PICOD 8 W MEMOIR CONTAINING INVESTIGATIONS ON THE GEOGRAPHICAL DISTRIBUTION, CAUSES, NATURE, RELATIONS AND TREATMENT OF VARIOUS DISEAS^B^A 1855-1890. Vs. G. o J BY JOSEPH JONES. AA. D„ KI professor of Chemistry and Clinical Medicine, Medical Department Tulane University of Louisiana; Visiting Physician of Charity Hospital; Honorary Fellow of the Medical Society of Virginia; Formerly Surgeon in the Provisional Army of the Confederate States; President of the Board of Health of the State op Louisiana, 1880, i88r, 1882, 1883, 1884; President of the Medical Society op Louisiana, 1888; President of Section XV. {Public and International Hygiene} Ninth International .Medical Congress, Washington, D. C., U. S. A., 1887; etc., etc. VOLUME III.-In Two Parts. PART I. indemic, Epidemic, Contagious, and Infectious Diseases; Measures for their Prevention, and Arrest; Malarial Fever, Yellow Fever, Typhoid Fever, Asiatic Cholera, Small Pox, Varioloid, Varicella, Cow Pox, Vaccination Spurious Vaccination, Measles, Scarlatina, Diptheria, Phthisis Pulmonalis, Syphilis, Alcoholism. Theory and Practice of Quarantine, Relation of Drainage, Soil, Food, Water and Climate to Endemic, Epidemic, Contagious, and Infectious D iseases. Application of Measures for the Exclusion and Arrest of Yellow Fever and Small Pox in the Mississippi Valley, Illustrated by the Quarantine and Sanitary Operations of the Board of Health of the State of Louisiana during 18S0, 1881, 1882, and 1883. PART II. fonographs illustrating the following subjects: Philosophical Principles of Education and their Scientific ! Application to tiie Development and Perfection of the Medical Profession, Vital Capacity of the Human : Lungs in Health and Disease, Contribution to Teratologv, General Medicine, Diseases ot the Nervous System, Congenital and Acquired Insanity, Advancement in the Treatment of the Insane during the Nineteenth Century, Treatment of the Insane in Louisiana, Medical History of the Insane Asylum of the State of Louisiana, 1848-18S9. The Relation of Quarantine to Commerce in the Valley of the Mississippi River, The Use of Antipyretic Remedies in Febrile Diseases, Public and International Hygiene, Progress of the Discov- ery of Disinfectants and their Application for the Arrest of Contagion, A History of Maritime Hygiene as applied by the Great Naval Powers illustrated, by eight Chromo-Lithographic Plates; twenty-one Maps and Charts; twenty- two Extensive and Elaborate Tables, and seventeen Engravings. Vince Malum Bono. NEW ORLEANS, LA. : Joseph Jones, M. D., 156 Washington Avenue, Cor. Camp St,, 4TH District. 18©O. ALL RIGHTS RESERVED. Entered according to Act of Congress, in the Year 1887, by JOSEPH JONES, M. D., In the office of Librarian of Congress at Washington, D. C. HHINTED FOR THE AUTHOR BY L, GRAHAM & SON, 99-103 GRAVIER ST., NEW ORLEANS. LA. PREFACE. The term Memoir is used in its comprehensive sense, embracing not merely an account of transactions and events in which the author enacted a nominent part, but also monographs and exhaustive discussions and investi- gations of important subjects relating to the Science of Medicine. The term Medical is used in its widest acceptation, as embracing the discussion of subjects relating to the causes, nature, treatment and prevention of various diseases, including domestic sanitation and public and interna- tional hygiene. In this the third volume of the medical and surgical memoirs sub- jects of it.rtance to the welfare and advancement of the human race are discussed, in the order in which they have engaged the attention and engrossed the physical and intellectual energies of the author in the discharge of his official duties, and in the prosecution of his original investigation on the natural history and treatment of diseases, and their relations to soil, waters and- climate. While the experience and labors of thirty-five years of active and unremti- t:ng medical service has been freely used in conducting various medical and sanitary operations and investigations,recorded in this volume, it must, how- ever, be noted that the period especially under observation embraces the last decade, 1880-89, inclusive. The first four years (1880, 1881, 1882 and 1883) of these ten years must be regarded as most important in the history of public hygiene, in the North American republic, in the light of the magnitude of the issues involved and the importance of the lesults accomplished. When in 1880, the Presidency of the Board of Health of the State of Louisiana was imposed upon the author, through the action of His Excellency, Louis Alfred Wiltz, Governor of the State of Louisiana, the quarantine appli- ances were in a dilapidated condition, and the quarantine system in a deplorable state. Sanitary regulations were daily disregarded by the citizens, and the quarantine laws of the State were openly vio- lated by rich and powerful steamship and railroad corporations. The sanitary and quarantine authorities of Louisiana were regarded by many with suspicion, dread and hatred, and New Orleans was looked upon as a plague spot and: constant menace to the health and prosperity of the inhabitants of the great valley of the Mississippi. The diverse opinions of medical men as to the imported or indigenous nature of yellow fever, the pronounced hostility of many of the citizens to measures of quarantine, and the ravages of yellow fever in former y< ars, and more specialy in 1878. when it invaded New Orleans, availed itself of all ihe modern facdities of transportation and spreading itself broadcast over a wide area of the Mississippi valley, carrying death and terror: these were the potent causes which destroyed the confidence of the citizens of neighboring States in the wisdom of the medical profession and ill the honesty of purpose of the merchants of New Orleans, and laid the ground work for sensationaL rumors, panics and unreasoning and brutal shot-gun quarantines. 4 PREFACE. It was deemed of importance that all facts relating to the history, THEORY AND PRACTICE OF QUARANTINE, AND TO THE MEASURES INSTITUTED FOR THE ARREST AND EXCLUSION OF CONTAGIOUS DISEASES AND ESPECIALLY yellow fever from the valley of the Mississippi, should be fully set forth for the information and guidance-of the medipal profession . The Board of Health organized in accordance with the provisions of the Constitution of 1879, by the late Louis Alfred Wiltz, Governor of Louisiana, commenced its labors with scant resources, and with the quarantine establish- ment in a dilapidated condition. By rigid economy, and by the wise counsels of the patriotic members of the Board of Health, the quarantine stations were repaired and equipped, the approaches to the southern and eastern shores of Louisiana were strengthened by additional guards, every obligation was promptly met by cash payments, <ind the President and Finance Committee retired at the expiration of their terms of service, April, 1884, leaving a surplus of near ten thousand dollars in bank to the credit of the Board. During the four years 1880-1883, 4436 vessels (more than one-half or 2457 of which were large ocean steamships), exceeding 8,000,000 tons, were inspected by the officers of the Board of Health at the Mississippi quarantine station, together with their crews and passengers, which numbered over 100.000 During the same period 479 vessels from ports infected with yellow fever were held in the Mississippi quarantine, disinfected and fumigated. At the Atchafalaya station, 1064 vessels, about one-half of which were ocean- going steamships, with about 20,000 souls, crew and passengers, were in- spected ; and at the Rigoletes quarantine station, about 4338 vessels, chiefly schooners, with about 24,000 seamen and passengers, were inspected during the years 1880, 1881, 1882 and 1883. During the period specified, therefore, the Board of Health of the State of Louisiana, through its faithful, experienced and energetic officers, in- spected about 10,000 vessels, which carried not less than 150,000 seamen and passengers. Notwithstanding the prevalence of yellow fever in Vera Cruz, Havana, -and Rio de Janeiro during this period, and notwithstanding the prevalence of yellow fever at Brownsville, Texas, and at Pensacola. Florida, in 1882, and at the Naval Reservation, Florida, and at Brewerton, Alabama, in 1883, and notwite'tanding the presence of yellow fever at the Mississippi Quarantine Station in 1880 and in 1882, New Orleans and the Mississippi Valley were free from this terrible scourge. The reader will find in the present volume a detailed statement of the relations of climate to endemic and epidemic diseases and especially of heat and moisture to the origin and dissemination and progress of yellow fever, together with a full and accurate record of the sanitary measures instituted for the arrest of contagious and infectious diseases. The labors of the author in Louisiana during the years 1880, 1881, 1882 and 1883, have established the following conclusions: 1 Yellow fever is not indigenous to New Orleans. 2. Yellow fever is not indigenous to Louisiana. 3. Yellow fever is not indigenous to the Mississippi Valley. 4. Yellow fever can be excluded front New Orleans and the Mississippi I alley by a rigid and effective quarantine. 5. Quarantine to be effective, must embrace not merely inspection and detention, but discharge of infected cargoes, thorough ventilation and fumi- gation and disinfection by the recognized methods of Sanitary Science. 6. The citizens of Louisiana should demand that the members of the Board of Health appointed by the Governor and Common Council of New PREFACE. 5 Orleans should be men competent to devise and execute the measures necessary to the exclusion of foreign pestilence from the waters of Louisiana. After a continuous battle, of four years duration, in which the vast mari- time interests of the State, and the power and influence of the wealthiest rail- road and steamship company in the Southwestern States were marshalled against the legally constituted health authorities, the Board of Health of the State of Louisiana achieved a memorable and signal victory on the twenty- first of January, 1884, in the complete and triumphant vindication of its efforts to exclude foreign pestilence from the Nlississippi Valley, by the high- est legal tribunal of the State of Louisiana, (pp. clxix.) If the decision of the Supreme Court had been adverse to the Board of Health, the quarantine laws of Louisiana would have been rendered power- less for the exclusion of foreign pestilence. Quarantine must be sustained either by an appropriation from the State government, or from the inspec- tion fees ; the General Assembly of Louisiana had made no appropriation for the maintenance of quarantine; therefore if the decision of the Lower Court had been sustained by the Supreme Court of Louisiana, an extra session of the Legislature would have been necessary for the appropriation for the support of the officers and employees, the supply of disinfectants, the maintenance of the hospitals, and the isolation and treatment of seamen and passengers, suffering with contagious and infectious diseases. The actual ex- penses of an extra session of the Legislature of Louisiana would have imposed an additional burden upon the taxpayers of the State which would have exceeded the amount now collected for the support of quarantine at least four times ; in other words, the expenses of the extra session would have been sufficient to maintain the quarantine system, during a period of four years and longer. The records of the Board of Health show that the Morgan's Louisiana and Texas Railroad Company was indebted to the State of Louisiana, for quarantine fees, about $14,380; and the Cromwell Steamship Line $8400; total amount due to the State of Louisiana by the Morgan and Cromwell lines, about $22,785. The decision of the Supreme Court of Louisiana, in case No. 8755, not merely relieved the citizens from the additional expense of an extra session of the General Assembly, but also affirmed the right of the State to over $22,000 due for unpaid quarantine fees by the Morgan and Cromwell lines. The decision of the Supreme Court of Louisiana has confirmed the view held and strenuously advocated by the President of the Board of Health that: The fees collected by the State of Louisiana from vessels subjected to the queer antine laws are not in the nature of a tax or impost on commerce, but are a just and necessary .compensation for the great service rendered commerce in the cleansing and disinfection of the vessels and cargoes, in the care and treatment of the sick, by the medical officers of the State, and by the exclusion of foreign pestilence, and the establishment of public confidence and the maintenance of commerce, which, but for said quarantine service, would be greatly damaged. Were it not for the execution of the quarantine laws by the Board of Health of the State of Louisiana, the port of New Orleans would be hermet- ically sealed to commerce during from four to six months every year, and all intercourse with the surrounding States would be closed by the shotgun quar- antines controlling the river and railroads. The decision of the Supreme Court of Louisiana is of interest and im- portance to every State and municipal government in the United States of America, for the doctrine is hereby clearly recognized, that: The establishment and enforcement of quarantine by individual States 6 PREFACE. is not a regulation of commerce in violation of the provisions of the Federal constitution, but is the legitimate exercise of the police powers by the indi- vidual States, which are inalienable. The Supreme Court of the United States, in the appeal which was taken by Morgan's Louisiana and Texas Railroad and Steamship Company from the decision of the Supreme Court of Louisiana, sustained the decision on the 2 ist of January, 1886, and thus the views and actions of the author, in his official capacity as President of the Board of Health of Louisiana, are now upheld by the finding of the highest tribunal of the republic. These judicial decisions, which are of prime importance to all local and State Boards of Health, have been treated in the third volume of the Medi- cal and Surgical Memoirs, Part I, p. clxix; Part II, pp. 299-306. All facts and measures relating to the prevention of endemic, epidemic, contagious and infectious diseases are of interest and importance to sanita- rians, physicians and political economists. Efforts to exclude and arrest contagious diseases possess peculiar value, when exerted in behalf of the inhabitants of some great commercial metropo- lis, like New Orleans, whose existence and prosperity are indissolubly bound up with those of the people living upon the banks of her great river, and within the bounds of the fertile plains of its mighty valley. During the years 1853, 1854 and 1855, Mew Orleans lost 12,780 of her citizens by yellow fever, an exotic imported disease; and in 1878 she lost by yellow fever 4056 souls and $15,000,000. The internal or interstate trade of New Orleans equals annually about $200,000,000, exceeding greatly the value of the foreign imports and exports. The preservation of this internal interstate trade depends absolutely upon an efficient quarantine guarding the approaches of the Mississippi valley from the Gulf of Mexico. New Orleans will become a great manufacturing centre for cotton, tobac- co, jute and sugar, provided that pestilence is kept away by a rigid system of domestic sanitation. If yellow fever is allowed to enter, this port will be hermetically sealed ; and during the embargo, which may last as long as six months, there will be practically non-intercourse with the surrounding States, and all manufactories will be closed, as there will be no possibility of shipping manufactured arti- cles. No system of manufactories, however well ordered, can sustain such periods of inactivity. The exemption of New Orleans and the Mississippi valley from yellow fever during the years 1880, 1881, 1882 and 1883, has been with justice referred to the rigid system of quarantine inspection, detention and sanitation estab- lished and executed by the author. With the continuous execution of similar measures, it is reasonable to believe that yellow fever will be permanently banished from Louisiana. With the definite settlement of the relations of quarantine and commerce by the decisions of the Supreme Courts of Louisiana and of the United States, all the barriers which have hitherto barred the progress of scientific quarantine and maritime sanitation have been removed, and the establishments and reg- ulations of each and every State in the union are protected by the strong ARM OF THE LAW. By mutual agreements and by the adoption of uniform quarantine ar- rangements, and by a hearty cooperation with the representatives of the na- tional government, it will be practicable for the seaboard States of this republic to form an impregnable cordon against yellow fever and all other foreign pestilences. PREFACE. 7 We have presented tabular views of the comparative symptomatological and comparative anatomy and pathology of malarial and yellow fever, based upon the investigation of more than a quarter of a century. This tabular view is intended as a text book and guide to physicians, who may be brought in contact with yellow fever. See volume III, part I, pages 43'87; The prevalence of small-pox in the States tributary to the Mississippi river, and the constant danger to which Louisiana is exposed from her geo- graphical position, and from the peculiar race conditions of the lower sections of the Mississippi valley, as well as the neglect of vaccination by large masses of the population, and the growth of a sentiment opposed to vaccination, on the part of the profession and people, rendered it necessary that a special work should be issued on small-pox (variola), modified small-pox (varioloid), chicken-pox (varicella), cow-pox (varioloe vaccince), vaccination and spurious vaccination for the guidance of Quarantine Officers and Sanitary Inspectors and for the information of the legal and medical profession of the United States. No more important subject can engage the attention of the medical pro- fession and sanitary authorities, and the representatives of the State, Municipal and parish governments, than the prevention of small-pox. Vaccination and all that relates to vaccination is of paramount importance to the welfare of the inhabitants of this republic. In the first part of this volume of the Medical and Surgical Memoirs the author has reproduced the following works: ^An inquiry into the causes and effects of the variolce vaccince, a disease discovered in some of the Western counties of England, particularly Glou- cestershire, and known by the name of the cow-pox. By Edward Jenner, M. D. and F. R. S., etc. Third edition, London, 1801. We have selected the third edition of the works of Edward Jenner, published in London in 1801, because we find upon careful comparison of the three editions, published respectively in 1798, 1800 and 1801, that the latter appears to have received most careful revision by Dr. Jenner. I have selected the plates from the first edition, published in 1798, because the impressions are better defined and colored with more care than those of the second and third editions. The identical plates appear to have been used in the printing of the two editions. "Further observations on the Variolce VaccinceP By Edward JenneY, M. D. and F. R. S. "M continuation of facts and observations relative to the variolce vac- cince of Cow-Pox.'" By Edward Jenner, M. D. and F. R. S., etc. London, i8ot. ''•An inquiry into the history of the Cow-Pox, principally with a view to supersede and extinguish the Small-Pox." By George Pearson, M. D. and F. R. S. "Reports of a series of inoculations for the variolce vaccince or Cow- Pox with remarks and observations on this disease considered as a substitute for the Small-Pox." By William Woodville, M. D. The publication of these works is followed by the author's original remarks on the following subjects: The nature and causes of the Epidemics of Small-Pox which have fol- lowed the introduction of vaccination by Dr. Edward Jenner. In the comparative advantages of the Inoculated Small-Pox and of the Cow-Pox. History of Small-Pox Inoculation. 8 PREFACE. Mortuary Statistics of Small-Pox in various Countries. History of Cow-Pox Inoculation in Europe and America. History and Statistics of Vaccination in Europe and America. The relation of grease in the horse's heels to CoW-Pox. Character and Cause of Horse-Pox. General Description of Cow-Pox illustrated by chromo-lithographic com- parative views of the Natural Small-Pox, inoculated Small-Pox and Cow- Pox. Comparative Phenomena of Small-Pox, Inoculated Cow-Pox, Cow-Pox, and Modified Small-Pox, or Varioloid : illustrated by chromo-lithographs. Spurious Vaccination or the Abnormal Phenomena accompanying and following Vaccination. Causes of the various deviations of the Vaccine Disease from the Normal Course-introduction of other diseases into the organism by vaccination; Vaccine Syphilitic inoculation ; Accidents attending vaccination in the army of the Confederate States during the Civil War, 1861-1865: illustrated by chromo-lithographs. The portion of this work devoted to the consideration of Small Pox, Cow-Pox, Chicken-Pox, and Spurious Vaccination, extends from page 135 to page 542 inclusive of the First Part, and embraces absolutely all the investi- gations and observations of the author relating to these important subjects during the past thirty years. The Second Part of this Volume contains a series of monographs relating chiefly to: Medical Education. Teratology. Nervous Diseases. Insanity. Public and International Hygiene. Progress of the Discovery of Disinfectants and their Application to the arrest of Contagion. A History of Alaritime Hygiene as applied by the Great Naval Powers. This portion of the work occupies 551 closely printed pages, and con- stitutes the labors of the author in 1886 and 1887, as President of the Fif- teenth Section, Public and International Hygiene of the Ninth International Medical Congress, and as Vice-President, President and Chairman of the Committee on General Medicine of the Louisiana State Medical Society, during the years 1887. 1888 and 1889. The researches of the author on the history of insanity and its causes, and on the condition and treatment of the insane in Louisiana, completes his medi- cal and sanitary labors in behalf of his fellow citizens, conducted continuously during the past decade, 1880 to 1889. These researches in insanity have been conducted upon the broadest prin- ciples of humanity, and have for their sole object the alleviation of the condi- tion of the insane. In this monograph upon insanity as well as in the suc- ceeding one on the Relations of Quarantine to Commerce in the Mississippi Valley, the legislatures of the State and National Governments will find im- portant material for their careful consideration and official action. Some estimate of the extent of the labors now recorded for the use of the medical profession, may be formed from the facts that this third volume of the Medical and Surgical Memoirs embraces over 1540 closely printed pages, and is illustrated by 8 chromo-lithograph plates, 21 maps and charts, 22 large and elaborate tables, and 17 engravings. The chromo-lithographs relate chiefly to cow-pox, small-pox, and arm vaccination, varioloid, spurious vaccination and hospital gangrene. PREFACE. 9 The maps, charts and plans Illustrate the topography and settlement of the delta of the Mississippi Valley, and the progressive development of New Orleans. The great problem of effective drainage can best be eluci- dated by presenting a series of plans and charts. The medical topography of Louisiana can be comprehensively studied by the aid of the maps, colored ac- cording to the geological and botanical characters of the different natural di- visions of the State. The position and relations of the quarantine system of Louisiana, as well as the remarkable formation of the coast of this State, will be fully illustrated by the maps executed for the author by the late distinguished engineer, Col. T. S. Hardee. In the construction of the extensive and elaborate tables, the author has spent his time, labor and money to secure a tabular form of the vital, mortuary, commercial and climatic statistics of Louisiana and of New Orleans, and he feels assured that the great mass of facts thus tabulated will prove of lasting value to the students of medicine, hygiene, agriculture, commerce, cli- matology and political economy in this and other countries. Joseph Jones, M. D., 156 Washington Street, Fourth District, New Orleans, La., Jan. 1890. CATALOGUE OF CHROMO-LITHOGRAPHS, TABLES MAPS, CHARTS, PLANS AND ENGRAVINGS. CHROMO-LITHOGRAPHS ILLUSTRATING VOLUME HI-MEDICAL AND SUR- GICAL MEMOIRS OF JOSEPH JONES, M. D. PLATE NO. 17. Figure 76. Hand of Sarah Nelmes, a dairy-maid, infected with the cow-pox, Mav, 1796. plate no. 1. Case XVI. " An inquiry into the causes and effects of the Variola? Vaccinae, bv Ed- ward Jenner. PLATE no. 18. Figure 77. Arm of John Baker, a child vaccinated March 16, 1798. PLATE NO. 2. Case XVIII. Inquiry, etc., Edward Jenner. Figure 78. Arm of William Pond, Case XX. plate no. 3. Inquiry, Edward Jenner. Figure 79. Arm of Hannah Excell, Case XXL plate no. 4. Inquiry into Variola; Vaccina*. Edward Jenner. plate no. 19. Figure 80. The casual cow-pox in the teats and udder of a black and white milch cow. After Mr. Ceely of Alesbury. plate no. 20. Figure 81. Confluent Small-Pox. Figure 82. Confluent Small-Pox. Figures 83, 84 and 85. Small-Pox Pustules. PLATE NO. 21. Figures 86-90. Figure 86, Varioloid; Figure 87, Small-Pox eruption; Figure 88, Small-Pox eruption; Figure 89, Varioloid eruption; Figure 90, Varioloid eruption. PLATE no. 22. Figure 91. Arm of federal prisoner. Hospital Gangrene; attacked small abrasion near elbow; amputation; death. Andersonville, Georgia, Sept. 20, 1864. From nature, by Joseph Jones, M. D. plate no. 23. Figure 92,. Leg of Thomas Cole, private 3d Regiment Georgia Reserves, guarding federal prisoners at Andersonville, Ga., Sept. 22, 1864. While guarding the stockade Hospital Gangrene attacked abrasions of the skin on the right foot and leg. From nature, by Joseph Jones, M. D. plate no. 24. Figure 93. Hand of W. J. Black, Confederate soldier, poisoned by prick of pin whilst dressing. Hospital Gangrene. Represents gangrene spreading rapidly on third finger. October 3, 1864. Drawn from nature, by Joseph Jones, M.D. The plates 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 and 15, referred to in the Tabular Form en- titled General Outline of the Symptoms and Pathological Anatomy of Yellow and Mala- rial Fevers, pp. 44-85, Part 1, Volume iii, Medical and Surgical Memoirs, have already been presented in Volume ii. The reader is referred to Volume ii, Medical and Surgical Memoirs, for the plates il- lustrating this elaborate comparison of the Comparative Pathology of Malarial and Yellow Fevers. CATALOGUE OF CHROMO-LITHOGRAPHS, TABLES, MAPS, ETC. 11 Tables illustrating the Vital Nosological, Mortuary, Commercial, Climatic Statistics at the Delta of the Mississippi Valiev, and more especially of New Orleans, Louisiana; collected, classified and published by Joseph Jones, M.D., of New Orleans, Louisiana, for the illustration of Volume Hi of his Medical and Surgical Memoirs. Table illustrating the increase of population in the City of New Orleans during a series of 96 years, with the total mortality for each year, and the death rate per 1000 in- habitants per annum; also deaths from Yellow Fever, Maximum and Minimum Temper- ature and Rainfall. Volume iii, Part I. TABLE A.-Vital Nosological and Mortuary Statistics of the Charity Hospital of New Orleans, embracing Total Admissions and Discharges and Deaths, also admissions and deaths of the more important and prevalent Diseases, during a period of eighteen years preceding the American Civil War, and a period of seventeen years following the American Civil War, 1842-1867 and 1864-1880. Total period 34 years. Volume iii, Part I. TABLE B.-Foreign Countries and States of the American Union from which the pa- tients annually admitted into the Charity Hospital of New Orleans, Louisiana, have come, and the number from each during a period of forty-five years, 1830-1880. TABLE C.--Mortuary Statutes of New Orleans, Louisiana, during a period of thirty- four, years, 1849-1880, Volume iii, Part I. TABLE D.-Mortuary Records of New Orleans by the month and by the year for four years, 1850, i860, 1870 and 1880, in which the United States census was taken, and in which yellow fever did not prevail to any extent. Volume iii, Part I. TABLE E.-Mortuary Records of New Orleans by the month and by the year for four years, 1858, 1858, 1867 and 1878, in which yellow fever prevailed with the greatest severity in the annals of the city. Volume iii, Part I. TABLE F.-Vital and Mortuary Statistics of New Orleans--Mortality of White and Black Races in New Orleans, Louisiana, during three years, 1849, I85° and 1853 pre- ceding the Civil War (1861-1865), and during the period of slavery; also illustrating weekly and daily mortality by cholera and yellow fever for 1846, 1847, 1851, 1852, 1853, 1854, 1855, 1857, 1858, 1866, 1867 and 1878; also deaths from zymotic and epi- demic diseases (small-pox, measles, scarlatina, typhus fever, typhoid fever, yellow fever, malignant or Asiatic cholera, etc.), with death rate per 1000 inhabitants from epidemic and zymotic diseases. Volume iii, Part I. TABLE G.-Mortuary Statistics of New Orleans, La., illustrating the mortality by months in the white and black races, during five years, subsequent to American Civil War 1877, *878, i§79» 1880 and 1881. Volnme iii. TABLE H.-Meteorological Statistics of New Orleans for the year 1881, giving the daily range of mortality and of the thermometer, barometer and rainfall for the entire year; also deaths reported by the coroner and those which occurred in charitable and public institutions, including the Charity Hospital of New Orleans, during the year 1881. Volume iii. Part II. TABLE I.-Comparative Meteorological Records of the Years 1850, 186o, 1870 and 1880, in which the United States Census was taken, and in which yellow fever did not pre- vail to any extent. Volume iii. Part II. TABLE J.-Comparative Meteorological Records of the Years 1847, 1853, 1858 and 1878, in which Yellow Fever prevailed in the Epidemic Form. Volume iii. Part II. TABLE K. 1. Exports and Imports of New Orleans, from 1805 to 1882. 2. Exports and Imports of New Orleans during 1882. 3. Value of the Products of the Interior, received at New Orleans, 1841, 1842 to 1881-82. 4. Coffee Trade of New Orleans, 185410 1882. 5. Total Sugar Crop of Louisiana; annual values, with total deaths from all causes and from yellow fever, 1828 to 1882. 6. Sugar Crops of 1880-81 and 1881-82; number of sugarhouses in operation. 7. Molasses, crops of, 1877 to 1882. 8. Rice, 1865 to 1882. 9. Bacon, prices, of 1S74 to 1880. 10. Lard, monthly receipts 1880-81 and 1881-82; exports. 11. Flour, receipts, sales, export and stock by months, 1881-82; by years, 1874 to 1882. 12. Grain, shipments of, 1881-82. 13. Total number of vessels cleared 1881-82. 14. Grain, total export of, 1880-81. 15. Tobacco, receipts and exports, 1822 to 1882. 16. Cotton, receipts and exports, 1822 to 1882. • 12 CATALOGUE OF CHROMO-LITHOGRAPHS, TABLES, MAPS, ETC. 17. Southern Staples and Western Produce, value of receipts, 1841 to i860; (Cottonr Sugar, Molasses, Tobacco, etc.) 18. Cotton, total product, gross receipts at New Orleans, average price, 1870 to 1882; exports, whereto; futures, sales of; 1880-81; receipts at United States ports; sources of receipts at New Orleans; consumption. 19. Cotton, dates of first receipts, 1849 to 1882; number of bales received previous to August 31, 1870 to 1882. 20. Cotton, amount carried by Chicago, St. Louis and New Orleans Railroad, 1876 to 1882. 21. Cotton, exports of and destination, 1826 to 1836; tobacco, exports of and desti- nation, 1826 to 1836. 22. Exports of and destination, 1851 to 1857, tobacco, exports of and destination, 1851 to 1857. 23. Cotton, exports of and destination, 1871 to 1881. 24. Customhouse receipts, 1879-80 and 1880-81. 25. United States Sub-treasury, receipts and disbursements, 1880-81-82. 26. Imports from the Interior, 1847 to 1857. 27. Imports from the Interior, 1828 to 1836. 28. Cotton, exports and destination, 1851 to 1857; Tobacco, exports and destination, 1851 to 1857. 29. Sugar and Molasses, exports of, 1854-57; Flour, Pork, Bacon, Lard, Beef, Whisky and Corn, exports of, 1855 to 30. Coffee, Sugar and Salt, imports of, 1855 to 1857; Cotton and Tobacco, receipts of, 1847 to 1857. 31. Cotton and Tobacco, receipts and exports of, 1822 to 1857. 32. Specie, imports of, 1845 to I857> 33. Sugar, exports of, 1834 to 1855; first receipt of new crop. 34. Produce, receipts and estimate value and average price, 1S56 to 1S57. 35. Produce, value of, 1854 to 1857. 36. Produce, value of, 1847 to 1854. 37. Imports, dutiable, free and bullion and specie, 185510 1856. 38. Produce, receipts from the interior, 1853 to 1865. 39. Produce, receipts from the interior, value of and average price, 1859-60, 1863-64, 1864-65. 40. Produce, value of receipts from the interior, 1859-60, 1863-64, 1864-65. 41. Produce, receipts of, 1859-60, 1863-64, 1864-65. 42. Produce, table showing increase and decrease of receipts, 1859-60, 1863-64,. 1864-65. 48. Sugar, exports of, 1860-65. 49. Molasses, exports of, 1860-65. 50. Molasses, shipments up river, 1863-65. 51. Flour, Pork, Bacon, Lard, Beef, Whisky and Corn, amount, export and destinat- ion, 1863-65. 52. Staves, exports of, 1863-65. 43. Coffee, Sugar, Molasses, Salt, direct imports of, 1858-65. 44. New and Old Basins, receipts, at 1864-65. 45. Cattle, receipts of, 1864-65. 46. Cotton, exports of, destination, 1855-65. 47. Tobacco, exports of, destination, 1855-65. 53. Produce, exports of each class, 1864-65. 54. Cotton, receipts of, 1864-65. 55. Cotton, total crop, receipts at New Orleans, average price per bale, total value,, date of first receipt and receipts previous to Septembei 1, 1855-65. 56. Cotton, Middling, comparative prices of, 1860-65. 57. Cotton, total crop, received at New Orleans, average price per pound, 1853-65. 58. Cotton quotations for Middling at the close of each month, with rate of gold and sterling bills, 1864-65. 58. Cotton quotations of highest and lowest point in each month for Low Middling to Middling, 1864-65. 59. Cotton, receipts, exports and stock, 18^5-65; Cotton, statement of September 1, 1865. 60. Cottonand Tobacco, exports and destination, 1867-77. 61. Cotton and Tobacco, exports and destination, 1876-82. 62, Produce, imports from the interior, 1872-82. 63. Cotton and Tobacco, receipts, exports and stock, 1869-79. 64. Produce, imports from Northern ports bv Steamships and Sailing Vessels, 1876-79- 65. Produce, exports of, 1877-78. CATALOGUE OF CHROMO-L1THOGR APHS, TABLES, MAI'S, ETC. 13 <66. Old Basin, receipts at, 1878-78. 67. New Baisin, receipts at, 1878-79. 68. Livestock, arrivals of, kind, 1878-79; prices of different kinds, 1878-79. 69. Produce, amount of each kind received, average price, total value, 1875-77. 70. Produce, amount of each kind received, average price, total value, 1877-79; com- parative statement of total value, 1869-77. 71. Flour, Pork, Bacon, Lard and Corn, exports of and destination, 1876-79; Sugar and Molasses, exports of and destination, 1874-79. 72. Produce, amount of receipts, average price and total value, 1880-82. 73. Produce, exports of, 1880-82. 74. Coffee, Sugar, Molasses and Salt, direct imports of, 1879-82 75. Imports, from Northern ports by vessels, 1880-81. 76. Clearing-house, statement of, 1873-79. 77. Ships, Brigs, Schooners, Sloops and Steamboats, arrivals of, 1832-36, by month. 78. Ships, Brigs, Schooners, Sloops and Steamboats, arrivals of, 1854-57. 79. Flatboats, arrivals of, by month, 1856-57. 80. Seagoing Vessels, arrival of aggregate tonnage, aAerage tonnage, per vessel, 1850-60. 81. Seagoing Vessels, kind, arrivals of, 1847-65. 82. Clearances of Vessels, 1863-65, by months and kind. 83. Ships, Barks, Brigs, Schooners, Steamships and Steamboats, monthly arrivals, 1872-77. 85. and 84. Ships, Barks, Brigs, Schooners, Steamships and Steamboats, monthly clearances, 1874-79; statement of vessels belonging to New Orleans, 1877. 86. Vessels, number and tonnage of, kind of cargo, from whence and total tonnage by months, arrival from New Orleans, 1876-77. 87. Vessels, number and tonnage of, kind of cargo, from whence and total tonnage by months, cleared in New Orleans, 1876-77. 88. Vessels, number and tonnage of, kind of cargo, from whence and total tonnage by months, arrived in New Orleans, 1877-78. 89. Vessels, number and tonnage of, kind of cargo, from whence and total tonnage by months, cleared from New Orleans, 1877. 90. Vessels, number of, owned in New Orleans, 1878-79. 91. Vessels, nnmber and tonnage of, kind of cargo, from whence, and total tonnage by months, arrived in New Orleans, 1878-79. 92. Vessels, number and tonnage of, kind of cargo, from whence, and total tonnage by months, cleared in New Orleans, 1878-79. 93. Vessels, kind of, arrivals by months, 1876-81. 94. Vessels, number and tonnage of, cleared whence, 1880-81. 95. Vessels, number and tonnage of, owned in New Orleans, 1881. 96. Vessels, number and tonnage of, arrived whence, 1880-81. TABLE L. 1. Population of Louisiana, in the aggregate, and as white, free colored, slave, Chi- nese and Indian, at each census taken, from 1810 to 1880. 2. Population and males of voting age in each parish of Louisiana. (Census Bulletin No. 294) tenth census of the United States, 1880. 3. Summary of Area of States, Territories, etc., in square miles. 4. Number of Acres of Sugarcane and number of hogsheads of sugar and gallons of molasses produced therefrom in the year 1879. 5. Population City of New Orleans, 1769, 1785. 1788, 1797, 1810, 1820', and 1830. 6. Population of the Cities of New Orleans, Lafayette and McDonoughtown, 1840. 7. Population of New Orleans, 1850. 8. Population of Cities and Towns in Louisiana, 1850. 9. Population of New Orleans, i860. 10. Population of Cities and Towns in Louisiana, i860. 11. Population of New Orleans, 1870. 12. Population of City of New Orleans, 1870, i860 and 1850. 13. Population of New Orleans, in 1880, by ages, sex, nativity and race. 14. Changes in the population of New Orleans in 1866, 1870 and 1880. 15. Changes in the population of New Orleans between the ages of 20 and 50 years, during i860, 1870 and 1880. 16. Population, deathsand death rates per 1000 population, by age and race in New Orleans, in 1880. 17. Population, deaths and death rates per 1000 population, by sex and race, in New Orleans, in 1880. 18. Census of the City of New Orleans, by Wards and Districts, according to race and sex, 1880. 19. Population of 100 principal Cities of the United States. 14 CATALOGUE OF CHROMO-LITHOGRAPHS, TABLES, MAPS,. ETC.. TABLE M. i. Meteorological Record of 1882, for the city of New Orleans, together with the daily mortality. TABLE M-Continued. 2. Mortality of New Orleans during 1S82, classified according to diseases, months- and races. 3. Mortality of New Orleans during 1882; deaths in public institutions, as recorded by Coronor, classified according to their race and nationality. 4. Deaths in New Orleans during 1882, classified according to nativities. 5. Deaths in New Orleans during 1882, classified according to sex. 6. Death rate in New Orleans during 1882, per 1000 inhabitants. 7. Deaths in New Orleans during 1882, classified according to ages. 8. Deaths in New Orleans during 1882, in public institutions. 9. Deaths in New Orleans during 1882, reported by Coroner. 10. Still-births in New Orleans during 1882, classified by month, sex and race. 11. Mortality from some of the principal diseases in New Orleans during 18824 classified according to nativity. 12. Mortality from some of the principal diseases in New Orleans during 1882, classi- fied according to age and color. 13. Births in New Orleans in 1882, classified according to color, sex and nativity of parents. 14. Marriages in New Orleans in 1882, classified according to color and nativities. TABLE N. 1. Daily rainfall in New Orleans during a period of forty years-1840-1865, 1869- 1882. TABLE N-Continued. 1. Rainfall in New Orleans during a period of forty years-continued. 2. Table showing actual humidity, prevailing direction and average velocity of wind for each day during the months of April to October, during the years 1877, 1878, 1879, 1880, 18S1, 1882, in New Orleans. 3. Maximum and minimum temperature, prevailing winds, number of cloudy and rainy days and rainfall during a period of forty years, in. New Orleans. 4. Meteorological summary, year ending December 31, 1878. 5. Meteorological summary, year ending December 31, 1879. 6. Meteorological summary, year ending December 31, 1880. 7. Meteorological summary, year ending December 31, 1881. 8, Meteorological summary, year ending December 31, 1882. Report of observations of temperature of water at Port Eads, from September, i88ir to April, 1882, inclusive. Temperature of the water of the Mississippi, at Port Eads, La., 1882. TABLE O.-Intra-Mural Sepulture in New Orleans. Tabulated Results of an Inspec- tion of the Cemeteries of New Orleans, conducted by order of and under the imme- diate supervision of Joseph Jones, M. D., President of the Board of Health of the State of Louisiana, April, 1880-April, 1884. Girod Street Cemetery, 1833-1883 inclu- sive. Cypress Grove Cemetery, No. 1, 1841-1883. St. Patrick's Cemetery, 1841-1883. Charity Hospital Cemeteries, Nos- 1 and 2, 1850-1883. St. Joseph's Cemetery, 1855- 1883. United States Chalmette National Cemetery. New St. Louis Cemetery, 1856- 1883. Odd Fellows' Rest Cemetery, 1849-1883. Waters of Israel Cemetery, 1865-1883. Gretna Firemen's Cemetery, 1866-1875. St. Vincent de Paul Cemetery, 1851-1883. Cypress Grove Cemetery, No. 2, 1846-1883. Washington Cemeteries, 1843-1883. Temcine Deutsch Association Cemetery, 1858-1883. St. Louis Cemetery, No. it 1855-1883. St. Louis Cemetery, No. 2,1843-1883. German Evangelical Lutheran, 1867-1883. Greenwood Cemetery, 1855-1883. Great Samaritan Colored Cemetery, 1871-1883. Union Benevolent Colored Cemetery, 1874-1879. St. Bartholomew Cath- olic Cemetery, 1857-1871. Gates of . Prayer Cemetery, 1867-1883. Metairie Cem- etery, 1874-1883. Campo-Santo Cemetery, 3d District, 1875-1883. Holt's Ceme- tery, 1879-1883. Hebrew Rest Cemetery, 1866-1883. Firemen's Cemetery, Al- giers, 1878-1883. Dispersed of Judah Cemetery, 1846-1883. Grand Lodge- Cemetery, 1869-1883. Mortuary Statistics of the Girod Street Protestant Cem- etery, 1833-1883. Total deaths, and deaths by Yellow Fever, Small-Pox and Cholera. • TABLE O. Continued.-Intra-Mural Sepulture of New Orleans. Washington Cem- eteries, burials from all causes classified by months, 1843-1883, and by Yellow Feverr Small-Pox and Cholera, Charity Hospital Cemeteries, Nos. 1 and 2, 1850-1883- Total deaths each month, and deaths caused by Yellow Fever, Small-Pox anti Cholera. CATALOGUE OF CHROMO-LITHOGRAPHS, TABLES, MAPS, ETC. 15 TABLE O. Continued.-Intra-Mural Sepulture of New Orleans. Burials St. Vincent de Paul Cemeteries, total by months, and deaths caused by Yellow Fever, Small-Pox and Cholera, 1851-1883. St. Patrick's Cemetery, 1841-1883. Burials classified by months; also deaths by Yellow Fever, Small-Pox and Cholera. TABLE O. Continued.-Intra-Mural Sepulture, New Orleans. St. Louis Cemetery, No. 1, 1855-1883. Burials classified by months, and deaths by Yellow Fever, Small- Pox and Cholera. St. Louis Cemetery, No. 2. 1843-1883. Deaths by months, and by Yellow Fever, Small-Pox and Cholera. New St. Louis Cemetery, 1856-1883. By months and by Yellow Fever, Small Pox, and Cholera. TABLE P.-Mortuary, Meterological and Vital Statistics of New Orleans for the year 1883, classified according to months. Causes of deaths classified according to months, ages, sex and race for the year 1883. Maps, charts and plans, illustrating the topography and SETTLEMENTS OF LOUISIANA, AND THE PROGRESSIVE DEVELOP- MENT OF NEW ORLEANS, COLLECTED AND CLASSIFIED FROM ORIG- INAL WORKS, BY JOSEPFI JONES, M. D. The great problem of effective drainage can best be elucidated by presenting a series of charts and plans illustrating the topography and progressive development of New Or- leans. The maps now presented furnish important data to mark the progressive advance- ment of the drainage system of New Orleans, and in connection with those of the An- nual Report of 1880, are essential to the proper elucidation of many questions relating to the preventable causes of diseases and deaths, and to the climate and diseases of Lou- 'siana. ^o. 1-Carte de la Cote de la Louisiane depuis 1'embouchure du Mississippi, jusqu'a la Baie de Mobile, par M. de Serigny, en 1719 et 1720. No. 2-Vue de la Nouvelle-Orleans en 1719-Les Iles ou quartiers des Bourgeois sont entoures d'eau pendant trois mois de l'annee vu le debordement des eaux du fleuve, depuis le 25 Mars jusqu'au 24 Juin. Devant la ville il y a une levee etpar derriere un fosse et autres decoulements. No. 3--Embouchures du Mississippi d'apres Guillaume Delisle, Juin, 1718. No, 4-Carte de la Cote de la Louisiane, depuis 1'embouchure de la Riviere du Missis- sippi, jusqu'a la Pointe de la Mobile-Voyage de la Louisiane fait par ordre du Roi-en l'annee mil sept cent vingt, par le P. Laval, de la compagnie de Jesus. No. 5-Carte de la Louisiane et cours du Fleuve St. Louis, par M. Le Page du Pratz, 1757. En 1'Histoire de la Louisiane, contenant la decouverte de ce vaste pays. A Paris MDCCLVIII. No. 6-Parti de la Cote de la Louisiane. Dressee sur les manuscrits du Depot des Plans de la Marine, par N. B., Ingr. du Roi et de la Marine, 1744. No. 7-Plan of the City of New Orleans and the adjacent plantations, compiled in accordance with an ordinance of the Illustrious Ministry and Royal Charter, 24 December, 1798. Signed, Carlos Trudeau. No. 8-Plan de la Nouvelle-Orleans. Sur les Manuscrits du Depot des Cartes de la Marine. Par N. B., Ingr. de la M., 1744. Journal d'un Voyage fait par ordre du Roi dans l'Amerique, par le P. De Charlevoix, de la compagnie de Jesus; tome 6. No. g-Nouvelle-Orleans, capitale de la Louisiane, en l'annee 1720, par M. Le Page du Pratz. Tome second, page 345. No. 10-Plan de la Nouvelle-Orleans, telle qu'elle etait en Mai, 1728. No. ii-Plan of New Orleans in 1770, by Capt. Pittman, of the British army. No. 12-Plan de la Nouvelle-Orleans, capitale de la Louisiane-Memoires Historiques sur la Louisiane, composee sur les Memoires de M. Duinoud, par M. L. L. M. A Paris, chez J. B. Bauche, Libraire, MDCCLIII, avec appropriation et pri- vilege du Roi. No. 12-Plan de la Ville de la Nouvelle-Orleans, ou est marque la levee de Terre qui la garantit de 1'Inondation et l'augmentation des Maisons faites depuis le ler Sep- tembre, 1723. A la Nouvelle-Orleans, le 29 May, 1724. Signe, "De Pauger." No. 14-Map of Louisiana, showing topdgraphical features, prepared for the Medical and Surgical Memoirs of Joseph Jones, M. D., by T. S. Flardee, civil engineer. No 15.-Chart illustrating the course of total mortality, the mortality of children under five years of age, and the chief fatal diseases in the City of New Orleans, during the six months ending June 30, 1880, with Meteorological Observations during the same period, p. cxcvi. No. 16.-Chart illustrating the course of the total mortality, the mortality of children under five years of age and the chief fatal diseases of the City of New Orleans during the six months ending December 31, 1880, with meteorological observa- tions during the same period, p. cxcvi. 16 CATALOGUE OE CHROMO-LITHOGRAPHS, TABLES, MAPS, ETC. No. 17.-Chart illustrating the increase of population in the City of New Orleans during a period of 94 years, together with the total mortality for each year, and the death rate per 1000 inhabitants per annum, also deaths from yellow fever; mean, maximum and minimum temperature and rainfall for a number of years, as far as obtainable. Compiled from statistics compiled by Joseph Jones, M. D. ccxcvi. No. 18.-Map illustrating the Topography of New Orleans, and of the coast of Louisiana and Mississippi. This map will give a correct view of the nature of the coast of Louisiana and Mississippi to be guarded by quarantines, so as to protect these States and the Mississippi Valley from the introduction of foreign pestilence. Prepared for Joseph Jones, M. D., by T. S. Hardee, Civil Engineer. No. 19.-Topographical and drainage map of New Orleans, prepared for Joseph Jones, M. D., by T. S. Hardee, Civil Engineer. . No. 20.-Perspective View of New Orleans and environs from the south. No. 21.-Abstract of Ead's Jetties, prepared for the Medical and Surgical Memoirs of Joseph Jones, M. D., by T. S. Hardee, Civil Engineer. This map contains a view of the Mississippi River from above the forts to the Gulf of Mexico. ENGRAVINGS. No. 1. Vacuum-Pneumatic Spirometer. Part II, p. 119. No. 2. Mexican Idiots, "descendants" of the ancient Aztecs of Mexico. Part II, p. 128. No. 3. Cranium (front and side view) of Mexican Aztec women. Part II, p. 130. No. 4. Fossil Mammalia of the Valley of the Mississippi River. Cranium of Migal- on Jeffersonii. Molar teeth of Mastodon Giganteus. Molar of Eiiphas Primoginas, or Mammoth. Part II, p. 132. No. 5. Four-legged child, J. Myotte, Cuban, June 16, 1878, about 5 weeks of age. Part II, p. 139. No. 6. Miss J. Myotte Corban, about 4 years of age. Part II, p. 142. No. 7. Miss J. Myotte Corban, age 17 years. Part II, p. 143. No. 8. Double monster with two heads and two bodies, united at the sterna. Part II, p, 145- No. 9. Theory of double monster, united by sterna. Part II, p. 245. No. 10. Double monster with the lower portion of their trunks united. Part II, p. 148. No. 11. Single-headed and double-bodied monster, with four arms and four legs. Part II, p. 149. No. 12. Skeleton of single-headed and double-bodied monster. Part II, p. 149. No. 13. Brain of single-headed and double-bodied monster. Part II, p. 150. No. 14. South Carolina twins, or double-headed Nightingale; Millie and Chrissie. Part II, p. 151. No. 15. J. H. Allen, Hermaphrodite. Part II, p. 156. No. 16. J. H. Allen, Hermaphrodite. Part II, p. 157. No. 17. Miss Emily Landry, the bearded and hairy girl of Louisiana. Part II, p. 158. The various monographs, maps, charts and tables, composing this third volume of the Medical and Surgical Memoirs, have been printed at different times and in different places during the past 10 years, and therefore the author does not claim absolute uni- formity, the question being rather the actual preservation of this great mass of elaborate and extensive scientific and statistical matter under the most difficult and adverse circum- stances for the use of physicians and sanitarians. The maps and tables have been distributed in binding, so as in such manner as best to secure their preservation. F~ ' CARTE DE LA COTE de la [ WITI SHAKE 11 depuis , [L EMBOUCHURE DUMSSISSIH : jusqua La Baye de Mohi lit'. par M DF. SERIGNY en 1719 et 1720. F.fl. lesSofidugev sont. 7/ifov/tds m prds Kot a; •domrne la terr e. court Est et Quest dans I enfoncemerrt du. ,golfe du.Mexiquef on nr saujxivt setromper Jfaisrdy ayaxvt ^OltCUJies rernarques dans lcsterrcs,ni auxunes moniagnes; ^que ct So nt des tenvs plates ou. plustot des sables blancs „com/ne netgr, on nr prut rrm/uuci/rr ou /on este/ue par 2a r. Sonde Lac de Pont chart ra in COPT^hd translation Ft'O/n the Original Spanish Platt dictrp 1798, .SJUTWIKU THE City of New Orleans ITS TORTHTCATIONS AND ENVIRONS APRIL 1675 A EMBOUCHURES du MISSISSIPPI dapres Guillaume Delisle \ Juin ipS. • VUE DE LA NOUVELLE ORLEANS EX 1719. f, Les lies out/uartifrs des Ban ryeois sont entail res' dt.au. pendant troismeis de I an nee vu Is de horde -me nt des eau.X du. fleave de puis le 25 mars Jusquau 24-Juin Devant la villc it y a Une levee el pur derriere uh. fosse el autres deroulemeiits./, " I X* IO 4 T T Carte de In Coste de IaLovisja ea I djcpine lenibouctiure de la'Jit vie re deMicissjci | Tusquea aleFointe deda Mobile. | PLAN OF THE CITTOF NEW ORLEANS AND THE ADJACENT PLANTATIONS Compid.ed in urcordance jytth an drduiaj/re <rf the EUiLstrwiLsMird^try ajtd.JRoyat Charterf 24-Deeerrd&r^ 1798 ■ Sigt^d:CARLOS TRUDEAU. Jlemv)' des Sondes A go IP bond de vase grise et fine. B.Pend- C SO B: Fond de Sable fin mete de. vase fine. 1)35 B-'Pros Sable gris ' 3 B3O B' Pros Sable ? F 22 B- Fond.de e/ms Sable gris mete de roebe poime rouge. S /6 JFjfond de Sable fin vaseuac A £f /7 B- iland de Sable blane ■ £ 77 B 7'aiid de Sable gets vaseiac K-2SB-Sable noir '2'lap7vs sonde' mane fondr Sable fin gets mete de coijfuzllage. L £'2. B- find de Sable f n el vase-- Af 2SB. Sable gris vase ax REFERENCES. A Fcuish Church^- B Fort St Charles. € Fort St. John.. | U Fort StFerdumnd E FortFurgundy. F Fart Stloius. G FoyaZJdagaz mes. H FeyaZFespital. I IBarrarkj'. L GevernrnerdBuddzfig. M CfmrifyJld^pitaZ PLAN DE LA NOTVELLE ORLEANS SnrlesNamiscrits du Depot des Cartes de la "Marine ParF.B.ln9^deloMi7l7 A I pg lite farotesZMte desserne partes- Ccv>utin.r B Placed'Armes. C Couvent des- Capucins. -D Prisons. E Corps de garde F Gou verne went. Cr Inten. dance. FT Kopitail I Prsehhes- K ALagaztjis ftu- Poi X Caxemer. M Forges du Kot' N Moulin a- vent et a chevaZ ■ 0 Kangard de la Marine Sous tetfuoi P Corps de garde des Fuurgeots. Q Cabanes des Neg res, ipui>re>mentsoin.cbi R PvAj 'iete. HotMtif inajison ties Crselutes Voyage de la Louisiane fait par ordre du Roi en l'annee mil sept cent vingt par Le P. Laval de la compagnie de Jesus. p. 252 GoIjFE oc Nexiqve Carte de La Louisiane et, Course du Fleuve St. Louis Par M. Le Page du Pratz 1757. En 1'Histoire de la Louisiane, contenant la decouverte de ce vaste pays. A Paris. MDCCLVIII. FLEUVE M1SS1SSIPI Journal d'un Voyage fait par ordre du Roi dans l'Amerique par le P. De Charlevoix ; de la compagnie de Jesus, tome 6. Pi^sr of New Omi^ians in1770, by CafjtnPittman of the British Army References / CAurch. 2 Prison Eduard Aouse 3 Intendants house Louse oiLa Compagnie d Occident 5 Governors 6 PowderAfag. 7 Arsenal forLoats 8 Capuckines 9.Kings Storehouses /CPrsulines 7/ General Pospitai 72 Guard houses PAe dotted Squares are lots not yet granted MfHTVRT LR ORT.F.AXS o do la LOVTSIANE. /Place cCdrmt. 2£ghse fem?tss rate Sdoge ment des Cap tecins Cures' tfaa'trnmtM • SJntenclance. 6 Con serf. 7 7 Caze rues. S3 Mag comics q TO Corps de efardi' et Faison 77 Kcdigieuses IFrsiMnrs et HopdcC 72 Poudrzerc 73 Levee Fie live S* Louis . En l'annee 1720. Par M. Le Page du Pratz. Tome second p. 345. R l s l s ^r- : " ' - - - - Go LPHE D IT M EX IQ PE EXPLICATION de Clfyes lEglise StLguis Paroi/se 2 Les Capucins 2>Le Corps de Garde 4 La Prison J Place dAnnes GCazernes /Attendance J Afatfazins 9 (fuartiers des haiiians lOGouvernement flPoudrierv Itpndroitou efoit le Moulin LsBrupeterie ECouvent des IJrselines ISAfoutllaye des laifseaux 16)fouillaye des Pirogues ou Bateaus ILLalevee It Pet it Bayou ou-Lavoir idLeALarcke r x 20Fo/se (12) 21 Hotel Bien y Partie de LA COSTE DE LA LOUISIANA depths le Mississipi Jus qua St Marc d'Apalache Prassee sur lesMxnuscrifs duPepoC ttesPTans de laALarint Par SB Inrfdu Boy et de laJMctrme 174^. JEc/IELLES JLieuts Ooiitmu.ne.G- de France etc 25 cm deg re er w s.s £o 2) Luty MarmefdcFvance et dAttg leierne de 20 au deffre CHARTS Illustrating the Topography and Settlements jlouisiaka, and the Progressive Development of JIW ORKBANS Collected & Classified from Original Works New Orleans, January 1882. Plan de la/ NbllVellC Orleans Capitate de la Louisiana AfemoiresHistoriyaes sur La Louisiane compose sar les Afe'moires de TM.Duinond parJUL-LAI. A Pans cLej Cl. J.B.Pauc/te, Pit mire, ALT) CC-P/PP. avec Approbation pPrieileye du dot. theNEW ORLEANS LITHOGRAPHING C9 10 UNION ST. err a ^3^ 1 Illustrating the COURSE of the TOTAL M ORTALITY the MORTALITY of CHILDREN under five years of age, and the CHIEF FATAL DISEASES in the CITY of NEW ORLEANS DURING THE SIX MONTHS, ENDING JUNE 30 th 1880. With Meteorological Observations during the same period RAINFALL. 013 °-03 °-44 0-42 O.^L ^76 0.19 1.57 0.01 0.10 4-23 1.20 1.22 1.79 0,34 0.02 1,88 0.40 0.38 1.49 4.81 0,50 1.91 0.02 1.96 1.12 T<29.69' Mean Thermometer, 65-5 68,2 63.3 60,2 59.3 49.7 6O.5 00.3 67.5 69.3 69,1 61.3 ^64.0 67.6 67.1 68.7 74.7 73.7 72.6 76.6 75.0 77.4 81.4 81.5 so.3 77.8 80.7 69.2 Mean Barometer. 30.26 30.17 30.18 30.02 30-io 30.21 30.12 30.27 30.06 30.09 29.97 30.05 30.12 30.05 30.11 30.14 29.97 30.12 30.00 29.96 30.02 29.94 30.03 30,03 30.04 29.98 30.13 30.07 Death rate per \ TOTAL. 24.78 22.62 26.00 22.87 25j7 28.40 26.00 22.62 26.00 19.74 18,77 20.46 26.96 ~ 24.07 ~27.39 ~24.55 26.72 29^85 3033 33^94 334*2 36J1 39^96 27^" 27.68 2L96 204 1000 PopnlaUon. (White. 23.71 19.94 21.58 20.60 2gj£ 22.89 25,15 17,33 21.93 15.04 14.71 17.66 21.25 25.52 23.54 26.49 22.56 24.73 24.20 26.49 28.12 28.78 31.72 38.52 22.89 23.22 21.80 23.43 POD. 216.000 )con. 27.73 30.10 38.31 29,19 43.78 30,10 37.40 37.40 32.84 30.10 28.28 40.14 31.93 25.54 30.10 30.10 31.93 45.61 J1.Q5 50.17 45.61 48.35 43.78 40.14 40,14 31.96 36.35 JCORTUAHY. The heavy black line in centre of ^- ^rt represents the Total Mortality from all causes. The unbroken black line near bottom of Chart represents Total Mortality of Children under § years. The blue line near bottom of Chart rc.preSents Mortality by Phthisis Pulmonalis. The ochre line near bottom of Chart ^presents Mortality by Diarrhoeal Diseases. The crimson line near bottom of Cha^ represents Mortality by all Malarial Fevers. METEOROLOGICAL. The perpendicular bars at lop of Chart show daily rain fall (in inches^ The perpendicular bars in center of Chart show daily range of Temperature. The irregular crimson line in centre of Chart shows average Temperature (daily.) The irregular blue line in centre of Chart shows relative Humidity (daily?) The irregular ochre line in centre of Chart shows mean barometric pressure (daily?) T Amir. AT? VTF.W OF TTTF. WORTH ARV STATISTICS OF NEW ORLEANS. BY JOSEPH JONES M.. D.. PRESIDENT BOARD OF HEALTH. STATE >F LOUISIANA. c Ob BLES OF MORTALITY BY MONTHS f the PRINCIPAL DISEASES, TOTAL NUMBEL per 1000 Inhabitants p - ■ --- - - ■ ... - -- ■ ■ ■■ ■ TABLE SHOWING DEATHS FROM DIARREAL DISEASES, BY MONTHS, DURING THE YEARS 1869 11880, INCLUSIVE. TABLE ILLUSTRATING THE RELATIONS OF THE POPULATION OF NEW ORLEANS TO THE TOTAL MORTALITY FROM ALL CAUSES, DURING A PERIOD OF NINTY-FOUR YEARS. COMPILED BY PROF. JOSEPH JONES, M.D. Sh OMPARATIVE TA. ring Deaths from Some o DURING THE TWELVE YEARS-1869 to 1880. OF DEATHS according to RACE and COLOR, and DEATH RATE er annum. Year. Population. No. of Deaths Death Rate per 1000 Inhabitants. Year. Population. No. of Deaths Death Rate per 1000 Inhabitants. JANUARY JTJIAY January. February. March. April. | Jnne. "5 August. September. October. I 1 j November. 1 December. | Total. neatn Kate per | 1000 per annum Population. 1787.... 1796.... 1808.... 1810.... 1811.... 1812.... 1813.... 1814.... 1815.... 1816.... 1817.... 1818.... 1819.... 1820.... 1821.... 1822.... 1823.... 1824.... 1825.... 1826.... 1827.... 1828.... 1829.... 1830.... 1831.... 1832.... 1833.... 1834.... 1835.... 1836.... 1837.... 1838.... 1839.... 1840.... 1841.... 1842.... 1843.... 5,284 8,756 17,081 17,242 18,235 19,229 20,212 21,216 22,209 23,303 24,196 25,190 26.183 27,176 29,441 31,706 33,971 36,236 38,501 40,766 43,031 45,296 47,561 49,826 52,455 55,084 57,713 60 342 62,971 65,600 68,229 70,858 73,487 76,116 78,745 81,374 84.003 338 638 773 963 1,239 624 939 926 1,252 651 1,772 1,106 63.98 72.86 45.25 55.85 67.94 32.50 46.45 43.69 56.36 27.93 73.27 43.90 81.65 64.98 39.57 86.22 48.92 48.23 56.54 30.61 24.56 32.89 52.98 40.58 36.71 147.01 86.22 61.10 61.50 41.67 70.45 36.77 53.53 39.11 57.76 41.47 48.21 1844.... 1845.... 1846.... 1847.... 1848...- 1849.... 1850.... 1851.... 1852.... 1853.... 1854.... 86,632 89,261 102,070 108,699 115,503 122,511 129,747 138,599 147,441 154,132 156.556 158,980 161,404 163.828 165 450 166,500 168,670 169,907 171 134 172,361 173,588 174,815 178,042 181,269 184,496 187,723 191,418 193,412 196,406 198,900 201.394 203 888 206,382 208,876 211.371 213,865 216,359 4,620 2,783 4,220 9,043 7,407 9.862 7,819 7,275 8,693 15,787 11,347 10,096 5,689 5,581 11,720 6,849 7,341 5,772 6,278 7,172 8,498 7,016 7,754 10,096 5,343 5,593 6,942 6.059 6,588 7.995 7,193 6,535 6,685 7,169 10,717 5,122 5,623 ' 53.33 31.17 41.34 83.19 64.12 80.49 60.26 52.48 58.95 102.42 72.47 63.50 35.24 34.07 70.83 41.13 43 52 33.97 36.10 41.61 48.95 40.13 43.55 55 57 28.96 29.79 36.26 31.24 33.54 40.19 35.71 32.05 32.39 34.32 50.70 23.94 25.98 Populate Yellow I Malarial Typhoid Scarlet I Measles. Small Pt Diptherii Diarrhoea Congestit Convulsi Phthisis Deaths ft Total n Deaths. < Death rate pe 1000 inhabitan per annum 1869. Wt 1870. lite.. 1871. 1872. ..141 1873. 000 1874. Wt 1875. lite .. 1876. 187'/. 1878 155 1879. 000 1880. White 159,000 Colored 57,000 Total 216,000 Populati Yellow 1 Malarial Typhoid Scarlet I Measles. Small P< Diphthei Diarrhoes Congesti Convulsi Phthisis Deaths ii Total n Deaths. ■ Death rate pe 1000 inhabitar per annum - 1869. W1 1870. ite .. 1871. 1872 ..141 1873. 000 1874. Wh 1875. ite . 1876. 1877. 1878. 155 1879. ,000 1880. White 159,000 Colored 57,000 Total 216 000 1 26 7 11 9 Colored 50 000 Total -191 000 Colored - ao.uou 01 n non Vver Tntnl 191 non Total . _ _ 91 n non 1869 21 22 26 24 20 24 48 18 23 16 23 29 294 24.5 8 10 16 35 27 18 18 14 9 15 13 15 196 16.3 21 11 31 14 34 14 11 21 21 15 17 17 227 18.9 3 1 6 2 10. 48 61 38 68 238 55 81 67 41 56 33 81 62 101 52 53 56 738 61 5 54 42 46 30 71 52 62 54 49 39 32 588 49 0 36 37 39 39 30 42 26 27 37 57 21 26 417 34.7 35 41 27 29 30 36 38 37 32 29 21 23 378 31.5 30 28 27 26 34 46 20 35 27 24 26 25 348 29.0 44 45 45 31 45 38 20 29 44 27 22 21 411 34.2 35 35 26 29 31 36 21 25 20 24 22 22 326 27.2 422 432 452 390 724 429 399 386 449 385 345 331 5144 428 2.21 2.26 2.36 2.04 3.79 r ■ 191,000 eve - - 1 47 20 43 5 3 14 42 8 20 66 291 497 40 7 2 6 34 7 1 10 3 62 4 1 16 11 3 71 29 45 88 440 773 523 244 6 44.51 58.56 48.56 0.18 3.54 ST 26 47 3 33 6 1870 1871 13 6 15 4 3 "69 3 22 7 28 56 264 471 7 7 1 26 6 21 55 320 443 15 3 17 9 11 3 10 2 1 "32 1 48 8 26 80 364 572 329 232 11 25.47 50 61 32 68 6'57 4.57 15 3 19 ■'"8 4 18 8 14 76 269 434 -.69 165 22 4 ion 10 2 2 10 6 1 29 6 15 67 307 446 290 156 Fe Fev 'eve rer 67 17 39 20 55 9 20 17 4 54 19 19 82 351 635 394 228 13 41 9 j? ever Fever er r ; eve 1872... "3 2 21 11 16 42 214 328 1 "4 24 14 23 56 307 447 292 153 2 24.85 36.72 28.08 0.94 3.52 dur. "'64 20 17 23 90 395 642 388 249 5 33.02 59 76 40.33 1.06 5.65 AR "'87 8 24 12 15 81 342 583 329 242 12 25.47 52.80 33 31 0.63 4.63 "13 3 16 2 15 65 277 403 234 169 23 15 7 76 439 574 360 214 1 56 I 49 9 17 70 251 504 323 181 5 x 1 Diseases - m of brain - ms Pulmonalis - om all other causes umber of Deaths )X 41 13 52 22 21 68 399 700 457 231 12 35 31 51.40 40.00 ■3'83 3.8r 24 7 62 16 31 341 622 399 209 14 30.8'1 45.41 35.54 2.23 2,138 1,766 1,165 2,734 1,662 1,748 2,177 1,248 1.057 1,490 2,520 2,022 1,926 8,C99 4,976 3.687 3,873 2,734 4,807 2,606 3,934 2,977 4,549 3,375 4,050 1856.... 1857.... 1858.... 1859.... I860.... 1861.... 1862.... 1863.... 1864.... 1865.... 1866.... 1867.... 1868.... 1869.... 1870.... 1871.... 1872.... 1873.... 1874... 1875.... 1876.... 1877.... 1878.... 1879.... 1880.... 1873.. 1874 .... 2 5 3 7 13 4 0 1 5 ia d Diseases , m of Brain 6 54 15 33 67 300 551 1 46 17 26 58 285 488 3 30 17 12 56 313 483 303 5 39 11 18 69 269 492 317 175 2 57 8 10 98 205 422 262 160 6 32 11 14 67 238 422 276 1.46 2- 66 11 38 1' 47 3! 54 3i 55 21 42 2.24 L.90 83 2.13 1.83 1.64 1.53 I 210,000 )DS Puli om um' AVI Col nonalis all other causes ier of Deaths lites 1875 1876 1877.. 1878 w Co ored 177 3 25.78 42.48 30.34 2.13 3.52 ZS-TJ 226 34*61 0.06 2.95 4.21 31.22 2.70 4.14 A 30.66 :... 2.51 3.64 xurt 20 60 081 2.64 29.59 o"94 3.52 FE 27.83 0.44 3.46 1879 1880.. Total Average 20.82 36.00 24.80 0 85 4 34 26.'. 1 49.Id 32.62 145 4.22 18.11 36 87 23 02 'o\57 3.71 27 87 46.69 32.80 0.28 4 34 21.88 32.84 24.77 b'55 3.72 r ts ' Whites Colored - Total Yellow Fever Malarial Fever Phthisis Pulmonalis 30 50 49.74 36.28 3 14 25.00 39.49 28 80 2.34 4.00 24.47 38.18 28.11 1.49 2.68 3.94 20.28 34.91 24.11 0.17 1.88 5.60 20.82 30.73 23.44 0 05 1.44 3 72 ts " > v hi tew - - .............. Colored Total Yellow Fever Malarial Fever Phthisis Pulmonalis 2< 45 216,000 4.40 4.68 2.11 202,500 Yellow Feve Malarial Fei Typhoid Fev Scariet Feve Yellow I Malarial Typhoid Scarlet I Measles. ever ' ' 60 9 3 46 8 2 64 8 1 46 6 19 55 7 1 3 2 4 30 14 29 64 270 498 341 151 6 29.02 36 24 31.28 1.19 3.46 4.02 125 18 1 63 8 1 38 bi 1025 177 10 4 30 1 TABLE ILLUSTRATING DEATHS AND DEATH RATE FROM ALL CAUSES, AND FROM YELLOW FEVER, IN THE CITY OF NEW ORLEANS DURING A PERIOD OF SIXTY-FOUR YEARS. COMPILED BY PROF. JOSEPH JONES, M. D. er 8 4 2 1 8 9 13 43 202 292 y 11 5 9 1 1 5 1 JL4 29 S 2 1 \ 1 1 jc ev Kev eve ar 4 4 1 TABLE SHOAVING DEATHS FROM PHTHIIS PULMONALIS, BY MONTHS, DURING THE YEARS 1869 TC 1880, INCLUSIVE. 21 3 r 9 2 35 22 21 81 430 630 407 204 19 34.64 48 96 39.58 1^25 5.09 1 83 1 27 7 18 58 338 556 312 239 5 26.55 57.36 34.93 O."88 3.64 1 1 2 36 16 59 230 421 1 3 10 6 22 37 9 57 323 1 Small-po' Diphthei Diarrhieu Congestit Convulsi Phthisis Deaths ft Total 1 Deaths. ■ Death rate pe 1000 inhabitan per annum ia - 1 Diseases. m of Brain ms ■- - Pulmonalis - - - - om all other causes 56 "'io 7 19 52 266 429 2 2 16 8 16 54 233 347 82 4 18 14 23 64 262 481 279 196 6 21.60 42 26 27.48 6.68 3.66 44 6 16 3 16 84 271 454 290 153 11 22.45 33.38 25.94 6 46 4.80 25 14 11 6 60 290 460 302 158 1'1 9 7 12 81 259 589 3'6 i|3 20 4 15 6 11 391 511 324 187 Small-po Diphthei Diari hoea Congesti Convulsi Phthisis Deaths f Total n Deaths. Deatt rate pe 1000 inhabita per annum 4 1 37 14 11 48 306 480 10 6 42 76 19 69 342 708 515 188 5 39 85 41.00 40.45 '7.14 3.94 14 4 13 4 10 73 252 360 231 129 4 15 7 6 69 318 438 271 167 ia. 1 Diseases >n of Brain >ns Pulmonalis om all other causes J 39 21 22 63 331 551 "39 26 29 76 343 569 370 192 7 31 49 46.08 35.75 0.06 2.89 4.77 11. 3 4 57 33 43 88 346 1784 1521 263 9 21 7 16 47 287 422 264 158 7 26 9 21 54 251 407 249 158 Year. Deaths from all causes. Deaths from Yellow Fever. Death Ra from all causes. ;e per 1000 IromYellow Fever. Year. Deaths from all causes. Deaths from Y ello w Fever. Death Ra from all causes. te per 1000 from Yellow Fever. 3 27 62 207 447 275 168 4 21 29 36 65 25.54 0.28 3.6( 3.54 24 63 218 1869 1870 1871 1872.. 1873 s 42 56 56 90 81 80 76 74 65 76 67 818 u8.i| § 0 43 52 54 81 58 64 84 60 81 75 73 69 774 K-'( j I f i y S £ ~ Cd I ci' a 59 53 59 79 73 67 52 70 71 68 71 .69 791 62 64 74 66 58 58 59 64 92 108 37 70 812 67 .6 67 66 58 56 88 68 77 82 70 69 98 67 866 72.1 1c bi 59 48 63 76 64 69 62 63 57 88 47 54 750 0 S ® 02 51 71 63 57 67 51 87 88 83 89 54 65 826 Go .3 0 0 60 55 66 79 89 81 58 6C 62 59 10 61 83" a k O 61 53 88 68 57 66 52 92 83 89 54 94 857 a O O p 60 84 60 59 72 74 56 69 71 47 61 95 808 *7? O H 684 757 780 784 850 810 799 882 888 880 823 863 9800 <D Pl § 5 p- ce 0 3.58 3.96 4.08 4.10 4.45 3.85 3.80 4 20 4.23 4.19 3.92 3.99 4.03 S Population. 0 3.40 0.40 1.60 1.40 2.50 0.01 0.30 0.10 0.01 0.20 0.30 1.90 0.20 0.01 0.70 17.30 1.50 4.50 0.08 19.00 0.20 10.80 0.04 16.80 2.60 5.70 1.70 0.01 1.50 25.80 7.50 FROM SOU THE DEA 1849.... 1850.... 1851.... 1852.. - - 1853.... 1854.... 1855 1856.... 1857.... 1858.... 1859.... I860.... 1861.... 1862.... 1863.... 1864.... 1865.... 1866.... 1867.... 1868.... 1869.... 1870.... 1871.... 1872.... 1873.... 1874.... 1875.... 1876.... 1877.... 1878.... 1879.... 1880.... 1'H RAT 9 862 7.819 7,275 8.693 15.787 11.347 10,096 5.689 5,581 11,720 6 849 7,341 5,772 6,278 7,172 8,498 7,016 7.754 10 096 5,343 5,593 6,942 6.059 6.588 7,995 7,193 6,535 6,685 7.193 10.717 5,122 5,623 TE PRINOI E PER 1000 769 107 17 456 7,849 2,425 2,670 81 200 4,855 92 15 2 2 6 1 185 3.107 3 3 588 54 39 226 11 61 42 1 4,056 19 2 PAL DISE INHABIT. A. 80.49 60.26 52.48 58.95 102.42 72.47 63.50 35.24 34.07 70.83 41.13 43.52 33.97 36.10 41.61 48.95 40.13 43.55 55.57 28.96 29.79 3t.26 31.24 32.54 4C.19 35.71 32.05 32.39 3'1.32 55.70 r 1.94 i.98 , OF 6.20 0.80 0.10 3.09 50.90 15.40 16.80 0.50 1.20 29.30 0.50 0.09 6"di 0.01 0.03 0.01 1.00 17.10 0.02 0.02 3 10 0.20 0.20 1.10 0.05 0.30 0.20 0.U1 19.20 0.09 0 009 CHE W Co nvo ..w 1817.... 1818.... 1819.... 1820.... 1821.... 1822.... 1823.... 1824.... 1825.... 1826.... 1827.... 1828.... 1829.... 1830.... 1831.... 1832.... 1833.... 1834.... 1835.... 1836.... 1837.... 1838.... 1839.... 1840.... 1841.... 1842.... 1843.... 1844.... 1845.... 1346.... 1847.... 1848,... j 3 5 5 0 8 1 8 9 9 0 0 2 0 0 4 5 0 7 0 3 I 7 8 2 0 4 2 a m [>ETJ 73.27 43.90 81.65 64.98 39.57 86.22 48.92 48.23 56.54 30.61 24.56 32.89 52.98 40.53 36 71 147.01 86.22 61.10 61.50 41.67 70.45 36.77 53.53 39.11 57.76 41.47 48 21 53.33 31.17 41.34 83.19 64.12 JRTALITY SER WITH mm W1 Co ho r ts lites ored t stated r 1,772 1,106 2,138 1,766 1,165 2,734 1,662 1,748 2 177 1 248 1,057 1,490 2,520 2,022 1.926 8,099 4.976 3 687 3,873 2,734 4,807 2 606 3,934 2 977 4,549 3.375 4.050 4 620 2,783 4,220 9,043 7,407 JORTALIT 82 II 42 40 80 10 4 10 13 90 11 40 1,00 9 28 1,30 1 80 1,32 21 48 14 16 2,80 87 Y; TO nites - ored - 252 147 4 19.51 32.07 23.02 0 05 2.17 3 60 325 191 ' Whites Colored Total Yellow Fever... - - - Malarial Fever Phthisis Pulmonalis.... is'34 6.50 2 70 26^95 056 3 26 21ffi0 0 69 3 39 23 38 34 47 26.28 b'sb 3.43 24.46 59.56 33.65 i ii 4.63 25.08 40 80 29.20 0G0 3.14 17.88 28.14 20.57 0A7 4.17 20.45 35.16 24.33 0^2 3.83 r its 'Whites Colored Total Yellow Fever Malarial Fever [Phthisis Pulmonalis 26.45 j'77 3.70 30J5 0.18 2 89 3.01 34.61 0.12 4 02 3.96 25.16 41.67 29.48 3'48 3.25 117.74 57.38 101.94 58.57 10 21 5.03 20.43 34 47 24.11 0 23 1.71 2.68 18.79 33.26 22.61 "i.66 3.00 48 81 84 58 66 52 67 94 86 77 85 875 72 < Yellow F Malarial Typhoid Scarlet F Measles. Small-po? Diphthei Diarrhoet Congest! Convulsi Phthisis Deaths fr Total n Deaths. ■ Death rare pe 1000 inhabitan per annum Yellow F Malarial Typhoid Scarlet F MARCH Yellow b Malarial Typhoid Scarlet 1 Measles. Small-po Diphthei Diarrhoe Congesti Convulsi Phthisis Deaths f Total n Deaths. < Death rate pe 1000 inhabitan per annum Yellow 1< Malarial Typhoid Scarlet F SEPTEMBER, 1874 r 1 210,000 ever Fever Fever ever ia d Diseases m of Brain "13 '' 22 1 1 21 6 24 48 270 408 25.63 6'81 3.01 20 14 2 121 "15 8 "26 " 2 5 3 14 15 8 58 300 430 278 148 4 23.65 35.52 27.01 1.25 3 64 20 3 6 79 "34 15 16 66 364 603 323 275 5 27.49 66.00 37.88 "125 4.14 CL. 12 2 "88 6 14 13 13 52 252 452 250 192 10 19 35 41.89 25.82 bffis 2.97 14 4 2 "94 10 11 6 15 67 238 461 263 190 8 20.36 41.45 26.34 d'sb 3.82 13 27 9 22 2 21 15 14 94 337 559 347 212 26.86 46.25 31.94 074 5.37 12 5 3 7 260 4 il 16 1 I 52 4 15 12 15 77 244 437 259 178 20 05 38.83 24.97 " b di 4.40 11 1 3 17 12 4 77 251 376 222 154 17.18 33.60 21.48 0.63 4.40i 18 4 6 4 17 7 11 85 245 402 241 161 18.19 33.89 22.34 "i'bb 4.77 I'ever - Fever Fever 'ever - - x 61 1 i 231 90 12 2 3 1 41 13 22 71 372 858 53'bb 14.51 5.05 4.46 O 242 48 6 2 2 9 65 3 " i 27 12 9 63 262 451 28.33 0.56 4.08 3 96 OT 22 45 7 38 10 i "5 29 12 21 57 -.47 425 260 161 4 22.12 18.64 26.70 0.31 2 38 3.58 OE 24 32 6 108 91 6 7 6 30 15 23 67 271 624 457 160 7 18.89 18.40 19.20 6.78 5.72 4.21 IEE 79 3 1 2 8 7 34 23 30 89 358 713 510 196 7 43.40 47.04 44.79 4.96 4.96 5.59 2 50 9 '"b 6 36 14 10 51 256 440 291 148 1 1 22.52 32.29 25.14 0.11 2.85 2 91 L "6 79 16 241 20 100| 83 71 7 79 3 1 3 16 2 32 12 12 83 196 439 290 149 22.44 32 51 25.08 4.bi 4.74 io 7 1780 229 10 i 29 29 49 89 _J37 2558 2306 252 1 178.51 54.98 146.14 96.95 13 08 5.08 1065 163 7 ...' 79 3 1 1875 1876 4 25 87 34] 675 448 222 34.68 48.44 4 4 37 30 11 88 310 596 403 181 12 31.20 39.49 1877 1878 4 21 4 8 54 202 324 187 137 14.47 29.89 18.51 0.40 1.08 3.08 32 2 3 23 19 16 65 241 450 285 165 21.50 34.73 25.00 "'4.'38 3.61 1 39 7 2 • r-i r- CO r-< CO O| • • •! • .Ol • IO Ci • rH w GO 71 O j • • • 1 • ' CO । • 74 O ' C? C© 1 ' ' ' I • • • 1 • • ' 1 ' ' ' ; ' ' 1 ' vH 1O 31 8 16 84 32" 491 30.84 0.94 5.27 AI d Diseases in of Brain 35 7 25 51 241 422 26 .'51 '3.83 3 24 2 35 10 1879 ms. Pul b 16 DLLS Pul 1880 monalis 216,000 202,500 3.59 788 415 373 32.12 81.38 45.(i2 0.68 4.91 •om all other causes umber of Deaths AVhites Colored Not stated f Whites 1 Colored 1 Total | Yellow Fever 1 Malarial Fever [Phthisis Pulmonalis ever om um W Co No ts eve Fev i'ev eve all other causes jer of Deaths lites ored b stated Whites Colored Total - Yellow Fever Malarial Fever.... Phthisis Pulmonalis .... Total Average | DIFFERENT DIST tic PS OF THE CITY OF NEW ORLEANS, FOR THE Y1 R 1880. 38.5734.05 1.3c 1.14 5.71, 4-74 4.9715.03 3; 15 5W 56 TABLE SHOWING DEATHS FROM MALARIAL FEVERS BY MONTHS, DURING THE YEARS 1869 TO Districts Population f White . First District 43,319 14,126 57,445 Second District 31,368 13,301 44,669 Third District 33,732 11,856 45,588 Fourth Distric 30,625 6,910 37,535 Fifth District 5,022 Sixth Distric 11,951 4,078 16,029 j Seventh ;• District ' 3,112 3 125 6,237 Deaths in Charity Hospital 1869 ki cs PI 13 15 7 15 17 11 10 15 22 10 10 150 a Ph 8 9 11 20 14 12 8 14 20 7 3 13 139 fl p 13 20 15 20 20 12 14 13 12 16 11 18 184 188 P4 16 20 15 14 17 16 19 19 23 23 8 14 201 0, IN 22 31 11 31 30 24 15 20 IS 11 13 21 25" rcLi ® a 19 50 35 18 25 24 26 23 4" 26 1( 3! 341 JSIV 'p" 1-3 47 43 4C 34 6$ 6" 3! 55 4 4" 35 2( 53 "E. be 60 46 64 46 55 125 63 38 61 177 30 30 795 5 a ® & ® tz: 61 90 65 38 91 50 101 82 71 221 If 7f 984 3 I October. ! a ® i> 0 27 46 26 11 25 36 18 41 29 I 55 20 ) 32 366 a ® ® 0 21 17 14 12 11 32 If 24 17 8 12 1<1 203 75 ■© H 342 435 348 291 44f 488 383 401 409 773 202 33C 1 4854 fe a ® p c- w PS 1.79 2.26 1.82 1.52 2.33 2.32 1.82 1.91 1.95 3.68 0.96 1.55 .... .2 ft 0 P ( 191.000 f 4 210.000 216.000 3.834 8,856 er sr 16 2 45 2 4 35 10 59 20 2 7 2 122 1 19 7 17 74 274 545 15 9 14 3 1 10 5 2 24 13 14 49 283 418 264 147 7 22.46 35.28 26.26 "0.'88 3.08 17 3 1 6 67 2 108 10 15 68 303 600 341 242 17 29.02 58.08 37.69 1.06 4.27 16 1 19 2 19 2 18 30 25 2 17 11 21 58 244 447 241 185 21 18.66 40.36 25.54 "i.'08 3.25 S3 6 4 2 157 3 *8 14 57 249 555 316 239 24 46 52.14 31.71 i.'31 3.25 23 2 8 3 14 4 3 20 fevt fev eve ir ar I Tots 1 18 2 2 1 31 10 32 10 14 66 286 475 278 197 21.52 42.98 27.14 "i'31 3.77 I 5 1 13 1 26 6 10 63 249 417 251 166 19.43 36.41 23.83 '2.28 3.60 Yellow Fever 2 74 7 19 20 13 72 40 55 222 869 1,393 62 16 12 20 "14 22 65 21 168 715 1,115 82 16 15 35 1 20 36 18 45 135 758 1,161 42 9 4 13 ib 73 18 28 114 401 720 2 "7 7 5 8 25 81 142 "ib 6 3 6 '"7 7 3 19 29 230 329 *2 ; b 4 2 5 । 9 , 104 | 128 "38 3 69 9 1 159 378 657 Small-pos Diphther Diarrhoea Congestit Convulsit Phthisis Deaths ft Total r Deaths. < Death rate pe 1000 inhabitar per annum Yellow I Malarial Typhoid Scarlet I 94 9 24 15 16 79 355 609 349 255 5 27.02 55.63 34.80 o.9i 4 51 62 4 18 12 12 65 323 522 300 213 9 23.22 46.47 29>2 1.08 3.31 Small-po? Diphther Diarrhoea Congestit Convulsi Phthisis Deaths fi Total n Deaths. • Death rate pe 1000 inhabitai per annum Yellow 1 Malarial Typhoid Scarlet I Measles. Small-po Diphthei Diarrhoe Congesti Convulsi Phthisis Deaths f Total r Deaths. 1 Diseases m of Brain K 1 26 18 16 79 325 532 346 173 13 29 44 41.52 33.42 1.50 2'01 4.96 2 46 17 16 81 366 636 444 178 14 34.37 42.70 36.34 0.34 4.51 4.63 4 1 64 19 56 269 440 4 28 4 16 74 232 369 251 118 19.43 25.74 21.08 b'46 4.22 2 20 7 6 68 317 461 326 135 24.54 28.42 25.61 0.77 3,77 1 30 30 60 296 474 29.78 0.12 2 19 3.77 1 28 4 16 277 681 42'78 15 20 3 01 3.46 2 27 8 23 66 240 441 27'70 1.38 2.82 4.14 7 20 35 8 10 2 24 27 29 59 476 1845 1631 214 126.25 46.69 105.43 60.85 9.31 3.37 10 26 10 15 101 291 492 317 175 24.54 38.18 28 11 0.28 1.83 5.77 13 25 12 15 60 292 466 326 140 24.60 29.43 25.88 0.05 2.16 3.33 jnaianai rev Typhoid Dex cr er 1 Diseases Scarlet Fever n oj DPS 20 11 58 66 262 234 473 439 317 278 155 144 4 17 24.5-'21.52 33.1031.41 27.0^25.08 1-A 0.85 3-M 3.20 3 31 3.77 1870 Small Pox Diptheria Diarrhoeal Diseases Congestion of Brain Convulsions Phthis Pulmonalis All other deaths.. Number f Total - Pulmonalis om all other causes 72 312 555 om um W1 Col 1871 1872 1873 >cr of Deaths um W1 Col No oer 01 ueauw rites - lites ored 5 stated Whites Colored Total - - - - • Yellow Fever Malarial Fever Phthisis Pulmonalis .... 34*86 i.bb 4.52 34'24 1.25 4.65 27.64 6'94 3.52 .No r its ' Whites Colored Total Yellow Fever Malarial Fever - - - Phthisis Pulmonalis 1874 1875 1876 1877 • 1878 1879 1880 .. .. ot Deaths. [ Death Rate per 1000 Inhabitants per annum Vhites Colored - Yellow Fever Malarial Fever. Phthisis Pulmonalis 884 509 0.05 1.28 3.86 699 416 1.39 3.76 774 387 1179 2.76 506 214 i.ii 3.37 91 51 0.79 2.82 196 123 0ffi2 1.80 62 | 66 0^32 1.44 422 • 235 ts ' Wh Cole ites 20 40 36.10 24.24 22.28 31.27 24.96 22.94 32.62 25.47 16 52 30.96 19.18 18.12 13.30 16.03 16.40 30.16 20.52 19.92 21.12 I 20.52 MAY V red 22 7 2 74 31 7 5 78 4 61 9 22 53 346 621 11 4 2 1 31 3 22 4 6 68 22 35 79 438 713 450 243 20 38.29 30 4 21 71 2 238 21 30 73 440 930 568 354 8 48.34 84.96 58.43 188 4.58 24 4 1 15 4 2 20 3 13 72 11 4 47 14 21 70 326 601 362 233 6 28.02 50.83 34.34 i.14 4.00 18 5 16 7 13 3 1 26 3 5 39 1 4 45 12 36 69 351 581 361 220 ''eve Fe r ver 27 3 1 2 32 106 46 4 1 1 4 45 12 21 53 172 4C5 19 26 4 7 11 4 1 17 25 5 1 1 26 8 45 16 16 57 283 500 342 154 4 29.10 36.96 31.41 1.06 1.57 3.58 2 36 7 r 4 IS 41 1 6 1 29 5 147 55 4 20 3 32 4 6 r ex Total CENSES OF THE STA1 The following statemei to the Census Office by the E The statement of the p rections by reason of the dis< r ex eve E OF LOUISIANA-FROM THE TENTH CENSUS OF THE I it exhibits the results of the first count of population according to t numerators of the several districts concerned. opulation in relation to any township, town, city, or county is still st JNITED STATES. re schedules returned ibject to possible cor ts returned. ever 1 1 9 Small-po: Dipht het Diarrhoet Congesti Convulsi Phthisis Deaths f Total 1 Deaths. Death rate pe 1000 inhabitar per annum 79 6 66 12 19 67 270 548 331 207 10 25.62 45.16 31.31 i.37 3.82 26 6 38 14 13 52 233 403 272 124 7 21 05 27.05 23.02 0 85 2.97 105 3 54 12 9 71 461 738 433 305 12 3 55 6 16 68 352 325 210 £ 10 14 38 6 2s 66 320 527 348 170 9 26.94 37.09 30.11 0.11 2.05 3.77 1 30 3 6 50 29 9 20 b 12 fa 92 2L 337 4411 587 7 1 44 9 11 83 353 543 341 202 1 4s 19 25 59 345 602 '" 38 16 59 275 411 2 42 10 13 71 354 509 336 173 ia 45 16 22 88 343 568 31 6 15 68 282 430 267 156 7 22.72 37.44 27.01 0.44 0 69 4.27 7 27 6 22 89 135 492 360 132 7 22 8 9 54 287 410 267 143 10 21 11 10 94 329 517 345 172 11 Diseases on of Brain ons Pulmonalis 44 2 20 61 260 452 rl Diseases m of Brain ms - Pulmonalis ■om all other causes Average 12.5 11.6 15.3 17. ( 21. 28.^ 44. 66.2 82.( 58. 30.5 16.9 404 1.99 202 500 sovery ot omissions or duplications or na mes in the lists ot inhabitar om uml W1 Co tNo r its an uiuci uluses >er of Deaths DEATHS IN THE CHARITY HOSPITAL. CITY OF NEW ORLEANS, DURING THE YEAR 1880. Total. 940 263 Male. 468.911 Female 471,352 Native. 886,119 Foreign 54.144 White. 455.063 Colored* 485,200 um w her 01 ueams lite ored lite 314 IS 4 24.31 27.27 25.3] 0.5! 1.0! 2.9 360 220 7 7.87 8.00 3.54 0.23 2.34 5.25 DEATHS. January. February. March. । April. 1 CO S g August. September. October. November. December. I Total. II rne m t stated I Nr r ds PARISHES. Ascension Assumption .... Avoyelles Bienville Bossier Caddo Calcasieu Caldwell Cameron Catahoula Claiborne Concordia De Soto East Baton Rouge East Carroll East Feliciana... Franklin Grant Iberia Iberville Jackson Jefferson Lafayette Lafourche Lincoln Livingston Madison Morehouse N atchitoches .... Orleans.... o H 16890 17OK 16747 10442 1604; 2630." 12488 5770 2415 10287 18858 14914 15605 19986 12147 15132 6495 6188 16686 17600 5328 12166 13236 19113 11075 5258 13908 14206 19722 216140 aS 8507 8632 8663 5234 8187 13159 6473 2t88 1215 5248 9473 7525 7721 10058 6330 7348 3281 3096 8538 8914 2636 6188 6702 9762 5555 269.i 7088 7086 9764 100919 0) a o 8389 8378 8084 5208 7858 13146 6015 2882 1200 5039 9385 7389 7884 9928 5817 7784 3214 3092 8148 8686 2692 5978 6534 9351 5520 2563 6820 7120 9958 115221 ft 16441 16789 16475 10422 15954 25665 12174 5740 2364 10201 18825 14798 15535 19475 11979 14890 6418 6161 16202 17232 5324 11170 12970 18733 11048 5121 13754 14111 19473 174965 .9° o £ 455 221 272 20 91 640 314 30 51 86 33 116 70 511 168 242 77 27 484 368 4 996 266 3'0 27 137 154 95 249 41175 g £ 5966 8937 8482 5456 3252 6922 9924 2873 2087 5729 8544 1317 5115 7110 10<6 4495 2702 3320 8101 4805 2925 4864 7696 11287 6175 4265 1251 3544 7642 158379 5 _o 10930 8073 8265 4986 12793 19383 2564 2897 328 4558 10314 13597 10490 12876 11121 10637 3793 2868 8585 12795 2403 7302 5540 7826 4900 993 12657 10662 12080 57761 PARISHES. Ouachita Plaquemines .... Pointe Coupee... Rapides Red River Richlaud Sabine St Bernard St. Charles St. Helena St. James St.John Baptist.. St. Landry St. Martin St. Mary St. Tammany.... Tangipahoa Tensas Terrebonne Union V ermillion Vernon Washington Webster W. Baton Rouge West Carroll West Feliciana .. Winn .... g 0 H 14723 11575 17799 23597 8573 8440 7344 4405 7161 7504 14714 9686 40002 12662 19891 6887 9638 17824 17956 13526 8735 5160 5190 10005 7667 2776 12809 5846 © a 7407 6241 9105 11984 4347 4429 3691 2439 3719 3803 7632 5023 20534 6326 10564 3522 4881 9044 9296 6739 4366 2520 2635 5142 3966 1402 6355 2914 a Ph 7316 5334 8694 11613 4226 4011 3653 1966 3442 3701 7082 4663 19468 6336 9327 3365 4757 8780 8660 6787 4369 2640 2555 4863. 37011 13741 6454 2932 g "3 * 14480 10690 17566 23237 8540 8360 7313 4016 6987 7456 14393 9415 39475 12437 19021 6550 9365 17654 17646 13475 8589 5149 51184 9924 71551 2756 12646 5835 _il) ® O P 243 885 233 360 33 80 31 389 174 48 321 271 527 225 »70 337 273 170 310 51 146 11 6 81 116 20 163 11 g s 4516 4251 4782 9526 2506 3204 5486 2104 1400 3326 4850 3855 20471 5782 6717 4255 5603 1574 8613 8016 6779 4783 3475 4323 2252 1347 2279 4797 3 5 o 0 10207 7324 13017 14071 6067 5236 1858 2301 5761 4178 9864 5831 19531 6880 13174 2632 4035 16250 9343 5510 1956 377 1715 5682 5415 1429 10530 1049 f Whites - - - 33 52 66.54 42.17 i'02 4.05 25.16 45.81 30.57 "b'bi 3.88 26.01 37.74 29 08 0.74 4.05 27.24 46.31 32.27 1.44 3.83 Death Tate pe 1000 inhabitai per annum r White Colored - 25.75 44 07 31.03 0.05 1.65 4.74 27.87 28.80 28.11 8.40 20.67 31.20 23.43 26.03 36.21 28.72 Colored Total f Yellow Fever Malarial Fever.... Phthisis Pulmonalis 37.82 1.38 3.70 39.01 1.94 3.33 25.82 0 69 3.70 58.32 44.79 1.94 4.96 Total Yellow Fever Malarial Fever Phthisis Pulmonalis .... 28.39 1'69 3.83 29.21 6.66 2.89 3.33 35.68 0.67 1 63 5.52 3.14 5 08 1 14 3.08 1.77 _ 5.22 Yellow I M alarial Typhoid Scarlet I Measles. Small-po Diphthei Diarrhoet Congesti Convulsi Phthisis Deaths f Total Deaths. Death rate pe 1000 inhabitar per annum ''eve JU 1ST E Yellow Malarial Typhoid Scarlet b Measles Small-po Diphthei Diarrhoe Congest: Convulsi Phthisis Deaths t Total Deaths. Deat rate pt 1000 inhabita per annuir "21 6 2 "'88 "'35 9 21 60 321 561 35.3' i'3i 3.7' BI 5 17 6 4 1 2 3; 7 26 84 325 512 32 0.21 1.0C 5.2' SO. 2 14 2 1 ' i 26 15 8 60 30C 422 26'bl 0.15 0 81 3.7' EM 2 12 9 'ii 1 29 9 15 59 326 473 298 17C 25 3C 40 81 >29.71 0.B 0.7. 3.71 BE 1 32 1 15 13 36 3 24 74 394 59' 39C 19; ( 30.6; 42.54 34.11 0.0. 1.81 4.21 i If <1 a ... J 1) 3 3d 4[l 3f ii 24. ( 37.1 28.< 04" 0.D 1 24 2 69 6 25 16 8 69 333 560 330 219 11 25.54 47.78 32 00 0.05 1.37 "17 5 9 20 9 9 71 273 415 266 149 20.59 32.51 23.71 0.97 4.05 3 8 6 24 4 15 47 252 359 236 123 18 27 26.83 20.51 0.17 0.46 2.68 "12 3 7 22 4 12 61 338 459 320 139 24.77 30 32 26.23 0ffi8 3.48 ib 4 10 ib 20 16 13 95 270 460 291 169 21.96 35.57 25.55 iibi 5.27 Malarial Fever Typhoid Dever 1 1 8 1 2 4 2 7 1 2 4 1 1 6 3 8 4 4 1 1 8 29 7 1 7 2 9 2 38 3 69 9 1 159 378 19 4 2 3 2 55 9 34 62 284 525 32.98 1.19 3.89 50 7 8 9 59 2 81 4 28 64 361 673 42.28 3.i4 4.02 35 7 67 20 26 74 306 535 33.61 2. is 4.65 18 4 17 1 41 12 39 66 374 572 336 219 17 28.59 52 56 35 93 1.12 4.14 25 2 13 3. 1 56 19 27 58 326 562 332 220 10 28.25 52 80 35 31 1.57 3.64 24 13 "73 10 33 10 18 58 278 , 517 310 193 14 24.00 42 11 29.54 1.37 3.31 26 8 "30 "si 15 24 59 303 551 346 192 13 26.78 41 8! 31.48 i'49 3.37 23 3 6 63 10 5 62 6 27 64 346 615 363 238 14 28.10 51.92 35.14 i.31 3.66 47 7 1 1 137 101 0 2 19 92 201 ~33 355 278 27.48 60 65 36.17 '2'68 26 3 " "i8 6 52 9 16 108 189 427 271 156 20 98 34 03 24.40 1.49 6.17 16 3 53 9 17 37 262 402 248 154 19.20 33.60 22.97 b.di 2.11 32 6 23 "9 56 15 14 70 343 573 376 197 28.37 41.47 31.83 " i'77 3.89 Fev Fev feve X... ria.. 11 2 "52 31 15 IC 72 301 504 305 201 25.71 48.01 31.6( b'bi 4.5S 1 ever Fever 'ever - - - ia il Diseases.... on of Brain ons - Pulmonalis ■om all other causes number of Deaths White Colored er Diarrhoeal Diseases Congestion of Brain 6 2 1 ai on of Brain ons Pulmonalis rom all other causes number of Deaths f Whites < Colored Phthisis Pulmonalis All other deaths 14 42 11 34 5 24 13 46 14 25 1 2 7 17 0 26 2( 15 29 24 35 12 42 Total 67 51 39 65 46 4 7 46 48 47 61 76 64 657 [Ni 1* its t stated................... ' White Colored Total Yellow Fever Malarial Fever Phthisis Pulmonalis .... ( Nt 1 jr nts )L sLaLea................... 'Whites Colored Total Yellow Fever Malarial Fever Number of Whites Number of Colored Number of Chinese 44 23 33 16 0 26 13 43 . 22 ! _ 23 23 3 1 27 6 19 2£ 1! 32 15 40 21 56 20 38 26 422 233 0 including, in uie state, mo unmese, oiy inaians ana naii-ureeas, □ nan-uninese, a yv can mutau, aiiuiuaoL Indian. ■ (Phthisis Pulmonalis.... - - - - M)IWSWTA <- TOPOGRAPHICAL FEATURES PREPARED FCR THE MEDICAL AND SURGICAL MEMOIRS OF- JOSEPH JONES, M. D., -BY- T.S. HARDEE, CIVIL ENGINEER, 1879. Total Area of State 39950 Sanare Miles LAND CLASSIFICATIONS : CONTAGIOUS -tvustid- INFECTIOUS DISEASES. MEASURES FOR THEIR PREVENTION AND ARREST Malarial Fever, Yellow Fever, Typhoid Fever, Typhus Fever, Asiatic Cholera, Small-Pox, ( Variola,) Modified Small-Pox, ( Varioloid), Chicken- Pox, (Varicella), Vaccination, Spurious Vaccination, Measles, Scarlatina, Diphtheria, Phthisis Pul monalis, Syphilis, A Icoholism. Theory and Practice of Quarantine, Relations of Drainage, Soil, Food, Water and Climate, to Endemic, Epidemic, Contagious and Infectious Diseases. Application of Measures for the Exclusion and Arrest of Yellow Fever and Small-Pox in the Mississippi Valley, Illustrated by the Quarantine and Sanitary Operations of the Board of Health of the State of Louisiana, during 1880, 1881, 1882 and 1883, By JOSEPH JONES, M. D., 156 Washington street, corner Camp, Fourth District, New Orleans, La. CONTENTS. Page Small-pox . ii Measures instituted by the President and Officers of the Board of Health for the arrest of small-pox in New Orleans, during the years 1880, 1881, 1882 and 1883 • iii Cases and deaths of small-pox in New Orleans in 1882, classified accord- ing to the district in which they occurred, color and sex.... v Number of free vaccinations performed by the Sanitary Inspectors of the Board of Health during the years 1881, 1882 and 1883 vi Cases of small-pox reported to the Board of Health, January 1, to September 30, 1883, classified according to districts in which they occurred viii Report of R. A. Bayley, M. D., Sanitary Inspector First District ix Report of C. Faget, M D., Sanitary Inspector Second District x Report of Eng. J. Mioton, M. D., Sanitary Inspector Third District. xi Report of W. R. Mandeville. M. D., Sanitary Inspector Fourth District. xii Report of A. M. Beret, M. D., Sanitary Inspector Fifth District xiii Report of Wm. Ryan, M. D., Sanitary Inspector Sixth and Seventh Dis- tricts xiv Summary of the efforts of the Board of Health to arrest small-pox xv Views of Hon. I. N. Marks with reference to the efforts of the officers of the Board of Health to arrest the spread of small-pox in New Orleans... xvii Resolutions of Hon. Edward Booth, with reference to the efforts of the officers of the Board of Health of the State of Louisiana, for the suppression of small-pox in New Orleans xvii Cases and deaths from small-pox from January 1, 1883, to December 31, 1883, inclusive xx Total deaths from all causes,and from small-pox, in New Orleans, classi- fied according to race, in New Orleans, during 1880, 1881, 1882 and 1883 xx Deaths from small-pox classified according to nativity and race,1880,1883 Deaths from small-pox classified according to sex xxi General conclusions with reference to small-pox in Louisiana xxii General results of the Quarantine operations of the Board of Health of the State of Louisiana for the exclusion of foreign pestilence, and more especially yellow fever, from the Mississippi Valley, during the years 1880. 1881, 1882 and 1883 xxiii Condition of Mississippi Quarantine Station in 1880 xxiii Repairs for the Mississippi Quarantine Station, advocated by the Presi- dent of the Board of Health in 1880 . xxiv History of the erection, an<l amounts expended upon the Mississippi Quarantine Station xxv Quarantine of vessels from the infected port of Rio de Janeiro; dis- charge of cargoes at the Mississippi Quarantine Station ; disinfec- tion of coffee in the warehouses of New Orleans xxviii Inspection station established at mouth of Mississippi River xxix Reports of J. F. Finney, M. D., resident physician Mississippi Quaran- tine Station, and history of bark Excelsior, from Rio xxx Reports of J. F. Finney, M. D., detailing Quarantine operations at the Mississippi Station, 1880, 1881, 1882 and 1883 xxxi, xxxvii, Ixxxi, civ Report of Daniel W. Adams, M. D., Rigolet's Quarantine Station, 1880.. xxxi Reports of N. L. Sigur, M. D., Atchafalaya Quarantine Station xxxiii Quarantine work accomplished by the Louisiana Board of Health dur- ing 1880 xxxii Outline of Quarantine operations, 1881 xxiv Inspection of infected ships; yellow fever in Rio de Janeiro, 1880 and 1881 xxxv Report of W. H. Carson, M. D., resident quarantine physician, Fort Pike, Louisiana xxxviii 6 Con tag io us Diseases- Con t en ts. , Page Letter of President of Board of Health to Attorney General of Louisiana, with reference to the resistance of Quarantine laws by Morgan's Louisiana and Texas S. S. and R. R. Company clxvii Expenditures by the Board of Health for Quarantine purposes, 1869-1882. clxviii Letter of the President of the Board of Health to the Governor of Lou- isiana, with reference to the decision of Judge Monroe, issuing an injunction against the Board of Health, and declaring the Quaran- tine system of Louisiana, established by the act of 1855, illegal clxviii Quarantine fees-they are legal exactions of the State in payment for special benefits-the Quarantine laws do not infringe the power of Congress to regulate commerce clxix The Morgan Company required to pay the Quarantine fees fixed by the laws of Louisiana clxix Highly important decision of the Supreme Court of the State of Lou- isiana, sustaining the Quarantine laws of the State and vindicating the action of the Board of Health in the collection of the Quarantine fees and in the maintenance of the Quarantine service clxiv Opinion of Supreme Court of Louisiana, delivered by Associate Justice Fenner, January 21, 1884.... clxix Comparative view of the mortality of New Orleans, 1880 to 1883, inclu- sive clxxii Relations of disease and deaths in New Orleans to race, temperature, rainfall and moisture-Outline of the sanitary work performed under the direction of the Board of Health of the State of Louisiana, dur- ing 1880, 1881, 1882 and 1883-Comparative tables of the diseases and mortality of the various districts of New Orleans clxxiv Population of New Orleans, 1880-1884 clxxiv Mortality of New Orleans, 1880, 1881, 1882 and 1883 . clxxiv Mortality from some of the chief fatal diseases in the city of New Or- leans during the four years, 1880 to 1883, inclusive, by weeks clxxv Mortality by weeks during four years, 1880 to 1883, inclusive, of deaths per 100 inhabitants clxxix Mortality of New Orleans, during four years, 1880-1883, classified ac- cording to districts, race, sex and principal diseases clxxxvi Reports of Sanitary Inspectors of Board or Health clxxxi-cxciv Comparative rates of mortality in New Orleans-Sanitary measures ne- cessary to the health of its citizens, and mortuary statistics ... cxciv-ccii Mortality and sanitary history of New Orleans, 1881 ccii-ccix Mortuary statistics of New Orleans . ccix Deaths from sun-stroke ccx Deaths reported by Coroner ccxi Mortality of the colored race ' ccxi Small-pox ccxii Mortality and sanitary history of 1882 -Deaths in New Orleans from principal diseases, classified according to districts, race and sex ccxiii-ccxiv Yellow fe^er in the Third District, 1882 ccxvii Sanitary measures instituted by the President of the Board of Health for the arrest of yellow fever in 1882 ccxvii Mortality of New Orleans during 1882.... ccxxv Relations of rainfall to mortality ccxxvi Deaths of 1882, classified by race and general divisions ccxxvi Malarial fever, 1882 ccxxvii Mortality and sanitary history, 1883 ccxxxii-ccxxxix Mortality from principal diseases.. ccxi Observations on the climate and health of Louisiana ccxliv-cclxxv Effects of the rivers, lakes, bays, and of the Gulf of Mexico, on the climate of Louisiana ... ... ccxlviii Monthly and annual rainfall with deaths from yellow fever in New Or- leans 1817, 1881 , ccii Monthly mean temperatures, and mean temperatures spring, summer, autumn and winter-Annual temperature in New Orleans during a series of years cclv Extreme maximum and minimum temperatures in New Orleans during a series of years ccliii Observations on the elevated temperature and sun-stroke or heat apo- plexy of June, 1881 ccix Deaths from sun-stroke and congestion of the brain iu New Orleans dur- ing a series of years cclxii Contagious Diseases-Contents. 7 -Page. Relations of malaria) and yellow fevers to climate cclxvi Monthly deaths by yellow fever, during a period of thirty-two years . .. cclxvi Fever statistics of the Charity Hospital of New Orleans-tables showing the annual and monthly admissions of the different fevers cclxviii Deaths from malarial fevers, by months-1869-1880 cclxxi Statistics of yellow fever in the Charity Hospital, during a period of fifty-seven years cclxxii Statistics of the Charity Hospital of New Orleans .. cclxxiv Practical observations on yellow fever in New Orleans cclxxv Relations of fevers to drainage cclxxxi Sanitary measures recommended by the President of the Board of Health cclxxxi Cleanliness and drainage of paramount importance to the city of New Orleans cclxxxii Drainage canals of New Orleans cclxxxiii Difficulty of establishing a correct system of drainage in the area occu- pied by the city of New Orleans ' cclxxxv Cases and deaths of the various fevers treated in the Charity Hospital, during a period of thirty-four years. cclxxxvi Deaths from the various forms of fever in the city of New Orleans, dur- ing a period of thirty-four years ' cclxxxxvii Report on proposed system of drainage for the first drainage district, New Orleans, by Major G. T. Beauregard, Chief Engineer, New Or- leans, December 26, 1858 cclxxxix Vital statistics of New Orleans cclxcvi Table illustrating the relations of the population of New Orleans to the total mortality from all causes, during a period of ninety-four years, ccxcvi Table illustrating the death rate from all causes, and from yellow fever, in New Orleans, during a period of sixty-four years ccxcvi Population and mortality of New Orleans, during four years, 1880-1883.. ccxcvii Vital and mortuary statistics of New Orleans, monthly mortality, 1849- 1881 ... - - ccxcviii Nationalities of the dead in New Orleans, 1853-1881 ccxcix' Deaths from zymotic and epidemic and endemic diseases in New Orleans, 1844-1881 ccc Deaths from phthisis pulmonalis, 1869-1880 ccciii Deaths from diarrhceal diseases, 1867-1880 ccciii Deaths from infantile diseases, during a period of twenty-seven years, 1867-1880 . ccciv Malignant, or Asiatic cholera „ cccv Scarlatina, measles, whooping-cough and diphtheria cocvii Venereal diseases-syphilis, gonorrhoea anti orchitis cccvii Typhus or ship-fever, typhoid or enteric fever cccix Prisons, police stations and charitable institutions, as sources of disease. cccxi Statistics of the parish prison of New Orleans cccxii Sick destitute poor of New Orleans cccxiv Vital statistics of New Orleans-comparative mortality of white and colored races cccxviii Deaths at the different periods of life. cccxxi Mortality amongst the sexes in New Orleans, 1849-1881 cccxxii Preventable causes of disease and death cccxx vii Intra-mural sepulchre in New Orleans-effects of the mode and place of burial on the health of the inhabitants cccxxvii nterments in the various cemeteries of New Orleans-total deaths, and deaths from contagious and infectious diseases, 1833-1883 cccxxxii oison, suicide, violence, murder, accident, drowning, stabbing, intem- perance and insanity cccxxxvi Inspection of drugs, milk, articles of food, etc ccxxxvii Difficulty of controling the sale of poisons cccxxxviii Irritant poisons ccxxxcviii Narcotic, or cerebral poisons . ecexxiw Spinal poisons ....... cccxxxix Cerebro-spinal poisons cccxxxix Gaseous poisons ................... •••••••••.. cccxxxix Lightning, cold, heat, starvation and drowning cccxxxix Copper vessels and copper, in articles of food cccxi Lead, and its compounds cccxlii 8 Contagious Disenses- Contents. Page. Actual number of cases of poisoning, accidental or intentional, in New Orleans cccxlv Poison statistics of Charity Hospital, 1842-1880 cccxlv Deaths from poison, suicide, murder and accidents, in New Orleans, 1849- 1880 ... ..... cccxlviii Process for the recovery of drowned persons. cccxlvii Poisonous effects of alcohol . cccxlviii Food resources of Louisiana. cccl Purity of the sugar and molasses of Louisiana cc®?! Cotton seed oii ccclviii Nutritive and agricultural value of decorticated cotton seed cake and meal ccclxi Chemical examination of Louisiana rock salt ccclxiii Abundant supplies of fruit, game and fish in Louisiana ccclxvii Effects of overflows upon the health of the inhabitants of the delta of the Mississippi river ccclxix Overflow of the city of New Orleans ccclxix Amount of the sediment in the water of the Mississippi river ccclxxi Early investigations on the sediment of the Mississippi river ... . cclxxii Previous to the erection of levees, the delta of the Mississippi was annu- ally overflowed coclxxyi Floods of the Mississippi ccclxxviii Relation of overflows to disease and death ... ccclxxix Water supply of New Orleans ccclxxxii Outline of the history, theory and practice of Quarantine 1 Relations of Quarantine to Constitutional and International Law and Commerce The theory and practice of Quarantine, and its relations to Constitutional and International Law and Commerce 1 The English Colonies of America adopted Quarantine regulations long before their separation from the Mother Country and the achievement of their independence 2 South Carolina, history of Quarantine . 2 Massachusetts, history of Quarantine 3 Rhode Island, Quarantine laws of . . 4 New York, history of Quarantine 7 All the essential questions relating to Quarantine, and the relations of the indi- vidual States to each other and the general Government, were thoroughly discussed shortly after the formation of the Federal Union of the Inde- pendent Colonies 9 On the organization of the Federal Government, in 1779, several of the seaboard States had Quarantine laws and regulations adopted by the Colonial Gov- ernments, and which had been in effect for nearly a century 9 History of Congressional legislation with reference to Quarantine 9 Discussion of the subject of Quarantine in the Fourth Congress of 1795 10 Bill passed by United States Congress, January 29, 1779, respecting Quarantine and Health laws Congress clearly indicated, by the acts of 1796 and 1799, that Health and Quar- antine laws were not in the nature of regulations of commerce, and did not violate the provisions of the Constitution, but were essentially, in their essence, police regulations, based upon the indestructible and inalienable right of self-preservation 18 Decision of Judge F. A. Monroe, in the case of Morgan's Louisiana and Texas Railroad and Steamship Company vs. The Board of Health 18 Quarantine established and recognized by International law Examples illustrating the forcible execution of Quarantine for protection against contagion 20 Quarantine facilitates commerce, in that it furnishes the only legal certificate which grants to vessels subject by International, National and State laws to quarantine, liberty to unload 21 Contagious Dis eases- Contents. 9 PAGE. The Quarantine system of Louisiana, in the principles involved, is essentially the same as the systems of France, Sardinia, Portugal, Turkey, Tuscany and other European powers ' 21 Commercial statistics of New Orleans, 1805 to 1860 22 Commercial statistics of New Orleans, 1862 to 1882. -. 23 Important services rendered by detention, cleansing and fumigation in Quaran- tine . 24 Services rendered to commerce by the removal of the sick from the vessels and their treatment in the Quarantine hospitals 25 History of the erection of the Mississippi Quarantine Scation 25 General conclusions relating to the theory and practice of Quarantine, and its relations to constitutional law and to commerce 27 Contagious and infectious diseases, measures for their prevention and arrest.... 35 Definition of terms contagion and contagious diseases 37 Classification of contagia 38 Metabolic contagion 38 Conditions which favor the spread of contagious diseases 39 Measures for the prevention and arrest of contagious diseases 40 Yellow fever 41 Destructive effects occasioned by yellow fever and the more fatal diseases in New Orleans.... . .41 Total number of cases and deaths of the various forms of fever treated in the Charity Hospital in New Orleans, during a period of thirty-four years (1844 to 1880) 41 Deaths from the various forms of fever in New Orleans during a period of thirty- four years (1844 to 1880) 42 Measures for the exclusion, prevention and arrest of yeilow fever . 43 General outline of the symptoms and pathology of yellow and malarial fevers.. 44 Yellow fever, symptoms and pathology 44 Malarial fever, symptoms and pathology 44 General conclusions as to the nature of yellow fever, as drawn from original in- vestigations 45 Changes of the blood in yellow fever 45 Various forms of malarial fever 45 Changes of the blood in malarial fever 48 Chemical and microscopical examination of the blood in malarial fever.. . 50 Microscopical examination of blood in yellow fever 51 Organized bodies in the blood of yellow fever 51 Examination of the organic formsin the yellow fever (atmospheric) during the epidemic of 1878 * 52 Changes of temperature and pulse in yellow fever 52 Nature of the febrile stage of yellow fever 53 Changes of the circulation, respiration and temperature in yellow fever , 53 Hemorrhages in yel low fever 54 Chemical and microscopical characters of the black vomit of yellow fever 55 changes of the urine in malarial fever. 55 Chemical changes of the blood in yellow fever 58 Comparison between malarial, haematuria and yellow fever 58 Causes of black vomit in yellow fever 58 Changes of the urine in yellow fever 60 Tabular view of the pathological anatomy of yellow and malarial fever 65 Yellow fever, exterior 65 Malarial fever, exterior 65 Yellow fever, cerebro spinal and sympathetic systems 65 Malarial fever, cerebro spinal and sympathetic nervous systems 65 Yelow fever, pathological changes of the heart, acute.fatty degeneration of... 67 Malarial fever, heart 67 Yellow fever, lungs 70 Malarial fever, lungs. 70 Yellow fever, stomach 70 Malarial fever, stomach ; 70 Yellow fever, intestines 71 Malarial fever, intestines 71 Yellow fever, pathological changes of the liver 72 Malarial fever, microscopic and chemical character of liver 72 Fatty liver of yellow fever 73 Pigment liver of malarial fever 73 YelDw fever, gallbladder 74 Yellow fever, supra-renal capsules 75 10 Contagious Diseases-Contents. Page. Malarial fever, supra-renal capsules 75 Yellow fever, pathological changes of kidneys.. 75 Malarial fever, kidneys 75 Pathological condition of kidneys in yellow fever 76 Pathological changes of kidneys in malarial hannaturia 75 Constitution of the atmosphere during yellow fever epidemic of 1878 82 Results of the microscopical examinations of the air of rooms in which yellow fever cases were confined, during the epidemic of 1878 82 Origin of hospital grangrene, erysipelas and puerperal fever ... 85 Agency of the organisms observed in the atmosphere of yellow fever, and in the blood aid black vomit .... 87 Practical application of the results obtained from the experiments illustrating the nature of the air in yellow fever, and the poisonous properties of black vomit and putrid blood 87 Quarantine and sanitation of ships 88 Rules and regulations of the Board of Health of the State of Louisiana for the government of Quarantine officers and stations, and for the enforcement of the acts of the legislature of Louisiana 89 Sanitary rules regulating shipping in the port of New Orleans. 94 Prevention and arrest of yellow fever in the cities and towns of the Valley of the Mississippi, and more especially in the city of New Orleans 95 'Small-pox . 96 History of small-pox in Louisiana 96 Small-pox of comparatively rare occurrence in New Orleans, from 1803 to 1861. . 97 Deaths from small-pox in New Orleans, 1844 to 1883 98 Population of States tributary to New Orleans . 99 The colored population of the States tributary to New Orleans constitues more than one-third of the entire population 99 Difficulty of eradicating small-pox in New Orleans 99 Population of the principal cities of the United States, classified according to race 100 Prevalence of small-pox in the Mississippi valley 101 Plan for the eradication of small-pox 101 Relations of small-pox in New Orleans to temperature and seasons 103 Deaths in New Orleans from small-pox during a period of sixteen years.... ... 103 Cases and deaths from small-pox in New Orleans in 1882, classified according to districts and race 103 Measures for the preservation of the public safety 104 Measures for the arrest and prevention of small-pox in Louisiana 105 Natural history of small-pox-facts essential to the sanitarian 108 Definition of small-pox 108 Small-pox, aetiology. 108 Varieties of small-pox 108 Small-pox, prognosis 109 Vaccination 110 Phenomena of vaccinations 110 Re-vaccination ' . Hl Performance of vaccination Ill Selection of lymph Ill Methods of collecting lymph 112 Free vaccination Investigation as to the results accomplished by vaccination in the city of New Orleans during the first twenty-three weeks of 1883 113 General results of the inspection of twenty-six asylums, houses of refuge, educa- tional institutions, and the parish prison of the city of New Orleans, in the month of June, 1883, establishing the healthy condition of the inmates, and the total absence of small-pox. on account of thorough and successful vac- cination by experienced physicians 116 Results of inspection of public schools in New Orleans. 1883. 121 General conclusions as to the results accomplished by vaccinnation in New Or- leans 124 Sanitary measures for the arrest of small-pox ", 125 Conduct of the sick-room in cases of small-pox 126 Disposition of the dead of small-pox _ 127 Disinfection of dwellings and premises after recovery or death from small-pox 127 Disinfection and disinfectants 127 Diphtheria 128 History of diphtheria in New Orleans.... I."'"' 128 Contagious Diseases- Contents. 11 Page. Diphtheria-natural course . .. 129 Diphtheria'-incubation 129 Contagious nature of diphtheria . 129 Rules governing families afflicted with diptheria .... 130 Scarlet fever 131 Mortality occasioned by scarlet fever in New Orleans 131 Facts of interest in the natural history of scarlet fever for the guidance of sani- tary officers • 131 Contagious and infectious diseases, measures for their prevention and arrest, by Joseph Jones, M. D ... 135 Vaccination-Variolae Vaccinae (cow-pox); variola and varioloid; accidents attending vaccination; spurious vaccination 135 Circular No. 2-Prepared for the guidance of quarantine officers and sanitary inspectors of the Board of Health of Louisiana, by Joseph Jones, M. D. 135 Compulsory vaccination. 136 Ordinance relative to compulsory vaccination 136 Extract from the proceedings of the meeting of the Board of Health, State of Louisiana, September 6, 1883, relative to small-pox and vaccination........ 137 Mortality from small-pox during the first months of 1883, in New Orleans, La.. 138 Letter of president of the Board of Health to mayor of New Orleans 140 Causes of the popular opposition to vaccination .. 141 Works of Edward Jenner 142 An inquiry into the cansesand effects of the variolae vaccina; a disease, discovered in some of the western counties of England, particularly in Gloucestershire, and known by the name of the cow pox; by Edward Jenner, M. D. F. R. S. Third edition, London, 1801 143-159 Further observation on the variola; vaccina;, by Edward Jenner.. 161-177 A continuation of facts and observations relative to the variolae vaccinae or cow- pox, by Edwaid Jenner, M. D., F. R. S., etc., London, 1801 179-188 Dr. Jenners account of the origin of the vaccine inoculation 189-191 Dr. Jenner's instruction for vaccine inoculation 191-193 An inquiry concerning the history of the cow-pox, principally with a view to supersede and extinguish the small-pox, by George Pearson, M. D., F. R. S., physician to St. George's Hospital, of the College of Physicians, London, 1798 195-222 Reports of a series of inoculations for the variolae vaccina;, or cow-pox; re- marks and observations on this disease considered as a substitute for the small-pox, by William Woodville, M. D., physician to the Small-pox and In- noculation Hospitals, London, 1799. 223-250 The errors of Drs. Woodville and Pearson arose from the performance of cow- pox innoculation in an atmosphere poisoned by the contagious emanations cf small-pox. Correction of the errors of Dr. Woodville by Dr. Jenner.... 251 Experiments of Dr. Robert Willan in the years 1799 and 1800, on the combined innoculation of the variolous and vaccine fluids. . 252 References illustrating the extensive nature of the contributions by various observers to the literature of cow-pox inoculation, during the first five years after Jenner's announcement of his discovery 253 Report of the Royal College of Physicians of London on vaccination, with an appendix containing the opinions of the Royal College of Physicians of Edinburgh and Dublin ; and of the Royal College of Surgeons of Loudon, of Dublin, and of Edinburgh 255-262 The occurrence of small-pox after vaccination, excited in the minds of some, distrust as to the protective power of cow-pox inoculation 263 Dr. Jenner referred the reputed failures of vaccination to several causes 263-265 Epidemic small-pox of 1818 .. 266 Hostility aroused against vaccination 267 Investigations of Dr. Alexander Monro on small-pox and vaccination 267-272 Mr. Brice's test 269 Opinion of the medical profession in 1818, as to the protective power of vaccina- tion against small-pox 271 Dr. Thomson's theory of the identity of chicken-pox and modified smal'-pox.... 272 Establishment of re-vaccination 273 Professional views held in 1839 as to. correct vaccination and impediments thereto 275 History of small pox inoculation . 277 Comparative advantages of the inoculated small-pox and of the cow-pox 278 Mortality occasioned by inoculated small-pox ■. 282 12 Contagious Diseases- Contents. Page. The practice of inoculation for the small-pox, substituted a comparatively mild form of the disease, attended with but small mortality ; but the total num- ber of deaths by small-pox was thereby increased, and the perpetuation and spread of this loathsome pestilence on the surface of the earth was promoted by inoculation .... 282 The mortuary statistics of London demonstrated that inoculation actually in- creased the mortality from small-pox 284 The advantages of cow-pox inoculation demonstrated by official records and statistics 286 Mortuary records of London 287 Mortuary records of England 288-290 Mortality by small-pox in Copenhagen for a period of 100 years before vaccination and during vacination 291 Death rate from small-pox in various countries before and subsequent to yaccin- ation 292 Outline of the introduction of cow-pox inoculation in various countries. . 296 History of cow-pox inoculation in England 296 History of cow-pox in Ireland 299 History of cow-pox in the Duchies of Schleswig and Holstien 300 Cow pox in Germany 306 Cow-pox in France.... 307 Observations of Bosquet on the cow-pox discovered at Passy, near Paris, in 1836. 307 Comparison by Bosquet of the phenomena of the old and new vaccine r_... 308 Discovery of cow-pox in America ' 310 Introduction of vaccination into the United States of America 312 Introduction of vaccination into the New England States, more especially into Boston, Massachusetts, by Dr. Waterhouse * 312 Letter of Mr. Jefferson to Dr. Jenner 313 Lettter of John Quincy Adams to Dr. Jenner 314 Introduction of vaccination into the Southern States by Thomas Jefferson of Virginia 314 Correspondence between Thomas Jefferson and Dr. Benjamin Waterhouse, of Cambridge, Massachusetts, with reference to vaccination 316-322 Introduction of vaccination into New York, United States of America 323 Total Deaths from all causes, and from small-pox, measles, scarlet-fever and phthisis-pulmonalis in the city of New York during a period of fifty years, from 1804 to 18^3 325 Introduction of vaccination into Philadelphia, Pennsylvania 326 Deaths from small-pox in Philadelphia from 1807 to 1882, inclusive. 327 Mortuary statistics of Philadelphia 328 Small-pox and the introduction of vaccination in South Carolina, 329 Deaths in Charleston, South Carolina, from all causes and from small-pox, 1822- 1848, inclusive 334 Deaths iu Charleston, South Carolina, from all causes and from small-pox, 1844 1865 335 Sanitary Statistics of South Carolina 335 Small-pox and vaccination in Georgia 338 Deaths from all causes and from small-pox in the white population of Savannah, Georgia,, during a period of fifty years, 1804-1853, inclusive. 339 Total deaths from all causes and from small-pox in the white and colored popula- tion of Savannah, Georgia, during a period of sixteen years, 1854-1869 339 Deaths from fever and other causes in Savannah, Georgia 341 Small-pox and vaccination in Augusta, Georgia 343 Deaths from all causes and from small-pox, whites and blacks, in Augusta, Georgia, during forty-eight years, 1818-1866 343 Introduction of Vaccination into the Possessions of Spain in North and South America 344 The relations of grease in the horses' heels to cow-pox 348 Artificial production of horse-pox by inoculation 352 Artificial production of horse-pox by inoculation by injection of lymp 352 Character and course of horse-pox 353 General description of cow-pox 354 Observations on cow-pox, by Robert Ceely 355 Illustration of the appearance of cow-pox 355 General description of cow-pox 355 Comparative view of the natural small-pox, inoculated small-pox and cow-pox. 359 Small-pox contagion-nature of the virus of cow-pox and small-pox 360 Small-pox communicated to man and animals by eating the small-pox matter. in 1779 361 Contagious Diseases-Contents. Page. Microscopical characters of vacciue lymph and the contagions matter from the pustules of small-pox . 