REPORT 
ON THE 
CLIMATOLOGY AND EPIDEMICS OF SOUTH CAROLINA. 
MANNING SIMONS, M.D., 
J.) ’ 
CHARLESTON, SOUTH CAROLINA. 
BY 
EXTRACTED FROM THE 
TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION. 
PHILADELPHIA: 
COLLINS, PRINTER, 705 JAYNE STREET. 
1872. REPORT 
ON THE 
CLIMATOLOGY AND EPIDEMICS OF SOUTH CAROLINA. 
BY 
MANNING SIMONS, M.D., 
CHARLESTON, SOUTH CAROLINA 
EXTRACTED FROM THE 
TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION. 
PHILADELPHIA: 
COLLINS, PRINTER, 7 05 JAYNE STREET. 
1872. REPORT ON THE CLIMATOLOGY AND EPIDEMICS OF 
SOUTH CAROLINA. 
South Carolina possesses a climate almost as varied as the 
physical features of the country which composes its different 
sections. 
To render a clear description of the climate, and its relations to 
the health and diseases of the State, it is well that we should first 
make a brief survey of the character of its territory, and mark its 
geographical situation. 
Wedged in between North Carolina on the north, northeast, and 
Georgia on the west, it is bounded on two sides of the triangle 
which constitutes its figure by water; the Atlantic Ocean on the 
east, southeast, and the Savannah River on the west. It lies 
between 30° 4' 30" and 35° 12' north latitude, and 78° 25' and 
83° 40' west longitude from Greenwich, and covers an area of about 
30,000 square miles. 
The physical features of the country vary with the proximity 
or distance from the coast of the different sections. Passing from 
the coast line north-northwest, the country is flat, and rises in an 
almost evenly gradual ascent until the mountains are reached, 
when a height of 3000 to 4000 feet is attained at their highest 
points. 
“ South Carolina is equally divided between the primitive and 
alluvial region.” The alluvial extends about 100 miles from the 
sea-coast, and the primitive occupies the rest of the State. Within 
the first are found marine shell limestone and its attendants. The 
upper border of this formation passes in a northeasterly direction 
from the Savannah River, through the lower portions of Sumter, 
Darlington, and Marion, into North Carolina, forming almost a 
parallel with the sea-coast. 
In the primitive formation, which extends from this line north- 
northwest, is found the granite and its attendants. 4 
REPORT ON THE 
Each of these geological formations impresses its character upon 
the physical conformation of the country which it embraces; and 
at the same time influences the climate, and to a certain extent the 
diseases incident to the divisions severally. 
In considering the physical features of the sections, we will 
begin with the sea islands, which are scattered along the coast from 
Winyaw Bay to the Savannah River. These islands are generally 
sandy, and for the most part healthy, being open to the sea, and 
under the influence of the fresh pure sea breeze and winds; 
removed moreover from the generating sources of malaria. To 
these succeeds the flat country, which extends for about 100 to 120 
miles, when it terminates in the “ Sand Hill” region. This Sand 
Hill region deserves more than the passing notice which we can 
give it. It is a belt of, about 30 miles wide, extending in a direc- 
tion from northvnest to southwest, and passes through this State’ 
into North Carolina and Georgia. “It corresponds with the point 
of transition of the tertiary to the primitive geological formation, 
and in some places presents an admixture of some of the elements 
characteristic of both.” 
The surface soil of this region is generally pure white sand, 
resembling that of the sea islands, and maintains this character to 
some depth. 
This region appears to have once formed the shores of the 
ocean, which covered all the country below it. It is traversed by 
numerous small streams, or branches, as they are denominated, of 
clear, pure water, which wend their way to the rivers to which they 
pay their tribute. These streams are fed by natural springs, which 
flow from the sandy soil, of an icy coldness. 
Taking the whole year round, there is no country more healthy. 
The rivers in this section are bordered by a great extent of 
alluvial soil, extremely fertile, but at the same time unhealthy, and 
they furnish a stronghold and workshop for malaria. 
Here, therefore, we have health and sterile soil allied, and 
fertility combined with unhealthiness. 
Situated on the highest point of this Sand Hill range is Aiken, 
well known as a sanitary resort for invalids suffering with pulmo- 
nary troubles. This town, situated partly in Barnwell, partly in 
Edgefield Counties, is 120 miles from the coast, and has an eleva- 
tion of 600 feet above the sea. The climate is characterized by a 
dry atmosphere; the mean temperature is 61.69°, and the mean 
temperature of the cold season 51.63°. We would refer to a CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
pamphlet, by Drs. A. Coffin and W. H. Geddings, for an exhaustive 
treatise on Aiken, as a sanitary resort. 
From the Sand Hill region north-northwest, the character of the 
country is rolling; the sandy soil is exchanged for one of red clay, 
and the scenery becomes more varied. This country gradually 
passes into the mountainous region, and the section is reached into 
which the Allegheny range of mountains projects, the highest 
points of which rise from 3000 to 4000 feet above the ocean. 
In reviewing this change of country, which embraces all the 
phases and transitions from sea-coast to mountains, one must be 
impressed with the natural inference that the climate must vary 
proportionally, and such indeed is the case, and to a certain ex- 
tent the diseases also with the physical features. 
“The upper part of South Carolina,” says Mills, in his statistics, 
“we would repeat, is full of interesting scenery; her mountains 
present every variety of the wild, abrupt, sublime, beautiful, grand, 
and awful. Her rivers offer numerous cascades, placid surfaces, 
foaming torrents, and deep waters; the climate is the most delight- 
ful in the world; the Montpelier of the United States (as the 
amiable Abb& Corr&, ambassador of the King of Portugal, observed 
when he visited this State), the very seat of Hygeia herself.” 
Having arrived at the northern boundary of the State in our 
description thus far, we will retrace our steps, and in so doing refer 
to the rivers, and their variation in character in the different 
sections; for, as we will see, the health and diseases depend very 
"■much upon their nature. 
The whole State is intersected by numerous rivers and streams, 
which uniting form combinations fewer in number but of greater 
size, which wind their serpentine course through the length and 
breadth of the country, to add their mite to the vast volume of the 
Atlantic. 
The mountain region gives origin to a number of streams, which 
uniting themselves form the Broad and Saluda; these two coming 
together constitute the Congaree. The Savannah River, which 
rises in the mountains of North and South Carolina, traverses the 
whole length of the State from mountains to sea-coast, and forms 
its western boundary. The Catawba, arising in North Carolina, 
passes into South Carolina, where, with the numerous tributaries 
which it receives in its course, it forms the Wateree. This latter 
with the Congaree forms the Santee. The Great and Little Peedee 6 
REPORT ON THE 
also, which rise in North Carolina, pour through the northeastern 
portion of the State, and empty into Winyaw Bay. 
These rivers, especially those in the northwest, possess all the 
characteristics for about half their course of mountain streams. 
They rush their headlong course, and precipitate themselves over 
their rocky beds, forming cascades and numerous falls of great 
beauty. In this impetuous temper, they continue their course 
until the upper border of the tertiary geological formation, already 
mentioned, is reached, when they become calm and placid, as if 
preparing themselves at the end of their mad race for their termi- 
nation in the ocean. 
Augusta, Columbia, and Camden mark the points of transition, 
from the turbulence of mountain torrents to tranquillity, for the 
Savannah, Congaree, and Wateree respectively. The Savannah, 
Santee, and Peedee may therefore be regarded as the great channels 
by which the mountain waters find their way into the ocean. 
From the points at which these rivers become tranquil, and 
smooth in their course, their borders change character with the 
streams. Here the well-known and historical swamps make their 
appearance and extend in some places to the distance of five, six, and 
even seven miles on either side. The borders of these rivers, there- 
fore, present miles and miles of swamp land, which, in proportion to 
the character of the seasons, are alternately overflowed and dried, 
leaving a vast area of land impregnated with organic vegetable 
and animal matters exposed to the action of the sun. Here the 
naked cypress raises its branches stained with the clay marks of 
many a freshet, warning as it were against the subtle malaria 
which everywhere surrounds. Here, too, the dark beautiful green 
foliage of the water or live oak betokens the enriching power ex- 
ercised upon the soil by that very process which accompanies the 
production of the poison. 
The Sand Hill region gives origin to many streams, and branches 
which unite to form rivers. The Edisto, Salkahakhie, Combahee, 
Black River, etc., are all the result of these combinations of smaller 
streams which rise in this region. Most of these are derived from 
the pure springs already alluded to as abounding in the Sand Hill 
region. The waters of which they are composed are pure and 
clear near their sources, and maintain this character for some extent 
of their course, until their purity is marred by the accessions of 
surface water which they receive. A beautiful instance of this 
clear crystal character is given by the Eutaw Creek, which derives CLIMATOLOGY, ETC , OF SOUTH CAROLINA. 
its supply from the spring which is situated near, and bears the 
name of, one of the historical battle-fields of the Revolution of 1776. 
The waters of this creek are so clear and limpid, that minute 
objects can be distinctly seen on its bed, to the depth of 10 or 15 
feet. 
As the sea-coast is approached, there is another class of rivers 
of which the Cooper, Ashley, Wando, Waccamaw, Sampit, Stone, 
Ashepoo, Pocotaligo, Coosaw, Broad, etc., are types. They are 
peculiar in character, combining the nature of rivers with that of 
prolongations of the sea. They are generally wide and bordered 
with great expanse of marsh and black mud, with only an occa- 
sional bluff to change the monotony of the scene. They are gene- 
rally affected by the rise and fall of the ocean tides, and in some 
of them even to their sources. Their waters are to some distance 
salt or brackish, but to what extent depends upon the seasons. At 
their heads they are supplied with fresh water derived from ex- 
tensive swamps, and the drainage of the surface water of the 
neighboring country. 
In the region of country bordering the coast and the rivers of 
the flat country, from the requirements of the cultivation of rice, 
there are many collections of fresh water called reserves. These 
are made as reservoirs to supply water for flowing the rice fields 
in the event of drought, and the consequent brackish state of the 
waters of the rivers just described. These collections of water, 
being still, offer a great superficial area to the process of evapora- 
tion, decomposition and decay. Their borders and surfaces, in the 
summer season, are covered with a green slimy mass, the result of 
the collection and accumulation of the putrescent and decayed 
animal and vegetable matters. 
The rice fields border the rivers in the low country. They are 
on a level below the water line of the rivers, from overflow by 
which, they are protected by a system of banks or “dams.” Trunks 
and floodgates connect these fields with the rivers, and furnish them 
their water supply. These fields are alternately flowed and drained 
during the spring and summer months, according to the exigencies 
of the rice crop, and therefore likewise furnish a fruitful1 source of 
malaria. 
Climate.—South Carolina lies “in the same parallel with 
Cyprus, Candia, Morocco, Barbary, Damascus, Tripoli, Palmyra, 
Babylon, and with other parts of Turkey in Asia, and with part? 8 
REPORT ON THE 
of Persia, India, and China.” “In comparing American climates 
with those of Europe, to bring them on a par with each other, a 
difference of 12 degrees should be allowed for peculiarities in the 
American Continent. The most remarkable of these is such a 
predominance of cold, as subjects an American, living in north 
latitude 35 to an equal degree of cold with an European residing 
in north latitude 47. If this opinion is correct, we should look for 
a resemblance of South Carolina, not in the countries which have 
been mentioned as lying in the same latitude, but in Aix, Rochelle, 
Montpelier, Lyons, Bordeaux, and other parts of France; in Milan, 
Turin, Padua, Genoa, Parma, Mantua, and other parts of Italy; in 
Buda, Beuda, Crimea, and other parts of Turkey in Europe; in 
Circassia, Astrachan, and other parts of Russian Tartary, and of 
Chinese Tartary, which lie between the 44th and 47th degrees of 
north latitude. It is certain that the points of resemblance are 
more numerous in the latter than the former case” {Ramsay, Medi- 
cal History of South Carolina). “ The climate of South Carolina is 
a medium between that of tropical countries and of cold temperate 
latitudes. It resembles the former in the degree and duration of 
its summer heat, and the latter in its variableness.” It is favored 
with a serene, clear, blue sky, bright sunshine, sparkling stars, and 
soft moonlight, taking into consideration the influence of the ordi- 
nary inclemencies of the seasons. Its air is balmy, and the thermo- 
metric extremes moderate. The winters are short and gradually 
merge into the delightful weather of the southern spring. The 
summers are long, but the heat is by no means so great compara- 
tively as is supposed by those who inhabit more northern and 
western regions. The character of the seasons varies, to some 
extent, with the proximity to, or distance from, the sea-coast. 
Advancing to the north and northwest, the summers become 
shorter and the winters longer in proportion as the mountainous 
regions are reached. Though the summers are longer, and con- 
tinue for 3 or 4 months, yet the thermometer rarely rises higher 
than in Baltimore, Philadelphia, and New York, and frequently the 
temperature of the latter is greater and exceeds that of this State. 
The degrees of extreme heat are less in Charleston, and in the 
coast districts and islands, than in the interior and northwestern por- 
tions of the State. Two causes operate to bring about this result. 
First. In situations near the sea and open to its influence, the 
sea breezes, which spring up generally about 10 A.M., temper the 
great heat and fan the heated inhabitants CLIMATOLOGY, ETC., OF'SOUTH CAROLINA. 
9 
Secondly. These situations are subject to frequent rain showers, 
generally accompanied by thunder and lightning, which quickly 
give way to bright sunshine and clear sky, but greatly reduce the 
temperature. 
In Charleston the temperature rarely exceeds 95° Fahr., in the 
shade, and does not frequently reach this point, but usually varies 
from 80° to 9-0°. In Aiken and other points of the interior, the 
thermometer has attained the height of 102°. 
This season, as we have-remarked, is shorter in the mountainous 
portions of the State. In this section, during the night and early 
morning, a blanket is frequently found necessary to comfort, 
though the heat of the day may exceed that of the coast districts. 
The annual mean temperature for Charleston is usually about 
64° 88', which may be taken as illustrative of that of the other 
sections lying on the sea-coast. The mean annual temperature of 
Aiken is 61.69°, as given by Drs. Coffin and Geddings, which may 
also, in the absence of data, represent that of the middle or Sand 
Hill region. 
The number of extremely hot days is not great, and these do not 
exceed more than four or five successively. 
The winters are short, seldom extending over a greater period than 
three or three and a half months. They are generally mild, and for 
the most part there is a clear, transparent atmosphere, with a bright 
sun. Many days are warm, resembling spring and even a moderate 
summer’s day. The difference, mentioned in relation to summer, 
between the upper and lower sections, still obtains as to the winter. 
As the heat of summer is moderated by proximity to the sea, so is 
the severity of winter softened and tempered by the influence of 
the gulf stream, which brings its warmth from hotter climes. The 
winters seldom present any very great degree of cold, and though 
the cold days occur in greater number proportionally, to those 
which are distressingly hot in the summer season, yet they seldom 
continue except for a short period, and only in succession of five 
or six at any one time. 
