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YELLOW   FEVEK
A   NAUTICAL   DISEASE.
ITS  ORIGIN AND PREVENTION.
r
JOHN  GAMGEE
   "AS FAR AS WE KNOW, LOW TEMPERATURE IS THE ONLY AGENCY THAT CAN BE
RELIED ON SAFELY TO DESTROY THE INFECTION OF THIS DISEASE."—Br. Carpenter.
   "Frost puts an end suddenly to our epidemics. Art never can do bet-
ter than to imitate nature."—Dr. J. C. Faget.

1*
             NEW YORK:
D.  APPLETON AND  COMPANY,
        549 AND 551 BROADWAY.
                 1879. 
WCK
Gl97y
\%19
    COPYRIGHT BY
D. APPLETON AND COMPANY.
      1379. 
                        TO

MES.   ELIZABETH  THOMPSON.
           Madam : Mankind is forgetful.   Perhaps I should say man-
       kind  is  exacting.  Every generous thought  and  every noble
       deed, assimilated for man's growth and development, is lost to
       sight in the very act.
                          " Time hath a wallet at his back,
                "Wherein he puts alms for oblivion ;
                A great siz'd monster of ingratitudes:
                Those scraps are good deeds past; which are devoured
►                As fast as they are made, forgot as soon
                As done."
           You  caused the investigation of the Yellow Fever Epidemic
       of  1878.  You started our dead friend, John  M. Woodworth,
       in the excellent work which demanded  one more martyr.  His
       willing,  sleepless brain and  frame, stirred  by your  impulse,
       found rest only in death.
           "What remains ?  For two centuries  the gnawing canker of
       commerce, on the Atlantic coast  of America, has been  that
       pestilence, destructive to more property  than  lives, but which is
       so  well  calculated by its appearance,  in bustling seaports, to
       create panics and distract the wisest councilors. 
4
DEDICATION7.
   You have brought order out of chaos.  A Central Authority
now coordinates for  good the many willing, who, seeking the
best, often attained the worst.   The result is  manifest.  The
public will be saved from that never-ending conflict of medical
opinion, powerful  in crushing bookshelves and powerless to
save one human life.  Ultimately and soon Yellow Fever will
be counted with the plagues that were.
  A common object, a common purpose, a common good—
aimed at and secured with the same ease as touching a button
atomized the Hell Gate rocks.  To you the country owes this
touch—a touch  of human nature making the whole world kin.
   "With grateful appreciation of your kind friendship, I re-
main, madam,
                   Your obedient servant,
                                        John Gamgee.
Washington, D. C, August 18, 1879. 
PEEF AO E.
    A sound medical  philosophy  is fast becoming  a reality.
 Whoever in the future may prove its  eloquent exponent, only
 a John Hunter or a Helmholtz can be equal to  the  task.  It
 demands a man of true genius, chained to the car of experimen-
 tal physics, capable of piercing  the bubbles of tradition, strong
 in  marshaling  facts and figures, prompt and  clear with his
 relentless logic.
    The science of thermo-dynamics had to be born to render
 this possible.   Lomonossow, Rumford, Joule, Mayer,  Clausius,
 Rankine, Sir William Thomson, and Hirn had to do their work.
 This science is no branch of other sciences.  It is the ground-
 work on which astronomy, biology, pathology, and all other ex-
 act studies must be based.   "Writers like Dr. La Roche, whose
 work on Yellow Fever is a monument  of painstaking zeal and
 industry, will continue to amass data, so slightly clouded by the
 fashionable opinions of their time that the  vigorous reaping
 machine of the future may garner ready-stacked treasures.
    Every reasonable hypothesis must expedite the future demon-
 strations.  It is absolutely essential to broad scientific develop-
ment.  The record of known truths and the views propounded
in the following pages may therefore serve an important  pur-
pose.   "With the confidence of  just perception,  guided by a 
6
PREFACE.
very varied  experience, I  commend  to all the means whereby
the prompt extinction of yellow fever on  the Atlantic coast of
the New World is, in my humble opinion,  a matter of certainty.
    To Dr. J. C. Faget, of .New Orleans, now pertains the credit of
having first formulated the idea of  resorting to artificial refrige-
ration for the purification of ships.   His clear exposition of the
probable origin and definite course of yellow fever, in the ship-
ping and seaport towns, has recently  given precision and direct-
ness to my  labors.  His name and writings were unknown to
me a few  weeks since.  I shall henceforth hold both in  grate-
ful remembrance.

   Riggs House, Washington, D. 0., August 22, 1879. 
CONTENTS.
Dedication     .....
Preface        .....
Introduction   .....

                                CHAPTER I.

Yellow Fever a Nautical Disease—its Origin and Prevention :  Classifica.
    tion of Diseases in  Man  and Animals into international, indigenous, and
    independent—Yellow  Fever indigenous—Damp Ships unhealthy—Where
    do we find Yellow  Fever? and  whence does it reach us?—Yellow and
    Paludal Fever—Protection of New Orleans—Original Views on Contagion
    —Yellow  Fever defined as Nautical  Typhus—Obstructive  Quarantines-
    Yellow Fever in Steamers and Sailing Vessels—What Ships may be con-
    sidered infected—Epidemic Nucleus  adjoining Shipping—Course  of  the
    Yellow Fever in Cities—Location of Infected Cities—Altitude as affecting
    Yellow Fever—Barometric Pressure—Is  there a Proper Soil for the Dis-
    ease ?—Yellow  Fever an Exotic in every  Land—Naturalization of the Dis-
    ease  on Land impossible—Its Propagation—Alternating between Sea and
    Land—Humboldt's Views—Probable Origin in the  Tropical Atlantic Basin
    —Usual Yellow-Fever Course from the Tropics  northward—Floating Center
    of Origin—Yellow Fever originating in Mid-Ocean—Type of Disease in the
    Eastern and Western Atlantic—Contagionists on Spontaneous Origin in
    Ships—Conditions essential to Yellow-Fever Development—Yellow Fever
    a Hybrid  Typhus—Propagation  of Jail and  other  Fevers—Pyaemia or
    Purulent Infection—Other Diseases propagated after Spontaneous Develop-
    ment—DiflBculties of ventilating Ships—Asphyxia in Ships—The Atlantic
    Yellow-Fever Center—Influence of Temperature of Sea-water on a Ship's
    Ventilation—The Cargo—Disinfectants  not used  at  Sea—Cause  of  the
    Outbreak in Memphis      .       .  •
3
5
9 
8
CONTENTS.
                               CHAPTER  II.
General Historical Considerations : Past History of Yellow Fever—Ancient
    History of Yellow Fever—Diseases of the Red Men—Spanish and Portu-
    guese Traders—The Spanish Galleons—Sir Walter Raleigh's Voyage—An-
    son's Voyage around the World—Ships composing the Squadron—Anson's
    Fleet  Surgeon's Opinion—Outbreak of the Calenture—What is a Calen-
    ture ?—Rest at St. Catherine's—Scurvy in the Pacific—Capture of Pizar-
    ro's Galleon—No Yellow Fever in the Pacific—Captain Cook's Voyage—
    Pringle's Eulogy—Bryan Edwards on West Indian Fever—Yellow Fever in
    British and French Guiana—Yellow Fever on the African Coast—Yellow
    Fever in Charleston—European  Outbreaks of Yellow Fever—Recent Out-
    breaks in France  and England—Clean Bills  of Health—Special Data re-
    lating to the West India Islands   .       .       .       .       .      .74

                               CHAPTER  ni.
Contrast  and Comparisons between  Yellow Fever and  other Diseases:
    Relapsing and Yellow Fever—Remittent and Yellow  Fever—The Pulse             '
    and Thermometer in Yellow Fever—Dr. J. C. Faget's Observations—Epi-
    demic Fever of Young Children in New Orleans—Oroya Fever—Cholera
    and Yellow Fever.  Contrast of a Land  and  an Ocean  Plague—Analogy
    between  Typhus and Yellow Fever in  a Ship     .       .       .      .113

                               CHAPTER  IV.
Developmental Phenomena : Where and  how may Yellow Fever develop ?—
    Statement of the Germ Theory—Unformed Ferments—Germs unrecogniz-
    able—Lower Organisms not specifically  injurious, nor structurally char-
    acteristic of Fevers       .      .      .       .       .       .      .137

                               CHAPTER V.
The Prevention op Yellow Fever :  Making Quarantines pay—Destruction of
    Yellow-Fever Germs by Cold—Artificial Refrigeration proposed by Dr. J.
    C. Faget—Cold as an Antidote endorsed by the Board of Experts—How is
    it proposed to deal with Shipping ?—Little Danger from Cargo—Thorough
    Disinfection essential—Why not  attack the Disease off  Land?—The
    Classification of Ships—Special Ships for Special  Cargo—Is it necessary
    to  distinguish between Infected  and Non-Infected Vessels ?—Cold the
    Natural Antidote of Yellow Fever—How to produce and apply the Cold—
    Disinfection of Air—Disinfection  of  the Bilge—Disinfection of Cargo-
    Refrigerating Machinery—Store of Cold—Cost of  Refrigeration—Report
    of the Naval Engineers on the Refrigerating Ship—Cooling and ventilating             *»
    Ships—High Temperature as a Yellow-Fever Antidote—Fire  as a Disinfec-
    tant—Ventilation of  Ships by an Injector—Prevention of Yellow Fever in
    Cities—Cold and Ventilation—International Cooperation      .      .150

                               CHAPTER VI.
Conclusions   .
195 
YELLOW  FEVER.
                     INTRODUCTION.

    A nautical disease, a product of foul ships in the equatorial
 Atlantic caldron, yellow fever, the dreaded scourge of American
 commerce, is far more easily, surely, and permanently prevent-
 able than typhoid or scarlatina.   The sewage fever of cities may
 for centuries afflict humanity.   With zeal and firmness, coopera-
 tion and persistent effort, a decade should practically abolish the
 ocean pestilence.  Mystery where there should be no mystery—
 doubt where rays of discriminating light can penetrate—a moun-
 tain of a molehill—fairly characterize the involved doctrines
 which pass current as to the genesis and nature of yellow fever.
    My temerity and apparent dogmatism, in a sketch fashioned
 and almost written at one sitting, may startle many.   Such  a
 sketch may prove serviceable.   It is always instructive to view
 a question from all points, and I believe that mine is not  the
 least  commanding eminence whence to photograph fresh  im-
 ages of this dire disease,  since Audouard, Humboldt, Copland,
 Currie, La Roche, and especially Dr. Faget,  of New  Orleans,
 have indicated  how much there is of truth  in regarding yellow
 fever as something more  than, and something different from,  a
 land disease.
   No recondite research is needed to  reveal a new elixir of
life.  Fresh air, dry air, cold air, available  in all parts, driven
through and through the stagnant pest-holds  of vessels, suffice.
The details hereafter. 
10
INTRODUCTION.
   Pure and frigid air must and can rid the mercantile marine
of this ship-typhus—the analogue, in a sense, of that jail pesti-
lence which John Howard banished from British prisons.
   It is sometimes well in medicine  as in politics to sink minor
differences, and  strike for some reform  which can not fail to
commend itself  to the vast majority.  In this  spirit I advocate        '
that natural  antidote which, during  epidemics  in this country,
has been universally recognized as all-sufficient with  approach-
ing winter.
   Stumbling into volunteer service on  this question, no  time
has been lost, no thought or trouble spared, since  last Decem-
ber.   With La Roche I might say that,  " painful as the avowal
may be, it is  a fact, the truth of which can not be denied, that,
notwithstanding all that  has been  written on the subject of the
yellow fever in this and other countries—all the labor that has        e-
been bestowed, or any investigation of its causes, character, and
anatomical phenomena—little progress has so far been made in
a knowledge of  the pathology of  that disease."  May not the
fact  reveal itself that the disease, in  its real  origin, has  been
necessarily less investigated, because that origin is at sea, and
the most skillful and painstaking observers are on  land?  A
knowledge of the climate and diseases of the sea, in the pesti-
lential mercantile craft of the tropical Atlantic, acquired by an
expert in pathological physics of  the  modern  school, would, if
in our possession, add a long, brilliant, and marvelously enlight-
ening chapter to the many penned by city physicians.
   In chemistry we  have to adopt at one time the  analytical,
at another the synthetical, method in ascertaining the nature of
substances.   In  pathology, touching such a question as yellow
fever, investigations of all kinds must be instituted; but, while
we are told so much—and so much that is conflicting—concern-
ing the causes and development of the disease, I for one think it
high time that a combined international  effort  be  made to de-
monstrate, by complete and practical measures, how far perfect        *
ventilation and cleanliness of ships  will contribute to extermi-
nate yellow fever.  It is my conviction that it will do so as effec-
tually as prison sanitation has made us strangers to the pestilen-
tial typhus of foul dungeons.  To clear the Atlantic seaboard of
such  a plague, the medical authority of one country, however 
                       INTRODUCTION.                     H

eminent it may be, can not assert itself with the desired prompt-
itude, nor  without measures which might  be  resented.  But
all—and  notably the Brazilian Emperor—might be expected
promptly to lend intelligent and financial aid to rid the  com-
merce of the New World of its fatal obstruction—the withering,
palsying  scourge of seaports and of  the noblest seacoast under
heaven.
   The humblest and the  mightiest may join in good works;
and as a simple interpreter, according to my lights, of some pas-
sages of epidemic history, I commend to all the one great  prac-
tical recommendation, viz.: the instant and absolute purification
of the merchant marine, at all hazards, between New York and
Rio.  It  is not light work, but on the other hand it  is definite.
The remedy in this case can not fail to prove far better and in-
finitely less costly than the disease. 
CHAPTER I.
YELLOW FEVER A NAUTICAL DISEASE—ITS ORIGIN AND PREVENTION.

    Every disease afflicting man and animals admits of being
grouped under one of three heads.  A contagious and  com-
monly malignant class embodies all essentially migratory mala-
dies, communicated by  a specific  virus from the  sick to the
healthy.   They  can  be  reproduced  at will  by  collecting  and
inoculating this virus,  which is endowed with a latent vitality
equal, in  some cases and  under suitable conditions, to the seeds
of  plants which  have  germinated after preservation in the tis-
sues of  Egyptian mummies.*  These specific diseases are prop-

   * The diseases  of plants  supply us  with highly instructive examples. In the
vine disease due to Phylloxera vastalrix, the living organism inducing and propagat-
ing  it is an insect which undergoes a variety of metamorphoses,  and eluded for long
the  vigilance of naturalists by its varied abodes in different stages of its existence.
The native American vines on which the  phylloxera lives, without  destroying the
plants, are an illustration of immunity by  " survival of the fittest," which enables
scientific men to propose a remedy wherever the malady has been introduced.  Pro-
fessor Riley, of the United States Entomological Commission, having discovered
that the cultivated American vines possessed a varying degree  of resistance to the
disease, recommended that those least  susceptible to it should be used in the French
vineyards as stocks, on which to graft their own vines.  The demand for cuttings
of such American vines has this year exceeded the supply.   All other remedies are
being abandoned in France, and by means of the American vines there is hope of
restoring the blighted vineyards.  This serious malady was introduced into France
by vine-cuttings after the civil war, and it  threatens Spain, Portugal, Switzerland,
Austria, and Prussia.  Its  complete history is highly suggestive to the pathologist,
as a type of contagion with manifest traveling germ.  The wingless phylloxera
travels  over the surface of the ground  from vine to vine, or beneath the ground
where roots interlock;  while in the winged form it  may fly or  be carried as  many
as fifteen or twenty miles, and under exceptional conditions even more.  Through 
DISEASE CLASSIFICATION.
13
 agated through time and space by contagion, and by contagion
 alone.  The leading types are small-pox in all its varied forms,
 as afflicting men and animals; the lung-plague of cattle; hydro-
 phobia in men  and animals;  and  certain parasitic  maladies.
 These are essentially International in their manifestations—
 may be exterminated  anywhere, and, once exterminated in any
 locality,  can only  recur by reimportation,  recommunication
 from the sick to  the healthy.
    A second and much larger group includes some of the most
 devastating plagues, but the fundamental character in common
 is localization as to origin.   There may be, and there is, some
 uncertainty as to the precise line  of  demarkation between these
 diseases and the  pure contagia.  It is the same in every classifi-
 cation of animals and plants themselves.   But history records
 periodic manifestations always traced  to  definite regions.  A
 susceptible man  may be inoculated with small-pox anywhere; a
 bullock will take the  lung-plague in any latitude and at any
 altitude, and there is practically no difference known in the type
 and severity of the  disease wherever it may occur.   The local-
 ized endemic or  enzootic maladies are influenced materially and
 radically by season,  temperature, humidity, soil,  systems of agri-
 culture, sanitary conditions (especially in relation to disposal of
 sewage and  the  water-supply), the geographical distribution of
 animals  and plants, and other secondary circumstances too nu-
 merous  to  mention.    These maladies travel  and sometimes
 widely; but their main centers of development are known or
 knowable, and their common method of propagation usually in-
 volves the contamination of air, water, food, or  soil to breed a
 pestilence.   It is obvious at once that the leading and strikingly
 characteristic types of this group are the cholera of Hindostan;
 the ancient plagues of the East, derived from Africa,  and pass-
 ing through  Egypt to desolate the Roman Empire; the yellow
 fever of the  tropical Western Atlantic basin; the varied  forms
 of malignant anthrax (due to great heat and humidity,' seriously

 man's agency, by commerce in plants and cuttings, it may be carried to indefinite
 distances.  It has always been by man's agency that Asiatic cattle-plague, reputed
harmless in the Steppe herds, has been communicated westward as far as the British
 Isles.  The general similarity of the diseases of plants and animals indicates that
they are susceptible of similar classification. 
14
YELLOW FEVER A NAUTICAL DISEASE.
aggravated by filth and foul air and  known to us  as the Sibe-
rian boil plague), the bubonic fever or pestilence, etc.;  the
splenic  fever  of Texan  cattle, pervading perennially  a wide
region of natural grazing ground, beyond which, in the healthi-
est localities, the excreta  of the apparently healthy and certainly
thriving animals contaminate the grasses, and destroy, with the
fury of genuine plague,  the sound kine of  northern latitudes;
ague; phthisis;  and (as a last example), we  may adduce certain
parasitic maladies—not those dependent on acari which live in
any latitude, but the tropical screw-worm invading every sore
and festering, to  bodily death, every simple wound.  Think of
the South African tsetse, the Guinea worm, and that thread-
worm of the  blood (Filaria sanguinis hominis) which afflicts
man throughout the tropical zone.  These  are  the Indigenous
enemies of  high forms of  animal  life—the  plagues of  definite
home, but occasional wide-spread fatality. Directly or indirect-
ly, through  the flora and fauna of a definite  region, they spring
from the soil, can always be traced to a natural habitat, and may
properly be termed Autochthonous.
    Lastly, we have to deal with maladies due to individual pre-
dispositions and to accident, isolated sickness, disease, or injury.
A man  suffers from  dyspepsia, a woman from cancer, a child
from rickets, or a horse from colic.  In these and similar in-
stances  there is  no pretense for confusion with contagious and
with localized or indigenous diseases.  The maladies or the in-
dividual instances of  the maladies are Independent and purely
sporadic.  These may be and are often due to special  idiosyn-
crasy or to hereditary transmission.

   Well do I  remember the days when the doctrine  of  spon-
taneous generation was  so facile an  interpretation of  all  hu-
man ills, that  the strict  definition of a  specific animal poison,
and its  peculiar history  as an agent of destruction, met with
great  incredulity among  physicians  and  others.   Maladies
such as smallpox or  cholera were  supposed to originate any-
where.
   The tendency now is to  the other extreme, viz.:  that no
widespread pestilence can occur without  a definite disease-germ
—a link between a preexisting case and the present one.   The 
YELLOW FEVER A  NAUTICAL DISEASE.           15
 well-informed in pathology run no risk in confounding relaps-
 ing or famine fever with such  a disease  as variola.  When I
 first demonstrated the exotic character of the animal contagia in
 the British Isles, and pointed out to some of the best European
 authorities that epizootic aphtha, the Russian murrain, the lung-
 plague in cattle, and genuine exanthemata, had no home, but
 traveled in the lines of communication established by wars or
 trade, and were never (in the popular acceptation of the term)
 acclimatized anywhere, the conclusion was deemed far-fetched
 and was only tardily accepted.  For nearly thirty years my mind
 has been attracted to these questions, and,  in all probability, the
 wider field of comparative  pathology gave me no small advan-
 tage over those whose sole field of observation related to diseases
 of man.  For the past ten years my attention has been directed
 to  disinfection and disinfectants, and more especially to anti-
 septic cold.  The last has  led to that all-absorbing branch of
 practical engineering and  applied physics, artificial  refrigera-
 tion ;  and  little did I think, when I aimed at isolating the Brit-
 ish Isles from cattle contagia, by favoring the  importation of
 dead meat instead of live  animals, that my researches might
 lead me, as  I  believe they must,  to the practical demonstra-
 tion of the means whereby yellow fever may be  held perma-
 nently in check, if not totally extinguished, on  the Atlantic sea-
 board.
    These words of explanation are needed  as an excuse for, per-
 haps rashly, forcing myself before the public with an exposition
 of views so  widely different  from those generally held.  The
 public (and I include scientific men) is not satisfied  with the
 current knowledge on the  subject of  yellow fever.  There are
 many who scout the idea of informing the public on such ques-
 tions.  I belong  to that class of ardent  believers in popular
 knowledge who consider no  adage more  ridiculous than that
 which avers  that a little "knowledge is  a dangerous thing."
 Better a little than none, and that  little will grow.  The germ
of truth remains, the lie vanishes.
   We have arrived at  a stage when we  may generalize  with
profit, when at all events we  may define, and I  venture to be*
lieve that the classification of  all maladies under the three great
heads— 
16
YELLOW FEVER A NAUTICAL DISEASE.
   International or Contagious,
   Indigenous or Autochthonous,
   Independent or Individualized—
will clear away some of the mist enshrouding this great question;
and in due time the skillful aetiologist—the student of disease-
causation—will split up these  great groups into lesser and well-
defined orders, genera, and species, and abolish the ancient no-
sologies based on theories, swept away together, in due time, by
the torrent of medical progress.
   Remember the three I's, and one of  the fundamental features
of yellow fever can not be forgotten, viz., that it belongs not to
the contagious diseases.   Its poison has not been collected on a
pin's point to propagate the malady from the sick to the healthy.
The virus of small-pox is known to us by its effects,  and so is
the poison of yellow fever ;  but there is not one of the pure con-.
tagia that will not yield a secretion—such as the system does not
produce in yellow fever—which can be desiccated or otherwise
preserved; and so long as it is undecomposed, or retains its latent
vitality, when introduced  into the blood of the susceptible crea-
ture,  a disease is  induced  with a  definite period  of incuba-
tion,  a characteristic invasion, and aggravation of symptoms,
until  a crisis occurs, to be followed by death or convalescence.
So concentrated or  so virulent  may  be the  poison,  that the
ordinary course and symptoms  abort, and a  rapid poisoning
results in what the French so graphically name un acces fou-
droyant.
                 Yellow Fever  indigenous.
   Yellow fever pertains to the indigenous plagues, the diseases
of localized origin;  and  future  observers may and no doubt
will, as past  ones have done, ally with it, or  show some rela-
tionship to it, of diseases in various  parts of the world.  Its
most  striking and constant characteristic  is development in a
confined atmosphere  on or near the equator  in the  Atlantic,
with  a virulence almost  proportionate to the protracted heat,
humidity, and stillness of the air breathed by man.  These are
the conditions under which decay or  common putrefaction of
organic matter occurs; and it were well to investigate further
the statements concerning  the rapid  decomposition of meats
and other perishable provisions in yellow-fever-laden air. 
DAMP SHIPS UNHEALTHY.
17
                   Damp Ships unhealthy.
    Dr. Turner, Secretary of the National Board of Health, has
 written very forcibly on the insalubrity of damp ships—of ships
 whose air is kept damp  by perpetual swabbing and washing.
 The  conditions he describes and denounces are the conditions
 favorable to the development of what is  called " ship fever,"
 which in the tropical Atlantic means, to all intents and purposes,
 Yellow Jack.
    The region whence yellow fever travels northward is remark-
 able for humidity, and that humidity does not depend on rains,
 which so often favorably influence the health of infected  cities
 in the United States, but saturation of the atmosphere at high
 temperature—a state favoring  the rapid rusting of metals and
 instant corruption of organic remains.
    " Dr. E. H. Barton, of New Orleans, informs us, as the result
 of an examination of fifteen epidemics, that the average dew-
 point at the commencement of the sickness was 95*82; the aver-
 age at the maximum of the epidemic was 74*34, and that at the
 declination 62*12.   The difference between the period of the
 commencement and that of declination was 13*70;  and we have
 the remarkable fact that a diminution of the dew-point brought
 the epidemic to its maximum of intensity, while a further dimi-
 nution brought it  to its declination.  Dr. Barton  remarks, in
 reference to this matter, that during the  last nine  epidemics it
 was found that,  although the results stated were but an average
 of the whole, the extremes  or  variations from  it,  in any year,
 were  very small;  in  other words, the minimum dew-point at
 which the  epidemic  passed  off, and which  was required to de-
 stroy that character, was noted at 58*26, and the maximum, in
 any year, under which it ceased its ravages, was 66*64, being a
 difference of a fraction over 8° only."*
   Pending researches by a competent commission at Havana,
 it may be rash to predict that little more is likely to be learned
 of the specific germ  of yellow fever  than we know of  the or-
ganic elements incident to and connected  with putrefaction.
 There is a question of intensity, as well as of specificity, pend-
ing—an  intensity  bearing almost a definite relation to high
                    * La Roche, vol. ii., p. 159.
          2 
18
YELLOW FEVER A NAUTICAL DISEASE.
 temperature  and atmospheric humidity, darkness, and intestine
 inertia in the deepest holds of vessels.
    Whatever may be the results of this year's investigations, I
 am sure that the  concentration of  attentive thought and skill-
 ful inquiry, now so fortunately inaugurated, will dispel much
 mystery, and especially  any mystery still lurking,  which sur-
 rounds the spontaneous or imported character of the disease, so
 far as the United States are concerned.  The facts  recorded
 during the past century already constitute a broad and inspiring
 basis on which to found  a rational and perhaps incontrovertible
 opinion.   The very discrepancies brought out by the contagion-
 ists and  anti-contagionists—by those in favor of the theory of
 spontaneous  development in the Southern States, and those
 holding the opposite view—have enlarged our sphere of vision.
   . We must not expect a prompt unanimity of  opinion.  That
 we may never have, but this off-hand essay would not have
 been  written had  I not, in the course of my inquiries with a
 view to the prevention of yellow fever,  found so much to guide
 our thoughts into new channels, that  I felt impelled to take
 others promptly into  my confidence, with  a view to expediting
 the experimental work which, in my opinion, must lead to the
 final and permanent exclusion, as an epidemic or pestilence,  of
 ship or yellow fever from all lands.

 Where do wejmd Yellow Fever f and whence does it reach us f
    These two questions can undoubtedly be  answered, and  in
the main answered conclusively.  I shall not  attempt to lay all
the evidence in my possession before my readers.   That would
defeat my object, which is to be brief and prompt.  I shall con-
fine myself as much as possible to adducing those striking facts
and data which seem to me established beyond question.
    " Yellow fever was not known to the people of the Eastern
hemisphere until after the discovery of  America by Columbus.
The earliest epidemics of which we have any historical informa-
tion occurred during  the first half of the seventeenth century,
in the West India Islands." *

   * " Conclusions of the Board of Experts authorized  by Congress to investigate
the Yellow Fever Epidemic of 1878."  Washington,  18*79. 
                 PROTECTION OF NEW ORLEANS.              19

    It appears that yellow fever first occurred within the present
 limits of the United States in 1693, in Boston, Massachusetts,
 and in 1699  in Philadelphia,  being imported both times from
 Barbadoes.  It entered New York from St. Thomas in 1702, and
 for the first time reached New Orleans in 1796.
    We must eliminate  all doubtful cases.  The recognition  of
 isolated or sporadic cases (so called) of yellow fever is attended
 with great difficulty, and the most important point for future
 observers to  clear up is the positive recognition in the earliest
 stages of characteristic signs of the disease.   But so many epi-
 demics have  been studied that the mass  of  authenticated out-
 breaks is enormous, and some able physicians  have arrived  at
 conclusions which bear the stamp of ample justification.  " I re-
 main convinced," says Dr. Faget, of New Orleans, in his admir-
 able letters on this subject, " that yellow fever never  occurs in
 New Orleans unless it  is imported;  for in  my opinion it owes
 its origin always to special germs {sentences speciales) which are
 brought to us in the holds of certain ships." *

                  Yellow and Paludal Fever.
    Dr. Faget published his "Memoires" in great measure  to
 define the contrast between ordinary marsh, miasmatic, malarial
 or paludal  fever, and yellow  fever;  and he says: " Now the
 principal object which I am pursuing in my studies of the two
 fevers is that both can be attacked  in their origin {dans leur
 causes) or their morbid principles; the  yellow fever by special
 means of sanitation  applied to the holds of  importing vessels,
 there where the germs exist; the paludal fever by turning our
 marshes into healthy lands, and meanwhile, by quinine, pursuing
 the poison  itself and destroying it, even  in  the depths of the
 organism."
                 Protection of New Orleans.
    Dr. Faget remarks  that  after a winter with frost  New Or-
 leans can be readily preserved  from all yellow fever, and at the
 time he was writing (June, 1863) five years had  elapsed without
 a visitation of the disease.  " The blockade, and, after the  block-
 ade, the severities of the state of war, that is  to say, the absence
   * " Memoires et Lettres sur la Fievre Jaune et la Fievre Paludienne."  Par le Dr.
J. C. Faget.  Nouvelle Orleans,  1864. 
 20          YELLOW FEVER A NAUTICAL DISEASE.

 of maritime commerce [the italics are his], have protected us
 marvelously, and especially in 1862, when our city was crowded
 with thousands of strangers from the North, shut up {entasses)
 in hot  barracks, which were ventilated  with difficulty.  More-
 over, in the winter of 1862-63 we had a severe frost."

                Original Views on Contagion.
    Such facts, and all the facts known concerning the early in-
 vasions of yellow fever in Europe and America, at first led to
 the unanimous opinion that it was a contagious disease.   De-
 veze, Nathaniel Potter, Charles Maclean, and others successfully
 combated this view.  One of the benefactors of the human race,
 Chervin, contested  the  prevailing opinion, and visited America
 to collect  facts in opposition to the doctrines propounded.  In
 1828, at Gibraltar,  Chervin attributed yellow fever to the cess-
 pools of the city.   Louis and Trousseau inclined to the importa-
 tion theory.  There was so much truth in Chervin's views  as to
 the  actually non-contagious character of yellow fever that, al-
 though he went too far and thought  the disease might develop
 anywhere, he was the great reformer of  the rigorous  and inhu-
 man regulations of the French quarantine system, and received,
 in recognition of his eminent services, the prize of 10,000 francs
 from the French Institute.*
    The two leading opinions which are fought over to this day     *
 relate to  communication by actual contact, contagion, or com-
 munication by aerial infection, once the disease manifests it-
 self.  At  the  present time I believe I am  correct in declaring
 that the statement  made  by the  Board  of  Experts (Joe. cit.) is
 accepted by the best informed, viz.: " In the dissemination of
 yellow  fever,  atmospheric air  is  the usual medium through
 which  the infection is received in the human system."   It is,
 however, not " carried to any considerable  distance  by  atmos-
pheric currents."

          Yellow Fever defined as Nautical Typhus.
    Faget, discussing the many theories respecting the nature of
yellow fever and marsh fevers, says, in a  letter written in July,
* Faget, he. cit. 
OBSTRUCTIVE  QUARANTINES.
21
 1859: " Audouard seems to me to have come nearest the truth in
 establishing a distinction between nautical typhus (yellow fever)
 and paludal typhus (malarial fever).   Nothing seems to me to
 throw more light on the study  we have undertaken than this
 remarkable distinction.  If I do not err, it will be more profita-
 ble  to enter on this course, which has been little studied, than
 to continue the discussion of contagion or infection which turns
 up whenever we have to deal with the question of importation."
    Chervin, the enemy of quarantines, said they would  cease
 the moment it was proved that yellow fever was not contagious,
 and therefore could  not be imported.   Chervin accomplished a
 great work, and yet  he was, as mankind usually has  been, only
 half right.  We blunder into wisdom.   We fight and slaughter
 each other into enlightenment.   He was  perfectly correct  that
 yellow fever is not  a  personally contagious malady like small-
 pox  ; but he overlooked the fact  that the common putridity of
 a foul city may harbor and nourish the uncommon putridity re-
 sulting from imported infection in ships.

                  Obstructive  Quarantines.
   We always  fly to  extremes  in moments  of panic.  Good
 government demands the prevention of frantic popular terror,
 by the investigation and publication of truth in relation to all
 epidemics, as much as by the firm adoption of  preventive meas-
 ures against disease.  Dr. Vanderpoel, of New York, recognizing
 fully the  imported character of  yellow fever, raises his voice,
 as Chervin did, against  oppressive and obstructive quarantine.
 He says :  " The pestilence of the past season, which has raged
 so fearfully through  the Southwest, has produced a feeling akin
 to terrorism throughout  that whole section.  The  leading phy-
 sicians make no other  suggestion against future  invasions  of
 yellow fever than absolute non-intercourse between that section
 of country and the West Indies for six months of each year." *
   At the  present  moment (August,  1879), throughout  the
 South, the people  are  in a  state of abject  terror, flying from
their homes, and tortured by a stalking  specter—the jaundiced

  * " Quarantine, with reference solely to Seaport Towns."  By D. Oakley Vander-
poel, M. D.  New York, 1879. 
22          YELLOW  FEVER A  NAUTICAL DISEASE.
image of death.   Shot-gun quarantine and the brutal repulse
of wanderers are the evidences of an inhumanity engendered by
fear.   The Memphis outbreak should be the last of these terri-
ble inland visitations.  Even Chervin recognized  that the foci
of infection were  derived from vessels at sea, true ambulating
foci  {vrais foyers ambulants), which constitute the radiating
points whence the disease extends more or less widely among
the adjoining dwellings.  He  recognized that the ships were
charged with the infected atmosphere, the potential cause of
yellow fever outbreaks.
   Speaking both of yellow fever and cholera, the  Board of
Experts said: "It is  now known that the poison of  neither is
susceptible of long vitality when exposed to the open air; but
it is not yet determined how long its  infectious properties may
be preserved in closely shut chambers or in  compartments of
vessels, or when inclosed in  the folds of clothing or goods.  It
consequently follows that ships are especially dangerous carriers
of these diseases, and also that they remain sources of infection
for months after having been infected with the poison."

       Yellow Fever  in Steamers and Sailing  Vessels.
   Dr. Yanderpoel has contributed, in his work on quarantine,
some  valuable observations on the relations which steamers
and sailing vessels maintain to each other, in disseminating the
germs of epidemics.   He says:
   " First, steamers are  far less  liable than sailing vessels to
become infected with the germs of yellow fever.  It is admitted
by most writers that yellow fever is not contagious, or, if under
certain conditions it becomes so, it is so slight as not to require
consideration in this connection.  It  is then transmitted from
place  to place  by  the  vessel, the cargo, the baggage and effects
of passengers and sailors.  The conditions which would modify
this receptivity in the two classes of vessels should therefore be
taken  into  account.   Of the ways of transmission, the vessel
itself  plays the most important part.   The  germs of yellow
fever increase with  fearful rapidity where the conditions of
filth, heat, and fermentation are in active operation.  These are
supplied in full measure in the  hold of a vessel lying for weeks
under a tropical sun, being loaded, as most of those  coming from 
IN STEAMERS AND SAILING VESSELS.
23
 fever ports are, with crude sugar and melado.  It is in the bilge
 of the vessel where this filth accumulates, and where the fever-
 germ  revels in its propagation.  The facilities for removing
 this filth and maintaining cleanliness are far greater on steamers
 than on sailing vessels.   In the former, in addition to the filth
 from the cargo, the oil and dirt from the machinery and the
 water  from condensed  steam settle in the bilge,  to  remove
 which the steam-pump  is brought into frequent use. Not only
 can the matters which accumulate there be readily pumped out,
 but clean water may from time to time be thrown in to remove
 more  effectually the  filth, and preserve the vessel from disa-
 greeable odors.  On the other hand, in sailing vessels all pump-
 ing must be done by hand, and is just so much less effectual and
 imperfectly performed; consequently, in the same proportion
 is the vessel liable to convey the morbid germs.
    " Again, steamers, in most instances, belong to lines which
 fun at regular intervals, remaining in port but a few days, as
 the cargo  is already engaged  by  regular  consignees.   Sailing.
 vessels, on the other hand, often  lie for weeks in an  infected
 port, under a tropical sun, and their officers are too often in-
 different to the hygienic conditions of the vessel and crew, until
 the vessel becomes a pest-house of sickness ; or, if the occupants
 escape while still  in  port, the germs remain in the bilge, and
 yellow fever breaks out later—the length of the voyage, a fer-
 mentable cargo, a dark  and heated hold,  all favoring the devel-
 opment of the disease.
    " As just intimated,  the length of time occupied by the voy-
 age is a decided element in favor of steamers, in lessening the
 opportunity for the development of the germ; for, as I shall
 show when speaking of  the measures  proper to repress yellow
 fever, I regard it of the highest moment that vessels should be
 discharged as  soon as they enter port.  Steamers  also possess
 the  appliances for forced ventilation, and currents of  air may
 thus be kept circulating throughout the vessel, a condition unfa-
 vorable for germ-propagation.  Experience of some years has, I
 think, shown that  steamers rarely become  infected; while not
unfrequently they  reach this  port with sick persons, it  will
usually be found that these individuals came on board during the
incubative period of the disease, having contracted it on land. 
24
YELLOW FEVER A NAUTICAL DISEASE.
   " The average duration of the trip of a sailing vessel extends
in most cases far beyond the period of incubation, and the cases
of sickness  she  brings  to port  must  be  regarded as deriving
their origin from the vessel.
   " While as a precautionary measure both must discharge in
quarantine, the  deduction is a fair one that far less danger of
importing the disease is  to be  ascribed to the steamer than to
the sailing vessel, and that measures of cleanliness and disinfec-
tion  should be  more  thoroughly carried  out on  the  latter.
It may  also be added that the  facilities of  cleaning with
steam-pumps, after discharge of the cargo, are manifestly also
in favor of the steamer.   It  is also a proper  question  to
consider whether an iron vessel  would be as likely to become
infected as  one of wood,  where the saturation of the latter
would be another element in the fermentative or decomposing
process.
   " While, then, I regard steamers as exerting a favorable san-
itary influence in the prevention of the transmission of yellow
fever,  as compared with sailing vessels,  their relation to  the
transmission of  cholera  is the reverse.   This latter disease is
transmitted primarily by the individual, and not, as in yellow
fever, wholly by the surroundings."


            What Ships may be considered infected.
  A ship entering  a  seaport infected, or developing in  the
waters where it is  lying at anchor a yellow-fever infection, has
almost always  been  charged with  contracting the disease from
land.   Even a superficial study of certain West Indian islands
indicates that  the chances of contamination by organic decay
are infinitely less on shore than in the shipping; and it has not
unfrequently happened that  a foul vessel has discharged appa-
rently healthy passengers and crew, and, on hiring labor to clean
the hold and purify the bilge,  the susceptible landsmen have
been instantly stricken with fever.
   Every ship therefore,  whose  sanitary condition is  doubtful,
hailing from the West Indian seas, without the stain of having
communicated with an infected port,  may be regarded as possi-
bly or probably  infected. 
EPIDEMIC NUCLEUS ADJOINING SHIPPING.          25
           Epidemic Nucleus adjoining Shipping.
    The extension of yellow fever from the shipping occurs usu-
ally to dwellings adjoining wharves; or the sailors and passen-
gers from an infected ship crowd with their baggage and cloth-
ing, which are tainted by the air of the hold, into close quarters,
where an impure atmosphere speedily multiplies the putrefying
centers of effete organic matter.   So near may be a foul ship to
a readily fouled dwelling, that, with a favorable wind, the pes-
tilential vapors find their way on land with fatal effect, without
any human carrier; but the distance that infection can be usu-
ally carried, by the unaided wind, is exceedingly small.
    Dr. Faget has referred specially to two epidemics which he
studied closely in New Orleans, viz., that of 1853  and that of
1858.  He shows how the " epidemic  nucleus"—the center of
origin—defined itself promptly in 1853 around a circumscribed
part of the port at Lafayette, precisely where certain cases of
yellow fever had been recognized in the shipping.   In 1858 the
" epidemic nucleus" was  at the  end of the street near the pier
33, where public rumor had indicated the presence of yellow
fever among the ships.

           Course of the Yellow Fever in Cities.
    From the original centers of infection, the most accurate
records indicate the spread of the disease, whenever it has been
newly imported, from house to house and street to street, proxi-
mately, without intervening healthy oases, steadily invading in
advancing outline the infected area, as oil spreads when dropped,
as Dr. Faget graphically puts it.   One part of  a city is the seat
of the virulent epidemic, and another is free.  The doctors in
one part are prostrated by overwork, whereas  in another idle-
ness and  indifference prevail, until the infected atmosphere has
crept from house to house and street to street, drowning in fetid
vapor  every  habitable quarter.   At last it  meets a barrier; it
reaches the city limits.  In  the  country, beyond the afflicted
town, cases of malarial fever and local black vomit occur at all
times,  but yellow fever  never,  except among refugees.  It is
here that the competent observer can  appreciate the immense
difficulties of diagnosing isolated cases of yellow fever, and the 
26
YELLOW FEVER A NAUTICAL DISEASE.
ease with which the course of the malady may be traced from
infected centers to the edge of the surrounding country, into
which it can not penetrate as an epidemic.
   Dr. Faget has brought this peculiarity of yellow fever inva-
sions out strongly and clearly.   The learned Dr. Francis says,
referring to its  importation and  extension  in foul cities, " im-
purities can not change its nature, but may augment its influ-
ence."

                Location  of Infected Cities.
   Dr. Daniel Osgood, of  Havana, in a  letter  on yellow fever
in 1820, says:  " Adjacent to all the places  in which  this  fever
becomes endemic is the sea, or some  other body of water.  In
the West Indian islands, with the exception of the very small
ones, persons who reside in the inland parts, when affected with
fever, have it not  of  this kind.  But instances of its being of
this kind are seen in them, when they have become disordered
shortly after they have left the interior and removed to the sea
or a harbor.  On the contrary, even  strangers from cold cli-
mates, who  on the first  arrival at a  tropical one go into the
country and remain there, escape the disease."
   In confirmation of Dr. Osgood's  opinion, the Camp Jacob
in the interior of Guadaloupe has been established  for fresh
troops from France, so as  to acclimatize them.  On the coast
of Africa we observe exactly the  same conditions.  It  has oc-
curred at St. Louis, Cape de Yerde, Goree and Bissagos Islands,
Sierra Leone, Cape Coast  Castle, etc., but never beyond the
points of  direct communication  with shipping.  No land in
Africa breeds it.
   And here  is the  strong point which, in Dr.  Faget's writ-
ings, confirms  the opinion I  had formed when Dr.  Wood-
worth  first  consulted me about ship disinfection.   He says
distinctly that  no cities attract yellow fever, unless on the sea-
shore, or in close  and direct communication with the commer-
cial marine.
   Every city in  which ice forms freely in winter is thereby
purified from  yellow fever; and, according to  Dr. Faget and
others, no disease  can occur there subsequently except  as the
result of reimportation.   In those cities,  like  Havana,  Yera 
LOCATION OF  INFECTED CITIES.
27
 Cruz, and the Brazilian ports, where frost is unknown, suscep-
 tible persons may contract the malady at any time, especially in
 summer; but these ports might again become pure were the
 shipping not permanently infected and eminently fitted to keep
 up the reproduction of a  sufficiently virulent poison to perpetu-
 ate the malady.
    Is  it not singular that, in the  immediate  vicinity of Yera
 Cruz, such a port as Tampico should be more rarely infected,
 and only when contaminated by the shipping ;  and that  a town
 almost  adjoining Yera Cruz, like Jalapa, should never be visit-
 ed by the malady except among infected refugees from Yera
 Cruz ?   So  long as the heat and stagnant air permeate every
 house  in Yera Cruz, it is most  dangerous,  even for transient
 travelers; but toward the fall of the year a " norther" venti-
 lates the dwellings, and infection is rare.
    Dr. A. N. Bell, in an ably written paper in the " Transac-
 tions of the Epidemiological Society " for 1867, says: " Stagnant
 air, dampness, darkness, and warmth are frequently the insepa-
 rable conditions  of  vessels  in warm climates.   If to these con-
 ditions there be added a filthy vessel, putrid  provisions,  or bad
 water, or if the cargo consist of materials peculiarly liable to
 infection, such as rags, hides, feathers, sponge,  or sugar, the cir-
 cumstances are then complete, not only for the  reception of the
 poison, but for its origination and continuance," in the delta of
 the Mississippi, which Dr. Bell considers the  home of  yellow
 fever.
    Another and an older  ship-surgeon, in a report published in
 the " Medico-Chirurgical  Review"  for 1840,  says: " That  in
 many cases, and the worst cases, West Indian fever is essentially
 connected with some agency in the interior of  ships, altogether
 independent of personal communication, or collections of extra-
 neous matters, all discriminative experience shows."
    Briefly, yellow fever is  a disease of the intra-tropical and
 juxta-tropical Atlantic  ocean, always infesting ships, and only
 attacking towns  in direct  communication with those ships ; dis-
 appearing entirely whenever frost  can reach it;  but continu-
ing almost perennially in  some cities which are in constant in-
tercourse with shipping, and  in which the temperature is never
low enough to destroy the poison. 
28
YELLOW FEVER A NAUTICAL DISEASE.
             Altitude as affecting Yellow Fever.
    Yellow fever is a disease of a dead sea-level; and, the deeper
the ship and flatter the city, the more readily it pullulates  and
destroys.   Gravitation  favors  stagnant vapor and molecular
masses  of organic decay.  Below the sea-level in the holds of
ships its maximum intensity is matter of history.  In low, close
dwellings and cellars on land, the mortality is  frightful.  Alti-
tude  bears an indirect ratio  to  the prevalence  of the malady,
all other conditions being equal.
    Since, as we have stated, the malady does not spread beyond
inhabited seaports in low situations, and  is intimately associated
with confinement of human beings in inclosed spaces, if cases
of yellow fever have occurred, as Humboldt says, 3,243 feet above
the sea, it could only have  been  exceptionally among persons
who have contracted the disease near  the sea-shore or accessible
shipping.  Memphis is 400 feet above the sea-level, and there is
no doubt as to the virulence  of  a genuine  epidemic  at this alti-
tude on the banks of the Mississippi; but, the higher the land
and the drier the atmosphere, the more difficult is the propaga-
tion of the disorder.

                    Barometric Pressure.
   Dr. Barton, of Louisiana,  demonstrated, so far as his observa-
tions extended, a relation between the prevalence of yellow fever
and high barometric pressure.  Basing  his  calculations on an
examination of fifteen of  the epidemics which had occurred in
that city, the mean pressure of the atmosphere was,  at the com-
mencement, 30*108 ; at the maximum of the epidemic, 30*024;
and at  the declination,  30*074.   The difference between  the
pressure at  the  commencement and  at  the maximum of  the
epidemic is *084; and that between the maximum and the  declin-
ation, *050.
           Is there a Proper Soil for the Disease ?
   The learned Noah Webster,* not a medical man but  a pure
historian, set himself to prove at the  close of the last century
that celestial, telluric, and volcanic disruptions and other pro-
   * "A Brief History of Epidemic and Pestilential Diseases," Hartford, 1799. 
         IS THERE A PROPER SOIL FOR THE DISEASE?       29

digious phenomena  cause epidemics; that "the weapons  of
Apollo," translated into " intense heat of the sun," and Diemer-
broeck's seminarium, or deadly  pestilent germ,  sent from
heaven, developed all plagues; that the  Hippocratic to theion
and seminarium e ccdo demissum was the yellow-fever germ of
the present day.  Boldly does Webster declare: "That some
such general cause exists in  the atmosphere, at certain periods,
will be rendered very probable, if not certain, by the facts here-
after to be related."
    As easily as he noted coincidences between comets and boils
have others recognized an indispensable affinity between yellow
fever and land;  first  all  lands, and then wisdom  has led them
to discriminate against other lands but their own.  Dr. Francis
vehemently uttered:  " No land has been more earnestly libeled
by her own sons than ours by our own who have adopted  the
domestic theory."
    A navy surgeon,  who had ventured to draw a sound  conclu-
sion from that  which he had seen, says: " The yellow-fever
poison may originate on  shipboard independently of any com-
munication with an infectious city."   It is to be regretted that
Dr. Wilson, who penned this phrase, should have indulged in the
belief  that Nature is uncertain and irregular in her ways; that
so simple and  sufficient a cause should have to be supplemented
or modified by something else.   He  says: * " The yellow fever,
prevailing more or less constantly in all  the cities of tropical
America, is endemic in those cities.  When unusually prevalent
and exceedingly fatal, without apparent reason for this  change
of character, yellow fever is said to  prevail epidemically, or to
have become epidemic.   In  this case an epidemic influence is
supposed to be superadded to the ordinary causes of the disease."
   A sensible naval surgeon, whose words I have already quoted
in another connection, but who is only known to us as a name-
less reporter to the " Medico-Chirurgical Review," on the health
of the navy from 1830 to 1836, says: "If this disease were the
spontaneous production of America, how comes it that it did not
destroy the British armies which acted in the late war in Penn-
sylvania, Yirginia, and Carolina, as it  has done of  late in the
West Indies ?"
                * "Naval Hygiene," Washington," 1870. 
30
YELLOW FEVER A NAUTICAL DISEASE.
   And if we seek for any expression, on the part of well-in-
formed authorities, in the West Indies, we utterly fail to  learn
anything of local conditions adequate to more than the develop-
ment of periodic affections.  In many cases we have evidence
of the great salubrity of individual West Indian islands.   Re-
ferring to St. Eustatia  and Curacoa, Dr. Peixotto published a
vigorous  defense in 1822,  and described both as being dry,
rocky, and proverbially  healthy.  He says:
   " Curacoa is situated in latitude 12° 8' N., and longitude 69°
W., distant twenty leagues from the coast of South America, of
which the highlands  are  plainly discernible in clear  and  calm
weather.   The island extends from  the northwest to the south-
east, in length forty miles, and its mean breadth may be fifteen.
The general appearance of the island is barren and parched, its
surface broken into abrupt masses of hill, which raise their pic-
turesque forms in every direction.  They are, however, bare of
all marks of vegetation or verdure, cultivation being confined to
the vales, in which the fruit and maize plantations are more ad-
vantageously located.
   " The soil is superficial, consisting of a slight mold covering
a rocky substratum, in which gypsum,  pumice, ochre, and some
argillaceous  earth  are found.   Water  is to be had by digging
into the rock; but there are no rivulets of fresh water, nor any
marshes to be seen in any part of the island.  The hills are of no
inconsiderable height, some of them having an elevation of from
ten to fifteen hundred feet above the level of the sea.   They no
doubt serve a highly useful purpose, by collecting and conduct-
ing the currents of air along valleys; and, adding to their force
and impetus, they refresh the atmosphere."
   Abbe Raynal and Bryan Edwards,  in their admirable works
on the West Indian islands, describe no feature—no general or
localized conditions—to which we can  ascribe  any but the ordi-
nary malarial diseases.   Indeed, Mr. Edwards, in describing the
uniform high temperature in all the lands beneath the tropic of
Cancer, the distinction between the two seasons, the wet and the
dry, how the weather  becomes dry, settled, and sultry  when
the tropical summer reigns in full glory, adds a note—a contrast
between the healthiness of the West Indian islands as compared
with the southern provinces of North America.  " In Yirginia," 
         IS THERE A PROPER SOIL FOR THE DISEASE?       31

Mr. Jefferson relates, " the  mercury in Fahrenheit's thermom-
eter  has been known to descend from 92° to 47° in  thirteen
hours."  And, with  pride, exultingly he  adds: " The West In-
dian islands are happily exempt from these noxious emanations,"
produced by sudden  change from great heat to great coolness.
   The most diligent search will fail to reveal that even in their
ancient state they were noxious to health.   Maize was regularly
sown twice a year in the plains or savannas;  the  islands were
populous and necessarily cleared of underwood ; the trees which
remained afforded a shade that was cool, airy, and delicious.
" Such were these orchards  of  the sun and woods  of perennial
verdure," says Edwards.
   The sanitary history of the West Indian islands,  after Cornil-
liac,  is sketched in the next chapter, and  we derive from a gen-
eral survey the strongest presumption that not even Martinique
and Cuba, which  have suffered most, present  a single rood of
soil in which yellow fever was ever known  to develop spon-
taneously.   If it  has, the crop has been most erratic,  and un-
like  the unhappy perennial  results of  man's abode  in swamps
and jungles.
   Some of the  cities now constantly preyed  upon by yellow
fever, such as Rio de Janeiro, were absolutely free from the
malady not many years since.  Rio was,  for  over  a  century
probably, as free  as  any European port;  but commercial inter-
course has given it the tropical ship fever, the permanent source
of contamination  being ships  on which yellow fever infection
often continues so long as such  vessels float.
   The industrious La Roche, compiling with the greatest care,
writes with a mild bias, sufficient to show that his mind was not
free from views which time must  modify.   He says: "Be the
causes, however, what they may, on one point there can be no
doubt—that  the yellow fever  has geographical limits, beyond
which it does not appear, and that within those very  limits
there are many places where  its usual apparent  cause would
seem  to  exist, but where, nevertheless, it has  never shown it-
self, or  has done  so very seldom.  The  West  Indian islands
and part of the coast of South and North America constitute its
proper soil.  From Brazil to  Charleston in one direction, and
from  Barbadoes to Tampico in  another, the causes of this form 
32
YELLOW FEVER A NAUTICAL DISEASE.
 of fever are in constant, though unequal force, in regard to dif-
 ferent seasons and localities." *
    " Its true area,"  says  La Roche, " includes the Caribbean
 and other islands  called the West  Indies, and  Bahamas; the
 contiguous coast of  Colombia and  Guatemala," northward as
 far as Boston.  The true area is partly around the regions indi-
 cated in this quotation, and  not near the Atlantic shore of the
 United States, embodied in  his full sentence, and which I  em-
 brace in the words-"northward as far as Boston."
    The Board of Experts say : " From the West Indian islands,
 as the earliest historical focus of  the disease, yellow fever  has
 been carried  at different times into several of the countries of
 Europe,  Africa, South America, and North America.
    " Yellow  fever has  never made  its appearance on the great
 continent of  Asia, nor in Australia, nor in any of the islands of
 the Pacific Ocean ;  and it  has not prevailed extensively on the
 Pacific coast  of the American continent.
    " In all the countries- outside of the West Indies which have
 been visited  by it, yellow fever is an exotic disease;  and in all
 of them  its introduction can be traced  either directly or indi-
 rectly to the  West Indies.  In some of them  it seems  to have
 established itself permanently, and  to have become endemic;
 as, for example, in the Brazils.  In  most of  them it has failed
 of naturalization, and successive epidemics can be traced to suc-
 cessive importations."
   Dr. Daniel Osgood, of Havana, shows how the 'West Indian
 islands can not be the "proper soil"  for the disease now, if they
 were not the  " proper soil"  before the days of Columbus.   It
 was not  seen, wherever it is  said to have arisen, until after  a
 considerable progress  had been made in the population of those
 places, covering town sites with streets and buildings, and estab-
 lishing centers of active trade.