363 Comparative phenomena of inoculated small-pox and cow-pox 365 Inoculated cow-pox vaccination . 366 Phenomena of variola (smallpox) 367 Illustrations of confluent and distinct small-pox and of varioloid .. 368-370 Development and structure of the small-pox pustules . 370 Changes of the temperature and urine in small-pox (variola), and in modified small- pox (varioloid) J 372 Temperature in small-pox 373 Temperature in varioloid 375 Constituents of the urine in varioloid and variola .... 378 Spurious vaccination, or the abnormal phenomena accompanying and follow- ing vaccination 383 Causes of the various deviations of the vacciue disease from its normal course.. 383 In the early history of vaccination, protective powers against certain diseases were erroneously attributed to cow-pox inoculation 384 Spurious vaccination, or the abnormal phenomena accompanying and following vaccination, excited the attention of the medical profession of England in the earlier period in the history of vaccination 386 Attacks upon vaccination by Dr. Win. Rowley, B. Moseley, and R. Squirrel (John Gale Jones) 386 Views of Dr. Jenner on the causes of the abnormal phenomena of vaccination.. 387 Researches upon spurious vaccination, or the abnormal phenomena accompany- ing and following vaccination in the Confederate army, during the recent American civil war, 1861-1865, by Joseph Jones, M. D 391 Section I-Preliminary observations-Accidents attending vaccination among the citizens and soldiers of the Confederate States-Necessity for the inves- tigation-Method, extent and object of the inquiry-The injurious effects of vaccination referred to six causes-Circular letter addressed to the medical officers of the late Confederate army 391-395 Eacts illustrating the value of vaccination, and the fatality of small-pox 393 Description of small-pox, by Sir Matthew Hale 394 Dr. Jenner pointed out some causes of the accidents attending vaccination, and gave rules for their avoidance 395 Section II-Modification, alteration and degeneration of the vaccine vesicle, de- pendent upon depressed and deranged forces, resulting from fatigue, expos- ure, and poor diet; and upon unhealthy, vitiated and scorbutic conditions of the blood of the patients vaccinated and yielding vaccine matter 396-419 In scorbutic patients, all injuries of the skin tend to form foul ulcers, of an un- healthy character 319 Effects of scurvy upon the character and progress of the vaccine vesicle....... 397 Investigations upon the effects of vaccination among the Federal prisoners confined in Camp Sumpter, Andersonville, Georgia 397 Examination of the charge urged by the United States Military Commission, that the Confederate Surgeons deliberately poisoned or destroyed the Fed- eral prisoners at Andersonville, with poisonous vaccine matter 397-419 Dr. Hamilton, on spurious vaccination in the United States army 406 Dr. L. Guild, on the Medical Records of the Army of Northern Virginia 409 Reports on spurious vaccination in the Confederate Army, by S. E. Habersham, 410 Report of Dr. James Bolton, of Richmond, Virginia, on the accidents attending vaccination in the Army of Northern Virginia .... 413 Lexter of Gen. R. E. Lee, with reference to Federal prisoners 416 Hon. Alexander H. Stephens on the condition of the Federal prisoners at Ander- sonville 417 Letters of Gen. J. E. Johnston, Gen. G. T. Beauregard, and W. Gilmore Simms, relative to Federal prisoners 417 Letters of Drs. Middleton Michael, Hunter McGuire, James Bolton and Thomas F. Wood, relative to ''Researches on Spurious Vaccination in the Confed- erate Army," 418 Section III-The employment of matter of pustules which had deviated from the regular and normal course of development in the vaccine vesicle 420-441 Such deviation or imperfection in the vaccine disease and pustule, due mainly to previous vaccination ; or, in other words, the employment of matter from patients who had been previously vaccinated, or who were affected with some skin disease at the time of the insertion of the vaccine virus 420 Prof. Paul F. Eve, M. D., on spurious vaccination 421 Dr. R. Hamilton, of Chattanooga, Tenn., on spurious vaccination among the Confederate forces serving in East Tennessee . 422 13 14 Contagious Diseases-Contents. Page. Investigations of Dr. Edward Jenner on the varieties and modifications of the vaccine disease 423 Answer to Dr. Jenner's inquiries, by the Rector of Lackhamstead . 423 Observations of Dr. James Davis, of Columbia, South Carolina, on the vaccine and varioloid disease 425 Examination of the doctrine of John Hunter on diseased actions as being in- compatible with each other . 427 Relations of the vaccine disease to measles and other diseases, with the observa- tions of numerous authors . 429-435 Relations of chicken-pox to small-pox . 435 History and phenomena of chicken-pox (varicella). 435-441 Differential diagnosis between variola, varioloid and varicella . 440 Section IV.-Dried vaccine lymph or scabs, in which decomposition has been excited by carrying the matter about the person for a length of .time, and thus subjecting it to a warm, moist atmosphere 441-443 Section V. The mingling of the vaccine virus with that of the small-pox mat- ter, taken from those who were vaccinated while they were laboring under the action of the poison of small-pox.. 443-449 Observations of Drs, Jenner,Woodville, Adams, Willan, George Hennen, Fowler and Bosquet upon the relations of the vaccine disease and small-pox ..... 444-449 Section VI.-Dried vaccine lymph, or scabs, from patients who had suffered with erysipelas during the progress of the vaccine disease, or whose systems were in a depressed state from improper diet, bad ventilation, and the exha- lations from typhoid fever, erysipelas, hospital gangrene, pyaemia, and offensive suppurating wounds 449-462 Dr. Wm. Gerdner, of Green county. Tennessee, on the relations of erysipelas to vaccination 450 Cases of erysipelas following revaccination, reported by Dr. Greene to the Boston Society for Medical Improvement 451 Cases of erysipelas following vaccination, reported to the Boston Society for Medical Improvement by Drs. J. B. S. Jackson, Cabot, Bigelow, Hernans, Putnam and Channing 452 Cases of constitutional irritation following vaccination, reported by Dr. Chas. E. Buckingham, of Boston, Massachusetts 452 Erysipelas following vaccination in the French army 453 Observations of various authors on erysipelas following vaccination. 454 Dr. Paul F. Eve did not admit the possibility of the inoculation of erysipelas by vaccination 455 Facts illustrating the propagation of erysipelas by contagion .... 456 Testimony of Drs. Wells, Pitcairn, Stevenson. Gibson, Lawrence, George Greg- ory, Elliottson, Arnott, Thomas Watson, Rogers, Campbell de Morgan and others as to the contagious nature of erysipelas. 457-458 Dr. J. C. Nott on erysipelas in the Confederate army 459 Report of Dr. J. F. Bell on the prevalence of erysipelas among the Confederate wounded in the Moore Hospital, Manassas Junction, Virginia, in the month of January, 1862 460 Immunity of the array of General Jackson from erysipelas : report of Dr. Hunter McGuire, Medical Director Army of Valley of Virginia 461 Section VII.-Fresh and dried vaccine lymph and scabs from patients suffering with secondary or constitutional syphilis, at the time and during the pro- gress of vaccination and the vaccine disease. 463-542 Vaccine syphilis in the Confederate army. 465 Testimony of Dr. L. D. Gilmore as to the syphilitic origin of a portion at least of the cases of spurious vaccination in the Confederate army 465 Report of Dr. James Bolton, on the relations of syphilis to vaccination in the Con federate army . 466 Testimony of Drs. A. H. Powell, J. A. Ethridge, Hicks, HaigiU and Rutherford, with reference to the causes of spurious vaccination in the Confederate army Dr. Paul F. Eve held that syphilis might be communicated by vaccination 470 On vaccination and variolous disease, by Dr. O. Kratz.... 470 Dr. Wm. F. Fuqua testified as to the syphilitic origin of a portion at least of the cases of spurious vaccination in the Confederate army . .. 471 On the communicability of syphilis by vaccination, by Wm. F. Fuqua, M. D., Appomatox county, Virginia 472 Abnormalities of vaccination, by Frank A. Ramsey, M. D 473 Dr. Crawford, of Greenville, Tenn., traced the impure vaccine virus which pro- duced indurated ulcers, and constitutional syphilis, to a single individual, and the disease thus disseminated by innocuiation yielded to the remedies best adapted to the treatment of syphilis 476 Contagious Diseases-Contents. 15 PAGE. Report on the communication of syphilis through the medium of vaccine virus among the inhabitants of Graniteville and vicinity in South Carolina, in 1866, by W. F. Percival, M. D., of Aiken, S. C .\ . .. . 477 Testimony of Dr. E. A. Flewellyn as to the dissemination of syphilis by vac- cination, in the Confederate army 479 Small-pox epidemic in Mobile, Alabama, during the winter o£1865-66, by Dr. J. C.Nott . 480 Syphilitic vaccine and the means of preventing it 482 Testimony of Dr. Geo. H. Hubbard, of the United States Army, as to vaccino- syphilis 483 Opinion of Hebra, as to the question whether lymph from a true Jeunerian vesi- cle has ever been a vehicle of syphilitic, scrofulous or other constitutional in- fection to the vaccinated person ? 484 Replies of various surgeons and physicians as Acton, Addison, Alderson, Balfour, Barlow, Beatty, Bright, Brinton, Brodie, Burrows, Busk, Ceely, Clark, Crampton, Davis, Erich sen, Farr, Jenner, Jones, Latham, Locock. Marson, Noble, Tompkins, Travers, Watson, West, Williams, Wilson, Ackerly, Bennet, Fleming, Hutchinson, Laycock, Lever, Martin, Morley, Startin and White- head to the question propounded in 1856, by Mr. Simon, "Whether they had any reason to believe or suspect that lymph from a true Jennerian vesicle has been the vehicle of syphilitic infection . 485-487 Inoculability of Tubercle 487 Experiments of M. Villermin, Lebert, Burdon, Sanderson, Koch and Formad on the nature and inoculability of Tubercle 487-494 Mortality occasioned in New Orleans and the Mississippi Valley by phthisis.... 488 ^teology of Phthisis.... .... 488 Possibility of transmitting scrofula by vaccination-views of Dr. Edward Bal- lard. . 493 Inoculability of cancer. 494 Contagious nature of constitutional Syphilis 495 Testimony of Gaspard Torella in 1498 as to the contagious nature of constitu- tional syphilis 495 Facts published by William Clowes in 1637, illustrating the contagious nature of constitutional syphilis 495 Testimony of Gideon Harvey in his " Venus Unmasked," published in 1665, of Daniel Turner in 1717, and of John Hunter in 1776, as to the contagious na- ture of constitutional syphilis 496-498 Facts illustrating this subject, recorded by Drs. Duncan, William Watson, Clement Hamerto^, Egan, Gavin, Price, Rizzi, Waller, Gilbert and others, 498-505 Experiments of Prof. Pelizzari, of Italy, demonstrating the possibility of inocu- lating healthy subjects with blood drawn from patients suffering with sec- ondary or constitutional syphilis * 502 Communication of syphilis by vaccination; post-vaccinal syphilis; vaccino- syphilitic inoculation 505 Cases of vaccino-syphilis recorded by Dr. Whitehead l 507 Observations of M. Viennois on vaccino-syphilis 508 Communication of syphilis to forty-six children and twenty nurses, at Rivalta, Italy, by vaccination ... 509 Account of the tragedy of Rivalta, by Dr. Pacchioiti, of Turin 510 Genealogical scheme of the Rivalta series of vaccino-syphilitic inoculations .. . 511 The Lnpara series of vaccino-syphilitic inoculations 512 Genealogical scheme of vaccino-syphilitic inoculations, Lnpara series 513 Bergame, or Terre de Busi, series of vaccino-syphilitic inoculations 514 Genealogical scheme of vaccino-syphilitic inoculations, Bergame series 515 Vaccino-syphilitic inoculations, Auray series 515 Genealogical scheme of vaccino-syphilitic inoculations, Auray series 517 Cases of vaccino-syphilis recorded by Dr. Jonathan Hutchinson 518-529 Modified, or lacto-variolus inoculation 530 Variolation of the cow 533 Animal vaccination 1.. 535 Precautions for the prevention of accidents in vaccination, and more especially for the exclusion of the syphilitic virus 539 ENDEMIC, EPIDEMIC, CONTAGIOUS AND INFECTIOUS DISEASES-MEASURES FOR THEIR PREVENTION AND ARREST-THEORY AND PRACTICE OF QUARANTINE-RELATIONS OF CLIMATE, SOIL AND WATERS TO DISEASES-APPLICATION OF MEASURES FOR THE EXCLUSION AND ARREST OF CONTAGIOUS AND INFECTIOUS DISEASES. INDEX. PAGB. Accidents in vaccination-Precautions for the prevention, and more especially for the exclusion of the syphilitic virus • 1 539 Accounts of the tragedy of Rivalta, Italy, by Dr. Pacchiotti, of Turin 510 Ackerley, of Liverpool, on vaccino-syphilis 484 Acts establishing Quarantine in New Orleans and Louisiana, 1846, exlix: 1847, cl; 1855, cli; 1882, cxvi Acts relative to Quarantine passed by United States Congress, 1799 15 Acton, on vaccino-syphilis 485 Adams, John, President of United States, views of, with reference to exclusion of yellow fever, 15 Adams, John Quincy, letter of, to Dr. Edward Jenner, with reference to vaccination 314 Adams^ Daniel W., M. D., Quarantine report by xxxii Adam. Dutch ship burnt by the Spaniards in 1748 20 Air. in yellow fever epidemic of 1878 82 Results of the examination of the air of rooms containing patients sick with yellow fever, 1878-Experiments upon living animals with the water through 'which the yellow fever air of 1878 in New Orleans had been passed 83 Practical application of the results obtained from the experiments of 1878, illustrat- ing the nature of the air of yellow fever, and the poisonous properties of black vomit and putrid blood 87 ^Etiology of Phthisis 488 Addington: Comparative view of the natural small-pox, inoculated small-pox, and cow-pox, by Dr. John Addington 359 Adams. Joseph, M. D., on morbid poisons 429 On the relations of the vaccine and variolus poisons 445 Alcohol, poisonous effects of cccxlviii Adelasio, Dr., on vaccino-syphilis-Bergame, or Terre de Busi series 514 Andrews, C. C.. United States Consul, Rio de Janeiro, report of deaths from yellow fever, from 1850 to 1883 eix Ages, mortality at different, in New Orleans, Louisiana cccxxiii Addison, on vaccino-syphilis .. 485 Algid fever, pathology and symptoms of 46 Arnott, Professor, on the contagious nature of erysipelas 458 Apoplexy--observations on the elevated temperature, and sun-stroke or heat apoplexy, of June, 1881 eel America, discovery of cow-pox in 310 Introduction of vaccination into 312 America, North and South, introduction of vaccination into the possessions of Spain in 344 Andersonville, Georgia: Investigation of the effects of vaccination amongst the Federal prison- ers confined in Camp Sumpter, Andersonville, Georgia 397 Andersonville, Georgia: Examination of the charge urged by the United States Military Com- mission, that the Confederate Surgeons deliberately poisoned and destroyed the Federal prisoners at Andersonville, with poisonous vaccine matter 397-419 Animal vaccination 535 Animals, communication of small-pox to Anson, Lord, scurvy amongst his seamen 401 Arabians, origin of small-pox amongst • • -77 Archer, John. M. D., of Maryland, on the cure of whooping-cough by vaccination 336 18 Contagious Diseases-Index Pagb Army, Confederate, spurious vaccination in 391-539 Erysipelas, vaccino-syphilis, and spurious vaccination in ... 450-479 Asiatic cholera • cccv Atchafalaya Quarantine Station, La, report of Quarantine operations at, 1880-83... xxxiii. xl, Ixxxiii, cvi, civ Atmosphere, its condition in yellow fever of 1878 82 Relations to hospital gangrene, erysipelas and puerperal fever 85 Agency of the organisms observed in the atmosphere of yellow fever, and in the hlood and black vomit 87 Augusta, Georgia, deaths from small-pox in, 1818-1866 343 Auray series of vaccine-syphilis 515 Genealogical scheme of vaceino-syphilitic inoculations 517 Avicenna, on small-pox 278 Bacillus anthracis, in black vomit of yellow fever 51 Bacterium termo, in black vomit of yellow fever 51 Badcock, on the variolization of the cow. or the production of vaccina by inoculation of the cow with the lymph of human variola 534 Ballard. Edward. M. D., on vaccination 455 On the relation of scrofula to vaccination .. 493 Balfour, Barlow, Beatty, Bright, Brinton, Sir Benjamin Brodie, Dr. George Burrows and George Burke on vaccino-syphilis 485 Bacteria in blood and black vomit of yellow fever 50-87 Bayley, R. A., M. I).. Sanitary Inspector Board of Health, State of Louisiana, reports of, 17 et seq Beauregard, G T., General, letter of. to Joseph Jones. M. D., with reference to Federal pris- oners 417 Report of, on proposed system of drainage for first drainage district of New Orleans, by Major G. T. Beauregard, Chief Engineer, December 26. 1858. . cclxxxix Bateman. Dr., on chicken-pox 439 Baron, John. M. D., Life of Edward Jenner 364 On horse pock, 349 (sends equine matter to Dr. Jenner) 350 Bailie, on contagious nature of erysipelas 456 Beale, Lionel, of London, on microscopical characters of the small-pox poison.. 363 Bell, J. F., M. D., Surgeon C. S. A., on the prevalence of erysipelas among the Confederate wounded in the Moore Hospital. Manassas Junction, Va., January, 1862 460 Bergame, or Terre de Busi, series of vaceino-syphilitic inoculations-genealogical statement.. 414-415 Berna, bark, infected with yellow fever xc Beret. A. M , M. D., Sanitary Inspector Fifth District. New Orleans, report of xiii Bennet, John Hughes, M. D., of Edinburg, on chicken-pox 438 Bigelow, Dr., of Boston, on erysipelas following vaccination .... 451 Bile in yellow and malarial fevers 74 Blair, M. D., on cow-pox 254 Black, W., M. D., on small-pox ... . 283 Blane, Sir Gilbert, on diseases of seamen .. 403 Bladder, urinary in yellow and malaria fever 81 Bladder, gall in yellow and malarial fever 74 Black pigment of malarial fever 49 Black vomit of yellow fever. 47-87 Poisonous properties of 87 Bennet, J. R., M. D., on vaccino-syphilis 486 Blood, contagious nature of, in constitutional syphilis .. 502 Changes of, in yellow fever .. 46 Chances of, in malarial fever 48 Corpuscles, in yellow fever 47 Chemical and microscopical characters of, in malarial fever 50 Micro-organisms developed in, during the progress of yellow fever . . 51 Experiment on the putrefaction of, and the development of micro-organisms in, the blood of yellow fever 51 Organisms in blood of yellow fever 87 Putrid and black vomit, poisonous properties, practical application of the results obtained from the experiments illustrating the nature of the air in yellow fever and the poisonous properties of black vomit and putrid blood . 87 Board of Health of the State of Louisiana- Extract from minutes of September 6. 1883. relative to small-pox 137 Quarantine operations of xxiii, xxxiv, xl. lii Minutes of special meeting, June 27, 1882. with reference to case of yellow fever, Henry Forbes Iv, lx Proceedings, August 17, 1882 Ixxii Proceedings, July 13, 1882 Ixxvii Proceedings, July 17, 1882..., Ixxviii Proceedings, July 27,1882 Ixxix Quarantine operations .. Ixxxiv Rules and regulations governing Quarantine and Sanitary officers.... 89 Additional Quarantine proclamation of xci Extracts from proceedings of July 19, 1883, relative to Quarantine and New Orleans Auxiliary Sanitary Association xciii Adopts resolution of lion. I. Marks requesting the Governor of Louisiana to issue a proclamation declaring non-intercourse with places infected with yellow fever xcv Resolutions requesting withdrawal of Governor's non-intercourse proclamation cii Action of, with reference to United States Marine Hospital Service and Ship Island. c Act proposed by, for the establishment of floating hospital, or ward, in the harbor of New Orleans cxix Bolton, James, M. D., of Richmond, Va., on the accidents attending vaccination in the army of Northern Virginia 413 On the relations of syphilis to vaccination in the Confederate army 466 Contagious Diseases-Index. 19 Page Booth. Edward, Hon., resolntions of, relative to small-pox in New Orleans xvii Views of, on Quarantine lx Resolutions of, w^h reference to epidemic fund Ixxiii Resolutions of, to National Board of Health Ixxviii, Ixxxiv Bosquet, observations on the cow-pox, discovered at Passy, near Paris, in 1836 307 Comparison of the phenomena of the old and new vaccine 308 Boston. Massachusetts, inoculation for small-pox in, 1722 ...... 28 Society for Medical Improvement, report of 451 Bosworth, S. W., Col,, member of Board of Health of the State of Louisiana, remarks on Quarantine lx Bourne, Hon., of Rhode Island, debate on Quarantine 11 Bracquet, of Lyons, on lacto-variolous inoculation 530 Boylston, Z,, M. D.. first practiced inoculation for the small-pox in Boston, Mass., 1721 281 Brent, Hon., of Virginia, on Quarantine 13 Brenton, Edward Pelham, Captain, on battle of New Orleans . cxlii British Consul, A. de G. de Fonblanque, protest of, against action of Board of Health in re- turning steamship Marco Aurelio to Mississippi Quarantine Station Ixi Buckingham, Charles E., M. D., on erysipelas and vaccination 452 Buchanan on vaccination 455 Bryce, tests for scientific vaccination 269 Budd, George. M. I)., of London, on the dissemination of cancer 494 Burial, mode of, in New Orleans, La cccxxvii Intra-mural, efiects of, on public health cccxxix c Cabot, Dr., of Boston, on erysipelas following vaccination 451 Carro De, M. D.. letter to Dr. Jenner 351 Cancer, inocculability of . . 494 Ceely, Robert, observation on cow-pox, with general description 455 On variolation of the cow 534 On vaccino-syphilis 485 Cemeteries of New Orleans cccxxvii Cases and deaths from small-pox in New Orleans, 1882-1883 v, viii, et seq Carson, W. H., M. D., Quarantine Physician Rigolets Station, reports of, 1881 and 1882 xxxviii, Ixxv. Ixxxii, cxciii, Icvii Carrington, P. S., M D clxiv Cerebro spinal, nervous system, pathology of. in yellow and malarial fevers 65 Canals, drainage of New Orleans, filthy condition of cclxxxiii Dimensions of cclxxxiii Clark, Sir James, on vaccino-syphilis 485 Cerioli, of Lucca, on vaccino-syphilis.... 507 Chambon, on animal vaccination 536 Chauyeau, on the nature of the small-pox poison 363 Classification of contagia 38 Clinical report of the case of Louis Deadlier ... Ixiii Champlin, A. Parker, M D., President of Hancock County (Miss.) Board of Health-Co-oper- ation of. with Louisiana Board of Health Ixxxv Claiborne, Governor of Louisiana, on yellow fever cxl Charity Hospital of New Orleans cxxxix, ccxlvi Fever statistics of. cclxviii, cclxxiii Statistics of cclxxiv Children, diarrhoeal diseases of ccciii Relation of milk and its adulteration to the diarrhoeal diseases of children ccciii Cerebral and cerebro spinal poisons cccxxxix Charitable institutions of New Orleans ■ cccxi Chamber of Commerce of New Orleans-resolntions of. with reference to Quarantine clxi Choppin, Samuel, M. D , President Louisiana Board of Health, on Quarantine cxxiii, clxii Chapman, on cow pox 254 Chipman, N. P., Judge Advocate U. S., in trial of Henry Wirz, of Andersonville 395 Cholera infantum, deaths from, in New Orleans during a period of 27 years (1847 to 1880) ccciv Climate-Observatn ns on the climate and health of Louisiana, and more especially upon the relations of the climate of New Orleans to endemic and epidemic diseases cclxiy Climate and health of Louisiana.... ccxlvi Commercial statistics of New O' leans 23 Colonies, American, history of Quarantine in 2 Contagia, metabolic 38 Contagious and infectious diseases, measures for their prevention and arrest, by Joseph Jones, M. D ii, ccc-2-542 Contagion and contagions, definition of terms ■. - - Contagious diseases, conditions which favor their spread 37 Congress of the United States, annals of, relative to Quarantine in 1796 10 Consumption (phthisis pulmonalis) ccc Convulsions, deaths from, in New Orleans ccciv Convulsions, infantile, deaths from, in New Orleans ccciv Coroner, inquests of, in New Orleans cccxvi Court, Supreme, of Louisiana, decision of sustaining the Quarantine laws of Louisiana and the acts of the Board of Health of the State of Louisiana clxix Cohn, lerdinand. M. D . on the nature of the small.pox poison • •• 539 Copenhagen, mortality by small pox during a period of 100 years, betore vaccination and during vacci atioti ..... 291 Circular No. 1-Prepared for the guidance of the Quarantine and Sanitary officers of Louisiana, by Joseph Jones, M. D Circular No. 2-Prepared for the guidance of the Quarantine and Sanitary officers of Louisiana, , by Joseph Jones, M. D 135-542 Constantinople, inoculation for small-pox in 280 Circassia and Georgia, inoculation for small-pox in 280 20 Contagious Diseases-Inder. Page. Compulsory vaccination 136 Ordinance relative to compulsory vaccination 136 Chinese method of inoculation for the small-pox 287 Channing, Dr., of Boston, on erysipelas following vaccination 452 Chicken-pox-Dr. Thompson's theory of its identity with varioloid 272 (Varicella) relation to small-pox, history and phenomena 435-441 Differential diagnosis between variola varioloid and varicella 440 Chauveau on the artificial production of horse-pox by inoculation 352 Confederate States of America, researches upon spurious vaccination, or the abnormal phe- nomena accompanying and following vaccination in the Confederate army during the Amer- ican civil war (1861 to 1865), by Joseph Jones. M. D 391 Confederate Army- Dr. Gardner, on the occurrence of erysipelas after vaccination 450 Dr. Paul F. Eve. on erysipelas 47o J. C. Nott, M. D., on erysipelas 459 Prevalence of erysipelas among wounded at Moore Hospital. Virginia, Jan., 1862.... 460 Immunity of the army of Gen. Jackson from erysipelas, report of Dr. Hunter McGuire, Medical Director Army of Virginia . 461 Vaccino-syphilis in ..... ... 465 Reports of Dr. T. O. Gilmore on syphilis following vaccination in 465 Dr. James Bolton, on the relations of syphilis to vaccination in 466 Spurious vaccination in, testimony of Drs. Powell, Etheridge, Hicks. Hazgill and Rutherford 469 O. Kratz, M. I)., on vaccination in 470 Dr. Wm. F. Fuqua, on syphilitic origin of spurious vaccination in 478 Drs. Ramsey, Crawford and Flewellen. on spurious vaccination and vaccino- syphilis in . 473-479 Confluent small-pox 368-370 Colored race, vital statistics of. in hospitals of New Orleans cccxviii Clewes, William, on the contagious nature of constitutional syphilis 495 Constitutional Syphilis- Contagious nature . 495 Testimony of Guespard Torella. in 1498, as to the contagious nature of 495 Contagious nature, illustrated by William Clows, in 1637 495 Gideon Harvey, 1665: Daniel Turner, 1717; John Hunter, 1776; Drs, Duncan. Wm. Watson,' Clement Hamerton, Egan. Gavi, Price Rizzi, Waller Gilbert and others, on .... 496-605 Constitutional Syphilis: Experiments of Pellizari. of Italy, demonstrating the possibility of inoculating healthy subjects with blood drawn from patients suffering with secondary or constitutional syphilis 502 Cow-pox- Literature of 253-255 Vaccination-variola1 vaccines (cow-pox); variola and varioloid : accidents attending vaccination; spurious vaccination 135 Circular No. 2-Prepared for the guidance of the Quarantine Officers and Sanitary- Inspectors of the Board of Health of Louisiana, by Joseph Jones. M. D 135 Compulsory vaccination 136 Ordinance relative to compulsory vaccination 136 Extract from the proceedings of the meetings of the Board of Health, State of Louis- iana, September 6, 1883, relative to small-pox and vaccination • 137 Mortality- from small-pox during the first eight mouths of 1883, in New Orleans 138 Letter of President of Board of Health to Mayor of New Orleans 140 Causes of the popular opposition to vaccination 141 Works of Edward Jenner 142 An inquiry into the causes and effects of the variola1 vaccina?, a disease discovered in some of the western counties of England, particularly Gloucestershire, and known by the name of the "Cow-pox," by Edward Jenner, M. D., F. R. S. Third edition. London: 1801.. 143-159 Further observations on the variola1, vaccina1, by Edward Jenner 161-179 A continuation of facts and observations relative to the variola? vaccina1 or cow-pox, by Edward Jenner, M. D., F. R. S.. etc., London. 1801 179-188 Dr. Jenner's account of the origin of the vaccine inoculation 189-191 Dr. Jenner's instructions for vaccine inoculation 191-193 An inquiry concerning the history of the cow-pox. principally with a view to super- sede'and extinguish the small-pox. by George Pearson, M. D., F. R. S., Physi- cian to St. George's Hospital, of the College of Physicians. London. 1798 195-222 Reports of a series of inoculations for the variola? vaccina*, or cow-pox-Remarks and observations on this disease, considered as a substitute for the small-pox. by William Woodville, M. D.. physician to the Small-pox and Inoculation Hospi- tals, London. 1799 ". 223-250 The errors of Drs. Woodville and Pearson arose from the performance of cow-pox inoculation in an atmosphere poisoned by the contagious emanations of small- pox- Correction of the errors of Dr. Woodville by Dr. Jenner 251 Experiments, of Dr. Robert Willan in the years 1799 and 1800, on the combined inoc- ulation of the variolus and vaccine fluids 259 References illustrating the extensive nature of the contributions by various observ- ers to the literature of cow-pox inoculation, during the first five years after Jenner's announcement of his discovery 253 Report of the Royal College of Physicians of London on Vaccination, with an appen- dix containing the opinions of the ..oyal College of Physicians of Edinburgh and Dublin, and of the Royal College of Surgeons of London, of Dublin, and of Edinburgh 255-262 The occurrence of small-pox after vaccination, excited in the minds of some dis- trust as to the protective power of cow-pox inoculation 263 Dr, Jenner referred the reported failures of vaccination to several causes 263 -265 Epidemic small-pox of 1818 265 Hostility aroused against vaccination 267 Oantagious Diseases-Index. 21 Page. Cow Pox- ' Investigations of Dr. Alexander Munro on small-pox and vaccination 267-272 Mr. Bryce's test 264 Opinion of the Medical Profession in 1818 as to the protective power of vaccination against small-pox 271 Dr. Thomson's theory of the identity of chicken-pox and modified small-pox ' 272 Establishment of re-vaccination 273 Professional views held in 1839, as to correct vaccination and impediments thereto, 375 History of small-pox inoculation 277 Comparative advantages of the inoculated small-pox and of the cow-pox 278 Mortality occasioned by inoculated small-pox 282 The practice of inoculation for the small-pox, substituted a comparatively mild form of the disease, attended with but small mortality: but the total number of deaths by small-pox was thereby increased, and the perpetuation and spread of this loathsome pestilence on the surface of the earth was promoted by inoc- ulation 282 The mortuary statistics of London demonstrated that inoculation actually increased the mortality from small-pox 284 The advantages of cow pox inoculation demonstrated by official records and sta- tistics .' 286 Outline of the introduction of cow-pox inoculation in various countries 296 History of cow-pox inoculation in England 296 History of cow-pox in Ireland z. ■ 299 History of cow-pox in the Duchies of Schleswig and Holstein 300 Cow-pox in Germany 306 Cow-pox in France 307 Observations of Bosquet on the cow-pox discovered at Passy, near Paris, in 1836.... 307 Comparison by Bosquet of the phenomena of the old and new vaccine 303 Discovery of cow-pox in America 310 Introduction of vaccination into the United States ef America 312 Introduction of vaccination into the New England States, more especially into Bos- ton, Massachusetts, by Dr. Waterhouse 312 Letter of Mr. Jefferson to Dr. Jenner 313 Letter of John Quincy Adams to Dr Jenner 314 Introduction of Vaccination into the Southern States by Thomas Jefferson, of Vir- ginia - 315 Correspondence between Thomas Jefferson and Dr. Benjamin Waterhouse, of Cam- bridge, Massachusetts, with reference to vaccination ... 316-322 Introduction of vaccination into New York, United States of America 323 Total deaths from all causes, and from small-pox, measles, scarlet fever and phthisis pulmonalis in the city of New York during a period of fifty years, from 1804 to 1853 325 Introduction of vaccination into Philadelphia, Pennsylvania .. 326 Deaths from small-pox in Philadelphia from 1807 to 1882, inclusive ... 327 Mortuary statistics of Philadelphia 328 Small-pox, and the introduction of vaccination in South Carolina 329 Deaths in Charleston, South Carolina, from all causes and from small-pox, 1822-1848, inclusive 334 Deaths in Charleston, South Carolina, from all causes, and from small-pox, 1844-1865 335 Sanitary statistics of South Carolina 335 Small-pox and vaccination in Georgia 338 Deaths from all causes and from small-pox in the white population of Savannah, Georgia, during a period of fifty years, 1804-1853, inclusive 339 Total deaths from all causes and from small-pox in the white and colored population of Savannah, Georgia, during a period of sixteen years, 1854-1869 339 Deaths from fever and other causes in Savannah, Georgia 341 Small-pox and vaccination in Augusta. Georgia .. 343 Deaths from all causes and from small-pox, whites and blacks, in Augusta, Georgia, during forty-eight years, 1818-1866 343 Introduction of vaccination into the possessions of Spain in North and South America 344 i The relations of grease in the horse's heel to cow-pox 348 Artificial production of horse-pox by inoculation 352 Artificial production of horse-pox by inoculation by injection of lymph 352 Character and course of horse-pox 353 General description of cow-pox 354 Observation on cow-pox, by Robert Ceely 355 Illustration of the appearance of cow-pox 355 General description of cow-pox- • 355 Comparative view of the natural small-pox, inoculated small-pox and cow-pox 359 • Small-pox contagion-Nature of the virus of cow-pox and small-pox 360 Small pox communicated to man and animals by eating small-pox matter, in 1779... 361 Microscopical character of vaccine lymph and the contagious matter from the pus- tules of small-pox 4 363 Comparative phenomenon of inoculated small-pox and cow-pox 365 Inoculated cow-pox vaccination 366 Phenomena of variola (small-pox) 367 Crampton, Philip, Sir, on vaccino syphilis 485 Cullen, on the contagious nature of erysipelas 455 Cruickshank, on measles and small-pox 430 Copper vessels and copper in articles of food-Effects of, upon human health .. cccxl Cyanide of potassium, poisonous properties of cecxliil Davis, James, M. D., of Columbia, S. C., on the vaccine and variolous diseases 425 Davis, Theodore, on vaccino-syphilis 485 22 Pagb. Deaths, from all causes, and from small-pox, in New Orleans, 1880-83 xx From small-pox, classified according to months ami race, 1881-83 xxi From small-pox, classified according to sex, 1880-81-82-83 xxii From small-pox, in New Orleans, during 16 years 103 In Rio de Janerio, from yellow fever and all causes xxxvi . Preventable causes of cccxxvii, lii Death rate of New Orleans ccxcviii Of New Orleans. 18-19 to 1881.... ccxxcviii Debility, infantile ccciv Diarhcea and diarrhceal diseases ccciii Relations of milk a d its adulterations to the diarrhceal diseases of children ccciii De Roaldes, A. W„ M. D.. surgeon Charity Hospital, report of case of yellow fever, 1882 Ivi Deschler, Louis, taken sick at 1010 Tchoupitoulas street; died in Charity Hospital of New Orleans, July 17, 1882; clinical report of Ixiii Dr. Cliarles Schuppert on nature of disease .. . Ixiv Orders of President of Louisiana Board of Health to sanitary inspector and officers of Fourth District, with reference to disinfection of 1010 Tchoupitoulas street Ixiv Reports of Sanitary Officer John Logan and Sanitary Inspector Dr. Mandeville as to nature of disease of Louis Deschler Ixv Delta of the Mississippi River ... ccclxix, ccclxxxi Disinfectants-Amount paid by the City of New Orleans for disinfectants, (1870 to 1881) xliv Disinfection and disinfectants 126 Of infected ships from Rio de Janeiro, measures of disinfection instituted by Joseph Jones, M. D '- xxxv Deaths from yellow fever in Rio de Janeiro .. xxxvi Of dwellings and premises after recovery or deaths from small-pox 127 Of privies and water-closets 127 Of ships 89-91 Definition of terms relating to contagion and contagions diseases 37 Of yellow fever 44 Of malarial fever 44 Diphtheria, history of, in New Orleans 128 Nature and cause of 129 Incubation of 129 Contagious nature of 129 Rules governing families afflicted with 130 Development and structure of small-pox pustule 368-370 Distinct small-pox 368 Diseased actions-Doctrine of Dr. John Hunter, as being incompatible with each other 427 De Cantcla Benarpo, M. D.. on variations of the progress of the vaccine disease 388 Belgrade, Dr., on the simultaneous occurrence of measles and small-pox 431 Denby, on the period of the incubation of the small-pox poison 448 DePaul, on the contagious nature of constitutional syphilis, and on vaccine-syphilis 501-507-512-515 DeVergie, on contagious nature of constitutional syphilis 501 Dreux, on lacto-variolus inoculation 530 Dunning, Richard, on vaccination .. 254 Drainage-Relations of fevers to drainage, malarial fevers, .yellow fever, diarrhceal diseases; measures recommended by the President of the Board of Health of the State of Louisiana cclxxxi Report on proposed system of drainage for First Drainage District, New Orleans, by Major G. T. Beauregard, Chief Engineer of New Orleans, Dec. 20, 1858.... cclxxxix Eagan, Dr., on the contagious nature of constitutional syphilis 500 Eagan, J. C., Attorney General, State of Louisiana, letter of Dr: Toseph Jones, President of the Board of Health of the State of Louisiana, with reference to the cases of Morgan & Co, vs. Board of Health clxvii Endemic, epidemic and contagious diseases-Measures for their prevention and arrest, by Joseph Jones, M. D .' .ii-ccc, 1-542 England, mortuary records of ... 288-290 History of cow-pox inoculation in 296 Edinburgh, report of Royal College of Physicians of, on vaccination 470 Elliotson, Dr., on contagious nature of erysipelas . 458 Enteric, or typhoid fever cccix Englisb-Lookont. report of Dr. W. H. Carson, Quarantine Inspector at, 1883 cvii Epidemic diseases, deaths from, in New Orleans ccc Erickson,'Mr., on vaccino-syphilis 485 Erysipelas- Relations of. to vaccination 449-462 Dr. Wm. Gardener on 450 Cases of, following vaccination, reported by Dr. Green to the Boston Society for • Medical Improvement 451 Cases reported by Drs. J. B. S. Jackson, Cabot, Bigelow, Hernans, Putnam, and Channing 452 Following vaccination in the French army 453 Dr. Paul F. Eve. on its relations to vaccination 455 Observations of various authors on erysipelas following vaccination 454 Facts illustrating the propagation by contagion 456 Contagions nature, testimony of Drs. Wells. Pitcairn. Stevenson. Gibson. Lawrence, George Gregory, Elliotson. Arnott, Thos Watson, Rogers, and others ...... 457-458 Dr. J. U. Nott, on erysipelas in the Confederate army 459 Report of Dr J. F. Bell on the prevalence of erysipelas among the Confederate wounded in the Moore Hospital, Manassas Junction, Virginia, in the month of January. 1862.... .. 160 Immunity of the army of Gen. Jackson from, report of Dr. Hunter McGuire, Medi- cal Director of the Army of the Valley of Virginia 461 Contagious Diseases-Index. Contagious Diseases-Index. 23 Page. Etheridge, J. a., Surgeon C. S. A., on spurious vaccination 469 Eve, Paul F,, M. D , on spurious vaccination ... . .. 421 Eolations of erysipelas to vaccination 455 Held that syphilis might be communicated by vaccination . 470 Excelsior, Swedish bark, occurrence of yellow fever on board in harbor of New Orleans, 1880- action of Board of Health in returning Excelsior to Mississippi Quarantine xxx Expenditures of the Board of Health of the State of Louisiana. 1869-1881 xliii, xlix Exports, value of, at New Orleans xxxiii Exterior ot body after death from yellow fever 65 Fair, Arthur, on vaccino-syphilis 485 Federal Prisoners-Investigation of the condition of diseases of the United States soldiers, con- fined in Camp Sumpter, Andersonville, Georgia, by Joseph Jones, M D., Surgeon ' C. S. A : 396-419 Food of, at Andersonville, Georgia 405 Illustration of hospital gangrene following local injuries among 407 Faget, C.. Sanitary Inspector Second District, New Orleans, report of x Fever-Destructive effects occasioned by yellow fever and the more fatal diseases in Mew Or- leans, Louisiana 41 Various forms of; total number of cases and deaths of the various forms of, treated in the i harity Hospital of New Orleans, during a period of thirty-four years, 1844 to 1880 41 Deaths from the various forms of, in New Orleans, during a period of thirty-four years, 1844 to 1880 42 Measures for the exclusion, prevention and arrest of yellow fever 43 General outline of the symptoms and pathology of yellow and malarial fevers 44 Symptoms and pathology of malarial fever 44 Total number of cases and deaths of the various forms of fever treated in the Charity Hospital during a period of thirty-four years cclxxxvi Deaths from*the various forms of fever in New Orleans, during a period of thirty- four years .... cclxxxvi Monthly and annual rainfall, with deaths from yellow fever, in New Orleans, during a series of years ccli Fever, yellow, monthly deaths from yellow fever during a series of years cclxvi Intermittent lever, cases of, admitted into the Charity Hospital... cclxviii Statistics of various fevers treated in the Charity Hospital. cclxviii Malarial fever, deaths from ... cclxxi Yellow fever, statisiics of, in Charity Hospital, 1822 to 1880 cclxxii Yellow fever, practical observations on cclxxv Puei peral 85 Fatty degeneration of the heart in yellow fever and other diseases 68 Fat, its relations to certain pathological changes in yellow fever 69 Ferguson, Robert, on vaccino-syphilis 485 Fisher, John, M. D., of Boston, description of discrete confluent and inoculated small-pox..... 368-438 Flewellen, F. A., M. D., testimony of, as to the dissemination of syphilis by vaccination in the Confederate Army 479 Testimony as to condition of Federal prisoners at Andersonville, Georgia 479 Fenner, Associate Justice Supreme Court of Louisiana, delivers opinion of Supreme Court sus- taining the action of the President of the Board of Health and the Quarantine laws of the State of Louisiana clxix Fleming, of Glasgow, on vaccino-s\ philis. 486 Fosbrooke, J. D., Rev., observations on Dr. Hooper's cases of cow-pox 253 Remarks on Dr. Pearson's communication 254 Financial operations of the Board of Health of the State of Louisiana, 1870 to 1881 xl Receipts of the Board of Health, 1869 to 1881 xlii Expenditures, 1869 to 1881 j ■ .... xliii Expenditures for repairs of Mississippi Quarantine Station, for disinfections and publication of rules and regulations cxlvii Finney, J. F., resident physician Mississippi Quarantine Station, reports of., xxxi, xxxvii, Ixxxi. xcix, civ Floating ward, or hospital, for port of New Orleans cxviii Formento, Felix, M. D., member of Louisiana Board of Health, remarks relative to quarantine and sanitation lx Resolutions of, relating to co-operation with New Orleans Auxiliary Sanitary Asso- ciation xcii Fonblanque, A. de G. de, British Consul, on Quarantine Ixi Forbes, Henry-First case of yellow' fever in 1882 .. Iv Measures adopted by Board of Health for arrest of yellow fever 98 Old Levee street in 1882 Ivi Orders issued by the President of the Board of Health for the disinfection of the premises occupied by Henry Forbes Ivii Sanitary condition of steamship Marco Aurelio, which brought Forbes from Havana to New Orleans .... Iviii Formad, H. D., M. D., of Philadelphia, on tuberculosis 491 Foul vessels .. 93 France, history of cow-pox in 307 French-French domination in Louisiana from 1684 to 1763, progress of commerce and popula- tion during cxxxi Fowler, Robert, M. D., on the simultaneous action of the vaccine and variolus poison 448 Frank, Dr., of Vienna, on chicken-pox 436 Fumigation, disinfection and purification of vessels from ports in which yellow fever usually prevails 91 Fungi, developed in black vomit of yellow fever 48 Contagious Diseases-Index. 24 Pagb. Gaseous poisons cccxliii Gall bladder in yellow and malarial fevers.. 79 Gallatin, of Pennsylvania, on Quarantine 12 Gangrene, hospital 85 Hospital, in the Federal and Confederate armies, and among the Federal prisoners confined at Andersonville. Ga., with casesand drawings illustrating the disease, by Joseph Jones, M. D., Surgeon C. S. A 405-406-407-408-409 Garner, on variolation of the cow 533 Gavin, Hector, Dr., on the contagious nature of constitutional syphilis 500 Germany, history of cow-pox in 306 Georgia, small-pox and vaccination in 338 Savannah, Ga.; deaths from small-pox in 339 deaths from fevers in 341 Augusta, Ga., small-pox and vaccination in 343 Andersonville, Ga., effects of vaccination upon Federal prisoners confined at 397 Examination and refutation of the charge that the Confederate surgeons destroyed the Federal prisoners at Andersonville with poisonous vaccine matter 397-419 Gardner, Wm.. M. D.. of Greene county, Tennessee, on the relation of erysipelas to vaccination 451 Gilmore, L. D., M. D., testimony of. to the syphilitic origin of a portion of the cases of spurious vaccination in the Confederate army 465 Guild, L., M. D.. on the medical records of the army of Northern Virginia during the Ameri- can civil war % 409 Giles, of Virginia, on Quarantine 11 Glenn, Col. John W., United States Superintendent of Public Buildings, statements of, with reference to the conduct of the Ship Island Quarantine c Godfrey, John, Surgeon United States Marine Hospital Service, statement of relative to Ship Island Quarantine, as conducted by the United States Marine Hospital Service c Gibson, Dr., on contagious nature of erysipelas. 457 Goldson, of Portsea. attack on Dr. Jenner 265 Greene. Dr., of Boston, on erysipelas following vaccination 451 Greenhill. Dr., on vaccino-syphilis 485 Grease in the horse's heels, relations of, to cow-pox 348 Grease, or horse-pox, artificial production of, by inoculation 352 Character, symptoms and course. 353 Gregory, George, M. D., on eruptive fevers and the contagious nature of erysipelas 457 Guild, L., M. D.. Medical Director C, S. A., on spurious vaccination 409 Haematin of colored blood corpuscles in malarial fever 48 Hmmaturia. malarial pathology of 47, 80 Comparison between malarial, hamiaturia and yellow fever 58 Hamilton, J. B., M. D., Surgeon General United States Marine Hospital Service Lxii, Ixxix Correspondence of, with President of Louisiana Board of Health Ixxx Inspection service of the United States Marine Hospital service Ixxxi, Ixxxvii Letter 'o the President of the Louisiana Board of Health Ixxxviii Letter with reference to floating ward, or hospital, in the harbor of New Orleans, for the isolation and treatment of contagious and infectious diseases cxix Hargis, K. B. S., M. D., President of Pensacola Board of Health, letters of. to President of the Louisiana Board of Health, August 11, 1882 Ixxiii Hamilton, Dr,, of Chattanooga, Tennessee, on spurious vaccination amongst the Confederate forces serving in East Tennessee 422 Hamilton, Frank Hastings, M. D., on the condition of Confederate wounded at Murfreesboro, Tennessee 406 Habersham, S. E., M. D., report on spurious vaccination in the Confederate army, by 410 Harvey, Gideon, in his "Venus Unmasked," records facts illustrating the contagious nature of constitutional syphilis .. . 496 Hamlin, Augustus C., M. D., Medical Inspector United States Army, on Federal prisoners con- fined in Camp Sumpter, Andersonville, Georgia 400 Heart, pathology of, in yellow fever 67 Pathology of, in malarial fever 67 Hebra. Prof., opinion of, as to the question whether lymph from a true Jennerian vesicle has ever been a vehicle of syphilitic, scrofulous or other constitutional infection to the vacci- nated person 484 Heberden, on varicella (chicken-pox) 436 Holland, of North Carolina, on Quarantine 1 13 Hister. of Pennsylvania, on Quarantine 11 Holwell, Mr., on inoculation for the small-pox in India 279 Homans, of Boston, on erysipelas following vaccination 7 Hooper, on cow-pox 353 Home, Dr , of Edinburgh, inoculation of measles, 1758 434 Holstein, history of cow-pox in 300 Horse-pox, relations of grease in the horse's heels to cow-pox 348 Artificial production of, by inoculation 352 Character symptoms and course of 353 Hippocrates, on erysipelas .... 455 1'icks, Surgeon C S. A., on spurious vaccination 469 Haigill, Surgeon C. S. A., on spurious vaccination 469 Hammerton. Clement. M. D., on contagious nature of constitutional syphilis 500 Holt, Joseph, M, D., Sanitary Inspector First District of New Orleans, report of, to Board of Health ..." . ' clxxxi Hospital, Mississippi Quarantine Station xxv, xxxvii Charity of, New Orleans cxxxix Gangrene * 85 Contagious Diseases-Index. 25 Page. Hunter, John, examination of his doctrine that diseased actions are incompatible with each other. 427 On the contagious nature of constitutioual syphilis 497-499 Humboldt, Alexander, on cow-pox in America 345 Hutchinson, Jonathan, Mr., cases of vaccino-syphilis recorded by 518-529 Huder, on poisonous vaccine lymph -. 455 Huxham, John, M. D . on putrid fever . 401 Hunter, John, on scorbutic ulcers 102 Hubbard, George H., Surgeon U. S. A., on vaccino-syphilis 483 Hunt, Thomas, M. D., on vaccino-syphilis 485 Hiibner, on vaccino-syphilis 507 Hutchinson, J., on vaccino-syphilis 486 Hydrophobia. Dr. Jenner, proposed vaccination as a remedy for 335 Imports, value of in New Orleans xxxiii Infantile diseases, deaths from, in the city of New Orleans during a period of 27 years (1847 to 1880) ccciv Infected ships from Rio de Janeiro xxxv Vessels at Mississippi Quarantine Station xxxvii Vessels from Rio cviii Inoculation for small-pox, history of 277 Practice of. 282 Mortuary statistics of London relating to inoculation 284 In India" 278 Mr. Holwell's description of inoculation for the small-pox in India 279 Chinese method of inoculation for the small-pox .... 279 The mortality statistics of London demonstrate that inoculation actually increased the mortality from small-pox 284 Inoculation for the measles first performed by Dr. Home, of Edinburgh, in 1758.... 434 Inoculation for measles by Wachsel and von Katina 434 Inoculation for small-pox, comparative phenomena of, and cow-pox 365 Inoculation for cow-pox (vaccination) 366 Inquests held by coroner in New Orleans cccxvi Intermittent fever, pathology and symptoms of 44-81 Table showing the prevalence of in New Oileans at different seasons of the year.... clxviii Fever statistics of the Charity Hospital of New Orleans; table showing the monthly and annual admissions of the different fevers and diseases cclxviii Ireland, history of cow-pox in 299 Deat hs from small pox in 290 Intra-mural sepulture in New Orleans cccxxvii Jacobs, on cow pox 253 Jefferson, Thomas, of Virginia, President of the United States, introduction of vaccination by, into the Southern States.... 315 Letter of to Dr. Edward Jenner 313 Correspondence of with Dr. Benjamin Waterhouse, of Cambridge, Mass., with reference to vaccination 316-322 Observations on yellow fever in New Orleans, and measures for its prevention cxxxvi Jenner. Edward, M. D.- Works of Edward Jenner 142 An inquiry into the causes and effects of the variolse vaccinas. a disease discovered in some of the western counties ot England, particularly Gloucestershire, and known by the name of the cow-pox, by Edward Jenner. M. D., F. R. S. Third edition, London, 1801 ' 1.. 143-159 Further observation on the variolas vaccinffi. by Edward Jenner 161-177 A continuation of facts and observations relative to the variol® vaccina; or cow-pox, by Edward Jenner, M. D., F. R. S., etc , Loudon, 1801 179-188 Dr. Jenner's account of the origin of the vaccine inoculation 189-191 Dr. Jenner's instructions for vaccine inoculation 191-193 Dr. Jenner referred the reputed failures of vaccination to several causes 263-265 Views of Dr. Jenner on the causes of the abnormal phenomena of vaccination 387-393 Letter of Thomas Jefferson to 313 Letter of John Quincy Adams to 314 Pointed out causes of the accidents attending vaccination, and gave rules for their avoidance . . 423 On the varietie# and modifications of the vaccine disease 423 Answer to his inquiries by the rector of Lackhamstead 423 On the relations of grease in the horse to cow-pox 348 Opinion of on the value of vaccination to prevent the Oriental plague 384 Proposed vaccination for the cure of hydrophobia 385 Refutes the attacks of Mosley, Rowley ana Squirrel ............... 387 Careful attention of Dr Jenner to the deviations of the vaccine vesicle 394 On causes of failures in vaccination 423 Letter to Dr Waterhouse 429 On contamination of vaccine matter with small-pox matter 499 Johnston, Joseph E., General C. S. A,, letter of, relative to Federal prisoners 417 Joler, on epidemic measles 433 Jenner, Henry S., on advantages of vaccination 254 Johnson, Wirt, M. D . on small-pox in Mississippi 101 Jones, Stanhope, M. D . report of inspection of shipping in the port of New Orleans cvi Jenner, William, on vaccino-syphilis 486 Jones. Mr., of Chesterfield, on vaccino-syphilis 486 26 Contagious Diseases-Index. Page Jones, Joseph, M. D., President of the Board of Health of the State of Louisiana, 1880 to 1884; measures instituted by, for the arrest of small-pox iii Report of, detailing the general results of the Quarantine operations of the Louisiana Board of Health, 1880 to 1883 xxiii Instructions to Inspector at Port Eads xxix Official action in case of British Steamship Vanguard xxix In case of Swedish Bark Excelsior • •' nx General review of the operations of the Louisiana Board of Health, 1870 to 1881-..... xl Report of yellow fever of 1882, and measures instituted for the arrest thereof, in New Orleans, Louisiana . lv Official action of, in the ease of John Forbes, attacked with yellow fever at 98 Old Levee street, July 22, 1882 Ivi Official action with reference to Steamship Marco Aurelio, which brought John Forbes from Havana to New Orleans Iviii Orders issued to Sanitary Inspector, Third District, New Orleans, with reference to isolation and disinfection of No. 98 Old Levee street and Steamship Marco Aurelio . Iviii Orders issued to Captain of Steamship Aurelio Ixi Order commanding Civil Sheriff of parish of Orleans, to remove the Steamship Marco Aun lio to the Quarantine station Ixi Correspondence with the Consul of the British with reference to the forcible seizure of the steamship Marco Aurelio 1 Letter to Governor of Louisiana relative to return of steamship Marco Aurelio, Ixii Report of case of Louis Deadlier, July 17. 1883 Ixiii Directions to Sanitary Inspector Fourth District, with reference to case of Descbler, , Ixv Report of case of Johannes Stroh, attacked with yellow fever July 27, 1882, at No. 25 Enghein street, New Orleans, Ixvi Instructions to Sanitary Inspectors and municipal authorities of New Orleans, with reference to the isolation and disinfection of No. 25 Enghein street, and the surrounding portions of New Orleans Ixviii Report of the case of Malachias England Ixx Establishment of Quarantine against Pensacola, Florida .. Ixv Orders with reference to bark Berna, with yellow fever, at Mississippi Quarantine Station xc Quarantine proclamation, July 23, 1883 .. xciv Letter to Governor of Louisiana, with reference to exclusion of infected vessels from the months of the Mississippi River, September 19, 1882 - Climate and diseases of Rio de Janeiio cix History of Quarantine in Louisiana cxix Letter' to J. Flo\d King, with reference to National and State Quarantine cxiv Interstate Quarantine ... .. ... cxvi lie-establishment of Marine Hospital Service in New Orleans cxvii Efforts to secure the passage of at. act by Congress establishing a floating ward in the harbor of New Orleans ... cxviii Letter to Governor of Louisiana, urging the necessity of legislative action with ref- • e> ence to the maintenance of the Quarantine laws ot Louisiana cxxiv Letter to Speaker of House of Representatives of Louisiana, in 1882, urging action on the Quarantine bill. May 8. 1882 cxxvi Letter of, to me Governor, President of the -enate and Speaker of the House, of the General Assembly of Louisiana, discussing the relations of Quarantine to the public health and commerce .. cxxvii Letter to the Attorney General of Louisiai a, with reference to the suit of Morgan's Louisiana Railroad Company against the Board ot Health .. clxvii Letter to Governor of Louisiana, with reference to the decision of Judge Monroe.... clxviii Comparative view of the mortality of New Orleans during a period of four years. 1880, 1881, 1882, 1883 '..... clxxiii Outline of the history, theory and practice of Quarantine 11-30 Measures for the prevention and arrest of contagious and infectious diseases 35-133 General outline of the symptoms and pathological anatomy of yellow and malarial fevers , 44-81 Constitution of the atmosphere in yellow fever epidemics 82 Rules and regulations governing Quarantine, and quarantine stations and vessels in Louisiana 89 Prevention and arrest of yellow fever in cities and towns of the Mississippi Valley, 95 Measures for tne prevention and arrest of small-pox 116 Vaccination, variolas vaceinte (cow-uox), variola and varioloid, and spurious vaccina- tion in general, civil, hospital and military practice, and in the Confederate armyduiing the American civil war, 1861-1865 A 135-542 Johnson, Wirt, M. D., on small-pox in Mississippi Ill Kelley, Prof., M. D., President of Board of Health of Galveston, Texas, letter of President of Louisiana Board of Health to. relative to the case of Louis Deschler, June 17, 1882 .. Ixiv King, Hon. J. Floyd, correspondence of, with President of Louisiana Board of Health with reference to a National Quarantine cxv Kettera, of Pennsylvania, on Quarantine 11 Kidneys, pathological anatomy of, in yellow fever and in malarial fever .. 75 Kratz, O., M. D., surgeon C. S. A., on vaccination and variolous diseases 470 Lacto-variolous, or modified inoculation 530 Langenbeck, on the inoculation of cancer 494 Lafosse, on the artificial production of horse-pox by inoculation 252 Lankford, A. P., M. D., of St. Louis, Mo., on epidemic yellow fever of 1878 clxiv (Jantagious Diseases-Index. 27 Page. Larry, on erysipelas following vaccination in the French army.... ..... 454 Latham, P. M., M. D., on vaccino-syphilis 486 Lebert, on the inoculation of tubercle .' 487 Lanoix, of Paris, on animal vaccination 536 Lead, poisonous effects of cccxli Lee, Robert E., Genetai, letter to Dr. Joseph Jones, with reference to Federal prisoners 413 Levees of Mississippi river ccclxvii Lind on scurvy 402 Literature of vaccination 253 Locock, Charles, Sir, on vaccino-syphilis 486 Lever, on vaccino-syphilis 486 Liver, pathological changes of, in yellow.fever 72 Pathological changes of. in malarial fever .. 72 Fatty degeneration of. in yellow fever 72-75 London-Report of the Royal College of Physicians of London on vaccination 355 Report of Royal College of Surgeons on vaccination 260 Mortality of .... 283 Mortuary statistics of . 284 Statistics illustrating the annual average births and burials in (1671 te 1781) 285 Deaths from small-pox in (1807 to 1860) 285 Mortuary records ot 287 Logan, John, sanitary officer Fourth District, report of case of Louis Deschler Ixix Lookout Station-Establishment of Quarantine Inspector and officers at English Lookout, on the coast of Louisiana, opposite Mississippi, for the protection of New Orleans trom the introduction of yellow fever from Mississippi. Alabama, Floiida, Mexico and the ports of South America and the West Indies Ixxiv, Ixxvii, cvii Louisiana Board of Health-Measures instituted by its President for the arrest of contagious and infectious diseases ... ii General results of Quarantine operations of 1880-1881 xxiii, xxxiv General review of financial operations of xl Quarantine ami sanitary operations, 1882 ■ li Quarantine operations, 1883 Ixxxiv Proceedings of. Ixxii, Ixxvii, Ixxviii, Ixxix, xcv, xcv Action of, with reference to United States Marine Hospital Service o Non-intercourse in 1883 . xcv, Xcvii, ci Acts proposed by, for the establishment of a floating hospital or ward in the harbor ot New Orleans, for the isolation and t eatment of contagious and infectious diseases .... .. cxix Rules and regulations for the government and Quarantine officers and stations. 89 Sanitary rules for shipping 89 Disinfection and disinfectants 91 Disinfection, fumigation and purification of vessels from ports in which yellow fever prevails 91 Discharge of cargo and purification of infected vessels 91 Rules governing the sick at Quarantine stations 92 Classification of merchandise at Quarantine stations for sanitary measures 92 Rules regulating foul vessels ...'. 92 Sanitary rules governing shipping in the port of New Orleans 94 Proceedings September 6, 1883, relative to small-pox 137 Louisiana-Small-pox in . . xix, xx, xxi, xxii History of Quarantine in cxxi Progress of commerce and population in, during the French domination 1684 to 1763, Progress of population and commerce under the Spanish domination .. cxxxv Under American domination cxxxvi Quarantine acts of 1855 v cli Lay, on horse-pox 350 Lufron, on horse pox 350 Lunford, of Jamaica, on yaws 431 Lyman. W Hon. of Massachusetts, on Quarantine 12 Louis XIV.. of France, charter granted 1 rosart ... cxxxi Louisiana-Climateand health of; observations on the climate and health of Louisiana, and more especially upon the relations of the climate of New Orleans. Epidemic and endemic diseases by Joseph Jones, M. D .. ccxliv et seq Lymph, dried vaccine lymph, or scabs, in which decomposition has been excited by carrying the matter about the person for a length of time .' 441-443 Dried vaccine lymph, or scabs, from patients who had suffered with erysipelas during the progress of the vaccine disease, whose systems were in a depressed state from improper diet, bad ventilation, and the. exhalations from typhoid fever, erysipelas, hospital gangrene, pyaemia and offensive suppurating wounds 449-462 Lnpara, lupara series of vacci no-syphilitic inoculations 512-513 Lungs, patnology of, and in yellow and malarial fevers ■ 70 ZMZ Malarial Fever - . Symptoms of. 44-46-81 Varieties of 47 Haematuria 47-57 Hsematuria comparison with yellow fever 57 Fevers, table of admissions into Charity Hospital of New Orleans, 1849-1861 cclxviii Fever statistics of theChailty Hospital cclxviii Deaths from, bv months, 1869-1880 cclxxi Marson, on vaccino-syphilis .. . . 486 Marten, Dr., of Bristol, on vaccino-syphi'is 486 Marley, of Suud<Hand, on vaccino-syphilis 486 Marone, on vaccino-syphilis .- . 510 Maitland, Sir Thomas, established a cordon sanitaire around Voletta in 1813 20 28 Contagious Diseases-Index. Pagr. Martin, Henry A., M. D., of Boston. Massachusetts, on Jefferson as a vaccinator 315 Inttoduces animal vaccination into America 537 Mahomet and his followers spread the contagion of small-pox 277 Mather, Rev. < otton. advocated inoculation for small-pox in America. 281 Mandeville, W. R., M. D., Sanitary Inspector Fourth District New Orleans. La., reports of xii Instructions to, by President of the Boaid of Health in case of Louis Deschler Ixy Report of, in case of Louis Deschler - Ixv, Ixvi Report of Ixxvii Marks. I. N.. member of the Board of Health of the State of Louisiana- On arrest of small-pox xvii On Quarantine lx Resolutions of, relative to United States Marine Hospital Service Ixxii Resolutions of, with reference to Memphis embargo against New Orleans Ixxviii, Ixxix Resolutions indorsing United States Marine Hospital Service Ixxxvii Relative to New Orleans Auxiliary Sanitary Association xciii Relative to Dr. Rauch xciii Resolutions of, requesting the Governor of Louisiana to issue his proclamation declaring non-intercourse with places infected with yellow fever xcvii Mainegra, Dr., report on diseases of Vera Cruz cxii Maritime Association of New Orleans, resistance of, to the Quarantine laws of Louisiana xxxv Mead, J. A.j M. D., secretary Hancock County (Miss.) Board of Health Ixxxyi Mexico- Vera Cruz, mortality of cxii Milledge, of Georgia, on Quarantine 18 Monroe, Judge., of New Orleans, decision of, in case of Morgan vs. Board of Health 18 Micrococci iii yellow fever blood 57 Micrococci in blood and black vomit of yellow fever . . 87 Milk, relations of its adulterations to the diarrhoeal diseases of children ccciii Mioton. Eug. J., M. I).. Sanitary Inspector Third District New Orleans, Louisiana, report of... xi Instructions of the President of the Board of Health, with reference to the Marco Aurelio, and case of Forbes •. _ lyii Also, the case of Stroh and report of. Ixix, Ixiii Mississippi Quarantine Station, history of, and operations at- xxiii, xxix, xxxi, xxxiv, xxxvii, xlvi, Ixxx. Ixxxix. civ, cxiii, cly Mississippi River, quarantine inspection station established at mouth of xxixi Miles A.. B., M. D.. House Surgeon, Charity Hospital, report of. Ixiii, Ixxiii Memphis Board of Health, embargo established by, against New Orleans. Ixxviii Macbride. Daniel, M. D . on scorbutic ulcers 402 Maeleod, George H. B.. M. D., on hospital gangrene in the Crimea 404 McMichael, on variolation of cow 533 McGuire, Hunter, M. D., report on the wounded of the army of General Jackson in the Valley of Virginia .. 4G1 Moreland, Dr., of Boston, on the relations of variola and vaccination 432 Measles-John Hunter on the occurrence of during small-pox 428 Joseph Adams, M. I)., on the relation of measles and scarletina to small pox 429 Drs. Stetson. Winterbottom and Wilson, on 129 Relations of to small-pox and vaccination 429-435 Deaths from in New York during a period of 50 years (1804 to 1853) 325 Deaths from in Philadelphia 328 Medical Profession, opinion of, in 1818 and in 1839 as to the protective powers of vaccination.. 271-275 Microscopical characters of vaccine lymph and the contagious matter from the small.pox pustules 363 Massachusetts, introduction of vaccination into, by Dr. Benjamin Waterhouse 328 Number of cases in Military Commission-Examination of the charge urged by the United States Military Commis- sion, that the Confederate surg ons deliberately poisoned or destroyed the Federal pris- oners at Andersonville, with poisonous vaccine matter 418 Michel, Middleton. M. D., on vaccination 418 McGuire, Hunter, M. D., on vaccination 418 Measles, relations of the vaccine disease to measles, with the observations of various authors. 296-303 Mead, Dr., on origin of the small-pox 278 Experiments on inoculation for small pox 280 Montague, Lady Mary Wortley, introduces inoculation for the small-pox into England .... 280 Moore, S. P., Surgeon General C. S. A., orders of 39p Measles, inoculation of, by Home, Wachsel and Von Katona 434 McEnery, Samuel Douglass, Governor of Louisiana, Quarantine proclamations of Ixxiv, xcvi Letter of to the Louisiana Board of Health, urging the adoption of non-intercourse with places infected with yellow fever. .... xcv Letters to President of Louisiana Board of Health xcvii Makes final disposition of Dr. Patton, inspector of the National Board of Health .. xeix Proclamation of September 3, 1883 cii Marco Aurelio steamship, case of vellow fever in one of her crew (Henrv Forbes), June 22. 1882 Ivi Sanitarx condition of Ivii Orders issued by President of Board of Health with reference to steamship Marco Aurelio, and sanitary measures to prevent the spread of the infection from Forbes (correspondence with British consul) Ivii, lx, Ixi, Ixii, Ixiii Mortality of New Orleans Iii, liv, clxxxiii, clxxiv, clxxv. clxxix, clxxxi, clxxxli, cxcii, exeix, exeyi Of white and colored races... . cccxviii In different ages cccixx. cccxx From principal diseases . ccxxcii Among the sexes cccxxii In different periods of life cccxxiii Occasioned by inoculation of small-pox 282 Mortuary statistics of London, showing that inoculation increased the number of deaths from small-pox / .' 284 Record of London 287 Records of England 288-296 Contagious Diseases-Index. 29 Page. Mortality by sniall-pov, in Copenhagen 291 In New Orleans 138 Occasioned in New Orleans and the Mississippi Valley by phthisis 488 Modified, or lacto-variolous inoculation .... .... 530 Mosely, B., M. I)., attack of, on vaccination 386 Mississippi River, chemical and physical properties of its waters, sediment of and overflow of cclxix. ccclxxxv Sediment of. ccclxxv^ 1ST National Board of Health, inspection service of Ixxvii, Ixxviii, Ixxix, Ixxx, cxiv Disposition of Quarantine Inspector of, by Governor McEnery xcix Neqni, of Naples, on animal vaccination 535 Negro race, vital statistics of and mortality of cccxviii Nervous system, cerebro-spinal pathology of, in yellow fever 65 In malarial fever 65 New England States, introduction of vaccination in by Dr. Benjamin Waterhouse, of Cam- bridge, Massachusetts ... 312 New York, introduction of vaccination into 323 Deaths from all causes, small pox, measles, scarlet fever and phthisis pulmonahs. during a period of fifty years (1804 to 1853) 325 Quarantine laws of , 7 New Orleans. Louisiana- Sanitary condition and diseases, mortality and vital statistics of ...ii, v, viii. xix. xxi, xxii, xxx Value of imports and exports * xxxiii House to house inspection in lii Mortality lii, lii Mortality from 1845 to 1882 liv Sanitary condition lx Yellow fever of 1882 lx, Ixvi Sanitary measures instituted bv the President of the Board of Health for the sup- pression of the yellow fever of 1882 .... Ixviii Yellow fever of 1882 • Ixix, Ixx Quarantine against Pensacola , Ixxiii Protection of from yellow fever Ixxxv Inspection of shipping cvi History of under French domination (1684 to 1783) cxxxi, cxxiv History of under Spanish domination (1763 to 1802) cxxxy History of under American domination cxxxvi Population in 1803 cxxxvii Population in 1806 cxxxviii Population in 1810 cxl Battle of cxli Epidemics cxlvi. cxlyii Imports and exports of clvi, clvii, clviii Mortality of clxxiii. clxxiv. clxxv. clxxxi Vital and mortuary statistics of cclxv, clxxii, ccci. clxxxi. ccciii, cccvii Small-noxin .... 135-138 Mortality occasioned by fevers 488 Non-interconrse-Exclusion of vessels infected with yellow fever, and vessels from ports in which vellow fever was prevailing, from the waters of Louisiana ... . Ixxxix Nott, J. C., M. D., on erysipelas in the Confederate army '. 459 On small-pox epidemic in Mobile, Alabama, during the winter of 1865-6 480 Noble, of Manchester. England, on vaccino-syphilis 486 o Observations of Drs. Jenner, Woodville, Adams, Willan, George Hennen, Fowler, and Bosquet, on the relations of the vaccine disease to small-pox 444-449 Ogden. Hon. R N.. Speaker Louisiana House of Representatives, letter of President of Board of Health to, relative to Quarantine laws, May 30, 1882 cxxvti Organisms, microscopical-Agency of the organisms observed in the atmosphere of yellow fever, and in the blood and black vomit 87 Orleans, parish of, population in 1880 cxxxviii Oriental plagne, experiments of M. Valli in 384 Opinion of Dr. Jenner as to the possibility of arresting it by vaccination 385 Description of .' 335 Relations of the oriental plague to vaccination 336 Outline of the Sanitary and Quarantine operations of the Board of Health, State of Louisiana, 1880-1883 iii, cc, ccli Results of post mortem examination in case of yellow fever Ixxxiv Quarantine operations. 1883 s Ixxxiv Overflows of the Mississippi River ccclxix Amount of sediment contained in the waters of the Mississippi ccclxxi Early investigations on the sediment of the Mississippi River.... ccclxxiii Previous to the erection of levees, the delta of the Mississippi was annually over- flowed '. ccclxxvii Floods of the Mississippi ccclxxix Pathology of yellow and malarial fevers - 44-85 Pathological anatomy of yellow and malarial fevers 65-81 Pacchiotti, of Turin, on vaccino-syphilis 509 Paul, De, on vaccino-syphilis.;... 501, 507, 512, 515, 517 30 Contagious Diseases-Index. Page Pearson, George, M. D-An inquiry concerning the history of the cow-pox, principally with a view to supersede and extinguish the small-pox. By George Pearson, M. I)., F. it. S., Physician to St. George's Hospital, of the College of Physicians, London. 1798 195-222 Letter of, on the effects of inoculating the vaccine disease 253 Statement of the progress in vaccine inoculation 253 On the eruptions resembling the small-pox. which sometimes appear in the vaccine disease 154 Par6, on gunshot wounds 401 Passy, near Paris, discovery of cow pox at, in 1836 307 Pelli'zari. of Italy-Experiments of demonstrating the possibility of inoculating healthy subjects with blood drawn from patients suffering with secondary or constitutional syphilis 502 Pepys, Lucas, President of the Royal College of Physicians, report on vaccination 255 Pitcairn, on the contagious nature of erysipelas 457 Pertussis, vaccination recommended as a cure in, by Dr. Archer, of Maryland 335 Philadelphia, deaths from small-pox, scarlet fever and typhoid fever in 327 Phthisis pulmonalis, deaths from, in New York, 1804-1853 . ... 32C Inoculability of tubercle. 487 Experiments of M. Villemin, Lebut, Burden Sanderson. Koch and Formad, on the nature and inoculability of tubercle 488 Mortality occasioned in New Orleans by 488 etiology of 488, ccc Deaths-from, in New Orleans cccxi Pike, Fort, Quarantine operations at xxxii, xxxviii Pensacola, Florida, establishment of Quarantine against, August, 1882 Ixxiii Pearl River, and Pearlington, Miss., protection ol New Orleans from, yellow fever by way of... Ixxxv Parish prison of New Orleans, statistics of. cccxii, cccxiii Percival, W. D., M. D.. on the communication of syphilis by vaccination, among the inhabitants of Graniteville and vicinity, in South Carolina, 1866 477 Powell, A. H., M. D , Surgeon C. S. A., on spurious vaccination 469 Prisons of New Orleans cccxi Police stations of New Orleans cccxi Poor, sick and destitute, of New Orleans cccxiii Public institutions of New Orleans deaths in cccxv Post mortem examination of Louis Deadlier Ixiii Of Johannes Stroh Ixvif Of Malacbias England, yellow fever, 1882 Ixxiii Pratt, George K., M. D., member of the Board of Health of the State of Louisiana, views of, on Quarantine lx Proclamations. Quarantine ....Ixxxiv, xcvi Population of the principal cities of the United States, classified bj' race , 100 Puerperal fever 85 Putrid blood, poisonous properties of Price, M. I)., on contagious nature of constitutional syphilis 509 Preventable causes of disease and death cccxxvii, ccclxciii Plague, oriental, relations of, to vaccination 384 Prisoners, Federal, confined at Andersonville, Georgia 397 Effects of scurvy on 397 Effects of vaccination on 397 Results of the investigations of Surgeon Joseph Jones, M., D., on their condition and diseases 397-419 Testimony of Dr. E. A. Flewellen. on condition of. 479 Preventable causes.of disease and death cccxxvii Mode of burial cccxxviii Interments in the various cemeteries of New Orleans, 1833-1883 cccxxxi Preventable causes of diseases and death... cccxxxvi Adulteration of drugs cccxxxvii Difficulty of controlling the sale of poisons cccxxxviii Irritant, poisons .. cccxxxviii Neurotic, spinal, cerebro spinal and gaseous poisons .. ccxxxix Copper vessels and copper, in articles of food . cccxi Lead, and its compounds cccxiii Gaseou s poison s cccxliii Number of cases of poisoning, accidental or intentional, in New Orleans: cccxlv Deaths from poisoning in the Charity Hospital cccxlv Cases of deaths from poisoning, suicide, murder, and general and local injuries. 1849-1880 cccxlvii Poisonous effects of alcohol cccxlviii Food resources of Louisiana cccl Purity of the sugar and molasses of Louisiana cccli Nutritive and agricultural value of cotton seed ccclix Louisiana rock salt cccxiii Abundant supplies of fruit, game and fish in Louisiana ccclxvli Effects of overflows upon the health of the inhabitants of the delta of the Mississippi river . cccxix Relations of overflows to disease and death ccclxxix Water supply of New Orleans~'-Chemieal composition of the water of the Mississippi and of the cisterns, and of other rivers in Louisiana ccclxxxii Poisons, divisions of, and effects of, upon the mortality of the human race cccxxxviii, cccl Q Quarantine- General results of the Quarantine operations of the Board of Health of the State of Louisiana. (1880 to I884)....xxiii, xxv, xxvii, xxviii, xxix, xxx. xxxi, xxxii. xxxiii, xxxiv, xxvv, xxxvii, xxxviii, xl, li, Ixxi, Ixxiii, Ixxxi, Ixxxiii, Ixxxiv, Ixxxv. Ixxxvii, I X'viii, Ixxxix, xci, xcii, xciv, xcv, xcvi, xcvii, xcviii, xeix, c Contagious Diseases-Index. 31 Page. Letter of President of the Louisiana Board of Health to the Governor, with refer- ence to the exclusion of infected vessels from the waters of Louisiana cii Quarantine operations in 1883 civ, cvi, cvii. cvii, cix Maintenance of the Quarantine laws of Louisiana cxiv Relations of National and State Quarantine cxiv History of Quarantine in Louisiana cxiv, cxv, cxvii. cxviii Efforts of the Louisiana Board of Health to secure the passage of an act by Con- gress for the establishment of a floating ward or hospital in the harbor of New Orleans cxix History of Quarantine in Louisiana cxx, cxxi, cxxiii, cxxiv Letter of President of the Louisiana Board of Health to the Governor, December 8, 1881, relative to the necessity of legislative action on the subject of Quarantine cxxiv Letter of President of the Louisiana Board of Health to the Speaker of the House of Representatives, urging legislative action on Quarantine cxxvi Relations of the Quarantine established by the State of Louisiana in 1855 to public health and commerce cxxvii, cxxxi, cxxxv, cxxxvi, cxliv Quarantine ordinance in 1846 ... exlix Quarantine ordinance in 1847 cl Quarantine ordinance in 1855 ... cli Fees collected at the Quarantine stations (1857 to 1881) civ Quarantine and commercial operations., clvi, clvii, clvii, clxix, clx, clxi, clxii, clxiii, clxv, clxvi R sistance to the Quarantine laws of Louisiana by Morgan & Co clxvi, clxvii Expenditures for Quarantine purposes clxviii Letter of President of Louisiana Board of Health to Governor, with reference to the decision of Judge Monroe clxviii Decision of Supreme Court of Louisiana, January 21, 1884, sustaining the Quarantine laws clxix Outline of the history, theory and practice of Quarantine 1 Relations of Quarantine to Constitutional and International laws and commerce 2 The .English colonies of North America adopt Quarantine regulations before their separation from the mother country 2 History of Quarantine in South Carolina. 2 History of Quarantine in Massachusetts 3 History of Quarantine in Rhode Island i 4 History of Quarantine in New York 7 All essential questions relating to State and National Quarantine were discussed shortly after the formation of the Federal Union 9 Several seaboard States had Quarantine laws before the organization of the Federal Government, in 1789 ... 9 Discussion of Quarantine in the Federal Congress of 1795 10 Quarantine bill passed by United States Congress in 1799 10 Congress indicated by the acts of 1796 and 1799 that health and Quarantine laws were not in the nature of regulations of commerce 18 Quarantine recognized by International law 19 Examples of the forcible execution of Quarantine 20 Quarantine facilitates commerce 21 Commercial statistics of New Orleans 22 Commercial statistics of New Orleans (1805 to 1882) 23 Important services rendered commerce by detention, cleansing and fumigation of vessels in Quarantine.... 24 Services rendered commerce by the removal of the sick, and their treatment in the Quarantine hospitals J 25 History of the erection of the Mississippi Quarantine Station , 25 General conclusions relating to the theory and practice of Quarantine, and its rela- tions to constitutional law and commerce 27 Rainfall-Monthly and annual rainfall, with deaths from yellow feverin New Orleans for a series of years, consolidated by Joseph Jones, M. D .... ccli Races-Comparative mortality in white and colored races in New Orleans cccxviii Ramsay, Frank A , M. D., Surgeon C, S. A., on the abnormalities of vaccination .... 473 Report of the Royal College of Physicians of London on vaccination, with an appendix contain- ing the opinions of the Royal College of Physicians of Edinburg and Dublin, and of the Royal College of Surgeons ot London, Dublin and Edinburg 255 Report of Commission of the Academy of Paris, consisting of M. C, Velpeau, Ricord, Devergie, Depaul and Gilbert, on the contagious nature of constitutional syphilis 501 Ricord on the contagious nature of constitutional syphilis 501 Re-vaccination, establishment of 273 Rivalta, Italy-Communication of syphilis to forty-six children and twenty nurses at Rivalta, Italy, by vaccination 509 Account of the tragedy, by Dr. Pacchiotti, of Turin 510 Genealogical scheme of the Rivalta series ot vaccino-syphilis inoculations 511 Reno, Dr., on cow-pox ... 254 Rhazes, on small-pox 278 Rezzi, on the contagious nature of constitutional syphilis 501 Robertson, of Manchester, on vaccino-syphilis. 486 Rhode Island, Quarantine laws of 4 Royal College of Physicians and Surgeons of London. Edinburg and Dublin, on vaccination ... 255 Rowlev, Win.. M. D., attack on vaccination 386 Russell, on the reciprocal influence of small-pox and measles r .. 432 Rubiola and small-pox 427-435 Rutherford, Surgeon C. S. A., on spurious vaccination 469 Receipts of the Board of Health, 1869-1881 xiii, xlviii Registration of births and deaths xlviii Ryan. M. D, Sanitary Inspector, sixth and seventh districts, reports of xiv. Ixxvii 32 Contagious Diseases-Index. Pagb. Rigolets Quarantine Station, Quarantine operations at xxxii, xxxviii, liclv Rio de Janeiro, inspection of infected ships from xxxv Yellow fever in 1880-1881 xxxv. xxxviii Deaths from yellow fever in cix Case of bark Excelsior from cxi Rules and regulations of the Board of Health of the State of Louisiana, for the government of Quarantine officers and stations 89 Sanitary rules for shipping 90 Sanitary operations of the Board of Health of the State of Louisiana (1880 to 1884) xxiii, xxxiv, li Measures and reforms cxcviii Rules for shipping 88 Ships, sanitary rules for and disinfection of. 88-91 Sanitary and medical inspection of Mississippi Valley Ixxvii Scarlet fever Mortality occasioned by 131 Pacts of interest in the natural history of, for the guidance of sanitary officers ... 131 Schuppert, Charles R., M. D., report of case of L'. Deschler.... liv Sediments of Mississippi river ccclxxi, ccclxxvii Sigur, N. L., resident physician Atchafalaya Station, reports of xxxiii, >1, Ixxxiii Shakspeare, Joseph A., Mayor city of New Orleans-Instructions of President of the Board of Health with reference to the sanitary measures for the arrest of the yellow fever of 1882 in the Third District Ixviii Ship Island, service of U. S. Marine Hospital at c South Carolina. Quarantine laws of 2 Smith, Hon., of Marx land, on Quarantine 11 Small-pox- Measures for its arrest bv the President and officers of the Board of Health of the State of Louisiana during the years 1880-1884 iv, v, ix, x, xi, xii, xiii, xiy, xix Cases and deaths, classified according to race and nativity xxi, xxit History of in Louisiana (1803 to 1861) ' 97 Deaths from 98-99-101 Relations to temperatitre and seasons 103 Deaths in New Orleans 103 Measures for the preservation of the public safety 104-105 Natural history or, facts essential to the sanitarian - 108 Treatment of . 109-110 Vaccination iii Arm to arm vaccination 112 Results accomplished in New Orleans by vaccination •• 113 Results of the inspection of the asylums, educational institutions and public schools of New Orleans 46 Sanitary measures for arrest of 125 Disinfection and disinfectants (disposal of dead) 125-127 Measures for the prevention and arrest of 135 Occurrence of after vaccination 263 Epidemic of 1818 266 Investigations of Dr. Alexander Monro 267-272 * Theory of Dr. Thompson 272 Inoculation 277 Mortality occasioned by inoculated small-pox 282-284 Death-rate from in vat ious countries before and after introduction of vaccination: deaths in England from 288-290 Small-pox and vaccination in South Carolina 329 In Georgia ' 338 In New York (1804 to 1854) 325 In Southern States 315 In Philadelphia (1807 to 1882) 327 In Charleston 334 In Savannah 339 In Augusta 343 Phenomena of 367 Comparative view of the natural, inoculated and cow-pox 359 Nature of contagion of 360 Communicated to animals 361 Microscopical characters of the contagious matter 363 Illustrations of confluent and distinct small pox and varioloid 363-370 Development and structure of the small-pox pustules 370 Changes of the temperature and urine in 372-375 Description of by Sir Matthew Hale 394 Relations of chicken-pox 435 Effects of mixture of small-pox and vaccine matters 444-449 Observations of Jenner, Woodville. Adams, Wilson, Hennen, Fowler and Bosquet upon the relations of the vaccine disease and small-pox 444-449 South Carolina-Small-pox and vaccination in 329 Sanitary statistics of . 335 Spain, possessions of in North and South America-Introduction of vaccination into .. 344 Schleswig-Holstein-History of cow-pox in 300 Sunstroke, or heat apoplexy cclx Deaths from, in New Orleans, during a series of years cclxiii Statistics, vital, of New Orleans .' ccxcvii Vital and mortuary ccxcviii, ccc, cccxviii Stephens, Alexander H., Vice President of the Southern Confederacy, on the condition of the Federal prisoners at Andersonville 417 Simms. W. Gilmore on exchange of rebel prisoners 417 Contagious 1) i seases-Index. 33 Page. Suttons, inoculated for small-pox in England <... 281 Seaton, Edward 0., M. D., on vaccination, cow pox, horse-pox, etc 352-354 On vaccination - 532 On animal vaccination 536-538 Sanderson, J. Burden, M. D., on small-pox poison.. - 362 Stout, S, D., Medical Director of the general hospitals attached to the Army of Tennessee, on spurious vaccination .... 478 Simon, Mr., inquiries with reference to the relations of syphilis to vaccination 485 Stokes, of Dublin, on vaccino-syphilis 486 Startin. on vaecino-syphilis 486 Sunderland, on variolation of the cow 533 Sex. mortality among the races, males and females, in New Orleans, Louisiana cccxxii Stroh. Johannes, attacked with yellow fever July 27, 1882 ; died August 1st, at No. 27 Enghien street. New Orleans l<vi Post mortem examination of. Ixvii Instructions issued by Joseph Jones, M. D., President of the Louisiana Board of Health, to the Sanitary Inspectors and officers of the third district, and to the municipal authorities, with reference to disinfection, cleansing and fumiga- tion, and the measures for the arrest of yellow fever Ixviii Spleen, pathological anatomy of, in yellow and malarial fevers 75 Stomach, pathological changes of. in yellow and malarial fevers 70 Supra-renal capsules, pathological alterations of, in yellow and malarial fevers 75 Sediment of the Mississippi river ccclxxvi Swanrick, of Pennsylvania, on Quarantine ii Symptoms and pathology of yellow fever 44 Of malarial fever 44 Spirillum tenue. in yellow fever black vomit 57 Scurvy, in scorbutic patients all injuries of skin tend to form ulcers of an unhealthy character, 396 Effects of, on the character and progtess of the vaccine vesicle 397 Relations of, to the diseases of the Federal prisoners confined at Camp Sumpter, An- dersonville, Georgia 397 Sumpter, Camp, Andersonville, Georgia, effects of vaccination on Federal prisoners confined in, 397-419 Spurious vaccination 383-378 Or the abnormal phenomena accompanying and following vaccination, excited the attention of the medical profession of England in the earliest period in the his- tory of vaccination 386 Researches on, in the Confederate Army, during the civil war, 1861-1865. by Joseph Jones, M. D 391-539 In the United States Army Z 403 Syphilis, relations of, to vaccination-Fresh and dried vaccine lymph and scabs from patients suffering with secondary or constitutional syphilis at the time and during the progress of vaccination, and the vaccine disease-Production of syphilis by vaccino-syphilis 463-542 Vaccino-syphilis in the Confederate Army 465 Syphilis, vaccino, report of Dr. James Bolton, of the Confederate Army, on 466 Testimony of Drs. Powell, Etheridge. Hicks, Haigill, Rutherford, and others, on.... 469 Dr. Paul F. Eve held that syphilis might be communicated by vaccination 470 Wm. M. Fuqua, M. D., of Virginia, on 472 Dr. Crawford on, in the Confederate Army ,... 476 Prevalence of, at Graniteville, South Carolina, report of, by W. D. Percival 477 Testimony of Dr. E. A. Flewellen, of the Confederate Army, concerning ..... 479 J. C. Nott, on 480 Means of prevention 482 Report of Dr. George H. Hubbard, of the United States Army, concerning 483 Opinion of Hebra on the question whether lymph from a true Jennerian vesicle has ever been a vehicle of syphilis, scrofula, or other constitutional infection, to the vaccinated person 489 Replies of various Surgeons to the questions propounded by Mr. Simon, as to the possibility of communicating syphilis by vaccination 485-487 Syphilis, constitutional, contagious nature of- 495 Testimony of Gaspard Torrelli on. 1498 495 Illustrated by the writings of various observers, as William Clowes, 1637: Gideon Harvey, 1665; Daniel Turner, 1717; John Hunter, 1776; Drs. Duncan, William Watson, Hamerton, Egan, Garvin, Price, Rezzi. Waller. Gilbert, and others.. 498-505 Experiments of Pellizzari, of Italy, demonstrating the possibility of inoculating healthy subjects with blood drawn from patients suffering with constitutional syphilis 503 Post vaccinal 505 Cases of, recorded by Dr, Whitehead 507 M. Viennois, on vaccino-syphilis 508 Rivalta series of . 509-511 Lupara series 512 Bergame series.... 514 . Auray series 515 Cases recorded by Jonathan Hutchinson 518-529 Syphilitic virus, precautions tor its exclusion during vaccination 539 Stiomeyer, on vaccination 259 Squirrel (John Gale Jones), attack on vaccination 386 Tables- Cases and deaths from small-pox. v, viii, xii, xix, xxi, xxii Receipts of Board of Health xxvii Expenditures xxvii Vessels arriving at New Orleans xxviii Inspection at Mississippi Quarantine xxxii Exports and imports of New Orleans xxxiii Contagious Diseases-Index. 34 Page. Tables- Vessels at Quarantine xxxvii. xxxviii Receipts and expenditures of the Board of Health of the State of Louisiana. 1869-1871 xlii, xliii Amounts paid by the City of New Orleans for disinfectants, 1870-1881 xliv Estimateu receipts of the Board of Health, 1881 .... xl Estimated expenditures 1 House to house inspection lii Mortality of New Orleans, 1883. lii Mortality of New Orleans, 1845-1882 liv Vessels at Mississippi Quarantine Station, 1883 cvi Vessels at Atchatalaya Quarantine Station, 1883 cvii Deaths from yellow fever in Rio de Janeiro, 1850-1883 cix, cxi Mortality of Vera Cruz, 1881-1883 cxii Number and class of vessels inspected at the Mississippi Quarantine Station, 1880- 1883 cxiii Population of the territory of Orleans in 1806 cxxxviii Births and deaths in New; Orleans in 1808 cxxxviii Receipts at Louisiana Quarantine Station civ Arrivals of vessels in New Orleans, 18674831 clvi Imports and exports of New Orleans. 1805-1860 clvii Receipts and expenditures for Quarantine purposes in Louisiana clxviii Population and mortality of New Orleans clxxiv Mortality of New Orleans classified by diseases, weeks and months, clxxv, clxxvi, clxxvii clxxviii, clxxix, clxxx, clxxxi. clxxxii, clxxxiv, clxxxv, clxxxix, cxci, cxcii Population of the principal cities of the United States, classified by race 100 Relations of small-pox to temperature 103 Death from small-pox in New Orleans during a series of years 103 Commercial statistics of New Orleans 23 - Deaths from fevers in New Orleans 42 Giving the number of deaths by phthisis pulmonalis in the different districts of New Orleans cc Deaths by yellow fever in New Orleans during 12 years, 1869-1880 cc Deaths in first district of New Orleans, 1881 ccii Deaths in second district of New Orleans, 1881 cciii Deaths in third district of New Orleans, 1881 cciv Deaths in fourth district, New Orleans, 1881 ccv Deaths in fifth district, New Orleans, 1881 ccvi Deaths in sixth district, New Orleans, 1881 ccvi Deaths in seventh district, New Orleans, 1881 ccviii Deaths in first district. New Orleans, 1882 ccxiii Deaths in second district, New Orleans, 1882 ocxv Deaths in third district, New Orleans, 1882 ccxvi Deaths in fourth district, New Orleans, 1882 ccxix Deaths in fifth district, New Orleans, 1882 ccxxi Deaths in sixth district, New Orleans, 1882 ccxxiii Deaths in seventh district, New Orleans, 1882 ccxxiv Deaths in first district, New Orleans, 1883 ccxxxii Deaths in second district, New Orleans, 1883 ccxxxiii Deaths in third district, New Orleans, 1883 ccxxxiv Deaths in fourth district, New Orleans, 1883 ccxxxv Deaths in fifth district, New Orleans, 1883 ccxxxvi Deaths in sixth district. New Orleans, 1883 ccxxxvi Deaths in seventh district, New Orleans, 1883 ccxxxviii Mortality in the city of New Orleans during 1883, classified by months ccxxxix Mortality caused by the principal diseases of 1883 cxl Mortality of 1883, classified according to general classes, months and races ccxli Mortality from some of the principal diseases during 1882 ccxiii Deaths classified according to nationality ccxliii Rainfall-Monthly and annual rainfall, with deaths from yellow fever in New Orleans during a series ot years ccii Monthly and mean temperature of New Orleans, during a series of years cclv Tuberculosis, and deaths from, in New Orleans ccciv Tabes mesenterica, deaths from ccciv Typhus fever, death from cccix Vital and mortuary statistics of New Orleans ccxcvii, ccci Deaths from phthisis, 1845-1880 ccci, ccciii, ccciv Extreme maximum and minimum temperature in New Orleans during a series of years cclviii Deaths from sunstroke cclxiii Monthly deaths by yellow fever during a series of years in New Orleans cclxvi Fever statistics ot the Charity Hospital of New Orleans cclxix Fever statistics of the Charity Hospital of New Orleans during a period of 57 years.. cclxxii Results of cow-pox inoculation, by Wm. Woodville 244 Mortality statistics of London and England, illustrating the relative value of inocu- lation and vaccination 285-289 Mortality of England 289 Deaths from small-pox in Ireland 290 In Copenhagen 291 In various countries 292 Fatality of small-pox as it affects the vaccinated and unvaccinated ... 293 Deaths from small-pox, measles, etc., in New York, 1804-1853 325 In Philadelphia, 1807-1882 327 Mortuary statistics of Charleston, S. C 334 Of Savannah, Georgia .... 339-341 Of Augusto, Georgia 343 Composition of urine in small-pox 380-382 Thompson, theory of, as to,the identity of chicken-pox and varioloid...... 272 Contagious Diseases-Index. 35 Page. Temperaturet changes of, in small-pox 372-373 Tennessee East, spurious vaccination among Confederate troops serving in 422 Tubercle, inoculation of . 489 Tubercle, inoculability of, experiments of Villemin, Lebert, Buiflen Sanderson, Koch and For- mad, on the nature and inoculability of. 487-494 Mortality occasioned by, in New Orleans, and in the Mississippi Valley 488 ^Etiology of 488 Turner, Daniel, M. D., on the contagious nature of constitutional syphilis 498 Torella, Gaspard, on the contagious nature of constitutional syphilis 498 Tennessee Medical Society, resolutions of, relative to vaccination .... 419 Taynton, on cow-pox 254 Timconi, Dr., on the inoculation for the small-pox at Constantinople, in 1713 290 Trotter, Thomas, M. D., on malignant gangrenous ulcers 404 Thompson, John, of Edinburgh, on small-pox 427 Tompkins, on vaccino-syphilis .. 486 Turner. Daniel, on the contagious nature of constitutional syphilis 497 Theil, Basil, Dr., on lacto-variolus vaccination 530 Tebault, C. H., M. D., on lacto-variolous inoculation 530 Thiele, of Kassan, on variolization of the cow 533 United States Marine Hospital Service- Resolutions adopted by the Board of Health of the State of Louisiana, sustaining the same Ixxii Inspection service of. Ixxix, Ixxxi Indorsed by Louisiana Board of Health Ixxxvii, Ixxxviii Letter of Surgeon General Hamilton to President Louisiana Board of Health Ixxxviii Ship Island c Re-establishment of, at New Orleans, and history of cxvi, cxvii Act of Congress, proposed by the President of the Louisiana Board of Health, for the establishment of a floating ward, or hospital, in the harbor of New Or- leans, for the isolation and treatment of cases of contagious and infectious diseases cxix Urine, changes of, in malarial fever 55 In intermittent and remittent fevers 55-26 In malarial haematuria '. 57 In yellow fever 60 Constitution of, in small-pox 372-380-382 United States of America, introduction of vaccination into 312 United States Military Commission, in the trial of Henry Witz charged that the Confederate medical officers poisoned the Federal prisoners with poisonous vaccine matter 397 Examination and refutation of the charge. 397-419 Spurious vaccination in the United States Army 406-483 Unanrfe, Dr. Don Apollos, of Lima. Peru, on the climate and diseases of Peru 345 VeraCruz, Mexico-Purification of vessels from, at the Quarantine Station xxxviii Mortality of, during 1881, 1882 and 1883, from yellow fever and other diseases cxi Vomberg, on yellow fever ... ' ... 55 Vomit, black, of yellow fever 55 Vital and mortuary statistics of New Orleans ccxvii, ccxviii, ccc Venereal diseases, syphilis, etc cccvii Villermin, on the inoculability of tubercle..... 487 Velpeau, on the contagious nature of constitutional syphilis 508-514 Voigt, Leonhard, M. D., on the variolization of the cow 535 Vital and mortuary statistics of New Orleans, Louisiana cclxii, cclxvi. cclxviii, cclxix, cclxx, cclxxi, cclxxii, cclxxiii, cclxxiv, cclxxxvi, ccxcvii, ccxcvi ccxcviii, ccxix, ccc, ccci, ccciii, ccciv, cccxii, cccxiii, cccxvi, cccxviii, cccxix, cccxxi cccxxi, cccxxii. cccxxii. Vaccination-variolae vaccina (cow-pox), variola and varioloid : accidents attending vaccination; spurious vaccination 135 Causes of the popular opposition to . 141 Compulsory 136-140 Works of Edward Jenner on 142-193 George Pearson, on 192-222 Wm. Woodville, on , 223-2L, References illustrating the extensive nature of the contributions by various observ- ers to the literature of cow-pox inoculation, during the first five years after Jenner's announcement of his discovery 253 Report of the Royal College of Physicians, of London, on vaccination, with an appen- dix containing the opinions of the Royal College of Physicians of Edinburgh and Dublin, and of the Royal College of Surgeons of London, of Dublin, and of Edinburgh . 255-262 The occurrence of small pox after vaccination excited in the minds of some distrust as to the protective power of cow-pox inoculation 263 Dr. Jenner referred the reported failures of vaccination to several causes 263-265 Epidemic small-pox of 1818 ... 266 Hostility aroused against vaccination 267 Investigations of Dr. Alexander Munro on small-pox and vaccination 267-272 Mr Bryce's test .... 267 Opinion of the medical profession in 1818. as to the protective power of vaccination against small-pox 271 Dr. Thomson's theory of the identity of chicken-pox and modified small-pox 272 Establishment of revaccination .... 273 Professional views held in 1839, as to correct vaccination and impediments thereto, 275 Contagious Diseases- Index. 36 Page Vaccination- History of small-pox inoculation . 277 Comparative advantages of the inoculated small-pox, and of the cow-pox 278 Mortality occasioned by inoculated small-pox 282 The practice of inoculation for the small-pox substituted a comparatively mild form of the disease, attended with but small mortality; but the total number of deaths by small pox was thereby increased, and the perpetuation and spread of this loathsome pestilence on the surface of the earth was promoted by inocula- tion 282 The mortuary statistics of London demonstrated that inoculation act ually increased the mortality from small-pox 284 Introduction into United States of America , 312 Introduction into Massachusetts 313 Introduction into New England States 313 Introduction into Virginia and the Southern States x ... 315 Introduction into New York 323 Introduction into Philadelphia 326 Introduction into South Carolina 329 Introduction into Georgia 338 Introduction into the possessions of Spain in North and South America 344 Vaccination in Augusta, Georgia 343 Comparative view of phenomena of 365 Spurious vaccination, or the abnormal phenomena accompanying and following vac- cination 383 Causes of the various deviations of the vaccine disease from its normal course 383 In the early history of vaccination, protective powers against certain diseases were erroneously attributed to cow-pox inoculation 384 Spurious vaccination, or the abnormal phenomena accompanying and following vac- cination. excited the attention of the medical profession of England in the earlier period in the history of vaccination . 386 Attacks upon vaccination by Drs. Wm. Rowley, B. Mosely, R. Squirrel (John Gale Jones) . 386 Views of Dr. Jenner on the causes of the abnormal phenomena of vaccination 389 Researches upon spurious vaccination, or the abnormal phenomena accompanying and following vaccination in the Confederate army, during the recent American civil war, 1861-1865, by Joseph Jones, M D 391 Section I-Preliminary Observations-Accidents attending vaccination among the citizens and soldiers of the Confederate States- -Necessity for the investigation, method, extent and object of the inquiry-The injurious effects of vaccination referred to six causes-Circular letter addressed to the medical officers of the late Confeder ate army 391-395 Facts illustrating the value of vaccination and the fatality of small-pox 393 Description of small-pox by Sir Matthew Hale '. 394 Dr. Jenner pointed out some causes of the accidents attending vaccination and gave rules for their avoidance 395 Section LI-Modification, alteration and degeneration of the vaccine vesicle, depen- dent upon depressed and deranged forces, resulting from fatigue, exposure and poor diet; and upon unhealthy, vitiated and scorbutic conditions of the blood of the patients vaccinated and yielding vaccine matter 396-119 In scorbutic patients, all injuries of the skin tend to form foul ulcers of an unhealthy character . 396 Effects of scurvy upon the charactor and progress of the vaccine vesicle 399 Investigations upon the effects of vaccination amongst the Federal prisoners con- fined in Camp Sumpter, Andersonville. Georgia.... 399 Examination of the charge urged by the United States Military Commission, that the Confederate Surgeons deliberately poisoned or destroyed the Federal pris- oners at Andersonville, with poisonous vaccine matter 397-419 Dr. Hamilton, on spurious vaccination in the United States Army 406 Dr. L. Guild, on the medical records of the Army of Northern Virginia 409 reports on spurious vaccination in the Confederate Army, by S. E. Habersham 410 Report of Dr. James Bolton, of Richmond, Virginia, on the accidents attending vac- cination in the Army of Northern Virginia 413 Letter of Gen. R. E. Lee, with reference to Federal prisoners 417 Hon. Alex. H. Stephens, on the condition of the Federal prisoners at Andersonville. 417 Letters of Gens. J. E Johnston and G. T. Beauregard, and W. Gilmore Simms, rela- tive to Federal prisoners 418 Letters of Drs. Middleton. Michael, Hunter. McGuire, James Bolton and Thomas F. Wood, relative to researches on spurious vaccination in the Confederate Army, 418 Section III-The employment of matter of pustules which had deviated from the regular and normal course of development in the vaccine vesicle 420-441 Such deviation or imperfection in the vaccine disease and pustule, due mainly to pre- vious vaccination ; or, in other words, the employment of matter from patients who had been previously vaccinated, or who were affected with some skin dis- ease at the time of the insertion of the vaccine virus 420 Prof. Paul F. Eve. M. D., on spurious vaccination 421 Dr R. Hamilton, of Chattanooga, Tenn , on spurious vaccination amongst the Con- federate forces serving in East Tennessee 422 Investigations of Dr. Edward Jenner, on the varieties and modifications of the vac- cine disease 423 /Answer to Dr. Jenner's inquiries, by'the Rector of Lackhamstead. 423 Observations of Dr. James Davis, ot Columbia, South Carolina, on the vaccine and varioloid disease 425 Section IV-Dried vaccine lymph, or scabs, in which decomposition has been excited by carrying the matter about the person for a length of time, and thus sub- jecting it to a warm, moist atmosphere 441-443 Section V-The mingling of the vaccine virus with that of the small-pox matter, taken from those who were vaccinated while they were laboring under the action of the poison of small-pox 443-449 Contagious Diseases-Index. 37 Page. V accination- Observations of Drs. Jenner, Woodville, Adams, Willan, George Bennen. Fowler and Bosquet upon the relations of the vaccine disease and small pox 444-449 Section VI-Dried vaccine lymph, or scabs, from patients who had suffered with erysipelas during the progress of the vaccine disease, or whose systems were in a depressed state from improper diet, bad ventilation, and the' exhalations from typhoid fever, erysipelas, hospital gangrene, pyiemia, and offensive sup- purating wounds 449-462 Dr. Wm. Gardner, of Greene county, Tennessee, on the relations of erysipelas to vaccination .... 450 Cases of erysipelas following re-vaccination, reported by Dr. Greene to the Boston Society for Medical Improvement 451 Cases of erysipelas following vaccination, reported to the Boston Society for Medical Improvement by Drs. J. B. S. Jackson, Cabot, Bigelow, Hernans, Putnam and Channing 452 Case of constitutional irritation following vaccination, reported by Dr. Charles E. Buckingham, of Boston, Massachusetts 452 Erysipelas following vaccination in the French army 453 Observations of various authors on erysipelas following vaccination... 454 Dr. Paul F. Eve did not admit the possibility of the inoculation of erysipelas by vaccination 455 Facts illustrating the propagation of erysipelas by contagion 456 Testimony of Drs. Wells. Pitcairn. Stevenson, Gibson, Lawrence, George Gregory. Elliotson, Arnott, Thomas Watson, Rogers, Campbell de Morgan and other's, as to the contagious nature of erysipelas 457-458 Dr. J. C. Nott on erysipelas in the Confederate army 459 Report of Dr J. D. Bell on the prevalence of eiysipelas among the Confederate wounded in the Moore Hospital, Manassas Junction, Virginia, in the month of Tanuary, 1862 . 460 Immunity of the army of General Jackson from erysipelas, report of Dr. Hunter McGuire, medical director army Valley of Virginia 461 Vaccino-Syphilis- Section VII-Fresh and dried vaccine lymph and scabs from patients suffering with secondary or constitutional syphilis, at the time and during the progress of vaccination and the vaccine disease 463-542 Vaccino-syphilis in the Confederate army 465 Testimony of Dr. L. D. Gilmore on, to the syphilitic origin of a portion at least of the cases of spurious vaccination in the Confederate army 465 Report of Dr. James Bolton, on the relations of syphilis to vaccination in the Con- federate army 466 Testimony of Drs. A. H. Powell, J. A. Etheridge. Hicks, Haigill and Rutherford, with reference to the causes of spurious vaccination in the Confederate army, 469 Dr. Paul F. Eve held that syphilis might be communicated by vaccination 470 On vaccination and variolous disease, by Dr. O. Kratz.... 470 Dr. Wm. F. Fuqua testified as to the syphilitic origin of a portion at least of the cases of spurious vaccination in the Confederate army 471 On the communicability of syphilis by vaccination, by Wm. M. Fuqua. M. D., Ap- pomatox county, Virginia 471 Abnormalities of vaccination, by Frank A. Ramsey, M. D 473 Dr. Crawford, of Greenville, Tenn., traced the impure vaccine virus which produced indurated ulcers and constitutional syphilis to a single individual, and the disease thus disseminated by inoculation yielded to the remedies best adapted to the treatment of syphilis 476 Report on the communication of syphilis through the medium of vaccine virus among the inhabitants of Greenville and vicinity, in South Carolina, in 1866, by W. F. Percival, M. D., of Aiken, S.C 477 Testimony of Dr. E. A. Flewellyn as to the dissemination of syphilis by vaccination in the Confederate army .... T : ...' 479 Small-pox epidemic in Mobile, Ala., during the winter of 1865-1866. by Dr. C. Nott, 480 Syphilitic vaccine, and the means of preventing it 482 Testimony of Dr. Geo. H. Hubbard, U. S. A., as to vaccino-syphilis 483 Opinion of Hebra, as to the question whether lymph from a true Jenneriao vesicle has ever been a vehicle of syphilitic, scrofulous or other constitutional infec- tion to the vaccinated person 484 Replies of various surgeons and physicians, as Acton. Adderson, Balfour, Barlow. Beatty, Bright, Brenton, Brodie, Burrows, Busk, Ceely, Clark, Crampton, Davis, Erichson. Farr, Jenner, Chesterfield, Latham. Locock, Marson, Noble, Tompkins. Travers. Watson, West, Williams, Wilson. Ackerly, Bennett, Flem ing, Hutchinson, Lacock, Lever, Martin. Morley, Starten and Whitehead, to the question propounded in 1856, by Mr. Simon, "Whether they had any reason to believe or suspect that lymph from a true Jennerian vesicle has ever been the vehicle of syphilitic infection" 485-487 Inoculability of tubercle 487 Experiments of .4. Villemin, Lebert. Burden Sanderson, Koch and Formad, on the nature and inoculability of tubercle 487-494 Mortality occasioned in New Orleans and the Mississippi Valley by phthisis 488 ^Etiology of phthisis 488 Possibility of transmitting scrofula by vaccination, views of Dr. Edward Ballard... 493 Inoculability of cancer 494 Contagious nature of constitutional syphilis 495 Testimony of Gaspard Torella, in 1498, as to the contagious nature of constitutional syphilis 495 Facts published by William Clowes, in 1637, illustrating the contagious nature of constitutional syphilis 495 Testimony of Gideon Harvey, in his " Venus Unmasked," published in 1665, of Dan- iel Turner in 1717. and of John Hunter in 1776, as to the contagious nature of constitutional syphilis 496-498 38 Contagious Diseases- Index. Pagb. V accino-Syphilis- Facts illustrating this subject, recorded by Drs. Duncan, William Watson, Clement Hamerton, Egan, Gavin, Price, Rizzi. Waller. Gilbert and others .. 498-505 Experiments of Prof. Pellizzari. of Italy, demonstrating the possibility of inoculat- ing healthy subjects with blood drawn from patients suffering with secondary or constitutional syphilis • ■ • 502 Communication of sypliilis by vaccination-Post-vaccinal syphilis-Vaccino-syphil- itic inoculation 505 Cases of vaccino-syphilis recorded by Dr. Whitehead .. 507 Observations of M. Viennois on vaccino-syphilis 508 Communication of syphilis to forty-six children and twenty nurses, at Rivalta, Italy, by vaccination . 500 Account of the tragedy of Rivalta. by Dr. Pacchiotti, of Turin.. 510 Genealogical scheme of the Rivalta series of vaccino-syphilitic. inoculations 511 The Lupara series of vaccino-syphilitic inoculations . 512 Genealogical scheme of vaccino-syphilis inoculations, Lupara series 513 Bergame. or Terre de Busi, series of vaccino-syphilitic inoculations.. 514 Genealogical scheme of vaccino-syphilitic inoculations, Bergame series 515 Vaccino-syphilitic inoculations, Aurav series 515 Genealogical scheme of vaccino-syphilitic inoculations, Auray series ... _ 517 Cases of vaccino-syphilis recorded by Dr. Jonathan Hutchinson 518-529 Modified, or lacto-variolus, inoculation 530 Variolation of the cow 533 Animal vaccination 535 Precautions for the prevention of accidents in vaccinations, and more especially for the exclusion of the syphilitic virus ... 539 Vaccine lymph, microscopical characters of 363 Virginia, introduction of vaccination into, by Thomas Jefferson .. . ■ 315 Valmis, Dr. Francis X de, introduces cow pox and vaccination into the possessions of Spain in South and North America 346 Valentin, of Nancy, on the inoculation of the cow, horse and dog with small-pox matter 349 Valii, experiments of, on the prevention of the plague by vaccination 284 Varicella (chicken-pox), relations to small-pox 435 History and phenomena of .. • 435-441 Differential diagnosis of 440 Vaccine disease-Relations of the vaccine disease to measles and other diseases, with the obser- vations of numerous authors • 429-439 Vennois, observations of, on vaccino-syphilis 508 Variolas equina* 369 Variolas vaccinae. an inquiry into the causes and effects of the, by Edward Jenner, M. D 141-159 Further observations on the, by Edward Jenner, M. D 161-177 A continuation of facts and observations relative to the. by Edward Jenner, M. D.. 179-188 Dr. Jenner's account of the origin of vaccination .' .. 18$ Dr. Jenner's instructions for vaccination 191 Water supply of New Orleans ccclxxxii Water of Mississippi River and Bogue Falaya ccclxxxii Watson, Sir Thomas', on vaccino-syphilis 486 On contagious nature of erysipelas 458 Watson, Win., M. D., on the contagious nature of constitutional syphilis 499 Waller, experiments of, proving the contagious nature of constitutional syphilis 502 Wirt, Dr., on vaccino-syphilis ..;; 486 Williams, C. J. B., on vaccino-syphilis 446 On the cahses of phthisis 489 Wilson. Sir Erasmus, on vaccino-syphilis 486 Whitehead; Dr., of Manchester, oil vaccino-syphilis 487-507 White race, mortality of in New Orleans .... cccxviii Wilkinson. 0, P., M.' D.. Assistant Quarantine Physician, report of relative to steamship Marco Aurelio ' ; Ivii Wise, J. H. P., M. D., resident physician at Atchafalaya Quarantine Station, reports of in 1883 cvi White, C. B., M. D., on Quarantine .' cxxi Western Company, charter of cxxxii Wiltz, Louis A., Governor of Louisiana. Quarantine proclamation of, July, 1880 clxv Waterhouse, Dr., introduces vaccination in America. 310-312-315-322 Wirz, Henry, trial of as commander of the Confederate military prison at Andersonville, Ga ... 397-419 Wood, Thomas F., M. D.. of Wilmington, North Carolina, on vaccination 418 Whitehead, Dr,, cases of vaccino-syphilis recorded by • 507 Woodward,- on spurious vaccination in the United States army 483 Woodville and Pierson, Drs., errors of, arose from the performance of cow-pox inoculation in an atmosphere poisoned by the contagious emanations of small-pox-Correction of the errors of Dr. Woodville by Dr. Jenner.. . 251 Willan, Dr. Robert, experiments of in the years 1799 and 1800 on the combined inoculation of the variolous and vaccine fluids 252 Operations of in chicken-pox.... - 437 On variolous inoculation - .. 252 Description of irregular vaccine vesicles 252 Ou relations of small-pox, measles and scarlet fever 429 Winder, Cant. W. 8., order to Captain Wirz 400 Winter, William, on the relations of the vaccine disease to measles Wells, Dr., on deaths following re-vaccination 453 On the contagious nature of erysipelas 456 Watry, on the effects of putrid vaccine matter • • • 456 Woodville, William, M. D., report of a series of inoculations for the variolas vaccina*, or cow pox; remarks and observations on this disease considered as a substitute for the small- Eox, by William Woodville, M. D., physician to the Small-pox and Inoculation Hospitals, ondon, 1799 223-250 Contagious Diseases-Index. 