Frost rarely occurs earlier than the 26th of October, and gene- 
rally makes its first appearance early in the month of November; 
earlier, however, in the interior than on the seaboard. Snow is 
but rarely seen in the lower portions of the State, and then in 
quantity scarcely sufficient to cover the ground. In the upper 
districts, however, the mountains are, near the northwest boundary, 
frequently covered with snow, but even here it does not remain 10 
REPORT ON THE 
upon the ground for any lengthy period. In these sections the 
winters are often severe and approach in character those of northern 
regions. They also begin earlier, and the cold weather continues 
longer than in the more southern portions of the State. 
South Carolina is subject to frequent rain-falls, which occur 
most frequently in January, June, July, and August, and especially 
in the lower districts. The condition of the atmosphere, as to 
moisture, differs materially in the several sections of the State, and 
this variation depends much upon the physical character and loca- 
tion. In the lower counties and on the sea-coast, the dew point is 
generally high. This is accounted for by the following reasons: 
1st. Proximity to the ocean. 2d. The numerous swamps, rivers, 
lowlands, rice fields, and the collection in low places in the flat 
country of the surface water, which, by reason of this very flatness, 
in the absence of proper drainage, is unable to find a free escape. 
3d. The subsoil water is in many places on a level but a few 
inches below the surface. 
On the islands, and on the coast, in proximity to the sea, digging 
to the depth of a few inches will cause an abundant spring of 
water, brackish however to the taste. In Charleston and its neigh- 
borhood, from wells sunk to the depth of from six to twelve feet, 
water can be obtained. This character changes, however, as the 
distance increases from the lower country, and in Aiken and other 
sections of the Sand Hill region the atmosphere becomes so dry 
and the dew point so low, that surgical instruments may be 
exposed for a lengthy period without rusting. 
We here introduce the Meteorological Table for 1871, compiled 
from observations taken at Charleston, and regret that insufficient 
data have prevented us from giving similar reports from other 
sections of the State. CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
Meteorological Abstract of the Barometer, Thermometer, Dew Point, Winds, and Weather at Charleston, /S'. (7., /or the 
year ending December 31, 1811. 
Taken under tlie direction of R. Lebby, M.D., City Registrar. 
January 
February.... 
March 
April 
May 
June 
July 
August 
September... 
October 
November... 
December 
1871. 
Months. 
30.500 
30.514 
30 400 
30.500 
30.410 
30.300 
30.260 
30.320 
30.466 
30.464 
30.468 
30.508 
Maximum. 
Barometer. 
30.020 
29.866 
| 29.812 
| 29.614 
29.860 
29.900 
30.025 
29.770 
29.940 
29.875 
29.710 
29.876 
Minimum. 
.480 
.648 
.58S 
.S86 
.550 
.400 
.235 
.550 
.526 
.589 
.758 
.632 
Kange. 
46.32 
54 00 
62.25 
66.63 
73.32 
79.80 
83.87 
75.12 
74.10 
68.06 
58.46 
47.77 
Mean. 
8 A. M. 
Thermometer 
ATTACHED. 
58.93 
64.54 
71.35 
78.23 
79.58 
86.36 
88.06 
85.06 
78.63 
77.64 
68.13 
59.58 
Mean. 
2 P.M. 
51.54 
54.28 
63.25 
66.93 
72.45 
78.90 
80.96 
79.12 
72.53 
69.70 
57.80 
50.79 
Mean. 
8 P. M. 
31 
26 
15 
7 
22 
20 
10 
4 
17 
16 
30 
24 
Hottest day. 
to ►—1 CO ' tO ►—1 
—‘t—‘tOOC£>CtCOC5tO*-'-<ICD 
Coldest day. 
45.80 
50.00 
62.32 
66.96 
73.29 
80.76 
81.45 
82.96 
71.16 
65.80 
5816 
45.87 
8 A. M. 
Mean Temperature. 
Thermometer detached. 
51.09 
63.92 
1 
70.19 
76.33 
79.19 
85.86 
90.16 
85.72 
78.53 
77.50 
67.82 
58.87 
2 P. M. 
50.19 
55.00 
62.29 
65.96 
71.16 
78.30 
80.77 
78.87 
72.03 
68.64 
54.00 
.49.19 
8 P. M. 
C5 *<J *<J COOOCOCOOD< ISAM 
H-. CO 0« CO 05 o 05 CO C5 H— | O A. ill. 
Max. 
9 P T\f 
-4 M- 05 CO W— tO 05 CO O O 4- *-• JOi.lU. 
C5-'4*<JCD00COCO~'I*<IC5O5O5 
054-C«O>f^C0C0C0C0C0t+-“0t 
co 4*. 05 o* -4 -<i -4 o» o» 4- co co 
050505cococ« 
8 P. M. 
8 A. M. 
Min 
19 PM 
-'I Cl O bO Ci O Cl Ci CO CD “-4 *0 I O X . *U. 
CO 05 C5 -4 *<I Cl C« Ci >4- >4- 1 fi p M 
CO O LO 0 to to -«4 05 ►+- LO O I 0 r. ill. 
38.61 
47.00 
53.00 
57.16 
60.35 
71.20 
71.51 
71.51 
63.17 
62.16 
51.16 
41.32 
Mean night. 
Register 
therm. 
59.09 
64.50 
71.87 
78.46 
80.35 
87.33 
91.54 
36.06 
77.27 
78.32 
75.20 
59.67 
Mean day. 
39.61 
46.57 
51.22 
53.21 
55.86 
77 82 
66.11 
70.51 
62.03 
60.19 
49.98 
40.57 
Mean. 
0 
5 H 
3 3 
M H W M ’ M feJ 
Ul 
Prevailing winds at. 
sunrise. 
3 
Prevailing winds at 
4 P. M. 
tOtO>—‘tOtOtOi—'tO*—'*—' 1 Pair 
1— oco*-4Ot05H-i‘--aco“-Jco 1 rdir* 
Wea- 
ther. 
1 Cloudy. 
1 R&itt 
.85 
3.74 
4.37 
4.30 
3.74 
3.19 
.81 
16.18 
5.29 
2.86 
3.64 
2.00 
g Quantity of rain. 
Prevailing weather. 12 
REPORT ON THU 
Diseases.—The diseases of South Carolina are none of them 
peculiar to its territory, nor do they differ from those, which exist 
in other portions of the United States, except perhaps the yellow 
fever. For healthfulness, it ranks high as compared with the other 
States, and its yearly mortality will bear a favorable comparison 
with that of other sections. In illustration of this point, we will 
introduce the mortuary reports of the City Eegistrar of the city of 
Charleston for the years 1866, 1867, 1868, 1869, 1870, and 1871. 
In order that these statistics may be understood, it is proper to 
state, that the proportion of whites and blacks to the total popula- 
tion is about equal. During the year ending December 31,1866, 
there died in the city of Charleston:— 
Whites 607 
Blacks and colored 1164 
Total 1771 
Proportional mortality to population 1 in 19.774. 
The entire population being estimated at 35,000. 
In 1867. 
Whites 462 
Blacks and colored 879 
Total 1341 
Proportionate mortality to population 1 in 26.099. 
Entire population estimated at 35,000. 
In 1868. 
Whites 390 
Blacks and colored 818 
Total 1208 
Proportionate mortality to population 1 in 28.973. 
Entire population estimated at 35,000. 
In 1869. 
Whites 453 
Blacks and colored 918 
Total 1371 
Proportionate mortality to population 1 in 32.77. 
Total population by census 1869, 44,923. 'CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
In 1870. 
Whites 539 
Blacks and colored 1075 
Total 1614 
Proportion of deaths to population 1 in 80.33. 
Estimated population by census 1870, 48,956. 
In 1871. 
Whites 714 
Blacks and colored 956 
Total 1670 
Proportion to population 1 in 28.11. 
In reviewing these tables, one must be impressed with the justice 
of the preceding remarks. It will be observed that the death-rate 
of the blacks and colored is universally greater than that of the 
whites, and the number of deaths of the former is at a moderate 
estimate double that of the latter. 1871, it must be remembered, 
was a yellow fever year, and yet we find this disproportion in the 
death-rate unchanged, though the difference is not so marked as 
in the preceding years. We must observe that although the yellow 
fever existed in the summer of 1871, the mortality was not great 
enough to make any material difference in the proportional mor- 
tality. 
On comparison of the years 1871 and 1866, we find that in 
the former the proportional mortality was 1 in 28.11, whilst in 1866 
it was 1 in 19.774. This difference may be accounted for, in the 
different results of the census on which the calculation was made; 
but this is not sufficient to vitiate the value of the statistics, as the 
census by which the calculation of 1866 was made, was in all 
probability not a less accurate estimate of the population than that 
of 1871. 
Principal among the diseases of South Carolina may be placed 
the malarial, in its various grades and types. These, however, as 
a rule, are mild; their character as to frequency and severity 
varying with different seasons. In some years the poison appears 
to be generated in greater quantity, and to be more concentrated. 
The congestive forms are, however, not frequently met with, and 
as compared with the types met with in the West are less malignant. 
From the brief sketch already made, it can well be understood why 
malaria claims the first consideration in a description of the dis- REPORT ON THE 
eases of this State. In considering their distribution, we may make, 
for convenience, a rough division of territory into three sections. 
I. The first of these may be made to comprise all that section 
tying intermediate between the sea-coast and Sand Hill region. 
Here exists all that combination of circumstances calculated to 
generate the malarial miasm, granting that the present most received 
opinion of its production, from decayed and decaying vegetable 
matter, under the influence of heat and moisture, be the correct one. 
In this region exist the wide extents of swamp land, either entirety 
or partially overflowed by the streams which they border, spreading 
for miles over the country. The land is flat, with deficient artificial 
drainage, and not sufficient natural slope or elevation to furnish a 
proper free escape for the accumulation of water, which becomes 
stagnant, and remains under the influence of the intense rays of 
the summer sun. 
In this region are located for the most part the rice fields, which, 
as we have before said, are abundantly flowed with and drained of 
water, according to the requirements of the crop. With these are 
their reserves of stagnant water. Besides these sources of malaria, 
there arise from the flat nature of the country abundant collections 
of surface water, the result of the frequent and heavy rain-falls to 
which this section is subject. In addition, may be mentioned the 
subsoil water, which is but little below the surface. This section 
may therefore be denominated the malarious district. Even in 
this section, however, the malarial influence does not envelop all 
localities. There are many broad extents of' barren pine land, 
which enjoy immunity from the poison, that may exist in all its 
virulence at the distance of only a few miles, which separate them 
from the sickly plantations. 
These regions furnish summer resorts to many of the planters, 
who are able to go each day to the scene of their labors and return 
at nightfall to the “ Pine Land,” where they as a rule have immu- 
nity from malarial infection. The sea islands also form an excep- 
tion to this general diffusion of malaria, at least those which are 
open freely to the sea ; of these Sullivan’s Island is an instance. It 
is a summer resort for the people of Charleston and the vicinity, 
and is (with the exception of a small area) free from this influence. 
This island even escapes, in most instances, the epidemic influence 
of yellow fever when this disease exists in all its virulence in the 
city of Charleston, distant only about five miles. 
Charleston, situated on a tongue of land at the confluence of the CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
15 
Cooper and Ashley Rivers, also possesses a remarkable freedom 
from malarial disease. Though bordered by marsh land, and in 
proximity to St. Andrew’s and Christ Church parishes, it is rare 
for a case of malarial poisoning to have its origin in the city proper. 
The upper wards, composed of what was formerly known as the 
Neck, do not enjoy the entire immunity possessed by the lower 
portion, but even here malaria but rarely originates. Years ago, 
before the Neck and city proper were united under one municipal 
government, the former section was subject to a fever denominated 
“ neck fever,” a species of malarial disease. With the growth and 
increased population which the section has received, this disease 
has greatly diminished, and is now merely known as a tradition 
of the past. 
II. The second division of the State may be made to include that 
portion of rolling clay land country which extends to the lower 
border of the mountain region. In this division, although malaria 
exists, it is by no means so diffused as in the preceding division, 
and is confined to certain regions, generally in the neighborhood 
of the water-courses. In the Sand Hill region proper, malaria 
does not exist; in fact it enjoys almost entire immunity, except in 
the swamps which border the rivers at or near its upper and 
lower boundaries. 
III. Lastly, the third division may comprise the mountain region, 
where malaria arrives at its minimum. 
The malarial diseases prevail in the latter part of spring and 
during summer and autumn, until the first heavy frost, when they 
disappear, to return with the next season. The cases which occur in 
winter are the result of infection during the preceding season, and 
are generally intermittents, frequently of the quartan type. These 
diseases, manifestations of malarial poisoning, are generally tract- 
able, and mostly under the control of quinine properly administered. 
Typhoid fever exists, but rarely becomes epidemic, and though met 
with in all sections, is more frequent in the upper districts. 
South Carolina is subject to its share of the generally diffused 
diseases of the chest; pneumonia, pleurisy, catarrhs, and throat 
affections are present, particularly in the winter season; but these 
are by no means so frequent as in the more northern region. This 
is particularly the case with bronchial catarrhs and throat affections. 
It is well to note in this place the difference as to frequency of 
occurrence and fatality in relation to diseases of the chest, espe- 
cially pneumonia, in the whites and negroes. The latter suffer far 16 
REPORT ON- THE 
more severely, and appear to have a peculiar vulnerability in 
respect to these diseases. All of our reports from the interior of 
the State concur in this statement. By way of illustration of this 
point, we will introduce the following figures from the city Begis- 
trar’s reports of the city of Charleston, of the deaths from pneu- 
monia, during the years 1866, 1867, 1868, 1869, 1870, and 1871. 
During the year ending on December 31st, 1866, there died of 
pneumonia:— 
Whites 18 
Blacks and colored 75 
Total *93 
1861. 
Whites 15 
Blacks and colored ........ 49 
Tothl 64 
1868. 
Whites 10 
Blacks and colored 31 
Total 41 
1869. 
Whites ........... 18 
Blacks and colored 53 
Total 71 
1810. 
Whites 16 
Blacks and colored ........ 54 
Total 70 
1871. 
Whites 10 
Blacks and colored 31 
Total 41 
It will be observed that the death-rate from all forms of pneu- 
monia, among the blacks and colored, is always greater than among 
the whites, and that this proportion remains unchanged during the 
six years, the statistics of which we have given, in so far as they 
bear on this point. 
South Carolina is no exception to the rule of general distribution 
of consumption throughout the world, and especially in temperate 
latitudes; but it must be added that it is far less common than in CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
localities further north. We would note here, also, the very fre- 
quent occurrence proportionally of this disease among the negro 
portion of the population. This point has been observed in this 
city before, and has furnished a topic of discussion, but our atten- 
tion has been particularly attracted to it of late by our own obser- 
vations. 
We will introduce the statistics of the six years already alluded 
to, drawn from the same source, to illustrate and verify this state- 
ment. 
There died of consumption, in the city of Charleston, during the 
year:— 
1866. 
Whites 53 
Blacks and colored 75 
Total 128 
1867. 
Whites 44 
Blacks and colored . 85 
Total . 129 
1868. 
Whites 47 
Blacks and colored 77 
Total 124 
1869. 
Whites ........... 38 
Blacks and colored ........ 94 
Total 132 
1870. 
Whites 47 
Blacks and colored 134 
Total .... 181 
1871. 
