AMERICAN 
MEDICAL GAZETTE. 
Vol. X. 
NOVE2YIBEK, 1859. 
No. 11. 
ORIGINAL DEPARTMENT. 
IMPORTANT DISCUSSIONS ON 
YELLOW FEVER AAO QUARANTINE. 
BEFORE MEDICAL SOCIETIES IN PHILADELPHIA AND NEW YORK. 
New York Academy of Medicine. 
(Prepared for the Medical and Surgical lieporter from phonographic reports.) 
The President being absent, from indisposition, Dr. S. C. Foster, 
Vice-President, took the chair, at the meeting on the 5th of October. 
The following preamble and resolution, offered in July last, were 
made the special order for this regular meeting: 
Whereas, The National Quarantine and Sanitary Convention, held 
in this city in the month of April lasQ adopted a resolution in the 
words following, to wit: 
11 Resolved, That, in the absence of any evidence establishing the 
conclusion that yellow fever has ever been conveyed by one person to 
another, it is the opinion of this Convention that personal quarantine 
of cases of yellow fever may be safely abolished: Provided, that 
fomites of every kind be rigidly restricted." 
Therefore, Resolved, That the opinion expressed in said resolution 
is concurred in and adopted by this Academy. 
After the preliminary business, Dr. Griscom opened the discussion 
by reading a paper, substantially as follows: 
It is not with the expectation of adding anything to the stock of 
knowledge of the members of the Academy, or from any claim to a 
practical intimacy with the character, habitudes, or treatment of the 802 
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great scourge which is the subject of the resolution now under dis- 
cussion, that I venture to occupy a few minutes of time upon it. 
Well may inexperience shrink from any participation in the manage- 
ment of this almost uncontrollable subject; and well may he be con- 
sidered presumptuous, whose unproven hands shall be stretched forth to 
uphold an ark which it would seem to be within the province of the 
high priests of medical science alone to touch. But as the mover of the 
resolution, in opening the debate upon it, I desire opportunity merely 
to express a few thoughts which have occurred to me in relation 
thereto, and to present, in as brief a manner as possible for me, the 
reasons why I shall give an affirmative vote upon the proposition be- 
fore us. 
It is unnecessary, in this place, to spend a moment in depicting the 
magnitude, of the enemy of the human race, whose traits we are now 
to discuss, and whose mode of advance and attack is the chief ques- 
tion before us. It will suffice for this, to remember, 
1st. That it has destroyed in some places, during its brief epidemic 
visitations, 3 in 1 of the population; and 
2d. That the mystery of its movements has been such, that a cen- 
tury of observation and study by the acutest medical minds of the 
civilized world has not sufficed for the settlement, upon an indisputa- 
ble basis, of its laws and philosophy. 
It is probably safe to say, that of the entire catalogue of " the ills 
which flesh is heir to," this stands above all, in the amount, the extent, 
and, to use a gentle phrase, the animation with which its various 
points have been discussed by philosophers, both medical and non- 
medical, from the time of its first appearance upon the globe to the 
present hour. Whether we Tegard its true nosological position, its 
topography, its type, its symptomatology, its pathology, its diagnosis, 
its prognosis, or its etiology, these have excited interest in profes- 
sional circles to such an extent, that the Bibliographic Record of our 
fellow-countryman, Dr. La Roche, enumerates the titles of 991 books 
and essays consulted by him in the preparation of his own voluminous 
and erudite work. 
On the present occasion, under the terms of the resolution before 
us, one only of the numerous points of this knotty subject is presented 
for discussion, and to that I purpose to confine my remarks. The res- 
olution declares, in effect, that yellow fever is not personally communi- 
cable. In its own language, it says, " in the absence of any evidence 
establishing the conclusion that yellow fever has ever been conveyed MEDICAL GAZETTE. 
803 
by one person to another." Mark the precision of the language- 
" evidence, establishing the conclusion." 
We have had presented to us some evidence to the contrary, but it 
was declared by Dr. Benjamin Rush, just sixty years ago, after the 
epidemic of 1799 in Philadelphia, that " out of upward of 1,000 per- 
sons who have carried the disease into the country from our cities, 
there are no more than three or four instances to be met with of its 
having been propagated by contagion." 
If so important a question is to be determined upon testimony so 
rare and disproportionate as this, where the witnesses pro are only 
three or four to the thousand con, surely we may be allowed to hesi- 
tate before deciding it against the liberty of the subject of the dis- 
ease. But Dr. Rush was at that time a non-contagionist, and we 
may therefore be cautious respecting his statements. Yet, if we ex- 
amine the testimony adduced in favor of the personal communicability 
of the disease as furnished by its advocates themselves, we shall find 
it lacking in much that is essential to a satisfactory solution of the 
question. Such an examination I do not propose now to make in 
extenso; abler critics have passed their judgments upon the various 
items. But one point I may mention, as presented in the cases cited 
by that ablest of American contagionists, the late Dr. David Hosack, as 
worthy of special attention. I refer to the entire absence of any allusion 
to the possibility of fomites having had any part in the production of 
the disease in the cases quoted. In the instances referred to by Dr. 
Hosack in his paper on the " Laws of Contagion," in the Transac- 
tions of the Literary and Philosophical Society, from Rev. Dr. Moore, 
and Dr. Caspar Wistar, this deficiency is most marked, and the per- 
sonal contagious property of the disorder in those instances is assumed, 
without any inquiry into the probability, or even possibility, of the 
clothing and effects of the patients having been the vehicle of the 
poison to others; and this, too, though the patients had fled from in- 
fected districts, after a residence long enough therein to have imbibed 
it into their own bodies, and may reasonably be presumed to have 
carried their clothing and other effects with them in their flight. 
On the other hand, there are strong grounds for the opinion, in 
the Germantown cases reported by Dr. Wistar, that clothing from the 
infected city might have been, or was, the vehicle of the disease; for it 
is distinctly stated, that the mother whose daughter had lived in the 
infected portion of Philadelphia, and died of the fever in a few 
days after getting home-that this mother, Mrs. Johnson, had "as- 804 
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sorted the clothes of her deceased child," and afterwards took the dis- 
ease and died. Now, although the case of this mother is accepted as 
one of personal contagion, the existence of the child's clothing, as fo- 
mites, is wholly ignored, and the same oversight occurs with regard to 
others who died at the same house about the same time. 
Without a full investigation upon this point-without what our 
legal friends would denominate a " cross-examination," testimony of 
this kind is, to say the least, only negative, and from the extremely 
small number of cases relied on, and especially in view of the additional 
thousands who, since the days of Rush, have been sick with the dis- 
ease in uninfected districts, without communicating it to others, we 
are driven to the conclusion, that positive testimony of the personal 
communicability of yellow fever is utterly insufficient, in fact almost 
Next to Dr. Hosack, perhaps the most ardent and unflinching of 
the advocates of the contagious property of yellow fever, is his pupil, 
our highly esteemed and most worthy associate, Dr. John W. Francis, 
our regard for whose personal and professional character demands for 
ail he says the most attentive consideration. I would therefore oc- 
cupy a few moments in paying my respects to one of the cases relied 
upon by him as evidence of the doctrine which he upholds. It is his 
own case which he has related to us upon this floor, and also before 
'the late Quarantine and Sanitary Convention. That I may not mis- 
take the case, I quote all that relates to it from the report of his 
speech before that Convention, as revised by himself. It is as follows: 
u Of the fever of 1795,1 shall state my own individual case to illus- 
trate its communicability. My father contracted the disease in Octo- 
ber of that year, and died on the 23d of that month. The day before 
his death I was seized with the pestilence. I could never learn that 
the infected district had invaded that part of the city, in which was 
our residence, near the head of Pearl Street, nor that I had, as a 
child, aged six years, wandered at all from the premises. Personal 
communication about the sick-bed of my father had engendered the 
disease. I was informed that my prescriber was Dr. Wm. Pitt Smith, 
who died shortly after, of yellow fever. I narrowly escaped, and well 
remember my coffin set up in the corner of the room; for in those 
days of dismay, the patient was scarcely dead before interment took 
place; you were hardly cold before the grave received you; such was 
the dispatch with all classes of citizens." 
To this recital the same objection lies as against the others, that MEDICAL GAZETTE. 
805 
nothing is said about the possibility of the disease having been com- 
municated from father to son through the clothing brought by the 
former from the infected district, where he doubtless imbibed the 
poison, which he carried home with him, and caused his own death, 
So also the case, reported by Dr. Fenner, (in the Transact. Amen 
Med. Association, vol. vii., p. 539,) which is the only one quoted by 
Dr. Dickson in the second edition of his Elements of Medicine, p.. 2*14,. 
in support of his opinion as to its contagiousness, in the following lan- 
guage: "xA Mr. McManus, who lived on the hills of Hinds Co., more 
than 40 miles from Vicksburg, went down to that city and remained 
there several days in 1841, when it was severely scourged by epidemic 
yellow fever. Returning home, he was soon attacked by yellow fever* 
of which he died after throwing up black vomit. A few days after 
his death, his wife, who had nursed him assiduously during his illness,, 
and had not been away from home, was attacked in a similar manner* 
and died with black vomit and yellowness. Their residence was in a 
high and healthy locality, where yellow fever was never known to pre- 
vail. Now, it is evident," says Dr. Fenner, "that Mr. McManus 
contracted his disease in Vicksburg; but, if any one can doiibt that 
Mrs. McManus caught the same disease from him, I must confess it is 
more than I can do." 
Now here again nothing is said about the infected clothing or mer- 
chandise, which the patient carried home with him, and yet upon such 
negative testimony, Drs. Fenner and Dickson yield all doubts. 
In illustration of the absurd extent to which the sentiment of the 
contagiousness of yellow fever will sometimes be carried, and as an 
offset to the case just given, I will quote the case of my own father, 
who was attacked in Philadelphia in the disastrous epidemic of 1193. 
He was pursuing his mathematical studies, when the disease appeared. 
I give his own account: 
" I continued until no one but myself remained, and until my teacher 
himself was seized with fever and confined to his bed. He considered 
his recovery, I apprehend from the beginning, to be doubtful, and 
furnishing me with the outlines of his will, desired me to prepare it in 
due form. Having assisted him in signing it, and perceiving him to 
be very ill, I was induced, although very desirous to remain with him 
and assist his wife in nursing him, to yield to their advice and leave 
the city I embarked in a sloop for Alloway's Creek, and spent one 
night on the water, and on the following night I was seized with a 
heavy chill, followed by high feverish excitement, which was consider- 806 
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ed as an evident attack of the disease from which I had fled. My 
parents, eight miles distant, were informed in the morning of my situ- 
ation, and no time was lost in sending for me. 
" My situation excited much sympathy in the town of Salem, (N. 
Jersey,) where I was pretty well known, and the attendance of my 
physician, who resided in the town, was very assiduous, until the fears 
of the inhabitants for his and their own safety, laid him under a posi- 
tive interdict, as I grew more and more ill, no longer to enter my 
room or to go inside of the house. The very atmosphere of our dwell- 
ing was considered to be infected, so that travelers along the road, 
apprised of my illness, would climb over the fences and make a wide 
circuit to avoid the danger. But my physician, Dr. Rowan, though 
prohibited from seeing me, or coming to the house, continued his daily 
journeys to a tree, above a quarter of a mile distant, where he met 
my father, learned the symptoms, and prescribed what he thought 
best. The disease terminated in a dysentery, which being suitably 
treated, I began rapidly to recover, and was soon restored to health." 
No other person in the house took the disease. Seeing then such 
omissions and admissions as these, may we not concur in the idea ex- 
pressed in the resolution, as to the absence of evidence " establishing 
the conclusion that yellow fever has ever been communicated by one 
person to another?" How can any one maintain the idea of conta- 
giousness upon such evidence as this ? 
In the next place, I would present a single argument against the 
possibility of yellow fever being a contagious disease. This argument 
I have seen alluded to only in two works-that of Prof. Smith on 
Epidemics, and that of Dr. La Roche on Yellow Fever-and yet, in 
neither, in my judgment, is the argument pushed so completely to its 
conclusion as it appears capable of being, and it seems, to my mind, 
that had it been presented in its full effect, the mooted question might 
have long ago been settled. 
To understand fully the nature of the argument, we must first know 
the real meaning and application of the word "contagion," as now 
generally received. 