           Yellow Fever an  Exotic in every Land.
   The malady is  as  much an exotic in the West Indies as it
is in New Orleans.  In relation to all  lands, I say what Dr.
 Francis said of New York: " The disease is an exotic .... in

  * " Yellow Fever," by R.  La Roche, M.D., Philadelphia, 1855, vol. i. (p. 119). 
     NATURALIZATION  OF THE DISEASE ON  LAND IMPOSSIBLE.  33

 all cases an imported pestilence."  Havana has no greater affin-
 ity for yellow fever, or the fever for it, than Pensacola; and it
 behooves the British, Spanish, Mexican, and Brazilian Govern-
 ments,  as well as the United States, to join hand in hand
 firmly and speedily  to test  the  truth  of such  an assertion.
 Yaluable as the scientific researches at present in progress must
 prove, we have here work demanding less of microscopic inves-
 tigation  than broader serological, meteorological, and geograph-
 ical study.
    The  impression produced on my mind from the first by the
 conclusions of the Board of Experts was eminently favorable.
 Reading them, after months of thought and greater familiarity
 with the question, I still consider them in the main sound ;  but
 on some fundamental points, when  yellow fever is practically
 extinguished by the best known means of sanitation, those con-
 clusions, prepared in 1878, will mark a  line of distinction be-
 tween the matured views of the period and the revelations of
 subsequent inquiry.   The most obvious conclusion arrived at by
 the Board of Experts is that yellow fever is a disease of cities;
 that its habitat is the West Indian islands; and that it has not
 failed of " naturalization"  in  " countries outside of the West
 Indies."   From this I unequivocally dissent.

      Naturalization of the Disease on Land impossible.
    Ague is a disease natural to marshes, and the splenic fever
 of Texas is peculiar to a certain  soil and grass.  We have no
 difficulty in migrating to or from the regions where these diseases
 exist, but no such knowledge is possessed in relation to yellow
 fever.  Popular opinion has long adopted the view that any
 malady afflicting a people may in the  long run so establish itself
 among them that it can not be  eradicated.   Such  a  view is
 totally erroneous in relation to the pure contagia and to  plague
 or yellow fever: they cease when the active causes of their de-
 velopment cease.   The dependence of  some diseases  on the
 aquatic organisms of a country is well known to medical men.
 The alternate  generation of trematode  or sucking worms de-
mands water and animals that  live in water.   The  earlier and
more immature forms of animal life occur in water.   In the air
they dry and die.  The rich, warm, and  phosphorescent waters
           3 
34          YELLOW FEVER A NAUTICAL  DISEASE.
of the tropical Atlantic have great capabilities in favoring cer-
tain  forms of putrescence.  Many animal and vegetable forms
in them die so soon as they are inclosed where stagnation and
decay may be  favored.   This  putrefiable matter abstracts oxy-
gen from  the  sulphates, producing sulphurets; a sulphuret of
sodium  is  formed; this  again, acting  upon  the water, decom-
poses it, and sulphuretted hydrogen is disengaged.  No sulphu-
retted hydrogen is found in sea-water, even on marshes, where
an abundant oxidation is possible.  Fermentation or putrefac-
faction is essential to this complex chemical decomposition.  A
slight access of air is necessary to start it—free ventilation
kills it.  The deoxidizing power of  putrefying  substances is
very remarkable, and the irrespirable character of gases rising
from the bilge can be readily accounted for.

                      Its Propagation.
   The remark made by the Board of Experts, that  yellow
fever has never appeared in any place in the United  States in a
shorter  time than  would enable  intercourse with an infected
place, is correct as  applied to inland dispersion of the disease,
but it is quite certain that the  disease has frequently been gener-
ated or developed in a ship  at sea between two ports, or in
some cases possibly within the harbor of the city it has infected.
This depends on latitude; and, while  no such origin de novo
could occur in  the waters of New York, it  certainly could in
Florida straits or even Havana harbor.
   " Yellow fever is transmitted through the interior of a coun-
try by steamboats, barges, and  other river craft; and by railroad
cars, wagons, carriages, and other land vehicles; and the infec-
tion may be attached to the boats, cars, or other vehicles them-
selves, or to their cargoes, or to the persons traveling upon them
with their  baggage." *

            Alternating between Sea and Land.
   Mr. Tytler, in 1799, said: " This distemper attacks sailors in
the West Indies more than any other  set of  men, even of new
comers."   Dr.  Stevens  saw cases  of yellow fever in St. Do-
* "Conclusions of the Board of Experts," pp. 15,16. 
HUMBOLDT'S VIEWS.
35
 mingo  during the months  of  August and September,  1798 ;
 and these were entirely confined to American seamen, while the
 native inhabitants of the city were totally exempt from it.  It
 is well  to  remember that the  malignancy of yellow fever, as
 Dr. Bell has shown, appears to depend primarily and most gen-
 erally upon suddenness  of exposure to the poison, and secondly
 upon an atmosphere unfavorable to  recovery.  The islanders,
 accustomed to the climate, have acquired a certain degree of re-
 sistance to all heat disease.  The  sailors arriving  in the danger-
 ous tropical season from healthy latitudes are exceedingly suscep-
 tible ; and, from the confined space in which they are compelled
 to live and sleep, they are exposed to  a concentrated infection.
    The conditions on shipboard and in a house are not dissimi-
 lar, except i/n degree, as to stagnation of air and accumulation of
 putrescible organic matter in the air and recesses; and there is
 abundant evidence of the element of  time being in some sense
 related, in the ship and the house, in the development of foul
 air and yellow fever.  Aerate  and disinfect  the  house or the
 ship,  and the disease is gone.   It is  in the  true sense of the
 words endemic or naturalized nowhere, in no fixed spot; and on
 a clean coast it contaminates the seaport towns without reaching
 the villages  of  the  seashore close by.   There is an alternate
 transit from ship to house and from  house to ship in seaports;
 but anywhere both can be, in my opinion, radically and perma-
 nently purified.   I do not hesitate to condemn the too common-
 ly used  expressions acclimatized, naturalized, and localized as
 an endemic, in relation to any city on  the Atlantic seaboard.

                     Humboldt's Views.
    What did Humboldt say many years ago ?  " In all climates
 men imagine they find some consolation in the idea that a dis-
 ease reputed pestilential is  of  foreign  origin.  As  malignant
 fevers are  easily engendered, amid a large crew, crowded to-
gether {entasses) in filthy vessels, the commencement of  an epi-
demic dates pretty often from the arrival of a squadron.  Then,
instead of attributing the evil  to the vitiated air contained in
vessels deprived of ventilation, or to the effect of  a hot and un-
healthy  climate  on  newly arrived sailors, people  affirm  that it
has been imported from a neighboring port, where the vessels 
36
YELLOW FEVER A NAUTICAL  DISEASE.
in the convoy have touched, on the passage from  Europe to
America.  It is thus that we often hear it said in Mexico that
a vessel of war, in which such or such a viceroy has arrived at
Yera Cruz, has introduced the yellow fever, which had  ceased
to reign for some years past; it is thus that, during the hot
season, Havana, Yera Cruz, and the  ports of the United States
mutually accuse each other of being the source of the disease
by which they are visited."

      Probable Origin in  the  Tropical Atlantic Basin.
   I have shown that yellow fever undoubtedly belongs  to the
second great group  of indigenous  diseases, but the  conditions
favoring it are on the ocean; the major factor in its genesis
is  traced, by the general  history of yellow fever, to the region
of intense heat in the Atlantic, possibly to the whole equatorial
belt, from 35°  north  latitude across the tropic of Cancer, and
down to  latitude  5° south.   Its most prolific region is west of
25° west longitude, and between the calm belts of  Cancer and
the Equator in the Western Atlantic.   " The Amazon, always
at a high temperature,  because it runs from west  to east, is
pouring  an  immense  volume  of warm water into this part of
the ocean.   As this water and the  heat of the  sun raise the
temperature of the ocean along the equatorial sea-front of this
coast, there is  no escape for the liquid element, as it  grows
warmer and lighter, except to the north."  The waters must
flow  north.   The great  equatorial  caldron,  "which Cape St.
Roque blocks up on the south, disperses its overheated waters
up toward the  40th degree of north latitude, not through the
Caribbean Sea and Gulf  Stream, but over the broad surface of
the left basin of the Atlantic Ocean."  (Maury.)
   " Until  recently," La Roche  tells us, " the river Amazon,
which divides Brazil from Guiana, formed the boundary of the
disease south of the equatorial line ;  for, although it is said to
have prevailed at  Olinda  from 1687 to 1694, and to have shown
itself  as far as Montevideo in the beginning of the present cen-
tury, the latter circumstance is open to some doubt; while in
Brazil, from the close of  the seventeenth century to the middle
of the present, the disease was not observed.  Since 1850 it has 
        USUAL COURSE FROM THE  TROPICS  NORTHWARD.      37

 invaded Rio Janeiro, Bahia, Pernambuco, and other places of
 that country." *
    The history hereafter given of  Anson's voyage round the
 world indicates that in 1740 St. Catherine's Island, in 27° south
 latitude, was  visited by yellow  fever of  the most malignant
 kind; but, so far as we know, the  disease was limited to the
 British squadron.  Anson's ships sailed west from Madeira, be-
 came sickly in the equatorial  belt, and struck south on nearing
 the American continent.

   Usual Yellow-Fever  Course from the Tropics  northward.
    These points in relation to temperature and equatorial cur-
 rents may account for the localization of yellow fever in this
 region, and almost justify the old name  of typhus  tropicus.
 The  past history  of yellow  fever  indicates that the  disease
 travels  in the  direction of the northward flow of the heated At-
 lantic and the Gulf Stream rather than southward.
    " A distinguished physician of  New  Orleans,  Dr. E. H.
 Barton, to whom the scientific world is  deeply  indebted for
 ample and correct meteorological records and valuable  observa-
 tions relative  to the etiology of the  yellow fever, has called  at-
 tention to the fact that within  the limits of the zone above
 pointed out the  disease  usually commences its epidemic career
 in the south, and progresses gradually toward the north."   He
 points out the course and cities successively infected from  May
 to September  in any year, and adds " that in this mere histori-
 cal statement  it is not intended to be implied that the yellow
 fever is imported from the south  to the north in this regular
 gradation, but  merely that the physical changes inviting and pro-
 ducing  its development become evolved as the season advances."
   Are not, however, the following  words  of La Roche highly
 suggestive, when we connect the origin of  the disease with the
 ocean rather than with cities where  the disease is supposed to
 have become naturalized ?  He says it follows " that it usually
 commences earlier  in southern latitudes, inasmuch as the ther-
mometer reaches there the requisite average sooner than in the
northern sections of the zone.   But,  as we proceed, facts will be
* La Roche, op. cit., p. 120. 
38          YELLOW FEVER A NAUTICAL DISEASE.
adduced which  show that the disease has  not unfrequently ap-
peared later in  southern latitudes than it usually appears with
us."
                Floating  Center of Origin.
   Its center of origin is a floating one, and  the  combined fac-
tors, incident to human intercourse in the ships and cities of the
tropics, skip and scatter the undulating plague, in its yearly in-
cursions on land, to the confusion of past history, the dismay of
all, and the destruction of terrestrial endemicity dogmas.
   La Roche tells us that, " according to Yines, it  appeared in
Barbadoes in 1647.   Ligon, who records  the  same fact, states
that  the  inhabitants of the island, and shipping too, were so
grievously visited with the  plague (or as killing a disease) that,
before a  month had expired after his arrival, the  living  were
hardly able to bury the dead.   In  speaking of  the following
year, 1648, Du  Tertre says: ' During this year, the plague, un-
known in these islands since the time they were inhabited by
the French, was introduced therein  by some vessels.   It com-
menced at St. Christopher, and in.the course of eighteen months
carried off one  third of the inhabitants.'  Writing ten years
later, Rochefort remarks:  ' The  plague was  formerly unknown
there (the West Indies), as well as in China  and some other
eastern countries.  But a few years ago, the greater number of
these  islands were  afflicted with malignant fevers which the
physicians regarded as contagious.'   It prevailed in Jamaica in
1671.  The event  was connected with the return of the victo-
rious  fleet ' from the  signal Panama expedition,'  when ' they
brought with them a high, if not pestilential, fever, of  which
many died throughout the country.'  The fever appeared twenty
years  later at Leogane (St. Domingo), in 1691, on which occa-
sion, according  to  Moreau de St. Mery, it was brought by the
fleet of Admiral Ducasse.  The same year it  showed itself at
St. Christopher, and the next at Port de Paix.  The outbreak
of the disorder, and its extensive ravages  in Pernambuco (Bra-
zil), from 1687 to 1694, is known to most  readers; so, likewise,
its supposed  introduction  thence into Martinique in  1690, by
the Oriflamme,  which there touched on her return from Siam.
It prevailed also in the city of the Cape (St. Domingo), in 1696,
and at Leogane in 1698.   Hughes, in his  ' Natural History of 
          YELLOW FEVER ORIGINATING IN MID-OCEAN.       39

 Barbadoes,' writing on the authority of  Dr. Gamble, mentions
 the prevalence of the fever in that island in 1691.  It was then
 and there called the new distemper, or Kendal's fever, after a
 distinguished and popular officer of that name.   Hughes also
 mentions its occurrence in 1696.  According to Captain Philips,
 who visited the island in 1694, it prevailed there very exten-
 sively, and had done so during the war some years before."
    Long after yellow fever had first  declared  itself in the
 American Archipelago, its recurrence in  seaports, sometimes at
 long intervals, led medical men to fix new dates and new sources
 of its  origin.   Thus Warren, who lived at Barbadoes in 1739,
 believed the disease had never been in the island before 1721,
 when it was brought from Martinique in the Lynn man-of-war.
 The disease appeared, according to him, a second time in 1733,
 when  it also reached Martinique.  He believed it  to be of
 Asiatic origin, and ascribed  it to a Provencal fleet which ar-
 rived from Marseilles at Port St. Pierre in Martinique, having
 on  board several bales of Levant goods taken in at  Marseilles
 from a ship just arrived  from St. Jean d'Acre.  Upon opening
 these bales  of goods at Port St. Pierre,  the distemper immedi-
 ately showed itself, and well it might if they came from a vessel
 infected on the passage in the tropical Atlantic.  The coinci-
 dence  might be accounted for  by the now known frequent at-
 tack of men engaged in unloading the vessels, and custom-house
 officers, who first have access to the hold  of the ship after it has
 become infected on the high seas.

          Yellow  Fever originating in  Mid-Ocean.
    Sir Gilbert Blane, in his work on the " Diseases of Seamen,"
 relates: " With regard  to the effect of putrid exhalations, I
 need only mention that at the time of the battle of the 12th of
 April,  17S2, there was not a sickly ship in our fleet; but many
 of the officers and men who were sent to take care of the French
 prizes were  seized with the yellow fever; and it was observed
 that when at any time the holds of these  ships, which were full
 of putrid matter, were stirred, there was an evident increase of
those fevers soon after."
   Dr. Copland, entertaining views not very dissimilar from
those suggested before by Humboldt and Audouard, says that 
40          YELLOW  FEVER A NAUTICAL DISEASE.
since his visit to several places in Africa, and knowing the very
limited space in which a large number of slaves are often con-
fined, both on shore and in slave vessels, he entertained the idea
that this pestilence or its  seminium, or specific infection, had
been generated originally by the congregation of negroes in a
close atmosphere, or is generated de novo  by this  race  when
placed in the circumstances now stated; and that,  although it
affects them in a comparatively slight manner, it is most par-
ticularly baneful to the natives of the colder regions.  Of course
the slavers arrived near the equator reeking with foulness, and
readily imbibed the local factor of yellow-fever infection, as they
approached the eastern shore of Central and Southern America.
    La Roche refers to records of the rise and spread of yellow
fever on board of ships occurring, as they often have done, under
circumstances  which forbid the supposition of a foreign source
of contamination, and point to the vessel itself as the focus of
infection.  He says: " A careful perusal of the numerous facts
we possess on  the  subject before us, so far from justifying  the
propriety of discarding as  spurious and  erroneous all that  has
been said in support of the malarial origin of the fever on ship-
board,  will fully sustain the opinion of  those who  ascribe, in
very many instances, the appearance and spread of  the disease
in such localities to the operation of morbid effluvia generated
in the  timbers of the vessels themselves, or the materials they
may contain."
    Dr. Currie, of  Philadelphia, complimented by La Roche as
" a distinguished countryman of ours," never could discover the
most remote reason for admitting that the yellow fever had ever
originated in this country ; he thought that " crowded transports
or ships of war generally, if not always, constituted the original
and proper sources of the matter of contagion or the poison of
the disease."
    Dr. Faget  states most  categorically  that  facts  prove that
yellow fever may break out in ships at sea {meme enpleine mer),
without searching  beyond  them  for any cause capable of pro-
ducing such a malady.
    Through the kindness  of  Dr. Cabell, the President of  the
National Board of  Health, I have had  the gratification of read-
ing  a  most able letter whieh appeared in the " Pensacola Ad- 
          YELLOW FEVER  ORIGINATING IN MID-OCEAN.        41

 vance" on  the 30th of April last.   The author of that letter
 was Dr. Robert B. S. Hargis, and in it he says, backed by a
 quarter of a century's experience:  " After mature consideration,
 I long since reached the conclusion that yellow fever is not only
 exotic, so far as North America is concerned, but  never origi-
 nated anywhere on land / and that it had its genesis on ships
 or  the  sea-going vessels within' the  tropics."  Further  on he
 remarks that " filth, either per se or associated with an epidemic
 constitution of  the air,  free from  yellow-fever germs  found
 abroad, will not cause yellow fever on  land.  I say ' on land'
 anywhere on the face  of this globular mass we live on."  He is
 explicit as to its undoubted origin.  He  says:  " In the hold of
 a ship, in which proper hygienic or sanitary measures have been
 neglected, that has sailed within the tropics a considerable length
 of time, there  may, nay do, often  exist powerful causes  of  in-
 fection of a peculiar  character or nature, due to the sea water,
 which always in the ship's hold contains large quantities of dead
 organic matter, peculiar to itself, mixed with dead rats, and  in-
 sects which always infect ships to a very great extent, and which,
 together with  the  debris  of  an assorted cargo, excluded from
 fresh air and light, and subjected to a very high degree  of heat,
 exceeding often 110° Fahr., give rise to  that very peculiar and
 specific infectious  principle that causes  yellow fever.  In  the
 hold of a ship, then, in the tropical seas, may be found the habi-
 tat of the yellow-fever germ; there the fons et origo mali ex-
 ists, which has been the ' stone of Sisyphus' to New Orleans for
 three quarters of a century."
    Dr. Hargis cites a number of cases on which his very posi-
 tive opinion is based.  He refers to the ship Le Bceuf in 1635 ;
 in 1726, in the fleet of Admiral Hesser off Portobello; in 1746,
 the  Spanish ships  Angel  and Astra on their way to the West
 Indies; in 1783, in Admiral Solon's squadron; in 1785, Spanish
 ship Aldefensa;  in 1703, British ships Beaford and Kent; ship
 Hankey in 1792; besides ships in our own day.
    La Roche accepts without  qualification the opinions of the
 origin of yellow fever  on shipboard from local sources of infec-
tion, and independently of external influences. *  He discards a
  * " In the performance of this task, attention might perhaps be called to the
history of the disease as  it prevailed on board the Princess Caroline, at Curacoa, in 
42           YELLOW FEVER A NAUTICAL  DISEASE.
 host of doubtful instances.  He refers to it the epidemic which
 occurred on  board the  U. S. ship Delaware in  1790-1800 at
 Curacoa. Dr. Anderson, of that ship, informed Dr. Yaughan, of
 Wilmington (Del.), " that the  disease unquestionably originated
 on board, in the harbor of Curacoa, while the inhabitants of the
 island were perfectly healthy.  As  soon  as the nature of the
 disease was known, they put  to  sea, in hopes of  receiving ad-
 vantage from a pure circulation of air; but  the sick-list increased
 daily, and they returned to the harbor of Curacoa  in a much
 worse condition than they left it.   Forty sick were landed; and,
 though there was no restriction in intercourse with the inhabi-
 tants, there was not a single suspicion of contagious influence."
    Dr. Nathaniel Potter quotes the remarkable case of the  Bus-
 bridge Indiaman, which  sailed from England to Madras and
 Bengal on the 15th of April, 1792; on the 26th of  May she
 crossed the equator in 27° west longitude,  i. e., passing far  west
 of the Cape de Yerde Islands and  near St. Paul's Islands, so as
 to enter the yellow-fever zone.  The mercury ranged from 80°
 to 96° ; and " in this state of things the yellow fever broke out,"
 says Dr. Brice, " although we had touched  at no  port, nor had
 any communication with any vessel."
    On the 3d of June, 1799, the frigate  General Greene left
 Newport,  R. I.,  for Havana, which  she  reached on the 4th
 of July.  She was beset by a  storm which lasted  several days,
 and she made a great deal of water, notwithstanding that she
 was a new ship.  A great heat prevailed ; her ballast containing
 earth charged with organic  matter, and a quantity  of cod-fish
 on board, putrefied.   Notwithstanding all the sanitary measures
 taken immediately, yellow fever broke out.  It  gradually ac-
 1763, as so graphically described by Rouppe; on board of the Majestic, at Port
 Royal,  Martinique, in 1795;  of the Ganges; of the Peacock and Grampus; the Sea
 Island  at Middletown, in 1820; the Polly, at Chatham, Conn., in 1796; the Ten
 Brothers, at Boston, in 1819 ; the Favorite and Ocean,  at Perth  Arnboy, in  1811;
 the various vessels from New Orleans, at Staten Island, in 1848; the Bann,  at As-
 cension, in 1823; the Palinure, at Martinique; the Nereide; the Expeditive;  the
 Gloriole; the Eglantine; the Africaine; the Middleburg; the Chichester; the Her-
minie; the Vestal; the La Ruse and  the Grayhound, at the Wallabout, in  1804;
the Ann Maria, at the New York Quarantine, in 1821;  the Alban, at Port Royal,
Jamaica; the Snake,  at St. Jago, Cuba; the Tartarus, Crocodile, Dee, Satellite
Hecla, Megsera, and others, of which we have the records." (La Roche, vol. ii.,
p. 423.) 
          YELLOW FEVER ORIGINATING  IN  MID-OCEAN.        43

 quired virulence and activity, until the ship touched the port of
 Havana, where at the time the disease did  not exist. Dr. Holli-
 day of this city identified the disease.   This ship suffered again
 in 1800, the disease proving still more malignant and fatal, and
 attacking  some individuals  from the town of  Newport,  who,
 after her arrival, worked on board.  The air in the hold of this
 vessel, when  first  inspected, was so contaminated as  to extin-
 guish lights immediately.
    In September, 1828, when Yera Cruz  was quite free  from
 yellow  fever, the United States  ship Hornet, lying three miles
 off at Sacrificios, suffered from an outbreak.  The ship had been
 repaired and  " salted," was very damp, and foul with fetid bilge-
 water, putrid wood, chips, and shavings; and the external  tem-
 perature averaged 87° at noon, ranging from 79° to above 90°.
 She left for the north, and as the thermometer descended to the
 freezing point the disease entirely disappeared.
    The United States ship Levant contracted the disease, owing to
 the foul state of its hold, in 1841, on a cruise by the West Indies
 to Pensacola, and it only disappeared after several severe frosts.
    A Court of Inquiry, ordered  by the Secretary of the Ameri-
 can Navy, dealt with an outbreak of yellow fever  on board the
 frigate  Macedonia, in the  summer of 1822.   She sailed  from
 Boston for the West Indies on the 2d of April, reaching Havana
 healthy at the end of the month.  Here she lay till the 4th of
 June.   She subsequently touched Cape Haytien and  Port-au-
 Prince.  All these places were remarkably  healthy.  Yellow
 fever broke out on board on the 8th of May, extended rapidly
 among the crew, and carried off  several of the officers.  On the
 14th of June she sailed for  San  Domingo, but the disease con-
 tinued, and on the 24th of July she sailed  from Havana for the
 Chesapeake.  The officer in charge found at Havana  that the
 air in the ship's hold was dense, close, disagreeable, and hot.
 Her ballast was found muddy and dirty.  Water was let into
 the hold between the 28th  of  April and the 7th of May.   The
 captain having been informed by some English officers,  who
 arrived there after the Macedonia, that there was a " standing
 order in the English service that water should not be let into
their vessels  in the port of Havana,"  the practice was discon-
tinued.  The bilge-water then became filthy and  offensive, so 
44
YELLOW FEVER A NAUTICAL  DISEASE.
that the men were dispersed and sent off from the ship when it
was pumped out.  " There was a gelatinous substance of a very
offensive character on the chain cable when hove in;  and on
taking out the starboard cable a part of it was found to  be wet,  *
in consequence of a leakage from one of the berth-deck scup-
pers.  The casing of this being removed, about two bucketfuls
of very offensive filth was found."
   " The sickness and mortality on board, according to Captain
Biddle, were greatest among the persons employed in the hold
and among the carpenter's crew, who, by working the  pumps,
were most exposed to the bilge-water discharged from the ship;
and by Dr. Chase, one of the surgeons, it is stated that  the dis-
ease commenced near the pumps.  The boat crews were, on ex-
amination, found to have suffered less than the rest of the ship's
company.   It  appears that the awning was constantly spread      <
while in Havana, and that the men were very little  exposed
to wet or to the sun, or to duty in boats, or to fatiguing duty on
board, being excused from keeping watch at  night.
   " From these various circumstances the inference is natural
that the disease, which carried off one hundred and one individ-
uals out of a complement (including officers) of three hundred
and seventy-six, arose from the operation of causes located in the
vessel itself.  There was, as we have seen, no yellow fever at
the time in the city or port of the Havana,  and  the same fact
has come to my knowledge through other channels.  Other ves-
sels, at no great distance from the  frigate, did not suffer from
the disease, and neither  officers nor  men could have communi-
cated with individuals  already affected.  Hence, it was impos-
sible for the fever to have arisen from the introduction of a con-
tagious germ,  or from morbid effluvia proceeding from the port
and wafted from a distance.   The disease thus produced contin-
ued on board during the passage to St. Domingo, and therefore
could not have depended on a cause existing in the harbor or city
of the Havana, for in that event it would have ceased soon after      '
the vessel put to sea.   It increased at Port-au-Prince; and, as
the fever was not prevailing  there  at the time, its aggravation
was not the result of external influences having their source at
that place.  It is to be remarked that the disease continued to
prevail  during the passage back to the Havana, as well as during 
          YELLOW FEVER ORIGINATING IN MID-OCEAN.        45

the stay there, and did not cease before the arrival of the vessel
at Norfolk and the landing of the crew.  To this must be added
that the ship's hold was the receptacle, while at the Havana, of
materials which in other localities have, under atmospheric and
thermometric conditions of like nature, given origin to morbific
effluvia of a most pestiferous character;  that the disease first at-
tacked and prevailed most severely among those most exposed to
the effluvia from the hold; that the boat's  crew, who were less
exposed to those effluvia or to the  contaminated  atmosphere of
the ship, were less affected by the fever than those who remained
on board; and that the medical officers of the ship, Drs. Cadle
and Chase, and Dr. Dayers of the navy, whose opinion was asked
by the court, and who was familiar with all  the circumstances
of the case, expressed the opinion that the fever originated from
noxious effluvia generated in the ship's hold.*
    " Scarcely less important," says La Roche, " than the  pre-
ceding, is the history of  yellow fever  on board the United
States brig Enterprise, in 1822.  In the middle of May she was
three days off the Morro Castle, Havana, which is believed, after
careful investigation, to have been  free from the fever in an
epidemic  or sporadic form.  She sailed for Charleston near the
end of June, and  remained there eight days;  but when she
reached there one of the lieutenants  was sick.  He died  on the
1st of July.  The cases multiplied; the ship sailed for New
York with ten on  board, and  the next day they increased to
thirteen.  On the 2d of August, twenty-five days after her arri-
val, and after repeated whitewashing, letting in water, and con-
stant ventilation, one of the sailors obtained permission to take
his wife on board; this woman was taken sick with yellow fever
on the 9th of August, and she died in the  Marine Hospital on
the 18th of that month."
    This ship Enterprise is referred to in a  private letter to me
from  Dr.  J. C. Faget.  He remarks that  Melier would have
called  her " sick  with the yellow fever " {malade de la fievre
jaune).  She was the  subject of some special observations by
Dr. Carpenter, who stated that she had been often disinfected
according  to methods then known, such as aeration, chloride of
* La Roche, vol. ii., pp. 429, 430. 
46          YELLOW FEVER A NAUTICAL DISEASE.
lime, etc.; but, whenever she sailed in the hot tropical seas, there
were invariably sailors affected with yellow fever.   But at last
she spent a winter in  New York and was cured.   Thereupon
Carpenter declared that only cold would destroy the germs  of
yellow fever.
   " Other cases of evident infection generated on board Amer-
ican vessels,  and spreading among the officers, crew, or pas-
sengers, or on land in  the vicinity,  are on record, and are of a
nature which admits  of no/doubt."  So states the learned com-
piler,* who proceeds with  further references, which I venture
to transcribe and abridge:
   " In 1799 the  sloop Mary was sent into Philadelphia, as a
prize to the ship of war Ganges.   She was not from a sickly
port, and at the period of her arrival there was  no one sick  on
board.  As  soon  as  her cargo was removed, her decks were
washed, and the hatches and ports all shut down.  In this way
she remained three weeks, the weather being at the time very
hot and dry.   The hold and the interstices between the timbers
contained a quantity of vegetable matter (coffee), which, being
mixed with the bilge water and that which had fallen from the
deck at the time of washing, aided by the high temperature and
close confinement of  the air, fermented, and gave  rise  to the
development of highly offensive effluvia. ' The noxious effluvia,'
says Dr. Caldwell, ' that were generated in  abundance, having      t
no vent to escape and be dissipated in the atmosphere, mingled
with the air in the vessel's  hold, and produced it in an extreme
degree of vitiation.   A smell resembling that of common bilge-
water, but more offensive, became troublesome to those engaged
about  the wharf, and was at length traced  to the place where
the  Mary lay.  She  was soon suspected as the source  of the
nuisance.  Her ports and hatches were accordingly thrown open,
when the foul air rushed out in torrents, and spread through the
neighborhood a suffocating stench.  Several persons exposed to
these  effluvia were a few days after seized with decided symp-
toms of yellow fever.'"
    In 1803 the Hibbert, a British three-decker, left Portsmouth,
England, in  ballast,  and  arrived in  New York on the 3d of
July, where  she  had orders to load  with pine, for the  bay of
                 * La Roche, op., cit. vol.  ii., p. 432. 
         YELLOW FEVER ORIGINATING IN  MID-OCEAN.       47

Honduras.  The workmen engaged in loading the ship found
that  the  ballast, composed of sand, had not been changed for
many years, and that the woodwork as well as the bridges were
covered with excreta.  The stench occasioned  by the collection
and  removal  of this  offal was  intolerable.   The men were
obliged to run to the port-holes and hatches for fresh air.  They
removed  all centers of putrefaction, but several of the workmen
suffered  from  haemorrhages, black vomit, yellow fever, and
some died  very rapidly.  No one could imagine that a ship
which had left England could bear the morbid principles in so
violent a form.  Nevertheless, after strict inquiry, it was proved
that  the  Hibbert, employed in 1801  to transport soldiers from
Portsmouth to  Halifax, had from thence served to transport
another regiment from Nassau to the Bahama Islands, and from
thence she returned to Portsmouth with a third regiment; that
in this triple voyage,  as well as  in that  she  made from Ports-
mouth to New York, the same ballast had been in  the ship, and
she had  been totally exempt from disease.  After leaving  New
York, the Hibbert, incompletely disinfected, lost several sailors
on her passage to Honduras, and there she was the cause of the
deaths of several persons, but, adds Deveze, " only of those who
went on  to the  ship and there became infected."
   In 1821 yellow fever broke out in the tropics on  board the
English armed  transport Dasher, the frigate  Pyramus, and an
unarmed transport.   " The Dasher left Barbadoes for Tobago
on the 26th of August, but, in consequence of severe gales, was
obliged to go to St. Lucia.   Proceeding thence  to Tobago, she
there received on board a company of the Ninth regiment, and
sailed for Grenada, in order that the men might avoid the en-
demic fever of the former place.  This company, while on board,
was  perfectly healthy.  On  their landing at Grenada, the men
were immediately placed in quarantine, and remained so for the
space of fourteen days, during which period  not an individual
sickened. ' The Dasher, after landing this company at Grenada,
proceeded hither (Antigua); but, a few days before she reached
this  port, yellow fever made its appearance among her crew, and
previous to her arrival six men had been attacked, two of whom
died.'  The crew  was landed, and the disease ceased among
them. Blacks  were employed to remove the ballast and clear 
48
YELLOW FEVER  A NAUTICAL DISEASE.
the hull.  At the urgent solicitation of Dr. Hartle, the limber-
boards were taken up."
   Here lay the mischief.   Carpenters' shavings in great quan-
tity were discovered in a state of putridity, choking up the lim-
ber-holes so that the water could not pass to the well of the
pump, and lay  stagnant.   Dr. Hartle declared that the fever
"was generated on board, by noxious  effluvia received  into
crowded and badly ventilated berths"; for, the  moment the
crew and marines were removed, the disease ceased.   Nothing
like the most distant appearance of  contagion could be traced,
for none but those residing on board the ship, or exposed to the
effluvium from her hold, prior to  her expurgation, suffered by
the fever.
   " The  Pyramus left  English  Harbor,  Antigua, perfectly
healthy  on the  19th of October for St. Kitts, where she re-
mained until the 28th, when she sailed for French Harbor.  A
day or two prior to her arrival at the latter place, fever of a
most alarming type made its appearance among the officers and
crew.  The sick were landed, and the ship sailed for Barbadoes;
but the disease continued to prevail.   A medical board was as-
sembled, in order to investigate the  probable cause of  the sick-
ness.  The vessel, at the  suggestion of the board, sailed from
Barbadoes, and  cruised as far as  28° north; but finding this
avail nothing, and that the disease became more alarming, the
captain hastened to English Harbor, where he arrived on the
3d of January, 1822.  The crew was there landed, and the ship
emptied of her stores, shot, tanks, ballast, etc.   On the opening
of her hold, the effluvia which issued surpassed anything Dr.
Hartle had ever witnessed, and affected every one exposed to
its influence.
   " The quantity of filth which was taken out was sufficient to
fill four  large mud-boats, consisting of shavings mixed with coal-
tar and the water which, in consequence of  the choking of the
pumps,  had accumulated  under the limber-planks.   All the
cases which occurred during  the process of  expurgation were
easily traced to exposure to this bog; and Dr. Hartle very justly
refuses to  refer  the disease to  the influence of English Harbor,
inasmuch as other ships of the squadron that lay much longer
there escaped the infection.  It may not be  amiss to remark 
          YELLOW FEVER ORIGINATING IN MID-OCEAN.       49

 that the sick of tliis ship were landed and placed in Antigua
 dockyard on the 15th of January; that between  that day and
 the 30th only eighteen cases occurred ; but that on the 31st six
 fresh attacks were added to the list, and the disease again ap-
 peared with increased violence and malignity.  Dr. Hartle adds:
 ' This sudden reappearance and violence of the disease induced
 me to believe that the people had some communication with the
 ship, which was then undergoing a general expurgation.   This,
 with a  little trouble, I ascertained to be the  case.'   Changes
 were made in the distribution of the convalescents and the rest
 of the crew, and the disease was put a stop to completely.   The
 crew reembarked on the 14th of March in excellent health, and
 remained so.
    " As regards the transport above alluded to, the disease broke
 out  on  her passage from Barbadoes to  English Harbor.   The
 sick and all the troops on board were landed, and the vessel,
 after a partial cleansing, proceeded to St. Kitts; whence, having
 landed the stores and baggage,  she returned to English Harbor.
 She then underwent a general purification, when a portion of
 the troops reembarked and sailed for Grenada, where they ar-
 rived in good health, the fever not having reappeared on board.
    " It  is a pleasing reflection," adds Dr. Hartle, " and a source
 of great gratification to me, that, notwithstanding  one hundred
 and forty-seven cases of yellow fever, as distressing and malig-
 nant as  any I before witnessed, have been by the  three vessels
 imported  into  this island since September, 1821, we have  not
 had a single instance of any individual but those directly exposed
 to the local causes being attacked."
   As we peruse these cases, and remember that decayed tim-
 bers and rotting wood-shavings have been  frequently charged
 with mischief, a hint may be given to future observers carefully
 to look for the  connection between the decomposition of differ-
 ent organic substances in ships in the tropics and yellow fever.
   " Dr. J. H. Dickson,  in a  report to the Transport Board,
 alludes to the generation of the yellow fever in several vessels,
the Blonde, Gloire, Star, Wanderer, and  particularly the Dart.
 The disease broke out on board of the latter  m April, 1807, and
was satisfactorily traced to effluvia exhaling from offensive mat-
ter collected at  the bottom of the water tanks.
         4 
50          YELLOW FEVER A NAUTICAL  DISEASE.
   "' So many people,' Dr. Dickson remarks, ' were taken  ill
after going on board this vessel, lying guardship at  Barbadoes,
that it was difficult to account for it, except on the principle of
contagion, until the peculiar construction of the ship—viz., her
being divided into compartments below, so as to prevent the
circulation of  air, and the stowage of the water in bulk—was
adverted to; and, on examining the large tanks or cisterns, their
bottoms were found covered with an offensive slimy  mud or de-
position.'  On the removal of some of these causes, the knock-
ing down of the bulkheads, and the cleansing out of the cisterns,
the fever was put a stop to.  In the Thetis, in 1809, ' the fever
did not appear until the hold was broken up, when about a dozen
of men so employed were taken sick, and four out of five car-'
penters who lifted the limber-boards died.'
   " In his account of the fever which  prevailed on board the
Nyaden, the surgeon observes: ' In clearing the after-hold, which
was  very offensive, several men  immediately took the fever,
some of whom died.  This effect,' continues Dr. Dickson,' is the
more evident when contrasted with the healthiness of some ves-
sels close to them, which were either accustomed to the  climate
or differently employed.' Well could Dr. Dickson, with these
facts before him, remark :  ' The power of impure but strictly
local effluvia in producing yellow fever on board ships also, as
well  as on shore, is unquestionable.' "
   Dr. Gillespie * speaks of the events on board the  ships cruis-
ing in the West Indies during the years 1795-'98, and remarks
that  at that time all the vessels of the squadron had  their crews
in good  health, except the  frigate La  Pique, which had  been
captured and carried into an English harbor, Antigua, to be re-
fitted.
   " In the beginning of November that frigate arrived at Mar-
tinico, and the remains of the crew had  acquired a good state of
health, though they had the sallow complexion which men gen-
erally have when confined in impure air.   November the 12th
she sailed for Barbadoes, having received a draft of seventy-five
men from the Ganges.  From being embarrassed with a convoy,
and  from unsettled southerly weather, the passage was  long;
two hundred French negroes were taken out  of a vessel, which
              * " Diseases of the Leeward Islands Station." 
          YELLOW FEVER ORIGINATING IN MID-OCEAN.       51

 was in danger of foundering, and were kept on board the Pique
 until her arrival at Barbadoes.   They were confined some time
 in the hold.   Such a mixture of men, strangers to each other,
 has been often found to occasion sickness in ships, and, together
 with other causes, fatally operated here before the arrival of the
 ship at Barbadoes.   A malignant  yellow fever had made  its
 appearance, and continued  to  rage with  destructive violence
 among the crew of the Pique,  and  is supposed to  have  proved
 fatal to a hundred and  fifty men.   Out  of  the Ganges draft,
 twenty-eight alone are said to have survived the epidemic.  The
 negroes, it is probable, were saved by being disembarked on the
 arrival of the Pique  at  Barbadoes.   This," continues Dr. Gil-
 lespie, " is a melancholy instance of  the  generation of a fatal
 epidemic  on board of a ship, at a time when  the inhabitants of
 Barbadoes and the crews of the other ships in company remained
 free from any such disease."
    La Roche says that Dr. Gillespie being, as every page  of
 his volume attests, fully competent to discriminate between true
 yellow fever and  other  forms  of  febrile  disease  observed  on
 shipboard, his statement of the  occurrence in the ill-fated vessel
 " will of itself be sufficient to scatter to the winds all the doubts
 entertained by fanatic contagionists as to the possibility of that
 generation."
    Dr. Trotter publishes the following interesting letter  from
 Dr.  Crawford,  relating  to  Port-au-Prince,  in his  "  Medica
 Nautica": " On the  capture of the port, June 4, 1794, about
 forty sail  of  merchantmen were found  in the  harbor, most of
 them large vessels, the  cargoes of  which  were coffee,  cotton,
 sugar, and indigo, that had been stored  in them from one year
 to three, in which time many of them never had their holds
 opened, from the disturbances that prevailed among themselves.
 On board  of them men were sent from the whole  squadron, to
 fit them for the  passage to Jamaica, which, from the state they
 were in, was not to be soon done. The weather was excessively
 warm, and some days elapsed without a breath of wind.  The
 very first  day the people proceeded to work, many were taken
ill, and sent on board  their respective  ships with fever;  several
with strong convulsions that were succeeded  by fever, and one
or two died.  I was sent  to several to remove the sick, where I 
 52          YELLOW FEVER A NAUTICAL DISEASE.

 found the stench from the damaged coffee and sugar almost in-
 supportable ; it wanted no degree of penetration  to  prognosti-
 cate the  consequences in two, where there was a quantity of
 sugar, etc., melted in the hold.  I saw the mixture in an actual
 state of effervescence, and bubbling up from every part.  From
 these ships, I can vouch, the disease was first  introduced to the
 Penelope.  I most  truly think that .the primary cause of this
 horrid disease originated from these ships.  One thing is most
 certain, that, if it did not originate there, it was much increased
 in  violence by our  connection  with them.   After they were
 fitted out, on their passage to Jamaica, the lost were then three
 to one in comparison with the men-of-war, although this passage
 was not more than  seven days.   In the Horizon, on board of
 which were Lieutenant Gaeren and Mr. Stupart of the Europa,
 the crew had been replaced three times, and from  illness got in
 her died thirty men.  Seven out of ten died on the passage to
 Jamaica; another of them was  picked up at sea  by a Guinea-
 man, with every soul dead on board; even a number of negroes,
 who afterward cleaned them, died from fevers caught on board
 of them."
    In 1800, at Demerara,  where, according to Drs. Ord  and
 Durkin, no  fever existed, " a ship arrived about the beginning
 of  July or end of June from Liverpool, after touching at Suri-
 nam.  The filth on board, occasioned by a cargo of horses  and
 the extreme neglect  of the  officers and  crew, was such as beg-
 gars description.  Infection was the consequence.  Her officers
 were the first sufferers; every man  died.  All who went on
 board were attacked, within thirty hours  after, with a fever of
 infection. What a lesson this to masters of vessels!  How clear-
 ly it exhibits the necessity of exertion on their part to maintain
 cleanliness on board their ships!  And how evidently does it dis-
•play their responsibility to the public for the consequences of
 misconduct!"
    La Roche declares this to be as clear a case of the generation
 of the yellow-fever poison on shipboard as could be desired.  It
 is indeed admitted as such by Dr. Chisholm, the stern advocate
 of contagion.
    Chisholm cites another highly interesting case, showing that
 fermenting wine  may be as bad  as decayed wood or stinking 
          YELLOW FEVER ORIGINATING IN MID-OCEAN.       53

molasses.  " Ships containing wine in their holds in a state of
decomposition are generally extremely sickly, and the character
of the prevalent disease is that of yellow remittent fever.   Sev-
eral instances of this took place in Fort Royal Bay, in the years
1797, 1798;  and the situation of the ships in the open bay, far
from the influence of marsh effluvia, precludes a suspicion of the
fever proceeding  from that cause.   The ship Nancy, Captain
Needs, from Fayal, with a cargo of wine for the army, arrived
at Fort Royal, Martinico, in the month of October, 1798.  She
met with a gale of  wind at sea on  the 17th of September, and
several of the casks, from the motion of the ship, became leaky.
The captain  was actually taken sick at sea, and died with every
symptom of  the highest grade of yellow remittent fever.   The
mate and several  of  the crew were attacked  with  the same
complaint; they recovered; but a mate  shipped at Fort Royal
fell ill on board and died.  The ship lay out in the open bay ;
no vessel near her  was sickly; and she herself  became  very
healthy after the cargo was landed."
    The Regalia sailed with black recruits from the coast of Af-
rica for the West  Indies in 1815.  The ship was good and crew
healthy until she took on board on  the African coast a quantity
of green firewood.   The ballast had never been changed or shift-
ed from the time the vessel left England.   It was shingle ballast,
with a considerable  mixture of mud and other impurities.  The
Regalia was far from a dry ship, and the absorption of sea-water
among foul  ballast  and green wood could scarcely fail to prove
unwholesome. Yellow fever broke out on the voyage, and contin-
ued up to the time of her arrival at Barbadoes.  The blacks were
exempt, and  though the Regalia communicated freely with the
seaports of Barbadoes and  other islands, landing the sick or dy-
ing subjects of that  disease  among the inhabitants or at the hos-
pitals, the infection  was not communicated anywhere.
    I shall not quote the histories of outbreaks on the Rattle-
snake  in 1824,  or  on the  Eclair in 1845, * which have been

   * " Were it necessary,  similar instances of this mode of origin might be adduced
from the history  of British vessels—the Childers, the Isis, the Ferret, the Scylla, the
Thracian, the Iphigenie, the Wasp,  the Tribune, the Farmer, the Bustard, the Py-
lades, the Antelope, the Tigris, the Scamander, the Blossom, the Kent, the Circe,
the Trinidad, the Serpent, the Brazen, the Busbridge, the' Pompey, the Bedford, the 
1
54           YELLOW FEVER A NAUTICAL DISEASE.

viewed by some as typical of original ship infection; but I shall
follow La Roche in  his search among French writers.   I make
no apology for entering into lengthened details on this evidence,
since they are essential to an understanding of the question.
   Dalmas  relates  an outbreak  of  fever on the  Souverain, a
seventy-gun  ship, on her passage from Europe to the West
Indies.   Chervin gives several examples of yellow fever at  sea
before the infected vessels had reached West Indian ports.
   Yellow fever broke out in the brig Fabricius of Marseilles
in 1818, on her passage to Fort Royal; and, before reaching any
point where  infection might be  due to the wafting of the ef-
fluvia from the shore, yellow fever broke out.
   " The French brig of war  the Euryale, commanded by M.
Yillaret  de  Joyeuse, was attacked with  the yellow fever while
on a cruise, and compelled in consequence to seek shelter in Fort
Royal, Martinique, about the close of June, 1821.   Before reach-
ing that  port the Euryale had already lost six men, and among
them the surgeon; and at the time  of her arrival the sick-list
was very large.   The sick were  sent  to the hospital,  and  the
convalescents removed  to Fort Bourbon.   In neither of these
places was the disease communicated to the attendants or others;
but, on the  other hand, a number  of men who were sent to
work on board were seized with the fever, and several died.
In this, as in other instances, the disease did not  extend beyond
the focus of infection where it had  originated, and  where it
affected those who exposed themselves to its action.
   " Dr. Lefort, to whom we are indebted for the above case,
adduces,  as  additional proof of the local  origin of the yellow
fever on shipboard, the  account of three other  vessels of war.
The Egerie, the Diligente, and the  Silene, which, during  the
sickly.season of 1821, anchored at Trois Islets, a port situated
at the bottom of the Bay of Fort Royal, Martinique.   During
their stay, the Egerie was attacked with fever and lost a great
many men.   She was ordered to sea ;  but, the disease increasing,
instead of being arrested, she reentered the port,  and there went

Powerful, the Pilot, the Scout, the Volage, the Vestal, the Skipjack, the Rainbow,
the Magnificent, and others; but enough has already been said on the subject to
place the question of that origin beyond the possibility of a doubt."   (La Roche,
vol. ii., p. 447.) 
        TYPE IN THE EASTERN AND WESTERN ATLANTIC.      55

 through the usual process of purification.  While the  Egerie
 was at anchor at  the Trois Islets, the intercourse between her
 and the Diligente and Silene was in no  way prevented; not-
 withstanding which, these vessels remained perfectly free from
 the disease.  On the 19th of October the Diligente proceeded
 to Fort Royal, and soon after was itself attacked with the fever.
 On the 30th she was ordered to sea in company with the Silene,
 and during the passage from Martinique to Porto Cabello, but
 more especially after a week's sojourn in that place, suffered ex-
 tensively from the disease.  During the  whole of this time the
 Silene continued free from the infection, although daily visited
 by men  from the suffering vessel.   It  is  scarcely necessary to
 remark that if the Egerie had derived the disease from the at-
 mosphere of the  Trois Islets, or from contagion, the Diligente
 and the Silene would, being exposed to the same causes, have
 shared a similar fate ; and, had the Diligente not suffered from
 the action of some cause inherent  to the vessel itself, it  is diffi-
 cult to understand how its  companion, the Silene, could  have
 escaped so effectually the  inroads of the fever, exposed as it was
 to the same atmosphere,  communicating in the same way with
 the shore, and visited  frequently by the  crew of its infected
 companion." *

    Type of Disease in the Eastern  and Western  Atlantic.
    The following case  suggests the idea that a foul ship, being
 sickly in the Eastern Atlantic,  may gradually develop, as the
 western shores  are approached, a genuine yellow fever.   I have
 omitted mention of many cases (they are literally innumerable)
 of  the disease  breaking out  some days after leaving the West
 Indies.   My main object is to insist on close investigation in a
 comparatively  new direction; and it is a matter of first  impor-
 tance if we can determine, as I feel sure  we can, that  yellow
 fever is in its essence not  a shore disease, but rather creeps  on
 shore from infected vessels, and is the product of putrefaction and
 ordinary fermentation, under conditions  similar to  those which
 would develop  hospital gangrene, puerperal fever, and pyaemia.
    " In the year 1802 a flotilla filled  with French troops  sailed
from  Tarentum for the island of  St. Domingo.   The  vessels
                  * La Roche, vol. ii., pp. 448, 449. 
1
56           YELLOW FEVER A  NAUTICAL DISEASE.

consisted  of  small Neapolitan  polaccas, under the escort of a
frigate, each  of which, though only intended for the accommo-
dation of  at most one hundred  men, received one hundred and
fifty.  Encountering, soon after leaving the port, a severe storm,
the vessels were dispersed, and sought shelter where best they
could.  They reassembled at Leghorn, and thence proceeded to
Cadiz, there to join another division of troops that were to form
part of the expedition.   Stopping again at Cartagena  to take
in proper  provisions  and to refit, the expedition set sail for St.
Domingo—^-the  troops being  now transferred to eight vessels
freighted  for that purpose. Of these vessels, one was set  apart
for  the accommodation of the sick.
    " The spring had  been cold and wet.  Summer came  on sud-
denly, and was  characterized, during the months of June,  July,
and August, by intense heat.   Soon  after the departure of the
vessels from Cartagena fever broke out on board, and continued
to prevail in- some of the ships till their arrival at Cape Haytien
—spreading more extensively and acquiring  greater malignancy
as they approached the tropics and  were exposed to a higher
temperature.   The disease, without  doubt, consisted of one of
the  forms of true yellow fever;  but it exhibited, especially at
first, a mild character.  At the time of arrival, the yellow fever,
in all its purity, was prevailing among the troops at St. Domingo;
and, by comparing the symptoms presented by the cases on board
with those noticed ashore, the surgeon of the squadron was en-
abled to convince himself of the identity of the two diseases.
    " In this instance there can  not be the remotest reason for
referring the disease to any other than a local origin.  Nothing
is said of the soldiers having  imbibed the  cause  at Leghorn,
Cadiz, or  Cartagena,  in neither of which places, indeed, it ex-
isted that year.   Dr.  Beguerie lays some stress on the effects of
bad regimen, but especially on the excessive heat to which the
men were exposed;  as also on  vicissitudes of  temperature and
exposure to night air; but he likewise attaches much  impor-
tance to the morbid exhalations arising from the accumulation
of the troops and the decomposition of animal and vegetable
substances contained  in the vessels.   It may  not be improper to
add that the disease manifested  no contagious property.'1 *
                 * La Roche, vol. ii., pp. 451, 452. 
        CONTAGIONISTS ON SPONTANEOUS ORIGIN IN SHIPS.     57

        Contagionists on Spontaneous Origin in Ships.
    Contagionists  have certainly denied, and denied  emphati-
 cally, the production of yellow fever anywhere on land.   They
 admit the possibility of its origin in ships within narrow bounds,
 and  perhaps  with justice, "rejecting as unfounded and even
 absurd the idea of including within these any section  of  the
 temperate zone."  ..." The facts," continues La  Roche, " pre-
 sented  in the preceding pages, and which have been  collected
 from sources  entitled to full confidence,  are of a nature to over-
 come effectually all the objections raised against the reality of
 the generation of  the yellow-fever poison on shipboard."
    " The facts  that have been adduced," he adds further  on,
 " establish, beyond the possibility of a denial, the reality of  the
 development  of the yellow fever on shipboard, from the opera-
 tion of causes existing therein, and  unconnected with  any con-
 tagious or infectious germs introduced from without."
    A case is recorded by Dr. Ranee.  In 1852 the bark Flora
 arrived from Bordeaux at New Orleans.  She had  necessarily
 to touch the tropical zone of  the Atlantic.  She took on board
 some perishable goods, and, these  becoming putrefied toward
 the end of August, some cases of yellow fever appeared in her
 in mid-ocean.
    These cases suggest the possibility of an outbreak of yellow
 fever occurring, as on the ship Plymouth, when a tempest over-
 takes a vessel, and the provisions for ventilation, always  defec-
 tive,  with hatches battened down, are rendered impossible.   A
 mass  of human beings contaminating a hot and humid atmo-
 sphere, putrefaction actively setting in wherever decaying tim-
 bers,  organic matter, heat and moisture,  and unavoidable exclu-
 sion of light, are found combine to constitute conditions which,
 in  a  certain part  of  the tropical Atlantic zone, may result  in
 yellow fever.  The Plymouth had been infected before, and this
 leads  to the belief that the germs of yellow fever remained in
 her;  whereas  in all probability she is a rotten ship, and will be
 foul and unsafe for all time in the West Indian seas.
    Dr. E. M.  Schaeffer, of Washington, has kindly directed my
 attention to some important contributions on yellow fever  in
the " Army Statistical Reports of Sickness " from January, 1855, 
58          YELLOW FEVER A NAUTICAL DISEASE.

to January, 1860.  Assistant Surgeon La Fayette Guild, report-
ing on the disease at  Fort Columbus, N. Y., in  1856, says:
" Yellow fever, so long the scourge of  the tropics, has for the
last few years been steadily and progressively encroaching upon
the temperate regions of our country."  His observations were
confined to Governor's  Island, in latitude 40° 42', longitude 74°
9', situated in New York Harbor, at the junction of the North
and East Rivers with the bay, and about 22 feet above low-water
mark.  He says: " All agree that yellow fever can be generated
on board of vessels.  Whether the morbific agency depend upon
the decomposing timbers, the bilge-water, the putrefying cargo,
or what not, still the fact is beyond  a doubt that the disease can
be so produced.   The first case that occurred in this harbor last
summer was on board  of a vessel, and not only did one vessel
arrive in this port with the disease  on board, but several;  and
they were all collected and placed in quarantine, whence, in my
opinion, the disease was disseminated throughout the different
places along the  bay that were not protected from the wind that
swept over  this congregation of infected ships, filling  the  air
with their pestilence.  The facts that substantiate this opinion
are that the epidemic broke out simultaneously in  different lo-
calities on shore, after the ships had  been placed and the process
of unloading and cleaning them had been commenced ; that the
disease was confined to the southern portion of Governor's Isl-
and, and to those habitations which were openly exposed to the
winds from the quarantine;  that the intervention of their board
partitions, trees, shrubbery, and elevated portions of the ground,
which served to shut off these winds, gave to individuals so pro-
tected an  immunity, and that the  removal  of the inmates of
South Battery to a place where they were protected from these
winds checked the ravages  of the disease among them."  (Pp.
18,  19.)
   Further on he says: "It certainly is a question  that should
engage the studious attention of  boards of health, and of those
members of the  medical profession  whose duty it is to regulate
the quarantine enactments and to guard the public health against
the pestiferous influences of infected ships that annually arrive
in our cities on the seaboard."   (P. 23.)
   Surgeon Charles McDougall reports on an outbreak  at Fort 
       CONTAGIONISTS ON SPONTANEOUS ORIGIN IN SHIPS.     59

McHenry, Maryland, from the 16th to the 26th of September.
I quote it for the definite information as to  the health of the
fort at the time of the outbreak, and the probability of the im-
pure air of the ships being wafted on land with sufficient viru-
lence to propagate the malady.  He says: " After a careful and
critical examination of Fort McHenry and its immediate locali-
ties, nothing could be found which would predispose to or en-
gender disease.  The police was perfect; the drainage as com-
plete  as could be desired; no standing water; clothing and diet
of the soldiers excellent; the general habits of the command
perhaps better than at most of our military posts.  How, then,
could the yellow fever originate, or whence contracted ?  All of
the cases but one occurred in the row of frame shanties  north-
east from the fort, some eighty yards.   Five  of the inmates
were  attacked by  the  fever about one time, and all  within a
period of eight days.  The shanties were clean  and well white-
washed, but old and deficient in  sub-ventilation.  We can im-
agine that the sweepings and washings of years might have pro-
duced a condition like that of  defective sewerage, which would
favor or induce disease.  But  most unlikely in  regard to those
shanties.  We believe that the yellow fever at  Fort McHenry
came from vessels infected with the disease at quarantine, near
by; that the infecting poison was carried by the winds to the
frame shanties facing the bay; and those who  inhaled the poi-
son, being in condition, took the disease.   The command in the
fort were protected by the ramparts; not one  of them  sickened.
Why their immunity from an attack ?  There seems to me not
a doubt that the materia morbi of yellow fever is portable, and
where it finds favoring conditions will  reproduce itself and ex-
tend its dreadful ravages."   (P. 85.)
   Surgeon B. M. Byrne, in a report  on yellow fever at Fort
Moultrie, speaks of the high reputation of the  island  for salu-
brity, but the disease entered it from  Charleston with four thou-
sand  refugees; it  was  communicated  to twenty soldiers, of
whom ten died  and ten recovered.   The first  case which had
occurred at Charleston in July was in the person of a man who
left an infected vessel lying at quarantine.
   Assistant Surgeon A. F. Watson relates the invasion of Fort
Brown, Texas, by  yellow fever, and again shows how, when a 
60
YELLOW FEVER A NAUTICAL DISEASE.
ship has carried  the  disease,  it may at times be  propagated
under the most favorable conditions.  He says: " Previous to
the breaking out of yellow fever the city and fort were remark-
ably healthy, and in  the city there had been many improve-
ments carried on  for  the last  two years.   The fort also was at
the time in remarkably  good  and clean order.  There was no
apparent local cause of fever here.   The meteorological register
did not indicate any extraordinary condition of the atmosphere."
(P. 183.)

