" 1 ; s 9 5 1*1 BBSS LIBRARY OF CONGRESS. §\n\ ;?r;tjrig|i f tt + Slielf_.o^.ST' UNITED STATES OF AMERICA. y Yellow Fever, ey THOS. O. SUMMERS, M.D., Professor of Anatomy and Histology in the University of Nashville, and Vanderbilt University \ COPYRIGHTED. v,. 1879. ^ NASHVILLE, TENN.: WHEELER BROTHERS, i8 79 . (. TO THE MEMOR Y OF THOMAS WILLIAMS MENEES, M.D., Associate Demonstrator of Anatomy in the Vanderbilt University, and University of Nashville ; MARTIN CLARK BLACKMAN, M.D., AND ORLANDO DUFF BARTHOLOMEW, M.D.. My former Students and Co-laborers, WHO FELL IN THE GREAT EPIDEMIC OF 187 8, THESE RECORDS ARE TENDERLY DEDICATED PREFACE. TT is with a considerable degrse of diffidence that I offer to the Pro- -■■ fession a work upon a subject of such momentous consequences as Yellow Fever. And yet, I cannot but feel it my duty to set forth, as best I can, the experience which I so richly enjoyed during the Epidemic of 1878. I have endeavored to do this plainly, concisely, honestly, and I trust, humbly, for the consideration of those of my brethren whose lines may fall in the places of the pestilence. T. O. SUMMERS. Nashville, January 1, iS? and outward too, for that matter. Water and ice will cool it, and cool it effectually. The wet pack is a very rational line of treatment. I only saw it applied in one instance, and that successfully.. The fact is, we have all been too timrd in applying our philosophy of treatment. With what breathless anxiety -did we await the result of Dr. Choppin's sprinkling treatment with his patient in New Orleans, and not a man of us had the courage to carry it out, though I have yet the first one to meet who does not endorse it as rational. Water is the rem- edy in Yellow Fever. In regard to the diet of the patient as the fever pro- gresses, I know of nothing more grateful or harmless than good fresh buttermilk. It should be iced, and the patient may take it whenever he chooses. After the second day, unless the symptoms impera- tively demand interference, all medication should be stopped, — lemonade, buttermilk, and a little brandy, with frequent sponging, furnishing the best line of treatment. There will, however, be likely to arise obstinate constipation, which is best relieved by freshly prepared Citrate of Magnesia ; and, if that does not operate, an enema of castor oil and Castile soap should be resorted to. Whenever black vomit is threatened the creosote and morphia mixture should be promptly used, and in order to restore the tone of the stomach, and also to prevent 64 YELL OW FE VER. or check hemorrhage, I have found the folio win o- an ex- cellent formula: R Tinct. Cinchonae, > aa " Calumbae, J gi ss " Ferri Muriat., gj M. S. Teaspoonful every four hours. This is to be used where the retching is violent, or when hemorrhages are threatened ox occur. Along with this, pounded ice should be always kept by the bed- side, and the patient allowed to partake of it freely. If the pulse and the temperature should keep up not- withstanding the sponging and cold applications, Tinc- ture of Aconite may be used with caution, say begin- ning with three drops every half hour, and increasing it gradually according to circumstances, in the course of twelve hours, or until there is some marked impression made. Very great care is needed here, for, as we have said, it is much easier for us to bring down a pulse than to bring it up, and if the temperature remains the same, then everything which depresses the circulatory system is contraindicated, and stimulants should be at once re- sorted to. In regard to Calomel, I am free to say that my ex- perience is decidedly adverse to its use, except in very minute doses. During the pyrexia, when the liver and secretory apparatus generally was threatened with engorgement, I have seen - of a grain of Calomel administered every hour prove greatly beneficial, putting the whole alimentary canal under the stimulus of healthy bile, and, in fact, opening up generally the channels of the system. As an eliminator Iodide of Potassium frequently will TREATMENT AND PROPHYLAXIS. 65 favorably turn the tide of the disease, but great care must be observed with regard to the time aiad quantity of its administration. It should never be used when the stomach is irritable, and in larger doses than five grains, which may be repeated every half hour until the effects are observed. In regard to the various remedies that have been used for the first time in this fever during the late epidemic, I hcfye nothing to say, except one which was much vaun- ted as a diuretic. I speak of Jaborandi. Scarcely a paper failed to contain some recommendation of this remedy, but I have failed to see the slightest good effect from its use ; nor do I believe that its administration to this end is at all rational or scientific, for reasons already suggested. What I have already given covers the medication necessary in Yellow Fever. As far as possible the use of drugs should be avoided. Nursing — careful, anxious, incessant nursing — is the Hamlet of the play in Yellow Fever. Water, ice, lemonade, buttermilk and prudence, — these furnish the basis of therapeutic action in this disease. During convalescence the patient should be most care- fully watched, as he will most certainly act with impru- dence if allowed to do so. The diet should be very light — 4ov the most part broth. A dried herring — broiled on the coals — may be eaten daily ; in fact, I have known this little fish to quiet the stomach when black vomit was threatened, and nothing else-seemed of any avail. The idea was first suggested to me at sea, where, in most instances, I found it an effectual antidote to sea-sickness. Quinine may be used in tonic doses with good effect