Whatever may have been the views of the earlier medical philoso- 
phers, as to the precise meaning to be given to the word, or however 
it may have been confounded with infection, the modern application 
of it is clear and precise. Nowhere, probably, shall we find a more 
distinct and comprehensive definition of it than in the first four lines 
of the body of the work entitled, "Elements of the Etiology and MEDICAL GAZETTE. 
807 
Philosophy of Epidemics," by Joseph Mather Smith, M.D. This 
definition is in the following words: 
" Contagion is a poison generated by morbid animal secretion, possess- 
ing the power of inducing a like morbid action in healthy bodies, whereby 
it is reproduced and indefinitely multiplied" 
Accepting this definition, we perceive, 1st, That it is a secretion, 
(not a mere excretion,) the product of a living animal action; 2nd, 
That it is a morbid product, i. e., the result of a diseased action; and 
3rd, It possesses the power of inducing a like morbid action in healthy 
bodies, and of multiplying and reproducing itself. 
Applying this definition to certain well-known diseases-small-pox, 
for instance; or measles, or scarlatina-and we have a full and distinct 
comprehension of its different points. The virus of variola, whencever 
it came originally, responds completely to them all. It is a poison 
reproduced in and secreted by a living, not dead, or decomposed tissue; 
it is an animal, and not a vegetable production; infused into a healthy 
body, it reproduces small-pox et prateria nihil. 
By the same author, contagion is contra-distinguished from infection 
by applying the latter to the product of the decomposition of animal and 
vegetable substances, taking the same view of the distinction as did Dr. 
Richard Bayley in 1796; and although other authors differ as to the 
most appropriate application of the word infection, some, as Wilson 
Philip, and Dr. Bateman, the supposed author of the article, "Conta- 
gion," in Rees's Cyclopaedia, appropriating it to " the act of communica- 
tion of the disease;" yet the definition of the word contagion, as given 
by Prof. Smith, is the almost universally accepted one, and, with few 
exceptions, the same may be said of infection, and is evidently the most 
free from objection. 
But, to be the product of decomposition, the vitality of the decom- 
posing substances must first be destroyed. No time need be spent in 
the elucidation of these points, since they have been ably discussed by 
some of the authors alluded to, and I content myself with the remark, 
that these definitions and distinctions appear to me to constitute the 
really correct interpretation of these pregnant words. 
Let us then apply them to the case before us. The first question 
which arises is this: Admitting the broad distinction thus drawn be- 
tween these two sources of disease, contagion and infection-the one 
the product of living animal action, the other the result of the decom- 
position of dead animal or vegetable matter, or of both combined- 
can these two classes of poisons, so distinct in their chemical and phys- 808 
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iological characteristics, produce the same results, when absorbed 
into the healthy body ? Are they convertible influences ? 
For example-can the marsh miasm, which is the source of inter- 
mittent fever, by passing through the living body, cause the elimina- 
tion of a poison capable of reproducing itself, or the miasm which is 
the cause of the more pernicious remittent, from Panama and other 
parts of the Isthmus, which for several years past has crowded our 
hospitals, did it ever, or can it, by being distilled through the animal 
alembic, generate a poison capable of producing the same disease in 
another ? Every one knows to the contrary. 
It may be stated as a medico-etiological axiom, that two different 
and distinct causes cannot produce the same effect. 
Now, what is the original source of yellow fever ? I say the original 
source-is it a secreted animal poison, generated by morbid animal 
action ? On the contrary, it is universally accredited, even by the ad- 
vocates of its contagious power, to a poison derived from vegetable 
putrefaction. By those who believe it to be exclusively an imported 
disease, as by those who consider it wholly of domestic origin, as well 
as by those who regard it as both exotic and indigenous, its original 
ultimate source is thought to be no other than vegetable decomposi- 
tion, terrene exhalations, or both combined, aided and controlled by 
certain meteorological circumstances. Not one writer, within the 
range of my observation, has ever attributed it to an animal poison 
secreted by the living body, and probably not one could be found, even 
in the ranks of the most decided contagionists, to hazard the expres- 
sion of an opinion to that effect. If, then, it has no other origin than 
vegetable putrefaction or terrene exhalations, it cannot, according to 
the axiom before announced, have any other source; and, further- 
more, admitting, for the sake of the argument, that a body laboring 
under yellow fever produces any secretion, or aura, or poison in any 
shape, (though this has never been proved,) that poison has a living 
animal, and not a dead vegetable origin, and it cannot produce the 
same disease as the original poison produced; and it must, therefore, 
if anything, produce something different from yellow fever, which is a 
specific disease, the result of one specific cause-Quod erat demon- 
strandum. 
Such, Mr. President, is, I think, the true philosophical basis upon 
which this question should be discussed. If the principle which I 
have stated, viz., that two different and distinct causes cannot produce 
the same disease, is not merely an apothegm, but has the force of an MEDICAL GAZETTE. 
809 
axiom, as I claim for it, then there is an end to this long-waged dis- 
pute, respecting the contagious property or capability of yellow fever. 
But is it so ? I have been as yet unable, in my brief reflections, to 
find an exception to the rule; and moreover, I am inclined to the be- 
lief that this law is in accordance with the views of the teachers of 
medicine generally, though it may not have been heretofore so epi- 
grammatically stated. 
But I find this proposition met at the outset by another, which has 
had some currency among medical writers and teachers, and which is 
distinctly enunciated in the following passage in the speech of Dr. 
Francis, already alluded to: 
" The complexity of the assimilative powers," says Dr. F., " tells 
us of man's subjection to noxious agencies, and that while the laws 
of life enable him to hold in abeyance, to a certain degree, specific 
causes, inexplicable evidence compels us to recognize the generating 
development of contagion and infection in his own individuality. We 
are forced, therefore, to admit the contagious principle more or less 
intense in fevers of a continuous nature; and yellow fever is one of 
those disorders, and hence communicable from one person to another." 
And in another place he remarks: " It falls not within the category 
of small-pox; and ship and typhoid fevers may prove more fatal to 
medical attendants; but if we discard the quality of contagion, we 
rob continued fevers of one of their characteristics." 
If this be true; if continued fevers, of whatever specific character, 
are, ipso facto, generators of a contagious principle, then indeed must 
the other law, which I have stated above, be null and void; in fact, 
no law at all. What may be the particular ground upon which this 
law, as given by Dr. Francis, is assumed to stand, I confess my ina- 
bility to perceive; and I cannot doubt that, on a hearing of the argu- 
ment upon it, the profession would, as the Court for the Correction of 
Errors, pronounce it unconstitutional; or at least, after the Scotch 
fashion, unproven. 
In the absence of sufficient evidence to the contrary, having, by this 
process of reasoning, satisfied myself, at least, of the non-contagious- 
ness of yellow fever, aud being convinced, also, that it has its origin 
here solely by importation, there remains the question, " How is it prop- 
agated ?" 
This question, though pertinent to the general subject, has not a 
sufficient bearing upon the resolution before us to justify the expend- 
iture of much time upon it. I can only say, therefore, that I regard 810 
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the introduction of a ship-load of the atmosphere of an infected locali- 
ty, as of Havana or New Orleans, when the disease is rife there 
-as the sowing of a seed-our own atmosphere may be prepared 
for its germination and growth, or it may not. If not so prepared, 
the seed has fallen upon barren soil; but if it is so prepared, then it 
has fallen upon good ground. 
But I am further of the conviction that, like good farmers, we may 
not only prepare and enrich the atmospheric soil for its reception and 
growth, by manuring it with domestic guano in the shape of street 
filth, foul yards, bad drainage, but particularly by domiciliary crowd- 
ing, ill-ventilation, and the absence of proper sanitary supervision; 
but that we have it in our power also, like good sanitarians, to dimin- 
ish its fertility to a great degree, and deprive the germ of its pabulum. 
Prof. Smith, while regarding the disease as sometimes a home pro- 
duction, produced by an exhalation 11 from masses of public filth, and 
soils containing putrescent matter," at the same time admits, that it 
requires for its generation, " a high range of temperature, and cer- 
tain epidemic influences of the general atmosphere." 
This " epidemic influence of the general atmosphere" is the " good 
ground" to which I have alluded, in which the imported germ must 
be sown to be propagated, but in what that influence consists is the 
great question to which the minds of sanitarians have of late years 
been devoted to the study of. Whether the whole secret has been 
revealed in the highly interesting results obtained by Dr. E. H. Bar- 
ton, and his co-laborers, of the late New Orleans Sanitary Commission, 
may be yet a mooted point; but that we had in 1856 a most striking 
evidence of the probable correctness of their theory; and also that a 
very narrow line does sometimes divide the borders of the barren and 
the fertile yellow-fever atmosphere, as on that occasion, when the 
Hygrometers of Fort Hamilton and New York showed such a wide 
difference in the amount of atmospheric moisture, is a fact that cannot 
be overlooked, nor easily contravened. 
But, in answer to the theory of assimilative fermentation, as of a 
spark thrown by importation among combustible materials in a city, 
and reproducing itself, Dr. Smith maintains that " such a process can- 
not account for the slow and progressive manner in which cities usually 
become pestilential;" that " the poison emitted from infected vessels, 
and their cargoes, together with the noxious exhalations from the soil, 
is swept away by every passing breeze; and consequently, it cannot 
gradually extend by a process of assimilation." This appears to me MEDICAL GAZETTE. 
811 
eminently unsatisfactory, and inconclusive. Nor is it any more satis- 
factory, as further stated by the same author, that, 11 if an assimila- 
tive fermentation can really take place, it is obvious that the air of a 
whole, city would very soon become pestilential; for the miasm being 
scattered by the wind through the streets generally, would quickly 
reproduce itself alike in every quarter." It is incorrect, because the 
process is not necessarily a quick one; it is probably and doubtless 
subject to some law of growth and increase not yet understood, de- 
pending upon temperature, moisture, electricity, ozone, or whatever 
yet undiscovered principle may exist in the atmosphere, which vary from 
day to day, and from hour to hour; at one moment rife and prolific, 
at another curtailed and altered. No more need it be quick to spread, 
than that a child should be quickly raised to manhood, an acorn to an 
oak, or a larva to a fly; and that whole cities are generally not subject 
to the pestilential power, (while it is admitted that the poison does 
spread gradatimj may be accounted for, by the fact that some are larger 
than others, and the poison can continue to spread only so long as the 
necessary circumstances exist in the atmosphere; as long as the heat 
and moisture are sufficient. Fortunately for us, these are not peren- 
nial; and a single touch of frost instantly destroys the morbific princi- 
ple, whatever it is. 
Now, in all this, there is nothing incompatible with the idea of an 
assimilative operation-or rather, I would say, with the growth of a 
principle-call it fungus, algae, animalculi, miasm, or what you will, 
as long as the favoring circumstances exist. 
Says Dr. Smith: "The poison emitted from infected vessels and 
their cargoes cannot gradually extend by a process of assimilation, be- 
cause it is swept away by every passing breeze." Carrying out this 
idea to its fair and legitimate extent, we might assert that no poison 
of any kind can lurk in the air. Let the microscopic bladders of the 
genus nostoc, with which our gifted Torrey recently calmed the excited 
populace, teach us a lesson of wisdom-that if the laws which govern 
the coming and going of water-growths, with intervals of years greater 
than the average length of human life, are so entirely beyond our 
comprehension-so may the still more subtle and intractable influ- 
ences of the invisible atmosphere give growth to powers which are 
none the less real, because beyond the detection of any instrument or 
test yet known to us. 
That there is an entity, a corporeal substance, or at least an active 
principle, poisonous in character, and yet physically undistinguishable 812 
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by any human means, is admitted; its effects are too apparent to be 
denied. That it possesses sufficient materiality to be absorbed by, or 
attached to certain porous substances, though this property is denied 
by a few, is acknowledged by the author of the " Elements" himself. 
Why, then, should it be denied a power of growth, of increase, of 
progression, of extension ? If the grosser "air-plant," suspended by 
a thread or wire, or the delicate fungus attached to the naked rock, 
will grow upon atmospheric food alone, we may easily believe that an 
invisible, intangible material may also there find a pabulum. 
The resolution before us concludes with these words: "Provided 
that fomites of every kind be rigidly restricted." This covers all the 
ground left unoccupied by the body of the resolution itself. But the 
question here arises-what are fomites!-a question equally interesting 
in a literary as in a medical point of view. What say the diction- 
aries? 