      Conditions essential to Yellow-Fever Development.
    Dr. Faget considers that the three conditions alone essential
for the development of yellow fever are:
    1. Organic matters in a state of decomposition.
    2. A maritime center—in fact, a ship—in the Atlantic.
    3. A tropical temperature.
    The weight of evidence coming to his support is great, and
it carries conviction with it that it is the shipping  in the tropi-
cal Atlantic zone  which first becomes infected.
    It has been  incontestably shown that the malady exists in a
region where a high degree of humidity as well as high tem-
perature, still air, and ill-ventilated ships always coexist.   These
conditions alone suffice to lower the stamina and induce disease
among picked seamen.   No better soil could be found than in
one of these vessels for the development of yellow-fever poison,
should any specific germs have to be deposited for that purpose.
But admitting for argument's  sake their indispensable presence,
is it a far-fetched view  to take of the matter that the richly
charged waters of the ocean in the tropics bear the elements
essential to the  development of  this  disease, by favoring  a
virulent putridity alone sufficient to generate that element ?   I
have  very  carefully consulted with  travelers, and all declare
that in no city of the West Indies,  of Central or South Ameri-
ca, is yellow fever considered  indigenous by the best informed.
In this way, so far as  the cities are concerned, the disease exists
nowhere.  The conditions  of  heat, humidity, and  decay occur
of  course where  paludal fevers (the Chagres and  other fevers)
abound ; but here is one  circumstance, and an all-important one,
viz.:  that ships, the partially submerged abodes of man, usually 
YELLOW FEVER A HYBRID TYPHUS.
61
without any, or with very imperfect, provisions for ventilation,
surrounded by hot and humid air above, and the warm waters
of the tropics below, constitute wells of  foul organic deposit in
which there is an aggravation of conditions inimical.to human
life, well calculated to produce what Audouard called nautical
typhus, and what in the West Indian seas is yellow fever.  Clos-
set in IS77 recognized its association, at  all events, with putrid
typhus, and so did Drogart.

               Yellow Fever a Hybrid Typhus.
    Yellow fever has been regarded as a hybrid form of typhus
" by some physicians of a former generation—Blane, Lempriere,
Dickson, and  Chisholm."  (La Roche.)   It may be typhus modi-
fied by a special factor.  Chisholm thought it was " the typhus
of  Europe grafted on the yellow remittent fever of the torrid
zone."
    It is of course a matter of the highest and most pressing im-
portance to determine the identity or dissimilarity of the vomito
prieto, or malarial black vomit • of the Mexican coast,  and that
of the lowlands of Louisiana. Are  all cases of black vomit, so
fatal in Yera Cruz, cases of yellow fever ?  Speaking of Mexi-
co, Prescott says : * " All along  the Atlantic the country is
bordered .by a broad track, called  the  tierra caliente, or  hot
region, which has the usual high  temperature of equinoctial
lands.  Parched and sandy plains are intermingled with  others
of  exuberant  fertility, almost impervious from thickets of aro-
matic shrubs and wild flowers, in the midst of which tower up
trees of that magnificent growth which is found only within
the tropics. In this wilderness of sweets  lurks the fatal malaria,
engendered probably by the decomposition  of rank vegetable
substances  in a hot and humid soil.  The season of the bilious
fever—vomito, as it is called—which scourges these coasts, con-
tinues  from the  spring to the autumnal equinox, when it is
checked by the cold winds  that descend from Hudson's Bay."
Further on (p.  300, vol. i.), speaking of the sand-hill district of
Yera Cruz, he asserts that " the bilious disorders, now the terri-
ble scourge of the tierra caliente, were little  known before the
conquest.   The seeds of the poison seem  to have been scattered
               * " The Conquest of Mexico," vol. i., p. 6. 
62           YELLOW FEVER  A NAUTICAL  DISEASE.
by the hand of civilization ; for it is only necessary to settle a
town, and draw together a busy European population, in order
to call out the malignity of the venom which had before lurked
innoxious in the  atmosphere."  The periodical changes of site
of La Villa Rica of  Cortes,  Old Vera  Cruz and New Vera
Cruz, have all been ascribed to the vomito afflicting the  inhabi-
tants ; but, as Prescott states, they have gained little  by the
exchange.  The mere fact of its always having been a  seaport
would suffice to keep up a true yellow fever ; but,  according to
Faget, the  city limits contribute  the  boundary  beyond which
it can not pass into the  open country.   Might  the site of the
city not have been changed because the  disease did not  invade
the part chosen, as an experiment for  future habitation,  but
that this immunity was due to " open space " ?   The connection
between vomito and European invasions is more than a tradition.
No mention is made of the disease in the  records of the con-
querors.  " The fact doubtless corroborates," says Prescott," the
theory of those who postpone the appearance of the  yellow
fever  till long after  the occupation of the  country by  the
whites.  It proves at least that, if existing before, it must have
been in a very much mitigated form." *
   Dr. Faget has no doubt whatever of  the complete indepen-
dence {individualite morbide) of yellow fever, and speaks of it
as quite as distinct from other  diseases as cholera or the plague.
In this he is  supported, as we have  elsewhere  shown,  by the
ablest authorities, old and new, and to him is due the credit of
discovering distinctive signs, to be described in a later chapter.

          Propagation of Jail  and other Fevers.
   Let us  not forget the conditions under which some local,
endemic, or indigenous diseases became virulent plagues.
   Dr. Bancroft, in his " Essay on Yellow Fever," published in
London in  1811, referred to the transmissibility of diseases in-
duced at first by foul  atmosphere, rendered impure by putrify-
ing organic matter ; and he says: " Many writers  of celebrity,
and among them the great Lord Bacon, have thought that no
effluvia were so infectious and pernicious to mankind as those
which issued from  putrefying human bodies; and although a
                       * Op. cit., p. 394. 
YELLOW FEVER A HYBRID TYPHUS.
63
century and a half has elapsed since Diemerbroeck (' Tractato de
Peste,' lib. i., cap. viii., p. 41) attempted to convince physicians
that, at least, such effluvia could not produce the plague, yet the
old opinion has kept its ground ; and it is still believed that, in
their  milder state, they must cause putrid fevers, and in their
more concentrated state a true pestilence."
    Bancroft had reason to believe that the yellow fever had
been  much more frequently produced than is generally  im-
agined by miasmata  resulting from the decomposition of vege-
table and other matters in the holds of ships.
    The late Dr. Murchison, of London, whose recent premature
death is so deeply lamented by all who knew him,  writing con-
cerning the '* Independent Origin of Typhus," says:  " The con-
ditions under which  the  poison  is developed de novo are over-
crowding of squalid  human beings and deficient ventilation ; in
other words, the poison is generated by the concentration of
the exhalations from living beings, whose  bodies and  clothing
are in a state of great filth.  The  intimate connection between
the prevalence of typhus  and overcrowding has  been already
demonstrated, and is generally admitted."   Dr. Murchison  di-
rects  special attention to the indispensable high temperature for
the development of  yellow fever, and  says that it  is quite pos-
sible  that  the alleged  exemption of the Laplanders and  Esqui-
maux from typhus, if true, notwithstanding the bad ventilation
of their dwellings, may be due to the cold climate.
    Typhus-fever poison  has  been supposed  to be a chemical
compound of ammonia;  but  the particles of degraded animal
matter, capable like  pus-corpuscles of multiplying in a suitable
soil, are probably the  offending agents,  according to  Murchi-
son.  It is evident he had no  idea of the compound exhalations,
smelling of rotten eggs, in  the tropical Atlantic, and which en-
gender yellow fever.
   Sir  Gilbert Blane, in  a  letter to  Rufus King, American
Minister to England, said in 1799 : " It appears  to  me that the
yellow fever can  not be produced but in a season or climate in
which the heat of the  atmosphere is  pretty uniformly, for a
length of time, above the eightieth degree of Fahrenheit's ther-
mometer ; that, under the influence of this heat, Europeans new-
ly arrived, and more  especially in circumstances of intemperance 
64
YELLOW FEVER A NAUTICAL DISEASE.
or fatigue in the sun, may be subject to it in  many instances;
but it has usually become general only by the previous influence
of that infection which produces the jail, hospital, or ship fever,
or from the influence of putrid exhalations."
   Space forbids any lengthened reference to the contagion of
the Egyptian plague, or to the putrid fever which attacked the
survivors of the Black Hole of Calcutta imprisonment.
   The reports  of virulent infection in the form of jail  and
ship fever, when no cause but overcrowding and bad ventilation
existed, are numerous and  well authenticated.   What Chervin
did for the abolition of oppressive quarantine was accomplished
to a much higher degree by the great philanthropist Howard,
who devoted his life to prison reform.  Prison typhus was com-
mon, and often passed beyond the prison walls.  One of the most
notable instances in history is that of the black assizes at Oxford
in July, 1577, when the jail fever spread from the prisoners to
the court, and within two days had killed the judge, the  sheriff,
several justices of the peace, most of the jury, and a great mass
of the audience, and weeks afterward spread among the people
of the town.  Dr. Arnott remarks, " This was  a  fever which
did its work as quickly as the cholera does now."

              Pycemia or Purulent Infection.
   It is just over a quarter of a century since  my brother, Mr.
Samson Gamgee, of Birmingham, threw  himself  with great
energy into the  investigation of purulent infection in surgical
wards^ a subject then almost hidden from view.   I pursued with
him, and afterward alone, many experiments, and among other
points ascertained that  an animal might suffer little from .the
injection into the veins of an isolated dose of laudable undecom-
posed pus; but, if the pus were putrid, the infection was prompt
and fatal.  The history of contaminated hospital wards is full of
interest in  connection with the history of  yellow fever  in con-
taminated ships.
    There is no  natural nor  artificial safeguard protecting the
seaman in his tight dungeon amid the waters.   Any leakage is
not of pure air,  such  as  actually  finds its way through solid
bricks and  mortar, and which is the active preserver of  human
life in thousands of ill-ventilated dwellings.  On land we are in 
        SPONTANEOUS  DEVELOPMENT OF OTHER DISEASES.     65

 a sea of air.  At sea the leakage is of warm and highly charged
 water teeming with organic matter, a rich mother-liquor for the
 most active fermentation  and rotting, so that a ship sealed, if
 possible hermetically, might burst under the pressure of  accu-
 mulated gases.  Read the  case of the sloop Mary.  She had
 been lying shut up, a war prize.   Foul smells about the wharf
 (Philadelphia) directed attention to her condition.  Her  ports
 and hatches were thrown open, when  the foul air rushed out in
 torrents, and the persons who inhaled it were seized with yellow
 fever.

  Other Diseases propagated after Spontaneous Development.
    America is signally free from all the purely contagious epi-
 zootics, if we except the lung-plague imported from Europe,
 nearly fifty years since, into the dairies of Eastern cities.  I have
 already alluded to  the American cattle  plague proper, origina-
 ting  in Texas, and which, like all indigenous maladies, when
 once understood is most  easily prevented in its spread among
 northern  animals.   It is  otherwise  with the widespread and
 popularly designated hog cholera.  This singular malady,  at-
 tacking an omnivorous animal, when collected in large numbers
 from various sources on a limited area of ground, is developed
 like a virulent camp fever in  man, and, strange to say, appears
 when once developed to be communicable to most warm-blooded
 animals, and I  should say, under certain circumstances, un-
 doubtedly to man.   The varied developments of the disease are
 of striking  interest in relation to those human disorders which
 spring from overcrowding, and in which nature's process of de-
 puration produces  at  one time hsemorrhagic exudation, at an-
 other a malignant angina and catarrh, at another diarrhoea and
 enlargement of  the  intestinal glands, whence the disease has
 been confounded with human typhoid.   The infected pigs die
 by thousands.   They are purchased from healthy  sources, and
 remain  healthy where they are bred,  but, whether or not con-
fined in sties or the open air, the soil on which they lie and live
becomes saturated  with  putrefactive  emanations, which rapidly
undermine the animals and breed in them a malignant and  com-
municable disease.   I am  not attempting to  be precise, and I
only wish to show that there is no oddity, much less impossibil-
           5 
1
66           YELLOW FEVER A NAUTICAL DISEASE.

ity, in the manifestation of  a disease from the congregation of
living creatures under definite unwholesome conditions, which,
once developed, spreads even by direct contagion.
   A more familiar  example in medicine is that  of purulent
ophthalmia of soldiers and  children, which originates in over-
crowded barracks and wards, and is rapidly propagated, causing
intense suffering and frequent blindness, by the particles of de-
composed pus, floating in the atmosphere, adhering to the towels
and other  objects, and of ten  forced into the eyes in the innocent
act of rubbing them, as a baby so often does with its little fist.
   I  might multiply instances of a spurious form of contagion
which bears the same relation to a specific virus that the pus of
soft chancre  does to the discharge of a genuine Hunterian in-
durated sore.  It is as nearly as I can state in that relation that
I consider yellow fever and an epidemic outbreak of small-pox
in an  unvaccinated community.  The one is in its early outward
signs  scarcely distinguishable from  the  local marsh or paludal
fevers—a hybrid typhus—and, until Dr. Faget's  researches,
scarcely capable  of  accurate and certain diagnosis.   The other
stamps itself  from its invasion  as  an unmistakable eruptive fe-
ver, due to a specific organic poison.  The first spreads like mud
pervading a pool by continuity from one disturbed center.  The
other dots the surface, and skips  here and there in  direct rela-
tion to personal intercourse with the sick  and susceptibility of
the people.   Both are deadly, but both vary materially in their
course and development.

               Difficulties of ventilating Ships.
   Now, in relation to the ships which are such admirable pest-
traps, I desire most  forcibly to remind my readers of the great
difficulty experienced in getting free currents of pure, dry air
through the interior of a ship at sea. So essential is this that I
hope  the National Board of Health will investigate  the subject
and enact rules to  be  adopted by ports, favoring  well-venti-
lated  vessels and  condemning the  stagnant tubs of pollution to
protracted and prohibitory detentions.
    The difficulty of clearing the  hold  of a deep vessel of foul
air, without adequate blast, is  much like  the difficulty experi-
enced in ventilating an old  gasometer,  on first entering which, 
ASPHYXIA  IN SHIPS.
67
 after it has been left open for days and weeks, a workman, unless
 he be most careful, may promptly sacrifice his life  and that of
 others  who seek to rescue him.

                      Asphyxia in Ships.

    Dr. David Boswell  Reid, a worthy and able advocate in the
 field of hygiene, quotes in his treatise on the " Theory and Prac-
 tice of Ventilation " (London, 1844) a narrative of the accident
 in the  ship Minden in the year 1819-'20 (pp. 371-'72):
   " On board H. M. Ship Minden, bearing the flag of Admiral Sir Eichard
 King, in the harbor of  Trincomalee,  in the year 1819-'20, a boatswain's
 mate was ordered to see the pump-well swabbed out.  A man was  accord-
 ingly 6ent down with a bucket and swab; but, as he neither filled the bucket
 nor answered when called to, a second man was sent  down to see what he
 was about.   He also refused  to answer immediately.  Three more rushed
 down into the well, who all, like the first two, remained silent. It was then
 reported on the quarter-deck that the men in the pump-well were supposed
 to have  got into the spirit room.  The master, on entering the cockpit, sus-
 pected the true cause of the men's silence,  and ordered a lantern to be low-
 ered into the well, the light in which went out when about half-way down.
 It was let down a second time, and the light burned long enough to show the
 whole of the men lying over each other on the keelsou.  On being lowered
 down a third time, the light was found to burn dimly at about six feet above
 the men.  The master, with a bowling knot under his arms, descended the
 well, leaving directions to haul him up the moment he could not answer.
 He succeeded in slinging the men, who were hauled up and laid on the main
 deck, to all appearance quite dead.  In a short time they began to respire; the
 lips and face became black ; they foamed at the mouth, and the whole were
 fearfully convulsed.  None of them recovered their usual health, and some
 of them were invalided.  The man who descended the well  first was the
 first who recovered.
                                        " (Signed) John Milleb,
                                       " Late Master of the Minden.
   " London, December^ 1842.

   " Mr.  Miller has since added:
   " The officers who assembled in the cock-pit, on hearing what had taken
place, remonstrated against the master descending into the  well; but he
replied that he thought that  he  could breathe at least as low  down  as a
light would burn, and on reaching the light he felt no inconvenience;  and
even  after  he had succeeded in slinging the whole of the  men, though he  ,
was engaged for a full quarter of an hour, he did not subsequently expe-
rience any further inconvenience  than a slight headache.   From the agita-
tion, the air continued to improve  gradually in the well, and, by the time he 
68
YELLOW FEVER A NAUTICAL DISEASE.
had left, the candle was not extinguished when lo.wered to the keelson
(about six feet lower than it was capable of burning at first)."
   It is easy to imagine how much worse must be the air in
many an old ship with rotten timbers and  putrefying stores or
cargo in the tropics.  How utterly impossible it must be to se-
cure health in such ships, and how easily a veritable ship-typhus
may actually originate there!

            The Atlantic Yellow-Fever  Center.
   The Atlantic region, in which ships  run special risk of yel-
low fever from contamination, is well known to present very
characteristic meteorological features, which tend  to  interfere
materially with the ventilation of ships.   At  the equatorial
calm-belt a conflict of winds  occurs, for a northeast trade-wind
and a southeast trade-wind can not blow in the  same place  at
the same  time.   The air-particles  have been put in motion by
the same power;  they meet with equal force; and therefore at
their place of meeting they are arrested in their  course.  There
is consequently a calm-belt, as at Capricorn and Cancer.
   In relation to the difference in the severity or character  of
fevers engendered in foul ships crossing the Atlantic  from east
to west, it must be remembered that the western half is far hot-
ter than the eastern.  High as the temperature is within 5° of
the equator north or south, the remarkable contrast between the
climatology of the sea and land must not be forgotten.   Maury,
to whom I am  indebted for my information on the climate of
the sea, remarks  that " on the land February and August are
considered the  coldest and the hottest  months; but, to the in-
habitants of the sea, the annual extremes of cold and heat occur
in the months of March and September.  On the dry land, after
the winter is ' past and gone,' the solid  parts of  the earth  con-
tinue to receive from the sun more heat in the  day than  they
radiate at night, consequently there is an accumulation of caloric,
which continues to increase until August.   The  summer is now
at its height; for, with the close of  this month, the solid parts
of the earth's crust and the atmosphere above begin to dispense
with their heat faster than the rays of the sun can impart fresh
supplies, and  consequently the climates which  they regulate
grow cooler and cooler until the dead of winter  again.  But at 
          INFLUENCE OF  TEMPERATURE OF SEA-WATER.       69

 sea a different rule seems to prevail.  Its waters are the store-
 houses in which  the  surplus heat of summer is stored away
 against the severity of winter, and its waters continue to grow
 warmer for a month after  the weather  on shore has begun to
 get  cool.  This brings the highest temperature to the sea in
 September, the lowest in March." *

 Influence of Temperature of Sea-water on a Ship's Ventilation.
    It is at first somewhat startling that the period of lowest sea-
 water temperature at  the equator should be  about the period
 when yellow fever gets  its  start  northward ; but we  must here
 consider the effect of temperature in the calm-belts on the ven-
 tilation of ships.  Atmospheric pressure is high.  Polar refrac-
 tion is greater than the equatorial.  The mean height of the
 barometer in the calm-belts  of the tropics is greater than it is in
 any other latitude.  There is an accumulation of air in the
 tropical belt about  the  earth in each hemisphere.   Could we
 view our atmosphere  from above, we should discover a ridge
 and not a valley over the equatorial calm-belt.  " In the  belts
 of low barometer—that is, in  both the equatorial  and polar
 calms—the air is expanded, made  light, and caused to ascend
 chiefly by the latent heat that is liberated by the heavy precipi-
 tation which takes place there.  This causes the air which ascends
 there to rise up and swell out far above the mean level of the
 great aerial ocean.  This intumescence  at  the equatorial calm-
 belt  has been  estimated  to  be several miles above the general
 level of the atmosphere.   This  calm-belt air, therefore,  as it
 boils up and flows  off through  the  upper regions, north  and
 south, to the tropical calm-belts,  does not so flow by reason of
 any  difference of barometric  pressure, like that which causes
 the surface  winds to blow,  but it so flows  by reason of differ-
 ence as to level." f
   It is, I think, obvious that a  ship in  the calm-belts, and say
 near the equator  in March,  is under the influence of the low-
 est external temperatures at its deepest part;  it is likewise un-
 der the influence of a still, heavy, and saturated atmosphere
  *" Physical Geography of the Sea," by M. F. Maury, LL. D., London, 1869,
p. 383.
  f Ibid., p. 355. 
70          YELLOW  FEVER A NAUTICAL DISEASE.
above.  Every condition favors the gravitation of the foul air
toward the bilge, and the only circulation  is due  to the rising
from this of  the  gases of  decay which are disengaged with
great freedom.  Air colder  than the ocean-water would perflate
its way through the ship, if  any inlet could be found.   A natu-
ral  ventilation would be  forced in  spite of iron  sides or sod-
den wooden walls.  Hence,  how soon  a ship purifies  itself on
its northward  passage, unless ports and hatches are fast!   The
trade-winds are the mighty purifiers of the Atlantic atmosphere
within their reach.   Insufficient they may be under overwhelm-
ing conditions of atmospheric impurity within  ships, but their
ventilating power is indubitable, and it is probably beyond their
life-giving blast that those fatal influences are most rife which
are capable of engendering yellow fever.

                         The Cargo.
   Whatever may be the belief as to a ship in mid-ocean, under
the requisite combination  of circumstances, becoming infected
with yellow fever without catching the  disease in port, it is cer-
tain  that, though atmospheric  currents, even at sea, may with
great difficulty bear on their course yellow-fever germs, the cargo
can be of such a nature as to be either the carrier or the producer
of such contamination as will engender the disease.  A barrel
of potatoes from an infected ship has been known to communi-
cate the disease  to a seaport town.  This  might and probably
would occur by the  adherence of foul ferments to the barrel
or the potatoes.  Sometimes, but rarely, a bale of cotton has
been the accused carrier.  Coffee is said to be usually innocent,
and it is very generally acknowledged  that the sound contents
of an infected ship can be easily purified by  free aeration.  In
the channels of commerce little harm has arisen from  contami-
nated merchandise.
   On the other hand, we have the most convincing testimony
of the injurious and most probably sufficient cause of specific
mischief in  decomposing  or decaying  wood, wine, sugar, mo-
lasses, and bituminous coal.  The fermentations started in the
bilge-water by hydrocarbons, which drop  or percolate into it,
are certainly not innocent; and the gaseous emanations, heated
in the process of their production, permeate, to the  detriment of 
DISINFECTANTS NOT  USED AT SEA.
71
human comfort and human life, into every part of the contami-
nated vessel.  The sailors acquire a sallow and depressed look.
Their exhalations add to the atmospheric filth.  The saturated
atmosphere prevents relief by the natural excretions, and, with-
out regard  to  premonitory signs, without intelligent action to
relieve the situation, a state  of  morbid indifference develops,
which culminates in a pestilential outbreak.

               Disinfectants not used at Sea.
   I know from  experience that  it is the hardest possible thing
to get skippers to use the most desirable disinfectants, which in
my country must be carried by law.  A few gallons of stinking
carbolic acid—that curse of inefficient and blinding sanitation—
of chloride of  zinc or aluminium, could however, even if used,
be of little or no service under such circumstances.
   Frequently has attention  been directed to contaminated  bal-
last, and it is by  no means a far-fetched supposition that ballast
charged with putrifying organic matter may, in the tropics, foul
to pestilential  virulence the confined air of  a ship.   From  this
point of  view  the case of the ship Hibbert  is interesting; for
the only connection with the necessary focus in the tropical  At-
lantic basin was by  ballast,  which for years did no damage,
infected no one, until ultimately  saturated with putrefiable mat-
ter and  subjected to intense heat.  Then a  disturbance of  the
filth, and  probably that  universal swabbing  and washing which
Dr. Turner exposes, established  the link, with other favoring
causes, to produce a true nautical typhus or yellow fever.
   There are many instances of ships escaping infection in ports
contaminated  by yellow fever, and we  have all heard of naval
officers vaunting their conquests over the epidemic  by cleanli-
ness and free ventilation.  The foul ships and the old ships are
the yellow-fever ships ; but the same would occur in  relation to
most diseases, and notably in relation to small-pox.  A very
exhaustive analysis of all cases,  recorded  or hereafter coming
under observation, of yellow fever in ships, and of its uniform
absence or frequent recurrence in certain ships, is imperatively
demanded, and will more amply repay investigation than  the
study of  yellow fever  in towns.   It is most dangerous to trust
to tradition.  Our knowledge, such as we possess, is based far 
72          YELLOW FEVER A NAUTICAL DISEASE.
too much on that already.  The prompt investigation of last
year's  epidemic was most fortunate, and,  although confined
mainly to the infected cities, will undoubtedly contribute much
to enrich our understanding  on this question.   It  is well now
that the National  Board  of  Health is so  closely watching the
shipping.   There is the mine for the  yellow-fever pathologist;
and, that once thoroughly explored, we shall wonder that, after
man's  experience in camp and jail fevers, we have been so  re-
miss, so reckless, and so blind.
   What relation does the cargo, in its nature, hold to outbreaks
of yellow fever ?   Record, classify, and learn!  Is it enough to
have the exhalations from human  beings  in  ill-ventilated ships-
in the tropics to breed the disease ?  Who  knows ?  Probably
the animal matter from living creatures, with tropical organic de-
composition and  climatic conditions,  complete the  circuit for
fatal invasions.  To arrive at essentials, we must eliminate the
non-essentials;  and we know that in  the North Atlantic, the
Mediterranean, or  the Indian Ocean, thousands of ill-ventilated
ships, laden with fish or fruits and well filled with human beings,
have been decimated—but not  by yellow fever.  The tropical
something must be there from the West  Equatorial Atlantic;
hence  yellow fever is indigenous, not to  the  soil, on which  it
never breeds, but to the ocean;  there where, since ships traded,
the disease has undoubtedly recurred, at intervals which seem
to bear an inverse ratio to the activity of  maritime intercourse.
It is undoubtedly and  incontrovertibly indigenous  to ships, al-
though it  may be—nay, in all probability, is—exotic on every
land.   Its importation and persistence in certain harbors and
cities are not more marvelous or inexplicable than the effects of
crowdrpoisonmg in any latitude—the  manifestation of the bu-
bonic plague of old, and the  dissemination of hog cholera.
   As I am writing I receive the annexed extract through the
friendly hand of a journalist, and, without committing myself
to the view that Memphis received no fresh infection this season,
I can not do better than constitute it the finale to this chapter.

               " Cause of the Outbreah in Memphis.
   " The true reason of the present outbreak of yellow fever lies not so much
in the filthy streets and alleys of the city, but in the cupidity of some of 
DISINFECTANTS  NOT  USED AT  SEA.             73
 our people, who would not give their consent to destroy even the bedclothes
 upon which patients died of the fever.  It has never been demonstrated
 that the yellow-fever germ can be preserved through the frosts and breezes
 of the winter in the foul air of a privy vault;  but it has been shown time
 and again that woolen goods, especially blankets, that have become satu-
 rated with the yellow-fever poison, will retain it for a very long  period
 even in cold weather.  It is well known that many persons in Memphis did
 not hesitate to preserve and even to sleep upon beds and bed-clothing  that
 had been poisoned  by the infected air of a sick-room, or by direct contact
 with the yellow-fever  patient.  These articles had been kept, of course, in
 bed-rooms where the  heat of a fire during the day and the warmth of  the
 sleeper's body at night  prevented the germ from  being frozen out.  In
 many instances woolen clothing that had been hanging in the sick-room,
 where the air was reeking with the foul fumes of the fever, was packed
 away in trunks, or,  with the poorer class, in wooden  boxes.  Here it re-
 mained during the winter.  The warmth generated by the fabric was amply
 sufficient to preserve the germ in all  its former vigor, and there it lay, like
 a deadly serpent, only waiting for the heat of summer to warm it into life.
 Mulbrandon's coat, which, like the shirt of Nessus, carried death in every
 fold, is now a matter of history.  Another is that mentioned in the  " Ava-
 lanche" of yesterday morning, of a South Memphis woman who has kept
 in a wooden box all the clothing of her husband, who perished by the fever
 last year, and even the bed-clothes on  which he died, stained all over with
 black vomit.  One of  the ablest physicians in Memphis said not long ago
 that there was not  a  house in the city, whether ocoupied during the fever
 or not,  that  had not been  thoroughly  infected by the yellow-fever poison.
 It should be remembered also that even those who fled from the city when
 the fever broke out  lefb behind them carpets, bedding, and winter clothes,
 to receive in trust for them the insidious  poison which they were trying to
 escape.   This reasoning may not be founded upon the principles of medical
 science, but it is certainly justified by common sense;  and, by getting up
 all the evidence to be  had in regard to the matter,  the medical fraternity
 may be  able to throw some light  upon the origin of the present outbreak
 of yellow fever in our  city.—(From the Memphis " Avalanche.")

    How much like the dried, compressed  yeast—a preserved
ferment—does this  read !  How fortunate that its  development
demands abundant  moisture, and that free aeration is as fatal to
it as to the sulphuretted hydrogen  exhalations on open salt
marshes!   Hence the absolute freedom of inland towns. 
CHAPTER  II.
            GENERAL HISTORICAL CONSIDERATIONS.

   Physicians in attendance on the  sick, in epidemic times,
have manifested almost as little acumen, in regard to the imme-
diate source of pestilence, as success in treatment.   This is not
meant as a reflection on the medical profession, since, for a hun-
dred years  past, highly competent and judicious investigators
have amassed the data and discussed opposite views with ardor,
always supplying some facts with lengthened arguments, so as to
enable the careful student, now, to take advantage of world-wide
observations, accurate records of the  course and  symptoms of
the disease, its field of progress, development, and  limitation.
The apparently interminable diversity of opinion is undoubtedly
the basis of a unity which can  not fail to strike us as growing
and consolidating.
   When I first investigated the  lung-plague in cattle in the
London dairies, the mortality was frightful and  the proposed
remedies were innumerable.  Professional and non-professional
observers were unanimous as to the origin of the disease in the
London dairies, and those most  active in attendance on the sick
animals were apparently least competent to take a broad view
of the nature and method  of  propagation, which  Gerlach in
1836 found to be pure contagion, and which I afterward proved
to be the case with  this and other epizootics, the concomitants
of the free import  of live animals into Great Britain, on the
adoption of the otherwise glorious policy of free trade.
   Sound pathological knowledge, guiding the statesman, from
1839 to 1846 and since, would have saved the British Isles from 
GENERAL HISTORICAL CONSIDERATIONS.          75
ten to twenty millions sterling per annum during nearly forty
years.  The British people have lost not less than £250,000,000
sterling, or, approximately, the appalling sum, in round num-
bers, of $1,200,000,000, by the direct and indirect  effects  of
specific animal contagia.
    Calculations have been made of the losses incurred  by the
United States from the yellow fever, and they are enormous.
Conjectural as these figures may be, it would be well, some day,
for a political economist to investigate  this subject,  especially
should  this be needed as an incentive in inaugurating so  radical
a policy, in relation to the shipping connected with the tropical
Atlantic belt, as will guarantee the ports from disease invasion.
The people of the United States are generous and humane, so
that any statesman  may count on national support who will take
this subject in hand, and so cooperate with other governments
as to accomplish the object in view thoroughly, not  counting
the cost.
    Humanity, apart from any sordid considerations,  demands
the prompt and final extinction of yellow fever by all the means
which science and  a sound international  policy may suggest.
The helpless, dying seamen utter but faint cries, soon  buried
with their bodies in the deep.   One crew is dispatched—another
secured, to follow likewise; and a convalescent woman—a heroine
—with  a dying father, husband,  or  brother by her side,  may
have to navigate the ship, with none but almost images of death
to sail and steer.  We search for autochthonous causes of  yellow
fever on the banks  of the Mississippi, as people  were  searching
for them in Dr. Tully's  days on the Connecticut.   We so soon
forget the signals of distress waving from pestilent vessels,  which,
helpless on the Gulf, have to be towed to quarantine.  Thence
germs, if germs—things, if things infected—find a readier en-
trance to the houses and stores of benighted Memphis than  of
the Crescent City.
   A Plimsoll is wanted in America—one who can and will
search out the conditions under which the shipping of the West
Indies exists.  The  recklessness of ignorance must oft be added
to the recklessness of intoxication, to induce even a brave  young
seaman  to step into a charnel-house  and cast his lot with the
decomposing bodies of those still partially living.  I have some 
76          YELLOW  FEVER A NAUTICAL DISEASE.
idea of the horrible, fiendish purposes of  man  in  trade, when
time and danger have hardened him to unmanly deeds.  Let us
save the brave and inexperienced from any stealthy demoniacal
assaults, and in doing this we shall reward the humane and care-
ful—the model sea-captain and his cleanly crew—by depriving
the diseases of the delta of the Mississippi and the waters be-
yond it of all their horrors—of their hold on human life and  on
the destinies of a glorious continent.

              PAST HISTORY OF YELLOW FEVER.
    My treatment of this subject can only be partial, and its ob-
ject, so far as I can extend it, is to add convincing proof of the
soundness of the view that yellow fever is a disease of ships  in
the tropical waters of the Atlantic.   It is undeniable that it has
a permanent home in the shipping, a sub-permanent home in
seaports, and a transient home in river ports and inland towns,
centers of commerce or the resorts of refugees.
    Were I to undertake a purely medical history, I might divide
the century since 1780 into the eras  of  fashionable medical
opinions: the first, when  the malady was  deemed a  visitation
of  God and  springing anywhere; the days when  Noah Web-
ster wrote  on Pestilence, when Pym, Deveze, Nathaniel Potter,
and a host  of others enriched the literature of yellow fever and
developed the fight with the apostles of contagion; the second
closing with the labors of Chervin, Louis  Trousseau, and the
eminent pathologists of that era;  the third ending  with Dr.  La
Roche's searching exposition of accumulated knowledge; and
now, in the fourth quarter, the science of  preventive  medicine
has made such strides that pills and potions are almost  cast* aside
for the greater conquest of mind over matter—the control of
conditions which  may cure the city rather  than the sick—save
the ship  and the seaman too.  It is  this proud end  for which
the foundation should practically be laid  before the close  of
1880, and I trust I am not deceived  in believing that 1879 may
be rendered memorable  as the last  year in which yellow fever
had a firm  hold on any important town in the United  States. 
ANCIENT  HISTORY OF YELLOW FEVER.          77
              Ancient History of Yellow Fever.
    We know comparatively little of the ancient history of yel-
 low fever.  It was unknown before  the discovery of the New
 World by Columbus.  America was  undoubtedly the seat  of
 indigenous maladies—maladies actually springing from the soil,
 or autochthonous ; and we readily learn that they presented one
 common character, well understood by the modern pathologist.
 They were all such as are influenced in their periodicity by qui-
 nine.  Yellowness, not necessarily jaundice, and haemorrhages
 are  common symptoms both of these endemics and of yellow
 fever; black vomit—vomito prieto or  negro—pertains occasion-
 ally to both.
    The endemic character of yellow fever on land has met with
 the widest support, owing, in a great measure, to the  compara-
 tive immunity enjoyed by the people of the West Indian Islands
 and Central American Atlantic shore  during yellow fever out-
 breaks, and the virulence of the malady among strangers.  That
 vaunted freedom is  in a sense illusory.   It is not unlike the
 asserted  soundness of Texan herds, which  destroy, by pasture
 contamination, northern cattle feeding with them.   Texan bul-
 locks thrive while 95 per cent, of  animals grazing with  them
 succumb to splenic fever with haemorrhagic symptoms.  On my
 visit to Texas  I discovered that the vaunted immunity was a
 myth.   Every animal bore marks of organic lesions which indi-
 cated a sub-acute and chronic state of sickness or previous at-
 tacks.  Dr. Cornilliac * directs attention to the undoubted cases
 of yellow fever among Creoles, and quotes Dr. Catel's observa-
 tions in 1838, as also  the  statements of Professor  Lufz, to the
 effect that in times of yellow fever the children of  a town, and
 especially the new-born, pass through the malady, however mit-
 igated it may appear and unobserved by the parents.   The sal-
 low and jaundiced look of the people of a malarial country is
 proof positive that their  health is  or has been impaired.   Dr.
 Cornilliac asserts that the opinion respecting the identity of the
nature of the fever which attacks children and indigenous adults
during epidemics of yellow fever  is accepted by all doctors in
Martinique, where he has studied the disease.
        * "fitudes sur la Fievre Jaune a la Martinique," 2d ed., 1875. 
78          YELLOW FEVER A NAUTICAL DISEASE.
   Oviedo * reports that in 1494 a disease associated with jaun-
dice  appeared two months after the  arrival of Columbus;  and
Gimaron alludes to the yellowness of the followers of Colum-
bus : they were saffron-colored, or, as Herrera stated it, azafra-
nados.
                  Diseases of the Med Men.
   Dr. Hosack published letters from a trustworthy observer in
the first volume of the  "New York Medical and  Physical
Journal" (1827).   This gentleman, Mr. John D. Hunter, says:
" The diseases of the Indians  are for  the most part simple. . . .
Those inhabiting wet, marshy land, especially such as reside on
the shores of rivers which inundate their banks to a considerable
extent, are somewhat subject, during the vernal and autumnal
months, to bilious remitting and intermittent fevers ; and those
who have been reduced by the enervating corruptions of the fron-
tier settlers have of late years been afflicted with typhus fever."
   Rheumatism was the  deadly disease  which  shortened  life
and rendered their brief span of existence a period of torment.
They were excellent weather prophets, for  their twinges  and
pains told of approaching atmospheric changes.   They submit-
ted to the most  violent  remedies.  A hole was dug  in  the
ground, a fire of dry sticks and brush was built over it, and on
this water was poured, into which they entered as hot as it could
be endured.  Bushes and leaves were placed on them to retain
the vapor, and, half suffocated, they remained there an hour
or more.  In Mexico to this day holes are dug in the ground by
the Indians;  stones are heated by fire and placed  in the hole,
and withdrawn at the right time ; and the patient then enters
and is packed in, keeping only the head out of water.
   Reference has often been made to wide-spread disease among
the Indians, both in  the Northern States after the first arrival
of Europeans and in the tropics.   A very remarkable circum-
stance attending these outbreaks has been the ready propagation
of the malady inland, its long continuance at all seasons and for
several successive years, and the non-communication of the mal-
ady to the whites, notwithstanding that in all probability the
disease, which may have been small-pox, was first introduced by
a new-comer.
* " Historia General de las Indias." 
DISEASES OF THE RED MEN.
79
    Humboldt,* whose chapter on this question, extending over
 38 quarto pages, is admirably  lucid  and terse, says:  " Long
 after the  arrival of Cortes an epidemic reigned periodically in
 New Spain, which the  natives called matlazahuatl, and which
 authors have confounded with the vomito or yellow fever.  This
 pest is probably the same as that which in the eleventh century
 forced the Kalteques to continue their migrations  southward.
 It committed great ravages among the Mexicans in 1545, 1576,
 1736, 1737, 1761, and 1762; but, as we have already indicated
 above, it was  characterized by two features which were essen-
 tially different from those of the vomito of Yera Cruz:  it at-
 tacked the natives and the copper-colored race almost solely, and
 it prevailed in the interior of the country at 1,200 or 1,300 feet
 above the sea-level.  It is true that the Indians of the Mexican
 valley died by thousands in 1761, victims of the matlazahuatl,
 vomiting blood, which was ejected by the mouth and nose; but
 these gastric  haemorrhages {hematemeses) often occur in the
 tropics, accompanying the low bilious fevers.   They have been
 likewise observed during the epidemic of 1759, which traversed
 all South America from Potosi and Oruro to Quito and Popayan,
 and which, according to Ulloa's description, was a typhus pecu-
 liar to the elevated regions of the Cordilleras."
    Prescott distinctly avers that, when Cortes and his followers
 first entered the  tierra caliente, in 1519, precisely the period
 when vomito is now known to have raged with greatest fury, no
 mention was made-of an uncommon mortality.  He says: " The
 fact doubtless corroborates the theory of those who postpone the
 appearance of the yellow fever till long after the occupation of
 the country by the whites."
   I have striven to trace evidence of genuine yellow fever
 among the aborigines of America, and consulted Major Powell,
 whose knowledge of the Indians is surpassed by none; and there
 is  absolutely no trustworthy evidence of ravages by any such
 disease.   Decimation by small-pox has been common, and the
pioneer settlers in Massachusetts, intent on converting the savage,
asserted that the plague was evidence of God's wrath for the
inhospitable treatment they had  shown  His chosen people, the

  * "Voyage de Humboldt et  Bonpland," p. 752, 3d part, vol. ii., Paris, 1811. 
80
YELLOW FEVER A NAUTICAL DISEASE.
whites.   When the Plymouth  pilgrims  arrived, the Indians
feared a repetition of outbreaks, which were then on the decline.
   During the reign of Charles Y. of Spain, Yelasquez, Gover-
nor of Cuba, determined on attacking  Cortes on the  Aztec
coast, and he  sent a force under the command of a Castilian
hidalgo, Panfilo de Narvaez.  The surprise and capture of the
latter quickly followed, but Cortes took advantage of  a formid-
able number of his foes by making them confederates, distribut-
ing gold and  other precious commodities among the soldiers of
Narvaez.  Thus came the natives to experience far more injury
from  pestilence than war. A negro in Narvaez's suite brought
with  him the small-pox.  " The disease spread  rapidly in that
quarter of the country, and great numbers of  the Indian popu-
lation soon fell victims to it." *
   I note this well-authenticated case to show  that contact with
Europeans destroyed the  Indians by other maladies than yellow
fever—that disease of ships and seaport towns, and not of the
wigwam.
              Spanish and Portuguese Traders.
   By a papal bull of Alexander YI. the discoveries in the
Indies were made over to Spain and Portugal, but the difficul-
ties attending the peopling and commercial development of the
region led to licenses being  given by the Spanish Government
to private traders.  As Prescott states,f the discoveries of Co-
lumbus resulted in a spirit which was evinced " in the alacrity
with which private adventurers embarked in expeditions to the
New World, under cover of  the general license during the last
two years of  the [fifteenth]  century.  Their  efforts,  combined
with those of Columbus,  extended the range of  discovery from
its original  limits, twenty-four degrees  of north latitude, to
probably more  than fifteen south, comprehending some of the
most important territories in  the western  hemisphere.  Before
the end of 1500 the principal groups of the West India Islands
had been visited, and the whole extent of the southern coast,
from the Bay of Honduras to St. Augustine.   One adventurous
mariner, indeed, named Lefe, penetrated several degrees south
of this, to a point not  reached  by any other voyager for ten or
   * " Conquest of Mexico," vol. ii., p. 272. Herrera, " Hist. General."
   f " History of the Reign of Ferdinand and Isabella," p. 505. 
THE  SPANISH  GALLEONS.
81
 twelve years after.   A great part of the territory of Brazil was
 embraced in this extent, and two successive Castilian navigators
 landed and took formal possession of it for the crown of Castile,
 previous to its reported discovery  by the Portuguese Cabral,
 although these  claims to it were  subsequently relinquished by
 the Spanish Government,  conformably to the  famous line of
 demarkation established  by the treaty of Tordisellas."
    It is asserted, and Cornilliac believes, that  during all  this
 period the  yellow fever was  the Indians'  ally or auxiliary in
 their defense against the cruel cupidity of the Spaniards.
    In Peru it has been noticed that the  Indians  are peculiarly
 liable to yellow fever, and do not enjoy the immunity of the
 negroes and Mongolians.*

                     The Spanish  Galleons.

    It is my belief  that  the Spanish galleon is the genuine an-
 cestor of our plague-stricken ships.  Dr. Joseph Jones, of New
 Orleans, f has rendered good  service by directing special atten-
 tion to this  point.   It is  full of interest in tracing the first lines
 of the history of yellow fever.   He says:

   " At the time when Spain possessed by far the best and largest portion
 of the American Continent, extending from the  north of California to the
 Straits of Magellan—a space  of  between six thousand and seven thousand
 miles—a system of commerce was  established which  appeared to be emi-
 nently favorable to the origin and spread of  yellow fever.  The Spanish
 galleons were, in fact, very large men-of-war, built in such a manner  as to
 afford ample room for the stowage of merchandise, with which they were
 commonly so encumbered as to be rendered incapable of defense.  The fleet
 of galleons consisted of eight  such men-of-war, and generally convoyed from
 twelve to sixteen merchant-men.  During times of peace the galleons sailed
 once a year regularly, though at no  set time, but  according to the pleasure
 of the King of Spain and the  convenience of the merchants.
   " They sailed from Cadiz to  the Canaries, thence for the Antilles, and
 after reaching this longitude  they bore away for Carthagena.  As soon as
 they came in sight before the mouth of Rio de la Hacha, after having doubled
 Cape de la Yela, advice  of their arrival was sent to all parts, that everything
 might be prepared for their reception.  They remained a month in the har-

   * See report by Dr. John M. Browne on  the Oroya fever, "Medical Essays
 U. S. N.," Washington,  1872.
   f "Proceedings of the Louisiana State Medical Association," New Orleans, 1879,
p. 64.
            6 
82            YELLOW  FEVER A NAUTICAL DISEASE.
bor of Carthagena, and landed there whatever was designed for terra firma.
They then sailed to Puerto Velo, where, having staid during the fair, which
lasted five or six weeks, they landed the merchandise intended for Peru,
and received the treasures and commodities sent from thence.  These gal-
leons then sailed back to Carthagena, and remained there till their return
to Spain, which usually happened within the space  of two  years.  When
orders for returning home arrived, they sailed first to the Havana, and hav-
ing joined the flota, and what other  ships were bound to Europe, they
steered northward as far  as Carolina, and then, taking the westerly winds,
they shaped their course to the Azores, when, having watered and victualed
afresh at Terceira, they thence continued their voyage to Cadiz.
   " The Spanish flota consisted, like the galleons, of a certain number of
men-of-war and merchant-ships; there were seldom more than three of the
former and sixteen  of the latter in this fleet.   They sailed from the coast
of Spain some time  in the month of August, in order to obtain the winds
that  blow  in November, for the more easy pursuing their voyage to Vera
Cruz.  They called  at Puerto Rico on their way to refresh, passed in sight
of Hispaniola, Jamaica, and Cuba, and, according to the winds and season,
sailed either to the coast of Yucatan, or higher through the Gulf to Vera
Cruz.  The Spanish flotilla  being intended to furnish not only Mexico, but
the Philippine islands also, with the goods of Europe, was obliged to remain
in Yera Cruz for  a considerable time, and sometimes found it necessary to
winter in that port.  This fleet usually sailed from Vera Cruz in the month
of May, but was sometimes detained as late as August;  it then made for
Havana, and returned to Spain in company with the galleons.
   " The Spanish towns were generally built in low, unhealthy localities,
surrounded by marshes and swamps, with  narrow streets and high walls
and  fortifications, which  not only compressed the  towns within  certain
limits, and induced crowding and favored the accumulation of filth, but also
prevented  to a certain extent the free circulation of air."


                Sir Walter  Raleigh's  Voyage.

   When Columbus had  shown the road, others were not slow
to follow, and the British, French, Portuguese, and Dutch ships
added to the facilities for the development of  the tropical pes-
tilence.   We have to read the history of the seventeenth cen-
tury to approach the conditions of common  infection  by yellow
fever in tropical seas.   One notable instance which bears strong-
ly on my views of its development in mid-ocean is furnished by
Sir Walter Raleigh's voyage  in 1616.   His fleet  left England
pure, healthy, and uncontaminated.  It arrived off Lancerota on
the 6th of September, and thence they steered to Gomera.   After
leaving this the  weather was stormy, the  ships were  damaged, 
ANSON'S VOYAGE ROUND THE  WORLD.          83
 perpetual rains and intolerable heat prevailed on their west-
 ward course.   That they were steering close to the equator, to-
 ward Guiana, is proved by the high temperature encountered,
 which bred disease on board,  as usual  in this region, destroyed
 great numbers of men, and ultimately attacked the Admiral him-
 self.  He was seized with the most violent fever, and his re-
 covery was despaired of.  On the 12th of October, after having
 been at sea over a month, they struck a dead calm, and toward
 the end of the month their water was short.  The sickness con-
 tinued with great intensity among the crew, and at last on  the
 11th of November the fleet arrived off Guiana.  That this, like
 all other fleets afflicted with specific sickness in the tropical At-
 lantic, was stricken with yellow fever,  I for one do not doubt.
   William Piso, in his  splendid " Natural History of the Bra-
 zils " (1648), writing " De Morbis Contagiosis,"  distinguishes the
 endemics of the Brazils from the " maligna et contagios a febre "
 attacking the Portuguese sailors and soldiers on the ocean.   More
 than a third of those proceeding from Europe to the Brazils died
 in 1639. The long and tedious voyage, corruption of  food, etc.,
 induced the " morte repentina" characterized by blood extrava-
 sations.
   Without attempting  a critical investigation of minor out-
 breaks of ocean pestilence, we may review the  most interesting
 of all the grand disasters assailing the fleet of one of  the great-
 est of England's mariners.