Whites 53 
Blacks and colored ........ 135 
Total .......... 188 
It appears to us, that, besides the genial character of our climate, 
there is another reason which operates to confer on us, to a certain 
extent, immunity from the very common occurrence of pulmonary 
consumption as it exists in the more northern States. It is this: 
the severity of our winters is rarely so great as to require the use 18 
REPORT ON THE 
of registers, for heating the houses, either by steam or otherwise. 
Notwithstanding the frequent very cold spells, which occur during 
our winters, it is very rare to find the houses or even the public 
buildings heated in this manner. With no double doors and 
windows, the inhabitants content themselves with such warmth as 
may be obtained either with stoves, grates, or open fireplaces. In 
the cities and towns, grates, and in the country districts, the old- 
fashioned open fireplaces, with the cheerful oak fire, are in use. 
By this means, the great transition from the dry heated atmosphere 
of the house to the very intense cold without is not experienced, 
and the catarrhs and bronchial affections dependent thereon are 
not so frequently met with. 
Measles, scarlatina, hooping-cough, and catarrhal fever have 
existed at various times during the past year; and in this, up to 
the present time, but neither in such amount nor so diffused as to 
entitle them to the term epidemic, except perhaps mumps, since 
March, 1872. Such cases of scarlatina as have occurred were of 
the simple variety. 
Smallpox, which has laid such a heavy hand upon Philadelphia, 
New York, and other of our sister cities at the north, has not as 
yet visited us in anything like an epidemic form. Only a few 
cases have made their appearance in the entire city of Charleston, 
and we have received no reports of its existence in the interior 
portions of the State. These cases have been traced to a passenger 
by one of the steamers from New York, who developed the disease 
after his arrival in the city of Charleston, and with him, the indi- 
viduals who were the subject of the succeeding cases had direct 
communication. Vaccination and revaccination have been gene- 
rally employed; the people being willing and anxious to have the 
operation done, though there is no law to compel them to do so; 
and they have manifested none of the late fashionable prejudices 
against it. 
We have now to speak of the epidemic of yellow fever which 
visited the city of Charleston, and to a small extent the town of 
Beaufort, during the summer of 1871. 
Charleston has at various times, and at varying intervals, suffered 
from the ghastly ravages of yellow fever, frequently and justly 
denominated pestilence. There is some question as to its first 
appearance among us, but it is generally assigned to the year 1699 
or 1700, when from its fatality it was called the plague. Having 
once got its foothold, and found a genial atmosphere, it returned CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
19 
in epidemic form in 1703. In 1728 it again returned, and received 
the name yellow fever. In 1732 it began to rage as early as May, 
and continued until September and October. In 1739 it was nearly 
as violent as in 1732, and was observed to fall most severely on 
Europeans. In 1745 and 1748, it was less violent. Again, in 1753 
and 1755 there were a few cases. Forty-four years elapsed from 
1748 before Charleston was again visited with this disease as an 
epidemic. In 1792 a new era occurred in the history of yellow 
fever. It raged in that year, in 1794,1795,1796,1797,1798, 1799, 
1800, 1802, 1804. and 1807. In 1803 and 1805 there were a few 
cases, but in both years the victims did not exceed 59. In 1793 
and 1808 the disease is not mentioned, and in 1806 only a few cases 
occurred. From 1807 to 1817 there are no records of its existence 
as an epidemic, although there were sporadic cases. In 1817 it 
prevailed with great malignity. In 1819, in 1824, when it reached 
Sullivan’s Island, in 1827, 1828, 1830, 1838, and 1839, the disease 
was epidemic. From the last date, a period of nine years, there was 
no epidemic, and the disease did not appear except, in a few cases, 
in the suburbs of Charleston in 1841. It is a remarkable fact, 
deserving of note, that in the last-mentioned year, although cases 
were carried into the city, the disease did not propagate or spread. 
In 1850, break-bone fever existed as a wide-spread epidemic. 
In the words of Dr. Wragg, in an address to the Medical Society 
of South Carolina, “Perhaps the annals of medicine will not furnish 
another instance of such general sickness, and such small mortality” 
. . . . “ seven-tenths or eight-tenths of the people were sick.” The 
small amount of electricity in the atmosphere during this summer 
was particularly noted. 
In 1852, yellow fever was again present, but, though wide spread, 
many of the cases were very mild, and doubts were entertained of 
the genuine character of these. In 1853 a few sporadic cases are 
noted, which did not spread. In 1854 the disease again prevailed 
very extensively, but the epidemic, like that of 1852, was charac- 
terized by a large number of mild cases, as to the genuine character 
of which the same doubts were entertained. Dr. Dickson, writing 
of this epidemic in the Charleston Medical Journal, said: “ The 
number of persons attacked by fever in the city was wholly beyond 
precedent, except during the prevalence of influenza, or the inva- 
sion of dengue.” Dr. Cain spoke of it as “not an epidemic but a 
pandemic.” In 1854 the disease also appeared in Georgetown and 
Beaufort. 1857 was marked by an appearance of yellow fever at 20 
REPORT ON THE 
Mount Pleasant, two and a half miles from Charleston, where it 
was said never before to have been present, and to a very small 
extent in the city. In 1858 a severe epidemic visited Charleston, 
and prevailed on Sullivan’s Island; and in 1864, during the war, 
the disease prevailed to some extent in Charleston. We have been 
unable, unfortunately, to lay our hands on the only written account 
of this latter epidemic, but, so far as we can arrive at the facts, it 
began in the northwest portion of the city, and prevailed in the 
upper wards, above Calhoun Street, which formerly marked the 
division between the city proper and the Neck. In 1866 there was 
a wide-spread epidemic of fever, concerning the nature of which 
there was much dispute; it resembled the dengue, however, in this 
much, that the mortality was exceedingly small. It was called 
dengue, break-bone, relapsing, and sweating fever, after that of the 
middle ages. It defied classification in any of the groups of writers 
on fever. It was a wide-spread epidemic, and all classes of the 
population were attacked, irrespective of age, nativity, acclima- 
tion. We were informed by the late Dr. Wm. C. Holbeck, an 
accomplished and skilful physician, who had much experience in 
yellow fever, that he saw, during this epidemic, several cases of 
well-marked yellow fever with black vomit. It is a matter of 
regret that no history of this epidemic has been written. 
As to the mortality of these epidemics of yellow fever, which have 
prevailed as above detailed, we have but vague accounts up to the 
year 1799. In 1732, when the population was about 10,000, it is 
recorded that at the severest period of the epidemic there died 
daily from eight to twelve persons. 
In 1799 . . died 299 In 1804 . . died 148 
“ 1800 . . “ 184 “ 1807 . . “ 102 
“ 1802 “ 96 
The population at these periods was about 20,000. 
In 1817 . . died 270 In 1830 . . died 31 
“ 1819 . . “ 176 “ 1834 . . “ 49 
“ 1824 . . “ 231 “ 1835 . “ 24 
“ 1827 . “ 62 “ 1838 . . “ 353 
“ 1828 . “ 26 
The population in the last year was estimated at 30,000. 
In 1839 . . died 133 In 1856 . . died 206 
“ 1849 . . “ 123 “ 1858 . . “ 680 
“ 1852 ... “ 280 “ 1864 , . “ 
« 1854 . . “ 624 “ 1871 . . “ 213 CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
This brings us to the year 1871 in the history of yellow fever in 
its connection with this city. In reviewing this record, we are 
struck with the irregularity in the visitations of this disease in its 
epidemic form, and search in vain for anything like system or 
method. This character of irregularity is as much to be marked 
in the frequency of its occurrence as in the severity of the disorder, 
and on a careful study, we are also struck by the increasing mild- 
ness of the epidemics since 1824, if we except the years 1838 
(when the great fire occurred), 1854, and 1858. We will also 
remark the frequent occurrence (almost in alternation) of epidemics 
of break-bone or dengue, with those of yellow fever since 1849; 
and again the large proportion of mild cases to the severe, in the 
various epidemics from 1839 to the present time, as compared with 
the epidemics of preceding years, is also a matter of note. 
It will be observed that the disease is mentioned as sporadic in 
many of the years which made the intervals of its epidemic attack. 
In 1871 this much dreaded malady again laid its hand upon the 
city of Charleston. It weighed down the energy which was mani- 
fested in her repair, improvements, and elevation from her disasters; 
clenched its remorseless fingers around her sources of pros- 
perity ; closed up her avenues of commerce; and brought desola- 
tion and mourning to the homes of her people. It marked a new 
era in quarantine, and, by land quarantine as well as that by sea, 
ostracized and debarred her from communication even with her 
sister cities. 
The health of Charleston had been unusually good during the 
spring and early summer of 1.871; indeed, to so great an extent, 
that it was the subject of general remark among the people, who 
congratulated themselves upon this favorable disposition of Provi- 
dence. But they were unhappily soon awakened from their state 
of security, and deprived of this source of self-congratulation, by 
the appearance in their very midst, without warning from without, 
of their old and dreaded enemy. Difficult as it was to relinquish 
the hope of a continuing healthful state, the profession was obliged 
to admit the genuine character of the disease which presented 
itself to their observation. 
On the 19th of July the first case was seen. As this case has 
been disputed, we give the notes furnished us by Dr. Jno. L. 
Ancrum, who was in attendance. “ Lizzie Clark, Irish, aged 31, No. 
10 Chalmers Street, twenty years in Charleston, but had travelled 
about a great deal, and had never had yellow fever, was first seen 22 
REPORT ON THE 
on the evening of 19th July. High fever, pain in head and back, 
tongue furred. 20th. Had a restless night, fever unabated, eyes 
suffused, urine pale and scanty. 21st. Delirious last night, vomits 
all ingesta, passed little or no urine, eyes much injected and slightly 
tinged with yellow. 22d. Partial collapse, wild delirium, black 
vomit in large quantity. 23d. Collapse complete, still vomiting, 
but not so frequently, suppression of urine complete. 24th. 
Comatose, icteric hue intense. 25th. Died early this morning. 
“These notes are given partially from memory, the essential 
parts from note-book.” The certificate was given for “ Icterus.” 
On the 29th of July the first undisputed case developed itself in 
the person of a German, Wagner by name, who was employed 
and resided at Mr. Claussen’s steam bakery in Market St. between 
Anson and East Bay Sts., a distance of two squares to the north and 
two to the east of Chalmers St. This man was attacked on the 
29th of July, and admitted into the City Hospital at 9 A. M. on the 
3d August. At 9 P. M. vomited copiously black vomit, and died 
on the same evening, his body tinged yellow. 
August 6th. Jas. Maloney, an Irishman, aged 24, a clerk who 
had resided in Charleston twenty months, was attacked in the even- 
ing, at No 37 Market St., and died on the 11th August. 
August 10th. A female child aged 4, native, residing in Market 
St. opposite Mr. Claussen’s bakery, was attacked, but was conva- 
lescent on the 25th. 
August 11th. A German who was employed and resided at Mr. 
Claussen’s bakery was attacked; he was removed to the corner of 
George and Meeting Sts., where he died on the 16th, having vomited 
black vomit. 
On the same day, August 11th, Mary Morumy, an Irish girl aged 
21, who had resided in Charleston two years and six months, was at- 
tacked at her residence in Beaufain St. opposite Archdale four 
squares west and one square north of Claussen’s bakery, and died 
on the 15th with black vomit. 
August 16. Mrs. W., Irish, two years in Charleston, residing at 
the same place as Morumy, was attacked; she did not vomit black 
vomit, and recovered. 
August 17. A Canadian residing at No. 8 Beaufain St. was 
attacked and died on 24th with black vomit. 
On same day two cases were reported on East Bay near Market St. 
August 18th. One case reported in Market St., one case at No. 10 
Anson Street. August 19th, one case on East Bay near Market St. CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
20th. One case Market near Anson, one case in Market St. be- 
tween King and Archdale Sts. 
21st. One case at the corner of Franklin and Queen Sts., one in 
the southwest portion of the city, one case in Beaufain St., one 
at Claussen’s, one in Market near Anson St., one No. 11 Anson St. 
22d. One case in King St. above Queen. 
23d. One case in Stolls Alley in southeast portion of the city. 
This patient had worked at the new Custom House at the foot of 
Market St. on Cooper Biver. 
24th. Two cases in Coming St. opposite George St. three squares 
north and two squares west of Beaufain St., one case corner Market 
and Meeting Sts., one case corner of Hasel and Meeting Sts., one 
case in Chalmers St. 
These cases were reported at an extra meeting of the Medical 
Society of South Carolina held for the purpose, and were transcribed 
by our own hands as secretary of the society. 
Without further relating cases, we will trace the disease from 
its point of departure, and note its course as it developed itself over 
the city. 
It will be observed that the disease extended itself first west- 
wardly, and from its first step distributed itself in all directions. 
It travelled up Meeting St., where we hear of it at the corner of 
Hasel St.; down Meeting, where we hear of it in Chalmers St.; 
westwardly, at the corner of Franklin and Queen; northwest, in 
Coming opposite George. On the 24th of August deaths were re- 
ported in Lamb&l St. in the extreme southwest portion of the city, 
on the 26th, and in Philadelphia St. in the southeast on the same 
date. From this period, the disease burst upon the entire lower 
portion of the city from Calhoun St. to its southern extremity. 
On the 31st of August, the first death was reported above Calhoun 
St. in Yanderhorst, and again September 3d a death was reported 
in Spring St., thus showing that in three days the disease had made 
a jump of five squares. 
It will be seen from this statement that the disease pursued an 
erratic course from its point of starting, following no direct line, 
nor did it step from house to house, summoning their occupants 
to submit to its power, but leaped about in different directions, and 
made its appearance in various localities of the city at the same 
time, as if uncertain where to reap the rich harvest which lay open 
to it. It must be admitted, however, that, in the beginning of its 
career, Market Street was its favorite point of attack, and this pro- 24 
REPORT ON THE 
clivity it maintained during its prevalence in the lower wards, 
Claussen’s, the place of its birth, furnished five victims during the 
epidemic; indeed so marked was its violence at this point that we 
note the fact here, in order that in our inquiry into the cause of its 
origin we may bear it in mind. The epidemic tendency continued 
from seventy-five to ninety days. 
The number of deaths was 213. The nativities of the victims 
were as follows:— 
United States. 
Alabama ... 2 
Connecticut . . 2 
Georgia ... 4 
Indiana ... 1 
Massachusetts . . 1 
New Jersey . . 2 
New York ... 6 
North Carolina . . 2 
Ohio .... 1 
Pennsylvania . . 2 
Virginia ... 3 
Louisiana ... 1 
Maine .... 2 
South Carolina . . 40 
Charleston . . .41 
District of Columbia . 1 
Foreigners. 
Scotland ... 1 
Bohemia ... 1 
Bavaria ... 1 
Poland ... 6 
Germany . . .62 
Sweden ... 1 
Canada ... 2 
England ... 5 
Spain .... 1 
Italy .... 2 
France ... 1 
Ireland . . .17 
Denmark ... 1 
It will be observed that the number of deaths of natives of 
Charleston is large in proportion to those of foreigners and natives 
of South Carolina and other States of the United States. This 
strikes us particularly, as in former epidemics it was generally the 
case that native adults who had resided always in the city of 
Charleston were as a rule exempt from attacks of yellow fever. 
