Yellow fever, a nautical disease : its origin and prevention

Front matter

YELLOW FEYEE

A NAUTICAL DISEASE.

ITS ORiaiS AND PREVENTION.

Dedication

You have brought order out of chaos. A Central Authority now coordinates for good the many willing, who, seeking the best, often attained the worst. The result is manifest. The public will be saved from that never-ending conflict of medical opinion, powerful in crushing bookshelves and powerless to save one human life. Ultimately and soon Tellow Fever will be counted with the plagues that were.

A common object, a common purpose, a common good — aimed at and secured with the same ease as touching a button atomized the Hell Gate rocks. To you the country owes this touch — a touch of human nature making the whole world kin.

With grateful appreciation of your kind friendship, I remain, madam.

Preface

A SOUND medical philosophy is fast becoming a reality. Whoever in the future may prove its eloquent exponent, only a John Hunter or a Helmholtz can be equal to the task. It demands a man of true genius, chained to the car of experimental physics, capable of piercing the bubbles of tradition, strong in marshaling facts and figures, prompt and clear with his relentless logic.

The science of thermo-dynamics had to be bom to render this possible. Lomonossow, Eumford, Joule, Mayer, Clausius, Eankine, Sir "William Thomson, and Hirn had to do their work. This science is no branch of other sciences. It is the groundwork on which astronomy, biology, pathology, and all other exact studies must be based. "Writers like Dr. La Roche, whose work on Yellow Fever is a monument of painstaking zeal and industry, will continue to amass data, so slightly clouded by the fashionable opinions of their time that the vigorous reaping machine of the future may garner ready-stacked treasures.

Every reasonable hypothesis must expedite the future demonstrations. It is absolutely essential to broad scientific development. The record of known truths and the views propounded in the following pages may therefore serve an important purpose. "With the confidence of just perception, guided by a

PREFACE.

very varied experience, I commend to all the means whereby the prompt extinction of yellow fever on the Atlantic coast of the New World is, in my humble opinion, a matter of certainty.

To Dr. J. C. Faget, of .Kew Orleans, now pertains the credit of having first formulated the idea of resorting to artificial refrigeration for the purification of ships. His clear exposition of the probable origin and definite course of yellow fever, in the shipping and seaport towns, has recently given precision and directness to my labors. His name and writings were unknown to me a few weeks since. I shall henceforth hold both in grateful remembrance.

EiGGS House, Washington, D. 0., August 22^ 1879.

OOITTEN TS.

Dedication

Preface

Chapter I

Yellow Fever a Nautical Disease — its Origin and Prevention : Classifica. tion of Diseases in Man and Animals into international, indigenous, and independent — Yellow Fever indigenous — Damp Ships unhealthy — Where do we find Yellow Fever? and whence does it reach us? — Yellow and Paludal Fever— Protection of New Orleans — Original Views on Contagion — Yellow Fever defined as Nautical Typhus — Obstructive Quarantines — Yellow Fever in Steamers and Sailing Vessels — What Ships may be considered infected — Epidemic Nucleus adjoining Shipping — Course of the Yellow Fever in Cities — Location of Infected Cities — Altitude as affecting Yellow Fever — Barometric Pressure — Is there a Proper Soil for the Disease ? — Yellow Fever an Exotic in every Land — Naturalization of the Disease on Land impossible — Its Propagation — Alternating between Sea and Land — Humboldt's Views — Probable Origin in the Tropical Atlantic Basin — Usual Yellow-Fever Course from the Tropics northward — Floating Center of Origin — Yellow Fever originating in Mid-Ocean — Type of Disease in the Eastern and Western Atlantic — Contagionists on Spontaneous Origin in Ships — Conditions essential to Yellow-Fever Development — Yellow Fever a Hybrid Typhus— Propagation of Jail and other Fevers— Pyaemia or Purulent Infection — Other Diseases propagated after Spontaneous Development — Difficulties of ventilating Ships — Asphyxia in Ships — The Atlantic Yellow-Fever Center — Infiuence of Temperature of Sea-water on a Ship's Ventilation — The Cargo— Disinfectants not used at Sea — Cause of the Outbreak in Memphis . . • .

