ANALYSIS 
OF THE RECORD OF 
YELLOWFEVE[[IN NEWOi|LEAt(S, 
IN 1876. 
BY JOSEPH HOLT, M. D„ 
Sanitary Inspector for the Fourth District, New Orleans. 
From the New Orleans Medical and Surgical Journal, January, 1877, 
Seymour & Stevens, print, 96 and 98 Common at. O, ANALYSIS 
OF TIEailE RECORD OF 
YELLOWFEVEp p OpAt(S, 
IN 1876. 
A PAPER READ BEFORE THE NEW ORLEANS MEDICAL AND SURGICAL ASSOCIATION, 
SATURDAY EVENING, NOVEMBER llTH. 1876. 
JOSEPH HOLT, M.D., 
Mr. President and Gentlemen: It 1ms been my official duty, 
as Sauitary Inspector, to prepare for the Board of Health a 
special report concerning the recent outbreak of yellow fever in 
the Fourth District of this city. In the performance of this task, 
nothing has been attempted beyond the recording of cases and 
of relative events. The report is simply a statement of facts as 
they occurred, without comment. Nothing has been incorpo- 
rated without the evidence of its truth having been critically 
examined. 
The only incentive to the performance of this work has been 
the hope of accumulating a mass of reliable data, whence pos- 
sibly may be drawn some conclusions of practical value; or that 
this, with other records of its kind, may ultimately furnish the 
basis for generalizations improving to our knowledge of this pes- 
tilence, and giving precision to our methods of dealing with it. 
Being the record of seventy-four cases, to each of which is 
appended a summary of symptoms determining diagnosis, the 
report itself is too voluminous to be presented for our considera- 
tion this evening. In its stead, I respectfully submit the follow- 
ing analysis and resume, adding a few general remarks sug- 
gested by observation and reflection. 
Sanitary Inspector for the Fourth District, New Orleans. 2 
ORIGIN OF THE PESTILENCE. 
Permit me to direct your attention to the probable local origin 
of the disease in two foci. 
The first case occurred, August 11th, on Tchoupitoulas street, 
lake side, between First and Second streets. The patient was a 
German servant girl, who had been in New Orleaus eighteen 
mouths. On the second day of her illness she was removed to 
No 24 Eighth street, between Tchoupitoulas and Fulton, where 
she died on the 18th inst. Careful and repeated investigation 
by the President of the Board of Health, by the sanitary officers 
and myself, failed to discover the slightest clue to foreign infec- 
tion from any ship, person or material. This applies with equal 
force to the following series of cases. 
The next case occurred at No. 125| Philip street, corner of 
Annunciation, in a child seven years of age, and resident in New 
Orleans 3 years. 
Besides the difference of twenty-three days in the appearance 
of these cases, there had been no communication, and between 
them were five squares, measured diagonally. These squares 
were compactly built, and many of the inhabitants were ascer- 
tained to be wholly unacclimated. It is not likely, therefore, 
that the disease could have spread from the first to the second 
case without infecting others on its way. It is more reasonable 
to believe that the causes of infection in the first case operated 
independently to produce it in the second. 
SPREAD OF THE DISEASE FROM ITS SECOND FOCUS. 
The.next point of interest to be observed is, the rapid appear- 
ance of cases in,the second focus of infection and the extension 
of the disease. 
From September 3d to September 7th, inclusive, five cases 
occurred—three of them on the 5th, and all within a radius of 
two hundred feet. In this immediate neighborhood the disease 
spread with great rapidity. Many of the cases occurring about 
this time were suspected, but recovering, were not pronounced 
yellow fever, because of their lacking some of the unquestionable 
diagnostic features found oidy in cases usually fatal. 
It was not until the 13th of the month that we had alarming- 
evidence of the epidemic tendency of the disease, shown in its 3 
advance towards the heart of the city. By this time it had 
passed Constance street, and appeared in St. Joseph’s Asylum. 
The invasion was west and northwest, directly in the face of 
a strong and constantly prevailing northwest wind. This seems 
to strengthen the observations in respect to the method of pro- 
pagation, set forth in a paper on the origin, spread, aud the 
power of controlling the yellow fever infection, read before this 
Association by Dr. C. B. White: ’‘Reasoning from the method 
and range of action, and mode of propogation of yellow fever, 
its poisonous cause is evidently not gaseous in its nature. It 
evidently attaches itself to surfaces, the soil, probably to walls 
and surfaces in general. If it be a germ, either vegetable or 
animal, it seems to be low-lying, propagating from centres along 
surfaces equally in all directions, against the wind as freely as 
with air currents.” 