39 Woodville, William, M. D.- PaGK' On the occurrence of pustules in cow-pox 252 Notes on the cow-pox gen Woodall (charigeous mate), on scurvy 4Q, Wunderlich, C. A., M. D.. on the temperature in small-pox 37g Xpsilandry, Hospodar, of Wallachia, on the relation of vaccination to the Oriental plague 334 Yaws, Dr. Lunfeld. of Jamaica, on... 43. York, His Royal Highness the Duke of, account of an institution for inoculating the (vaccina; parts, patronized by His Royal Highness the Duke of York 353 Yellow Fever- Cases of yellow fever on Swedish bark Excelsior, in 1880 Y In New Orleans in 1880 Y In New Oi leans in 1882 ' j First case of, in New Orleans in 1882 (Henry Forbes) lv Special meeting of the Board of Health of the State of Louisiana, held June 27, 1882. to consider the case of Henry Forbes jv Letter of Dr. A., de Roaldes, House Surgeon Charity Hospital, announcing case of. lvi Clinical history of Henry Forbes jvj Orders issued by President of Board of Health to Dr. Mioton, Sanitary Inspector of Third District, with reference to the isolation, cleansing and disinfection of the house and premises, No. 98 Old Levee street, at which Henry Forbes was attacked with yellow fever , Sanitary condition of the steamship Marco Aurelio, which brought Henry Forbes from Havana to New Orleans Board of Health orders the return of the Marco Aurelio to the Mississippi Quaran- tine Station ]Y Correspondence of the President of the Board of Health with the British Consul with reference to the return of the Marco Aurelio to the Mississippi Quarantine Station Letter of the President of the Board of Health to the Governor of Louisiana, with reference to the return of the Maeco Aurelio to the Mississippi Quarantine Station Ixii Caseof Johannes Stroh, attacked with yellow fever July 27,1882, died August 1, 1882, at No. 15 Enghein street, New Orleans .' jxvj Outline of results of post-mortem examination of Johannes Stroh Ivii Instructions issued by President of the Board of Health to Dr. Mioton, Sanitary Inspector of the Third District, with reference to the disinfection of No. 25 Enghein street and the surrounding portions of New Orleans Ixviii •■'anitary measures instituted by the President of the Board of Health for the arrest of yellow fever in New Orleans in 1882 lxjx Case of Malachias Englund, who died of yellow fever in the Charity Hospital, August 14, 1882 , 1IX Report of deaths from, at Rio de Janeiro. Empire of Brazil, 1850-1883 cjx Climate of Rio de Janeiro cx Mortality of the city of Rio de Janeiro from, during the years 1850-51-52-80-81 cxi Introduction of, into harbor of New Orleans, from Rio de Janeiro, in 1880, by bark Excelsior cxj Mortality of the city of Vera Cruz from, during the years 1881, 1882, 1883 Cxii Number and class of vessels inspected at the Mississippi Quarantine Station, in 1880, 1881,1882,1883 cY»i Not indigenous to New Orleans cxiii Destructive effects of, in New Orleans 41 Cases and deaths of, in Charity Hospital, during a period of thirty-six years, 1844-80, 41 Deaths from, in New Orleans, 1844-1850 40 Measures for its prevention and exclusion 43 General outline of its symptoms and pathology 44 Symptoms and pathology of « 44 General conclusions as to its nature, drawn from original investigations 45 Changes of blood in 46 Chemical and microscopical changes of blood in 48-58 Organized bodies in blood of 51 Organic forms in atmosphere of, in 1878 52 Changes of temperature and pulse in 52 Nature of the febrile stage 53 Changes of the circulation, respiration and temperature in 55 Hemorrhages in 54 Black vomit of, chemical and microscopical characters of 55 Comparison with malarial haematuria 58 Causes of the black vomit of 58 Changes of urine in 60 Tabular view of the pathological anatomy of malarial and 65 Exteror, in deaths from 65 Changes of cerebro-spinal system in 65 Acute fatty degeneration of heart in 67 Lungs in 70 Stomach in 70 Intestines in 71 Liver, pathological changes in 72 Microscopical and chemical changes of fever in 72 Fatty liver of- 73 Gall-bladder I I? sules 75 40 Contagious Diseases-Index. > Page. Yellow Fever- Pathological changes of kidneys 75 Constitution of the atmosphere during yellow-fever epidemic ot 1878 ... 82 Results of microscopical examination of the air of rooms in which yellow fever cases Were confined during the epidemic of 1878 82 Analogy between the origin of hospital gangrene, erysipelas, puerperal fever and yellow fever 85 Agency of the organisms observed in the atmosphere, blood and black vomit of yellow fever 87 Practical application of results obtained from experiments illustrating the nature of the air in yellow fever, and the poisonous properties of black vomit and putrid blood.... 87 Quarantine and sanitation of ships 88 Rules and regulations for the guidance of Quarantine officers 89 Sanitary rules regulating shipping in the port of New Orleans 94 Prevention and arrest of yellow fever in the cities and towns of the Mississippi Valiev 95 Report of deaths from, at Rio de Janeiro, Brazil, 1850-1883, by C. C. Andrews, U. S. Consul General . cix Monthly deaths bv, in New Orleans, during a period of years cclxvi Fever statistics of the, Charity Hospital of New Orleans-tables showing the annual and monthly admissions of the different fevers cclxviii, cclxxviii Practical observations on, in New Orleans cclxxv Z Zymotic diseases-Deaths from zymotic and epidemic diseases (small-pox, measles, scarlatina, typhus fever, typhoid fever, yellow fever, malignant or Asiatic cholera, diphtheria, whooping-cough), and from all diseases, with death rate per 1000 inhabitants, from epi- demic and zymotic diseases, and from endemic diseases and from all diseases, in New Orleans, during a period of years. 1846-1881 co TOSrTI^ODTTCTIOTSr. MEASURES FOR THE PREVENTION AND ARREST OF EN- DEMIC, EPIDEMIC, CONTAGIOUS AND INFECTIOUS DISEASES. All facts and measures relating to the prevention of endemic, epidemic, contagious and infectious diseases, are of interest and importance to san- itarians, physicians and political economists. Efforts to exclude and arrest contagious diseases possess peculiar value, when exerted in behalf of the inhabitants of some great commercial met- ropolis, like New Orleans, whose existence and prosperity are indissolubly bound up with those of the people living upon the banks of her great river, and within the bounds of the fertile plains of its mighty valley. During the years 1880, 1881, 1882 and 1883, embracing the term of ser- vice of the author as President of the Board of Health of the State of Louisiana, the diseases which have most seriously engaged the attention of the health authorities have been Small Pox and Yellow Fever, and it is of moment that a concise account should be rendered of the measures instituted for the prevention and arrest of these diseases^ IV Introduction. This case occurred at 216 Josephine street, in a crowded locality, and was treated by the President of the Board of Health; the premises were fumigated and disinfected, and free vaccination was offered to every citizen. No other case occurred or was reported in the Fourth District during 1881. Owing to the prevalence of small-pox in the Northern, Eastern and Western States, the disease continued to be introduced into New Orleans in a continuous stream. After its appearance in the cities, towns, villages and plantations along the Mississppi river, the number of cases increased as they were introduced, and at the same time the United States Government was without any hospital for the isolation and treatment of small-pox jases. Early in 1882, the President of the Board of Health, after a careful in- spection of the Small-Pox Hospital, urged the Board of Health to take the most vigorous means for the suppression of small-pox, and also urged similar measures upon the Common Council. The response of His Honor, Mayor Shakspeare, was prompt, intelligent and humane. In the able report of the Board of Heal th,drawn up by Drs. F. Formento, Chas. Turpin and J. C. Faget,many important measures were urged by the committee upon the Honorable Common Council ; such as the closure of the Small-Pox Hospital, on account of its location and bad management: the erection of a suitable hospital for the treatment of contagious and infectious diseases, the proper isolation of patients, disinfection ot clothing and bedding, the proper disposition of the dead, the employment of special wagons perfectly covered and cleansed for the conveyance of small-pox patients. The action of his Honor the Mayor, Joseph A. Shakspeare, for the establishment of a Small-Pox Hospital, as well as the efforts of the Board of Health, were arrested by judicial proceedings. The following is the record of the cases of small-pox and deaths in the different districts, classified by race, sex and month for the year 1882 : Cases and Deaths of Small-Pox-1882. V MONTHS. First AV 1 Disti C. 3 8 23 28 19 7 4 10 3 16 13 17 51 ■ict. © H 4 8 30 36 29 18 7 10 3 16 20 42 223 Secoi w id Bis C. 3 I 30 33 37 39 9 2 3 1 tr't. © H 3 4 40 54 54 56 21 5 4 1 Thir< W. 3 6 30 32 35 37 10 5 5 1 12 181 I Dial C. 3 10 40 47 67 61 13 17 14 20 12 19 313 rict. § 6 16 70 79 102 98 23 22 19 Four W. th Dis c. dr't. © Fiftl W. Dist C. rict. © Sixtl W. 1 Dist C. rict. 3 © 1 1 1 1 3 1 3 Seve W. nth D C. istrict © 'J w. 5 9 52 64 05 67 31 13 8 6 8 60 388 :ot^ c. 9 20 99 116 129 118 39 35 24 39 33 44 705 _L. © 14 29 151 180 194 185 70 48 32 45 41 104 1093 SE M. 9 19 90 107 89 87 40 25 13 20 16 50 565 X. F. 5 10 61 73 105 98 30 23 19 25 25 54 528 Nu D W. 1 3 11 24 17 22 13 6 1 1 3 14 116 mhe eath C. 5 7 49 48 52 47 18 12 14 15 8 24 299 • of 8. 3 o H 6 10 60 72 69 69 31 18 15 16 11 38 415 3 .10 21 17 17 12 3 1 1 1 1 3 7 8 10 11 3 1 1 1 1 2 10 1 4 3 2 4 6 3 10 6 4 4 1 8 9 5 10 6 9 6 1 1 1 ••• • • • • ••••••••••• 1 1 1 6 ..... * 1 4 1 1 3 5 2 1 1 25 13 1 1 3 36 56 1 5 2 10 1 5 2 10 ^N'ovoin^or • ...... ........ 7 25 72 3 15 25 Decdufjor • • ••••• •••••.... 2 86 1 159 3 245 21 494 21 31 16 38 58 2 9 11 - - CASES AND DEATHS OF SMALL POX IN NEW ORLEANS IN 1882. Classified according to the District in which they occurred-Color and Sex. VI Introduction. The Board of Health,as at present organized, has offered free vaccination during the years 1880, 1881, 1882, 1883. The following data illustrate the operations of the Board of Health with reference to free vaccination performed by the Sanitary Inspectors of the Board of Health during the years 1881, 1882, 1883: 1881 1,370 1882 4,725 1883 First nine months 5,549 Total free vaccinations 11,644 Eleven thousand six hundred and forty-four citizens of New Orleans have been vaccinated free of charge by the Sanitary Inspectons of the Board of Health during the years 1881, 1882 and 1883, first nine months. Each and every citizen of New Orleans has had the opportunity of free vaccination at the hands of the officers of the Board of Health. In accordance with the organic acts of the Legislature of 1882, about one hundred and seventy physicians have registered at the office of the Board of Health up to July 1, 1883. The physicians of New Orleans number at least 225, or about one physician to every 1000 inhabitants. Without doubt a large number of vaccinations have been performed by the physicians of New Orleans, many of which have been gratuitous. The six sanitary officers of the Board of Health have performed, during the present small-pox epidemic, 11,644 free vaccinations ; or an average of 1940 vaccinations to each inspector. If the physicians of New Orleans had performed one-half the vaccina- tions, say about 1000 each, then they would amount to about 225,000. We have no means of ascertaining the exact number of vaccinations, but from an inspection of the orphan asylums, houses of refuge, educational institutions and the Parish Prison in this city, conducted by the President of the Board of Health, during a period of fourteen days, May 31 to June 14,1883, it was established : 1. That in the period mentioned not a case of small-pox existed in any of these institutions. 2. During the years 1882, 1883, only four cases appeared; two prisoners, one employe and one orphan were attacked by small-pox in the twenty-six institutions specified; of these cases of small-pox, four in number, all re- covered. 3. The President of the Board of Health ascertained, upon personal inspection, that every one of these inmates of these twenty-six institutions had been vaccinated by the appointed physicians. 4. Amongst four thousand three hundred and thirty-five inhabitants of the various charitable institutions of New Orleans, only one in one thous- and and eighty-three suffered from small-pox, and not one died during 1882 ^nd 1883. 5. The escape of these citizens and inmates of the charitable institutions of New Orleans, was due to the faithful performance of vaccination by the physicians of New Orleans. It is but fair to conclude that the physicians of New Orleans have been equally faithful in vaccinating the families under their charge. We conclude further, that the vast proportion of the population of New Orleans has been properly and thoroughly vaccinated by the medical profession. Joseph Jones, M. D., on the Arrest of Small-Pox. VII Small-pox has been confined chiefly to the negro race and to the destitute whites. This conclusion is shown by the large number of deaths reported by the coroner, these victims of this foul pestilence having perished without medical attendance. Shortly after the organization of the Common Council, in accordance with the provisions of the charter granted by the General Assembly of 1882, the sanitary necessities of New Orleans were urged by the President of the Board of Health upon this body, in accordance with the organic acts of the General Assembly of 1855, 1858, 1870, 1877 and 1882. The subject of small-pox audits isolation, the necessity of regulating funerals, the erecttion of a small-pox hospital and all similar subjects, were urged, but without avail, upon the attention of the Mayor and Com- mon Council. The labors of the Board of Health have been fully recorded in the report to the General Assembly of 1882 and the first six months of 1883. VIII Small-Pox; Cases and Deaths-1883 DEATHS BY SMALL-POX From January 1, 1883, to October 1, 1883. w. c. TOTAL. 24 52 76 48 83 131 72 149 221 102 159 261 80 95 175 53 96 149 44 40 84 31 36 67 12 29 • 41 466 739 1205 MONTHS. 1st District. 2d District. 3d District. 4th District. 5th District. 6th District. 7th District. TOTAL. In Hospital. W. C. Total W. C. Total W. C. Total W. C. Total W. C. Total W. C. Total W. C. Total VV. c. Total July 11 3 17 14 8 28 19 11 7 6 5 7 6 9 14 12 14 5 o 3 1 8 6 2 9 1 2 7 14 1 12 3 8 9 11 20 12 11 3 1 3 1 6 2 1 2 1 1 2 2 44 31 12 40 36 29 84 67 41 17 12 6 Sfiptfimhftr 1 19 39 58 18 22 40 12 4 16 15 7 22 15 28 43 4 4 8 4 1 5 87 105 192 35 MONTHS. January February March April May June July August September 1st District 2d District. 3d District. 4th District. 5th District. 6th District. 7th District. TOTAL CITY. W. 37 34 52 63 41 13 17 6 5 C. 56 50 65 74 62 67 27 14 9 93 84 117 137 103 80 44 20 14 W. 18 37 75 84 41 16 13 8 6 c. 30 42 104 110 61 41 10 18 9 rO 48 79 179 194 102 57 23 26 15 W. 23 38 97 117 105 31 12 10 3 C. 18 51 110 180 97 69 11 4 3 eH 41 89 207 297 202 100 23 15 7 W. 17 14 40 32 25 18 21 22 3 c. 23 18 18 18 13 12 11 11 5 40 32 58 50 38 30 32 33 8 W. 2 2 5 9 16 35 15 3 1 C- | 2 2 4 9 14 25 34 54 70 44 79 15 30 30 33 23 24 W. 5 7 27 34 11 10 10 4 c. 3 5 10 21 4 4 14 6 H 8 12 37 55 15 14 24 10 W. 1 1 1 1 6 2 c. 5 9 7 2 1 1 "2 0 6 10 7 3 1 1 1 6 4 W. 103 133 296 340 239 123 89 59 20 C. 135 177 323 430 292 238 88 84 52 3 238 310 619 770 531 361 177 143 72 1 268 424 692 298l 425 723 436 545 981 192 129 321 88 202 290 108 67 175 12 27 39 1402 1819 3221 |l DEATHS BY SMALL-POX CLASSIFIED AS TO DISTRICTS. CASES OF SMALL-POX REPORTED TO THE BOARD OF HEALTH. January 1 to September 30, 1883, classified according to Districts in which they occurred. Report of R, A. Bayley, M. I)., on Small-Pox. IX The labors performed under the direction of the President of the Board of Health for 1883 by the sanitary inspectors are fully unfolded in the fol- lowing reports : OFFICE SANITARY INSPECTOR, FIRST DISTRICT, ) New Orleans, October 15, 1883. $ Joseph Jones, M. D., President Board of Health : Sir-In the daily papers of late, as well as in the proceedings of the New Orleans Aux- iliary Sanitary Association on the eleventh instant, the small force of the Board ot Health available for sanitary purposes has been much dwelt upon, and especially so in connection with the stamping out of small-pox in this city. I would like to take ad- vantage of this opportunity to say a few words in behalf of the officers of your honor- able Board, and assert that it is no fault of theirs that small-pox still lingers in our midst, and that the force is an efficient one, and does all in its powor. It is certainly true that in an epidemic, as in the past winter months, the available force of sanitary policemen is taxed to the utmost, but not to such an extent as might be inferred or commonly believed. The trouble is not that these men cannot attend to an epidemic, but in addition to the regular house-to-house inspections, and the latter work is usually deferred to a more favorable opportunity, complaints may be attended to which comprise any serious nuisances. In the First District, for instance, two officers looked after small-pox, and one officer to nuisances in general. The force was, therefore, adequate for all practical purposes. A large force is not necessary in any district to attend to infectious and contagious dis- eases, even when very prevalent. What is essential, is that the force be composed of con- scientious and trustworthy men-one good man is worth a dozen poor ones. This city may never have such a metropolitan force as New York boasts of, and be able to station a policeman on every infected square to prevent ingress to or egress from flagged houses; nor is that necessary, in my opinion, provided that the men are competent. I have been connected with the. Board of Health of this city and State for the past eight years, and the present organization of the inspectors and policemen is as thorough and reliable as any I have known. I will illustrate my remarks by mentioning the labors of officers E. Bohner and Geo. Zeller, during the past nine months of the present year. The work of looking after small-pox and attending to complaints was placed in their hands, and I was never disappointed in the trust. The fact of so little complaint con- cerning the disease at our hands, appearing in the reporters' columns of the papers, is self-evident, and sufficient to support my views. These officers kept every infected house under surveillance after flagging, and in this way discovered concealed cases re- peatedly, and also cases not reported by the attending physician. The disease was fol- lowed up closely, and known in the district as on a map, every infected premise was thoroughly disinfected and the rooms fumigated, at the earliest moment, and the bedding and covering and wearing apparel either destroyed on the spot or conveyed to the vicini- ty of the Small-Pox Hospital on Hagan Avenue, and there burned. Cases not properly isolated, or in attendance of a physician, were sent to the hospital. This was often done at file risk of these men, as friends and relations would often object. In a very few instances did the disease re-occur after fumigation and disinfection, unless the case occurred in a tenement house, where many families lived in adjoining rooms. The dis- ease has been stamped*out in one locality after another, until it is about extinct in this district. I have made it a rule to order the owners of tenement houses so infected, to have them whitewashed throughout, including the outstanding wood-work. What is said for the First District applies to the others. It is a common thing for our officers to act as pall-bearers and pseudo-undertakers for the poor, forsaken wretches dying of this disease. The public, of course, is unaware of the extra exertions to stamp out the dis- ease in any locality. I have held the opinion always that removal to the hospital stamps out the disease in any locality even more effectually than vaccination, with less danger of its subsequent spread. In answer to your communication of the thirteenth instant, I will give a table of the work done in this district since the beginning of the year. I may add, that vaccination has been offered to persons residing in the neighbor- hood of small-pox cases, but with indifferent success. Nothing short of compulsory laws will ever accomplish the purpose. Yours respectfully, R. A BAYLEY, M. D., Sanitary Inspector, First District. X Report of C. Fagct, M. D., on Small-Pox. [Table Attached. | Table showing the statistics of small-pox in the First District since January 1, 1883, to date, including inspection work, etc. : No. of cases of small-pox. 640 No. of cases sent to hospital. 167 No. of deaths from small-pox 186 No. of cases after fumigation 54 No. of premises fumigated 532 No. of premises disinfected 532 No. of premises where clothing was destroyed 132 No. of house-to-house inspections 8742 No. of re-inspections 5481 No. of nuisances abated . 2100 No. of vaccinations 650 No. of vaccination certificates 875 OFFICE SANITARY INSPECTOR, SECOND DISTRICT, > New Orleans, La., October 18, 1883. $ Jeseph Jones,M. I)., President Board of Health: Sir-I respectfully submit this report on the subject of small-pox, in answer to your communication of the thirteenth inst., on the following questions : 1. Number of cases of small-pox which have occurred in your district from January 1, J883, to October, 1883 : 586 cases of small-pox ; 225 whites, 361 colored, have been reported to this office, or found out by the sanitary officers and police. 2. Number of deaths 342 ; 107 whites and 165 colored, giving a percentage of more than one death to two of cases reported, showing that there is a great neglect in reporting of cases on the part of physicians, and also that many cases are treated without physicians, in order to escape being reported. 3. Number of premises, rooms, etc., fumigated for small-pox: 345 premises were fumigated for small-pox. 4. Mode of dealing with small-pox, etc.: when a case of small-pox is reported to this office or found out, a yellow flag is immediately nailed to the house occupied by the patient. This is the best practical means of isolation, and also warns the neighborhood to provide themselves with vaccination at the earliest moment. This vaccination is offered by us to all infected localities and neighborhood where small-pox exists. 5 Number of cases sent to hospital: only those are sent who are willing to go, or have no person to take care of them ; ten were sent to the Small-Pox Hospital. Give number and a detailed statement of your efforts to suppress small-pox in your district; also number of vaccinations from January, 1883, to October, 1883. When cases are reported well, or when scabs have fallen off, the premises are thoroughly fumigated, and the clothes which have been used by patient washed in boiling water, and sometimes burnt, with the consent of their owners. The number of cases reported is so much greater than that of fumigations because, as a rule, many cases occur in the same localities ; as an instance, thirty-one cases occurred in four houses on St. Peter street. I vaccinated from January to October, 1883, 1548 persons, 909 whites and 639 colored; 1040 were secondary, and 508 primary, 563 were vaccinated at the office of the Board of Health and 965 at their homes and public in- stitutions. There were no applications for certificates of vaccination this year. Three thousand three hundred and thirty house-to-house inspections from January to October 1883; 1195 nuisances were abated. Respectfully yours, C. FAGET, M. D., Sanitary Inspector, Second District. SMALL-POX IN SECOND DISTRICT. No. of cases of Small-Pox in the Second District from January 1, 1883, to September 30, 1883. January. o February. a March. 3 a o CH April. o tn w. c. May. s June. ° July, p August. s o September. ■- a ■ TOTAL. a 1 Total W. & C. lieport of Eugene J. Mioton, 21. D., on Small-Pox. XI DEATHS FROM SMALL-POX FROM JANUARY 1, TO SEPTEMBER 30. JAN. FEB. MARCH APRIL. MAY. JUNE. JULY. AUG. SEPT. TOTAL. Total W. & C, W. C. W. C. C. W. C. w. C. W. C. W. c W. C. - C. W. C. 11 11 18 23 36 27 38 17 21 1 10 20 8 7 6 6 5 8 107 165 342 JAN. FEB. MARCH APRIL. MAY. JUNE. JULY. AUG. SEPT. TOTAL. Total W. & C. * C. W. C. W. C. W. C. W. C. W. C. W. C. W. C. w, C. W. C. 52 119 193 134 306 187 278 142 39 22 10 12 12 10 9 7 10 6 909 639 1548 NUMBER OF PREMISES FUMIGATED FOR SMALL-POX. JAN. FEB. MARCH APRIL. MAY, JUNE. JULY. AUG.' SEPT. TOTAL. 14 38 64 64 62 44 28 20 11 345 Number of cases of small-pox sent to Small-Pox Hospital from January 1, to September 30,1883, 10. PERSONS VACCINATED FROM JANUARY 1, 1883, TO SEPTEMBER 30, 1883. OFFICE SANITARY INSPECTOR, THIRD DISTRICT, ? New Orleans, October 14, 1883. 5 Joseph Jones, M. D., President Board of Health: Sir-In compliance with your communication of the thirteenth inst., I beg leave to report as follows, to the data contained. 1. From January 1, 1883, to October 13, 1883, 887 cases of small-pox have been record- ed at the office : 463 males and 424 females ; 443 white, 444 colored ; 348 adults over sixteen years of age and 539 children under sixteen years of age. For further par- ticulars please see Table 1 accompanying this report. 2. The total number of deaths from that disease in the Third District during the same length of time is 284 ; whites 149, colored 135 ; please see Table 1. 3. 2059 rooms were fumigated and 877 premises were disinfected, (See Table 2). 4. As regards the mode of dealing with small-pox, the isolation, disinfection and fumigation of premises and transfers to hospital, we have conformed to the rules and orders given by the President of the Board of Health, viz : As soon as a case was reported a*t our office, our inspector made it his duty to visit the patient at once in order to ascer- tain for himself the reality and severity of the case ; this being done the yellow flag was immediately displayed, free vaccination offered and urged as much as possible to the occupants of the infected house, strict orders given to prevent visitors from entering the premises, free vaccination offered to all neighbors, warnings given as to the dangers of attending the disease and advice given fortheir protection against the malady. At the termination of each case, the house where the case had occurred was thoroughly fumigated with sulphur for at least four hours ; all articles that served for the patients during illness were either destroyed or boiled for at least twelve hours in a solution of carbolic acid, privies were ordered emptied and notice served to that effect; the premises thoroughly disinfected with a solution of copperas and carbolic acid. It may be well to state here that your inspector and his sanitary officers, Messrs. J. Nowell and H. F. Evans, also during six weeks, Messrs. Taylor and Wittie, officers of the city police, who were detailed to the Board of Health during that time, are the only persons who have attended to the enforcement of the rules and regulations of the Board of Health in regard to small-pox in the Third District. All cases that were not attended by a regularly practicing physician or where their management was bad, were sent to the hospital in the charity wagons in charge of the city. 5. Thirty-five cases were sent to the hospital by our special order, ten whites, and twenty-five colored. XII Report of Wm. R. Mandeville, M. D., on Small-Pox. Quite a number of cases of small-pox having at their own request been transferred to the hospital (we do not count this in our total thirty-five), having already given in section four a detailed statement of our efforts to suppress small-pox, I will, nevertheless, put to account several reports on the management of the Luzenburg Hospital, which probably have had something to do with the closure of this establishment, the largest focus of infection and contagion in the city. It may be well to state here that on the twenty-sixth day of September, 1883, accompanied by Mr. A. De Fonblanque, British Consul, and my officer, Mr. J. Nowell, a general and thorough inspection of the hospital was made by your inspector. All articles of bed-clothing, wearing apparel, curtains etc., belonging to the patients that were soiled or could carry contagion were set apart and burnt the following day by the officers under my supervision. All the wards, public and private, the apartments of the late Dr. Hayes, the kitchen,, washing-rooms, were thoroughly fumigated and disinfected; the privies were first thor- oughly disinfected and then notice to have them emptied given and served. 6. Total number of house-to-house inspections from January 1, 1883 to October 13, 1883, 7023. For further particulars please see Table 2. 7. Total number of persons vacillated during the same length of time, 1069. 8. Total number of nuisances abated since January, 1872. For particulars see Table Number 2. 9. It is impossible for me to give a definite and correct account of the number of certificates issued to school children, as I have kept no memoranda of those given, but I may, however, safely say, from 250 to 300 such certificates were given by me since January 1, 1883; all of which is most respectfully submitted. EUG. J. MIOTON, M. D , Sanitary Inspector, Third District. TABLE 1. SHOWING NUMBER OF CASES OF SMALL-POX From January 1 to October 13, 1883, in the Third District. Total S3 s - g » SE ©* ® iL c- 5 § 5 ® ■ • • ■ MONTHS. o 16 36 112 126 92 53 17 4 : Males. to 15 37 103 103 95 44 12 10 Females. £ 21 38 107 104 104 36 18 10 4 1 Whites. £ 10 35 108 125 83 61 11 4 * Colored. 00 to 0D £ ££ W JO W O Adults. 15 40 123 156 110 62 18 6 2 Children. 23 51 160 150 135 45 21 8 8 Recovered. -1 © 8 12 21 38 27 30 6 5 2 3 Died. !-i 10 34 41 25 22 2 1 a © • ■ to • m w • Sent to Hospital. JO O' • ■ • w to cn So jo • 1 2059 75 141 302 514 475 304 165 62 19 o Number of Rooms Fum igated. 00 00 31 73 215 229 187 97 29 14 9 3 Premises Disinfected 3 to jo *-»t0©0Dt0t-*MW _cs©>u©M«4©um»-* cases on hand Oct. 13, 1883. Total Cases Remarks. TABLE 2. HOUSE-TO-HOUSE INSPECTION. Premises inspected 7023 Premises occupied-whites 3399 Premises occupied-colored 1326 Nuisances abated 1872 No. of squares disinfected 110 No. of premises disinfected 887 No. of rooms fumigated 2059 No. of persons vaccinated 1069 E. J. MIOTON, M. D., Inspector. OFFICE SANITARY INSPECTOR, FOURTH DISTRICT, ( New Orleans, October 18, 1883. S Joseph Jones, M. I)., President Board of Health: Sir-I herewith submit the following report of small-pax in the Fourth District from January 1883, to October, 1883. The method adopted to prevent the spread of this disease has been that so urgently recommended by yourself. As soon as notified of a case of small-pox, the house is immediately flagged in a con- spicuous place, and the case isolated as much as possible ; free vaccination is offered to all persons within a radius of four squares. In case of death all gatherings around the body were prohibited, and also large attendance at the funerals. lieport of A. M. Beret, M. D., on Small-Pox XIII The rooms were thoroughly disinfected by burning sulphur for from ten to twelve hours. The vaults are emptied and disinfected with sulphate of iron and carbolic acid. The rooms are white-washed,and when practicable, bedding and clothing were destroyed. Free vaccination was offered to several colored congregations, but they declined to avail themselves of the opportui ity. During the past two months but few persons have presented themselves for vaccina- tion at this offiice Small-pox cases were only transferred to the Small-Pox Hospital, when found to be in want; of these there were twenty-nine. As a rule , they object strongly to being sent to the hospital; they consider it death. At the present time, we have not a single case of small-pox in the Fourth District. Very Respectfully, W. R. MANDEVILLE, M. D., Sanitary Inspector, Fourth District. SPECIAL EEPORT OF W. R. MANDEVILLE, M. D„ SANITARY INSPECTOR, FOURTH DISTRICT, From January 1, to October 13, 1883, on Small-Pox. Number of cases 326 Number of deaths 99 Number of premises fumigated 225 Number of rooms fumigated : 573 Number of yellow flags displayed 225 Number of cases sent to hospital 29 Number of house-to-house inspections 4906 Number of nuisances abated 1425 Number of free vaccinations 663 Number of certificates issued _ 698 W. R. MANDEVILLE, M. D., Sanitary Inspector, Fourth District. New Orleans, October 16, 1883. OFFICE SANITARY INSPECTOR, FIFTH DISTRICT, ? New Orleans, October 13, 1883* 5 •Joseph Jones, M. D., President Board of Health; Sir-I respectfully submit herewith my report from January to October, 1883: Enclosed is a tabulated report of cases of small-pox in the Fifth District, with the number of deaths, etc., as requested by the Honorable President of the Board of Health; also a statement of the efforts to suppress small-pox in the Fifth District, isolation, disinfection, fumigation, etc., yellow flags and cases sent to the hospital. I herewith state that as much as it was in my power to prevent gatherings at funerals or communication, from house-to-house where there was a case of small-pox, I have done so; among the white class I was able to make them understand the necessity of such a measure, to prevent the spread of the disease, but with the negroes it was nearly useless, as they will not understand. I will also state, that in every house where there was a case of small-pox reported, a yellow flag was exhibited on the house visited by me, and if there was no physician in attendance or nurse, or unable to be provided for, the case was sent by me to the hospital. I have thus sent, as the report will show, four whites and ninteen colored ; total twenty-three. I will state, that in every house where a case of small-pox has been, the premises were entirely disinfected by sulphur and carbolic acid, the privy ordered to be cleaned and free vaccinnation offered, but in many cases refused. I have also destroyed in thirty-two premises, bedding, and clothing, etc. Enclosed herewith is also a statement of house-to-house inspections, and total number of nuisances abated from January 1 to October 13, 1883 ; also a table, showing free vaccinnation in the Fifth District. Very respectfully, your obedient servt, A. M. BERET, M. D., Sanitary Inspector, Fifth District. XIV Deport of Wm. Ilyan, M. 1)., on Small-Pox. TABLE 3. FROM JANUARY 1 TO OCTOBER 13, 1883, Showing Number of Cases of Small-Pox in Fifth District. MONTHS. No. of Cases No. Sent to Hospital. Flags. Diad. No. of Rooms Fumigated No. of Premises Disinfected W. C. W. C. V/. c. J anuary .. 2 1 2 4 2 February. 3 1 1 4 10 4 6 7 1 3 3 24 13 April 9 25 3 8 31 4 60 31 May 15 DD 8 15 59 3 1 120 5!) June 35 44 10 16 67 7 148 67 July 27 25 3 6 29 1 o 71 32 September 1 2- 1 11 18 i 30 18 October... 1 4 1 4 1 14 4 Total. 116 206 39 66 259 4 19 520 259 Grand total 322 105 259 23 520 259 A. M. BERET. M. I).. Sanitary Inspector, Fifth District. Nuisances abated 595 | Inspections made 2425- Total vaccinations-white 78 Total vaccinations-colored 321 Total certificates given 69 Grand Total Vaccinations 399 OFFICE SANITARY INSPECTOR SIXTH AND SEVENTH DISTRICTS, f New Orleans, October 15, 1883. \ Joseph Jones. M. D., President Board of Health: Sir-I respectfully submit to you the following report of the sanitary condition of the Sixth and Seventh Districts, commencing January 1, 1883, and ending October 13, 1883; whites. 117 colored 87 gases of small-pox in both districts whites 7 colored 22 Cases sent to hospital whites 33 colored 27 Deaths, Recovered, whites 77 colored 38 Persons vaccinated, whites .. 497 colored 723 Certificates issued 835 Number of premises where small-pox existed 139 Premises disinfected and fumigated 1 . 221 Rooms disinfected and fumigated 491 At tj.ll places where small-pox existed we placed a yellow flag on the premises, In con- spicuous positions, so as to warn the people of the existence of this disease. The sur rounding neighborhood was visited, and free vaccination offered to all the citizens. Isolation was made as complete as possible ; houses were fumigated with burning sul- phur, which was left in the room from ten to twelve hours. Patients were transferred to the Small-Pox Hospital in public wagons, provided for that purpose. Circulars containing the instructions of the Board of Health in regard to cleanliness, etc., were distributed freely ; also disinfectants were distributed free. We have visited house-to-house and solicited vaccination. In cases where it was im- possible to isolate, 1 sent them immediately to the hospital. Total nuisances abated, 545 ; inspections and re-inspections, 7981. This work has been accomplished with only one officer, who has to leave one district for the other in case of an emergency, and there is very much valuable time lost in so doing. I also forward you a complete report of sanitary work in the Sixth and Seventh Districts, from January 1, 1883, to October 13, 1883. I am, respectfully, yours, WM. RYAN, M. D., Sanitary Inspector Sixth and Seventh Districts. In traduction. XV HOUSE-TO-HOUSE INSPECTION IN THE SIXTH DISTRICT, From January 1, to October 13, 1883. Premises inspected 2695 Number of persons occupying premises-white 5440 Number of persons occupying premises-colored 1559-6999 Inspections made 3761 Re-inspections 561-4322 Nuisances abated 465 Premises disinfected 200 Premises fumigated 200 Rooms fumigated and disinfected 429 Number of cases of small pox-white - 110 Number of cases of small-pox-colored 10- 170 Number of premises where small-pox existed 127 Number of cases sent to hospital-white 7 Number of cases sent to hospital-colored 15- 22 Number of deaths from s.nall-pox-white 28 Number of deaths from small-pox-colored 18- 46 Number recovered from small-pox-white 75 Number recovered from small pox-colored 27- 102 Persons vaccinated-white 344 Persons vaccinated-colored 389 -733 Number of certificates issued 531. WM. RYAN, M. D., Sanitary Inspector, Sixth District. HOUSE-TO-HOUSE INSPECTION IN THE SEVENTH DISTRICT. From January 1, to October 13, 1883. Premises 987 Persons occupying same-white 1826 Persons occupying same-colored 2479-4305 Inspections made 3571 lie-inspections made 8$ Nuisances abated 80 Premises disinfected 21 Premises fumigated 21 Rooms fumigated 62 Cases of small pox-white 7 Cases of small-pox-colored 27 -34 Number of premises where small-pox existed 12 Number of cases sent to hospital-colored. ...f 7 Number of deaths-white 5 Number of deaths-colored.- 9- 14 Recovered-white 2 Recovered-colored 11- 13 Vaccinated-white 153 Vaccinated-colored 339- 492 Certificates issued - 324 WM. RYAN, M. D., Sanitary Inspector Sixth and Seventh Districts. From the preceding reports of the Sanitary Inspectors of the Board^of Health of the State of Louisiana we obtain the following general results jas to the operations, designed more especially for the arrest of small-pox. X-yd In the First District 640 cases of small-pox, with 186 deaths, were reported; 167 cases of small-pox were sent to the Small-Pox Hospital. 532 premises were disinfected and fumigated; clothing and bedding de- stroyed in 132 premises. The inspections and re-inspections numbered 14,223; and 2100 nuisances were abated; the vaccinations numbered 650, and 875 certificates were issued. Vaccination has been freely offered to all persons in the vicinity ot small-pox cases. By the energetic measures instituted by Dr. Bayley the small-pox has been extinguished in the First District of New Orleans. In 1880, the population of the First District was: white, 43,319; colored, 14,126; total, 57,445. At the present time, the population of this District is not less than 60,000, and it probably includes within its area, more wealth engaged in XVI Joseph Jones, M. 1)., on Arrest of Small-Pox commercial ami mercantile pursuits than in all the other Southern cities, exclusive, perhaps, of Baltimore. But one case in the entire First District, October 24, 1883. Second District-586 cases of small-pox; 225 white ami 361 colored ; 342 deaths; 167 whites 165 colored. 345 premises fumigated; 10 cases sent to hospital; vaccinated 909 whites ami 639 colored; total 1548; 4297 house to-house inspections, and 1195 nuisances abated. Third District-887 cases small-pox ; whites 443, colored 444; deaths 284 ; whites 149 and colored 135; 2059 rooms were fuminated, 887 premises disinfected; 35 cases small-pox sent to hospital; 7023 house-to-house in- spections; vaccinations 1069; nuisances abated 1873. Only three cases of small-pox in this District at present time, October, 1883. Fourth District-At the present time not a case of small-pox in this District; total number of cases 326; deaths 99. Premises fumigated, 224; number of rooms fumigated, 573; yellow flags displayed, 225; cases sent to hospitel, 29; house-to-house inspections, 4006 ; nuisances abated, 1425; number of vaccinations, 663; certificates issued, 638. Fifth District-cases small-pox, 322; whites 206, colored 116; deaths 105; whites 66, colored 39 ; number of flags 259, sent to hospital, 19 whites and 4 colored; total, 23; rooms fumigated, 540; premises disinfected, 259; house-to-house inspections, 3840; nuisances abated, 595; total vaccinations, 399 ; certificates issued 69. Sixth and Seventh Districts-Cases of small-pox, 204; white 117, colored 87 ; sent to hospital 29; deaths,-white 33, and colored 27; total 60; certifi- cates issued, 835; vaccinations, white 497; colored 723; premises fumi- gated, 491 ; nuisances abated 545 ; inspections 7981. From the preceding facts we deduce the following conclusions : 1. Small-pox has been arrested in New Orleans by the measures devised and executed by the Board of Health of the State of Louisiana. 2. In the efforts to isolate and arrest small pox during 1881, 1882 and 1883, the main difficulties were due to the following causes: a. The large number of colored inhabitants and poor whites, who disre- garded and refused vaccination. b. The fact that the prevalence of the disease was due chiefly to filthy habits and neglect of vaccination is conclusively shown by the large num- ber of deaths reported by the coroner. c. The constant introduction of the disease by strangers from the sur- ounding States and cities. 3. If the statistics be carefully examined it will be seen that the most marked increase of the disease was concurrent with the movement of the great staples of the valley and the congregation of large masses of people in this city from surrounding States. The decrease of small-pox during the hottest months was due to the efforts of the officers of the Board of Health at a time when commerce and trade was at the minimum. 4. The small-pox increased in proportion to the prevalence of the disease in surrounding States and cities and on the plantations along the banks of the Mississippi River. 5. New Orleans will be perpetually exposed to the introduction of small- pox when the disease prevails in the Mississippi Valley. 6. The entire subject of small-pox and vaccination in Louisiana is of paramount importance and should engage the earnest attention of the General Assembly at its next regular meeting in June, 1884. Views of Hon. Isaac N. Marks. XVII The preceding report was read at the regular meeting of the Board of Health of the State of Louisiana, October 25, 1883. VIEWS OF HON. I. N. MARKS. Mr. Marks reviewed at length the efforts of the Board of Health for the suppression of small-pox, and called attention to the vast amount of valu- able sanitary work performed by the medical officers in the various dis- tricts. The free vaccinations performed by the sanitary inspectors had reached 11,644, and had conferred great benefits upon the citizens; and if persons had neglected vaccination in New Orleans it was not the fault of the Board of Health, for vaccination had been offered freely to all citizens, ir- respective of color, race or present or previous condition. If each physician had accomplished only one-half the work performed by each sanitary inspector of the Board of Health, then we should have had, as shown by the President, at least 225,000 vaccinations. The assertions emanating from the executive committee of the New Or- leans Auxiliary Sanitary Associations were incorrect; every measure,such as the use of small-pox flags, the erection of small-pox hospitals, the con- veyance of the sick in wagons devoted specially to this purpose, the isola- tion of the sick, and the prevention of gatherings at funerals, had been urged, and as far as the means of the Board extended, been exerted by the faithful and zealous officers of the Board of Health from the first appear- ance of small-pox in 1881. These remarks, he said, were made because the step lately taken by the Auxiliary Sanitary Association and the appointment by that association of a number of physicians to inspect the various residences and vaccinate all persons not vaccinated, seemed to lead to the impression that the board had not done its duty. The Sanitary Association had appropriated $5000 for that purpose, and begain their labors at the present time, when there is no necessity for such action, for, by referring to the mortuary reports, it will be seen that during the past two weeks only six deaths had occurred by small-pox, and these at the small-pox hospital, showing that there had been no deaths in private practice of physicians. The board and its officers had done their duty, as their reports showed, and that the work done by the sanitary inspectors has met with its just reward by the arrest of small- pox in the city, and deserves commendation on the part of the people. The following resolutions were offered by Mr. Booth, and adopted: Resolutions of Hon. Edward Booth with reference to the efforts of the officers of the Board of Health of the State of Louisiana for the suppression of small-pox in New Orleans. Resolved, That the board have heard read with profound satisfaction the report of its President, giving an outline of its labors and the detailed re- ports made by Drs. Bayley, Faget, Mioton, Mandeville, Beret and Ryan, respectively medical inspectors of the seven districts of the city, upon the subject of small-pox. 1. As to the methods adopted for its isolation and suppression. 2. As to the difficulties encountered and overcome. 3. As to the enormous amount of careful and systematic work done, and finally the abundant success which, under Providence, has crowned their labors, by a reduction of the weekly mortuary of small-pox from a maximum XVIII Views of Hon. Isaac N. Marks. of 86 for week ending April 7, 1883, to the present minimum of three for week ending October. 20, 1883, a point which has not been reached since November, 1882. Resolved, That the board recognize the impossibility of forecasting what the future may have in store for our people, but will not refrain from con- gratulating the community upon the substantial cessation of small-pox, as well as the entire absence of any form of contagious or infectious disease. Resolved, That the President and medical staff of the board have merited, and are hereby tendered, at the close of the season, the thanks of the peo- ple, as far as the board can express them, and are requested to continue their well-begun work for the absolute eradication of small-pox, trusting for their reward to the appreciation of the beneficiaries, and remembering the appositeness of the maxim that "nothing succeeds like success." Resolved, That the President be and is hereby authorized and requested to embody in his annual report to the General Assembly of Louisiana the valuable and important facts reported by the medical inspectors, and to make such other use of the same as he shall deem to be for the public in- terest. The number of cases of small-pox reported to the Board of Health of the State of Louisiana, during the year 1883, was whites, 1475; colored, 1891; total cases, whites and colored, 3366. The number of deaths from small-pox in New Orleans, during 1883, was whites, 493; colored, 773; total, whites and colored, 1266; the percentage of deaths among whites, was 29.8; among the colored, 24.4 ; whites and colored, 26.5. The ratio of mortality was without doubt much less, as a large number of the cases were not re- ported, the failure to report the cases to the Board of Health was attribu- table in many cases to the poverty of the sick, and the absence ot medical attendance. Thus, during the year 1882, 139 deaths from small-pox were reported by the coroner; twenty-one whites and 118 colored. The full sig- nificance of this statement is, that during the year 1883, one hundred and thirty-nine persons died of small-pox in New Orleans, who were unable to procure the services of a physician, and that if the deaths be rated as being about one sixth of all the cases of varioloid and variola, then 824 cases which recovered among the poorest citizens received no medical atten- dance and were consequently not reported. In the following table, the cases and deaths from small pox reported in New Orleans during 1883, are classified according to districts, mouths, and races: Small-Pox in New Orleans, 1880, 1881, 1882 and 1883 XIX Months . First District. Second District. Third District. Fourth District Fifth District. Sixth District. Seventh Dist. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. De'ths Cases. De'ths. Cases. De'ths Cases. De'ths w. c. | L»OX w. c. | 'MOI w. c. | Tot'l. w. c. | Tot'l. w. c. | Tot'l. w. c. | Tot'l. w. c. | Tot'l. w c. | Tot'l. w c. | Tot'l. w c. | Tot'l. w. c. | Tot'l. w c. 0 H w c. Tot'l. w c Tot'l. Jan 37 34 52 63 41 13 17 11 4 1 6 56 50 65 74 62 67 27 19 10 4 5 4 93 84 117 137 103 80 44 3(1 15 8 6 10 9 12 1U 19 22 9 11 5 3 3 2 0 17 18 1 I 11 29 31 17 14 8 5 7 2 26 30 24 23 51 40 28 19 11 8 9 2 18 37 75 84 41 16 13 8 8 3 1 5 30 42 104 till 61 41 10 16 8 7 4 7 18 79 179 194 102 57 23 24 16 10 5 12 ii 21 28 18 9 7 6 5 "i 1 11 17 36 36 22 20 7 6 9 1 2 4 14 21 57 64 40 29 14 12 14 1 3 5 23 38 97 117 105 31 12 11 4 1 18 51 110 180 97 69 11 7 4 3 41 89 207 297 202 100 23 18 8 4 9 19 26 39 26 12 5 2 13 36 86 92 25 25 3 1 22 55 112 131 51 37 8 6 2 17 14 40 32 25 18 21 27 4 1 1 23 18 18 18 13 12 11 11 5 40 32 58 50 38 30 32 38 9 1 1 4 4 7 12 « 7 5 9 1 1 9 7 4 7 5 2 5 13 11 11 19 6 12 7 14 1 1 2 2 5 9 16 35 15 5 2 4 15 4 *2 9 25 54 41 15 27 22 16 6 8 2 4 14 34 70 79 30 32 24 20 21 12 1 1 5 7 27 34 11 10 10 4 3 5 10 21 4 4 14 4 8 12 37 55 15 1 1 24 8 1 2 8 8 1 1 3 1 4 7 1 1 3 1 1 4 12 15 2 2 6 2 1 1 i i 6 2 5 9 7 2 1 1 2 6 6 10 7 3 1 1 1 6 4 6 4 2 3 1 2 3 1 No. of Cases up to Dec. 31, 1883- Whites 1,475 Colored 1,891 Total 3,366 No. of Deaths up to Dec. 31,1883- Whites 493 Colored 773 Feb March .. April.... May June July. ... Aug 3 7 15 12 3 i 11 3 4 6 18 14 8 9 11 4 6 1 4 9 25 29 20 12 11 5 17 4 1 2 1 1 1 1 1 1 2 2 2 1 Oct 1 4 i 1 2 2 4 0 2 2 0 1 1 Total 1,266 284 443 727 98 173 271 309 440 749^107 171 2781439 552 991 143 282 425 200 120 329 56 39 95 114 228 342 56 81 137 113 66 179 27 19 46 16 33 49 6 8 14 CASES AND DEATHS BY SMALL-POX FROM JANUARY 1, 1883, TO DECEMBER 31, 1883. XX Small-Pox in Neto Orleans, 1880, 1881, 1882 and 1883. From January 1 to May 12, 1883, 152 deaths from small-pox occurred in the Luzenburg Hospital, accredited to the total number of deaths in the Third District. From May 1 to December 31, 102 deaths occurred in the City Small-pojc Hospital, accredited to the total number of deaths in the First District. A large proportion of the deaths from small-pox occurred among strangers and non-residents of New Orleans, and among the natives of foreign coun- tries, as will be shown from the preceding table, giving the total number of deaths from all causes, and from small-pox, during a period of four years in New Orleans, namely-1880,1881, 1882 and 1883, classified according to years, months, nativities and races. During the period embraced in the table, the total annual deaths from all causes, and from small-pox, were as follows: Years. Deaths, All Causes. Deaths, Small-Pox. Whites. Colored. Total. • Whites. Colored. Total. 1880 3,637 1,986 5,623 1 0 1 1881 4J27 2'279 6,406 3 2 5 3882 3,582 2,340 5^922 116 299 415 1883 f 4r552 2^971 7,523 493 773 1,266 15,898 9,576 25,474 613 1,074 1,687 During 1880 and 1881, not a single native of Louisiana died from small-pox. In 1882, of a total death from small-pox of 415, sixty-five were natives of other States of the American Union, 330 were natives of Louisiana, and twenty of foreign countries. Of the natives of other States, two were white and two hundred and sixty-three colored. Of the natives of Lou- isiana, ninety-fivefive were white and 235 colored. In 1883, of a total of 1266 deaths from small-pox, 181 were natives of other States, 1011 of Louisiana; seventy-four of foreign countries; of the natives of other states, thirty-four were white,, and 147 colored ; of the na- tives of Louisiana, 392 were white, and 619 colored. Of the 1687 deaths from small-pox during the four years specified, 250 were from other States; whites, thirty-eight, colored, 213; of 1341 from Louisiana, 487 were whites, and 857 colored, the ninety-six from other countries were all white; of the total number of deaths the whites were 613 and the colored 1074. The difference in favor of Europeans and foreigners generally, was not due solely to differences of population but clieifly to the more perfect and general vaccination of the inhabitants of England, France, Germany and Italy. This table also illustrates the large proportion of fatal cases occur- ring amongst negroes not natives of Louisana. Small-Pox in New Orleans, 1880, 1881, 1882 and 1883. XXI MONTHS. Small-Pox. Total Deaths. NATIVITIES. All Causes. Total Deaths. Grand Total. Un'd States Louisiana. Germany. France. Ireland. England. Spain. W. Indies. Other For'n Countries. White. Colored W. c. AV. C. AV. c. W. C. AV. C. AV. c. W. C. AV. C. W. c. White. Colored f May 1 361 220 581 Q Total 1 1 3.637 1.896 I ' Total, 1880.... * 5,623 ( 1 1 343 186 529 1 1 1 1 450 233 683 1 1 2 2 1 306 175 481 53 aJ Total 3 2 1 2 1 1 4,127 2,279 Total, 1881 .... 5 3 1 1 6,406 1 5 1 1 4 282 186 468 3 7 4 3 3 266 151 417 11 49 1 24 7 24 3 209 24 48 15 19 33 3 f 1 308 231 539 May 17 52 3 14 49 2 1 330 259 589 June 22 13 47 18 1 4 2 19 12 43 16 1 2 335 288 226 172 561 460 6 12 2 5 10 1 267 176 443 Soptp.m'hor 1 14 1 13 1 239 161 400 r-4 1 15 2 1 13 306 183 489 Xovombor 3 8 2 2 6 1 322 184 506 14 24 3 1£ 21 1 383 202 585 116 299 2 263 95 235 11 3. 3 3,582 2,340 5,922 Total, 1882 ... 415 265 330 11 3 3 5,922 January 24 52 2 14 19 38 3 393 214 607 February. .... .. 48 83 4 20 37 60 5 1 1 1 2 354 253 607 TO1 140 5 40 56 105 P 1 J SAO 350 7U A pril 102 159 5 23 78 136 8 5 1 1 4 374 339 713 May 80 95 4 14 67 79 2 3 1 2 1 1 1 388 278 666 53 96 o 15 46 81 o 1 1 1 404 250 654 *- .Tnl y 44 40 5 6 35 34 2 1 1 373 199 572 C"1 A iigust 31 36 1 3 26 33 3 1 310 211 521 & September 12 29 1 2 10 27 1 345 223 568 r-t OcVibar. 6 11 2 2 4 9 367 214 581 Novombfir 15 15 1 4 10 H 2 1 1 452 226 678 December 6 8 2 2 4 6 410 212 622 Total 493 773 34 147 392 619 36 15 4 1 1 2 2 2 7 4 4,552 2,971 Total, 1883 1,266 181 1,011 36 15 4 2 2 4 11 7,523 Sum- { Total w & c. ... 613 1,074 38 212 487 854 47 19 7 1 1 <3 2 10 4 15,898 9,576 mary j Grand Total 1,687 < J50 1,341 4' 19 7 2 3 4 14 25,474 XXII Small-Pox in New Orleans, 1880, 1881, 1882 and 1883. The following table presents the deaths by small-pox classified according to sex. In 1880 one death was caused by small-pox in the month of May, the pa- tient was a male; in 1881 one death occurred in April and one death in May, and three deaths in December. Total, five deaths, all males. Deaths from small-pox in New' Orleans, during the years 1882 and 1883, classified according to months and sex: MONTHS. • 1882. ' 1883. Deaths by Small-pox. Deaths by Small-pox. Males. Females Total. Males. Females Total. 6 0 6 37 39 76 February 7 * 3 10 81 50 131 March 36 24 60 124 99 221 April 45 27 72 154 107 261 May 37 32 69 98 77 195 June 33 36 69 80 69 149 J uly 17 14 31 49 35 84 August 11 7 18 35 32 67 September 8 7 15 24 17 41 October .... 10 6 16 9 8 17 November 4 7 11 20 10 30 December 16 22 38 6 8 14 Total.... 230 185 415 717 549 1,266 Total deaths from small-pox during the years 1880, 1881, 1882 and 1883' 1687; males, 953; females, 734. The preceding statistics establish the following conclusions : 1. During the years 1880 and 1881, all those who died by small-pox were males, and brought the small-pox to New Orleans from the surrounding States. 2. In the month of February, 1882, the six deaths were all males ; during this year, out of a total of 415 deaths caused by small-pox, the males ex- ceeded the females in the proportion of 230 to 185. 3. In 1883, out of a total of 1266 deaths, caused by small-pox, 717 were males, and 549 females. 4. The largest proportion of deaths occurred amongst the male popula- tion, although the females in New' Orleans outnumber the males. Thus, ac- cording to the United States census of 1880, white males 75,692, white fe- males 82,702; total whites 158,695; colored males, 25,247 ; colored females 32,510 total colored 57748; total males 100,945 ; total females 125,203; total males and females, 215,143. 5. The greater number of deaths from small-pox among the males must be referred to several causes as: (a) Greater exposure of the males to contagion. (b) The large number of males conducting the commerce of the Missis- sippi river. (c) The large number of males engaged in building the railroads leading to New Orleans Quarantine Operations Louisiana Board of Health, 1880-1883. XXIII 6. Small-pox entered New Orleans and formed a lodgment, not from the ocean and Gulf of Mexico, by merchant vessels, but it was brought in from the surrounding States, by steamboat and by rail-road. 7. The colored race, in their present condition of ignorance, poverty and helplessness form the great hot-bed or breeding ground for the preserva- tion and dissemination of small-pox. Before the recent civil war, and be- fore the emancipation of the slaves, the planters employed competent phy- sicians, enforced vaccination, and when small pox occurred, they isolated the cases in houses and hospitals built for the purpose of segregating con- tagious diseases. 8. New Orleans will be perpetually exposed to the introduction and rav- ages of small-pox, whenever the disease appears and prevails among the colored people of the Mississippi valley. 9. The subject of vaccination should engage the earnest consideration of the United States government and of each State government, and suitable laws regulating and perfecting and enforcing, vaccination upon all citizens, irrespective of race, and condition should be devised and executed. 10. The question of the spread of small-pox amongst the colored race of the Southern States is one of paramount importance, and should engage the earnest consideration of wise and humane legislators. GENERAL RESULTS OF THE QUARANTINE OPERATIONS OF THE BOARD OF HEALTH OF THE STATE OF LOUISIANA, FOR THE EXCLUSION OF FOREIGN, PESTILENCE AND MORE ESPECIALLY YELLOW FEVER, FROM THE MISSISSIPPI VAL- LEY DURING THE YEARS 1880, 1881, 1882 AND 1883. MISSISSIPPI QUARANTINE STATION. CONDITION OF MISSISSIPPI QUARANTINE IN 1880 ; REPAIRS, ADVOCATED BY THE PRESIDENT OF THE BOARD OF HEALTH. 1880 ; RIGOLETS AND ATCHAFALAYA QUARANTINE STATIONS, 1880. The Mississippi Quarantine Station is located upon the eastern bank of the Mississippi river, about seventy-five miles below New Orleans, and thirty-five miles from the Gulf of Mexico. The grounds immediately on the Mississippi river are enclosed by a levee of moderate height and strength. The levee, running parallel with the Mississippi river, is about 1700 feet in length, and the opposite or back levee, about 1600 feet; the upper and lower levees running perpendicularly to the Mississippi river measure each about 730 feet in length. The entire area enclosed by this levee within the lines of which are situated the Quarantine hospitals, physician's residence, and the United States warehouse, is about 1,113,750 square feet. The grounds slope back gently to Quarantine Bay, an arm oi the Gulf of Mexico, about one mile distant. By reference to the map of Louisiana, it will be seen that from a point about midway between New Orleans and the Gulf of Mexico, the eastern portion of the alluvial delta, through which the Mississippi River flows, is narrowed to a mere strip of land, ranging from one to two miles in width. This entire strip of land is subjected to peculiar climatic conditions. On the one side flows the Mississippi River, bearing its cool waters from the XXIV Quarantine Operations, Mississippi Quarantine. Alleghanies in the east and the Rocky Mountains in the west; on the other open the waters of the grand Gulf of Mexico. Located thus between the Mississippi River and an estuary of the Gulf of Mexico, the atmosphere is agitated by sea breezes, and the climate is purer and more stimulating than that of New Orleans. Careful inquiry revealed the facts that whilst this narrow strip of land is elevated only a few feet above the level of the Gulf of Mexico, at the same time, from the close proximity of the atmosphere of the salt water of the Gulf, the type of malarial fever in these localities, where rice is not culti- vated, is mild, and many diseases of more elevated regions, as typhoid fever, inflammatory rheumatism, pneumonia, pleuritis, and phthisis are al- most unknown. Under moderate circumstances, and when removed from the vicinity of rice fields, the inhabitants of this portion of Louisiana enjoy as long lives as in the most famed regions of the tropical and semi-tropical and temperate regions of the earth ; whilst at the same time the soil is of unexampled fertility, and the earth rewards the labors of the husbandman with abundant fruits and harvests. The orange attains perfection, and the sugar-cane has been known to tassel in this portion of the delta, whilst the surrounding waters abound with fish, shell fish, crabs and shrimp, and in the winter season teem with ducks and geese. The Mississippi River at the Quarantine Station, as well as in the harbor of New Orleans (whkh in depth and safety is unsurpassed by any other on this globe), affords an anchorage for ships of all sizes. It is evident, there ore, from the preceding facts, that the location of the Mississippi Quaranti le Station was well chosen, both for the protection of the Mississippi Valley from foreign pestilence and for the welfare and pro- tection of shipping during the performance of quarantine. This Quarantine Station commands the mouths of the Mississippi Fiver, and can be superseded by no other quarantine removed from the banks of this river. Quarantine establisl ments may be located either at the mouths of the Missis- sippi Fiver or at the h md of the Passes, or further up beyond the present loca- tion, nearer the city, as was the case .in former times at the English Turn. But the protection of the Mississippi Valley from the introduction of foreign pesti- lence demands the existence of a thoroughly equipped and efficiently officered quarantine establishm ut on the banks of the Mississippi Fiver, betiveen New Orleans and the Gulf of Mexico. No one at all conversant with the topography of the coast of Louisiana, Texas, Mississippi and Alabama would for a moment conceive tha t the commerce of this great valley could be forced by the ivay of Ship Island or any other point be- yond the borders of the Mississippi Fiver. However and whenever detained and quarantined on the coast of the Gulf of Mexico, ships must again undergo thorough inspection, and be subjected to rigid quarantine regulations, when they enter the gateway of the Valley of the Mis- sissippi. Drainage canals are located on the water side of the upper and lower levee, and communicate with Quarantine Bay, and the grounds are inter- sected with ditches at regular intervals. The levees are covered with grass, and at the upper bank and lower lines are in better condition than on the river front. Upon the area surrounded by the levee the following buildings are lo- cated. and in this examination we will proceed from the upper portion of the quarantine grounds downwards. 1st. Fever Hospital. The Hospital devoted to the treatment of fever, and more especially yellow fever, is a two-story frame building, situated about 230 feet from the line of the upper levee, and 150 feet back of the levee fronting the river: 125 feet long, 33 feet wide and 35 feet high ; upper and lower galleries, 9 feet wide and 125 feet long, run along the front of the Hospital. This building contains nine rooms on the lower floor and four looms on the upper: in all thirteen rooms. Hails divide the lower floor at right angles. Quarantine Operations, Mississippi Quarantine. XXV The upper floor is divided into four capacious, well-ventilated wards. The rooms and halls are plastered, and the ventilation is excellent, The entire building is well adapted to the treatment of fever patients. The wards are supplied with windows, at regular intervals in front and rear, and thorough ventilation can at all times be secured. The cubic capacity of the wards and rooms of the fever hospital is 55,030 cubic feet; of the halls and corridors 8788 cubic feet, giving a total cubic capacity, exclusive of the galleries, of 63,818 cubic feet. If 1100 cubic feet of air be allowed to each patient, this hospital is capable of accommodating about sixty patients. In the rear of this hospital, or connected with it by a platform' 20 by 4 feet, is a kitchen with two rooms 14 by 14 feet and 10 feet in height, with gallery 28 by'8 by 14 feet. The graveyard of the Quarantine Station is located about 200 feet to the rear of the fever hospital, and is surrounded by a rude fence and covers about three-fourths of an acre. Marks of about one hundred graves can be discerned in the enclosure, which are thickly covered with tall grass, brambles and shrubs. There is only a solitary marble monument, which bears the following inscription : " A la m moire de Trente Marins, faisant partie de 1'equipage del'avito a vaisseau de la Marine Imperiale le Tonnerre. d6c6d6s a la Quarantine de la Nouvelle Orleans en Aofit, 1857. Erig6 par 1'odre de S. E. 1'Ad- miral Hamelin, Ministre de la Marine de 1'Empereur Napoleon III." BOATMEN'S QUARTERS AND QUARANTINE LIGHT. This wooden structure is situated 320 feet from the centre of the Fever Hospital, immediately in front of the levee; 31 by 21 feet, divided into six rooms. The quarantine light is connected with the boatmen's quarters by a gangway 126 feet long and 5 feet wide, projecting into the Mississippi river. The lower portion of the quarantine lijjht has been used as a boat-house until the formation of a sand-bar rendered it useless for this purpose. The quarantine light is a wooden structure, 33 by 21 feet. A large bell, which is tolled in foggy weather, is attached to the quarantine light. Immediately in the rear of the boatmen's quarters (40 feet within the line of the levee) stands a small frame house, 30 feet square, which is used as a storehouse lor disinfectants. RESIDENCE OF QUARANTINE PHYSICIAN. The residence of the quarantine physician and his assistant occupies very nearly the centre of the frent of the quarantine grounds, about 314 feet from the boatmen's house and 100 feet back of the levee. This small wooden building contains four rooms, a hall, gallery and kitchen. A small house, 12 by 16 feet, occu- pies the upper angle of the small enclosure, surrounding the resident physician's quarters. SMALL-POX HOSPITAL. The small-pox hospital, situated 500 feet from the physician's residence and 106 feet from the front levee, has two stories, each of which has four rooms or wards, 18 feet wide, 20 feet long and 11 feet high, giving a cubic capacity of each ward of 3960 feet, and for the entire hospital, eight wards, 31,860 cubic feet. There is on each floor a cross-hall, 20 feet long by 7 feet wide and 11 feet high; cubic capacity of each hall, 1590 cubic feet, and of both halls, 3080 cubic feet, Total capacity of small-pox hospital (80 feet in length, 20 feet wide, 11 feet high), 34,760 cubic feet. If 1100 cubic feet of air be allowed to each patient this hospital would accommodate about thirty patients Galleries run the length of the front of the hospital, above and Delow. and are each 80 feet in length, 9 feet in width and 11 feet in height. There is a small building in the rear designed as a kitchen, 14 by 14 by 10 feet. UNITED STATES WAREHOUSE. The government grounds commence about 70 feet from the small-pox hospital, and extend to the lower levee. The government warehouse is a substantial fireproof brick building, situated about 125 feet from the centre of the small-pox hospital, and consists of a main hall and two wings, and is two stories in height. The upper story is supported by brick and iron arches. No wood is used in the construction of the building. The two main halls, in the first and second floors, are each 140 feet in length by 23 feet in width, and 12 feet in height, giving a cubic capacity of 28,640 cubic feet; total 77,289 cubic feet. The two wings are each 54 feet in length and 25 feet in width and 12 feet in height, each floor giving a capacity of 16,200 cubic feet for each wing; total capacity of wings 64,800 feet; total capacity of government warehouse 142,080 cubic feet. The United States wharf is substantially built, with boat-house attached. The main wharf is 100 feet long by 30 feet, and the depth of water immediately at thb river front is 22 feet. The gangway leading from the wharf to the warehouse is substantially built, and is 239 feet long by 20 feet wide, with wooden railway extending from the wharf to the warehouse. HISTORY OF THE ERECTION, AND AMOUNTS EXPENDED UPON THE MIS- SISSIPPI QUARANTINE STATION. On the fifteen of March. 1855, the Legislature of Louisiana, appropriated the sum of $50,000 for the erec- tion at the Quarantine Station, on the Mississippi River, of two separate buildings as hospitals for the sick- of a small house as residence for the otficers appointed under this act, and of a well ventilated store for the reception of the freights of such infected vessels as the Resident Physician may deem necessary to cause to be unloaded. By the first section of act of Congress entitled ''An Act making appropriation for certain civil expenses of the government for the year ending the thirtieth of June, 1858," approved third of March, 1857 the sum of $50,000 was appropriated for the construction of warehouses at Quarantine Station, on the Mississippi River below New Orleans. i r On the eighth of February-, 1858. it was enacted by the Senate and House of Representatives of the State of Louisiana, in General Assembly convened, "that the State of Louisiana does cede to the United States jurisdiction over the site of such warehouses as shall be constructed under the act of Congress approved the third of March, 1857. aforesaid, at Quarantine Station on the Mississippi River, below New Orleans and does hereby further grant to the United States the use of so much land as maybe necessary-for the construc- tion oLsuch warehouses, with water front, and privilege of the wharf now built or hereafter to be built on said Station," It was furher enacted "that the Board of Health of the State of Louisiana be and they are hereby anthor. ized and required to designate so much land to said Quarantine Station as may be necessary for the construction of the warehouses aforesaid," ' XXVI Quarantine Operations, Mississippi Quarantine. On the eighteenth of March, 1858, it was enacted by the Senate and House of Representatives of the State of Louisiana in General Assembly convened. "That the property at the Quarantine Station, on the Missis- sippi River, located in this State, the use and jurisdiction over which has been granted by the State of Louis- iana to the United States for the purpose of constructing government warehouses, together with the im- provements and buildings which the Government of the United States may erect thereupon, shall be and is hereby exonerated from all taxation and assessments by the State, or by any authorities acting under the State,'so long as said property is in possession of the Uiiited States." CONDITION OF THE MISSISSIPPI QUARANTINE STATION AT THE TIME OF THE INAGURATION OF THE PRESENT QUARANTINE PHYSICIAN, AP- POINTED BY GOV. WILTZ. The hospitals were almost absolutely bare of furniture, beds, bedding and utensils, and without the ne- cessary facilities for the treatment of even a limited number of sick ; the grounds were open and roamed over by cattle, the drainage ditches were in many places choked up, and the building needed cleansing, painting and thorough repair. GENERAL CONCLUSIONSAND RECOMMENDATIONS SUBMITTED TO THE BOARD OF HEALTH, WITH REGARD TO THE MISSISSIPPI QUARANTINE STATION, BY THE PRESIDENT, ON THE TWELFTH OF JUNE, 1880. 1. (a). The location of the quarantine grounds and buildings is excellent, and the service is energetic. (b). The Mississippi quarantine contains a considerable amount of valuable property. The United States warehouse alone cost $58,000, and is well adapted to the reception of the cargoes of ships. The entire value of the buildings cannot be less than $75,000. (c). The immediate wants of this Quarantine Station are: 1, Medical stores for hospitals. 2. Bedding, linen, and utensils for hospitals. 3. Fumigating apparatus. 4. One launch boat. 5. A competent man. who shall be placed in charge of the hospital stores and furniture. 6. One or more laborers, whose duty it shall be to open the drains, repair and build the fences, whitewash the houses and wards and keep the buildings ■and grounds in good sanitary condition. (d). The position of the Quarantine Station, at the mouth of this great river, which lias over 20,000 miles of navigable streams, tributary to the great valley with its 20,000,000 of inhabitants, is of vast importance. (e). It is the solemn duty of the Board of Health of the State of Louisiana to place the Mississippi Quar- antine Station in the best' and most eifective condition, to fulfill its important mission of protecting this great valley from the importation of foreign pestilence, and at the same time affording a safe retreat, where sick seamen may receive kind and humane nursing and skillful medical treatment. 2. (f). While protecting this valley rigidly from the introduction of foreign pestilence, at the same time the commerce and prosperity of the valley should be promoted by the perfection and enlarged application of all reliable means for disinfection, fumigation and sanitation. 3. (g). The Mississippi Quarantine Station, notwithstanding the absence of certain hospital furniture and supplies, is administered by the quarantine physician and his assistant with intelligence and ensrgy. 4 (h). The laws of the State of Louisiana, and the rules and regulations of the Board of Health, are rig- idly executed. (i). All vessels arriving frprn infected ports, or from ports in which yellow fever usually prevails at cer- tain seasons of the year, are detained and thoroughly cleansed and fumigated. (j). All vessels arriving at Quarantine Station are carefully inspected. (k). All vessels from infected ports, even though they may bring clean bills of health, are detained not less than seventy-two hours for inspection, observation, purification, disinfection and fumigation. (I). The length of the detention depends upon the nature of the bill of health, the condition of the port from whence the vessel sails, the history of the vessel while in port and during the voyage, and the actual condition of the crew, cargo aud vessel at the time of arrival at the Quarantine Station. This is the case with the ships from Rio de Janerio, a badly infected port. Every effort is made for their thorough purification. The cargo is removed from the hold and thoroughly ventilated ; the hold fumigated at intervals with sulphurous acid gas; the sides aud floors of the ship and decks are scraped aud washed with antiseptic disinfectants ; the bilge water is removed and replaced by a solution of copperas and carbolic acid. In such cases the detention is not less than ten days, aud often varies from fifteen to twenty days. 4. (m). In order to secure thorough inspection and observation, the shipping is again inspected in the harbor of New Orleans; and the cargo of ships from badly infected ports again subjected to fumigation and disinfection. (n). The vigilance exercised over our shipping is also extended to the city of New Orleans, and the members and officers of the Board of Health stand ready to investigate all cases which may arise in the future, and will use all known useful means for the abatement, circumvention and eradication of infectious 5. (o). In conclusion the President of the Board of Health respectfully urges that the Board of Health confer upon him the power to make, at the earliest practicable moment, the following appointments and the following appropriations for the Mississippi Quarantine Station: One hospital steward and druggist. One laborer. One hospital nurse. Amount for disinfecting apparatus $250 Hospital furniture, beds and bedding 250 Hospital utensils Drugs, medicines and medical apparatus • • • • • • • • 100 'Hospital and quarantine tools, spades, axes, hatchets, saws, planes, hoes, nails, whitewash brushes, etc 95 Repairs of boats 59 Removal and repair Of boat-house 150 Disinfectants 1°° Total * $1,125 In the above estimate I have included only those expenditures which are immediately demanded to give efficiency to the Mississippi Quarantine Station, and to provide for the actual wants and treatment of the sick. Quarantine Operations, Mississippi Quarantine. XXVII The thorough repair of the buildings and the thorough ditching and fencing of the grounds, together with the erection of a suitable frame building for the well passengers, will require further consideration and liberal appropriations. At this moment the Board of Health of the State of Louisiana is not in a position to advance the neces- sary amounts. Bufwith economy, energy and perseverance, it is the hope of the board that the Mississippi Quarantine Station may be placed in tlie most effective condition for the protection of the State from the importation of foreign pestilence and for the protection of commerce and the relief of sick and suffering humanity. The relations of the actual resources and the necessary expenses of the Mississippi Quarantine Station, are shown by the following tables: RECEIPTS OF THE BOARD OF HEALTH FROM QUARANTINE STATION. 1869 $23,960 00 1870 20,995 00 1871 23,624 00 1872 18,803 50 1873 18,336 69 1874 19,280 60 1875 13,801 59 1877 15,121 60 1878 19,931 00 1879 18,114 75 ANNUAL EXPENSES FOR SALARIES. Resident Physician . $5,00q Assistant.... 2,000 One Watchman 540 One coxswain 540 Four boatmen 1,920 Total annual expenses for salaries of officers and boatmen 10,000 NECCESSARY EXPENSES FOR THE EFFICIENT CONDUCT OF THE MISSISSIPPI QUARAN- TINE STATION. One Druggist and hospital steward, at $75 per month-12 months $900 Two Hospital nurses, at $50 per month-12 months 1,200 One Hospital cook, at $30 per month-12 months ; 360 Two Laborers and keepers of hospital grounds, at $30 per month each 720 Medicines and hospital supplies, furniture, bedding, etc... .... 1,000 Repair of boats 300 Disinfectants and disinfecting apparatus 1,500 Repair of buildings, painting, whitewashing, etc., per annum 5,000 Food and stimulants for the sick 1,000 Ship chandler supplies 500 $12,380 According to the organic law of the State the salaries of the President, and of the Secretary and Treas- urer should be included in the above estimate; which at the present rates per annum would bring the total amount necessary for the proper conduct of the Mississippi Quarantine Station during the year 1880, up to at least $26,780, a sum considerably in excess of the receipts of any one year, since the recent civil war. The report was received and adopted, and $2200 appropriated by the Board of Health, to be applied by the President and finance committee for the necessary suplies of medicines, disinfectants, and disinfecting ap- paratus for the Quarantine Station. Hospital furniture, beds, bedding, mosquito bars, blankets, pillows and pillow-cases, and medicines suffi- cient for the efficient treatment of about twenty patients, together with cooking stove and kitchen furni- ture, and disinfecting apparatus, paints, tools, etc., were purchased at the earliest practical moment and shipped to the Quarantine Station. At the meeting of the Board of Health on the nineteenth of November, an additional sura of five thou- sand dollars ($5000) was appropriated to the repair of the Mississippi Quarantine Station. In order to supplement the operations of the Mississippi Quarantine and of the Rigo- lets, and in order to secure the highest attainable sanitary condition in the shipping in the harbor along the river front and within the basins lying within the heart of this great city, the President drew up a code of sanitary rules and regulations, which were unanimously adopted and promulgated by the Board of Health on the 22d of April. In accordance with section 3 of the Sanitary Rules of the Board of Health of the State of Louisiana, regulating shipping in the port of New' Orleans, the President commis- sioned the Sanitary Inspectors of the several districts and appointed an Assistant Dep- uty Inspector, and empowered them, in accordance with the acts of the Board of Health, to carefully inspect the shipping, and to use such measures as were in accordance with the regulations. From the following table it will be seen that during the months of May, June, July, Angust, September and October 462 vessels were inspected in the harbor of New Orleans, exclusive of the vessels inspected in the old and ueyy basins, XXVIII Quarantine Operations, Mississippi Quarantine. TABLES SHOWING THE NUMBER, CLASS, AND NATIONALITY OF VESSELS ARRIVED IN THE PORT OF NEW ORLEANS DURING THE SIX MONTHS ENDING OCTOBER 31, 1880, WHICH WERE INSPECTED BY THE SANITARY INSPECTORS OF THE BOARD OF HEALTH, STATE OF LOUISIANA. Months. Steamships Ships. Barks. Brigs. Schooners. Total. May 33 15 25 5 18 96 J U H 6 35 o 17 1 11 July 40 2 18 I 6 67 A llgllSt a 38 3 11 4 56 September ... 53 13 3 4 73 October 77 7 25 5 104 Total 266 42 99 7 48 462 N ationality. Steamships Ships. Barks. Brigs. Schooners. Total. American 103 27 21 2 42 195 British 134 9 26 1 170 Spanish 26 14 1 41 Norwegian 10 1 11 Swedish . 3 1 4 Herman . -. . 3 3 3 9 Italian .... 7 1 8 "French ........ 3 8 1 12 A nstrian 6 6 Mexican 5 5 Danish 1 1 Total 266 42 99 . 7 48 462 Sanitary rules were also recommended by the President of the Board of Health of the State of Louisiana, to be observed by vessels during their stay in the port of New Or- leans, and in other ports and on their passage to and from New Orleans. The co-opera- tion of the State and Federal authorities and of the various Foreign Consuls was urged. Four thousand copies of these sanitary rules were printed, and they have been syste- matically and continuously distributed by the Sanitary Inspectors of the Board of Health and by the various quarantine officers at the Mississippi, Atchafalaya and Rigo- lets Quarantine Stations to the captains, masters and agents of all vessels entering the waters of Louisiana. On May 24, 1880, the rules and regulations for the government of quarantine officers and stations, and for the enforcement of the acts of the Legislature of Louisiana, "es- tablishing and regulating quarantine for the protection of the State,"* were submitted by the President and unanimously adopted by the Board of Health, and four thousand copies have been printed and distributed by the Board of Health to the local boards in the United States, to foreign consuls, captains, masters and agents of vessels. QUARANTINE OF VESSELS FROM THE INFECTED PORT OF RIO DE JANERIO, DISCHARGE OF CARGOES AT THE MIS- SISSIPPI QUARANTINE STATION, DISINFECTION OF COF- FEE IN THE WAREHOUSES IN NEW ORLEANS. The prevalence of yellow fever in the city of Rio de Janerio, received the prompt and earnest attention of the Board of Health immediately after its reorganization in April, 1880. The various vessels arriving with coffee, from this port, were detained at the Quar- antine Station for periods ranging from twelve to twenty days, the resident Quarantine physician was ordered to shift the cargoes by acclimated laborers, (that is by men who had suffered with yellow fever). Whenever it became necessary to send down men to discharge cargo, each man was, examined by the President of the Board of Health, and his statement taken under oath and a careful record was preserved, as to the age, nativity, previous attack of yellow fever, attending physician, residence, etc. As a general rule the coffee ships from Rio discharge their cargoes in the First iDstrict of New Orleans, in which are located the large coffee warehouses. Each cargo of coffee was fumigated by the Sanitary Officer . ♦Acts of the Legislature of Louisiana establishing and regulating quarantine for the protection of the State ; organizing and defining the powers of the Board of Health, and regulating the practice of medicine, midwifery, dentistry and pharmacy; also, rules and regulations of the Board of Health of the State of Louisiana and health ordinances of the city of New Orleans, by Joseph Jones, M. D , New Orleans. 1880 pp. 36-51. Quarantine Operations, Mississippi Quarantine. XXIX The following facts with reference to the prevalence of yellow fever, and other diseases in Rio de Janerio, were communicated monthly to the Board of Health by the Consul, General Thomas Adamson. In Rio de Janeiro there occurred in the month of November, 1879, total deaths from all causes 850, yellow fever 9, small-pox 11, enteric or typhoid fever 20, pernicious fever 22; month of December, 1879, total deaths 915; yellow fever 18 ? small-pox 9, enteric or typhoid fever 13, pernicious fever 43, consumption 153, mouth of January, 1880, total deaths 1062, yellow fever 133, small-pox 2, enteric or typhoid fever 14, scarlet fever 5, pernicious fever 54, consumption 166, month of February, 1880, total deaths 1352; yellow fever 484,'small-pox 1, typhus fever 1. typhoid or enteric fever 19, scarlet fever 1, pernicious fever 76. consumption 140. Present estimated population of Rio de Janeiro 330,000. March total deaths 1389; yellow fever 468, typhus fever 3, enteric or typhoid fever 17, pernicious fever 60, consumption 153, month of April, 1880, total deaths 1008, yellow fever 274, typhus fever 2, enteric or typhoid fever 15, pernicious fever 40, consumption 150. month of May, 1880, total deaths 914, yellow fever 105, typhoid fever 14, pernicious fever 28, consumption 148, month of June, 1880, total deaths 812, yellow fever 55, typhus fever, typhoid fever 8, pernicious fever 24, con- sumption 143. INSPECTION STATION ESTABLISHED AT MOUTH OF MISSIS- SIPPI RIVER. In accordance with the resolution of the Board of Health empowering the President to appoint a Quarantine and Sanitary Inspector for the Mouths and Passes of the Missis- sippi River, with headquarters at Port Eads, the following circular letter embraces the more essential instructions issued annually to the medical officers who have occupied this responsible and important post during the past four years, 1880, 1881, 1882 and 1883; OFFICE BOARD OF HEALTH, STATE OF LOUISIANA, ? New Okleans, , 1880. $ Dr. , of New Orleans, is hereby appointed Quarantine and Sanitary Inspector for the mouth of the Mississippi River, with ample power of supervision over the shipping entering the mouth of the Missis- sippi River, and over the inhabitants, shipping and visitors and employes at the Jetties, Port Eads, Pilot Town and Southwest Pass. Dr. , Quarantine and Sanitary Inspector of the Board of Health of the State of Louisiana, will allow no communication between the shore, by unauthorized persons, with vessels subject to the quarantine regulations and laws of the State of Louisiana and the rules and regulations of the Board of Health. He will regulate the mode of towing infected vessels, and he will report promptly to the Board of Health, through its executive officers, all infractions ot the quarantine laws and of the rules and regulations of the Board of Health of the State of Louisiana. The Quarantine Inspector will also direct the sanitary affairs of the Jetties, Port Eads and Pilot Town, and report promptly the occurrence of contagions or infectious diseases to the President of the Board of Health. The Quarantine Inspector is also empowered to investigate all cases of disease, and especially all varie- ties of fever of a serious character, which may prevail along the banks of the Mississippi River, between the mouths and the city of New Orleans. In the discharge of the above important duties, the Quarantine Inspector of the Board of Health of the State of Louisiana will be obeyed and respected accordingly. JOSEPH JONES, M. D., President of the Board of Health State of Louisiana. This inspection service was maintained, during the existence of the Quarantine pro- clamation of the Governor of the State of Louisiana, annually in 1880,1881, 1882 and 1883. The entire cost of this inspection, as maintained by the Board of Health, during this period of four years, was less than three thousand dollars ; nevertheless, the results ob- tained were of the most important character, in furnishing prompt information to the President of the Board of Health, of the appearance of infected vessels at the mouth of the Mississippi river, and also in preventing improper and illegal intercourse between vessels from infected ports, with steamers, tug-boats, and with the inhabitants of the surrounding shores. . The stringent measures of 1883, which excluded all vessels from ports infected with yellow fever from the waters of Louisiana, could not have been properly executed by the President of the Board of Health, in accordance with the proclamation of the Gov- ernor of Louisiana, without an active and faithful officer at the mouth of the Mississippi river. The resistance of the Quarantine authorities, by the British Steamship Vanguard, on the twenty-third of May, 1880, was promptly met; the Civil Sheriff, of the parish of Orleans, in accordance with the order of the President of the Board of Hea 1th, forcibly seized the Steamship Vanguard, and returned her to the Quarantine Station*. *For details of the case of the British Steamship Vanguard, see Annual Report of the Board of Health of the State of Louisiana, for 1880, pp. 25-28- XXX Quarantine Operations, Mississippi Quarantine. The Swedish bark Excelsior, Captain J. T. Bjorkgren, left Rio Janeiro on the tenth of May, 1880, and arrived at the Mississippi Quarantine Station June 24, having been on the voyage about fifty-six days. Her crew consisted of three officers and nine seamen. No case of sickness occurred either at Rio or on the voyage to the Mississippi Quaran- tine Station. After detention at the Mississippi Quarantine Station for twelve days, during which period no sickness occurred, the bark was released, and reached New Or- leans on the fifth of July. One of the crew was seized with fever on the seventh, and on the tenth of July was transferred from the vessel to the Touro Infirmary, and the case reported to the President of the Board of Health. Upon examination I found the man suffering with yellow-fever. The vessel was boarded, the crew mustered upon deck and carefully examined. I was convinced that at least two of the seamen presented febrile symptoms, and concluded that they would develop into yellow-fever. The officer in charge was ordered to keep his men on board, and to proceed with all possible dispatch to the Mississippi Quarantine Station. Captain Thomas McLellan, of the New Orleans Towboat Line, was ordered to return the bark to the Mississippi Quar- antine Station. The officer in command of the Excelsior refused to leave the wharf, on the ground that the vessel was not properly ballasted, and would capsize if towed into the stream. I then issued an order to the Civil Sheriff of the Parish of Orleans, commanding him, in the name of the State of Louisiana, and the Board of Health, to remove the bark Excel- sior forthwith to the Mississippi Quarantine Station. From the following extracts from the financial report of the Secretary and Treasurer of the Board of Health, you will observe that the execution of this order was attended with a considerable expense to the Board of Health. Paid expenses attending removal of infected bark Excelsior from city to Quarantine Station: Civil Sheriff's fees $ 63 50 Tug Wilmot, towage bill 150 00 Eager, Ellerman & Co., for ballast 15 00 Dr. Mioton, special services 25 00 Total expenses attending removing of bark Excelsior paid by Board of Health. .$253 50 If to this be added the expenses of the Texas Health Officer and of the Texas Com- mittee and Members of the Board of Health, who visited the Mississippi Quarantine Station for the purpose of investigation, $139, we have a total expense of $392 50. Telegrams and also written instructions were dispatched by the President, to the resi- dent and assist resident physicians at the Mississippi Quarantine Station, giving the facts relating to a case of fever and the return of the vessel to quarantine; and strin- gent orders were issued to keep the vessel and crew in close quarantine, separated from all other vessels, allowing no communication with the shore on either side, or with the city of New Orleans, or with the settlements at the jetties and Pilot Town. The Board of Health retained the Excelsior at the Quarantine Station for over one month after the removal of the last case from the vessel on the fourteenth day of July. The man removed on the twelfth to Quarantine Hospital, and who recovered, was re- leased on the twenty-fifth from the hospital as entirely convalescent. The President of the Board of Helth advocated the release of the vessel one month after the removal of the last case to the hospital, on condition that she be retained at some point below the city, on the opposite side of the river, there receiving her cargo. It was held that it was not advisable for the vessel to come into the harbor among the shipping. The opinion of the resident quarantine physician was also to the same effect, as will be seen from the following letter: MISSISSIPPI QUARANTINE. August 4. I860. Dr. Joseph Jones. President of Board of Health, New Orleans, La.: Sir-Knowing of considerable discussion arising as to the detention of the Swedish bark Excelsior at thi8 station, I beg leave to state: That it having been abundantly proved that the vessel and cargo were thoroughly fumigated at this station, and the yellow fever contracted by members of th? crew was contracted while the crew were en- gaged in the then unfumigated portion of the cargo, which they were shifting preparatory to fumigation; and, that the first, case of yellow fever occurring on said bark in New Orleans, appeared on the eighth day of July, without further spread of the disease. That the second, third and fourth cases appeared at this station respectively, the eleventh, thirteenth and fourteenth of the same month. That the two last died respectively on the seventeenth and eighteenth of t ame month; all their eff >cts brought on shore, consisting of a shirt, pair of pants, shoes, socks and a quilt, were buried with them. That the first case occurring here has recovered and is now on board the bark, 1 eing returned there th rty-flrst of July, having first thoroughly washed himself, a clean suit of clothes ^iven him. and those with which he came on shore having been thoroughly boiled and washed. That the i essel has again been su dected to a thorough disinfection with sulphurous acid gas, copperas and carbolic r cid. That no further cases of ill less or disease at any time having occurred on board since the vessel has been at this station, I suggest tha. after another fumigation, and should no further cases of illness occur on lieport of J. F. Finney, M. D., Mississippi Quarantine Station. XXXI board within thirty days after the last, that the vessel be allowed to proceed to New Orleans, and, to satisfy public uneasiness, be made to anchor in mid stream; receive her supplies and cargo there, and be allowed to proceed to sea In my opinion, the best manner of proceeding in reference to the repsMrs necessary at this station, would be to request one of the State Board of Engineers to proceed to this station, make a thorough examination and report plans and specifications upon the same; upon which report the Board of Health could advertise for sealed proposals for the work. * Respectfully, your obedient servant, JAS. F. FINNEY, Resident Physician. [Telegram. | NEW ORLEANS. August 16, 1880.-Dr. Finney, Mississippi Quarantine: Board directs release of Excel- sior thirty days from transferring last case of fever to hospital, July 14. Fumigate ship, clothing, etc. Sprinkle ballast with fifty gallons copperas and carbolic acid solution. JOSEPH JONES, M. D. President Board of Health, State of Louisiana. The Bark Excelsior was released from quarantine on the eighteenth of August, and was allowed to come up to Wood's Powder Wharf, on the opposite side of the Mississippi River, below Algiers, across from the United States Barracks. The President of the Board of Health placed the vessel in the charge of Dr. Mioton, Sanitary Inspectar of Fifth District. A policeman was detailed to remain on board to prevent communication with shore or city. The vessel was sealed by acclimated carpen- ters, and loaded with grain, the floating grain elevator being towed down. Every effort was made to protect the State of Louisiana and Valley of Mississippi from the introduction of yellow lever from this vessel; and the effort of the Board of Health was crowned with success, as no case of yellow fever was propagated from the bark Excelsior. The malarious nature and non-contagious character of the cases of paroxysmal fever which occurred in and around, above and below Point Michel, in the Parish of Plaque- mines, during the summer and autumn of 1880, was fully and unequivocally established by the investigations of the officers of the Board of Health, the local practitioners, and by the committee appointed by the National Board of Health. The results of these inquiries were published in the Annual Report of 1880. The preceding official records illustrate the prompt action of the Board of Health of the StaAe of Louisiana, in the cases of the Vanguard and Excelsior, and the efforts to cleanse and disinfect vessels from Rio de Janeiro, and other infected ports, regardless of the time necessary to accomplish these .esults. The nature of the quarantine operations conducted by the Board of Health of the State of Louisiana during the year 1880, will be most fully shown, by the following extracts from the official reports of the quarantine officers : REPORT OF J. F. FINNEY, M. D., RESIDENT PHYSICIAN MISSISSIPPI QUARANTINE STATION. Quarantine Station, Mississippi River, La., i January 1, 1881. \ Dr. Joseph Jones, President Louisiana State Board of Health : Dear Sir-I have the honor to transmit to you thia, the annual report of the affairs of this station for the year ending December 31, 1880, and it is with a feeling of no little pleasure; that I can say no vessels have been permitted to pass this station with sickness on board during the past seven months, notwithstanding the fact that there were 208 more vessels this year than last. It is true, sickness occurred on board the bark Excelsior after her arrival in the city, but, as you are well aware, that was due to no lack of vigi- lance on the part of myself or my assistant, as that vessel underwent a very rigid quar- antine at this station for a period of twelve days, during which time no disease mani- fested itself. I append to this report a classified list of vessels passing this station during the past year, the total number is 1271, and the aggregate tonnage of this fleet will reach nearly two millions, which is I believe the largest ever arrived at this port. ♦Annual report of the Board of Health of the State of Louisiana to the General Assembly for the vear 1880. p. 34-192. Bark Excelsior, p. 34-43, p. 65-85, p. 88-108, p. 109 126. Malarial Fever of Plaquemines Parish, Louisiana, during the months of August, September and October, 1880, p. 127-132. Report of Dt- B. F. Taylor, p. 133. Report of Dr. George A. B. Hays, of Point Michel. Louisiana, p. 127 130. Testi- mony of Dr. A. C. Love, of Donaldsonville, Louisiana, p. 130. The Rice Fever. Reports of Drs. Brown and Davidson on the fever which prevailed in Plaquemines Parish, p. 135-140. The Fever on the Lower Mississippi, p. 144-190. XXXII Report of D. W. Adams, M. D., Rigolets Quarantine Station. There were detained at this station during the past year, for purification, disinfection and fumigation 151 vessels, among which were but four having any sickness on board ; the patients were all transferred to the hospital for treatment, with the following results: First. The steamer Chilian, one case intermittent fevej^ Discharged. Second. The bark Excelsior, after return from the city, three cases yellow fever. Two died, one recovered. Third. The steamer Tan talon, one case bilious remittent. Discharged. Fourth. The steamer Wanderer, one case rubeola. Dissharged. Of the 151 vessels detained at quarantine, there were in January, 1 ; April, 2 ; May, 23 ; June, 21 ; July. 29 ; August, 17 ; September, 27; October, 29 ; November, 2. NUMBER AND CLASS OF VESSELS PASSING THIS STTION DURING EACH MONTH OF 1880 Steamships Ships. Barks. Brigs. Schooners. Total. January 47 9 47 4 11 118 February 60 16 44 5 18 143 March 43 12 31 6 20 112 A pril 45 7 27 3 21 103 May 48 3 23 6 20 100 June 40 2 23 1 10 76 July 45 3 2g 2 7 79 August 44 4 9 0 3 60 September 64 12 6 0 7 89 October 65 14 28 1 7 115 November 55 24 40 5 10 134 December 58 15 56 6 7 142 Total .. 614 121 356 39 141 1271 With the hope that we may have a healthy and prosperous year before us, I remain, Very respectfully your obedient servant, J. F. FINNEY M. D., Resident Physician. < * REPORT OF DANIEL W. ADAMS, M. D., QUARANTINE PHYSL CAIN RIGOLETS STATION. To the Honorable the President and Members of the Board of Heath, State of Louisiana: Gentlemen-A year of good health, yet prodigal of incident, has intervened since I had the honor to present my annual official report to your honorable body. Its events have vindicated your policy and seem steadily pointing the way to the security which quarantine requires in order to make it acceptable to trade and commerce. During the past season 1170 vessels in all have been inspected by me at the Rigolets Station. Of these 26 were steamers and 1144 were schooners. Of the 1144 thirty-six (36) had been acting as lighters to foreign vessels. Of the 26 steamerr two (2) had been acting as lighters to foreign vessels. The Mexican steamer Victoria, from Frontera Tobasco, Mexico, arrived Julv 6, 1880. She had reported at the Jackson County, Quarantine Station, Pascagoula, and had remained there seven days, was there im- perfectly disinfected.' I round on removing the limber boards-which I learned had not been removed for years-the bilge water offensive, and much filth from decayed lumber. President Jones was present at the inspection. DATES OF ARRIVALS FROM INFECTED PORTS. American schooner Henriette Esch, arrived May 30, 1880 from Vera Cruz via Tuspan. Mexican schooner Norma, arrived from Tobasco, June 9, 1880. American schooner Mary A. Rushing, from Tuspan. July 31, 1880. American schooner Henrietta Esch, from Tuspan, Mexico, August 4, 1880. American schooner Annette, from Havana, Cuba, August 9, 1880. These schooners were detaieed 72 hours, and thoroughly cleansed, On the latter of these trips of the Henrietta Esch, a sick person was landed and placed in the hospital-a case of intermittent fever yielding readily to treatment. The employment of a watchman has had a beneficial effect on quarantine discipline and in some degree supplied the wants of a collector of permits at each one of the basins. For the ensuing season a new Whitehall yawl, clincher built, will be required, 16 feet long, 5 feet beam, copper fastened and riveted. The property on hand is carefully packed and left in charge of the ordinance sergeant at Fort Pike. I have the honor to be gentlemen. Very respectfully yours, etc., DANIEL W. ADAMS, M. D., Resident Physician. Rigolets Quarantine. Report of N. L. Sigur, M. D., Atchafalaya Quarantine Station. XXXIII ATCHAFALAYA QUARANTINE STATION. By the seventh section of the act of 1855, " To establish quarantine for the protection of the State," it is ordained that there shall be a quarantine "on the Atchafalaya River, two miles below Pilot's Station, at 1 he mouth of Wax Bayou." It is also enacted that " There shall be no permanent building erected at Pilot's Station, on the Atchafalaya River, but the Board of Health shall use as an hospital for the reception of the sick, hulls and cabins of steamboats." In the twenty-fifth section of the same act it is further stated that. "At the Atchafalaya Station, a good shed shall be provided for the freights of vessels to be unloaded. The Board of Health shall receive the transfer of such lands as may be necessary at the Atchafalaya River, in the same manner and under the same conditions as are required by section one, and all plans, specifications and contracts for the above buildings, shall be submitted to and approved by the Governor of the State ; provided that the cost of said buildings shall in no case exceed the amount hereinafter appro- priated." In accordance with the acts of the General Assembly and the proclamation of the Gov- ernor of Louisiana, a quarantine strictly governed by the rules and regulations of the Board of Health, was maintained on the Atchafalaya River until the first of November. During the entire period of the maintenance of the quarantine no infected vessel arrived at the station, and Morgan City remained free of contagious and infectious diseases. REPORT OF N. L. SIGUR, M. D., RESIDENT PHYSICIAN, ATCHAFALAYA QUARANTINE STATION. MORGAN CITY; January 25, 1881. Boarti of Health, State of Louisiana : Gentlemen-I respectfully submit the following report of the quarantine operations at the Atchafalaya Station during the year 1880 : On May 29, 1880, I inspected the steamship Gussie, of the Morgan Line, Captain Richard Hill, 998 tons, which left Havana, Cuba, in ballast, on the twenty-sixth of the same month. On August 8th, the steamship Wm. G Hewes, also of the Morgan Line, Captain Richard Hill, 1117 tons, which left Havana, Cuba, in ballast, on the fourth of the same month. On August 31st, the schooner Adolphe Flake, Captain Edwin L. Snow, 48 tons, which left Tampico, Mexico, with a cargo of honey and dye wood. On October 6th, the steamship Gussie, above mentioned, which left Havana, Cuba, on the second of the same month. All of which I have inspected, fumigated, disinfected and detained the time prescribed by the law. It affords me the greatest pleasure to state that I found them all in excellent sanitary condition aiid their crews in excellent health. I am, very respectfully your obedient servant, F. L. SIGUR, M. D„ Quarantine Officer at the Atchafalaya Station for 1880. QUARANTINE. WORK ACCOMPLISHED DURING 1880 BY LOUISIANA BOARD OF HEALTH. During the year 1880, 1271 vessels were inspected, detained, cleansed and fumigated, in all cases deemed necessary for the public welfare. The aggregate tonnage of this fleet reached over 2,000,000 tons, and wras believed to be the largest received through the Mississippi Quarantine Station since the American Civil War. The activity of the commerce of New Orleans, during 1880, is also shown by the fact that 1,170 vessels were inspected at the Rigolets Quaratine Station. The total exports and imports for the year 1880 amounted to $102,528,336, which is greater than any year during the past ten years, as will be shown by the following stat- istics of the United States Custom House. Through the courtesy of the Collector of the Port of New Orleans, we have been per- mitted to extract the following general results from the records of the United States Custom House: TOTAL VALUE OF COMMODITIES EXPORTED AND IMPORTED AT NEW OR- LEANS FOR THE FOLLOWING PERIODS. Years. Exports. Imports. Years. Exports. Imports.' 1870 $101,385,257 93,532,797 95,950,942 100,930,307 87,974,797 76,695,700 $17,705,655 18,333,530 30,000,377 18,825,527 13,472,483 11,637,168 1876.... $ 81,387,836 70,270,593 74,366,388 81,105,822 102,528,366 $ 9,634,253 11,340,752 8,725,751 8.259,606 11,800,977 1871 1877 1872 1878 1873 .. 1879.... 1874 1880 1875 XXXIV Outline of Quarantine Operations, 1881. The year 1880 was distinguished by the absence of contagious aud infectious diseases, and more especially of yellow-fever, not only in New Orleans aud Louisiana, but throughout the Valley of the Mississippi. The total deaths from all causes in the city of New' Orleans during the year 1880 num- bered 5,623, and the death rate per 1,000 iuhabitants was 25.98. Death rate per 1,000 whites, 22,87 ; per 1,000 colored, 34.84. The death rate of New Orleans during 1880 will compare favorably with that of any American or European city of similar population, and was much less than that of the city of Memphis. The statistics recorded in the annual report of the Board of Health of the State of Louisiana for the year 1880, show that there has been an evident decline in the death rate of New Orleans during the past tw'euty years-1860-1880. These statistics also show that the establishment of quarantine at the mouth of the. Mississippi River, and at the Rigolets anti on the Atchafalaya, has tended to diminish the frequency of yellow'-fever epidemics. Thus, from the establishment of the quarantine at the mouth of the Missis- sippi River in 1855 to the end of 1880 (twenty-five years), there have been but three epi- demics of yellow-fever of any magnitude, namely: in 1858, 1867 and 1878; while in the preceding thirty-nine years (1817-1855) no less than nineteen severe visitations of yellow- fever have been recorded. During the year 1880, the Board of Health of the State of Louisiana not only met all its liabilities from its legitimate revenues established by the acts of the Legislature, but expended several thousand dollars on the repair and equipment of the Mississippi Quar- antine Station. The Mississippi Quarantine Station, with its capacious government fire-proof ware- house, has justly been regarded as the equal, if not superior, of any similar establish- ment south of New York. Notwithstanding the false alarms concerning yellow-fever ; notwithstanding the pre- judice of surrounding States against local Boards; notwithstanding the hostile forces arrayed against the Board of Health, within and without this city, it is an established fact, that with the exception of the years 1827 and 1879, the year 1880 was the healthiest in the past ninety-four years; and that the foreign commerce of New' Orleans was larger in 1880 than in any previous year since the close of the civil war. OUTLINE OF THE QUARANTINE OPERATIONS OF THE BOARD OF HEALTH OF THE STATE OF LOUISIANA FOR 1881. MISSISSIPPI QUARANTINE STATION. The dilapidated condition of the hospitals, wharf and boat honse, and the neglected and undrained and unprotected condition of the grounds of the Mississippi Quarantine Station, were subjects of constant consideration and anxiety, and the earliest opportunity was embraced to urge this sub- ject upon the attention of His Excellency, Governor Louis A. Wiltz, and of the Board of Health. The chief measures advocated are stated in the following correspondence: . New Orleans, October 23, 1880. Hon. Louis A. Wiltz, Governor of the State of Louisiana : Dear Sir-I have the honor to request your Excellency to examine the accompanying letter, embracing the request of the Board of Health of the State of Louisiana that the State Board of Engineers should ex- amine the quarantine stations and the drainage canals of New Orleans, and report the necessary improve- ments and estimates of expenses. Such information will prove of value to the Board of Health, and the indorsement of your Excellency is most respectfully requested by Your obedient servant, JOSEPH JONES, President Board of Health, State of Louisiana. Office Board of Health, State of Louisiana, 1 New Orleans, October 22, 1880. 5 Col. Henry B. Richardson, Chief Engineer, State of Louisiana: Dear Sir-At the regular meeting of the Board of Health, on the twenty-first instant, the President di- rected the attention of the Board to two subjects which he regarded as of the utmost interest to the sani- tary advancement and welfare of the State of Louisiana and the city of New Orleans. 1. The quarantine stations needed repair and improvements. The eyes of the people of the entire valley were upon the Board of Health of the State of Louisiana, and more especially upon the condition and con- duct of the Mississippi Quarantine Station. Unless the Board of Health take immediate and decided ac- tion looking to the thorough equipment of the quarantine stations, the distrust and abuse on the part of the surrounding States may be even greater than during the present summer and autumn. The most compe- Outline of Quarantine Operations, 1881. XXXV tent authority to give advice to the State Board of Health on this subject is the State Board of Engineers, and the President urges immediate and decided action on the part of the Board of Health, requesting their aid and advice upon this important subject of the repairs and improvements of the quarantine stations. 