which that section of Syria was assigned, did not conquer Phenicia, but occupied only a small portion of it. The Phenicians were a commercial and not a war- like race and their policy from the onset towarcls the Chosen People was one of conciliation and the two races afterwards became stalwart friends. From the earliest period the Phenicians occupied them- selves in distant voyages and their skill in shipbuilding is a matter of history. Lebanon supplied them with abun- dance of timber and Cyprus gave them all necessary tiaval equi])ments, from the keel to the topsails. In the reign of IMiaraoh-Necho, these daring navigators even circum- navigated Africa. The commerce of Tyre extended all over the ancient world, from India to England, and the maritime knowledge and experience of the IMienicians led to the founding of numerous colonies in Cyprus, Kliodes, Sicily, Sardinia and even in distant Spain, where they founded the famous city of Gaddier, now known as Cadiz, eleven centuries before the Christian Era. With Smyrna as a nidus, yellow fever could thus easily have been imported to the seaports of the Mediterranean by the active commerce in which these remarkable people ^ were engaged in. ]Mosquitoes are plentiful in Western J| Asia and Southern Euro])e and the great jdagues which history recounts as having almost depopulated the world HISTORICAL SUMMARY. 119 at certain epochs in the distant past, were possibly yellow fever epidemics, spread far and wide through the medium of mosquito-infected ships, which sailed from infected points to countries free from the disease. These countries, in their turn, proved so many foci of infection, whence yel- low fever radiated to susceptible localities. In course of time, the disease was imported to America b}' the early voyagers who visited this country centuries before the time of Columbus and gradually spread over the con- tinent, until it found a home suited to its permanent hibernation in what is now known as the yellow fever zone. Simple, is it not? We shall undoubtedly find scof- fers and unbelievers, but Ave advance the theory with the same assurance that all i^revious theories have been pro- mulgated and can safely challenge auA'one to prove the contrary. This is the beauty of theories. You may not be able to prove what you say by what lawyers call ''docu- mentary evidence," but the burden of proving the con- trary is on the other fellow, and he is generally in the same fix when it comes to trotting out facts to prove that you are talking through your chapeau. "Admitting your theory to be correct," observes my astute friend, Mr. Doubting Thomas, "why has yellow fever ceased to visit Smyrna?" For the same reason that it is no longer prevalent in Spain, Philadelphia, Boston, New York,* and scores of other places Avhere it was, at some time or other, consid- ered endemic. What has brouglit about this change? ''The disappear- ance of the Stcgomyia Calopus from these localities," Avould be the logical answer. But smh is not the case. The yellow fever moscpiito has been banislicd from New York, Boston, Philadelphia and other Northern places, * See the very interesting theory advanced by Col. W. C. Gorgas concerning the disappearance of the Stegomyia from Philadelphia, New York and other Northern locali- ties, published in another part of this volume, under the caption "The Effect that the Completion of the Panama Canal Will Have Upon the Probable Extension of Yellow Fever to Asia." 120 HISTORY OF YELLOW FEVER. but, according to Theobald,^^ these insects are still to be found in Spain at the present da.y. And yet, yellow feyer, except in a few isolated instances, has been unknown in that kiniidom since the great epidemics which rayaged it in the beginning of the last century. Theobald does not designate Smyrna as one of the habi- tats of the Stego)ui/ia CuJopu.s, but mentions the tact that the insects are preyalent in Tjre, Sidon and Palestine, neighboring localities. "Where the climate is not too dry," obseryes Howard,'''^ '"Sfegoinj/Ui Fasciata will, with little doubt, upon close search, be found.*' The climate of Smyrna is an ideal one for the propagation of the insect under discussion and it has no doubt been domiciliated there from time immemorial. But here comes the clincher : "If Stcgomi/iae flourished in Smyrna ages j^ast and yellow feyer was an endemic, how is it that, with all the conditions which were then present existing at the present day, the disease no longer manifests itself?'' The only way to get rid of this Gordian Knot is to treat it a-la-Alexander : Let us suppose that the great pestilences which deyas- tated Europe, Asia and Africa centuries before the Chris- tian Era were yellow feyer epidemics. History tells us that these outbreaks caused fearful mortalities and that at times "nearly half the population of the world" was swept away. As the years went by, new generations were attacked by the disease, which became milder and less murderous for want of fresh material, until it came to pass that those who remained became immune through acclimatization or because they had withstood a preyious attack, and the disease gradually disappeared from its old-time haunts. Immigration, one of the most fertile feeders of endemic disease, was no longer a factor in the Old A\'orld after the twelfth century of the Christian Era, for the nomads of that period had penetrated as far as they dared to go, and with the whole population of the "Theobald: A Monograph of the Culicidae of the World, 1891. '* Howard: Concerning the GeograpJiic Distribution of the Yellow Fever Mosquito, 1905. HISTORICAL SUMMARY. 121 world iiiiinime from yellow fever, it is natural that the scourge should cease to manifest itself. It is a remarkable truth that persons born in a com- munity' where a disease is endemic, seldom, if ever, experi- ence an attack. Humboldt notes the fact that a person born and brought up in Vera Cruz is not subject to the disease. The same observation has been nmde in regard to Havana. And yet, the natives of Havana are often at- tacked with yellow fever when they visit Vera Cruz in August and September ; Avhile, on the contrary, natives of Vera Cruz, who were known to have passed unscathed through violent epidemics in their natal place, have died of yellow fever in Havana, Jamaica and the United States. "New sources of disease are developed by civilization," observes Gouverneur Smitli,-^^ "new measures of prophy- laxis germinate simultaneously with each genesis. Many of the poisons with Avliich we are familiar, and which were known to our ancestors, are not as yet to be extinguished, but are to continue to harass posterity. Posterity will en- counter ills which have not afflicted us, and the medical literature of future centuries will relate the outcrops of novel disorders, and record the successful means by which they were held in abeyance. If the chemists are capable of producing new compounds, it can be inferred by anal- ogy, and even inferred from a study of past ages, that in the mutations of society new forms of aerial contamina- tions and new zymotic affections will be developed by reason of the overcrowdings of population, by the influ- ences of new occupations and of new relations of life. The opening of new territories to civilization will be at- tended with its dangers. Indigenous germs of disease may exist in unexplored Africa and in other secluded parts of the globe, which are in time to be conveyed to marts of commerce, and thence to be still more widely diffused." Gouverneur Smith's observations, made thirty years ago, upholds the point we Avish to elucidate. What has kept alive the fires of pestilence in tlie West Indies? War and the S]janish soldiery. For hundreds of years, Spain was engaged in putting down insurrections in " Trans. N. Y. Academy of Medicine, vol. 2, 1876, p. 362. 122 . HISTORY OF YELLOW FEVCR. Cuba, and for liimdreds of years has yellow fever mowed down her soldiers by the thousands. During the period of ten years, from 1870 to 1879, there arrived, at the port of Havana, 151,423 Spanish sol- diers. During that same period, out of a total death-rate of 92,231 from all diseases in Havana, there were 11,837 fatalities from yellow fever alone, of which 4,139 were newh'-arrived soldiers, or nearly half the total mortality from yellow fever. Look over the long list of epidemics in the West Indies since the beginning of the last century, and you will see that in almost every instance the disease was either im- ported or attacked the newly-arrived. The natives (that is, descendants of the original settlers of the islands), if they had not been contaminated I)}- this susceptible ele- ment from a foreign clime, would never have contracted the disease. According to the views of the Havana Yellow Fever Commission,^- the pure-blooded American red Indian an- nually proves at Vera Cruz his present susceptibility to 3^ellow fever; hence there is no reason to disbelieve that the aborigines of San Domingo and other Antilles were susceptible, but had, in 1492, acquired immunity from the disease by the same process and to tlie same general extent , now enjoyed b^^ the white, black, and yellow or red natives of habitually infected localities in Cuba and elsewhere. The same reasoning holds good for Smyrna, Spain and other old-world localities. Natives of susceptible climes not having emigrated to these countries for centuries past, the occasional visitor of to-day is safe from attack, as the infected mosquitoes and their immediate posterity have long since "passed in their checks" and their descendants content themselves in disseminating malaria and kindred transmissibh' diseases. I>iit let a single case of yellow fever be imported into the heart of Spain, Smyrna or any presunmbly former habitat of the disease, and the world will witness a repetition of the terrible ravages of the past. Previous to 1793 yellow fever was unknown in Dem- ^- Annual Report National Board of Health, 1880. HISTORICAL SUMMARY. 123 erara, Britisli Giiiaiia, wliich is noted for its low, swampy soil, aboundiug iu vegetable matter iu a state of decom- position, the whole constituting a true hot-bed of pollu- tion, where ^tcfjomykic breed by millions. Yellow fever could not, and never would have, developed itself in that region; but, according to Bally,^^ it was introduced by the schooner Futifan, in the ^^ear above mentioned, and finding an habitat suited for its propagation, became es- tablished there, and Demerara is to-day one of its focal points. Diseases, like fashions, have their whims. A locality may for years — aye, even centuries — be afflicted with a certain ailment and then, souu^times suddenly, sometimes with such gradual decadence as to be scarcely noticeable, ,the endemic disappears, to manifest itself in places where it was unknown before and create the same havoc, inspire the same terrors and display the identical idios^^ncrasies whiclr characterized it iu its old habitat. According to Muhrj',^^ if we except the admirable and accurate descriptions of diseases contained in the writings of the Arabian physicians, we have scarcely any of an earlier date than the beginning of the sixteenth centurj^, sufficiently full and correct to enable us, by comparing the phenomena of the diseases which now prevail with those by which the same diseases were accomi)anied at former periods, to detect their points of i'eseud)lance or discrepanc} . Judging, however, from the few and imper- fect details furnished us by medical writings of former daA's, we believe that there are good reasons for conclud- ing that the more prominent diseases to which the human organism is now liable, are essentially tlie same, in all their leading features, with those to which it was subject as far back as medical histoi-y leads us. Muhry further asks if it is true, however, that diseases which formerly prevailed have entirely disai)peared? This is by no means improbable. The history of endemics proves very clearly that certain forms of disease depend upon cases of a sti-ictly local character, and no longer occur when these local causes are removed. It is cMiually "^ Bally: Typhus d'Amerique, p. 60. "Muhry: Historical Immutability of Nature and Disease, 1844. 194 HISTORY OK YELLOW FEVER. reasonable to suppose that morbitic causes of wider extent may become extinct either spontaneously or through the agency of nuin, and with their extinction would, of course, cease the diseases i)r(;duccd by them. ]>ut it is not so very certain, that among the diseases to which the human or- ganism is still subject, some at least of those which are presumed to have disapeared are not to be included, but in a form so far modified that the resemblance between them and their prototypes is overlooked. It is, also, prob- able that disease^ which formerly prevailed as endemics or epidemics, still occur sporadically; isolated cases ap- ])earing occasionally and at long intervals, and hence at- tracting little attention, being viewed as anomalous forms of some one of the more prevalent att'ections. Muhry's masterly diagnosis is admirably suited to the subject under discussion in these pages. Take away the Stcgonn/ia Calopiis and you take away yellow fever. The experience of New Orleans in 1905 is incontestible proof of the truth of this assertion. Although all the conditions which prevailed in 1905 existed in 1900 ( with the excep- tion, of course, of the millions of Stegomyia), not a case of yelllow fever occurred among the vast cosmopolitan population of the ^letropolis of the South, and only a single case, undoubtedly imported, is known to have oc- curred throughout the entire State of Louisiana. And this, thanks to the untiring work of the eminent sanitari- ans in whose hands were the destinies of the State and City Boards of Health, was soon rendered inocuous. Let us again look into the fascinating question of Asiatic origin of yellow fever. Without desiring to be irreverent to the shades of Audouard, Bally, Chisolm and others, we think that there is more in the theory of Asiatic origin than appeai-s on the surface, when one comes to weigh it in the balance of conjecture. How do we know that the pestilential ardent fevers, or can. si, of whicli rei)eated mention is made in the works of ancient writers, were not yellow fever mani- festations? In reading descriptions or the can si, not only in the Epidemics of Hippocrates, but also in the writings of his contemporaries, Thucyuant smallpox, or, at all events, a malady totally dittereut from yellow fcyer. Sydenliam, the ij;reatest epidemiologist of modern times, describes the Plague of London, in the summer and autumn of 16G5, as haying been ushered in by a malignant feyer, and also alludes to a disease similar to yellow feyer which prevailed in Moscow in 1771, where it destroyed 80,000 persons. Alccording to Merlins, one of the physi- cians appointed by the Empress of liussia to attend the infected, the pestilence was introduced in Moscow by Turkish prisoners. In Hume's Histonj of Eiujland (page 33), occurs the following passage: ^'The reign of Oswy was rendered memorable by a most destructive pestilence called the YcJloir Phif/uc, which, commencing in GG4, ravaged the whok' island during twenty years, with the exception of the liighlunds of Scotland.'' A fever similar to yellow fever has been observed in England and Ireland. Dr. Hamilton describes its appear- ance at Norfolk and Drs. Graves and Stokes''''^ speak of its prevalence in Dublin in 1826, though the latter ex- presses some doubts as to the disease being yellow fever. Dr. Graves, however, avers that the symptoms and ana- tomical cliaracters were the same as those laid down in cases of ycHow fever by the best authorities. Anstie/'^ in comparing English epidemical disease with yelbtw fever, says: "In trutli, it is diflicult to read care- fully the histories of West Indian epidemics of yellow fever without being tempted to believe that the disease has strong affinities with our English ty]ihus; and the ])ecu- liar symptoms (jaundice and Itlack vomit) of wliich so mucli has been made, are in truth phenomena which are not infrequently witnessed in typhus and relapsing fever ""Lectures on Fever, by Wm. Stokes (1876). p. 37, ""Notes on Epidemics, by Francis Edmund Anstie (1866), p. 86. HISTORICAL SUMMARY. 129 ill Britain/'- So often has this been the case, that one can hardly avoid thinking that, were these latter fevers trans- ported to the peculiar tropical regions which liave been mentioned, tliev would develop these features with con- stancy, instead of occasionally, and would then be indis- tinguishable from true yellow fever." The great American historian and philosopher. Hum- bolt, makes the following observations: "It is certain that the voinito, which is endemic at Vera Cruz, Cartha- gena, and Havana, is the same disease as the yellow fever, whicli, since the year 1793, has never ceased to afflict the people of the United States. This identity, against which a very small number of physicians in Europe have started doubts, is generallv acknowledged by those of the Faculty who have visited the Island of Cuba and Vera Cruz, as well as the coast of the United States, and by those who have carefully studied the excellent nosological descrip- tions of M. M. Makittrick, Kush, Valentin, and Luzuriaga. We shall not decide whetlier the yellow fever is percepti- ble in the caiisus of Hippocrates, which is followed, like several remittent bilious fevers, by a vomiting of black matter ; but we think that the yellow fever has been spor- adical in the tAvo continents since men born under a cold zone have exposed themselves in the low regions of the torrid zone to an air infected with miasmata. Wherever the exciting causes and the irritability of the organs are the same, the disorders which originate from a disorder in the vital functions ought to assume the same aijpear- ances." Conclusion. As previously observed, we lean to the doctrine of Asiatic origin of yellow fever, but we are in no wise unal- terably wedded to the hypothesis. We have tried hard to be convinced, but the bewildering mass of evidence, pro et con, has raised a lingering doubt in our mind, which no amount of reasoning has been able to eradicate. The diffai'ential diagnosis between typlius and yellow fever in this country is too well established to need comment- ing upon. — G. A. ISO HISTORY OF YELLOW FEVER, We now bring this historical summary to an end, think- ing it uuuecessary to burden these pages with further quotations and observations. We feel we have proved nothing new concerning the origin of yellow fever and, taking you into our contideuce, patient reader, we must confess we never had the remotest idea of launching a new theory. AVe simply culled from the best observers and trust to the iutelli<^ence of the reader to make whatever deductions may seem proper or reasonable in the premises. So far as we are personally concerned, we beg to express our opinion of the whole business by the following quota- tion from Peisse, taken from his great work. La Medecine et Lcs Medccins : "Quand, par Vohservation directe da regne animal, etiid'iG dans son organization intcriciirc la jjZms delicate, Curicr eat fini son traca'il, il trouca qwil etait arrive a pen pres aux memes dimsions qii/Aristote avadt etahlies, il y a- plus de deux mille ans." To paraphrase the above: After carefully sifting the opinions of the most noted writers on the origin of 3'ellow fever, we have arrived at the same conclusions reached by all of them — that the disease either was endemic in America centuries before the arrival of Columbus, or was imported from some transatlantic country hy the hordes of nondescript personages who swarmed to the New World in search of riches and adventure. But where the invaders primarily contracted the disease, is a question which reminds us of the immortal (piestiou of the small boy, ])ropounded ages ago to his preceptor: "\\ liich was born first, the egg or the chicken?" AV'e find no record of the learned gentleman's explana- tion, and the problem will undoubtedly remain forever unsolved. We cheerfully relegate the jellow fever brain- racker to the same fate. PART THIRD. HISTORY OF YELLOW FEVER, BY LOCALITIES. I YELLOW FEVER AS IT CONCERNS ASIA THE EFFECT THAT THE COMPLETION OF THE PANAMA CANAL WILL HAVE UPON THE PROBABLE EXTENSION OF YELLOW FEVER TO ASIA. By Col. W. C. Gorgas. Assistant Surgeon-General, U. S. Army; Chief Sanitary Officer, Panama Canal Zone. To get a basis for the discussion as to what will be the probable effect of commerce through the Panama Canal upon the introduction of yellow fever into Asia, it will be necessary to review roughly the past and present habitat of yellow fever, and its method of extension in the past. Yellow fever has only been recognized as a disease since the discovery of America, and its principal habitat since that time has been the West India Islands, and the main lands of both North and South America bordering the Gulf of Mexico and the Caribbean Sea. It has, however, extended at time very widely from these localities, on the eastern and western coast of North and South America, and the western coast of Africa, and the southwestern coast of Europe. It seems to have had its widest exten- sion during the latter part of the eighteenth century and the earlier part of the nineteenth. It has been as far North as Quebec in North America and as far South as Montevideo in South America. There have been several epidemics in Spain, and minor epidemics in France and Wales. In Europe a few cases have originated as far east as Genoa, Italy. It has never extended farther east in Europe than Genoa, nor has it a;t any time affected Asia, or the islands of the Pacific. With our present knowledge of its means of propaga- tion one can readily understand why it has not spread beyond these limits. The great road of travel during the old days of sailing ships, between Europe and America on the one hand, and Asia on the other, was around the Cape of Good Hope. This took four or five months. The only possibility of such a ship transmitting yellow fever would be that the ship itself would become infected, and 156 HISTORY OF YELLOW FEVER. continue to have a snecessiou of ca^es, and thus keep alive infected mosquitoes during the whole voyage. She would have to be breeding stegomyia mosquitoes aboard and have a case of yellow fever introduced, and infect these mosquitoes, and then have a succession of cases of yellow fever among her non-immunes that would keep up the dis- ease for several months. The probabilities are greatly against this. The probabilities are that within the first two months all the nonimmunes aboard would contract the fever, and at the end of a couple of months, we would have a ship peopled by immunes. Every probability is that the infected mosquitoes left at the end of two months would die from natural causes within the following three months, and by the time the ship reached India, she would be entirely free from infection. Another gTeat means of protection was the fact that the vessel was exposed to freezing weather for several weeks in jiassing the Cape. Before the days of the Suez Canal there was not a great deal of traffic through the ^Mediterranean Sea to Asia, and what there Avas, was carried on by means of pack trains of various kinds. One can readily understand the im- probability of transmitting yellow fever in this way. I think our experience points to the fact that yellow fever is nearly always transmitted from place to place by a sick person going from an infected point, and infecting the mosquitoes in an uninfected place. It apparently takes pretty frequent communication to transmit the disease. In tlie earlier days of yellow fever in the United States it was almost entirely confined to tlie littoral and was looked upon as a disease of the sea coast. As the country became settled up and river traffic became great, it was found that it would spread up the rivers, but it was still looked upon as a disease confined to the sea coast and large rivers. AVhen railroads were introduced, it was found that it spread with equal facility along railroad routes. The small amount of commerce and the great length of time that it took for a sailing vessel to cross the Pacific would readily account for yellow fever not having spread across the Pacific. With the introduction of steam ves- sels one would have expected that yellow fever would ASIA. 1S7 have been more likely to spread to Asia, but a steam ves- sel breeds many less mosquitoes than a sailing vessel. The sailing vessel, for her long- voyage, had to carry large quan- tities of fresh water, which were prolific breeding places for the stegomyia. A| steam vessel, while she can and does breed mosquitoes, does not do so to anywhere near the ex- tent that the sailing vessel does. Her expenses being large, she cannot afford to spend such length of time in port as the sailing vessel does, and is, therefore, less likely to become infected. And then again, the routes of com- merce do not extend directly from infected ports to Asia. It is very seldom that a vessel goes directly from Havana or Kio de Janeiro to Asia. The exchange is almost en- tirely carried on by means of London or Hamburg, or some other European port. The effect that the Suez Canal has had as a means of the introduction of infectious and contagious diseases from Asia to Europe, would be some indication of what effect the Panama Canal will have upon the introduction of such diseases from America to Asia. The probabilit.y, while remote, of the introduction of j^ellow fever from America to Asia, was certainly increased by the opening of the Suez Canal. The city of Para, in Brazil, is the port in America nearest to Asia going east by the Suez Canal, which is at present permanently infected with yellow fever. The time by steamer from Para to India has been reduced by the Suez Canal more than half. The whole route via the Suez Canal lays in tropical and subtropical latitudes. The likelihood of the introduction of yellow fever from Para to India via the Suez Canal is at present just about the same as it is for the transfer of the same disease from Guayaquil to Hong Kong. Both Guayaquil and Para are permanently infected with yellow fever and have been for years. The steaming distance from Para east through the Suez Canal to India is about the same as that west from (juayaquil over the Pacific to Hong Kong. While we would have to acknowledge the possibility of the conveyance of yellow fever to Asia by either of these routes, it is evidently extremely improbable. The Suez route has been in use for a generation, and the Pacific route for some three centuries, with never a single in- 138 HISTORY OF YELLOW FEVEH. stance of jellow fever getting to Asia. But it is probable that in that time there has never been a single instance of a vessel going directly from either Para or Guayaquil to Asia. As commerce goes on increasing they may, how- ever, occur. A very good example of a large commerce between ports infected with 3'ellow fever, without the transmission of the disease, is that between the i)orts of Rio de Janeiro and Para, infected ports on the eastern coast of South America, and England. Also that between Guayaquil, an infected port on the west coast of South America and San Francisco. Commerce is very intimate between these infected ports south of the equator and the non-infected regions mentioned north of the equator. Vessels sail between these ports oftener than weekly, and the steam- ing time is less than a month, yet, to my knowledge, yel- low fever has never been carried either to England or San Francisco from these sources.* But, before the open- ing of the Suez Canal, one, in discussing the probable dangers, would have thought that plague and cholera would be much more likely" to be introduced from Asia to Europe than yellow fever from Europe to Asia. The com- merce is large and the trip not more than three weeks, infection from this source. Europe has, however, taken Yet there has been little, if any, trouble in Europe with the precaution to establish an International Board of Health which has sanitary supervision over the Canal and guards this route very carefully'. I think the above fairly satisfactory reasons why yel- low fever in the past has not spread to Asia. It is inter- esting here to note the fact that tlie yellow fever zone had greatly decreased before we knew that it was transmitted * In one isolated in-stance (1883), yellow fever was imported into San Francisco, but did not spread. In 1897, 1898, 1902 and 1903, vessels coming from South American ports infected with yellow fever, or on which cases had had developed, died or convalesced, were detained at the San Francisco Quarantine Station, but no new cases developed while the ships were in the harbor. For full particulars, see detailed account under "California," in another part of this volume. G. A. fl ASIA. 139 by the mosquito, and before any general measures of any kind were taken for its extinction. It extended most widely about the beginning of the nineteenth century. At this time, Philadelphia, New York, Boston, Baltimore and Charleston were all liable to yellow fever and had fre- quent epidemics. From this time it has become less and less frequent on the Atlantic Seaboard of the United States and in the United States itself. At present, I do not think the stegomyia is found fartlier north than Nor- folk, and she proba]>ly had the same habitat a hundred years ago, and it is hard to understand how New Yorli and Philadelphia could have ever had yellow fever. But the probable explanation is that before they had water supplies they used Avells and cisterns generally as a means of storing water and thus had excellent means of breeding stegomyia. Sailing vessels frequently came in with num- bers of stegomyia aboard. When these arrived in the summer time, the ships continued to breed mosquitoes for weeks at a time while they were tied up to the wharves. Many of these mosquitoes wandered otf to the neighboring houses where they fouud ready means of breeding, and thus, in a few weeks, the town became well stocked with stegomyia. Quarantines were very lax and a case would be introduced from an infected ship and find a good ground for spreading the disease" through the city. As the cold weather came on all the stegomyia would be killed, but in some other year the same thing would occur over again. At present in Philadelphia thev have no tanks or cisterns and very few places where the stegomyia would breed, but communication with ports where stegomyia breed is almost altogether through steamers which are not likely to bring many stegomyia, and she has a good quarantine which stops the large majority of yellow fever cases. These are the causes, I think, that have led to the contraction of tlie zone of yellow fever. The samie statements would apply to Spain and Eng- land. They are not countries where the stegomyia breed, and these mosquitoes couhl only flourish there when in- troduced during the summer time, and when the condi- 140 HISTORY OF YELLOW FEVER. tions as to water receptacles were favorable to their breed- inu,* In our Southern Gulf States the stegomyia has its natural ha]>itat. The weather duriniLi' the winter is not sufficiently cold to kill otf all tlie adults, so that we are still liable to an occasional epidemic when the disease is introduced from the neij^^hborinj^' West Indian ports. But even in these localities the winters are so cold that the mosquito becomes dormant and yellow fever disajjpears, even no sanitary measures are taken. As we go farther south and get into the tropics we find that the stegomyia breeds as well, as far as temperature is concerned, in one season as in another, and Aaries principally according to rain fall, or conditions that give more or less numerous breeding places. Now let us consider a moment the distribution of yel- low fever at the present time and the possibility of its transmission to Asia. It is at present in Cuba, ^Mexico, Central America, and on the east and west coast of South America. At present I do not think there is any direct communication between an infected port and Asia. The West Indies and the eastern coast of South America ex- change their wealth with the wealth of Asia principally through the European ports, and Guayaquil, which is the only infected port of auj- consequence on the west coast, carries on whatever commerce she has with Asia through San Francisco. In Southern Asia and the Philippines the stegomyia is a very common mosquito. The population in China and India is very dense and non-immune; the Cliinaman and Coolie being just as liable to yellow fever as tlie European, and as far as we can see, it will only require the introduc- tion of a case of yellow fever to cause a very devastating e])idemic, wliich, in the state of civilization existing in Asia, would be entirely unconti'ollaltlc. If the Canal were opened to-morrow I do not think the chances of carrying j-ellow fever to Asia would be one whit increased over what they are to-day. At the present * According to Theobald (Monograph of the Culicidae of the World, published in 1891), stegomyia have been found in Spain. G. A. ASIA. 141 time sucli danger is very remote. It is only a possibility. On the Pacific side we have only one infected port, Guaya- quil. It is within the bounds of possibility^ for a steamer, to sail directly from Guayaquil to an Asiatic port, be- come infected at the time of leaving Guayaquil, continue the infection h\ means of a succession of cases during the two months it would take her to reach an Asiatic port and implant the infection at such port. But it is extremely improbable. If a weekly steamer sailed from Guayaquil to a tropical Asiatic port the probabilities would be in- creased. The chances of a ship remaining infected for two months are snmll. Take, for instance, the relations between Cuba and Spain. For the twenty years befoi'e the Auun-ican occupation of Cuba frequent steamers sailed from Havana to the ports of Spain. They were crowded with i)assengers, civil and military. Havana, during these years, always had yellow fever, summer and winter. Spain, as previous history has shown, Avas capable of be- coming infected. But such intimate commerce ccmld go on for twenty years without establishing yellow fever in the country. Small local epidemics have been established two or three times in Spain by this commerce since the in- troduction of the steamship. But it is rare. Now if the time of transit were made eight weeks, instead of two, the probabilities of carrying the disease would be greatly de- creased. I think that if such had been the case, Europe would have remained as free from yellow fever as has Asia. The Commission which was appointed by the United States to examine and report upon routes across the Isthmus, and which finally recommended the Panama route, discussed at considerable length as to what would be the probable amount of ccnimerce through the Canal and as to where it would conu^ from. They (juote the commerce of the great canals of the world at present in operation and its rate of increase yearly from the open- ing of these canals. From this data they conclude that ten millions tons per year, will be a large touage for the first ten years. Assuming that commerce will always follow the short- est and quickest routes between two points, they show 142 HISTORY OK VELLOW FEVER. that almost all European ports are nearer Asiatic ports via the Suez Canal than via the I'anania Canal, and that, therefore, l*anama will get very little trade from Europe. They conclude that the traffic through the Suez Canal will not be interfered with by the Panama Canal; that this traffic will come principally from the United States; some from the West Indies and South America and a very little from England. Accepting this as a basis for discus- sion, we see, that, if yellow fever infection is distributed, at the time of the opening of the Canal, as it is at present, ships passing through the Canal and going to Asia from Vera Cruz, Havana and Rio de Janeiro, would be the only ones which could possibly carry infection. A half a dozen ships a year Avould be a large average for these ports. The other ports at present infected will probably never send a ship through the Canal to Asia. How will the opening of the Panama Canal affect the chances of this introduction? It will, no doubt, increase somewhat the commerce between infected ports and Asia, and vastly increase the commerce between Xorth America and Europe, on the one hand, with Asia on the other. Ships in passing through the Canal will touch at Panama and Colon and be some twelve or fifteen hours crossing the Isthmus. If this territory is infected with yellow fever at this time it will greatly increase the chances of some of these numerous vessels becoming infected, and therefore, the possibility of yellow fever spreading to Asia. If we could bring about such conditions, therefore, that no vessel in passing through the Isthmus would be liable to become infected witli yellow fever, and so that no ves- sel from an infected port would be alloAved to go through the Canal, with am' possibility of her carrying infection, Asia would be no more liable to get yellow fever from us than she is at present. To bring this happy condition about, we would have to keep the Isthmus itself free from yellow fever, and to guarantee, by means of rigid quarantines, that no infect- ed vessel ])assed through the Canal. Both these things are p(;ssible of acc(;m])lishment. 31odern sanitary meas- ures liJive demonstrated the fact that even in the tropics it is possible to rid a locality of yellow fever and keep it ASIA. 143 free. This has already been done at Panama. It has been over a jear since a case of yellow fever has occurred in the city of Panama, and only one case has occurred on the Isthmus in the year 190G. There is a much larger non- immune population on the Isthmus at present that was ever here before, and that probably ever will be here after the construction of the Canal, The same system of quarantine that has kept yellow fever for the past three years from being introduced by shipping from the neighboring infected ports, into the Zone, Avill also in the future prevent an infected ship from passing through the Canal. Whether the Panama Canal, when completed, will be a menace to the health of Asia all depends upon the effi- ciency of the government which controls the Zone through which it passes. If the Zone remains an endemic focus, as in years past, the probabilities of transmittina- yellow fever to Asia, by the largely increased direct traffic, will be augmented. If the Zone is kept free from yellow fever, and the last three years of sanitary work by the United States Government at Panama has shown that this is entirely possible, then the liability of the introduction of yellow fever into Asia will not be at all increased by the opening of the Canal. SYRIA. Geographical and Historical. Syria forms part of Asiatic Turkey, south aud south- east of Arabia aud borders ou the Mcditerraueau. It has a popuhitiou of about 1,500,000, aud area of about 70,000 square miles. In ancient times, Syria formed a part of the Byzautine Empire, aud was successively conquered by the Persians, the Greeks and the Komans, Siuce then, its political history has been varied and sensational. It was taken hy the Arabs in 63G A. D,, by the Sedjuk Turks in 1078, by the Crusaders, by the Mamelukes and by the Ottoman Turks, who added it to their empire in 1517. In 1833, it was couipiered by Mehemet Ali aud annexed to Egypt, but was restored to Turkcn- in 1810 by the interven- tion of the great powers of Europe. Bethlehem, the birth- place of our Savior, is located in Syria. Alleged Oiitbrcah of Yellow Fever in 1800. Yellow fever has never invaded Asia, so far as history informs us. The probability of the disease being carried to the Ancient Continent is ably and compveheusiveh' dis- cussed by Col. Gorgas in the preceding Chapter. We do not believe that the incident related below was an out- break of yellow fever, but gi\e it a i)lace in this volume to complete our rec]ace and the atmosphere. The wife of General Kochler, commandant of the Eng- lish forces, was the first to be stricken with the disease after the artificers had been attacked, and died' on the seventh day. The general, who had faithfully nursed his consort during her illness, also contracted the disease. He died on the third day after being taken ill. The disease caused much mortality among the soldiers. In the months of November and December it subsided and was replaced by the i)lague, Avhiih was brought into Egy])t by the invading armies and raged with unusual violence in that already much afflicted country. It is to be regTetted that Dr. Larrey could not collect 146 HISTORY OF VE. LOW FEVER. irioio oircumstantial details relative to this outbreak, os- Ijecially as reoards the ])atliolovest coa»t of Africa, south of tlie Cougo Free State. It consists of four dis- tricts — Cougo, Loauda, Beuguela and Mossamedos. An- gola was for a long time the radiating point of the slave- trade. Capital, St. Paul de Loanda. YELLOW FEVER YEARS. 1860 ; 18(32 ; 18C3 ; 1SC5. SUMMARY OF EPIDEMICS. 18C0. Although the coast of Angola was discovere] h\ the Portugese in 148(1 and colonized soon after, we find no mention of yellow fever having prevailed in that locality previous to 18(50. As Angola was the most active centre of the slave-trade in the past, there is no douht that the dis- ease was iin]»oi't(. It was brought that year from Angola to Grand Bassam \{\. v.). 1805. The year 1805 furnishes the last record of jellow fever in Angola. According to IMackay (cited by Berenger- Feraud, page 111), it was quite severe at St Paul de Loanda. ASCENSION ISLAND. Description. The Island of Ascension is a mere speck near the middle of the South Atlantic Ocean, about 750 miles northwest of the historic Island of St. Helena, and belongs to Great Britain, It is only 36 miles in circumference;, 8 miles at its widest part, is of volcanic origin, and is chiefly cele- brated for its turtle, which are the finest in the world. The capital, George Town, located on the west side, has a population of about 150, and is governed under the admir- alty by a naval officer. The total jjopulation of the colony is about 400. YELLOW FEVER YEARS. 1818; 1823; 1838; 1847; 1859; 1873. SUMMARY OF EPIDEMICS. 1818. According to the Second Report on Quarantine,^ page 197, a fever called "bilious remittent," but which was, no doubt, yellow fever, prevailed on the Island of Ascension in 1818. The fever attacked "every man on the island," but the mortality was small. In the journal kept by Mr. Robert ^Falcolm, who was stationed at George Town in 1818, api)ears the history of a case of the disease, which commenced on the first day of June and '^as terminated by death the next day, "with all the symptoms of yellow fuffusion and black vomit," The fever was, no doubt, imported from America by * Second Report on Quarantine : Yellow Fever, with Appen- dixes, by the General Board of Health; Presented to Both Houses of Parliament by Command of Her Majesty. London, 1852. The First Report is a general treatise on epidemic disease's; the Second Report deals principally with yellow fever. ASCENSION ISLAND. 1'5S some of the many trading ships v^hich stopped at Ascen- sion on their way to African ports, but the framers of the "Second Eeport'- vehemeutl}' deny this, claiming that the fever was engendered "b^^ an unusually wet turtle season, when the men are much exposed by watching at night to turn these animals." This explanation seems amusing and absurd when viewed in the light of our present knowledge of the trans- mission of yellow fever, but the statement was undoubted- ly acceiJted as gospel truth by the learned men of the period. It must also be remembered that the "Second Re- port" was written under direction of the British Govern- ment, and as England's merchant marine dotted the seas at that time, the interests of her vast commerce demanded that the theory of importation be tabooed and ridiculed, even at the sacrifice of truth. According to an old saying of the ante-bellum Louisiana negro, Ravct pa (jdif/niii raiso)i divan poulij- and the astute and narrow-minded compilers of this "Report" resort to all sorts of ingenious metaphors in their attempt to refute every proved instance of importation of ^'cllow fever, twisting facts with amaz- ing cold-l)loodeduess and striving with every fiber of their prejudiced minds to prove that everybody but themselves are falsifiers. We regret not l)eing able to give a detailed account of this outbreak, the first on record in tlie epidemiological history of Ascension. Even our old reliable friend, Ber- enger-Feraud, disposes of the subject >vitli barely two lines, referring the reader to the unsatisfactory account con- tained in the "Second Report on Quarantine," which, as we have seen, is historicall}^ incomp>( to. An Heirloom in the Annals of Medicine. — 77/ r Case of the ''Bann." In 1823, the diminutive islet of As^cension, whi
  • nitu(le of a cont ?i(Mit in tli'.* iiiiagiiia- (ion of the lioar.v-headed cln-oiiielM's wlio cjiteied to public opinion in tlie heiiinninu of the last centurv. Tlii.s anomal- ous state of tliinjis was broui»ht about by an oecurrence wliieli led the medical men of the period into a renewal of the aci'imonious and endless controversies concerning the contaiiiousuess or non-contagiousness of yellow fever — a war of words which had been waged with more or less fierceness since 1793, and which furnished material for dis- cussion in tlie lay and medical press for fifty years after- ward.^. This noteworthy event ^\as the arrival, on April 25, 1823, of the British sloop lianii in the harbor of George Town, the lava-fringed capital of the Islai.d. The case of the Bunn is an heirloom in the annals of epidemiology. To publish all that has been said, dis- cussed and written about this "celebrated case," would take, at least, half a dozen volumes of several hundred pages each-; so we will merely confine ourselves to a recital of the incidents wliich led to the infection of the Island of Ascension, as abstracted from the report of Sir William Burnett, in his comprehensive work published in 1819.^ Owing to the universal interest which was evinced in the case of the Baun during the last c.'ntury, we have seen fit to go into details which will d(5ubtless seem unimi)or- tant — and, iiiaylia]), tirescjuu^ — to the lay nader, but which are absolutely essential to a faithful narration of the historic event. The Bi'itish sbjop Batiu a;ichor(Ml in the Sierra Leone river, AVtst Africa, on the 11th of J^niuary, 1823, after having cruiscMl in the Bight of Benin. She remained at Sierra Leone until the 25th of ^larcli, part of her crew be- ing employed in her tender, the Kmi RuphdiL The men were greatly (\\]»osed in refitting Ihe i-igging of both ves- sels, and the schooner having been sent up the river to Bounce Island to have her bottom repaired, she was there laid on the beach, and the men ex])os(Hl (in shore in one of the raost unheal tliy s])ots in the colony. On the 1st of Mardi, Mr. Higgon was seized with fever while on the t<ek. On the -Slst there was a case of more sT'vcritv, the patient having been on the sick list for nine- teen days. On the 3rd of April, there were four attacks. These, with one exception, were all slight cases. On the 7th of A])i'il, eleven days after the Ha mi left Sierra Leone, there was a severe case, which terminated fatally on the 12th. I-'rom this time the disease assumed a greater de- gr(M' of malignity and tlie (b atlis IxM-ame more frcipient. Only one of the cases which occurred about this period is detailed in the surgeon's journal. The patient was at- t;\cked on tbe 11th, but ba 15 men out of (50 within a period (»f 40 days. But, to the credit of the astute disputants of the period, the Waterwitch was never accused (^f liaving brought the pest to Ascension, 1847. Importation J)i/ tJic "'Edaii'.'" Eiglit years elapsed without a single case of yellow fever being noticed at Ascension, but an epidemic was nar- rowly averted in the beginning of 1847, when tAVO cases developed on board the British ship Rosumo)id, formerly the Eclair, which vessel had played such a sensational role in the transmission of yellow fever to Boa Vista, Cape Verd Islands, in 1845, and to Woolwich, England, the following year (1840). The history of the inception and progress of the disease on board the Eclair is interesting. To avoid repetition, we refer the reader to the compre- hensive account given elsewhere in this volume of the memorable ei)idemic which devastated Boa Vista in 1845.'' The facts of the outbreak of 1847 are as follow? : From the account given by the i^ecoud Report on Quar- antine, page J)8, the Eclair was completely overhauled and fitted out anew at ^Voohvich. where she was commissioned for the Cape of (Jood lloi)e on November 5, 184G, under the new name of Rosamond, as the old name was looked upon as a "hoodoo." It is of record that during the time of fitting out, four cases of typlius fcember 27 several new cases occurred and the ship sailed for the Island of Ascen- sion. In neither of the above instances was the disease communicated to the inhabitants of Ascension. 1873. The Case rjf the '-'Amethyst:' For fourteen years, Ascension had a respite from yellow fever, and would have enjoyed innnunity to this day, had not importation again threatened tc kindle anew the dor- mant tires of i)estilence. It does not ai)peai' that any cases of yellow fever were observed among (he British war ves- sels or the land forces in the vicinity of the Island, yet the ship Amethj/st is accused of having brought the fever to Ascension from Cape Coast, Africa. ASCENSION ISLAND. 161 This war steamer, accordiut'- to Smart,^ was despatched from the coast with a large number of invalids, many of whom were from Elmina. After five days at sea, she reached Ascension on the 20th of December, and landed her invalids. Among these there was a case of continued fever with great nervous tremor^ who died on the seventh day after landing. Another case was moribund when sent ashore, dying in thirty-six hours. The symptoms were great anxiety, intense headache yvitli deafness, epigastric pains, dry red cylindrical tongue rapid pulse and respira- tion, injected eyes, a yellow surface, ecchymosed as deatli approached, relaxed boAvels, vomiting of dark tar-like fluid, and suppression of urine — symptoms closely allied to those of yellow fever. On the third day after being landed, one of the invalids, after a few hours of slight discomfort, fell down almost lifeless, and vomited and purged at the same moment a dark tar-like fluid mixed with pure blood; the features were deathlike, the surface cold and of a dii'ty yellow color, pulse scarcely perceptible, respiration slow and sighing. Under treatment by stimulants, with opiates, he rallied, vomiting ceasing after a few hours, when a typhous state supervened, lasting to the end of the second day, after which he convalesced. Another case was similarly attacked on the fourth day after landing, went through an analogous course of symp- toms, convalescing from the end of the following day. The train of symptoms and events in the above cases, according to Dr. Smart, were sufficiently diagnostic of severe bilious remittent fever of the English nosology, and of the gastroenteric type of algide pernicious fever of the French nosology; from which tlie Doctor infers that the disease carried from Cape Coast to Ascension in the Amethyst was of the remittent, and not of the yellow fever type. Be that as it may, we think the cases sufficiently diagnostic of yellow fever to class them as such and place this outbreak amonff our records. 'Smart: Transactions Epidemiological Society of London, vol. 3, p. 508. BANANA ISLANDS. Description. The Banana Islands are a i»roiip of small islands off the coast of Sierra Leone, Africa. They are seldom visited by white men, which no doubt accounts for the fact that only a single outbreak of yellow fever is recorded as having taken place there. . YELLOW FEVER YEAR. 1847. SUMMARY OF EPIDEMIC. Our authority^ does not give the Kjurce of infection, but relates the folhnving facts :' On the 2Gth of eTuly, 1847, the British brig ^ijren detached a party of three officers and twenty seven men to the Banana Isla*jds, for the purf)ose of blockading the Sherbo River. On August 14, a case of fever occurred, and, sul)sequently, scattered cases ap- peared till September 20tli, when the blockade was aban- doned. The first cases were said to be of a purely endemi- cal character. The disease then assumed a worse form, until it merged into yellow fever, witli its characteristic symptom, black vomit. The number of cases and deaths is not oiven.^ *Bryson: British and Foreign Medico-Chirurgical Review, 1849, vol. 4, p. 470, ° This is unfortunately the case in about every account of yellow fever in Africa. BENIN. Description. Benin i« a nei>To kingdom of West Africa, in Upper Guinea, on the Bight of Benin, extending along the coast on both sides of the Benin Biver, west of the Lower Niger, and some distance inland. It Jias no political unity and has no commercial importance. Benin, the principal town, has a population of about 15,000. In the days gone by, it was the great slave emporium of the district. The religion is fetichism. Human sacritices are numerous and cruelty, in its most atrocious forms, is characteristic of the people. YELLOW FEVER YEARS. 1520; 1553; 1558; 158S; 1828; 1852; 1853; 1851; 1855; 1850; 1857; 1862; 1873. SUMMARY OF EPIDEMICS. 1520. Berenger-Feraud/^ quoting Valkanaer,^^ gives an ac- count of an epidemic, said to be yellow fever, which at- tacked the crews of the Portugese explorers in the Gulf of Benin in 1520. No information as to the origin of the dis- ease is given. 1553. In August, 1553, an Englishman named Windham and a Portugese, Antoine Pinteado sailed from Plymouth, England, for the West Coast of Africa, to exi)lore and colonize the country. The ex])edit^*on consisted of two ships, manned by a crew of 140 men. Shortly after reach- ing the Gulf of Benin, the vessels were attacked by a malig- nant fever, which proved so fatal that it was found neces- " Berenger-Feraud : Traite Theorique et Pratique de la Fievre Jaune (Paris, 1890), p. 27. "Vol. 1, p. 370. IGi HISTORY OF YELLOW FEVER. sary to bni-ii the ships, there uot being enough men left to man them. Only 39 of these adventurers returned to Plymouth, making a death-rate of 70 per cent. This "malignant fever" is said to have been yellow fever, but how, where and by what means the infeoticn was contract- ed, oui source of information^- does not say. As AVind- ham's vessels originally sailed from a port where fever has never prevailed de novo, communication Avas evidently had with some of the slcive-ships which then did quite an ex- tensive business between Africa and Cuba^ Alexico and t^outh America — for even at that early period the Span- iards stole negroes by the thousands to work their planta- tions in the New World — and the sturdy sons of a north- ern clime proved easily susceptible to the bites of the stegomyia. 1558. In 1558, an explorer named Torwson and his compani- ons were stricken with yellow fever while in the Gulf of Benin. ^'^ The data as to this outbreak are very meagre. 1588. Bird and Xewton,^^ intrepid voyagers in search of ad- venture and wealth, and their companions are said to have experienced vellow fever while in the Gulf of Benin in 1588. 1828. From 1588 to 1828, a period of two hundred and forty years, there is no record of any yellow fever outbreak in the (iulf of l^enin. This seems almost incredible, but even such a careful observer as Berenger-Feraud has failed to find any data for these "silent years." In 1828, however, the disease broke out afresh,^'* being imported from Sierra Leone by the ship La JionJclaisr, and ravaged all the coast *owns from the Gulf of Benin to Gambia. ^- Gazette des Hopitaux, Paris, vol. 57, p. 661. "Berenger-Feraud, loc. cit., p. 27. •■■ Berenger-Feraud, loc. cit. p. 27. '=* Berenger-Feraud, loc. cit., p. 105. I BENIN. 165 1852 to 1857. After an iiiterral of twenty-four years, yellow fever was ao-ain imported to the Gulf of Benin in 1852 nnd cases occurred sporadically^ every year from that date until 1857. Our authority^^ does not give any details. 1862. In 18G2, yellow fever was imported to Benin and other countries on the West Coast of Africa (presumably from Havana or South America) by some of the nondescript craft engaged in the slave-ti'ade between Africa and the Spanish-American countries. Early in ^lay, the fever l)roke out among the natives huddled in the towns and liaudets located along the banks of the Bonny T?iver, and spread ra])idly to the officers and white porti( i«s of the crews of the palm-oil vessels in the river. The contagion then successively attacked the crews of vessels lying at anchor in the numerous rivers flowing into the Gulf of Biaffra/" more especially tlie Okl and New Calabar and Brass rivers. It was particularly fatal at Bonny, then a notorious slave-mart, where it mowed down natives and Europeans alike. The epidemic, although of a vicious and generally fatal type, was of short duration, disappear- ing from all the rivers and bordering villages by the end of June. The source of this epidemic has never been clearly estab- lished. That section of Africa was then one of tlie most active centres of the slave trade and, although British war vessels blockaded the coast and were on the lookout for slave-traders, the high rate of speed possessed by the ves- sels engaged in this nefarious trade and the thorough knowledge the marauders had of the many inlels where they could find a safe hiding place Avhen the scout-ships were sighted, enabled them to navigate the mar.y rivers of that section almost unmolested. As most of these slave- ships came from Cuba or South America, where yellow '" Berenger-Feraiid, loc. cit., p. 122. " Statistical Report of the Healtli of the Navy for the Year 1862 (London, 1865), p. 157. 166 HISTORY OF YELLOW FEVER. fever reigns at almost any season of the 3'ear, the yellow fever mosquitoes could easily be imported. The only mat- ter of surprise is that tlie disease has not been more fre- quently propagated by these vessels. 1873. In 1873, yellow fever was imported to the island of Sal, one of the Cape Verds, from Brazil, and tl'ence to Benin. Small vessels, laden with grain from South Ameri- ca were then in the habit of first stopping at tlie Cape Verd Islands on their way to West Africa, and as yellow fever has been epidemic in Brazil almost every 3-ear since 1819, this visitation can surely be attributed to importa- tion from that country. The first knowledge at Cape Coast Castle of the pres- ence of yellow fever in the Bights was late in November, on the arrival of the mail packet Anihri::, having the dis- ease among her crew.^^ The vessel was at once quaran- tined, her mails being put on board the Biafra and both vessels steamed off. The Amhriz lost thirteen of her crew before she reached the Cape Verds, and the Biafra six. From the meagre report furnished, this outbreak does not appear to have been either extensive or attended with much mortality. BOA VISTA. (See Cape Verd Inlands.) " Smart: Trans. Epidemiological Society of London, vol. 3, p. 507. BONNY. Description. Bonny is a town of West Africa, on the Bonny Eiver. Jt is surrounded by a pestilential swamp and is inhabited by degraded savages. It does a good exporting business in palm oil. It was once the most notorious slave-port in Africa. YELLOW FEVER YEARS. 1862; 1891. SUMMARY OP EPIDEMICS. 1802. The epidemic of 1862 almost deciminated Bonny and was as fatal among the blacks as among the few white settlers of the colony. The fever was originally intro- duced by some of the trading vessels plying between Bonny and the Cape Verd Islands. Two-thirds of the inhabitants of Bonny are said to have perished. Out of a population of 140 Europeans, 70 were attacked in the space of a month. In one day, as many as twenty bodies were taken out of the same house. The mortality in the shipping was heavy. The bark PhrcnoJof/ist lost its captain, pilot, first mate and two sailors. The ship G^ra*i Bonny lost four men. Between April 4 and ^May 5, there were 62 deaths among the crews of vessels at Bonny. ^^ "Landa: La Espana Medica, 1863, vol. 8, p. 427; also: Statisti- cal Report of the Health of the Navy for the Year 1862 (London, 1865), p. 157. 168 HISTORY OF YELLOW FEVER. 1891. The second recorded outbreak of yellow fever at Bonny occurred in 1891. The epidemic histed from February to April. -^ Cases and deaths are not given. As this is the only locality in Africa where the fever prevailed in 1891, it was probably imported from that prolific source of in- fection — Brazil. A glance at the consular reports and re- ports of quarantine officers published in the Weeklt/ Ab- stracts of Sanitarij Reports for 1891, brings out the fact that almost every vessel reported as "infected with yellow fever'- during that year originally sailed either from Bahia, Eio de Janeiro, Santos, Para, Pernambuco, or other in- fected Brazilian i^orts. It is surprising that, owing to the lax quarantine methods then in vogue in Africa, that tlie whole coast was not infected. An explanation will no doubt be found in the absence of the festive Calopus from the localities which escaped a visitation. =» Weekly Abstracts of Sanitary Reports, U. S. P. H. & M. H. S., 1891, vol. 6, p.p. 266, 298. 4 BULAM. Description. Biilani or Boullam (now called Biilam or Bolama), is one of the Bisagos, a group of about thirty islands near the west coast of Africa, opposite the mouth of the Rio Grande, between lat. 10° and 12° N. The largest of the archipelago, Orango, is about 25 miles in length, and most of the islets are inhabited by a rude negro race, with whom some desultory trade is carried on. Most of the islands are under native chiefs, nonunally vassals of Portugal. At Bulama, once a British settlement, but abandoned as unhealthy in 1793, there is a Portuguese town, a thriving) and pleasant x)lace, the seat of government for the I'ortu- guese possessions in this quartero The, earliest description of Bulam is given b}' the Che- valier de Marchais, in Father Labat's Voyages du Cheva- lier de Marchais en Quince ct au.x Ties Voisincs. vol. 1, p. 68, of which the following is a translation : ''The bed of that river (Sierra Leone) contains a quantity of islands, densely wooded; the soil is rich and produces all that is necessary to life. The air is very jjure and one is not sub- ject to those violent and dangerous diseases which prevail on the Coast of Guinea and which are so fatal to Euro- peans." , Dr. Lind, in his Diseases of Hot Climates^ ]}. 5G, also speaks favorably of these islands. According to Chisolm,-^ the most correct description of the Island of Bulam can l)e found in the African Plot, a paper published by Capt. Norris in 1796 (or thereabouts), in which it is stated that "Boullam" is located in "latitude 11° N. and longitude 3° W. from Farro, almost in the moutli of the Rio Grande, having Hen Island between it and tlie ocean. It appears to be nearly circular, about 15 miles long and 15 broad; and, consequently^ about 45 round." -'An Essay on the Malignant Pestilential Fever introduced into the West India Islands from Boullam, etc., by C. Chisolm (1799), p. 85. 170 HISTORY OF ^TEXtOW *>eVE«. YELLOW FEVER YEAR. 1792. . A VENERABLE MEDICAL HEIRLOOM. The alleoecl importation of 3'ellow fever by the British ship Hankcij from Biihuii to the ishind of Greuada, West Indies, in 1793, is one of the mustiest heirlooms in the annals of medical history. Tooethcr with the case of the Bann (Island of Ascension, 1823) and that of the Eclair (Boa Vista, 1815-6), it forms a triumvirate which, for nearly a century, was the cause of most acrimonious con- flicts between medical men and gave rise to controversies which remain unsettled to this day. The believers in the specific nature of yellow fever, headed by Sir William Pym, and the "other side,-' composed of men who upheld the theory that the disease should be placed in the same category as malarious fevers, wrote books and brochures by the score and burdened the columns of the medical press of the i)eriod with articles which are brimful with personalities of the most volcanic type. When, through sheer exhaustion, partisans abandoned the fray, fresh re- cruits would take up the gauntlet and, imbued with seem- inglv ii'repressible liatred, would '"sail in" with fiendish fury and renew hostilities, scattering vituperation right and left, without the least regard for age, official position or facts. A specimen of this mode of warfare will prove interest- ing. According to the British and Foreign Medico-Chir- urgical Rcrieu-f- we find Sir William Pym stating that Sir William Burnett and Dr. Bryson, his antagonists, ''have gone unnecessarily and wantonly out of their way, to make unfounded and malicious statements," and giving utterance to a pious wish that these gentlemen may profit by the information he has given them, and may "pray for- giveness for their inconsistencies and misrepresentations." He informs us that lie has been induced to take up the gauntlet again, by the "wanton, false, abusive, and un- founded attack" made by Sir William Burnett upon him =-Vol. 4, 1849, p. 459. BULAM. 171 in reference to the Eclair. On the other side, Dr. Bryson accuses Sir William Pjni of attacking him "in inost un- justifiable and unprofessional languai-e ;" of making use "of garbled and unfair extracts;" of ''disingenuously mix- ing up facts and statements in a confused manner, for the purpose of making out charges of inconsistency," and he regrets that Sir William Pyni's review of his "Heport of the Diseases of the African Station" "is written in a style which prevents his replying to it with the respect due to a man of Sir William Pym's age and position in society." Other equally amiable diatribes are of record, but we will pass them by and revert to the fossilized case under discussion. HOW bula:*! became famous. Up to 1792, Bulani was an unknown quantit3^ m the af- fairs of men. It is true that it occupied a ])lace in the charts of the bold, but cautious navigators of the time, but insofar as its climate and the people which inhabited it were concerned, it was as deep a mystei-y as the North Pole is to us at the present writing. How it suddenly sprang into world-wide prominence and ains- in the archipelago. On tlie admiral's flag-ship alone, 15 died. The fever is said to have been brought to the Canaries by Spanish vessels returning from San Domingo.'*^ IGOl. The year 1601 witnessed another outbreak of pestilential disease in the Canaries. Some chroniclers says it was the plague, but Berenger-Feraud^- is of the opinion that it was yellow fever. 1006. The Canaries were again afflicted in 1606. Opinions are divided as to whether this epidemic was yellow fever or the Oriental plague, but Berenger-Feraud thinks it was yellow fever."*^ 1701. For nearly one hundred years— 1606 to 1701 — the Canaries were free from yellow fever. No explanation of this extraordinary immunity for such a long period is given by historians, even our old stand-by, Berenger- Feraud, whose writings we always consult when ''up a tree," being as mum as the proverbial clam. Of course, we could venture an opinion, but as same could not be based upon even a scintilla of fact, it would be valueless. In 1701, yellow fever was c])idemic in Havana, Barba- does, Martini(pie and the English Antilles, and according to Arejula,^^ was brought from Havana to the Canaries, i\ " Berenger-Feraud, loc cit., p. 27. *- Berenger-Feraud, loc. cit., p. 38. " Berenger-Feraud, loc. cit., p. 38. ■"Arejula: Archives de Medecine Navale, Paris, Vv>l. 7, p. 251. CANARY ISLANDS. 18S where it caused a great mortality. As is the case with every meution of epidemics of yellow fever during colonial days, no details are given. In speaking of this outbreak, Berenger-Feraud informs us that elle fit dc grands ravagcs,^^ but says nothing of the number of victims nor of the extent of the disease. As will be seen b}^ consulting our Chronology, yellow fever was also present in Spain in 1701. 1771. Another prolonged lapse of time took place before yel- low fever again visited the Canaries In 1771, a vessel from the West Indies, where yellow fever prevailed, in- fected the islands.^*^. The outbreak was attended with much mortality. 1772. A Spanish regiment is said to have brought j-ellow fever from Havana to the Canaries in 1772. Though not as gen- eral as the year previous, the epidemic was quite severe.^"^ 1773. A mild epidemic of yellow fever prevaikd in the Cana- ries in 1773.^^ The source of infection couid not be ascer- tained. ISIO. The year 1810 witnessed another murderous eruption of yelh)w fever on the island of Teneriffe. The history of this outbreak is interesting, and goes to show how steadily and treacherous is the advent of this terrible disease. What makes the circumstance i-^till more remarkable, is the fact that tlie Canaries escaped un- scathed during the great epidemics which devastated Spain *" "It caused great mortality." "Berenger-Feraud, loc. cit., p. 55. " Berenger-Feraud, loc. cit., p. 55. •" Berenger-Feraud, loc. cit, p. 56. 184 HISTORY OK YELLOW FEVER, in 1800 and 1804 — an immunity wliicli one can only ascribe to Divine Providence, for communication between the islands and their Mother Country was free and fre- quent during- the above mentioned years. To Spain belongs the credit of having imported the fever to Teneriffe in 1810. The disease was almost general in Andalusia, causing much mortality in Cadiz, Barce- lona, Carthagena, Seville and (libra] tar. In the beginning of October of that year,'*^ a panto nc, or prison-ship, sailed from Cadiz with French prisoners on board and landed at Santa Cruz de Teneriffe. where the human cargo was disembarked and lodged in the town barracks. It is said that the prison-ship was a hot-bed of yellow fever, but this fact was withheld from the port authorities, and as the disease had not been observed on the island since 1773, they were lulled by a false sense of security. About the middle of October, the practitioners of Santa Cruz de Teneriffe noticed that there was an unusual number of cases of malignant bilious fever and the fact was reported to the health authorities. The warning was at first un- heeded, but the malady soon became so widesiiread, that an investigation was ordered and it was found by ex- perts — men who had already gone through epilemics of yellow fever — that the prevailing sickness presented the identical symptoms whicli had characterized tlie disor- ders of Andalusia in 1800 and 1801. The authorities awoke from their lethargy, but it was too late. The disease had spread indiscriminately to several quarters of the town and ])reventive measures were unable to ch^^ck its de- structive progress. To prevent the pestilence from being carried to the other towns of the island, a sanitary cordon was established around Santa Cruz de Teneriffe and intructions were sent to the other islands of the archi- pelago to take the necessary precautions to prevent the in- troduction of the fever. These jjrompt and rigid measures limited the epidemic to its original present, should not have been frequently ravaged by the scourge; but, with the exception of the islands of San lago and Boa Vista, the group has been remarkably free from tlie disease. YELLOW FEVER YEARS. 1510; 1511; 1512; 1513; 1514; 1515; 1639; 1807; 1821; 1822; 1827; 1837; 1838; 1845; 1847; 1862; 1864; 1868; 1873. 190 HISTORY OF YCLLOW FEVER. SUMMARY OP EPIDEMICS. 1510 to 1515. Berenger-Feraiid,®- quoting Yalkenaer (vol. 1, p. 370), says that yellow fever prevailed at the Cape Verd Islands from 1510 to 1511. No details as to how the disease was brought to the islands or the extent of the invasit>n, could be obtained. The mortality is said to have been consider- able on the vessels stopping at the archipelago during these years, on their way from Europe to the West Indies and vice-versa. 1639. One hundred and twenty-four years elapsed without yel low fever being noticed at the Cape Verd islands. In 1639, the Spanish fleet, on its way to Brazil, stopped at the islands and is said to have been contaminated by a pestil- ential disease, which carried off 3,000 soldiers. (Berenger- Feraud, p. 27.) The disease is said to have been yellow fever, but how it reached the Cape Verds, history does not informs us. It is worthy of note, however, that yellow fever made its initial appearance in Brazil in 1640 and it is plausible to incriminate the Cape Yerds in this out- break. According to Boudin, yellow fever prevailed in the island of Santiago in 1778. He gives the testimony of Dr. Bochard, surgeon of the French frigate Coitsolantc, who states that his ship stopped for a week at Santiago in the latter part of 1778. He was told by the inhabitants that they were just recovering fr(»m an invasion of yellow fever. AVhat gives additional creden e to this statement, is the fact that, a few days after leaving the island, yelloAV fever broke out on board the Consolante, resulting in the death of 150 seamen in the short space of five weeks.^^ "- Berenger-Feraud, loc. cit., p. 26. •"Boudin: Traite de Geographie et de Statistique Medicales des Maladies Endemiques, Paris, 1857; Cornilliac, La Fievre Jaune Dans le Antilles, 1886, p. 445. CAPE VERD ISLANDS. 191 The report does not state how and whence the disease came to Santiago, but as j^ellow fever was epidemic in Senegal, Sierra Leone, the Gold Coast and Gambia in 1778, we can safely incriminate Africa. 1821. From 1778 to 1821 the islands were free from epidemic disease. In 1821, according to M'Williams,'^"^ an outbreak of the fever took place, but was not attended with much mortality. 1822. In 1822, another mild outbreak took place.^^ No details are obtainable. 1827. YelloAv fever was imported to Santiago in 1827, pre- sumably by a ship from America. The mortality was very great. Among the victims were the British Consul and some of the members of his family. The American Consul, who was then just recovering from an attack of the fever, took charge of both consulates The British ship Tweed, which was on its way to the Cape of Good Hope Station, touched at San Jago and a part}^ of junior officers went on sliore. These were all attacked with fever and, with one exception, died. The Portugese troops were decemated.^^ 1833. There was a mild outbreak in 18n3.^" 1837. In 1837, yellow fever ravaged the whole coast of Guinea and was imported to the Cape Yerds,^^ where it caused mucli mortalitv. "Second Report on Quarantine (1852), p.. 110. " McWilliams : Second Report on Quarantine, p. 110. "*Ibid.; also: Lancet, London, 1848, vol. 1, p. 52. " Berenger-Feraud, p. 108. •^Ibid., p. 109. I 192 HISTORY OF YBLLOW FEVER. 18^5. The Famous Case of the "Eclair." The epidemic of 1845 fiiruislies the first iutelligent and coniprc^liensive report of yellow fever in the Cape Verd archipelago. This outbreak, Avhich was confined to the island of Boa Yista, was considered at the time the car- dinal point in the discussion of the contagiousiLess of yel- low fever. All the acrimony which had been smouldering broke out afresh and the honorable and dignified medical men airayed on both sides renewed the conflict with greater frenzy and venom. The controversy, -svhich had begun with the epidemic of Philadelphia in 1793, had bo])l>ed up again when the Spanish disorders of 1800-1804 took i)]ace, had been once wiuve rejuvenated by the Bann episode at Ascension in 1823, was gone all over again and made still wider the breach between the rabM contagionists and their opponents. As this is another cause cclchre in the annals of epi- demiology, we will give it generous s]>ace. The facts are as follows •.^'■^ On July 23, 1845, the British ship Eclair sailed from Sierra Leone, which seems to have been the natural source of infection during the last century, and reached Boa Vista in August of the same year. During; the voyage, 60 of the crew died of yellow fever. According to the testi- mony of Dr. Xavier de Almeida, who went to practice medicine in Boa Vista in 1809 and was the only resident j)hysician of the island for tliirty-eight years, yellow fever had not been seen in the vicinity for nearly fifty years pre- vious to the arrival of the Eclair. The disease was, there- fore, undeniably imported by the infected ship- While at Boa Vista the ofticers and crew of the Eclair mingled freely with the inhabitants and when the ship finally weighed anchor, she left the nucleus of the epi- demic in the towns of Eabil and Porto Sal Key. Of the three soldiers who constituted the guard at the fort when the vessel left the island, two, a corporal and a private, *" British and Foreign Medico-Chirurgical Review, 1848, vol. 2, p. 164. CAPE VERD ISLANDS. 193 were stricken Avitli tlie disea.se. Thev died on September 22d, after an illness of five or six days. The surviving private of this guard, being attacked Avitli a high fever some days after this, was removed, togetter Avith a sick comrade, to a small hut at Pao de VereUa. Here the stricken men were visited and nursed by a woman named Anna (lalinha, who also contracted the disease and died on the 10th of October. The scourge subsequently spread through the town and committed much havoc. The case of Louis Pathi, a laborer of Rabil, who was taken ill after having worked for two da^^s on board the Eclair is of pathetic interest, even at this late date, sixty- three years after the occurrence. We quote the following from the report of Dr. ^McWilliams, who was sent by the Bi'itish Government to investigate the origin and cause of the epidemic '?'^ Tcsiiiiioiiij of Louis Pathi. il. llow long were you employed on bonrd the Eclair? A. About eight days. <}. AVhat family have 3'ou? A. 1 have none left. Q. What family had you? A. I had a wife and three children. Q. Did they all die of fever? A. Yes, all of them. (i. AVere you attacked? A. Yes; I was first attacked. (^ When were you attacked? A. Three days after I went to Rabil from the ship. Q. You were with vour family wlien you were taken sick? A. No ; I was at Moradinha. Q. How long did you stay at Moradinha? A. I was there eight days, sick. Q. What did you complain of? A. I had general fever, headache, pain of back and limbs ; very sick. "Report on the Fever at Boa Vista, by J. O. McWilliam, Lon- don, 1847. * 194 HISTORY OF YELLOW FEVER. Q. How long were you sick after returu to your owd house? A. Kearl}^ three weeks. Q. Who, after yourself, was first takeu ill? A. My daughter, 12 years of age. Q. How long after your return from the Eclair? A. It was in the beginning of October. Q. AYho Avas next attacked? A. Another girl, 7 years of age, four days after the first died. Q. AVho was next? A. My boy, 11 years of age. He was taken ill eiglit days after the second girl died. Q. And your wife last? A. Yes ; my wife was taken ill the same day as the last of the children died. A melancholy sequel to the above happened in the home of iNlanoel Fachina, who lived next door to Pathi and who, together with his wife, nursed the stricken family. After the death of Pathi's wife, the Fachinas were taken sick with the fever, but recovered. Their child caught the dis- ease and died in three days. We find the Eclair again playing tbe role of importa- tionisf in 181(1 After the melancholy experience she had undergone in 1815, the ship was sent to the navy-yard at Plymouth, England, where she Avas thoroughly cleaned and repainted and given the name of Kosamond.^^ She was put in commission and left England for the Cape of Good Hope in Februar}-, 181G. 1817. Yellow fever is said to have prevailed at the Cape Verds in 1817, but whether it was a recrudoscence of the previ- ous visitation or a new importation, our source of informa- " For fuller details, see notice of epidemic at Island of Ascen- sion in 1846, page 152 of this volume. 1 I CAPE VERD ISLANDS. 195 tion'^^ does not say. It is claimed that the British ship Grotcltr was contamiuated at the Cape Verds and brought the disease to Barbadoes. 1862. 18G2 was a disastrous yellow fever year in Africa. Al- most the entire coast, from Senegal to St. Paul de Loanda and the Cape Verd and Canary Islands, suffered from the disease.^^ The outbreak was not verv severe at tlie Cape Verds. 1864. The Cape Verds were again invaded in 1864,'^^ but no details are obtainable. 18G8. In 1868, yellow fever was imported to the Cape Verds from French colonies of the West Coast of Africa, Goree and Senegal, and made its first appearance in Bissam.''^^ The epidemic was most severe in the city of Praia, in the island of Santiago. Commencing in the middle of July, 1868, the disease spread with such rapidity that a very large proportion of the European inhabitants became suc- cessively or simultaneously affected, so much so, that dur- ing the month of August there were received into the Military Hospital at Misericordia no less than 285 cases, of which, by September 1, 41 had proved fatal. During the month of October, there was a considerable decline of the epidemic, the affected persons being those who came from the interior of the island of Santiago or other points. The disease, however, spread to the island of Braza. one of the first victims being the medical officer, Theophilio .Toa(|uim Vieiria. There were also ,^oine cases in individuals who had fled from the city of Praia to other " Berenger-Feraud, p. 118. " Ibid., p. 139. "Ibid., p. 141. " Medical Times and Gazette, London, 1869, vol. 1, p. 119. 196 HISTORY OF YELLOW FKVKR. points of the island of Santiago. Nearly the whole med- ical stall' stationed on the island suffered, Senor Pimenta, of the Pharinaceutical Branch, succumbing from the disease. 1873. In 1873, yellow fever was imported to the Cape Verds, presumably from Brazil.^'"' The invasion vras confined to the island of Sal, where the fever ran a mild cour,ion of yellow fever in the Cape Verd archipelago after 1873. The geiieral use of steam-power and the strict attenth)n given ta ventila- tion and hygiene in the construction of vessels at present, has done much to destroy the breeding places of the mos- quitoes in the holds of sea-going craft and thus given a quietus to the importation of the saff'ron pcstilenie. "Smart: Transactions Epidemiological Society of London, voK)r 3, p. 508. I £• U CONGO COAST. Descript'tGn. Tlie ConjiO Coast was formerly iinderstcod t > embrace all the countries ou the West coast of Africa behveen the equator and latitude 18° South, but is now restricted to the northernmost district of the Portugese colony of An- gola. Cabinda, with a population of 8,000, is the capital. YELLOW FEVER YFAES. 1816; 1860; 1862; 1000. SUMMARY OF EPIDE:^[IC?. 1816. , .1 Mcniorahic J-J.r/xdifioii and its Disa's1rou,j End. Tiie history of the tirst invasion of the C')ni>o by yellow fever I'cads like, a romance. We have been much interested in the quaint account of the famous Tuckey expedition, l)ublished in an old hybrid French medical journal hmu; since defunct and f<;r,ii((tten, and iiive in the followiuijj lines a faithful translation. ^"^ In the bejiinninjj;- of 1816, the British Government fitted out an expedition to explore the Conrs('d in the topogra])hv of the country. Alas for hunuin short-sightedness and ambition! This Avant of caution undoubtedly pa\'ed the an'Rv for the terrible afflic- tion Avhich afterAvards annihilated the I'ttle baud of ""Loc. cit., p. 332. " Berenger-Feraud, loc. cit., p. 87. 202 HISTORY 0¥ YELLOW KKVER. pioneer explorers and deprived science of some of its most enthusiastic devotees. 18G0. Yellow fever i)revailed quite extensively along the Congo Coast in 18G0 and was particularly severe at Angola and St. Paul de Loanda.^^ The source of importation is not given. 1862. In 18(32, yellow fever invaded almost the entire African coast from Sierra Leona to ^>aiut Paul de Loanda. (Ber- enger-Feraud, p. 139.) The epidemic, though widespread, was not very severe. 18G5. The epidemic of 1-865 was mild and was not attended with much mortality. Berenger Ferand (page 111) only makes a hrief mention of the incident. 1900. In 1900 yellow fever was imported from Senegal to the French Congo. ^^ On May 26, the steamship VilJe dc Pernamhiico, plying hetween France, West Africa and Brazil, stopped at Dakar where yellow fever was prevailing. While riding at anchor, three sisters of charity who were on board the vessel exchanged greetings with members of their order who had come to the wharf to see them. It is claimed that no other communication was had with the inhabitants of Dakar, but the statement must be taken cum r/ratiis sails. The vessel left Senegal for the usual voyage down the coast and arrived at Loango, one of the ports of tht Fi-ench Congo, on June 15th, wliere the sisters disembarked. They were all successively taken ill. One of the sisters died on June 20th and another on July 2d. The third recovered. " Berenger-Feraud, ix 136. "Kermorganl: Receuil des Trav. du Com. Con. d'Hyg. Pub. de France, 1901 (Paris, 1903), vol. 33, p. 394. CONGO COAST. 205 Autopsies revealed the fact that the two deaths bad been caused by yellow fever. The fourth case at Loanj^o mauifested itself iu the per- son of a young negress aged 16; who had nursed the sister of charity that recovered. The patient died a few days later, with black vomit. The port physician took extra- ordinary precautions to prevent a spread of the disease, which was contiued to the cases above mentioned. A' remarkable feature of this invasion, is that the only person infected by the sisters was a native African and that the few whites in the town escaped an attack. The natives of Western Africa are generally immune and the rare occurrence of a case among them certainly deserves special mention. This is the fifth and last authentic instance of yellow fever on the Congo Coast ; but other visitations of the dis- ease no doubt took place before, between and after the dates chronicled in this history, for it is a notorious fact that St. Paul de Loanda was one of the most infamous cen- tres of the slave-trade in by-gone days and was frequented by the worst class of trans-oceanic freebooters. DAHOMEY. Description. Dahomey is a ne^TO kingdom of WestoMi Afj'ica, in Guinea, with a coast-line only 35 miles in leng;th, nearly the whole of wliieh is composed of islands and swamps. The natives are all pation of the alleged epidemic de])icted by Dr. Larrey,''^ Ave fail to find anywhere any mentk n of j'el- low fcA'er in Egypt. We have ransacked the works of ancient, medieval and modern Avriters on epidemiology, but oidy find tbe solitai-y instance narrated by Baron Larrey. In our opinion, this Avas not yellow ityer, for **Dowell: Yellow Fever and Malarial Diseases (1876), p. 25. "Larrey: Memoirs of Military Surgery and Campaigns of the French Armies, etc., (Hall's Translation), 1814, p. 230. EGYPT. ;2 I 1 that disease could uot originate in Egypt, and nowhere in Larrey's account do we find any mention of importation. We would have passed this account by without giving it any attention had the author been an irresponsible or less distinguished personage, but Baron Larrey was one of the most noted surgeons of his day, holding the post of Sur- geon-in-Chicf of the Army of Napoleon in his foolhardy invasion of Egypt, and was the author of notable surgical works His post naturally afforded him abund:?.nt oppor- tunities for practical study and a careful perusal of his writings shows that he studiously availed himse-f of his astute powers of observation and (1 eduction by collecting numberless important and interesting facts. Dr. Larrey was a close and intelligent observei, and his descriptions of the several jjliases of the disease he had to deal with, even if antagonistic to the tenets of this en- lightened age, are so replete with interesting dv^ail, that we Avill quote at length from his views on the cause, path- ology and treatment of the maladv which decimated the ar:sny of the great Xapoleon in the campaigns wlii( h proved so disastrous to the French arms. "The fatal consequences which took place in a great number of our men who Avere wounded in the battle of Heliopolis,-' observes Dr. Larrey, "and at the siege of Cairo in 1800, led our soldiers to belitve that th(^ balls of our enemy were poisoned. It was not difficult to unde- ceive them; but not so easily could we arrest the progress of the disease." This eminent authority further asserts that the malady presented all the symptoms of the yellow fpver observed in America during the caniiiaigns of the French armies in the West Indies and which, according to the re])ort of Dr. (xilbert, his former colleague, Avhu Avas pliysician-general of the army of St. Domingo, reappeared among the French troops during the expedition to that island in tb-f" last de- cade of the eighteenth century. A peculiarity noted by Dr Larrey in Egypt Avas that the fever attacked none luit the Avounded. ami more particu- larly those Avho had been injured in tlie articulations, or had fractured bones, Avith injuries of the nerAX-s, of the head, of the abdomen or thorax. The disease appeared 212 HISTORY OF YELLOW PEVKR. about the 5th of April, 1800. and d'saj.peaced alout the last of 31ay. Dr. Larrey skives th': followinji details of the principal symptoms which tlie malad}'' presented: ''The wcmnded had scarcely received the jirst assistance, or submitted to an operation, when they f(^ll into a state of faintntrss and anxiety; rigors were felt over 'he whole bod}', and esi)eeially in the inferior extremities. At the first attack the eyes were heayy, the eonjunctiya yellow, the yisaiie copper eolortd, and the pulse slow and eon- tracted. The patient felt pain in his right hypochondrium, and his wounds were dry, or diseharged a red serum. These syni])t()ms were followed by much general heat, burning thirst, yiolent pains of the intestines and head, sometimes aceompanied by delii-inm, frenzy, op^)ression, and frequent sighing.'- Speaking of the causes of the epidemic, Di. Larrey says : "T think that many causes coneurr«Ml in producing the yellow feyer among our wounded The tirst was, crowd- ing the hospitals; as insurmountable difficulties opposed the formation of other estal)lishments, we could not reme- dy this. Besides, the wounded occTi])ied th(^ wards on the ground lioor, the moisture of which increased the disease,, It did not appear in the elevated and airy A\ards to any considerable extent. ^Nloreoyer. the troops, of which these wounded \yere formerly a ])arr. wei'e encam])ed on the west of Cairo, between this city and Boula(i, in a situation low and moist, more espeeially after the waters of the Nile had recech d from a ])lace where they had undergone de- composition, by remaining long expos«^d to the heat. The sudden ti-ansition from the scorching heat of the day t(» the moisture of the night, to which the troops were ex- posed, necessarily tended to weaken them and predispose to the disease. The atmosplu re, in the s(as(,n of khamsyn, is hot and moist, and consecpiently injnrious to health. At this time also the ])lague prevails, and we might say that the yellow fever, from the sinularity of its effeets. and its speedy termination, bears some analogy to this scourge. "To the causes already enumerated, we might add the excessive fatigue of the soldiers, the deficiency of good ali- EGYPT. 