Yellow Fever
FACTS,
AS TO ITS
Nature, Prevention and Treatment
BY
JOHN B. C. GAZZO, M. D.,


   PARISH OF LAFOURCHE, LA., 1878.

\*j
                <Jty
M. F. DUNN & BRO., PRINTERS,

   72 Camp street, N. O. 
 
    YELLOW   FEVER  FACTS,
As to its Nature, Prevention and Treatment
            By JOHN B. C. GAZZO, M.  D.,
                  Parith of Lafourche, La., 1876.
  The present essay might be devoted to many interesting sub-
jects, physical and medical, but I am induced from many con-
siderations to restrict my attention particularly to three articles.
You have long been acquainted with the important controver-
sies that have existed on that great subject of medical disputation,
coutagion, with the various and contradictory  opinions that
have been promulgated as to its nature aud effects, and with
the manner in which these controversies have been conducted,
especially by French, German and Italian  physicians.  The
question  of contagion and infection has also occupied, as yon
well know, a large share of the attention of the medical writer*
of Great  Britain, especially  within the last thirty years.  Much
less diversity of sentiment, however, exists in this country than
in our own, and in the discussion much  less of asperity has
been manifested.
  Some experience with yellow fever in the city of New Orleans,
in 1837, and in the city of Vera Cruz, Mexico, 1839, and for the
last forty years in  the parishes of Lafourche and Terrebonne,
La., and  the perusal of most of what has been written upon the
subject have impressed  convictions, the truth of which, if they
be conformable to fact, is so important as to make it justifiable,
if not  a  duty, to give  them publication at the  present time,
without claiming novelty for my views.  Therefore, my purpose
is to endeavor to give the results of a careful investigation of the
facts, and, if possible, an approach to a consistent hypothesis,
with direct practical application.  To this end, it will be best to
attempt a brief summary of the subject in a methodical form.
  Yellow  fever is usually classed with the fevers of remittent
type, and in all essential particulars this is certainly the relation 
4
of febrile affections to  which it presents most affinity.   How
ever, yellow fever is, iu  certain epidemics, marked by a^ tendency
to divide itself into distinct and separate phases, rather than by
any  characters ot  daily remission of the pyrexial  phenomena,
the name given to that  acute disease which, during hot weather-
particularly after the summer solstice, prevails among huuinu
beings on the continent of North America.   It also occurs in
the south of Europe, on the coast of Africa and  within  the
tropical regions of  Asia.  In a particular manner it originates
and  prevails in  ships  and  sea  vessels of all kinds, which  are
suffered  to  become tainted by deleterious emanations  from
orgauic matters or malaria,
  The term  u yellow "  is given to the fever because many who
are invaded by it become tinged or even deeply tinctured with
that color.   This change of complexion is no sign of fatality of
the fever;   therefore,  many persons or patients recover  after
having become remarkably yellow.  In many cases the yellow-
ness increases or comes on after death.  But frequently, too, it
happens that persons who undergo severe attacks of fever have
little or  no  yellowness.  The word, therefore, being employed
to express a sympton which many cases of the disease do not
possess, which is very improper.  It is sufficiently clear that
the yellowness is not owing to absorbed or requigitated bile.  It
is, therefore, wholly different  from the hue which  prevails in
jaundice, which is only alteration from the coloring matter of
the bile that passes into the circulation in  sufficient abundance
so as to impregnate and give that yellowish tinge to the body.
  It has been called by nosologists a "fever," though many per-
sons have undergone it within the city of New Orleans, and also
in other places j  as, for  an example, during the epidemic of 1837,
three brothers (the Messrs. Dupasse), of that family at New  Or-
leans, all of them natives of the citj of Marseilles. France,  with-
out any symptoms of preceding chill and augmentation of febrile
heat, and neither increased frequency of pulse,  etc.,  which
nosologists  consider as necessary assimilation to it, although
they  were attended by Dr. M. Halphen,  an experienced and
highly  intelligent  physician,  who  had no  hesitation  in pro-
nouncing these cases yellow  fever.  My  impression  and 
5
observation  derived  from  practical   experience  in  treat-
ing  yellow  fever  is, that  it  is  a  violent  acute  disease
of   single  paroxysm  lasting  about  seventy-three  hours,
more  or  less,  and  presenting  strongly  marked  char-
acteristic  symptoms  by  which  it  may readily  be  distin-
guished  from all other types of fevers.  The truth is, yellow
fever is  so closely allied  to various remittent  types  that  no
uniform  and  reliable distinction  can be  drawn between them in
its early progress.  It is through these sensations of chilliness
which accompany the heat in the  febrile condition.  They are
in  reality  but peripheral  phenomena, which the outer parts of
the body are freezing and the inner are burning.  Increase of
temperatuTe to the extent may be of 4° above the standard is
to be regarded a constant and at least an essential condition of
fever, while the natural blood heat in health may be about 98°,
when the stage of heat or fever is developed.  The thermometer
in the mouth, the axilla, and suitable parts of the body will be
found to indicate an increase of the patient's temperature to
100°, 102° and 104°, and it may  be even above those degrees or
indications.   The pulse 100° and  respiration about 20',  This
increase of heat is  the surest mark of the existeuce of yellow
and typhus fevers, which produces a maximum  of caloric, and
 being the one in which a considerable elevation  of fever exists
 with a moderate acceleration of the pulse.  My views in regard
of using the thermometer in diseases were  published in  the
 American  Lancet at New York, vol. XL, 1854, principally in test-
 ing and  showing the value in the phenomena of fevers. The fever
 makes its  appearance with lassitude after more or less malaise
 and sensation of fatigue, in which vibrating chills, with a fever,
 during which a febrile excitement, accompauied by  headache,
 pain in  the back, the thighs and calves of the legs, the skin is
 generally  hot and dry, the heat  of the body is very pungent.
   The malady has also been distinguished by the appellation of
 "black vomit," because in some of the worst forms of it, and
 very often the cause of negligence in not calling a physician in
timfi, and  especially  in maltreated cases, who are attended  by
persons  having no experience in the science of medicine, by the
use of improper remedies in these cases, the sick eject from 
6
the stomach a dark colored or black liquid.  This is the pure
cnmito pruto, or black vomit.  This, however, is only a symptom
of certain violent and disorganized structures of the whole sys-
tem within these cases, but by no means a characteristic of the
vellow lever in  all  instances.   The actual experiments  and
researches on black  vomit by Dr. Joseph Jones, Professor  of
Chemistry, etc.,  in  the  Medical  Department, University  of
Louisiana, " has given  '.he proof of the changes in chemical
ami physical alteration of the blood in black vomit of yellow
fever."  Thus in the phenomena, which results from the orgauic
chauges of the tissues in the essential elements and chylitication
of the  blood, is the cause of black vomit in yellow fever, which
has time  to take place in  the circulation.  Then the blood flows
of a black color,  which is  vomited or thrown up of that hue, and
in other hemorrhagic forms, which are never siDgle, nor from
auy one source or organ only. Black vomit is combined with
profuse intestinal hemorrhages,  with bleeding from the nose,
the mouth and  the  gums,  etc.,  and also  from several parts
of the cutaneous  surface,  denuded of epithelrium by vesication,
and in  fact uhrasurc gives rise to  bleeding more or less profuse,
and the only ineaus we can obtain at the prognostic that yellow
fever is in a state of existence and prevailing, is by  observing
the liual  issues,  whether in death or convalescence, and  the
former is by far  the  most  conclusive of the two indications.
Even in the epidemic of  this year, 1878, many  cases occurred
which  uo oue would have thought of calling it yellow fever, if
it  had  not been  known that many of the same  character and
appearance had terminated with  the black vomit.
  Certainly  there seems  to be uo reasonable grouud for  the
belief of contagion in yellow fever.  How is it possible to main-
tain it  after the dangerous experiment of Dr. Chervin, of Paris,
upon himself as testing black vomit and innoculatiou  with it
and with serum  and saliva of patients with the fever.  I have
myself, after being acclimated by the process of yellow fever,
slept for a considerable  time on repeated occasions, for want
of better quarters, under  the same roof and in immediate con-
tiguity with my patients  laboriug under a very high stage of
yellow  fever from the first day of the attack to the last hour of 
7
existence,  I have also denuded the  cutaneous surface of my
hands when handling black vomit and other fluids and tissues
of the body of patients who died of yellow fever and still suf-
fered not least inconvenience from this centact and  exposure,
and I do not believe the exhalations from  the bodies of those
affected  have the least effect in reproducing the yellow fever.
Doubtles the vitiation of the air by means of these  effluvia is a
strong predisposing cause in the same degree that an  impure
atmosphere from any other cause would be and  certainly is.
  It is frequently the case that the onset of the yellow fever is
of so mild a character, that the subject of it continues walking
about for  five or six days,  thinking himself not very ill, and
even refusing to consult a physician until black vomit appears,
not being upon his back  probably  more  than  twenty-four
hours, indeed, some of the most intractable and fatal cases are
those of which the early symptoms are the mildest in foreigners,
and  apparently  inconsiderably so, that the violence  of the
invading approach of the yellow fever is no indication of its
danger or its liability to proceed a to fatal issue. Therefore it is
necessary to be  on  the guard or watch.  Yet there are some
of these cases  that do  not terminate fatally, for one week or
three  weeks  or more,  consequently these cases are probably
seen  for  the  first time,  after  the disease  has  had  almost
uninterrupted  sway during  five  or  even seven  days.  The
patient at this time is unable to give any account of himself.
These cases  linger sometimes  for many days  or even  weeks
or months, and die eventually of softening of the brain,  spiual
marrow  and spleen  arises doubtless from complete mortifica-
tion of the mucous membranes of the stomach and intestines,
and by  proper  medical and judicious  management may some-
times recover.
