Remarks on the epidemic yellow fever, which appeared at intervals on the South Coasts of Spain, since the year 1800 ...

Preface

THE epidemic, known by the name of yel¬ low fever, which has ravaged the sea coasts of the south parts of Spain at intervals since the beginning of the present century, and which has excited alarms in other parts of Europe, had not as yet come under the wri¬ ter's notice ; and, as he had seen much of the disease which bears the name of yellow fever in the West-Indies, he was desirous of satis- Tying himself by his own observation of their difference or identity if the accidents of chance should ever put it in his power to do so. A fever of an alarming kind was reported to have made its appearance at Cadiz in the

autumn of the year 1819. The author, desi-

r

rous, as a physician, of knowing of what na¬ ture it was, and conceiving that it might be an object of some importance to the nation a

IV

PREFACE.

to ascertain distinctly whether or not it was contagious, took the liberty of making an offer to the British Government, through the Director General of the medical department of the British army, to undertake the investi¬ gation of the subject, and to proceed to Ca¬ diz for that purpose without loss of time, and without any other condition than a pas¬ sage free of expense, and such form of intro¬ duction to the Spanish Authorities as would enable him to prosecute his object without interruption. The offer was made as soon as the newspapers announced the appearance of the malady ; and, in five or six weeks there¬ after, an answer was transmitted to the writer, who then lived in the country, that the

Spanish Government was not averse, and that the Secretary of State for war and colo¬ nies, (to whose office it would appear the matter had been referred,) was not unwilling to defray the expense of the passage to the place where the disease was. The author set out for London immediately on the receipt of the information : he was not able to set out

for Cadiz in less than three weeks, detained, as it appeared, by the backwardness of the

Spanish ambassador to grant the necessary papers to enable him to enter Spain. It was

PREFACE.

V now the month of December; and, though it was more than probable that the epidemic had subsided, if it had not altogether ceased, he still persisted in his design ; in the hopes that, though he might not have the opportunity of seeing the disease in its strength, if he should see it at all, he might still have the opportunity of obtaining more correct infor¬ mation respecting it than he could otherwise expect to obtain. With this expectation lie embarked at Falmouth in the December packet, and arrived at Gibraltar about the end of the month. In a very few days after his arrival, and when in the act of setting out for Cadiz to commence his research, informa¬ tion was received by the Governor of the gar¬ rison that an insurrection had taken place among the military, which threatened a sub¬ version of the government: the isla de Lean was in their possession, consequently the route to Cadiz by land was obstructed.

The author, defeated in his purpose by this accident, waited for nearly two months at Gibraltar, in daily expectation that the insur¬ rectionary movement would be appeased, and that the route to Cadiz would be free. The detention was irksome; and finding, after a long delay, that there was no calculable time

VI

PREFACE.

for the removal of the impediments, it occur¬ red to him to make an excursion to the Le¬ vant, with the intention of being at Cadiz next autumn, so that he might be on the spot, in case the yellow fever should then re-appear. He undertook the journey to the Levant on his own motive and at his own expense; partly in the desire of seeing Greece, a coun¬ try in which he had lived in idea the greater part of his life, and partly in the hope of ob¬ taining information respecting the nature of the diseases of the Mediterranean shores: particularly respecting the plague, a disease which he had never seen, and concerning the history and nature of which he could form no distinct idea from what he had read. — In pro¬ secution of this purpose, he went from Gibral¬ tar to Malta ; from Malta to Constantinople ; from Constantinople to Smyrna; and from Smyrna, passing among the islands of the Archipelago, to Athens and the Morea, em¬ barked at Patras for Zante, where he arrived in the month of June.

The plague did not prevail in the Levant during the time of this excursion ; consequently one part of the object of the journey was de¬ feated: other parts of it were defeated from oilier causes. it was in the author’s intention

PREFACE.