Within a period of eighteen days from the 3d of September, it 
had spread over an area of thirty-nine squares, densely inhabited. 
This area was bounded by Magazine street and the river front, 
St. Andrew and Second streets. Of the seventy-four cases re- 
corded, sixty were within these limits. Those who were stricken 
elsewhere in the Fourth District had been much exposed within 
this area. This rule prevailed, with three exceptions only, to 
the end of the season. 
CHARACTER OR TYPE OF THE DISEASE. 
As a matter for investigation, it lias been suggested that yel- 
low fever of local origin is apt to assume a type more in keep- 
ing with our ordinary indigenous fevers, and is therefore 
milder or in some other way differs from the infection imported 
directly from tropical ports. However natural this suggestion, 
it has never been my good fortune to discover a manifest differ- 
ence in type between different invasions of yellow fever; at least, 
in no such degree as to permit the term malignant as if iu con- 
tradistinction to a non-malignant variety. The word malignant 
is painfully applicable to all the yellow fever I have ever seen; 
having been associated with the disease to observe it since 1853. 
The sameness of the disease at different times and in different 
places, accepting the testimony of others, has impressed itself 
upon me. While admitting that, under aggravating circum- 
stances there may exist an exceptional intensity of virulence, 4 
I object to any expression implying, even by inference, its non- 
malignancy. All yellow fever is dangerous, and should be 
feared; the most favorable case may eventuate fatally. As for 
this recent visitation, when recording the eighteenth case I also 
recorded the thirteenth death, and out of seventy-four cases, 
thirty-five were fatal. The most of those who recovered mani- 
fested dangerous symptoms, many of them escaping so narrowly 
as to occasion special wonder. 
After the labors of the medical profession, m this city and 
elsewhere, during the last sixty years, this rate ot mortality 
would seem to indicate how little is to be hoped from an improved 
treatment of those attacked. It would seem to show that, in 
this particular we have made no step in the general advance- 
ment of applied medical science. 
Even granting that all practitioners possess a consummate 
skill in the treatment of yellow fever, there are so many requisites 
to recovery other than the administration of drugs, (frequently 
the most hazardous and least important of all) such as skillful 
and constant nursing, the avoidance of every imprudence in 
exposure and dieting, a favorable state of the weather, no dan- 
gerous and unaccountable change in the symptoms demanding 
instant attention, that when many are attacked, these require- 
ments cannot be complied with, and therefore failure must often 
result. 
No amount of medical skill can neutralize the mischievous 
effects of poverty and ignorance in determining the death-rate 
ot‘ this disease. The larger the number of cases, the more 
lorcibly does this apply. 
The history of yellow fever teaches that the mortality is great, 
even under the most favorable circumstances. This would seem 
to indicate a necessity of turning our attention from the vain 
endeavor to combat the disease by an improved treatment of 
the sick, to the other alternative, its actual prevention. 
THE PERIODS OE ACCESSION, ACME AND DECLINE OF THE RE- 
CENT INVASION. 
From the time ot its appearance, on the 3d of September, to 
the last case on the record, October 13th, the visitation continued 
forty days. 5 
It reached its heighth in twenty days, continued, without 
spreading, fifteen days, and declined in five days. 
METEOROLOGICAL RECORD. 
When the infection was developed in the first case, August 
11th, the mean temperature was 77° F.; weather very dry; 
wind south When developed in its second focus, September 
3d, the mean temperature was 80° F. Eight days later it began 
t'o fall, and on the 17th had ’declined to F.; it then rose 
steadily to 77.5° on the 20th. On the 28th it declined to 72° 
F.; and continued falling until it touched its lowest point, 58°, 
ou the 3d of October. From this time to the 13th, it varied 
between G2° and 68° F The weather continued excessively dry, 
and high winds prevailed from the north and northwest. 
It is interesting to compare with this the meteorological re- 
cords of some of the famous yellow fever epidemics—the epidemic 
of Memphis in 1873, for example. 
The first case appeared on the 14th of September; diurnal 
mean temperature 59.5° F. The temperature gradually rose to 
7C.5° on the 18th inst., and fell the next day to 02.5°, and the 
following day to 58° F. It again rose until it reached its highest 
point, 77°, on the 2Gth, aud fell to 58.5° on the 30th of the mouth. 
