YELLOW FEWER, 
Or “YELLOW JAUNDIOE” 
IN 
NEW ORLEANS IN 1882. 
Disputed Case of Louis (or Ludwig) DescMer. 
By STANFORD E. CHAlLLlS, M. D. 
P rof. of Physiology and of Pathological Anatomy, Medical Department, 
University of Louisiana. 
fc. GRAHAM & ION, •TATWHEftS AND PRINTtRS, 127 6RAVIIR IT., N. 0. Yellow Fever, or “ Yellow Jaundice” in New Orleans in 
1882. Disputed Case of Louis (or Ludwig) Descliler. 
BY STANFORD E. M. D. 
Professor of Physiology and of Pathological Anatomy, Medical Department, University 
of Louisiana. 
[Read August 5th, 1882, before the New Orleans Medical and Surgical Association and 
published at its request.] 
Louisiana has only two officers whose duty it is to study aud 
to teach pathological anatomy. These are the accomplished 
microscopist, Dr. EL D Schmidt of our Charity Hospital, and 
myself. The official report of the former, upon the post- 
mortem examination of Deschler, was published in the 
August No. of the New Orleans Medical and Surgical Jour- 
nal, and as I also, wituessed the same p )st-mortem, I shall 
now contribute, as a pathological anatomist, the facts observed 
and the views entertained by me. 
This contribution is prompted by the following facts : Dr. 
Jones, President State Board of Health, who, like Dr. Schmidt 
and myself witnessed only the post-mortem, assigns or suggests 
four causes for the death, viz: Alcholism, Bright’s disease, 
Jaundice and Malarial Fever.* Dr. Chas. E. Schuppert, a gradu- 
ate of 1879, who examined the patient very casually on July 
12th, the first day of his last sickness, aud more carefully, but, 
as there is good reason to believe, without taking the pulse otf 
temperature, in a dark room, aud for the second aud last time 
on the 13th, diagnosed gastro-duodeuitis aud jauudice. t 
*See Aug. No- N. O. Medical and Surgical Journal, pp. 154-5, Wherein will also be found 
the decisive report of Dr. Miles, House Surgeon of the Charity Hospital. 
tSeeN, 0, Picayune of July 19th. 1882. 2 
Farther, the proceedings of the State Board of Health, as pub- 
lished in the Times-Democrat of July 21st, reported that one 
member denounced the National Board of Health as follows: 
“The appalling spectre of yellow jaundice, if notof yellow fever, 
had to be thrown upon the Cougressioual camera. If that did 
not accomplish the object, the only hope left would be a recur- 
rence of a Plaquemines rice fever epidemic.’' And, finally, the 
Picayune, abetted by the local press generally, very broadly 
intimated, that Drs. Jones and Schuppert, alone of the eleven 
physicians who examined the case alive or dead, understood 
their business, in as much as it was “a pronounced case of 
alcoholism and jaundice” and that the rumors that it was yel- 
low fever were “unfounded.”* 
It is worthy the consideration of the medical profession, 
whether the rumors originating from the conscientious opin- 
ions of all of the eleven physicians, except Drs. Jones and 
Schuppert, were in truth unfounded. It should not be for- 
gotten that among the nine, who differed from these two, 
there were five State officers, namely, the House Surgeon, As- 
sistant House Surgeon, Pathological Anatomist, physician 
attending the Ward and the Chairman of the Board of Admin- 
istrators of the Chairity Hospital. With these officers the 
representative of the National Board of Health concurred to the 
extent, that the post-mortem gave “ strong though not conclu- 
sive evidences of yellow fever. ” However, before the corpse 
was seen, from which this opinion was derived, four of these 
State officers had already diaguosod yellow fever. It should 
also be remembered, that out of the eleven physicians, four of 
them, in addition to Dr. Schuppert, saw the man alive either 
on the 16th or 17th, or on both of these two last days of his 
sickness jt that these four (one being a graduate of 1880) con- 
curred in the diagnosis of yellow fever; and that, as is well 
*See Picayune of July 19tb, 1882. 
