' ^ <^ ^ /^ n£K. M. D. Secretary Howard Associotion. I should not omit to mention in this connection that there were 2811 patients admitted for yellow fever into the New Orleans Charity Hospital. Nor should I omit to mention, injustice to the medical profession of this city, that 12,368 patients vere admitted into this institution and treated gratuitously during the year 1847. The able house surgeon, whose whole time and attention are occupied in the discharge of his onerous duties, is the only medical man that receives any compensation for the vast amount of professional service rendered at this large hospital. If the facts here stated reflect no credit upon the generous citizens of New Orleans, then is benevolence a vain illusion, and sordid selfishness the only feeling really worth cherishing. New Orleans is a very re- markable place in many respects, but perhaps there is nothing for which it more justly deserves to be distinguished than its active and untiring benevolence. When the stranger visits our city during the winter season, he cannot fail to be struck with the extraordinary display of industry and energ;- in business everywhere to be seen. If he would come ao^ain during the prevalence of an epidemic, when sickness and sorrow and death shed a gloom on all around, he could not fail to be struck with the contrast, yet he would discover something of the same indefatigable energy in the performance of the melancholy duties of humanity. The poor sufferer, without money, or friends or acquain- tances, remains desolate no longer than his cries for help can be heard. As soon as his affliction is ascertained, men and women whom he never Dr. Fenner on the Yellow Fever of New Orleans. 1S9 saw before, and upon whose kindness he has no other claim but that ot* simple hwnanity, seek him out wherever he may be, and supply him with food and medical aid : they also have him nursed day and night, until he either dies, or is set upon liis feet again and prepared to resume the duties ol life. How many victims have thus been snatched from the jaws of death — how much pain, destitution and anguish have thus been relieved is known to but few besides Him who imbued our hearts with more or less of benevolence and charity, and enabled us to enjoy " iAe luxury of doing good." It often happens that these kind offices are bestowed upon beings so degraded as to be incapable of gratitude ; but this does not stay the hand of charity or stifle the voice of consola- tion. I have concluded to republish, in this place, the following editorial remarks on the yellow fever of 1S47, which appeared in No. 4, vol. 4, of the New Orleans Medical and Surgical Journal. More mature re- flection has Koi caused me to alter any conclusion there expressed, as will be seen by the subsequent history of the epidemic. "YELLOW FEVER. "The late Epidemic was probably the most extensive that ever pre- vailed in this city. As to its severity and mortality there may be dif- ference of opinion. It is impossible to make a correct computation of the whole number of cases. Some have estimated it as high as twenty or twenty-jive thousand, but we are inclined to think either of these cal- culations above the truth. As to the mortality, the reports from the cemeteries, as well as they could be obtained by the Board of Health, only make out something upwards of 23:^00 from yellow fever ; but this is again thought by many to be fav short of the reality. It is much to be regretted that we cannot obtain greater precision in such important details. The fever raged as an epidemic about two months, and the greatest mortality from it was in September, when the number of deaths reported to the Board of Health, amounted to 1,044. During the pre- A'alence of yellow fever in this city, the most frightful and exaggerated reports circulated abroad, but this is nothing unusual. A careful collection of all the important facts connected Avith the rise, progress and decline of the late epidemic, would form an exceedingly interesting memoir, and we have it in contemplation to undertake the task, but it must necessarily require a good deal of time and labor. On the other hand, it would seem to be almost useless to write anything more on the subject of yellow fever. We really believe that the archives of the profession already contain every thing that need be said on the subject ; and yet the world is but little wiser in regard to it than it was half a century ago. Every debateable question which was then discussed, in relation to its cause, nature, propagation and treatment, still remains undecided ; and, with the exception of a single point {blaclc vo?nit), there seems to be as great a diversity of opinion at this moment, as at any previous period. We believe the physicians of New Orleans and Mo- bile have completely settled the point, that black vomit is a hemorrhage from the stomach ; but, doubtless, there are some who do not even admit this. Medical are very much like religious controversies : in either case, when men have formed and expressed opinions, they seem to shut 190 The Epidemic Yellow Fever of 1847. their eyes against all farther light, and hold on to them with like perti nacity. Then why write any thing more upon a subject that has been so fully and so ably discussed as yellow fever? It would certainly be vain to do so with a view to enlighten or change any who have formed and expressed opinions. But is it not our duty to transmit our observa- tions to those who are to come after us ? There is scarely any point on which some of us are not probably right, and many wrong. With oj'ails to a considerable extent in Dr. Porter's Hospital. There are about 350 in it and in Dr. Laub's, of the 1st infantry, and some 82 quarter-master's men. (Of course, the Doctor means, of all cases. F.) But it has not the malignancy I was led to expect it would present here. The most of the cases I have seen present more the appearance of re- mittent than of yellow fever ; and were it not for the brilliant and red appearance of the eye, and above all, the termination of the cases in black vomit, it would be thought, in the country, remittent fever. They either run their course with great rapidity, or improve. I have seen but few cases of the typhoid fever which was seen last summer in near- ly all of the patients suffering from it in the N. O. Charity Hospital, and in which it was almost universally fatal. The fever is very high for the first 24 or 36 hours ; remission then takes place, of variable degree and duration, and mounts up again, and again remits, until the 5th or 8th day, when the patient either throws up black vomit or is left in a state of great exhaustion, free from fever and convalesces slowly &c. ********** * * * « j)j.