5  )  MOMS   (^Y«)
AN
                ESSAY

                    ON THK

  YELLOW   FEVEE,

       AS IT HAS OCCURRED IN CHARLESTON,

INCLUDING ITS OBIGlrf AND PROGRESS UP TO THE PRESENT TIME,
      BY THOS.  Y. SIMONS, M.D.,
PORT PHYSICIAN, FORMERLY PRESIDENT OF THE MEDICAL SOCIETY AND PROFESSOR
  OF PRACTICE OF PHYSIC IN THE LATE MEDICAL COLLEGE OF SO. CA., MEDICAL
   ADVISER AND FORMERLY CHAIRMAN OF THE BOARD OF HEALTH, ETC.
READ BEFORE, THE SO. CA. MEDICAL ASSOCIATION,
     at its Anniversary meeting, may, 1851.
       CHARLESTON,  S.  C:
STEAM POWER-PRESS OP WALKER AND JAMES.

                 1851. 
ft

I
K^
 
SIMONS ON YELLOW FEVER.
/
 
 
AN
ESSAY
  YELLOW   FEVEE,



       AS IT HAS OCCURRED IN CHARLESTON,



INCLUDING ITS ORIGIN AND PROGRESS UP TO THE PRESENT TIME,





        BY THOS.  Y. SIMONS,  M.D.,
 PORT PHYSICIAN, FORMERLY PRESIDENT OF THE MEDICAL SOCIETY AND PROFESSOR
   OK PRACTICE OF PHYSIC IN THE LATE MEDICAL COLLEGE OF SO. CA., MEDICAL
     ADVISER AXD FORMERLY CHAIRMAN OF THE BOARD OF HEALTH, ETC.
READ BEFORE THE SO. CA. MEDICAL ASSOCIATION,

      AT ITS ANNIVERSARY MEETING, MAY, 1851.
        CHARLESTON,  S.  C:

STEAM POWER-PRESS OF WALKER AND JAMES.

                  1851. 
 
ESSAY.
  On the present occasion, 1 propose to call your attention to
a consideration of the Yellow Fever as it has occurred in
Charleston, in which I shall confine myself, as far as practi-
cable, to the characteristics of the disease as exhibited among
us.
  In the performance of this duty, I will,
  1st. Give the history of Yellow Fever from its first appear-
ance  to the present time.
  2dly. Inquire into the causes which  have been supposed
to produce the disease.
  3dly. The former condition of Charleston, its present con-
dition, and the system of medical police adopted.
  4thly.  The peculiar character of the  disease and the diag-
nosis  between it and other fevers among us.
  5thly.  A succinct  view of the  various  remedial  agents
adopted  for its cure.
  In prosecuting this subject, I shall confine myself, as far as
practicable, to the  experience and observations of our own
physicians—omitting what relates to other cities in our own
or other countries.
  The first inquiry then, is, the history of the disease.*  The
yellow fever,  says Dr. Good, as far as we have any record
of its  origin, was at Barbadoes, whence it spread to different
West India Islands, and at length  made its appearance at
Boston, in North  America, in 1693, to which  place it was
carried from Martinique, by the fleet under Admiral Wheeler.