tLouis Deschler 31 years of age, an Alsation by birth, and a brewer by trade, wa* 
admitted into the Charity Hospinal at 9 A. M., Sunday July 16th, died Monday 12:30 P. M 
and the post-mortem was made about 3:15 P- M the same day. It was during this tim« 
that all of the eleven physicians, except Dr- Schuppert, saw the case- Therefore, of the 
total ten physicians who saw Deschler alive or dead on the two last decisive days, all 
except Dr. Jones, President of the State Board, believed the death due to yellow fever. 3 
known to all, the diagnostic evidences of this disease are far 
more decisive on the two last than on the two first days of its 
existence. All yellow fever experts are familiar with the great 
frequency of such occurrences as the very recent one, where 
Johannes Stroh, who died August 1st, of unquestionable yel- 
low fever, as unanimously declared by eight physicians (three 
of them being members of the State Board), was not even 
suspected by his attending physician with having this disease 
until the very morning of the day of Stroll’s death, although 
he had been visited by his physician July 30 aud 31st, as well 
as on August 1st. 
On the one hand, there were, as already stated, nine physi- 
cians who believed that Deschler died of yellow fever, aud on 
the other hand, there were two who suggested five other causes, 
namely: alcoholism, Brights disease, malarial fever, (of 
course, hsemorrhagie malarial fever), jaundice and gastro- 
duodeuitis. 
Was Deschler’s death due to any one or to a complication of 
several or of all of these five causes? 
He was represented by many to have been an habitual and 
excessive drinker, and especially, of beer, as he was a brewer, 
but some few of those, who knew him well, averred that he was 
a very moderate drinker of beer. All the evidence, I have ob- 
tained, is to the effect that he was a most excellent aud desirable 
workman, which is inconsistent with excessive intemperance. In 
any case, his liver was as smooth as au egg, entirely free from 
granulations, hobnail tuberosities, cirrhosis and any evidence 
of the increased tibroid tissue so characteristic of alcoholism. 
He died on the sixth day of his sickness, with a temperature of 
109°F. aud without symptoms of delirium-tremens, the only 
result of alcoholism which kills so quickly. The frequency 
with which yellow fever attacks the intemperate is well known. 
Did Deschler die of Bright’s disease ? I examined the kid- 
neys macroscipically ouly, and found them large, as usual in 
yellow fever, from blood engorgment, but their structure 
appeared so normal that my suspicion of Bright’s disease 
was not even aroused. There was no dropsy or even oedema, 
nor has any evidence been given of albuminuria and of urae- 4 
mia, prior to his admission, on the 16th, to the Charity Hospital. 
Yellow fever is often attended, as in this case, with forty- 
eight hours suppression, the passage of a few ounces of highly 
colored urine, loaded from one-third to one-half with albomen, 
uraemia, high temperature and death ; if Bright’s disease ever 
thus kills I have never seen it. So far as the microscopic ex- 
amination of the kidneys is concerned, Dr. Schmidt, who made 
it with great care, states as follows: “ The kidneys at the 
death of the patient, were in the initial stage of degeneration, 
such as 1 have described in my treatise on Yellow Fever.’’ 
“ The declaration that Deschler died from Bright’s disease, yet 
with an intensely congested brain, absence of dropsy, etc., ap- 
pears to me not only unscientific but preposterous. Bright’s 
disease is, as everybody knows, a chronic affection, in which 
the brain towards the close (death) is anaemic and oedematous.’’ 
Did Deschler die of hemorrhagic malarial fever ? The 
liver as well as the spleen were free from the characteristic 
pigmentary deposits and the spleen was firm, normal in ap- 
pearance and small in size for a man so large and robust. 
In April, 1879, when fresh from the study of the epidemic of 
1878, Dr. Joues, Professor of Chemistry and uow President 
State Board, presented, in the Proceedings of the Louisiana 
State Medical Society, his “ general conclusions as to the na- 
ture of yellow fever, which I (Dr. J.) have drawn from my 
original investigations during the past twenty-three years.” 
