Yellow fever

“ For some reason yellow fever, in the minds of people generally, is covered with a cloak of mystery. In communities where it prevails there are hundreds of remedies and courses of treatment that are vaunted as being infallible cures, and the more ignorant and uneducated the possessors of [Pg 65] these specifics, the more readily they seem to be accepted by the people generally. But yellow fever, like every other acute disease, has its own natural history, and man at present knows no remedy that can shorten or change its course. ”

“ As I have said before, a person who has once had yellow fever is not liable to a second attack. Such person is known as an immune. To prove immunity, a passenger or member of the crew was required to present a written statement from [Pg 262] some recognized authority stating that the writer knew that the person under consideration had suffered from an attack of yellow fever.
Wherever yellow fever is endemic, it is a well-recognized fact that the native of the endemic area is not subject to this disease. ”

“ The American physicians are so convinced that the yellow fever is contagious, that they scrupulously prohibit persons in health from all communications with those diseased; they order frequent waterings in the streets and about the houses where the fever has manifested itself, and aromatic fumigations. They even order the clothes of those who have fallen by it to be burned, as is practised with respect to those who die with the plague. ”

“ In 1815 he published an account of yellow fever under the title of ‘Observations upon Bulam Fever,’ proving it to be a highly contagious disease (London, 8vo) . This is the first clear account of the disease now known as yellow fever. In this work Pym maintains (1) that it is a disease sui generis known by the name of African, yellow, or bulam fever, and is the vómito prieto of the Spaniards, being attended with that peculiar and fatal symptom the ‘black vomit;’ (2) that it is highly infectious; (3) that its infectious powers are increased by heat and destroyed by cold ”

“ Yellow fever is not at all contagious in the sense that a healthy person can contract the disease by contact with a yellow-fever patient, or with his discharges from the stomach, bowels, or elsewhere, and is probably only communicated to man by the bite of a particular kind of mosquito harboring the yellow-fever organism in its body. ”

“ The mere fact that the individual has resided, even for a day, in a city where yellow fever is present, has been sufficient cause to subject his baggage to rigid disinfection by the sanitary authorities. To determine, therefore, whether clothing and bedding which have been contaminated by contact with yellow fever patients and their discharges can convey this disease is a matter of the utmost importance. ”

“ THE RESULTS ACCOMPLISHED IN HAVANA From the account already given of yellow fever it is evident that the parasite has to be introduced into a locality, either in the body of a human being sick of yellow fever, or in the body of a female stegomyia mosquito which has become infected by the parasite. It is evident that if the health authorities can keep out these two sources of infection, yellow fever can never occur in that locality. ”

“ While negroes are susceptible to yellow-fever infection, attacks are far less fatal than among whites.
SYMPTOMS IN MILD OR SIMPLE CASES.—Yellow fever is usually sudden in its onset. Persons are liable to be seized while pursuing their ordinary avocations, or, as often occurs, the attack may begin during the night. The initial symptoms are chilliness or cold sensations, seldom amounting to a decided rigor. Reaction is usually prompt and decided, the temperature reaching within a few hours 102° to 105° F. Yellow fever is not a disease in which it is very common to observe excessive body heat. ”

“ Why should it surprise us to see a yellow fever generated amongst us? It is only a higher grade of a fever which prevails every year in our city, from vegetable putrefaction. It conforms, in the difference of its degrees of violence and danger, to season as well as climate, and in this respect it is upon a footing with the small-pox, the measles, the sore-throat, and several other diseases. There are few years pass, in which a plethoric habit, and more active but limited miasmata, do not produce sporadic cases of true yellow fever in Philadelphia. ”

“ The difficulties of diagnosis are often very great; particularly so in the earlier cases of an epidemic. When several deaths, preceded by fever and black vomit, have occurred within a limited area and in quick succession, a suspicion of yellow fever becomes a certainty. There is no clinical feature, so far as is known, which would distinguish a mild attack of yellow fever from an ordinary febricula, nor any pathognomonie clinical sign that would absolutely distinguish a malarial remittent from yellow fever. Probabilities must be weighed in diagnosis when it is based on clinical grounds alone. ”

“ That the microörganism discovered by Professor Giuseppi Sanarelli, of the University of Bologna, Italy, and by him named “bacillus icteroides” is the cause of yellow fever.
Second. That yellow fever is naturally infectious to certain animals, the degree varying with the species; that in some of the rodents local infection is very quickly followed by blood infection, and that, while in dogs and rabbits there is no evidence of this subsequent invasion of the blood, monkeys react to the infection the same as man. ”

“ From the best statistics which I could get on the Isthmus, I found that the French lost yearly by death from yellow fever about one-third of their white force. If we lost in the same ratio it would give us about thirty-five hundred deaths among our Americans yearly. We, therefore, during [Pg 150] the first year made yellow fever the first consideration, and gave it the most attention.
The two principal foci of infection for yellow fever were the towns at either end of the railroad, Colon at the northern end, on the Caribbean Sea, and Panama at the southern end, on the Pacific Ocean. ”

“ On considering the yellow fever particularly he is of opinion that the remarkable dissolution of the blood, together with the tendency to putrefaction in the whole body, the black vomit, and other characteristic symptoms, are often accidental though fatal appearances in fevers of the West Indies. They proceed, according to him, in such as are newly arrived, sometimes from a gross habit of body, excessive drinking of spiritous liquors, and from being afterwards overheated in the sun; but the intense heat and unhealthfulness of the air does much more frequently produce all those symptoms. ”