2. The drainage canals of the city of New Orleans are choked up with filth, and need dredging and cleans- ing. This question is of paramonnt importance to the sanitary welfare of New Orleans, and, in the opinion of the President, the Board of Health should, at the earliest practicoble moment, investigate the entire subject, and urge the City Council to immediate and energetic action. In accordance with the suggestions of the President of the Board, the following resolutions were unani- mously adopted: "Resolved, That the State Board of Engineers be requested, at their earliest convenience, to examine and report upon the condition of the several quarantine stations, and especially upon the condition of the Mis- sissippi Quarantine Station. "Resolved, That the State Board of Engineers be also requested to report in detail the necessary repairs and improvements, with accurate estimates of the cost of the same. "Resolved, That the President of the Board of Health be authorized to request the State Engineers and the City Surveyor to inspect the drainage canals of New Or leans, and to report on their condition and pre- pare estimates of the costs of dredging and cleaning canals." As President of the Board of Health, I would most earnestly urge upon the State Board of Engineers the execution of this investigation, which will render material aid to the Board of Health in the perfection and execution of the quarantine and health ordinances of the State and city. Respectfully, your obedient servant, JOSEPH JONES, M. D., President Board of Health, State of Louisiana. After a careful examination of the quarantins stations by the State Engineers and the President, and after advertising for scaled bids, the contract of repairing the hospitals and physicians' quarters and the building of a suitable boat-house aud substantial wharf, was awarded to Messrs. Hanley, Kevlin & Garrett, of Algiers. The following work was completed and accepted on or about the 1st of May. 1881: A substantial wharf, '260 long by 10 feet wide, with pier-heads, 60 by 30 feet, with depth* of water on river front of 25 feet, cost $1400. This wharf is one of the finest in the State, and is considered equal, if not supeiior to the wharf erected by the United States Government, two years before, at a cost of $5000. Connected with the quarantine wharf a commodious boat-house has been erected 50 by 40 feet, elevated about 45 feet above the water, surmounted by an octagonal tower 14 feet in height, and ten feet in diameter. The sides of this tower are of plate-glass, and a beacon light is kept burning from sundown to sunrise, for the guidance of vessels, and can be seen far below Forts St. Philip and Jackson. A watchman is kept on duty all night, and in foggy and stormy weather the»quarantine bell is tolled. The tower serves the purpose of a valuable light-house to all vessels coming up the Mississippi at night, and is believed to be the only light-house between the passes and New Orleans. The President of the Board of Health also purchased for this station, a strong "first- class" boarding yawl, about 27 by 6 feet, made of white cedar, with black waluut seats and facings, all the fastenings and appointments being of brass and copper. A strong boarding boat of this nature, or better still, a steam launch, is considered as absolutely necessary to the efficiency of the Quarantine service, which in the Mississippi River, is of the most dangerous character, requiring active and experienced officers and boatmen. The boarding of vessels in this turbid and rapidly rolling river, is especially danger- ous in dark and stormy nights. The fever and small-pox hospitals have been thoroughly repaired, supplied with cisterns and painted within and without, and a barb-wire fence of substantial character, 3110 feet in length, has been erected on the side and back levees. The physician's residence has been thoroughly repaired and painted, and sur- rounded by a substantial fence, 350 feet square. In accordance with the formal resolutions of the Board'of Health, the President paid Messrs Jerome Hanly, A. G. Garrett and H. Kevlin, the sum of $5695, immediately upon the completion and Acceptance of the works and repairs as above described ; and the entire amount of money paid (in hard cash), by the Board of Health for the repairs at the Mississippi Quarantine Station, and for supplies, disinfectants and salaries of officers, boatmen, watchman and hospital keeper, during 1881, was $18,104 08. The expenses of the Atchafala^a Quarantine Station were $690 and of the Rigolets Quarantine Station, $1536 93. On the other hand the total receipts from all the quarantine stations, by in- spection and fumigation fees, was only $18,555. INSPECTION OF INFECTED SHIPS-YELLOW FEVER IN RIO DE JANEIRO DURING 1880 AND 1881, AND THE MEAS- URES INSTITUTED FOR THE DISINFECTION OF THE VESSELS ARRIVING AT THE MISSISSIPPI QUARANTINE STATION FROM THIS PORT. The extent and value of the coffee trade and the intimate relations of New Orleans with Rio de Janeiro, and the important fact that more than one destructive epidemic in past times had been referred to the coffee ships XXXVI Deaths in Itio Janeiro during First Six Months of 1881. of the latter port, necessitated the continuance of the system of inspection, disinfection and shifting of cargoes, instituted by the President, immediately after the re-orginizatiou of the Board of Health, on the eighth of April, 1880. The following facts with reference to the prevalence of yellow fever and other diseases in Rio de Janeiro were communicated monthly to the Board of Health by the Consul Gen- eral, Thomas Adamson. In Rio de Janeiro there occurred in the mouth of November, 1879, total deaths from all causes, 850-yellow fever 9, small-pox 11, enteric or typhoid fever 20, pernicious fever 22; month of December, 1879, total deaths, 915 yellow' fever 18, small-pox 9, enteric or typhoid fever 13, pernicious fever 43, consumption 153; month of January, 1880, total deaths, 1062-yellow fever 133, small-pox 2, enteric or typhoid fever 14, scarlet fever 5, pernicious fever 54, cousumption 166; month of February, 1880, total deaths, 1352-yel- low fever 484, small-pox 1, typhus fever 1, typhoid or enteric fever 19, scarlet fever 1, per- nicious fever 76, consumption 140. Present estimated population of Rio de Janeiro, 330,000. March, total deaths, 1389-yellow fever 468, typhus fever 3, enteric or typhoid fever 17, pernicious fever 70, consumption 153; month of April, 1880, total deaths, 1008-yellow fever 2, enteric or typhoid fever 12, pernicious fever 40, consumption 150 ; month of May, 1880, total deaths, 914-yellow fever 105, typhoid fever 14, pernicious fever 28, consump- tion 148; month of June, 1880, total deaths, 812-yellow fever 55, typhus fever 1, typhoid fever 8, pernicious fever 24, consumption 143; month of August, 1880, total deaths, 743- yellow fever 9, September, 1880, total deaths 758-yellowr fever 4, small-pox 1, typhoid fever 3, pernicious fever 24, pulmonary consumption 168; month of December, 1880, total deaths, 812-yellow fever 14, small-pox 8, typhoid fever 14, small-pox 8, typhoid fever 12, scarlet fever 1, pernicious fever 26, consumption 141. DEATHS OCCURRING IN RIO JANEIRO, DURING THE FIRST SIX MONTHS OF 1881, FROM ALL CAUSES, AND FROM THE DISEASES SPECIFIED, CON- SOLIDATED FROM THE REPORTS OF THOMAS ADAMSON, CONSUL GENERAL, UNITED STATES. Diseases. January. February. March. April. May. June. Yellow Fever 31 54 42 23 24 13 Consumption.. 153 131 125 137 140 137 Pernicious Fever 30 39 40 24 28 16 Small-pox. 15 4 2 5 1 2 Typhoid Fever... 11 13 20 14 8 8 Typhus Fever 1 1 3 Scarlet Fever 2 Diphtheria Cholera Other causes 629 672 739 613 653 620 Totals 869 916 968 817 857 796 July, 1881, total deaths, 773-yellow fever 9, small-pox 2, typhoid fev^er 4, pernicious fever 15, consumption 134; August, 1881. total deaths, 769-yellow fever 5, small-pox 5, enteric or typhoid fever 5, pernicious fever 20, consumption 126; September. 1881, total deaths, 669-yellow fever 1, small-pox 9, typhoid fever 8, pernicious fever 14, consump- tion 116; October, 1881, total deaths, 803-yellow fever 2, small-pox 18, typhoid fever 17, pernicious fever 17, consumption 146. Estimated population of Rio de Janeiro, 330,000. The prevalence of yellow fever in Rio de Janeiro received prompt and earnest atten- tion. The vessels arriving with coffee from this port were detained at the Quarantine Station for periods ranging from twelve to twenty days; the resident physician was ordered to shift the cargoes into the government warehouse by acclimated laborers (that is, by men who had suffered with yellow fever), natives of New Orleans. The crews were not allowed to handle the cargo or to descend into the hold. The men were carefully examined by the President of the Board of Health, an oath administered as to the date and nature of the preceding attack of yellow fever, and a record of the essential facts made before they were permitted to leave New Orleans for the Mississippi Quarantine Station. The ships from Rio and other infected ports were thoroughly cleaned and fumigated, ventilated and disinfected; the coffee in the warehouse was also subjected to heavy fumigation with sulphurous acid gas. When the coffee arrived in New Orleans it was again disinfected and fumigated in the warehouses where it was stored. Quarantine Operations, 1881, Mississippi Station. XXXVII MISSISSIPPI QUARANTINE STATION. Quarantine Station, Mississippi River, La., I December 1, 1881, f Dr. Joseph Joges, President of the Board of Health of the State of Louisiana: Dear Sir-I would respectfully submit the following report of vessels arriving at and passing this station during the eleven months ending November 30, 1881; also, number of quarantined, number of sick admitted to hospital, and list of vessels required to dis- charge their cargoes for the purpose of thorough disinfection. Your obedient servant, J. F. FINNEY, M. D., Resident Physician. VESSELS PASSING MISSISSIPPI QUARANTINE STATION FOR ELEVEN MONTHS ENDING NOVEMBER 30, 1881. Steam- ships. Ships. Barks. Brigs. Schoon- ers. Total. January 55 4 35 7 11 112 February 36 15 20 7 14 92 March 48 10 44 3 9 114 April 53 12 35 3 16 119 May 61 8 20 2 16 107 Quarantine of 72 hours. June 36 4 14 1 10 68 July 37 2 12 2 13 63 Quarantine of 240 hours. August 29 5 7 _ - - . - 4 45 September 36 o 7 3 9 60 October 60 7 1 11 87 Oct. 15th-Quarantine of 72 hours November 47 14 18 2 9 90 Quarantine raised. Total... 498 87 219 31 122 957 . VESSELS QUARANTINED. MONTHS. Bremen Rio. Havana Vera Cruz. Colon. Other Ports. Total. January 1 ... 1 Other ports February . . - . .... ... - .... include La- March -.. .... 2 .... 2 guayra,Pro- April .... 3 .... .... .... 3 gresso, Co- May .... 3 14 6 1 i 25 atzacoalcos, June .... 1 10 8 2 2 23 Martinique, July .... 2 2 6 .... 2 12 Pointe a Pi- August .... 2 5 5 1 2 15 tre, Sagua, September 2 3 3 .... 4 12 la Grande, October 4 12 8 1 25 Matan z a s, November and Santia- --- - -- - - - ■ - go de Cuba. Total 1 19 46 36 4 12 117 Date. Diseases. No. Vessel. From. Result. January 11.. Small pox 1 Steamship Nurnberg Bremen Discharg'd May 27 Bilions fever.... 1 Steamship Whitney Vera Cruz .. Discharg'd July 12 Wound of foot .... 1 Steamship Bolivar .... Vera Cruz Discharg'd August 23 Chagres fever 1 Steamship Historian .. Colon and West Indies Discharg'd August 26 Colitis 1 Steamship Historian .. Colon and West Indies Disch ar" 'd August 26 Malarial fever 1 Steamship Historian . Colon and West Tn dies Discharg'd August 27 Continued fever 1 Bark St. Olaf Rio de Janeiro Discharg'd ADMITTED TO HOSPITAL. XXXVIII Quarantine Operations, 1881, Higolets Station. The Steamship Nurnberg had on board 85 crew and 173 passengers from Bremen. Ar- rived on January 11, 1881, with one case of small pox on board. The crew and passen- gers had been vaccinated by Dr. Noer, the accomplished surgeon of the ship, on January 5th. Not one case presented the least sign of successful vaccination. Everybody on board was re-vaccinated at this station, and the case removed to the hospital. Of the 257 vaccinated, 254 were secondary vaccinations; 3 were primary vaccinations ; 98 sec- ondary vaccinations were successful; 3 primary vaccinations were successful. LIST OF VESSELS LOADED FROM RIO DE JANEIRO AND VERA CRUZ, ARRIVING AT THE MISSISSIPPI QUARANTINE STATION, AND REQUIRED TO DISCHARGE CARGO FOR PURPOSES OF BETTER PURIFICATION AND DISINFECTION OF VESSEL AND CARGO- Date of Arrival at Mississippi River Quaran- tine. 1881 Vessel. From Date of Depart-jNumberofBags Sick on Board and | Sent to Hos- pital in Rio. Released from Quarantine. ure from Port of Cotfee. March 14... Bark Maria Rio December 12... 5,000 2 March 27 14. Bark Stephanie Rio 17... 5,040 2 27 April 8... Bark Eastern Chief Rio January 27... 7,064 5 April 19 •• 9... Bark Nancy Holt Rio. February 21... 6.000 1 23 •• 9... Brig Finn rid Kio •• 6... 5 500 5 •• 23 May 1... Bark Just, H. Ingersoll.. Rio .... March 13... 11 160 May 13 3... Steamship Nasmvth Rio April 12... 28,054 15 10... Bark Venice Rio March 21... 10 500 1 24 June 6... Brig Anita Owen Rio * •• 31... 1,006 June 19 July 10... Bark Klien Holt... Rio M ay 23.. 5 671 J ul V 26 '■ 30... Ship Virginia Rio June 12.. 4 600 August 13 August 17... Bark Glitner... Rio July 4... 5,000 •° 31 •" 22... Bark St. Olaf. Rio • • 4... 4 610 September 5 September 19... Schooner Seguin........ Vera Cruz September 7... 2,328 30 27... Brig John Wesley Rio 6 961 October 17 •• 30... Bark Berville.../. Rio 13... 5'000 10 Quarantine Station, Mississippi River, I January 5, 1882, t Dr. Joseph Jones, President of the Louisiana State Board of Health : Dear Sir-I herein forward you a classified list of vessels passing this station during the month of December, which completes the year 1881: NUMBER OF VESSELS PASSING MISSISSIPPI RIVER QUARANTINE STATION. Months. Steamships. Ships. Barks. Brigs. Schooners. Total. November. .. 47 14 18 2 9 90 December.. . 43 5 23 2 10 85 Total.. . 90 19 43 1 4 19 175 You will see by the total arrivals (1042) that we have had 229 vessels less than the year previous, which is a great decrease, and has diminished our receipts nearly $■4000. The falling off is due to the partial failure of crops, the low rate of freights, and the inauguration of "ten days' quarantine" during the pastyear; however, I think we should thank a kind Providence, and congratulate ourselves on the fact that we have passed another year without any infectious or contagioas disease passing the station Very respectfully, your obedient servant, J. F. FINNEY, M. D., Resident Physician. REPORT OF W. H. CARSON, M. D„ RESIDENT QUARANTINE PHYSICIAN. RIGOLETS STATION, FORT PIKE, LOUISIANA To the Honorable, the President and Members of the Board of Health, State of Louisiana: Gentlemen-I have the honor to present the following for your consideration, as a report of my labors at the Bigolets Quarantine Station, Fort Pike, Louisiana, during the past quarantine season of 188L The quarantine station was opened and placed in working order commencing May 6, 1881. and ending October 31. 1881. The total number of vessels noted and reported as passing the station, undergoing boarding and inspec- tion and receiving permits to proceed, amounts to one thousand three hundred and fourteen (1314), of which number seventy-nine (79) were steam vessels and one thousand two hundred and thirty-five (1235) were Schooners, sloops and luggers. XXXIX The crews of these vessels numbered, in the total, four thousand seven hundred and forty (4740), and the passengers numbered two thousand live hundred and ninety (2590. I am pleased to state that, during the entire season, no vessel visited this station with any evidence of infection of any nature or with the slightest suspicion of such condition. 1 would state in this connection that but four vessels, large schooners, generally termed "outsiders," the Emma White, Henrietta Esch, Geo. W. Dill and the Stella, presented themselves at this station during the season from ports of departure where any possible suspicion of infection was warrantable or justifia- ble, the first named coming from Cedar Keys, Florida, the remaining three from Tuxpan, Mexico. All re- ceived the usual and customary sanitary attention of cleansing, disinfection and fumigation. All ■were in ballast with iron and without any porous material calculated to convey infectious or contagious disease. On the thirty-first of August, 1881, I was informed by telegram from President Jones of the anticipated approach of an infected vessel, the schooner "Vernal," clearing from a Mexican port; ordering her deten- tion subject to orders, and ordering me to report the condition and all other matters of importance; the vessel, however, never appeared at the station, but it is reported was obliged to put in at Mobile Bay in distress. The above about completes all that can be said in regard to the practical quarantine operations at this station for the season just closed. In regard to the revenue, the collection of quarantine fees, the difficulty still exists, with no tendency towards improvement, but rather to grow worse. The kindly expressions from members of the Finance Committee, as well as other members of the Board, to the effect that any opinion of mine relative to the revenues and finances of the station would be ex- tremely acceptable, and that all consideration would be shown any suggestion presented, justifies as well as induces me to make the following statements relative to the collection of quarantine fees and its co- atteuding features. The schedule of quarantine fees has been changed more than ence during the past season, and on each occasion reduced in a spirit of liberality and kindly feelings to satisfy all parties concerned, and hoping to make the collection of quarantine fees by a small tax, as well as to lessen, I am informed, the delay and difficulty of collection by the boarding officer. The various reductions of the schedule of fees have still failed to give the satisfaction desired and achieve the result desired to be obtained, and again does indirectly an injustice to the resident physician, which, I am quite satisfied, never entered into their reckoning when framing the schedule; a condition of affairs and annoyance which the committee never intended, and would not have permitted had they any knowledge of the fact, or their attention been called to it. The point I refer to, and to which I would call the special attention of the Board, that as the last revised schedule of quarantine fees now stands adopted, August 22, 1881, wherein the schedule of fees for the second time revised, steamboats and schooners are rated and taxed at one dollar, a deduction from five to one in behalf of the steamboat, and a dollar and a half in behalf of the schooner, from that charged in the opening of the quarantine season. This, the last reduction, still failed to give the satisfaction desired, or to increase the revenues of the station, and created additional burdens, fatigue and danger that the gentlemen never anticipated, or for a moment intended, inasmuch as vessels that previously would not pay a copper in the day, and that formerly would lay over and anchor at night, now deemed it to their interest and advantage, when caught by nightfall, to pay this modicum of a dollar and rouse the r esident physician at all hours, and in any weather, to board, inspect and grant them permit and release. These vessels previously, when in quarantine after senset, when the resident physician was legally relieved from boarding, would come to an anchor and await for the morrow's sunrise and. then proceed defiantly on. and without impost or payment of the schedule tax, to their port of entry. It has been understood and customary' for the Resident Physician, in many seasons past, to board and inspect all vessels after sunset, so requesting, upon their payment of the schedule rate of quarantine tax fee-no extra charge being allowed or provided for. The law in regard to quarantine does not call or compel the Resident Physician to board or inspect after sunset, but in view of the small revenue attending the station it has been, as I have before remarked, the custom of the Resident Physician to board and inspect, facilitating commerce as well as collecting the tax fee not otherwise assured. This, in the main, was reasonable and without objection, and such boarding and collection of tax fees has been the practice, and still continues to be. And now that the situation has, I believe, been intelligently explained. I do not doubt but what some consideration and relief is requisite in the matter. When you take into consideration that the Resident Physician is aroused often three, four and five times a night, at any time and in all weather, to board and inspect vessels (that, as I before remarked, would not pay a copper in the day), his boatmen being relieved and assured of their time and rest, the inconsistency' is manifest. I have presented this unlooked for annoyance as full and complete as possible, satisfied that the gentlemen of the committee framing this schedule of tax fees and now in force, all of whom I am per- sonally acquainted with and entertain the highest respect for, will provide a suitable remedy. It is to be hoped that, in the near future, some improvement in the surety and mode of collection of this quarantine tax fee will be assured. If congressional action is necessary in the premises, it should be early and promptly applied for, soliciting their favorable action to relieve much of the embarrassment and indig- nity attending the present form of collection. A quarantine fee bill, without compulsory and without legal support, is superfluous, embarrassing to the official and in the main inoperative. To depend upon the bene- volence, charity' and sanitary interests on the part of owners of vessels of this class, in protecting the health of the community in general by the payment of a minimum quarantine tax, is deplorable, deceptive and untrustworthy. No quarantine'fee bill should be framed that cannot be collected and enforced under com- pulsion if necessary. Although my quarantine fee collections twice exceed any for many years past, but in a slight degree represent what might be collected. The station should unquestionably'be self-supporting, and yield under more favorable circumstances no mean surplus. I would especially call the attention of the Board to the unsuitable location, and the attendant require- ments necessary to carry out an effective and proper quarantine. The attention of the board has been called to the many wants and deficiences existing at this station, by most of my predecessors, and the same condi- tion still exists, only in a more intensified and aggravated form. That the location is unsuitable is undenia- ble ; though within an hour or so between the Quarantine Station and New Orleans, no assurance can be placed in the character of communication, the nearest telegraphic communication and only accessible by water, is four or five miles distant and can only be reached in the calmest weather, not considering the course or strength of tide or the disturbing features resulting from the detailing from the small force em- ployed to send a telegraphic message such a distance. The regular mail reaches the station once a week and is extremely' uncertain and unsatisfactory, one official communication often accompanying another though differing in dates many days, yet arriving at the station the same moment. The quarters of the boatmen are in a most deplorable condition, and it is safe to assume that, on the open- ing of the coming season, they will be positively uninhabitable. The wharf is in a most wretched and wrecked condition and in a short time will have wholly' disappeared. In view of the many deficiencies, the unsuitable location, the deplorable condition of the buildings and the poor and inadequate facilities for boarding, I would respectfully suggest to the Board some location in Quarantine Operations, 1881, Rigolets Station, XL Financial Operations of the Louisiana Board of Health, 1870-1881. the immediate locality of the Rigolets Bridge, where the better supervision of vessels could be obtained, more sure and quick mail facilities assured, and in every way the efficiency of the " Rigolets Quarantine Station " be improved. A new white-hall boat has been furnished the station the past season, allowing the old boat, some years in use, to be repaired and made serviceable, only however, in mild weather. The new boat has been round in every way serviceable and satisfactory. Thanks are due Mr. Thomas Cooney, Ordinance Sergeant, U, S. A., in charge of Fort Pike, Louisiana, for the safety and preservation of a quantity of quarantine stores deposited in the casements of the fort. On the sixth, seventh and eighth of February last a violent storm r aged, backing up the waters to such an extent and height as to flood cellars, gun-rooms and casements to the depth of two or three feet, relieving the quarantine yawl of all of her supports and washing her out to the parade ground. The other stores, much of which was perishable, were secured and placed in safety, but a barrel of copperas escaped and was totally dissolved in the waters, not a pound of the chemical remaining. This constitutes the greatest loss, and much credit is due Sergeant Cooney, in preventing further damage and loss, and his disinterested con- duct in this connection. A11 stores now on hand I have left in his charge, he of course assuming no direct responsibility. These stores and all other property have been carefully packed and appropriately stored, a complete and detailed list of which is herewith furnished. In conclusion I would bear testimony to the trustworthiness and efficiency of my subordinates at the sta- tion, each in their respective capacities of boatmen and watchman : Joseph, Frederick and Lewis, boatmen, and Loring D Allen, watchman, all rendering full satisfaction and strict observance of discipline. I have the honor to be, gentlemen, very respectfully, your obedient servant, W. H. CARSON, M. D., Resident Physician, Rigolets Quarantine. REPORT OF N. L. SIGUR, M. D., RESIDENT PHYSICIAN, ATCHA- FALAYA STATION. Morgan City, February 9, 1882. To the President and Members of the State Board of Health, New Orleans, La. Gentlemen-I have the honor to submit to you my official report of the operations at this station during the quarantine season of the past year ending October 31, 1881. The number of vessels frequenting this port was about the same as that of the preceding year, one hun- dred and nineteen steamships and eighty-one schooners, hailing chiefly from Galveston, Indianola and Brazos. The ships carried, besides their cargo and regular crew, a great many passengers, about ten thou- sand in number, showing at this point a great increase in travel. The schooners had only their crew and cargo. All were inspected upon their arrival, and it affords me pleasure to state that no'sicknesss of an epidemic or contagious character has manifested itself this season, either at the port of Brashear or in Mor- gan City. Out of so many vessels, only one came from an infected place. This was the steamship Whitney, which left Vera Cruz on the twenty-sixth of October, with full cargo, thirty-nine crew and fifteen passengers. Although provided with a clean bill of health from the Mexican authorities, she was stopped by me upon her arrival at quarantine station on October 30, and it was only after the required inspection, detention and fumigation, that she was allowed to proceed to Morgan City. I found the ship in good sanitary condition, the crew and passengers in excellent health, with the exception of an old English gentleman who labored under a severe attack of malarial fever which yielded readily to the free administration of the sulphate of quinine. Hoping that the coming year will prove as healthy as the last. I have the honor to subscribe myself, Very respectfully, your obedient servant, N. L. SIGUK, M. D. Quarantine Officer, Atchafalaya Station, for 1881. GENERAL REVIEW OF THE FINANCIAL OPERATIONS OF THE BOARD OF HEALTH OF THE STATE OF LOUISIANA. 1870-1881. In the history of Louisiana no Board of health has to meet graver responsibilities, and at the same time has had less support from tiie State and city governments. In proof of this proposition, we have to look, on the one hand, to the large sums re- ceived by former Boards of Health from the Legislature and City Council and the results accomplished, and, on the other hand, at the magnitude of the work which has devolved upon the present Board, and which, in virtue of the most rigid economy, its judicious expenditures have been successfully accomplished. In 1869 the Board of Health received from the Legislature of Louisiana $19,258 85 ; in 1870, $4625 ; 1871, $1630; 1872, $2916; 1873; $3561; 1875, $18,000; 1876, $6751; total received by the Board of Health from the Legislature for the support of quarantine during the eeven years specifiied, $56,735 85. Amounts paid by the city of New Orleans for disinfectants ordered by the Board of Health: In 1870, $2851 77; 1871, $1448 21; 1872, not recorded: 1873, $16,069 83; 1874, $2482 35; 1875, $12,376 25; total paid by the city of New Orleans for disinfectants during five years, $35,128 51. Thie amount stated, $56,735 85, as paid by the Legislature for the support of quaran- tine during the years specified, 1869-1876, represents the cash received from the sale of State warrants, the sums appropriated being far greater. Financial Operations of The Louisiana Board af Health, 1870-1881. XLI The amount stated, $35,128 58, as paid by the city of New Orleans for disiefectants, 1870-1875, does not include the outstanding claims. Neither does this amount include the salaries of the Sanitary Inspectors and Sanitary Police, paid by the city, which ex- ceed the annual budgets of the City Council appropriated to the Board of Health during the past two years. As a grand result of the appropriations by the Legislature for quarantine purposes, and by the City Council solely for disinfectants, during seven years, 1869-1876' we have the imposing sum of $91,864 36. The preceding statements have been based upon the following statistics, which are presented in full, as they form important data in the history of the Quarantine and San- itary Affairs of Louisiana. • XLII Receipts of Louisiana Board of Health, 1869-1881 To September 1,1881. To September 1,1880. i JD 0 1878 § 3 o 1875 3 4*. E18I 3 to 90 3 1870 1 YEARS. 1 $12,222 00 | $12,692 00 g^gsssssssss Mississippi Quarantine. $286 50 I s 674 15 301 85 93 50 178 00 174 75 1,635 65 445 15 $3,557 60 2,947 60 255 00 817 60 Rigolets Quarantine. 8 g 40 00 60 00 40 to © ©H* ©o nsgggs 8S8SS8 Atchafalaya Quarantine. tS IEZ. H ] $1,673 58 $1,389 32 2,827 79 2,872 61 3,106 69 Recording Births, Deaths and Marriages. i $4,591 00 1 $4,851 00 $5,218 51 8,839 55 7,192 50 6,725 00 Coal Oil Inspection. 1 $1,721 25 | $2,264 25 JOJ"* o/*4 C' •- W Cl -4 © r- © CH gggs Privy Permits. £ o g 3 & gggg Interment Permits g $90 00 142 00 133 75 49 75 Body Permits. C' 8 $ g $121 00 128 00 87 50 14 00 Building Permits. 90 001$ g g- 00 19 .... 10 00 09 09$ Fines. 10 45 48 00 • - $0 ( . ggggg $95 00 75 00 Miscellaneous. $1,181 25 O O ao); co jo © Q •' CH © Ci ObO . si- sgg^g : gg: ggggS State of Louisiana. • Cl : g s •4 D X 5 © 8 City of New Orleans. ' $20,652 79 । $22,835 10 $47,898 95 29,670 60 26,149 50 24,591 15 25,541 84 20,005 25 32,194 35 27,276 55 23,750 55 32,752 34 30,634 51 35,939 94 Total. RECEIPTS OF BOARD OF HEALTH, STATE^OF LOUISIANA. 1869-1881. Expenditures of Louisiana Board of Health, 1869-1881* XLIII Years. Mississippi Quarantine. Rigolets Quarantine. Atchafalaya Quarantine. Coal Oil Inspection. General Expenses. Total Expenditures. Liabilities at End of Year. ***- ■" ▼ 1R69 $15,019 85 $2,941 33 $1,474 60 $8 310 89 $27,746 66 1A70 . 13 201 28 2,543 21 2,259 50 8 950 01 26'954 00 1R71 14 285 19 1,940 64 1'308 10 10 772 31 28'306 24 $1,800 60 187? 12 402 84 895 35 981 00 10 377 49 24 656 68 5,362 00 1873 13 493 73 1,557 08 699 10 9^893 74 25,643 65 6,000 00 1874 11 557 10 380 85 190 00 7,325 10 19'453 05 ' 10,826 36 1875 .... 9 598 59 1,347 97 1,320 00 17 098 73 29 365 29 4,539 50 1876 14 038 97 662 32 51 80 7 854 32 22 607 41 4,199 61 1877 9,314 71 1,387 66 847 50 $1,556 00 8,934 46 23.040 33 f 4,668 04 May' | 3,003 63 1878 13,858 80 929 19 711 99 2,991 20 13,574 72 32,065 90 $ 4,668 04 1879 9,869 21 1,599 23 1,134 49 2,751 88 12,933 89 27,288 70 J 1,399 34 ) 4,668 04 1880 14,388 91 1,720 17 813 83 2,667 30 15,434 33 35,025 04 $ 4.640 29 Tip to Sept. 1, 1880 $8,305 93 $1,093 36 $437 50 $1,777 50 $8,242 88 $19,857 17 Upto^ept. 1, 1881 $13,239 23 $1,019 50 $460 00 tl,686 75 $9,109 93 $15,515 41 EXPENDITURES OF BOARD OF HEALTH, STATE OF LOUISIANA- XLIV Financial Operations of the Louisiana Board oj Health. STATEMENT OF THE AMOUNT PAID BY THE CITY OF NEW ORLEANS FOR DISINFEC- TANTS, FROM 1870 TO 1881. 1870 am? in June 11-Pickles & Albers , m on July 20-Pickles & Albers September 15-F. B. Albers _ „B. O7 November 4- F. B. Albers _____ Total amount expended in 1870 1871 *77 12 August 9-F. B. Albers w Total amount expended in 1871 $2,448 27 1872. No record. April8'3' 29-Thos. Pickles 29 May 17-Dr. Albers "I? June 21-Dr. Albers iao o« August 15-W. J. Kelly 799 September 5-W. J Kelley BB October 14-W. J. Kelly , a? ok December 28-W. J. Kelly Jl " 1874. March 14-W. J. Kelly ™ £ March 26-W. J. Kelly 99 99 May 25-Page & Co 3,000 00 June 6-Page & Co 3.000 00 June 23-Page & Co 3.664 22 June 23-Page & Co 5'^ 92 ' June 23- Page & Co 129 89 1875. 10 00 March 10-W. J. Kelly •••• 10 00 Total amount expended in 1873 16,069 8g June4' 6-W. J. Kelly *7®3 35 J nue 30-W. J. Kelly 778 99 October 21-W. J. Kelly 107 2o 1875 January 13-Thos. Pickles 92 99 February 16-W. J Kelly J* 30 March 10-W. J. Kelly , ^9 35 December 23-W. J. Kelly 1,165 60 1876. oi OK May 3-W. J. Kelly 91 25 1877 June ' 2-W. J. Kelly 340 75 Total amount expended in 1874 $2,482 35 1875 • AA February 10-W. J. Kelly A J97 "0 March ' 16-W. J. Kellv. « March 22-W J, Kelfy 874 99 April 15-W.J. Kelly 15 30 June 30-W. J. Kelly 99 29 July 20-W. J. Kelly 72 99 July 31-Thos. Pickles 787 90 September 22-Thos. Picldes 1,421 45 January 10-Thos. Pickles 2 89 June 14-Thos. Pickles June 26-Thos. Pickles J 7899 August 9-Thos. Pickles August 16-Thos. Pickles 294 4^ August 23-Thos. Pickles 488 00 August 30-Thos. Pickles 48 78 September 14-Thos. Pickles 7 00 1878- ' . AW, July 1-Thos. Pickles 7>071 13 July 26-Thos. Pickles 299 77 August 2-Thos, Pickles 110 38 7879• • KK September 25-Thos. Picklos 98 October 7-Thos. Pickles "0 00 7889 ■ AOA W October 7-Thos. Pickles November 4-Thos. Pickles 79 88 December 29-Thos. Pickles L987 84 December 31-Thos. Pickles * 1,464 0* 1881. , 1Q. January 6-Thos. Pickles 1,184 14 Total amount expbndcd in 1875 $12,3i6 35 Financial Operations of the Louisiana Board of Health. XLV 1876. February 23-Thos. Pickles 57 20 April 13-Thos. Pickles .29 00 May 6-Thos. Pickles 459 75 September 58-Finlay & Co 261 78 October 5-Finlay & Co 175 68 October 7-Thos Pickles 364 10 October 12-Finlay & Co 1,306 10 October 15-Finlay & Co 110 96 October 19-Thos. Pickles 360 00 October 19-Thos. Pickles 384 00 November 8-Finlay & Co 20 75 December 7-Finlay & Co 14 26 Total amount expended in 1876 $3,543 58 1877. March 15-Thos. Pickles $5109 May 11-Thos. Pickles 119 70 June 16-W. J. Kelly 15 21 August 16-Finlay & Co 2,856 18 Total amount expended in 1877 • $3,04118 1878. February 6-Finlay & Co $63 59 May 28-Finlay & Co 12 98 August 2-Finlay & Thompson 14 24 1879. August 16-Streubel & Co., for sprinkling disinfectants 235 00 August 19-Finlay & Thompson.... 2,500 00 August 19-Streubel & Co., for sprinkling disinfectants 408 50 August 26-Finlay & Thompson 2,22132 September 6-Finlay & Thompson 2,406 50 September 6-Balder, Adamson & Co 422 18 September 6-I. L. Lyons & Co 1,214 45 September 6-Finlay & Thompson 219 15 September 6-Streubel & Co , distributing disinfectants 47 50 September 28-Finlay & Thompson 139 36 October 1-Balder, Adamson & Co 364 67 October 1-Finlay &■ Thompson 1,250 55 October 17-A. Vizard 103 50 October 17-Page & Co . 252 00 November 8-A. vizard 32 00 1880. January 26-Finlay & Thompson 30 00 December 22-Finlay & Thompson . 269 73 Total amount expended in 1878 $12,207 22 $55,020 49 RECAPITULATION. Amount paid for the year 1870 $2,851 77 Amount paid for the year 1871 2,448 21 Amount paid for the year 1872 Amount paid for the year 1873 16.069 83 Amount paid for the year 1874 2,482 35 Amount paid for the year 1875 12,376 35 Amount paid for the year 1876 3,543 58 Amount paid for the year 1877 3,041 18 Amount paid for the year 1878 12,207 22 Amount paid for the year 1879 Amount paid for the year 1880 $55,020 49 N. B.-The amounts above stated are the actual amounts paid by the city of New Orleans, to January 29> 1881. but there are still amounts due to sundry parties lor disinfectants furnished during several years, which are still unpaid. On the other hand, during the years 1880, 1881, 1882 and 1883, not one farthing has been appropriated by the Legislature to the maintenance of her quarantine establishments, and the City Council has appropriated an amount in the annual budgets inadequate to the pay of the sanitary inspectors and sanitary police, leaving nothing whatever for the pur- chase of disinfectants. The Board of health paid during the year 1880 the following sums, which should have been paid by the City Council: To I. L. Lyons, balance of account for disinfectants, $428 64; to G. R. Finlay & Co., for disinfectants furnished in 1880, $667 82; to salaries of sanitary inspectors, $1550 ; to G. R. Finlay & Co., for disinfectants supplied during this year, in addition to the amount stated above, $334 92. We have thus a total of $2930 38, paid by the Board of Health out of the revenues derived from the quarantine fees, the registration of births, deaths and marriages, privy permits and coal oil inspections, for material and services justly chargeable to the city. When, in accordance with the organic acts of the Legislature of Louisiana, the Presi- dent of the Board of Health assumed the direction of the quarantine establishments of Louisiana in April, 1880, he found them in a dilapidated and deplorable condition. XLVI Financial Operations of the Louisiana Board of Health, 1870-1881. At the Mississippi Quarantine Station, the fever hospital, and more especially the small-pox hospital, which had been occupied as a residence by oue of the officers, were in wretched condition. The quarantine boat house and wharf were undermined and unsafe; in fact, it was necessary to moor the physician's boat in the river, without pro- tection from the rain, at the government wharf. The inside of the quarantine boat had been stove, and it was necessary to replace it with one capable of executing the hazardous labors of boarding in the treacherous waters of the Mississippi River. The levees were broken and the drains of the hespital grounds were open, without fences, and were roamed over by cows, horses and hogs. The graveyard was a mass of tangled brushes, brambles, briars and sedge grass. The plastering of the hospital walls was broken, the windows open, the roof leaking, and there was an absolute absence of all decent and comfortable beds aud bedding. The supply of drugs and medicines and medical appliances was exhausted. After carefully viewing the situation the first work accomplished by the executive of the Board, with the advice of Col. I. N. Marks, the able and patriotic chairman of the Finance Committee, aud the assent of the Board, was the equipment of the hospital with beds, bedding, mosquito bars, blankets, sheets, crockery, cooking stoves aud utensils, and a full supply of fresh, pure drugs. In 1880 the Board was without the necessary funds, and the season so far advanced that it was out of the question to attempt any repairs during the summer and fall. But as soon as funds had been accumulated by the most rigid economy, upon the urgent recommendation of the President, indorsed by the chairman of the Finance Committee, about $6000 was devoted to the repair of the Missis- sippi Quarantine Station. Estimates were made by the State engineers, but the contract was awarded to private parties, who executed the work at the lowest possible figures, and the Mississippi Quar- antine Station was placed in an effective condition and in complete repair, and was thoroughly equipped by the first of March, 1881; aud but for the diversion of a portion of the funds to pay the sanitary inspectors and sanitary police in the autumn and winter of 1880, it would have been possible to have placed the Rigolets Station in comparative effective condition. A detailed statement of the expenditures at the Mississippi Quarantine Station will be presented under the appropriate head. Under the system of rigid economy exercised by the Finance Committee, acting in full accord with the President of the Board, the following important works have been accomplished during 1880-1881: 1. The publication of one thousand copies of the Acts of the Legislature of Louisiana establishing and regulating quarantine for the protection of the State; organizing and defining the powers of the Board of Health; and regulating t|ie practice of medicine, midwifery, dentistry and pharmacy, rules and regulations of the Board of Health, and ordinances of the city of New Orleans. This volume of 100 pages, illuminated by valuable maps, illustrating the position of the quarantine establishments and the medical topography of New Orleans and lower Louisiana, was digested, consolidated and passed through the press by the President without auy cost to the Board of Health, except in the mere matter of printing aud paper. 2. The preparatiou, publication and distribution by the president to the shipping agents, shipping masters, and captains, and foreign consuls, and leading merchants in the port of New Orleans, 7500 copies of the rules and regulations of the Board of Health governing quarantine. Upon assuming the duties of President of the Board of Health of the State of Louis- iana, in April, 1880, the necessity for collecting and publishing all the laws of Louisiana, bearing on sanitary science and public hygiene, was at once realized, as the acts of the Legislature, the ordinances of the City Council and the rules and regulations of the Board of Health were scattered through various official documents, or existed only in manuscript in the archives of the City Hall and Board of Health. Measures were taken for the collection of the existing laws and ordinances, and the importance of their publi- cation for the guidance of the officers and employes of the Board of Health, and the public, in the execution of sanitary measures and reforms-, was urged upon the Board of Health. Notwithstanding the pressure of official duties, the President deemed this work of such importance in its bearing upon the public welfare, that he embraced every opportunity and every moment of time for its successful completion. The labor by the President in the collection and classification of the quarantine laws of the State, and ordinance of the Board of Health and City Council, was indorsed by the Board of Health, and their publication at the earliest practical moment granted. On the fourteenth of October, 1880, the laws of the State of Louisiana regulating the establishment and enforcement of quarantine for the protection of the State, and defin- ing the powers of said Board of Health ; also, the health ordinances of the city of New Orleans, and the rules, regulations and forms of the Board of Health, were published and distributed to the State and civil officials, and to the prominent physicians and sani- tarians of this and other Southern and Western States. Financial Operations of the Louisiana Board, of Health, 1870-1881. XLVII 3. The publication and distribution of one thousand copies of the circular of the com- mittee charged with the arrangement and programme of the quarantine convention ; the prompt payment of all the expenses incurred in the conduct of the quarantine con- vention. Whilst the quarantine convention, as a body, was deaf, dumb and blind to matters relating to quarantine and sanitary science, and to the welfare of Louisiana, neverthe- less its discussions revealed the plan of action of the enemies of this board, which was vigorously executed during the winter of 1880 and 1881, and the spring of the latter year, by certain voluntary associations in this city and elsewhere. 4. The weekly publication and distribution to the chief health officials in this country and Europe of the mortuary and meteorological statistics of the Board of Health. All important reports of committees, and all matters relating to the health of this city and State, published in the daily press of New Orleans, have in like manner been promptly forwarded to the Boards of Health and Quarantine Stations in surrounding States. By such measures, neighboring States, and especially those of the valley, were divested of all excuse for establishing quarantine against a healthy city. 5. The publication and distribution of 3000 copies of the annual report, in accordance with the formal resolution of the board. Said report was illustrated with maps, charts and lithographs, and distributed to the members of the State Legislature and of Congress, and to all known boards of health and health organizations. This work was published at the lowest possible cost, and the demand has been so great for it, not only in this but in other States, that the entire edition is now well nigh exhausted. 6. The prompt payment of the pay-roll of the Board of Health, which now amounts to $2400 per month. No board of health has ever before attemped to carry out effective quarantine inspec- tion at the mouth of the river, to maintain an inspection at Port Eads, or to maintain inspectors of shipping for the river front and the Old and New Basins. In this respect alone the Board of Health has a monthly expense of $250 above that of any former board. The system of harbor and basin inspection, as well as that of the hygienic conduct of ships, was proposed and perfected by the executive officer of this board. At the present moment, the active force of the Board of Health consists of: The Presi- dent, the Secretary and Treasurer, two clerks for the registration of deaths, births and marriages, clerk and book-keeper, messenger and collector, two coal oil inspectors, two police deputy inspectors of shipping in the Mississippi river and in the Old and New Ba- sins, one porter; two quarantine officers at the Mississippi Stations, four boatman, one watchman, one nurse, one keeper of hospital grounds; at Port Eads-one quarantine in- spector and two boatmen ; at Rigolets-one quarantine physician, two boatmen and one watchman; at Atchafalaya ; one quarantine physician and one boatman. The officers and employees of the board of health proper, therefore, number about twenty-seven. The preceding estimate does not, of course, embrace the Sanitary Inspectors and Sani- tary Police, paid by the city out of the budget appropriation to the Board of Health. This sanitary corps consists of six inspectors and twelve policemen-total, 18. The entire effective force of the board of health during the years 1880 and 1881, officers and men, was about 45. Not only has the entire corps been promptly paid, but the four quarantine stations have been fully supplied with disinfectants, coal oil for lights, and all the necessary equip- ments for the boats and hospitals; and the Board of Health has purchased and distributed gratuitously to the poor of the city of New Orleans, during the years 1880 and 1881, about 150,000 pounds of copperas, 150 gallons of carbolic acid, 9000 pounds of sulphur. Under the able management of the Chairman of the Finance Committee, acting in full accord with the executive officer of the Board of Health, every obligation has been promptly met by cash payments, and the present small amount of money in the treasury of the board is an evidence that its revenues have been faithfully and promptly applied in accordance with the laws for the protection of the people from foreign pestilence, and for the prevention and arrest of disease in our midst. New Orleans, during the past two years, 1880 and 1881, has been free from yellow fever, and all contagious or pestilential diseases, and this result has been accomplished at an annual cost of about $50,000 (fifty thousand dollars). Of this amount, the city of New Orleans has annually contributed $10,000 ; and the remainder ($40,000) has been collected chiefly from quarantine fees and the small amounts paid for the registration of births, deaths and marriages, etc. We have a board of health upon which the greatest responsibility rests, and which is charged with the execution of the most important offices with reference to the protec- tion of the Mississippi Valley from the importation of foreign pestilence, and yet no man within the bounds of Louisiana feels the burdens ; for so skillfully and wisely have the sanitary and quarantine laws been framed, that there is no direct taxation, with the exception of the small amount furnished by the city. The revenues derived from the quarantine fees are returned a thousand fold to the merchants and shippers, ship masters and seamen, in that foreign pestilence is excluded, the health and hygiene of ships im- XLVIII Financial Operations of the Louisiana Board of Health-1870-1881. proved, and the sick seamen carefully and comfortably treated in commodious hospitals. The citizens of New Orleans derive great benefits from the registration of births, deaths and marriages, in various ways ; but we will direct attention to only the follow- ing results flowing from this portion of the labors of the Board of Health : 1. The preservation of accurate records of the names, ages, nativity, residences, at- tending physicians, and diseases of all fatal cases, furnishes the only date upon which a correct estimate maybe based as to the rate of mortality and the nature of the pre- vailing diseases. The systematic consolidation and publication of these statistics at regular intervals has enabled the executive of the Board of Health to meet and over- throw the slanders constantly launched by the enemies of New Orleans against her reputation for health. Whilst the cost of such publications enters as a considerable item in the expenses of the board, the return thus far in the maintenance of friendly relations with the health authorities of surrounding States, and in the prevention of senseless and destructive inter-State quarantines, has been more than one million fold. In addition to the preceding considerations, it is well known that upon an accurate record of deaths numerous questions of life insurance and successions of property frequently hinge. A stranger diesin New Orleans; he leaves a widow and several children ; he also leaves a policy in a life insurance company. The payment of the policy to the des- titute widows and orphans depends absolutely upon the establishment of the proofs of death, including date, place and cause. The records of the Board of Health furnish the necessary particulars. Hundreds of thousands of dollars annually depend upon the truth and accuracy of these records. Again, it is of the utmost importance that the ballot-box should be kept sacred and free from fraud. The daily mortuary records of New Orleans furnish the data by which the list of voters is constantly purged of what might be called literally "Dead Heads" in contradistinction of the dead-heads and dead- beats of sailor boarding-houses, corner groceries, unoccupied vacant lots and the charity wards of the eleemosynary institutions. 2. It is impossible to over-estimate the value of accurate records of births and mar- riages upon the welfare of the citizens ; the simple records of births or deaths may decide, upon one side or the other, the suit for valuable possessions, and either establish or destroy the claim to honorable and untainted birth. 3. Questions delating to age, sex, race, occupation and nativity can alone be studied of well-recorded and classified mortuary and vital statistics. 4. Upon the proper action of the Honorable Mayor and the City Administrators of New Orleans, in providing the necessary means for the payment of the Sanitary Inspectors, and in furnishing the necessary police, and the necessary disinfectants and the carts for their distribution, depends in a large measure the sanitary condition of the city of New Orleans. New Orleans has no system of sewers; the excrement from her 216,000 inhabi- tants, and from the masses of strangers that constantly crowd her streets, may be re- moved by her manual labor. It is horrible to contemplate the effect of hoarding up the vast accumulations of human filth in this damp, hot, semi-tropical climate. In the present condition of New Orleans the only method of dealing with this gigantic evil, which is a constant menace to the health and comfort to the people, is to clean the privies by mechanical means-by well-devised, odorless apparatus, and to keep them continually disinfected by cheap and reliable disinfectants accessible to all at lowest prices. As President of the Board of Health, after careful 'investigation, I Jhave recommended copperas (sulphate of iron) and carbolic acid as the cheapest and .most reliable disin- fectants. The constant and systematic removal of the human and animal excrements, as well as the maintenance of a good sanitary condition of all private premises, must be based upon systematic house-to-house inspection. Thorough inspection and thorough attention to domestic sanitation requires intelligent, faithful and honest sanitary inspectors, and efficient and honest sanitary police, sub- jected to rigid discipline. The organic acts of the Legislature make it imperative upon the honorable Mayor and Administrators of New Orleans to furnish an adequate police force to perform the sanitary offices indicated by the Board of Health as necessary to the preservation of the health of the people; and it is equally the duty of the municipal government to furnish the necessary funds for the payment of the sanitary inspectors and the supply of sufficient amounts of disinfectants. The continuous and efficient inspection of the shipping in the harbor of New Orleans should also be provided for by the City Council. ESTIMATED RECEIPTSiOF THE BOARD OF HEALTH, STATE OF LOUISIANA. (Receipts for', the Ten Months Ending October 31, 1881. ( To cash and uncollected drafts on hand January 1,1881 $ 5,858 91 Mississippi Station-Amount fees from vessels via Station $14,622 22 Rigolets Station-Amount fees from vessels via Station 506 00 Coal Oil Inspection-Amount fees gauging and inspection : 2,230 14 Recording Births-Amount fees .. 1,142 50 Recording Deaths-Amount fees. 1'2.654 50 Financial Operations of the Louisiana Board of Health, XLIX Recording Marringes-Amount fees 1,008 00 Marriage License-Amount fees l,0t>5 50 Record Certificates-Amount fees 91 00 Privy Permits-Amount fees 2,039 50 Body Permits-Amount fees i 42 25 Building Permits-Amount fees 49 25 Interment Permits-Amount fees 51 00 Amount received from city of New Orleans for disinfectants - 500 00 Amount divided from deposits in New Orleans Savings Institution 47 80- 26,039 66 Total $31,898 57 (Estimated Receipts for Two Months ending December 31.) To Mississippi Station-Amount of fees from vessels via station $4,595 00 Coal Oil Inspection-Amount fees for gauging, etc 66120 Recording Births, Deaths and Marriages-Amount fees 889 50 Privy Permits-Amount fees 100 00 Buliding, Body and Interment Permits-Amount fees 7 50- 6,253 20 $38,151 77 To balance 98 71 Total $38,250 48 DISBURSEMENT OE THE $10,000 APPROPRIATED BY THE CITY OF NEW ORLEANS FOR THE USE OF THE BOARD OF ^EALTH, STATE OF LOUISIANA, FOR ITS EMPLOYMENT OF SANITARY INSPECTORS AND POLICE, DURING 1881. January... .Five Sanitary Inspectors, at $100 $500 00 .. One Sanitary Inspector 75 00 .. Six Sanitary Policemen, $50 300 00-$ 875 00 February and March-Amount of rolls, at $875 1,750 00 April Six Sanitary Inspectors 575 00 .. Thirteen Sanitary Policemen 425 00- 1,000 00 Maj' Five Sanitary Inspectors, at $100 500 00 .. One Sanitary Inspector 75 00 Eleven Sanitary Policemen, at $100 500 50- 1,125 000 June Pay-roll same as May 1,125 00 July Pay-roll same as June 1,125 00 August ... .Pay-roll same as June 1,125 00 September. .Pay-roll same as June • 1,125 00 October Five Sanitary Inspectors, salary reduced to $43 48 217 40 One Sanitary Inspector, salary reduced to $32 60 32 60- 250 00 November. .Pay-roll same as October 250 00 December...Pay-roll same as October.... 250 00 Total $10,000 00 The receipts of the Board of Health for the year 1882 will be from the same sources as at present, and will not varj- materially from the estimate of 1881, apart from the appropriation by the City Council. ESTIMATED EXPENDITURES OF THE BOARD OF HEALTH. (Expenditures for the Ten Months ending October 31, 1881.) By Mississippi Station- Paid resident physician $4,166 61 Paid assistant resident physician 1,166 60 Paid boatmen's wages 3,052 00 Paid for repairs to station 6,470 41-$15,355 62 By Rigolets Station- Paid salary resident physician 750 00 Paid wages boatmen 720 00 Paid sundries for station 52 43- 1,522 43 By Atchafalaya Station Paid salary resident physician 450 00 Paid wage's boatmen 240 00- 690 00 By Coal Oil Inspection- Paid Inspectors' salaries 2,000 00 Paid for sundries 96 75- 2,096 75 By Court Deposits- Amount deposited in court 12 00 By General Expenses- Paid salaries officers and employees 8,803 19 Paid sundries 2,790 22- 11,593 41 $31,300 21 (Estimated Expenses for Two Months ending December 31.) By Mississippi Station- Paid salaries physician and boatmen $1,786 64 By Coal Oil Inspection- Paid sa laries Inspectors $400 00 Paid sundries 20 00- 420 00 By General Expenses- Paid salaries officers and employees. 1,926 64 Paid printing and lithographing annual report 1,530 00-$5,663 28 6 L Financial Operations of the Louisiana Board of Health. LIABILITIES. Balance due Woodward & Wight, supplies Mississippi Station 8190 96 Balance due G. II. Finlay & Co., supplies to Board 935 78 Balance due J. S. Rivers, stationery 144 85 Balance due Danziger for draping office 15 40- 1,286 99 Total i $38,250 48 RECAPITULATION. Expenditures for ten months $31,300 21 Estimated expenditures for two months 5,663 28 Liabilities 1,286 99-$38,250 48 Receipts for ten months /. 31,898 51 Estimated receipts tor two months. 6,253 20- 38,151 77 Probable deficit $98 71 STATEMENT OF SUMS NECESSARY FOR THE MAINTENANCE OF THE QUARANTINE AND SANITARY OPERATIONS OF THE BOARD OF HEALTH DURING 1882. TO MISSISSIPPI QUARANTINE STATION. Salary Resident Physician $5,000 00 Salary Assistant Resident Physician . 2,000 00 Wages of watchman.... 540 00 Wages of coxswain 540 00 Wages of four boatmen 1,920 00 Druggist and hospital steward 900 Ou Two hospital nurses at $50 per month 1,200 00 Hospital cook 720 00 Medicines and hospital supplies 1,000 00 Repairs of boats .. 200 00 Disinfectants. 1.500 00 Food, bedding and supplies for sick 2,000 00 Shipchandlers' supplies, oil for lamps, etc 500 00 Expenses of telegrams .... 250 00 Inspection expenses, towage of infected vessels 1,000 00 Repairs of buildings 2,000 00 Steam launch and crew' 2,500 00 $23,770 00 TO KIGOLETS QUARANTINE STATION. Salary Resident Physician $900 00 Wages of boatman 480 00 Wages of watchman 300 00 Purchase of grounds and erection of buildings for sick and discharge of cargo 3,000 00 Disinfectants 300 00 Supplies for sick, medicines, etc 500 00 Repair of boats, shipchandlers' supplies 500 00 5.980 00 TO ATCHAFALAYA QUARANTINE STATION. Salary Resident Physician .... $450 00 Wages of boatman 240 00 Wages of watchman 240 00 Purchase of grounds and erection of buildings •. 2,000 00 Disinfectants.... 200 00 Telegrams and inspection service ....... 250 00 3,380 00 TO OFFICE AND GENERAL EXPENSES. Salary of President $2,400 00 Salary of Secretary and Treasurer .... 2,000 00 Salary Deputy Recorder Births, Deaths and Marriages 1,200 00 Salary Assistant Recorder Births, Deaths and Marriages 1,000 00 Salary Clerk Board of Health. 1,000 00 Salary Messenger and Collector 480 00 Salary Porter 120 00 Salary Quarantine Inspector, Port Eads 600 00 Salary Coal-oil Inspectors 2,404 00 Salar'v Attorney 600 00 To printing annual report 1,200 00 To lithographing same 400 00 To telegrams, publication, transmission to health authorities of special reports 500 00 To books (record of births, deaths, marriages) and stationery 500 09 To publication, distribution of sanitary circulars, health laws, quarantine proclama- tions 500 00 To rent of office of Coal oil Inspectors 100 00 To bungs, corks and glue 130 00 15,300 00 ESTIMATE OF EXPENDITURES FOR THE CONDUCT OF THE SANITARY AFFAIRS OF THE CITY OF NEW ORLEANS FOR THE YEAR 1882, UNDER THE CONTROL OF THE BOARD OF HEALTH OF THE STATE OF LOUISIANA. Six Sanitary Inspectors at $100 per month $7,200 00 One Sanitry Inspector 1,500 00 Two Inspectors of Shipping in River and Basin 1,200 00 9.900 00 Sanitary and Quarantine Operations of 1882 LI Disinfectants- 20 pounds Copperas to each house (40,000), total Copperas 1,200,000 lbs at ljc per lb. 1,800 00 1,000 gallons Calvert's No. 5 carbolic acid at $1 20 per gallon 1,200 00 25,000 pounds sulphur at 2Jc per pound 687 50 500 barrels lime at $1 10 per barrel 550 00 15 barrels chloride of lime at $12 per barrel 180 00 5 barrels sulphate of zinc at $21 per barrel 105 00 4,522 50 Miscellaneous- • Printing and distribution of circulars 500 00 Office rent Sanitary Inspectors 500 00 Vaccine matter for schools and colleges and citizens 500 00 Disinfecting apparatus, pots, pans, etc., warehouses, shipping, dwellings, etc 500 00 2,000 00 Total •. $16,422 50 In addition to the above the Honorable Mayor and Administrators of the city of New Orleans should fur- nish the Board of Health the following policemen and force for house-to-house inspection and disinfection : First District, Sanitary Policemen 4 Second District, Sanitary Policemen 3 Third District, Sanitary Policemen 3 Fourth District, Sanitary Policemen 3 Fifth District, Sanitary Policemen 2 Sixth District, Sanitary Policemen 1 Seventh District. Sanitary Policemen I First District, Carts with Drivers and Teams for the distribution of disinfectants 2 Second District, Carts with Driver and Teams for the distribution of Disinfectants 1 Third District, Carts with Drivers and Teams for the distribution of Disinfectants 1 Fourth District, Carts with Drivers and Teams for the distribution of Disinfectants I Fifth District, Carts with Drivers and Teams for the distribution of Disinfectants 1 Sixth District, Carts with Drivers and Teams for the distribution of Disinfectants 1 Seventh District, Carts with Drivers and Teams for the distribution of Disinfectants 1 The cost to the city of an epidemic of yellow fever lias been estimated at not less than $15,000,000 (fifteen millions of dollars). The estimate which, as President of the Board of Health, I have made for the conduct of the sanitary affairs of New Orleans, is not more than one-thousandth part of the cost of a single-epidemic. In the conduct of the sanitary affairs of New Orleans the organic acts of our Legislature have made the City Council responsible for the prompt supply of the necessary funds for the payment of the Sanitary Inspectors, and for the purchase of the necessary disinfectants, and for the detail of the necessary police. The prompt fulfillment of these important duties by the Honorable Mayor and City Council will establish the fullest confidence in surroundng communities, and will promote the highest and best interests of the city and State in protecting for- eign and internal commerce from unnecessary quarantine, and above all, in protecting the lives and promoting the health of the people. OUTLINE OF THE QUARANTINE AND SANITARY OPERATIONS OF THE BOARD OF HEALTH OF THE STATE OF LOUIS. IANA FOR 1882. MISSISSIPPI QUARANTINE STATION. The total number of vessels inspected at the Mississippi Quarantine Station during the year 1882 were : Steamships, 615 ; ships, 53 ; barks, 160 ; brigs, 28; schooners, 142. Total, 998. The total number of vessels held in quarantine was 117, distributed thus during the months: May, 16; June. 22; July, 8; August, 12; September, 28; October, 26 ; Novem- ber, 5. The quarantined vessels came from the following ports, in the numbers specified: Rio Janeiro, 8; Havana, 49 ; Vera Cruz, 25; Minatitlan, 2 ; Celon, 11; Tampico, 2; Martinique, 5 ; St. Jago de Cuba, 3. Some vessels arrived with sick on board at the Mississippi Quarantine Station on the following dates: May 8, June21, September 3, September 29, October 4, October 15, November 16. The total number of sick was twenty-one, with three deaths. The cases were referred to the various forms of malarial paroxysmal fever; no case of yellow fever occurred at the Mississippi Quarantine Station during 1882. RIGOLETS QUARANTINE STATION. Total number of vessels boarded and inspected at the Rigolets Quarantine Station, during 1882 was 933, the great majority of which were schooners. The season of quaranti re restriction at this station lasted from May 1 to November 1, and during this period no case of sickness of any nature was observed at the Rigolets Quarantine Station. LII Sanitary Operations and Mortality of 1882. ATCHAFALAYA QUARANTINE STATION. During the quarantine season, at the Atchafalaya Station, first of May to first of November, 1882, 129 steamships, 59 schooners and 6863 passengers were inspected. Ten ships hailed from infected ports. QUARANTINE STATION AT ENGLISH LOOKOUT. The Boatd of Health established and maintained a quarantine station, with one medi- cal inspector and two sanitary policemen, at English Lookout, on the Mobile Railroad, from the latter part of August until the close of October, and all passengers and baggage were subjected to inspection. QUARANTINE OBSERVATION AT PORT EADS, AT THE MOUTH OF THE MISSISSIPPI. A quarantine officer was maintained at the mouth of the Mississippi River, from the first of May until the first of November, and vessels entering the mouth of the Missis- sippi River were subjected to inspection and observation. HOUSE-TO-HOUSE INSPECTION AND NUMBER OF NUISANCES ABATED DURING 1882. No.of Inspec- tions made. No. of Re-in- spections. No. of Nuis- ances abated. 15 981 10 091 8 639 Second District 7^995 3.646 3J72 H'hir'fl lliat.rir.t . 12 160 4 822 3 086 Fourth District 9 869 2 839 2 814 Fifth District.••• ............ 3 690 578 650 Sixth District 4 374 1 156 813 SAxrATifli at.riPt. ...... 2 971 566 Total - 57.040 23,698 19,174 In the First District, 3828 premises were disinfected, and a proportionate number in the other districts. Where contagious diseases were reported to the Board of Health, the premises were disinfected and fumigated. MORTALITY OF ^NEW ORLEANS DURING 1882-MORTALITY IN THE DIFFERENT DIS- TRICTS IN NEW ORLEANS DURING 1882. Whites. Colored. Total. First District 1,381 820 2,201 Second District 606 468 1,074 Third District 732 570 1,302 Fourth District 493 200 693 Fifth District 87 89 176 Sixth District 216 115 331 Seventh District 67 78 145 ' ■ - - Total 3.582 2,340 5,922 DEATH-RATE PER 1000 INHABITANTS PER ANNUM IN THE VARIOUS DISTRICTS DURING 1882. DISTRICT. White. Colored. Total. First 31.87 58 04 38'31 Second . 19.31 35 18 24 04 Third ... 21.70 49.45 Fourth .... 16.09 28.94 18 40 Fifth- .... • 17.32 23.20 19 87 Sixth 18.07 28.20 20 05 Seventh........ 13.44 25.06 23.24 First District-Maximum death-rate: White, December, 44.87; lowest, September, 26.59. Colored-Maximum, April, 67.95; lowest, February, 43.32. Colored and white- Maximum, December, 49.29; minimum, July, 32.79. Mortality of New Orleans in 1882. LIII Second District-White: Maximum, May and June, 24,48; minimum, March, 14.15. Colored-Maximum. May, 55.03 ; minimum, December, 27.96. White and colored-Maxi- mum, May, 33.82 ; minimum, September, 20.14 Third District-Maximum death-rate: Whites, April, 27.39; minimum, November, 17.72. Colored-Maximum. May, 80.16; minimum, August, 30.19. Total white and colored-Maximum, April, 39.85; minimum, August, 21.58. Fourth District-Maximum: White, December, 26.25; minimum, September, 9.79. Colored-Maximum, December, 41.67j; minimum, March and September, 15.63. Total white and colored-Maximum, December, 29.09; minimum, September,H0.87. Fifth District-Maximum, May, 33.45; minimum, June, 9.55. Colored-Maxi- mum, 46.93; minimum, February and March,* 12.51. Whites and colored-Maximum, July, 29.80; minimum, February and March, 12.19. The death-rate rrom phthisis pulmonalis in the different districts (per 1000 inhabitants per annum) was as follows: First District, 5.01; Second District, 3.71; Third District, 3.01. The death-rate from malarial fevers: First District, 1.94; Second District, 1.36; Third District, 0.55. MORTALITY BY MONTHS AND BY RACE. MONTHS. Deaths. Total Deaths* W. C. • 282 186 468 February 256 151 417 March 256 209 465 April 308 231 539 May 330 259 589 June 335 226 561 •Tnlv ... . 288 172 460 An <511 st 267 176 443 Seotember ; 239 161 400 October . • 306 183 489 November 322 184 506 December 383 202 585 Total 3582 2340 5922 ESTIMATED POPULATION OF NEW ORLEANS. Whites 163.606 Colored v 59,949 Total 223,555 * MONTHS. Death Bate per 1000 per annum. Death rate per 1000 per annum. W. &C. w. C. January. 20.68 37.23 25 12 February 19.51 30.22 22.38 March 18 77 41 83* 24.96 A pril 22.59 46.23 28.31 Mav .... . . ... 24 20 51.84 31.61 June 24.57 45.23 30.11 July 21.12 34.42 24.69 Ancmat... 19 58 35.23 23 77 September 17.53 32.22 21.47 October 22.44 36.63 26 24 November 23 61 36.80 27.16 Dpe.ATnhAr. . 28.09 40.43 31.40 DEATH-RATE OF NEW ORLEANS, PER 1000 INHABITANTS, DURING 1882. Death-rate during first six months of 1882: whites, 21.72; colored, 42.10; total, 27.18. Death-rate during last six months of 1882: whites, 22.06; colored, 35.96; tatal, 25.79. Death-rate for the entire year 1882: whites, 21.89; colored, 39.03; total, 26.45. Sex: Whites: males, 2104; females, 1478. Colored: males, 1225; females, 1115; Total males, 3329; total females, 2593. Of the total number of deaths, 3605 were natives of Louisiana, and 977 of other States, and 1240 of foreign countries; Germany heads the list, with 441 deaths, then follows Ireland, with 420 deaths, and next France, with 187. LIV Mortality of New Orleans during 1882 and Other Years. The deaths in public institutions numbered 1127; of which 805 occurred in the Charity Hospital. The deaths reported by the coroner numbered 1028. The deaths in public institutions, together with those reported by the coroner, amounted to 2155. Of the total deaths occurring in New Orleans during 1882, only 3767 received medical attention in their homes and residences. It is evident from the preceding statistics that the death-rate of the white inhabitants of New Orleans, if calculated upon a basis of actual inhabitants, exclusive of foreigners and strangers, and laborers from the levees of the Mississippi River and from the various lines of railroads, crowding the hospitals, prisons and asylums, would not exceed 15 per 1000 inhabitants per annum. The white population of New Orleans manifested a lower death-rate (if the calcula- tion be made upon the basis just indicated) than that of any other city of the same size and similarly situated in the civilized world. Average daily mortality in New Orleans during the year 1882, 16.22. Lowest daily mortality in first six months of 1882, January 19, when only six deaths occurred. Highest daily mortality in first six months of 1882, April 29, when thirty-four deaths occurred. Lowest daily mortality of last six months of 1882, on August 11 and October 1, when five deaths were recorded upon each of the days specified. Highest mortality during the last'six months of 1882, October 14, when thirty deaths occurred. The highest daily mortality occurred on April 29, and the next highest on October 14. The lowest daily mortality occurred on August 11, October 1, and January 19. • MORTALITY OF NEW ORLEANS DURING 1882, COMPARED WITH THE MOR- TALITY OF PRECEDING YEARS. YEAR. Death-rate per 1000 population per annum. « Whites. Colored. Total. 1845.. 25.10 22 50 24 32 1847 79.86 37.08 62.03 1849.... 81.92 62.91 77 44 1850.... 62.08 52.10 59 80 1852 67.91 43 04 62 90 1853 124.68 48,98 110 09 1856 32.98 35.66 33 89 1857 34.86 38.07 35.49 1858 69.64 80.37 72 70 1859 33.58 86 98 41 53 1860 41.99 52'79 43.51 1861 31.58 37.16 31.87 1863 37.30 59.53 41.35 1864.. 42.14 81.75 49.86 1865 33.32 60 88 38 99 1866 36.77 42.52 1867 56.79 47.80 54.69 1868 25 49 38 97 28 60 1869 27.29 44 80 31 73 1870 33.74 52.20 88.61 1871 27.26 42.76 31.32 1872 27.29 41.93 31.17 1873.... 32.79 51.42 37.73 1874 29.53 45.44 33.75 1875 26.28 40.25 30.00 1876 25.87 42.56 30.31 1877... 25.96 49.02 32.11 1878 52.05 39.94 48.81 1879 20.85 32.41 23.91 1880 22 96 34.38 26.05 1881 25.79 38.95 29.31 1882 21.89 39.03 26.45 Cases of Yellow Fever in 1882. LV During the period of thirty-two years, embraced in the above table, with the exception of the year 1879, the death-rate among the whites was the lowest in 1882. The average death-rate for the thirty.two years among the whites, was about 39.6. Among the colored population the death-rate of 1882 was greater than that of 1845, 1847,1856, 1857, 186'1, 1868, 1879, 1880 and 1881; whilst it was less than the death-rates of 1849, 1850, 1852, 1853, 1858, 1859, 1860, 1863, 1864, 1865, 1866, 1867, 1869, 1870, 1871, 1872, 1873, 1874, 1875, 1876, 1877 and 1878. The average death-rate per annum during the thirty-two years specified amongst the colored population was about 47.1. During the period of thirty-two years the death-rate of the total population was lower than that of 1882, during only three years; namely, 1845, 1879 aud 1880, During the four years, 1879, 1880, 1881 and 1882, the minimum death-rate amongst the whites was 20. 85, and the maximum 25.79 ; whilst the minimum death-rate amongst the colored race was 32.41, and thejmaximum 39,03; in the total population during the same period, minimum 23.78, maximum 29.31. The mortality amongst the whites during the last four years has been less than ever before in the history of New Orleans; and the result must be mainly attributed to the following causes and conditions : 1. The absence of any marked or great prevalence of pestilential diseases. The small number of deaths from yellow fever in 1879 exerted no appreciable influence upon the general death-rate. 2. The freedom of New Orleans from yellow fever during the past thiee years, 1880, 1881 and 1882, must be attributed to the execution! of the quarantine laws, and to the sanitary measures enforced by the Board of Health-measures embracing the isolation and disinfection of the first cases of yellow fever. The prevalence of yellow fever on the east at Pensacola, Florida, and on the west at Brownsville, Texas, during the autumn of 1882, would indicate that the absence of yellow fever in the epidemic form, was not due to any peculiar climatic conditions within and around New Orleans. 3. Systematic house-to-house inspection and domestic sanitation, carried forward un- der the direction of the Board of Health. 4. The prompt removal of the garbage and foecal matters of the city, and the systematic discharge of the same into the Mississippi River, in accordance with the provisions of Acts 14 and 84, of 1877. The attempt of the honorable City Conncil to improve the drainage of the city was limited chiefly to the First District, and was too circumscribed in its nature to admit of a definite calculation of its effects upon the .public health. Nevertheless, the work of deepening and cleansing the drainage canals of New Orleans should be continued under the direction of skillful engineers and faithful and honest city officials. The subject of the drainage of New Orleans was fully discussed in the annual report of 1881, and it is evident that the facts and observations need not be repeated, as the arguments for the perfection of the drainage system of New Orleans are unanswerable FELLOW FEVEB IN 1882. The official mortuary records of the Board of Health of the State of Louisiana contain four certificates which assign the cause of death to yellow fever ; one death was re- ported in June, one death in July, and two in August. The subjects were all of the white race. The interests of science as well as the advancement of the material interests (com- mercial, manufacturing and sanitary) of New Orleans and of the State of Louisiana de- mand the record of the measures devised by the Board of Health for the arrest of yellow fever in 1882. This record possesses an especial interest and value, in that yellow fever in 1882invaded Brownsville, Texas, in the West, aud Pensacola, Florida, in the East. The Board of Health of the State of Louisiana devised and executed the measures for the arrest of yellow fever in New Orleans during the year 1882. FIRST CASE OF YELLOW FEVER IN NEW ORLEANS IN 1882- HENRY FORBES. SPECIAL MEETING OF THE BOARD OF HEALTH, HELD AT 1 O'CLOCK P. M., JUNE 27, 1882. The President, Dr. Joseph Jones, stated that he had convened the board in special session, open to the representatives of the press and of the medical profession, and, in fact, to all respectable citizens, in order that the people here, and in all surrounding LVI Cases of Yellow Fever in 1882. States, should receive a full and accurate statement of all the facts with reference to the occurrence of the first case of yellow fever in 1882. On the morning of June 26, the following communication was received from Dr. A. W. deRoaldes, Surgeon in charge of the Charity Hospital: CHARITY HOSPITAL. STATE OF LOUISIANA, ) New Orleans, June 26, 1882, 5 Dr. Joseph Jones, President Louisiana State Board of Health : Dear Doctor-My attention was called this morning to a patient, coming from Havana, in ward 27 of the hospital, After a careful examination, I find the case a very suspicious one, to say the least. I would earnestly request you to call at the hospital at your earliest convenience, when I shall take pleasure in seeing the rase with you. ' Your most obedient servant, DR. A. W. DeROALDES, House Surgeon. I repaired immediately to the Charity Hospital, and ascertained the following facts at the bedside of the patient, and from the hospital register . Henry Forbes, aged 20, native of England ; has resided about ten days in New Or- leans ; entered Charity Hospital (ward 27, bed 396) at nine o'clock a. m., Sunday, 25th, instant. The patient gave the following history : "Left Montevideo on Spanish brigantine Ritta, for Havana, via Costa Rica. On board this vessel was a passenger recovering from chills and fever, contracted in Rio de Janeiro. Length of passage from Montevideo to Havana, fifty-four days. * "Was in Havana five Jays, during which time he was on shorea day and a-half, but did not pass a night on shore. Came from Havana to New Orleans on steamship Marco Aurelio. Was eight days from Havana to New Orleans, including the detention at the Mississppi Quarantine. "Arrived in New Orleans on Sunday, eighteenth instant, and was discharged on Tuesday, and went to boarding-house 98 Old Levee street, near corner of Enghien street, where he remained until Wednesday, twenty-first. "Wednesday morning, went on board of steamship "Commander," of London, and was set to work painting the ship. On Thursday, twenty-second, at 8 a. m., was taken with a chill, followed by fever. Returned to boarding-house on Old Levee street, and re- mained there until Sunday morning, twenty-fifth instant, when he was sent to the Charity Hospital. At the time of admission to Charity Hospital appeared jaundiced and weak." , The following is the record, as detailed by the hospital student and entered upon the Hospital Register: "9 a. m., Sunday, twenty-fifth instant: Appeared jaundiced and weak; had rather intense fever, nausea and vomiting, diarrhoea, tongue coated with whitish fur, head- ache, no backachetenderness and pain on pressure over stomach, spleen and liver; tendency to epistaxis; small amount of blood vomited-may have been from epistaxis; general appearance of vomit was bilious. Ten grains each of calomel and soda given ; also one ounce of liquor cinchonidiae. Half at 11 a. m., remainder at 8 p. m. June 26, 5:30 a. in.: Patient ejected a considerable amount of black vomit; tempera- ture 100° F. in axilla; pulse frequent and weak ; 12 m. tincture of digitalis given. 8:15 a. m.: Temperature in axilla 103.2°; pulse 108 and weak; patient rational, but deaf from effect of abscess of ear, which occurred some weeks ago. Passed no urine since 9 o'clock last night; at 8 a. m., June 26, catheter was introduced, and about four ounces of urine drawn, which contained an immense amount of albu- men, and a considerable quantity of urates; tongue very red, with dry, brownish fur in center; gums congested; epistaxis, palpebral conjunctiva distinctly injected; sclerotic yellow; photophobia; patient burning, with a dry skin of a yellowish hue over trunk. Great tenderness over region of epigastrum, over spleen and liver, but no enlargement of these organs; black vomit continues. Temperature at 9:40 a. m. 102.5°, pulse 105. The preceding notes were recorded by Mr. H. B. Williams, resident student, Charity Hospital. Dr. C. Faget, Sanitary Inspector of the Second District, and visiting physician of the Charity Hospital, also furnished the following statement to the President of the Board of Health. NEW ORLEANS, June 26, 1882. Information received from patient Henry Forbes, sick in Charity Hospital, ward 27. Henry Forbes arrived from Havana on board steam-bark Marco-Aurelio on Sunday, June 18, now lying at Algiers. He was taken sick June 22, on board steamer Commander, which has now departed for Liverpool. Seen to- day in Charity Hospital, ward 27, throwing up black vomit (coffee ground), red and yellow suffusion of eyes and skin, pain in epigastric region, pulse rapid and weak, slight delirium (prognosis unfavorable). Upon careful examination of Henry Forbes at 10:30 o'clock a. m., I found the patient with a temperature of 102.5° ; full but soft pulse. 100 per minute; jaundice; capillary congestion of surface and conjunctiva; ejection of black vomit at short intervals ; urine limpid contained albumen and casts. -The urine and black vomit were examined imme- OP Illustrating the COURSE of the TOTAL MORTALITY, the MORTALITY of CHILDREN under five years of age, and the CHIEF FATAL DISEASES in the CITY of NEW ORLEANS DURING THE SIX MONTHS, ENDING DECEMBER 31st. 1880. With Meteorological Observations during the same period H»wori<»Muao(Wh1»s.naEDs»vi»g^^ Week July. August. September. Oetober. s November. । December. Ending. 3d 10th 17th 24th 31st 7th 14th 21st 28th 4th 11th 18th 25th 2d 9th 16th 23d 30th 6th 13th 20th 27th 4th 11th 18th 25th 31st ■ ' ----- ; - -4 i- - -- ; i i ! । I - - ' . . > : . : . rr RAINFALL, 1.64 3.10 1.91 1.35 3,22 2.61 1,93 0.06 0.00 1.90 2.67 0.00 2.14~ 0.79 0.18 0.67 0.00 1.01 2.19 1.73 1.48 0.55 0.67 1.05 2.17 1.88 0.78 I T3768' Mean Thermometer, 32.5 83.3 82.5 81,2 80.5 81.2 80.2 83.o 82.5 82.1 76.1 77.1 77.8 72.8 72.4 74.7 62,6 63.4 6u 60.0 49.9 517 65.9 537 6io 46.4 37.1 Mean Barometer. so.os 30.10 30.05 30.03 30.04 29.99 30.03 30.05 30.03 29.88 30.01 30.05 30.07 30.11 29.98 so.os 30.22 30.02 30.03 30.11 30.22 30.27 30,29 3074 2974 30.15 30.23 Deati rate per / TOTAL. 26.96 23.83 24.07 22,38 18.25 21.42 17.33 25.75 24.55 24.55 21.66 ~3077 ^03 2575 2311 25.03 2778 ~2942 2971 26.96 31.53 23.59 20?46= " 25.75 | 23.5^1^781 25.19 ] 1000 Population. White. 23.87 21.58 22.22 19.62 15.37 13.40 15,37 23,54 21.25 20.27 18.64 24.85 23.54 23.22 21.25 22.22 23.87 29.10 28.45 28.12 21.58 27.40 2372 1672 2573 1733 25.32 22.28 WAsm pool'd. 35.5s 30,10 29.19 30.10 26.45 43.79 22.80 32.84 33.75 36.49 30.10 46.49 29.19 ^29.19 3871 2574 28.28 23.71 ~3LoF' 33.75 41.96 4277 24.63 1*274 25.54 41.05 46.02 3373 MORTUARY. The heavy black line in centre of Chart represents the Total Mortality from all causes. The unbroken black Une near bottom of Chart represents Total Mortality of Children under y years. The blue line near bottom of Chart represents Mortality by Phthisis Pulmonalis. The unbroken ochre line near bottom of Chart represents Mortality by Diarrhoeal Diseases. The broken ochre line at bottom of Chart represents mortality by Yellow Fever. The crimson line near bottom of Chart represents Mortality by all Malarial Fevers. METEOB_OLO G-ICAL. The vertical bars at top of Chart show daily rain fall (in inches?) The perpendicular bars in center of Chart show daily range of Temperature. The irregular crimson line in centre of Chart shows average Temperature (daily?) The irregular blue line in centre of Chart shows relative Humidity (daily?) The irregular ochre line in centre of Chart shows mean barometric pressure (daily?) Yellow Fever, 1882-Case of Forbes. LVII diately at my office. The black vomit contained masses of haematin, altered blood, cor- puscles, cells of the mucous membranes of the stomach and mucous corpuscles. The casts of the tubuli uniferi in the urine were opaque and filled with granular matter. In reply to a dispatch asking full particulars as to the sanitary condition of the steam- ship Marco-Aurelio, the Assistant Physician at Mississippi Quarantine Station replied as follows: MISSISSIPPI QUARANTINE STATION, ? June 26, 1882. ' J To Dr. Herrick: The new iron steamship Marco-Aurelio was in fine sanitary condition. Three days from Havana and three days here, total six. All well wh n she left here, June 17; thoroughly fumigated and disinfected here. She is a cattle boat, and thoroughly ventilated, C. P. WILKINSON. I next visited the locality from whence the seaman, John Forbes, had been removed to the Charity Hospital. Mrs. Viana, residing at No. 98 Old Levee street, stated that Henry Forbes came to her house on Monday, the nineteenth. On Wednesday, the twenty-first, he took his cloth- ing and went on board the "Commander," and commenced painting the ship. Slept aboard the "Commander" Wednesday night. Was seized with a chill Thursday morning, and returned to her house. The man ap- peared to be in good health on Monday and Tuesday. When he returned on Thursday his eyes were bloodshot, and he complained of a severe headache. On Friday had fever; was very restless, and drank much water, and vomited at intervals. Finding the man ill. and having no means with which to employ a physi- cian, he was sent to the Charity Hospital on Sunday morning. Mrs. Viana is forty-eight years of age, native of Germany ; has resided in New Orleans thirty-six years; has one child, thirteen years of age. Her premises are clean. She stated that the room in which Henry Forbes had lain sick had been thoroughly cleansed and left open, and I found the door and window open and the floor clean. The adjoining premises, corner Old Levee and Enghien streets, are occupied by Madam De Bly, who has lived in New Orleans twenty-eight years, and has had yellow fever- daughter twenty-one years of age, native of New Orleans ; has two children, one of them an infant at the breast. The front portion of her house is occupied by Mrs. Mary Jalet age thirty, who keeps a grocery. This woman was suffering with neuralgia of the rioht side of the face, to which she has been subject In the other portion of the back premises resided a man and his wife and three healthy children. In a small room in the rear of that occupied by Henry Forbes resided an old man. It is evident, therefore, that fifteen souls occupied the front, rear and side premises which surrounded a small yard or court. Inspection of the houses in the immediate vicinity failed to reveal any cases of sickness. The following instructions were issued to Dr. Mioton, in person, by the President of the Board of Health. Dr. E. J. Mioton, Sanitary Inspector, Third District: Sir-You will proceed immediately to inspect, disinfect and fumigate the house No. 98 corner of Old Levee and Enghien streets, occupied by Mrs. Viana, from where Henry Forbes, seaman from steamer Marco Aurelio, was removed to the Charity Hospital on the twenty-sixth. Thoroughly fumigate the rooms and all clothing with sulphurous acid gas, and disinfect the privies and drains with copperas and carbolic acid. All unpainted wood-work should be whitewashed. Proceed in this manner until the entire block and the block on the other side of Enghien street, have been thoroughly cleansed and disinfected ; then continue in same manner for the blocks in the rear and on either side of the row mentioned. Hold the entire neighborhood under close surveillance. Detail Officer Evans for this special duty. Your sanitary office has been amply supplied with disinfectants, by the Board of Health for all present emergencies. The Auxiliary Sanitary Association will furnish two carts and four men for the distri- bution of the disinfectants of the Board of Health, as you will obser ve from the enclosed communication of the Sanitary Director. Have a careful sanitary inspection made of the immediate vicinity, and report the re- sults to the Board of Health. I shall continue to inspect the locality in person. The Board of Health demands that your action should be prompt and vigorous. Detail Officer Nowell to the disinfection and fumigation of the steamship "Marco Aurelio," now lying directly across from the United States Mint, near the Third District ferry-landing. Furnish her with all necessary disinfectants and apparatus. JOSEPH JONES, M. D., President Board of Health, State of Louisiana 7 LVIII Return of Steamship Marco Aurelio to Quarantine. STEAMSHIP MARCO AURELIO. I visited the steamship Marco Aurelio, lying about two blocks above the Third District ferry-landing; thoroughly inspected the ship, and mustered and examined her officers and crew. The steamship Marco Aurelio was built at Greenock, Scotland, for the cattle trade. Her first trip was on August 21, 1881, to Kingston Jamaica: and since that time she has been running between Havana (Cuba), and Truxillo (Spanish Honduras), engaged in the cattle trade. Laid at Truxillo at anchor from May 16 to June 6 ; reached Havana on the ninth of June; laid at anchor half a mile from shore, about abreast of Casa Blanca. The only time that she communicated with the shore was when her cargo of cattle was landed, then moved out in harbor half a mile from shore. Took in some coal from a barge along- side of her. Took no cargo, no ballast at Havana ; in fact, her ballast is simply water ballast. Remained two days at the port of Havana. Had twenty-eight men when she arrived; twelve men left, and four new men were shipped, including Henry Forbes. These men came on board on the tenth and eleventh of June. Henry Forbes, who came on board on the tenth, was used as an assistant to the cook. The names of the men shipped at Havana were, Thomas Martin, Lars Peder- sen and Peter Pedersen. These men were diseharged after their arrival in New Orleans, and are now in the city. CONDITION OF CREW. Careful inspection of each of the crew, the mate, engineer, the firemen and sailors, revealed them in perfect health. Appended is a detailed list. The following detailed statement was drawn up on the deck of the steam vessel; the facts being elicited by direct inquiries and personal examination of the officers and crew : Steamship "Marco Aurelio" (English), Thos. Morgan, Captain, was built at Greenock in 1880, and has been in the cattle trade between Truxillo (Spanish Honduras) and Havana since that time. From May 16 to June 6, 1882, she was lying at Truxillo, when she left for Havana with a cargo of cattle, arriving there June 9. On June 11, after discharging cargo, she left Havana in ballast, and arrived at the Mississippi Quarantine Station at 11 o'clock p. m., June 14. Here she was detained three days (the time prescribed by the proclamation of the Governor), leaving the station at 9:39 p. m., June 17, and arrived at Algiers at 9:30 a. m., June 18. From Truxillo to Havana she carried altogether twenty-eight men ; twelve of these left there and four new hands were engaged, leaving her only twenty men, with which number she arrived at New Orleans. Since her arrival here three of these men have al- ready left the port on other vessels, eight are still working in the ship, and four (among which is the man "Forbes") are on shore. Three of these board at a house on St. Peter, between Chartres and Royal streets, kept by Mr. John Ward. The following gives their names and history : Lars Pedersen, age thirty-two years and six months, native of Norway, has sailed in hot climates for the past twelve years; has had what he considers yellow fever on the coast of Africa ; was ashore in Havana on and off for about eight or nine days. Peter Pedersen, age thirty-five years, native of Denmark, has sailed between the West- ern Coast of South America and Australia. Came last from Montevideo to Havana, where he boarded for eight or nine days in a house near the Gasworks ; has never had yellow fever. Thomas Martin, age thirty-four years, native of Liverpool, has been sailing between New Orleans and Liverpool for the last eighteen years ; has never had yellow fever. The following is a list of the men remaining on board ship : Thos. Morgan, captain : Win. A, Gaw, first mate ; Jno. Ballawitch, second mate; A. L. Shaw, chief engineer; Theod. Clark, steward; Stephen Valero, watchman; A. Lazaro- wich, seaman ; B. Judewich, seaman ; J. Beriat, seaman ; Manuel Peralto, fireman ; Ben- ito Dusse, fireman ; Seraphina Espanio, fireman ; Douglas Thompson, carpenter. All of these men are thoroughly acclimated, except perhaps the three seamen (Aus- trians), and these have had what they call "Tampico" fever. Henry Forbes, the man now sick at the Charity Hospital, is a young man about twenty years of age, and a native of England. Two months ago he shipped as seaman on the Spanish brigantine " Rita," bound from Montevideo to Havana, stopping on her way at Porto Rico. At Havana Forbes left the "Rita" and boarded ashore near the Gasworks for eight or nine days, when he shipped on the steamship Marco Aurelio. After arriving at New Orleans and being paid off, he went to board at No. 98 Peters street, Third Dis- trict, June 19. Made arrangements to work his passage to Liverpool on the steamer Commander, and was engaged on this ship, painting, until Thursday, June 22, when he Action of Board of Health, June 27, 1882. LIX came to his boarding house sick with fever and a severe headaeho. Not having much money, no physician was called in to attend to the man, but, growing worse, he was sent to the Charity Hospital on Sunday, June 25. CONDITION OF VESSEL. The vessel is one of the cleanest that I have ever inspected. The forecastle has been thoroughly painted, and she is being refitted and painted throughout. I placed Officer Nowell in charge of the vessel, and directed him to thoroughly fumi- gate and disinfect all parts. The three men were next visited on St. Peter near Chartres street, and carefully ex- amined with the following result: Lars Pedersen, native of Norway, has been sailing in tropical seas for many years, and has had yellow fever on the coast of Africa. Peter Pedersen, native of Denmark, has been in New Orleans and the West Indies for the last fourteen years, but has not had yellow fever. Thomas Martin, Englishman, has been in New Orleans on and off during the last twenty years. The following communication has been addressed to Dr. C. Faget, Sanitary Inspector, Second District: C. Faget, M. D., Sanitary Inspector, Second District: Sir-Hold the men, Lars Pedersen, Peter Pedersen and Thomas Martin, now in a board- ing house on St. Peter, between Chartres and Royal streets, under close observation. Fumigate and disinfect their clothing and the premises which they occupy. Inspect and disinfect the entire block upon which they are now located. Act immediately and promptly. The Board of Health has furnished your district with ample supplies of disinfectants. Respectfully, (Signed) ' JOSEPH JONES, M. D., President Board of Health. After the President had stated these facts he directed the attention of the Board of Health to the fact that both the house in which Forbes had died and the Marco Aurelio had been taken possession of by the officer of the Board of Health, Dr. Eugene Mioton, Sanitary Inspector of the Third District, who had thoroughly fumigated the house and premises No. 98 Old Levee street, disinfected the rooms, yard, drains and privy, and burnt up the clothing, bed and bedding of Forbes. The Marco Aurelio was under his direction also thoroughly disinfected and fumigated. The work of disinfecting every yard and house in the square in which Forbes lay sick, as well as those in surrounding squares, was progressing under the direction of the Sani- tary Inspector of the Third District. Upon the conclusion of the report of President Jones, Hon. Edward Booth offered a resolution that the Board approve the action taken by the President, and that they rely confidently upon the experience and skill of the medical staff of the Board to give the official force to the necessary repressive and preventive measures which a first case will naturally suggest apd justify. This was unanimously adopted, and the following dispatch was read: Baton Rouge, June 27, 1882. President Board of Health: Assemble the Board of Health and recommend the extension of quarantine to not less than twenty days. S. D. McENERY. The President stated that he had telegraphed His Excellency, Governors. D. McEnery, all the essential facts of the case of Forbes, and the preceding telegram was in response to his telegram. The Governor's telegram coming up for action, Dr. Pratt said he was in favor of in- creasing the detention at quarantine of vessels arriving from infected ports, from ten to twenty days, as the Governor recommended, believing the same to be a wise precaution, . and necessary under the circumstances. Dr. Formento said that, with all due respect to the Governor, he would ask the Board to forget the source of the telegram, and act upon the question to the best of their judgment as a body of intelligent sanitarians. In his opinion, time was of less conse- quence in preventing the appearance of yellow fever than the mode of treatment at Quarantine. Dr. Kells was in favor of an amendment that the Quarantine physician be instructed to exercise more vigilance. Dr. Pratt said the period of incubation of yellow fever was unknown. In Forbes' case, he was taken sick twelve days after he went on board the Marco Aurelio. Dr, Formento desired to be informed of the meaning of the words "an infected ship," LX Action of Board of Health, June 27, 1882. Dr. Kells moved that further consideration of the question to extend the quarantine to twenty days be postponed until the regular meeting to-morrow evening. Mr. Bosworth favored immediate action. The public mind was agitated over this one case of yellow fever, and he thought it but right that the Board should allay this excite- ment by increasing the time, as the Governor recommended. The yeas and nays being called on postponement, Drs. Formento, Von Gohren and Kells, and Messrs. Marks and Booth voted in the affirmative, and Dr. Pratt and Mr. Bosworth in the negative. Hon. Edw. Booth, after citing the case of the Excelsior, offered the following reso- lution : Resolved, That the President of the Board take immediate steps to return the steamship Marco Aurelio to Quarantine, there to await the further orders of the Board. Dr. Jones considered it unnecessary to send the vessel back to quarantine, as she had been thoroughly disinfected, under liis orders to Dr, Mioton, and is isolated. Dr. Formento said he should oppose the passage of the resolution for these reasons, and also if there was any danger the mischief was done already, as she had been at Algiers nine days and had been visited by various persons who cannot now be found. Mr. Booth believed in the Board doing what it could, if it could not do what it would. Dr. Jones said the cases of the Excelsior and Marco Aurelio were different. On the former the men sickened on board, and she had a cargo, while no sickness has occurred on the latter, the Marco Aurelio having no cargo on board and coming in with water ballast. Dr. Formento said he did not consider the Marco Aurelio an infected vessel. Dr. Pratt considered it possible that she might be so. Mr. Booth believed in the Board taking action as if she was, and sending her back to quarantine. Dr. Formento said the man evidently contracted the fever at Havana, and not on board the vessel. Dr. Pratt said, under the circumstances, it must not be presumed that the Marco Aurelio was free from infection simply because there was no sickness on board. Mr. Booth said that the ship that brings a case of yellow fever from an infected port must be held responsible as a sanitary criminal, and must be treated accordingly. Dr. Formento said he was unable to see any criminality, sanitary or otherwise, in the case of the Marco Aurelio, she having broken no quarantine rule or regulation. Mr. Marks referred to the vessel which sent a cargo of sugar in lighters to Brooklyn, and one of the crew being taken sick with yellow fever in that city, and the vessel and man were sent back to quarantine. The yeas and nays being called for on the passage of the resolution, Drs. Pratt and Kells aud Messrs. Marks and Booth voted in the affirmative, and Drs. Formento, Von Gohren and Mr. Bosworth in the negative. Dr. Jones asked for the views of the board in relation to returning the unacclimated members of the crew to quarantine with the vessel. Dr. Pratt was in favor of sending the men back with the vessel. Mr. Booth suggested that they be kept under surveillance by the sanitary inspectors. The Board of Health then adjourned. Immediately after the adjournment of the Board of Health, the follow- ing orders were issued: Office Board of Health, State of Louisiana, ) New Orleans, June 27, 1882. $ Captain Thomas Morgan, Master Steamship Marco Aurelio, New Orleans, La. : Sir-Your attention is directed to the following resolution of the Board of Health of the State of Louisiana : fExtractfrom Minutes of Board of Health, special meeting held June 27, 1882]. "By Mr. Booth- "Resolved, That the President of the Board take immediate steps to return the steam- ship Marco Aurelio to quarantine, there to await the further orders of the.board." This resolution was offered in consequence of the death by yellow fever this morning in the Charity Hospital of New Orleans, of Henry Forbes, who wasshipped on board the Marco Aurelio at Havana, and.brought by said vessel to this port on the eighteenth of Tune. You will also cause the return of all seamen and officers who were present on board the Marco Aurelio at the time of her leaving Havana, on the eleventh of June. 1882, in- cluding Lars Pedersen, Peter Pedersen and Thomas Martin, now residing at No. 40 St. Peter street, at a house now kept by Mr. John Ward, to the Mississippi Quarantine Station. Action of Board of Health, June 27, 1882. LXI Therefore, in behalf of the public safety, and in obedience to the acts of the General Assembly, establishing and regulating quarantine for the protection of the State against the importation of fever and pestilence, you are hereby commanded to return y our vessel, the Marco Aurelio, to the Mississippi Quarantine Station or to any point without the waters of Louisiana. (Signed) JOSEPH JONES, M. D., President Board of Health, State of Louisiana. Office Board of Health, State of Louisiana, ( New Orleans, June 27, 1882. ( To the Civil Sheriff of the parish of Orleans, Greeting : Whereas, due and sufficient proof has been adduced before the Board of Health of the State of Louisiana, that the steamship Marco Aurelio did, on or about the eighteenth day of June, 1882, bring a seaman named Henry Forbes to the port of New Orleans, and that the said Henry Forbes sickened with yellow fever June 22, and died on June 27 of yellow fever, in the Charity Hospital of New Orleans: At the special meeting of the Board of Health, held this day, June 27, 1882, it was Resolved, That the President of the Board take immediate steps to return the steamship Marco Aurelio to quarantine, there to await the further orders of this board. Now, therefore, this is to command you to remove, forthwith, said steamship, withher officersand crew, including Lars Pedersen, Peter Pedersen and Thomas Martin, now boarding at No. 40 St. Peter street, at the house kept by Mr. John Ward, to the Missis- sippi Quarantine Station, subject to the further orders of the Board of Health, in accord- ance with the laws of the State of Louisiana, instituted for the protection of the State against the introduction of foreign pestilence. Given under my hand and the official seal of the Board of Health of the State of Louisiana, in the city of New Orleans, this twenty-seventh dav of June, 1882. (Signed) JOSEPH JONES, M. D., President Board of Health, State of Louisiana. CORRESPONDENCE OF BRITISH CONSUL. BRITISH CONSULATE, ) New Orleans, June 28, 1882. j Dr. Joseph Jones, President Board of Health, New Orleans, La.: , . Sir-The captain of the steamship "Marco Aurelio" has laid before me your letter to him, dated yester- day, in which he is commanded to return his ship to the Quarantine Station, "in obedience to the acts of the Senate and House of Representatives, regulating quarantine for the protection of the State." I respectfully beg to be referred to the section under which this command is made. I have the honor to be, sir, your obedient servant, (Signed) A. de G. de FONBLANQUE. BRITISH CONSULATE, > New Orleans, June 28, 1882. 5 Sir- The master of the British steamship "Marco Aurelio " has laid before me your letter to him of the twenty-seventh instant, in which you required him to cause the return of all seamen and officers who were present on board of her on the eleventh of June, 1882, including Lars Pederson. I have the honor to inform you that the entire crew of this steamship were paid off and discharged before me on the twentieth instant, and that consequently the master has no authority over them. With regard to returning the ship to Quarantine Station. I await your reply to the question put in my first letter of this day, Begging you will have the goodness to refer me to the Revised Statute of the State for any legislation prior to March 14, 1870, I have the honor to be, sir, your obedient servant, A. de G. de FONBLANQUE. OFFICE BOARD OF HEALTH, STATE OF LOUISIANA, I New Orleans, June 28, 1882. 5 Hon. A. de G. de Fonblan'que, Consul of Great Britain: Sir-I have the honor to acknowledge your communication of this instant, and in accordance with the request of the British Consul, enclose extracts from the Organic Acts of the Legislature of Louisiana, relating to the case of the steamship. Respectfully your obedient servant, . (Signed) JOSEPH JONES, M. D., President Board of Health, State of Louisiana. [Extracts from the Acts of the General Assembly establishing quarantine for the protection of the State.] Section 6 of "An act to establish a quarantine," etc., approved March 15, 1855, reads as follows : ***** The Board of Health shall have power to issue warrants to any constable, police officer or sheriff in the State, to apprehend and remove such persons as cannot be otherwise subjected to the provisions of this act, or who shall have violated the same, and whenever it shall be necessary so to do, to issue their warrants to the sheriff of the city or parish where any vess d may be. having violated the provisions of this act. commanding him to remove said vessel to the quart ntine grounds, and arrest the officers thereof, all which warrants shall be executed by the officer to wh nn the same shall be di ected, who shall possess the like powers in the execution thereof, and be entitled tc the same compensatio 1 as if the same had bepn duly issued out of any court in the State. * * * * * Revised Statutes of Louisiana fot"187b: ' ' LXII Letter of President to Governor McEnery. Sec. 3039. * * * * The Boar(i of Health shall have power to issue their warrants to the sheriff of New Orleans or of any parish where anv vessel may be to have such vessel, if they deem it necessary for the protection of health, removed to the Quarantine Station. * * * The Board of Health shall have power to extend the quarantine, should it be deemed necessary by them. Section 6 of an Act approved March 16, 1870, reads: The Board of Health shall have power to issue their warrant to any constable, police officer or sheriff in the State, to apprenend and remove such person or persons, as cannot otherwise be subjected to the provis- ions of this act, or who shall have violated the same, and whenever it shall be necessary so to do, to issue their warrants to the sheriff of the city or parish where any vessel may be having violated the provisions of this act, commanding him to remove said vessel to the quarantine ground, and arrest the officer thereof, all which warrant shall be executed by the officer to whom the same shall be directed, who shall possess like power in the execution thereof, and be entitled to the same compensation as if the same had been duly is- sued out of any court in the State BRITISH CONSULATE, 1 New Orleans, June 29, 1882. J Joseph Jones, M. D., President Board of Health, New Orleans, La. : Sir-I have the honor to acknowledge the receipt of your letter of the twenty-eighth instant and its in- closure. Section 3039 of the Revised Statutes appears to be conclusive as regards the ship. I have the honor to be, sir, your obedient servant. A. dbG- de EONBLANQUE. EXECUTIVE DEPARTMENT, STATE OF LOUISIANA, ) Raton Rouge, June 17, 1882. 5 Dr. Joseph Jones, President Louisiana Board of Health: Dear Sir-In view of existing danger, I respectfully recommend that the period of detention at Quaran- tine be extended not less than t wenty days, and that the full powers of the Board of Health be employed in securing the safety of this and and neighboring States. V ery truly, yours, S. D. McENERY, Governor. LETTER OF PRESIDENT OF BOARD OF HEALTH TO GOV- ERNOR McENERY, INCLOSING ORDER RELATING TO THE RETURN OF THE "MARCO AURELIO" TO MISSISSIPPI QUARANTINE STATION. Office Board of Health, State of Louisiana, > New Orleans, June 29, 1882. ( His Excellency, S. D. McEnery, Governor State of Louisiana, Baton Rouge, La.: Dear Sir-I have the honor to inclose for the information of your Excellency, the es- sential facts relating to the case of yellow fever which terminated fatally, in the Char- ity Hospital, on the twenty-seventh instant; also, the orders issued to the captain and Civil Sheriff for the removal of said vessel to the Mississippi Quarantine Station. This case furnishes a striking illustration of the neccessity of legislative action, fixing a definite period of quarantine detention of not less than ten (10) days, as in the original act of 1855. This subject was urged by the President upon the General Assembly of Louisiana, in the annual report of the Board of Health for 1881 (see introduction and pp. 109, 120, 292), but up to the present moment, no action has been taken by the General Assembly with reference to this most important matter. Every precaution has been taken, and the necessary sanitary measures will be con- tinued, and upon a calm review of the situation, I hope for a complete suppression of all ill effects from this imported case. With great respect and high esteem, I have the honor to remain, Your obedient servant, (Signed) JOSEPH JONES, M. D., President Board of Health, State of Louisiana. MISSISSIPPI RIVER QUAR \NTINE, ? , June 26,1882. 5 Dr. S. S. Herrick, Secretary Board of Health, New Orleans: Dear Sir-Enclosed please find roll for week ending June 24, 1882, and checks 433-438 inclusive of each- The new iron steamship Marco Aurelio has been engaged during the past winter in carrying cattle from Truxillo to Havana. She arrived at this station on June 14, at 10 o'clock p. m., with all well on board, and having had no sickness on board at all. Was fumigated and disinfected on the fifteenth. Every one being well on board, on June 17, at 10 o'clock p. m., she was released from here. The vessel is now lying at Algiers, and can be inspected there. Your obedient servant, C- P. WILKINSON, Assistant Resident Physician. QUARANTINE STATION, June 29, 1882. Dr. Joseph Jones, President Board of Health: The Marco Aurelio, with a crew of twelve, and four deputy sheriffs ou board, arrived last evening. Ha^e detained sheriffs. All Well. U. P'. WILKINSON, M. D, Case of Louis Deschler, of 1010 Tchoupitoulas Street. LXIII MISSISSIPPI RIVER QUARANTINE, ? J"uu© 29 1662 S Dr. Joseph Jones, President Board of Health, New Orleans: Sir- About 7 o'clock p. m. yesterday, the steamship Marco Aurelio arrived here, having on board a crew of twelve men and four deputy sheriffs. The vessel was seized and sent away from New Orleans without giving any opportunity to the officers or crew to secure any provisions or bedding or mosquito bars. The sheriffs having come down on board of the steamer, and none of them having had yellow fever, I hav» detained them on board and subjected them to the same quarantine as the crew of the vessel. About the same time of the arrival of the steamship the Norwegian bark Hans Nilsen Hauge arrived at the station with a cargo of sugar from Havana and Cardenas. She lay thirty days in Havana. I respect- fully suggest that discharge of cargo for purposes of better purification be ordered for this and similar vessels from Havana. Your obedient servant, C. P. WILKINSON, Assistant Resident Physician. _ T ™ ™ ~ NEW ORLEANS, July 7, 1882. To J. F Finney, M. D.: If satisfied that the Marco Aurelio is no longer a source of danger, and if officers and crew are in good health, release her. JOSEPH JONES, M. D., President Board of Health. The preceding telegram was forwarded in accordance with the formal resolution of the Board of Health. In accordance with the petition of Thomas Martin, P, Pedersen and L. Pedersen, the Board of Health appropriated an amount satisfactory to these men, sufficient to reimburse them for their extra expense while upon the Marco Aurelio. Mrs. Viana was also reimbursed for articles destroyed by burning. CASE OF LOUIS DESCHLER, OF NO. 1010 TCHOUPITOULAS STREET, DIED IN CHARITY HOSPITAL OF NEW ORLEANS, JULY 17, 1882. Charity Hospital, July 17, 1882. Dr. Joseph Jones, President State Board of Health : Dear Sir-A case of yellow fever died in ward 24 this evening at 1 o'clock. We will give you the history of the case. The body lies exposed for your examination. Very respectfully, ' A. B. MILES, M. D. CLINICAL REPORT OF THE CASE OF LOUIS DESCHLER, AS FURNISHED TO THE BOARD OF HEALTH OF THE STATE OF LOUISIANA, BY DR. A. B. MILES, SURGEON IN CHARGE OF THE CHARITY HOSPITAL OF NEW ORLEANS. Louis Deschler, aged 31 years, native of Germany, resident in New Orleans twelve years, entered the hospital, ward 24, at 9 a. m. Sunday, the sixteenth of July. Patient's account of his early illness are conflicting At one time he stated that he had been sick one week, with accessions of fever every second day; later he informed the student of the ward that he had fever every day. The temperature was not regis- tered upon admission, but to the touch, seemed normal. Condition at 7 p. m., July 16, noted by Dr. Jamison: Patient jaundiced; tongue pointed, with red edges; gums congested; epigastric tenderness; urinary bladder empty. Patient stated that no urine had passed since Friday, the fourteenth of July. Mind unsteady, patient responding incoherently. Temperature, 104° F. ; Pulse, 120. Monday, 17, 9 a. m.: Jaundice increasing; epigastrum more painful upon pressure. Patient passed urine during the night (two ounces), which, upon examination, contained albumen (thirty-three per cent), hyaline casts and large quantity of bile. When left alone, patient wandering and restless; when aroused answering correctly; Tempera- ture, 105° F.; pulse, 120. During the forenoon on Monday, the symptoms increased in severity. The tempera- ture ranged between 105° and 106° F. Pulse rapid, excited by convulsive muscular movements; marked tenderness over the epigastrum; nausea, but no vomiting ; a red, glazed tongue; gums congested, with some hemorrhage; conjunctiva jaundiced and in- jected; and, withal, the facies, which we regard as almost characteristic. Before death, patient exhibited the nervous phenomena of uraemic poisoning, and died at 12:30 p. m, July 17, with a temperature of 109° F. Diagnosis, yellow fever, indorsed by physicians in attendance, Drs. Veazie, Jamison and Miles. LXIV Case of Louis Deschler, of 1010 Tchoupitoulas Street. Office Board of Health, State of Louisiana, I New Orleans, June 17, 1882. ) Dr, Kelly, President Galveston Board of Health, also Presidents of Boards of Health of Tennessee, Missis- sippi, Alabama and Florida, and to the Associated Press : This day (July 17), about 2 p. m., I was requested by Dr. Miles to examine a corpse lynig in the dead-house of the Charity Hospital. Exterior of body, golden colored; no marked mottlings of dependent portions. Unusual golden color of integuments ; fibrous tissues and coats of vessels and serous membranes yellow from the diffusion of bile. Heart normal in size, firm in texture; under microscope transVersed strife of muscular tissue distinct; no fatty degeneration of heart. Textures of heart and pericardium dis- colored by bile. Liver congested and of a browisnh red color, with portions of a lighter shade; under microscope, liver cells distinct, with no marked accumulation of oil glo- bules, as in the liver of specific yellow fever. Mucous membrane of stomach highly congested; contained two fluid ounces of a reddish-colored liquid, congealable by heat and nitric acid, and abounding with epithelial cells of mucous corpuscles, with compara- tively few blood corpuscles. Liquid of stomach contained bile. The gall bladder contained about one and a half fluid ounces of a reddish albumenoid liquid, congealable by heat and nitric acid, containing numerous epithelial cells. Kidneys large and congested. Urinary bladder contained about one fluid ounce of golden-colored urine, containing a moderate quantity of albumen and golden-colored casts. Many of the casts were transparent, with littleor no granular matter, indicating that Bright's disease may have existed before the supervention of jaundice and fever. History of Case.