Chapter II

General Historical Considerations : Past History of Yellow Fever — Ancient History of Yellow Fever — Diseases of the Red Men — Spanish and Portuguese Traders — The Spanish Galleons — Sir Walter Raleigh's Voyage — Anson's Voyage around the World — Ships composing the Squadron — Anson's Fleet Surgeon's Opinion — Outbreak of the Calenture — What is a Calen- * ture ? — Rest at St. Catherine's — Scurvy in the Pacific — Capture of Pizarro's Galleon — No Yellow Fever in the Pacific — Captain Cook's Voyage — Pringle's Eulogy — Bryan Edwards on West Indian Fever — Yellow Fever in British and French Guiana — Yellow Fever on the African Coast — Yellow Fever in Charleston — European Outbreaks of Yellow Fever — Recent Outbreaks in France and England — Clean Bills of Health — Special Data relating to the West India Islands . . . . . .74

CHAPTER ni.

Contrast and Comparisons between Yellow Fever and other Diseases:

Relapsing and Yellow Fever — Remittent and Yellow Fever — The Pulse ^ and Thermometer in Yellow Fever — Dr. J. C. Faget's Observations — Epidemic Fever of Young Children in New Orleans — Oroya Fever — Cholera and Yellow Fever. Contrast of a Land and an Ocean Plague — Analogy between Typhus and Yellow Fever in a Ship . . . .113

Chapter IV

Developmental Phenomena : Where and how may Yellow Fever develop ? — Statement of the Germ Theoi-y — Unformed Ferments — Germs unrecognizable — Lower Organisms not specifically injurious, nor structurally characteristic of Fever a . . . . . . .137

Chapter V

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

CHAPTER VL

Conclusions

YELLOW FETER.

INTEODUCTIOK

A NAUTICAL disease, a product of foul ships in the equatorial Atlantic caldron, yellow fever, the dreaded scourge of American commerce, is far more easily, surely, and permanently preventable than typhoid or scarlatina. The sewage fever of cities may for centuries atflict humanity. With zeal and firmness, cooperation and persistent effort, a decade should practically abolish the ocean pestilence. Mystery where there should be no mystery — doubt where rays of discriminating light can penetrate — a mountain of a molehill — fairly characterize the involved doctrines which pass current as to the genesis and nature of yellow fever.

My temerity and apparent dogmatism, in a sketch fashioned and almost written at one sitting, may startle many. Such a sketch may prove serviceable. It is always instructive to view a question from all points, and I believe that mine is not the least commanding eminence whence to photograph fresh images of this dire disease, since Audouard, Humboldt, Copland, Crn'rie, La Roche, and especially Dr. Paget, of New Orleans, have indicated how much there is of truth in regarding yellow fever as something more than, and something different from, a land disease.

'No recondite research is needed to reveal a new elixir of life. Fresh air, dry air, cold air, available in all parts, driven through and through the stagnant pest-holds of vessels, suffice. The details hereafter.

INTRODUCTION.

Pure and frigid air must and can rid the mercantile marine of this ship-typhus — the analogue, in a sense, of that jail pestilence which John Howard banished from British prisons.

It is sometimes well in medicine as in politics to sink minor differences, and strike for some reform which can not fail to commend itself to the vast majority. In this spirit I advocate that natural antidote which, during epidemics in this country, has been universally recognized as all-sufficient with approaching winter.

Stumbling into volunteer service on this question, no time has been lost, no thought or trouble spared, since last December. With La Roche I might say that, " painful as the avowal may be, it is a fact, the truth of which can not be denied, that, notwithstanding all that has been written on the subject of the yellow fever in this and other countries — all the labor that has been bestowed, or any investigation of its causes, character, and anatomical phenomena — ^little progress has so far been made in a knowledge of the pathology of that disease." May not the fact reveal itself that the disease, in its real origin, has been necessarily less investigated, because that origin is at sea, and the most skillful and painstaking observers are on land? A knowledge of the climate and diseases of the sea, in the pestilential mercantile craft of the tropical Atlantic, acquired by an expert in pathological physics of the modern school, would, if in our possession, add a long, brilliant, and marvelously enlightening chapter to the many penned by city physicians.