This subject, therefore, claims our attention, and is worthy of an 
investigation. During a large portion of the war, the city to the 
extent of more than half was uninhabitable, and uninhabited by 
the people by reason of its being under fire of shells. A large 
part of the people were, therefore, obliged to seek safety for their 
families in the interior of the State. During this time and the 
period before their return to their homes, many children were born 
and were consequently unacclimated, and hence as fit subjects for 
yellow fever as foreigners. Again, a very large portion of the 
male population were in the armies, which took them out of their 
native atmosphere. If the point is conceded, that acclimation once CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
25 
obtained can be lost by removal for the period of four years, this 
class also afforded fit food for the epidemic. 
Another point to be investigated is, the large proportion of the 
German population, to whom the disease came in a fatal form, as 
compared with that of other nationalities. The solution of this 
may be found in the fact, that in the last five years our increase of 
population from foreign sources has been by an accession of Ger- 
mans almost exclusively. To this, and not to any peculiar suscep- 
tibility on the part of the German to the poison of yellow fever, is 
to be assigned this disproportion of mortality. 
In the earlier epidemics of yellow fever in Charleston, the negro 
population enjoyed a peculiar immunity. 
In the year 1802 there was not a single death among the blacks, 
and only one mulatto died of the disease. In subsequent years 
they were not so fortunate. Dr. H. W. DeSaussure, in his “ Report 
of the Meteorological and Sanitary condition of Charleston for the 
years 1857-58,” read before the Medical Society of South Carolina, 
remarks: “A marked feature of the epidemic of this year [1858] 
was its proclivity to attack the colored and black population. This 
tendency was somewhat developed in 1854, but acquired a great 
increase during the present season, and the deaths among this class 
of population were more than double those of 1854. The mortality 
was very small, however, in proportion to the number attacked.” 
This tendency was continued in the epidemic in 1871. There 
died 28 black and colored; and the same remark may be made, in 
relation to the proportionate mortality to the number attacked, as 
in 1858. 
The fevers of the epidemic of 1871 presented themselves under 
forms so different "as, in the opinion of many, to warrant a distinc- 
tion between them. They may be divided into two classes, ac- 
cording to their course and groupings of symptoms. 
I. Yellow fever proper, and II. an opidemie form of fever, by<1 
some denominated break-bone. 
I. The first, as the most severe, fatal, and typical, deserves the 
first mention. Yellow fever has been so graphically painted by 
the able pens of LaRoche and others, that we will content ourselves 
with a simple narrative of those symptoms and groupings of symp- 
toms most frequently manifested in the epidemic, which forms the 
subject of our present consideration. 
The invasion was usually sudden, though occasionally prodromic 
symptoms gave warning of its approach; these prodromata, when 26 
REPORT ON THE 
present, differing in no material point from those of the continued 
fevers. A chill generally announced the onset, or frequently, in the 
absence of this, its place was supplied by sensations of chilliness, 
immediately followed by pain in the head, back, and limbs, which 
was often exceedingly severe. Nausea with vomiting of the con- 
tents of the stomach, and afterwards of biliary matter, frequently 
accompanied this stage. The chill or chilly sensation rarely en- 
dured any length of time, and was followed by fever. The skin, 
usually intensely hot to the touch, was in most cases dry, but not 
invariably so, as sweating was sometimes present, though it did not 
abate the feeling of heat. The pulse was frequent, ranging, how- 
ever, from 100 to 120 or more in the minute; its character vary- 
ing in different cases according to the habit of the patient under 
observation. The pain in the head, back, and limbs increased in 
this stage, and formed one of the most distressing symptoms. The 
headache was intense, usually frontal, though its location was not 
invariably in this point, but extended to the orbits and globes of the 
eyes. The face was usually flushed, though not always, this symp- 
tom varying in different cases. The eyes were red and injected, 
having the appearance so well described as like that produced by 
smoke. A watery character was not invariable, and the dry glassy 
eye could be occasionally seen. 
The circulation, at first active in the capillaries, as the disease 
advanced became sluggish, giving a dusky appearance; the blood 
returning slowly after pressure from the vessels. With the ad- 
vance of this stage, these symptoms became intensified, and the 
pains already noted became very severe and tormenting, especially 
that in the back and head, and, as a result, jactitation and restless- 
ness were added, accompanied by moans. Delirium and restlessness 
characterized the nights, but the former symptom was not present 
in all cases. Thirst was frequently complained of as an annoying 
accompaniment of this open febrile stage. Inward heat and pain 
on pressure, in many cases, over the epigastric region, with irrita- 
bility of the stomach, were present. The duration of this stage 
varied from twelve to seventy-two hours or longer, and generally 
it passed off suddenly. In fatal cases the termination seldom oc- 
curred at this time. 
At the end of the period stated, the distressing symptoms became 
ameliorated: pain ceased or was much mitigated, the skin cooled 
to the touch, the pulse diminished in frequency. But this calm was 
generally only a lull preceding the storm which was to break upon CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
27 
the patient, in many instances to overwhelm him. The stomach 
became more irritable than in the preceding stage, everything was 
rejected and medicine had to be omitted. The matters vomited 
consisted of mucous or watery fluid, at first clear, but further on, 
when settled, depositing grayish or black specks with great apti- 
tude likened to snuff or grounds of coffee. This vomit was but 
the harbinger of the approach of the ominous black vomit, with 
reason dreaded. The skin lost the flush which it had in the pre- 
vious stage, and assumed a deeper or livid hue, and collapse was 
marked, constituting the second stage. 
The brain and nervous system were often engaged in this stage, 
manifested by delirium or sluggishness of intellect. Many cases 
terminated here with the life of the patient; others passed into 
the third stage, marked by many of the symptoms of the second, 
but with others superadded, indicative of the disorganizing blood 
change which was progressing. The vomited matter became 
blacker, greater in quantity, and easily ejected. 
The capillary circulation diminished in activity in the earlier 
portion of the disease, rapidly became more sluggish, and a very 
fatal symptom was manifested, suppression of urine. The eyes 
and skin assumed the yellow hue which has given the name to 
the disease, in some cases becoming dark. Occasionally, hemor- 
rhages were added to the already fearful scene, which was closed, 
in most cases that reached this point, by death. 
We are informed that a few cases of the algid form were seen 
during the epidemic. In some cases, the subjects of which had 
been addicted to excessive drinking, the disease ran its course 
very rapidly, the several stages being run into each other, the 
symptoms bearing on their face their fatal character in the incep- 
tion. 
Albumen early appeared in the urine, in most of the severe, 
well marked cases having been observed as early as the second 
day. In fact it was almost a constant symptom. Black vomit 
occurred in a large number of cases, but it must be observed here, 
that in this epidemic a number of cases, especially in children, in 
which this symptom wras manifested, finally recovered. Suppres- 
sion of urine was seen in a very large proportion of the fatal cases, 
and was regarded as a most ominous sign, betokening the fatal ter- 
mination of the cases in which it occurred. 
We annex thermometric records of several cases of this form 
of fever. REPORT ON THE 
Thos. Fox (Irish), T months in Charleston; malignant case. 
Admitted into City Hospital, August 21. 
Date of 
Temperature. 
Pulse. 
Respiration. 
£3 
a 
g 
< 
pi 
pi 
d 
d 
o 
d 
d 
o 
a 
o 
O 
S 
W 
& 
> 
1 
August 21 
2 
“ 22 
105 noon 
106 
106.5 
3 
“ 23 
105.5 9 A.5i. 
105 
104 
4 
“ 24 
104 
103.5 
100.5 
5 
“ 25 
102 
100.5 
101.5 
6 
“ 26 
died 
Black vomit on fifth day of disease. 
Albumen in urine on day of admission. 
Segin Sabbath {Poland), 7 months in Charleston; gravior. 
City Hospital. 
Date of 
Temperature. 
Pulse. 
Respiration. 
S3 
S3 
<5 
k 
Ph' 
P 
r-t 
a 
o 
© 
d 
d 
© 
a 
O 
O 
a 
t* 
w 
S3 
o 
W 
1 
2 
105.5 1 f.m. 
105.5 
105 
3 
105 9 a.m. 
105 
105.5 
4 
102 
102.5 
5 
102 
102.5 
102 
6 
102.5 
102 
101 
/ 
7 
100 
100 
100 
Black vomit on fifth day of disease ; albumen in urine on third day of disease. 
Died, on fourteenth day of sickness, of “ septicaemia. ” 
Wm. R. D., native, unacclimated, 22 years ; gravion; recovered. 
Date of 
Temperature. 
Pulse. 
Kespiration. 
| Disease. 
Month. 
a 
o 
Noon. 
<6 
pq 
Morn. 
Noon. 
<D 
> 
w 
Morn. 
Noon. 
a3 
> 
W 
1 
Sept. 
U 
23 
104.2 
110 
22 
2 
24 
100 
100.8 
101 
104 
92 
92 
24 
20 
20 
3 
a 
25 
102.8 
103.2 
R.2 
88 
86 
22 
4 
u 
26 
101.2 
100.2 
102 
72 
60 
64 
5 
it 
27 
100 
99.5 
100 
64 
68 
64 
6 
u 
28 
99.5 
S.i 
98.7 
60 
52 
7 
u 
29 
98.5 
99.2 
99 
52 
56 
52 
8 
a 
30 
98.4 
98.4 
99 
60 
56 
60 
9 
Oct. 
1 
56 
56 
1 Sweating ; no observation was taken. 
2 Refrigeration having reduced temperature, no observation was taken. CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
Jos B., native, unacclimated, 25 years old ; mitior; recovered. 
Date of 
Temperature. 
Pulse. 
Respiration. 
Disease. 
Month. 
fl 
O 
S 
a 
o 
o 
£ 
© 
> 
W 
« 
u 
© 
s 
a 
o 
o 
© 
> 
w 
d 
© 
a 
fl 
O 
© 
£ 
W 
1 
2 
3 
4 
5 
6 
7 
Sept. 25 
“ 26 
“ 27 
“ 28 
“ 29 
“ 30 
Oct. 1 
100.8 
98.4 
98.4 
98.9 
98 
98 
98.2 
102.2 
100.4 
98.4 
98.4 
99.5 
76 
96 
72 
72 
72 
68 
72 
96 
88 
68 
72 
72 
20 
• •• 
20 
Our thermometric records are too few to permit us to hazard an 
assertion, but we are prepared to admit that the febrile movement 
of yellow fever is characterized by remissions in an eighth hour 
cycle. In making this statement, we desire to be distinctly under- 
stood, as not intending to confound remittent fever due to malaria, 
with specific yellow fever. * 
In the second or stage of calm, though the skin may return to 
the normal or go below, in its temperature, this remains high, in 
most cases, falling somewhat in certain instances at the time of 
the occurrence of black vomit. This will be observed particularly 
in chart number 1. 
There were noted as sequelae of the yellow fever, in one case, 
parotiditis, and in a number of cases a forrq of entero-colitis, 
characterized by dysenteric discharges, which continued a variable 
period after the disappearance of the symptoms of yellow fever, 
and rendered the convalescence tedious. We have also been 
informed of the occurrence in two cases of gangrene of the 
scrotum and penis. 
This type of fever attacked principally foreigners and those 
residents of the city who had but recently made it their home, 
having come from colder and more northern regions. Those 
natives, who were the subjects of its attack, were generally chil- 
dren under eleven years; the youngest whose death is reported 
being three months. But seven deaths were recorded of adult 
natives; these were aged 15 years 6 months, 18, 19, 22, 25, 31, 34. 
The case reported as having died at thirty-one years was Lizzie 
Clark, whose case was the first of the epidemic. She had resided 
twenty years in the city, but had travelled about, during this 
period, a great deal from place to place, returning at intervals to 30 
REPORT ON THE 
the city of Charleston. The death at thirty-four was of a gentle- 
man who spent nearly every summer on the sea islands, and could 
not be considered as acclimated. That at twenty-five was of a 
gentleman who, though recorded as a native, had lived but five 
years in Charleston. The death at fifteen years and six months 
was of a young lady who had resided but five years in the city, 
and that at twenty-two was of a young man who had resided 
twenty years in the city. 
It will be observed, that by far the most part of the natives who 
died were either children under eleven years, adolescents, unac- 
climated adults, or those who having been acclimated lost this 
protection by absence from their native place. 
II. Ephemeral Fever, or, as denominated by some, Febricula, or 
“Break Bone.” This fever consisted of a febrile paroxysm lasting 
from twelve to forty-eight hours. It was ushered in occasionally 
by a chill, generally simply by the shivering or alternate flush- 
ings and chilly sensations common to the beginning of fevers, 
followed by febrile reaction, pain in the head and limbs, occasion- 
ally severe. The skin was hot, pulse frequent, generally full; the 
tongue was furred, sometimes almost natural in appearance- 
Nausea and vomiting were occasionally present but not constantly; 
the eyes were clear and devoid in most instances of the red watery 
character which was displayed in the form described above. At 
the end of the period varying from twelve to forty-eight hours, 
generally twenty-four, the fever abated, and the patient entered 
upon convalescence, without any symptoms which would indicate 
the second stage of yellow fever. 
We must remark, that, in some cases, in the advanced period of 
the epidemic, it was impossible to arrive at any judgment as to the 
course which would be assumed by the case under observation. 
In cases even where the paroxysm was severe, the patient would, 
at the termination of the fever, enter immediately upon convales- 
cence at the end of eighteen or twenty-four hours. Again, instances 
occurred in which cases at first mild passed into the most severe 
and malignant form of well-marked, typical yellow fever. 
This fever differed in the large majority of cases in no essential 
particular from ordinary febricula, and was in many instances 
reported as such to the Medical Society, during the existence of 
the epidemic, while the typical yellow fever was present in all its 
majesty. It respected no bounds, and attacked native as well as 
foreigner, but was mild in character, no fatal case having been re- CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
ported as resulting from it, where the forms were distinguished in 
the report. The two forms went hand in hand, visited together, 
and the two diseases could be seen claiming their subjects in the 
same house and even in the same bed. 
Previous attacks of well-marked yellow fever in former epi- 
demics, as well as acclimation, afforded but feeble barriers to the 
attack of the ephemeral fever. Natives who in former epidemics 
had well-marked yellow fever, were just as well subjects for it as 
the native adolescent or the adopted citizen. As one of a number 
of instances of this peculiarity may be mentioned the case of a 
German who had suffered from yellow fever in Havana, had been 
in Charleston through other epidemics with impunity, but did not 
escape an attack of this ephemeral fever. It frequently preceded 
the yellow fever, leaving the subject of its attack still to suffer 
from the inroad of its more powerful and dangerous companion. 
Instances of this kind were too numerous to be considered simply 
as coincidences. By way of illustration we will introduce a few 
instances. 
Jno. Williams, born on Long Island, New York, a sailor, was 
admitted into the City Hospital, October 15, with "ephemeral 
fever,” and was discharged cured on October 23. Readmitted on 
October 30, with yellow fever well marked, and died with black 
vomit November 3. This case is taken from the hospital case- 
book. 