VII to have visited the whole of the Ionian islands that are under protection of the British ; and, after that, to have continued the route by the sea coasts of Italy, France, and Spain, to Gibraltar, for the purpose of observing the medical topography of the different parts on the coast, and of thus extending and con¬ necting his view respecting the material cause of febrile diseases, as a subject of general science. Investigation into the nature of the yellow fever was the author’s motive for lea¬ ving England; it was therefore his determina¬ tion to be at Cadiz in August. The time was now short; and there were moreover so many chances of interruption on the route, so much fatigue to a person advanced in years, and in an infirm state of health, and so much expense to a man of narrow pecuniary means in tra¬ velling by land, that the idea was abandoned, and the first opportunity embraced which pre¬ sented itself by water. One being soon found, he embarked at Zante, and arrived at Gibral¬ tar in the latter end of July ; and from thence, after being refreshed, and somewhat recruited by the more than common kindness of the Governor and his family, he set out for Cadiz on the 23rd and arrived on the 25 th of August, it must be considered as among contingencies

VI II

PREFACE.

in the operations of nature, whether or not the yellow fever should appear in Cadiz in the year 1820; but it so happened that it did ap¬ pear; and moreover that its appearance was announced on the 25tli, the day on which the author entered the city. It was epidemic at Cadiz for two months or more; but it was not epidemic to great extent. A similar di¬ sease appeared at Xerez de la Frontera much about the same time; and, by report, of an aggravated degree of virulence. The author remained at Cadiz until he had satisfied him¬ self respecting the nature of the malady which prevailed at that place ; and, as the malady which raged at Xerez was of a severer feature and of a greater proportional mortality than that at Cadiz, he went there with a view to ascertain, in so far as he could, what its real condition was. He was desirous to obtain in¬ formation on the subject; and he believes he has attained some information which may be relied on. His health was infirm at the time; and, as he could not have done much by his own endeavours, he owes much gratitude to those who assisted him in doing what he has done.

General Sir George Don, Lieutenant Go¬ vernor of the garrison of Gibraltar, (a person

PREFACE.

IX whose attention to the health concerns of those who are placed under his jurisdiction* whether they be civil or military, has perhaps no parallel among generals and governors in the British dominions), permitted Mr. CT Halloran, assistant surgeon of the 64th regiment of foot, to accompany the writer to Cadiz. Mr. O’ Hallofan wras known to him in the West-Indies, known moreover to be a person who had courage to look danger in the face in whatever shape it might present. He was zealous in the pursuit of professional know¬ ledge, and of an ardency of temper which committed him wholly to the duty which he undertook. He was active in his pursuit while at Cadiz ; and in the month of Sep¬ tember he went to Xerez, where there was a great field for observation, and where he found the opportunity of making trial of his practical skill. Mr. O’Halloran opened some dead bodies both there and at Cadiz ; and to these dissections, and to the experiments which he made, the author is indebted for the means of proving the truth of opinions that he could not otherwise have had the oppor¬ tunity of proving in Spain. Without Mr. O’Halloran’s experiments the author is ready to confess that his views of practical treatment

b

X

PREFACE.

would have been no more than presumptive

*

of the truth : as it is they are next to demon¬ strative ; and he thinks that he now sees to what extent reliance may be placed on the medical art in controlling, even in arresting, the course of this formidable disease. It is not pretended that success uniformly followed the measures of cure that were adopted by Mr. OTXalloran ; but it may be said with safety that the failures were comparatively few ; and it is moreover reasonable to believe that they would have been still fewer, if cir¬ cumstances had permitted the full execution of the view that was contemplated. But, be this as it may, the experience alluded to proves dis¬ tinctly that blood-letting and other means of depletion may be employed freely, even with as Great freedom in the vellow fever of An-

O j

dalusia as in the fevers of other countries; for it was here distinctly seen that, where abstraction of blood was carried to extent, success was comparatively certain — the cure for the most part speedy and perfect. The endemic yellow fever of the south of Spain is in itself a disease of great danger; and, under certain conditions, it is a disease of great treachery. It is not unmanageable, or beyond the power of the medical art ; but the ma-

PREFACE.