  The Creoles  and natives  of most Southern  States are not
subject to the fever in its continued  form,  but when it does
invade them,  it  more  commonly assumes a remittent or
intermittent type.  Europeans  and northern  Americans, who
have resided during a period of several years in the country or
parishes of the State of Louisiana, are seldom attacked with the
fever in its continued  form, but when it seizes them  it com 
8
raonly assumes the type of a remittent.  These persons of this
class, the body  from long exposure to the climate has become
creolised or acclimated.  Women and children are less frequently
the object of  its attack,  and wheu  it does  seize  them it is
commonly mi'der and less rapid in its progress.
  If the yellow fever is protracted beyond seven or twenty-one
days, which in certain cases occurs, it presents more character-
istic appearances of euteric fever.  This change is evidently
a continued fever of a single paroxysm, in which remission aud
exacerbations  is seldom observed, and  in the worst cases too,
in the paroxysms  which  constitutes  secoud  stages  never
occurred, but the disease passed immediately from the first into
the  last  stage,  without going through the secoud  type of
reaction.  These are  the  cases which  run  in the congestive
variety of yellow fever, and  attended with great prostration
and  oppression.
  Its exciting causes may even  be engendered in the human
stomach and bowels, from venous azotic materials of our food.
Hence sporadic cases of yellow  fever or typhus fever  have
occurred to individuals who had never visited a ship or a city
etc.,  and  who lived 'in  a  healthy   neighborhood  and  in
a clean  house.  For instance, I have seen and observed in the
Faubourgs of the  city  of Montreal, Canada, in  1827,  many
cases of that  kind which occurred among the voyageurs, the
Canadian name of  a class of  men employed  formerly  in
transporting  goods  from remote  stations  on the Ohio  and
Mississippi rivers  and  in the nort-west trade, occurring very
often in an overheated close room, warmed by a large fiery stove,
which are used in Canada during winter  seasons, which has
consecutively  bad effects, so as  to  produce various  changes
within the system of these persons and mask the symptoms of
its malady, who have  lived most all their life out-doors in a
pure atmosphere in the active occupation they pursue.  Such
is very often  the case in patients who have never been confined
in closed quarters, are more liable  to become very  sick aud
which will promote the malignancy of the  disease.  Men on
board of vessels should  not be allowed  to sleep on board in the
hold of a ship wheu in  Southern  ports.  It is possible for such 
9
persons  to be  thrown into  typhus  or yellow  fever, from
substantial  septic matters engendered within their  own  ali-
mentary canal.
  It is  a characteristic evidence  of yellow fever aud the un-
mistakable  criterion which its attack is known to be ushered
in with  a  chill aud pains in the  back and  loins and in the
limbs, the  knock down influence  of  the yellow  fever  upon
the patient's strength from the first moment of invasion.  The
Jesuits   and  Domican  Fathers   described  such  cases as
" coup de Barre," and of frequent  occurrence  in the  epidemic
of the West Indies and the shores of the Mexican  coast, which
is met  with iu  the  epidemics  of  Vera Cruz*  Howeveri
during an epidemic all diseases will assume the types of yellow
fever, but they have other predisposing causes than that which
initiates the real yellow  fever,  into organized individuals full
of health.  But a few  hours  before a sudden change  in the
temperature provokes,  the latter particularly  iu  the afternoon
as the suu's rays leave the earth.  Wheu the thermometer falls
sensibly, at the period of the epidemic visitation, are to the
acclimated  invigorating  to  the  frame.  A disagreeable fetid
odor, arising from the perspiration of the sick, aud this odor
is also  conclusive of  the presence of  yellow  fever,  and is
familiar as such to every  physician  who has  acquired  knowl-
edge  of  the fever.  To prevent it being noxious to the patient,
from  reiuhaling  it,  is  to  purify the  atmosphere  of it,
by insensible ventilation, it is simply to take one of any  of the
various kind of glass  lamps, for burning coal oil, as for exam-
ple,  aud fill it  with chloric ether.  This suggestion  is really
worth remembering  in burning  one  of  these lamps,  for  the
comfort  of  a sick room,  because  it is easily accomplished in
purifying than  any process known.
  Yellow fever,  " for  we  must call it  so,   notwithstanding
impropriety of the name," seems  to have an immediate con-
nection  with an atmosphere  locally  vitiated.  The  common
mischievous agent is septic exhalations, formed from alluvial
marshy soil,  The period at which the effluvia is eliminated is
during the  process  of desication.   Wherever the disease is
found in its endemic form, as it is only met with in such
    2 
10
 situations that breed vegetable substauces, which contain its
 radical  azote  or  septon,  the  basis of  this  acidissible  gas
 becoming bydrogenated  is  highly active  aud  deleterious,
 exciting a multitude of bad effects upon  constitutions  pre-
 disposed to be acted upon by it. This is clearly proven by the
conditions of things in the lower lands and marshy swamps of
 Louisiana, where the disease is endemic.  Now here we have
 two conditions of soil  brought in immediate contrast,  one
 constantly iu undated aud the  other to periodic inundation
and evaporating,  aud whilst fever is frequently raging in one
 situation, it is never known in the other.   Thus, when men
 are  working in the swamps of  Louisiana, they  are  never
 attacked by disease, whilst those  kept outside upon the coast
 of the river and  in mouths of bayous, are more liable to be
sick with fevers.   This  I believe  is also the  case  in every
country where  yellow fever prevails, aud this was found to be
true in Vera Cruz, Mexico, in the epidemic of 1839.  Here also
 the disease is confined to the same condition of soil, for it is
not found upon the elevated lands but always  confined  to
 marshy districts overflowing.  Now it is positively certain that
wheu yellow  fever  prevails  there is also found generally all
 varieties of remitteut aud intermittent  fevers.  These diseases
arising  from  the  same cause by different degrees of iuteusity
of the ozote or air-viscee.
   In the year of the bombardment of the city  of Vera Cruz,
 Mexico, 1838, by the French npon the Island Salmadina, where
 they had placed their Naval Hospital but  removed not less
than five miles from  the Mexican shore, being a small Coral
 Island,  perfectly  dry and very healthy, yet  upon  this spot
 there were men attacked by the yellow fever who had  not
been off it for  weeks and months.  Thus showing that  yellow
fever is not a contagious disease, as these cases only occurred
during the prevalence  of strong and continued breezes from
the land, which invariably produced  a  great number of cases
and aggravated the symptoms of those already sick.  The
very reverse was the case during the prevalence of strong and
continued breezes from  seaward, these  uever failed to reduce
the number of cases aud improve the condition of the sick. 
11
As a chauge in the winds become almost as certain an indica-
tion of the u umber and condition of the sick as the thermome-
ter  of the temperature of the air,  and heat was excessive
that season, it  ranged  from 90° to  100° in the shade.   The
ordinary degree  being 85°.  Therefore the idea that malaria
can only be carried a short distance, which I apprehend is an
error, but on the contrary, that it  can be born, to very great
distauces through the medium of the air.
   The places  where  the mischievous agent is most  readily
formed aud most highly concentrated is on board of sea vessels
which contain corrupting articles  of freight, which constitute
a  large  proportion of the cargoes;  they frequently get  into
putrefactive state on board, and then the exhalations pent up
in a tight vessel  become very malignant and venomous; hence
it  happens that so many of our seamen are  cut off in  this
trade—they are killed by the malarial  air engendered in their
own vessels and that not unfrequently when they  are outward
bound, but more  commonly while they lie in foreign harbors
or  are returning home,  because there has been  longer  time
given for the septic  or azotic  matter to turn to an  noxous
effluvium and insinuate itself through every space within  her.
Hence the crew  are thrown into ship-typhus or yellow fever.
One of  the best illustrations  perhaps, is furnished  by  the
sailors or  river  men  belonging  to   the  bayous  and  lake
schooners or vessels frequenting the Mississippi river.  These
men, as a body, are in the prime of life, robust and  well  fed.
Most of them  are Italians,  Americans, French  and  of  the
British nations.   But  as I found by examining  many of these
schooners,  the  place  where they  sleep,  the forecastle, is  ex-
cessively small and coufined with this  serious additional evil,
that as the hatchways usually flush with the deck,  it becomes
necessary whenever there is  much sea, to close it down, when
the  unfortunate  sailors must be  without any  window, as if
shut up  in a close box.  When too,  the schooners come to
New Orleans,  as only one man is  required to keep watch at
night, all the sailors  are crowded together in their  closely
packed berths.
  Many  years ago, the  attention  of  Dr.  MeKelvey, the  dis- 
VJ
tinguished surgeon  of the U.  S.  Marine Hospital  of New
Orleans, and also Dr. John J. Ker, of the Circus street Hospital
of the same city, who  in  addition to the above,  know of
several cases in their hospitals, and  both physiciaus  were
attracted to the large number of typhus cases which  were
admitted  in  18.11, aud to the fact  that  of all the vessels in
New  Orleans, the bayou aud river men  or sailors,  were most
subject to the fever,  In  investigating this question, I could
detect no other cause than the polluted air which  these men
must have breathed in  the coufined forecastle  and  that there
is nothiug connected with  a  sailor's mode of life to  expose
him to typhus  fever,  which is proved by the experience of
well managed vessels or ships  which have never had a single
case of that disease on board.