  * I may here remark that most of this is taken from my report to the Board of
Health, as its Chairman, in 1839. 
6
Simons on Yellow Fever in Charleston.
  Dr. Craigie, in his interesting article on  yellow fever, in
his work on the Practice of Physic, remarks :
  " It is uncertain  whether yellow fever prevailed among
the indigenous inhabitants of the American continent previ-
ous to the period when it was visited by Europeans.  From
the testimony  of Alzate and several Spanish authors, it ap-
pears that long before the arrival of Cortez in Mexico, a dis-
ease  named Matlazahuatl, attended with hemorrhages from
the nose and mouth, and extremely  fatal, used occasionally
to prevail among the native Americans, and was particularly
mortal,  so early as 1545 and 1546—and afterwards raged ep-
idemically in 1736-7, and 1761-2."
  Humboldt, indeed, maintains that this disease is totally
different from the  yellow fever, because it attacks the red
or copper colored race, and is confined to the interior and
elevated table  land of Mexico at 1200 or 1300 tasis—7200 to
7800 feet above the level of the sea.
  Dr. Craigie  does not think Humboldt's objections satisfac-
tory.  I must, however, regard  them as very potent if not
conclusive.  I have never yet heard of an instance of real
yellow  fever prevailing among the copper  colored race, or,
ia another phrase, American Indians.  Nor has  it prevailed
in any  agricultural districts.  It  has been confined exclu-
sively to cities, and cannot be propagated in the country, as
will in our progress of investigation be shewn—and in cities,
the blacks and mulattoes, for we have no Indians  in cities,
are almost entirely exempt.  My own opinion is, that Hum-
boldt was right as  regards the disease not being yellow fe-
ver.
  Dr. Craigie  again remarks:
  " One of the earliest distinct record of the disease, is given
by Echard, who informs—that when the expedition against
Hispaniola under Venables, returned to Jamaica, they met
there an enemy more severe than the Spaniards, which he
says was the plague, and which, he adds, in a little time re-
duced their army, originally 7000, to fewer than 2000."
  Dr. Craigie  regards this epidemic  as yellow fever and not
plague—in which opinion I concur.   On the  earlier appear-
ance  of  Yellow Fever  in  America,  and  particularly in 
Simons on Yellow Fever in Charleston.         7
Charleston, it was at first regarded as the Plague.   Having
given this general history of the first knowledge of the exist-
ence  of  yellow fever, we  will now consider its history
among us.
   Its first appearance in  Charleston  was in 1699 or 1700,
and it was  called by  Dr. Hewat the infectious distemper,
and considered by the inhabitants as  a  plague.  In  1703 it
again occurred.   It also made its appearance in 1728.  That
summer was uncommonly hot and dry;  the  beasts  suffered
from the want of water, and the fever raging with violence,
swept off an immense number of whites and some blacks.
The state of the city was  truly deplorable, as the town, says
Dr. Hewat, depended entirely on the country for fresh pro-
visions, the planters would suffer no person to carry supplies
to it, for fear of catching the infection  and bringing it to the
country.   The physicians knew not how to treat this uncom-
mon disorder, which was  suddenly caught and proved sud-
denly fatal.   The calamity was  so general, that few could
grant assistance to their neighbors.  So  many funerals  hap-
pening every day, while so many lay sick, white persons suf-
ficient for burying  the  dead were scarcely to be found.
Though they were often interred on the same day that they
died, so quick was the putrefaction,  so offensive and infec-
tious were the corpses, that even  the nearest relations seemed
averse from performing the necessary duties.   In  1732 and
1739, it raged with so much violence that when at its height
from  ten  to  twelve  died  daily.   It did not re-appear until
1745 and  1748,  and was  then comparatively mild.  A few
cases occurred in 1753 and 1755, and then there was a cessa-
tion of the disease until 1792, with the exception of a few
sporadic cases, which occur more  or  less every year.  " In
the year 1792," says Dr. Ramsay, " a new era of the yellow
fever  commenced.   It raged in Charleston in that year and
1794, '95,  '96, '97, '98,  '99, 1800, 1802, 1804 and 1807. A
few cases  occurred  in the years  1803, and  1805;   in  both
years its victims did not exceed  59.   In the years 1793 and
1808, the disease is not mentioned at  all;  and in the  year
1806 it is only mentioned as having occurred in a very few
cases  under particular circumstances.  In its visitations it 
8         Simons on Yellow Fever in Charleston.
extended from July to November, but was most  rife in Au-
gust and September;  with  a very few exceptions, chiefly
children, it exclusively fell on strangers.  The unseasoned
negroes were not exempt from its ravages, but they escaped
oftener than the  white strangers;  and when attacked they
had the disease in  a lighter  degree, and if properly treated
were more generally cured.  Persons, both black  and white,
arriving from the West  India Islands, enjoyed  similar ex-
emptions from the  yellow fever of Charleston.  In the year
1796 and 1798, it raged with  the greatest violence; but since
that time, has considerably abated both in frequency and vi-
olence."
  From 1807 to  1817,  we have no records of the existence of
this disease  as an  epidemic, although there were sporadic
cases.  In 1817, it prevailed with great malignancy.  It again
occurred in  1819,  1824, 1827, 1828, 1830,  1838  and 1839.
From the statements 1 have thus brought to your view, it will
be seen how irregular have been the visitations of this disease.
  I will now present  you, so  far as we have any records,
with the number of deaths  in these respective  years.  In
1699, the fever which prevailed, swept off  a great part of
the inahbitants and a number of families.  It was then con-
sidered to be a plague, " though afterwards," says Dr. Ram-
say, „" supposed to be the yellow fever."  " In 1723," Dr.
Hewat says, " the  physicians knew not how to treat the dis-
ease."  In 1732, when the population must have been very
small,  from  8 to 12 whites died daily, which exceeds  any
mortality in  our city since that time, although our  population
has greatly  increased.   The following facts I collect from
Dr. David Ramsay:
       In  1799,  there  were    -     -    239 deaths.
       "  1800,        "    -            184
       "  1802,   "           -     -     96
       "  1804,        "    -            148
       "  1807,   "           -          162
  From 1807 we have no account of the  existence of the
fever until 1817.  1 have collected the reports of  the disease
subsequent to that  period, from the  records of  the Board of
Health. 
Simons on Yellow Fever in Charleston.          9
  In 1817, there were 268 deaths, of whom were adult males
164; adult females 56;  and natives under eighteen 48.   19
blacks died, of whom 14 were males and 5 females.
  In 1819, there were  172 deaths; of whom 130 were adult
males, 24 adult females, and 18 natives under the age of 18.
There  were 5 blacks, 3 males and 2 females.
  In 1824, there were  236 deaths ;  160 adult males, 32  fe-
males, and 44 natives under 18.  No blacks  died this year
of the  disease.
   In 1827 there were 67 deaths ; adult males 40, females 3 ;
native children over fourteen 4, under that age 10; stran-
gers' children 6.  Blacks 2, who were males.
  In 1828, there were 26 deaths ; adult males 21, females 3,
native  children  1, strangers1  children 1.  There were  no
blacks.  This year, a disease having many of the incipient
symptoms of yellow fever, viz.,  the Dengue, prevailed as an
epidemic, affecting every one, but proving only in a few  in-
stances fatal.  It is probable that the prevalence of  this epi-
demic caused the  cessation of the yellow fever and limited
its extent.
  In 1830, there were 29 deaths ; adult males 23, females 1,
native children 1, strangers' children 4.  Blacks 1.
  In 1834, there were 46 deaths; adult males 28, females 10,
native  children  1, strangers1 children 5.  No blacks.
  In 1835, there were 26 deaths; adult males 16, females 5,
native  children 4.  Blacks 1.
  In 1838, there were 353 deaths ; adult males 281, females
30, native children 17,  strangers1 children 11.  Blacks 4 fe-
males.
  In 1839, there were 134 deaths; adult males 104, females
14, native children 8, strangers1 children 7.   Blacks 1 female.
The first appearance of the disease occurred earlier this year
than usual.
  The yellow fever did not appear in Charleston proper,
again,  until  1849.  But it made its appearance in 1841 in the
suburbs of the city, beyond the  incorporated limits.   No re-
gistry having been kept of  deaths, 1 am  unable to say how
far it extended,  But I believe  it was limited in extent, and
certainly did not occur in the city. 
.10        Simons on Yellow Fever in Charleston.

