RC 
 
 206 
 
 C6 
 
 1898a 
 
 PUBL 
 
 UC-NRLF 
 
 1 
 
 B ^ 527 133 
 
 A HISTORY 
 
 OF 
 
 YELLOW FEVER 
 
 ORIGliSLAND^QVUSE 
 
 ^Iff 
 
 And its present artificially acquired habitat, with reasons going 
 
 to show the possibiUty of its complete extinction from 
 
 the globe, its nature, ariatomical characteristics, 
 
 symptoms, course and treatment with 
 
 an addendum on its twin sister 
 
 DENGUE 
 
 Containing a parallel table of the most prominent symptoms 
 of each disease. 
 
 1^*4^*1^*^'' 
 
 BY 
 
 W. L. COLEMAN, M. D. 
 
 Houston, Texas, 
 
^ 
 
A HISTORY 
 
 OF 
 
 YELLOW FEVER 
 
 tl^t^tS^t^ 
 
 And its present artificially acquired habitat, with reasons going 
 
 to show the possibility of its complete extinction from 
 
 the globe, its nature, anatomical characteristics, 
 
 symptoms, course and treatment with 
 
 an addendum on its twin sister 
 
 DENGUE 
 
 Containing a parallel table of the most prominent symptoms 
 of each disease* 
 
 ^2^ ^^^ %^^ 9^^ 
 
 BY 
 
 W. L. COLEMAN, M. D. 
 
 Houston, Texas, 
 

 In compliance with current copyright 
 
 law, U. C. Library Bindery produced 
 
 this replacement volume on paper 
 
 that meets ANSI Standard Z39.48- 
 
 1984 to replace the irreparably 
 
 deteriorated original 
 
 2002 
 

 DEDICATION. 
 
 This book is affectionately dedicated to the 
 Medical Profession, in which I have been a 
 hard and earnest worker forever forty.years, with 
 the hope that through them it will be the means 
 of accomplishing much good for my fellowmen. 
 
 The Author, 
 
% 
 PUBLISHER'S STATEMENT. 
 
 The Author's manuscript was prepared dur-^ 
 ing the year 1 891 and has been carefully and pains- 
 takingly revised in the office of publication, to 
 comply with the political conditions now exist- 
 ing. It is believed that 'the Doctor's predictions 
 are correct and that we shall never have another 
 widespread epidemic of yellow fever, particular!)' 
 if his suggestions for the prophylactic treatment 
 herein expressed are faithfully carried out. 
 And if cases do occur we believe that the author 
 and his many co-workers will be able to demon- 
 strate that the disease can be more successfully 
 combatted along alkaloidal lines than it has 
 ever been before. We therefore heartily com- 
 mend the little book to all who would know the 
 truth of the past, the present and the probable 
 iuture of yellow fever. 
 
 The Clinic Publishing Gompany. 
 
 Chicago, July, 1898. v 
 
r 
 
 PREFACE. 
 
 While the launching of this frail little cjaft, 
 pilotless as it were and from an . unknown 
 
 jDuilder, upon the literary ocean of ^nedicine, 
 and especially upon that part of that turbulent 
 sea the surface of which has been so frequently 
 agitated by the fiercest and most bitter wordy 
 combats and violent controversial storms con- 
 cerning its subject, may be regarded as an act 
 of foolhardy temerity; yet although it is the 
 author's first venture in this particular depart- 
 ment he sends it forth fearlessly, utterly ignor- 
 ing and indifferent not only to the ^Hmprimatur'' 
 of the celebrated French Academy of Sciences, 
 so highly prized and desired by Dr. Audouard, 
 but also to the endorsement of all the sp-called 
 scientific societies of the world, fully convinced 
 and well satisfied that it will be eagerly sought 
 for and read by that large and rapidly increas- 
 ing body of intelligent, progressive physicians, 
 "The Burggraevian Dosimetrists of Europe," 
 and "The Abbott Alkalometrists of America," 
 
 ^who, being dominated solely by that rare 
 quality of mind, common sense, ''prove all 
 things" and are in no way governed by the old 
 rule of /'Magister dixit." 
 
 I do not mean the least disrespect or dispar- 
 
4 PREFACE. 
 
 agement of them when I say I ignore the learned 
 scientific bodies of the world and do not care 
 the snap of my little finger whether or not they 
 read a line of my unpretentious little collection 
 of irrefutable truths concerning the subject of 
 my work. They ignored Dr. Audouard's valu- 
 able brochure because it did not bear the seal of 
 the French Academy, although he was a special 
 representative of that society on the official 
 commission appointed by the French govern- 
 ment in 1821-23 to investigate the yellow fever 
 epidemics of Spain; while mine is not only 
 entirely destitute of a seal from any kind of a 
 society, but it is the production of one who 
 determined forty-five years lago, when a student, 
 to discover all possible hidden truths of this 
 disease about which the most brilliant and 
 gigantic minds in the profession had been 
 wrangling for nearly a century without coming 
 to a clear understanding about any of them. 
 
 And now, without a scintilla of egotism or 
 spirit of boasting, I present as a result of my 
 labors the chief of those old points of contro- 
 versy cleared of all mystery and established 
 upon the firm basis of immutable truth; and 
 doing this in a spirit of perfect confidence born 
 of this result of my labors, I demand rather 
 than solicit, as authors usually do, the attention 
 and investigation of the rank and file of the pro- 
 fession — that great body of hard workers who 
 always honestly desire and earnestly seek for 
 
- PREFACE. 5 
 
 the truth in such questions, well knowing that 
 correct diagnosis and successful treatment can- 
 not be attained without a perfect knowledge of 
 the origin, cause and nature of disease. Hence 
 as it is to their interest, I expect they will be 
 my principal readers and I trust they may be 
 greatly benefited by my labors; but whether or 
 not I am mistaken and am premature in my pre- 
 diction that the scourge has. 
 course, and that it will neveF^roduce a general 
 and destructive epidemic in this country again; 
 yet it is reasonable to expect that on account of 
 the present strained state of affairs between 
 Spain, Cuba and our country, there is great 
 danger of a more wide-spread epidemic of yellow 
 fever this summer throughout the length and 
 I breadth of our land than ever has occurred or 
 
 [ ever will again occur; and in that event, there will 
 
 I be a greater number of this class of. physicians, 
 
 called upon to treat this disease than ever before 
 [ in its whole history. Naturally our soldiers 
 
 I will as a rule be non-immunes, and I fear, alas, 
 
 I that more of them will be cut down by this ter- 
 
 rible disease than by Spanish bayonets and 
 ^ ^ bullets. 
 
 It is under just such circumstances that I 
 hope this little brochure will be of great help and 
 benefit; for while I have not given the profession 
 a treatment that will always cure the disease, 
 none having been discovered, yet they will find 
 in this work advice, directions and warnings for 
 
6 PREFACE. 
 
 preventing or modifying it that cannot be found 
 elsewhere and which, if heeded and carefully 
 followed, will save many valuable lives. 
 
 Ihave no grounds for egotism or boasting, as 
 nearly all the facts presented were obtained by 
 eminent men all along the line down to the 
 present; but I have been enabled by the evi- 
 dence of subsequent historical events to use 
 these facts in deducing and establishing truths 
 which they could not see for want of this later 
 evidence, thus proving Audouard's theory to be 
 no longer theory but a stern, irrefutable truth. 
 
 W. L. C. 
 
 Houston^ Texas, U. S. A. 
 
INTRODUCTION. 
 
 "To all facts there are laws; 
 
 The efifect has its cause, and I mount to the cause." 
 
 —Lucile. 
 
 The world is too busy to form its opinion on 
 a question at first hand; hence important his- 
 torical facts and truths are seldom recognized 
 or understood by people of the age in which 
 - they occur, for some are at times suppressed 
 before suitable knowledge is obtained of them, 
 some for political and some for commercial 
 reasons and yet others from bigotry; so it 
 \ requires time for these different objections to 
 
 I pass away, as well as for the corroborative 
 
 I evidence of subsequent events to establish them 
 
 \ beyond question as facts and truths. In the 
 
 [ course of this paper I will mention a marked 
 
 \ instance of the suppression of truth for each of 
 
 I the aforesaid reasons, and thus show that even 
 
 j medical men are often blinded to the truth by 
 
 their prejudices and passions. We of all men 
 i should be liberal-minded, free from bias and 
 
 \: bigotry and incapable of being swayed by polit- 
 
 1 ical, commercial, religious or other influences 
 
 that tend to obscure or suppress truth. 
 
 I have been intending for some time past to 
 
 I undertake the task of collecting and arranging 
 
 ; for publication the records of facts and truths 
 
 that I have obtained by personal experience, 
 
 I observation and investigation of yellow fever 
 
8 INTRODUCTION. 
 
 during more than forty years, together with 
 everything else of interest and scientific value 
 that r have obtained from reliable sources which 
 would help to make a correct history of the dis- 
 ease. But procrastination has been the bane of 
 my life^ and I fear I have delayed the work till 
 it is too late to accomplish it in a manner that 
 will render it interesting and profitable to the 
 present and future generations of medical men. 
 My feeble condition and rapidly failing strength 
 warn me that but little time is left in which to 
 work. Would that some younger and more 
 fitting hand and brain had the task ! 
 
 In the beginning of my medical - studies a 
 fascination for the subject of yellow fever took 
 possession of my mind and I have never been 
 able to wholly shake it off.- During many weary 
 years of study I wandered blindly through the 
 mazy labyrinth of mysteries surrounding it, 
 seeking light and truth but finding none. At 
 the point of despair I was led from that state of 
 uncertainty by a ray of light emanating from a 
 gem of truth seventy-five years old which reached 
 my dull brain by penetrating through the preju- 
 dice and passion that had resisted its entrance 
 for forty years; and I set to work to bring order 
 out of the chaos of facts and truths which had 
 been gathered by myself and others during the 
 past history of this horrible scourge. 
 
 The two greatest barriers to the reception of 
 truth, prejudice and passion, having been re- 
 
INTRODUCTION. 9 
 
 moved, it became easy to accept and understand 
 the plain solution of the etiological "x" in the 
 problem stated by Dr. Audouard seventy-five 
 years before and to see its complete verification 
 by every event in the subsequent history of 
 every thing connected with the subject. It was 
 about this vexed point that some of the fiercest 
 and most violent controversial storms raged that 
 ever disturbed the medical mind; while the ques- 
 tion of its contagion, nature and connection 
 with malarial fever came in for their share; in 
 the controversies which, with each recurring 
 epidemic, were indulged in by the giants of the 
 profession from the days of the great Benjamin 
 Rush down to those of Doctors La Roche and 
 Warren Stone. 
 
 Surveying those wordy contests, which were 
 conducted with so much heat and passion of 
 argument^ by the light derived from the knowl- 
 edge of its true origin, shows them to have been 
 supremely ridiculous; for it reveals the ignorance 
 of both parties concerning the question under 
 discussion in which both claimed to be, and 
 honestly thought they were, exactly right. It 
 was always a mystery to me why they so stub- 
 bornly adhered to their respective opinions, for 
 they were men eminent in the profession who 
 readily yielded to reason upon other subjects. 
 The mystery has been cleared up by the n^w 
 light, the knowledge of which however lay hid- 
 den for nearly seventy-five years; and in the 
 
INTRODUCTION. 
 
 course of my discussion of that point it will 
 readily be shown that both parties were right at 
 that time, however paradoxical this assertion 
 now seems. - - 
 
 For more than two centuries this unique dis- 
 ease was an unsolved mystery standing solitary 
 and alone, as has been said of the great Napo- 
 leon, ''grand, gloomy and peculiar, wrapped in 
 the solitude (mystery) of his own originality." 
 Claiming no land as its birth place (and it never 
 has originated de novo) it is absolutely and 
 wholly a filth disease, a specific animal poison 
 of peculiar filth, born or generated upon the high 
 seas and under peculiar conditions (which have 
 ceased to exist), as a result of man's violation 
 of Nature's immutable laws and the inexorable 
 fiat of their Author that the violation of one 
 natural law brings its own punishment by 
 setting into active operation another law govern- 
 ing the changed condition. It can truly be said 
 to be ''the pestilence that walketh in darkness, 
 the destruction that wasteth at noon day;" and 
 after years of study and investigation of this 
 scourge I can come to no other conclusion but 
 that it is a Nemesis, an agent of retributive 
 justice in the hands of Him who hath said 
 "Vengeance is mine, I will repay." But since 
 the cruel traffic to which it owes its origin has 
 long since ceased, and the institution of slavery, 
 of which J. K. Ingram said (Encyclopedia 
 Britannica — "Slavery"): "It was politically as 
 
INTRODUCTION. H 
 
 well as morally a monstrous aberration, and never 
 produced anything but evil," has been abolished 
 by all the nations of the earth, I have believed that 
 this instrument of punishment would also be re- 
 moved. After finishing my-work in Memphis in 
 1819 I predicted that there would never be an- 
 other serious and widespread epidemic of this 
 disease in this country; for I had the presump- 
 tion to think that the South had received its full 
 meed of punishment for the part it took in that 
 great sin, that is, if we reckoned in the estimate 
 the horrors of the four years of civil war as 
 legitimate results; while the North received its 
 portion from 1693, the date of its first appear- 
 ance in this country, down to 1822, since when 
 its visits to that region have been few and far 
 between and confined to small areas. 
 
 In the following history of yellow fever I hope 
 to be able to establish as an irrefutable truth 
 Dr. Audouard's theory of its origin, and thereby 
 refute and show the littleness of the damaging 
 epithet of Prof. Hirsch who, in describing it in 
 his treatise on ** Geographical and Historical 
 Pathology," characterized it as '*eine der 
 abenteuerlichsten hypothesis," a Quixotic idea 
 unworthy of credence. And I think it appro- 
 priate to remark just here, if I succeed in this 
 object, that the Royal Medico-Chirurgical So- 
 ciety of London, in whose library a copy of 
 Audouard's book lay with uncut leaves for sixty 
 years, certainly owes it to his memory and to 
 
12 INTRODUCTION. . 
 
 the medical profession in general to resurrect 
 and republish his work as a partial reparation 
 -for their neglect and quasi suppression, for more 
 than half a century, of a book containing a truth 
 as grand and useful as any other discovered 
 during this wonderful nineteenth century. 
 
 Before going into the chronological history of 
 yellow fever, I deem it necessary for a clear 
 understanding of my design to give my views 
 and final conclusions in regard to this disease. 
 
 1. Yellow fever is not native to any conti- 
 nent of the old or new world, and never per sc 
 originated de novo upon any spot of land upon 
 the globe. 
 
 2. Yellow fever is a specific disease peculiar 
 to itself; and while there are several apparently 
 analogous diseases, yet it stands separate and 
 distinct from all others. It is always identical 
 in every climate where 4t prevails and is not a 
 grade or type of malaria or other zymotic fevers. 
 
 3. Yellow fever is pre-eminently a filth dis- 
 ease . caused by a specific infection or animal 
 poison generated from a peculiar fifth and un- 
 der peculiar conditions, and possessing a germ 
 capable of transportation and reproduction. 
 
 4. Yellow fever is never contagious but is 
 highly infectious; and its germs, while unlimited 
 as to quantity, are limited to two stages of exist- 
 ence in their power of reproduction. 
 
 5. When this germ resulting from that spe- 
 cific poison is introduced into a locality where 
 
L-^4*^X^^v^^^ ' 
 
 1 / 
 E 
 
 INTRODUCTION. 
 
 13 
 
 where the unsanitary conditions and the meteor- 
 ological stage of the atmosphere are suitable for 
 its existence and propagation, the second stage 
 is ushered in by the production of the true 
 pathogenic microbe of yellow fever in such 
 quantities and numbers as to fill the atmosphere 
 of that region as far as the suitable conditions 
 extend. - 
 
 6. When a sufficient portion of this specific 
 poison once enters the human organism and 
 produces its characteristic phenomena,its vitality 
 ceases and it becomes so innocuous that'a healthy 
 person may drink the blood or be inoculated 
 with the black vomit or other secretions and 
 excretions of a fatal case of yellow fever with 
 impunity, thus verifying the teaching of thou- 
 sands' of observations and centuries of experi- 
 ence that personal contagion in this disease is 
 an impossibility. 
 
 7. For the same reason what are known as 
 h^ibernating germs or microbes, or those which 
 have failed to find a field in which to propagate 
 and at the end of the epidemic are so favorably sit- 
 uated as to have their vitality and virulence pre- 
 served from destruction by the cold of the suc- 
 ceeding winter, can only produce sporadic cases 
 the following season-^-never an epidemic. 1 
 have witnessed numerous examples, after various 
 epidemics, which go, to establish this position- 
 beyond question, besides having the testimony 
 of reliable physicians to the same effect; in fact 
 
14 INTRODUCTION. 1 
 
 it is plain that if the preceding proposition is 
 true, this necessarily follows as a natural and 
 logical sequence. 
 
 8. And finally: the peculiar filth which orig- 
 inally gave rise to the specific infection of yellow 
 fever was for nearly two centuries deposited in 
 a number of the^ harbors of our Atlantic sea- 
 board and in the alluvia of the Mississippi at 
 New Orleans, and this in quantities sufficient to i 
 
 feebly naturalize or render it indigenous to these 
 localities. But the rushing, rolling, raging 1 
 
 billows and the fierce, passionate, pitching, I 
 
 plunging tides of the Atlantic have long since ^ 
 
 washed every trace of it from the mud of every | 
 
 American port from Cape Cod to the Cape of j 
 
 Florida; while the massive volume of water J 
 
 annually rolling down the Mississippi has cleared 1 ; 
 it out of the port of New Orleans where it has . 
 been more frequently claimed to be indigenous 
 than at any other point on our continent; hence 
 the value of strict and perfect coast-line quaran- 
 tine. . „ 
 
 i 
 
PART I 
 
 ORIGIN AND CAUSE. 
 
 "Felix qui rerum potuit cognoscere causas."— F/rf//. 
 
 Perhaps no disease in the annals of medicine 
 exhibits so many unique and remarkable facts 
 in pathology or has elicited as many fierce con- 
 troversies and differences of opinion as has 
 j yellow fever. These hotly debated controversies 
 
 ; as to its nature and origin, more especially the 
 
 [ latter, have been conducted and engaged in by 
 
 I some of the most brilliant medical minds of 
 
 ( America from the days of Rush, Physick and 
 
 [ Currie down to those of Laroche, Dickson, 
 
 \ Campbell, Warren Stone and others. 
 
 \ Until 1766 there seems to have been no dis- 
 
 i .... ... 
 
 ! agreement m the profession as to its origin, 
 
 ': - being always regarded as an imported disease; 
 
 and by common consent its home was located 
 
 exclusively in the West Indies in general, and 
 
 I in Havana in particular. But the earliest his- 
 
 1 torians of those islands ascribe its origin to the 
 
 I East, and for many 5^ars from its first appear- 
 
 j ance there it was known as the ''mal de Siam,^' 
 
 1 Subsequent history proves those writers to have 
 
 i been perfectly correct as to the direction whence 
 
 ! this terrible scourge came; but they located its 
 
i6 YELLOW FEVER. 
 
 brrth-place too far east, for neither Asia nor 
 Africa can be truthfully charged directly with 
 its origin. 
 
 In my opinion, formed from a careful study 
 and review of the whole history of yellow 
 fever, ther^ could be no more appropriate place 
 for its original home on this little globe than 
 the notorious '^middle passage" with all its 
 attendant atrocious horrors. 
 
 The "facts" about which those giants in the 
 medical profession wrangled and contended so 
 earnestly during the last quarter of the eighteenth 
 century are now proven to be errors, at least 
 most of them; while a few, which were facts in 
 truth, have ceased to exist from removal of their 
 cause, thus showing that facts as we see and 
 comprehend them are not always final truths. 
 "Truth is immutable and eternal," yet often the 
 truth (supposed) bf today is the error of 
 tomorrow. At the proper time I hope fo be 
 able to make good my promise to show clearly 
 to every unprejudiced mind that both parties in 
 those fierce controversies were right at that 
 time but would not be so now. 
 
 Yellow fever in its history has been so inti- 
 mately connected with the old African slave 
 trade in its rise and decline, both as to time and 
 place, not only at the pof ts of debarkation in , 
 the Western but also in the ports of the Eastern 
 Hemisphere where the disease prevailed so vio- 
 lently whenever one of these vile, filthy ships 
 
i- ■ 
 
 YELLOW FEVER. 17 
 
 cast anchor in the harbor on the return trip, 
 tliat the history of the one necessarily involves 
 that of the other. This singular but constant 
 association of the two strangely seems to have 
 been entirely overlooked by all the early as well 
 as the later writers upon the disease. Nor has 
 any one of them, so far as I know, noticed or 
 made special mention of the decline and disap- 
 pearance of yellow fever from_ our most impor- 
 tant northern ports as soon as the legitimate 
 slave trade was abolished, where it had pre- 
 vailed frequently and virulently for more thaji a 
 century after its first appearance in 'Boston in 
 1693. These places, wherever the disease had 
 occurred, had also been ports of debarkation for 
 the slave ships during the long period when the 
 trade was recognized as legitimate and carried 
 on principally by England. 
 
 For nearly Iwo centuries the fouly iermenting 
 and putrefying d3^senteric discharges, along with 
 other filth from the poor negroes which accumu- 
 lated in the holds and poisoned^ the bilges of 
 hundreds of slave ships, had been pumped out 
 to mix with the mud of those harbors. The 
 quantity of this peculiar filth finally became 
 sufficient to give rise to yellow fever, thus render- 
 ing it feebly indigenous and endemic at those 
 ports till the traffic ceased. When the traffic 
 was abolished and those ships therefore ceased to 
 arrive, yellow fever also disappeared from these 
 ports but could; yet be found associated else- 
 
i8 YELLOW FEVER. 
 
 where with the same traffic which had .-now 
 fallen into the hands of contrabands. and was 
 carried on by stealth; and as those contraband' 
 ships sought ports only where their cargoes 
 were wanted, the disease accompanied them to 
 our southern ports, the gulf ports of Mexico and 
 the South Atlantic ports of Brazil. 
 
 This plain and indisputable historical fact 
 seems to have attracted but little notice and 
 elicited but little comment in the past from 
 the historians of yellow fever. This oversight 
 emphasizes my first statement that sucji facts 
 are seldom recognized and understood at the 
 time of their occurrence; and sufficient time must 
 elapse for the passions and prejudices against 
 them to subside and pass away before they can 
 be looked at in the right light and established 
 as truths. But the greatest oversight of all was 
 in regard to the fearful epidemics which ravaged 
 the ports of Spain during the first quarter of this 
 century, causing the death of over one hundred 
 and forty thoiisand persons in the one year of 
 1804. So, in my opinion, any period prior to 
 the great epidemics of 1878-79 which occurred 
 in the Mississippi Valley from New Orleans to 
 Memphis was too early in which to write the 
 correct history of yellow fever, a disease which 
 I confidently believe to be now making the final 
 chapter in its history. 
 