XI nagement of it requires close observation of circumstances, with a prompt and efficient application of remedies, which, as things were, could not be commanded in Spain.

The author set out to investigate the nature of the yellow fever under sanction of the Bri¬ tish Government, — even with an allowance in money to defray the expense of the passage to Cadiz. He had no instruction ; and he did not conceive himself to be a person acting in mission; he notwithstanding thought it to be his duty to transmit to Government, such in¬ formation respecting the nature of the disease, as, in his opinion, bore on the regulation of intercourse with infected places. This he did under the impression that it was his duty to do so. He now perceives that it was an unnecessary, and perhaps an impertinent duty which he had assumed. When he returned to England, which was in the month of De¬ cember, 1820, he reported his arrival at the office of the Secretary of State for war and colonies, offering at the same time to give whatever information he might possess on the matter which had been the subject of investigation in the journey. The Secretary of State did not desire to see the writer ; and did not think it worth while to require any

PREFACE.

• •

XU

information from him ; and, as the remarks in the papers which were transmitted from Cadiz, were pointed remarks — in his own opinion conclusive of the non-contagious na¬ ture of the yellow fever, and consequently of the inutility of quarantine in so far as re¬ spects that disease, he can scarcely avoid con¬ cluding that these papers, if they have been received, have not been read; or that the subject to which they relate, viz. the law of quarantine, is a prerogative subject not to be touched by the uncourtly pioneers of truth. The author has, for this reason, incorporated the material facts and arguments stated in the papers alluded to into the following pages ; in expectation that, as the matter of fact is correct, (if medical facts are ever to be deemed such,) the public may have the opportunity of seeing it as it is, and of judging for them¬ selves whether or not the conclusion to which it leads concerns their interests.

Such as has been stated was the motive of the present undertaking. The execution of it was attended with some difficulty ; and the author is aware that it is only imperfectly executed. Ill health was an impediment to activity during the investigation ; and inve¬ terate habits and old age are now chargeable

PREFACE.

XIII with some of the imperfections which attach to the execution and literary composition. Much of the author’s life has been spent in military hospitals, where the physician com¬ mands by authority and probably becomes imperious. Habit gives maimer, and the wri-

t

ter is sensible that, as a writer, he is harsh and didactic. He may even seem to be sometimes presumptuous ; but, if he be so, he must take leave to say that he is not so from self-opinion. He wishes to give all the information he can; and it is probable that he will be considered by some to be too minute, even perplex¬ ing by the distinctions which are made in the differing conditions of the same disease. The distinctions, he believes, are founded in truth ; and though they may be obscurely defined, he trusts they are so defined as to be intelligible, if they be duly considered. Besides the imperfections alluded to, the ad¬ vanced age at which the author writes will not be overlooked by the candid, if it so hap¬ pen that the same thing be repeated oftener than once in the course of these pages ; or if things, necessary to be said for the elucidation of the subject, be altogether forgotten. The author is ready to admit that there may be unnecessary repetition on some occasions, or

XIV

PREFACE.

omission of things necessary on others ; but he believes that what he has said is founded in truth, and he trusts that there is little of it which may not be useful, if it be rightly comprehended.

. 4

Chapter I

A Sketch of the Medical Topography of Cadiz and its Envz? ons im »«• «*• ... ... ...

Chapter II

A Short History of the Introduction of the Yellow Fe¬ ver into the Sea Ports of the South of Spain, with some Account of its supposed Propagation by Land , extracted from the most creditable of the Spanish Medical Writers , confirmed or refuted by the Evi¬ dence of respectable Persons who observed the Facts and , to a certain extent, by the Author’s Observations on the spot ... ... ••• ... ...

Recapitulation ... ...