In chemistry we have to adopt at one time the analytical, at another the synthetical, method in ascertaining the nature of substances. In pathology, touching such a question as yellow fever, investigations of all kinds must be instituted ; but, while we are told so much — and so much that is conflicting — concerning the causes and development of the disease, I for one think it high time that a combined international effort be made to demonstrate, by complete and practical measures, how far perfect ventilation and cleanliness of ships will contribute to exterminate yellow fever. It is my conviction that it will do so as effectually as prison sanitation has made us strangers to the pestilential typhus of foul dungeons. To clear the Atlantic seaboard of such a plague, the medical authority of one country, however

IXTRODUCTIOX. IX

eminent it may be, can not assert itself with the desired promptitude, nor without measures which mi^ht be resented. But all — and notably the Brazilian Emperor — ^might be expected promptly to lend intelligent and financial aid to rid the commerce of the New "World of its fatal obstruction — the withering, palsying scourge of seaports and of the noblest seacoast under heaven.

The humblest and the mightiest may join in good works ; and as a simple interpreter, according to my lights, of some passages of epidemic history, I commend to all the one great practical recommendation, viz. : the instant and absolute purification of the merchant marine, at all hazards, between New York and Kio. It is not light work, but on the other hand it is definite. The remedy in this case can not fail to prove far better and infinitely less costly than the disease.

Chapter I. Yellow Fevee A Nautical Disease — Its Origin And Prevention

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

* The diseases of plants supply us with highly instructive examples. In the vine disease due to Phylloxera vastatrix, the living organism inducing and propagating it is an insect which undergoes a variety of metamorphoses, and eluded for long the vigilance of naturalists by its varied abodes in different stages of its existence. The native American vines on which the phylloxera lives, without destroying the plants, arc an illustration of immunity by " survival of the fittest," which enables scientific men to propose a remedy wherever the malady has been introduced. Professor Riley, of the United States Entomological Commission, having discovered that the cultivated American vines possessed a varying degree of resistance to the disease, recommended that those least susceptible to it should be used in the French vineyards as stocks, on which to graft their own vines. The demand for cuttings of such American vines has this year exceeded the supply. All other remedies are being abandoned in France, and by means of the American vines there is hope of restoring the blighted vineyards. This serious malady was introduced into France by vine-cuttings after the civil war, and it threatens Spain, Portugal, Switzerland, Austria, and Prussia. Its complete history is highly suggestive to the pathologist, as a type of contagion with manifest traveling germ. The wingless phylloxera travels over the surface of the ground from vine to vine, or beneath the ground where roots interlock ; while in the winged form it may fly or be carried as many as fifteen or twenty miles, and under exceptional conditions even more. Through

DISEASE CLASSIFICATION.

agated tlirough. time and space by contagion, and by contagion alone. The leading types are small-pox in all its varied forms, as afflicting men and animals ; the lung-plague of cattle ; hydrophobia in men and animals ; and certain parasitic maladies. These are essentially International in their manifestations — may be exterminated anywhere, and, once exterminated in any locality, can only recur by reimportation, recommunication from the sick to the healthy.