  In 1849, there were 123 deaths ; 89 males,  34 females.
Of whom, 65 from Ireland, 34 from Germany, 3 from Eng-
land, 3 from Scotland.  New-York 6, Boston 1, Georgia 1,
Italy 1, U. S.2, Portugal 1, St. Johns, N. B. 1, South-Caro-
lina 33, Charleston 2.  Total 123.
  Of the two cases in Charleston, one was a young gentle-
man who contracted fever from exposure on a sea island near
Charleston—was brought up to the city and died. The other
was a black man.
  From the condensed statements of  the fever in  this city
which have  just been made, we may deduce the following
conclusions, to which 1 invite your attention :
  The number of  native children who die  during the preva-
lence of fever is small in proportion to strangers, considering
the  great number  who are liable, and is remarkably small in
comparison with  those who die of other diseases to which
children are subject.
  All who have not been acclimated to Charleston, are lia-
ble  in the  years when it prevails, to  the fever, from which,
however, many escape ;   but those  from southern latitudes
are  much  less liable  than  those from northern  latitudes,
either in America  or Europe ; and those from our surround-
ing  country are much less liable than those from the upper
country.
  In conclusion, 1 may remark, that  all natives arriving at
the  adult age are exempt from this disease, as well as those
strangers who  have had the disease, and not having it have
been here many years
  The number of  male adults is greater than that of females.
There are more males liable to the disease than females, and
they are more exposed to exciting causes and more careless
in their habits and mode of life.
  The number of  blacks who die is small, and the deaths are
among those who have been brought from the  country and
are  unaccustomed to the city, but these cases are  rare and
generally mild  and manageable.
  The fever generally occurs at  the middle or end of July,
and prevails in August, September and October, and a few
cases sometimes occur in November.  In 1839, it commenced 
Simons on Yellow Fever in Charleston.        11
in June, and the only instance of its occurring earlier, was
in 1732, when it commenced in May and terminated in Oc-
tober.  The following statistics on  this point, are extracted
from the. records of the  Board of Health.
  In 1817, there were  3 deaths in July ; in August 80 ;  in
September 149 ; in October 33 ; in  November 3 ; and these
were in the beginning of the month.
  In 1818, in August 55 ; in September 27, and in October
20.
  In 1824, in August 32 ; in September 145;  in October 42;
in November 17.   The frost occurred  very early this year.
  In 18-27, in August 10; in September 38 ; in October 18.
  In 1838, in August 44 ; in September 219;  in October 77 ;
in November 6; which were in the  first week of the month.
  In 1839, there were  in June 5 cases ; in July 17;  in Au-
gust 73 ; in September 32 ; in October 9.
  There were fewer cases in September than usual, for as
soon as a peculiar fever  resembling the Dengue appeared,
the yellow fever began to disappear.
  In 1849, the first case occurred on the 26th August, and to
September there were  3 cases; in September 37 ; in October
65 ;  in November  18 ;  16 occurred up to the 10th of Novem-
ber, and 2 subsequently died in the Poor House, between the
26th and first of December.
   The  next question  which presents itself,  is,  the causes
 which produce this disease.  By some, and  at an early pe-
 riod, most physicians attributed its prevalence to importation.
   I am not disposed to enter largely into this  vexed question,
 upon which so much has been written,  and unfortunately with
 a partisan rather than  philosophic  spirit; and after all  the
 discussions for two centuries and better, there is still discrep-
 ancy of statements and differences of opinion upon this point.
 Let me  summarily bring to your notice the opinions of the
 most eminent physicians  among  us in Charleston, before en-
 tering upon the philosophy of this very important question.
   Dr. Lining, who first gave the most graphic description of
 this disease, remarks,  » and lastly, whenever the disease ap-
 peared here, it was  easily traced  to  some person who  had 
12
Simons on Yellow Fever in Charleston.
lately arrived from some of the West India islands, where it
was epidemical."
  This eminent physician does not give us any evidence in
confirmation of this sweeping proposition, and it is not unfair
to conjecture that his mind was  biased  by the opinion that
the  disease was first brought to Boston by Admiral  Wheeler,
from Martinique, in 1693.  As Dr. Rush, when he recanted
his  opinion of the  propagation of the disease by contagion,
acknowledged he was led to ascribe the yellow fever prima-
rily in Philadelphia, in 1693-4 and 97, to contagion, he was
influenced by the opinion of Dr. Lining  and others.
  Dr. John Moultrie, of Charleston, who wrote an admirable
thesis in 1749, when he graduated in Edinburgh, and  which
has been translated from the Latin into German and French,
disagrees with the  opinion of Dr. Lining, and those whu ad-
vocated the introduction and  spread of the disease by con-
tagion.
  1 will now quote another passage from Dr. Lining: although
says the Dr.,  " the infection was spread through  the  town,
yet, if any from the country received  it  in the city  and sick-
ened and died on their  return home, the infection spread no
further, not so as to one in  the same house."  The  same fact
has ever since held true, as far as my experience of thirty
years has extended, and I  have never heard anything to the
contrary.   This fact will evidently show that at  least the
contagious or infectious character differs  widely from those
acknowledged as contagious and infectious by the whole pro-
fession.  Such as small-pox, for example.   But there is one
striking circumstance which occurred in 1841.  The yellow
fever occurred on  the  Neck or  suburbs of Charleston, yet
strange to say, that many who sickened were brought to the
city and died, and it did not spread or generate a single case
in the city.
  Let us now consider other medical opinions of  more mo-
dern date.  Dr. David Ramsay, in a  letter to Dr. Miller of
New-York, in 1800, remarks :  " The disputes  about the
origin of yellow fever, which have agitated  the  Northern
States, have never existed in Charleston.   There  is but one 
Simons on Yellow Fever in Charleston.
13
opinion among  the  physicians and  inhabitants, and that is,
that the disease was neither imported nor contagious."
  This was the unanimous sentiment of the Medical Society,
who in pursuance of it, gave their opinion to the Government
last summer, that  the rigid enforcement of the  quarantine
laws, was by no means necessary on account of yellow fever.
  Now these opinions were generally entertained until 1839,
the particulars of which it becomes my duty to give, and let
others form their judgment.  The circumstances then occur-
ring, has awakened doubts if not convictions in the minds of
some  few very intelligent physicians, whether  the  yellow
fever has not occurred among us through importation, and
 either by infection cr contagion, or  to  use a new phrase,
 transmissibility.  1 will, therefore, give you all the facts and
 the opinions predicated upon them, and leave it to your judg-
 ment to decide.
   In 1839, the late Dr.  Stroble endeavored to prove it oc-
 curred from importation, and predicated upon this, he wrote
 a work to prove the transmissibility, or in other words, con-
 tagious character of the disease.  I refer you to the work for
 particulars, and will  content  myself with quoting from the
 w ork on the Practice of Physic,  by our  esteemed and emi-
 nent associate, Prof. S. H. Dickson, for whose medical opin-
 ions generally I have much respect.
   uDr.  B.  B.  Stroble,  of  this city," says  Dr.  Dickson,
 " struck with the early and unexpected appearance of yellow
 fever here in June, 1839, was led to a patient, impartial and
 attentive examination of  the  subject.  For the detail of his
 facts  and arguments I refer you to his  published work.
 They seem to me weighty if not conclusive, and if they do
 not prove, they surely render highly probable, the doctrine
 that yellow fever is in this country and climate, as it has been
 long maintained to be elsewhere, contagious and  communi-
 cable, or, as Dr. Stroble has phrased it,  transmissible, yellow
 fever is contagious; in other words,  a  case of yellow fever
 having been generated in a favorable season and locality, by
 its unknown and undetected cause, becomes itself a genera-
 ting centre productive of other causes, or of a morbid agent
 capable of producing them. 
14
Simons on Yellow Fever in Charleston.
  " It is transmissible from any one centre to another, or from
any one of its generating centres to a healthy locality, and
this communication or  extension  may  take  place in  two
modes, either by consequence of a portion of atmosphere in
which is diffused its undefined specific cause, as in the hold
of a foul vessel, from any place where it prevails epidemically
or by the introduction of a sick body or any formiles imbued
with its contagion."
  Now, here we have the opinion on one side.  Let me pre-
sent you the other.
  On the 7th of June, 1839, three patients were admitted into
the Marine Hospital, from the ship Burmah, which had ar-
rived from Havana, of which I was informed by the physi-
cian of that institution.  The pilot, contrary  to the regula-
tion that all vessels  having  sickness on board should be
brought to quarantine, brought in this vessel.   The remain-
der of the seamen on board that were sick, were sent to the
Lazaretto, and  the ship was  thoroughly cleaned and venti-
lated, she being in ballast.  She was in  the stream and did
not come to the wharf for some weeks after, and had no com-
munication,  as far  as  could  be  ascertained, with other ves-
sels.  On the  17th and 19th, cases  were admitted into the
Hospital from  the ships  Chatham,  Leonore and Elizabeth
Bruce.  The Chatham  and  Elizabeth Bruce, were lying at
Fitzsimmons1 wharf, the Leonore was lying in the stream,
opposite these vessels, and had never been to the wharf; the
Burmah was lying- in the stream off Roper's wharf: the dis-
tance from each of the vessels was therefore  considerable,
and there were a good many vessels between, on board of
which no sickness had as  yet occurred..  The Chatham ar-
rived here from Boston, on the  5th of June, in ballast; the
Elizabeth  Bruce arrived  in  Charleston from  New-York,
7th of June, in ballast; and the Leonore sailed from Boston
and arrived  on the 7th of June, in ballast—all the crews were
well.   Subsequently, the disease occurred in different vessels
in the harbor, which it would be unnecessary here to detail.
  The appearance of the disease so early in  the season and
so soon after its occurrence on board of the Burmah, created
a suspicion of contagion in the minds of some, but 1  could 
           Simons on Yellow bever in Charleston.         15