“ The Doctor divides this disease into three species: 1. Where “signs of putrefaction are evident at a very early stage, which is generally rapid in its course, and which casually terminates in black vomiting. Yellowness seldom or never fails to make its appearance in the present instance; and perhaps it is the only one which, strictly speaking, can be called the yellow fever. 2. A form of fever which has either no remissions, or remissions which are scarcely perceptible; in which signs of nervous affection are more obvious than symptoms of putrescency ”

“ Dr. Desportes lost one half of all the patients he attended in the yellow fever in one season in St. Domingo [126] . His remedies were moderate bleeding and purging, and the copious use of diluting drinks. Dr. Bisset [432] says, [**LQU] the yellow fever is often under particular circumstances very fatal, carrying off four or five in seven whom it attacks, and sometimes, but seldom, it is so favourable as to carry off only one patient in five or six [127] .” The doctor does not describe the practice under which this mortality takes place. ”

“ The first case of yellow fever at the Dry Tortugas, in the epidemic of which I now speak, occurred on the 18th of August, 1867, in Company K, which was located in the casemates on the south side of the Fort immediately over the unfinished moat, which at low tide gave rise to quite offensive odors. To this circumstance the surgeon of the Post attributed the cause of the disease, and at his request the company was removed and the portholes ordered to be closed, to prevent the supposed deadly miasma from entering the Fort. ”

“ The predisposition of our citizens to be affected by the remote and exciting causes of the yellow fever would be very much lessened by their living sparingly upon fresh animal food, and chiefly upon broths and fresh vegetables, rendered savoury by spices and a small quantity of salted meat, during the summer and autumnal months. A constant attention should be paid at the same time to bodily cleanliness. ”

“ It is not many years since yellow fever was one of the most dreaded diseases in warm countries. To-day there is not the same fear of it, for the source of the disease has been discovered and practical methods have been devised to get rid of the mosquito which carries it. ”

“ A favorable termination is indicated by a gradual amelioration of all the symptoms, or sometimes by profuse perspiration, sudden cessation of nausea, rapid return of the pulse to its natural fullness and strength, or other marked event, which seems to indicate a crisis in the disease.
The symptoms of yellow fever vary exceedingly at different times, in different localities, and in different persons. Sometimes a person is smitten with the disease as with apoplexy, falls into a profound collapse, and dies in a few hours. ”

“ All these modes of removing the causes of malignant and yellow fevers, and of promoting strict and universal cleanliness, are of more consequence in the middle and northern states of America, than in countries uniformly warm, inasmuch as the disease may be taken as often as our inhabitants are exposed to its sources. In the West-Indies, a second attack of the yellow fever is prevented by the insensibility induced upon the system, by its being constantly exposed to the impressions of heat and exhalation. ”

“ The circumstances which seem to favour the communication of the yellow fever from one person to another, by means of what has been supposed to be contagion, are as follow:
1. A patient being attended in a small, filthy, and close room. The excretions of the body, when thus accumulated, undergo an additional putrefactive process, and acquire the same properties as those putrid animal matters which are known to produce malignant fevers. ”

“ Even the characteristic symptoms of yellow skin and black-vomit may occur in other diseases, and they may both be absent in yellow fever. These differences in the disease are largely due, in all probability, to individual idiosyncrasies, and to the simultaneous presence of other morbid processes. ”

“ While I thus deny the yellow fever to be the offspring of a specific contagion, and of course incapable of being imported so as to become an epidemic in any country, I shall admit presently, that the excretions of a patient in this disease may, by [219] confinement, become so acrid as to produce, under circumstances to be mentioned hereafter, a similar disease in a person, but from this person it cannot be communicated, if he possess only the common advantages of pure air and cleanliness. ”

“ The mortality, the anatomical lesions, the course of the pyrexia, the leading clinical symptoms, are all widely distinct in the two affections; and, finally, no spirillum has been found in the blood in yellow fever. Yellow fever is an extremely fatal disease; the ordinary form of relapsing fever has a mortality of 2 to 10 per cent.; the bilious typhoid form, one of 33 to 50 per cent. In yellow fever the spleen is but slightly enlarged, and the liver is pale and softened; in relapsing fever the liver and spleen are greatly enlarged, and there is great tenderness over the hypochondriac region. ”

“ Yellow fever epidemics do not occur in the winter months in the temperate zone and they do not occur in arid regions. As epidemics have frequently prevailed in seacoast cities known to be in an insanitary condition, it has been generally assumed that the presence of decomposing organic material is favorable for the development of an epidemic and that, like typhoid fever and cholera, yellow fever is a "filth disease." ”

“ Yellow fever occupies a singular position between the contagious and non-contagious diseases. The poison is not, like that of small-pox, directly communicable from a sick person to a well one; but, although the emanations of the sick are connected with the spread of the disease, they seem to require an appropriate nidus in which to germinate and develop. ”

“ It fixes them, when it affects the mouth and throat, upon parts which are capable of bearing great inflammation and effusion without any danger to life. The stimulus which produces the yellow fever acts in ways the reverse of those which have been mentioned. It produces violent irregular or wrong actions. It determines them to internal parts of the body, and it fixes them upon viscera which bear, with difficulty and danger, the usual effects of disease. ”

“ I have constantly reprobated the practice of burning the clothes and bedding of the dead, and have never found any bad results to occur to those who followed my advice. From a consideration of all these facts, I must once more express it as my decided opinion, that the yellow fever, so far as I have had an opportunity of observing it, is not a contagious disease. ”

“ In summer it is likewise observed to be of a more florid colour than in winter. If heat thus gives a more bright red to the blood, it undoubtedly also makes it more fluid, and in proportion to its fluidity it will likewise become acrimonious; though this acrimony is not necessarily connected with a florid colour, as the blood of the arteries is not more so than that in the veins. In the yellow fever, however, the blood sometimes, towards the end of the disease, becomes endowed with extreme acrimony. ”