^ Dashiell states a case of yellow fever that occurred previous to his departure from Vera Cruz, of a man in good health who was getting shaved in a barber's shop, and who commenced at once to throw up the hlack vomit, expiring (as a matter of course) shortly af- terwards. This comprises the latest medical information I have receiv- ed from that portion of the army in the direction of Vera Cruz. Very Respectfully, CHARLES McCORMICK, Ass't. Surg. U. S. Army." About the 1st of July an arrangement was efTected by which all sick soldiers were taken to Dr. Luzenberg's private hospital, situated on the Pontchartrain railroad, about 2J miles from the centre of the city. At this beautiful and commodious establishment they enjoyed every com- fort and attention that could be desired. There was probably an aver- age of 500 sick soldiers at this hospital from July to December. As before stated, amongst the large number of disabled soldiers returned Dr. Fenner on the Yellow Fever of New Orleans. 197 from Mexico, there were very few cases of yellow fever. Dr. Luzen- berg's hospital consists of three extensive buildings on the same lot, but a little removed from each other. The grounds are spacious and ornamented with flourishing and beautiful shrubbury. The establish- ment is in the suburbs, and quite retired from the populous part of the city. During the prevalence of epidemics a considerable number of yellow fever patients are generally received into this institution, and this year they were confined to one of the buildings, (the centre.) At tRis hospital the sick and wounded soldiers were entertained during this sickly summer and autumn, without communicaiing or receiving yellow fever, so far as I have been able to ascertain. How could this have happened, if the disease were either contagious or infectious? These soldiers were mostly from the interior of the country — probably not one in a hundred of them had ever suffered or seen yellow fever. The vessels at this time plying between this city and Vera Cruz were chiefly engaged in the transportation of men, horses and provis- ions, and their place of landing was Lafayette; yet the epidemic was not declared there as soon as it was in this city.* So much for the effect of our intercourse with the pestiferous city of Vera Cruz. From the time that city succumbed to our victorious arms, predictions were rife that a severe epidemic would follow as a natural consequence. I am aware that the impression has gone abi'oad that our sickness last year was mainly attributable to this source ; but, from the best information I have been able to obtain in relation to it, I am compelled to think such a conclusion altogether unwarrantable. Sanatory condition of the City. — The city was, perhaps, never in a more filthy condition than it was throughout this year. Notwithstand- ing the admonitions of the Board of Health and the remarks on the con- dition of the streets offered by the editors of this Journal and the news- paper press, from time to time, our city authorities took no precautions against sickness. Even the customary very imperfect measures for cleaning the streets were more neglected than usual. New Orleans is notoriously a dirty place, but in 1847 it may be said to have luxuriated in filth. In the month of April, the river rose very high, and for a week or two, poured through the cross streets into the swamp in the rear of the city. At the highest stage of water, a crevasse occured opposite the city, in the little town of Algiers. A vast quantity of water escaped in that direction, before the crevasse was repaired. After this, stagnant water remained upon the Bingaman race-track until it disappeared by evaporation. Nothing more need be said about the hygienic condition of the city, as it was about as bad as it could be. Commencement of the Epidemic. — We had the customary diseases up to the month of June, such as intermittent, remittent and typhoid fevers, diarrhoea, dysentery, and besides, an extraordinary amount of typhus or ship fever. This latter disease prevailed chiefly amongst the * The distant reader should be informed that Lafayette adjoins New Orleans immediately above, and contains some 8 or 10,000 inhabitants. 198 The Epidemic Yellow Fever of 1847. European emigrants, an extraordinary number of whom came over this spring. During the months of April, May, and June, 641 cases of ship fever were admitted into the Charity Hospital alone. June is generally the healthiest month of the year in New Orleans. Our citizens enjoyed their customary exemption from sickness during this month, with the excep- tion of a mild influenza which prevailed to some extent immediately be- fore yellow fever made its appearance. As usual, the epedemic fevers gradually assumed a graver type, as the season advanced. Remittent bilious fever increased considerably in June, and soon after the 1st of July, was merged into yellow fever. Some of the severe cases of remittent fever resembled yellow fever so much that they would have unquestionably been pronounced such, if they had occurred a month later. Indeed, cases much less strongly marked than some of these, were pronounced yellow fever during the prevalence of the epidemic. But it is customary here not to call any thing originating here yelloio fever, early in the season, unless black vomit is seen, or has occurred. If the patient should have recently ar- rived from Vera Cruz or Havana, he will l)e pronounced yellow fever, no matter how light his symptoms. Let us now see how the disease began and when it was declared to be epidemic by the Board of Health, 'i'he term epidemic is used in this city as much to designate the amount of yellow fever, as anything else. Hence we sometimes hear people say — " we have a good many cases of yellow fever, Ijut it is not epidemic." Also the in- quiries — "have you any yellow fever? "Yes." "Is it epidemic? " No, or yes" — as the case may be. From such remarks it may also be inferred that yellow fever, in its early stages, does not always present such peculiar and decided symptoms as invariably distinguish the disease. So far as I could ascertain, the following is the first case of black vomit that occurred this season. The case was reported to me by Dr. A. Mercier. An Irish drayman, who said he had lived in New Orleans about five months — residence near St. Mary's Market, in the upper part of the city — whilst on a visit to a friend who resided on Adeline street, three squares back of the Charity Hospital, was attacked with fever on the 21st of June. He soon became so ill that his friend would not permit him to return home, but sent for Dr. Mercier. Dr. Mercier found him laboring under high fever, with the usual pains in the head, back &c., but as it \vas so early in the season, he did not suspect yellow fever — thought it only an attack of bilious remittent. He bled him copiously and continued to treat him, but the fever proved very obstinate, and about the 11th day began to look so much like yellow fever that he in- vited Dr. Landraux to see the case. Dr. Landraux concurred Avith Dr. Mercier that it was now a decided case of Yellow fever, with every prospect of death by black vomit. He continued to get worse — turned yellow — had hemorrhage from the gums — threw up black vomit for ten hours before death, and died on the 3d of July, the 14th day of illness. The following is a list of the first ten cases admitted into the Charity Hospital, made out by myself at the time of occur- Dr. Fenner 071 the Yclloic Fever of New Orleans. 