 The first authentic appearance of yellow fever 
 was in 1647, shortly after the first arrivals of 
 
YELLOW FEVER. 19 
 
 slave ships in the West Indies, a terrible 
 epidemic occurring at Bridgetown, Barbadoes,' 
 an English possession and settlement. It was 
 spoken of at that time as "a. new disease" and 
 as '*ari absolute plague, very infectious and 
 destructive." But the Jesuit narratives of the 
 period of Columbus describe a similar fever of a 
 malignant type, attended with yellowness of 
 skin and very fatal to the newly arrived Euro- 
 peans, prevailing epidemically in St. Domingo 
 and other islands in 1494, 1514, 1568, and in 
 Central America in 1596, and among the Indians 
 of New England in 1618. Some writers on the 
 subject claim these epidemics to have been 
 genuine yellow fever; but there being no account 
 of these fevers, except by non-professionals, the 
 large majority of reliable historians oppose this 
 view and have agreed upon 1647 as the date of 
 the first authentic record. It was not till 1691, 
 after the arrival at Martinique of the Oriflamme 
 and two other vessels loaded with French colo- 
 nists fleeing from Siam on account of an insur- 
 rection, ^at it was first called the "ma/ de 
 Siam'' and was so designated^for many years 
 thereafter. 
 
 The true history of these three vessels prior 
 to that trip would be a very interesting as well 
 as useful subject for investigation; for it would 
 be strong corroborative evidence in favor of the 
 truth of Audouard's theory if the records would 
 show that they had been old slavers. There are 
 
20 YELLOW FEVER. 
 
 good grounds for the belief that such was the 
 fact, but I am unable at this writing to find the 
 record of my authority for this statement. 
 ) Its first appearances in the United States 
 were at Boston in 1693, in Philadelphia and 
 Charleston, South Carolina, in 1699, and in 
 New York in 1*702; and from the first named 
 date, 1693, down to 1879, a period of 185 years, 
 there were 115 epidemic years in which the 
 disease visited 338 different cities and towns in 
 this country, many of them repeatedly and some 
 almost every year of its appearance. New York, 
 Philadelphia and Charleston, South Carolina, 
 were visited most frequently during the period 
 of the so-called legitimate slave trade; they 
 being the greatest centers of population were 
 the principal ports of debarkation for the miser- 
 able captives. Its most frequent and regular 
 visits were during the contraband slave trade 
 from 1808, the date of the abolition of the legiti- 
 mate traffic, down to 1860, a period of fifty-two 
 years. During this period it failed to appear in 
 two years only, viz., 1813 and 1836. ^ And the 
 record shows the significant fact that the first 
 named cities. New York and Philadelphia, were 
 practically exempt during that period and that 
 the disease appeared almost exclusively at X)ur 
 southern ports into which those illegal vessels 
 easily gained surreptitious entrance because 
 their cargoes were in such demand. Comment 
 is unnecessary upon the above significant and 
 
i - 
 
 YELLOW FEVER. 21 
 
 undeniable facts; for they zxe^ prima facie evidence 
 of such a close and constant connection between 
 the slave trade and yellow fever as to force us 
 to the unavoidable conclusion that the relation 
 was one of cause and effect. 
 
 All the facts presented by the history of the 
 disease since 1860 go to strengthen and confirm 
 the above conclusion; and it is plain to be seen 
 by any one who has closely watched the course 
 of yellow fever for the last forty years that it has 
 disappeared from the harbors of the United 
 States as an indigenous disease; and the natural 
 inference is that this is the result of the cessa- 
 tion of the annual addition of the peculiar filth 
 from the holds of African slave ships to the mud 
 of those harbors. If I thought it would be 
 deemed necessary or demanded by the profes- 
 sion I could easily give the names of all the 
 places visited, with date and mortality of each; 
 but it would require fifteen or twenty pages of 
 names, dates and totals, which would be dry 
 reading and useless except for reference. It is 
 on record and can be found in several histories 
 of yellow fever and I therefore will omit it. 
 
 Yellow fever visited Cadiz, Spain, in 1705, 
 the first authentic record of its appearance in 
 Europe; and yet the venerable Dowell, who was 
 my personal friend and whose memory I revere, 
 says in his immense volume on yellow fever 
 (which by the way contains many absurd and 
 unwarranted assertions and contradictions): *'It 
 
22 YELLOW FEVER. 
 
 was undoubtedly introduced from Africa to 
 America. [No reason or authority given for this.] 
 That it existed in Africa, eastern Asia and 
 southern Europe long before the establishment 
 of the Greek and Roman empires is generally 
 well established by Hertardo, even running 
 back a thousand years before Christ; that it has 
 become endemic alongthe coasts of Africa, both 
 east and west, as well as in the West Indies and 
 northern coast of South America, and that in 
 all these districts it has its epidemic years and 
 its years of nearly entire exemption, is also well 
 known." 
 
 But Dowler, who is considered better authority, 
 says: ''The slightest notice of yellow fever is 
 nowhere found among ancient writers, although 
 they have not failed to record incidently or 
 directly the time, place and progress of numerous 
 epidemics with more or less particularity, so 
 that their characteristics may now, after the 
 lapse of centuries, be ascertained." 
 
 Yellow fever does not appear to have been 
 noticed until after the discovery of America by 
 Columbus. Had it prevailed in ancient times, 
 its prominent features, so very remarkable at 
 least in its advanced stages, would doubtless 
 have been recorded. From 1705 to 1808 it 
 visited Cadiz nine times, but after that it broke 
 out and raged like a prairie fire all along the 
 coast of Spain, appearing frequently at all the 
 important ports till 1823. Why was Spain 
 
YELLOW FEVER. 23 
 
 alone of all Europe thus scourged? Because 
 she was the first nation to. inaugurate the 
 African slave trade and the last to abandon it; 
 because the contraband ships were nearly all 
 owned by her citizens and the illicit trade was 
 thus virtually carried on by her tacit permission, 
 which gave easy entrance into her ports for 
 these vessels and which was denied them at 
 the ports of all the other nations; and so they 
 came on the round voyage from Africa to the 
 West Indies or the Brazils and back laden with 
 the products of those countries — cotton, sugar, 
 tobacco, etc.; and although they generally came 
 with "clean bills of health" from Havana or 
 Rio, yet their holds were reeking with the 
 peculiar filth that gave rise to this Nemesis-like 
 scourge. It is estimated that the population of 
 Spain was diminished one million by this disease 
 alone; the official report of deaths from yellow 
 fever for one year amounted to one hundred and 
 twenty-four thousand. 
 
 The disease spread to a greater extent in the 
 interior than it ever did in any other .country, 
 visiting twenty-five cities and. towns in the year 
 1804. In some of these the number of persons 
 affected amounted to 1 in 27*78 of the population; 
 and the average proportion of deaths to the 
 number afflicted was 1 in 3.087, the extremes 
 being 1 in 1.3 and 1 in 6.42. The extreme 
 virulence of the disease and the great mortality 
 was undoubtedly due to the fact of the specific 
 
Pi 
 
 24 
 
 YELLOW FEVER. 
 
 poison coming directly from the holds of those 
 slave vessels which were never properly cleaned; 
 and thus Spain received her full meed of. pun- 
 ishment for the part she took in this great crime 
 against humanity. 
 
 The oversight of yellow-fever historians and 
 of the profession generally in the matter of the 
 Spanish epidemics forcibly illustrates how super- 
 ficial we are at times in our observations and 
 investigations of a subject; for although 
 Audouard pointed out the path of truth in 1825 
 and the facts in the case are now historical and 
 as plain as day-light, yet no attention has been 
 paid them and little or no importance attached 
 to them. The facts to which I refer are all 
 included in Audouard's discovery made while 
 officially investigating the epidemic in 1821 and 
 1823, viz. : The cause of the prevalence and final 
 disappearance of yellow fever from the coast of 
 Spain.' And I add, why were these particular 
 ports thus scourged while the rest of Europe 
 escaped? 
 
 It is true that Dr. Audouard's report pf his 
 discovery and his-essays containing his theory 
 were ignored and, to a certain extent, suppressed 
 by the French Academy of Science by the with- 
 holding of their ^ Hinprvnaiur''- for political rea- 
 sons, fearing to offend England; and so his book 
 was shelved in the libraries of the scientific 
 societies where it lay with uncut leaves and 
 covered with dust for more than half a century. 
 
YELLOW FEVER. 25 
 
 positive evidence that not a single officer or 
 fellow of those learned bodies ever read a line 
 of it. But there was still another reason why 
 Audouard's theory attracted so little attention in 
 Europe; and that was that those terrible epi- 
 demics of yellow fever in Spain were over, 
 having ceased with the removal of the cause; 
 and thus the danger of future epidemics being 
 also removed, all interest in the disease ceased 
 and no future investigations were made because 
 they contended that it was a disease wholly of 
 the Western Hemisphere and that it always had 
 been imported whenever it had prevailed in the 
 Eastern/never having originated at any time or 
 place on that side of the globe. But the first 
 historical reference to yellow fever ascribes its 
 origin to the East; and even down to the present 
 time there is a vague idea in the minds of med- 
 ical men that, though it had become domes- 
 ticated and indigenous in the West Indies, it 
 originally came from Asia, the home of so many 
 dreadful plagues. 
 
 A calm and impartial review of the history of 
 the disease reveals the fact that there is no 
 ground to sustain either opinion; and it now 
 devolves upon me to state the facts and reasons 
 for my opinion that it never originated, upon 
 land but that it was born upon the sea. I do 
 not. mean by this that it was born or generated 
 originally in the sea water itself, though it seems 
 to have become an aquatic bug in its artificially 
 
26 YELLOW FEVER. 
 
 acquired habitat. The only spot on earth where 
 it can now be truly said to be indigenous and cap- 
 able of constant reproduction, is in the foul and 
 offensive waters of the low land-locked, almost 
 tideless and stagnant Bay of Havana, with its 
 one single, narrow outlet. We will discuss this 
 point more fully later on; but let us now take a 
 map of the world and paint a yellow dot where- 
 ever yellow fever has been known to prevail in 
 the past, beginning where it first appeared on 
 our Atlantic seaboard and has since disappeared, 
 using the lightest shade and deepening the color 
 as we trace it in close companionship with the 
 slave traffic, declining southward until we reach 
 our gulf ports and the West India Islands, 
 where the deepest shade must be used to indi- 
 cate that there it still exists. A few Mexican 
 and South American ports must also be colored; 
 but crossing to the Eastern Hemisphere, Europe 
 requires no paint except at certain ports in 
 Spain already mentioned. Africa requires only 
 two or three small dots on its western coast 
 where slave ships trafficked and obtained their 
 cargoes, while Asia, long supposed to be its 
 original home, takes no paint at all. It has 
 often been asked why the ports on our Pacific 
 seaboard were never visited by the scourge, and 
 the only rational answer is that slave ships never 
 traded on that coast. The only points on the 
 whole line of the Pacific seaboard where, the 
 yellow fever ever did obtain a foothold were Cal- 
 
YELLOW FEVER. 27 
 
 lao and Lima, Peru, in 1853; and its outbreak at 
 these points is strong corroborative proof of the 
 truth of Audouard's theory. It was universally 
 ascribed to the arrival of filthy ship-loads of 
 Chinese coolies who were brought over by con- 
 tract, as the Africans had been, in badly 
 equipped and over-crowded ships and most of 
 them suffering terribly with dysentery. And 
 as Audouard reasoned in the case of the 
 Africans that the specific poison which caused 
 yellow fever having come from the negro body 
 could not poison the negro again, not being 
 auto-inoculable, therefore he was exempt from 
 the disease, so it was found that the Chinese in 
 Peru were as much immune from yellow fever 
 as the negroes on the Atlantic Coast. 
 
 The intimate association and close connection 
 of yellow fever with the slave traffic is clearly 
 shown by a glance at our colored map; for 
 nearly all the yellow spots are on our Atlantic 
 seaboard and at northern points which were the 
 first ports of debarkation for the slave ships 
 during the period of the legitimate traffic cover- 
 ing more than a century because the centers of 
 population at that time were all in the New 
 England and Middle States. It is true the first 
 authentic epidemics occurred in the West Indies 
 in 1647 shortly after the arrival of slave ships 
 there, and fifty years prior to its first appearance 
 on our continent at Boston, in 1693, after Eng- 
 land had begun to supply her American colonies 
 
YELLOW FEVER. 
 
 with African slaves. But it must be remembered 
 that Spain was the first civilized nation to use 
 Africans as slaves; and she first supplied her 
 West India possessions with them by contracts 
 with other powers, she having been interdicted 
 by Pope Alexander VI (1493) from going east of 
 a certain meridian. So as African slavery was 
 first established in the West Indies, this consti- 
 tuted them the '^fons et origo'^ as they continue 
 to be till this day, the fountain head of yellow 
 fever; though as the early writers attributed the 
 first epidemics to the arrival of slave ships, they 
 thought its origin must be in the East. But 
 of all our yellowed spots showing where the 
 disease has prevailed at some time in the past, 
 there is, not one spot of land among them shown 
 to be its birth-place or original home. 
 
 Now Dr. Audouard's discovery was that the 
 terrible epidemic at Barcelona in 1821, in which 
 five thousand persons died, was caused by the 
 arrival of two old slave ships, the Grand Turc 
 and the St. Joseph, with a cargo of West India 
 produce; and they were found to be so foul and 
 filthy that they had to be scuttled. At Passages 
 in 1823 he found an innocent looking brigantine, 
 the Dionostiarra, which had brought a cargo 
 from Havana and was then having her hull re- 
 paired. The first cases of yellow fever occurred 
 among the carpenters engaged in these repairs, 
 and they attributed their illness to a foul, sick- 
 ening smell issuing from the hold and bilges of 
 
YELLOW FEVER. 29 
 
 the vessel. From these cases an epidemic fol- 
 lowed; and inquiry into the vessel's history re- 
 vealed that she was then engaged in the contra- 
 band slave trade and was completing her round 
 voyage, having taken negroes from Africa to the 
 West Indies and- broiiglit back a cargo of the 
 products of" those islands. Dr. Audouard, find- 
 ing that there were, sixty" or seventy ships en- 
 gaged in this traffic making these round voyages, 
 argued that the same circumstances that he 
 found at Barcelona and Passages must have oc- 
 curred repeatedly at the various other Spanish 
 ports where yellow fever had been epidemic time 
 and again. The historical fact that when these 
 vessels ceased to arrive at those ports yellow 
 fever also ceased to prevail and disappeared 
 from the coast of Spain to return no more, is 
 strongly corroborative negative evidence of the 
 truth of his argument. 
 
 The theory deduced by Dr. Audouard from 
 the occurrences at Barcelona and Passages was 
 that the specific infection which caused yellow 
 fever issued from the hold of the slave ships, 
 having been generated by the fermentation and 
 putrefaction of the dysenteric discharges and 
 other filth accumulating from the negroes 
 during the voyage over from Africa. So great 
 was this accumulation that the cleansing of a 
 slaver was said to be a Herculean task indeed 
 at which white men could not work, and the ne- 
 groes were thus forced to do it. This was where 
 
30 YELLOW FEVER. 
 
 the traffic was carried on under government in- 
 spection and larger and better ventilated ves- 
 sels were used. But the contraband ships were 
 small, ill-ventilated, over-crowded and never 
 properly cleaned or disinfected; so that it can 
 be readily perceived that they carried within 
 their walls enormous quantities of that peculiar 
 filth necessary for the development of the germ 
 principle of the disease, and that thus they be- 
 came mediums for the transmission of the 
 materies.mo7'bt of yellow fever back and forth 
 over the Atlantic and were a menace and source 
 of danger wherever they cast anchor, even though 
 they came with clean bills of health and no cases 
 of the disease had occurred during the voyage. 
 Audouard and other writers upon this point 
 seemed to think it was necessary for this filth to 
 be thrown overboard and mixed with the mud 
 and filth of the seaboard cities in order for it to 
 produce yellow fever; but there is no reason 
 why under suitable meteorological conditions it 
 should not develop on board and become the 
 fever of the voyage. This is why I said it was 
 born upon the high seas; and taking into con- 
 sideration all the facts and conditions connected 
 with its production and comparing them with a 
 few well authenticated and similar cases, we are 
 fully justified in concluding that the first cases 
 of yellow fever with which our race was afflicted 
 originated on board slave ships during the voy- 
 age from Africa through the '^Middle Passage;" 
 
YELLOW FEVER. 31 
 
 and this is the only rational explanation of the 
 enormous mortality among the white crews of 
 these ships. 
 
 That this excessive mortality did occur was 
 learned only by Clarkson's persistent inquiry 
 and investigation of the matter; for the knowl- 
 edge of it was suppressed by the owners of the 
 vessels, as they feared that if it were_ generally 
 known it would prevent their obtaining a suffi- 
 cient number of recruits to properly man and run 
 the ship. This was an example of the suppres- 
 sion of truth for mercenary and pecuniary rea- 
 sons. While Audouard's theory was suppressed 
 at first for political reasons, it was afterwards 
 suppressed or rejected by the physicians of the 
 United States, especially those of the South, 
 through bigotry caused by the passions and 
 predjudices arising out of the institution of 
 slavery. That institution was maintained and 
 guarded with so much jealousy, and our minds 
 were so deeply imbued with the theory of the 
 local origin of yellow fever as taught by the 
 great Doctors Rush and Physick, that we had no 
 patience to entertain or investigate any theories 
 which reflected upon or conflicted with that in- 
 stitution. Born and reared upon a slave plan- 
 tation, as were my father and grandfather before 
 me, and familiar with all the workings of an in- 
 stitution which was so lon^ a curse and incubus 
 upon our fair land, I feel privileged to speak 
 thus of fhe institution and its evil results. 
 
32 YELLOW FEVER. 
 
 To my mind there is no one single etiological 
 or pathological fact in the domain of medicine 
 that rests upon so sure and clear a basis for its 
 truth as the fact that this far-reaching Nemesis, 
 yellow fever, was the product solely of the ne- 
 farious slave traffic. This can be demonstrated 
 beyond the power of refutation, and clearly con- 
 stituted it an artificial disease resulting from 
 man's violation of natural law; hence it should 
 be and is in the power of man to exterminate it. 
 I claim that it has been driven to and is now oc- 
 cupying, the last ditch, not by man's efforts, it 
 is true, but by the forces of nature: working un- 
 der favorable conditions. In this last ditch of 
 defense, or rather of existence, but little of man's 
 labor would be required to aid the same forces to 
 silently but effectually sweep the last vestige of 
 this scourge from the earth. 
 
 Look again at our yellow-spotted map of 
 the world and with unprejudiced mind trace 
 the traffic and mark the ports of most frequent 
 debarkation during the periodwhenit was recog- 
 nized as a legitimate trade and see its constant 
 and intimate association with yellow fever from 
 1693 down to 1808. Read the history of its fre- 
 quent and destructive ravages in the most im- 
 portant of those northern ports, Boston, New 
 York and Philadelphia; then mark its sudden 
 and complete disappearance upon the abolition 
 of the traffic by England and the United States 
 in 1808. Observe how closely it accompanied 
 
YELLOW FEVER. 33 
 
 the contraband trade to the West Indies, where 
 its most destructive epidemics occurred during 
 the most prosperous period of the illegal traffic; 
 and how when this was suppressed by English 
 and American cruisers it was diverted to South 
 America; and how, as the slave trade of Brazil 
 enormously increased, yellow fever again made 
 its appearance in Rio Janerio for the first time 
 in a century and a half. 
 
 As stated before, the terrible epidemics that 
 ravaged the coast of Spain during the first quar- 
 ter of this century were shown by Audouard to 
 have been caused by the specific infection issu- 
 ing from the hold of one or more of those con- 
 traband ships which had arrived, shortly before 
 the epidemic began, with a cargo of West Indian 
 products on the return voyage from having car- 
 ried a cargo of negroes from Africa to^ those 
 islands. Audouard in his investigation of the 
 epidemic at Passages in 1823 found that the 
 Donostiarra, a slaver, had arrived from Havana 
 with a clean bill of health and that there had 
 been.no case of yellow fever aboard during the 
 voyage, neither had there been any in the port 
 prior to her arrival. Her cargo being disposed 
 of and her hull needing repairs, -the carpenters 
 of Passage were employed to do the work; but 
 as soon as the first plank was ripped from her 
 bottom the workmen one after another began to 
 fall ill of yellow fever, and they rightly attrib- 
 uted their illness to a sickening smell that came 
 
34 YELLOW FEVER. 
 
 from the foul bilges of the vessel as they opened 
 them up. Will any unpredjudiced person de- 
 mand clearer proof of the relation of cause and 
 effect as presented in the history of this case (and 
 it is not a solitary case either), or will any one 
 be so unreasonable as to require further evidence 
 of the relationship between the slave traffic and 
 yellow fever than I have adduced in the preced- 
 ing pages wherein I have shown by incontro- 
 vertible historical facts that a most intimate, 
 constant, close and unbroken connection and 
 association existed between the two, both in 
 time and place, from their earliest history down 
 to the time when, the traffic being suppressed,- 
 the cause ceased to exist. 
 
 Is it then unreasonable to hope, yea, to expect 
 and believe that in time the effect, too, may be 
 eradicated? This has already transpired at 
 various times and places. Just prior to the war 
 of American Independence the slave trade was 
 at its height. England alone had one hundred 
 and ninety-two ships engaged in the traffic, with 
 space for transporting 47,146 negroes (Encyclo- 
 pedia Britannica — "Slavery.") with which she 
 was supplying her North American colonies that 
 she was so soon to lose. Thus during the le- 
 gitimate traffic these vessels, with many of 
 other nations, entered our northern ports hun- 
 dreds of times annually; and the peculiar filth 
 which gave rise to the specific infection of yel- 
 low fever was pumoed up and thrown overboard 
 
YELLOW FEVER. 35 
 
 from their holds in material quantities to mix 
 and mingle with the mud of their harbors and to 
 penetrate the soil under the wharves and low- 
 lying quarters of the towns where, under the 
 heat of a summer's sun, it fermented and gener- 
 ated that specific poison, thus enabling the 
 disease to become and remain indigenous so 
 long as the yearly accretions of that peculiar 
 filth continued; and this afforded a rational 
 basis for the opinions enunciated in 1798 by 
 Doctors Rush, Physick and others of the Phila- 
 delphia Academy of Medicine that the disease 
 was a native of our country. But see how soon 
 after the suppression of this traffic the scourge 
 ceased to occur in those same ports where for'a 
 century it had prevailed so frequently and viru- 
 lently. 
 
 Water, one of nature's most useful and 
 powerful forces, in the shape of the turbu- 
 lenti tossing, pitching waves and tides of 
 the Atlantic Ocean was the means by which 
 those polluted harbors were cleansed, the local- 
 ities being favorably situated for the accomplish- 
 ment of this purifying process without man's 
 aid. All cause of the local origin of the disease 
 thus having been removed the rigid enforcement 
 of a perfected quarantine system has since pre- 
 served them, with one or two exceptions, from 
 any more of its ravages. This is only one ex- 
 ample of the many furnishing incontestable evi- 
 dence of the exotic nature of the maieries morbi 
 
36 YELLt)W FEVER. 
 
 of this specific disease and of the intrinsic value 
 of quarantine in preserving a country from its 
 invasions. 
 
 Yellow fever prevailed at Rio Janerio for a 
 number or years during the latter part of the 
 iVth century, but disappeared, when the slave 
 trade was diverted to the North American Con- 
 tinent, and was unknown there for a century and 
 a half; but when the contraband ships, seeking 
 a market for their cargoes, after being driven 
 from the ports of nearly all other countries, be- 
 gan to arrive there in 1849, yellow fever also 
 accompanied them and established itself as a 
 disease new to the country, prevailing with un- 
 exampled virulence. It has remained there ever 
 since and is said to have become indigenous. 
 