Mr. E. H. C., born in Walhalla, South Carolina, resided in 
Charleston seven years, employed in the office of Mr. Claussen’s 
Bakery, Market Street, was attacked with a mild form of fever on 
September 1, recovered, and was well enough to attend to his 
business. At the end of fourteen days, he was attacked with yellow 
fever and died. 
We have reports of two other cases in which, a month after 
attacks of ephemeral fever, the subjects had severe typical yellow 
fever. 
The following are taken from the books of the Medical Society 
of South Carolina. 
“ One case was that of a mulatto woman, aged 30 years, a native, 
who had been away for the summers during twelve or thirteen 
years. In September she had an attack of ephemeral fever, which 
lasted thirty-six hours; she recovered, and at the end of two weeks 
she had a second attack of fever, which ran the course and pre- 32 
REPORT ON THE 
sented the symptoms of yellow fever, from which she also 
recovered.” 
“A German, who had been in this country eighteen months, was 
attacked with the ‘ prevailing fever’ comparatively severely; gums 
were touched with mercury. The patient remained well for a 
month, and is now suffering from an identical attack.” 
These instances might be cited to a much greater length, but 
we deem these sufficient to establish the point. We append a 
chart showing the range of the thermometer in a mild case. 
Meta A. A., native, 5 years 1 month; mild ephemeral; recovered. 
Date of 
Temperature. 
Pulse. 
Respiration. 
Disease. 
Month. 
d 
o 
a 
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o 
© 
w 
d 
o 
s 
d 
o 
© 
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d 
tH 
o 
d 
o 
© 
$5 
W 
1 
2 
3 
4 
5 
6 
Aug. 31 
Sept. 1 
“ 2 
“ 3 
“ 4 
“ 5 
102.3 
97.5 
97.5 
98.5 
98.5 
102.8 
102.1 
97.2 
Between these classes of well-marked typical yellow fever and 
the ephemeral fever, there were cases which occupied a middle 
ground, exhibiting the pointed tongue with white coat and red 
edges and tip, and in which the stomach asserted in a more pro- 
nounced manner its part in the disease than in the mild form. 
Proportional Mortality.—It is a difficult matter to arrive at an 
estimate of the proportion of fatal cases of fever to the number of 
cases which were seen during the epidemic. This difficulty arises 
from several sources. 
Hospital statistics, which are generally employed as the means 
of information, avail us nothing on this occasion. Most of the cases 
treated in hospital are seldom admitted on the first day of the dis- 
ease, and oftener later than the second. Under such circumstances, 
the death-rate must necessarily be very high, as the good results 
of treatment could not be expected when the most important time 
for its employment had passed before the patients came under 
observation. Mild cases were seldom under observation, for the 
reason that the majority terminated within the first twenty-four 
hours. Calculations based upon such statistics would, for obvious 
reasons, give but an unfair estimate of the general proportion of 
mortality. CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
We have, therefore, been obliged to resort to the results of 
private practice for the materials necessary; but even here we are 
met by another source of error, which arises from the different 
views as to classification entertained by different practitioners. 
Many made no distinction between the fevers, but classed them all 
under the head of the “Prevailing Fever;” under these circum- 
stances the results of their work must show greater success than 
that of those who were more strict in their classification. 
Of 1177 cases of all types and phases of fever met with during 
the epidemic, selected only for the accuracy with which they were 
recorded, there were 43 deaths or .036 per .cent. This statement 
demonstrates clearly the mild character of the epidemic, the 
mortality of which will compare favorably with that of measles, 
and offers a record much better than that of smallpox or scarlatina. 
Of 585 cases of fever, noted as “ ephemeral or break-bone,” there 
was not a single death. In 300 cases of fever, 75 were noted as 
yellow fever; of these 75, 15 died, or 20 per cent. In 484 cases, 
124 were noted as yellow fever; of these 124 cases, 7 died, or 
per cent. Of 20 cases noted as yellow fever, 8 died, or 40 per 
cent. In 43 cases of fever, noted as yellow fever, under the liberal 
classification, 1 died, or a little over 2 per cent. 
It will be observed, therefore, that the mortality of the yellow 
fever varied, according to the views (as to classification) of the 
individual observer, from 2 per cent, to 40 per cent. In noting 
the mild character of the epidemic, we do not wish to convey the 
idea that the cases which were well marked as yellow fever were 
peculiarly mild in character, or that the disease presented itself in 
a form different from that which we have before known. 
Many of the cases were exceedingly malignant, especially in 
those instances where its subjects as strangers afforded a field for 
its unrestricted action. The number of light cases of fever gave 
to the epidemic those features which entitle it to the term. The 
number of people who were sick with fever during the season was 
very great, although the mortality, as already shown, as estimated 
in relation to the number of cases considered without distinction 
of type, was very small. The field of operation for yellow fever 
was much diminished by the departure from the city of many of 
those who were or considered themselves subject to its attack. It 
is said that people to the number of 5000 left the city within two 
weeks. REPORT ON THE 
Treatment.—As to the treatment, we have but little to say. No 
heroic plans were adopted or countenanced. In the early period 
of the disease a mercurial cathartic generally began the treatment, 
followed by a saline. On the occurrence of irritability of stomach, 
all efforts were directed to its relief or amelioration. For this 
purpose, such agents were used as corresponded to the views, or 
were in accordance with the special inclination of the individual 
practitioner. For our part we relied upon milk, ice, and lime- 
water, and were satisfied with the results obtained. Stimulants 
were used in the latter stages as they appeared to be necessary. 
In the febrile paroxysm, cold sponging, the wet sheets, and other 
methods of refrigeration were employed, with marked diminution 
in the temperature, and to the great comfort and relief of the 
patient. The sulpho-carbolates were used, but the results obtained 
were not such as to demonstrate any peculiarly beneficial effect. 
Blair’s treatment, by twenty grains of calomel and twenty-four of 
quinine, was tried, but did not claim many strong adherents; 
indeed, the employment of quinine was not much in favor. We 
are informed from many sources (which coincided with our own 
experience) that the effect upon the nervous system, especially the 
brain, was in a number of instances very unfavorable. We tried 
this method in one instance, but were so much dissatisfied with the 
effect that it was not repeated in any others. No estimate could 
be put upon the power to abort the attack claimed by Dr. Blair 
for his method, for many more cases of fever terminated at the 
end of eighteen or twenty-four hours, without such treatment as 
he recommended, than did with it. 
During the prevalence of the epidemic, there were reported, at 
the meetings of the medical society, cases of mumps and chicken- 
pox. Ephemeral fever was reported as present in July. 
Absurd as it may appear at the present period, when diseases 
are studied with the light of experience gained by time, and 
clinical observations are so carefully made, the question must be 
raised, "What constitutes yellow fever?” With the impressions of 
an epidemic of this disease and the results of its fatal effect fresh 
upon our minds, and its ravages but a few months at an end, the 
profession of Charleston are divided in opinion upon this point. 
A well-marked typical case, with its stages, formidable array of 
symptoms, its fearful black vomit, passive hemorrhages, and yellow 
skin, presents a picture which, once seen, makes its indelible 
impression upon the mind. It is not this class of cases, unmis- CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
takable and impressive, which causes difficulty in diagnosis; its 
reality is too fearfully marked, and its features too fatally 
characteristic, to admit of hesitation. The so-called phases and 
variations of type, however, are far from plain, and it is the 
recognition of these, as identical with the typical cases, that has 
brought about the complexity which now invests the subject. 
This admission had been productive not only of disappointment 
and loss of faith in the teachings of former experience, but in 
many instances the sacrifice of life, by reason of confidence based 
upon the immunity supposed to have been conferred by attacks 
of those modified forms of yellow fever which have been classed 
in the same category as the disease to which the term was 
originally applied. 
No one can review the mass of literature of yellow fever, and 
not be impressed with the necessity of studying each epidemic of 
fever, by itself and in its relations to the peculiarities of the 
locality in which it occurs. With this view, we have been 
induced to make a distinction between the two predominant forms 
of fever met with in the epidemic which forms the subject of our 
consideration. In doing this, we are not ignorant of the terms 
of compassion in which Rush speaks of those physicians who, in 
the epidemic that visited Philadelphia in 1793, were guilty of 
recognizing in the “ tertian” and “ q uartan” types (during the 
intervals of the attacks of which the patients were able “to go 
abroad”) “ as many diseases as the yellow fever had symptoms.” 
In so doing, we have not lost sight of the number of phases and 
variations of type attributed to yellow fever, by those who have 
described epidemics and written on the subject; and the extensive 
latitude allowed to this disease beyond all others for its manifesta- 
tions. 
The results of our own observations have induced us to 
distinguish the ephemeral form of fever from the typical yellow 
fever; although we are aware that this opinion is not without 
opponents even in our own community. Yeitch, in his letter to 
the commissioners for transports and sick and wounded seamen, 
published in London in 1818, uses the following expression: 
“ The confounding the remittent fever with the ardent fever of 
strangers in a tropical climate is not the result of the difference 
between them passing unobserved, but it often arises from an 
injurious tendency to generalize.” 
By this system of generalization, during the presence of yellow 36 
REPORT ON THE 
fever, especially in those places where it does not occur epidemi- 
cally, except at intervals, all forms of fever are assigned to its 
influence, irrespective of symptoms or the grouping of them. This 
is demonstrated by a statement made by Mr. Blair in his accounts 
of the epidemics of Georgetown which occurred during 1837 and 
subsequent years. He notes three forms of yellow fever, Gravior, 
Mitior, and Simplex, but remarks, "the simplex form was not 
distinctly recognized till 1841.” It is natural to suppose, that, if 
this simplex or "ephemeral form” of fever had presented the 
characteristics of yellow fever, it would not for nearly five years 
have escaped the vigilance of so acute an observer as Dr. Blair. 
Under the influence of the dogma, that the presence of one 
disease of power drives away all others before it, we have departed 
step by step, and little by little, from the original type of the 
yellow fever, until now, under this pressure, it is not even necessary 
that fever should be present, or that the individual should be 
confined to the house, who is supposed to be laboring under the 
disease that was considered to be as malignant and fatal as the 
plague, with which it has been confounded. 
Rush included in his 3d class, "those in whom the miasmata 
acted so feebly as not to confine them to their beds or houses.” 
Gillkrest, who, in the Cyclopedia of Practical Medicine, gives 
an admirable sketch of the history of yellow fever, says: "From 
what has been said, it must be evident that great difficulties stand 
in the way of affixing pathognomonic symptoms to yellow fever; 
it has even been observed that those very slight attacks which 
occur not unfrequently during epidemics, and in which we have 
not a single well-marked symptom of fever, seem to give the ad- 
mitted degree of immunity during subsequent epidemics.” 
Should we accept this classification, yellow fever, justly con- 
sidered as most fatal and malignant in its true type, fades off into 
health so imperceptibly that it is impossible to draw the line of 
demarcation where the one ceases and the other begins. 
Yellow fever, which in the early history of Charleston is de- 
scribed as so fatal on its first appearance in 1699 or 1700 as to 
have given it the appellation of "the plague,” in this and 
subsequent years sweeping off the population by families, and 
claiming as its share three-fourths to one-sixth of all those whom 
it selected for its attack, in 1871 prevailed with a mortality of 
.036 per cent. Under this view, one by one the landmarks have 
been removed from the history of yellow fever. One attack, which CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
was formerly supposed to give immunity from another with rare 
exceptions, now provides no barrier to a repetition—nay, to attacks 
with each appearance of the disease. In illustration of this point, 
we will introduce the following: Dr. Thomas, in his treatise on 
yellow fever, as observed at New Orleans; Paris, 1848, Review, 
Charleston Medical Journal, states, that three varieties of yellow 
fever were admitted in a report to the medical society, an attack 
of either of which was sufficient to give immunity from second 
attacks. In the first variety, the symptoms of the first stage alone 
existed, and the case then terminated in convalescence. In the 
second, besides the symptoms of the first stage, more or less of 
the symptoms of the second and third stages were present, the 
greater proportion of these recovering. In the third variety, the 
symptoms of all three stages existed in great severity, or else 
the disease ran its course so rapidly that the stages were indistin- 
guishable. He did not admit the first class as genuine cases of 
yellow fever, since they did not give immunity from subsequent 
attackcases having come under his personal observation, of 
individuals contracting yellow fever years after undergoing attacks 
of the first variety, although continual residents of New Orleans. 
His definition of yellow fever is, a disease which, besides symptoms 
of the first period, presents some of those characteristics of the 
second. Those cases of fever in which the symptoms of the first 
stage were alone present, he considered simple inflammatory fever. 
Dr. Blair states, that, “ although the inhabitants of Georgetown 
who passed through the late epidemic had resided there during the 
epidemic of 1819, there was no instance of a sufferer from the 
epidemic of 1819 being attacked.” That those who suffered from 
fever in the epidemics which he describes, after the ephemeral 
form was detected, were not so fortunate, we may infer from the 
following quotation from his book: “The disease, however, was 
frequently baffled, and returned; and the liability to a return was 
in proportion to the mildness or shortness of the previous attack.” 
Adult natives of localities in which yellow fever frequently 
appears, who were considered as inured to the disease, now expe- 
rience attacks of the ephemeral type as readily as the latest arrived 
immigrant takes the typical disease. In addition to this, the 
epidemic of 1871 has demonstrated (if this classification be correct) 
that one attack of mild form of so called yellow fever, so far from 
protecting, leaves the individual subject, at the end of a time 
varying from a week to a month, to another attack, during the REPORT ON THE 
same epidemic, and in strangers almost invariably of the severe 
form in which, in many cases, to lose life. 
With these reflections, we venture to make a discrimination 
between the fevers which came under our observation during the 
last summer. 
"The disease which forms the subject of our present inquiries 
does not vary in regard to its pathognomonic phenomena in what- 
ever region or at whatever period in the same place it may show 
itself sporadically or in epidemic form.” (La Roche.) This 
acknowledgment concedes to yellow fever a type of its own, by 
which its individuality, and claims to consideration as a special 
and specific disease, have been established. This type, though not 
invariably manifested by the same symptoms, still has always and 
in all localities been marked by such combinations, and groupings 
of phenomena, as to designate its true character. Like all other 
diseases, yellow fever assumes different aspects at different periods 
by the predominance of certain symptoms, or the absence of others, 
which have at other times been present in a more pronounced 
degree. Yet, even under these circumstances, the links which 
bind these symptoms and phenomena in the chain of morbid 
sequence, have been sufficiently strong to keep up the characters 
peculiar to it. 
The epidemic under our consideration offered no exception to 
this rule. The disease manifested itself with its usual variations, 
still, however, clothed in its usual “livery.” The pronounced cases 
differed in no way from those, which have characterized other 
epidemics; its predilections remained the same, and its features 
were sufficiently familiar to make its recognition prompt. 
“The discrimination between yellow fever and other febrile 
complaints is a subject which under ordinary circumstances can 
prove of little difficulty to a physician familiar with the pathogno- 
monic phenomena of the disease, and of those with which it is con- 
trasted.” (La Roche). The truth of this statement cannot be doubted 
with the premises required; remove the factor of ordinary circum- 
stances, and the nature of things changes, though the other factors 
remain the same. 