213 luent: of cooliufi: remedies and acid drinks, and the want of cloaks to cover them during tlie night," The surrender of Cairo having re-established coniniuni- cation with the outside world, the French were enabled to establish new hospitals, and to procure good aliment, medicines, linen and bed furniture. Tiiey removLd a great part of their sick to more sanitary quarters. These cir- cumstances, and the return of the wind to the north, in the judgment of Dr. Larrev, soon caused the disease to disappear. The following mode of treatment followed by Dr. Larrey is certainly unique: "When yellow fever was acute, and presented the symp- toms of an inflammatory fever with jaundice, spasmodic vomiting, delirium, etc., dry scarifications of the liga- mentum nuchae and on the iiypochondria, produced very good etfects, or in lieu of them, a small quantity of blood was taken from the arm. But copious blood letting was fatal, and it was even necessary to use the greatest cir- cumspection in the first detraction of blood. Nitrated tanuirind water, sweetened with honey or sugar, or a few glasses of nitrated and anodyne camphorated emulsions taken at night, relieved thirst and moderated intestinal ir- ritation. If, in conjunction with these remedies, the bowels were moved in the first t^^enty four hour^-^., Ave had hopes. We then continued the use of cooling medicines, of anodynes, of antispasmodics, followed by laxatives of neutral salts, and calomel, tonics, and antise])ti<-s by de- grees. Emetics would have been pernicious. But if in an opposition to these means the symptoms increased, the disease terminated fatally. When, on the contrary, the disease commenced with ataxic symptoms, such as pros- tration of strength, faintness, chillhic^s, blackish tinge of the tongue, and constipation, emetics in gruel removed the spasm, re-established the powers of the stoma/^h, and facilitated the actions of the tonics and antiseptics; we then exhibited these latter with some success; chinchona, camphor combined with opium, Hoffmann's mineral licpior. and l)itters in suitable doses. The cortex appeared to be less effectual than jiood wine brewed with sweetened 214 HISTORY OF YELLOW FiJVER. lemonade, and to wliicli a portion of ether ^vas a^ierwards ad led "CoftYe was to ns liiglilv useful, and we employed it to great advantage when the disease had passed tie second stage, Avlien suppuration was re-established in the wounds, and the patient was about to recover. It expedited in these cases the return of the vital powers and gave nourishment. These means were persevered in, and their use modified at every stage of the disease. Spurge-laurel and mustard, pounded with vinegar, and applied to the hypochondria or back, co-operated greatly with these remedies. In this dis- ease, I remarked the injurious effects of cantharides; therefore, I seldom used them. ''Wounds complicated witli bilic.us fevers, Avere dressed according to the particular indicrtion They were sprinkled with camphor and bark, wlicn they were threat- ened with gangrene, and we used the vegetable acids, L'hiefiy of the lemon, which is abundant in thi« country. If they assumed the symptoms of putridity, I also ordered lotions of vinegar strongly camphorated, to be nsed on the head and over the surface of the body. "Those who survived the \ellow fever, had a tedious convalescence; some even had rela])ses and died in a few days. The yellow fever did not si)are the Turks who were wounded. Being requested by the commander-in-chief, after the surrender of Cairo, to afford them assistance, I had them all collected in a mosfpie, to dress V\oni more conveniently. "■A large proportion of the Turks who were attacked by this disease fell victims to it. We nm.v attribute these un- fortuiuite results to the bad treatment to wliich tliey were subjected, and to the privations v.iiich tley u'iderwent during the siege." The following remarks on the pathology of tlie disease are interesting : "The effects of this disease appeared on opening the dead bodies. We found a reddish serum in the cavities of the chest and abdomen, inflation and ■.nflammation of the intestines; obstruction of th{> liver and spleen; Ihe gall bladder contained but little bile, and this was thick and of a black color: gangrenous affections were seen in differ- EGYl'T. 215 ent parts of the body, and csY)ecially in tlie ad* pose sub- stance. The organs of the thorax presented notlung re- markable; all the soft parts of the wounded limb were ganjirenous, and emitted a nauseous and fetid odor. Two hundred and sixty out of six hundred, who were wounded at the seige of Cairo and the taking of Boulaci, died with a eomijlication of this disease." ' An exhaustive review of Ur Larrey's work is given in the I'Jdiiihiirg Medical Bci'icic^^ and the epidemic de- scribed by him is commented upon by Gamgee in his treatise on yellow feA'er.^"-^ AVe find 'no mention of the in- cident in other works on epidemiolcgy. A curious passage occurs in Dr. Larrey's book, which throws some light upon the peculiar beliefs of the time. It seems that before Napoleon's army left Syria, a great numb(>r of the soldiers were attacked by the plr.gue. "It seldom attacked the wounded men," observes the doctor, "and scarcely an instance occurred of anyone bemg affect- ed by it whilst the wounds were in a state of su])puration, though man}' were infected as soon as the wonnds were healed." According to the Edlnhurff Medical Journal of 1804 (page 217), the above observation was made by all .writers on the plague, and it was currently reported at the time that Europeans Avho were established in Egypt and Syria guarded themselves from this pest, or at least seemed to be less disposed to be affected by it, by means of ha))itual ill- ness. Whether the sporadic outbreak depicted by Baron Lar- rey was yellow fever or not, we cannot say, as no corrobo- rative evidence can be found to sustain the eminent Frenchman's views; but if the disease was yellow fever, it certainly could not have sprung from the soil or from climatic conditions, but must have been imported by the French war vessels, either from Spain, whore the disease was widespread in 1800, or from Mexico or the West In- dies, where yellow fever was ever present in the past. From the West Indies or Mexico to Egypt is a long jour- *U804, p. 213. *" Gamgee: Yellow Fever a Nautical Diseases, 1879, p. 105. ?16 HISTORY OF YELLOW FEVER. noy, to ])(' sure, Inii Slcf/fjiiij/ia have been known to live for months in tlio holds of vessels and to be just as active in ino(iilatin«i" tlie liernis of yellow fever on being liberated as if tliev were fresh from the nidus of infection. I FERNANDO-PO. Description. Feniaudo-Po forms one of a group of four ii-hmds in the Bight of Biaffra, West Africa, 20 miles off the coast of Guinea. Tlie other islands of this group are Annobon, Princess Island and St. Thomas. The two last named be- long to England; the others to Spain. Fernando Po and Annobon were discovered bv the Portugese navigator, Fernao de Poo, in 149(5, and annexed to the croAvn of Por- tugal. The islands were ccdonized by that country in 1592, but proving an unprofitable venture, were ceded to Spain in 1777. In 1827, the islands had become merely a nominal Spanish possession. English intrigue having al- most absorbed them ; but Spain suddenly woke up to the state of things and filed a vigorcms protest against the machinations of the English court. Tlie British Govern- men, balked in its scheme to surreptitiously annex the islands, offered to purchase them for 1300 000. This proposition, after being considered ami debated for nearly fourteen years, was finally rejected by the Corte- in 1841. Eniiland reluctantly disgctrged the prize, recalled its gov- ernor-general and tlu^ Spanish flag has been floating over the islands to this day. But John Bull, wh(»'^e hind- grabbing policy has Avon for him a niche in the hall of di])lomatic intrigue, no doubt still looks with covetous eyes upon those two islets and Ave may Avake u]) one of tlu^se fine mornings and read of England being sole )wner and dictator of this quartette of islands nestling like huge rocks deep in the Bight of Binffra. The population of Fernando Po is about 20,000, being a mixture of negroes, Portugese and other Europeans. The capital is Clarence Town YELLOW FEVER YEABS. 1792; 1812; 1829; 1839; 1857: l.%0 ; 18G2; 1804; 18G0; 1868; 18G9. 218 HISTORY OF YKLLOW FEVKR. NUMMARY OF EPIDE?.nCS. 1792. Th3 first recorded invasiou of yellow fever at Fernaudo Po took place iu 1792, Xo details are given bj our authoritv."^"^' 1812. In the bejiinning of the year 1812, the disease was im- ported by three vessels, the Carldad^ the Isabel aud the Perla. We have becu unable, beyond ascertaining- the i5ames of the vessels, to cull any data concerning this out- break, as our authority'-^'^ has unfortunately neglected to touch upon this important detail. The ferer was either imported from the West Indies, as the names of the ves- sels suggest that they sailed under the Spanish flag and the commercial relations between Fernando Po and the West Indies Avere frequent aud extensive; or, which is no doubt still more probable, these vessels came from Spain or Portugal, stopped on their way to Fernand(» Po at Sierra Leone, aud were infected while at anchor in one of the harbors of that notorious focus of yellow fe*. er propa- gation. Xo mention is made in the account of this outbreak of the cas(^s of mortality at the island, but the statement is given that the total luortality on board the three vessels aggregated 42, including the surgeou-in-chief of the Pcrla. ' In this connection, it is to be dei)b>red that such an authority as Dr. Pey, who writes so minutely and inter- estingly of the history, climate, topography and natural resources of Fernando Po, did not take the trouble to give the details of this "epidemic" — as he terms it and thus add additional historical value to his v\-ork. Put he little dreamed that this infornuition would be of immense value to the compiler of this history and overlooked the impor- tant function. This is only one of the million illustrations of that trite Americanism, "everv little bit Li-lps." "" Berenger-Feraud, loc. cit., p. 60. "Rev: Archives de Medecine Navale, Paris, 1878, vol. 29, • p. 407. FERNANDO-PO. 219 1829. After a lull of fifteen j^ears, yellow fever again made its appearance at Fernando Po. This time, the infection is indisputably traced to Sierra Leone. Tlie facti* are as follows:'-'- "' At the inception of the epidemic of yell(.>w fever which decimated Sierra Leone in 1829, the British ship Ed€)i was anchored in the roads, off Freetown, and, as was the usual custom in those days, her officers were occasionally on shore. On the 3d of iMay, a man, who two days previ- ously had come aboard the IJdcn from Freetown, was taken ill with yellow fever and died on the Tth. On May 5, two days after this man had been taken ill, a mid- shijjman, who had been on board a detained vessel of which lie had charge, returned on 1)oard tlie Edcii. He had been taken ill on April 29th and died the da}- following his re- moval to the Eden. On May 12, some other cases occurred among the ship's crew, and on the 20ih of ^lay the Eden left for Fernando Po. She arrived at her destination on the 11th of June, having lost during this period 25 officers and men. She was thoroughly cleaned, fumigated, and whitewashed at Fernando Po, and then, re-embarking her coiivalescents, sailed for Princess Island on the 9th of July. After the departure of the Eden, the disease broke out at Fernando Po, where it prevailed with great severity. The mortality Avas not very great. During the voyage from Fernando Po to Princess Island, the fever reappeared aboard the Eden, and the mor- tality was considerable. The fever continued to rage till August, and the Eden lost, between the months of May and December, 110 persons out of a complement of IGO. At the same time that tlie Eden carried the disease to Fernando Po, the C/utnipion sailed from Sifrra Ltone with several bad cases of fever on board and arrived at Clarence Town three days after the Eden. As on board the Eden, the fever which was ravaging the Champion was of a most malignant type and the landing of her sick at the little "^Bryson: Report on the Climate and Principal Diseases of the African Stations, p. 39. 220 HISTORY OF VELT.OVV FEVER. town added fuel to the dormaut fires of pestileuce already' kindled by the Eden. Aecoi'din the small juarrison and the mechanics on shore. In a yery short time, 7G, out of 200 composing the entire purely Spanish population, were carried away by the dis- ease. A remarkable phase of this epidemic is that it Ayas confined exclu?iyely to the Spaniards of unmixed blood and did not attack the colored (^'uban settlers {cinanci- />«Jo.s'), althouii'li the latter nursed the sick and yisited freely all the foci of infection. This proyi^s conclusiyely I hat the disease was the genuine West Indian yellow feyer,^ lor the cniaiicipados, who cyi(hntly had experi- enced an attack in their own country, escaped unscathed. The .scsurce of importation is dispuicd. Some authori- ties claim that the inter-colonial mail steamer Jxctricrcr brought the disease from Bonny, Af]'ica, while Bourru, Berenger-Feraud and Yglesias y Pardo^" assert that the English ship Fcrrol, wliich left Hayana on June 10, 1802, with 200 eiiKiiiciixKJo.s, should be looked upcui as the nidus of infection. The French ship La Zclcc was infected at Fernando-Po in 1802 and brought the disease to Grand Bassam (q. y. ), 1864. Another outbreak of yellow feyer occurred at Fernando- Po in 1861. No details are giyen.'''* 180G. The ei)idemic of 1866 c(»ntinues the cliain of importa- tion. On August 2, 18()6, the sliip Rosa (hi Turia, having on "Bourru: Geographie des Epidemics de Fievre Jaune, p. 7; Berenger-Feraud, p. 139; Yglesias y Pardo, loc. cit., p. 12. "' Berenger-Feraud, loc. cit., p. 141. 22? HISTORY OF YELLOW FEVER. board about 200 couvicts, sailed from Havana for Fernan- do-Po, wbich Avas theu a penal settlement, arriving at her destination on October 3 of the same year. During the two months the vessel took to make ti^e trip, yellow fever prevailed to a more or less extent among Ler crew and living cargo, but this did not deter those in conanand of the vessel from landing the 200 convicts on the island. A disastrous epidemic broke out shortly aftervrards, which caused much mortality on the island and lasted until the end of November. Again we find occasion to criticize the excellent and astute Dr. Eey,^^ to whom we are indebted for the above narration of the epidemic of ISO'G. The genial doctor de- cries the attempts made by certain chroniclers of the period to hide the true nature of this epidemic under the name of bilious pernicious fever, but overlooks the most important information, the statistics ot the outbreak. He informs us that the Perle lost ten of her crew, but is mute as to what happened to the uufortuimie inhabitants of the island. 18CS. On September 24, 1808, the ship General Alia arrived at Fernando-l*o from Havana. '^'^ A few days after the vessel'^' arrival, yellow fever broke out on the inland, but was not very severe. 1869. On ^NFay 22, 1809, the transport San Franeisco dc Borja arrived at Fernando-Po witli 250 men deported from Ha- vana. ^"^'"^ Yellow fever prevailed to some extent en board the vessel, but no mention is made of the disease having reached shore. *Rey: Archives de Medecine Xavale, Paris, 1878, vol. 29, p. 407. ""Bourru: Geographie des Epidemies de Fievre Jaune (Bor- deaux, 1883), p. 7. ^°* Penard and Boye: Annales d'Hygiene et de Medecine Col- oniales, 1904, vol. 7, p. 509, FRENCH GUINEA. Description. Freucli Guinea, as the name implies, is a French col- onial possession on the west coast of Africa, bounded on the north by Seneiiambia, on the east by the Ivory Coast, on the soutli by Liberia and bierra Leone and on the west by the Atlantic Ocean. Capital. Conakry, situated on the Tombo Peninsula, Conakry is of recent ori«iin. It was founded in 1889 and has at present a population of about 12,000, principally natives. The European population is about 350, but is hardly 275 during' the sickly season, YELLOW FEVER YEAR, 1901. SUM^IARY, French Guinea was in imminent danger of being invaded by vellow fever during the epidemics at Senegal in 1900 aiid 1901 and at Grand Bassam in 1902 and 1^03 ; but save for a single case, observed December 21, 1901, at {'ouakry, tlie territory seems to have been exempt fvoui tlie disease. It is not known definitely whethei' or net isiegoiiii/ia Calopus breed at Conakry, as no special observations Iiave been made in that direction, but tlie fact that this solitary instance of the appearame of yellow fevei- iri the locality did not cause a general eruption, may be taken as a tentative proof of the non-existence of tlie in,s;'ct there. The case mentioned above was pjob^ddy iinjjorled from Senee:al. GAMBIA. Dcscripticn. ■riui.ihia is a British colony of Western Africr, consist- i''o- (..[• the ishmd of St. ^lary, the town of IJatLnrst (the caj it.'] ) and other minor dependencies. Area; \>J square Mih.'s ropulation about 15,000. YELLOW fp:vek YEAKS. 170;^; 17()4; 1700; 1708; 1700; 1778; 1825; 1828; 1837; 1850; 1800; 1805; 1800; 1878; 1884; i:)00. SUMMARY or EPIDEMICS. 1703. Tlie first outbreak of velloAV fever in Gambia (17G3) is coincident with the tirt-t appearance of tie di-ease in Si( ri-a Lecnie and was no doultt importevl fr , it will be seen that tlie authorities sup- pressed the fact that a virulent eruption of yellow fever was causing great mortality at Bathurst and ihe sur- rounding country and it was only when the LoniJoii Times received private information concerning the state of affairs and gave the matter ]»nblicity, that an "investigation'' was ordered by the British Government. ^'^ 18S4. In June, 1884, yellow fever Avas present in Sierra Leone; in August, it invaded Gambia ^" Here we And the same old story of importation from Sierra Leone. The outbreak does not appear to ha^e been severe. 1900. The year 1900 furnishes the last recorded appearance of yelloAV fever in Gaud)ia. A s])oradic outbreak occurred at Bathurst, but the disease did not gain a very disastrous footing, as the white settlers fle distance of fifty miles The climite is very un- healthy. The chief forts and settlements are Cape Coast Castle, Elmina, Accra, Axim, Dixcove and Arnamabee. Estimated population, 1,500,000, of whom only about 200 are Europeans. YELLOW FEVER YEARS. 1778; 1786; 1822; 1823; 1824; 1852; 1853; 1854; 1855; 1856; 1857; 1862; 1898. SUM^IARY OF EPIDE^nCS. 1778. Althouj2,h the Gold Coast was colonized by tl e Portu- gese in the early years of the seventeenth century, the first recorded invasion of the territory by yellow fever took ])lace in 1778, when an epidemic wave of the disease swept almost the whole West African coast occupied by Europe- ans. No details of the epidemic are i]i;iven.^'' 1786. Another outbreak of yellow fevi r took place in 1786, but the original source of infectioji i^ not given. It is stated, however, that the ship E.vperiment, v/liich had been sent by the British Government to assist in the establish- ment of trading places, lost many of her men by a "malig- nant fever."^^ " Berenger-Feraud, p. 56. ^ Berenger-Feraud.p. 58; Valentin, p. 77. 230 HISTORY OF YELLOW FEVER. 1822 to 1824. No mentiou of yellow fever havinia; prevailed along the Gold Coast is made from 1786 to 1S22. According to BrysoD,-^ the mortality was great among the detachments which arrived at Cape Coast Castle in 1822, 1823 and 1821. 1852 to 1857. In 1852 yellow fever was imported to the GoM Coast and sporadic cases were observed e\'ery year from. 1852 to 1857. The Government records, following the nsual cus- tom, give no detail of this series of outbreaks, and Berenger-Feraud-- disposes of the matter ?n a few words only. 1862. Yellow fever was almost general along the T\cst coast of Africa in 1862. The Gold Coast suffered considerably. (Berenger-Feraud, page 139.) GOREE. {See Senegal.) GUINEA. {See Benin, Dahomey, French Guinea, Gold Coast, Grand Basani, Ivory Coast, Lagos, and Sierra Leone.) "Bryson, loc. cit., p. 33. "= Page 122. IVORY COAST. Description. The lYory Coast is a part of the coast of Gumea, be- tween Cape Appolonia and Cape Palmas, West Africa, Its western portion belongs to Liberia; its eastern half, now counted as part of the Gold Coast (q. v.), ?s shared between England and France. The French colony com- prises three fortified centres : Grand Bassam, Assinie and Dabou. The first two are situated at the mouth of the Grand Basam Eiver, on a narrow tongue of land between the sea and a shallow lagoon. Dabou is sixty miles from Grand Bassam. Since the date of their establish- ment, these colonial towns have been visited nine times by yellow fever. In every instance, the disease was im- ported. YELLOW FEVEE YEAKS. 1852; 1857; 1862; 1863; 1899; 1902: 1903; 1901; 1905. SUMMARY OF EPIDE:\[ICS. 1852. In 1852, many localities on tlie CJulf of Guinea were in- vaded by yellow fever.-^ At Grand Bassam the mortality was over fifty per cent, among the French troops stationed at that post. 1857. Grand Bassam. Sporadic cases of yellof fever began to be observed at Grand Bassam in February, 1857. The disease pursued an uneventful course until April, when it seemed to have died out. About the middle of April, the >;+eamship ^ Berenger-Feraud, p. 122. 232 HISTORY OF YELLOW FEVER. P(in(ir,fa arrived from France, having on board many col- onist*^ Avlio liad been employed to work at the town factory. One man came on shore on April 15, was taken sick the next day, and died on the 19th. Fifteen days later, three more colonists landed. They were all taken ill and died between the 12th and IGth of ^Nlay. At abont the same time, a soldier arrived from Dabou, was taken ill and died. These new cases revived the epidemic and many who had previously l)een spared were attacked and died. During the revival of the epidi'mic, the gunboat La Tourmcnte arrived near Grand Bitssam, but could not reach the town on account of shallow water. The Cap- tain was rowed to shore, contracted the disease and died during the first days of June. AVe have no data concerning the mortality among the natives, but the fatalities among the Avhite colonists was excessive, for, out of a population of GG, there were 22 deaths.2^ The disease did not spread to the other ports of the Ivory Coast, with the exception of two imported cases at Dabou. Dahou. In IS.")", two employes of a comr;ierc:al house at Grand Bassam went on a mission t> Dab;.u. Shortly after their arrival, the men were almost simuUaneously at acked by yellovr fever and died. Xo new cases resulted. 1802. The Epidemic on Board the Dispatch-Boat V Archer, at (I rand Basisam. In ]iis account of the epidemic of 18G2, Sarrouille gives more elal>orate details.-^ A r-efereuce to ou" chronological tables will show that yellow fever was widespread along the west coast of Africa in 1862. Rumors of the existence "Salis: Archives des Hopitaux du Senegal; Sarrouille, Theses de Paris, 1869, No. 150, p. 14. =° Sarrouille: Theses de Paris, 1869, No. 150, p. 21. IVORY COAST. 233 of the disease reached Giaud Bassam as early as the mid- dle of the year, but it was not until November that the first case was observed in the dependency. On the IGth of that month, the French dispatch l)oat V Archer, which had been infected at Saint Paul de Loanda, by communicating Avith the Diulniath^ arrived at Grand Bassam and lai-ded one white and ten native sailors. The white sailor was taken ill on the 17th and died on the 20th, with unmistakable symptoms of yellow fever. None of the blacks who were put on shore at the same time contracted the disease. The fever did not spread immediately to the mainland, but soon broke out on the vessel. On November 26 the second steersman was strickeri. The *:*ever spread rapidly, five deaths occurring: between November 28 and J>ecember 5. Dr. Sarrouille himself was attacked. On December 7 the commandant, thinking tliat VArdwr had been infected at (irand Bassam, took on board all the white inhabitants of the post Avliich could be si)ared, and sailed foi- Dabou. But the disease continued to lage ow board and l)y the time the A'essel reached Oabou, December 12, three more sailors had succumbed. The men who had ])een taken on board at Grand Bassam were landed at ^)abou and; strange as it may seem, not a single case developed among (hem, the pestilence being confined exclusively to the sailois. This immunity, in our opinion, can onh^ be explained on the ground that the landsmen slept on d« ck, where the in- fected mos(|uitoes had no access, wliile tlie poor sailors were com])Llled, in the performance of their duties, to re- main below decks most of the time, A\here they were un- protected from the bites of the insects. On Deceml)er 12tli, when tlie ship's mechanic died, only three of the eleven men who com])rised the comiih-ment of V Archer on NoA'ember 2(1, when the first case broke out, re- mained, namely, the captain. Dr. Sarrouille and a sailor. It was thought that the e])idemic had ceased witli the death on the 12th, but on the 18th tlie \\(-V(y.c captain, whc; liad nursed his comrades throughout the terrible ordeal and had seen them die one after the other, was takrr. ill and was soon added to the list of victims. It will tin s be seen that, out of a crew of eleven, we have ;dliug record of ten attacks and nine deaths, Dr. Sarrouille beiuj? the 234 HISTORY OP" YELLOW FEVER. only one who survived an attack and the sailor ahove men- tioned being- the only member of the crew who proved im- mune to the pestilence. Grand Bassarn. Cases begin to appear at Grand Eassam shortly after the death of the sailor landed from V Archer. The outbreak was quite severe, resulting in twelve cases and s*x deaths, out of a white population of eighteen. Assinie. The European population at Assinie in 1802 consisted of (n\\\ five persons — the governor, the resident surgeon and three soldiers.-*^ About 'he lOtli of December, two of the soldiers were taken ill and the symptoms diagnosed tis yellow fever. Both died s few days later. The gov- ernor and the surgeon were then sacce'sively attacked, the latter dying on the 27th. The former recovered. The na- tives of the villages contiguous to Assinie suffered severe- ly, but in the town proper there were only four deaths among the blacks, making a total mortality of eight. General Summary of the Epidemic of lS6i. The epidemic which began at Grand Bas.sam lu Novem- ber, 1S()2, was one of the most virulent on record, for out of 27 Europeans attacked, 18 died. The cases and deaths were as follows: Locality. Cases. Deaths. On boiu-d the V Archer 10 ' 9 Grand Bassam 12 (\ Assinie (white population only 5) 10 8 32 23 The combined white population of Grand Bassam and Assinie amounted to 23. As will be seen, this small num- " Sarrouille, loc. cit., p. 35. IVORY COAST. 235 ber furnisbed IT cases and 9 deatbs. "'^be most appalling mortality, however, was ou board of V Archer^ y.here ten cases were followed by nine fatalities. The disease did not spread to Dabou.-^ •, 18C3. Sporadic cases of yellow fever appeared at Assinie and Grand Bassam in 1863, but almost entirely among the natives. We find the record of only one death among the Europeans at Grand Bassam, an agent sent by a French commercial house to est/iblish a factory at this post. He arrived at the '"unhealthy season*' and remaiued three months on board a vessel in the harbor. During the month of February, thinking that a 1 danger was past, he went on shore. Fifteen days later, he wa« stricken with yellow fever and died eight days after the onset of the maladv.^^ 1809. Through some source which is not given, yellow fever was brought to Grand Bassam in 1899 and for a time threatened to assume epidemical proportions. Strict sani- tary measures were adopted, however, and the disease was restricted to the vicinity of the original outbreak, re- sulting in six cases and five deaths. The infected terri- tory extended from the Gold Coast up to and including Half Jack on the west,^® The other African stations were not affected. 1902. The epidemic of 1C02 broke out .suddenly and. 'although it lasted hardly a month, was characterized by nearly one hundred per cent, mortality. On July 14, 1902, a sergeant of infantry, who had only been at Grand Bassam two or three weeks, was taken ill -'Huard: Theses de Montpellier, 1868. . ^ Sarrouille, loc. cit., p. 41. ^'U. S. Public Health Reports, 1899, vol. 14, pp. 1336, 1812; Annales d'Hygiene et de Medecine Coloniales, 1903, vol. 6, p. 325. 236 HISTORY OF YkLLOW FEVER. with fever. He died on the 19th v^ith "suspicious symp- toius," but as yellow fever had not been observed in the colony since 1899, the case was diagnosed as "pernicious fever'' by the attending physician On July 20, an Australian prospector, aged 30, who, to- gether with three other prospectors, had landed at Grand liassam June 27, died with ))lack vouiit, and the authori- ties concluded that they were face to face with an invasion of yellow fever and cabled the facts to the colonia' officials. Orders were received to take ininitdiale sanitary measures and to nuike war against mosquitoes. The three other prospectors, room-mates of the case above mentioned, were successively atracked, on the 23d, 25th, and 26th of Julv; one recovered, thf' others died on the 30th. In the four last cases above noted, bla-k vjmit was present. On July 24, a white servant, aged 34, who had been in the colony two months, died at the infirmary, a iter four days' illness. On July 24, a notary's clerk, also a new arrival, died after tliree days' illness. A young cor.plc who occupie either at the whr.rf ;.r on board the ves- sel and afterward had a mild attack of yellow fe\er. Be- ing convalescent when transferred to the Tibet, the excite- ment incidental to his removal brought on a relapse, which terminated as above set forth. This circuitous mode of infection may seem a little far- fetched, but it is plausible, and^ in the absence of proof to the contrary, is just as good as any other theory. '^Vivie: Annales d'Hygiene et de Medecine Coloniales (Paris), 1907, vol. 10, p. 121. JOHANNA ISLANDS. Dcscrijdion. Jolianua is one of the Coiuore Islands, in the ^Nfozam- bi(ine Channel, between Mada.uasrar a ad tlie maiiilaud of Africa. Its capital is the walled town cf Johanna. ALLEGED YELLOW FEVER YEAR. 1801. SUMMARY OF ALLEGED OUTBREAK. Bancroft, in his t^castric re«i;ion, and an in- vincible irritability of the stomacli; t!ie vomitini;, in all cases, beinii,- of a bilious nature and a yellow-ureenish as- pect, which, towards the fatal teripination of the disease, assumed a dark-brown olive or clu <()l»te crdor In none of the bad cases were remissions well mark«nl, and in most of those who died, a yellow suffusi(tu of tl.e skin of a lemon hue, was conspicuous i-nly a shr.it time pr-jvious to death; in all, however, after death th\< appearance was common. The discharges by stool manifested a similar variety, but they were so hiiihly corrosive and acid as to excoriate the anus and natex, and to excit*^ tlie ji<'neral dread in the patient on the apjiroach of the evacutition. Out of twelve men attacked, six dicl ; those wlio recov- ered did not have the dark colored von itin^ and their <-on- valescence was extremely tardy. With the exception of the alletied oi'tbre.'^k at ^ladagas- car (q. v.), this is the only record o" yellow ffver, or a 242 HISTORY OF YELLOW FEVER. disease simulatiu*:: that seoiiri?e, on the eastern sliores of Africa. Bancroft says that this sloop of war car.ie direct from England, which precludes the thr-cry of inijortation. We arc prone to believe that it was simply a vir\:lent out- break of paludial fever, aggravated by exposure and fatigue. f LAGOS. Description. Lajoos is a British colony in Upper Guinea, on the Gulf of Benin. The capital, Lai»os, the largest port in Western Africa, has a population of about 40,000. The population of the colony is about 100,000, mostly negroes. Lagos was once a noted slave mart. YELLOW FEVEE YEAR. 1864. SUMMARY OF EPIDEMIC. There is a solitary record of yellow fi ver having invaded Lagos (Berenger-Feraud, p. 141). In 1864, the disease was in Sierra Leone and was brought to Lagos by trading vessels. The outbreak does not appear to have been of much consequence, as it is barely mentioned in the official reports. MADAGASCAR. Description. Madagascar, the third largest island iu the wor-d, is sit- uated iu the Indian Ocean, 210 miles from the ^^^st coast of Africa, from which it is separated by the ^lozandnque Channel. It is about 1,000 mile« loni; and has an aver- age breadth of 250 miles. ro])ulation, 3,520,000. Capital, Tananarive. Chief port, Tamatave. The island is under French protectorate. YELLOW FEVi:i{ AS IT COXCERXS MADAGASCAK. Berenger-Feraud, in the (razctte Medical dc Xanfcs* and Joseph Jones, in the Transactions of ihc Loiiisiaua State Medical Society for 1879 (page 63), make brief mention of yellow fever having been observed in .Madagascar in 1790, but a search through the litei'ature of that a ear and a careful perusal of the principal works on Madagascar, fails to throw any light on ^he subjcL Bancroft, in his Sequel of Yellow Fever (page 135) claims that an English warship contracte'l a pestilential disease at Madagnscar in 1800, but makes no mentiiai of +he alleged outbreak of 1790. Bancroft's account is as follows: In the year 1800, a seventy-fonr gun ship of th- British navy st<)i)ped at Madagascar for the ])nr])ose of obtaining fresh l)eef, vegetabU^s, fruit, wood and water. In conduct- ing these duties it was necessary to em])l()y mai]y of the men; and of all the parties thus employed, none remained on shore during the night, (^\cei)t ;i guard of marines, sent in the evening on i)urp()se for the i)r()tection of Avate|r casks, etc.; and it was so arranged thai no man bad occa- sion to be out of the ship more than one night. Notwith- standing these ])recauti()ns, a fever of malignant nature ap- peared among the marines, and of twenty-four attacked in a violent degree, six fell victin)s to the disease. The symptoms here were not exactly similar to those wit- * 1S83-4, vol. 2, p. 6. f MADAGASCAR. 245 nessed in Joliauna ;^"'' death in several cases v.as sudden and unexpected, preceded by a vi<;]ent buininii sensation at the epigastrium, which was only a precursor of death by a few hours, and in one case by a few minutes. In these cases neither was a yellow suffusion of the skin con- stant, nor the eyes so hij^hly inflamed, nor the countenance so much flushed as in the fever of Johanna; but a sallow, dingy, disagreeable aspect of the countenance prevailed. In some of these cases the ship's surgeon was inclined to think the individuals in a state of intoxication, from the very great degree of vertigo and staggering present; but a siiort time served to convince him of his error. This variety of appearance in the two diseases thi^ officer ascribed to peculiarity of constitu.tion only, and not to any difference of climate; those who were alTected at Johanna were young and recently arrived from their nativ^^ climate; whereas the people subjected to the Madagascar fever had been some length of tinu^ in India, and had but lately ar- rived from a long cruise of four months, tlie greater part of which they had subsisted on salt provisions, and symp- toms of scurvy had appeared among them for s<»me time before their arrival at jMadagascar. This outbreak Avas certainly not yellow fever. Nowhere can we discover in Bancroft's account any mention of previous contamination of the wai'ship, and unless the vessel stopi)ed at some infected port on its way f'/om Eng- land to Madagascar, the contagion which prevailed on board was not, and could not have been, undef the wildest stretch of the imagination, yellow fever. The mode of propagation of this disease is now too well established to need elucidation, and, unless the mosijuitoes of Mada- gascar were imbued with the venom of infection simply for this special occasion, the incident can positivelv and for- ever be dismissed as being ])uerile jmkI <'himerical. It is a well known fact, however, tliat i)alndial fever reigns with great intensity in the litoral of the island and commits fearful ravages among the whites. In this conne; tion, the historic words of liadama, King of the Hovas, ^^hen con- fronted with invasions by tlie FreLch, "I have at my ser- vice the great General Tago (fever) and in his hands I'll ^'■' See article on Johanna Island, in this volume. I 246 HISTORY OF YELLOW FEVER. leave tlie whites for a while; I have no fear of the results," proved terribly prophetic, for the shores of the great island are so thickly studded with the gTavestones of the invading French, that Madagascar h?s been christened Le Tombcau des Francais. I MADEIRA ISLANDS. Description. The Madeiras are located in the Atlantic Ocean, about 440 miles off the west coast of Africa and consist of the islands of Madeira and Porto Santo aiul th.ree islets called the Desertas. The group belongs to Portugal. Popula- tion, 123,841. Capital, Funchal^, on the island of Madeira. 1738. YELLOW FEVER YT:AK. SUMMAPiY OF EPIDEMIC. Altliough the Madeiras hav-e been Iviiown to Europeans for four hundred and seventv-six .year>, only once has yel- low fever invaded the group. Like the Canary and Cape Verd islands, the Madeiras are directly in the path of com- merce between Europe and Africa and were no doubt the rendezvous of the delightfully unsanitary galeons, buc- caneers, slave-traders and gentlemanly cut-throats of by- gone days; but, strange and inex])licable as the ^.tatement may seem, the dreaded pcste, altlKuigli it devastated the other islands off the African coast, only found lodgment once on the shores of this salubrious Portugese possession. This solitary record of tlie ap])earMnce of the "Ameri- can Pestilence" in the Madeira Islands nuiv be found in an old Portugese Avork published nearly two hund'ed years ago, by Jose Rodriguez de Avreu,^^ phvskian to King Juan V, of Portugal. No details are given of this inva- sion, beyond the statement that it caused much mortality in the city or Funchal. From 1738 to this day, yellow fever has never been ob- served at the Madeira archipelago. How can this immunity be explained? Only by hypothesis, and as hypotheses are generally concocted of such volatile ingredients that they collapse of their own weight, we shall not indulge in any, but will sum up the "Jose Rodriquez de Avreu; Historiologfa Medica, vol. 1. p. 620. 248 HISTORY OF YELLOW FEVER. whole matter in five little "words: The abscnc'^ of the Stegoiiiijia. This, in our opinion, is the true explanation. It is not a liyi)oth('sis, bnt a fact, that the HiajOiiniia CaJ- opus, the only active a<>eut in .the transmission of yellow fever, does not flourish in the ^ladeira group. The insect was imported once to the islands and that solitary instance furnished the delijihtfnl little city of Fnnclial the only epi- demic of yellow fevei^ Avliich ha.s ever invaded that locality; and, as soon as* the climatic conditions k f the island proved hostile to the propagation of the mosquito and the im- ported insects died, the pestilence wLivh they liad pro- duced ceased and the old-time health con^litions of the country re-established themselves and ]iave endured to the present day. t I MOROCCO. Description Morocco is a country occupying- the uortlnvest pxtremity of Africa. Area, about 200,000 s'ing circumstances (Bryson, loc. cit., p. 57) : The HijhiUe was infected by some vessel attached to the British South Atlantic squadron in 1820 and suffered much from the ravages of yellow fcve/'. On September 1, 1821), she arrived at Saint Helena. The epidemic had ceased and no one was on the sick list. She shortly sailed on a cruise and met with the Black Joke, with which she com- 252 HISTORY OF YELLOW FEVER. iimnicatcd. Tliis v( ssol had just recovered from a severe visiiatiou of vcllow fever. The disease ao details are given. 1588. The same authority ( ]). 27) also informs us tliat Bird and Newton, English explor-rs, and their crew.s, were at- tacked by yellow fever at Saint Thoiuj-s in 1~8S. Where the disease was contracted, whether it was lla'u pievailing on the island or was brought there by the explorers, our source of information does not reveal. SENEGAL. Description. Senegal is a French colonial dependency in West Afri- ca, in Senegambia, comprising the island and to\yn of Saint-Louis, at the mouth of the Senegal River, the island and town of Goree, Albunda on the Gambia, and other stations south of Cape Verd. It was first settled by the French in the beginning of 1600. taken by the Fnglish in 1756, retaken by the French in 1759 ar^d 1779, and subse- quently held by the English until 18 j 4, when it again came under control of the French, who have retained pos- session to this day. Capital, Saint-Louis. Other towns and stations: Goree, Dakar, llufisque, Thies. Senegal being one of the most important colonial pos- sessions on the West Coast of Africa, having extensive trade relations with America and Europe, v, description of ^ its principal centres of popuLition will not be out of place in this volume. The reader Avill thus be in a better posi- tion tc understand the radiations of ihe many epidemics which have ravaged this distant' land. Saint-Louis. Saint-Louis, capital of the French possessions in Sene- gambia, was founded in 1626, It is situated on an island of the same name, at the mouth of the Senegal River. It has tine public buildings and mission schools. The white population occupies the centre of the is'and, whik the huts of the natives are located at both extremities. The streets are large and macadamized in the business section, but the houses, with few exceptions, are of ancient construction. Several bridges over the small arm of the Senegal connect the island with the peninsula of Barbary, a narrow sand- bar, on Avhich are located the native villages of Guet N'Dar and N'dar Toute. The cemeteries are located at Sorb, on the mainland and separated from the island by (he great arm of the Senegal. A single bridge connects Sorb with the capital. SENEGAL. 255 The natives are exceedingly filthy in their habiis*. Those residing- in the Enropean section of the city occupy the basements, where they operate small stores. In the small court-yards attached to these houses, they keep chickens, hogs, sheep and often cows, and when the yards become overcrowded, which is a common occurrence^ tiiese ani- mals are often quartered in the living ;ipartment-ji Under such conditions, it is not surprising that the lieairh of the city is always on the wrong side of thc^ balance Saint-Lotiis has a population of 15,758, mostly natives. The white population is transient and licnerally ;eaA'es for Europe at the beginning of the rainy season. Gorce. The rocky island of Goree, which Is entirely occupied by the town of the same name, lic;s in the Atlantic Ocean, south of the Cape Verd Peninsula It is directly opposite Dakar, with which town it is so closfiy allied that the name Goree-Dakar is now generally used when alluding to the twin cities. It is claimed to be tie healthiest place in West Africa. The native quarter is composed of grass huts, but the houses of the Europeans are of fair construc- tion and decorated with tine flowering plants and shrubs. The elevation of Goree above the sea level varies from 2 metres on the northwest to 31 on the southeast Goree was for years the pi'incipal port of the colony, making rapid strides in population ra-'road. Population. 5,280. YELLOW FEVER YEARS. 1759; 17()(); 17«)9: 1778; 1779: 1828; 1829' 1S30; 1837; 1859; 1800; 1807; 1872; 1878; 1879; 1880; 1881; 1882: 1900; 1901; 1905. SUMMARY OF EPIDE]MICS. 1759. The tirst aj^jjcarance of yellow fc'ver on the mainland of Africa, according to Lind,^^ occurred at Senegal in 1759. We can find no details of this invasi(^n. It would cer- tainly ])rove interesting to be abl" to trace tlie origin of this outbreak, which planted the seeds of a disease hereto- fore^ unobseryed on the continent (»f Africa, and wiiich was destined to commit such fearful ravages among tlie unfor- tunate pioneers sent to colonize its slujjes. 1700. Oorrr (dhI Sainl-Loiiis. The second a])pearance of yellow fever on continental Africa took i)lace in Senegal in 1700, when the iowns of ^^Lind: An Essay on Diseases Incidental to Europeans in Hot j Climates, vol. 1, p. 51. SENKGAL. 2.57 GorcG and Saint-Louis lost nearly their entire wli'te popu- lation, composed of Freneli soldiv'is and traders. No de- tailed accounts of this e])ilenii.: aie obtainable, our autliorities (Lind and l?eren!j;er-I''eTaiul ) being deplorably uncommunicative on this score. 1709. Berenoer-Feraud (page 55) goes into more explicit de- tails concerning the outbreak of IKiO, but is certainly not prolix. We could obtain no statistics, but learn from his account that the French troops sent U> capture Galam, on the Senegal IJiver, were so decimatrd hy yellow fever, that there were not enough men left to undertake tlie task. 1778. Saint-Louis. The epidemic of 1778, which is the first on African soil where details are obtainable, was murderous in its inten- sity and almost depopulated the d-^pendency of its white settlers. Senegal was then in the turmoil of war, the English having wrested the <-olony fr(>m the French. Tlie fever first appeared on the (iold Coast, Avhence it was brought to Sierra Leone, which, in its turn, infected Gam- bia. From Gambia, it s])read to Goree and thence, accord- ing to Hirsch,'^'^ to Saint-Louis. The i)rogress of the disease in the town of Saint-Louis is one of the saddest pages in the history of the colony. We cull our information from an old work ]»ublish( d by Schotte in 1782, Avhich gives a compichensive account of the rise and fall of the epideuiic."^'^ Srhotte, wh(f was sur- geon-in-chief of the British garrison at Sainl-Loui. in 1778, lirst wi'ote this treatise in Latin, but .vas finally ])revailed to i)ublish it in English. The work was considered of such ^"Hirsch: Handbusch der Historich Georgraphischen Path- ologie, Stuttgart, 1881. *" Schotte; A Treatise on the Synochus Atrabiliosa, London, 1782. 258 , HISTORY OF YELLOW FEVER. importaiue at the time, that it was trar^slated into French and German. The first case in Saint-Lonis was imported from Goree- Dakar and was observed in tlie hospital on August 3, ter- minating fatally on the 7th. The last death was that of Governor Clarke, the commandant of the island, on Sep- tember 18th. Schotte observes that up to the end of July 1778, the garrison and the inhabitants of Senegal were, for that time of Ihe year, remarkably healthy. Ii; the beginning of August, "a sudden and most dreadful disease broke out," which, raging until the middle of Se] tember, carried off the greatest part of the Europeans and a great number of the native mulattoes and blacks. The whites suffered much more, in proportion, than the mulattoes and the latter much more than the blacks. The few who had es- caped the fury of the pestilence were not attached after September 18th; but those who had recovered were seized with rela])se during the following month and some died as late as December, The course of the disease was frightfully rapid. There was hardly a day between the 9th of August and the 18th of September without one or two deaths. Out of so small a pojjulation as 02 Europeans, we find tlie melancholy record of four deaths on August 28d, four on the 26th, three on the 27th and five on September 5th. The total number of deaths reached 59. Eigl t of the convalescents were still too feeble to walk when the French took possession of the island on January 28, 17'^0. Schotte, who was a valorous champ'cn of African ende- micity of yellow fever, believes thot the disease originated spontaneously on the Gold Coast and was then spread by contagion to the localities mentioned in this account. As the French and English were at loggerheads, however, and probably drew on their West Indian tleets for transports and l)lockade runners, it does not require a gigantic stretch of the powers of observation to see ho^v easily the disease could liave been imported to the w?Rt cnast of Africa. Si, SENEGA I-. 2.59 Saint-Louis. The French, undaunted by the many reverses and the ravaj>es of disease whicli had marked their attempts to colonize Senegal, determined to recapture Saint-Louis, and, in 1779, sent a force of about 200 men, headed by the Due de Lauzun, to dislodge the British. The soldiers were recruited from the crack Walsh Regiment, the Queen's Regiment and volunteers and were a fine body of men, vig- orous and healthy. The invading force arrived afc their destination January 29, 1779, in the dead of nighi, intend- ing to take the garrison by surprise, but they found that not even a solitary sentry guarded the place, and the 33 Englishmen who had survived the terrible epidemic which had just come to a close, too Aveak aud disheartened to offer any resistance, surrendered unconditionaUy, and were sent to France as prisoners of war. Two were drowned by the upsetting of a boat at the mouth of the Senegal and three died in transit, so ihat out of 99 men whicli originally comprised the garrison, only 28 reached Europe alive. But the bloodless victory achieved by the French was destined to have a terrible .^eagated itself throughout tlie town. Saint-Louis, which had a white population of OoO, suf- fered cruelly, for out of 600 cases, tliere resulted 32S fatali- ties. Out of ten physicians, eight were attacked and six died.^-* Probable Cause of the Epidemic. For a long time epidemiologists were at a loss to account for the cause of this fulininating outbreak, which seemed to have si)rung from the ground. No suspicious vessels had been observed in the harl)or of Goree at that period and the entire colony was in a perfect sanitary condition. Some tried to prove that it was a reawakening of the ''germs" of the epidemic of the previous season and even " Berenger-Feraud's statistics say that out of 12 physicians 10 were attacked and 6 died; but Duval and Lejemble attest to the correctness of the figures given in the above ac- count. 262 HISTORY OF YELLOW FEVER. Berentjer-Feraud half-lieartedly espoused that theory. This view was no doubt plausible years ago, but its ludi crousness at the present age is too apparent to need com- menting upon. The elusive yellow fever germ may be eaten for breakfast, lunch and supiier, j-et no iH results will follow; you can take it by its caudal appendage and toy with it from sunrise till moonset, smear it all over your body, bite its head off or swallow it in your milk or pousse-cafe — you .may do all this and set remain healthy and frisky. But let a Stegomyia which has taken a draught of blood from a yellow fever sufferer in the first stages of the disease bite you, and if yt>u are not an im- mune, it's a chance out of a thousand that you will con- tract the disease. The outbreak at Goree in 1830 can easily and satisfac- torily be elucidated. All we have to do, is to take a peep into the past and see what was happening in that far-ott' land at the time of the outbreak. As we ha\e already seen, , -the inhabitants were celebrating a religious feast, and, as is usually the case with celebration;.- of the Catholic church, the whole zeal of the people Avas concentrated in making the event as gay as the solemn rites of the Church AvouJcl permit. Flags, decorations and bunting were uSed with profusion. Berenger-Feraud anri Lejemble inform us that, for some days previous to the «;elebration, the Sis- ters of Charity were busy making odds and ends with a lot of bunting which had been stored in an out of-the-way room since the epidemic of the year before. The room had never been aired since the rags were jdaced tliert. When the good sisters removed tiie lot, the mosquitoes, which had been hibernating during the wirier, v/ere liberated |i' and, famished after such a long fast, fed eagei'ly apon the blood of the ]>(>])ulace, ])ropagating the germs of the terri- ble disease far and wide. 1S3T. (Jorce-Dalar. 1 The epidemic of 1837 was the result of flagi'aut neglect on the part of the authorities of Goree-Dakar. Since the begin7iing of June, rumors of the existi nee of yellow fever SENEGAL. 26S at Batliurst, iu Gambia, reached the town. In the be- ginning of July, the Britisli Government sent to Goree- Dakar for medical assistance and the surgeon-in-chief of the colony. Dr. Dupuis, was sent to the afllicted locality. He returned on July 21 and rei)ortel that the fever had subsided at Bathurst, but advised that strict qiiarantine be maintained. On August 12, a coaster arrived at Goree from Bathurst, having on board three Europeans. In spite of the warning of the colonial surgeon, the vessel was allowed free pratique and two of thj white passengers, AA'ho were ill, were admitted into the liospital. The third passenger was next attacked and a)l t) ree died with un- mistakable symptoms of j^ellow fever. The disease soon manifested itself in the town and lasted until November 23, during which time, out cf a white population of 160, there were 80 cases and 46 deaths.'^''' The French ship Malouine,^*^ which ^ad been sent by the French Government to found a town at the mouth of the Casamanza Eiver, in Senegambia, wis contaminated at Goree and experienced a severe epideiuic. Out ( f a crew of 57, there Avere 42 cases. Saint Lot! ifi. The fever was introduced from Goree into Saint-Louis late in the year, but did not become epidemic. About a dozen cases were observed.^" 1859. For twenty-two years Goree guarded itself against yel- low fever invasion. On August 9^ 185t), the dis])atch boat Le Ruhi,s arrived at Goree from Bathurst, where the fever was prevailing, with two sick passengt rs, the vicai-general and a merchant. The vessel was allowed free pratique and the patients transferred to the hospital. The mer- chant recovered, but the priest died on the 12tl). I'rom that date to Septend)er 30, no otlu^r cases were observed, "Dupont: Archives de Medecine Navale, 1880, vol. 34, p. 262. ** Duval: La Fievre Jaune a Goree (Bordeaux, 1883), p. 17. ■" Berenger-Feraud, p. 111. 264 HISTORY OP' YELLOW FEVER. whou the death of a niercliaut was? recorded. TL's- was fol- lowed by anotlier death on Octol>er li't. The physician who attended these two cases contracted the disease and died on October 12. The dis< as'- ther became A\idespread and there were 54 deaths in October, 25 in November and G in December. Ont of a wliite population of 267, there were in all 244 casese and 102 deatlis.^^ Haint-Loiiis The infection spread from Goree to Saint Lou-s, result- ing in 41 cases and 11 deaths.^^ 1SC6. Go7^ee. The epidemic of 1800 is dhecth' traceable to Gambia. News of the existence of yellow fever along the coasts of Sierra Leone and Gambia reached Goree early in ^lay and measures were at once taken to prevent importation of the disease. On August 3, a coastinj.: vessel, the Marie Antoinette, arrived from Bathurst and, tlirough false representations, was admitted to pra^icpie. It v, as after- wards discovered that tlie vessel did n< t have a cb'an bill of Ileal th. The captain was arrested and lined heavily, but ^ the evil had already been done. On September 15, a case i of yellow fever erupted in the town, followed l>y sj^oradic cases. The ei)idemic lasted until January 27, 1807, re- sulting in 241) cases and 110 deaths. •''•*^ The civil population of Goree in 1800 was as follows: ** Berenger-Feraud ; Duval; Lejemble. x *^ Berenger-Feraud, p. 135. ""Cedont: Archives de Medecine Navale, Paris, 1868, vol. 9, p. 334. SENEGAL— 1866. 2G5 Natives (blacks) 2,500 Miilattoes, JMales . 3*55 Mulattoes, Females „ , . 4;]! Europeans (whites), ]Males 55 Eiiropeaus (whites), Females iS 'GG 103 3,309 Miiitar^^ population (white) 105 Total , 3,534 The cases and deaths were disti'lbut h1 as follows: Whites . . Mulattoes Blacks . . . Cases. Deaths 242 107 4 •) 3 1 T<;tal 249 110 It will thus he seen tliat out of a total white ix/pulation of 268, there resulted 242 cases and 107 deaths. The mulat- toes, numherino- 7()(), furnished 4 cases, foHowul by 3 deaths, while tlie l)hicks, 2,500 strong, had onlv 3 cases, with 1 death. Tliis remarkable immuTiity has always ])re- vailed among the blacks, not only in Africi', but through- out the world. Dakar. The ]m)ximity of Dakar to Goree and tlx' unrestrained communication between the two towns, could not fail from resulting in the infection of (he latter. The first case in Dakar was observed on O^'tober ]2tlT, followed by death on the 14tli. From that date until the end of the e])idemic, there resulted 80 cases and 30 deaths, distributed as follows: ("ases. Deaths. Civilian population 24 11 INfilitary population 50 25 80 36 266 HISTORY OF YELLOW FEVER. Tho last death at Dakar oeciuTcd on January 21, 1807. Oil the Snrpri'^e. The gunboat ^Sur prise was the only vessel which did not take any i)iv('autions a<;ainst infe< t'on and it was also the only one to experience a visitation of the disease. On November 5th, while in the harbor of Dakar, the first case manifested itself on board". Nearly the entire crew was attacked, resulting in 14 deaths. Rupsque and i^icdhninn. From Dakar, the fever spread to Rufisque and Sedhnion, but was not severe. It will be seen below how the infection was carried from Eufisque to Gorte ihe following- year (1867). ^aiut-Louis Thaidvs to the rigid quarantine ob.^erved by tlie health otticers, not a single case was observed at Saint-Louis. 18GT. In October, 18(>(), a clerk emplcytd in Rutisque who had gone on a visit to Dakar, Avas taken ill on his return home and died in a few days. His employer sent to France for a new clerk, who arrived in January 1867. Tlie new-comer was given the same room which liis predecessor had occu- l)ied and soon shared the same fate. In April, another tlerk arrived from France, was given the same living room as the two employes who had died of fever. A few days aftei- his arrival, he was taken ill and died. A third unfortunate shared the same fate. A friend i>i the latter, who had been his room-mate on board the ship which brought him from h^rance, visited him while he Avas in the first stages of the disease, and, taking pity upon his lone- liness, resolved to nurse him. He soon contracted the sick- ness, and, together with his companion, was transported to the Hospital of Goree, where both oatients died a day or two after. The news of the reappearance of yellow SENEGAL. 267 fever in the town created profound consteriiatiou and the governor ordered the embarkation of i\\\ the troo])S on board the Crocodile and VEtoile and tcausjiorted them to Saint Louis. Shortly afterwards, the disease broke out in Saint-Louis and histed until the cool season. The disease spread to Leybar^ Lam],gar and other mili- tary posts of the colony, whore many cases and deaths oe- curred. The cases and deaths in the localitie.?! affected by the epi- demic of 18()7 are not given by Berenger-Feraud, Lejemble nor Duval, from whose works the above resume is made. 1868. According to the London Medical Times and (kizettcj^^ yellow fever was present in Senegal in 1868 and was im- jtorted to the Cape Verd Islands (q. v.) by trading vessels from (joree-Dakar. The French authors deny th;it the dis- ease Avas in Senegal that year and implicate Sierra Leone in the importation. 1872. Ooree-Dalvar. On October 5, 1872, the ship Baal arrived at Gioree- Dakar from Bathurst, where yellow fever was raging, with three European passengers, and ap])liecl for pratique. This was refused l)y the liealth officer in charge. Dr. Ber- enger-Feraud. The merclunits uf tlie town {protested against what they considered harsh measures, asserting that there was no sickness on board the Baal^ but their ob- jections were overruled and tlie vessel ordered to tlie quarantine station at Dakar, ^Much pj'essui'c was brought to have the order revoked and the govf^'nor was about to yield, when the quarantine officer reported that one of the white passengers had been taken ill with fever. The pa- tient was at once taken to the lazaretto, where lie expii-ed on the 0th. A second passenger was taken ill and died on the lOth. The third, a Spaniard, who had had yellow fever at Buenos Ayres the year before, was not alTected.^- " Medical Times and Gazette, London, 1869, vol. 1, p. 119. '" Berenger-Feraud, p. 147. 268 HISTORY OK YELLOW FEVER. Sliortly afterward, another vessel f?"(>m Bathurst fur- nished a tliird ease, whicli also res\dt^^d in death at the lazaretto. Only one inhabitant of Dakar was attaeked, a soldier who had been one of the henlth-jiuards around the lazarLito, and who died in a ^ew days after the onset. It will thus be S(^''n that of the four j^orsons attaeked, all died, and tlie salvation of tlie eohuiy v.as no doubt due to the energetic measures taken by the eoinnuindirg health offtetr. 1S78. Gotrc-Dalar. We must look to (Taml)ia auvl Sierra Leone for the seeds of the terrible epidemic which decin-.at''d Seneg'al in 1878.''^ During the first five months of 1878, the public health was excellent throughout Senegal. A Jth and three on the 27tli. The state of affairs was ^a ell-known to the authorities, who were day by day informed of the progress In compiling the history of this memorable epidemic, we have consulted the writings of the following eminent French writers: Berenger-Feraud, Lejemble, Duval, Dupont, Daril, Forne, Kermorgant, and Vincent. The full title of these works will be found in the Bibliography at the end of this volume. I SENEGAL — 1878. 269 of the outbreak, but the facts were suppressed from the general i)ublic and it was only on July 30, when it was seen that the ei)ide]uic was gettinji- beu«nd coiiti'ol, that a proelaniation announcing the existence of tlic disease was published in the 3Ionitenr Officicl du Senegal. Saint-Louis was thrown into a panic. Strict (juai-antine Avas maintained against (Joi-c^e and tlu pest was tempora- rily kei)t away from its doors. The epidemic made rapid progress at Goree and soon spread to its suburb, Dakar, At the end of July, the bar- racks were evacuated, as a sanitai-y precaution, and the sohli(a-s dispersed to minor posts of the colony, being; (piar- tered at Ilann, ^rBidgen, Bel- Air arid Thies. But this exodus did not sto]) the ravages of the disease Between tlie 1st and 15th of August, 30 deaths occurred at (ioree- Dakar; between the 15t'h and 30th, 20. The epidemic then seemed to be on the wane, for only 12 deaths occurred in tlie months of Septeml)er and October. Only one death took ])lace from Se])t(Miibei- 2S to October 28, and the ei)i- demic was thouglit to be emUMl, whei' some ne>\ arrivals rekindk'd the spark of contagion and we find a record of 3 deaths on October 29th and 4 on Deceml^er 9th. The population of (loree-l)akar in 1S78 was about 3243, of whicli 120 were Eui'iJjx'ans. When 'he (i)ideiuic broke out, 21 tied to Europe, leaving a white population of 99. Out of this number, there were 88 deaths, Saint-Louis I'emained uncontaiiiinat d uiitil Siptember (I, when the dispatch boat ll^jntilini a 'rived from Jiakel and was allowed free communication with the inhabitants of the town. On Se])tember 9, the ship's surgeon was taken ill with "bilious fever" and trans]K)rtrd to the mili- tary hos])ital, where lie died on the 13! h, with unmistak- able symptoms of yellow fever. The invasion would in all probnbility have been con- fined to this case, for Saint-Louis had up to that date suc- cessfully ballled the jK'stiieiire whi( h was at its very doors, had it not been for an un])ardonable 'mi)rudencc on the part of the health authorities, caused by over-contidence 270 HISTORY OF YELLOW FKVIR. and commercialism. On September 29, the dispatch boat Cygne. which had taken part in the expedition against the natives of the Upper Senegal, returird to Saint-Louis, having' on board 51 wounded, of which 17 were Europeans. The Cyyne was permitted to land her passengers unmo- lested, although it was known that the vessel came from an infected territory. The soldiers returned to their homes and mingled freely with the pojulation. In a few da3% the poison began to diffuse itself through the town and the tirst death from yellow fever oocurT-ed on October 6. The next day, another case terminated fatally. Other cases followed rapidly, proving fatal in almost every in- stance. On October 8, the disease was widespread. In spite of this deplorable state of affairs, the authorities strenuously denied all knowledge of the existence of j-ellow fever in the town, even after eight fatalities had taken place between the 9tli and 15th of October. About that date, although still refusing to admit that the epidemic was one of yellow fever, the administ. ation began sending the sick and the "suspicious cases" to an improvised lazar- etto at the Pointe-aux-Chameaux, a short .listauce from Saint-Louis. The truth of the presence of the terrible disease in their midst soon l)ecame too apparent to Iv? discountenanced and the stolid optimism of the little group of Europeans suddenly gave place to panic and despair. A rumor was circulated that all the cases transported to Pointe-aux- Chameaux died as soon as they reached the lazeretto and the families of the "suspicious cases" soon began to con- sider an order for the transportation of a beloved one equivalent to a burial permit. ^, Lcjcml)le graphically descril)es the wav in v.hich the unfortunates were transferred to the lazarettu. Every |^* morning, about nine o'clock, the patrol Avould make its f:~ rounds and anyone found with fever, or even "suspicious," was taken in tow. It was a gi-uesome sight to see these wretches dragging their Avays thrcugb the streets of the town, some clad only in the blanket which had covered them on the sick-bed, some so weak that they had to be propped up and helped along by the native healtli-guards. But tlie people, dazed by the teriiiiie Jiav^c which was SENEGAL. 1878. 87 1 goiug- on iu their midst, looked on >vitli sullen indifference at the spectacle of their relatives cr comrades being driven like cattle to the water's edge, where tiicy would be packed into a small boat hardly able to contain half their num- bers and rowed by blacks for two, Weary hours, under a blazing tropical sun, to the pest-hovse at the Pohite-aux- Chameaux. No wonder that they were either dead or mori- bund vrhen they reached their destination. And (lie terror which the simple Avord "Lazaretto" caused the people was certainly well-founded, for out of about 150 yellow fever patients transported from Saint-Loui?! to the Pointe-aux- Chameaux between October 15 and T\oven'iber IT, there were 108 fatalities. If the mortality at the Pointe-aux-Chameaux lazaretto was excessive, other localities, where the soldiers were sent by the authorities in a frantic endeavor to stop the ravages of the disease, suffered as much. At O'Niaga, Lampsar, N'Dialakkar, Bel-Air, Cape Manuel, Hann, M'Bidgen, Tides, and other j^osts, we find the same terrible record of fatalities. The fatalities in Saint-Louis, when ihe last death took place (December 17), amounted to 3r> among the civil population (Europeans) and 30 sold'ci's. The Disastrous Lor/o U-vpt Jition While the epidemic was raging at Goree, the French government ordered that a punitive foi ce be sent lo Logo, a district northeast of Sieri-a Leone, +o avenge some fan- cied wrong committed by tlie natives. The chief health officer of Saint-Louis, the starting ])oint of the expedition, sent a vigorous protest against su^di a measure, urging as the ])rinci])al reason the unsanitary coMdition of the country, the fact that yellow fever was raging "up the river," and the distance of the territory to be invided; but his protestations were unheeded On September 11, a few days before the fever broke out in Saiiit Louis, the troops were embarked on the dispatch boats Arahc, Ci/f/nc and Espadon. The expedition consist', d of 535 iiit n, 317 Europeans and 218 native soldiers. The l.ealtl: of the column was perfect. 272 HISTORY OP" YELLOW FEVER. The fii>t cases on board the flotiihi took place in the vicinity of Daiiana and Podor and the first death occurred at Kakel, in FriMich Sondan v<|. v.), on September 15, foui' days after leavini* Saint-Louis. ]*revions to the arrival of the vessels at l^akel, where the ••jirrison consisted of only eij^lit Europeans, there had becTi seven deaths from yellow fev( r in the villaiie Ijetwc-n Aujnist 10 and Se])teni- ber 11. Includinii tht^ case Avhich terr-inated f-iLally on September 15, and wliich was im])orted by the exi^edition, lliei'e were altogether 17 deaths at Bnkel between Aujiust 10 and October 27. Nine of these denths resulted from eases landed from tlie Arahc and Esjxnlon. Yellow fever was also prevailinji at Salde, a small post on the Upper Sene<»al Kiver, which haO been contaminated by Tialiel, for some time previous to tlie arrival of the fleet. A death occurred on August 22d, one on tlie 2(it)i, and a third on September 5th. After the "battle" of Saboucire, the soldiers stopi)ed at Salde on their \, av to Sanit-Louis and we tind a, record of three deaths on October 3 and one on October 11, making a total of nine deatlis between August 22 and October 11. The "battle" of Saboucire t(K>k j)lace on September 22 and lasted four hours, Avithout accomplishing anytliing decisive. The column immediately Ik gan its journey h(uiiewai-d. For ten days the expedition slowlv wended its way down the Senegal Kiver, harassed by disease and fatigu' . Tnable to proceed further, owing to the wide- sjiread ])revalence of fev<'r in their ianl>s, a portion of the retreating column haltet. Sani- tary measures were at once taken and the disease restrict- "Noury: Gazette Medicale de Nantes, 1884, vol. 2, p. 85. 27* HISTORY OF YELLOW FEVER. ed to its orij»iiial site. The j»ensis of this outbreak has never been clearly elucidated. Beren^er-Feraud^^ notes the fact that the tailors liad been occupied in remodeling cloth iiarments wliich had been stored juuce the great epi- demic of 1878, and attributes the infection to this fact. But this theory can hardly be seriously entertained. The epi- demic of 1878 came to an end on Drcember J 7 of that year and the outbreak under discussion took place in March, 1880. It will therefore be seen that th*^, veteran fit.egomyia Calopac of 1878 must have been endowed with phenome- nal powers of endurance to hibernate for fifteen months in a lot of old garments and then be possessed with sufficient l)ugnacity and vigor to introduce tlie poison into the systems of the unfortunate wielder« ol the needle and tiiread. That the health authorities of Saii't-Louis l)Plieved in the theory promulgated by Rerenger-P'.-raud^ was proved by the fact that the offending garments were oidered to be incinerated and the vestment makers were put under strict surveillance. The outbreak wa< stamped out at once and the public health continued to be excellent throughout the winter. In tlie beginning of November, however, the fever again broke out in tlie infantry barracks of the garrison of Saint-Louis and lasted until the begin- ning of 1881, resulting in eighty d(atliJ-. Tbe cause of this second outbreak has never been lu< idlj explained. 1S81. Saint-Louis. The year 1881 witnessed another terrible epidemic of yelloAv fever in Senegal. We are indebted to Berenger- Feraud, Duval, de Bois'se,. Xourv and Esclagon for the facts.'"' 'The first case was observed on June 20, in a soldier at- tached to the marine infantry of Snint-Louis, wlio was ad- °* Berenger-Feraud, p. 169. '* Berenger-Feraud, loc. cit., p. 170; Duval, loc. cit, p. 24; de Boisse: Theses de Paris, 1884, No. 52; Noury: Gazette Medicale de Nantes, 1884, vol. 2, pp. 84; 103; Esclagon; Theses de Paris, 1883. i SENEGAL 1881. 275 mitted into the hospital on the 27th, and died July 2d. On July 20, another soldier entered tlie It spital and died on the 23d, with unmistakable symptoms of yellow fever. In the interval between these two eases, three others, followed by death, had broken ont in different sections of the town — one on July 5th, which proved fatal on the 10th ; one death on the lltli and another on ti'e 15th. On July 23, several cases suddenly manifested them- selves all over the city and at the barracks. From that date, the epidemic had full sway ai-d Ir.sted until Septem- ber 26th. Out of a population of 1,000 Europeans, there resulted 524 cases and 425 deaths. M alcana. On July 25th and 28th, 108 sohlieis were transferred from ^aint-Louis to Makana, a village near Lampsar. Al- most immediately after their arrival, eight men were stricken with fever and died in a day or two nfter the onset of the disease. A ninth case liianifested itself and died August 14th. On the 20th another case occurred, followed by death on the 23d. This concluded the outbreak at Makana. No cases originated in the village, the attacks being confined to persons who had ret ently arrived from Saint-Louis. This probably saved the balance of the refugees, for every attack resulted in death. Pointe-aux-Cham eanv. Ninety-three soldiers were sent fr'jm Saint-Louis to rointe-aux-Chameaux ; 92 to N'Dijigo and 83 to Eichard- Toll. Not a single case occurred at any of these posts. Bop-Diarra. On July 30th, 215 men from the Saint-Louis barracks were transported to Bop-Diara. From that date to Sep- tember 10th, 21 cases and 13 deaths were recorded in the three camps improvised at this post. 276 HISTORY OF YELLOW FEVER, Govee-Dalcur. The Castor played a more uiifortuiiate role iu the chain of iufection than any other vessel in Liie waters of the Senegal, for it transmitted the di^^ea-'C to Gorte-Dakar, which had remained uncontaminat(Ml whil? the ])estilenee was being carried in every direction by rcfngers from Saint-Lonis and other infected posts. The Castor will be remembered as one of the dispatcli- boats which helped in the transportation of the Logo Expedition of 1878 and which fnrnislied its qnota of Aictims in Ihe memorable ei)idemic of that year.'''' In the l)eginning of the epidemic of 1881. a case of yel- low fever had been bronght from the Castor to the military hospital at Saint Louis. The vessel was then sent on a mission to the Cape Verd Islands, wiih the hope that the trip would prove sanitary and prevent further eruptions. No further cases occurred. ^Vllen the vessel returned to Saint-Louis, it was learned that the disease had assumed grave proportions in the town and she was ordered to Goree. Tlie crew continued healthy and Goree was con- gratulating itself upon having kej't the pestileuce away from its doors, when the commandant of the Castor was taken seriously ill. On the pretext that it was simply mal- aria, for if yellow fever had been mentioned the pati(mt would have been turned away, tlie case was admitted into the hospital at Goree. The patient died on September 5th. The attending physician. Dr. Carpentin, who had seen the disease at Guadeloupe, unhesitatingly pronounced it yellow fever, but refi-ained fi-om givi'ig publicity to the fact, fearing a panic and thinking no other cases would ensue. A day or so after the death of the officer, a work- man on board the Castor was taken i'l and died in a few days. Tlie news of tliis second case roused the health authorities from their lethargy and tl.e vessel was put under strict quarantine and sent to Bel -Air. On Septem- ber 12, another yellow fever death took place on the Castor. The crew was transported to tents on shore and Hie vessel thoroughly fumigated. The creAV v^'as then re-tmbarked, " See account of the Senegal epidemic of 187S in this volume. SENEGAL 1881. 877 as the accommodatious on sliore wore mise^^ably deficient. The health of the sailors continuing to be bad, the vessel was ordered to France. But the evil was already beyond redemption. The germs of infection created by the adniis\sion of the commandant of the Castor at the Goree military hospital, though slow to manifest themselves, finally gave evidence of their virility. Two physicians attached to the liospital were successively attacked, one of the cases resulting in death. Dr. Carpentin's secretar}^ was the next victim. The doc- tor himself contracted the disease and died and the young man who had succeeded the first secretary shared the same fate. The disease seemed to be confined tc the hos- pital, when a Sister of Charity iittacl:c-d to the parochial school was suddenly stricken, dying shortly af.'^erwards. After this, sporadic cases were observed here and there throughout the city. The disease was at no time virulent at Goree-Dakar. There were altogether 16 deaths. The Fever on the GovernAiievi Vessels. While the epidemic was raging at Soint-Louis, five gov- ernment vessels w'ere moored at the wh.irves, namely: The Jaguar, the Alecton, the African, Vae Cijf/ne and the EcureuU. The dispatch-boat VAfricain. an "(»!d tub," and at the time seldom in active service, had a crew of forty whites at the inception of the epidemic. It was anchored, or rather tied, to the wharf at Saint-Louis and was used as a sort of floating workshop bv the military authorities. It was in continuous communication with the shore. On July 2()th, the first case of yelloAv fever was observed on board, followed shortly after by six others. On August 12th, the old hulk was take'i in tow by VEcureidl and brought to -Mouit, where her crew^ was transported to im- provised tent-hospitals on shore, a short distance from those occupied by the sick from the Jacfuai, On August 10, a new case developed in the camp, and from July 20, the date of the first case, until October, ihere were 33 cases and 23 deaths. 278 HISTORY OF YELLOW FEVER. The Jaffuar, an old wooden gunboo.t, illj-constructed and badly ventilated, and wliicli had i.ininterrupted com- mnnieation with Saint-Louis, had a crew of GO whites and 25 blacks.^^ On July 29, the first ease broke out on board, followed on the 31st by six others. August 1st, another case. The vessel was ordered down the river to ^Mouit, where three large tents were constructed for th'^ accom- modation of the sick and other members of the crew. In spite of these precautions, up to the fii&t days of October, 43 new cases developed in the improvised hospitals. Total cases, 51 ; deaths, 23. The Cygne was in dock when the epidemic began. On August 4, the repairs being completed, the vessel was again placed in commission with a crew of 21 whites and 24 blacks, and anchored at the same place where the Jaguar had been Avhen the fever first manifested itself on board, where it remained four days. On August 8, the ves- sel left its moorings and anchored in the middle of the river. On the 9th, four members of the crew Avere taken ill with fever, but recovered after only three days' illness. These four cases presented no symptoms whatever of yel- low fever, but on the 13th, two other members of the crew were taken ill, presenting totally different symptoms, and were sent to the hospital. One of the cases recovered after a brief illness, but the other proved to be a typical case of yellow fever and died three days after the onset. The Cygnc left Saint-Louis on xVugust lO for Bop-Diarra, hav- ing in tow a barge containing a large number of patients destined for the hospital at tliat point. On September 26, the Cjjgnc, which in the interval had made several voyages from the Point-aux-Chameaux to Saint-Louis, returned to her ancliorage at tlie latter town. Being the only vessel then available, it was immediately pressed into service and sent up tlie river Avith a tow of barges containing pro- visions and medicines for the yellow fever sufferers. It Avas soon discovered that the machinery of the Cygnc Avas not strong enough for such a heaA'y toAA', but the necessity ''All vessels plying in the waters of the Senegal River are equipped with native sailors, who do most of the out- door work, as the whites cannot stand the fierce rays of the tropical sun. SENEGAL 1881. 279 being- urgeut, the cariio was traiis])orted on board the ves- sel, Avhicli proceeded on its mission. The voyage came to an end on October 8 and the vessel returned to Saint-Ix)uis October 17, where two white army officers from Bop- Diarra, where yellow fever was still present, and one hun- dred negro workmen from Saint-Louis, were embarked, destined for work on the railroad in course of construction up the Senegal Kiver. During the voyage, which lasted until October 30, not a single case of yellow fever was ob- served on board the vessel. On its return to Saint-Louis, forty Africans and fifty Moroccans' were sent on board and ordered transported to the railroad camps up the river. The jMoroccans, who originally nundiered 150, had lost one-third of their fellow-men by yellow fcA^er at Saint- Louis. The voyage was uneventful and when the Cijgne returned to the capital, the epidemic had almost died out. The last death in town took place on November 20th and quarantine was raised December 10th. We have given a full account of the transactions in which the Cycjne participated, because the vessel showed a remarkable freedom from infection. Out of 21 Euro- peans on board, only one attack, followed by death, took place, although the vessel was activel}^ engaged in trans- porting the sick and the pestilence was raging all around her. Tlie fact that the vessel was fresh from the dock, where she had been thoroughly overhauled and repaired, probably saved her from an invasion of the Stegomijia Calopiis, and to this must we attribute lier immunity after the first case, Avhich had evidently been imi)orted. The Alevton, a dispatch-boat employed in the coast ser- vice, was at Dakar when the epidemic broke out at Saint- Louis. She was forbidden communication with the in- fected town. About the end of August, she left Dakar and sailed up the Senegal Biver, anchoring a short distance below Saint-Louis, to the windward of two merchant-ves- sels, the General Bcif/c and tlie (lahrlcUr. There had been yellow fever cases on board both these vessels, but the fact had been withheld from the authorities and the little dis- patch-boat remained for a week in the vicinity of the ships, unsusi)ici()us of danger. On Se])tember 0, she was sent to the Cape Verd Islands with a dispatcli from the Governor 280 HISTORY OF YELLOW FSVER. of the colony. "While enroiite to the islands, snspirions cases began to show themselves among the officers and the vessel was sent to the Saint Vincent Island quarantine sta- tion on her arrival at the Cape Yerds, but only remained there a few hours, her captain preferring the open sea. On September 14, on the return voyage to Saint-Louis, the first death took place, followed the next day by two others. On tlie 17th, the vessel re-entered the Senegal River and the crew was disembarked and placed in a tent on Baba- guay Island, where the last death took place on October 1. There were altogether 15 cases and 8 deaths. The Ecureuil, a new vessel, with a crew of 40 whites and 25 blacks, arrived at Saint-Louis on the same day that the epidemic broke out. Her officers and crew had uninter- rupted communication Avith the town, and, being the only available vessel for the purpose at the time, it was used to transport the troops to the several towns up and down the Senegal River. No ill effects were observed on board until August lltli, when the cook and the mess-boy pre- sented characteristic symptoms of yellow fever and were transported to the military hospital at Saint-Louis, where they died in a few days. On August 15, the Ecureuil was sent on a mission up the Senegal and during a cruise last- ing a little over a month, no other cases developed. About the end of September, the vessel returned to Saint-Louis, but profiting by past experience, it did not anchor opposite the town, luit proceeded to the Pointe-aux-Chameaux, where it remained until the end of the epidemic. Statistics of the Epidemic. The total mortality from yellow fever among the Euro- pean population during the epidemic of 1881 has been esti- mated at TOO (Duval). We could only get statistics of transactions at the principal places of the colony. No- where do we find a word about the progress of the malady among the natives. The following recapitulation will give an idea of the malignity of the outbreak : 51 23 33 23 15 8 2 2 1 1 SENEGAL. 281 Locality. White Population. Cases. Deaths. Saint-Louis 1,000 524 425 Bop-Diarra 215 21 13 Makana 108 10 10 Goree-Dakar 16 14 Unclassified 362 181 On vessels : ' Jaguar 60 L'Africain 40 Alecton 47 L'Ecureuil 40 Le Cygne 21 1035 700 The number of "unclassified" cases (362) is estimated on a mortality of fifty per cent., based upon the excessive death-rate at every locality where the disease prevailed. For example, Saint-Louis, with a population of 1,000 Europeans, had 524 cases and 425 deaths; ]Makana had a mortality of one hundred per cent. ; the gunboat Jaguar, with a crew of 60, had 51 cases and 23 deaths. The "un- classified" mortality being 181, we believe that the cases were certainly not over double that number; they were probably less. The soldiers, as usual, paid a heavy tax to the pestil- ence. The following figures speak for themselves : Total number of soldiers in the colony, 550. Number attacked, 246, or 44 per cent. Deaths, 216, or 81.7 per cent, of the number attacked. Forty-five officers succumbed. 1882. Goree. The epidemic of 1882 does not appear to have been im- ported, but to have been of spontaneous origin. The de- 282 HISTORY OK YELLOW FEVER. molition of the old military hospital at Goree is given as one of the causes. This work was to have been done dur- ing the winter, but, for some cause or other, was delayed until June. It is natural to infer that the razing of this old pest-house should liberate thousands of mosquitoes and that these insects, still impregnated with the virus of the epidemic of the year before, should engender another outbreak of a disease which has been the executioner of the unfortunate European residents of Senegal for nearly two centuries. The first case manifested iteslf on June 12, in the per- son of Dr. Duval, one of the health officers of the colony, who wrote an elaborate historj^ of his illness and to whom we are indebted for the facts of the rise and progress of the epidemic.''^ It seems that, while the workmen were engaged in tear- ing down the old building. Dr. Duval moved his office to a room which had in former years been occupied by the munici])al board of health. Owing to the warm weather, the windows were kept open during the business hours, thus allowing full ingress to the dust and mosquitoes from the falling timbers. The doctor states that he began feel- ing ill about June 12, but did not take to bed before the 15th. He gives a detailed account of the attack, which was a typical case of mild yellow fever. He was confined to his room for eleven days and made an uneventful re- covery. Xo other case was observed until July 7, when a wash- erwoman employed in the barracks was taken ill, dying on the 12th. On July 8, a merchant was stricken, recovering after an illness of thirty-four days. The fourth case, July 9 (a clerk), recovered. The four sporadic cases above noted were not made pub- lic by the authorities. On July 24, the number of cases became so numerous, that the fever was declared officially present, and active sanitary measures were put into execution. On July 26, the other posts in Senegal quarantined against Goree. When the fever was declared epidemic, there were 1,800 blacks and about 67 whites at Goree. Of these 67, there "Duval: La Fievre Jaune a Goree (Bordeaux, 1883), p. 94. I SENEGAL !88«. 283 were 37 who had already suffered an attack of yellow fever in previous epidemics, thus leaving 30 susceptible to infection. The virulence of the epidemic was certainly notable, for of this small number, 27 were attacked and 15 died. The last case manifested itself on September 17 ; the last death occurred September 22d. The epidemic of 1882 gave rise to much discussion among the French medical men. Some claimed it was imported from Brazil, others from Gambia, while the ma- jorit^^ (among whom we notice Duval and Berenger- Feraud) insist that it originated at Goree. AVe tliink the last hypothesis correct, as there was no yellow fever in Gambia in 1882 and no suspicious vessels from Brazil were observed in the waters of the Senegal that year. The demolition of the old military hospital probably hastened the outbreak, but the infected Stcgomjjia would no doubt eventually have ventured into the open and diffused the X)oison among the susceptibles. Dakar. Dakar, a suburb of Goree, separated from the town by an arm of the Atlantic Ocean, observed a strict quarantine, but the harl)ormaster of tlie vilhiige went on a secret visit to Goree about the end of August and was stricken with yellow fever a few days after his return home. This im- prudence cost him his life. No other cases were noticed in Dakar until the middle of November, wlien the quartermaster of the dispatch- boat AUnitvofiS, then anchored opposite Dakar, died at tiic hospital under circumstances which strongly pointed to yellow fever infection. A soldier at the barracks was the next victim. A panic ensued when the news of these two deaths became known and eight white men engaged in rail- road work fled to Yof, some distance from Dakar, wliere the fever broke out among them. Concluding that they would receive better medical attention at Dakar, they re- turned to the village, where three of their nund>er died. The fever pursued an erratic course at Dakar and finally came to an end on December 22. There were altogether 10 cases and 30 deaths. 284 . HISTORY OF YELLOW FEVER. Riifisque. Rufisqiie, also located on the continent, opposite Goree, furnished two cases, one on August 10, followed by re- covery, and the other in the beginning of September, re- sulting in death. The source of infection is not given, but the natural inference is to incriminate Goree. 0)1 the Albatross. The dispatch-boat Albatross, newly-built and fresh from France, arrived at Saint-Louis, September 10, 1882'. It had a crew of 52 whites, which was increased to 80 by ^ho addition of 28 blacks upon reaching the capital. Tli3 quarantine against Goree was raised October 27, 1882. The Albatross^ which had in the meantime been emxjloyed in carrying the mails from Saint-Louis to Dakar, took some passengers from Goree for Saint-Louis on the day the quarantine Avas raised. These consisted of whites and blacks, who had been in the infected town for some time and who were anxious to return home. On November T, the vessel returned to Dakar, Avith passengers for a ves- sel then about to sail for France. On the Avay to Dakar, the Albatross stopped at the Pointe-aux-Chameaux and took some passengers. One of these men had been ill for some days and was brought on board in a litter. There being no suspicious sickness at the Pointe, no objections were raised to the embarkation of the patient, who was said to be suffering from malaria. Arrived at Dakar, the patient Avas transported to the hospital, Avliere he died on Koveml)er 13. An autopsy reAeahnl lesions which raised some doubts as to the natui'e of his illness and his com- panions were put under surA'eilance. No cases dcAeloped among them. A fcAV days later, the quartermaster of the Albatross was taken ill and trans])orted to the hospital at Dakar, where he died shortly afterAvard. A soldier was taken ill at the barracks and died. Yellow fever was then officially declared present on the Albatross and at the Dakar hospital. The crcAv of the vessel were transported to the lazaretto on November 21. SeA'eral deaths occurred at the lazaretto. On December I SENEGAL — 188a. 285 30, the sailors retiirued on board the Albatross^ which had been thoroughly disinfected, A few days after the return of the crew, the new cases developed. This was followed by live fatal cases between the 8th and 11th of January, 18S3. Orders were then received to return to France and the vessel arrived at Brest on March 15. The course of the disease on board the Albatross was very severe. Out of a crew of 52 whites, there resulted 21 cases and IS deaths, including two officers. A perplexing question now presents itself: Where did the Albatross contract the infection? Xot at Saint-Louis, for not a single case was observed there in 1882 ; not at the Pointe-aux-Chanieaux, for the place is said to have been remarkably healthy at the time and to have had no communicaticn wliatsocver with infected localities. These two places being disposed of, suspicion naturally falls upon the only other locality visited by the unfortunate vessel — Dakar. Duval incriminates the Point-aux-Cham- eaux in the infection of the Albatross, basing his accusa- tion on the fact that the tirst case of fatal illness observed on board was that of the passenger from that hamlet. We do not believe this was a case of yellow fever at all. The fact that none of the other passengers were attacked (ex- cept some time afterwards, when the disease had assumed epidemiological proportions at Dakar) leads us to believe that it was simply an aggravated case of paludism. Now, let us see what Avere the conditions at Dakar. Duval himself] (Joe. cit., page 40) relates the case of the harbormaster of Dakar, who is supposed to have nmde a secret visit to Goree, in spite of the rigid quarantine then existing, and who died of yellow fever at Dakar during the last days of August. It will be remembered that tlie Albatross was in constant communication with that vil- lage from the date of her ari'ival in Senegal (September ID), doing service as mail-])a(ket between that pla<'e and Saint-Louis. The quarantine against Goree was raised on October 27. This was followed by an exodus from Goree to Saint-Louis, but none of the refugees infected Saint-Louis and it is natural to presume that they did not carry the contagion on board the Albatross. The first case of vellow fever officiallv observed after the quarantine a86 ilISTORY OK YELLOW FEVER. against Goree had been raised did not take place on board the Albatross, but originated in the barracks at Dakar and it was only after the crew had been transported to the lazaretto at Dakar that the disease manifested itself among the unfortunate sailors. It is true that the death of the quartermaster of the Albatross preceded that of the soldier, but the former was oftener on shore than on boai'd while at the village wharf and could easily have been infected while off duty. We make this explanation to escape the charge of inconsistency. From the end of August, the date of the fatal illness of the harbormaster, to the middle of November, when the first death took place among the sailors, is undoubtedly a long time between cases, but it must be borne in mind that, in 1882, Dakar was peopled principally by negroes, with a sprinkling of whites here and there, most of them immune through having suffered during previous epi- demics, and it was only wlien non-immunes arrived at the village that the ^itcgoinyiac, infected months lU'eviously, proved their virility. 1000. The First Prc-Epidemic Cases. The demolition of tlie old military hospital wliich had for years been the disgrace of Goree must have given the quietus to the infected ^tef/omi/iac which had been the bane of Senegal since 1878, for not a single case of yellow fever was served in tlie colony from 1882 to 1900, a period of eighteen years. The focus of tlie epidemic of 1000 began at Dakar. On April IG, a clerk employed in that village was admitted into the Goree hospital, in the last stages of an illness diagnosed by the attending physician as "diphtheria." He died an hour after admission, with black vomit. The autopsy revealed no trace whatever of diphtheria. Sus- picious lesions were observed, but as yellow fever had not been noticed in the colony for years, no thought was given to this malady and a verdict of "death from pernicious fever" recorded. I SENEGAL 1900. 