Dr. Parr, in his compendious work, gives the following definition: 
" Fomes, fuel, when spoken of in diseases, is the remote cause of 
the disease; most commonly the material, efficient cause. In the plural, 
fomites, it is generally applied to the infection contained in woolen or 
cotton, and rendered more deleterious by confinement." 
The word here used, it will be observed, is infection, and fomites is 
the infection contained in the goods. 
Dunglison's definition is: 
" Fomites, from fames, ' fuel,' anything which retains heat. A term 
applied to substances which are supposed to retain contagious effluvia, 
as woolen goods, feathers, cotton, etc." 
This language, taken in its strict sense, is certainly obnoxious to 
criticism; substances supposed contain contagious effluvia being made 
fomites. 
Hooper says: "Fomites, a term mostly applied to substances imbued 
with contagion," thus restricting the poison to contagion, but requiring 
the vehicle to be actually imbued with it; while Reese, in his Lexicon, 
in copying from both, copies the errors of both, and says, fomes, 
fomites, terms applied to articles supposed to be imbued with conta- 
gion." 
The language used by Dr. Pereira Gardner, in his Medical Diction- 
ary, is still more objectionable. His definition is, "fomites, plural of 
fomes. Fomes, fuel. In medical language a fomes means a porous 
substance, capable of absorbing and retaining contagious effluvia. 
Wool and woolen cloth are among the most active fomites;" so that MEDICAL GAZETTE. 
813 
the coat I now wear is a fomes, because capable, of absorbing and re- 
taining a contagious effluvia. 
It is remarkable that there should be such a difference in the lan- 
guage of medical lexicographers, a difference so great, that a student 
of medicine who desires to be classically accurate, might be not a 
little puzzled; for while Parr applies the term to the infection con- 
tained in the woolen and cotton stuff, Dunglison and Hooper apply it 
to the stuff which contains, or is imbued with it, and Gardner to a 
substance capable of absorbing and retaining it. 
To obtain a correct and exact appreciation of these words, we must 
go back to the original, and we shall there find that the idea which 
underlies the whole is that of a cherisher or nurser, and in its literal 
meaning it is, in the singular, a spark, or kindler, and in the plural, 
that which aids and assists, as kindling-wood, touch-wood, or tinder. 
Thus Festus, a learned author of the third or fourth century, on the 
"signification of words," says " the sparks are called fomenta which are 
struck from red-hot iron;" and Andrews, in his Latin and English 
Lexicon, has the following passage: 
" Fomites sunt assula ex arboribus, dum cceduntur excussa-fomites 
are the splinters or chips shaken from trees while being cut down." 
Fomes, then, in its medical sense, is the poisonous spark, which wants 
but the opportunity to exercise its power, and is cherished and pro- 
tected by being retained within the folds or pores of some appropriate 
substance, and the two together constitute the fomites. 
But it is claimed by Dr. Francis that the human body is not only 
the generator of the contagion, but that it may be itself also the 
vehicle of the poison to others. The following passage from his speech, 
from which I have already quoted, interests not only by the eloquence 
of its expression, but also by the boldness of its sentiment. Address- 
ing the Convention, he said: 
" You say in your contemplated resolve, there is no evidence of the 
personal communicability of yellow fever, independent of fomites, by 
which I infer you admit its contagious or infectious nature, when such 
agencies are present. How are you to liberate the afflicted patient 
from the action of fomites, or the by-stander who occupies his room 
and surrounds his bed ? Everything, it is suggested, is to be removed; 
if there be a deficiency of electricity, I suppose it is to be restored; 
the patient is to be divested of all apparel; and thus, with proper 
ablutions, you say he becomes innoxious. The clothing which he im- 
pregnated with the emanations of his pestilence, is to be carried out 814 
THE AMERICAN 
of sight. But of the patient himself, the immediate source of all the 
poison, the generator of the fomites, what of him ? Shall every tan- 
gible portion of his body, where the evil may lurk, be subjected to 
certain nameless operations ? Is he to be shorn ? Is he to be de- 
nuded ? If a bank-bill that has had some currency among many 
hands, can circulate the fever by its transmission from one person to 
another, (as has been asserted by the very authority which denies con- 
tagion,) what is to be the lot of the patient himself, the fountain of 
all the evil ? In other words, gentlemen, you tell us, remove every 
source of contagion, and then the patient is unable to spread yellow 
fever. Pardon me, if I think I am warranted in saying, this doctrine 
is neither deferential nor inferential, nor consequential. It is a nega- 
tion. Well, after all, thus safely ensconced in the ark of safety, lit- 
tle may be dreaded of the troubled elements. A particle of these 
wonderful fomites, even of an impregnated bank-note, may spread 
desolation and death; the corrupt or diseased patient, the source of 
all the danger, is, however, an impotent and harmless mass. If this 
is the theory espoused here, I am strongly reminded of a nursery 
couplet that I early learned: 
' South Hampton's wise sons found the river so large, 
Though 'twould carry a ship, 'twould not carry a barge. ' 
" To constitute fomites, as I understand it, there must be an external 
poisonous principle by a porous substance, and the hold upon wrhich 
must yet be so slight that it may be immediately thrown off when ex- 
posed to the air, so that it may be inhaled or absorbed by a human 
being, in whom it may produce its specified morbid effects. 
"Now, is it credible, as is intimated in the passage above quoted, 
that the living human body can become such a fomes ? that it can ab- 
sorb into its texture, like a blanket, the miasm of yellow fever, and 
emit it again when approached by a healthy subject ? The question 
conveys its own answer. 
" To employ the illustration of the couplet, a ship retaining within 
its hold an infected atmosphere may be regarded as fomites, while the 
living bodies of the passengers cannot be so considered. 
" The language of the proviso is to be taken in its strict literal sense: 
if the infection lurks under the nails, pare them down; if in the hair, 
shear it; but a simple ablution, in my judgment, will suffice to disin- 
fect the entire body, rendering it harmless, even though itself laboring 
under the morbid effects of the poison." 
Such, Mr. President and gentlemen, are some of my reasons for MEDICAL GAZETTE. 
815 
the vote I shall give in the affirmative on the resolution which was 
passed so nearly unanimously by the late Convention. 
After Dr. Griscom had finished the reading of his paper, 
Dr. Reese obtained the floor, and stated that he had prepared a 
paper on the subject. He then proceeded to read it in his usual em- 
phatic manner; its chief points were as follows: 
He first considered the introduction of this resolution as an anomaly; 
it was wholly unprecedented, in his opinion, that a National Conven- 
tion should in person, by its President, solicit the endorsement of a 
local body for any opinions which they, on their own responsibility, 
saw fit to promulgate. He granted in the present case, that there was 
a sad need of endorsement by somebody. The late action of the Sani- 
tary and Quarantine Convention had, he claimed, been renounced and 
repudiated by every medical journal in the land which has the authority 
or qualification to speak upon the subject. But he must confess his 
amazement at the temerity of an attempt to bring a resolution before 
this body, the passage of which would only stultify the Academy it- 
self; a resolution which he considered intrinsically absurd, and at 
variance with science and common sense. 
He regarded the declaration in the resolution, that yellow fever was 
not contagious from person to person, but contagious fomites or things, 
as a contradiction and absurdity. This was the gist of the resolution, 
divested of its ambiguity and circumlocution. How could the clothes, 
bedding, etc., of a patient communicate the disease to a well person, 
when the sick body itself, the source of the malady, did not ? This 
is not merely transcendental mysticism, but sublimated absurdity, and 
he would submit, with great deference-" arrant nonsense." 
Secondly, fomites could not be predicated to exist, and never were 
alleged to exist, except in the presence of contagion. At the time of 
Parr and the earlier waiters, no distinction had been made between 
contagion and infection, the terms then being used synonymously. 
Fomites were those agents which had received contagion from the 
body of the sick person, and these, being propagated among the 
healthy, produced disease. In the case of small-pox, the danger from 
fomites is eminently great; yellow fever, however, not being contagious 
-according to the opinion of the Convention-the very idea of fomites 
was absurd. It asserts the existence of fomites, while denying the 
contagiousness of yellow fever-the essential element of fomites. 
After a humorous allusion to the " Sepoys," at Staten Island, who 
had practically carried out the doctrine of the Convention, before it 816 
THE AMERICAN 
was promulgated by that body, by burning up all fomites at the island, 
the Doctor continued, that it was worthy of consideration that the 
resolution brought forward to be endorsed by this Academy is at di- 
rect variance with a resolution passed by the same Convention, held 
the year before in Philadelphia, in 1858. This same Convention, 
made up, to a great extent, of the same men, resolved, then, that yel- 
low fever was communicated from person to person, and not by fomites- 
Is it New York versus Philadelphia ? He would let the two Conven- 
tions fight it out, Kilkenny fashion, until they have devoured each 
other. 
He further continued, that although his individual opinions were 
well known to the Academy, he would take occasion to repeat, that 
he denied that yellow fever was contagious, either by persons or fomites, 
when removed to a healthy atmosphere; and he regarded the restric- 
tions of quarantine, except for cleansing and fumigating purposes, as 
a relic of barbarism, worthy only of the Dark Ages, disgraceful to 
science and civilization. 
Dr. Reese alluded to instances of which he knew, when the medical 
officers connected with the quarantine had proved themselves inca- 
pable of making a diagnosis, whether patients had yellow fever, remit- 
tent or intermittent fever. 
When a patient, whose disease had been first diagnosticated inter- 
mittent or remittent fever, was sent to the city, and died of yellow- 
fever, they call it "bilious remittent fever of a high, grade" to ?con- 
ceal the ignorance of diagnosis, and send the vessel on which he 
arrives, back from her wharf down the bay, and yet, with all this 
backing and filling, floating hospital and all, there has been no spread 
of yellow fever in the city. Meanwhile this caricature of a quaran- 
tine.had been kept up, at an expense of hundreds of thousands of dol- 
lars, and a still greater loss to commerce, without influencing the 
sanitary condition of the city. The sanitary officers might as well be 
absent with Dr. Jerome, or at the bottom of the sea. 
He would protest against the passage of this resolution, wffiich had 
damaged our reputation more at home and abroad than any other 
action of any medical body. It had been passed by a Convention, 
not representing the majority of the profession, but composed of the 
"odds and ends" of Boards of Health, the majority of whom had 
never seen a case of yellow fever. 
Dr. Francis next took the floor. He remarked that he had waited 
a moment or two after the remarks of Dr. Reese, expecting that his MEDICAL GAZETTE. 
817 
venerable friend, Dr. Smith, would take this opportunity to address 
the Academy. He had listened with great consideration to the scien- 
tific paper of Dr. Griscom, which was marked throughout by that 
mental discipline which characterized the gentleman who had been so 
long devoted to, and was so intimately acquainted with, the sanitary 
affairs of the city, and the paper to which the Academy had listened 
was both honorable to his head and to his heart. 
But he had been too long acquainted with medical history and medi- 
cal men, not to know that even the most assiduous and acute philoso- 
phers occasionally fall into error, and he could not for a moment 
believe, but that Dr. Griscom was laboring under a strong delusion. 
Upon this everlasting topic of yellow fever, upon which so much had 
been said and written, that its contemplation, even now, almost gave 
him the black vomit, he would pray most earnestly that this distin- 
guished Academy would not hastily commit itself. 
He regarded the resolution passed by the late Sanitary Convention, 
and now before this Academy, as a counterfeit issue, and God forbid 
that its members should aid in passing it. That the proposition was 
fraught with many absurdities, is unquestionably true, as that very 
astute man, Dr. Reese, had observed to-night. Let the whole matter 
be postponed, and postponed, and indefinitely postponed, until it shall 
have died away. 
The theory was set forth elaborately in Dr. Griscom's paper, that 
fomites propagated the disease; and yet that the contagion is spread 
from the patient to these things, called fomites, is denied. Can there be 
anything more absurd? He was convinced that there was not a man 
in this Academy who can believe this doctrine of the Sanitary Con- 
vention. A great difficulty arises in combating this theory, because 
no distinction can be made between fomites and the body itself; you 
cannot separate fomites from the body. Here is always a loophole 
to escape. When a case in which contagion is incontrovertibly clear is 
brought up-why, it is said, it was not the body which spread the con- 
tagion, but the fomites. 
When the subject was discussed here on a former occasion, Dr. 
Smith came forward and quoted the authority of Louis, (?) who re- 
ported to the Academy at Paris, that yellow fever was not contagious. 