199 rence ; or rather, this is an abstract from notes taken by myself and some of the attending physicians. The main object in view was to as- certain in what parts of the city they occurred and whether there was any connection between them. First cases of yellow fever at the Charily Hospital, in 1847. Case \st. — Wilhelm Renners, age 28 years — a seaman, native of Prussia — arrived here from Liverpool, about 5 years ago — has lived in New Orleans ever since, mostly in the Third Municipality or lower part of the city — worked on the levee loading and unloading vessels — went to Brazos Santiago and returned about 15 weeks since. Entered the hospital on the 5th July, had then been sick with tever six days. Commenced throwing up black vomit on the evening of the sixth and died on the 7th. An unquestionable case. Case 2d. — John Gooder, Englishman — age 19 years — a steamboat man — last from Halifax, Nova Scotia — in New Orleans 12 months. Entered the hospital on the 4th July, then sick 4 days — died with black vomit on the 8th. Unquestionable Case. Case 3d. — Christopher Muhl, a German — age 27 years — a cooper by trade — arrived in this city on the 12th April 1847 — had suffered from diarrhaea for a month before getting here. Lived in the lower part of the city. Has been admitted and discharged from the hospital on three different occasions on account of his bowel-complaint. Was admitted last on the 3d July, having fever, but complaining chiefly of diarrhcEa. Took astringent medicines, which stopped the diarrhoea and he became much worse — on the morning of the 8th commenced throwing up his food and drinks, and at 7 P. M. black vomit appeared — this continued until the 10th at 10 o'clock A. M., when he died. N. B. The postmortem examination of this case created some doubts as to its being genuine yellow fever. No black vomit was found in the stomach or intestines. The gastro-intestinal mucous membrane throughout was infiltrated with limpid serum — it was in a dropsical con- dition — that of the stomach was of a rose color — there was a slight abrasion near each of the orifices of the stomach, not larger than the finger nail, but no appearance of blood about them. There was about 2 quarts of clear serum in the peritoneal sack — lymphy deposits over the surface of the liver, spleen and heart. Adhesions between the heart and pericardium, also between the lungs and ribs. The liver and spleen were very dense, the latter enlarged. The kidneys were granul- ated ; the left greatly hypertrophied, the right atrophied. The blood coagulated readily. The body and eyes were very slightly yellow. Several experienced physicians who witnessed this examination con- cluded that the case was not yellow fever, but chronic gastro-enteritis terminating in hemorrhage, alias black vomit.. Case 4 of investigation, my friend Dr. Mag- ruder informed me that he had a patient laboring under a similar dis- ease, the Rev. Dr* Teavel, whom on the following day I was called to see. I found him laboring under incipient black vomit and in a sinking condition. He expired the next morning, after throwing up large quan- tities of this fluid. He had been for some time engaged in the duties of his station, in holding a protracted meeting, and had not been near the quarantine depot, steamboat landing, or visited any sick person for some weeks. His residence was in the centre of the square upon which the old uninhabited buildings in a decaying condition spoken of above were 222 The Epidemic Yellow Fever of 1847. located, and immediately north of an old theatre which had been a short time previously torn down and removed by order of the city authorities, disengaging large quantities of poisoned air which had been the pro- duct of fermentation for years, which no doubt was wafted by the south- ern breezes directly into his bed chamber and thus in part poisoned his system. Several other cases occurred upon the same square, simultane- ously with that of Dr. Teavel ; a Jewess, Henry Wirtz, and Mrs. Jane Porter, all of which terminated fatally; the first and last about the 5th day of the attack, the second lingered for several weeks, having relapsed. Not having been physician to the foregoing cases, I cannot give the history and treatment, but only mention them as being interesting in connection with the origin of the disease, not one of them having had any intercourse with steam boats, quarantine depot, or even been absent from the city for months previous, and up to this period no person sick of yellow fever had been permitted to enter our city. The attentive health officer strictly and faithfully discharged his duty. The fatal ten- dency of the disease produced great alarm and excitement amongst our citizens, many left their homes and fled for safety to the country. But in a few days the wind shifted to the north, and the fever assumed a milder type, which caused many of our citizens to return to their homes and resume their daily occupations. On the 19th of September I was summoned to visit Daniel Mont- gomery. I found him complaining of severe pain in the head, eyes high- ly injected, pain in the back and lumbar region, soreness of the flesh, constant aching and tired feeling in the extremities, great irritability of stomach, vomitting incessantly. TreaiinenL — V. S. § xx, pills of blue mass and comp. ext. colocynth, which were immediately rejected ; twelve leeches applied to the epi- gastrium, active enema ; ice to the head and hot mustard pediluvia every four hours. 10th — Patient still restless, stomach irritable ; enema had acted three times ; complained of violent pain in the eyes and forehead ; irritability of stomach still very distressing. Blister plaster 10 by 10 ordered to epigastrium, leeches to the temple, iced gum water for drink, mustard pediluvia ordered to be repeated. 11th — Irritability of stomach still continues ; distress insupportable ; throws up large quantities of mucus ; entire absence of. bile; blister had drawn well; remove cuticle and dress with niorph. and sulph. quinine. 