be contagious. I shall now mention the proofs of that assertion, and
endeavour to explain instances of its supposed contagion upon other
principles.
FACTS,
INTENDED TO PROVE
_THE YELLOW FEVER_
NOT TO BE CONTAGIOUS.
When fevers are communicated from one person to another, it is always in
one of the following ways. 1. By secreted matters. 2. By excreted
matters. The small-pox and measles are communicated in the former way;
the jail, or, as it is sometimes called, the ship, or camp, and hospital
fever, is communicated only by means of the excretions of the body. The
perspiration, by acquiring a morbid and irritating quality more readily
than any other excretion, in consequence of its stagnation and
confinement to the body in a tedious jail fever, is the principal means
of its propagation. The perspiration[23] is, moreover, predisposed to
acquire this morbid and acrid quality by the filthiness, scanty, or bad
aliment, and depression of mind, which generally precede that fever. It
is confined to sailors, passengers, soldiers, prisoners, and patients, in
foul and crowded ships, tents, jails, and hospitals, and to poor people
who live in small, damp, and confined houses. It prevails chiefly in cool
and cold weather, but is never epidemic; for the excreted matters which
produce the fever do not float in the external atmosphere, nor are they
communicated, so as to produce disease, more than a few feet from the
persons who exhale them. They are sometimes communicated by means of the
clothes which have been worn by the sick, and there have been instances
in which the fever has been produced by persons who had not been confined
by it, but who had previously been exposed to all the causes which
generate it. It has been but little known in the United States since the
revolutionary war, at which time it prevailed with great mortality in the
hospitals and camps of the American army. It has now and then appeared in
ships that were crowded with passengers from different parts of Europe.
It is a common disease in the manufacturing towns of Great-Britain, where
it has been the subject of several valuable publications, particularly by
Dr. Smith and Dr. John Hunter. Dr. Haygarth has likewise written upon it,
but he has unfortunately confounded it with the West-India and American
yellow fever, which differs from it in prevailing chiefly in warm
climates and seasons; in being the offspring of dead and putrid vegetable
and animal matters; in affecting chiefly young and robust habits; in
being generally accompanied with a diseased state of the stomach, and an
obstruction or preternatural secretion and excretion of bile; in
terminating, most commonly, within seven days; in becoming epidemic
_only_ by means of an impure atmosphere; and in not furnishing ordinarily
those excretions which, when received into other bodies, reproduce the
same disease.
[23] The deleterious nature of this fluid, and its disposition to
create disease, under the above circumstances, has been happily
illustrated by Dr. Mitchill, in an ingenious letter to Dr. Duncan,
of Edinburgh, published in the fourth volume of the Annals of
Medicine.
I have been compelled to employ this tedious description of two forms of
fever, widely different from each other in their causes, symptoms, and
duration, from the want of two words which shall designate them. Dr.
Miller has boldly and ingeniously proposed to remedy this deficiency in
our language, by calling the former _idio-miasmatic_, and the latter
_koino-miasmatic_ fevers, thereby denoting their _private_ or _personal_,
and their _public_ or _common_ origin[24]. My best wishes attend the
adoption of those terms!
[24] Medical Repository, hexade ii. vol. i.
I return to remark, that the yellow fever is not contagious in its simple
state, and that it spreads exclusively by means of exhalations from
putrid matters, which are diffused in the air. This is evident from the
following considerations:
1. It does not spread by contagion in the West-Indies. This has been
proved in the most satisfactory manner by Drs. Hillary, Huck, Hunter,
Hector M'Lean, Clark, Jackson, Borland, Pinckard, and Scott. Dr. Chisholm
stands alone, among modern physicians, in maintaining a contrary opinion.
It would be easy to prove, from many passages in the late edition of the
doctor's learned and instructive volumes, that he has been mistaken; and
that the disease was an endemic of every island in which he supposed it
to be derived from contagion. A just idea of the great incorrectness of
all his statements, in favour of his opinion, may be formed from the
letter of J. F. Eckard, Esq. Danish consul, in Philadelphia, to Dr. James
Mease, published in a late number of the New-York Medical Repository[25].