             AJSTSOn's VOYAGE KOTTND THE WORLD.
   Anson's " Yoyage Round the World " is replete with interest,
 and  was published in London  in 1749,  the nominal editor being
 Richard Walter, M. A., Chaplain to his Majesty's Ship Centu-
 rion. Benjamin Robbins, the  author of " Mathematical Tracts,"
 was  in  truth intrusted with working  Mr. Walter's notes into
 shape, and produced a work of great accuracy and repute.  The
 Spaniards adopted, as  we have seen, a policy of  exclusion in
their relations with the western islands and shores of the Atlan-
tic, and such as would lead  to conflicts and jealous aspirations.
In the summer of 1739 it was foreseen that a war with Spain
was inevitable, and Sir Charles Wager, deeply intent and active,
summoned Anson to the Admiralty.  After some negotiations 
1
84          YELLOW FEVER A NAUTICAL DISEASE.

as to the ships and force to be employed, the Duke of Newcas-
tle, Principal Secretary of State, delivered on the 28th of June,
1740, his Majesty's instructions to Mr. Anson.  And here we
have a  singular instance of that misdirection, so common in
starting important aggressive operations, which must so often
have failed but for the determined pluck and unflinching en-
durance of England's army and navy.  George Anson was sent
to the  South Seas with Chelsea  Hospital  invalids, and nearly
half  of  the five hundred veterans who were the fittest for duty
deserted at Portsmouth, and were replaced  by two hundred and
ten marines, raw and undisciplined men, culled from the differ-
ent regiments, who went on board on the 8th of August, ena-
bling the squadron to sail on the  10th of August, 1740.
   The statement is made by  the editor (and it is important in
such a  record as this) that the Chelsea out-pensioners were op-
posed to and alarmed  at the prospects  of a voyage, " hurried
from their repose into a fatiguing employ,  to which neither the
strength of their bodies nor the vigor of their minds was in  any
ways proportioned, and where, without seeing the face of the ene-
my,  or in the least promoting the success of the enterprise, they
would in all probability uselessly perish by lingering and painful
diseases."   How true these anticipations were we shall soon  see.

               Ships composing the Squadron.
   " The squadron allotted to this service consisted of five men-
of-war, a sloop-of-war, and two victualing ships.  They were the
Centurion,  of sixty guns, four hundred men, George  Anson,
Esq., commander; the  Gloucester, of fifty guns, three hundred
men, Richard Norris commander;  the  Severn, of fifty guns,
three hundred men, the Honorable Edward Legg, commander;
the Pearl, of forty guns, two hundred and fifty men, Matthew
Mitchel commander; the Wager, of twenty-eight guns, one hun-
dred and sixty men, Dandy Kidd  commander; and the Tryal
sloop, of eight guns, one hundred men, the Honorable John
Murray commander.   The two victualers were pinks, the larg-
est of about four hundred, and the other of about two hundred,
tons burden; these were to attend us till the provisions we had
taken on board were so far consumed as to make room for the
additional quantity they carried with them, which, when we 
SHIPS COMPOSING THE SQUADRON.
85
 had taken into our ships, they were to be discharged."  The
 16 ships numbered 1,510 men on board.
    After leaving St. Helen's Anson joined a convoy and traders,
 "making  up  eleven men-of-war and about  one hundred  and
 fifty sail of merchantmen, consisting of the Turkey, the Straits,
 and the American trades."   On the  25th of October Anson's
 squadron and the two victualers cast anchor in Madeira, having
 long parted company with the rest.   They took in water, wine,
 and provisions, made  some changes in the officers, and on the
 4th of November sailed, naming St. Jago, on the Cape de Yerde
 Islands, as the first place of  rendezvous  in case of separation.
 If they did not meet  the Centurion there, they were to make
 the best of their  way  to the island of St. Catherine's, on the
 coast of Brazil.
    They first heard at  Madeira of  a  cruising squadron, which
 they afterward ascertained was Don Joseph  Pizarro's.  A his-
 tory of  the Spanish squadron is given by the editor.*  On the
 21st of  December Pizarro heard of  the treachery of the Portu-
 guese governor of St. Catherine's, of Mr. Anson's having arrived
 at that  island on  the 21st of December preceding, and of his
 preparing  to put to sea again with the utmost expedition.  Pi-
 zarro's fleet suffered seriously; and here the editor adds:  " To
 all the misfortunes we had in common with each other, as shat-
 tered rigging, leaking ships,  and the fatigues and despondency
 which necessarily attended these disasters, there was superadded,
 on board our squadron, the ravage  of a most  destructive  and
 incurable disease."
    Instead of touching at St. Jago, Anson ordered his fleet to
 the Island of St. Catherine's  on the  coast of Brazil.
   * " This squadron (besides two ships intended for the  West Indies, which did
 not part company till after they had left the Madeiras) was composed of the follow-
 ing men-of-war, commanded by Don Joseph Pizarro: The Asia, of sixty-six guns
 and seven hundred men, which was the Admiral's ship; the Guipuzcoa, of seventy-
 four guns and seven hundred men; the Hermiona, of fifty-four guns and five hun-
 dred men; the Esperanza, of fifty guns and four hundred and fifty men; the St.
 Estevan, of forty guns and three hundred and  fifty men; and a patache of twenty
 guns. These  ships, over and above their complement of sailors and marines, had
 on board an old Spanish regiment of foot, intended to reenforce the garrisons on the
 coast of the South Seas.  When this fleet had cruised for seven days to the leeward
of the Madeiras, they left that station in the beginning of November, and steered
for the river Plate." 
86          YELLOW FEVER A NAUTICAL DISEASE.
   " On the 20th of November the captains of the squadron
represented to the Commodore that their ships' companies were
very sickly, and  that it was their own opinion, as well  as their
surgeons', that it would tend to the preservation of the men to
let in more air between decks; but that their ships were so deep
they could not possibly open their lower ports.  On this  repre-
sentation, the Commodore ordered six air-scuttles  to be cut into
each ship, in such places where they would least weaken it."

              Anson's Fleet Surgeon's Opinion.
   And here we have a singular instance of that prescience on
the part of a skillful surgeon which might have saved many a
fleet if attended to.   He  said:  " And on this occasion I can not
but observe how much it  is the duty of all those who, either by
office or authority, have  any influence  in  the direction of  our
naval affairs, to attend to  this important article, the preservation
of the lives and health of our seamen.   If it could be supposed
that the motives of  humanity were insufficient for this purpose,
yet policy and a regard to the success  of  our arms, and the in-
terest and honor of each particular commander, should naturally
lead us to a careful and impartial examination of every probable
method proposed for maintaining a ship's crew  in health  and
vigor.   But hath this always been done ?  Have the late invent-
ed plain and obvious methods of keeping our ships sweet  and
clean, by a constant supply of fresh air, been considered with
that candor and temper which the great benefits promised here-
by ought naturally to have inspired %  On the contrary, have not
these salutary schemes  been often treated with neglect and con-
tempt ?  And have not some of  those who have been intrusted
with experimenting their effects been guilty of the most inde-
fensible partiality in the accounts they have given of these  trials %
Indeed, it must  be confessed that many distinguished  persons,
both in the direction and command of  our fleets, have exerted
themselves on these occasions with a judicious and dispassionate
examination, becoming the interesting  nature  of the  inquiry;
but the wonder is that  any could be found irrational enough to
act a contrary part in despite of the strongest dictates of pru-
dence and humanity.   I  must, however, own that I do not be-
lieve this conduct to have arisen from motives so savage  as the 
OUTBREAK OF THE CALENTURE.
87
 first reflection thereon does naturally suggest;  but I rather im-
 pute it to an obstinate, and in some degree superstitious attach-
 ment to  such practices as have been long established, and to a
 settled contempt and hatred of all  kinds  of innovations, espe-
 cially such as are projected by landsmen and persons residing on
 shore.  But  let us return from this, I hope, not impertinent di-
 gression."
                  Outbreak of the Calenture.
    They crossed the equator on  the  28th of November, and on
 the 11th of December they were  thirty-four leagues off  Cape
 St. Thomas, right in the yellow-fever belt.
    " We began to grow  impatient for a sight of  land, both for
 the recovery of our  sick, and for the refreshment and security
 of  those who,  as yet, continued healthy.   When we departed
 from St. Helen's, we were in so good  a condition that  we lost
 but  two men on board the  Centurion in our long passage to
 Madeira.   But in this present run  between Madeira and St.
 Catherine's we  were remarkably sickly, so that many died, and
 great numbers  were confined to  their hammocks, both in our
 own ship and in the rest of the  squadron, and  several of  these
 past all  hopes of  recovery.  The  disorders  they in general
 labored under were such as are common to the hot climates, and
 what most ships, bound to the southward, experience in a greater
 or less degree.  These are those kind of fevers  which they usu-
 ally call calentures; a disease which was not only terrible  in its
 first instance, but even  the remains of it often proved  fatal to
 those who considered themselves as recovered from it.  For it
 always left them  in  a  very weak and helpless condition, and
 usually afflicted with fluxes or tenesmus.  By our continuance
 at sea all these  complaints were every day increasing, so that it
 was with great joy that we discovered the coast  of Brazil on the
 18th of December at seven in the morning."

                   What is a Calenture?
   Dr. Ferguson, Medical Inspector of  Hospitals, a most compe-
tent observer at the close of the last century, and well acquainted
with the West Indian islands, explains this word calenture, which
even Cornilliac has alluded to, and which was one of the earliest,
possibly the earliest, name given to  yellow fever by naval sur- 
88           YELLOW FEVER A NAUTICAL DISEASE.

geons, who had never seen or heard of the disease before enter-
ing, for the first time, the deadly Atlantic belt.   Dr. Ferguson
says " soldiers and others have  been attacked and died of yellow
fever before  they landed in the West Indies, or could be ex-
posed  to the influence  of land  miasmata in any shape." .  . .
" From this  it would appear  that a  calenture, the synocha of
Cullen (the pure offspring of heat, as pneumonia is  of  cold),
runs a course similar to the yellow fever—the same as  the true
bulam."
    The run  from Madeira  lay  right across the yellow-fever
region, and the thirty-seven days in heavily laden ships, deep in
the water and crowded  with  men and provisions, developed
disease the nature of which is  not doubtful.  Special  attention
must be paid to the acknowledged state of health at  St. Helen's
and the disastrous fever  which immediately followed.

                  Rest at St. Catherine's.
    They anchored at 5 p. m. of the 18th off the N.  W. part  of
the Island of  St.  Catherine's.   On the morning of the 20th the
squadron weighed and  stood  in; a pilot went  on  board, and
brought them to anchor  in five fathoms and a half, in a commo-
dious bay, called Bon Port by  the French.  The next  morning
they weighed anchor again, running between the castles of Santa
Cruz and St.  Juan, and again anchored at one in  the afternoon.
" In this position we moored at the Island of St.  Catherine's on
Sunday, the 21st of December, the whole squadron  being, as  I
have already mentioned, sickly and in great want  of  refresh-
ments: both which inconveniences we hoped to  have soon re-
moved at this settlement, celebrated by former  navigators for
its healthiness and the plenty of its provisions, and for the free-
dom, indulgence, and friendly assistance there given to  the ships
of all European nations in amity with  the crown of Portugal."
    The bad  reputation for unhealthiness of the  equinoctial  or
south seas has been referred  to; and below Capricorn, where
the squadron  was now anchored, the conditions for health were
better, but still bad for infected ships.
    The narrative  continues:  "Our  first  care,  after having
moored our ships, was to get our sick men on shore; prepara-
tory to which, each ship was ordered by the Commodore to erect 
REST AT  ST. CATHARINE'S.                 89
 two tents: one of them for the reception of the diseased, and the
 other for the accommodation of the surgeon and his assistants.
 We sent about eighty sick  from the Centurion, and the other
 ships, I believe, sent nearly  as many in proportion to the num-
 ber of  their hands.  As soon as we had performed this neces-
 sary duty we scraped our decks, and  gave our ship a thorough
 cleansing; then smoked it between decks ;  and after all washed
 every part well with vinegar.  These operations were extremely
 necessary for correcting the noisome  stench on board, and de-
 stroying the vermin; for, from the number of our men and the
 heat of the climate, both these nuisances had increased  upon us
 to a very loathsome degree, and, besides being most intolerably
 offensive, they were doubtless in some sort productive of the
 sickness we had labored under for a  considerable  time before
 our arrival at this island."
    No one who  has  studied  the history of  yellow fever can
 doubt the nature of the evidence here before us; and it is espe-
 cially valuable as proving the undoubted  development of the
 plague at sea on perfectly healthy ships and with healthy people
 at the time of departure from St.  Helen's.
    The narrator speaks of the luxuriant soil of the island, fragrant
 woods, abundant fruits  and vegetables, so that there is  no want
 of pure apples, peaches, grapes, oranges, lemons, citrons, melons,
 apricots, and plantains.   Onions, potatoes, cattle, and pheasants
 add to the abundance of the  place ; and the water on the island
 was excellent, preserving at  sea as well as that of the Thames.
 These data are all  of great interest in relation to the salubrity
 of the region, which was undoubtedly greater than in  the  yel-
 low-fever equatorial zone.   The  editor says: " These  are  the
 advantages of this  island of St. Catherine's; but there are many
 inconveniences attending it, partly from its climate, but more
 from  its new regulations,  and the  late form of government
 established there.   With regard to the climate, it must be re-
 membered that the woods and hills which surround the harbor
 prevent a free circulation of the air.   And the vigorous vegeta-
 tion which constantly takes place there furnishes such a  pro-
 digious quantity of vapor, that all the night and a great part of
the morning a thick fog covers the whole country, and  con-
tinues until either  the sun gathers strength to dissipate  it or it 
90
YELLOW FEVER A NAUTICAL  DISEASE.
 is dispersed by a brisk sea-breeze.  This renders the place close
 and humid, and probably occasioned the many fevers and fluxes
 we were there afflicted with."
    The continued sickness, which was not at all to be wondered
 at, is ascribed to the unhealthiness of the place, the melancholy
 proof of  which was that the  Centurion buried twenty-eight
 men  since her arrival, and  the number of her sick  increased
 from eighty to ninety-six, a proportion which would undoubted-
 ly have been much greater had they anchored in the West In-
 dies or been detained by storms nearer the equator.
   The editor comments on  Brazil, its gold and diamonds;  on
 the Rio Grande and St. Catherine's, where during their whole
 stay  they  were refreshing  their  sick  on shore, wooded and
 watered the squadron, and cleansed the ships; and Mr. Anson
 gave  directions that the ships' companies should be supplied with
 fresh meat, and that they should be victualled with whole allow-
 ance of all kinds of provisions.
   They left St. Catherine's on the 18th of January, and soon
 encountered  a storm.  The Pearl was nearly captured by the
 Spanish squadron.   Captain Kidd  died on the 31st of January,
 and Anson's squadron cast anchor on the  17th of February at
 St. Julian's.  The Tryal had lost  her mainmast, and had to  be
 repaired.   There is no mention whatever of  sickness here, ex-
 cept that Captain Saunders, who was promoted to the command
 of the Tryal sloop, was dangerously ill  of a fever on board the
 Centurion.  Captain Kidd's  death necessitated changes and pro-
 motions, and on the 27th of  February the  squadron weighed at
 seven in the morning and stood to sea.
   On the 7th of March, in the morning, they opened the straits
 of Le Maire; and  about 10 o'clock, the Pearl and the Tryal be-
ing ordered to keep ahead  of  the squadron, the straits were
entered by the latter, with fair weather and a brisk gale.   They
all thought the greatest difficulty of their passage was at an end,
and, animated by flattering delusions, they passed those memora-
ble straits ignorant of the  calamities  then impending, and that
the time drew near when the squadron would be separated, never
to unite again.   They experienced, on leaving the southern ex-
tremity of  the straits, a violent storm.   Doubling Cape Horn
was discovered to  amount really to an enterprise, and for the 
REST AT ST. CATHARINE'S.
91
 three succeeding months the distresses with which they strug-
 gled could not easily be paralleled by any former naval expedi-
 tion.   The tempests were dreadful and occurred at deceitful in-
 tervals.  On the 18th of March cold was intense, and I need
 not detail the accidents, separations, and permanent losses sus-
 tained from this time till the month of May.   I wish here to
 note that yellow fever was evidently at an end before they
 reached  Cape Horn, and the winter weather had  doubtless
 cleared the ships of every vestige of that disease.  It is instruc-
 tive therefore to see under what conditions, in these days when
 lime-juice and preserved vegetables were unknown as remedies
 for scurvy, this malady broke out.
    Our author says :  " Soon after our passing the straits of Le
 Maire, the scurvy began to make its appearance among us; and
 our long continuance at  sea, the fatigue  we underwent, and
 the various disappointments we met with, had occasioned its
 spreading to such a degree that at the latter end of April there
 were but few on board who were  not  in some  degree afflicted
 with it, and in that month no less than forty-three died of it on
 board the Centurion.  But though we thought  that the distem-
 per had then risen to an  extraordinary height, and were willing
 to hope  that  as we advanced to the northward its malignity
 would abate, yet we  found, on the contrary, that in the month
 of May we lost  near double that number; and, as we did not
 get to land till the middle of June, the mortality went on in-
 creasing, and the disease  extended itself so  prodigiously that,
 after the loss of above two hundred men, we could not at last
 muster more than six  foremast men in  a watch capable of
 duty."
   It is not my object to prolong this interesting chapter  of the
 history of seafarers' diseases.  On the 9th of June the Centu-
 rion arrived, at' daybreak, at the island  of Juan  Fernandez,
 where the excellence of the climate, and the abundance of veg-
 etable productions  of all  sorts, constituted  the best  possible
 remedies wherewith  to recruit the squadron's remnant.   With-
 out relating the many brave deeds of the handful of men after
leaving St. Juan, I may refer to the fact that  the pink Anna
had to be broken up  as unseaworthy toward the  end of August;
and our author adds as follows: 
92            YELLOW FEVER  A NAUTICAL DISEASE.
   " This transaction brought us down to the beginning of September, and
our people by this time were so far recovered of the scurvy that there was
little danger of burying any more  at present;  and therefore I shall now
sum up the total of our loss since our departure from England, the better
to convey some idea of our past suffering and of our present strength.   We
had buried on board the Centurion since our leaving St. Helen's 292, and
had now remaining  on  board 214.   This will doubtless  appear a most ex-
traordinary mortality, but yet on board the  Gloucester it had been much
greater; for out of a much smaller crew than ours they had lost the  same
number, and had only 82  remaining  alive.  It might  be expected that on
board the  Tryal the slaughter would have been the most terrible, as her
decks  were almost constantly knee-deep in water; but it happened other-
wise, for she escaped more favorably than the rest, since  she only buried
42, and had now 39 remaining alive.  The havoc of this disease had fallen
still severer on the invalids and marines than on the sailors;  for on board
the Centurion, out of 50 invalids and 79 marines, there remained only 4 in-
valids,  including  officers,  and 11  marines;  and on board the Gloucester
every invalid perished, and out of  48 marines only 2  escaped.  From this
account it  appears that the  three ships together  departed from England
with 961 men on board, of whom 626 were dead before this time ;  so that
the whole  of our remaining crews, which were now to  be distributed among
those ships, amounted to no more than 335 men and boys—a number great-
ly insufficient for manning the Centurion alone, and barely capable of  navi-
gating all three, with the utmost exertion of their strength and vigor.  This
prodigious reduction of our men was still the more terrifying as we  were
hitherto uncertain of the fate of Pizarro's squadron, and had reason to sup-
pose that some part of it at least had got round into these seas.  Indeed,
we were satisfied from our  own experience  that they must have suffered
greatly in their passage; but then, every port in the  South  seas was open
to them, and the whole power of Chili and Peru would doubtless be united
in refreshing and refitting them, and recruiting the numbers they had lost."

    A most  striking example  of the vast difference  there is in
different  seas, when an overcrowded ship is on a perilous voyage,
may be adduced in the case of the Centurion,  which fought the
Spanish galleon,  a  rich prize,  amounting  to  near $1,500,000,
which she captured off Cape Espiritu  Santo.

   " The Commodore, when the action was ended, resolved to make the best
of his way with his  prize  for the river  of Canton, being in the mean time
fully employed in securing his prisoners and in removing the treasure from
on board the galleon to the Centurion.  The last of  these operations was
too important to be postponed; for, as the navigation to Canton was through
seas but little known, and where from the season of the year very tempest-
uous weather might be expected, it was of great consequence that the trea- 
REST AT  ST.  CATHARINE'S.
93
 sure should be sent on board the Centurion, which ship, by the presence of
 the commander-in-chief, the  larger number of her hands, and  her  other
 advantages, was  doubtless better  provided against  all the  casualties  of
 winds and seas than the  galleon.  And the securing the prisoners was a
 matter of still more consequence, as not only the possession of the treasure
 but the lives of the captors depended thereon.  This was indeed an article
 which gave the Commodore  much trouble  and disquietude, for they were
 above double the  number of his own people ; and some of them, when they
 were brought on board the Centurion, and had observed how slenderly she
 was manned, and the large proportion which the striplings bore to the rest,
 could  not help expressing themselves  with great indignation to be thus
 beaten by a handful of boys.  The method which was taken to hinder them
 from rising was by placing all but the officers and the wounded in the hold,
 where, to give them as much air as possible,  two hatchways were left open;
 but then (to avoid any danger that might  happen while the Centurion's
 people should be  employed  upon  deck) there was  a square partition of
 thick planks, made in the shape of a funnel, which  inclosed each hatch-
 way on  the  lower deck  and reached to  that  directly over it on the
 upper  deck.   These funnels  served to communicate the air to the hold
 better than could have been  done without them, and at  the same time
 added greatly to the security of the  ship; for, they being seven or eight feet
 high,  it  would have been extremely difficult for the  Spaniards to have
 clambered up; and, still to augment that difficulty, four swivel-guns, loaded
 with musket-bullets, were planted at the mouth of each funnel, and a sen-
 tinel with lighted  match was posted there ready to fire into the hold among
 them  in  case of any disturbance. Their officers,  who amounted to seven-
 teen or eighteen, were all lodged in the first lieutenant's cabin under a guard
 of six men; and  the general, as  he was wounded, lay in the Commodore's
 cabin,  with a sentinel always with him.   Every prisoner, too,  was suffi-
 ciently apprised that any violence or disturbance would be punished with
 instant death.  And, that the Centurion's people might be at  all times pre-
 pared,  if, notwithstanding these regulations, any tumult should arise, the
 small  arms were  constantly kept loaded in a  proper place,  while all the
 men went armed  with cutlasses and pistols; and no  officer ever pulled off
 his clothes when he slept,  or when he lay down omitted to have his arms
 always ready by him.
   " These measures were obviously necessary, considering the hazards to
 which  the Commodore and his people would have been exposed had they
 been less careful.  Indeed, the sufferings of  the poor prisoners, though im-
 possible to be alleviated, were much to be commiserated;  for, though the
 weather was  extremely hot, the  stench of the  hold loathsome beyond all
 conception, and their allowance of water just sufficient to keep them  alive,
it not being practicable  to spare them more than at the rate of a pint a
day for each,  the crew themselves having only  an allowance of a pint and
a half—all this considered, it is wonderful that  not a  man  of them died
during their long confinement, except three  of the wounded,  who expired 
91
YELLOW FEVER A NAUTICAL DISEASE.
the same night they were  taken, though it must be confessed that the
greatest part of them were strangely metamorphosed by the heat of the
hold; for when they were first brought on board they were sightly, robust
fellows; but, when, after above a month's imprisonment, they were dis-
charged in the river of Canton, they were reduced to mere skeletons, and
their air and looks corresponded much more to the conception formed of
ghosts and specters than to the figure and appearance of real men."

   Here have we a splendid series of examples, indicating, first,
the development of mortal yellow fever when the squadron
sailed westward from Madeira,  crossing the line and  sailing
slowly southward to St. Catherine's Island ; secondly, of scurvy
by improper diet and  privations after  rounding Cape Horn;
and thirdly, the complete immunity with which  a  ship which
had  been badly  infected with  yellow fever  (subjected,  it is
true, to severe  frost the first winter after the  outbreak) con-
veyed its crew and a host of prisoners across the Pacific Ocean.
They suffered all the  horrors of a short supply of  water, and
foul stenches from  enforced  imprisonment of crowds in the
hold, and yet reached Canton without the loss of a single fife
by disease, such as would undoubtedly have decimated them in
the American archipelago.

                   Captain Cook's  Voyage.
   The history of Cook's celebrated voyage from  1772  to 1775
affords an instructive and never-to-be-forgotten contrast to An-
son's disasters from pestilence.   Commanding H. M. ship Reso-
lution, he had with him a company of 118 men,  performing a
voyage of three years and eighteen days throughout all the cli-
mates from 52° north to 71° south, with  the loss of only one
man by sickness.  " How great  and agreeable, then, must our
surprise be," said Sir John Pringle when presenting Sir  God-
frey Copley's gold medal, at  a  meeting of the Royal  Society,
to Captain Cook, " after  perusing the histories of long naviga-
tions in former days, when so many perished by marine diseases,
to find the air of the sea  acquitted from all malignity ;  and, in
fine, that  a voyage round the world may be undertaken with
less danger perhaps to health than a common tour in Europe."
    To this day has the illustrious Cook's lesson proved almost  a
dead letter.   He had the advantage  of  some, but still slight, 
CAPTAIN COOK'S VOYAGE.
95
knowledge of antiscorbutics.  He established a  system of three
watches for the crew;  the sailors  generally had dry clothes to
put on when they happened to get wet, and every precaution
was taken not  to expose them unduly to wet.   Cook did  not
believe in seasoning his men by rough and  debilitating means.
They were compelled to keep clean not only in their persons,
but with their hammocks,  bedding, and clothes.   The  ship was
kept clean and dry between decks.  Fires were used for airing,
or the ship was smoked with gunpowder, vinegar, and  water.
" I had also," says  Captain Cook,  " a fire made in an iron pot
at the bottom of the well, which was of great use in purifying
the air  in the lower parts of  the  ship.  To this and to  clean-
liness as well in the ship as among the people,  too great  atten-
tion can not be paid; the  least neglect occasions a putrid  and
disagreeable smell below, which nothing but fires will  remove."
Facts enabled Cook exultingly to declare " that our having dis-
covered the possibility  of preserving health,  among a numerous
ship's company, for such a length of time, in such varieties of
climate, and amid such continual  hardships and fatigues,  will
make this voyage remarkable in the opinion of every benevo-
lent person, when the disputes about a southern continent shall
have ceased to engage the  attention and to divide the judgment
of philosophers."
   The eloquent Pringle, addressing the Royal Society as he
handed  Captain Cook the  medal, said : " If  Rome decreed the
civic crown to him who saved the life of a single citizen, what
wreaths are due to that man who, having himself saved many,
perpetuates in your ' Transactions' the means by which Britain
may now, on the most  distant voyages, save  numbers of her in-
trepid sons—her mariners  who, braving every danger, have so
liberally contributed to the fame, the opulence, and to  the mari-
time empire of their country."
   I have purposely enforced this  lesson by Sir John  Pringle's
words, since history has to instruct us, not only concerning the
ravages  of plagues, but on the  conditions under  which  these are
prevented. 
96            YELLOW  FEVER A NAUTICAL DISEASE.
           Bryan Edwards on  West  Indian Fever.

    Numerous are Edwards's allusions to this subject, and in one
he says: *

    " Four years have elapsed since I closed the details of the military opera-
tions of the British army in St. Domingo, and I grieve  to  say that what
was then prophetic apprehension is now become historical fact.  This once
opulent and beautiful colony, the boast of France, and the glory of the new
hemisphere, is expunged from the chart of the civilized world!  The pros-
pect of such  lamentable ruin might  give occasion for many observations
and reflections; and I shall present to my readers, in the following very
imperfect sketch (for such it is  in every sense), a few that occur to me;
more than this I dare not attempt.  Were it in my power (as in truth it is
not) to continue in a regular series the history of those sad events which have
led to this miserable catastrophe, I should indeed decline a  task which would
be equally disgusting to my readers and  painful  to  myself.  In a climate
where  every gale was fraught with poison, and in  a contest with uncounted
hosts of barbarians, what could the best  efforts of our gallant countrymen
effect?  Their enemies indeed fled before them, but the arrows of pestilence
pursued and arrested the victors in their career of conquest!  Scenes like
these, while they afford but small cause of gratulation to the actors them-
selves,  furnish  no topics to animate  the page of  the historian, who would
have little else to display but a repetition of the  same disasters—delusive
promises, unrealized hopes, unavailing exertions, producing a complication
of miseries, disease, distraction,  contagion, and  death!
    " At the same time (although I know not that the reader will derive any
great degree of consolation from the  circumstance) it is  incumbent on me
to observe that, during the  disastrous period of which I treat, I  have not
heard that any misconduct or neglect was ever fairly imputed to those per-
sons who had the direction of the enterprise, either in the  public depart-
ments  of Great Britain, or in the scene of action itself.  The names  of
Williamson, Forbes, Simcoe, Whyte, and  Maitland carry with them a dem-
onstration that neither courage, nor energy, nor military talents were at any
time wanting in the principal department.  Reinforcements of troops, too,
were sent by the British Government with a more liberal  hand than in for-
mer years.  Toward the latter end of April, 1795, the 81st and 96th regi-
ments  (consisting together of 1,700 men) arrived from Ireland;  the 82d,
from Gibraltar, landed 980 men in August; and  in  April, 1796,  the 66th
and 69th regiments, consisting of 1,000  men each, with  150 artillery, ar-
rived from the same place,  under the command of General Bowyer; so that
the whole number of effective men which had landed in St. Domingo down
to this  period (including  some small detachments  sent up at different times
from Jamaica) amounted to 9,800.  In June following, four regiments of
* " History of St. Domingo," pp. 383-386, London, 1801. 
BRYAN EDWARDS ON WEST INDIAN FEVER.          97
 infantry, and a part of two others, arrived from Cork, under the command
 of General Whyte.   These were soon afterward followed by seven regiments
 of British  together with three regiments of foreign cavalry; besides two
 companies of British, and a detachment of Dutch artillery;  making  in all
 a further reinforcement  of about 7,900.
    " But what avail the  best concerted schemes of human policy against the
 dispensations of Divine Providence ?  A great part of these gallant troops,
 most of them in the bloom of youth, were conveyed, with little intermission,
 from the ships to the hospitel—from the hospital to the grave!   Of the 82d
 regiment, no less than 630 became victims to the climate within the short
 space of ten weeks after their landing.  In  one of  its companies no more
 than three rank and file  were fit for duty.  Hompesch's regiment of hussars
 was reduced in little more than two months from 1,000 to 300, and the 96th
 regiment perished to a man !   By the 30th of September, 1796, the regis-
 ters of mortality  displayed a mournful diminution of no  less than  7,530 of
 the  British forces  only; and  toward the latter end of 1797, out of the
 whole number  of troops, British and foreign, which had landed and were
 detained in this devoted  country, during that and  the two preceding  years
 (certainly not far short of 15,000 men), I am assured that not more than
 3,000 * were left alive and in a condition for service.
    " ' In these adventures,' observes Mr. Burke,' it is not an enemy we have
 to vanquish,  but a  cemetery to acquire.  In  carrying on war in the  West
 Indies, the hostile  sword  is merciful;  the  country itself  is the  dreadful
 enemy; there the European conqueror finds a cruel defeat in the very  fruits
 of his success.  Every advantage is but  a new demand for recruits to the
 West Indian  grave.' Let us also hear on this subject the Poet of the  ' Sea-
 sons ':
                        "' Then wasteful forth
               Walks the dire power of pestilent disease,
               Sick nature blasting, and to heartless woe
               And feeble desolation casting down
               The towering hopes and all the pride of man!
               Such as of  late at Carthagena quenched
               The British fire.
                                Gallant Vernon saw
               The miserable scenes,
               Heard nightly plunged amid the sullen waves
               The frequent corse !'
                                                           (Thomson.)
   " This miserable scene, however," says Edwards, " has  been frequently
repeated since the siege of Carthagena, where  the disease was imported from
the West Indian Ocean.  It was exhibited at the  Havana  in 1762; at the
Eiver St. Juan, and lately in the Windward Islands; but nowhere, I believe,
with greater  force and effect than in St. Domingo."

   * " The loss of  seamen  in the ships employed  on the coast is  not included.  It
may be stated  very moderately at 5,000 men."
             7 
98
YELLOW FEVER A NAUTICAL DISEASE.
       Yellow Fever in  British and French Guiana.
   There are  three centers of epidemic  outbreaks  of yellow
fever which, without special reference to chronological  order,
tend to throw light on the conditions existing in the most in-
salubrious ports, and which have, to some  extent, misled the
most skillful observers.
   Dr. Daniel Blair published a work on  yellow fever as it
invaded British Guiana.   This is a low, flat, very marshy coun-
try, lying between 6° and 8° north latitude, having  a  uniform
high temperature and humidity, and its climate has obtained a
very ill repute from the ravages of this epidemic.
   Yellow fever had  been  in  Georgetown in 1819, but  its
characteristics had been forgotten;  it had  passed from mem-
ory, and the harbor had acquired a high character for healthi-
ness.   Nevertheless, the mercantile part of  the town was low,
overcrowded, and in far too close proximity and  too nearly on
the level with the shipping.  Water Street and Robb's Town
are embraced in this region.  The " mud-lots " of "Water Street,
formed by the embankment that prevents the overflow  of the
river-tide, have attached  to each a " stelling," or landing-wharf,
extending beyond the buildings into the shelving clay-bed of
the river.  Seven public stellings, at several  intervals, keep up a
free communication between the city and the shipping.  Across
Water  Street six sluices  discharge the drainage  and sewerage
past the stellings into the river.  The bulky materials of any
kind floating among the  piles  are necessarily entangled and
detained below the stellings. Over some of the stellings, where
the water is quiescent, the most offensive smells  arise, and the
white paint of the wooden houses is speedily reduced to metallic
lead.
    It was on the mud-lots of Georgetown and their immediate
neighborhood, close to those stellings where ships  for the West
Indies lie alongside, that a number of cases, soon recognized as
mortal yellow fever, were recognized by the  physicians of the
city, including Dr. Blair.  The importation by the shipping was
not traced nor apprehended.  But, for all  that, Blair did not
overlook, in the low room where he witnessed his earliest case,
that it was a "filthy hole," with a sickening smell of rotten salt 
        YELLOW FEVER IN BRITISH  AND FRENCH GUIANA.     99

 fish, tobacco, damp, and dirt.  This original neighborhood, most
 accessible to the shipping, maintained its virulence during the
 epidemic, though this was most prevalent at the very mouth of
 the river, the moorings  most sought after by shipmasters  on
 account of the advantages of the free, open breeze.
    Till 1842 Dr. Blair had charge of the plantation hospitals,
 and he noticed that, in proportion as the immigrants approached
 town or coastward in  their locations, the yellow fever predom-
 inated, and  as  they receded the  intermittent fever asserted
 supremacy.  Whatever might be the cause inducing the epi-
 demic, Dr. Blair had  sufficient  evidence to show that  inquiries
 in this matter must be directed  to  the shore.  " Some new ele-
 ment," he says, " is required in the generation of yellow fever
 besides what  is to be found usually within our embankments,
 and it is in all probability dependent on a sea change."
    The disease was recognized as not contagious.  Dr. Blair
 declared that opinion in Demerara as " totally obsolete."   In
 1852 he witnessed  another epidemic, and speaks of  cases in his
 private practice as occurring in the  neighborhood of Robb's
 stellings.
    I may incidentally mention that a careful account has been
 given by a French naval surgeon, Dr. Lucien Richepin,* of the
 introduction of yellow fever in French Guiana in 1872; and his
 data assured him,  and "for his part he was profoundly con-
 vinced" that the yellow fever which broke out in 1872 in Gui-
 ana was developed  in the hold of the Topaze.  Men on  board,
 soldiers and sailors, were there infected, " and the seeds of the
 disease there  fructified as on a propitious soil."
   He cites a case from the second  volume of the " Archives of
 Naval Hygiene,"  for  1864, which establishes propagation by
 clothing.   Six men out of  eleven, who lived with the  pay-
 master, were  seized with yellow fever, and  in this  paymaster's
 house were deposited the clothes of the soldiers who had  died
 in the hospital.
   Another instance is most instructive, showing the influence
 of atmospheric  communication  or  isolation.   At  Tampico a
 company of soldiers was lodged in barracks contiguous  to the
hospital, but separated by a high wall.  For two months there
          * "These pour le Doctorat en Medecine," Paris, 1875. 
100         YELLOW  FEVER A NAUTICAL DISEASE.
was  complete immunity.   Windows  were then  made  in  this
wall,  and the soldiers, so far spared, were attacked  in a  few
days,  and decimated by the plague.

             Yellow Fever on the African Coast.
   If we cross the Atlantic in the same degrees of latitude  pre-
cisely as Guiana, we find another clinching group of facts which
support most strikingly the naval origin of yellow fever.  We
do not lack data.   A high authority, Mr. R. Clarke, late surgeon
to the natives on the west coast of Africa, contributed a valu-
able  paper to the Transactions of the Epidemiological Society
in 1863.  I need  not detail the conditions which render  this
region so deadly to Europeans.   He  tells  us, " the epidemic or
yellow fever, which at uncertain intervals scourges the colonies
of Sierra Leone and  the  Gambia, is wholly unknown on  this
coast."  Speaking of Cape Coast Castle, which was built by the
Portuguese in 1612, and has been held by the British since 1672,
he says: " The removal of the jungle and the tillage of  the waste
lands  in the neighborhood of Cape Coast would free  it from a
perpetual source of febrile and dysenteric diseases, which at all
times more or less afflict its  inhabitants."   The sanitary condi-
tion of the town of Cape Coast  is deplorable.   No public cloa-
cinw; foul stenches everywhere; by-paths and beach offensive
from accumulations of human ordure or filth;  turkey-buzzards,
many curs, and ill-conditioned hogs, devour the excrementitious
matters which are left to rot upon the street;  a ravine—a vast
surface-sewer—is strewed  over with animal and vegetable refuse
in every stage of decay; at the seaside where it terminates, the
surface-water is dammed up by the sand thrown up by the surf
on shore, and is there collected into fetid pools.  The  houses in
Cape  Coast  are  so closely connected  that a free current of air
between them is much impeded; the population is condensed,
for a number of  families occupy each hut  or house. The mass
of the inhabitants bury their dead in the basement fioor of their
houses, a practice not  confined to the pagan part of the popula-
tion, but also practiced by many respectable and  wealthy fami-
lies.   Precious relics  and gold-dust are buried with the dead,
and in times of  trouble the tombs are opened, and the gold so
deposited is applied to meet pressing claims.   Mr. Clarke inci- 
            YELLOW FEVER  ON THE AFRICAN COAST.         101

 dentally states that King David  had a large treasure placed in
 his tomb by his son Solomon.
    During a  service of nearly twenty-three years' duration at
 Sierra Leone  and the Gold Coast the diseases afflicting Euro-
 peans were seen by Mr. Clarke among the natives—fevers gen-
 eral slight; intermittent and typhoid prevalent.   Yellow fever
 never attacked the  natives in 1837,  1838, 1839, 1847 or 1859.
 It is  confounded with small-pox in records of deaths, and  this
 has led to confusion.
    Elephantiasis and lepra in all its hideous forms prevail:
    Sierra Leone is well known as possessing a most insalubrious
 climate.  It is a terra inhospita for all Europeans who venture
 to reside in it, but  it has suffered from yellow fever only in
 the way that this disease  has attacked at intervals the  several
 West Indian islands.
    From the  Army Medical Department Reports we  learn of
 a severe epidemic in 1815, but the first authentic notice of  yel-
 low fever in the colony is due to Copeland, who mentions that
 several cases  occurred  among the seamen.   The  garrison re-
 mained  exempt.  In IS22  the first  epidemic at Freetown oc-
 curred, and was  ascribed to the captain of a merchant-vessel
 who took ill after having piloted H.  M. S. Ranger into harbor.
 The timber vessels were the most affected.
    Space forbids my following  the recorded outbreaks from
 British official documents or the really classical works of  Dr.
 Berenger Feraud on yellow fever in Senegal.   The history is a
 repetition of the history of the disease in the West Indian isl-
 ands, but it illustrates most forcibly the manifestations of the
 malady primarily in the shipping and most frequently in the
 timber-laden mercantile craft; thence the disease enters the isl-
 ands and seaports, having reached Cape Coast Castle and Elmira
 during the Ashantee campaign  in 1873 (as any one might have
 foreseen it  probably would), uniformly sparing the negroes,  and
 never traveling, much less  originating, beyond the confines of
 the pestilent cities.

                 Yellow Fever in Charleston.
   I am indebted to Dr. J. M. Toner, of Washington, for his
valuable essay on " the Natural History and Distribution of Yel- 
102         YELLOW FEVER A NAUTICAL DISEASE.
low Fever in the United States from 1868 to 1874."   In this he
points out very distinctly the influence of elevation  on the dis-
ease and its preference for the low lands of the Gulf States and
the Atlantic coast—density of population or crowding in cities
favoring the spread of the disease.

   Charleston, South Carolina, is only ten feet  above the level
of the sea,  and has been more frequently affected,  since 1699,
than any other city in the United States, excepting New Orleans.
It has had  fifty-three epidemics in  220 years, whereas New
Orleans has had 74 since 1769.  Charleston has been singularly
exposed as a low-lying port readily accessible to vessels from
the yellow-fever  belt and bathed by ocean water, so favorable
to the disease, whereas New  Orleans is on an inland river.   The
much more  extensive trade of the latter and its position account
for its frequent infection since its first, epidemic 110 years since.
   If there be any city in  the  United States where  the local
origin of yellow fever might by some be deemed possible, it is
Charleston; and  probably the same  conditions exist nowhere
else.  It is  easy, however,  to see that these features account
more readily for  the  production of the disease in ships in the
harbor than in the city to which it has so  often  been communi-
cated from the shipping.
   I  have  had the privilege of perusing a very interesting re-
port of Dr. A. N. Bell, whose investigation of the tidal drains
of Charleston is  very suggestive in relation  to the influences
favoring the inroads of the disease.
   The city is built on  quicksand.   The old drains had been
laid  down  without any definite plans on  different  levels,  and
ending in cul-de-sacs.  Dr. William I. Wragg was the author of
the tidal drains, built at a dead level  30 inches above mean  low
water, and the top of the arch a  foot above ordinary high water.
Water-tight doors were  provided at each end, so that at  the
highest  tide those at the  upper end would  be opened  for a
couple of hours  or more to admit of filling the drains; then
these doors were closed, and  at the next low tide  the lower gates
would be opened to  empty the drains.   The wash was always
in one direction, and, so long as a  special drain attendant  was
employed, the stagnation  of sea-water and organic  refuse  was 
               YELLOW FEVER IN CHARLESTON.            103

never allowed to  undergo the deleterious changes which would
obviously occur with time and high temperature.
    The drain-keeper was dismissed, and the police permitted to
undertake and neglect his duties on a change of administration,
after the tidal  drains were in fair working order.  The result
has been the filling up of these dead-level passages, which, con-
trary to the original intent, have been made the receptacles for
the sewage of houses and public institutions.
    Dr. Bell, well acquainted with the special evils attendant on
stagnant sea-water charged with  excreta, shows that  the tidal
drains were solely adapted to surface and soil water.  They are
certainly the most dangerous devices of man in  such  a latitude
and such a port as Charleston.  They are now almost  complete-
ly obstructed, and a source of accumulating danger.  The  let-
ting in of the tide at high water and  opening the gates at low
water now flushes nothing.   It merely saturates  the  contained
mass, trickles out equally at both ends,  and saturates the  con-
tiguous soil by leakage.  The filth in the slips and on the river
front is exceedingly offensive, and a coating of lead paint is black-
ened in a night.  Sulphuretted hydrogen is there evolved where
the  charged sea-water is imperfectly aerated, and there seems
to be fair ground for the belief that these conditions,  which in
a ship at sea or in a foul harbor in the West Indies  will engen-
der  yellow fever, may have been sufficient  to engender a fatal
ship fever and possibly yellow fever in Charleston harbor.
    This is related in the " Official Report " of Dr. Robert Leb-
by for 1876.  In that  year, "the  first  case of fever  which
approximated yellow fever occurred on board a schooner laden
with coal from Philadelphia at  Johnson's wharves, on Cooper
River, northeastern section of the city.  The schooner had been
at this wharf for several days, and the mate sickened August
30th and died September 3d.   A second case of a mild type
was  a clerk of the W. P. Hall on Brown's wharf.   Again, on
board the barque Sylph,  which  discharged her ballast of rock
and  sand, and, loaded with naval stores, hauled out into the
stream off East Battery, the first mate sickened that night, then
the second mate, and afterward two boys.....The two mates
died, and the  boys recovered.   Several  vessels  at Marshall's
wharf, and other wharves near the outlets of large drains, had 
104         YELLOW FEVER A NAUTICAL DISEASE.
their crews attacked with this fever.   From all the information
I have been able to collect, I am of opinion that the fever was
of local origin."
    Dr. Bell continues: " In one of these slips, and  on one of
the hottest days of my inspection in August, I observed dredg-
ing going on at low water, with the view of getting  rid of the
liquid filth dammed up by the solid deposit at the outer margin.
The loaded flat was pulled off to the edge of the  channel  only,
and the load there dumped, in position to be swept back by the
tide to the place from which it was taken, or into neighboring
slips."
    " Many of the houses of the  poor people are devoid of cis-
terns, and the only drinking water is that which  is supplied  by
shallow wells, virtual drain-holes of the foul premises.  On in-
quiry among the families,  I learned  that their  dead  children
were more numerous than their living ones."
    Sullivan's Island and Mount Pleasant—summer resorts com-
posed of sand-dunes; a very small portion turfed and few shade
trees—the  sandy  surface  the  "catch-all"  of all the filth—
when the air is still evolve the  characteristic odor  of a  dung
heap.  Mount  Pleasant is  under better cultivation than Sulli-
van's Island.  Both commonly subject to yellow fever whenever
it prevails in Charleston.
   This  apparent exception to  my view of the impossibility of
engendering the disease on  land  may turn out to be one of the
clear indications of  the soundness of  the doctrine I am  incul-
cating.  The coal-ship in the reeking harbor under the influence
of protracted heat and humidity could engender yellow fever in
August as readily in  Charleston as in the port of  Kingston,
Jamaica, or Havana, where  such events  have no doubt been ex-
ceedingly common.  A ship entering Charleston with putrid
bilge-water, and contaminated by infiltration of the  putrescent
mixtures in the Charleston slips, would constitute an admirable
pest-trap, and the means of propagating infection when once the
malignant ferment had gained supremacy.

           European Outbreaks of Yellow Fever.
   Forgetting chronology, here again I desire to show that the
ports affected on the ocean shores, or the towns on the Spanish 
           EUROPEAN OUTBREAKS OF YELLOW FEVER.       105

 and French rivers, have derived all their yellow fever from the
 tropical Atlantic.
    The earlier invasions of this century secured to science many
 excellent contributions, especially from French and British phy-
 sicians.  The disease afflicted  many ports, such as Cadiz, Car-
 thagena, Gibraltar, Leghorn, and Malta, and harassed the French
 and British fleets and troops in Egypt.
    To Baron Larrey we owe one of the most singular—and in
 a pathogenic sense—one of the most instructive records of  this
 plague.  It  seems  to have spread among  the wounded  like
 erysipelas or septicaemia, and we must not forget that it is a pu-
 trefactive disease.  Larrey* relates  that the mortal accidents
 which afflicted the wounded, after the  battle of Heliopolis  and
 the siege of Cairo in 1800, led the French soldiers  to fear that
 the enemy's balls had been poisoned.  It was easy to dissuade
 them of this, but not so easy to arrest the effects of  the malady.
 It appeared on the 5th of April and lasted to the end of May,
 attacking only the formidably wounded.  It was a genuine  yel-
 low fever.   Two hundred and sixty wounded of all kinds died
 with this complication, out of about six hundred from the siege
 of Cairo to the taking of Boul&g.
    Dr. Savaresz, who saw the yellow fever in the Antilles,
 recognized the disease attacking the wounded as  typhus ictero-
 des of the  English and French nosologists—the vomito prieto
 of the Spaniards.
    The English who followed the French in Syria and Egypt
 suffered of yellow fever in their ships.

        Recent Outbreaks in France and England.
    The activity of commerce between England, France,  and the
 West Indies has, at times, been attended by the accidental arrival
 of cases of yellow fever, further north on the European than on
 the American Atlantic shores.  Dr. F. Melier has, by his work on
 " Yellow Fever at St. Nazaire," rendered memorable an outbreak
 at this port, on the Loire.  He has pointed out, in the first place,
that the majority of the European  outbreaks of yellow fever
have been due to sugar ships.  In the special invasion he reports,
the focus of the malady was in the ship itself, and the hold was
       * "Memoires de Chirurgie Militaire et Campagnes."  Paris, 1812. 
106          YELLOW FEVER  A NAUTICAL DISEASE.
its seat.  So long  as this hold remained closed, a very limited
number of accidents occurred in crossing the Atlantic, but it
was  on opening the scuttles and  hatchways that the disease
spread in the port, in the ships and among people engaged on
the infected vessel.  This might be compared to a lethal weapon
which exploded, killing all within its reach.  The delinquent
ship,  the  Anne Marie, had left  Nantes for Havana, which it
reached in ballast on the 12th of May, 1861.  On the  13th of
June she left with all hands healthy and a cargo of sugar; she
passed through Florida Straits, and was becalmed twelve days.
The  heat was intense, and abundant rains and tempests  contrib-
uted to render the passage tedious.  It was seventeen days after
leaving Havana  before  a man became sick.  A young sailor,
nineteen years old, was seized on the  1st of  July.  Later the
same day another was attacked, and the two died  on the 5th.
A third case occurred on the 2d, and so forth till  eight sailors
were down and then the captain took it.  Nine cases altogether
occurred among sixteen persons, and two died.  Twenty days
after the last death, on the 25th of July, the vessel reached St.
Nazaire, and from  the length  of time without a  case no quaran-
tine was enforced.   I shall not detail the cases which occurred
in two ships which were moored near the  Anne Marie, or on
land among persons who frequented or came near the vessel.
A limited outbreak was the result in  the  northern parts of
France.
   Dr. George Buchanan was called upon officially  to report on
an outbreak of yellow fever at Swansea, in South Wales.  Lati-
tude 51° 37' north, and longitude  3° 55' west.  Population in
1861, 42,581.  The outbreak was unprecedented, and Mr. John
Simon has epitomized as follows: " The broad facts of the case
may  be told in very few words under the following two heads:
First, the  Hecla left Cuba on the  26th of July with  cases of
yellow fever on board, had successive new cases till toward the
end of August, entered Swansea harbor on  the 9th of Septem-
ber, with  one of her seamen dying and two others but  conval-
escent from the fever, and was immediately moored alongside a
wharf, where she landed her sick, discharged  (though not unin-
terruptedly) her cargo, and remained  stationary till the 28th;
when remonstrances, which at last had become irresistible, led 
CLEAN BILLS OF  HEALTH.
107
 to her being removed from within the dock.   Secondly, from
 September  15th, six  days after  her arrival, to October 4th, six
 days  after  her  removal, Swansea witnessed the  entirely new
 phenomenon of  yellow fever attacking in succession some twenty
 inhabitants  of the  town, besides others who suffered  less defi-
 nitely, or more  mildly; and this not indiscriminately over the
 whole large area of Swansea, but only in definite local relations
 to the ship; while at Llanelly there  also  fell sick in the same
 way three of the crew of a small vessel which had been lying
 alongside the Hecla at Swansea."
    Still more recent but isolated cases have occurred, but I shall
 notice only one which enforces  the lesson that  a disease which
 can originate at sea need not be referred to any port the ship
 has touched.
                   Clean Bills of Health.
    In the " Lancet" for May 12,1877, a case is reported of a sick
 German seaman landed from the brig Daring, which had arrived
 at Salcombe from  St. Lucia.  The captain  had a clean  bill of
 health from the latter port, which may have been quite correct
 if the disease developed at sea, and Messrs.  Cornish and Webb,
 medical officers of the union, recognized all the  symptoms of
 yellow fever in their patient, who died after removal  to the
 Hospital  of the Kingsbridge Workhouse.  When the  nature
 of the disease was discovered, all other patients were  removed
 and the building submitted to a  process of disinfection.
   With this I shall rest satisfied, and merely indicate by a rapid
 survey of the West Indian Islands how singularly their experi-
 ence tallies with the observations made at New Orleans, Charles-
 ton, or other ports where we now know the disease never  does
 and never can originate spontaneously within the city precincts.

    SPECIAL DATA  RELATING TO  THE WEST INDIAN  ISLANDS.
   The island of  Martinique, in 14° north latitude, has been
afflicted most frequently with yellow fever.  Its  history  in a
sense  indicates why it should, for it has been the center of  very
active operations, before and  since the Creole was  known.  If
yellow fever springs from the soil anywhere, it is in the island
of Martinique ;  but every autochthonous disease on the globe,
that has yet been described with any precision, has been traced 
108         YELLOW FEVER A NAUTICAL DISEASE.
to a limited area marked by special conditions, as in the case of
ague, cholera, and the more recent Oroya fever.  The disease
always continues somewhere within the belt of its origin, at its
appropriate season and under well-known conditions. It is true,
taking the widespread anthrax of animals, or malignant pustule
in man, that it shifts its ground; and in the hot, dry season, when
it prevails on clayey soils, it does not appear on less retentive
lands ; and vice versa, in warm, wet years, it spares the heavy
clays.
    All familiar with similar interesting maladies in men and
animals know that the  circumstances under which the indige-
nous diseases are made manifest, or attain exceptional virulence,
are known, and constitute the basis of well-directed precaution-
ary measures. But I challenge any one to glean, from the many
volumes which a century has produced relating to yellow fever,
anything  like so definite a statement as  can be  made  off-hand
relating to endemic  and enzootic affections scattered  over the
whole world.
    Let any one consult the annexed table, which I have pre-
pared  after Cornilliac.   There are two outbreaks in the seven-
teenth century—one short, in 1669, and  the  other long, of 24
years, with an intervening period of 12 years, during which the
island  was absolutely free.  The years when it was only par-
tially free  are those figured in italics,  and the number is set out
in the right-hand  columns.  During the  eighteenth century we
have four epidemic periods, of 13, 6,12, and 17 years respective-
ly ; but the periods of immunity are actually longer, viz., 15,14,
6, and 19  years respectively.  With the more active commerce
of the nineteenth century, we count  from 1810 to 1873  four
outbreaks, the duration of which was  12, 7, 8, and 5 years, and
with this  aggravating sign, that they were years  without any
seasonal  intermission — no respite, but  continuous mortality.
The periods of immunity are also four, viz., two of 8, a  third
of 6, and  a fourth of 10 years, when the island enjoyed perfect
health.
   Admitting, for argument's sake, that this chart may not be
absolutely accurate, it is  certain that other West Indian islands
of bad repute, and  indeed all of them,  manifest similar and
more startling contrasts, which prove, with absolute and incon- 
Periods  of  Yellow-Fever Epidemics,  and of Complete Immunity, observed at Martinique.
  nth
Century, "
' 1st Epidemic Period.
 Immunity..........
  18th
Century, "
  19th
Century,
 2d Epidemic  Period..


 Period of Immunity..

 3d Epidemic Period..

 Period of Immunity..
 4th Epidemic Period..
 Period of Immunity..

 5th Epidemic Period..
 Period of Immunity..