  Yellow  fever  has  beou  said  to have been  imported from
foreign places into the  United States, and with this opinion
many  of our fellow-citizens console themselves.  They  are
positive that the disease originates solely iu the West Indies,
and is merely derivative to them.  To these persons  it is a
sufficient reply that the people  of the West Indies are  quite
as positive that it never arose spontaneously in their towns or
cities, but iu all cases, without exception, is imported  to them
from Baltimore,  Charleston, New Orleans,  Philadelphia, New
York aud our other Atlautic and Gulf settlements.  The truth
is,  that  it does in  some degrees arise  from the local and
domestic  causes in all these places, which might be owing to
physical changes iu the constitutional element  of men.  Thus,
probably, the co-incidence  which are the climacteric diseases
aud mortality among  the northern people in their  cardinal
evolutions, and more particularly is locally eugengered on ship
board. Filthy and polluted vessels, the factorium, the nurseries
and vehicles of yellow and ship fevers thus sail from port to port
and give  color to the unhappy  and pernicious  notion,  that
the  place from  whence  they  last  came  is sickly; whereas,
there is in fact no more connection between the sickness of a
crew  and the state  of health in the place whence  the vessel
sailed  than  there is between  the  corrupting of a  cargo of
provisions and the latitude of the  place  at which they were 
13
produced, though  the exciting cause of yellow  fever may be
on board a ship from the West Indies or  Mexican  port;  that
the port or place has nothing to do with it, for it was bred on
board  the vessel.  The  way  to  destroy  it is  to  cleanse the
ships or  vessels.   When filthy,  may be rendered  clean by
the same means that houses are purified, to  wit: by lay  lime,
chlorides  of lime aud zinc, carbolic acid, etc.  Consequently
the exciting  cause of yellow fever is locally produced within
ships aud not imported from foreign countries.  It  is, however,
not contagious,  as some have mistakenly  supposed.  In the
summer of 1839, there were a great many  naval and merchant
vessels lying at  anchorage at  Anton Lizardo,  twelve miles
south of Vera Cruz at the distance of at least three miles from
shore, with which there  was no communication, and yet  men
were constantly attacked by the yellow fever, notwithstanding
they  had not left their ships for  a very long time before the
disease appeared.
   Next to sea vessels, cities  and towns are most unhealthy,
because many of them are built upon low grounds, are inhabited
by large  numbers of intemperate and filthy people, and are
governed by a wretched police.   Nothing is known as to the
effects on the human system of the meat of animals butchered
 while suffering from blood diseases, such as the serious zymotic
diseases,  as western hog  cholera and  Texas cattle  fever.
 Surely this a matter which merits through scientific investiga-
tion, as says, Dr. S. S. Dozinsky in the Medical  and Surgical
 Report of August  the 17th, 1878, and thinks the  government
in these United States, should take it in haud, and the corrup-
ting provisions in the supply  of life, are usually stored, and
 kept indiscriminately within them, and often vitiate the atmos-
 phere to an noxious degree.  In many places the foundation of
 the streets, houses  and  yards, is a  mere collection of putrid
 mud, corrupting recrements and animal offal hardened by  com-
 mixture with some sand by pressure and  by  paving, and  in
 addition  to these abundant and  alarming,  it is the fashion in
 some of the cities of the  United States, to collect and retain all
the excrements of the inhabitants from year to year and  from
 century to century.  In  Boston  and New York, this precious 
14
material is preserved with great care and expense, the  pro-
prietors of towns lots dig deep pits  iuto the earth, and these
they surronnd with walls of brick and  stone, and  cover with
strong timbers and plauks, that nobody may have access to it
and steal it away.   Here the  owners flatter  themselves it lie
safe  and  dormant, but they  are mistaken;  already has  this
accumulated excremeuts  perniciously poisoned  below the sur-
face of the soil their water, and annually when the  weather  is
hot enough,  does it rise iu   pestiferous gaseous vapors; in
fact the atmosphere  then sickeu  or  destroy those from  whose
bodies it was discharged and as well  as to others, hence, there-
fore, are the most frequent manufactories of night soils,  which
go under  various names,  these kind of  matters beiug of an
noxious emanation and undergo most inconvenience in derang-
ing the fuuctions  through pestilential disorders, which  that
offspring of contamination and corruption  excites.   From the
like materials and malarial which effect ships aud cities, mauy
particular tracts  of country, iudividual houses,  public hotels,
single rooms iu a house, or eveu particular parts of a chamber,
become charged  with essential materials  that  may turn to
pestilence, kindle up typhus or yellow fever, and end in black
vomit, or by dark  colored dejection through  the  bowels;
hence, we hear of these  fevers now and then  in cities,  and
also in the interior parts  of the land, far away from  ships and
seaport towns and cities.

                      PREVENTION.
  Quarantine is  now carried out by towns and villages,  and
eveu by certain  police juries of parishes within the State of
Louisiana, as a part of their duty.  Thus as being no protection
and iuterest that Ruch  sanitary applianees  are not yet all that
could be wished in these communities, and are  they available
and do they do any good  ? I say no, particularly if  the views
advocated in the preceding pages are correct, it falls to the
ground, of course.  But we have more than that to say against
it; it never has  succeeded, and never can.   Let us look at the
facts:
  I have copied  three or  four  clauses from the report  of the
General Board of Health, England,  in the conclusions  of the
preceding evidence, respecting yellow fever, which have been
published since in the New Orleans Times, and also in the Louis- 
15
ville Courier-Journal.   The board, comprising all the eminent
and skillful physicians of the day, was  assembled in the Col-
lege of Physicians, London, and after declaring  opposition to
the unanimous opinion  of the physicians of Malta, West and
East Indies, that no measures of  external precaution for pre-
venting the introduction of the yellow fever, by rigorous quar-
antine, have hitherto been found ineffectual, and after consid-
ering a great deal of testimony relative  to the localizing con-
dition  which favor the origin aud  spread of yellow fever, and
showing the evidence of identity, as found within all countries
where it prevails, and propagation of it.   Therefore  I note the
 following sections of this important and  valuabl  joocument, as
 a synopsis in consideration of that subject:
  " That yellow fever epidemics break  out  simultaneously in
 differeut and distant towns, and in different aud distant  parts
 of the  same town, often  under circumstances in which com-
 munication with iafected persons is impossible.
  " That yellow  fever  epidemics  when  they invade a district
 do not spread from the house  first infected to the  next, and
thence to the adjoining, and  thus extend from a centre; but
 on the contrary, are often confined to particnlar  rooms on the
same story.
  " That in general when yellow fever breaks out in a family,
only one or two individuals are attacked;  commonly the attend-
ants on the sick escape; and when several members of a family
are successively attacked, or the attendants on the sick suffer
either, the epidemic was general in the locality.
  " That when yellow fever is prevalent in a locality, the most
rigid seclusion in the locality affords no protection from the
disease."
  The  object of quarantine is to prevent the introduction of
epidemic  diseases from one  country  into  another,  and the
agency which it employs for this purpose is the isolation of the
sick, the detention of and the placing under inspection, for a given
period, persons who come from an  infected  country or district,
though they may not be actually sick, and purification of com-
merce presumed to be capable of imbibing and conveying pes-
tilential virus, before such goods are landed  and dispersed.  It
appears that facts and observation place  beyond all reasonable
doubt the utter inutility of this system.
  If there be any truth in the preceding representations, that
epidemic  diseases are universally and inseparably connected
with an epidemic atmosphere, the question  is at once decided.
Quarantine can exercise no more control  over this epidemic
atmosphere than over the solar  system and temperature of the
common  atmosphere,  and  the directions  and force of the
wind.
  " Yellow fever," says Senator L.  Q, C. Lamar, of Mississippi,
" though a malignant scourge to the world, will, through the
wise beneficent dispensation under which we live, be productive 
16
of consequences favorable alike to science and humanity.  Be-
ing instrumental in throwing much  light on  the practice  of
physic,  it will  prove highly influential iu extinguishing the
belief in pestilential contagion and bring into disrepute the
quarantine establishments that have hitherto existed."
  One of the most  important and interesting facts connected
with the history of  quarantine occurred at Natchez, Miss., and
the same predicament or category appeared this year and since
in many places who had the belief iu the doctrine of quarantine
as a  safe  protection.   Having suffered  to  an extent  truly
appalling in  the year  1837, the citizens  determined to estab-
lish cordons sanitaires, which was  enacted and no  doubt as
rigidly  enforced as  human efforts would  admit. Natchez not
ouly escaped an epidemic, but there was no case officially an-
nounced or admitted during that period, and they thought they
had found iu quarantine ;i guardian angel tor all future time.
But two years  after, 1839,  though the same restrictions were
more  rigidly enforced than  in 1<S:17, Natchez had an epidemic
of yellow fever.  As an instance of this, Natchez may  serve as
an illustration aud warning to other cities.  That city, with  a
vast number of inhabitants, active, commercial aud industrious,
many of them  manufacturers and artizaus.  A quarantine of
twenty  days,  with  difficulties almost insurmountable  which
it entailed, was established  on the borders of  the  Mississippi
river and around the city, maintained witharigor which might
serve as a model to other countries.  But in tne midst of this
apparent security, au irishman living in the back part of the
town  was attacked  by the yellow  fever, and iu a few days the
fever appeared.  The most miuute researches on tne part of the
public authorities could not  discover any communication be-
tween this Irishman  with any stranger or  goods suspected of
being infected coming from the city of New Orleans; but wheu
the fever spead and developed itself gradually and progressively
the authorities saw  too late the deep injury which their sanitary
quarantine had  inflicted.  A multitude of families aud hun-
dreds of individuals were plunged into extreme misery. For
the sudden cessation of commerce and consequent suspension of
labor had deprived them of the means of subsistance.
  "All  these  circumstances," says Dr.  Chervin,  of  Paris,
France, in speakiug of restrictions and cruelties of quarautiue,
•k are calculated to fill with horror the breast of every feeling
and honest man, and we are really obliged  to offer violence to
ourselves in not giving vent to indignation against the partizans
of contagion who yet desire to continue to defend their erroneous
opinions aud who to this day have used all their efforts to make
obscure and disfigure the subject to the great detriment of truth,
who have never ceased to deceive governments which think  it
their duty with regard to this disease (yellow fever) to surrender
themselves to the judgment and  presumptive kuowledge of
medical meu; who  have never ceased to  describe it as conta- 
17
gious, and have induced those authorities to adopt, with respect
to it, the most false and contrary measures, and to neglect the
suitable, prophylactic and preservative means and others which
might have put an end to the disastrous epidemics of this dis-
ease, and that it is they  that have  always acted contrary to
truth, to the interest of governments and humanity."