The epidemic of 1871 did not occur under ordinary circum- 
stances, and the difficulty of discriminating the forms of fever 
which we have already described was great, so great, indeed, as to 
divide in opinion physicians very “familiar” with the “pathogno- 
monic phenomena” of yellow fever. “ In yellow fever, as in every CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
febrile complaint, there is an assemblage of phenomena which 
enables the experienced observer to ascertain its nature and dis- 
cern its relations to other disorders.” In an epidemic of yellow 
fever, when there is present a fever which is not possessed of this 
assemblage of phenomena, which runs its course at the same time 
as the well-known disease, and appears in some instances wearing 
its “ livery,” there is a difficulty which even the most experienced 
cannot remove in a manner universally satisfactory. Such a com- 
plication the ephemeral or break-bone fever brought about during 
the last year, and so remarkable was its course and behavior, that 
we deem it fit to bring it to your attention. It has been well said 
by Dr. Nott, that if a physician were called in the forming stage 
of a number of cases of plague, smallpox, yellow fever, some forms 
of typhus, and other diseases, arising from morbid poisons, as well 
as certain vegetable poisons, he would be much at a loss how to 
distinguish them for two or three days, and in some of those in 
which the characteristic signs are never developed, as smallpox 
without eruption, etc., a diagnosis never could be made. Let us 
apply this as a test to the ephemeral form of fever. In the large 
majority of cases, the disease terminated in eighteen to twenty-four 
hours, having manifested no symptoms, which would establish the 
family resemblance to yellow fever; hence, were its diagnosis as 
yellow fever dependent upon a linking of the febrile paroxysm 
with the subsequent stages described as characteristic of that dis- 
ease, there would have been a failure to point out the likeness in 
the large proportion of cases. It is admitted, even by those who 
contend most warmly for the unity of the two forms of fever, that 
it would have been impossible to diagnosticate this ephemeral fever 
as yellow fever in the absence of its well-marked and typical com- 
panion. In illustration of this, we will mention that physicians of 
well-known acuteness of observation, who now hold the opinion that 
these fevers are one and the same, reported cases of the mild form 
of fever as ephemeral fever or febricula; called attention to the 
clear eyes, to the character of the headache, and clean tongue, and 
expressed the belief, that they were due to common causes, and had 
no analogy to yellow fever; and this, too, in the presence of typical 
yellow fever. 
It must be admitted, then, that the break-bone or ephemeral 
fever was permitted by courtesy to a classification with yellow 
fever, and not by a recognition in its individual characters of 
sufficient claims to that position. Here, therefore, we have not to 40 
REPORT ON THE 
deal with facts but theories; not with the symptoms, clinical 
history, and course of disease, but with philosophical speculations 
as to the causes of the diseases of which we are treating; namely, 
that, as other diseases manifest themselves in mild forms, so must 
also yellow fever; though in those mild forms it loses its likeness 
to the original stock. The true way, therefore, to carry on our 
investigation into the claims of these fevers to be considered sepa- 
rately, is to inquire into the behavior of this ephemeral yellow, or 
“ prevailing fever,” as compared with those epidemics not accom- 
panied with such a wide-spread and extensively prevailing accom- 
panying fever as in the epidemic under consideration. 
Dr. Ramsay, in his Medical History of South Carolina, said of 
yellow fever, “with a very few exceptions, chiefly children, it 
exclusively fell on strangers.” So marked was the exemption of 
natives from the disease, that it was denominated the “ stranger’s 
fever.” 
It is a generally admitted fact, that those persons who have lived 
in localities subject to frequent occurrence of yellow fever become 
inured to the climate, and enjoy immunity from the disease. 
“With these facts before us, we are better prepared to under- 
stand, that, in places where the yellow fever is endemic, where the 
climate is continuously warm, and the causes of the disease are 
more or less permanent or frequently evolved, individuals accus- 
tomed by long residence to the influence of that climate, and the 
agency of those causes, lose their susceptibility to an attack. They 
become acclimatized or creolized, and are henceforward placed 
beyond the reach of danger.” (La Roche.) Strangers, however, 
especially those from cold climates, afford to the disease its favorite 
food, and such but rarely escape attack on going into regions where 
the disease exists. Natives, also, lose their immunity, after resid- 
ing for a lengthy period in cold regions. It is admitted, generally, 
that there are those who are privileged, and others who are sus- 
ceptible to the disease, and such has been the experience in this 
city, in previous epidemics, with few exceptions. 
In 1852, the proportion of persons, natives, attacked was greater 
than in former epidemics, but here, too, the question of an inter- 
mingling of break-bone was entertained. Native children have 
been those who have suffered from yellow fever in epidemics of 
previous years, and, as we have already shown, this obtained in the 
last. 
The ephemeral form of fever of 1871 did not respect these limits, CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
which by experience have been considered laws with but limited 
exceptions. It attacked adult natives as well as children, and the 
foreigner and unacclimated as often as the native. Immunity is 
even claimed to be conferred by those very mild fevers, which are 
called seasoning. Be this as it may, the immunity said to be con- 
ferred by one attack of yellow fever has been compared to that 
enjoyed after an attack of smallpox. To this, as to other rules, 
exceptions occur; but the opinion is very generally held by authors. 
This claimed immunity has no protection against the mild form of 
fever we have described; nay, so numerous are the instances in 
which an attack of ephemeral grade was followed by a severe 
attack of yellow fever in foreigners, that they cannot be considered 
as simple coincidences. In some of these cases the last attack ter- 
minated the existence of the subject. The intervals by which these 
two attacks were separated, varied from one week to a month. Dr. 
Blair says of second attacks, “neither do I believe there is an in- 
stance of a second complete attack after a month’s perfect restora- 
tion to health.” The subjects of two attacks in the epidemic of 
1871 were well enough during the interval to attend to their 
business; the second attacks cannot therefore justly be called re- 
lapses. Those who contend for the unity of the two forms of fever, 
and classify all as grades under the same head, account for these 
second attacks on the supposition that the first was due to a small 
dose of poison, the second to a larger. Such may be the true ex- 
planation, but the assertion is one which can be neither proved nor 
disproved by facts. It would appear to us, however, after a con- 
sideration of the facts stated in respect to the liability of a for- 
eigner to be attacked with yellow fever in the locality of this dis- 
ease, that this explanation cannot be admitted. In view of the 
fact that immunity is claimed after an attack of yellow fever, 
granting that a second should occur, it is reasonable to expect that 
the subject would have received some degree of protection by the 
first, or at least some amelioration of the severity in the second. 
This view would appear to us to be reasonable, by analogy with 
smallpox or vaccinia, which, though it may not give perfect immu- 
nity, generally grants an amelioration in the symptoms of the dis- 
ease, should the subject undergo a subsequent attack of smallpox. 
There is also another point to be considered as bearing upon 
the claims of the ephemeral form of fever of the last epidemic, to 
a position by the side of yellow fever. The mortality of yellow 
fever has varied as much as its symptoms in different epidemics, REPORT ON THE 
but in the undoubted cases of the disease it has invariably been 
high. The mortality which always attends its presence has ob- 
tained for it a position as one of the most malignant and fatal of 
diseases, and given it a rank by the side of the oriental plague, and 
the great loss of life in proportion to the number of the sick has 
branded it as a fearful calamity. 
“ In this latter respect no disease, the black plague of the fif- 
teenth century and the Asiatic cholera in our own days excepted, 
can compare with it. The oriental pestilence itself, though it oc- 
casioned, a century or two ago, a frightful mortality throughout 
many parts of Europe, and though it has given rise up to this day, at 
each epidemic return, to a mortality equally large in proportion to 
the number of individuals attacked, did not, at the time of its widest 
diffusion, or, if it did, has long since ceased to produce as great loss 
as has resulted from the disease in question.” (La Roche.) It is 
true that the disease has at some periods presented itself in greater 
degrees of malignity than at others, but this fatality has always 
been one of the characteristics of the genuine disease. So firmly 
has this characteristic of yellow fever impressed itself upon the 
minds of writers and observers of the disease, that the unprece- 
dented success of treatment claimed by Hastings and others has 
suggested doubts of the genuine character of the disease with which 
they had to deal. 
Dr. Barton says: “ It has been expressed to me by some of our 
oldest inhabitants, those who have been observers of the disease 
twenty or thirty years ago, that it was no longer the same disease, 
that in fact the unequivocal malignancy and peculiar type which 
■characterized it exist no longer; and this is most amply verified 
by the symptoms, aspect, and history of the disease, as seen and 
described by those who had witnessed it from 1804 to 1832.” 
The epidemic of 1871 bears a most remarkable contrast, as far 
as malignity is concerned, with the former epidemics which have 
visited this city previous to 1849 and to that of 1858. As already 
shown, the proportion of mild ephemeral or break-bone fever to 
the marked yellow fever was large, and in the former there was 
no mortality. As to the marked cases of the latter, which corre- 
sponded with the history usually assigned to the stranger’s fever, 
we cannot say the same, for the mortality in these varied from 5 to 
40 per cent., and even much higher. These cases presented no 
change of type, but bore on their face their true character and 
family resemblance to the old stock. CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
How then are we to account for the mild fever ? In answering 
this question we must review the characters of the epidemics of 
this city and note their variation. 
Previous to 1849, the yellow fever remained unchanged in its 
type; when it affected strangers, it showed the same malignant 
features as that of the West Indies, and so also it did in 1858. 
In 1850, break-bone or dengue visited Charleston, and prevailed 
in the form of a wide-spread epidemic. In 1852, when the yellow 
fever again appeared, it presented itself, accompanied with an 
unusual number of mild cases, which were recognized by many as 
bearing the stamp of the epidemic of 1850. That this is not merely 
a local tradition, we may see from the following quotation from 
Dr. La Roche’s book. In speaking of the complications of yellow 
fever, he remarks: “ The yellow fever which prevailed in Charles- 
ton in 1852 was accompanied by and blended with dengue or 
break-bone fever.” In 1858, yellow fever presented itself again 
in its true garb, as may be noted from the fact that in a popula- 
tion of less than 60,000 there were 680 deaths. 
Again, in 1866, there prevailed a wide-spread epidemic which 
attacked the great mass of the people, nearly every one being sick 
during its course, irrespective of acclimation. As we have stated, 
this disease did not present the type of yellow fever, and was 
variously classed as dengue, break-bone, relapsing, and sweating 
fever, and yet there were a few cases of sporadic yellow fever. 
In 1871, yellow fever was again present in its unmistakable 
form, but accompanied by and blended with a fever which did not, 
bj' its symptoms or course, uncomplicated, demonstrate its family 
relationship to the former, except in the fact of its occurrence at 
the same time as the first. 
The mild form of fever made its appearance first, which is in 
direct opposition to the usual history of other epidemics, in which 
this form presented itself, as the more severe disease died out. 
It is true that the mild fever of 1871 did not present the course 
perfectly of dengue; but, on the other hand, it could not, except in 
the presence of yellow fever, be diagnosticated as belonging to the 
same group as the latter. 
It can scarcely be denied, in view of these statements, that the 
epidemics have undergone a change of decided amelioration in 
their character. This change cannot be said to have taken place 
in the yellow fever proper, for we meet with it in its usual form. 
We are, therefore, for our part, compelled to seek for the explana- REPORT ON THE 
tion of the unprecedented prevalence of mild cases, during the last 
epidemic, in the fact that, since the occurrence of dengue or break- 
bone, its impress has remained; and that these mild cases result 
from a combination of the yellow fever with the former, and the 
mild forms are the result of the mutual moulding—the special 
characters of one being more prominent in some cases, whilst those 
of the other are in the ascendency in the others. 
Dr. Barton remarks: “ Many instances were mentioned, and will 
be found in our records, of repetition of attack, and the liability of 
those born here (and not of creole parents, and some that were, and 
grown) were very numerous, more so than has ever been noticed 
before, even reaching the limits of adult life, and the dread of 
yellow fever began to be brought home, and even experienced by 
the fully developed natives. This has been attributed during the 
fever to the uncommon malignity of the disease. May be the 
opinion I have heretofore advanced is the true one, and I repeat, 
although in vivid recollection of the scenes of last year, that the 
clear and unequivocal type is not so distinctly manifested in the 
mass of cases as it was twenty or thirty years ago. 
“ A hope is entertained in Charleston, that from the liability to 
attack of the more advanced adults, and in proportion to this 
retardation of age, ‘ there exists the strongest possible proof that 
our circumstances are undergoing a change of nature calculated to 
sustain the opinion that yellow fever is gradually ceasing to be an 
endemic or climatic disease among us.’ If this is true, I know no 
reason why it may not apply also here, .... the fever is becoming 
more indistinguishable from the ordinary fevers of the season and 
country.” 
"With these observations, from such authority as Dr. Barton to 
sustain us, we feel less reluctance in expressing the opinion that 
we have advanced, namely, that the mild characters of the epidemics 
in Charleston since 1850 (except 1858) are due to the mutual 
modification with dengue. 
Origin of the Epidemic.—In considering this portion of our 
subject, we will first investigate the facts relating to importation, 
as the possible means of the introduction of yellow fever into the 
city of Charleston in 1871, and we will draw largely upon the 
report of Dr. Lebby, Port Physician, for the facts. He says: “ It is 
a remarkable fact, and an occurrence which has never taken place 
before in my experience, that from the 1st of May at sunrise, until 
the 25th of September, not one single case of sickness came into CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
the port of Charleston, nor an infected vessel. All the vessels 
from the West Indies were in ballast, with healthy crews and in 
good condition, including a few fruit schooners from Ilqthuria, 
Harbor Island, Barracoa, and Nassau, where no fever has ever 
existed, except the last-named.” 
“The last arrival previous to the occurrence of yellow fever in 
the city was on the 25th of June, the vessel and crew in good con- 
dition and healthy. The only case of sickness was from scurvy, 
on a vessel one hundred and twenty days from Callao, which came 
in on the 25th of September.” 
The following shows the number of vessels that arrived and 
were examined at the quarantine in Charleston harbor, from the 
1st of May, 1871, to the 31st of October, 1871:— 
1871. 
Months. 
Steamers. 
Ships. 
Barks. 
Brigs. 
Schooners. 
j Sloops. 
Total. 
May .... 
26 
6 
11 
22 
1 
66 
June .... 
22 
6 
4 
26 
58 
July .... 
28 
3 
7 
18 
56 
August .... 
23 
6 
2 
17 
48 
September 
22 
2 
2 
20 
46 
October .... 
16 
1 
4 
2 
18 
41 
Total 
137 
1 
27 
28 
121 
1 
315 
The following shows the localities whence they came and their 
condition upon arrival:— 
1871. 
Months. 
Coastwise. 
England. 
West Indies. 
Malaga. 
Callao. 
S. America. 
Total. 
Number 
healthy. 
May 
52 
13 
... 
1 
66 
66 
June 
50 
1 
6 
1 
58 
58 
July 
56 
... 
... 
... 
... 
56 
56 
August . 
44 
3 
1 
48 
48 
September 
43 
1 
1 
i 
46 
46 
October 
35 
2 
3 
... 
i 
41 
41 
Total . 