Remarks on the Law of Quarantine

V

REMARKS,

Chap. I

A Sketch of the Medical Topography of Cadiz and its Environs.

The province of Andalusia, which forms the south, and one of the richest parts of Spain, is of an irregular surface, and in many places the scenery is beautifully picturesque. The surface is inter¬ sected by various chains of mountain, some of them of considerable elevation. The plains or vallies which intervene between the chains of mountain, are of various form and dimension. Some of them are extensive and level, studded here and there by eminences, or broken irregularly by ravines and gullies. The plains, though the soil be light, often literally sand, do not appear to be infertile, if opi¬ nion may be formed by the quantity of grain which they produce with inferior culture ; or the number of cattle which they maintain in good condition,

B at most seasons of the year, without extraordinary care. The hilly or elevated part of the province— not mountain, is generally dry, of a light and ap¬ parently unproductive soil, and covered with heath or brush wood. The extensive level plains which furnish pasture for horses, cattle, or flocks of sheep, as not drained by art, are nearly in a state of bog in the rainy season. The soil is generally loose and light : water penetrates deep into it ; and, as there is little current or outlet, and rarely a tenacious clay to form a superficial crust pre¬ ventive of exhalation, the absorbed water continues to rise in vapour from an apparently dry surface during the great heats of summer. Exhalation from the earth is known to be a cause of intermit¬ ting fever. The people who live upon the plains, or on eminences near the plains, are consequently, as might be expected, much harassed by agues. The type sometimes assumes the quartan form ; sometimes it appears as distinct remittent ; and sometimes it sinks into obscure remittent or gastric. From gastric there is an easy transition to conti¬ nued or contagious typhus ; and sometimes, under epidemic influences, a form of disease not unlike that which has obtained the name of yellow fever prevails to some extent.

The province of Andalusia, as of great variety of surface, and not drained and cultivated with a view to diminish the force of the cause of the di¬ sease which belongs to the soil, does not strike those who visit it transiently as a country favour-

I able to health. The tertian ague, which belongs to the soil, presses severely upon the inhabitants at particular times in most of the lower districts ; and adventitious epidemics rage with violence on some occasions like a pestilence. The latter have been destructive at intervals since the beginning of the present century, at different points on or near the sea coast. Cadiz, Xerez de la Frontera, Se¬ ville, and Malaga, have suffered conspicuously, — Cadiz more frequently than the others.

The city of Cadiz occupies the point of a penin¬ sula which is nearly level with the sea. The site is circumscribed — rhomboidal in form. The houses or habitations of the people are erected on shelves of rock at one place, on alluvial sand at another; of course many of them stand over a bed of water. The site of Cadiz being of small extent, and the commercial business of great compass, the dwel¬ ling houses have been raised to great height, al¬ ways to four stories, sometimes to more. The streets are in straight lines, remarkably well paved, and cleaner perhaps than the streets of any town in Europe : — they are narrow from the circumscri¬ bed bounds of the locality. The houses are good, almost without exception ; many of them are mag¬ nificent : the apartments are lofty ; the windows of the sitting rooms descend to the level of the floor ; the sitting rooms are thus well ventilated ; the sleeping rooms are not always so. The apartments are narrow in proportion to the height of the roof, ^~an aukvrardness in dimension which conveys an idea of prison-like confinement. Most of the dwel¬ ling houses have an interior court or area, with a well of excellent water for the supply of the whole of the families who live under the same roof. Cadiz may in fact be considered as one of the finest towns in Europe : in Spain it bears the name of beautiful, — and the name is not misapplied The nuisances of a common sea beach are covered from the view by walls and ramparts, terraced walks, and bomb-proof cellars ; insomuch that this city, crow¬ ded as it is with population, rarely, if ever presents any thing* that is offensive to the eye, or that can be supposed to be noxious to health.