But he did not consider him a trustworthy authority. When he was 
present in the Academy at Paris, in 1816, and the report was made 
that yellow fever was not contagious, President Charles, at the same 
meeting of the Academy, gravely related that gout had been commu- 818 
THE AMERICAN 
nicated to a man by taking from a clothes line, and wearing, the 
stockings of a patient affected with that disease. How can you trust 
such authority as this? 
He did not wish, however, to enlarge upon the subject; this subject 
could never be settled by discussions of this kind; it would be far bet- 
ter to postpone the matter. There was another circumstance con- 
nected with the subject, to which Dr. Reese had already adverted. 
You have done more recently by this discussion on yellow fever to in- 
jure the medical profession, than can be imagined; and if you adopt 
such an extravagancy as this, you discard and throw into disrepute all 
the great names of the profession. 
Dr. Rush had been cited in this discussion; but he is no authority 
on this subject. He may tell you that the more you bleed the greater 
will be the probability of saving a man from hydrophobia, but the man 
who believes in contagion in one year, and is a non-contagionist the 
next, cannot be confided in. This is like Armstrong. First, it was 
all bleeding in puerperal fever, and then it was all cathartics. Rev- 
erently as he was disposed to feel towards Dr. Rush, he could not but 
believe that the fact first promulgated by him cannot be altered. "A 
fact is an eternal thing," said Cicero, and as such, it must remain un- 
altered. 
If you adopt this resolution, you will commit this Academy, and 
perform what I call a felo-de-se. You are only following in the train 
of men who have never seen a case of yellow fever. Popular feeling 
is against you. When you state that there are fomites, you actually 
admit that yellow fever is contagious. 
Dr. Jos. M. Smith followed next, and gave a clear and succinct defi- 
nition of fomites, which he considered the real issue of the discussion. 
He could not see any difficulty in defining the word. He regarded 
the fact as settled, that there is such a thing as fomites. It had been 
stated by Dr. Griscom, that fomites meant material which may absorb 
poison, (or contagion, if you please,) and by that material may be con- 
veyed to others, and reproduce disease by emanations. Fomites, then, 
in the general term, comprise any material that can convey disease of 
whatever character. The older physicians understood by contagion, 
fomites; and infection, any agents capable of producing disease. If a 
miasm sprung up, it was called contagion-infection, the term as then 
used, meant anything and everything pestilential in its character. The 
union of any substance, such as woolen, cotton, etc., with a morbific 
agent, produces fomites. The learned doctor here cited numerous in- MEDICAL GAZETTE. 
819 
stances of diseases which produced various kinds of fomites, such as 
rubeola, variola, scarlatina, &c. 
There are, however, other poisons not developed in a vitalized body, 
but generated without the body, by noxious emanations, not of a spe- 
cific character, such as the exhalations from the lungs and skin, which, 
when condensed and accumulating on board of a ship, give rise to 
typhus fever, and though almost all the passengers may escape the in- 
fection, yet persons not acclimated to these fomites will be seized with 
the disease. Thus, also, a ship arriving from the West Indies, where 
yellow fever has been endemic, may carry the fomites of yellow fever, 
whatever their nature may be, with them, even though none on board 
may be affected with the disease. 
Dr. Smith then discussed the question of the assimilative power of 
a yellow-fever atmosphere, referred to in Dr. Griscom's paper at length, 
contending that in cases where it was not dispelled, it might be slowly 
assimilated and propagated by the soil. 
Dr. Mott, in a few remarks, expressed his belief that yellow fever, 
with which he has been perfectly well acquainted since 1804, was oc- 
casionally a contagious disease. He wished to know why physicians 
in this city and elsewhere had more fear of visiting a patient with yel- 
low fever than one with intermittent. He would oppose this resolu- 
tion, so far as his vote was concerned, because he looked upon it as 
of a very injurious tendency. 
Dr. Reese again took the floor, in order to explain his position. He 
was perfectly well aware that the term " fomites" was formerly applied 
by writers to agents which we do not now regard as producing conta- 
gious diseases. They applied this term to those diseases which they 
supposed were contagious. But, in his opinion, it was perfectly plain 
that, without contagion, there can be no fomites. A ship coming from 
a pestilential, infected locality, carried the infection, not in fomites, 
but in its atmosphere; and this poisonous atmosphere it is which pro- 
duces the disease. He denied that there has been a single established 
fact which demonstrates that yellow fever has ever been communicated by 
fomites. 
Dr. Alfred C. Post regarded the arguments of Dr. Reese as in per- 
fect harmony with the theory of fomites, and as contradicting himself. 
That gentleman had said that yellow fever was propagated by the at- 
mosphere of vessels coming from infected ports. These vessels, then, 
according to the gentleman himself, can only be regarded as gigantic 
fomites. All those who advocate the theory of fomites, understand 820 
THE AMERICAN 
by that term, any material which is capable of absorbing poison, and 
conveying that poison from place to place, and then giving it out so 
as to produce the disease in others. This does not convey any idea of 
contagion. Suppose it had some chemical cause; suppose it to be 
something of whose intimate nature we know nothing: in this view of 
the case, the ship is regarded as a fomes, although on a much larger 
scale than a trunk or a bale of cotton. The gentleman has admitted 
that the disease may be conveyed by a ship; now it does not matter 
whether the fomites be a thousand cubic feet or one cubic foot in size, 
so long as it is capable of communicating the disease. The members 
of the Sanitary Convention, he believed, understood the term in that 
sense. Fomites have no regard, then, to size. 
This idea that fomites and contagion are inseparable, is a man of 
straw, which these men have set up to pierce with their darts; they 
have accused us of entertaining absurd doctrines, which we have no 
idea of entertaining. 
The discussion was then postponed to the next meeting, and the 
Academy adjourned. 
Philadelphia County Medical Society. 
(Reported by W. B. Atkinson, M.D., Regular Meeting, Sept. 14, 1859.) 
Dr. Jewell read the following paper: 
" Has yellow fever ever originated in the latitude of Philadelphia ?" 
is the deeply interesting and highly important question suggested by 
the Committee on Lectures, and the subject for our investigation on 
this, the opening occasion of our winter's campaign of conversational 
meetings. 
The question under consideration conveys, in its meaning, two propo- 
sitions, viz.: the domestic, and the foreign or exotic, origin of yellow 
fever-one of the most fearful and fatal of all epidemic diseases. 
Dr. La Roche, in his elaborate and distinguished work on yellow 
fever, has presented to the wide world the name of Dr. W. Jewell, 
(your humble speaker,) as an importationist; while on the other hand, 
Dr. J. C. Simonds, of New Orleans-in the report of the Sanitary 
Commission of that city, alluding to the same documentary evidence 
as referred to by the former gentleman-says that I am an advocate 
for the domestic origin of yellow fever. I introduce these two antag- 
onistic opinions in order to avoid the implication of inconsistency, in MEDICAL GAZETTE. 
821 
the event of my embracing either the one or the other horn of the 
dilemma in which I find myself placed by these eminent writers. 
If facts make up the history of any subject under investigation, it 
becomes me in the present instance to take simple facts, unbiased by 
favorite theories or plausible pleadings, and place them impartially 
before you, in order to receive any light upon the origin and develop- 
ment of yellow fever. 
To narrow down my introductory remarks to a single point, and 
desirous, also, to relieve you from any anxiety or doubt as to the 
opinion I entertain of the question before you, I will premise the few 
words I shall say, by giving you to understand, that I have no hesita- 
tion in believing that yellow fever not only may, but has originated in 
the latitude of Philadelphia, entirely independent of all modifying in- 
fluences, and all labored efforts to connect its origin and existence with 
a foreign poison. At the same time, and with the same candor, I de- 
sire to be distinctly understood as acquiescing in a prevalent sentiment, 
that yellow fever may be, and has been introduced into the latitude of 
Philadelphia through foul vessels. 
In proof of the assertion of its domestic origin, I will only carry 
you back to 1856, and remind you of the cases of yellow fever, five in 
number, that occurred in our own city. Being local or sporadic in 
their character, and not having been followed by a desolating train of 
consequences, no one that I know of ever attempted to entangle them 
with any foreign alliance. The same may be told of the cases of 1854. 
Nor should I omit to include, on the authority of Dr. La Roche, those 
of 1801 and 1826, wherein the most persevering contagionists could 
not find the smallest chance of deriving the disease from abroad. It 
is unnecessary to multiply authorities and cases. I have confined my 
proof to our own city, and even here, I might, with propriety, enu- 
merate other analogous occurrences of the disease; but I forbear. I 
will only, however, allude to the fact, that Dr. La Roche, in his work 
on fever, and Barton, in his Sanitary Commission of New Orleans, offer 
such abundant evidence of the local or domestic origin of yellow fever, 
not only in tropical, but in temperate locations, as to stamp the opinion 
with the seal of truth. 
Again, and here I quote the language of Dr. La Roche, " If sporadic 
attacks of the yellow fever are admitted to be the result of domestic 
causes, and to arise independently of importation and contagion, it is 
difficult to understand on what grounds the disease is denied to be due 
to the same causes, and why we should attribute it to a foreign source, 822 
THE AMERICAN 
in those instances where, instead of appearing to a limited extent, it 
spreads over a broader surface, and, assuming the garb of an epidemic, 
attacks a large number of individuals. It cannot be hazarding too 
much to say, that in both instances the cause must be the same." 
Now, I infer, that in the former instance there is no prevalent epidemic 
constitution of the atmosphere to favor the virulence and spread of the 
disease, while in the latter, the peculiarity of the hygrometrical, elec- 
trical, and thermometrical states of the atmosphere favor to a far 
greater extent the evolution of the febrile poison, and give to it 
greater energy and diffusion. 
The remaining proposition in the question looks to the importation 
of yellow fever from abroad. It would seem hardly fair to discuss the 
one, without an allusion to the other. Indeed, it is almost impossible 
to separate them, in my own mind; for while I admit a domestic origin 
for the disease, I am unwilling to lose sight of the fact that yellow 
fever has been conveyed by foul vessels into places and ports from trop- 
ical climates, where the disease occurs endemically. This fact is 
acknowledged by the most strenuous advocates for the indigenous ori- 
gin of the disease, and that, too, in the latitude of Philadelphia. Even 
the distinguished Dr. La Roche receives this opinion to a limited ex- 
tent, for he says, (I quote from vol. 2, p. 582,) " It must be borne in 
mind, in addition, that in every instance in which the disease has been 
traced to a ship, its cause was local in the latter, and, as already 
stated, did not spread its morbid influence beyond a short distance, 
and that the influence ceased to be felt after its removal, or the dissi- 
pation of the effluvia it had left behind;" and in the 1st vol. of his in- 
imitable work, at p. 593, he further says, " the yellow fever has often 
been known to arise from the foul exhalations of ships." Now, as 
regards the infection of a ship, arising invariably from foul bilge-water 
or the decomposition of vegetable and animal materials under the lim- 
bers or in the seams of the vessel, the inference is not altogether clear 
to my mind. During the present season a ketch from Havana was 
detained at our Lazaretto, having lost several of her crew with yellow 
fever; but her condition was by no means foul, and yet, during the time 
of discharging her cargo, both the physician at the station and the in- 
spector of vessels contracted the fever, the latter of whom died. In- 
deed, it would not be difficult, did time allow, to bring forward numer- 
ous instances of infected vessels arriving at our ports from the tropics, 
where they had cases of yellow fever originating on board from port 
to port. MEDICAL GAZETTE. 
823 
But allow me to dwell for a moment upon those cases where the 
fever has originated from a local cause on board of a ship. This in- 
fected vessel arrives in a healthy port, then, according to the evidence 
of Dr. La Roche, and with which I entirely agree, its morbid influ- 
ence may spread, not beyond a short distance, he says, and the effluvia 
may not be entirely dissipated after its removal. This concession on 
the part of that distinguished author affords me a foothold on which 
to build my opinion that yellow fevei' may be, and has been imported 
into the latitude of Philadelphia. And I go further, and believe that 
this yellow fever germ or miasm, or whatever else you please to desig- 
nate it, originating either from putrescent materials on board the 
vessel, or confined in fomites, or remaining in the confined atmosphere 
of the hold during the voyage-if introduced into a contaminated at- 
mosphere, and thus finding materials to feed upon, and capable of ex- 
haling a morbid effluvia-it serves as the nucleus or ferment, and in an 
atmosphere with an epidemic constitution, the result will be the prev- 
alence of a disease, the extent and malignity of which will depend 
upon the condition of the poison eliminated. 