Concerning the liver and spleen he states, p. 159, the following 
well known facts, confirmatory of my experience since 1851 
aud also of everybody’s recorded evidence. “ In malarial 
fever, both these organs are loaded with the altered blood cor- 
puscles and with the pigment granules resulting from the al- 
terations of the colored corpuscles, whilst neither the spleen 
nor the liver in yellow fever afford any evidence of alterations 
of the colored blood corpuscles.” He describes the yellow 
fever spleen, “as a general rule but slightly enlarged. In 
many cases normal in size and appearance.” On the other 
hand, the malarial spleen is described as “ enlarged, softened” 
and “ in many cases the spleen is so soft that it ruptures when 
the attempt is made to remove it from the cavity.” 5 
In addition to the significant facts stated concerning the spleen 
and liver, it is equally as significant, that while there were extra- 
vasations of blood from the gums and stomach, there was no 
blood in the urine. The hmmaturia, so frequent in hemorrhagic 
malarial fever and so important in the differential diagnosis, 
was entirely wanting. 
Did Deschler die of gastro-duodenitis and jaundice resulting 
therefrom ? Gastro-duodenitis does not destroy life in less 
than six days, with hemorrhagic lesions, suppression of 
urine, albuminuria, uraemia, and a temperature of 109° F. The 
jaundice, which frequently results from gastro-duodenitis, is 
due to biliary obstruction, which, according to my own ex- 
perience and to all authorities, always produces discoloration 
of the liver-tissue with bile pigments. The liver-tissue was 
as entirely free from bile pigments as from the slate colored 
deposits of malarial fever. Further, in jaundice from obstruc- 
tion, the gall bladder is habitually distended with bile, but, in 
this case the gall bladder, while not empty, was flaccid. 
If the jaundice was not due, as it certainly was not, to ob- 
struction, whether by gastro-duodenitis or by cirrhosis or by 
any other cause, then, to what was it due? Frerichs, Murchi. 
son and all authorities agree that, when jaundice is not caused 
by biliary obstruction, it is due generally to morbid changes of 
the blood, such as dissolution of its red corpuscles, and that 
these changes result from specific poisons, especially from spe- 
cific fevers and more especially from yellow fever. Jaundice 
may occur iu malarial fever, but I have yet to learn that 
malarial fever with jaundice ever destroys life and yet fails 
totally to discolor the liver, either with biliary or malarial pig- 
ment. I have never either seen or read of any such case, and 
Dr. Jones’ “ original investigations ” to 1879 justify the pre- 
sumption, that he never had. On the other hand, uncompli- 
cated yellow fever does present livers free from these discolora- 
tions. It also deserves notice, that of the various diseases 
(other than yellow fever) which produce jaundice independent 
of biliary obstruction, notable hepatic lesions, not present in 
this case, occur, such as atrophy, softening, etc. Although no one of the five causes suggested suffices alone 
to account for the death, yet it deserves consideration, whether 
a combination of these causes might not suffice. The evidence 
on this view will be adequately completed, it is believed, in 
now considering whether Deschler died of yellow fever. 
The integument struck me as of an iutenser and brighter 
yellow than usual in yellow fever. However, La Roche cor- 
rectly teaches that tbe shade of yellow, in different persons 
and in different epidemics, varies greatly. Dr. Jones reports, 
in this case, that the “exterior, [was] golden coloied” On p. 
151 of his “original investigations” he states, as to the exterior, 
that the “skin of face and upper portions of trunk [arejof a 
golden yellow coler.” Many authors use, in their descriptions, 
the same words. Dr. Jones also reports, that there was “ no 
marked mottling of the dependent portions ” of Deschler’s 
body; in truth, the mottling was well marked to others, but 
not as excessive as usual, which was not surprising, since the 
body was examiued with unusual promptness, that is, within 
three hours after death, on a cool pleasant day, when the maxi- 
mum temperature was 28° and the minimum 76 5°. 
The eyes of the corpse were jaundiced, aud failed as usual 
*b present the marked capillary iujection testified to as existing 
in life. The tongue had a raw, glazed look at its tip and 
edges, confirming the evidence that it had presented, in life, 
the appearance usual in yellow fever. 
The gums after death were not red and spongy in Deschlers 
case, nor in the two undisputed cases, thus far in 1882, of 
either Forbes or Strob,* nor usually after death, but there was 
evidence of hemorrhage from the gums, which in life were said 
to have been swollen, red and bleeding. 