-From the Hospital Register, as well as from a searching personal investigation, I gather the following facts: Louis Deschler, age 31; native of Germany; resident of New Orleans twelve years; brewer by occupation ; is said to have had yellow fever in 1878 ; has suffered with a large ulcer on left leg, for which he was treated in the surgical ward of the Charity Hospital from October, 1881, to twenty-ninth December, 1881. For some years worked in Canal Brewery, near Old Basin ; on twenty-ninth December, 1881, entered brewery 540 Tcboup- itoulas and remained there until thirty-first March; twentieth June, 1882, entered brew- ery 1010 Tchoupitoulas street, near elevator. This house is the only one on the square, and is entirely isolated. Habits like those of many brewers, intemperate. On Tuesday night, eleventh July, whilst drunk, lay during the night in open air; complained next day of sore throat, and wrapped ice around his neck. Dr. C. R. Schuppert, Jr., saw him on twelfth, and states that he was jaundiced and suffering from the too free use of alchoholic stimulants; pre- scribed a dose of Glauba salts; thirteenth, jaundice well marked, no fever; head cool; patient complained of chilly feelings; prescribed podophilin as a purgative. According to statements of landlady, on fourteenth (Friday) ami fifteenth (Saturday) patient was alternately up and obout and lying down, and drank two bottles of wine. Admitted to Charity Hospital morning of sixteenth instant, and stated that he had suf- fered with access of fever every second day. Fever increased at 7 p. m.; temperature of axilla, 104° F; seventeenth, at 9 a. m., temperature 105° ; 12 m., 107°; 1 o'clock p. m., temperature of axilla 109.5°. The patient died in less than twenty minutes after this rapid rise of temperature. We have in this case a history embracing intemperance, intense jaundice, free purga- tion, no vomiting, albumenania, congestion of internal organs, rapid rise of tempera- ture, and death. (Signed) JOSEPH JONES, M. D., President Board of Health, State of Louisiana. COPY OF LETTER FROM DR. CHAS. R. SCHUPPERT, WHO ATTENDED TO L. DESCHLER, ON TCHOUPITOULAS STREET. NEW ORLEANS. July 18, 1882, 1 P. M To Edw; Booth: The man who died at the Charity Hospital did not show any symptoms whatever of yellow fever. Mv diagnosis is gastro-duodenites, brought on by over-indulgence in spirituous liquors and exposure. I will gladly give any further information required. It is as ridiculous as unjust to even surmise yellow fever in this case. With great respect l am yours. (Signed) CHAS. R. SCHUPPERT. In addition to this Dr. Schuppert was visited by a Picayune reporter yesterday. He stated that the pa- tient, Deschler, was represented to be sick from lying out at night when intoxicated. On Thursday last, when Dr. Schuppert examined him, he says Deschler had no sign of fever whatever. He had a cold, clammy sweat upon him at that time, and his eyes were injected with bile. He complained of a pain in the stomach. For many days previous to this attack he was complaining of indigestion, with a slignt pain in the abdomen. lieport of Dr. Mandeville on Case of Deschler. LXV Dr. Schuppert states that he prescribed for jaundice, caused by an inflammation of the stomach and du- odenum, technically called duodenites. Dr. Schuppert says he was informed that on the following evening, in addition to drinking spirituous liquors and beer, Deschler drank two bottles of red wine. The next morning he was conveyed to the Charity Hospital. The men present at the autopsy were Dr Joseph Jones, President of the State Board of Health : Dr. S. S. Herrick, Secretary of the Board; Dr. S. E Chaille, resident member of the National Board of Health : Dr. Thomas Layton, Vice President of the Board of Administrators of the Charity Hospital; Drs. A. B. Miles and D. Jamison, respectively, Chief and Assistant House Surgeons of the hospital. Office Board of Health, State of Louisiana, ) New Orleans, July 18, 1882. ) Dr. Mandeville, Sanitary Inspector Fourth District: Sir-In consequence of the occurrence of a severe case of disease, attended with jaun- dice and high fever, at No. 1010 Tchoupitoulas street, and the fatal termination in the Charity Hospital, on the seventeenth instant, you will proceed at once to execute the following: (a) Proceed at once with your sanitary officers to 1010 Tchoupitoulas street, and make a thorough inspection. (b) Proceed at once to disinfect and fumigate the premises. (c) Keep the brewery, at No. 1010, near the gram elevator, under careful observation, and make inquiry as to prevailing diseases. ♦ (d) Extend inspection and disinfection to the squares around 1010 Tchoupitoulas street. (e) Act at once with energy, and report result to President of Board of Health. Respectfully, (Signed) JOSEPH JONES, M. D., . President Board of Health, State of Louisiana. NEW ORLEANS, LA., July 25, 1882. Joseph Jones, M. D.,'President State Board of Health: Sir-I would respectfully state I did not understand that a report was desired to be made on the twentieth instant, as I was anxious to obtain all facts relating to the case of Louis Deschler before doing so. On the eighteenth instant, in compliance with written instructions from you, I proceeded with my officers to the brewery, No. 1010 Tchoupitoulas street, and there fumigated thoroughly the room and bedding that had been occupied by Louis Deschler, after which the vault was disinfected with a solution of carbolic acid and feuic sulphate. The drains and gutters connected with the brewery were also cleaned and disin- fected with the same material. Chloride of lime was sprinkled around the yard. The batture of the river front was also treated in a like manner. All the vaults, drains and gutters from Washington to Toledano, and from the river front to Annun- ciation street, have been thoroughly cleansed and disinfected with the copperas and carbolic acid solution, all of which I superintended personally. As regards the loaning to the Sanitary Auxiliary Association of copperas, I would simply state that dur- ing my absence from the city, Dr. Bayley loaned them thirteen barrels of copperas, which has since been returned, and which we are now using. A requisition was made from this district on the Board of Health for one barrel of carbolic acid. We received only twenty gallons. The Sanitary Auxiliary Association furnished the lime and one-half barrel of acid, also one cart and four men, the Administrator of Improvements giving us the use of one man and a wagon. We are still disinfecting block by block, and by Saturday will have reached Laurel street. The health of the inhabitants in this locality is good. We have consumed twelve bands of copperas, and have eight on hand. No copperas has ever been dis- tributed gratuitously amongst the citizens in this district from this office, except when they called in per- son for it. The Sanitary Auxiliary Association have, however, distributed packages through a portion of this district. All of the disinfection and fumigation which has been done in this district has been under the direct control and supervision of myself and officers. It is but just to ourselves that we should not allow the Sanitary Auxiliary Association to take all the credit upon themselves in this matter, for we have done the work, and can do as well without them as with them. Very respectfully, W. R. MANDEVILLE. M. D„ Sanitary Inspector Fourth District. NEW ORLEANS, July 27, 1882. Joseph Jones, M. D., President Board of Health: Sir-In compliance with your verbal request of the twenty-sixth instant. I have the honor to make the following report regarding the case of Louis Deschler, No. 1010 Tchoupitoulas street: Mr . Jacob Web, No. 1005 Tchoupitoulas street, testifies as follows: Knows Louis Deschler one year, says that he complained about eight oi' ten days before going to the hospital, thinks he went to the hos- pital in a street car, habits have been intemperate Mr. J. Jung, No. 1013 Tchoupitoulas street, says that he has known Mr. Deschler for three weeks be- fore he went to the hospital, and told him that when he first saw him, that he had jaundice, and also says that his habits were intemperate. Chas. Horning, barber, No. 1019 Tchoupitoulas street, says that he shaved Deschler several days pre- vious to his sickness, and that he was then yellow ; knows positively that for two months he had a'yellow appearance, and that he never had any communication with the shipping; says that he went to the hos- pital in a street car. Mrs. Bassimer, who lives at the brewery, says that he worked there twenty-seven days, and in that time had no communication with the shipping : thinks that the statement of Dr Schuppert. ns she read it in the paper, is the correct one. 8 LXVI Yellow Fever, 1882-Case of Johannes Stroh. Andrew Miller, of the same place, coincides with the above statement in every particular. These are all the facts that can be obtained in regard to this case, and can be sworn to if required. Very respectfully, JOHN LOGAN, Sanitary Officer Fourth District. NEW ORLEANS, La., September 13, 1882. Joseph Jones, M. D., President Board of Health: Sir-I enclose a condensed report of the case of Louis Deschler for your consideration, supposed to have died of yellow fever, in the Charity Hospital, on the seventeenth day of July, 1882. The testimony of the neighbors regarding his intemperate habits are so un nimous that I have not embodied their statements in this report. They can, however, be furnished in extenso if necessary. Very respectfully. ' W. R. MANDEVILLE. M. D., Sanitary Inspector, Fourth District. Louis Deschler, age 31 years, a native of Alsace, was admitted into the Charity Hospital, July 16, and died July 17, 1882. His previous history, as far as can he obtained, is as follows: Has been a'resident of this city for the past twelve years, was always a man of intemperate habits, drank freely of beer, and was often drunk; has always worked in a brewery, and never on the docks or elevator. He was employed at the brewery of Mr. Mouse, No. 1010 Tchoapitoulas street; he worked there twenty-seven days, when he was taken sick; fourteen days previous to his confinement to bed his friends noticed that be had a jaundiced hue, and that he had been indulging freely in all kinds of ardent liquors, and slept in the brewery on sacks, taking but little care of himself, and being constantly exposed to alt kinds of weather. Dr. Charles E. Schuppert attended the man three days previous to his admission to the hospital; he prescribed a simple purge, and looked upon the man as having an attack of jaundice. On July 16 the man was removed to the hospital (in street car) and died the following day. His friends state that, previous to his removal to the hospital, he drank two bottles of claret, and also partook freely of lemonade to quench his thirst. A postmortem examination was held, the result of which was made public through the daily prints. A section of the liver, spleen and kidneys were furnished me for microscopic examination by the President of the Board of Health, and on careful examination there was nothing found to justify the suspicion of this being a case of yellow fever. I am now mounting stained specimens of these organs, and will furnish them for examination to those who desire to see them. All of which is respectfully submitted. W. R. MANDEVILLE, M. D., »Sanitary Inspector. Fourth District. CASE OF YELLOW FEVER. JOHANNES STROH, NATIVE OF GERMANY ; AGE, TWENTY-TWO YEARS ; CIGAR. MAKER; RESIDENT OF NEW ORLEANS TWO YEARS; ATTACKED WITH YELLOW FEVER JULY, 27, 1882, 10. P. M.; DIED AUGUST 17, 1882, 6 P. M. AT No. 25 ENGHIEN STREET, NEW ORLEANS, LA. MEASURES OF DISIN- FECTION TAKEN BY BOARD OF HEALTH. About 2 o'clock Tuesday afternoon, August, 1, 1882, Dr. V. C. Frogne reported to the President of the Board of Health, that he had a suspicious case of fever at No. 25 Enghien street, Third District. The President of the Board of Health, accompanied by Dr. Frogne, immediately visited No. 25 Enghien street, and found the patient Johannes Stroh, with the following symp- toms : Surface of face and body moderately jaundiced, of a light yellow color; Coma: eyes aud mouth tightly shut; if an effort was made to open the eyelids by force, they were closely and strongly contracted, and considerable force failed to open the mouth ;twitch- eng of muscles and face. Temperature of axilla 103 ; pulse 116. Retention of urine. In- troduced catheter and drew off about four ounces of high colored deep orange-red turbid urine, which proved to be aibumenous, and contained numerous cylindrical yellow gran- ular casts, and detached cells from the tubuli uriniferi. Upon careful examination, the President of the Board of Health ascertained the fol- lowing facts concerning the history of this case. Johannes Stroh, aged twenty-two years, a native of Baden, Germany, came to New Orleans, April 28, 1880, and went immediately to Little Rock, whence he returned to this city in October of the same year. For several months he has worked in the mould de- partment of S. Hernsheim & Bro's, cigar factory. Stroh resided at No. 25 Enghien street, with the family of Jacob Wipf, a shoemaker, which consists of five persons besides Stroh, namely, Wipf, fifty years old, who had yellow fever in this city in 1867; his wife, forty-two years old, German by birth, and a resident of this city since 1865, having passed through the epidemics of 1867 and 1878, but is not known to have had the fever; a daughter, Louise, sixteen years old, a native of New Orleans; a second daughter, Selena, ten years old, born in this city, and a third daughter, Lizzie, eight years old, also a native, and known to have had the fever in 1878. The other two girls have constantly resided in this city, but have not had yellow fever. The entire household is thus shown to have been acclimated, with the exception of Stroh, the lodger. Mrs. Wipf states that Stroh came home on Thursday night, July 27, apparently well, but was taken sick about ten o'clock, saying he had taken cold. Friday morning, the twanty-eighth, he went to work, but came home at nine o'clock in the morning, with Sanitary Measures Instituted by President for Arrest of Yellow Fever LXVII burning fever, and remained at home during the day. On Friday evening Mrs. Wipf gave him a hot foot-bath and a dose of castor oil. He coughed a great deal, and said his trouble was caused by taking cold. Ou Sunday, fever continued, and the patient was delirious. On Sunday morning, July 30, at nine o'clock, Dr. V. C. Frogne, of 77 Enghien street, was sent for. He found a temperature of 106 Fahrenheit, under the patient's tongue, and a pulse of 130. The patient's tongue was dry and coated, gums red and soft, no vomiting, no signs of jaundice, urine scanty. Gave patient 8 grains of calomel, followed by quinine in five grain doses every two hours, until twenty grains had been taken. The same evening the patient's temperature was 105, pulse 110. Sunday night he vomited bilious matter, was restless and delirious. On Monday morning the patient showed a temperature of 102 and a pulse of 112. He was delirious. Administered quinine in five grain doses every three hours, until twenty grains had been taken. Vomited bilious matter, flecked with brown or coffee ground particles, spit a little blood from gums, urine scant; did not see patient that night. On Tuesday moruing the armpit showed heat of 102 with a pulse of 99. Patient vomited bilious matter, flecked with brown specks, and showed outward signs of jaundice, with eyes bloodshot. The attending physician then thought the case was so much like yellow fever that soon after noon he reported the matter to the President of the Board of Health. At two o'clock, the President of the Board of Health was at the patient's bedside and found his temperature 162 and pulse 116. He was delirious, kept his mouth and eyes tight y closed and exhibited much nervous agitation. By means of a catcheter the bladder was emptied of four ounces of a high-colored, turbid urine, which being tested at the neighboring drugstore of C. F. Seeman, 513 Royal street, exhibited albumen, and showed a specific gravity of 1.020. Thesurface of the body was jaundiced, gums swollen. Dr. Jones, at 5 o'clock, notified Dr. Faget, chairman, and Dr. Pratt, members of the Committee on Contagious Diseases, and the resident official of the National Board of Health, of the existence of the case, and requested the committee to examine it. Inspec- tor Kohlhaase was instructed to keep in communication with Dr. Frogne, and report the progress of the disease. The committee made the examination, and reported the case to be yellow fever. The patient subsequently died during the night. NEW ORLEANS, August, 1, 1882. Dr. S. E. ChaillS, Supervising Inspector, National Board of Health : Sir-A case of yellow fever at No. 25, Enghien street, name; Johannes Stroh; under investigation. Drs. Faget and Pratt notified. Respectfully, JOSEPH JONES M. D., President Board of Health, State of Louisiana. Mr. Kohlhaase reported that the patient died at 6 o'clock on Tuesday evening, and a post-mortem examination was arranged for Wednesday morning, at 9, o'clock, at which Drs. Jones, Faget and Pratt, of the State Board of Health, Dr. Chailid, of the National Board, and Dr. Frogne, attending physician, and others, were present. OUTLINE OF RESULTS OF POST-MORTEM EXAMINATION. Surface of yellow color, dependent portions of spine, of trunk, neck and extremities mottled. Dura and pia mater of brain congested. Blood-vessels of cerebral substance congested. Lungs normal, mucous membrane of stomach highly congested and of a scar- let and purplish ecchymosed appearance over a considerable portion. Stomach contained about six fluid ounces of black vomit, which, upon careful microscopical examination, was found to contain blood corpuscles, mucous corpuscles, masses of haematin, epithelial cells from the mucous membrane of the stomach, bacteria, etc., and spores of fungi. Liver yellow, and in a state of "acute fatty degeneration." Microscopical examination revealed large numbers of fat globules within and around the heptic cells. Heart of brownish yellow color, and softer than usual, and, upon microscopical exam- ination, numerous oil globules were found, within and around the muscular fibrillae of the heart. The striae of the muscular fibres were not as distinct as in the normal heart, or in the heart of malarial fever. Kidneys congested and ecchymosed When sections were subjected to microscopical examination, many of the tubuli uriniferi were found filled with detached cells, granu- lar matter and oil globules. The physicians present v ere unanimous in regarding the lesions as characteristic, of yellow fever. • Immediately after the p ist-mortem examination, on Wednesday morning, August 2, 1882, about eighteen honr< after the case was seen by the Presioent of the Board of Health, he sent to Dr. Atkinson, President of the Board of Health, Nashville, Tenn., to Dr. R. M, Swearingen, Health Officer of the State of Texas, at Austin, to Dr. W, D. Kelly, LXVIII Sanitary Measures Instituted by President for Arrest of Yellow Fever President of the Galveston Board of Health, to Dr. Johnston, Secretary of the State Board of Health of Mississippi, at Jackson, to Dr. Fournier, Health Officer of Mobile, and to Governor McEnery, at Baton Rouge, the following telegram : "A case of yellow fever reported at No. 25 Enghien street, Third District, yesterday, at 2 p. m. Died during the night. The Board of Health has taken all necessary meas- ures of disinfection, fumigation and isolation. No other case known in the bounds of the city. City healthy and in good sanitary condition. Death rate per 1000 whites, 26.61. ' JOSEPH JONES, M. D., President Board of Health. The following instructions were issued : New Orleans, Ausrust 2, 1882. Dr. E. J. Mioton, Sanitary Inspector, Third District: Sir-The Sanitary Inspector of the Third District will proceed to execute the follow- ing at once : 1. Disinfect and fumigate the house, yard and surroundings of No. 25 Enghien street. 2. Destroy by fire the bed, bedding, bed clothes and wearing apparel ot Johannes Stroh, who died of yellow fever last night. 3. Allow no gathering of people in and around No. 25 Enghien street. 4. Cause the immediate burial of the body of Johannes Stroh. 5. Place your officers in charge of No. 25 Enghien street and of the surrounding blocks, and carry forward systematic inspection and disinfection throughout this section of the city. 6. The Sanitary Inspector should attend to the execution of these measures in person, and report all facts immediately to the Board of Health. I send man and cart, with one barrel carbolic acid, one-half barrel sulphur and four barrels copperas. I have ordered Sanitary Policemen Wiltz and Blanchard to report to you for duty. JOSEPH JONES, M. D., President Board af Health, State of Louisiana. Board of Health, ) New Orleans, August 2, 1882. ) Hon. Joseph A. Shakspeare, Mayor City of New Orleans : Dear Sir-The occurrence of a case of yellow fever at No. 25 Enghien street, in the Third District, demands prompt and decisive action on the part of the Honorable Ad- ministrators and Chief Executive Officer of New Orleans. The following measures are respectfully and earnestly commended to your Honor. 1. The detail of a sufficient force of laborers for the thorough cleaning of the gutters, streets, alleys and foul premises of the section of the Third District in and around No. 25 Enghien street. 2. Quick-lime and copperas should be freely used in the gutters and damp premises, and all unpainted woodwork should be whitewashed. 3. This section of New Orleans, embracing eight blocks on the river front, and eight blocks in depth (sixty-four blocks) with Enghien street as the centre, should be furnished with 128 barrels of lime (two barrels to each block), thirty-two barrels of copperas, and eight barrels of carbolic acid. These disinfectants will be distributed under the im mediate direction of the Board of Health 4. Two carts and four men for distributing of lime and disinfectants. Respectfully, your obedient servant, JOSEPH JONES, M. D., President Board of Health. The Mayor immediately indorsed the communication as follows : "Referred to the Aministrator of Improvements, who will purchase the within articles (which will be paid for in cash) and distribute the same under the supervision of Dr. Jones, of the Board of Health. "You will please give this your immediate attention. "Yours respectfully, "JOS. A. SHAKSPEARE, Mayor." New Orleans, August 2, 1885. Hon. John Fitzpatrick, Administrator of Improvements, City Hall: Dear Sir-I would respectfully urge upon the Honorable Administrator of Improve- ments the necessity of placing a large force of laborers, with two carts and four men, in the Third District. The occurrence of a case of yellow fever at 25 Enghien street renders it necessary that, the gutters, streets, alleys and foul premises of this section of New Orleans should be* thoroughly cleansed and disinfected. Quick-lime should be freely used in the gutters of damp premises, and all unpainted woodwork should be whitewashed. Sanitary Mesures Instituted by President for Arrest of Yellow Fever LXIX I advise the Honorable Administrator of Improvements to furnish at once to this sec- tion of New Orleans, embracing eight blocks on the river front and eight blocks in depth (sixty-four biocks), with Enghien street as the centre, 128 barrels of lime (two barrels to each block) and thirty-two barrels of copperas, and eight barrels of carbolic acid. Respectfully, your obedient servant, JOSEPH JONES, M. D. New Orleans, August 2, 1882. Hon. Albert Baldwin, President New Orleans Waterworks Company: , Dear Sir-I would respectfully urge upon the President of the Waterworks Company the necessity of opening the plugs along the river front for several squares back in the Second and'Third Districts. The occurrence of a case of yellow fever at No. 25 Enghien street calls for the active assistance and co-operation of the Waterworks Company in the efforts to improve the sanitary conditions of the central portions of New Orleans. Respectfully, your obedient servant, JOSEPH JONES, M. D., President Board of Health, State of Louisiana. Mayoralty of New Orleans, ) New Orleans, La., August 3, 1882. ( Joseph Jones, M. D., President Board of Health: Sir-His Honor the Mayor is in receipt of your communication of this date, and directs me to notify you that your suggestions meet with his approval, and he has directed the Administrator of Improvements to purchase the articles mentioned in your communica- tion, and to have them distributed and used under the immediate direction of the Board of Health. By direction of the Mayor, E. L. BOWERS, Chief Clerk. Dr. Bayley, Sanitary Inspector First District, and Dr. Mandeville, Sanitary Inspector of the Fourth District, were assigned to temporary duty in the Third District, to aid Dr. Mioton. It was arranged that an inspector was perpetually on duty directing the sanitary op- erations in the Third District. With reference to the origin of this case, the following is a brief summary of the facts: The house in which Stroh died, 25 Enghien street, is on the north side of the street, between Decatur street and the levee, and two doors from the north corner of Decatur, It is an old two-story brick building, in which Stroh had a back room on the ground floor. The house in which Forbes, the sailor from Havana by the steamship Marco Aurelio, first showed symptoms of yellow fever, is on the saline square, on the opposite side of the street, but in full view, and 250 feet away. The number of the house was given in previous statements as 100 Levee street, but being on a corner, its side doors is 4 Enghien street, so that the near proximity of the building may be seen at a glance. The neighborhood is inhabited almost exclusively by acclimated persons, except an oc- casional new comer, like Stroh. Several cases of malarial fever have occurred lately in that locality, but there was nothing particularly suspicious, as the patients have usually been acclimated persons. No detailed connection between Stroh and Forbes, who died on the twenty-seventh of June, of yellow fever at the Charity Hospital, but the proximity of their respective resi- dences creates a strong presumption of such communication, and investigation may es- tablish it. Inquiry of the Messis. Hernsheim developed the testimony from their books that their last importation of leaf tobacco and cigars from Havana, the sole articles they get from that port, was received here February 14 of this year. In June they also received sev- eral cigar hands direct from Cuba, but they did not work in the same department with Stroh, and nothing can be traced to the factory. The case points to Forbes, the sailor, who died in the Charity Hospital, but was taken sick at his lodgings, No. 4 Enghien street, and from there, in all probability, the disease has emigrated. OFFICE SANITARY INSPECTOR, THIRD DISTRICT, ? New Orleans, La., August 31, 1882. 5 Joseph Jones, M. D., President Board of Health: Sir-The following brief report of sanitary operations performed in the Third District is respectfully Submitted for consideration: LXX Yellow Fever, 1882-Case of Malachias Englund. As is shown by considering the tables annexed to this report, the work performed during the month has been considerable, notwithstanding the warm weather : but it must be remembered that during the month two cases of yellow fever have taken place, one case at 25 Enghien street, the other at 85 North Peters street; and, therefore, our sanitary force had been at one time greatly increased, first by two medical in- spectors, Drs. Bayley and Mandeville, by six sanitary officers of the'Board of Health, ten men from the City Hall and three from the Auxiliary Sanitary Association. During the month 4395 inspections were made, 605 notices to empty privy vaults served, and 84 squares or 3240 premises thoroughly cleansed and disinfected, also two squares or 86 houses whitewashed. Since the eighth of August no other case of yellow fever has been reported, and the health ot the district continues to be excellent, though we have on hand at the present date five cases of small-pox. Very respectfully submitted, EUG. J. MIOTON, Sanitary Inspector, Third District. CASE OF YELLOW FEVER-MALACHIAS ENGLU'ND. Board of Health, 12 in., August 10, 1882. Dr. E. L. Mioton, Sanitary Inspector Third District: Sir-You will please report at once at the office of the Board of Health, as I desire to confer with you on a matter of much importance. Respectfully, JOSEPH' JONES, M. D. Dr. Mioton was informed that a man had been taken sick, August 9, at 85 North Peters street, between Mandeville and Spain streets, at a Carpenter shop, with chill, at 4 a. m. Entered Charity Hospital the same day. At 12 m. August 9, temperature 104, pulse 90. 3 p. m., temperature 104, pulse 80. August 10, the nurse is said to have taken the temperature at 6 a. m.. and found it to be 101. Dr. Miles took the temperature at 8 a . m., and found it 103, with pulse 59. Slight trace of albumen was said to have been found in the urine. Dr. Mioton was directed to investigate the case; to examine the house from whence the patient had been removed; to gather all the facts; to cleanse, fumigate and disinfect the premises, and order privy immediately emptied. Dr. Faget, Jr., gave the above facts. Dr. Mioton reported at once, as I had sent my horse and carriage for him. Board of Health, August 10, 1882. Dr, J. C. Faget, Chairman Committee on Infectious and Contagious Diseases: Dear Sir-I would respectfully request that, as Chairman of the Committee on Infec- tious and Contagious Diseases, you should at once repair to the Charity Hospital, and examine critically a man in ward 21, from carpenter shop, No. 85 North Peters street, between Mandeville and Spain streets, taken sick, at 11 a. m., August 9, with chill. Please report your views of the case, at the earliest practicable moment; and if possible be present at the meeting of the Board of Health, this evening, and give the Board the benefit of your extended experience. Respectfully, yours. JOSEPH JONES, M. D., President Board of Health. Board of Health, August 10. 1882. Dr. George K. Pratt, Member of Committee on Infectious and Contagious Diseases: Dear Sir-Will you. in your official capacity as member of the Committee on Conta- gious and Infections Diseases of the Board of Health, of the State of Louisiana, repair at once to the Charity Hospital, amLexamine critically a man in ward 21, carpenter, from 85 North Peters street, between Mandeville and Spain streets, who was attacked with chill August 9, and has high fever. Please report at earliest convenience ; and hope that you will be present at the meeting of the Board of Health, and give the re- sults of your investigation and experience. Respectfully, yours, JOSEPH JONES, M. D., President Board of Health. In order to facilitate the investigation, I requested Dr. Faget, Sanitary Inspector of the Second District, to visit his patient in my carriage, and to return to the Board of Health from the Charity Hospital. Dr. Faget reported as follows: Malachias Englund, 30 years old, native of Cardiff (Wales), two months in the city, taken sick August 9. at 4. a. in., with chill,.at No. 85 North Peters street, between Man- deville and Spain; admitted in the Charity Hospital, August 9, morning; at 12m., August 9, temperature 104. pulse 90; 3 p. m., August 9, temperature 104, pulse 80 ; a. m., August 10, temperature 103, pulse 59 (albumen in urine); 2 p. m., August temperature 102L pulse 01) (i albumen at 10 a. m). Yellow Fever, 1882-Case of Malachias Englund. LXXI CASE OF MALACHIAS ENGLUND, WHO DIED OF YELLOW FEVER, IN THE CHARITY HOSPITAL, NEW ORLEANS, AUGUST 14, 1882. CLINICAL REPORT, CHARITY HOSPITAL. . NEW ORLEANS, August 9, 1882, Malachias Englund, carpenter, aged 30 years, native of Cardiff (Wales) Time in the city two months and a half, married; does not drink whisky, but occasionally drinks a moderate quantity of lieer. Has not been exposed to the sun, as he works in carpenter shop, No. 85 Peters street. He went to bed feeling per- fectly well last night, at an early hour. He awoke at 3 a. m. with a chill. When the chill passed off he was brought to the hospital at 8 a. m. First observation at 9.15 a. m.; temperature in mouth 103 2-5°, pulse 92 ; face injected, eyes brilliant, conjunctiva red, acute cephalalgia, general pains particularly in lumbar region: skin dry and hot Pulse full, hard and not fast; disposition to vomit, scant urine (no albumen); tongue red on edge, thickly coated and dry; great thirst, peculiar odor of breath, pulsations at epigastrium extremely violent. Patient states he has only been in the city two months and a half; he came from Cardiff (Wales), on steamship . Has not been unwell since he came here until 3 o'clock a. m., August 9, 1882. Says it is only two blocks from where last case came from. Temperature at 8:45 a. m , 103 2-5; temperature taken just after a bath. Been working for Mr. Hickey, 85 Peters street. August 10-Temperature at 8 a. m.,103 F., pulse 69, respiration 17. Vomited some bilious matter this morning Gums somewhat congested. No hemorrhage ; no epigastric tenderness. Urine examined at 9:45 a. m.; albumen to about one-fourth of whole amount. August 11-Temperature 104$, pulse 52, respiration 22. Patient this morning calm and resting easy; says he is suffering no pain whatever. Urine examined again this morning, one-fourth of which is found to be albumen. No tendency to suppression ; no epigastric tenderness August 12-Temperature at 12, 104; temperature at 6 p. m., 104; respiration, morning, 17; temperature, morning, 103$; evening. 104: pulse, morning, 92; evening, 80. August 13-Temperature, morning, 101; evening. 102; pulse, morning, 69; evening, 64; respiration, 17. August 14-Temperature, morning, 104$ ; respiration, 22. REMARKS. August 10-At 10 a. m. urine one-fourth albumen. August 12-Pulse, morning, 60; evening, 70; respiration, morning, 24; evening, 30; temperature, morn- ing, 102; evening, 103. August 13-Pulse, morning 60, evening, 70 ; respiration, morning, 24 ; evening, 30j; temperature, morning, 103; evening, 103. August 14-Pulse, morning, 62; evening, 74; respiration, morning, 26; evening, 23, temperature, morn- ing, 103.5; evening, 103 6. August 15-Pulse, morning, 100; evening, 110.5 temperature, morning, 104; evening, 105. From August 10, when the urine was found to be highly albumenous (one-fourth in volume), the tempera- ture ranged between 103.5 and 104, until August 15, when the temperature was one degree higher than it had been at any other time. After August 12 the patient became restless, tossing about constantly in bed. The symptoms enumerated at the first observation became intensified, and he died August 15, at 4 o'clock p. m., having been sick seven days and twelve hours, Death occurred without any protracted struggle, apparently from a uraemic com- vulsion. Diagnosis: Yellow fever. CHARITY HOSPITAL, August 16, 1882. Dr. Joseph Jones, President Bdhrd of Health: Dear Doctor-In compliance with your request, I herewith transmit report of the case of Malachias Englund, who diedin the hospital of yellow fever. * * * I inclose report of our pathologist. Respectfully, [Signed] A. B. MILES, M. D., House Surgeon. PATHOLOGICAL DEPARTMENT, CHARITY HOSPITAL, I August 16, 1882. 5 Dr. A. B. Miles, House Surgeon : Dear Sir-I herewith present the report of the pathological condition of the organs of the body of Mala- chais Englund, as revealed by the autopsy. The urine examined the day before death contained a considerable quantity of albumen, and also bile, besides great numbers of lencocytes (probably from the bladder), with epithelial cells from this organ, and a few granular cylinders from the kidneys. The same elements were found in the urine taken from the bladder after death. The liver presented in its greatest part the so-called nutmeg appearance, while in some parts it showed a blue color, due to the congestion of its blood vessels ; besides this, however, a decidedly golden color, due to the presence of bil' in the organ. The gall-bladder contained a quantity ot dark-brown bile. The microscopical examination showed the hepatic cells infiltrated with a considerable number of larger and smaller fat globules. The kidneys presented a dark, bluish-red color, both upon the outer and the cut surfaces, indicating a high state of congestion. Small yellow spots were observed upon the cut surfaces, which, upon microscopi- cal examination, proved to represent Uriniferous tubules, the epithelial cells of which contained larger and smaller fat globules. These fat globules appear to represent rather a fatty infiltration than true degenera- tion . The snpra-renal bodies presented upon the section an abnormal appearance, the substance being very dark brown, due to the extravasation of free hcemoglobin. The stomach was large, and its mucous membrane appeared greatly swollen. Upon the internal surface of the latter were observed many blue patches, and also spots of ecchymoses, indicating previous conges- tion. The liquid found in the stomach after death contained great numbers of gastric epithelial cells, and also a number of decoloiixed colored blood corpuscles. Besides these elements, there were a small number of small masses, consisting of conglomerated, decolorized colored blood corpuscles, with free haemoglobin, imparting to the whole a yellow color. The latter elements were the only representations of the so-called black vomit met with in this fluid. The spleen was considerably enlarged by congestion, and presented a dark-brown color. LXXII Action of Board of Health, August 17, 1882. The pia mater of the brain was congested throughout, presenting very many patches of extravasation of free hmmoglobin. The substance of the brain was also congested. The heart was quite large ; microscopical examination showed the commencing fatty degeneration of its muscular elements. In taking the above-stated pathological condition of the respective organs examined in this case into con- sideration, as a totality, I may fairly pronounce them as characteristic of yellow fever. The condition of the brain, and that of the heart, particularly, may, in this case, be looked upon as pathognomonic. In all my former autopsies, I have never met with a brain exhibiting more the congestion of this organ, in its typical form, than the case in question. Very respectfully, R. D SCHMIDT. Pathologist. EXTRACTS FROM PROCEEDINGS OF THE BOARD OF HEALTH, AT THE MEETING AUGTST 17, 1882. RESOLUTIONS BY HON. I. N. MARKS AND THE HON. ED. BOOTH, RELATIVE TO UNITED STATES MARINE HOSPITAL SERVICE AND THE APPROPRIATION BY CONGRESS. The regular weekly meeting of the Board of Health was held, Dr. Joseph Jones, President, in the chair, and Drs. Faget, Von Gohren, Pratt and Kells, and Messrs. Marks, Booth and Bosworth present. Dr. Jones referred to the continued healthy condition of the city, and reported that during the five days of the present week there were only forty deaths from all causes. This, with a population of over 220,000. was almost unpaialled in this or any other coun- try in mid-summer. There was not at present a single case of yellow fever in the city. Dr. Jones stated that he had received a copy of the printed circular issued from the office of the Supervising Surgeon-General of the United States Marine Hospital Service, relative to the disposition of the hundred thousand dollars in the hands of the Secretary of the Treasury in threatened or actual epidemics. Under date of Angust 15, Dr. R. A. Bayley, Sanitary Inspector of the First District, reported that the front of the same, from Magazine street to the river, had been thor- oughly inspected, disinfected and cleaned up. Upon the written request of Dr. Bayley, he was granted a leave of absence for six weeks, ill health of himself and wife being assigned as the reason. Dr. W. R. Mandeville, Sanitary Inspector of the Fourth District, was assigned as Sanitary Inspector of this district also, during the absence of Dr. Bayley. Dr. Jones read a list of the amounts drawn to the thirty-first of July by the Board of Health against the appropriation of $10,000 by the Common Council for the year 1882, as follows: January, $575; February, $625; March, $625; April, $637 50; May, $650; .lune, $650 ; July, $650. Also in July the sum of $782 91 was paid by the city to G. R. Finlay & Co., and $197 90 for stationary, on account of the Board of Health, making a total of $5,393 31. The monthly prorata of the appropriation is $833, and the pro rata for seven months to August 1, $833 33, leaving a balance in favor of the board to that date of $34 02. Dr. Jones read an elaborate article on the subject of the public health and quarantine under the laws passed by the last General Assembly. The President stated that he had instructed Dr. Finney, the resident physician at the Mississippi Quarantine Station, to hold vessels from Mexican ports for observation till satisfied, as all Mexican ports were considered in the light of suspected ports. A communication from Mr. N, G. Gunnegle and others, residing at McDonoghville, re- commending that syphons be conveyed from the river over the levee, in order to produce a current of fresh water of sufficient force to cause the present stagnant water to recede, was referred to the committee on conference. The committee reported recommending the petitioners to make their application to the Administrator of Improvement. A communication from the Produce Exchange was lead, inclosing a copy of a resolu- tion adopted yesterday, and asking that the Board of Health, in the event of any case of yellow fever occurring under its jurisdiction, report the same as soon as ascertained to the Exchange, to be posted on the bulletin boards for the information of all the members of the body. The request will be granted. Mr. Marks offered the following resolution, which was unanimously adopted : Whereas, the President of the United States and the Secretary of the Treasury have very wisely determined that the appropriation made by Congress in aid of State and local boards of health shall be expended by the Marine Hospital Service of the govern- ment, be it therefore Resolved, That the State Board of(Health of Louisiana will thoroughly co-operate with the Marine Hospital Service of the government in all measures having for their object the preservation of the public health and the improvement of the sanitary condition of this city and its territory. Establishment of Quarantine Against Pensacola. LXXIII Resolved, That the thanks of this board be tendered to the President of the United States, the Secretary of the Treasury and Surgeon-General Hamilton, fortheir wise, prompt and efficient action in aid of State and local boards of health. Resolved, That the Secretary of this board be instructed to convey copies of these reso- lutions to the President of the United States, the Secretary of the Treasury and Surgeon- General Hamilton. The folio wing resolution, introduced by Mr, Booth at the previous meeting and laid over for one week, came up and was unanimously adopted, with an amendment inserted that the Governer co-operate with the President of the Board. Whereas, the Congress of the United States has generously appropriated the sum of $50,000 in care of the National Board of Health, to be applied in aid of State and local boards, therefore be it resolved by the State Board of Health of Louisiana that the Presi- dent in its name be instructed to apply for $25,000 of said sum to be expended by this board under such regulation as may be deemed advisable by the Honorable Secretary of the Treasury, said disbursements to be devoted to the following objects : Twenty thousand dollars to the improvement of the Mississippi River Quarantine Station. Four thousand dollars for the improvement of the Rigolets Quarantine Station. One thousand dollars for the improvement of the Atchafalaya Quarantine Station. OFFICE SANITARY INSPECTOR THIRD DISTRICT, > New Orleans, La., October 1, 1882. J Joseph Jones, M. D., President Board of Health : Sir-I have the honor to present for consideration the following biief report of sanitary operations per- formed in this office during the month of September. 1882; The health of the community in this part of the city is very fair indfeed, though variola still continues to be the prevailing disease, twenty-five cases of this malady having been reported this month. The character of this disease is of a mild type', there having been only four deaths from it during the month. The public and private markets have been the object of a careful inspection, and it is my pleasant duty to report the same, witli a few exceptions, in a fine and clean order-water supplies amply sufficient. Eighteen hundred and six inspections were made, two hundred and sixty-five nuisances abated, and one hundred and seventy-seven notices to empty privy vaults served. In the neighborhood of No, 312 Port street seven hundred and ninety premises were disinfected with lime, copperas and carbolic acid. A special communication to the Street Commissioner, in order to clean gutters of that vicinity, was sent, which was responded to immediately. Respectfully submitted, E. J. MIOTON, M. D,, Sanitary Inspector Third District. ESTABLISHMENT OF QUARANTINE AGAINST PENSACOLA4 BY THE BOARD OF HEALTH OF THE STATE OF LOU ISIANA. OFFICE OF BOARD OF HEALTH, ? Pensacola, Fla. August 11, 1882, 5 Joseph Jones, M. D., President Board of Health, New Orleans : Dear Sir-I return thanks for telegram regarding case of yellow fever at Charity Hos- pital, and beg leave to say that I shall transmit you to-morrow copy of the Pensacola Advance Gazette, containing detailed statement regarding suspicious cases in the Spanish bark Saleta, at Sullivan's wharf, Pensacola, ten days ago. Let me observe here in re- ference to those cases that to our experienced eye, notwithstanding no characteristic signs or symptoms were manifested during life, they would have been pronounced yellow fever. The one that died, on post-mortem inspection of the body, untouched by the knife, showed bloody exudation in mouth and throat. I saw the case late in the evening of the ninth instant; one was nearly in extremis and died at 8 a. m., next morning. This is the case in which the sanguinolent effusion was observed. I could obtain no urine for examination. I ordered the captain to weigh anchor and proceed at once to the Quarantine Station for observation and treatment, but as she had received on board almost her whole cargo, captain concluded to put to sea. Very respectfully and faithfully yours, ROBT. B. S. HARGIS, M. D., President Board of Health. P. S.-The dead man was ordered to be buried at sea, as he was denied interment within city limits. Yours, etc., R. B. S. H. CHARITY HOSPITAL, STATE OF LOUISIANA, i New Orleans, September 21,1882. 5 Joseph Jones, M. D., President Board of Health, State of Louisiana. New Orleans: Dear Doctor-In compliance with the request of the Board of Health, the following statements are fur nished: LXXIV Establishment of Quarantine Against Pansacola. 1. Number of patients in the hospital, 646. Of the acute diseases the malarial feversand the intestinal disorders predominate. 2. Our records show the case of Englund, admitted August 9, died August 15, the last case of yellow fever in the hospital. 3 The following case, rumored suspicious, of which you inquire, is copied from our records: "John Buckley, aged sixty years, homeless, was admitted into the hospital August 10, and died August 12 of chronic gastro enteritis." At present no yellow fever, no suspicious case of fever, under our charge. Very respectfully, A. B. MILES, M. D. OFFICE OF BOARD OF HEALTH, I Pensacola, Fla., August 10, 1882. 5 At a meeting of the Board of Health, held this day, the following preamble and resolutions were adopted In view of the fact of the unnecessary alarm created by the sending off, by the Board of Health, of a vessel having on board cases of sickness, in their opinion, of a suspicious nature, be it Resolved, That the Board of Health, as in honor and duty bound, as the guardians of the public health, will officially announce the existence, of the very first case of yellow fever which may occur. It was further Resolved, That the public be notified that the board does not apprehend the breaking out of an epidemic, the city never being in a more healthy condition, and every precaution being taken to enforce a rigid and strict quarantine-the board taking every precaution, and, in every instance, giving the benefit of the doubt to the public and not to the shipping. On motion, the above were ordered printed in the city papers. R. B. S. HARGIS, M. D., President. J. C. Whiting, M. D., Secretary. [Telegram. ] PENSACOLA, FLA,. August 25, 1882. Dr. Joseph Jones, President Board of Health, New Orleans: This morning the mate of Italian bark Tiacenso Accame, in the stream, died, and the case pronounced yellow fever; vessel sent to Quarantine Station, when post mortem was held. On opening stomach, showed indications of black vomit matter. The vessel has been in port sixty days and came from Port Elizabeth, where yellow fever does not exist. D. A. BRENT, Chairman Executive Committee Board of Health. [Telegrams.1 PENSACOLA, FLA., August28, 1882. Dr. Joseph Jones, President Board of Health, New Orleans, La.: The board officially reports the existence of two cases of yellow fever in the city. No deaths. J. C. WHITNIG, M. D., Secretary Office Board of Health, State of Louisiana, ? New Orleans, August 28, 1882. J Dr. Finney, Mississippi Quarantine Station; Dr. Carson, Rigolets Quarantine Station ; Dr. Sigur, Mor gan City : Yellow fever at Pensacola. Subject all vessels from that port to ten days' quarantine. JOSEPH JONES, M. E. PRECAUTIONS AGAINST PENSACOLA. THE PROMPT ACTION OF THE HEALTH AUTHORITIES IN KEEPING THE PESTILENCE AWAY FROM NEW ORLEANS. New Orleans Picayune, August 30, 1882.1 The dispatches reporting a serious outbreak of yellow fever at Pensacola, for the first time made public on Monday, were the subject of much interested inquiry and anxious comment on Tuesday. Applica- tions to Dr. Jones, President of the Board of Health, elicited some information of interest as to the pre- cautions which had been taken to guard against the introduction of the infection into this city from that quarter. Dr. Jones showed from his official letter book, in the office of the Board of Health, thatas early as August 11 he had been suspicious of possible danger from Pensacola, and on that date had issued to Dr. Finney, Quaran ine Officer at the Mississippi Station, and to Dr, Carson, who holds a like position at the Rigoletes, orders to hold all vessels from Pensacola subject to the orders of the Board of Health. The case of the bark Iris, which had been discharged from quarantine at Ship Island with yellow fever on board, and so returned to Pensacola, was not calculated to strengthen confidence in that station, which was chiefly relied on by Pensacola as an outpost for the arrest and detention of infected ships visiting the waters of West Florida, and for that reason a close watch was set upon all water craft visiting this port from Pensacola. The steamer Amite, sailing to Cedar Keys, but suspected of having communication with the shipping at Pensacola, had been made the subject of strict observation and examination, ns was reported at the last meeting of the Board of Health. A further order had been telegraphed to all the Louisiana coast quarantine stations to subject all vessels from Pensacola to strict quarantine under the ten days' regulations, and Dr. Jones said he had little apprehension of danger by sea. As to communication by land, the doctor had relied heretofore on the fact that Pensacola had been quaran- tined and watched by Mobile and Montgomery, and it was scarcely possible for freight orfiassengers to reach this city without first passing an inspection before reaching Mobile; nevertheless, he had already had a conference with Superintendent Harahan, of the Louisville and Nashville Railroad, and had delivered to him an order, of whieh the following is a copy: OFFICE BOARD OF HEALTH, STATE OF LOUISIANA, ? New Orleans, August 29, 1882. 5 J. T. Harahan, Superintendent Louisville and Nashville Railroad: Sir-You are hereby prohibited from bringing any cars, passengers, merchandise or baggage from Pensa- cola within the bounds of the State of Louisiana. JOSEPH JONES, M. D., President Board of Health, State of Louisiana. Louisiana Board'o f Health Quarantines Pensacola. LXXV He further stated that the trains would be inspected. The doctor said the entire matter will come up before the Board of Health on Thursday night, when further details will be arranged. In any case, he will relax no energies and neglect no precautions to protect the public health and keep the city in the excellent sanitary condition which has existed all through the summer so far. Dr. Jones also exhibited the following correspondence on the subject of repairs to the government ware- house at Mississippi Station ; it explains itself: UNITED STATES CUSTOM HOUSE, ) New Orleans, August 29, 1882. S Dr. Joseph Jones, President Board of Health, New Orleans, La.: Work on the Mississippi River Quarantine Station will begin at once. JOHN W. GLENN, Superintendent. OFFICE BOARD OF HEALTH, STATE OF LOUISIANA, ? New Orleans, August 29,1882. j Gen. John W. Glenn, Superintendent United States Custom House: Dear Sir-I desire to express the thanks of the Board of Health for the valuable efforts which yon have made in behalf of the State quarantine, near the mouth of the Mississippi River; and I feel assured that the action of the Honorable Secretary of the United States Treasury in his prompt response to the telegram of his Excellency, Gov. S. D. McEnery, will command the thanks of the citizens of this State and of the entire valley Respectfully, your obedient servant, JOHN JONES, M. D. PENSACOLA QUARANTINED-DR. JONES ISSUES ORDERS PO PROTECT NEW ORLEANS BY LAND AND WATER. Times-Democrat, Wednesday, August 30, 1882.] Yesterday the outbreak of yellow fever in Pensacola, Fla., was the principal matter under consideration at the office of the Board of Health. For some three weeks past, the quarantine physicians, under instrac- tions of Dr. Jones, have been on the lookout for vessels from Pensacola. On August 11, Dr. Jones instructed them as follows: " Hold vessels from Pensacola subject to orders of Board of Health." A few days later, August 16, Dr. Jones also instructed them, "exercise utmost vigilance with all vessels from Mexican ports. Yellow fever reported at Tampico and Tuxpan. In every "case hold vessels from Mexican ports for observation until satisfied." Upon learning of the fever at Pensacola, Dr. Jones instructed the physicians at the quarantine stations as follows; AUGUST 28, 1882. Dr. Carson, Miller's Bayou : Hold Henrietta Esche ten davs. Fumigate and disinfect thoroughly. JOSEPH JONES, M. D. AUGUST 29, 1882. Dr. Finney, Resident Physician, Mississippi Quarantine Station: Yellow fever at Pensacola. Subject all vessels from this port to ten days' quarantine. JOSEPH JONES, M. D. AUGUST 29, 1882. Dr. Sigur, Quarantine Physician, Atchafalaya Quarantine Station : Yellow fever at Pensacola. Subject all vessels from this port to ten days' quarantine. JOSEPH JONES, M. D , OFFICE BOARD QF HEALTH, STATE OF LOUISIANA, ? New Orleans, August 29,1882. 5 J. T. Harahan, Superintendent Louisville and Nashville Railroad: Sir-You are hereby prohibited from bringing any cars, passengers, merchandise or baggage from Pen- sacola within the bounds of Louisiana. JOSEPH JONES, M. D. Mr. Harahan, who called on the Doctortshortly afterward, fully approved of the order, and will obey it to the letter He informed Louisville, Pensacola. Montgomery and Mobile of it by telegraph, and also fur- nished a copy to the Associated Press. Dr. Jones will have an inspector placed on the trains, and take all the necessary precautions to guard against the admission into the State of any person from Pensacola. He informed the different boards of health of his action. RIGOLETS QUARANTINE STATION, ? Fort Pike, La., August 29,1882. 5 Joseph Jones, M. D., President Board of Health, State of Louisiana: Dear Sir-I have the honor to acknowledge the arrival, this moment, 4:20 o'clock p. m , of your telegram of even date, informing this station of the presence of yellow fever at Pensacola, with instructions to de- tain all vessels from that port ten days in quarantine. Very respectfullv, your most obedient servant, WM. H. CARSON, M. D., Resident Physician. RIGOLETS QUARANTINE STATION, t Fort Pike, La., August 29, 1882. $ Joseph Jones, M. D., President Board of Health, State of Louisiana: Dear Sir-I have the honor t > scknrwledge the receipt of your telegram of the twenty-eighth instant, with instructions to detail the Schooner Himietta Fsd e ten days and cleanse. The vessel has already recon ed one course of fumigation and disinfection, and they are at present scrub, bing and washing all parts of 1 h« vest el that can be reached . I will give her anothei fumigation before re- eaeing. All on board of the l.doipho Flake and Henrietta Esche remain in good health and spirits. LXXVI Louisiana Board of Health Qudrantines Pensacola. Both vessels are anchored well out of the channel, and there is noehance of any intercourse or danger to vessels passing. The Adolphe Flake will be released to-morrow evening (Wednesday) at 6 o'clock. She has been thor- oughly attended to, and is as clean a vessel as one could wish. I remain, sir, very respectfully, your obedient servant, WM. H. CARSON, M. D., Resident Physician. OFFICE BOARD OF HEALTH, STATE OF LOUISIANA, 1 New Orleans, August 30, 1882. 5 Wm. R. Mandeville, M. D., Sanitary Inspector Board of Health, State of Louisiana: Sir-You are hereby assigned to duty at Lookout, near the boundary of Louisiana and Mississippi, and opposite the mouth of East Pearl liver. You will carry out the following instructions : 1. Inspect all trains from Mobile, and prevent the introduction into the State of Louisiana of all pas- sengers, merchandise and baggage from Pensacola, Fla. 2. Board all vessels entering the mouth of East Pearl river, or any of the approaches in the neighbor- hood of Lookout, and subject all vessels from Pensacola or any other infected port to the provisions of the quarantine laws of Louisiana. / 3. I have ordered Sanitary Policemen E. Bohner and L. D. Allen to report to you at Point Lookout for duty. (seal.) JOSEPH JONES, President Board Health. State of Louisiana. NEW ORLEANS, August 30, 1882. E. Bohner, Sanitary Policeman, Board of Health, State of Louisiana: Sir-You are hereby directed to report to Sanitary Inspector, Dr. Mandeville, for special inspection and quarantine, duty at Point Lookout, near the boundary line of Louisiana and Mississippi, and opposite the mouth of East Pearl River. |Signed] JOSEPH JONES, M. D. NEW ORLEANS. August 30, 1882. L. D. Allen, Sanitary Policeman Board of Health, State of Louisiana: Sir-You are hereby directed to repert to Sanitary Inspector, Dr. Mandeville, for special inspection and quarantine duty at Point Lookout, near the boundary line of Louisiana and Mississippi, and opposite the mouth of East Pearl River. [Signed] JOSEPH JONES, M, D. Dr. C. Faget, Sanitary Inspector Second District: Sir-In consequence of the temporery absence of the Sanitary Inspector of the First District, you are hereby directed and empowered to assume direction of the First District in addition to the Second District, and will discharge the duties of both districts until furthur orders. Respectfully, [Signed] JOSEPH JONES; M. D. OFFICE BOARD OF HEALTH. STATE OF LOUISIANA, > New Orleans, August 30,1882. 5 Dr. Wm. Ryan, Sanitary Inspector Sixth and Seventh Districts; Sir-In consequence of the temporary absence of the Sanitary Inspector of the Fourth District, you are hereby directed and empowered to assume direction of the Fourth District, in addition to the Sixth and Sev- enth Districts, and will discharge the Sanitary ditties of these districts until further orders. ' Respectfullv, [Signed] ' JOSEPH JONES. M. D. NEW ORLEANS, August 30, 1882. Mr. Ward, U. S. Customs Inspector, Lookout Station, Louisville and Nashville Railroad: Dear Sir-The Board of Health "of the State of Louisiana has assigned Dr. Wm. R. Mandeville to quar- antine and inspection duty at Lookout. Dr, Mandeville has assigned to him two sanitary officers, Messrs. Bohner and Allen. Any assistance you may be able to render Dr. Mandeville in the discharge of his inspection duties will be appreciated bv Yours, respectfully, JOSEPH JONES, M. D. OFFICE BOARD OF HEALTH, STATE OF LOUISIANA, > New Orleans, August 30, 1882. 5 J. T. Harahan, Esq , Superintendent Louisville and Nashville Railroad Company : Sir-The Board of Health of the State of Louisiana has assigned Sanitary Inspector Wm R. Mandeville, M. D., to duty at Lookout Station, on the Louisville and Nashville Railroad. You will stop all trains from Mobile, for a sufficient length of time for the inspection of passengers, bag- gage and merchandise or freight, by the Inspector of the Board of Health of the State of Louisiana. I have ordered Sanitary Policemen E. Bohner and L D. Allen to report for duty to Dr. Mandeville, at Point Lookout. Respectfully. JOSEPH JONES, M. D. LOUISVILLE & NASHVILLE RAILROAD COMPANY, ? Office of Superintendent, New Orleans, La., August 27, 1882. J Joseph Jones. M. D.. President Louisiana Board of Health : Dear Sir-I enclose you circular issued in reference to suspected persons from Pensacola I think it will assist in protecting us. I am reliably informed there are quite a number of people en route to Few O: leans from Ptmeo«mla> I euggoet to you that the only way to stop this is to put on inapoctors. Thio uoiuptuty will Sanitary and Medical Inspection of Mississippi Valley. LXXVII of course pass these inspectors free over this road, and will assist them all that lies in our power. Mobile just informs me that your actions in quarantining against Pensacola assists them very much, and is very much appreciated by them. I think by co-operation everything will run smoothly. Yours, very truly, J. T. HARAHAN, Superintendent. TO ALL AGENTS AND CONDUCTORS. The Louisiana State Board of Health and the Mobile and Montgomery Boards of Health have quaran- tined ag iinst Pensacola. There is some fear that passengers may come to points on the New Orleans and Mobile division, and then return to those points that have quarantined. You will watch all strangers and suspicious persons, and where tickets are sold or persons get on the trains, notify the conductor of this, stating who the party is, giving the number of the ticket the party purchased, that they may be identified. Should no ticket be purchased, notify the conductor, giving him a description of the party. Conductors will notify the Board of Health Inspectors on their trains ot the information given them, and will also notify me by wire from first open telegraph station. Good judgment must be displayed by agents and conductors that no unnecessary hardship may be imposed on innocent persons. Agents will ask all sus- picious persons if they are from Pensacola, and should they have been there within the time prescribed by the Boards of Heaith,'you will refuse to sell tickets to all points that have quarantined, informing the per- sons that quarantine has been established against them. This is for your private information. J- T. HARAHAN, Superintendent: NEW ORLEANS, La., October 5, 1882. Joseph Jones, M. D., President Board of Health : Sir-I respectfully present this, my report for the month of September as Quarantine Physician, English Lookout, L. & N. R. R., Louisiana. Enclosed will be found a table showing number of trains inspected, passenger and freight, and number of persons detained in quarantine. I examined into the sanitary condi- tion of the lake towns, and find that they have no local boards of health, under ordinary occasions, nor any quarantine regulations. The fcecal matter from the vaults is used as garden manure, and that every one i's his own sanitarian. At Biloxi there is constant and daily communication with Ship Island, by means of sailing boats, but they are not allowed to enter the quarantine grounds. Special praise is due Officers Allen and Bohner for the faithful and conscientious manner in which they discharged the delicate duties required of them; also to Mr. Victor Ward, the United States Customhouse officer, for kind assistance in enabling us to board vessels. Very respectfully, W- Rt MANDEVILLE, M. D., Quarantine Physician, English Lookout. NEW ORLEANS, October 16, 1882. To Joseph Jones, M. D., President Board of Health, State of Louisiana : Dear Sir-I respectfully submit to you the following report of inspections of trains and passengers, made at English Lookout Quarantine Station, Louisiana, this is from October 1, 1882, up to and including Octo- ber 16, 1882. On Saturday evening, October 7, 1882. I detained six sailors at Lookout Station; they had been at Ship Island. On Monday, October 9, 1882, these sailors were released from quarantine, by order of the President of Board of Health. The following is the history of the case : The American schooner Susan Scranton cleared from the port of Havana, on August 12, with water ballast, and clean bill of health. She arrived at Ship Island on the twenty-second day of September, was fumigated and detained there ten days ; left Ship Island on the third of October for Pascagoula; on Octo- ber 4, went to Scranton, Mississippi. The following are the names of persons of the Susan Scranton who were detained at Lookout: Capt. H. Schriever, who had yellow fever in Havana, about twenty years ago. Mate : John M. Lococh had yellow fever in Tampico. Sailors-Lewis Evenson, Henry Grard, Thomas Peterson, Christian Jackson. None of sailors have had yellow fever. There is a health officer stationed near Grand Bay, Miss., who examined all trains from Mobile, Ala. This is the form of certificate given to conductors : FORM NO. 1. I hereby certify that train No. , Conductor , from Mobile, Alabama, has complied with all rules and regulations of the Mississippi State Board of Health, relating to trains entering the State. Station on Louisville and Nashville Railroad, near Grand Bay. Date 1882. J. C. COWAN, M. D., Health Officer. The United States mails from Pensacola are fumigated at Pensacola Junction, before entering Mobile. On the following pages you will find a complete list of freight and passenger trains inspected at English Lookout Quarantine Station, also time of arrival and names of conductors. The way bills of freight trains have been examined, so as to have nothing from infected districts escape. I am, very respectfully, WM. RYAN, M. D. Quarantine Inspector, English Lookout, La. SANITARY AND MEDICAL INSPECTION IN THE MISSISSIPPI VALLEY. [Extract from the Proceedings Board of Health, July 13, 1882.] THE BOARD OF HEALTH-REGULAR WEEKLY MEETING-THE HEALTH OF THE CITY GOOD-THE BOARD RESENT THE INTERMEDDLING OF THE OFFICERS OF THE NATIONAL BOARD OF HEALTH. The regular weekly meeting of the State Board of Health was held last evening, Dr. Joseph Jones President, in the chair, and Dis. Formento, Faget, Von Gohren and Kells, and Messrs. Marks, Booth and Bosworth present Dr Jones called the attention of the Board to the remarkably healthv condition of the city for this season of the year, and to the almost total absence of any contagious or infectious diseases. During the week end. ing Saturday last, there were only 102 deaths in New Orleans from all causes, and dining the last five days, en ing Thursday evening, but forty-six deaths had occurred. two of which were from scarlatina, one from small-pox, anil one from malarial lever. The steady high temperature which we have had of la tot was con- ducive to health. LXXVIII Sanitary and Medical Inspection of Mississippi Valley. Dr, Jones stated that he held under personal inspection the house No. 98 Old Levee street, where Henry Forbes was first taken sick, and although there were fifteen persons in this and the adjoining house, six of whom were small children, not a single case of sickness had occurred among them to date, and all were in a perfectly healthy condition. In regard to small-pox, Dr Jones said the Board and its officers had done everything in their power to prevent the spread of that disease, and regretted that vaccination was not made compulsory by law. Reference was made to the quarantine and health laws passed at the recent session of the Legislature. The former was in substance the same law as that passed in 1855. with but slight change in the wording. The act requiring that al) inhabitable rooms should be provided with a water capacity of 200 gallons, Dr. Jones said was in the right direction, but this supply was insufficient. A special report from Dr. Beret. Sanitary Inspector of the Fifth District, was read relative to the health of Algiers in connection with the overflow in the rear from the Live Oak crevasse, showing that as yet no serious effects hail resulted therefrom. A communication from Dr. Finney, Resident Physician at the Mississippi Quarantine Station, was read, showing that all the vessels there were in a clean and healthy condition. Mr. Marks introduced the following resolution: Whereas, the Memphis Board of Health has adopted a resolution to the effect that on and after the fifteenth inst.. and until October 1, 1882, coffee, rice, sugar, molasses, spices, and all tropical fruits, etc., shall be prohibited from entering Memphis, coming from Southern ports, and this extraordinary and uncalled-for action (as far as New Orleans is interested), has been superinduced by the action of the National Board, in suspending its inspection service ; and whereas, the city of New Orleans is entirely free from epidemic diseases of every kind and in a state of health comparing favorably with any of the large cities of 1he Union ; and whereas, the efforts of intimidation that are being made to terrify Congress into .making appropriations for the support of the National Board, by declaring non-iutercourse with this city, or through the appeal of the Secretary of the National Board to the trusty shotgun, should not assume the dangerous form of the unnecessary destruction of commerce; be it therefore Resolved, That the State Board of Health of Louisiana views with regret and astonishment, the action of the Board of Health of Memphis, and respectfully requests that so far as this city is concerned this action be reconsidered. Mr. Marks said that if this action by the Memphis Board was to protect the people of that city from the. introduction of any contagious or infectious disease, why was it that such articles of commerce as were excluded from New Orleans, after being subjected to thorough disinfection and a detention of ten days at the quarantine station, were received from New York with only one day's detention at the quarantine station there ? The resolution was unanimously adopted and the Secretary instructed to forward a copy to the Memphis Board of Health. Mr. Booth introduced the following resolution : Whereas, an effort is being made to have it appear that the health of the people of New Orleans, of Louisiana and of the Mississippi Valley is being jeopardized by the Congress of the United States in refusing to continue the appropriation.for the salaries of the official staff of the National Board of Health : and whereas, Dr. J. T. Turner, Secretary of said National Board of Health has caused to be circulated Jt is to be supposed), by order of said Board, a scandalous telegram, as below, to say : Memphis, July!).-Dr. R. W. Mitchell, resident member of the National Board of Health, this morning received the following telegram from Dr. J, T. -Turner, Secretary of the National Board of Health at Wash- ington : "Give notice to all concerned to be prepared to close inspections on the fifteenth inst., and get all govern- ment property ready to place out of commission. Notify the valley. This action is owing to Congress failing to make an appropriation, and in the event of an outbreak of fever along the coast, remands the residents of the Mississippi Valley to such protection as can be given by the State and local boards of health and the trusty shotgun," This alleged notification, as aforesaid, intended as a libel upon this and other State Boards of Health, and, by thus defaming them, to bulldoze the Congress of the United States, into granting said National Board of Health their accustomed moneys and salaries ; and Whereas, said National Board of Health, by the emission of such innuendos and incendiary publications, violates the conventionalities of official intercourse in a gross and unwarrantable manner, showing what it would do if it once had power, and reflecting most aristocratically upon seif-governing ability of the American people ; therefore, be it Resolved, That the telegram of Secretary Turner be copied and forwarded to President Cabell, of the Na- tional Board of Health, with a request that in future-if the board has any future-their communications to the people of the valley be couched in more decorous language when alluding to the board. Resolved. That the State Board, supported by the confidence of the people, will continue its efforts, with aid from State, city and volunteers, to ward off the importation of foreign pestilence, and trusts that, with the help of a beneficent Providence guiding the skill and courage of man, the health of the valley may be preserved without recourse to the "trusty shotgun," recommended by the National Board of Health. The resolution was adopted, when the board adjourned. [Extracts from the proceedings of the Board of Health, State of Louisiana, regular meeting July 20, 1882.] The following communication from the President of the National Board of Health was read: NATIONAL BOARD OF HEALTH, > University of Virginia, July 17, 1882, $ S. S Herrick, M. D., Secretary of Board of Health, New Orleans, La. : Dear Sir-I have this minute'received your communication of the fourteenth inst., transmitting a copy of resolutions offered by Mr. Booth, and adopted at a meeting of your board, held July 13. In reply, I have to say that Dr. Turner sent no such telegram', as was falsely alleged in the Picayune of July 10. His message to Dr. Mitchell, which I have seen on the stub of the telegram book, closed with the words " Notify the valley." The last sentence of the message ascribed to him, beginning with the words, " This action, etc.," and closing with the words "trusty shotgun," is apparently a comment added by the person transmitting the message to New Orleans from Memphis. I have seen the same message, in identical tetms. printed in an Indianapolis newspaper, but there it is printed correctly. The marks of quotation include only the part ending with the words. "Notify the valley." The added sentence is printed in a distinct type, without marks of quotation, as the comments of another person. The message to Indian ipolis bears the same date (July 9) as that to New Orleans, and was evidently sent by the sumo party and at the same time I am constrained to infer that the alteration was made in New Orleans, Very respectfully. J. L. CABELL, President National Board of Health. Sanitary and Medical Inspection of Mississippi Nalley. LXXIX Mr. Marks indignantly denied that the dispatch had been changed or manipulated in the office of any journal in Mew Orleans, and he was sure this charge was unjust. The Secretary of the National Board of Health had not given any distinguished evi lence of his prudence and wisdom in writing letters about health matters in the Mississippi Valley. A dispatch was read from Surgeon-General Hamilton, of the Unitad States Marine Hospital Service, under date of July 17, to Dr. John Godfrey, at the Customhouse, in this citv, empowering him to inspect vessels departing for ports up the river, on the request of masters of vessels, and directing him to refer the matter to the State Board of Health, which Dr. Godfrey had done, transmitting a copy of the dispatch from Surgeon-General Hamilton to the board. Mr. Marks said in this connection : " It is a matter of great importance that wide publicity be given to this proffer on the part of our government, not only because the service will be faithfully performed, and without cost to the steamboat interest, but because, above all else, it will command the confidence of the people of the Mississippi Valley. " The National Board, of Health has created the impression that the costs of the inspection service on railroads and steamboats has been paid out of the appropriations of Congress, and in consequence of the failure of Congress at this session to make additional appropriations it threatened the dissolution of the service on the fifteenth of July, and would turn over this section of the country to the guardianship of the " trusty shotgun." This deception was perfectly in keeping with the past history of the National Board. It is well known to the officers of that institution that the inspection service was not dependent upon congressional appro- priations. It was within their full knowledge that railroads and steamboats had been required to pay the costs of inspection, and that inspectors upon railroads had been drawing salaries of $150 per month, paid by the railroads themselves. " Why was this gross deception practiced upon the people? Why was a suspension of the inspection service threatened '! Tae answer is simply this, because Congress required, in the opinion of the National Board officers, a certain amount of fright and intimidation. "I trust that it will be generally made known that the inspection service is not, and has not been, con- tingent upon congressional aid or National Board deceptions." Mr. Marks moved to adopt the offer of Surgeon-General Hamilton, and that the shipping inspector be directed to distribute copies of Dr. Godfrey's letter. Carried. [Extracts from proceedings of the Board of Health, State of Louisiana, at regular meeting, July 27, 1882. The Board of Health assembled at their rooms in the St. Louis Hotel building at seven o'clock on Thurs- day evening, with the President, Dr. Joseph Jones, in the chair, and Messrs. Booth and Marks ana Drs. Formento, Faget, Kells and Von Gohren present. The President made a verbal report of matters before the Board, in the course of which he stated that under rhe new law providing for quarantine fees from vessels visiting this port he did not think the income would be more than $20,000 for the year. In 1855 it had been $45,000, but the tendency of commerce in this day is to increase the capacity of vessels at the expense of their number, and hence a system of fees based on the nu -ber of such vessels showed a falling off. He stated that all the cities of neighboring states had exhibited the utmost good feeling towards New Or- leans, with perhaps the exception of Memphis and Vicksburg, but Memphis alone had made threats of quarantine Chicago, away off on the lakes, had also tried to create a public opinion against New Orleans, but that need scarcely be mentioned. The relations of this city with St. Louis, Galveston, Mobile and other points were of the most satisfac- tory character. The proposition from Surgeon General Hamilton, of the marine hospital service of the United States, to take charge of the inspection of vessels on the Mississippi river, he considered to be of the utmost impor- tance, as it placed the inspection service in reliable and impartial hands. He had written to Surgeon Gen- eral Hamilton conveying the high appreciation of the Board in the premises, and in view of the fact that Congress has made an appropriation for a marine hospital at this point he had ventured to suggest that it would be wise for the government to establish here a floating hospital in the river for the care and isolation of cases of yellow fever, small-pox and the like, occurring among sailors. Mr. George Pandely came in and handed the President a dispatch just received from a correspondent in Galveston stating that a disease resembling yellow fever, but not yet pronounced on by the physicians, had made its appearance at Matamoras, Mexico. It was resolved to telegraph promptly to get the facts. Mr. Booth arose to protest against expressions made in some of the public prints to the effect that the members of th is Board were the creatures and minions of its President, and only acted at his dictation. He then offered the following : Resolved, That this Board is in full accordance with its President, Dr. Joseph Jones, as to the administra- tion ofWiis office, and any attempt to single him out by name for animadversion, or to separate him from his fellow members as though they were opposed to, him but were somehow controlled to his support, falls far short of its intended object, and can only expose the animus of whoever, for their own reasons unfriendly to the Board, would thus seek to divide and conquer. After a failure to lay on the table, the resolution was passed. Mr. Marks arose to a question of privilege to defend himself against statements made in the Times-Demo- crat of last Sunday. He read from that journal a communication from Dr. S. E. Chailld, of the National Board of Health, and also editorial remarks thereon, reflecting, as he thought, on himself. Mr. Marks said : The communication, comment and publication arises out of statements made by me at the last meeting of the Board of Health. The statements made that the railroad companies were paying the salaries of the inspectors were correct, and I had high railroad authority for making them. This I will show before I get through. Such being the case, why was the Memphis Board of Health, immediately under the supervision of the National Board of Health Inspector, permitted to lay an embargo upon the commerce of New Orleans, as- signing as its reason the discontinuance of the inspection service on the fifteenth of July. Knowing, as they did, that the inspection service was to be continued, and at the cost of the railroad companies, they deliberately deceived the public, and did this solely with the view of advising Congress of the terrible danger the clean city of Memphis would be exposed to, in the event of the suspension of the pro forma rail- road inspection service. But let me review Dr. ChaillO's statement, and endeavor to get at the true inwardness of it. He states that '•dining the year 1881 the total amount expended on the inspection service, under my con- trol and for the benefit of New Oilcans, was $C372 80." As but $440 was paid by the railroad, and nothing by river craft, the public would like to know in what manner the balance of the amount was expended in the inspection service. For this purpose I proposed to respectfully request the Supervising Inspector to reply to the following interrogatories : LXXX Inspection Service of National Board of Health. 1. When did the inspection service commence on the Chicago and St. Louis Railroad and on the Louisville and Nashville Road in 1882 ! How long did it continue I How much did these roads pay ! How much was paid by the National Board ? 2. Have there been any inspectors on the Morgan Texas Road in 1881 and in 1882 1 If not, why not! If there has been any inspection on this road in either year, by whom was it paid, and what amount! 3. How much did the steamboat inspection service cost in 188i ami 1882, and by whom paid ! 4. How much has been paid out of the inspection service fund in 1881 and 1882 for the expenses of the Ship Island Quarantine Station ! 5. How much lias been paid out of the inspection service fund in 1881 and 1882 for the running and maintenance of the steam launch Day Dream ? 6. How much has been paid out of the inspection service fund in 1881 and 1882, for the following items, viz.: The salary of Dr. Patton, at the Mississippi Quarantine Station. The salary of the Supervising Inspector. The salary or emoluments of the resident member of the National Board. 7. Does this inspection service fund contribute to any expense incurred outside of this State! If so, what amount, and where! 8. State any other items, charged to this fund. The object of these inquiries is to ascertain how much is actually paid the inspection service at this point; not how much is charged up to this item When this information is furnished we shall be partially informed of the true inwardness of the workings of the so-called inspection service. While waiting for this, I will throw some additional light upon the subject. When I found that the statement I had submitted, on good railroad authority, had been questioned, and that there was a determina- tion to maintain the false impression that has been created, that the railroad inspections had been paid for by the National Board of Health, and were contingent upon additional congressional appropriations, I addressed communications to two of the railroad companies, to which I received prompt replies. The Chicago and St. Louis Road writes as follows: NEW ORLEANS, July 24, 1882. I. N. Marks, Esq., Member State Board of Health, 33 Camp street, New Orleans: Dear Sir-In the absence of Mr. Clark, I beg to acknowledge receipt of your favor of this date, as to cost of National Board of Health inspection service to this company. I would say, in reply, that we paid in 1881 $220 for such service, and have agreed to paj- at the rate of $150 per month during its continuance the cun ent year, comnjencing July 1. Respectfully, T. E. KING, Secretary, for President. The $220 paid in 1881 was for inspection service from August 17 to September 30, about seven weeks. The inspection service of this year commenced on July 1, fifteen days before the Memphis quarantine. Subsequently to receiving this letter, I learned from an officer of the company that in 1880 this railroad paid $4380 for this service. The Louisville and Nashville Road writes as follows : NEW ORLEANS, July 25, 1882, "I, N. Marks, Esq., New Orleans, La-: "Dear Sir-Tours of the twenty-fourth received this a. m. In reply, will say that during the year 1881 this company paid $225 to the National Board of Health for an inspector for this road. We have also agreed to pay $150 per month, commencing with the first of July, this year, and to be paid as long as the inspector is kept on. "Hoping this information will be all you need, I am, yours truly, "J. T. HARAHAN, Superintendent." Is it necessary to comment upon this extraordinary development! Is it not about time that the false public opinion, which has been instigated and engineered by the paid agents of the National Board, should be dissipated, and that a just and proper appreciation of its workings be manifested by all of the public press and people! Should it not be declared that, when Memphis establishes an antediluvian quarantine that the N. B. engineer is on duty ! That when the Illinois council is sending forth its fulminations, that the salary of the engineer has been doubled ? That when Jackson and Vicksburg and LittloRock cry out for additional aid for the National Board, that the shrill cry of the appropriation steam whistle speeds the ubiquitary pretense of the same engineer ! Thus the whole of this so-called public opinion emanates from the paid agents of this institution. This board can confidently and securely rest upon the true public opinion of this community, as recently manifested in the strong endorsement of it by the Chamber of Commerce and the Produce Exchange, and in the good opinion of all surrounding communities not manipulated by or tampered with by the salaried agents of the National Board, * And in full accord with and supported by the Governor of Louisiana, and executing in good faith the laws of the State, it can afford to permit all the pigmy attempts of its opponents to defame it, or to weaken public opinion in its support, to proceed ad libitum. The board went into executive session and adjourned, OFFICE BOARD OF HEALTH, STATE OF LOUISIANA, > New Orleans. July 19, 1882. 5 To Surgeon-General Hamilton, United States Marine Hospital Service, Washington, D C.: The welfare of the country will be promoted if the Inspection Service of the Mississippi Valley, and throughout the United States should be confided to your department, which has facilities for the proper treatment and isolation of infectious and contagious diseases. New Orleans is in good sanitary condition, and absolutely free from yellow fever. Annual death rate per 1000 white inhabitants, 20.3. ' * * * * JOSEPH JONES, M. D., President Board of Health, State of Louisiana. I Telegram.] TREASURY DEPARTMENT, 1 Office Supervising Surgeon-General, U. S. Marine Hospital Service, > Washington, July 20, 1883. ) To Joseph Jones, M. D. President State Board of Health of Louisiana, New Orleans: Sir-I have the honor to acknowledge the receipt of the dispatch of this date, and to enclose you a copy of an order this day sent Dr. Godfrey, the medical officer in charge of this service at the port of New Orleans. Mississippi Quarantine Station, 1882. LXXXI Iu this connection, you are informed that a copy of your dispatch has been forwarded by the Secretary of the Treasury to the Senate Committee on Appropriations, with the information that the facilities exist in the Marine Hospital Service for the proper inspection of vessels proceeding up river from New Orleans, without any additional appropriation from Congress. I have to further request that you will, at any time, suggest any method by which this service may aid the State Board of Health of Louisiana, so far as the treatment of sailors and persons employed on steam boats is concerned. Very respectfully, JOHN B. HAMILTON, Surgeon-General, U. S. M. H. S. TREASURY DEPARTMENT, ) Office Supervising Surgeon-General, U.S. Marine Hospital Service, S • Washington, July 20, 1882. ) P. A. Surgeon John Godfrey, U. S. Marine Hospital Service, New Orleans, La.: Sir-I inclose for your information a copy of a dispatch this day received from Dr. Joseph Jones, Presi- dent of the Board of Health of the State of Louisiana, and to inform you that the same has been laid before the Secretary of the Treasury, who directs that you inspect vessels leaving New Orleans for up river, on the request of the masters, and furnish a certificate of the result of the same without charge. Dr. Jones has been informed of this action, and also that you will co-operate with him as far as is in your power. Yours, very respectfully, JOHN B. HAMILTON, Surgeon-General, M. H. S. U. S. MARINE HOSPITAL SERVICE, 1 District of the Gulf, Port of New Orleans, > Surgeon's Office, July 24, 1882. ) To President Board of Health, State of Louisiana: I have the honor to say that hereafter such up-river vessels as desire health inspection can have it done without cost, and obtain certificates of sanitary status of passengers and crew, if the masters thereof wil make application at my office in the Custom House. Assistant Surgeon Armstrong will inspect in person Very respectfully, JOHN GODFREY, Past Assistant Surgeon, M. H. S. CIRCULAR-THREATENED OR ACTUAL EPIDEMICS. TREASURY DEPARTMENT. ) Office Supervising Surgeon-General, United States Marine Hostital Service, v Washington, D. C.. August 9, 1882. ) To Medical Officers of the Marine Service and Officers of State and Municipal Boards of Health . I am directed by the Secretary of the Treasury to inform you that Congress, at its last session, enacted that- " The President of the United States is hereby authorized, in case of a threatened or actual epidemic, to use a sum not exceeding one hundred thousand dollars, out of any money in the Treasury not otherwise appropriated, in aid of State and local boards, or otherwise in his discretion, in preventing and suppressing the spread of the same." He further directs me to inform you that the President has decided to employ this contingent appro^. priation through the agency of the Treasury Department, and that, in case of a threatened or actual epi- demic, immediate action will be taken, upon application, from the Governor of a State addressed to the Secretary of the Treasury. JOHN B. HAMILTON, Supervising Surgeon General United States Marine Hospital Service. MISSISSIPPI QUARANTINE STATION, 1882-REPORT OF J. F FINNEY, M. D., RESIDENT PHYSICIAN, MISSISSIPPI QUAR- ANTINE. Mississippi River Quarantine, Louisiana, ( . December 31, 1882. $ To the Hon. President and Members Louisiana State Board of Health, New Orleans, La. : Gentlemen-I respectfully submit this my report of this station for the year ending December 31, 1882. It is embraced in tabulated statements numbered one to four, whose headings indicate the nature of each. In reference to these statements, I would call your special attention to the fact, as shown by number four, that there has not been at this station dr ring the past year a case of yellow fever; notwithstanding the fact that one occurred in New Orleans as early as June, and which would have been developed here if at that time there had been a quarantine detention of ten days for vessels arriving from infected ports. I fail to see the wisdom of or benefits to be derived from a quarantine detention of three days for a short while, and then increasing it to ten days for the remainder of the season. If it is the intention of your honorable body to quarantine vessels from infected ports during the summer for a minimum period of ten days, I would suggest that you so pro- claim it from the beginning. in LXXXII Mississippi Quarantine Station, 1882. Last September we -were visited by a terrible cyclone which did considerable damage. The grounds were submerged by sea water for three days, the fencing and watei closets blown down and much of the fencing and loose articles washed away, the painting on all the buildings was either washed off or discolored, and considerable plaster fell from the walls and ceilings. Since then, however, with the limited means at hand, I have managed to have the grounds and buildings thoroughly cleansed and disinfected, the latter being necessary on account of the number of drowned animals and decayed vege- table matter left by the subsiding waters, the fences repaired as far as possible and levees put in good condition, with the exception of fascining, which is very necessary, and the walls and ceiling repiastered. I have made the following estimate of the material and repairs needed and cost: Lumber, $105; barb wire and staples, $45; labor, $50 ; painting exterior of buildings, two coats in oil and whitewashing fences and outbuildings, $500. Total, $700. With this small outlay the buildings will be preserved and the station present a commendable appearance. In conclusion, I would ask your honorable body to allow me the employment of a man as hospital steward, the same to be a competent druggist, to take charge of and care for the hospitals and their effects, compound medicines, and perform such other duties as may be required of him by the Resident Physician. Such an officer is essential for the proper management of this station. Very respectfully, your obedient servant, J. F. FINNEY, M. D., Resident Physician. [No. 1.] VESSELS ARRIVED, 18S2. [No. 2.] COLLECTIONS, 1882. MONTHS. Steemmship. Ships. Barks. Brigs. Schooners. TOTAL. MONTHS. Tax Fee. Fumigation. 1 Other, 1 TOTAL. January February March April May June July August September October November December Total 46 36 41 59 51 30 24 45 61 53 74 95 6 5 9 2 5 2 2 5 3 4 7 24 11 25 9 10 12 5 5 9 9 14 27 4 3 8 2 3 2 2 2 2 8 10 15 21 14 17 9 7 11 7 D 12 88 65 98 93 80 64 42 60 88 72 105 143 January February March April May June July August September October November December Total $1285 00 930 00 1372 50 1012 50 940 00 737 50 572 50 1502 50 1870 00 1522 50 2102 50 3139 00 317 00 408 00 154 00 262 00 512 00 537 00 105 00 5 00 5 00 5 00 $1285 00 930 00 1372 50 1012 50 1262 00 1150 50 726 50 1774 50 2387 00 2059 50 2207 50 3139 00 615 53 160 28 142 998 $16986 50 $2305 00 $15 00 $19306 50 No. 3. VESSELS QUARANTINED, 1882 Id o g£jh^ - & B, ® = ® : •_ : § z S* •, • z • * • x , • • • 00 • to to • • CO Rio Janeiro. Ox CO o< CJ «© -4 Havana. io ox Vera Cruz. to . . m • • • M Minatitlan. w • to CO to I-4 co • Colon. to ■ M M • Tampico. Ox Z to to»- • • • Martinique. to • ; ►->-• ; ; St. Iago de Cuba. to • : w • • • • Brazos St. Iago. to • • to • J Z Z Pernambuco. to • • • St. Thomas. co ::<::: St. Ana, Mexico. H* . . m • • • • Pensacola. H* • • M • • • • Corpus Chrisei. H* I Z m • z z z Poi-to Rico H* Z m z z z z ' Bahia. c Ul Jn 00 to oo to 5 Total. Rigolets and Atchafalaya Quarantine Stations, 1882. LXXXIII [No. 4] VESSELS ARRIVING WITH SICK ON BOARD, 1882. Date. Name. From. No. of days on passage. No. of sick. Disease. 1 Removed to hospital. Died. Post-mortem examination. Remarks. May 8.... Sch..J.G. Whipple Minatitlan 9 6 Mal. fever. 0 1 1 June 21 Sch. Tomas .... Tampico 5 4 Mal. fever. 0 1 1 Sept. 3... Sch. Laura Lewis Brazos St. Jago. 8 2 Mal fever. 0 1 Chronic. Sept. 29.. Sh. J ,C.Robertson Colon 18 3 Mal. fever. 0 0 Chronic. Oct. 4.... S.S. Prinz George Martinique .... 8 4 Mal. fever. 0 0 Occurred while in quarantine. Oct. 15... S S. Explorer... Vera Cruz 3 1 Mal. fever. 0 0 Chronic. Nov. 16.. S. S. Alava Cienfuegos 3 1 Mal. fever. 0 0 Died in New Orleans. REPORT OF W. H. CARSON M. D., RESIDENT QUARANTINE PHYSICIAN, RIGOLETS STATION, FORT PIKE, LA., 1882. To the Honorable, the President and Members of the Board of Health, State of Louisiana : Gentlemen-I have the honor to report the following duty performed at the above named quarantine station, from the first of May to September 14, 1882 : This station was promptty opened on the first of May last, by the Board of Health of the State of Louis- iana, in compliance with the proclamation of His Excellency,' S. D. McEnery, Governor of the State of Louisiana. Every detail in the furnishing of the station was looked to, and the instructions given by the honorable President, Joseph Jones, M. D?, fully attended to and carried out. The station was thoroughly equipped as to its boarding and inspection appliances, and in every way prepared for any requirements incidental to a quarantine station. The total number of vessels (in the great majority schooners) noted, undergoing boarding and inspection, amounted to (933) nine hundred and thirty-three. During the period of inspection no case of sickness of any nature was observed, nor was there any other feature creating or requiring any concern or unusual attention. I may here mention that, during the quarantine season, I was repeatedly notified and forewarned by telegram from President Jones of the approach of suspicious vessels. However, none were discovered to be infected, and they were released after undergoing rigid inspection, fumigation, the other disinfective measures and ten days' detention, under daily observation. The question in regard to quarantine fees, the difficulty and uncertainty of collection, still require due consideration and solution: my views, as expressed in my annual report of 1881, I yet entertain, and from subsequent experience know of no reason to change or modify them. I again recall attention to the increased importance of the station, and its removal to some locality in the immediate neighboorhood of the railroad crossing of the Rigolets, so as to inspect and control communica- tion both by rail and water. Respectfully submitted, W. H. CARSON, M. D., Quarantine Physician, Rigolets Quarantine Station, Louisiana. REPORT OF N. L. SIGUR, M. D., RESIDENT PHYSICIAN ATCHAFALAYA QUAR- ANTINE STATION, LOUISIANA, 1882. MORGAN CITY, January 19, 1882. To the President and Members of the State Board of Health, New Orleans, La.: Gentlemen-I have the honor to forward you my report for the operations at this station during the ses- sion of 1882 It is meet that I should first speak of the overflow which, last year, afflicted this entire country, and of its influence here over the public health and navigation. I shall call your attention to the fact that, whilst the flood lasted, and even after its withdrawal, few deaths occurred from disease; these were chiefly the result of accidents, such as drowning It was only two or three months afterward that sickness com- menced to prevail; dysentery and malarial fevers became rife, and the death-rate among infants from mal- nutrition and intestinal derangements grew unusually large. Yellow fever, however, failed to put in its appearance, showing that something else besides the great revolutions of nature is requisite for its pro- duction. I shall not mention the ravages perpetrated by the waters, nor the houses, cattle and even human beings that they have carried away. This, however interesting, would perhaps appear foreign to my subject. Suffice it, therefore, for me to state that owing to the removal of the Morgan wharf and the cessation of railroad travel, the steamships of the line did not visit this place before May 28. The return of schooners was even more retarded; the current proved, for many weeks after, too strong to be stemmed. In addi- tion, their trade, which consisted for most part of timber and cross-ties, had suffered considerably. These had been washed away in great quantities. This accounts for the notable reduction in the number of steamships, schooners and passengers as compared with the preceding year. In making a summary of all my weekly rolls, I find that, during the whole past season, one hundred and twenty-nine steamships, fifty-nine schooners and six thousand eight hundred and sixty-three passengers have come under my observation. Out of these ships, ten bailed from infected ports, two were from Vera Cruz, the others from Corpus C iristi. I have dealt with them all, according as your instructions and cir- cumstances required. Whenever they allowed me some margin, I always made it a point to be guided by expediency, and to complv wi h the spirit of the law, rather than with its letter. I must congratulate myself upon this course of con luct, since it has been my good fortune, so far, to give satisfaction to all without ceasing, at the lame th le, to preserve the public health. I am, very respectfully, your obedeint servant, N. L. SIGUR, M. D., Quarantine Officer, Atchafalaya Station, for 1882. LXXXIV Outline of the Quarantine Operations of 1882. OUTLINE OF THE QUARANTINE OPERATIONS OF THE BOARD OF HEALTH OF THE STATE OF LOUISIANA FOR 1883. TRANSFER OF QUARANTINE STATION FROM FORT PIKE TO RABBIT ISLAND, EAST RIGOLETS, BY THE BOARD OF HEALTH OF THE STATE OF LOUISIANA. By a rigid system of economy, and by husbanding the resources, the Board of Health was able in the month of April, 1883, to empower the President to erect the necessary buildings, wharfs and boat-house on Rab- bit Island, and to transfer the Quarantine Station to this locality from Fort Pike. The total expenditures by the Board of Health at the Rigolets Quuran tine Station during the quarantine season of 1883, extending from 1 May, to 1 November, was $3762 64, whilst the receipts were only $238,50. In response to the request of the President, the Finance Committee, composed of Hon. I. N. Marks, Colonel A. W. Bosworth and Hon. Ed. Booth, visited and inspected the Louisiana Quarantine Station on Rabbit Island, and reported as follows : To the Board of Health, State of Louisiana : Gentlemen-The Finance Committee, in company with the President, have visited the quarantine station at the Rigolets. They inspected the buildings recently erected, and find them well constructed and conveniently adapted for the purposes intended. The new site at Rabbit Island ^United States Government property) is far superior to the old one at Fort Pike, commanding, as it does, both the Rigolets, East Louisiana and the railroad. The money spent upon this work has been well expended. I. N. MARKS, Chairman, A. W. BOSWORTH, ED. BOOTH. New Orleans, June 14, 1883. QUARANTINE. Office Board of Health, ( New Orleans, April 18, 1883. ) Captains and masters of vessels, shippers and ship agents, and all parties concerned, are hereby notified that, in accordance with official action of the Board of Health of the State of Louisiana, the quarantine station has been removed from Fort Pike to Rabbit Island, East Rigolets. After the first of May, 1883, vessels entering East and West Pearl Rivers and Rigolets will report at Louisiana Quarantine Station on Rabbit Island, East Risrolets. (Signed) , JOSEPH JONES, M. D., President Board of Health, State of Louisiana. QUARANTINE PROCLAMATION, BY SAMUEL DOUGLAS MCENERY, GOVERNOR OF LOUISIANA. Executive Department, State of Louisiana. Whereas, On the eighth day of March, 1883, the Board of Health of the State of Louisiana did request the Governor of the State to issue his aunual proclamation of quarantine, and did advise in regard to the terms and conditions of the same. Now, therefore, in accordance with law, and upon the recommendation of said Board of Health, I hereby issue my proclamation that quarantine take effect from and after the first day of May, 1883, with the following specifications : All vessels, together with their crews, passengers and cargoes, arriving at the several quarantine stations of the State from the Mexican ports of Matamoras, Tampico, Tux- pan, Vera Cruz and Minatitlan, from all ports on the islands of Cuba, Hayti or San Do- mingo, Porto Rico and Jamaica, and from the Brazilian ports, Rio de Janeiro, Bahia and Pernambuco, to be detained ten full days, and the vessels and cargoes to undergo cleans- ing and disinfection. Also, that vessels from other West Indian Islands and from ports along the Isthmus of Panama and the coast of South America as far south as Brazil be subjected to inspection and such cleansing, disinfection and detention as the Board of Health may direct; partic- ular reference being had to the Islands of Barbadoes, St. Thomas, Martinique, Guade- Protection of New Orleans from Foreign Pestilence. LXXXV oupe and Trinidad, and to the ports of Colon, Carthagena, Savanilla, Baranquilla, La Guayra, Georgetown, Cayenne and Paramaribo. The quarantine officers at th^ several stations are specially charged and directed to enforce strictly the execution of this proclamation, and the Board of Health is requested to prosecute vigorously all violations of the same, or of the quarantine laws of the State. Given under my hand and the seal of the State of Louisiana, at the city of Baton Rouge, this fourth day of April, 1883. (Signed) S. D. McENERY. [Seal]. By the Governor. . Oscar Arroyo, Assistant Secretary of State. PROTECTION OF NEW ORLEANS FROM THE INTRODUCTION OF FOREIGN PESTILENCE, THROUGH EAST PEARL RIVER AND BY WAY OF PEARLINGTON, MISSISSIPPI. In accordance with the formal resolution of the Board of Health, Dr. William H. Carson was appointed Qnarantine Inspector at English Lookout, on the fifteenth of May, 1883: OFFICE BOARD OF HEALTH, STATE OF LOUISIANA, 1 New Orleans, May 14,1883. 5 In accordance with the action of the Board of Health at the last regular meeting on the tenth of May 1883, Dr. William Hunter Carson is appointed Quarantine Inspector at Lookout Station, Parish of Orleans' La., and will be respected and obeyed accordingly. Dr. Carson will execute the following duties, in obedience to the direction and in accordance with the powers of the Board of Health, State of Louisiana: 1. Boarding and inspection of all vessels entering Lookout. 2. All vessels from infected ports must be directed to report to the Louisiana Quarantine Station, on Rabbit Island, Rigolets 3. Dr. Carson will report all violations of the Quarantine Laws of Louisiana to the President of the Board of Health. He will also communicate all facts of importance relating to vessels from infected ports included in the Governor's Proclamation, to Dr. Adams, resident quarantine officer at Rigolets. 4. Dr. Carson will report promptly to the President of the Board of Health the entrance of a vessel or vessels from an infected port into the waters of Mississippi. 5. Dr. Carson will also hold supervision over the railroad trains, and allow no passengers qr baggage from an infected port to enter Louisiana. (Signed) JOSEPH JONES, M. D„ President Board of Health, State of Louisiana. OFFICE BOARD OF HEALTH, STATE OF LOUISIANA, ) New Orleans, May 14, 1883. 5 Capt. Ward, United States Customhouse, Lookout, La, : Dear Sir-The bearer, Dr, William Hunter Carson, has been appointed Quarantine Inspector at Lookout Station, and I would respectfully request that you extend to him the same kind courtesy exhibited to the State health officer during the quarantine against Pensacola in 1882. The object is to exclude foreign pestilence, and the quarantine service will be facilitated if the Custom- house officer would permit Dr. Carson to accompany him in his boat in boarding vessels. Respectfully, your obedient servant, JOSEPH JONES, M. D., President Board of Health, State of Louisiana. OFFICE BOARD OF HEAL TH, STATE OF LOUISIANA, > New Orleans, May 14, 1883. 5 J. T. Harahan, Superintendent Louisville and Nashville Railroad : Dear Sir-In order to perfect, as far as practicable, the quarantine system of Louisiana, and guard all the avenues from the approach of foreign pestilence, the Board of Health have assigned the bearer, Dr. William Hunter Carson, to Point Lookout. I respectfully request that the railroad, which you represent with so much ability, grant Dr. Carson, a free pass between Mobile and New Orleans. It may be necessary to order an investigation at any time, and at anv point on your road. Respectfully, your obedient servant, JOSEPH JONES, M. D., President Board of Health, State of Louisiana. [From Regular Monthly Meeting Board of Health, May 10, 1883]. Dr. Jones stated that he thought an officer should be placed at Lookout Station, as vessels from infected ports passed that station on their way to Pearlington. He thought the Board of Health of Louisiana should co-operate with the State of Mississippi in maintaining quarantine, and to that end communicated to the authorities of the State of Mississippi that the Board of Health of Louisiana would permit infected vessels to come to Rabbit Island Station, and there be disinfected before proceeding to Pearlington. The Board of Health having, by formal resolution, authorized the President to confer with the health co thorities of Mississippi most nearly connected with the quarantine system of Louisiana, the following rrespondence will give the results of his visit and personal interview with the President and members of e Board of Health of Hancock county, Miss., on the sixteenth of May, 1883. LXXXVI Protection of New Orleans from Foreign Pestilence. BAY ST. LOUIS, Miss., May 13, 1883. S. S. Herrick, M. D., Secretary Louisiana State Board of Health : Dear Doctor-Yours of the twelfth instant, informing me of action of your board, and that Dr Joseph Jones, President of the same, would visit thebay, etc., was received this morning. You will please state to Dr. Jones that I have called a meeting of our board for Wednesday next, sixteenth instant, and would be pleased if he could so time his visit as to be present. Time of meeting 7 o'clock p. m., at courthouse. I will be pleased to meet Dr. Jones and confer with him in regard to the English Lookout Quarantine matter, and I hope that some mutual understanding can be arrived at, as I consider it the only way. suc- cessfully, to protect your city and Pearl River from infection by that channel, from any vessel which may endeavor to avoid quarantine elsewhere. Will be pleased to meet you when you visit the bay. Yours truly, ' A. PARKER CHAMPLIN, President Hancock Connty Board of Health. COURTHOUSE, HANCOCK COUNTY, MISSISSIPPI. ? Bay St. Louis, May 16, 1883. 