not, upon the minutest investigation, come to that conclusion,
and a committee, consisting of Drs.  Lopez, Moultrie, Ged-
dings, Campbell, Winthrop and  Horlbeck, which was  ap-
pointed by the Medical Society, after making a minute and
thorough investigation, came to the conclusion that the fever
was not introduced by the Burmah, or by  contagion, but
was produced by the peculiar condition of our atmosphere.
In  other words, it  was  epidemic, and arose from  causes
among us.
  From that report 1 select the following passages:
  " By an  examination instituted  through  reference to  the
captains and mates of the various vessels, whose information
was given  from the log books, your committee have ascer-
tained that they had, at the time of their sailing from the dif-
ferent ports,  viz., Liverpool, Boston, and New-York, for this
port, perfectly healthy crews, with sound cargoes, incapable
from their  character of generating foul air.  That there was
no malignant disease  prevailing at the time of their depart-
ure ; that  their crews had  not, while in this  port, any com-
munication, either direct or indirect, with the Burmah or her
crew ; and finally, that that ship, in all these instances, lay in
the stream, from a quarter  to half a mile from them, except
for a short  period, of which mention will hereafter be made."
—Page 5.)
  Again :  " The presumption is thus fairly induced, that the
cleansing and ventilation must have disinfected her, (the Bur-
mah,)  sufficiently  of her  foul atmosphere for purposes of
safety, else, why none other  of her  crew remaining on board
THENCE TO THE TIME OF DEPARTURE FROM OUR PORT, CON-
TRACT THE DISEASE ?"—(Page 7.)
  Again :  " Thus far  your committee have satisfied them-
selves, that the transmission of the fever through the agency
of the Burmah, is neither tenable as a fact, nor in accordance
with the opinions of a great  majority of the medical profes-
sion in this country."—(Page 8.)
  And again :  " Your committee therefore, are  of  opinion,
that the yellow fever which has prevailed, and still continues
this season, has its origin, not from contagion  derivable from 
16
Simons on Yellow Fever in Charleston.
those cases imported in the ship Burmah on the 6th of June
last, but from local and general causes."—(Page 10.)
  1 may here remark, that Dr. Lebby, in a letter to Dr. Stro-
ble, shows that yellow fever occurred at Fort Johnson, some
time before the Burmah arrived—and could not be possibly
traced as  arising from any foreign agency.
  I may here also remark, that in 1838, a fire occurred which
destroyed one-third of the  city of Charleston—and  in this
year and 1839, the exposure of an  immense mass of mate-
rials on the surface of so much uncovered earth, and water
in the  cellars,  were exposed to solar influence, sufficient of
themselves to generate yellow  fever.
  I have thus given you the opinions of our  own writers and
physicians.  You are all  doubtless well acquainted with the
different  views  taken  by medical  authors in the United
States as well  as  Europe, and I think after  a  thorough
investigation, you will readily  perceive different conclusions
drawn from  the same  facts,  and indeed, what is more
unpleasant,  often  discrepancy of  opinion, as regards the
facts.  Likewise that bilious  remittent fever has been not
unfrequently   confounded with  yellow  fever,  and above
all, in the ardor of  discussion,  philosophic  research after
truth has too often been  lost  in the maze  of controversial
sophistries.   Y^et, I think that the most  general opinion
is,  that  the  yellow  fever,  when  epidemic,  arises  from
local causes, while its contagious, or rather infectious influ-
ence, under certain circumstances may occur.  All epidemics
may become infectious without being  strictly contagious or
capable  of  transmissibility or extension, beyond  a certain
limit; and hence, in former ages, they were all regarded as
contagious, whereas, now it is more than questioned by many.
  Let us now enquire into a very interesting point of med-
ical philosophy, which may throw some light on this subject.
In former times the system of medical police  and medical
hygiene  were miserably pursued.   It was then  in  the
treatment a  rule,  to  have  all  fresh air  excluded  from
the sick, for fear of catching cold.  Now from this regime,
we observe that not only there was an accumulation of fo- 
           Simons on  Yellow Fever in Charleston.         17

mites emanating from the  body, but  an exhaustion of vital
air, oxygen gas and the accumulation of carbonic acid gas,
(non vital,) hence the aggravated type  and infectious char-
acter of the  diseases  then existing ;* and under such a sys-
tem of regime, it is  not at all surprising that those, as nurses
or friends, who were  exposed to  such a vitiated air, should
themselves feel the  effects of the  disease.  Hence the terri-
ble accounts which were given of the  infectious and pesti-
lential nature of epidemics, and the  violence and mortality
incident  thereto.   From  chemical discoveries, and  the  ju-
dicious application  of these discoveries to useful and practi-
cal purposes,  a new  system of medical police and medical
hygiene became gradually to be adopted, the effects of which
have been signally  observed wherever they have been faith-
fully used.  We now regard it as  essentially important, to
have a free ventilation to such an extent as to correct the  vi-
tiated air produced from the sources already stated, and  we
likewise use certain substances which  are regarded at least,
as partially disinfecting agents, and that plan  has had a man-
ifest influence and effect in diminishing the aggravated types
of epidemics.   We  hear now no longer of the typhus gravior,
which was so strongly depicted heretofore, which, says South-
ward  Smith, is not known in the hospitals ; but we have had
evidences of the same disease in cases of emigrants crowded on
board of vessels ill-ventilated, and accumulation of filth gene-
rating a foul and pestilential atmosphere, and creating a fever
very similar to the  description given of the typhus gravior.
   From  the  great  improvement  in  medical police,   the
apprehension  of the propagation  of  these  fevers  by  in-
fection,   has   been  much  questioned   by  many,  and   the
virulence and mortality evidently greatly diminished.  Pre-
dicated  upon  these  principles,  that extraordinary  genius,
Bonaparte, peformed an act which had a powerful influence