 Personally I know nothing of the topography 
 of Rio or other Brazilian ports; yet it is fair to 
 presume that having disappeared once, naturally, 
 it may do so again or be made to do so by the 
 intelligent efforts of man. But the great 
 source of danger to our country is not the ports 
 of Brazil nor the Island of Cuba itself nor the 
 city of Havana in particular, but the putrid 
 water of the bay of Havana — an almost tideless, 
 stagnant pond dotted with mud-banks or shoals 
 and surrounded by high hills with but a single 
 narrow opening to the Gulf, so that its waters 
 cannot be changed. It has so long been offen- 
 sive and full of decomposing organic matter that 
 as far back as 1821 there was a standing order 
 
hi^ '57 •^-- 
 
 YELLOW FEVER. 37 
 
 in the the British naval service not to use the 
 water for any purpose. Doubtless -the first poor 
 negroes and slaves in the Western Hemisphere 
 came in a Spanish galleon into that then un- 
 polluted-bay; for it is said that a few were 
 brought over even during the time. of Columbus, 
 and that he recommended the exchange of In- 
 dian prisoners for Africans. Be that as it may, 
 Havana was headquarters for the slave traffic 
 from its beginning until -its cessation; and for 
 three centuries hundreds of slavers annually 
 cast anchor in the bay, scoured and threw over- 
 board the filth of their holds and pumped the 
 putrid water of their- bilges into it. So great 
 was the quantity of this peculiar filth thus added 
 to these quiet waters at times that it penetrated 
 and became a part of the mud-banks, perme- 
 ating even the soil of the shores, of the wharves 
 a^d of the low-lying quarters of the town, viti- 
 ating and polluting the sea water to the extent 
 of rendering it temporarily destructive to the 
 fish. - 
 
 I mentioned that Dr. Audouard found that the 
 Donosfiarra, to which he traced the origin of 
 the epidemic of yellow fever at Passages in 1823, 
 had arrived from Havana with a clean bill of 
 health and had had no cases of the disease oh 
 board during the voyage. Innumerable instances 
 of the same kind are on record of vessels having 
 left Havana with clean bills of health, not a 
 single case of yellow fever existing in the city at 
 
38 YELLOW FEVER. 
 
 the time of their sailing; yet they proved to be 
 sources of danger and infection to other places 
 which they visited months afterwards because 
 they took with them in their holds and bilges a 
 sufficient quantity of the necessary filth, obtained 
 from the water of the bay, to generate the spe- 
 cific infection. A great deal has been said and 
 written about these Cuban * 'clean bills of 
 health," and Dr. S. E. Chaill^, President of the 
 United States Havana Yellow Fever Commission, 
 in 1879, writes in his report: **Tp the sani-' 
 tarian it is a deplorable farce that commerce 
 should be burdened with such bills of health as 
 the Cuban authorities at Havana issued after 
 October 4, 1879." But if Professor Chaill^ and 
 the Cuban authorities had understood clearly 
 the true status of the case and known where the 
 real danger lay, he would not have had occasion 
 thus to characterize them for they would npt 
 have been issued if the authorities had been 
 honest. This, however, the professor questions 
 in no doubtful language; but let us leave the dis- 
 cussion of this point to future revelations upon 
 the subject. 
 
 The great difficulty and hindrance to the ac- 
 quisition of a correct knowledge of this unique 
 disease, from the days of Rush down, has been 
 too much egotism and too great confidence in 
 the mind of each observer and investigator that 
 he alone was right and everyone else wrong in 
 regard to the respective theories and ideas ad- 
 
YELLOW FEVER. 39 
 
 vanced. This most singular of all peculiar 
 diseases produces very strange but varying im- 
 pressions upon the minds of persons in the dif- 
 ferent walks of life who have been so fortunate 
 as to recover from an attack. Dr. LeMonnier 
 in an article upon the subject written after the 
 epidemic of IS^S says: ''The more we physi- 
 cians see of thedisease the more we desire to see 
 of it and the greater we discover our ignorance 
 to be;" and Chopin, of New Orleans, whose op- 
 portunities for investigation and observation 
 during the epidemic of 1878 were unequalled, 
 writes: "We really know nothing about yellow 
 fever." But the most singular effect of all is 
 that which it produces upon the minds of non_ 
 professionals. I do not think I exaggerate miich 
 in saying that nine hundred and ninety-nine in 
 every thousand who pass through the disease 
 successfully get up deeply imbued with the idea 
 that they possess all knowledge of the disease; 
 and in succeeding epidemics many of them pre- 
 sent themselves as superior not only to all skil- 
 fully trained yellow-fever nurses but to the 
 whole medical profession in their ability to care 
 for and treat patients; and in addition some 
 write learned (?) essays for the newspapers on 
 the origin, nature, treatment, etc., of yellow 
 fever. It is possible that the medical profession 
 is responsible for this because of their proneness 
 to over-medication, especially in a disease like 
 yellow fever of the nature of which we are 
 
40 YELLOW FEVER. 
 
 totally ignorant and for which no antidote or 
 positive cure has been discovered. That Chopin 
 was practically right in 18 78 and that we have 
 made no material advance in our knowledge of 
 this disease since the days of Rush, was clearly 
 demonstrated during the late epidemic of so- j 
 
 called yellow fever which prevailed so exten- 
 sively throughout the entire Southwest during } 
 the months of September, October and Novem- | 
 ber, 1897. I 
 
 If it were not the fact that but few physicians j 
 
 of the present generation have ever seen a case | 
 
 of yellow fever and that its visits to this country I 
 
 fortunately are becoming fewer and farther be- 
 tween, it would seem passing strange that the 
 profession are still wholly unable to recognize j 
 
 this unique disease which is,so strongly individ- j 
 
 ual in its characteristics and whose facies are so 
 remarkable that they should not be confounded 
 with those of any other malady. But I am 
 wandering from the real subject of this section " . - 
 which I will close by endeavoring to recapitulate 
 the main points that I have presented. 
 
 I believe that I have established as a fact 
 beyond the possibility of refutation that there 
 has always been such a close and continuous 
 connection between the old African slave trade 
 and yellow fever as to clearty put • them in the 
 relation of cause and effect. This being ac- 
 cepted as a truth places yellow fever in a cate- 
 gory by itself as a purely artificial disease, that 
 
YELLOW FEVER. ' 41 
 
 is, one caused solely by acts of man; hence it is 
 possible to exterminate and eradicate it from the 
 globe. The history of the cause, th^ slave 
 traffic has been closed forever; while the con- 
 tinuous history of the effect, yellow^ fever, dem- 
 onstrates the plausibility and great probability 
 of the fulfillment of my prediction. It" needs 
 but a glance at our yellow-dotted map to show 
 that, since the complete suppression of the 
 trafiic, yellow fever has entirely disappeared 
 from the ports of Spain and all other places on 
 the Eastern Hemisphere where it had prevailed 
 during the existence of the slave ships. So also 
 it has ceased to appear at theports of our Atlantic 
 seaboard; and it is only occasionally now that 
 it slips into a few of our gulf ports owing to 
 their contiguity, to its last .stronghold, Havana, 
 which has so long and so generally, though 
 erroneously, been supposed to be its original 
 home. _ 
 
 I have not been able to find an author who' 
 could ascribe its origin positively to' any 
 country. The United States and Mexico ascribe 
 its origin to importation from Havana, while 
 Havana and Brazil attribute it to Spain who in 
 turn haughtily rejects it and refers the origin 
 back to the West Indies, or to Asia and Africa; 
 but these countries indignantly deny the charge 
 and say that they never gave it to Europe, but 
 always received it from her. So as no land has 
 been found that will acknowledge the paternity 
 
42 YELLOW FEVER. 
 
 of this nomadic Nemesis or accept it as a 
 legitimate offspring, I claim my location of 
 its origin to be the true one — born upon the 
 high seas as a specific infection generated from 
 peculiar filth found in the holds of African slave 
 ships, these vessels being the medium by which 
 this poison was transported to and distributed 
 among the various ports to which their nefarious 
 traffic directed them. I find as valuable a testi- 
 mony to sustain my position as I could ask, 
 given, though unwittingly, by Prof. S. E. 
 Chains in 1874. In his paper on ''Vital Statis- 
 tics of New Orleans from 1769 to 1874" he 
 closes the paragraph on yellow fever, while yet 
 arguing against the value of quarantine and in 
 favor of the local origin of the disease, with the 
 following: ''The experience of the United 
 States river fleet at New Orleans in 1863-64 con- 
 firms many other indications that yellow fever is 
 especially prone to originate in the holds of 
 vessels." 
 
 Now Assistant Surgeon Harvey E. Brown of 
 the United States Army, in his report on 
 "Quarantine on the Southern and Gulf Coasts,^" 
 referring to this same "river fleet" of 1863-64, 
 says: "The vessel on which the yellow fever 
 originated, the Virginia I believe, had been an 
 old slaver but was captured in the early part of 
 the war and turned into a gunboat." What 
 more direct and positive evidence of the truth 
 of this proposition could be desired? While it 
 
YELLOW FEVER. 43 
 
 was a strange admission for one to make who 
 was even then teaching the local origin of . the 
 disease, yet it is not a solitary case; for from the 
 days of Rush down to the present I find the 
 .most ardent and zealous of the medical writers 
 who taught this theory qualifying their opinions 
 and reports by admitting that the arrival of 
 vessels from the West Indies or other known 
 foci of infection frequently caused a rapid in- 
 crease of the fever, owing to the foul air and 
 offensive odors which issued from their filthy 
 holds and reeking bilges. 
 
 Surely they do not mean by these admissions 
 to claim that the holds of those nomadic buc- 
 caneers were a part and parcel of the port in 
 whose harbor they temporarily cast anchor; for 
 it was only in the holds of vessels of this class, 
 slavers, that the specific poison has ever heen 
 known to be generated, with the notable excep- 
 tion of a few transports carrying negroes and 
 Chinese coolies and of certain wooden ships lying 
 up in West Indian ports. I will now give, an 
 account of these, quoting from* the writings of 
 Dr. C. Creighton to whom I am much indebted 
 for many of my foregoing thoughts and also for 
 recalling Dr. Audouard's theory to my attention, 
 which I had rejected and refused to properly 
 investigate forty odd years ago. 
 
 * 'The Regalia, a British transport, was em- 
 ployed in 1815 to carry black recruits from the 
 coast of Guinea to the West Indies. When on 
 
44 YELLOW FEVER. 
 
 the coast the health on the ship had been excel- 
 lent, but during the voyage much sickness, 
 chiefly of the dysenteric kind, occurred among 
 the blacks. Thereupon yellow fever broke out 
 with great malignancy, attacking all on board 
 except the blacks who from first to last were 
 exempt." The case of the Regalia is weil 
 known and it used to be quoted as showing that 
 yellow fever was only a form of malarial fever, 
 the malarial miasm in this case having come 
 from a quantity of green wood that had been 
 shipped at Boa Vista. The green-wood theory 
 was always, improbable, and the modern dis- 
 entanglement of yellow fever from malarial 
 remittents deprives it* of whatever small prob- 
 ability it ever had. The other case which I 
 take from Gillespie is equally suggestive. The 
 French frigate, La Pique, fell into the hands of 
 the English when Martinique was taken in 
 1'794, and in November 1*795 was sent with a 
 prize crew to the Barbadoes. On the voyage they 
 took two hundred negroes from a French vessel 
 that was in danger of foundering. The negroes 
 were confined in the hold and in a short time 
 yellow fever appeared among the La Pique's 
 crew and proved fatal to one hundred and fifty 
 of them, although it did not attack the negroes 
 at all. ''Such a mixture of men, strangers to 
 each other," says Gillespie, "has often been 
 found to occasion sickness in ships; and together 
 with other causes operated fatally before the 
 
YELLOW FEVER. 45 
 
 arrival of the ship at the Barbadoes. * * * This 
 is a melancholy instance of the generation of a 
 fatal epidemic on ship board at a time when, the 
 inhabitants of the Barbadoes and the crews of the 
 other ships in company with the La Pique re- 
 mained free from any such disease." 
 
 It will readily be seen that Audouard's theory 
 of the immunity of the pure-blooded negro from 
 yellow fever is perfectly sustained in both these 
 instances. As still further testimony- of its 
 truth, Dr. Creighton, referring to the French 
 expedition to Mexico, and says; "The Nubian 
 regiment of five hundred blacks, recruited by 
 the French in the Soudan and Nubia for this 
 expedition, did not lose a single man nor even 
 have a single case of yellow fever in the epi- 
 demic at Vera Cruz in 1866, while the French 
 soldiers were dying by the hundreds." He also 
 cites the circumstance of the production of 
 yellow fever on the coast of Peru, in 1853, by 
 the importation of Chinese coolies, and says: 
 * 'Although apparently in contradiction these 
 facts are really corroborative, for the Chinese 
 themselves were as exempt from the disease 
 there and then as were the negroes on the oppo- 
 site side of the continent, having been brought 
 there under the same conditions." 
 - Of wooden ships -Dr. Creighton says: ^'I 
 shall mention briefly the most terrible historical 
 instance of ships charging themselves with the 
 poisonous mud of a slave port. On the capture 
 
46 YELLOW FEVER. 
 
 of Port au Prince, Hayti, June 4th, 1794, about 
 forty merchantmen were found in the harbor, 
 most of them large vessels laden with cargoes 
 of coffee, sugar, cotton and indigo which had 
 been lying stored in them from one to three years. 
 Owing to the suspension of business during the 
 Revolution many of them had never had their 
 holds open all that time. English prize- 
 crews were put on board to navigate them 
 to Port Royal and other British West Indian 
 ports, and they had hardly put to sea when 
 yellow fever attacked them with unheard-of sud- 
 denness and virulence. One of the prizes was 
 picked up by a Guineaman and everyone on 
 board was found to be dead. Even the negroes 
 who were put to cleaning them out took the fever 
 and died." 
 
 I will now go back to the fierce controversial- 
 ists in the last decade of the eighteenth century 
 at Philadelphia, for I promised to explain my 
 paradoxical remark that both parties were right 
 in those angry controversies. I verily believe 
 that if those intellectual giants in medicine. Doc- 
 tors Rush, Hutchison, Physic and others of the 
 Academy of Medicine on the one side, with Doc- 
 tors Curry, Carpenter, Chapman and others of the 
 College of Physicians on the other, could revisit 
 the scenes of their labors and see the present 
 status of the two, which I call cause and effect, 
 /'. e.j the slave traffic and yellow fever, they 
 would all be enabled easily to see not only 
 
YELLOW FEVER. 47 
 
 wherein they were right, but also wherein they 
 were wrong and would grandly confess their 
 errors, unitedly agreeing that my deductions- 
 are rational and that they are sustained by all 
 the facts in the subsequent history of the disease. 
 
 First. I have shown that from the time of the 
 arrival of the Dutch ship with a few Africans on 
 the Virginia coast in 1620, down to 1776, pos- 
 sibly to 1793, the peculiar filth to which the dis- 
 ease owes its origin had been gradually deposited 
 in various harbors of our Atlantic coast, especial- 
 ly irr the mud of the Delaware at Philadelphia, 
 till a sufficient quantity had -accumulated to ren- 
 der the disease temporarily indigenous, sustain- 
 ing Doctors Rush and his party in claiming that 
 it did originate there after 1793. But, as I have 
 said before, I find that they nearly always quali- 
 fied their reports by referring to fresh arrivals 
 of infected vessels as adding greatly to the fury 
 of the disease. 
 
 Second. The importationists, Curry and 
 ■his followers, were right. This party is al-^ 
 ways right everywhere, for if my location of 
 the birthplace of the scourge is correct, that it 
 originated de novo on the high seas, it necessarily 
 follows that it was originally an exotic to all 
 countries and had to be imported. But at 
 Philadelphia this party erred in denying that it 
 ever originated at all, although tHey could hardly 
 be blamed, for it was never, defacio, a native 
 there, as the material for its generation was 
 
48 - . YELLOW FEVER. 
 
 brought in the bottoms of transient rovers of the 
 seas and deposited there. 
 
 Third. They would readily see that the dis- 
 ease has entirely disappeared since the suppres- 
 sion of the slave traffic, and that the waters of 
 the Atlantic, unaided, had long since removed all 
 traces of its peculiar filth from every port on 
 that coast where it had so frequently prevailed 
 in their day, from Portsmouth, N. H., on the 
 north to the cape of Florida on the south, and 
 that a rigid quarantine had barred its entrance. 
 Yellow fever has since also disappeared from 
 our gulf ports as well, New Orleans prob- 
 ably being the last point to yield because of 
 later additions to the filth at that point; but 
 the immense volume of water annually poured 
 down the mighty Father of Waters has finally 
 been victorious and swept the last vestige of it 
 into the sea, so that it cannot be truthfully 
 claimed to be indigenous to any part of the 
 United States. 
 
 Fourth. They would also see that it has 
 ceased in all places in Europe and Africa where 
 it prevailed almost constantly during the exist- 
 ence of the slave traffic, as well as in all the 
 ports of that hot-bed, the West Indies, except- 
 ing the foul bay of Havana; and they would not 
 say, after a glance over our yellow-dotted map, 
 that I am using a fanciful or extravagant ex- 
 pression in saying that it now occupies the last 
 ditch, in a forlorn hope of continued existence 
 
^^ 
 
 ■^ YELLOW FEVER. 49 
 
 from whence it occasionally does send out de- 
 tachments of germs of the specific infection in 
 fomites of various kinds in filthy vessels to 
 ravage certain localities, but that it cannot and 
 never will again pollute -another harbor of the 
 world sufficiently to enable it to become an 
 indigene in that country. 
 
 That "ditch" can easily" be cleaned by intel- 
 ligent efforts directed to aiding Nature's great 
 minister of cleanliness, water, to properly per- 
 form its task of ablution, by digging two or 
 more canals from different points on the coast 
 (even across the island if necessary, for expense 
 should not be counted in such an enterprise) 
 opening into that sluggish bay, in order" to 
 create currents sufficient to completely change 
 the water and carry out all the fermenting and 
 piitrifying organic matter contained therein. 
 Then should follow proper cleaning and scien- 
 tific disinfection of the mud of the shores and 
 low-lying parts of the town, until every 
 trace of the poisoti be eradicated; and at the 
 same time all negroes should be removed from 
 these localities. 
 
 I know this will never be done by the present 
 owners of the Island; but it can and should be 
 done for the good of humanity. Two powerful 
 and highly civilized nations like England and 
 the United States, by assuming a protectorate 
 over Cuba for Spain," (I doubt if the present 
 population is worthy or capable of self-govern- 
 
50 YELLOW FEVER. 
 
 ment) could easily accomplish this and at the 
 same time put a stop to the inhuman butchery 
 now going on (the winter of '97-98), which is a 
 disgrace to the nineteenth century. 
 
 Let all harbor revenues above the expenses of 
 the protectorate be applied to this one object and 
 it would soon be accomplished. Then the work 
 of this Nemesis will end, its mission of venge- 
 ance having been accomplished, and yellow 
 fever will become as truly a thing of the past as 
 has its cause, the slave traffic; while at the same 
 time the value of Cuba will have been enhanced 
 an hundred-fold. 
 
 One thought more. I have stated the error 
 of the importationists; that of che other party 
 was two-fold, both in denying the possibility 
 of the transportation and importation of the 
 materies morbi of yellow fever, and still worse 
 in attributing its origin to local filth, the putrid 
 exhalations of alleys, gutters, docks and stag- 
 nant water near the city, thus making it belong 
 to the class of paludal or marsh fevers — an idea 
 overflowing with error and danger, yet still ad- 
 hered to by many. In Memphis, 1878, thirty 
 out of forty-five young, healthy, stout, volunteer 
 physicians sacrificed their lives to this hideous 
 error. The transportability and importation of 
 yellow fever has long since been definitely 
 proven; and it is as distinct and different from 
 malarial and other epidemic fevers of this coun- 
 try as smallpox is from measles. While I admit 
 
YELLOW FEVER. 51 
 
 that it is pre-eminently a disease of filth, 'yet I 
 agree fully with my lamented and revered 
 teacher the late Professor H. F. Campbell of 
 Augusta, Ga., when he said: "We may accum- 
 ulate filth, piling it up from the pavement ta 
 the sills of the second-story windows, and it will 
 never enable us to manufacture a single case of 
 genuine yellow fever without the specific 
 germ, any more than we can manufacture a 
 case of smallpox without the specific virus of 
 that disease." 
 
 Dr. Campbell had a clearer idea of, and 
 understood yellow fever better than any modern 
 investigator of the disease; and only lacked the 
 certain knowledge that the disease owed its 
 specificness to a specific infection generated 
 from the peculiar filth of another race and found 
 in the holds of old African slave-ships to make 
 ^ hirn perfect master of the whole subject. 
 
PART II. 
 
 NATURE, ANATOMICAL CHARACTER, 
 
 SYMPTOMS, COURSE AND 
 
 TREATMENT. 
 
 I shall have but little to say under the above 
 headings; for while I claim that we have more 
 exact and positive knowledge, and a clearer 
 comprehension of the etiology of yellow fever 
 than of any other known disease, yet I admit 
 that we are still groping in the dark as to its 
 nature and cure. We know that it is a specific 
 fever of one paroxysm lasting from thirty-six 
 to seventy-two hours, and thar-it can kill or 
 cease in these few hours. I maintain that the 
 cause of this fever is a specific infection en- 
 gendered from a fermenting, putrifying mass of 
 the natural excreta and morbid discharges of 
 another race occupying a lower order in the 
 scale of the human family. Of the physical and 
 chemical nature of this poison nothing is defi- 
 nitely known; but reasoning from its observed 
 phenomena, which are constant, we may safely 
 conclude that it is an organized, disease-pro- 
 ducing germ — a particle of living matter from 
 the living matter of the organism of that lower 
 
YELLOW FEVER. 53 
 
 _ race, transportable in fomites of various kinds, 
 capable of growth and multiplication to an in- 
 definite extent, and, in suitable conditions, gen- 
 erating the true pathogenic microbe of yellow 
 fever, its last stage of existence. Hence these 
 microbes may hibernate and survive the winter, 
 under favorable surroundings, and be revivified 
 by returning warm weather; but they have no 
 power of reproduction and can give rise to spo- 
 radic cases only, never to an epidemic. When 
 this specific germ is introduced into a locality 
 . where the conditions are suitable, it takes up its 
 march along the surface of the earth and begins 
 its function-^rapid reproduction and' genera- 
 tion of the fever-producing microbes which rise 
 and fill the air of the locality. From repeated 
 observations made by myself and many others \ 
 in numerous epidemics, it has been found that | 
 the germs travel about forty feet a day and that 
 nothing impedes or stops their progress, being 
 apparently governed and controlled only by the 
 iy earth's lines of magnetic force in circles. 
 
 I have never entered an infected district but it 
 recalled an incident of my boyhood days in which; 
 I was teasing an immense rattle snake with a 
 long fishing'pole, amused at the reptilis's 
 ever-increasing anger. It finally became so en- 
 raged that, after inflicting its own death-wound, 
 it exhaled from its fangs a powerful, sickening 
 odor which quickly filled the air and in a few 
 seconds so affected me that 1 seemed to be stand- 
 
54 YELLOW FEVER. 
 
 ing in a circle of suffocative yellow haze. Drop- 
 ping my pole, I ran for pure air till exhausted I 
 fell almost fainting upon the ground and vomit- 
 ed freely. The odor perceived in localities in- 
 fected by yellow fever and described by many 
 as being of a fishy character, never so impressed 
 my olfactories, but was the rather a constant re- 
 minder of the dissecting room of my college 
 days. A person soon becomes so accustomed to 
 this odor as not to perceive or notice it after be- 
 ing in the infected region a few days; just as one 
 who smokes does not perceive the odor of tobac- 
 co in his room, while it will be very offensive 
 to one entering who does not use tobacco. 
 This odor of yellow fever, as well as the 
 microbes, seems to be governed by the same 
 mysterious force as that which controls the 
 march of the germs; and there is often a well 
 defined line of demarcation between the infected 
 and the pure air, readily recognized by the odor 
 above mentioned. 
 