[25] For February, March, and April, 1804.
2. The yellow fever does not spread in the country, when carried thither
from the cities of the United States.
3. It does not spread in yellow fever hospitals, when they are situated
beyond the influence of the impure air in which it is generated.
4. It does not spread in cities (as will appear hereafter) from any
specific matter emitted from the bodies of sick people.
5. It generally requires the co-operation of an _exciting_ cause, with
miasmata, to produce it. This is never the case with diseases which are
universally acknowledged to be contagious.
6. It is not propagated by the artificial means which propagate
contagious diseases. Dr. Ffirth inoculated himself above twenty times, in
different parts of his body, with the black matter discharged from the
stomachs of patients in the yellow fever, and several times with the
serum of the blood, and the saliva of patients ill with that disease,
without being infected by them; nor was he indisposed after swallowing
half an ounce of the black matter recently ejected from the stomach, nor
by exposing himself to the vapour which was produced by throwing a
quantity of that matter upon iron heated over a fire[26].
[26] Inaugural Dissertation on Malignant Fever, &c. published in June,
1804.
To the first four of these assertions there are some seeming exceptions
in favour of the propagation of this fever by contagion. I shall briefly
mention them, and endeavour to explain them upon other principles.
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. I have heard
of two or three instances in which a fever was produced by these means in
the country, remote from the place where it originated, as well as from
every external source of putrid exhalation. The plague is sometimes
propagated in this way in the low and filthy huts which compose the
alleys and narrow streets of Cairo, Smyrna, and Constantinople.
2. A person sleeping in the sheets, or upon a bed impregnated with the
sweats or other excretions, or being exposed to the smell of the foul
linen, or other clothing of persons who had the yellow fever. The disease
here, as in the former case, is communicated in the same way as from any
other putrid animal matters. It was once received in Philadelphia from
the effluvia of a chest of unwashed clothes, which had belonged to one of
our citizens who had died with it in Barbadoes; but it extended no
further in a large family than to the person who opened the chest. I have
heard of but two instances more of its having been propagated by these
means in the United States, in which case the disease perished with the
unfortunate subjects of it.
To the above insolated cases of the yellow fever being produced by the
clothing of persons who had died of it, I shall oppose a fact
communicated to me by Dr. Mease. While the doctor resided at the
lazaretto, as inspector of sickly vessels, between May, 1794, and the
same month in 1798, the clothing contained in the chests and trunks of
all the seamen and others, belonging to Philadelphia, who had died of the
yellow fever in the West-Indies, or on their passage home, and the linen
of all the persons who had been sent from the city to the lazaretto with
that disease, amounting in all to more than one hundred, were opened,
exposed to the air, and washed, by the family of the steward of the
hospital, and yet no one of them contracted the least indisposition from
them.
I am disposed to believe the linen, or any other clothing of a person in
good health that had been strongly impregnated with sweats, and
afterwards suffered to putrify in a confined place, would be more apt to
produce a yellow fever in a summer or autumnal month, than the linen of a
person who had died of that disease, with the usual absence of a moisture
on the skin. The changes which the healthy excretions by the pores
undergo by putrefaction, may easily be conceived, by recollecting the
offensive smell which a pocket-handkerchief acquires that has been used
for two or three days to wipe away the sweat of the face and hands in
warm weather[27].
[27] See Van Swieten on Epidemic Diseases, Aphorism 1408.
3. The protraction of a yellow fever to such a period as to dispose it to
assume the symptoms, and to generate the peculiar and highly volatilised
exhalation from the pores of the skin which takes place in the jail
fever. I am happy in finding I am not the author of this opinion. Sir
John Pringle, Dr. Monro, and Dr. Hillary, speak of a contagious fever
produced by the combined action of marsh and human miasmata. The first of
those physicians supposes the Hungarian bilious fever, which prevailed
over the continent of Europe in the seventeenth century, was sometimes
propagated in this way, as well as by marsh and other putrid exhalations.