12th — Patient passed comparatively a quiet night ; pulse 90 ; skin soft; morph. and quinine dressing continued. 13th — Black vomit ; appeared to be sinking ; ordered enemas of cam- phor grs. V and quin. sulph. grs. x, every four hours, in mucilage. This prescription arrested the vomiting, but as soon as the vomiting ceased, the patient complained of partial loss of vision and delirium. 14th — Pulse full and regular ; skin soft and moist ; tongue furred in the centre, with red edges ; hemorrhage from the nose and gums ; total loss of sight; cannot distinguish a bright sunshine from the darkness of a clouded night ; eyes had the appearance of being natural with the ex- ception of slight dilitation of pupils and an injected condition of the con- junctiva. Blisters ordered to the temples and nucha, suppuration of Hicks 07i the Yellow Fever of Vicksburg, Mississippi. 223 the blistered surface on the epigastrium encouraged by dressing with the unguentum resinosum, brandy toddy and arrow root. 15th — Pulse more feeble ; hemorrhage from the bowels ; subsultus. Camphor and sugar of lead enemas ordered every four hours ; brandy toddy and arrow root continued. From this time the patient continued to sink gradually from the ex- hausting hemorrhages from the nose, gums, bowels and urethra, until the 24th, when he expired, after having been sustained by the extraordinary means adopted after the appearance of black vomit — I am of opinion that the patient would have sunk on the 5th day of his attack had he not been sustained by the camphor enemas. I have never witnessed a recovery after the appearance of black vomit, except by the camphor treatment. On the 29th day of September, I was called to see Thomas McCon- Tiel, whose residence was on the same square as that of Dr. Teavel. I found him entirely delirious ; could not keep him in bed ; pulse 128, full and hard ; violent pain in the head and back; eyes highly injected; great restlessness ; aching feeling in the extremities ; universal sore- ness of the flesh. Ordered blood-letting 3 xxx. ^- massa hydr. comp. ext. colocynth. u a. "^ i., make 8 pills. Take four at once, four in three hours ; ice to the head ; hot mustard pediluvia. 30th — Pulse 100, skin soft, medicine had acted twice ; tongue red on the edges, furred in the centre ; pain in the back ; tired, aching feel- ing in the extremities. Ordered cups to the epigastrium ; warm mustard bath, mucilaginous drinks. Oct. 1st- — Patient spent a restless night ; suppression of urine ; epis- taxis; irritable stomach; rejects every thing taken. Ordered the fol- lowing enema. ^. spir. turpentine 3 ij, Tr. assafoet. 3 ij, mixed in § iv. mucilage; blister plaster to the epigastrium. 2d — Hemorrhage from gums and nose ; irritability of stomach sub- siding, slight passage of urine, enema had acted once ; patient restless; remove cuticle from blister ; dress with \ gr. sulph. morph. and grs. x of sulph. quinine, morning and evening. 3d — Hemorrhage from gums and nose very much increased ; con- siderable hemorrhage from blistered surface, so much so as to wet the patients bed with blood. Dress blister with 4 grains sulphate of iron, grs. X. sulph. quinine and ^gr. sulph. morph. 4th — Exceessive hemorrhage from the gums, nose and bladder, univer- sal yellowness of the skin, pulse small and frequent ; nearly suflbcated with the bleeding from the gums whilst sleeping ; bloody froth issues from the mouth ; friends suppose him to bodying. Blister dressed with sulph. quJn. and sulph. ferri.; ice to the head ; sinapisms to the ex- tremities. 5th— ^Slight improvement ; patient more rational ; slept calmly seve- ral hours ; hemorrhage still continues from nose and gums ; morph. and quinine dressing for blister with the ungentum resinosum ; this readily caused suppuration which invariably improves the gastric symptoms. The quinine and morphine dressings were continued until the 8th, when the patient was discharged cured and, as was generally the case, con- valescence was rapid. 224 The Epidemic Yellow Fever of 1847. Blood letting, cupping or leeching, mustard baths, enemas and thd endermic use of quinine and morphine in the advanced stage of yellow- fever, have proved more successful than any other course of treatment adopted by the pliysicians of this city, so far as the writers observations have extended. In fact, in all cases in which the stomach, the main citadel, has been taken possession of by disease, the endermic use of remedies is the principal reliance for a successful issue of the case, and deserves the consideration of the profession. Many patients have been hurried out of existence, by crowding an already irritated stomach with nauseous drafts. I have related the three cases above, to give some idea of the general character of the disease, but the greater number of the cases were of a much milder type. All cases were initiated with the same symptoms, differing in degree ; some would readily yield under the milder remedies, other cases would assume a more malignant or typhoid character. In the mild cases, there was an early appearance of a prickly heat eruption, which was a sure indication of a speedy con- valescence. This eruption never occui'red in the malignant or typhoid cases, but occasionally fine petechise, which I supposed to be an effort of nature to throw the eruption to the surface. But her powers being too feeble, she failed to accomplish her design. All cases of disease ran into the epidemic type. The yellow fever commenced at the close of the month of August. In the course often days it had become deci- dedly epidemic, prevailing to a very great extent. Nearly all of our citizens felt its influence, though the disease had become remarkably mild, not more than three per centum proving fatal. The disease subsided about the 25th of October, at which time we had a slight frost, though a few sporadic cases occurred until the 10th of November, when all nature was clothed in ice. Our city has been visited with epidemic yellow fever during the years 1841, '43 and '47. That of 1841 was of a most malignant typhoid character, one case out of every four proving fiital under the best treat- ment. The epidemic of 1843 was more limited, of decided inflammatory symptoms, and less fatal ; about one death in six. The epidemic of 1847 may be properly styled mild epidemic yellow fever, being remar- kably easily managed, and only about 25 deaths out of nearly 800 cases. In consequence of the mild character of the disease, many doubted whether it was yellow fever or not, and some difference of opinion ex- isted amongst the physicians, as was the case in 1841, until nearly 200 of our citizens had been taken to the burying ground. Nearly all of the cases that terminated fatally, closed with' black vomit, except those in Avhich excessive hemorrhages occurred. I have never wit- nessed black vomit in the endemical fevers of our vicinity, but have often met with miasmatic fevers of a heavy grade in which hemorrhages from the nose, gums and bowels were not unfrequent in the closing stage of the disease. From all the facts that we can gather from the history of yellow fever as it has heretofore prevailed in this city, we have not been able to trace a single instance in which it showed the least disposition to mani- fest a contagious character. In 1837, when the city of Natchez was laid waste by its devastating influence, numerous cases in every stage of the disease, from the initiary CARTvviaGiiT on the Yellow Fever of Natchez, Mississippi. 