A second and much larger group includes some of the most devastating plagues, but the fundamental character in common is locahzation as to origin. There may be, and there is, some uncertainty as to the precise line of demarkation between these diseases and the pure contagia. It is the same in every classification of animals and plants themselves. But history records periodic manifestations always traced to definite regions. A susceptible man may be inoculated with small-pox anywhere ; a bullock will take the lung-plague in any latitude and at any altitude, and there is practically no difference known in the type and severity of the disease wherever it may occur. The localized endemic or enzootic maladies are influenced materially and radically by season, temperature, humidity, soil, systems of agriculture, sanitary conditions (especially in relation to disposal of sewage and the water-supply), the geographical distribution of animals and plants, and other secondary circumstances too numerous to mention. These maladies travel and sometimes widely ; but their main centers of development are known or knowable, and their common method of propagation usually involves the contamination of air, water, food, or soil to breed a pestilence. It is obvious at once that the leading and strikingly characteristic types of this group are the cholera of Hindostan ; the ancient plagues of the East, derived from Africa, and passing through Egypt to desolate the Roman Empire ; the yellow fever of the tropical Western Atlantic basin ; the varied forms of malignant anthrax (due to great heat and humidity,' seriously

man's agency, by commerce in plants and cuttings, it may be carried to indefinite distances. It has always been by man's agency that Asiatic cattle-plague, reputed harmless in the Steppe herds, has been communicated westward as far as the British Isles. The general similarity of the diseases of plants and animals indicates that they are susceptible of similar classification.

YELLOW FEVER A NAUTICAL DISEASE.

aggravated by filth and foul air and known to us as the Siberian boil plague), the bubonic fever or pestilence, etc. ; the splenic fever of Texan cattle, pervading perennially a wide region of natural grazing ground, beyond which, in the healthiest localities, the excreta of the apparently healthy and certainly thriving animals contaminate the grasses, and destroy, with the fury of genuine plague, the sound kine of northern latitudes ; ague ; phthisis ; and (as a last example), we may adduce certain parasitic maladies — not those dependent on acari which hve in any latitude, but the tropical screw-worm invading every sore and festering, to bodily death, every simple wound. Think of the South African tsetse, the Guinea worm, and that threadworm of the blood {Filaria sanguinis hominis) which afflicts man throughout the tropical zone. These are the Indigenous enemies of high forms of animal life — the plagues of definite home, but occasional wide-spread fatality. Directly or indirectly, through the flora and fauna of a definite region, they spring from the soil, can always be traced to a natural habitat, and may properly be termed Autochthonous.

Lastly, we have to deal with maladies due to individual predispositions and to accident, isolated sickness, disease, or injury. A man suffers from dyspepsia, a woman from cancer, a child from rickets, or a horse from colic. In these and similar instances there is no pretense for confusion with contagious and with localized or indigenous diseases. The maladies or the individual instances of the maladies are Independent and purely sporadic. These may be and are often due to special idiosyncrasy or to hereditary transmission.

"Well do I remember the days when the doctrine of spontaneous generation was so facile an interpretation of all human ills, that the strict definition of a specific animal poison, and its peculiar history as an agent of destruction, met with great incredulity among physicians and others. Maladies such as smallpox or cholera were supposed to originate anywhere.

The tendency now is to the other extreme, viz. : that no widespread pestilence can occur without a definite disease-germ — a link between a preexisting case and the present one. The

YELLOW FEVER A NAUTICAL DISEASE.

well-informed in pathology run no risk in confounding relapsing or famine fever with such a disease as variola. When I first demonstrated the exotic character of the animal contagia in the British Isles, and pointed out to some of the best European authorities that epizootic aphtha, the Russian murrain, the kmgplague in cattle, and genuine exanthemata, had no home, but traveled in the lines of" communication established by wars or trade, and were never (in the popular acceptation of the term) acclimatized anywhere, the conclusion was deemed far-fetched and was only tardily accepted. For nearly thirty years my mind has been attracted to these questions, and, in all probability, the wider field of comparative pathology gave me no small advantage over those whose sole field of observation related to diseases of man. For the past ten years my attention has been directed to disinfection and disinfectants, and more especially to antiseptic cold. The last has led to that all-absorbing branch of practical engineering and applied physics, artificial refrigeration ; and little did I think, when I aimed at isolating the British Isles from cattle contagia, by favoring the importation of dead meat instead of live animals, that my researches might lead me, as I believe they must, to the practical demonstration of the means whereby yellow fever may be held permanently in check, if not totally extinguished, on the Atlantic seaboard.