While the epidemic was rapidly spreading, and had not reached 
its height, the mean temperature fell as low as 49.5~, October 
6th. It rose gradually to 72.33° on the 16th inst., and declined 
to 48.33° on the 20th inst., and to 38.5° on the 23d inst. 
Frost during the nights of October 6th, 7th and 31st. 
The pestilence terminated November 9th, having lasted fifty- 
six days. Mortality 1244. The weather prevailing, very dry. 
This is not an exceptional instance in the meteorological re- 
cord of yellow fever epidemics in the United States. 
Although a long continued high range of temperature is 
required to originate the infection, when once started it seems 
to extend itself without being especially influenced by a temper- 
ature varying between 55° aud 80° F. 
It is the popular belief, endorsed by some of our closest 
observers, that no decline short of a decided frost will abruptly 
terminate an epidemic. Besides the one just mentioned, many 
of the epidemics which have prevailed in Woodville, Natchez, 
Vicksburg, New Orleans, and elsewhere, confirm this opiuiou. The power of cold in checking yellow fever is to be looked for 
in its retarding effect upon decomposition, rather than to its 
immediate killing of hypothetic germs. The rapid decomposition 
of organic matter, especially such as is found in privies and 
sewers, is undoubtedly an essential factor in the origin, and 
furnishes the pabulum for the extension, of the yellow fever in- 
fection. To appreciate this is of far more importance than to 
project theories concerning its essential nature. With this we 
can deal practically, whether the infection be a living germ, or a 
catalytic state induced in the products of decomposition by the 
combined action of heat with unknown telluric agents. 
Rain storms and hurricanes have been said to cut short an 
epidemic. Although unable to cite an instance in this country, 
I can clearly comprehend the effect, seeing that one heavy fall 
of rain may accomplish the work of a thousand scavenger carts. 
We may say that nature is sometimes doubly merciful: in one 
instance she prevents decomposition by cold; in another by 
removing our filth. But oftener she is just; and with pestilential 
stripes compels us to know her laws, when we disobey them. In 
her schooling we pay dearly for ignorance and sloth. 
Many epidemics have commenced and have prevailed during 
dry weather. 
The recent invasion was originated at a time when the soil 
was parched by a long drought, and vegetation was suffering 
for rain; the roads were deep in dust, and every gust of wind 
raised clouds of it. Commencing in a drought, increasing and 
running its course during a drought, it is hardly reasonable to 
suppose that dry weather exercised any influence upon the 
infection to destroy it. 
EFFORTS OF THE BOARD OF HEALTH TO CONTROL THE DISEASE 
BY THE LIMITATION AND ACTUAL DESTRUCTION OF ITS CAUSE. 
DISINFECTION. 
In case 1, the disinfection with carbolic acid was pushed vigor- 
ously and made complete. On the square where this patient fell 
ill, all of the premises were thoroughly sprinkled with Calvert’s 
acid, No. 5, diluted, one part with fifty of water. 
To be explicit, the yard, avoiding dowers and shrubbery, a 
space under the edges of all raised houses, the walks, drains, and 
privy vault of each residence, were made thoroughly wet with 7 
the solution, and a continuous line of it formed around the entire 
premises. The streets bounding this square were sprinkled with 
crude carbolic acid, one barrel being used. The premises of the 
square on which she died, and of the square opposite were in 
like manner treated with the pure acid solution, and the boun- 
dary streets with two barrels of the crude acid. This case 
remained isolated, no other occurring on the infected or adjoin- 
ing squares. Cases 2, 3, 4, and 5, in the second locus of infec- 
tion, appearing eighteen and twenty days later, were not disin- 
fected. 
These became the recognized center of the epidemic which has 
furnished the cases for this record. From this focus the disease 
spread, and in eighteen days had invaded thirty-nine squares, 
besides scattering cases beyond these limits. 
A general disinfection was commenced on the night of Sep- 
tember 22d. Until this time, all efforts had been limited to the 
disinfection of the houses and premises of those who died. On 
the night of the 22d, a quadruple cordon of the pure acid solu- 
tion, one part acid to forty of water, was thrown around the 
infected area, by a thorough sprinkling of the boundary streets 
and banquettes, a line for each side the street; and in the same 
way, of the next inner line of boundary streets. The object of 
this was to put a stop to the march of the pestilence by forming 
around the infected locality a barrier. To accomplish this 
required 235 gallons of the pure acid. 