  I am of opinon that the oppressive features of our quarantine
system should be reckoned among the relics of knownothingism
and of  uncivilized  savages,  which an  enlightened  legislature
should make haste to abrogate for the  sake of our character as
a nation.  There is no pretext for the perpetuation of a system
founded in ignorance and fruitful only in  public and  private
injustice, cruelty, injurious aud faulty,  etc., etc.
  Dr. G. Milroy, one  of the ablest aud most industrious sani-
tarians  of our  time, states iu his " Essay on Cholera and Yellow
Fever"—which are  from a condensation of the conclusions in
the preceding  evidence  respecting cholera  and yellow fever—
and this is his account of the state of quarantine in different
countries:
  " What is most remarkable in the quarantine regulations of
different countries  at  present is the fact of  their  want of
accordance, hardly  any two being" alike.  Another noticeable
point is, that  the more liberal the  government of a country
generally,  and the  freer its  institutions,  the fewer  and less
stringent are the quarantine restrictions.  In the Baltic States,
iu Sweden, Denmark, Prussia, Holland, the regulations form-
ally enacted may be considered almost as a dead letter.  So in
Belgium, where they are nominally,  really in force.  In the
United  States of America, each State of the Union has its own
code, all of them according to the resolution of the Quarantine
Convention of 1857, inefficient and  often prejudicial to the
interests of the  community.  In Chili and Peru along the
whole western coast  of South America, the tendency  is to dis-
regard all quarantine  regulations as interfering with the freedom
commerce.  Iu that anarohical country, Mexico, quarantine is
under no legislation, the board of health having unlimited power,
which it sometimes exercises most tyranically."
  The inefficiency of  quarantine as  a matter has been proved
by  demonstration ; quarantine,  even when rigidly enforced,
has not kept  out diseases of the contagious nature,  of which
there is no question, such as small-pox and other exanthemata,
within  Southern and  Northern regions of countries.
  Great many of the European  nations,  taught by sad and
lamentable experience,  have withdrawn their quarantiue regu-
lations  and acknowledged not their inutility, but that they are
productive of immense evils, aud those evils of  quarantine are
great, almost  incalculable.  Sir Robert Peel, speaking in the
House of Commons, London, in 1849, gave it as his belief that
the losses from quarantine iu Europe and America, on these
two continents,  were  not  less  than  fifty  millions  sterling
3 
18
annually.   But  what  if  instead of  preserving,  quarantine
actually involves often  sacrific of life with yellow fever ; the
quarantine epidemic in New York  harbor in the year  1863,
exemplefied this in various quarters ; reports of travellers have
shown the miseries  aud  dangers  of the Lazeretto and the
confinement on those vessels or ships detained iu  qnarantiue.
  What more do we need to show in this instance, than the
casualty of the steamship Virginia, which arrived  from Liver-
pool at New York Quarantine  Station.  The officers of health
ordered aud directed the Virginia to undergo quarantine before
landing the passengers, which the captain of the said  steam-
ship would not consent to ; so she left for the eity of Quebec,
Crnada, arrived at the Grass Isle Quarantine Station with 1044
passengers, most being German aud  Dutch.   Ou leaving Liver-
pool the ship fever broke out among the steerage passengers in
the orlop, below the deck, aud beneath the water line   Forty-
nine died during the voyage.  After reaching quarantine, being
detained there, the fever increased, but still  it was exclusively
confined to the steerage passengers.   The disease did not exist
at Liverpool, and had not since, as showu by a number of arri-
vals at the Quebec harbor from the port of  Liverpool.   Later
did not exist at Liverpool.  It was on the voyage, and at the
Quarantine Station,  confined  entirely to the steerage passen-
gers, of which a large number  sickened and  died on board the
vessel.
  Will give another accouut of another  steamer,  attacked
within the same latitude  and longitude as the steamship Vir-
ginia.  The steamship  England, of the  Canadian Dominion
Line, in the year of typhus ship fever, in North America, sailed
from Liverpool to a port of Quebec.   Fifty passengers out of
1204 died  on  the vessel during the voyage,  chiefly Irish  aud
German emigrants.   She was prohibited from entering the har-
bor of Quebec; all were detained ou board at Gross Isle Quar-
antine, and by June the 29th,  150 more deaths occurred. In
all 200 died while in quarantine.  If the 1200  passengers had
been landed and scattered on Gross Isle, a very large island in
the St. Lawrence river, I, for one, doubt the occurrence of the
disease of ship typhus  fever in ten of their number, especially
as it was reported as altogether confined to the  steerage, and
will give a striking confirmation of the statement I have in
relation reported.
  Were such measures  sure to preserve from the epidemic the
whole people of our continent, a sacrifice  like this might find
excuse iu principle of truth and reality.  I regard it as an act
of cruelty and savageness.   Geueral Pelissier, in Algiers, was
thought a monster for  suffocating  a baud of guerrillas iu  a
cave, but what are these cases of the  steamships Virgiuia and
England more like, except in motive ?   It is closing up hun-
dreds of people for death, as though  it might be owing to an
impropriety of uusuitableness in  the construction of narrow 
19
 doors and high windows from the bottom of floors so as to im-
 pede or prevent the escape of thousands of our fellow-citizens
 from a burning theatre, such as that of which we read  an ac-
 count in the newspapers of the day, some  time since,  of the
 Brooklyn and  Fifth Avenue Theatres, in New York city.  Aud
 what, says the American Journal of Medical Sciences, January,
 1875, in reviewing several recent  works ou Quarantine, these
 changes are all in the direction  of improvement.   This will in-
 evitably follow until the last remnant of the semi-barbarism of
 personal quarantine shall have gone out of existence.   Intelli-
 gent measures, not only  of local preventive sanitation,  but of
 maritine hygiene  and  also  of the inspection and compulsory
 purificationof vessels at quarantine stations, will remain aud
 will produce those effects vainly sought through rigid quaran-
 tine.
   In Prussia  and Austria  in  1831,   all  sanitary  measures
 enforced by these powerful governments,  were unable to pre-
 vent the approach and spread of the cholera throughout these
 empires, and  such  was the case with  many of the Northern
 States  and Canada.   Prussia employed seventy-five thousand
 of her  best troops  to enforce her rigorous restrictions and
 travellers  bear  testimony  to  their  severity.   What have
 been the results ?  An immense expenditure of money.  The
 suspension  of  commerce, a stop  put to  all industry, multitudes
 deprived of the means of  acquiring subsistence, and  whole
 families plunged  into  misery and rendered favorable subjects
 for  the disease, but  with  no  stop  to its extension, ou  the
 contrary its progress was rendered more fatal.
   Dr.  Harris of the Uuited States Sanitary Commission, says
 there were  in  1863, over two hundred cases of yellow  fever,
 which occurred in the river fleet of  which fifty-seven died.
 From  this  fact wre  find  that rigid military discipline did not
 make quarantine a protection against yellow fever.  The city
 of New  Orleans was  more exempt from fever during the five
 years  preceding the war, with  all its filth, want of sanitary
 police  and  no  quarantine,  then  it was during  its military
 occupation under General Butler with  its military quarantine
 and sauitary police,  and proper measures, that made it the
 cleanest city in the  United States of  America.   And also in
 the  history of Mobile  we have an interesting parable to the
 history of New Orleans, in  regard to the yellow fever duriug
 the war, situated in a different latitude and longitude from the
 latter city, having greatly suffered during the years 1837, 1839,
 1841 aud other years.  Therefore there was no epidemic from
 1854 to  1867,  and not a single  case  during the  entire war,
 though  blockade runners were coming in every week.
  In the year 1847 the Irish and  German emigration  exceeded
that of any previous years.   The anxieties to reach  America,
after severities of famine, forced them to take the first chance
for passage, and  in  almost  every instance  ships  arrived 
20
burdened  with more than the number of passengers allowed
by  law. iuto the ports of  Quebec, New York, New  Orleans
and others, they were, of course, subject to diseases,
  Ship aud typhus fever  owe their origin to this cause.  The
reports  ou every arrival gave a large proportion  of deaths ou
the voyage, the survivors, debilitated  by short rations  of food
and  pure  water, arriving  in a  climate so different from that
they had  left, under any circuinstances should have exercised
prudence  iu their food aud cleanliness in their habits, to ward
off  the  diseases of various latitudes ;  instead of which,  they
indulged  together  iu  damp  aud  unwholesome residences.
The sisters of charity, above all, iu the above cities were called
without pause aud iuterruptiou near the sick emigrants, over
the couch a.ud watch by the side of the children of affliction,
whether protestant, catholic, Israelite  and  of other faith did
suffer considerably.
  If the great practical truth, taught by modern  investigation
aud experience, be, that the only real security  against any
kiud aud  degree of epidemic  diseases is  an abundant and
coustaut supply of  pure air.  The prevention of over-crowding
and the dispersion of  the  sick  especially is of notable import-
ance;  that  is. the establishment of emigrant houses in salubri-
ous  places,  five or seven miles from the limits of a city, into
which persons from tainted vessels, most liable to yellow fever,
cholera or typhus,  may  be received.  On the occurrence there
of the first cases, aud if as is generally agreed, confinement iu
a  foul atmosphere  can convert any fever into pestilence, aud
ventilation  aud dispersion can  dissipate any contagion  with
proper  sanitary  measures,  theu quarantine must  be not
only useless but pernicious.  Since  the unmistakable effect of
quarantine  as hitherto practiced iu all couutries, has been the
congregation  aud confinement of the  sick  and  of those who
though not actually sick  are  suspected  to have iu  them the
seeds of  disease, requiring only a few days or hours tor their
development.  Therefore the congregation and confinement of
persons in  a  limited space, often in a filthy ship or lazaretto,
and an unhealthy  locality and  always uuder  circumstances
calculated to  excite apprehension aud alarm, which are condi-
tions in  the highest degree favorable to  the generation and
spread  of disease;—it  follows  that  quarantine,  instead of
guarding against aud  preventing yellow  fever, fosters and
concentrates  it,  aud place*  it under conditions,  the  most
favorable that can be devised for  its general extension, aud
therefore must  not only  fail to accomplish its  object, but to
produce the very calamity  which it endeavors to prevent.  The
principal  grouud on which  objections are made to  the con-
tinuance  of quarantine  is that  the fundamental  principle on
 which  it is based is fallacious, aud that  the only  means of
 preventing the origin and  spread of the epidemic yellow fever,
 is  the adoption of sanitary measures, substitution of sanitary 
21
measures for quarantine restrictions, which would  render the
transmission of any disease from one country into another in
the highest degree impossible.
