SEC. XVI.-Exposure; Fatigue; Excesses, &c. There can be no doubt that yellow fever is frequently the immediate result of the operation of the ordinary occasional or exciting causes of disease; and that persons exposed to the essential poison of the disease might escape, were it not for the co-operation of the latter influences. Still, it must be admitted that the extent to which these causes act, in the production of the disease, has been only very loosely studied and very imperfectly ascertained; and, in many instances, the power of the endemic cause is so great and so overwhelming as to stand in need of no assistance from accidental or collateral agencies. Dr. Barrington says from all he has seen, he is convinced, that the temperate man as a general rule has the best chance; but he says, also-and these are his words-"I have not observed that those who were accustomed to the regular and moderate use of spirituous drinks, were more obnoxious to attacks of fever than others of rigidly temperate habits; on the contrary, and I regret to say it, because it affords a pretext for the intemperate, in two or three instances, I have seen the abstemious carried off in a few days, while hard drinkers, under the same exposure, have escaped." Dr. Rush, in his account of the fever of 1803, in Philadelphia, says: "I did not see a single case in which the disease came on without an exciting cause; such as light clothing and bedclothes, sitting at doors after night, a long walk, gunning, and violent and unusual exercises of any kind." This observation would be of more value than it is, if Dr. Rush had been somewhat more careful and discriminating than he was, and less ready to jump blindly to general conclusions. Dr. Hillary-that honest and careful old observer-says: "The disease most readily seizes those who use vinous or spirituous liquors too freely; and still more readily, those who labor hard, or use too violent exercise, and are at the same time exposed to the influence of the scorching rays of the sun in the daytime, and soon after expose themselves too suddenly to the cold dews, and damp air of the night, and especially if they drink spirituous liquors too freely at the same time."3

Sir Gilbert Blane, speaking of acute diseases generally, amongst Europeans newly arrived in the West Indies, says: "It cannot be too much inculcated on those who visit tropical countries, that exercise in the sun, and intemperance, are most pernicious and fatal

Am. Journ. Med. Sci., Aug., 1833.

3 Rush's Hillary, p. 107.

? Med. Inq., vol. iv. p. 58.

112

practices, and that it is in general by the one or the other that the better sort of people, particularly those newly arrived from Europe, shorten their lives." Matthew Carey says of the Philadelphia epidemic, of 1793: "To tipplers and drunkards, and to men who lived high, and were of a corpulent habit of body, this disorder was very fatal. Of these many were seized, and the recoveries were very rare." Dr. Devèze, in his account of the same epidemic, says it has always been remarked that, during the prevalence of yellow fever, persons newly married are constantly its victims.3 "Of all the exciting causes of yellow fever," says Bally, the "act of coition is the most powerful; how many have we seen, seized by a chill on leaving the arms of Pleasure, terminate in a few days their career! How many even have we seen the victims of a simple nocturnal pollution !" [There are good reasons for supposing that the poisonous agent that produces yellow fever, like that which produces the typhus, finds in the system vital opposing forces, which unembarrassed often effectually resist and finally eliminate the poison; but, overwhelmed, or even oppressed by other influences, they can no longer suppress the manifestations of the morbific agent. This appears to be the theory on which the doctrine of exciting causes is based, in every specific disease, in intermittent, remittent, typhus and typhoid fevers, no less than in the yellow fever. In these cases the disease follows promptly, sometimes immediately, the action of the exciting cause. Thus it is, probably, that grief and fear, especially overwhelming sorrow and panic, overpowering offensive odors, and previous disease have counted each their victims.]

SEC. XVII.-Essential Poison. In regard to the essential poison, the application of which to the system gives rise to yellow fever, I can do but little more than to repeat the remarks that have already been made in connection with the essential etiological poisons of other fevers. The nature and composition of the former, like those of the latter, are entirely unknown to us. It would seem to be clearly enough of terrestrial origin; and not capable of being transmitted, to any considerable distance, through the atmosphere. Most of its ascertained properties and relations have already been indirectly stated; inasmuch as they are connected

1 Diseases of Seamen, p. 132. 3 Devèze, p. 114.

2 A Short Account, etc., p. 61.

Du Typhus d'Amérique, par Vr. Bally, p. 375.

with the causes of yellow fever already detailed. It is quite unnecessary, and it would be a very thankless and unprofitable labor, to enumerate the successive hypotheses and speculations which have been started in regard to the origin, nature, and mode of action of this poison. The animalcular or cryptogamous hypothesis seems to me more plausible and less refractory than the others; but it is only a pure hypothesis. As to its mode of action on the system, the organs by which it is received, and so on, we are as profoundly ignorant as we are of its nature and composition. It is probable that it is introduced into the system through the lungs ; although this is merely a conjecture. It is entirely philosophical, to consider it as a peculiar poison-an agent sui generis-differing from all others, like the essential poison of smallpox, hydrophobia, and so on. A very short exposure to its influence is sufficient to produce the disease; it is very probable that a single inhalation is enough. It may be retained for a considerable period of time shut up in the holds of vessels, in trunks or bales of clothing, in bedding, and even in apartments of houses, while the surrounding atmosphere is free from it; in some of these forms it may be transported long distances from the place of its origin, and there give rise to the disease. The only known means of destroying it consists in a temperature as low as the freezing point, and this is always immediate and complete in its operation.