287 On April 19, a patient entered the hospital, suffering from lieadache, dizziness and ditliculty of speech. He g-radually became worse and died on the 27th. The autopsy revealed unmistakable lesions of yelloAV fever, but the physicians present scouted the idea. One of those who participated in the autopsy remarked that, at any other time, he would have had no hesitation in pronouncing- it a case of genuine yellow fever, but that the health of the colony and the surrounding country was perfect and lie joined his confreres in giving a verdict of death from "in- fectious jaundice." The first case had already been forgotten and no one thought of connecting the two deaths with a common cause, although they had occurred at an interval of only eleven days and had presented identical pathological lesions. The third case was admitted into the hospital on April 30 and died on ]May 3. On May 8, a man and a woman were transported to the hospital. The first case died the following day ; the second, five days later. All these cases came from Dakar and in each instance presented typical symptoms of yellow fever. The last two deaths awakened a vague suspicion on the part of the authorities that the sanitary conditions of Dakar demand- ed an investigation, but not wishing to alarm the popula- tion, orders were given to proceed with great secrecy. Un- der such conditions, no open precautionary steps were taken and the slumbering pestilence, untrammeled by pre- ventive measures, gathered fresh fuel each day. On May 11, a Moroccan, who had left Dakar seven days previously, died at Thies, an army post on the railroad, be- tween Rufisque and Tivaouane. A mulatto girl, aged 4, was taken ill at Dakar about the same time and died on the IGth. On INfay 18, the disease was for the first time officially admitted, the director of public health giving oi-ders that the following be inserted in all bills of health given vessels leaving the colony: There exists a few isolated cases of suspicious ijrUoir fever at Dalar a)id its ricinifi/. HISTORY OF VKIICW FEVER. Dakar was declared infected aud placed under quar- antine. The people of Dakar, far from being frightened by this official declaration, indignantly denied that such a state existed. They claimed that the doctors had blundered ; that yellow fever, according to the views of the oldest in- habitants, had never been known to proceed at such a snail's pace, luit by leaps and bounds. They claimed that the prevailing illness was an aggravated type of malaria, caused by extensive digging operations at Hann, a neigh- boring village. The merchants, seeing their trades imperiled, took ad- vantage of the trend of public opinion and vigorously pro- tested against the institution of rigorous sanitary meas- ures. The authorities were hamj)ered, hooted and abused, cases were hidden and the way thus paved for an epidemic which was destined to ravage nearly every city, town and hamlet in Senegal. On ]May 22, the troops stationed at Dakar and Rufisque were ordered dispersed along the railroad running between Dakar and l^aint-Louis, only about four hundred being left behind. This was done without consulting the author- ities of Dakar, and a storm naturally ensued when the news became public. In this connection, it is interesting to note tliat the first cases were all among the civilians, the military being attacked onh^ in June, two months after the outbreak at Dakar. On May 22, two cases broke out anunig the personnel of the railroad com])any at Dakar, followed the next day by a case in the same house where the first victim of the epidemic had died (April 16). Two of these cases proved fatal. The railroad hospital, where the two first cases were originally l)rought, was at once disinfected by the authori- ties and ordered closed. On jMay 17, tour workmen arrived at Senegal from ^Forocco. Two lemained at Dakar, while the other two ])r( needed to v^aint-Louis. On ]May 23, the two who had been left behind were taken suddenly ill and transferred to the town hospital, where they died on the 28th, with undeniable symptoms of yellow fever. SENEGAL, 1900. '289 By a peculiar coincidence, one of the ^Moroccans was taken ill at Saint-Louis on the 23d, the same day his com- rades were stricken at Dakar, and died on the 2Gth. It will thus be seen that, notwithstanding- the fact that yel- low fever had been present at Dakar since April KUh, and that communications between that village and Saint-Louis was figuratively unrestrained, the capital was only in- fected on May 23. May 28, another death at Dakar. From that date, the situation seemed to improve. Some of the more timid Europeans, however, left the colony, but the majority, thinking the outbreak was at an end, concluded there Avas no danger and laughed at the fears of their less courageous countrymen. Recrudescence at Dakar. The slow progress of the disease is one of the most re- markable features of this epidemic and can only be ac- counted for by the fact that the Calopae had not yet be- come active, the weather being still a little too cool to per- mit them to freely circulate among the population. From May 2Sth to June 7th, no cases were observed. Lulled into a false sense of security by this subsidence of the disease, the quarantine against Dakar was raised. From April IG to May 28, there had been 14 cases and 11 deaths. Tliis is what Dr. Kermorgant terms the "first, or pre-e])idemic period." Tlie progress of the epidenuc under discussion showed the identical characteristics which has attended nearly every outbreak of yellow fever in Senegal : First, a few cases, followed at long intervals by others. The disease then seemed to advance by gusts, each time more serious and less removed, until its viru- lence finally asserted itself and each day brought a case or two or a death. Up to June 8, the mortality had been 78.6 per cent. On that day, a sergeant of infantry stationed at Camp ]Made- leine No. 2, near Dakar, was stricken and died on the 10th. Before dying, this officer admitted that he had evaded the quarantine regulations and had slept at Dakar on several occasions. 290 HISTORY OF YELIOW FEVER. June 9. The bishop of Saint-Louis, while making pas- toral calls at Dakar and Kufisque, was taken suddenly ill and died on the 13th. June 10. A clerk at Dakar succumbed, after a brief illness. June 11. Two sisters of charity, one of whom had nursed the bishop, were stricken. On June 10, Dakar was again quarantined. A military sanitary cordon was placed around Cape Yerd peninsula and the terminus of the railroad moved to Rufisque. The authorities had at last awakened to the seriousness of the situation ; but it was a sad analogy of the trite expedient of locking the stable after the horse had been stolen — the germs of pestilence were already too widely disseminated and no preventive measures under heaven could check the march of the saffron scourge. The mass of the people, still unconvinced, looked upon these acts as an uncalled for usurpation of power and continued to clandestinely visit the nidus of infection. June 15, two new cases at Dakar, followed by one death. On June 27, a new case at Dakar, followed by another on the 20th. The first case died on' the 30th, the second on July 1. There liad been no new cases since June 15. From tliat date, the epidemic had full sway. Every place in Senegal became suspicious of its neighbor. Local quarantines were established, every town and hamlet inter- dicting communication with the other. The panic reached such an acute stage, that armed guards were stationed everywhere and natives who attempted to get within the lines were shot down like dogs. Panic and Flight. It was only towards the end of June that the European population of (loree, Saint-Louis and other towns of Sene- gal began to realize that something unusual was taking place in the health conditions of the colony, The peo- ple awoke, as if from a dream, to find itself facing what seemed inevitable death. All the horrors of previous epi- demics were suddenlv brought to mind. Indifference to SENEGAL, 1£00. 291 existing condition^ gave way to consternation and panic. The physicians were no longer hooted or ridiculed, but were besieged for advice as to the best preventive methods to follow. Hundreds sold their belongings and sought se- curity in flight. The passenger steamers leaving for Europe were taxed to their utmost capacity and when the large mail steamers, fearing to contaminate their crews, refused to take passengers, the refugees were only too glad to escape by means of the filthy coasting vessels, which took them to ports where quarantines were not in force, whence they proceeded by roundabout ways to Europe. Some even took passage on vessels bound for South Ameri- can ports, trusting to luck to meet some European-bound vessels on the high-seas. The official journals of Senegal, in their accounts of this wholesale exodus, state that near- ly 3,000 persons left tlie colony between June and Sep- tember. The following tableau of departure from Senegal by ocean steamers from July 1 to August 16, gives an idea of the eagerness of the people to flee from, this plague spot of Western Africa : Passengers. July 1. By steamer Faidherhe 15 July 1. Bv steamer Vcnihan 160 July 12. By steamer Villc de Pernam'biu^o . ... 82 July 26. By steamer Caravellas 435 July 27. By steamer Ranta Fe 223 Aug. 13. By steamers Ville de Maccio and Macina 278 Aug. 16. By steamers Richelieu and Campana 473 Total 1.666 In addition to the above total, must be included the departures prior to 3\\\y 1st, and the exodus by the coast- ing vessels and other French and English vessels, of which no record was kept by the port authorities. That the fears of the owners of these passenger steamers were well grounded, was exemplified by the fact that cases occurred on many of these vessels. The disease did not spread, however, being confined to the original cases. 292 HISTORY OF YELLOW FEVER, The disease was ev^en brought to the lazaj'etto at Paulliac, France, where several cases were treated without creating any focus. Even Paris — careless, wicked, fun-loving Paris — was wrought to fever heat at the policy of concealment pur- sued by the colonial authorities. The government had sent 2,000 young soldiers a few months previous to Senegal, to "pacify" the natives in the interior, and the public wanted to know why their countrymen were sent to this barbarous region to die like rats, alleging that these dependencies, whose only products were pestilences and murderous negroes, were not worth keeping. The Paris Soleil, in commenting on the epidemic, thus concludes an inspired article: "Physicians die like flies. Sisters and infirmarians fol- low the same road. Mass is no longer said in public on account of contagion. Fortunately, there will always re- main a negro priest to absolve the last who die, for it is a curious fact that the negroes are completely immune." . Consul Strickland, the representative of the United States, at Senegal, from whose reports some of the details of the inception of this epidemic are taken,^^ gives graphic pen-pictures of the scenes at Goree-Dakar and Saint Louis. "The epidemic has brought the business of the colony com- pletely to a standstill," he observes, "and all Europeans have got away, who could command the means to do so. The stores are shut, and it is difficult to obtain the neces- saries of life." Consul Strickland sailed from Senegal during the last days of July, 1900, and the United States Consular reports give no details of the progress of the epidemic after that date. We are indebted to the exhaustive accounts pub- lished by Dr. Kermorgant in the Annalcs cVHygiene et de Medecine Coloniales and the Reaiidl des Travaux de Comite Consiiltntif d'Hygiene Puhliqiie de France, for most of the facts which precede and follow.®^ °'' Strickland: U. S. Public Health Reports, 1900, vol. 25, pp. 1679; 1866; 2025; 2188. "Annales d'Hygiene, etc., -rol. 4, pp. 325, et seq. ; Recueil, etc., Paris, 1903, vol 31, pp.. 369, et seq. SENEGAL, 1900. 293 MARCH OF THE EPIDEMIC. Dakar. As already noted, the true epidemic epoch may be said to have manifested its-'.elf Avith the series of cases and deaths at the end, of June, 1900. On July 4th, 5th and 6th, cases cropped out everywhere, and it was a question of satire qui pent. The authorities resorted to the tardy expedient of sending the white troops back to Europe, and replacing them with native soldiers. From the 1st to the 31st of July, there were sixty cases and thirty- one deaths, at Dakar. The exodus of a majority of the white population does not seem to have done much toward arresting the progress of the pest, for twenty-nine cases were admitted into the hospital, in August. Of these, four cases came from Saint Louis and Thies, and five were taken f'rom the steamships General Dodds and Vauhan. The nine importations, there- fore, leaves the actual number for Dakar at twenty. The epidemic gradually subsided, for want of material, in September, nine cases and four deaths being recorded for that month, October, three deaths. The epidemic finally came to an end in November, with two cases and one death, making a grand total for Dakar, from April 16, to November, of one hundred and forty-two cases and seventy-six deaths. GOREE. Goree quarantined against Dakar, May 27th, 1000, but not much attention was paid to the mandate, communica- tion between the two localities beiug almost uninterrupted. This lack of precautions soon bore fruit. A soldier of infantry, who had been given a furlough, celebrated the event by making a round of the barroouis of Dakar, on Sundaj', June 17th, and returned to camp in a beastly state of intoxication. On the 20th, he was sent to the hospital, where he died with black vomit, on the 23rd. 294 HISTORY ()!• \ ELI.O\V FEVER. The white garrison of Goree was immediatelT trans- ferred to a point near Yof, only a few being retained for emergencies. These were quartered in the Castle, the highest part of the town. From June 23rd, to July 4tli, nothing abnormal was observed. Thinking that the death of the soldier was merely an imported case, and that no others would result, the company which had been sent to Yof, was recalled. The return of their comrades was taken as a pretext for jollification by the soldiers in the Castel, and much carous- ing and drunkenness ensued. The personnel of the gar- rison numbered seventy- five. On July 14th, one of the soldiers who had returned from Yof, was taken ill and died five days later. From that date, the cases followed each other in rapid succession — three on the 16th, two on the 18th, one on the 19th, two on the 20th, and one on the 21st. Thus it went until the end of July, Avhen a total of nineteen cases and seventeen deaths was recorded. Three cases were observed in August, the last on the 17th. The total number of cases at Goree were 22 ; deaths, 20. Kot a native was attacked, this frightful tribute to the scourge being paid only by Europeans. RUFISQUE. On ]\ray 12th, 1000, a clerk employed by the Compngnic Francaisc dc VAfriquc Occidcniulc was taken ill at Eufisque, and transported to the hospital at Dakar, where he made an uneventful recovery. May 17th, two new cases. For over a month, no other cases. On June 21st, an- other employee of the Cowpaf/uic Francaisc was taken ill and died shortly afterward. This case caused some consternation, and the rai/road terminus, which had been moved from Dakar to Rufisque, was changed to Thies. A part of the white population of Kufisque became apprehensive, and 68 took passage for France on the steamship Gi/ptis. SENEGAL, 1900. 295 June 22nd, four new cases, followed by three deaths. Nothing abnormal until July 9th, when two new cases, followed by death, were observed. No other cases in July, probably due to the fact that nearly all the non-immunes had fled. In August, 3 cases and 2 deaths. In September, no cases in town, but one on board the Steamship Faidlierhe, followed by death. October 26th, one case. No cases in November, but on December 24th, a clerk who had arrived from France on the 10th of the month, died with black vomit. The total number of cases reached 18 ; deaths 15. Saint Louis. Saint Louis had more cases than all the other localities in Senegal combined, and came within 21, of equaling the combined mortality of all the other afflicted places. The statistics for the colony are 416 cases and 225 deaths ; the figures for Saint Louis alone, 218 cases and 102 deaths. It will be remembered that a sporadic case of yellow fever was observed in Saint Louis, on May 23, 1900, in the person of a Moroccan, who, with a companion, had arrived from Dakar eight days previously. The patient died on May 26th. The pliysicians of Saint Louis denied at the time that it was a case of yellow fever, but when the dis- ease had become epidemic in the town, they admitted that they had been mistaken in their diagnosis. . The death of the IMoroccan was not followed by imme- diate results and no new cases were observed until July 16, seven weeks later, when the fever manifested itself simultaneously in opposite parts of the town, one case in the Rognat-Sud barracks, located in the center of the island, and the other at No. 14 Rue de la Mosque, at the north end. The case in the Eue de la Mosque proved to be the com- panion of the Moroccan, who had died on ^lay 26th, in this same house. He died on July 17th. Dr. Kermor- gant attributes this fatal case to emanations from a trunk 296 HISTORY OF YELLOW FEVER. containing clothes which had been packed at Dakar, when the foreigners took their departure, and which was opened for the first time at Saint Louis in the beginning of July. The infection of the Eognat-Sud barracks, acording to Dr. Kermorgant, was caused by the opening of hogsheads packed with military garments brought from Dakar by the steamer Saint-Kilda, and which had been distributed among the soldiers without being disinfected. But, why not directly accuse; the Saint-Kilda of being the active agent of importation? It is of record that the vessel had sojourned five days at Dakar before proceeding to Saint Louis, and that communication between the crew and the inhabitants of the village had been uninterrupted. At Saint Louis, the Saint Kihia was subjected to a quar- antine of only three days, and her cargo consisting mainly of cases of cotton and woolen goods, was disinfected ex- ternally, and only unpacked when it had reached the con- signees. Of course, the contention that the infection was carried by these goods is too puerile to admit of argu- ment, but it is a well-known fact that mosquitoes will live for days without water, and even if a solitary infected Stcgom/jjia had found lodgment in one of the packing- cases, this was sufficient to spread the contagion. And this is undoubtedly what happened. There is no doubt in our mind that the infection was brought by the Saint-Kilda. During the time the ship was quarantined, the passengers and crew were allowed free intercourse with the shore, and the crew are said to have been quite "chummy" with the soldiers, mingling with them in barrooms and other places generally fre- quented by sailors. We do not wish to convey the impres- sion that this affiliation could transmit the germs, as they are not disseminated by contact, but relate the incident to show that no precautions at all were taken to prevent the importation of the disease into the capital, although it was a notorious fact that Dakar was at the time a hot-bed of contagion. The simultaneous explosion of the disease in two widely separated sections of the town can be explained by the supposition that the Moroccan, like all those of his race, SENEGAL, I too. 297 who come by hundreds to Senegal every year, was em- ployed as laborer along the river front, and formed one of the gangs engaged in discharging the Saint-Kilda. The opening of a trunk almost two months after the death of the first Moroccan could not create a new focus of in- fections. No Stegomyia, no matter if endowed with phe- nomenal vitality, could live for that length of time shut out from water and air, and we must look elsewhere for the source of <'ontamination. And, naturally, we incrimi- nate the vessel under discussion. It is worthy of note that all the customjhouse employes who assisted in checking and examining the cargo of the Saint-Kilda, were one by one attacked by the disease in the beginning of the epidemic. This, of itself, should suffice to incriminate the vessel. There is no record of the appearance of tlie disease on board, but as the crew were principally natives, whose immunity to yellow fever is proverbial, and the officers were probably acclimatized, the vessel escaped an invasion. But here comes our astute friend, Mr. Doubting Thomas, with his over-ready interrogation point, and wishes to know how it is that the case of the first Moroc- can, who died on May 26th, did not disseminate the germs far and wide, but that the disease only became epidemic in July? The explanation is just as easy as eating water- melon with a spoon. The case of the first Moroccan was a notoriously imported one. The poison was in his sys- tem when he left Dakar for Saint Louis, and the natural sequence was that it manifested itself when the period of incubation had reached its limit. Had he gone to Paris, London or any other place on the face of the earth, which could be reached within the period of incubation, the dis- ease would have asserted itself just the same. And, as at Saint Louis, it would have stopped right there, if the active agent of dissemination, tlie Stcgomia, was not present to convey the poison. And what saved Saint Louis from invasion in May, was the fact that the cold season was not yet over, and the yellow fever mosquito had not yet begun its activity. 298 HISTORY OF YELLOW FEVER. In July, wlien the Saint KUda arrived at Saint Ix)iiis, fresli from a nidus of infection, conditions were different. The mosquito season was in its zenith, and a single case of yellow fever was all that was needed to cause an epi- demic. And, as we shall, see, the capital of the colony provided an ideal field for the propagation of the malady and paid the heaviest penalty. Although the first death' from yellow fever in the Rognat-Sud barracks took place on July ITth, the garri- son was only removed from that place on July 25th, up to which time, eleven soldiers had already been attacked. About twenty Avere left behind, and this imprudence was the cause of successive contaminations, the barracks thus becoming one of the most active foci of infection. The second focus, created by the case in the Rue de la Mosque, radiated towards the north, successively infecting all that section between the starting point and the native quarters. A third focus was created in the quarters .devoted to colonial affairs, where the goods from the Saint-Kilda had been landed, and thence radiated towards the southern part of the city and across the small arm of the Senegal to tlie natiA'e village of Guet-X'Dar, on the Barbary Peninsnla. From July 16th, to August 5th, cases cropped out here and there, which goes to jirove that the infection Avas l^retty widely distributed, ^loat of these cases were fatal. On August 5th, seven new cases. From that date, the epidemic waA'O surged over the island with such fierce in- tensity, that it is hardly possible to keep ])ace Avith its progress. Of the tAA^enty soldiers Avho had remained at the Rof/))af-Siid barracks, fifteen Avere sent to the military hospital betAveon Auguse Tth and 21st. The majority sue- v< combed. On August 8th, forty-fiA'e soldiers were transferred to the natiA'e Aillage of N'Dartoute and tAA'enty to Pointe- Nord. These remained uncontaminated until the end of September, Avhen nineteen of the men at Pointe-Xord were attacked. The troops were then sent to M'Pal and Louga, Avhre they remained until the end of the epidemic. ^1 SENEGAL, 1900. 299 The epidemic began to subside at Saint Louis, about September 15tli. .New cases were observed September 20th, 25th, 26th and 27th, and October 5th, 10th 13th and 14th. There were no cases in November. On December 31st, one new case, a civilian from Louga. A civilian who had recently arrived in the colony was taken ill on January 11th, 1901. The epidemic of Saint Louis thus came to an end on that date, after having la/sted for nearly six months, if we are to compute the true epidemical period from July IGth, or nearly eight months, if we calculate from May 2r)th, the date of the first case. During that time, ninety-nine Europeans and three natives had fallen victims to the saffron scourge. Thies. On May lltli, 1900, a Moroccan who had arrived from Dakar, a week prevously, died at Thies. As in all other instances of "first cases," in other localities, a long inter- val elapsed before another case manifested itself. On August 27th, more than three months after the case im- ported from Dakar, an agent and a doctor arrived at Thies from Saint Louis. The agent was taken ill on his arrival and the doctor on the 29th. Both cases were sent to the Dakar hospital. Another case erupted on Auguse 31st. Altogether, seven cases were observed, the last on Feb- ruary 28th, 1901. Total cases, 7; total deaths, 4. - TlVOUANE. The first case at Tivouane, took place in August, 1900. This case was folloAved by recovery. Cases were also observed on October 2nd, November 15th, and Novem- ber 25th. The last case took place January 18th, 1901. Total cases, 4; total deaths, 4. 300 HISTORY OF YELLOW FEVER. On Vessels. Recalling the fearful ravages made by yellow fever on board the vessels doing service in the colony in 1878, every government vessel was ordered to keep away from the centers of infection during the epidemic of 1900. The only vessels which were retained, were the Hirondcllc, the Heroine and the Ahla. All three were finally iafected. The Ahka, Avhich did service as a water-boat, had a crew of eleven natives and six Europeans. It was anchored opposite Saint Louis during the epidemic of 1900, and was used for transferring the troops from one post to an- other, as they successively became infected. The first case on board occurred on August 14th, followed by three others. Only one death resulted. The Heroine, which was used as a floating hospital, had a crew of twenty-four Europeans. The vessel was anchored opposite Dakar. The first case on board occurred July 25th, the second, August 10th. From August 10th to 14th, five new cases. Between the 14th and 25th, there were only six Europeans on board the pontoon. On the last mentioned date, two new cases, followed by others on the 2Gth and 27th. In short, from July 25th, the date of the first case, to August 27th, nine cases developed on board, followed by six deaths. On August 20th, contrary to the wishes of the colonial government, a number of officers were sent on board the Hirondelle, with instructions to proceed to French Sou- dan. Forty-eight hours after the departure of the vessel, yellow fever broke out on board. The facts were imme- diately cabled to the government, and the Hirondelle was ordered to return to the capital, without touching at any point on the river. On her return, the captain reported that five cases and two deaths had taken place during the voyage. STATISTICS OF THE YELLOW FEVER EPIDEMIC IN SENEGAL, 1900-1901. The yellow fever epidemic which ravaged Senegal from April 16th, 1900, to February 28th, 1901, may be con- sidered as one of the most virulent explosions of the dis- SENEGAL, 1900. 301 ease on record. Almost the entire non-imimine popula- tion fled when the disease was officially declared epidemic, and nearly all the white troops were ordered back to France. Notwitlistandinj]j this depopulation, one hun- dred and twenty-nine soldiers were attacked, and sixty died, and of one hundred and sixty-seven civilians at- tacked, one hundred and three died. The mortality would certainly have been terrible had not three thousand Europeans souglit security in flight. Every walk of life was invaded. Soldiers, ecclesiastics, civilians, and strangest of all, natives paid tribute to the awesome pestilence. For the first time in the history of yellow fever invasions in Senegal, the natives w^ere pro- miscuously attacked. Tlie black troops alone furnished twent}^ cases and eight deaths. The appended tables, compiled expressly for this work from official records, Avill be found interesting, especially Table B, as it is the first time in the annals of epidemiology that a complete resume of an epidemic in Western Africa has been obtained. SENEGAL EPIDEMIC OF 1900. Table A. Localities Afflicted, with Cases and Deaths. Locality Soiircfi ('f Infection Dat« of 1st Case l)»te of l8t Death Date of Last Case Dflteof Last Death ToiM Ca«e8 Tofl D'th Carabane 4 4 Dakar Disputed 1 Apr. 16 Apr. 16 Nov. — Nov. — 142 76 Goree Dakar June 20 June 23 Aug. 17 Aug. — 23 20 Mehke 1 N'Dande.. .. 1 1 Rufisqiie Dakar May 12 June — Dec — Dec. 24 18 15 Saint-Louis.. Dakar May 23 May 26 Jan. 14 1901 Jan. '01 218 102 f hies Dakar Rufiisque May — Aug. — May 11 Feb. 28 1901 Jan. 18 1901 7 *4 3 Tivouane 3 416 225 302 HISTORY OF YELLOW FRVER. Table B. CLASSiriKD Resume of Cases and Deaths. Cases. Deaths. Marines G5 34 Gunners 29 12 Spaliis 7 5 Instructors 8 1 Total among white troops 104 52 Native sharpshooters. . 25 8 Total among troops ■ — — Municipal Service: Hospital Corps 23 8 Gendarmes 4 3 Unclassified 1 1 Total among munici- pal employes — — Colonial Government Service : Local Marine Corps . . 16 10 Department of Fi- nance 2 Department of Public Works 2 2 Department of Agricul- ture 4 1 Department of J u s - tice 1 1 Customhouse Inspec- tors 8 6 Post-Office and Tele- graph 4 2 Home Office 2 Unclassified 9 5 Total among govern- ment employes ... — -- Total Cases. Deaths. 129 60 28 12 52 29 SENEGAL, 1900. 303 23 13 5 5 2 10 3 167 103 416 225 Miscellaneous : On board local vessels. Ecclesiastics . School teachers Sisters of Charity . . . . Civilians OlJGlN OF THE EriDJ:MI('. When the first case of yellow fever broke out at Dakar, on April 16th, 1900, health conditions were excellent throu«>hout the colony. There had been no outbreak in Senegal since 1882. Under the circumstances, the ques- tion naturally propounds itself: What was the cause? It could not have been a recrudescence of the epidemic, for such a tiiinf? is impossible after a lapse of eighteen years. It could not have been caused by the digging of the soil and the shifting of earth laden with dejections from pre- vious epidemics, for yellow fever germs do not propagate in this fashion. There is only one door left open : Impor- tation. But whence and how? The answer is as elusive as the honest man whom our old friend Diogenes is no doubt looking for through the trackless regions of the nether world. Let us see what localities were suffering from yellow fever in 1899 and 1900, and we may find a clue. In 1899, the French Ivory Coast was the only locality in Africa where yellow fever prevailed. The only other cases in the Eastern Hemisphere were imported from A^era Cruz, and were observed on shipboard in the harbor of Nantes on the western coast of France. The fever pre- vailed epidemically in Central America, Mexico, the United States, the West Indies and South Ahierica. Could infected mosquitoes have been imported from Grand Bassam to Dakar, in 1899, where they hibernated until the advent of warmer weather? The Ivory Coast is a French possession and communication between the capi- tal of that dependency and Senegal was almost uninter- 3j4 history of yellow fever. rupted, in spite of quarantine regulations. Smugglers in- fest the coast and they are certaiuh' not respectors of san- itary or any other laws. In 11)00, yellow fever had. not been observed in Africa previous to the outbreak at Dakar. We must, therefore, look elscAvhere for the source of importation. Epidemics of more or less intensity prevailed that year in Central America, Mexico, the United States, Brazil and Columbia. The early appearance of the disease at Dakar, precludes an3- i^ossibility of its having been brought from the United States, for the disease only manifested itself in this country in the middle of the year. It rarely begins before July. In South America, however, conditions are different. There we find yellow fever in almost any season of the year. The disease was very severe in Brazil, in 1S99 and 1900— the death-rate being 731 for the former and 311 for the latter year. South America has been a notorious focus of infection since the early fifties, when the scourge estab- lished itself epidemically in Brazil, and it is quite natural to suspect Rio de Janeiro or its sister cities of having con- taminated Senegal in 1900. Yellow fever is present in Bio de Janeiro, from January to December, each year. Trade relations between Brazil and the ^Vest Coast ot Africa is quite brisk. In addition to the independent craft which ply between the two continents, two French steamship companies make regular trips from France to Brazil, and the La Plata region, stopping at Dakar on their return trip. A case of yellow fever, or infected mos- quitoes could thus easily be transported from the epidemic foci of South America to the shores of Senegal. It is of record that two of these French vessels brought yellow fever cases from Senegal to Havre (q. v.) during the epidemic of 1900. the CaravaUcs, August 9th, and the ^antci Fc, August 10th. These cases were infected at Dakar, where the steamships had touched, to take passen- gers for France. The fever did not spread, for the simple reason that the yellow fever mosquito does not flourish at Havre, and whatever infected insects had been taken on board the vessels while in Senegal, perished when they SENEGAL 1905. S05 reached an altitude hostile to their existence. Under the same conditions, the fever could be transported from South America to Senegal, but with different results, for the Stcgomyia Calopiis flourishes in nearly every country on the West Coast of Africa, and a single infected female of that species is all that is needed to start a focus, which can eventually contaminate the entire coast. Dr. Kermorant denies the charge of importation, either from other African stations or South America, leaning to the theory of revivescence of germs from previous epi- demics by the disturbance of the soil, a dogma which at the present day has reached the last stages of attenuation. There is, we repeat, but one possible source: Importa- tion. But whence or how, we can only surmise, having no proofs. 1901. Sporadic' cases of yellow fever Avere observed in Senegal, during 1901. The first case of the year manifested itself at Thies, on January 3rd. A fatal case was observed at Saint Louis, on January 14th, and one at Trivouane, on the 18th of the same month. Another case erupted at Thies, on February 28th. With the exception of a case at Dakar, on Alpril 10th, no others were observed until late in the year. Between September 21st and October 13th, two cases erupted at Dagana and three at Saint Louis, followed by three deaths. ^- Total cases for 1901, 10 ; total deaths, 5. Nearly all these cases were new arrivals in the colony. The disease did not l)ecome epidemic, for the simple reason that those who had fled in 1900, wisely remained in France. 1905. For four years we hear nothing about yellow fever in "Proust and Faivre: Rec. dcs Trav. du Com. Consult. d'Hyg. Pub. de France, 1901 (Paris, 1903), p. 336; also Ker- moTgant: Ann. d'Hyg. et de Med. Colon., 1903, vol. 6, p. 626. 306 HISTORY OF YELLOW FEVER. Senegal, not even a sporadic case being mentioned in the official reports of the health of the colony. On May 31, 1905, the startling news was disseminated throughout the colony that an engineer emploA-ed at the •water works at Dakar had died of a malady officially declared by the physicians, both civil and military, to be yellow fever. As may well be imagined, the announce- ment caused consternation among the European popula- tion, and a general exodus took place. All steamers sail- ing for Europe were crowded to their utmost capacity, as a repetition of the disaster of 1900 was apprehended and the large number of non-immunes then in the colony concluded that they would be safer with the ocean between them and the seat of contagion. According to Mr. Strickland, ^^ American Consul, and Dr. Eibot/'* the authorities at (lOree-Dakar, warned by the disastrous epidemic of 1900, used the most energetic meas- ures to prevent the disease from spreading. The house where the patient died was burned and his effects destroyed, the government assuming the loss. His family was isolated and all suspicious cases of sickness were closely watched. The chief health officer of Goree pur- chased two immense woven-wire cages which had been used by Consul Strickland during his sojourn in Senegal, one to sleep in and the otlier to enclose his writing-table and book-cases. The largest case was capable of accom- modating two single beds, a chair and a table, while the smallest could contain a bed, a chair and a table. The cages were mounted in tlie hospital, and all cases of sus- picious fever were placed therein. Our representative says that he has used such cages since 1877, and attributes liis immunity from the diseases incidental to the climate to this precautionary measure. Orders were received by the colonial government from the mother country to wage incessant warfare against the mosquitoes in general and the ^tcf/onri/ia Calopiis in par- ticular, as the female of this species, and not dirt, eman- " StrickTand^ U7~sr"Public~^Heartir Reports, 1905, vol. 207?- 1473. "^Ribot: Annales d'Hygiene et de Medicine Colonialcs (Paris), 1907. vol. 10. D. 79. SIERRA LEONE 307 ations or buried germs were responsible for the si)read of yellow fever. An old and tried proverb asserts that an ounce of pre- vention is better than a pound of cure, and to the strict sanitary measures adopted by the authorities, Senegal probably owes her escape from an epidemic in 1905. Be that as it may, no other cases developed and the timorous, who had been on the anxious seat and only awaited the eruption of a second case to flee, settled down to their usual avocations, and the business of the colony resumed its normal stage. It would have been interesting to analyze the genesis of this isolated case; but, unfortunately, beyond the report of Consul Strickland, we have failed to discover any arti- cle which could throw additional light on the subject. That the case did not originate de novo is certain, f^or it would have been followed by others. In the absence of proof that it was imported, however, we cannot positively assert that it was of foreign origin, although we are in- clined to that belief. We shall leave the question for future theorists to elucidate. CONCLUSIONS. 1908. Up to the time this transcript is handed to the printer, October, 1908, we have not heard of any other eruption of yellow fever in Senegal, and with the present known mode of transmission of the disease, there is no reason why yellow fever, should it manifest itself in that far-off land, should not be confined to a few cases. SIEREA LEONE. Description. Sierra Leone is a British crown colony on the west coast of Africa. It is a coaling station for the Royal Navy, and the headquarters of the West Indian regiments, stationed on the African coast. The colony consists of Sierra 308 HISTORY OF YELLOW FEVKR. Leone proper, Sherbro Island, several small islands and the whole coast region from the lower limits of French Guiana, on the northwest to Liberia on the southwest. Capital, Freetown, where most of the inhabitants live. HISTORICAL RESUME. Sierra Leone was discovered by the Portugese, in 1463, but no settlement was attempted, owing to the deadly nature of the climate and the ferocity of the savages who inhabited the interior.. From time to time, spasmodic efforts were made to establish colonies along the coast, but the mortality which attended these efforts was such, that Sierra Leone was designated by Europeans as "The White Man's Grave," an appellation which has clung to it to tliis day. On May 9th, 1787, about sixty Englishmen and four hundred blacks landed at the peninsula of Sierra Leone, and founded Freetown, whicli was destined to be the haven of all the escaped, rescued and emancipated slaves of the world. On September 16th, 1787, disease had so deci- mated the colony, that only two hundred and seventy-five IDcrsons remained. These either emigrated to other climes or were murdered by the natives. In 1791, the English Parliament, to encourage the work of the abolitionists, authorized the formation of a powerful company. The year following, this company sent 1200 liberated slaves from Nova Scotia and the Bahamas to rebuild the aban- doned town of Freetown. Shortly after, a pestilential dis- ease ravaged the colony and the project was about to be abandoned, when an Englishman named Clarkson, a brother of the originator of the scheme, took energetic con- trol, and induced the pioneers to remain. The ill-starred venture was destined to again suffer destruction. In 1791, a French squadron, not knowing of the philanthropic nature of the settlement, but seeing only a possession of the hated Englishman, completely destroyed the town. The French government severely censured the command- ant of the squadron for this action, but it was too late — Freetown was a heap of debris. SIERRA LEONE. 309 With the stubbornness which characterizes the Brit- isher, and to which is due his eminence in the history of nations, John Bull resolved to again put its pet scheme into execution, and in 1808, purchased all the rights of the Sierra Leone Company, and the territory became an English possession. In 1812, a new mode of colonizing the country was put into execution. All slaves taken iVom ships captured by the English, were sent to Sierra Leone, and given their liberty. From that date, the colony prospered and became the Mecca of emancipated slaves. Other towns were founded in rapid succession: Leices- ter, in 1809; Eegent, in 1812; Gloucester, in 1816; Leo- pold and Kissey, in 1817; Charlotte, Wilbeforce and Bat- hurst, in 1818; Kent, York, Wellington, Hastings and Waterloo, in 1819. The population of Sierra-Leone grew rapidly. In 1811, there were 4,500 persons, half of which were liberated slaves; in 1819, it had more than doubled, being 12,000, including 200 white soldiers; in 1828, it had grown to 17,566, and in 1819, to 46,569. The last census (1891), gave the dependency a population of 74,835, mostly natives and descendants of liberated slaves. From 1812 to 1835, the liberated slaves sent to swell the population of Sierra Leone, amounted to 27,167. The European population was more numerous in the first years of the colony than afterwards. This was due to the fact that the insalubriety of the climate is extremely hostile to the whites. In 1818, the town of Regent, alone, had a population of 1300 whites and 1700 blacks. In 1826, only 535 English soldiers could be found in the entire colony. To-day, the population is almost totally black. A few white merchants remain during the healthy season, but as soon as the rains set in, they return to Europe. Tlie white soldiers have been replaced by blacks, and with the exception of a few white officers, the gov- ernor and his clerical help, no whites reside permanently in the colony. 1 THE FEVERS OF SIERRA LEONE. Sierra Leone may now be considered as one of the en- 310 HISTORY OF YELLOW FiCVKR. (lemic foci of yellow fever iu western Africa. Previous to 1763, when the disease was imported to the colony, it was unknown; but, finding a home suitable for its retention and propagation, it took firm root, and is now one of the natural products of that insalubrious region. According to Lamprey,^^ there are three types of fevers commonly met with in Sierra Leone: (1), ague; (2), bili- ous fever, and (3), pernicious or yellow fever. The first is not of frequent occurrence; the second is the common- est; the third the most fatal. Dr. Lamprey, who made a special study of the yellow fever outbreaks in Sierra T^one, observed that, though, the character of these fevers, when developed, show a distinctivenss of type one from another, yet so alike are they at the incipiency of the attack, that it requires some experience to define them. Tt is found expedient to carefully watch the various symp- toms of a suspicious case, before absolutely j)ronouncing the disease to be yellow fever. , The unsanitary condition of Freetown is especially adapted to the propagation of pestilence. The city is situated in an amphitheatre, surrounded on three sides by a range of hills rising from 500 to 3,000 feet above the town. In this circumscribed area, a large and dense pop- ulation are crowded together. The houses are, for the most part, unscientifically constructed and illy ventilated, and are surrounded by privies, cesspits and wells. From the latter the inhabitants obtain their drinking water. During the "wet" season — May to August — it rains in- cessantly. The natural slope of the land drains this heavy rainfall into the cesspits and vaults, which overflow into the wells, concocting a beverage for the benighted Free- townites, compare
  • li.,20, . 20. A. 1'. ir. A. .Vol. IV. Mo.l.aiidSiii;,'. lte|).,No. 17.p. :!77, Vol. .\XV. (Toner.) A. r. II. .\., Vol. IV. I 2i:! d.Mtlis, T'rans. .A. .M. A.. Vol. Will, p. ■2'Xi. (Toner.) Cieiifiii -o.s. Ilnvaii.a J'.oard of llr.illh La., 1871, f..'. d<>atlis. Kep. N'.O. r.. o(ll.,)871. (Toner.) .10 dr., Ills, Hep. N. O. 1!. of II., 1872, p. 17. I (Toner.) New York I ' B. M. ami S. .L, Vol. LXXX, No. 23, j.. 587. (Toner., New Orli'aiis I'ensar.d.-i ... Havana. -do I 1871 ! 1>7.-. E 1875 E 1875 E 187G E 1870 1870 1877 1878 E 1876 if;78 187'J IPSO lSf-2 1882 18K2 E l>->:i E 188:J 1884 1887 E 1887 1888 E 1883 1891) 189 J E 1803 New Orlr.nns liarranias, Ela. . . Fasia<;onla, M iss . . .do i:. S. -M. H. S. Hep., 187.1. 225 deaths; 11. of U. La., lS7:i. A. I'.H. A ., Vol. IV. 01 deallm, K. V. Mi.liel, fjiiarle^ton M. J. and K.. 1.^74.Vol. l,p. 2.-i'.l. (Toner.) A.IMI.A., Vol. IV; J. M. AVoodwortli, U. S. M. U. S. l;ep..l87:!. The eit\ was iufeeled tliroiifjli tlio Castropoa from Havana. (Hep l'. .S. Mod. Com., U. S. M. II. S l;ei>., 1871 ; A. r. U. A., Vol. IV.) li.of II. I, a., !S74. U. S.M. U.S. K.p.. 1875. 1'. S. M. II. S. Leie, 1K75, fiO deatli.q. Kev We.st 1 ::8 duath.s. (U. S. M. II. .S. Ito])., 1875.) Uiiiuswick ' Il.iv.ma : 112 dealliJf. (Smitli in tlic L'. S. M. II. S. I I l.'.ps., 1870-77, p. 185 Dobov.Ca 1 V , to {'airo. 111. New Orkana New York .. . New (Jrli ans. Key "West C.iiv.-.^ton Ni-w tlilean.>( I'ensa. .,1a r.i.'wlon. Ala . . . I'eusa.-.da W.st Indies ... l''ensaeola(?). Kej West Tampa. El.a .lacks.jiiville, Ela Havana.... Xl.il an/as . . l>.nsa...la.. Havana.... Ha\ ana... Tanii)a. Ela Itrnnswiek, li.a Eninswiek. On., and adjaeent islands. I Satiila lliver.Ga d lo A. V. IT. A.. Vol. IT. and Sternberc. Tlio .steamer ICinily Soilder brou;;lit the .lisease to the V the I'ly mouth. (Med. lap. U.S. Navy, 1879,Dr. W.^olvertou.) National B of II. Rop ,1882. V. S. M II. S. Kep., 1883, 192 deaths. MILS. Kep.,lhK4. Sp.iradic cas.s, hot there was an epidemic at tin- ijav\.yaril, '.i miles from. I'ensaeola. (M. U.S. Kep.'; 1884, p, 200.) Abstraet of .'^an. K.p., F. S. M. H. S., 1887, and r.S. M.H.S. l;.)!., pp. 12, i:j, 1887; 280 cascB ,'inil 02 iloaths np to S.jitember. f.S. M. U.S. li. p., lS)^7-88. I'l.-int City and ueighli.irin;; eitics. U. S. M. H. S. l{c^l.,18^8. rrobably from Tatnpa epidemic of 1887. 52 deaths. Abstr.a.t of S,an. Hep., 1894. p. 81; U..S. M. U.S. Rep., 1«93. Do. ALABAMA. Summary of Yellow Feveh in Alaiiama, by Localities. ALCO. 1897. Cases, 1; death, 0. ATHENS. 1878. Cases, 2 ; deaths, 2. BAY MINETTE. 1897. Cases, 1; deaths, 1. BLADEN SPKINGS. 18o3. Sporadic cases, sclelj among refugees. BLAKELY. 1822. Severe eiiidemie. No statistics, BREWTON. 1883. First case, September 12; first death, Septdiiber 10. Last case, November 6. Cases, 70; deatlis, 28. CAILVWBA. 1853. No record of cases and d'caths. (\VSTLEBEKKY. 1905. Cases, 2; deaths, 2. .(^rrK(J\FLLE. 1853. No record of cases and (hiiths. 782 HISTORY OK VKLI.OW FEVER. COUKTLAXD. 1878. Infected l»y Memphis. Cases, 1; deatlis, 1. DECATUR. 1878. Population, 1,200. Cases, 187; deaths, 51. 1888. First case, September 4th; first death, Septem- ber 11. Cases, 10; deaths, 1. At the beginning of the outbreak, nearly the whole population fled. DEMOPOLIS. 1853. Xo record of cases and deaths. DOG RIVER. 1853. Population, 300. First case, August 18th ; first death, August 22nd. (\ases, 00; deaths, 23. FLOMATOX. 1897. Cases, 98; deaths, 5. FLORENCE. 1878. Poi)ulation, 2,500. Cases, 1,109; deaths, 50. FORT CLAIBORNE. 1819. I'irst case, July 4; last case, December 1. No statistics. FORT RAYON. 1893. First case. July 30; first (h-ath, August 3; last (balli, Ncveiiibcr KJ. Cases, (1; (baths, 5. FORT mor(;an. 1807. First case, August 13. No statistics. 1893. Cases, 2; deaths, 1. ALABAMA. '783 FOET ST. STEPHEN. 1819. First case, July 4 ; last case, December 1. FULTON. 1853. No record of cases aud deaths. GREENSBORO. 1897. Cases, 1 ; deaths, 1. HOLLY WOOD. 1858. Infected hv New Orleans. Fii>t case, Auoust 15th; first death, August 29tli. Last case, September 20th. Cases, 10; deaths, G. HUNTSVILLE. 1873. Cases, 3; deaths, 1. 1878. Cases, 33; deaths, 13. All impoiled cases. JUNCTION. ::873. Population, 35. Cases, 22 ; death-;, 14- LEIGHTON. 1878. First case, August 18; first death, August 24. Cases, 4; deaths, 1. :morile. 1705. Seveial historians state tliat yellow fever made "great havoc" in ^Mobile in 1705. No statistics are given. 1765. Epidemic. N({ record of cases and deaths. 17r»n. Sevci-o cpidomic. \vvy fatal among new comers. 1819. I»(;pulati(n, 1,200. Numer who fled, 300. First case, August 19; last case in Novemlier. On October 22, tliere was a liglit frost, l)ut the disease continued un- 784 HISTORY OK YELLOW FEVER. nbatcd until tlie eud of November. Many persons were lured to the city by the frost and fell yictims to the fever. 1821. Sporadic oases; 7 deaths in October. 1822. "Only 4 or 5 cases." 1821. Six fatal cases in September; last case on the 25tli, notwithstandin the mcsqnito doctrine of the transmission of yello^v feyer, oyer half a c(ntnry aiio, ^vill lie fonnd interesting-: On the 12tli of Angnst, jnst aliont the time yello\y feyer bcuan to assnme the ejiidcMiiic form in ^fobile, and one month after the first in)]!(.rted case. Dr. Nctt Ayas called to see a yonn.i»- man, wlio had a Ay(41-marked attack of the disease, at a boarding; honse in Mobile, on St. Lonis Street, near St. Josei)h. On the 14th, the patient Ayas leiiH y(Ml on a stretcher to the houpe of liis brother-in-law, in Sj)riiiii' Hill, about the center of the setllement. He recoy(a'ed, and twenty days after lic^ han a lot about 10 yards north of the orii»iiia] source of infection, and his A. ABAMA ^ 789 household, wliite and Idack, eciisisted of sixty persons. Ou tlie 7th of September, oue of his iieuro woiiuii Avere attaeked, on an adjoining lot ; on the Sth, his danghter- in-law, Mis. John Deas, and on the 9th, Mrs. Brown, his daughter; each being in a different lot, and one hundred yards from each other. The disease then spread rapidly through the families of the three adjoining premises, at- tacking Ayliites and blacks indiscriminately. Fifty-four were attacked out of the sixty, and in fourteen days the Ayliole tale y>as told — tiye whites, two mulattoes and one black were dead with black yomit, and the rest were con- yalescent. One-half of the whites attacked died. Cases existed simultaneoui-ly at AVm. Stewart's, 'Sir. Wheeler's, and Mr. Puryis' and T<;ulmin's houses, widely s(^})arated from eacli other; and in the lattei- ]tart of Sep- tember and through October, the disease yisited the houses of (^ipt. Stein, IMcMillan, Rey. Mr. Knapp, Mrs. George, Dubbse's, John Battle's and some others. The disease skipped about in an extraordinary manner; some houses escaped entirely, some had but one or twe) cases. Dr. Xott fails t(( giye the number of cases and deaths. 1878. Oiw death, Octolier 14, a refugee from :Mobile. Xo cases in the yillage. STEVEXSOX. 1878. Population, 200. Probably infected by ]Mem- phis. Fiist case', Septemlier 1. Oases, 11; deaths, 0. ST STICPHEX'S BOAT). 18.j;i First case, August 23. Infected by Mobile. TOWX OBEEK. 1878. Population., 7."). Deaths, 4. TrS(\VLOOSA. 1878. (^ises, 2; d( albs, 2. 790 HISTORY OF VELLOW FEVER. TUSCUMBIA. 1878. Populatiou, 1,200. InftH-ted by Memphis. First case, September 5. Cases, 97; deaths, 31. WAGAE. 1897. Cases, 15; deaths, 3. WHISTLER. 1878. A few cases among refugees; inliabitauts not attacked. One death oulv. Father ^rarlev, of Mobile, occurred on October 18. 1897. Cases, 122 ; deaths, 7. WHITING. 1870. Sporadic cases ; refugees. 1875. Cases among refugees. BIBLIOGRAPHY OF YELLOW FEVER IN ALABAMA. Anderson (W. H.): Report on the Diseases of Mobile in 1853. Trans- actions of the Medical Association of the State of Alabama. Svo. Mobile, 1854. Cochran (J.) Contributions to the Transactions of the Medical As- sociation of the State of Alabama, session of 1S74. I. The yellow fever epidemic of 1873. 8°. Montgomery, 1874. Cochran (J.) : The Outbreak of Yellow Fever at Brewton in 18S3. Tr. Med. Assn. Ala., Montgomery, 1884, vol. 36, p. 170. Also: Rep. Bd. Health Ala., 1883-4, Montgomery, 1885, p. 47. Forest (W. E.) : The cost of Yellow Fever Epidemics; the Epidemic at Decatur, Ala., in 1888. Med. Rec, N. Y., 1889, vol. 35, p. 620. Gilmore (.T, T.) : An Account of Yellow Fever as it Prevailed in Mobile and Vicinity in 1873. Reports Am. Pub. Health Assn., 1873, vol. 1, p. 393. Glennan (A. H.): Report of the Operations of th9 Service in Ala- bama during the Epidemic of Yellow Fever in 1897. Rep. Superv. Surg. Gen. Mar. Hosp. 1896-7, Wash., 1899, p. 649. Lrewis (P. H.): Medical History of Alabama. New Orleans Medical and Surgical .Journal, iii. 691; iv. 3, 151, 318, 459. ALABAMA 791 Lewis (P. H.) : Sketch of the Yellow Fever in Mobile, with a brief Analysis of the Epidemic of 1843, etc. N. O. Med. & Sur. Jl., vol. 1, pp. 281, 413. Marks (J. C): Yellow Fever of Selma, Alabama, in 1853. Transac- tions 0^ the Medical Association of the State of Alabama. Mobile, 1854. Michel (R. F.): Epidemic yellow fever in Montgomery, Ala., during the summer of 1873. Charleston M, J. & Rev., 1873-4, vol. 1, pp. 289- 305. Also: Reprint. Michel (R. F.): Epidemic of yellow fever in Montgomery, Ala., sum- mer of 1873. Tr. M. Assn. Alabama, Montgomery, 1874, p. 87. Also, Reprint. Nott (J. C): Sketch of the Epidemic of Yellow Fever in 1847, in Mobile. Charleston Med. .11., vol. 3, p. 1. Nott (J. C.) : The Epidemic Yellow Fever of Mobile in 1853, com- municated with the Sanitary Commission of N. O. N. O. Med. and Surg. Jl., 1853-4, vol. 10, p. 571. Report of the committee appointed to investigate the causes and extent of the late extraordinary sickness and mortality in the town of Mobile. 8°. Philadelphia, 1820. Also, in: Med. Reposit., N. Y., 1820, VOL 20, pp. 333-344. Riggs (B. H.) : The history of the yellow fever epidemic in Selma in 1853. Tr. M. Assn. Alabama, Montgomery, 1882, p. 400. Boling (W. M,): Yellow fever in Alabama. N. O. M. & S. JL, 1853-4, vol. 10, p. 409. Stone (G. H. & Carson (W. H.) : Epidemic of Yellow Fever at Brew- ton, Ala., Rep. Superv. Surg.-Oen. Mar. Hosp., Wash., 1883-4, p.. 223. Wahly: On the Treatment of Yellow Fever as it occurred in Mobile in the fall of 1853. New Orleans Medical and Surg'ical Journal, vol. 11, 1854-5, p. 289. Wilkinson (J. A.): A sketch of yellow fever at Whiting in 1870, and 1873. Tr. M. Assn., Ala., Montgomery, 1883, p. 175. Also: Rep. Bd. Health, Ala., 1883-4, Montgomery, 1885, p. 120. ARKANSAS. AUGUSTA. 1.S78. ropulatic.i), 1,200. Infected by steamboat Ruth, from ^Memphis. First case, October 12, followed by death two days later; last case, ()ctol)er 20. Cases, 7; death, 7. COLUMBIA. 1853. Infected by steamboat J. M. Brff, from >'ew Orleans, in June. Patient was an Irishman who developed the disease on board, and was left at a wifodyard just above the town. He died with black vomit, but did not communicate the disease to any one. Six other cases were put off different steamboats at Columbia in July. The H. D. Bacon stopped at this place about September 1, having- 20 cases of yellow fever on board. The captain and cliambermaid were attacked while the boat was at the landinji', and both died shortly after her departure. Fen- ner (Kj/uJfinica. etc.. jt. 107 i, says that ''nearly every 1)oat from Xe^w Orleans" wliich stopped at Columbia during the terrible epidemic of 1853, had yellow fever on board. The ])eo])le of the town visited the boats, but no one caught the disease. FOKEST CITY. lo7.'). Two cases, i-efugeH'S from ^Me^mphis. 1870. Infected by Memphis. First case, October 2; first death, Octolier 8; last case, November 25; last death, Xcvcmlicr 28. Cases, 23; deaths, 15. VOWV S.MITII. 1823. liii|i(;it< (1 (ases; no slalifctics. COLDFX LAKE. 1878. Tliicc (Mscs, rcfimccs from Xcv.- OHcans. ARKANSAS. 793 GEAND LAKE. 1853. Infected liy steaiuljoat Binily r Hill, from New Orleans. First ease, Ani^iist 24, in a niaii avIio had taken passage on the boat at Natchez, Miss. Patient died on the 24th. Tliree residents of (Irand Lake, who vlj-ited the boat, were attacked, but recovered. There was no spread of the disease. HAYNEJr^ BLUFF. 1878. Cases, 100; deaths, 10. HELENA. 1878. Infected l)y ^Ienii>his. First case, Augu^^t 17; first (loath, Angnst 2L Cases, 77; deaths, 9. HOPEFIELI). 1878. Infected by Men)i)his on Sei)tenilier 1 ; last death, October 23. '<'ases, 117; deaths, 7. Thexe figures also include the immediate vicinity. 1870. Two cases, ab.out a mile from Hopefield. No eases in town. LITTLE lUH K. 187S. A litth' boy, a refug(H' frcin Memphis, wlio lit clerk (who had been ashore) had an attack and died 3Iay 2. Xo other cases reported. 1903. September 10, steamslnp Colon, from Panama, arrived in ])ort Avith a case of yellow fever on board. l*atieiit Avas immediately removeel to Au«»el Island (Quar- antine Station, where he died the following; day. The case was certainly an interesting- one from a fpiar- antine standp((int. Patient was a strou«>, lithe man; age given npou articles, 23 years (probably 28 or 30) ; native of Chili. He shii)i)ed at Acapnlco upon the elown voyage. AVas ashore at Panama, but at no port upon the up trip. A'essel loadeel in open water from lighters at all ports en r(nite. Fifteen days from Panama, in the early mornii'g, the man reported to the slii])'s snrgeon with headaclie, jiains in back over liye^r and elown right shoulden-. History of chill dining night or early morn- ing; no history of malariy Passed Assistant Snrgeon Cumming, from whose re])ort this history is summarizeel, the man had jnst been bi'onglit from the forecastle in the gang- way in tlie cold wind. He was semi-conscious, res])ond- ing to loud iiKpiiry as to vvhether he wanted water. Body bi-onze vellow; eyes very yellow; tongne not enlarged, ])(.i))tcd, red ai'ound edge, some sores; left parotid glanel < idarged and tender; some shrinking on pre»ssure in epi- gastric i('gi<:n; si)l( en and liver not enlarged (])ercussie)n and iialjiation I. Some bb;od sigiis on Idanket, bnt pos- sil)ly due to ulcer on left ( Ibow. After having been i-emcjved, catluMerization bronght 235 c.c. of nrine liighly co]( red, sliglitlv cloudy. S]teciGc gi-avity, 1010. l-!cacti(.n, acid. .Mbiniiiii in largo (jnan- CALIFORNIA. 797 titic^s by all tests used. Examination of bhiod for malaria by hieveral officers, ne.uativ(\ ]*ns in parotid jiland, ordi- nary dii)l(H-(tcci. l*atient j^rew worse, features frcnn a sanitary point a?e: First attack fifteen days from the only place reported infected (Panama), and about three days after leaving Acai)nlc(:. The vessel was thoroughly searched by Sur- geon humming, other (officers, and attendants for mos- <|uit<(S, (l(^ad (sr alive, and not one was found, despite a <-onsiderable reward ottered. The original source of infection was evidently Pananui. BIBLIOGRAPHY OF YELLOW FEVER IN CALIFORNIA. Bereng^r-Feraud: Fievre Jaune, etc., Paris, 1890, p. 189. Bally: Typhus d'xVmerique ou Fievre Jaune, p. 39, Comming (H. S.): History cf yellow fever case on steamship Colon, at San Francisco Quarantine, from Panama; yellow fever on vessels in previous years. Pub. Health Rep. U. S. Mar. Hops. Serv., Wash., 1903, vol. IS, p. 1631. Lind: Diseases Incidental to Seamen in Hot Countries, vol. 1, p. 39. Medical News, X. Y., 1883, vcl. 43, p. 420. Nelson (W.): Yellow Fever Considered in its Relation to the State of California. Rep. Bd. Health Calif. Sacramento, 1884-6, vol. 9, p.. 220. Perry (A. W.): Yellow Fever at San Francisco. Western Lancet, San Francisco, 1883, vol. 12, p. 389. U. S. Public Health Reports, 1897, pp. 563, 607, 685. Ibid., 1898. p. 634. Ibid., 1902, p. 1172. Ibid , 1903, pp. 1540; 2298. CONNECTICUT. CHATHAM. Um. First case, August 21). Infected by brig- Polly, from Sail Domingo, West Indies. Xo record of cases and deaths. HARTFORD. 1798. Sporadic cases, imported. No statistics. 1800. Old chroniclers say that yellow feyer Ayas im- ported to Hartford in 1800, and "created much alarm and raged for a time with consideral)le mortality." Xo statistics. KXOWLES LANDING. 170G. First case, Angiist. Deaths, 9. MIDDLETOWN. 1820. First case in June. Tnf( cted by schooner Milo, from West Indies. NEW HAVEN. 1735; 1743; 1794; 1803; 1804; 1805; 1819; 1845. Yel- low feyer was imported to New Ilayen in the years men- tioned, but no reliable statistics could be obtained. NEW LONDON. 1798. Source of infection not stated, writers of the ])eriod attributing the outbreak to "a lot dried fish, which had decomposed and exposed on the public wharyes.'" First case, August 25; last case, October 28. Deaths, 81. NORWALK. 1798. Mild outbreak. No statistics. CONNECTICUT. 799 NOKWICH. 1801. Importation. No record of cases and deaths. STANFORD. 1745. Mild outbreak; no statistics. STONINGTON. 1798. Mild outbreak; no record of cases and deaths. BIBLIOGRAPHY OF YELLOW FEVER IN CONNECTICUT. Bancroft: Essay on Yellow Fever, p. 399. Beck (J. B.) : Communications concerning the yellow fever at Middletown (Conn.) In: Hosack (D.): Observations on febrile conta- gion, (etc.). 8°. N. Y., 1820, p. 53. Channing: An Account cf the Pestilential Disease which prevailed at New London in the summer and autumn of 1798. New York Medical Repository, vol. 2, pp. 402-405. Coit (T.): Additional account of the pestilential fever which pre- vailed at New London, Conn., (1799). Ibid., 407. Holt (C): A short account of the yellow fever, as it appeared in New-London in August, September and October, 1798; with an accurate list of those who died of the disease, the donations, etc. 8°. New- London, 1798. Medical Repository, 1805, vol. 3, p. 292. Monson (Sen'r.): Letter on the Treatment pursued, and most suc- cessful in the cure of the Yellow Fever in New Haven in 1794. Webster's Collection, p. 184. Monson (Jun'r.) : Letter on the Origin, Sym]itonis, Progress, etc., of the Yellow Fever in New Haven in 1794. Webster's Collection, p. 173, etc. Scott (Charles): Short Account of the Yellow Fever, as it appeared in New London in 1798. New London, 1798. Strobel: p. 101. Tully: Yellow Fever of Middletown in 1820, and Chatham and its Neighborhood in 1796. Essays on Fevers and other Subjects, by Thomas Miner and William Tully. 8vo. 1823. Tully (W.) : History cf the yellow fever as it occurred at Knowles Landing, Conn. N, Y. M. & Phys. J., 1822, vol. 1, pp. 153-158. Tully (W.) : History of the peculiar fever that occurred at Middle- 800 HISTORY OF YELLOW FEVER. town, Connecticut, during the months of June and July, 1820; yellow fever in Chatham, in 1796, and its origin. In Miner (T.) & Tully (W.) Essays on fevers and other medical subjects, Middletown, 1S23, pp. 291-403. Tully (W.): Observations on yellow fever, with cases which oc- curred at Middletown and Chatham, in Connecticut, Virginia M. J., Richmond, 1856, vol. 7, pp. -139-459. II DELAWARE. CHIUSTIANA. 1708. Infected bj' Wilmington, Delaware. No stat- istics. DELAATAKE BKEAKWATEII. Yellow fever cases were brought to LcAves (Delaware Breakwater Quarantine Station) by ships from the West Indies in the following years : 1878. ^rauY cases Avere landed from ships. Deaths, 9, of which 7 were sailors. 1887. August 8, bark Ada (rray, from Ilavana. One case; recovery. 1888. Brig Tmrriffe, from Havana. First case, July 22; first death, July 27; last case, July 23; last death, July 27. Cases, 3 ; deaths, 2. 1889. June 9. Steamship Baltiinorc Cifij, from San- tiago de Cul)a. Two cases. 1892. During 1892, the following infected vessels were detained at this station : Ma^' 10. Norwegian bark Xor, from Rio de Janeiro. Nine cases and two deaths at Eio and during passage. June 1. British bark WilJoir Bii.sh, from Rio de Janeiro. Had several cases at Rio and one death during voyage. June 6. British ship FAinhaulc from Rio de Janeiro. Several cases during voyage. June 28. (ierman ship IxudoJpli von Bruninf/cr, from de Janeiro, via Barbados. Eleven cases and five deaths while at Rio. July 25. British bark Arr/riifa, from Pernambuco, via Santos. Several cases and one death after leaving Santos. August 3. British l)arkentine Fredcrica, from Santos, via Guantanamo. Several cases during voyage. It will thus be seen that six vessels, actually infected with yellow fever, reached Delaware Br(akwater Quar- 802 HISTORY OF YELLOW KKVER. antiue during 1892. "While no cases erupted during tlieir detention, there is no telling what might have been the consequences if rigorous sanitary precautions had not been taken. While the Stcgomijia CaJopiis no longer thrives in the locality, the epidemic which ravaged certain sections of Delav.are a hundi'ed years or so ago, prove that the insects, when imported during the summer months, can be domesticated long enough to propagate the disease under discussion. 1893. July 20. American schooner Hannah McLoon, from Havana and Matanzas. Captain had died from yel- low fever and was buried on arrival. Five other cases en route; all convalescent when the ship arrived. Vessel disinfected. Xo other cases. 1897. June 21. German bark Zion from Eio de Janeiro. Two cases while at I\io and two en route. Quarantined and ordered to New York without pratique. October 3. Norwegian steamship Jolui ^yl^son, from Bocas del Toro, Colombia. Had previously left Mobile (an infected place), and had had a case of yellow fever before reaching the South American port, and another after leaving Bocas. Owing to the fact that yellow fever was widespread in the South that year, much excitement was caused at Delaware Breakwater (iuarantine and vicinity, when news that an infected vessel had arrived became public. Th cargo, which consisted of bananas, was dumped five miles at sea and the vessel ordered to Keedy Island for oltservation. Xo other cases developed. Since 1897, infected vessels have arrived at this station, but no interesting developments followed. DUCK CREEK. 1720. Yellow fever imported, but beyond the state- ment that '^the village was almost depo])ulated," no other information can be gleaned from the historians of the period. XEW CASTLE. 1798. Severe outbreak; no statistics. Probably io- fected by Wilmington. DELAWARE. 803 WILMINGTON. 1798. First case in September. Probably infected by refugees from Philadelj^hia. Deaths, 200. 1802. Mild epidemic "in the autumn." No statistics. BIBLIOGRAPHY OF YELLOW FEVER IN DELAWARE. Bancroft: Essay on Yellow Fever, p. 357. Medical Repository, 1805, vol. 3, pp. 128; 136; 221; 336; 368. Monro: Remarks on the Epidemic of the Summer and Autumn of 1798, at Wilmington, Delaware. Medical Repository, 1805, vol. 3, p. 136. Tilton: Observations on the Yellow Fever as it appeared at Wilming- ton Delaware, in the Summer and Autumn of 1798. Medical Reposi- tory, 1805, vol. 3, p. 128. Vaughan (J.) : A Sketch of the History of the Diseases of the State of Delaware. Medical Repository, 1805, vol. 3, pp. 221, 336, 368. Vaughan: A Concise History of the Autumnal Fever which prevailed in the borough of Wilmington (Del.) in the year 1902. Svo. Wil- mington, 1803. Vaughan: An Account of Diseases at Wilmington (Del) in the sum- mer and autumn of 1800; of the disease originating on board of the U. S. Ship Ganges, etc. Medical Repository, 1806, vol. 4, p. 238. DISTRICT OF COLUMBIA. WASIUXGTOX. 1855. A few imported eases "from the South." 1878. ropiilation, 179,402. First case, xViigust 10. Cases, 5; deaths, 5; all refugees from Southern cities. 1898. One fatal case, a refugee BIBLIOGRAPHY OF YELLOW FEVER IN DISTRICT OF COLUMBIA. Dick: Fever at Alexandria, District of Columbia. New York Medical Repository, vol 7, p 100. Keating: History of Yellow Pcver, p. 97. Lancet (London), lSo5, vol. 2 p. 208. Medical Statistics U. S. Army, 1819-39, p. 54. Annual Report Supervising Surg.-Gen. U. 3., 1899, p. 391. FLORIDA. APALACHICOLA. 1820. Sporadic cases; no statisitcs. BARTOW. 1888. Population, 2,500. A few imported cases. BRAIDENTOWN. 1888. Scattered cases; imported. BRENT. 1908. One fatal case, a refugee. CALLAHAN. 1888. Infected by Fernandina. First case, September 10; last case, October — . A few cases, refugees. 1871. Infected by Havana. Mild epidemic. No statistics. DRY TORTUGAS. 1893. One fatal case; imported. ELLAVILLE. 1888. A fatal case in November; imported. EGMONT KEY. 1887. First case in July; first death, July 11. Two cases, resulting in death. ENTERPRISE. 1888. Severe outbreak, considering the limited number of inhabitants. No statistics. 806 HISTORY OF YELLOW FEVER. FERNANDINA. 1877. Infected by Havana. Cases, 1,500 ; deaths, 112. 1878, Three deaths on a bark from Matanzas, Cuba. 1888. Infected by Jacksonyille. First case, August 17, terminating fatally on the 22nd. Complete statistics lacking. FORT BARRA^'CAS. 1822. Deaths, 7. Source of infection not stated, but probably Hayana or Pensacola. 1853. Infected by Pensacola. Cases, 5. 1854. T^yo deaths ; imported. 1873. First case, September 2G; last case, Xovember 12. Cases, 12 ; deaths, 3. 1875. There are different speculations relatiye to the origin of the feyer in 1875, but it is the opinion of the majority of writers that it A\as brought by the Von Moltlcc, from the AYest Indies, ^vllich anchored betAyeen Forts Barrancas and Pickens, the pilot not being able to bring her to the quarantine station, owing to the ad- verse wind and tide. It is currently believed that a boat from Barrancas with enlisted men boarded i\iQ vessel during the night to obtain liquor. It is certainly peculiar the men who were supposed to have gone on board, were the first to have taken the fever. It proved to be of a very virulent type, and spread with fearful rapidity. The commandant of the Navy Yard making a call on the citi- zens, they responded at once, and formed a picket guard, cutting off what is known as Tartar Point, and extend- ing from the present custom-house station to Bayou Grande. Not a case of yellow fever made its appearance in the adjacent villages or the Y^ard. Pensacola, having quarantined against Barrancas, was equally fortunate. 1897. Cases, 4 ; deaths, 1. ' ■ FORT JEFFERvSON. 1873. First case, August 24; last death, October 6. Cases, 25; deaths, 13. FLORIDA. 807 FORT PICKENS. 1875. Sporadic cases. No statistics. GAINESVILLE. 1871. First case in August. No statistics. 1888. Infected bv Jacksonville. First case, Septem- ber 11, terminating fatally on the 17th ; last case, Novem- ber 28. Complete statistics lacking. GREEN COVE SPRINGS. 1888. Sporadic cases. INDIAN KEY. 1841, In the early part of the autumn of 1841, the brig Jefferson, from Mobile, Ala., where a mild outbreak of yellow fever was in progress, landed several cases at Indian Key. The disease did not spread. About the same time, the schooner Ostego, "from the west coast of Florida," lost several of her crew at the Key from yellow fever, without contaminating the in- habitants of the village. INTERLOCHEN. 1887. One case, October 7, from Tampa, terminating fatally on the 13th. JACKSONVILLE. 1857. Severe epidemic. Probably imported from Havana by smugglers. No statistics. 1877. Epidemic. No statistics. 1888. First case in a man from Tampa, Florida, where "sporadic cases" had been observed, and who was taken ill July 20. A severe epidemic resulted. Complete stat- istics not given. 808 HISTORY or YELLOW FEVER. KEY WEST. ' 1823. Epidemic; probably imported from Havana. The fever was so fatal among the United States troops stationed at the place, that the post was abandoned by the government and the soldiers removed to Pensacola. 1824. Mild epidemic. 1828. Epidemic 1829. Population, 350. The epidemic of 1829 was probably imported from Cuba, between which Island and Key West much smuggling was then going on, as the first case was in a seaman who had been sent ashore from a vessel in the harbor. Deaths, 26. 1841. Mild outbreak. No statistics. 1853, Infected by Tampa. First case, August — ; first death, August — . Deaths, 2. 1854. Cases, 240; deaths, 98. 18G2. Infected by Havana. First case, June 20 ; last case, October — . Deaths, 75. 1864; 1865; 1867. Mild manifestations of the disease. No statistics. 1869. Infected by Havana. No statistics. 1875. Population 10,000. Infected by Kingston, Ja- maica. First case, March 19 ; first death, March 21 ; last death, August 11. Deaths, 38. 1876. At Quarantine: Cases, 2; deaths, 1. I 1878. Population, 5,000. Infected by New Orleans. First case, July 10; first death, July 11; last death, Octo- ber 19. Cases,' 162; deaths, 20. 1880. Population, 12,000. First case, July 16. Deaths, 34. 1881. First case, August 22; first death, August 27. Deaths, 8. 1887. Infected by Havana. First case, May 21; first death, May 23. Cases, 283; deaths, 64. 1889. Population, 25,000. First case, September 21; last case, November 15. Mild, sporadic manifestation. Cases, 7; no deaths. 1890. One death. ) FLORIDA. 809 1892. Cases, 0; no deaths. 1893. Cases, 2; deaths, 2. 1894. A few eases on vessels in harbor. No cases in town. 1899. Cases, 1,291; deaths, 65. 1900. A case was observed as earlv as January 8, in the person of a civilian employed at the United States Army Post; second case, January 16. These were un- doubtedly "echoes" of the epidemic of 1899, as no other cases occurred in 1900. 1901. Cases, 1. LIVE OAK. 1888. Sporadic cases. MACCLENNY. 1888. First case, August 8. Cases, 338 ; deaths, 23. MANATEE. 1888. Population, 200. Infected by Tampa. First case, July — ; first death, July 20. Cases 51. MANGO. 1888. First case, September 2. Cases, 6 ; deaths, 0. MANY LAKES. 1887. Cases, 2 ; deaths, 1. ^lELLENVILLE. 1888. Cases, 2 ; deaths, 0. MIAMI. 1899. Cases, 47 ; deaths, 4. 810 HISTORY OF YELLOW FEVER. MICANOPY. 188S. Cases among- refugees. MILLLVIEW. 1883. Population, 300. First ease, September 7; last case, September 10. Cases, 70; deaths, 12. MILTON. 1853; 1855; 1869. :\rild outbreaks. No records of cases and deaths. MOLINA. 1883, Infected by Pensacohi. ]\rost of the cases oc- curred in the country adjacent to Molina, but a few being observed in the town. MULLET KEY. 1892. Cases, 3 ; deaths, 1. PALATKA. 1887. Infected by Tampa. First case, October 7 ; last case, October 13. Only a few cases, all imported. Deaths, 1. PALMETTO. 1888. Population, 250. Infected by Manatee. First case, November 19 ; last death, November 23. Cases, 85 ; deaths, 11. PENSACOLA. 1764. First appearance of yellow fever in Pensacola. No record of cases and deaths. FLORIDA PENSACOLA. 811 17G5. Deaths, 125. 1810; 1811. Mild epidemic. No record of cases and deaths. 1822. Infected by Havana. First case, August 12. Between the 13th and 20th of August, 20 deaths occurred ; and on the 26th, the troops abandoned the town and encamped on a dry elevated position in the vicinity. As some men were necessarily left behind to guard the public property, many cases occurred among them. Three med- ical officers, Drs. Elliott, McMahon and Merrill, were attacked, the tirst of whom fell a victim to the disease. Last case, October 10. Deaths, 237. 1824. Deaths, 2. 1825. Yellow fever prevailed to a considerable extent in Pensacola during the summer of 1827. The soldiers suffered much. Among those attacked were Paymaster Wright and his whole famih^, his assistant, and also Dr. Lawson, the Army Surgeon of the post, and a sergeant. No record of cases and deaths. 1828; 1829; 1830. Severe on vessels in harbor; only a few cases in town. 1834. First case, August 23. Limited outbreak. 1835. Sporadic cases. 1839. Infected by New Orleans early in September. First death, September 5. Several doctors died during the course of the epidemic. 1841; 1842; 1843; 1844; 1845; 1846. Mild outbreaks. 1847. Infected by United States frigate, Mississippi, from Vera Cruz. Limited outbreak. 1848. Infected by ships from Vera Cruz. 1853. In July, 1853, the steamer Vixen arrived at Pensacola Navy Yard from the West Indies, both officers and men suffering severely from yellow fever. They were at once sent to the Naval Hospital, situated about one- half mile west of the yard. The vessel was put out of commission, hauled along side one of the yard wharves, and employes were sent aboard to tallow machinery and clean bilges. These men were, with scarcely an exception, taken sick with virulent yellow fever, and the spread 812 HISTORV OF VKLI.OW FEVER. of the epidemic could be distinctly traced, step by step, to this focus. The scourge raged with fearful violence from the latter part of July to about the lOtli of October, carrying off about 200 victims out of a population of only 1,200. 1854. Infected by ship Yijcen, from Tampico, Mexico. 1858. Sporadic cases. 1863. Infected l)y Ignited States ordnance supply ves- sel Nigh tin f/alc. At the time tlie Civil AA'ar was iu pro- gress and there were some 4,500 people in the town, due to a heavy influx of refugees, besides a floating population of about 2,000 more. It is impossible to estimate the number of deaths, but the havoc caused by the pestilence was fearful, it being a common occurrence to see four or five coffins carried in a graveyard in an oxen-team, the only available conveyance at the time. Most of the men belonging to the mortar fleet were camped on the island, and it is said that more than 200 people were buried there. The fever was of a virulent kind, which did not spare the acclimated portion of the community. Strange to relate at that time there were about 3,000 troops stationed at and about Barrancas, and not a case of fever occurred at that point, owing to a strict quaran- tine picket being kept by cavalry extending from the hospital to the bayou, men being close enough to hail one another. 1867. Infected by Jamaica. The United States gun- boats TacoHji and Yiircn were at the Xavy Yard at the time. The officers and men had free intercourse with Pensacola, little suspecting the danger to which they were exposing themselves, until two men belonging to the TfU'0)if/. who had been on liberty and in Pensacola, were taken sick with yellow fever. The infection spread i"^p- idly. The total number of cases could not be ascertained, but the deaths were 227. 1873. Infected by Havana. First case, August 5; last case, October 15. Cases, 600; deaths, 62. 1874. Population, 3,347. Number who fled, 1,947. FLORIDA. 813 Infected by Havana. First case, August 17; last case, November 9. Deaths, 354. 1878. Popnlation, 5,000. American brig- J. A'. Bar, from Cuban ports, arrived August 17 with the mate dead and crew sick with yellow fever. The cases were seciues- tered, and Pensacola escaped an invasion. 1882. Infected by bark SnJrfa, from ^Matanza. I'irst case, August 8 ; tirst death, August 26 ; last case, 'Novem- ber 2(); last death, November 2o! Crises, 2,351 ; deaths, 108. 1883. The Pensacola Navy Yard was infected by Havana, the first case erupting May 27 ; first death, June 2. From this focus, the fever was carried to Pensacola. The first case being reported August 5, and the first death on the 11th. Vjases, 201; deaths, 31. 1881. Sporadic cases. 1891. (\ases, 2; deaths, 1. 1893. (^ases, 2. 1897.^ One fatal case at Quarantine. 1905. Cases, 564; deaths, 81. • PLANT CITY. 1887. Population, 300. Infected by Tampa. First case, Octolier — ; first death, November 14; last case, August 18. 1888. Population, 300. Number who fled, 100. First case, June — ; first death, June 22; last case, August 18. Deaths, 21. PROGKESO. 1887. First cas(-, Se])tember 30. Cases, 0; deaths, 1. SANFOIM). 1887. Infected by Tamjia. I^irst case, October 8. Cases, 150; deaths, 8. 1888. Among refugees. No record of cases and deaths. 1889. Population, 3,000. An imixnted ';. Hargis (R. B. S.) : Yellow fever epidemic at Pensacola. N. O. M. & Surg. Jl., 1873-4, n. s., vol. 1, p. 781. Hargis (R. B. S.) : The Pensacola yellow fever empidemic of 188?. Am. Pub. Health Assn., Rep. 1883, Concord, N. H., 1884, vol. 9, p. 306. Heiron (J. S.) : Yellow fever at Pensacola in 1874. Rep. Superv. Surg. Mar. Hosp., Wash., 1873-4, p. ]95. Martin (W.) : Conclusions as to the outbreak of yellow fever -it Pensacola in 1882. Proc. Naval Med. Soc, Wayh.. 1882-4, vol. 1, p. 168. Porter (J. G.) : Yellow fever in Tampa and Pensacola, Florida, 190l* Rep. Surg.-Gen. U. S. P. H. & M. H. Service for 1906 (Wash., 1907), p. 173. Report on Yellow Fever and Quaiantine; visit to Pensacola. Tr. M. Assn. Ala., Montgomery, 1883, p. 144. Report of the outbreak of the yellcw fever epidemic at the nav.'.l station, Pensacola, Florida, 1807. Med. & Surg. Reporter, Phila , 186S. vol.17, p.. 227. Sternberg (G. M.): Yellow fever in Pensaccli, Fla., in 1873, 1871, and 1875. Am. Pub. Health Assn. Rep. 1875, >'. Y., 1876, vol. 2, p. 46 ». Townsend (P. S.) : Account of the Introduction of the Yellow Feve- into Pensacola and New Orleans in the year 1822. Mew York Medicp.l and Physical Journal, vol. 2, p. 315. Tryon (J. R. ): Epidemic of yellow fever at the navy yard, Pensaco a, Fla., during the summer and fall of 1S74. San. & M. Rep. U. S. Na'/y 1873-4, Wash., 1875, p. 451. The Yellow fever at Pensacola (1SS2). Med News, Phila., 1883, vol 13, p. 233. Yellow Fever at Pensacola. Proc. Fla. Med. Assn., Jacksonville, 1886, p. 36. Wilson (J) et al.: Report of a naval medical board to investigate the circumstances connected with the visitation of yellow fever at navy yard, Pensacola. Hyg. & M. Rep. U. S. Navy, Wash., 1879, vol. 4, p. 699, PALMETTO. AVall. J. P.: (Loc. cit.) PLANT CITY. United States Congress. Senate. ..A. bill for the relief of Wm. P. Head, of Plant City, Fla. (Compensation for loss destroyed by fl e FLORIDA. 819 while in possession of the Mar. Hosp. Board, whilst being fumiga'.o'i in the Summer of 18SS, for the purpose of eradicating the germs of Yellow Fever.) 51st Cong., 1st Sess. S. 1746. Jan. 6, 1890, Intrcd. by Mr. Pa.sco. Roy. Svo. (Wash., 1S90.) Wall. J. P.: (Loc. cit.) SAINT AUGUSTINE. Strobel, p. 131. SAINT JOSEPH. Boston Med. & Surg. Jl., IS—, vol. i;5, p. 17. TAMPA. Porter, J. G. : (Loc. cit.) Raymond, H. I.: Yellow Fever at Camp Tampa HeighlT. Medir-n News (1898), vol. 72, p. 683. Wall. J. P.: (Loc. cit.) \ GEORGIA. 4TLANTA. 1870. A few rases, refugees from Savaiiuah. 1S07. Refugees. Cases, 3; deaths, 0. 1905. One fata] cai^e, a refugee. AUGUSTA. 1825. At arsenal. Cases, 31 ; deaths, 7. No diffusion of the disease. 1830. During the summer of 1839, most of the cities of the Soutliern States suffered severely from yellow fever. Although the citv of Augusta experienced its worst rav- ages, the garrison of this post, with the exception of one case, was exempt from the fatal epidemic. This man passed a night in the city, in a state of intoxication. In regard to the origin of this epidemic which hegan in July, much diversity of opinion, as has been found to obtain at all periods existed. A committee consisting <»f pliysicians of August, by whom the question of its origin and cause Avas carefully investigated, reported that the disease was of domestic origin, a tenet which cannot be countenanced at the present day, but which was seriously accepted then. The /oy/.s- ct 0////0 niali was traced to a point called "trash wharf," a slide or inclined plane, erected in 1834, for the purpose of throwing the filth of the city, including dead animals, into the river. This mass of animal and vegetable matter having accumulated to the upwards of 200,011(1 cubic feet, it was resolved by the autlu!riti(s of the <-ity to have it removed. Accord- ingly, during the months of ^fay and June, "its interior was exposed to the action of the sun." Having penetrated the exterior crust, tlie heat evolved was so great tliat the workmen, although wearing thick slioes, were compelled to desist from their work, '"for two hours at a time, so as to suffer it to cool." I GEORGIA. 821 The excayatioii of this trash heap was giyen by the Commission as the cause of the epidemic, but we are more prone to accuse the proverbial "ship from the West Indies," The number of cases and deaths is not stated. 1854. A few imported cases. 1876. Infected by refugees from Savannah. Outbreak not general, but confined to persons residing in the neigh- borhood of the railroad freight 3 ards. Cases, 20 ; deaths, 4. BLACKSHEAR. 1887. One case; imported BAINBRIDGE. 1873. Sporadic cases. BRUNSWICK. 1870. Infected by Havana. First case, August 20; first death, August 21. Deaths, 112. 1881. A few cases at Quarantine. 1890. There is no "official'' record of the prevalence of yellow fever in Brunswick in 1890, but during the ex- amination of the mortuary records of the town by officials of the United States Marine Hospital Service in con- nection Avith the yellow fever epidemic there in 1893, it was demonstrated, by the peculiar "jumps" in the mor- tality, that the disease had prevailed in Brunswick in 1890, and had been kept concealed. Not only did the mortuary records show this, though the cases were not diagnosed as yellow fever, but evidence of creditable cit- izens was obtained to this effect; and reliable testimony, that one of the physicians of Brunswick liad made the statement in the fall of 1890, that yellow fever was pre- valent — almost epidemic — and "if the Lord did not send a frost soon, it would be impossil)le for them longer to conceal it." It is known now that yellow fever had ex- isted in 1893, a month prior to its being declared epidemic. 1893. The America.i barkentine Anita Bcnciiid, from 822 HISTOR^ OF yellow fever. Havana, arrived at the Brunswick quarantine — jiood san- itary history— June 15, 1893. Cleared June 10, 1893, presumably three days after disinfection. The master, who is said to have been feeling badly before leaving, was in Brunswick. The vessel reached Conquest's wharf on the Satilla (only a wharf with no people living there) on the 20th, on tlie evening of which day the master took to his bed. On June 21 he was moved to Conquest Camp, a cross-tie camp, 8 miles distant from Brunswick, where he died on June 25. Diagnosis during sickness and an autopsy by Dr. Dunwoody, yellow fever. Two colored women nursed the patient and several men were especially exposed towards the last of his life and after death; Drs. Atkinson and McKinnon attended him. ^Y^th the exception of burning the mattress and bedding, no disinfection worth anything was practiced, and there was no isolation save what the fears of the people compelled; the two nurses sleeping in the house and circulating freely among the others. There were 73 persons in the camp, living in small houses scattered through the brush. Suspicious cases subsequently erupted in the vicinity, and there undoubtedly were cases in Brunswick, but it was only on September 9, when Surgeon Brenham, of the United Slates Marine Hospital Service, was taken ill and his case diagnosed yellow fever, that the disease was officially declared present in the town. The first death among the inhabitants of Brunswick r<'])orted as yellow fever took place Sei)tember 13. Dr. Brenham died on the 20th. Te fever was not of a virulent character, for out of 1,001 reported cases, only 53 died — 40 whites, 12 negroes and 1 Mongolian. A notable feature of this epi- demic was the unusual mortality among the blacks. 1894. At quarantine, two deaths. 1897. A few cases at quarantine. 1899. Cases at quarantine. GEORGIA. 823 CONQUEST CAMP. {Sec Bniii.sa-ick, 1893). DARIEN. 1S7G. Infected bj Doboy. First case, September 26; last death, November 7. Cases, 8; deaths, 2, 1879. On bark Caspiau, from Havana. First case, August 24; last case, August 24. Cases, 4; no details. I) ALTON. 1878. Infected by Chattanooga, Tenn. First case, Oc- (obor 2, terminating in death on the 4th. Cases, 3; deaths, 3. BOBOY ISLAND. 187(3. Infected by bark Valentine, from Havana. No record of cases and deaths. FORT OGLETHORPE. 1828. Deaths, 10. ISLE OF HOPE. 1876. The Isle of Hope is ten miles southeast of Savan- nah, with which city it is in constant railroad communi- cation. It has always been considered a place of refuge during seasons of epidemic influence; in 1876 at least three thousand individuals were added to its population. The first case of yellow fever which occurred in this locality in 1876 was in the person of a man named De Gauge, a refugee from Savannah. This man slept on the Island, but spent each day in the city. He died about the 22nd of September. The second case was in the person of a man named Grover, also a refugee from Savannah, who only slept on the island. He died on the 23rd of 824 HISTORY OF YELLOW FEVER. September. From these cases the disease spread, and many fatal eases occurred. Opposite the Isle of Hope, and at but a comparatively short distance from the houses in which the epidemic in- fluence was most strongly exihibited, is the celebrated Bethesda School, at one time so dear to the heart of John Wesley. At this point a considerable number of persons were congregated, but no case of the disease occurred. JEKYL ISLAND. 1893. Imported cases. JESUP. 1893. Sporadic cases; imported. ^[ACON. f 1876. Early in October two cases of yellow fever oc- curred in the persons of employees of a Macon cotton ginnery. At the residences of these persons were sev- ei-al refugees from Savannah. Both of these cases died with black vomit. After these deaths occurred, the refugees removed to other portions of the city, where they were subsequently taken with the disease, and in one in- stance a fatal case again occurred from their presence. During the prevalence of this slight outbreak, the greatest number of cases occurred on the two blocks between Fourth and Fifth Streets, and Pine and Oglethorpe Streets, immediately in front of the Southwestern Kail- road depot, at which all freight from Savannah was re- ceived and delivered. A few cases occurred in the vicinity of the Macon and Brunswick Bailroad depots, and other sporadic cases in the vicinity of the railroad yards. OLIVER STATION. 1876. During the epidemic in Savannah, a case oc- curred at Oliver Station, on the Georgia Central Rail- GEORGIA. 825 road. For the accommodation of the Central Railroad employees and the citizens of Savannah during the epi- demic, a daily train was run to this station, Avhich is some forty odd miles from the city. The train remained at Oliver over night and returned to the city in the morning. On the night of September 10, a man named Lufburrow slept on board this train, and on the 16th Avas suddenly taken with yellow fever, of which he died on the 21st. This man had not been to the citj^, and the only contact which he had with infection was on the night he slept in the cars. Two cases of the disease occurred ^mong some Ignited States troops who were encamped at this point, having evacuated their barracks in Savannah on account of the epidemic, but on other cases occurred in the locality. SAVANNAH. 1801 ; 1807 ; 1808. Mild epidemics. No records. 1817. Cases were observed earlier than usual in 1817, and by July the disease was epidemic. No record of cases and deaths. 1818. Mild outbreaks. 1819. The epidemic of 1819 made its appearance in the latter part of June, and went on increasing in extent and destructiveness, until the frost came and ended it. 1820. Population, 5,000. The disease made its appear- ance in May. A death occurred on the 7th, another on the 10th, and another on the 30th of that month. In June, the mortality was augmented to a death on every second day, and the whole sum, at the end of the month, amounted to 11. In July, the number of deaths ran up to 39, being an advance to more than double the devasta- tion of June. In August, it amounted to 111; in Sep- tember, to 241; in October, to 208; in November, to 50, and in December, to 3. The degree of mortality, on the surface of tliis statement, appears to have undergone a gradual reduction after the month of September. But 8t6 HISTORY OF VLELOW FEVKR. when it is considered, tliat, in the course of this period, tlie population liad l)een srci^tly diminished by absence and death, it becomes evident, that, so far from havinj? sustained any diminuition, it was really increased throughout the month of October. The whole aggxegate of deaths resulting from the epidemic, from its commence- ment in May, to its conclusion in December, was at GG6. When the epidemic first appeared in ^lay, the jiopula- tion of Savannah was computed at 5,000 whites. In June, and beginning of July, it was probably reduced, from emigration, to 2,500 ; and, en the 14:th of September, when the ^Mayor's proclamation was ])ul)lished, the num- ber was still further reduced, and could not have exceeded 1,500. The medial population, therefore, of white inhab- itants, may be fairly estimated at 3,000, for the whole season ; which would constitute a sum of mortality amounting to one in five. 1821; 1827; 1831; 1839; 1850. Epidemics of more or less intensity. Xo authentic records, 1852. Deaths, 19. 