225 symptoms to the black vomit point, were landed from boats and ushered into crowded filthy boarding houses, with ten or a dozen in a room, and in not a single instance did a nurse or attendant become aifectcd with the fever, though many of those landed died with black vomit. Such was the case in 1839 — the writer attended numerous cases that were landed from boats from Natchez, our city being then crowded with pau- pers who were flying from disease and contagion as they supposed, as is usual in our southern cities when an epidemic breaks out ; but in no instance did he witness any disposition to contagion. In 1841 many citizens fled from Vicksburg when the epidemic was declared to exist. A large portion of them sickened at different points, and many died; Judge Anderson in Bolivar county. Dr. Wellcr and his son in Raymond, Messrs. Vail and Davenport in Clinton, all of whom had numerous attendants and in no instance did any of their friends or nurses sicken with the disease, notwithstanding they all died with black vomit, the ripe stage of contagion, if contagion could be. During the past season, in vain did the advocates of contagion look for a source of disease from importation. They asserted that Dr. Teavel had visited the quarantine depot and had thus taken or contracted the disease, and that Trynor did not have yellow fever because he did not die. But it was ascertained that Dr. Teavel had not been within a mile of the quarantine landing since its establishment. The evidence of local origin was so plain that the advocates of contagion became quiet, our city authorities suspended the quarantine regulations, com- merce resumed her sway, the resounding echo of the signal cannon re- lapsed into silence and steam boats were permitted to glide to our wharfs, all being satisfied that we were suffering the penalties of sanitory neg-- lect. Your friend, B. J. HICKS. Vicksburg, Mississippi, January 20th, 1848. IV. — On the Yellow Fever of Natchez, Miss., in 1847. By Samuel A. Caktwkight, M. D. De. Fennek, Dear Sir : — I have just returned from a three-month's tour to the North, for the benefit of my health and to pick up medical information, and I find among my letters one from you so tar back as the 17th of December last, which I now proceed to answer. In regard to your questions about yellow fever of last year, I have to inform you that we had in Natchez only a few sporadic cases. I was called to see Mr. Haffner, a German, from the Rhine, who had been living in this city for a year or two, and had always been healthy — a tailor by trade. He had not been out of town during the summer, nor any where among the sick. He resided in a low, con- fined place, and the back yard was very dirty. He died on the fourth or early on the fifth day, with genuine yellow fever, on the 2d. of Octo- ber. I saw another case which died on the 0th of November, on the third day. He was a stout Irishman — had not been out of town or any I •326 The Epidemic Yellow Fever of 1847. where to contract the disease. He lived in a close, confined room, and dirty, ill-ventilated back-yard ; his name was O'Rourke.. He lived in a different part of the town from Haffner, and a month or more oc- curred between the two cases. These were the only two cases I saw in town ; but some three or four other sporadic cases occurred. A German woman died in October of yellow fever, and my overseer, also a German, living on my plantation, G miles from Natchez, in La.,, went to see the woman with yellow fever when he was exposeti to the same local causes which gave it to her. Late in October last I visited New Orleans. On my return, Mr. Grejer, my overseer, I found had died, during my absence in N. Orleans, with yellow fever. Black vomit very copious and frequent. None of my negroes nor any of the per- sons who attended him took the disease ; nor did any of the persons living near O'Rourke and Haffner take it. The reason why so few had the disease, I attribute to the fact that most of our people are acclimated and are not susceptible to it. For instance, we had the lever in the epidemic form in 1837 and 1839, and ial844 we had a good many straggling cases. We have kad little or no ac- cession to our population since, and consequently no subjects for it. We have had what is called a quarantine, and may attribute our exemption since 1839, (1844 excepted,) to the quarantine. Those persons trace ^r pretend to trace the cause in 1844 to Woodville or your city, and not being able to trace the cause of last season to any foreign origin, they :doubt whether the cases above stated were yellovt^ fever. I tkink there is no doubt of it.* In fact, for the last twenty-five years, I have seen cases of yellow fever almost every year, originating, as I believe, here under some strong local or predisposing causes. In one of your questions, you ask if yellow fever disappears before frost ? I have known it to continue for some weeks after frost, when it begins late in the season — and quit before frost when it begins early. I have seen many cases after several frosts. The quarantine regu- lations were not rigidly enforced. People would land on the other side * In confirmation uf the testimony here given by Dr. Cartwright, in regard to the eifeets of quarantine at Natchez, I will add the followiBg memoranda^ kindly furnished me by Dr. James Young of Memphis, Tennessee, a talented and accomplished physician, who resided in Natchez in 1844. Tiiey are given in his own words. F. "Natchez, 30th September, 1844, Called to see Dr. Craig this evening at 7 p. m. The Doctor informed me he had been sick three days. October 1st. — He commenced throwing up black vomit at 6 o'clock, p. m. 2d — At 5 o'clock, a. m., threw up black vomit, again at 7 o'clock, and died at 10 o'clock, p. M. Dr. Craig was seen by Dr. Cartwright and Dr. Davis. fcsamuel. R. Hammitt, attacked with yellow fever 19th October, — sick five days. — Recovered. T. Cranch, attacked with yellow fever 28th October, — sick ten days. — Ke- covered. The three cases of yellow fever occurred in Natchez, when the city was generally healthy. Neither of the patients had been where the disease was prevailing, nor had either of them seen any individual laboring under the disease. J. Y." McCrAVEn on the Yellow Fever of Houston, Texas. 