On the night of the 23d, the sixteen streets of the infected 
area were similarly disinfected. From this date, the daily occu- 
pation of the sanitary force consisted in disinfecting the premises 
of squares within this area. To complete five squares was a 
day’s work. Whenever a case occurred outside these limits, the 
premises of the square and of the one opposite, together with 
the boundary streets, were disinfected. Every precaution 
was taken to avoid bringing the acid in such proximity to the 
patient as might do harm. For this reason the premises of the 
sick, and those adjoining, one on each side, were not touched. 
A special cordon of the pure solution was made around these. 
On the night of the 28th, beginning at ten o’clock, the sprink- 
ling carts were filled with the crude carbolic acid undiluted. 
They were then driven through a double line of boundary 
streets of the infected area, in the manner already described for 8 
the night of the 22d. The following night, a single line of the 
same was extended through the sixteen intersecting streets. 
This was done as a precautionary measure, inasmuch as a 
prevailing strong wind, together with a burning heat of sun, 
had been acting to dissipate the volatile combination of cresylic 
and carbolic acids, here spoheu of as pure acid, distributed on the 
nights of the 22d and 23d. The crude acid was used in order to 
retain these more volatile constituents by reason cf their com- 
bination with tar and the heavier coal tar products. These are 
no doubt of themselves powerfully disinfectant. For the work 
of these two nights twenty barrels of crude acid were used. 
Great stress was laid upon the assumed limiting power of the 
disinfectant. The area infected was so immense as not to per- 
mit of an actual and complete disinfection of its entire surface 
with any amount less than an unlimited supply of the acid. To 
disinfect all houses and premises was utterly impossible. The 
most that could be hoped in this direction was to apply the 
agent, although at best in an imperfect and unsatisfactory man- 
ner, to as many premises as we were able. 
Our main effort and supply were expended upon hedging in the 
pestilence by carbolizing the streets and gutters—just as would 
be done, in its own proper way, in the case of a great fire. 
Except where some one had died, not a private house and 
only two-thirds of the premises were disinfected—many not 
touched, except the privies. It was clearly foreseen, therefore, 
that even after our best efforts cases would continue to occur in 
this locality. 
From the beginning, it was an established rule to pay par- 
ticular attention to the thorough carbolizing of privies. Even 
in cases where admittance to premises was otherwise refused, 
this much was insisted on; second to this, the carbolizing of 
street gutters. 
It has been shown by our writers, that yellow fever in its 
origin is essentially a disease of large towns and cities. There 
must exist, then, as a result of the congregation of large num- 
bers of human beings, some special conditions of sanitary dis- 
obedience which, in combination with other requisite factors, 
not all of them recognizable, favor the appearance and spread 
of the pestilence. There is no sanitary violation so prominent 
in all large communities as the accumulation in foul privies of 9 
the excrement of all these beings; the whole soil becomes satu- 
rated with their excreta. 
In reply to the question why yellow fever originates in large 
towns and cities, we are supported by abundant testimony in 
declaring as one of the factors absolutely essential, accumulated 
human excreta and the offal in foul street gutters; and in 
further declaring that, without these it would not originate, and 
would not spread when imported. 
Allow an explanation. In speaking of foul accumulations in- 
cident to communities as furnishing one of the factors in the 
primary development of yellow fever, and also the pabulum of 
its growth or medium of its spread, we neither affirm nor deny 
the specific character of the materies morbi. The weight of evi- 
dence determines the opinion that it is specific, highly infectious, 
and contagious in comparatively slight degree. 
The word factor is here used in the sense in which we would 
apply it in speaking of a marsh or swamp as being a factor in 
the production of mosquitoes. So well do we understand the 
requisites in the development of these insects, such as long con- 
tinued high temperature, and open stagnant water, especially in 
marshy places, that we predict their appearance when perceiving 
the association of these conditions. Again, accepting the theory 
of a specific catalysis, the term jactor is applied to decomposing 
organic matter and its emanations, as we speak of the dry grass 
covering a prairie furnishing one of the essential elements in 
the production of a conflagration. We may regard the fire as 
the specific catalytic agent, usually imported, but which may be 
originated under certain combinations of circumstances in this 
special prairie. Once started, it spreads so long as it finds mate- 
rial suited for its proper action. But at any time, even in its 
fiercest spread, remove a single factor, the grass for example, or 
change its condition by making it wet, and at once the fire 
ceases. Regarded from a hygienic point of view, yellow fever 
then is a result of sanitary negligence, not a universal conse- 
quence, and, for reasons unknown, limited geographically. 