  Quarantine would no longer  occupy the legislature and the
medical world in learned iutermiuable disputes of its question-
able utility.  It is only impossible and imperfectly fulfilling the
objects of quarantine to keep off a diseased or an infected sub-
ject or to prevent the spread of malarial effluvia, by fumigating a
ship-hold:  Doubtless the vitiation of the air by this agent, when
the half starved or poorly provisioned emigrant is either sent to
the eity convalescent, without ability to work or penniless, and
not equal to it,  they then have to feed upon the cheapest grub,
huddled together iu delapidated houses or  hovels, and  form
of themselves a focus of infection for the whole city, when the
money thus lavished upon quarantine laid out in two or three
buildings and provisioning iu large  and commodious emigrant
houses, not distant from the vicinty of the city of New Orleans,
where both sick and well of the steerage passengers of vessels
shonld be forced to  remain at least  a week or two, until they
undergo  complete  cleansing of their persons; wholesome air
and food would then dispel the effects of ship confinement and
the regret of their native country. In  such establishments labor
would seek them, averting  from them the evils arising  from
runners of low boarding houses who not only rob them' of their
little store, but fatten  on the premium obtained from the sale
of  their time to contractors.  Such  an establishment would
be  philanthropical, benevolent and economical.   The mortuary
statistic of all sea port towns  furnish us with the fact  that
the poor emigrants introduced or if not generated and dissemin-
ate disease among assimilating elements in all of them.  It is
evident  that such  an  institution would be a  benefit for the
State economy and to the  whole people's industrial resources,
consequently would be a  falling off in  the admissions to our
public hospitals, a  protection and a gaiu to the public health,
and in its turn  increased wealth to the  people in general  aud
a saving of money to the State of Louisiana. With such legisla-
tive  enactment, the sanitary board iu  the  department of
health could take  care  of  its control and duties in regard of
the emigrant houses.
   But it will be asked, would you abolish all  quarantines  and
 abandon all inspection  of  ships whatever ?  No, I  would not,
 but   I  would abandon  althogether  the  whole theory of
 quarantine, as against yellow fever  and cholera, most particu-
larly.  Sanitary inspections are paramount necessity, aud it is
an imparative duty  to see  them duly carried out, as if properly
performed;  they will tend greatly  to prevent an hrruption of
yellow fever.  These are  the most efficient means for neutra-
lizing and destroying the force of epidemic diseases, and  thus
tend generally,  if not to the prevention of epidemic, especially
of  yellow and typhus  fevers at least, powerfully  to dimiuish 
>>*)
their virulence, for the pabalum  of all infections.   Complaints
is found to exist  in the mephitic air of  low, moist, closed and
narrow streets and shut up retreats, where these are crowding,
bad ventilation and the invariable accompainments of poverty
and drunkeness ; add  to these, impure water, and  there  is
all that is requisite  to breed sickuess aud to invite and arrest
yellow fever in its prevalence.
   Ships  should  be inspected on approaching ports,  because
they may have unsanitary conditions intensified in them, on a
scaie sufficiently  to be important.   This should be a  part of
sanitary police, nor should iuclude any  restriction  of persons,
at the most, louger than enough for cleansing of the body and
of the clothing, and  purification of merchandise by fresh air
and possibly by some disinfecting process in certain cases.
   A careful  sanitary police, hence  the absolute necessity for
systematic sanitary visitation of the dwellings of the poor, and
the yards, courts and alleys wich they inhabit; such as of late
exist in  certain  cities,  as in Canada and Great Britain, and
which can be effectually carried  out only in the appointment of
" Inspectors of Nuisances," by able aud intelligent men, which
includes the protection of available  measures  for the  preven-
tion, and obviating  the  development  aud extension of the
disease in any place.
   On this ground the sanitary precautions are not many, nor
always difficult of observance,  but they  are imperative and
commonly very effectual aud to be relied upon  with  confideuce,
aud are familiar.  Thorough and frequent  cleansing of all
streets, alleys, yards, wharves and vessels, private and public
buildings and empty lots,  the abatement of all nuisance, daily
removal of offal, efficient sewerage,  etc.   The emanations from
privies are always offensive aud injurious to health, particularly
in close, pent-up yards ; even the best constructed water closets
are  not at all  free from objection.   The cleansing,  ventilation
and disinfection of cess-pools and water  closets among all signs
of danger of the location of yellow fever, none is more signifi-
cant than the privy odor.   Let  it be everywhere annihilated.
Lime,  charcoal,  dry  earth,  chloride of  lime,  liquid coal  tar,
chloride of zinc, sulphate  of  iron aud carbolic acid, are about
the most available of  disinfectants.  The uext point of import-
ance that may be used to correct foul smells, yet it must not be
forgotten that they do not entirely  destroy the noxious effects
of the effluvia, the  shoot, which ii an excellent deodorizer of
every house, should be collected, to be strewu occasionally into
the privies and water closets.
  The floors of the dwellings should be well scrubbed  with lie
or chloride of soda at least once  a week, and thorough  ventila-
tion, every  tenement should be supplied  with  abundance of
good water.   That from wells in  ordinary yards is always more
or less impure and is frequently most injurious, being saturated
with all the fifth that soaks through the earth from the privies. 
23
Chloride of lime or carbolic  acid may be placed in a plate in
any  suspected rooms or other locality in a house during the
prevalence of yellow fever.  Lime, dried  pulverized plaster of
paris, mixed with rather more than one-fifth its weight of pow-
dered charcoal is a cheap disinfecting compound, may be thrown
every three days on the floors or any other places.   It entirely
removes the  noxious  emanations  from decomposing organic
bodies and matters, especially in case of the patients with the
disease.   Every vessel  used may and should  be  disinfected
constantly by a diluted  solution of chloride of zinc ore, Sir Wm.
Burnett's  disinfecting  fluid; yet  it is very manageable aud
efficient that every house should be supplied with a  little of
this fluid, to which there is always attached clear directions for
its  use.    The immediate  removal of  all  discharges from
the  sick room, their   disinfectionand  transportation  to the
safest  possible   place  of  elimination,  oughtfco   be  im-
peratively maintained.  All foul bed apparel aud clothes must
be promptly washed, or if  very  bad,  disinfected   These pre -
cautions have been proved to be capable of essentially limiting
 and mitigating the prevalence of epidemic fevers.   Therefore,
internal sanitary arrangements and no quarantine and sanitary
 Hues are the safeguards of uations against epidemic diseases.
   What is very good to cast into cess-pools aud drains, some
 of the black  amraonical liquor  which is antiseptic and disin-
 fectant, that abounds in the New Orleans aud Jefferson gaslight
 factories, and also the lime that is served for the purifying of
 the  gas  is very useful  in destroying noxious odors.  All holes
 and cavities about dwellings should be tilled with  old  mortar,
 ashes aud lime from the New Orleans gas factories, which seem
 to be eveu better deodorizers than  fresh lime.  All three sub-
 stances  are excellent disiufectauts, and instead of being con-
 verted into nuisances in the streets, should be used in the man-
 ner  indicated, by  which they  would become useful  and be
 sought  after.  Epidemics  are sure to alight where terrestial
 emauations of a mephitic nature exist.
   In cities and towns it has almost always been the  lowest, most
 crowded aud  most filthy sections that  have suffered most.
 Where there  is not a free circulation of air,  aud where  the
 cheering breeze of the wind seldom penetrates, these localities
 are always raw and chilly, aud there is constantly a very per-
 ceptible repulsive aud  musty odor, and the inhabitants are pale,
 " Fievre lentev and debilitated, and the utmost care should be ob-
 served  to  obtain perfect ventilation.   Whilst impure aud con-
 fined air in crowded apartments or rooms is always deleterious,
 it is eminently so iu times of yellow fever and during the preva-
 lence of all epidemic diseases.   The breathing of foul air predis-
 poses to  every disease, enervates  the body and  destroys all
 moral  and physical  energy.   The  fire-places and  wiudows
 should be  kept open, and  every room have, if possible, an open-
 iuto the chimney near the ceiling for the escape of the heated 
24
and deteriorated air.  A fire should be kindled for the double
purpose of imparting ventilatiou and causing a draught in the
house.

              TREATMENT OF YELLOW FEVER.

  The investigation of the nature of Yellow Fever continues in
all parts of the world, but as yet with no positive results.   I
have  endeavored by  patient examination  to  arrive  at  some
conclusion from the various  statements made  by learned men,
but in vain.  All that the most careful  dissections have taught
us is that there is uo invariable or essential doctrine of the en-
demic.  Only one thing certain has been found out,—that there
is an alteration of the blood within the body.  Thus in the se-
rum of the blood which  loses one third  of its fibrine and brings
forth  a considerable diminution of chyle and propagates a very
large excess of nitrogeu and  hydrogen in  the  circulation;
whether these changes are primary or secondary no oue can
tell.  Therefore  I may  assert  that  all  the  changes  of  these
causes might  be owing to the defalcation  of its alkalies  as
being the proper agents to maintain and to hold  in the state of
the process of its nutriments, which nutrition of the body is
dependent.upon the  healthy action of the alimentary organs,
which effects indicate a continual presence of bilious action,
but actually produces a morbid alteration in the  blood  before
it induces fever.  This exciting disorder is  due to the amount
of alkalies wasted in  the chyle and  are  due to the  increased
excretion of urea and phosphates from  the kidneys.