  * I may mention here an anecdote of that original and eccentric medical genius,
Dr. Radcliffe, in the reign of Queen Anne. He was attending the young Duke o
Beaufort, in small pox, and in opposition to the received medical opinion, as wellaa
the stron<T remonstrances of the Duke's mother, ordered the windows opened to ob-
tain fresh air, which was strenuously resisted—he, however, persisted, and from th
period, a change in the symptoms took place, and ultimate recovtry.
           2 
18
Simons on Yellow Fever in Charleston.
as regards his undaunted courage among his soldiers, and of
good sense by his medical staff, when he passed through un-
dismayed the hospitals in Arabia, encouraging his men suf-
fering with the plague,  a disease which,  like yellow fever,
was regarded with as much horror as the leper  in ancient
times, and which made the boldest warriors shrink from with
terror.  These hospitals were well ventilated, and the  viru-
lence and mortality was much diminished.
  There can be no doubt then, that an atmosphere can be so
generated in a ship or residence, as to produce a similar dis-
ease to those in its immediate atmosphere; but whether a per-
son or persons coming  into a healthy city could  propagate
the disease so as to vitiate the atmosphere of  a whole city,
and create an epidemic, is very questionable.  I will here in-
troduce two very interesting  cases  1 published many years
ago, illustrative of this subject.   A Spanish vessel came into
Charleston and anchored at quarantine, with all her officers
sick with yellow fever.   The mate  of an American vessel
sailing from New-Orleans to Philadelphia, was  placed on
board the Spanish vessel  while at  sea, to navigate her to
Charleston. The mate, when I visited her, was perfectly well;
the next  day however, he was seized with yellow fever, and
died on the fourth day with black vomit.
  To satisfy my mind as far as practicable, I wrote to New-
Orleans to ascertain if yellow fever was prevailing  there at
that time, to which I received in answer it was not.  I then
wrote to the port physician of Philadelphia, to ascertain if
any sickness existed on board of the vessel on  its arrival at
quarantine, and the reply was—4i There was none."
  Now, here seems to me a clear case of infectious influence.
  Again,  of another disease,  viz.,  Cholera, I will  cite  an
instance which occurred on our  sea-coast, and which 1 pub-
lished.   The brig " Amelia"'  was stranded on Folly Island,
about twenty miles or more from Charleston,  with  patients
suffering from cholera.  Several of  those who went to the
wreck and encampment near, thereby took the disease, and as
soon as the vessel and all her materials were burnt, the dis-
ease became arrested.   Two of the sailors absconded and
arrived in Charleston, sickened with cholera in Elliot street, 
Simons on Yellow Fever in Charleston.
19
 and died—but no other cases occurred in the city, nor was it
 propagated therefrom.
   Dr. Dickson wrote a very graphic account of this circum-
 stance, and it was regarded by him and the contagionists, as
 a most powerful evidence of its infectious character.  Now,
 I admit and concur in the fact of its  infectious influence to
 the extent in which it was generated.   But  still it  is ques-
 tionable if it could have  extended beyond a certain limit, or,
 in other words, would have in  a city produced a general  epi-
 demic.  Be this as it may, the circumstances prove an  im-
 portant lesson in medical police, to prevent all cases of such
 kind being introduced  into a  city.  From what I have pre-
 sented to you, you will perceive I have  endeavored to do so
 in the most impartial manner.   You will likewise perceive
 that I regard it as peculiarly essential to  have a judicious
 regulation  of external and internal  medical  police.  The
 laws  of epidemics are  puzzling problems  in medical re-
 research, and have not been satisfactorily explained either by
 chemical analysis or meteorological observations.  Yet the
 investigations in these  respective departments  of scientific
 research have led to  much valuable and useful improve-
 ments in medical police, if not  in preventing,  at least greatly
 ameliorating, the mortality by  epidemic  disease.
   I will now consider the  condition of Charleston formerly,
 and its present condition,  and the consequent progressive  im-
 provement in the  medical police.  The following  extract is
 from Dr. Ramsay's History of  South-Carolina, a work now
 out of print.   The extract is long, but I hope I will  be  ex-
 cused in presenting it.
   " George Chalmers, in  his political  annals of the United
 Colonies, printed in 1780, page 541, 542,  observes  that:
 ' Charleston was long unhealthful.  From the month  of June
 to October, the courts  of justice were  commonly shut  up.
 No  public business was  transacted.  Men  fled from it as
 from a pestilence, and orders were given  to inquire for situa-
 tions more friendly to health.'   This statement is corrobora-
ted by tradition from the elder citizens, who inform us that in
the time of their fathers, the sick were sent from Charleston,
to expedite their recovery in the more  wholesome  air of the 
20         Simons on Yellow Fever in Charleston.

country; and that the country was preferred on the score of
health, as a summer residence.  This is by no means impro-
bable.   The situation of Charleston in its natural state, was
a slip of land stretching southerly between the two rivers, and
projecting into the  harbor formed by their junction, and di-
vided into a number  of peninsulas by creeks  and marshes
indenting it on three sides, so as to leave but littJe unbroken
high land in the middle.  The first buildings extended along
East Bay street, and had a  marsh in their whole front.   A
considerable creek, named Vanderhorsfs Creek occupied the
foundation of  Water  street,  and  passing beyond  Meeting
street,  sent out  a branch to the  northward, nearly to the
Presbyterian church.  Another  creek stretched northwest-
wardly nearly  parallel to East Bay street,  from the neigh-
borhood of Macleod's lots, through Longitude Lane and to the
north of it. The  same kind of low ground ran up Queen
street, then called Dork street, beyond  the French church
and through Berresford's alley, till it approached Meeting
street.   The north  end  of Union  street  was  planted with
rice about the  middle of the 18th century.  Another very
large creek occupied the site of the present central market,
and  extended westwardly beyond Meeting  street, which di-
verged southwardly almost to the Independent church, and
northwardly spreading  extensively and  dividing into  two
branches, running to the north-west and  to the north-east,
so as to cover a large portion of ground.   Besides the marsh
and these creeks, which  nearly  environed three sides of the
improved part of Charleston, there was another creek a little
to the  southward  of what  is  now  Water  street,  which
stretched westwardly over Church street; and another, which
ran northwardly up Meeting street, and then extended across
westwardly nearly  to  King street.  A  creek ran from the
west near where Peter Smith's house now stands, and nearly
parallel to South Bay, till it approached  the last mentioned
creek, and was divided  from it by King street and a slip of
land on each side.  Six  other creeks ran eastwardly from
Ashley river, three of which  stretched across  the peninsula
so as to approximate to King street.   There were also ponds
and  low grounds in different parts of the town.   One of 
           Simons on Yellow Fever in Charleston.        21