during convalescence. I know of no better tonic, how- ever, during the convalescent stage of Yellow Fever than Caswell, Hazard & Co.'s Ferro Phosphorated Elixir 66 YELL OW FE VER. of Calisaya. It is grateful, assimilable, and invigor- ating. If the patient is an habitual smoker, he may smoke moderately during convalescence, and it often appears to have a fine effect upon the nervous system. The use of ale or beer, when agreeable to the taste of the patient, may be entered upon early in convalescence. All oily or greasy substances should be avoided ; so also sugars of every sort. Particular attention must be paid to the temperature of the room. It should be kept equable and entirely free from draughts. The mind of the patient should, as far as possible, be kept quiet and free from anxiety, care, and excitement. PROPHYLAXIS. There are two standpoints from which to view this branch of our subject ; First, as to individuals ; Second, as to communities. As to the individual it might be expected that my ob- servations must be brief. It has for many years been supposed that one attack of Yellow Fever imparts to the system immunity from another. My venerable friend, Prof. Dowell, of Gal- veston, still strongly adheres to this belief. But, while I am ready to accept this as a fact in the history of the disease, as manifested in its former purity, I cannot but think that the experiences^ of the last epidemic go to show that malarial influences have so modified the mani- festation of the Yellow Fever poison, as to diminish in a large degree the protection afforded by previous inocu- lation. Very many persons died of Yellow Fever in 1878, who had come through violent attacks in 1873, and, in- TREATMENT AND PROPHYLAXIS. 67 deed, so marked was this fact, that the inhabitants ceased to. rely upon the immunity supposed formerly to be en- joyed by those who, during previous epidemics, had yielded to the poison. As to any protective agents, Iknow of none that may be used as specific prophylactics, and yet there are steps which may be taken, and which I shall enumerate, that may serve to strengthen the powers of resistance in the organism, or at least very much modify the attack if it should occur. The bowels should be kept regular, and if there is constitutional predisposition to constipation, they should be kept a little loose by the use of Seltzer Water, or some other mild saline laxative. Lager Beer should be used freely every day in quantities sufficient to act freely upon the kidneys. The diet should be light and nutri- tious, avoiding all heavy meats, pastry and sugars. Phosphate of Ammonia, and Hyposulphite of Soda (see Formula, page 59) should be taken once a day to pre- vent the development of microzymes in the blood. If this, however, becomes disagreeable to the stomach, it should be discontinued. The skin should be kept active all the time. For this purpose small portable vapor baths should be procured and used by one exposed to the infection every night before retiring, taking care to rub the person dry afterwards. Frequent ablutions are beneficial. The mind should be kept free from anxiety. No person who fears the fever should remain within range of its infection, if it is possible for him to get off. Likewise all recklessness should be avoided, and a per- fect equanimity diligently cultivated. Quinine, as an antiloimic agent, is utterly worthless, and, I believe, most positively harmful. No eruptions upon the skin should be checked. A gonorrheal flow should be allowed to take its course. 6S YELL OW FE VER. Venereal indulgence should be limited. It more than- all else puts the system in a proper trim for the fever. Flannel should be worn next the skin, and changed twice a week. Night air should be avoided as much as possible. The bed should be rolled in the middle of the room, and the whole house should be ventilated through the day and closed at night. Sulphur should be burned and powder exploded in every room at least once a day — better in the afternoon. Exercise should be taken daily, but it should be neither violent nor protracted. Exposure to the sun should be avoided as much as possible. Smoking, when in the sickroom, has been proven to be to some extent prophylactic. A certain amount of sleep is required — six hours at the very least — and there must be no extra exertion or overwork. This, I regard especially, as an important injunction, since those who remain during an epidemic, generally, in their efforts to serve others lose all thought of themselves, and sink with prostration in the midst of the excitement and enthusiasm which surrounds them. But the best of all prophylactics is to remove from the infected districts. This is not only expedient, but it is the bounden duty of every one who is not rendering actual service to the sick and needy. As to communities, the question of prophylaxis has two aspects — i7iter7ial and external protection. But little benefit seems to have been derived from the use of fires built along the streets. There were large quantities of sulphur consumed in Memphis. At night the very air was laden with the fumes, yet it did not appear to have any effect whatever in checking the rav- ages of the pestilence. It was, however, a source of comfort,* and of a certain degree of satisfaction to those who saw it, to know that efforts of some sort were being TREATMENT AND PROPHYLAXIS. 