280 
7 
24 
1 
2 
l 
315 
315 
“ From the above tables it will be seen that there was no arrival 
at this quarantine from the West Indies during the month of July. 
In June there were six, the last on the 25th. In August there was 
one arrival on the 24th. This vessel was quarantined thirty days 46 
REPORT ON THE 
until September 23d. Except those from coastwise ports, all these 
vessels were quarantined twelve to thirty days, exclusive of the 
number of days they were at sea, and most of these were in ballast 
with perfectly healthy crews who continued so; several of the ves- 
sels did not go up to the city, but were towed up Ashley River, 
loaded with phosphate rock, and from thence proceeded to sea.” 
On the 20th of June, a quarantine station was established in St. 
Helena Sound, to the north of Morgan’s Island, and equidistant 
from the entrances of Bull and Coosaw Rivers, distant between 
seven and ten miles from the settlements on Chisolm’s and Hutch- 
inson’s Islands, and about sixty miles from Charleston. Hr. W. H. 
Bailey was put in charge as quarantine officer. I take the follow- 
ing from his report: "On the 30th of June, the barkantine Teresa, 
Captain Adams [with ten men] arrived from Havana with the 
first mate and one seaman convalescing, but still weak from fever. 
.... She was brought up by pilot Davis into Bull River; I 
visited her in Bull River, reprimanded the pilot for transgressing 
the quarantine laws (I did no more, because the quarantine had 
been but recently established), and ordered the vessel to the quar- 
antine ground. She dropped down to that point, and remained 
there until the morning of the 31st of July, having been released 
on the 30th.” 
“ On board the Teresa I found the first mate and a sailor con- 
valescent but still weak from fever ; the second mate quite sick 
(from fever, also), but just entering upon convalescence; and a 
sailor decidedly very sick. I could not then, nor am I willing now 
to, characterize this fever as yellow fever, although circumstances 
seemed to render such an opinion probable at least. The mates 
and the first sailor to whom I alluded, recovered; the last conva- 
lesced so far as to be able to walk about the deck, overate himself, 
had a relapse, and died on the 10th of July. This is the only 
death which had occurred at the quarantine ground, and, with one 
exception, the only white death which we have had on Bull River 
or its vicinity this summer I have stated that there was 
one white death at Bull River this summer. The unfortunate 
victim was warned, as well by myself as by others, in vain ; intem- 
perance and an exposure brought on the attack I am 
satisfied he did not die of anything that even resembled yellow 
fever. To this I am willing to make affidavit.” 
We have evidence that the Teresa did not impart infection 
at Chisolm’s Island where the Mining Companies carry on their CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
47 
operations. We have mentioned only the Teresa at St. Helena 
Island, as no other vessel from an infected port arrived at that 
station until August 17th, except the Raleigh, which arrived in 
June, and had previously been admitted to pratique by the officer 
at Hilton Head. 
The first case of yellow fever, as we have already mentioned, was 
that of Lizzie Clark, at No. 10 Chalmers Street, who was attacked 
between the 16th and 19th of July, and died on the 25th, sixteen 
to nineteen days after the arrival of the Teresa at the quarantine 
station at St. Helena Sound. Between these points, Charleston and 
St. Helena Sound, there is difficult and not very frequent communi- 
cation. This case was attributed by report to communication with 
the second mate of the Teresa. Dr. Ancrum, who attended this 
case, reported to the Medical Society “that the report was false 
which attributed her illness to communication with a man from a 
vessel infected with yellow fever at Bull River. The origin of the 
report was probably in the fact that six or eight months previously 
a young man who lives on Bull’s Bay had been with her.” In 
addition to this statement of the attending physician, based upon 
information obtained at the time, we have the following testimony 
from totally different sources. 
Dr. Lebby in his report says: “ On the 11th of July I boarded the 
Teresa at quarantine grounds, St. Helena Sound, and examined 
her captain and crew personally. Both of the mates were on 
board on the 12th of July when I passed in the steamer on my way 
back to Charleston. It was impossible for either mates or crew to 
arrive in Charleston before the 14th, and then only by way of the 
Savannah and Charleston railroad, a distance of twenty-six miles 
from the vessel’s location, which renders their presence in Charles- 
ton almost an impossibility. But the testimony of the second mate 
and two of the crew, taken by Mr. David Lopez and Captain Henry 
J. Elliott, gentlemen of the highest respectability, in whose employ 
at the Coosaw Works these men are now, will show the utter 
falsity of these rumors.” The following questions were put and 
answered:— 
1st. “Were either of the mates or any of the crew of the bark- 
antine Teresa from Havana, in Charleston or Beaufort between the 
30th of Jane and 31st of July?” “No.” 
2d. “During the time the Teresa was at quarantine did any of 
the men desert from her, and return back onboard?” “No.” 
3d. “ On her discharge from quarantine, and her arrival at the 48 
REPORT ON THE 
Coosaw Works, how many men, captain included, were on board 
the Teresa? “Ten” [the complement of the ship on her arrival]. 
4th. “ Did the mates and captain remain on board the Teresa 
until loaded, and proceed to sea in her? and were they ever in 
Beaufort or Charleston to your knowledge or Capt. Elliott’s ?” 
“ They did remain on hoard, except Captain Adams, who visited 
Beaufort on the night of August 14th, and went to Charleston next 
day by Charleston and Savannah Railroad, and returned on the 
17th by steamer Pilot Boy, and got on his bark, and was never 
ashore after. The second mate and two seamen have been em- 
ployed at the Coosaw Works since the bark left quarantine.” 
It is evident, therefore, that by the mate’s own statement, cor- 
roborated by the evidence of others, he did not go to Charleston, 
and as a necessary consequence had no communication with Clark. 
Capt. Adams, the only person of the ship’s company who did go 
to Charleston, did not arrive there until the 15th day of August, 
before which time, as we have stated, yellow fever was present in 
this place. The barkantine Teresa must be acquitted from the 
charge of having introduced yellow fever into Charleston. 
There is yet another report which must be considered in this 
connection. That the crew of a vessel in Bull River from Havana 
deserted their ship and were arrested on their arrival at Charleston. 
There was ground for this report, in so much as that a desertion 
took place from a ship, but not from a vessel from Havana. In 
proof of this we will again extract the facts from Dr. Lebby’s re- 
port. He gives the written statement of Captain John Johnston, a 
shipping broker of this city, who says, “ I shipped from this city, on 
the 28th of August, seven white men for the bark Raleigh, loaded 
with phosphate rock in Bull River and ready for sea. The second 
or third night they took the 1 ship’s boat,’ deserted and returned 
to Charleston ; after their arrest the Captain refused to receive them, 
and I shipped seven colored men in their place, when she went on 
her voyage.” 
There are three reasons why this occurrence cannot be taken 
in evidence as favoring the hypothesis of importation. 1. The 
men went from Charleston. 2. They remained only two days on 
board the ship, which had been admitted as in a healthy condition 
at Hilton Head. 3. And, most important, this desertion took place 
nearly thirty days after yellow fever had been developed in the 
city of Charleston. 
As will be seen by reference to the tables of arrivals at the port CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
of Charleston, already introduced, the last arrival from the West 
Indies, preceding the outbreak of yellow fever, was on the 25th 
of June, and the ship was in good condition, with a healthy crew, 
and with no history of sickness, previous to her arrival, on the 
voyage. It appears to us that it would be unfair to attribute the 
disease to this ship, for it did not exist in her at the time of her 
arrival, and she had not suffered before, and did not afterwards 
suffer from it, and especially as she was in ballast. 
Were this not sufficient to convince, the evidence is completed 
by the fact that the disease did not begin its attack on those who 
were likely to be brought into connection with the shipping, but 
first appeared in a location distant from the wharves in a part of 
the city, the situation of which does not bring it in connection 
with the commercial portion of the community. It is, moreover, 
stated, on the authority of the Rev. Mr. Yates, seaman’s chaplain, 
whose works of humanity and philanthropy, especially among 
the sailors, are well known in our community, and who has had 
much experience in the epidemics which have visited this city, 
that there was not a single case of yellow fever occurring among 
the sailors until the middle of October, and then not exceeding 
three. 
The second case occurred on the 29th of July, at Mr. Claussen’s 
steam bakery in Market Street, in the person of a cake baker. It 
is not natural from the character of this man’s employment that we 
should expect to find him engaged on shipboard, and in any way 
connected with the shipping. We have been informed, on inquiry 
at Mr. Claussen’s, that this man had not been in any way exposed 
to such infection, and that his employment did not even require 
his presence in that portion of the establishment where he would 
have come in contact with others who might have been engaged 
in the shipping. It was not until a number of cases had already 
been developed that we met with the disease among the fruit 
dealers, who have their depots on Market Street and Bast Bay. 
We have not in the history of this epidemic those instances of 
laborers engaged in loading and unloading ships as the first 
affected, which have in some of the former epidemics furnished 
the grounds of argument to those who espouse the cause of importa- 
tion to the exclusion of any other mode of origin for yellow fever. 
The Marine Hospital played no part in the history of this, as it 
did in some of the former epidemics. 
There is another fact which will prove of interest to those who 50 
REPORT ON THE 
devote much thought to the origin of yellow fever. In the report 
of the Registrar of the City of Charleston we find this statement: 
“The first death from yellow fever in New Orleans, in 1871, took 
place on the 4th of August, the last on the 4th of December.” 
The first undoubted death from yellow fever in Charleston took 
place on the 3d of August, and Clark, the case reported as icterus, 
died on the 25th of July. The last death was on the 6th of De- 
cember. This might be considered as a mere coincidence but for 
the fact which we will now state. 
Dr. R. A. Kinloch, in an article on the yellow fever which 
appeared in 1857 at Mount Pleasant, Charleston Medical Journal, 
January, 1858, says: “The bills of mortality of the two cities of 
Charleston and New Orleans, up to the middle of September, proved 
them to be exempt from yellow fever. But after this date we 
find the disease appearing in both of these cities about the same 
time, and prevailing to a very limited extent, proportional in each 
to their population. Is it likely that germs of a foreign disease 
should have arrived simultaneously in both places? If they did, 
it was a remarkable coincidence.” 
In 1871 we again have a repetition of this “remarkable coinci- 
dence.” To us it has a significant bearing upon the origin of 
yellow fever, and goes far to substantiate the views of those who 
believe in the influence of geographical position. 
Perhaps there is no subject in the scope of the science of physic 
which has been so thoroughly discussed, and has been the cause of 
more able and angry controversy, than the origin of yellow fever. 
Since 1849, in Charleston, the line has been sharply drawn 
between those, on the one hand, who believe in importation, and, 
on the other, those who have put their faith in the local origin of 
the disease. Up to a comparatively short period no middle ground 
was allowed; the contest was, importation against local origin, and 
on this ground rested all controversies. 
We do not propose to enter into this contest, nor to deny the 
portability of yellow fever, and its propagation under favorable 
circumstances, but we cannot admit this as the only or general 
origin of the disease, at least in this locality. 
The epidemic at Wilmington, North Carolina, in 1862 (an account 
of which, by Dr. Wragg, can be found in the New York Medical 
Journal for August, 1869), goes far to prove local origin, and it 
must be admitted that the condition of that city at the time of the 
outbreak was eminently fitted to produce disease. Few can read CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
51 
the accounts of that epidemic without being convinced that, in the 
face of the fact of the occurrence of several cases of yellow fever, 
before the arrival of the steamer Kate, to which the importation 
of the disease is by some assigned, the charge cannot be sustained. 
The epidemic of 1871 has unequivocally eliminated the factor of 
importation from the influence which brought about the disease, 
and even the most enthusiastic importationists are dumb. Beyond 
this, the epidemic of which we have treated has produced no new 
fact which bears upon the peculiar and specific cause of yellow 
fever. The same mystery still hangs about it which has always 
invested the subject, for the discovery and unravelling of which 
the noblest minds have labored in vain. That importation, so far 
as Charleston is concerned, is not sufficient to propagate the disease, 
is proved incontestably by the history of the outbreak in 1854. 
On the 11th of May, the Isabel arrived from Havana and Key 
West. Three days after her arrival, a steerage passenger, who had 
been taken in at Key West, was sent to the Marine Hospital with 
well-marked symptoms of yellow fever; he recovered, but threw 
up black vomit freely. He was placed in a ward with others sick 
of other diseases, and no propagation of the disease occurred, 
either by contagion or by infection. On the 11th of July, the 
Isabel again arrived from the same ports, one of her passengers, an 
Irish nurse, went to the Pavilion Hotel, at the corner of Hasel and 
Meeting Streets, in the heart of the city, complaining of the effects 
of sea-sickness. On the following afternoon she attempted to leave 
in one of the New York steamers, but was prevented by her 
extreme illness. She was sent to the lazaretto the same evening, 
and died that night, throwing up black vomit freely. Again there 
was no extension of the disease. On the 26th another vessel arrived 
from Havana. It was not for some time after, that yellow fever 
appeared in the city. 
It is evident, then, that some factors other than importation are 
necessary to produce an epidemic. 
Heat and moisture, or dryness with animal and vegetable 
decomposition, and absence of electricity from the atmosphere, 
have been invoked to solve the problem, but the difficulty yet 
remains. What is the subtle combination of telluric and atmos- 
pheric influences necessary to produce yellow fever in epidemic 
form yet remains a mystery, and cannot even now be more satis- 
factorily explained than by the trite expression of Sydenham, “ an 
epidemic condition of the atmosphere.” 52 
REPORT ON THE 
Having failed to prove importation in 1871, we must look 
amongst ourselves for the cause of the disease. Next to importa- 
tion must be considered the question of propagation from dormant 
germs. The theory of germs as applied to disease is yet an open 
question, especially in its relations to yellow fever; we will not, 
therefore, enter into it. There are, however, certain facts in rela- 
tion to its bearing on the epidemic of 1871, which should be 
mentioned. 
The germ of yellow fever, if it does exist, and whatever it may 
be, should be specific, and as a consequence must be the result of 
the propagation and germination of its like. It is most natural, if 
this proposition be granted, to look for the parent in the next pre- 
ceding epidemic, which is that of 1864. Granting that the germs 
of this epidemic escaped the wilting cold of our winters, there is 
yet an obstacle to their acceptance as the cause of the disease of 
1871. 
In 1864, Charleston was in a state of siege; its lower portion 
from Calhoun Street to the White Point Garden was under the 
fire of shells, and deserted by its population. The streets of this 
section, and the waste places left by the disastrous fire of 1861, were 
overgrown by the natural spontaneous growth of weeds, which 
reached to the height of a man’s head, giving to the locality the 
appearance of a deserted city. The people had collected in the 
upper portion of the city, above Calhoun Street, which extends 
east and west from river to river. Here it was that the yellow 
fever prevailed, and not in the lower districts, which were unin- 
habited except by the small garrisons which acted as guards to 
the batteries on White Point and the Cooper River. 
The fever is said to have begun in the northwest portion of the 
city, in 1864.. In 1871, as we have already shown, it commenced 
its attack in the southeast, and prevailed in the lower districts to 
a great extent before a case appeared in the upper wards, which 
had been the scene of its action in 1864. 