   The most formidable affectiou  presenting itself in the stom-
ach and intestines of yellow fever patients, is that in which we
have a congested, yet weakened aud atonic state of the mucous
 membraue.  Hemorrhage, and more mucous irritation precede
 this condition, and after a time we  have gaseous  motorism of
 the intestines.  The abdomen is distended aud fiud tympanitic
 sound on percussions.  This  distension of the intestines is a
 source of distress in two forms, firstly, from the accumulation
 of air in the  stomach and  bowels themselves; and next from
 interference with the process of respiration.   The desceut of
 the diaphragm  being impeded and prevented by the swollen
 state of the  iutestiues, we often  find  in connectiou  with this
 state an  irritation  of'the gastric membrane  of the  stomach,
 such that the patient rejects  a portion  of  almost everything
 that is swallowed.  There  is at the  same time an irritable
 action of the kidneys, when elimination is defective, leading to
 accumulated excretions and with retention of uriue, or with the
 discharge of only small quantities of it.  Under these circum-
 stances drink aud medicines accumulate iu  the intestinal tract,
 while gases are generated  in excess.   The absorbent powers
 of the mucous  surfaces seem  for a time  to  be in abeyance,
 while the muscular fibres are loss of voluntary motion and  the 
25
stomach and intestines seem incapable of freeing themselves of
their matters by peristaltic or anti-peristaltic.  There can be
but little  doubt that the state above described  is one  often
brought on  by the injudicious use  of medicines.  Very cold
water and farrago of substances supposed to be proper or use-
ful in the sick room ; the injudicious use  of  mercurial drastics
or saline purgatives at the outset  of the fever, leads in some
instances to hypercathasis within.   W7e still have to apprehend
an atonic state of the muscular coats of the stomach and its re-
sults as above described.  The excessive and rather  abuse  of
cold iced driuks and fruits and all the other stimulating slops
supposed to be necessary or good to the  yellow fever patient,
couduce to a like effect.   This irregular  and nervous stage is
always to be regarded as  a formidable complication and state
in the yellow fever aud when  developed  to  an extreme degree
and persisting for two or  three days resisting treatment, it  is
an indication of all but fatal consequences.
  The fever, seizing  with  peculiar  violence upon the organs  of
the secretions, and especially upon those which  belong  to the
digestive operations,  hence the liver will suddenly pour forth
an immense  flow of bile, so vitiated in  quality as to irritate
and inflame whatever it touches, and so abundant in  quantity
as rapidly to diffuse itself over every part of the body, and  to
tinge   every tissue and  every fluid at  the same time; the
stomach and  the intestines  may  be  involved in such  acute
fever  that  the  power of life may  be  exhausted  in  a few
hours, by incessant vomiting.  That there is  from the beginning
a great prostration  of strength and a  rapid increase  in the
derangement of the nervous  and  sensorial  functions, together
with  a brown tongue aud dark  and  offensive stools,  which
show   the contiuual presence  of the exciting bile, which, but
actually produces a morbid alteration within the  blood  before
it induces febrile heat to high degree.
  The death in yellow fever by mecurializing patieuts out of
the world, is all wrong and pernicious; never meddle with the
stomach and other functions; which  we learn from Sir John
Gilpin of the  British army,  and  Dr.  P. C. A. Louis in the
epidemics of yellow fever in Spain—the stomach is the " throne
of yellow  fever," and if in  undisturbed  state, left in perfect
repose in that stage, will not  throw  up black vomit.  But all
this is too plain perhaps, for the utera preseribers in mineral
and vegetable poisons, too uusophistieal for mysterious dogmas
of charlatans.  Dr. Hosack, of New York, was laughed  at for
piaisihg castor oil and catnip  tea, the humble instruments by
which the quaker physician, Dr. B. Underbill, cured so  many
persons in one of the worst scourges of yellow  fever in  Phila-
delphia.
  Soon as the patient is attacked,  put  him  in a warm bath  in
which two drachms of strong sulphuric acid,  has been dissolved
4 
26
 to each  gallon of water; the patient remains  in  the bath a
 quarter  oV half an hour and is afterwards wrapped in a cotton
 sheet and sponged with the same fluid as that which forms the
 bath, every two  or three bonis; this  procedure or  mode of
 treatment/which seems to act through  the blood in inducing
 diaphoresis,  and theu  by lessening at the  outlet the primary
 febrile paroxysm.                    n     .        t  .   ..
   The indications for the employment of curative agents in the
 form of fever are furnished by the state of the suffering orgau;
 the skin, which  is hot  and  acrid, and the mucous membrane
 require  to restore  their appropriate secretory  and absorbing
 functions,  aud  the glands to their secretory  aud depuratory
 office.                                          .      , .
   Ou the skin we should act at once by means of cool air  aud by
 immersion in a sulphuric acid bath, has been  attended  with
 excellent effect by  often  arresting the fever in its first stage,
 and by  greatly mitigating the violence  and  gravity  ot  the
. symptoms in its progress, iu which the capillaries are iu a state
 of morbid excitement and largely evolve by heat;  at the same
 that the breathing is labored and the brain oppressed, a sul-
 phuric  acid bath rouses the  nervous  system from  its torpor
 and restores the respiration to its former state.  According to
 the predominance of excitement in an organ or region—as, at
 one time of the head,at another of the epigastric region—which
 will  be the special direction  of  the refrigerant applications to
 the head; aud I have used with marked benefit the  following
 lotion, to be applied to  the epigastric region, head and over the
 abdomeu; the febrile part of  which, indeed, is  often  very
 excessive in yellow fever.
   R.    Liquor Soda Chlorinata, "Labarraque," Iviij.
         Sp. Lavandula,                          3"j.
         Sp. Kosemarini,                         3v.
         Soda boras,                              Iss.
   Add two pints of cold water to the above formula,
   Directions:   Wet a  piece of  cotton cloth  three or  four in
 thickness, sufficiently large to cover the  epigastric region aud
 abdomen ; should be re-applied every time when dry in order to
 maintain an equalization  of the temperature in the body and
 proper  distribution of  circulation.  The temperature of the pa-
 tient should not be allowed to run^above 103° or  104°  Fahren-
 heit.  Usually  the temperature  may be kept withiu this range
 by means of the above application, aud the patient will press
 with evidence of  pleasurable sensations of the lotion on his
 epigastrique and ask for a renewal of them.
    If remission or retirement of fever and perspiration has been
 attained,  sulphate of  quinine in ten grain doses, every  two
 hours, until its effects ou the nervous system aud circulation is
 fully obtained through the normal temperature, which consists
 in not allowing the temperature to rise above the regular stand- 
27
ard.   If it does it  is at once lowered by  the  sulphuric acid
baths and topical means which  this will arrest the rapid repro-
duction and keep down the excessive burning heat within the
body.
  Under the supposition that our patient is laboring with com-
pletely formed  fever and is in that stage in which professional
assistance is commonly wanted  in the forming or preliminary
stage of the yellow fever, that iu which the nervous system is
the part chiefly affected and  in  which the temperature of the
surface is unequal, the patient at  one  hour shivering, at
another complaiuing of too much heat. A warm hip or foot bath
in which has been dissolved a considerable  quantity of chloride
of lime, this bath  must be continued until  the  patient  per-
spires when given; these baths have uo other advantage than
that of purifying the atmosphere of the room, and will prove to
be soothing and salutary, and may, if its operation be aided by
simple  drinks, such as elder  flower tea,  orange leaf tea or
flower tea, to bring on diaphoresis or produce perspiration, which
will restore the skin to its natural state and contribute to an
equalizing of other  deranged  fuuctions.  It is important to bear
in mind the fact that the salutary  change which is brought
about in the capillary circulation and secretions of the skin, are
 responded to in a similar sense by the gastroenteric and pul-
monary mucous membrane.  The  thirst, dryness aud heat  of
 the mouth  and face, and the gastric sensation  of heat, are all
 greatly mitigated after a chloride of lime bath, aud, in  combi-
 nation  with the refreshing lotion on the  whole body  of  the
 patient; the breathing also is freer, and the expired air less hot
 and offensive.
   Various means have been proposed and recommended to calm
 the stomach.  Leeches and  cups  to the epigastrium, in cases
 where they are admissible, have occasionally been found bene-
 ficial.  The physician must watch the efforts of nature aud pro-
 mote any  critical  movement she  may- indicate.  The most
 alarming symptoms in this fever is irritability of the stomach,
 and  in many instances associated with vomiting. It is apt to
 be present and so often uncontrollable that  it is  of importance to
 indicate remedies  to check  them.  When the  gastric juice is
 about changing or deriorating in  the stomach, there is a burn-
 ing sensation, is generally relieved by  the  use of chlorate of
 potassium, super-carbonate of soda  or lime water. I have gen-
 erally succeeded with the following prescription, viz.:
          ft      Acid citric                 |ss.
                 Sub. carb. amon.          3ij.
 and  when the efferveseuce  has ceased, add simple syrup,
 two ounces ; camphor water, one  ounce.
   Give one tablespoouful every half hour or  two  hours,  accord-
 ing to the  attack,  and for the excessive nausea aud efforts to
 vomit  in the  gastric disturbance,  a mixture  which acts quite
 promptly. 
28
        R       Chlorate hydrat              ?j.
                Potassa bi-carbonate        ~ij.
                Spt. Chloroform             ~;iij.
                Syr. Tolu                 oijss.
                Aqua' camphora             5J.
one teaspoouful every half hour or half a tablespoouful every
hour, if this mixture do not suppress vomiting, you may have
recourse to the following preparation to check vomiting.
       R      Bromide potassa,             3ij
               Syr. zinzileris.
              Tiuct. opii. camp. aa. ti.      3 ij
  Dose.—Give one teaspoouful  every  half hour, or each time
after the patient vomits.