5 By the Board of Health of said County- Resolved, That the propositions of Dr. Joseph Jones, President of the Louisiana State Board of Health, be and the same are hereby adopted, as follows: " The Board of Health of Louisiana desires to co-operate with the Hancock County Board of Health, in the event of vessels coming from infected ports and entering the waters of East Pearf River, with the design of loading lumber at Pearlington; that they be requested to undergo inspection and disinfection at the Quarantine Station at EastRigolets. The object of this regu- lation would be to give security to New Orleans in her intercourse with Pearlington or any point along the Gulf coast in Hancock County." Provided there is no expense to vessel for such service. A true copy. [Signed| J. A. MEAD, Secretary Hancock County Board of Health. The complete record of the labors of the Board of Health of the State of Louisiana, in the operations which successfully excluded yellow fever from entering New Orleans from the Mississippi Gulf coast, would cover much more space than could be devoted to this section of the quarantine of 1883 ; the following official ordersand correspondence will, however, illustrate the character of the operations of this branch of the service : NEW ORLEANS, June 29.1883. Messrs. Poitevent & Favre, Pearlington, Miss. Gentlemen-A communication from the President of the Hancock County Board of Health informs us that a vessel presumed to be infected is now lying at Ship Island, and is about to receive a cargo of lumber, by means or lighters, from the Pearl River Mills At its meeting last night this Board agreed to co-operate with the Hancock County Board, through its officers at the Rigolets ana English Lookout, and will, at the request of that Board, disinfect and cleanse anjT lighters which may have communicated with vessels from infected ports. It is proper to add that this Board feels bound to use all the means in its power for the protection of our city and State from foreign infection, and that any laxity along the Mississippi coast or on Pearl River will compel us to observe special measures of self-protection in those directions. Respectfully, your obedient servant, JOSEPH JONES, M. D., President Board of Health. NEW ORLEANS, June 29.1883. Dr. W. H. Carson, Quarantine Inspector, English Lookout: Dear Sir-This Board has agreed to assist the Hancock (Miss.) County Board of Health in the cleansing and disinfection of vessels from infected ports, and particularly of lighters communicating with such ves- sels. You are therefore requested to perform this duty whenever required by these authorities. Dr. Adams will send you all the materials needed for this purpose-sulphur, copperas, carbolic acid, and two iron pots. You are also requested to exercise the utmost vigilance with reference to all such vessels, both seagoing and lighters, especially as we have intelligence that there is now a vessel at Ship Island from an infected port, which has come for a cargo of lumber, to be received by lighters. This vessel has a case of yellow fever on board. Respectfully, JOSEPH JONES, M. D„ President Board of Health. NEW ORLEANS, July 2, 1883. A. Parker Champlin, M. D., President Hancock County Board of Health, Bay St, Louis, Mississippi: Dear Doctor-Enclosed please find copy of telegram from J. B. Hamilton, Surgeon General, United States Marine Hospital Service; also telegrams from the Board of Health of the State of Louisiana, addressed to Messrs. Poitevent & Favre, of Pearlington, Dr. Carson, Lookont Station; J. W. Adams. M. D.. Quaran- tine Physician, Rabbit Island, Rigolet Station; also copy of letter of Messrs. Poivevent & Favre, of June 30. Please furnish this Board with prompt information relating to occurrence of yellow fever in shipping. We desire full and specific information in reference to the following points: In whose charge is the quarantine at Ship Island? Has the Mississippi State Board of Health any representative on Ship and Round Islands? Who are the health officers or quarantine physicians at Pass Christian, Biloxi, Mississippi City, Ocean Springs and Pascagoula? Have these places any efficient quarantine regulations? In this emergency, when the coast of Mississippi is seriously threatened with an invasion of yellow fever, the Board of Health of the State of Louisiana desire to co-operate freely and efficiently with the Health authorities of Mississippi, for the exclusion of foreign pestilence. Respectfully, your obedient servant, JOSEPH JONES, M. D., President Board of Health. United States Marine Hospital Service. LXXXVII NEW ORLEANS, July 2, 1883. Poitevent & Favre, Pearlington, Miss.: Your letter of thirtieth received. If you allow your lighters to communicate with infected vessels and witli vessels from infected ports, and refuse to conform to the agreement between the Louisiana and Han- cock County Boards of Health of May 16, this Board of Health will institute quarantine against Pearling- ton. The following telegram has been sent to Drs. Carson and Adams : Norwegian bark Alma, with two cases of yellow fever, sent from Pascagoula to Ship Island on June 27. Inspect all vessels from Pascagoula and Ship Island ; if they have communicated with any infected vessels, direct them to proceed to Rigolets Quarantine Station Investigate all facts as to the existence of yellow fever at Pascagoula or Ship Island, or any point on the coast of Mississippi, and report immediately to the Board of Health. TOSEPH JONES, M. D„ President Board of Health. Dr. Adams, Rigolets Quarantine Station ; Dr. Carson, Lookout Station, La. : Norwegian bark Alma, sent from Pascagoula to Ship Island with two cases of yellow fever June 27- Inspect all vessels from Pascagoula and Ship Island ; if they have communicated with any infected vessel, direct them to proceed to Rigolets Station. Investigate all facts as to the existence of yellow fever at Ship Island or Pascagoula or anypoint on the coast of Mississippi, and report immediatly to the Board ofHealth. (Signed) JOSEPH JONES, M. D., President Board of Health. EDWARD BOOTH. I. N. MARKS. G. K. PRATT, M. D„ F. FORMENTO, M. D. NEW ORLEANS, July 7, 1883. Wm. H. Carson, M. D., Quarantine Inspector, English Lookout : Sir-I have ordered Sanitary Officers Allen and Bohuer to report for duty at English Lookout, under the following instructions. 1. To aid Dr. Wm. H. Carson in the execution of the following labors ordered by the board. (a). Fumigation of vessels. (b). Inspection of all trains passing from Mississippi into Louisiana. The inspectors should in order to avoid interrupting trains proceed on the out-bound train as far as ne- cessary say to Pascagoula, Biloxi or Bay St. Louis, and return with the train bound for New Orleans and inspect the passengers. (c). Where passengers have been subjected to proper quarantine detentions at the regular Quarantine Stations and their baggage fumigated, they may be allowed to proceed to New Orleans at the discretion of the Quarantine Inspector: said discretion being exercised as to the efficiency of the quarantine and the actual state of health of the passengers. (d.) The Board of Health of the State of Louisiana demand that the Inspector at English Lookout should exercise the utmost vigilance, and allo w no passenger or seaman to enter the State of Louisiana who has left an infected port, in any vessel, whether infected or not, without having been subjected to quarantine. (e.) Furnish this Board of Health with written weekly and if necessary daily reports: also telegraph at once every evasion of quarantine and every point of interest. Respectfully, JOSEPH JONES, M. D., President Board of Health, State of Louisiana. ERECTION OF BUILDINGS, WHARF AND HOUSE AT ATCHAFALAYA QUAR- ANTINE STATION BY THE BOARD OF HEALTH OF THE STATE OF LOUISIANA. In accordance with the formal resolutions of the Board of Health, the President visited Morgan City, and. in company with the quarantine physician, Dr. J. H. P. Wise, inspected the quarantine grounds and agreed upon the neecssary plans for quarantine buildings. The said buildings were erected in accordance with the specifications, and, after being duly accepted by the President, were paid for by the Board of Health, as will be seen by the following receip t: MORGAN CITY, La,, May 5, 1883, State Board of Health To Drews' Planing Mill, Dr. (Gus Drews, Proprietor.) To building wharf and house at Atchafalaya Quarantine Station $525 00 To 1 cistern 30 00 To 1 sign 4 00 To 1 flagstaff 3 00 $562 00 Paid. (Signed) GUS DREWS. THE UNITED STATES HOSPITAL SERVICE INDORSED BY THE BOARD OF HEALTH OF THE STATE OF LOUISIANA-RESOLUTIONS BY HON. I. N. MARKS. The Board of Health held a special meeting at their rooms, corner of Royal and St. Louis steeets, on Thursday evening, April 19, stt 7 o'clock, with the President, Dr. Joseph Jones, in the chair, and Messrs. Bosworth, Booth, Paget, Formento, Marks, Pratt and Von Gohren present. The President stated that the meeting had been called at the request of the Chairman of the Finance Committee. LXXXVIII United States Marine Hospital Service. Mr. Marks, chairman of the committee, stated that the object of the meeting was to bring before it a matter which was thought to be of sufficient importance to call the Board together. The Mississippi Val- ley Sanitary Council, in its late session at Jackson, had manifested a great desire, and bad made strenuous efforts to secure possession, for the National Board of Health or some other body in alliance with it, of the sum of $100,000 appropriated by Congress, and now in the hands of the Secretary of the Treasury at Wash- ington, to be used for the suppression of epidemic contagious diseases. This Board, he said, was only interested in having the Mississippi Valley protected from the ravages of disease and as far as the handling of the Congressional appropriation is concerned, it was desired to see it placed in the care of those who will use it with due honesty and efficiency for the great objects to be attained. There is a service of the government which can be most safely and fitly intrusted with these important duties, and it was desirable that this Board should put itself on record as indorsing that service. Therefore, he offered the following: Whereas, the Congress bf the United States, at its last session, placed at the disposal of the President the sum of $100,000, to be used under his direction for the suppression of epidemic contagious diseases : and Whereas, it is of paramount importance, with a view to the protection of the sanitary cond ition of the country, that the munificent appropriation of Congress be disbursed, if the exigency arises, through that branch of the public service recognized for its age, experience, economy and practical utility, and through which the representatives of the people designed and intended it should be disseminated; Be it therefore resolved, That the State Board of Health of Louisiana respectfully but earnestly request- the President of the United States to place at the disposition of the Marine Hospital Service of the govern- ment the entire appropriation of Congress, in the event that its use should unfortunately become nec- essary . Resolved, That the State Board of Health of Louisiana unequivocally indorse the Marine Hospital Service, and points with pride and satisfaction to its good record last summer in Texas, to the liberal arrangement it made for the protection of Pensacola, and the practical experience and economical administration of its i m portant functions. Resolved, Thatthe President of the United States can rest assured that the sentiments contained in these resolutions are a true reflex of the public opinion of the people of Louisiana. Resolved, That the President of this board transmit to his Excellency the President of the United States a copy of these resolutions. They were unanimously adopted. The President reported that on the thirteenth instant, he had received notice from Dr. Finney, quaran- tine officer at the Mississippi Station, that the three-masted schooner Ajax had passed the Quarantine Sta- tion without stopping for examination. The President has caused the captain to be arrested and the vessel to answer for the violation of the law. The captain, Northrup, and the agents, Messrs. A. K. Miller & Co., appeared, and the captain made oath that he had never before entered the Mississippi River, but he had sailed up to Port Eads on the twelveth instant, and had signaled for a pilot and towboat, but getting none, ami having a fail' wind, he sailed up the river to a point within twenty-five miles of this city, when the wind changed and he came to anchor. He passed the Quarantine Station because he knew nothing about it, but knowing from the papers that the quarantine season did not begin until the first of May, he had no idea of violating any law or regulation of the State, his vessel having sailed direct from New York, and tonchiug at no point on the way. ' The matter having been considered by the board, the fine in such case was remitted on the payment of the usual costs of court. A letter from Dr. Wise, quarantiae officer at the Atchafalaya Station, reports the construction of the new wharf and new buildings there as progressing favorably? Like oeports were received from the work on the improvements at the East Rigolets Station. The President reported that in obedience to a resolution of the Board, in company with Dr. Formento and Mr. Booth, he had called on Mayor Behan, in reference to the need of the city for more sanitary police officers. The Mayor had received them courteously, and had placed at the disposal of the board sanitary policemen, -who, with those already on duty, make up a total of twenty on inspection duty with the several District Inspectors. After some general discussion, the board adjourned. OFFICE BOARD OF HEALTH, STATE OF LOUISIANA, New Orleans, April 20,1882. j His Excellency Chester A. Arthur, President United States of America, Washington, D. C.: Rear Sir-I have the honor to enclose resolutions unanimously adopted by the Board of Health of the State of Louisiana, at the regular meeting held April 19, 1883. With great respect, your obedient servant, JOSEPH JONES, M. D., President Board of Health, State of Louisiana. TREASURY DEPARTMENT, OFFICE SUPERVISING SURGEON-GENERAL, ? U. S. Marine Hospital Service, Washington, May 24,1883. 5 Joseph Jones, M. D. President State Board of Health of Louisiana, New Orleans, La.: Rear Sir-I have the honor to acknowledge the receipt of the resolutions passed by the Board of Health of the State of Louisiana complimentary to this service, under date of April 19. 1883, and to respectfully tender you the thanks of the Bureau for the same. The courtesy shown this service by the Board would long ago have been acknowledged, but almost every day it was supposed that a decision would be made in the matter of the epidemic appropriation, which was thie subject of the resolutions, and I am now happy to inform you that the disposition of the fund for the prevention of the spread of epidemic diseases has been placed in the direction indicated by your Board. Thanking you for the kindness and hearty support you have given this service, and on behalf of the service assuring you bf its sympathy, I am, Very respectfully, your obedient servant, JOHN B. HAMILTON, Surgeon-General, M. H. S. The attention of His Excellency, Governor S. D, McEnery, and of the General Assembly of Louisiana, was directed during the session of 1882 to the important subject of quarantine, and more especially to the resistance to the quarantine laws of the State by C. A. Whitney, President of the New Orleans Auxiliary Sanitary Association, representing Morgan's Louisiana and Texas Railroad Company, and by certain other ship-owners, shippers, and ship agents and brokers. TABLE JL. Vital, Nosological and Mortuary Statistics of the Charity Hospital of New Orleans, embracing Total Admissions and Discharges and Deaths, also Admissions and Deaths of ihe more important anti prevalent Diseases, during a Period of 18 years preceding the American Civil War, and a Period of 16 years following the American Civil War, namely: 1842-1860: 1864-1880: the Total Period embraced in tl ie Tables is 34 years. The Materials for the Table have been collected from all available sources, and have been Classified and Consolidated by Joseph eones, M. D., of New Orleans, Louisiana. New Orleans, 156 Washington street, Fourth District. January 1. 1882. Total Admissions " Discharges " Deaths " Remaining • " Natives Foreign Countries " " United States ■' * GENERAL DISEASES. Yellow Fever Typhus Fever Typhoid Fever Dengue Fever Nervous Fever. • • • Adynamic or Ataxic Fever • Ephemeral Fever Continued Fever Catarrhal Fever Gastric Fever. f Remittent 1 ever Intermittent Fever Malarial Paroxysmal Congestive Fever. | Pernicious and Malignant lever... or •( Malarial Fever | " Poisoning Paludal Fevers. " Cachexia | Typho-Malanal 1 ever (Other Fevers I Small Pox Eruptive Fevers < Measles (Scarlet Fever Diphtheria Cholera (Malignant or Asiatic) Cholera Morbus • Cholera Infantum Erysipelas Puerperal Fever Rheumatism Syphilis - Phthisis Pulmonalis Tabes Mesenterica Scurvy Scrofula Cancer Leprosy (Elephantiasis Greecorum) -- Yaws -- Diabetes Anaemia Anasarca (General Dropsy) LOCAL DISEASES. Diseases of the Nervous System. Congestion of the Brain Abscess " " --- Cerebritis and Encephalitis Phrenitis Meningitis • • * ■ * ' Ceiebro Spinal Meningitis Softening of the Brain Apoplexy Sun-Stroke (Insolation) Paralysis Paraplegia ■ ■ I Unclassified Tetanus s Idiopathic ( Traumatic Trismus Nascentium Convulsions Epilepsy ',v: Delirium Tremens (Mania a Potu, Alcoholism) Intemperance Insanity Dementia and Idiocy Neuralgia Diseases of the Circulatory System. Pericarditis Carditis and Endo-Carditis Heart Clot Hydro-Pericarditis - - - Hypertrophy of Heart Fatty Degeneration of Heart Mitral Regurgitation and Obstruction Tricuspid Obstruction : Aortic Obstruction and Regurgitation Aneurism Heart Disease (Unclassified) Diseases of the Respiratory System. Pneumonia Pleurisy Hydro-Thorax Pneumo Thorax Hydro-Pneumo Thorax Abscess of Lungs Gangrene of Lungs Catarrh Influenza Laryngitis Bronchitis Diseases of the Digestive System. Diarrhoea Dysentery Constipation Colic Colica Pictonum (Painters-Colic) Gastritis 1 'eritonitis Enteritis Gastro-Enteritis Gastro-Duodenitis Hepatitis A bscess of the Liver Cirrhosis of the Liver Jaundice (Icterus) Ascites Hernia Diseases of the Urinary and Generative Organs. Nephritis A1 bumenuria Bright's Disease Gravel and Calculus Hrematuria Gonorrhoea Orchitis Cystitis . Cellular and Cutaneous System. Elephantiasis Psoriasis General and Local Injuries, Etc. Ulcers Abscess Burns Scalds 1 Frac ture Contusion Luxation. Wounds. Fistula, including Fistula in Ano Frost Bite Ptyalism All other Diseases... * TOTAL NOTE-I have constructed the above Table from the Annual Reports, in which the diseases preserved. In the Report for 1842, the figures re due in a measure to the entrance upon the repor of the admissions and remaining, which numbere 18 4? 3,. 3, i® 425 "35 3 1 """ 3 10 172 1,121 50 69 1 1 27 226 137 97 15 1 4 1 1 83 2 1 4 4 11 3 '"4 9 122 '6 1 1 86 3 41 15 89 108 232 ~ 8 30 14 69 15 71 64 10 16 27 19 1 1 46 13 4 236 3! 10 22 131 67 5 121 4,404 from were press of a d 621 12 104 516 760 449 155 e A 211 15 2 1 '4 2 24 16 0 8 1 78 "1 1 "1 28 7 1 1 3 0 1 1 4 3 29 4 1 4 1 28 3 1 3 26 104 8 21 10 '2 1 1 1 3 1 4 9 2 4 76C the 1 simp ating large >. T1 18 5,( 3,1 1, 3, 1, co JO 1,096 3i 2 1 1 15 277 823 32 6 68 9 53 241 146 194 8 4 1 114 9 22 is 6 2 10 81 23 43 3 1 106 60 11 49 17 111 153 231 3 19 133 2 36 66 15 50 12 61 23 3 2 171 51 9 9 67 141 11 74 14 5.013 eport y pul the d numl le un 3 )13 372 )41 129 )2l 192 A_ 487 16 1 1 12 14 1 16 1 "io 87 1 29 14 1 1 1 1 6 21 39 4 6 1 13 110 6 1 26 7 1 2 2 ■ 4( 1.04 S of 1 dishe eaths >er of <nowi 18 5, 4, 1, i 1 s 169 142 10 12 307 1,591 131 10 10 3 2 3 64 276 227 146 10 4 3 3 11 35 29 18 3 T 4 16 6 12 123 19 6 10 3 119 59 "'lO 10 19 125 173 404 13 16 15 169 9 71 68 20 32 60 11 3 4 21 27C 5' If 2* 61 20S 8f If If 15: 1 5.841 he Cl I in a ijn ml snpe 1 nati 14 ■46 159 320 165 530 116 s A 83 58 2 o 12 6 58 2 1 7 1 110 1 4 7 17 7 1 4 4 2 18 1 1 1 35 11 6 13 24 168 7 4 26 15 10 3 2 27 1 1 2 1 £ >1 82( arity Iphal )er up rveni vities 183 6, 5 4, 1, O0 S'" 1 154 12 179 1,497 21 2 346 329 165 27 95 64 42 150 259 279 18 21 72 73 33 87 34* 41 " 7: 19: "ii 1 36' 6.13( Hosp hi ica on ac eg di , are 5 36 46 563 >01 Z86 150 "S ""50 '5 3 3 4 107 '"17 9 16 6 4 11' 36 60 9 20 12 1 1 15 6 163 563 it al Ol oider dition seases nclud 18 8, 6 1, I 11 ^2 146 192 3 1 2 115 1,995 42 27 6 1 18 9 3 34 '515 392 239 24 10 10 I 23 60 45 3 4 7 2 6 1 6 6 2 14 175 24 2 52 3 8 1 14 "1 70 71 2 "i 7 18 19 266 299 473 16 16 14 92 9 77 89 12 23 2 27 7 1 1 166 26 2 7 468 90 15 29 108 455 4 121 20 2 9 654 8.044 New , has 760, tllll $d un 46 044 074 855 501 271 773 Ai A 96 79 "5 22 14 J 1 3 3 153 4 6 25 20 5 3 3 5 1 2 2 4 25 3 1 7 26 8 7 4 7 50 130 7 10 29 10 2 1 *5 3 8 "'i 1 2 32 855 Orle< been while s ma der tl 18 11 10 1 10 1 1,234 2 155 "'9 92 6 13 667 2,392 56 " 31 6 6 662 1 59 1 338 206 268 9 9 2 1 156 35 35 15 1 1 '8 8 10 10 8 9 1 12 3 12 185 52 2 6 20 13 6 ' 21 3 21 74 44 8 2 0 1 40 12 183 459 421 4 3 47 105 10 68 39 38 4 2 29 56 15 i 3 49 17 10 6 403 127 27 9 90 186 14 113 21 15 241 11,945 ms, v a wor the n ring le hea 48 945 010 897 828 366 579 c© "S Q 420 344 1 14 '" 31 2 396 1 26 1 3 2 159 i 7 4 21 12 1 1 5 6 4 2 2 3 i 7 3 2 17 5 2 1 7 20 2 "4 6 64 168 2 14 19 9 4 1 3 32 3 2 '2 7 2 "'3 "ii 1,897 'hi ch k of c umbe he ca d of I 18 15, 12 2 13 1 i S 1,062 1.C99 f0 21 963 4,445 39 1 6 92 2 L813 48 6 389 304 303 2 14 17 7 1 20 6 16 14 4 3 2 7 10 11 4 1 11 1 4 15 233 84 2 0 17 14 1 9 23 57 76 1 58 19 176 1,386 320 56 27 40 84 11 69 50 31 3 36 67 9 3 3 2 1 70 26 7 2 7 385 154 24 3- 101 232 18 146 26 502 15 558 I hav onsid r giv ses tr <ativi 49 558 U3 741 719 776 782 2 e 545 224 1 10 30 1 28 1'122 9 4 4 184 1 3 1 4 1 4 16 9 2 2 2 2 1 1 9 1 5 42 2 3 15 6 4 1 3 4 131 117 1 1 14 21 11 2 3 29 2 2 2 4 2 1 6 14 " 2 40 2.741 e obtt erabl en in eated is of 18 18 15 1 16 1.* 0^ 10 1.049 208 1 4 90 105 47 2.380 7,889 47 1 35 1 4 724 3 2 25 5 408 439 382 4 21 6 2 1 32 18 16 "'9 2 1 1 7 9 66 14 3 7 4 14 4 4 19 190 48 15 16 13 25 1 6 90 58 1 1 1 47 8 132 907 426 63 66 84 93 11 21 34 1 37 1 33 64 14 6 8 3 2 70 11 4 1 2 500 157 29 27 100 223 27 115 6 486 18,476 lined 3 mag the R actu< ?orei> 50 476 989 884 702 74 CO 52 A 4 155 34 6 29 43 39 1 6 ' 530 2 4 3 219 4 1 1 13 8 15 8 2 1 6 9 32 4 1 1 11 4 3 6 3 ""14 i 32 i 1 183 162 I 2 19 8 3 1 6 38 1 1 4 1 1 3 3 9 3 2 78 1,884 from ni toil eport illy g pi Co 18 18 17, 1 16 1, is 7 1.462 271 2 1 62 104 2.456 6,955 93 38 4 47 1 2 382 4 2 57 1 363 408 412 4 9 21 16 1 32 78 19 8 1 10 4 3 24 29 30 6 1 8 3 10 12 216 44 15 6 19 3 9 50 80 61 4 "1 4 47 '"8 170 872 601 42 20 72 66 8 99 36 1 60 4 2 27 38 9 4 6 2 1'7 33 1 6 492 123 24 45 102 285 19 124 17 19 731 18,319 every e, am acce reater an trie 51 319 047 869 694 485 c© e Q 0 278 66 1 4 17 48 26 8 ' 292 "'2 1 238 4 2| 6 13 20 15 "'8 3 3 20 16 3 2 62 1 "" " 21 31 2 1 4 7 141 2 9 8 12 9 26 4 2 7 13 1 3 2 1 1 3 1 7 2 13 112 1.869 avail 1 has pted than s. Ii 18 18, 15, 2, 16. 1. <3^ 49' 1.009 500 1 2 49 471 1.852 5,447 205 40 19 8 485 8 3 63 9 522 463 474 1 14 8 11 34 57 17 3 1 5 16 29 26 12 3 2 9 16 216 20 6 18 9 3 126 93 3 0 97 8 15 373 1,017 414 67 80 79 60 15 47 12 68 6 37 70 11 8 14 6 '' '138 30 3 1 372 167 34 25 132 205 18 233 12 12 1,109 18.031 able s been by th ad mi 1 evei 52 031 057 098 980 322 709 Q 339 150 106 48 40 107 2 4 1 "358 1 3 8 i 1 209 1 0 6 20 16 ' '2 1 5 .... 14 16 1 i 9 6 59 7 1 3 i 40 8 1 1 17 152 126 1 7 10 7 i 17 3 6 10 36 1 6 1 3 6 3 4 2 "39 2 098 onre1 daily j adm ssion y ins 18 13 10. 3 12 1, B s 3,317 241 219 75 78 446 2.635 23 30 13 35 8 194 13 4 '2 474 456 3'4 3 70 28 10 1 '"30 58 16 6 8 1 9 20 31 3 3 3 8 "4 19 183 88 20 1 1 39 108 3 1 "i 45 12 8 231 667 250 77 51 50 91 11 30 9 2 36 8 7 27 32 16 2 1 112 36 7 1 3 399 104 35 8 119 197 19 259 21 "19 2,155 13 759 after prosi inistr 3. Tl banco 53 759 733 164 453 306 c Q 1,890 59 63 3 16 6 18 2.) 2 1 2 115 4 2 10 199 3 1 1 8 4 20 9 3 6 12 4 i 3 2 6 54 1 12 37 4 J 1 1 4 3 "12 117 110 2 4 3 4 "(i 6 1 14 2 i 6 1 9 i 9 20^ 3 164 the c cuter ation le adr the 18 13. 9. 2 11 1 Co £ § 2,743 237 21 73 39 20 74 701 2,182 13 29 47 ]<• 13 13 418 15 6 25 "i'll 472 359 4 13 6 17 19 3 6 4 16 29 13 4 1 3 6 6 23 218 145 13 1 33 4 r, 1 0 0 31 140 64 4 38 6 9 184 944 279 60 27 47 97 12 26 19 24 3 8 18 40 9 6 3 2 1 1 18 1 3 460 113 33 3 100 173 26 227 26 "14 1,111 13.192 onsui , dun is 704 ition figure 54 192 976 702 690 502 e A 1,233 18 73 7 ""18 1 8 0 1 4 352 6 1 3 208 2 4 2 2 3 12 3 .... 16 13 1 1 1 2 8 61 1 17 29 7 i 3 15 153 1 4 4 7 3 l 20 1 1 2 1 1 3 "5 1 ii "2 195 2.702 nptio ng th I. TL of th s rej 18 12 9 2 10 1 § 2,198 54 297 '7 ii 19 11 439 2,162 5 31 18 26 6 16 "351 10 9 38 420 429 324 46 12 14 3 " i 39 28 11 1 3 19 11 37 8 9 1 1 4 1 22 136 62 11 27 4 2 1 4 38 147 63 6 4 3 96 207 760 3.53 46 30 60 60 12 58 18 "18 "12 33 83 13 ""c 10 3 1 41 31 6 1 7 289 105 36 4 136 142 26 241 20 10 1,5.3 12,192 1 of I e lion e dis e deal resen 55 192 701 391 545 904 288 c© A 1,099 29 103 3 "14 18 1 1 225 6 1 2 3 194 4 1 4 "1 6 8 1 1 4 "3 !8 4 1 "■■4 1 4 40 i 1 i i 12 37 15 2 3 1 8 61 4 3 4 8 3 37 2 '" 2 1 3 8 7 1 ""i(> "ioi 2.391 nucli rs, b 3 rep a lis fai >ing 18 9 8 8 1 98 27 155 "16 15 329 2.079 30 6 26 4 32 9 ?8 465 536 353 4 24 17 20 3 "4 30 22 17 16 "3 13 25 7 11 2 8 3 21 224 84 12 33 7 3 1 3 46 x 125 1 68 12 194 660 303 60 34 41 34 15 46 17 15 8 34 62 17 6 14 1 69 27 8 2 7 364 88 47 2 121 273 264 15 1,320 9,432 time etwee icy is '1844 he at 56 432 398 974 063 369 e A fl 11 56 i 9 1 13 21 3 1 " ii 7 3 2 3 165 3 3 9 1 4 4 9 7 4 10 3 4 3 7 2 3 61 1 3 1 16 35 3 1 1 1 15 118 76 3 14 10 10 3 g 21 1 6 3 2 15 "'8 '"87 974 md la n 4 refer give I m iss 18 8 1 1 Is S'" 235 9 154 i 38 " 226 1.721 18 2 23 55 4 1 24 3 42 1 • 484 440 370 11 13 31 4 31 9 16 1 6 7 2 ii 20 12 8 9 4 27 192 18 21 4 1 ei 162 i 71 19 15 211 550 288 58 17 36 38 17 24 21 i2 7 10 36 50 18 3 17 1 "84 27 9 10 267 69 40 9 142 194 31 272 28 3 1,515 8,903 bor. >'clcc able t s the ous 57 903 913 017 326 577 Co A 155 84 0 1 "16 6 1 1 8 3 3 1 3 4 164 0 1 1 3 15 1 2 "3 i 1 3 '8 1 8 42 1 1 26 to 3 4 1 0 14 97 76 1 12 14 3 6 6 30 2 0 7 1 2 4 'll ii 1 63 1,017 As fa < an 0 typ numb if Na it 11 8 2 9 1 2 e 2 727 134 9 205 1,899 "16 1 22 10 ill 8 59 460 314 366 6 24 22 24 7 10 54 9 6 2 8 6 29 „..ao 48 4 44 121 47 6 i 6 112 21 16 129 698 243 44 16 25 58 18 16 26 7 10 36 26 26 4 15 1 "72 18 9 3 4 £97 95 54 6 138 196 22 285 I 15 1,362 11,337 r as i d 9 igrap er 82< tives 58 337 923 290 644 586 751 e A 1,382 53 2 9 1 2 9 t 164 0 I 1 6 4 9 7 1 2 4 8 1 1 3 6 55 3 6 15 43 2 3 3 134 1 9 3 3 12 4 8 6 2 7 2 1 3 3 7 3 16 ' 1 16 ""84 2,290 ny in >'cloc iical ), whi of tL If 12 11 1 10 Qi 107 22 298 32 707 3 707 74 26 1 15 18 5 14 1 579 513 4 2 2 17 18 17 "6 39 42 25 3 i 12 28 9 10 1 8 16 254 153 18 4 7 161 76 3 71 9 16 215 927 261 32 36 38 113 11 9 10 " 42 6 33 61 28 6 7 125 44 4 3 289 127 38 4 157 587 20 257 16 3 12 1,461 12.775 >rma r, A. errors le the ie Un 59 321 730 761 014 A 84 10 99 3 ::::: 38 J 24 1 1 i i i i i '. 4 8 6 1 3 6 251 c 1 7 1 1 8 20 5 i 1 n 4 8 1 3 8' 1 0 12 59 6 1 0 1 1 8 146 90 2 11 9 1 6 "15 4 6 31 1 0 7 1 9 ""i> 2 1 19 " iii 1.321 ;ion e M., , and num ited if 14 12 1 11 2 0 3 148 4' 8 "12 45 702 3,249 38 38 21 16 10 15 58 589 556 431 11 8 16 4 74 33 18 0 'is 1 16 36 7 1 9 1 11 21 345 11 1 79 2 4 4.1 2 6 82 1 173 11 20 213 1,286 464 91 28 3> 92 10 26 16 41 3 25 34 41 6 23 iio 29 8 0 15 484 167 82 164 400 28 322 26 5 14 1 584 14,000 xtem L'lrinc the 11 ber er Scate 60 OnO 357 390 891 728 272 ss <15 A 74 ...... 1 1 3 9 9 4 195 ...... 16 14 13 32 6 3 1 1 4 V 4 80 32 1 i 12 112 11 4 1 4 19 218 89 8 4 12 1 14 27 15 i 3 5 11 3 77 6 44 47 1,390 s, the 1 he umbe iterec 3 and Total 1 20 17 2 O® 16 073 7 220 3.144 481 50 27 560 1 020 97 111 13.157 S3 7r9 346 120 502 233 125 5.122 147 48 795 33 7.526 6.767 5.699 39 322 192 186 26 25 596 760 315 2 144 18 75 44 170 346 10 402 104 81 24 22 lie 17 297 3,290 1,443 215 38 504 107 60 59 26 50 483 2,075 1 123 8 19 43 1.144 147 231 3,359 12 125 6,242 805 534 718 1.454 196 868 657 58 '64 94 549 834 275 58 84 51 25 10 1,435 413 97 17 83 6,484 1,874 547 274 1.962 4,417 308 3,319 305 21 157 17,359 207,356 collec Spring r of det upon Farei<. 8 Tears 7,356 1,261 L614 c© I 8.081 1 301 983 13 4 75 3 266 53 485 221 1 15 83 13 29 1 3,402 37 38 124 24 40 63 3,084 29 27 16 66 4 4 82 226 221 0 95 8 43 33 142 170 6 49 12 24 15 14 92 15 39 84 783 82 8 0 34 8 30 4 20 169 684 103 3 34 30 29 171 1.925 2,004 1 3 15 82 117 173 230 21 161 49 66 373 20 8 40 27 i 3 13 3 1 24 42 73 33 227 29 4 189 2 6 1 471 29,614 ion of and Su iths ha jhe Hos ;u Cout of Deaths "11T - A 50.2 18.0 31.2 26 0 14 8 " 7'3' 2'o 0.01 50.9 63.8 "2O.O 16.5 5.5 23 2 6 6 66 4 25 1 79.1 15.6 72 7 0.5 0.9 54.1 74.3 8.3 8.3 35 4 15.3 16 0 13.7 29.7 70 1 100.0 65.9 44.4 57.3 75 0 83.5 49.1 60.0 12 1 11.5 29.6 67.5 63 6 79.3 88.2 51 1 28 2 23.7 5 6 3.7 0.1 31.7 13.3 50.8 15.4 40.0 34.9 32 8 9 1 45.5 35.0 47.3 79 0 2 6 4.7 12.4 5.1 15 8 32.1 0.1 0 5 5.6 59.6 19.9 35.0 36.2 28.9 76.5 70.2 13 6 -14.7 7.2 13.7 47.6 52.9 " ioio 0.1 0.7 13.4 17.6 1.2 0.3 2.2 13.3 12.0 11 5 0 6 1 3 5 6 0 6 ""38 8.4 14.2 'eports tnmer ir 3 been pital R itries, IS 4 3 1 * e «s 2 51 61 1 049 21 3 188 17 49 38 2 7 3 4 35 2 245 2-0 245 18 9 18 4 8 9 2 25 9 7 1 1 17 28 89 62 ib 1 1 3 68 12 1 28 61 698 76 18 12 3 2 ? 4 " ib 9 10 31 16 15 "50 19 3 1 160 45 12 1 76 4 72 11 1 "602 4.861 in my ionths retai eport adopt 64 861 999 812 423 970 891 00 8 A 1 35 ib 2 20 3 28 4 " 6 1 3 4 1 1 137 3 ii 3 9 j 2 1 2 i 1 3 7 4 4 1 i 1 15 40 3 1 i 241 69 3 1 1 2 'i ib 8 1 "'b 3 1 4 3 64 812 posse of 1 ned a is 713 ed of it 9 8 1 6 ec, % a 3S S' 130 "bb 10 "ib " 501 2,807 40 " 173 3 29 12 4 300 26 2 39 " 339 544 242 1 17 13 25 1 bi 15 6 7 4 '*2 9 20 41 12 11 5 6 1 3 30 77 41 3 3 6 44 117 32 1 1 24 9 81 702 39 37 17 15 16 2 45 3 17 21 17 12 1 33 144 42 6 3 295 95 24 9 116 131 31 309 24 1 8 707 9,329 ssion 881. s pub . In fi nail 66 32 10. 12 73, 93. 39 i 93 " 42 ""8 'ib 11 29 '"58 3 1 1 ' '237 1 2 1 5 2 109 1 3 1 9 4 6 4 " 2 2 8 6 3 3 6 1 4 6 1 2 1 13 38 1 i 1 0 95 86 i 3 3 1 8 3 7 2 6 9 1 0 1 "'2 1 ""6 9 fef 1.125 is th It is lishe 1376 y by 18 8. 7 1 6, 2. ? e % 1,493 "bb 3 ii 296 2 225 58 " 298 ""10 '"'2 94 13 1 27 364 419 332 1 10 12 22 24 10 3 "'2 3 " 6 8 10 29 21 10 2 12 66 9 9 23 4 1 42 99 27 25 "i 87 359 259 22 16 9 11 4 11 i 19 ii 16 17 9 1 28 2 1 84 33 2 299 63 41 89 8f 11 22C 24 43£ 8.61£ e mos impo d by the the 67 612 260 438 637 512 100 A 672 is "2 ""28 13 48 bi 70 i 0 4 4 144 1 1 "'8 5 3 2 2 4 7 1 3 1 3 4 1 0 4 8 8 1 "2 19 35 2 i " io 58 71 "i 2 6 b "4 3 8 1 6 1 7 7 '5 5 "ic 1.43f t com rtant he an remai Adip 18 4, 4, 3. 1, ii 8 " ii "119 995 13 8 410 '4 '2 1 15 12 ""5 2oi 612 314 1 6 14 27 i2 18 8 4 '"5 g 7 4 15 16 5 1 14 25 56 5 5 16 1 *8 104 18 4 b 1 6 4 63 154 197 23 27 2 2 3 2 2 14 11 3 14 13 12 "'ib 18 275 51 2( 53 86 28 123 13 50f 4 981 plete to no thori ning inistr 68 981 165 490 660 443 538 A 5 "'8 11 8 11 "1 9 1 0 109 1 1 "lb 6 1 8 2 "i "2 6 1 3 3 4 1 i 4 1 1 ..... 24 2 1 i 1 1 8 27 48 i 2 2 i 9 i 3 6 7 i 11 ""it 49( one n te thi ties 0 jases ators 18 6. 3, 2. 4 1 35 i i 60 1 461 47 297 27 28 31 1 13 20 307 584 356 3 8 25 36 "i 6 22 11 3 6 1 I 9 41 22 15 16 30 34 71 7 6 21 1 "'i 2 ii b 94 15 "i bi 2 8 118 227 148 2 6 13 14 9 5 ii 8 11 9 13 12 4 25 14 2 2 110 43 10 4 296 52 35 114 151 2f 11 754 6 17* ow in folic ' the n the of t 69 177 327 784 716 499 678 Co C yu A 1 1 16 4 7 34 bi "2 i 3 i 1 6 159 2 2 8 9 9 3 "b 1 1 8 2 7 7 11 2 4 1 3 i ib "2 41 3 i 3 82 57 1 1 i 0 7 2 3 3 11 8 $ 1 1 16 101 78< exis wing dospi Hos} he Hi 18 6. 1, 4. 2 § 8 518 1 37 i 3 "2ii 1,723 9 341 3 "45 13 6 "i "ib 1 396 658 331 3 6 £0 38 1 1 4 3 4 ""ib 3 ii 9 17 27 14 9 1 48 121 21 23 0 i 3 1 bi ii 87 23 1 3 3 26 3 8 69 345 180 18 6 10 11 3 " i 17 8 17 2 61 4 i 31 7 2 2 236 8* 3' 1?£ 54 It 26£ 2^ 1 lit 7.83 tence. discr tai. >i tai a >spita 70 837 764 118 672 951 886 e© A 262 1 17 6 7 '"60 2 ' "2 "'i 1 1 5 9 181 2 "17 1 3 4 "b 2 ib 2 6 1 9 8 1 "'i 3 36 46 1 2 3 84 53 5 6 2 3 i 1 10 1 27 1 9 8 2 "if .... . 12( 1,11 Se< epanc In 184 re ini 1, hav 18 6, 4. 2, c© § iS*5 29 " bb "'i 3 "ii 1,382 21 26 558 1 1 0 2 12 30 0 262 459 391 0 1 31 3 7 13 i i 4 1 9 8 31 33 17 4 1 4 1 36 117 13 8 29 6 1 1 1 4 60 4 106 26 8 65 388 194 18 " i4 8 3 4 ""ib 38 7 6 1 39 8 "' '1 80 47 8 6 37* 7£ 41 121 IE 27t 1 83 6.65 reral les, w 13,t hi tludet e bee 71 651 730 891 700 133 518 § A 20 14 i 3 17 10 53 3 1 i i 2 13 188 1 1 io "i 3 8 1 1 4 1 9 4 8 9 2 1 1 4 i 4 6 5 2 35 1 38 1 1 92 77 1 1 2 10 20 2 1 11 3 1 2 2 4 14 89 repor rhich tota I in t n rets 18 4, 3 2. CO 1 11 "21 1 1 10 ""69 909 24 431 5 10 12 1 i 39 4 299 372 359 8 14 27 20 14 9 9 13 6 44 26 11 3 4 40 107 8 16 16 15 5 0 7 2 28 7 25 139 18 2 9 2 11 85 298 289 10 6 10 21 2 8 1 8 21 8 10 16 47 1 4 43 32 14 4 8 421 59 29 91 8t 14 25S 2' 31 11 5,54 s wer are m 1 case he lis lined. 72 541 846 825 570 288 253 । g A ' 8 i T b ib 28 "2 1 "2 3 3 3 176 . 7 1 1 6 1 3 4 9 i 7 3 1 1 3 1 5 12 1 1 2 4 2 17 3 13 58 3 "2 6 95 59 4 7 1 7 4 2 15 1 4 1 19 1 2 1 3 14 ""ii 91 82 e obt ost pi s recc t of d 18 3, 2 IS 118 ii 88 6 2 687 15 510 ib 2 1 42 i bi 12 "bi 2 216 274 2)1 8 3 21 31 1 3 15 11 15 11 6 4 48 9 3 "bb 152 ""ib 12 19 6 1 11 9 60 161 28 1 2 2 6 1 5 85 277 185 6 1 1 28 1 8 1 20 1 22 4 9 3 3 38 2 59 f j 204 5; If 10 1 24 3 1 45 l| 5.09 lined 'obab rded isease 73 090 124 993 543 05> 035 c© ^5 A 75 6 5 13 6 59 '2 1 1 i '" bi 9 "i 1 5 14 177 1 1 16 1 i 6 2 14 "i 7 1 6 3 14 5 2 2 3 "b 18 2 7 47 61 6 1 1 2 12 53 73 6 2 5 14 5 0 22 £ > f J • i... li 1 1 i| 4 10 0 99 from y du in th s recr JOS 18 4. 3, 2 ii ©■" 9 2 ""b 2 ii 929 5 1 712 9 22 0 2 i 36 "204 220 338 2 2 24 36 3 11 7 9 1 2 3 1 5 10 16 36 27 14 3 "'i i 35 112 "19 13 29 3 6 1 11 63 130 28 1 1 ib 75 381 156 9 4 7 14 7 9 3 19 12 18 8 6 25 2 39 2 2 38 29 11 2 22" 4£ 2 5 "b 1 26 2 L 4 41 3| 5 23 the s to t e lis rded, EPH 74 231 360 860 554 030 201 <» A 6 i i 1 95 "'2 2 5 10 170 2 16 i 3 6 7 1 2 3 7 4 7 3 6 i 9 12 1 ' 3 30 43 4 1 1 2 6 82 67 2 7 7 4 0 b 8 13 1 4 1 12 i 1 1 1 2 1 1 6 7 "b 11 86 New C ypogr ; nun the t JONI 18 4. 4. 2. 2. <^> C© 16 4 i 90 695 4 7 721 40 20 11 i bi 259 188 307 0 12 35 b 6 1 4 2 5 9 ID 47 -.4 18 'b i 31 84 14 9 1 2 2 1 8 " 24 ""bi 113 28 1 2 4 4 48 282 178 4 4 10 21 b 3 " ib 5 19 9 8 13 2 43 1 1 30 12 12 5 3 17£ 5t 21 i ""4 6 1 1 17 2 2 55 0 4,84 frleai aphic abere otal i ES, M 845 121 753 525 646 199 8 <^> A 11 i b 3 67 2 5 i "b 4 9 181 1 2 11 1 1 4 1 2 1 8 7 1 6 6 0 1 4 i 2 1 1 7 ib ib 37 1 1 2 b 5 75 38 5 'b 2 3 1 13 3 2 3 20 b 1 2.... 1 i "9 5 75 s Me al err i 506 1 the • D., 18 2. 2. 3 " ib 2 2 1 "129 1,364 11 11 1.165 20 15 4 1 25 35 1 1 "b 2 30 4 290 285 350 1 15 32 5 'b "i b 68 44 26 ' "8 2 32 127 6 15 31 3 1 " bb 7 7 20 121 22 2 i 3 79 354 161 18 8 10 14 5 2 2 16 3 13 7 6 7 2 61 1 3 23 13 24 1 2 3D 1 4 1 4: ' i 9 1 9 16 1 1 6 .... i 3 5,69 dical ors, w 7, Wj table 156 W 76 690 780 742 693 999 691 <w 1 A 2 5 1 ib 8 92 4 2 0 * 1 1 1 1 4 4 2 149 10 1 b i 2 3 11 6 1 'i 10 2 1 1 ib 1 9 49 4 2 b 11 60 32 4 : 0 8 3 2 26 1 3 1 5 1 5 '. " "b 0 74 Jour Inch file tl being ashin 18* 6. 5 3, 2, 1 "'b 1 "ibo 1 568 6 15 325 17 9 80 14 1 i 3 3) 241 211 341 2 3 13 1 7 4 12 4 "2 0 2 7 4 9 44 31 20 4 3 1 28 1.2 15 13 23 6 3 4 10 13 21 155 28 4 1 1 1 89 349 145 3 8 1 "25 9 18 7 6 14 45 21 0 4 45 12 8 : 30£ 41 1 ""b 1 1 26 1 3 56 2 6.00 nal a can no le Ho 6030 gton 7 002 290 805 >00 282 720 A 6 i ib 6 12 41 8 i 4 5 165 1 "'20 1 5 4 2 1 1 6 4 4 5 1 3 i 15 i 4 3 3 "io 3 6 13 56 2 i i 9 74 49 1 6 4 13 1 1 2 2 22 3 1 1 .... 1 8 5 .... 1 10 2 80 nd fr t now spi tai beinj street 18* 4 1, 3, 2, A) Is 817 1 0 60 1,091 1 44 96 1 13 6 11 1 2 190 168 362 0 5 i 4 0 4 2 3 ii 37 32 30 3 2 4 28 21 21 3 2 4 1 35 1 12 12 8 131 39 1 3 3 64 291 146 13 1 ib 5 ib ""22 3 4 28 36 1 "bb 16 .... 1 ."" 3 i'bb 5 5.87 om I be r< Repo r in e corn "8 878 615 120 169 709 GO "S A 411 11 1 9 20 "4 i 5 166 i 2 0 3 6 1 6 4 3 3 3 1 bi 1 3 3 4 37 3 1 3 "2 63 33 i b i 9 18 i 2 "bb 81 112 enner jctifie rt gi xces< er of 18* 4. 2, gc A 1 98 948 15 78 146 3 10 1 1 "b bi 224 200 341 1 9 59 9 2 0 1 ..... 26 42 18 *3 1 1 23 127 34 33 6 8 0 74 15 132 33 1 1 1 1 """ 6 113 304 149 10 1 15 9 5 12 2 "b 10 21 6 33 1 '"bi If 1 22( 5 4 7 ..... 18 1 1 2 1,00 01 5,24 's Re d, as ves a of thi Camp 9 248 390 >93 585 636 612 GO A 1 8 6 14 14 1 1 5 4 150 1 24 1 i 1 1 1 4 2 21 4 J 3 4 1 1 12 6 1 0 38 6 38 2 i "b 42 28 i 3 1 3 li 1 11 14 i 0 3 7 11 8 69 ports the 01 total adm , Fou 18f 4 4 0 Cq GO i 4s 101 1,048 "bb 1 Z"" 3 1 4 14 152 187 35 L i 54 1 1 1 11 3 8 26 21 38 15 32 lit. 24 18 2 3 8 60 3 32 17 89 17 i 1 i 125 303 97 7 " ib 14 6 " "22 25 12 1 4 11 14 '"25 11 0 3 21- 9. 2 ) "i: 3 1 1 8 18 2 i "bb 3| 4 88 Th igina of on ission rth D 0 884 180 558 534 531 353 c© A> A 2 1 25 6 3 3 164 i 16 2 1 1 11 i 3 i 23 6 1 5 1 2 " i 17 1 8 43 3 J 1 15 16 1 2 4 i 14 1 i 0 4 1 2 1 .... 7 "b 4 65 e cla man y 501 s, wh istric Total IC 91 82 14 Ai GO P 3.160 2 377 155 1 79 19 "2204 20 881 2b6 132 6 251 431 90 117 15 389 158 28 443 12' 12 437 22 4.195 5,761 5.251 35 104 225 516 21 2 33 138 136 104 13 40 69 37 48 163 108 570 431 240 72 8 56 6 36 469 1,405 430 252 188 326 50 26 6 6 54 19 460 4 61 115 359 1,846 394 21 3 8 14 22 168 10 101 1,307 5 712 2.837 213 150 122 219 66 96 35 2 249 67 296 >39 147 174 42 543 143 17 21 957 381 145 34 3s 4,02< 92 44 1 1 1,20 86 20 1 3,14 31 0 9 10,88 8 96,85 ssificat n script 3 a dm if ich are ;, New Tears .857 ,259 ,105 Q© e A 1,568 2 180 13 li5 214 99 636 50 66 5 4 10 8 13 343 29 46 16 44 96 14 199 4 8 34 43 88 11 30 4 24 38 139 42 100 69 40 47 i 24 81 131 15 12 27 14 5 5 26 13 237 2 16 40 189 684 47 2 4 9 16 4 11 105 1 278 856 1 2 4 42 46 35 21 60 39 174 15 55 17 11 224 61 2 6 | 24 £ 2^ 5. 7 10 ) 1 9 5 13 9 3 1,68 7 14.10 on anc 5 of the sions; report Orleans Z C/ OC'It/b of Deaths 14.5 g c© A 49.6 100.0 47.7 16.i 65 0 3 80.4 75 0 10.1 11.6 7.7 56.4 33.3 1.0 6.3 47.0 46.4 77.4 21.9 75.0 10 5 72 7 1.0 1.6 48.0 71.4 14.4 6.2 38.5 1'1.0 24 0 24.6 31.6 84.6 84 6 75.0 80.0 79 7 64.8 79.1 85.2 38.8 17.5 16 0 16 6 65.2 62 5 81.5 100 0 60 6 17.2 3.4 4.7 2.6 54.0 53.8 83.3 83.3 48.1 68.4 51.5 50.0 26.2 34.7 52.7 37.0 11.9 31.3 66.6 50.0 64.2 72.7 2.5 10.8 8.0 22.3 30.1 0.4 1.3 3.2 19.1 69.5 36.4 60.0 biii" 58.2 58.7 10.8 37.8 9.7 26.2 41.2 42.6 11.7 28.5 0.2 "ibis 14.7 0.5 5.9 17.8 8.3 8.5 1 1.5 2 0.9 4 4.2 1 0.9 3.4 4 7.7 1 15.4 4 14.5 conso Annua this d s ed as 5 , Louis Total 3-1 301 256 41 a© 19,233 7 222 3,521 636 51 27 563 1 099 116 111 15.361 74,670 1.218 478 6.251 431 95 117 135 891 391 142 43 5,565 268 60 1,232 11 721 12.528 10 950 74 426 417 702 47 58 7,4 896 419 15 184 23 144 81 218 509 118 972 535 321 96 30 172 23 108 766 4,695 1,873 467 226 830 157 86 6 65 80 19 460 4 61 165 8*2 3 921 1,517 76 11 27 14 65 1,312 157 335 4,666 17,837 9,079 1,018 684 840 1,673 262 964 692 60 806 131 390 6^8 981 449 100 627 194 42 31 2,392 791 242 51 lit 10,51. 2,79 98 28 3,16 5,28 51 6,46 62 5 2 28,24 304.21 idation Report crepanc 390 ; bi ana, A Tears ,213 ,520 7i8 0© 9,667 1,303 1,163 ib 4 88 J 3 311 128 699 320 636 50 8 66 20 87 23 37 14 3,745 66 47 172 40 84 159 5,609 54 42 30 265 8 ib 116 269 309 13 125 12 98 57 180 309 48 149 81 64 62 19 141 21 63 165 914 97 20 7 2 61 22 35 30 ^3 237 2 16 60 358 1,368 150 32 5 13 9 50 34 7 40 216 3,203 2 860 2 19 124 163 208 251 21 221 88 240 90 428 37 19 264 88 2 7 4 3 37 | € 4f 9' ) 15$ 3 33 0 4 7 32 0 0 9 1 2 3,15 3) 43.71 of the s have y appe it noti ugust'1 of Deaths 14 3 § © § A 50.2 18.0 33.0 "25'4 14.9 8.0 0.8 2.7 2.0 0.1 57.3 66 9 10.1 It 5 8.4 47.8 14.8 9.7 5.8 26.0 32.5 67.3 24.6 78.3 13 9 72.7 0.7 1.2 51 2 72.9 9.8 7.1 37.7 17 0 20 6 15.8 30.0 73.7 86.6 67.9 52.1 68.0 70.3 82.7 60 7 40.6 15.3 15.1 19.9 64.5 63.3 81.9 91 .3 58.3 21.5 19.4 5.1 4.2 3.1 0.2 38.8 83.3 53.8 35 0 68.4 51.» 50.0 26.2 36 3 42 5 34.8 9.8 42 1 45 4 48.1 64.2 76.9 2 5 4 4 11 9 5.9 18 5 31 5 0 2 0 7 2.2 7.4 62.2 21.5 36.2 35 0 27 4 67.1 61 5 13.0 43.6 8.2 19.0 42.1 45 3 4 7 22 5 0.1 0 3 15.3 I 15.7 0.8 0.4 3.4 15.3 11.8 10.4 0.8 1.1 I 4.9 5 0.8 1 2.0 0 4.7 2 11 1 81 14,3 diseases not been ars to be n excess , 1881. Exclusion of Infected Vessels from Mississippi River. LXXXIX Great service was rendered the State by the firm support yielded by the General Assembly to the quar antine laws of Louisiana, and their enemies received a well merited and severe rebuke by the passage of Act No. 69, "To fix and regulate quarantine charges at the Mississippi River Station, to establish a lieu and privilege on vessels inspected in favor of the Board of Health for the same, and to provide for their enforcement and collection by provisional seizure." Had the enemies of the Board of Health succeeded in convincing the Legislature that this bill, intro- duced into the House of Representatives of Louisiana by the honorable Chairman of the Committee on Health and Quarantine, " plainly and palpably violates at least two provisions of the United States Con- stitution, and in its tendency to prejudice our growing commerce is materially subversive of the great in- terests of Louisiana," the city of New Orleans, the State of Louisiana, and the entire Mississippi Valley would have been thrown open to the ravages of yellow fever. The representatives of the people assembled in Congress manifested their want of confidence in the Na- tional Board of Health, and provided no adequate means for the protection from foreign pestilence of the Atlantic and Gulf coasts ; and if the General Assembly had not defeated the designs of those immediately interested in the shipping of the port of New Orleans, and their representatives in the daily press, the scenes of suffering, pestilence and death witnessed in Pensacola on the East, and Brownsville on the West, would have been enacted upon a dreadful scale in New Orleans. The decision of Judge Munroe, in the case of the Morgan'S Louisiana and Texas Railroad Company against the Board of Health. No. 7001 of the docket of the Civil District Court for the Parish of Orleans, enjoining the board from collecting any fees under the quarantine la-ws of the State of Louisiana, practi- cally declared the quarantine system of Louisiana, established by the act of 1885, illegal, unconstitutional, and without any practical benefit to commerce. An immediate appeal to the Supreme Court of the State has been taken by the Board of Health and the Honorable Judge E. D. White and Hon. H. N. Ogden have been employed as additional counsel in this case. As President of the Board of Health of the State of Louisiana, I have endeavored impartially to execute the quarantine laws, and have exerted every lawful means for the preservation of the city and State from the introduction of foreign pestilence. EXCLUSION OF VESSELS INFECTED WITH YELLOW FEVER, AND VESSELS FROM PORTS IN WHICH YELLOW FEVER WAS PREVAILING FROM THE WATERS OF LOUISIANA. The efforts of the Board of Health of the State of Louisiana, during the year 1883, which resulted in the exclusion of yellow fever from the State, and from the Mississippi Valley, are worthy of record. It will be seen from the following record, that although yellow fever was brought into the Mississippi River and cases landed at the Mississippi Quarantine Station on the eighth of July, and then subsequently other cases were brought by infected ships from Vera Cruz, nevertheless the city of New Orleans, the State of Louisiana, and the entire Mississippi Valley were protected by the efforts of the Board of Health. MISSISSIPPI RIVER QUARANITINE, LA., J July 10, 1883. 5 To Dr. Joseph Jones, President Board of Health, New Orleans, La.: Sir-I have the honor to report that the Swedish bark Berna, from Vera Cruz, arrived at this station on the morning of Sunday, July 8, 1883, entering the Mississippi River byway of S. W. Pass, having on board four cases of yellow fever, The history of ihe vessel is as follows: Arrived in the harbor of Vera Cruz, from Cardiff, on April 26. 1883, with the following crew: 1. Nyberg, captain, Swede. 2. Hugberg, mate, Swede. 3. Heick, second mate, Swede. 4. Hanson, carpenter, Norwegian. 5. Bergren, cook, Norwegian. 6. Larsen, steward, Dane. 7. Rosenbloom, seaman, Norwegian. , 8. Magnersen, seaman, Norwegian. 9. Sedenwald, seaman, Swede. 10. Abramson, seaman, Swede. 11. Halberg, seaman, Swede. 12. Person, seaman, Swede. Mrs. Nyberg, wife of captain, and Magnus Nyberg, his son ; being in all fourteen persons. All remained well, with the exception of some mild intestinal affections, until June 20, when serious illness occurred, necesitating the presence of physician on board. The following list will show the dates of illness, and. as far as the captain knows, the nature of the disease: 1. Person, June 20, sick three days, fever, now on board. 2. M. Nyberg, June 21, sick three days, fever, black vomit, died in Vera Cruz. 3. Johansen, June 21, sick four days," fever, black vomit, died in Vera Cruz. 4. Rosenbloom, June 22, sick four days, left in hospital in Vera Cruz. 5. Sedenwald, June 24, sick three days, died in Vera Cruz. 6. Capt. Nyberg, June 24, Bick five and one-half days, now on board, well. 7. Mate Hugberg, June 25, sick four and one-half days, now on board, with yellow fever 8. Manguersen, June 26, left in hospital in Vera Cruz. 9. Larsen, June 29. now on board, with yellow fever. 10. Mrs. Nyberg, July 2, now on board, with yellow fever. 11. Halberg, July 2, now on board, with yellow fever, convalescent. 12. Lagagren, July 2, sick three days, new on board, well. 13. Hugberg, July 7, now on board, sick with yellow fever. XC Exclusion of Infected Vessels from Mississippi River. Thus of the original crew, all have been sick, either in Vera Cruz or since leaving there, with the excep- tion of Bergren, the cook, and Ambramson, seaman. The latter was indisposed in Vera Cruz, but for only a few hours. Lagagren joined the ship the day before she left Vera Cruz (June 29), but had been sick in the hospital at Vera Cruz for three days, and was said to have had fever. The captain supplied the places of his absent men by shipping Lagagren and four negroes, and started for Frontera on June 29. Sickness overcoming soma of the crew, he changed his course for Pensacola, but finally put in to Southwest Pass, and was immediately towed up to this station, arriving here on the tenth day after leaving Vera Cruz, having on board Larsen, in the tenth day of sickness. Mrs. Nyberg, in the seventh day of sickness. Halberg, in the seventh day of sickness; convalescent. Hugberg, in the third day of sickness. • All the rest well. Mrs. Nyberg and Halberg entering the convalescent stage, and Hugberg, so far, pro- gressing favorably toward recovery, I have the honor to be your obedient servant, (Signed) J. F. FINNEY, M. D., Resident Physician. THE BARK BERNA-STATEMENT BY DR. JONES CORRECTING SOME FALSE STATEMENTS. NEW ORLEANS. July 14, 1882. Editor of the New Orleans Picayune: Dear Sir-I would not trespass upon your valuable time, so fully and intelligently devoted to the advance- ment of the best interests of our State, to notice malicious and scurrilous attacks on personal grounds ; but the editorial in the City Item of July 13, contains statements of a nature to be used by those unacquainted with the character of their author, and by the enemies of Louisiana in Chicago, Memphis, Vicksburg and other places in Hlinois, Tennessee and Mississippi, for the purpose of injuring the sanitary and commercial reputaaion of New Orleans. The Item, in an editorial of the thirteenth instant, states that ' ' On Friday, July 6, the Swedish bark Bernia, nine days out from Vera Cruz, entered the river at Southwest Pass, having lost a number of the crew by yellow fever, and with four men then sick and several others convalescent. She was taken in tow by one of the tugs of the Ocean Line and brought up to Quarantine. * * * " Her arrival in the river and her condition were promptly reported to Chicago on the sixth. A dispatch was immediately addressed from that city to Mr. E. K. Converse, and received by him on the seventh, ask- ing if the reports were true. As he had. heard nothing of them, he sent post-haste to the office of the Board of Health for information. "Dr. Jones was absent as usual, and there was no one about who had heard the news, which had already traveled to Chicago many hours before. "In a few days, however, the quarantine officials awoke to the fact that a fever infected ship had arrived ; had been permitted to come up to quarantine, and some three days after her entry into Southwest Pass Dr. Jones fairly set to work issuing orders, as follows." * * * * * * The statement of the chief operator of the Ocean Towboat Telegraph Company, and of Hon. E. K. Converse, President of the New Orleans Produce Exchange, herewith inclosed, fully expose the infamous and scurrilous fabrications of the City Item. With great respect and high esteem, truly yours, JOSEPH JONES, M. D., OCEAN TOWBOAT LINE TELEGRAPH SERVICE, NO. 199 COMMON STREET, 1 New Orleans, July 14, 1883. 5 I hereby certify that no dispatch relative to the arrival of the bark Berna at the mouth of the Mississippi River was received at this office until the seventh of July, 1883. This is the only line communicating by electric telegraph from New Orleans to the mouth of the Missis- sippi River at Port Eads and Pilot Town. Dr. Finney's telegram was received at this office on the eighth of July, and was transmitted to the Presi- dent of the Board of Health on the evening of the eighth instant, and reached Dr. Joseph Jones after the closure of this office. The statement in the City Item, of the thirteenth instant, is incorrect, as the Berna was not sighted at the Southwest Pass until the seventh of July, and the disease was reported as climatic fever. No dispatch was received directly from the officers of the vessel, and no dispatch was sent from this office to Chicago. The accompanying records from the books will give the dates of dispatches received concerning the Berna. r WILLIAM WHANN, Chief Operator, Ocean Towboat Line Telegraph Company. Extracts from record and books of Ocean Towboat Line Telegraph Service: Southwest Pass, July 7, 9 a.m., 1'883.-A bark (Berna) anchored to west of bar, with Jack for pilot. THORP. Port Eads, July 7.-Ella Andrews left at 2:30 p. m. to tow a bark (Berna) from Southwest Pass to Quarantine. Southwest Pass, Jluy 7, 1882, 6 p. m.-Ella Andrews tewing bark Berna. Inside. Mississippi Quarantine Station, July 8, 1883.-Ella Andrews arrived up at 1:30 a. m. with a bark (Berna) and anchored it. NEW ORLEANS, July 14, 1882. Dr. Joseph Jones: Dear Sir-In reply to your inquiry, I received no dispatch from Chicago in relation to fever at all, nor in reference to any fever ship arriving at the mouths of Mississippi River. Reports of firms here from Chicago asking if yellow fever was prevailing in New Orleans, to which receivers of those dispatches replied, " City perfectly healthy " Upon suggestian of Director it was thought best that I should send dispatch over my signature as President of the Produce Exchange to Board of Trade, Chicago, denying the rumor. Before sending I tried to telephone you, asking the question, but finding Board of Health has no telephone, I sent to Mr. I. N. Marks, who informed me you had just left his office, remarking, "No yellow fa ver and even no malarial." Respectfully. E. K. CONVERSE. Exclusion of Infected Vessels from Mississippi liiver. XCI MISSISSIPPI QUARANTINE, July 18, 1883. To Dr. Joseph Jones, President Board of Health : Steamship Buteshire arrived last night from Vera Cruz, where she had six cases of yellow fever, two of whom died there. She has had seven cases since, one of which died evening before last at sea. I removed three to the hospital this morning, one of whom will die this evening, the others are so far doing well. The Steamship Merchant arrived day before yesterday from Vera Cruz, having lost one of her crew at sea from yellow fever ; everybody well since. [Signed] J. F. FINNEY, Resident Physician. Copy of telegram to Dr. Finney relative to the above: NEW ORLEANS, July 18, 1882. To Dr. F. Finney, Mississippi Quarantine Station : Isolate, disinfectand fumigate steamships Buteshire and Merchant. Execute all rules and regulations of Board of Health. Hold these vessels subject the orders of the Board of Health. Keep the Board advised by telegram. [Signed| JOSEPH JONES, M. D„ President Board of Health, State of Louisiana. NEW ORLEANS, July 19, 1883. His Excellency, Samuel Douglas McEnery, State Capital, Baton Rouge, La.: Dear Sir-I have the honor to enclose for the consideration of your excellency the following: 1. Table L, Illustrating the Progress of Population in Louisiana During the Past Cen- tury, Including Census of 1880. Upon the data furnished in this letter must be based the calculations of vital and mortuary statistics m all the various parishes. 2. History and Theory of Quarantine-A Defence of the Quarantine Laws of Louisi- ana. This is the most vital and important of all questions with reference to the future prosperity of Louisiana. 3. Report of Conference Committee. Two more vessels have arrived at Mississippi Quarantine Station, with yellow fever aboard. No case and no suspicious cases reported in this city. The situation, however, is grave. We are surrounded with yellow fever. Every vessel leaving Vera Cruz, Havana or Rio de Janeiro is more or less infected. I shall advise the most stringent measures at the meeting of the Board of Health this night, and I will urge the passage of an ordinance prohibiting the passage of any vessel from any Quarantine station to the city of New Orleans. The cargoes can be sent down on lighters, and the vessels depart from the Quarantine Station. Respectfully, JOSEPH JONES, President Board of Health, State of Louisiana. BOARD OF HEALTH PASS ADDITIONAL QUARANTINE REGU- LATIONS (JULY 19, 1883). [Extract from minutes of Board of Health, regular meeting, evening of July 19,1883.] In conformity with previous action of the Board, the President announced that he had written to the Governor of the State representing the danger of any species of commu- nication between quarantine stations and the surrounding country during the existence of yellow fever there, and in reply he had received the following : EXECUTIVE DEPARTMENT, STATE OF LOUISIANA, ) Baton Rouge, La., July 18, 1883. $ In accordance with a preamble and resolution of the Louisiana State Board of Health, adopted July 12, 1883, a copy of which is hereto annexed, and in considA'ation of the imminent danger. that the city of New Orleans, the State of Louisiana, and the Missis- sippi Valley are now in from the arrival at quarantine of infected vessels, any unneces- sary intercourse between the Mississippi Quarantine Station and other quarantine sta- tions and the city of New Orleans is hereby strictly prohibited, and any permission for that purpose heretofore granted is hereby revoked. The laws of Louisiana and the rules and regulations of the Board of Health must be rigidly enforced and obeyed in this and all respects while danger continues. Intercourse between the quarantine stations and New Orleans must be under the exclusive control of the Board of Health, I invoke the vigilance and co-operation of all good citizens during this season of threatened calamity. This order will be communicated by the Board of Health to all persons concerned therein. S. D. McENERY, Governor, The following paper wras then read. The President stated that it wTas an addition to the quarantine regulations of this port, providing increased precautions for the protec- tion of the city and State against the invasion of yellow fever. It provides the com- plete exclusion of yellow lever ships from this port, and for the inspection of railways. Its proposition will be seen in detail as follows : XCII Exclusion of Infected N tssels from Mississippi Hirer. Office Board of Health, State of Louisiana. Wheieas, the Mexican ports of Matamoros, Tampico, Tuxpan, Vera Cruz and Mina- titlan ; all ports on the islands of Cuba, Hayti or San Domingo, Porto Rico and Jamaica, and the Brazilian ports of Rio de Janeiro, Bahia and Pernambuco are now infected with yellow fever; and. Whereas, no proper system is enforced to prevent the spread of the pestilence to the adjoining coast, many towns and villages of which are in hourly and daily unrestricted intercourse with said infected places, thus rendering them liable to momentary infection, even if the disease does not exist there now ; and Whereas, Asiatic cholera is now prevailing in certain ports of Asia and Africa, and re- ports of its spreading to European ports are prevalent, from which contagion might be introduced by vessels arriving at this port therefrom ; Whereas, Section 4, of the act of the State of Louisiana, approved March 18, 1858, and section 1 of the act of March 24, 1876, and section 7 of the act of April 20, 1877, vest in the Board of Health of the State of Louisiana the power and authority in cases of emergency to issue proclamation of quarantine and enforce the same, as against ports other than those named in the proclamation of his Excellency the Governor of Louisiana, the said board issues this its proclamation that quarantine take effect from the date hereof as against all places and towns adjacent and contiguous to the Mexican ports of Matamorous, Tampico, Tuxpan, Vera Cruz and Minatitlan, and the Brazilian ports Rio de Janeiro. Bahia and Pernambuco, and between which and said infected ports unre- stricted intercourse is allowed and no rigid quarantine enforced, and all vessels coming therefrom shall be detained ten days and fumigated and cleansed as m cases of vessels coming from infected ports named. Also, that all vessels or persons holding intercourse or having personal contact with any or all vessels, or the crew, passengers or inmates thereof, quarantined, at Ship Island or any other point on the Mississippi coast or any of the quarantine stations, shall not be allowed to enter the State of Louisiana unless detained at the nearest quarantine station for the space of ten days, and after being cleansed, fumigated and disinfected. That all vessels or the crews thereof, actually infected with yellow fever or Asiatic cholera, arriving at the quarantine stations, will not be allowed under any circumstances to come to the city of New Orleans; but all such vessels having cargoes for or desiring to load from said port, will be required to discharge and receive cargo by lighters and barges, in conformity to such rules and regulations as may be from time to time adopted by the Board of Health. That all railroads conveying passengers and freight in and to the city of New Orleans will be required to stop any and all trains at the quarantine stations established on their respective routes a sufficient length of time for proper inspection, under such rules and regulations as may be from time to time adopted by the Board of Health in relation thereto. The quarantine officers at the several stations are specially charged and directed to enforce strictly the execution of this proclamation, and to exercise the utmest vigilance in exacting the strictest conformance thereto, and the Board of Health of the State of Louisiana will apply the most summary methods accorded by the laws of the State of Louisiana in punishing any violation or evasion of its provisions. Issued by order of and under the seal of the Board of Health of the State of Louisiana, at the city of New Orleans, this day of , 1883. The paper excited some debate, Dr. Formento demanding non-intercourse with Vera Cruz and Havana as long as yellow fever exists at those places. Mr. Marks moved that it be adopted. Dr. Formento said it contained too much and not enough. It took in several countries as a whole. He thought a clause should be introduced requiring complete non-inter- course with Vera Cruz and Havana for the present. We cannot be too strict with these localities. Mr. Booth said that non-intercourse was the refuge of fear. He did not think such a step should be taken at once without consideration. Quaran- tine meant investigation. He said the vessels arriving had been notoriously bad so far as their condition was concerned. He could not give his consent to so severe a measure as non-intercourse. There are fair vessels coming from these ports. He favored the rail- road quarantine spoken of in the proclamation. Railroads had brought every inland town to the borders of the sea. Mr. Marks favored the adoption of the proclamation, and said the Board never before stood in such a responsible position. He strongly favored the clause preventing the coming to the city of vessels on which fever cases may have shown themselves. They should be kept at the quarantine station, and should discharge their cargoes there if the consignees so desired. Every avenue should be closed between the sta- tion and here to prevent contagion from entering. This might require a sacrifice on the part of commerce, but this was necessaty. Exclusion of Infected Vessels from Mississippi River. XCIII Mr. Booth said the importance in a commercial point of view was very great. This proclamation would cut off certain vessels from our wharves. The Board had never gone so far before, and the community might not like so much extra zeal. The proclamation was then unanimously adopted. Mr. Booth urged that this board should execute the laws as it finds them. Quaran- tine does not mean non-intercourse, but restrained intercourse in the interests of public health. The regulations were adopted as read. Deputy Inspector of Shipping Dr. Stanhope Jones reported for May : vessels inspected 73, seamen 1636, passengers 271; total persons 1997. Inspected for June-Vessels 65, seamen 1285, passengers 350, total persons 1625 ; vessels ten days in quarantine 34, vessels five days in quarantine 5, total vessels in quarantine 39 Inspected in July to 19th inst.-Vessels 34, seamen 609, total persons 703; vessels ten days in quarantine 7, vessels five days in quarantine 2, total 9. Total vessels inspected 172, total seamen 3530, total passengers 705, total persons 4535; total vessels ten days in quarantine 4b, total five days 7, total vessels that have passed through quarantine 48. He also reports the river front has been carefully watched, and all vessels arriving have been inspected. Vessels which have been detained in quaran- tine, on reaching this city are inspected, re-visited and watched. The condition of all such vessels showed upon arrival that they had been thoroughly fumigated, disinfected and cleaned at Quarantine Station. He also reports that the basins have been constantly visited and the watercraft therein inspected. All have been found in good condition. Up to July 19 there has not been in the shipping in port a single case of yellow fever or a suspicions case. Under the head of new business, Dr. Formento called up his resolutions of co-opera- tion, laid over from the last meeting. Amended by Mr. Marks they read as follows: " Whereas, the combined efforts of all the citizens of New Orleans are absolutely necessary, in order to improve the sanitary condition of our city and render it both healthy and attractive. "Whereas, hygienic measures of any magnitude cannot be accomplished without large sums of money, which in the present financial condition of our city and State Govern- ments, must come from the voluntary contributions of the people. "Whereas, the public good should be our sole aim, and to that end all partisan and technical considerations should be discarded. " Whereas, it is of vital importance to pe.fect this coming season our system of local sanitation, in order that the vast concourse of people from all parts of the Union who will attend the World's Cotton Centennal Exhibition should be favorably impressed with the sanitary condition and general appearance of the city ; be it therefore Resolved, That the Board of Health of the State of Louisiana, responsible guardians of the public health, recognizes the absolute necessity of co-operation and concert of action with all citizens and associations having at heart the welfare and sanitary im- provement of the city, and hereby expresses its desires and readiness to adopt any plan of action conducive to the public good, without, in any manner, delegating to others its constitutional authority; be it Resolved, That to better secure such desirable co-operation and assistance the Con- ference Committee of this Board of Health be duly instructed to meet in consultation the Conference Committee of the Auxiliary Sanitary Association and all other volunteer organizations desirous of promoting the sanitary improvement of the city, whenever such association shall have endorsed and commend to public confidence the State Board of Health of Louisiana." Dr. Formento resisted the amendment, and his motion to lay it on the table was de- feated by the following vote : To lay on table-Formento and Van Gohren, 2; noes Booth, Bosworth, Kells, Marks and Pratt, 5 The debate on the resolutions which then came up for adoption was interesting. Mr. Marks showed that the Sanitary Association had invariably allied itself to bodies authorized and unauthorized, that had been habitual slanderers of this board, enemies of the quarantine system and Board of Health of the State of Louisiana,had always been received with open arms by the New Orleans Auxiliary Sanitary Association. Mr. Booth contended that the Sanitary Association did not ask any co-operation from this board, and he did not see why the board, representing the law and vested with all the power in matters of health, should unasked seek co-operation with a volunteer body of citizens, unless there was some assurance that the volunteer body wanted co-operation. For the purpose of securing some such assurance on the subject he voted for Mr. Mark's amendment. The resolutions as amended were then adopted. Mr. Marks then offered the foilowing: " Whereas, Dr. J. H. Rauch, the Secretary of the Board of Health of the State of Illi- nois, has recently visited New Orleans and directly interfered and tampered with the health operations of the State Board of Health of Louisiana ; and XCIV Non-Iniercourse with Cities Infected with Yellow Fever. "Whereas, since the dissolution of the National Board of Health there has been an effort made by illegal bodies to assume to perform its pernicious functions and mis- chievous tendencies: / "Re it resolved, That the President of this board be and he is hereby requested to re- spectfully suggest to his Excellency the Governor of Louisiana to confer with his Excel- lency the Governor of Illinois on the propriety of confining Dr. J H. Rauch to health op- erations within his own State, and to instruct him to cease his designing eff rts to im- pair public confidence in the State Board of Health of Louisiana." The resolutions were adopted, after vigorous and emphatic speeches by Messers. Marks and Booth, reciting in detail the interferences of Dr. Rauch with the operations to this boatd. The board then adjourned. « PROCLAMATION. Offices Board of Health, State of Louisiana. Whereas, the Mexican ports of Matamoros, Tampico, Tuxpan, Vera Cruz and Minatit- lan ; all ports on the islands of Cuba, Hayti or San Domingo, Porto Rico and Jamaica, and the Brazilian ports of Rio de Janeiro, Bahia and Pernambuco are infected with yellow fever; and Whereas no proper system of quarantine is enforced to prevent the spreadof the pes- tilence to the adjoining coast, many towns and villages of which are in hourly and daily unrestricted intercourse with said infected places, thus rendering them liable to momentary infection, even if the disease does not exist there now ; and Whereas, several vessels from said districts of country infected with said disease are now lying in close proximity to the seacoast of Mississippi and the Mississippi Quaran- tine Station ; and Whereas, Asiatic cholera is now prevailing in certain parts of Asia and Africa, and reports of its spreading to European ports are prevalent, from which contagion might be introduced by vessels arriving at this port therefrom ; and Whereas, Section 4 of the act of the State of Louisiana, approved March 18, 1858, and section 1 of the act of March 24, 1876, and section 7 of the act of April 20, 1877, vests in the Board of Health of the State of Louisiana the power and authority in cases of emergency to issue proclamation of quarantine and enforce the same, as against ports other than those named in the proclamation of his Excellency the Governor of Louisiana; The said board issues this its proclamation, that quarantine take effect from the date hereof as against all places and towns adjacent and contiguous to the Mexican ports of Matamoros, Tampico, Tuxpan, Vera Cruz and Minatitlan, and the Brazilian ports of Rio de Janeiro, Bahia and Pernambuco, and between which and said infected ports un- restricted intercouse is allowed and no rigid quarantine enforced ; and all vessels com- ing therefrom shall be detained ten days and fumigated and cleansed, as in cases of ves- sels coming from the infected ports named. Also, that all vessels or persons holding intercourse, or having any personal contact, with any or all vessels, or the crews, passengers or inmates thereof, quarantined at Ship Island or any other point on the Mississippi coast or any of the quarantine stations- shall not be allowed to enter the State of Louisiana unless detained at the nearest quar- antine station for the space of ten days, and after being cleansed, fumigated and disin, fected. That all vessels or the crews thereof actually infected with yellow fever or Asiatic cholera arriving at the quarantine stations will not be allowed, under any circum- stances, to come to the city of New Orleans. That all railroads conveying passengers and freight in and to the city of New Orleans will be required to stop any and all trains at the quarantine stations established on their respective routes a sufficient length of time for proper inspection, under such rules and regulations as may be from time to time adopted by the Board of Health in relation thereto. The quarantine officers at the several stations are specially charged and directed to enforce strictly the execution of this proclamation, and to exercise the utmost vigilance in exacting the strictest conformance thereto, and the Board of Health of the State of Louisiana will apply the most summary methods accorded by the laws of the State of Louisiana in punishing any violations or evasions of its provisions. Issued by the order of and under the seal of the Board of Health of the State of Lou- isiana, at the city of New Orleans, this twenty-third day of July, 1883. JOSEPH JONES, M. D., President Board of Health, State of Louisiana. A true copy: S. S. Herrick, M. D., Secretary. Non-Intercourse ivith Cities Infected with Yellow Fever. XCV NON-INTERCOURSE WITH CITIES AND LOCALITIES IN EECTED WITH YELLOW FEVER OR ASIATIC CHOLE RA. [Extracts from Proceeding of the Board of Health, State of Louisiana, held Monday evening, July 23, 1883.1 On Monday evening, at 7:30 o'clock, there was a special meeting at their rooms, corner of St. Louis and Royal streets, of the Board of Health to confer with a joint committee representing the commercial bodies of'this city. Of the Board of Health were present: President Joseph Jones, M. D.; Drs. Faget, Formento, Pratt and Von Gohren, and Messrs. Booth, Bosworth, Kells and Marks. Of the joint committee were Messrs. J. J. Stewart, A. Schreiber, J. V. Moore; of the Stock Exchange were C L C. Dupuy, H. W. Connor and H. Neugass; H. D. Cole- man and W. G. Wheeler, of the Mexican Exchange; Fendel Horn, L. H. Joseph and W. M. Burrell, of the Chamber of Commerce ; also Messrs. A. A. Woods. A. Leblanc, Col. J. W. Glenn, Capt. Joseph H. Lawler, Dr. W. G. Austin, and other citizens. The President of the Board of Health read a telegram from Surgeon General Hamilton of the Marine Hospital Service at Washington, announcing the existence of Asiatic cholera at London. He also read the following letter from Gov. McEnery: Executive Department, State of Louisiana, ) Baton Rouge, July 20, 1883. J To the Louisiana State Board of Health: Gentlemen - Owing to the number of infected vessels with sick crews and dangerous cargoes arriving in the Mississippi and detained at Quarantine Station, that station has become practically an infected port, and especially dangerous from its proximity. This causes great aud rapidly increasing alarm at home and in adjoining States, as well as throughout the Southern Valley of the Mississippi. While a stupendous calamity threatens the lives of our people, all rational measures of self-protection become just and imperatively necessary. The safety of our city and State and the highest public interests now demand stringent precautionary measures. Therefore I suggest and urgently recommend that from this date until the first of November no vessels infected or vessel with sick crew or passengers be permitted to enter the Mississippi River, and that all infected vessels and vessels with sick crews now at Quarantine Station be sent out of the river as soon as practicable to some convenient locality. The action of the Board of Health in this regard will be maintained to the full extent. S. D. McENERY, Governor. Mr. Schreiber of the Joint Committee then presented the resolutions adopted at the meeting of the Cotton Exchange on Saturday. Resolved, That the State Board of Health be requested to petition the Governor of the State to have all infected vessels now in the waters of this State removed out of the same, and that he issue his proclamation that henceforth no vessel from any port be permitted to enter the waters of this State. Resolved, That the Board of Health be requested to reconsider and rescind its action of eighteenth instant, relative to loading cargoes of infected vessels at Quarantine Station. Resolved, That the commercial bodies here represented have confidence in the State Board of Health and in its efficiency, and believe it is entitled to the confidence of the people throughout the Valley of the Mississippi. Mr. C. L. C. Dupuy spoke, declaring the importance of the policy embodied in these resolutions. Mr. Burwell spoke as to the importance of protecting our trade relations with the tropics by all possible safe-gnards against disease, but at the same time to beware of the efforts of communities north of us who are interested in breaking down by every pos sible means the commerce of New Orleans in the interest of Eastern railways. Col. F. C. Zacharie, counsel for the board, read a legal opinion on the power and rights of States to exclude infected shipping from their ports. The President then spoke of the work of this board, as at present organized, since 1880. With stinted means at its command it had undertaken to guard the entire coast of Louisiana, and so far no epidemic of foreign pestilence has made its appearance in this cit> or State. During the present year the three principal quarantine stations of the State had been improved and made more adequate to the uses they were intended for, and every effort had been made to render the service if possible more efficient. The station at the Rigo- lets had been removed to Rabbit Island and had been greatly improved. It is so sit- uated as to command the entrance to Pearl River, and it is working in connection with the authorities of Harrison county, Mississippi, for the protection of all points on Pearl River. The Rigolets station protects the back door of New Orleans; two thousand ves- . els enter the city annually from the Lake. XCVI Non-Intercourse with, Cities Infected with Yellow Fever. He spoke also of the vessels in the river from Vera Cruz. The Buteshire has been completely isolated from communication with the city, and is about to depart, while the Merchant, which has had no sickness while in quarantine, has sailed. At the last meeting of the board stringent regulationshad been adopted for the treat- ment of infected ships. The State of Louisiana and the Mississippi Valley had been protected from yellow fever by the rigid and intelligent execution of the quarantine laws of Louisiana, w hich the President conceived to be ample for the present and all future emergencies. Mr. Marks then offered the following: Resolved, That the State Board of Health of Louisiana fnlly indorses the resolutions adopted by the committee of the conference held at the Cotton Exchange on the twenty* first: Resolved, That the Governor of Louisiana be and he is hereby requested to issue a proclamation of non-intercourse with ports infected with yellow fever, namely [list to be added]; and to order all infected vessels out of the waters of the State, as recom- mended by him in his letter of the twentieth instant to this Board. The resolutions were favored by Messrs. Marks, Formento and Von Gohren. Mr. Booth said he could not support them. They destroyed all scientific quarantine. Quarantine was not the blockading of a port, but the detention under wise regulation of infected persons and ships. Quarantine meant originally forty days. We could detain vessels and persons as long as might be necessary to give protection, but he was opposed to the barbarous processes of exclusion. We had protested against the merciless shot- gun quarantine as applied to us, but we now propose to apply it to shins in distress. Hospitality has its just demands as well as commerce, and to listen to the counseling of a blind panic is not the part of the guardians of the public health. The resolutions were put to a vote and adopted, Mr. Booth alone voting no. The following, offered by Dr. Formento, was adopted: Whereas, there is danger of yellow fever being introduced into New Orleans through unrestricted communication between Ship Island and the coast of the State of Missis- sippi ; be it Resolved, That the Governor of the State of Louisiana be requested to call the attention of the Governor of Mississippi to this fact, and urge him to take stringent measures to put a stop to this dangerous intercourse ; be it Resolved, That the general government be requested, through the proper authorities, to order that no communication should be held between Ship Island and the Mississippi coast. Dr. Jones said that since the station at Ship Island had passed into the hands of the Marine Hospital Service it has been guarded with great strictness, and he did not believe there was any justice in attacks on it. He believed that Surgeon General Hamilton and his assistants were exerting their utmost to isolate the place, and he felt sure it was being done. The State Board of Health of Mississippi does not take proper care of the sea coast line of the State, which is left to local sanitary authorities. The meeting then adjourned. New Orleans, July 24, 1883. His Excellency, Samuel Douglas McEnery, Governor State of Louisiana, Baton Rouge, La.: Dear Sir-I have the honor to inclose herewith resolutions adopted by the Board of Health, of the State of Louisiana, at the special meeting held last evening, for the pur- pose of considering the communication of your ' Excellency ; also copy of resolutions of joint conference of meeting of official committees of New Orleans commercial bodies. With great respect your obedient servant, JOSEPH JONES, M. D., President Board of Health, State of Louisiana. OFFICE SECRETARY OF STATE, STATE OF LOUISIANA, > Baton Rouge, July 24, 1882. 5 Dr. Joseph Jones, President Board of Health, New Orleans: My Dear Doctor-I am directed by the Governor to transmit to you. herein enclosed, his proclamation, in pursuance with the resolution of the Board of Health, with the request that you will give it as much pub- licity as you can, in view of the importance of the subject matter. Very respectfully, your obedient servant. OSCAR ARROYO, Assistant Secretary of State. ADDITIONAL QUARANTINE PROCLAMATION. EXECUTIVE DEPARTMENT, ( State of Louisiana. 5 Whereas, at a meeting of the Board of Health of the State of Louisiana, held in the city of New Orleans, on the twenty-third day of July, 1883, the following resolution was adopted: Non-Intercourse with Vessels Infected tvith Yellow Fever. XCVII Resolved, That the Governor of Louisiana be and is hereby requested to issue a procla- mation of non-intercourse with ports infected with yellow fever, to-wit: Vera Cruz, Rio de Janeiro, Havana, and such other ports as may become infected with yellow fever, and to order all infected vessels out of the waters of the State, as recommended by him in his letter of the twentieth instant to the board." Now, therefore, I, Samuel D. McEnery, Governor of the State of Louisiana, by virtue of the authority in me vested by law, and in pursuance of the above resolution, do hereby order and direct that all vessels now at the Quarantine Station, on the Missis- sippi River, which are infected with yellow fever, be removed without unnecessary de- lay * * and I do hereby further order and direct that all vessels from the ports above named, and such other ports as may become infected with yellow fever, be pro- hibited from entering the waters of the State of Louisiana. The Quarantine officers at the Quarantine Station are especially charged and directed to enforce strictly the execution of this proclamation, and the Board of Health is re- quested to prosecute vigorously all violations of the same. Given under my signature and the seal of the State of Louisiana, at the city of Baton Rouge, this twenty-fourth day of July, A. D., 1883. S. D. McENERY, By the Governor: Governor of Louisiana. Oscar Arroyo, Assistant Secretary of State. EXECUTIVE DEPARTMENT, STATE OF LOUISIANA, Baton Rouge, La., July 28, 1883. $ Dr. Joseph Jones, President Louisiana Board of Health : Sir-Respecting the vessels sent away from the Mississippi River, it is obvious that their future course and destination are entirely beyond the control of State authorities. It is for their owners or masters to send them to the ports whence they came or to a nearer temporary refuge. They will naturally for the most part be sent to the nearest refuge station. Such infected vessels as may go from the Mississippi River to Ship Island will be received at the United States Refuge Station there, of which I have the direct assurance of the Hon. Chas. J. Folger, Secretary of the Treasury, by telegraphic dispatch dated July 27. Masters of vessels sent away should be informed of this privi- lege, with or without counsel in the matter from the Board of Health, as the latter may see proper. The clearing of the Mississippi River from infection is a measure of para- mount necessity. While tye endeavor to mitigate the incidental hardships resulting from its execution, we assume no new responsibility. I have abiding confidence in the vigilance, energy and wisdom of our State Board of Health. Yours very respectfully, S. D. McENERY, Governor State of Louisiana. QUARANTINE, July 25, 1883 Joseph Jones, M. D., President Board of Health : No new cases. Only three convalescents ; balance well. Have had no sickness on any vessel here, ex- cept bark Berna and steamship Buteshire. The following vessels are here: Brig Ana Faura, steamship Gracia, ship Angelita, steamship Emiliano and schooner Susan Scranton, from Havana; schooner Alice C. Noyes, from Carthagena, and steamship Architect, from Colon, and bark Berna. from Vera Cruz, which will leave shortly. J. T. FINNEY, M. D , Resident Physician. QUARANTINE, July 26, 1883. Joseph Jones, M. D., President Board of Health, State of Louisiana: Does Governor's proclamation apply to vessels nearly ten days here, and which have been perfectly healthy ? Does it include vessels arriving from all the Cuban ports, or only vessels from Havana direct ? J. T. FINNEY, M D. PORT EADS, July 25, 1883. Dr. Joseph Jones, President Board of Health: E. D. Sidbury in sight, from Vera Cruz. If sickness on board, what steps shall I take ? HART, Inspector. NEW ORLEANS, July 25, 1883. Dr. G. H. G. Hart, Board of Health Inspector, Port Eads: Anchor Sidbury and await further orders, and allow no communication whatever. JOSEPH JONES, M. D. THE BOARD OE HEALTH RESOLVES NOT TO PERMIT THE STEAMER EMILIANO, FROM HAVANA, TO COME TO THE CITY. The Board of Health met at their rooms corner of St. Louis and Royal streets, on Fri- day afternoon at 1 o'clock, July 27, 1883, with President Joseph Jones, M. D., in the chair, and Messrs. Booth, Bosworth, Kells, Marks and Drs. Formento and Von Gohren present. XCVIII Non-Intercourse with Vessels Infected with Yellow Fever. The board then went into executive session and so continued for nearly an hour. About 2 o'clock the doors were opened, when the President read a number of communica- tions, the most importaat of which were the following: A telegram from Dr. Finney at the Mississippi Quaratine Station : Quarantie Station, May 25, 1883. Joseph Jones, M. D., President of the Board of Health: No new cases of yellow fever ; only three convalescents, balance all well; have had no sickness on any vessels here except bark Berna and steamship Buteshire. The fol- lowing vessels are here : Brig Anna Faura, steamship Gracia, ship Angelita, steamship Emiliano, also the schooner Susan Scranton from Havana, schooner Alice C. Noyes from Carthagena and steamship Architect from Colon. The bark Berna from Vera Cruz will leave shortly. J. T. FINNEY, M. D., Resident Physician. Also the following from Dr. G. H. J. Hart, medical officer at the Jetties: Jetties, July 25. Dr. Joseph Jones, President of the Board of Health Steam schooner Sidbury in port, at anchor, from Tampico, previously from Vera Cruz, HART, M. D. Inspector. Also, the following from the clerk of the Commissioner of Police: Department of Police and Public Buildings, ? New Orleans, July 27, 1883. $ Sir-I am directed by Commissioner Mealey to ask you if you would be kind enough to request the Sanitary Inspectors of the different districts to visit the markets and ex- amine the meats offered for sale, and he will instruct the inspectors of the markets to be under the control of your inspectors. There appears to be a strong desire to correct the abuse of selling unwholesome food in the markets, and he asks that you and your inspectors help in this matter. Yours, etc., D. M. MCCARTHY, Chief Clerk. Also the following, which is a copy of instruction sent to the medical officer at the jetties : Office Board of Health, State of Louisiana, 1 New Orleans, July 26, 1883. j Dr. G. H. G. Hart, Quarantine Inspector, Port Eads: Sir-Inclosed I herewith forward for your information and guidance, additional quar- antine proclamation of His Excellency, Samuel Douglas McEnery, of July 24, 1883; also proclamation of Board of Health of State of Louisiana, of July 23, 1883. Show the proclamation of His Excellency, Gov. S. D. McEnery, to the captain or master of vessels from ports infected with yellow fever informing him that in accordance with the orders of the Governor of Louisiana, he will not be permitted to bring his vessel with her crew and cargo within the waters of this State. Proceed in a similar manner with all vessels coming from the ports named in the Governor's proclamation. In the event that a vessel should arrive from any other port in which yellow fever or Asiatic cholera is prevailing, or in the event that any vessel has had yellow fever or Asiatic cholera, in the ports from whence she sails, or on the voyage, proceed in the same manner. Allow no vessel from the ports mentioned, or from any port infected with yellow fever or Asiatic cholera, to enter the Mississippi River. Inform the pilots of the provisions of the Governor's proclamation, and report any violation of the laws of Louisiana by the pilots, or any seaman, traveler or citizen, to the Board of Health. Respectfully, JOSEPH JONES M. D., President Board of Health, State of Louisiana. Mr. Marks then stated that the chief business of the meeting was to act on the peti- tion of A. K. Miller & Co., stating that the Spanish steamship Emiliano, from Cien- fuegos, Cuba, via Havana, had arrived at Quarantine Station at 11:45 p. in., twenty- third instant, with all well on board. He asked that this vessel, an iron steamship, in ballast, be permitted to come up the river after the ordinary quarantine observations, as she had arrived previous to the declaration of the non-intercourse policy. He did not see how the board could admit any ship from the infected ports named in the proclamation of non-intercourse, as it was the presence in the waters of the State of these very ships that had caused the public alarm that had given rise to this policy of non-intercourse. Mr. Marks then offered the following . Resolved, That under existing proc'amations concerning quarantine, the Board of Health cannot grant the request made in behalf of the steamship Emiliano. Non-Intercourse with Vessels Infected with Yellow Fever. XCIX Dr. Formento, one of the prime movers of the original resolutions on non-inter- course, now advocated the granting of the petition of Messrs. Miller & Co., and offered the following : Resolved, That the steamer Emiliano, which arrived in the Mississippi River before the issuance of the Governor's non-intercourse proclamation, and is not an infected ship, be detained at the Quarantine Station until such time as the Board of Health may con- sider proper to allow her to come to the city. Mr. Marks said a vessel from an infected port is in public opinion an infected vessel, and in the opinion of the people of the Mississippi Valley a subject of alarm, and this Board cannot trifle with such a matter. The presence of yellow fever of a virulent type at Havana and VeraCruz had excited such general alarm that leading commercial bodies and citizens of all classes had demanded the entire exclusion of all vessels coming from those ports attempting to enter here. The vessels in the river at Quarantine Station from those ports had caused the general outcry for their exclusion. This Board cannot afford to pass resolutions of non-intercourse and then set them aside for any considerations of friendship or commercial profit. Mr. Booth said he was not suiprised that the severity of the rule of non-intercourse, even at this early day, was found to be oppressive by its promoters and originators. He, for his part, had opposed such a policy . He had thought that this Board, by means of its excellent and thorough arrangements for detention and disinfection, was able to cope with the dangers of infected shipping ; but absolute exclusion of all shipping ar- riving from certain ports had been insisted on, and that policy had become a law to bind this Board. Now there was nothing left to this Board but to execute that law with the utmost strictness. It had been said by another, General Grant, he believed, that the best way to do away with an obnoxious law was to enforce it with stern impartiality, and there is no other way to act in the present instance. Dr. Formento's substitute for Mr. Marks's resolution was put to the vote, and lost byK the following: Ayes-Formento and Von Gohren-2. Noes-Booth, Bosworth, Marks and Kells-4. Mr. Marks's resolution to exclude the Emiliano was then adopted. MATTERS AT QUARANTINE-GOVERNOR McENERY MAKES FINAL DISPOSITION OF DR. PATTON-A STUBBORN SKIPPER-A FEVER SHIP OUTSIDE THE BAR. The following dispatches passed yesterday: New Orleans, July 31, 1833. Dr. J. F. Finney, Resident Physician, Mississippi Quarantine Station: The quarantine powers of the National Board of Health having expired, and Dr. G. Farrar Patton being a representative neither of the National Board nor of the United States Marine Hospital Service, the order permitting him to remain at the Mississippi Quarantine Station is hereby rescinded, and the said Patton, formerly Inspector of the National Board of Health, is hereby ordered to leave the Mississippi Quarantine Station, and will be subjected to such quarantine, isolation, detention and disinfection as may be in accordance with the rules and regulations of the Board of Health of Louisiana. S. D. McENERY, Governor of Louisiana. Mississippi Quarantine Station, ? July 31, 1883. $ Dr. Joseph Jones, President Board of Health: The captain of schooner E. D. Sidbury refuses to leave here unless he is permitted to discharge his cargo. Everybody perfectly well here. J. F. FINNEY, Resident Physician. [Answer,] New Orleans, July 31, 1883. To Dr. J. F. Finney, Resident Physician Mississippi Quarantine Staiton: Inform captain of the E. D. Sidbury that he will not be allowed to discharge his cargo; neither will he be allowed to come up to the port of New Orleans. I have seen Gov McEnery, and this is his decision, in accordance with that of the Board of Health. The Governor of Louisiana will use every means, moral and physical, to sustain the pro- visions of his proclamation for the protection of the State of Louisiana and the Missis- sippi Valley from the introduction of yellow fever and Asiatic cholera. JOSEPH JONES, M. D., President Board of Health, State of Louisiana. C United States Marine Hospital Service. Port Eads, July 31, 1883. To Joseph Jones, M. D., President Board of Health : Steamer , four days from Vera Cruz. One case sickness on board. Anchored one mile to sea. G. H. J, HART, M. D., Inspector. New Orleans, July 31, 1882. To Dr. G. H. J. Hart, Quarantine Inspector Port Eads : 1 have consulted Gov. McEnery. He will maintain his proclamation by force if necessary. If steamer attempts to enter the waters of Louisiana telegraph me immediately, in order that proper measures may be instituted. Warn all pilots and captains of towboais that if they disobey the proclamation of the Governor of Louisi- ana the Board of Health will take immediaie measures for their arrest and punishment according to law. They are prohibited from piloting or towing any vessel from ports infected with yellow fever or Asiatic cholera. Report immediately any violation of proclamations of Board of Health and of Governor. JOSEPH JONES, M. D., President Board of Health. UNITED STATES MARINE HOSPITAL SERVICE AND SHIP IS- LAND-RESOLUTIONS OF HON. I. N. MARKS, REAFFIRM- ING HIS PREVIOUS RESOLUTIONS ESTABLISHING NON- INTERCOURSE WITH PLACES INFECTED WITH YELLOW FEVER. [Extract from proceedings of the Board of Health of the State of Louisiana, regular meeting, August 2, 1883.] Dr. John Godfrey, of the Marine Hospital Service, being present, was invited to speak as to the arrangements for the isolation of the Quarantine Station at Ship Island, under the control of his office. Dr. Godfrey said that when the Marine Hospital Service took charge of the station at Ship Island it was intended to make it a refuge station for infected vessels, and to pro- vide all the means and appliances under the most comprehensive and stringent regula- lations that experience and science had taught were necessary to guard the coast from the invasion of foreign infection. Some time ago the Louisiana Board of Health had passed resolutions implying that there was uninterupted intercourse between the Quarantine Station nt Ship Island and the coast of Mississippi. The speaker denied that there had been such intercourse since the station had been in charge of the Marine Hospital Service. The most thorough reg- ulations for the isolation of the Quarantine Station had been in force all the time. At night all the boat oars on the infected ships were put under lock and key, so that deser- tions in small boats would be impossible. A patrol boat passes around the infected ships, day and night, to intercept any attempt to communicate between the vessels and shore. No bedding, clothing or other articles of the kind were permitted to be- cast into the sea from the ships. All such matter as was to be destroyed was conveyed ashore and burned, and clothing and other textiles that -were to be disinfected were boiled thor- oughly with cloride of lime. As to stories told of bedding found floating in the water along the Mississippi coast, he could say it did not come from the Quarantine Station or the vessels under detention at Ship Island. Thore is no intercourse except official, under strict regulations. The Marine Hospitdl Service has at its disposal ample means and these were being used under thorough and skillful management to fence out foreign in- fection from the ports of the country, and so far they have been used effectually. Col. John W. Glenn United States Superintendent of Public Buildings, said he had personal knowledge of the regulations in force at Ship Island Quarantine,and they were strictly and faithfully executed. He had the testimony of parties who had seen the float- ing mattresses complained of by some persons as having possibly been thrown from ships, and the information was obtained that they were not ships' mattresses, and were not of the sort used at sea. He explained also that there is a great difference between Ship Island station and Ship Island anchorage. The anchorage, which is several miles from the island, is a place were ships may lie in water of four or five fathoms in depth, protected from the force of the open sea. This anchorage is resorted to by ships which cannot enter the shallow ports along the coast, and has nothing to do with the island and no connection with the quarantine fleet, which lies at the east end of Ship Island. United States Marine Hospital Service. CI The President expressed his entire confidence in the wisdom and efficiency of the Ma- rine Hospital Service, and was sure it is accomplishing a good work in protecting the country from foreign disease. Since this service had become known to the public by its work there had been a greater sense of security and an almost complete absence of such sensational rumors as had obtained at this season in former years. Nearly every port on the coasts of the country had been threatened by yellow fever, but the thorough and prompt arrangements that had been made to meet it had been such as to win and justify public confidence in spite of the hostility of interested parties. Dr. Formento said he had been the author of the resolutions implying that there was unrestricted intercourse between Ship Island and the adjacent coasts. He made the statement on the representations of Commodore Maginnis and Dr. Austin, but this inter- course might have taken place before the regulations of the Marine Hospital Service were put into execution. At any rate, he now has confidence in the service and faith in the strong arm of the Government as perhaps the only rightful authority competent to exercise and enforce quarantine on the coast. Mr. Booth protested against the assumption by the last speaker that the State Gov- ernment had no right to declare and enforce quarantine it its waters. He claimed this right for the States, but recognized the value of the General Government to settle ques- tions where the interests of the States might not harmonize in matters of quarantine. The President reported that the record of deaths showed sixty-seven deaths in the past four days, five of which are from small-pox and four from malarial fevers. Mr. Marks- quoted Dr. Miles, House Surgeon at the Charity Hospital, for testimony as to the un usual freedom of the city from malarial fevers, and Dr Formento said the private prac tice of all the physicians in the city showed the same fact. The President read several communications from Hon. Warner P. Sutton, U. S. Counsul General at Matamoros, Mexico, protesting against the quarantine restrictions against his city, which is healthy. Letters were read from Messrs. G. Corral & Co. and others, asking that the Spanish steamer Gracia and the barks Angelita and Anna de Faura be allowed to come up to the city from quarantine, where they now are. Also from Smith Bros. & Co., asking a cargo of Mexican coffee on board the schooner Sidbury be permitted to be landed at quarantine and after disinfection be brought to the city. Mr. Marks then ordered the following: "Whereas, as a measure of full public safety for the health and lives of the people of Louisiana, the Valley of the Mississippi and the surrounding States, the Governor has issued a proclamation of non-intercourse with the yellow fever infected ports of Vera Cruz, Havana and Rio de Janeiro : and Whereas, next in importance to the protection ef the health and lives of the people comes the preservation of the commerce, interstate and inland, of the city of New Or- leans upon which during the summer months the commercial prosperity of this city depends ; And whereas, good faith to the Governor of this State, proper respect and regard to the expressed opinions of the commercial exchanges of New Orleans and undoubted security against the admission of foreign pestilence, imperatively demand that no vessel from a yellow fever infected port shall enter the harbor of New Orleans during this summer, load or unload at any of the quarantine stations of this State. Be it therefore resolved That the President of this board be and is hereby instructed not to permit any vessel now in the waters of Louisiana, from any yellow fever infected port, either to load or unload cargo at any quarantine station of the State, or proceed from such station to the city of New Orleans." Mr. Marks urged the importance of the emergency which required such action, and the great responsibility resting on this board. Dr. Formento advocated admitting the vessels now at quarantine. Mr. Marks' resolutions were adopted. Mr. Booth offered a supplementary resolution specifying the names of the vessels now at quarantine as included in the prohibitory proclamation of the Governor, which was adopted. A letter from the postmaster at New Orleans was read stating that a package of mail marked Buras, and bearing evidence of being foreign mail matter, had been received at the postoffice. It had been referred to Dr. Finney, quarantine officer at the Mississippi Station. His reply was read, stating that this mail consisted of letters written by two acclimated and healthy passengers of the schooner Sidbury, from Tampico. The foreign mail brought by the Sidbury is still in the ship detained at quarantine. The board then adjourned. New Orleans, September, 7, 1882. His Excellency Samuel D. McEnery, Governor State of Louisiana, Baton Rouge, La.: Dear Sir-I have the honor herewith to enclose resolutions unanimously adopted by the Board of Health of the State of Louisiana, at the regular meeting, September 6 CII Withdrawal of Non-Intercourse Proclamation. 1883, requesting your Excellency to withdraw the Quarantine Proclamation of July 24, said withdrawal to take effect on the fifteenth of September, 1883; the original procla- mation of the fourth of April remaining in full force. The thanks of the State Board of Health of Louisiana are respectfully tendered to your Excellency for thorough co-operation with the Board, and for the firm maintenance of the quarantine laws of Louisiana. Respectfully, your obedient servant, JOSEPH JONES, M. D., President Board of Health, State of Louisiana. COPY OF RESOLUTIONS BOARD OF HEALTH, STATE OF LOUISIANA. By Mr. Marks: Whereas, in the month of July last, it became necessary for the preservation of the health and lives of the people of Louisiana the surrounding States and the Mississippi Valley, to proclaim non-intercourse with yellow fever infected ports of Havana, Rio de Janeiro and Vera Cruz; and Whereas, this measure was not only demanded by the exigencies of the situation, but was imperatively called for by the various commercial representative bodies of New Orleans; and Whereas, believing that the period has been reached, with the close of summer, when commerce with the proclaimed portscan be relieved from the rigorous, though necessary, interference to which it has been subjected; be it therefore Resolved, That the State Board of Health of Louisiana respettfully request his Excel- lency Governor S. D. McEnery to withdraw his proclamation of non-intercourse of July 24, 1883; leaving in full force the proclamation of detention previously issued. Resolved, That the thanks of the State Board of Health of Louisiana be and they are hereby tendered to his Excellency Samuel D. McEnery, Governor of Louisiana, for his thorough co-operation with this Board, and for his firm maintenance of the quarantine laws of Louisiana. A true copy. S. S. HERRICK, M. D., Secretary Board of Health, State of Louisiana. Executive Department State of Louistana. Whereas, at a regular meeting of the Board of Heath of the State of Louisiana, held in the city of New Orleans on the sixth day of September, 1883, the following reso- tion was adopted : ''That the State Board of Health of Louisiana respectfully request His Excellency, Samuel D. McEnery, to withdraw his proclamation of 'non intercourse'of July 24, 1883, on the fifteenth instant, leaving in full force the proclamation of detention previously issued." Now, therefore, I, Samuel D. McEnery, Governor of the State of Louisiana, by virtue of the authority in me vested by law, and in pursuance to the above resolution, believ- ing that the period has been reached, with the close of summer, when commerce with the proclaimed ports can be relieved from the rigorous, though necessary, interference to which it has been subjected do hereby withdraw my proclamation of non-intercourse of July 24, 1883, said withdrawal to take effect on the fifteenth instant, the original pro- clamation of the fourth day of April, 1883, remaining in full force and effect; and the quarantine officers at the qnarontine stations are specially charged and directed to enforce strictly its execution, and the Board of Health is requested to prosecute vigor- ously all violations of the same. Given under my signature and the seal of the State of Louisiana, at the city of Baton Rnuge, on this eighth dav of September, A. D., 1883. (Signed) S. D. McENERY, By the Governor: WILL. A. STRONG, Secretary of State. New Orleans, September 12, 1883. His Excellency Samn»l Douglas McEnery, Governor State of Louisiana, State Capitol Baton Rouge, La. Dear Sir-I have the honor to acknowledge the letter of your Excellency of the eighth instant, enclosing copy of note from the diplomatic representative of Spam, commu- nicating the complaint of parties interested against the Board of Health of the State of Louisiana; also letter of Hon. John Davis, Acting Secretary of State, bearing date Washington, D. C., September 9, 1883. Letter of President Jones to Governor of Louisiana. CIII In accordance with the request of your Excellency, I herewith return the said docu- ments; and also present the enclosed copies of the acts of the Bo&rd of Health, relative to the Spanish brig Ana Faura, the Spanish Corvette Angelita, and the Spanish steamer Gracia. (a). Certificate of arrival of brig Ana Faura and ship Angelita. (b). Certificate of arrival of steamship Gracia. (c). Permission to coal steamship Gracia. (d). Authority to coal steamship Gracia at Port Eads, under direction of Dr. Hart. (e). Certificate issued by President of Louisiana Board of Health to brig Ana Faura (f). Certificate issued by President Louisiana Board of Health to steamship Angelita. (g). Communication to Dr. Finney, Resident Physician Mississippi Quarantine Station. (h). Extracts from minutes of Board of Health. Resolutions adopted August 3, 1883. (i). Extracts from minutes Board of Health, August 3, 1883. (j). Letter of President Louisiana Board of Health to Hon. Pedro de Solis, Consul of Spain, August 4, 1883. (k). Letter of President Louisiana Board of Health to Messrs. Miller and Finney attorneys at law. August 4, 1883. (1). Letter from His Excellancy S. D. McEnery, Governor of Louisiana, to President Board of Health, July 23, advising the policy of non-intercourse. (m). Extracts from minutes of meeting of Board of Health, July 23, 1883. Action, with reference to non-intercourse with infected ports. (n). Extracts from minutes of meetings Board of Health, August 2, 1883, with refer- ence to interpretation of non-intercourse proclamation; also w'ith reference to steamship Angelita, steamship Gracia and brig Ana Faura. (o). Additional quarantine proclamation of His Excellency S. D. McEuerv, July 24, 1883. (p). Original proclamation of His Excellency S. D. McEnery, April 4, 1883. (q). Proclamation of His Excellency S D. McEnery, September 8, 1883, withdrawing non-intercourse proclamation of July 24, 1883. (r). Reports of conference committee of Board of Health, with reference to British steamship Plessy, refused entrance to mouth of Mississippi, August 29, 1883. (sj. Report of meeting of Board of Health, July 23, 1883; action on non-intercourse by Board of Health and commercial bodies. (t). Extract from minutes of Board of Health, September 6, 1883, requesting His Excellency S. D. McEnery to withdraw proclamation of non-interconrse. In response to the request of your Excellency that I should present my views as to the action of the Board of Health with reference to the vessels specified by the Spanish Ambassador, I beg leave to submit the following in additibn to the inclosed papers - a-t. 1. The following facts are well established and will apply to the proclamation of July 29, 1883, excluding vessels from ports infected with yellow fever and Asiatic cholera from the waters of Louisiana, and to all acts of a similar character which may in the future be demanded for the preservation of the public health. (ap Quarantine regulations and restrictions relate to the preservation of the health and lives of the people, and are based upon the evident and inalienable right of self- preservation. The duty of each State to protect its citizens from the importation of foreign pestilence is clear and imperative. (b). The State of Louisiana has recognized these principles, and in her sovereign capacity has enacted laws and commissioned the proper officers, including the Chief Executive of the State, and the members of the Board of Health, duly confirmed by the General Assembly, and sworn to support the laws of Louisiana and of the United States, for the express purpose of exercising the police powers of the State for the exclusion of foreign pestilence and the protection of the health and lives of the people. (c) The power to establish and enforce quarantine regulations had been exercised by the individual colonies, and has never been surrendered to the General Government. 2. The establishment and enforcement of quarantine, and even the absolute exclusion of infected ships and ships from infected ports, is not a regulation of commerce in viola- tion of the Federal Constitution and of foreign treaties; but it is simply the exercise of their police powers by the individual States which are inalienable, and which have not and which cannot be surrendered to the General Government, and which cannot be disre- garded or violated by any domestic or foreign power. 3. In accordance with section four of "An act Supplementary to an Act Entitled 'An Act Relative to Quarantine,' " approved March 18, 1858, "In case of emergency the Board of Health shall have power to issue proclamation of quarantine without reference to the Governor, and to enact all needful regulations for the enforcement of the same." By the act of March 29, 1876, the time of quarantine detention was left discretionary with the Board of Health ; the time of detention might be just sufficient for inspection, or it might be ten or twenty or 100 days. CIV Mississippi Quarantine, 1883. By the act of April 30, 1877, "To Reorganize and Render More Efficient the Board of Health of the State of Louisiana." etc,, section 17, it is ordained that the Board of Health "shall have power and authority to establish quarantine stations upon any of the approaches to the city of New Orleans whenever, in its discretion, such stations may be rendered necessary to protect the health of the city of New Orleans or the State, and to make all needful rules and regulations witn reference to the management and po- lice of such stations. In virtue of the preceding organic acts of the General Assembly, the Board of Health of the State of Louisiana has established quarantine stations at the most important points on the confines of Louisiana, viz., Port Eads and the mouths of the Mississippi; English Lookout, on the borders of Mississippi. At both stations ships, passengers and railroad trains are admitted or excluded from the limits of the State, in accorcance with the oidersof the Board of Health. No infected person or ship is allowed to enter the State. During the non-intercourse proclamation, at the mouths of the Mississippi River, ves- sels from ports infected with yellow fever were allowed to ride at anchor in the waters of the Gulf, to proceed to any port they may desire, and all the necessary wants were sup- plied under the supervision of the officers of the Board of Health, but in this time of danger and peril they were notallowed to jeopardize the health of the State and of the Valley of the Mississippi by entering the waters of Louisiana. 4. The right to exclude vessels from infected ports, for the protection of the public health Is recognized and practiced by all civilized nations, and by no nations more freely than Spain and England. At the present moment Egypt and the neighboring countries of Europe and Asia and Africa, furnish examples of the most despotic and rigorous systems of non-intercourse for the arrest of asiatic cholera, and the Spanish government has called loudly upon England for the enforcement of the most rigorous measures of quarantine and non-intercourse. Numerous examples might be cited of the exercise of forcible protection against conta- gion, but the following will illustrate the mode in winch States have dealt with infected ships and towns. In 1748, the Adam, a Dutch ship, carrying rice from Damietta to Marseilles, was cast on the shore of the Island of Majorca in a tempest. The inhabitants (Spaniards) refused to permit the crew to laud, as they feared the plague, from the fact of the ship sailing from the Levant. As the shipcould not be removed, the Spaniards set her on fire, having previously furnished the crew with five boats, in which to save themselves and part of the cargo. In 1719, the captain of the Grand Saint Antoine, a French ship, returning to Marseilles from the Levant, and having lost some of his crew from the plague, fraudulently pre- tended that they had died of bad provisions, and neglected to go into quarantine. This cruel fraud was the cause of the death of half the inhabitants of the city. By order of the Minister the vessel was burnt. When Valetta was attacked by the plague, in 1813, Sir Thomas Maitland ordered a cordon sanitaire to be drawn around the town, and every person who attempted to pass it to be shot. 5. The action of the Board of Health of the State of Louisiana, in excluding vessels from ports infected with yellow fever from the waters of Louisiana, was taken at a time when yellow-fever stricken ships were scattered along the Atlantic and Gulf coasts and the State of Louisiana and the entire Mississippi Valley were menaced by yellow fever. By the exclusion of vessels from the City of New Orleans, which had sailed from the infected ports, Havana, Vera Cruz and Rio de Janeiro, commerce was protected, and the health of Louisiana and the Mississippi Valley protected by the exclusion of yellow fever. The Spanish marine and nation have been and will be benefited by the prompt and energetic action of the health authorities of Louisiana. With great respect and high esteem I have the honor to remain vour obedient servant, JOSEPH JONES, M. D. President Board of Health, State of Louisiana. MISSISSIPPI QUARANTINE STATION-REPORT OF DR. FINNEY, 1883. Quarantine Station, Mississippi River, ? Louisiana, January 3, 1884. ) To the Hon. President and Members of the Louisiana State Board of Health, Now Orleans, La.; Gentlemen-I would respectfully submit the enclosed report of the work done at this station during the year ending December 31, 1883. In addition to the repairs suggested by me in my last annual report, and which have not been made so far, I would advise that the present wharf and boat-house be extended at least sixty feet further into the river, as at present it is impossible, in low river, to get near the boat-house in our boat. Missisippi Quarantine Station, 1883. CV Speaking of boats, I think, in the interests of the shipping and to facilitate the work at this station, your honorable body could not invest money to better advantage than in purchasing a suitable steam launch for the purpose of boarding vessels with and for making the necessary daily inspection of the fleet that is in quarantine during the sum- mer months. During the past summer I had as many as fourteen vessels in quarantine at one time. These vessels must have a good and safe anchorage, and consequently have to be some distance apart. That being the case, it is impossible to make a daily inspec- tion of so many vessels and perform the other necessary duties of boarding, disinfecting and fumigating with a boat propelled by oars. I would also ask that you gentlemen al- low this station a druggist, who should act as hospital steward as well. Hoping you will take action in these matters as soon as possible, I remain vour obedient servant. J. F. FINNEY, M. D., Resident Physician. TABLE NO. 1.- RFPORT OF VESSELS BY MONTHS PERMITTED TO PASS THE MISSISSIPPI RIVER QUARANTINE STATION WITH THE AMOUNTS COLLECTED AND CLASSIFICA TION OF VESSELS. MONTHS. Steamship. Sail Ships. Barks. Brigs. Schooners. Steam Tugs 1 Total. 1 1 Tax Fees. ' Fumigation Fees. i Total Fees. .T ruh rt y 62 8 25 3 14 o 112 $2 195 00 $2 195 00 Vp/brtiRry. ... 57 7 30 2 16 o 112 2,180 00 2 180 00 82 14 4 16 o 121 2 315 00 2 315 00 59 4 32 4 16 1 116 2 180 0Q 2 180 00 May 53 1 12 5 21 0 92 1'647 50 $533 00 2'180 50 36 o 7 0 11 4 66 922 50 316 00 1 238 50 32 1 4 0 7 1 47 752 50 305 00 1 057 50 An0*11 st. ...... 