1853. Sporadic cases. 1854. The first case of yellow fever to precede the epi- demic of 1854, occurred on August 5, at the corner of Lincoln and Broughton Streets. Regarded merely as a sporadic case, it was not reported as yellow fever, and no precautions were taken. Between that date and the mid- dle of the month, a few more cases occurred, but the health authorities remained inactive, scoffinf!; the idea of the disease becoming epidemic. Soon after that date, cases manifested themselves in almost every quarter of the town and the pestilence soon swept with fearful deso- lation over the entire city. Following is a record of the deaths : August 132 Septend)er 381 October 67 Total 580 GEORGIA. 827 Xotwitlistanding the large negro population of Savan- nah at the time, only about 15 of that race died from yellow fever during the epidemic. The disease exhibited its greatest violence from the 20th of August to the 20th of September, having com- menced as an epidemic in the. northeastern part of the citj; it advanced directly to the southwest, spreading north and south until its influence was felt in ever^' part of the city. The infection is said to have been brought from Havana by the brig Charlotte Hague. 1858. Sporadic cases. 1876. The jear 187(1 witnessed the most mortal epi- demic of yellow fever which has ever visited Savannah. Between August 21, the date of the first recorded death, to December 1, when the last death took place, the pestil- ence x-arried off 1,066 persons, of which 809 were white and 257 black. The infection is said to have been brought by a vessel from Havana, either the brig Ynes (which arrived on July 16), the bark Maria, (July 17), or the brig Pepe (August 2). But which of these was the active agent of transmission, has never been definitely settled. The first recorded death from yellow fever occurred on August 21, on Wright Street, a short ciil de .mc, about fifty yards long, the culmination of Bryan Street, in the northeastern part of the city. The second occurred in the same street and same locality, August 22. The third and fourth, August 26, same locality.. The fifth, August 26, on East Broad Street, two doors north of Broughton ; the sixth, August 27, on Reynolds Street, next to Gas House; the serenth, August 27, on Broughton Street, three doors west of Reynolds ; the eighth, August 27, on East Boundary Street, north end; the ninth, August 27, on Randolph and President Streets. On August 28, five deaths were recorded, one on Stone Street, one on State Street, between Whitaker and Bar- nard, and the remaining three in the northeastern part of the city. 8a8 HISTORY OF YELLOW FEVER. Ou August 28, the otlior two not specified. After this the disease spread rapidh^, and was not con- fined to any locality. The highest number of deaths in the city from yellow feyer in an}- one day Ayas thirty-three, on the 20th of September. These occurred in the fifth week of the epidemic, embracing the period between the ISth and 24th of September. SOUTH ATLANTIC QUARANTINE STATION. 1887. Infected by Para. First case, May 22. 1880, One case, April 12; recoyeied. 181)1. No record of cases and deaths. 1894. No record of cases and deaths, 1895. Cases, 1 ; deaths, 1, ST, MARY'S, 1808. First case, September 5; last cas(^, October — . Deaths, 84. UPTON VI LLE. 1888. First case, October 24. Cases, 2; no deaths. BIBLIOGRAPHY OF YELLOW FEVER IN GEORGIA. GENERAL. Felder (W. L.) : Observations on the Yellow Fever Epidemic of 1854, in Augusta, Georgia. Southern M. & S. J., Augusta, 1855, vol. 11, p. 598. Holt (W. F.): Report of the State Board of Health of the late epidemic of yellow fever in the State of Georgia. (With appendix > Report Board of Health Georgia, 1876, Atlanta, 1877, vol. 2, pp. 1, etc. Kollock (P. M.): Notes on the epidemic fever in 1854. Southern M. & S. J., Augusta, 1855, n. s., vol. 11, p. 453. Logan (J. P.) : Observation in regard to the yellow fever epidenaic of 1876 upon the coast of Georgia. Richmond & Louisville M. J, Louisville, 1877, vol. 23, p. 223. McClellan (E.) A study of the yellow fever epidemic of ISl^, as it < GEORGIA. 829 affected the State of Georgia. Trans. Am. Pub. Health Assn., 1S77-S, vol. 4, p.. 249. Seagrove (J.) : Origin of yellow fever in the contaminated air of a coasting vessel, and of the town of St. Mary's, in Georgia; with aii enumeration of its symptoms and mortality, and the beneficial effects of volatile alkali as a remedy, during the autumn of 1808. Med Reposii., N. Y., 1810, vol. 13, p. 135. Also: Am. M. & Phila. Reg., N. Y., 1814, vol. 3, p. 417. White (J. E.) : Typography of Waynesborough (Georgia) and its vicinity, with the State of the thermometer and weather for part of the year 1802; to which is added some account of the disease which prevailed, and a few observations on yellow fever, and the princip:;! remedies of fever. Med. Repository, N. Y., Second Hexade, vol. 3, pp. 36; 140; 241. ATLANTA. McLellan: Trans. Am. Pub. Health Assn., 1877-8, vol. 4, p. 282. Sawtelle (H.. W.) : Report of Measures taken at Atlanta, Ga., in con- nection with the Yellow Fever Epidemic of 1897, under the direction of the Burgeon-General. Rep. Superv. Surg.-Gen. Mar. Hospi 1896-7, Wash., 1899, p. 665. Summerall (W. B.) : The case cf yellow fever recently occurring in Atlanta, Ga., history, clinical notes, and observations. Atlanta J. Rec, Med., 1905-6, vol. 7, p. 505. U. S. Public Health Reports, 1897, p. 1419. Ibid., 1905, p. 2754. AUGUSTA.. Austin: Trans. Am. Pub. Health Assn., 1877-8, vol. 4, p. 234. Campbell: Ibid., 1879. vol. 5, p. 132. McLellan: Ibid., 1877-8, vol. 4, p. 281. Boston Medical & Surgical Jl., 1839, p. 36. Medical Statistics U. S. Army, 1819-1839, pp. 37, 349. Nashville Jl. Med. & Surgery, 1854, p. 345. Report of the Origin and Cause of the late Epidemic (Yellow Fever) in Augusta. Submitted to a meeting of the physicians of Augusta on the 10th of December, 1839. Reprinted by order of Council, November, 1877. Svo. Augusta, 1877. Robinson (F. M.): A Report on the Origin and Cause of the late Epidemic in Augusta, 1839. Augusta, 1839. Smelt: An Account of the Epidemic Disease which prevailed at Augusta (Georgia) and its Neighborhood in 1804. Medical Repository, vol. 9, p. 125. 830 HISTORY OK YELLOW FEVER. BRUNSWICK. Booth (A. R.) : Tables Showing the results of Observations with Regard to Remittent and Yellow Fevers, taken During the Yellow Fever of 1893, in Brunswick, Ga. Rep. Superv. Surg.-Gen. Mar. Hosp., 1894. Wash., 1895, p. 323. Faget (C): Some Observations on Yellow Fever in Brunswick, Ga., in 1893. Rep. Superv. Surg.-Gen. Mar. Hosp., 1894. Wash., 1895, p. 328. Le Hardy (J. C.) : The Yellow Fever Epidemic of Brunswick and its management by the Marine Hospital Service. Virginia Medical Monthly, Richmond, 1894-5, vol. 21, p. 594; 688; 835; 961; 1103; 1200. McLellan: Loc. cit., p. 275. Smith: Ann. Rep. Surg.-Gen. U. S., 1876., pp. 77, 185. Elliott: Nat. Board of Health Bulletin, 1881-2, vol. 3, pp. 92, 127. Ann. Rep. S.-G., U. S., 1894, p. 298. U. S. P. H. Reports, 1894, vol. 9, pp. 668, 728. Ibid., 1897, p. 775. BAINBRIDGE. Washington Republican, Oct. 25, 1871, p.. 1. BLACKSHEAR. U. S. Pub. Health Rep., ISSS, p. 192. DARIEN. McLellan, loc. cit., p. 279. Harris: Nat. Bd. Health Bulletin, vol. 1, p. 104. DALTON. Keating: History of Yellow Fever, p. 93. Trans. Am. P. H. A., vol. 4, p. 251. FORT OGLETHORPE. Med. Stats. U. S. Army, 1819-1839, p. 66. ISLE OF HOPE. McLellan, loc. cit., p,. 280. MACON. McLellan, loc. cit., p. 281. ' GEORGIA. 831 OLIVER STATION. McLellan, loc. cit, p. 281. SAINT MARY'S. Seagrove (James) : An Account of the Origin and Nature ol the Yellow Fever, as it prevailed in the Town of St. Mary's, Georgia, in the Autumn of 1808. Medical Repository, vol. 13, p. 135; Medical Register, vol. 3, p. 417. SAVANNAH. Arnold (D.), of Savannah: Two Cases of Black Vomit, with Observa- tions. American Journal of the Medical Sciences, N. S., vol. 3, p. 316. Austin: Trans. Am. P. H. A., 1877-8, vol. 4, p.. 234. Berenger-Feraud, pp. 88, 89, 108, 134. Byrd (H. L.) : A few facts relating to the late epidemic of yellow fever in Savannah. Oglethorpe M. & S. J., Savannah, 1858-9, vol. 1, pp. 286-301. Chaille: Virginia Med. Jl., 1858, p. 491. Daniell (W. C): Observations upon the Autumnal Fevers of Savan- nah. 8vo. Savannah, 1826, De la Motta (J.): An oration on the causes of the mortality among strongers, during the late summer and fall. 8°. Savannah (1820). Falligant (L. A.): A monograph of the yellow fever of 1876, in Savannah, Ga., N. Am. J. Homoeop. N. Y., 1878, vol. 26, pp. 289, 458. Falligant (L. A.) : Report on the epidemic of yellow fever in Savannah, Georgia, duiing the months of September, October and November, 1876. N. Am. Homoeop. J., N. Y., 1878, vol. 26, pp. 289, 458. Hume (W.) : On the introduction of yellow fever into Savannah in the year 1854, in reply to a letter from R. C. Mackall. Charleston M. J. & Rev., 1856, vol. 11, p. 1. Le Hardy (J. C.) : Yellow fever; its history, causes, nature, path- ology and treatment; considering exclusively the epidemic of 1876 in Savannah. Tr. Georgia M. Assn., Atlanta, 1878, vol. 29, p. 64. Mackall (R. C.) : Introduction of Yellow Fever into Savannah in the year 1854. Charleston Medical Journal, 1885, vol. 10, p. 150. Russell (H. P.): An official register of the deaths which occurred among the white population in the city of Savannah during the extra- ordinary season of sickness and mortality which prevailed in the summer and fall months of the year 1820; to which is annexed a list of the persons (as far as could be ascertained) who died out of the city after retreating from it. Also the aggregate amount of deaths among the people of color. 8°. Savannah, 1820. 832 HISTORY OK YELLOW FEVER. Smith (H.): Yellow fever at Savannah and Brunswick. Rep. Superv. Surg. Mar. Hosp., Wash., 1878, p. 175. Stone (G. H.) : Yellow fever at Savannah, Ga. in 1876. Rep. Surg.- Gen., 1878, p. 107. Ward (John E.): Reports to the City of Savannah for the year 1854. 8vo. Savannah, 1854. Waring (W. R.): Report to the City Council of Savannah, on the Epidemic Disease of 1820. 8°. Savannah, 1820. White (O. A.) : Report upon yellow fever as it appeared in Savannah, Georgia, in 1876. X. York M. J., 1877, vol. 25, p. 249. WoodhuU (A. A.) : On the causes of the epidemic of yellow fever at Savannah, Georgia, in 1876. Am. J. M. Sc, Phila., 1877, n. s., vol. 54, p. 47. White: May not yellow fever originate in the United States? An etiological study cf the epidemic at Savannah in 1876. Trans. Pub. Health Assn., 1879, vol. 5, p. 107. i ILLINOIS. CAIRO. 1873. Infected by river boatmen from Memphis. New Orleans and intermediate points. On the 1st of September, two cases of yellow fever were received at the hospital from the steamer Man/ Alice; on the 10th, two cases from the tow-boat B: and on the 24th, one case from the Kci/stone. Four of these case» were fatal, beiuj;' in the stage of collapse when brought in. The fatal cases all had black vomit. Tlie first fatal case among the citizens did not occur until i?ei)tember 13, Avhen the cashier of the Illinois Cen- tral wharf-boat died. Then followed in rapid succession several other cases among persons employed in the same locality. Xext, a man on Captain Phillips' wharf-boat sickened, and died on the fourth daj-. A colored woman, who did the washing of his clothing, took the disease and died one week after; and a cliild in the house Avhere the nurse died, also took the disease, but recovered. There were in all 13 deaths out of 43 cases of yellow fever among the citizens, making, with the four deaths among those landed here with the disease, seventeen deatlis from yellow fever between September 1 and Sep- tember 25. It was especially noted that the disease was confined to persciis ('m])loyed about the river and the localities above desci'ibed; the four or five excei)tioi)s which occurred be- ing in the families of men who were thus employed. The disease did not make its appearance among the cit- izens until after the first two cases were received at the hospital from the steamer; aiul no new fatal cases oc- cuii'ed among citizens after the establishment of quar- antine. 834 HISTORY OF YELLOW FEVER. 1878. Infected hy steamboats from "points below," as follows : On An.uust 3, 1878, the steamboat Golden- Crown an- chored in the river opposite Cairo ; Avas examined by the quarantine physician, and one case of yellow feyer found on board. Two other cases of the disease were reported as being secreted on the boat at the same time. The steamer was not allowed to land. August 9, the steam- boat John A. iec from New Orleans. DANVILLE. 1878. One case, September 3; died on the 9th. FILLMOKE. 1878. One fatal case, a refugee from New Orleans. FULTON. 1878. Cases, 12; deaths. 5. HICKMAN. 1878. Yellow fever was never epidemic in Hickman, until 1878. The first case was Charlie Hendricks on August 13, supposed to have been infected on the railroad trains, as he jieddled apples and mixed with passengers. He died August 10, on the 17th his little sister, Louisa, died, affected similarly; both had black vomit. No death until August 28, when Edward Mangel 840 HISTORY OF VKL1.0W FEVER. died. Mrs. J. AYitting died the 29tli, Jimmie Young; the 30th, and numerous new cases continued to occur through- out the town. A panic ensued, scores were dead or dying, Imndreds ill and over a thousand fled. Nearly all the local physicians died, four of the volunteer doctors died, 450 citizens were prostrated with the fever, 150 died. Date of the last death, November Gth. Total cases, 454; total deaths, 180. JORDAN STATION. 1878. Deaths, 2. LEXINGTON. 1905. Cases, 2. LOUISVILLE. 1873. First case, September 22 ; last case, October 15. Deaths, 5. 1878. Population, 100,890. Early in the yellow fever season, Louisville opened her gates as a "city of refuge" from the raging disease. Thousands flocked from the South, many bringing the disease. On the 17th of August, 3 cases of fever were sent to the United States ^Marine Hospital, from the steamer ^unfloiccr Belle, 1 white and 2 colored. On the 23rd of August, Mr. H. R. Davis, of the firm of Rrynut & Davis, Grenada, came to Louisville and put up at the AN'averly Hotel. In a few days he was stricken. Drs. Walling and Gaillard were summoned and later Dr. Luke Blackburn was called to see him; he had black vonut and died on the 31st. A hearse was driven up the alley in the rear of the hotel and the coffin borne huri'iedly away at midnight. When he was first taken ill, two nurses were emi)l()ycd. A young man, also from Grenada, who assisted in nursing, was also taken ill with fever, but recovered. On the 12th of September, Drs. Lloyd and Griffith were summoned io a refugee family on 33rd Street, and found 7 occupying a small room on KENTUCKN ^^LOUISVII.LE. 841 the ground floor of an old frame house. Three children with yellow fever lay in one corner, the father in the other, and the mother, with a babe in arms, watching and nursing them. Conveyances were telegiai)hed for, and in a little while two hacks carried them to the- yellow fever hospital, an infirmary which the city had erected and equipped for this disease early in the season. Mr. Lutz died September 25, on 11th Street near Maple, also two cases (colored) on Bible Alley. Meta Flynu, Nathanial Mudd, Wm. Shaw, Eddie Beiryman, Mrs. Ryan and many others died of black vomit on or near Maple, Eleventh and Bible Alley, all being near the L. & N. B. B. depot; but a diversity of opinion existed as to the disease. Some excitement arose. Three physicians, Drs. Bell, Yandell and Force, i^ublishing a card endeavoring to allay excite- ment, caused a panic for a day or two, but the frightened ones were ridiculed out of their alarm, and returned. No case originated elsewhere in the city. Total cases, 12G; total deaths, 34. 1879. Population, 175,000. A fatal case, a refugee from Memphis. 1888. Population, 200,000. A fatal case, a refugee, September 19. 1897. On August 14, 1897, a man came to Louisville from Ocean Springs, Mississippi, and was taken ill on his arrival. His case was diagnosed as yellow fever by the attending physician, who had lived in the South, and had clinical experience with the disease. The patient was immediately spirited away from the hotel, where he had been taken ill to a jjrivate sanitarium in the city, where he exhibited all the phenomena of yellow fever. He died on the IGth. He was (piietly buried by the health author- ities. There were no developments from this case. At the time, there was no suspicion that yellow fever was prevalent in Ocean Springs, although 'Slengue'' was said to be epidemic in the town. Nevertheless, the Louis- ville health officer immediately notified the healtli author- ities of New Orleans of the circumstances, naturally concluding that this city would be vitally interested in 842 HISTORY OK YKM.OW FEVER. investigating!: the "suspicious cases," wliicli had mani- festcMl themselves in Ocean S])i'in^', and which had been diaiinosed as denj^ue by the physicians. Actinteuiber 25; last 846 HISTORY OF YELLOW FETER. case, November 10; last death, Xoveiiiber 10. Cases, 77; deaths, 21. 1905. First ease, August 1. Cases, 15; deaths, 0. BAYOU BRULO. 1905. First ease, October 4. Cases, 40; deaths, 6. BAYOU CANE. 1905. First case, September 3. Cases, 1; deaths, 0. BAYOl^ COOK. 1905. First cat-e, July 3. Cases, 2; deaths, 1. BAYOU CYPBEMOKT. 1878. Infected by Thibodaiix, La. First case, Novem- ber — . Deaths, 7. BAYOU GOULA. 1878. Deaths, 4. 1905. First case, August 1. Cases, 17; deaths, 3. BAYOU NATCHEZ. 1005. First case, t^epteiuber 3. Cases, 20; deaths, G. BAYOT' PLA()UE:\IINE. 1853. First case, September 17; last case, September 30. Cases, 9; deaths, 0. BAYOU SARA. 1839; 1847; 1853. No record of cases and deaths. 1878. Population, 700. Cases, 250; deaths, 13. LOUISIANA. 847 BAYOU TEKKEBONNE. 1905. First case, September 4. Cases, 1; deaths, 0. BEL AMI. 1905. First case, September 8. Cases, 106; deaths, 15. BELLE GROVE. 1905. First case, August 31. Cases, 74 ; deaths, 12. BELLE HELENE. 1905. First case, October 17. Cases, 2; deaths, 0. BELLESEIN PLANTATION. 1905. First case, August 2(1. Cases, 43; deaths, 5. BELMONT. 1905. First case, August 29. Cases, 1 ; deaths, 0. BERWICK crrr. 187S. Population, 150. Infected by iNforgan City. First case, September 27; last case, November 4; first deatli, October 7. Cases, 99; deaths, 7. 1879. Population, 500. Infected by Morgan City. First case, September 8; first death, September 12; last case, December 1; last death, December 1. Cases, 75; deaths, 16. 1905. First case, September 7. Cases, 1 ; deaths, 1. BIG BURNS. 1905. Cases, 1 ; deaths, 0. 848 HISTORY OF YELLOW FKVtR. BLANCHARD. 1S7D. Cases, 1 ; deaths, 1. BON AMI. 1005. First case, August G. Cases, 5(5; deaths, 8. BONNET CAERE. 1878. Several cases and deaths; no record. BORGUEMOUTH. 1905. First case, September 20. Cases, 1 ; no deaths. BORODINO. 1905. First case, September 24. Cases, 1; no deaths. BOWIE. 1898. First case, October G; last case, October 6. Cases, 1; no deaths. 1905. First case, July 2G. Cases, 1 ; deaths, 1. BROUSSARD. 1878. Deaths, 1. BRULE SACREMENTO. 1878. Deaths, 22. BUNKIE. 1905. First case, July 20. Cases, 22; deaths, 8. BUR AS. ]S47. Sporadic cases. No statistics. 1854. First case, September 22. No record, 1878. Infected by New Orleans. Cases, 14; deaths, 3. LOUISIANA. 849 CANAAN LANDIN(J. 1878. Cases, 28; deaths, 0. CAROLINE LANDIN(J. 1878. A fatal case in October. CAREOLLTON. {A District of Ncio Orleans^ icJiich see). CEDAR GROVE. 1905. First case, September IG. Cases, 2; deaths, 0. CENTREVILLE. 1853. First case, September 15; last case, November 18. Cases, 45; deaths, 7. 1855. First case, September — ; last case, October — . 1879. First case, September 21 ; first death, September 25; last case, December 4. Cases, 44; deaths, 14. CHALMETTE. 1905. First case, September 30. Cases. 7; deaths, 0. CHENIERE CAMINADA. 1905. First case, August 27. Cases, 02; deaths, 5. CHENIERE CANE. 1878. No record. CINCLARE. 1898. First case, October 15; last case October 25. Cases, 11 ; deaths, 1. 850 HISTORY OF YELLOW FKVEll. CLARK CHENIERE. 1905. First case, July 1(>. Cases, 44; deaths, 3. CLIXTOX. 1854. First case, September 1 ; last case, December — . 1S7S. Infected by Xew Orleans. Fir>;>t case, Septem- ber 23. Cases, 96; deaths, 15. CLOUTIEIIYILLE. 1853. V'lvst case, Aiu»iist 14; first deadi, December 14. 1854. Xo record. COLUMBIA. 1878. Infected by X'ew Orleans. First case, October 3; last case, October 27. Cases, 2; deaths. 0. COOK'S LANDING. 1878. Population, 35. Cases, 15; deaths, 4. CORIXXE. 1905. First case, July 20. Cases, IG; deaths, 4. COTE BLANCHE. 1905. First case, Angust 18. Cases, 300; deaths, 51. COVINGTON. 1847. Sporadic cases. No record. 1905. Infected by New Orleans. First case, Septem- ber 23. Cases, 4; deaths, 1. All refugees. CRESCENT FARM. 1905. First case, Angust 30. Cases, 205; deaths, 1. It seems incredible that such a small mortality should LOUISIANA. 851 have resulted, but the liiiiircs are "official/' and we eaii do 110 more than publish them. In our opinion, seventy-live per cent, of the eases reported as ""yellow fever'' were erro- neoush' classified as such. CYPREMORT. 1879. Infected by Xew Orleans. First case, October 17 ; first death, October 25 ; larst case, November 22. Cases, 33 ; deaths, 9. DELHI. 1878. Population, 500. Infected by Vicksburg-. First case, August 11; first death, August 15. Cases, 164; deaths, 34. DELOGNY. 1898. First case, October 1; last case, October 1. Cases, 1 ; deaths, 1. DELTA. 1878. Population, 300. Infected by Vicksbnrg. First case, August 27; first death, September 2. Cases, 87; deaths, 47. 1905. Cases, GO ; deaths, G. DES ALLEMANDS. 1878. Population, GO. First case, August 20; last case, October 27; first death, August 24; last death, Octo- ber 30. Cases, 32; deaths, 17. DESLONDE. 1870. First case, September 22. Cases, 40; deaths, 1. DIAMOND. 1905. First case, August 16. Cases, 8 ; deaths, 0. 852 HISTORY OF VKLLOW FEVER. dia:\iond plantation. 1005. First case, Jnly 20. Cases, 55; deaths, 10. DOXALDSONVILLE. J 1827. No record. 1839. Infected by New Orleans. Deaths, 15. 1878. Population, 1,500. Cases, 484; deaths, 83. 1905. First case, August 28. DUNBOYNE. 1878. Deaths, 5. EDGARD. 1905. First case, September 11. Cases, 3; deaths, 0. ELLENDALE. 1905. First case, August 30. Cases, 27; deaths, 2. EMPIRE. 1905. First case, July 31. Cases, 1 ; de.-ilhs, 0. EkSTELLE i»lantation. 1905. I-'ii-st case, September 5. Cases, 3; deaths, 0. EFKEKA. 1878. Deaths, 1. F^'F1{ETTE. 1905. First case, Septeuiber 1(>. Cases, 1; deaths, 1. EVEKGREEN. 1905. Cases, 2; deaths, 0. 853 LOIIIMANA. FI8H lUVEK. 1878. Xo record of cases autl deaths. FLORE NVILLE. 1905. First case, September 3. Cases, 1 deatlis, 1. FOLEY PLANTATION. 1879. First case, October 10. Cases, 4; deaths, L FORT PIKE. 1820. Sporadic cases amciiii soldiers. No statistics. FORT ST. PHILIP. 1820. Sporadic cases aiuciiii' troops. No record. 1905. Cases, 1; dealhs, 0. FRANKLIN. 1830. No record of cases ard deat1;s. 1853. First case, October 10; first dealh, October 23; last case, October 24; last death, October 25. Cases, 3; deaths, 2. 1854; 1858; 1807. No record of cases and deaths. 1897. Cases, 3; deaths, 1. 1898. Cases, 007; deaths, 9. 1905. First case, Septeiuber 25. Cases, 5; deaths, 0. FRELLSIN. 1900. First case, October 18. Cases, 1; deaths, 0. pre:\ieaux. 1879. First case, October 22. Cases, 2; deaths, 1. 85i HISTORY OK YELLOW FEVER. FEEXCH SETTLE:\rEXT. 1871). First case, Xoveiiibei' 11) ; last case. December — . Cases, 60; deaths, 5. GLENWILD PLANTATION. 1905. First case, September 15. (\'iscs, 2; deaths, 1. rJOOJ) llOFE PLANTATION. 1905. First casi^, Auj-ust 10. <'j!ses, 2t\: deaths, 1. GliAMElJCV. 1905. First case, Septembci" L Cases, 1 : deaths, 0. GEANI) ISLE. 1905. First case, September 4. Cases, 74; deaths, S. GKAND LAKE. 1905. First case, July 25. Cases, 41; deaths, 7. GREENWOOD. 1873. Infected by Slireyepcrt. Fii-st case, September 29; first death, October 3; last death, October 29. Cases, 19 : deaths, 4. 1905. First case, September 7. Cases, 1 ; deaths, 0. GEETNA. 1878. Deaths, 53. 1905. First case, September 22. Cases, 5; deaths, 2. GROSSE TETE. 1905. V\v>t case, September 2. Cases, 45; deaths, 5. LOUISIANA. H55 HAHNVILLIO. 1S7S. Population, 200. No slitCs-llc s. HAMMOXl). 187S. InfcH'tcd by Ozyka, Miss. Vwat chhq, September IS; lirst deatli, September '21; lawt death, November 1. Deatlis, 5. IIAKKISONBUEG. 187S. r(ti)nlali()ii, 275. Cases, 30; deaths, 10. HARVEY'S CANAL. 1898. First ease, September 24; last case, October 6. Cases, ^11; deaths, 3. 1905. First case, September 1. Cases, 5; deaths, 0. HENDERSON. 3878. ropulatioi), 400. First ease, August 30. Cases, 75;. deaths, 18. HOUMA. 1878. First case, October — . Deatlis, 6. 1898. First case, September 23; last case, October 5. Cases, 40; deaths, 2. 1905. First case, August 30. Cases, 7; deaths, 0. JACKSON. 1898. First case, October 15. Cases, 15 ; deaths, 0. JACKSON P.AKKACKS. 1834. Deaths, 3. 856 HISTORY OF YELLOW FEVER. JEFFERSON PAEISH. 1898. First case in September. Cases, 5; deaths, 0. JEANERETTE. 1854, No record. 1857. First case, October 7. JESUIT BEND. 1854. First case, September 12. 1878. First case, Se])trnil)(T 22. Cases, 2; deaths, 2. KEMPA BEND. 1905. First case, September 17. Cases, 2; deaths, 0. KEXTWOOD. 1905. First case, September 18. Cases, 2; deaths, 0. KENNER. 1905. First case, Aiiiiiist 18. Cases, 360; deaths, 33. LABADIEVILLE. 1878. Popnlation, 180. Infected by New Orleans. First case, August 10; first death, Aujjust 21. Cases, 160 ; deaths, 24. LAFAYETTE. 1905. First case, September 26. Cases, 4; deaths, 0. LAFOURCHE CROSSING. 1878. First case, September 12; last case, December 18; first death, September 18; last death, December 21. Cases, 209 ; deaths. 26. LOUISIANA. 857 1879. Infoeted by Morgan City. First cas-o, Octolier 2; first deatli, October 5; last case, December 1; last death, Noyeiiiber 27. Cases, 40; deaths, 9. 1905. First cace, August 26. Cases, 35; deaths, 5. LAKE CHARLES. 1898. First case, October 10. Cases, 1; deaths, LACtOXDA tlaxtattox. 1878. Iiif(H't(Hl l)y Xe^y Orleans. First case, Septem- ber 5; first death, September 10. Cases, 591 ; deatlis, 42. LAKE PROVIDENCE. 1853. Population, 1,000. Infected by XcAy Orleans. First case, Angnst; first deatli, Augnst 31. 1905. Firsf case, July 21. Cases, 327 ; deaths, 23. LAPLACE. 1905. First case, August 10. Cases, 103; deaths, 18. LAROSE. 1905. First case, August 29. Cases, 13; d(>atlis, 5. LECOMPTE. 1905. First case, September 11. Cases, 2; deatlis, 0. LEEYILLE. (LafourrJtc Pa visit ) . 1905. First case, May 24. Cases, 375; deaths, 07. 858 HISTORY OF YEI.I.OW FEVER. LOBDELL. 1808. First case, Oc-tober 12; last case, Octolicr 12. Only case recorded. LOWEK TEXAS. 1871), Cases, 30; deaths, 7. LUCY. \'.)V,7t. i'^iisi case, OcUjIht .">. Cases, ;> : deal lis, 0, LUDIXGTOX. 1005. Cases, 38; deaths, 0. LULING. 1878. Viv>i case, Scjitciiilici' 1."). Cases, 2 (hat lis, 0. LUTCHEIJ. 181)8. First case, Octohcr IT), (^ases, 14; deatlis, 2. irxi";. V\v>t case, Aii.uust 11. (^ases, 5; dtallis, 0. :\IAF1S(JXVILLK. 1905. First case, August 14. Cases, 1 ; (h'atlis, 0. :\ FA L:\roT. 1879, h'ii-st case, XoveiiilxM' 1. Cases, 1; deatlis, 0. :\JAXT)FVILLE. 1847. Xo record nstl7; last case, Xovemher 10; first death, Auo-ust 22; last death, November 11. Cases. 586; deaths, 109. 1879. Population, 3,000. First case, July 25; first death, August 10; last case, December 1; last death, De- cember 4. Cases, 89; deaths, 25. 1905. First case, July 28. Cases, 11 ; deaths, 0. MOISE SETTLEMENT. 1905. First case, August 30. Cases, 52 ; deaths, 3. NAPOLEONVILLE. 1878. Population, 500. Infected by Lafourche Cross- ing. First case, August 10. Cases, 3; deaths, 0. NATCHITOCHES. 1839. No record of cases and deatbs. 1905. No record of cases and deaths. 1905. First case, September IG. Cases, 1; deaths, 1. NERO. 1905. Cases, 1. LOUISIANA. 861 NEW IBERIA. 1839. No record of cases and deaths. 1867. No record of cases and deaths. 1870. No record of cases and deaths. 1905. First case, October 10. Cases, 18; deaths, 1. 1900. First case, Angnst 19. Cases, I. NEW IBERVILLE. 1905. Cases, 2; deaths, 0. NEW ORLEANS. 11 ISTOKICAL ReSUMK. Thv Birth of the rity. In the spring of 1718, Bienville selected a site for fi town on the banks of the ^Mississippi, anments. For three y( ars Bienville's headqnarters remained at ^Mobile. Tlie liisterian, :M. Le I»age Dn Pratz, who came over with a coloDV of eii>ht hni'dred men in 1718, under the ansDices of the A\'est India Comnany, states that six weeks before the arrival at Cai)e Francais, St. Domingo, fifteen hundred persons died of an epidemic called the Siam Distemper. l)u Bratz uives, however, no facts to show that anv of the body of emigrants, some of whom settled at New Oi-leans and others at Natchez, suffered A\ith yellow fever, Uw he stales that after a passage of 862 HISTORY OF YELLOW FEVER. three months, ineludiuo- the six Avoeks spent at Cape Francais, thoy arrived at the Ishmd of ^Massacre, since called Isle of Daiiphiue, on August 25, after a prosperous voyage, no one having died, or having been even danger- ously ill. Du Pratz describes the location of the future capital of Louisiana in 1718, as being marked cut by a hut covered with palmetto leaves. As early as the year 1718, when Xew Orleans was founded, a company ship had sailed from France with troops and one hundred convicts, destined for Louisiana, but had never been heard of. Toward the close of 1821, there arrived in Louisiana, a French officer who gave some account of this ill-fated vessel. It was now dis- covered that like the fleet of LaSalle, she had missed the Mississippi, and had been driven to the west. Her com- mander had mistaken the island of Cuba for that of St. Domingo, and had been, compelled to pass through the old channel to get into the gulf. He made a large bay, in the 29th degree of latitude, and discovered that he had lost his way. His misfortune aa as increased by a disease breaking out among the convicts. Five of the officers thought it less dangerous to land, with provisions for eight days and their arms, than to continue on board. FirKl ImportaiiGU of African AS7f/rr.s. The first importation of African slaves numbering 500, was made in 1711), a large portion ot Avhich was sent to Xew Orleans, and transferred to the Avest bank of the river to a plantation oAvned by a company. The re- mainder Avere sold chiefly to the agricultural settlements of the lower ^Iississipi»i. AVe haAC no accounts of any importation of yelloAv fever by these or subsequent cargoes of slaves under the French reign. The ''Phi f/ lie of Mar.^ciUcs/' P.eii.ard de la Harpe states that on the 1st of July, 1720, the king's ships, Jjc Conitc dc Toulouse, sixty-four guns, cpmmanded by Af. de Vatel, after the death of M. de Cafaro, on tlie 17lh of June, and the ^aint Henri, seventy NEW ORLKANS. 863 gims, commanded by M. Douce, arrived iu Louisiana. They broujilit with tliem from the island of St. Domingo, a contagious fever or mahidy, whicli carried oft' a great number of persons every day. After opening several bodies, it was discovered that the disease came from a. corruption which engendered a quantity of worms iu the stomach. Francois Xavier 3Iartin gives a wholly different ac- couiit of the origin and nature of this malady, and classes it with the Oriental Plague. He says: ''Two line-of- battle ships came in the latter part of June, 1720, from Toulon. They were in great distress; Caftaro, the com- modore, and most of their crews had fallen to the plague, which some sailors iu these ships Avho come from Mar- seilles, had communicated to the others; that city being ravaged by jiestilence, brought there by a ship from Lyde, in the J.evant. Father Laval, a Jesuit, royal professor of hydrography in the colleges of Toulon, had hj the king's order, taken passage on board this fleet, with directions to make astronomical observations in Louisiana. The chaplains of the ship having died, the father, considering science an object of minor consideration to a minister of the altar, thought it his duty to bestow all his time in administering spiritual relief to the sick, who for a long time Avere very numerous, and he sailed back with the ships. Orif/in of ^htnrii in Loidmrua. Experiment having shown that Europeans could not stand the labors of tiie field, but sickened and died under the burning suns of Louisiana, and the chilling dews and fogs of night; the Western Company was, tliercfore, com- pelled to introduce African negroes to cultivate the plan- tations scattered on the bayous and rivers of the delta of the ^lississippi, and for several years it furnished the agricultural interests of the colony with several liundred annually, which was the origin of African slavery in Louisiana. In 1824, ^F. de Bienville drew up a code, con- taining all the legislation a]»iilicaltle to slaves in Louis- 864 HISTORY OF YBLLOW FKVIR. iana, which remained in force until 1803. It appears that duriu*; the rear 1781, Louisiana received no less than 1,3(>T nejiroes from the coast of Africa. We have failed to discover in the writinf^s of La Harpe, Du Pratz, Char- levois, ^lartin, Gayarre and others, any facts sustaining the view advanced by some, tliat yellow fever was first imported into Louisiana by the slave shi])S. Du Pratz, wlio visited New Orleans and BiUtxi in 1722, states that at the latter place more than five hundred persons died of famine. He states that ''the lireat plenty of oysters found ujion the coast saved the lives of them, although obliged to wade up to their thighs for them, a gunshot from the shore. If this food nourished several of them, it threw numbers into sickness, wliicli was still more heightened l)y tlie bmg time they were obliged to be in the water." Families aud Hnrricaurs. In the beginning of August, 1723, Bienville removed his head(]uarters to New Orleans. A most destructive hurricane desolated the province on the lltli of Septem- ber, 1723. The church, hospital and thirty houses were levelled to the ground in New Orleans; three vessels that lay before^ it were driven onshore. The crops above and below AV('r<^ totally destroyed, and many houses of the planters blown down. Famine threatened the colonists with its horrors, but they were in some degree relieved l»y the appearance of an unexpected cro]) of rice. 7)/,s- ea^c luhhtl in flic full, ils honorx to lliosc of iiiipciKtluif deafJi. In 1724, the white population of Louisiana, says La ITarpe, amounted to aboutl,700 souls, and the black pop- ulation 3,:5()(). If La llarpc's statement be true, it shows an astonishing diminution of the Nxliitc jtopulation, which in 1721, was comi>ulcd at 5,400. .1// Hiiilji Deforcsiuiioii Ed id. During the fall of 1726, Perrier, a lieuteuant of the king's ships, having been appointed commandant general of Louisiana, sli(.i- ( f Louisiana \\iiicli lies on tlie wi'steni side of tlie Mississii)i)i, iiicludiiij; the City of Xew Orh^aiis. The suhseqiient history of New Orleans, including: the cession to the Ignited States and other political events, is well knoAvn to the niajoritv of onr readers. This re- sume, taken from the memoirs of the late Joseph Jones, one of Louisiana's most distin«>nishcd suri»eons and autlioi's, '-overs the most interestiuo' period in the life of the lii aiitifnl metropolis of the South. Si'^niARY OF Epii)e:mi('s.* Accordimi' t,000. The yellow fever years in New Orleans, from 17(11) to the last epidemic (11)05), nuiy be summariztd as follows: 17(11). I-'irst traditional appearance of yellow fever in New Orleans. No statistics. 1791 ; 1793; 1791. No record asin ) was begun in" 1794. 1795. Limited (Uitbreak. 179(1. I-'irst anthentic invasion of N( w (h-leans by yel- low fever. No reliable statistics obtainable. 1797. N(» rec( rd of cases and deaths. The Old Basin, the present liead of the Carondebt Canal, ^^•as excavated in 1797 1799. No record of cases and di aths. Crevasse ab(;ve the city. 1800; ISOl; 1S()2; 1S03; 1S()4; ISOl); ISll. No record of cases and deatlis. Hurricane, doinj^ mneh damage lo city, in ISll. isi2. roiuilation, 19,229. W ar with (Jreat Britain. * Dates of important excavations, etc., are given because of their fanciful association, at the time, with yellow fever out- breaks. NEW ORLEANS. 869 1817. ropiilation, 24,19(;. Infected 1)y British Cutter Phocui.r, frciii Havana. First ease, Jniie 18; last death, December — -. Deaths, 80. Extensive crevasse al)()ve city the year jirevioiis. 1818. Pcpnhition, 25,100. :Mild epidemic. Deaths, 115. 1819. rust 15. Cases, 20; deaths, 18. 1833. Population, 57,713. First case, July 12. Cases, 422; deaths, 210. Heavy rains, lasting- from June to September. 1834. l»oi)ulation, 00,342. IMrst case, Au.mist 28. Cases, 150; deaths, 95. 870 HISTORY OF YELLOW FIVER. 1835. Population, 02,971. First case, August 23. Cases, 505 ; deatlis, 281. '■ 1830. Population, 05,000. First case, August 21. J Cases, 0; deaths, 5. 1837. Population, 08,229. First case, July 21. Cases, 998 ; deaths, 112. 1838. Population, 70,858. First case, August 25. Cases, 22 ; deaths, 17. 1839. Population, 73,137. First case, July 23. Cases, 1,080; deaths, 152. 1810. Population, 70,110. First case, July 25. Cases, 3; deaths, 3. 1811. Population, 78,715. First case, July 27. Cases, 1,111; deaths, 591. Drainage Commission actively en- gaged in drainage and clearing. 1812 Population, 81,371. First case, July 30. Cases, 425 ; deaths, 211. 1813. Population, 81,003. First case, July. Cases, 1,090 ; deatlis, 187. 1811. Population, 80,032. First case in July; last case, September. Cases, 109 ; deaths, 83. Overflow from Lake Pontchartrain; city liooded to Burgundy Street. 1815. Population, 89,201. Deaths, 2. 1810. Population, 102,070. First case in August ; last case in October. Deaths, 110. Faubourg Lafayette an- nexed to city, increasing population. 1817. Population, 108,099. First case, July 0; last case in December. Deaths, 2,300. War with Mexico. Melpomene Canal cleaned out. Heavy rains. 1818. Population, 115,503. First case, June 21 ; last case in November. Deaths, 808. Extensive excavations made for foundations of T'nited States Custom-house. This Avork went on uninterruptedly until September, 1819. Two acres, 20 by 7 feet wide and 8 feet, 7 inches deep, were excavated. 1819. Population, 122,511. First case, July 28; last case, Decemlier — . Deaths, 709. 1850. Population, 129,717. First case in January, terminating fatally; 2 deaths in ]March, 1 in ^May, 1 in NEW ORLEANS. 871 July, G2 ill Aiiiiiist, 33 in September and 4 iii October. Total deaths, 107. 1851. ropulation, 138,599. Deaths, 17. Excavations for railroads, gas and waterworks. 1852. Population, 117,411. First case, July ; last case, December — . Deaths, 45G. Claiborne Canal dug. 1853. Population, 151,132. Infected by ship Camhodcn Castle, from Kingston, Jamaica. First case, May 22; last case, December. Deaths, 7,849. The epidemic of 1853 was the most mortal which has ever afflicted Xew Orleans. 1854. First case. May ; last case, December ; first death, June 12. Deaths, 2,425. 1855. First case, June 19; last case, December. Deaths, 2,670. 1850. Population, 153,421. Infected l^y Vera Cruz. First case, June 28 ; last case, Xoyember — , Deaths, 74. 1857. Population, 157,242. Infected by Havana via Mobile. First case, January; last case, December. Deaths, 200. 1858. Population, 101,033. Infected by St. Thomas, West Indies. First case, June 10; first death, June 10 ; last case, October 10. Deaths, 4,845. 1859. Population, 104,804. Infected by brig Elizaheih EUrn, from Havana. First case, June — . Deaths, 91. 1800. Population, 108,075. Deaths, 15. 18(;i. Population, 170,949. Civil War. No cases. 1802. Infected by Key West. Deaths, 2. 1803. Population, 175,497. Deaths, 2. 1804. Population, 177,708. Deaths, 6. 1805. Population, 180,943. Cases, 1 ; deaths, 1. 18()0. Population, 182,318. First case, August 10. Deaths, 185. 1807. Population, 184,503. First case, June 10; last case, December 22. Deaths, 3,107. The first case died in the Charity Hospital on June the 10th, a seaman who had been em]»b!y(Ml in the navigation of the Lake. Three weeks before his death he had shipped upon the bark Bessie, loading with staves in the Fourth 872 HISTORY OF YELLOW FEVER. District, and boniid fdi- Barcelona. This vessel had sailed from Havana in .Mareli, airivinii liere in April laden with sn«iar. 8he was reported clean and liealthy. Soon after arriving', went into dry doek in Algiers. Inqniries were made as to her after her sailino-. She arrived at her desti- nation Avithont mishap as to the lives of her crew. The second case reported was by Dr. Rrickell, as hav- ing;' been taken on the 13th of Jnne, on St. Charles Street near Jnlia. The man, John Boddis, recovered. The third case, reported by Dr. Folwell, on Jnlia Street, between Camp and St. Charles Streets, died on the 23rd ol" Jnne. The fonrth case died on the 2r)th of Jnne. His name Avas J. B. Bonnonan. He arrived npon the steamer W. G. He ties, from Galveston, on the 21st, whence he came from Indianola direct. He had a chill at Calveston on the 19th and died on the 2nt]i. The fifth case, J. Dongherty, reported by Dr. L. H. Cohen, died on the 20th of Jnne in the Charity Hospital. He came from Xo. fil Girod Street, and was employed on coal bariies at Aliiiers. The sixth case was Lient. Dewey, who died at the St. Charles Hotel. He came by steamer direct from Indian- ola, and was bronmht from the vessel to the hotel sick. The vessel cominji' to this port, clearly infected, was 11m' l»ai-k Florence J-\'frrs. which saib^l from Havana on the 3rd of Jnne laden ^\^\\h snuar. She was stopped at the Qnarantinc Station, Jnne the 12th, whei'e she was delaiix'd ten days, alllnMiiih ]'ei)orted clean and healthy, was fnhiiuated and released. She arrived at Ali»iers, June 22. The wife (;f the ca])tain, !Mrs. Hooper, died of yellow fever on the 30th. This case was reported by Dr. Brnns. Her sister also was attacked on the 25th, bnt recovered. The second mate (Thomas) was taken ill Jnly 4, and died ill the TMiarity Hospital on the Otli. The ca])tain also died on the 13th. ' The fever existed thi-cnuhcnt Jnly in the city, and nntil near the middle of Anj^nst before acqnirinji- epidemic l)r(.porficns. NEW ORLEANS. 873 Froui the middle of August to the end of September, the mortality' Avas considerable. 18GS. Population, 18(5,008. First death, October 5. Deaths, 5. 18G9. Deaths, 3. 1870. Infected by steamship A(/itcs, from Honduras. First case, ]May IG; last case, December. Deaths, 588. 1871. Infected by brig Mar// Pratt, from Cuba. First case, August 1; last case, October. Deaths, 51. 1872. First case, August 28; last case, November 30. Deaths, 39. 1873. Infected by bark Val/un-aiso, from Havana. First case, July 1; last case, November 19; first death, July 8. Cases,*^3G8; deaths, 22G. 1871. The outbreak of 1871 is interesting, fiom a point of high rate of mortality, considering the limited number of cases. There were altogether 20 cases, of which 17 died. The first two cases were discovered by the Bai(ii)iie Sti-eet — Recovered. Octobe'r 8 — No, 112 ^Magazine Stre^et — Dieel. October ..—No. 102 Old Levee Stre'et— Died. October . . — Unknown — Died. 874 HISTORY OF YELLOW EEYER. October 15 — No. 15 Rousseau Street — Died. Octol>er 17 — Xo. 1)5 Spain Street — Jvecovered. October 21— Xo. im Orleans Street— Died. October 22— Xo. 619 Goodcliildren Street— Died. X^ovember 1 — Bark Qiicriisstoioi — Recovered, X>)Ycniber 2 — Bark Qiiccii.stoini — Died. X^'ovember 28 — Chartres Street — Died. According" to the records of the Board of Health (1871), the fourth case occurred in the same scpiare where yellow fever had prevailed the year before. Cases 5, and G were infected at Pascagoula, Miss., and cases 18 and 19 were imported from Havana by the bark Qiicenstoicn. 1875. First case, August 8; first death, August 12; last case, X'ovember 28. Cases, 100; deaths, CI. 187(>. Deaths, 41. 1877. Tlie history of yellow fever for the year 1877, in X'ew Orleans, is limited to a single case. A man ar- rived on the steamsh'p St. IjOh'is. from Havana, X'ovember 6, and died the next morning at the corner of Rousseau and IMiilip Streets, with ui)uiistakal)le symptoms of yellow fever. He had sickened four days previously, within a few hours after leaving Havana, where he had stayed three Aveeks; but continued to go about the ship until after passing the quarantine, and in this way failed to attract the attention of the resident physician. 1878. This is one of tl)e most notabb^ (epidemics of yellow fever in th(^ history of X'ew Orleans, ov\ing to the numer- ous ])laces which were infected frcnu tliis focns. On ]\ray 22, 1878, the ship Eiiiihi Ji. >^oii'Irr arrived at fpiaiantine below X>w Oi-leans, having called at Havana during her tri]). T'pon her an-ival. Dr. Carrington, the quarantine ofhcer, after making an examination, tele- gra]»lied Dr. Chop]un, President cf the Louisiana Board of Health, as folbnvs: "The SoiuJci- has a case of intermittent on board. Wliat shall T do?"' NEW ORLEANS 187 8. 875 Dr. Clioppiu replied: "Fumigate and disinfect the ship and satisfy yourself of the character of tlie disease before you let her come up." The sick man was placed in the quarantine hospital and finally recovered. Tlie Sotulcr after five hours' detention, and disinfection with sulphur burned in pans, was permitted to go up to the city.* Soon after arrival at her wharf, ^Ir. Clark the purser, was taken ill, and Dr. Drew, of Pilot Town, who had taken passage at that point, was called to treat the case. The physician did not consider this a case of yel- low fever, as he signed the certificate of deatli, ''Malarial fever." An investigation of the case at the house where he died, however, slicwed that the treatment was more suitable to yellow fever than to am^ other disease. This death, was n(;t brought to the notice of the Board of Health by any direct communication, official or otnerwise, but from infcu-mation received tlirough rumor. It is a significant fact in connection with Clark's case, that he died at 2 o'clock, a. m., and was buried at 10 a. m., the same day. Xo public announcement of his death v;i;-..i mad(^ until the following Sunday. Mr. Elliott, the second engineer of the louder, was taken sick sliortly after his arrival, and was attended by a private physician at his boarding-house, corner of Front and Gircd Streets, until the evening before his death, without apparently a suspicion on the part of any one that lie had yellow fever. Late in the evening of May 29, he was removed to Hotel Dieu, where he died within a few hours. A careful post mortem examination Avas made by two competent physicians, and the body was sub- se(pi(U)tly inspected by Dr. Choppin. Xo one of these physicians doubted the nature of the disease. For about two months after the above occurrences, no * Detention of ])assengers in quarantine, for observation, abolished by Legislature of 1876 and reliance placed on disinfection alone. 876 HISTORY OF YELLOW FEVER. now casos dev( loped. If yellow fever existed, it was not reported to the l^oard of Health, or was of such a mild nature as not to be differentiated from the malarial fevers common in th<(se days. Alxtut file middle of July some cases of a strongly sus- picious character came to li<>ht on Constance Street, near its intersection with Terpsichore, and in a few days all doubt was removed of their true natui'e. About the 7th of July, a younj>' man, named Cohn, came to the Touro Infirmary frcnn Gasquet Street, between Yillere and ]\larais. ])resentiu_i>- str(tn<>' a])pearances of yellow fever, but he recovered before atteution Avas drawn to Constance Street, and his case was considered questionable. AVithin a few days, cases were found near the corner of Front and Girod, where Elliott had sickened; on Bienville, near where Clark had died and on Clail)orne Street; a case on Robertson Street, near the home of Colin, who had been at the Touro Infirmary, not much more than a quar- ter of a uiile fr(fm where Clark died, and a still less dis- tance from Hotel Dieu, Avhere Elliott died. The line of infection was tolerably char, thouj^h lonj? latent, from Clark to Colin and subse(iuent]y to the cases on Bienville and Ivcfbertson Streets; also fr(;m Elliott, sick at his b(;ardii»,u-]iouse, t<» the subse(|uent outbreak at the coi'uer of b^ront and (lirod; but the outbreak on Con- stance Street was so far from the wharf of the t>ioiibont (lidrlir Wootl. This lioat lay at the same v»iiarf occU])ieust the fever began spreading rai)idly througli the city and vicinity, and throughcnit all of Sep- tember and most of October, raged furiously, attracting by its terrible death roll, the attention of this and many foreign nations. From all quarters, physicians, nurses and sui)])lies came, but not until late in Xovend)er did the demon of pestilence finally make his exit from the unfortunate city. This memoral)le epidemic may be briefly summarized as follows : Population of New Orleans in 1878, 210,000. Infected by ship E hill 11 li. Saiidci; from Havana. First case. May 22; first death, .Mav 25; last case and death, Decendter 12. Cases, 27,000 ; deaths, 4,04(5. 1871). First case, ]March 20, on board steamship Balti- more, recovei-y. No other manifestation until June, when the first case in the city jtrojjer occuricd at No. 184 Tliird Street, and was reported by Dr. r^dmond Souchon. The first death took placc^ on July 27, corner Second and Con- stance Streets. The epidemic lasted until October, last case on the 21st and last death on the 2;ird. Cases, 48; deaths, 19. 1880. Deaths, 2. 1883. One death. 878 HISTORY OK YELLOW tEVER. 1889. One fatal case, imported from Livingston, Guatemala, under the following- circumstances : Mr. E. DeVilla, United States consular agent for the United States of Colombia, had been at Guatemala City, and from there went overland to Livingston, Guatemala, where he took passage on the steamship City of Dallas for New Orleans, on the 26th of September. The second dav out he was taken Avith a cliill followed by fever, but did not keep to his berth after the chill. He continued to feel ill during the voyage, but before arrival of the vessel at the Mississippi quarantine, he dressed himself and went on deck, thus passing insi)ection by the quar- antine officer. The master of the vessel made affidavit that there had been no one sick during the voyage. The vessel had a clean bill of health, and there being no report of yellow fever at Livingston, the vessel, after being dis- infected, was allowed to proceed to Xcav Orleans, Avhere she arrived at 8 p. m., October 1. The patient was seen by Dr. J. J. Castcllanos, October 2, had had fever, nausea, hiccough, pain in the region of the stomach, and bilious vomiting. When seen again at night he was vomiting black A'omit, followed by black hemorrhagic stools. The next morning, black vomit still persisted and he had urinary suppression, hicocugh and unemic convulsions. Dr. Castellanos reported the case to the Board of Health office, and a commission of experts, composed of Drs. J. P. Davidson, C. J. Bickham and George Howe, was summoned and requested to see the case and pass upon it. In the mean time the man had died (October 3, 11:35 a. m. ), and at 2 p. m. the above named physicians, with Dr. Castellanos and Dr. B. Matas, who had been called in consultation, proceeded to the house, Xo. 149 Decatur Street, and after obtaining a history of the case and hold- ing an autopsy, unanimously declared that death had benn caused l)v yellow fever. There were no devcloiiments from this case and the city continued to be free from epidemic disease during NEW ORLEANS. 879 the oJ<>lit followinii- years, and would nudoubtedly have enjoyed a longer inimiinit3^ but for infection from out- side sources in 1897. 1897. The first authentic case of yellow fever in New Orleans in 1897, was reported by Dr. Sidney L. Theard, on Sep- tember 4th. The biennial report of the Louisiana State Board of Health for the years 1896-97, published in Feb- ruar}^, 1898, recounts that an earlier case had been re- ported as suspicious on September 1st, by a prominent physician of N'^w Orleans (Dr. E. T. Shepard), which, on investigation by members of the Commission of Ex- perts of the State Board of Health, had been declared not to be yellow fever. Of this, however, no one had any knowledge at the time except those immediateh^ connected with the public health service. Dr. Shepard's case ended in recovery. The case of fever in Dr. Theard's practice was reported by him to the Secretary of the State Board of Health, on Saturday, September 4, (1897), at 3 o'clock p. m. ; the President of the Board having left that same evening for Ocean Springs, to again investigate the prevailing fever at that point, believed to be dengue.* i Dr. Theard, having been engaged in practice al)out six: .years only, had had no occasion to see yellow fever, the last epidemic of that disease having occurred in 1878, and only had a book-knowledge of the disease. For that reason two members of the Commission of Yellow Fever Experts were delegated to consult with him. The patient was seen that same evening at 8 p. m., and the case pro- nounced to be one of malarial hemorrhagic fever. A prolonged search was made the next morning by Drs. Theard and Pothier, the latter a distinguished pathologist, for malarial organism in the patient's blood, but none found. * Previous investigations of the fever at Ocean Springs by the State health officials of Mississippi, Alabama and Louisiana, had resulted in a diagnosis of dengue fever. 880 IIJSTORV OK YELLOW FEVKR. Oil Moiidny moriiinji- tlie i)atieiit (IJaoiil (U'lpi) dietl, and ])r. Tlieard iiotitied the secietaiy of ilie Board of Health, by ]»hone, that he would ho doAVii in person at the Board of Health office to j-iiiii the deatli retnrn, and wonld aseiihe the deatli to yelloAv fever. On his arrival there, shortly afterward, he found a nuniber of piiysicians in waitinji', seekiuj^" news about Oeean Springs, among them one of the experts who had seen the ease on behalf of tlie Board of Health, and who was still of so strong a mind that the ease was malaria that he offered to sign tlie death eertitieate as sueh. This Dr. Tlieard would not accept, unshaken in his own ution 1100,000. No outside aid was accepted, and several offers for assistance were declined with gratitude. Besides the above amounts, there was raised considerable NEW ORLEANS 1905. 885 mont'T by the voliiutoer ward organizations, who spent $30,000 for screening of cistern, and oiling them, and in iusjiections for sanitary pnrposes. The fight against in- fection was extended to every parish in Louisiana, wherever tlie fever appeared, and some of the expenses were borne b}' local appropriations. fhily 21st, an address was issued to the citizens of New Orleans, signed by Dr. Quitman Kohnke, health officer, and Dr. J. H. ^Vhite, Surgeon U. S. P. H. & M. H. Service, and endorsed by the advisory committee of the Orleans Parish Medical Society, calling attention to the emergency existing in the city, and asking the help of every individual for the limiting and preventing of the spread of the disease. It having been scientifically proved that the mosquito is the only means of transmis- sion of yellow fever, it is especially urged tliat the fol- lowing %simple directions be followed by the householders of the city, for the summer months : 1st. Empty all unused receptacles of water. Allow no stagnant water on the premises. 2nd. Screen cistern after placing a snmll (]uantity of insurance oil (a teacupful in each cistern), on the sur- face of the water. 3id. Place a snmll quantity of insurance oil in cess- pool or privy vault. 4fh. Sleep under mosquito nets. 5th. Sci-een doois an Rico, from Vera Cruz, 1. August 12. ASV//y/n'/-, from Colon, 3. August 24. Ori(/('ii, from Colon, 4. September 8. E.rcclsior, fi'om Havana, 1. October 27. Cifij of Tain pica, from Vera Cruz, 1. October 27. St.' Croix, from Vera Cruz, 1. Total cases imported, 14. All of these vessels, except the Excelsior, and the Porio Eico, had been fumigated at the port of departure, and the disease broke out, on all of tluMu, wiUiin live days after fumigation. Dr. Thomas said "I believe that yellow fever is usually, if not always imported throuuh an infected individual, with the disease incubating in his system, who ])asses through one of the many quarantine stations, and gets into the country before the initial attack of fever. Since it is known, however, beyond doubt, that the mosquito is the conveyor of the disease, I believe that, under favor- able conditions, mosquitoes can be imported from infected ports, and be the means of conveying and spreading the LOUISIANA. 893 disease in the couutry. If this were not a possibility, what is the use of fumigating vessels, for we fumigate now, to kill mosquitoes only? ''We were infected this year thruogh one of these sources; I am unable to say which, for I do not know. If however, it was through imported infected mosquitoes, I would say that we got our infection from Colon, or from Havana. If through an infected individual, from Havana, most likely — possibly from a port within the five days' limit, and the case developed after five days." NEWTON. 1905. One case; recovery. OLIVIA. 1905. Cases, G; deaths, 1. OMEGA AND RALEIGH LANDINGS. 1878. Deaths, 5. OPELOUSAS. 1826. Infected by New Orleans. Cases, 3; deaths, 1. 1828. Infected by Ncav Orleans. Cases, 4; deaths, 3. 1829. No record of cases and deaths. 1837. First case, October 20; last case in November. 1839. First case in August; last case in November. 1842; 1853; 18G7. No record of cases and deaths. OSTRICA. i 1905. First case, July 26. Cases, 1 ; deaths, 0. 894 HISTORY OF YILLOW KKVER. PAINCOUETVILLE. 187S. Population, 400. First case, August 14; last case, October 2G. Cases, 181; deaths, 15. PATTERSON. 1853. Infected by New Orleans. First case, August 13; last case in December. No statistics. 1854 ; 1855 ; 1857. First case, September. No statistics, 1863, First case, August 8; first death, August 13; last case and last death in December, Cases, 500 ; deaths, 45. 1878, The first case, Mrs. Dr. L. W. Tarleton, con- tracted the disease at Logonda Plantation, where the disease is supposed to have been brouglit from New Orleans, September 2. She died soon after. The disease spread rapidly and was very malignant. Cases, 125; deaths, 28, of which 5 were colored. Cases near town, white and colored. 175; deaths outside town, whites, 40; colored, 25. Date of last death, November 23. 1879. First case, Noveml)er 20 ; last case, December 6. Cases, 2; deaths, 0. PHARR PLANTATION. 1879. Infected by Berwick. First ease, November 10 ; last case, December 2. Cases, 6; deaths, 5. PILOT TOWN. 1878. Infected by Port Eads. First case, August 18; last case, October 16; first death, August 22. Cases, 113; deaths, 17. PATTERSON. 1897. Cases, 1 ; no deaths, 1905. First case, July 31. Cases, 700; deaths, 52. PECAN GROVE. 1878. Deaths, 2. 1905. First case, August 18. Cases, 20; deaths, 5. LOUISIANA. 895 PLAQUEMINE. 1837 ; 1839 ; 1847. ^'o record of cases and deaths. 1853. First case, August 20 ; first deatli, August 26 ; last case, December 15; last death, December 9. 1858. No record of cases and deaths. 1878. Population, 1,500. Infected by Xew Orleans. First case, August 1. Cases, 1,159 ; deaths, 125. 1898. First case, October 15; last case, October 15. Cases, 6; deaths, 1. POIXTE MICHEL. 1880. Sporadic cases. POINT PLEASANT. 1878. Fever appeared in August. There were about 60 cases and 13 deaths. PLATTENVILLE. 1905. Cases, 1 ; deaths, 0. POINTE-A-LA-HACHE. 1851. First case, October. . 1878. Cases, 4; deaths, 4. 1905. First case, October 2. Cases, 1; deaths, 0. POINT CELESTE. 1905. First case, July 30. Cases, 32; deaths, 6. PONCHATOULA. 1878. Infected by New Orleans. First case, October 6 ; first death, October 10. Cases, 12 ; deaths, 3. PORT BAPKE. 1870. No record of cases and deaths. 896 HISTORY OF YELLOW riTEK* POIiT BAIiKOW. 1878. Deaths, 7. 1905. First case, July 24. Cases, 73, deaths, 10. PORT EADS. 1878. August 5, one case of yellow fever appeared, and August 11, fourteen cases. Dr. Warren Stone, with two nurses, Mrs. Dupree and ^frs. Eastman, came from New Orleans to attend them. He telegraphed back, "fever in- creasing." The first fatal case was Mrs. Capt. Moran. The cases occurred rapidly. Many workmen went away, and work on the jetties was suspended. Total cases, 02; total deaths, 11. Date of last death, October 11. PORT HUDSON. 1839. Infected by New Orleans. 1811. No record of cases and deaths. 1813. No record of cases and deaths. 1878. First case, September 9; first death, September 13. Cases, 100; deaths, 11. PUGH PLACE. 1879. First case, October 2. Cases, 33 ; deaths, 0. PROSPECT PLANTATION. 1905. Cases, 8; deaths, 1. RALEIGH LANDING. 1878. No record of cases and deaths. 1905. One case, August 6. REBECCA PLANTATION. 1905. First case, September 10. Cases, 20; deaths, 1. LOUISIANA. 897 RED RIVER LANDING. 1878, No record of cases and deaths. RESERVE PLANTATION. 1905. First case, August 14. Cases, 11; deaths, 2. RICHOC. 1878. Cases, 62; deaths, 18. RIVERSIDE PLANTATION. 1905. First case, July 23. Cases, 218 ; deaths, 10. ROSEDALE. 1905. First case, September 5. Cases, 5 ; deaths, 1. SARPY. 1905. First case, August 19. Cases, 13; deaths, 2. SHELBURN. 1905. Cases, 15; deaths, 1. SHREVEPORT. 1853. No record of cases and deaths. 1873. Population, 9,000. Infected by New Orleans. First case, August 12; first death, August 19; last case, November 10. Cases, 3,000; deaths, 759. 1905. Cases, 3; deaths, 1. SHREWSBURY. 1905. First case, August 15. Cases, 6 ; deaths, 2. SMITHLAND. 1878. A plantation in Point Coupee Parish, La. The only fatal case reported is that of Dr. W. D. Smith, who died September 25. 898 HISTORY OK YELLOW FEVER. SMITHVILLE. 1905. First case, Sei^tember G. Cases, 1; deaths, 0. SMOKE BEXD. 1905. First case, August 28. Cases, 3; deatlis, 1. SOUTHDOWN. 1905. First case, OctoLer 19. Cases. 1; deaths, 1. SOUTH PASS. 1878. Cases, 42; deaths, 2. SOUTHWEST PASS. 1878. Cases, 2G ; deaths, 8. STEVENSON. 1878. Two fatal cases. ST. BERNARD. 1878. Infected by New Orleans. First case, August 25 ; first death, August 29. Cases, 19 ; deaths, 7. 1905. First case, July 20. Cases, 51; deaths, 2. ST. CLARE. 1905. Cases, 1; deatlis, 0. ST. ELIZABETH. 1905. First case, July 13. Cases, 21; deaths, 8. LOUISIANA, 899 ST. FKANCISVJLLE. 1811 ; 1817 ; 1819 ; 1823 ; 1827 ; 1828. Xo record of cases and deaths. 1829. First case, September 22. 1839. First case, August 28. 1813. First case, August 28. 184G. Deaths, 1. 1848. Deaths, 1. 1853. No record of cases and deaths. ST. GABRIEL. 1878. Population, 425. Cases, 132; deaths, 38. 1905. Cases, 2; deaths, 0. ST. JAMES. 1878. ~ Cases, 36; deaths, 4. 1898. First case, October 1; last case, October 1. Cases, 1 ; deaths, 0. ST. JOSEPH. 1905. First case, September 18. Cases, 3; deaths, 0. ST MARTIXVILLE. 1839. No record of cases and deaths. ST. ROSE. 1905. First case, August 22. Cases, 61 ; deaths, 6. STORY'S. 1905. Cases, 2; deaths, 0. SUNRISE. 1905. First case, July 30. Cases, 1; deaths, 0. 900 HISTORY OF YELLOW FEYER. TALLULAIL 1878. Cases, 33 ; deaths, 4. 1905. First case, about August 8. Cases, 1,040; deaths, 23. TANGIPAHOA. 1878. Population, 200. Infected by Xe\\' Orleans. First case, September 1. Cases, 150; deaths, 50. TECHE COUNTRY. 1878. Population, 1,033. First case, September 10; first death, September 13. Cases, 715; deaths, 81. TERKE-AUX-BOEUF. 1905. First case, September 9. Cases, 1; deaths, 0. THIBODAUX. 1839. Sporadic cases. 1846. First case, September 20 ; last case, October 15 ; last death, October 14. 1853. Deaths, 100. 1854. First case, September 12 ; last case, October. 1878. Population, 2,800. First case, July 30; first death, August 28. Cases, 750 ; deaths, 65. 1879. First case, October 15; last case, October 15. Cases, 1; deaths, 0. 1905. Cases, 1; deaths, 1. TOCA. 1905. First case, September 8. Cases, 10; deaths, 0. TRENTON. 1853. Population, 145. Infected by New Orleans, First case, August 1; first death, August 6. Cases, 52; deaths, 28. •I LOUISIANA. 901 UNION PLANTATION. 1905. First case, October 13. Cases, 1; deaths, 0. UPPER TEXAS. 1879. First case, October 6; last case, October 6. Cases, 2; deaths, 0. VACCARO. 1905. First case, July 2G. Cases, 2 ; deaths, 0. VACHERIE. 1878. No record of cases and deaths. A^\RNER. 1898. Cases, 1; deaths, 0. VERRET. 1905. First case, September 4. Cases, 2; deaths, 0. VIDALIA. 1853. Population, GO. Infected by Natchez, iMiss. First case, August 20 ; first death, August 25. Deaths, 16. VILLE PLATTE. 1870. No record of cases and deaths. VIVIAN. 1879. Cases, 4 ; deaths, 0. WAOCr A:\rAN. 1905. First case, July IG. Cases, GO; deaths, 5. 902 HISTORY OF YELLOW FEVER. WASHIXGTOX. 1837. No record of cases aud deaths. 1852. Infected b}^ New Orleans. First case, Septem- ber 14 ; first death, September 16. 1853. First cae, August 15. 1851; 1867. No record of cases and deaths. WATERLOO. 1839. Infected by New Orleans. WATEKPKOOF. 1905. First case, September 23. Cases, 1 ; deaths, 0. WEEK'S ISLAND. 1879. No record of cases and deaths. WESTWEGO. 1905. First case, July 25. Cases, 2 ; deaths, 2. WILSON. 1898. First case, Septendx-r 26; last case, October 15. Cases, 303; deaths, 7. WOODLAWN. 1905. First case, July 30. Cases, 16; deaths, 2. Insert Bibliography NEW ORLEANS— ^RIOGRAPHY. 903 BIBLIOGRAPHY OF YELLOW FEVER IN LOUISIANA. NEW ORLEANS. Albers (P. B.) : Cases of Sporadic Yellow Fever (1857). N. O. Med. & Surg. Jl., November, 1857, p. 357. American Institute of Homoeopathy. Special report of the Homeoo- pathic Yellow Fever Commission ordered by the * * * for presentation to Congress. 8°. New Orleans, 1879. Analysis of the "records of yellow fever in New Orleans in 1876.. N. O. Med. and Surg. Journal, 1876-7, n. s. vol. 4, p. 480. Axson (A. F.): Report on the Origin and Spread of the Epidemic in New Orleans in 1853. In Report of the Sanitary Commission of New Orleans, 1854. Bahier (A.) (et al.) : Rapport fait a la Societe Medicale de la Nouvelle-Orleans sur I'epidemic de fievre jaune qui a regno dans cette ville pendant I'ete et I'automne de I'annee 1839.. 8°. Paris, 1840. Barbot (J. P.): Cases of Yellow Fever (1857). N. O. Med. and Surg. Joumal, November, 1857, p. 358. Barton (Ed. E.): Account of the epidemic fever which prevailed in New Orleans during the autumn of 1833. American Journal of Med. Sciences, vol. 15, p. 30. Barnes (F. ): Yellow fever in New Orleans. New Orleans Med. and Surg. JL, 1867, vol. 20, p. 196. Barton (Ed. E.): Report read to the Academy of Sciences of New Orleans in defence and explanation of the report of the Sanitary Commission to the City Council. N. O. Medical News and Hospital Gazette, vol. 2, No. 3, p.. 97. Barton (Ed. E.) : Report of the Board of Health of New Orleans, November 17, 1841, on the fever of that year.. Bulletin of Medical Sciences, vol. 2, p. 1. Barton (Ed. E.): Report upon the Sanitary Condition of New Or- leans, in report of the Sanitary Commis"ion of New Orleans for 1853, p. 213. (See review of the above Report, in N. O. Med. and Surg. Journal, vol. 11, p. 523; do., in Charleston Medical Journal and Review, vol. 10. p. 535.) Barton (E. E.) : Account of the Epidemic Fever which prevailed in New Orleans during the autumn of 1833. American Journal of Medical Sciences, vol. 15, p. 30. Same in pamphlet form, with additions, pp. 52, Philadelphia, 1834. Barton (Ed. E.) : Report to the State Medical Society on the Meteorology, Vital Statistics, and Hygiene of the State of Louisiana. 8vo. New Orleans, 1851. 904 HISTORY OF YELLOW FEVER. Barton (E. H.) : The cause and prevention of yellow fever at New Orleans and other cities in America; and notices of the report of the Sanitary Commission, dated New Orleans, December 12, 1854. 3 ed. 8°. New York, 1857. Barton (E. H.) : Report on 'the Meteorology, Mortality and Sanitary Condition of New Orleans, for the years 1854 and 1855. Trans.. Amer. Med. Assn., 1856, vol. 9, p. 723. Barton (Ed. E.): Introductory Lecture on Acclimation. 8vo. New Orleans, 1857. Baxter: Statement of the Yellow Fever as it Occurred in New Or- leans in 1819. New York Medical Repository, vol. 2i, p. 1. Baxter (J.): Reply to the Replication of the Medical Society of Louisiana. Med. Repository, 1822, n. s., vol. 8, pp. 223; 229. Berjot (E.) : Report of the epidemic of yellow fever, which raged at New Orleans in 1878. N. O. Med. and Surg. Jl., 1880, n. s., vol. 8, pp. 139; 145,. Board of Health and Yellow Fever. New Orleans Med. Jl., 1844-5, vol. 1, pp. 217; 219. Barren (P. D.) : An Historic Memorabile (relating to the j'ellow fever epidemic of 1799). New Orleans Medical and Surgical Journal, 1896-7, vol. 49, p. 318. Bemiss (S. M.) : Report upon yellow fever in Louisiana 1878, and subsequently. N. O. M. & S. Jl., 1883-84, n. s., vol. 11, pp. 81, 161. 4 diag. 2 oh. Also: Reprint. Beugnot (J. F.) : An Essay on Yellow Fever. N. O. M. & S. Jl., vol. 1, p. 1. Beyer (G. E.): On the origin of sporadic cases of fever. N. O. M. & S. JL, 1906-7, vol. 54, p. 407. Boyce (R.): Yellow Fever Prophylaxis in New Orleans, 1905. Liver- pool School of Tropical Medicine, Memoir XIX, 1906, p. 1. Brady, (C. M.) : Circumstances of the First Appearance of Yellow Fever in New Orleans. N. O. M. & S. Jl , 1905, vol. 58, p. 743. Bruns, (H. D.) : Experiences during the Yellow Fever Epidemic of 1905. N. O. M. & S. Jl.. 1906, vol. 59, p. 196. Cartier (A. J. F.): La fievre jaune de la Nouvelle-Orleans. 8°. Paris, 1859. Carroll (J.): Yellow Fever in New Orleans. N. O. M. & S. JL, 1906, vol. 59, p. 180. Castellanos (J. J.): An Historic :\remorabile. Proc. Orleans Parish Medical Society, 1896, New Orleans, 1898, p. 168. Cartwright (S. A.): Prevention of Yellow Fever. N. O. M. & S. JL, 1853-4, vol. 10, pp. 292, 406. Also: Ohio M. & S. JL, Columbus, 1853-4, vol. 6, pp. 201, 227. I NEW ORLEANS — R IBLIOGRAPH > . 905 Chaille (S. E.) : Yellow Fever of 1S5S in New Orleans. N. O. M. & 5. Jl., 1858, vol. 15, pp. 805, 819. Chaille (S. E.) : The yellow fever, sanitary conditions, and vital statistics of New Orleans during Its military occupation, the four years 1862-5. N. O. M. & S. Jl., 1870, vol. 23, pp. 536, 598. Also: Reprint. Chaille (S. E.): Yellow fever, or "yellow jaundice" in New Orleans in 1882; disputed case of Louis (or Ludwig) Deschler. N. O. M. & S. JL, 1882, n. s., vol. 10, pp. 194, 205. Chaille (S. E.) : Some Yellow Fever Data. N. O. M. & S. Jl., 1905, vol. 58, p. 191. Coleman (W. L.): Yellow Fever. N. O. M. & S. Jl., 1879, n. s., vol. 6, p. 618. Considerations generals sur les mesures a prendre pour mettre la Nouvelle-Orleans a I'abri de la fievre jaune. 8°. Nouvelle-Orleans, 1864. Conkrite (L.): An inquiry into the pathology and 'treatment of yellow fever, as it prevailed at New Orleans, August, 1829. West. J. M. & Phys. Sc, Cincin., 1830, vol. 3, pp. 367, 393. Davidson (J. P.): Some personal reminiscences of early epidemics in New Orleans. New Orleans Med. & Surg. JL, 1886-7, n. s. vol. 14, p. 920. Detention (The) Camp at Oakland Park. Rep. Bd. Health La., 1896-7, Baton Rouge, 1898 ,p. 44, 3pl. Delery (C): (Rappoit du Bureau de sante de la Nouvelle-Orleans pour I'annee 1860.) Jo Soc. Med. de la N, -Orleans, 1860-61, vol. 11, pp. 181, 185. Delery (C. F.) : Memoire sur Tepidemie de fievre jaune qui a regne a la Nouvelle-Orleans et dans les campagnes pendant I'annee 1867. 4°. Nouvelle-Orleans, 1867. Del Orto (J.): Yellow fever. N. O. M. & S. JL, 1879, n. s., vol. 6, p. 638. Diary (The) of a Samaritan. By a member of the Howard Associa- tion of New Orleans. 8°. New York, 1860. Dowler (B.): Tableau of the yellow fever of 1853, with tp.pographical, chronological, and historical sketches of the epidemics of New Orleans since their origin in 1796, illustrative of the quarantine question. 8°. New Orleans, 1854. Dowler (B.): The first death from yellow fever in New Orleans, in 1854. N, O. M. & S. JL, 1854-5, vol. 11, p. 284. Dowell. Weekly summary cases and deaths in 1873. In his Yellow Fever and Malarial Diseases, 1876, p. 31. Dowler (B.) : Researches, Historical, Topographical and Critical, on Yellow Fever. N. O. M. & S. JL, 1846-7, vol. 3, p. 165. 906 HISTORY OF YELLOW FEVER. Drew (E. S.) : The first case of j'ellow fever in New Orleans, 1878. Santarian, N. Y., 1880, vol. 8, pp. 35, 37. Dupuy: Precis historique de I'epidemie de fievre jaime qui a regne en 1819 a la Nouvelle-Orleans. J. Gen. de Med., Chir. Pharm., Paris, 1821, vol. Ixxiv, pp. 203, 229. Also Transl. (Abstr.) : Med. Reposit, N. Y., 1821, n. s., vol, 6, pp. 15; 19. Editorial: Yellow Fever Situation (1905). X. O. M. & S. Jl., 1905, vol. 58, p. 254. Epidemic (The) of 1853, at New Oi leans. Golvestou M. Jl., 1867, vol. 2, pp. 876, 907. Epidemic (The) summer. List of interments in all the cemeteries of New Orleans from May 1st to November 1st, 1853... To which is added a review of the yellow fever, its causes, (etc.) 8°. New Or- leans, 1853. Escumbas (M.): La fievre jaune observee a la Nouvelle-Orleans pendant les mcis de .Juillet, Aout, Septembre, Octobre, 1878, et son Traitement. 16°. Nouvelle-Orleans, 1879. Extraits de quelques-unes des lettres sur la fievre jaune. I, 2, 4, 7, lettres et appendise. 8°. Nouvelle-Orleans, 1S59. Faget (.1. C): Etude medicale de quelques questions importantes pour la Louisiana, et expose succinct d'une endemie paludeenne de forme catarrhale, qui a sevi a la Nouvelle-Orleans, Particulierement sur les enfants, pendant I'epidemie de fievre jaune de 1858. 8°. Nouvelle-Orleans, 1859. Faget (J. C): Considerations generales sur les mesures a prendre, sanitaries et quarantenaires, pour mettrw le Nouvelle-Orleans a I'abri de la fievre jaune. Union Med., Paris, 1864, 2. s., vol. 24, pp. 196, 334. First (The) death from yellow fever in 1858. N. O. M. & S. Jl., 1858, vol. 15, pp.. 568, 573. Fenner: The epidemic of 1847. N. O. M. & S. JL, vol. 5, 1848-9, p. 192. Fenner (E. D.) ; An account of the Yellow Fever which prevailed in New Orleans in the year 1846. N. O. M. & S. Jl., vol. 3, 1846-7, p. 445. Fenner: An Account of the Yellow Fever in New Orleans in 1848. N. O. M. & S. Jl., vol. 6, 1849-50, p. 9. Fenner: History of the Epidemic Yellow fever at New Orleans in 1853. 8 vo. New York, 1854. Fenner: Fever Statistics; showing the relative proportion of the different forms of fever admitted into the New Orleans Charity Hospital during a period of seven years, etc. N. O. M. & S. Jl., 1848-9. vol. 5. Grcs et Girardin: Rapport fait a la Societe Medicale (de la Nouvelle- Orleans), sur la fievre jaune qui a regne d'une maniere epidemique pendant I'ete de 1817. 8vo. New Orleans, 1817. 1 NEW ORLEANS — BIHLIOGRAPH Y. 907 Halphen (Michel): Memoire sur le Cholera Morbus complique d'une epidemie de Fievre Jaun qui a regne simultanement a la Xouvelle- Orleans en 1832. 8vo. Paris, 1833. Harris (E, B.): Cases of the yellow fever prevalent at New Orleans in the summer and fall cf 1833. Am. J. M. Sc, Phila., 1834, vol. 14, pp. 41 74. Harrison (John): Remarks on Yellow Fever. X. O. M. & S. Jl, 1845-6, vol. 2, pp. 129, 321. Hava (Adrian) : The Essential Roles of the Pneumo-Gastric Nerves in Yellow Fever. N. O. M. & S. JL, 1898, vol. 50, p. 574. Health of the City. N. O. M. & S. JL, 1849-50, vol. 6, pp. 407, 410. Herrick (S. S.) : Review of the Yellow Fever in New Orleans, 1869-74. Ibid., 1874-5, n. s., vol. 2, pp. 645, 652. History of the yellow fever epidemic in the Fourth District; disin- fection and fumigation; sanitary conditions of the district; sanitary measures generally considered. Rep. Bd. Health Louisiana, 1878. X. O., 1879, pp. 77; 95. Holcombe (W. H.) : Repoi't on the yellow fever of 1867, to the American Institute of Homoeopathy. 8°. New Orleans, 1869. Holt (J.): Cases of yellow fever in New Orleans in 1876. N. O. M. & S. JL, 1876-7, n. s., vol. 4, pp.. 337, 427. Holt (J.): Analysis of the record of yellow fever in New Orleans in 1876. Ibid., pp. 480, 495. Also, Reprint. Holt (J.) : Yellow fever in New Orleans during the year 1879. N. O. M. & S. JL, 1879-80, n. s., vol. 8, pp. 615, 625. Holt (Dr.): And the Pass Christian delegation. 8°. (New Orleans, 1886). Repr. from New Orleans Daily States, October 18, 1886.. Holt (J.): The chain of circumstances connected with the appear- ance of yellow fever in New Orleans during the summer of 1879. N. O. M. & S. JL, 1879-80, n. 3., vol. 7, p. 375. Hort (W. P.): Report of the Board of Health of New Orleans, 1846. N. O. M. & S. JL, vol. 3, p. 467. Hort (W. P.): Remarks connected with the sanatory conditions of the city of New Orleans. N. O. M. & S. JL, 1848-9, vol. 5, pp. 256, 266. Husemann (T.): Die Sterblichkeit der Angehorigen verschiedener Lander am galben Fieber in New Orleans wahrend der 1853 er Epidemie.. Mcnatsbl. f. Med. Statist, u. off. Gsndtspilg., BerL, 1859, p. 29. Jones (Joseph): Yellow fever epidemic of 1878, in New Orleans. N. O. Med. & Surg. JL, n. s., vol. 6, pp. 599, 683,763, 851, 946. (See also his Medical & Surgical Memoirs). Jones (J.): Notes upon the yellow fever of 1873, in New Orleans. Boston M. & S. JL, 1873, vol. 89, pp. 543, 546. 908 HISTORY OK YELLOW FEVER. Kohnke (Q.): The Yellow Fever Epidemic of 1905 in New Orleans. American Public Health Association Reports, 1907, vol. 32, pt. 1, p. 39. Layton (T) : Address delivered at the fifth anniversary celebration of the New Orleans Medical and Surgical Association. Yellow Fever.) N. O. M. & S. Jl., 1879, n. s., vol. 6, p. 511. Lawrence (J. V. O. B.) : Discection of subjects dead of yellow fever, made at New Orleans, during the years 1817, 1818 and 1819. Phila. J. M. & Phys. Sc, 1825, vol. 10, pp. 2, 252, Lemoine: Rapport sur une relation de I'epidemie de fievre jaune qui a regne a la Nouvelle-Orleans en 1839. Rev. Med. Franc, et Etrang., Paris, 1840, vol. 4, p.p. 321, 342. Malignant billious remittent, or yellow fever, in new Orleans. Med. Reposit , N. Y., 1820, vol. 20, pp. 269, 273. Martin (S.): Protestation centre quelques attaques du dr. C. Faget. T. Soc. Med. de la N.-Orleans, 1860,61, vol. 2, pp. 133, 146. Maurice (E. F.): Reflexions sur la fievre jaune a la Nouvelle-Orleans. Gas. d. Hop , Paris, 1863, vol. 36, p. 406. Mercier (A): (Memorials to the Legislature of the State of Louisi- ana.) N. O. M. & S. JL, 1858, vol. 15, pp. 221, 252. (See, also. Supra, Axson.) Mercier: La fievre jaune a la Nouvelle-Orleans. Gas des Hop., Paris, 1858, vol. 31. pp. 467, 567, 1859; vol. 32, pp. 27, 71, 114. Mercier (A.): La fievre jaune; sa maniere d'etre a I'egard des strangers a la Nouvelle-Orleans et dans les campagnes. Quelques mots sur son passe et son avenir en Europe. Letters adressees a la Gazette des hopitaux de Paris, avec un avant-p.ropos et un appendice. 8°. Paris, 1860. McFarlen (J. S.): The epidemic summer (in New Orleans in 1853), with a review of the Yellow Fever, its Causes, etc., with some Re- marks on Hygiene. Svo. New Orleans, 1853. McMain (Eleanor) : Behind the Yellow Fever in Little Palermo (New Orleans). Charities, 1905, vol. 15, p. 152. Message of the mayoi-alty to the Common Council of the City of New Orleans, October, 1853. 8°. New Orleans, 1853. Mortuary Statistics. A Repor't of Deaths in New Orleans for the month of January, February, March and April, 1850. N. O. M. & S. Jl., vol. 7, p. 46. Perry (.\. W): Yellow Fever in New Orleans in 1873. Reports American Public Health Assn., 1873, vol 1, p. 434. Powell (R. D.): Hospital treatment of yellow fever in New Orleans. Virginia M. J., Richmond, 1857, vol. 8, pp. 469, 471. Proceedings of a mass meeting held in New Orleans, Devember 6, to return thanks for the succor extended to the city during the epidemic cf 1878. 8°. New Orleans, 1878. NEW ORLEANS — BIBLIOGRAPHY. 909 Proceedings of the Board of Experts, authorized by Congress to investigate the Yellow Fever epidemic of 1878. N. O. M. & S. Jl., 1879, n. s., vol. 6, p. 558. Randolph (R. C.) : Remarks on the endemic yellow fever of New Orleans during the summer and autumn of 1822. Med. Repository, N. y., 1821, vol. 21, pp. 165, 172. Raoul de Champmanoir: Lettre sur la methode de traitement employe dans la fievre jaune depuis 1304 jusqueen 1821. Nouveau Jour, de Med., Chir., Pharm., etc., Paris, 1822, vol. 13, p. 185. Rapport fait a la Societe medicale de la Nouvelle-Orleans, sur I'epidemie de fievre jaune qui a regne dans cette ville pendant I'ete at ■ I'automne de I'annee 1839, vol. 1, pp. 155, 273. Rapport fait a la Societe Medicale de la Nouvelle Orleans sur I'epidemie de fievre jaune qui a regne dans cette ville pendant I'ete et I'autome de I'annee 1839, par MM. Nahier, Fortin, Daret, Sabin Martin, D. M. Journal de la Societe Medicale de la Nouvelle Orleans, No. 4, 1839. Rapport publie au nom de la Societe Medicale de la Nouvelle Orleans sur la Fievre Jaune qui a regne epidemiquement durant I'ete et I'Automne de 1819. Svo. Nouvelle Orleans, 1820, p. 60. Report of the Howard Association of New Orleans of receipts, expenditures, and their work in the epidemic of 1878, with names of contributors, etc. New Orleans, 1878, A. W. Hyatt. 59 p. 8°. Report of special committee on yellow fever, and the best measures for preventing its recurrence in New Orleans. N. O. M. & S. JL, 1879, n. s., vol. 6, p. 633. Report of the Committee of the Physico-Medical Society of New Orleans on the Epidemic of 1820. Svo. New Orleans, 1821. Report of the Sanitary Commission on the Epidemic Yellow Fever of 1853; published by authority of the City Council of New Orleans. Svo. New Orleans, 1854. Report of the Howard Association of New Orleans, with addenda; epidemic of 1853. 12°. New Orleans, 1853. Report of the Howard Association of New Orleans, 1867. 8°. New Orleans, 1867. Report of the Howard Association of New Orleans of receipts, expenditures, and their work in the epidemic of 1878, with names of contributors, etc. 8°. New Orleans, 1878. Replication of the Medical Society of the State of Louisiana to a statement of the yellow fever as it occurred in New Orleans in 1819, by J. Baxter. Med. Reposit., N. Y., 1822, n. s., vol. 7, pp. 75, 77. Rise and Progress of the Yellow Fever Epidemic at New Orleans. St. Louis Medical Review, vol. 52, 1905, pp. 160, 180, 202, 220, 241, 263, 285, 303, 322, 346, 363, 384, 403. 910 HISTORY OF YELLOW FEVER. Russell (S. C): Yellow Fever. Rep. Bd. Health Louisiana 1873, New Orleans, 1874, pp.. 46, 65. Russell (S. C): Some account of yellow fever as it appeared in New Orleans in 1873. Am. Pub. Health Assn. Rep., 1873-4, N. Y., vol. 1, pp. 430, 436. Schmidt (H. D.) : Researches into the pathology and cause of the present epidemic, ordinarily called "yellow fever." Southern J. M. Sc, New Orleans, 1867, vol. 2, pp. 460, 488. Seconde memoire ou complement du rapport de 1864. 8°. Nouvelle- Orleans, 1864. Simonds (J. C): Statistics of yellow fever and of all diseases at the Charity Hospital of New Orleans for thirty years, from 1830 to 1849, inclusive. Southern Medical Reports (Fenner), 1850, vol. 1, Simonds (J. C): Sketches of the epidemic yellow fever of 1854 in New Orleans. N. O. M. & S. JL, vol. 11, 1S54-5, p. 415. Slade (J. B.) : Reports of cases of Yellow Fever treated in the Medical Wards of the New Orleans Charity Hospital in 1843. New Orleans Medical & Surg. Jl., vol. 1, p. 85. Smith (A. C.) : Yellow fever in New Orleans. Public Health Rep. U. S. Marine Hospital Serv., Wash., x905, vol. 20, p. 1505. Souchon (E.): The lessons cf the yellow fever in New Orileans in 1879; forty-one cases and nineteen deaths; crude scientific sanitation and no quarantine. N. O. M. & S. Jl., 1899-1800, vol. 52. p. 133. Sternberg (G. M.) : Is yellow fever endemic in New Orleans? Am. M. Times, N. Y., 1864, vol. 8, p. 197. Taillefer (J. G): Precis Analytique des Travaux de la Societe Medicale de la Nouvelle-Orleans. 1817 to 1818. New Orleans, 1819. Theard (S. L.): New Orleans Yellow Fever in 1905. N. O. M. & S. JL, 1906, vol. 59, p. 361. Theard (S. K): An imported case of yellow fever; death. N. O. M. & S. Jl., 1897-8, vol. 50, p. 279. Also: Proceedings Orleans Parish Medical Society, 1897. New Orleans, 1898, p. 180. Thomas: Traite pratique de la Fievre Jaune observee a la Nouvelle- Orleans. 8vo. Paris, 1848. Thomas: Rapport fait a la Societe Medicale sur I'epidemie de fievre jaune qui a regne a la Nile. -Orleans pendant I'ete et I'automne de 1837. J. Soc. Med. de la N.-Orleans, 1839, vol. 1, pp. 57, 63. Thomas: Relation de I'epidemie de fievre jaune qui a regne pendanr I'ete et I'automne de 1841 a la Nouvelle-Orleans. Bull. Acad, de Med., Paris, 1841-2, vol. 7, pp. 1016, 1037. Townsend (P. S.) : Account of the introduction of yellow fever into Pensacola and New Orleans in the year 1822. N. Y. M. & Phys. J., 1823, vol. 2, p. 315, 320. NEW ORl.KANS BIBLIOGRAl'HV. 911 Veazie (H. A.): Estivo-Autumnal Fever in New Orleans. 1S96. Watson (F. H.): Yellow Fever in New Orleans. John Hopkins University Bulletin, 1906, vol. 17, p. 61. AVhite (C. B.) : Disinfection in yellow fever, as practised in New Orleans in the year 1870 to 1876, inclusive; evidence of effectual sanitary resources against the specific causes of the fever. Am. Pub. Health Assn. Rep., 1875-6, N. Y., 1877, vol. 3, pp. 151, 161. Also, Reprint. White (J. H.) : Service Operations in Connection with the Epidemic of Yellow Fever in New Orleans. Report Supervising Surgeon General, U. S., 1906, p. 143. W^yman (W.) : Yellow Fever in New Orleans. Public Health Rep. U. S., Marine Hospital Service, Washington, 1905, vol. 20, p. 1557. Yellow fever in New Orleans. N. O. M. News & Hosp,. Gaz., 1860, vol. 6, p. 766. Yellow Fever in New Oi leans. N. 0. Journal of Medicine, 1868, vol. 21, p. 194. Yellow Fever in New Orleans, in 1853, N. York M. Gaz. & J. Health, 1854, vol. 5, pp. 158, 165. Yellow ^(The) Fever of New Orleans in 1855. N. O. M. & S. Jl., 1855-6, vol. 12, pp. 285, 288. Yellow Fever in New Orleans in 1882. (Edit.) N. O, M. & S. Jl., 1882, n. s., vol. 10, pp. 146, 147. "Yellow fever and results of disinfection in New Orleans." Rich- mond and Louisville M. J., Louisville, 1874, vol. 17, pp. 224, 251. Yellow Fever. N. O. M. & S. Jl., 1852-3, vol. 9, pp. 418, 421. Yellow Fever. N. O. M. & S. JL, 1873-4, n. s., vol. 1, pp. 306, 308. Yellow Fever (in city of New Orleans), 1871. Rep. Bd. Health La.., 1871, N. O., 1872, pp. 11, 26. Yellow (The) fever epidemic at New Orleans in 1878; submitted by the New Orleans Auxiliary Sanitary Association, Dr. C. B. White, sanitary director. Am. Pub. Health A sn., Rep. 1881, Boston, 1883, vol, 7, p.p. 201, 204. Yellow Fever at New Orleans. Boston M. & S. JL, 1853-4, vol. 49, p. 165. Yellow Fever in New Orleans in 1882. (Edit.) N. O. M. & S. JL, 1882, n. s., vol. 10, pp. 227, 233. ' Yellow Fever and the Fruit Ti-ade. Editorial in New Orleans Picayune, December 10, 1905. Yellow Fever in New Orleans during the year 1879. N. O. M. & S. J., 1879-80, n. s., vol. 7, p. 615. Yellow Fever; first cases in 1857. N, O. M. & S. JL, November, 1857, p. 357. 912 HISTORV OF YELLOW FEVFR. SHREVEPOPT. Jones (J.) : Yellow Fever in Shreveport. Boston M. & S. J., 1874, vol xc, pp. 73, 151. Dowell (G.) : Epidemic of 1873 (Shreveport). In his "Yellow Fever and Malarial Diseases," 1876, p. 39, Report of the committee [of the Shreveport Medical Society] on the yellow fever epidemic of 1873, at Shreveport, Louisiana. 8°. Shreveport, 1874. Smith (H.): Report of the yellow fever epidemic of 1873, Shrevep-ort, La. 8°. New Orleans, 1874. Spinzig (C): In his "Yellow Fever; Nature and Epidemic Character," St. Louis, 1880, pp. 19, 24, 46, 64, 65, 67, 97, 98, 99, 103. Yellow Fever Epidemic in Shreveport (1873). London Med. Times & Gaz., 1873, p. 9. Ibid., 1874, p. 13. -J GENERAL. Bemiss (S. M.) & Mitchell (R. W.) : The fever on the Lower Missis- ippi. Nat. Bd. Health Bull., Wash., 1880-81, vol. 2, pp.. 553-557. Carroll (J.): Lessons to be learned from the present outbreak of yellow fever in Louisiana. Jl. Am. M. Assn., Chicago, 1905, vol. 45, p. 1079. Chaille (S. E.) : Our yellow fever, sugar and cotton crops. N. O. M. & S. JL, 1881-2, n. s., vol. 9, p. 683. Circular of the Legislative Committee of the La. State Med. Assn. and of the Board of Health to Physicians throughout the State. N. O., 1878. 22p. 8°. Colvis: Fievre jaune a la Louisiane; doctrines de I'epidemicite et de I'importation. Gaz. Hebd. de Med., Paris, 1863, vol. 10, p. 635. Cooke (T. A.): Practical Remarks on the Epidemic of Yellow Fever which prevailed at Opelousas, in the years 1837, 1839 and 1842. N. O. M. & S. Jl., vol. 3, p. 27. Cooke (T. A.): An Account of the Yellow Fever which prevailed in the town of Washington (La.) in 1853. N. O. M. & S. JL, vol. 10, p. 602. Cooke (T. A.): Pratical remarks on the epidemic of yellow fever which prevailed at Opelousas in the years 1837, 1839, 1842. N. O. M. & S. JL, 1846-7, vol. 3, p. 27. Delery (C): Yellow fever in St. John the Baptist, La. N. O. M. & S. JL, 1853-4, vol. 10, p. 405. Dungan (J. B.): Yellow Fever at Jeannerette, La., in 1854. Trans. Amer. Med. Assn., 1856, vol. 9, p. 697. Fassitt (C. R.): Yellow Fever in the Country. An Account of the Disease as it Prevailed at Judge Baker's Plantation, Parish of St. Mary, La., in 1854. Trans. Amer. Med. Assn., 1856, vol. 9, p. 663. ■I* LOUISIANA BIBLIOGRAPHY. 9 1 S Fassito (C. R.) : Yellow fever in the country; an account of the disease as it prevailed at Judge Baker's plantation, Parish of St. Mary, La., in September and October, 1S54. N. O. M. News & Hosp. Gaz., 1855-6, vol. 2, p. 406. Fenner (E. D.) : Report on the Epidemics of Louisiana, Mississippi, Arkansas and Texas, in the year 1853. Tranastions Amer. Med Assn., vol. 7, page 421. Fever Prevailing in Parish of Plaquemines, September, 1880. Re- ports by J. Dickson Bruns, J. P.. Davidson and Geo. M. Sternberg. 8°. (New Orleans, 1878.) Fievre (La) Jaune en Louisiane (1878). L'Union Medicale, Paris, 1878, vol. 26, pp. 275, 398. Fox (D. R.) : Yellow Fever in the Country: An Account of the Disease as it Prevailed on the Coast below New Orleans, in 1854 and 1855. Trans. Amer. Med. Assn., 1856, vol. 9, p. 665.. Gilpin (J.): An Account of the Yellow Fever that Prevailed in Covington, Louisiana, in 1847. N. O. M. & S. JL, vol. 5, p. 216. Gustine (S. D.) : How the Yellow Fever Situation was Handled in Kenner, 1905. N. O. M. & S. Jl., 1906, vol.. 59, p. 282. Heusti,3 (J. W.) : Physical observations, and medical tracts and re- searches on the topography and diseases of Louisiana. 8°. New York, 1817. Heustis (Jazeb) : Phj'sical Observations and Medical Facts and Re- searches on the Topography and Diseases of Louisiana. 8vo. New York, 1817. Hacker: Yellow Fever in Plaquemine. N. O.. M. & S. JL, vol. 10, p. 668. Hale (J.): Observations on the fever which prevailed at Alexandria, Louisiana, in the autumn of 1830. Transylv. J. M., Lexington, Ky., 1831, vol. 4, p. 229. Heustis (J. W.): Observations on the disease which prevailed in the army at Camp Terre-aux-Boeufs, in June, July and August, of the year 1809. Med, Reposit., N. Y., 1817, n. s., vol. 3, p. 33. Jones (A. P.) : Yellow fever in a rural district, August to December, 1853. N. O. M. News & Hosp. Gaz., 1854-5, vol. 1, pp. 180, 205. Kelly (Howard A.): The lesson of little things; the conquest of yellow fever. Boston, 1907, p. 15, fol. Cutting from The Youth's Companion, Boston, 1907, vol. 81, p. 15. Leary (M. F.) : Yellow fever at Greenwood, La.; a case of contagion. N. O. M. & S. J., 1873-4, n. s., vol. 1, p. 628. Louisiana Bd. of Health Circular Embodying Brief Directions Appli- cable to the Usual Types of Yellow Fever. Aug. 23, 1878. 4°. New Orleans, 1878. 914 HISTORY OF YELLOW FEVER. Lambert (P. A.): An Essay on Yellow Fever, read before the La. Medico-Chirurgical Soc. N. O. M. & S. Jl., vol. 1, p. 4. Lyman (J. W.): Yellow Fever at Franklin, La., in 1853. N. O. M. & S. Jl., vol. 10, p. 670. McKelvey (P. B.): Yellow Fever at Francisville. La. N. O. Med. & Sur. Jl., 1849-50, vol. 6, p. 64. McLeod (M. A.):' Yellow Fever in Thibodeaux, La., in 1854. Trans. Amer. Med. Assn., 1856, vol. 9, p. 682. Phares (D. L.): Bayou Sara V3. Yellow Fever, Tr. Mississippi M. Assn., Jackson. 1879, vol 12, p. 117. Proceedings of three conferences held by the representatives of the Mississippi, Alabama and Louisiana State Board of Health, and Marine Hispital Service, at Ocean Springs, Miss., September 4, 5 and 6, 1897, to determine the character of the prevailing fever. Rep. Bd. Health La.,' 1896-7, Baton Rouge, 1898, p. 29. Scruggs (S. O.) : Report on the Epidemics of Louisiana, Mississippi, Arkansas and Texas. Trans. American Med Assn., 1856, vol. 9, p. 623. Scruggs (S. O.) : Yellow Fever at ithe Village of Cloutierville, La., in the years 1853 and 1854. Trans. American Med. Assn., 1856, vol. 9, p. 704. Sternberg (G. M.) et al.: Reports in regard to a form of fever recent- ly prevailing on the lower Mississippi River. X. O. M. & S. JL, 1880-81, vol. 8, p. 382. Wood (W. B.) : Yellow Fever at Centreville, La., in 1855, with Some Remarks on the Disease as it apeared in the Parish of St. Mary, La., in 1853, 1854 and 1855. Trans. Amer. Med. Assn., 1856, vol. 9, p. 671. Tuck fW. J.) : Letter on Yellow Fever. N. O. Med. & Surg. Jl., vol. 10, p. 663. Yellow fever at Lake Providence, La, London Med. Times & Gaz., 1853, vol. 7, p. 465. Yellow fever at Madisonville, La., in 1818. (French.) Tralliet, Examen Critique, etc., Relatif a la Fievre Jaune (Lyons, 1830), p. 15. I I 915 MAINE. EASTPORT. 