Heat and moisture are generally acknowledged to be the two active 
agents in the production of the poison; and wherever, either within the 
tropics, or in temperate climes, or on board ships at sea, we have this 
combination existing in the midst of surrounding infusoria favorable to 
fever of a malignant type, there we may have yellow fever. What 
the exact condition of this state of chemical action must be, in order 
for the development of the disease, no one has attempted successfully 
to define. 
I therefore entertain the opinion that there exists, at certain periods 
and under certain meteorological and terrene conditions, an epidemic 
constitution of the atmosphere, which is susceptible of the production 
of a poison peculiar to the development of yellow fever in the human 
system. This poison, I hold, is capable of reproduction, or will pre- 
vail in locations badly ventilated and fruitful in filth, where there exists 
a crowded and vagrant population, to a far greater extent than in 
more sparsely settled, better ventilated, and more cleanly neighbor- 
hoods. 
Therefore it is a matter of indifference to me where this poison is 
produced, whether on shipboard, in a foreign port, or on shore in our 
own city, provided the meteorological and terrene phenomena be such 
as I have described, we shall be liable to have the fever break out and 824 
THE AMERICAN 
spread to a greater or less extent, according to the influences at work 
and the local peculiarities of the surrounding neighborhood. 
Who will deny that the few cases of yellow fever which were found 
in our own city last year, (1858,) were the offspring of a poisoned at- 
mosphere in and about the two West India vessels that had escaped 
quarantine, and lay moored in the vicinity of Lombard Street wharf ? 
These vessels had arrived here in the month of July, from ports where 
yellow fever was prevailing at the time of their departure, and they 
had lost several of their crew from the disease on the voyage home. 
A custom-house officer, who had one of the vessels in charge, and who 
resided at Roxborougb, went home sick, and died of yellow fever on 
the 5th day after his attack. A night inspector of the same vessel 
also took the fever from the infected atmosphere on board, and died on 
the 6th day. Besides these two cases of direct communication with 
the vessels, nearly all the others could be traced directly to a residence 
or to a visit in the immediate vicinity of where they lay. 
But let me refer you to another instance of similar character of less 
recent date, and which, from the peculiar circumstances accompanying 
the results, has been made the subject of much discussion among the 
advocates for the domestic and foreign theories, wherever its history 
has become known. You will anticipate me, that I have in view the 
case of the Mandarin, and the yellow fever in this city in 1853. Of 
this epidemic the most of you were eye-witnesses: I need not, there- 
fore, occupy your time with the details. My principal motive in call- 
ing attention to it here, is to repeat, what I have elsewhere asserted, 
that this vessel, in my opinion, was instrumental in originating or in- 
troducing the infection into our city, by means of a morbid effluvia 
generated under her limber planks, from a putrescent state of her bilge- 
water; and notwithstanding all the arguments-and they carry with 
them great weight-that the able Dr. La Roche has brought forward 
to refute the position I then held as to the origin of the fever, I am in 
no wise shaken in the sentiment. If the barque Mandarin had no 
hand in infecting the atmosphere in the vicinity of South Street wharf, 
in 1853, then am I persuaded that all writers advocating the local 
origin of yellow fever on board of foul ships have erred; that even Dr. 
La Roche, with all his deep researches into the nature and origin of yel- 
low fever-and no man living has waded more thoroughly through the 
history of the disease, or possesses greater facilities for obtaining infor- 
mation and knowledge in his own extensive and unrivaled library of 
works on yellow fever, containing, with but few exceptions, everything MEDICAL GAZETTE. 
825 
that has ever been written on the subject, " from the tiny pamphlet to 
the fat and stately quarto, or even folio"-even Dr. La Roche himself 
has erred; and that Dr. Harris, in his account of the spread of the 
yellow fever at Fort Hamilton, on the Long Island shore, Brooklyn, 
Governor's Island, Staten Island and New Jersey shore, ascribing the 
same to the spread of an infected atmosphere in and surrounding the 
yellow fever fleet at quarantine, during the summer of 1856, has also 
erred. 
I am aware that Dr. La Roche has cited an isolated case of yellow 
or malignant fever which is said to have occurred in the city ten days 
or more previous to the arrival of the Mandarin-though at the dis- 
tance of two-thirds of a mile from South Street Ferry-although it was 
not certified to as yellow fever at the time, and that he lays much 
stress upon the fact that none of the stevedore's gang or other per- 
sons engaged in unloading the Mandarin, nor that any of her sailors, 
took the disease. All this may be admitted, and still the argument I 
have advanced is not weakened. The isolated case referred to rather 
strengthens my opinion, as it goes to prove the existence of a suitable 
condition of the atmosphere to elaborate the poison under propitious 
circumstances. And as to his argument of the escape of the steve- 
dores, laborers, and crew of the Mandarin, it proves nothing more 
than that they, like hundreds who were similarly exposed to the in- 
fectious atmosphere in the vicinity of South Street wharf, were also 
innocuous to the poison. As well might we use the argument, that be- 
cause all the boarders and the family at the Champion House, at 
South Street wharf, were not stricken down with the disease, hence it 
could not have been yellow fever. 
I have not time allowed me, nor would it be pertinent to the occa- 
sion, to engage in an examination of all the points taken up and 
argued by Dr. La Roche, in his endeavors to disprove the agency of 
the Mandarin in introducing the fever of 1853 into our city. Suffice 
it to say that the facts bearing on her instrumentality in the case in 
question are so clear to my own mind, as to defy the ingenuity and 
philosophy of the most erudite to obscure them. 
I have thus, Mr. President, taken a very brief and hasty view of 
the question offered for the evening's discussion. The subject is one 
of interest. As physicians of a great commercial city, it becomes us 
to familiarize ourselves with its history, its nature and origin, its 
sporadic and epidemic visitations, its pathology and treatment. There 
is enough, however, in that department of the subject before us by ap- 826 
THE AMERICAN 
pointment this evening to engage our undivided attention, and I trust 
the members present are not only prepared, but will come up spirited- 
ly and cheerfully with the numerous arguments which may be ad- 
vanced for and in behalf of either side of the debate. I have opened 
the way, I expect others to follow. 
Dr. Condie remarked, that from the manner in which the question 
proposed for discussion this evening was worded, he had been unde- 
cided whether the inquiry was as to the origination of yellow fever in 
places situated upon the same parallel of latitude as Philadelphia, or 
simply, has it ever originated in this city. The two questions are 
very distinct from each other, and open up somewhat different fields 
of investigation. Finding that the gentleman who had just sat down 
confined his remarks to the origin or non-origin of the disease in Phil- 
adelphia, Dr. C. would, in those he was about to offer, follow his ex- 
ample. 
That yellow fever has repeatedly occurred in this city, and in some 
of its occurrences here, has prevailed somewhat extensively, will be 
admitted, he presumed, by every one. Now, we know of only five 
ways in which its occurrence can have taken place. 
1st. From endemic causes. That is, from strictly local morbific 
conditions-aerial or meteorological, telluric, and accidental. 
2d. From epidemic causes. That is,, from some general morbific 
condition of the atmosphere, which, as simply a generator of disease, 
would seem to act in some degree altogether irrespective of local ap- 
preciable conditions, whether of the atmosphere or of the soil, or con- 
nected with the civic and domestic relations and industrial pursuits of 
the inhabitants. 
3d. From contagion, brought from abroad in the persons of those 
laboring under the disease, or in their clothing or baggage; or in cer- 
tain portions of the cargo of a vessel recently arrived from an infected 
port. 
4th. From a zymotic germ-a morbific ferment, imported in the 
atmosphere of a vessel, in the clothing of its crew or passengers, or in 
its cargo, from a place at which yellow fever prevailed at the period 
of her departure. 
5th. From an especial morbific condition of the atmosphere of a 
vessel, and of her cargo, arriving at a port, after a long voyage, at a 
particular season of the year, and under, perhaps, special meteoro- 
logical conditions; whether the vessel had come from a yellow fever 
port, or had cases of the disease on board, or not. MEDICAL GAZETTE. 
827 
We can conceive of no other manner save one or other of the fore- 
going, by which the yellow fever can be produced in this or in any 
other city. 
It is to be remarked that when the disease has occurred in Phila- 
delphia, it has always been at a particular season of the year, and one 
marked by certain peculiarities of atmospheric temperature and moist- 
ure, and always in certain circumscribed localities. It has never 
spread generally, over a large portion of the city, or throughout its 
entire limits. 
To examine carefully into all the facts connected with the occur- 
rence of yellow fever, at each of its visitations to this city, with the 
view to a settlement of the vexed question as to its domestic or foreign 
origin, would occupy too much time. Neither could it be done with- 
out the preparation beforehand of a docket of the leading facts in 
each case, with their particular relations and bearing. In our at- 
tempt, to-night, to solve the question proposed for discussion, we must 
adopt some more comprehensive, and, under the circumstances, feasible 
plan. The best probably is that by exclusion. Let us endeavor to 
discover by which of the already referred to modes of development 
the occurrence of yellow fever in Philadelphia cannot, with a due re- 
gard to facts, be accounted for, and we may, perchance, be led to the 
discovery of the true source of the disease, when it makes its appear- 
ance in our midst. 
In the first place, the occurrence of yellow fever in this city cannot 
be referred to an imported contagion-whether conveyed to us in the 
persons of the sick, or in fomites of any conceivable kind. There ap- 
pears to us to be no question connected with the etiology of any dis- 
ease more fully settled than is the non-contagious character of yellow 
fever. 
The simple fact that the disease is confined to particular seasons; 
that it prevails only under particular meteorological conditions, and 
within certain well-circumscribed localities, characterized by bad hy- 
gienic conditions, is strong prima facie evidence of its non-contagious 
character. Of which of the confessedly contagious diseases can the 
fact just referred to be, in truth, predicated? 
The arrest of the disease by removing all the inhabitants from the 
infected districts, and admitting no person subsequently to enter them, 
until after the occurrence of frost, is another fact which disproves its 
contagious character; and still another is the free admission of yellow 
fever patients into the sick-wards of our public hospitals, and their 828 
THE AMERICAN 
treatment there in the immediate vicinity of patients affected with 
other diseases, without, in a single instance, the spread of the fever to 
the latter, or to the nurses and medical attendants. 
The fact that yellow fever most generally has made its appearance 
in Philadelphia, upon one or other of the Delaware wharves, in the 
immediate vicinity of the foreign shipping, is adduced as a strong evi- 
dence that the disease is the result of an imported contagion. But 
we are to recollect that in a season of sufficient heat, the wharves 
present all the circumstances favorable for the generation of a mala- 
rious atmosphere adapted to produce the most malignant forms of yel- 
low fever. Our wharves are badly constructed, out of perishable tim- 
ber, and filled up with a porous mass of decomposable and partly de- 
composed material, which is kept constantly soaked by the water of 
the river. The surface of the wharves and the heads of the numerous 
docks receive the filth and various refuse matters from ships loading 
and unloading, from a number of coasting and market boats, and from 
the neighboring stores and dwellings. Into the river, at the wharves, 
open the mouths of all the sewers which drain the most populous por- 
tions of the city. Much of the filth thus brought into the river ac- 
cumulates in the docks, and at low tide lies exposed to the sun, a fruit- 
ful source of the most pernicious malaria. The wharves, too, are in- 
variably, in some places, many feet below the level of the part of the 
city in their immediate vicinity; they are bordered by large ware- 
houses for various kinds of merchandise and produce, or by high 
dwellings, which, with the narrow courts and lanes that occur along 
much of the Delaware Kiver front of our city, are inhabited each by a 
number of families, by whom little attention is paid to the require- 
ments of personal or domestic hygiene. The malaria constantly gener- 
ating from all the foregoing sources, along our wharves, and the hu- 
midity arising from the neighborhood of the river, have little chance 
of being dissipated, where everything in the neighborhood thus con- 
spires to prevent a free ventilation. Hence, in seasons of intense 
heat, our wharves must necessarily become the hot-beds of disease. 
Yellow fever cannot be said to have ever occurred in this city as an 
epidemic, in the strict sense of the term. Its appearance has always 
been surrounded by too many specialities of season, meteorological 
phenomena and local conditions, to be considered in the light of an 
epidemic. No epidemic, that we know of, breaks out in certain nar- 
row, circumscribed localities, beyond the limits of which it rarely 
spreads. Such a disease is an endemic of a particular place, origin- MEDICAL GAZETTE. 