 these extended on the east  side of King street, almost the
 whole distance between Broad and Tradd streets.  This was
 granted to the French church in  1701, but being useless in
 its then state, was leased out by them for fifty years.  In the
 course of that period the tenants improved and built upon it.
 There was also a large body  of low grounds at the intersec-
 tion of Hasell and  Meeting streets.  The elder inhabitants
 often mention a  large  pond where the Court House now
 stands.  It is believed that this, though real, was artificial.
 It is probable that  the entrenchmemts attached to the west-
 ern fortifications of Charleston, which extended up and down
 Meeting street, from the vicinity of the  Independent church
 to the vicinity of the Presbyterian church, were dug so deep
 as to cause a constant large collection of water at that mid"
 die part of the lines.  It was  the site of Johnson's covered
 half moon, and of a draw bridge, over which was the chief
 communication between the town and the  country.  No
 prudent engineer  would erect such works as these on a pond,
 though when they were erected  in the  soft soil of Charles-
 town, they would be very likely to produce one.  Whether
 this was a natural or artificial collection of water, there  was
 enough in other parts of  the town to  make  it unhealthy.
 Such, with some  small  alteration, was  the situation of
 Charlestown for the first seventy years after its settlement.
  " To reduce such a quagmire  as a great part of Charles-
 town originally was, to a firm, high and dry state, required
 time, labor and expense.  Much  has been done, but much
 remains for future enterprise.
  " The pond at the south end of  Meeting street, was filled
 up and built upon  by Josiah Smith, in the years 1767, 1768
 and  1769, at an expense of about £1200  sterling.
  " Vanderhorst's creek was turned into firm, solid land,
 between the years 1788 and 1792, and obtained the name of
 Water street.
  " The  creek running under the governor's bridge,  was
finally obliterated and-turned into a market, between  the
years 1804 and 1807.  The extensive  marsh  land  and  low
ground to the north and west of this  creek, had been filled
up and built upon some years before, by John Eberly, An- 
22
Simons on Yellow Fever in Charleston.
thony Toomer, and others.  The time when the other creeks
were converted into solid land and improved, cannot be ex-
actly ascertained."
  Such, then, was the condition of Charleston when it was
early settled.  Gradually and progressively, all of these ponds
and creeks were filled up.  Subterraneous drains  in the dif-
ferent streets were made, and drains from  the yards of re-
spective premises were made to communicate with the drains
in the streets.  But it was found that the drains  having the
grates in the centre of the street  and becoming  thus  filled
up, caused, after heavy  rains, a vast  quantity of water to
be accumulated in the streets, making them at times almost
impassable.  The offals of the city were required regularly
every day, except Sunday, to be removed.
  The first improvement was the paving of East  Bay street
and Elliott street, where the  yellow  fever  was  generally
the most rife; a great improvement in the healthiness of these
localities was found to be the result.  The great and general
improvement, however, commenced in the  administration of
General  Hayne, in 1836, at which  time 1 was a  member oi
the Council.  It was then determined to make a general sys-
tem of internal medical police.  The leading objects were to
have :
  1st. Every low lot drained thoroughly, so as not to allow
water to remain  thereon and become stagnant, and if they
could not be drained to have them filled up.
  2d. To have all  the  cellars existing to be  kept so con-
structed as not to allow accumulation of water in them, and
if this could not be done  to have them filled up.
  3d. To forbid subterraneous cellars in all subsequent build-
ings.
  4th. A great and important object was adopted, to  have
the streets paved or Macadamized convexly, and to have side
drains in the streets  communicating with the main drains in
the streets, thus preventing the accumulation of water; and
having likewise the  drains  thus cleartsed,  and thereby pre-
venting the accumulation of filth requiring them to be opened
and cleansed,—a great cause, in my opinion, of disease. 
Simons on Yellow Fever in Charleston.
23
  Now these plans have been progressively going on, and in
proportion has the healthiness of our city been improved; and
while the public  authorities are gradually, nay, I may say
actively, pursuing this plan,  1  firmly believe it will  be  the
cause of making the city not only one of the healthiest among
commercial cities, but may possibly make us in a great de-
gree, if not entirely, exempt from yellow fever, and should it
occur, lessen its virulence and mortality.   From a long expe-
rience and observation, I regard it  the solemn duty of the
public authorities to go  on with this plan, regardless of ex-
pense, not only for the preservation of health, but for the ex-
tension of commercial prosperity.
  Let  me now say what is generally admitted ;  that the ex-
altation of heat without moisture or accumulated  vapor, as
exhibited by the dew-point, will not produce yellow fever any
more than moisture without high temperature will  do it.
  It is only in more modern times that we have had  proper
meteorological  observations.   The thermometrical heat
among us was formerly given, but  the hygrometrical and
dew-point were not understood, nor had  we electrometers.
Hence, in 1728, we are informed that the  summer was  hot
and dry, meaning there was no rain; yet, I  have  no  doubt
the atmosphere was damp and the  dews heavy.  Such, at
least, is my experience in dry seasons among us.
  From the statements which  I  have  brought  to your
view, you will  readily perceive, that while I regard it as
proper to prevent, as  far as practicable, the introduction of
yellow fever from other sources, we should not be forget-
ful  to remove  all causes  which may  arise among  us to
produce the disease.  It  is  a great  error  to conceive that
we  receive all the evils of epidemics  from  other sources,
rather  than causes among ourselves.   The true, and in my
opinion, the wise  plan, is to attend  particularly to internal
medical police, with a judicious care as regards introduction
of it from other sources.  I must in candor say, that I do  not
believe the yellow fev.er  was ever produced in  Charleston
from importation; and this is the result of an experience of
thirty years  as Port Physician, and twenty-four years a mem- 
24
Simons on  Yellow Fever in Charleston.
ber of the Board of Health, many years of which I have been
its chairman.  ^-"^
  We will now describe yellow fever:
  1st. To give its peculiar characters.
  2d. The different subordinate forms which it exhibits.
  1st. Yellow fever is a continued fever for three days, some-
times less, which may be called its first stadium or paroxysm.
   The  fever comparatively subsides after  this period, or
we have the commencement of black vomit.  There is in the
first stage much irritability of the stomach and pain in the
epigastric region, which, if not controlled, produces in the se-
cond stage an ejection first of a greyish floccent matter, ac-
companied with viscid mucus, and if this is not arrested, the
black vomit,  resembling  coffee grounds, is thrown up.  In
this stage sometimes, there is bleeding from the nose, gums,
and ears, and  even the finger nails, with vomiting of venous
blood, previous to black vomit.  The  circulation becomes
now languid, the  skin cool, and in many places of a bluish,
mottled appearance, especially along the spinal column, pro-
bably from the  pressure in remaining in a recumbent posi-
tion ; there is heavy and deep sighings, sometimes hiccoughs,
and a slow and laborious breathing.  These then are the
general phenomena presented, according very much to what
was described  so graphically by Dr. Lining, as far back as
1748, showing no change in the character  of the  disease in
this long interval of time.  Having given these general symp-
toms as 1 have observed them, we will proceed,
  2dly.  To the varieties which are presented which depend
upon the constitutional temperament of the  individuals at-
tacked.   Thus in  the sanguineous  and bilio-sanguineous,
we find a high exhaltation of  nervous and circulatory ex-
citement; generally in the latter, a higher degree of circula-
tory action  than in  the  former.  In these  cases  there are
always a strong action of the heart and a  strong pulse and
active capillary circulation,  exhibiting  the following pheno-
mena :  quickness  of  respiration and great uneasiness,
and even acute pain in the epigastric region, increased ani-
mal heat in the cutaneous surface, with redness  of tongue
and excessive thirst.   The cerebral excitement is  great, ac- 
Simons on Yellow Fever in Charleston.
25
 companied in some instances with delirium, and if not, with
 violent pain in the cerebrum, in the cerebellic portion of the
 brain, and the spinal column; there  is likewise irritability of
 the stomach,  a diminution in the secretions of the liver, kid-
 neys, and cutaneous  surface,  and frequently in the mucus
 membrane, as evinced by the dryness of the tongue.   1 have
 seen some cases where the  intensity has  been concentrated
 in the  brain and  cerebro  spinal column,  in which there is
 intense agony with symptoms  of the character of phrenitis.
 In such cases the  extremities are very cold.
   Now there are  cases again where  the general symptoms
 are directly the reverse, and these are in the phlegmatic tem-
 peraments.  In such cases there is a languid circulation,  the
 pulse being slow and easily compressed, a slow respiration, a
 languor of cerebral functions with a torpidity of mind and drow-
 siness,  a pale  and cool skin, having at times a mottled  ap-
 pearance and a diminution of animal heat, evincing a feeble
 capillary  action.   The other symptoms are not  dissimilar
 to what have  been already  described.  These two different
 forms are the   inflammatory  and the congestive,  in both of
 which the characteristic diagnosis of yellow fever is main-
 tained, and in both these forms will be found, generally speak-
 ing, a striated redness in the tumica  conjunctiva,  gradually
 in the progress of the disease, (pari passu,) with  the skin  be-
 coming yellow.
   We  are next to consider the  prognosis  of  the disease.
 1  regard  this in  many  instances difficult.  If  the  various
 symptoms which   have  been  already  described,  are  not
 relieved, and the  irritability of  the  stomach continues with
 the vomiting of black vomit, the prognosis is unquestionably
 unfavorable, although there have been extraordinary cases of
 recovery under these inauspicious circumstances.  A heavy
 and  deep sighing  with  laborious breathing, in  all cases
 wherever the other phenomena are favorable, is in this, as in
 other fevers, a dangerous indication.'  If  these indications
 are relieved and the patient has biliary evacuations, and all
 the active derangements  composed  after the fourth day, the
prospects of recovery are cheering, although there have been
many melancholy and fatal changes. 
26        Simons on Yellow Fever in Charleston.
  It is, in truth, a very difficult matter in all cases, however
seemingly favorable, to make a prognosis ;  and the patient
should always be regarded as in a precarious condition until
all the unfavorable symptoms disappear.
  1 will now consider briefly the diagnosis  of the disease.
The fever with  which it has been frequently assimilated,  is
the bilious remittent fever,  and hence by some it has been
called the paludal fever—upon the  supposition that it was
produced by marsh miasmata.
  1st. Yellow fever is a continued fever  of one  paroxysm
and different stadia, as already described.   Remittent fever
has, as its name imports, daily remissions and exacerbations.
  2d. Yellow fever prevails in cities, and  cannot  be  propa-
gated in agricultural districts, and rarely is  known in cities
upon navigable rivers, far remote from the ocean—although
there are exceptions to this rule; but 1 think it was  frequently
the bilious remittent fever of an aggravated type, in place of
yellow fever.  Oftentimes physicians thus fall intothe same er-
ror as many Europeans, from not examining the vomit eject-
ed.  Remittent fever is peculiarly  endemic in agricultural
countries in warm latitudes.
  3d- Once having the yellow fever, is an exemption from fu-
ture invasions. In remittent fever, once having it, so far from
being an exemption, renders one more susceptible  to the ma-
laria influence.
  Such, then, are  the prominent diagnostics.  The peculiar
yellowness of  the skin, in the  progress  of yellow  fever,
resembling  jaundice  and   its type, being  of  continued
character, induced Sauvage and Cullen, two celebrated no-
sologists,  to  give the following terms to the disease—Sau-
vage  denominates it  typhus ieterodes; Cullen, typhus cum
flavedine cutis, a  distinction without  a  difference.  The
yellowness of the skin is not a diagnostic symptom of yellow
fever,  as it is almost equally an accompanying symptom of
bilious remittent fever;  Nor can it be regarded as a typhus,
as yellow fever requires altitude  of  temperature, and is the
disease of warmer climates; the other of diminution of tem-
perature, and is the disease of cold climates.  The black vo-
mit, the vomito prieto of the Spaniards, has been regarded 
           Simons on Yellow Fever in Charleston.        27