1902. For the first aud ouly time iu its history, .yellow fever was brought to the doors of Eastport in 1902, The Brit- ish bark Birnam Wood from Rio de Janeiro, June 19, in baUast for St. John, New Brunswick, anchored iu Little Machias Bay, Sunday night, iVugust 3, flying signals of distress. Dr. Shaw, of ^Macliias boarded the vessel and found that the ba.k had yellow fever on board; three of the crew having died and the captain and cabin boy being down with the fever. After fumigating the vessel, she was towed to St. John, Xew Brunswick, and arrived at quarantine outside Partrdige Island, on August 5. There was no diffusion of the disease ashore. PORTLAND. 1801. On August 19, 1801, the ship Ocean arrived at Portland from Havana via New York, where she had performed quarantine twenty da,ys. The vessel had lost several of her crew from yellow fever during the voyage, and had left some sick at the hospital on Staten Island. A merchant of Portland and liis clerk who visited the ship on business, were attacked shortly afterward (Au- gust 24) with a disease which proved to be yellow fever. Both recovered. The merchant's son, a lad of 12, who had accompanied his father on board the ship, next took the disease (August 25) and died on the 31st. Two of the merchant's laborers were also attacked and died on the fifth day after the onset. The next cases occurred in the persons of two young men, from a remote and healtliy part of the State, who 916 MAINE. T went ou board the Ocean soou after their arrival at Port- land, and assisted in removing sundry articles from the ship's hold. Four days after, they were both attacked with 3'ellow fever, but eventually recovered. The disease did not spread to the other inhabitants of Portland, but was confined solely to persons who com- municated with the vessel, which proves that the infected mosquitoes did not migrate to the shore, ^| Total case, 7; deatlis, ?i. In addition to the above cases, it is worthy of note that the captain of a packet, who took goods out of the Ocean and carried them to Boston, was seized with yellow fever on liis arrival at the Massacliusetts town and died. One of his crew, who had assisted him in removing the cargo, also sickened and died. ''His skin," says the old chron- icler, "was of a deep yellow color.-' 1839. In 1830, it is again ''a ship from Havana," which brings yellow fever to the City of Portland. There were only a few cases, confined to the ship's crew. The inhabitants of Portland were not affected. BIBLIOGRAPHY OF YELLOW FEVER IN MAINE. EASTPORT. Small: U. S. Public Health Reports, 1902, vol. 17. p.. 1871. PORTLAND. Barker: N. Y. Medical Repository, 1803, vol. 6, p. 78. Austin: Trans. American Medical Association, 1877-8, vol. 4, p. 235. 917 MARYLAND. BALTIMORE. According to Carroll (Old Man/land, 190G, Vol. 2, p.' 17), yellow fever must have been introduced a great many times in Baltimore, yet the only important epidemic outbreaks of the disease took place in 1794, 1797, 1800 and 1819. It is notable that all the outbreaks began at Locust Point or about the docks and wharves, and they can be traced directly or indirectly to the shipping. The relative high ground upon which the city is built and the distance at the time of the city proper from the wharves and shipping, explain why the inter-urban resi- dents suffered but little, while those living upon the poorly-drained, low-lying districts near the river, were compelled upon such occasions to flee for safety. Summary of Epidemics. 1783; 1789. Berenger-Feraud (Fievre Jainic, etc., 1890, pp. 57 and 58), says that yellow fever prevailed for the first time in Baltimore in 1783, and reappeared in 1789, but gives no details. 1794. The epidemic of 1794 is the first of which any authentic information is available. According to Carroll (lor. cit., p. 18) who quotes Dr.vs- dale as his authority (see Bibliography at the end of this article), the yellow fever epidemic of 1794 first made its appearance at two points, remote from eacli other, viz. : at Bowley's Wharf, in the town, and at Fell's Point. Many cases occurred throughout the town, but these originated eitlier from communication with liowley's Wharf or the Point, and the infection could be distinctly traced to one of those two jjlaces. Bdiig puzzled to ex- 918 HISTORY OF YELLOW KEVER. plain why the infection was confined to those two places, Dr. Drvsdale f(nind that the first cases on the Point were confined to liouses whose celhirs were filled with sta low and flat; its streets j;enerally not paved, its alleys filthy and the i^round marshy in many places. The fre(]uent warm rains kept the noxious places constanth' moist under a hot sun. Dr. Carroll observes that we can easily recop,nize these as conditions favorable to the multii)l<-ation of mosqui- toes, and the domestic habits of the Stcf/oini/ia mosquito would tend to keep the infection rather closely confined to these localities. Dr. Drysdale further makes the si«>,nificant statement that remittents were present from a very early period. It is more than probable that many of these remittents were true yellow fever, because under the belief then pre- vailin.s:, that these were simply the prevailing? types of summer fever, they would not be reported. It is also probable that if occasional cases were known to have been yellow fever, some physicians would have concealed them, from the same motives that prevail to-day. Dr. Drysdale saw the first case just before death, on the 7tli of August at Bowley's Wharf, in the town, and on the 14th, 20th, 22nd and 2-3rd of the same month, he saw five additional cases at the same jtart of the wharf. There were also at the same place some other cases which did not come under his care. Dr. Drysdale states that there was consideiable sickness at Fell's Point after the death of his l?rst case, and many deaths had occurred suddenly or after a short indisjMJsition. An investigation was made by three of the most respectable i)hysicians who reported that the prevailing fever was the common endemic of the season, Avhich visited the Southern and Middle States annually, viz. : the bilious remittent fever. The number of eases now rapist direction, and diffused the infection among the inhabitants in the ujiper parts of Frederick, Gay and Calvert Streets, who became im- 920 HISTORY OF YELLOW FEVER. mediately implicated in the horrors of yellow fever." {Carroll, loc, eit., p. 21). The outbreak was limited and the mortality small. 179S. Sporadic cases; developments unimportant. 1800. Carroll {Old Maryland, 190(3, vol. 2, p. 21) is authority for the statement that the epidemic of 1800 was the sever- est Baltimore has ever experienced. The mortality from yellow fever is recorded to have been 1,197, or about one in fifty of the population of 60,000. Again the disease began at Fell's Point, on the borders of the Cove, which extended from Jones' Falls to the interior. The Faculty of Medicine of Baltimore, after investigation, reported to the Mayor that in their belief the disease was not im- ported btit originated in the Cove from the stagnation and putrefaction of filth, under a summer's sun. Of course, at this enlightened age, we know this theory to be wrong and the natural tendency is to incriminate our old friend, "a ship from the West Indies." The first two cases appeared on the 2nd of May, an- other on the 8th of June, one on the 9th, 10th and 13tli; then from the 22nd they became more numerous. It is unfortunate that there is no detailed description of this epidemic, the most disastrous that Baltimore ever ex- perienced, i 1800; 1801; 1802; 1805; 1818. Sporadic cases: no statistics. 1819. The next general outbreak took place in 1819 {Carroll, loc. fit., p. 21), following the arrivnl of an infected ship from Havana. In a letter to the editors of the Medical Repository (1801, vol. 4, p. 351), Dr. Pierre Chatard, of Baltimore, writing October 19th, cites the first cases as follows : The fever commenced raging at Fell's Point in MARVI.ANU ^BALTIMORE. 921 the beginning of July, and never ceased there until the end of October. It appeared also at Smith's Dock, toward the end of July, carrying off five persons whose names are given, and others. The persons named had counting houses on the dock or in the vicinity. No other cases appeared at the dock for two months, at the end of which time two more appeared. Dr. Chatard attributes the absence of cases during this time to the great quantity of lime that had been strewn on the ground, by order of the Mayor. The lime was again applied and the cases ceased. At Fell's Point the disease raged for three months before it subsided. The greater part of the population retired to the healthier portions of the city and many of them sick- ened and died there, but none of their friends or relatives suffered in consequence. 1820 ; 1821 ; 1822. Sporadic cases. No statistics. 1858. Sporadic cases. Ten cases are reported to have oc- curred at Fort ]\rcHenry, from infected vessels in (piar- antine. 18G8; 1873. Imported cases. No developments. 1870. The last serious outbreak of yellow fever in Baltimore took place in 187(5. The history of this epidemic is as follows (Morrifi, Tranfi. American Piihlic HcaUh .l.s.s'ori- ation, 1877-8, vol. 4, p. 212) : The first case (death) was reported by Dr. Winter- nitz, on the 14th of September, 1876. This was followed by forty-four cases of the disease, of which forty died. Then the authorities, thoroughly alarmed, had all the people living in the infected quarter, sick and well, r um- bering in all, one hundred and fiftv persous, removed to the Quarantine ITospital, sctme miles from the city. A cordon was placed around the locality; the Avhole place Avas purified; nearly a hundred cart loads of filthy ac- cumulations were removed; the privies were emptied and 922 HISTORY OF YELLOW FEVER. filled up with clay; the homes and clothing of the people were cleansed and disinfected, and a certain pon'tion of the latter destroyed, and every possible source of infection was reuKJved. The result of these measures was that not a single case of the disease occurred afterwards, and the whole trouble disappeared as if by the power of a majii- clan's wand. Tliouiih - the sick — nurses, physicians, etc. — contracted the disease. Only one sing'le death took place at a distance from the infected district, and that was a patient who had lived in one of tlie houses in which tlicre had been several cases, and who . 310. Another epidemic distemper, similar to ;hat of 1647, passed through New England in 1655. It began in June, MASSACHUSETTS. 927 and few persons escaped. Anion_i>' those who died was Eev. Xathaniel Eogeis, of Ipswich. Sickness and mortality thronghout New England in 1658. Croup is first mentioned in the annals of the country in IGSO. Other malignant diseases also prevailed about this time. Thirty children died in Rowley, ^Nlass, A day of thanksgiving was appointed in Connecticut, for the "abatement of the sickness in the country, and a supply of rain in time of drought." Small-pox was very fatal in Charlestown, ]Mass., in 1677. The records state that thirtV'-one died of the dis- ease, one of whom was the Eev. Thomas Shepard. In 1678, small-pox in Boston ; but we have seen no ac- ecount of its victims. Seven or eight hundred are said to liave died of it in Massachusetts. About this time "the seasons were unfavorable, and the fruits blasted, while malignant diseases prevailed among the people. The sick- ness and bad seasons were attril)uted by our pious an- cestors to the irreligion of the times, and to their disuse of fasting; and a meeting was held to investigate the causes of God's judgments, and to propose a plan of re- formation." Webster, vol. 1, p. 203. Tlie influenza began in Xovemlx^', 1697, and prevailed until I^'bruary, in ^Massachusetts. Whole families and whole towns were seized nearly at the same time. In the following year (1608), a "mortal disease prevailed so much, in Fairfield, Connecticut, that well persons were not found to take care of the sick and bury the dead. Seventy died in three months, out of a population of less than one thousand. At the same time, a dreadful mor- tality occurred in Dover, New Hami)shire. Yellow fever i)revailed at Ilollin.ston, ]Nrassachusetts, "of which died, Mr. Stone, the minister, and 14 of his congregation." How the fever was introduced, is left to conjecture. In 1743 an "infectious fever" ]M-evaib'd in liciston. Yellow fever prevailed in New York, Philadelphia, New Haven, Conn., and Stamford, Conn., was distressed by a 928 HISTORY OF YELLOW FEVER. malignant dysentery, which swept away 70 inhabitants out of a few hundreds. "About the same time (the precise year is not known) a malignant epidemic disease laid waste the Indian tribes, which, from the description given by the traders, would appear to be, though it probably was not, the infectious Yellow Fever. In consequence of it, the Senecas removed their quarters two or three times in a few jears. The dis- ease was said to have been confined to the Indians, the white people living and trading Avitli them not being affected. (Griscom, p. 4). The Mohegan tribe, between New London and Norwich, were "wasted by the same malady" in 1746. From an account given by a Mohegan priest, "a man of good sense and integrity," as related by a Dr. Tracy, of Norwich, who attended them as a physican, and was the only white man atfected, the following were the symptoms of this disease: The patient first complained of a severe pain in the head and back, which was followed by fever; in three or four days his skin turned as 3'ellow as gold; a vomiting of black matter took place, and generally a bleed- ing of the nose and mouth, which continued till the patient died. One hundred of the tribe died.." Summary of Yi:llow Fever Years. BOSTON. 1G21. According to Dowler (1853, p. 7), first appear- ance of yellow fever in Boston. No authentic statistics. 1G93. An English squadron under Admiral Wheeler, after remaining a month at Barbadoes and twenty-one days at ]Martiniqu(s l)i'ought yellow fever to Bost(m, where it caused great mortality. (Hiifcltiiisoii's History of ^cw England, vol. 5, p. 110). 1795. Infected by vessels from the West Indies. Only a few cases. The fever did not spread to the inhabitants. 179G. Yellow fever broke out on August 26, the first death taking place on the 29th. Source of infection MASSACHUSETTS. 949 obscure. Warren (see Bihliography) , like the majority of the good old souls of the period who have written on yellow fever, maintains that "it was caused by noxious sub- stances exhaled into the atmosphere from putrefying ani- mal or vegetable matter or both." Only 130 deaths are recorded, which proves that the disease was undoubtedly confined to imported cases. 1798. Serious outbreak. Deaths, 200. 171)9; 1800. Imported cases; no important develop- ments. 1801. The master of a packet plying between Boston and Portland, Maine, who took goods out of a ship in- fected with j^ellow fever, which was at the latter port, was taken ill with the disease on his arrival at Boston, and died shortly afterAvards. One of his sailors sickened also at the same time and died. The marked yellow^ color of the skin of the latter is specially mentioned by the chroniclers of this episode { Banker , New York Medical Repository, 1803, vol. 6, p. 78). The fever did not spread to the inhabitants of Boston, 1802. Limited outbreak. Deaths, GO. 1805; 1819; 1858. Infected by the shipping. No im- portant developments. 1885. On September 24, the steamship Craighill, from Colon, Panama, anchored in Boston harbor. Four cases of yellow fever were discovered on board, and were trans- ported to Gallup's Island Hospital, where they eventually recovered. The captain of the vessel had died from yellow fever during the voyage. The city was not infected. CHELSEA. 1877. Two yellow fever patients were disembarked at the Chelsea Hospital, on December 12, from the ship Laura Wilson, from San Domingo City. One of the patients died on the IGth, the other recovered. HOLLISTON. 1741. Holliston, 25 miles from Boston, was the scene of a mild outbreak in 1741. Deaths, 15. 930 HISTORY OF YELLOW FEVER. NANTUCKET. 1763. Deaths, 259. NEW BEDFORD. 1800 ; 1801 ; 1821. Yellow fever outbreaks. No record of cases and deaths. NEWBURYPOET. 1796. According? to Brockway (National Board of Health Bulletin, 1881-2, toI. 3, jl 179), yelloAv fever vis- ited Newbiiryport on several occasions. As early as 1793, at which time yellow fever was devastating Philadelphia, Governor Hancock, of Massachusetts, issued the follow- ing proclamation : "Whereas a dangerous and infectious disease is prevalent at this time in the city of Philadelphia, and it being highly expedient that effectual measures should he adopted to prevent its introduction with- in this commonwealth [Massachusetts], "I do, therefore, in pursuance to a resolution passed by the two branches of the legislature this day, require all sheriffs and their deputies, the selectmen and constables of the several towns in this commonwealth, to take effectual measures for examining all persons, with their baggage and other effects, by land or water, coming from Philadelphia or any other infected place, and where there is reason to apprehend that the infection may be communicated, that they take such measures as the law in such cases made and provided directs for detaining and cleansing the persons and baggage from which danger may be apprehended, so as to effectually prevent the intro- duction and spreading of said infectious disease among the good people of this commonwealth." (Signed, etc.) Newburyport, in response to this proclamation, and in view of the great mortality from yellow fever raging at Philadelphia, the accounts published from there, stating that one hundred persons were buried in one day at this time, and in the general alarm which prevailed, issued this "notification :" MASSACHUSETTS NEWBURYPORT. 93 1 "Whereas a dangerous and infectious disease is now prevailing, not only in Philadelphia, but also in the leeward and winward West India islands, this is to forbid all pilots, and others, on penalty of the law, from bringing any vessel from Philadelphia higher up the Merrimac River than the Black Rocks, or any vessel from a foreign port to any wharf in this town, but let them remain in the stream until examined by the health officer and certificate from him be ob- tained certifying her being, in his opinion, free from infection. "By order of the selectmen. "Published September 23, 1793." The quarantine ground, so called, was about a mile and a half below the town. The selectmen also reminded the inhabitants, at this date, to give special attention to cleanliness and recom- mended the most scrui^ulous examination of the streets, that no dead carcasses or other offensive things are suf- fered to remain, and to the "necessity of causing all drains and offensive, stagnant waters in yards or near houses to be cleansed," etc. The selectmen of Newburyport, in tlie summers of 1794 and 1795, urge a strenuous enforcement of the quarantine regulations, as the yellow fever was prevailing in several of the cities in the United States, especially in New Haven, in 1784, to such an extent as to break up the col- lege; and, as early as i\fay 14, 1795, the pilots and masters were ordered by the selectmen of Newburyport "not to bring any vessel above Black Rocks then having, or dur- ing the voyage having had, any person on board infected with small-pox or any pestilential disease, or coming from any port where such diseases prevail, until liberty is ob- tained from the selectmen. On hoisting a color on the shrouds (of the vessel) a proper person will attend on board to see the vessel well cleansed and to make report of her situation." Summary of Epidemics. 1796. The same authority quoted above (Brockway) states that yellow fever made its appearance in Newburyport in 1796, causing great elarm, but it was not until about the 932 HISTORY or yellow fever. middle of August that it was publicly noticed, although it commenced lu Juue, aud from the middle of that mouth until the 5th of October, tifty-tive faltal cases were re- ported. Tradition says that some of the prominent citi- zens of the town at this time took steps to secure the services of an experienced French physician, Dr. Francis A^ergnies, whom the local paper mentioued as having ar- rived in Xewburyport in the summer of this year, from the island of Guadaloupe. That this gentleman rendered important service was evident, as the town at a public meeting of the citizens, in April of the following year, 1797, unanimously voted "that the thanks of the town be given to Dr. A'ergnies, for his prompt assistance aud advice the last summer (1796), when the town was visited Avitli a malignant disorder." Dr. Vergnies continued his residence in Xewburyport in the general practice of his medical profession until his death in 1830. These cases of yellow fever are the tirst which Dr. Brockway found publicly acknowledge as such, and re- ported in the history of the town. One of the historians of Newburyport remarks that "this malignant fever, a disease then practically unknown to the members of the medical faculty here, but which was thought to be sim- ilar, if not identical with the yellow fever of the Houth, first appeared in a house on Water Street, etc., in the immediate neighborhood of one of the wharAcs in the har- bor, and its ravages were contined to a narrow locality and short distance in this street, whicli was closed or -chained up' to prevent passage." It was conjectured by some that the disease originated on the s])ot, but the most reasonable conclusion Avas that it was brought in a ves- sel from one of the West India islands; and this opinion was generally entertained. That the fever Avas caused bv decayed fish in the dock was believed in by nuniy, there is no doul>t, as the town, at a special meeting called July 21, 1796, chose an "inspector of police" to remove all nuisances, and to "prohibit fish beinii' thrown Into the river," etc. Among the victims to this disorder, which caused great excitement in the town, and widespread MASSACHUSETTS NEWBURYPORT. 933 alarm, were several prominent citizens of the town, in- cluding an eminent resident physician, Dr. J. Bernard Swett. The fever disappeared with the frost. In 1797, July 27, the town voted to choose a health officer to carry into effect a law of the commonwealth passed the month previous, "to prevent the spreading of contagious sickness." Public attention in this town was again called in the following summer to the danger from yellow fever by its prevalence in Philadelphia, New York, Alban3% Newport, Boston and several other places at the North, up to the middle of September. 1799. In the summer of 1799 there was a return of yellow fever at Newburyport, which the petitioners for a special town meeting called "an alarming mortal sickness;" and a health committe was chosen to adopt measures to pre- vent the fever from spreading, and to secure a more rigid quarantine. The reappearance of the yellow fever this summer in Philadelphia caused general alarm, and in this town the fear Avas not groundless, as the health committee reported nine persons "as having died of malignant fever" up to July 23. The health officer, meantime, had ordered the free use of unslacked lime in the streets of the town, and wherever there was any accumulation of filth, "and par- ticularly in vaults." Up to the 6th of August there ap- pear to have been fifteen fatal cases, and the health com- mittee reported on that day "that the fever had not been communicated except in the vicinity of the lower Long Wharf," and they recommend that those persons who have left that neighborhood remain away until notified by the committee. A week later several of the traders advertise that they have returned to the town with their goods to their places of business in Water Street. The fever in this instance Avas sup])osed to have been brought into town by a vessel which arrived from St. Thomas on the 29th of June, and is re]iorted in the news- 954 HISTORY OK YELLOW FEVKR. paper as having discharged her cargo at the wharf men-; tioned above, and that nearly all those who !iad died, had labored on board of this vessel. 1829. Two cases, in 1829, close the history of yellow fever in Newburyport. A prominent physician of the town, Dr. Bradstreet, who was then Health Officer of the port, vis- ited a vessel "from the South,'' which was then ai quar- antine and contracted yellow fever, and died shortly after the onset. His daughter shared the same fate. The disease did not spread to the other inhabitants of the place. SALEM. 1798. Limited outbreak. No authentic statistics. BIBLIOGRAPHY OF YELLOW FEVER IN MASSACHUSETTS. BOSTOX. Ayer (J.) : Yellow fever in Boston. Extr. Rec. Bost. Soc. M. Improve. (1856-9), 1859, vol. 3, p. 255. Also: Boston M. & S. J., 1858-9, vol. lix, p. 140-143. Brown (Samuel): An Account of the Pestilential Disease which prevailed at Boston in the summer and autumn of 1798. Medical Repository, vol. 2, p. 390. Brown (S.) : A Treatise on the Nature, Origin, and Progress of the Yellow Fever, especially as it has prevailed in Boston. 8vo. Boston, 1800. (See a Review of this volumns in Medical Repository, vol. 4, 1901, p. 63.) Case of the Ship Ten Brothers; being the Report of a Committee of the Board of Health, unanimously accepted, and published by order of the Board. Boston, 1819. Glover (M. W.): Yellow Fever. Invasions of the Disease (in Bos- ton) in Early Times. Yellow Fever Institute Bulletin, No. 2, 1902. Ingalls: Weekly Reports to the editors of Medical Repository of New York, on the malignant Yellow Fever in Boston in 1819. Medical Repository, vol. 10, p. 256. Interesting (An) account of the plague, yellow fever, etc., as they have prevailed in different countries; printed at the request of thie Boston Board of Health. 8°. Boston, 1820. MASSACHUSETTS. 935 Page (W. H.) : Yellow fever in Boston.. Boston M. & S. Jl., 1S70, vol. Ixxxiii, p. 253. Rand: Of the Epidemic lately prevalent in Boston (179S). Medical Repository, 1S99, vol. 2, p. 486. Rand and Warren: Account of dissections of bodies dead of tlie late malignant epidemic at Boston. Ibid., 249-252. Also: Mem. Am. Acad. Arts & Sc, Cambridge, 1804, vol. 2, pt. 2, p. 130-136. Report of the Joint Special Committee of the House of Representa- tives of Massachusetts, to whom were referred the memorials of the Massachusetts Medical Society, and American Statistical Association, etc., for a Sanitary Survey of the State. 8vo. 1849. Warren (J.): Yellow fever in Boston. Med. Communicat. Mass. M. Soc, Boston, 1809-13, vol. 2, p. 462. Yellow Fever in Boston in 1819; to which is added a Note by Dr. George Hayward on the same subject. The New England Journal of Medicine and Surgery, 1819, vol. 8, p. 380. See also: North American Review, vol 10, p. 395. GENERAL. Buel (W.) : An Account of the febrile disorders which prevailed in Sheffield, in the State of Massachusetts, in the years 1793, 1794 and 1795. In: Webster (N.) : Collection of papers on fever. 8°. N. Y., 1796, p. 53. Coffin (C): An account of the pestilential fever which prevailed at Newbury Port, State of Massachusetts, in 1796. Med. Repository, N. Y., 1797-8, vol. 1, p. 504. Parrish (J.) : Remarkable account of the yellow fever as it prevailed among the Indians on the Island of Nantucket, in 1763-64. N. Jersey M. Reports, Burlington, 1852, vol. 6, p. 107. 936 MICHIGAN. DETROIT. 1878. A solitary case, "imported from the South," is the only record for Michigan. The incident happened during the great epidemic of 1878, which devastated the Southland. Our authority does not state whence the refugee came, but simply records the fact that he fled from some Southern city to escape the pestilence, and that he died shortly after reaching Detroit. (Vide Annual Report Michigan State Board of Health, 1879, pp. 221, 224). » 937 MISSISSIPPI. ANGUILLA. 1905. Cases, 1 ; deaths, 0. BAEKLEY. 1897. Cases, 10; deaths, 4. BAY ST. LOUIS. 1820. Cases, 280. 1830. Xo record of cases and deaths. 1835. Cases, 9; deaths, 1. 1853. No record of cases and deaths. 1878.^ Population, 3,000. Infected by New Orleans. First case, August 11; last case, December 24; first death, Auo'ust 15. Cases, 030 ; deaths, 82. 1897. Cases, 40; deaths, 4. BEACHLAND. 1878. Deaths, 24. BELLE FONTAINE. 1878. No record of cases and deaths. BENTON. 1853. No record of cases and deaths. 1878. First case, October 11. Cases, 3; deaths, 1. BILOXL 1702. Tradition says that yellow fever was pi-esent in Mississippi during; the early years of the eii^hteenth cen- tury. The bio_ora])her of Iberville, in his memoirs, states that he had vellow fever at Biloxi in 1702, Avhicli nuide 938 HISTORY OF YELLOW FEVER. such ravages on his constitution as to cause his return to France for the purpose of restoring his shattered health. This was the first appearance of yellow fever on the Gulf Coast of the United States. 1702 ; 1839 ; 1847 ; 1853 ; 1858. Yellow fever years. No record of cases and deaths. 1878. Population, 2,000. Infected by New Orleans. First death, August 17 ; last death, November 23. Cases, 600 ; deaths, 45. 1897. Cases, 592; deaths, 27. 1905. A few imported cases. No developments. BLUFF SPRINGS. 1873. Population, 200. First case, September 9; deaths, 9. BOLTON. 1878. Population, 200. First death, August 12. Cases, 144; deaths, 34. BOVINA. 1878. Population, 100. Deaths, 7. BEANDON. 1853. Population, 1,200. Infected by Vicksburg. First case, September 18; first death, September 23; last case, December 3 ; last death, December 3. Cases, 13 ; deaths, 9. 1854. First case, September 23; last case, November 18. BROWN'S PLANTATION. 1878. Infected by Canton, ^Miss. First case, Aug-ust 13 ; first death, August 18. Cases, 21 ; deaths, 4. BRYAN. 1878. Infected by New Orleans. First case, Septem- ber 29. Cases, 10 ; deaths, 1. Missisisippi. 939. BYKAM. 1878. No record of cases and deaths. CANTON. 1855. No record of cases and deaths. 1878. Population, 3,000. Infected by New Orleans. First case, August 1; last case, December. First death, Aug-ust 19. Cases, 921; deaths, 180. 1898. First case, October 10; deaths, October 28. Cases, 9; deaths, 0. CARSON'S CITY. 1879. No record of cases and deaths. CARDIFF LANDING. 1878. Deaths, 8. CARROLLTON. 1878. No record of cases and deaths. CAYUGA. 1878. Cases, 38 ; deaths, 9. 1897. Cases, 25; deaths, 1. CENTERVILLE. 1899. Cases, 2; deaths, 0. CLIFTON. 1853. No record of cases and deaths. CLINTON. 1897. Cases, 42; deaths, 2. 1898. First case, October 8; last case, October 15. Cases, 40 ; deaths, 0. 940 HISTORY OF YELLOW FEVER. COOPER'S WELLS. 1855. Infected by New Orleans. First case, Angust 23 ; first death, August 31. Cases, 70 ; deaths, 13. CONCORDIA. 1879. Population, 250. Number Avho fled, 130. First case, August 2G; first death, August 31; last case, Octo- ber 24. Cases, 75; deaths, 20. CORINTH. 1873. Cases, 3 ; deaths, 0. COUNTY FARM. 1897. Cases, 2 ; deaths, 0. COX LANDING. 1878. Cases, 12; deaths, 4. CRYSTAL SPRINGS. 1898. First case, October 11; last case, October 21. Cases, 7; deaths, 0. DRY GROVE. 1878. Infected by Brown's Plantation. First case, September 2 ; first death, September 7. Cases, 75 ; deaths, 41. DUCK HILL. 1878. Cases, 36 ; deaths, 14. DURANT. 1878. Deaths, 1. 1897. Cases, 1; deaths, 1. Mississippi 9 + 1 EDWARDS. 1878. Deaths, 3. 1897. Cases, 455; deaths, 29. 1898. First case, September 27; last case, October, 15. Cases, 12; deaths, 1. ENOKA. 1905. Cases, 1; deaths, 0. EUCUTTA. 1898. First case, June 21; last case, June 21. Cases, 1 ; deaths, 0. FAYETTE. 1898. Cases, 5; deaths, 0. FLORA. 1899. No record of cases and deaths. FORT ADAMS. 1839. Infected by New Orleans. FRIAR'S POINT. 1878. Population, 550 ; first case, August 17 ; last case, November 1. Cases, 25; deaths, 7. GAINSVILLE. 1878. Cases, 5; deaths, 2. GARNER STATION. 1878. Population, 200. f\nses, 31; deatlis, 13. GOODRICH LANDING. 1878. Population, 1509. First case, August 1. Deaths, 42. 942 HISTORY OF YELLOW FEVER. GKAND GULP. 1839. No record of cases and deaths. 1853. Infected by Port Gibson, La. First case, Sep- tember 10. GRAND PLAIN. 1878. No record of cases and deaths. GRAVEL PIT. 1878. Population, 85. Cases, 20. GREENVILLE. 1853. PopulatioD, 300. Number Avho fled, 100. First case, September. Cases, 17; deaths, 9, 1878. Population, 2,300. First case, August 18; last case, November 10; first death, August 21; last death, November 15. Cases, 1,000 ; deaths, 400. GRENADA. 1878. Population, 2,500. First case, July 26; first death, July 31. Cases, 1,040 ; deaths, 326. 1878. Cases, 87; deaths, 17. GULMAN STATION. 1878. Infected by Vieksburg. HANSBORO. 1879. First case, June 17. Cases, 2. HAMBURG. 1905. Cases, 50 ; deaths, 8. MISSISSIPPI. 943 HANSBOKO. 1878. Infected by Kew Orleans. First case, August 31 ; last case, January 19 ; first death, September 24 ; last death, December 21. Cases, 200; deaths, 16. 1905. Cases, 5; deaths, 0. HARRISON. 1898. First case, October G; last case, October 30. 1905. Cases, 2; deaths, 0. HATTIESBURG. 1898. First case, October 8 ; last case, October 21. r I HERMANVILLE. 1898. First case, October 4; last case, October 13. Cases, 2; deaths, 0. HENDERSON'S POINT. 1897. Cases, 3 ; deaths, 0. HERNADO. 1878. Population, 1,200. First case, August 15; last case; August 21. Cases, 240; deaths, "80. HINDS COUNTY. Convict Camp. 1897. Cases, 6; deaths, 0. HOLLY SPRINGS. 1873. Infected by ]\remphis. Only a few imported cases. 1878. Population, 3,000. First case, August 18; first death, August 25. Cases, 1,369; deaths. 309. 944 HISTORY OF YELLOW FEVER. HOEN LAKE. 1878. Cases, 30; deaths, IT. 1879. A few imported cases lUKA. 1878. Infected by Memphis. First case, September 18; first death, September 27. Cases, G; deaths, 3. JACKSON. 1853. Population, 3,000. First case, August 21 ; first death, September 5. Cases, 350; deaths, 112. 1854, Sporadic cases. 1878. Population, 2,250. Infected by New Orleans. First case, August 20 ; last case, December 1 ; first death, August 31 ; last death, November 28. Cases, 480 ; deaths, 86. 1888. Cases, 15; deaths, 5. 1898. First case, September 10; last case, November 10. Cases, 208; deaths, 11. 1899. Cases, 61 ; deaths, 9. KING'S POINT. Cases, 92 ; deaths, 6. LAKE. 1878. Population, 325. Infected by Mcksburg. First case, August 24; first death, September 5. Cases, 300; deaths, 86. LAWRENCE STATION. 1878. Cases, 16; deaths, 5. LEBANON. 1878. First case, August 29. Cases, 90 ; deaths, 10. MISSISSIPPI. 945 LEOTA LAXDIXG. 1878. Infected b^^ Greenville. First case, Kovember 21; last case, Xovember 21; tirst death, Ivovember 26; last death, November 20. Cases, 1; deaths, 1. LIVINGSTON. 1878. Infected by Canton. First case, August 28. Cases, 15; deaths, 10. LOGTOWN. 1878. Cases, 40 ; deaths, 9. LONG BEACH. 1905. , Cases, 1 ; deaths, 0. LUMBERTON. 1905. Cases, 1 ; deaths, 0. MADISON. 1878. Population, 50. A few imported cases. , McCOMB CITY. 1878. Population, 1,000. First case, September 28; first death, October 2. Cases, 63 ; deaths, 21. McHENRY. 1897. Cases, 30 ; deaths, 1. 1898. First case, June -9; .last case, June 29. Cases, 22; deaths, 0. McNIARY. 1878. Cases, 36; deaths, 9. 946 HISTORY OF VKLLOW FEVER. MEKIDIAN. 1898. First case, October 15; last case, October 17. Cases, 3; deaths, 0. MICHIGAN CITY. 1878. Cases, 2; deaths, 2. MISSISSIPPI CITY. 1878. Infected by New Orleans, First case, August 21; last case, December 10. Cases, 200; deaths, 15. 1879. Infected by New Orleans. First case, July 7; first death, July 16. 1899. Cases, 27; deaths, 2. 1905. Cases, 71; deaths, 0. MOSS POINT. 1905. Cases, 3; deaths, 0. MT. PLEASANT ROAD. 1879. No statistics. MULATTO BAYOU. 1878. Cases, 1 ; deaths, 1. NATCHEZ. "'r'"^ ■■ 1817. First case, September — ; last case, November 9. Deaths, 9. 1819. First case, September — ; last case, December — . Deaths, 180. 1823. First case, August 10; last case, October 18. Deaths, 312. 1825. Deaths, 130. 1827. No statistics. MISSISSIPPI. . 947 1828. Deaths, 90. 1829. First case, September 1; last case, November. Deaths, 90. 1837. First case, September 8 ; last case, November 25. Deaths, 280. 1839. First case, September — ; last case, November. Deaths, 235. 1811. No statistics. 1818. First case, June — ; last case, November. 1853; 1851; 1855; 1858. No statistics. 1898. Cases, 37 ; deaths, 4. 1900. No statistics. 1905. Cases, 143 ; deaths, 7. NITTA YUMA. 1897. , Cases, 27 ; deaths, 11. OAK GKOVE. 1879. Infected by Memphis. OCEAN SPRINGS. 1878. Population, 600. Infected by New Orleans. First case, August 15 ; last case, December 2 ; first death, August 18; last death, December 5. Cases, 175; deaths, SO.^ 1897. Cases, 23; deatlis, 6. New Orleans was in- fected from this focus and experienced a serious epidemic. OKOLONA. 1878. First case, August 10. Cases, 3 ; deaths, 1. ORWOOD. 1898. First case, August 31; last case, October 27. Cases, 100; deaths^ 5. 948 HISTORV OK VKLLOW FKVER OXFORD. 1898. First case, September 21; last case, October 27. Cases, 86; deaths, 12. OSYKA. 1878. Population, 925. Infected by Xew Orleans. First case, July 27; tirst di^atli, Auinnst 15. Cases, 300; deaths, 45. 1900. Sporadic cases. PASCACiOULA. 1847. No statistics. 1875. Deaths, 60. 1878 ; 1893. No statistics. 1897. Cases, 35; deaths, 2. PASS CHRISTIAN. 1843; 1847; 1855; 1858. No statistics. 1878. Population, 2,000. Infected by New Orleans. First case, August 29 ; last case, December 4 ; ^rA death, September 4; last death, November 22. Cases, 199; deaths, 23. 1879. No statistics. PEARLINGTON. 1878. Cases, 201 ; deaths, 24. 1905. Cases, 2; deaths, 0. PERKINSTON. 1897. Cases, 1 ; deaths, 0. 1898. First case, June 22; last case, June 22. 1; deaths, 0. PF/riT GULF HILLS. 1853. No statistics. . ases MISSISSIPPI. 949 POPLARVILLE. 1898. First case, October 9; last case, October 23. Cases, 24; deaths, 1. PORT GIBSON. 1853. Infected by New Orleans. First case, August 15; first death, August IT. 1878. Population, 1,400. First case, August 3; first death, August 8. Cases, 620 ; deaths, 115. 1898. First case, October G; last case, October G. Cases, 1; deaths, 1. 1905. Cases, G3; deaths, 2. QUARANTINE. 1878. Cases, 5; deaths, 2. 1884. Infected by Colon. Cases, 1 ; deaths, 0. 1888. Infected by ship Maria, from Havana. Cases, 3; deaths, 0. 1890. Cases, 6; deaths, 2. 1891. Infected bv (Miandeleur. Cases, 12; deaths. 1. 1892. Cases, 4; deaths, 0. 1893. Cases, 3; deaths, 1. 1895. Cases, 3. 1897; 1898; 1899. Cases from infected vessels. 1903. Cases, 4 ; deaths, 2. 1905. Cases, 41; deaths, 1. REFUGE LANDING. 1878. First case, September 9; first death, September 29. Cases, 19 ; deaths, 11. QUEEN niLL. 1808. I'^irst case, October 15; last case, October 15. Cases, 1; deaths, 1. 950 msiouv of vkllovv fever RIDGELAND. 1898. First case, October 8; last case, October IT. Cases, 7; deaths, 0. ROCKY SPRINGS. 1878. Deaths, 38. RODNEY. 1829. No statistics. 1843. First case, September 6. 1817. No statistics. 1853. Sporadic cases. ROSETTA. 1905. Cases, 32; deaths, 7. ROXIE. 1905. Cases, IG; deaths, G. SCOTT'S. 1878, Population, 50. SCRANTON. 1878. First case, October 5; first death, Ojtober 11. Cases, 60 ; deaths, 20. 1897. Cases, 3G3; deaths, 18. 1905. Cases, 17; deaths, 0. SSNATOBIA. 1878. Population, 1,400. Cases, 2G; deaths, 7. SHIELDSBOROUGH. 1820. First case, August 20. 1828. No statistics. 1829. First case, August 5. Cases, 46 ; deaths, 8. 1839. No statistics. 1 MISSISSIPPI. 951 SMITH'S STATION. 1878. Infected by Yicksburg. Cases, 16. SOEIA. 1905. Cases, 2 ; deaths, 0. STARKVILLE. 1898. First case, October G; last case, October IS. Cases, 9; deaths, 0. STONEVILLE. 1878. Population, 50. Infected by New Orleans. Cases, 23; deaths, 15. SULPHUR SPRINGS. 1878. Infected by Canton. First case, August 23; first death, August 28 ; last death, October 26. Cases, 15 ; deaths, 5. SENATOBIA. 1878. Population, 1,200. Infected by Grenada. First case, September 1. Cases, 26; deaths, 7. SUMMIT. 1878. Deaths, 4. SUMRALL. 1905. Cases, 1; deaths, 0. SUNFLOWER. 1878. Cases, 48; deaths, 15. TAYLOR. 1898. First case, August 1; last case, October 21. Cases, 106; deaths, 14. 95S HISTORY OF YELLOW FEVER. TERKEXE. 1878. Cases, 12; deaths, 4. TERKY. 1878. Population, 225. Cases, 10; deaths, 5. TOUGALOO. 1898. First ease, October 16; hist case, October 17. Cases, 2; deaths, 0. TOULNE. 1878. No statistics. VICKSBURG. 1839. Infected by New Orleans. Deaths, 50. 1841 ; 1847. No statistics. 1853. Population, 4,000. Infected by New Orleans. First case, July — ; first death, August 1. 1858; 1871. 'No statistics. 1878. Infected by Ne^y Orleans. First case, July 21 ; last case, December; first death, July 24; last death, Noyember 21. Cases, 5,000; deaths, 872. 1905. Cases, 185 ; deaths, 28. WARDVILLE. 1898. Scattered cases. WASHINGTON. 1825. First case, August; last case, Noyember. Deaths, 52. WATERFORD. 1898. First case, September 9; last case, October C. Cases, 2 ; deaths, 0. MISSISSIPPI. • 953 WATEK VALLEY. 187l, i*opiilatiou, 3,000. First case, August 9; first death, August 30. Cases, 200; deaths, 64. 1898. First case, Octohei- 7; last case, October 21. Cases, 12; deaths, 0. WAVELAND. 1897. Cases, 4; deaths, 0. 1898. First ease, October 10; last case, October 18. Cases, 20 ; deaths, 1. W. PASCAGOULA. 1897. Cases, 8; no deaths. WHITZELL'S LANDIXC. 1877. No statistics. WINONA. 1878. Population, 1,500. lufected by (Jreiiada. I'^irst case, August 9. Deaths, 3. WINTERVILLE. 1878. Infected by Greenville. First case, August 28; first death, September 15. Cases, 151 ; deaths, 20. WOODVILLE. 1844; 1852. No statistics. 1853. First case, August 9; first death, August 13. 1855. First case, August 27; first death, Sei)tcniber 2. 1858. :So statistics. 1898. First case, October 0; last case, October 0. Cases, 1; deaths, 0. OS* HISTORY OF ■SEI.I.OW FKVER. YAZOO CITY. 1853. ropiilatiou, 2,000. First case, Anj-iist 28; fiis-t death, September 1. 1878. PopiilatioD, 2,500. Infected by Vicksbiirn:. First case, September 15; first death, September 21. Cases, 17; deaths, 9. 1898. First case, October 0; last case, November 10. Cases. 2fi ; deaths, 0. BIBLIOGRAPHY OF YELLOW FEVER IN MISSISSIPPI. Anderson (E. H.) : The late Jackson fever, and previous epidemics elsewhere. Memphis Med. Monthlj', 18S8, vol. 8, p. 545. Anderson (E. H.) : Some remarks upon our recent invasions of yellow fever, by an octogenarian M. D, Memphis M. Monthly, 1897, vol. 17, p. 549. Archinard (J. J.) : The yellow fever at Ocean Springs, Miss., report of a case and autopsy. X. O. M. & S. Jl., 1897-8, vol. 1, p. 258. Ballard (J. C): In regard to yellow fever at Hattiesburg, Miss., a criticism of Rev. Mr. Peebles. Med. News, N. Y., 1898, vol. 73, p. 663. Beazley (J. S.): An account of the Epidemic Yellow Fever at Cooper's Well, Miss., in 1855. Trans. Amer. Med. Assn., 1856, vol. 9, p. 685. Cartwright (A) : Post-mortem examinations in the yellow fever of Natchez. X. O. M. & S. Jl., March, 1857, p. 649. Cartwright (Samuel A.): On the yellow fever of Xatchez, Miss., in 1847. X. O. M. & S. Jl., vol. 5, p. 225. Cartwright (S. A.): The yellcw fever at Xatchez in all its bearings on the quarantine question and yellow fever at New Orleans. N. O, M. Xews & Hosp. Gaz., 1855-6, vol. 2, pp. 1, 16. Champlin (A. P.) : The fever at Biloxi, Miss., during the summer and autumn of 1886. Gallard's Med. Jl., X. Y., 1887, vol. 43, p. 335. Grant (H. A.), Tackett (J. R.) and Folkes (H. M.) : Yellow Fever. Mississippi Med. Assn., Biloxi, 1898-9, vol. 2, p. 33. Guiteras (G. M.) : The Epidemic in Vicksburg. Ann Rep. Sup. Surg.-Gen. U. S., 1906, p.. 148. Hicks (B. J.): On the yellow fever in Vicksburg, Mississippi, in 1847. X. O. M. J., vol. 5, p. 220. Hogg (Samuel): An account of the Epidemic Fever of Xatchez, Mississippi, in the years 1837, 1838, and 1839. Western Journal of Medicine and Surgery, vol. 1, p. 401. MISSISSIPPI. 955 Holt (A. C.) : Yellow fever at Woodville, Miss., and its vicinity. Trans. Amer. Med. Assn., 1S56, vol. 9, p. 653. Johnston (W.): The outbreak of yellow fever at Jackson, Miss., in Sept., 1888. Am. Pub. Health Assn., Rep. 1888, Concord, 1899, vol. 14, p. 51. Jones (R. E.) : If it was not Yellow Fever, what was it? Journal Miss Med. Assn., 1899, vol. 3, p. 800. Kilpatrick (A. R.) : An account of the Yellow Fever which prevailed in Woodville, Miss., in the year 1844. N. O. Med. & Surg. JL, vol. 2, p. 40. Kilpatrick (A. R.): Epidemic of Yellow Fever which scourged the inland town of Woodville, Miss., in 1844. Med. and Surg. Reporter, Phila., 1878, vol. 40, p. 85. Lavinder (C. H.): Yellow fever at Natchez, Miss., Rep, Surg.-Gen. U. S. P. H. S. M. H. Service for 1906. (Wash., 1907), p. 155. Lewis (P. H.): Thoughts on the yellow fever, being a brief critical notice of the following recent works, viz: 1st. 'Observations on the epidemic yellow fever of the South West, by J. W. Monette, 1843;" 2d. "Sketches from the history of yellow fever, showing its origin; to- gether with facts and circumstances, disproving its domestic origin, and demonstration of itsc transmissibility, by W. M. Carpenter, 1844." N. O. M. & S. JL, 1844-5, vol. 1, pp. 31, 44. Louisiana State Board of Health: Report on the Biloxi Fever. N. O., 1886. Reprint from X. O. Picayune, Sept. 8, 1886, vol. 8. Louisiana State Board of Health: Outbreak of yellow fever at Biloxi, Harrison County, Miss., and its relation to interstate notifica- tion. N. O., 1886, vol. 8. Magruder (A. L. C): A history of the epidemic, which prevailed at Vicksburg during the Fall of 1847. N. O. M. & S. JL, vol. 4, p. 689. McAllister: The yellow fever of Grand Gulf, Miss., in 1853. N. O. M. & S. JL, 1853-4, vol. 10, p.. 675. McMullen (J.) : Yellow Fever in Hamburg and Roxie, Miss. U. S. Marine Hospital Service. Report of the Supervising Surgeon General for 1906, p. 167. Merril (A. P.): An Essay on the Yellow Fever, as it appeared at the Bay of St. Louis in 1820. N. O. M. & S. JL, vol. 8, p. 1. Merrill (A. P.): Ibid. In his: Med. Essays. 8°. N. O., 1851, p. 3. Merrill (A. P.): On the Epidemic of 1852 in Natchez, Mississippi, North American Medical & Surgical Journal, vol. 2, p. 217. Merrill (A. P.): On the Yellow Fever of 1823 in Natchez, Missis- sippi. Phila. Medical and Physical Journal, vol. 9, p. 235. Monette: Observations on the Epidemic Yellow Fever of Natchez, and the Southwest. Louisville. 1842. Monette: Epidemic Yellow Fever of Washington, Mississippi, 1825. Western Med. and Phys. JL and Am. JL, vol. 1, p.. 243. 956 HISTORY OF VKLI.OW FEVKR. Monette (J. W.) : The Epidemic Yellow Fever of NaJtchez. An essay read before the Jefferson College and Washington Lyceum, December 2, 1837, 12mo. Natchez, 1838. Perlee (A.) : An account of the Yellow Fever at Natchez as it pre- vailed in the autumn of 1817 and 1819. Phila. Med. and Phys. Jl., vol. 1, p. 1. Stone (C. H.): Quarantine and Yellow Fever at Natchez in 1853, and 1855, etc. N. O. Med. New. and Hosp. Gaz., November, 1855. Ibid., Trans. Amer. Med. Assn., 1856, vol. 9, p. 643. Stone (C. H.): Report on the Origin of Yellow Fever in the Town of Woodville, Miss., in the summer of 1844. N. O. M. & S. Jl., 1844-5, vol. 1, p. 520. Stone (C. H.): The History of the Mild Yellow Fever, which pre- vailed in the City of Natchez in 1848. Natchez, 1849. See also N. O. Med. and Surg. Jl., 1848-9, vcl. 5, p. 549. Stone (C. H.): The history of the mild yellow fever, which pre- vailed in the city of Natchez in 1848, with observations respecting its chainaoter and natural mode of cure; to which is appended, from various authors, descriptions and notices of that disease, of dengue, and of inflamation of the stomach and bowels. 8°. Vidalia, La., 1849. Stone (C. H.): Report on the Origin of Yellow Fever in the Town of Woodville, Mississippi, in the Summer of 1844. N. O. M. & S. Jl., vol. 1, 1844-5, p. 520. Thornton (J. J.): Yellow Fever at Brandon, Miss., in 1853 and 1854. Trans. American Med. Assn., 1856, vol. 9, p. 699. Tcoley (Henry): History of the Yellow Fever as it appeared in the City of Natchez in 1823. Vol. 8, Natchez, 1823. (Second Edition. Washington, Mississippi. Same date.) Valetti (C. de) and Logan (T.): A Report on the Yellow Fever that recently prevailed at Woodville (Miss.), 1844. N. O. M. & S. Jl., 1844-5, vol. 1, p. 237. Vansant (J.): Brief account of yellow fever at New Orleans and Pascagoula in 1875. Rep. Superv. Surg. --Gen. Mar. Hosp., 1874-5, Wash., 1876, p. 147. Wasdin (E.): Inspection of the Gulf Coast between Mobile and Pass Christian; yellow fever in Mississippi City, Gulfport and Handsboro; Gulf Coast Maritime Patron. Rep. Surg.-Gen. U. S. P. H. S. M. H. Service for 1906. (Wash., 1907), p. 169. Williams: On the Yellow Fever at Rodney, Mississippi, in the year 1847. N. O. M. & S. Jl, 1848-9, vol. 5, p. 217. Williams (W. G.) and Andrews: An account of the Yellow Fever which prevailed at Rodney, Mississippi, during the autumn of 1843. N. O. M. & S. Jl., 1844-5, vol. 1, p. 35. Williams: Yellow Fever in Mississippi. N. O. M. & S. JL, 1853-4, vol. 10. pp. 327, 385. 95/ MISSOURI. In the sumiiior of 1819, yellow fever iiiaile its appear- ance simultaneously at many plaees throughout tlie United States. A bilious remittent fever of a malij-uant teudeuej' became epidemic both in Missouri territory and in the State of Illinois. Although it generally assumed a milder form than on the seaboard; yet many of the eases reported had the characteristic features of typhus ict erodes so decidedly marked, that the Surgeon-General entertained no doubt of the identity of the disease. {Arnii/ Med. Stats., 1819-1839, p. 8). There is no record as to what localities in Missouri were affected. NEW DESIGN. 1797. Population, 200. Deaths, 57. Source of in- fection obscure. ST LOUIS. 1854. A few cases were imported to St. Louis in 1854. No statistics. 1855. August 14, an imported case. No developments. 1878. ]Many cases of yellow fever were brought here. Among the first fatal cases was Capt. W. O. Nelson, of Port Eads, commander of the Dredge-boat at that place, and member of the firm, Eads & Nelson, wreckers. He died at St. Louis, August 13. Fatal cases among refugees con- tinuing, much excitement arose, and a strict quarantine was established. Total cases, 110; total deaths, 40. The following resume by Surgeon Walter Wyman, United States :Marine Hospital Service, and ])ublislied in his Annual I{ei)ort Un- that year, is of sufficient interest to be reproduced here : ]^r. Wyman observes that tlie chief point of interest connected with the epidemic of 1878 in St. Louis, is that, 958 HISTORY OF YELLOW FEVER. for the first time in tli history of the city, yellow fever seized iiiion inhabitants not previonsly exposed in more southern latitudes. During previous epidemics, isolated cases brought from the South have been treated with no thought of pos- sible danger ; but the experience of the outbreak under dis- cussion, showed that former immunity from the disease is no guarantee of the city's future safety. There were at least fourteen local cases of yellow fever contracted — three within the city limits, five upon the quarantine transfer boat, and six at quarantine hosx)ital. Ten of the fourteen died, and it is reasonable to suppose that had it not been for the efficient regulations of the Health Department, the scourge would have been felt far more severely. The first case occurring in St. Louis was that of a steamboat clerk just from New Orleans, who showed the first symptoms upon the 15th of July, and died upon the 19th. Several cases of a like nature soon followed, and the Board of Health becoming concerned by reason of these deaths and the large number of refugees flocking to the city, determined to open the quarantine hospital located ten miles below, upon the western bank of the river. At first the quarantine restrictions were limited, but as the ejDidemic increased in severity, more rigid regu- lations were enforced. All boats were obliged to land and were detained for a thorough inspection. Their holds were disinfected with chlorine, and all sick persons re- moved to the hospital. Trains entering the city from the South were also boarded, to prevent the admission of yellow fever cases. Within the city limits, all refugees were ferreted out by the police and by health officers ap- pointed for that purpose, and nolens volcns were taken by ambulance to the steamer EdwanUvillc — a ferry-boat prepared for the reception of such cases — and at once con- veyed to quarantine. MISSOURI ST. LOUIS. 959 Between August 21, the date on which the station was opened, and October 22, the date of the reception of the hist case, there were treated at quarantine 129 patients, 88 of whom had yellow fever. Of the 88 yellow fever cases, 42 died. There was nothing peculiar in the character of these cases, unless it were a marked suppression of the urine, which characterized nearly all of them. The average period of incubation cannot be determined from the records of the hosiDital. Of the cases of local origin the majority were con- tracted or treated at quarantine, but for convenience tbe following tabulated statement of all local cases is ap- pended: Nurse in city hospital . . . Steward at quarantine ... Xieht watchman at quarantine luisrineer at quarantine . . . I'oliceuian at t[\xarantine . . . Resident physician at quaran- tine Cook of quarantine-boat . . Xurse on quarantine-boat . . Dauehter of quarantine-stew- ard Wile of the cook of quaran- tine-! loat l>eck-han On board of lioat Oct. 18 Quarantine Quarantine Quarantine On board of boat Unknown Cit.\' • . . City Oct. 22 . . Q\uiranline On board of boat Oct. — . . Cit.\- . . . It will be noticed in the al)ove table that five of the employes of the transfer-boat Edicanhvillc con- tracted yellow fever and died; not one recovered. It 960 HISTORY OF YELLOW FEVER. slioiikl, in candor, be stated, however, that tlie disease of v/liich the boat's eaptain died was returned by the attend- ing physician as typho-niahirial fever, but was considered by others, wlio were ])robal)ly correct, to have been yellow fever. The two fatal cases Avhich were taken from the city and died at (piarautine possess some interest. One was the wife of the cook of the boat. This man, Nicholas (raft, v»as taken ill on the 9th of October, (Wednesday), left the boat and visited his wife in the city. The followinjj: day (Thursday) he was removed to quarantine. I'pon the following Sunday, (October 13), his Avife manifested sypmtoms of yellow fever, was removed to ({uarantine, where she died October IG. The other city case, which died at (piarantine, was re- moved from South St. Louis, commonly called Caron- delet. The resident physician pronounced it an undoubted case of yelloAv fever, stating that the patient had black vomit and other well-marked symptoms. The boy was removed by order of the health officers, who found him lying by the side of a sister who had expired a short time previous, with apparently the same disease. The physicians in attendance upon the sister, returned as the cause of her death, a disease other than yellow fever, and, upon incjuiry, it was found that some nine or ten deaths had occurred in the same gen- eral neighborhood, the symptoms of which closely simu- lated yellow fever; but the diagnosis nmde, had been typho malarial fever, malarial h:emori'hagica, &c. Whether these were cases of yellow fever or not became a subject of warm dispute among the Carondelet physi- cians, the nmjority, liowc^ver, claiming exemi)tion of that portion of the city from the plague. One other fact concerning the lo the feyer, served to gTeatly swell the mortality. 1802. Sporadic cases; deaths, 10. BIBLIOGRAPHY OF YELLOW FEVER IN NEW HAMPSHIRE. Berenger-Feraud: Fievre Jaune, etc., Paris, 1890, p. 8. Keating: History of Yellow Fever, p. 81. New York Medical Repository, 1799, vol. 2, p. 211. I ■^'3^' 96ar NEW JERSEY. BRIGHTON. 1798. Limited outbreak. Xo statistics. BURLINGTON. 1798. Limited outbreaks. No statistics. CAMDEN. 1853. Infected by Philadelphia. No complete stat- istics. GLOUCESTER. 180o.~ Source of infection obscure. Outbreaks was not general. 1870. A few cases, refugees from New York and Gov- ernor's Island. No accurate statistics. JERSEY CITY. 1878. One case, Septendier IG, a refugee, terminating in death on the 20th. PERTH A]MBOY. 1811. Deaths, 5. PORT ELIZABETH. 1798. Infected by Philadelphia. First case, August 9; last case in September. Cases, 13; deaths, 6. WOODBURY. 1798. Probably infected by Philadelpliia. No record. 1853. One case, a refugee from Philadelphia. Re- covery. 984 HISTORY OE YELLOW EEYER. BIBLIOGRAPHY OF YELLOW FEVER IN NEW JERSEY. Gotham: N. Y. Med. Repository, 1856, p. 564. Griscom: Visitations of Yellow Fevor. u. 9. History of the Yellow Fever which prevailed at Perth Amboy, New Jersey, in the Summer of 1811, and of the Evidences of its Importation into that place. Medical and Philos. Register, vol. 3, p. 94. Keating: History of Yellow Fever, p. 80. Report of the Board of Health of New York on the Yellow Fever at Perth Amboy in 1811, by Drs. Hosack, Bayley, and Douglass. Medical and Philosophical Register, vol 3, p. 95. Edinburgh Medical and Surgical Journal, vol. 8, p. 165. Lee: N. Y. Med. Repository, 1800, vol. 3, p. 246. Report Sup. Surg.-Gen. U. S. A., 1873, p. 87. Report Board of Experts, 1878. Transactions College of Physicians, Phila., 1853. II 965 NEW YORK. ALBANY. 1746. First case in August. Deaths, 45. 1798. No statistics. BAY RIDGE. 1856. Infected by Brooklyn. Only a few cases resulted. ?■ BKOOKLYN. 1809. First case in July; last case in September. Deaths, 40. Infected by ship Concord, from Havana. 1823. No statistics. ' 1856. Infected by Governor's Island. First case, July 14. Cases, 29. 1878. At Navy Yard. First case, July 12; last case, July 18. Cases, 8; deaths, 3. / 1879. Population, 565,000. Deaths, 11 ; all refugees from infected places. 1888. Population, 805,855. Infected by Spanish bark Maria Louisa from Havana and steamship Ccarcusc from Pernambuco. CATSKILL. 1743 ; 1794. Sporadic cases. 1803. First case, August 10 ; last case, September 23. Deaths, 8. 1804. No statistics. GREENFIELD. 1798. Sporadic cases. GOVERNOR'S ISLAND. 1856. Infected by shii)piiig. On July 26, the nrst case of yellow fever occurred in a resident of Rotten Row — she died with black vomit, August 2. On August 1, three 966 HISTORY OF YELLOW FEVER. otlier eases oceurred, one in IJotten Kow and two from South Battery; and in these two places the disease fixed its abode, as it were, almost exclnsively, and eontinned until tlie number of cases amounted to sixty-three, iifteen of whom died, 1 in 4,2. Very few cases occurred on other parts of the Island, liesides fc^outh Battery and Kotten Bow, and those that did thus occur were in almcst eyerj instance (probably all) in persons ^^h(! were in the habit of yisiting Botten Bow. In South Battery the disease continued its rayajLics un- til early in September, Avhen the cccupants were renujyed to quarters in audtlu^' pcrtion of the Island, only two cases occurring' auicnu tluin after tluir remoyal. In Botten Bow it linjiered until checktd by cool weather on the 9tli of October. Cases, 150; deaths, 52. 1870. Bopulation, 771. I-'irsl case, August 13; tirst death, August 20; last case, October 2(5; last death, Octo- ber 29. Cases, 159 ; deaths, 52. GOWANUS. 1S5G. Infected by shippinji". Sporadic cases, HUXTINOTOX. 1795; 1798. Limited ()ntl)reaks. Xo authentic stat- istics. LOCKPOBT. 1878. One fatal case, a refu.i'ee from ^lemphis, Sep- tember 29. :\rONTAT'K POINT. 1898. Cases, 1; deaths, 0. NEW YOBK. 1008. First appearance of yellow feyer in the United States. Xo complete statistics. Yellow feyer rajned seyerely in New Ycik, to such a dejiCi'ee that scarcely a iiaticiit suryiy<'d it; and, by some NEW YORK CITY. 967 accounts, it was niore fatal than any disease since that period. It was popnhnly known as "the f>Teat sickness." One account states that several hundred died uj) to Sep- tenihei*, and 70 more during tlie succeeding week, in a population of only (),00() or 7,000. On account of the pestilence, the Assemhly was held at Jamaica, Long Island. The disease was said to have l)een imported from St. Thomas. Last deatli, Se])tendier 30. Deaths, 370. 1711). "In the vcnr 1710, there were a few cases of yel- low fever near the Old Slii) ; but by the vigorous exertions of the Board of Health and the blessing of Divine Provi- dence, it was su])i)ressed before it had attained an alarm- ing height." (Bardic, p. 22). 1743! Deaths, 217. 1745; 1747; 174S; 1703. Yellow fever years. No statistics. 1780. Deaths, 70. 1701. First case, August — ; last case, October 15. "Oeneral Malcolm and some other very respectable citi- zens fdl victims to its fury." (Hardir, p. 1). 1702; 1703; 1704. Yellow fever years. No statistics. 1705. hirst case, July 10. Deaths, 732. 170(1; 1707. No statistics. 170S. (Jreat epidemic. Deaths, 2,080. (From 1700 to date, unless otlierwise noted, the figures given in this resume represent occurrences at the (Quar- antine Hos])ital ). 1700. First case, July — ; last case, Novend)er. Cases. 163; deaths, 74. 1800. First h the inactivities of the *s7r//oy//_///r/ CaJopus, who confined tluii* oi)erations to a circumst rihed area. The following;' resnme is made from the account given by Dr. INIoreau JMorJ'is, City Sanitary Inspect(;r, in the Amiud] Report of tJtc Xcic Yorl- Bo5 obscure, however, and we have grave doubts that tliis outbreak was yellow fever. 1878. Population, 3,700. First cases were Chas. Degelman, engineer, and A\'m. Koidler, of the steamer Joliii iHibKon, which landed three miles below the city on August 20. September 11, JoseiJh Porter, Avatchman of the Joliii D. Porter, died. His body was not permitted to be moved from his house, nor his wife to leave. The Kch(yol;^ closed, business suspended and many citizens tied. ]Mrs. Brown died September 27, below town, where the infected dis- irict was located. The disease disappeared October 17. Total cases, 51 ; total deaths, 31. MARIETTA. 1832. No statistics. NEWTON FALLS. 1898. No statistics. BIBLIOGRAPHY OF YELLOW FEVER IN OHIO. Long (V^. H.):. Yellow Fever at Gallipo'.is, 1S7S. Rep. Supeiv. Surg.- Goii. Mar. Hosp., Wash., 1878-9, p. 127. Medaris: (Cincinnati, 1898). Ohio Med. J., 1898, vol. 9, p. 25. Minor (T.. C): Special report on yellow fever in Ohio as it ap- peared during the summer cf 1878. Rep. Health Dept. Cincin.; 1879, vol. 12, p. 173. Reeve (J. C): Was it a Case of Yellow Fever? Cincinnati Lancet- Clinic, 1879, vol. 3, p. 187. 986 PENNSYLVNNIA. BALD EAGLE VALLEY. 1799. Sporadic cases. CHESTEIL 1798. Deaths, 50. CHESTEK COUNTY. 1805. Sporadic cases. KENSINGTON. 1793. Sporadic cases. LISBURN. 1803. First cases in August. No statistics. MARCUS HOOK. 1798. First case, August. Cases, 60; deaths, 4. NITTANY^ 1799. Sporadic cases. PHILADELPHL\. 1093. First appearance of vellow fever in Philadel- phia, according to Webster, La Roche and Berenger- Feraud. No record. 1G95. Traditional outbreak. 1699. First outbreak epidemic. Population, 3,800. First cases in June: first death, July 15. Deaths, 220. 1732. Deaths, 250. PENNSYLVANIA PHILADELPHIA. 9FT 1741. First case, 3Iay; first death in June; last case in Ir^eptember. Deaths, 210. 1712; 1713; 1711. Yellow fever years. Xo statistics. 1717. First case in June; last case in October. 1700. Scattered cases. 1762. First case, August 28; last case, November — ; last death, October 30. No statistics. 1763; 1789; 1791. Yellow fever years. No statistics. 1793. Great epidemic. Population, 10,111. Number who fled, 17,000. First case, August 18; first death, August 22 ; last case in December. Deaths, 1,011. 1791; 1795; 1796. Scattered cases. 1797. Severe epidemic. First case, August 1; last case, October 15. Deaths, 1,292. 1798. Another great epidemic. Population, 60,000. First case, August 1 ; last death in November. Deaths, 3,506. 1799. Severe epidemic. First case, June 28 ; last case in October ; last death, October 18. Deaths, 1,015. 1800. First case in Julv; last case in September. Deaths, 20. 1801. Scattered cases. 1802. First case in August. Cases, 598; deaths, 307. 1803. First case, July 19; first death, July 25; last case, October 5; last death, October 20. Cases, 3,900; deaths, 195. 1805. First case, Julv; last case, October, 1806; 1807; 1808; 1809; 1810; 1811; 1812; 1813; 1814; 1815; 1816. Scattered cases. No statistics. 1818. Cases, 2; deaths, 2. 1819. First case, June 23. Cases, 21 ; deaths, 20. 1820. First case, Julv 21 ; last case, November. Cases, 125 ; deaths, 83. 1826. Scattered cases. 1853. Infected by ship Mandarm, from Cuba. First case, July 19 ; last case, October 7 ; last death, October 12. Cases, 170 ; deaths, 128. 1854. Scattered cases. 1870. First case, June 29. Deaths, 18. i'8« HISTORY OF VEI.I.OW FF.VKU. 1878. Two cases, refugees frcm Vicksburg, August 24. Canes, 4; deaths, 1. 1879. Cases ou brig SJtasta, from Havti. 1883. Cases on brig Julid Blake, from Havana. 1893. Cases, 3; deaths, 0. In haibor. PITTSBUKG. 1878. One case from the ill-starred John D. Porter, died soon after arrival at Pitts-burg. I\o de^.elcpments. SOUTHWARK. 1793. A suburb of Pliiladelpliia, viiich see. BIBLIOGRAPHY OF YELLOW FEVER IN PENNSYLVANIA. Academy of Medicine cf Philadelp.iia: Proofs of the Origin of the Yellow Fever in Philadelphia and Kensington, in the year 1797, from Domestic Exhalations, etc. Philadelphia, 1798. Account cf the Rise, Progress, and Termination of the Malignant Fever lately prevalent in Philadelphia. Small 8vo. Philadelphia, 1793. Bache (Thomas Hewson) : Observations on the Pathology of the Cases of Yellow Fever admitted into the Penncylvania Hospital during the summer of 1853. American Journal cf the Medical Sciences, N. S., vol. 28, p. 121, July, 1854. Bond (Thomas): An Introducto:y Lecture to a course of Clinical Lectures in the Penn. Hospital, deliveied en the 3rd of December, 1766. North American Medical and Surgical Journal, vol. 4, p. 264. Caldwell (C): A Semi-annual Craticn on the Origin of Pestilential Diseases. Delivered before the Arademy of medicine of Philadelphia; 17th December, 1798. 8vo. Philadelphia, 1799. Caldwell: Facts and Observations relative to the Origin and Nature of the Yellow Fever. Medical and Physical Memoirs, etc. 8vo. Phila- delphia, 1801. Caldwell: Thoughts on Febrile Miasms: Intended as an Answer to the Boylston Medical Prize Question for 1820, Whether f«ver is pro- duced by the decomposition of animal or vegetable substances, etc.? 8vo. Boston Medical and Surgical Journal, vol. 3, p. 473. Caldwell: An Address to the Philadelphia Medical Society on the Analogies between Yellow Fever and true Plague. 8vo. Philadelphia, 1801. PENNSYLVANIA. 98^ Caldwell: An Essay on the Pestilential or Yellow Fever as it pre- vailed in Philadelphia in the year 1S05. 8vo. Appendix to Alibert. Philadelphia. Caldwell: Escay:; on Malaria and Temperament. Svo. Lexington, isai. Caldwell: An Anniversary Oration on the subject of Quarantine, delivered before the Philadelphia Medical Society, on the 21st Janu- ary, 1897. Caldvv-ell: Thourhts on Quarantine and other Sanitary Systems, being an escay which received the prize of the Boylston Medical Com- mittee of the Plarvard University, August, 1834. Boston, 1834. Caldwell: A Rei;ly to Br. Kaygarth's "Letter to Dr. Percival on Infectious Fevers," and his "Address to the College of Physicians at Philadelphia on the Prevention of the American Pestilence," etc. Svo. Philadelphia, 1802. Caldwell: A Dissertation in answer to certain Prize Questions, pro- posed by his Grace the Duke of Holstein Oldenberg, respecting the Origin, Contagion, and General Philosophy of Yellow Fever, etc. Medical and Fhyjical Memoirs. Svo. Lexington, 1826. Caldwell: General Physiology of Yellow Fever. 1841. Carey (M.): Observations on Dr. Rush's Inquiry into the Origin of the late Epidemic Fever in Philadelphia. December, 1793. Philadel- phia. Carey (M.) : A short Account of tire Malignant Fever lately pre- valent in Philadelphia, etc. Svo. 1794. Cathrall: Medical Sketch of the Syncchus Maligna, which prevailed in Philadelphia In 1793. Svo. Philadelphia, 1794. College of Physicians of Philadelphia. Proceedings relative to the Prevention of the Introduction and Spreading of Contagious Diseases. Svo. Philadelphia, 1793. Ibid.: Facts and Observations relative to the Nature and Origin of the Pestilential Fever which prevailed in this City in 1793, 1797, and 1798. Philadelphia, 17C8. Ibid.: Additional Facts and Observations relative to the Nature and Origin of the Pestilential Fever. Svo. Philadelphia, 1806. Cresson (Joshua) : Meditations, written during the prevalence of the Yellov/ Fever in the city of Philadelphia, in the year 1793. Small Svo. London, 1803. Currie: A Eketch of the Rise and Progress of the Yellow Fever, and of the proceedings of the Beard of Health, in the year 1799. Svo. Philadelphia, 1800. Currie (Wm.) : A Treatise on the Synochus Icterodes, or Yellow Fever, as it Ic-tely appeared in the city of Philadelphia. Svo. Phila- delphia, 1794. 9;^0 HISTORY OF YELLOW FEVER. Currie: Memoir on the Yellow Fever which prevailed in Philadel- phia in the year 1798. 8vo. Philadelphia, 1798. Currie and Cathrall: Facts and Observations on the Origin, Progress and Nature of the Fever which prevailed in certain parts of the city and districts of Philadelphia in the summer and autumn of 1802; to which is added a Summary of the Rise and Progress of the Disease in Wilmington, communicated by Dr. E. A. Smith, and Dr, J. Vaughan. Svo. Philadelphia, 1802. Deveze (J.): Recherches et Observations sur la Maladie Epidemique, qui a regne a Philadelphia en 1793, depuis le mois d'Aout jusque vers le milieu de Decembre. Philadelphia, 1794. French and English. Deveze (J.) : Dissertation sur la Fievre Jaune, qui regna a Phila- delphia, depuis le mois d'Aout, jusque vers le milieu du mois de Decembre, 1793. An. xii. 1804. Folwell. Short History of the Yellow Fever that broke out in the City of Philadelphia in July, 1797. 8vo. Philadelphia, 1797. Griffiths (S. P.): (Copy of manuscript memorandum book kept by during the yellow fever epidemic in Philadelphia in the year of 1798; with annotations by J. K. Mitchell). MS. foolscap. Helmuth (J. Henry C.) : A short Account of the Yellow Fever in Philadelphia, for the reflecting Christian. Translated from the Ger- man, by Charles Erdmann. 8vo. Philadelpliia, 1794. Helmuth (J. H. C): Kurze Nachricht von den sogenannten gelben Fieber in Philadelphia fur den nachdenkenden Christian. 16°. Phila- delphia, 1793. History of the Yellow Fever that \)roke out in the City of Phila- delphia in July, 1797. 8vo. Philadelphia, 1797. Jackson (Sam.): An Account cf the Yellow or Malignant Fever which appeared in the city of Philadelphia in the summer and autumn of 1820. 8vo. Philadelphia, 1821. Originally published in the Phila- delphia Medical and Physical Journal, vol. 1, p. 313; vol. 2, p. 1, Jewell (Wilson): Yellow or Malignant Bilious Fever in the vicinity of South Street wharf, Philadelphia, 1853. Svo. Philadelphia, 1853. Se also Transactions of the College of Physicians of Philadelphia. Jones (Absalom) and Richard Alleno: A Narrative of the Proceed- ings of the Black People during the late awful calamity in Philadel- phia in 1793. Svo. Philadelphia, 1794. La Roche (R.) : Remarks on the Origin of the Yellow Fever which prevailed in Phila. in 1853. Transactions of the College of Physicians, N. S., vol. 2, Phila. La Roche (R.): A Statement of Facts respecting the mortality oc- casioned by the Yellow Fever in the City of Philadelphia during the various epidemics from 1699 to 1620, etc. Charleston Med. Jl., Vol. PENNSYLVANIA. 991 7, p. 458. La Roche: Remarks on the Origin of the Yellow Fever which pre- vailed in Philadelphia in 1853. Transactions of the College of Physicians, N. S., vol. 2. Philadelphia, Letter from the Secretary of the Commonwealth of Pennsylvania, relative to the late Malignant Fever. Philadelphia, 1798. Minutes of the Proceedings of the Committee appointed on the 14th September, 1793, by the Citizens of Philadelphia. 8vo. Philadelphia. 8vo. Philadelphia, 1794. (New Edition in 1848.) Mitchell (T. D.) : Why has Yellow Fever ceased to visit Philadel- phia as an Epidemic? N. O. M. & S. Jl., vol. 9, p. 717. Nassy (D.): Observations on the Causes, Nature and Treatment of the Epidemic Disorder prevalent in Philadelphia. 8vo. (French and English). Philadelphia, 1793. Occasional e3say3 on the yellow fever, by a Philadelphian. 8°. Phila., 1800. Parrish: Some Account of the Appearances on Dissection in certain cases cf Yellow Fever, and notices of some symptoms of the disease as it appeared in the City Hospital in the year 1805. Coxe's Medical Museum, vol. 3, p. 187. Pascalis: An Account of the Contagious Epidemic Yellow Fever which prevailed in Philadelphia in the summer and autumn of 1797. 8vo. Philadelphia, 1798. Patterson (J): Remarks on some of the Opinions of Rr. Rush re- specting the Yellow Fever which prevailed in Philadelphia in 1793. 8vo. Londonderry, 1795. Philadelpliian (A) : Interesting Essays chiefly on the subject of the Yellow Fever. 8vo. Philadelphia, 1820. Philadelphia (A.): Occasional Essays on the Yellow Fever. 8vo. Philadelphia, 1800. Purse (B. S.) : Yellow Fever and Filth. Med. Rec. N. Y., 1878, vol. 14, p. 327. Report of the Joint Committee of Councils relating to the Malignant or Pestilential Diseases of the summer and autumn of 1820, in Phila- delphia. Philadelphia, 1821. Rush (Benjamin) : Letter to Dr. John Rodgers, of New York, on the Fever of 1793, dated October 3, 1793. Duncan's Medical Comment- aries, vol. 19, p. 345. Rush: An Inquiry into the Origin of the late Epidemic Fever in Philadelphia. In a Letter to Dr. Redman, President of the College of Physicians. December, 1793. Rush: Observations upon the Origin of the Malignant Bilious Fever in Philadelphia, and upon the Means of preventing it. Addressed to the Citizens of Philadelphia, 1799. 99:2 HISTORY OF yellow fever, Rndi: A Second Address to the Citizens of Philadelphia, containing Additional Proofs of the Domestic Origin of Yellow Fever. 8vo. Philadelphia, 1799. Rush: An Ancient of the Bilious Remitting Yellow Fever, as it ap- peared in the City of Philadelphia in the year 1793. 8vo. Philadelphia, 1794. Rush (B.) : Medical Inquiries and Observations. 4 vols. Phila., 1809, Containing an Essays on the Xon-Contagion of Yellow Fever, and Ac- counts of the Epidemics cf Phila. in 1793, 1794, 1797, 1798, 1799, 1802, 1803, and 1805, and of the Sporadic Cases which occurred in 1795, 1796, 1800, 1801 and 1804. Shaw (Wm.) : Cn the Autumnal Epidemic Fever which prevailed in Philadelphia in 1803. 8vo. Philadelphia, 1804. Stavely (A.) : A statistical history of Yellow Fever in Philadelphia, with a report of two cases recently treated at the Episcopal Hospital. Med. News, Phila., 1891, vol. 58, p. 509. Stuart (Jame3): Dissection of a Body that died of the Yellow Fever at Philadelphia, in the Autumn of 1805, with Practical Observations and Remarks. Medical Museum, vol. 2, p. 299. 993 RHODE ISLAND. BLOCK Ifc^LAND. 1801. First case in April; first death, August 2; last case in December. BRISTOL. 1795; 1790; 1797. Yellow fever years. No statistics. NEWPORT. 180G. Scattered cases. PROVIDENCE. 1791. Infected by a tramp ship which had communi- cated with vessels from West Indies. No statistics. 1795. Deaths, 45. 1796; 1797; 1800. Scattered cases. 1802. Infected by ship Frassana, from New Orleans. 1805. Scattered cases. WESTERLY. 1798 ; 1808. Scattered cases. BIBLIOGRAPHY OF YELLOW FEVER IN RHODE ISLAND. Bancroft: An Essay on Yellow Fever, p. 401. Berenger-Feraud : Fievre Jaune, etc., Paris, 1S90, p.. 81. Bowen (Parden) : Observations on the Origin and Nature of the Yellow Fever which prailed in Providence (R. I.) in the summer of 1805, in a letter to J. Hardie, Secretary of Board of Health of New York. Med. and Philos. Register, vol. 4, p. 331. Bowen (P.): Observations on the Foreign Origin and Contagious Nature of the Yellow Fever as it prevailed in Providence (R. I..), and other parts of the United States, in a letter to Dr. Hosack. Med. and Philos. Register, vol. 4, p. 341. 994 HISTORY OF YELLOW FEVER Brown (M.) : Brief remarks on the origin of yellow fever in some parts of the State of Rhode Island. Med. Reposit., N. Y., 1800, vol. 3, p. 267-270. N. Y. Med. Repository, 1805, p. 267. Snow (E. M.) : History of yellow fever in Providence, in years 1797, 1800, 1803, 1805, 1820. Reprinted from the journal of June, 1857. [Newspaper cutting from Providence Journal, Sept. 23, 1878.] Wheaton (L. J.) : A Brief Account of the Yellow Fever which has appeared at different times in Providence, Rhode Island, with a Topographical Sketch of that town, and some Reflections on the use of Mercury. Medical Repository, vol. 10, p. 329. Willey (A. C.) : A short account of the yellow fever which ap- peared on Block Island, in the summer and autumn of 1801. Ibid., 1803, vol. 4, p. 123. 995 SOUTH CAROLINA. BEAUFORT. 1817. Infected by Charleston. No record of cases and deaths. 1871. First case, August 6. Deaths, 7. CHARLESTON. 1693; 1699; 1700; 1703; 1728; 1732; 1731; 1739; 1745; 1718; 1749; 1753; 1755; 1761; 1762; 1768; 1770; 1792; 1794 ; 1795 ; 1796 ; 1797 ; 1798. Yellow fever years. No authentic statistics. 1799. No record of cases; deaths, 239. 1800. No record of cases; deaths, 184. 1801. Scattered cases. 1802. No record of cases; deaths, 96. 1803. Scattered cases. 1804. No record of cases; deaths, 148, 1805. Scattered cases. 1807. No record of cases; total deaths, 162. 1809 ; 1812. Scattered cases. 1817. First case, July ; last case, November. No record of cases; total deaths, 272. 1819. First case, August; last case, October. No record of cases; total deaths, 177. 1822. First case, June; last case, August. No record of cases, total deaths, 2. 1824. First case, August; first death, August; last case, November. No record of cases; deaths, 235. 1825. First case, August; last case, September. No record of cases; deaths, 2. 1827. First case, August; last case, November. No record of cases; deaths, 64. 1828. First case, August; last case, September. No record of cases; deaths, 26. 1830. First case, September ; last case, November. No record of cases ; deaths, 30. 996 HISTORY OF YELLOW KKVER. 1834. First case, August; last case, October. Xo record of cases; deaths, 49. 1835. First case, August; last case, September. Xo record of cases; deaths, 25. 1838. First case, August; last case, November. Xo record of cases; deaths, 351. 1839. Infected by Burmah, from Havana. First case, June 7 ; first death, June, 8 ; last case, October. Xo record of ca&es; deaths, 131. 1810. First case, August; last case, October. Xo record of cases ; deaths, 22. 1813. First case, Xovembor ; last case, Xovember. Xo record of cases ; deaths, 1. 1819. Infected by ship Xiima, from Havana. First case, August 6 ; last case, X'ovember. Xo record of cases ; deaths, 125. 1852. First case, August; last case, Xovember. X"o record of cases; deaths, 310. 1851. Population, 50,000. Infected by Key West. First case, May 14; first death, August IG; last death, Xovember. Cases, 20,000; deaths, 027. 1856. First case, August; last case, X^ovember. Xo record of cases; deaths, 211. 1857. First case, September; last case, Xovember. X'o record of cases; deaths, 13. 1858. First case, July; last case, December; last death, December 22. X'o record of cases; deaths, 717. 1862. Scattered cases. 1864. First case, July 27 ; no record of cases or deaths. 1871. First case, Julv 10; no record of cases; deaths, 213. 1874. X^o record of cases; deaths, 37. 1875. One fatal case from Savannah. 1876. X^^o record of cases; deaths, 27. 1898. Charleston Quarantine. One death. COLUMBIA. 1854. Xo statistics. SOUTH CAROLINA. 997 FOET MOULTRIE. 1824. Population, 70 soldiers. Cases, 12; no deaths. 1834. Infected by Charleston. Cases, 5; deaths, 2. 1852. First case, September 7. Cases, 33; deaths, 4. 1858. First case, August 15. Xo record of cases and deaths. GEOllGETOWN. 1854. First case, August 20 ; last case, October 28. No record. HILTON HEAD. 1862. First case, September 8; last case, October, 25. Xo record. JAMES ISLAND. 1876. No record of cases ; deaths, 2. MOUNT PLEASANT. 1817; 1848; 1852; 1854; 1856; 1857; 187(5. Yellow fever j^ears. No statistics. PORT ROYAL. 1877. X"o record of cases; deaths, 25. SULLIVAN'S ISLAND. 1876. X'o statistics. BIBLIOGRAPHY OF YELLOW FEVER IN SOUTH CAROLINA. Am. Jl. Med. Sciences, vol. 32, p. 564. Epidemic of 1856.) An Account of the Yellow Fever of Charleston, South Carolina, as it appeared in the year 1817. Philadelphia Medical and Physical Journal, vol. 3, p. 250. Bancroft: Essay on Yellow Fever, pp. 352; 470. Byrd (H. L.): Observations on Yellow Fever. Charleston Medical Journal, vol. 10. p. 329. 998 HISTORY OF YEl.I.OW KKVER. Cain (D. J.) : History cf the Epidemic of Yellow Fever in Charleston, S. C, in 1854. Trans. American Med. Assn., 1856, vol. 9, p. 588. Chalmers: An Accoimt of the Weather and Diseases of South Carolina. 2 vols. 8vo. London, 1776. C'aisolm (J. J.): A brief Sketch of the Epidemic of Yellow Fever of 1854 in Charleston. Charleston Medical Journal and Review, vol. 10, p. 433. Currie: Observations on Dr. Tucker Harris' paper on Yellow Fever of Charleston, Barton's Medical and Phys. Journal, vol. 2, p. 21. De Saussure (H. W.) : Statistics of the cases of Yellow Fever re- ceived into the Almshouse, Charleston, South Carolina, from 1840 to 1843. Charleston Medical Journal, vol. 2, p. 3. 1847. Dickson: Remarks on the Yellow Fever in Charleston, South Caro- lina, in the Summer of 1828. Eclectic Journal, vol. 4, p. 109. Fever (Yellow). Epidemic in Charleston, 1849. Charleston Medical Journal, vol. 4. 1849. Harris (Tucker) : Facts and Observations, chiefly relative to the Yellow Fever, as it has appeared at different times in Charleston, South Carolina. Barton's Med. and Phys. Journal, vol. 2, p. 21. Hayne (A. P.): Notes on Yellow Fever, as it prevailed in Charles- ton during the Summer cf 1849. Charleston Medical Journal, vol. 6, pp. 341, 481, 627; vol. 7, p. 1. Hewitt. History of South Carolina. 2 vols. 8vo. London, 1779. Hume: An Inquiry into some of the General and Local Causes to which the Endemic Origin of Yellow Fever has been attributed by myself and others. Charleston Medical Journal, vol. 9, p. 721. 1854. Hume (Wm.) : Meteorological and other Observations in reference to the cause of Yellow Fever in Charleston, etc. Charleston Med. Jl , vol. 5, p. 1850. Hume (Wm.): On the Introduction, Propagation and Decline af the Yellow Fever in Charleston, during the summer of 1854. Charleston Med. Jl., vol. 10, p. 1855. Hume (Wm.): Report to the City Council of Charleston, relative to the source and origin of Yellow Fever, etc. Charleston Med. Jl., vol. 9, p. 145. Hume (Wm.): Sequel to Meteorological and other Observations in reference to the causes of Yellow Fever in Charleston, brought for- ward to 1852. Charleston Med. Jl., vol. 8, p. 55. Hume (Wm.) : The Yellow Fever of Charleston Considered in its Relation to the West India Commerce. Charleston Med. Jl. and Rev., 1860, vol. 15, p. 1. Also: Reprint. Johnson: Oration delivered before the Medical Society of South Carolina, December 24, 1807. 8vo. Charleston, 1807. SOUTH CAROLINA. 999 Johnson (Joseph) : Some Account of the Origin and Prevention of the Yellow Fever in Charleston, South Carolina. Charleston Medical Journal, vol, 4, p. 154. Legare (Thomas): Dissertion cu the late Yellow Fever in Chaiies- ton. 8vo. 1817. Mackall (R. C): Introduction of Yellow Fever in Savannah in the year 1854. Charleston Med. Jl., vol. 10. p. 150. X. Y. Med. Repository, 1801, vol. 1, p. 217.. (Epidemics of 1700, 1732, 1739, 1745, 1748 and 1792, in Charleston.) N. Y. Med. Repository, 1801, vol. 4, p. 217. (Epidemic of 1800 in Charleston.) Porter (John B.): On the Climate and Salubrity of Fort Moultrie and Sullivan's Island, with Incidental Remarks on the Yellow Fever of the City of Charleston. American Journal of Medical Sciences, July and October, 1854; Ibid., January, April and October, 1855. Ramsay (David): Facts concerning the Yellow Fever at it ap- peared at Charleston, South Carolina, in 1800. Medical Repository, vol. 4, p. 217. Ramsey: Remarks on the Fever of 1807 at Charleston. Medical Repository, vol. 11, p. 233. Ramsay: The Charleston Medical Register for the year 1802. 12mo. Ramsay: The History of South Carolina, etc. 2 vols. 8vo. 1809. Ramsay (W. G.) : Observations on the cases of Yellow Fever re- ceived into the Marine Hospital, Charleston, from July, 1834, to Nov. 1838. Charleston Med. JL, vol. 2, p. 635. Shecut (J. L. E. W.): Medical and Philosophical Essays, etc., con- cerning the Domestic Origin of the Yellow Fever of Charleston, South Carolina. 8vo. Charleston, 1819. Simons: A eRport read before the City Council of Charleston, with an Appendix, in Reply to the Report of Wm. Hume, M. D. Charleston Medical Journal, vol. 9, p. 329. Simons: A Report on the History and Causes of the Stranger's on Yellow Fever of Charleston. Read before the Board of Health. 8vo. Charleston, 1839. Simons: An Address delivered before the South Carolina Medical Association, in May, 1851. 8vo. Charleston, 1851. Simons (T. Y.): An Essay on the Yellow Fever as it has occurred in Charleston, including its Origin and Progress up to the present time. Charleston Med. Jl., vol. 6, p. 798. Simons: Observations in Reply to William Hume, M. D. Charleston Medical Journal, vol. 10, p.. 170. Simons: Observations on the Yellow Fever, as it occurs in Charles- ton, South Carolina. The Carolina Journal, etc., vol. 1, p. 1. 1000 HISTORY OF VKM.OW FEVER, Simons: Reply to the Report of Wm. Hume, M. D. Charleston Med. Jl., vol. 9, p. 329. Strobel: Yellow Fever, etc., p. 171. (Epidemic of 1S39 in Charles- ton.) Strobel: Yellow Fever, etc., p. 219. (Early epidemics in Charleston.) "Waring: A Summary of the Climate and Epidemics of Savannah during the series of years from 1826 to 1829. (This is the Breakbone Fever, which Dr. W. regards as analogous to Yellow Fever.) North American and Surgical Journal, vol. 9, p. 374; vol. 10, p. 136. Waring (J. J.): The epidemic at Savannah, 1876; its causes; the measures of prevention adopted by the municipality during the ad- ministration of Hon. J. F. Wheaton, mayor. Savannah, Ga., 1879. 188 p. 4 pi. 1 may. 8°. Yellow Fever in Charleston in 1838. American Jl. Med. Sciences, 1838, vol. 45, p. 263. 1001 TENNESSEE. BAILEY STATION. 1879. Infected by Memphis. No records of cases and deaths. BAKTLETT. 1878. First case, August 20; last case, October 20; last death, November 8. Cases, 74; deaths, BEACH GKOVE. 1878. One death, a refugee. BELL'S DEPOT. 1878. Cases, 5; deaths, 3. BETHEL SPRINGS. 1878. One death, a refugee. BROWNSVILLE. 1873. Cases, 4 ; no deaths. 1878. Number who fled, 3,000. Infected bv Memphis. First case, August 20 ; first death, September 1 ; last case, October 29 ; last death, November 8. Cases, 747 : deaths, 212. BUNTYN. 1878. Throughout the epidemic of 1878, Buntyn was crowded with ]\[emphis refugees, and the first case of fever occurred October 1st. Among the last cases was that of Jefferson Davis, Jr., son of ex-President Jefferson Davis. He died October Ifith. 1879. Infected by Memphis. Cases, 15; deaths, 3. lOOi HISTORY OK YELLOW FEVER. CHATTANOOGA. 1878. Numbei- wlio tied, (),000. First case, August 15 ; first death, Aui-iist 21 ; last death, November 10. Cases, 44G; deaths, 135. COLLIERSVILLE. 1878. Number who fled, 100. Infected by :N[emphis. First death, August 21. Cases, 135; deaths, 5C. COVINGTON. 1878. Population, 1,200. Almost entire pojjulation fled. No record of cases; deaths, 1. EIUN. 1878. Population, 723. Cases, 38; deaths, 10. FOl^EST HILL. 1879. No statistics. FRAYSER STATION. 1878. No statistics. GADSDEN. 1878. Population, 530. Cases, (5; deaths, 4. GALWAY. 1878. Population, 00. Cases, 13; deaths, 8. GERMANTOWN. 1878. iTifectod b^- :\remphis. First case, August 20. Cases, 89 ; deaths, 35. TENNESSEK. lOOS GILL'S STATION. 1878. No records of cases; deaths, 1. GIJAND JUNCTION. 1873. Cases, 1; deaths, 0. 1878. Number who tied, 100. First case, August 11; first death, August 17. Cases, 185; deaths, 71. HARKISON STATION. 1879. PopuhUiou, 100. Infected by Memphis. Ca^es, 12. HERNANDO ROAD. 1879. Infected b}^ Memphis. Cases, 4. HORN LAKE. 1879. First case, September 11 ; first death, September 14; last case, September — ; last death, September 18. Cases, 3; deaths, 1. HORN LAKE ROAD. 1879. First case, August 20; first death, August 25. Cases, 13; deaths, 5. HU:Mr>OLDT. 1873. Infected bv Mempliis. Cases, 3; deaths, 0. HUNTINGTON. 1873. No record of cases; deaths, 1. JACKSON. 1878. No record of cases ; deaths, 3. KNOXVILLE. 1878. Cases among refugees, principally from Chat- tanooga. loot HISTORY OF YELLOW P'KVER. LA GRANGE. 1878. First case, September 3; first death, September G. Cases, 128; deaths, 37. MAKTIN. 1878. Number who fled, 250; first case, August 28. No record of cases; deaths, 40. MASON. 1878. First case, August 29 ; first death, September 2. Cases, 61; deaths, 21. McCALLUM FARM. 1879. No statistics. McKENZIE. 1878. No record of cases; deaths, 3. ME:MPnis. 1828 : 1853 ; 1855 ; 1860. No statistics. ■.1867. No record of cases; deaths, 231. 1873. Infected by Cochran, Alabama. First case, September 14; last case, November. Cases, 10,000; deaths, 2,000. 1878. Number who fled, 30,000. Infected by New Orleans. First case, August 6; last case, December 12. Cases, 18,500 ; deaths, 5,000. 1879. Population, 40,000. Numbei' who fled, 23,890. First case. May 23; first death. May 26. Cases, 2,010; deaths, 587. 1897. Cases, 52; deaths, 14. TENNESSEE. 1005 MILAN. 1878. Number who fled, 1,800. Infected by Memphis. First case, August 26; first death, August 29.Cases, 19; deaths, 12. MOSCOW. 1878. Number who fled, 70. Infected by Memphis. First case, August 21. Cases, 109; deaths, 35, MUKFKEESBORO. 1878. No record of cases ; deaths, 2. NASHVILLE. 1878. Infected by Memphis. First case, August 3L Cases, 27 ; deaths, 13. NUBIA. 1878. Cases, 2 ; deaths, 2. PAHIS AND SUBURBS. 1878. Nearly the whole population fled. Infected by Memphis. First case, August 23; last case. October 4. Cases, 35; deaths, 23. PIGEON ROOST ROAD. 1879. No record. RALEIGH. 1878. No record of cases; deaths, 14. ROSSVILLE. 1878. No record of cases ; deaths, 6. 1006 HISTORY OF \ELLO\V KF.VER. SHELBY DEPOT. 1873. No record of cases ; deaths, 3. SHELBYVILLE. 1879. lufected by Memphis. Xo record of cases; deaths, 1. SOMEBVILLE. 1878. yuml)er who fled, (I.jO. Infected \>\ Memphis. Cases, 167; deaths, 57. TULLAHOMA. 1879. One fatal case in August, from ShelbTville. UXIOX CITY. 1878. Xo record of cases; deaths, 1. VICE-PEESIDEXT'8 ISLAXD. 1879. InfiM-ted liv Minipliis. First and only case, October 8; died October 13. WHITE HAVEX. 1878. Population, 100. Cases, 1; deaths, 2. WHITE STATIOX. 1878. Infected by Memphis. First case, Auj;ust 25; first death, Auijust 28. Cases, 05; deaths, 50. 1879. Infected bj Memphis. First case, October 6. Cases, 1; deaths, 0. WTLLTSTOX. 1878. Cases, 18; deaths, 11. TENNRSSEE. 1007 WINCHESTEE. 187S. Cases, 1; deaths, 1. WYTHE. 1873. Infected by ]Mempliis. Cases, G ; deaths, 0. 1878. Xo record of cases; deaths, 1. BIBLIOGRAPHY OF YELLOW FEVER IN TENNESSEE. Am. Jl. Med. Sciences, 1856, p. 624. (Memphis, 1828.) Baxter (G. A.): Atmospheric dissemination of yellow fever, with methods of disenfections used at Chattanooga, and the results. Tr. M. Soc. Tenn., 1879, vol. 46, p. 158. Bougarel (C): La Fievre Jaune a Memphis. France Medicale, Paris~, 1879, vol. 26, pp. 533, 573 and 589. Cochran (J. F.): Observations on yellow fever in Bartlett, Tenn. Richmond and Louisville M. J., Louisville, 1879, vol. 27, p. 1. Dake (J. P.) : The yellow fever of Memphis. (From, Nashville Daily American). Med. Counselor, Chic, 1879-80, vol. 2, p. 16. Dowell, p. 32. (Memphis, 1873). Ernskine (J. H.): A Report on Yellow Fever as it Appeared in Memphis, Tenn., in 1873. Reports American Public Health Assn., 1873, vol. 1, p. 386. Hamilton (F. B): Quarantine in Jackson, Tenn. Nashville J. M. & S., 1879, n. s., vol. 23, p. 53. Keating (J. M.) : A history of the yellow fever. The yellow fever epidemic of 1878, in Memphis, Tenn., embracing a complete list of the dead, the names of the doctors and nurses employed, names of all who contributed money or means, and the names and history of the Howards, together with the other data and lists of the dead elsewhere. Memphis. 1879. 454 p. roy. 8°. Le Monnier (Y. R.): Epidemic of Memphis in 1873. N. O. Med. & Surg. .Jl., vol. 1, n. s., 1873-4, pp. 449, 536, 656. Letter from Memphis. Boston Med. & Surg. JL, vol. 101, p. 388. Merrill (A. P.): On the Health and Mortality of Memphis, Tennes- see. A. Public Address, etc. 8vo. Memphis, 1853. Saunders (D. D.): Observations on the five yellow fever epidemics occurring in the city of Memphis. Tennessee. Tr. M. Soc. Tennessee, Nashville, 1882, p.. 62. Saunders (D. D.) : Epidemic of Memphis in 1873. N. O. Med. & Surg. Jl., 1873-4, vol. 1, n. s., p. 791. 1008 HISTORY OF YELLOW FKVKR. Smith (George and Tuck (W. J.): Letters on the Yellow Fever at Memphis, Tennessee, in 1853. New Orleans Medical Journal, vol. 10, p. 662. Smith (G.) and Tuck (W. J.) : Letters on the Yellow Fever of Mem- phis, Tenn., in 1853. N. O. Med. Jl., vol. 10, p. 662. Thorton (G. B.) : The Memphis yellow fever epidemic of 1879. Boston Med. and Surg. JL, 1879, vol. 101, p. 787. Vanderman (J. H.): Yellow fever in Chattanooga in 1878. Nash- ville J. M. & S., 1879, n. s., vol. 24, p. 47. Wight (E. M.) : Yellow fever at Chattanooga in 1878; topographic, telluric, atmospheric and other influences. Tr. M. Soc, Tenn., 1879, vol. 46, p. 161. 1009 TEXAS. ALLEYTON. 