Dr. Richard Pearson, in his observations upon the bilious fevers which
prevailed in the neighbourhood of Birmingham, in England, in the years
1797, 1798, and 1799, has the following remark: "In its first stage, this
fever did not appear to be contagious, but it evidently was so after the
eleventh and fourteenth day, when the _typhoid_ state was induced[28]."
As this protracted state of bilious fever rarely occurs in our country,
it has seldom been communicated in this way.
[28] Page 13.
It is not peculiar, I believe, to a bilious and yellow fever, when much
protracted beyond its ordinary duration, to put on the symptoms of the
jail fever. The same appearances occur in the pleurisy, and in other, of
what Dr. Sydenham calls _intercurrent_ fevers, all of which I have no
doubt, under certain circumstances of filth, confinement, and long
duration, would produce a fever in persons who were exposed to it. This
fever, if the weather were cold, would probably put on inflammatory
symptoms, and be added, in our nosologies, to the class of contagious
diseases.
From the necessary influence of time, in thus rendering fevers of all
kinds now and then contagious by excretion, it follows, that the yellow
fever, when of its usual short duration, is incapable of generating that
excretion, and that, instead of being considered as the only form of
bilious fever that possesses a power of propagating itself, it should be
considered as the only one that is devoid of it.
4. Miasmata, whether from marshes, or other external sources, acting upon
a system previously impregnated with the excreted matters which produce
the jail or ship fever. Mr. Lempriere informs us, that he saw what were
supposed to be cases of yellow fever communicated by some sailors who
brought the seeds of the ship fever with them to the island of Jamaica.
The fevers which affected most of the crews of the Hussar frigate,
mentioned by Dr. Trotter[29], and of the Busbridge Indiaman, described
by Mr. Bryce[30], appear to have been the effect of the combined
operation of foul air in those ships, and human excretions, upon their
systems. The disease was barely tinged with bilious symptoms, and hence
the facility with which it was cured, for the jail fever more readily
yields to medicine than the yellow fever. The former was probably excited
by some latent exhalation from dead matters in the holds of the ships,
and hence we find it ceased on shore, where it was deprived of its
exciting cause. It is true, great pains were taken to clean the hold and
decks of the Busbridge, but there are foul matters which adhere to the
timbers of ships, and which, according to Dr. Lind, are sometimes
generated by those timbers when new, that are not to be destroyed by any
of the common means employed for that purpose. Of this Dr. Kollock has
furnished us with a most satisfactory proof, in his history of the yellow
fever, which prevailed on board of the frigate General Greene, on her
voyage to the Havanna, in the year 1799. "The air in the hold of the
vessel (says the doctor) was so contaminated, as to extinguish lights
immediately, and candles in the cockpit were almost as useless from the
same cause. The fish were thrown overboard, and the decks washed and
scoured, the ventilator and wind sails put in motion, and every measure
of purification adopted that their situation allowed; notwithstanding
these precautions disease invaded us. The men were unceasing in their
exertions to purify the ship; washing, scouring with vinegar, burning
powder and vinegar, old junk, and sulphur, added to constant ventilation,
proved unequal even to the amelioration of their calamities, while they
were in the latitude of _great heat_. After the removal of the sick, the
ship was disburthened of her stores, ballast, &c. cleansed and
white-washed throughout; still new cases occurred for nearly two months.
Some days, two, three, or four were sent off to the hospital, which would
seem to indicate the retention of some portion of this noxious principle,
which was lodged beyond the reach of the cleansing process." That this
noxious principle or matter existed in the ship, and not in the bodies of
the crew, is evident from its not having been communicated, in a single
instance by a hundred of them who were sent to an hospital on
Rhode-Island, notwithstanding an intercourse sufficient to propagate it
was necessarily kept up with the inhabitants. Even their nurses did not
take it[31].