The mucous membrane of the stomach and the omentum 
were much injected from blood-engorgement. The few ounces 
of neutral liuid in the stomach had a dark purplish color, the 
latter hue being undoubtedly due to blood. It also contained 
some bile, inappreciable to tiie eye, but giving a green reaction 
with nitric acid. La Roche calls attention to such discolored 
* Forbes, an imported and the first case, died June 26th, Descbler July, 17th aud Strob 
August 1st, 1882. 7 
fluids, as having been frequently observed as precursors of 
veritable black vomit, which this fluid certainly was not. Bile, 
but usually in abundance, characterizes the vomit of hemor- 
rhagic malarial fever; on the other hand, Dr. Joues is not alone 
in stating that bile is not always but “ almost always absent 
from the black vomit of yellow fever” (p. 156, Op. cit.). 
The heart, kidneys, bladder and brain preseuted ecchymotic 
spots or patches. These ecchymoses, with the extravasations 
of blood from the gums and stomach, aud with the high tem- 
perature, which exceeded in the liver 107° three hours after 
death, stamp the disease as, beyond all question, a hem- 
orrhagic fever. 
There was a very little urine in the dead bladder. Nitric 
acid and heat coagulated fully one-half of it. As is not infre- 
quent in yellow fever, and as is more frequent in bilious ma- 
larial fever, it contained some bile. Dr. Layton and myself 
both observed several broken granular casts, but neither in 
the casts, nor in the fluid, were there any blood corpuscles. 
However, on p. 142 of the publication already cited, Dr. Jones, 
differentiating hemorrhagic malarial from yellow fever, taught, 
that, u as a general rule, albumen is abseut from the urine in 
malarial fever, and when present, as in malarial haematuria, it 
is accompanied with blood corpuscles and with casts of the 
tubuli uriniferi containing blood corpuscles.” (See also p. 161.) 
While th * spleen did contra-indicate malarial fever, it did 
not contra-indicate yellow fever. While the liver contra-in- 
dicated malarial fever, alcoholism and jaundice by obstruction, 
it did not contra-indicate yellow fever. It was large, from 
blood engorgement, and of normal color, except that there 
were a few small yellowish patches by the side of the broad 
ligament. Had the entire liver been of the color of these patches, 
it would have been describable as the characteristic cafe au lait 
liver of Louis. Under the microscope the liver cells, in the 
sections of the small portion of the liver examined by me, were 
well dotted with minute fatty granules, but did not present 
the appearance, frequent in yellow fever, of gross fatty infll- 8 
tration.t 1 have preserved specimens of the liver, of the urine 
and of the stomaeh-tiuid for the examination of experts. 
The very important fact remains to be stated, that Desehler’s 
three most intimate friends, Georger, Stefan and Betzer,t fel- 
low-countrymen who knew him, the first iu Alsace and the 
three since his arrival in New Orleans, all testify positively 
that he was not acclimated and did not have yellow fever in 
1878. His special friend Georger, a native and resident of the 
same village, came to New Orleans in the same steamship with 
Deschler, iu October, 1872. 
As to the cause of death, the following pregnant facts seem 
certain: Deschler was uuacclimated; he did not cease work 
until he was found sick on Wednesday morning, July 12th., 
and he died a little after mid day on the following Monday, 
July 17th; he had evidences of jaundice on the second day of 
his sickness as testified by Drs. Sohuppert and Fisher (the 
latter saw him only for a moment accidentally) and Mr. Maus, 
foreman of the brewery ;| he suffered with great epigastric 
tenderness; he had a hemorrhagic fever of some kind; his eyes 
were injected; his tongue was red at its tip and edges; his 
gums were injected, swollen aud hemorrhagic; his omentum 
and stomach were gorged with blood, aud the latter coutaiue d 
alter death a bloody fluid; ecchymoses were found upou or 
within his heart, kidueys, bladder and brain ; there was sup- 
pi essiou of urine for forty-eight hours, aud the little urine 
finally secreted was highly albumiuous; he died with symp- 
toms of unernic poisoning, aud with a sudden rise of tem- 
perature from 105° at 9:30,A.M., to 109° at 12:30,P.M., when he 
died. 
