Page:Encyclopædia Britannica, Ninth Edition, v. 24.djvu/781

YELLOW FEVER 735 the 18th century, Rush gained much credit for his incessant labours in bleeding the victims during the violence of the paroxysm. Al though blood-letting to relieve the congestions has been given up, experience still favours the resort to vigorous measures at the out set. The following practice was adopted with much success by Dr Joseph Jones during the epidemic of 1878 at New Orleans, an emetic of ipecacuanha, followed by a powder of calomel (10 to 20 grains), with as much quinine added (the latter ingredient of doubt ful utility), and that again followed by a full dose of castor oil. Beyond that heroic medication at the outset of the febrile paroxysm, the treatment was directed to assisting the action of the skin and kidneys, by keeping the temperature of the room uniform, by mustard foot-baths, and by copious draughts of lemonade or other aerated water, or of barley water. The diet indicated is fever diet : i.e., it should exclude solid food. For such symptoms as tender ness over the stomach a mustard poultice is applied; for diminished secretion of urine, dry cupping over the loins. When the lull occurs, the patient should oil no account be allowed to get up, as sudden failure of the heart is apt to follow exertion. Iced cham pagne and beef-tea are found to be the best supports for this stage. The only thing to do when black vomit threatens is to give the patient ice to suck, or (more questionably) to place an ice-bag on the abdomen. When the stage of prostration assumes a "typhoid" character, an enema of ice-cold water, with a little turpentine in it, helps to get rid of the flatus and to stimulate the kidneys. Re covery is in all cases more probable where there is abundant cubic space and good ventilation. Patho- Yellow fever is of the nature of typhus, in the language of ogy. older writers, a nervous or putrid fever. The two salient things about it are the internal haemorrhages and the almost complete arrest of the function of the liver ; of these the latter would seem to be primary and the former secondary. The state of the liver on examination after death from yellow fever is by far the most significant feature in the morbid anatomy: the bile-ducts and gall bladder are empty, or contain only a clear albuminoid fluid ; the organ is bloodless and of a golden yellow colour ; and the hepatic cells are everywhere full of fatty granules or other molecular detritus. It shows, in fact, the morbid anatomy of acute yellow atrophy, or that state of the hepatic structure and functions which is due to total inhibition or arrest (see PATHOLOGY, vol. xviii. p. 386), whether the inhibiting influence be phosphorus poisoning, or emotional strain, or something in the pregnant state, or the infective influ ence of yellow fever. All the other phenomena of this fever are grouped around the liver derangement, as around a centre, namely, the yellow tint of the skin, the fatty degeneration of the heart favouring syncope, the haemorrhages from the mucous membranes (including the black vomit), the degeneration of the renal epithe lium with albuminuria, and the coma and convulsions. Yellow fever therefore may be styled a sudden or arbitrary infection im posed from without, the distinctive mark or " note " of which is the same peculiar group of symptoms that is found in the rare and sporadic cases of yellow atrophy. To reach the full and correct doctrine of yellow fever, we have to harmonize the clinical and pathological facts of the disease, as already given, with the histori cal, geographical, racial, and other associated circumstances now to be stated. History The first authentic account of yellow fever comes from Bridge- and geo- town, Barbados, in 1647, where it was recognized as a "nova graphical pestis," that was unaccountable in its origin, except that Ligon, distribu- the historian of the colony, who was then on the spot, connected it tion. with the arrival of ships. It was the same new pestilence that Dutertre, writing in 1667, described as having occurred in the French colony of Guadeloupe in 1635 and 1640 ; it recurred at Guadeloupe in 1648, and broke out in a peculiarly disastrous form at St Kitt s the same year, and again in 1652 ; in 1655 it was at Fort Royal, Jamaica ; and from those years onwards it became familiar at many harbours in the West Indies and Spanish Main, and in the Atlantic ports of the British American colonies. It is a question whether it had not occurred at Porto Rico, San Domingo, and other places in the Spanish Antilles a good many years before ; but the reports from the colonies of New Spain, both for that and subsequent periods, are highly defective as regards the data needed to distinguish yellow fever from the bilious remittent form of malarial fever, which is a non-infective sickness. The Mexican form of typhus, called " matlazahuatl," which has been an indigenous disease of the native population in the interior for several centuries, has no other connexion with yellow fever than that it belongs to the same family of typhus ; its circumstances are quite different, especially in respect that it is a purely inland form of fcbris paupcrum. In 1853 yellow fever appeared for the first time at Callao and Lima in Peru ; and almost in the same months a severe epidemic prevailed among the plantation hands in the sierra region of the interior. The two forms were described as the same disease by Dr Archibald Smith ; but the fever of the sierras was afterwards shown to be a form of typhus, analogous to the native Mexican form, and