These words of explanation are needed as an excuse for, perhaps rashly, forcing myseK before the public with an exposition of views so widely different from those generally held. The public (and I include scientific men) is not satisfied with the current knowledge on the subject of yellow fever. There are many who scout the idea of informing the public on such questions. I belong to that class of ardent believers in popular knowledge who consider no adage more ridiculous than that which avers that a little "knowledge is a dangerous thing." Better a little than none, and that little will grow. The germ of truth remains, the lie vanishes.

We have arrived at a stage when we may generalize with profit, when at all events we may define, and I venture to be^ lieve that the classification of all maladies under the three great heads —

YELLOW FEVER A NAUTICAL DISEASE.

International or Contagious,

Indigenous or Autochthonous,

Independent or Individualized — will clear away some of the mist enshrouding this great question ; and in due time the skillful aetiologist — the student of diseasecausation — will split up these great groups into lesser and well-defined orders, genera, and species, and abohsh the ancient nosologies based on theories, swept away together, in due time, by the torrent of medical progress.

Kemember the three I's, and one of the fundamental features of yellow fever can not be forgotten, viz., that it belongs not to the contagious diseases. Its poison has not been collected on a pin's point to propagate the malady from the sick to the healthy. The virus of small-pox is known to us by its effects, and so is the poison of yellow fever ; but there is not one of the pure contagia that will not yield a secretion — such as the system does not produce in yellow fever — which can be desiccated or otherwise preserved ; and so long as it is undecomposed, or retains its latent vitality, when introduced into the blood of the susceptible creature, a disease is induced with a definite period of incubation, a characteristic invasion, and aggravation of symptoms, until a crisis occurs, to be followed by death or convalescence. So concentrated or so virulent may be the poison, that the ordinary course and symptoms abort, and a rapid poisoning results in what the French so graphically name un acces foudroya/nt.

Yellow Fever indigenous.

Yellow fever pertains to the indigenous plagues, the diseases of localized origin; and future observers may and no doubt will, as past ones have done, ally with it, or show some relationship to it, of diseases in various parts of the world. Its most striking and constant characteristic is development in a confined atmosphere on or near the equator in the Atlantic, with a virulence almost proportionate to the protracted heat, humidity, and stillness of the air breathed by man. These are the conditions under which decay or common putrefaction of organic matter occurs ; and it were well to investigate further the statements concerning the rapid decomposition of meats and other perishable provisions in yellow-fever-laden air.

DAMP SHIPS UNHEALTnT.

Damp Ships unhealthy.

Dr. Turner, Secretary of the National Board of Health, has written very forcibly on the insalubrity of damp ships — of ships whose air is kept damp by perpetual swabbing and washing. The conditions he describes and denounces are the conditions favorable to the development of what is called " ship fever," which in the tropical Atlantic means, to all intents and purposes, Yellow Jack.

The region whence yellow fever travels northward is remarkable for humidity, and that humidity does not depend on rains, which so often favorably influence the health of infected cities in the United States, but saturation of the atmosphere at high temperature — a state favoring the rapid rusting of metals and instant comiption of organic remains.

" Dr. E. H. Barton, of IS^ew Orleans, informs us, as the result of an examination of fifteen epidemics, that the average dew-point at the commencement of the sickness was 95*82 ; the average at the maximum of the epidemic was 74*34, and that at the declination 62"12. The difference between the period of the commencement and that of declination was 13'70; and we have the remarkable fact that a diminution of the dew-point brought the epidemic to its maximum of intensity, while a further diminution brought it to its declination. Dr. Barton remarks, in reference to this matter, that during the last nine epidemics it was found that, although the results stated were but an average of the whole, the extremes or variations from it, in any year, were very small; in other words, the minimum dew-point at which the epidemic passed off, and which was required to destroy that character, was noted at 58-26, and the maximum, in any year, under which it ceased its ravages, was 66*64, being a difference of a fraction over 8° only."*

Pending researches by a competent commission at Havana, it may be rash to predict that little more is likely to be learned of the specific germ of yellow fever than we know of the organic elements incident to and connected with putrefaction. There is a question of intensity, as well as of specificity, pending — an intensity bearing almost a definite relation to high * La Roche, vol. ii., p. 159.