 During the epidemics of 1 878-79 in Memphis, 
 Tennessee, while gazing upon the icteric and 
 bronzed countenances of the victims of ' 'yellow- 
 jack," I was continually reminded of the min- 
 gling of the blood of the white and black races, 
 possibly because I was then earnestly engaged 
 in studying and investigating the long neglected 
 theory of Dr. Audouard; and my mind may have 
 been so influenced by his ideas as to cause me 
 to view everything through the medium of his 
 
YELLOW FEVER. 55 
 
 theory, just as yellow-fever experts are some- 
 times charged with seeing all kinds of fevers 
 through .a yellow haze and diagnosing them to 
 be yellow fever. The fear that my mind might 
 have been biased in this investigation has caused 
 me to delay this writing from year to year for 
 twenty years; and now it is almost too late, on ac- 
 count of my feeble health and failing physical 
 and mental vigor, for me to expect to secure for 
 this idea the recognition which- it deserves. 
 It is a task for me to write now, for memory has 
 failed to such an extent that I have to depend 
 entirely upon records, and they are in such con-" 
 fusion that I fear I shall fail in making interest- 
 ing and useful reading of them. But the sub- 
 ject has lost nothing by this delay, while I have 
 gained experionce and, I trust, a moiety of wis- 
 dom along with the additional historical facts 
 and events of these twenty years that sustain 
 and strengthen my position and my predictions 
 made at that time. 
 
 To return to the subject proper: Yellow fever 
 is not in its nature contagious in any sense of 
 the word; and while we say it is an infectious 
 and epidemic disease, yet I must insist that it is 
 so only in a limited sense, and not like cholera, 
 la grippe, d engue, the plague, etc., which at 
 times sweep, with greater speed than the wind, 
 over extensive sections. It is well known that 
 yellow fever, with rare exceptions, never spreads 
 from an infected town or city into the surround- 
 
56 YELLOW FEVER. 
 
 ing country, but is frequently confined to a tier 
 of blocks or limited to one side of a street. The 
 only rational explanation of this peculiarity of 
 the disease is that which I have already given, 
 that it must be under the control of the earth's 
 lines of magnetic force of which we as yet have 
 a very vague and indefinite knowledge, despite 
 the immense advances being made in the con- 
 trol and use of electricity and magnetism during 
 the closing decades of this century. 
 
 The profession, at least those who have seen 
 and studied the disease, seem to be "a unit upon 
 the question of contagion; but it strikes me that 
 their ideas and the ideas of sanitarians gener- 
 ally, more especially those in charge of our quar- 
 antine affairs, must be vague and unsatisfactory. 
 If it is truly a non-contagious disease, I ask why 
 that unknown and unsolved question, the period 
 of incubation, should cut any figure in the 
 matter of quarantine, there being no possibility 
 of contagion from the person. Now I want it 
 understood that I am an earnest and zealous ad- 
 vocate of rigid, individual state quaratine based' 
 upon true, scientific principles; and in the case 
 of yellow fever, upon its two, prominent and 
 generally admitted characteristics, viz., the un- 
 doubtedly easy transmissibility and receptibil- 
 ity of the atmospheric germ, and the entire ab- 
 sence of contagion in the subject. 
 
 A quarantine based upon and administered in 
 accordance with these principles will forever 
 
YELLOW FEVER. - 57 
 
 prevent a recurrence of that relic of barbarism, 
 "shotgun quarantine, " the inconvenience and 
 tyranny of which 1 experienced several times 
 last fall ( 189'?) when it was established all oyer 
 this broad State; and this all on account of the 
 insane and frenzied panic resulting from a few 
 cases out of many thousands of that painful but 
 innocent disease, dengue, having been diagnosed 
 as yellow fever by certain officials who ought to 
 have known better. The recovery of every case, 
 so diagnosed in Galveston and Houston may be 
 considered /r/wa/^aV evidence, in the absence 
 of all other information, that the diagnosis was 
 incorrect. For we have the unanimous testi- 
 mony of all past observers and wiriters upon 
 yellow fever that nearly all of the first cases in 
 every epidemic of true yellow fever die. There 
 are good reasons why this is so: first, because 
 the peculiar poison always attacks those of fee- 
 blest constitution first; second, because of the - 
 inability to make a correct diagnosis till several 
 deaths have established the identity of the dis- 
 eases. 
 
 It is folly to claim that the small mortality 
 of the so-called yellow fever in the South in 
 1897 was due to the great improvement in mod- 
 ern treatment and a better understanding of the 
 disease; for it is an undeniable fact that not a sin- 
 gle case diagnosed as yellow fever in Texas dur- 
 ing that time had the slightest advantage of 
 that wonderfully improved treatment of thej^« 
 
58 YELLOW FEVER. 
 
 de Steele. And I do not hesitate to say that this 
 much vaunted improvement in treatment is a 
 myth, and that if we ever have another serious 
 epidemic of genuine yellow fever in this coun- 
 try, which I think is extremely doubtful in spite 
 of the many dire prophecies for this year, there 
 will be the same old death-rate of from twenty- 
 five to fifty per cent. 
 
 But to continue the subject of quarantine: 
 The so-called period of incubation has been 
 reduced gradually by these sanitary scientists dur- 
 ing the past twenty years from forty days to five. 
 And if it could be demonstrated beyond doubt 
 to even be one day or one hour only, again I 
 ask what it has to do in the question of quar- 
 antine. As I have clearly shown, centuries of 
 observation and thousands of experiences have 
 fully demonstrated the perfect harmlessness of 
 the unfortunate refugee who seeks shelter and 
 hospitality at our hands in his hurried flight 
 from this deadly pestilence. But this statement 
 will require to be more fully understood before 
 it will be accepted even by the modern sanitary 
 scientists, who profess to believe and do teach 
 that yellow fever is not contagious, but who yet 
 enforce a quarantine and maintain camps for the 
 detention of unaffected persons, which act flatly 
 contradicts all their teachings and affords 
 rational grounds for the people in the country 
 to establish * 'shotgun quarantine." These ob- 
 servations are of times prior to this fast period 
 
YELLOW FEVER. 
 
 59 
 
 I of countless railroads and rapid transits, when 
 
 I the common people apparently understood 
 
 yellow fever better than the medical profession 
 of today, experts included; for they knew it was 
 not contagious and did not hesitate to receive 
 the fleeing refugees with open arms, caring 
 I tenderly for the sick and closing the eyes of the 
 
 dying, confident that there was no danger to 
 themselves. And they knew, too, that when 
 the speei^;^ exotic poison was introduced into a 
 city wh^ri% obmd thrive and propagate itxooild 
 not be confinc(i;iif i^touse or block by all-l®8I?I 
 I powers and ingenuity of man. --'^iMS 
 
 { Why in those ^ays -yello^v fev<^ "^s so 
 
 I rarely, if ever, spread by the refugee was due 
 
 mainly to the slow methods of traveling by stage 
 and private conveyance, so that by the time he 
 reached his destination the germs contained in 
 his wearing apparal and baggage were all dissi- 
 pated or destroyed by nature's other great puri- 
 L fier, the air; and though his blood was teeming 
 
 with the poison sufficient to finally produce the 
 disease, with black vomit and death, it has been 
 fully demonstrated that he could no more have 
 communicated the disease to others by any 
 emanations or excretions from his body than 
 one poisoned with strychnine could communi- 
 cate his terrible tetanic convulsions to his 
 attendants. As it is clearly apparent that it 
 would require a sufficient amount of strychnine 
 to produce the same poisonous symptoms in an- 
 
6o YELLOW FEVER. 
 
 other, so it would require a fresh supply of out- 
 side atmospheric disease-germs to .produce a 
 case of yellow fever among those surrounding 
 the bed of the dying refugee. 
 
 But in these days of rapid transit the refugee 
 may pack his trunk in an infected city, take a 
 fast train and travel one, two or three hundred 
 miles in a few hours; and while there is not a 
 particle of danger from his person, although it 
 may be filled with the deadly poison, yet not 
 only his apparel and his trunk but the uphol- 
 stered car in which he comes may be full of the 
 fever-producing germs and become foci for the 
 spread of the disease, if suitable conditions pre- 
 vail in that locality. This explains the unprece- 
 dented extension and spread of yellow fever, 
 during the past twenty-five years, into the 
 interior cities and towns from the seaboard 
 cities that have always been considered its 
 natural habitat. 
 
 All the foregoing statements have been proven 
 to be true, times without number; if it were not 
 so it would be the extreme of stupidity and folly 
 to say that yellow fever is not contagious. But 
 notwithstanding these facts, the system of quar- 
 antine established and enforced in this country 
 is a complete stultification of our professed 
 belief and teachings. 
 
 With a clear understanding of these well- 
 established facts of the nature of yellow-fever 
 poison, is it not possible for scientific sanitarians 
 
YELLOW FEVER. 6i 
 
 to formulate and put into operation, at far less 
 expense than the present incongruous and 
 absurd system incurs, a modified quarantine 
 ' based upon rational principles, and one that will 
 j command respect and obedience because it will 
 
 j no longer contradict that important and gener- 
 
 ; ally acknowledged principle, the impossibility 
 
 of personal contagion? This system would do 
 away with the expensive camps of detention and 
 observation; stop the trains from an infected 
 city five miles from the quarantining city; re- 
 I quire the refugee to take a bath, clothe him in a 
 
 fresh suit supplied for the occasion, and allow 
 him to go to his destination (even though he be 
 j then suffering with the fever) in other cars sent 
 
 ■ for the purpose. The train bringing him would 
 
 then be returned to the infected city and his 
 own clothes and trunk with its contents would 
 be thoroughly ventilated and sent after him 
 as soon as possible. I say ventilated instead 
 of disinfected, the term now in vogue, be- 
 cause in this era of new things and new 
 methods, the sanitarian, in his search for 
 and experiments with chemical germicides or 
 some new artificial disinfectant, seems to have 
 forgotten the only reliable germicide of olden 
 - times, nature's great disinfectant and purifier, 
 the air in motion. 
 
 We have seen that in consequence^ of the 
 slow modes of open-air travel in the past the 
 clothing and other fomites of the refugee were 
 
62 YELLOW FEVER. 
 
 purified, all the germs in them being either disr 
 sipated or destroyed; thus were afforded thou- 
 sands of instances of positive proof that yellow 
 fever was not contagious, and this was recog- 
 nized by the people at large as well as by the 
 profession. With such a system of quarantine 
 for the interior, wisely and honestly adminis- 
 tered, confidence would reign once more among 
 the people; and the frightful frenzies that we 
 have lately witnessed would give place to the 
 common sense and common humanity exercised 
 fifty to a hundred years ago. 
 
 What I have said has been in reference to in- 
 land quarantine only, and for the purpose of 
 showing the inconsistency between our pro- 
 fessed belief and our actions, and also to con- 
 trast the present conduct of the general public 
 with that of fifty years ago. I have no exper- 
 ience in coast quarantine whatever; but if my 
 ideas and theory of yellow fever are correct ( a few 
 more years will either verify or prove them false), 
 the point, for quarantine inspection, at which to 
 prevent the importation and introduction of the 
 infectious germs of this now clearly proven ex- 
 otic disease would properly be at its natural 
 habitat. But this can be accomplished only 
 through an international compact between 
 Spain, the United States and other interested 
 nations. 
 
 It seems passing strange that such distin- 
 guished and able investigators and writers on 
 
fi. 
 
 'c 
 
 YELLOW FEVER. 63 
 
 yellow fever as Doctors LaRoche, Chaill^, Fa- 
 g6t, Ford and many others should come so near 
 I' the truth arid yet fail to grasp the key to the 
 many perplexing mysteries and semeiological 
 phenomena of this disease; for what Creighton 
 said of LaRoche is applicable to all of them: 
 *'I find nowhere in his pages any evidence that 
 he had mastered the facts of Audouard's argu- 
 ment or duly weighed its conclusions, thus failr 
 ing to catch the sparkle of the gem for which he 
 was seeking". These writers frequently men- 
 tioned the proneness of yellow fever to originate 
 in the holds of vessels; but this was too general, 
 and they thus failed to catch Audouard's idea 
 that it was in sj>ea'a/ vessels only in whose holds 
 was found that peculiar filth of another race 
 which breeds it. Had Professor ChailM clearly 
 understood this I do not think he would have 
 labored so ingeniously as he did to prove that 
 quarantine was ineffectual against what he then 
 thought was an indigenous disease, because the 
 rigid military quarantine of 1864 did not prevent 
 the occurrence of yellow fever in New Orleans 
 that year. 
 
 But Professor Fag^t testifies that the quar- 
 antine was against vessels in the merchant 
 and not those in the naval service; while 
 Dr. Fehner says: "Vessels of war were rigidly 
 quarantined, but those for transportation were 
 not." The decision of this point is rendered 
 immaterial by the light which later develop- 
 
64 YELLOW FEVER. 
 
 ments throw upon the true origin of the yellow 
 fever of that year; for it was found that there 
 had been a vessel lying at anchor in the river 
 since spring, which had within its depths that 
 peculiar filth that under suitable conditions en- 
 genders the specific infection of the disease. 
 I refer to the gun boat Virginia before men- 
 tioned, an ex-slaver which. Dr. Brown says, 
 "had been captured in 1863, shortly after land- 
 ing a cargo of Africans on the east coast of , 
 Cuba, taken to New York, turned into a gun < 
 boat, and her hold thoroughly cleansed, when 
 it was found that her hull was iron, with double 
 walls and that the interspace being inaccessible '(^ 
 was never cleansed. As a consequence the >j 
 bilge water became so foul from the impurities ' 
 contained therein that the pumps could not be | 
 used. However she remained a healthy vessel j 
 till the fall of 1864, when in September she was 
 hauled onto the river bank for repairs, pumped 
 out dry and cleaned." As a natural sequence 
 to this proceeding came an outbreak of yellow 
 fever. 
 
 The many acrimonious controversies that have 
 occurred about this disease were the result of 
 the great difference of opinion as to its true 
 origin, the nature of its poison, its portability, 
 contagiousness and period of incubation, and 
 also, as it would now seem, the lack of knowl- 
 edge of the whole truth about the disputed 
 points, on the part of both parties to the debate. 
 
VELLOW FEVER. 65 
 
 Prof. Chains, after summarizing, under three 
 heads, the various theories of yellow iever held 
 by the profession, adds a fourth, a part of which 
 is as follows: ^'Yellow fever is produced by 
 two poisons, or, rather, by one which produces 
 different results depending on the place where it 
 is generated, the quantity generated, and the 
 different conditions of these poisons. Thus the 
 poison sometimes is either contagious or porta- 
 ble, or both, and at other times is not." 
 
 Now, while yellow fever is said to be identical 
 in the various climates where it prevails, it is 
 very natural to suppose that the nearer it pre- 
 vails to its origin the more virulent and destruc- 
 tive will be its effects. It is in this way I ac- 
 count for its unexampled fatality and enormous 
 rate of mortality in Spain; for her contraband 
 ships could not be repaired or cleaned in any 
 other ports; and after discharging their cargoes 
 of West Indian and Brazilian products, which, 
 have themselves been proven to be splendid fo- 
 mites for carrying the germs of the disease, they 
 sometimes lay from three to five weeks in the 
 harbor, undergoing repairs, scouring their foul 
 holds and pumping their filthy bilges into the 
 water of the bay. 
 
 The rate of mortality in yellow fever has been 
 less in the United States than in any other coun- 
 try, because the poison was more diluted and 
 weakened in our harbors; and, as I have shown, 
 since the complete suppression of the slave trade 
 
66 YELLOW FEVER. 
 
 they have been thoroughly cleansed of every trace 
 of it by the action of the waves and tides of the 
 Atlantic, so that yellow fever has ceased to re- 
 cur in them as an indigenous disease. Hence 
 my prediction that it is nearing the end of its 
 existence and can be eradicated by the properly 
 directed efforts of man. If this hope is fulfilled, 
 it will prove the correctness of the views of those 
 who now hold that yellow fever is a specific dis- 
 ease J"z^/^^;z^m; but I find Prof. Fag^t, in 1870, 
 exclaiming against this expression found in 
 Prof. Atken's ''Practice and Science of Medi- 
 cine," saying: "Yet, it has no characteris- 
 tic or pathognomonic sign; black vomit even is 
 not such for it. It is only by the agglomeration 
 and co-ordination of its symptoms, by its origin 
 and modes of importation, development and ces- 
 sation, by its march especially, and by some other 
 peculiarities, that it may be distinguished from 
 other types; it thus essentially constitutes a 
 truly morbid species." Strange words, truly, to 
 come from him who taught the profession that 
 a regular decrease of pulse with an increasing, 
 temperature from the first or second day to the 
 fourth was an unfailing pathognomonic symp- 
 tom of yellow fever not found in any other fe- 
 brile disease, and who has further taught that it 
 strongly individual in its characteristics. 
 
 But as surely and certainly as the historical 
 facts and truths of the disease revealed in its 
 nineteenth-century record demonstrated that 
 
YELLOW FEVER. 67 
 
 yellow fever is not a morbid species, but a 
 disease sui generis and peculiar, so surely is time 
 proving that this much-relied-upon pathogno- 
 monic sign is no more peculiar and characteristic 
 of it than even are black vomit and jaundice. 
 While for twenty-five years I have relied largely 
 upon this sign, but more upon the fact of its be-^ 
 ing a fever of one simple paroxysm, as an aid to 
 diagnosis, yet I have always been convinced that 
 there is no one single pathognomonic symptom 
 by which the observer may be enabled to say 
 positively, ''This is yellow fever." The entire 
 group of disease phenomena alone furnishes the 
 key to a correct diagnosis, and which when ana- 
 lyzed exhibits the strong individual characteris- 
 tics of yellow fever. 
 
 The period of incubation is a myth, and being 
 an unknown quantity is of no value in diagnosis. 
 There is no need of an incubating nidus in the 
 organism; for the germs incubate in the atmos- 
 phere, and every person in the infected area in- 
 hales and swallows myriads of these disease- 
 producing bacilli. But Pasteur proved that these 
 micro-organisms cannot infect the body while 
 the vital equilibrium is perfectly undisturbed (a 
 condition unfortunately very infrequent); hence^ 
 the great difference in time in which different in- 
 dividuals in the same epidemic succumb to the 
 poison, owing to the individual powers of re- 
 sistance; some escape its effects altogether. 
 
 I myself passed unscathed through half a 
 
68 YELLOW FEVER. 
 
 dozen epidemics, and when I finally succumbed 
 it was because my vitality was below its normal. 
 But my attack was an unusually light one, fever 
 lasting only thirty-six hours, with but little 
 cephalalgia or other pain. I left my bed on the 
 fifth day and was out seeing patients on the 
 eighth. This imprudence, with over-eating and 
 the care of five children suffering with the same 
 disease, caused a relapse eight days later which 
 put me in bed for six weeks. On the day of re- 
 lapse I returned home from making calls at 
 three o'clock p. m., feeling well but a little 
 jaded; ate a hearty dinner and lay down for a 
 short nap. I must have slept heavily; and as I 
 had been losing sleep my wife did not allow me 
 to be disturbed till 5:30 p. m., when she came in 
 with a lamp and aroused me. In that heavy sleep 
 of two hours and a half I had become deeply 
 jaundiced; hemorrhage from the nasal and buc- 
 cal membranes had commenced, and I had swal- 
 lowed a considerable quantity of blood which so 
 nauseated me that on awakening I vomited freely 
 and threw up such a large quantity of dark col- 
 ored undigested food that my wife and my friend, 
 Dr. A. H. Ketchum then fresh from college, 
 thought I had the black vomit and so reported; 
 but it was not true, and I never vomited or was 
 nauseated again during my six weeks' confine- 
 ment. There was never the least sign of fever 
 and my pulse continued to descend until it 
 reached forty per minute, then, after I was able 
 
YELLOW FEVER. 69 
 
 to be out again, slowly ascended to one hun- 
 dred and oscillated back and forth for months 
 before it became steady at seventy-four, ten beats 
 less than my normal pulse was before the attack. 
 I had a narrow escape and only speak of my 
 case at this length because so many lose their 
 lives by the same imprudent course that I pur- 
 sued; and I earnestly desire to impress upon 
 physicians that it is our duty to warn ever yel- 
 low-fever patient, no matter how light the fever 
 has been, of the great danger and risk to life 
 from getting up too soon and indulging the ap- 
 petite; for, while many escape without further 
 trouble, I have known patients, who were being 
 congratulated on their quick recovery, to die as 
 early as forty-eight hours and as late as six weeks 
 after the fever. The one, two or three days' 
 fever, during the lifetime of the microbes as they 
 ravage the life-stream and afterwards pollute it 
 with their carcasses, is by no means the whole 
 of the disease. It is really only the first stage. 
 The calm following the febrile stage is a very de- 
 ceptive one and is often a more or less profound 
 state of collapse, the result of the destructive 
 changes wrought in the blood-stream by the poi- 
 son, and often escapes the eye of the busy, over- 
 worked practitioner until it is too late. It is 
 during and after this stage of calm that organic 
 changes begin; and their extent and gravity, 
 with the consequent depression of vital proc- 
 esses, depend upon the extent of blood- 
 
70 YELLOW FEVER. 
 
 changes and the amount of paralysis sustained 
 by the great sympathetic. 
 
 But to finish the subject of incubation: Dr. 
 Dowell and other authors on yellow fever re- 
 port numerous instances of persons who, having 
 fled from an infected city to the country /Or a 
 distant town, were attacked from three to six 
 weeks afterward; and these authors adduce these 
 facts as positive proof that the incubation period 
 may be that long. But this can be more ration- 
 ally explained by the now well established fact 
 of the easy portability of the disease-producing 
 germs and microbes in the wearing apparel and 
 baggage of the refugees. These people packed 
 their trunks, generally of the largest Saratoga 
 pattern and several of them, in the infected city, 
 thereby enclosing a portion of the disease-laden 
 air with their winter garments, which they al- 
 ways carry knowing they will not be able to re- 
 turn till after a freeze. The late development of 
 the fever in them was not due to incubating 
 germs inhaled while in the city, but to their in- 
 haling those enclosed microbes, ^^compagnons 
 de voyage,'' upon opening their trunks at the 
 periods mentioned. Their nervo-vital powers 
 having been lowered by the excitement, fright 
 and fatigue which they had undergone, they fell 
 an easy prey to the action of the poison. Nu- 
 merous instances of this kind are on record 
 which have been thoroughly investigated; and 
 abundant evidence, too plain and convincing to 
 
k 
 
 1; - YELLOW FEVER. 71 
 
 F be gainsaid, has been found to prove that my ex- 
 
 j^: planation is the correct one. 
 
 fj: Reasoning from analogy, I am of the opinion 
 
 that when this deadly animal poison gains an 
 entrance into the blood-stream, it begins its 
 work at once and acts as rapidly as the venom 
 of the rattlesnake. In every epidemic I have 
 seen numerous instances in which persons were 
 stricken down within twenty-four hours after 
 entering the infected atmosphere; and the rea- 
 son that every non-immune is not thus affected 
 is that the vital energy of the lungs and alimen- 
 tary canal is sufficient to resist the entrance of 
 the microbes into the circulation and also to de- 
 stroy them. As soon however as a breach is 
 found in a weakened organism the microbes 
 rush in, rapidly fill the blood-stream, and the 
 work of destruction and death begins. Instantly 
 all is confusion and terror; and urgent, pleading 
 messages for help flash over the nerves from 
 every organ and tissue to the great central organ 
 of nervo-vital energy, the brain. So numerous 
 and rapid are these messages, saying that func- 
 tion is impossible with such a blood supply, that 
 the poor brain, suffering from the same cause 
 also, becomes so irritated, confused and help- 
 less that in dispair it flashes to the outer world 
 the concentrated impressions of the entire or- 
 ganism, and there appears upon the countenance 
 an expression of surprised horror, followed 
 quickly by one of fierce inquiry in which the 
 
72 YELLOW FEVER. 
 
 eyes seem to pierce the inmost soul of the piiy- 
 sician, seeking help and hope; and seeing only 
 dispair there, the expression of that emotion 
 spreads over the countenance as the last ray of 
 expiring intelligence, and the whole frame be- 
 comes convulsed. The dumbfounded physician 
 and attendants can only watch, powerless to 
 help. Convulsion succeeds convulsion till at 
 last the material body of the miserable victim 
 exhausted dies, exhibiting all the phenomena of 
 putrid decomposition. 
 