337 of the river and cross over in the Natcliez ferry boat, or below town or above the quarantine ground. One of the landing places was hu- morously called the upper quarantine. 5th and 6th Interrogatory. — I believe the yellow fever originates in Natchez. From 1825 to '35 we had no quarantine, and the yellow fever was imported into Natchez almost every year, but it never spread, and no one ever took it from the patients themselves. The boats some- times seemed to be infected. 9th Interrogatory. — "Has yellow fever prevailed at your place before?" Yes— epidemically in 1817, 1819, 1823, 1825, 1837, 1839. A few cases almost every year, and a great many cases in 1829 and 1844— but not epidemic. I have, in answer to your 10th question, seen a few cases of the ordinary fevers terminate in hemorrhage and black vomit,* without being, as I thought, yellow fever, properly so called. Yellow fever I take to be a disease separate and distinct from bilious fever. It gives a peculiar expression of countenance to the patient. It is I believe ari American disease. If contagious, it is not more so than the common bilious fevers. All fevers are more or less contagious, and all dis- eases for that matter, in one sense of the term, as they vitiate the atnlosphere. Very respectfully, your obedient servant, ' SAMUEL A. CARTWRIGHT. V. — On the Yellow Fever of Houston, Terns, in 1847. By WiLiiAM McCeaven, M. D. Houston, Texas, Jan, 12, 1848. Dear Sir : — I did not receive yours of the 10th ultimo, till about the 1st instant, and take pleasure in furnishing in reply such information as the data in my possession will permit. In answer to your first in- terrogatory : The first case of yellow fever occurred here on the 4th of October. A case of rather doubtful! character had occurred four days previous and was then on hand. As it excited a good deal of interest here, and, as I think, there can be little doubt that it was yellow fever, at least in the end, I will give some account of it. Mr. V. had been indisposed at Galveston for three or four days. Yellow fever was then prevailing at Galveston, though not admitted to be epidemic. He had two or three light fevers then, as he informed me, and took some pur- gatives and quinine, but most of the time was actively and laboriously- employed. He arrived here on the evening of 30th September. He had fever that night, but was up in the morning, and took dinner with * The fact here stated by Dr. Cartwright, is confirmed by Dr. Thomas Fearn, of Huntsville, Ala., and Mr. W. P. Hort, of this city, two distinguished physicians now retired from the practice. I obtained their testimony in recent interviews with these gentlemen. I myself have seen cases of bilious fever terminate in fatal hemorrhage from the mouth and bowels, though not black vomit, in Hinds Co. Miss. I might differ with Dr. Cartwright as to yellow fever being " a disease separate and distinct from bilious fever,"' — but will take aorae other occasion to argue the point. F. 29 228 The Epidemic Yellow Fever of 1847. some appetite. In the afternoon he was taken with rigors and violent pain in the head, back and extremities, attended with fever. In this condition I was called to prescribe for him. He was alarmed and rest- less — thought he had yellow fever and was apprehensive of the result. His pulse was a good deal accelerated, quick and compressible — his skin hot and dry — his eyes suffused and red, tongue moderately coated with whitish fur, and red on the tip and edges. The symptoms were strongly indicative of yellow fever. But the proceeding symptoms — the decided remissions which had evidently occurred — the time which had elapsed since fever first made its appearance, threw doubt on the case, and rendered a diagnosis uncertain. It was evident to me he was not in the 4th or 5th day of yellow fever. I enquired if his eyes had been previously inflamed. He told me they had been red and somewhat in- flamed, but had gotten well. I regarded the case as doubtful, but determined to treat it as yellow (ever. The fever continued with little abatement until the third day. The pains were mitigated, but not relieved entirely. On the 4th day, fever was almost gone, but I did not think him entirely free till the 6th. The skin and eyes were decidedly icterose. He was desponding and very nervous. Dozed a good deal and muttered in his sleep, which was light and interrupted. Often changed his position. For about 24 hours he appeared much improved. Tongue cleaned off" — had some appe- tite and read a newspaper. Skin moist and heat well diffused. His gums had been bleeding a little for a day or two. On the evening of the 4th he had an operation which showed appearances of blood. He rested tolerably well and had no further movement till next mor- ning, when his discharge consisted almost entirely of blood, but with- out any pain, except a little uneasy sensation just before a movement took place. The tongue became healthy in appearance. The ex- tremeties continued warm ; skin moist, and pulse very little above the natural standard, ranging from 80 to 90. In despite of all remedies the hemorrhage continued, and he died on the 10th, retaining his mental faculties till a few hours before his death. Indeed, for a day or two previous, his mind appeared less clouded than in the earlier stages of his illness. I was informed by one of his attendants, that just before he died he threw up black matter, which was probably black vomit ; but as I did not see it, and the attendant had never seen black vomit, I am unable to speak positively upon the subject, This was probably a case of yellow fever supervening on ordinary remittent, and was almost an exact counterpart of a case, the first which originated here in 1844. On the morning of the 5th Oct., I was called to see Mrs. W. She was taken the evening previous with chilliness, attended with fever and excruciating pains in the head, back and limbs. I saw her in this condition. There was but little redness in the eyes. In the evening she was better. She complained of ringing and exceedingly disagreeable feeling in her head, from the effects of quinine. Next morning she was free from fever, and continued so, notwithstanding the excitement and distress she passed through afterwards. This was a slight case, though the symptoms were severe at first. If it had McCraven on the Yellow Fever of Houston, Texas 229 occurred alone, I should not have regarded it as yellow fever. I have seen such however. Mr. T., her brother, was ill in the house at the same time ; he wastaken with the same symptoms on the morning of the 