29 o 2 3 10 0 44 565 00 99 00 664 00 September 57 2 1 0 6 0 66 1,355 00 224 00 1,579 00 October 76 4 10 1 13 0 104 2,167 50 470 00 2 637 50 November 62 10 25 4 17 o 118 2.227 50 2 227 50 Tier, ember 82 4 32 4 10 1 133 2,860 00 2,860 00 Total 687 46 194 34 157 7 1.125 $21,367 50 $1,947 00 $23,314 50 TABLE NO. 2.-REPORT OF VESSELS QUARANTINED AT MISSISSIPPI RIVER QUARANTINE STATION BY MONTHS AND CLASSIFICATION OF VESSELS. MONTHS. May June July August CO 'x X 17 8 9 3 9 16 62 Iw I H- o©^©^! Sail Ships. on Ji 5 4 6 4 0 0 5 19 X m 4 2 1 2 0 1 10 pr 1 w K>©wocw 1 Schooners. 11© 1 © © © © i© © 1 Steam Tugs. 28 26 18 5 11 26 114 July 24, noh-intercourse proclamation. September 12, non-intercourse proclama- mation modified to ten days detention. September October.... Total CVI Atchafalaya Quarantine Station, 1883. TABLE NO. 3-REPORT OF PORTS QUARANTINED, WITH NUMBER OF VES SELS FROM EACH. BY MONTHS. Port. May. June. July. August. September. October. Total. Havana . 15 7 10 1 10 43 Vera Cruz.... 4 5 1 4 19 Colon .... 3 2 3 2 3 J 17 Campeche.... 2 1 2 1 11 Barbadoes .. . . ... 1 3 4 8 Tampico 2 1 3 Port de France . .. .... 2 ] 3 Kingston.... 1 1 Matanzas 1 1 Pernambuco 1 1 Porto Kico 1 I Progresso... i i 1 Samana Bay . 1 1 St. Lucca.... .. . i 1 St. Thomas .. .. 1 1 Trinidad . 1 1 Total 28 26 18 5 ii 26 114 INSPECTION OF SHIPPING IN PORT OF NEW ORLEANS, 1883. New Orleans, November 1, 1883. Dr. Joseph Jomes, President Board of Health, State of Louisiana : I respectfully submit the following report, as Deputy Inspector of Shipping for the port of New Orleans, from May 1 to November 1, 1883. Date-1883s Number Vessels Inspected. Number of Seamen. Number of Passengers. Total Seamen and Passengers. May. . - 73 1,636 271 1,907 June 65 1,285 340 1,625 July 50 1,032 272 1,304 August ... 43 908 230 1,138 September. 58 1,570 490 2,060 October 62 1,740 240 1,980 Totals. 351 8,171 1,843 10,014 All vessels along the river front and water-craft in the New and Old Basins have been found in a uniform cleanly condition, and the health of the men composing the crews of vessels in this port has been good. No case of contagious or infectious disease has oc- curred in the shipping up to date. Very respectfully, " STANHOPE JONES, M. D., Deputy Inspector of Shipping Port of New Orleans. ATCHAFALAYA QUARANTINE STATION-REPORT OF DR. WISE, 1883. MORGAN CITY, LA., November 1, 1883. To the President and Members Louisiana State Board of Health: Gentlemen-I have the honor to submit the following report of my action at the Atchafalaya Quarantine ^u^he^fth^da^o^Aprtl last, in company with Dr. Joseph Jones, the President of the State Board of Health I visited-the Quarantine grounds, and together we selected a site for a warehouse and wharf, situ- ated upon the school lands, the property of the state of Louisiana upon the right bank of the Atchafalaya, near Wax Bavou The plans for the same were approved, and the building erected the same month, together with- a substantial wharf. These improvements were very necessary as during the past few years th? boatman at the stat i m had no shelter, neither was there any provision made for the care of sick . During the season I h ive issued permits to two hundred and thirty-three vessels, as will be seen in the tabulatea statement hereto annexed. English Lookout Station, 1883. CVII But two vessels were detained at the Quarantine station during the past season, viz., the schooners Millie Williams and Mary E. Clarke, both from Tampico. No sickness occurred on board at any time from date of departure from Tampico until they were released. They were detained ten full days, thoroughly cleansed and disinfected. One case of small-pox was removed from the tugboat S. C. Hall, from New Orleans. The case was isolated and provided with a nurse, as directed by the board. The man died on the third day. I have found it impossible to collect the quarantine fees from vessels not quarantined. Many ship masters have expressed a willingness to pay nominal fees to cover expense of boarding, etc., but as I was not authorized to accept any other than full dues, it was declined. The quarantine property is in good order, and I would recommend the employment of a keeper during the winter, otherwise the property may be carried away or destroyed. A plain substantial fence is also necessary. In conclusion, I desire to call your attention to the growing importance of this station. The rapidly in- creasing lumber trade with Mexico from this port will necessitate the exercise of great vigilance every season, and the same may be said of " Calcasieu Paes," the outlet of the Lake Charles region. " I append a tabulated statement of all vessels arrived during the past season, and an inventory of prop- erty, supplies, etc., on hand. I am, gentlemen, very respectfully, J. H. P. WISE, M. D., Resident Physician, Atchafalaya Station. REPORT OF VESSELS ARRIVED DURING SEASON 1883. October - Total I iqc. B JO s < r. 4 MONTHS: o w 23 25. 19 15 9 12 Steam ships. w ° 24 18 31 27 14 16 Schooners. to 8 47 43 50 42 23 28 Total Vessels. 00 co 00 Ci O CO 18,447.84 18,552.07 15,598.29 11,015.41 6,096.45 9,276.02 Total Tonnage. 867 863 727 585 283 455 Crew. - o 304 309 193 191 104 303 Passengers. tn £ 1,171 1,172 920 776 387 758 Total Number Persons. I $3,877 50 $22 50 $855 00 862 50 720 00 645 00 302 00 493 00 Fees due. TOT A $7 50 , 15 00 Fees Collected. REPORT OF VESSELS QUARANTINED SEASON 1883. Date. Name. Class. Wherefrom. Days out. Bill health. Crew. 1 Passengers. Sanitary condition. Remarks. Mav 14. Millie Williams. Schooner. Tampico. 8 Clean. 7 2 Good. Ten days. June 25. Mary E. Clarke. Schooner. Tampico. 6 Clean. 6 12 Good. Ten days. INVENTORY OF MOVABLE PROPERTY AT ATCHAFALAYA QUARANTINE STA- TION, OCTOBER 31, 1883. One yawl boat, in good repair. One pair oars. Two cot-beds. Two furnaces. Two iron pans. One lot kitchen utensils. One yellow flag (worn). One piece yellow bunting. Nine and one half barrels copperas. Two barrels roll sulphur. Thirty gallons carbolic acid. I certify that the above is a correct inventory of movable property on hand at Quarantine Station. J. H. P. WISE, M.D., Resident Physician. REPORT OF W. H. CARSON, M. D., QUARANTINE INSPECTOR OF THE BOARD OF HEALTH OF THE STATE OF LOUISIANA, AT ENGLISH LOOKOUT, LA. (ON THE LOUISVILLE AND NASHVILLE RAILROAD AND ON EAST PEARL RIVER, THE SOUTHEASTERN BOUNDARY LINE OF THE STATE OF LOUISIANA. NEW ORLEANS, La., Octobers, 1883. To the President and Members of the Board of Health, State of I ouisiana: Gentlemen-I have the honor to snbwt the following as my official report of the 11 Quarantine Season,* tummenciug at English Lookout Station, on May 15, anil ending October 1,1883: CVIII English Lookout Station, 1883, Ou the date of receiving my commission, May 14, 1883, I received the following written instructions from President Joseph Jones, with orders to execute them in obedience and in accordance with the powers of the Board of Health of the State of Louisiana. I. Boarding and inspection of oil vessels entering English Lookout. 2. All vessels from infected ports must be directed to report to the Louisiana Quarantine Station, on Bab- bit Island. Rigolets. 3. Dr Carson will report all violations of the quarantine laws of Louisiana to the President of the Board of Health. He will also communicate all facts of importance relating to vessels from infected ports included in the Governor's Proclamation, to Dr. Adams, Resident Quarantine Officer at Rigolets. 4. Dr. Carson will report promptly to the President of the Board of Health any entrance of a vassel from an infected port into the waters of Mississippi. 5. Dr. < arson will also hold supervision over the railroad trains, and allow no passengers or baggage from an infected port to enter Louisiana. (Signed) JOSEPH JONES, M. D., President Board of Health, State of Louisiana. In accordance with these instructions, twenty-four vessels were boarded, and their crews, numbering 114 men, were inspected up to the closing of the station. October 1, 1883 These vessels, the great majority of which were schooners, were engaged in the carrying of lumber from mills in the interior and adjacent to Pearl River (East) to foreign vessels lying in Mississippi Sound. The great danger to be feared was the possible intercourse or contact, direct or indirect, of these vessels with the infected shipping undergoing quarantine at the Ship Island Quarantine Station. It is proper to state, however, that I never had any ground for suspicion that any such intercourse occurred or was probable during the administration of quarantine regulations by the United States Marine Hospital Service. Not withstanding, all vessels on their return were rigidly inspected and attended to before going up East Pearl River to the interior country. v None of these vessels engaged in lightering required any long detention, nor was there any case of sick- ness that came under my observation, and I am reliably informed that no disease of a contagious or infectous nature occurred in the interior country that could be attributed to their intercourse with outside shipping. It is to the credit of Messrs. Poitevent & Favre, of Pearlington, Miss., extensive mill owners on East Pearl River, that they gave every assistance in the furtherance of our quarantine regulations, and whose vessels were at all times extremely careful to avoid ships on the outside whose health status and ports of clearance were not known. I was at all times well informed as to name, location and health of the vessel that they were having intercourse with. On tho seventh of July, 1883, a detail of two sanitary officers was ordered by President Jones to report for duty at English Lookout, and under the following instructions: 1. To aid Dr. W. H. Carson in the execution of the following labors ordered by the board : (a). Fumigation of vessels. (b). Inspection of all trains passing from Mississippi into Louisiana. The inspectors should, in order to avoid interrupting travel, proceed on the out-bound train as far as ne- cessary, say to Pascagoula, Biloxi, or Bay St. Louis, and return with the train bound for New Orleans and inspect the passengers. (c). When passengers have been subjected to proper quarantine detention at the regular quarantine sta- tion, and their baggage fumigated, they may be allowed to proceed to New Orleans at the discretion of the quarantine officer, said discretion being exercised as to the efficiency of the quarantine and actual state of the passenger. (d). The Board of Health of the State of Louisiana demand that the inspector at English Lookout, exercise the utmost vigilance, and allow no passengers or seamen to enter the State of Louisiana, who have left an infected port, in any vessel, whether infected or not, and without having been subjected to quar- antine. (e). Furnish this board with written weekly, and if necessary, daily reports. Also telegraph at once any evasion of quarantine and any point of interest. (Signed) ' ' JOSEPH JONES, M. D.. President Board of Health. In accordance with these instructions all trains, both passenger and freight were subjected to a most thorough inspection. The evening express was boarded at Bay St. Louis, Miss., about thirty miles distant and beyond English Lookout, thus affording the quarantine officials ample time to satisfactorily examine a train. In this branch of the service we were at all times courteously and efficiently assisted by the railroad au- thorities, in their respective departments, of the Louisville & Nashville Company. On several occasions passengers by rail, en r oute to New Orleans, were discovered as having come from proscribed ports and lo- calities, and, with but one exception, left the train graciously to seek, for the time being, some more hos- pitable and appr eciative locality. All morning trains were inspected at the quarantine station (English Lookout); the way bills, the cars and caboose of freight trains all received a close examination. It cannot be doubted, from the above retrospect, that the selection of this locality as a quarantine inspec- tion station was most judicious. The satisfactory and gr atifying results of the season just closed, as well as its previous though shorter season in 1882, the year of its inaugural, go far to substantiate its importance. In conclusion, it affords me pleasure to commend the promptness, energy and intelligence manifested by your detail of sanitary officers L. D. Allen and Bohner in the discharge of their fatiguing duties. I also take occasion to specially acknowledge the manifold courtesies on the part of Captain A. V. Ward, the United States customs officer at English Lookout, La., with whom I had pleasant quarters during the season, and to whom 1 was oftentimes indebted for assistance in the boarding of vessels. I am, sir, very respectfully, your obedient servant; W. H. CARSON, M. D., Quarantine Inspector. INFECTED VESSELS FROM RIO. The discharge of the cargoes of coffee ships from Rio, was conducted by order of the Board of Health during the years 1880, 1881, 1882 and 1883. This course was necessitated by the presence of yellow fever in Rio during this period, as will be seen from the report of the United States Consul General of Rio. Yellow Fever in Rio de Janeiro, 1850-1883. CIX Consulate General of the United States. 1 Rio de Janeiro, Brazil, January 30, 1884. ( Dr. Joseph Jones, President State Board of Health, New Orleans - Dear Sir-Your esteemed favor of October 12, was duly reoeived as also a copy of the annual report of Board of Health Louisiana, 1882-3, for which I am very thankful; but 1 would be glad of a copy for the succeeding year. I delayed sending your returu of deaths from yellow fever, that I might give them complete for 1883; and I now beg to hand you a table showing the number of deaths from that disease in this city each year since and including 1850. However, 1 am able to give them for each month only from and including 1873. And the deaths from all causes, I am able to give only from and in- cluding the year 1872, If I can secure any official medical publications I will send them to you. I send you regularly, a monthly report of the mortality in this city, which I hope is duly received. Very respectfully, yours, C. C. ANDREWS, Consul General. __ ♦ REPORT OF DEATHS FROM YELLOW FEVER AT RIO DE JANEIRO, EMPIRE OF BRAZIL. The following table gives the number of deaths from yeLow fever, 1850-1883, inclusive (thirty-four years), and shows the same by months since and including 1872; also shows the total number of deaths from all causes since and including 1879: U. S. Consulate General, ) Rio de Janeiro, January 8, 1883. ' 5 □DxaoaooooDaDODOoooODODScQDOoooaDOoaDaDOCGcoocrQDacaDacoDOooooccrac OOaoOOOCM^MMMMMMM^OiOO)OOiCiC:C)OaO<UlC3CnU<OiOiCiCnOi Years. ■ 1 C. C. ANDliEWS, Consul General. i 889 16 23 122 3 77 127 150 31 2 8 January. 1087 51 168 319 10 326 204 489 54 3 84 February. 008 168 385 1357 39 264 226 465 43 11 325 ■ March. 575 297 301 946 23 99 160 268 25 13 542 • April. e 1 180 165 244 375 22 42 69 103 24 6 274 • May. 3 83 69 104 129 11 19 53 48 13 3 107 - June. 1 20 25 36 41 4 18 42 18 13 1 65 July. 3 5 10 12 15 4 26 8 6 31 ■ August. 1 2 1 5 6 7 8 11 5 1 12 September. 1 or tooiaoocT^iuocnaD • ■ October, 16 2 10 3 4 18 2 9 10 4 i.2 November. 71 13 13 8 2 53 11 18 14 3 29 ■ December. 10,556 11,057 9,875 10,3(5 13,912 * ■ Total from all Causes. 272 1117 3 102 3467 826 1291 3317 213 880 950 1583 219 39 1494 500 1249 247 12 1425 4160 475 1943 853 21 Total, Yellow Fever. CX Yellow Fever in Rio de Janeiro, 1850-1883. With the terrible experience of the past, it is evident that in a city situated on the borders of the Gulf of Mexico, between the twenty-ninth and thirtieth degrees of north latitude, separated by only a few hours' steam navigation from the great centres charged with the perennial development of yellow fever, quarantine laws must be rigid, and must be adapted to the geographic, topographic and climatic conditions and relations. The first object of importance in this inquiry relates to the geographical position, cli- mate and medical history of Rio de Janiero, as far as it relates to yellow fever. The city of St. Sebastian, or, as commonly called, the city of Rio de Janeiro, dates its foundation from about the middle of the sixteenth century. It is now the oldest as well as the largest city in America south of the equator, and is computed to have at the pres- ent time a population of 330,000 inhabitants. This city, the capital of Brazil, is situated in latitude 22° 55'south, and longitude 43° 09' west from Greenwich, on the western shores of an extensive bay, the extreme di- ameter of which is about twenty miles, more or less. This sheet of water is pear-shaped, and broken in many places by islands of considerable size. The background is formed of precipitous mountains, varying in height from 1500 to 3000 feet, and clothed with the luxuriant vegetation of the tropics. Its geographical position makes it a commercial centre for trade with India, Oceanica, South America and Europe. Ships of almost every nation are found, in the course of a year, landing or unloading cargoes at this port. The site of the city is a marshy plain, studded by lofty hills of granite or granitic gneiss. When the city was commenced, on the Punta Calabouca, the vicinity was al- most constantly overflowed by pools of stagnant water, which was supposed to be prejudicial to the general health of the population. Intermittent fever prevails at all seasons along the shores and upon the islands of the bay, especially among those of the population who are imperfectly nourished and sheltered. Occasionally it is severe and fatal in its effects. Placed immediately beneath the tropic of Capricorn, Rio de Janeiro is under all the climatic influences common to equatorial and intertropical regions. The granite hills around the city, as well as the expanded surface of the bay, constitute reflectors of the caloric rays which augment the temperature and humidity. The at- mosphere fe more or less impregnated with vapors, and sometimes covered with clouds, which hang about the mountain peaks, and cause on some days a suffocating heat, called by Brazilians mormaco-a sultry time-which is so debilitating as to deprive one of the appetite for intellectual or muscular exercise, as well as the powers of digestion, and lead to a belief that the temperature is much higher than indicated by the thermometer. CLIMATE OF RIO DE JANEIRO. Meteorological observations made during thirty years by Benito Sanchez Dorta, in the last century, show that the annual mean temperature of Rio de Janeiro was 73°04, whilst the more recent hourly observations of A. M. de Mello, made during the present century, show an annual average increase of 2C11. the temperatuie lor the year being now 75° 151. This auermentatiou of the annual mean temperature is attributed to the clearing of the forests in the interior and in the vicinity of the city, which not attracting rain as frequently as formerly, the atmosphere and earth are not washed as often by summer showers; besides, the land wind not receiving exarations from the multiplicity of the leaves, the air is not so much freshened as when the forests were abundant, and for this reason it is supposed that the temperature has been greater. The mean annual temperature of New Orleans is 69°48. The mean summer temperature of New Orleans is 82° 53; of Havana, 84° 2; of Vera Cruz, 81c5. The average spring and winter temperature of those places in w'hich yellow fever is said to be indigenous or perennially present, are as follows: Havana, Cuba: Spring, 75° 7 ; winter,'68° 4; Kingston, Jamaica: spring, 78° 1; win- ter, 76° 1 ; Matanzaa, Cuba : spring, 78° 9 ; winter, 73° 4 ; Nassau : spring, 77° 7; winter, 70° 7; Rio de Janeiro: spring, 74° 7; winter, 70° 1; Vera Cruz, Mexico : spring, 77° 8-78 : winter, 77° 79-8. In New Orleans, on the other hand, the average temperature of spring is 69° 58, and 12 degrees above that of winter, 57° 04. It will be noted from the preceding data that the annual mean temperature of New Orleans is about six and a half degrees colder than that of Rio de Janeiro. The winter in New Orleans is marked by far lower temperature, the average temperature being 57° 04, while the average mean temperature of the winter in Rio Janeiro ranges above 70°"01. The winters of New Orleans are invariably cold enough to arrest yellow fever. On the other hand, the winters of Rio de Janeiro are not sufficiently severe to arrest yellow fever. Hence this disease may prevail during every month of the year, as it does in Havana, the climate of both places being in their relations to health and yellow fever similar. Yellow Fever in Rio de Janeiro, 1850-1883. CXI MORTALITY OF THE CITY OF RIO DE JANEIRO FROM YELLOW FEVER DURING THE YEARS SPECIFIED. 1850. 1851. 1852. 1880 1881. January 11 243 150 133 31 February 37 70 176 484 54 March 60 303 142 468 44 April 165 403 153 274 23 May 98 325 82 105 24 June 28 189 73 56 13 July 9 93 26 No report. 9 August 62 29 * 9 5 September 4 62 7 4 1 October 19 37 7 No report. 2 November 26 47 6 No report. No report. December . 8 109 2 14 No report. Total 475 1943 853 1546 206 The reports for 1882 have not yet been completed, owing to the length of time neces- sary for their transmission; but to the date of the last report, in July, deaths from yellow fever have occurred during every month. It foilows from the preceding facts that yellow fever prevails during every month in the year in Rio de Janeiro. It is evident that during the past three years the port of Rio de Janeiro has been dan- gerously infected with yellow fever, and that deaths from yellow fever have occurred in every month. Dr. Candido asserts that the dwellings of Rio de Janeiro, in a majority of instances, are better adapted to Lapland or Greenland than to the tropic region. They are erected in rows, often upon a level below that of the streets and gardens. Their dimensions are small. The roofs of tile are low ; often a wooden floor rests upon a damp soil, and is constantly in a state of decay. They are badly lighted and illy ven- tilated. In the houses of the opulent are spacious saloons which are reserved for the reception of guests, while the wealthy inhabitants sleep in a close alcove covered with mosquito nets or bars. The walls are covered with paper which retains the humidity of the air. In the greatest yellow fever epidemic of this city, New Orleans was without a Board of Health, and the quarantine restrictions practically valueless ; therefore, the exact origin of this epidemic has been a matter of dispute, but it was established by the testi- mony of Mr. Lonsdale, one of the largest dealers in coffee, that nearly all the vessels that arrived here from Rio, after the first of April, 1853, had suffered more or less from yellow fever after leaving that port. Thus the ship Siri, Capt. Higgins, arrived at New Orleans on the tenth of May, and took position at post 13. The captain had lost his wife, son and some of the crew before leaving Rio. The ship Mary Kendall arrived from Rio on the twenty-fifth of June, via Jamaica, where she had put in on account of distress from yellow fever; she left Rio on the twenty-fifth of January. The origin of the epidemic has also been referred to the ship Camboden Castle, from Kingston, Jamaica, which arrived at New Orleans on the seventeenth of May, 1853, and took position at post 27. It is evident, however, that tho arrival of the infected ship Siri, from Rio de Janeiro, was some days in advance of the Camboden Castle. The public safety demands that cargoes from this port should be deemed infected, and as subject to fumigation, aeration or disinfection. The climate of Rio de Janeiro cannot enjoy the reputation of being very salubrious, on account of its tropical position, the nature of the locality and the mode in which the houses of the masses of the people are built. Paludal fevers, of the intermittent and remittent form, sometimes complicated with ataxic or adynamic phenomena, cause the greater part of the mortality, principally after the evaporation of the waters of summer, ordinarily in the months of February, March and April. A comparison of the present sanitary condition with that of more remote periods shows an increase of phthisis, diarrhoea, scarlatina, typhoid, pernicious and malarial fevers and yellow fever. Some practitioners affirm that yellow fever is endemic in Rio de Janeiro, modified by the condition of the atmosphere. THE INTRODUCTION OF YELLOW FEVER FROM RIO DE JANEIRO IN 1880, BY THE BARK EXCELSIOR. The circumstances connected with the appearance of yellow fever upon the Swedish bark Excelsior have been fully recorded in the annual report of the Board of Health for 1880, pp. 34-43. CXII Introduction of Yellow Fever from Bio de Janeiro by Baric Excelsior. The circumstances of special interest in connection with the present inquiry are briefly these: The bark Excelsior sailed from Rio on the tenth of May, 1880, with a cargo of 3600 sacks of coffee, and a crew consisting of three officers and nine seamen. She arrived at the Mississippi Quarantine Station on June 24, having been on the voyage about forty-six days. She was released from quarantine and arrived at New Orleans on the fifth of July. No case of sickness occurred on the voyage or at the Mississippi Quarantine Station. About sixty hours after the vessel reached New Orleans, and after the dis- charge of her cargo, James Kenney, one of her crew, was attacked with yellow fever and died in the Touro Infirmary, afterthrowing up black vomit, on the eleventh of July. The case was not reported to the Board of Health until the tenth of July, when the crew were mustered and ordered to remain on board. The bark was forcibly returned to the Mississippi Quarantine Station, by order of the Board of Health. Cases of yellow fever occurred on board the Excelsior on the twelfth, thirteenth and fourteenth of July, and deaths from this disease occurred in the Quarantine Hospital on the seventeenth and eighteenth of July. The Board of Health retained the Excelsior at Quarantine Station for over one month after the removal of the last case from the vessel on the fourteenth of July. It is but just to .conclude that the prompt action of the Board of Health in sending the Excelsior back to the Mississippi Quarantine preserved the city of New Orleans and the Mississippi Valley from an epidemic of yellow fever in 1880. Nevertheless, it is true that never before in the history of this country were such efforts made to create alarm in the surrounding States. The vindication of the health and good sanitary condition of New Orleans, and its freedom from yellow fever during 1880, are matters of history, as well As the illegal and unconstitutional usurpation of power by agents of the National Board of Health, pro- hibiting the shipment of coffee from New Orleans. In like manner the rigid quarantine maintained by the Board of Health during 1880, 1881, 1882, and 1883 against various ports of the Antilles and along the coast of Mexico, Central and South America, has been fully justified by statistics. * Dr. Mainegra, of New Orleans, who was commissioned by Surgeon- General Hamilton to reside at Vera Cruz during the summer of 1883, upon the recommendation of the President of the Louisiana Board of Health, has furnished the following valuable statistics with reference to the pres- ence and prevalence of yellow fever in Vera Cruz, Mexico, during the past three years: MORTALITY OF THE CITY OF VERA CRUZ DURING THE YEARS 1881, 1882 AND 1883, FROM THE FOLLOWING FEVERS: •Incomplete. Totals 5 2 2) 0 < 2 0 -i _ -k- 0 January February March.... April May June July August Sentein her _ Month. Ci 8-1 28 21 27 28 94 234 132 39 22 24 18 4 Yellow Fever. 00 OP to co Cl W £ <C tC Cl 5 £ QO W Ci >U Pernicious Fever. co to CO>-1 CJ( tC J-1 CO r-1 CO r-1 Kemittent Fever. 00 tc J. m -q W © Cl 60 W 60 Gastro Ent. Fever. M to wwaaSiMHOTMtCHH Yellow. Fever. 1882. 76 21 5 2 4 .... 4 .... 3 .... 3 1 9 1 8 5 11 5 10 7 9 .... 6 .... 4i..._ Pernicious Fever. Remittent Fever. cc w M M • OiWtUWbOC3tCM Gastro Ent. Fever. ♦ to 5 3 7 ' 16 90 261 200 67 34 29 Yellow Fever. 1883 u* co )-» CC'OC.-!' CC Remittent Fever tC ,u © : to Perniciou Fever. * M ! -q - h* ci i- i- »-• Gastro Ent. Fever. Vessels Inspected at the Mississippi Quarantine Station, 1880-1883. CXIII The nature of the quarantine labors of the Board of Health of the State of Louisiana, duriug the years 1880, 1881, 1882 and 1883, have been illus- trated by the preceding statistics, and they may be viewed in a more com- preheusive manner by the consideration of the following abstract of the quarantine reports : TABLE GIVING THE NUMBER AND CLASS OF THE VESSELS INSPECTED AT THE MISSISSIPPI QUARANTINE STATION DURING FOUR YEARS, 1880, 1881, 1882 AND 1883. 1883 Total GO X be 30 io >0 X YEARS. 2,457 c» Ci Ca cs GO H- M -I Of M Steamships. 312 H- Cr'C LC Cb CO be h- Sailing Ships. 954 I-1 IO CO c© Ci rf- Ca 5-C 4- C Barks. w .+* CO be Co CO GO CO CO Brigs. Ca be Ca Co Schooners. -q •« < Steam Tugs. 7^ o M CO O LO to c©> -« C>< GO be 1-1 Total. This large fleet, numbering 4436 vessels (more than one-half qr 2457 of which were large ocean-going steamships), exceeding 8,000,000 (eight mil- lion) tons, were inspected by the officers of the Board of Health at the Mississippi Quarantine Station, together with their passengers, crews and cargoes, during the years 1880, 1881, 1882 and 1883. During this period not less than 100,000 seamen and passengers passed through this station. Notwithstanding the prevalence of yellow fever in Vera Cruz, Havana and Rio daring this entire period, and notwithstanding the prevalence of yellow fever at Brownsville, Texas, and at Pensacola in 1882, and at the Naval Reservation and at Brewton, Alabama, in 1883, and notwithstanding the presence cf yellow fever at the Mississippi Quarantine Station in 1880 and in 1883, New Orleans and the Mississippi Valley have been free from this terrible scourge. During the same period (1880, 1881, 1882 and 1883) 479 vessels from ports infected with yellow fever, or suspected of being ihfected, were held in quarantine, disinfected anti fumigated. At the Atchafalaya Station alone 1,064 vessels (about one-half of which were ocean-going steamships), with about 20,000 souls, crew and passen- gers, were inspected. At the Itigolets Quarantine Station about 4338 vessels, chiefly schooners, with about 24,000 seamen and passengers, were inspected during the years 1880, 1881, 1882 and 1883. During the period specified, therefore, the Board of Health of the State of Louisiana, through its faithful, experienced and energetic officers, in- spected in round numbers about 10,000 vessels, which carried not less than 150,000 seamen and passengers. The grand conclusions which we reach from these practical operations are: 1. Yellow fever is not indigenous to New Orleans. 2. Yellow fever can be excluded from New Orleans and the Mississippi Valley by a rigid and effective quarantine. 3. Quarantine, to be effective, must embrace not merely inspectipn and detention, but discharge of infected cargoes thorough ventilation and fumigation. 14 CXIV Relations of National and State Quarantine. MAINTENANCE OF THE QUARANTINE LAWS OF THE STATE OF LOUISIANA. RELATIONS OF NATIONAL AND STATE QUARANTINE-INTERSTATE QUAR- ANTINE-RE-ESTABLISHMENT OF THE MARINE HOSPITAL AT NEW ORLEANS-FLOATING HOSPITAL IN THE MISSISSIPPI RIVER FOR THE ISOLATION AND TREATMENT OF CONTAGIOUS AND INFECTIOUS DISEASES. HISTORY OF QUARANTINE IN LOUISIANA. Resistance of the Maritime Associations of Neic Orleans to the Quarantine Laws of Louisiana-Relations of the Quarantine Established by the State of Louisiana in 1855 to Public Health and Commerce-Progress of Popu- lation and Commerce in Louisiana During the French Domination, 1683 to 1763, During Which No Quarantine Existed-Progress of Commerce and Population in Louisiana During the Spanish Domination, 1763 to 1802, During Which Period the Province Was Without Quarantine Re- strictions and Laws-Progress of Commerce and Population and Outline of Epidemic Visitations in Louisiana During the American Domination, 1803 to 1883, in Which Quarantine Has Been Established and Maintained at Various Periods-General Conclusions-History of Quarantine 1855 to 1883-History of the Epidemic of Yellow Fever of 1878 in the Missis- sippi Valley-Resistance of the Quarantine Laws of Louisiana by Morgan's Louisiana and Texas Steamship and Railroad Company. DECISION OF THE SUPREME COURT OF LOUISIANA SUSTAINING THE BOARD OF HEALTH AND THE QUARANTINE LAWS AND INSPECTION FEES OF THE STATE OF LOUISIANA. RELATIONS OF NATIONAL AND STATE QUARANTINE. The important character of the issues involved in the controversy between the State and National Boards of Health will best be shown by the following extracts from the proceedings of the Board of Health at the regular meeting March 9, 1882. PROPOSED CONGRESSIONAL ACTION ON THE SUBJECT OF QUARANTINE AND THE NATIONAL BOARD OF HEALTH. At the regular meeting of the Board of Health, March 9, 1882, the President submitted the following cor- respondence : OFFICE BOARD OF HEALTH, STATE OF LOUISIANA, 1 State House, New Orleans, February 14, 1882. 5 Hon. J. Floyd King, House of Representatives, Washington, D. C.: Dear Sir-I would respectfully request the honorable Representative from Louisiana to favor this board with the complete text of his "bill relating to quarantine, the National Board of Health, and the protection of the United States from yellow fever." I quote from newspaper repoits, and therefore may be in error as to the title of the bill of the Honorable Representative. The members of Congress representing the State of Louisiana will confer a favor and promote the cause of sanitary knowledge by forwarding to the President of the Board of Health all bills discussing and papers relating to domestic and foreign quarantine. An early reply is respectfully requested. Your obedient servant, • JOSEPH JONES, M. D„ President Board of Health, State of Louisiana. Relations of National and State Quarantine. CXV HOUSE OF REPRESENTATIVES, Washington, February 27, 1882. Joseph Jones, M D., President Board of Health, State of Louisiana, New Orleans: Dear Sir-I have mailed you the bills that are before the Committee on Public Health, in accordance with your request. Please notify me if they reach you. I will be glad to get your views on any points in any of them. Very respectfully yours, J. FLOYD KING. OFFICE BOARD OF HEALTH, STATE OF LOUISIANA, ) State House, New Orleans, March 4,1882. J Hon. J. Floyd King, House of Representatives, Washington, D. C.: Dear Sir-I have the honor to acknowledge the receipt of your favor of the twenty-seventh of February, together with the accompanying bills numbered respectively 3032, 4043 and 4290. In accordance with your request that I should give my "views on anypoints in any of them," I beg leave respectfully to submit the following: 1. The bill (Forty-seventh Congress, first session, H. R. 3032) entitled a bill to amend an act entitled "An act to prevent the introduction of contagious or infectious diseases into the United States," introduced by Mr. Van Aernam, January 16, 1882, and the bill 4043, entitled "A bill to prevent the introduction of con- tagious and infectious diseases into the United States," introduced by Mr. Van Aernam on the sixth of February, 1882, are essentially the same, with the exception that the latter has the following additional clause under section two: "But if it shall appear to the President that such detail cannot be conveniently made, and such decision shall be notified by him to such Board, the latter shall be authorized to appoint such medical officer at its discretion, and if so appointed his salary shall be defrayed from the appropria- tion under its control " The phraseology of section three is altered, whilst the intent and force remain the same The two bills of Mr. Van Aernam may be regarded as almost identical. The bill (Forty-seventh Congress, first session, H. R. 4290) introduced by Mr. King on the thirteenth of February 1882, and entitled a bill to amend an act entitled "An act to prevent the introduction of conta- gious or infectious diseases into the United States," is essentially the same in language and spirit with the bills of Mr. Van Aernam. We fail to discover any essential difference between the bill of Mr. King, in- troduced on the thirteenth of February, and the bills previously introduced by Mr. Van Aernam on Jan- uary 16 and February 6, 1882. I have been thus explicit in order that the observations on the spirit of one bill will apply to all. 2. The bills of Mr. Van Aernam and of Mr. King have evidently been drawn up in favor of the National Board of Health for the enlargement of its powers, and for the subjection of the entire quarantine system of the United States and the subordination of all State Boards of Health and all State quarantine estab- lishments to the control of the said National Board of Health. Thebillsof Mr. Van Aernam andMr. King place the President of th eUnited States under the control of the NationalBoard of Health in certain sanitary matters, and erect the said board into an arbitrary and despotic tribunal, clothed with plenary powers to pass its opinions upon the quarantine regulations of any State, port or municipality ; and induce the President of the United States to order the legally constituted authori- ties appointed and elected, and commissioned by the people of the individual State to make, adopt, and en- force such rules and regulations as the National Board of Health may present. If the sanitary authorities of the States and municipalities should exercise the rights of freemen, as conferred upon them by the con- stitution of the United States or by the will of the people, and fail or refuse to enforce the rules and regula- tions promulgated for their instruction and guidance by the National Board of Health, then the President shall detail an officer or appoint a proper person for that purpose. 3. Thebillsof Messrs Van Aernam and King prescribe rules and regulations for foreign shipping in foreign ports, and subject all vessels to a fine, not to exceed $1000, (one thousand dollars), which do not con- form with the provisions of these bills at the ports of departure. Whether the jurisdiction of the United States extends in sanitary matters to all ports, of all the world, is a question of maritime law. Whether the United States will he rich enough to supply the vast sums required to maintain sanitary- inspectors, con- duct fumigations and enforce sanitary rules in all the chief ports of the world, must be ultimately deter- mined, by the people who bear the burdens of taxation. 1. Section five of the bills of Messrs. Van Aernam and King places the regulation of quarantine in the hands of the National Board of Health and effectually abolishes State quarantines The effort is thus made to have Congress pass a law delegating certain powers to the President of the United States and to the National Board of Health, which have not been embodied in the constitution of the United States. Asis well known to the learned and able representative of Louisiana, that the powers of thePresident of the United States are specially laid down in article two of the constitution, and it is evident that no power what- ever is conferred upon him to control or intermeddle with the quarantine and sanitary affairs of the indi- vidual States. The National Board of Health as now constituted, was the creation of President Hayes, and derives its existence from a special act of Congress, and not from the votes of the people ; the creature, therefore, cannot be greater than the.creator, and the assumption by Congress of powers not conferred by the constitution of the United states is subversive of the inalienable rights and liberties of the people. The plea that such measures should be sustained because they are dictated for the preservation of the public health will not bear examination for if the States are deprived of their rights of local government and self- protection in sanitary and quarantine matters, they may in like manner be deprived of all civil rights. In section four of the constitution of the United States, a republican form of government is guaranteed to every State comprising the Union. If the organic acts of individual States relating to sanitation and quarantine are to be set aside according to the opinions of the creatures of Congress or of the President, the Republic has been transformed into a centralized despotism. 5. The spirit, as well as the letter of the bills of Messrs Van Aernam and King dispose summarily of the question as to the absolute power of Congress to deal with quarantine in all its bearings as between foreign nations and domestic ports and individual States. Has Congress the power to pass sanitary and quarantine laws intended to act with equal and uniform power in every State and city in the Union, and controlling the foreign and domestic commerce of every port? It does not appear that Congress has the power to pass such laws. We fird in Brightly's Digest, p. 810, under the head of Quarantine and Health Laws, an act of Congress passed February 25, 1779. By the third section of this act it is provided that " there shall be purchased or erected, under the orders of the President of the United States, suitable warehouses, with wharves and inclosures, where goods and merchandise may- be unladen and deposited from any vessel that may be sub- ject to a quarential or other restraint, pursuant to the health laws of any State as aforesaid, at such con- venient place or places therein as the safety of the public revenue and the observances of such health laws may require." It is evident that this provision has reference to the safety of the revenue and not to the enforcement of quarantine law; That the subject of quarantine is held to be a State and not a United Stutts matter CXVI Inter-State Quarantine. will appear evident from the whole tenor of this law- Thus the first section provides that the quarantine laws of the States shall be observed by the Federal officers; and that the Secretary of the Treasury is authorized to extend the time for making entries, etc., when a conformity to such health laws shall re- quire it. Section two provides that vessels prohibited by the health laws of any State from coming to at ports of delivery, may unload elsewhere ; the cargo to be warehoused, and special permits granted, etc. Sections four, five, six and seven, provide for the removal of Custom-house officers, prisoners, public officers, and the Supreme Court from unhealthy to healthy places, and section eight provides that the costs of such removal shall be reported to Congress. Throughout the whole of this law it is evident that the authority of the States to enact quarantine laws is fully recognized. The injunction it contains upon Federal officers to aid in the execution of such laws confirms and strengthens tnis view. In the case of Gibbons vs. Ogden (Wheaton's Reports, vol. 9) Mr. Webster, in his opening argument, says : "When, until now, have they (the States) interfered with the navigation of the country? The pilot laws, the health laws, or quarantine laws, and various regulations of that class which have been recognized by Congress, are no arguments to prove, even if they are to be called commercial regulations (which they are not) that other regulations, more directly and strictly commercial, are not within the power of Con- gress." "The truth was," he thought, "that all these things were, in their general character, rather reg- ulations of police than of commerce, in the constitutional understanding of that term Quarantine laws, for example, may be considered as affecting commerce, yet they are in their nature health laws. In Eng- land we speak of the power of regulating commerce as in Parliament, or the King as arbiter of commerce, yet the city of London enacts health laws. Would any one infer from that circumstance that the city of London had concurrent power with Parliament or the Crown to regulate commerce 1 Or that it might grant a monopoly to navigate the Thames ? While a health law is reasonable it is a health law, but if, un der color of it, enactments should be made for other purposes, such enactments might be void." Mr. Emmett agreed with Mr. Webster that quarantine laws are not within the competency of Congress. The Attorney General, Mr. Wirt, viewed quarantine laws as police and not commercial regulations. Chief Justice Marshall delivered the opinion of the court, and referring to the arguments of counsel drawn from the nature of the inspection laws, quarantine laws, etc., he says (idem, p 203): "They form part of that immense mass of legislation which embraces everything within the territory of a State not surrendered to the general government; all which can be most advantageously exercised by the States themselves. Inspection laws, quarantine laws, health laws of every description,'as well as laws for regu- lating the internal commerce of a State, and those which respect turnpike roads, ferries, etc., are component parts of the same." "No such general power over these subjects is granted to Congress, and consequently they remain sub- ject to State legislation," These opinions of the most eminent legal minds of the United States seem fully to settle the question as to the source from whence quarantine laws must emanate. 6. The letter and the spirit of the bills of Messrs. Van Aernam and King are in direct opposition to article four, section one, of the Constitution of the United States, which ordains that " Full faith and credit shall be given in each State to the public acts, records and judicial proceedings of every other State. And the Congress may, by general laws, prescribe the manner in which such acts, records and proceedings shall be proved and the effect thereof." Constitution of the United States of America, article four, sec- tion one. The Legislature of Louisiana, as the representative of the people of this State, has passed organic acts establishing a Board of Health, clothed with certain powers, for the regulation of quarantine and the pro tection of the State against the introduction of foreign pestilence. The President and Congress of the United States are bound by the constitution to give full credit and support to the acts of the Legislature of Louisiana, which in no' manner violate the constitution of the United States. I hope that the honorable Representative from Louisiana will pardon the frank and earnest manner in which I have met his request to express my views with reference to the bills relating to quarantine and the National Board of Health now before Congress. I hold it to be the dutv of the Representatives in Congress to sustain the will of the people of Louisiana as expressed in the organic acts of her General Assembly. The Board of Health should be the first to ac- knowledge any just or good work or measure for the perfection of the sanitary and quarantine affairs of Louisiana by her Representatives in Congress. It is well known that previous to the recent civil war the learned and patriotic Representatives in the national halls accomplished much good for the State of Louisiana and for the entire Mississippi Valley by securing from Congress a liberal appropriation for the erection of a commodious fireproof warehouse at the Mississippi Quarantine Station ; but subsequently to this great calamity the labors of the honorable Rep- resentatives of this province have as yet yielded no result that has tended to strengthen the hands of those charged by the laws of the State with the conduct of her sanitary and quarantine affairs. It is but too true that since the civil war the legislation and decisions of the United States Courts have tended to weaken and derange the quarantine system of Louisiana, and to strengthen the hands of those who, for mercenary reasons, oppose the legislative enactments for the exclusion of foreign pestilence. With great respect I have the honor to remain your Obedient servant, JOSEPH JONES, M. D., President Board of Health, State of Louisiana. A true copy from the minutes of the meeting of the Board of Health, State of Louisiana, held March 9. 1882. . S. S. HERRICK, M. D., Secretary. INTER-STATE QUARANTINE. The President of the Board of Health has, at various times during the existence of the present Board of Health strenuously advocated : The passage of a joint ordinance by the Board of Health and City Council, imposing severe lines upon any railroad corporation or official, and upon any captain or officer of a steamboat, who shall bring within the limits of New Orleans any case of small-pox or ofher contagious disease. The process should be so simple and withal so summary, that parties bringing small-pox or any other contagious disease within the limits of New Or- leans, should be immediately arrested and punished. Similar laws should be enacted by Marine Hospital of New Orleans. CXVII the Legislature for the entire State, thus protecting Louisiana from the contagious dis- eases of surrounding States. No State in this Union has been more exposed to the pesti- lences of surrounding States, cities and countries than Louisiana, and no State has been more generous or noble in her ministrations to the sick. The vast burden which has been imposed upon the State of Louisiana, and more es- pecially upon the medical profession of New Orleans, in virtue of the position of this State at the mouth of the Mississippi River, and in virtue of the vast number of strangers, merchants and emigrants, passing this gate-way of the Mississippi Valley is shown by the following facts : During the past forty-five years Louisiana has cared for and treated in the Charity Hospital a grand total of 340,411 sick ; of this vast number, foreign countries furnished 290,128, and the various States of the Union, 80,289; England contributed 15,907, France 19,788, Germany 43,435, Prussia 6,880, Scotland 5,432, Spain 3777, Sweden 2,350, Switzer- land 4,649, Canada 2,693, Ireland 137,099 patients to the Charity Hospital. Total from these countries, 252,945. During this period Louisiana furnished only 17,013 patients to the Charity Hospital. Louisiana, in addition to the 260,128 foreigners (during the period specified, 1830-1880), has cared for 53,570 sick and destitute poor within the walls of Charity Hospital, the vast proportion of which came from such States as Alabama, Ohio, Kentucky, Iowa, Pennsylvania, New York, North Carolina, Mississippi, Tennessee and Missouri; 11,611 natives of New York and 7,462 natives of Pennsylvania have been treated within the Charity Hospital. Ireland alone has furnished eight times more patients to the Charity Hospital than Louisiana. If the annual cost of maintaining the Charity Hospital is placed at $100,000, then the total amount expended by the State of Louisiana in caring for and treating the sick and burying the dead of this grand total of 340,411 human beings, from all countries and from all States, was $4,500,000. Of this amount the natives of Louisiana received about one-twentieth, or about $225,000, while the natives of foreign countries and of the sur- rounding States composing the American Union received $3,225,000. In view of the preceding facts illustrating at once the vast mass of human sickness and sutfering which has been relieved by the State of Louisiana, so ably represented by her self-sacrificing and learned physiciaus, it is surely remarkable that the surrounding States should strive incessantly to injure the fair name of Louisiana, and more especially of the members of the medical profession, by reiterating the slanders that the existence of pestilence m New Orleans has been repeatedly ignored for the purpose of promoting the needs of commerce ; and it is still more astounding that men claiming to represent Louisiana in sanitary and quarantine affairs, should be active agents in the promulga- tion of the slander. RE-ESTABLISHMENT OF THE MARINE HOSPITAL OF NEW ORLEANS. The greatest danger to New Orleans from small-pox has been the absence of a marine hospital for the cure of infectious and contagious diseases among that class for whose care and treatment the United States government is alone responsible. It is a remark- able fact that, with all the perpetual agitations, with reference to the public health, by the National Board of Health during the past three years, the United States government should be without any hospital for the treatment of seamen suffering with contagious and infectious diseases at the great port of New Orleans. In the year 1798 a law was enacted by Congress imposing a tax of 20 cents per month on seamen employed on American vessels engaged in the foreign and coasting trades, to be collected by the several collectors of customs ; and out of the funds thus created the President of the United States was authorized to provide for the temporary relief and maintenance of sick and disabled seamen in hospitals, or in such other manner as he should direct; provided, however, that the moneys collected in each district should be expended therein. The same act provides that when there should be a sufficient surplus, after defraying the expenses of temnorary relief to seamen, it should be used in erecting marine hos- pitals. For nearly forty years after the establishment of marine hospitals the expense attending the maintenance of sick and disabled seamen had to be met out of the funds created by the tax on seamen. The demand for relief far exceeded the resources at command. Those who engaged in the commerce of the Western rivers were subjected to climatic changes that were very pernicious. The numbers who perished in the long-descending voyages of the flat-bottomed boats, which left the upper waters of the Mississippi and its tributaries in summer and early autumn, to find a market for the fruits of their toil at New Orleans, were very great. Nothing was more common than for two out of the five hands who generally managed these boats to die, and it sometimes happened that the whole crew perished from disease and that the boat with its cargo was left deserted. CXVIII Marine Hospital of Note Orleans. The steamboats ascending the Mississippi and its tributaries brought up every year a great number of deck passengers, chiefly the sons of farmers, returning from that flat- boat voyage, many of whom died on board, while others were left on shore at the river towns, helpless among strangers. The cholera epidemic of 1832 and 1834 added greatly to the catalogue of ills. Moved by a feeling of common humanity for the large class of young men who have surrendered the comforts of home and embarked in the daring, pre- carious and toilsome interest of commerce, and sensible also of the suffering attendant upon such an improvident life, whole communities, both on the seaboard and in the interior districts, petitioned Congress for additional appropriations and the enactment of laws providing increased facilities for the relief of this unfortunate class Their appeals were heeded by the representatives of the people, and Congress passed an act, which was approved March 3, 1837, authorizing the Secretary of War to appoint a Board of Medical Officers of the Army to select and purchase sites for marine hospitals on the Mississippi and Ohio rivers and Lake Erie. HOSPITAL AT MacDONOUGH'S, OPPOSITE NEW ORLEANS, kSOLD). In the year 1837 a site upon which to erect a Marine Hospital for the port or New Or- leans was purchased at MacDonough's, on the right bank of the Mississippi River, and opposite New Orleans. The hospital was commenced in 1838 and completed in 1849 at a total expenditure of $122,772 70. The hospital was first opened for the reception of patients in 1842, and was continued in use until early in June, 1858, when it was abandoned, and the patients were removed to the United States Barracks, below the citv of New Orleans, in consequence of an in- undation of the Mariue Hospital grounds by the overflow of the Mississippi River. Such remnants of the building as remained after the close of the war were sold in 1806 for the sum of $300, but the amount does not appear to have been paid into the treasury. SECOND HOSPITAL AT NEW ORLEANS, UNFINISHED AND OCCUPIED BY CITY AS AN INSANE ASYLUM. Five years after the hospital of MacDonough, which had required about twelve years to' complete, was first occupied, and while it was in successlul operation, a site for a second Marine Hospital for New Orleans was selected in a swamp back of the city, and the erection thereon of an immense cast-iron building was commenced in 1856. Not- withstanding the preparation for a foundation for the building by the driving of piles, the walls for a portion of the structure sank about two feet before completion and had to be reconstructed. The work on the hospital building was suspended in July, 1860, after more than half a million of dollars had been expended. During the war a large amount of work was done on the building by the Quartermaster Department of the army to fit it for a military hos- pital, including the erection of a kitchen and the flooring of the entire building. Notwith- standing the inauguration of a system of drainage and the improvement of the grounds, resulting from the filling up with decaying vegetation, during these seventeen years, which had elapsed since the military command of Gen. Butler, the site still remains un- healthy. To complete the building it is estimated that it would require an additional expenditure of $200,000. The building has never been occupied as a Marine Hospital, and is at present used by this city as an Insane Asylum. This building after extensive advertisement by the United States authorities, was offered for sale at public auction. There was but one bid for the property, and that so far below its real value that the Secretary rejected the bid. New Orleans, therefore, was dining 1880, 1881, 1882 and 1883, without any Marine Hospital, the patients being treated in wards of the Hotel Dieu and Touro Infirmary from which all such infectious and contagions diseases as small-pox are excluded. From the annual report of the supervising surgeon-general of the Marine Hospital •Service of the United States, for the fiscal year 1881, we gather that the receipts from all sources were $386,059 81, and the net expenditures $400,404 46; and during the year 32,613 patients received relief from the service. Notwithstanding the expenditure of this large sum, the United States has been with- out any proper hospital for the treatment of small-pox in New Orleans. The seamen afflicted with this horrible disease are allowed to depend upon the provisions of the ciiy of New Orleans and the Board of Health for their isolation. It was urged that the Representatives of Louisiana in Congress should be instructed by the Governor and General Assembly to endeavor to cause the passage by Congress of the necessary bills and appropriations for the erection of a suitable Marine Hospital at New O leans, in order that their constituents in Louisiana might be protected from those contag ous and infectious diseases, as small-pox and yellow fever which are disseminated to a gr sat extent by the sc amen of the United States. This subject was urged 1 y the President of the Board of Health, upon the representa- tives of Louisiana in the United States Senate and House of Representatives; and it is Floating Hospital in the Harbor of New Orleans. CXIX held, that the agitation of this subject, resulted in the passage by Congress of the act approved August 7, 1882, appropriating for the purchase of a site and the erection of a marine hospital at New Orleans, of $100,000. A site has been selected at New Orleans by Supervising Surgeon General John B. Ham- ilton, consisting of twenty-two acres of ground and the batture. Plans for the building have been prepared under the direction of Col. John W. Glenn, Supervising Architect, and approved by Supervising Surgeon General Hamilton, of the United States Marine Hospital Service. We have been informed that the hospital will be completed in 1884. EFFORTS OF THE LOUISIANA BOARD OF HEALTH TO SECURE THE PAS- SAGE OF AN ACT OF CONGRESS FOR THE ESTABLISHMENT OF A FLOAT- ING WARD OR HOSPITAL IN THE HARBOR OF NEW ORLEANS. OFFICE BOARD OF HEALTH, STATE OF LOUISIANA, ? New Orleans, October 12, 1882. 5 To the Representatives of Louisiana in the United States Senate and House of Representatives : Gentlemen-I have the honor to place in your hands the enclosed : 1. "An act to authorize the Board of Health of the State of Louisiana to establish quarantine stations at the various approaches to the city of New Orleans," etc 2 "An act to organize, support and maintain a floating ward or hospital in connection with the United States Marine Hospital at this port." You are earnestly requested by the IXiard of Health of the State of Louisiana to urge the passage of these acts upon the Congress of the United States at the next session, commencing December 3, 1882. You are also most respectfully and cordially invited to appoint such time and place in the city of New Orleans as may suit your convenience and pleasure to meet the Board of Health in conference concerning the important measures embraced in the proposed acts. I have also taken the liberty to enclose a copy of my letter to Hon. R. N. Ogden, Speaker of the House of Representatives, dated May 30, 1882, relative to the subject of quarantine in Louisiana for the exclusion of foreign pestilence from the State and Valley. With great respect and high esteem I have the honor to remain vour obedient servant, (Signed) JOSEPH JONES, M. D., President Board of Health, State of Louisiana. OEFICE BOARD OF HEALTH, STATE OF LOUISIANA, ? New Orleans, November 23, 1882. $ Hon. E John Ellis, New Orleans, La.: Dear Sir-In accordance with your request I have the honor to enclose the following : (a). An act to construct, maintain and support a floating ward or hospital connected with the United States Marine Hospital at New Orleans. (b). Copy of letter of Surgeon General Hamilton, of the United States Marine Hospital Service, relative to said act,'marked ^a). (C). An Act to authorize the State of Louisiana to establish quarantine stations, to inspect and disinfeet vessels, and to collect an inspection fee. (d). Opinion of Col. F. C. Zacharie, relative to the quarantine laws of Louisiana. In presenting the preceding (enclosed) acts, for the action of Congress, the Board of Health of the State of Louisiana desires that you should exercise your discretion as the honorable representative of this State. With great respect and high esteem, your obedient servant, [Signed] JOSEPH JONES, M. D., President Board of Health, State of Louisiana. TREASURY DEPARTMENT, ) Office Supervising Surgeon-General, U.S. Marine Hospital Service, V Washington, November 6, 1882. ) Joseph Jones, M. D., President Board of Health, State of Louisiana, corner of Royal and St. Louis streets, New Orleans, La.: Sir-I have the honor to acknowledge receipt of your letter of the third instant, inclosing for suggestion a draft of a bill to construct and maintain a floating ward or hospital in connection with the Marine Hospital at the port of New Orleans, and return the draft herewith, with certain verbal alterations, some of which, perhaps, are not important, but seem necessary. It seems to me that section two might be shortened with- out detracting from its stringency, inasmuch as the statutes cover the manner in which public works shall be advertised for, etc. I have therefore stricken out in pencil such sentences as I think could be dispensed with, and made an amendment to section two. In section three I have added " Revenue Marine, and of the Marine Hospital Service," instead of the Marine Hospital Service alone. The other alterations are merely verbal, in the interest of brevity, except section four, which I think should provide for the care of foreign sailors, who are, under the Revised Statutes, admitted to marine hospitals on the application of consuls of the nations to which they respectively belong. Also, the words "Secretary of the Navy," wherever they occur, have been changed to read " Secretary of the Treasury," as this bureau is one of the so-called. " independent " bureaus under the direction of the Secretary of the Treasury, which, until the formation of the National Board of Health, was intrusted with the execution of all laws affecting commerce and requiring action by the Federal authorities. I refrain from making any indorsement of the proposed act, at this time, as it will doubtless, in the course of business, be referred to the Secretarv of the Treasury by the committee of the House of Representatives having the matter in charge, and such report as I may have to make upon it will be made at that time. It is proper to say, however, that I have embodied your suggestions as to the construction of a floating ward in the annual report of this service, which will be issued in a few weeks, and will report the same favorably when it is referred as above stated. Very respectfully, JOHN B. MAMILTON, Supervising Surgeon General. CXX History of Quarantine in Louisiana. AN ACT. To construct, support and maintain a floating ward or hospital, in connection with the United States Marine Hospital, at the port of New Orleans, in the State of Louisiana, for the purpose of isolating and main- taining sailors, mariners and United States Marine Hospital patients afflicted with contagious or infec- tious diseases; to provide a steam launch therefore, and to appropriate the sum of thirty thou8and,dollars for the construction, organization and maintenance of the same, under the direction and control of the United States Marine Hospital Service. Section 1. Beit enacted by the House of Representatives and the Senate of the United States, in Congress As' sembled, That the sum of thirty thousand dollars be aud is hereby appropriated from moneys not otherwise appropriated from the Treasury of the United States for the purpose of constructing and maintaining a float- ing ward or hospital at the port of New Orleans, Louisiana, in connection with tne United States Marine Hospital at that port.. Sec. 2. Beit enacted, etc., That immediately after the passage of this act the Surgeon General of the United States Marine Hospital Service shall cause to be prepared plans, designs aud specifications for the building of said boating ward, which shall be submitted to the Secretary of the Treasury for his approval and adoption, and that on the approval and adoption by the Secretary of the Treasury'of said plans, designs and specifications, the building shall be constructed under the direction of the Supervising Architect, iu accordance with existing law. Sec. Be it enacted, etc., That on the completion of the same the Secretary of the Treasury shall cause the same to be inspected by an officer of the Revenue Marine and of the United States Marine Hospital Ser- vices, who shall report in writing the condition thereof and whether the terms and specifications of the contract have been faithfully complied with, and the Secretary of the Treasury, on a favorable report being made, shall receive the same and turn it over to the United States Marine Hospital Service. Sec. 4. Be it enacted, etc., That the Surgeon General of the United States Marine Hospital Service shall assume control thereof, and see that the same is properly provided for the reception, treatment and main- tenance of all United States Marine Hospital patients and of foreign sailors admitted thereto, suffering from contagious or infectious diseases, and shall cause said patients to be thereto removed, from time to time, and isolated and maintained separate and apart from the other United States Marine Hospital patients and from communication with persons from the shore, save those necessary to the conduct of said floating ward and hospital, and then under such rules and regulations of the United States Marine Hospital Service, or such as may be established by the. Surgeon or Surgeons, Physicians or Physician in charge, under the direction of the United States Marine Hospital Service. Sec. 5. Be it enacted, etc., That the said floating hospital or ward shall be moored in the stream of the Mississippi River, at such point or points as the Board of Health of the State of Louisiana may direct, so as to best avoid the danger of infection or contagion to the shores thereof, and best subserve the proper conduct and administration of said ward. Sec. 6. Be it enacted, etc., That so much of the balance of the appropriation herein made as may not be used in the building, constructing, furnishing and finishing of the said floating ward shall be devoted to the purchase of a suitable steam launch of such build and design as shall be approved by the United States Marine Hospital Service, to be used in conveying patients and supplies to said floating ward, and in the necessary business thereof, and the remainder of said appropriation, if any there be, shall be applied to the maintenance of said floating ward; and the funds appropriated shall be drawn and expended in the manner now provided by the laws and rules of the United States Marine Hospital Service, and the laws and rules and regulations of the Department of the Treasury of the United States. The first great practical and permanent advance in sanitary science by the Representatives of the people of Louisiana in General Assembly con- vened, was made in March, 1855, when an act was passed u To establish quarantine for the protection of the State." This valuable act, in its twenty-ninth section, provided not merely for the maintenance of an effective and enlightened system of quarantine, but also established and clothed with ample powers a Board of Health, com- posed of nine enlightened citizens of the State. The Legislature of 1877, which superseded the Radical rule, passed four acts of importance, which reorganized and rendered more efficient the Board of Health, provided for the disposition of offal, garbage and night soil and dead animals in the parishes of Jefferson, Orleans and St. Bernard, regulated the cleaning of vaults and privies, and provided for the gauging and inspecting of coal oils and illuminating oils, or fluids de- rived wholly or in part from coal or petroleum. By act No. 80, approved April 20,1877, the registration of births, deaths and marriages in the parish of Orleans was confided to the Board of Health; by act 14, approved March 23, 1877, the present system for the disposal of offal, garbage, night soil and dead animals, at certain desig- nated nuisance wharves or landings, and by suitably constituted boats, was inaugurated. The former act increased the revenues of this Board, and tended to render more accurate the record of the vital statistics of New Orleans, whilst to the latter must be attributed results of the greatest HISTORY OF QUARANTINE IN LOUISIANA. History of Quarantine in Louisiana. CXXI importance to the sanitary improvement of the city in daily removing and effectually disposing of the refuse and excreta of 230,000 inhabitants by consigning them to the bosom of the great Mississippi. Without doubt no measure of greater moment to the State of Louisiana and to the Mississippi Valley was discussed and acted on by the General Assembly of 1882 than that which related to the regulation of quarantine charges at the mouth of the Mississippi River. Great legal difficulties were involved in the question of quarantine charges, and without a fixed and definite revenue the maintenance of an efficient quarantine on this great river for the protection of the State and valley was impossible. It is, therefore, of importance that a clear statement should be made, for the guidance of future legislatures and boards of health, of the questions involved and the arguments advanced during the discussion of questions relating to the maintenance of quarantine by the State of Louisiana. THE MAINTENANCE OF QUARANTINE ON THE MISSISSIPPI RIVER AND AT OTHER POINTS ON THE MAIN CHANNELS OF COMMERCE BY THE STATE OF LOUISIANI. The quarantine act of 1855 appears to have been in operation, without "legal" opposi- tion, until 1874, when Charles Morgan, John H. Clark, C. H. Mallory et als., and Fred. Baker, commenced legal proceedings, to enjoin the Board of Health from collecting the quarantine fees, in accordance with the organic acts of the Legislature of Louisiana, approved March 15, 1855, and March 18, 1858. The action of the Board of Health, with reference to this matter, is of importance ; as to its indecision and failure to uphold the laws of Louisiana, regulating quarantine, un- necessary burdens were imposed upon the tax-payers, and great damage wrought of to the quarantine system instituted by the Legislature of 1855 for the protection of the valley from the importation of foreign pestilence. At a meeting of the Board of Health, on the twentieth of May, 1874, upon motion of Mr. Burwell, seconded by Mr. Heath, it was "resolved that, with reference to the in- junction brought against the board by Charles Morgan, restraining the board from exer- cising the provisions of the act of quarantine, approved March 15, 1855, and the amend- ment thereto, be referred to the President, C. B. White, to take such action, after consultation with the attorney of the board, C. S. Rice, Esq., as he might deem necessary in the premises." It appears that this injunction was not resisted by the Board of Health, and that, instead of pressing this important question to a final decision, the Legislature was petitioned for funds to conduct the Mississippi quarantine, and that an appropriation was made in warrants, which yielded in cash $18,000. This same Board of Health had, in 1869, ob- tained from ^he Legislature $19,258 85 in cash. How large a sum in warrants, and how many thousands of dollars were saddled upon the taxpayers of Louisiana by these trans actions is unknown, in the absence of the books of the Auditor and Treasurer. The President of the Board of Health, Dr. C. B. White, in the report for the year 1873, states that "the appropriation (by the Legislature) last year was but seven thousand dollars, instead of twelve thousand, as considered necessary by the board, and owing to the pressure of creditors, the warrants? were immediately sold, and resulted in an addition to the funds of the board of but thirty-one hundred dollars and eighty-six cents, whilst its indebtedness was over five thousand dollars, thus leaving about two thousand five hundred dollars to be paid out of quarantine receipts of 1873." " In estimating the revenues of the board, and as partly explanatory of its yearly expenses over receipts, it is to be considered that the receipts at the Mississippi Quarantine Station have decreased from twenty- five thousand in 1869, to eighteen thousand in 1873, although the receipts from the Atchafalaya Station hav ing increased about one thousand dollars per annum, the actual decrease of receipts is about six thousand per annum, as compared with 1866." It is evident, from the preceding statement, that the warrants issued to the Board of Health by the Legislature were worth less than half their face value. Dr. C. B. White, in his report of 1874* to Gov. William Pitt Kellogg, thus states the *The Board of Health, in 1774, was thus constituted: Members-G. W. R. Bayley, Esq., C. E.; Edward Heath, Esq ; Thomas J. Woodward, Esq.; Wili am M. Burwell, Esq.; A. W* Smythe, M. D.; S. M. Bemiss, M. D.; E. B. Gaudet, M. D.; James F. Finney, M. D.; C. B. White. M. D., President. Secretary and Treasurer, S C. Russell, M. D.; Attorney, Charles S. Rice, Esq.; Chemist, S. S. Herrick, M. D.; Clerk, Isaac Stathem ; Sanitary Inspector, First-District, S. S. Herrick, M. D.; Second District, James F. New- man, M. D.; Third District, Gustavus Devron, M. D.; Fourth District, Joseph Holt, M. D,; Fifth Dis- trict, Charles H. Young, M. D.: Sixth District. George Kellogg, M. D.; Seventh District. George K. Pratt, M. D. I CXXII History of Quarantine in Louisiana. financial condition of the Board of Health and the effects of the injunction obtained by Morgan and others, restraining the collection of quarantine fees at the Mississippi Quar- antine Station. " The neglect of the General Assembly, at its session of 1874, to provide by appropriation for the usna annual deficiency in the revenues of the board, and the additional pecuniary embarrassment caused by the action of certain ship-owners in enjoining the Board from collecting quarantine dues, threatened the whole quarantine system of the State with immediate dissolution. To bring this important matter promptly and clearly before the only authority competent to remedy this unfortunate and dangerous condition of affairs, a special report was submitted to the Legislature immediately upon its assemblage. Being of permanent interest, it is made a part of the annual report, and now follows: "The Board of Health respectfully submits a special report. " This report exhibits the receipts and expenditures of the Board of Health during the year 1874, its liabilities at the present date, the considerable decrease during the present year of the revenue which supports the quarantine system and the Board of Health, and the probable total annihilation of that reve- nue in the near future." * * * This report shows that during the year 1374 the total cash received from vessels, via the Mississippi Station, was $19,237 60; and the entire revenue from all quarantine sta- tions, including the sum just mentioned, was $20,438 72. The account shows that this entire sum was expended, and that the liabilities of the Board of Health of the State of Louisiana, on the twenty-first day of December, 1874, amounted to $10,826 36. Dr. C. B. White thus enumerates the causes of the large indebtedness of the Board, as shown by the statement of the Secretary: " The deficient appropriation by the General Assembly at its session of 1873, which left debts of the Board unliquidated amounting to $2500. "2. The Legislature of the session of 1874 made no appropriation whatever for the relief of the Board, which consequently began the year with the burden of seven thousand dollars of debts. "3. The receipts of the Mississippi quarantine Station have decreased from twenty-five thousand dollars in 1860 to nineteen thousand dollars in 1874. "4. The cost of carrying on the operations of the Board is somewhat enhanced by the increased price of supplies in general, while quarantine dues, not being, as formerly, paid in gold or its equivalent, their purchasing power is, to a corresponding extent, diminished. "5. While the revenues of the Board have thus seriously decreased, its expenses, even with constant efforts at economy, have decidedly increased. "The General Assembly is respectfully reminded that, previous to the act of March 11, 1870, increasing the powers of the Board, and consequently its duties, this body was in effect merely a Quarantine Board; and its duties and powers as a Board of Health practically nothing. " Previous to that date there were no meteorological or other observations made, no extended or sys- tematic or continuous recording of the facts of epidemics and epidemic diseases, no laboratory work or ex- penses, no vaccine furnished to physicians of the city and State, no purchases of scientific instruments or use made of them, no house-to-house inspection with its attendant expenses. Whatever reports were made to the Legislature consisted of a few pages containing some valuable facts, but no way comparable with the accurate, extended and complete reports which are now annually presented, and whose value is dis- tinctly recognized by all experts in sanitary matters throughout the United States. " As has been stated, the Board of Health began its fiscal year with a debt of seven thousand dollars. To increase its financial difficulties, Charles Morgan and other steamship proprietors procured, in the United States Court, an injunction forbidding the Board to collect quarantine dues from vessels belonging to the before-mentioned persons. The diminution of the revenues of the Board from this cause, during the year just closed, amounts to the sum of twenty-six hundred dollars. " In April, upon the recommendation of tliis Board, Dr. Alfred W. Perry was appointed quarantine physician at the Mississippi Station. * * Dr. Perry mads a contract with the Board to accept salary at the rate of thirty-five hundred dollars per annum, instead of five thousand' dollars, and to furnish an assistant at five hundred dollars per annum, in- stead of two thousand, as salaries are allowed by law. In addition to these reductions, he bought down the pay-roll of the station, by the discharge of employes, not required by the necessities of the station, and by- reducing its supplies used, so that the expenses of the Mississippi Station were reduced from about twelve hundred to seven hundred and thirty dollars per month ; and at the date of his arrival had laid before the Board a proposition, whilst increasing the salary of the assistant physician, to bring the total expenses of the station to six hundred and ninety dollars per month, being at the rate of, say, eight thousand five hun- dred dollars per annum, instead of fourteen thousand six hundred dollars, as under his predecessor. " Much to the regret of the Board of Health, ou the fourteenth of October, Dr. Perry was superseded by- Dr. Howe, who held the position about five weeks, during which period all attempts at economy were dis- dained, and the expenses brought up to the former rate of about fifteen thousand dollars per annum. " At the request of the Board of Health, made in consequence of this official extravagance, and also be- cause of disobedience to positive instructions of the Board, directing disinfection of vessels from infected ports, Dr. Howe, on November twentieth, was superseded by- Dr. Julius Clark. By Dr. Clark the plans of the Board for the economical management of the Mississippi Quarantine Station are cordially and completely carried out, the rate of expenditure at the present time being somewhat less than under the administration of Dr. Perry. " It is evident therefore that the receipts of the Board have therefore been so managed that, had the'action of the courts not deprived it of a portion of its usual revenue, they would have very nearly provided for its expenses. The indebtedness of the Board, December 31, 1873, seven thousand dollars, and its loss of revenue by injunctions, two thousand six hundred dollars, approximate closely to the ten thousand dollars indebted- ness of the Board, December 31, 1874. This debit will require an appropriation by the General Assembly equivalent to ten thousand dollars in cash. "As was suggested in the opening sentence of the report, it is almost certain that all revenues of the Board of Health will be taken away very early in the year. If the maiuteinance of quarantine and the con- tinued existence of the Boardiof Health be esteemed desirable by the Legislature, action io that end is neces- sary. The amount of appropriation necessary for the support of quarantine and the Board of Health during 1875 is twenty-six thousand dollars. The small amount of three hundred dollars tor nails and paints is nec- essary to prevent the rapid and serious deterioration of the quarantine buildings. The work and repairs could be done by the employes of the Station."-Annual Report of the Board of Health, to the General Assem- bly of Louisiana, 1874, Session at New Orleans; printed at the Republican office, 95 Camp street, pp, 9-17. History of Quarantine in Louisiana. CXXIII It will be observed from the foregoing statement of Dr. C. B White, President of the Board of Health, that a complete and unconditional surrender of the questions at issue which related to the maintenance of the quarantine system of Louisiana by the organic acts of the Legislatures of 1855 and 1858 was made by the Board of Health. The President held that it was "almost certain that all revenues of the Board will be taken away very early in the year f' therefore, instead of defending the quarantine laws and ex- hausting all legal measures to settle this important question, the injunction against the Board of Health was allowed to remain in the lower court, in which it originated, and the responsibility of maintaining the Board of Health and quarantine was referred to legislative action, and ten thousand dollars solicited to pay the indebtedness of the Board, and twenty-six thousand dollars asked for the support of quarantine and the Board of Health during 1875. This appeal was not without its effect, and Dr. C. B. White, in his annual report for 1875, informs "His Excellency, William P. Kellogg, Governor of the State of Louisi- ana," that the appropriation made by the General Assembly, session of 1875, for the maintenance of health and quarantine, together with the receipts from the Mississippi Quarantine Station, have greatly relieved the financial embarrassment of the Board of Health, and but for circumstances beyond its control the relief would have been com- ' plete, and the Board at the close of the year been entirely out of debt." From the report of the Treasurer, S. C. Russell, M. D., we gather that the Legislature appropriated $24,000 to the Board of Health, as per act No. 17, of 1875. Eighteen thousand dollars of this appropriation, together with $13,735 50 were received from fees on vessels at the Mississippi Quarantine Station during the year 1875.. The total receipts of the year 1875 were $33,180 02; this entire amount was expended, and still the liabili- ties of the Board, on fche thirty-first of December, 1875, were $4530 50.* Dr. Felix B. Gaudet was elected President of the Board of Health in 1876, and no report was issued for this year. After the overthrow of the Packard government, the reorganization of the Board of Health was effected under act eighty of the Legislature, on the first of May, 1877. Dr. Samuel Choppin, in his report to His Excellency, Francis T. Nicholls, forthe year 1877, thus alludes to the questions at issue with reference to the resistance to the collection of quarantine fees by certain ship agents and owners: I take occasion here to point out the necessity for legislative action in some important particulars, for the benefit of our quarantine system. The successful resistance of a number of ship owners to quaran- tine exactions has seriously diminished the resources of the board, and it is likely to produce still greater damage in the future, unless the basis of charges be mbdified so as to obviate the constitutional provision forbidding State authorities to levy taxes on tonnage. It is suggested that the fees should be graduated ac- cording to work performed; that is to say, proportioned to number of the vessel's company, when visited and inspected by the quarantine physician; and besides a charge for disinfection, when found necessary, which might lie graduated upon the same basis. "While it is desirable to reduce these charges, the board are restricted, in the present terms of the law, from curtailing one principal item of expense; that is, the salaries of the resident physician and his assist- ant at the Mississippi Quarantine Station. The salaries of these two officers are fixed by law, and amount to $7000. while there is no doubt that the board might, if empowered to make the selection, obtain equally good service, and save from $2000 to $3000 annually in salaries. Another reason for leaving this appointment to the board is, that they are held responsible to the public for the proper administration of quarantine; and, indeed, the principle insisted on is recognized with the other stations, in giving the board full control over the choice and compensation of officers, "The Board of Health earnestly urge upon the Legislature the importance of memorializing Congress upon the absolute necessity of passing a law authorizing the State to levy tax for quarantine purposes upon all shipping as a matter of self-protection. "In this connection, I desire to call attention to the necessity of a legislative appropriation for repairs of buildings and construction of fences at the Mississippi Quarantine, and for the erection of suitable build- ings at the Rigolets and Atchafalaya, where none now exist. By courtesy of the military authorities, the quarantine physician and his assistant at the Rigolets have been accommodated for several years with quarters at Fort Pike, but aside from the impropriety of thus being dependent on solicited hospitality, it is found that the fort is not the proper place for the quarantine station, which should be near the railroad bridge over the Rigolets, and'within plain view of the mouth of West PeariRiver. At the Mississippi Station the need of repairs is urgent, to save the buildings from ruin. The estimated cost of repairs and fences for this station is $10,000 ; for the Rigolets, $2500, and for the Atchafalaya $2500 "-Annual Report of the Board of Health of the State of Louisiana to the General Assembly for the year 1877 (Session of 879(, pp. 15-17. In his report of 1879, Dr. Choppin again urged upon the General Assembly the neces- sity of legislating on the subject of quarantine. Thus he says: " It is necessary to adopt some other basis than tonnage for forming a scale of quarantine fees. The revenues from the Rigolets and Atchafalaya stations are utterly insignificant, owing to the refusal of the owners and masters of vessels to pay any fees, unless they actually have sickness on board. In this course they are sustained by decisions of the Federal courts, and we have no remedy, without modification of the law. I would suggest that the number of people carried by a vessel be made the basis of a scale of fees. Then there would be no tax on tonnage, but an inspection fee granted according to the works actually per- formed,"-Annual Report of the Board of Health of the State of Louisiana to the General Assembly for the year 1879 (Session 1880), pp. 25-36. *0f the total amount, $33,180 02, expended by the Board of Health during the year 1875, the following sums were paid for printing and stationery: Paid John W. Madden for printing annual report of 1872, $900: lithographing 2000 charts for annual report of 1872, $500; paid for printing and stationery, etc., in full, for the year 1873, $760 30 ; paid for printing 1000 copies of annual report of 1873, $900 ; lithographing 2000 charts for annual report of 1873, $500; lithographing 2000 charts for annual report of 1874, $750; printing, sta- t ionery, etc., forjthu years 1874 and 1870 in full, $1322 30 ; total, $5832 90. CXXIV History of Quarantine in Louisiana. From the preceding statements by the late Dr. Choppin, it is evident that, during the years 1877, 1878, 1879, to April, 1880, the Board of Health received no specific legislation on the subject of quarantine, and took no steps to raise the injunction obtained, in 1874, by Morgan and others, or to probe the difficulty to the bottom, by conducting the case to the Supreme Court of the United States. In accordance with the provisions of the Constitution of 1879, the Board of Health was reorganized in April, 1880, after the adjournment of the General Assembly of 1879-1880; and it was impossible to obtain any modification of the existing quarantine law previous to the meeting of the Legislature in May, 1882. The President, however, brought the subject at issue before the Board of Health, and urged immediate and persistent prosecution of the cases up to the Supreme Court of the United States. A correspondence was conducted by the President with the Chief Execu- tive and quarantine and health authorities of the individual States, in order to obtain all possible information as to the nature and mode of execution of the quarantine laws in the Atlantic and Gulf and Pacific ports of the United States. The first occasion which offered, for the invocation of legislative action, namely, the Extra Session of 1881, was embraced, and His Excellency, Governor S. D. McEnery, was respectfully urged to bring the subject before the General Assembly; it was, however, wisely decided by the Chief Executive of Louisiana, that the question of quarantine de- manded for its consideration and discussion the necessary time and opportunity afforded by the regular sessions prescribed by the Constitution, The following extracts from the official records of the Board of Health will place in a clear light the efforts which were made by the President to sustain the quarantine laws of Louisiana, and to secure the important and essential support of his Excellency, Gov- ernor S. D. McEnery, and of the General Assembly of the State, To accomplish the most important result, namely, the proper framing of such an act as would remove objectionable expressions and at the same time increase the force and render more effective the quarantine laws of Louisiana, the necessity of employing able legal counsel was urged, and sustained by the Board of Health, as will be shown by the following correspondence : RESISTANCE OF THE MARITIME ASSOCIATION OF NEW ORLEANS TO THE QUARANTINE LAWS OF THE STATE OF LOUISIANA. LETTER OE THE PRESIDENT OF THE BOARD OF HEALTH TO HIS EXCELLENCY, S. D McENERY, GOVERNOR OF THE STATE OF LOUISIANA, RELATIVE TO THE NECESSITY OF LEGISLATIVE ACTION. NEW ORLEANS, December 8, 1883. Dr. Joseph Jones, President of the Board of Health of this port: Dear Sir-Herewith we respectfully call your attention to a copy of a communication hereto annexed, and which was submitted to the New Orleans Maritime Association at their meeting last evening and approved, with instructions to us to carry out the suggestions made therein. We deem it proper to first address you on the subject, explaining that the Maritime Association does not wish to interfere in the least with the quarantine officers or their rights or duties, but they do desire that the expenses of examining and passing healthy vessels on their arrival at Quarantine Station shall be paid by the State, where it legally belongs, as customary in other United States ports, and not to be a tax upon vessels and their owners, as imposed upon them in this port. We further add, that we are informed by good authority that for several years past vessels of a certain line coming to this port have not, and still up to this day do not, pay the fees for examining such vessels arriving between sunrise and sunset, as charged for and collected on vessels con- signed to us. We, therefore, respectfully ask that, you will cause all such unjust collections to cease, and grant to such vessels the same rights and privileges as now enjoyed by the vessels referred to by the preferred party. Awaiting your reply, we remain yours respectfully.' COMMITTEE .ON ABUSES. Per Robert Oerlein, Chairman. Robert Oerlein, Esq., Chairman Committee on Abuses, New Orleans Maritime Association: Sir-At the present time, and for many years past, the State quarantine officers have been collecting fees from all vessels consigned to us, regardless of condition or port from which they sailed. We believe this illegal and an injury to our port, and ask you to investigate this matter. We suggest that if the Governor, being informed of t his fact, declines to ascertain the legality of such onerous fees, and order such collections to cease, that you proceed to take steps to obtain an injunction against collections that are unconstitutional. New Orleans, November 24, 1881. NORTON & BELL. Ship Agents. A. K. MILLER & CO.. Ship and Steamship Agents. HALL & VAUGHN, Ship and Steamship Agents. FORSTALL, ROSS & CLAYTON, Ship and Steamship Agents. JOS. F. LOVELL & CO., Ship Agents. SILAS WEEKS & CO., Ship and Steamship Agents. History of Quarantine in Louisiana. CXXV NEW ORLEANS, December 19, 1881. His Excellency, Governor S. D. McEnery, Governor of the State of Louisiana: Dear Sir-I have the honor to submit to your Excellency the enclosed communication from the New Or leans Maritime Association of December 18, signed by Robert Oerlein, Esq., Norton & Bell, A. K. Miller & Co., Hall <fc Vaughn, Forstall, Ross & Clayton, Jos. F. Lovell & Co., and Silas Weeks & Co., ship agents. It will be seen that the gentlemen composing the New Orleans Maritime Association have determined to resist the laws of Louisiana regulating the entire subject of quarantine. The law now in force, and upon which the Board of Health has acted since its organization, is as follows : "An act supplementary to an act entitled an act relative to quarantine," approved March 15, 1855. Sec. 2. Be it further enacted, etc., That the Resident Physician at the Quarantine Station on the Missis- sippi River shall receive a salary of $5000 per annum, and shall be appointed by the Governor of the State, with the consent of the Senate, and shall be removable at the will of the Governor. It shall be the duty of the Resident Physician or his assistant to visit and inspect every vessel entering the port of. New Or- leans through the Mississippi River. Vessels free from disease and not in a foul condition, and not from an infected district, which shall be decided upon by the Resident Physician, shall be furnished with a cer- tificate of health, and allowed to proceed to the city. The Resident Physician shall require for every cer- tificate thus furnished the following fees: Every sailing vessel of 1000 tons and over shall pay $30 ; every ship of 1000 tons or less shall pay $20 ; every bark shall pay $15; every brig shall pay $10; every schooner shall pay $7 50 ; every steamboat (tow- boats excepted) shall pay $5; every steamship from Florida, Alabama, Mississippi or Texas shall pay $10 ; every steamship from other ports shall pay $20. The Resident Physician shall return to the Secretary of the Board of Health a weekly list of all vessels inspected by him, as well as all fees collected by him, which shall form a fund for the support of quarantine. WM. W. PUGH, Speaker of the House of Representatives. C. H. MOULTON, Lieutenant Governor and President of the Senate. ROBT. C. WICKLIFFE. Governor of the State of Louisiana. A. true copy: ' ANDREW S. HERRON, Secretary of State. It will be seen that the gentlemen composing the New Orleans Maritime Association pronounce the laws of the State of Louisiana unjust, and demand that the collection of the fees at the Missssippi Quarantine Station shall cease. The statement with reference to certain lines of vessels, or vessels of a certain line, refers to certain suits against former Beards of Health. Thus, the following cases were entered in the United States Cir- cuit Court in New Orleans: Charles Morgan vs. Board of Health, No. 7236, in 1874. John H. Clark et als. vs. Board of Health, No. 7241, in 1874. C. H. Mallory & Co. et als. vs. Board of Health, No. 7268, September 11, 1874. Fred. Baker vs. Board of Health, No. 7267, September 11, 1874. In these cases judgment was rendered pro confesso, no defense having been set up by the Board. At the present moment the former steamship line of Charles Morgan, now represented by Charles A. Whitney & Co., hold an injunction against the Board of Health, but, nevertheless, during my term of office, it has paid a considerable amount toward the support of quarantine. In view of the preceding facts, I would respectfully submit the followings 1. The commercial prosperity of New Orleans, and of the entire Mississippi Valley, demands that an efficient quarantine should at all times, and all seasons of the year, be maintained at the mouth of the Mis- sissippi River. 2. The protection of New Orleans, the State of Louisiana and the entire Mississippi Valley from the introduction of foreign pestilence, as Asiatic cholera, Oriental plague, ship or typhus fever, small-pox, leprosy and yellow fever, depend absolutely upon the maintenance of a rigid quarantine at the mouth of the Mississippi River. 3. If the quarantine of the Mississippi be allowed to fail, either by a combined effort of the merchants, shipmasters and enemies of quarantine and the health and prosperity of the State, the port of New Orleans will be hermetically sealed during six months of the year. 4. New Orleans is becoming a great railroad centre, and the vast interests of the great States concen- trating here demand a rigid and thorough system of quarantine. The President was authorized to employ the services of Col. Frank Zacharie as his special counsel, and at the earliest practical moment all laws and acts relating to quaran- tine in this and other States were placed in his hands, and in due time the form of a bill to be presented to the General Assembly, together with his legal opinion, were perfected and laid before the Board. The form of the bill: " To fix and regulate quarantine charges at the Mississippi River Station; to establish a lien and privilege on vessels inspected in favor of the Board of Health for the same, and to provide for their enforcement and collection by provisional seizure, was adopted by a unanimous vote of the Board of Health, and the President was authorized to present the said bill to the General Assembly for adoption. The President of the Board of Health visited Baton Rouge in person on the tenth of May, 1882, two days after the organization of the General Assembly, and delivered the bill relating to quarantine charges at the Mississippi River, to Uis Excellency Governor S. D. McEnery, to Hon. George L Walton, President pro tern, of the Senate, and to Hon. Robert N. Ogden, Speaker of the House. The bill was accompanied by the letter which was published in the Official Journal of the House of Representatives: CXXVI History of Quarantine in Louisiana. Office Board of Health, State of Louisiana. / New Orleans, May 8, 1882. ) Hon. Robert N. Ogden, Speaker House of Representatives, State of Louisiana, Baton Ronge: Dear Sir-The attention of the Honorable Speaker of the House of Representatives is respectfully directed to the enclosed bill, entitled "An act to fix and regulate quarantine charges at the Mississippi River Station ; to establish a lien and privilege on vessels in- spected in favor of the Board of Health for the same, and to provide for the enforce- ment and collection by provisional seizure." The necessity for prompt and decided action on the part of the Gent ral Assembly for the regulation of the quarantine fees for the protection of the State and Mississippi Val- ley from the importation of foreign pestilence has been fully demonstrated in the annual report of the Board of Health (pp. 103-109). •The bill now submitted has received the unanimous approval of the Board of Health. The commercial prosperity of New Orleans and of the entire Mississippi Valley de- mands that an efficient quarantine should at all times, and at all seasons of the year, be maintained at the mouth of the Mississippi River. The protection of New Orleans, the State of Louisiana, and the entire Mississippi Valley from the introduction of foreign pestilence depends absolutely on the maintenance of a rigid quarantine at the mouth of the Mississippi River. If the quarantine of the Mississippi be allowed to fail by the combined efforts of the merchants, ship-masters and enemies of quarantine, the port of New Orleans will be hermetically sealed during six months of the year. New Orleans is fast becoming a great railroad centre, and all the vast interests of the great States concentrating here demand a rigid and thorough system of quarantine. Former Legislatures, by their organic acts, have based the support and maintenance of the various quarantine stations of the State absolutely and wholly upon the fees de" rived from vessels entering the waters of Louisiana. Two items alone, the salaries of the quarantine physician and his assistant, amount annually to the large sum of $7000. Add to this the pay of the necessary boatmen, watchman and hospital stewards, nurses, etc., necessary to the proper care of the build- ings and sick, and the necessary fumigation, ten men at $50 per month, equal to $500 per month, or $6000 per year; annual repairs and supplies for sick, ship chandlers' supplies, disinfectants, ets., at $10,000, and we have a total of about $23,000, actually required to maintain the Mississippi Quarantine Station alone. The actual receipts from the fees collected at the Mississippi Quarantine Station dur- ing 1880, were $21,872. This sum was inadequate to the support of the quarantine es- tablishments of Louisiana. In 1881, the receipts amounted to only $18,052, whilst the repairs alone upon the Mississippi Station reached $6000, and no provision has been made by the Legislature to meet the necessary expenditures of the Board of Health, for the maintenance of an effective quarantine. The exports of 1880 reached $102,528,376, and the imports $11,809,977 ; total exports and imports for the year 1880, $14,338,353. The total amount collected during 1880 from this vast sum for the protection of the commerce and health of New Orleans and the Mississippi Valley was $21,872, and in 1881 the amount was only $18,052, and owing to the gambling operations in cotton and the failure of the grain crop, the quarantine fees of 1882 will fall short of those of 1881. The preceding facts relate solely to the mercantile and money value of the question- During the years 1853, 1854 and 1855, New Orleans lost 12,780 of her citizens by yellow fever, an imported pestilence, and in 1878 she lost 4056 souls and about $15,000,000 by the same scourge. The State of Louisiana has a right to demand that commerce, which benefits the entire valley, and derives its richest rewards from the cotton, sugar and grain of these great Southern and Western States, should pay a sufficient amount for such a system of inspection and disinfection and quarantine as will prevent the introduction of foreign pestilence. It is but iust that the immigrants from foreign countries should be taxed a sufficient sum for their proper protection from disease and their proper treatment when sick within the limits of the State. During the past forty-five years Louisiana has cared for and treated in the Charity Hospital a grand total of 340,411 sick. Of this vast number foreign countries furnished 260,128 and the various States of the Union, 80,289. Of this vast multitude, equaling more than one-third of the present population of the State, Louisiana furnished only 17,013, History of Quarantine in Louisiana. CXXVII The Board of Health of the State of Louisiana relies with confidence upon the wisdom and justice of the General Assembly for the enactment of such laws as will effectually maintain the health of the Mississippi Valley by the efficient support of the quarantine establishments. I have the honor to remain, with great respect, your obedient servant, JOSEPH JONES, M. D., President Board of Health, State of Louisiana. In order to expose and defeat the efforts to overthrow the quarantine system of Louis' iana, by the owners and agents of steamships and other vessels, and certain parties em' ployed in undermining, misrepresenting and defaming the legal and constitutional labors of the Board of Health of the State of Louisiana, the President addressed the following communication to His Excellency S. D. McEnery, and to Hon George L. Walton, Presi- dent pro tern, of the Senate, Hon. Robt. N. Ogden, Speaker of the House.* THE RELATIONS OF THE QUARANTINE ESTABLISHED BY THE STATE OF LOUISIANA IN 1855 TO PUBLIC HEALTH AND COMMERCE. Office Board of Health, State of Louisiana, ( New Orleans, May 30, 1882. $ Hon. B. N. Ogden, Speaker House of Bepresentatives, Baton Rouge, La. : Dear Sir-The Official Journal of the House of Representatives of the State of Louis- iana ('twelfth day's proceedings, published in the daily Capitolian-Advocate of May 24, 1882, contains a memorial from certain owners and agents of steamships and other vessels,! certain statements of which demand critical examination. The memorialists affirm that the bill introduced into the House of Representatives of Louisiana by the honorable chairman of the Committee on Health and Quarantine, en- titled "An act to fix and regulate quarantine charges at the Mississippi River Station, etc., plainly and palpably violates at least two provisions of the United States Constitu- tion, and in its tendency to prejudice our growing commerce, is materially subversive of the best interests of Louisiana." It has been shown in the annual report of the Board of Health of the State of Louis- iana for 1881 (Introduction, p. 8), and also by the learned counsel of the board in a legal opinion now in the hands of the honorable Committee on Health and Quarantine, that the quarantine laws of Louisiana are not in conflict with the Constitution of the United States, and that they form part of that immense mass of legislation which embraces everything in the territory of Louisiana not surrendered to the General Government. It has been shown that inspection laws, quarantine laws, health laws of every description as well a» laws for regulating the internal commerce of a State, and those which respect turnpike roads, ferries, are regulations of police rather than of commerce in the consti- tutional understanding of that term. This feature of the proposed act to fix and regulate fees at the Mississippi Quarantine Station having been referred to the Judiciary Committee of this honorable body, will not be further discussed ; but we will confine our attention chiefly to the assertion made by certain owners and agents of steamships in New Orleans, that this bill tends to prejudice our growing commerce, and is materially subversive of the best interests of Louisiana, and imposes heavy additional charges against an interest already heavily burdened. * This protest was signed by the following ship and steamship agents in New Orleans: B. B. Post & Son, Agents Tampa St amship Company; Charles A. Whitney & Co., Morgan's Louisiana and Texas Bailroad and Steamship Company; Forstall, Boss and Clayton. Agents French Canadian Line of Steam- ships ; Silas Weeks, Ship and Steamship Agents; A. K. Miller & Cd., Ship Agents; Edw. A. Yorke, p. p. Bichard H. Crawford, Agents New York, Havana and Mexican Steamship Line; Alfred Moulton & Co., Cromwell Steamship Line ; Norton & Bell, Ship and Steamship Agents; L. LaCombe & Co., Ship and Steamship Agents; Lucas E. Moore & Co., Agents Harrison's Line ; T. & G. Forwood, agents W. L. and P. Steamship Line ; Ed, F. Stockmeyer & Co., Agents North German Lloyd; Shultz & Co., Ship Agents ; A.. B. French & Co., Steamship Agents ; Louis Banger & Co., Agents Steamship Line ; S. A. Cosulich, Ship Agent; Jos. T. Lovell & Co., Ship and Steamship Agents; Joseph Kelly, Ship Broker; S.Oteri; Macheca Bros., Managers N. 0. and B. B. M. Steamship Line; Hall & Vaughan, Steamship and Ship Agents. t This communicgtion was referred to the Committees on Health and Quarantine in the House and Senate and was not read, and did not appear upon the official journal of the General Assembly. Notwithstanding that the memorial of the ship agents and maritime men of New Orleans, attacking the quarantine system of Louisiana, together with the protests against the substitutes for the quarantine bill, by various members of the General Assembly, were read and published in full in the official journal of the House of Represen- tatives. In this emergency, service of no ordinary value was rendered by the Daily New Orleans Picayune in the prompt publication of the exposition of the relations of quarantine to commerce, and the distribution of the views held by the Board of Health as to its official duties and powers on this important subject, to every member of the Senate and House of Bepresentatives. CXXVIII History of Quarantine in Louisiana. It lias been well said that no city in the world occupies a more important commercial position than New Orleans. Situated on the most important point on the Mississippi be- tween the shores of the Gulf of Mexico and the borders of the great lakes, New Orleans holds communication with all the great ports of Europe and America, and furnishes them with the vast supplies drawn from the great valley, bounded by the Alleghanies and the Rocky Mountains, comprising an area of 2,455,000 square miles, extending through thirty degrees of longitude and twenty-three of latitude. No city in the world has suffered more obloquy than New Orleans in relation to health, and more especially in regard to its epidemics of yellow fever; and however devoid of sanitary laws and hygienic regulations, and however filthy and neglected the towns and cities situated within the Valley of the Mississippi and its tributaries have been in times past, they have ever sought to lay their own devastating epidemics at the door of this great commercial centre. The rapidly advancing millions of the great valley look with increasing interest upon the sanitary condition and quarantine laws and regulations of New Orleans It will not be beyond the bounds of truth to affirm that, but for yellow fever, New Or- leans, even at this day, after the ravages of civil war, and the ruthless plundering of her hostile rulers, would have exceeded every other city of America in the magnitude of her imports and her exports. 5. The former Lesislatures, by their organic acts, have based the support and maintenance of the various quarantine stations of the State absolutely and wholly upon the fees derived from vessels entering the waters of Louisiana. Two items alone, namely, the salaries of the quarantine physician and his assistant, amount annually to the large sum of $7000. Add to this the pay of the necessary boatmen, watchmen and hospital stewards, nurses, etc. necessary to the proper care of the buildings and sick, and the necessary fumigation, ten men at $50 per month, equal to $500 per month, or $6000 : annual repairs and supplies for sick, ship-chandlers' supplies, disinfectants, etc. $10,000; and we have a total of about $£1,000 actually required to maintain the Mississippi Quarantine Station alone. The actual receipts trom the fees collected at the Mississippi Quarantine Station have been during the past year (1880) $21,872. This sura has been inadequate to the support of the quarantine establishments of Louisiana; and for the repairs of 1881, amounting to $6000. for the Mississippi Quarantine Station, no adequate provision has been made by the Legislature. The exports of 1880 reached $102,528,376, and the imports $11,809,977 ; total exports and imports. $114,338,353. The total amount collected from this vast sum for the protection of the commerce and health of New Or- leans and the Mississippi Valley was $21,872. It is not true that the quarantine charges aud expenses are higher in New Orleans than auy other port in the United States. The preceding facts relate solely to the mercantile aud money view of the question. But when we re- member that during three years-1853,1854 aud 1855-New Orleans lost 12,780 of her citizens by yellow fever, an imported pestilence, and that only four years ago she lost 4056 souls, and about $15 000,000 by this same scourge, the action of the Maritime Association with their aids and abettors, in their attempt to destroy the quarantine system of Louisiana, is seen in its true light. • But arguments and explanations avail nothing with men who are willing to resist the laws, and thereby avoid the pa> ment of the just quarantine dues established by the General Assembly of Louisiana, and who are willing to break down every barrier against the importation of foreign pestilence aud to utterly destroy at once the health and commercial prosperity of the State, in an effort to avoid the payment of a few dollars. The State of Louisiana has a right to demand that commerce, which benefits the entire Valley and derives its richest reward from the cotton and grain of these great Southern aud Western States, should pay a suffi- cient amount for such a system of inspection and disinfection and quarantine as will prevent the introduc- tion ot foreign pestilence. It is but just that the immigrants from foreign countries should be taxed a sufficient sum for their proper protection from disease aud their proper treatment when sick, within the limits of the State. During the past forty-five years Louisiana has cared for and healed in the Charity Hospital a grand total of 340,411 sick. Of this vast number foreign countries furnished 260,120, and the various States of the Union 80,280. Of this vast multitude, exceeding by more than one-half the present population oj this city, Louis- iana furnished only 17,913. The State, iu addition to 260,220 foreigners, has cared for 53,570 sick aud desti- tute poor within the walls of her charitable institutions, the vast proportion of which came from such States as Alabama, Kentucky, Iowa, Ohio, Pennsylvania, New York, North Carolina, Virginia, Mississippi, Tennessee, Missouri; 41,611 natives of New York and 7462 natives of Pennsylvania have been treated within the Charity Hospital, In conclusion, I would most respectfully suggest that, if it should be deemed necessary to prolong the extra session ot t Iio Legislature, that your Excellency should embrace in the call the important subject of the quarantine. The questiou w'ill be solved by the united wisdom of the Chief Executive aud General Assembly, aud I feel assured that it will be possible to devise means by which the quarantine laws may be either promptly vindicated or so modified as to render their induction and invasion upon any technical terms utterly im- possible. With great respect and high esteem, I have the honor to remain your obedient servant. JOSEPH JONES M. D., President Board of Health, State of Louisiana. OFFICE BOARD OF HEALTH, STATE HOUSE, STATE OF LOUISIANA, I New Orleans, December 12, 1881. 