1867. First ease, September 4; last case, December. ]No record of cases; deaths, 45. ANDEKSON. 1867. No record. AUSTIN. 1867. No record. BASTROP. 1867. No record. BEAUMONT. 1863. No record. 1897. Cases, 1; deaths, 0. BELLEVILLE. 1855. No record of cases; deaths, L BRAZOBIA. 1859. No record. BROWNSVILLE. 1853. First case, September 23; last case, December 23. No record of cases ; deaths, 50. 1862. No record. 1879. No record. 1882. Population, 4,500. First case, June 24: first death, —; last case, November 10; last death, November 6. Cases, 1,072 ; deaths, 63. 1010 HISTORY OF YELLOW FEVER. BRENHAM. 18G7. First case, August 11; last case, October 31. No record of cases; deaths, 120. CALVERT. 1SG7. First case, October 12; last case, January 10, 1868. No record ol" cases or deaths. 1873. Population, 1,500. Number who fled, 900. In- fected by Shreveport, La. First case, September 5; first death, September 10; last death, December 29. Cases, 450; deaths, 125. CAMEL. 1903. Cases, 28; deaths, 1. CINCINNATI. 1853. No record. CHAPEL HILL. 1807. First case, August 8 ; last case, December. No record of cases; deaths, 123. COLUMBIA. 1833 ; 1873 ; 1903. No statistics. CORPUS CHRTSTI. 1853. No record. 1854. Population, 1,000. Infected by New Orleans. No record of cases; deaths, 30. 1862. No record. 1867. Infected by Indianola, Texas. First case, Au- gust. No record of cases or deaths. 1873. No record. TEXAS. I I 1 1882. (Eefuge Camp). First case, August 23; first death, August 25; last ease, August 23; last deatb, August 25. Cases, 4; deaths, 2. 1903. No record. CORSICANA. 1873. No record. CASTEOVILLE. 1903. Cases, 1. CYPRESS BAY. 1853; 1859. No statistics. DANVILLE. 1867. No record. DE WITT COUNTY. 1903. Cases, 5; deaths, 1. EDINBURG. 1859. First case, July. No record of cases ; deaths, 13. GALVESTON. 1839. Population, 1,000. First case, September 30; last case, October 11. No record of cases; deaths, 250. 1844. Population, G,000. First case, July 5. No No record of cases; deaths, 400. 1847. Population, 0,000. First case, October 1; last case, November 25. No record of cases; deaths, 200. 1853. Population, 8,000. First case, August 30; last case, November 28. No record of cases; deaths, 536. 1854. First case, August 9 ; last case, November 5. No record of cases ; deaths, 404. 1012 HISTORY OK YELLOW FKVER. 1858. Population, 10,000. First case, August 27 ; last case, iNovember 14. JS'o record of cases; deaths, 873. 1850. Population, 10,000. First case, (September 17; last case, iS'ovember 30. No record of cases; deaths, 183. 1864. Population, 5,000. First case, {September 1; last case, Kovember 20. Xo record of cases ; deaths, 259. 1866. Population, 12,000. No record of cases; deaths, 3. 1867. Population, 22,000. First case, June 26; last case, November. No record of cases; deaths, 1,150. 1870. Population, 22,500. No record of cases ; deaths, 16. 1873. Population, 25,000. No record of cases; deaths, 7. 1882. No statistics. 1894. No record. On vessel in harbor. 1895. No record. On vessel in harbor. 1897. Cases, 12; deaths, 0. On vessel, 1905. One case, on vessel in harbor. GOLIAD. 1867. First case, July 12. No record of cases; deaths, 23. HARRISBURG JUNCTION. 1867. No record. HEMPSTEAD. 1867. First case, Auniist 0: last case, November 25. No record of cases; deaths, 151. HOCKLEY. 1853. No record. HONDO. 1903. One case, a refugee. TEXAS. 1013 HOUSTON. 1839 ; 1844 ; 1847 ; 1848. No statistics. 1853. Population, 7,000. First case, August 28; first death, September 4. No record of cases and deaths. 1854; 1858; 1859; 18(54. No statistics. 1870. No record of cases ; deaths, 1. 1897. Cases, 3; deaths, 0. Refugees. HUNTSVILLE. 1868. First case, August 9 ; hist case, October 19. No record of cases; deaths, 130. INDEPENDENCE. 1867. No record. INDIANOLA. 1852. No record. 1853. PopuLation, 1,000. Infected by New Orleans. First case, August. 30. No record of cases; deaths, 106. 1858 ; 1859 ; 1862. No statistics. 1867. Infected by ship Margarita from Vera Cruz. First case, June 20. No record of cases ; deaths, 80. LA GRANGE. 1867. First case, August ; last ca»*^e, December. No record of cases; deaths, 200. LAREDO. 1903. Cases, 1.008; deaths, 107. 1904. Cases, 10. LIBERTY. 1867. No record. 1014 HISTORY OF YELLOW FEVER. LIVEKPOOL. 1853. First case, August. Xo record of cnscs; deaths, 4. LYNCHBUEG. 1853. Scattered cases. Xo statistics. MATAGORDA. 1862. X'o record of cases; deaths, 120. 1803. X"o record. MILLICAN. 1864. X^o record. 1867. First case, October 15; last case, X'ovemher 12. No record of cases; deaths, 4. MIXERA. 1903. Cases, 137; deaths, 16. XAVA80TA. 1867. First case, August 12 ; last case, December. Xo record of cases; deatlis, 154. OLDTOWX. 1867. Xo record. PALARYAXA. 1882. Infected by Point Isabel, Texas. Cases, 18; deaths, 2. POIXT ISABEL. 1853. Xo record. 1882. First case, August 29. Cases, 208. PORT LAVACA. 1867. First case, July 3; last case, October 29. Xo record of cases or deaths. TEXAS. 1015 KICHMOND. 1853; 1859. No record. RIO GRANDE CITY. 1867. Xo record. SABINE CITY. 1853. Population, 200. First case, July; last case, October 1. No record of cases ; deaths, 11. 1863. First case, July; last case, October 1. No record of cases; deaths, 14. SALINA. 1853. No record. SALUVIA. 1853. No record. SAN ANTONIO. 1903. Cases, 43; deaths, 16. SAN JACINTO. (See Lynchburg). SANTA MARIA. 1882. First case, October 24; first death, October 29. Cases, 3; deaths, 0. SUGARLAND. 1859. No record. VELASCO. 1853. Infected by New Orleans. No record. VICTORIA. 1867. First case, Anjjust 1 ; last case, December 25. No record of cases; deaths, 200. 1016 HISTORY OK VEI.I.OW FEVER. BIBLIOGRAPHY OF YELLOW FEVER IN TEXAS. Bowers (J. M.): The yellow fever epidemic at Columbus, Tex., October, 1873. Letter to Dr. C. O. Weller. Texas Med. Jl., Austin, 1903, p. 164, vol. 19. Dinwiddie (R. L.) : Yellow fever; the Laredo epidemic. Tr. Texas M. Assn., Austin, 1904, vol. 36, p. 140. Goldberger: Transactions on account of the yellow fever at Laredo, Tex. Pub. Health Rep. U. S. Mar. Hosp. Serv., Wash., 1904, vol. 19, p. 962. Guiteras (G. M.): Report on the epidemic of yellow fever of 1903, at Laredo, Minera, and Cannel, Texas. Rep. Surg.-Gen. Pub. Health & Mar. Hosp. Serv., U. S. Wash., 1904, p. 303. Guiteras (G. M.) : The yellow fever epidemic of 1903 at Laredo, Tex. J. Am. M. Assn., Chicago, 1904, vol. 43, p. 115. Harrison (R. H.) : Yellow Fever Reports. Texas Med. News, Austin, 1896-7, vol. 6, p. 490. Heard (T. J.) : On the Topography, Diseases and Climate of Wash- ington, Texas. Trans Amer. Med. Assn., 1856, vol. 9, p. 690. McCraven (W.): On the Yellow Fever of Houston, Tex., in 1847. N.O. Med. and Surg. Jl., vol. 5, 1848-9, p. 227. Parker (D.) : Facts and Conclusions in Regard to the Calvert Epidemic of 1873. Trans. Tex. Med. Assn., 1878, vol. 10, p. 164. Purnell (J, H.): Report of conditions existing in San Antonio, Tex., and vicinity with relation to preventing spread of yellow fever. Pub. Health Rep. U. S. Mar. Hosp. Serv.. Wash., 1903, vol. 17, p. 1768. Purnell (J. H.) : Transactions on account of yellow fever at Laredo, Tex. Pub. Health Rep. U. S. Mar. Hosp. Serv., Wash., 1904. vol. 19, p. 715. Reuss (J. M.) : An outbreak of yellow in DeWitt County. Tr. Texas M. Assn., Austin, 1904, vol. 36, p. 135. Richardson (T. F.): Yellow Fever in DeWitt Co. (Texas). U. S. Public Health Reports, 1903, vol. 17, p. 1925. Smith: An Account of the Yellow Fever which appeared in the City of Galveston, Republic of Texas, in the Autumn of 1838, with Cases and Dissections. 12mo. Galveston, 1839. Smith (A.) : Med. Topography of the City of Galveston, Tex., with an Account of the Symptoms and Pathology of the Yellow Fever which prevailed in that City in the Autumn of 1839. Amer. Jl. of Med. Scien., vol. 25, p. 499. Smith (Ashbel). Yellow Fever of Houston, Texas, in 1853. See Fenner's Report, vol. 7, of the Transactions of the American Medical Association, p. 530. TEXAS. 1017 Fenner (E. D.) : On the Yellow Fever of Norfolk and Portsmouth. Va. Trans. American Med. Assn., 1856, vol. 9, p. 711. Hazen (C. M.): Yellow fever in Virginia. Med. Reg. Richmond, 1899-1900, vol. 3, p. 137. Koiner (A. Z.) : The case of (transported) yellow fever in Rich- mond. Virginia M. Month., Richmond, 1878, vol. 5, p. 668. Mitchell: Additional Observations on the Yellow Fever of Virginia, addressed to Dr. Franklin. American Medical and Philosophical Register, vol. 4, p. 383. Mitchell John) : Letter to Governor Golden, containing an Account of the Yellow Fever as it appeared in Virginia in 1737, 1741, 1742. Medical Museum, vol. 1, p. 1. See also Medical and Philosophical Register of New York, vol. 4, p.. 181. Tabor (G. R.): The 1903 epidemic of yellow fever in Texas, and the lesson to be learned from it. Austin, 1905, 22p. 8°. Forms No. 64, of Bull. Univ. Tex. Med. Series No. 3. Thayer (A. E.) : Study of a case of yellow fever. (Galveston, 1905.) Med. Rec, N. Y., 1907, vol. 71, p. 45. Wassam (A. M.): The recent yellow fever scare in Southwest Texas. Southern Clinic, Richmond, 1898, vol. 21, p.. 33. West (H. A.): Yellow Fever in Galveston. Phila. Med. Jl., 1898, vol. 1, p. 685. 1018 VIRGINIA. ABINGDON. 187S. First and only case was Judge L. V. Dixon, a refugee from Memphis, who died September 17. ALEXANDRIA. 179G. No statistics. BELLONA ARSENAL. 1S29. No record of cases ; deaths, 1. BOWER'S HILL. 1855. Infected by steamer Ben Franlcliii from St. Thomas, West Indies. First case, Julv; first death, Au- gust; last case, July; last death, — . Cases, 2; deaths, 2. CAPE CHARLES QI\\RANTINE. 1893. Cases, 3. 1894. No record of cases; deaths, 2. 1897. No record. 1898. Cases, 2; deaths, 1. CAPE HENRY. 1894. Cases, 3. CITY POINT. 1798. No record. FORTRESS :\rONROE. 1888. Infected by Spanish bark, Bucuavriifiira, from Havnnn. One case, Octoher 26, terminating in death on the 27th. VIRGINIA. 1019 GOSPORT. 1855. No record. HAMPTON ROADS. 1809. Xo record. 1883. Infected bv vessels. No record of cases or deaths. 1899. At National Soldiers' Home. Source of infec- tion undetermined, but ''an old soldier/' who had recently arrived from Santiago de Cuba and was taken ill at the Home, thought to have been original focus. First case died July 28. Depopulation resorted to by U. S. Marine Hospital authorities, with such good results, that out of the 3,500 inmates of the Home, only 45 contracted the fever, ^lortality 13. Last death, August 7. Only one case occurred outside of the above limits, name- ly, in the town of Phoebus, directly "across the creek" from Hampton, the source of infection being plainly traced to the Home, NORFOLK. 1737; 1711; 1742; 1747; 1789; 1794; 1795; 1796; 1797; 1798 ; 1799 ; 1800 ; 1801 ; 1802 ; 1803 ; 1804 ; 1805. Yellow fever years. No statistics. 1821. First case, August 1. No record of cases or deaths. 1825; 1826. No statistics. 1848. Infected by Vandalia. Cases, 2; deaths, 0. 1852. Cases, 3 ; deaths, 3. 1854. No statistics. 1855. First case, June 30; last case, October. No record of cases; deaths, 1,807. Infected by Bcii Fraiil-Uii, St. Thomas, West Indies. 1878. No record of cases; deaths, 1. PETERSBURG. 1798. No statistics. 10^0 HISTORY OF YELLOW FEVKR. PHOEBUS. 1899. Cases, 1 ; deaths, 0. PORTSMOUTH. 1834. One death. 1852. Cases, 4; deaths, 4. 1854. Infected by French ship, Chimcre, from T\'est Indies, Cases, 7; deaths, 2. 1855. Infected br Norfolk. No complete statistics. RICHMOND. 1806. No statistics. 1878. One case, a refugee. SCOTT'S CREEK. 1855. No statistics. WINCHESTER. 1802; 1803. Scattered cases. No statistics. 1804. First case in July. No record of cases and deaths. 1871. One fatal case. BIBLIOGRAPHY OF YELLOW FEVER IN VIRGINIA. Acher (Robert): History of the Yellow Fever, as it appeared at Norfolk during the summer and autumn of 1821. Medical Recorder, vol. 5, p. 60. Armstrong (G. D.) : The summer of the pestilence. A history of the ravages of the yellow fever in Norfolk, Va., A. D. 1855. 12°. Phila.. 1856. Colden: Observations on the Yellow Fever of Virginia, with some Remarks on Dr. J. Mitchell's account of the Disease. In a Letter to Dr. J. Mitchell, of Virginia. Medical and Philosophical Register, vol. 4, p. 378. Donaldson (F.) : Yellow Fever at Hampton, Va. Medical News, 1899, vol. 75, p. 240. VIRGINIA. 1021 Ramsay (W. G., of Norfolk, Va.): Letter to Dr. Mitchell concerning the Pestilential Sickness in Norfolk in the summer and autumn of 1795. Webster's Collection, p. 154. Report of the origin of the yellow fever in Norfolk during the summer of 1855. Made to city council by a committee of physicians. 8°. Richmond, 1857. Selden and Whitehead: On the Yellow Fever at Norfolk, Virginia, in the Summer and Autumn of 1800. Medical Repository, vol. 4, p. 320; Ibid., vol. 6, p. 247. Stephenson (F. B.) : Yellow fever at Norfolk, and Portsmouth, Va , in 1855. Proc. Nav. Med. Sec, Wash., 1882-3, vol. 1, p. 84. Storrs (R. S., Jr.): Terrors of the pestilence; a sermon, preached in the church of the Pilgrims, Brooklyn, N. Y., on occasion of a col- lection in aid of the sufferers at Norfolk, Va., September 30, 1855. 8°. New York, 1855. Yellow fever in the National Soldiers Home, near Hampton, Va. Pub..^ Health eRp. U. S. Mar. Hosp. Serv., Wash., 1899, vol. 14, pp. 1253, 1309, 1359. 1022 VERMONT. GKAKD ISLE. 1789. Condie and Folwell (p. 98), state that yellow fever caused "considerable mortality in Grand Isle in 1798." Source of infection not stated. EOYALTON. 1798. Epidemic (Condie and Fohvell, loc. cit.) Xo statistics. WINDSOR. 1798. The same authorities state "a similar fever" pre- vailed at Windsor in 1798. No statistics. BIBLIOGRAPHY OF YELLOW FEVER IN VERMONT. Condie and Folwell: History of the Pestilence commonly called Yellow Fever, which almost desolated Philadelphia in the months of August, September and October, 1798. Philadelphia (no date), pp. 97, 98. 1023 WASHINGTON. PORT TOWNSEND QUARANTINE. 1S97; 1902. Infected vessels from South American ports. No cases erupted at Quarantine or in the city. BIBLIOGRAPHY OF YELLOW FEVER IN WASHINGTON. U. S. Public Health Reports, 1897, p. 1041. Ibid., 1902, p. 2539. 1024 WEST VIRGINIA AVHEELIXG. 1878. One ease, a refugee. PART IV. YELL.OW FEVER EPIDEMIC OF 1905. I EXPERIENCES DUKINd THE YELLOW FEVER EPIDEMIC OF 1905. By Henry Dickson Bkuns, ^L D., XE^v Orleans, La. As "all experience is au areli where tliro' i>leaiiis the imtraveird world," and as no faithful account of any portion of a j^reat event by an eyewitness can be wholly useless or uninteresting", I have decided to offer you these notes of my experience during the epidemic of 1905 — the more as I was engaged not as a practitioner, l)ut as a volunteer sanitary lab()rer, l)ut seeing and acting always from the viewpoint of the medical man. You all know how the summer of 1905 wore uneventfully along, until the latter part of July, when a sudden "slump" in stocks set all male gossips agog seeking an explanation. You recall how, in casting about to finance the immediately necessary sanitary work, our health officers called to- gether the representatives of the associated banks and made known to them the secret, and how, like all secrets communicated to more than one person, it soon became the common property of the town. On July the 21st the news reached my ears ; on Thursday, the 25th, it was un- obtrusively i)ublislicd in the newspapers. That night I received a note asking nu' to meet certain neighbors on the evening of the 2Cth in the basement of Trinity Church. Those invited all lived in the middle portion of the Tenth Ward, and the me(4ing, it was w(^ll understood, was to devise means to place our immediate surroundings in the best possible sanitarj-^ condition with the least possible waste of time. The Tenth Ward (tf New Orleans, you must know, runs from the river to the swam]), and from Felicity to First Streets. ^leetings of citizens had already been called and volunteer work had already liegun in sev- eral of the other wards. ]\eporting at the designated time and i)lace, I found present the Rev. Beverley Warner, the signer of the call ; Dr. Joseph Holt, ^Messrs, Hunt and William Henderson, 1028 angustin's history of yellow fever. ]\rr, Hewes Gnrlev, ^Ir. George Leverieh, Capt. Robert Perriu, Messrs. Charles and Arthur Palfrey-, Capt. I. L. Lyons, Mr. Eobert B. Parker, Dr. G. King Logan, Mr. Harrj Charles, Mr. George Allaiu, Dr. Allan Eustis, Dr. L. G. LeBeuf and Mr. Hoffman. With little ado the meeting was organized by calling me to the chair. Without debate it was decided that the first thing to be done to comliat inyasion of our neighbor- hood b}- the feyer was to make our cisterns impossible to the stegomyiae as breeding places. To do this, according to the scientific knowledge of the day, it would be neces- sary to oil them (pour upon the surface of the water a small quantity of coal oil) and next to coyer their tops in such a way that no opening larger than one-sixteenth of of inch square should remain unclosed. Secondly, that all premises should be frequently inspected and all stand- ing water poured out, drained away or oiled, and all cess- pools, and priyy yaults cleansed and oiled not less than once a week. Primarily our efforts were to be directed to covering (''screening'' was the Ayord uniyers-ally adopted) as rapidly as might be consistent with thorough- ness, our employees endeayoring to extc^nd their useful- ness by warning and instructing householders as to the need and the mode of cleansing and keeping their premises so as to make them inhos])itable to the mosquito. As a matter of course, money would be at once needed, and the chair was authorized to ap])oint a finance and other necessary committees. He was also asked to be- come the organizer and diiector of the work. I accepted on the express condition that I should haye absolutely nothing to do Ayith the raising or handling of the funds. The condition being agreed to, haying no faith in the per- formance of large committees — especially where time is a consideration — I appointed ^Ir. Hunt Henderson chair- man of the Finance Committee, with power to appoint other members if he chose, and Dr. Jos, cf which an unexpended balance of |234 was, by mutual agreement, turned over to the Bev. Beverley Warner, superintendent of volunteer ward organizations, and was by him covered into the general fund raised by the citi- zens in fulfillment of their promise to the United States Public Health and ^Marine Hospital Service; so that our work cost us almost |33 for each of the thirty-eight blocks worked over. Save in emergencies, nearly all suppli<^s were lirought througli a purchasing agent, a ])osition which Mr. Hewes Gurley kindly volunteered to fill. Tin- approved bills were paid by our treasurer. He also paid the weekly clerical and labor payrolls ])i'e])ared by our office force, so that every bill ])assed throiigli at bast two hands and no question as to the misapplication of a cent could possibly arise. The final statement already referred to contains many interesting data as to the amount -ot matei'ial consumed in protecting tlie tliirty-( iglit rather thinly-built-up blocks in the area of work, For instance, we used no less than 200 pounds of bill posters' tacks, 41 hammers, 28 ])airs of shears, 58 l)alls of twine, 3 dozen sacking needles, (> gross of large safety i)ins and IT ex- tension ladders, besides many one and tw(:-i»:allon oil cans, several large and small tin funnels, barrel faucets, scratch ])ads and bill files. All these not consumed in service PERSONAL EXPERIENCES, 1905 HRUNS. 1031 we turned over to the Public Health and Marine Hospital Service officer in charge of the ward on the completion of our work. Seven barrels of oil Avere given us by the Gen- eral Citizens' Committee; of which we used four and re- turned over three to the Public Health and Marine Hos- pital Service Acting Assistant Surgeon. Unfortunately no exact idea of the amount of cloth consumed can be arrived at, because a large quantity of cotton cloth of excellent quality was given us by the ^Nlaginnis Cotton Mills, and because, until we had finished "screening'' and were engaged only in inspecting and repairing, all other cloth was purchased and presented to us by Mr. Kobert Parker. That, during the work of inspection and repair alone, we found it necessary to use no less than 1,034 2-3 yards at a cost of |38.82 faintly indicates the great quan- tity consumed. Another donation, six barrels of creosote, given us by ]Mr, Sylvester Labrot, Avas experimented with in treating gutters, both stagnant and flowing. It was found very useful, for its specific gravity being high it sinks and continues for a long time to produce an oily film upon the surface of the Avater. On this account, and by reason of its antiseptic and deodorizing properties aiso, a half and half mixture Avith coal oil Avas found to be the best material for treating privy- vaults (Dr. Samuel Logan, Acting Assistant Surgeon, Public Health and Marine Hospital Service) and exposed pools, from the sur- face of Avhich coal oil scum quickly cA^aporates. Our first day, July 27, Avas mainly occupied in finding proper foremen, but Avork Avas begun. From the start Ave determined to send out no Avorkmen except under trustAvorthy and intelligent foremen, and Ave Avere for- tunate in obtaining men. A few were secured on July 27, and the others in the next day or tAVO. They Avere: L. Mitchell, E. F. Salerno, C. P. May and K. i\ Finlay, under-graduates of Tulane ]Nredical Dei)artment; C. J. Chapotin, C. Kubel, A. M. Warner, George I^])ton and the Pev. George Summey, editor of the "Southwestern Presbyterian,-' a volunteer. The course of Dr. Sunnney cannot be too highly praised. Quietly, Avithout in any Avay seeking notoriety, he abandoned his i)rofessional and 1032 augi:stin's history of yellow fever. editorial labors and devoted his whole time to working; as an oiling and screening foreman. The Avisdom of secur- ing entirely competent foremen before putting any laborers in the field became more and more apparent as we went on. Not only were the men kept steadily at work and all questions of "soldiering-' eliminated, but great loss of time in getting to work in the morning, in keeping well provided with material and in deciding promptly upon the correct solution of many difficult little mechanical problems of thorough cistern covering, which frequently arose, were prevented. These foremen rapidly got together a highly efficient l)ody of workmen, as they were given full i)ower to employ and discharge, and the lazy or incompetent were soon weeded out. Indeed, fail- ure to secure the right kind of foremen and to grant them these powers, together with the intrusion of political in- fluences which insisted upon the employment of dwellers in a ward upon work in that ward, regardless of fitness or sobriety, often forcing the retention of men, drunken, inept or incompetent, seemed the chief source of wasteful expenditure and inefficient work which I observed in some parts of the city. Our foremen and clerks (except the volunteers) received two dollars a day, and our laborers one dollar and fifty cents. The largest number of laborers employed was seventy-five and the smallest, six. Our highest weekly payroll was |502.15, and the lowest, $(iC).~o. The opportunity to earn this money at the height of the dull summer season and during a time of epidemic was a godsend to a large number of men, some middle-aged with dependent families, but the largest number young and single. Tlie (piality of lal)or we were able to engage was quite extraordinary, consisting of clerks and minor railroad employees of every kind, factory hands, mechanics, etc. — all men of intelligence and en- ergy. ]Mauy were young fellows who had come here during the prosperous winter, obtained work, been dis- charged when quarantine confined the business of the city, and who Avere thus enabled not only to support them- selves, but to lay aside enough to pay for transportation to other, and for the time more favorable, fields of PERSONAL EXPEIENCES, 1905 BRUNS. 103S employment. The s^ame was true, of eoiirse, throTitjjliout tlie city, and the money put into ciieulation in the execu- tion of sanitary work and for material was instrumental in conyerting Ayliat must otherwise have been a season of poverty and privation to the masses into one of compar- ative prosperity and comfort. AMiat a contrast to' the old days, when under a. visitation of the yellow plague there was nothing to be done but to sit . still, to suffer and to die! How often is wisdom not only justified of her children, but of her collateral descendants! We began work knowing that wire gauze was ue ob- tainable in the city and that our scieening must be done with cloth. We made use of three (jualities, being always glad to use what we could get, and generally 1;( ing unable to choose what we would take. One was a good cheese- cloth heavy enough to be used in single thickness; another, a much more sleasy material, requiring to be doubled to be of sufficient strength, and the third, the material given by the Maginnis JMills, good heavy coarse sheeting and good light duck. This we found far and away the lieyt, and our expen'ience led us to believe it morc^ suited even to permanent work than wire gauze because, being more pliable, it can be more exactly apjilied to the closing of minute cracks by the average workman, and, if well painted over, it must prove more durable, for every variety, save the very expensive true bronze-wire gauze-, rapidly corrodes. Our first day's experience showed that, b(^«:ides th.e ob- viously necessary barrels of coal oil and the extension ladders, five and two gallon oil cans, tin funnels, barrel spigots, hammers and tacks, shears, sacking needles and twine, and large safety pins were needed for cutting and fastening the cloth. Our men tried, but (piickly rejected one after the other, all the suggest(>d oiling devices, from bottles tied to poles to tin cans which ojjened wIku pressed upon the cistern rim.- Some of these were found difficult and time-consuming to fill, others c(!uld n< t be introduced behind the overhanging eaves of certain types of cisterns, Avhile still others were more likely to shower their contents upon the heads of the users tlian within 1034 ArGusTix's history of ykllow fever. tlu* cisterns to he oiled. They were all superseded by a ladder and a commou pint or uarded by pasteboard, as they held the cloth better and could be more rapidly used. To supply these needs we asked the assistance of the ladies of the neiiihljorhocd, and in a day of two they furnished us with more than two dozen carpenters' aprons of cheap ticking- and no end of pasteboard cut into squares of about one inch. The whole leisure time of our office force and of all our visitors was spent in pushing- tacks throui2;h these pasteboard squares, l)ut dnrinji' the height of the work the demand exceeded this supply, and we were f)bliged to engage two small boys at a quarter of a dollar a day. The speed developed by these- little professionals, their rivalry and their devic(^^ for facilitating their work afforded us all much amusement. Early experience showed the best working unit to be a foreman and two laborers for an oiling gang, and three laborers for a screening gang. In the oiling gang this allowed two laborers to carry the extension ladder, their bottles and a two-gallon oil can each, while the foreman usually carried an extra oil can. In the screening gang, two lal)orers, if the cistern wore large, worked on the ladders, while the thii-d and foreman, who directed the ■^ijork, assisted in moving the ladders, handing up the material, helping to diajie the cloth, etc. If the cisterns •were small two of the lal)orers worked at one and the foreman and the remaining man at another. Toward the beginning of the second week many of our foremen were able to work two or even three gangs of three men each upon the cisterns of contiguous ]»rop(Tties; l)ut the reit- erated instructions to all were thoroughness and diligence, but no more speed than was compatible with efficient work. The route from premise to premise was usually PERSONAL EXPERIENCES, 1905 BRUNS. 1035 by means of their laddc^is ovei- back fences. Tims unoc- cupied premises were reached as rapidly as occupied ones, and the front streets, as a rule, presented no evidence of the presence of the workers. Occasictnally a ladder or a big oil can standing- by a front fence, a wagon cloth and laddor laden, its sleepy driver lolled upon the seat, its hang-dog-looking mule somnambulistically stamping flies beneath the torrid sun, would serve to guide the executive who wished to drop in unawares to see how his men were getting on. Two wagons- were used during the whole of our work, save for the last few days of reinspection. One Avas furnished by Mr. Eobert Parker, tlu^ diriver being paid by us; the other, together Avith its driver, was sup- plied bA' the Messrs. Henderson. During the first days they hauled the oil l)arrels and dei)c:>ited them in the yards of obliging citizens at convenient points throughout the distinct ; they carried fresh supplies to the oiling gangs as the contents of their cans were used up; and, on morn« ings when oiling was to be begun at a distance from headquarters, they carried the men, their ladcbrs and their oil to the starting point. After the first five days, when oiling had been completed and the oil barrels had been hauled back to head(|uarters, they hauled the ladders and material to the starting ])oints every morning, and were fairly busy all day hauling extra material or trans- porting gangs, which had comi)leted one block, to a new one. When not emi)loyed they reported to headcpiarters and remained in its immediate vicinity leady to be dis- patched on any errand. Our office force, composed of Dr. O. King Logan, Cap- tain T^obert Perrin (volunteer), Mr. C. i\ Waterman, Mr. George Leverich and Dr. J. D. Weis (volunteer), soon had everything systematized and working with machine-like smoothness. Our day's work began at 7 a. m., and at that hour of each sunnner's morning I found one or two members of the office force, the foreman and their gangs, and the two wagons ass( lubled befo.ie the basement of Trinity Church. The doors were unlocked, the hiig gates of the yard swung o]ien, and a scene of orderly haste and bustle began. Tlie uauiis loaded their 1036 augistin's history of yellow keyer. ladders and the day's supplies of cloth upon the wagons, and then each foreman i-eceived from one (f the office men, stationed at a window opening ou the Ya-rd, oil cans, funnels and a box containing tacks, carjienters' aprons, hammers, shears and all things needed bv his gang for the day. These boxes were also placed in the wagons and away they went to the parts of the district wherein work was to be pushed during the day. At p. m. the wagons loaded with the boxes and ladders returned. The two ladders belonging to each gang, tied together and properly numbered were stored in the yard. Oil cans and work boxes were passed by the foremen through the window to a member of the office force, Ayho looked to see that all tr>)ls taken cut were returned. Each foreman handed his day's report to another member of the office force, who had charge of that particular, and the day's work was at an end. Owing to the yarying density with wliich the squares in the territory were built up and the great ditferences in size of cisterns encountered, to ayoid also any stimulus to hasty work by the excitement of tiyalry between our foremen, no effort was made to keep account of the num- ber of yaults and cisterns oiled and screened daily. In- stead, a large diagrammatic map of the thirty-eight squares, showing their city numbers and the streets bounding them, was prepared and posted upon one wall of our headfiiiarters. As the oiling was com])leted on a s([uare, a blue circle containing the date was drawn upon the square indicated on the map; when the screening of a square was finished a red cross holding within its arms the date was drawn. Eyery morning a general order directing each foreman to the square that he and his gang would lie em])loyed upon during the day was hung upon a bill-filp near the map. If a square had been so far completed dui-ing one day it was sure to be finished the next, then the general order would irdicjito the )-(|uare to which the gang should next ])roceed. In this Ayay a glance at the map told not only how tlu^ w( rk was pro- ceeding and how long a time had elapsed since a partic- ular square had been oiled or screened, but just where PERSONAL EXPERIENCES, 1905 URUNS. 1037 every foreman and his gnng mii>lit be found at any par- ticular time if need arose to eommnniciite witli liim, send additional supplies, etc., as very often happened. Extra material needed throu.iih the day was issued u])on a writ- ten requisition upon headquartea's by a foreman. ''" material was issued by a member of the office force, one of whom was always present, and the requisition hun«^ on a bill-file kept for that purpose and properly labeled. Foremen were supplied with small scratch pads. On the first leaf, under the date of each day, they copied from the general order their assignment, and on the following leaves kept account, by street and number, of the premises visited, and the number of vaults and cisterns oiled and screened at each. They also jotted down the presence of any nuisance on any premise and anything else note- worthy. The last leaf bore the names cf the gang em- ployed under that foreman during the day and was signed by him. From these reports the daily labor roll could be made out without fear of mistake e)r contradiction. All reports of nuisances, improperly wire-screened cisterns, ■old wells which should be filled, pools or butts of stand- ing water, were hung upon a file. Every night these were taken up l)y a special volunteer aid (Dr. Joseph D. Weis), who devoted himself to this task, writing and mailing a courteous note to the property holder asking for a recti- fication of the condition. The number of concealed cis- terns (many in small back rooms), of old unuse^d wells (some under but slightly raised buildings), or paitly buried water-butts, shallow ponds, etc., discovered in the comparatively small area under our care, was astonish- ing. A wall file was also kept for the posting of com- plaints of property holders, and these you may be sure were numeious and varied. ]Many seemed unable to real- ize that damag(^ to a piece of rotten gutter pii)e was far more than compensated by the value of the cistern screening being elone for them at public expense. How- ever, each com])laint Avas taken uj) and attended to, and in the end, we believe, to evei'y one satisfactorily. It will be seen that hanging bill-files i)layed a large part in systematizing our work. It was found the least trouble- 1038 aloustin's history of yellow fever. some war of keeping all kinds of niemoraucla and accounts in a business of emergency like this. Indeed, the walls of our headcjuarters were covered with rows of files, each surmounted by a label indicating its purpose. Only two boo;ks were kept, one, the property book, an inventory of our tools and stores entered as they were purchased ; the other, the alphabetical payroll made up from the daily reports of the foremen for the laborers and for the office force by our chief clerk. An important file, called the "Skip Book,'' hung from a nail in the wall. It contained a list of particularly difficult jobs of cistern covering. For it came to pass that, during the first rush of the screening gangs over the district, certain cisterns were left unscreened, either because they were overlooked or were hidden away in houses or sheds, when they were usualh' reported to us by tenants, or because they were of such size, height or other difficult nature as to be beyond the skill of the first gang which encountered them. Those unfamiliar with New Orleans must know that the main drinking-water supply is from rain collected from the roofs in wooden containers like railroad tanks, and almost always fitted with covers. ^Many of these receptacles are arranged one above the other in two or even three tiers or stories, so that the top of the highest may be level with or even a little above the house roof. They are to be seen of every diameter and height. The covers may be of plank, in which case they are often old and rotten or constructed of sheet-iron over wooden frames, conical, dome or minaret sha])ed, and these often prt^scut seam-cracks or rust-lKilcs. Many very wide cis- terns, twelve to fifteen feet in diameter, without covers of any sort, were met with. The ^'skips'' were for the most part of this character, and a gang of specially handy- men under a foreman of exceptional intelligence and aptitude was constantly engaged in dealing with them. In this ^Messrs. Summey and Horton rendered valuable service. In covering lai'ge cisterns with \ov\ rotten tops or none at all, a ladder had to be passed across the top from one point on the rim to another, and a rude frame of boards or scantling constructed. A large sheet made PERSONAL EXPERIENCES, 1905 URUNS. 1 039 by se^Ying breadths of cloth together, the seams being carefiillT wrapped iu and stitched with twine, was then drawn over the frame and taclved down all around. In screening to cover cracks and holes in sheet iron domes, similar sheets had to be made and wrapped about these cupolas. Sometimes poncha-like discs with a central hole were slipped over the spike, which, like that on a German helmet, often adorns these metallic domes, and Avere fastened down everywhere to the side of the cistern. In the case of a large cistern encased in cement, into which tacks could not l)e driven, the cloth cover was allowed to depend far down and then drawn close to the cistern circumference with cord passed around and around it. ^lany of the ways in wliicli the cloth was fitted close around awkward inlet and outlet pipes did credit to the American reputation for ingenuity. Indeed, these inlet and outlet pipes were a subject of much concern to all engaged in cistern covering. At first we enclosed outlet pipes satisfactorily by i)utting a s^puire of cloth <;ver the lower end, gathering the edges close about the pipe and securing them in this position by wrapping around and around with tAvine. But sometimes trash accnmuhited at the lower end of the pipe, behind the cloth, and caused stoppage. Later a better plan, suggested by one of the Marine Hospital surgeons, of fastening with cord to the lower end of the pipe a sleeve of cotton ch)th about eighteen inches long, Avas adopted. AVhen the cistern overflowed water passed freely through the sleeve at the end of the pii)e; wlien the flow ceased tlie clotli collapsed and prevented the ingress of mosipiitoes. Inlet pipes coming from the roof gutters we at first closed by i»lug- ging the topening from the gutter into the i)ipe with a cone made of wire gauze i)ainted to i)revent rusting. The cone, about six inches across the top, could be ])U>hed tightly into the opening of various sized pipes, effectu;jlly sealing them against tiie entrance of anything more than one-sixteenth of an inch in diameter. They could be quickly made by rolling up a s(iuare of wire gauze, as a cornucopia is made from a sheet of paper, and fastened My a few turns of wire raveled from the edge of thei 1040 augustin's history of vei.low fever. gauze. A handy workman was kept making them, and we used up many dozen ; sixty-six feet of yard-wide gauze being consumed before we abandoned this method. The cones were given up partly on account of the impossibility of getting fine gauze and partly because householders objected to them, on the ground that trash washed down the roof gutter would dam against the cone edges and cause the roof gutter to overflow. I confess, however, that it seemed to me better that this should occasionally happen than that the trash should find entrance into my cistern, as the cone could easily be pulled out and the gutter cleaned whenever necessary. We substituted the same sleeves that were tied over the ends of outlet pipes. Where the cistern end of the inlet pipe could be readily got at, the sleeve was tied over its open end just as with the outlet pipes. Where the cistern end of the inlet pipe was within the cistern cover and not get-at-able, the sleeve was passed into the inlet pipe at its origin from the roof gutter; then a straight bit of elastic steel about a foot long, and one-sixteenth inch thick, and a half ot an 'inch wide, Avas curled into a circle and passed justj within the mouth of the sleeve. When released it ex- panded to the circumference of the pipe and held the mouth of the sleeve closely applied to the pipe's inner surface. For these sleeves we were also indebted to the ladies of our neighborhood, who had several hundred made for us at a cost of five dollars. Our main task was completed at about the time that the Health and 31arine IT()S])ital Service ottlce, under Act- ing Assistant Surgeon Samuel Logan, was established in the ward. For the sake of greater ease of co-operation, our lH'a(l(|uarters were, therefdre, now moved to the com- modious buibling occupied as head(iuartcrs by Dr. Logan. Our force, which had been gradually reduced as the work drew to completion, was cut down to two gangs of a fore- man and three men each. These were, naturally, selected from among the most conscientious, experienced and in- genious of all Avho had been in our employ. On August 9th they began a systematic, minute inspection of all screen- ing Avork. Their orders were to re-oil any cistern found PERSONAL EXPERIENCES, 1905 BRUNS. 1041 defective and to leave all mosquito-tight behind them. One wagon was retained to carry the ladders, cloth and other material to and from work. Following instruc- tions, the foremen themselves mounted the ladders and inspected every foot of screening at close range, examin- ing especiall}' the cistern tops and the inlet and the outlet pipes. If any defect was found the cistern was oiled, the men were instructed how to make it mosquito-tight, and exact completion of these repairs carefully overseen. At the same time an additional lookout for standing water, hidden wells, or other nuisances was kept, and all such were noted in the foreman's daily report. These reports were at once turned in to Acting Assistant Surgeon Logan, who instituted instant and energetic measures for the treatment and abolition of these nuisances. Although we thought our screening had been exceptionally well done, and always under repeated instructions t6 prefer thoroughness to speed, yet so many were the damages in- nicted by wind and weather, and so numerous the other small defects and omissions discovered on critical review that it took twenty days to go over the territory (thirty- eight blocks) and make all perfect. The wire screening at this time being put on by private contractors to replace our cloth proved especially defective and vexatious. Those engaged in wire screening seemed, for the most part, to have failed to grasp its purpose and to be unable to realize that a gap of over one-sixteenth of an inch makes a whole job useless. They seemed to tliink that anything which would exclude an English sparrow would answer the purpose. As soon as this first inspection was finished (August 29th) reinspection was begun. Those blocks which had first been given to one inspector were now assigned to the other and vice versa. By Sej)t. 7th, this second inspection being virtually completed, and the acting assistant sur- geon of the Public Health and Marine Hospital Service having the whole sanitary work of the ward well in hand, I could see no reason for the maintenance of an extra cog to the machinery. I therefore closed our office. The ladders and other implements on hand were, after con- 1C42 augustin's history ok yellow fever, sultation with those interested, turned over to the Public Health and Marine Hospital Service officer ; our accounts were balanced by Captain I. L. Lyons, our actinp: ch«ir- man of the Finance Committee, the cash surplus donated through Dr. Warner to the Citizens' Auxiliary Commit- tee, and our work was done. It is pleasant in looking back to be able to believe that we accomplished what we set out to do: To make a belt across this large and populous ward so thoroughh' oiled and screened as to be mosquito-proof, and thus to save to the central authorities care, expense and, above all, time. The area, six by six blocks, Avas sufficiently large to form an interesting experiment. So far as I know it was the only district in which volunteer sanitary work was carried on from beginning to end under the constant personal supervision of a medical man. By all testimony the stegomyia, though not as extinct as the dodo, became in the center of this tract a curiosity. Around some of its edges, where our neighbors were not so well protected until the Public Health and Marine Hospital Service took hold of the work, I am told that many could be found. The area became infected seventeen times; the first time in the last days of July, but so far as we know the in- fection' never spread but in a single instance — in the square at the corner of Camp and Felicity Streets. Ten times out of the seventeen the infection occurred on the boundaries of the area. It occurred six times on the (.'amp Street and three times on the Baronne Street boundary; never on the First Street boundary. One may be sure that the experience of our men was checkered with incidents both ]deasant and unpleasant during their forty- five days' campaign. Though for the most part the people acquiesced very good-naturedly in what was being done for the common weal, tlie belief in the mosquito theory was by no means universal. One liard-h(»aded old Irishwoman obdurately refused to allow her cistern to be oiled. When finally pc^rsuaded by one of the most diplomatic of our foremen she exclaimed : "W(41, come in and do it, if yez is bound to, but I don't believe yez can keep the Lord from gittin' those He wants PERSONAL EXPERIENCES, 1905 BRUNS. 1043 by piittin' a little ile on the cistlierns." The most un- pleasant incident had to do with ward politics. After we had been at work about a day and a half, the political leader of the ward called a meeting- to "organize the ward." This meeting was attended by nearly all, if not all, the gentlemen who had been piesent at the Trinity Church meeting and others from the central division. The meeting was organized by the ward leader, and all motions carried and all nominations confirmed were made or suggested by him. The ward was divided into three sections. The middle one, extending from Camp to Baronne Street, was confided to our care. It was resolved that the chairman of the meeting and the executives of the three divisions should meet and appoint a Finance Committee to have charge of collections and disburse- meiDts for the whole ward. The gentlemen from the central division, at whose instance I had begun the work, were without confidence in sanitary work conducted under political auspices. I was unwilling to direct such Avork in co-operation with a Finance Committee for whose appointment I should share responsibility, but in whose selection I should, at best, have but one vote out of three. We therefore left the meeting and determined to continue our work independently. Afterwards a rumor was cir- culated that the wealthier inhabitants of the central divi- sion selfishly subscribed money to protect themselves alone and left their jKiorer neighbors of the front and rear to meet the cost of sanitary work as best they could. This is untrue. I know that more than a score of the well-to- do living in the middle division contributed to the oiling and screening in all three divisions; many most gener- ously to the Avard funds and to the general fund besides. That more Avliom I do not know did so is highly probable. The slow progress of our first inspection, which took twenty days, was the subject of some disagreeable criti- cism. I mention it here to emphasize the difficulty and the time-consuming nature of this work when thoroughly done. It was said that our men Avere not doing their duty, but were dawdling over their Avork for the purpose of drawing pay for a longer time. The accusation was 104.4 auoistin's history ok yellow fever. ridiculous. First, the two foremen in charge of inspec- tion and repair were selected from the large number who had been in our employ by reason of their trustworthi- ness, diligence and skill. Their characters to those who know them are refutation enough. Secondly, their work was not done in secret, but under the eyes of the nuiny Public Health and Marine Hospital Service men who were constantly about the premises where they Avere employed, of the citizens in whose yards they worked and under my ;own, for I frequently dropped in upon them at uuex- pected times. Thiidly, a like opinion has never been heard from any who closely followed this kind of work. On the contrary, that two gangs of four each could have thorougholy covered thirty-eight blocks in twenty days has seemed to them evidence of remarkable industry. A reliable man of experience stated that he had found m one block in another district twenty-six cisterns, supposed to be properly screened, which were lamentable defective and which would have required many days to repair effectually. Such criticism shows ignorance of the jirac- tical difficulties to be overcome in so closing the various types of cisterns in any district of New Orleans as to make them absolutely' mosquito-tight. Suggestions. The experience of our summer's work resulted in the following reflections : That the attempt to screen during an epidemic is most unfortunate. During such a time of stress the work is hur- riedly and imperfectly done and cisterns which are really open to the mosquito are sui)i)()sed to be properly closed. Too much attention is concentrated upon this work and the search for other standing water is neglected. These and the cesspools remain uncnii)tied or unoiled and con- stitute a source of great danger. It would be far better during the actual prevalance of the disease to concentrate all attention and all work upon keeping every cistern propei'ly oiled and reoiled, upon seeking out and emptying or oiling every body of standing Avaatcr, and upon the thorough fumigation and refumigation of dwellings. PERSONAL EXPERIENCES, 1905 BRUNS. 1045 The thorough screening of cisterns so as to leave no opening larger than one-sixteenth of an inch can only he done hy skilled workmen. A very common fault in this work is the neglect to carry the wire gauze or othen material a foot or two down the sides of the cistern. The staves of many cisterns do not come close together at the top, and, especially in dry spells, there are large cracks between the staves, extending down a foot or more from the top through which any mosquito can readily pass. Inspection and reinspection of the screening are as im- portant as the work itself, and must be thoroughly, in- telligently and conscientiously done to be of value. In practice it was found impossible to do this work with less than two workmen to move altout the long extenFion lad- ders and a foreman g€ greater sagacity- and fidelity' to observe, note and direct the necessary repairs. Inspec- tion done from the grouiul, done in any way than by going over the whole Avork minutely from a ladder-top, is worse than useless, in that it establishes a false belief in safety where no safety exists. The work too, if well done, is tediously slow, and many gangs will be required to in- spect a whole city within any reasonable time. I'nless our health authorities are particularly careful and for- tunate in the selection of their emjiloyees for this avc-i'K, the foundation of a calamity will be laid. It is certain that the accrage city employe possesses neither the intel- ligence nojr the fidelity to be a foreman of such work. Eeinspection is necessary because most of the material commonl}' used is very perishable. Only the l)est qiuility of bronze wire effectively resists the constant action of air and water. It is a pity that the screening ordinance does not permit the use of a good <|uality of duck. Our experience led us to the conviction that this material can be more closely and effectively applied by the ordinary workman than wire gauze, and when oil painted it cer- tainly lasts longer. The objection that it prevents adequate aeration of the water is without force. It is practically impossible to close hermetically a wooden cis- tern. Rain water is charged to saturation as it falls: coolness and darkness are unfavorable to vegetable and 1046 AUGUSTIN S HISTORY OF YELLOW KSVER. therefore to animal life, and make for purity of tlie con- tained water. As it is impossible to know liow lonj; de- fects may have existed before they are found, all cisterns with gaps more than one-sixteenth of an ineh should be at once reoiled by the inspectors. There can be but little doubt that the Stcgoinj/ia. Avhat- ever may be her haliits now, will, if driven to it, take to depositing- her eggs in gutter water and that the larva? will learn to endure their new environment. Hence it is of the greatest importance not only that underground drainage and sewerage should be pushed to completion as rapidly as possible, but that paving with asphalt, upon which unbroken surfaces must be maintained, should go hand in hand with this work. The asphalt pavement, sloping gradually to tlie curl>, leaves no deep gutter in which stagnant pools can be maintained. Wherever tne wfork has been done in such fashion as to leave these, it should be remodeled without delay, and where the neces- sities of heavy hauling demand material other than asphalt, it should be so laid as to abolish forever the old- fashioned deep gutter. A comparison of the gutters on Gravier Street from Camp Street to Baronne witli those on Howard Avenue from St. Charles to Baronne; of those on Po^'dras Street from Camp to Baronne Avith those on Girod between the same streets, and of those on St. Charles Street between Julia and Girod with those on Carondelet between the same streets, will give a striking illustration of the importance of this work and the need for prompt remodeling. In some cities the tenant is required by law to- sweep) or cause to be swept down every morning the stretch of gutter before his house. The ordinance is easily enforced by a word from the policeman on the beat to the house- holder or his servant, and all are easily educated to the advantages of the plan. It appears that such an ordi- nance would be specially useful in this city. An experience with even a very limited area showed that this old city is peculiarly rich in hidden Avells, cis- terns and other containers. I beg to suggest that an PERSONAL EXPERIENCES, 1905 BRUNS. 1047 important part of the work of our health officers in pre- paring for the coming- summer should consist in obtain- ing as complete a knowledge of the location of these containers as possible. This could be done by urging all citizens possessing such knowledge to communicate it at once to the health authorities either directly or through the public press. We found last summer that many tenants were unaware of the presence of such sources of danger on their premises, and we often obtained knowl- edg of them in an indirect Ay ay from former tenants or builders of the houses. The search for all unscreened bodies of standing water on all premises cannot be pushed with too great a yigor if we are to exterminate the Stcffoinf/ia. ^fay I be permitted to say that perliaps the health authorities might enlist the seryices of the physicians of the city as yolunteer inspectors of premises, alleys, etc? The general practitioner on his rounds penetrates into eyery quarter and into almost eyery dwelling of the city. In furtherance of the general good these gentlemen might be persuaded to note doAyn and report to the health officer eyery threatening nuisance which comes under their eyes without any uncomfortable use being made of their names. It seems to me also that it has become eminently a part of our duty to encourage by word and example the sentiment that, its mode of propagation being well under- stood, yellow feyer has been robbclitful to expect an epidemic of vast proportions, high mortality and long duration. What actually happened was this: The total number of cases officially' reported was 3,384 with a mortality of 451, about 13%. As always, many cases must have failed of report, while deaths were necessarily reported. The fever was over about the first of November, although the first frost occurred only on December 5, and the funds raised for the sanitary campaign were not exhausted. The onh' difference in the warfare waged against the pestilence in 1905 and that of previous campaigns was that measures were based solely on the mosquito doctrine: the protection of the sick against the bites of mosquitoes by means of screens, mosquito bars, &c. ; the killing of mosquitoes in infected premises, chiefly with sulphur fumes; also the gradual de>:truction and elimination of all Stcfjonii/ia by general fumigation, the screening oi cisterns and other water containers. The education of the public at meetings and lectures were auxiliary methods of material assistance. Not only there was no general exodus of non-immunes, but oi^ those who did go away, none took sick who re- turned after the disease was under control and before the occurrence of frost. Formerly this was a danger against which people had been warned ; invariably, a few of those who did not heed the warning fell sick shortly after their return, owing to the lack of destruction of infected mosquitoes. Why, then, this enormous difference in the ])revalence, the mortality and the duration of the ei)idemic? Why should there have been in 1853, when the fever became epidemic in the same month, a mortality of 7,849; in 1878, when the fever was epidemic a month later, a mor- tality of 4,050, or respectively about eighteen and nine times greater than in 1905, when the po])u]ation had largely increased? Why should tho epidemic have been arrested before frost for the first time in the history of the disease in New Orleans, although there yet remained a large percentage of non-immunes? LESSONS TAUGHT BY EPIDEMIC OF 1905 CHASSAIGNAC 1051 Because the mosquito doctrine was for tlie first time the basis of the work done for the control of the disease and, notwithstanding the formidable difficulties encoun- tered, it proved emiuently successful. Similar results followed analogous measures at many localities in Louisiana and Mississippi. I shall relate only a striking- instance as observed directly' by me in Tallulah, iu Madison Parish, where I was recpiested to go by the president .of the State Board of Health in the middle of September. Tlie infection had been brought there on July 21. The first suspicious cases were discovered about August 9. Precautionary measures taken after the confirmation of the diagnosis, gave rise to the hope that there would be no further cases and a greater sense of confidence was engendered by the statement, on August 2G, that all cases of illness in the town had been critically examined by a representative of the Public Health and ^Marine Service who declared that there was not a suspicion of yellow fever in tlie town. Owing to this the people threw caution to the winds, screens were torn out because they increased the heat, persons about to flee decided to remain. By the end of the month undoubted and severe cases were recognized, and on September 5 there were at least twenty cases among the comparatively small white population, while fatalities among the best known people gradually wrought the pox)U- lation to a high pitch of excitement and panic. Many fled, including prominent officials, the terror being intensified because practically all were non-immunes, the little town never before having had a visitation of the scourge, and because of the high rate of mortality. ' Arriving on September 11, I found that over a dozen deaths had occurred and that of the forty town blocks, all but three or four were infected; in other words, the infection was general. The only Avatcr su]»])ly was de- rived from cisterns, tanks, barrels and wells, and the town was swarming witli stegomyia mosquitoes. An anti-mosquito campaign was inaugurated at once; all Avater containers were oiled within twenty-four hours; 1052 /-ugistin's history of yellow fever. the sick were screened or protected by netting ; systematic fumigation was carried on vigorously; latrines were treated with crude oil and lime. Within a week the number of new cases, which had been progressively increasing, were diminishing and by the end of September, long before frost, the epidemic was over, although a census taken at that time showed that there were yet not fewer than 200 nonimmunes who had nat had the fever. Confirmatory evidence in a negative sense is not lack- ing. Referring to only one notable instance, I shall quote from the report of the State Board of Health in regard to Patterson, La., where "conditions were such as to make it practically impossible to control the people, and the fever, although repeatedly checked, ran its course until frost." This and a few analogous experiences of both tj'pes showed that there was that year no exceptional tendency in the fever to end early, but that where the mosquito fight was properly carried out the outbreak was stopped before frost, otherwise it continued as usual until frost. Infection in Proportion to Xunihcr of Bites. A lesson taught also by occurrences in 1905 is that, other things equal, the degree of virulence of the infection is probably due to the number of bites by infected mos- quitoes received by the victim. It is natui'al this should be so as there is no poison known, animal or vegetable, organic or inorganic, the effects of which are not in pro- portion to tlie dose. The more bites the larger the dose. My attention was attracted to this point early during my stay in Tallulah. The houses in which the infection had been most severe, as evidenced by the number both of cases and of fatalities were those where mosquitoes abounded, where water receptacles were most numerous. An interesting and significant contrast was shown in the history of two practitioners who both did courageous and useful work in the ill-fated village. One was a young physician employed by the State Board of Health, who thought himself immune as he had LESSONS TAUGHT BY EPIDEMIC OF 1905 CHASSAIGNAC. 1053 had a slight attack during' a previous epidemic, and who labored faithfully without thinking of taking any pre- cautions. ]More than once during the first days he showed me the bites he had received while on his morning or his evening round, considering them somewhat as a joke and mentioning how he had watched some of the insects at work. In less than ten days after he went on duty he was stricken with a characteristic attack of 3'ellow fever, being apparently overwhelmed by the toxemia and suc- cumbing earlj', notwithstanding his youth and the de- voted care he received. The other was an older practitioner, a local man, who had never been exposed to the disease and frankly ac- knowledged his fear of it, nothwithstanding which he did his duty as nobh^ as the other. The difference is that he used all possible precautions, sleeping in a screened house, smearing his face and hands with pennyroj-al frequently, using a fan, and otherwise dodging mosquitoes as best he could. This man escaped the fever, o^', as I believe, four ov five days after receiving the only noticeable bite he suffered, he had the slightest kind of a walking case, well-nigh imperceptible. The surroundings, the worK, the degree of fatigue were the same in both men. x^e.^^sychic element, the age, the comparative immunity were all in favor of the one who contracted the disease in a virulent and fatal form. The conclusion seems obvious. In line wdth the facts just mentioned it must be recalled that it has been asserted previously, especially by the French observers in Brazil, that the number of bites were the bites of one mosquito produced only a mild attack. Virulence Diminishes ''Pari Passu" icith ihc Destruction of Mosquitoes. For the reasons given above, systematic fumigation, and the destruction of mosquitoes by any other means, first shows its effect by a reduction in the mortality rate, by a decrease in the intensity of the symptoms in those stricken. This can be understood easily. As soon as 1054- augustin's history of yellow fever. tlie number of infected mosquitoes is materially lessened, it stands to reason that those who are unfortunate enough to be bitten at all are likely to receive fewer bites than those who became victims when there were yet numerous hordes of the dangerous pests. As long as there are any infected mosquitoes at all and also non-immunes exposed to their bites, so long must there break out some cases of fever, hence the length of time that usually elapses before the very last case is observed; in a much shorter time enough mosquitoes are destroyed to cut down the average number of bites received by those who are exposed, con- sequently the virulence is diminished long before the dis- ease is completely arrested. This was shown conclusively by the course of events in New Orleans during 1005. For July, before the san- itary campaign was effective, the rate of mortality among the reported cases was 20% ; for August it dro])ped to 13%; yhile for the other two months of the epidemic it averaged 11.5. In Tallulah, this was observed also. The fatalities were most numerous just before the inauguration of active warfare against mosquitoes and they diminished steadily thereafter. So much so that no one died of yellow fever who took sick after the work was well started but the much regretted young physician whose case has already been outlined and was excei)tional in more ways than one. The mortality was arrested first, then the severity of the cases further decreased noticeably some time before the epidemic was over. Susccptihilitij of Xcgrocs. It was shown conclusively dnring 1905 that negroes are about as ]ial)le to contract tlie disease as the whites, but that they have it usually in a remarkably mild form. There again a valuable illustration can be obtained from Tallulah and vicinity: of 90 white cases, IS died, or 20%; of about 950 coloi'ed cases, only 5 died, or little over 1/2%. In Lake Providence and vicinity, of 80 whites who were stricken, 15 died, or nearly 20%, while, of 247 colored LESSONS TAUGHT RY EUDEMIC OF 1905 — CHASSAIGNAC. 1055 patients, 8 died, or a little more than 3%. There were reported from Patterson about 500 cases amoni? the white, with a mortality of 51, yet, of about 200 colored casea only one died, Several negroes were observed by me in Tallulali, who had symptoms just about sufficient to make a diagnosis possible, yet who were scarcely sick, some not even inter- rupting- their work. At first very few of the darkies re- ported their sick and it was only when it became bruited about that the sick were supplied with delicacies, especi- ally chicken during convalescence, that we obtained any idea of the large number who were having the disease. The difference between the morbidity in the two races might be explained by the greater resistance of the blacks to the poison after its entrance in the system, but I am inclined to the belief that it is because, other things equal, the black man receives a smaller dose of the poison owing to the fact that he gets bitten less. This may be due to his tougher skin, or to the strong musky smell cominj]^ from his surface which may keep the mosquitoes away in a way analogous to that of pennyroyal nnd other strong scents which are used with that end in view. Be that as it may, we all know that mosquitoes are less felt by the colored than by the Avhites, and 1005 showed that negroes are just as prone to contract yellow fever as their white neighbors, but have it in a very mild form. Tliis is an exceedingly important lesson for obvious reasons, as it was formerly thought that the negroes were practically immune and cases among them must have been overlooked easily and frequently. Q uaran t Ines Uniii tcUif/cnt. Numerous occurrences, illustrating different phases of the subject, have shown that the kind of quarantines re- sorted to up to 1005 were, to say the least, unintelligent because they either were unnecessary, on the one hand, or did not attain their ]uirpose, on the other. Quaran- tines other than those against persons wlio might be infected or objects that might carry infected mosquitoes were proved to be unnecessary by the large number of 1056 augustin's history of yellow fever. places which remained free of the disease notwithstandinji: the fact that ordinary business shipments were received as usual, or at most were fumigated before leaving tlie infected locality. The United States postal authorities refused to fumigate the mails and no harm came of the o^mission. On the other hand, some places became infected which had tried the non-intercourse or shot-gun quarantine born of ignorance and panic. No land quarantine can be absolute; every avenue can not be guarded adequately. The stricter the quarantine the more object there is in evading it and the more apt is the evasion to be success- ful; also the average quarantine is apt to be put on, in these days of rapid and easy communication only after people have scattered from the point of original infection, some of them perhaps to the quarantining place which is lulled into a sense of false security because it has put up the bars against the rest of the world. We have learned that the only sensible restrictions are : 1° Detention, for a sufficient time, of persons coming from an infected or suspected point. 2° Fumigation with sulphur of any inanimate oljjects or packages, coming from such places, which might by any chance contain living mosquitoes, possibly infected. 3° Careful screen- ing of trains, steamboats or other means of transjjortation between infected and non-infected points. Prophylaxis in Place. It was demonstrated during the prevalence of yellow fever in 1005, that a community able and willing to rid itself of stegomyia mosquitoes could look upon the in- troduction of a case of tlie disease wiili e(iuanimity. The means of propagation having been disposed of there can be no danger of a spread of the infection and the presence of the infected person is no longer a menace to the population. ^[organ City, for instance, its health and municipal authorities having been among the early converts to the mosquito doctrine, had its cisterns oiled and screened, its street gutters liberally treated with Beaumont crude oil, and became practically free from the stegomyia. On LESSONS TAUGHT BY EPIDEMIC OF 1905 CHASSAIGNAC. 1057 an important factor in the degree of infection and that two, if not three, different occasions, patients ill with yellow fever came into the town from near-by infected points and remained during the course of the disease without their presence causing any outbreak of the pestilence. This and analogous experiences make it clear that any place, by means of a timely expenditure of energy and money, may put into effect prohjlactic measures whose efficiency can be counted upon. Prophylaxis in Person. In places where general preventive measures have not been attempted or have proved inadecjuate, iudividuals may do much in the way of personal prophylaxis. The screening of buildings or of living rooms and re- maining within them from before sunset to after sunrise proved of value during 1905. For those who had to go about, anointing the face, neck and hands with penn^-royal, camphor or other pungent substance; the systematic use of kid gloves and fans; wearing a wide flounce of niosb* to continue their peregrinations without additional inter- ference or delay. In the past, a larger number have been kept away from places infected, suspected or sus- ceptible, by the dread of being bottled up indefinitely through quarantine than by the fear of the disease itself. We have learned how to provide against this risk by means of detention camps and how to esta])lish them promptly at a reasonable cost for equipment and maintenance. TJie Great Lesson. The epidemic of 1905, and all it meant of financial loss, suffering, grief and death, could have been avoided by the timely acceptance of the mosquito doctrine and the practical application of its principles. As always, the LESSONS TAUOHT BY EPIDEMIC OF 1905 — CHASSAIGNAC. 1059 ounce! of prevention would have betn better than the pound of cure. Let us hope that this lesson has been well learned and has sunk deep. The people of New Orleans, of Louisiana, of our Southland, did nobly, a3 they always do, when confronted by an appalling emer- gency' ; but, with their mercurialism, will they give proper heed to future possibilities now that conditions are normal again? We must persevere in our study of sanitary problems in general and the warfare against mosquitoes in partic- ular. Neither is it too early to give serious attention to the chances of entrance of bubonic plague, nor premature to train our batteries on the rats. A stitch in time saves nine times nine. 1060 THE WOJUv OF THE MEDICAL rKOFESSION OF NEW ORLEANS DUIUXO THE EPIDEMIC OF By Louis G. LeBkuf. M. 1)., Xi:w Orleans, President Orleans Parish Medleal Society, 1905; Visiting Physician to Charity Hospital, yew Orleans. In September, 1897, a special meeting- of tlie Orleans Parish Medical Society was called to discuss the yellow fever situation. This meeting- was also convened to in- struct the Younger members of the profession into the etiologv, symtomalogY and treatment of the disease. The conference proved verv valuable. Profiting by this ex- perience, a similar meeting was called at the outset of the fever in 1905. In calling the met ting to order the Chair- man expressed himself in tbe foll(»wii>g words: "No experience in my eighteen years of practice ever impressed me more forcibly than just such a meeting as this 'held eight years ago in the room of this society, called by Dr. John Callan, the then efficient President, for the discussion of the same subject. It was also to try and educate the new men of our profession who had never seen this dreaded disease. At t'liat time we had with us men who told us of just such a meeting called nineteen years before, in 1878. We are happy to say that most of these men are still with us. These two previous meetings, epoch-making as they were, undoubtedly also were the saddest occurrences of our corporate existence, and we must hope that this will be the last we ever will 'hold for this purpose. Let us trust that the work now being done along the line of destruction and pro- tection, following the ascertion, belief and dogma on the etiology of yellow fever, will mean the turning point of a new era, the regenera- tion from our former abject, hopeless condition to something definite, something tangible. "Let us remember how we felt twenty-six years ago. Let us remem- ber how we felt eig'nt years ago with nothing ahead of us, nothing which could be planned, nothing to combat. Prophylaxis in person always failed, prophylaxis in place always futile. No measure ever controlled the situation; no amount of disinfection ever helped, and when the entire truth was told, the only relief which came was v.-'hen the frost of November appeared as a Heaven-sent Nemesis to our WORK OF THE MKDICAL HROFhSSION, 190 LkPeUK. lOGI dreadful scourge. To-day the situation is different, and though we may not succeed entirely in this present campaign, though we may not c'jeck the disease at once (for various causes which will have to be told later), we hope to restrict it to some extent, to diminish its too extensive spread, and to instill some hope into our municipal fellow- citizens, a hope which will mean the regeneration and the rehabilita- tion of our dear city to the standard which she cQould have amongst the future great cities of our co.;ntry. "I want to report, besides, that your Advisory Committee has been continuously and actively at work since last Saturday night. The task has not been the easiest and pleasantest. We will submit a very thorough report later wihen the work is over, and we hope then to show you that we have endeavored rigidly to coiiform with the princi pies which govern the disinterested, and high ethical standard estab- lished by this society. We Ciave taken part in every conference, in every meeting called for the organization of the great work which is being, tried in this city. One of the members cf your society wrote the first instructions which were published last Sunday morning to govern all households regarding the control of t'le situation, Another mem- ber of the committee helped on a committee of three to plan and organ- ize the up-to-date Emergency Screened iHospital, which was placed in operation in thirty-six hours. And though their names do not appear in print, nearly every important article or medical direction in the public press "iias been furnished or revised by your committee. As we are still actively at work in the campaign undertaken, we wish merely to report this as brief, temporary report until later, when we can give you a fuller and final report." Tliougli Carlos Fiulay had advanced the tliecrv ( f iiios- qnito dissemination of yellow fever since 1881 at Havana, and tlionjih the U. S. Army YelloAv Fever Commission, consistinii- of Reed, Carroll, Amrcmonte and Lazear, had made their epoch makinii' experiments in IflOO, and Lazear had already sealed the trnth of the mosciuito-infected transmission by his martyrdom as a holocaust to the proof of his hcjicf, and tlKiniih we had had the rejiort of the Yellow Fever AN'orkinii' Party No. 2, consistinu' of Drs. Pothier and Parker and Prof. Beyer, with their conclusions frcnu their work at Vera Cruz, still our public was profoundly i.iin(;rant of these scientitic discoveries. When the tirst knowled.uje reached our city of the jircsence at this dread disease in our midst, there was almost a. panic — stocks and bonds went beogino^, a pall seemed to \06'2 AIGUSTIN S HISTORY OF YELLOW KEVER. be tlirown on all things, a general exodns of these who could atford it took place and the coniniereial interests seemed paralyzed. The experience of former years was staring the nnitiated public in the face. They remem- bered the injury to the city commercially, and the thous- ands of lives lost in the previous epidemics. New Orleans was like a rejuvenated city, with the millions spent here in public improvements, and the great activity in bus- iness and in railroad construction, due to the recognition of its wonderful future and prospects from the advantages of proximity to the promised Panama Canal South Amer- ican trade. Everything showed it to be on the eve of great growtli and development, so that when the news came to us of this epidemic, it was a dreadful catastrophe. The public remembered the pitch barrels of 1878, the flags and costumes of gruesome attendants in 1897, ard nearly all were in mourning for some dear frierd or relative. Yellow fever itself, when i)r(:p(rly treated or better, Avhen properly let alone and nursed, is not sucl) a vei'y fatal disease. In the hands of a competent medical at- tendant the mortality is not so great as many other dis- eases, but it was the mystery of its onset and the strnnuc unaccoui'table manner of its ]iroi)agation wliich chilhMl the heart and struck terror to the bravest. All mankind has some innate su])erstiti(}n, and any disease which comes in the night, as in this instance stealin;': from house to house, sometimes taking a vnIicIc l)l(:(k witlujut cross- ing the sti'cet, but n)ost times si;i ending all over like wildfire, without any one being alsh' to ex]tlain its exact cause and mode of trai'smission, I'atuially ai)))all( d every one. This was the condition of affairs wlicn tltis campaign opened, and this was tb" st-it<> of (Imt- - - 'en, on July 22nd, we were told publicly of this trouble. No '^' tressed people ever found its medical nrcifession more united and more willing to help than errs was on that date. There was a trenierdonr, v-nk ahffid of us, the work of education, of teachina' tl-e new lelief and the training in the great eam];aign ef pirj I'vlaxis and de- WORK OF THE MEDK AL PROFESSION, 1905 LeBuEF. 1 0G3 striiction, the tlioii&auds of laymen who were willing to make the good fight. Our part was the important one, and the difficult one ; it is not very easy to reform the uninitiated to new ideas; ignorance is generally self- satisfied and prejudiced, and the propagandist of the new theory and ot the new scientific facts has to proye his contention before it is helieyed. It was not all to tell the public of the established facts of Los xVnimas and Vera Cruz; we were forced to start a campaign of education and forced to labor on the front line to direct the work of destruction and preyention. The old theory of fomites and infection was oyer, and the simple fact that, first, a mosquito, and the female ^tcgomyia Calopus at that (fasciata as it was caliea then) was the offender; secondly, it could transmit the disease only if it was allowed to bite a yellow feyer patient during the first three days of illness ; thirdly, and lastly, that this yello^y feyer infected mosquito could uot reproduce the disease before about twelve days after its inoculation or injection. So, starting from these three basic fundamental truths, three specific lessons had to be taught, and practiced as the very catechism and Bible of our entire conduct. (a) Enforce the protection of the yellow fever patients from the bite of all mosquitoes, to exclude the special offender; /. c. provide mosquito bars and screen the room of the patient at once. (b) This work of screening had to be performed as early as possible to prevent infected moscpiitoes from escai)ing and propagating the disease. (c) The final destruction of all the mosquitoes v,lti<-^' might have perchance bitten a case, befoie the t\velve days of incubation or digestive preparation was completed in the salivary glands or digestive tract of the irsect and thus rendered it dangerous to other human beings. Though these three simple truths were i)lain and easy, it was only the starting point of the great educational fight the medical profession had ab.cad of it. To be more certain of our success, it was ^^•iser to destroy all the mos- 1064' augustin's history ok vnliow fever, quitoes we could, both directly by neueral fiimii;ation, and also by diminislilDii- the probalile sources of their habitat. Screeuiu<»-, saggiuo- outters of roofs, barrels, water con- tainers or any stationary vehicle where larva? niijoht be hatched — this was the do<>ma and instruction vre bad to disseminate. If we were successful, thou.nh we might not be able to stop the disease, as we had been informed of it too late, and for various inexplicable reas^ons the fact of tbe presence here had been uiirecoiiiiized, or if recognized had been through criminal neglect and blindness allowed to spread beyond control, we would possibly, with a good fight, be able to restrain its too great spread, and prove to the Avorld by this re^trictiou tliat we could do some- thing that would affect its unlimited spread, and therefore re-establish confidence aud build for our future an assur- ance of action and control which would allow us to throw off our chains and fetters, and forever juove our immunity from what we could henceforth call the Mosquito Fever, instead of the awe-instilling name of Yellow Fever. As a good deal of the following history which must be related personallv refers to the Avork of the Advisory Com- mittee of the Orleans Parish ^Nfedical Pnciety. of which the present writer was Chairman, I will take the liberty, in most of the remainder of this article, to give excerpts of reports written by Drs. Sidney L. Theard, the ablei Secretary of the City Board of Health; Prof. Kupert Boyce, Dean of the Liverpofil School of Tropical ^Nfcdi- ciiie; Beverend Beverly Warner, in charge of the Citizens' Educational Campaign, and the 1005 Annual Beport of llie Orleans Parish Medical Society: The First Stcpft in fJir Caiii/xiif/ii (iiid the Orf/diii.zatio'H of the Refioi(rce!< of the Citi/ /o Coinlxtt fJic Disease. On Friday, July 21st, a meeting of the State and City Boards of Health, the representatives of the Public Health and ^Marine Hospital Service, and Health Officers from surrouudiug States with Drs. LeBeuf and ^Magruder, was convened in order to reassure the public and to WORK OF THE MKUICAL PROFESSION, 1^05 LkBeUF. 1065 check the stringent and onerous quarantine precautions which had, on the rumors of the presence of yellow fever, been promptly taken by the surrounding States against New Orleans, although as yet no official declaration had been made. As an example of this promptitude, it is worthy of note that the State of Mississippi had issued a quarantine ordinance on the daj' cf the meeting. Shortly after the meeting on Friday the first step in gen- eral medical organization was taken by the appointment on the following day, July 22nd, of an Advisory Board, consisting of the Chairman, Dr. Louis LeEeuf and three other nieml)ers of the Orleans Parish :\redical Society, viz., Drs. John Callan, ^larcus J. Magruder and John F. Oechsner. This Committee was appointed to co-operate with the health authorities and to help to the best of their judgment in the campaign ahead of them. It was now fully recognized by these representative medical men that much valuable time had already been lost, and that the prophylactic measures which had up to this time been adopted by the health authorities were neither sufficiently extensive nor precise. The failure of New Orleans in this respect emphasizes what every International Sanitary Convention had drawn attention to, namely, the necessity of prompt notification of yellow fever. Without this, in- ternational and interstate laws of sanitation can not be administered with science, Avisely and humanely. On the evening of July 22nd, the Advisory Committee, the Medical Health Officer and Dr. J. H. White, V. S. ;Marine Hospital Service, after a protracted consultation, issued the first authoritative and collective pronounce- ment upon the precautions which were necessary to be adopted. The manifesto reads as follows : An emergency exists in our city which demands the attention of every individual, with the view to limiting and preventing the spread of epidemic disease. It has been scientifically proved that the mosquito is the only means of the transmission of Yellow Fever. Measures sCiould be especially directed against them. It is especially urged by the undersigned that the following simple directions be followed by the householders of this city during the summer months: ]066 aigustin's history of yellow fever. First — Empty all unused receptacles of water. Allow no stagnant water en the premises. Second — Screen cisterns, after placing a small quantity of insurance oil (a teacupful in each cistern) on the surface of the water. Third — Place a small quantity of insurance oil in cesspools or privy vaults. Fourth — Sleep under mosquito nets. Fift'J — Screen doors and windows wherever possible with fine mesh wire. (Signed) QUITMAN KOHXKE, Health Officer. J. H. WHITE, Surgeon, U. P. H. and M. H. S. ADVISORY COMMITTEE, O. P. M. S. Ou the same day (July 22) the aiithcritit^-, italizina: that New Orleans was unprcvided with a Fever Isolation Hospital, took steps to ac(piire an old house in the in- fected quarter in the Italian district. It seems, of course, very extraordinary that in the tyventieth century, and in a port of the jireat importance and size of Xew Orleans, that no proper provision should haye existed for the isola- tion of infectious cases. . There is no doubt, however, after having- paid dearly for their experience, that the Citizens of New Orleans will rot in future allow this defect to go unremedied. The Hospital receiyed its first patients on July 2r)th, and in spite of the fact that it was placed in the midst of most unsanitary surroundings and overcrowded, it, nevertheless, answered its purpose very well, owing to the very rigid precautions against the possibilities of mosquitoes becoming infected from the patients. It was, indeed, a most striking- demonstration of the harmle^^sness of the disease in the absence of the Stcf/ojuj/in ; seven non^ immunes, including myself, spent a portion of each day in the wards, but in no instance did infection arise. The entrance to all the wards was barred by double screened doors, so that one set c-f drjcrs were closed before the second set were opened. A few weeks after the opening of this Hospital, it be- came necessary to change into another temporary make- shift. WORK OF THE MEDICAL PROFESSION, 190.5 LEBi-UF. 1067 The new premises were lai'ij;er, more airy and situated amongst more sanitary surroundings. Owing to the sub- sidence of the fever, it had, however, far less work to do than the former. There is no doubt that the emergency hospitals did magniticent service, and that the greatest credit was due to Dr. Hamilton P. Jones, Dr. Paul Emile Arcliinard, Dr. J. Birney Guthrie, and to these who as- sisted them in the most arduous and difficult task, ren- dered still more trying owing to the ho^-tile attitude of tiiC poorer classes of Sicilians and Italians. Simultaneously with the fcrniation of the Medical Advisory Board, a meeting was held in the City Hall, under the auspices of tli3 Mayor, the State and City Health Officers, and a number of citi5:eEs prominent in business and professional life, to review the fever sitiia- tion~ and to raise money. The outcome of the meeting was the successful launching, under the chairmanshi]) of Mr. Charles Janvier, of a Finance Committee — The Citi- zens' Yellow Fever Fund Committee — for the purpose of collecting funds to carry on the tight against the fever. On Sunday, July 23rd, the Bevererd Dr. Beverlv Warner, from his pulpit, took the first step in Anti-Y(^lh>w Fever propagandism amongst religious derominations, and on Monday, Julv 24tli,' the Fourteentih Ward of the Citv organized and met for the purpose of cleaning up and screening its own district, and for authority to Issue an advertisement '"For bids to screen its 250 cisterns with copper gauze or cheese cloth, and for tenders to clean out the drains." All present at this meeting subscribed to the Ward Funds. Its example Avas immediatelv fol- lowed l)y the otl'(M- wards, rrd thus we started the Ward Organization, which was subsequently placed under the direction of Dr. Warner. It will now be simple to trace the steps in the campaign if I follow tlie work of the sev(M'al organizations: 1. The Local Medical Organization. 2. The Ward Oraanization. 3. The Public Health and ^Maiine Hospital Service Organization. 4. The Educational and Press Organization. 5. The Financial Organization. I06i augustin's history ok ^ eli.ow fever. THE LOCAL MEDICAL ORGANIZATION. Appeal for Ciric Co-operation. On Monday, Jnly 24tli, 1905, a prorlaniation was issned, signed bv the Mayor and concurred in by the ^Medical Authorities, setting forth the situation, and calling upon the citizens to co-operate with the Health Authorities in stamping out the fever. It read as follows: Mayoralty of New Orleans, City Hall, July 24th, 1905. To the People of New Orleans: The Health situation in this city is serious, but not alarming. Be- cause of this situation, quarantine has been declared against New Orleans by several States and Cities. It is proper that the actual facts be recognized and dealt with resolutely and calmly. It is authoritatively stated by eminent sanitarians that within recent years visitation of Yellow Fever, more widely spread than that wh:'ch is in our City, have been successfully met and absolutely suppressed by methods whose potency has been demonstrated by as- certained results, and the application of which is simple. T'lose methods are now adopted by our own State and City Health Authori- ties, with the volun'teer assistance of the United States Marine Hospital Service, and the Orleans Parish Medical Society of this Parish. To the perfect and speedy success of the mea:>ureo to be followed, the co-operation cf every householder is necessary. That given, the people may confidently expect a speedy release from the trying conditions in which they are now placed, and from the appre- hension of its recurrence in the future. I, therefore, as Mayor, urge all citizens and householders to render cordial and ready obedience to the instructions which may from time to time be given hy the Healt)'.i Authoritie.--, and to render every aid within their power to those Authorities in the earnest efforts which they are now making, and in which they will persist for the absolute stamping out of this infection. These instructions are not difficult of performance; tl'aey are easily to be understood, and can be followed with but little expense. Since the consensus of sanitary and medical opinion of to-day is that the infection of Yellow Fever is transmitted, or can be transmitted, only by means of the sting of the insect known as the "cistern mosquito," the following advice recently given by Dr. Kohnke, the City Health Office; by Dr. Souchon, President of the State Board of Health; Dr. White, Surgeon of t^ae United States Marine WORK OF THE Mi<;DICAL PROFKSSION, 1905 LeBeUF. 