Sanitary negligence in India is punished with cholera; in the 
Orient, with plague and leprosy, in Europe, the British Islands 
and the northern United States, with typhus, typhoid, diphthe- 
ria and scarlatina, in their malignant and epidemic forms; and 
in the West Indies, in the tropical and semi-tropical Americas, 
with yellow fever. 10 
For disobedience of sanitary law, these are among the prices 
paid by the human race, acording to its distribution upon the 
earth. The choice among these would indeed be a choice 
between evils, hard to determine. It is a special mission of 
science to teach us how to avoid them. 
RELATION OF DISINFECTION TO THE SPREAD, THE LIMITING, 
AND FINAL CHECK OF THE DISEASE. 
There were seventy-four recorded cases. 
During the twenty days from September 3d to the night of the 
general disinfection, September 23d, there occurred thirty-five 
cases. During the twenty days following, to October 13th, the 
date of the last case, there occurred thirty-eight cases, and these 
we will analyze. 
First, let us bear in mind the statement concerning the impos- 
sibility of disinfecting all of the premises on infected squares, 
and that none of the houses were disinfected except in case of 
death. Many people in the infected area were residing in houses 
and on premises never touched with disinfectants—many in 
houses with the sick. Next, we must allow a time for incuba- 
tion in those already infected at the moment from which we 
date—9 oTelock p. in., September 23d. A period of incubation, 
varying from a few hours to eight or twelve days, has been 
generally conceded. In the present calculation we will allow 
five days only. 
Seventeen of the thirty-eight fell sick during the first five 
days, leaving twenty-one cases for the remaining fifteen days. 
Of the thirty-eight cases, eleven occurred outside of the in- 
fected Hurts. Eight of these had been nursing the sick or visit- 
ing socially in the infected area. The remaining three had no 
such history, but had evidently contracted the disease outside 
this locality. They occurred in persons who had been in close 
proximity to the sick, about the intersection of Eighth and Con- 
stance streets, who had been infected in the diseased locality. 
This appearance gave reason to fear the development of a new 
centre of infection. This new area comprised the sixteen squares 
bounded by Magazine and Chippewa, Washington and Ninth 
streets. 
From September 29th to October 5th, the disinfection of this 
quarter was accomplished. The boundary streets and gutters 11 
were sprinkled with the crude acid, the intersecting streets with 
the pure solution at first aud with the crude acid a few days 
later. The premises ef several squares were disinfected, and 
every privy was carbolized carefully with crude acid, two quarts 
to each. 
Because of a limited supply of material wherewith to accom- 
plish this work, an improved method of distributing the acid 
was adopted. The ordinary street-sprinkling apparatus was 
removed, and in its stead, two one-inch hose of thirty feet each 
were attached to the reservoir. On the end of each hose was 
an ordinary garden-sprinkler, eight inches in diameter. Thus 
arranged, the cart bearing the reservoir was driven down the 
middle of each street, while the gutters and edges of banquettes 
on both sides were effectually drenched with the acid. By this 
means, we were enabled to extend a perfect double cordon 
around each square with the least expenditure of acid. 
It is better iu effect, and far less objectionable to the inhabi- 
tants, to go over an infected area in this manner several times, 
a few nights intervening, than to deposit the whole supply at 
'once. 
THE DISEASE IN PUBLIC INSTITUTIONS, AND ON SHIPS. 
On the 13th of September a case occurred iu St. Joseph’s 
Asylum, corner of Laurel and Josephine streets. On the 15th 
another; one on the 10th, and one on the 17th. Two of them 
were fatal. 
On the 17th the building and premises were disinfected with 
the pure acid solution. The same was applied to all bedding 
and clothing removed from the patients. This was accomplished 
by the Sisters, guided by Dr. Layton. Again on the 20th, by the 
Sanitary force, the yard, sewers and privies, were thoroughly 
treated with the pure acid, one part to fifty ot water. This was 
repeated on the 25tli. (Other public institutions to be men- 
tioned were disinfected iu the same way.) No case after the 
17th. 
Living on the premises were 210 white persons, of whom 25 
were cloistered nuns. Of the entire number, six were already 
acclimated by having had yellow fever. 