69 made to stay the hand of the destroyer, and especially upon the minds of the lower classes was this effect pro- duced. In the summer of 1877, at the meeting of the Amer- ican Association for the Advancement of Science, a paper was presented and read by Mrs. Ingram of Nashville, upon the destruction of germs in the air by concussion, illustrated by the killing of musquitoes in a room by the explosion of a small quantity of gunpowder. During the epidemic I received several letters from this lady urging the firing of cannon throughout the city. Others also favored the trial, but it was utterly as impracticable, as it was impossible, in times like those, to obtain gunners, and to carry out to any practical extent the application of the theory. I have no doubt, however, that it might prove of considerable value if it could be practically car- ried out. The disinfection of localities is a matter of time. It cannot be done after the epidemic has set in, and, in fact, Yellow Fever does not seem to like one place any better than another, and I have often thought that if there was any difference the most cleanly portions of the city suf- fered most the ravages of the fever ; and yet it cannot be denied that proper hygienic surroundings are in gen- eral better likely to place the systejn on a higher ground of resistance than the opposite condition. For the protection of communities visited by Yellow Fever, I know of no grander nor more successful scheme than that originated and carried out by Gen. Luke E. Wright and the late Charles G. Fisher, of the Citi- zens Relief Committee at Memphis. Several miles outside of the city a large camp was org&tized under military discipline. Col. Jno. Cameron was placed in charge. His gallant company, the Bluff City Greys, and a finely organized colored company un- 70 YELLO W FEVER. der command of Capt. J as. Glass, performed guard duty during the whole of the epidemic. Tents were forwarded by the Government, and nearly a thousand persons were at times accommodated in the camp. A regular Quar- termaster and Commissary Department was organized, and rations daily furnished. A hospital was erected, and all persons coming into camp with the fever in them, or on them, were sent thither, and attended by a regularly appointed surgeon — Dr. R. B. Nall, of Memphis. No person was allowed to enter or leave camp without a permit, and everything was furnished from the city by a special train leaving daily for the camp and returning. In this way the fever was kept from spreading, and the camp throughout the whole course of the epidemic enjoyed unusual health for that season of the year. This system of depopulation proved such a brilliant success that I have thought it worthy of special and de- tailed notice. It should be adoptee^ promptly at the very beginning of the epidemic, and martial law called in requisition if necessary to enforce its acceptance by the people. It is effectual, practicable, economical, and ex- pedient. And now as to the external aspect of prophylaxis as applied to communities. This brings us face to face with the questio vexata of Quarantine. In the Chapter on Etiology, I have already intimated that the idea of a general quarantine is utterly preposterous. In the first place, it proceeds upon a false basis of Etiology. I have shown that while Yellow Fever may have originally been an imported disease — an exotic — it is now no longer so. 'Just a v s some plants, which, when originally brought to our latitude required the pro- tection of hot-houses and tender nursing, but now grow wild in our woods; so has Yellow Fever become 'modi- fied by the changed external conditions to which for TREATMENT AND PROPHYLAXIS. 71 years it has been subjected, and adapted to its surround- ings by those immutable laws of assimilation and selec- tion which govern all life from the protozoa to the verte- brates ; and in this modified manifestation it is indigen- ous. But the advocates of quarantine triumphantly assert that some of the smaller towns along the lines of travel, where quarantine was rigidly enforced were not visited by the epidemic, and this is offered as a conclusive argu- ment in its favor. But this proves nothing ; for in the neighborhood of those towns were others where the quarantine was not enforced, and where not a single case of fever occurred, except what was imported. For example, the town of McKenzie, fairly interlaced by the channels of the epidemic, with free entry and exit, two main railroad trunks crossing it, and coming in every direction from the infected districts, and yet not a single case of indigenous fever. Can the supporters of the quarantine say whether the small towns which they cite enjoyed their immunity from natural causes or from the efficiency of quarantine ? I think not. And again, quarantine can never be perfect, and is therefore impracticable. It would require a cordon of ships from the Bay of Fundy to the Gulf of California, so close together as to touch each other, in order effect- ually to carry out to perfection the prophylaxis of quar- antine. One case is sufficient to infect a continent, and if a ship is out at sea with Yellow Fever aboard, my own experience is, that she will land somewhere despite all precautions and restrictions. It is therefore imprac- ticable. It is, besides, most lamentably destructive to com- merce, and damaging to all the interests of a country; besides in itself being a source of unlimited expense. I can, therefore, do nothing in any way to encourage 72 YELLOW FEVER. the establishment of a National Quarantine. The battle- ground is not here. We cannot keep from our shores that which has already become acclimated and indigenous to the interior of our land. We must recognize in this fearful malady an internecine foe, dangerous and deadly. It belongs to us to meet it within our borders, and I doubt not that the day will soon come when, as in those countries where Yellow Fever had its birth, it will no longer be the terror of our people, nor hang like a pall over all our social and commercial interests.