Wilson. In 1824, the disease prevailed extensively on board the Rattlesnake, a new British ship, on the West India station. She had just been thoroughly cleaned. Dr. Wilson says: "When the process of purification was considered complete, I examined every part of the hold's surface, and found it in every part, from the hatches to the kelson, clear, clean, and dry, scarcely capable of soiling a white glove." It is proper to state, however, that in most instances of the occurrence of the disease on shipboard, it has been in connection with very damp and filthy holds. I do not mean to say that accumulated and concentrated filth, acted upon by a high temperature, does not promote and favor the origin and spread of yellow fever; there is good evidence that it does so; I mean merely to say that we have no sufficient grounds for referring the disease directly and exclusively to this cause.

In connection with this subject, it may be mentioned that Dr. John Wilson, apparently an attentive observer of yellow fever, and generally a sensible writer, is disposed to refer the disease to a peculiar kind of ligneous decomposition, for its essential cause. He thinks this hypothesis corresponds to all the observed facts in connection with the subject, better than any other.' I cannot see that it is any more plausible or any more reasonable than the rest.

SEC. XV.-Contagion. Let me relieve the friendly and indulgent reader who has accompanied me, cheerfully and not without interest, I would fain hope, thus far, in my history of yellow fever, from an apprehension that he may very naturally feel, on beholding the caption of the present section in my manifold chapter on the etiology of this disease;-it is not my purpose to occupy his time and attention with anything like a history of the multiform, complicated, and sometimes bitter controversies, which have run through the medical annals of the last fifty years, upon the contagious and noncontagious character of the disease. In conformity to the general design and arrangement of my book, I shall confine myself to a simple statement of the actual and positive condition of our knowledge upon this subject; all which can be done, I think, in the space of a few pages.

There have been three leading and principal doctrines, or opinions, upon the question before us, each of which I wish and will

I Memoirs of the West Indian Fever, p. 139, et seq.

endeavor to state, together with the grounds upon which it rests, as fairly and explicitly as I can.'

The first of these doctrines is that which attributes to yellow fever an absolute and unqualified contagious character. The advocates of this doctrine allege, that the disease is directly and immediately transmissible from one person to another, like measles or smallpox. Dr. Chisholm, one of the earliest and most zealous promulgators of this doctrine, thus states the leading circumstances which influence the action of the contagious poison; those who most

The great controversy between the contagionists and the non-contagionists originated in the following circumstances. Towards the close of the last century, a project was formed in England for the establishment of a colony-partly benevolent and partly commercial in its character-on the island of Bulam, or Boullam, lying at the bottom of a deep bay, about fifty miles from the open sea, on the western coast of Africa, in the 11th degree of north latitude. Early in the month of April, 1792, the ship Hankey, in company with another vessel loaded with stores and adventurers, sailed from England for Bulam, where she arrived just before the commencement of the rainy season. The Hankey remained at the island nine months; soon after her arrival, a malignant disease appeared amongst her passengers and crew, consisting of more than two hundred persons, three-fourths of whom were its victims. Aided by a few seamen procured from other ships, the Hankey finally sailed for the West Indies, and arrived at Grenada on the 19th of February, 1793. According to Dr. Chisholm, the first person who visited the Hankey on the evening of her arrival, was a Captain Remington; and in a few days afterwards, he died with yellow fever. The crew of the Defiance were the next who visited the Hankey; five out of six were immediately seized with the fever, and died in three days. The disease now began to appear in the other vessels in the harbor, and spread successively from one to another, not one escaping. Until the middle of April, the disease was confined to the shipping in the harbor; it then appeared in a house close to the wharf, where it was introduced, according to Dr. Chisholm, by a negro woman who took in sailors' clothes to wash. The disease then extended to different parts of the town, and during the months of May, June, and July, it appeared at various points in the neighboring country, carried thither, says Dr. Chisholm, by persons who had imprudently visited infected houses in town. From Grenada, as from a focus, this nova pestis-this new Malignant Pestilential Fever of Dr. Chisholm, spread to the other islands, to Jamaica, St. Domingo, and to Philadelphia-the infection being generally carried from place to place in the woollen jackets of deceased sailors.-Chisholm's Essay, vol. i. p. 102, et seq. Dr. Chisholm attributes the introduction of the disease into Philadelphia, not to the damaged coffee, but to some sailors sick with yellow fever, on board the same vessel that brought the coffee, as part of its cargo.-Ibid., vol. i. p. 220. Dr. Chisholm, it is important to state, looked upon this fever as quite unlike the ordinary remittent yellow fever, as he called it, of the West Indies; the latter, he admitted, was of domestic origin, arising from miasmata, endemic, and not contagious. The former, he says, may have owed its production, in some instances, to the united action of pestilential contagion and the miasmata of marshes, and other direct causes of yellow remitting fever.-Ibid., vol. i. p. 208. This is the doctrine of contingent contagion, of which I shall speak more fully by and by.

CAUSES.-CONTAGION.

carefully avoid houses where the infection is, are the most certain to escape the fever; although the disease may be in the same house, avoiding the chamber of the sick prevents infection; merely entering the chamber of the sick, without nearly approaching the diseased person, has never communicated infection; approaching near enough to the diseased person to be sensible of the fetor of his breath, or of the peculiar smell which is always emitted from the bodies of the sick in this disease, or touching the bedclothes, generally occasions nausea, slight rigors, and often headache at the moment, and, some hours after, the disease itself; actual contact, so that the perspired fluid of the sick person may adhere to the hands or other parts, of the healthy person, more certainly produces the fever; touching the wearing apparel of a person who is actually diseased, or has just recovered from the disease, as certainly communicates the infection to the healthy person, and finally, merely passing a person infected, or who wears the clothes he had on during the existence of the disease, in such a manner that the effluvia proceeding from them may be blown on the healthy person, has produced the disease.'