as  a diagnostic sign,  although black vomit has occurred in
other cases.   Yet it is comparatively with few exceptions in
this disease—the  termination  of the  first stadium.  There
is often in bilious remittent fever, a kind of black atrabilious
matter ejected, which has, upon ordinary inspection, the exact
appearance of the black vomit of yellow fever, but subjected
to minute examination, will be found widely different.  The
opinion of Dr. Rush, and some others, was, that yellow fever
was nothing more than an aggravated type of bilious fever,
and that the black vomit was nothing more than vitiated bile.
Dr. Physick, however, made many interesting  autopsies, and
clearly proved that in all the cases, with few exceptions, the
liver was  in a healthy condition, and no vitiated bile in the
gall bladder; that the stomach was the centre of the disease,
showing abrasions, congestions,  etc. etc., and he demonstra-
ted the difference  between vitiated bile and  black vomit.
Subsequent  anatomical  investigations  have  confirmed his
views.   Many years  since, when I was Physician to the
Alms House Hospital,  I  collected the vomitings from those
affected with bilious fever, and those with yellow fever, and
as Professor of Practice of Physic, demonstrated clearly the
difference between them. In repose, they could hardly be dis-
tinguished; agitated and placed on paper,  the vomit of the bil-
ious remittent patient would show the  marks of bile; the
yellow fever, the same  coffee ground appearance untinged.
These were mere confirmations of Dr. Physick's previous expe-
riments.   (
   You are well aware that there are various physiological
theories  and speculations  as  regards the character of the
gastric juice; among others,  that it  was free muriatic  acid.
At that time, when as Professor  of Practice  of Physic,  I lec-
tured on yellow fever, I made experiments before the class,
of fresh  drawn  venous blood,  to which I added diluted mu-
riatic acid gas, and  after shaking  it, there was all the
appearance  of the black vomit—and  when tested in every
way,  could not  be  distinguished from the black vomit
which  I  had preserved—both  being exhibited at  the same
time.  Those who are curious  can repeat the experiments.
It is evident, therefore,  that  a  great mistake has  been
made as  to the  character  of  the  ejections of  the sto- 
28         Simons on Yellow Fever in Charleston.