 The expressions of the emotions of surprise 
 and horror appear so nearly simultaneously that 
 I designate the combination as ''surprised hor- 
 ror." I have never seen this expression of the 
 countenance in any other disease; still it cannot 
 be strictly considered pathognomonic, except 
 in a limited sense, as it is seen only in those 
 rapidly fatal cases constituting about ten per 
 cent of the whole number. I mention it because 
 it is only one of the ensemble of expressions that 
 go to make up the peculiar facies of yellow 
 -fever. I have personal knowledge of its appear- 
 ance being deferred in quite a number of cases 
 till that deceptive stage of calm just after the 
 subsidence of the febrile stage; and in every in- 
 stance the patient was sleeping quietly, and the 
 expression was produced by the shock from be- 
 ing suddenly awakened by a loud noise, as the 
 blowing of a steam whistle or _ the ringing of a 
 church bell near by. 
 
YELLOW FEVER. 73 
 
 One such case was that of a man who occu- 
 pied a room in the second story of a building on 
 The Strand, Galveston, Texas, during the epi- 
 demic of 1859. He had passed through the fever 
 safely and, though recognized as very ill, hopes 
 were entertained of his recovery. He slept qui- 
 etly through the night tillSiOO o'clock a. m., 
 when a Trinity River steamer arrived at the 
 wharf just under his window and began to blow 
 its discordant whistle. At the first blast the pa- 
 tient sprang up on the side of the bed and with 
 hands over his ears said, **If that whistle does 
 not stop in five minutes, I am a dead man." 
 Knowing the custom of the boat to blow half an 
 hour, a messenger was hurriedly sent to have the 
 noise stopped; but before it ceased that horrible 
 expression appeared upon the sick man's coun- 
 tenance and was followed by a convulsion which 
 soon closed the scene in death. 
 
 Another was that of Mrs. H., Calvert, Texas, 
 1873. She passed through three days' intense 
 fever but did not exhibit the amount of prostra- 
 tion usually seen in the stage of calm. I saw 
 her at midnight, twelve hours after the fever 
 had subsided. She was feeling so well that she 
 insisted that her lady friend who was nursing 
 her should go to bed and let her thirteen-year- 
 old daughter lie by her on the bed to call if any- 
 thing was needed. She slept quietly till 5:00 
 a. m., when a switch engine, standing upon the 
 track forty or fifty feet from her window, having 
 
74 YELLOW FEVER. 
 
 gotten up steam, blew a sudden shrill whistle 
 which instantly awakened her and she sprang 
 out of bed in great alarm, with eyes wide open 
 and wildly rolling as if she saw all the hob-gob- 
 lins ever imagined. Her little daughter pushed 
 her back upon the bed and called for help. Liv-. 
 ing only a block distant, I was at her bed-side in 
 less than ten minutes; but alas! those invariably 
 fatal convulsions had begun, and they continued 
 until she died at ten o'clock that morning. 
 
 That common and annoying nuisance, the loud 
 and long blowing of whistles, should be strictly 
 prohibited by law during an epidemic of yellow 
 fever; for it is well known that many a poor suf- 
 ferer, with life trembling in the balance, has had 
 the scale turned against him by their unearthly 
 and at all times needless screeches. In this 
 city of railroads, Houston, Texas, where some 
 fifteen or twenty either center or pass through, 
 with its several oil mills, ice, beer and other fac- 
 tories in active operation, discordant and disa- 
 greeable steam whistles are to be heard almost 
 constantly day and night, often preventing con- 
 versation for the time being. This should not 
 be permitted at any time; for there are nervous 
 sick people all the time, and the shocks from 
 these piercing, ear-splitting sounds is very inju- 
 rious to them. 
 
 I said these unfortunate patients die with all 
 the signs of putrid decomposition; and this is 
 the only anatomo-pathologic feature or charac- 
 
YELLOW FEVER. 
 
 75 
 
 teristic of any importance that I shall notice in 
 detail; for in my search for diagnostic signs I 
 have been in the habit of studying the disease 
 in the living subject in preference to the -ca- 
 daver, and consider it a waste of time to study 
 the useless natural history of the latter. The 
 above pathological fact was first brought to my 
 attention years ago by an observing undertaker, 
 in the case of one of my patients' who had died 
 within forty-eight hours after the attack began. 
 He said to me, "Dr. I want to get that man into 
 his coffin just as soon as possible, and if you 
 will go with me I will show you how very rap- 
 idly decomposition goes on in those who di« so 
 . quickly of yellow fever; you can explain to the 
 family my apparently indecent haste." ■ I found 
 that he had to use great care in washing the 
 corpse lest the skin should slip off; and the 
 muscles had a peculiarly soft, doughy feeling 
 which produced the impression that with a little 
 more pressure the fingers would easily penetrate 
 the yielding mass. The odor of putridity was 
 exhaling from all parts of the body. Since then 
 I have closely observed all such cases, and have 
 invariably found decomposition of a putrid char- 
 acter progressing far more rapidly than I have 
 ever seen it in any other disease, both before 
 and after death. This decomposition, the result 
 of the profound blood changes wrought by the 
 poison, undoubtedly begins with the first en- 
 trance of the microbes and is continuous until 
 
pp 
 
 76 YELLOW FEVER. 
 
 the fatal termination; then of course it becomes 
 more rapid, all vital resistance having ceased. 
 This rapid decomposition is greater and more 
 readily observed in all those quickly fatal cases 
 in which the system is, as it were, overwhelmed 
 by the immense quantity of poison entering it; 
 still it occurs in all cases, to a greater or less 
 extent, even in those who recover. 
 
 This tendency to rapid decomposition is de- 
 nied by some observers, and admitted by others. 
 These latter, however, go a step too far in de- 
 ducing the theory that this rapid decomposition 
 constitutes a condition which causes a rapid in- 
 crease of bacteria, fungi and other simple organ- 
 isms that become carriers of the poisons and 
 thus aid in disseminating the disease. This is an 
 utter impossibility, for there is no longer any 
 yellow-fever poison in that dying or dead body. 
 The specific, yellow-fever microbes perish in the 
 system amid the wreck and ruin wrought by 
 them just as quickly as does the rattlesnake 
 from its own venom self-inflicted. If this were 
 not true we should be compelled to admit that 
 yellow fever is contagious from the person, 
 , I have repeated this because I want the profes- 
 sion to get a clear understanding of the idea and 
 to become familiar with it; for it was a long time 
 before Prof. H. F. Campbell could get this 
 truth to penetrate my dull brain so that I was 
 able to thoroughly understand it; and without 
 the proper comprehension of the whole idea it 
 
YELLOW FEVER. ^ 77 
 
 is impossible to comprehend the non-contagious- 
 ness of yellow fever from the person, when there 
 are so many instarices on record of an epidemic 
 having started in an hiterior town soon after the 
 arrival of refugees from an infected city. Even 
 Prof. Chaili^ admitted that-he found it difficult 
 to comprehend the distinction apparently made 
 between the non-contagiousness from a patient 
 in his clothes and the portability of the-disease 
 by the same clothes. But I would be considered 
 prolix and tiresome if I again repeated what has 
 already been mentioned twice in the preceding 
 pages, and I hope my readers are now able- to 
 fully and clearly understand the point in ques- 
 tion. 
 
 It would seem that the anatomo-pathologic 
 lesion above mentioned ought to be sufficient 
 under this head; but I will mention briefly two 
 others which I observed frequently while mak- 
 ing some investigations in Memphis in 1879. Of 
 twenty-five cadavers the kidneys m twenty were 
 enormously hypertrophied -and the parenchyma 
 and cortical substance were so softened that the 
 finger could be easily pushed into the mass. The 
 other, which I found frequently, was defibrinated 
 blood and granules of black vomit extravasated 
 "into the cellular tissue along the track of the 
 larger vessels of the vascular system and from 
 the dilated capillaries. This was due to thedi- 
 latation and softening of the walls of the vessels 
 in consequence of the paralysis of the sympa- 
 
78 YELLOW FEVER. 
 
 thetic. These two lesions may be considered 
 a part of the universal decomposition going on 
 in the organism. 
 
 But in my opinion the cadaver is not the right 
 place to seek for diagnostic symptoms; and 
 it-^is extremely doubtful if the pathological 
 anatomist ever lived who became so ex- 
 pert and familiar with all pathological lesions 
 occurring in the body, from any cause,, that he 
 could by a careful and complete postmortem ex- 
 amination, and without any prior knowledge or 
 suspicion of the causes of death, pick out in a 
 dozen or more cadavers those that were known 
 to have died of yellow fever. 
 
 The living subject should be the field for re- 
 search, and the blood should be the special part 
 investigated; and this investigation should be 
 begun the moment it is known that the enemy 
 has gained an entrance. The blood is the 
 point of invasion, the material which constitutes 
 both the food and the tomb of the inyisible, 
 mysterious and deadly foe. All the immediate 
 effects the irregular or paralyzed nerve action, 
 organic or functional derangements, and all ar- 
 rest of vital metabolic processes are secondary, 
 and are being continuously augmented by the re- 
 flexes from the irritated and rapidly weakening 
 nerve centers, all of which reflexes result from the 
 destructive changes produced in the live stream. 
 This rapid destruction of the red blood corpus- 
 eels is followed by arrest of the functions of the 
 
YELLOW FEVER. 
 
 79 
 
 liver and kidneys; and on account of this impaired 
 or suppressed elimination and the consequent 
 accumulation of bileand excrementitious constit- 
 uents of the urine, all of which add to and in- 
 crease the disorder, distress and suffering reign 
 in the system. 
 
 Doubtless every practitioner who has had 
 much experience with this disease has seen, as 
 I have, patients die in from twenty-four to thir- 
 ty-six hours from the commencement of the dis- 
 ease; then am I not justified in saying that I be- 
 lieve that the poison begins to act as soon as it 
 gains an entrance, and that this work of de- 
 struction is continuous and as rapid as that of 
 the venom of the rattlesnake? The frequent 
 analysis of the blood during the first twenty- 
 four hours of the attack furnishes the best diag- 
 nostic points found in the ensemble of pathogno- 
 monic signs by which yellow fever is recognized; 
 but, as I have said before, there is no one single 
 distinct symptom by which it can be diagnosed 
 at a glance. 
 
 It requires a close observation for several 
 hours by a practiced diagnostician to make a 
 positive and unerring diagnosis, although it is a 
 specific and unique disease. But the same dif- 
 ficulty is found prevailing in nearly all other 
 specific diseases; for who can sit down by the 
 bedside of a patient suffering with a high 
 grade of fever, on the first, second or even on 
 the third day of its continuance, and diagnose it 
 
8o YELLOW FEVER. 
 
 "Variola!," having no knowledge that his patient 
 has been exposed to the contagion of that dis- 
 ease? No one; even in this enlightened day. 
 Still I believe that such a sign taken in connect- 
 tion with the assemblage of known symptoms 
 does exist not only in variola but also in yellow 
 fever and all specific diseases, as has been found 
 in pertussis and rubeola; when I said there was 
 none in yellow fever, I meant none had been 
 discovered as yet. 
 
 But suppose there was one well-known, clear, 
 distinct, and infallible symptom that would en- 
 able us to make a correct diagnosis at once, cut 
 bono'? Has the physician discovered a balm 
 that will cure? Has he formulated a therapeu- 
 tic measure or compounded an elixir that will in 
 the smallest degree modify, shorten or abort 
 this terrible disease? Has the profession, as a 
 whole, advanced a single iota in treatment since 
 the days of the great Dr. Rush with his lancet 
 and huge doses of calomel and quinine? Alas! 
 far from it; and now at this period of life, having 
 retired from active practice and being simply a 
 looker-on in the Venice of medicine, though one 
 intensely interested in all that pertains to im- 
 provements in the profession in which I have 
 labored so long, the conclusion is forced upon 
 me that the profession, by over-medication, 
 often prolongs a case by adding drug-disease to 
 the original one and thus frequently prevents the 
 recovery of some who otherwis^e would get ^ell. 
 
YELLOW FEVER. 8i 
 
 The experience and knowledge gained in lat- 
 er years convinces me that when in my first 
 years of practice I gave, as I had been taught, 
 ten to twenty grains of calomel, frequently add- 
 ing twenty grains of quinine as an initial dose 
 in the treatment of yellow fever, I had aided the 
 enemy in destroying its victim; but I am thank- 
 ful to say that I earned, by my conservative 
 course afterwards, the equivocal compliment 
 from a wealthy client who said, in advising oth- 
 ers to employ me, that if I did no good I was 
 sure to do no harm. 
 
 But to close the subject of symptoms and diag- 
 nosis I will say: Yellow fever is more easily 
 recognized in the first stage than is any other 
 one of the special diseases. When a physician 
 who is perfectly familiar with bilious fever, un- 
 expectedly and with no suspicion of its nature, 
 meets his first case of yellow fever, he is imme- 
 diately impressed with the conviction that it is 
 something different from what he has ever seen 
 before — a something in the tout ensemble of the 
 facies, indescribable by words, which impresses 
 itself on the close observer in a way never to be 
 forgotten, and furnishes him an invaluable aid 
 to a quick diagnosis in the future. It is the fa- 
 cies vultuosa^ caused by stasis of the blood in 
 the capillaries, a consequence of the primary 
 weakening effect of the poison upon the heart. 
 
 This stasis produces a reddish, florid color, 
 inclining to purplish upon the forehead, face and 
 
82 YELLOW FEVER. 
 
 extending down over the neck and the uppei 
 part of the chest, afterwards changing to a bronze 
 tint, or to an orange-yellow color if general jaun- 
 dice is to ensue. In the eyes, which are red- 
 dened and turgid, sometimes blood-shot, are 
 to be seen at first expressions of apprehension, 
 anxiety and inquiry soon changing, in serious and 
 fatal cases, to those of apathy, wild, fierce de- 
 lirium, or inexpressible horror, depending upon 
 the temperaments of the patients. There is 
 generally severe headache and much pain in the 
 back and limbs, attended with great restlessness 
 and nervous agitation, all due to and produced 
 by the rapid accumulation of bile and the con- 
 stituents of the urine in the blood. 
 
 The pulse is the next noticeable symptom 
 fwhich will arrest the attention of the investiga- 
 jtor. It differs greatly in these two fevers which 
 j[or two centuries were erroneously regarded as 
 fldentical in nature, only differing in degree, and 
 /arising from the same cause. This also furn- 
 ishes additional aid in diagnosis; for in bilious 
 fever, during the first twelve to eighteen hours, - 
 it is full and frequent — one hundred and twenty 
 to one hundred and thirty per minute — with in- 
 creased tension and force; while in yellow fever 
 the pulse reaches its acme, never over one 
 hundred and twenty, in the first three to six" 
 hours; and the physician, at his first visit, gen- 
 erally finds it between ninety and one hundred,, 
 soft and full, with but little force or tension; and 
 
YELLOW FEVER. 83 
 
 also finds a remarkable discrepancy and want of 
 co-ordination between it and the temperature. 
 The time of the onset of yellow fever is at night, 
 almost invariably between nine o'clock at night 
 and three in the morning; while no type of pa- 
 ludal fever, according to my observation, ever 
 begins at that time of night. This fact and the 
 course pursued by yellow fever, the most unique 
 yet regular of any known disease, both afford 
 important and valuable help in diagnosis. In 
 fact, each and every phenomenon in the assem- 
 blage constituting the disease may be truthfully 
 said to be pathognomonic of it; and the physi- 
 cian who familiarizes himself with them singly 
 or as they appear inrthe group becomes as nearly 
 infallible in diagnosing this 'disease as it is pos- 
 sible for man to be. This is no exaggeration. 
 He can, by familiarity with the symptoms, as 
 readily distinguish yellow fever from dengue an d 
 bilious fever as he^can distinguish, by color and 
 other characteristics, the pure blooded. African 
 from the fairest Castilian who ever vailed her 
 unsurpassed lovliness from the vulgar gaze. 
 
 Having spent my long life wholly in paludal 
 regions, and in localities frequently visited by 
 yellow fever, it was but natural that T should 
 have made these two most important fevers the 
 subjects of special study and investigation. 
 
 But when I first began my investigations, my 
 knowledge and ideas of these diseases were too 
 limited, vague and crude to be of any satisfac- 
 
84 . YELLOW FEVER. 
 
 tion to myself or real benefit to others; still I 
 persevered, under many difficulties and discour- 
 agements, determined to acquire all the knowl- 
 edge that had been or could be acquired about 
 them; till at last I became not only very success- 
 ful in treating bothj but could also tell my pa- 
 tient'the day and the hour when the malarial fever 
 would return as surely as the sun would rise that 
 day, if they did not carry out the prophylactic 
 course I had prescribed, but which nine-tenths 
 were very sure not to do because they were feel- 
 ing so well that they thought it useless to con- 
 tinue taking medicine; and I have heard pa- 
 tients boast an hour before the paroxysm did 
 return that they felt better than they had felt for 
 a month. 
 
 This is very common in malarial fevers of all 
 types; and I infer from it that the cause of these 
 fevers produces first a stage of stimulation, by 
 irritating certain nerve centers, followed by a 
 reaction in the form of a chill and fever, con- 
 stituting the stage of depression or probably 
 better a true neurasthenia. But while learning 
 this I found that nothing of the kind occurred 
 in yellow fever and that there did not exist 
 the faintest or most remote trace of relation- 
 ship between it and this class of fevers, or 
 any other for that matter; but that it was so ex- 
 clusively sui generis that it would never asso- 
 ciate or co-exist in the system with them, or 
 with any other acute disease. Thus I soon 
 
P" 
 
 YELLOW FEVER. 35 
 
 learned to differentiate and easily distinguish it 
 from any other fever or morbid condition, and 
 I have been so fortunate in this regard as never 
 since to have been mistaken in my diagnosis. 
 
 God knows I write this in no spirit of vain- 
 glory or boasting; for the consciousness and 
 memory of the many errors and mistakes of my 
 early years are ever present with me, and are 
 too hiimilating ever to permit me to become vain 
 or puffed up by all the knowledge that I can 
 acquire of this or any other disease. 
 
 It has been my duty on three different occa- 
 sions to be the first to announce the existence 
 of yellow fever in interior towns, from the fact 
 that the first cases among the refugees incident- 
 ally came under my care and treatment; and'in 
 every instance I had the misfortune to be at first 
 opposed in my diagnosis and announcement by 
 the rest of the resident profession; and in the last 
 instance I was opposed not only by resident 
 doctors but also by a dozen or more physicians 
 and yellow-fever experts from other towns And 
 cities. In the excitement and terror of last 
 year (1897) I took a decided stand at the begin- 
 ning, vehemently combatting the diagnosis of the 
 official experts and contended that only dengue, 
 in .a more serious and grave form than usual, 
 was prevailing not only in this state (Texas) but 
 throughout the whole Southwest. Time, which 
 proves all things, fully sustained and justified 
 me in my diagnosis in the three instances first 
 
86 - YELLOW FEVER. 
 
 named; for a serious epidemic ensued in each 
 case, and a number of valuable lives were lost 
 which would have been saved by flight but for 
 the number and unanimity of opinion of those 
 dissenting from my report that it was yellow 
 fever. As regards the epidemic of last year the 
 evidence, at this time, is overwhelmingly in my 
 favor that not a single case of yellow fever oc- 
 curred in Texas, and is sufficient also to cause, 
 grave doubts of there having been any true yel- 
 low fever east of the Mississippi during the same 
 period. 
 
 Having expressed opinions of the incompati- 
 bility of yellow fever with the paludal fevers and 
 all acute maladies, opinions which are diamet- 
 rically opposed to the teachings of two of our 
 most learned and distinguished authors on the 
 subject, Drs. LaRoche and Fag^t, I deem it 
 incumbent upon me, before taking up the subject 
 of treatm.ent, to give my reasons therefor and 
 the evidence upon which they are based. But I 
 will first say that I "am inclined to think that the 
 positions which these distinguished gentlemen 
 occupied in the profession were too high to allow 
 them time or opportunity to make such close, 
 critical and scrutinizing observations (or to follow 
 individual cases to their termination) as a 
 physician can who occupies an humbler posi- 
 tion and is not hampered by official or public 
 duties. I think I am justified in expressing 
 such an opinion from the number of oversights 
 
|: YELLOW FEVER. 87 
 
 j. and mistakes which I have witnessed in phy- 
 
 p sicians filling professorships, and whom I re- 
 
 f garded is much my superiors in their knowledge 
 
 ;' of this disease. In every epidemic of yellow 
 
 fever, with which I have had experience, I have 
 i^ witnessed the sudden cessation of malarial 
 
 f fevers which had been very rife just prior to the 
 
 introduction of the exotic and major poison; 
 W and the only cases of it with which I met during 
 f the prevalence of the epidemic were in persons 
 
 who had been subject to recurring attacks of 
 the intermittent from every fourteen or twenty- 
 one days, and these persons were invariably 
 among the last to be attacked by the yellow 
 fever. During such an epidemic I have never 
 met with a case of malarial fever occurring 
 de novo in a person not previously subject to it, 
 except in Memphis in ISVS. 
 
 Now I know that I shall be charged with 
 calling any and every case of fever occurring 
 during an epidemic, yellow fever. But correct 
 diagnosis has been my one special pride and strong 
 point during all the years of my practice; and I 
 do not feel that I have ever been guilty of the 
 mistake of diagnosing and calling a case of 
 malarial fever, yellow fever, or vice versa; for it 
 was between these fevers especially that I had 
 an ambition to learn how to make a differential 
 diagnosis, and to this end I labored and strove 
 during all the early years of my professional life. 
 I willingly admit that the two diseases are'occa- 
 
 $-: 
 
88 YELLOW FEVER. 
 
 sionally seen prevailing in the same place at 
 the same time; but my observation has been 
 that the paludal fever gives place gradually and 
 completely to the specific one, and this spares 
 no one (except the pure-blooded African) from 
 the infant at the breast to the aged pilgrim 
 tottering on the verge of the grave. Hence I 
 think that the distinguished Professor Fag^t 
 strained a point unsuccessfully in attempting to 
 prove that the children of Creoles were not liable 
 to yellow fever, when he endeavored to show 
 that the large number of cases of fever among 
 them, attended with hemorrhages and black 
 vomit, in the epidemic of 1853, '58, '67, were not 
 yellow fever, but **haematemesic paludal fever'' 
 which prevailed epidemically those years con- 
 jointly with yellow fever. 
 