4th. Sick 24 hours when I saw him. His eyes were quite red ; pulse frequent, quick and compressible ; tongue fiery red on the edges and tip, partly coated and partly as though it had been scalded and the epithelium peeled off; restless and thirsty. His was a well-marked case of yellow fever of a bad type, and as his constitution was very delicate, I augured un- favoi-ably of its termination. It did not run a regular course however. Fever declined gradually, but did not leave him till the 6th day. His tongue at one time had been very dry and almost black, especially on the denuded portions, became moist and looked well. He had become very yellow— had some appetite and no thirst. He was cheerful, and I thought almost out of danger on the 10th. But that night he grew worse. I found him on the morning of the 11th, much to my surprise, with dry hot skin, great thirst and restlessness ; tongue again dry. He died on the evening of the twelfth, with all the characteristics of yellow fever, including black vomit, which occurred just before his death. Mr. W., of very feeble constitution and nervous temperament, was taken oh the evening of the Gth, two days after his wife, with severe symptoms. Fever abated on the 3d day. Got out of bed and lay on the sofa. Being a self-willed, obstinate man, with some very strange notions, he did just what he pleased. Amongst othef imprudences, he ate some very indifferent water-melon. On the 10th, he dressed him- self and went into the adjoining house, as his own family were all sick, and he wished to be quiet. On the 11th, he went to his store and re- mained til] evening. This was the Gth day from his attack. He re- turned home and spent a restless night. In the morning I found him in bed, perspiring freely ; surface warm, pulse about 60, and of pretty good strength. He appeared strange and very slow of comprehension. He gradually became more and more stupid — complained of nothing — had no fever, and extremities warm — drowsy — sleep troubled — mutter- ing — eyes half closed. He became unconscious towards evening and very restless, often attempting to get out of bed, and requiring consider- able force to restrain him. Skin and eyes yellow. He died on the night of the 13th, eighth from the attack — did not vomit after his re- lapse. Miss W., daughter, and Miss T., sister of Mrs W., were taken on the 7th with same symptoms, but of milder character. Miss W.'s fever lasted two or three days, and left her languid and listless for several days. Her eyes were very yellow ; her skin of a dusky reddish hue, as though the superficial capillaries were congested — a circumstance which I have frequently observed in yellow fever. And hence, proba- bly, arises the great danger of exposing convalescents to a draught of cool air before the system has had time to recover from the shock. The power of generating heat is so feeble that the system will cool down under the influence of a current of cool air, almost like an inani- mate substance. I came near losing a patient under such circumstances in 1844. All symptoms of the disease had disappeared. He was lying between two windows and had fallen asleep without cover. He was 830 The Epidemic Yellow Fever of 1847. almost as cold as a corpse and nearly pulseless, yet seemed unconscious that anything was wrong. It took an hour or two of the most active stimulation external end internal to rouse him. No serious incon- venience seemed to follow. But to return to my subject. Miss T. had ▼ery little fever after the first day, and indeed not much then, but like all the rest, was chilly and had intense pain in the head. She insisted for a day or two that nothing else was the matter. For several days her stomach was very irritable, and most that she threw up was of a grass green color. She and Miss W. both recovered, but were much debilitated for several days. Had Miss T's case occurred alone, I should not have regarded it as yellow fever ; but occurring as it did with four others, ail at the same time, in fact every member of the family was down at once, I could not but consider it of the same character with the rest. She was not much jaundiced. A young man who had been boarding in the family was taken about the same time — said to be yel- low fever. I did not see him. They were all unacclimated. On the 20th and 22d, two cases occurced in (he adjoining house— r^ fever with rigors at the commencement ; violent pain in the head, back and limbs ; red watery eyes ; fever abating on the third day, with much debility ; skin and eyes yellow — in fact, regular cases of yellovy fever throughout. Both recovered. These are fair samples of the cases as they came under my notice. They were not numerous at any time in my practice. It could not, I think, at any time be fairly re- garded as an epidemic, and the best evidence of this fact I think was, that our ordinary fevers prevailed at the same time and greatly pre- dominated over the yellow fever cases. This was not the case in 1844. In August of that year, I scarcely met with a case of fever that did not distinctly present the features of the epidemic. From about the time of the last mentioned cases till the middle of November, a good many scattering cases were reported. Quite a number of Germans, recently arrived and settled around the suburbs of the town, died. What pro- portion had yellow fever I do not know, as they were mostly attended by German physicians, who I think did not regard the cases as yellow fever ; but whether they were familiar with the disease or not, I am unable to say ;- — can only speak of two cases which I was requested by some charitable ladies to visit, as the family had not much confi- dence in the attending physician. I was at the time informed that one of the patients was throwing up black vomit, and it was not expected that anything could be done for him, but something it was hoped might be done for the other case. When I called one was just dead, and while I remained, the other threw up black vomit and died next day. I was informed that the other had vomited matter of precisely the same appearance, and from the signs which I saw, I have no doubt it also was black vomit. The attending physician, I believe, though I had no conference with him, called the cases congestive fever, at least I so understood from the father, an intelligent German, who could speak a little English. From these cases I supposed that pro- bably a good many of the Germans had died of yellow fever ; but this is only a supposition. The cases among the American part of our population were not numerous, but the deaths in proportion were con- siderably greater than in 1844. I saw one case, a black, on the 1st McCraven on the Yellow Fever of Houston, Texas. 