 6th Epidemic Period..

f Period of Immunity...
) 7th Epidemic Period..
 Period of Immunity..
 8th Epidemic Period..
 Period of Immunity..
 9th Epidemic Period..
 Period of Immunity..
 10th Epidemic Period.
          Epidemic Periods and Periods op Immunity.
The figures in italics represent the year of intermission when the plague
            disappeared for several months in the year.
 1669.................................................
 1070 to 1681 inclusive..................................
  1682, 1683, 1684, 1086, 1687, 1688, 1689,  1690, 1691, 1692,
  1693, 1694, 1695, 1696, 1697, 1698, 1699,  1700, 1701, 1702,
  1703, 1704, 1705, 1706................................

j 1707, 1708, 1709, 1710, 1711, 1712, 1713, 1714, 1715, 1716, )
( 1718, 1719, 1720, 1721, 1722...........................J
j 1723, 1724, 1725, 1726, 1727, 1728, 1729, 1730, 1731, 1732, )
\ 11ZB,1734, 1735......................................)
 1736 to 1749 inclusive....................................
 1750, 1751,  1752, 1753, 1754, 1755.........................
 1756 to 1761 inclusive....................................
( 1762, 1763, 1764, 1765, 1766, 1767, 1768, 1769, 1770, 1771, )
1 1772,1773...........................................J
 1774 to 1792 inclusive....................................
j 1793, 1794, 1795, 1796, 1797, 1798, 1799, 1800, 1801, 1802, )
\ 1803, 1804, 1805, 1806, 1807, 1808, 1809.................J

 1810 to 1817 inclusive....................................
 1818 to 1829 inclusive....................................
 1830 to 1837 inclusive....................................
 1838 to 1844 inclusive....................................
 1845 to 1850 inclusive....................................
 1851 to 1858 inclusive....................................
 1859 to 1868 inclusive....................................
 1869, 1870,  1871, 1872, 1873..............................

                Grand Totals (extending over two centuries)..
Numbek op Epidemic Years.
Without
Respite.
12




 3

 1

 5


13


12

"n

*8

 i
63
  With
 Seasonal
Abatement.
12




10

*5

 7
42
Total.
24




13


 6

12


17


12

"l
105
  Years
   of
Immunity.
12





15



14

 6


19
 6

10
>
W
M

i>
t-3

Q

O
O
CO 
HO         YELLOW  FEVER A NAUTICAL DISEASE.
trovertible certainty, that yellow fever never did, and therefore
never will, appear as a land disease or a disease of the land, au-
tochthonous or indigenous, on any of the West Indian islands.

                        GUADELOUPE.*
    This French island, in latitude 15° north, was discovered in
1493 and occupied in 1635, when it was first attacked with yel-
low fever, as it was in 1640, 1648,  and 1653.   The intervening
years were healthy.   We then have to jump one  hundred and
forty years, viz., to 1793, for an outbreak, and  then nine years
to 1802. The malady prevailed in 1803,1805,1807,1814,1816,
1824,1826,1838,1841,1842,1852,  1853, 1854,  1855, and 1856;
so that up to the last year given by Cornilliac in his " Chronol-
ogy," viz.,  1861, there were only  sixteen  epidemic years and
forty-five of absolute immunity.

                       Other Islands.
    Let  us take the islands on which it has been  asserted that
yellow fever was first seen:
    Isabella, in latitude 19° north,  discovered by  Columbus in
1493, was afflicted in 1494 and 1495, and not once since.
    Vega Eoyale, in latitude 19° north, is supposed to have been
visited by the disease in 1496, though it was not regularly set-
tled till 1500.  Since then no disease.
    Hayti, or San Domingo, situated in  latitude 18° north, was
peopled in 1498.   It suffered three outbreaks in the sixteenth
century, viz., in 1503,  1533, and 1585.   Then we have to skip
to 1792, 1801, 1802, and 1805;  so that we  have four invasions
and only four  years' prevalence as an epidemic  in nearly two
centuries.   How does this  indicate  an  autochthonous disease
springing from the soil ?
    Trinidad, much nearer the tropics than the foregoing, viz.,
in latitude 10° 40' north, discovered in 1498 and settled in 1797,
has had one outbreak, in 1838.
    Curacoa, in latitude 11° north, settled in  1634, was affected
with yellow fever in 1750 and 1760.

   * " Recherches Chronologiques et Historiques sur la Fievre Jaune," par J. J. J.
Cornilliac. Fort de France, 1867. 
OTHER  ISLANDS.
Ill
   Tobago, situated in latitude 11° north, has had two epidem-
ics, one lasting two years, the other one.
   Barbadoes, in latitude 12° north, settled in 1646, suffered in
1647, 1691, 1693, 1694, 1696, 1699, 1701, 1715, 1721, 1723,
1733, 1750, 1760, 1763, 1766, 1767, 1792, 1793, 1794, 1795,
1811, and 1814.  This ugly-looking list only gives  twenty-two
years out of two  hundred  and fifteen, counting up to 1861.
How did local conditions vanish which developed  the disease
only one year in ten, with two intervals as long as forty-four
and forty-seven years ?
   Saint Vincent, in latitude  13°  north, has had  the disease
once since its settlement in 1660.
   Saint Lucia, in latitude 13°  north, three times since 1639.
   Dominica, in latitude 15° north, five times since 1660.
   Montserrat, discovered by Columbus in 1493, has had four
outbreaks since 1632.
   Sainte Croix, in latitude 17° north, has since  1640 suffered
ten years, of which six were in succession, from 1794 to 1800.
   Saint Christopher is one  of the islands early recorded.  It is
situated in latitude 17° north, was settled  in 1625, and suffered
in 1648, 1652, and 1653. During the present  century it was
infected, probably by the French fleet, in 1812.
   Nieves, in latitude 17° north, established in 1628, has had
one outbreak,  in 1706.
   Antigua, also in latitude 17° north, settled in 1629, has had
but ten epidemic outbreaks, and  the  longest duration of the
disease on the island was three years.
   Porto Kico, in latitude 18°  north, settled  in  1508, was  that
year affected, and again invaded in  1843.
   Jamaica, reputed not long  since to be always infected, was
discovered  in 1494, in latitude 18° north.   It  was settled in
1509, and had no yellow fever till 1691—that is, for one hun-
dred  and eighty-two years after its  being  first peopled.  Since
then, and prior to 1861, it had  only eight epidemics, the last in
1819.
   Saint Thomas, in latitude 18° north, has had only three epi-
demics  since 1650, the date of its settlement.
   Port de Paix, in latitude 19° north, has  had only one epi-
demic outbreak, lasting the two years 1690 and 1691, since 1663. 
112         YELLOW FEVER A NAUTICAL DISEASE.
   Cap Francais, in latitude 19°  north, had 17 epidemic years
in the 18th century, none in the 17th, and only two—1801 and
1802—in the 19th.
   Port-au-Prince, in latitude  19° north, settled in 1668, had
the disease in 1795 and 1796.  In the 19th century, up to 1861,
it was afflicted only in 1838,1840, 1841,1843, 1844,1845, 1850,
1853, and 1854.
   Lastly, Cuba, in 23° north latitude, settled in 1511, had no
yellow fever till  1762; then in 1793, 1794,  1800, 1801, 1804,
1811, 1819,  1829, 1833, 1838, 1840,  1844, 1861.  This, "the
Pearl of the Antilles," whence the  United States has been so
often infected, has had thirteen  epidemic  outbreaks in  350
years.

   The foregoing data, are certainly sufficiently accurate to show
that, on the most frequently, as well as the least frequently, af-
fected of the West Indian Islands, the record of positive epidem-
ics shows habitual health, and not a standing state of yellow-fever
contamination.  It is, I believe, safe to infer that for  the past
two centuries no single  year has been free from infected ships
on the Atlantic.   How and where did they become infected %
Often, we know,  they have  shown disease in harbor without
communicating it to  land, and it is very likely that, in a port
like  Havana, with stagnant water contaminated by sewage, fre-
quent outbreaks on  ships have arisen while at  anchor.   This
gives great importance to Dr. Vanderpoel's suggestion respect-
ing the purification of Havana harbor, and the project can only
result in good.  I trust I  have said  enough in the foregoing
pages to indicate that a careful survey and sanitary history of
each island  should be made, so as to prove whether the proxi-
mate truth  we  have so far gleaned is  not  confirmed by the
closest investigation.
   I do not hesitate to say that  none of the West Indian Isl-
ands—not one per se—can be reckoned as supplying the world
with yellow-fever poison.   Germs or no germs, yellow fever is
not produced there  endemically, and the secret of its develop-
ment has been long locked 'tween decks, and in the fetid bilge. 
CHAPTEK  III.
   CONTRAST AND COMPARISONS BETWEEN  YELLOW FEVER AND
                       OTHER DISEASES.

    Natuke is sparing in means, but fruitful in ends.   This trite
lesson was early instilled into my mind by my great teacher in
physiology, Dr. Sharpey.  His  learning and sound  judgment
influenced my labors, as they did those  of all his pupils, more
than the teachings of perhaps any other of his many colleagues.
In part this was doubtless due to the nature of his subject, and
to the paramount importance of  a thorough knowledge of  the
functions of the body to the student of pathology.
    ]STot in vain, I trust, have I  observed that the very difficult
investigation of  disease causation is materially simplified by  the
recognition of the fact that the fundamental origin of indige-
nous  and of contagious maladies is usually simple and singular.
We are very apt to blur and hide it by publishing a catalogue of
predispositions.   Involved sentences and wordy generalities  are
made to stand in the place of fact and precise statement of defi-
nite knowledge.   The  practice of sifting and classifying actual
data, rather than filling volumes with pleas and opinions, leads
us by the only hopeful path.  Beyond the truths clearly recorded
and ascertained  is  that vast forest  of briers and thorns, well
calculated to entrap the dreamy thinker.
    It is true that if we study the history of goitre and cretinism,
of the Andean verrugas (an endemic of bleeding warts), of  the
cachexia ossifraga (fragility of bones) in animals in the hills of
Lanarkshire and Central Europe, of the  typhoid  or enteric
fever  of large cities, we find that there are many unknown ele-
           8 
114         YELLOW  FEVER A NAUTICAL DISEASE.

ments in the aetiology of each.  But that is no justification for
mystifying the essentials, or the  known, by inferences which
stretch to the unknown; and I hope  the time has arrived for a
very careful culling of positive data from the mountain of chaff
encumbering yellow-fever literature.
   While writing these words, a friend brings me a lecture by
Dr. Alfred  Stille, Professor of the Theory and Practice  of
Medicine in Philadelphia.  Kelating to the confusion caused by
attempting explanations not warranted by facts, he says:  " In
default  of any demonstrable  or real cause, the usual refuge of
ignorance has  been  eagerly sought for by theorists who are not
content to seem  ignorant of anything.   They attempt-  to blind
themselves and  us with a cloud  of words which describe  or
define nothing, and which, when reduced to their simplest ex-
pression, read i zymotic poison.'   Upon calm  reflection  this
phrase turns out to be little else than  ' words without knowl-
edge.' "
   As a sample of empty verbiage I may quote Dr. Griesenger
as translated by Lemaitre. He says: " Yellow fever  is devel-
oped  under  the  influence of general climacteric  conditions: it
is essentially a disease of  the Western  Hemisphere and of  the
Continent of America."   Is  it possible to compress within  a
round phrase greater inaccuracy ?
   Very early in the medical records of yellow fever do we
trace the thoughtful and judicious utterances of competent ob-
servers.   Note the ring of the words  of  men who knew and
spoke with prescience.
   Sir Gilbert Blane, in  a letter (dated 1798) to Rufus King,
the ambassador from America to the Court of England, says:
" It has been alleged by some authors that the yellow  fever is
produced by the same marshy  exhalations which  produce  the
intermittent and remittent fevers, and that it is only a variety
of the latter;  but the remitting fevers  differ from it  in some
essential symptoms, and the yellow fever has been known to
arise both in ships and  on shore where men were entirely out
of the reach of the vapors of the marshes."
   Dr.  Joseph Bailey,  Medical Officer of the Port  of New
York, writing  in 1821, says that bilious remittents, remittents,
and intermittents have nothing to do with yellow fever.  " Does
/ 
COMPARISONS BETWEEN YELLOW FEVER, ETC.
115
 the principle of transmutability obtain in yellow fever ?  If it
 does, I have never been favored with a view of such transmu-
 tations.   Hard or black frost has been long observed to destroy
 the contagion of yellow fever, but not to put an end to bilious."
    When, in 1822, all were seeking, and, as they thought, find-
 ing, explanations of  the local origin of  yellow fever in New
 York and Philadelphia, Dr. Tully, of Middletown, Connecti-
 cut, defines its occurrence in small and  healthy ports of New
 England, on the Connecticut River, as affording " the most in-
 controvertible  evidence of its foreign origin " ; and he  adds:
 " There has been scarcely a  season for the last  five-and-twenty
 years  in which individual instances have not occurred on the
 river,  though  the greatest number that  has happened at one
 time has been  at Hartford,  at  Middletown, and at Knowles's
 Landing; and, with the exception of a few theorists, there never
 has been a doubt of  its foreign origin."  And what Dr.  Tully
 said of  Connecticut  we now know to  be true of the whole
 United States.
    At the very commencement of this  century, Sir William
 (then Dr.) Pym showed that the disease is totally distinct from
 bilious remittent fever of warm climates, has  no  connection
, with or relation to marsh miasmata, and occurs in the  West
 Indies (where  he had seen what was called, after Chisholm, the
 bulam fever) under  peculiar circumstances.  Sir William was
 the first, or certainly one of the first, who demonstrated the
 immunity enjoyed after one attack of yellow fever.
    Another sound practical man, Dr. Daniel L. M. Peixotto,
 of  New York, formerly of  Curacoa, says,  in  1822,  "that  it
 should  be cited in conjunction  with  those places in the West
 Indies whose  localities, abstractly considered, render them per-
 manently unhealthy,  neither experience  will warrant nor my
 regard  for truth suffer me  to  pass by without contradiction.
 The yellow fever is confined  to the neighborhood  of the sea;
 in the inland districts of the large islands and of the American
 continent it is unknown.  There is a sufficient number of facts
 on  record to prove that the fever occurs in hot latitudes at sea,
 before new comers have  approached the land." *
    Dr. Cyrus  Perkins, of New York, addressed a very able
       * "New York Medical and Physiological Journal," vol. i., 1822. 
116          YELLOW FEVER A NAUTICAL DISEASE.
letter to Dr. Daniel Osgood, of Havana, in  1820, giving pre-
cision to the word contagion, as only applicable to a diseased
animal secretion, and striking  a broad line of demarkation be-
tween this and infection, or  aerial poisoning by matter and
things, not to be confounded with a specifically morbid  animal
secretion.
    Dr. Stille remarks:

   " The late Dr. Nott, who spent nearly all his professional life in Mobile,
and whose competence in such a question no one will doubt, states his judg-
ment thus:  ' Yellow fever is not generated in the human system, nor trans-
mitted from one person to another in any way ; its germ or poison is gener-
ated outside of the human system, and is taken into  the system after the
manner of the marsh-malaria poison. But, unlike the latter, its germ  is
portable, and may be carried from one point to another, and thus propa-
gated.' And again he says: * Few of the old and experienced physicians of
the yellow-fever zone believe in the contagiousness of the  disease, and their
convictions are  based upon facts coming  under their observation.  During
thirty years' residence in Mobile, my experience corresponded with theirs.'
   " The late Dr. Warren Stone, of New Orleans, who probably had more
experience of yellow fever than any man who ever lived, stated emphati-
cally the exact truth when he declared, ' I am perfectly convinced, beyond
all doubt  or hesitation, that, personally, it is not contagious;  I know that
it is not.  In this city, at various times during nearly a century, local epi-
demics of yellow fever have occurred from time to time, every one of which
was distinctly traceable to vessels from infected ports.  Many of the patients
were received into our ordinary hospitals, and perhaps not always with due
care to leave behind their infected clothing; and yet in no single instance
has the disease attacked their attendants or the surrounding hospital pa-
tients.' "

   A striking  contrast is  furnished  by Dr.  Turner  to "the
average opinion of medical officers of the navy,  who have ob-
served yellow fever and experienced an epidemic visitation."
The average opinion  is as follows :  " In addition to the causes
of malarial fever, originating  from  vegetable decomposition,
there is superadded a miasmatic poison from animal  decomposi-
tion—a faicalpoison''  Now read the other, from an eminent
member of Dr. Turner's own  corps, who thus tersely and sig-
nificantly  puts  the  conditions:  " Crowd filthy,  half-fed  emi-
grants in a filthy, unventilated ship, to cross the North Atlantic
—what follows ?  Ship-fever, genuine typhus.  Try the experi-
ment in a tropical  river" [he should have  said the tropical 
          COMPARISONS BETWEEN YELLOW FEVER, ETC.      H7

 Atlantic—J. G.], " and you get typhus icterodes (yellow fever)."
 I count the eminent member of Dr. Turner's own corps among
 my supporters, in the opinion that yellow fever originates in the
 ship.
    However  tempting  may be a prolonged demonstration, I
 must pause, not to unduly swell this volume.  The most posi-
 tive statement of the fundamental  evidence, proving  the  dis-
 tinction between the consequences of  indigenous  land miasm
 and yellow fever, as also between relapsing fever and this last, is
 furnished by three of the most learned and recent authors—Dr.
 Faget,  of New Orleans, Dr. Charles Murchison, of London, and
 Dr. L.  J. B. Berenger Feraud, of Paris.*
    Dr. Murchison f says that the frequency with which relaps-
 ing fever is complicated with jaundice has caused it to be mis-
 taken for true yellow fever.   The differences  are stated very
 distinctly  under  the  following heads,  omitting the last line,
 which  declares that " relapses  of any  sort are rare in yellow
 fever," since it is universally reported that  a patient  appears
 convalescent, leaves his room and house, and a deadly relapse
 frequently supervenes:
    a. Yellow fever exhibits no predilection  for the poor and
 destitute, but  attacks  all classes alike.  Indeed, according  to
 some writers,  feebleness of constitution prevents  rather than
 favors an attack.
    b. Yellow fever attacks the same individual only once ; re-
 lapsing fever confers no immunity from subsequent attacks.
    c. Jaundice is an almost constant symptom in yellow fever,
 whereas it  is  much oftener absent  than present in relapsing
 fever.
    d. Yellow fever is a most mortal  disease ;  relapsing  fever is
 rarely fatal.
    e. Death in  yellow  fever is  usually preceded by  "black
 vomit," which  in relapsing fever, even  when fatal, is  so rare
 that some of the most  experienced of  observers have doubted
 its occurrence.
   f Lastly, the yellow fever of  the  tropics never follows the
   * " De la Fievre Jaune au Senegal," Paris, 1874.
   f " A  Treatise on the Continued Fevers of Great Britain," by Charles Murchi-
son, M. D., LL. D., F. R. S.  Second edition, London, 1873. 
118           YELLOW FEVER  A NAUTICAL DISEASE.
peculiar course  of relapsing fever—a febrile paroxysm, lasting
for a week, terminating  in a critical  sweat, followed by a com-
plete intermission of a week, and then by a second paroxysm.
    Dr. Feraud says:  "Yellow fever can  not  be  confounded
with the  diseases  of warm countries, except the bilious remit-
tent  (melanuric) fever."  And here I translate his tabular ex-
position of symptoms, in parallel  columns :

  DIFFERENTIAL  DIAGNOSIS  BETWEEN BILIOUS  REMITTENT  FEVER
                      AND  YELLOW FEVER.
      Bilious Remittent Fever.
   Prolonged stay in a marshy coun-
try is the most potent and indisputa-
ble predisposing cause.


   The disease is always preceded by
many and frequent attacks of palu-
dal fever; simple at first, then more
or less  complicated, and assuming
generally more and more the bilious
aspect,  there being very  notably
anaemia  of the subject.
          Yellow Fever.
   Prolonged sojourn  in  hot  coun-
tries, whether  or  not marshy, gives
immunity relative to the duration of
such sojourn.

   The disease commences very gen-
erally amid a perfect health, and may
occur  in subjects who have never.
had intermittent fever, or who pre-
sent the features of a most satisfac-
tory state of plethora.
The malady is generally ushered     The disease very frequently com-
in by a violent shivering fit, of great-
er or less duration,  in every case
similar to paludal fever.
   Jaundice appears forthwith with
the first attack at the beginning of
the malady.  It is never absent, and
causes  from the beginning to the
end a  yellow  color,  varying  from
green-yellow to very marked ochre.
The color is general and of the same
tint throughout.
mences with  a headache, which in-
creases, and  the  commencement,
which is instantaneous, can not be
defined so well as the ushering in of
an attack of paludal fever.

   Jaundice  appears  consecutively
about the third  day, and takes the
place of a red color of the integu-
ments, which exists at the outbreak
of the disease.   The symptom is
wanting in slight cases or when re-
covery is  rapid.    It  is  sometimes
limited to certain  regions, or presents
some notable  differences of intensity
in different parts of the  same indi-
vidual.
   The course of the disease is from     The  course of the disease is con-
the first intermittent or remittent,  tinuous from the first, and inflamma- 
DIAGNOSIS  BETWEEN  REMITTENT  AND YELLOW FEVER.   H9
and  the  pulse, urine, and vomitings
follow these changes very  exactly.
When the fever ceases, the period
of weakness  and reparation in no
way resembles the remission of yel-
low fever, and is not separated, in a
perfect and absolutely defined man-
ner,  from  the  first  seizure;  one
might say that the fever yields un-
willingly and  attempting to return,
if the patient succumbs in the fe-
brile stage.  If the  patient reaches
the  adynamic stage, he dies more
from  a   profound exhaustion than
from the effects of decomposition.

   The pulse follows the usual varia-
tions of  the paludal fever,  during a
febrile period of two or three exacer-
bations,  which  constitute the first
part of the malady.  It does not fall
suddenly, and is in this absolutely
and in all like the pulse of a case of
intermittent.  Even  when all is go-
ing favorably, daily observations in-
dicate differences which constitute
the vestiges of abortive attacks, so
to speak.

   Headache  occurs like a load on
the cranium, and increases for six or
eight hours, then notably diminishes
and  disappears, sometimes to recur
with the next attack.


   The  expression  of the  face is
sunken, yellowish from the  first or
soon  after the invasion of  the  dis-
ease.   The conjunctiva? are  of a yel-
lowish color, but injected and bright
as in a case of incipient conjunctivi-
tis.

   The pains  of the body are round
the waist from the loins to  the hy-
pochondriac  region; great  pain is
tory during two, three, or four days;
one transition then supervenes, which
is sufficiently marked to have deserved
the name mieux de la mort  (which
may be translated the  calm before
death).   For from six to twenty-four
hours one may imagine the  disease
has ceased and the patient is becom-
ing convalescent. The second period
is perfectly separated from the first
by this transition; it is a period of
demolition  of the  subject,  killing
him by decomposition, suppuration,
haemorrhages, etc.


   The pulse is at first  full, regular
as in a continuous  fever, and it re-
mains so until the transition  termed
mieux de la mort, or calm of death.
At this period it sinks suddenly, and
remains soft, slow, and compressible.
   Supra-orbital  headache  is very
intense, but it  yields rapidly to re-
medial measures, and continues with-
out intermission  to  the  end of the
inflammatory stage in from one to
two days.

   It is only after some days that the
patient appears yellowish about the
aim nasi, the lids and lips. The eyes
are  bright, conjunctivae injected,
sometimes slightly bleared, as in a
commencing conjunctivitis.


   The lumbar pains which are called
coup de barre are characteristic, from
their  intensity; they are very vio- 
120           YELLOW FEVER A NAUTICAL DISEASE.

sometimes evinced in the region of  lent, and do  not extend round the
the liver and epigastrium, and touch-  waist.   The  hepatic and epigastric
ing them  causes  lancinating pains,  regions are not painful to the touch.
which cause  cries; but often  they  There are frequently acute pains of
are scarcely marked, so much so that  the limbs, and especially of the calves
sometimes these pains and the pains  of the legs.
in the limbs present neither great
acuteness  nor great persistence, and
are more like a feeling of uneasiness
than marked pains.
   The vomitings are bilious, of a very
marked green color, most frequently
like spinach water; they appear from
the beginning of the attack, and cease
with it, to return with the next.
   The urine is black from the com-
mencement, and the color is so char-
acteristic that the patient is amazed
   Yomitings not frequent at  first,
and  in all cases  not bilious;  they
do not, moreover, manifest intermit-
tence, as in bilious remittent fever.
   The urine at the outset is reddish
and  simply febrile,  limpid, scanty,
and  discharged at  rare intervals.
   After the first or febrile period of
the disease, the vomitings continued,
retaining exactly the same characters.
They discolor  linen  of a  lightish
green, and if collected in a basin are
very transparent, of a fine  emerald
green, or of an olive-like color.


   There is sometimes a bilious diar-
rhoea, from the beginning of the ma-
lady and during the vomitings.  Later
there is  frequently  diminution  of
stools, and one must  have recourse
to mild purgatives in order  to keep
the bowels in order.
   The tongue is moist, large, covered
at first with a whitish mucus.   This
mucus soon acquires the greenish
color of the vomitings.  The tongue
is not red, either at its top or at its
sides; it remains large, swollen, and
humid to the end of the disease.
   After  the  inflammatory period,
the vomitings  when they appear are
at first watery  and colorless,  then
gray, then brown,  then containing
black matter like soot, giving a black-
ish color and  not a limpid green to
linen.  Absolutely opaque when col-
lected in a basin.

    Constipation very  generally oc-
curs at first;  diarrhoea only comes
on when the  disease  is prolonged,"
and then it is  not bilious, but on the
contrary very  fetid, indicating a pro-
found decomposition, and often con-
taining the black matter, which  is
absolutely unknown in bilious re-
mittent.

    Tongue white on its center, where
it is furred, red at its top and borders;
not so large, and somewhat globular.
Later  it is bleeding  and shriveled
(raccornie), of a mottled  red  as  in
typhoid affections. 
DIAGNOSIS BETWEEN  REMITTENT  AND  YELLOW FEVER.  121
at it.  It is generally very abundant
and frequently discharged, and has
only the melanic aspect  during the
exacerbations.   Later  the urine  is
still strongly colored, but no  longer
black.  It sometimes contains a little
bile at this stage—never at the be-
ginning.  Sometimes it is not abun-
dant, but never suppressed except a
few hours before death.

   The attacks at the outset may  be
arrested by quinine, and never de-
mand antiphlogistics.

   The  malady is manifestly linked
with paludism;  it follows and is fol-
lowed by attacks of  intermittent  fe-
ver.   It is absolutely non-transmissi-
ble from man to man.
   The  exacerbations  are very fre-
quent, and more  and more ready as
the attacks increase in  number.
Later, if the disease becomes aggra-
vated, the urine is thick and turbid;
generally it becomes more and more
scanty, and often at the last there is
complete suppression for one or two
days before death.
   [It is albuminous.—J. G.]
   The fever  continues  from the
start, can not be stopped by quinine,
and often requires antiphlogistics.

   The influence of paludism has not
been brought out in an incontrovert-
ible manner.  The malady is not ne-
cessarily nor (may it  be  said) nor-
mally preceded or followed  by at-
tacks of intermittent fever.

   The return is  extremely rare—so
much so,  that the possibility of a
second attack  has been  denied by
physicians.

   There is frequent swelling of the
parotids toward the close of the mal-
ady.
   Swelling of the parotid glands is
very rare and quite accidental from
the prolonged administration of calo-
mel determining stomatitis.  I have
only seen two or three cases of this
kind in over three hundred  observa-
tions, and the relation of cause and
effect was readily established in each
case.

    " It is obvious," adds Dr. Feraud, " that the  differences are
so sharply defined that  I hope  hereafter no one can for a mo-
ment confound the two diseases.  After this comparison, hesi-
tation, which comes from the assertion of facts which have been
superficially or  insufficiently observed, will finally disappear, to
the great  advantage of  the sick."  Dr. Feraud states as a char-
acter of yellow fever that its transmission from man to man  is
terribly frequent, but  this is almost universally denied by the
best authorities. 
122         YELLOW FEVER A  NAUTICAL DISEASE.

   Dr. Faget, of course, points  to the  origin of yellow fever,
not only on  the ocean,  but in the ships—"une origine non
seulement maritime, mais navale."  That  malarial fevers per-
tain to marshes, and only to marshes.  The air of the infected
ship, like the air of the marsh, may travel within  certain limits,
and winds have thus tended to propagate both.  Yellow fever
is  transmitted—marsh fever never.   The marsh fever, which
can be wafted by the winds, probably farther than yellow fever,
can not, as Melier puts it, be charged or loaded on board ship.
For more obvious reasons  it can not be carried in  a  box,  in
clothing, and  especially  woolen garments.  It is the mediate
communication which gives to yellow fever the aspects  of con-
tagion, especially when the things which carry  it are on the
bodies of the sick.  The cases to prove contagion demanded by
Chervin (" Chervin etait difficile ;  c'etait son devoir de l'etre,"
says Faget) " were cases in  which the patient had been divested
of all  clothing,  especially  of woolens  coming  from  the  place
where the disease had originated."
   " Paludal fever continues after frost," says Dr. Faget, " but
I have never seen yellow fever after simple white frost."
   And lastly, he says, so far as yellow fever is concerned, the
morbid principle, the poison, can be destroyed, whatever it may
be, before there is  any contact with  susceptible  individuals.
For this  it is sufficient to purify, in an isolated locality, the
ships which import it, which carry it especially in their  holds
after unloading.  To be more certain, it is prudent to exercise
some precautions with regard to merchandise and also  with pas-
sengers.
   In marsh fevers the poison can only be traced, reached, and
killed in the system by the use of the one specific which art has
given us, viz., quinine.
   It is to be hoped that henceforth  all those who claim an
adequate medical knowledge to report  on cases  and  outbreaks
of yellow fever  may cease  to air  their theories  on marsh and
malarial poison, " epidemic influence," and " epidemic constitu-
tion."  I have had many a battle with these mouthy impedi-
menta, whose authority in my country outweighed for long all
industry, research, and well-founded perception. 
     DIAGNOSIS BETWEEN REMITTENT  AND YELLOW  FEVER.   123

        The Pulse and Thermometer m Yellow Fever.
    Dr. J. C. Faget * has cleared away many doubts and difficul-
 ties as to the nature and diagnosis of  yellow fever,  by his pains-
 taking  and enlightened  researches  during epidemics  in  the
 South.   In determining the continuity of the febrile action of
 yellow fever, hence  its specific distinction from paludal fevers,
 he says : " If there be in the world a marshy region par excel-
 lence, it is New Orleans; and if there be, consequently, in spite
 of statements to the contrary, a locality rich in marsh fevers of
 all sorts, which very frequently complicate  the maladies  and
 communicate to them their own paroxysmal features, it is as-
 suredly our unfortunate city.  If, then, in such a region, the
 symptoms of yellow fever, as observed by us, are found to be
 those of continued fevers, or of fevers having a single paroxysm,
 it will be proved that yellow fever is everywhere, essentially, a
 fever of the continued type."  Furthermore: " The four or  five
 great epidemics of yellow fever which we  have experienced at
 New Orleans during these last twenty years, from 1853 to 1873,
 were all complicated with  malarial fevers, of  the hsematemesic
 (black vomit) or hsemagastric type; hence all  our difficulties."
    In yellow fever  only one attack, one paroxysm, one access,
 and not two, never a true remission, except the final, and  this
 single  access, very remarkably, declines from the time it com-
 mences ; its course  is descendent almost immediately  after it
 manifests itself.   The duration of the pyretic action is six to
 seven days.  The temperature rises  rapidly to ordinary fever
 heat, 40° Cent., or 104° to 105° Fahr.; this is termed the period
 of effervescence.   This short and rapid period of increase is fol-
 lowed by a tolerably slow and protracted period of decline—that
 of defervescence.
    In ordinary fevers the fall of  the temperature is more rapid
 than its rise.   It is the contrary in yellow fever; in it the effer-
 vescence continues from one to three days, and  the defervescence
 from four to seven days; this gives  twelve days  as the total
mean duration  of the febrile temperature in yellow  fever;
whereas, in the initial fever of variola and varioloid, which has
   * " The Type and Specificity of Yellow Fever established with the aid of the
Watch and Thermometer."  Paris and New Orleans. 1875. 
124         YELLOW FEVER A NAUTICAL DISEASE.
so much resemblance, at the commencement, to yellow fever, the
rise of temperature, or effervescence, is four days, and the defer-
vescence two days.
    In the fatal cases, the defervescence, arrested in its descent
by the visceral congestions which we have described, in those
cases, sometimes assumes an ascending course toward the end till
death, but not always.   Sometimes the temperature continues
to sink during the death agony.
    There is a rapid  and early rise of  the pulse up to one hun-
dred and twenty pulsations or almost double the normal figure;
then  the pulse sinks in frequency slowly and with increased
slowness as the disease progresses.   The maximum average being
120 the first day,  the second it is 10 or 12 beats less, then in 24
hours a dozen fewer; on the fourth day it oscillates toward 80;
it reaches 60 the seventh or eighth day;  on the tenth an astound-
ing minimum will be occasionally obtained; in some patients,
in convalescence, the pulse  does  not exceed 40 in  the minute.
There is a little habitual evening exacerbation, which the lines of
temperature show in yellow fever, as in almost all fevers.  The
tendency of the pulse to lessen the number of its pulsations
does not, in yellow fever, proceed to the extent of rendering
the heart insensible to the effects of secondary visceral conges-
tions.  "When the termination is  to be fatal the pulse rises, ex-
ceeding the early maximum, and being at last so that it can not
be counted, but with this terminal rise of  the pulse there is a
fall of the temperature.
    The fever-producing principle  is  a concrete entity, material
and real; it escapes  the senses, because it  is infinitely minute,
but the effects which  it produces are appreciable by the senses,
and these are the specific effects which enable us to assert its
real and specific existence.   It is an entity invisible, impalpable,
inaccessible  to our senses; but it  is  so real that it can be de-
stroyed where it is known to exist, as  in the holds of certain
ships, and sometimes in ships on which  there are no  sick people,
or on which, at least, there have been no sick for a long time.
This  yellow-fever-producing principle is quite  apart from all
human organisms, and existing by itself, whatever it may be.
    Of all fevers, yellow fever alone presents a steady diminution
in the number of arterial pulsations from the onset,  directly the 
       THE PULSE AND THERMOMETER IN YELLOW FEVER.   125
a
maximum of the pulse is attained, that is to say, from the initial
hours  of the fever, at the maximum of the febrile reaction of
the  organism;  this, with the rising temperature, indicates a
probable special action of the fever-producing principle on the
heart.
    We therefore conclude, according to Dr. J. C. Faget and in
his very words,  that in yellow fever, from the first, the line  of
the pulse descends, while that of the temperature maintains  it-
self horizontal in the great majority of cases, or even rises for
two or three days or more, in two thirds  of the  cases at  least.
This is the gnomonic clinical symptom of yellow fever.
    The continuity of the pyretic action, with divergence of the
lines at the commencement, the line of the temperature in par-
ticular maintaining itself high, ought to make the balance in-
cline to the side of yellow fever.  On the other hand, digres-
sions, abrupt falls, especially in  the  temperature, with sudden
risings, involving parallel elevations of the line  of the pulse,
will reveal to the physician that the paludal element is at work,
and will induce him to  have recourse  boldly to  quinine, from
the commencement of these hsemorrhagic fevers of  ataxic form,
which have a course equally deceptive and full of peril.
    In relation to prognosis, the two  lines descending parallel,
at least from the third or fourth, slowly and steadily descending,
is the  most assuring fact in the  course of yellow fever.  If,  in
their descent, they stop and present  horizontal  oscillations,
something abnormal has occurred ; then is  the time to subject
the organs to an attentive examination, and to reserve the diag-
nosis.
   Lastly, a little later, if the two lines show a divergence in-
verse to that at the commencement, if  that of the pulse takes an
ascending course at the end, while that of  the temperature sinks
low, death is almost certain, or, rather, it is even impending.
   The name yellow fever is derived from that special symptom
which may not appear in all the sick but in all it destroys.   It
is quite a special kind of persistent yellow, not due  to jaundice,
in which nitric  acid  at once detects biliverdine, but, with the
yellowness, albumen appears in the urine.   The black  vomit  is
very marked, and perhaps not a single body, dead from yellow
fever, but has the stomach full of it.   The true black vomit has 
126          YELLOW  FEVER A NAUTICAL DISEASE.

the appearance of the  infusion and grounds of coffee.  Corpses
in other fevers may contain it.
    Acute fatty degeneration of the liver seems also to be a
structural alteration constant after yellow fever.  Like black
vomit, it is found in  the bodies of those who have died from
other fevers; but, when it is not found in a case believed to have
been yellow fever, it is probable that there has been an error in
diagnosis.
    Such are Dr. Faget's views, and they may be regarded as the
most recent and definite exposition of genuine originality.
    In a  highly interesting letter  on " The Epidemic Fever of
Young Children now prevailing  in New Orleans," which  he
addressed to  the  New Orleans  " Daily Picayune," on August
24, 1878, Dr. Faget shows the vast importance of the diagnostic
signs he has  discovered, and of the consequent adaptations of
treatment to  the  recognized character  of  the  disease.   He
says:

   "Yellow fever has been rapidly spreading  in our midst.  But, at this
season of the  year, in August, near to September, is our city  and is the
country around it exempt  and free from malarial fevers, and have not these
fevers a larger share of the mortality than is allowed ?
   " Can  not both the yellow and the malarial fevers coexist in the same
locality, and do they not  sometimes attack simultaneously the  same per-
son?
   " Is it positively to yellow fever that are due all the deaths of young
children of only a few months, or even of a  few years (two, three, four
years ....), which  appear every morning in the  papers in the list of
deaths from yellow fever?
   " An important and well-established fact is, that the older the patient
the more  severe is the type of yellow fever.  Under ten years, dangerous
and particularly fatal cases are very rare.
   " It is an undeniable fact that in this city, during the first fifty years of
this century, that is from the first appearance of yellow fever here, in 1796,
until 1853, it was considered that our children, born in the city, had no-
thing to fear from the disease; it did not seem that they had ever been af-
fected by  it.
   "But in 1853, and even more so in 1858, while yellow fever was deci-
mating the unacclimated foreigners, a great number of young children, born
and raised here, were carried away by a fever presenting some analogy with
yellow fever.  Many physicians believed that it was yellow fever, and aban-
doned their former opinions on the subject.  I am  one of those who still 
       THE  PULSE AND  THERMOMETER  IN YELLOW  FEVER.    127

adhere to the opinion that the natives of this city are exempt from yellow
fever;  that they are not subject to it any more now than formerly.
   "Already during the  great 'double'  epidemic of 1853, in an attentive
study of the  course of the  disease which was  striking  down the children,
some of the cases being with ' black vomit,' I had observed first, that the
course  of  the disease  was similar  to that  of pseudo-continuous paludal
fevers; and second, that  the disease yielded to sulphate of quinine, when
given in time, and in sufficiently large doses.
    " 1. The febrile action or force in this fever of  children manifests itself
 by ' exacerbations,'' while in yellow fever there is but one paroxysm.
    "2. The matters  black-vomited,  instead of resembling an infusion  of
 coffee, with the grounds at the bottom, of the yellow fever cases, generally
 presented black grumes with a great deal of mucus from the stomach, heavier
 than water, so that, in order to find it at the  bottom, under  the vomited
 liquids, they had first to be carefully poured out.  The liquids are of vary-
 ing brown shades, reaching the black color of prune juice.
    " 3. The black vomit in the paludal fevers is not a sign of much gravity,
 while in yellow fever it is almost a sure sign of approaching death.

    "4. Except in cases complicated with jaundice the  corpses were' not
 yellow as they always are in yellow fever, even when the yellow color did
 not appear during life.
    " 5. The relapses are as frequent as they are rare in yellow fever.
    " 6. Quinine, which is of doubtful efficiency in yellow fever, was the
 ' specific' remedy in  this fever of children.  In 1858, in the epidemic  of
 the children, where quinine was not used, the proportion of deaths was  as
 great as in yellow fever; and,  on the contrary, where quinine was given  in
 sufficiently large doses, and when it was absorbed in the system, there were
 but few deaths.
    "It strikes me that those differences are sufficiently marked and real  to
 justify the opinion, that the fever, which decimated the young children  in
 New Orleans,  during  the  yellow fever  epidemic of 1858, was not yellow
 fever.
    " In the last  mortuary report for the week ending Aug. 18th, we find
 315 deaths within the limits  of the city of New Orleans, of which 185
 deaths are imputed to yellow fever.  The mortality,  divided according  to
 age, is as follows: Under 1 year 20, from 1 to 2 years 22, from 2 to 5 years
 50, from 5 to 10 years 16.
    " It would thus appear that the more tender the  age, the more deadly
the yellow fever.
    " This would be the complete subversion of all that was known hitherto
of yellow fever, as studied in all countries, by all writers and at all epochs.
    " Is nature no longer constant and invariable in  its laws ?  Or is not this
epidemic fever of young children, which is called 'yellow fever,' the same
which prevailed in 1853 and 1858, during  the yellow fever  epidemics of 
128           YELLOW  FEVER  A NAUTICAL  DISEASE.
those years, and of which I have given above, as before in 1859, the differ-
ential characteristics as compared with yellow fever.

    " If yellow fever, from the very beginning, presents almost constantly
this characteristic of a diminution of arterial pulsations, without any de-
crease of the febrile heat, and sometimes even while the fever is increasing,
if this sign belongs only to yellow fever, then we have at once the means,
from the very first hours, to know it from among all other fevers.  It fur-
nishes a prompt and safe guide to decide whether the present fever of young
children is or is not yellow fever.
    "If, at the very height of  the fever, and from the beginning, there
should be observed, in  the sick children, a diminution of the arterial pulsa-
tions, then the fever would be the yellow fever.  This is what I have never
found either in 1853, in 1858, or during the present year.  On the contrary,
in this fever of young children, which, in all cases coming within my ob-
servation, I have always found (unless quinine had intervened energetically
from the outset) to be a fever with  several paroxysms  or exacerbations,
there is no discordance or  opposition between the  pulse and the tempera-
ture ; in other words, if the febrile heat increases the  pulsations are more
rapid.
    " I hear it said  rather vaguely:  The progress of fevers is not the same in
adults as in children.  This may be.  But let us be precise.  Do not poisons
generally produce,  all  proportions  being allowed, the same effects in chil-
dren as in adults ?   Do not digitalis and veratrum, causing a diminution  of
the arterial pulsations in the adults, produce a like diminution of pulsations
in children ?  Why, then, should not the yellow-fever poison, which causes
such a remarkable diminution of the pulse in adults, cause also the same
diminution of the pulse in children ?
    "Therefore, if,  in this fever of  children which we are now considering,
there is no  diminution of the pulsations, while the temperature increases
or remains  stationary;  if there is no discordance between the pulsations
and the febrile heat; if both the  pulse and the temperature increase during
the paroxysms, then we say it is not the yellow fever.
   "The existence of this hasmatemesic form of the malarial hsemorrhagic
fever can no longer be denied.  It was even known in the days of Hippo-
crates, and is mentioned by him..  It was also known by the physicians of
Spain as early as the middle of the last century, long before yellow fever
had been imported into Spain from its colonies.   And although it was sup-
posed by some, in 1869, to be a  new disease, it had been mentioned and
described since about twenty-five years by the physicians in the Antilles.
   "We consider that the  existence of the hsematemesic form of the
malarial hemorrhagic fever is as clearly established  as its haBmaturic  form.
   " My conclusion is that quinine should be freely given  in the epidemic
fever which now prevails on young children. 
OROYA FEVER.
129
   " The only means of knowing positively that it has been absorbed is to
 ascertain that it has  produced  its  physiological effect, the  hardness of
 hearing.
   " If quinine can not be given through  the stomach or the rectum, fric-
 tions can be used, with some benefit, in cases of small children whose skin
 is very delicate.  But in severe cases it is  always unsafe to trust too much
 to frictions, and recourse should be had to  subcutaneous or hypodermic in-
 jections ; they sometimes  cause  local  inflammation; but, again, what is
 that in such a danger ?  As Hippocrates so excellently says in his Aphorisms:
 ' To extreme ills, extreme remedies.'
                                       " De. Ohaeles Faget."

    I have diligently sought  for any  evidence of the land origin
 of a disease similar to yellow fever, and perhaps the most strik-
 ing on record is
                         Oroya Fever.
    The recent construction of the Callao,  Lima, and  Oroya
 Railroad has been  attended  by the manifestation of a pestilen-
 tial fever  of great malignity, confined to the line of  grading,
 which had no previous existence,  and which is commonly called
 the " Oroya fever."
    Dr. Browne, Fleet Surgeon of the Pacific Station, writing
 in 1872, says it commences " at La Chosica, 33 miles from Callao,
 at an elevation of 2,800 feet; its locality extends along the course
 of the road through the valley of the Rimac River for about 22
 miles, to the  elevation of  6,500 feet"—in  the  same locality
 where prevail the verrugas and simple intermittent fevers.  Dr.
 Fasset, of Lima, considers it "but an  aggravated  form of the
 pernicious paludal intermittent  fever that is common to marshy
 localities, or where  rice is cultivated, and particularly in the deep,
 hot, and tumid valleys of  the Sierra."
    The atmosphere circulates badly  in the humid gorges of the
 Sierra.  The work upon the road in  many places, by the ground
 being broken up, has occasioned the emanation  of a fetid odor,
 more offensive than that of sulphuretted  hydrogen.  " It may
 be," says  Dr. Browne, " that this telluric miasm, acting upon a
 system previously  impressed with a miasm of the ordinary in-
 termittent, may develop a highly malignant  fever."  It attacks
the whites, the mongrel, and  especially  foreigners.  Negroes,
 Chinese, and Indians are most exempt.  It subjects to a second
attack, does not preserve from yellow fever, nor does the latter
           9 
130         YELLOW FEVER A NAUTICAL DISEASE.
grant immunity from it.  It is non-contagious, non-ambulant,
or non-transmissible, and removal to  a short  distance is suffi-
cient for withdrawal from its influence.
   " Departing from Lima, the railroad follows the left bank of
the Rimac, and until  it reaches  La Chosica the workmen  are
only subject to simple  intermittent; from thence, where  the
verrugas waters commence, they are exposed to this pestilential
fever up to the point where  begins  the cold climate  of  the
Sierra."
   Oroya fever is sometimes continuous, at others periodic.  Its
features have confounded the medical observers in all " save its
lamentable frequence and fearful destruction."  Dr. Browne says:
   " Death  may occur in twenty-four hours from the  attack,
though the duration of the disease usually  is several days,  and
in some cases prolonged into weeks.  Dr. Rush, an  American
physician in the company's service, died in thirty-six hours from
the first invasion, apparently in ordinary health until the  mo-
ment of the attack.   In certain cases a slight attack is followed
by a seeming convalescence; the patient goes out, a relapse en-
sues, and he dies suddenly.  It  is the rival  of yellow fever,
equally formidable, and, though differing in many of  the symp-
toms, the result is nearly the same.  It has  been observed that,
if the access belongs to the quotidian  type, it is  favorable if it
delays;  and, on the  contrary, it is unfavorable if it anticipates
when of  the tertian variety.
   " In the commencement the symptoms are usually the same:
intense cold, accompanied by severe pain in the head, loins,  and
limbs, succeeded  by febrile movement, varying in intensity,
with continuance of headache, pain in loins, etc.  This stage is
followed by an intermission or remission, or the severity of  the
fever may subside into a feverish condition which has continu-
ance, or the paroxysm may be succeeded by copious  sweats, af-
fording no exemption from other paroxysms.  The intermissions
and remissions are exceedingly regular, or after a single one the
fever may  become  continuous.  Prostration, relaxation of  the
muscles, and anaemia are often sudden, and followed by aphony.
   " Early in the fever nausea and vomiting  usually occur, the
matter at first being yellowish and greenish in color, then brown,
then resembling coffee-grounds, and finally melanie.  There are 
OROYA FEVER.
131
severe pains in the region of the spleen, liver, and stomach; no
tympanites when unattended with peritonitis, but contraction
of the abdominal walls toward the dorsal spine; in some cases
iliac tenderness, with absence of gurgling sound.   The bowels
are generally constipated, therein differing from the grave cases
of the pernicious intermittent of the country, when diarrhoea,
often bloody, supervenes. Intelligence may be good, or a mani-
acal delirium at the outset.  Petechial spots occasionally found;
urine brown, as in yellow fever, but  not often suppressed, ex-
cept with peritoneal complication.   Tongue presents a gray
coating or greenish yellow at first, but becomes red and raspa-
tory.  Sordes not  frequent, gums bloody, breath tainted.   The
blood seems deprived of hsematosine and globules.  The patients
take an icteric tint like that of yellow fever.
    "As the  disease  progresses the ataxic symptoms  denoting
the typhoid state are evident, viz.: low delirium, sordes, subsul-
tus tendinum, etc.   The comatose or convulsive state frequently
happens, and the last condition appears to be less  dreaded, how-
ever violent it may be, than the first, except a nervous trembling
of the limbs and tongue, a bad augury.
    " I was unable to obtain any satisfactory information as to
the morbid  appearance  after  death, post-mortem  examinations
having been very rarely performed.  Dr. Fasset asserts, how-
ever, that the pathological alterations  produced by yellow fever
are perhaps surpassed by the  pernicious paludal  intermittent
fever, of which he regards the Oroya fever as a variety."
    The manifest importance of  tracing every form of disease
on land bearing any similarity to yellow fever must be my suffi-
cient excuse for so long an extract.*

   Cholera and Yellow Fever.   Contrast of a Land and an
                       Ocean Plague.
    Scarcely possible  does it  seem to me that the, great dispari-
ties between a disease  springing from the soil, like cholera, and
an  ocean  pestilence,  like yellow fever,  should  not long since
have forced on medical men the view that the last is  a disease
of the mariner.
   * On Oroya Fever in "Medical Essays by Medical Officers of the U. S. Navy."
Washington, 1872. 
132         YELLOW FEVER A NAUTICAL DISEASE.

   Hindostan, guarded from the world beyond it by the Hima-
layas and a shore distant from European ports, protected by caste
prejudices, which have preserved ancient rites and a peculiar
civilization, retained till  late many secrets,  and among them a
knowledge of its virulent  endemics.   Its pestilential jungles and
still more pestilential salt marshes have for ages bred remittents
and dysenteries.  Our knowledge of the people of India and
their diseases dates back only to Vasco de Gama, toward the
close of the 15th century.   One  of  his countrymen, a Portu-
guese physician, Gaspar Correa, describes cholera in the " Lendas
da India " as killing in 1503 20,000 men in the army of the Za-
moryn sovereign of Calicut, the enemy of the King of Cochin.
Here and later at Goa (1543) the disease, unlike yellow fever, is
observed spreading among soldiers on land as it has done, mov-
ing from camp to camp, among the British forces since we have
held possession  of  the  East Indies.  Oola Beebee,  the goddess
of cholera in Lower Bengal, specially worshiped during the more
deadly months of April,  May, and June, still exists to bear tes-
timony to the antiquity of this indigenous plague (Macnamara).
   The annals of cholera teem with  observations from 1503 to
1807, when it first became epidemic under British rule.   "When
Dr. Tytler first wrote of  the disease on the  23d  of August,
1817, he said: " The disease is the usual epidemic of this period
of the year,"  and  the magistrate of Calcutta, writing to the
government in September,  observed  that a disease prevailed, as
it generally did to  a greater or less degree " at the  present sea-
son of the year "—" of the species of cholera morbus."
   No such record is given, by the early and trustworthy Ameri-
can authorities, of yellow fever, which they believed had sprung
upon  them, under some  mysterious  epidemic influence, in the
busiest seaports and nowhere else.
   Of the six great Indian outbreaks of cholera,* the very first
one in 1817, within three months from its appearance, had been
generated throughout the province of Bengal, including some
195,935 square miles, and within this vast area, says Macnamara,
the inhabitants of hardly a single village or town  had escaped
its deadly influence.  In 16 months the disease was generated
   * " A History of Asiatic Cholera," by  C. Macnamara, F. C. U., Surgeon to the
Westminster Hospital, London, 1876. 
CHOLERA AND YELLOW  FEVER.             133
throughout the length and breadth of Hindostan.  Thus spreads
a land plague.
    When yellow fever entered Philadelphia in 1699, it killed
220 people out of a population of  3,800, and as usual was con-
fined to the port.  In the ever memorable outburst of 1793, in
the same city, 3,548 died out of a maximum number of 50,000
inhabitants, and the one third of these who escaped inland pro-
pagated no disease.  I am  aware that I can quote numerous in-
stances of most grievous loss of life, such as in  Spain  at the be-
ginning of the present century; but, whenever an outbreak of
yellow fever is studied, it will be found dotting about  among
the seaport and river  towns, and not besmearing, as you can a
map of Hindostan with a paint brush, an entire continent within
the limits of ocean and impassable mountains.
    It is highly interesting and instructive to note the  universal
and invariable tendency of the human mind to discover an im-
mediate cause for epidemic outbreaks.  Just as the appearance
of  yellow fever from the  very first developed the erroneous
opinion of its origin in New York, Philadelphia, and elsewhere,
but always locally, so when cholera first broke loose in 1819, and
was taken to the Mauritius, the local commissioners assembled
were unanimous in not  supposing the disease contagious, or of
foreign introduction;  the cause was supposed to exist  in the at-
mosphere.
    Each and every year cholera occurs inland during the hotter
months, and ceases in winter.   The  great epidemics like that of
1817-'23 wear away.  Recrudescence each year occurs  in all
directions, and not, as in yellow fever, invariably near an expanse
of water—ocean or river.
    Yellow fever may be said to wear away; but, as innumerable
observers  have noted, and Drs. Faget and Hargis have stated,
the seasonal remission, as a rule,  demands renewed importa-
tion.  You must resow it like the cotton plant, which lives per-
ennially in  the tropics, but  can not resist the winters  in  the
United States, and like the  indigo in Tirhoot, which must be
raised from imported seed.
   When cholera spreads  beyond  Bengal—its true home—it
spreads by pollution of water; and, if not renewed by fresh con-
tact with Bengal, the disease in those parts where it has reached 
134         YELLOW FEVER A NAUTICAL DISEASE.
gradually  dies out and  disappears.   Where imported,  cholera
seldom continues for more than three consecutive seasons in any
one place.
   Yellow fever passing from the ships to land may and does
in hot countries remain for  years  in seaport towns, but the
smaller of the West Indian Islands are free from the disease in
their interior, and  only  retain the disease for limited periods.
They all enjoy protracted periods of immunity when there is
absolutely no sign  of  tne disease.  The  remark that Dr. Blair
makes concerning Demerara, which  escaped from 1819 to 1837,
shows this ; for, when the malady broke out in the latter year, no
one could be sure of its nature, for the physicians who had seen
the previous epidemic were either dead or had left the colony.
The same would happen in the case of cholera beyond its home;
but there is no land, no  island, and only a seaport in communi-
cation with shipping, where yellow  fever can demand medical
attention every succeeding year.
   The appearance of cholera in America for the first time in
1830, '31 and '32, was due to an epidemic outburst which com-
menced in Bengal in 1826.  It traveled  through many lands,
and crossed vast continents, as well  as seas, to reach the New
World via Dublin.  As Macnamara says, this  " mighty conti-
nent contains people living under every variety of climate and
of varying social circumstances; none of these, however, had
developed cholera among her  people."
   Could yellow fever  ever  reach  Bengal across continents ?
Even ships fail to carry it there.  It can not travel by easy
stages from place to place, over months  and years, and con-
tinue to  exist, much less  to destroy with  pestilential viru-
lence.
   Cholera  affords proof how  persistent  and troublesome an
exotic  land  disease may be  far from  its well-known home.
Writing in July, 1875, Mr. John Simon says : "Recent facts as
to cholera in Europe have undoubtedly been of very evil omen.
Europe within the  ten years time has twice been overrun with
cholera.  From the middle  of  1865, when one great diffusion
of the disease began, till after the middle of  1874, when a sec-
ond great diffusion had apparently run its  course, there possibly
was no moment at which the disease was extinct in Europe, and 

                CHOLERA AND YELLOW  FEVER.             135

there certainly was but little time when it could even be sup-
posed to be extinct."*
    We are now witnessing an exceptional persistence of yellow
fever in Memphis, but has it disseminated itself like a land dis-
ease?   Did it do  so  even  in 1878, that  year of  exceptional
invasions at points somewhat remote from water,  though still
within easy reach of Mississippi and its  infected steamers ?
    Yellow fever does not demand, as conditio sine qua non for
its development, the introduction of a sick human being into a
port to propagate the malady.  Frequently the ship's company
has been landed, and the susceptible laborer, stevedore, custom-
house officer, or ship-keeper has been the first to contract the
malady, and with others aid in its  transportation from the ship
to the port.   An  example of propagation, essentially non-per-
sonal, is afforded in Surgeon-General Woodsworth's tenth re-
port, dated September 14,  1878.   On  the 4th of September
four members of a family, residing two  miles from Cairo upon
the banks of the Mississippi, were suddenly stricken with  yel-
low fever.   On  the 18th, the remaining two members of the
family were attacked,  one died.   The children found an aban-
doned skiff  on the  river, at  a time when infected steamers  had
been working mischief, and removed it to the house for repair.
Three or four days afterward all who were around the boat were
stricken with the fever in one day.   The extension of  cholera,
on the other hand, bears a close and definite relation to personal
traffic: in various important cases the arrival of  persons affected
with the disease was unquestionably the starting-point  of local
and perhaps national epidemics; and no extension of the dis-
ease was to be found where the arrival  of human beings from
previously infected places was not either proven or probable.
(Simon.)
   Outside the limits of India, Mr.  J. Netten  Radcliffe, in his
very wide study of cholera, extending from England to the tor-
rid climates of Africa and Southwestern Asia, finds no reason
to impute to cholera any other mode of  origination and exten-
sion than such as that doctrine expresses.