Iu the Jewish Orphan’s Home, corner Jackson and Chippewa 
streets, a case occurred September 21st, one on the 25th, and one 
on the 27th. Two of these were fatal. The interior of this 12 
building was repeatedly disinfected by the inmates, directed by 
Dr. Lreber, in the manner just mentioned. The premises, includ- 
ing yards, drains and privies were disinfected by the sanitary 
force, September 2Gtli. No other case occurred. 
Residing on the premises were 110 white persons, of whom six 
had previously had yellow fever. 
In the Convent of the Sisters of Mercy, on St. Andrew street, 
between Constance and Magazine, a case occurred September 
29th. It terminated fatally. This institution was disinfected, 
October 2d. Living on the premises were 43 Sisters of Mercy, 
19 employees, and 70 orphans—122 persons, all white. Ten of 
these had already had yellow fever. 
By contrast, it is interesting to note that, in the immediate 
neighborhood of these institutions, the private residences in- 
vaded but never disinfected, seemed to fare differently. The 
disease in many instances attacked in succession every member of 
the family liable—frequently three, four, and as many as eight. 
The sailing ship Belgravia arrived direct from Liverpool, 
August 29th. She landed about the foot of Second street, where 
she has remained to the present time. 
The crew were allowed to go on shore at will. One of the 
sailors was taken ill aboard ship, September 17th. On the 
20th, he was conveyed to the Touro Infirmary, where he died 
the same day. 
On the 20th, the ship was thoroughly disinfected with carbolic 
acid and chlorinated lime. The bedding and clothes of the 
deceased were tied in a bundle, weighted with stones, and sunk 
in the river. The ship was thoroughly washed throughout. 
After this, she was repeatedly cafbolized and cleansed. During 
the ten days following the death of this case, the crew remained 
closely about the vessel. After this time, some of them became 
reckless, and frequented the places in the infected area where 
this man caught the disease. Two ot the crewr fell ill of the dis- 
ease on the morning of October 8th, and died at the Tonro 
Infirmary, one on the 12th, and one on the 14th inst. The com- 
manding officer predicted the illness of these men, in a conver- 
sation with me a few days before they were taken, because of their 
foolhardiness. Living on board, officers and crew, twenty men; 
none of whom had ever been exposed to yellow fever. 
Just astern the Belgravia lay the sailing ship Evangeline- 
Officers and crew unacclimated. The captain’s wife spent a 13 
sabbath evening with a friend living in the infected center, 
October 1st. She was taken ill the following morning, and died, 
having thrown up black vomit freely, October 6th. The same 
method of disinfection was pursued as with the Belgravia. No 
other case occurred. 
This completes the analysis of the record. The following is a 
RESUME. 
Total number of cases 
white, 71 
colored, 3 
=74 
“ “ natives of New Orleans 17 
“ “ “ tl Louisiana 4 
“ “ of deaths 35 
Total amount of disinfectants used—pure carbolic acid, Cal- 
vert’s No. 5, 19 barrels, ranging from 46 to 50 gallons each 
= about 912 gallons. 
Total crude carbolic acid compound, 40 barrels, containing 45 
gallons each = 1800 gallons. 
Total areas disinfected, streets and premises of sixty-four 
squares. 
Total areas disinfected a second and third time, streets and 
premises of twenty-four squares. 
The following is the census of the thirty-nine inhabited 
squares, bounded by Magazine street and the river front, St. 
Andrew and Second streets, not including asylums: 
Number of premises 1143 
“ “ persons on premises. 
.white, 5869 
colored, 538 
=6407 
“ “ “ born in New Orleans 3713 
“ “ “ “ 11 Louisiana 211 
“ u “ arrived in New Orleans since 1867*... 467 
“ “ “ born “ “ “ “ “ 1760 
“ 11 11 who have already had yellow fever: 1 
white, 1162 > 
colored, 34) 
=1196 
“ u 11 “ never had yellow fever 5211 
It is not the object of this paper to discuss of'to venture an 
opinion concerning the essential nature of the yellow fever infec- 
tion. There is no intention to defend any theory whatever, bub 
* The date of the last great epidemic. 14 
only to make general observations, based upon such facts as 
have been accumulated in this city and elsewhere. 