quite unconnected with the yellow fever of the coast. In the harbours of the American colonies (United States) the history of yellow fever has been as follows. It begins to be heard of at Charleston in 1693, and at Philadelphia the same year. The South Carolina port has the fullest record of it, next in order in the earlier period being Philadelphia, New York, and Norfolk (Va.). Towards the end of the 18th century the ports of New England, as far north as New Hampshire, have visitations, and it begins to be quite common at Baltimore, Wilmington, Savannah, and New Orleans. At a still later period (within the 19th century) we find the centre of incidence shifting so as to include Mobile, Memphis, Natchez, St Francisville, and Baton Rouge ; and in the most recent period outbreaks are recorded at Galveston and other ports of Texas, and at Pensacola, Vicksburg, and Key West. The Atlantic ports gradually lost it and the Gulf ports took up the inheritance, several of them keeping it still. Some of the epidemics were very disastrous, one of the Philadelphia outbreaks corresponding to the pestilence which figures in the List section of Longfellow s Evan- gdine: "Wealth had no power to bribe, nor beauty to charm the oppressor." In the New Orleans epidemic of 1878 the deaths num bered 4056. The American ports mentioned have been only its principal seats, many other smaller harbours having had outbreaks now and then, such as New Haven (Conn.), Providence (R.I.), Swedesborough (N.J.), Alexandria (Va. ), Augusta (Ga.), St Augus tine (Fla. ), Opelousas (La.), and Houston (Tex.). Along with the harbours and anchorages of the West Indies and Spanish Main, the three chief harbours of Guiana (Cayenne, Suri nam, and Demerara) have had an equal share, and for almost the same period. But for Brazilian ports there is no record of yellow fever until 1 849, when it appeared for the first time at Rio de Janeiro, Bahia, and other places. These ports became endemic seats of the infection from that year, and are now more distinctively the head quarters of the disease than its old West Indian and Mexican Gulf centres. Monte Video had a disastrous epidemic in 1857, and Buenos Ayres a visitation in 1858 ; but the shipping places of the river Plate are not in the same class of endemic foci as the harbours of Brazil. There have been a few epidemics at trading places on the West Coast of Africa, most of them subsequent to 1820, and all of them confined generally to white residents. During the great period of yellow fever (1793-1805), and for some years afterwards, the disease found its way time after time to various ports of Spain. Cadiz, indeed, suffered five epidemics in the 18th century, Malaga one, and Lisbon one ; but from 1800 down to 1821 the disease assumed much more alarming proportions, Cadiz being still its chief seat, while Seville, Malaga, Cartagena, Barce lona, Palma, Gibraltar, and other shipping places suffered severely, as well as some of the country districts nearest to the ports. These Spanish outbreaks were clearly connected with the ar rival of ships, but for the most part there hail not been cases of yellow fever on board the ships. The last severe epidemic on Spanish soil was at Barcelona in the summer of 1821, when 5000 persons died. The most recent disastrous epidemic in Europe was at Lisbon in 1857, when upwards of 6000 died in a few weeks. The outbreaks at St Nazaire (1861), Leghorn, Swansea (1864), and Southampton have been carefully studied, but are otherwise of minor importance. Yellow fever is dependent upon high summer temperature for its Special epidemic development, and it requires a good deal of heat to continue local and even after it has once acquired epidemic intensity. In its endemic racial centres in the New World it clings peculiarly to the lower quarters cireum- of the seaports, to the alluvial foreshores, and to the anchorages ; stances, on many occasions it has been prevalent among the crews of men- of-war and of merchantmen at anchor, or moored in the harbour, or lying up in the carenage, when there has been none of it among the residents ashore. It is admitted that the endemic influence which causes it is effluvial or miasmatic from the harbour mud, or from the bilge-water of a ship that had lain in the harbour, or from the alluvial foundations of houses nearest-to the beach. So far as prevalence on shore is concerned, it seems to follow the same laws as cholera and typhoid fever : that is to say, it is an exogenous or soil infection, a fermentation of filth in the ground, with a seasonal activity closely following the movements of the subsoil water. In like manner, when it has been imported to Spain, it lias clung to alluvial soil and has spread after the fashion of a soil-borne infec tion rather than by personal contagion, although in Spanish ports, just as in Philadelphia, according to Rush s opinion, contagious ness has been found to be " contingent " to it under certain circum stances. To establish an epidemic in a distant port, it has been necessary that there should be carried thither a material quantity of the specifically poisonous harbour-filth in a ship s bilges, and that the conditions favourable to its increase and diffusion by fer mentation should exist in the new soil. The next most significant thing in the incidence of this fever is that new arrivals at an indigenous centre are peculiarly liable to take it, and most liable of all the sailors and others from northern latitudes, such as Sweden, Finland, Holland, and Germany. In

fact an epidemic outburst in a yellow-fever port or endemic centre