829 
ating in strictly local causes, and has not any affinity with an epi- 
demic, dependent upon some widely-spreading distemperature of the 
atmosphere. Small-pox, cholera, and influenza, if they do not occur 
simultaneously over large cities or tracts of country, progress invaria- 
bly from one point to another; from east to west, from north to south, 
or vice versa; along a wide or narrow strip of the earth's surface, in 
a comparatively short space of time. It is very certain that certain 
morbific conditions, existing at particular points, often invite, as it 
were, epidemic maladies to prevail there to a greater extent, for a 
longer period, and with more intenseness, than in healthy localities; 
nevertheless, such local morbific conditions are by no means necessary, 
as they are in the case of yellow fever, for the occurrence and preva- 
lence of an epidemic disease. 
The hypothesis, first advanced by Dr. Hosack, of New York, but 
essentially altered of late years in some of its details, which assumes 
that yellow fever, or rather a yellow-fever producing atmosphere, may 
be generated in any eminently malarious locality, during the heat of 
summer, by the introduction of a zymotic germ through the air, or 
cargo of a vessel, arriving from a yellow fever port, requires only a 
passing notice. We admit that this hypothesis presentsan etiological 
position, which may, or may not be true; that there is nothing im- 
possible about it. Its adoption gets us rid of many difficulties, with 
which both the theory of the domestic origin of yellow fever, and that 
of its importation through a contagious matter in the clothing or per- 
sons of the passengers and crews of vessels, arriving from infected lo- 
calities, are encompassed. It unites upon the question of importation 
the advocates of the contagious character of yellow fever with the non- 
contagionists-the advocates of the strictest system of quarantine, 
with those w'ho would mainly depend for the prevention of yellow 
fever upon the enforcement of a thorough and enlightened system of 
public and domestic hygiene. Unfortunately, however, this very con- 
venient theory of atmospherical zymosis, by the introduction of a 
foreign morbific germ, is merely a plausible hypothesis, unsupported 
by a single well-established fact or analogy. It is, after all, only the 
revival, under a modified form, of the repudiated doctrine of contagion 
as applied to yellow fever. As a most convincing evidence of the 
truth of this theory, its advocates assert that yellow fever always 
makes its appearance, when it occurs in our midst, subsequently to 
the arrival of infected vessels, persons, baggage, clothing, merchan- 
dise, etc.; with the latter, therefore, and the occurrence of the disease, 830 
THE AMERICAN 
it is inferred that there is an intimate connection; by them, it is 
argued, a poison is introduced which, under certain favorable circum- 
stances, has the power so to change the condition of the atmosphere 
of the place as to render it a yellow-fever producing atmosphere. 
But neither the fact thus asserted, nor the conclusions that have been 
drawn from it, are founded in truth. It is not true that the appear- 
ance of yellow fever in this city has been, in every instance, preceded 
by the arrival of infected vessels, persons, clothing, baggage, etc. 
Such was not the case, certainly, in 1805 and 1819. Even when the 
outbreak of the disease has followed promptly the arrival of a vessel 
from an infected locality, it has not always been proved that any in- 
fection existed on board of her; or when such infection did exist, could 
any connection be traced between the vessel' and the cases of fever 
which occurred among our own citizens. In some instances, it would 
seem more than probable that the very vessel which had been accused 
of bringing the disease to our shores, has actually had it produced on 
board of her while she lay at one of our own wharves, from the same 
local causes which produced it in such as dwelt in, or visited, the in- 
fected district in which she had her berth. 
Yellow fever has frequently made its appearance in mid-ocean, 
among the company of a ship that had sailed from a perfectly healthy 
port. In such cases, from whence was derived the zymotic germ, or 
the contagion ? Equally difficult will it be found to explain, by the 
zymotic theory, or by that of contagion, why it is that the yellow 
fever has attacked on board of a foul vessel, undergoing repairs, those 
only who worked in the lowest part of her hold, while all the work- 
men, without a single exception, who were engaged in other parts of 
the vessel, escaped. Both theories are incompatible with the well- 
known fact that the infected air productive of yellow fever is often 
strictly confined within the limits of certain well-defined localities, and 
that by removing all persons from such infected locality, and prevent- 
ing any one from entering it, until after the setting in of frost, yellow 
fever may be arrested, by preventing most effectually the possibility 
of the occurrence of new cases. 
We believe that the foul air of a ship's hold will, under certain cir- 
cumstances, after her arrival in port, and the opening of her hatches, 
produce the yellow fever in her crew, and such persons as come on 
board of her, as well as in those who are in any way exposed to the 
pestilential air emanating from her; nay, further, we believe that there 
is overwhelming evidence to prove that, when a large number of foul MEDICAL GAZETTE. 
831 
vessels are crowded together in a damp, hot atmosphere, the pestilen- 
tial air generated on board of them may be wafted by the wind to 
perfectly healthy localities in their immediate vicinity, and in so undi- 
luted a state as to produce there, disease. Now, it is to be borne in 
mind, that " the importation" of yellow fever in this manner, may be, 
by vessels coming from ports where no yellow fever, no disease, indeed, 
of any kind prevailed at the period of her departure, nor immediately 
preceding or subsequent thereto, and without having on board, previ- 
ously to her arrival, a single case of yellow fever, or any other dis- 
ease. It must be recollected that the vessels referred to, with their 
foul atmosphere, constitute, to all intents and purposes, infected dis- 
tricts; by those who reside or come within which only can disease 
be contracted; and with such the disease stops; it never becomes en- 
demic to any other locality than the ship's hold. It cannot be shown 
that in a single instance they left behind them an infected atmosphere 
capable of producing yellow fever. 
We have only one set of causes, by which we can account for the 
occurrence of yellow fever in our own city, and that set are strictly 
endemic; they occur in our very midst, and to a very great extent are 
under our control; for although, in the production of yellow fever, 
there no doubt enters some other element than atmospherical heat 
and moisture, and an accumulation of putrescent or decomposable ma- 
terials, and notwithstanding our entire ignorance of the nature of that 
other essential morbific element, still, it is very certain that it is, of 
itself, inefficient for the production of disease; and that, by removing 
or guarding against the other morbific agents, which give to it effi- 
ciency, the occurrence of yellow fever may be prevented; or if the 
disease do occur, it may be circumscribed in extent, and disarmed of 
its malignancy. From the foregoing considerations, we are convinced 
that the proper answer to the question under discussion is in the 
affirmative-yellow fever has originated in Philadelphia. 
Dr. Darrach asked the use of the present form of quarantine, if 
yellow fever be of home origin ? 
In 1853, and subsequently, several unqualified cases of this too fatal 
disease were under his observation. He witnessed, also, several au- 
topsies, some of which were made by himself, and that with much 
accuaracy, and the deepest interest. In regard to the clinic of said 
cases, its category of symptoms was peculiar-entirely different from 
that of malignant remittent. It consisted of inaction of mental facul- 
ties without delirium, emotionless, torpid functions, especially that of 832 
THE AMERICAN 
the liver, and extreme depression of strength. As in cholera, so here 
the breath and yellow skin were inodorous and of low temperature. 
In the autopsy, neither odor nor halitus were detected from the 
exposed serous surfaces of the chest and abdomen. The mucous sur- 
face of the prima via and the internal surface of the arteries were ex- 
tensively reddened from an indelible blood-stain, which doubtless was 
owing to a moribund capillary exosmose. There was no extra-venous 
nor extra-capillary congestion. 
The organ most remarkable was the liver. It was firm, resilient, 
and of diminished size; and its color was that peculiar tint of yellow, 
which in autumn is on the sycamore leaf, when it passes from its 
brighter yellow into brown. Yet more remarkable and peculiar were 
its internal conditions. According to the microscopical observation of 
the resident physicians of the Pennsylvania Hospital of 1853 and 
1854, the liver-cells were filled with oil; this was also outside the 
cells, and these were distinguishable from the oily liver of the con- 
sumptive and the drunkard, by their disposition to disintegration. 
This tendency was so great that the cells under the microscope pre- 
sented, in the place of the normal clear outline, a ragged edge. This 
yellow-fever liver is in glaring contrast with the enlarged, engorged, 
softened, and dark liver of malignant remittent, especially that which 
Johnson describes in the Hoogly case. This implies a veno-hepatic 
congestion and inflammatory softening, whilst that of uncatenated 
yellow fever might seem to signify dehepatization, with palsy of the 
capillary. 
He regarded yellow fever, therefore, as a peculiar disease, non-con- 
tagious and of tropical origin. 
He was aware that often at Philadelphia the month of July had a 
tropical character. But vegetation here is not then under decomposi- 
tion; we have never the rank vegetation of the tropics, and it has not 
been in this month that the fever in question has here prevailed. Be- 
sides all this, the question arises if vegetable decomposition can pro- 
duce more than the miasm of inter- and remittent. The etiology of 
yellow fever is somehow associated with the tropical vegetation in 
connection with the oceanic salts and alkaloids, and the filth of neg- 
lected sea-vessels. This triple compound, under the zenith rays of a 
tropical sun, may produce the poison which, being incorporated into 
woolen and cotton goods, and other substances, may be exported from 
the tropics, where it was fabricated. If so, then exclude it; and if it 
has entered, fence off the infected locality, and properly empty it of MEDICAL GAZETTE. 
833 
humanity. He did not fear the removal of the cases from the infected 
spot when washed and reclothed. They could not communicate the 
disease. He illustrated this idea by the supposition of a spot infested 
with serpents, where, if a person goes, he receives a mortal wound, but 
cannot communicate it. 
In respect to the specific nature of yellow fever, it may consistently, 
like intermittent and remittent fever, and scarlatina and other epi- 
demics, have its scale of virulence and its acme and decline, and 
thereby assume different modes. 
Dr. Bell said that the question, as propounded, might seem to im- 
ply a doubt whether the yellow fever ever prevailed in Philadelphia. 
The subject, if taken up as a matter of original inquiry, may be ex- 
amined in two ways-first, by a priori reasoning; second, by the aid 
of history. Knowing the nature of the climate, the season, and the 
particular localities in which yellow fever finds its origin, and a con- 
genial home, as in the West Indies and the maritime region surround- 
ing the Gulf of Mexico, as well as those spots in Southern Europe in 
which it occasionally occurs, we have but to compare those regions 
and places with that portion of Philadelphia along the Delaware 
River, and then ask whether, in the tropical heat or many of our sum- 
mers, the exposure of a part of the bed of the Viver at receding tides, 
and the mud and vegeto-animal matters of which it largely consists, 
acted on by a fervid sun, similar matters poured into the stream from 
numerous sewers, and sometimes alike exposed to high solar heat, not 
to speak of the made ground of our wharves and the decayed wood of 
their facings, are not adequate to the production of yellow fever, cer- 
tain atmospheric, but not well-defined conditions, added to high heat, 
favoring ? The climate, as far as relates to the tropical heat of our 
summers, topography, and the occasional adventitious circumstances of 
faulty public hygiene in Philadelphia, are analogous to those which are 
constantly found in the admitted homes of yellow fever. But-and 
herein is a difficulty in the way of etiology not yet solved-in all that 
portion of the eastern hemisphere which embraces Asia and its islands, 
there are extensive districts with maritime exposures and alluvial soil, 
at the months and on the margin of rivers, in which, so far as regards 
climate and all the atmospheric and terrene state of things, we see all 
the conditions for the generation of yellow fever, and yet this disease 
is never met with. Why, for example, should not yellow fever appear 
as regularly at Calcutta and the Delta of the Ganges as it does at 
New Orleans and the lower country of the Mississippi ? 834 
THE AMERICAN 
The historical side of the inquiry exhibits little that is satisfactory. 
You know what was said of Herodotus, the father of history, that he 
was the father of lies-an unjust stigma; but I only refer to it now to 
remark on the extreme difficulty, even when the documents are col- 
lected, of writing a history which shall truly represent the facts and 
incidents as they really occurred. In the question before us, respect- 
ing the alleged foreign origin of the yellow fever, we are almost en- 
tirely wanting in the first series of facts, viz.: the actual sanitary state 
of the port at the time of the departure of the vessel which was rep- 
resented to have brought with it the materies morbi in the shape of a 
virus, communicable by contagion, or a miasm, transmitted by con- 
tact of the sick with the well. Now, whether we regard the defective 
evidence in the first part of the inquiry, or the failure of proof in the 
second or home branch, wre can confidently say that a case involving 
questions of property or of life not better sustained by more connected 
testimony, would inevitably be thrown out by a jury, as " not proven." 