The point where Cadiz stands, and which pre¬ sents itself as a shoot from the isle of Leon, is joined to the isla and port San Fernando by a low bank of sand, which is elevated by a pavement of massive stone to a magnificent causeway. The isla itself is of considerable extent : a great part of it is swamp intersected by numerous sluice canals. The swamp, impregnated with a saline material in high proportion, is converted into a manufactory for salt; and it is one of great extent and value. The whole of the isla, as nearly on a level with the sea, is saturated with water. It is not unhealthy com¬ paratively ; and, as such conclusion would not be formed from the superficial appearance of a simple swamp, it is reasonable to believe that the com¬ parative salubrity is owing to the strong impregna¬ tion of the moisture of the soil with saline particles.

s

Puerto real , which lies on the south-east side of the bay opposite to Cadiz, appears to have been once a considerable place : it suffered extremely, was in fact nearly demolished by the French during their occupation of Spain, and it is not yet rebuilt. The site is dry and somewhat elevated above high water mark : it is said to be healthy comparatively among the towns on the coast.

Puerto de Santa Maria , a considerable and rather a handsome town at the north east side of the bay, near the mouth of the Guadelete river, is subject to the action of the causes which float in the atmosphere of the bay and its environs ; and likewise to the contingencies which arise from its intimate commercial connexion with Cadiz. The site of Puerto de Santa Maria is upon the whole dry in itself : it is near the embouchure of the Gua¬ delete river ; and, as such, exposed to the exha¬ lations which arise from the banks of that river, which are low, swampy, and often inundated.

Xerez de la Frontera , an open town, built on a ridge of height of a somewhat irregular sur¬ face and of nearly three hundred feet elevation above the bed of the Guadelete, from which it is distant about two miles, is another of the places which requires to be noticed on this occasion. Xerez contains forty thousand inhabitants or up¬ wards. The town is not drained, and only a few of the streets are paved. The un paved streets are miry in wet weather ; and many of them are more¬ over offensive by accumulations of rubbish and other nuisances in the dry season. There are some good houses in Xerez — commodious and well equip¬ ped ; many are low,, damp, and ill ventilated. The soil of the site is sandy, such as absorbs the rain which falls upon it. The moisture disappears from the surface in a short time after rain : it pre¬ sumptively remains at a certain depth in the earth, not beyond the reach of the action of the summer's heat; consequently it is exhaled in vapour; and, if we may judge by the effect, it acts noxiously on the health of the inhabitant. The people of Xerez, particularly labourers who dwell in ground floors, or in cottages near the town, suffer much from in¬ termittent fever of the tertian and sometimes of the quartan type.

The sketch of locality here given is only a su¬ perficial one. It is however evident from the statement, superficial as it is, that intermittent and remittent fever, more or less complicated and dan¬ gerous according to circumstances, may be expec¬ ted to be the prevailing form of malady of the whole of the environs of the bay. Near the sea coast, particularly in the autumnal season, the more prevailing form is presumptively that which is not improperly termed gastric, easily convertible into yellow fever under the occurrence of one of those unappreciable epidemic influences, which arise at certain intervals, and for a time pervade and ravage, like a pestilence, certain districts of the earth.

THE SOUTH COASTS OF SPAIN.

Chap. II

A short History of the Introduction of the Yellow Fever into the Sea Ports of the South of Spain, with some Account of its supposed Propagation by Land , extracted from the most creditable of the Spanish Medical Writers, confirmed or re¬ futed by the evidence of respectable Persons who observed the facts, and, to a certain extent, by the Author's observations on the spot.