   * " Reports of the Medical Officer of the Privy Council."   New Series.  No. V.
London, 1875. 
136         YELLOW FEVER A NAUTICAL  DISEASE.

   Analogy between Typhus and Yellow Fever in a Ship.
   Dr.  Melier  reports  a highly instructive instance of  ship
typhus, which  occurred  on the imperial transport Duperre,
employed in bringing back to France the wounded from the
Crimea, which were in that  state of debility and sickness named
by Michel Levy " Crimean cachexia."  Having left Eupatoria
on the 18th of April, she arrived at Toulon on the 2d of May.
In the  22 days' voyage  there were many deaths.   The vessel
was purified with scrupulous care—450 men remained on board
and continued to sicken.  On the  13th of May, viz., after 11
days, 23 cases had been sent to  the Hospital Saint Mandrier,
five or six very severe and presenting the symptoms of  typhus.
These, it might have been thought, were cases of prolonged
incubation, but on the  22d  new cases occurred.  M. Melier ex-
amined  the vessel with great diligence.  Everything seemed in
perfect condition. Admiral  Dubourdieu, then Maritime Prefect
of Toulon, graphically pronounced the verdict, " C'est lenavi/re
qui est malade" (it is the ship that is  sick).  The time came
for the men to leave the ship; their time had expired. Another
crew takes its place, all new men ; and they are seized slightly,
it is true, but with unmistakable symptoms—demi-typhiques. 
                      CHAPTER  IY.

                 DEVELOPMENTAL PHENOMENA.

    The contrasts, causal and  symptomatic, between different
 morbid conditions, embraced under the general head " fevers,"
 suggest deeper  differences, which may be defined as develop-
 mental.  Acute observers have shown us the essential signs of
 demarkation between periodic and continued fevers—between
 eruptive fevers with typical structural lesions and fevers which
 are unattended with a specific anatomical change.
    It is in my opinion impossible to exaggerate the importance
 of Dr. J. C. Faget's diagnostic investigations, in relation to palu-
 dal and yellow fevers.   They must mark an era in the study of
 these diseases; and for the purposes of medical practitioners du-
 ring epidemics,  they constitute the true  beacon lights, which
 should keep out of print a host of  immature observations, capa-
 ble of  materially hindering the growth  of exact  knowledge.
 The looseness of records, and the cloud of  baseless theories, are
 responsible for that chaotic complexity of medical opinion, which
 I desire, in some measure, to dispel.
    The researches of great difficulty and importance into the ul-
 timate nature of true contagion, and the primary causes of some
 diseases of local  origin, have led us one step beyond the bedside
 observations.  They have shown, in some cases, that special ele-
ments are at work, associated with and characterized by peculiar
structural formations and living organisms.  Many mere coinci-
dences have been interpreted as cause and effect.   It were well
if all coincidences had been always noted to the fullest possible 
138         YELLOW FEVER A NAUTICAL DISEASE.
extent, and then the natural growth of biological knowledge
would have explained phenomena beyond the ken and grasp of
the prescriber.   His primary duties, responsibilities, and fatigues
unfit  him for calm and  continuous  thought and work on the
deeper and most difficult problems of life, while the battle with
death is being fought red-handed.   The first injunctions to the
clinical student should be to note everything, however trivial,
and never trust to memory.  The accuracy of medical writings
would be enhanced immeasurably if  we could delete from past
records the imaginative pictures of cases which have been drawn
with rounded phrases and well-chosen periods, months and years
after observation.  They  are stumbling-blocks in the way of the
accurate philosopher.   They are just as pernicious, in medicine,
as fanciful and incorrect representations of  animals and plants
would be to the anatomist and botanist.
   Hasty generalizations have materially retarded  the develop-
ment of medical knowledge, and I desire, in submitting to my
readers some speculations based on the knowledge acquired, to
be more  suggestive than doctrinaire—thought-inspiring rather
than limiting mental effort, even by reasonable explanations of
manifold phenomena.
   A morbid  principle—a fever-poison—has been very widely
accepted as a bloooZpoison.   So common and constant is the dis-
persion of intoxicants through the system by the organs of cir-
culation, that the instant and primary effect of an infection  is
interpreted as  due to an action on the blood.  The surgeon who
talks of " shock " apprehends the all-pervading influence of the
sensorium, and its subsidiary ganglia and nerves.  The soldier
who, as Guthrie relates, was killed by a bullet  striking the pit
of the stomach, producing only a contusion, affords an instance
of that exquisite relation between  animate man  and his  sur-
roundings which has bewildered so many.
   So hard is  it to discipline the intelligence to any limitations
that, by a bound, the metaphysical labyrinth is reached,  even by
our best experimentalists.  No less  a  man than G. A. Hirn *
has compared inorganic matter—homogeneous, susceptible of be-
ing broken into fragments, and of indefinite continuance in a
   * " Consequences Philosophiques et M^taphysiques de la Thermodynamique."
Par G. A. Hirn. Paris, 1868. 
HIRN'S PRINCIPE ANIMIQUE.
139
state of absolute unchange unless disturbed  by external influ-
ences—with the living being, essentially heterogeneous in struc-
ture, with diversified organs and  functions necessary to limited
existence.  Internal rest of its constituent parts is in direct op-
position to life; it grows and feeds on its surroundings, and the
smallest instant of  time, during which the necessary changes of
its integral constituents may be stopped, suffices to kill and con-
vert the living into ordinary matter of the physical world.
    The living being creates nothing—it only assimilates.  If
parts or things are thrust on it, not compatible with its organism,
it makes a supreme effort to reject them, and failing in this dies.
" If, therefore," continues Hirn, and here I quote literally, " a
special principle is necessary to the constitution of the whole (I''en-
semble) of a living being, the principle is,  once for always, in
it, qualitatively and quantitatively, from the moment of its birth
to that of  its death.  This principle can not be regarded as a
force." .  .  . . " The expressions organic forces, vital forces, have
no meaning."  And he goes on to argue in favor of a principe
animique as a necessity, that is to  say, " as an affirmation which
subsists because no other can be found to take its place." Where
his  demonstrations fail,  he deems it imperative to  impose a
dogma.
    The origin and propagation of yellow fever indicate the de-
velopment of a virulent something which, within certain limits,
reproduces the same morbid appearances in susceptible individ-
uals.  One of the most striking and distinctive of its features is
that this virulent entity exerts such an influence on the human
system, as to make  this resist, more or less  effectually, any sub-
sequent attack.
   And by way of  parenthesis I  must here note how some of
the ardent disputants have attempted to bend facts, or rather to
substitute assertion for fact, in support of their theories.   In
attempting to controvert the  opinion that yellow fever was a
contagious disease, and before Sir  William Pym and others had
demonstrated freedom from second  attacks, Dr. Charles Mac-
lean had " completed  his  convictions " that  " no  general disease
which is capable of affecting the same person repeatedly is ever
propagated by contagion " ; ergo, after Pym's  researches it was
admissible  to  consider yellow fever a pure  contagion.  Expert- 
140         YELLOW FEVER A NAUTICAL DISEASE.

ence lends much more weight  to  another dictum which reflects
great credit on Dr. Maclean's perceptions, especially if we con-
sider that he belongs practically to the last century.  He laid
down, perhaps not absolutely  for the first time, the principle
" that a disease capable of being propagated by a specific virus
can never be produced by any other  cause; and that a disease
produced by other causes can never be propagated by a specific
virus." *
   But yellow fever is  transmissible, though not  inoculable,
and, in all probability, always an  imported  disease on land, not-
withstanding Maclean's logic and Chervin's  eloquence; and it
is necessary we should show  in what it differs from the pure
contagia,  the  specific inoculable diseases,  with  which,  as I
have before explained,  it  can not for one  moment  be  con-
founded.
   We must not be rash in our  inferences, but  bear in  mind
the advice given by Dr. Latham in his clinical  lectures.  He
says: " Let a man use his own experience as best he can for the
present, but let him not, upon the strength  of it, rebuke the ex-
perience of  all  past  times and dictate to the experience of all
future; for if  he live long enough, nothing is more likely than
that he may find himself under his own  reproof, and incon-
veniently confronted by his own maxims."
   In  the  distinction between inoculable and non-inoculable
maladies, we may find cause for confusion of thought.  Usually
diseases dependent  on a specific virus are inoculable, whereas
other maladies are non-inoculable; but just as a sound piece of
meat may be inoculated by that ferment which causes putrefac-
tion, so do we find, as I  have personally witnessed and actually
suffered from, non-specific venom communicated from irritated
and inflamed mucous surfaces, producing inflammation and pus-
tular eruptions of the unabraded  skin.  The juices of the flesh
of an animal that has died of  an autochthonous  anthrax have
produced a fatal erysipelas.  In man  phagedsena reproduces its
like, and will do so repeatedly;  and although it may have super-
vened  upon a syphilitic sore, it  may communicate to  another
person not syphilis, but phagedaena.   If this sets in before there
   * " Evils of Quarantine Laws and Non-existence of Pestilential Contagion." By
Charles Maclean, M. D.  London, 1825. 
CAUSES OF  IMMUNITY.                141
has been time for general contamination, it may sometimes pre-
vent constitutional syphilis.*
    Again, too much faith should not be placed in any profound
and complex reason assigned for the  immunity enjoyed after
one attack of any disease.   Yery simple circumstances account
for the possible  ravages of cystic parasites in the  young and
tender animal,  which are rendered  impossible when the tissues
acquire a  special density by age. Moreover, we might adduce
many  instances from the inorganic  world, and especially from
the field of metallurgy, of profound  and lasting modifications in
the toughness,  ductility, resiliency, and so forth, of material, ac-
cording to the methods of preparation and subsequent treatment.
    It  is well to remember  that  complex organic matter is gov-
erned  by the same laws of energy as those which operate in all
other  matter.  A man stores potential energy in the shape of
oxidizable food elements and tissues, and is affecting all around
him by the manifestations  of a  kinetic energy—heat and me-
chanical work.   In health and full vigor he is always expending
less matter and energy than he takes  in, and provides for growth
in  the young  and almost superabundant deposits in vigorous
manhood.   These relations can  be  disturbed in a very simple
manner, and such disturbances may result in death or life-long
idiosyncrasies.
    One of the most simple and  most  sure methods of instan-
taneously upsetting the relations  between systemic demand and
supply, is by modifying the usual normal relations between the
tensions of the gases in the blood  and in the external atmosphere,
respiration consisting in the equalization of those tensions.  In
virtue  of  the very low tension  of the oxygen of its blood, an
animal placed in a confined space can consume almost the whole
of the oxygen which that space contains, while the evolution of
carbonic acid is  very soon  stopped  by an  equalization of  the
tensions taking place (Wilh. Miiller). f
    In  studying the development of a  disease which, whatever
may be its specific cause, originates  and spreads in foul air, and

   * "Lectures on  Syphilis."  Delivered at the Harveian Society, December, 1876.
By James R. Lane, F. R. C. S.  London, 1878.
   f " Elements  of Human Physiology."   By Dr. L. Hermann.  Translated by A.
Gamgee, M. D., F. R. S. 
142         YELLOW FEVER A  NAUTICAL DISEASE.
the virulence of which apparently bears  a direct ratio  to this
foulness and the confined nature of the space occupied, we have
to bear in mind the conditions of normal and abnormal respira-
tion—the conditions of normal and abnormal oxidation through-
out the system.

        Where and How may Yellow Fever Develop ?
    An empty ship from the tropical Atlantic, relieved of  its
crew and cargo, has been closed alongside a wharf in hot weather,
and an active decomposition has set in, so that, when ports and
hatches were opened, the volume of fetid gases has overwhelmed
the bystanders, engendering yellow fever.
    More commonly a foul ship entering a harbor from the yel-
low-fever zone, without manifest sickness ampng its crew, has
been detained under conditions favorable to increasing foulness;
and either a  ship-keeper, shipping-clerk, or friends of the ap-
parently healthy crew, have gone on board, returned home, and
introduced yellow  fever in  the port.  Still more commonly the
sickness develops at sea near the equator, when the ship  is shut
up loaded, and  remarkable  for  numerous  impedimenta, as well
as for being deep  in  the water.  The sailors may be buried at
sea, and the ship is placed alongside other foul ships in harbor,
or in a slip near some foul dungeons—too  bad to  be honored by
the title of dwellings—and the fetid emanations from the hold
are transferred more or less directly into other ships  or into
these pestilential foci  on land.   Just  according to the facilities
of such intercommunication, does the disease become prevalent
in the harbor or town, or both.  Its inland inroads are practi-
cally abortive.
    It is, therefore, incontrovertible, and very diverse facts can
be adduced in support of the view, that the poison is generated
outside the human frame.   It originates, as Dr. Sanderson might
say, in a quasi-spontaneous  manner, in inclosed floating chasms,
whence a pronounced rotten-egg fetor is the most obvious char-
acteristic.  Never  has it been found to originate in vessels con-
fined to inland lakes or  rivers.   It is always to be found some-
where in the ocean shipping, traversing  the Atlantic calm-belts.
I shall not prolong this statement by needless repetitions, and my
main object  at  this point is to establish that there are certain 
                      THE  SHIP POISON.                  143

 undeviating conditions,  beyond the  sick man on land, under
 which we can trace and reach the poison, where there can be no
 pretense that man is carrying it, and only very slight, indeed,
 for suspecting that man played any part whatever in  engender-
 ing it.
   Now this ship poison is breathed by a susceptible man, and
 it kills him.  It poisons him if the dose be large, perhaps  as
 quickly as a mortal  dose of phosphor paste or  corrosive subli-
 mate.   Like these it produces very definite lesions and symp-
 toms, and like these, I believe, so far as I can determine by all
 inquiries in my power, it is not reproduced in the system. Some
 of it may be and possibly is thrown  off without change; but if
 unable to kill the person attacked, it  leaves its most marvelous
 impress on the system, by creating an immunity from subsequent
 attacks.
   The coincidence  of cases, as the disease spreads, indicates a
 pestilential  condition of the ship or low-lying dwelling,  and not
 propagation by contagion from the sick to the healthy.  Sanitari-
 ans, it is true, have been driven to practice isolation and to depend
 on it mainly, but simply because the presence of  the virulent
 entity I have before mentioned, though readily attaching itself
 to things rather than persons, can only be determined by the
 sanitarian wherever its physiological effect is obvious.   It were
 well could we trace it before it enters the human system; but
 all effort so far to ascertain its definite and recognizable exist-
 ence, apart from  the human system, has failed, just as much as
 the recognition  of snake-poison apart from the  snake.  And
 probably we may fail throughout all  time, as we  have failed in
 recognizing the reproductive animal poisons which flow in with
 diseased animal secretions or suppurations.
   There are the gases of decomposition, which often announce
the probable locale of the insidious enemy; but the  disease is
witnessed spreading where all fetor is lost, or at all events where
it is imperceptible, and we have then to trace its operations  in
the animal economy.
   There is organic matter within and without the body, which,
with our present means of investigation, seems almost formless
protoplasm, capable  of  motion and endowed with vitality  or
irritability.  Structure in no way indicates  that which  belongs 
144         YELLOW  FEVER A NAUTICAL DISEASE.

to a jelly-fish or a man.   Protoplasm is all albuminoid, convert-
ing external matter into itself, and being capable of such changes
as will contribute to the firm  growth and development of the
higher as well as the  lower forms of organic life.   This proto-
plasm is undoubtedly  susceptible of lasting as well as transitory
impressions; and what the change is, we know not, which insures
the development of secondaries  in syphilis, or the periodic re-
currence of ague long after a man has left the marshes.
   A formless  protoplasm, for aught we  know, may be the sea-
ferment in ships growing out of putrid  and fermenting bilge-
water,  and its action may be almost catalytic—an action by mere
presence, or contact with the blood-protoplasm.  This  undoubt-
edly changes, for the blood is affected at once; the arrest of the
higher secretive functions, the  instant cessation of molecular
"assimilation in the tissues, the retrograde  changes to  fat in mus-
cles and liver, and the passage of free albumen into the urine,
indicate how profound and unmistakable  has been the  influence
of that agent which progressively checks and ultimately arrests
all normal nutritive function.  So fierce  and active may be the
first invasion of a ready victim, that general cessation of func-
tion, for that instant of time mentioned by Hirn, seems to be the
method of death.  But if the influence is milder and a progres-
sive course be engendered, then the reparative powers surmount
the disintegrating force and conquer.
   I may  have formed a wrong impression of the possible action
of this poison, but certainly I  am not in  error that the product
of foul fermentation may elude  our perception, and may, with-
out necessarily  reproducing itself in  the  human system, so im-
press the  living albuminoid molecules  of the body as to arrest
development and insure molecular and then bodily death.
   There  is one possible  method of  action which undoubtedly
operates to some extent in the ship's hold.  The active agent is a
deoxidizing compound; and when we consider how carbonic oxide
kills without reproducing itself  in the living body, by exclud-
ing the possible oxygenation of the blood, we may have a clew
to the operation of this agent.
   Dr. Edward C. Seaton,  in  a  preliminary note to the Local
Government Board on Dr. Klein's " Report on Infectious Pneu-
mo-Enteritis of  the Pig," said so late as the summer of 1878, that 
STATEMENT OF THE GERM THEORY.           145
 " a general result of the studies, which have of late years been
 made by various pathologists, as to the intimate nature  of the
 different zymotic contagia, has  been to render  it extremely
 probable that each  distinct zymotic disease is, in its essence, an
 invasion of the animal body by a distinct, extremely minute,
 living,  and self-multiplying  thing, biologically specific  in the
 changes of growth which it undergoes, and chemically specific
 in the fermentations which it can effect; that  the infinite mul-
 tiplication and swarming of this specific organism, in the blood
 and tissues  of the infected body, underlies and causes in each
 case the more obvious characters—the anatomical and chemical
 changes, and the so-called symptoms of the disease; and that
 the infinitely minute germs of the specific organism, barely per-
 ceptible with the highest powers of the microscope, constitute,
 as they pass  from animal to  animal,  the essential means  by
 which the specific disease is communicated and spread."
    In yellow fever we  have undoubtedly the origin of the dis-
 ease in  putrefaction—hence in a septic ferment, which in all
 probability only develops in ocean waters under tropical  condi-
 tions in the Atlantic.  In no  other  sea has  the disease been
 known to infect ships, ports, and harbors.  But this in no way
 indicates a necessary dependence  on a living ferment.
    Professor  Panum,  of Copenhagen, Drs.  Bergmann  and
 Schmiedeberg,  and Dr. Burdon-Sanderson  have proved  that a
 specific  chemical body, separable by filtration from  any fluid
 containing  it through porous porcelain, not albuminoid in its
 reactions, and having a remarkable power of generating  bacte-
 ria in a " cultivation  fluid,"  is the active  septic poison which
 induces  the symptoms  of a  putrid infection.  Dr. Sanderson,
 writing in 1876, states that the facts promulgated by Professor
 Panum  ("Yirchow's  Archives") are quite irreconcilable with
 the often too carelessly received assumption, " that the process
 of septic infection is dependent on the development of a living
 contagium."  The only group of bodies to which this  fever-
poison may be compared is that of the so-called " unformed fer-
ments."
   This suggests the possibility  of a very decided and  funda-
mental  distinction between the organic and parasitic causes of
the pure contagia  and  the inorganic  " sepsin"  or " septine,"
            10 
146         YELLOW FEVER A NAUTICAL DISEASE.

which may play a conspicuous part in the development of such
diseases as typhus and yellow fever.
   We must not allow these investigations into ultimate causes
to bewilder or disturb us.  We can stamp out the disease with-
out the microscope or profound chemical research, though an
intimate acquaintance with  the  pyrogenic  agency might sim-
plify our work.   Whether the body be organic  or inorganic,
bacteria may have, and most probably do have, a very important
purpose to  serve as carriers of  the agent—starters of decompo-
sition ; and heat  is essential to  their motion, to the activity of
their production,  and to the ready transmission of the  disease.
Chilled and motionless, they are inert;  and once the yellow-
fever poison sinks to the soil, or is subjected to a temperature
below 32°,  it is gone at  once and for always.  This is the one
great and positive fact which the history of yellow fever has in-
variably revealed.
   The known action both of heat and cold on the yellow-fever
poison would indicate that bacteria can not be the ultimate essen-
tial elements in the production of  yellow fever; for while per-
manent spores resist temperatures up to 212° Fahr. (Schwann),
230° Fahr.  (Pasteur), and even 266° according to Schrader, bac-
teria were  reduced down  to 0° Fahr. by Cohn  without killing
them,  though their movements and reproductive powers  or
activity as ferments ceased till again  heated.  By the aid of
liquefied carbonic acid,  Frisch has lowered  the temperature of
bacteria down to —124-6° Fahr., but on warming them again
he has developed  coccus and further bacteria. Schumacher has,
however, said that sudden and extreme lowering of temperature
changes the organisms.   The degree of heat for greatest activ-
ity of development is  95°  Fahr. according to Onimus.  The
bacteria were supposed to be reproduced both by spores  and
subdivision.   The spores or permanent germs capable of  resist-
ing the high temperatures above stated have been regarded as
constituting the principal sources for the dissemination of these
inferior organisms.*  To bacteria we owe the prompt reduction
of dead organic to inorganic matter.
    So far had I written when  I had an opportunity of reading
Dr.  J. J. Woodward's " Address on Dysentery and Bacteria,"
        * "Lea Bactenes," These par le Dr. Ant. Magnin, Paris, 1878. 
             YELLOW-FEVER POISON  NOT BACTERIA.         147

 published in 1878, and a profoundly instructive paper by Dr. Tim-
 othy Richard Lewis, on " The Microscophytes which  have been
 found in the Blood, and their Relation to Disease."  Dr. Wood-
 ward has failed to find " the relation of bacteria, and especially
 of spherical bacteria, to dysentery." He asks, " Is it at all  rea-
 sonable to believe that these vegetable rods or granules, always
 present  in such countless numbers in the healthy stools, are  the
 occult cause of the diphtheritic process in the intestine ?  Cer-
 tainly, I must believe  that if the case  of dysentery were  the
 only case of the  kind, all men knowing  the facts would answer
 in the negative."
    There is no evidence with  regard to yellow fever that bac-
 teria of  any kind  produce it.  The effect  of  temperature on
 spores and bacteria indicates that they can not, as it has been
 supposed, be operating as different conditions of the same organ-
 ism in the production of yellow fever, which is arrested both by
 steam-heat and ice-cold.
    The abundant development of bacteria demands oxygen,  but
 this is reduced to a minimum, or is absent, where the most viru-
 lent form of yellow-fever development may be advancing in  the
 holds of  ships.  Wherever nature is favoring that cycle of opera-
 tions, between the organic and inorganic world, so essential to
 human life, whether in  the West Indian  marsh-lands or African
 jungle, prompt and abundant oxidation, and the undoubtedly
 unfettered development of untold myriads of bacteria, are of
 necessity concurrent phenomena.   There no yellow-fever poison
 forms nor has its origin.  This is my conviction, after a most
 careful search for evidence; and if the conclusion may be deemed
 by some  somewhat far-reached, it is impossible to deny that
 yellow fever and  bacteria  are best developed, in the first case,
 where dangerous  deoxidation has rendered air irrespirable, and
 in the second, where the fresh  breeze of sea or abundant air con-
 tributes to an active vitality.
   Dr. Lewis  in his admirable and logical exposition shows,
 according to Nageli,'that the forms of plant-hfe, which have been
 mostly recognized as having been more or less closely  associated
with changes in living animal substances, are the lower kinds of
fungi.
   Nageli separates these into three groups: 
148          YELLOW FEVER  A NAUTICAL  DISEASE.

   1. Molds—characterized by branched,  segmented, or unseg-
mented filaments.
   2. Sprouting fungi—yeast-cells of various kinds, consisting
of more or less oval corpuscles, which multiply by means of
sprouts from their surfaces.
   3. Cleft fungi or schizomycetes—minute  spherical or oval
bodies, which are multiplied by fission only,  and which some-
times remain isolated, at  others form unbranched  rows (rods,
threads, etc.), but only occasionally present  a  cubiform aspect.
To this group the bacterium, vibrio, vibrio-bacillus,  spirillum,
etc., belong.
                   Germs Unrecognizable.
   Yirchow,* a strong advocate of the germ theory of disease,
in attempting to explain away the apparent identity of vegeta-
ble forms in healthy and dysenteric stools, says:  " Although we
may be unable to see these  inner  differences in such minute
bodies as vibrios and bacteria, yet we ought to remember that
in case of  the formative  cells of  the ovule, and of numerous
pathological growths, although they  appear as  gigantic forms
alongside of vibrios, we are  unable to predict what will  grow
out of them.  Yea, eggs themselves are often so similar to each
other, that the differences of the animals which will proceed
from them  can not be suspected in the least degree."
   Nageli  has pointed out the serious and almost unavoidable
fallacies  attending conclusions from  cultivation experiments.
The  assertions, such as Schumacher's, as to the transmutations
of organisms, are unsupported by adequate evidence.  A fun-
gus, according to De Bary, undergoes but  a very limited and
well-defined  range of changes.   The mold and sprout fungi
are closely  related, but with one exception—they have not yet
been  seen  to pass from  one  form  into the other (Nageli).
Fission fungi do not germinate, so that the spores which resist
high heat  and the bacteria which  live at the lowest possible
temperatures are independent organisms.
   Bacteria, vibriones, and bacilli are commonly detected in the
muco-salivary fluid from the mouths of  healthy persons.  Dr.
Beale, writing in 1870, said :  " The higher life is, I think, every-

   * See Dr. Woodward's Address before the University of Pennsylvania in 1878. 
THE GERM THEORY "NOT PROVEN."          149
where interpenetrated, as  it were, by the lowest life."  He
considered there was no evidence that " bacteria are really the
active agents, in cases  in which the  blood has been shown to
exhibit the properties of a specific contagious virus "; and he as-
serted that " it is difficult to imagine anything further removed
from the fact than the statement that the dust of our air con-
sists of disease germs."
    Dr. Beale's judgment may not have been infallible, but he
has  rendered excellent service, and  uttered  some wholesome
cautions,  in  opposition to the boldest speculators on the ques-
tion.
  Lower Organisms not specifically injurious,  nor structurally
                   characteristic of Fevers.
    Pasteur—the greatest mind grappling with the difficulties
of living ferment investigations—has stated that the blood  in
health is absolutely free from the microphytes; and Drs. Doug-
las  Cunningham, and  Lewis  were able  to satisfy themselves
some years ago that bacteria, vibriones,  bacilli, and  so forth,
very speedily disappear from  the liquor  sanguinis, even when
introduced into it during life in considerable  numbers.  Their
presence in appreciable numbers  is, judging  from experience,
incompatible with a state of perfect health.  The same remark
does not  hold good as regards parasites  of, apparently, animal
nature.  In certain diseased conditions microphytes are  very
generally present—not invariably, nor proportionate to the grav-
ity of the malady.
    Dr. Lewis refers to the fact that any organic substance, added
to suitable urine, would be followed by a crop of bacillus.  He
once tested this and found it to be the case.  " It need hardly
be added that organisms thus obtained would produce no effect
on animals if freed from the decomposed urine."
    Dr. Lewis states most  forcibly the grounds for  forbidding
the adoption of the doctrine of a germ theory of disease,  indi-
cating (1) that these organisms,  as  ordinarily met with, are not
specifically injurious when introduced into the  animal econo-
my ; or (2)  that the forms found in  disease  are not proved to
be morphologically different from those known  to be innocuous.*
       * " Quarterly Journal of the Microscopical Society," July, 1879. 
150         YELLOW  FEVER A  NAUTICAL DISEASE.
   The attractive theory of germs or spores, inducing yellow
fever, is leading physicians and journalists to develop some de-
cidedly false theories and views of the disease; so that it is high
time to point out that, without attempting to solve the ques-
tions  arising from  discussions of  the " vital"  and " physico-
chemical " theories of fermentation, we know that yellow fever
originates in putrefaction—is nourished by decay and dirt; and
that this peculiar decay or putrefaction is arrested and killed by
almost any temperature  below 32° Fahr., and probably below
still higher degrees of heat.   Dry, cold air is its great enemy,
and that is what the engineer can provide in every ship  that
floats, and every home invaded by  the pestilence. 
CHAPTER  Y.
              THE PREVENTION OF YELLOW FEVER.

    In the summer of  1878  I was in  St. Louis, and, with the
 outbreak of yellow fever in the Mississippi Yalley, it was per-
 fectly clear that general medical knowledge and the most heroic
 zeal stood but poorly in stead of a definite  and comprehensive
 understanding of the origin and nature of the disease.   I heard
 enough of the evils and brutalities of inland quarantines, though
 these were mild and innocent compared with the tortures en-
 dured in  the lazarettos which Chervin abolished.   I can not
 resist quoting a paragraph from a St. Louis newspaper, which I
 cut out last summer, but without name and date :

                     Making Quarantines Pay.
    An excuse  was  sought for, about a week  ago, by the authorities of a
 number of cities and towns not far distant, to quarantine against  St.  Louis
 on account of yellow fever—although it was known by all intelligent people
 in those cities and towns, as well as in St. Louis, that no genuine case of
 yellow fever ever existed in this city, and the plague did not exist here at
 all,  as an epidemic or otherwise.  In view of which,  the question very
 naturally arises, whether the authorities of the cities and towns in question
 had not, aside from protecting themselves, an eye  out for the "main
 chance." The " New Orleans Times " has an illustration in point:
   " Take the case of Washington, in St. Landry parish, for example—only
 for  example ; there  are a dozen or two more  of  the same sort.  Washing-
 ton  quarantines against New Orleans,  prohibiting passengers, freight, and
 everything.   The local newspaper, with  a sweet and childlike trust, too
 heavenly for this cold world, expresses the hope that ' our merchants will
 be fair and considerate to the people ' while the embargo lasts; but it turns
 out  that the presiding official is a leading grocer, and that others of the
authorities are dealers in articles which a quarantine will enhance, and the
next thing we hear from Washington is  that coffee has gone up to forty 
152           YELLOW  FEVER A  NAUTICAL DISEASE.
cents a pound.  Of course these towns have a deeper interest in a tight and
binding quarantine than New Orleans can  possibly have.  It enables the
prominent merchants to work off  their old stocks at famine prices, and to
make  a general clearing up on terms of bewildering advantage to them-
selves.  We do not expect them to listen to our arguments in the matter
of merchandise.  It pays to be  mortally frightened under such circum-
stances, and we know human nature too well to waste time in expostulation."

    I  then felt what I now  know, that to permit  such a  disease
to penetrate so far up that  splendid river was a crime  originat-
ing, as all crimes must, in ignorance and cupidity.
    I  reached Washington in September,  and frequent inter-
views after that with Surgeon-General  Woodworth convinced
me that the non-intercourse system, in a  trading community, was
permanently impossible, but that much might be done  to limit
quarantine  if ships could be disinfected.  The only agent known
to be the real destroyer of  yellow-fever poison was cold, and my
practical familiarity with the subject of artificial refrigeration
led me to pen the following statement, at Dr. Woodworth's re-
quest, on the 23d of last  December, which he  read before a
meeting of the Board of Experts held in New Orleans :

                Riggs House, Washington, D. 0., December 23, 1878.
              Destruction of Yellow-Fever  Germs by Cold.
   The disinfection of delicate and perishable merchandise, the demand for
some efficacious means of purifying a ship some distance from land, and the
difficulties incidental to the purification of  the bilge, have suggested the
construction  of a steamboat or barge for these and similar objects.
   The  approach of -a. suspicious craft, hailing from infected ports, might
suggest  precautionary  measures, notwithstanding  the health  of crews,
proof  against yellow fever and the pernicious influences of malaria.  The
brief delay and expense  of lowering the temperature of everything on board,
during the dangerous season, would be regarded as  of little moment com-
pared  to what might be deemed unfair exclusion from markets. Ships laden
with fruit, however delicate, would not suffer if the whole were brought down
to 32° F., and at this temperature the contagion of yellow fever is killed.
   It is therefore proposed to design and construct a boat, requiring a mini-
mum space and fuel for its engines, capable of steaming out into the Gulf of
Mexico or up the Mississippi.  This ship will be provided with every con-
venience for  a medical or sanitary inspector, and the necessary help to carry
out the process of purification by cold.  An ice-machine,  capable of lower-
ing the temperature of  an entire ship  down to 10° or 20° below freezing-
point, if necessary, will be  erected in the disinfeoting  steamer, and its
practical application will be as follows: 
THE PREVENTION OF YELLOW FEVER.          153
   1. The blowing of cold air at any desired temperature into every part
of the ship.   Cold air gravitates and permeates almost like water, and, by
suitable flexible appliances, streams of intensely cold air will be directed to
the lower and most inaccessible parts.  This air, heated, will ascend, and,
being aspirated by suitable fans or  blowers, will be purified and passed
round and round, till the desired purity and temperature are obtained.
   It is obvious that microscopical and chemical tests can be applied to this
air in circuit, at first for the purposes of scientific observation, but after-
ward, probably with the best effect, as a means of determining  the influence
of the refrigeration.
   I desire  to direct special attention to Dr. Angus Smith's paper on Am-
monia in the " Chemical News " of July  26, 1878, and to the ready method
there described for applying the Nessler test to the atmosphere, which may
be combined with the well-known glycerine slides  for microscopical ex-
amination with a view to the detection of organic matter.
   2. Pumps will be provided to clean out the bilge, and then wash this
out by antiseptio salts, of which perhaps none would be better than chloride
of magnesium, which may be obtained in any quantity from sea-water by
freezing out other salts and water, and is itself  uncongealable.  The use of
concentrated sea-water at say 15° F. for this purpose, would  preclude the
use of costly and unpleasant disinfectants, which by their odor and fumes
might damage cargo and injure the ship.
   3. In the case of fruit-bearing schooners and other ships, the purifying
cold process would admirably prepare the cargo for storage on land.  In a
cold fruit store any quantity of imported produce might be kept harmless
and wholesome.

    Attempts have been made with ice to cool a ship  in the port'
of New York;  but when the work to be done for effectual re-
frigeration of the hold  of  a large vessel is  considered, it  is  ob-
viously futile to attempt any such  means.*  Any ice-apparatus,
calculated  to lower the temperature of a ship, would  have to be
used with  salt, and by no known means could the quantity of
ice and salt required to overcome the heat of a ship absorb that
heat rapidly enough to obtain a satisfactory and economical result.
    No  substantial truth in  relation  to disease-prevention has
ever been more faithfully or justly accepted  than that the ex-
posure of naval vessels to the intense  cold of northern winters
purified them.   Apparent exceptions to this have been  always
recognized, but such exceptions rather tend to prove the rule;
   * Dr. A. N. Bell informs me that in the U. S. S. Susquehanna, on which it is sup-
posed a fair experiment in refrigeration for the destruction of yellow-fever poison
was conducted, only nine tons of ice were used, at a cost to the Government of
twenty thousand dollars! 
154:         YELLOW FEVER A  NAUTICAL DISEASE.

and a confirmed yellow-fever ship has been recognized as one
entirely devoid of means for adequate ventilation and permanent
sanitation on a long cruise in the tropics.  The history and de-
scription of those ships which have  resisted  any disinfectants,
and in which disease reappears notwithstanding the application
of processes adequate for other ships, must be investigated  and
written in future for the guidance of the sanitarian.  Such
ships will be  found peculiarly favorable to stagnation of air,
old and decayed,  and liable in the tropical belt to the develop-
ment of yellow fever under ordinary systems of ventilation.
   Dr. Faget  quotes Dr. Carpenter,  who, in his sketches from
the history of yellow fever in New Orleans, expresses the re-
markable  opinion, which at the time attracted but little atten-
tion  (presque inapergue), that " as far as we know,  low tempera-
ture  is the only agency that can be relied on safely to destroy the
infection of this disease''
   " Let us hope," says Dr. Faget, " that the future will benefit
by this remark."  " For my part," he  says, " I am persuaded
that  in New Orleans, when ice has formed  in winter, a new
importation by the shipping [the italics are his] is indispensable
for a new epidemic; and  that, on the contrary, the absence of
cold  in the winter following an epidemic may permit, the fol-
lowing year, a new eruption of yellow fever without fresh im-
portation.  For instance:  In  1854 we had a small epidemic,
which was very severe elsewhere.  Not knowing whether there
was  any frost  in the winter of 1853-'54, the yellow fever of the
latter year might occur without  importation as a heritage of
1853.  I am simply citing a supposititious case, for it might by
no means be  impossible to obtain proof of an importation in
1854 as well as 1853."
   It  is thus that matters ojccur in Yera Cruz,  Havana, the
Antilles, where indigenous ice is unknown, and where the tem-
perature of the air is  never lowered to the freezing-point; in
such localities an indefinite series of  epidemics is possible after
a single importation.

     Artificial Refrigeration proposed by Dr. J. C. Faget.
   Tersely, suggestively, and with no doubtful expression, Dr.
Faget penned  the following in 1864, soon after the importation 
   ARTIFICIAL REFRIGERATION PROPOSED BY  DR. J. C. FAGET. 155

into New Orleans of the Carre ammonia machines,  which have
continued in operation ever since:
    " It is positive, and tradition has always  recognized the fact,
that the cessation of our epidemics of yellow fever is with the
first white frost.
    " This fact, that  frost puts an end suddenly {tout d coup) to
our epidemics, naturally leads us to think that the germ of these
epidemics is therefore destroyed by the lowering of temperature,
provided it reaches to 0° C.  Now, art never can do better than
to imitate nature.
    " The lowering  of  the temperature in  the  holds of  ships
which have to be purified should be tried.  Might not frigorific
mixtures be obtained at low cost ?  To-day, that  they have suc-
ceeded in  manufacturing ice on a large scale and at little cost,
even in New Orleans, in midsummer, can't  we foresee there a
means to destroy the germ of yellow fever in the holds of ships
which import this terrible plague ?   I give this idea for what it
is worth ; it seems to me worthy of attention."

    Cold as an Antidote endorsed by the Board of Experts.
    This excellent instruction to sanitary reformers fell flat; but
the Board of Experts recently uttered no doubtful  echo to Dr.
Faget's views and sentiments when they said: " Yellow fever,
in its epidemic form, is a disease of warm climates, and of warm
seasons of the year.  The yellow-fever poison is  not able to
withstand the influence of frost, and, when exposed to a freez-
ing temperature,  it is rendered innocuous, and is probably de-
stroyed."
    Having had an opportunity of explaining my system of re-
frigeration and disinfection  to  the Board  of Experts, special
reference is made to this at page 27 of the published conclu-
sions.  They say: " Research and experiment in reference to
disinfection should be liberally encouraged.   This is  particularly
true in respect to those  experiments which aim at the practical
destruction of yellow-fever and  cholera poison, by artificially
produced extremes of temperature, either of cold or heat.  If
the apparatus and experiments now projected for the utilization
of extreme cold to this purpose should be found  to  be of  prac-
tical application to the disinfection of the holds and other parts 
156          YELLOW FEVER A NAUTICAL DISEASE.
of vessels, their success would prove to be a sanitary acquisition
of inestimable value.  Should this method of disinfection prove
impracticable in its application to holds of  vessels, it may still
prove more efficient in destroying the infection of clothing, bag-
gage, and many kinds of goods, than any other artificial means
which can be employed."
    It is not my intention at present to give  a description of the
elaborate designs which  have been developed since my first con-
ference with Dr. Wood worth, but the opinion of the  Board of
Experts encouraged me to spare no pains and no expense to ob-
tain the most perfect possible result;  and the National Board of
Health has, since Dr. Woodworth's death, endorsed my measures
and honored me with confidence.
    Here I desire to pay a just tribute of recognition to Senator
Isham G. Harris, Chairman of the Senate  Committee on Epi-
demic Diseases.  Startled at first by the  announcement of the
bare  possibility that we  could refrigerate infected ships in the
Gulf of Mexico, he spared no pains and  lost no opportunity to
satisfy himself of the real merits of the project, and of my fitness
to conduct the experiments.  He searched till he felt sufficiently
convinced to  endorse my plan.  From first to last he was stead-
fast, and so loyal to the cause that, if the experiments, demand-
ing  as  they  did a  not unimportant  appropriation, are  carried
out, and result, as  they are sure to, in success, it should never
be  forgotten  that to Senator Harris  is due the passage of the
following  short act, the first  measure approved by the Presi-
dent during the extra session of 1879 :
    Be it enacted,  etc.,  That the Secretary of the Treasury be, and hereby
is, authorized to contract for the purchase or construction of such steam-ves-
eel and refrigerating machinery, or  to arrange with the Navy Department
for the use of such vessel, as may be recommended by the National  Board
of Health, to disinfect vessels and cargoes from ports suspected of infection
with yellow fever or other contagious diseases, the construction of the same,
if such construction shall be recommended by said Board of Health, to be
under the inspection of an officer of the Bureau of Steam Engineering of the
Navy, who may, at the request of the Secretary of the Treasury, be detailed
by the Secretary of the Navy for that purpose; and for the purpose of such
purchase or construction the sum of $200,000, or so much thereof as may be
necessary, to be immediately available, is hereby appropriated  out of any
moneys in the Treasury not otherwise appropriated.
   Approved April 18, 1879. 
COLD ENDORSED BY THE BOARD OF EXPERTS.      157
    When the measure for the construction of  my refrigerating
ship was  before  the  Senate, Governor Harris was fortified by
the following expression of opinion:

                                     Washington, D. C, March 27,1879.
    Sib :  In reply to your  letter  of  the  26th instant, requesting that we
should give you our opinion as to the merits of Professor John Gamgee's
proposed refrigerating  steam-vessel as a means of disinfecting vessels and
cargoes,  we have the honor to report  as follows:
    1st. We have examined the models and the drawings relating to this
apparatus; have listened to the  explanations given  by Professor Gamgee
and the engineers who  have been engaged with him upon this subject.
    2d. We are of opinion that the apparatus, if properly constructed and
managed, will produce a temperature below the freezing  point of water,
probably as low as zero Fahrenheit.
    3d. In an  empty ship it is probable that this low temperature can be
produced throughout by the refrigerating vessel, if sufficient time be allowed
for the working of the  apparatus.
    4th. In a ship with a cargo in it, it will be more difficult to produce this
uniform low temperature; and it is probable that in  almost all cases it will
be  necessary to discharge the  cargo  before a ship can be properly disin-
fected by this  or any other process.
    5th. Whether the production of a  temperature, even as low  as zero, in a
ship, for a comparatively short period of time, id est, for a few hours, will
destroy or render permanently harmless the yellow-fever poison, we do
not know, there being no satisfactory evidence in existence upon this point.
But from what is known as to the effects of temperature upon this disease,
we are of the opinion that the experiment is worth trying.
    6th. It will be  seen that we consider the project  as an experiment; it
is in fact impossible to  view it otherwise.
    But even in the case of failure the  results can hardly fail to be of consid-
erable scientific value, while in case of success the cost would be a compa-
rative trifle.
                We are respectfully, etc.,
                                        THOMAS J. TURNER,
            Medical Inspector United States Navy, member of National Board of Health.
                                        J. B. HAMILTON,
                Surgeon United States Marine Hospital Service, Treaswy Department.
                                        J. B. BILLINGS,
                                               Surgeon Unittd States Army.
    Hon. Isham G.  Haebis,
         Senator and Chairman of the Committee on Epidemic Diseases.

    The discussion in  the House indicated the faith reposed by
Southern  members in the effects of frost as a preventive.  Gen-
eral King, of Louisiana, said: 
158          YELLOW FEVER A NAUTICAL DISEASE.
   Gentlemen who have witnessed the ravages of yellow fever can only
appreciate the necessity which is felt in that portion of the  country of
keeping out an enemy so subtle and so destructive.  We know that during
the hot weather that disease spreads and carries devastation with it on all
hands.  We  know that on the first day of frost a shout of relief goes up,
quarantine is broken, and commerce once more begins to flow in its usual
channel; and we know also that,  with the announcement in  springtime of
the approach of the yellow fever, terror is at once depicted in the counte-
nances of the inhabitants of that part of the country.   On the application
of the Board of  Health of the city of New Orleans, I therefore urge this
House to take into earnest consideration measures to prevent the introduc-
tion of this enemy into our  midst  again.  They approve of  this freezing
process.  It may be suggested that this is experimental; but it is in the right
direction.  The question is, how far will this Government exert its power
for the protection of its citizens against this terrible disease ?  Millions are
spent in the destruction of men.  Is it not time that, by the authority of a
civilized people, thus represented, thousands at least should be spent for the
protection and preservation of human life and happiness ?

    The  Hon. John Goode, of  Yirginia, followed  with much
earnestness, and remarked, inter alia :

   Now it has been said here that this proposition is endorsed by the Na-
tional Board of Health—a board selected by the President, a board com-
posed of the most eminent sanitarians in this country; and not only endorsed
by the Board of Health, but it has the approval of the most eminent scien-
tific men in the land.   The whole bill proceeds upon the basis  that the
yellow fever is an exotic brought  to this country from tropical climates in
the holds of vessels,  and the germs from which it is  propagated  may be
effectually frozen out and destroyed by the refrigerating process.  In other
words, it is now a  generally conceded fact that the yellow fever can not live
in a freezing temperature;  and, as my friend from Louisiana [Mr. King] has
just remarked, so well is this fact known in the South that the good-people
in the churches always pray for  frost, and when frost appears there is a
shout of joy throughout the fever-stricken localities.

    General C. E. Hooker, of Mississippi, said :

   We propose to try this experiment with nature's great teachings as our
example.  We are, in other words,  endeavoring to do for every vessel that
comes into our ports from an infected region that which nature does where
her laws do not interfere with any of the comforts, conveniences, and ne-
cessities of man; and I say that experience has demonstrated that wherever
a certain amount of  cold is  reached, there we believe the disease, though
decimating by thousands, will be disposed of, and general  health prevail in
the cities. 
         HOW IS IT PROPOSED TO DEAL WITH  SHIPPING?     159

    The Hon. J. G. Updegraff, of Ohio, added:

   In some sense any plan of quarantine, and  especially any plan to keep
out of the country a terrible  epidemic, is an experiment.  But these basis-
facts are established: first, that yellow fever is not a native of this coun-
try, but is an exotic brought to us from tropic climates under certain con-
ditions, one of which is heat; second, it is well established that cold is the
destroyer, the antidote, of yellow fever.  This has been well  settled since
this disease prevailed first in America.  Nearly one hundred years ago Dr.
Rush connected its prevalence  with hot  weather and its disappearance
with cold.
   This proposition is to use a refrigerating ship to  freeze out and purify
vessels coming into our ports, as recommended by the National Board of
Health.

    Dr. George B. Loring, of Massachusetts,  in an eloquent ap-
peal, stated:

   I wish to bear my testimony to the value of all such endeavors and ex-
periments to suppress contagious and infectious disease in this land. There
are certain facts, Mr. Speaker, known with regard to the control of yellow
fever, about which there can be no doubt, and one is that frost and cold
will  kill it.   The experiment tried  on  board the Plymouth  furnishes no
exception to the rule, and the accidents which befell  it then cast no reflec-
tions upon it.   I consider it, therefore, fixed and established  that diseases
of this sort can be controlled by proper application of cold.   So much for
acknowledged facts.
   Now, sir, in this age of experiment, moreover, is  it not the duty of the
Government to institute all proper experiments for the control and suppres-
sion of ravages of this description ?   Why, it is manifestly so. The whole
history of science shows us that it is the duty of the Government to en-
courage scientific investigations for the suppression of destructive contagious
and  infectious diseases.   In all its operations  science has gone on, in our
day, proving that man has in his hand the power to control those diseases
in the animal and vegetable kingdom which are injurious to the community
and destructive to life.

          How is  it proposed to deal with Shipping f

    My observations on  this point shall be  preceded by some
very practical remarks by Dr. Yanderpoel on quarantine.   He
says  that " all  we know  of the yellow-fever germ  teaches us
that it propagates with the  greatest  rapidity whenever the ele-
ments of heat, moisture, fermentation, and no circulation of air
are  present.   These elements  are eminently combined  in  ves-
sels  coming from the tropics.  Their cargo is sugar or melado ; 
160         YELLOW FEVER  A NAUTICAL  DISEASE. .

they are put on board under a tropical sun ; both are dirty car-
goes,  and more or less  leakage  goes on into  the  bilge; the
hatches, too, are tightly battened.  If the germs are  on the ves-
sel, can there be conditions more favorable than these for their
active increase %   Experience. daily teaches us that on such ves-
sels, should the voyage be prolonged, cases  of sickness  follow
each other in rapid succession, until the vessel becomes  a  very
pest-house ;  whereas, if the voyage is completed in eight or ten
days, we find the sickness breaking out but a day or  two before
entering port, where prompt measures put a stop to its further
progress.  The longer such  a vessel  is allowed to remain un-
touched, i. e., the longer a  quarantine is exacted, the greater
will be  the virulence of the disease, and the greater  the  danger
of spreading the infection.  The epidemic which appeared  at
Bay Ridge, Long Island, some years since, was undoubtedly due
to this cause.  Yessels were strung along the Long Island shore
to ride out a specific quarantine, until the whole fleet was thor-
oughly  infected, and  the disease passed readily to the main-
land.   It  is this practice of  detention which  in  the past has
contravened the interests of shipping and commercial men, and
has kept up a chronic warfare between merchants and quaran-
tine."*
   No words could better unfold the  dangers of commercial ob-
structions in the  nature  of protracted quarantine, nor suggest
more cogently the radical methods to be adopted  for  instant
and absolute purification.
   Dr.  Faget,  writing in 1859, said: " Quarantine  measures
must  aim at destroying the  morbid principle—the germs  of
the disease.  Now this is not a question of time; it is  a ques-
tion of  instant action by all the means of purification, and this
after  the  complete unloading of the ship."  These means  of
purification  he defines, in September, 1859, as  currents of air
and water, submersion, refrigeration, chlorine fumes.  " Mer-
chandise," he says, "can be very easily disinfected.  Passen-
gers can be treated very rapidly, provided their goods are  thor-
oughly purified."