 It is passing strange that this peculiar and 
 rare type of malarial fever, which is only occa- 
 sionally seen in sporadic form, should have 
 prevailed epidemically during the severe yellow- 
 ever epidemics of those years and never, at 
 least to any extent, before or since. I have 
 seen a dozen cases in one season since, but did 
 not regard this as an epidemic. It has never fallen 
 to my lot to see a case in which beyond all doubt 
 the two diseases co-existed in the system. As 
 I have said before all persons subject to re- 
 curring attacks of intermittent fever were among 
 the last to succumb to yellow fever, and then 
 not until the intermittent had been arrested. 
 
YELLOW FEVER. 89 
 
 And my observation has invariably been that in 
 all cases where the paludal poison had posses- 
 sion, by preemption or priority of entrance, the 
 yellow fever poison either could not or would 
 not enter until the former had been dislodged 
 or had thoroughly I evacuated the premises. 
 
 Let me illustrate my idea further by a few 
 cases. In Calvert, Texas, in 1873, I treated a 
 young man in July, August and September for a 
 recurring intermittent and failed to arrest its 
 regular return every twenty-one days, because 
 he was too busy to take the prophylactic rem- 
 edies I had prescribed. In October my friend, 
 the late Dr. Greenville Dowell, who was daily 
 visiting myself and family during our attack of 
 yellow fever, was called to see this same young 
 man. His favorite remedies for yellow fever, 
 calomel and quinine, quickly cured him; and the 
 good Doctor, in his efforts to persuade me to 
 take the same, related this among other cases to 
 show the great success of his treatment. Now 
 the truth was, this was simply the fourth recur- 
 rence of his intermittent fever without any sign 
 of yellow fever at all; for late in November, 
 ten days after safely passing the time for the 
 fifth period, when he was congratulating himself 
 on at last being rid of his chills, he was seized 
 with a violent attack of yellow fever accompanied 
 by black vomit, and died in a few days. 
 
 I met with a dozen or more just such cases in 
 Memphis in 1878. I made it my special duty to 
 
90 YELLOW FEVER. 
 
 watch them all closely; and while three of them en- 
 tirely escaped yellow fever, the rest were attacked 
 during November; but not in a single instance 
 did the yellow fever supervene until it had been 
 demonstrated that the intermittent had been 
 arrested, which was known by the patient's 
 safely passing an expected period ten days. 
 
 My driver, a young man aged 22, was a not- 
 able case. He regularly had an attack of inter- 
 mittent fever every fourteen days during August, 
 September and October; refusing to take any- 
 thing to break up or prevent the return of the 
 paroxysms because he had heard that a person 
 could not have yellow fever as long as he had 
 intermittent. So he lost two or three days every 
 two weeks, but he would get a younger brother 
 to drive for me until he was able to resume his 
 place. I treated his father and mother and 
 seven brothers and sisters, sick with yellow 
 fever during September and October, without 
 the loss of one. He escaped the intermittent 
 paroxysm due November first, and on the tenth 
 of that month he was seized with a violent attack 
 of yellow fever and came near dying; but he 
 finally recovered after six weeks' confinemient to 
 the bed where I left him, the epidemic being 
 over. 
 
 But the saddest case remains to be told. On 
 October seventeenth, while eating supper at the 
 Peabody Hotel where the volunteers were all 
 lodged by the Howard Association, I received a 
 
YELLOW FEVER. 91 
 
 message from a very prominent volunteer phy- 
 sician, from one of the Northern States, request- 
 ing me to come to his room as soon as I had 
 finished supper. I knew he was subject to 
 recurring attacks of intermittent fever; and as 
 he had informed me that he had yellow fever in 
 ■ Mobile more than twenty years before, I sup- 
 posed there was nothing serious the matter. 
 Upon entering his room I found him sitting on 
 the side of the bed and clad in his underclothes. 
 As he had a rather dejected or apathetic expres- 
 sion of countenance, I greeted- him pleasantly 
 with, "Well, Doctor, are you having another 
 one of those annoying paroxysms of ma- 
 larial fevers?" "Yes," he replied, ''but a very 
 anomalous one; for it postponed a week, 
 and I was feeling better than usual, when 
 to my surprise at three o'clock yesterday morn- 
 ing I had a very severe chill followed by a fever 
 lasting till noon today. I took three compound 
 cathartic pills last night and have taken about 
 forty grains of quinine in ten-grain doses today, 
 but I am feeling very queer tonight." I was 
 feeling his pulse while he was saying this, and 
 watching his countenance. To my intense sur- 
 prise, I felt the characteristic yellow-fever pulse 
 and saw plainly depicted the unmistakable facies 
 of that terrible disease, exhibiting what I con- 
 sider its fatal aspect. 
 
 With watch in hand I said: "Doctor, I have 
 an engagement to meet our medical director, 
 
92 YELLOW FEVER. 
 
 Dr. Mitchell, in five minutes, which I had for- 
 gotten till this moment. If you will excuse me 
 I will run down to headquarters, sec him and 
 then ask him to come back with me to see you. 
 r will not be gone ten minutes. Let me suggest 
 that you lie down and cover up until I return." 
 The Howard Medical Headquarters were only 
 half a block distant. I found Dr. Mitchell, and 
 said: *'One of your volunteer physicians is 
 quite ill at The Peabody, and I want you to go 
 with me at once to see him." On the way he 
 asked a number of questions; but I said, "Wait 
 until you see him, for I want your opinion un- 
 biased by mine." 
 
 Again the patient was found sitting upon the 
 side of the bed. I saw Dr. Mitchell's eyes dilate 
 as they fell upon him; and greeting him kindly 
 by name, he aoked abruptly: ''Dr. K., when did 
 your kidneys act? How much urine have you 
 passed today?" The question seemed to con- 
 fuse and irritate the Doctor, and he replied a 
 little petulently: "Now Doctor Mitchell, don't 
 think I have yellow fever, for I had it twenty 
 odd years ago in Mobile, Alabama; but really, I 
 do not remember having passed any urine today, 
 or since yesterday afternoon for that matter." 
 "Will you please allow me to try the cathe- 
 ter?" asked Dr. M. ; consent being readily given 
 the instrument was quickly introduced but only 
 half an ounce of urine was obtained. With- 
 drawing and replacing the instrument in its case 
 
YELLOW FEVER. 93 
 
 and feeling his pulse, Dr. Mitchell arose saying: 
 *'Well, Doctor, you do not need anything tonight 
 except a diuretic mixture and a good nurse 
 to stay with you, both of which we will send 
 you." 
 
 "But I do not need a nurse," replied the pa- 
 pient. "But," said I,- "you may need to send 
 for obe of us during the night, or to send a mes- 
 sage to some friend, so let the nurse come and 
 stay." 
 
 There was no need to ask Dr. Mitchell if he 
 thought as I did and saw what I had seen. Go- 
 ing down the stairway his only remarlc was: 
 "How sad! Is it our duty to inform that doomed 
 man that he is dying?" I replied that my ex- 
 perience was that no good ever resulted from so 
 doing. Our unfortunate confrere died between 
 three and four o'clock the next morning, forty- 
 eight hours from the inception of the disease. 
 
 Many similar cases might be cited from every 
 yellow fever epidemic prevailing in paludal 
 regions; but the foregoing ought to be amply 
 sufficient to clearly illustrate my idea and posi- 
 tion as to the impossibility of the co-existence of 
 the two diseases in the same system. 
 
 During this same Memphis epidemic, how- 
 ever, I met with certain peculiar cases illustra- 
 ting the fact that yellow fever can co-exist with 
 certain acute diseases, although, as I have 
 shown, it cannot with intermittent fever. 
 
 On September twenty-fifth Dr. Mitchell said 
 
94 YELLOW FEVER. 
 
 tome: **I want you to take charge of Major 
 R., aged about sixty years, a particular friend of 
 mine, whose family, except his oldest son, is 
 out of town. I have been treating him for sev 
 eral days for a severe attack of facial erysipelas 
 which began on the side of the nose and now 
 involves the whole face. His face is so cedema- 
 ous that his eyes are closed, the line of demarka- 
 tion being just above the eyebrows. At three 
 o'clock this morning he had a chill which was 
 the beginning of an attack of yellow fever; and 
 as you are hunting unique cases I turn him over 
 to you,' having confidence that you, being a 
 stranger to him, can treat him more successfully 
 than I can. I want ycu to do your best." In 
 twenty-four hours from the inception of the yel- 
 low fever all signs of erysipelas had disappeared 
 except a slight desqamation, and the case pra- 
 gressed so favorably, in every respect, that the 
 patient was able to leave his bed and sit up a 
 short time the morning of the ninth day. That 
 evening the erysipelas returned, beginning at 
 the line above ^the eyebrows (the point it had 
 reached when arrested by the yellow fever), and 
 continued its course over the scalp down to the 
 nape of the neck before it could again be ar- 
 rested. 
 
 His son, a young man of thirty-two years, was 
 his principal nurse, and I cautioned him not to 
 inhale his father's breath while handling him. On 
 the first of October the son exhibited symptoms 
 
YELLOW FEVER. 95 
 
 indicating that erysipelas was commencing in his 
 throat. But he had a chill that night ushering 
 in an attack of 3^ellow fever, which ran a course 
 very similar to his father's case. At my after- 
 noon call, October ninth, I found him sitting up 
 at a window, enjoying the gentle Southern 
 breeze. I told him it was very imprudent, as I 
 thought he still had to suffer with the erysipelas 
 which certainly was commencing when he was 
 taken with yellow fever. He went back to bed, 
 saying his throat was feeling a little sore. At 
 nine that night he had a severe rigor; but he 
 did not send for me till six o'clock the next 
 morning, and it was eight o'clock before I 
 reached his bedside. I found him in a horrible 
 condition. He took my tablet and wrote: **For 
 God's sake give me something to put me out of 
 my misery." His tongue was black and swol- 
 len until it protruded between his lips so that he 
 could not articulate. I sent a messenger for 
 Dr. Mitchell, who arrived in a short time, and 
 we did all in our power lo relieve him, but in 
 vain. He died a horrible death at noon the next 
 day. 
 
 I will cite one more case to illustrate how gen- 
 erally in an epidemic of that disease everything 
 s called yellow fever, not only by ordinary phy- 
 sicians but also by those occupying high posi- 
 tions. By permission of my friend, Dr. Green- 
 ville Dowell, who had charge of the Market 
 Street Hospital, and at the patient's request, I 
 
9") YELLOW FEVER. 
 
 was called to treat Dr. S. H. McCormick of Sa- 
 line City, Indiana, who was sick in the hospital. 
 This hospital was a four-story building, with a 
 capacity for accommodating two hundred pa- 
 tients, by crowding a little. Dr. McCormick 
 w^as in the fourth story and was the fifteenth pa- 
 tient in a rather small ward. 
 
 On the third morning Dr. Dowell invited me 
 to accompany him on his rounds through all the 
 wards of the hospital, an invitation which I 
 gladly accepted. He remarked as we started 
 that ninety per cent of all the patients who had 
 been brought into that building so far had been 
 sent out through the dead house. What a ter- 
 rible report! But it was explained by the fact 
 that many were picked up on the streets and 
 brought in from elsewhere in a moribund condi-, 
 tion. The Doctor's progress was so rapid that 
 it was with difficulty that I kept up with him, 
 and of course could derive no benefit from the 
 trip. But the Doctor, notebook in hand, pre- 
 scribed for each case; but as the treatment was 
 routine, that w-as not difficult. At last,, on the 
 third floor, in passing cot after cot, he remarked 
 as he passed a certain one: "This man is from 
 your town in Texas." Upon recognizing him I 
 asked why he was there. The Doctor replied 
 that he was brought in that morning sick with 
 yellow fever. ''But come back here, Dr. Dow- 
 ell," I said, ''this man has had yellow fever in 
 a previous epidemic and cannot have it now." 
 
YELLOW FEVER. 
 
 97 
 
 "Oh yes," replied the doctor, ''he has a genu- 
 ine case. " ' 
 
 I sat down by the cot, and taking hold of the 
 man's wrist found a pulse indicative of an inflam- 
 matory fever. Calling him by name, I said: 
 "Look here! Tell me the truth! What has hap- 
 pened to you?" 
 
 "Well, Doctor, in getting out of the carriage a 
 few days ago, at a funeral, the horse started sud- 
 denly and I was thrown violently against the 
 wheel hurting my left testicle severely." 
 
 "Yes, Joe," said I, "I heard that cart-wheel 
 story in Philadelphia, in my student days, years 
 ago. Let us see the amount of the damage." 
 
 Examination revealed an intense orchitis, the 
 cause of his fever; and I said, "You had better 
 get out of here, for nearly everyone who comes 
 indies." I lanced his testicle twice after he re- 
 turned to Texas. He said he never was so re- 
 lieved in his life as when he heard me say that 
 he did not have yellow fever. 
 
 Upon arriving in Memphis, in 1878, I was 
 much astonished to find such a virulent epi- 
 demic prevailing; and although familiar with it, 
 the odor was so intolerable at the hotel that I 
 requested the clerk to give me a room in the 
 fourth story. After entering upon my duties in 
 the district assigned me, I would dismiss my 
 buggy in the suburbs at six in the afternoon, 
 spending the night at the residence of some im- 
 portant patient who was always glad to have me 
 
98 YELLOW FEVER. - 
 
 remain, and would order my driver to return in 
 time to take me to the hotel for breakfast. 
 
 I was also astonished to see the number of 
 mexperienced officers in this terrible battle — 
 young physicians, principally from the great 
 Northwest, who had never seen the disease and 
 who were totally ignorant of its nature. It oc- 
 curred to me that this was a splendid oppor- 
 tunity to obtain statistics and make certain ob- 
 servations in regard to the disease, which I had 
 long desired to do. I therefore maxie it a point 
 to obtain the name, address and time of arrival 
 in Memphis of every one I saw wearing a How- 
 ard Medical badge. One evening after supper 
 quite a number of them gathered around me, 
 w^hile I w^as entering data obtained that day, and 
 were very curious to know why I was thus get- 
 ting their names and addresses. I replied: 
 
 "Young gentlemen, I am deeply interested in 
 the study of yellow fever of which I know noth- 
 ing, though I have been seeing it at intervals for 
 twenty-five years. I am also much pained to see 
 you manifest such careless indifference to the 
 great danger into which you have unwittingly 
 rushed; for let me tell you that in the fiercest 
 battle of the late war the danger to the same" 
 number of officers was never half as great as 
 that to which you are all exposed." They laugh- 
 ingly replied: 
 
 "Why, it is only a malignant form of bilious 
 fever, totally non-contagious, and we are going 
 
I .. YELLOW FEVER. 99 
 
 to cure it with plenty of calomel and quinine, 
 and keep it off by taking quinine." To this I 
 ; said: 
 
 r **If one in twenty of you escape an attack^ I 
 
 will be much surprised"; and showing them 
 my book in which I had entered their names r nl 
 drawn lines for columns headed, - ''date of arri- 
 val, date of attack, period of incubation, result, 
 i recovery, died," I added, "and I very much fear 
 
 I that many of your names will appear in the last 
 
 column." 
 I I obtained a list of forty-five, to which Dr. 
 
 j Mitchell added nine more. Of my forty-five 
 
 1 only one escaped having this fever, one who 
 
 i wisely deserted and returned home after that 
 
 night's talk; and thirty were buried in the beau- 
 j: tiful cemetery of Elmwood in less than thirty 
 
 days from that hour. Many of them requested 
 me to attend them, if they should accidentally 
 contract the disease; but the confusion that 
 reigned and certain uncontrolable circumstances 
 combined to prevent this, so that I only attended 
 three, one of whom being too obstinate to listen 
 to advice from any one died in the second re- 
 lapse. The shortest period of incubation was 
 one day, the longest twenty-five days; and in 
 these two instances also the patients, for weeks 
 previously, had suffered recurring attacks of inter- 
 mittent fever. Noble band of martyrs! In their 
 anxiety and effort to relieve the distress and suf- 
 fering surrounding them, they ignored their 
 
loo YELLOW FEVER. 
 
 own danger and died without a thought of self. 
 
 Upon the announcement of the first cases in 
 July, 1879, I was appointed inspector under the 
 National Board of Health and ordered to Mem- 
 phis to investigate their origin. This appoint- 
 ment was due, I suppose, to two members of the 
 board, Doctors Mitchell and Bemiss, who well 
 knew my theory of hibernating germs. Upon 
 arriving in Memphis about July twelfth, I found 
 that on the ninth three cases had occurred in 
 different parts of the city a mile apart and ap- 
 parently having no connection with each other. 
 There had been a celebration of the Fourth on 
 the bluff, at which there was an immense gather- 
 ing, and the day was intensely sultry. I found 
 that certain parties had ordered two box-cars of 
 bananas from New Orleans especially for this 
 celebration; and after three weeks of patient in- 
 vestigation and inquiry, I established the fact ^ 
 that the three cases first reported were in per- 
 sons connected with the handling and sale of 
 those bananas. 
 
 Knowing from past observation that this par- 
 ticular fruit was a splendid fomite for the trans- 
 portation of yellow-fever germs, I obtained from 
 the records of the railroad office the numbers of 
 the box cars in which this fruit was brought to 
 Memphis and the date of their arrival. Armed 
 with this information, I went to New Orleans; 
 and going carefully over the Custom House rec- 
 ords of the arrival of every vessel from the first 
 
YELLOW FEVER. loi 
 
 of May to the thirty-first of July, I selected the 
 steamer E. B. Ward, Jr., which had arrived 
 from Blue Fields, June twenty-seventh, as the 
 vessel most likely to have brought in those ba- 
 nanas which I believed to be the cause of the 
 outbreak. 
 
 Further investigation developed the fact that 
 the two box cars in question had been run 
 down alongside of the Ward, June twenty-eighth, 
 and loaded directly from her hold with bananas 
 for Memphis. This steamer belonged to that 
 wealthy Italian who a few years afterwards, with 
 a number of others, was shot to death by a mob 
 in the jail of New Orleans, and was one of the 
 line of vessels running to Blue Fields under 
 special privileges, not being inspected or de- 
 tained at quarantine. 
 
 When I announced, as the result of my inves- 
 tigations, that this vessel had brought the germs 
 of yellow fever that was then prevailing in New 
 Orleans and Memphis, a vigorous protest was 
 raised; and a number of prominent business 
 men and managing officials of transportation 
 lines said: 
 
 "Doctor, it will never do to make such a re- 
 port. Why, not a single case of yellow fever 
 has occurred on that vessel this season!" 
 
 "And a good reason why there has not," said 
 I, "for her astute owners have selected her crew 
 with that object especially in view; all are well- 
 known immunes." . 
 
I02 YELLOW FEVER. 
 
 Two of the crew informed me that the steamer 
 called at Havana on the return trip of that date; 
 but from lack of authority and opportunity I 
 failed to obtain their sw^orn statements to that 
 effect. So once more commercial and pecuniary 
 interests were powerful enough to suppress 
 truth in reference to this terrible scourge. 
 
 And now what shall I say upon the subject 
 of treatment, which really does not come within 
 the purview of this work and the discussion: of 
 which properly belongs to those who are still in 
 active practice and yearly seeing the disease? 
 Although I have been deeply interested and 
 have spent much time in the study and investi- 
 gation of the origin, cause and nature of yellow 
 fever, still I have never lost sight of and have 
 tried to keep pace with all the novelties and sup- 
 posed modern improvements in its treatment. 
 Nor have I found it a difficult task; for, after 
 an impartial review of the subject and a study of 
 the different methods of treatment that have 
 prevailed from its earliest history to the present 
 time, I must candidly say that I fail to see 
 wherein classic medicine has made any advance 
 or improvement upon the treatment of Rush and 
 Physick, barring their lancets, or can boast of 
 any better success; w^hile homeopaths, expect- 
 ants and other irregulars have jogged along, 
 pari passu, claiming equal if not better success 
 and that too not without good show of reason 
 and statistics. 
 
YELLOW FEVEK. 103 
 
 At that last meeting of the Howard Medical 
 Association of Memphis, reports were made by 
 different members of the corps of the individual 
 methods of treatment, statistics of success, etc., 
 during that terrible epidemic of I8ld then rap- 
 idly drawing to a close. While the treatment 
 of no two of them was exactly alike, yet when 
 analyzed the differences were found to be im- 
 material; for calomel and quinine seemed to in- 
 itiate and calomel and quinine to close it. That 
 was active medication indeed; for death fre- 
 quently dropped the curtain on the closing scene 
 unknown to the physician, as I accidently learned. 
 Among those reporting were some on my list 
 who had passed through an attack successfully, 
 and were rather exultant over their method of 
 curing the disease with teaspoonful doses (as 
 they expressed it ) of quinine. But unfortunately 
 they had not learned the course of the 
 disease, even from their personal experi- 
 ences, and supposed that the subsidence of 
 the fever with the deceptive calm at the end of 
 seventy-two hours was the result of their large 
 doses of quinine and the end of the disease; and 
 on account of the number of calls which they 
 had to attend they dismissed sucH cases from 
 their minds, thinking that they were really con- 
 valescent. 
 
 After our active labors were over, our Medi- 
 cal Director requested me to make a careful can- 
 vass of several of the districts for the purpose of 
 
104 YELLOW FEVER. 
 
 obtaining certain statistical data as well as to 
 learn all the facts surrounding the death of sev- 
 eral of the volunteers on my list, who had died 
 in private houses, that we might be enabled to 
 answer intelligently letters of inquiry from their 
 families. It was while I was engaged in this duty 
 that I learned the facts just stated; and I was 
 pained to hear, in many houses, not loud but 
 deep and bitter curses against the physicians for 
 giving such large doses of quinine to their loved 
 ones and then heartlessly, as they supposed, 
 neglecting them. I also learned that, still la- 
 boring under the erroneous idea of a relation- 
 ship between malarial and yellow fever, they had 
 advised a continuation of these doses three 
 times a day after the subsidence of the fever to 
 prevent its return! So in my last paper before 
 the Association I thought there could be no im- 
 propriety, considering the difference in our ages, 
 for me to say: **If those gentlemen who have 
 been advocating the use of quinine in such large 
 doses would take the trouble to go over their 
 part of the battle ground again with a list in 
 hand of the patients treated, they would be 
 astonished to find the number of those they had 
 marked convalescent who had since died." 
 
 Like all young graduates I had reverence and 
 love for my Alma Mater, and implicit confidence 
 in the wisdom, knowledge and infallibility of 
 those whose names were appended to my di- 
 ploma. But this glamour quickly wore off under 
 
YELLOW FEVER. 105 
 
 the effects of personal observation and stern bed- 
 side experience; and I must confess that I was 
 not long faithful to the magister ^/.^c//,- especially 
 in reference to this disease. I soon found that 
 personal observation and experience are the only- 
 masters who never deceive and upon whose dicta 
 we can always depend. Under the guidance of 
 these teachers it will not take the observer long 
 to find out that yellow fever will run its pecu- 
 liar but regular course unaffected, whether medi- 
 cine has been administered or not. Upon learn- 
 ing this fact, the question immediately presented 
 itself: What then is the indication for the ten 
 to twenty grains of calomel and twenty grains 
 of quinine with which I was taught to begin the 
 treatment? 
 