Although we do not propose to enter into a discussion of the 
causes of local origin of yellow fever, there are some facts in the 
history of the fever, in its connection with Charleston, bearing 
upon this point, which should be mentioned. We allude to the 
close connection of the disease with reclaimed land, and the filling 
of low places with the offal and scavenger accumulations of a 
closely inhabited city. 
“The site of Charleston in its natural state was a slip of land CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
53 
stretching southeastwardly between two rivers, and projecting 
into the harbor formed by their junction, and divided into a 
number of peninsulas by creeks and marshes, indenting it on three 
sides so as to leave but little unbroken highland in the middle. 
{Ramsafs Medical History of South Carolina.) Under these cir- 
cumstances the town was a prey to malarial fevers, which rendered 
it almost uninhabitable from June to October. By the process of 
filling and building, these fevers gradually diminished, and at the 
present day have disappeared. Dr. Ramsay continues, in speaking 
of this amelioration produced by this process, “From the operation 
of these causes a change for the better has already taken place to 
a certain extent.” “With the exception of the more frequent re- 
currence of the yellow fever, Charlestown is more healthy than it 
was thirty or forty years ago Bilious remittent autumnal 
fevers have for some time past evidently decreased.” 
It has been attempted of late years to explain the disappearance 
of malarial fevers from Charleston, on the supposition that they 
were chased away by the more powerful yellow fever; but this 
explanation scarcely accords with the observation of Dr. Ramsay, 
just recited. It would appear to us that by the very process by 
which the one was diminished, the other has been increased. In 
illustration of this view, we will mention certain facts for which we 
are indebted to the reply of Dr. Wragg, 1859, to a letter from Al- 
derman Robert Lebby, M.D., addressed to certain members of the 
profession of Charleston, asking their opinions on several questions 
as to yellow fever. 
In 1833, yellow fever was localized and bounded by lines, which, 
although they may have been overstepped in some points at times, 
were nevertheless tolerably accurate limits to the infected district. 
The southeast part of old Charleston was the doomed territory, and 
Water Street on the south, King Street on the west, a line some- 
what below Calhoun Street on the north, with Cooper River on the 
east, formed its boundaries. The west end of Broad Street was 
considered safe, and all that part of the city known in old times as 
Harleston’s Green, lying west of Rutledge and north of Beaufain 
Streets, was still more exempt. Cannonsborough, still further 
north, was a safe resort for strangers, provided they did not go far 
enough up on the neck to incur risk from country fever. The 
same may be said of Mazychborough, Wraggborough, and Hamp- 
stead, on the east of the city, and also of the intermediate central 
ridge from the citadel and St. Paul’s Church, upwards until the 54 
REPORT ON THE 
region of country fever was reached. As late as 1838, it was safe 
for strangers to remain in the city in yellow fever seasons, provided 
they did not go below Calhoun Street. At the present time there 
is not a location within the city boundaries which can be said to 
be free from liability to the disease. In former times it did not 
intrude upon these regions which were blest with a peculiar im- 
munity, but in 1838 the spell was broken, and safety was no longer 
found in one at least of the favored precincts. Cases of the disease 
occurred in the neighborhood of Judith and Elizabeth Streets, this 
year, for the first time. We quote from Dr. Wragg’s letter above 
referred to. 
“ Let us look around and see if any local changes in the region 
about the houses may have had influence in producing them. A 
year or two before John Robinson had commenced the improve- 
ment of his lots partly on Judith Street, and in the square bounded 
by Elizabeth Street on the west and Alexander Street on the east; 
these lots were low and were near the mouth or outfall of a long 
narrow marsh flat, which, commencing here, ran from an eighth of 
a mile westward, as far as King Street. The natural effect of the 
filling up of these lots was to injure the drainage of all that part of 
the marsh flat lying west. So completely was this effect produced, 
that frequent inspections were held yearly for the purpose of 
remedying the nuisance, but in vain, since the stoppage of the 
natural drainage could only be compensated by artificial drains of 
sufficient size and depth to take off water, while at the same time 
provision should be made for improvement of the low ground 
above. But as there was no authority or means to carry this into 
operation, the nuisance became more and more intolerable from 
year to year.” “ For the improvement of his lots Mr. Robinson 
had used wood and other destructible material to a considerable 
extent, and had also transferred by means of a temporary railroad 
the whole of the mound of earth (a remnant of the old fcitrtee) which/ 
formerly stood at the corner of Meeting and Mary Streets.” 
“ From this time the exemption previously enjoyed by this re- 
gion vanished. Since then we have not only seen yellow fever 
claiming its victim there, but typhus, scarlet, and other epidemic 
fevers have from time to time severely scourged it. About the 
time of which I am speaking, the eastern end of Calhoun Street 
was in the enjoyment of a reputation for health not inferior to any 
other portion of the neck. I well remember, that, in 1836, when 
cholera made its visitation to Charleston, I only saw a single case CLIMATOLOGY, ETC, OF SOUTH CAROLINA. 
55 
in that part of the street where the free ebb and flow of the tide 
over the low grounds kept them clear of decomposable deposits. 
Within the last ten years the street has been made up with wood 
and the low lots filled with chaffj sawdust, and such destructible 
material, and now the neighborhood has lost its reputation for 
health. Within the last twenty years, during which time the work 
of filling up low places with garbage, sawdust, chaffy etc., has been 
going on on Gadsden’s wharf, that place has been steadily becoming 
more and more unhealthy, till last summer the work of death was 
so actively carried on that the population was almost decimated. 
Since the filling up of White Point Garden with the same destructi- 
ble materials, yellow fever has got a foothold along the formerly 
healthy region of South Bay .... The same observation holds 
good for all the shore line of the Ashley, and accordingly we see 
victims of the disease in Legare, Gibbes, Tradd Streets, etc., and 
when you reach the low grounds extending from Tradd Street on 
the south to Beaufain Street on the north, and from Franklin on 
the east to the river on the west, you come to one of the most in- 
fected of all the districts of the city You will remember 
that this very spot was referred to above as one of those in which 
even the stranger felt secure in former times from yellow fever. 
The change that has taken place is its conversion from a marsh 
overflowed twice in twenty-four hours by pure sea water into a 
porous, putrefying, undrained soil, composed almost wholly of the 
offal of the city The jail and Marine Hospital have occu- 
pied their relative situations for fifty years. During the whole 
of this long period the hospital has received and treated yellow 
fever patients; while I was a student I have taken my first lessons 
in the disease at the bedside of patients who might have almost 
jumped from their beds into the inclosure of the jail; but never 
was the yellow fever known to have entered that building till 1852; 
since then it goes into it as regularly as into the houses of Elliott 
Street. Let us turn to the condition of things in the neighborhood, 
and we will find just such a change as has been shown to have been 
the precursor of the introduction of yellow fever into all the other 
locations referred to above. And the remarks made in reference 
to the jail hold good with regard to the private residences around 
these buildings. The offal of the city makes the soil all around. 
It has been stated above that the once healthy region 
known as Harleston’s Green is no longer exempt from epidemics 
of yellow fever. The same local changes have taken place there. 56 
REPORT ON THE 
Low places have been filled up with the usual mixture of animal 
and vegetable compost, and while the pure tide water of the ocean 
has been excluded, its healthful presence has been replaced by filth, 
corruption, and putrefaction This region previous to the 
changes I have been tracing was a country fever district. It at 
once became the nidus of yellow fever.” 
We have introduced this long extract for the reason that it con- 
tains facts historical of the march of yellow fever in the city of 
Charleston. That the influences above mentioned are great in 
the production and spread of yellow fever, the fact of the occur- 
rence of epidemics after large fires goes far to prove. The first 
appearance of the disease in Charleston in 1699 or 1700 followed 
upon the “calamities resulting from a disastrous fire and a fatal 
epidemic of smallpox.” 
The municipal authorities, taught by the hard lessons of expe- 
rience the truth of the deductions mentioned above, passed the 
most stringent laws forbidding the use of such material in filling 
up and improving lands; which, if they could not undo the damage 
already done, would prevent the further extension of the evil. 
From 1861 to 1865 the exigencies of war prevented the proper 
execution of sanitary policing, the evil results of which negligence 
culminated in the epidemic of 1864. Since 1865 these laws have 
been treated as a dead letter, partly from the necessity of filling 
up lots which had been dug out to furnish earth for the building 
of the numerous batteries which dotted the sea face of the city, 
partly from the ignorance of the traditions of the city on the part 
of the executive officers of the municipal government, many of 
whom dated their residence in this city but a few months back. 
Lands were reclaimed and stolen from the domains of the tide-water; 
the materials used in this improvement of property being the same 
disease-generating putrescent compost of garbage and city offal. 
In 1869 the work was begun of filling and reclaiming certain water 
lots composing Bennet’s millpond, covered in the natural state by 
tide-water let in through floodgates. These water lots are situated 
in portion of the city, bounded on the north by 
Yandt»iiorst Street, south by Calhoun Street, east by Smith Street 
and the rear of lots on the west side of the last-mentioned street 
already built upon, and west by the rear of premises fronting on 
Rutledge Avenue. By the order and with the consent of the then 
Mayor, the city scavengers Were ordered to deposit the accumula- 
tions of city garbage and offal on this spot. On a reference to the CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
records of the City Council, February 23d, 1869, we find two memo- 
rials from citizens residing in the neighborhood, bitterly complain- 
ing against the procedure, for the reason that the “stench arising 
from the large quantity of offal collected is already offensive, and 
we believe will be the cause of much sickness as the weather 
becomes warmer.” “ The number of buzzards collected by the 
carrion seriously damage the water of the cisterns by defiling the 
neighboring sheds.” At the urgent solicitation of these memorialists, 
a committee of five of the prominent medical men of the city was 
appointed to investigate the matter, and through their chairman, 
in a report, set forth at length the injurious results to be expected 
from the process of decomposition which would ensue, and recom- 
mended the immediate cessation of the work and the covering of 
the deposit already made by dry sand. This was done, not, how- 
ever, until too late to prevent much mischief, which was manifested 
by the occurrence of typhoid fever in the neighborhood soon after. 
In the latter part of June, 1871, Vand&horst Street, from Eutledge 
Avenue to St. Philip’s Street, was graded, covered with large stones, 
and the interstices betweeen them filled with small stones. Over 
this was spread the black mud, containing the results of the 
drainage and filth of the neighboring premises, taken from the 
tidal drain in Coming Street. About the same time, lots on the 
corner of Eutledge and Calhoun Streets were prepared for building, 
by laying on the mud of the water lots beams of wood side by 
side, and these were filled upon by shavings, sawdust, and black 
earth. What was the result of all this? We learn from the 
report of the City Eegistrar that fifteen cases of yellow fever 
occurred in Pitt Street, and many deaths in its vicinity. This 
street passes from Yanduhorst Street, and runs parallel with Smith 
Street on which the offensive lots are situated, and one square east 
of it. 
Let us go from here to Market Street, where the yellow fever 
showed itself in its most virulent form. On the 11th of July during 
the absence of Dr. Lebby, the City Eegistrar, a new drain was con- 
structed one hundred and twenty yards east of Meeting Street and 
about one hundred and fifty yards from Mr. Claussen’s. On open- 
ing the main sewer with which the new drain was to be connected, 
so offensive was the stench, and so noxious the gases which were 
diffused, that the workman who was engaged in the work was re- 
moved in an insensible condition and suffered a severe illness. 
Next to Mr. Claussen’s establishment, and separating it from that 58 
REPORT ON THE 
of Campsen & Co., is an alley known as Rafers Alley, running 
north and south from Market to Guignard Streets. The condition 
of this alley has been described to us by the employes of Mr. 
Claussen as having been most filthy previous to the outbreak of 
the yellow fever, and the stench arising from it'very distressing. 
The drain which passes through its length had caved in, and the 
noxious gases which arose from it were diffused in the atmosphere 
of the neighborhood. This alley had already been reported as a 
nuisance, and the neighbors, fully impressed with the necessity of 
remedying it, had offered J,o the municipal authorities to share in 
the expense of its repair. We learn from the report of the City 
Registrar for 1871, that, with the exception of part of Tradd and 
Thomas Streets, the sewers are filled up to the crown of the arch, 
and in the large majority have not been cleaned since 1859 or 1860. 
In addition to these fruitful causes of disease, the meteorological 
phenomena of 1871 were eminently suitable to convert into an 
epidemic any disease capable of assuming this form in the summer 
season. In May, June, and early part of July there was extreme 
heat and dryness, which continued nearly forty days. Only 1.47 
inches of rain fell, at long intervals and in light showers, with a 
mean temperature of 88.84°. 
Between the early part of July and 1st of August there was a 
period of intense heat, the thermometer rising to 102° on July 10th. 
From the latter part of July to the end of October there were heavy 
rains and a noted absence of electricity. During the four months, 
July, August, September, and October, there was a rain-fall of 
27.20 inches, and a range of temperature from 57° to 102°. During 
the rains of the last of July and beginning of August, the collections 
of water in the cellars and burned district were so extensive as to 
require the use of the steam fire-engines continuously for days to 
remove it. In some localities as fast as the water was removed 
from the cellars they were refilled by the percolation of the subsoil 
water, and in some instances they had to be pumped out three or 
four times. On Market Street the cellars of the fruit shops were 
in an extreme degree of filth. They are dug in the made land, of 
which a large part of this portion of the city is composed, and their 
contents of cabbage leaves and other refuse attendant upon shops 
of this kind, when saturated with the water of the heavy rains, 
acted upon by a burning sun, produced a state of things not easily 
described. 
Yellow fever also visited the town of Beaufort in 1871. In the CLIMATOLOGY, ETC., OF SOUTH CAROLINA. 
59 
recollection of the oldest inhabitants, this town has been visited 
only three times by this disease; first in 1817, next in 1854, and 
in the last year. 
The first case occurred on August 6th, in a man, who was 
brought from Bull River, sick with fever, and died on the 17th 
with marked symptoms of yellow fever. The disease ran its course 
from this time until November 21st, when the last case terminated 
fatally. “ There were forty-one cases among the whites, and one 
colored; seven of these (whites) died.” We regret that we are 
unable to enter into the details of this visitation, by reason of the 
absence of the necessary data. 
It is a matter of regret that we have not obtained more extended 
statistics from other parts of the State in relation not only to the 
meteorology but the diseases that may have prevailed during the 
period of which we have treated, hence, we have been obliged to 
be restricted in this report principally to Charleston. 
Inasmuch, however, as the disorder we have chiefly discussed, 
not only a scourge to the people of Charleston but a terror to all 
strangers who may have propinquities towards the city, has occu- 
pied so much attention both at home and abroad in scientific and 
other circles, we may find some compensation for the paucity of 
other interesting materials from different portions of the State. 
Whatever may be the origin of the epidemic in the considera- 
tion of which we have been engaged, those who would lend their 
energies to the prevention and removal of the agents likely to 
contribute to the diffusion and continuance of the distemper before 
it does assail us, although they may not succeed in excluding it 
altogether, would confer a blessing not in health only, but in all 
the avenues of comfort and prosperity, which would entitle them 
as well to the gratitude of our people as the universal commenda- 
tion of all the humane.