It may be interesting to my readers, while it will best illustrate the subject before us, to be made acquainted with some individual facts which tend to support the above-mentioned doctrine. Sir Gilbert Blane, in a letter to the Hon. Rufus King, relates the fol"On the 16th of May, 1795, the Thetis and lowing occurrence. Hussar frigates captured two French armed ships from Guadaloupe, on the coast of America. One of these had the yellow fever on board, and out of fourteen men sent from the Hussar to take care of her, nine died of this fever before she reached Halifax, on the 28th of the same month. Part of the prisoners were removed on board of the Hussar, and though care was taken to select those seemingly in perfect health, the disease spread rapidly in that ship, so that near one-third of the whole crew was more or less affected by it." It is greatly to be regretted that the circumstances thus related, by Blane, like so many others of a similar character, should be in many respects so loose and defective. The previous history of the Hussar is not given; we are not told upon whose authority the entire narrative rests; and nothing conclusive is stated as to the real character of the fever on board the Hussar. [Besides, the first part of this narrative proves nothing more than that yellow2 Blane's Dis. of Seamen, p. 603.

1 Chisholm's Essay, vol. i. p. 309.

fever poison, without reference to its nature, existed on board the captured vessel; and in the second, as in almost every instance of which contagion is asserted, nothing is said of the personal effects and other articles brought from the infected ship or place; so that those who believe in the doctrine of fomites remain unconvinced.] A similar occurrence is related amongst the documents submitted by M. Chervin to the Royal Academy of Medicine. According to M. Lemarinier, in October, 1808, the French brig Palinurus, of which he was surgeon, attacked and captured, near Barbadoes, the English brig Carnation. The yellow fever was prevailing on board the Palinurus at the time. The English prisoners were most of them placed on board the latter, and nearly all of them had the fever. The day after the capture, M. Jance, commander of the Palinurus, at the time mortally sick with the disease, was carried on board the Carnation, where he died on the following day. M. Lemarinier and a portion of the French crew were also transferred to the prize. The yellow fever immediately appeared amongst the crew of the Carnation, who had had no direct communication with the Palinurus. Several of them died. Matthew Carey says: "Since the first edition appeared, I have had information from a number of creditable persons, that the idea that the disorder has not been communicated out of Philadelphia, is erroneous. A family of the name of Hopper, near Woodbury, took it from some of our infected citizens, and three of them died. A woman in Chester County, who had boarded and lodged some of the sick, died of the malignant fever. Three people of one family in Trenton, took it from a sick person from Philadelphia, and died of it. A negro servant, belonging to Mr. Morgan, took up an infected bed floating in the Delaware, which spread the disorder in the family, and Mrs. Morgan and her girl both died of it. It was introduced by his son from Philadelphia into the family of Mr. Cadwallader, at Abington, some of whom died with it. Some others in different places caught the infection and died. But the cases of this kind have been extremely few, considering the numbers who carried the disorder from hence, and died with it in the country." I may dismiss this branch of the subject with the remark that cases even of apparent communication of the disease, directly from one person to another, in an uninfected district, and without the aid of fomites, are exceedingly rare; and it may reasonably be doubted

1 Rapport de l'Acad. Roy. de Méd., p. 8.

2 Carey's Account, &c., p. 81.

CAUSES.-CONTAGION.

whether a single such case, of entire and unquestionable authenticity, has ever been known.

The second doctrine upon this subject is in direct and positive opposition to the foregoing. Its advocates deny that yellow fever is, ever, or under any circumstances, transmissible, by a contagious poison, from one person to another. They allege that it is strictly endemic in its origin and character, and absolutely non-contagious, like ordinary remittent fever. The general ground upon which they rest this opinion is the fact, almost universally admitted, that the disease, in a pure atmosphere, is manifestly and unequivocally not communicable from one individual to another. They say, further, that the disease can never be traced from one person to another, or from one family to another-its extension not depending upon personal intercourse;-that its extinction by cold weather is an argument against its contagious quality; and that the inconsistencies and contradictions which constantly attend the application of this doctrine render it altogether inadmissible. Since the beginning of the great controversy on this subject, in 1793, a large proportion of observers-both amongst private practitioners and writers at least in the United States and Great Britain-have ranged themselves in the ranks of the non-contagionists. Amongst the earliest and ablest champions of this doctrine, in our own country, were Dr. Caldwell, Dr. Edward Miller, Dr. E. H. Smith,' and Dr. Rush. Dr. Devèze, however, preceded them all; and his merits, in this respect, have been most strangely and most unjustly overlooked.

2

In the third place, there is a doctrine holding a sort of middle ground between the two extreme opinions which I have just stated. This has been called the doctrine of qualified or contingent contagion.

1 Dr. Smith was one of the editors of the Medical Repository. He was one of the victims of the New York epidemic of 1798. Dr. Miller's brother and biographer pays the following tribute to his memory. "Never can the writer of these lines forget the funeral of Dr. Smith. It was when the ravages of pestilence had become so tremendous as to drive almost every individual from the city who was able to fly; when scarcely any passengers were to be seen in the streets, but the bearers of the dead to the tomb; and when it appeared as if the reign of death must become universal; it was in circumstances such as these, that Doctors Mitchill and Miller, accompanied with two or three other friends, bedewed with their tears, and followed to the grave, the remains of a young man, in some respects the most enlightened and promising that ever adorned the annals of American Science."E. Miller's Works, p. lx.

Amer. Journ. Med. Sci., vol. iv.

p.

523.