 Further experience and observation taught me 
 that the condition produced in the system by the 
 effects of the poison was one not of sthenia or 
 inflammation, as believed and taught by the 
 great Doctor Rush (which belief caused him to 
 use the lancet), but one of asthenia, general de- 
 bility and lowered vitality. Hence not only the, 
 utter uselessness but the extreme harmfulness 
 of these two potent remedies which I had used 
 so freely, for their effects tended only to increase 
 the existing debility and still further to lower vital 
 energy. I saw that medicine had discovered no 
 antidote; nor had it instituted any method of 
 treatment that could modify, shorten or abort 
 this terrible disease. And while I regarded ex- 
 
io6 YELLOW FEVER. 
 
 pectancy as pusillanimous in the physician pro- 
 fessing ability to combat disease, yet in the light 
 of my experience so far I considered it prefer- 
 able to a course of active medication which, I 
 had found to do more harm than good. 
 
 I further learned from observation and actual 
 bedside experience that a large per cent of the 
 whole number of cases in an epidemic would 
 recover without any medication whatever, if they 
 were controlled properly, nursed carefully and 
 kept from exposing themselves or committing 
 any great imprudence; while on the other hand 
 I found that a smaller per cent, although con- 
 stituting a fearful rate of mortality (say twenty- 
 five per cent of the whole number), would die 
 in spite of all that medical art had learned to do 
 for them. I believed it to be the obseryant phy- 
 sician's first duty, and not a difficult one either, 
 to learn in every epidemic to distinguish quickly 
 between those non-fatal and fatal cases, so that 
 he might avoid increasing the rate of mortality 
 by too much officiousness and over-medication 
 in cases that would naturally recover — faults un- 
 fortunately too common in young physicians 
 during their first experience with this disease. 
 I do not hesitate to admit that such was the case 
 with myself; and as I have been a close observer 
 during my whole professional life I have seen the, 
 same faults in others. 
 
 Of the one hundred and eleven volunteers on 
 the Howard roll at Memphis, in 1878, how 
 
YELLOW PEVER. 107 
 
 many could claim to be cool, close, critical ob- 
 servers; especially in those first hours of con- 
 ' fusion and terror? Less than fifty of them had 
 ever seen the disease before; and the impres- 
 sion made upon me, as I v^atched them start 
 eagerly for the districts assigned them by our 
 Director General, v^as that there was a braver 
 set of men than any that ever charged a battery 
 upon the most fiercely contested battle field in 
 the world's history. Ay ! braver than Tenny- 
 son's **six hundred" as they rode, on that mem- 
 orable occasion of folly, "into the jaws of death. " 
 A poet laureate sang their brave but useless 
 deeds, and a grateful nation immortalized them 
 in brass and marble; but the nobler deeds of 
 these unselfish heroes have never been sung. Day 
 after day and week after week they- unfalter- 
 ingly met and battled with that unseen foe, 
 passing through scenes in comparison with 
 which the most hideous of battles pale into utter 
 insignificance. War furnishes scenes of mangled 
 men and animals only, while those resulting 
 from the murderous work of this King of Ter- 
 rors often included whole families — father, mother 
 and children (four, five, six, and seven) all dead 
 in one room, and lying in every conceivable 
 posture. In one instance a tender babe was the 
 only one found alive, and it was vainly endeavor- 
 ing to draw nourishment from the breast of its 
 mother lying dead upon the floor; in another, 
 the dead babe was found with its little gums 
 
io8 YELLOW FEVER. 
 
 clinched around the nipple of the left breast of 
 its mother who was sitting stiff, stark dead in a 
 chair. 
 
 Such were some of the scenes which met the 
 eyes of many of these physicians in their first 
 rounds; and although some of the few survivors 
 said to me that they felt their hearts blanch as 
 they had never done when in the deadly breach of 
 battle through which they had passed, blanch 
 with an undefinablefear or momentary dread that 
 certain annihilation awaited them as well as the 
 doomed city, yet they neither faltered nor grew 
 weary of their self-imposed tasks but were un- 
 tiring in their efforts to stay the ravages of the 
 plague. In fact, after the slight shock of the 
 first reconter had passed they were seized with a 
 fascination for this new, strange and hidden foe 
 that they had volunteered to fight; and forgetting 
 self, like the bird charmed by the rattle snake, 
 they labored and fell (as many as six in one 
 day) at their posts of duty till the rate of mor- 
 tality among the non-immune volunteer phy- 
 sicians in Memphis reached sixty-six and two- 
 thirds per cent! Two-thirds of that noble band 
 of volunteers died on the doctors' battle field, 
 under circumstances which should entitle them to 
 wear the crown of martyrs as well as heroes. 
 "Greater love hath no man than this, that he lay 
 down his life for his friend." 
 
 These facts first attracted my attention and 
 set me to thinking of this peculiar scourge as a 
 
YELLOW FEVER. 109 
 
 Nemesis, an agent of retributive justice for, the 
 punishment of a great sin which for commercial 
 and pecuniary gain had been jointly carried on, 
 for' nearly two centuries, by all the civilized 
 and Christianized nations of the earth, as a 
 legitimate traffic (God save the mark) against 
 the most benighted and ignorant race on the 
 globe. Notwithstanding the eloquent sermon 
 preached by Rev. H. C. Morrison, at the 
 Broadway M. E. Church, South Louisville, 
 Kentucky, Sunday, October 18, 1878, in which 
 he took the position and endeavored to 
 prove that yellow fever could not be in any 
 sense a scourge or punishment for a sin 
 which the Southern people could be held as 
 guilty, I still held to my idea. But the rev- 
 erend gentleman was plainly ignorant of the 
 true history of its origin and especially of its 
 intimate and constant connection with that ne- 
 farious traffic, the old African slave trade, all 
 of which has been detailed in the preceding 
 pages. 
 
 Now, to finish the subject of treatment : 
 Having discarded the orthodox method I learned 
 in the halls of classic medicine, I adopted the 
 simplest method possible, not to be "expectant" 
 though bordering closely on it. First: I cleared 
 the bowels perfectly, as early as possible in the 
 disease, with a dose of castor oil or a large 
 enema of hot water, not disturbing them again till 
 after the fever subsided. . Second : I kept the 
 
% 
 
 no YELLOW FEVER. 
 
 patient perfectly quiet in a horizontal position, 
 never allowing him to rise up even for a drink 
 of water, nor to see any one except his physician 
 and nurses; and to be perfectly on the safe side 
 this was kept up religiously for eight or nine 
 days (this is not absolutely necessary in all mild ' 
 cases). Had this been done in Memphis many 
 valuable lives would have been saved. 
 
 Let me mention three notable cases to show, 
 how easily and by what a little thing, in this dis- ' : J 
 ease, the scale is turned against the patient. 'i'-- 
 
 When Mr. R. A. Thompson, the postmaster, was 
 stricken, his friend, Herbert Landrum, the 
 quick, witty, sparkling, and bright city editor of 
 T/ie Avalanche, took him to the home of his 
 father, the Reverend Doctor Landrum, pastor 
 of the Gentral Baptist Church, and tenderly 
 nursed and cared for him. On the third day, 
 the day of the treacherous, deceptive calm, he 
 was free from fever and thought to be convales- 
 cent. That morning he changed his pillow and 
 position from the head to the foot of the bed, 
 contrary to the advice of his physician. Dr. 
 Mitchell, made himself comfortable and read the 
 morning papers while he leisurely partook of , 
 some tea and toast. In sixteen hours he was 
 dead. 
 
 His friend, Herbert Landrum, was taken 
 down in a few days with a mild attack; and 
 although this example of the terrible effects of a 
 little imprudence was fresh in his memory he 
 
YELLOW FEVER. iii 
 
 got up on the fourth day and went to his office 
 to answer a few letters. In less than forty- 
 eight hours he too was dead. 
 
 Mr. Catron, a very close friend of both, 
 nursed and helped to bury his two friends; he 
 was mildly attacked in a few days, committed a 
 little imprudence after it was thought that he 
 was convalescent, and soon followed them to 
 the cemetery. 
 
 It will readily be seen from these cases that 
 good nursing and prudently remaining in bed a 
 sufficient time is worth more than all the medi- 
 cine that can be given; and I mention them as a 
 warning, hoping that they will be the means of 
 saving valuable lives in the future. 
 
 Pirst: Keep the head cool by bathing it with the 
 old French^ 'Eau Sedative''' and the feet warm by 
 applying bottles of hot water to them. If the 
 skin is hot and dry during the fever direct the 
 nurse to sponge the patient under cover every 
 two hours with tepid water and whiskey, wiping 
 thoroughly dry each time; but if the skin is 
 moist during the febrile stage this sponging will 
 be unnecessary. If there is much pain in the 
 back or the head, apply to the spinal column a 
 flannel strip saturated with spirits of turpentine* 
 put a dry cloth over this, and for ten or fifteen 
 minutes gently rub a flat iron, as warm as can 
 be comfortably borne, up and down the spinal 
 column. This is the most grateful thing you 
 can do for your patient and will not only 
 
112 YELLOW FEVER. \ 
 
 relieve the pains but at the same time will cause 
 the whole body to perspire gently. 
 
 In the olden time I frequently applied six or 
 eight cups along the spinal column, wet or dry - 
 depending upon the condition of the patient; 
 and I will add just here in regard Jo this old 
 procedure, which seems to have been entirely 
 discarded of late years because there is a little /' 
 trouble connected with it, that when there is in- 
 tolerable nausea or incoercible vomiting in yel- 
 jow fever or any other malady wet cups applied 
 freely over the ganglia of the celiac plexus 
 and the oesophageal branches of the pneumo- 
 gastric, from whence nerves are distributed over 
 the stomach and other abdominal organs, will 
 relieve these intolerably miserable and some- 
 times dangerous conditions more promptly j 
 and effectually than any internal or other 
 external remedy. Allow the patient all the 
 cracked ice he desires; use diluents freely, such - -j 
 
 as teas made of watermelon seed or flax seed 
 
 and flavored with fresh lemon juice, hot or cold 
 to suit the patient's taste; but be careful never =" 
 
 to offend the stomach by forcing upon it any- ; 
 
 thing that it dislikes. . ~i 
 
 No arterial sedatives or other febrifuges are 
 required or are even permissible; for the first 
 and principal effect of the poison is upon the ^ 
 
 heart c^nd the blood, and the pulsations are too ^^^^ 
 rapidly diminished from this effect to allow i 
 
 agents to be used that will increase it. From the 
 
YELLOW FEVER. _ _ 113 
 
 inception of the disease strychnine and digitalin, 
 in doses of half a milligram (gr. 1-134) each, 
 should be given every hour to maintain nervo- 
 vital energy and to sustain the heart's action. 
 
 Tlie foregoing was my first departure from the 
 teachings of the Masters, if departure it may be 
 called. I have yet to find anything that does 
 not belong to regular or classic medicine, or to 
 find a court for the final decision of disagree- 
 ments in matters of this kind. If this were not 
 so there would have been no necessity of Pope's 
 asking: *'Who shall decide where doctors dis- 
 agree?" But later, learning of M. Polli's dis- 
 coveries in regard to the sulphites and bisul- 
 phites and their uses in medicine and especially 
 in zymotic diseases, and being encouraged by 
 my use of them in variola, rubeola and chronic 
 paludal fevers, I determined to try them in yel- 
 low fever, especially the hypo-sulphite of soda 
 which I knew would do no harm even if it ac- 
 complished no good. 
 
 Now I went to Memphis to do all tlie good I 
 could for that sorely afflicted people, but also 
 for the purpose of making a special study of cer- 
 tain points in the disease which I knew I could 
 not do if I were over-burdened with patients. 
 At my first meeting with the Howard Medical 
 Society, which met at nine o'clock every night 
 with Doctor Mitchell in the chair, to listen to 
 the daily reports from this army of one hundred 
 and eleven volunteers, I heard some of my new 
 
114 YELLOW FEVER. 
 
 friends, whose names I had been taking down 
 that very day, report having attended seventy- 
 five to one hundred cases. I thought it was my 
 time to turn pale, as I had only twenty to re- 
 port; and I knew I was not physically able to 
 see and treat such a number of cases, scattered 
 as they were over the district — ^old Fort Picker- 
 ing and South Memphis — to which I had been as- 
 signed the day before. 
 
 I therefore inquired what they did for such a 
 number of patients. "Oh, we took~ down their 
 names and addresses, with street and number, 
 to report at this meeting." I replied that I 
 thought that that was the duty of the Howard 
 visitors, of whom the Association had quite a 
 number employed, as well as to see that they 
 (the sick) obtained their medicines promptly; 
 but that 'I found that the first prescription I 
 had made the morning before had not been filled 
 until that evening on account of the rush and 
 the number ahead of it. ' I said I thought we 
 had better all go home for the good we were 
 doing, unless Dr. Mitchell would pernxit us 
 to carry what few medicines we needed and 
 dispense them ourselves; for there were not 
 prescription clerks enough in the city to dispense 
 one hundred of the prescriptions made daily. 
 Moreover, my plan would mean a great saving 
 of expense to the Association; for the prescrip- 
 tion which I had referred to (sodium hyposul- 
 phite, one-half ounce; syrup of orange, one 
 
YELLOW FEVER. 115 
 
 ounce; water, four ounces) was charged to the 
 Association at the very moderate (?) price of 
 two dollars, and was received by the patient too 
 late to be of any particular benefit. Dr. 
 Mitchell said the suggestion was a good one; 
 and from that time on the physicians carried the 
 necessary medicines the Association having ob- 
 tained possession of a wholesale drug store that 
 was closed and put in volunteer clerks who sup- 
 plied us with whatever we needed. 
 
 I said moreover that I intended to see each 
 of my patients twice a day, and therefore could 
 not add a greater number of new cases daily 
 than I discharged old ones. I treated about 
 two hundred and forty patients in Memphis, of 
 whom about thirty were malarial intermittents 
 to whom I gave but little attention; but I 
 selected one hundred typical cases of yellow 
 fever, of which I kept a regular daily record of 
 the pulse, temperature, tongue, bowels, urine, 
 respiration, appetite and sleep. Of these I 
 I treated fifty with sodium hyposulphite as the 
 dominant medicament and the other fifty with 
 sodium sulphocarbolate, giving these medicines 
 in doses of twenty grains every two or three 
 hours; and in cases where adynamia predom- 
 inated I also gave ammonium phosphate in the 
 same dose, and in extreme cases I gave ammo- 
 nium carbonates in doses of five to ten grains. 
 
 Whether the treatment pursued in these cases 
 had any beneficial effect I am unable to say; and 
 
ii6 YELLOW FEVER. 
 
 although there were only twelve fatal cases 
 among them, a reasonably small death rate, yet 
 I am so skeptical about any good ever having 
 been accomplished in the disease by any course 
 of treatment with the old galenical preparations 
 that this question arises in my mind: Would not 
 the eighty-eight have recovered anyhow, if Ihad 
 not seen them or if not a single dose of medi- 
 cine had been administered to thern, provided 
 they had been kept in bed and properly nursed. 
 I had not then learned the method of '<Mod- 
 ern or Improved Allopathy," taught by the 
 celebrated professor of Ghent, Dr. Adolph 
 Burggraeve, although it had been known and" 
 used all over Europe for ten years or more. 
 It is strange that the physicians of the United 
 States, who are noted for being so progressive 
 and up-to-date and even in the lead in many of 
 the modern discoveries and improvements in the 
 science of medicine and who eagerly received 
 and tried Koch's Tuberculin, Brown-Sequard's 
 Elixir of Life, etc., should have been so slow to 
 investigate and try this very simple yet truly 
 scientific method of exact, positive medication 
 with the alkaloids and other active principles of 
 plants. Its distinguished author, who depre- 
 cated its being called a new system of medicine, 
 named it ''Dosimetry" meaning measured doses. 
 He and his co-laborator, M. Charles Chanteaud 
 of Paris, devised machinery by which the alka- 
 loids and other active principles were thoroughly 
 
YELLOW FEVER. 117 
 
 triturated with sugar of milk and then mechani- 
 cally divided into mathematically exact doses 
 and shaped into granules, thus putting into the 
 hands of the physician "arms of precision" 
 upon which he could rely implicitly and by 
 which he might secure with extreme exactness 
 any physiological or therapeutical effect he 
 desired. 
 
 This admirable method has been tried by a 
 few Brazilian physicians in the treatment of 
 yellow fever, though not in accordance with my 
 ideas of the nature of the disease. But as I am 
 convinced that no method of medication or any 
 kind of medicine will have any effect upon the 
 disease in those rapid cases which seem to be 
 over-whelmed by the poison and stricken to die 
 in a short time in spite of all that medical art 
 can do for them, so I should ftot expect any 
 better success from the use of this method 
 except as a prophylactic measure. I have given 
 dosimetry ten years of close, careful and un- 
 biased investigation and trial in all the acute 
 diseases which prevail in this southern country; 
 and I have found that the most of them can be 
 prevented, aborted, or jugulated by it — this of 
 course depending upon the time treatment is 
 instituted. Hence we may reasonably expect 
 to accomplish the first result, prevention (which 
 is always better than cure), by the use of this 
 method during an epidemic of yellow fever. 
 
 There seems to be as much difference of opinion 
 
ii8 YELLOW FEVEK. 
 
 regarding the nature of the disease as iheie is 
 regarding its cause; and this accounts for the 
 great number of therapeutic remedies that we 
 find advocated in its treatment. The majority 
 of writers claim that it is the nervous system 
 which is first attacked by the poison of the dis- 
 ease; and yet at the same time they inconsistently 
 classify it among the zymotic affections. 
 
 Now if this theory of its cause which I have 
 been advocating is true (and this is too clearly 
 and perfectly sustained by all known historical 
 facts concerning the disease for it ever to be suc- 
 cessfully controverted) then it ought to be plain 
 to every intelligent investigator that the specific 
 infection causing yellow fever is a blood poison, 
 and that the toxicohemia is the result of a virus 
 or animal poison which introduced into the cir- 
 culating fluid produces septic or priitrescent 
 effects in the blood which is the point of in- 
 vasion. This is strongly sustained by the fact 
 that putrefaction takes place more rapidly after 
 death from this disease than any other, and alfo 
 by the so-called black vomit which is far more 
 frequent than even experienced physicians are 
 aware of; for I do not recall a single post- 
 mortem that I ever made or witnessed in which 
 abundant evidence was not found of the com- 
 mencement of this change or decomposition of 
 the blood, although in many no evidence of it 
 was seen during life. In fact, it seems to me 
 that it is a misnomer to speak of it as a vomit; 
 
 m 
 
YELLOW FEVER. 1 19 
 
 for the stomach is not its only source by any 
 means; it oozes out through the mucous surfaces 
 of the mouth, throat, oesophagus, stomach and 
 intestinal canal, and also transudes through the 
 weakened and distended walls of the blood 
 vessels. 
 
 You who have had much experience with the 
 disease are doubtless familar with the scene 
 of the patient every now and then throwing his 
 head back and spurting a mouthful of the horrid 
 stuff against the wall, upon the floor, the bed or 
 upon your person, or even into your face if you 
 are not on your guard. This is what trickles 
 down from the gums and fauces and does not 
 come from the stomach at all; and it is not till 
 there is an accumulation of it in the stomach 
 that it is vomited, unless that organ is in an irrita- 
 ble condition and vomiting is occurring from 
 other causes. 
 
 All my observations before and after death 
 tend to confirm the opinion that it is the blood 
 which is first invaded and affected by the spe- 
 cific poison of yellow fever; and remembering 
 that the blood makes the round of the circula- 
 tion in sixty seconds, or a little less, it can be 
 understood at a glance how easily and quickly 
 the nervous system as well as all the tissues and 
 organs of the body, can become affected and all 
 their functions deranged. 
 
 I have said that I should not expect any be tter 
 success with the dosimetric method of treatment 
 
I20 YELLOW FKVER. 
 
 of yellow fever than with any other, except as a 
 prophylactic measure. But I should not make 
 such a sweeping declaration after the great suc^ 
 cess I have had with it during the last ten years 
 of my active practice, for Lhave not had the op- 
 portunity of trying it in this disease. It would '^ 
 afford me great pleasure to have the opportunity 
 of treating, according to this method as a cura-. ' 
 tive measure, one hundred typical and serious , 
 cases of yellow fever after the disease'' had act- I 
 ually commenced, and also a hundred or more 
 non-immunes by the same method as a prevent- ^4 
 ive or prophylactic measure. I have seen all -' 
 other infallible (?) prescriptions and vaunted 
 prophylactics tried and fail; but I have perfect ^j 
 confidence that the dosimetric method would 
 prove a success as aprophylactic at least; and 
 I should not feel that I was experimenting with ^ 
 human life in trying this method in yellow fever 
 for the first time, especially after having seen ^11 
 other methods tried with but little benefit. 
 
 Moreover, this method does not discard any -■ 
 
 old prescription or remedy which has been tried 
 and found useful. I said it was '^improved 
 allopathy;" it is more, it is an improved method 
 of therapeutics. And while it is a very plain 
 and simple method, yet the physician who would 
 practice it successfully must become a good : -. 
 therapeutist; and to do this he must be well ^ 
 versed in every department of medicine, and >" 
 also be a close observer and a good reasoner. 
 
YELLOW FEVER. 121 
 
 Besides this, whether it be the nervous system 
 or the blood which is first attacked, this method 
 points out exactly what is necessary to be done 
 in either case. 
 
 As all schools admit that prevention is better 
 than cure, I will, from my experience with this 
 method as a prophylactic in other serious dis- 
 eases, give the course I would advise all non- 
 immunes to pursue — a course which I think best 
 calculated to prevent the disease entirely, or 
 failing in that to at least so modify it as to ren- 
 der it benign and innocuous. Take one granule 
 of arseniate of strychnine, gr. 1-134, and two 
 granules of arseniate (or hydroferrocyanate) of 
 quinine, gr. 1-6 each, every one or two hours 
 till six doses are taken in a day. At the same 
 time take two granules of calcium sulphide, gr. 
 1-6, five or six times a day. Take no purgatives, 
 and end each day at bed-time by taking two 
 granules each of the celebrated dosimetric trin- 
 ity — arseniate of strychnine, gr. 1-134; aconitine, 
 gr. 1-134; and digitalin, gr. 1-67. This combi- 
 nation will help nature to restore the vital energy 
 used up during the day, equalize the circula- 
 tion and strengthen the heart's action, as well 
 as procure quiet, restful sleep. Occasionally 
 take, what Doctor Burggraeve calls a lavage in- 
 tesitnalej a teaspoonful of seidlitz salt — Abbott's 
 Saline Laxative (neutral sulphate of magnesia 
 in effervescent combination) in half a glassful 
 of water, before breakfast, followed by sucking 
 
122 BELLOW i^ EVER. 
 
 the juice of half a fresh^lemon. This will carry 
 off the previous night's accumulation of vitiated 
 matters and mucus from the mouth, stomach 
 and intestines, thus preventing foulness of the 
 stomach and constipation. This general pre- 
 scription should be kept up for ten days after 
 entering a yellow-fever infected district, and 
 then omitted for a week; but, to be on the safe 
 side and take all necessary precautions, I would 
 advise non-immunes to take during this inter- 
 val two granules of strychnine hypophosphite, 
 gr. 1-134; and two or three tablets of Nuclein 
 (Aulde), two drops each, four times a day. 
 These will sustain vital energy and repair the 
 waste which is going on more rapidly than un- 
 der ordinary circumstances, and will thus pre- 
 vent the entrance of any pathogenic microbes 
 into the organism. 
 