The usual significance of these symptoms and lesions is well 
known. It is also well known, that such high temperatures 
occur iu fewr diseases; that a sudden rise of temperature before 
•Dr. Schmidt, whose authority in microscopy I defer to, and who examined th eliver 
more thoroughly than I did, states: “ While the organ still showed, in some places, the 
traces of portal congestion, it presented, in others, the characteristic appearance of com- 
mencing fatty infiltration.” 
tXhe first now at Weckerling’s and the last two at Auer’s Brewery. 
jOut of 385 cases recorded by Blair, eight were jaundice on the first day, sixteen on 
the second, etc. See La Koche on Yellow Fever, p. 231, vol. I. 9 
death, always remarkable, occurs in still fewer diseases, but 
not in any of the five suggested diseases ; and that both pecu- 
liarities have been long recognized, the former as a frequent, 
and the latter as an occasional characteristic of fatal yellow 
fever. Dr. Jones, on pp. 139, 140, 145, etc., of his “ origina- 
iuvestigations ” calls special attention to this symptom as one 
of those differentiating malarial from yellow fever. He records 
one case, where, as in this case, the temperature, before death, 
suddenly ascended to “ 109° on Gth day.” He teaches, that in 
malarial fever, the temperature does not exced ]07.5° and 
that this occurs only during the paroxysm. Wunderlich’s 
high authority is that in malarial diseases the thermometer is 
“ only exceptionally a little higher than 106.7°,” and in his 
work of 1868 he called attention to the sudden rise in fatal 
cases of yellow fever. 
These facts can leave little doubt, in the mind of any un- 
prejudiced physician, that Deschler died of yellow fever. 
Neither jauudice, nor gastro-duodenitis nor alcoholism, nor al- 
buminuria, nor malarial fever present the symptoms and lesions 
seen in his case, and there is little reason to believe that any 
i combinatiou of these diseases could produce the symptoms and 
i lesions observed on July 16th and 17th. However, there is no 
incompatibility betweeu yellow fever and any of these diseases, 
so that, feven if ic could be proved that jauudice, or any one or 
more of the five causes had existed prior even to August 12th, 
' it could not be denied that yellow fever might, none the less, 
have been, and most probably was, the immediate cause of 
death. 
Whatever some doctors, the newspapers, the public and 
politicians might report, I have had perfect confidence that the 
vast majority of the medical profession would, when all the 
facts were known, unhesitatingly decide, that the representa- 
tive of the National Board was thoroughly justifiable in de- 
claring that the post-mortem gave strong evidence of yellow 
“ fever, confirmatory of the diagnosis made by all four of the 
physicians who last saw Deschler alive. 
The only fear felt has been, that many physicians might be 
surprised that the post-mortem evidence was not considered 10 
The reasons were as follows: All the facts 
now stated were not known on the night of July 17th, when 
this opinion was formed. The pathological anatomy of yellow 
fever still lacks pathognomonic lesions, and the cases are cer- 
tainly very few where, when the disease is not prevailing, the 
pathological anatomist, without recourse to the clinical history, 
could pronounce the lesions conclusive. In this case, two of 
the most important lesions, the gastric and hepatic, though 
compatible with yellow fever, were none the less, not decisively 
characteristic. While these facts justified a guarded opinion, 
they were insufficient to prevent the case from being considered 
a very suspicious one, as it officially became, and from necessi- 
tating all sanitary precautions, justified in undoubted mellow 
fever. 
It deserves the consideration of those who believe, as I do, 
that yellow fever is communicable, that Deschler’s case could 
not be traced to any such source and that no evil results have 
apparently followed, within the three weeks which have now 
elapsed since his death.* To this objection to the diagnosis of 
yellow fever, the only answer is, that the sporadic, untraceable 
and fruitless cases of yellow fever have, at all times and 
in all places, proved, heretofore, more numerous even than 
those which could be traced to a communicable source. 
Hence, many wise and experenced physicians still insist 
that yellow fever is not communicable. However, trichi- 
nosis, helminthiasis of all kinds, diphtheria, typhoid fever 
and cholera are all communicable diseases, as, in intenser 
degree, are gouorrhcea, measles, searlet fever and small pox, 
yet, no one now doubts the communicability of any of these, 
because he may find it impossible to trace to their source many 
cases of even the four last named diseases, which all admit are 
communicable in far higher degree than yellow fever is be- 
lieved to he. In any case, no true lover of science will permit 
the full and faithful record of facts to be prejudiced by any 
theory whatever. 