The importation of the disease called yellow fe¬ ver to the West-Indies from Asia or Africa, and the exportation of it from the West-Indies to the sea ports in the south of Spain, though not proved and presumptively not capable of proof, is still credited by a considerable number of medical writers of dif¬ ferent nations, by the mass of the people of Spain, by the official authorities who are appointed to pre¬ side over the health concerns of that kingdom,and even by the authorities of those European states which have commercial connexion with places where the disease prevails. If the opinion assumed on this occasion be not founded in truth, it is evi¬ dently injurious to the interests of the community that it should be allowed to have credit and currency ; and, for this reason, it is necessary to give a statement of the grounds on which the assumption is built, and on which it still obtains credence among the health counsellors of European states. There is not perhaps one practitioner in one hun¬ dred who has resided for years in the West- Indies, who believes that the concentrated endemic of that country, usually called the yellow fever, is a disease which possesses the power of propagating itself from person to person within the tropics. Ships leave the West-Indies not unfrequently with a nu¬ merous list of persons ill of the disease called yellow fever. The number of the sick increases alarm¬ ingly on some occasions at the early part of the voyage; there is not, it is believed, one authentica¬ ted instance where the original has reached any sea port in Great Britain, or even perhaps any sea port in the south of Spain, in genuine form. If this be well founded, and it cannot be controverted by true testimony, the idea of the importation of the yellow fever from beyond the seas, cannot be maintained by any person who is not predetermined to main¬ tain error in the face of truth. The case stated is fundamentally true if reduced to its principle ; but it is proper to observe, at the same time, that it is so disguised by circumstances on some occasions as to embarras those who are satisfied with opinions drawn from superficial appearances only. It is necessary to mention what may be : — if a vessel, for instance, should happen to have a great number of persons ill of the yellow fevcr*in its passage from

THE SOUTH COASTS OF SPAIN.

the West-Indies, it is possible and even probable that, by throwing these persons together in the mass in ill-ventilated apartments, (as the Tween decks of a ship, even of a ship of war, must necessarily be), the contagion, which belongs to an atmosphere corrupted by accumulation of living subjects in narrow space, can scarcely fail to be generated : a contagious fever will thus be produced and carried to whatever port the vessel may be destined to go. This is within the circle of possibility ; and it has probably sometimes occurred. The imported fever is contagious ; but it is not the yellow fever, though the yellow fever may be the source from whence it originally springs.

The question of importation, or non-importation of the yellow fever from the West-Indies or North- America, to the southern parts of Spain, has been a subject of unpleasant and unprofitable controversy among medical writers for some time past. It is important to the community that it should be de¬ termined ; and it is fortunate that the occurrences of the year 1820 bid fair to determine it, so as to set it at rest for ever. The case is not equivocal. An epidemic fever, commonly called yellow fever, made its appearance at Cadiz in the month of Au¬ gust, 1820. No vessel had arrived from a foreign port near that period to which its importation could be assigned; consequently those who believed in the opinion of importation from a distant country were silent. A similar disease appeared at Xerez de la Frontera somewhat earlier. Xerez is not a sea port, and has no direct communication with the sea or with shipping. It is not known, not even conjectured, in what manner the fever was introduced into Cadiz ; nor can it be distinctly proved in what manner it was brought to Xerez. The vulgar report is here stated ; not that it is cre¬ dible, but that the reader may have the opportunity of knowing the flimsy foundations on which opini¬ ons on this subject ordinarily rest. A young wo¬ man, who had been on a visit at Cadiz, arrived at Xerez in the early part of August, under indisposi¬ tion. She was received into the house of a friend or acquaintance ; and, the disease threatening to be severe, she was sent to the hospital, where she died in a few days. The physician who attended the hospital does not, according to report, acknow¬ ledge that the disease was yellow fever ; but, as yellow fever first made its appearance in the house where she had lodged, suspicion attached to her as the importer. It is impossible to speak positively on the subject; but this at least is positive, that yellow fever was not acknowledged to be in Cadiz for ten days or more after the person alluded to was dead and buried. Notwithstanding what is now said, the common voice still considers her as the importer ; even the physicians were credulous at first. They abandoned their opinion after a formal investigation of the circumstances : they had not courage to speak out boldly ; for it is, or has been dangerous to speak unpopular truths in Spain. It is a distinct fact that the disease did appear at Cadiz