 The foregoing is all that I would advise in the 
 way of medication; and it ought to be kept up 
 for the first month or six weeks of exposure, and 
 at intervals during the entire epidemic, depend;- 
 ing upon the amount of labor and exposure and 
 fatigue that these parties have to undergo in the 
 discharge of their duties. And while there is 
 apparently a great deal of medicine involved in 
 the course, judging from the number of doses, 
 yet, when summed up, the aggregate will be 
 found to be an extremely small amount — say 
 about twenty grains of quinine and twenty grains 
 of calcium sulphide, with less than one grain of 
 
YELLOW FEVER. 123 
 
 Strychnine, in ten days. It was this method, es- 
 pecially through the labors of Dr. Fontaine, 
 of Barsur-Seine, that brought the sulphide of 
 calcium so prominently into use as a remedy in 
 all zymotic diseases, and which Dr Burg- 
 graeve terms ''the parasiticide par excellence," 
 while he has named the arseniate of strychnine 
 his ''cheval de bataille.'' 
 
 I will attempt no outline of what my curative 
 treatment of yellow fever would be according to 
 this method, but will say that under any and all 
 methods it requires no potent nerve depressors, 
 no powerful arterial sedatives nor antiphlogistics 
 of any kind; for it is from the beginning a terrible 
 state of asthenia with a tendency to rapid de- 
 struction and putrefaction throughout the whole 
 organism, and requires all the skill and all the 
 agents of our art to counteract it and to sustain 
 struggling nature with nervo-vital incitants, ton- 
 ics and reconstructives^until the danger is passed. 
 
 In speaking of the use of sulphide of calcium 
 in all zymotic diseases I did not mean to imply 
 thereby that yellow fever belongs to that class, 
 though I have been guilty of so doing in the past 
 simply from force of habit and because it has 
 been so classified by nosologists generally. 
 This, however, is an error; for it does not belong 
 to that class at all. It is essentially a septic 
 fever caused by the introduction of a specific, 
 septic, animal poison into the circulatory system, 
 thus producing a true blood poisoning. 
 
124 YELLOW FEVER. 
 
 As the difference between zymotic and septic 
 poisons in their course, action and effects is sel- 
 dom mentioned and as they are sometimes 
 used synonymously, I will give you my idea of 
 the difference between them — an idea derived 
 from long . comparative observation of the 
 various diseases produced by them; for to 
 my mind a clear comprehension of this dif- 
 ference greatly aids us in understanding sev- 
 eral disputed points in regard to the nature of 
 yellow fever. 
 
 The zymotic contagium — be that whatever it 
 is, whether vegetable germ or zo-ospore — requires 
 a nidus within the human body in which to in- 
 cubate and then hatch. During this period of 
 incubation no appreciable change or reaction 
 follows but at the end of this period, which is 
 longer or shorter according to whatever the dis- 
 ease is, the pathogenic virus is hatched out, and 
 infects the whole economy at once, giving rise 
 to general symptoms which are common to 
 all diseases of the class. So that in diseases pro- 
 duced by zymotic poisoning there are three dis- 
 tinguishable stages: first, an incubative or dor- 
 mant stage without symptoms; second, a stage 
 of hatching and general infection accompanied 
 by general symptoms common to all of that class; 
 third, a stage in which the specific symptoms 
 pathognomonic of that disease appear. In 
 measles there is first the incubative stage last- 
 ing from ten to fourteen days; second, the ca- 
 
YELLOW I^EviiJK. 125 
 
 tarrhal and febrile, three to four days; third, the 
 eruptive, three to five days. 
 
 There are no such observable stages in dis- 
 eases produced by septic poisoning; for these 
 poisons incubate and hatch into the pathogenic 
 virus outside of the body, which then gains en- 
 trance into the body through the natural pas- 
 sages by being inhaled into the lungs with the 
 air breathed and swallowed into the stomach 
 with the liquids and foods taken by the indi- 
 vidual in a locality infected by the virus. In the 
 case of a true germ disease, like yellow fever, 
 countless myriads of the pathogenic microbes 
 gain entrance thus far; but the vast majority 
 and in many cases all of them are destined to be 
 destroyed by the vital energy of the organism 
 into which they have gained entrance. But 
 , when they once meet with a vulnerable surface 
 
 ! through which they can enter the blood-stream 
 
 their work of destruction begins and, in conse- 
 quence of the rapidity of the circulation, reac- 
 tion commences and the whole body is infected 
 at once and specific symptoms follow imme- 
 diately. 
 
 The next general difference between these poi- 
 sons is that in septic diseases the gravity, vio- 
 lence and result of the attack depend in each 
 case upon the virulence and quantity of the sep- 
 tic poison introduced; while in zymotic poison- 
 ing this makes absolutely no difference in the 
 violence of the reaction or the result. 
 
126 YELLOW FEVER. 
 
 Finally: In contagious, zymotic diseases the 
 disease-producing germs or microbes continue 
 to propagate and multiply in the organism which 
 they have invaded and escape from that organ- 
 ism to infect others, thus causing new cases; 
 whereas the septic poison reaches the limit of 
 its existence in each case infected and is 
 either vanquished and cast out as effete matter; 
 or it overwhelms and destroys the individual 
 and, Sampson-like pulling down the pillars of 
 life's citadel, is involved in the ruin wrought by 
 it. Hence, as a rule, septic diseases are not 
 contagious, while zymotic diseases are. 
 
 This explanation of the principal points of 
 difference between the zymotic and septic poi- 
 sons enables one to understand easily why yel- 
 low fever is not contagious from the person; for 
 the pathogenic bacilli, after accomplishing their 
 work, perish in the body and thereby become 
 innocuous; and as they do not multiply or propa- 
 gate in the body there can be no infectious or 
 contagious emanations from that body. It also 
 enables one to clearly comprehend how and why 
 a refugee from an infected district, although he 
 may not have the disease himself and may even 
 be an immune, is a source of danger to others if 
 he comes to them in the same suit of clothes 
 which he wore while in the infected district, and 
 particularly when he brings a trunk of clothing 
 packed in that district. 
 
 Thus my readers will be enabled to understand 
 
YELLOW FEVER. 127 
 
 why I advocate a quarantine; not against the 
 person of the refugee, but- against his clothing 
 and against everything he brings from the in- 
 fected district which may serve as fomites for 
 the transmission of the disease, from which he is 
 fleeing. • 
 
APPENDIX. 
 
 Containing a parallel table of the principal 
 characteristic symptoms of Yellow Fever- and 
 Dengue, and so comparing them as to show how 
 a differential diagnosis can be made and the two 
 diseases- distinguished. Also, a few more im- 
 portant facts and data which were unintention- 
 ally omitted, and which greatly strengthen the 
 theory of the origin of Yellow Fever and all the 
 positions and predictions concerning the disease, 
 closing the whole matter by a repetition of how 
 the disease may be eradicated. 
 
APPENDIX. 
 
 There are a number of reasons which impress 
 me with a sense of the propriety and even the 
 necessity of closing this very imperfect history 
 of yellow fever with a short chapter upon what 
 is frequently termed its twin sister — dengue, a 
 disease equally as unique and mysterious as the 
 former, and as little understood by the pro- 
 fession. 
 
 Principal among these reasons are : First, 
 the position I took in reference to the epidemic 
 of 1897; second, since dengue is frequently 
 taken for yellow fever, scarlet fever, and some 
 other diseases, to show the great difference 
 between the two diseases; and third, tg acknowl- 
 edge my error, if I was wrong last year, and to 
 show how it was possible forme to have been 
 so, thus convincing my readers that I am not in 
 the least biased or governed by prejudice or 
 bigotry but am desirous that truth alone 
 should prevail even at the risk of my being 
 misunderstood. 
 
 I took a firm stand at the beginning of the 
 alarm, expressing the opinion that there was 
 not and would not be a case of yellow fever 
 in Texas this year (1897) and that there 
 
132 APPENDIX. 
 
 was good reason for doubticfg that the disease v#i 
 then prevailing east of the Mississippi was yel- j^ 
 
 low fever. I have always been very decided in 
 my diagnosis, though sometimes slow to arrive at 
 one, yet have always been open to conviction. 
 In the earlier years of my practice, during the 
 prevalence of an epidemic of dengue, I once 
 diagnosed a case as scarlatina and was very 
 confident that I was correct until convinced of -^ 
 
 my error by an older confrere and by subse- ! 
 
 quent events in the course of the epidemic. 
 Then I candidly confessed my mistake and 
 profited by it afterwards. I have since known 
 a number of physicians to make the same mis- _^j 
 take who would not be convinced by all the 3 
 
 arguments and facts that could be brought to ~ v' 
 bear upon the points. And I have been afraid 
 that the official experts of last year were a. j 
 
 little inclined to be of that stubborn class 
 who thought it beneath the dignity of their 
 position to confess that it was possible for them 
 to err. 
 
 Now, although I was not in active practice at 
 the time, I had been watching closely the reports 
 of the progress and course of the dengue (which 
 so far as I can learn began in San Antonio) for 
 a month or more prior to any excitement or talk 
 of yellow fever; and having passed through a 
 number of such epidemics and listened to the ■ 
 
 disputes and arguments of members of the pro- 
 fession as to what it was, I was prepared 
 
APPENDIX. 133 
 
 * 
 
 to hear it called yellow fever, scarlatina or 
 almost anything else calculated, to alarm the 
 people. To do what 4 could to prevent the 
 frantic stampede which I knew was bound to 
 follow the report of the official experts then mak- 
 ing investigations in Galveston, I wrote several' 
 short articles for the daily paper of Navasota, 
 Texas, where I was staying temporarily, advising 
 the people to remain quietly in their comfortable 
 homes, and warning them that they were liable 
 to contract worse diseases in their huts and 
 camps in the forest to which they were preparing 
 to flee; and that all would in the end regret this 
 hasty and injudicious step. But it was all in 
 vain; I was a comparative stranger and my 
 advice was unheeded. And they all had the 
 dengue, from which they were fleeing, far worse 
 than they could have had it had they remained 
 at home; and as I had predicted they deeply 
 regretted not doing so. Never in its history did 
 yellow fever take such a sweeping course as was 
 exhibited by this epidemic of dengue. And 
 this is one of the important characteristics dis- 
 tinguishing it from yellow fever; ioi dengue 
 not only takes in cities, towns and villages but 
 the entire region which it has invaded and in- 
 cludes almost the whole population among its 
 victims, seldom, if ever ending- fatally as a dis- 
 ease per se. Persons who have had previous 
 attacks of dengue, as well as those who have had 
 yellow fever, are equally as liable to dengue as 
 
li^ APPENDIX. 
 
 those who have never suffered attacks of either. 
 On the other hand, one attack of yellow fever is 
 protective against a second attack, and the dis- 
 ease, as a rule, is confined to the large cities on 
 the seaboard (though occasionally its germs 
 have been carried in fomities by railroads into 
 interior towns); but its spread has never been 
 of an extensive, sweeping, epidemic character 
 like that of dengue and la grippe. 
 
 Another fact in connection with this last 
 epidemic is contradictory of all the past history 
 of yellow fever; namely, that eight out of every 
 ten cases discovered and diagnosed as yellow 
 fever in Galveston, with nearly as many in 
 Houston, all recovered — an unheard of and un- 
 precedented result in that disease. Neither was 
 there any further infection from that number 
 oi foci in the two cities, nor could a source of 
 infection be traced in a single one of these cases; 
 but the conclusion of the officials was that some- 
 how it must have slipped in with the dengue. 
 How I wish they had told us from whence came 
 this dengue and also something about its modes 
 of travel and transportation, and by what route 
 it invaded our State ! 
 
 The foregoing, I think, sufficiently explains 
 my position in the matter; and doubtless ninety 
 per cent of the physicians of Texas agree that I 
 was correct, for subsequent events fully sustained 
 me. Just here let me parallel the principal 
 characteristics and symptoms of the two diseases. 
 
APPENDIX. 
 
 135 
 
 YELLOW FEVER 
 
 DENGUE 
 
 (i) Is a non-contagioas (but 
 highly infectious) epidemic, non- 
 eruptive fever of only one par- 
 oxysm lasting from thirty-six to 
 seventy-two hours— a disease of 
 but two stages. 
 
 (2) Cause:— A specific, septic, 
 animal poison of known origin 
 and with no incubative period in 
 the person affected. 
 
 (3) Onset:— As a rule__pccurs 
 at night between nine p. m^ and 
 three a. m., with no prodrornic 
 symptoms except a few honfs' of 
 exhilaration or stimulation pre- 
 ceding the sudden invasion. 
 
 (4) Course :— The most regular 
 of any disease; always exhibiting 
 characteristic phenomena "pecul- 
 iarily its own, variable only in 
 intensity. 
 
 (5) Tongue: — Clean, except—a 
 little white furr, anH with edges 
 reddened^— bec^oming_dry^r£ism 
 and cracked in the second stage. 
 
 (6) Eyes deeply injected, tur- 
 gid and yellowish; expression oft- 
 en fierce, anxious and enquiring. 
 
 (7) Headache frontal, with in- 
 tense supraorbital pain; also pain 
 in back and calves. 
 
 (8) The face, neck and upper 
 part of chest flushed, puffy, red- 
 dish inclining to purple, yielding 
 later to an orange or bronzed as- 
 pect caused by stagnation of the 
 blood m superficial arterial cap- 
 illaries. 
 
 (9) Hemorrhages from the 
 gums, cracked tongue and all 
 mucous surfaces, as well as from 
 kidneys, uterus and stomach. 
 
 (10) Urine frequently albumin- 
 ous, 30 to 40 per cent. Specific 
 gravity low— i.oio to 1.012; sup- 
 pression common. 
 
 (i) Is a non-contagious but es- 
 sentially infectious, epidemic 
 typically eruptive fever of two 
 paroxysms separated by a short 
 remission lasting in all five days 
 {\S: the second paroxysm is not 
 prevented). 
 
 (2) Cause: — Wholly unknown, 
 but supposed to be some elec- 
 trical disturbance in the air or 
 earth; closely akin to la grippe. 
 
 (3) Onset:— Usually occurs in 
 the daytime, from nine a. m. to 3 
 p. m. ; invasion is generally sud- 
 den, but this is irregular as is 
 everything else about the dis- 
 ease. 
 
 (4) Course : — Very erratic; - re- 
 sembling varioloid in thermo- 
 metric records, yellow fever in 
 march of pulse and scarlatina or 
 measles in eruption 
 
 (5) Tongue :— Clean but red in 
 first paroxysm; becoming thickly 
 coated and enlarged in second, 
 with offensive breath. 
 
 (6) Eyes and physiognomy not 
 peculiar, or simply expressive of 
 the intense pain being endured. 
 
 (7) Headache occipital or pari- 
 etal, with deep, intense pain back 
 of the eyes; soreness of all mus- 
 cles; neuralgia in certain nerves 
 and rheumatic pains in all the 
 joints. 
 
 (8) Skin flushed bright red and 
 eyes suffused, but exhibiting none 
 of the other variations of color 
 seen in yellow fever resulting 
 from the sluggish movement of 
 blood in capillaries. 
 
 (9) No hemorrhagic tendency; 
 occasionally obstinate epistazis 
 and sometiihes hematuria. 
 
 (10) Albuminous urine rare; 
 specific gravity high— x. 030 to 
 1.063 — sugar more frequent than 
 albumin, hut only temporary. 
 
136 
 
 APPENDIX. 
 
 -^ 
 
 YELLOW FEVER 
 
 DENGUE 
 
 (ii) Muscular prostration very 
 great; convalescence slow and 
 tedious; relapses frequent. 
 
 (12) One attack affords almost 
 certain immunity for the future. 
 
 (13) Mortality very great— 25 
 to 66 2-3 per cent. 
 
 (14) Apeculiar.putrescent odor 
 exhales from all parts of the body 
 — more pronounced in second 
 stage and in some epidemics than 
 in others. 
 
 - (15) Liver, stomach, heart and 
 kidneys affected. 
 
 {16) No sequel, except oc- 
 casionally swellings of lymphatic 
 glands in neck, axilla, groin and 
 testicle. 
 
 (11) Muscular prostration shght;. 
 convalescence rapid; little ten-, 
 dency to relapse. 
 
 (12) One attack affords no im- 
 munity; rather seems to predis- 
 pose to others. 
 
 (13) Mortality nil if uncompli- 
 cated and not overmedicated. 
 
 (14) No odor perceptible ex- 
 cept in the last paroxysm when it 
 is from the stomach and bowels 
 only and of the nature of sulphu- 
 retted hydrogen. 
 
 (15) These organs show no 
 pathological changes unless they 
 have been previously diseased. 
 
 {16) Frequently followed 
 boils and carbuncles. 
 
 by 
 
 Leaving out the v^rant of parallelism between 
 the pulse and temperature in yellow fever, the 
 foregoing constitutes the principal characteristic 
 symptoms exhibited by the two diseases; but as 
 I have said there is no one single symptom yet 
 discovered that can be said to be truly pathog- 
 nomonic of either. It is only by grouping the 
 phenomena constituting each disease that the 
 observer is able to form a correct diagnosis; 
 but it soon becomes as easy for the educated 
 and critical observer to diagnose these diseases 
 by this means and to distinguish between them 
 and all other diseases as it is easy for one to 
 recognize and distinguish his friends and inti- 
 mate acquaintances from strangers by their gen- 
 eral personal appearance and make-up. 
 
APPENDIX. 137 
 
 But I will close by endeavoring to show how 
 it was possible for me to have been in error in 
 regard to last year's epidemic; and, if so, to 
 show that my error was simply another addi- 
 tional incontestible proof that I am correct in all 
 my positions and predictions in regard to that 
 hitherto terrible scourge, yellow fever. In the 
 first place I must insist that if. the few cases 
 diagnosed as yellow fever, in Galveston and 
 Houston, were indeed and in truth genuine yel- 
 low fever, then , all the other thousands upon 
 thousands of cases, not only in ''the twin cities 
 by the sea" but also all those in every interior 
 town and village of this state as well as all east 
 of the Mississippi, were bound to be the same 
 disease — true yellow fever; it was either all 
 dengue or all yellow fever. There_ could be 
 no other rational explanation "or reason given 
 why this supposed epidemic of dengue exhibited 
 a greater resemblance to and possessed more of 
 the pathognomonic symptoms of yellow fever 
 than it ever did before. And if it is true that it 
 was genuine yellow fever and not dengue at all, 
 then I repeat what I said in a paper upon this 
 subject in The A Ikaloidal Clinic oi ]?iTL\i2iXyj 1898: 
 ''The scourge of the south has lost its malig- 
 nancy; its death-dealing fangs have been ex- 
 tracted, and it will no longer be dreaded as it 
 has been in the past." 
 
 I will now show how this is simply another 
 strong proof of the truth of my theory, positions 
 
138 APPENDIX. 
 
 and predictions as set forth in the preceding 
 pages of this little book. And it should require 
 but little or no argument or explanation to es- 
 tablish the truth of this last assertion. In fact, 
 it is only what would be naturally expected to 
 occur, according to the past history of the dis- 
 ease and the history of what I have attempted 
 to prove was its origin and cause, the African 
 slave trade. And before closing I will mention 
 some very important facts which I have strangely 
 overlooked and omitted to give in their proper 
 order; for they, are as strongly corroborative 
 and confirmative of my theory as anything yet 
 adduced. 
 
 These facts are as follows : The island of Cuba 
 has two hundred capacious harbors into most of 
 which ships of the line can enter. Slave ships 
 used to enter them, and yellow fever prevailed 
 there as long as that was the case. But their sit- 
 uation and openings into the Gulf were such that 
 nature's great purifier— ^water— had such free ac- 
 cess and egress that as soon as those vile ships 
 ceased to arrive these harbors like those on our 
 Atlantic seaboard were cleansed by the natural 
 action of the waves and tides and yellow fever 
 ceased to prevail. And it is now as unknown in 
 the interior of Cuba as it is in Michigan and Illi- 
 nois or any of our interior states. This shows 
 conclusively that it did not originate in that 
 island. 
 
 I think I have succeeded in proving satisfac- 
 
APPENDIX. ^ 139 
 
 torily that since the complete suppression and 
 removal of that cause the disease has also dis- 
 appeared from and ceased to exist in all parts 
 of the world where it had prevailed so often and 
 so virulently during the existence of the nefari- 
 ous traffic, except from that filthy little pond — 
 the bay of Havana, Cuba.. I have also shown 
 that while it has disappeared from all the other 
 ports of the West Indies^ the reason why it has 
 been so slow in disappearing from this particu- 
 lar harbor is: First, that it has always been the 
 headquarters for slave ships from the inaugura- 
 tion of the traffic until its close; and hence has 
 received into its mud banks a larger material 
 quantity of the peculiar filth than has any other 
 port; second, that the sluggishness of its waters 
 and its narrow outlet makes it almost impossi- 
 ble for those waters to be completely changed 
 and purified without the help of man, at least in 
 any reasonable time; third, because it was the 
 last point on the globe to receive accretions of 
 that peculiar filth from which the specific poi- 
 son of the disease is generated — slaves having, 
 according to the best authentic accounts I can 
 find, been landed there as late as 1876. From 
 this it will be seen that no additions of this filth 
 had been made to its mud banks for twenty-two 
 years; consequently the slow action of the little 
 tide by which its waters are affected has in that 
 time so diluted, attenuated and carried out por- 
 tions of this filth that it can no longer give rise 
 
140 APPENDIX. 
 
 to the virulent type of yellow fever of former 
 days. 
 
 Now if this is not a true statement of the condi- 
 tion now existing in the harbor of Havana, and if 
 the viateries morbi of yellow fever is still there 
 in all of its original potency and virulence, then 
 the prophecies and predictions of the croakers 
 will have abundant opportunity for fulfilment. 
 For since the treacherous and villianous blowing 
 up of our peaceable visitor — the warship Maine 
 — the stirring up of that filthy mud, theremoval 
 of all quarantine restrictions, and the fleeing of 
 thousands from that port to our shores (espec- 
 ially at this particular season) will all be the 
 occasion and means of the introduction of a 
 greater quantity of the disease-producing germs 
 of yellow fever than ever came to our shores in 
 one season before. And if they possess any of 
 the old-time vigor and virulence of the yellow' 
 fever germs of forty years ago, it will knock my 
 theory into a cocked hat and scatter my deduc- 
 tions and historical data to the four winds of 
 heaven; and in addition to the horrors of a 
 foreign war we may confidently expect our 
 country to be scourged from Texas to Maine 
 and from the Atlantic to the Pacific by this hor- 
 rible plague. 
 
 But I have so much confidence in the histori- 
 cal data which I have furnished in regard to its 
 cause, and am so well assured that these data 
 rest so securely upon the firm basis of eternal 
 
APPENDIX, 
 
 truth that they cannot be overturned, that 
 have no fears of such a result. 
 
 It is possible that I am a little premature in 
 my predictions and that the virus in that dirty 
 little pond of Havana is still virulent enough to 
 be capable of producing another terrible epi- 
 demic. If so, then the sooner my suggestions 
 are adopted the better it will be for humanity 
 in general. 
 
 I propose to cut canals and turn the Gulf 
 Stream into the bay, and thus wash out the last 
 traces of ''the most cruel traffic that ever visited 
 any American port from Cape Cod to the Cape 
 of Florida — a traffic that brought in its train a 
 far-reaching Nemesis such as wrong-doing never 
 fails to bring." 
 
 FINIS.