   * " Quarantine," by S. Oakley Vanderpoel, M. D., LL. D., New York, p. 20. 
LITTLE DANGER FROM  CARGO.
161
                 Little Danger from  Cargo.
    Dr. Yanderpoel  states  that " the experience of many years
 at this port—and in this I am confirmed by the observations of
 the St. Nazaire epidemic in 1862, and others in Spain and Por-
 tugal—has led to the conclusion that little  danger of transmis-
 sion arises from the cargo proper.  The clothing and effects of
 the individual, and the dark recesses of the hold, are the favorite
 lurking-places of the poison."
    The doctor briefly describes his practice  as follows (p. 21) :
    " In the case of  the city of New York,  the  vessel is sent to
 the  upper bay for the purpose of discharging the cargo, the
 spot being nearly two miles distant from the  nearest shore, where
 the  bay is five  or six miles wide.  The crew of the vessel is
 usually discharged before the cargo  is broken.   Stevedores,
 coopers, and all who work in the hold at this discharge, reside
 in hulks anchored near by, and are not allowed to return to the
 city until a period of five days has elapsed since they worked on
 a suspected vessel.  The  cargo is swung upon open lighters,
 and then  carried to  storehouses about three miles  distant.   No
 special precaution is exacted of the lightermen, except that they
 are not allowed to go on the vessel which is  unladen ; nor is the
 cargo subjected to any restrictions concerning the  warehousing.
 During the discharge  of the cargo, fumigations with chlorine
 should be made  once or twice daily.
    " The vessel once emptied of her cargo, the process of puri-
 fication begins.   With steamers this  is comparatively speedy
 and  easy of accomplishment.   A fire-hose  is  attached to  the
 force-pump, carried to«the hold, and a full head of water thrown
 into every part  of it.  At the same time men are set to work
 with scrub-brooms,  who  work  until  every portion has been
 scrubbed and is as clean as a housewife's kitchen.  A discharge-
 pump is kept working at the same time, and  the water is poured
 in, not only until thorough  scrubbing is completed,  but until the
 discharge-water is as clean as that which enters.  Hatches are left
 off, ports are opened, and  the fullest airing is given until  the
vessel is dry; then everything is closed, and fumigation is start-
ed in every part of the vessel.
   " Pratique is then given, and the vessel returns to commerce.
           11 
162         YELLOW FEVER' A NAUTICAL DISEASE.
   " With sailing vessels the process of purification is slower, on
account of the absence of the steam-pump.  It is often found
advisable  to have a tug-boat lie  alongside, so that use may be
made of its force-pump and  hose in  the same manner as on a
steamer.   The subsequent measures to be carried out are the
same in both kinds of vessels.   In other cases dependence must
be placed  upon the ordinary hand deck-pump; the purification
and cleansing, though occupying a longer time, can be made
equally effective.   I place far more reliance upon the liberal use
of water, the scrubbing until the vessel is absolutely clean, the
pouring out of clean water from the bilge, than  upon any pro-
cess  of mere disinfection and fumigation.  These measures,
which are simple  and easy of application, are, I believe, when
thoroughly carried out, perfectly  efficient."
   Dr. Yanderpoel is only half right in a sentence  which was
adduced in Congress  in opposition to the construction of my
refrigerating ship.  He says  (p. 22): " While  all such work
must  be thorough, we should not lose sight of the economical
feature in the  process.  A method of  purification, which may
be unobjectionable in principle, may also • be  expensive, and so
complicated in application as to cause a tax which no commerce
could sustain, and which would practically work  its  entire ob-
struction.   So, while  I recognize the  efficiency of steam, great
heat, or intense cold, as agents which all attain with certainty
the desired result, I recognize also that their practical applica-
tion is enormously expensive, requiring  complicated  machinery
and a corps of skilled men, and .does not insure results that are
better or more certain than those attained by the more simple
processes."
   Note Dr. Yanderpoel's declaration that with sailing vessels
" it is often found advisable  to have a tug-boat lie alongside."
But if a tug is wanted for washing, is it not most desirable to
clear  the  hold, at the very beginning, of the pestilential air,
which has so  often overcome the workmen engaged in purify-
ing a  ship ?  Moreover, in warmer climates the tendency to
infect the  tugs, by the foul air of the  infected vessel, is a much
more serious cause of alarm  than in the port of New York,
where the atmospheric conditions are naturally inimical to the
ready propagation of  the  disorder. 
THOROUGH DISINFECTION ESSENTIAL.           163
    The cost of thoroughly disinfecting ships in New York will
be far less, moreover, than the  present cost of inspection and
necessary detention.  On the score of  economy everywhere, if
we must save the  pence to take care of the pounds, a skilled
and competent staff of disinfectors on board a proper disinfect-
ing  ship, or floating laboratory, must be recognized as prefer-
able to the half measures which have proved so illusory.

               Thorough Disinfection Essential.
    The epidemic of 1879, especially in New York, demonstrates
that it is  not safe to rely on  partial disinfection by chemical
agents, and  giving ready  pratique  from  infected  ships, if we
wish to avoid cases of  sickness, though isolated, and a (per-
haps senseless) panic.  The disease  pierces with great difficulty
through such barriers as Dr. Yanderpoel has at his command;
but he has felt compelled, by an unusual gathering of foul ship-
ping,  to  allay public  fears  by more  stringent  measures, and
measures which  should hereafter be  rendered needless  by a
wholesome supervision of vessels in foreign  ports, and effectual
disinfection off land.
    As I am writing, August 7, the " New York Herald " reaches
me, and contains  the annexed paragraph:

   The owners of steamers engaged in the Havana trade have concluded to
suspend the regular trips of their vessels, and unite in sending their freights
by one or another of the regular lines alternately, pending the present quar-
antine regulations, which forbid them to  discharge their vessels or take in
cargoes at the docks.  The steamship Niagara, now at Upper Quarantine, will
probably be the first vessel loaded, and leave for Havana upon the new plan.
   Dr. Vanderpoel has issued orders to the officer in charge of Lower Quar-
antine to permit no sailing  vessels from  infected ports to come up until
further instructions.  This order has been issued in consequence of the ac-
cumulation of a large fleet of vessels at the discharging grounds, between
Robbin's Reef Light and Bedloe's Island.  There are as many there now as
the stevedores can manage, and until the fleet is thinned out no more can
be admitted.  The steamships  are not included in this order. They will
be allowed to come  up, after undergoing the usual quarantine regulations,
as heretofore.
    Two other items from the same paper indicate how much a
rational  national  or international organization everywhere is
needed.   They read as follows : 
164          YELLOW FEVER A NAUTICAL DISEASE.
   Only five feet of water in the hold of the hospital ship Illinois, and
eleven souls on board.  This is the brief comment on the leaky hulk that
stands guard at our Lower Quarantine.  Truly, what a careful set of health
officials we have in New York!
   The Hospital Ship Sinking.—The Illinois, which is anchored in the
lower bay and was originally intended for the reception of invalids from
infected vessels, but is now used as a boarding station from which all ves-
sels from infected ports are visited, was yesterday in a sinking condition.
The vessel is a very old one;  contact with ice has stripped her of all her
sheathing, and her seams have opened as she has gradually become worm-
eaten.  For several days past she has been  leaking, and yesterday there was
five feet of water in her hold. On board  were Dr. McCartney and eleven
other persons, including women and  children.  Quarantine Commissioners
McQuade and Oakley visited the Illinois in  the afternoon, and, in answer to
a dispatch, a large schooner of the Coast Wrecking Company, in tow of a
tug, started for Lower Quarantine.  It is thought that when the Illinois is
once pumped out her own pumps will be equal to the task of keeping her
free.  She has not been in a dry dock for eight years.


            Why not Attack the Disease off Land?

    The first practical question, which started the idea of the re-
frigerating ship, came from  a  New Orleans steamship owner,
who wished to know how to  disinfect the bilge, and otherwise
purify a ship, without pulling her to  pieces  or destroying her fit-
tings, etc., by  steam at  high  temperature.  Information soon
reached me that a  yellow-fever ship often  approached port fly-
ing signals of  distress, and communication  with land was forth-
with established by a  pilot  and tug-boat—both unable to do
more than take the vessel to  quarantine, where  the pilot and
tug-boat  crew  would not care  to  remain, and  might therefore
carry in their  clothes or vessel the  infection to  the city from
the stricken ship.
    The non-intercourse system I have advocated consists in hav-
ing special ships, special officers, and special crews trained, as in
the case of fire-ships, for special service.  Can anything be more
judicious  or more  reasonable 1  I have  striven to  explain this
question to all inquirers, and I am  glad  that the course of my
studies has led me to a more thorough discussion of the whole
question from a general  scientific  and practical  standpoint, so
that the raison d'etre of my refrigerating-ship experiments may
be the better appreciated. 
                THE  CLASSIFICATION OF SHIPS.             165

    A most  ignorant  question has been urged  against the con-
 struction of my refrigerating ship, viz.: What can one ship do
 against all the ships on the Atlantic coast ?  If we succeed with
 this first experiment,  will the people  hesitate to protect them-
 selves on the ground  of cost ?  Will any seaport  be satisfied to
 remain without the  means of preventing yellow fever?   To
 succeed, you would  require a fleet  of refrigerating ships, I
 am told; and  I  admit that the safety of human life on the
 Atlantic seaboard of America demands, for some years at least,
 and perhaps permanently, a floating sanitary police attached to
 the principal  ports,  capable of enforcing sanitary  regulations
 and succoring  the  afflicted.  This  can only be subservient to
 and in aid of  the quarantine officers on land; but  even  in the
 port of New York, if a  ship comes  in from  Havana or Rio,
 what harm can come  of an hour's detention to connect a double
 hose, of adequate capacity, and blow through the ship fifty or a
 hundred thousand cubic feet of cool air per minute, and straight-
 way wash out the bilge with pure and cooled sea-water ?  Any
 sick may be taken at  once to quarantine,  and the healthy with
 their clothing and baggage subjected to such purification as may
 warrant their landing.  The cargo can then be landed, and the
 best place for it is in  good, economical, cold stores, where it can
 be  subjected to a definite blast of pure air at any desired tem-
 perature and  for any required time.  The  ship then can be
 cleaned, ventilated, and  literally  frozen  out,  according to its
 size, for an expense varying from fifty to one hundred dollars;
 and it is quite certain that such purification and refrigeration
 as I have proposed would leave nothing behind.

                 The Classification of Ships.
    The facts revealed in the foregoing pages prove, as the case
 of the Plymouth recently proved, that it may be very danger-
 ous to  reload  an old ship with its decayed  timbers, and send
 her sailing down toward the equator, with a  susceptible human
 freight, and especially should a storm overtake her, compelling
 the fastening of the ports and hatches.
   But, in the first place, international regulations should be
adopted similar to those relating to load-lines and seaworthiness.
No ship should be allowed to trade in the tropics without ade- 
166         YELLOW FEVER A NAUTICAL DISEASE.
quate ventilating appliances for all weathers.  There is no prac-
tical difficulty in this, and the great  benefits derived  from the
trifling expense incurred in  providing  and fitting such appli-
ances would handsomely repay all,  and especially those engaged
in carrying  perishable products.   Every steamer  could easily
provide for the air that is to  be drawn through its hold being
cooled and even dried.
   So essential is it that no unreasonable demand  be  made on
the mercantile marine, that  measures should be  matured and
improved by all the governments  interested, so as to command
willing and even eager acquiescence on the part of  ship-owners.
   All ships that are not worth ventilating should be condemned
and ordered off the  lines of trade.  This would be no  hardship.
It would soon result in a new and fine  class of vessels, classed
A1 under a sanitary code, and which would cause  little trouble
in the future.

              Special Ships for Special Cargo.
   People in the tropics are not disposed to change from  their
ordinary practices.   They run little risk  compared to the people
of healthy seaports, and no improvement is made  in the meth-
ods of transporting  such produce as is calculated to foul a ship.
But the time has arrived for native northern ingenuity to de-
sign ships for the West India  trade  which will prevent  the ready
leakage of fermentable matter  into the  bilge.   Iron  tanks and
wells may in some cases serve, and in every case the ventilation
of the bilge must and can be  secured.
   The paltry objections, constantly made against condemning
a lot of crazy, plague-engendering vessels, are not  worthy of
consideration when  the millions  annually lost by interrupted
and actually mortified commerce are  considered.   The seaports
first, the ships next.  No town can protect itself against yellow
fever but by excluding it!   Let this be  remembered  here-
after.   What can  be the meaning of the subjoined extract
from a report of the Board  of Sanitary Commissioners of Sa-
vannah, Georgia, on certain statements in reference to the sani-
tary condition of that city by Sanitary Inspector A. N. Bell,
M. D. ?—" The assumption  of Dr.  Bell  that  ' the  people do
not realize their danger, and  do not believe that they can  have 
SPECIAL SHIPS FOR SPECIAL CARGO.          167
yellow fever unless it is brought to them from somewhere else,
and in the seaport towns  they insist that the disease never
reaches them except by ship,' is  without foundation, and is a
misrepresentation of the views and opinions entertained by this
board, as well as the opinions of a large number  of practicing
physicians in this city."
    The Board of Sanitary Commissioners were quite justified
in believing (if  they so believed)  that yellow fever would not
enter seaport towns except by ship.  This is the rule, and at all
events, indirectly if not directly, it can only reach them by ship.
Dr. Bell has written so well on this question in the past, that  I
must confess myself utterly puzzled by this extraordinary para-
graph.
    The Board were quite  safe in thundering forth the follow-
ing challenge.   They say:  " We challenge Dr. Bell or any one
else to prove the origin  of a  single case of yellow fever occur-
ring on board a ship which has left this port, which was due to
the impurity of the river water taken from  a point  adjacent
thereto.   On the contrary,  our merchant marine will bear testi-
mony to a preference for the Savannah River water over any
that can be supplied to them at other ports generally."
    In a paper on " Marine Hygiene, and the Prevention of Epi-
demic Diseases by Commerce," Dr. A. N. Bell says: " A. ship
should be, and  if well  constructed and  properly  ventilated is,
the most healthy of all  abodes; yet we are constantly appalled
by the rise, spread, and fatality of  diseases on board, which even
the most  ordinary application of intelligence and care would
wholly avert.   Persons on  board ship are more at  the mercy of
those who  regulate and  control it than are the criminals of  a
penitentiary to a turnkey.
   ■" A vessel may be built and sent to sea with no opening save
the hatchway for cargo, so that when it  is closed there is no
light nor means of renewing the air.  The forecastle, where the
sailors sleep, in small vessels especially,  is rarely even high
enough to admit of an erect posture;  and from its position, even
in moderate weather, it is frequently  necessary to close it, while
with the greatest care it is usually subject to being wet.
    " Many of our coasting and West Indian traders and steam-
boats—and some of these latter of palatial-like dimensions—al- 
168         YELLOW FEVER  A NAUTICAL DISEASE.
low of less than fifty cubic feet of air-space to the individual,
for the sleeping apartments of their employees.  The bunks or
shelves, into or upon which the sailors and hands of these classes
of vessels are  stowed, are rarely  or never provided with  any
opening  save  the narrow hatchways  leading  to  them.  They
are the stow-holes for every kind of rubbish, rarely or never
cleansed, and  probably  the most prolific of all the  sources of
typhus fever in and about New York.
   " The writer distinctly calls to mind a visit he once  paid to
an American whaler brig, in a foreign port, to see the  captain,
who was ill, where twelve out of a crew of nineteen men  had
died of ship fever, from these causes.  While he was abusing the
filthiness of the town and the sickliness of the port, the fore-
castle of  his vessel would have been disgraceful for a pig-sty." *

  Is it necessary to distinguish between Infected and Non-In-
                      fected Vessels?
   The classification of ships according to sanitary rule demands
inspection by  a competent officer; and is it not quite as impor-
tant to see if human beings are to be decimated by foul air and
disease, as it is  to inspect boilers for protection against explosions ?
   The Board of Experts stated in their conclusions " that only
a small percentage of  vessels and  boats, coming from infected
places, are themselves  infected.   The discovery  of  a method
which would enable us to discriminate between infected and un-
infected vessels, without placing in jeopardy the lives of human
beings, would  be of inestimable value."
   It is not at all likely that any surer test of  infection will be
found than  the history of  the  ship, if trustworthy, the actual
presence  of sick on board, and the knowledge of the port whence
the vessel has  sailed, or of the part of the intra-tropical seas she
has crossed.   No harm can come, until vigorous inspection and
disinfection before and after unloading ships in summer are in
practice,  from treating all ships as infected, entering the United
States from the West Indian Islands, Central America, or  Bra-
zil.  They should all be disinfected, and  the  tax for this, tri-
fling as it would be in proportion to the advantages derived from
   * " Transactions of the Medical Society of the State of New York for the year
1864," p. 384. 
TREATMENT OF INFECTED VESSELS.           169
 it, might be borne in part by the governments  and in part  by
 the ship-owners.   We know that steamers are more  safe than
 sailing vessels, and that the soundness and  age of a ship and
 the nature of her cargo enable us to judge of the likelihood of
 yellow-fever infection.
     The loss to the commercial world, the loss to the countries
 invaded by yellow fever, is so constant and so large, that no out-
 lay demanded for the most  absolute prevention of the disease
 need be a cause of difficulty.   The cost of navies for aggressive
 and defensive purposes is  not grudged.   Why should a charge,
 which in comparison to that of navies would  be exceedingly
 small, be refused for the final extirpation of a cruel pestilence ?
 Yotes of three millions sterling  at a time are agreed to in the
 House of Commons for an expedition to thrash savages.  How
 much better would such money not be applied to such a purpose
 as I propose ?  But sanitary measures are cheaper than armed
 invasions; and moreover, in the long run, they pay.  This may
 recommend them to merchants, legislators, and statesmen.
    Before entering into any details as  to the production and
 operation of cold, or the design of my refrigerating ship, it is
 well to summarize so far that, whatever measures of disinfection
 may ultimately be adopted, they should be thorough, conducted
 under competent  and independent  officials, not dependent for
 their berth or salary on ship-owners; and that within certain
 lines of trade, so long as yellow fever is a disease of the Atlan-
 tic Ocean, ships should be disinfected, both  before loading  to
 proceed on a voyage, and after unloading, when at their ports of
 destination.  Moreover, if my views are correct, no ship should
 leave a port, nor be allowed in another, without paying a very
 heavy  penalty, or being liable to prolonged  detention, unless
 some effectual and approved method of constant and positive ven-
 tilation has been adopted.
    I have lived to see national measures enforced for the preven-
 tion of disease which were  formerly deemed impossible, and
 spoken of as  unwarrantable interferences with  trade interests.
 I have personally suffered for antagonizing wealthy and influen-
tial traders.   I now know that, sooner or later, the public insists
on life-saving measures, and all it asks is to be led, in its process-
es and  expenditures, by enlightened and upright counselors. 
170          YELLOW FEVER  A NAUTICAL  DISEASE.
    Congress has appropriated money for  a  first  refrigerating
ship.   If that one is built, I am sure its efficacy will lead  to
others being placed at foreign as well as home  ports, and in
some cases machines being erected on land to accomplish a sim-
ilar purpose.

         Cold the Natural Antidote of Yellow Fever.                \
    It has been said that a fundamental difference between the
poison of yellow fever and of paludal fever is that the former
ceases to have any action ; it is  discharged from the system of
the person  diseased, and dies.  Not so with malarial poison,
which accumulates, and is thrown off, leaving a latent remnant        <
to renew the periodic attack.
    Yellow-fever poison is destroyed  by severe frost whenever
or wherever  it is not protected from it, so that it is  extermina-
ted by this means after epidemics, and can only be renewed by
reimportation.   There are conditions under which  it hibernates
or lives through a mild winter ; but it  is in the folds of reten-
tive clothing, in the interior of frost-proof houses, in dormant
centers of decay or putrefaction, beyond the reach of a temper-
ature of 32° F.; and possibly may it be preserved in a grave.          •
   But, according to my inquiries, the mass of organic molecules
floating in the air are precipitated and congealed by cold at the
simple temperature of  a white frost, and are as effectually dis-
posed of, in  all probability, as if  a putrid piece of flesh were
boiled in a hermetically sealed bottle for six  hours.  For long,
and indeed until quite recently, I hesitated to commit myself
unconditionally  to  this  view.   I felt  that  low temperature
might scotch and not finally destroy the poison.   To-day I agree
with Professor  Carpenter that ulow temperature is  the  only        <
agency that can be relied  on safely to destroy the infection of
the disease," and for the following reasons:
   1. The  abstraction of  heat is  a simple  mechanical  process,
which can be secured without limit.   The lowest temperature
may be maintained, if necessary, for a practically indefinite time.
   2. Air cooled can be  used in enormous volumes to sweep
out dwellings and ships, to dry and freeze, to sweep away  all
products of decay, and exert a lasting antiseptic action.
   3. I regard the operation of cold in a yellow-fever ship  in 
            HOW TO  PRODUCE AND APPLY THE  COLD.        171

the same light that I would regard the forced blowing of cold air
through a close chamber containing putrid meats.   Of course it
is not proposed to forego  the removal of all centers of  decay
and foulness ;  but by draughts of intensely cold dry air, all pu-
trefaction can be stopped and bodies mummified as if by heat.
It is only a question of time and opportunity.
    A quantity of pestilential matter  may be wrapped in  dry
clothing, curtains, and blankets, and preserved, as  it is alleged
has been done in Memphis; just as sour hams  may be housed
from one year to another, and when summer  returns  expedite
the  decay of sound  hams stored with  them.   For this reason
scrubbing, washing,  and either burning or disinfecting by  chem-
icals, must come  to our aid,  whether we use cold or not.   If
a  man is  told to wash^ himself, he is also told to put  on clean
clothes.   When we attempt to purify a ship or a house, we must
purify thoroughly; and, with  it all, we may occasionally be de-
feated in removing every source of infection.

            How to  Produce  and Apply the  Cold.
    It would be foreign to my purpose, in this monograph, to
describe freezing machines or the details of  the refrigerating
ship.  In a communication addressed by me to Congress on the
3d of February, 1879, I wrote as follows:

To the Committees of the Senate and Rouse of Representatives of the  Con-
     gress of the United States, upon the subject of Epidemic Diseases.
   Experience proves that the poison of yellow fever can with difficulty be
reached by  chemical antiseptics and disinfectants, more especially in the
lower portions of laden ships, where it most  frequently lurks.  It may be
scalded out by intensely hot steam, but this is destructive to the cargo and
to the ship's fittings; more or less it is harmful even to the hull,  since a
high temperature distributed unequally causes irregular expansion, buckling
of plates, and starting of rivets.
   Considerable experience in sanitary work led me to suggest to Surgeon-
General Woodworth that a handy steamer, of adequate strength and form,
might be built to carry a powerful refrigerating machine and a standing
store of cooled uncongealable liquids, whereby, at  short notice, any  ship
might be effectually  subjected in every part  to any desired temperature,
above or below the freezing-point of water.
   Dr. Woodworth most readily seconded my suggestion, by causing an ex-
perienced draughtsman at the Navy Yard to be detailed and cooperate  with 
172           YELLOW FEVER A  NAUTICAL DISEASE.
my own engineer, Mr. W. E. Sudlow, to make the necessary designs.   It
was first my duty to establish the basis of this work, and I determined that,
in dealing with the largest ships usually entering such a port as New Orleans,
it would be necessary to provide sufficient power to produce an effect equal
to the melting of from fifty to one hundred tons of ice, as fast as refriger-
ated air or liquids could be distributed in  the infected vessel, viz., within
an hour or two.  Whereas the average size of merchant vessels entering
the port of New Orleans is under 800 tons,  I have deemed it wise to calcu-
late the machinery for the disinfection of the largest vessels usually entering
that port, viz., of 1,500 tons.  Even these can be so rapidly refrigerated, by
the contrivances designed,  that it would only require a few more hours'
work to deal with much larger steamers.

                          Disinfection of Air.
    The Board of Experts, authorized by Congress, to investigate the yellow-
fever epidemic,  have declared that " in the dissemination of yellow fever
atmospheric air is the usual medium through which the infection is received
in the  human system."  It is therefore of paramount importance  to deal
effectually with the  air confined in the ship.  We have provided for the
complete circulation, washing, and cooling, to any desired  temperature, of
the entire volume of air in a 1,500-ton ship, in five minutes.   The  blower
draws  and delivers 26,400  cubic feet of air per minute, whereas the ship
holds, empty, 150,000 cubic feet of air.
    No part  of the air can  remain stagnant or quiescent, for no part of a
ship is made  so  air-tight  that provision  can not be made to exhaust effec-
tually by a suitable apparatus.

                       Disinfection of the Bilge.
    Pumps of adequate size will clear out  the bilge as much as possible.
But the difficulty, especially in wooden  ships, is the adherent organic mat-
ter, which penetrates the wood and remains there a constant source of dan-
ger, discharging into every fresh influx of air, or new cargo, more and more
of the infecting material.
    To meet this, a strong solution of chloride of magnesium will be pumped
into the bilge; and wherever necessary,  under a high pressure, by means of
a hose, a current of this  artificial "pickle" will be driven into the crevices
and pores of  the wood.   Chlorides used in this way have a preservative in-
fluence on the wood, and effectually control the putrefactive  or  fermenta-
tive changes  which the fetor indicates  as  concomitants of the contagious
principle.  The  solution  thus forced may be at 20° or 30° below  zero of
Fahrenheit,  if necessary; and on the assumption of the Board of Experts,
that " the yellow-fever poison  is not  able to withstand the influence of
frost," it is not difficult to maintain the frozen liquids in circulation, in con-
tact with the contaminated parts of a ship,  so long as to render  innocuous
and even destroy such poison.
    So far as the purification of  the bilge is concerned,.the action  of deli- 
DISINFECTION OF  CARGO.
173
 quescent  chlorides and glycerine,  such as I employ in my refrigerating
 machinery, has an effect independent of temperature.  My own experiments
 with inoculable virus prove that these agents destroy the reproductive power
 of animal or certain vegetable organisms and poisons by their affinity for
 water.  They shrivel and modify the chemical constitution of any virus, and
 thus affect its vitality.
    We therefore  have two  weapons  in our hands, and I can with great
 confidence declare that the  most difficult branch of a ship's  disinfection,
 viz., purifying the bilge, is the easiest and  most certain in the  way pro-
 posed.
                         Disinfection of Cargo.
    Again, referring to the  conclusions of the Board of Experts, we find at
 page 27 that artificial cold  may " prove more efficient in destroying the in-
 fection of clothing, baggage,  and many kinds of  goods, than any other ar-
 tificial means which can be employed."
    Again, they say, " Atmospherio air is an efficient, as well as a  generally
 applicable, disinfecting agent, both as respects yellow fever and cholera."
    It therefore follows that,  according to the kind of cargo imported by
 any ship, a more or less reduced temperature of air-currents driven through
 it may afford protection ; but the system of " cold storage," widely adopted
 even in Northern cities, is  available at  quarantine grounds, and a ship, re-
 lieved of its burden, may proceed again on its voyage, practically without
 detention.
    The cargoes of fruit, which so commonly carry infection, may be  bene-
 fited by a reduction to 32°  short of freezing the fruit.  Every Southern city
 should have its cold stores,  and in this way the produce meets with  a
 steadier market,  and the  sacrifice  due to "gluts" may be permanently
 averted.
                       Refrigerating Machinery.
    The steamer designed is to be built  of steel, and stanch enough to bear
 the incessant strain and work incidental to an active service such as I have
 contemplated.
    Apart from the compound engine and propeller, to drive the boat, it
 will hold a thermo-glacial  engine of my latest design, which is practically
 independent of the temperature of condensing water.  The abstraction  of
 heat is equivalent to one ton  of ice for every 425 pounds of pure  ammonia
 gas, alternately liquefied and  evaporated.
   Unlike the freezing machinery hitherto used, especially for the  supply of
 ice in New Orleans, whatever the heat of the weather or of the waters of
 the Gulf of Mexico, ray thermo-glacial engine will  produce the same amount
 of refrigerating effect, and  will abstract 30° of heat every time the 26,400
 cubic feet of  air above mentioned flows through our cooler.

                             Store of Cold.
   In order to concentrate  the power of the machine, it will always have
from forty to fifty tons of chloride of magnesium solution in the ballast 
174          YELLOW  FEVER A NAUTICAL  DISEASE.
tanks of the steamer, cooled down below zero of Fahrenheit.  This re-
serve will  enable us  at short notice  to overwhelm by cold every part of
the foulest ship, without danger of interference by surrounding tempera-
tures.
   It may be necessary to freeze more than one  moderate-sized ship per
day, and by this process the freezing machinery can be kept at work night
as well as day, and be constantly in proper condition to meet the require-
ments of trade.
                       Cost of Refrigeration.
   Making allowance for the most skillful sanitary and engineering super-
intendence, this steamer will cost about $2,000 per month, to be kept in
operation.  Calculating that  thirty  ships only are purified within  the
month, the cost of disinfection will be under  $70 per vessel.  What  is this
compared to the cost  of protracted quarantine 2

    Writing on  the  22d  of  April to the  National Board of
Health, I added:  " That  a  ship should be used as a  floating
sanitary laboratory or workshop in the way suggested is entirely
novel, and the points which led  me to its adoption were as fol-
lows :
    " 1. An infected ship is often in distress, owing to the sick-
ness of its crew or other accidents, so liable  to occur when  offi-
cers and  men are  mentally and  physically  disabled.   Whether
in distress or not, a pilot has to  board her,  and thus a constant
link is established between floating centers of infection  and
land.  In addition to a pilot, a tug is often  needed, and the tug
with its crew constitutes a second source of  danger.   The  disin-
fecting or refrigerating ship can therefore  serve with manifest
advantage as a pilot-boat, a  tug, and a purifying vessel, carry-
ing all the appliances to minister to the comfort of the sick and
the protection of human lives.
    " 2. A ship is available with  its disinfecting or refrigerating
machinery over a wide area near a quarantine station, and, as in
the case of New Orleans, may steam down to the bay and  pre-
vent the towing of infected vessels past Port Eads and between
fairly populous lands, before it can possibly be taken charge of
by sanitary  officers in quarantine.
    " 3. The disinfecting ship may have to  deal with the cargo
of an infected vessel first, disinfect this and land it, and then
proceed to disinfect the ship by refrigeration or otherwise.
    " 4. The refrigerating  machinery on board the disinfecting 
THE REFRIGERATING SHIP.               175
vessel can be utilized at quarantine while lying alongside; and,
if desired by the National Board of Health, I will supply de-
signs for the most efficient form of cold disinfecting  chamber,
to be erected on land, and maintained at a low temperature  by
the refrigerating ship."
    " In addition to refrigeration, I propose to provide the fol-
lowing means:
    "a.  Deliquescent chlorides, and especially the chloride of
magnesium, to  remove from the air all molecular matter and
moisture.  The air will be thus rendered absolutely and optically
pure.   The  bilge,  after complete pumping and washing, will
likewise be  purified by chloride of magnesium solution at low
temperature.  Muddy ballast, etc., can be rendered innocuous
by such treatment.
    " b.  A close chamber, to be raised to any desired tempera-
ture for disinfecting purposes, or in which fumigation may be
thoroughly  carried  out,  to purify loose and movable objects,
clothing, etc.
    " c.  An entirely new system of temporarily substituting for
the air of a ship antiseptic gases, measured, weighed, and intro-
duced as liquids in  the most inaccessible parts, and which, pass-
ing spontaneously from the state of  liquid to  that  of gas, will
permeate  everywhere, and, if necessary, be made to  penetrate
under pressure. Then fumigation will not be simple chance work.
    " d.  Electrical apparatus for lighting  and  safely inspecting
every part of an infected vessel, or for conducting work during
the night.
    " Electrical  indicators for automatically registering the tem-
peratures pervading every part of a ship during the process of
purification.   These self-registering indicators will serve  to
prove when and how  a ship  has been purified at a home or
foreign  port.
    "e.  Chemical, spectroscopic,  and microscopic apparatus of
entirely novel character, to determine at  any moment the con-
dition of  the atmosphere; means of collecting and examining
air and all atmospheric impurities.
   "/.  Medicated  or disinfected baths, or chamber in  which
convalescent people, or persons exposed  to contagion, may be
purified before  landing. 
176          YELLOW FEVER A NAUTICAL DISEASE.
    " g. Apparatus  for superheating, and with an entirely novel
method of so regulating superheated steam, if ever used  in dis-
infecting a ship which has been stripped for the  purpose, as  to
maintain safe temperatures and prevent firing or other  incon-
venience."
    I have  planned a variety of methods, which I know from
experience to be satisfactory, whereby  inclosed  spaces  can be
purified; and it must always be a matter of  importance to dis-
cover  the most readily  applied and most economical that are
compatible with a sure result.
    The  National Board of Health, and under it a Board  of
Naval Engineers, have approved of my plans and suggestions,
and recommended  them for practical  execution.   It is best,
therefore, to enforce the lessons to which I have devoted these
pages by direct experiment; and extracts from the report of the
Board of Naval Engineers may prove instructive and encourag-
ing to those who are disposed to follow my advice.

  Report of the Naval Engineers on the Refrigerating Ship.

    That  Board published  their report on the 12th  of June,
after six weeks' close and searching investigation.  They say:

   The problem of refrigerating a vessel  carrying a miscellaneous cargo
differs materially  from anything heretofore  attempted, and the data fur-
nished by machines employed in ordinary refrigerating processes can not
be applied to the solution of the present problem without material modifica-
tions.
   The conditions under which the work has to be done will vary greatly
with the size of the ship to be refrigerated, the material of the hull, the
character of the cargo with  which she is laden, the  temperatures of the
surrounding water and  air, and the temperature of refrigeration to be-main-
tained in the vessel.
  By reference to the steam-logs of several United States naval vessels, it
was found that the mean temperature of the  water is about 84° F.  Under
the above conditions, the temperature of the vessel must be reduced to at
least the freezing-point of water in eight hours, and the machinery must be
capable of  maintaining a temperature of 0° F. for an indefinite period of
time, while the vessel is being unloaded, cleaned, and disinfected.
   A vessel having a register tonnage of 1,500 tons has a capacity of 150,000
cubic feet.  Taking the mean of the dimensions of several vessels of this.
capacity, but of different models, we  find that the immersed surface of such
a vessel when laden is  10,800 square  feet; the area of the sides when laden 
REPORT ON THE REFRIGERATING SHIP.           177
is 5,200 square feet;  the immersed surface when empty is 8,500 square feet;
the area of the sides when empty is 7,500 square feet; the area of the deck
is 6,600 square feet.
   The total weight of the hull proper of an iron vessel of the  given ca-
pacity is 730 tons.  Deducting  50 tons from this weight for  the rail and
other upper works, the  stem, stem-post, etc., we get for the weight of the
hull actually inclosing the space which is to be refrigerated 680 tons.
   The work to be done during the first eight hours has been  calculated in
British units of heat, being the sum of the following quantities:
   1. The units of heat absorbed in reducing the temperature  of the air in
the vessel from 84° to 32° F.
   It has been assumed that the cargo actually occupies 70 per cent, of the
cubical capacity of the vessel, leaving 45,000 cubic  feet of air.  Since the
volume of air is reduced 10 per cent, in lowering its temperature from 84°
to 32° F., 4,500 additional cubic feet will enter the vessel during  refrigera-
tion, making the total quantity 49,500 cubic feet.
   2. The units of heat absorbed in condensing the watery vapor contained
in 49,500 cubic feet of air at 84°  F. when in  a state of saturation, and in
lowering the temperature to 32° F.
   No allowance  has been made for the heat set free by the freezing of
the water which remains in the vessel after it has been pumped as dry as
possible.
   3. The units of  heat absorbed in reducing the iron hull, weighing 680
tons,  from a temperature of 84° to 32° F.
   A wooden hull is about 10 per cent, heavier than an iron hull, and the
specific heat of wood is far greater than  that of iron;  but, on account of
the relatively low thermal conductivity of wood, the final temperature of
refrigeration would be reached, and could be maintained a long time within
the vessel,  before the heat would he  abstracted from  the whole mass of
wood.
   4. The quantity of heat absorbed from the cargo is assumed to be equal
to the quantity of heat absorbed from the hull.
   This assumption  appears to  furnish a safe average.  In case the cargo
consisted of metals, the whole  mass  would give up its heat;  while in the
case of a closely packed material having a higher specific heat, but lower
thermal conductivity, relatively  little heat would be absorbed.
   5.  The quantity of heat transmitted through the immersed hull from the
water, being calculated by the following formula of Peclet, adapted by Kan-
kine to British units of measure:

                                t — U
                        a{l + B(t-U)

where q is equal to the number of units of heat transmitted  per  hour
through one square foot of surface of a plate * inches in thickness.  The aver-
           12 
178           YELLOW  FEVER  A NAUTICAL DISEASE.

age thickness of iron hull, considered as a uniform solid wall, separating the
cold air inside the vessel from the warm water surrounding it, has been taken
as being equal to three fourths of an inch.  The value of t,  representing the
temperature of the water in motion, is constant, viz., 84° F.   The value of
th representing the temperature of  the refrigerated air, varies between
84° F. at the commencement of refrigeration and 32° F. at the expiration
of eight hours.  The transmission of heat  has been  calculated for a mean
difference of temperature of 26° F. for eight hours.
   6. The quantity of heat transmitted by contact of the warm outside air
with the sides and the deck of the vessel.  This quantity is calculated by
the following formula of Dulong and Petit, as modified by  P6clet, viz.:
C = 1136 #i"233 (2), in which C is the number of calories (or  French units
of heat) transmitted per square metre per hour, when # represents the dif-
ference of temperature in- degrees centigrade.  (A calorie is transformed
into British units of heat by multiplying it by 3-96832.)
   Since the transfer of  heat through  the deck and the sides of the vessel
may be prevented to a great extent by covering them with blankets,  mat-
tresses, sails, etc., only one tenth of the quantity found by equation (2) has
been taken into account.
   As only a rough approximation of the quantity of heat thus transmitted
was attempted, the difference of temperature has been taken as being one
half of the  final  difference during the whole eight hours; that is to say,
# = 14-44° C.
   The absorption of heat from and the transmission of heat through the
hull form so large a portion of  the total heat to be absorbed in the case of
an  iron  vessel, while these quantities would be relatively  small with a
wooden hull, that a machine capable of refrigerating an iron vessel will be
amply sufficient for a wooden one.
   The number of  units of heat to be abstracted  per hour by the  machine
in order to maintain the temperature of the vessel at 0° F. has been calcu-
lated from formulas (1) and (2), assuming that the temperature of  the ves-
sel is.0° F.,  and that the  areas of the  immersed  hull and of the sides are
those obtaining when the vessel is empty.

          Units of heat to be abstracted in  the first eight hours.
Units of heat abstracted in  reducing temperature of 49,500 cubic feet
  of dry air from 84° to 32° F...................................     44,645
Units of heat abstracted in reducing the vapor contained in the air, when
  saturated,  to  water of 32° F..................................     98,722
Units of heat abstracted in reducing iron hull from. 84° to 32° F......   8,696,863
Units of heat abstracted from cargo (estimated).....................   8,696,863
Units of heat transmitted from water  through iron hull...............   3,868,300
Units of heat transmitted from air through protected iron hull........    106,423
       Total  units of heat to be abstracted during first eight hours.... 21 511 816
       Average work to be done per hour..........................   2,688,977 
REPORT ON THE REFRIGERATING  SHIP.
179
 Units of heat to be abstracted per hour in order to  maintain the tempera-
                        ture of the vessel at  0° F.
 Units of heat transmitted per hour from water at 84° F. through iron
   hull having an interior temperature of 0° F.......................  1 469 000
 Units of heat transmitted per hour from air at 84° F. through protected
   iron hull having an interior temperature of 0° F...................    69 000
       Total...................................................  1,538,000

    Although the work required to be done per hour in reducing the  tem-
 perature from 84° to  32° F., during the first eight  hours, is much greater
 than that required to maintain the temperature of the vessel at 0° F., a ma-
 chine  capable of doing the latter amount of  work is sufficient if a store of
 some cold medium is provided to be used in aiding the  machine, during the
 first eight hours, in reducing the temperature  to 32° F.
    The transmission of heat through the hull increases so rapidly with a
 reduction of the interior temperature, that a machine capable of abstracting
 the heat transmitted,  when  the interior temperature is 0° F., will be  suffi-
 cient to abstract any additional heat introduced during the hoisting out of
 cargo, etc., and gradually to reduce the interior temperature from 32° F.
 till the limit of its capacity at 0° F. is reached.
    Since the work of refrigeration is to be done by introducing cold air into
 the vessel under treatment, it is  convenient to express this work in terms
 of cubic  feet of  air.  The work of abstracting 1,538,000 units of heat is
 equivalent to lowering 75,000,000  cubic feet of air at zero of Fahrenheit
 1°, or  1,000,000 cubic  feet of air 75°.
    In  order to maintain the temperature of the vessel  at zero  of Fahren-
 heit, the refrigerating  air entering the vessel must  have a lower  tempera-
 ture, so as to absorb the heat transmitted through the  hull; the volume of
 the entering  air has to he increased in the direct ratio in which the differ-
 ence of temperature of the entering air and the hull is decreased.  It ap-
 pears impracticable, for several reasons, to let the air enter the  vessel  at a
 lower  temperature than about —25° F., and  3,000,000  cubic feet of air  of
 this temperature would be required  per hour to maintain the temperature
 of the  vessel at zero of Fahrenheit;  and to maintain this  temperature  uni-
 formly at every point,  the above quantity would have to be evenly distrib-
 uted over  and brought into direct contact with the surface of  the  hull.
 This, however, is manifestly impracticable, and great  differences of  tem-
 perature must  consequently always  exist within the  vessel, and a large
 quantity of the refrigerating air will pass  through  the  vessel without  pro-
 ducing any useful effect.
    We must, however, assume that,  in order to maintain the required  tem-
perature, the machine  must be capable of reducing  3,000,000 cubic feet of
air from zero to —25° F. per hour.
   In  the plans submitted, the refrigeration  is to  be effected by the com-
pression and  expansion of air, or by the evaporation of some volatile liquid. 
180          YELLOW FEVER  A NAUTICAL  DISEASE.

   The cooling of air by its own  compression and expansion recommends
itself at first sight, on account of the apparent simplicity and effectiveness
of the process.
   The  machinery required for this purpose is simple in its construction,
consisting of an ordinary steam-engine and boiler, cylinders for compressing
and expanding the air, and an intermediate reservoir, in which the compressed
air is cooled to, approximately, its initial temperature, with pumps for cir-
culating  the cooling water.   The ordinary running expenses of this  ma-
chinery are represented by the consumption of fuel in  the boiler, and the
expenditures for  attendance, lubricants,  and the  renewal  of  valves  and
packings. With coal in the  bunkers, the machinery may at all times be
ready for operation.  No  difficulty exists in securing  at any time, for its
manipulation, persons thoroughly  familiar with all its parts, experienced in
working compressed-air engines, and competent to attend to any repairs and
adjustments which may be required.
   The temperature of the air may be reduced by this process probably to
a lower point than by any other applicable on a large scale.
   The  principal  advantage  connected with the production of a very low
temperature in the air-machine, by using a high  degree of compression and
expansion, consists  in the fact that a smaller volume of air is required for
the absorption of a given quantity of heat, and consequently smaller cylin-
ders may be employed; on the other hand, the excess of power expended in
compression, over  that recovered by the expansion of the  cooled air, in-
creases with the degree of compression, while the loss of power, due to fric-
tion and leaks, and the irregularity of the resistance, increases likewise with
the higher final pressure.
   In order to produce  the greatest effect with refrigerating machines
working with compressed air, it is necessary, first, to compress the air at
a constant temperature; second, to avoid exceeding the lower temperature
strictly necessary for producing the desired frigorific effect.
   The abstraction of the heat generated during compression is effected in
the simplest and  most efficient manner by injecting water into the  com-
pressing cylinder; surface cooling alone has been abandoned in air-machines.
The several devices presented, for increasing the cooling surface in the com-
pressor, will be found inefficient or impracticable.
   The final temperature of the compressed air must depend  on that of the
cooling water.  It is, however, possible to utilize to some extent the un-
avoidable waste of refrigerated material in further reducing this tempera-
ture.
   It is  important, for a twofold purpose, that the air should enter the
expanding cylinder as dry as possible:  First, the heat set free by the con-
densation and congelation of the watery vapor would raise the temperature
of the expanded air; secondly, the formation of ice in the expanding cylin-
der would tend to choke up the ports and passages, and increase greatly the
friction of the moving parts.
   In order to reduce the temperature of saturated air from 84° to — 25° F. 
REPORT ON THE REFRIGERATING SHIP.           181
 (making allowance for the rise of temperature due to the congelation of the
 vapor) by expanding it to a pressure of 15-5 pounds per square inch, its ini-
 tial pressure must be 48-73 pounds per  square inch.  This pressure can be
 attained, without difficulty, by compression in a single cylinder.
    In some of the submitted plans it  is proposed to compress the air in
 stages up to from 80 to 120 pounds per square inch.  This would entail a
 useless waste  of power and unnecessary multiplication of machinery.
    Most of the proposed air-machines are so ill-proportioned, and the effi-
 ciency claimed for them is so greatly overrated, that it has been considered
 instructive to calculate the principal proportions and the power required for
 air-machines,  capable  of doing  the work  of refrigeration required under
 favorable conditions, in order  to present a standard for comparing the effi-
 ciency of the various plans and methods of refrigeration.
    The maximum speed of large air-machines should not exceed, according
 to good authorities, 360 feet per minute, and at this speed the mass of air
 discharged would be equal to about 80 per cent, of the space swept through
 by the  piston.  To discharge 3,000,000 cubic feet  of air per  hour would
 require, at this rate, eight compressing  cylinders, each 63 inches in diame-
 ter, and having 6 feet stroke of piston, the engines making 30 double strokes
 per minute.  Taking  the atmospheric pressure at 14-7 pounds, the initial
 pressure in the compressing cylinder would be about 13-5 pounds.

                                                                Pounds,
 In compressing this to 50 pounds  per square inch at a constant tempera-
   ture, the mean unbalanced pressure per square inch of piston is......   17,658
 And the mean unbalanced pressure on each  piston....................   55,044
 The friction of the leather packing-rings of each piston would be about..     2,517

      Total resistance of each piston...............................   57,561

   To discharge the same weight of air at a temperature of  —25° F. and a
 pressure of  15-5 pounds per square inch, there should be eight expanding
 cylinders of 47 inches  x 72 inches.  Assuming that  the air enters in a  state
 of saturation, at a pressure of 49  pounds and at a temperature of 84° F., and
 that it expands sufficiently to lower its temperature to —25° F. (making al-
 lowance for the rise of temperature due to the heat set free from the congealed
 vapor), the unbalanced mean pressure per  square  inch of piston is 21*26
 pounds; the unbalanced mean pressure on each piston, 36,886 pounds; the
 friction of the leather packing-rings of  each piston would be about 2,258
 pounds; effective  pressure on piston, 34,628 pounds; difference between
 resistance in each compressing  cylinder and effective pressure in each ex-
 panding cylinder, 22,933  pounds; indicated horse-power of steam-engine
 required to discharge 3,000,000 cubic feet of air under the above conditions,
 assuming the efficiency of the engine to  be 80 per cent, of the total power,
 2,500.
   This enormous expenditure of power is due to the fact that the work
to be done by  an air-machine depends on the volume of air discharged and 
182          YELLOW  FEVER  A NAUTICAL  DISEASE.
on the respective temperatures during compression and expansion, without
reference to the quantity of heat abstracted during refrigeration.   The tem-
peratures range in the present case between 84° F., the temperature of the
injection water, and —25° F., the temperature of the expanded air. By uti-
lizing the cold air leaving the vessel at 0° F. in reducing the temperature
of the injection water, the power required for refrigeration may be reduced
to some extent.
   The disadvantages under which all refrigerating air-machines labor are
concisely stated by M. A. Terquem in a paper read before the French Acad-
emy of Sciences in 1877.  He says :
   "But even under the best conditions it  does not seem possible for the
cold-air machines to compete with  machines worked with volatile liquids.
They present, in  fact, the same inconveniences as the hot-air motors. These
inconveniences are as follows:
   " 1. The necessity of using large dimensions in  order to obtain small
effects, on account of the low density and the low specific heat of air.
   " 2. The passive  resistances due to these large dimensions and to the use
of two cylinders; these resistances  being proportional to the sum of  their
energies, the work to be expended  being proportional to the difference of
the same.
   " 3. The inability of these machines to accommodate themselves to dif-
ferent  degrees of refrigeration, the dimensions of the cylinders having to
be proportioned for the temperatures T and Ti, between which the machine
has to function."
   Among the volatile  liquids, or liquefiable  gases, used in refrigerating
machines, there  are several, like  ether, chymogene, and sulphurous acid,
which should not be used on board of  a  steamer on account of their explo-
sive or poisonous character.
   These objections do not exist in the case of ammonia,  while its effi-
ciency as a cooling agent is eminently high on account of the low tempera-
ture at which it evaporates under ordinary pressures, and the large quantity
of heat which becomes latent during its evaporation.   Difficulties experi-
enced  at first in using such agencies have been  overcome by making the
compressing pumps  single-acting, thereby preventing leakage through  stuff-
ing-boxes, by introducing various  devices equally effective for avoiding all
loss from clearance at end of stroke, and by adopting such forms of conden-
sers and refrigerators as to insure a rapid  transmission and absorption of
heat.
   Confining ourselves to the consideration  of machines  working with
anhydrous ammonia, it becomes apparent at once that there exist still  many
grave difficulties connected with the use of  this gas.   Its great  affinity for
many substances, in common use in other motive machinery, makes neces-
sary a careful selection  of the material  with which it may come in con-
tact.
   At the mean temperature of our Southern ports, this  gas  has  to  be
worked on very high pressures.  The great differences of pressure existing 
I
               REPORT ON THE REFRIGERATING  SHIP.          183

in the machine require an unusual degree of exactness in the fitting of the
working parts.  The necessity of making many of the joints rigid by sol-
dering increases the liability to leakage, in consequence of unequal expan-
sion from differences of temperature.  The  introduction of this agent is of
relatively recent date, and it may be  difficult to procure at all times the ser-
vices of persons thoroughly familiar with its character,  and competent to
manipulate large and complex machinery in which it is used.  The escape
of this gas in small masses causes annoyance; in large masses it might be
dangerous, by causing suffocation.
   Hence ammonia-machines must possess very decided advantages, if they
are to be selected instead of the simple but bulky and expensive air-ma-
chines for purposes of refrigeration.
   The Board  has experienced much difficulty in securing reliable data
regarding certain physical properties of ammonia necessary for calcula-
tions of  the power  developed  in  its compression and expansion ;  and
the following calculations are to be accepted only in  so far as the laws
governing the  compression of permanent gases are applicable to ammoni-
acal gas.
   In order to  reduce the temperature of 3,000,000 cubic feet of air from
0° to —25° F., the machine has  to work under the following conditions.
Pictet states that in his ice-machines, working with sulphurous acid, there
must be  about 20° F. difference of temperature  at both extremes of the
process, between the gas and the water used for congelation on the one
hand, or for removal of excess of heat on the other.  The same differences
have to  exist in the ammonia-machine, except that, for refrigerating the
air, this  difference has to be somewhat greater.   Hence we may assume
that, since the  temperature of the cooling water is 84° F., the temperature
of the gas in the condenser will be 104° F., and that the temperature of
the gas in the refrigerator has to be  about —50° F. in order to cool the air
to -25° F.
   The pressures of saturated vapor of ammonia,  corresponding to 104° F.
and  25°  F., are 227 pounds and 8-2 pounds per square inch, respectively.
Allowing for resistance in passages, and the excess of pressure required for
opening the induction-valve, the gas will enter the pumps at a pressure of
about 6 pounds per squar© inch.

Pounds of liquid ammonia, of 104° F., which  has to be evaporated under
  the pressure of 8'2 pounds in order to absorb 1,538,000 units of heat
  per hour.....................................................     1,880
Pounds of  ammonia which have to be evaporated per minute..........    31 • 33
Capacity of pumps required for exhausting this weight of gas at a pres-
  sure of 6 pounds per square inch, expressed in cubic feet, displaced by
  piston per minute.............................................  1,345*8
Work to be done in compressing 31 '33  pounds of gas,  having an initial
  pressure of 6  pounds and discharging it at  a final pressure of 227
  pounds per square inch, expressed in foot-pounds, per minute........6,614,230 
181
YELLOW  FEVER A NAUTICAL  DISEASE.
Indicated horse-power of steam-engine to do this work, assuming that the work
  done in  overcoming friction of load and resistance of engines proper is
  equal to 40 per cent, of the useful work...............................  280
Indicated horse-power  required to run pumps for circulating water and re-
  frigerating medium,  and fan-blowers for furnishing 3,000,000 cubic feet
  of air per hour................................................      100

      Total indicated horse-power of engines........................      380

   It will  be seen that, to produce the same frigorific effect under the given
conditions, the ammonia-machine requires less than one sixth of the power
required for working an air-machine.  This increase of power means not
only increase of running expenses, but increased bulk, weight, and cost of
machinery, and consequently, in the present  case, increased size and cost
of vessel  which is to carry the refrigerating apparatus.  Two ammonia-
pumps of moderate dimensions, worked by a pair of ordinary steam-engines,
and connected with tubular condensers and refrigerators, two small pumps
for circulating the condensing water and refrigerating medium, and two or
three large fan-blowers, could do the work under consideration, for which,
on the  other hand, eight ponderous air-machines, each consisting of two
air-cylinders, besides the necessary  steam-cylinders, would be required.
   In all  machines of this kind, when used on board of a vessel, the un-
avoidable fly-wheels form a very objectionable feature ;  although the varia-
tions in resistance are far greater in the ammonia- than in the air-machines,
the smaller size of the former reduces greatly the inconveniences resulting
therefrom.
   It is a decided advantage that with the ammonia-machine the quantity
of heat abstracted and the volume of air furnished in a unit of time can he
varied at will independent of each other.
   The  ammonia-machine is likewise free from the great waste of power
which  is unavoidable in air-machines, when working with air having an
initial temperature much lower than that of the cooling water.
   Much difficulty has been experienced in cooling air by direct contact
with the intensely cold tubes of the refrigerator, because the vapor present
in the  air would  congeal instantly, and, coating the tubes, would diminish
greatly their heat-conducting power.  This difficulty is obviated by using
some liquid as  a refrigerating medium which does not congeal at the tem-
peratures obtaining in the refrigerator.  This liquid falls in a shower into a
chamber, through which the air which is to be cooled is forced, and, after
abstracting its  heat, is returned to the refrigerator.

    After disposing of  the various plans  which failed to meet
the requirements  of  the Board, the following  observations are
made concerning my plans and  appliances :

   The characteristic features  of this process of refrigeration are the ex-
pansion of the compressed  gas; the use of rotary pumps for  the compres- 
REPORT ON THE REFRIGERATING SHIP.           185
 sion  and expansion of the gas; the cooling of the refrigerating  air by
 direct contact with a shower of a cold uncongealable liquid ; and the stor-
 ing of a supply of this cold liquid in insulated tanks.
    The expansion of the  compressed gas in a working cylinder is a feature
 not presented in the other plans submitted using ammoniacal gas, and re-
 duces the expenditure of power very materially.
    In the first place, the pressure in the condenser may be reduced approxi-
 mately to that of saturated vapor at the temperature of the cooling water
 —that is to say, in the present case, from 227 pounds to nearly 142 pounds;
 and the work of compression will be proportionately lessened.
    Secondly, part of the  work of compression is utilized by the expansion
 of the gas.  Consequently a material reduction would  have to be made
 from the result of the calculation heretofore presented, in the estimate of
 the power required  to work this machinery.   In the plan proposed, pro-
 vision is made for pumping the  liquid  ammonia from the condenser to  a
 boiler, where it  is to be evaporated under a pressure of  about 300 pounds
 per square inch, to be then used in the expanding cylinders.
    Although the use of ammonia as a motive power may be more economi-
 cal than that of steam, the Board are of the opinion that the difficulties to
 be apprehended from the  increased complication  of the operation, and from
 the additional valves, joints, and pumps, outweigh the possible economical
 advantages, and that the  expansion-cylinders should draw  their supply of
 gas directly from the condenser.
    The use of rotary pumps for compression of  gases to a high tension has
 a decided advantage over that of reciprocating pumps, in avoiding all shocks
 due to sudden changes of  motion under  great variation of pressure.   Diffi-
 culties that have been  encountered with pumps  of this type, especially on
 account of leakage, have been successfully overcome  in the  construction of
 the pump shown in the plan.   It is likewise proposed to use rotary engines
 of identical construction  for the steam-motor, to be used both for propel-
 ling the vessel and for driving the refrigerating machinery.
    The use of the same engines for  the double  purpose  of propelling the
 vessel and driving the refrigerating machinery possesses the great advantage
 of simplicity and economy.
    The so-called uncongealable liquid proposed is a solution of chloride of
 magnesium in water, with a small quantity of glycerine, which solidifies at
 about the freezing-point of mercury.  This solution  is forced  by an  inde-
 pendent reciprocating pump through  the refrigerator, which  consists of a
 series of tubes of unequal diameters.
   The larger tubes  are rigidly secured  at both  ends in fixed  tube-heads;
the smaller, which pass through  the  larger ones, are fitted in removable
heads and packed at both ends.   The ammonia circulates through the annu-
lar spaces thus formed, and the liquid to be cooled through the smaller and
around the larger tubes.  This arrangement presents a very large and  effec-
tive cooling surface in a small space.
   A rotary blower is coupled directly to the engine-shaft. 
186          YELLOW  FEVER A NAUTICAL DISEASE.