1 009 Hospital Service, and an Advisory Committee of the Orleans Parish Medical Society, should be willingly and implicitly obeyed by every householder in this city: First. — To keep empty all unused receptacles of water in every house, and allow no stagnant water on any premises. Second. — To screen all cisterns after placing a small quantity of in- surance oil (a teacupful in each cistern) on the surface of the water. Third. — To place a small quantity of insurance oil in cesspools or privy vaults. Fourth. — Sleep under mosquito nets. Fifth. — WCierever practicable, screen doers and windows with wire screens of close mesh. The foregoing advice may from time to time be given by the Health Authorities with more particularity. Whatever emanates from them must be accepted as given for the good of the city and the preserva- tion of every individual of its population, and should be respected and followed to the letter. I repeat, upon the information of t'iiose qualified from actual investi- gation and scientific knowledge to speak upon this subject, that the situation in our city is not alarming, and that if it is treated by our people earnestly and intelligently, that this situation will soon be eliminated and demonstration will be made to the world that for the future the infection cf Yellow Fever can have no permanent lodgement within the borders of the city of New Orleans. MARTIN BEHRMAN, Mayor. We concur in tCie above. QUITMAN KOHNKE, City Health Officer. EDMOND SOUCHON, M. D., President, L. S. B. H. J. H. WHITE, Surgeon, P. H. and Marine Hospital Service. ADVISORY COMMITTEE, Representing Orleans Parish Medical Society. II. APPEAL FOK EARLY NOTIFICATION. On July 24tli, 1905, a most iinportaiit notifo was also issued to the members of tlie ]Medical Profession from the Orleans Parish ^ledical Society, and sii^red by the Ad- visory (Vnimittee, Dr. \Miite, U. S. P. 11. & M. H. S., and the President of the Louisiana State Board of Health urging up6n each medical nmn the absolute necessity of 1070 augustin's history of yellow fevkr. early uotitication and of rcpoi-tiiiji all cj^hcs (if fever. It is iiuqiiestionably an exceptionally wise circular and touches a very weak spot. I reproduce it : Orleans Parish Medical Society, New Orleans, La., July 24, 1905. Dear Doctor: — We want to specially urge you to report all your cases of fever — malarial, typhoid or fever of any kind — during this summer, to the City Board of Health. It is absolutely essential to the checking of the spread cf Yellow Fever in our city that all cases of fever sihould be promptly and conscientiously reported. Our patients, the public and the surrounding communities, will naturally look to our profession in this great emergency, and the responsibility rests in a great measure with us to check this condition, or at least to limit its too extensive spread. It is a well known and scientifically proven dogma that the mosquito theory is to be accepted as a fact; then we must exert ourselves to the utmost to destroy the mosquito, the only host of transmission of Yellow Fever. Let us, 13hen, make a consis- tent campaign against it, educate our patients regarding this situa- tion and the danger of it, and direct them to place patients immediate- ly under netting pending action cf the Board of Health. Neither your patient nor the household will be subjected to the obnoxious house quarantine of several years ago. Above all things, report your cases promptly, to permit us to check any further foci of infection. Even if you are not positive tlhat the mosquito is the only source of transmission of Yellow Fever, give your city the benefit of the doubt in this important and vital matter. , Respectfully, BDMOND SOUCHON, M. D., President Louisiana State Board of Health. QUITMAN KOHNKE, M. D., Health Officer of the City of New Orleans. J. H. WHITE, M. D., Surgeon, U. S, Public Health and Marine Hospital Service, in charge of the Government Measures. JOHN CALLAN, M. D., J. F. OECHSNER, M. D. M. J. MAGRUDER, M. D., L. G. LeBeuf, M. D., Chairman, Advisory Committee, Orleans Parish Medical Society. WoRK OF THE MKDICAL PROFESSION, 190' LeBeUF. 1071 III. APPEAL FOR IMMEDIATE SCREENING OF SUSPECTED CASES AND FUMIGATION. This circular Avas immediately followed by another to the medical men, again urging the importance of early notification and careful fumigation. As regards the method of fumigation the circular is not as stringent on this subject as subsequent experience found to be abso- lutely" necessary to ensure safety: Orleans Parish Medical Society, New Orleans, La. Dear Doctor: — In an earnest attempt to work in harmony with the plan of procedure adopted 'by the HealUi Authority, and the U. S. Public Health and Marine Hospital Service, now being enforced in a general inspection of our entire city, we want to suggest to you, as your Advisory Committee acting with these bodies, that you report at once any case of fever in your practice remotely suspicious of being Yellow Fever. If you want to do your city the greatest good in this hour of trial, immediately constitute yourself as a Health Officer for the premises of the sick you are called to attend. Even before the regular Sanitary Inspector of the Board reaches the house, place the patient at once under a mosfiulio bar, pending further proceedings. •Also order at once another lOom fumigated with sulphur — 2 pounds to the 1,000 cubic feet — and then thoroughly scieen it. .'i it canG';t be done in a perfect manner at least order all the openings screened with either cheese c'ot'j' or other light material, well packed so a.i to allow no mosquitoes in the room. Keep only one door free, covering all the transoms in the same manner. On entering this door beat the air thoroughly with a cloth before opening. When the room is pre- pared, remove the patient to it, fumigating the room just vacated in the same manner. After the first three days of the fever the Stegomyia fasciata cannot be infected from that patient, but we must be careful to keep the room well closed until the final fumigation or destruction of any mosquitoes which might have remained in the room. Look to the general hygiene of the house, inquire whether the cirterns or any otTier open receptacles of standing water about the premises have been properly oiled or screened. Act in this matter regardless of the worK which will be done by the constituted authorities, for your own personal good and for the greatest good of your city. In other words, Doctor, take every possible precaution to protect all of your fever cases from being bitten by mosquitoes during the first three days of fever. 107 2 AL'GUSTIN S HISTORY OF YELLOW FEVER. Our interest in the entire matter is the same as yours, and we must worli for the same purpose. The part to be played by our profession is an extremely 'mportant one; the faith and trust of the entire com- munity is placed on our shoulders, and we must fully deserve fhe con- fidence reposed in us. Very sincerely yours, ADVISORY COMMITTEE, Orleans Parish Medical Society. IV. APPEAL FOR AN EDUCATIONAL CAMPAIGN. Another circular was issued on July 24tli, 1905, directed to the Board of Health, poiutiug out the necessity of a Campaign of Education, and urging the importance of asking the Clergy to especially disseminate knowledge from the pulpit in the matter of yellow feyer. The cir- cular then proceeds to give useful information in case of infection, and finally appeals for united action in a general warfare against the i^tcf/o)iii/ia : Orleans Pari;;h Medical Society, New Orleans, July 24th, 1905. Gentlemen: — ^The condition existing at present is one that calls for the most strenuous, prompt and vigorous measures capable of institu- tion. In view of the absence of the necessity for obnoxious local or house quarantine, the co-operation of physician and householder should be a matter of comparatively easy solution. A campaign of education s'hould be boldly inaugurated. The clergyman, during his rounds and from his pulpit, should be a valuable agent in the dissemination of this knowledge. The Advisory Committee of the Orleans Parish Medical Society begs to recommend that the following measures be instituted at once, with the view of stamping out the few foci of in- fection of Yellow Fever which now exists in our city: Cases of fever of any character developing in the infected area may be regarded as suspicious, and the patient immediately protected from mosquitoes. The house, cisterns, yards, drains, gutters, cesspools and vaults should be carefully inspected, and no breeding spots for mosquitoes should be overlooked. The gutters and streets must be carefully inspected, and no breed- ing spots for mosquitoes should be overlooked. The gutters and streets must not be neglected. If the case proves to be one of Yellow Fever, the house must be screened and the rooms in the house other than the one occupied by the patient must be fumigated to destroy all mosquitoes in them. When the case ends, either by recovery or death, the room occupied by the patient must be fumigated, for the same reason. WORK OF THE MEDICAL PROFESSION, 1905 Lb BeUF. 1073 The success of these procedures will largely depend upon the promptness and earnestness with w'hich mosquitoes are prevented from coming in contact with the patient and the destriction of all mosquitoes in the room after the patient is cured or dies. The new foci of infection must be diligently sought and drastic measures adopted for stamping them out. It is only through the pro- per conciliatory education of the physician and t'he layman, and through their sincere co-operation, that anything can be accomplished. For the vast portion of the city not infected, we recommend that a sufficiently large force of men be immediately organized to place oil in all unscreened cisterns, or other breeding places of mosquitoes, and distribute circulars among householders enlisting t'heir co-opera- tion. All gutters should either be flushed or oiled. An active, vigorous and persistent warfare on mosquitoes should, in our opinion, be immediately instituted from one end of the city to the other, as in this way localities now healthy may be kept so, even though foci of infection be Introduced. We believed t'hat the sanitary regeneration of this city depends entirely upon prompt and vigorous action upon your part.. With the profoundest assurances of our heartiest co-operation with you in any movement to better the sanitary conditions of the city, We beg to subscribe ourselves, ADVISORY COMMITTEE, Orleans Parish Medical Society. V. A WAEXIXG TO BEWARE OP THE DANGER OF OVERLOOKING THE LESS OBVIOUS BREEDING PLACES OF THE STEGOMYIA. A Tery useful aud practical notice was also sent out by the Advisory Committee, directing- attention to the importance of not overlookini«- possible receptacles of water in the house, as pitchers, flower-pots, etc. It reads as follows : Orleans Parish Medical Society, New Orleans, Louisiana. We desire to call your attention to the wrigglers seen inside of the residence of people. Probably the public in the fight against fhe mosquito have directed all their efforts against the cisterns and the barrels or the outside containers, still a source of great danger also exists inside of the bedrooms in the water-pitchers, in the dining- room, or in the conservatory in the water-pots, vases or pots for plants. A frequent error and a great menace Is t'he habit which some householders have of only partly emptying a water-p.itcher, and though 1074' AUGUSTIN S HISTORY OF YELLOW FEVER. it is refilled daily it is^ never entirely emptied, leading always one-half pint or so for the larvae to develop. Any physician in his daily rounds can see this illustrated by inspecting the various water-pitchers in the bedrooms. On this same line we beg to again call your attention to the accumu- lation of water in the urns of the cemeteries, as well as in the sagged gutters of the house drains, which are a great source of mosquito breeding after rain. VI. APPEAL FOPv A MORE SKILLED MEDICAL BODY TO CONDUCT THE CAMPAIGN. On August the 4tli, tlie fever still makino- headway in spite of all local efforts, the Advisory Board took very decided action. It candidly expressed the opinion that it had not confidence in the efficacy of the work performed up-to-date; THAT THIS WORK IMUST BE ABSO- LUTELY PERFECT IN ITS WORKING TO BE EFFI- CIENT, and to accomplish the desired re-organization it was necessary to call in the assistance of the Public Health and ^larine Hospital Service of the United States : Orleans Parish INIedical Society, New Orleans, La., August 4th, 1905. City Board of Health, New Orleans: As there has appeared a new case in the Frye focus, which ihas been in existence since Monday, while we had been told that the instruc- tions previously agreed upon in the management of all maturing foci had been rigidly carried out, and especially so in this case. As we are not satisfied that the fumigation performed by the City Board of Health has been absolutely effective, we feel, as we have shared some of the responsibility of this work, and that it is a matter of too great importance to be kept on in this unorganized and unsystematic manner. This is the first serious visitation of Yellow Fever in this country since the mosquito has been recognized as the only mode of transmission, and we are unwilling to support the City Board of Health in what we consider an ineffective service. We regard this as the first crucial test in America, and it must be absolutely perfect in its working to be efficient. We think that the community has lost confidence in this work. We know the profession has lost faith in it. Hence, we cannot keep on up^holding a system in which we do not fully concur, so we desire to strongly recommend WORK OF THE MEDICAL PROFESSION, 1905 Le BeUF. 1075 that the system be completely reorganized, or that the entire Yellow Fever situation in New Orleans be placed in the absolute control of the United States Public Health and Marine Hospital Service. Very respectfully yours, ADVISORY COMMITTEE, Orleans Parish Medical Society. As a result of this letter and of a telegram despatched to the President of the United States, the Public Health and Marine Hospital Service assumed, in a few days, assumed control of the campaign. The Advisory Com- mittee, however, continued their useful work and co- operated with the new forces under Dr. White, just as they had done with the Local Health Authorities, con- tinuing- to issue, with the advice of Dr. White, most useful circulars, and to generally encourage in every way the citizens to keep up the tight Avith unahated vigor. As the circulars which thc^y issued show a thorough knowl- edge of the situation and great foresight, I gave them in fail. VII. LETTER WARNING MEDICAL INIEN NOT TO OVERLOOK THE MILD TYPE OF YELLOW FEVER WHICH :\L\Y P>E FOUND IN THE NATIVE BORN. Orleans Parish Medical Society, New Orleans, La., August 17th, 1905. Dear Doctor: — In the consistent campaign we are now waging throug^hout the city against the fever we want to enlist your hearty assistance. We have shown up to now a uniform activity, and if some of the work already accomplished begins to show some little improvement, we feel it is greatly due to your co-operation. This, though, is the crucial moment and you must keep up reporting all your cases with unfailing promptness. THE NATIVE BORN WILL UNDOUBTEDLY BEGIN TO BE AFFECTED, AND WILL SHOW THE LIGHTEST AND MILDEST TYPES OF THE DISEASE; IT IS SPECIALLY WITH RE- GARD TO THESE THAT WE WISH TO WARN YOU, FOR IT IS AS IMPORTANT TO THE SUCCESS OF THE WORK BEING DONE BY THE U. S. P. H. AND MARINE HOSPITAL SERVICE THAT THE MILD CASES BE REPORTED AS WELL AS THE MARKED CASES. THESE MUST BE SCREENED AS CAREFULLY AS OTHERS. 1076 AUGrSTIN's HISTORY OK YELLOW FEVER. One stegomyia infected, in the first three days from such a case, can produce a number of serious and even fatal cases. Tae means employed are being systematized and rendered less objectionable daily by the service, so let us endure a little inconvenience for the welfare of all. Beware of the so-called immunization or acclimatization fever and report these cases as promptly and rigidly as if they were perfectly characteristic, so that the authorities will be able to give them the same sanitary treatment. Very earnestly yours, ADVISORY COMMITTEE, Orleans Parish Medical Society. VIII. APPEAL TO HOUSEHOLDERS TO DELAY ^'MOVING DAY" OX ACCOUNT OF DANGER OF SPREADING INFECTION. In view of the near approach of "Moving Day" (October 1st) the undersigned deem it their duty to direct your attention lo the danger likelv to attend a general moving of tenants from house i ) house. Persons moving from infected localities may later uev-j'op the ;ever in uninfected neighborhoods, thereby developing new ro ;. Others now residing in uninfected houses may contract the disease by removing into houses where mild cases of fever may have occurred and re- covered without medical attention, and consequently escaping fum)?"a- tion. Non-immunes coming into such 'houses will almost inevitably contract Yellow Fever, thereby adding to our present troubles. We do therefore urge the importance of taking such steps as may be necessary to delay the general movement for at least thirty days. ADVISORY COMMITTEE, Orleans Parish Medical Society. IX. DANGER OF RE^IOVAL OF TEMPORARY CISTERN SCREENS. Orleans Parish Medical Society, New Orleans, La., September 13, 1905. There being a pretty general understanding in the community that the cheese-cloth screens over cisterns have to be removed by October 1, and the regular 18-mesh to the inch wire screen substituted by that date, we believe that a number of persons are now having this change done to the great danger of a general liberation of all mosquitoes im- IM-isoned or bred from the pupae in the cisterns. We cannot afford, in the final fight of checking Yellow Fever in our midst, to neglect so important a matter as this, so we strongly urge that the change from WORK OF THE MEDICAL PROFESSION, 1 &05 LeBeUF. 2 077 (^lieese-cloth to wire, if not legally postponed until December 1, shall be by having the wire screen placed over the cheese-cloth without re- moving the latter. ADVISORY COMMITTEE, Orleans Parish Medical Society. Besides all this work, the Orleans Parish Medical Society issued seven thousand pamphlets of directions and instructions to the medical profession and the trained nurses of the entire South. Tln^se pamphlets were sent broadcast at the expense of the Treasury Deitartment of the United States. The c( intents of these pamphlets were carefully written by Dr. Kudolph ]Matas, and were approved hy the Society as an exact clinical and pro- phylactic treatise of the entire yellow fever treatment. In conclusion, let me add that the hard-worked pro- fession of New Orleans never demurred when called upon to do its duty in the repression of the epidemic. The fol- lowinji' al)le phyt'icians lectured ?nd demonstrated the propaganda of sanitary and hyj>enic rules in every corner of the city; from the pulpit of churches and synaocx>ues to the factories on the river front; from the nes^ro meeting houses back of town to the school houses on the front of the city. Yes, and further still, many were called cut to speak in country places as far as Opelousas and ^fer Rouj?e, at their own expense, and at great sacrifice to their practice. Amongst a list of volunteers, I Avish to name those that come to my juind at this moment: Dr. Juan Guiteras, from Havana; Sir Rupert Boyce, Dean of the Liver])ool Sclioid of Tr(f])ical ^Medicine, from England — two experts, as distinguished volunteers in our cause; Dr. Quitman Kohnke, wlu;se Lantern Slide demon- strations were most conclusive and interesting; Dr. Bev- erly AVarner; Dr. O. L. Bothicn-; Dr. Allan Eustis; Dr. P. E. Archinard; Dr. Chas. Chassaignac; Dr. J. 11. AVhite; Dr. J. A. Storck; Dr. Ilenrv D. Bruns; Dr. II. B. Oess- ner; Dr. S. L. Theard; Dr. John Oallan; Dr. J. B. Guthrie; Dr. E. D. :Martin; Dr. M. J. :\ragruder; Dr. John E. Oechsner; Dr. E. L. :McGelKe and Dr. Jos. Dolt. 107S STATISTICAL REVIEW OF THE YELLOW FEVEPw EPIDEMIC OF 1905, NEW OPLEAXS. P.Y JULES LAZARD, M. D., NEW ORLEANS, Statistician of the YcJloiv Fever (Uiin])ai(/u, Xeic Orleans^ 1905, U. S. rnblic HealtJi and Marine Hospital Service. General Remarks. Ill epidemics of all diseases, reference is always made to the previous visit of the disease in a community. Dur- ing the epidemic of 1905 in New Orleans, the table of the epidemic of 1878 was used in studying the progress of the disease, as this epidemic resembled the one of 1905, only that the latter began earlier in the year and for that reason it was prognosticated that it Avould be more severe, a prophecy not borne out by later results. Because of the use made of the figures of 1878, Avhicli were inaccurate and fragmentary, it was deemed advis- able to i^lace in a compact, intelligent and accurate form, the figures of 1905. The writer is quite aware that figures are very dry and uninteresting, unless some point is to be illustrated or proved. Xew Orleans succeeded very well f'or a number of yeais in keeping yellciw fever out by maintaining a maritime quarantine and an inspection system against the Tropics. This system succeeded very well from 1898 to 1905, but "the best laid schemes (if mic:> an' men," etc. It was in no position, however, to successfully combat the disease once it entered the community, except by some gigantic movement, entailing the labor of many men and the ex- penditure of much iiKsney. .^luch tinu' is Ic-st in training men, physicians, fumigators and laborers before the force can work intelligently. It was clearly seen in 1905 that the success of a fight against an e])idemic de])ended abso- lutely upon organization and e(|uipment. Good and liad are difPerent sides (if the same picture. The entry of the disease in 1897, with a slight reappear- ance the following year, taught New Orleans the ineflfici- STATISTICAL REVIEW, 1905 LAZARD. 1079 encT of her archaic sewerage system and her poor, poor water siipi)lY system, thonjih she was on tlie banks of the world's i;r(^atest river, flowin"' tlie purest water. The A'isitations of yellow fever above noted gave New Orleans sn^iiiestion for a change in these important sys- tems of a municipality. In 1807 and 1898, the mosquito doctrine was not fully known, or not known at all, but the helplessness of the city and the fervent prayers for an early frost, clearly indicated that something of a most radical sort must be done, if ever this disease made its entry again. A new drainage and water system was voted and passed upon. This was the good side of the picture of the epidemics of 1897 and 1898. Otherwise there is no telling how long the city would have delayed in insti- tuting these sanitary reforms. "With a free supply of water, cisterns — vats for collect- ing hnd retaining rain water from roofs — will soon lie torn down by order of the law, unless the "Taxpayers' Association" is stronger in its opposition than it seems to be. This will rid the city of the greatest breeding places of the l>^t('(/o)ni/ia fasciata or calopus, or whatever we may presently decide to call the mosquito which has cost the South so many thousands of lives and such vast sums of money. On July 21, 1905, a quarantine was declared against New Orleans by the neighboring states. There is no way by which it can be definitely stated when the first case appeared in this city. This is always a difficult matter. Below are some deaths taken from all sources — the records of the City Board of Health, Charitv Hospital, Touro Infirmary, Hotel I )ieu. It is conceded by all who watched the progTess of the disease that it began in the "Tnf(M'ted District," an area from tlie :\rississippi Biver to the wood side of Bourbon Street and the lower side of St. Ann to the upper side of I<:s])lanade Avenue — the "Little Italy'* of New Orleans, an area covering twenty-four Sipiares. Here is the record : "SUSPICIOUS" DEATHS, 1905, PREVIOUS TO EPIDEMIC PERIOD. June 19— L. M., Italian, aged 51— Chronic nephritis and aortic aneurism. June 20 — L. K., Austrian, aged 28 — Malarial remittent fever. 1080 avgustin's history oe yeilcw fever. June 23—1. B., Italian, aged 28— Malarial fever. July 1 — A. S., Italian, aged 40 — Endocarditis, 1118 Gallatin. July 2 — J. M., Italian, aged 14 — Continued fever. 1118 Gallatin. July 3— diV., Italian, aged 2— TyiAoid fever. lllS Gallatin. July 9— S. A., Italian, aged 24— Malarial Taxemia, 520 St. Philip. July 10— G. v., Italian, aged 65— Oastric Cancer, 528 St. Philip. July 12 — F. S., Italian, aged 28 — Ac. par. Nephritis, 1021 Decatur. July 12 — A. L., Italian, aged 26 — ^Hemorrhagic fever, 1039 Decatur. July 12— F., La., aged 16— Febris Hemorrhagica, 1028 Chartres. July 13— G. G., Italian, aged 32— Chr. Par. Nephritis, 528 St. Philip. July 17— F. S., Italian, aged 30— Typhoid, 1026 Chartres. July 17 — L. G., nationality not given, aged 45 — Alco^holism, 1105 N. Peters. July 17— J. S., Italian, aged 52 — Malarial fever, 1107 Decatur. July 17 — F. S., Italian, aged 45 — Pneumonia, 605 St. Philip. July 17— G. T., Italian, aged 46— Typhoid, 528 St. Philip. July 17 — J. E. A., nationality not given, aged 1 — 'Pertussis and Cong. of the brain, 1127 N. Peters. July 17— J. M., Italian, aged 14— Continued fever, 528 St. Philip. July 17— S. R., Italian, aged 22— Typhoid, 1123 N. Peters. July 18— J. G., Italian, aged 47— Typhoid, 1113 Chartres. July 18— Di S., aged 30— Typhoid, 514 Ursulines. July 19— N. T., Italian, aged 29— Typhoid, 533 St. Philip. July 19— V. S., Italian, aged Typhoid, 1139 Royal. July 19— L. B., Italian, aged 68— Typhoid, 1031 Chartres. July 19— R. M., Italian, aged 56— Typhoid, 1117 Decatur. July 20 — J. L., Italian, aged 53 — Malarial fever, 17th St. Canal. July 20— L. E., Italian— Typhoid, 1022 Conti. July 20 — S. v., Norwegian, aged 30 — Typhoid and Ac. Nephritis. July 20— G. D. A., Italian, aged 51— Typhoid, 528 Ursulines. July 20— B., Italian, aged 19— Typ'hoid, 528 Ursulines. July 22— M. C, Italian, aged 38— Typhoid, 624 St. Philip. July 22— D. di V., Italian— Malarial fever, 1115 Gallatin. July 22— G. R., Italian, aged 38— Typhoid, 524 St. Philip. July 24— M. G., Italian, aged 24— Anuria, 530 Ursulines. The report of tlie.se deaths is submitted as "'suspicious'* for the chief reason that they occurred in the "Infected District,'' or bore some rehition to tliis locality. Amonj^- other things Avhich New Orleans learned for herself and tau«»ht the world is that free publicity should be given to the first case. It does not pay to keep it as a secret, because it is a secret that refuses to be kept, and other reasons. The watchword for all communities when dealing with a contagious disease is Publicity. STATISTICAL REVIEW, 1905 LAZARD. 108! The figures below are as the cases appeared, are official, and Avere compiled by the writer in his daily rei)ort to the officer in command during- the e})idemic. From the in- ception of the disease to August 8th, the City Board of Health was in charge; after this time until to close of the ei)ideniic in Noyember, the U. S. Public Health and Marine Hospital Seryice^ — Dr. J. H. White in command, was in charge of the fight against the disear^e. The disease was fought on lines laid down by the mosquito doctrine; its success is a part of the history of the city, and a bright example of modern epidemiology. When quarantine was declared against the city, it was agreed upon that there must haye been 100 cases and 20 deaths prior to this date. A figure which is approxi- mately correct as in the beginning of the epidemic and up to August 5, the mortality was about 20 per cent. When the Marine Hospital Seryice took charge August 8, there were 101 foci, counting the ''Infected District'' as a single focus. On Xoyeml)er 7, there bad been 842 foci — meaning that there were 812 squares in which yelloy\' feyer had occurred. A "focus" was arbitrarily fixed and had no practical value in watching the course of the disease, it came about by staining the map of the city in the square in which a case appeared for the first time. A focus when once established was counted throughout the epidemic as a focus, when as a matter of fact it was no longer infectious It is best in all epidemics to giye the public all informa- tion desired, but this must be of the cliaracter that will be understood. A focus was not understood, and the public assumed very correctly from its limited knowledge that there were 812 points of infection in the city. DAILY RECORD OF CARES AND DEATHS AND CASES UNDER TREATMENT, 1905 EPIDEMIC. Under rinler Da' e Cases Deaths Treatment I )ate Cases Deaths Treatni't July 20 100 20 July 26 15 6 21 — 1 27 26 2 22 20 3 28 21 3 23 10 2 29 29 7 24 14 1 30 27 3 221 25 11 4 31 21 5 158 1082 ai'gustin's history of yellow fever, ] Sept. I'uder X'nder Cases Deaths Treatment Date Cases Deaths Treatm't 1 42 6 177 Sept. 16 42 2 370 2 32 11 190 17 24 2 363 3 54 5 226 18 34 6 351 4 43 5 257 19 34 4 341 5 30 8 270 20 50 6 365 C 28 8 266 21 36 4 359 7 32 8 272 22 37 4 352 8 60 4 306 23 45 6 352 9 63 7 338 24 24 2 331 10 68 5 385 25 37 3 322 11 61 9 401 26 31 5 308 12 105 9 476 27 19 5 300 13 50 12 465 28 23 4 291 14 55 12 470 29 28 2 287 15 62 6 504 30 31 2 272 16 66 4 546 Oct. 1 23 3 260 17 74 4 592 2 19 3 243 18 62 8 590 3 30 2 232 19 58 4 588 4 22 4 228 20 45 4 566 5 2S 3 219 21 61 9 566 6 25 4 214 22 57 9 518 7 29 3 226 23 53 5 528 8 19 226 24 44 7 522 9 17 1 216 25 65 6 525 10 18 4 201 26 47 10 500 11 16 2 195 27 31 13 448 12 15 2 192 28 45 5 434 13 25 4 185 29 45 7 418 14 19 5 181 30 46 4 419 15 9 3 162 31 41 6 402 16 15 3 155 1 39 4 389 17 6 1 144 2 37 3 375 18 5 130 3 29 o 364 19 8 122 4 55 5 405 20 4 112 5 32 2 348 21 7 105 6 31 4 357 22 2 94 7 35 6 346 23 4 77 S 44 4 348 24 4 2 65 9 41 1 346 25 9 2 66 10 27 7 331 26 3 57 11 38 334 27 2 4 58 12 43 3 340 28 4 39 13 43 4 353 29 2 1 32 14 49 6 346 30 4 26 15 43 2 357 31 3 2 22 STATISTICAL RKVIKW, 1905 LAZARD. I OSS Under Under Date Cases Deaths Treatment Date Cases Deaths TreatmU Nov. 1 2 19 Nov. 10 2 1 17 11 3 1 1 14 12 4 1 13 5 11 14 6 10 15 ' 7 11 16 1 8 9 Total 3,402 452 The i^eneral mortiility was 13.11 per cent., tliougli this must l)e coiisidered as beiuo- too low for the general epi- demic; bnt for the want of better figures we may accept this as the mortality for the yellow fever epidemic iu Xew Orleans in 1905. It is easy to understand that many cases were called yellow fever unless they showed very pronounced symptoms of other diseases early in their courses, owing to the importance of screening the cases early. Up to August 31, the Italians of native birth furnished 51 per cent, of the mortality. After this date the fire having consumed all available material in the ''Infected District" slowly became more evident in other residential districts. Deaths Clas-sified According to Age. Deaths from yellow fever up to November 8, 1905: Ages— 1-2 S 3-5 11 G-IO 10 11-15 38 10-20 50 21-25 50 20-30 05 31-35 30 30-40 47 41-45 30 40-50 23 51-00 27 01-70 10 71-75 1 430 lOS* augustin's history oe yellow feyer Conceded by Board of Health . . 20 Unclassified 2 4o2 Deaths by ]Moxths. July 57 August £20 September Ill October • 58 November 8 G ■152 Mouths. Male. Female. July 24 13 Auiiust 157 63 September 73 38 October 30 26 November 6 Males 290 140 Females 140 Board of Health . . 20 Unclassified 2 452 Deaths According to Nationality. Nationality. Deaths. Italy .'. 164 Fi'auce 30 (Jei-many 18 Austria 6 INlexico 4 Bussia 4 CMiiua 1 Sweden 1 Switzerland 1 Canada 2 Greece 3 Ireland 3 Australia 3 STATISTICAL REVIEW, 1905 LAZARD. 1085 Scotland 1 Denmark 1 Portngal 1 Norway 1 Spain 1 Holland 1 255 United States .'. 197 452 Louisiana furnished 137 of 197 deaths; many of which w^ere of Italian parentage. Six negroes died of yellow fever in this epidemic. On August 12, there were 105 cases rei^orted. This jump in the number of cases Avas more apparent than real and requires some explanation. In the interim of the transfer of tlie charge of the epidemic from the City Board of Health to the U, S. Public Health and Marine Hospital Service, there were a great number of medical inspector's cards which were held over for some days, while the arrangements were being perfected and the force or- ganized. It being the close of the Aveek, Saturday, the cards AA^ere counted in as neAV cases. On September IG the Diamond FestiA'al AA'as given, the revenue of Avhich went into the yelloAV fever campaign fund. On October 26, President Koosevelt paid the city a Aisit. His visit to the city allayed the scare, the "could get aAvays" returned, and commei ce, Avhich Avas not hurt as badly as in 1897 and 1898, AA'as resumed. Comparative ^Mortality, 1901, 1905, 190G. Comparative mortality from all diseases for Ncav Or- leans : 1901. 1905. 1906. w. c. w. c. w. c. June 17.15 28.57 19.68 29.72 19.29 35.32 July 16.22 28.43 19.53 22.46 15.82 30.00 August 14.57 24.43 26.01 27.91 17.34 31.36 September 15.19 25.14 18.57 27.77 12.54 24.41 October 15.76 19.11 17.02 31.53 15.70 28.33 November 17.76 30.71 16.72 27.23 17.68 30.82 1086 REQUIKEMENTS OF THE M0kS(21 ITo DOCTRINE.* BY DR. S. L. THEARD. Sccrctaru to Ciiij Board of Health, Xcic- Orleans, La. It was my intention at first to prepare an elaborate article, reviewing and analyzing some of the more im- portant recorded facts and incidents of our immediate sanitary history (and some as 3'et unrecorded ones), but I soon realized that whateyer might be said must finally be made to rest upon certain primary basic principles, a brief consideration of which would be all-sufiicient ; for upon their intelligent application must eventually depend the success of all sanitary' operations directed at the con- trol of yellow fever. I take for granted that everybody accepts to-day the mosquito doctrine of yellow fever transmission — that no one any longer seriously disputes the fact that the stegomyia mosquito, a most ccinmon species of the insect in the South and the Tropics, is the natural conveyer of of yellow fever ; that mosquitoes can suck up infectious germs from the blood-stream of yellow fever patients only during the first four days of the disease; that stegomyia mosquitoes become infectious only ten or twelve days after becoming contaminated; that tlie^- can transmit in- * The two articles which follow are from the pen of Dr. Sidney L. Theard, who has been closely associated with the health affairs of New Orleans since the establisfhment of a municipal hoard of health for that city in September, 1898, serving that body in the capacity of secretary and sanitary officer. The articles are reproduced from the transactions of the Louisiana State Medical Society for 1906. They are introduced because they contain som© important local history not generally known, and also because his conclusions are so different from those gener- ally accepted at the time. In one of the articles Dr. Theard has shown, with the force of mathematic precision, the invaluable services rendered by him in the fever fight of 1905.— G. A. MOSQUITO DOCTRINE THEARD. 1087 fection continually thereafter, at intervals of feeding, until death; that .stegomyia^ bite preferably in the day- time; that a non-immune inoculated by tlie l)ite of an infectious mosquito will show symptoms of yellow fever only three or four days afterwards (exceptionally, five or six). Rigid tests, both direct and eliminative, have established all of this. I assume also that the more important characteristics and habits of this species of mosquito are Avell-known, for instance, that it is a domestic, not a migratory mos- quito, flying but short distances and being habitually found within houses. All of which is suflflcient for present purposes. The fact, for instance, that only the female bites and not the male, is a matter of no practical importance here, how- ever entertaining it may be to lay audiences; for sanitary measures directed at mosquito destruction will in all like- lihood never include the weeding out of the males from the females. Ko greater importance attaches to many other details, purposely omitted here for that reason. To maritime quarantine the application of the mos- quito doctrine is most simple, fJicorcficalli/: It calls for disinfection, with an efficient culicide, of all vessels from infectible ports, together with their cargo, before unload- ing, and the detention for five days, for observation of all persons from such ports. This can never be put into practice, however, because of the exigencies of trade and travel. The disinfection of the cargo of fruit vessels, for instance, most attractive to mosquitoes (as much so almost as sugar), could not be effectively carried out with- out so injuriously affecting the fruit as to make it un- marketable. Again, I seriously doubt that hindrances thrown in the path of an American citizen because of the mere possibility of his being infected in consequence of his accidental residence in some port classed as "in- fectible," could stand the test of law. There is even less probaltility that nu'asur(>s api)roxi- matiug the extreme requireuHMits of the mosquito doctrine will ever be operated in guarding against the entrance of 1088 augustin's history of yellcvv fever. infection by way of the back-door — the railroads; for experience has tan<;ht ns tliat danger from that source is mucli less, and restrictiye measures will probably- alwa3'S be less stringent in consequence. The point which I wish to make clear and emphasize, is, that no system of (juarantine will eyer proye an ab- solute safeguard against the entrance of pestilence. It will merely reduce the danger to a minimum. Eyen if an apparently ideal system could be deyised, sober judgment would temper our expectations Ayith the thought that perfection, unfortunately, is of another world only. Our present system of maritime quarantine could be made the highest expression of what will probably eyer be attempted in this direction, at least for many years to come, by reyerting to the former practice of disinfecting the empty hold of fruit-yessels from iufcctihle as well as from infected ports. This seems to liaye giyen us tem- porary immunity in the past, for a period of years, as was pointed out to this Society at its 1903 meeting. We cannot brush by lightly the possibility of future infection. Just as long as yellow feyer exists, and I am yet to learn of a single disease which has eyer been wiped out from the face of the earth (names change, but dis- eases remain) ; just as long as there are stcgomyiip flying loose somewhere in this wide world of ours; just so long- will we haye to reckon with the possibility of the re- introduction of yellow feyer infection and be prepared to preyent its spread wlu^n it appears. AVhat, then, should our conduct be when the disease shows in our midst? is the (piestion which naturally sug- gests itself. Careful consideration of the mos(|uito doctrine, in its application to the local control of the spread of yellow feyer, forces upon us three conclusions : First. We must prevent the access of non-infected mosquitoes to yellow fever eases durinf/ tJie first four daj/s of the disease. This can only be done by the judicious use of the mosquito-bar, and those yarious oils so repul- MOSQuirO BOCTRINE THKARD. 1089 sive to mosquitoes. Necessarily the results obtained will lariiely depend upon the active co-operation of the house- hold. Second. Wc luiist destroy mosquitoes posslhhj already infected. This can be accomplished, partly by screening of the infected room or rooms (to prevent the escape of contaminated mosquitoes until thc}^ can conveniently be destroyed), and partly by fumigation (more especially of living apartments). In a measure we must again depend upon the co-operation of the household, both active and passive. Exceptionally another room may be prepared by screen- ing and fumigation, for the reception and further treatment of the case, and all mosquitoes immediately destroyed, by fumigation of the remaining rooms. Oiling of water containers in the infected and eight adjacent squares will also serve to diminish the number of mosquitoes liable to become infected, either from the actual case if the screening is imperfect or not continu- ously practiced, or from some other unrecognized or un- rej^torted case in the same neighborhood. Fumigation of contiguous houses might also be prac- ticed, where permitted. Third. IT^c must prevent the access of uon-Uuniuues to infected localities or infected premises. This can only be accomplished hj the judicious use of the sanitary cordon at the outset, and later of a modified house-quarantine for the prevention of promiscuous visiting and the removal of persons, possibly in the incubative stage of the disease, from infected to non-infected districts. These are the three basic requirements — the indis- pensable tripod — in all measures directed at the control of 3'ellow fever. They are the inevitable corollary of the Mosquito Doctrine; they naturally flow from it. To ignore any of them would be a grave mistake. Such omission could only result from the grossest ignorance of the subject or the poorest judgment. Or else we would have to look for its explanation in the inability to enforce full measures of prevention, because of a half -stand Avrong- fully taken at the outset, and persistently kept up there- 1090 aigustin's history of yellow fever. after for the aj^parent sake of consistency — the result of a rein^ehensible and futile effort to practice that al)om- inable policy — concealment. Futile indeed, for truth in the end must inevitably prevail. The principles themselves are not new. As for the methods here suggested for their enforce- ment, they have with me the strength of faith ever since my acceptance of the mosquito doctrine, and are, as suc- cinctly stated, the same views held and the same recom- mendations made, to the proper health authority, as early as July 13th, 1905. No one disputes the correctness of the first two jiroposi- tions : screening of patients and infected premises, and destruction of mosquitoes. Regarding the third there seems to be a divided opinion, (as far as I have been able to ascertain in couAersation on the subject). Some favor the sanitary cordon under all circumstances; others are in doubt as to its possible effect for good, save in the first two or three cases. All, however, seem to agree that a modified house-quarantine is most important. By modified house-quarantine I mean the stationing of guards at the door of infected premises to prevent re- movals and promiscuous visiting. No further restrictions need be placed on the members of the household, who can not, as we now know, convey infection to others, and who would be at perfect liberty to enter and leave the house as they please. In the light of the mosquito doctrine, the stringent measures of 1897 are no longer permissible. Guards might, additionally, l)c stationed at the four corners of badly infected s(|uares. And if the desirability of operating this measure be granted, we have, in essence, the rudiments of a sanitary cordon, which can be made large or small acocrding to the exigencies of the case, and the auiount of infection to be contended with. With this important difference, however, that such restrictive measure should be applied at the very outset, on the first intimation of the ])r('senco of infcctiou, in an endeavor to strangle' the disease outright, and not Ije gradually evolveel as the epidemic progresses. MOSQUITO DOCTRINE THEARD 1091 Agaiust liouse-quarantine the only argument, with a sembhiuce of force, wliioli can be advanced, is, that rigid measures might tend to discourage the reporting of cases. To begin with, a modified house-quarantine, such as 1 have suggested, is not a rigid measure. Nevertheless, let us carr}^ the argument to its logical conclusion. There are persons who object to a guard in front of their house in small-i)ox; others, to sanitary surveillance of conval- escent scarlatina cases; still others, to disinfection after diphtheria, or to a card on their door, or to any sanitary care and attention which ma^^ be bestowed upon them by boards of health. Shall all of this be abandoned in con- sequence? The very absurdity of the proposition be- comes apparent. The epidemic of 1005 has frequently been compared with that of 1878, and most laudatory conclusions have been drawn therefrom, from time to time. The truth of the matter is, that, while much was accomplished, a good deal of whpt might have been done was not even at- tempted. And here is tlie result : Though the screening of patients, and the wholesale destruction of mosquitoes, by fumigation and oiling, the number of cases Avas markedly reduced; it is probable, also, that the character of the epidemic was changed, from what appeared to be at the outset a most virulent type, to a much milder form of the disease; for, remember, the degree of reaction in indi- vidual cases depends as much upon the number of bites inflicted by contaminated mosquitoes as u])on tlu' degree of infectiousness of the contaminated mosquitoes them- selves. But, through failure to regulate the access of non- immunes to infected premises and localities, the disease was permitted to spread rapidly to the four corners of the city; and, appearing in our midst at about the same time that it had shown itself in 1878, it disappeared only when the usual duration of yellow fever e]u*demics had been spent, some ten days sooner only than in 1878. These are the bare facts of the subject, presented witli- out any blatant effort at rhetoric. In concluding, let me say that nothing is further from my mind than the desire to minimize or discredit any 1092 AUGUSTIX'S HISTORY OF YELLOW FEVER. good work wliicli may have been done iu the past^ or which may now be under way. The wholesale destruction of mosquitoes last summer was a most essential, proper and laudalde undertakino-, however costly and liowever much complained of at times; and the measures now operated throughout the city to stay the rapid breeding and multiplication of stegomyia^, are no less meritorious. At no time, in fact, should there be a relaxation in all those preventive measures, which alone hold out a promise of relative immunity. At no time should there be a lull, from a false sense of security, in that costly vigilance which is the price of safety. 1093 NEW ORLEANS YELLOW FEVER IN 1905.* BY DR. S. L. THEAKD. If the history of the yellow fever of last siiinmer is to be written in the aunals of this Society, there at least ]et it be written right. If what I am about to say has the appearance of an effort at self-praise, I earnestly ask that you pause a while and consider, that whatever may be said by me now, might have been said some eight or nine months ago, that I persistently refrained during all of that time from any public expressions or utterances in the matter, and that I am speaking now under stress of circumstances. The claim which I, in turn, advance (and it will be made good hy dates and by facts), is: That the back- bone of yellow fever was broken in this city last summer whilst the lamented Dr. Richardson and myself were in charge of the special sanitary operations of the Board of Health. As much was done then as could be accomplished at the time within the lines authorized by the Board of Health. Surely the disease could not have been aborted, for at no time was this feasible in the absence of any restrictive measures calculated to prevent the removal of persons, possil)ly in the incubative stage of the disease, from in- fected to non-infected districts, or the access of non- immunes to infected premises, and the consequent dissem- ination of the disease in that Avay. Now for the facts. Knowledge of the presence of yellow fever infection in New Orleans last summer was first had on the afternoon of July 12. On July 22 announcement of the fact was made by the State Board of Health. From July 13 to July 22 the sanitary measures prac- ticed were instituted, conducted and supervised by the City Health Officer. During that tinu' I was engaged in other work at the office of the Board of Health. See foot note to preceding Article. 1094 AUGUSTIn's HtSTORV OK YELLOW FEV«R. Ou July 23, after the announcement of yellow feyer, the sanitary operations of the Board were entrusted to m^' care and superyision. On Jul^^ 26, Dr. Farrar llich- ardson, of the Public Health and Marine Hospital Seryice, became associated with me in that work. The health officer at that time was engaged more especialh- in the deliyer^' of public addresses calculated to arouse the in- terest of the masses in the mosquito doctrine of yellow feyer transmission. On the eyening- of July 26, four days after being placed in charge of the sanitary work of the Board, I announced to the Adyisory Committee (a committee of seyen com- posed of two representatiye business men, two members of the Adyisorj' Committee of the Orleans Parish Medical Society, and two members of the Board of Health, with the City Health Officer, also chairman of the Board of Health, as chairman) that I had completed the arrange- ment of the sanitary forces of the Board into etfectiye organization. On August 12, in response to an appeal addressed on August 4 to the President of the United States by in- fluential citizens, members of the medical profession, the Goyernor, the ^Mayor, the then President of the Louisiana State Board of Health and the City Health Officer, the Federal authorities assumed entire charge of tlie sanitary work in progress. Formal transfer of the emergency forces had been made on August 8, ou pajjcr, in a letter addiessed by the Health Officer to Dr. J. H. White, of the Public Health and ^Marine Hospital Seryice; but the arinal transfer occupied seyeral days, being finally effected only on the morning of August 12. Xow as to the deductions to be di'awn from these facts. I haye here a chart, originally ])reparcd some three or four months ago, for possilde insertion in the biennial report of the Board of Health, llicn in course of ])rei)ara- tion. It shows the rise and fall of yellow fever from July 22 to November 22. ( No record was kept of cases reported from July 12 to July 22, and none can be presented). Dots with a connecting light line show the number of cases repoi-ted from day to day; heavy unbroken lines are made to divide the chart into periods of fifteen days ac- NEW ORLEANS, 1905 THEARU. 1095 tivity, aud the reading of the A'arioiis periods is facilitated by the iutroductiou of a heavy brol^eu line. The reading' of each period is made to include the figures of the first day of the following period for the reason that a large number of the cases reported each day Avere discovered the day before; and for the additional reason that efforts directed at mosquito destruction were in point of fact begun only on the cucnuig of July 13, after the Frey funeral, the sanitary operations of the Board thereafter, throughout the epidemic, being always from 3 P. M. one day to 3 P. M. the next day. The broken black line shows the "epidemic tendency" of the disease from time to time. It is not the total number of cases reported in any given period, as compared with the total number of cases in some other period, which enables us to determine the "tendency" of an epidemic to rise or to abate; it is the relation of the daily figures to one another, in either period, which establishes that fact. For example: If in a given period of fifteen days the cases reported show as 2, 4, C, 8 and so on up to 30, and in the next period as 30, 28, 2G, etc., down to 2, the total in either case Avill be the same — 240; but clearly in the first period the disease would be incrcasinfj and in the second period it would be dccreasinff. Bare figures here mean nothing; it is the fact or incident back of them which counts. To make this still stronger : If the daily rate of report was 2, 4, G, etc., up to 30 in one period, and 30, 29, 28, etc., down to 10 in the next period, we would, in the first in- stance, have a total of only 240, as against 345 in the next period; still the disease would be clearly increasing in the first, and decreasing in the latter instance. There is a great difference between the }iii)iihcr of people walking in a given place and the direction in which tliey walk. And the numerical strength of a retreating army is a matter of secondary importance when chronicling the fact that it is l)eing routed. It matters not that the disease was decreasing less rapidly than it had increased; the fact that it was decreas- ing remains. And clearly, a disease Avhich is decreasing is being controlled and is on the wane. 1096 .^£2 = S = be i = ^ = cSiS^ ~ ,_ -3 sj Jess- 1097 Cl c 5 "O c = V a.?i »,i f" ' r ] M<^;''">'^ \ ' W ;i 1 ! ! i i I ; M l^o'IsI-W'^iRfi 1 i I ! IJ r TT"T iif»n«3< 1 2 3 1 » «. ' 4 9 « 1. .II3UWJi7*,SI|lJ.!.-.'3rV!' :ti«(iJMV. J 3 4 5!.'7V9 1^,.[..;j|W,i, 1.7.6 ,.ll';4lM WW,!lil3i 1 ! 1 ; i ; , : ; i 1 ; 1 1 ! ; [ 1 1 1 1 ,■ ; i I 1 1 1 ' 1 ! i 1 1 * " ! ! ! ! ! - - - ., . , J . , , 1 1 |, -MM _ ] ^ 1 4 1 L-i-l 1 1 t 1 C ' - ~ : " . z : : .^ ^; ^ ' " " ": "X '-' - - - X -X ~ _ - - It _ , _ ^■"''■"ip-i :_ t i- ^----± r :---::::::::: :-:::::::::::-4i:::- ^ ip =t j: i::::^::::::::::::: :=:::: :=== ::=" = , 1 ^ 1 1 - = "=±="=:=±==::::::::::::::::::::::::::::::::::::±:::S::;:: _ _ . _ _ . . L _ _ __. _ . _ __ . - ---i- : ::::::::::::::::_:::::::::::::::::::::::::::::::: : :::3 " ML 41 J " ~ J" J r 1 1 ~ - - " ' ~r _ - - 1 ,- -^ + Jlx 1 XIT"" - J>J-l-i J M ^ft- - 1 1 , ._ 1 1 p- ^"M'N' Y'^aT^ "" " '":.:: .. ':":""_:_ - -K y-+ ^^ +— :-::::::::::::::::::::::g:::::- --|ixV ^1 ^ III "":: OiT ■"" " " '- . ' ^. ~ z: .' -Z :::i:..%>i:::tr:t':b-tl:::::: ::::: i _ -Xr^-,.^.. , \,XX^T +;3;:::;::::;:::::::::::: Ml i^^TT X- : \it;:::Tt: ::':::::-= i ^tt't-^ • - Mir^-^tr -x--i--:::;::::::::::::::::4::: |^^Si&---fe-^^^ -_::::::::::::::,:::::::::,: t^:::: ._^ ^ 1 ^^ _,..,_„f^-^^^ ^•pV ^jj^ f\^\ I ^li" ' " I L "X" " i :iH-'4tiii| - itrbyuffi ^;^vHi«4^+imA^^ 1098 augistin's history ok yellow fevkr. So much for the value of bare figures uusupported by facts or logical analysis. I now revert to the main proposition. From a sanitary point of view, the result or effect of efforts directed at mosquito destruction on a certain da^^, becomes noticeable onl3' fifteen days afterwards. With this important difference between ''point of time'' and "point of effect" well in mind, it must be apparent, even to the most suiDcrficial observer, that the sanitary control of yelloAv fever was well in hand at the time that the Federal Authorities took charge. Clearly the top was knocked from the epidemic as the result of the sanitary measures operated from July 28 to August 11; and wJio- ever teas then in charge deserves credit for that work. The meat and substance of it all — shown graphically on the chart presented — established definitely and abso- lutely and beyond all cavil, is : that the epidemic was on the ascending scale up to August 12 as the result of the naif-measures practiced prior to the announcement of yellow fever and during the few days required after that to bring order out of chaos and arrange the sanitary forces of the Board of Health into effective organization; that it Avas on the descending scale during the fifteen days which followed, as the result of the work conducted by Dr. Richardson and myself; that the fever showed a ten- dency to rise during the next fifteen days, probably be- cause of the swapping of horses in mid-stream, the T^nited States Public Health and ^Marine Hospital Service having taken full charge of the work by that time ; that it again abated during the following fifteen days; that the fever was never aborted at any time; that after the main force of the epidemic had been taken away from it (through work performed from July 28 to August 11, as expressed from August 12 to August 20) the fever tlureafter ran a mild course under the continuous sanitary measures ap- plied; but that it finally disappeared only after the usual ])eriod of duration of yellow fever epidemics had been reached — from three to five months — in this instance, approximately, five months. Dr. Tiieaud also said: NEW ORLEANS, 1905 THEARD. 1099 "I wish to add that the word epidemic has not been used by me in the usual and more commonly accepted sense of the word — that a majority of the people were afflicted with the disease, or that the deaths from the disease were for a time in excess of the total deaths from all other diseases; but merely and only in the sense that it was "on the people/' very much as rain mioht be, ex- tendinj>- as it did from Carrolltou to the Barracks, and from the River to the Lake. "I also wish to say that some ma}- possibly lean to the belief, held by a few, that fifteen days is too short an in- terval of time to judge of the effect or result of efforts directed at mosquito-destruction — that an interval of eighteen or twenty days is required. If so, it Avill only strengthen my position, for I would not lie called upon, then, to explain the apparent lack of success following the work practiced during the few days which I stated had been required to arrange the forces of the Board into effective organization.-' IIUO Aioi stin's history of vkllow fever. AXTI-MOSQUITO ORDIXA^'CES. Full Text of the Measures Adopted by the Citt Council of New Orleans During the Epidemic of 1905. On August 1, 1905, at a time wlieu the yellow fever epidemic Avas spreading with alarming rapidity, the City Council of Xew Orleans, adopted the following ordinance: Ordinance Xo. 319G. X. C. S. Section 1. Be it ordainiMl l)y the ('ouncil of the City of Xew Orleans, that no water liable to l)reed mosquitoes shall he stored within tlie limits of the city, except under the following conditions: Sec. 2. Water kept in cisterns, tanks, barrels, buckets or other containers for a period longer than one week shall be protected from mosquitoes in the following man- ner: Cisterns shall he covered with oil liy the property owner or agent thereof within forty-eight hours after the promulgation of this ordinance and provided with a cover of wood or metal ; all openings in the top or within six feet of the top larger than one-sixteenth of an inch to be screened with netting of not less than eighteen mesh, or cheese clotli or other suitable material by the ]iroperty owner or agent thereof within forty-eight hours after the promulgation of this ordinance; provided, that after the first day of October, 1905, all property owners shall be required to screen cisterns with wire netting of the proper size mesh as required by the Board of Health in sucli a manner as to prevent the entrance of mosquitoes. Sec. 3. Tanks or barrels or similar containers to be constructed in the manner provided for cisterns, or in some other manner satisfjutory to the Board of ITealth. Sec. 4. Buckets containing water for longer than one week (such as fire buckets in cotton presses) and other similar containers of stagnant water, shall be covered in such a manner as to prevent the entrance of mosquitoes. Sec. 5. Water in ponds, pools or basins, in public or ANTI-MO.SyllTO ORDINANCES, 1905. 1101 private parks, places of resort or resideuces, or iu depres- sions or excavations made for any purpose, shall be stocked with iiiosquito-d(^stroyino- fish, or covered with protective netting or shall Ite drained oft" at least once every week, or shall be covered with coal oil in a nienner satisfactory to the Board of Health by the owner or agent thereof within forty-eight hours after the promulgation of this ordinance. Sec. G. The Board of Health may, in its discretion, whenever deemed necessary, treat stagnant water by ap- plying oil to its surface in such a manner as to destroy mosquitoes. Sec, 7. The object and purpose of this ordinance is declared to be the preventon of the spread of disease by the destruction of mosquitoes. Sec. 8. The penalty for violation of this ordinance or any section thereof, shall l)e a fine /of not more than twenty-five dollars or imprisonment for not more than thirty days, or both, and failure to comply Avitli any pro- vision shall be considered a separate offense for each day of its continuance after proper notification bv the Board of Health. On September 2Gtli, the following ordinance was passed : Xo. 3277, NEW COUNCIL SEBIES. AN ORDINANCE to pi-omote the public health by pre- scribing the manner in which water lialde to breed mosquitoes shall be cared for within the limits of the City of New Orleans. Be it ordained l)y the Council of the City of New Orleans : Section 1. That it shall be unlawful to set up, liave, keep or maintain on any premises in the City of New Orleans, any cistern, tank or well that is not screened with wire mesh not coarser than (eighteen (18) wires to the inch, both ways, provided that the inlets and outlets of such cisterns, tanks or wells may be screened in any manner or with anv material ai)])roved by the Board of Health of the City of New Ojleans. that will thoroughly 1102 aigustin's history of ^ ellow fever. prevent the ingress or egress of mosquitoes to and from the water therein contained; provided, however, that no water seal shall be used in screening any such inlets or outlets. Sec. 2. That it shall be unlawful to have, keep or maintain on an3' premises in the Citj of Xew Orleans, lot or batture, or in anv cemetery, park or square, any pond, pool, fountain, trough, urn or water receptacle of any similar character or kind, unless the same is kept constantly covered with kerosene oil from February 1 to December 1 in each year, or be kept constantly stocked with mosquito-destroying fish, or covered with the protec- tive netting- specified in Section 1. Sec. 3. That it shall be unlawful between February 1 and December 1 in each and every year to have or keep on any premises, water in any can, pitcher, bowl, bottle, tub, bucket, barrel, trough or other receptacle, unless the same be thoroughly emptied, dried or cleansed every five (5) days before being refilled; provided, however, that fire liarrels may be maintained on premises, provided that they are properly screened with 18x18 Avire mesh, but all fire buckets shall be maintained empty. Sec. 4. Tliat it shall be unlawful to have or maintain on any jiremises in the City of New Orleans any open well, unless the same be continuously closed or screened as altove provided, so as to prevent the ingress or egress of mosquitoes to and from the Avater therein contained and the drawing of water therefrom be operated by pumi^s. Sec. 5. Tliat it shall be unlawful to have or maintain any gutter or drain or roof in or on whicli waler stands after rains, without drawing off thoroughly. Sec. 6. That it shall be unlawful to liave, keep or maintain on any premises in the City of yod taken from a yelb)w fever patient with- in tlie first three days and passed thr(»ugh a Chamberland ]110 AIGUSTIn's HISTORY OF YELLOW FEVER. filter has com'municated the disease by being injected sub- cutaneously into the system of a non-immune person. So evanescent is this poison, that after the third day of illness it seems to disa^jpear from the blood of the human subject. Writers of the present day refer to the germ of yellow fever as a ''parasite,'- following the idea of analogy, much as chemists have classified the hypothetical metal ammo- nium. In a recent monograph on yellow fever, Dr. Joseph Goldberger,- of the U. S. P. H. & M. II. Service, writes as follows on the subject: ''The Parasite. — While the organism of yellow fever has not yet been discovered, we are, nevertheless in pos- session of some facts which enable us to form' some idea of its character. The disease has been found to occur only in man and the mosquito, so that it is inferred that the parasite is one of those that requires for the complete evolution of its life cycle a mammalian and an arthropod host. We have familiar analogies in Piroplasma hige- iiiinum of Texas fever and the Plasmodium of malaria. Because of these analogies it is inferred that biologically it may be grouped with them as a protozoou. On the basis of these and other analogies, both Schaudinn (1901) and Novy & Knapp (1906) have suggested that it may be a ^pirochaeta. Stimscu's recent discovery of a spiro- cluT'te-like organism in the tubules of a yellow fever kid- ney is therefore exceedingly interesting and suggestive." It is now historical how enthusiastically the scientific world welcomed the announcement by Sanarclli in 1- there Avhen the vessel sailed from a tropical port, while simiiiar fumigation in detail was performed by burning sulphur in every living space of the vessel, making a clean sweep of all mosciuitoes on board. Under the prevailing delusion al)out "germs" disinfection of all fomites by steam heat was also laboriously per- ETIOLOGY l»ATTON. 1115 formed, this xjart of the work getting the principal credit for the good accomplished, after which detention sufficient to cover the estimated incubation period of the disease was enforced. ' With the further development of the germ theory and with the trend of thought induced by tlie researches of Koch, Eberth and others, we note a disposition to look for the germ of yellow fever as affecting specially the alimentary canal. Thus, in the section on yellow fev(>r in Looniis & Thompson's American System of Medk-ino, published in 1897, we read the following by no less an authority than Sternberg: ''Yellow fever is not a contagious disease in the strict sense of the word, i. e., it is not usually contracted by contact with the sick ; but, as in cholera and typhoid fever, the infectious element multiplies in the body of the sick, and epidemics usually extend from foci of infection origi- nating from the introduction of cases of the disease into localities previously free from it. \ Although not definitely demonstrated, it seems ex- tremely probable that this occurs in the same way as in the diseases mentioned, viz., through the excreta. This is indicated by the fact that while contact with the sick as nurse or physician does not lead to infection, the soiled clothing and bedding of yellow fever patients may induce an attack in those Avho handle them, and may originate an epidemic when transported without having been dis- infected to another locality." * * * * * "As heretofore suggested, the yellow fever patient, like the patient with cholera or typhoid fever, ]U'obably carries "germs" in his int(^stines wliich are ca])able of abundant deveh)pment outside the bodv wlien local conditions are favorable. *****' "In view of the facts lieretofore recorded and tlie con- clusions reached as the result of experimental investiga- tion, it is evident that the dejecta of yellow fever patients should be regarded as infectious material and should never be thrown into privy vaults until they have been completely disinfected." 1116 augustin's history ot yellow fever. III. Ti/rauiii/ of a False Doctrine. Whatever diversity of views existed as to other points in connection with yellow fever, physicians and laymen of the South were practically united in cherishing' a deepl}' rooted belief in its transmission b}^ fomites. That this conviction prevailed must appear not only natural, but inevitable, in view of the great mass of testimony in support of that belief which has been handed down from the i)ast by perfectly honest witnesses. In fact, some of the reported instances^ of the apparent transmission of yellow fever by fomites cannot possibly be reconciled with our present knowledge, compelling the conclusion that something is wanting in the evidence. It was not strange, therefore, that medical men of the South, and especially those officially charged with the responsibility of framing regulations for the protection of the puldic health, were somewhat slow in accepting the mosquito doctrine in its entirety. Dr. Edmund Souchon, President of the Louisiana State Board of Health, from February, 1898, to January, lOOG, and whose administration was thoroughly progressive, in his Report for 1900-01 (pp. 78-9), correctly defined his OAvn position and that of other Southern Health Officials, as follows: "While admitting that the mosquito has been shown to be a potent factor in conveying the disease, we South- ern Health Officers, charged with the grave duty of pro- tecting our people against this most dreaded of all dis- eases, are unwilling to accept the dictum of the experi- menters that yellow fever can be conveyed by no other auencv. * Those interested will find a compilation of twenty-seven authentically reported instances in Dr. Edmond Souchon's paper on the "Treatment of Vessels from Yellow Fever Ports"; N. Y. Medical Record, Feb. 8th, 1902. (Reprinted in the Biennial Report of the Louisiana State Board of Health for 1900-01, pp. 81-102.) ETIOLOGY PATTON. Jll7 We are willing- to be conyinced, but are not prepared to abandon established quarantine precautions on the stren<;th of such neji'ative evidence as that alt'orded by the reported experiments with fomites." Dr. Souchon, without for a moment questioning- that yellow fever is conveyed by the bite of a mosquito, was not willing- to admit that fomites or other causes could not also transmit the disease until time and further proofs should demonstrate this beyond all possibility of doubt. He felt that until this was done he would not be justified in altering the quarantine regulations, especially as the people of Louisiana, whose officer he was, still believed firmly in the conveyance of yelloAV fever by fomites. In justice to Dr. Souchon and other leading sanita- rians of the South, it is to be noted here that they lost no time in profiting by the evidence in support of the mos- quito doctrine which continued to accumulate at localities where the occurrence of yellow fever afforded opportuni- ties to verify in actual practice the conclusions relative to fonntes previously based only upon experiments, so that long l)efore the outbreak in Texas in 1903 the useless- ness of disinfection in yellow fever for any other object than the destruction of mosquitoes had been officially rec- ognized in Louisiana and to a great extent in adjoining States. IV. Convi))c'uiff Ohjrc't Lr.s-.von.s' of 1905. It is safe to assert that the experience gained during the prevalence of yellow fever in Louisiana and Missis- sippi in 1905 had the effect of banishing the last lingering belief in the conveyance of the disease by fomites so far as tlie vast majority of medical ni/en in the South were 1118 auglstin's history of yellow fever. coucerned^^ During- that outbreak no attention wliatever was paid to tlie disinfection of the clothing and bedding of patients by the State and Federal authorities who con- ducted the campaign, the first on record in Avhich the ferer was conquered before the coming of frost, all work being planned and carried out in strict accordance with the doctrine of its natui'al transmission occurring solely by the bite of the Stegomjia mosquito. The magnitude of the demonstration given to the world by that campaign left no ground for any objection that might have applied to experiments on a small scale or under artificial conditions. After that vast and costly object lesson in our own territory, the only "doctors" left unconvinced were (and are) a few old timers who still cling to the traditions of the past, refusing to be per- suaded that an insect as feeble and apparently insigni- ficant as the mosquito can be the sole agent concerned in conveying a disease so terrible as yellow fever. V. Efiological Role of the Mosquito. So thorough and complete was the work done by the II. S. Army Commission in Havana, as set forth in their successive reports,^ that aside from abundant confirma- * In New Orleans the g-reat mass of the laity became ready converts to the mosquito doctrine. This result was accom- plished largely through good missionary work done in the city and by public meetings and lectures; but the people themselves entered, heart and soul, into the great fight of 1905, and after witnessing the wonderful success of this new method of warfare against their ancient enemy needed no further piroof that the doctrine underlying that method must be correct. ' The Etiology of yellow fever. A preliminary note. — Re3d, Carroll, Agramonte and Lazear. Phil. Med. Journal, Oct. 27, 1900. The Etiology of yellow fever. An additional note. — Reed, Carroll and Agramonte. Jour. Amer. Med. Assn., Feb. 16th, 1901. The Prevention of Yellow Fever. — Reed and Carroll. X. Y. Med. Record, Oct. 26th, 1901. The Etiology of yellow fever. A supplemental note. — Reed and Carroll. American Medicine (PMla.), Fe-b. 22d. 1902. ETIOLOGY PATTON. 1119 lion hj other trustworthy experimenters and the convinc- ing proof of the correctness of their deductions afforded by the success with which the same liave been applied in the practical management of yellow fever, it may be said that nothing essential has been added to our knowledge of the mosquito doctrine since it was formulated hj its discoverers. The bas^c jn'inciples of that doctrine in relation to the etiology of yellow fever (without direct reference to quarantine and sanitary work) may be briefly stated, as follows: 1. The only natural agency by which yellow fever is transmitted to human beings is the bite of an infected female Stegomyia calopus mosquito. (Until recently known as Stcgoniijia fasciafa). 2. Therefore, the disinfection of inanimate objects, as formerly practiced for protection against the disease, is useless. 3. In order to possess the power of transmitting the disease, the mosquito must, at least twelve days previously, have fed upon the blood of a yellow fever patient during the first three days of that patient's illness. 4. After thus becoming able to transmit the disease, the mosquito retains (most probably) that power during the remainder of its life. 5. Neither in the mosquito nor in the human subject does the Bacillus ictcroidcft or any other parasite thus far discovered stand in any etiological relation to the disease. 6. After being bitten by a mosquito capable of trans- mitting tlie infection, a non-immune person will ordinarily develop yellow fever within five days, the time of incuba- tion varying from two days and one hour in the shortest recorded period, to six days and two hours in the longest. It is proper to mention here that the French C<»mmis- sino consisting of ^f. ;^^archoux, Salimbeni and Siniond, by whom the deductions of the U. S. Army Commission were corroborated in a series of experiments undertaken to still further study the etiological aspect of everything connected with yellow fever, reported one instance in which the power of conveying infection appeared to have 1120 augustin's history of yellow fever. been transmitted through the ova of an infected female insect to her progeny. Two of the most expert and re- liable experimenters of the U. S. P. H. ^ M. H. Service, llosenau and Goldberger, entirely failed to find any con- firmation of this hereditary transmission, and in the light of much i)ractical experience the majority of American authorities believe that it cannot take place. The scope of this article does not warrant an exhaustive review of various related matters of general interest, as for example, the habits and peculiarities of the ^^tcf/oniijia mosquito, its distinctive appearance, mode of attack — the female alone biting — the influence of temperature on its •'p<'rnicious activity," its longevity after becoming infected and ability to hibernate through a mild winter with little or no diminution of pathogenic vigor, as must have oc- curred in New Orleans following the little epidemic of 1897,— etc., etc. However, two of the special attributes of the Stegomym col o J) lis are entitled to consideration here as belonging to the chapter of etiology. , These are : A. The power which that mosquito alone appears to possess of transmitting yellow fever; and — B. Tlie interval of time, usually about twelve days (belie^<'d lo be influenced by temperature) required by the femak' insect to develop that power within her system after feeding upon the blood of a yellow fever i)atient dur- ing the first three days of that patient's illness. This in- terval is the "Extrinsic Incubation" of Cartt^r,^ who, in 1898, made a careful clinical study of the subject and, Avithout detecting the agency of the mos()uit(), correctly dctermiiM'd the period of incubation outside the human body as being "usually in excess of ten days." A. The first of the foregoing points may be regarded as established l)eyond any reasonable doubt l)y tlie negative 'A Note on the Interval Between Infecting and Secondary Cases of Yellow Fever. — H. R. Carter, M. D., Surg. U. S. Marine Hosp. Service, New Orleans Med. & Surg. Journal, May, 1900. ETIOLOGY PATTON . 1121 results whicli have attended all experimental attempts to convey yellow fever through the bites of other mosquitoes, as well as by the fact that however abundant mosquitoes may be at a locality in which a case of imported yellow fever develops, there is no spread of the disease unless the Stegomi/ia is present. This explains why certain in- terior localities have seemed to enjoy immunity, although in the "j^ellow fever belt." ' As to why this particular mosquito is the only one capable of transmitting yellow fever, we are thus for only in a position to conjecture, but venturing a seemingly plausible supjDosition covering the whole ground, we come to the second jDoint : B. From analogies of susceptibility and natural immunity observed among animals we may appear justified in ascribing to the delicate house-bred female Stegomijia hatched from the ovum of a mother fed on human blood, an actual susceptibility to this human disease not pos- sessed by any other mosquito, but with such natural power of resistence as to present an incubation period more than twice as long as in the human subject, and to remain physically uninjured by the attack. flhe supposition that the mosquito experiences some- thing corresponding with an attack of yellow fever in the more highly organized liuman subject is consonant with the scientific dogma that the period of "extrinsic incu- bation" represents the cycle of devclo])ment reciuired by a hypothetical parasite Avithin the system of the insect, in accordance with analogous examples in nature, and helps to account for the profound impression evidently made on that system. So deep and lasting is tliis iinj)ressi()n, like that of unchecked syphilis in man, as to produce perm-'- nent change of function, tlie seci'etion of the salivary glands of the infected mosfiuito remaining tainted for life. 1122 augustin's history of yellow fever. The period of incubation iii the mosquito, averaging about twelve days, added to the three, four or five days of incubation required for the development of the disease in the human subject, made up the interval of "smould- ering" between the first case (or group) and the next group of cases so j)uzzling and deceptive in former times, besides being so disastrous in results. Surgeon H. K. Carter of the U. S. Marine Hosptal Service, who is identified with much of the best yellow fever work done in recent years, realizing the importance of determining, if j^ossible, the exact relationship of this strange phenomenon, took advantage of a series of con- secutive cases at a lonely railroad telegraph station near New Orleans, in 1897, to make his first accurate observa- tions. These he was able to verify the next 3'ear under singularly favorable conditions at Orwood and Taylor, in north Mississippi, where the appearance of yellow fever among the non-immune population of a sparsely settled district furnislied an opportunity to determine with ab- solute accuracy the interval between certain isolated first cases and the resulting secondary cases, the period of in- cubation in the human sj'stem having already been satis- factorily ascertained. In this way he arrived at the con- clusions on which he based his first published statement regarding tlie "period of extrinsic incu])ation,"' the apt- ness of which designation has been generally recognized. The significance and scientific value of Dr. Carter's obsevations were not fully ap])reciated until the F. S. Army Commission working at Havana took up Finlay's uncompleted studies relating to tlie mosquito, after hav- ing determining that the BaclUns ictcroidcfi of Sanarelli is not an etiologic factor in yellow fever. This stiiinbliiig block having been eliminated, the genius of the united Commission, once started on the true path, with sugges- tions drawn from the analogy of malarial transmission by mosquitoes and the aid supplied by Carter's practical studies, readily worked out the remaining elements of the problem. ETIOLOGY PATTON. 112S The Commission had no difflculey in securing human subjects for experimentation. At the beginning, a sub- stantial cash bonus was ottered, but with characteristic heroism, American soldiers offered themselves as sub- jects without comx^ensation. There was plenty of yellow I'ever in Havana and Finlay aided in obtaining the prox)er mosquitoes for the experiments. A sufficient number of iiisects were allowed to bite patients on successive days to enable the Commission to study fully all questions of time, with the result that it was found impossible for a mosquito to become infected by biting a patient after about the third day of illness, and also imi)ossible for a mosquito, even when properly infected (i. e., by biting during the first three days of the attack) to transmit the disease to a human subject earlier than about twelve or fourteen days thereafter, thus beautifully demonstrating the rationale of Carter's "extrinsic incubation," of which the Commission had been duly mindful. i A majority of the yellow fever cases experimentally pro- duced, while relatively mild, were distinctly typical, but, as already mentioned. Dr. Lazear of the Commission died of an attack of the disease. Carroll, who allowed himself to be bitten by a stray mosquito, also had an attack so severe as to be nearly fatal. Among the supposedly non-immune subjects experi- mented upon some did not develop the disease, showing that they enjoyed a certain measure of natural immunity. Later, when sufficient proof of the conveyance of infec- tion by the bites of mosquitoes had accumulated to satisfy the most skeptical, experiments on human beings Avere discontinued as being attended with risk of life even when most carefully conducted. To test the reputed conveyance of infection by fomites, a quantity of clothing and bedding dir(M't from yellow fever cases and variously soiled with black vomit, feces, etc., was placed in boxes and stored in an isolated house erected for tlie experiment. This house was carefully screened toi exclude mosquitoes, and was kept artificially heated to imitate natural conditions. Seven non-immune 1124 ai'gustin's history ok yellow fener. subjects submitting to the experiment occupied a tent near by during tlie day, being carefully protected from the bites of mosipiitoes. Ever}- night a squad would move into the screened house, where they removed the funiites from the boxes, handling each article, putting on the soiled clothing, sleeping on beds made up with the "in- fected'' sheets and blankets, and repacking the whole out- fit in the boxes the next morning. Although exposed in this way for three weeks, not one of the seven subjects contracted the fever, but some of them subsequently ex- perienced experimental attacks after being bitten by in- fected mosquitoes under the proper conditions, showing that they were actually non-immune. The conclusions of the Commission were promptly put to a practical test by Major W. C. Gorgas, Surg., U. S. Army in charge of the sanitation of Havana, and with such wonderful success, following absolute failure by methods based on former theories, that he succeeded by entirely eradicating yellow fever from that city Avhere the disease had been perennial from time immemorial, thereby carrying conviction to the minds of admiring scientists all over the world. VI. TJtc Bacillii.s /cfcroidcs. Before dismissing the subject of experimental research to discover the cause of yellow fever, it is not inappropri- ate to add a final word about the UaciJlus ictcroidefi of Sanarelli. This parasite, wliilc not tlie actual "germ" of the disease, is undenialdy vci-y inter(\sting in certain respects. It is found in little groups in the capillaries of the liver and kidneys of y(dlow fever subjects, organs strikingly affected by the disease, and its behavior in the laboratory, esix'cially as regards agglutination tests'^ and •Archinard of New Orleans found in 1S97 that among twenty cultures of known parasites the only one showing agglu- tination with yellow fever blood was the Bacillus Icteroides. ETIOLOGY PATTON. 1125 the causation in certain animals of patholoi^ic conditions typical of the disease in man, certainly justitied sanguine belief in its being the long sought germ. Among ani- mals experimented upon the dog proved especially sus- ceptible, promptly developing characteristic symptoms of yellow fever, viz. : violent gastric disturbance, intestinal hemorrhages, albuminuria, suppression of urine and death in convulsions, with post-mortem findings of degenerative changes in the liver and kidneys corresponding with those present in human beings who die of yellow fever. Sanarelli reported five cases produced in human sub- jects by inoculation with filtered toxin from cultures of the Bacillus icteroides, all presenting clinical pictures of yellow fever. Altogether, it seemed conclusive that this must he the specific parasite of the disease, but the impartial investi- gations of the U. S. Army Commission at Havana, be- sides determining the absence of the Bacillus icteroides in the blood of a number of undoubted cases of yelloAv fever, further showed that blood serum from a fatal case, though absolutely sterile to culture media favoral)le to the growth of that parasite, produced an attack of yellow fever in a non-immune subject when subcutaneously injected. A similar sample of serum from the case thus experimen- tally produced likewise proved sterile, but also caused an attack resembling yellow fever when injected into the cir- culation of a non-immune person. From these observations, showing that the Bacillus icteroides is absent from the blood of yellow fever lyatients at times when the serum of that blood, even after being filtered through close gi*aiiied porcelain, is fully capable of causing yellow fever if inlrodiieed into tlie system of non-imimmes, it is self evident that we must look else- where for the specific cause of the disease, howcA-or in- teresting from a laboratory stand])oiiit that luiuarkable parasite may be. Here, it is evident that we still have something to learn. 11S6 augustin's history of yellow fever. VII. Dengue and Yellow Fever. In couclusion, there seems to be auotlier aud really ini- portant field for study as regards the frequent and hith- erto confusing association of yellow fever and dengue. Both diseases being transmitted by the bites of mosquitoes and often occurring simultaneously, as it were, in locali- ties where yellow fever almost immediately afterwards becomes epidemic, there would appear to be some grounds for suspecting a modified evolution of toxin in the system of the transmitting mosquito, either the i^icfjomji'm calo- pus itself or of some other memlier of the same grouj), whereby the original poison thus modified instead of causing undoubt(^d cases of yellow fever produces the sort of atypical fever which in the past has proved so con- fusing and disastrous. It is, of course, very easy to explain matters by simply assuming that the two diseases happen to lie present at the same time, but to those who have personally observed these puzzling twofold outbreaks some other explanation seems necessary, and it is not expecting too much of science, which has laid the Avorld under so many obli- gations, to express the hope that in the near future the solution of this long standing problem will be forth- coming. 1127 THE SANITARY PREVENTION OF YELLOW FEVER. By Quitman Kohnke, M. D., Health Officer of the Citi/ of Ncio Orleans, September 1898 to Scptemher 190G. The Yellow Fever Mosepiito. There cau be no yellow fever as a com'miinioal)le disease in the absence of its transmitting agent, the Stegonii/ia mosquito, first classified, entomologically, as culex fasciata, then as Stegoiiiijia fasciata, and later as Stef/omyia ca lopus. I'lie female only is a blood feeder and disease conveyer, the male on account of tlie peculiar construction of its feeding organ being unable to pierce the skin to obtain blood. The female deposits her eggs on the surface of still water, and under favorable conditions, the adult ins'ccts are develo])ed therefrom in about one week. The mosquito may be seen at all hours, but is oftenest observed in the morning and the afternoon. It selects shady ])laccs and avoids smdight. It is said to be a day feeder during the first four days of its existence after which time it feeds at any hour of the day or niglit. It may live for several months, nu}lil 1/ for Epiihiuics. Since the discovery of its mosquito transmission, the prevention of yellow fever is a much simpler problem than in the days of our ignorance of the mode in which the disease invariably spreads fi'om i)erson to person. While we have not yet discovered the germ of yellow fever or its primal origin, our knowledue of the manner and PREVENTION KOHNKE. 1129 character of its movement places a formidable weapon in our hands against its progress, and it may be said in reason and with fairness, that a community sulfering a yellow fever epidemic is lacking as a whole in the essential characteristics of intelligent manhood. Yellow fever in the ignorant past was a misfortune ; in the enlightened present it is a fault — in the moral future it may be a crime. III. The Sauitari/ Creed. The doctrine of the mosquito conveyance of yellow fever, for the practical application of preventive measures based thereon, may be expressed thus : The immediate causative factor, the germ of t-ie '.^i^.- ease, is accessible to the only natural vehicle of transmis- sion, the mosquito, during the first three days of the fever, and the germ after entering the mosquito's stomach requires twelve days to migrate to one of the salivary glands, from which the insect, while feeding, may inject it into the blood stream of its victim, in Avhose system the period of incubation is usually from three to five days, rarelj^ six. The human subject of the disease may be considered infectious, therefore, to the mosquito during the first three days of the fever, aiid not thereafter; the mosquito being infectious after the twelfth day from the date of inocula- tion, and not before. Its victim shows tlie first sym])tom of disease usuall}- in less than five days after infection by the insect. The exceptions to this rule are not sufficient to suggest its modification, but in actual practice the patient is con- sidered possibly infectious dnring four days, and the mos- quito possibly dangerous on the tenth day. A case of yellow fever cannot occasion another case in less time than the period of germ emigration in the mos- 1 1 30 augustin's history of yellow fever. quito, which is twelve days, added to the period of iiicuba- tiou in the human victim, which is seldom less than three ; fifteen days completing- the miDimum cycle of infection. We may say approximately that explosions of infection should be expected, and are observable semi-monthly, and the preventive effect, therefore, of disinfection cannot be determined earlier than fifteen days thereafter. We can not say how many cases niRj result from one case un- treated sauitaril}', but we can say positively that no case will result if there are no mosquitoes present of the Ste- gomy'ia variet^^ Conversely we may rightly apprehend a great infection in the presence of great numbers of mosquitoes. Tlie application of the mosquito doctrine to the pre- vention of yellow fever is all that need be done in any emergency; but to accomplish this, is a problem not to be solved by anv set formula. It is an easy iiiatter to set down on paper and in an office a lot of ruks in the abstract to be carried out in the field, but it is a different matter to apph' these rules concretely to actual ca!--es to obtain results. Circumstances and conditions met with in actual prac- tice may radically change the relative value of details, es- teemed of paramount importance theoretically. As a])p]icablo to a locality or community, there may be considered three propositions, upon the first two of which is based the third, which is offered in the nature of a conclusion. 1. Quarantine against yellow fever cannot be made absolute in its protective value. 2. Early recogiiih'on of the presence of yellow fever infection is difficult always, and at times impossible. 3. Tlie most dependable measure of prevention of yel- low fever is destruction of the ^^fr(/o)iii/}. January February .. March April May June July August . . September October — . November December 53 53 53 39 41 30 39 51 54 51 49 50 13 12 10 20 8-2 73 56 26 II 17 18 17 5 4 6 6 8 IM 16 21 14 8 2 II 16 8 13 13 28 55 59 79 66 25 24 26 V. Dcstntctioii of Htcfjomi/iac. Finally, we must, I think, conchide tliat the de- struction of the only transmitting' niedinm is Tfie surest preventive of .yellow fever. This measure also is subject, of course, to imperfect application in practice, and incomplete results. It is, for this reason, not sufficient, alone, to i>uarantee ai»aiiist infection, but it offers the important element of time during- whicli to arran.G,e for and encouraj^e its tliorou, p. 436. Also: Texas Med. Gaz., 1904, vol. 4, p. 172. Also: Med. News, N. Y., 1904, vol. 85, p, 878. U^Carter (H. R.): A correlation of some facts in the propagation of yellow fever, with the theory of its conveyance by the culex fasciata. Phila. Med. JL, 1901, vol. 7, p. 694. Carter (H. R.): Some characteristics of stegomyia fasciata which affect its conveyance of yellow fever. Med. Rec, N. Y., 1904, vol,. 