YELLOW FEVER A NAUTICAL DISEASE.

temperature and atmosplieric humidity, darkness, and intestine inertia in the deepest holds of vessels.

Whatever may be the results of this year's investigations, I am sure that the concentration of attentive thought and skillful inquiry, now so fortunately inaugurated, will dispel much mystery, and especially any mystery still lurking, which surrounds the spontaneous or imported character of the disease, so far as the United States are concerned. The facts recorded during the past century already constitute a broad and inspiring basis on which to found a rational and perhaps incontrovertible opinion. The very discrepancies brought out by the contagionists and anti-contagionists — ^by those in favor of the theory of spontaneous development in the Southern States, and those holding the opposite view — have enlarged our sphere of vision.

. We must not expect a prompt unanimity of opinion. That we may never have, but this off-hand essay would not have been written had I not, in the course of my inquiries with a view to the prevention of yellow fever, found so much to guide our thoughts into new channels, that I felt impelled to take others promptly into my confidence, with a view to expediting the experimental work which, in my opinion, must lead to the final and permanent exclusion, as an epidemic or pestilence, of ship or yellow fever from all lands.

Wliere do wejmd Yellow Fever f and whence does it reach us ?

These two questions can undoubtedly be answered, and in the main answered conclusively. I shall not attempt to lay all the evidence in my possession before my readers. That would defeat my object, which is to be brief and prompt. I shall confine myself as much as possible to adducing those striking facts and data which seem to me established beyond question.

" Yellow fever was not known to the people of the Eastern hemisphere until after the discovery of America by Columbus. The earliest epidemics of which we have any historical information occurred during the first half of the seventeenth century, in the West India Islands." *

* " Conclusions of the Board of Experts authorized by Congress to investigate the Yellow Fever Epidemic of 1878." Washington, 1879.

PROTECTION OF NEW ORLEANS.

It appears that yellow fever first occuiTed within the present limits of the United States in 1693, in Boston, Massachusetts, and in 1699 in Philadelphia, being imported both times from Barbadoes. It entered New York from St. Thomas in 1702, and for the first time reached New Orleans in 1796.

'We must eliminate all doubtful cases. The recognition of

o

isolated or sporadic cases (so called) of yellow fever is attended with great difficulty, and the most important point for future observers to clear up is the positive recognition in the earliest stages of characteristic signs of the disease. But so many epidemics have been studied that the mass of authenticated outbreaks is enormous, and some able physicians have arrived at conclusions which bear the stamp of ample justification. " I remain convinced," says Dr. Faget, of New Orleans, in his admirable letters on this subject, " that yellow fever never occurs in New Orleans unless it is imported ; for in my opinion it owes its origin always to special germs {semences speciales) which are brought to us in the holds of certain ships." *

Yellow and Paludal Fever.

Dr. Faget published his "Memoires" in great measure to define the contrast between ordinary marsh, miasmatic, malarial or paludal fever, and yellow fever ; and he says : " Now the principal object which I am pursuing in my studies of the two fevers is that both can be attacked in their origin {dans leur causes) or their morbid principles ; tJie yellow fever by special means of sanitation applied to the holds of importing vessels, there where the germs exist ; the paludal fever by turning our marshes into healthy lands, and meanwhile, by quinine, pursuing the poison itseK and destroying it, even in the depths of the organism."

Protection of New Orleans.

Dr. Faget remarks that after a winter with frost New Orleans can be readily preserved from all yellow fever, and at the time he was writing (June, 1863) five years had elapsed without a visitation of the disease. " The blockade, and, after the blockade, the severities of the state of war, that is to say, the absence

* " Memoires et Lettres sur la Fi^vre Jaune et la Fievre Paludienne." Par le Dr. J. C. Faget. Nouvelle Orleans, 1864.

YELLOW FEVER A NAUTICAL DISEASE.

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