[29] Medicina Nautica, p. 360.
[30] Annals of Medicine, vol. i. p. 116.
[31] Medical Repository, vol. iv. No. 1.
5. A fifth instance in which contagion has been supposed to take place in
the yellow fever is, where the exhalation from the excretions of a
patient in that disease acts as an _exciting_ cause, in persons
previously impregnated with the marsh, or other external miasmata, which
produce it. The activity of this exhalation, even when it is attended
with no smell, is so great, as to induce sickness, head-ach, vertigo, and
fainting. It is not peculiar to the exhalations from such patients to
produce morbid effects upon persons who visit them. The odour emitted by
persons in the confluent small-pox has been known to produce the same
symptoms, together with a subsequent fever and apthous sore throat. This
has been remarked long ago by Dr. Lind, and latterly by Dr. Willan, in
his Reports of the Diseases of London[32]. That the yellow fever is often
excited in this way, without the intervention of a supposed specific
contagion, I infer from its sometimes spreading through whole families,
who have breathed the same impure atmosphere with the person first
infected by the fever. This is more especially the case where the
impression made by the exhalation from the sick person is assisted by
fear, fatigue, or anxiety of mind in other branches of the family. In
favour of this mode of exciting the yellow fever, Dr. Otto communicated
to me the following fact. In the autumn of the year 1798, it prevailed
upon the _shores_ of the Delaware, in Gloucester county, in New-Jersey. A
mild remittent prevailed at the same time on the _high_ grounds, a few
miles from the river. During this time, the doctor observed, if a person
who had inhaled the seeds of the yellow fever in Philadelphia afterwards
came into a family _near_ the river, the same disease appeared in several
instances in one or more branches of that family; but where persons
brought the fever from the city, and went into a family on the _high_
grounds, where the mild remittents prevailed, there was not a single
instance of a yellow fever being excited by them in any of its members.
This fact is important, and of extensive application. It places the
stimulus from the breath, or other exhalations of persons affected by the
yellow fever, upon a footing with intemperance, fatigue, heat, and all
the common exciting causes of the disease; none of which, it is well
known, can produce it, except in persons who have previously inhaled the
putrid miasmata, which in all countries are its only remote cause. The
city of Philadelphia has furnished, in all our yellow fever years, many
additional proofs of the correctness of Dr. Otto's remark. In the months
of July and August, when miasmata are generally local, and float chiefly
near to their hot beds, the docks and holds of ships, persons who are
affected by these miasmata, and sicken in other parts of the city, never
communicate the disease; but after the less prepared and heterogeneous
filth of our whole city has been acted on by an autumnal, as well as
summer sun, so as to emit pestilential exhalations into all our streets
and alleys, the fever is now and then excited in the manner that has been
mentioned, by a single person in a whole family. The common intermittents
of the southern states are often excited in the same way, without being
suspected of spreading by contagion. Even the jail or hospital fever is
vindicated by Dr. Hunter from the highly contagious nature which has been
ascribed to it, upon the same principle. His words, which are directly to
my purpose, are as follow: "In considering the extent and power of the
contagion [meaning of the jail or hospital fever], I am not inclined to
impute to this cause the fevers of all those who are taken ill in one
family after the first, as they are all along exposed to the same
vitiated air which occasions the first fever. In like manner, when a poor
woman visits some of her sick neighbours, and is taken ill herself, and
afterwards some of her children, I would not impute the disease to
infection alone; she and her family having previously lived in the same
kind of vitiated air which originally produced the fever. If the cases in
which the infection meets with the poison already _half formed_ be
excepted, the disease in itself will be found to be much less infectious
than has been commonly supposed[33]." By the modes of communicating the
yellow fever which have been admitted, the dysentery, and all the milder
forms of autumnal fevers, have been occasionally propagated, and perhaps
oftener than the first-named disease, from their being more apt to run on
to the typhus or chronic state. Of this I could adduce many proofs, not
only from books, but from my own observations; but none of these diseases
spread by contagion, or become epidemic from that cause in any country. A
contrary opinion, I know, is held by Dr. Cleghorn, and Dr. Clarke; but
they have deceived themselves, as they formerly deceived me, by not
attending to the difference between secreted contagions and morbid
excretions from the body, produced by the causes which have been
enumerated, and which are rare and accidental concomitants of bilious or
summer diseases.