[SEC. XVIII.—Quarantine. The propriety of the quarantine principle, as applied to yellow fever, has been brought into grave doubt by the growing conviction in the minds of the profession that the disease is not communicable by personal miasm. The English General Board of Health presented to Parliament, in 1852, a report on yellow fever, in which they deny, as nine in ten of the physicians now alive deny, the contagiousness of the disease, and thence conclude that "the means of protection from yellow fever are not quarantine regulations and sanitary cordons, but sanitary works and operations, and when these are impracticable, the temporary removal, as far as may be practicable, of the population from the infected localities." Unquestionably, the grading, paving, and sewering of streets throughout an exposed city, filling sunken streets and lots with pure earth, cleanliness in streets, lots, docks, and dwellings, are among the most efficient means of protection against epidemic visitations. Unquestionably, removal from infected regions, when the disease has begun, has been the means of saving thousands

of lives, and is an imperative duty. Yet in this country, whatever may be true of the less ardent summer climate of England, these things are not all that is called for. Admit the doctrine of the domestic origin of the disease, and yet the whole ground is not covered. It is doubtless true that of the thirteen epidemics which have visited New York since 1790 (of the three or four previous ones no sufficient history is preserved), all but two have begun, and been most severe on the new-made grounds bordering on the East River, and in the vicinity of the offensive docks and sewers; and the sections newly made with the street filth and impure earth have been most severely punished for so gross a violation of the laws of health. Doubtless in its three visits to "the village" of Brooklyn (in 1804, 1809, and 1823), it selected the places where offensive decomposition most invited it. It may be true that in many of these instances, no valid suspicion existed that the fever was derived from a foreign source. Yet facts, almost numberless, remain to teach us that infected ships are full of danger. It is difficult to suppose that the little town of Passages would have suffered from yellow fever in 1823 if it had not been visited by the Spanish brig "from Havana." It can hardly be denied that the cases which occurred at Knowle's Landing, Connecticut, in 1796, are all to be referred, directly or indirectly, to the infection on board the brig Polly, from the West Indies. The same statement may be made regarding the cases which occurred at Middletown, Connecticut, in 1820,3 and their relations to the brig Sea-Island, also from the West Indies. "She lay opposite Middletown," says Dr. Beck, who was a decided non-contagionist, "and the fever followed. She lay opposite the factory, and the fever made its appearance here. She proceeded to Hartford, and there" occurred one case at least, which the presence of the vessel could alone explain. "It is true," adds Dr. Beck, "that all these cases cannot be traced directly. This, however, is immaterial. The fact that somehow or other the disease was connected with the presence of this vessel stares us too broadly in the face to admit of denial; and it shows beyond all controversy the propriety of those quarantine regulations, which by some are ridiculed, and by others are considered so unjust and oppressive." In these and many similar instances, the disease did not become epidemic. Since the establishment of the New

1 [Page 522.]

2 [Tully, Med. and Phys. Journ., vol. i. p. 153. 1

3 [Beck, Med. and Phys. Journ., vol. i. p. 158.]

QUARANTINE.

York quarantine, numbers of stevedores, lightermen, and others, who have visited infected ships, have sunk under the disease in seasons when no others have suffered.' The present summer (1856) has furnished numerous and striking instances of the danger of visiting such vessels; and when the history of the disease that still lingers (September 20th) at Fort Hamilton and Governor's Island is written, as well as of that which now seems to have died out at other places along the eastern shore of New York harbor, the historian will not forget to mention that this eastern shore has never till now been visited by this disease; and that now more than ever before the harbor is crowded with infected and suspected vessels; and, further, that before the affection showed epidemic tendencies the wind had blown for many days directly from the unhealthy vessels to the localities that have since become unhealthy (blowing on shore beds, garments, &c., rejected by these vessels), and at the same time that the city of New York, seven miles from the quarantine, has not shown a single evidence of local predisposition to the disease.

Whether merchandise and personal effects from infected vessels can retain the poison may be yet a debatable point, but the question is far from being settled in the negative. It will be difficult to persuade the physicians of New York that the disease did not, the present season, in repeated instances, follow in the track of lighters, transporting goods from quarantined vessels, even when they were six or seven miles distant from those vessels. But the admission of such a fact does not furnish support to the doctrine of contagion, as Dr. La Roche is disposed to admit. The agent that produces yellow fever, whether it be animal, vegetable, or gaseous, can as well be transported in bales of merchandise, beds, blankets, and trunks of wearing apparel, as if it were a personal effluvium, like the agent which produces smallpox; and as for the analogy it may establish, yellow fever has too many contending analogies with other disease to make one more or less of particular importIn this connection, a statement of Dr. Walters regarding

ance.

[Dr. Vaché, in his Letters on Yellow Fever, the Cholera, and Quarantine; Addressed to the Legislature of the State of New York, has summed up this account to the year 1851, in a way, it would seem, to convince the most sceptical that to abandon quarantine restraints against yellow fever, is to put a price on human life, and barter it for trade; or to sacrifice life and trade together to a temporary gain, and false theory.]

2 ["Yellow Fever," vol. ii. p. 515.]