  Or, the following prescription of Bromide,  after the  more
decided iu the depress powers of life, and prevent the tendency
to collapse:
       R      Bromide potassa,              jj
               Syr. zingeb. fl.                5)
              Sr. meuth. pip.               'iij
              Chloroform,                   Jj
  One  teaspoouful every two or three hours.
  We must continue by the use  of purgatives, elimination of
matter from digestive organ, which was begun by the efforts
of vomiting.   In the inception of the fever, by this  treatment
we remove some of the probable causes, aud abate, if not dissi-
pate,  some  of the obvious  troublesome symptoms in the first
formed stage  of  yellow  fever in milder eases.  This is ofteu
alone sufficient to check the farther progress of the disease and
to bring on couvalesence.    Whether we suppose t.hat there is
a morbid  excitement which required subduing, or an effusion
which  ought to be eliminated, we are fortified in acting ou  the
stomach aud  intestines in  the manner already mentioned.   If
we do not thereby cure, we, at least, diminish the probabilities of
further injury.   By the acid sulphuric aud  chloride of lime
bath, aud the continued  applicatiou of refrigerants, lotions,
externally, we abate the excessive fever or burning heat, itself
a disturbing cause both to the nervous and circulation of  the
sanguine systems  aud we rouse the patient from the delirium
to which he  had  been thrown  by  the workings of malaria
on the  brain aud other organs aud  functions of the body.
        R       Spirit aetheris nitrosi,     fj
                Citrat potassa,           ^ij
                Liquor ammonia acet,    ^iij
                Soda et potassa tart.     |iij
                Aqua rosa,             ^xij
  Two  tablespoonful  every  half-hour  or  four  tablespoouful
ever> two hours, according to the case, and to be given iu  the
l'uvei at its highest warm stage, or  exacerbation of the fever.
  I have  therefore, so  also employed the  boracic acid  as 
29
means of prevention in the incipient  stage  of mortification,
and  the sedative action  which  retain its efficacy for a long
time as antiseptic agent,  aud remedy in doses of from six to
ten grains or more as a corrective of bilious putrefactious.
  The Geneva medical papers,  say that Prof. Scbiff, formerly
of Rome, Italy,  has discovered an  infallible remedy, in the
salicylic acid, as a prevention of putrefaction chauges in febrile
cases, and  assimilated as a sedative.   All reports agree that
fifteen or twenty grains of salicylic acid per day may be taken
without any notable disturbance or alteration of the alimentary
canal.
   An invalid of yellow fever must be treated  like a child.   He
must be  kept entirely  under control;  it is  a  safe  rule  to
follow, to  do  for  the  patient precisly  opposite to  what
the  latter  wishes,  or what  he  does.   If  he is  thirsty,
a piece of  ice  may  safely  be placed   at  intervals  in  his
mouth,  which  is better to  allay  the  heated  thirst,  is  to
place  around the neck a piece  of  musliu saturated  in cold
water.  His excessive thirst must be restrained by four or six
tablespoonfuls of lemonade or  cold water after being boiled,
at some intervals; should  he throw  off his bed  coverings, it
 will  be found that his extremities  are cold, aud that the  cir-
culation  must be equalized by  warm or hot chloride of lime
foot bath and keep them well covered to  induce  perspiration,
 then to  place at intervals on the forehead  a  cloth saturated
 in cold water, and if he requires  the unremitting aid of external
 topical applications and sponging iu  ablutions constantly with
Louisiana Rum,  diluted  with  lime juice and  with  cologne
 water,  and  lavements  when   necessary, specially  if  much
 fever and headache, every two or  three hours, with a decoc-
tion  of flaxseed or okra.  (Hibiscus Exculentin.)  If he is  dis-
 posed to  coma rigid, or to be  watchful, invite  him to  sleep,
 by fanniug, and by the frequent passage of cologne moistened
 cloth on  the forehead aud temples; if too much prone to sleep,
 enliveu him with such subjects only as will not create excite-
 ment, by inducing too much though  fullness  iu a word.  The
 deceitfulness of symptoms to the physician and patient is a
 characteristic feature of  the yellow  fever, creating desires
 and" wishes iu the patient almost always antagonistic  to  his
 well-beiug.
   Strict  attention to the diet of the  patient is  not less impor-
 tant in the successful management  of the fever.   In the early-
 stages it should be  very light, consisting  chiefly  of liquid
 substances, solutions  of gum arabic, rice water, orange leaf tea,
 tost water, preserved jellies  mixed  with water, and similar
 preparations may be successively or iuterchangably employed;
 cold lemonade or orangade and pure rain water in moderation
 may also be used as drinks in the hot stage of fever, at a more
 advanced period, after five or six days for example, wheu the
 symptoms  of debility begin to show themselves, it  will  be 
30
necessary to support the  strength by  a more nutritive diet,
which, however, should  not be  stimulating.   Preparations of
rice or arrow-root of a  nearly  gelatinous consistence, thick
gruel  or  panada, may  new  be given, flavored with nutmeg or
other spice, and sugar, etc.  It will  often be desirable to give
these in certain quantities at certain intervals, so as to insure
that enough is taken. I  have generally been in the habit of
directing that a  cupfull  be given every two or three hours, or
less  frequent, according  to the apparent  strength  of  the
patient.  A cup of tea may also be  allowed  with dry toast or
water crackers, morning  and  eveuing; still  further on in the
stage of the fever, milk in small quantities, frequently repeated,
will be often found to suit the case admirably well; two table-
spoonfuls of it may be giveu  every  hour or  two through the
day, and if the stomach  be  irritable, it may very properly be
associated with one-third quantity of lime water.  In the last
or prostrate stage it is  proper that the diet should not only be
nutritive, but  also  stimulating; animal  broths and chicken
soup may now be given, aud in  lowest cases it is necessary to
resort to egg,  beat up with wine,  milk punch with Jamaica
rum, and essence of beef or mutton throughout the whole case.
The greatest attention  should be paid to cleanliness and venti-
lation, and when the atmosphere cannot be sufficiently purified
by these means, as  sometimes happens when many patients
are crowded together, recourse  may be had  to the corrective
influence of the chloric ether lamp in purifyiug it.
   One parting word may properly be added on the subject of
the treatment of yellow fever.  It is important that the public
should  understand  that the  disease has definite  minimum
direction, which nothing  can alter.   That her natural tendency
is, on the whole, to a favorable termination, and  that the  best
and most enlightened physicians are the most fairly convinced
that there exists uo practical  means of shortening the natural
term of this  malady.  Therefore, when I speak of treatment
by medical attention, I  mean  no  more than  this, that the
interference of  a vigilant  and skilful physician, frequently
prevests the  patieut from sinking under the  disease, before it
has run  its natural course  and averts some of those evil con-
sequeuces which  are apt to follow  when the patieut was pre-
viously iu delicate health or was affected with latent tendencies
to constitutional disease.   It is perhaps, a  matter of doubt,
whether the erroneous  popular notion  ou this point, which
attribute to the skilful  physician the power of cutting short
the most acute fevers with a few doses of medicine, have not
exercised as disasterous  an effect on medical sciences, in the
confidence of patients, iu their  advisers.   Uuconsciously and
involuntarily   medical   practioners  have   been  sometimes
tempted  by  the  urgent  desires of their friends, for  speedy
reh«f to  the sufferers and for  his immediate  deliverance from
danger, to spend their energy  upon the weakest and to neglect 
31
to stronger part of the defense against disease.  It can never be
too often repeated, that by the most difficult aud scientific
portion of the medical man's task,  iu  the  treatment of yellow
fever, is the  direction of hygienic measures, and above  all,  the
apportionment of the medicines,  and  the  exact  manner in
which that medicine  shall be given,  aud  that these  are  the
means by the right practice, of which the physician saves  his
patieuts, in  ninety out of a huudred cases,  which recover from
dangerous attacks of malignant epidemic yellow fever.

              REGULATION OF CONVALESCENCE.

   When convalescence has begun,  the patient  should be close-
 ly watched, lest by  some impropriety he  be suddenly cut off.
 Even after  having  passed near unto death's door, and when his
 march toward health, with all  its renewed  charms and pros-
 pects, the most important part of the management of conva-
 lescents refers to diet and exercise, etc.
   The necessity of caution in the quantity and quality of food
 at this time is even  greater than  during  the  progress of the
 fever, and cannot be too strongly  urged upon  the attention of
 the attendants.  From simple liquids which were all that were
 required to  satisfy the desires of the patieut during his period of
 febrile excitement,  and to more stimulating and solid  nourish-
 ment, the transition should be gradual.
   From inattention to this point in the management, a speedy
 and  happy convalescence  has often  gravely interrupted, aud
 many instances are on  record of  death having resulted.  No
 error is greater and more common among patients and their
 friends  than supposing that debility is always to  be removed
 by nourishing and stimulating food, wine or other stimulating
 beverages.   I have  seen  convalescents suffer most  severely
 from a single improper meal.
   The first change of diet should be to another article of  the
 same kind of food as was allowed during the progress of the dis-
 ease. For example,from simple arrow root mucilage to arrowroot
 and  milk or to some other of the farinaceous compounds.  From
 this  advance may be made to corn or ricemeal  mush, milk  and
 rice,  well-boiled, aud served up with milk aud sugar, nutmeg
 or other spice, rice puddiug and  custard.  If the patient de-
  sire  it, he  may partake of some of the fruits,  such as oranges,
  strawberries aud grapes, freed of  their skin aud seed. Iu the
  allowance  of animal food, it is best  to begin with broths of
  chicken, squirrel,  beef or mutton,  ou  account of its less stimu-
  lanting nourishment and easy digestion.  When wine is used,
  attention should be paid to the kind and quautity.  Sherry and
  claret are,  perhaps, preferable.  In  fixing  the quality to be
  allowed, the age, the degree of debility and  previous habits of
  the patient, should be taken iuto account.  It should be remem-
  bered that young persons and females are more easily excited
  by stimulants of this class than older persons; that youug per- 
32
sons, as a general rule, convalesce more rapidly than the »ged;
therefore, thev require  leas stimulant in proportion.  If the
patient, when'in health, has been in the habit of taking wine
or other alcoholic stimulants, he will reqnre wine in more liberal
quantities than if he had been strictly temperate, both during
the fever and in convalescence.   As health becomes confirmed,
it should be gradually withdrawn.