The commonest mistake in arguing is, that lapse of logic, which as- 
sumes two coincident facts or phenomena as bearing to each other the 
relation of cause and effect. In medicine our progress to a philosoph- 
ical system is continually embarrassed in this way; it confuses our 
etiological explanation^; it misleads in our therapeutical deductions 
and clinical experience. It is by a fallacy of this kind that a vessel 
arriving here from a suspected or diseased port, contemporaneously 
with the appearance of the yellow fever, is assumed to have imported the 
disease. Often, in cases where such a cause has been assigned, it has 
been shown that the outbreak of the fever had preceded the arrival 
of the accused vessel; and also, that cases of the disease had occurred 
in spots at a distance from its alleged focus, and among persons who 
had neither been near the vessel, nor had held any intercourse what- 
ever with the crew or passengers, or any other party visiting it or 
working on board. . 
Dr. Jewell, in the interesting remarks with which he has introduced 
the subject this evening, takes a kind of middle ground between the 
advocates of domestic origin of yellow fever, and of its importation 
or introduction from abroad. While admitting that the former does 
occur, he believes also that a vessel from a port in which the disease 
prevailed at the time of her departure, contained material in her hold 
and in her limbers which, acted on by heat, evolves the poisonous 
miasm of yellow fever. This may be considered as a conceded point, 
and it has been proven by, among others, Dr. La Roche, in his great MEDICAL GAZETTE. 
835 
work'on yellow fever. Dr. Jewell goes a step further, and in this also 
he is sustained by abundant testimony, viz.: that the miasm thus 
evolved becomes a cause of disease and death not only to individuals 
among her crew and passengers, but also, when she arrives here, (in 
port,) will give rise to the fever, both among those who come aboard 
of her to discharge cargo, and to those other persons who are near 
her, but yet on land. The vessel, in this case, may be said to represent 
a state of things ashore which is known to give rise to the fever-heat, 
moisture, and fermenting substances in a peculiar state of aggregation. 
But Dr. Jewell is disposed to enlarge the range of diffusion and mor- 
bid operation of the miasm evolved from a newly arrived and sickly 
vessel. He believes that this miasm, instead of losing its deleterious 
and toxical power by mixing with the air, acts as a ferment, and thus 
becoming diffused over a larger surface, gives rise to disease on a more 
extensive scale. He admits a certain predisposition in the state of 
the air to be thus affected by the miasm, but he is unable to define in 
what it consists; analogy fails to aid him. Were he to compare the 
process to cremacausis, the main condition determining which, viz., 
the presence of decaying matter, is wanting in the circumambient air, 
which, so far from submitting to its being converted into fresh miasm or 
poison, is itself, by its diluting powers, a weakener, if not direct de- 
stroyer, of such poison. Still more, the combination of this miasm 
with the oxygen of the air would be attended, as in the case of vege- 
table structures, with the disengagement of heat, and occasionally of 
light also; a result totally different from that supposed by Dr. Jewell. 
Looking to what takes place on land during the existence of a yellow 
fever, and to the limitation of the alleged miasm extricated from the 
surface, so that we can trace its boundaries, and at times fence it in, 
we do not find any proof of diffusion of the miasm from its original 
source, or its increasing itself in the atmosphere in the manner sup- 
posed by Dr. Jewell. 
In all our views of the etiology of yellow fever, there is still want- 
ing an essential element, the causa sine, qiba non, to complete and give 
effect to the other conditions for the production of the disease-high 
heat and moisture acting on vegeto-auimal matters. The alleged prod- 
uct of these known appreciable agents, to which may be added elec- 
tricity, we call, hypothetically, a miasm, or volatile poison; but of its 
actual presence, to say nothing of its inherent properties, neither 
chemistry nor microscopy has furnished any proof. 
Dr. Nebinger regarded the question under consideration as one of 836 
THE AMERICAN 
great importance, deriving its value from the results which may grow 
out of the manner in which it may, by physicians and public 
authorities, be determined. If it shall be the general conclusion that 
yellow fever with us can have only a foreign origin, that it can never 
spring up from nor be aggravated by domestic causes, then will all 
our means of prevention be directed to controlling its introduction 
from abroad. If, on the other hand, it shall be determined that it 
cannot be introduced from foreign sources, then there must follow an 
abrogation of all those means now thought important in preventing 
its introduction from such sources. But if it shall be the wise and 
true conclusion that yellow fever can have a foreign origin, and be 
aggravated by domestic causes, then our means of prevention must be 
such as shall meet the double necessity of the case. We must adopt 
the most stringent quarantine measures, and the most thorough do- 
mestic sanitary regulations. He felt confident that yellow fever could 
have a foreign origin, and that its spread, continuation, and malig- 
nancy could be vastly influenced by local causes. He had not arrived 
at this conclusion hastily. It was based upon facts and observations. 
It appeared to him that yellow fever was in some of its habits, and 
particularly that of love of locality, like most epidemic non-contagious 
diseases. It flourishes most where filth most exists, where the atmos- 
phere is most contaminated by noxious gases generated by the rapid 
decomposition of animal and vegetable matter mixed with earthy mat- 
ter. We discourse of cholera, yellow fever, and other diseases gen- 
erating poisons, but what is their shape, or how or in what form they 
exist in the atmosphere, no man knows. All we do know is the ulti- 
mate fact that there is a condition of atmosphere where an epidemic 
prevails, which excites in the living body certain conditions which we 
call cholera, yellow fever, typhoid fever, or otherwise, according to 
the morbid phenomena developed. In what these several diseases 
generating poisons differ, it has not been the happy province of any 
man to make manifest. Whilst, however, the nature and form of the 
materics morbi are not known, there are certain facts well understood 
in regard to the increase of that disease-generating matter; or, if the 
word increase was objected to, then he would say there are certain 
well-understood and duly-recognized conditions which have an influ- 
ence in extending, continuing, and increasing the malignancy of epi- 
demic diseases; and among these well-understood conditions there is 
none more universally recognized than the presence of animal and 
vegetable matter mixed with earthy matter, and influenced by certain MEDICAL GAZETTE. 
837 
thermal and hygrometric conditions. How these conditions influence 
the spread and increase the malignancy of epidemics, is a grave ques- 
tion, and worthy of the most profound consideration. The bare fact 
of the conditions referred to having the influence stated, is generally 
admitted; but the how and the why it is so, is not so generally agreed 
upon. 
The doctrine, he thought, is that, for example, when cholera has 
prevailed epidemically here, that its origin has been foreign; that the 
cholera matcries morbi has been wafted, upon the wings of the wind, 
from abroad. Such admitted, why, in the same city, has its ravages 
been much, very much more in some localities than others; and those 
always the foul and filthy portions of the city? Has an epidemic 
poison the power of self-multiplication ? If so, from what material 
does it multiply itself? Does it find in a pure atmosphere the constitu- 
ents necessary for its development and multiplication ? or are they only 
found in an impure atmosphere, rendered so by the putrefaction of 
animal and vegetable matter in the presence of earthy matter? 
From the fact that those who reside in localities where such an im- 
pure atmosphere exists, are most influenced by the epidemic poison, 
the inference is reasonable, that there is something in the impure at- 
mosphere, which, being acted upon by the epidemic materies morbi, is 
converted by it into matter like unto itself, and thus the epidemic 
poison, multiplying itself, increases in quantity, day by day, until the 
atmosphere of the foul locality becomes as deadly and as destructive 
as the atmosphere about the Upas. An almost infinitesimal quantity 
of the saliva of a rabid animal introduced into the blood of a healthy 
dog, produces, in that animal, hydrophobia, and the dog has generated, 
by the action of that infinitesimal quantity of materies morbi, an 
amount of the poison which so vastly exceeds that which was intro- 
duced into his blood, as to bear to it the relation of a million to one. 
The fact is conceded, that the small quantity of hydrophobic virus 
placed in the dog's blood acted upon the elements found there, and 
multiplied itself to such an extent as to develop in the dog a train of 
symptoms and phenomena identical with those in the animal from 
which it was taken. How was this done ? Who will answer? May 
not certain disease-generating poisons, acting upon elements which 
they find in a vitiated atmosphere, have the power to multiply them- 
selves out of those elements, as the rabies poison has the power to 
multiply itself out of elements in the blood? Starch, gum, and sugar 
are composed of C. H. O,, in precisely the same quantities; yet how 838 
THE AMERICAN 
dissimilar are these three substances! By the action of some law, by 
some peculiar arrangement, a grouping of these same elements, we 
have produced three bodies bearing not the least physical resemblance 
to each other. May not the materies morbi of an epidemic be so con- 
trolled, by some chemical lawr, which enables it to act upon elements 
which it finds in a foul atmosphere, of the character to which he had 
referred, and by its action so group and arrange these elements as to 
produce its kind, and thus multiply itself, until the foul locality be 
rendered remarkable because of the vast and extraordinary mortality 
produced by the epidemic ? Matter-changes, the production of new 
bodies-equally as difficult to produce as the materies morbi of an epi- 
demic in the manner stated-every moment of the day, are being in- 
duced; yet we cannot state or explain how they are produced. By 
the presence-that is the expression used by chemists-of a nitrogcn- 
ized body in a mixture of starch and water, alcohol is developed out 
of the elements of the starch. This is a purely chemical process, and 
when the time shall arrive for explaining the why and the how alcohol 
is generated under such circumstances, then, and not till then, will it 
do to scout the hypothesis 1 am pleading for in regard to the presence 
of the materies morbi of an epidemic being able to develop its kind, 
or multiply itself out of matter which it finds in an atmosphere ren- 
dered foul by the putrefaction of vegetable and animal substances, 
mixed with earthy material. 
In 1849, when cholera in an epidemic form prevailed in Philadel- 
phia, there was, in the southern section of the city, one locality where 
its ravages were so great as to render the place specially attractive- 
Reed Street, from Front Street to the Delaware River, was the local- 
ity. The mortality there was vastly greater than among the same 
number of citizens in any other portion of our city. So many were the 
victims, that it was the remark, at the time, that the undertaker's 
hearse was to be seen in Reed Street at every hour of the day, bear- 
ing away those who had perished by the malignant breath of cholera. 
Why was the mortality in Reed Street so much greater than the mor- 
tality among the same number of persons in other portions of the city ? 
Let the facts be answered: The drainage of Reed Street, from Front 
Street to the Delaware, was extremely defective; the street was not 
paved; from curb to curb, was one vast bed of black mud, enriched 
with kitchen refuse of several years' gradual deposit. At the end of 
the street, at the door of the last house, the culvert emptied thousands 
of gallons, per diem, of putrescent matter on the marsh, several hun- MEDICAL GAZETTE. 
839 
dred yards above low-water mark. There, spread over the marsh in 
the most favorable maimer to promote its speedy decomposition, these 
sewerage ejectments had generated from them malaria, which was 
wafted over Reed Street, and which, when combined with the noxious 
gases generated in the street, rendered the atmosphere of the neigh- 
borhood foul, indeed. A few years rolled by, and Reed Street was 
paved; the culvert extended to low-water mark; the broad marsh, for 
hundreds of yards in front of, and for hundreds of yards above and 
below Reed Street, was wharfed in, filled up, and completely reclaim- 
ed. The drainage was thus vastly improved. Cholera again presented 
itself in 1854. How different the scene then from the saddening one 
presented in 1849! The residents of Reed Street, in 1854, enjoyed as 
great an exemption from cholera as those of the most beautiful and 
attractive localities of our city. Why was this ? the same order of 
people resided in Reed Street in 1854 as resided there in 1849. The 
condition of the houses, as regards light and ventilation, was the same 
at both periods. But the causes of a foul and noxious atmosphere had 
been removed, and, therefore, the elements were not present, in 1854, 
upon which the materies morbi of cholera could act, and by its action, 
multiply itself, and by that multiplication, increase the number of its 
victims. 