mach, in bilious remittent and yellow fever,  by very many
medical gentlemen of high eminence.   It would  be tedious
and supererogatory to detain you longer,  or  enter more mi-
nutely into the pathological character of yellow fever.
  We are now to consider the treatment of this disease.  In
this, as in other diseases, great  diversity of opinion prevails.
From the description  of the  disease,  and its modifications,
you may readily perceive that we cannot depend exclusively
upon any one regular  course  of treatment.  The  American
and English physicians generally, regard calomel as the  sine
qua non,  or sheet anchor, to be used to ptyalysm.  The French
and Spaniards  condemn it as prejudicial and fatal, and give
mild laxatives, the warm bath, ptysans, etc.  The active pur-
gation with seneka  snake root and Epsom salts has been fre-
quently used.  There are others who regard calomel to a cer-
tain extent valuable, but cannot agree in the opinion that calo-
mel is a specific, or  sine qua. non. in the disease ; they regard
it valuable as exciting biliary secretion, for the liver in this
disease is torpid, and the production of biliary evacuations is
regarded as a very favorable  and important symptom.
  In the  treatment of the symptoms, blistering or cupping on
the epigastric region, mustard pediluvium, if the extremities
are cold, cupping or leeches to the head and spine,  or general
bleeding, cold affusion and warm baths, have all been used ;
and these applications must  be regulated by the tempera-
ment, and in  accordance with the  symptoms developed, and
according as the disease  is inflammatory or congestive. This
general view is all that is regarded as necessary  on this oc-
casion.
  1 will now present you briefly with the plan 1 have gene-
rally adopted in the treatment of this disease, referring you
to the different works published of the different views taken
of the  treatment by  others.   From  the  different forms in
which 1 have described as inflammatory and congestive, you
will  readily perceive  it would require  a different course of
treatment.  In the  inflammatory form, I use general bleed-
ing, so as to make  a  strong  impression.  Give a large  dose
of calomel, say twenty grains, and in four hours' time give
senaka  snake root and  Epsom  salts until it operates well, 
               Simons on Yellow Fever in  Charleston.        29

   ^£Z>g" "****»  bathed Wlth ^  ^ -id
     After the depletion by bleeding and purgation, if the pain
   in fte epigastnc region is not diminished", an'd if there   , ^
   b bty of stomach I immediately place in that region a large
   blister, and keep the irritation their continually, so  as to act
   as a powerful counter-irritant.   If the pain in the head con
   taiues, and in the spine, I use cupping and leeches.  Of me

   P Zata to°Wk *" ^ir^ °f Cal°me]' Whh SOme -eta
   of the tn    k   P  "P b,lmry SeCreti°n and Subdue acidity
   iniection 7     ' V^ 1^°^ °h^~^ an occasional
   kTd o?7er T; ,    Vegard illjections ver^valuabIe« -
   kind of derivative from the stomach, and preventing the sto-
   mach so peculiarly affected in this disease, from being imi-
   tated by cathartic medicine.   Such, then,  is the course of
   practice which I have followed in the  inflammatory"
   When the extremities are cold, mustard poultices are  then
    Thir ?fdenVatlVue' °r an^ other stimulating application.
    The next form „ the congestive, the symptoms of which
  iectT toeh     lu A§ ^  lhG Inflammat^ the great  ob-
   ect  ,s to  bring  the over-excited condition of the  system
  to such a  state as  to prevent  congestion  in the capillary
  system,  and  derangement  of functional action  in  the dif-
  ferent organs, so in the congestive form we must endeavor
  to  arouse the  system  from  the  extreme depression which
  exists,  t or this purpose, whenever practicable, 1 use warm
  stimulating  baths ;  and if not  convenient, 1  apply mus-
  tard  plasters to the  stomach and extremities,  and  sponge
  with  stimulating applications.  The great  indication is to
 arouse the  nervous system, and to have  a proper circu-
 lating action.  The other means  of practice is not dissimilar
 to what I have described, so far as medicine  is concerned in
 the inflammatory form.
   These, then, are the plans  in the first  paroxysm or  sta-
 dium.   I will now briefly consider the treatment in the second
 stage,  but previously remark that the great class of patients
are of  that population  where it is  difficult to carry out faith-
fully a judicious course of practice, except when in hospitals,
and hence the mortality.  Here, 1 frankly confess, all of our 
30         Simons on Yellow Fever in Charleston.

treatment is empirical.  The stomach, in the stage of  black
vomit, is evidently not only functionally but organically de-
ranged.  There is hypertrophy of the Vasa Brevia, and an
exudation of blood incident thereto, as I have previously ex-
plained.   In  this  stage,  yeast,  sugar  of  lead,*  efferves-
cence  of carbonate of soda,  and  tartaric acid,  carbonic
acid gas, and many other means of this kind, have  been
used.  My opinion is that no medicament in this stage can
be of any service  as taken in the  stomach.   The only plan
which may  be probably advantageous, is to keep  up in the
epigastric region a constant irritation, and to give, according
to circumstances, stimulating  injections.
  1 have thus endeavored, in a very humble way, to discharge
the duty assigned me, and as in my  introductory address.f
I repeat, I could have  wished  the appointment  as  your
orator had  been  given to  an abler member.   Should it
awaken  a proper feeling to investigate the peculiar charac-
teristics of our endemics, 1 should, indeed, be more than gra-
tified.  1 have now only to invoke the blessings of the Great
Supreme upon the labors of our Association, the objects of
which are to produce brotherly love, and promote the cause
of medical science and humanity.

  * Our late very eminent physician, Dr. Irvine, wrote a very interesting article on
yellow fever, in which he advocated the use of acetate of lead to act as a sedative
and subdue  the irritability of the stomach, and prevent the functional derangements
incident thereto.  But his theory was not sustained by practice.
  t This part of the Address was omitted as unnecessary, but will appear in the
proceedings of the Association. 
 
J >