   The capacity of the pumps and the engine and boiler power are sufficient
for the required work of refrigeration.
   The proposed appliances for distilling the anhydrous gas  from the am-
moniacal liquor, the provisions for  storing it, and the various devices for
obviating the difficulties arising from the high pressure and the subtle char-
acter of the gas, indicate a careful study of the whole subject.
   The arrangement of the deck-houses of the vessel proposed to carry the
machine shows the same  careful consideration of the subject of quarters,
bath-rooms, sick-chambers, instrument-room, etc., which may be required
in connection with the proposed object of disinfection.
   It appears doubtful whether the volume of extremely cold air required
for maintaining the temperature of a 1,500-ton iron vessel at zero of Fahr-
enheit  can be so  distributed as to be effective in completely absorbing the
heat transmitted  through the hull;  and it has to be assumed that, even after         t
the most careful  investigation of such  a novel subject, certain unforeseen
circumstances may exist which would increase the difficulties of accom-
plishing the desired object.  To provide  against such uncertain  elements,
and  at the same time for losses by conduction and decrease of efficiency
from wear and tear, it would not be prudent to allow less than 25 per cent.
in excess of the calculated capacity; or, the power of the machine being
proportioned to the calculated work required in reducing the temperature
of a 1,500-ton iron vessel to zero of Fahrenheit, a  correspondingly lower
actual performance has to be expected.
   After a close study of  the problem to be solved and a careful examina-,
tion  of all the plans presented, the Board find that the plans submitted by
John Gamgee show the most thorough and intelligent consideration of the
subject, and promise to do the required work most efficiently and econo-
mically.*
                Cooling and  Ventilating Ships.

    " The  state of  the air in  ships," says Dr. D. Boswell Eeid,
"is  much  influenced by  their construction, the materials of
which they are formed, the purposes to which they are applied,
the presence or absence of  the steam-engine, the climates which
they visit, the cargoes which they carry, the number of persons
that may be crowded within a  given  space, the  diet that  may
be provided, and  the discipline and  usages  which  may be
enforced."
   Without attempting  to forestall  observations  which  will

   *  For the full report the reader is referred to Senate  Document No. 30 of the
first session of the XLVIth Congress, of which the foregoing is an abridgment.  The
Board was composed of Mr. David Smith, Chief Engineer, U. S. N.; Mr.  C. R. Roel-
ker and Mr. W. A. H. Allen, Passed Assistant Engineers, U. S. N.; and Mr.  W. L.
Montanye, Naval Constructor, U. S. N. 
      HIGH  TEMPERATURE AS A  YELLOW-FEVER ANTIDOTE.  187

shortly be published  in  a special work on ventilation,  I  may
state  that the  permanent prevention of yellow  fever impera-
tively demands the supervision of ship construction for the pre-
servation of the seaman's health.  I have already explained that
the natural conditions on land, which  protect human lives  in
badly built dwellings, are absent in a hide-bound floating struc-
ture.  Wind-sails to force air into a ship, and cowls or wind-sails
to exhaust, are very useful appliances on shipboard; but for all
immediate practical purposes a small blower on Mr. John A.
Svedberg's patent, such  as I have introduced into my refrigera-
ting ship, should be connected with a pipe or pipes at the lowest
possible part of a ship, and made to extract foul air constantly.
    The primary object, in preventing yellow fever, is to relieve
the ship  of all stagnant  air  or putrescible liquids.  The bilge-
pumps must be used constantly and frequently.  Sailing  vessels
of adequate size would be benefited by carrying a donkey engine
and boiler for this pumping and positive ventilation of ships.
The engine could also be used to help  to load and unload the
cargo. Human hands may be made to pump and turn a blower;
but the work is very heavy in tropical climates, and the moment
sickness  begins to disable a crew, such work has to be neglected,
to the aggravation of all  unhealthy conditions.

       High Temperature as a Yellow-Fever Antidote.
    I  have noticed a tendency among some engineers and medi-
cal men  to believe more in the efficiency of  steam and  high
temperatures than cold;  but a careful consideration of the sub-
ject indicates that steam is usually impossible of application,
can not fail to injure  the ship's fittings,  and must leave a vessel,
especially if of wood, in  a much worse condition than if treated
by a dry process.
    Steam has  proved sufficient to disinfect a man-of-war; but
then, simple aeration and thorough cleansing have accomplished
the same purpose in favorable cases.  If the putrescent  matter
in a ship, adhering to the sides, penetrating crevices and decay-
ing wood, is of the nature of ordinary  putrefactive matter, we
have  experiments to  prove  that the direct subjection to a tem-
perature  of  212°, for  five or six hours, is essential in order to
prevent the renewal of life in the putrefying center. 
188         YELLOW FEVER A NAUTICAL DISEASE.
   We  have, no doubt, to deal  with a special product which
frost can destroy, but there are  indirect advantages in the pro-
cess which I have from the first projected.  It is not at all  im-
probable that when a city is subjected to a frost the gravitation
of atmospheric impurities to the  soil en  masse exerts a most
powerful influence; for once it is deposited, solid or liquid,  and
the air is left free, it would require a renewal of high tempera-
tures, such as does not occur after a frost, to  set the active  ele-
ments into motion again, and enable them to infect the air by
indefinite reproduction.
   When a blower is started with a shower of chloride of mag-
nesium  cooling the air, all moisture and organic matter is seized
and fixed by the strongly absorbing  solution.  If we blow  fast
and long enough, the air  is freed  of everything that does  not
rise at low temperatures from the objects included in the vessel;
and, having emptied these out, we  can treat the residual surface
and substances  secundum artem.
   Cold, therefore, enables  us to  imprison as well as destroy
offending matter, and it  is not in the least harmful to ship  and
cargo.
   Above all, my plan dries everything completely; and from
first to  last I must insist on that most dangerous of all atmos-
pheric agents to the  crew, as Levy puts it, viz., humidity.  As
Dr. Turner wisely says:  "The  actual humidity of the air on
decks at sea, or anywhere else, should never be supplemented
by artificial means to render it  saturated."   Above all, let us
bear in  mind Captain Cook's experience.
   With  the ready  methods compatible with prompt disinfec-
tion of  ships in port, it would be a most serious matter to steam
and then attempt a drying process.  Such measures may be re-
sorted to with naval vessels put out of commission at will, but
are certainly not practicable for the mercantile marine.

                  Fire  as a  Dismfectant.
   The drying of ships by currents of hot air has been adoptedj
perhaps insufficiently but frequently, since the days of Captain
Cook.
   A simple fire—not a pleasant companion in the tropics—may
be made to draw or drive the air from the bilge and other parts 
FIRE AS A DISINFECTANT.
189
 of the  vessel; but the Sanitary Council who may have charge
 of international regulations for the extirpation of yellow fever
 must remember that any power used to modify the nature of air
 in ships must be supplemental, or practically used by the employ-
 ment and construction  of  general and suitable channels of air-
 conduction, which will lead  to a complete renewal of air in a
 ship.
    Steam-coils, a tubular  heater, or any ready method of heat-
 ing air  in a circuit, may, with a capacious blower, be of service,
 but  more to desiccate  than to attempt the destruction of the
 poison by high temperature.
    M. L'Apparent, Director of Naval Construction in the French
 Navy, is mentioned by M. Melier as having proposed the gas-flame
 apparatus, which painters use to burn paint off wood, whereby
 to singe the whole interior of a vessel.  This ^6 douche, as he
 calls it,  may scorch out the disease under  careful supervision;
 but  the process is tedious and needlessly destructive of  the
 ship's internal surfaces.
    On  this  question of  ventilating  ships by heat, Dr. Reid  (p.
 361) says:
    " The fire of the galley has  occasionally been converted into
 a ventilating power; but, so far as I am aware, no general and
 systematic distribution of communicating channels  has accom-
 panied the application of this power.  Nothing, however, more
 certainly tends to improve the atmosphere of a ship than the
 influence of the galley-fire,  as it may be made to serve the same
 purpose as a shaft;  but the objections to sustaining the fire at
 night, and the size of the communications required for effective
 ventilation,  must prevent  its being so extensively  useful for
 such purposes as might be imagined.  In all cases where I have
 endeavored to apply its action, the objections  made appeared to
 me sufficiently cogent to force me to give up  the  idea of trust-
 ing to  it alone, as the effective means of inducing  a sufficient
 amount  of ventilation ; but, though not resorted to for this pur-
 pose, its power should not be thrown away. By establishing a
 communication between it and the hold, or any part of the ship
 where ventilation  may  be more urgently  required, a certain
benefit  may  be always secured,  which will  be productive  of
much good,  even where nothing else is attempted. 
190         YELLOW FEVER A NAUTICAL DISEASE.
   " The freedom of access generally necessary around the fire,
and the  construction  of the  cooling apparatus, does not afford
facilities for those large and air-tight channels  which are so es-
sential for  obtaining considerable power  from any heating ap-
paratus ; the  larger the area, however, and the more direct their
access to the  fire, or to any channel formed between hot plates,
the greater is the discharging power.  It is  almost superfluous
to observe, that all such air-channels should be  carefully protected
by several folds of  wire gauze from the ingress of any spark, as
without this there would not  be  a  sufficient  guard against the
risk of accident by fire.  The galley-fire operates  most  effectu-
ally when it  is supplied with  air by  air-tight channels, solely
from the places to be ventilated; but this is  incompatible  with
its use as an open fireplace.
   " In the temporary application of local fires on board ship, for
the purpose of drying or effecting a change  of air, much  may
often be done to  render them more useful by studying the cir-
cumstances under which they are applied, and  taking care that
a distinct course  shall be given  for the ingress of fresh air to
supply the  fuel, and another for the  discharge of the  vitiated
air or products of  combustion before they have cooled so far as
to lose their  ascending power.   When this  is not attended to,
the cold air  supplying the fuel  descending  through the same
channel as  that through which the escape takes place, the con-
flicting  currents retard each  other's progress; the vitiated air
gets  too cold, and often remains a considerable time,  to the
danger or annoyance of those who are  near it."

              Ventilation of  Ships by an Injector.
   Even without a steam-engine and blower,  a small boiler with
a Korting's injector, to exhaust  the air from  the bottom of  a
ship  daily,  is  a practical  and satisfactory apparatus.   It may
be depended  on  if  duly proportioned  to the  work to be done,
and regularly used.  The carrying of  such a boiler would be a
very simple matter in any ship, and require no engineer.  The
tubular connections with the interior of the ship  should be
directed  to the  lower levels, where the air is  most commonly
foul, and to all those parts where it may be  at any time  stag-
nant.   It must not be forgotten that yellow fever has very fre- 
PREVENTION OF YELLOW FEVER IN CITIES.       191
quently broken out when the hold of a ship has  been opened in
port after a passage across  the Atlantic without disease mani-
festations.   There is no reason whatever not to guard against
the possibility of any such accidents, for forced ventilation will
prevent them.
    In planning for the systematic ventilation of ships, attention
must be paid:
    1.  To the effectual removal or exhaust of foul air from the
lowest parts by positive agency.
    2.  Admitting air through  ample apertures, under such con-
ditions that by the suction from below an equal distribution
throughout the ship may occur.
    3.  Constructing channels, by partitions or otherwise, to give
direction to the air-currents.
    4.  Means of cooling and  drying the air, especially in  the
tropics.
            Prevention of Yellow Fever in  Cities.
    My observations on this subject shall be few.  My object is
to direct attention to the fact  that cities must remain in close
maritime  intercourse to suffer from the scourge.  The many
measures required to insure a  generally healthy state of seaport
towns do not admit of discussion here.   There is one, however,
which bears on my proposal to  resort to cold and free ventila-
tion, as the fundamental  means  on  which we must depend in
controlling yellow fever.  It relates to  the ventilation of  cities
and of residences.
    It  has often been remarked  that the great fire of London
annihilated the plague and established a solid groundwork for
the city which has since  flourished.  Fire is a great destroyer
of contagion and unwholesome dwellings.  If extensive enough
in a town, it may, as it not infrequently does, lay the founda-
tion for great social and sanitary improvements.   Chicago is a
recent instance.  The cheapest  thing for the country that per-
haps might have  happened last year would  have been a con-
flagration calculated to put Memphis in ashes.   I  am informed
that a forest fire around Yera Cruz, were such a thing possible,
might  save it if the cleared area were afterward kept clear by
human industry.   Such radical purifications are accidental, and
the sanitarian has to fight inch by inch, and step by step, against 
192         YELLOW FEVER A NAUTICAL DISEASE.
the habits of a people, the vested interests of property-holders,
and the intrigues, cupidity, and ignorance of local authorities.
It is an example of the highest form of statesmanlike care for
the public health that we can adduce in the bold remodeling of
so solid a city as  Birmingham, England.   Equally wonderful,
though springing from different circumstances, is the provision
made in many northern cities of the United States for health,  s
comfort, and the luxurious enjoyment of life.  The South un-
doubtedly demands unremitting attention to town sanitation.
So do the vineyards  of France demand  good culture, but  no
amount of vigilance would  arrest the phylloxera, in the absence
of such definite measures as experience suggests to strike at the
very root of the disease.  Local measures are therefore, some-
times, secondary to measures from a distance, and this in  my
opinion will prove to  be the case with yellow fever.  Clear the
shipping of  the disease, and the towns will almost take care of
themselves.
   The recent  epidemics have led to a natural awakening on
hygienic  matters.   They have  brought the subject of disease-
prevention to the front rank  among social  and political ques-
tions, and the  common enemy of the people  of the United
States is a preventible pestilence.  Medical men of the highest
qualifications have been marshaled as a Board to direct and en-
courage local measures.  To doubt the beneficent result of such
changes and reforms  is to doubt the  advantages of acquiring
knowledge, or of that lever without which science is valueless,
viz., method in  its application.

                   Cold and  Ventilation.
   Cities liable to yellow fever can and should have the advan-
tage  of unlimited supply of cold ; or in other words, the evil
effects of heat and excessive humidity should be counteracted,
by the abstraction of the  first and  condensation of the  last.
Many efforts have been  suggested, but few made, in this direc-
tion ;  and since the careful study of the means for the refriger-
ation and ventilation of ships, I have  pursued inquiries into the
practical  and economical means which can be employed for
supplying houses with pure cold air, just as we supply houses
with pure water.   Impossible as the  project has been deemed 
INTERNATIONAL COOPERATION.
193
hitherto, the saving I have been able to effect in operating freez-
ing-machines enables me to say that the great reform in tropical
habitations, which will surround the dwellers with a pure atmos-
phere, at any desired  temperature  and degree of humidity, is
attainable at moderate cost.   My work is not completed, but, so
far as I have gone, it results from my calculations that every
house, in a sufficiently large  group to warrant the investment,
can be supplied, at a  cost which will compare  favorably with
the cost of heating a New York residence, with  pure filtered
air from above  in  a constant stream, driving  out instead  of
attracting from below the dangerous atmosphere of streets and
sewers, in such a city as New Orleans.   Fifty cubic feet of air
per individual, at the  typical temperature of  70° Fahr. and 70
humidity, can be flowing in constantly, rendering life in Ha-
vana, Vera Cruz, or Rio something very different  from what it
is in the present sweating-houses—centers of human misery and
bodily enf eeblement.   The details  and calculations relating to
this proposal  will form the subject of a special  publication,
which is far advanced  toward completion.

                 International  Cooperation.
   The ravages of yellow fever are, in a sense, altogether dispro-
portionate to the ruinous commercial sacrifices which it inflicts
on the Atlantic seaboard.    The loss  of  life  this year will be
trifling compared to the mortality by typhoid or genuine indig-
enous malarial fevers.   But  the maritime intercourse, and  the
development of  that immense ocean freight business which  the
Mississippi is to  feed from the West, must be  dangerously crip-
pled by the inevitable quarantine regulations, which should give
way to the sanitary  regulations and classification  of  shipping, as
elsewhere indicated.
   The vigilance of the National Board of Health has brought
out very strikingly the benefits to be derived from watching for
infected shipping everywhere.   In these days of Red-Cross So-
cieties and International Commissions—of Plimsoll's Acts  for
the protection of the seaman's life against the cupidity  and
recklessness of ship-owners—it can not be difficult  to carry the
science of disease-prevention into every seaport on the Atlantic
coast of America, and on to  every ship floating in the yellow-
             13 
194         YELLOW FEVER A  NAUTICAL DISEASE.

fever area.  A commission of leading sanitary authorities, engi-
neers, ship-builders, and ship-owners, nominated by the United
States Government, the Mexican Republic, the Empire of Bra-
zil, and  the European governments whose colonies  stud the
western waters of the Atlantic,  or whose navies skim the ocean,
would in due time establish an understanding which would tend
immensely to cement good-fellowship and encourage commerce.
A preliminary and purely medical  commission  might  inves-
tigate the soundness of that view, the acceptance  of which,
more than all else, will facilitate  future operations, viz.: that
yellow fever is,  in its origin, simply and purely a nautical dis-
ease.  It is the ships which in the  first place have  to be puri-
fied  and reconstructed.  It is said that a  house never  can be
clean with a dirty kitchen: a seaport never can be pure with
infected shipping. 
CHAPTER  VI.
                        CONCLUSIONS.

    The facts and observations recorded in the foregoing pages
 warrant us in stating, with considerable precision, some of the
 fundamental truths which  are, perhaps for the first time, made
 evident and mutually dependent.
    1. Yellow fever exists  permanently in some of  the ships
 sailing in the West Indian  seas, extending eastward in  the At-
 lantic probably as far as the 26th or 27th degree of west longi-
 tude, southward to the  immediate  vicinity of the equator, and
 northward to the calm-belt of Cancer.  This is its permanent
 home.
    2. The ships obviously  or latently  infected, by  sojourn in
 these ocean limits, contaminate the ocean harbors chiefly and
 often, but less often the seaport towns themselves.   These har-
 bors and seaports cherish and  retain the infection in direct rela-
 tion to prevalent heat and moisture, hence to latitude, impurity
 by fecal or other contaminations, density of population,  activity
 of trade, and proximity of the shore dwellings to the shipping.
 The number, age, and character of ships in harbor,  the source
 and  cleanliness or impurity of the said ships, the character of
 trade or purpose for which the shipping is  used—whether in
 West Indian or colonial produce, liable to prompt decomposi-
 tion, or ores, cotton, and other merchandise less likely to change
 —materially influence the  severity, extent, and duration of an
 outbreak.   The nature of the population afloat or in the harbor,
in relation to susceptibility, is a potent factor under  this head.
 Seaports and harbors  constitute the subpermanent home of yel-
low fever. 
196         YELLOW  FEVER A  NAUTICAL DISEASE.

   3. River harbors and cities on river banks, above the points
of direct communication with the sea,  obeying the same condi-
tions as the above, constitute the occasional transient homes of
yellow fever.
   4. It must be accepted as conclusively proved,  that yellow
fever never has existed permanently, as  cholera has done in Ben-
gal, in any region—island or continent—on land.  Yellow fever
is simply accidental, and promptly extinguished the farther from
shore or the higher the ascent up hills and mountains.  Refugees
from infected  shore or ocean centers locate the rare and inhos-
pitable homes of yellow fever.  Therefore, in the interior of spa-
cious  islands and on the mighty continent of America, it never
did, never  could, and  never can live—much less originate.
   5. Yellow  fever is not one of the pure contagia, propagated
or reproduced, through time and space, by a specific  virus or
diseased animal  secretion, or definite migrating parasite,  capa-
ble of communication only from the sick to the healthy, in any
latitude.
   The "germ theory," as popularly understood, and the depen-
dence of yellow  fever on " specific spores " and " microphytes,"
may be regarded as having led  to fallacious reasoning. There
is  no foundation in fact for the plausible explanations of the
propagation of the disease by the reproduction of the lowest or-
ganisms.
   6. Yellow fever is not personally contagious, but transmitted
by definite, or " particulate," putrescent emanations which  foul
a confined  atmosphere.  Ill-ventilated  rooms, especially below
the level  of streets, deep  ships  with close  and confined air-
space, are the  favored sites of greatest malignancy.   The prod-
ucts of a  specific naval or  marine decomposition adhere to
clothes, woolen goods, sails,  and other articles  transported by
man, and, with heat, moisture, and stagnant atmosphere, repro-
duce  the  poison, which the vital tissues  and vital  organs of
the stoutest and healthiest men can not resist.
   7. Yellow fever is due to that form or specific  kind of de-
composition which demands  the sea-water of the defined area
named, with, possibly, the ocean atmosphere charged with the
organic products in this region  (of high humidity and constant
temperature of 80° or 90° Fahr.), besides sundry organic,  ligne- 
conclusions.                    197
 ous, or hydro-carbonaceous substances capable of fermentation.
 The  susceptible crew or  passengers, confined  (especially in
 storms) in a space totally unequal  to  the  wants of respiration,
 when ports and hatches are closed, discharging, as  all human
 beings do, much moisture and  effete animal  matter, contribute
 to the pestilential cause, and are almost victims of self-poison-
 ing—unwitting  and unwilling  suicides  and  plague-propaga-
 tors.
    8. The nature of yellow fever is best  expressed by naming
 it Equatorial Atlantic  Ocean typhus.  Fievre matelote, or sail-
 or's fever, and nautical typhus, are the next best terms; but there
 are other fevers of the sea, such as pure typhus, even in northern
 waters, from which it must be distinguished.  It is the analogue
 of the old jail fever of the British prisons, but has never been
 known to acquire its distinctive characters on land, except as an
 ocean pestilence.
    9. The distinctive signs of yellow fever are those of a putrid
 disease in which assimilation is suspended  and the tissues degen-
 erate.  There is no tendency to high organic development in its
 course, but only to retrograde tissue-changes and the dissolution
 of organs, explaining the incurability of the disease.  The ante-
 mortem decomposition is attended with arrest of secretions, and
 the diffusion  and dispersion of their usual ingredients through-
 out the system, whereby it is also poisoned; ejection of dead and
 disintegrated blood and tissues; progressively reduced functional
 activity, typified by the slow pulse; active chemical changes in
 the devitalized tissues without equalizing heat influences—hence
 the continued high temperature; lowered  or lost sensibility and
 profound cerebral changes—hence the occasional delirium and
 the mieux de la mort, or " calm before death."  Fatality or ma-
 lignancy seems closely related to the quantity of putrescent mat-
 ter  absorbed by  the susceptible  individual in close quarters—
 hence the terrible consequences of ship infection.
    10.  The phenomena after death are those of rapid decay, a
 continuous decomposition, sometimes  with actual post mortem
 increase of temperature,  in part analogous to  the changes in
 actual life.
   11. Treatment, in medical language, can only be expectant
and palliative.  No specific  cure ever has been or can be found. 
198         YELLOW FEVER A NAUTICAL DISEASE.
A case of virulent infection implies death as certainly as a dag.
ger-thrust into the heart.  By the most judicious nursing (the
retrograde tissue-changes ceasing) recovery occurs naturally. The
obvious antidotes are antiseptics, which, unfortunately, can ill
operate on the dying molecular matter  of  a still living man.
Cold usually accelerates death.
   12. Nature's antidotes against putrefaction are dryness, heat,
and cold.  The  effect of frost,  in a yellow-fever city, is  more
marked, because more prompt, than the effect of cold on the
decomposition of ordinary animal and vegetable products.   The
sudden arrest  of the disease, even in the homes of a suddenly
cooled city, shows that the products of specific yellow-fever de-
composition can only be produced and maintained at high tem-
peratures.  The.refrigeration of  ships will purify them, but all
foci of after-contamination should be removed—all chance of re-
newed and regenerated infection guarded against.  The same
reason that accounts for butchers' meat not decomposing in win-
ter, as it does in summer, explains how cold arrests yellow fever.
There  is  a difference in degree  in favor of  the arrest of  that
specific decomposition, to which  I have  alluded in relation to
this disease.   When heat is used,  the well-known  conditions
essential to the destruction of putrid elements in organic liquids,
as established by Pasteur and Wyman, must be attended to, viz.,
prolonged exposure to 212° Fahr. and upward.
   13. Prevention demands sound ships and pure  dry air in
abundance.  Every sailor should  have, and can have, from 1,000
to 2,000 cubic feet per hour, provided adequate appliances are
compulsorily introduced into the marine.  Clean ships, and the
absolute exclusion  from the area of probable ocean infection of
old and rotten vessels, must be  secured, coute qui coute; and
the combined  navies of the world, deeply interested  in the ex-
tinction of this plague of the sea, may and should join hand in
hand to facilitate the inspection and overhauling of all perilous
and infected craft.
   14. The concealment of  ship infection, the shipping  of a
healthy seaman or a  healthy crew on  an infected ship, and the
landing of people and  things from ships without adequate dis-
infection,  should be made penal offenses by the law of maritime
nations; and the penalties against all offenders should be severe, 
CONCLUSIONS.                    199
such as total loss of certificate for  officers, with imprisonment
without option of a fine.
   These are by no means all the conclusions I might draw, but
they are those of prime practical moment, calculated to disabuse
the public  mind as to the inevitable recurrence  of  this fearful
malady.  Strong in my convictions, earnest in  my work,  and
positive as to the benign influence  of a true enlightenment, I
have tapped the precious source of that flood of light which must
bear hope and comfort—a rational belief in future safety—wher-
ever the  fetid cause of yellow-fever mortality is desolating the
human family. 
 
INDEX   OF   AUTHOEITIES.
                                      PAGE
 Alexander VI., Bull......................   80
 Anson's (George) Voyage............... 8T, 83
 --- Fleet-surgeon's Views...............   86
 ---Ships, Yellow  Fever in---..........   87
 Archives of Naval  Hygiene...............   99
 Army Medical Department Eeport........101
 Arnott, Dr. on Oxford Assizes.............   64
 Audouard, Dr........................... 9, 61

 Bacon, Lord, on Effluvia..................   62
 Bailey, Dr. Joseph........................114
 Bancroft, Dr., " Essay on Vellow Fever "...   62
 Barton, Dr. E. H., Humidity in relation to
   Yellow Fever..........................   17
 ---Barometric Pressure.................   28
 ---Extension of Yellow Fever from south,
   northward.............................   37
 Beale, Dr., on Disease Germs..............  148
 Beguerie, Dr., on Yellow Fever in a Flotilla  56
 Bell, Dr. A. N........................  153,166
 ---Causes of Yellow Fever..............  27
 ---on Charleston........................ 102
 Bergmann, Dr............................  145
 Biddle, Captain, on Yellow Fever originating
   in the  Macedonia.......................  44
 Billings, Dr. J. 8., on the Refrigerating Ship 157
 Blair, Dr. Daniel, on Yellow Fever in British
   Guiana................................   98
 Blane, Sir Gilbert, on Diseases of Seamen..   89
 ---on Sickly Ships......................   89
 —- on Jail,  Hospital, and Ship Fever..  63, 114
 Board of Experts,  Conclusions of.. 20, 22,  82,
                              33, 84,172,173
 Board of Naval Engineers, Eeport of.. .176-186
 Brice, Dr., on the  Ocean Origin of Yellow
   fever..................................  42
. Browne, Dr., on Oroya Fever............. 129
 Buchanan, Dr.George, on Swansea Outbreak 106
 Burke, on West Indian Wars..............  97
 Byrne, Surgeon B. M., on Fever at Fort
   Moultrie...............................  59

 Cabell,  Dr.,  President National  Board of
   Health.................................  4°
                                     PAGE
Cadle, Dr., Origin of Yellow Fever in Mace-
  donia ..................................  45
Caldwell, Dr., on Sloop Mary..............  46
Carpenter, Dr............................ 170
---on Yellow Fever on the Enterprise....  45
---on Cold.............................. 154
Catel, Dr.................................  77
Chase, Dr., on Yellow Fever on the Mace-
  donia ..................................  44
Chervin, Dr.............................. 176
---Non-contagion of Yellow Fever.......  21
---on Quarantine........................  21
---on Yellow Fever at Sea..............  54
Chisholm,  Dr., on Yellow Fever due to
  Fermenting Wine in Ships..............  52
---Definition of Yellow Fever...........  61
Clarke, E., on African Diseases............ 100
Closset, Dr., found Analogy to Putrid Ty-
  phus...................................  61
Cohn,  Professor.......................... 146
Columbus................................  80
Cook,  Captain............................ 188
---Voyage of...........................  94
Copeland, Dr............................. 101
Copeland, Dr., on Specific Infection in Ships  40
Copley, Sir Godfrey, Medal..............   94
Cornilliac, Dr.........................*. 77,81
---on Calenture  .......................  87
Correa, Gaspar, Leudas da India........... 182
Cortes, Hernando.........................  79
Crawford, Dr., Yellow Fever in Ships at
  Port au Prince.........................  51
Cullen on Synocha........................  88
Currie, Dr.............................. 9, 40

Dalmas on the Souveraiii Outbreak.......  54
Dayers, Dr., on Ship-origin of Yellow Fever
  in Macedonia...........................  45
DeBary..................................  148
Dev6ze, Dr..............................  76
---on Non-contagion of Yellow Fever..... 20
Dickson, Dr. J. H, on Yellow Fever  in the
  Blonde,  Glolre, Star, Wanderer, and Dart  49
---on the Nyaden.......................  50 
202
INDEX  OF AUTHORITIES.
                                      PAGE
Dogart, Dr., found Analogy to Putrid Ty-
  phus...................................  61
Dubordieu, Admiral, on Sickly Ships....... 136
Durkins, Dr., on Yellow Fever on Ships at
  Demerara..............................   52
Du Tertre, on Yellow Fever..............   88

Edwards, Bryan..........................   97
---Salubrity of West Indian Islands......  80
---on West Indian Fever................   96
Enterprise, U. S. Brig, Yellow Fever Origin
  in.....................................   45

Fassett, Dr., on Oroya Fever..............  129
Faget, Dr. J. C....................... 183,137
---first formulated the Idea of Ship Re-
  frigeration ..............................    6
---Yellow Fever always imported.......   19
---Memoires et Lettres sur la Fievre Jaune  19
---on  Protection of New  Orleans........   19
---Course of Yellow Fever in Cities......   25
---Shore Cities attract Yellow Fever.....   26
---on Naval Origin of Yellow Fever......   19
---on Epidemic Nucleus near Shipping...   25
---Seasonal Extinction of Yellow Fever
  by Frost...............................   26
---on  Mid-ocean Outbreaks.............   40
---on Yellow Fever in the Enterprise___   45
---on  Essential Conditions for Yellow Fe-
  ver Causation...........................   60
---Researches..........................   66
---on Yellow and Periodic Fevers___122, 219
---Proposed Artificial Refrigeration......  154
---on Quarantine........................  160
Ferguson, Dr., on Calenture...............   87
---on Ocean Origin of Yellow Fever......   88
Feraud, Dr. Berenger.....................  101
---on  Bilious, Remittent, and Yellow Fe-
  ver................................ 118-121
Francis, Dr., Impurities augment Yellow
  Fever..................................   26
---Exotic Character of Yellow Fever.....   32

Gama, Vasco de..........................  132
Gamble, Dr., on Yellow Fever in Barbadoes.  39
Gamgee, Dr. Arthur......................  141
---Sampson, on Pyemia.................   64
Gerlach, Professor, on Pleuro-pneumonia...   74
Gillespie, Dr., on Yellow Fever in La Pique.  50
Gimaron.................................   78
Goode, Hon. John, on the Refrigerating Ship 158
Griesinger, Dr., Definition of Yellow Fever.  114
Guild, Dr. LaFayette, on Yellow Fever at
  Governor's Island.......................   58
Guthrie, on Death from Bullet Contusion...  188

Hamilton, Dr. J.  B., on the Refrigerating
  Ship...................................  157
Hargis, Dr. Robert B. 8...................  183
---Yellow Fever never originates on Land.  41
Harris, Hon. Isham G.....................  156
                                      PAGE
Hartle, Dr., on Yellow Fever in the Dasher
  and Pyramus...........................  48
Herrera, Historia General de las Indias___  78
Hirn.G. A............................... 138
Holliday, Dr., identified Fever in the Gen-
  eral Green..............................  43
Hooker, General C E., on the Refrigerating
  Ship................................... 158
Hornet, TJ. S. 8., Yellow Fever in..........  43
Hosak, Dr................................  78
Howard, John, Prison Reformer...........  10
Hughes, Dr., on Yellow Fever.............  39
Humboldt, Alexander von.-...............  9, 79
---on  Yellow Fever in relation to Alti-
  tude ...................................  28
---Yellow  Fever Exotic  everywhere  on
  LaDd...................................  85
---Origin of Yellow Fever in Ships......  85
Hunter, John  D., on Diseases of the Eed
  Men...................................  78

Jones, Dr. Joseph, on the Spanish Galleons.  81

King, General, on Frost and Yellow Fever. 156
---Eufus, Letter to Sir Gilbert Blane.....  63
Klein, Dr................................. 144

Larrey, Baron, on Yellow Fever in Egypt.. 105
La Roche, Dr...9,10,  86,87, 38, 40, 41, 45, 51, 52,
                               58, 57, 61, 76
Latham, Dr............................... 140
Lebby, Dr. Robert, on Outbreak in Charles-
  ton  .................................... 103
Lefe.....................................  80
Lefort, Dr., on Yellow Fever in the Euryale,
  Egene, Diligente, and Silene............  54
Lemaitre, Dr., Translator of Griesinger___114
Levant,  U. S. S., Yellow Fever in..........  43
Levy, Dr., on Marine  Hygiene............. 188
Lewis, Timothy Richard.............. 147,149
Ligon, on Yellow Fever...................  83
Loring,  Dr. George B., on the Refrigerating
  Ship................................... 159
Louis and Trousseau, on Yellow  Fever... 20, 76
Lufe, Professor...........................  77

MacDougall, Surgeon Charles,  on  Yellow
  Fever at Fort McHenry.................  59
Maclean, Charles..................... 189,140
---Non-contagion of Yellow Fever.......  20
Macnamara on Cholera.................... 182
Maury,  M. F.,  Physical Geography of the
  Sea...............................  86, 68, 69
Medical Society for the State of New York,
  Transactions of......................... 168
Medico-Chirurgical Review................  27
Melier, F„ on Ship-sickness...............  45
---on  St. Nazaire Outbreak.............. 105
---on Ocean  Origin of Yellow  Fever.....106
---on  Typhus in  a  Ship.................186 
INDEX OF AUTHORITIES.                        203
                                      PAGE
Microscopical Society, Quarterly Journal of. 149
Miller, John, on the Ship " Minden".......  67
Moreau, St. Mery, on Yellow Fever........  88
Miiller, Wilh., on Consumption of Oxygen.. 141
Murchison, Dr., on  Independent Origin of
  Typhus................................  63
---on Relapsing and Yellow Fever....... 117

Nageli on Lower Organisms............... 14*7
Narvaez, Expedition of, introduces Small-
  pox in Mexico..........................  80
National Board of  Health, Investigations
  required on Ventilating Ships............  66
---Watching Ships closely.........•......  72
---Letter to............................ 174
---Report of............................ 176
Newcastle, Duke of, issues Anson's Instruc-
  tions ...................................  84
Nott, Dr., Yellow Fever not Contagious.... 116

Onimus on Temperature as affecting Bacte-
  ria..................................... 146
Ord and Durkin, Drs., on Yellow Fever in
  Ship at Demerara.......................  52
Osgood, Dr. Daniel........................ 116
---on Location  of Infected  Cities near
  Water..................................  26
— on West Indian Islands..............  32
O viedo...................................  78

Panum, Professor, on Ferments........... 145
Pa'steur, Professor, on Germs.....146,149,198
Peixotto, Dr.  Daniel L.  M................. 115
---Salubrity of  Curacoa.................. 80
Perkins, Dr. Cyrus,  on Contagion.......... 116
Phelps,  Captain, on Yellow Fever.........  89
Piso, William, " Natural History of the Bra-
  zils," on Yellow Fever..................  83
Pizarro,  Don Joseph, his Squadron..........  85
Plimsoll, Samuel..........................  T5
Potter, Nathaniel.........................  76
---Non-Contagion of Yellow Fever........ 20
Powell, Major, on  the Indians..............  79
Prescott, W.H......................... 79, 80
--- on  the  Terra Caliente and Black
  Vomit................................... 61
Pringle,  Sir John.........................  94
Pym, Sir William................. 76,115. 139

Raleigh, Sir Walter's Voyage..............  82
Ranee, Dr., on Yellow Fever in the Flora...  57
Raynal,  Abbe,  Salubrity of West Indian
  Islands'.................................  80
Reid, Dr. David Boswell................... 186
---on  Ventilation of Ships................ 67
Richepin, Dr. Lucien, on Yellow Fever in
  French Guiana..........................  99
Robbins, Benjamin, author of Mathematical
  Tracts..................................  ^
                                      PAGE
Stevens, Dr. on Yellow Fever in Sailors....  85
Sanderson, Dr. Burdon, on Ferments..  142, 145
Savaresz, Diagnosis of Yellosv  Fever  in
  Egypt.................................. 105
Schmiedeberg, Dr., on Ferments........... 145
Schrader................................. 116
Schumacher.............................. 148
Schwann, Professor....................... 146
Seaton, Dr. Edward C, on the Germ Theory 144
Sharpey, Dr.............................. 113
Simon, John, on Swansea Outbreak........106
---on Cholera........................... 134
Smith, Dr. Angus, on Pneumonia in the Air 163
Stevens, Dr., on Yellow Fever in American
  Seamen.................................  84
Stillo, Dr. Alfred..................... 114, 116
Stone, Dr. Warren........................ 116
Svedberg, Mr. J. A., Blower............... 187
Terquem, M. A., on Air-Machines.......... 182
Thomson's Seasons.......................  97
Toner, Dr. J. M.,  on Altitude as affecting
  Yellow Fever................  .......... 101
Transactions of the Epidemiological Society 100
Trotter, Dr., " Materia Nautica "...........  51
Trousseau,  Professor......................  76
Tully, Dr., on Yellow Fever in Connecti-
  cut.................................  75, 115
Turner, Dr.,  on  Swabbing  and Washing
  Decks..................................  71
---on Damp Ships.............'.... 116, 188
---on the Refrigerating Ship............. 157
Tytler, Mr., on Yellow Fever in Sailors.....  34
---Dr., on Cholera.......................132
TJpdegraff, Hon. J. G., on the Refrigerating
  Ship...................................199
Vanderpoel, Dr., on Obstructive Quarantine  21
---on Purification of Havana Harbor.....112
---on Quarantine...............  159,161, 162
Views on Yellow Fever in Barbadoes......  88
Virchow's Archives................... 145, 148
Wager, Sir Charles, instigates Anson's Ex-
  pedition ...........:....................  83
Walker, Richard, on Anson's Expedition...  83
Warren on Barbadoes.....................  89
Watson, A. F., Assistant Surgeon, Fever at
  Fort Brown............................  59
Webster, Noah...........................  76
---on Origin of Pestilence................  28
---Brief  History of Epidemic  and Pesti-
  lential Diseases of 1799................ 28, 76
Wilson, Dr., on Cause of Yellow  Fever.....  29
Woodward, Dr. J. J., Address on Dysentery
  and Bacteria....................... 146, 147
Woodworth, Surgeon-General.........152, 171
Wragg, Dr.  William  I., suggested Tidal
  Drains.................................  102
Wyman, Professor........................ 198 
GENEEAL   INDEX.
                                      PAGE
Acclimatized Inland, Yellow Fever not___   85
Act approved April 18,1879...............  156
Africa, Yellow Fever not bred in...........  100
Ague Indigenous....................... 14, 33
Air carries Yellow-Fever Poison...........   25
----Disinfection of.......................  172
----Machines, Terquem on...............  182
Altitude affects Yellow Fever..............   28
Amazon River, LaRoche on the............   86
American Seamen, Yellow Fever in........   35
Anne Marie, Yellow Fever in..............106
Anson captures Pizarro's Galleon...........   92
Antigua, Yellow Fever in..................  Ill
Army, British, free from Yellow Fever du-
  ring American War.....................   29
Artificial Eefrigeration of Ships proposed by
  Dr. J. C. Faget.........................  154
Ashantee Campaign.......................  101
Asphyxia in Ships........................   67
Atlantic Yellow-Fever Center.............   68

Bacteria demand Oxygen..................147
----Influence by Temperature............  146
Ballast from West Indies..................   47
Barbadoes, Yellow Fever in...............  Ill
Bengal, Cholera in........................  183
Bilge, Disinfection of......................  172
Bills of Health............................  107
Boats, Oars, etc., transmit Yellow Fever ...   84
British Guiana, its  Topography and Dis-
  eases  ............................... ..   98
Busbridge Indiaman, Yellow Fever in the..   42

Cachexia Ossifraga........................113
Calenture, Nature of......................   87
Calm Belts, Atlantic......................   68
Camp Jacob in Guadeloupe................   26
Cap Francais, Yellow Fever in.............  112
Cape Coast Castle.........................  100
Cape Horn, Anson's Fleet doubling........   90
Cargo, Disinfection of.....................  173
--- not Dangerous from Yellow - Fever
  Ships...................................  161
                                      PAGE
Cattle Plagues, Losses by..................  74
Center, Yellow-Fever Atlantic.............  68
Centurion, Number of Sick on.............  89
Charleston Harbor, Foulness of............ 108
----Tidal Drains of...................... 102
Children of New Orleans.................. 126
----Epidemic Fever in................... 126
Cholera and Yellow Fever................. 181
Cities, Course of Yellow Fever in..........  25
Classification of Diseases in Man and Ani-
  mals................................. 18, 16
Cleft Fungi............................... 148
Cold, the Natural Antidote................ 170
----affects the Sick injuriously........... 198
---how to produce and apply  it........... 171
----Store of............................. 178
----Opinion of Board of Experts......... 155
----and Ventilation in Cities.............. 192
Commercial Loss  serious  through  Yellow
  Fever.................................. 169
Commission, International, Proposed...... 194
Compulsory Ventilation demanded.........169
Conclusions.............................. 195
Contagion in Yellow Fever................  20
Contagious Maladies......................  12
Contagionists on Ship Fever...............  57
Contagion, Spurious Form of..............  66
Contrast  and Comparisons................ 118
Cooling and Ventilating Ships.............. 186
Cuba, Yellow Fever in.................... 112
Curacoa naturally  Healthy................. 115
--- Yellow Fever in..................... 110

Daring Brig, Yellow Fever in.............. 107
Dasher, Yellow Fever in the...............  47
Delta of Mississippi, supposed Home of Yel-
  low Fever..............................  27
Destruction of Yellow - Fever Poison by
  Cold................................... 152
Developmental Phenomena................187
Disinfectants not used at Sea...............  71
Disinfection must be Thorough............163
Dominica, Yellow Fever in................ Ill 
GENERAL INDEX.
205
                                       PAGE
 Dryness of Ships insisted on  by Captain
   Cook...................................  95
 --- of Ships insisted on by Dr. Turner___  17

 Eclair, Yellow Fever in....................  53
 Effervescence and Defervescence of Yellow
   Fever.................................. 123
 Effluvia, Bacon and Bancroft on...........  62
 Elephantiasis..............................101
 Epidemic Diseases, Statement to Congres-
   sional Committees on................... 171
 Epidemic Nucleus near Shipping..........  25
 Equatorial Atlantic-Ocean Typhus......... 197
 European Outbreaks of Yellow Fever...... 104
 Euryale, Yellow Fever in.................  54
 Extinction of Yellow Fever by Frost.......  26
 ---of Yellow Fever by Northers.........  27

 Features of Plan for Eefrigerating Ship. 184,186
 Fire as a Disinfectant......................188
 --- for Ship Ventilation..................  95
 Foulness, Sources of to be removed........ 171
 Frost, Extinction by.......................  26
 ---where  unknown Yellow Fever Peren-
   nial....................................  27
 ---does not prevent Paludal Fevers...... 122
 Fungi, Cleft and Sprouting................148

 Galleons, Spanish.........................  81
 General Green Frigate, Yellow Fever in....  42
 Germ Theory defined.....................145
 --- Theory " not proven "................ 149
 ---Theory too widely applied............  14
 Germs, Unrecognizable.................... 148
 Guadeloupe, Yellow Fever in.............. 110
 Guiana, British and French, Yellow Fever in  98

 Hayti, Yellow Fever in.................... 110
 Heat as a Disinfectant..................... 187
 Hecla, Yellow Fever in.................... 106
 Hibbert, Ship, Yellow Fever in............  46
 Hindostan, Home of Cholera............... 132
 Historical Considerations.................. 174
 Hospital Ship sinking in New York........ 164
 House and Ship, Transmission of Fever___  85
 How Yellow Fever develops.............. 142

 Ice, Extinction of Yellow Fever by.........  26
 Immunity, Causes of...................... 141
 Impurities augment Yellow Fever.........  26
 Indian's Violent Eemedy in Disease........  78
 Infected Cities, Location of................  26
 ---Ships?  Which are....................  24
 ---Vessels.............................. 168
International  Cooperation................. 198
----Effort essential to Yellow  Fever ex-
  tinction.................................  11
---or Contagious  Maladies...............  12
Isabella, Yellow Fever in.................. 110
                                      PAGE
Jail and other Fevers, their propagation___  62
Jamaica, Yellow Fever in.................. Ill
Juan Fernandez, Anson's Ship at...........  91

Kendal's Fever...........................  89

Land and Ocean Plague, a Contrast......... 131
---Yellow Fever not naturalized on.......  33
---Yellow Fever never Originates on.....  41
Lemaire, Straits of.......................  91
Lepra.................................... 100
Llanelly, Yellow Fever in.................. 107
Location of Infected  Cities................  26

Macedonia, Frigate, Board of Inquiry on___  43
Machinery, Eefrigerating.................. 173
Maladies, Contagious or International......  12
---Indigenous...........................  18
---Independent..........................  14
Marine Hygiene, Dr. A. N. Bell on......... 166
Mary, Sloop, Yellow Fever in..............  47
Matlazahuatl..............................   79
Mauritius, Cholera in...................... 133
Maury, Climate of the Sea.................  36
Mediate Communication of Yellow Fever... 122
Martinique, Yellow Fever in........... 107-109
Memphis Outbreak, its Cause..............  72
Mid-ocean Origin of Yellow Fever.......39-55
Minden, H. M. S.,  on Asphyxia in..........  67
Montserrat, Yellow Fever in............... Ill
Mortality in Anson's  Ships................  92
Molds.................................... 148

Nancy, Yellow Fever in the................  53
National Measures adopted................169
Naturalization of Yellow Fever on Land Im-
  possible.................................  83
Nautical Typhus..........................  20
---Audouard on.........................  61
Naval Engineers, Eeport of................ 176
Nievres, Yellow Fever in the.............. Ill
Non-intercourse System................... 164
Non-personal   propagation   of   Yellow
  Fever................................... 185
Norther, stops Yellow Fever in Vera Cruz..  27
Nucleus, Epidemic, near Shipping..........  25
Nyaden, Yellow Fever in the..............  50

Ocean and Land Plague, a Contrast........131
Ocean Origin  of Yellow Fever, Dr. Ferguson
  on......................................  88
---Origin of Yellow Fever, Dr. Peixotto on 115
Oola Bebee, Goddess of Cholera............ 132
Oriflamme, Yellow Fever in the............  38
Origin of Yellow Fever, Tropical Atlantic.  36
---of Yellow Fever, Floating Center......  8S
---of Yellow Fever, Mid-ocean...........  39
Oroya Fever.............................. 129
Oxford Black Assizes......................  64

Pacific Ocean, Centurion  crosses,  without
  Yellow Fever...........................  92 
206
GENERAL  INDEX.
                                      PAGE
Paludal Fever after Frost.................. 122
Phagedena Inoculable..................... 140
Phenomena, Developmental................ 186
Phylloxera Vastatrix, the  Cause of a Vine
  Disease.................................  12
Plymouth, Yellow Fever in the......... 57,165
Port au Prince, Yellow Fever in........... 112
Port de Paix, Yellow Fever in ............ Ill
Porto Eico, Yellow Fever in............... Ill
Principe Animique, Hirn's................. 139
Public insists on Life-saving Measures..... 169
Pulse and Thermometer in Yellow Fever... 128
Putrefying Substances deoxydize...........  34
Pyaemia..................................  64
Pyramus, Yellow Fever in the.............  47

Quarantine, Dr. Vanderpoel on..........  21, 24
----making it pay........................ 121

Rattlesnake, Yellow Fever in the..........  53
Reasons for using Cold.................... 170
Refrigeration, cost of...................... 174
----work to be done on Ships......... 177,184
Regalia, Yellow Fever in the...............  53
Remittent and Intermittent Fevers........ 114

Sailing Vessels, Yellow Fever in...........  22
Sailors attacked by Yellow Fever...........  34
Saint Catherine's, rest of Anson at.........  88
----Christopher, Yellow Fever in......... Ill
----Croix,             "      "......... HI
---Lucia,            "      "......... Ill
---Thomas,           "      "......... Ill
---Vincent,           "      "......... Ill
Sanitary Measures pay..................... 169
----Police, Essential Afloat................ 165
Savannah Board.......................... 166
Scurvy in Anson's Fleet...................  91
Sea Diseases, Knowledge of desirable......  10
Sea-Water Temperature...................  69
Bepsin or Septine.......................... 145
Ship, the Refrigerating.................... 175
Shipping, Epidemic Nucleus near...........  25
----how to deal with it................... 159
Ships, if Damp, Unhealthy.................  17
----which infected........................  24
----which originate Fever at Sea........41, 55
----Classification of....................... 165
----Diflflculties of Ventilating..............  66
----Asphyxia in..........................  67
----in Calm Belts.........................  6S
----as affected by Sea-Water Temperature.  69
----Favorable to Yellow-Fever Development 60
----Infected  usually in Distress........... 174
----not naturally Permeable to Air........  64
----Refrigeration of, Work to be done. 177,1S4
----Poison in............................ 143
----Sickly............................... 136
----   "   Sir Gilbert Blane on............  89
----Special for Special Cargo..............166
                                      PAGE
Ship-Surgeon  on  Origin  of  West-India
  Fever...................................   2
Ships,  Wine-fermenting is  productive of
  Yellow Fever...........................  52
Shock in Surgery.......................... 138
Sickly Ships..............................  89
Small-pox in Mexico.......................  80
Souverain, Yellow Fever in the............  54
Spanish and Portuguese Traders...........  80
Splenic Fever Indigenous..................  38
Spontaneous development of Disease........  65
---Generation, Doctrine of...............  14
Spores and Bacteria as affecting Tempera-
  ture.................................... 146
Sprouting Fungi.......................... 148
Squadron, Ships comprising Anson's.......  84
Steamers, Yellow Fever in................  22
Sucking or Trematode Worms.............  88
Susquehanna, how Frozen 1................ 158
Swansea, Yellow Fever in................. 106
Syphilis and Phagedena................... 140

Temperature as affecting Spores and  Bacte-
  ria ...................................... 146
---of Sea-Water, in relation to Ship Ven-
  tilation ..................................  69
Thermodynamics, the Groundwork of other
  Sciences.................................   5
Thermometer and Pulse in Yellow Fever... 123
Tidal Drains of Charleston................. 102
Tobago, Yellow Fever in................... Ill
Topaze, Yellow Fever in the...............  99
Traders, Spanish and Portuguese...........  80
Transmission, Yellow Fever...............  84
Transmutability from Remittent  to Yellow
  Fever not observed...................... 115
Transport, Yellow Fever in................  47
Trinidad, Yellow Fever in................. 110
Type  of  Disease  in  Eastern and Western
  Atlantic...............................  55
---and Specificity of Yellow Fever....... 123
Typhus, Yellow Fever a Hybrid...........  61
----and Yellow Fever in a Ship............136

Unformed Ferments....................... 145

Ventilation, Abundant,  favors Bacteria, but
  prevents Yellow Fever.................. 147
----at Sea should be Compulsory......... 169
----of Ships, essential Conditions for...... 191
----of Ships by Fire.....................   95
---- of Ships, DiflBculties of................   66
Vega Royale, Yellow Fever in............. 110
Verrugas, Andean........................ 118
Vessels, Treatment of Infected............ 169
Vine Disease exported  from  America......   12
Virginia  more Insalubrious  than Went In-
  dian Islands...........................   80
Voyage, Anson's, round the World.........
----Captain Cook's......................   94 
GENERAL  INDEX.
207
                                      PAGE
Voyage, Sir Walter Raleigh's..............  62

Water, Diseases springing from............  88
----Trematode and Sucking Worms from.  88
---ofAtlantic...........................  84
West Indian Fever Originates in Ships.....  27
--- Islands more Healthy than Virginia...  80
----Islands, Yellow Fever  does not Origi-
  nate spontaneously in...................  81
--- Islands, supposed Proper Soil for Yel-
  low Fever..............................  81
----Islands, Dr. Daniel Osgood on.........  82
---- Seas, all Ships in, possibly Infected...  24
Where Yellow Fever develops.............142
Wounded attacked by Yellow Fever....... 105

Yellow Fever, Ancient History of..........  77
----a Disease of the Atlantic..............  27
----affected by Altitude..................  28
----and Bilious Remittent compared.. 118-121
----and Cholera.......................... 131
--- augmented by Impurities.............  26
----does not Originate in inland Lakes and
  Rivers................................. 142
--- due to Ocean Putrefaction............  16
----European Outbreaks.................104
---- Indigenous to the Sea................  16
---- Indigenous to Ships..................  72
----in Anson's Ships.....................  87
----in British and French Guiana.........  98
----in Charleston........................ 101
                                      PAGE
Yellow Fever, in Raleigh's Fleet...........  82
---- Prevention of, in Cities............... 192
----in Steamers and Sailing Vessels.......  22
----Names for........................... 197
----Naturalization on Land impossible..  88, 85
----Transmission of......................  84
----nowhere Indigenous on Land.........  60
----not bred in Africa....................  26
— not Contagious in Demerara..........  99
----Origin of, at Sea......................  10
----Origin of, in the Atlantic.............  86
----usual Course of.......................87
---- Pathology of, has been a Mystery.....  10
----passing directly from Foul Ships to
  Foul Dwellings.........................  25
----Perennial where Frost is unknown___  27
---- Prevention of........................  151
----Prevention  of demands International
  Effort..................................  11
---- Prevented by Ventilation and Cleanli-
  ness....................................  10
---- Propagation of, Non-personal.........  135
---- supposed importation of, with Levant
  goods..................................  39
----unknown before Columbus...........  18
----to be attacked off Land...............  164
----where found?........................  18
----Poison loses  Vitality  in  the  Open
  Air....................................  22
---Poison not Bacteria..................  147
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