  When  convalescence  becomes tedious  and profuse  and ex-
hausting sweats occur at night,  much benefit will accrue from
the administration of  the  aromatic sulphuric acid.   Conva-
lescence  appears to be  sometimes very  much retarded by  a
debility of the stomach, which  disable the  alimeutary canal.
From its appointed function, a species of hectic excitement is
sustained for a long time.   The  pulse remains frequent, some-
thing like a febrile paroxysm occurs  every afternoon  and the
patient sweats copiously at night.  Under these circumstances
1 have found nothing so effectual as the following formula :

           R      Iodine,               ~j
                  Potassa Iodide,      3ij
                  Syrup auranti corti, za\\
  M.—Ten drops in two tablespoonfuls cold water every three
hours.
  With  regard to exercise,  not  less care is required than con-
cerning the allowance of food.   Convalescents soon grow tired
of their beds, and not a few. if  unopposed, will overtask their
feeble strength by long sittings out of bed.  Errors of this sort
have  not unfrequently been followed by very bad consequences.
Iu  quitting his bed the patient  should do so gradually ; even
should the observance of this advice be unnecessarily strict, no
danger  can result; whereas, if  disregarded, dangerous if not
fatal consequences may  be incurred.
  Especial care is to be observed in  the return to out-door ex-
ercise.  The  patient may have  acquired sufficient strength  to
allow of his being  out of the bed the greater  part of  the day,
 but he should not on  this account thrust himself out of doors.
Injury has often resulted from venturing out too early during
the hot weather of summer and fall.  That many persons who
have  struggled through a  most dangerous fever, have, from
imprudent exposure to heat, been seized  with iutense inflam-
mation in some organ which rapidly destroyed  life. The Editor
of the London  Lancet, Feb., 1872, remarks, as  beariug upon
the important question of restraining extreme  heat of the body
in fevers:  ''We must remember that,  whereas, the  nitrogen
containing tissues are hardly consumed at all iu circumstances
of health.  The febrile state involved a large destruction of the
most  iiupoitant  organs of the  body, partly from the effect of
the excessive febrile heat on the vitality of the blood.   Exces-
sive heat does not meau pleuty of strength, but exactly the op-
posite ; it is an absolute proof that  the reserve forces of the 
33
body  are exceedingly  low,  and  are  being constantly  and
rapidly  reduced."
  During convalescence every source of mental exertion should
be  strictly avoided.  The  mind  should  be engaged without
being oppressed.  Much advantage may be afforded the patient
by  a  proper selection of visitors.  For,  above all things, the
presence of idle gossipersshould be avoided. These miseries, with
which the State of Louisiana is infested,  are usually very kind
indeed,  that  they almost  invariably leave  an infallible  pre-
scription of medicine or diet at  each successive visit, which
benefitted Mr. and  Mr, so and so, who  was for all the world
in a  similar  condition, aud it was used  by Dr. somebody and
highly recommended by the Reverend Mr. Sool.
  The imprudent use of cold water when a person is over-heated
almost  invariably  produces  spasms  of  the stomach,  wheu
specially bathed in  sweat after fever; this dangerous and fatal
practice, if  it even does not produce immediate death, almost
invariably lays  the foundation  of lingering and  destructive
fevers which are extremely difficult of cure.  That eminent and
distinguished  physician, Benjamin Rush, describes the causes
of  fatality in these  cases,  in  the  following manner:   '< When
large quantities of cold water  are taken into the stomach,
under circumstances of  fever or  over-heated system, the per-
son in a few minutes afterwards loses his sight and everything
appears dark about  him,  the breathing soou  becomes very
difficult and a rattling noise is heard in the lungs and throat, the
feet and hands  become cold, and the pulse cannot be felt, and
generally death is the consequeuce, unless speedy relief can be
obtained." Iced  toddy, wheu  taken under the same circum-
stances of being overheated, has ofteu been known to produce
the same fatal effects, and I have known many instances within
the city of New Orleans aud  in my parish,  iu which ladies in
full health have been  brought to the brink of eternity in a few
minutes from eating iced cream  when over-heated  by dancing.
The truth is that very cold  drink, even when the body of a
patient moderately  cool, iu fever, sometimes iu peculiar consti-
tutions  are productive of dangerous consequences; therefore,
cold water should not be used as a beverage in fevers ;  boiled
water and cold quenches thirst more permanently, and is not
liable to produce vomiting, and does not lower the temperature
of the constitution in  fever as it  does  not  in  air, after being
boiled.
  There are  no countries  within  the regions of endemic and
sporadic  fevers, which therefore are subject to intermit during
periods of greater  or less extent.  In the city of Vera Cruz,
the yellow fever,  now  so  prevalent, did not  prevail during
the space of nineteen years.   The first distinct account of its
appearance  given  at Barbadoes  in the year  of  1607,  as it
appeared in  that island in lf>08, it occurred at Boston  and
Quebec, and  the   next year appeared   at  Richmond,  Va., 
34
 and iu Brazil the jellow fever appeared in the years 1687 and
 1693, then the disease did not prevail for  one hundred and
 fifty-nine years during that whole length of  time.  After some
 years  it  declines from its producting real effects, and recurring
 at interval periods of time and thus, on certain series  of years,
 with seventy as all epidemic fevers do.  Consequently yellow
 fever like  all other epidemics,  which have  been  already ob-
 served and reported from real statistics in various parta of the
 world, has its period  of activitity and  lay up at intervals  in
 harmony for a space of time, between each event. New Orleans
 was free from it  during thirteen years from  1841  to  1853,
 except an  eudemic of ship fever or typhus, which oocurred  in
 the year 1847, amongst  emigrant  passengers  to  the port  of
 New Orleans.   All epidemics of yellow fever are like all other,
 owing to no aclimation  and being an inurement of benefit,
 once  having it, and is  an advantage for those persons  who
 are to be  insured,  whether native  or  foreigner  against its
 prevalence, although having been acclimated at that season
 however, which  should  be considered an acclimating fever,
 which is to moat persons a  condition of being secured from the
 further auxiety of the future.
  Its epidemic aspect  was of the  earlier and more  frequent
 occurrence  in northern  cities  than  iu   the  southern cities.
 During this century and  its epidemic wave, was never known
 south of the equator; on its first appearauoe in the last century,
 within the southern regions of countries in North America, in
 the single year 1872, more than two hundred thousand died in
 cities of Montreal, New  York and Philadelphia, in America,
 and  Paris, France, and  other  cities iu  Europe, one hundred
 aud  thirty  thousaud  were victims of  an  essential disease
 typhoid fever.  Meanwhile at times, the  phenomena of fever,
 which seemed to prove its  nature  to be  highly  malignant in
 severity, in a great many  parts of the world, aud we have a
 strikiug  illustration of the elements of both, the typhoid  and
yellow fever, consequently, through the efforts of the medical
 profession and judgment are of the opiuion  that  the former
epidemics of yellow fever have greatly ameliorated its severity.
Therefore, we should look forward  to a great change aud  per^
 haps exemption from an  epidemic visitation  in our loved land
for many years.
  There should be no panic about yellow  fever, particularly in
 the State of Louisiana.  Let the authorities do their full duty
 in sanitary measures of local improvement and renovation, not
to hide themselves out  of view through the delusive scheme of
 quarantine bubbles, who  lie concealed  in  the  very focus
 of its  existence aud production, and are more liable to  its
efficient effects on their system.   Let them give to our parishes
and our metropolis, the city of New Orleans, its pristine clean-
liness, and yellow fever may reach and  sweep across the equator
without a case occurring in our State.  Baltimore and Wh«I«- 
35
ington City have had such an immunity of visitation of yellow
fever more than once, and in our worst eruption the mortality
has not been very great.  Apprehensions, moreover, aggravate
the danger, while, if  it  appears again, those who can leave, as
well as those who cannot, will undoubtedly be most safe in the
open country, for those whose duties keep them in the metropo-
lis of New Orleans.   Courage and equanimity are not only be-
coming but expedient.
  In referring to the  production of  yellow  fever in every
instance to a material agency, we mean, also, to deny its propa-
gation by contagion.  Many are acquainted with the foregoing
facts.   Dr. L. Lamar, a physician who practiced  in the city of
New Orleans, in 1837,  made many  trials by  experiments, to
produce yellow fever  by  direct  contact, who  had inhaled his
patient's breath and inoculated himself with the blood of yellow
fever patients and tasted  their dejections without receiving the
yellow fever, and Dr. L. Lamar, in Havana, who in that city in
1839 and 1841, during the yellow fever epidemics of those years
lay  all night in the beds and in the clothes of  many of his pa-
tients, but was not affected or attacked by it.  I have  made
many other experiments,  as Dr.  Lamar, without  suffering any
injury or sickness whatever. There is but slight  exaggeration
in proverbial assertion that pestilence kills thousands, but fear
tens of thousands. Above all, tell every man in Louisiana, in the
hope thac no mistaken terror of contagion will ever lead to the
 extreme barbarity of deserting  of the sick,  whether rich or
 poor, or neglect of the dead.
   Yellow fever is not after  all a very serious disease to treat.
 To many experienced physicians it is one of the easiest to cure
 and  is  one of  the  most reliable  to  prevent  death,  when
 attacked from other diseases afterwards, and from  any  other
 foreruuuing maladies of  the human races in  the world, and
 who has had it  once or  having  passed through it, which has
 been ascertained by established truth and fact of proofs.
   The subject being entirely practical, I have confined myself
 aa much as possible to a detail of facts.  If at any time I have
 been led into digression,  it  has  been solely with  tjje object of
elucidating some point  of evincing importance,
   Lafourche Parish, La., October, 1878. 
ZJ
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