It does not affect the sanitary question an iota whether the 
infection of yellow fever be a germ, animal or vegetable, a cata- 
lytic state of the products of decomposition in effete animal 
matters, or be any other thing or condition which theory is 
pleased to assume. So long as it is intangible, imponderable, 
irrecognizable to any of the seuses, we can have no positive 
knowledge of the essential nature of the poison. Every effort 
to prevent its appearance or to limit its spread, must be purely 
experimental. 
Sanitary measures have dealt effectually with other infections 
equally mysterious in their nature, and may succeed with this. 
The sanitary control of yellow fever in benefits resulting, 
would be second only to small-pox. Its effect upon the growth 
and commerce of this city alone, would be incalculable. 
The following is a summary of observations. 
1st. Yellow fever, whether preexisting as a dormant germ or 
not, requires as factors of its development, a certain geographi- 
cal area of the earth, a continued high temperature, and the 
congregation in dense community, of a large number of people, 
as in large towns and cities. 
2d. That it is not the simple fact of people living together in 
large numbers which furnishes this last factor, but the violation 
of hygienic law likely to result from such massing of humanity, 
in the accumulation of their filth—a universally acknowledged 
cause of disease. 
3d. That whatever the essential nature and precise origin of 
yellow fever may be, it cau only be prevented or suppressed by 
removing or by neutralizing one of its factors. 
4th. That foul accumulation and its decomposition is the only 
one of its factors over which we may exercise control. We may 
remove this entirely, we may check its decomposition, or we may 
neutralize its products; to do any oue of these is tantamount to 
accomplishing the others. It is the same in effect to clean a 
privy absolutely, to freeze it, or to disinfect it. The amount of 
disinfection required is in direct proportion to the quantity of 
decomposing matter, and high range of diurnal mean tempera- 
ture. 
5th. That the specific cause of yellow fever is localized and is 
not borne about by the wind, but radiates continuously from its 15 
point of origin or of first appearance, traversing surfaces, par- 
ticularly of the soil, but not of water (as rivers or lakes). It is 
readily transplanted through fomites, as in the garments of the 
sick, as well as in the recognized methods along the highways of 
commerce by ships and other carriers of merchandise. In regard 
to the transmission of yellow fever, it is almost impossible to 
determine the boundary line in some instances between infection, 
strictly speaking, and contagion. 
6th. That carbolic acid not only retards decomposition and 
modifies its products, but seems to destroy directly the yellow fever 
infection, and in order to accomplish this, it is not essential that 
all surfaces be subjected to the actual contact of the disinfectant- 
Its destructive influence seems to extend even beyond the limit 
of actual contact of the acid solution. Completeness of applica- 
tion, however, should always be aimed at. 
Finally. That when the suppression of the disease is to be 
accomplished by disinfectants, these are to be thoroughly applied 
from the first moment of alarm. There must be an absolute 
parallel between the management of this disease and the man- 
agement of fire 
The Board of Health is the central office; each physician, having 
at heart the welfare of his fellow citizens, constitutes himself, 
as it were, an alarm box. • The first occasion of alarm is made 
known to the Board. Symptomatic evidence sufficient to estab- 
lish a reasonable presumption should be communicated, or at least 
made the occasion for a consultation. If further observation 
strengthens the presumption, it is but right that the Board 
should be possessed of the opportunity of adopting such precau- 
tionary measures as may be deemed necessary. 
Disinfection to limit the disease, may always be accomplished 
without offence or injury to the patient. 
A frank expression of truth should always predominate over 
every influence, from whatever quarter it may be brought to 
bear. This will establish a perfect reliance in our statements, 
at home and abroad. 
And now, a few words to the medical profession particularly. 
In an enlightened sanitary system, the physician is peculiarly 
the custodian of the public health. Of what use are all efforts 
to prevent the epidemic prevalence of any malignant infectious 
disease, unless the physicians themselves promptly report its 
existence in its incipiency, whether suspected or determined. 16 
As in the case of fire, the only hope of extinguishing a pesti- 
lence is in the very earliest knowledge of its appearance. Every 
hour of delay lessens the ability to combat and suppress it. 
Thus, we perceive, one of the highest interests of the community 
rests directly with the physician. And in seasons of danger, he 
has no right to remain silent even upon a reasonable suspicion 
of a malignant infection. The question at issue is not a per- 
sonal one, but concerns the entire people. 
There is abundant reason to believe the time is not remote, 
when a general epidemic of yellow fever in New Orleans will be 
as unlikely to happen, as another visitation of plague in Lon- 
don, or the decimation of Paris by small-pox.