What is true, I think, in regard to the manner in which the mate- 
ries morbi, the disease-generating element of cholera, multiplies itself, 
is equally true in regard to the matcries morbi of yellow fever. Let 
us sec. In the summer of 1853 yellow fever made its appearance in 
the neighborhood of South Street wharf. At that time the culvert 
emptied itself into South Street dock. The wharves in proximity to 
South Street were covered with mud and animal and vegetable 
matter to the depth of several inches. The locality was very filthy, 
and the atmosphere was loaded with foul gases generated by the de- 
composition of filth in the dock and on the wharves. Every case of 
yellow fever which occurred in 1853 has been fairly traced to some con- 
nection with South Street wharf. The fact is uncontrovertible, that 
the yellow fever poison was in the neighborhood of South Street wharf, 
and there only. Why did not yellow fever make its appearance else- 
where, if filth in the presence of earthy matter, and certain thermal 
and hygrometric conditions, are all that are necessary to produce that 
disease ? Why was it confined to South Street wharf, when there 
were other localities along the river front, where culverts emptied their 
thousands of gallons of the foulest of matter daily, and wharves also 840 
THE AMERICAN 
in the vicinage were equally as filthy as those in the neighborhood of 
South Street? The same thermal and hygrometric conditions were 
present in those localities as were present at South Street. Yet with 
the same terrene, thermal, and hygrometric conditions prevailing, yellow 
fever was absent. Baker Street, vastly more filthy than South Street 
wharf-Baker Street, the great depot of bones and rags gathered from 
the streets and gutters-Baker Street, with its denizens of all hues, 
from " sooty black to cherry ripe"-creatures as low in the scale of 
morals and human degradation as men and women can be, even they 
were as exempt, with all the excessive filth which was gathered about 
them, as were the residents of our rural districts, from yellow fever. 
Why was this ? There certainly existed in and about Baker Street, 
in the summer of 1853, the terrene, thermal, and hygrometric causes, 
said by some to be the only elements out of which the yellow fever 
poison can be developed. And here, too, were, of all persons, those 
who may truly be regarded as among the most predisposed to any such 
disease. Yet not a single case of yellow fever was developed in 1853, 
from the malaria of Baker Street. How can you account for the ex- 
emption of all the filthy localities of Philadelphia from the ravages of 
yellow fever in 1853-except South Street wharf and its immediate 
neighborhood ? There certainly must have been something peculiar 
to South Street wharf-something which did not exist at the other 
filthy localities, and which must have played a most important and 
grave part, withal, in producing the yellow plague of 1853. And 
was not such the case ? He would answer yes. The Mandarin, a foul 
vessel from a yellow-fever port, on board of which a death from yellow 
fever had occurred before her arrival, was there; and from her hulk, 
her festering, pestiferous hulk, there flowed into the impure atmosphere 
of South Street wharf the miasm, the materies morbi of yellow fever, 
and that miasm found in that impure atmosphere the elements out of 
which to multiply itself; and, thus multiplied most fearfully, did it deal 
its blows of death and consternation among those of that ill-fated 
locality. It will not do for us to close our eyes upon all these facts, 
and composedly say, while we wrap ourselves up in some cherished hy- 
pothesis with which these facts are at ajar, that the Mandarin had noth- 
ing to do with the development of yellow fever at South Street; that 
the fever, and her presence, were mere coincidents. He hoped such 
sad coincidents would not again occur. This doctrine of coincidents 
is dangerous; it is fraught with a host of the most serious consequen- 
ces. Its tendency is to the abolishment of rigid quarantine measures, MEDICAL GAZETTE. 
841 
and points to the throwing wide open the floodgates through which 
diseases may be introduced among us from abroad. If they pointed 
to Norfolk and Portsmouth, Virginia, and asked how he accounted 
for the origin of the terrible yellow fever epidemic there, he would an- 
swer-what the Mandarin was to South Street wharf, the Franklin 
was to Norfolk and Portsmouth. The Franklin there, as the Manda- 
rin at South Street, presented the miasm to a festering atmosphere in 
which it found the elements it required, to so group and arrange as to 
produce its like-the yellow fever materies morbi. He felt free to 
declare, that if the Mandarin had been moored at some other of the 
filthy localities of our river front, instead of at South Street wharf- 
yea, had it been possible to have placed her beside Baker Street, then 
would the other localities-or Baker Street and not South Street 
wharf-have been the place in which the yellow fever plague in 1853 
would have developed itself, and there, as it gathered force and power, 
struck down its victims. 
Dr. Condie said: In 1832 two portions of the British army march- 
ed across a desert in equal lines, but some few miles distant from each 
other. So hot and dry was it, that the bodies of those who died did 
not decompose, but became mummified. There could not have been 
there any decomposition of animal and vegetable matter, yet one of 
these portions of the army had cholera, and was decimated by it: the 
other remained perfectly healthy. Can the gentleman (Dr. N.) an- 
swer how it was that one part of the army was attacked with cholera, 
while the other escaped ? 
Dr. Nebinger said: If Dr. C. means that he should answer him 
now, he would do so. The Doctor knows quite well that there are 
strata as well as currents of atmosphere; that tornadoes or whirlwinds 
pursue for many miles their course in certain narrow lines, frequently 
not more than a quarter to half a mile in width, their whole track 
strewed with uprooted trees, destroyed villages, and desolated homes; 
whilst outside of this narrow line there existed no evidence to show 
any atmospheric disturbance. Vessels heavily laden with human 
freight have quitted Liverpool when there was no cholera there, and 
have, when in mid ocean, had cholera suddenly to make its appear- 
ance among the passenger^. It is conceded that such vessels have en- 
countered a current of atmosphere loaded with cholera poison, and 
from it the disease has sprung up. It is a fact, also, that in such cases 
the disease has subsided quite as suddenly, doing so, doubtlessly, be- 
cause the vessel had quitted the current of poisonous air. Such, indeed, 842 
THE AMERICAN 
is the case almost universally with epidemics. They travel in certain 
lines. They are pestiferous tornadoes, marking their course with 
death and desolation. Such instances of the development of epidemic 
diseases are facts which strengthen the hypothesis for which he con- 
tended. 
Dr. Jewell, in reply to Dr. Condie, remarked that it was true, ves- 
sels had frequently arrived at our wharves, and at the Lazaretto, 
during quarantine, from tropical ports where yellow fever was pre- 
vailing, and had lost some of their crew by the fever on the voyage, 
and even after their arrival at the Lazaretto, and yet had not intro- 
duced the disease; and why ? Because the condition of the atmosphere 
was not as propitious for the development of yellow fever some years 
as in other years; there is wanting that degree of heat and moisture 
to produce the fermentation and decomposition necessary to constitute 
what is called a distempered atmosphere. The arrival of the Man- 
darin in 1853, July 13th, was during that peculiar terrene condition 
of the vicinity of South Street wharf, from filth, and impurities of all 
kinds, acted upon by humidity in a temperature at mid-day, not less 
than 79° to 80°, and when there existed a more favoring state of 
things for the development of the fever. It cannot be denied that the cap- 
tain and mate, who slept on board the Mandarin from the time she ar- 
rived until she was discharged, and even up to the time of their attack, 
both had yellow fever, of which the mate died. Two of the crew died 
on the voyage home, from fever. While she lay at Lombard Street, 
after leaving South Street, where the fever first showed itself, besides 
the captain and mate of the Mandarin, Captain Robinson, of the brig 
Effort, lying in an adjoining dock, his mate, steward, and a seaman, 
all sleeping on board-together with the mate of the Mazeppa, lying 
alongside of the Mandarin, together with some nine others, residing 
on the wharf between South and Lombard Streets-all suffered from 
the yellow fever, between the 19th and 27th of July. These were 
the first cases. From this time, cases continued to occur in the ad- 
jacent streets of the neighborhood. If, as is admitted by Dr. Condie, 
the poisoned atmosphere of a yellow-fever ship may spread in a city 
to a limited extent, what are its bounds ? If it is capable of spread- 
ing 100 yards from the source of the infection, why may it not, waft- 
ed by the wind, or under peculiar states of the surrounding atmos- 
phere, infect a more extended space ? He meant by the state of the 
atmosphere, a condition to reproduce the poison or to increase it; 
whether bv fermentation or other chemical reaction of the elements MEDICAL GAZETTE. 
843 
of the air upon the poisoned air from the vessel, he would not pretend 
to say. Again, Mr. President, if, as the gentleman has told us, no 
epidemic of yellow fever has ever existed in Philadelphia-with which 
opinion all of us cannot agree-then, sir, the argument that the 
fever may be introduced and spread from a foreign poison, is still more 
plausible. Hence, in answer to Dr. Darrach, that if yellow fever 
originates at home, why is a quarantine necessary ? It is to prevent 
foul vessels introducing the disease into our ports; not by contagion, 
but by means of an infected atmosphere. 
At Memphis, in 1855, steamboats from New Orleans introduced 
the disease; and thus a large portion of the city was infected by con- 
taminating the surrounding atmosphere. 
Dr. Wallace asked if it had ever prevailed in Philadelphia, not co- 
incidentally with the arrival of a vessel infected with it. 
Dr. Jewell replied that it had; as no vessel had arrived in 1801, nor 
182G, nor in 1858 in Kensington, to which the disease could be traced. 
There was, in these instances, as far as could be observed, no foreign 
agency. In the latter year it occurred during the foul condition of 
the water in the Kensington basin, with which you are all familiar. 
SELECTIONS. 
[In Dr. Robert Ferguson's prefatory essay to the valuable work 
of Dr. Gooch, just published by the new Sydenham Society of Lon- 
don, we find tmejfollowing just and timely criticised upon the silly con- 
ceit of " Moral Jnsauity," a topic upon which we have haaf occasion 
to comment in t|ie GaZ^s, during the late Excitement produced by 
the Huntingtoil trial, and Hiq unsuccessful Morts of certain doctors 
and lawyers tomngraft it into "bur criming/jurisprudence. The views 
we have from time to time set fort^an^ which have been fully sus- 
tained by all the American authoritiej^u the reviews of our Report 
to the American Medical Associati^ for'1,85^, it will be seen are 
here amply corroborated by our Rntish confreres.-Ed.] 
| / Jr 
MOR^f INSANITY. 
From the chapter on in^iity, considered as an object of moral 
science, the student may replenish his armory with weapons ^ecessary 
to meet the attacks of those who, even at the present moment, con- 
tend that the knowledge of the physician is unnecessary and non- 
essential to the treatment of mental malady. If it be possible ever 844 
THE AMERICAN 
to rescue this most difficult of subjects from the audacity of diletante- 
ism, or from ignorant philanthropy, Gooch's arguments should do so. 
At first sight Gooch may seem to rely, too exclusively, on corporeal 
treatment, banishing the moral; but a collation of his views will show 
this idea to be erroneous, as his tenth case proves. So long as we 
acknowledge the " commercium," or fellowship of mind with body, so 
long must we not dare to neglect their reciprocal 'influence in the 
treatment of mania. The battle between Somatist and Spiritualist is 
an idle strife. The whole theory of morals is based on the postulate, 
that the mind is susceptible of change by spiritual agencies. The 
foundations of education repose on the fact of mental nourishment for 
mental development. A course of ethics is more likely to enlighten 
our morals than any alterative virtues of sarsaparilla; and the disci- 
pline of old Euclid will scarcely be displaced in elucidation of geometric 
truth by the quintessence of any pharmacopoeia. Look on the brain, 
as the organ of thought, and we adopt a theory with all its conse- 
quences-and the Iliad, the Paradise Lost, the delicim of Shakspeare 
and Dante, become mere cerebral secretions. Say that the brain is 
the medium by which we think, and we express a simple fact devoid of 
all theory, consonant with what we know of every other force in 
nature, namely, that not one is manifested to us except through a 
medium; its own essence, is behind the generated phenomena, in a 
world divined, but not seen nor felt. 
Besides these general arguments on the side of the Spiritualist, the 
sudden return to sanity of the insane, so frequently witnessed, is in 
accordance with the laws of mental change, and admits of no better 
explanation than that which accounts for our sudden convictions. 
Organic chemistry is too tardy in its exhibition of molecular action 
to afford the faintest aid in explaining the advent of that inner ray, 
which, in the twinkling of an eye, dispels the gloom of the disordered 
mind; still less will it account for those flashes from genius which 
lighten and guide mankind from age to age in its conflict with the 
moral and the material world. 
Gooch has barely opened the great question as to the nature of in- 
sanity, when he demurs to the legal definition of it, as consisting in 
"insane belief." The belief may be rational and well founded, but it 
may still exercise an undue action on feeling and conduct, breaking 
up those finer judgments and processes of thought by which the sound 
mind is regulated.