*Duchler lived and apparently contracted his diseases BOme three miles distant from 
the first imported case, (Forbes] and also from the first undisputed local case (Stroh). 11 
In concluding this report of Deschler’s case, I fully concur 
in the conclusion of the Hospital Pathologist, Dr. Schmidt, and 
testify, as a Prof, of Pathological Anatomy, that, while I can- 
not declare it impossible that Deschler may not have died from 
a combination of causes exclusive of yellow fever, I have, none 
the less, often seen such lesions in this disease, but never in 
any other disease or combination of diseases. 
It is worth nothing, that this case has secured a record in 
the U. S. House of Representatives. Our newspapers of 
August 5th reported that on the 4th the Hon. S. S. Cox, of New 
York, “ referred to an article in a New Orleans paper, to show 
that the National Board of Health had attempted to get up a 
yellow fever excitement over a case, which afterwards turned 
out to be a case of jaundice, and said that it was by such means 
that the Board sought to perpetuate its salaries and its in- 
utility.” How much more monstrous the misrepresention 
might have been, if the representative of the National Board 
had not had the evidence and the concurring opinion of five 
State officers and of three other physicians, can be readily 
imagined. It is plain, that whoever would testify to au un- 
welcome truth must risk the insult of having even the honesty 
of his intention questioned. 
ADDENDA. 
The following additional facts deserve record. The very 
first information given the representative of the National Board 
was received a little before 3, P. M., Monday, July 17th, in the 
following letter: 
“ Charity Hospital, July 17th, 1882. 
Dr. S. E. Chaill£, Supvg. Inspr. N. B. H.: 
Dear Dr.—A case of yellow fever died in Ward 24 this even- 
ing at one o’clock. [This was subsequently corrected to half 
past 12 o’clock.] We will give you the history of the case. 
The body lies exposed for your examinatiou at auy time this 
evening. Very respectfully, 
A. B. Miles, M. D.,” House Surgeon. 
Not only is this official notification from a State officer silent 
about ‘‘jaundice,” but, the certificate of death, the registers of 
the Charity Hospital and of the Board of Health, all controlled 12 
exclusively by State Officers, fail to say a word about “yellow 
jaundice,” since they all unite in the same decisive official re- 
cord that the case was “ yellow fever.” It is thus manifest 
that, if a case of “yellow jaundice” was manufactured into a 
case of “yellow fever,” this great scientific feat was effected 
earlier and more decisively by the State officers of the Charity 
Hospital, than by the representative of the National Board, j 
If this leat was reversed, it has been made sufficiently clear 
who did it. 
In addition, the Chairman of the Board of Administrators of 
the Charity Hospital, a distinguished graduate (D. M. P.) of 
Paris, and a native resident of this city, highly esteemed by all 
in and out of his profession, has written, in vindication of the 
truth, as follows: 
“ New Orleans, August 8th, 1882. 
I witnessed Deschler’s post mortem and Prof. Chaille’s mi- 
croscopic and chemical examinations of the liver, urine and 
gastric fluid; and, I fully concur in his statements of the evi- 
dences thereof ami of the conclusions therefrom, as presented 
in his paper, read August 5th, before the New Orleans Medical 
and Suigical Association. 
Thomas Layton, M. D.” 
Children are taught to “ tell the truth and shame the 
devil,” but experience brings at last the conviction, that one 
may do the former, as I have done, without accomplishing the 
latter. Hence, an experienced medical professor may be par-1 
doued for warning his medical students at least, that truth has 
ceased, with the adults of this country, to prove a specific for 
bringing to shame the devils of ignorance, prejudice, self-inter- 
est ahd dishonesty. 
Since correcting proof of the above, Dr. Chas. E. Schuppert 
has made the following statements. Several of Decider’s ac- 
quaintances say, that, before July 12th, he had been “ treated 
for disease of the kidneys,” that his “skin and eyes looked 
jaundiced ” and that he had a spree on the 11th. Dr. Schu»>pert 
says, that he “ noticed a pale yellow cast of his skin and con- 
junctival” on 12th, that on 13th he observed “some oedema”' 
on his legs and “ signs of an old ulcer ” also “ some febrile ac- 
tion,” and that he saw him a third and last time on the 14th, 
“ when there was no material change in his condition.”