65, p. 761. Carter (H. R.) : The Methods of the Conveyance of Yellow Fever Infection. Yellow Fever Institute Bulletin, No. 10, 1902 (Revised in report of t'he Supervising Surgeon General, U. S,, 1904, p. 436.) Also in Medical News, 1904, vol. 85, p. 878. Chabassu: Quelques Considerations sur I'Etiologie et la Therapeu- tique de la Fievre Jaune. 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Medical Record, X. Y., 1901, vol. 59, p. 201. TRANSMISSION BY MOSQUITOES BIBLIOGRAPHY. 1141 Finlay (C. J.): The mosquito theory of the transmission of yellow fever, with its developments. Medical Record, N. Y., 1901, vol. 59, p. 81. Finlay (C. J.): Transmission de la fiebre amarilla por el culex mosquito. Manuscrito de 1891. Rev. de Med. Trop., Havana, 1903, vol. 4, p. 124. (English Transl., p. 134.) Also: N. O. M. & S. JL, 1903, vol. 55, p. 800. Finlay (C): Yellow fever and its transmission. Jl. Am. Med. Assn., 1901, vol. 36, p. 1040. Finlay (C. J.): Yellow fever: Its transmission by means of the culex mosquito. Am. Jl. Med. Sciences, 1886, vol. 92, p. 395. Finlay (C. J.) and Agramonte (A.): The Transmission of Yellow Fever. Journal Amer. Med. Assn., 1903, vol. 40, p. 1659. Finlay and Delgado: Estadistica de las inoculaciones con mosquitos contaminados en enfermos de fiebre amarilla. 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Havelburg (W. ): Ueber die Beziehungen der Mooldten znni gelben Fieber. Berl. Klin. Wchnschr., 1903, vol. 40, pp 705, 735. Howard (L. O.) : Concerning the geographic distribution of yellow fever mosquito. Wash., 1903, Govt. Print. Office. 7p. 1 map. S°. Howard (L. O.) : Concerning the geographic distribution of the yellow fever mosquito. Wash., 1905, 9p. Ich. 8°. Forms Suppl. to No. 46, vol. 18, of: Pub. Health Reports. Howard (L. O.) : Mosquitoes: How they Live; How they Carry Dis- ease; How they are Classified; How they may be Destroyed. New York, 1902. Iglesias (M. S.): The disinfection of railroad cars as a precaution- ary measure against the propagation of yellow fever by mosquitoes. Am. Pub. Health Assn., Rep. 1902, Columbus, 1903, vol. 28, p. 267. (Iglesias (M. S.): Reflexiones acerca de la transmision por los mosquitos. Gac. Med., Mexico, 1901, 2 s., p. 152. Jousset (P.): La fievre jaune; immunisation; etiologie. Art. Med., Par., 1904, vol. 98, p. 161. 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Perroncito: Febbre gialla e zanzare. Policlin., Roma, 1902, vol. 9, sez. prat, p. 1569. Perroncito (E. ): Febre amarella e mosquito. Brazil-Med., Rio de Jan.. 1904, vol. 18, p. 113. Pioneer (A.) : In research on yellow fever. Brit. M. J., Lond., 1908, vol. 1, p. 1306. Pittaluga (G.) : Studi sulli etiologia della febbre gialla. Arch, Lat. de Med. y de Biol. Madrid, 1903, vol. 1, p. 161. Pothier (O. L.): The etiology of yellow fever and its transmission by the mosquito. X. Orl. M. & S. Jl., 1905-6, vol. 58, p. 326. TRANSMISSION BY MOSQUITOES — BIBLIOGRAPHY. 114-5 Purnell (J. H.); The mosquito an insignificant factor in the propa- gation of yellow fever. Phila. M. J., 1901, vol 8, pp. 189, 193. Proust and Wurtz: Role des Moustiques, etc. Recueil des Trav. du Com. Con. d'Hyg, Pub. de France, 1901. Paris, 1903, vol. 31, p. 337. Reed (W.): The Propagation of Yellow Fever. Medical Record, vol. 60, p. 201 (1901). Also reprinted in pamphlet form. Reed (Walter): The propagation of yellow fever; observations based on recent researches. New York, 1901. Reprinted from: Medical Record, August 10, 1901. Reed (Walter), Carroll (James) and Agramonte (A.): Experimental yellow fever, Phila., 1901. Reprinted from: Trans. Assn. Amer. Physicians, 1901, vol. 16. Also published in American Medicine, July 27, 1901. Reed (Walter), Carroll (James) and Agramonte (A.): Etiology of yellow fever. Journal Amer. Med. Assn., February 16, 1902. Reyaud (G. ): La transnission de la fievre jaune et la prophylaxie; le rapport de la mission francaise envoye au Bresil. Janus, Amst., 1904, vol. 9, p. 381. Rosenau and Goldberger: The hereditary transmission of the yellow fever parasite in the mosquito. Yellow Fever Inst., U. S. P. H. and M. H. S., Washington, Jan., 1906, Bull. No. 15. Ross (J. W.): Reasons for believing that the only way in nature for yellow fever to be contracted by man is from the mosquito. Med. Rec, N. Y., 1903, vol. 63, p. 124. Ross (J. W.) : Yellow Fever Contracted from the Mosquito. N. O. Med. & Surg. Jl. Also: Am. Pract. and News, 1903, vol. 35, p. 313. Sanarelli (G.): Febbre gialla et zanzare; rispostaal prof. E. Per- roncito. Policlin. Roma, 1902, p. 1766, vol. 9, sez prat. Sanarelli (G.): La teoria delle zanzare egli ultima studi sulla etiologia della febbre gialla. Gazzetta degli Ospitali, Milano, 1901, vol. 22, p. 1058. SanduUi (G.): II mixococc idium stegomyiae, parassita della febbre gialla. Ann. di Med. Nav. Roma, 1904, vol. 1, p. 408. Seidl (C): Os mosquitos e a febre amarella. Brazil-Med. Rio de Jan., 1903, vol. 17, p. 359. Smith (J. C): A summary of our knowledge concerning Stegomyia fasciata. N. Orl. M. & 'S. Jl., 1906-7, vol. 54, p. 421. Soriano (M. S.) [et. al.] : Dictamen de la Seccion de Higiene, sobre las proposiciones con que termina el informe del Sr. D — Suarez, Gamboa, relativo a las experiencias llevadas a cabo en la Habana, a proposito de la transmision de la fiebre amarilla. Gac. Med., Mexico, 1901, 2 s., vol. 1, p. 151. Souchon (E.) : Fruit vessels, mosquitoes and yellow fever. J. Am. M. Assn., Chicago, 1903, vol. 40, p. 1647. 114(5 augustin's history of yellow fever. stark (A. X.) : How the Army Yellow Fever Board conducted its experiments upon human beings. Bull. Univ. Virginia, Oaarlottesville, 1903, vol. 3, No. 2, p. 23. Sternberg (G. M.): Yellow Fever and Mosquitoes. British Medical Journal, vol. 2, for 1900, p. 1391. Sternberg (G. M.) : Dr. Finlay's mosquito inoculations. Amer. Jl. Med. Sciences, 1891, vol. 102, p. 627. Stiles (C. W.): Stegomyia calopus adopted as the official name for the yellow fever mosquito. Pub. Health Rep. U. S. Mar. Hosp. Serv., Wash, 1907, vol. 22, p. 381. Strain (W. L.): Yellow Fever; its Mode of Dissemination. Journal of Tropical Medicine (Lond.), vol. 1 for 1898-9, p. 238. Suarez Gamboa (R.) : Informe rendido a la Acad. X. de Medicina Sobre las experiencias llevadas a Cabo en la Habana a proposito de la transmision de la fiebre amarilla. Gac. Med., Mexico, 1901, 2 s., vol. 1, pp. 143, 150. Testi (F.): La diffusibilita della febbre gialla. Propaganda san., Firenze, 1908, vol. 2, p. 129. Theobald (F. V.): A Monograph of the Culicidae or Mosquitoes. In 3 vols. London, 1901-1903. Tombleson (J. B.) : A note on the etiology of yellov/ fever. Lancet, Lond., 1903, vol, 2, p. 594. Tombleson (J. B.): The etiology of yellow fever. Lancet, London, 1903, vol. 2, p. 1781. Treille (A.): Les stegomyes et la fievre jaune; I'epidemie de Saint- Xazaire. Gaz. Med. de Xantes, 1904, 2 s., vol. 22, p. 721. Trueheart (C. W.): Mosquito Extermination and its Bearings on the Yellow Fever * * * Quarantines. Texas Medical Journal, vol. 21, p. 391 (1906). Ward (H. B.): ^Mosquitoes in Relation to Human Pathology. Wood's Reference Handbook of the Medical Sciences, vol. 5, 2d Edition, p. 866. White (J. H.) : Practical Results of Reed's Finding on Yellow Fever Transmission. Science, vol. 23, p. 371 (1905). Wyman (W.): Geographic distribution of yellow fever mosquitoes, and the importance of accurate knowledge concerning all mosquitoos of the United States. Pub. Health Rep. U. S. Mar. Hosp. Serv., Wash., 1903, vol. 18, p. 1761. (Department Circular Xo. Ill, 1903.) Ybarra (A. M. F.) : The transmission of yellow fever. Jl. Am. M. Assn., Chicago, 1903, vol. 41, p. 505. 1147 PATHOLOGY OF YELLOW FEVER. BY OLIVER L. POTHIER^ M. D.^ Pathologist to Charity Hospital, New Orleans. Difficulty of Pathological Diagnosis. The pathology of yellow fever, like the clinical aspect of the disease, is dependent upon a number of factors which must be taken collectively, to establish the lesions of the infection. It could be embodied in a very few words by describing it as a general steatosis. No other infection produces such intense and widespread fatty degeneration as 3ellow fever. The sudden and general hemorrhages appearing during its course are due to the fatty degeneration of the endothelium. Yet there is not a single lesion of any organ which can be considered pathognomomic of yellow fever. It is the collective lesions and general pathological picture presented during the course of the infection and at the autopsy, which char- acterizes the disease. We do not find, as in typhoid fever, typhus and other infectious diseases, characteristic lesions localized in special organs. The lesions of yellow fever are dissemi- nated throughout the body, and it is the peculiar general picture presented by the lesions of the different organs, associated witli the history of the case, which makes up the basis of a pathological diagnosis. The lesions are characteristic in that they affect certain organs, while others remain apparently free. ' Yellow Color. To one familiar with yellow fever, the appearance of the body brings to his mind a number of features, which, though not absolutely characteristic, present an cnscmhlc on which at times a diagnosis may be based. The body presents a. yellow color, not the light or lemon color of ordinary jaundice, but a decided uniform deep orange yellow, which with the peculiar lividity generally exhib- 1148 AUGUSTIn's H'.STORY OF YELLOW FEVER. ited by the bodies, gives them a rather striking appear- ance. On the chest, neck, genitals, and, at times, other parts of the body, not necessarily the dependent parts^ are found number of small or large hemorrhagic areas, which appear to be cutaneous and subcutaneous hemor- rhages. The dependent parts show as a rule marki^d post- mortem hypostasis. The sclera are markedly yellow and frequently show hemorrhagic points; the pupils are usually dilated. HcinorrJifn/ic Hpofs. In a number of places the sul»cutaneous tissue show hemorrhagic areas, due to overdistention of the capillaries of the part, with rupture resulting from the fatty degen- eration of the endothelium. In some cases these hemor- rhages are numerous and quite extensive. The skeletal muscles do not present any marked changes, though, at times, areas of fatty degeneration are found. This, how- ever, is unusual. The Lungs. The lungs do not present any special lesions. They generally appear normal. The microscoi)ical picture may show slight engorgement, but nothing else of note. In their report on yellow f( ver ^Marchoux and Simoud state that the oedema fre([uently existing in autcjiKics of yellow fever, is possibly due to post-moi-tem changes. I must say that my experience with yellow fever, prompts me to agree with their statements, and that I have generally observed that the lungs show very few, if any, changes. The Heart. The heart and large vessels at its base show frequently hemorrhagic spots over their surfaces. The heart is usuall flabby, and of a yellowish-red color. The endo- cardium frequently shows hemorrhagic spots also. The organ may present all of these lesions in a marked degree^ PATHOLOGY POTHIER. 1149 or one lesioii may be more proiiounced, while the others do not shoAV. Again the organ may not show any lesions. It is rare, however, that one or the other lesions are not ajji^arent. The microseoi^ical examination may reveal ab times marked latty degeneration, while at others the muscle is normal. The Liver. The lesions of the liver are more frequently met with and are more characteristic, the organ presenting in typi- cal cases a marked fatty degeneration. It has a yellow cast, though I cannot say that it is always boxwood in color. At times it niay exhibit that appearance, but in the majority of ^Mstances the organ is simply yellowish. The microscopical appearance in cases that die early show fatty degeneration of the middle part of the lobule, 'or in what is kiiown as the hepatic arteiy zone. This appearance does not show, however, in cases that die after the fiflth or sixth day or tuV' /Hsease, is the fatty degenera- tion has involved all of the loLiile. In these cases the organ is transformed into a mass of fatty degenerated cells, little if any of the protoplasm of the cells remaining, while the blood capillaries and spaces are filled with blood. The early fatty degeneration as described above, limited to the middle zone of the lobule, is considered by some as characteristic of yellow fever; l)ut it is found in other infectious diseases, and is rather a characteristic of the fatty degeneration of acute hepatitis of infectious diseases. The Spleen. The spleen does not show anything of note, and is gen- erally normal in size. This is a dirfcrentiiil ])oiiit between yellow and malarial fevers. The spleen in the latter al- ways presentiiig the characteristic ap^iearance of malaria. The microscopical examination fails to show anything, but at times one may find a laigc (piantity of blood in the blood spaces, with fatty degeneration of endothelium. 1150 augustin's history of yellow fever. The KUlncys. The kidneys are usually of a reddish-Yellow color, and appear congested. On section the organ presents a marked yellow color, mixed with red and frequently small hemorrhagic areas are disseminated through the sui)stance of the organ. In some cases, however, this organ may not show any apparert lesions. The microscopical appearance is generally that of an acute parenchymatous nephritis, with extensive fatty degenerations, the cells of the tuhules appearing as granular masses lining the tubules and filled with fat droplets. The cells or what remains of them are desquamating and in many areas casts are found plugging the lumen of the tubules. The capillaries are filled with blood and in places blood is found in the connective tissue and at times in the tubules. In some cases, hardly any lesions can be demonstrated, with the exception of a few f'attv cells. The Adrenals. Tiij/roids and Pancreas. The adrenals thyroids and pancreas all present fatty degeneration of their respiective epithelium. The degen- eration in the adrenals seem to be more marked in the zona fasciculata. All of the different organs i)resent fatty degeneration, which seems to be the main lesion of yellow fever. The stomach. The stomach mucous membrane presents hemorrhagic spots, more especially near tlie cardiac extremity. The contents are of a semi-fluid or fluid dark-grumous color, or the viscus may be empty. The microscopical examina- tion reveals a swollen mucosa; the cells are desquamating and fatty, the fatty degeneration extending to the gland- ular cells even in the fundus of the glands. PATHOLOGY POTHIER. 1151 The Intestines. The small and large intestines, if we except the begin- ning- of the duodeum, do not present very ninch of note microscopically. Under the micro' cope we may find in the small intestines a swollen mucosa., the cells of which are desquamating and, occasionally, a few fatty cells; but these lesions are not constant. At the beginning of the duodenum, the firs^ two inches present very much the same lesions as those of the stomach. The Blood. The blood of yellow fever does not present much of note. The repeated examination of this tissue has failed to reveal anything definite. Some cases present appar- ently an increase of the platelets, but this is no\, a con- stant condition and cannot be considered typical of the disease. Again certain bodies have been reported as oc- curring in the plasma, but it is very probal)le that tliey are due to fragmented corpuscles or some artefact, and are not constant. The blood count is practically normal and there does not seem to be any constant variation in the amount of hemoglobin, thougli at times a series of cases may show a slight diminution. Taken as a whole in a large number of <^'ases the blood alteration are practically nil. The leucocytic count is also normal, and there does not seem to be a preponderance of either class of leuco- cytes. In the microscopical examination of organs, one is at times struck with the number of leucocytes carrying fat globules, or it may be undergoing fatty degeneration. 1 The Nervous Sijsteui. The central nervous system sliovvs lesions A\lii(h are practically the same as that of the other organs. Fatty degeneration, may be present, though probably not as extensive nor as intense. Tl.e surface of the organ is gen- erally congested and the centrum ovale shows a number or punctiform red areas, showing dilation an.l congestion of 1152 augustin's history of yellow fever. the blood vessels. The surface and even the white substance of the brain may show numeronr, small heniorrliajres. These are the most apparent gross lesions of the nervous system ; though at times /they are not noticeable. The microscopical examination of the differt^it jianglionic areas of the organ shows fatty degeneration of the nerve cells, all of which seem to be susceptible to the toxic in- fluence of the infection. The cells of Purkinje, according to Marchou and Simond, are less A'ulnerable. The spinal cord present the same general lesions found in the brain. Adults More (Susceptible. We must not forget that the majority of fatal cases of yellow fever occurs in adults, and that these may show lesions of previous diseases, and these lesions must not be looked upon as forming part of the pathology of yellow fever. Frequently the spleen of yellow fever cases is found enlarged and shows evidence of malarial infection previous to the yellow fever which caused the death of the case. Cirrhotic conditions of the liver are also fre- quently found, as well as the small granular kidney of chronic inteistitial nephritis. In fact all of the organs may present lesions Avhich antedated the attack of yellow fever. It is a question whether we would have as many deaths from yellow fever, if the ])atient's organs were healthy previons to^ the occur- rence of yellow fever. For it is remarkable how rarely children or young children die of yellow fever. In fact in them the disease is so mild as to pass unnoticed by the best experts on yelloAv fcncM-; n fact noted by all who have seen yellow fever and who have written on the subject. It is povssible, however, that children are less susceptible to the poison. General Steatosis ihr otHji i^prcial Characteristic Lesion. Before concluding this subject I wish again to impress that there is no special characteristic lesion of any organ PATHOLGY POTHIER. 1153 upon which we can base our diagnosis at autopsy. The general steatosis of practically all the organs, more or less marked in all of them, is the only constant lesion, and that it is the general picture presented by this char- acteristic associated with the clinical history of the case which enables us to make a positive diagnosis of yellow fever. 1154 diag:\osis of yellow fever. By Hamilton P. Jones, M. D., New Orleans. Resident Physician Isolation Hospital, Xeic Orleans, 1897; Chief burgeon Jones {Yellow Fever Hospital, Santi- ago de Cuba, 1898, U. S. A.); Physician-in-Chief Emergency Hospital, Xew Orleans, 1905. The diagnosis of yellow fever is perhaps one of the most difficult of all to make with certainty in the early stages of the disease, and there are probably many light cases of this disease not recognized at all, and during epidemics a great many diagnosed as such that are not. Most careful study, scientific observation and post- mortem of all of the cases in the Isolation Hospital (New Orleans, 1897), in the Jones Yellow Fever Hospital (San- tiago de Cuba, 1898), and the Emergency Hospital (New Orleans, 1905), all of which I had charge, and in which over a total of a thousand cases were treated, convinced me that not less than ten per cent, of the cases sent into these yellow fever hospitals did not have the disease. These institutions were all established with the primary end in view of protecting the communities from the in- fection, and for the treatment of yellow fever only, and in man}' instances police power had to be exercised to force indigent or unruly patients into them. It is natural to suppose that no such extreme steps would be taken until the physicians had convinced themselves of tlie truth of their diagnosis. If ten per cent, are sent into hospitals wrongly diagnosed, it is reasonable to suppose that at least ten per cent, escape diagnosis at all. This, it will be seen, still leaves the number of reported cases in any given outbreak approximately the correct number. It, therefore, l)ecomes imperative that tlie physician take every precaution for the community, by not being too sure of himself, but very sure of his screens for the first four days of any fever that might be confounded with this disease. While there is no doubt in my mind that the mosquito is the medium of conveyance of yellow fever DIAGNOSIS JONES . 1155 from man to man, and that the infected mosquito may pos- sibly be carried greater or less distances to accomijlish this, 3'et the history of all outbreaks are traced to the im- portation of some human being sick of the disease, upon whom the local mosquitoes feed and become infected. With this important fact in mind, it, therefore, becomes imperative to get an absolutely correct history of the patient's movements for at least ten days prior to being stricken down, and equally important to determine his haunts, the localities whence his associates have come, and whether or not there has been sickness among them. Equal in importance with the above as an aid to diagnosis, is a careful medical history of not only the present attack but the medical history of his whole life, personal habits and environment, all of which if known might help to clear up an awkward situation; for instance, history of gaH stones, cirrhosis of the liver, with repeated attacks of albuminuria and jaundice, etc. Unfortunately there is no cardinal symptom of yellow fever, nor any two or three symptoms that may be taken as f)athognomic at any one stage of the disease. The pic- ture is a complex one, gradually unfolding itself. In mild cases all symptoms may be so light as to escape all but the most careful scrutiny, while in severe cases so pro- nounced as to almost stamp the diagnosis on the body and face of your patient. Persons ill with yellow fever always say that they are very sick and always, no matter liow light the case may be, give the attending i^hysician that impression. Yellow fever, in common with such contagious diseases as smallpox, measles and scarlet fever, occurs as a gen- eral rule, but once during life, differing from them, how- ever, in that it has never been known to propagate beyond 48° north and ?>S° south latitude, nor lieloAV a temperature of 65° farenheit, corresponding to the possible geographi- cal distribution of the stcf/omi/ia calopii.^ and its temera- ture of activity; the disease sparing neither age nor sex,. only those ])eing exempt from its influence who have at some former time had it. Its attacks are confined neither to the night nor day, nor to any state of the system, 1156 augustin's history of yellow fevkr. whether of fasting or feasting, of plethora or anaemia, of robust health or chronic disease. First Stage. Yellow fever presents two well defined stages: First stage. — This is characterized by severe pains in the head, confined chiefl^^ to the eyes and forehead, back, lower extremities and epigastric region, with increase of pain and tenderness over the liver on pressure, a peculiar siilning or drunken appearance in the eyes, rapid circula- tion, and marked peripheral venous stasis and elevated: temperature. It more often attacks those who are appar- ently in perfect health ; they are seized with intense^lreu'd- aehe, chill, shivering pain in the limbs and back, followed by rapid elevation of temperature, increased action of the heart, animated congested countenance, red. glistening, suffused eyes, congestion of gums, as a rule, but not always; intense thirst, anorexia, uneasiness of the epigas- trium, nausea and vomiting. This stage may extend from 36 to ISOJiours without any distinct remissions, according to the severity of the disease. Second Stage. Second stage. — This is characterized by dei^ression of the nervous and muscular systems, and of the general and capillary circulation; capillary congestion more marked; slow and intermittent pulse; jaundice, albuminous urine loaded with granular casts and debris — always^ bile — stained. In more marked cases some, or all of these addi- tional symptoms may appear: A purplish and yellowish mottled appearance of the surface, urinary suppression, passive hemorrhages from the ears, stomach and l)0wels, gums, nose, tongiie, uterus, vagina, gall bladder and anus ; black vomit, interstitial hemorrhages, delirium, convul- sions and coma. DIAGNOSIS — JONES. 1157 The Blood. The blood in yellow fever has not shown any charac- teristic of the disease, except that it seems to be more concentrated than normal, all the various cells beinji; found, in uncomplicated cases, in otherwise healthy in- dividuals, in slightly greater numbers than in health, but in proper ratio with probably more platelets than normal. Hemoglobin percentage is always high in simple uncom- plicated cases of yellow fever, 100 per cent, and over. Urine. Albumin is an invariable constituent of the urine at one time or another during the course of yellow fever, ranging from a trace to 80 per cent, moist. Casts, renal epithelium, and debris, always bile-stained, and other evidences of an acute inflamation of the kidneys present in a great majority of all cases. In several instances the finding of casts and debris not bile-stained led me to suspect that the patient was not sutfering from yellow fever, but fron\ some other disease associated with kidney troubles, and subsequent developments confirmed the suspicion. One would naturally expect in the early stages of yellow fever, in a person already suffering from a cast producing dis- ease of the kidneys, to find casts not bile-stained, but they would as the disease progressed become so stained. In any other condition of the system associated with casts and bile pigments in the urine, we would expect to, and have found, the casts and debris bile-stained. I consider this observation of the greatest importance in the differential diagnosis of yellow fever. Facial Expression. There is a peculiar facial expression in yellow fever, brought about by the combination of the flushed and con- gested face and eyes and the underlying tinge of yellow that is quite characteristic of the disease. 1158 augustin's history of yellow fever. Jaundice. Early in the onset, while congestion is still active, blanching the lips or skin will reveal jaundice of the skin and mucous membranes. Jaundice usually develops rap- idly and is well marked by the time the congestive stage has subsided. Circulation. The venous statis is an important sign, and while not peculiar to this disease, is more or less well marked in all cases, the mark left by pressing with the finger on the cheek taking an appreciable time to return to the color of the surrounding tissues, from a few seconds to a minute or more, depending on the stage of the case and its severity. Temperature. The temperature in yellow fever is continuous, lasting from 24 to 150 hours. There may be a period of calm lasting a few hours, followed by a secondary rise ; this is a septic fever, of colon bacillus origin. Tellow fever it- self is a fever of one paroxysm only, but opens the way for many secondary infections, evidenced by furunculosis, parotiditis, carbuucles, etc. Cases having a temperature above 102>2 degrees farenheit, are severe, and on the ap- proach of death the temperature may go to 10() or 107, con- tinuing to rise after death for hours, sometimes reaching the extraordinary height of 112 or 114, a condition not often noted in other diseases, except sometimes in sun- stroke and injuries or diseases, affecting seriously the central nervous system, as abscess of the brain, apoplexy, etc. Pulse. The pulse during the onset of the attack is rapid as a rule and fairly full and strong, the rapidity, however, rarely corresponding to that found in other diseases with DIAGNOSIS JONES. 1159 an equal temperature. It frequently liapi^ens, however, that the i^ulse may never go above 100, no matter how high the temperature goes. Cases vary in this resj)ect very much. As a general rule there is lack of correlation between the pulse and temperature, frequently the pulse becoming slower while the temperature continues to rise. Even where there is correlation between pulse and temper- ature in 3'ellow fever, the pulse and temperature going up and down together, the pulse is usually from fifteen to thirty beats per minute less than would be found in other diseases. As the pulse in j-ellow fever falls, it becomes weaker, softer and more or less irregular as to time and strength of beat, and often intermittent. In fact so true is this that the attention of the attending physician may be drawn to the possibility of the presence of yellow ijever by the character of the pulse of other members of the household who give a recent history of some undetermined sickness. This is particularly valuable in the lighter cases of children. This slowness and irregularity of the pulse may last from a day or two to several weeks. Respiration. Respiration in yellow fever is rarely affected unless there is some intercurrent disturbing factor. Blood Pressure. ^ Blood pressure is almost uniformly low in yellow fever. At the onset of the disease it may be higher than normal, but as the disease progresses, usually by the end of the second day it has fallen below 120 m.m. of mercury, with a Riva Rochi Sphygmanometor 10 cm. bag, and may go below 70 m.m'. This low blood pressure is a valuable sign of this disease and seems almost to be a conservative protective step taken on the part of nature, and the blood pressure observations made at the Emero-ency Hospital, New Orleans, 100.5, threw important and interestinu; light on certain phases of the disease not before understood. 1160 augustin's history or yellow fevir. In order to briug my ideas out more clearly ou this phase of the disease, it will become necessary for me to digress from the diagnosis for a moment. One of the most pronounced effects of the yellow fever toxin is the profound fatty degeneration of every organ and structure of the body i)roduced. Even the epithelial cells and muscles of the deep urethra are affected. The effect of this fatty degeneration on the heart muscle is to weaken its action. The elfect ol^ this fatty degenera- tion on the blood vessels and capillaries is to impair their strength, and render stasis and hemorrhages, particularly capillary, more easy to i^roduce. When a patient becomes frightened, delirious, unruly or through ignorance gets up and exerts himself, the disastrous and oftimes fatal con- sequences are brought about by the increased heart action, and consequent increased blood j^ressure, causing rupture of the weakened and degenerated smaller blood vessels, producing hemorrhages into the meninges and gastro in- testinal mucous membrane, causing delirium, convulsions, black vomit, hemorrhages from the bowels, uremia and frequently death. The fatal effects of over-eating are due to the increased blood pressure, produced by the meal. A rapid pulse and high blood pressure, either singly or to- gether, are of the gravest import in yellow fever. From my observations it would appear that the crossing of blood pressure and pulse lines does not have the same sinister significance that the crossing of the temperature and pulse lines has in the chart; howcA'er, it is not altogether fav- orable for it to do so. In reference to the degeneration of the blood vessels, I have noted that yellow fever patients are more easily bruised, and that hypodermics are more liable to produce sul)cutaneous abscesses and sloughs than in most other diseases. Differ civtial Diagnosis. The following diseases may cause difficulty in making a differential diagnosis: Malaria. Yellow fever may be mistaken for certain unusual forms of malarial fever. Microscopical examina- tion of the blood, and the use of quinine will usually clear n Case No^ Name BMERGENCY HOSPITAL CLINICAL CHART Bed No.-.-vL. - ;- ■-. 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Z o < (A) UJ Of 300 290 280 270 260 240 2J0 220 2,0 200 IQO 180 170 160 150 140 1!0 120 no 100 50 30 20 10 2 •' o«y OF 0I5F*SE 2/ 3 ^ [7 I. /' 7 ? /^ -n r OAV OF MONTH :iy i " i" i> 1 s- ? /(? MOLB K .T^ ^ ^ ■.^ 4" .^"^ ^: KNT 41» — 40" — 39»- 33«-- 37»— 36»— KA>1 106« 105» 104" 103" 102" 101» 100" 99" 98" 070 9t." ; ^> si-/ — vT ^ ■ ^ V. > i ^ ^ ■^ \ :^ \ 1 — ^ — - \ K/ V \ •- •; ■; --:- -•- ■- -- ■- -'■; •- V \ <^ ■ — ISO 140 130 120 110 100 90 80 70 : ■ '■ : : ■1 ^1 ■ • : 1 '\ ? \ 9 J k 1 : i\ i i J \ :' '■\ 1 V % ' ' A. , : , : ,v \i \^ " l V k ' 50 45 40 35 30 25 20 15 10 : r» ^, ; ; A ; / \} s ^ : ; i V ; i- : : Diagnosis '^C'V^O^^ Chart kept by. EMERGEINCY HOSPITAL CLINICAL. CHART Case No. .3..PA.:.. Bed No 'A — _. Ward Name05^'>*c??=iV/>'> -Doctor in Charge /^J? JlaaeA _ Date Admission, 'i/i"^; UJ < LU a UJ h- 1/) -) =) a. z o < 51 U) m. m 300 290 2S0 2;o 260 250 240 230 220 210 200 190 180 170 160 ISn 140 1,1'] i:n lin ion 30 20 10 DISEASE % 3 y- i.' i y. /. ■f. 'a //■ /J 'J 'V ,,- ' L- , i 'f "^ ts ■i/ OAV OF MONTn H /i U V ff fif 3 •^ f / ^ - f t,-, i V ^ : ■ < \ ^ s : ;r ^ — — — .... " ;■ -J ■r- •f *^ 7 A f / 7\ -:- . ... -,... ... : L-* J ^ / V ^; i y 4 / — — ■ ■ ■ ; 150 140 130 120 110 lOJ 90 80 70 ■ : ■ V I'll :; ♦: I A A f' / ■'1 ■i\ J r\ , — • i\ f. o; ; ?. V \ f *■ V: \y / V 1/ > k-^ V, ^ / \ 1 n i / V \ A : r \ i I . A K 50 45 40 35 30 25 20 IS 10 \ r r^ /^ •s. / A f V^ / V i \ I V i — *% \ A ; i w I. \ \ m>^ f ' •:^ /• \ f A f ^ \ /": y / ^ r- U v ' L : ^ h Diagnosis 'h^JJLLtr^^^^n EMERGENCY HOSPITAL. CLINICAL CHART Bed No.-.«?=r- Ward -Doctor in Charge_^- C:^/?-€i? .<^^... Date Admission ..-<&?>r^£.!Li:!£.i DIAGNOSIS JONES. 1161 up this diagnosis, however, it is perfectly i)ossible to have yellow fever and malarial fever also. Jii this case the greatest care will be necessary, and difticulty will be ex- perienced in making the differentiation. Hemoglohinuric Fever. This gravest form of malaria resembles yellow fever somewhat in its onset and symp- toms — jaundice and albuminuria — but is characteristi- cally different in that you have evidence of the destruc- tive intluences in the reduced number of red blood cor- puscles and low hemoglobin precentage in malaria and abscence of hemoglobin in the urine, of uncomplicated yellow fever. Dengue. It is not difficult to differentiate be- tween marked types of yellow fever and dengue after the first two or three days. The principal points of difference are the almost universal pres- ence of an eruption in dengue and the absence of an eruption in yellow fever; the presence of jaun- dice in yellow and the almost universal absence of jaun- dice in dengue. Albuminuria is almost universally absent in dengue. It is possible for dengue and yellow fever to exist by side, but in that event it would be necessary to carefully and closely observe a good number of cases be- fore a positive differentiation could be made. It is not probable that a large number of cases of dengue and mild yellow fever could be observed Avithout some of tliese cases showing the characteristic lesions of the particular dis- ease more pronouncedly than the other, thereby relieving the doubt. La Giippe and acute lobar-pneumonia, particularly of apex, may possibly be counfounded with yellow fever, but a careful study of the case will reveal catarrhal symptoms, and the absence of bile-stained casts and debris in the urine, and ought not to be confounded with yellow fever. In 3^ellow fever, the lungs are normal. Typhoid Fever in the early stages may possibly be taken fotr yellow fever, but the history of the case and the finding 1162 AUGUSTIn's HISTORY OF YELLOW (EVER. of the Ebertli bacillus, the Widal reaction, and the co- relation of pulse to temperature will help to clear up the diagnosis. Yellow fever may engraft itself upon au}- dis- ease, and I have held post-mortems in Cuba, showing the characteristic lesions of yellow fever and of typhoid fever, in cases in which malarial plasmodia were found in the blood during life. Acute Yellow Atrophy of the Liver is a very rare dis- ease, accompanied with a rapid reduction of the size of the liver, whereas in yellow l^ever the size of the liver is normal or is slightly enlarged. WciVs Disease simulates yellow fever closely, the symp- toms being fever, jaundice, diarrhea and nephritis. The. marked enlargement of the spleen and diarrhea will tend to differentiate this disease. The spleen in yellow fever is not enlarged or tender. Catarrhal Jaundice. In this disease we have little or no fever and none of the evidences of pain and violent acute toxemia found in yellow fever. It may at times become exceedingly difficult to differen- tiate between a case of gastroduodinitis in a chronic alco- holic suffering from exacerbation of his chronic nephritis. Careful investigation of the history of a case of this sort and examination of the stools will throw light on the case. ; Acute Peritonitis associated with black vomit, may be mistaken for yellow fever, but here again the absence of bile-staining of the urinary debris will eliminate yellow fever.* General Suinniarij. i No reasonable person will, of course, discredit the value of clinical experience as an aid in diagnosis, and when the clinically experienced practitioner avails himself of the clinical laboratory aids, there is small likelihood of error. * Goldberger, Bulletin No. 16, U. S. P. H. & M. H. Service. DIAGNOSIS JONES . 1163 For the purpose of aiding those who may never have seen a case of yellow fever before, the following symptoms in the light of our present knowledge justify a diagnosis of yellow fever, after all other diseases have ibeeji. consid-^ ered and excluded, where possible, bearing in mind, how- ever, that in a small percentage of cases, yellow fever may be associated with any chronic disease, and some of the acute, as malaria and typhoid : 1. A continuous fever of one paroxysm lasting more than twenty-four hours, with sudden onset, assoeiated with violent pain in head, back or epigastrium, or any one of these localities — anorexia, nausea and vomiting. 2. Pulse rapid at onset, but steadily becoming slower in many instances, while the temperature, continues to rise; even, if rising and falling with temperature syn- chronously, being from 15 to 30 beats less than the usual ratio between pulse and temperature found to exist in most other diseases, often becoming very slow, GO or be- low, soft and at times intermittent, and very irregular, 3. Low blood pressure, 10 to Go m.m. of mercury below normal. 4. High blood count 4,000,000 and over, with other ele- ments in proportion, sliowing a concentrated blood. 5. High percentage of homoglobin in the blood, often 100 per cent, and over. G. Venous congestion, followed by stasis and jaundice in from one to several days, tending to l)ruise easily, and to hemorrhages of gums, bowels, etc., but never of kid- neys or bladder, sometimes, of urethra. 7. Albuminous urine, containing bile-stained casts and debris from the urinary tract; and often bile, and bile pigments. 1164 PEOGKOSIS OF YELLOW FEVER. BY CHARLES CHASSAIGXAC, M. D. Dcau Xcw Orleans FohjcJinic; Editor Xciu Orleans ^'Medical and Surgical Journal," etc. Tlie prognosis of yellow fever may be studied both from the general standiDoint and that of the individual patient. To-day tlie relative virulence of an outbreak or epidemic can be estimated fairly well in advance. Such estimate should be based on three factors especially: 1° The data of the inception or the introduction of the disease in a given locality; 2° the interval elapsing before the exist- ence of 3'ellow fever is discovered or acknowledged; 3" the degree of ability or desire on the part of the com- munity in which the disease prevails to carrj- out the proper sanitary measures. 1° The earlier in the season the first case occurs the more, everything else equal, is there likelihood of an epi- demic and of the prevalence of a severe type of the dis- ease. Statistics show that in the past all the bad epidemics occurring in the City of New Orleans began early, notably that of 1853, the worst in its history; that year the first case was reported as early as ]\Iay. All the other great epidemics started in either ]May, June or July. On the other hand, outbreaks beginning as late as August or September have invariably been of a comparatively mild type. 2° The longer the period between the outset of the disease in a given place and the discovery of its exist- ence, the greater the severity both as to the extent of its prevalence and its virulence. 3° When the authorities of an infected locality recog- nize the importance of intelligent sanitary work, where tlie inhabitants co-operate earnestly with them, and if sufticient means are available to institute promptly all measures necessary for the protection of the sick against the bites of stegomyia mosquitoes, the destruction of in- PROGNOSIS CHASSAIGNAC. 1165 fected mosquitoes, and finally the annihilation of all mosquitoes of the dangerous kind, either there is little danger of an epidemic if the early eases have neither been overlooked nor concealed, or at the worst the epidemic will be of a comparatively mild type and of short duration. It is unnecessary to go into details concerning the points outlined above in reference to prognosis in general, as they are readily supplied and explained by the mosquito doctrine of yellow fever which is adequately treated in other sections of this work. The prognosis in individual cases is not so easily made because numerous conditions and circumstances must be taken into account and carefully Aveighed before anything like a safe estimate can be made of the patient's chances of recovery. There is no doubt that the average case of yellow fever in an individual blessed with healthy organs is far from being the terrible thing that it is usually pictured. That it is a disease, nevertheless, which at times puts the in- effaceable stamp of death on its victims at the outset can not be denied. At the present time, the knoAvledge we possess concerning the propagation of yellow fever and its practical application to a modification of the type of the disease, justifies the prediction that the latter Avill become less and less to be feared. Apart from the general tendency of yellow fever in any given outbreak, as already considered, the points chiefly to be taken into account in Aveighing the chances of any particular patient are as follows: 1° age; 2° condition of the vital organs; 3° habits; 4° probable relative amount of poison introduced into the system; 5° sur- roundings of ])atient; G° race; 7° treatment. We shall review these points scfidiiiii, leaving for sub- sequent consideration the diagnostic significance of some of the important symptoms of the disease. Age. The younger the ])atient, tlie Ix'lter his chance of recovery. In infants and small children the disease i» so mild as to have led to the belief that natives of New Orleans and other points formerly subject to frequent 1166 augustin's history of yellow fever. outbreaks of yellow fever were immune to the disease. Natives usually had durino- childhood an attack so mild as to be unrecognized yet sufficient to produce immunity. The risk increases as the age advances, except in females at about the age of puberty, in whom the mortality ap- pears to be higher than in those a little older. Condition of the Vital Organs. When the organs are sound the patient, of course, has a better chance; especi- ally is this true as far as the kidneys, the liver and the heart are concerned, in the order named. The nearer normal is the individual, the less likelihood is there that some important organ will succumb either from toxemia or secondary septicemia, for the better can elimination IDrogress and the more pronounced the resistance of the organism as a whole. Habits. The patient's former ha])its should be taken into account in attempting to prognosticate the outcome of an attack of yellow fever. The alcoholic, those guilty of other excesses, the overworked — all make poor subjects and are apt to offer less resistance to the inroads of the disease, one of the organs bearing the brunt of the attack is much more apt to be weakened already. Temperate, steady, sanely and not too strenuously occupied individ- uals stand the disease better and, other things reasonably favorable, are very likely to recover. Amount of Poison. There is no doubt in the writer's mind that the comparative amount of poison injected into the system of the victim hy infected mosquitoes, plays an important part in determining the virulency of a given attack, as well as does the rapidity with which that poison is introduced. If and when that degree of infec- tion may be ascertained a prognostic element of value will have been secured. An individual who, through ignorance of danger or through apathy, recklessness, or the necessity of circumstances, receives numerous bites within a short period stands a good chance of having a dangerous attack and perhaps succumbing if some other unfavorable feature is present in his case. On the other hand, one who. despite his understanding of the conse- quences and all care possible, still gets a bite or two PROGNOSIS CHASSAIGNAC. 1167 will probably have only a mild attack. The French ob- servers iu Brazil have stated as one of the conclusions of their experiments that a single bite from an infected mos- quito never proved fatal. Surroundmgs. It stands to reason that well nourished people in comfortable and sanitary habitations, invalided in cheerful and well ventilated apartments do better than those who live in dark, dingy, close and unsanitary tene- ments. The mortality is always higher among the alien IDOor who live more or less crowded together in unsan- itary tenements. Bace. The prognosis is better by far among the blacks and colored than among the whites, even when the former are otherwise in less favorable condition or surroundings. Whether this is because the darkies merely possess a higher degree of resistance to this particular poison, or because their skin being tougher and their odor more repellent to the mosquito, they are less frequently bitten, we are not i^repared to say. The fact remains that the majority have the disease in a mild form and that the mortality among them is almost nil, so much so that they, like white children, had been supposed to be immune until comparatively recently. Treatment. The medical treatment and the nursing the patient receives figure largely in the result and a knowledge of what it is to be in any given case may be of material assistance in our prognostications. The suf- ferer who is fortunate enough to have an intelligent and experienced medical attendant of the ^'let Avell enough alone" type, and to be nursed by a quiet, careful nurse of judgment stands the best chance of getting well. The one who is treated by an inexperienced physician who is guided by the advice set down in Uw book of some noted therapeutic authority who has never seen a case of yellow fever is very apt to die. By weighing the elements tending for or against the patient according to the points considered under the seven heads above, one possessed of a fair amount of judg- ment can make a pretty fair prediction as to the outcome 1168 augustin's history of yellow fever. of any particular case, if at the same time, proper con- sideration is given to tlie prevalent type of the disease. In addition to what has jnst been said, it is proper to call attention to the relative prognostic value of some of the symptoms of the disease. These are mainly : the tem- perature, icterus, the urine, aud hemorrhage, including black vomit. Temperature. If at the outset the temperature is only of moderate inteusity, ranging not above 103 1/2° to 101° in adults, and especially if defervescence is prompt and rapid, the prognosis is good as far as this point alone can be a guide. With the same degree of elevation in the beginning, if tlie temperature remains stationary or, par- ticularly, if it rises at all the next day, the prognosis is gi'ave. Should the fever reach or surpass the 105 degree point during the first twenty-four hours the prognosis is l>ad; the patient has a very slim chance of recovery and that onh' if all other indications are favorable. Icterus. The more intense the icterus and the earlier it shows itself the graver the prognosis. When there is a very marked jaundice by the third day or earlier, it is an evidence of jDrofound toxemia and there is good ground for serious anxiety as to the outcome of the case. Urine. The condition of the urine furnishes valuable indications as to the prospect of recovery. Its quantity is of greater comparative significance even than its con- dition. As long as the patient can urinate abundantly the prospects are good, even if the percentage of albuuien is fairly large. In fact, I have seen patients recover whose urine was highly albuminous and loaded with casts but continued co])ious; the laboratory prognosis differed from the clinical and the clinical proved correct. Whenever the urinary secretion becomes scanty, dan- ger must be apprehended and suppression of urine moans death, the exception being that Avliich proves the rule. The patient is overwhelmed by toxemia, uremia and some- tiijies septicemia combined, coma or convulsions super- vene and the patient's sufferings are ended. Even retention of urine is a bad omen as it is frequently a forerunner of anuria. This is probably because the PROGNCSIS CHASSAIGNAC. 1169 impairment of fuuctiou leads to a very slow and gradual filling- of the bladder, the call for urination being slight in consequence and not becoming insistent before the secretion ceases ; when the catheter is introduced the first time a fair amount of urine may be withdrawn while at its second introduction, several hours subsequentl}', scarcely any maj- be found — there is no longer retention but suppression. Kothwithstanding what has just been written about the greater importance of the abundance of urine, it must not be concluded that the urinary findings are of no prognostic value. A very large proportion of albumin is of serious imi)ort, more so if jjresent early and especially as earl^' as the second day of the disease. The more casts are found, the more danger of serious damage to the kidneys. When the urine is highly albuminous, loaded with casts, and at the same time scantj^, the prognosis is most gloomy. Hcmorrhaf/c. From the injection of the conjunctiva, the flushing of the face, epistaxis and, later, other hemor- rhages, there is evidence througliout of the decided effect of the disease on the circulation. The degree of this effect and the time at which its phenomena appear are of prognostic import. Epistaxis and moderate menorrhagia or metrorrhagia, at the outset, produce relief often and are not a bad sign, except during pregnancy. It must be remembered, how- ever, that the bleeding at the nose may give rise to un- necessary alarm when the blood is swallowed and then is vomited after being in tlie stomach f(.r a while. This is taken by the inexi)erienced for black vomit, but may be differentiated chiefly by the fact that it can be ascertained there has been nose bleeding and that this occurrence comes early, generally some tinu' on the second day, a period too early for the true and much dreaded black vomit. ! Bleeding from the gums is a grave sympto/m and the earlier it appears the more significance must be attached to it. Coming as early as the third or fourth day, it in- dicates a very serious condition. Danger need be 1170 augustin's history of yellow fever. apprehended less if the si^onginess and bleeding of the gums is ])resent only after the fourth day. Hemorrhage from the intestines is always a dangerous indieation and death is ver^- apt to follow when there occur bloody stools of a gangrenous odor. Like other hemorrhagic symptoms, bleeding from the stomach, which produces what is usually termed black vomit, is of the grayest import when it occurs as early as the third day; on the fourth day it is still a very bad sign and means almost sure death if the gums also are bleeding; if only on the fifth or sixth day and, particularly if at that time the gums are still firm and do not bleed, the prognosis is not so gloomy. The quantity of vomit also counts, the more of it and the more often it happens, the worse the indication. It has been outlined, then, that by the aid of some definite propositions it is possible to prophesy about the type or degree of virulence of the disease which is to be characteristic of a given outbreak. It has been shown next that the past historj^ and the actual condition of the patient can furnish valuable prognostic data. Finally, we have determined that a proper stud}' of some of the important symptoms will yield important information as to the outcome of an attack of yellow fever. It must be added that, after all is said, tlie experience and judg- ment of the observer must remain important factors m determining the accuracy of his prognosis. Xeitlier must it be forgotten tliat ''yellow fever is a dij-ease of sui iirises." Some patients have died whose recovery had been con- fidently expected, wliile wo have known others who re- covered after their death certificates had actually been written out. As Touatre has said, ''a patient must never be given up !■' 1171 THE TEEATME:NT of YELLOAY FEVEli. By Lucien F. Salomon, M. D. Secretary Louisiana State Board of Health, 1886-1893. In i)reparing this article ui)oii the treatment of 3'ellow fever, it has been my effort to avoid technical terms and phrases, and so ex^n'ess myself as to make the subject plain to the lay mind so that in the event of a physician not being obtainable any person of intelligence will be able to manage a case, until the patient can be seen by one. On the other hand, the treatment here given is recommended to practitioners of medicine as the result of a very large and successful experience in yellow lever. Many j^ears ago, in the early days of my practice, I found that potassium nitrate was almost as efficient, if not as sure an antidote to the malarial poison, as quinine; and long before the microbiological investigations which have since been made, deuilonstrated that Yellow Fever was not caused by a microbe, the peculiar hemorrhagic tendency of the disease, resembling so closely the hemor- rhagic form of malarial fever, led me to use potassium nitrate in the treatment of Yellow Fever. As a result, I am i:)repared to state, and also confidently^ assert, that in a majority of instances, a case, if seen within the first twenty-four hours and treated according to the method which I shall give, is converted into a simple pyrexia, with rapidly declining temperature, terminating at the end of tlie third day, and not followed by the secondary rise so often seen. Of course, the mere administration of drugs does not constitute the entire treatment of any disease, but, having in the first instance administered what I cousider an antidote to the poison, tlien it becomes our duty to so manage the case as to conduct our patient to the safe liarl)or of recovery. Witli these preliminary remarks, I shall now proceed to describe how to treat Yellow Fever. The first step 1172 AUGUSTIN S HISTORY OK YELLOW FEVER. necessary is the admiuistration of a large saline purga- tive, preferably sodium sulphate. This will thoroughly cleanse tlie entire intestinal tract. It is not necessary to give calomel or any other purgative, because the sodium sulphate, in addition to its flushing power, also acts as a cholagogue. It will often be found that when the patient is seized with the attack there is undigested food in the stomach. If such should occur within a short time after eating, he will vomit and empty the stomach of the food. If the seizure should come on three or four hours after a meal, and there is still some undigested food in the stomacli, there will be nausea. In sucli cases it is well to give minute doses of calomel, for the purposes of quieting the stomach, so that the sodium suli)hate will not be rejected. For this purpose, the following combi- nation is best adapted to the i)urpose: A powder con- sisting of one-quarter grain of calomel Avith one grain of ingiuvin. This to be repeated every twenty minutes until four are taken, and then folloAved, in one-half an hour, with one-half or one ounce of sodium sul])hate dissolved in a glassful of water. It will be found very frecpiently that the intense headache accompanying the onset of the attack will be relieved after the administration of the saline. If not, relief can be obtained by the old-time hot foot-bath, which, by the way, I never use except for the relief of said condition. One hour after the administra- tion of the purgative, and without necessarilv waiting for its action, begin the administration of the following prescription : Potassi nitratis 1 dram Liq. ammonije acetatis 3K' ounces Syr. aurant flor Yi ounce The adult dosc^ of Ihis mixtnri^ is one-lialf <»nnce, re- peated i'\(n-y two hours during the continuance of the fever. The liquor ammonijpe acetatis is administered in conjunction with the potasium salt for its action on the skin, as it causes frcM' dia])lioresis, thus favoring elimina- tion. The potassium nitrate, in addition to what I con- TREATMENT SALOMON. 1173 sider its specitic effect as an anti-toxin, also plays a very important part by actini>- as a prophylactic diurectic. It will be fonnd, as a rule, within a few hours after beginning the administration of the above mixture, that the temperature, no matter how high at the onset, will begin to decline, and will decline progressively until the end of the third day, when convalescence will begin. In addition to the remedies above mentioned, there are several cardinal points in the management of a case of Yellow Fever which should be borne in mind. The first is absolute rest in the recumbent posture, not allowing the patient even to raise his head for any purpose what- ever. Second — Absolute abstinence from food of any description, liquid or otherwise, until the complete subsi- dence of the fever. Third — Careful attention to the thorough enipt3ing and cleansing of the lower bowel by large enemata administered at least once daily, using for this purpose at least two quarts of normal salt solution. Water and ice should be allowed ad Vihiinm, prefeial»ly carbonated water, such as Apollinaris, carbonated lithia water or seltzer water. If the patient is averse to the carbonated water, plain vichy may be given. After the fever has subsided, the temperature often becomes sub-normal. The patient is now in what is called the algid stage. Very often, the extremeties will be cold; sometimes the entire body is cold and clammy to the touch. For this condition there is nothing better to re- store the patient to a normal condition than a small glass of ale administered every two hours, in conjunction with mix vomica and caffeine. I usually administer one-eighth of a grain of extract of nux vomica with one or two grains of caffeine citrate every two or three h(5urs, as the case may require. In beginning to feed the patient, which may be done on the fourth or fifth day of the disease, great care is neces- smotion of organizations, and the measures for the prac- tical application of public hygiene," the Louisiana "system simply goes a step further in carrying hygienic instruc- tion to the masses of the people in the homes and by their firesides, by Chatauquan methods. At the New Orleans meeting of the American Medical Association, a resolution offered by Dr. Sanders, State Health Officer of Alabama, endorsing the principle of this system was unanimously adopted by the section on hygiene, referred under the rules to the general Committee en Resolutions and never reported back, so evidently the medical mind is not yet fully converted to the idea that the highest duty of the physician is prevention and not cure.* *Since this was written, the American Medical Association has had Dr. McCormaclc visiting the entire country, advocating Public Education in Hygiene, and at the Chicago Meeting of the Association, June 2-5, 1908, Dr. Burrell of Boston, its President, devoted his Presidential address to the "New Duty of the Medical Profession, the Education of the Public in Scientific Medicine. Vide Journal A. M. A., Vol. No. 23, p. 1873. At the same meeting Dr. Harrington, of Boston, in his address on "States Rights and the National Health," among other things said: "In arousing the public to a proper appreciation of the importance of public hygiene, we have far more to fear from professional than from lay ignorance." * * * The creation of educated public interest in the National health is a duty which happily does not belong to any one class or calling, each in his way can do his part by precept and example, of great value as shown in the agitation for the law relative to foods, and here, there and everywhere for the establishment of Sanatoria, for ordinances against the spitting habit, are popular lectures, magazine articles, and the sympathy of the press. 1180 augustin's history of yellow fever. In tbe winter of 1882, with the memory of the yellow fever epidemic of 1878-1879, still fresh, and the mortuary statistics of tuberculosis bristlinji,- with its annual holo- caust, a scheme of Public Instruction in Hygiene was evolved, which should start in at the Kindergarten, con- tinue through the primary and academic grades, to the college and university, and university extension Hvith s«me great Central Institute of Hygiene as a focal point from whose portals could be issued a journal, bulletins and leaflets in all the tongues spoken in the State, and a corps of trained Lecturers organized for the instruction of the masses. The scheme was considered a Utopian dream by most medical men, who hebl tliat the ^Medical Colleges nad Chairs of Hygiene, and that the rudiments of that science could be taught in the pul)lic school, unmindful of the fact that even in ^Medical Colleges Hygiene was usually an un- im])ortant adjunct to the Chair of Materia-^NIedica, and that the teachers in the public schools themselves needed instruction, and so the plan for want of means to carry it into execution failed to materialize. "Two years ago there was inaugurated at the Harvard Medical School a series of free public lectures, given on Saturday evenings and Sunday afternoons for four months, mainly on Preventive Medicine. The first series was a most giatifying success; the second so largely attended that at times more people were turned away than succeeded in securing places. The chief result is a widespread interest in public hygiene, and marked strengthening of the cordial relations which ought to exist everywhere between the pro- fession and public." (Journal A.M. A., Vol. No. 24, p. 1959.) On July 18, 1908, the editor of the Journal A. M. A., in an article entitled "Relation of Education to Preventive Medicine," in commenting on Dr. Ditman's monograph on "Education and its Economic Value in the Field of Preven- tive Medicine," says: "Eff active measures for removing the causes of disease can be carried out only with the support of an enlightened public opinion, and this must be formed by education." (Vide Journal A. M. A., Vol. 2, No. 3, p. 227). In volume 51, No. 4, p. 323, in commenting on "The Louisi- ana Sy.stem of Hygienic Education," the editor says: "On LOUISIANA SYSTEM OF HYGIENIC EDUCATION MAYER. 1181 One of the distinctive features of tlie system, and tlie one from which it was expected to i-et the best results, was a series of popular lectures illustrated with lantern slides, breaking the continuity ofi' the strain on the lay mind by appropriate musical and recitative numbers, be- tween each lecture and discussion. In 1885, as an exper- iment to test the correctness of the theory, this idea was carried into execution and the most gruesome subject purposeh' selected for a popular lecture, viz. : ''The Sani- tary disposition of the dead.'- The kindly manner in which this dismal topic was received, confirmed the cor- rectness of the theory; the only thing that remained to be proven, was: whether public interest could be kei)t up for any length of time, and the opportunity for proving this did not present itself until 1897, when the first popular Institute of Hygiene ever held was convened in the town of Opelousas, in this State. The session opened in the morning, lasted all day and all night. At mid-night an adjournment was taken to enable the ladies to retire, and the intelligent co-cperation of the public the ultimate suc- cess of Sanitary legislation must largely depend. A useful auxiliary in this direction already exists in what has been called 'The Louisiana System of Hygienic Education,' the essential feature of this movement, according to Dr. F. J. Mayer (Rept. of Spec. Med. Insp. La. State Board of Health, 1908), consits in the holding of Institutes of Hygiene before Colleges, High Schoo'.s and Special Institutes. By this means not only is a considerable portion of the populace instructed in the nature and prophylaxis of transmissible diseases, but the movement is farther extended by the 'per- fect correlation of the clergy of all denominations, educa- tors, scientists and the press with the health service of the State in its educational efforts.' * * * "The further extension of this movement is much to be desired. It seems desirable, however, as Dr. Mayer suggests, that the educators should be independent officials, not engaged also in field work; not only because there is work enough of that kind alone to engage their attention, but also because their teaching is apt to be looked on with suspicion by the ignorant if it emanates from one charged with executing the ordinances of the Board." (V. J. A. M. A., Vol. 2, No. 4, page 323). 1182 augu&tin's history of yellow fever. the lustitnte reassembled at 12:30 P. M., when a lecture was delivered for men only; it was 2 o'clock A. M. hefoi'e the successful experiment adjourned sine die. Many of the leadini;- Sanitarians of the State participated ; includ- ing Drs. Dalrvmple, Metz, Dver, Chassaignac, Formento, E. D. Martin and others. Those who have had experi- ence with agricultural and pedagogical institute work will recognize the success of holding the wrapt attention of an audience ilor such a len^lliv period. Water, Hygiene of the skin, Sexual Hygiene, Cremation, Antlirax (Charbon), Variola and Vaccination, Yellow Fever, Typhoid and Con- sumption were lectured on and discussed before a packed house. The practical benefits of this institute were felt the next day in an overhauling and cleaning of cisterns, the chief source of drinking water in the town. Some of these tanks had not been cleaned since the war, and contained two feet of black pultaceous mud reeking with organic filth. Attention was directed to the dangers of polluted milk supply, and peo])le boiled milk who formerly had con- sumed it raw, although the cows sup^tlying it drank from the town creeks polluted with sewage.** The next year another institute was held in Baton Rouge, through the exertious of Dr. Dalrymple, Professor of Comparative Anatomy in the L. S. U. & A. ]\r. College, and recently elected President of the American Veterinary ^ledical xVssociation. These two institutes, whih^ demonstrating the feasibilty of the plan, nmde maniftvst the fact, that the expense was **The unbroken continuity of interest manifested at this Institute was due to the fact: that under the guidance of an eminent musician the physiological effect of music on the nervous system wa3 taken full advantage of in lessening the strain on the lay mind, which otherwise would have been unbear- able in a mixed audience. The use of music is an impor- tant adjunct of the Louisiana System of Hygienic Education, and applies with equal force to all institute work; like all nerve stimuli, it must be used with discriminatory judgment, hence the very best musicians should be consulted in ar- ranging the musical part of the program; it would never do to follow a discourse on death in its protean forms, with an aria, one might say mal-aria, the lugubrious strains of which LOUISIANA SYSVEM Off" HYGIENIC EDUCATION MAYKR. 118S too heavy for the individual, and that it was the duty of the State to furuish tliis instruction. These institutes were held under the auspices of the ''Louisiana State Sani- tary Association." The purposes and objects of this cor- poration as set forth in Article II of its constitution adopted November 22nd, 1897, are declared to be: ''The advancement of sanitary science, "First. By the organization of a central body with auxilarj' circles in every parish in the State and its ex- tension, until it embraces all the Southern, and particu- larly the Gulf and the South Atlantic States. Second. The founding of a school of Hygiene and Quar- antine on the Chatau(pian plan of correspondence. Lec- tures and Summer Institutes. Third. The publication of a monthly Journal devoted to the objects of the Associations. Fourth. To secure through an educated public opinion the enactment of adequate health laws ; laws on vital stat- istics on food adulteration and water pollution, on meat, and dairy inspection, on vaccination and their enforce- ment; and the founding of hospitals for contagious diseases. Fifth. To systematically educate the people of the State to the necessity of substituting rational, scientific, uniform, maritime and inland quarantines during periods of epidemic danger or invasion for the barluirous shot- gun quarantines, whicli while crippling commerce, afford at best a doubtful and insecure ])rotection. Sixth. The restriction and prevention of tul»erculosis and the founding of sanitaria for its Hygienic-Dietetic treatment." following closely after the dreary dissertation might pile Pelion on Ossa; nor would it serve the purpose to follow the discourse with some excruciating rag-time that would rudely check the rising tide of sympathy and deflect its current into a channel of levitj% the sympathetic interest and attention of the audience would be balked. Rostand elaborated the idea in "Cyrano de Bergerac," when the thoughts of the starving Cadets of Gascony were turned and raised to higher levels by music that appealed to loftier instincts. 1184 augustin's history of yellow fever. The charter provides for representation of all interests coneerned particularly to that mighty a}j;ent of reform, the Press and declares : "That its Advisory Council shall consist of dele<»ates from each Sanitary Circle in the State, from each Town Council and Police Jury of the State, from tlie Ccimnun'cial Exchanges and Boards of Trade, from the Boards of Health, from the Medical, Pharmaceutical and Dental Societies, from the Colleges, from the Louisiana Chatauqua and other educational and scientific hodies, from the Press Association of the State, and the Press Club of New Orleans, and the Commercial Travelers' Association ; the basis of representation from each to be fixed by the Executive Committee.'' These two committees shall, in joint session, "Serve as a nominating committee of officers and committeemen, for the ensuing year and nmke such recommendations to the Association as shall best secure the (tbjects of its creation." The membership is composed of active, associate, hon- orary- and non-resident corresponding members, the Exec- utive Committee determining for which class a proposed member shall belong; there is no initiation fee and the annual dues are fixed at |1.00, and the liabilities of mem- bers limited to the amount of their annual diu'S, and "this society may incorporate with similar or other sanitary associations in the other Southern States in such manner as its Executive Committee may detei-miue."' The Secretary is ex-officio State organizer. Copies of this Charter were sent to the Exchanges and Transportation Companies, but failed to attract atten- tion, although as per reference to Section 5, of the Char- ter, it will be seen they would have been the chief benefici- aries. The business mind had no patience with any system that required time for a proper evolutionary devel- opment; what it desired was a speedy estoppel to shot gun embargoes on commerce, and vainly inuigined, as manj' of them still do, that all that was necessary was the exhibition of physical force on the part of the State or National government. Louisiana system of hygienic education — maver. 1185 Here it is where a great divergence of opinion exists, tliose who have more closely studied the (question, recog- nize that the average American is imbued with the old Anglo-Saxon idea, that every man's house is his castle, and that he has an inherent and inalienable right to de- fend it from invasion, whether the invader comes in the form of a burglar or a foreign disease germ, and that, whether he has a legal right or not, he is going to take it; now when whole communities become obsessed with this view, and, in the furtherance of their belief in the right of self-ijreservation, commit excesses not warranted by science, it is apparent that the only permanent relief to be obtained is from a better enlightened public opinion. In the reign of Elizabeth, a gibbet Avas set up at every mile post, from Lands End to New Castle, in the hope of stopping smuggling, and failed, and our own well ap- pointed revenue service cannot wholly prevent infraction of the law; the whole army of the United States if im- pressed into service as a quarantine guard might for a time enforce the passage of trains through territory quar- antineed against infected areas, but it could not prevent the torch from being applied to a railroad bridge, nor the raising of a rail by the inid-night prowler, and this would for a time put a stop to commerce. Nor could all the powers of the United States force a commuity to carry on business relations with centers of inf/ection if they felt indisposed so to do ; so in the last analysis any sys- tem of inter or intra-State (|uarantine, whether under the control of the Federal or State authorities, to be effective must have an enlightened public o])inion back of it so that its provisions may be enforced. For as Lincoln said : ''With public sentiment nothing can fail, witliout public sentiment nothing can succeed, consequently he who moulds public sentiment goes deeper than he who enacts statutes, or pronounces decisions, lie makes statutes and decisions possible to be executed.'' In 1898, and for four years thereafter, through the courtesy of the State Department of Agriculture, it was made possible to carry on a series of Lectures on Hygiene of the Home and Farm, including Lectures on Consump- 1186 augustin's history of yellow fever. tion, Small-pox, Typhoid Fever, Anthrax, Water and In- sects in their relation to public health, drainage, etc. At these lectures it was noticeable that the farmers took as much interest in Hygiene as thev did in the agricul- tural discussions, their questions showing that they real- ized that ill-health in man and beast was the most serious economic leak on the farm. In 1900, a bill was drafted and presented to the Gen- eral Assembly by the late Ex-Speaker Henry, of Cameron, to create a Commissioner of Hygiene whose function would have been purely educational and whose principal duty would have been to lecture before the Agricultural and Pedagogical Institutes, the Colleges and High Schools, and before Special Institutes of Hygiene at the Cotmty Seat of every Parish. Under the political conditions existing at that time, it was considered a hopeless task to attempt to pass any measure opposed by the Chief Executive, for the appoint- ive power i^laced in the Governor's hand, a sword with which he could slash right and left and Avhip recalcitrants into line with the flat side. Nevertheless, before this able body, with the Governor violently opposed to its passage, tlie Hygiene Bill won recognition b^' a vote of 63 to 27 in the Lower House, and 26 to 6 in the Senate, solely on the strength of its merit. The Governor vetoed the measure on the ground that the State was not able to stand the expense of |4000 per annum asked for. Two years later the Bill was reintroduced by Hon. W. W. ^'entress, a distinguished Sugar Planter of Iberville, passed the Lower House by 63 to IT, with 18 of its avowed protagonists unavoidably ab- sent, passed the Senate unanimously in desi)ite of the unprecedented and unseenly opposition of the Governor, and was again vetoed by him on the grounds set forth in his original veto message, that it was "a meritorious measure regretfully refused" for want of funds, and this in the face of his own message setting h:)vt\\ the fine financial condition of the State, and so for a season, a plan of public instruction in hygiene, upon which the leg- LOUISIANA SVSTKM OF HVGIEMC EDUCATION MAYER. 1187 islative will had been twice affirmatively expressed, fell, through the petty oppositiou o.f a politician — " Drest in a little brief authority Most ignorant of what he's most assured, His glassy essence like an angry ape, Plays such fantastic tricks before high heaven As make the Angels weep." The passage of this Bill, and the efficient execution of its provisions, would have saved the State the epidemic of 1905, and the incidental loss of two hundred millions of dollars to her comm,erce; this bold assertion is based on the fact, that after the epidemic had started and was under full headway, a campaign of Sanitary Educatioin along the lines i)roposed by the vetoed measure, succeeded in the brief period of sixty days in converting the people to the mosquito doctrine who for over a hundred years had been wedded to the fomites theory ; even the ignorant colored population being converted and co-operating with the magniticent work of the medicos and sanitarians of New Orleans; and for the first time in sanitary history an epidemic of yellow fever was practically stamped out of a great center of population before the advent of frost ; and the commercial conscience awakened to a realization that "Honesty is the best policy," and that the frank admission of the existence of a contagious or infectious disease, to- gether with tangible evidence that prom])t and scientific methods for its extinguishment are being pursued, is bet- ter than a policy of conc(>alment, which always leaves in the public mind a belief that the evils hidden are infinitely worse than they really are; it is the myste- rious and uidcnown that has always cai-ricd tei'ror to the human heart, full many a warrior wlio has hacked and hewn his way through aisles of bristling steel to fame, who on a hundred battl(» fields has ytroudlv carried his es- cutcheon untarnished by a stain, h;is forgoUcn the obli- gations of Christian chivalry and sullied his knighthood with a craven and dastardly fear in the ])resence of un- known danger, or supernatural terrors, especially when clothed in the garb of pestilential disease. 1188 augustin's history of yellow fever. In 1000, when Dr. C H. Irion became president of the Louisiana State Board of Health, one of Ids first acts was to carry into execntion some of the measures of this scheme of public education, and over one hundred insti- tutes of hvgiene were held throuii,hout the Infected area of tlie year before ; where the mos(|uito doctrine was ex- pounded in a series of illustrated lectures in English, French, German and Italian. At these institutes the co- operation of the priestliood and cleriiY was earnestly sought and secured, and by their influence aided materi- ally in securing attentive audiences. The good results were soon apparent in the passage of screening ordinances in most of the towns of the State, by post-c^pidemic fumi- gation, and other sanitary steps, Avith the result that there was no recrudescence of yellow fever for the first time in sanitary history, in a year following an epidemic year, the single exception occurring in a town that had persis- tently neglected screening and other sanitary precautions, and made no effort to secure the educational advantages of an institute. This correlated educational sanitary work was followed by a remarkable exemption later from the incursions of mosquitoes, and better health conditions generally than had ever been observed before, during the summer and autumn following prevailed indeed, the iiii]»roved condi- tions incident to the sanitary precautions taken in lOOfi, bore fruit as well in 1907, after they had ceased opera- tions, and this improvement continued until the people had lapsed back into the usual callous indifference that re(piires rude awakening by ei)i(lemic danger and constant preaching on sanitation. This institute work was supplemented by an annual Conference of the Sanitary Officers of the State, Parishes and ]\runicipalities wherein representation was accorded to all educational, medical, sanitary, commercial and transportation bodies, and sanitary measures were ex- hanstively discussed. At the last rouference held in Opelousas, the State Press Association, sitting in annual Convention in Lafayette, realizing the educational advan- tage adjourned as a body and joined the Sanitary Confer- LOUISIANA SVSTEM OF HYGIENIC EniXATION MAYER. 1189 once on invitation of President Irion. Tlie lit. Rev. James Blenk, Arelibisliop of tlie Diocese of New Orleans-, sent his personal representative to this Conference, the Rev. Father Kavanangh, Catholic Sni)erinten(lent of Educa- tion; the minutes of every meeting Avere published by the daily press, so the educational propaganda was carried to the farthest limits of the State.*** During the early months of the year an Anti-Tubercu- losis league was organized, whieli has already succeeded in establishing a consumptive sanitarium in the ozone belt of the State, besides carrying on its educational work by the Louisiana method. The earnest and noble women who took the initiative in this matter are very much hand, icapped by want of means. Among the unique results of this hygienic educational work was an institute, held l»y an attache of the Roard of Health, for the -exclusive benefit of the nuns, nearly four huudreel in number, under the auspices of the Superin- tendent of Catholic Educatiou. The good results of which cannot be doubted, when it is rememl)ered that most of these noble women are teachers, Avith a Avide circle of influence outside the school room, anel that sixty per cent, of their number throughoiU the Avcrld die of tubercu- losis, most frequently contracted in the rounds of their diiily charity labors. The State Board of Health has endeavored to give an institute AvhereA'er one Avas desired, and is now i)lanniug an extensive programme commencing A\ith a scorce of county fairs to bo held throughout the State. The prin- ciple of this system has received recognition in other ***Since this article was written, another sanitary convention under the auspices of the Louisiana State Board of Health was held in the spring of 1908, at Alexandria, which traversed the field of preventive medicine and was attended by Dr. McCormack, Secretary Kentucky Board of Health; Dr. Brumby, Chief Executive of the Health Department of Texas; Prof. Aswell, State Superintendent of Public Educa- tion; Dr. Caldwell, of the State Normal; Bishop Vander Ven, of the Catholic Diocese of Natchitoches; Dr. Kramer, Grand Master of the Masonic Order in Louisiana, who all delivered addresses. 1190 augustin's history of yellow fever. states, notably in Indiai^a, where under the able adminis- tration of Dr. Hurty, the politicians have been whipped into line by the farmers who recognized the value of hj'gienic lectures at their Agricultural Institutes. In New York last year a start was made, indeed the Health Commissioner in his report claims the honor of! priority of a plan tentively tested in this State in 1885, where it passed the experimental stage in 1897, and received a mag- nificent accentuation by the Legislative Assembly of 1900 and 1902, and by the Anti-mosquito Campaign of 1905 and 1906, and is now the fixed policy of the State Board of Health, being the first practical answer to Bowditches plea in 187G, before the National Medical Congress in Philadelphia, when he said : ^'Our j^resent duty is prgau- izatiou, National, State, Municipal and Village, from the highest place in the National Council down to the smallest village Board of Health, we need organization, jcith these organizations we can study and often prevent disease." The principle underlying the Louisiana system : Edu- cation, hand in hand with prevention, has reached France, and is protagouized by no lesser personage than ex-Pres- ident Loubet in his "PuerK'ulture," — Child Cultivation, who has brought together the National Union of Presi- dents of Mutual Benefit Societies and the ^Medical and Pharmaceutical Union in an educational camitnign on the plan of the Mutualists Anti-Tuberculosis Dispensary of the 13th Ward of Paris, and a camjiaign has been started against food adulteration, foul air, dirt, polluted milk, want and sanitary ignorance. The results obtained by the Schneiders at Cruzot, whose sanitary surveillance ofl the milk supply has reduced the infant m^ortality during the first year of life (the most dangerous period) from eighteen per cent, the average for all France, to nine per cent, for the past year, proves that no greater philanthropy or more patriotic duty confronts the people of our sister republic, than that now engaging the thouglitlis of ex-President Loubet.**** ****The establishment~of Infant^Milir^Dep^ots.^Iilk Dispensaries, or "Goutte de Haut," in different parts of the world, have invariably lessened infant mortality. The first institution of the kind was established in Stamberg in 1889, followed LOUISIANA SYSTEM OF HYGIENIC EDUCATION MAYER. 1191 The purve3'or of depraved milk, the ''great liquid food" iipou which so many iuiiocents depend for sustenance and life, is the most contemptible and sordid criminal that lives ''unwhipped of justice," beside whom the sneak thief, the burglar and the murderer stand in relative respect- ability, for he steals without the excuse of; hunger or other pressing want, and murders helpless innocents by inanition and deadly disease germs, one of which alone: Tuberculosis, (frequently transmitted by milk) carries oft" fifty per cent, of the children of Christendom, Under these institutes, it was intended that lectures would be delivered on Hygiene, Quarantine, ^larltiine and Inland, Miasmatic and Acute Contagious Diseases, Path- ology of Miasmatic, Contagious and ^lalarial Diseases, Bacteriology, Serum-Therapy, Physiology, Malarial Dis- eases, Contagious and Infectious Diseases of Children, Hygiene of Surgery, of the Eye, Ear, Nose and Throat, of the Skin, of the Mouth, Sexual Hygiene, Leprosy, Diet- etics, Influence of Alcohol and Narcotics in their relation to Public Health, Toxicology, School Hygiene, Agricult- ure and Manufactories in thcr relation to Hygiene, Con- tagious and Infectious Diseases ofl Animals, Sanitary Engineering, Sanitary Transportation and Disposition of the dead. Insane Asylums, Metereolooy and Climatology, IMunicipal Sanitation, Pailroad Car Sanitation, Construc- tion and Management of Detention and Observation Camps during Epidemics. Insects in their relation to public health. Tuberculosis restriction and ])ievention, Tuberculosis Hygienic, Dietetic treatment. The Louis- iana system has always emphasized the necessity of co- operation on the part of school aiithoT-ities and teachers with the healtli authorities in securing better school hygiene, recognizing that "as the twig is bent, the tree's inclined." and that among the children attending public by one at the Belleville Dispensary, Paris, in 1892; the first in this country was founded in New York City, by the philanthropist, Nathan Straus, who is indefatisable in his exertions to improve the milk supply furnished infants; .aside from the immediate good results that found their es- tablishment, they are valuable object lessons in pointing out the evils of impure milk and educating the masses to the danger. 119i scliools there were thousands who were siifferiug from l)reyeiitable diseases, the direct result of ignorance both on the part of parents and of the children themselves; that the pieaching they most needed was the gospel of soap, and that a vast stride in the right direction would be made, if all the children attending the i)ublic schools were examined by physicians, free of cost, with special reference to vaccination, tuberculosis, trachoma, decayed teeth, i)ersonal hygiene and malnutrition. The institute conductor of the Louisiana Board of Health addressed thousands of children in their sehools during the educa- tional campaign of 1 !)()(), on personal and school hygiene, and on the subject of mos<|uitoes and flies as transmitters of disease. It is pleasing to note that New York is also taking up the question of more hygiene and less phj-sical culture in the schools, a committee headed hj an ex-Superin- tendent (tf Education, Mr. IJurliugham, recently discov- ered an appalling condition of affairs, reporting that out of (;00,()OI) schoorchildren, 4(1,500 are physically'defective; that among the cases of malnutritiou, the greatest num- ber were founy a ])aternal g(xvernuieiit, was only devoted to educating the rising generation in the value of ])revention of disease, the go(ul results folhtwing would show the wisdom of the ex- penditure. ^Millions are spent for the encouragement of nnassimil- abl(^ immigrants, ignorant in many instances of our cus- toms, lial)its, speech, institutions and rcligi(in, but noi one cent for the conservation of the lives of our ])eo])le, 200,000 of whom annually go down to a consumptive grave, the majority at the age of greatest productivity. Tlie econo- mic loss has been conservatively set at three hnndicd mil- lions annually, aside from the humarJtarian aspect, }Uid taking a cold blooded, business view, it would pay to edu- cntr the i^asses to n i)i< per appreciation of the dangers +iiat hourly confront them. The American Public Health Association and the Sani- tary Institute of Great Britain for over a (piaiter of a century have carried on their educational work among sanitarians; the Louisiana system goes a step farlher and carries this instruction to the masses of the people, teach- ing themi not alone the aphorism of the Lai in poet Martial: "Life is not mere living but the enjoyment of health," and tlie maxim ((f the Koman law giver: "The sanitary safety of the Bepublic is the supreme law," b"t that the economic loss in the nntimelv removal of millions of human l^:ot t(nt , at th.' ]»eriod of Iheir greatest prodnc- 1194 augustin's history of bellow kkver. tivity, from (•oimniiiiicablc, prcvciitabJe diseases is due to ignorance, which it is the highest duty of tlie State to enlighten. Tlie system appeals not alone to the humanity hut to tli(^ common sense of the American people, pcnnts out that the victim of a contagious or infectious disease is not a criminal to be hounded to earth, but the victim of the sanitary laches of a community, it reiterates the averment of Dr. Benj. Rush : "City authorities were justly chargeable with the lives of all who die of preventable diseases within their jurisdiction, and that they should be made responsible bef(U'e the Courts of Justice." It ful- fills a high civic duty in correlating all educational fac- tors in the State, and focusing them on the all important moral, economic and political necessity of preserving the public health by reaching the masses and teaching the individual the value of a sound mind in a sound body, that to attain this it will not do to violate the sanitary law, and in our daily lives act — " As if this flesh which walls about our life Were brass impregnable." The annual address before the Orleans Parisli .Medical Society in January, 1898, was devoted to this topic, and an elaborate plan for a State Institute of Hygiene jU'o- ])<;sed which has never been carried iuto coni])l(»te (execu- tion for want of uieans, the ec(tnomic value of such a system is beginning to be appreciated, and the day is not far distant when every civilized State will liave an Institute of Hygiene on the Louisiana ])lan, with a National Institute to su])i)lement the w(n-k of the States, and an International Institute to focus a woi-ld wide movement in i^ublic instruction in hygieue, when the world will awaken to a realizing sens-e that an epi- (h'mic is the remorse of a guilty community, guilty of sani- tary laches, guilty of pollutions and desecrations of the Sacred Altar of Hygiea, in the words of Aristotle: "Of all these things the judge -"s time." J F.RSIT'' OF ^VLIFORNIA LIBRARY If UNIVERSITY OF CALIFORNIA LIBRARY Los Angeles This book is DUE on the last date stamped below. ^^^^^«r|fcal Library Sfofnedlcal Library 'DECEIVED 315 roA A 9-' ^ ^0^ u . 3 1158 00547 7863 ■IP