'iSl of December, which bore a strong resemblance to yellow fever. I would observe here, that some authors, I believe, deny that the blacks are subject to the epidemic, which is undoubtedly a mistake. They were subject to it here both in 1839 and 1844. I attended a number the latter season, as well-marked cases as any I saw. The disease, however, according to my observation is seldom fatal with them. The prevailing disease at the time that yellow fever made its appearance, was ordinary remittent or bilious fever, which, as I before observed, continued to prevail throughout the season. Dysentery had been more than usually prevalent for the last year. In the preceding winter, typhoid fneumonia prevailed and proved fatal in a good many cases, especially among the blacks. During the past twelve months I have had some six or eight cases of typhoid fever, the first I have met with in Texas : all in children under 12 years. They continued from 15 to 30 days. All but one recovered. In the early part of sum- mer, also, we had a remarkably large number of cases ui jaundice, of which I suffered myself, much to my surprise, as 1 was at the time of my attack in perfect health, not having been confined to bed a day since I had yellow fever here in 1639. It has appeared to me that for some years all our diseases were becoming more and more ataxic. I seldom meet with cases in which the lancet or any other mode of depletion can be judiciously employed to any great extent. Mercury, too, perhaps for the same reason, I find a very doubtful remedy in fevers. In fact, I seldom now employ it in fever, except in combination with mild purgatives, given occasionally in small quantity. I have already answered your 1st and ;5d questions. 2d. The town was in a tolerably cleanly condition. It js situated on the border of a flat prairie, and although there is no marsh in its im- mediate vicinity, the prairie is so level, that with the exception of that portion of the town near the bayou, it drains slowly. It is, however, much better drained now than tbrmerly ; and the soil is of such a na- ture, that when well drained, it dries rapidly. Our prevailing winds blow over the open prairie about a mile before reaching town. On the north of the town, the country is timbered for three or four miles, and our north winds are always regarded as unfavorable to invalids, par- ticularly in the fall season. If not attended with rain, they are remark- ably dry , and in summer hot. 4th. We have never had any quarantine establishment. 5th. The question whether yellow fever is of foreign or domestic origin, is one on which I have never been able to satisfy myself fully. I am not a partizan of any particular theory on the subject, but have diligently sought for facts on which to base an opinion. I was until last year strongly inclined to the belief, that with us it was always of foreign origin. In 1839 I was here, but not professionally engaged. I had the disease about the 22d ol October. It prevailed then in a ma- lignant form. It commenced, I think, about the 1st of September and continued till near the last of November. Our population was then probably less than 3000, and \ think there could not have been less than 200 victims to the epidemic. The town was then in a remarkably filthy condition. It was crowded with persons out of employment and (^eptitute of means, many of them intemperate. When taken with the 23 '2 The Epidemic Yellow Fever of 1847. fever, they had neither the necessary comforts nor the means to procure them, and sickness was so general that it was exceedingly difficult for a stranger to get proper attention even if he had money. It is not sur- prising that many died. I cannot speak positively respecting the first cases which occurred then, but think they came from New Orleans. Such I know was the impression on my mind at the time, but 1 caimot now recall the grounds on which it was based. This was the first appearance of yellow tever in our town, and it prevailed very generally, as but few of our citizens had had the disease, and most of those who had not, were attacked. It did not disappear till long after frost. Frost always I think operates as a check upon yellow fever, but if warm weather sets in atterwards and continues long, the epidemic will revive again and may be as bad as ever. A good frost I believe destroys the cause. The second appearance of yellow fever in this place, was in July, 1844, and of this epidemic I can speak with confidence, as I was actively engaged professionally through the whole of it, and several, of the first cases were under my charge. The first case arrived from Galveston, on the 10th of July, I think, and placed himself under my charge — he was then in the third or fourth day of his attack, without fever, but very nervous and greatly debilitated. He continued so for several days and recovered. I had three or four other cases under similar circumstances — -all having taken the disease in Galveston and come up in the boat. About the last of July I had a case which occurred in town and ran a course precisely parallel to that of Mr. W. cited above, and terminated in hemorrhage and death. In this case yellow fever seemed to supervene on another disease. About this time I saw a case of black vomit incidentally, but as the patient was not under my care, I do not know its history. About the 1st of August cases began to appear frequent, and in a few days the epidemic be- came general and spread rapidly through town, the cases from Gal- veston appearing to act as foci of infection. By the 1st of September it had nearly exhausted itself in the densely populated portions of town, but lingered about the outskirts for another month and disap- peared long before frost. The latter part of the fall was healthy. During its prevalence, scarcely any other form of disease manifested itr self Few unacclimated persons escaped, and none to my knowledge (and I made diligent enquiry) had the epidemic who had suffered a pre- vious attack. The epidemic was comparatively mild, and the proportion of deaths small, though it presented a malignant aspect at Galveston. The fever ran from one to three days, and although it left the sufferers "weak and exhausted, convalescence v/as generally rapid and complete in a few days. Black vomit was not a very common symptom even in fatal cases. Death I believe seldom ensued before the sixth or seventh day. The town was in a much better condition than in 1839, but worse drained and less cleanly than at present ; and there is still great room for improvement. As to the origin of the fever here the last season, all the facts seenj to point directly to a domestic origin. I could trace no connection Jjetween the family of W. and any other case of yellow fever. Mr, v., it is true, had been sick four days when the two first cases of ye]