[32] Page 13 and 113.
[33] Medical Transactions, vol. iii. p. 351.
6. The last instance of supposed contagion of the yellow fever is said to
arise from the effluvia of a putrid body that has died of that disease.
The effluvia in this case act either as the putrified excretions
mentioned under the first head, or as an exciting cause upon miasmata,
previously received into the system. A dead body, in a state of
putrefaction from any other disease, would produce, under the same
circumstances of season and predisposition, the same kind and degrees of
fever.
The similarity of the fever induced by the means that have been
enumerated, with the fever from which it was derived, has been supposed
to favour the opinion of its being communicated by a specific contagion.
But let it be recollected that the yellow fever is, at the time of its
being supposed to be thus received, the reigning epidemic, and that
irritants of all kinds necessarily produce that disease. The morbid
sweats which now and then produce an intermitting fever, and the alvine
excretions which occasionally produce a dysentery, act only by exciting
morbid actions in the system, which conform in their symptoms to an
immutable and universal law of epidemics. It is only when those two
diseases generally prevail, that they seem to produce each other.
Thus have I explained all the supposed cases of contagion of the yellow
fever. To infer from the solitary instances of it thus excited, is to
reason as incorrectly as to say the small-pox is not contagious, because
we now and then meet with persons who cannot be infected by it.
From the explanation that has been given of the instances of supposed
contagion of the yellow fever, we are compelled to resort to certain
noxious qualities in the atmosphere, as the exclusive causes of the
prevalence, not only of that fever, but (with a few exceptions) of all
other epidemic diseases. It is true, we are as yet ignorant of the
precise nature of those qualities in the air which produce epidemics; but
their effects are as certainly felt by the human body as the effects of
heat, and yet who knows the nature of that great and universal principle
of activity in our globe?
That the yellow fever is propagated by means of an impure atmosphere, at
all times, and in all places, I infer from the following facts:
1. It appears only in those climates and seasons of the year in which
heat, acting upon moist animal and vegetable matters, fills the air with
their putrid exhalations. A vertical sun, pouring its beams for ages
upon a dry soil; and swamps, defended from the influence of the sun by
extensive forests, have not, in a single instance, produced this disease.
2. It is unknown in places where a connection is not perceptible between
it, and marshes, mill-ponds, docks, gutters, sinks, unventilated ships,
and other sources of noxious air. The truth of this remark is established
by the testimonies of Dr. Lind and Dr. Chisholm, and by many facts in
Lempriere's excellent History of the Diseases of Jamaica. Dr. Davidson
furnished me with a striking confirmation of their remarks, in the
following extract from a letter, dated November 12th, 1794. "I have
mentioned (says the doctor) an instance of the remarkable good health
which the 66th regiment enjoyed at St. Vincents for several years, upon a
high hill above the town, removed from all exhalations, and in a
situation kept at all times cool by the blowing of a constant trade wind.
They did not lose, during eighteen months, above two or three men (the
regiment was completed to the peace establishment), and during eight
years they lost but two officers, one of whom, the quarter-master,
resided constantly in town, and died from over fatigue; the other arrived
very ill from Antigua, and died within a few days afterwards."
In the United States, no advocate for the specific nature or importation
of the yellow fever, has ever been able to discover a single case of it
beyond the influence of an atmosphere rendered impure by putrid
exhalations.