5 Robert Oerlein, Esq. : Sir-In reply to your communication of the eighth instant, inclosing a resolution by the New Orleans Maritime Association, signed by Norton & Bell, A. K. Miller & Co., Hall & Vaughn,Forstall, Ross & Clay- ton, Jos. F. Lovell & Co., Silas Weeks & Co., I have the honor to refer you to the enclosed organic act of the Legislature of Louisiana. Respectfully yours, JOSEPH JONES M. D., President Board of Health. Robert Oerlein, Esq. : The vast burden which has been imposed upon the State of Louisiana, and more especially upon the tn edical profession of New Oileans, in virtue of the position of this State at the months of the Mississippi TJLBLK B. Showing the Foreign Countries and States of the American Union from which the Patients annually admitted into the Charity Hospital of New Orleans, Louisiana, United States of America, have come, and the Number from each, during a Period of Forty-five Years, 1830-1880, collected, classified and consolidated from original reports and documents, by Joseph Jones, M. I)., New Orleans, 156 Washington street, corner of Camp, January 1, 1882. STATES, TERRITORIES, ETC. 1830 1831 1832 1833 1834 1835 1836 1837 1838 1839 1840 1841 1842 Total 13 Yrs. 1843 1844 1845 1846 1848 ! 1849 1850 | 1852 | 1853 1854 1855 1856 1857 1858 1859 | 1860 Total 16 1/ s 18(4 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 1876 1877 1878 1879 1880 Total T6 Yrs Total . 45 Yrs. Alabama 5 3 1 4 6 3 10 8 9 9 9 5 6 78 8 4 7 14 1 11 23 18 21 1 H 2- ( 2* 4! 3: 34 4 37 5- 65 51 5; lb lOt 10 8 10 8 9 Ilf 13: 9! 11 ID 1,49. 1,942 3 1 2 1 1 1 3 1 13 4 1 2 < 1 3 2 2 4 2 5( 4 I li 1' 1- L 1. 1 1( 11 1. 16. 234 21 2 29 21 2 23 Connecticut 24 27 27 36 49 38 31 51 24 23 25 17 12 384 19 24 38 38 24 23 15 11 12 IS IS 11 33f 2* 13 IE 11 IS 1< 1 1 1 171 S93 Delaware 9 7 2 7 25 17 m 20 20 3 11 12 9 164 11 8 15 13 9 Id 12 10 1 t 7 F J 8 13* ( f 11 1 7' 375 10 15 10 6 12 5 6 13 1 78 7 10 5 9 9 11 4 ( 9 1 If t li; f S 1-- If 1( ! 1( IE 2( 14 15f 347 Elorida 2 1 1 1 1 3 g 3 2 1 1 4 24 1 ...... 4 4 11 29 1 3 2 3 3f F 9 13 i: 93 t 33 IE 21 2C n 1 1 If If 21 2. 15 235 352 11 17 9 7 19 12 14 20 11 8 10 9 17 164 14 12 17 20 24 26 21 2 21 3; 35 3! 2" 31 4 Of 45 44 3! 3* 61 72 4* 5f 51 6( 3( 6C 4f 75 3i 56 81* 1,383 Illinois 5 71 1 2 2 7 2 4 6 7 6 8 3 124 2 7 12 12 13 14 12 19 12 16 18 1* 1! 16 31 4t 273 14 44 32 1( 25 46 3E 21 1( 2( 2f 3 35 3' 3' 22 435 832 82 77 1 7 10 11 7 12 21 12 8 8 10 26. 1« 13 24 29 23 23 27 24 10 23 16 11 21 23 24 28 337 27 33 25 If 13 36 IL IE If 11 2S 22 25 2£ 2c 26 356 959 Indian Territory b 3 22 1 1 2 2 2 Iowa 1 3 1 ...... 2 2 2 4 € 2 f t £ 3 55 77 Kansas . . • • • . .... ... 66 95 55 45 "'89 75 3 3 2 1 1 : 2 2 12 Kentucky 69 67 23 62 93 113 45 96 69 70 44 56 879 64 7( 114 4 0 53 71 6i 88 111 12 8 46 112 10( 66 155 20* 139 16* 135 14f 115 107 168 IP 145 88 2,00; 4,090 Louisiana 51 59 40 29 49 30 62 51 33 40 40 38 34 556 59 1 1. 119 145 111 147 264 248 228 252 328 34! 394 360 377 433 3.927 623 464 547 524 837 721 671 631 672 764 866 1,015 1.037 1.020 1.017 1,019 12,536 17,013 Maine 51 57 40 52 52 51 58 58 54 45 67 37 45 667 38 46 43 67 84 92 73 64 61 42 32 32 66 54 58 878 123 65 91 71 26 21 34 18 li 12 19 15 15 22 124 17 9 599 2,144 Maryland Massachusetts 86 83 55 82 84 82 82 87 45 62 56 58 48 910 58 81 64 87 73 76 52 6.* O 1 65 34 51 47 73 63 49 994 28 64 65 9.' 111 91 71 75 6: 6! 84 76 95 8( 7( 1,233 3,137 106 115 80 116 148 120 90 156 98 109 78 66 7 7 1 359 81 to 76 91 144 115 no Ill 44 98 71 4 | 65 88 108 142 1,495 61 104 73 45 5' 62 44 31 30 24 22 56 36 41 57 41 786 3.640 Michigan 2 2 1 3 1 3 4 7 1 24 1 1 1 2 2 2 3 4 1 4 4 7 19 6 19 76 2 0 9 1 c 15 4 6 4 7 6 9 11 13 4 13 117 217 Minnesota 19 30 1 4 1 1 1 2 ...... 3 1 J 2 3 2 17 22 Mississippi 14 4 8 9 6 8 12 14 8 13 7 9 112 6 10 11 26 13 11 18 23 19 35 18 28 51 325 160 to 65 62 157 142 139 123 107 12' 12c 153 134 165 171 125 2,031 2,467 Missouri 6 52 6 9 10 12 7 15 24 15 12 0 8 178 0> 18 23 13 30 39 30 25 27 30 24 24 31 53 84 480 26 75 74 37 91 94 98 86 78 72 62 89 75 92 92 77 1,21( l,s68 New Hampshire 19 24 11 23 35 32 15 36 17 31 9 14 9 275 19 2^ 24 21 28 20 21 21 12 10 • w 4 7 11 14 12 264 19 10 5 4 2 7 8 12 4 3 2 4 6 0 3 94 633 New Jersey 43 44 31 36 38 51 34 41 26 28 20 19 19 450 21 26 22 29 42 27 37 4. no 22 18 13 16 27 25 33 430 15 30 29 20 13 9 24 14 8 16 9 15 15 13 15 6 251 1,111 400 366 247 241 453 477 2 "448 242 1 2 5 5 New York 185 221 106 213 291 288 254 310 285 2H5 253 188 200 3,059 222 262 231 320 342 395 253 288 226 324 5.047 252 363 186 281 263 197 156 118 129 184 211 176 171 128 3,505 11,611 North Carolina 47 51 40 36 63 57 52 64 27 20 16 32 26 531 24 29 39 65 34 35 28 29 23 31 00 2< 61 26 28 34 538 29 22 23 23 74 80 82 87 52 64 65 69 49 55 54 58 886 1,955 Ohio 34 39 22 43 87 93 106 110 64 78 69 53 57 855 55 97 113 105 81 86 90 118 79 80 71 68 69 87 113 125 1 437 66 80 85 58 85 101 82 54 58 51 56 87 87 88 63 51 1,152 3,444 Oregon 234 "132 ...... "82 161 1 1 1 Pennsylvania 234 381 111 253 278 269 308 294 175 172 190 201 136 3 002 189 211 217 249 205 195 166 151 145 100 135 152 194 219 2,904 154 82 112 156 105 82 57 79 57 98 65 105 82 79 1 556 7,462 Rhode Island 34 37 20 23 25 14 15 28 17 9 14 14 9 259 4 9 1 15 20 27 22 29 11 11 6 12 4 17 14 6 222 6 21 19 8 3 9 8 8 1 8 0 2 5 3 3 7 116 597 South Carolina 36 39 15 23 49 39 35 50 23 23 29 22 30 413 29 24 26 46 45 39 44 o 17 25 22 32 28 29 39 !25 475 00 40 30 28 78 81 71 44 50 65 56 46 45 51 43 32 782 1,670 Tennessee 42 45 25 39 69 68 81 70 15 23 46 40 0" J 5-6 27 31 40 69 46 67 51 0 i 38 37 ■3d 43 47 48 69 47 752 35 71 67 28 90 107 105 106 75 75 61 73 100 77 72 61 1,203 2,541 1 2 1 11 3 5 3 3 < 10 13 10 69 20 31 27 30 22 23 23 20 29 31 25 26 31 22 25 25 410 479 28 Vermont 12 18 17 15 23 41 21 2*' 14 1 13 914 11 13 1 1 15 21 22 11 11 7 9 9 14 13 14 237 15 11 11 2 5 2 7 7 3 1 1 5 2 5 3 80 531 Virginia 131 135 71 108 149 147 UI 1 6 79 109 57 71 93 1,417 93 8 100 130 72 97 97 85 62 118 47 81 97 100 89 113 1,469 65 106 77 88 247 302 264 264 192 229 227 268 244 234 194 179 3,180 6,096 Wisconsin 1 1 1 1 1 4 1 4 3 c> 0 30 1 0 2 1 1 13 2 2 2 1 0 0 11 6 11 5 73 103 West Virginia 1 5 4 1 11 11 At Sea (U- S.) 2 20 2 4 3 9 9 Unknown 1 4 20 47 1 1 10 13 7 ..... 2 14 48 95 - - - - - - - - - 1,782 - - . - - - - - - - - - Total United States 1,336 1,704 771 1,245 1,677 1,610 1,512 1,797 1,180 1,172 I 126 980 941 17,05! 1.092 1,316 1,350 1 773 1,. 79 1,774 1,709 1,306 1,502 1,288 1,369 1 577 1.751 2,014 2, 72 25 454 1,891 2,394 2,10e 1,538 2,678 2,886 2,518 2,253 2,035 2,201 2,199 2,691 2,720 2,709 2,612 2,353 37,778 80,283 . FOREIGN COUNTRIES. Africa 3 5 4 6 7 1 1 27 1 1 1 4 1 2 1 2 1 2 1 1 18 4 4 1 6 9 2 0 8 5 7 3 5 2 4 62 107 Antigua Islands 1 6 1 1 1 Arabia 1 ...... 1 5 2 16 16 Asia 1 1 2 3 1 1 1 1 4 5 7 5 4 9 3 5 9 1 2 1 6 3 60 60 Australia ...... 38 69 63 1 ...... 1 3 1 2 2 1 1 13 1 4 28 29 Austria 2 3 a 10 3 15 29 35 79 54 57 83 58 80 114 88 872 22 95 121 55 25 23 22 17 28 25 20 22 29 31 20 19 574 1,456 Azores' Islands 1 6 22 29 29 Barbadoes 4 3 1 1 9 9 Bavaria 7 3 1 11 23 "35 2 4 4 1 12 9 24 17 20 2 93 106 2 1 2 10 15 11 11 22 22 17 36 33 57 36 30 35 35 35 438 21 35 30 21 20 24 8 11 18 17 9 13 20 17 6 10 282 735 49 1 1 1 3 3 Bohemia • • • • • . 8 14 5 3 6 85 ...... 3 1 1 2 6 4 17 102 Brazil 1 1 2 1 1 1 41 1 4 36 1 11 1 2 3 1 2 1 1 11 24 33 34 31 23 ..... 10 208 1 2 I 4 212 Buenos Ayres 1 76 1 2 2 Canada 8 24 16 24 36 67 42 8 32 41 37 43 42 420 36 51 41 80 55 86 85 68 67 73 49 47 72 131 183 1 203 68 154 95 43 64 79 90 61 48 48 39 49 49 57 38 38 1,020 2,643 0 3 2 2 5 3 17 1 1 2 1 5 22 Cape de Verde Islands ...... 1 1 2 1 5 5 Cape Good Hope 2 1 1 4 4 Central America 3 1 1 4 6 6 1 1 3 4 3 4 3 3 3 28 1 1 1 2 1 6 34 3 2 2 7 1 1 1 1 0 11 1 1 4 1 4 12 35 44 31 38 22 28 24 20 42 22 329 347 Corsica 5 . ..... 2 1 2 2 3 6 1 15 5 1 1 4 6 21 Cuba • 12 17 ■> 5 3 IL U 23 i 1 87 0 9 8 7 6 8 5 11 52 158 Denmark 12 19 8 13 38 44 42 41 19 27 38 31 37 369 28 47 25 42 107 94 95 63 61 82 94 38 29 63 79 73 1,020 19 64 59 18 26 42 42 31 28 15 17 15 24 22 13 18 453 1,842 East Indies 1 5 3 2 4 4 10 2 1 2 1 1 4 40 4 3 4 4 6 4 26 16 14 2 1 7 93 3 1 1 3 1 4 ■ 14 147 569 734 1 1 1 England 251 314 222 343 448 443 378 410 313 443 391 215 226 4 397 281 346 330 369 I io 567 519 459 335 329 347 463 591 629 7,643 158 427 455 203 193 337 298 211 225 209 162 221 194 223 147 204 3,867 15,907 Finland 3 1 4 685 1 6 8 9 9 7 8 5 14 4 4 14 4 93 97 Erance 142 199 172 253 262 278 202 270 154 332 314 383 279 3,24 354 350 357 506 621 8 >2 993 843 1.082 1,150 792 664 876 742 771 11 638 328 437 434 311 267 391 250 252 240 316 301 325 319 270 231 238 4,910 19,788 Germany 126 201 111 378 503 575 262 617 451 662 647 425 579 5 537 851 667 710 1,100 1 4e2 1,74- 1,972 2 352 2.291 2 784 2,840 1,402 1,214 1,938 1,748 2 279 27,292 411 994 951 518 604 1,084 780 729 735 645 520 581 606 596 418 454 10,626 43,455 Gibraltar 3 0 3 5 1 2 16 12 3 2 1 6 11 4 3 3 10 5 o 3 4 1 13 13 7 6 5 12 2 4 84 1 7 4 4 3 10 8 3 6 12 8 3 100 194 3 2 2 Hayti 3 1 4 2 3 9 13 Hannover 3 6 1 4 18 19 6 48 57 1 1 2 2 H indostan 25 31 2 2 1 0 5 Holland 12 10 16 16 11 42 34 26 10 6 4 14 201 8 13 41 40 37 20 32 21 21 31 26 41 424 28 16 10 3 11 16 13 10 15 4 126 751 Honduras 73 1 1 1 Hungary 1 1 o 2 3 4 16 12 0 16 10 4 1 .... 0 9 8 1 4 1 4 10 6 11 8 10 79 154 Ionian Republic .••••* • • • • • • • • • • • •••••• 1 1 .... 3 2 Isle of Man 0 2 3 2,477 3,107 6,232 8,678 9 3 3 3 1 22 2 2,290 2,069 1 1 3 4 14 38 Ireland 660 915 842 1,206 2,354 2,476 1,544 2,142 1 471 1,601 1,950 1,779 1,792 20,732 1,864 2317 11,132 10,195 7,217 5.491 4 786 4,287 4,010 4,568 5,888 6,416 88,665 1,541 3,564 3,079 1,691 1,837 1,489 1,255 1,2«5 1,157 1 337 1 543 1,357 1,147 1,061 27,702 137,099 Italy 11 5 12 43 53 4l 35 54 47 58 71 43 51 524 39 50 46 28 20 31 • 28 35 24 46 14 33 3- 25 73 535 37 71 103 77 50 68 47 53 55 61 68 69 78 67 53 75 1,032 2,091 J amaica 15 1 2 7 1 2 5 18 18 Jersey Islands 0 1 2 2 2 1 2 15 Madeira Malaga •••••• . • • • 3 3 6 6 7 1 26 3 1 1 10 2 2 1 1 4 25 51 1 6 6 3 4 3 6 3 6 1 1 29 Malta. 4 0 • > D 4 7 10 2 ... 2 0 6 1 (8 3 6 2 0 8 1 7 11 1 11 9 13 4 3 81 149 Manilla 1 7 3 3 7 5 33 1 3 3 1 2 0 15 20 2 54 87 Martinique 1 49 1 28 19 < Mexico 30 21 22 14 10 31 11 10 6 13 13 6 12 199 21 14 15 14 46 28 25 2d 26 30 15 14 36 31 38 427 io 2'2 43 19 19 8 13 17 13 12 7 11 10 13 264 890 New Brui swick 3 3 6 4 5 5 D 4 12 0 24 0 69 7 13 26 0 9 16 7 3 6 7 4 2 3 7 11 3 129 204 New Eoundland 2 1 1 4 4 4 4 4 0 3 2 2 28 5 8 3 6 8 3 3 5 3 6 2 2 3 7 64 96 New Holland 1 4 2 7 7 New South Wales 1 1 New Zealand 1 3 ..... 4 1 1 3 7 Orkney Islands 39 1 2 1 1 1 4 10 21 1 1 11 Norway 10 15 11 14 29 22 19 27 11 13 14 11 8 204 8 12 14 23 42 32 29 26 19 37 26 13 21 33 30 406 15 36 29 11 24 25 12 18 18 17 17 17 13 15 19 307 917 Nova Scotia 5 9 2 6 17 8 3 50 11 10 10 10 22 21 12 15 8 119 13 26 14 6 15 17 11 3 9 0 6 10 12 5 12 3 167 336 Netherlands ...... •••••• ...... ...... ........ 8 4 1 1 19 19 New Providence .... . • • •. ..... 4 2 I 1 4 3 2 1 1 19 19 Palestine 1 1 5 . ..... ...... ..... 1 Persia 1 2 1 1 2 7 Peru 16 20 0 17 15 18 18 4 1 2 116 3 1 1 13 2 1 10 - 1 1 2 128 Poland 12 7 6 5 40 16 14 6 8 17 7 11 149 7 12 6 14 16 31 12 7 23 24 10 8 14 17 9 223 4 8 8 J1 14 14 9 2 3 7 12 8 8 3 111 483 Phillippine Islands 31 58 28 1 2 1 1 2 3 10 10 Portugal 8 10 12 15 12 15 14 20 44 19 29 19 248 19 47 49 47 84 75 45 15 11 18 10 16 18 26 566 13 21 12l 7 7 11 7 49 26 33 20 21 17 11 10 15 280 1,094 Prince Edward's Island 26 240 290 4 520 1 0 3 1 1 1 3 5 1 15 20 Prussia Prussian Poland 2 49 12 16 22 25 26 16 13 17 18 27 269 25 83 141 414 440 554 7 415 10 501 353 2 297 13 523 10 514 31 255 12 5,565 85 74 345 360 109 5 1 30 55 34 33 1,046 6,880 85 Russia I I 1 9 3 5 7 12 12 12 3 2 6 6 5 9 5 8 105 2 35 53 18 8 2 5 3 6 5 10 7 156 262 Russian Poland San Domingo 5 17 29 2 1 2 3 11 1 1 11 29 11 Sandwich Islands 2 1 3 1 52 3 4 1 1 1 5 12 Sardinia 174 2 6 8 2 7 14 41 53 63 45 19 54 52 61 93 34 36 635 643 Scotland 86 95 93 123 178 168 186 146 106 50 93 85 1,583 92 141 128 152 170 258 267 252 144 153 125 li8 94 140 193 221 2,648 60 146 144 62 81 114 80 78 68 49 41 56 47 74 52 49 1,201 5,432 Shetland 23 1 1 2 4 3 2 9 11 Sicily 3 1 4 14 9 ID 4 17 17 11 69 7 13 26 8 6 234 1 2 2 4 4 13 251 South America 148 2 132 6 8 1 1 43 4 4 1 1 12 20 Spam 82 196 82 113 162 135 168 114 153 105 70 57 1 585 88 93 131 194 130 118 73 56 71 96 52 36 74 67 83 1,494 26 67 162 57 37 46 32 39 29 26 29 27 18 35 25 698 3,777 St. Helena 1 0 3 1 1 2 5 St. Thomas 64 102 1 69 1 1 1 1 8 8 Sweden 65 25 26 56 83 45 70 82 49 60 45 42 26 674 28 61 41 98 72 63 74 59 37 30 26 53 66 100 974 24 85 59 40 46 78 38 31 28 30 24 30 44 36 40 702 2,350 Switzerland 5 4 14 4 34 29 30 40 20 28 17 14 23 298 19 60 74 130 183 363 282 253 195 314 319 182 139 215 225 222 3,205 42 168 123 53 43 106 86 61 60 71 58 42 47 63 60 63 1,146 4,649 Turkey 1 3 4 1 .... 4 1 14 ...... .... 1 3 1 4 11 25 Tuscany Van Dieman's Land Venezuela 1 1 2 2 ..... 5 7 6 22 23 ..... •••••• ...... .... 1 1 2 2 23 1 2 0 17 5 5 Wales 5 14 12 9 63 22 16 12 31 15 12 13 11 6 1 UI 7 24 5 10 21 8 4 0 4 5 9 4 128 302 West Indies 5 9 16 15 27 38 31 8 6 12 167 18 15 14 19 19 0 16 13 21 17 22 16 0 250 6 26 27 11 28 27 24 28 10 3 3 5 3 3 ■ 12 216 633 Western Islands 9 11 19 28 10 18 9 104 11 1 2 2 6 1 15 1 2 1 2 1 3 55 159 Wight Islands Wurtemberg 1 1 1 1 - 1 5 5 12 17 5 17 Yucatan 2J 4 4 1 25 42 38 1 5 All other Countries 10 28 2 211 17 121 106 92 587 50 75 84 86 43 121 274 120 80 51 30 28 38 16 31 1,155 4 20 28 18 21 30 29 13 19 14 13 66 18 398 2,140 Total Foreign Countries 1,564 2,174 1.710 2.706 4.295 4.593 3,095 4,197 3,116 3,661 3,936 3.376 3 449 41.8*2 3.921 4,530 4.786 6.271 10.366 13.776 16,702 16.322 12,453 11.690 10.904 8.063 7.326 9,586 10,761 11,728 159 185 2.970 6.927 6.512 3,443 3 499 4.951 j4,133 _3,288 3.055 3,030 2,646 2.999 3,282 3,169 2 636 2,531 59,071 260,128 - - . - ' - '- - - - •- Total United States 1,336 1,704 771 1,245 1,677 1,610 1,512 1,797 1,180 1,172 1,126 980 941 17,051 1,092 1,316 1,350 1,773 1 579 1,782 1,774 1,709 1.306 1,502 1.288 1 369 1,577 1,751 2,014 1 2,272 25,454 1,891 2,394 2,100 1,538 9,678 2 886 2 518 2,253 2,035 2,201 2 199 2,691 2,720 2,709 2,612 2,353 37,778 80,283 Total Foreign Countries ' 1,564 2,174 1,710 2,706 4,295 4,593 3,095 4,197 3,116 3,661 3,936 3,376 3,449 41,872 3,921 4,530 4,786 6,271 10,366 13,776 16,702 16,322 12,453 11,690 10,904 8,063 7,326 9,586 10,761 11,728 159,185 2,970 6,927 6,512 3 443 3,499 4 951 4,133 3,288 3,055 3,030 2,646 2,999 3,283 3,169 2.636 2 531 59 071 260,128 Grand Total 2,900 3,878 2,481 3,951 5,972 6 203 4,607 5,994 4,296 4,833 5,062 4,356 4.390 58,923 5,013 5,846 6,136 8,044 11,945 15,558 18,476 18,031 13,759 13,192 12,192 9 432 8,903 11,337 12,775 14,000 184,639 4,861 9,321 8,612 4.981 6,177 7,837 6,651 5 541 5,090 5,231 4,845 5,690 6,002 [ 5,878 5,24S 4,884 96,84L 340,411 History of Quarantine in Louisiana. CXXIX River, and in virtue of the vast number of foreign emigrants passing through the gateway of the Mis- sissippi Valley, is clearly shown hy the statistics recorded in the tables, marked A and B.-Annual Re- port, 1881. The table marked B exhibits jthe foreign countries and States of the American Union from which the patients annually admitted into the Charity Hospital of New Orleans have come, and the number from each, during a period of forty-five years-1830-1880-and in addition to the facts stated in the preceding letter to his Excellency, S. D. McEnery, it should be noted that England contributed 15,907, Erance 19,788, Ger- many 45,435, Prussia 6880, Scotland 5438, Spain 3777, Sweden 2350, Switzerland 4649, Canada 2693 and Ire- land 137,669 patients to the Charity Hospital. Total from these countries, 252,645. Ireland alone has furnished eight times more patients to the Charity Hospital than Louisiana. If the annual cost of maintaining the Charity Hospital is placed at $100,000, then the total amount ex- pended by the State of Louisiana in caring for, treating the sick and burying the dead of this grand total of 340,411 human beings from all countries and from all States was $4,500,000 (four millions five hundred thousand dollars). Of this amount the natives of Louisiana received about one-twentieth, or about $250,- 000, whilst the natives of foreign countries and of the surrounding States composing this American Union received $3,225,000. At the same time the sole revenue which the State of Louisiana derives from foreign countries and the various States ot the Union for the prevention of the introduction of foreign pestilence and the relief of the sick at the various quarantine stations, and for the protection of the commerce of the Mississippi River, is derived from the inspection fees originally levied in 1855 and 1858 by the General Assembly of the State of Louisiana for the support of quarantine. In view of the preceding facts, illustrating at once the vast mass of human sickness and suffering which has been relieved by the State of Louisiana, so ably represented by her self-sacrificing and learned physi- cians, it is surely remarkable that the surrounding'States should strive incessantly to injure the fair name of Louisiana, and more especially of the members of the medical profession, by reiterating the slander that the existence of pestilence in New Orleans has been repeatedly concealed for the purpose of promoting the needs 6f commerce; and it is still more astounding that men claiming to represent Louisiana should be active in the propagation of this slander. Upon consultation with His Excellency, Governor Samuel I). McEnery, and with Col. I. N . Marks, the former Chairman of the Finance Committee, and Hon. Edward Booth. Chairman of the Finance Committee, and other members of the Board of Health, the suggestion of the President that able counsel should be employed for the thorough investigation of all points at issue with reference to the execution of the quaran- tine laws of Louisiana was fully indorsed. The appointment, as additional counsel, of Col. Frank Zacharie, received the cordial approval of His Excellency, the Governor. OFFICE BOARD OF HEALTH, STATE OF LOUISIANA, 1 New Orleans, December 20,1881. 5 Col. Frank Zacharie, No. 24 Exchange Place: Dear Sir-Enclosed please find the following documents: 1. Letter of President to His Excellency, Governor S. D. McEnery, of date December 19, 1881. Said letter relates to the subject of the resistance of quarantine fees by the New Orleans Maritime Association. 2. Communication from New Orleans Maritime Association to President of Board of Health. 3. Data furnished by S. S Herrick, Secretary of the Board of Health, relating to the state of the suits urged by Morgan and others against former Boards of Health. 4. Letter of the President of the Board of Health to Col. I. N. Marks. 5. Letter of President to Robert Oerlein, Esq. Judge Kennedy will, without doubt, be able to furnish additional information. It is desired that you should make a thorough investigation of this entire subject. It will be necessary to examine the court records, and to obtain accurate information at the outstep. Mr. F. A. Woolfley, Clerk of the United States Circuit Court, might give material aid. No more important question can be considered than that of the powers of the Legislature to regulate efficiently her quarantine affairs. Please suggest such course as you may think will best protect the interests of the State, and best cover all the points at issue. Action should be prompt and efficient. I have directed Dr. S. S. Herrick, Secretary and Treasurer of the Board of Health, and Mr. L. O'Donnell, Attorney of the Board, to render all possible assistance. The question of the liability of Chas. A. Whitney &Co. and of Alfred Moulton, for past quarantine fees, should be thoroughly investigated, as well as the ability of the Board to remove their former injunctions. Respectfully, your obedient servant, JOSEPH JONES, M. D., President Board of Health, State of Louisiana. OFFICE BOARD OF HEALTH, STATE OF LOUISIANA. ? New Orleans, December 17, 1881. 5 Dr. Joseph Jones, President Board of Health: Sir-In reply to your request concerning the injunction suits against the Board brought by certain ship- ping men some years since, I would offer the accompanying copies from the minutes. I learn from C. S. Rice, Esq., former Attorney of the Board, that the following cases were entered in the United States Circuit Court in this city : Charles Morgan vs. Board of Health, No. 7236, in 1874. John H. Clarke et als. vs. Board of Health, No. 7241. in 1874. C. H. Mallory et als. vs. Board of Health, No. 7268. September 11, 1874. Fred Baker vs. Board of Health, No. 7267, September 11, 1874, In these cases judgment was rendered pro confesso, no defense having been set up by the Board. I have written to Mr. F. A. Woolfley, Clerk of this Court, to ascertain whether nnal judgment lias been pronounced in the above, and he has promised to send an answer, but none has yet come. Messrs. Poitevent & Favre also applied for and obtained an injunction from the Superior District Court in 1874, restraining the Board of Health from the collection of quarantine fees. 1 have asked Mr. O'Donnell, our attorney, to aid in ascertaining the legal status of these suits, aud hope he will soon report to you. if he has not already done so. Respectfully, your obedient servant, S. S. HERRICK, M. D.; Secretary Board of Health. 16 CXXX History of Quarantine in Louisiana. EXTRACTS FROM MINUTES OF THE BOARD OF HEALTH RELATIVE TO RE- SISTANCE TO PAYMENT OF QUARANTINE FEES. NEW ORLEANS, May 20, 1874. Dr. C. B. White, President, in the chair. The President stated that the object of the meeting was to consider the injunction brought against the Board by Charles Morgan, restraining the Board from exercising the provisions of the acts of quarantine, approved March 15, 1855, and the amendment thereto, against the steamers owned and controlled by Charles Morgan, Upon consultation, ths Board agreed to test the legality of the injunction. Upon motion by Mr. Burwell, seconded by Mr. Heath, it was resolved that the President of the Board be advmed to take such action, after consultation with the attorney of the Board, C. S. Rice, Esq., as may seem necessary to be taken in the premises. NEW ORLEANS, August 16, 1877. Dr. Samuel Choppin, President in the chair. A letter was read from the Attorneys of the Board (Kennedy & Austin) in reference to the collection of quarantine fees at the Atchafalaya Station. • Col. Hardee moved that the attorneys of the board be authorized to make a test case, and to employ counsel at Morgan City. NEW ORLEANS, September 27, 1877. Dr. Samual Choppin, President, in the chair. Major Austin, attorney of the board, was called upon to express his opinion relative to the decision re- cently rendered in the suits for collection of dues at Quarantine Stations. He urged the necessity of push- ing the collection of these dues, as owners of vessels had been exceedingly lax in their settlements. I hereby certify that the above are true copies. S. S. HERRICK. M. D., Secretary Board of Health. COMMITTEE ON LEGISLATION. OFFICE BOARD OF HEALTH, STATE OF LOUISIANA, ) State-House, New Orleans, December 12, 1882. 5 Hon- I. N. Marks, Member Board of Health, State of Louisiana: Dear Sir-I have the honor to appoint you a member of the Committee on Legislation; said committee has not been organized at an earlier date from causes well known to yourself. It is important that the subject-matter of the resolution of Mr. Booth should be attended to, but it is of paramount importance to the welfare of the State of Louisisiana and the existence of the entire quarantine system, that the enclosed communication from the New Orleans Maritime Association should receive im- mediate and thorough attention. I have already explained this matter fully to one of the leading members of this association, but the explanation availed nothing with men who are determined to resist the law, and thereby avoid payment of the just quarantine dues established by the Legislature of Louisiana, and are willing to break down every barrier against the importation of foreign pestilence, and to utterly destroy at once the health and the commercial prosperity of the State. As former Chairman of the Finance Committee, it is well known to you that tho statements of these gen- tlemen are entirely incorrect. No distinction has been made in favor of any one line. Whitney & Co. (formerly Morgan & Co.) have for years resisted the collection «f quarantine'fees imposed by the Legislature of Louisiana, and obtained an injunction against the Board of Health for the collection of these fees- One other line has also, in like manner, resorted to the courts of justice. No distinction has ever been made by the Board of Health, or by the Finance Committee, or by the President, during my term of service, except that which has been forced by legal proceedings by the parties before named. The statement that the fees are illegally collected is erroneous. The Quarantine Physician collects them according to the following acts of the Legislature : It is also unjust to state that the quarantine fees are heavier here than in any other port in the United States. The gronnd upon which the decision was rendered against the Board of Health was, that our quar- antine system instituted a tax on tonnage. In my opinion, it does not constitute a tax on tonnage, but we need legal advice on this subject. You know very well how much assistance I have received in this-respect during my term of service as President of the Board. I would respectfully suggest that the President of the Board of Health be empowered, immediately, to employ an active and learned legal adviser. The Committee on Legislation, of which the President of the Board of Health is Chairman, should, at the earliest practicable moment, agree upon a definite line of action. With kind regard, truly yours, JOSEPH JONES, M. D., President Board of Health, State of Louisiana. The opening of the great State of Texas to railroad trade and traffic, and the vast movement of grain and cattle inaugurated during the past three years, inspire all good and true citizens with renewed hopes of a brighter future, and solemnly warn the mem- bers of the General Assembly that the welfare of millions will be involved in the manner in which they may devise and execute the quarantine and sanitary laws for the exclu- sion of foreign pestilence from the Mississippi Valley. It is natural that men engaged in a special branch of business should be influenced by their interests and prejudices, and be incapable of judging impartially and reasoning accurately about those matters which relate to the health and welfare of the people, irrespective «f trades, callings and professions. History of Quarantine in Louisiana : Joseph Jones, M. D. CXXXI In order to demonstrate that the proposed act to fix and regulate fees at the Missis- sippi Quarantine Station, etc., is not prejudicial to the commerce of New Orleans, and is not subversive of the best interests of Louisiana, and does not impose heavy additional charges on commerce, we will consider these questions in their broad relations to the remarkable political changes and revolutions, and epidemic visitations, which charac- terized this city and State. I-PROGRESS OF COMMERCE AND POPULATION IN LOUISIANA DURING THE FRENCH DOMINATION, 1684-1763, WHEN NO QUARANTINE EXISTED. For nearly a quarter of a century the French colonists endured a miserable existence, and nearly perished by starvation and disease on the barren sands of Ship Island and the adjacent coast, within and around Biloxi.* A new era of prosperity and hope dawned when, in the spring of 1718, Bienville se- lected a site for a town on the banks of the Mississippi, and placed fifty men to clear off the ground for the location of the future capital of the province. Next spring the river overflowed its banks, the new settlement was completely inundated, and the site seemed to present an uncertain location for a city, and New Orleans remained for several years little better than a military post. In the beginning of August, 1723, Bienville removed his headqnartars to New Orleans. In 1729 the white population of Louisiana, says La Harpe, amounted to about 1700 souls, and the black population to 3300.1 *A vessel from Havana, laden with provisions, brandy and tobacco, came early in January, 1709, to trade with the Colony of Louisiana. This was the first instance, ten years after the arrival of the French in Louisiana, of a vessel coming to trade with them. In 1713, there were in Louisiana two companies of infantry, of fifty men each, and seventy-five Canadian volunteers i« the King's pay. The rest or the population consisted of twenty-eight families, one-half of whom were engaged, not in agriculture, but horticulture; the heads of the others were shop and tavern- keepers, or employed in mechanical occupations. A number of individuals derived their support by minis- tering to the wants of the troops. There were but twenty-three negroes in the colony; adding to these, king's officer and clergy, the aggregate amount of the population was 380 persons. A few Indians and children were domesticated in the houses of the white people, and groups of the males were incessantly sauntering or encamping around them. The collection of these individuals into one compact spot could have claimed no higher appellation than that of a hamlet; yet they were dispersed through a vast extent of country, the parts of which were sep- arated by the sea, by lakes and wide rivers. Five forts, or large batteries, had been erected for the protection of Mobile, Biloxi, on the Mississippi, and at Ship and Dauphine Islands. Lumber, hides and peltries constituted the objects of exportation which the colony presented to com- merce. Lumber was easily obtained around the settlement of Biloxi. After the year 1709, vessels from St. Domingo and Martinique brought sugar, coffee molasses and rum to Louisiana, and took its peltries, hides and lumber in exchange. The colonists procured some specie from the garrison of Pensacola, whom they supplied with vegetable and fowls. tfhose who followed this sort of trade, by furnishing also the officers and troops, obtained flour and salt provisions from the King's stores, which were abundantly supplied from France and Vera Cruz. Trifling, bnt successful essays, had shown that indigo, tobacco and cotton could be cultivated to great advantage; but hands were wanting. Experience had shown that the frequent and heavy mists and fogs were unfavorable to the culture of wheat, by causing it to rust. t Louis the Fourteenth, in the charter which he granted Crozat, bearing date September 26, 1712, an- nounced that the attention the King had always given to the interests and commerce of his subjects, in- duced him, notwithstanding the almost continued wars he was obliged to sustain, since the beginning of his reign, to seek every opportunity of increasing and extending the trade of his colonies in America; that, accordingly, he had, in 1683, given orders for exploring the territory of the northern continent, be- tween New France and New Mexico ; and Lasalle, who had been employed in this service, had succeeded so far as to leave no doubt of the facility of opening a communication between Canada and the Gulf of Mexico, through the large livers that flow in the intermediate space, which had induced the King, immediately after the peace of Riswick, to send thither a colony and maintain a garrison, to keep up the possessions taken in 1683, of the territory on the Gulf, between Carolina on the east, and Old and New Mexico on the west. But, war, havin g broke out soon after in Europe, he had not been able to draw from this colony the ad- vantages he had anticipated, because the merchants of the kingdom, engaged in maritime commerce, had relations and concerns in the other French colonies, which they could not relinquish. The King declared that, on the report made to him of the situation of the territory now known as the province of Louisiana, he had determined to establish there a commerce which will be very beneficial to France, it being now necessary to seek in foreign countries many articles of commerce, which may be ob- tained there, for merchandise of the growth or manufacture of the kingdom. The King of France accordingly granted to Crozat the exclusive commerce of all the territory possessed by the Crown between Old and New Mexico and Carolina, and all the settlements, ports, roads and rivers therein-principally the port and road of Dauphine Island, before called Massacre Island ; the river St. Louis, previously called the Mississippi, from the sea to the Illinois ; the river St. Philip, before called Mis- souri; the river St. Jerome, before called the Wabash, with all the land, lakes and rivers mediately or im- mediately flowing into any part of the river St. Louis or Mississippi. The territory, thus described, is to be and remain included, under the style of the government of Louisi- ana, and to be a dependence of the government of New France, to which it is to be subordinate. The King's territory, beyond the Illinois, is to be and continue a part of the government of New France, to which it is annexed; and he reserves to himself the faculty of enlarging that of Louisiana. The right is given to the grantee to export from France into Louisiana all kinds of goods, wares and merchandise during fifteen years, and to carry on there such a commerce as he may think fit. All persons natural or corporate, are inhibited from trading there, under pain of the confiscation of their goods, wares, merchandise and vessels ; and the officers of the King are commanded to assist the grantee, his agents and factors in seizing them. The faculty is allowed him to send annually a vessel to Guinea, for negroes, whom he may sell in Louisi- ana, to the exclusion of all others. CXXXII History of Quarantine in Louisiana: Joseph Jones, M. D. The French had been unfortunate in the selection of the places they had occupied. The sandy coast of Biloxi is as sterile as the desert of Arabia. The stunted shrubs of Ship and Dauphine Islands announced the poverty of the soil by which they are nurtured. Shortly after the settlement of Louisiana, Iberville, finding from Bienville's report that the English meditated an establishment on the Mississippi, determined on effecting one immediately. He departed for that purpose in the smallest vessel, with fifty Canadians, on the 17th of January, 1700, having sent Bien- ville, by the lakes, to the Bayagoulas, to procure guides to some spot in the lower part of the river secure from the inundation. They led him to an elevated one, at the distance of fifty-four miles from the sea, where Iberville met them soon after, and the building of a fort was immediately begun. In this contracted spot, on which Sauvolle had located his brother on the Mississippi, the few soldiers under him, insulated during part of the year, had the mighty stream to combat. The buzz and sting of the mosquitoes, the hissing of the snakes, the croaking of the frogs and the cries of the alligators, incessantly asserted that the lease the God of Nature had given these reptiles of this part of the country had still a few centuries to run. The settlement near the fort at Mobile suffered much in the spring of 1711 from the overflowing of the river; and, in consequence of which, at the recommendation of d'Artaguette, the spot was abandoned, and a new fort was built higher up, which, till a late day, stood immediately below the present city of Mobile. In the barrens around this new fort of Mobile, the continual suah of the needle-leaved tree seemed to warn d'Artaguette that his people must recede fruther from the sea before they came to good laud. Whilst it is true, during the first thirteen years war had in some measure checked the prosperity of the Colony of Louisiana, although during this period, with the exception of the descent of the crew of a priva- teer from Jamaica, no act of hostility was committed by an enemy within the colony; but the incessant erup- tions on the land of the Indians, under the protection of Louisiana, by those in alliance with Carolina, pre- vented the extension of the commerce and settlement of the French toward the north. Yet all these difficul- ties would have b*en promptly overcome, if agriculture had been attended to. The coast of the sea abounded with shell and other fish; the lagoons near Mobile River were crowded with water fowls; the forest teemed with deer , the prairies with buffaloes, and the air with wild turkeys. By cutting down the lofty pine trees around the fort, the colonists would have uncovered a soil abundantly producing corn and peas. By abandoning the forts on the Mississippi, Ship and Dauphine Islands, and at the Biloxi, the necessary military duties would have left a considerable number of individuals to the labors of tillage; especially if prudence had spared frequent divisions of them to travel for thousands of miles in quest of ochres and min- erals, or in the discovery of distant land, while that which was occupied was suffered to remain unpro- ductive, Martin, vol. 1, p. XTl. The charter of the Western Company was registered in the Parliament of Paris, on the seventh of September, 1717; the exclusive commerce of Louisiana was granted to it, for twenty-five years, and all the King's subjects as well as corporate bodies and aliens, were allowed to take shares in it. All the other subjects of the King of Prance were prohib- ited from trading to Louisiana, under the penalty of the confiscation of their merchan- dise and vessels, but this was not intended to prevent the inhabitants from trading among themselves or with the Indians. The lands, coasts, harbors and islands in Louis- iana were granted to the Western Company, as they had been to Crozat; it was author- ized to make treaties with the Indians and to declare and prosecute war against them in case of insult; and the property of all Mexico was granted to it without payment of any duty whatever. The faculty was given to it to grant lands, erect forts, levy troops, and recruits even in France ; it was authorized to nominate the governor and the officers commanding the troops ; and power was given to fit out ships of war and cast cannon, and to appoint and remove judges and officers of justice. French vessels and crews alone were employed by the Western Company ; and the King transferred to it all the forts, magazines, guns, ammunition, vessels, boats, pro- visions, in Louisiana, with all merchandise surrendered by Crozat. The company en- gaged to bring in, during its privilege, six thousand white persons and three thousand negroes. The Western Company, to whom the exclusive commerce or Louisiana had been granted for twenty-five years, from the first of January, 1717, until the last of the year 1742, after lasting about fourteen years, finding themselves disappointed in the hope they had entertained of the profits- of their commerce, and the advantages they had imagined would result from the charter; alarmed at the great loss they had sustained at the Natchez, and the great expense necessary to be incurred in the protection and defense or the province, solicited, on the twenty-second of January, 1732, the King's leave to surrender the country and their charter. By an arrest of the council of the following day, ami letters patent, which issued therein, on the tenth of April, the retro- cession made by the company of the property, lordship and jurisdiction of the province ot Louisiana and its dependencies, together with the country of the Illinois, and the exclusive commerce to these places was accepted. The arrest declares the commerce of the retroceded countries free for the future to all the King's subjects. When the Western Company received its charter, the settlements in the wide, extended country ceded to it were confined to a very narrow space at the Biloxi, Mobile River Ship and Dauphine Islands. Two very small fortifications had been erected on the Mississippi-the one near the sea, the other at the Natchez, and one at Natchitoches on Commerce was Crozat's principal object and he contemplated carrying it on chiefly with the Spaniards His plan was to have large warehouses on Dauphine Island, and to keep small vessels'plying with goods to Pensacola, Tampico, Tuespe, Campeachy ana Vera Cruz. His designs, however, were frustrated the Spaniards, after the peace, refusing admittance to French vessels in those ports, on the solicitation of the British, to whom the King had granted privilege by the treaty of the Assiento. History of Quarantine in Louisiana, Joseph Jones, M. D. CXXXIII Red River. Agriculture had hardly reared its head, though rice was sowed in the swamps. Horticulture supplied the tables of a few with vegetables, and enabled some of the rest to procure a little money by supplying the Spaniards at Pensacola. When the Western Company resigned its charter, all the original settlements had con- siderably extended their limits, and a new one had been formed at the Alibamons. New Orleans was founded. Although there was no plantation below it a considerable one, with a gang of upwards of one hundred slaves, had been formed opposite the city, and there were many smaller, but still considerable ones, at Tchoupitoulas and Cannes Bruises. A vast number of handsome cottages lined both sides of the river at the Ger- man coast; grantees of wide tracts had transported a white population, and sent negroes to Manchac. Baton Rouge and Pointe Couple, and a settlement had arisen at Natchez, the rival of New Orleans; small colonies had gone to the Yazous and Arkansas, while others had descended from Canada to the Wabash and Illinois. The culture of indigo and tobacco had been added to that of rice. The forests yielded timber for various uses and exportation. Wheat and flour came down from the Illinois. Trade was carried on with the Indians at Natchitoches, Mobile, Alibamons and the Cadadoquois, far beyond the western most limits of the present State. Provision had been made for the regular administration of justice ; churches and chapels had been built at convenient distances, and without, perhaps, any exception, every set- tlement had its clergyman, under the superintendence of a vicar-general of the Bishop of Quebec, of whose diocese Louisiana made a part. A convent had been built, the nuns of which attended to the relief of the sick of the garrison, and to the education of the young persons of their sex. The monopoly which the company and Crozat had enjoyed and strictly enforced, had checked, and it may be said, destroyed the incipient trade the colony had before the peace of Utrecht; but the produce of the tilled land and the forest, the hides, skins, furs and peltries, which were obtained from the Indians for goods which were easily pro- cured in the company warehouses at the Biloxi, New Orleans, the Natchez and the Illi- nois, and which were disposed of at an enormous advance, enabled the company to dis- pose of considerable quantities of merchandise. The white population was raised from seven hundred to upwards of five thousand, and the black from twenty to two thousand. The Crown, through Salmon, the King's Commissioner, received possession of Louis- iana, and purchased all the property of the Western Company in the province, the ap- praised inventory of which-amounted to two hundred and sixty-three thousand livres, not equal in value to sixty thousand dollars. The propeity of the Western Company consisted of some goods in the warehouses, a plantation opposite the city, which was partly improved as a brickyard, in which were two hundred and sixty negroes, fourteen horses and eighty thousand barrels of rice. The negroes were valued at an average of seven hundred livres, or one hundred and sixty-three dollars and a third; the horses at fifty-seven'livres, or twelve and a half dol- lars, and the rice three livres, or sixty cents and a third the hundred weight. At these prices nineteen hundred weight of rice were given for a horse ; at the present value of rice (four cents a pound), the animal was worth seventy-six dollars, and the negro nearly one thousand dollars. The commerce of Louisiana, released from the restraint of the exclusive privilege of the company, now began to thrive. Indigo was cultivated to a considerable extent, and with much success, and with rice and tobacco, afforded easy means of remittance to Europe, while lumber found a market in the West India Islands. Important additions were made to the inhabitants by immi- grants, and more especially by the unfortunate Acadians. We have no precise data as to the actual population of the Province of Louisiana at the time of the cession of Louisiana to Spain, on the thirty-first of November, 1763; but according to a census of the inhabitants of the province, which was taken by direction of the first Spanish Governor, Don Antonio de Ulloa, it appears that there were one thousand eight hundred and ninety-three men fit to bear arms ; one thousand forty-four marriageable women ; one thousand three hundred and seventy-five boys, and one thou- sand two hundred and forty-four girls; in all, five thousand five hundred and fifty-six white individuals. The blacks were nearly as numerous. If the history of Louisiana be viewed in connection with its commercial and agricul- tural development, during the French rule, extending from the settlement on Matagorda Bay by La Salle, in 1684, to the treaty of Paris, in 1763, when France ceded to Spain and England her possessions in North America, during which entire period not a single quarantine restriction was imposed on commerce, we arrive at the following conclusions: (a). Under the French Government the growth of the population of Louisiana was very slow. According to a census of the inhabitants of the province, three years after the treaty of Paris, it had 1893 men fit to carry arms, 1044 marriageable women, 1375 boys, 1244 girls-in all 5556 whites. The blacks were nearly as numerous. The entire population of the province at the end of eighty years did not exceed 12,000. CXXXIV History of Quarantine in Louisiana: Joseph Jones, M. D. The growth of New Orleans had been very slow, and in fifty-one years after its foun' dation the population amounted to only 3190 persons, of all colors, sexes and ages; and of this number 1265 were slaves. The number of houses was only 468, and the greatest part of them were in the third and fourth streets from the river. The commerce of New Orleans, and the province generally was exceedingly limited during the French domina- tion. Thus the exports of the province, during the last year of its subjection to France, was as follows: Indigo $100,000 DeerSkins 80,000 Lunber 50,000 Naval Stores 12,000 Rice, Peas and Beans 4,000 Tallow 4,000 $250,000 Ab interlope trade with the Spanish Colonies took away goods worth.. 60,000 The Colonial Treasury gave bills on Government in France for 300,000 The province afforded means of remittance for $670,000 Few merchant vessels came from France, but the Island of Hispaniola carried on a trade with New Orleans, and some vessels came from Martinico. King's vessels brought whatever was necessary for the troops and goods for the Indian trade. The indigo of Louisiana was greatly inferior to that of Hispaniola, the planters being quite unskillful and inattentive in the manufacture; that of sugar had been abandoned, bet some lanters near New Orleans raised a few canes for the market. The navigation of the Mississippi from the Gulf to New Orleans was very tedious before the introduction of steam, and often occupied one month. The commerce of the city was very limited during the French rule. It is probable that La Salle and his men suffered with yellow fever in the West Indies as early as 1684, and they appear to have brought the yellow fever with them to the shores of the Gulf of Mexico. The next visitations of yellow fever were at Biloxi in 1701 and 1704. Iberville and 809 of his men died of yellow fever in the West Indies in 1706. The historian, Le Page du Pratz, states that six weeks before his arrival at Cape Francois, St. Domingo, in 1718, 1500 persons died of a distemper called the Siam disease, which was one of the French names for yellow fever. It is probable that yellow fever caused the great mortality among the troops and con- victs in 1718 on board the French ship, which had lost its reckoning and missed its des- tination, and passed to the west of the mouth of the Mississippi. As early as 1726, eight years after the foundation of New Orleans, the s'evere fevers of the summer and autumn attracted the attention of the government. The force which Bienville assembled in 1736 for the subjugation of the Chickasaws consisted of upwards of 1200 whites and double that number of Indians and black troops. This comparatively large army unaccountably spent six months in making preparations for its march. In the meantime, the troops lately out from France became unhealthy, many died, and the climate had an almost equally deleterious effect on those from Canada. In the Chickasaw war peace was purchased at the price of many valuable lives, estimated at 500, out of 1200 white troops not slain in battle, but destroyed by fevers of the climate. Experience having shown that European troops could not stand the labors in the field, but sickened and died under the burning sun of Louisiana and the chilling fogs of night, the Western Company was, therefore, compelled to introduce African negroes to cultivate the plantations scattered along the bayous and rivers of the delta of the Mis- sissippi, and for several years it furnished the agricultural interests of the colony with several hundred annually-which was the origin of slavery in Louisiana. We have failed to discover in the writings of La Harpe, Du Pratz, Charlevois, Martin, Gayarre and others, any facts sustaining the views advanced by some, that yellow fever was first imported into Louisiana during the French domination by the slave ships. The mortality on these ships was frightful, and was chiefly occasioned by bad diet, starvation, crowding, foul air, scurvy, diarrhea and dysentery. NEW ORLEANS, February 26, 1884. Dr. Joseph Jones, corner of Camp and Washington, city: Jfy Dear Sir--In a relation of the voyage of the Ursulines from Ronen to New Orleans, published in 1872, by Gabriel Gravier, a member of the Historical Societies of France and Normandy, and Secretary of the " Society of the Bibliophiles de Rouen," I have seen for the first time that Lawvoile died of yellow fever, in 1701. at the fort of Biloxi, I doubt the correctness of the statement, for in the numerous French docu- n'ents which I have examined nothing of the kind is mentioned. I take it for granted that the author re- sides in Rouen. He might be written to with a view of ascertaining on what authority his statement is based. Fer greater security, the letter to him might be addressed care of the publishers, Messrs. Maison- neuve & Co., Paris, Quai Voltaire, No. 15. Yours faithfully, CHARLES GAYARRt. Hospital Street, No. 121, Near Dauphine. History of Quarantine in Louisiana : Joseph Jones, M. D. CXXXV II-PROGRESS OF COMMERCE AND POPULATION AND OUTLINE OF EPI- DEMIC VISITATIONS IN LOUISIANA DURING THE SPANISH DOMINATION 1763-1802, IN WHICH PERIOD THE PROVINCE WAS WITHOUT QUARAN- TINE RESTRICTIONS AND LAWS. New Orleans during both French and Spanish rule, was without quarantine regula- tions and an organized board of health. That the commercial relations of New Orleans were considerably extended under the Spanish rule, is evident from the fact that in 1802, 258 vessels with a tonnage of 23,725 tons, entered the Mississippi; and during the same year, there sailedfrom the Mississippi 265 vessels with a tonnage of 31,241 tons. The rapid increase of the population of New Orleans under the Spanish rule, and the great influx of strangers from the United States, from Spain, from Arcadia and the Canary Islands, formed a most important condition for the spread of yellow fever when once introduced. In 1769, the total population of Louisiana amounted to 13,538, and that of New Or- leans to 3190, while in 1803, total population of the province 49,473, and of New Or- leans 8056; during the short period of thirty-four years the population had increased tenfold. The fall of 1765 was very sickly in New Orleans as well as that of 1766, when the population of the city was reduced by an epidemic which is said to have closely resem- bled yellow fever. Yellow fever prevailed in Mobile in 1765, and according to Bernard Romans, was brought there by a regiment from Jamaica. The author, when describing the disease of the Floridas, says: "I am persuaded that where the yellow fever has made its appearance in the Floridas, it was imported from Jamaica or Havana, as was the case in 1765." Romans says that "the first visitation of yellow fever was in 1769. Since that time it has continued to be an almost annual scourge. It was intro- duced into this continent in the above year by a British vessel from the coast of Africa with a cargo of slaves. Dr. Thomas fixes the first visitation of yellow fever in New Orleans in 1796, or about twenty years later. The army of 1400 men assembled by Galvez for an expedition against the English suffered considerable loss from the fevers incident to the climate. Dr. Daniel Drake, who visited New Orleans and instituted personal inquiries, states that the first invasion of yellow fever of which we have an authentic account was in the year 1791. Dr. Drake's informant, Richard Relf, Esq., was one of the most venera- ble citizens of New Orleans. On the ninth of May, 1794, Don Francisco Louis Hector, Baron de Carondelet, com- menced the excavation of what is now known as the Old Canal Basin for the purpose of draining the stagnant water of the city and environs into the Bayou St. John, which he regarded as the cause of the epidemics which were so fatal to the prosperity of New Orleans. The great sanitary problem of New Orleans-drainage-engaged the attention of its governors for seventy-four years before the practical and valuable experiment of Baron Carondelet. New Orleans was severely afflicted with yellow fever in the fall of 1796. In 1787 the population of New Orleans was 5384, with a total mortality of 338, one death in 15.04 inhabitants, a ratio per 1,000 inhabitants of 63.92. In 1796 the population of New Orleans was 8756, with a total mortality of 638, one death in 13 57 inhabitants, add 72.86 per 1000. In 1787, when there was no record of an epidemic in New Orleans, the mortality reached the proportion of one in fifteen of the inhabitants, and in 1796 this heavy mortality was still further increased by the yellow fever, to one death in 13.7 inhabitants. The mor- tality of both these years, 1687 and 1796, was in relation to the actual population, far heavier than that of the year 1878, which is memorable for its epidemic of yellow fever, and which stands as third in the list of great epidemics in New Orleans, from its founda- tion in 1718 to the present time. The total mortality for 1878 was 10,318, or one death in twenty inhabitants, or 50.17 per 1000. There are authentic works to show that yellow fever prevailed, or was present in New Orleans in 1794, 1795, 1796, 1797, 1798, 1799, 1801, 1802, 1803. In the light of such facts, it is but just to hold the view that New Orleans has been subject to pestilential fevers at various times since its foundation, and that the opinions as to its wonderful health- fulness from its foundation to 1796 are without foundation in fact. As the yellow fever, more especially during the latter portion of the Spanish rule, duiing which period the commercial relations with the United States extended, attacked chiefly Americans; and as yellow fever ravaged during this period Philadelphia and New York, the contagionists of New Orleans accused the Americans of introducing the disease. The foreign importation of yellow fever during the Spanish domination was referred to increased commercial relations. CXXXVI History of Quarantine in Louisiana: Joseph Jones, M. D. No quarantine restrictions were imposed upon the commerce of New Orleans during the Spanish and French dominions; under the former the progress of the colony was slow ; under the latter the increase of commerce and population was more marked. Therefore, during the first century of the existence of the colony of Louisiana, quaran- tine did not enter as an element for the exclusion of foreign pestilence, or for the ad- vancement or destruction of commerce. Ill-PROGRESS OF COMMERCE AND POPULATION, AND OUTLINE OF EPl' DEMIC VISITATIONS IN LOUISIANA DURING THE AMERICAN DOMINATION, 1803-1882, IN WHICH QUARANTINE HAS BEEN ESTABLISHED AND MAIN- TAINED AT VARIOUS PERIODS. On the twentieth of December, 1803, the United States Commissioners and forces entered New Orleans and took possession of Louisiana, in accordance with the treaty between Napoleon Bonaparte and the government of the United States. In 1801 the yellow fever had, in the autumn, been very fatal in New Orleans, and in connection with other remarks on the subject, Governor Claiborne, iu a message to the Legislative Council, on the seventeenth of December, 1804, called attention of that body to a plan devised by President Thomas Jefferson, to prevent the recurrence of such a calamity. Jefferson expressed the opinion that in building cities in the United States the people should take the checker board for their plan, leaving the white squares open and unbuilt forever and planted with trees.* Unfortunately the plan of Jefferson did not meet with favor in the gradual enlargement of New Orleans. Louisiana was purchased by the United States from France by treaty, April 30, 1803> for about $15,000,000. In 1811, it was admitted into the Union ; and this year is also memorable for the building of the first steamboat at Pittsburg. At that time, the quantity of land within the State, adapted to the cultivation of the three staples, was es- timated as follows: Sugar, 250,000 acres ; rice, 250,000; cotton, 2,400,000. The whole amount of sugar made in Louisiana iu 1810, was about 10,000,000 pounds; iu 1814, not less than 15,000,000 ; and in 1817, 20,000,000, or nearly one-third of the whole amount consumed in the United States. Previous to the closing of Bayou Manchac by General Andrew Jackson, New Orleans was really situated on an island-the Island of Orleans-formed by the River Mississippi on one side, and the Lakes Pontchartraiu and Maurepas, together with an outlet of the Mississippi, called Iberville, on the other about 160 miles long, and from three to fifty miles broad. The Island of Orleans produced sugar cane, maize, rice, indigo, cotton and tobacco, the peach, orange, three or four species of the fig, the banana, and most culin- ary vegetables. The circumstance, however, that rendered the political and moral picture of Louisiana peculiarly distinctive was that almost the total of the production of the industry of its inhabitants flowed to one common centre. And it was boldly predicted, after the coun- try fell iuto the possession of the United States, that: ''New Orleans alone will be for- ever, as it is now, the mighty mart of the merchandise and produce brought from more than a thousand rivers. Unless prevented by some great accident in human affairs, this rapidly increasing city will, in no distant time, leave the emporia of the Eastern world * Jteferring to the probable growth of New Orleans, the President said : "The position of New Orleans certainly destines it to be the greatest city the world Has ever seen. There is no spot on the globe to which the produce of so great an extent of fertile country must necessarily come1 It is three times greater than that on the eastern side of the Alleghanies, which is to be divided among all the seaport towns of the Atlantic States. There is also no spot where yellow fever is so much to be appre- hended. In the middle and northern parts of Europe, where the sun "rarely shines, they may safely build cities in solid blocks, without generating disease ; but under the cloudless skies of America, where there is so constant an accumulation of heat, men cannot be piled one on another with impunity. Accordingly we find this disease confined to the solid built parts of our towns, and the part on the water side, where there is the most matter for putrefaction, but rarely extending into the thin built parts ot the towns, and never into the country. In these latter places, it cannot be communicated. In order to catch it, you must go into the local atmosphere, where it prevails. Is not this then a strong indication that we ought not to contend with the law of nature, but should decide at once that all our cities should be thinly built?" After these introductory observations, the President expressed the opinion that in building cities, in the United States, the people' should take the checker-board for their plan, leaving the white squares open and unbuilt forever, and planted with trees. " As it is probable," he observed to Claiborne, ' that New Orleans must soon be enlarged, I enclose this same plan for consideration. I have great confidence that however the yellow fever may prevail in the old part of the town, it would not be communicated to that part which should be built on this plan, because this would be like the thin built parts of our towns, where experience has taught that a person may carry it after catching it in its local region, but can never communicate it out of that. Having very sincerely at heart that the prosperity of New Orleans should be uncheckercd and great faith founded, I think, on experience, in the effect of this mode of building against a disorder which is such a scourge to our close-built cities, I could not deny myself the communication of the plan, leaving it to you to bring into real existence, if those more interested should think as favorabiy of it as I do. For beauty, pleasure and commerce, it would certainly be eminent."-Executive Journal, vol. 1, p. 57. Hilsory of Louisiana, The American Domination: Charles Gayarre, 1866: pp. 36-37. History of Quarantine in Louisiana: Joseph Jones, M. D. CXXXVII far behind. With Boston, New York, Philadelphia and Baltimore on the left, Mexico on the right, Havana in front, and the immense Valley of the Mississippi in the rear, no such position for the accumulation and perpetuity of wealth and power ever existed." Nearly three-quarters of a century ago Mr. Darby said: "By repeated admeasurement upon the best constructed maps the Mississippi River and its tributary streams ^rain more than 1,400,000 square miles. If this expanse was peopled only equal to Connecti- cut, in ,1810, or about sixty persons to each square mile, the aggregate would be 84,000,000. It cannot be rashness to assert, if the present order of things continues to operate, that, at a period not more than two centuries distant, more than 100,000,000 of human beings will send the surplus fruits of their labor to New Orleans.* On the twentieth of December, 1803, the United States commissioners and forces en- tered New Orleans and took possession of Louisiana, in accordance with the treaty be- tween Napoleon Bonaparte and the government of the United States. ' In 1803, New Orleans had a military hospital and a charity hospital, with a few houses, yielding to it a revenue of about $1500 a year, t In 1802, two hundred and sixty-eight vessels (170 American, 97 Spanish and 1 French) of all kinds, with a tonnage of 23,725 tons, entered the Mississippi, eighteen of which were public armed vessels. In the same year, there sailed from the Mississippi 265 vessels (158 American, 104 Spanish, 5 French) with a tonnage of 31,241 registered tons. All the land on both sides of the Mississippi, from fifty miles below the city to Baton Rouge, had been granted to the depth of forty arpents, or one mile and a half, which is the depth of all original grants. Some had double and others treble grants, that is to say, a depth of eighty or one hundred arpents. A few grants extended as far as the sea, or a lake behind them. In other parts of the country the people, being generally set- tled on the banks of a river or creek, had a front of from six to forty arpents, and the grant generally expressed a depth of forty arpents. No authentic census of the inhabitants of the province since that of 1788 is extant, but one made for the Department of State, by the Consul of the United States at New Orleans, from the best documents he could procure in 1803, presents the following re- sults : In the city of New Orleans, 8056 ; from the Balize to the city, 2388 ; at Terre-aux- Bceufs, 661; Bayou St.John and Gentilly, 488; Barataria, 101; Tchoupitoulas, 7444; parish of St. Charles, 2421; St.John the Baptist, 1950; St. James, 2200, Lafourche, 3098; Valenzuela, 1057; Iberville, 1300; Galvez (town), 247; Baton Rouge, 1513; Pointe Couple. 2150 ; Attakapas, 1447; Opelousas, 2470; Washita, 361; Avoyelles, 432 ; Rapi- des, 753 ; Natchitoches, 1631; Arkansas, 368 ; Illinois and St. Louis, etc., 6028 ; Mobile, 810 ; Pensacola, 404 ; grand total, 49,473. The annual produce of the province was supposed to consist of 3000 pounds of indigo, rapidly declining; 20,000 bales of cotton, of 300 pounds each; 5000 hogsheads of sugar, of 1000 pounds each , 5000 casks of molasses, of 50 gallons each. There were but few domestic manufactures. The Acadians wrought some cotton into quilts and homespun, and in the more remote parts of the province, the poorer kind of people spun and wove wool mixed with cotton into coarse cloth. There "was a machine for spinning cotton in the parish of Iberville, and another in Opelousas, but neither was much employed. In New Orleans, there was a considerable manufacture of cordage, and a few small ones of hair powder, vermicelli and shot. There were near the city about a dozen distilleries, in which about four thousand casks of tatfa, of fifty gallons each, were made, and a sugar refinery, which produced about 200,000 pounds of loaf sugar. 1805-In July, 1805, after James Pitot had resigned his commission as Mayor, and Watkins had been appointed in his place, tbe new City Council went actively to work and to plan improvements. It passed resolutions requesting the evacuation of the forts around the city, which were occupied by the troops of the United States, their speedy destruction, and the filling up of the ditches, which surrounded the forts of New Or- leans. Claiborne partially complied with their request. In a communication of the *New Orleans is distant, by water, from the English Turn, 13 miles; Fort St. Philip, 70; Balize 102; the bar and sea, 105 ; Fort St. John, 5; Fort Petites Coquilles, 19 ; Mobile and Blakely, 164 ; Madisonville, over the Lake, 57 ; Natchez, 310 ; Bayou Sara, 160 ; Opelousas Church, 220 ; Natchitoches, 417 ; Hot Springs of Oua- chita, 645; Alexandria, 344, Mouth of the Ohio, 1050, Falls of Ohio, 1490, Pittsburg, about 1900; St. Louis, 1180 ; and the mouth of the Columbia River by St. Louis, 4700. By Land-Natchez, by Madisonville, 156; and by way of Baton Rouge, 224 ; Fort Stephens, 252 ; Fort Stoddard, 212; Nashville, by Madisonville, 480 ; Opelousas Church, 242 ; Philadelphia, by Knoxville, 1500 ; New York, by Knoxville. 1600 ; Natchitoches, 256 ; Nacogdoches, 437; St. Antonio, 744; City of Mexico, 1549 ; and Washington City, 1233 miles. t Tn 1804, the city of New Orleans was made a port of entry and delivery, and the Bayou St. John a port of delivery. The first act of incorporation was granted to the city of New Orleans by the Legislative Council of the territory in 1805, under the style of the Mayor, Aidermen and inhabitants of the city of New Orleans. The officers are Mayor, a Recorder, fourteen Aldermen and one Treasurer. This year a branch of the United States Bank was established in New Orleans. U CXXXVIII History of Quarantine in Louisiana : Joseph Jones, M. D. second of August, he said to them: "I am strongly impressed with the opinion that the stagnant water which accumulates in the old fortifications must prove injurious to the health of the city, that I cheerfully consent to the levelling of all of them, except those of Forts St. Charles and St. Louis. These two forts are garrisoned by troops of the United States, and cannot be evacuated but in pursuance of orders emanating from the President. Desirous, however, of co-operating with the City Council in all measures which may conduce to the health of the city, I have no objection to the draining of the ditches in the vicinity of St. Charles and St. Louis, under an impression that it can be done without injury to the works." 1806-The population of Louisiana was 52,998; slaves, 23,544; free people of color, 3355; whites, 26,069; of these, at least 13,500 were natives of Louisiana, for the most part descendants of the French; about 3500 natives of the United States, and the resi- due Europeans. In the beginning of July, Claiborne departed from New Orleans, partly to avoid a residence in the city during the sickly season. County. White Males Over 21. White Males Under 21. Females of all Ages. Col'd Males, Females and Children Free Slaves. Total. Orleans 2,108 1.422 2,781 2,312 8,378 17,001 555 647 972 229 3 285 5 BAR A c ad i a 607 822 1,332 53 2 248 5 062 362 461 731 71 965 *2 590 TAfonrithft ...... ... 586 977 1 335 25 610 3 533 Point Coupfie 267 258 443 115 2,251 3'334 Attakapas . 720 877 1 333 166 1 826 4 922 Opelousas 584 771 1,104 239 P091 3,789 Rapid am 488 513 746 15 716 2 478 R atch itoch es 407 270 410 121 1 209 2 417 Ouachita 200 143 256 4 122 725 Concordia 163 182 236 5 873 1,450 Total 7,047 7,343 11.679 3,355 23,574 52,998 GENERAL CENSUS OF THE TERRITORY OF ORLEANS FOR 1806. ARRIVALS AND DEPARTURES OF VESSELS IN THE PORT OF NEW ORLEANS. Mar. 1807 April May. June. July. Aug. Sept. Oct. Nov. Dec. Jan. 1808 Feb. Mar. Total. Arrivals, ships... 16 34 30 20 34 38 8 11 20 35 37 22 0 314 Departures, ships 20 49 44 27 26 19 10 11 14 20 51 11 8 350 Arrivals, ships... 96 106 173 44 4 2 0 0 0 5 0 0 0 340 Departures barges and keel-boats . 1 8 2 0 0 0 0 0 0 0 0 0 0 11 N, B.-According to this tableau, 316 vessels have cleared loaded with products of Louisiana or of im- ported goods. Vera Cruz and Havana had a certain number. Florida and Attakapag also. TABLE OF BIRTHS, DEATHS AND MARRIAGES IN THE CITY OF NEW ORLEANS from March, 1808, to March, 1809. Population October 30, 1808, 15,000. 1808. Births. Deaths. Marriages. Adults. Infants. W. C. W. C. W. C. W. C. April May June July Aug. Sept. Oct. Nov. Dec. • Feb. Mar. Catholic 23 24 80 2 6 16 4 4 5 9 6 8 6 9 12 14 16 16 13 9 8 6 12 12 16 1 28 4 1 2 4 1 , 0 Protestant Catholic Protestant.... 92 12 5 0 Catholic • 9 26 9 6 12 3 0 Protestant,.... t Catholic 25 61 19 5 9 2 0 Protestan t - - -. - Catholic 24 57 22 7 9 2 0 Protestant .. . .. Catholic 19 47 14 3 13 3 0 Proteatan t Catholic.... ........ 26 51 11 4 11 5 0 Protestant - - - Catholic 24 54 16 3 3 5 0 Protestant Catholic 15 22 11 3 12 1 14 2 1 1 3 2 0 Protestant Catholic ... 11 15 6 4 1 Protestant Catholic 6 16 2 5 4 Protestant .. Total • 137 319 318 286 56 109 60 8 History of Quarantine in Louisiana, Joseph Jones, M. D. CXXXIX FROM LAFON'S ANNUAIRE LOUISIANAIS OF 1809. DOCTORS AND SURGEONS OF NEW ORLEANS. J. B. Conrotte Conand R. Dow. Deveze 27 St. Donis street. 27 St. Louis street. 10 Conde street. Keene . Y. Labie G. Montegut J. Mitchel N. Robelet.... Raoul 0. Spencer St. Nudard J. Watkins 70 St. Louis street. 10 North Bourbon street. ...6 North Royal street. . 58 St. Louis street. 44 Dumaine street. 4 South Levee street. 8 Bienville street. .On the Suburbs. Bayeu St. John. W. Flood L. Fortin D. Fleitas Henderson C. Gros 32 North Bourbon street. 17 Bienville street. 23 Toulouse street. APOTHECARIES. Anfoux Blanquet Duffiloil 19 South Royal street. 22 Bienville street. 12 Toulouse street. Leonard Ferbin 5 Chartres street. 41 Chartres street. DENTISTS. Gardeth 17 North Royal street. | Roger 36 Dumaine street. 1808.-In the month of March, the City Council requested the Governor to consent to the demolishing of Fort St. Louis and the filling up of the trenches surrounding it, " inasmuch as it impeded the communication between the town and the suburb St. Mary, and the trenches were receptacles of stagnant water and ail manner of filth which en- gender disease-and the further request was that the material of said fort be left at the disnosal of the Council of the city." Claiborne consented to the first part of the request, but ordered that the material of the demolished fort be left at the disposal of the military agent of the United States who would employ them elsewhere for public levees.-Execu- tive Journal, p. 181, vol. 3; History of Louisiana, Am. Dom., Gayarre, p. 194. Between the nineteenth of May, and the thirteenth of July, 1809, thirty-four vessels arrived from the Island of Cuba, with 5797 individuals, of whom 1828 were white, 1978 free blacks or colored persons, and 1991 slaves. These people had sought a refuge in that island on the insurrection of the blacks in Hispaniola. On the second of November, 1808, the Secretary of War directed General Wilkinson to take measures, without delay, for assembling at New Orleans and its vicinity, a large portion of the regular troops, as circumstances would allow. General Wilkinson reached New Orleans on the nineteenth of April, 1809. The force which he found in the city was a little less than 2000 men, and one-third of it was on the sick list. HOPITAL DE CHARITE. L'ancien hdpital de charite fond6 par les Frangais, fut entierement detruit par Fouragan de 1779, Don An- dres Almonaster y Roxas, Colonel des Milices de cette ville. Alfards Royal, Regidor perpetual et chevalier de Saint Charles, fonda celui qui existe aujourd'hui, en l'ann6e 1786. Il le construisit entier a ses frais et depends, le meubla de tons les utensiles n6cessaires an service et sonlagement des malades, et lui legna cinq esclaves & talent, en assignant pour les rents les boutiques au riz de chausde de 1'encognure rue St. Pierre et de laLevde ; Il fit aussi reparer a ses depends cinq petites maisons, propridtd de l'ancien hdpital. H en fut nommd patron, et a son ddces ses enfants legitimes, et & defaut d'eux, les enfants de ses deux sceurs, on en cas de maladie le colonel de milices. La dotation est pour vingt-quatre lits destines des maladies qui ne soient ni incurable ni lepreux, mais pauvres et reconnus pour tels. Si quelquesautres maladies, n'dtant point rangds dans la classe des pauvres, veulent s'y faire traiter, ils sont tenus a payer une Tedevance particulidre, pour ne pas se faire prejudicier aux founds detaux. Cet fondation fut ddclarde par le monarque sous sa protection royalle immediate, sui- vant 1'instituiion et la volontd du fondateur, avec les privildges et les droits attaches au patron tat. MICHAEL ANTONIETTE LEON ARD E ADMONASTER, Patron. DON ANDRE FERNANDEZ, Majord. JUAN XIMENS, Admis. BLANQUET, Medecin. -Annuaire Louisianais pour VAnnee 1809, par B. Lafon, Ingenierie Geographe a la Nouvelle Orleans de rimprimerie de I'Auteur. He spent some time in reconnoitering the country around, in search of a spot, from which the troops might readily be brought into action, in case of an attack, and in which they might, in the meanwhile, enjoy as much health as the climate would allow. His choice fell on an elevated piece of ground on the left bank of the Mississippi, about eight miles below the city, near the point at which the road leading to the settlement of Terre-aux-Bceufs leaves that which runs along the river. The troops had hardly been three weeks encamped at Terre-aux-Bceufs when the most peremptory order from the Department of War, of the twenty-fourth of August, was received by General Wilkinson, directing him to embark his whole force, leaving only sufficient garrisons of old troops at New Orleans and Fort St. Philip, and to proceed to the high grounds in the rear of Fort Adams and Natchez. A difficulty in procuring boats, and other circumstances did not allow the troops to begin ascending the river, before the fifteenth of September ; CXL History of Quarantine in Louisiana: Joseph Jones, M. D. their progress lasted forty-seven days, during which time,out of nine hundred and thirty- seven men who embarked, six hundred and thirty-eight were sick, and two hundred and forty died. That yellow fever prevailed in New Orleans in 1809 is evident not only from the state- ments of Dr. Heustis, but also from the following facts communicated to Professor Hosack, of New York, by a gentleman of New Orleans: "It is well known to nearly all the inhabitants of La Fourche that in the year 1809 Captain Edward V. Turner and his wife, who resided at Point Honmas Plantation, lost their lives by opening a trunk of clothes, which had been sent from New Orleans during the prevalence of yellow fever; that they immediately sickened and died with black vomit, as did also the negro nurse who attended them."-An Account of the Yellow Fever as it Prevailed in the City of New York in the Summer and Autumn of 1822. By Peter S. Townsend, M. D. New York, 1823. Appendix, 345. 1809.-The revolution of St. Domingo had caused a French emigration into the Island of Cuba, and the ruthless invasion of Spain by France was a cause of another exodus of thefje same refugees, who sought in Louisiana an asylum which was denied them in that country, where they had become objects of hatred and suspicion. In the month of June, many of these emigrants had already arrived in New' Orleans, some with their slaves and whatever other property they could bring with them, and others utterly destitute. Not- withstanding the hostility shown to them by a portion of the population of Louisiana, the Hood of emigration had continued to pour in, and on the eighteenth of July their number amounted to 5759, of whom 1798 w'ere white people, 1977 free colored and black, and 1979 slaves. The perturbed state of the world at that time was the cause that many individuals, whose condition became unsettled, were looking around for places w'here they could better their fortunes, and not a few of them were daily arriving in New Orleans, from almost every quarter of the horizon which embrace the civilized portion of the earth, and particularly from Jamaica, Guade loupe, and the other West India Islands. British aggressions and conquests in those regions had disposed many of their French inhabitants to seek for refuge else- where. In consequence of the steady tide of emigration which was flowing toward Louisiana, chiefly from the shores of San Domingo, Cuba, Jamaica, and Guadeloupe, house rent in New Orleans and the price of provisions had become so extravagantly high, that in the month of November, 1809, families who had but limited resources began to find them drawing to an end, and the number of the poor destitute were daily aug- mented. In consequence of the frequent ravages of the yellow fever, particularly in the autumn of 1809, Claiborne recommended to the Legislature the policy of making, some general health laws, which should enforce cleanliness, and subject the shipping entering the Mississippi to those quarantine regulations which at other places had proved salutary."- Executive Journal, vol. 4, p. 219. Louisiana-American Domination. Gayarre, pp. 220- By a census taken in the year 1810, by the Marshal of the United States, under an Act of Congress, it appears that the population of the Territory was as follow's: City and Suburbs of New Orleans, 17,242 ; Precincts of New Orleans, 7,310. Total, 24,552. Plaquemines, 1549 ; St. Bernard, 1020 ; St. Charles, 3291; St John Baptist, 2990; St. James, 3955 ; Ascension, 2219 ; Assumption, 2472; Lafourche, 1995 ; Iberville, 2679 Baton Rouge, 1463 ; Point Coupde, 4539 Concordia, 2895 ; Ouachita, 1077 ; Rapides, 2200 ; Catahoula, 1164 ; Avoyelles, 1209 ; Natchitoches, 2870 ; Opelousas, 5048; Attakapas 7369. Grand total, 76,556. We observe, therefore, that the population of the Territory of Orleans had been rapidly augmented by emigration from the United States, and in seven years (1803-1810) had increased from 49,473 to 76,536, and the City of New Orleans from 8056 to 24,552. On the tenth of January, 1812, the inhabitants of New Orleans witnessed the approach of the first vessel propelled by steam which floated on the Mississippi, the New Orleans, from Pittsburg. The captain stated he had been but 259 hours actually on the way.- Martin's History of Louisiana, vol. 3, p. 311. This speed seemed at this time to be marvelous, and the whole population flocked to the river to examine the wonderful creation of the genius of man. On the nineteenth of August, 1812, Louisiana suffered from a severe hurricane, the ravages of w hich exceeded those hitherto known by any one of the inhabitants. Several buildings were blown down in New Orleans, particularly a very large and elegant market-house. 1813.-In this year Claiborne expatiated at length on the sufferings and losses of the planters on account of the overflows of the Mississippi, from the Parish of Concordia down to the Parish of Plaquemines, inclusively. Even New Orleans had been partially inundated by a break in the ievee at Kenner's plantation, some ten or twelve miles above the city. This overflow' was not the only calamity which New Orleans was to suffer. It History of Quarantine in Louisiana, Joseph Jones, M. D. CXLI was afflicted as much, by fire as by water. Constant conflagrations bad produced a feel- ing of despondency in the inhabitants, as no one was sure of a safe night's rest in his own house, which might be burned over his head before the next dawn of day. To remedy this evil, Claiborne, on the twenty-sixth of June, offered a reward of $1000 to any individual who should give such information as might lead to the discovery and punishment of these lurking incendiaries.-History La. Am. Domination. Gayerre, p. 292. Captain Edward Pelham Brenton records the interesting fact that the black soldiers of the West Indies, who comprised a portion of the British forces which invaded Louis- iana the winter of 1814-1815, suffered severely from cold. Thus he says: " Warm clothing for the black regiments had been urgently requested by Sir Alexan- der Cockrane, but none was sent; and these poor natives of a torried zone perished with cold on the shores of North America, where, on their arrival, they found the oranges frozen on the trees." "The weather was bad, the gales strong, and the cold intense. This fact is singular, and almost incredible, considering the latitude (29° NA The sol- diers, and particularly the black, suffered exceedingly."-The Naval History of Great Britain from the year 1783 to 1826. London, 1837. Vol. 2, pp. 530-532. 1815.-" On the evening of the eighth of January, 1815, the inhabitants of New Or- leans witnessed the arrival of a long train of wounded prisoners, whose number amounted to about 400. Immediately a large quantity of lint and old linen for dressing their wounds, of matresses and pillows and other articles for their comfort, were fur- nished by private contributions. All kinds of refreshments and every attendance which their situation required were liberally provided by the spontaneous action of the citi- zens. The colored women of New Orleans have acquired an honorable reputation for the skillful nurses they supply during those fatal epidemics which have so often devas- tated that city. On this occasion several of them tendered their services gratui- tously, and deserved the lasting gratitude of the numerous wounded whom they at- tended with the most humane disinterestedness."-History of La. Am. Domination. Gayarre, p. 478. > "The happy effect of peace was soon felt in Louisiana. On the sixteenth of March Governor Claiborne wrote to Mr. Monroe. Secretary of War : 'Great is the change which the return of peace has already made in this capital (New Orleans). Our harbor is again whitening with canvas ; the levee is crowded with cotton, tobacco, and other articles of exportation. The merchant seems delighted with the prosperity before him, and the agriculturist finds in the high price for its products new incitements to in- dustry.' "-Ibid, p. 535. Near the close of the year 1815 the entire population of Louisiana did not exceed 90,000 souls, of whom one-halt were black. The greater portion of this number were concen- trated in the city of New Orleans and upon the river coast for thirty miles below and seventy miles above the city. The inhabitants of these river settlements were chiefly Creole French, with a small admixture of Anglo-Americans. It was only after the year 1815, when Louisiana was relieved from the dangers of foreign invasion, and began to reap the advantages ot steam navigation on the river, that the State and New Orleans began to take the proud rank they now enjoy, in population, commerce, agriculture, and arts. In 1830, the State had increased to 215,740 persons, including 126,300 blacks. The census of 1840 gave an aggregate of 352,400 souls, including 168,452 slaves, which in 1845 had increased to more than 400,000 In point of agricultural and commercial importance, Louisiana had advanced to an elevated rank as early as 1830. In mercantile transactions, New Orleans in 1840 had attained a standing which placed her second only to New York, and the staple productions of the State were perhaps inferior in value to none in the United States. 1817.-A gentleman of New Orleans communicated to Professor Hosack the fact that in 1817 a trunk of dry goods or clothes were forwarded to the Choctaw Agent, who caught the yellow fever by unpacking the trunk, and died with black vomit. This cir- cumstance, as well as the name of the Choctaw Agent, was well known to Mr. Flower, of New Orleans.-An Account of the Yellow Fever as it Prevailed in the City of New York in the Summer and Autumn of 1822. By Peter S Townsend, M. D., p. 346. A Medical Examining Board, "Comitd Mddical," having functions also of an advisory character relating to the public health, was in active operation in 1817. That a well-organized medical society, composed of accomplished and learned French physicians, existed in the years 1817 and 1819, is evid-ent from the following observa- tions relating to the epidemics of yellow fever of these years, which I have derived from various original sources, but chiefly from the records of the Societe M^dicale : 1817.-The yellow fever committed ravages in New Orleans during the summer and fall of 1817, confining itself chiefly to Europeans and Americans. The epidemic de- clared itself during the month of July, but in the preceding month of June symptoms of the disease had been manifested in various portions of the town, but chiefly at the Civil Hospital, where it showed itself before the arrival of the schooner from Havana, which had lost part of her crew by the vomito. The disease continued its ravages dur- CXLII History of Quarantine in Louisiana: Joseph Jones, M. D. ing July ; assumed a greater degree of intensity in August, on account of the great num- ber of Europeans who landed and Americans who came down the river. The epidemic diminished after a severe storm, which took place at the commencement of September, f he weather was changeable until the twentieth of that month, then the south wind co mmenced blowing again ; the heat increased, accompanied with dampness, and the di Bease attacked several individuals newly arrived in the city. At length it disappeared in the month of October, except at the Civil Hospital, where it reigned for some time. '' MM. Gros and Gerardine, In their 'Rapport, Fait ala Society M<idicale, sur la Fif^vre Janne, qui a regn6 d'une manifere epidemique, pendant 1'EtA de 1817,' held that the di- sease was caused by the peculiar topography of New Orleans; abundant rains filling the stagnant marshes ; excessive heat of the summer and influx of strangers. This disease of endemic nature has become epidemic on account of a concurrence of circumstances favorable to its progress and developement. It has not been contagious, but it is sup- posed that, under certain circumstances, it may become contagious. 1819.-Yellow fever visited New Orleans as usual in the autumn. " But a great part of her inhabitants had become almost reconciled to its ravages, from the frequency of its return. For these it had no more terror than had the ancients for the skull which used to figure among the roses, and other legacies that adorned their banqueting tables. There were even some who felt friendly to the scourge, as, in their opinion, it checked that tide of emigration which otherwise would have speedily rolled its waves over the old population, and swept away those landmarks in legislation, customs, language, and social habits, to which they were fondly attached."-History of Louisiana : American Do- mination . Gayarre, p, 636. 1819.-The yellow fever of 1819 appeared on the seventh of May, when one, named John Gifford, was attacked and died. After this it manifested itself in another fatal case, continued in a sporadic form, augmenting progressively until the commencement of August, at which time the patients multiplied at such a rate at the hospital and in the town, that from that time it was regarded as an epidemic. It continued with great intensity until the commencement of August, at which time the patients multiplied at such a rate at the hospital and in the town, that from that time it was regarded as an epidemic. It continued with great intensity until the commencement of November, when the number of patients diminished in a sensible manner, until the middle of De- cember, which was regarded as its definite termination. The committee of physicians appointed by the "Society M^dicale de la Nouvelle-Orleans" to investigate the origin and nature of this epidemic, state that the yellow fever of 1819, as well as that of 1817, manifested itself sporadically from the month of May, but it became, at an earlier date, an epidemic in 1817, as it was regarded as such in the mouth of July,'whereas it was not so pronounced in 1819, until the commencement of August; which appears to indicate that the cause was more intense in 1817 ; however, the epidemic of 1819 lasted a longer time, terminating in December, while that of 1817 was considered as having terminated in October. The greater number of persons affected in both epidemics were Europeans or Americans, recently arrived. The Creoles of New Orleans, however, were not entirely exempt from the ravages of the fever. In 1817, not one negro is said to have been attacked by the disease, whereas in 1819 several died with yellow fever. Malarial and intercurrent fevers were more common in 1817. In 1819, yellow fever superseded all other diseases. The committee referred the yellow fever in 1819 to the burning heats of July, August and September, frequent rains, and stagnant water in the marshes. They regarded the yellow fever of 1819 as constitutional, non-contagious, indigenous (of spontaneous origin), and non-imported. Individuals contracting the disease in the city did not commu- nicate it to their families in the country. Not one of the inhabitants of St. Domingo was attacked by the yellow fever of 1819. In fine the committee* regarded the yellow fever of 1819 as due to heat, humidity, and local causes. 1820.-A gentleman of New Orleans communicated the following facts to Professor Hosack, of New York, illustrating the contagious nature of the yellow fever of 1820 : "During the present season (1820) a Miss Ouden, daughter of the watchmaker, who had lately arrived from France, and resided with a Miss Vignon, whose father lives near the Catholic Church, canerht the yellow fever, and was sedulously attended night and day by her friend till given over by her physician, when, to avoid the distressing scene of her disease, Miss Vignon retired to the school of Mr. La Fort, up the coast, which till that ihoment enjoyed perfect health. Miss Vignon, a Creole, was not affected with the disease, and it did not occur to Mr. or Madame La Fort, that she could communicate it by means of her clothing, etc. Mark the result! She, who had been the bed-fellow of Miss Ouden, also slept with one or both of the Misses Glovereys, nieces of Madam La * Rapport Public an nom de la Societ6 M6dieale de la Nouvelle-Orleans, sur la Fi6vreJaune qui y a regn6 A>id4ir>iquenient, diirant 'Et6 et rAutomme de 1819. Nouvelle-Orleans. The members of the com- mittee i/ere Tr ahuc, •'Presidert de la Society M6dicale," Fortin, President du Comity, Martin, Oonnant, Mlltenberger, Lacroix and Thomas, ''Secretaire Rapporteur." History of Quarantine in Louisiana: Joseph Jones, M. D. CXLIII Fort, who both took the fever and died of its worst symptoms! Fortunately, the medi- cal attendant in that institution is one of those liberal practitioners, who so far from seeking to persuade others that this disease is not infectious (and thereby being the means of its circulation), enforces every possible precautiou; and at his instance the pupils were immediately dispersed to places of security, one orphan boy, John Rouve, of Bayou Sara, only excepted and he having no place of refuge, fell a victim to the black vomit. Not one of those who left the seminary at that first alarm took the disease. "If you are acquainted with that part of the upper suburbs called the Nun's Point (a little below Rousseau's plantation) you must have remarked its high and healthy sit- uation, elevated several feet above the level of the city, at a great distance from the swamp and all stagnant water. There the inhabitants enjoyed the state of health to be expected from the purity of their atmosphere, entirely isolated from that of the city, till the following circumstances spread among them desolation aud death. Next door to Robin de Logny's there is a very inferior kind of a boarding-house, kept by a man named Marsh, who it; seems went to town in quest of sick boarders, and having found one (Gil- fillan, of the State of Pennsylvania) with the yellow fever, he brought him'to his house in a carriage, regardless of the safety of the other inmates. On the second or third day after his removal Gilfillan died ; next a Mrs. Jones, of Virginia; then Mr. Crane, Madam and Mr. Granville, all of Ohio ; a young child of Mrs. Howell, and lastly, one of Marsh's own children, all died of black vomit. A Mrs. Vodridge and a mulatto woman likewise had the yellow fever ; the former was saved by being removed to a female hospital, and the latter recovered. Marsh, his wife, and Mrs. Howell, who had the disease last year, appear to be the only persons in that house who did not take the infection. "There is along red building opposite to Madame Nadian's, the property of John Mornay, which is divided into six tenements, and is usually occupied by as many fam- ilies. In this building there were the following persons : Madame Odrigues, a Creole ; Mr. and Mrs. Schofield, Mrs. Hill and her daughter, the widow Jones, both of which families had several children ; Mr. Rodgers, chairmaker, and his wife ; besides these there lodged at Mrs. Hill's a Mr. Napper, a carpenter, and a Madame Odrigues, also John Smith, a mason. The fever was first brought among them by Napper, who caught it in the city, and died at Mrs. Hill's ; a negro woman caught it of him, and recovered ; next Mrs. Jones, who also attended Napper, caught it in the city, and died at Mrs. Hill's; next Mrs. Hill, whose body being taken to the grave by John Smith he complained of the unusually offensive smell, and sickened and died also. All these were marked cases of yellow fe^er, and terminated in black vomit. Two younger children of Mrs. Hill's and two of Mrs. Jones' also had the disease, but recovered. In the same building Mr. Rod- gers and his wife both had the yellow fever, and the latter died. Mr. and Mis. Schofield likewise had it. Within gunshot of the same spot, in a kitchen of John Mornay's for- mer abode, lives an honest German, usually called Dutch Joseph. This man being on board a German vessel in the river, infected with yellow fever, found an acquaintance extremely sick, and was induced by compassion to bring him to his own dwelling, where the man shortly died of that disorder, having first communicated it to Joseph's own wife and a young girl, both of whom also died, and but for the attention of Dr. Forsyth and the introduction of Guyton Morveau's fumigation it is probable the whole household would have perished. "The above facts are not only confirmed by eye-witnesses among the survivors, but by Dr. Forsyth himself, who attended most of the above patients, and who has very properly taken notes of the circumstances, under the most solemn conviction that the above numerous cases of fever originated in the contagion communicated by the three individuals respectively stated. "In the meantime there are families within view of the three last described houses, and consisting of a dozen persons, unseasoned to the atmosphere of the city in the sickly months, who have remained exceedingly healthy and perfectly secure from malignant diseases by vigilantly guarding against any communication with the sick. "Having thus detailed to you the manner of the yellow fever being introduced by four infected individuals into as many different habitations, all of these situated in a pure atmosphere, free from every predisposing cause of disease, and shown that, including the/our first cases, about thirty persons have caught the infection, of whom not less than eighteen have died, I beg you to reflect on the probable consequence of four similar cases being introduced among the dense population of any city in the Union, and whether thousands would not have fallen victims unless effectual measures were adopted to interpose a barrier between the sick and the sound. "There were one or two other striking instances of contagion that occurred below the city. An Irishman who went from town to General Wilkinson's plantation fell sick shortly after his arrival, and died with the black vomit. He was attended by a man who had not been to town during the season ; he also caught the disease, and died. "The yellow fever was likewise taken to Mr. Fleckner's plantation by a white man from town, who there died ; also the negro nurse who attended him, and the nurse of that negro also. CXLIV History of Quarantine in Louisiana, Joseph Jones, M. D. "Mr. Livingston's overseer, who had not been near the city, visited one of those sick white men, and he also took the disease, and died with black vomit.-An account of the yellow fever as it prevailed in the city of New York in the summer and autumn of 1822 By Peter L. Townsend, M. D. New York, 1823, pp. 346-349. 1820-The deaths from yellow fever for the year numbered 400. Deaths from yellow fever in the hospital, eighty-two. First admission, July 21; the last, December 21. In this year the physicians of New Orleans and its vicinity, "believing that a frequent interchange of opinions on subjects connected with their profession is the most effectual mode to promote its interest and extend their knowledge," formed a society or associa- tion known by the name of the Physico-Medical Society of New Orleans.* ESTABLISHMENT OF THE FIRST' QUARANTINE AND BOARD OF HEALTH IN NEW ORLEANS. The City and State authorities, fully alive to the sanitary interests of New Orleans, enacted health laws of the most stringent and extensive character, on the sixth of March, 1816, and eighteenth of March, 1817. Although these acts appeared to exhaust the sub- ject of hygienic legislation, they had no apparent effect on the march of yellow fever. Dr. Bennet Dowler states that quarantine laws were enacted in the winter or before the hot season (Tableau of the Yellow Fever of 1853, p. 14), but Dr. W. M. Carpenter quotes the New Orleans Gazette to the effect that "In consequence of the positive proofs of the importation of the disease in the dreadful year of 1817, the Legislature of that winter passed a quarantine law which, though far from perfect in its structure, might have been considered as a pledge of more efficient precaution."-Sketches from the His- tory of Yellow Fever, p. 17. The mortality for August, 1817, was 487 ; September, 304 ; October, 172 ; total for the three months, 965. This record was taken from the various cemeteries. Dr. Bennet Dowler gives the mortality during five months, as white male adults, 760 ; white female adults, 63; a ratio of more than twelve times less than the former ; total mortality for five months, 1142. The Physico-Medical Society, on the contrary, reported the deaths in August, 304; in September, 178; in October, 91; in November, 91; in December, 74. From these and various other data, Dr. Dowler estimated the deaths from yellow fever, this year, at 800. Governor J. Villerd, January 6, 1818, in his annual message, says : "That during the course of the last summer, the yellow fever had extended its "ravages over the city, chiefly falling on newcomers, but many of our citizens were its victims." He thinks that the disease was imported, and regards quarantine laws favorably. The yellow fever reappeared in New Orleans in 1818, and according to the estimate of some authors, the mortality amounted to 1151. Dr. Bennet Dowler gives the following statistics for 1818: Deaths, white male adults, 324; of female adults, 81; white chil- dren, 87; black male adults, 219; black female adults, 162; black children, 277. The mortality augmented in each month until September, in which 166 died. Total whites, 492; total blacks, 658; grand total, 1151. Dr. Barton does not include 1818 amongst the epidemic years, and the statistics given by Dr. Dowler evidently relate to all diseases. An act approved March 6, 1819, repeals the act establishing a Board of Health in New Orleans, the health officer and all laws for the prevention of the introduction of pestilen- tial, malignant and infectious diseases; directs the sale of the lazaretto and all its prop- erty; investing the Governor with autliority to establish quarantine by proclamation at his sole discretion. As we have seen, yellow fever prevailed as a destructive epidemic in 1819. The city proper had whites 13,604; blacks 13,592. The city and suburbs contained 45,958 souls. Mortality by months, beginning with January, 70; February, 102; March, 97; April, 78; May, 120; June, 130; July, 130. August, 292; September, 594; October. 513; November, 134; December, 109; total 2,369. It will be observed that the total mortality for August, September and October wm 1,199, during the prevalence of the yellow fever, or over one-half of the entire mortality for the twelve months. These figures taken from the reports of the medical society and cemeteries apply probably only to the city proper. Mr. Nuttal, the naturalist, in his travels, estimates the victims to yellow fever for this year in the city at from five to six thousand, an aggregate greatly exceeding prob- ability. In the official report of the United States Surgeon-General, it is said: "At New Orleans it was estimated that upwards of 3,000 died of yellow fever; and it was not until after the first of December that it was deemed prudent to return either to this city or Natchez. The interior o£ the country, in the Southern States, seemed to suffer in a corresponding ratio. In the West Indies the fever exhibited a still greater mor- tality." The grand total mortality, according to the report of the Medical Society (supposed to include only the incorporated limits) is but 1337; the males being 1142, the females 195 ; blacks, male adults, 182; female, 168. Deaths of blacks distributed almost equally History of Quarantine in Louisiana, Joseph Jones, M. D. CXLV among the months of the year, and little if any increased during the three epidemic months, while the deaths of white adults increased from 64 in July to 485 in September. Six white men died for one white woman. According to Dr. Bennet Dowler, the first two cases of yellow fever in 1819 occurred. May 7 and 12, the last death December 9. And as we have previously shown, the Com- mittee of the Medical Society, after minute inquiry, failed to trace the disease to other than local causes. Dr. Carpenter, on the other hand, in his special pleading for importation and conta- gion, says. "In June, several vessels, with crews sickly with yellow fever, entered from Havana, and about the first of July cases began to appear among the shipping in the harbor. The Governor now proclaimed quarantine, by a power vested in his hands, by the act repeal- ing the quarantine law. The disease, however, had already made some progress, and the thing was given up, and the vessels continued to come in, and some from Martinique, which were known to have lost some of their men on the voyage, and even on their way up the river, with the worst type of the ' vomito prieto,' and not a voice was heard to prevent their mooring on the levee. The disease became epidemic before the middle of August, and assumed a character of the highest malignity; medicine lost its effects; the skill of the physician was baffled, and multitudes were carried to the grave."-New Orleans Gazette, January 7, 1820, Sketches from the History of Yellow Fever, p. 18. It was held by some that the disease had originated in the city, before its introduction in the way mentioned by Dr. Carpenter. On the other hand, Dr. Dupuy de Chamberry, in his historical sketch of yellow fever, as it appeared in this city in 1819, says: I formerly believed the yellow fever to be con- tagious, but since I have been in the midst of it, my numerous practical observations have never been able to furnish me with one proof of this much dreaded attribute. In- deed, the result has been quite the reverse; and I am now convinced that the disease is permanently fixed to the spot, and within the limits of the place which has created it. No one case occurred beyond the limits of the city, during its prevalence in the years 1817 and 1819, that could be traced to our innumerable patieuts, although daily inter- course was kept up with the people of the neighboring estatesand plantations. A great number of our iuhabitants who carried the seed of the disorder abroad, seeking refuge from the danger at a distance, suffered an attack of thefeverand died, butin no instance was it communicated to their friends. Fifty times have I had my hands besmeared with the putrid blood, black vomit, or foetid slimy matter or perspiration. Fifty times have I been immersed in the effluvia issuing from a dead or living subject, and never been infected by the disease. Fr6m extensive observations I infer that the yellow fever of this place is a disease, sui generis, the product of local causes, and neither contagious nor exportable. Flight from the infected spot is the only preservation, and a distance of three miles appears to be quite sufficient to inspire the fullest confidence." New Orleans was again visited by an epidemic of yellow fever in 1820. Deaths from yellow fever in the hospitals, 82. First admission, July 21; the last, December 21. The deaths for August from all causes were 289, September 402, October 177; total 868. Dur- ing the same months, in 1817, the mortality was 965, and in 1819, 1199. Dr. Carpenter states that "about the twentieth of July, it became known that several cases of yellow fever had appeared among the shipping, and some at boarding houses. When the Mayor desired Dr. Davidson to examine all the vessels which had lately entered the port of New Orleans from the West Indies, where the yellow fever was then prevailing, who made diligent inquiries into, and investigated the grounds for the rumors which had prevailed in the city for some days past, that malignant fever had made its appearance, respectfully reports that: " The schooner Gold Huntress, Martin master, from Havana, entered on the seven- teenth of June, having lost two men on the passage with yellow fever; also, that the brig Charles Fawcett, Lamon master, from Matanzas, arrived on the tenth of July, having lost two men on her passage, and having others sick with yellow fever."-Letter of Dr. G. C. Forsyth, extract from New Orleans Gazette, November 15, 1820. Sketches from the History of Yellow Fever, p. 19. Governor Viller6 declared "that the scourge of war is preferable to yellow fever ; that the city had been twice ravaged in three years," (1817, 1819), and that it is contag- ious." He urged the Legislature to pass quarantine laws, in which he had the greatest confidence as a preventive. Governor Viller^, a firm advocate for contagion and quarantine, in his message of November 22, 1820, in relation to the existing epidemic of yellow fever, said : "All the medical faculty appear definitely to have adopted the opinion that the yellow fever, which during the last year has plunged us once more into mourning and desolation, is not contagious." But he argued: "During the months of August, September and October there has been almost constantly in the prison ol this city a great number of prisoners, and not a single one among them has been affected with the disorder. If the CXLVI History of Quarantine in Louisiana : Joseph Jones, M. D. yellow fever were natural to our climate, how has it happened that, among such a num- ber of persons, heaped together in so small a space as the prison in this city, not a single one should have been attacked ?" * Dr. Chabert, a physician of New Orleans, opposed the Governor's argument as to the prison, and maintained that the Creoles never take the yellow fever, though they do not shut themselves up to avoid it. Governor Viller6 reviews the report of the Medical Society for the current year, dis- sents from its deductions, which he regards as those of all the faculty, and denies what he calls "The constitutionality of the yellow fever."-Tableau of the Yellow Fever of 1853, etc., by Bennet Dowler, M. D., p. 17. On the eighteenth of December, 1820, Governor Robertson, in his inaugural message, urged the Legislature to establish quarantine against yellow fever. The quarantine laws passed by the Legislature in February, 1821, creating a Board of Health, with plenary powers, legislative, judicial, executive, pecuniary and sanitary, modeled after codes the most rigid, and enforced by the heaviest penalties, were carried into effect in March of the same year. The quarantine ground, established at the English Turn, including incidental expenses, cost over $22,000. The Board of Health commenced its duties on the sixth of March, and instituted measures for cleansing the city, improving its salubrity, and providing against the in- troduction of infectious diseases. The quarantine was under the direction of the Board of Health, and vessels arriving in port were compelled to contribute to its support. The board held its meetings every Tuesday afternoon at the Customhouse, until the first of June, and from that time until the first of November every day, excepting Sun- days. The Mayor, Joseph Roffignac, was president ex-officio, of the board, composed of twelve members, who received no pecuniary compensation for their services. The nature of the ordinance of the Board of Health may be gathered from the fol- lowing extracts from the Code of Public Health : " All keepers of inns, taverns, boarding-houses or other places, where persons are lodged for hire shall, once in every week, furnish the Mayor of the city, at his office, a list of the persons lodging or boarding at their houses respectively, according to the printed forms which the Mayor shall furnish at the expense of the corporation, which shall contain the names, apparent age, occupation, place of permanent residence, and nativity of such boarders or lodgers, and the time they have respectively lodged or boarded in such house ; and every person offending against this article, shall forfeit one hundred dollars ; or if knowingly furnishing a false return or list, shall forfeit a sum of five hundred dollars. " If any seafaring man or sojourner shall, at any such house as is described in the foregoing article, fall sick at any time between the first day of May and the first day of November in any year, the master of such house shall, within twelve hours, report the name of such sick person to the Board of Health, and describe the place at which he lies sick, unless such person is attended by a physician duly admitted to practice, and for every neglect to make such report every keeper of such house shall forfeit $20. "The sexton or keeper of every cemetery in the City of New Orleans, shall, every day during the months of May, June, July, August, September and October, and every week during the rest of the year, make a return to the Board of Health, of the persons buried in such cemeteries ; and for every such neglect such sexton or keeper shall forfeit $10. "Every person practising physic in the City of New Orleans who shall have a patient sick of the yeliow fever, or bilious malignant or pestilential fever, between the first of May and the first of November, in every year, shall within twenty-four hours make a report in writing to the Board of Health, at their office, and for neglecting to do so, he shall forfeit for every offense $300. The year 1821 proved salubrious-a result attributed to the strict quarantine. From the following table it will be seen that the deaths were only slightly augmented during the months of July, August and September: ANNUAL REPORT' OF INTERMENTS IN THE CITY OF NEW ORLEANS, COMMENCING ON FIRST DAY OF JANUARY AND ENDING ON THE THIRTY-FIRST DAY OF DECEMBER, 1821 AS MADE TO THE MAYORALTY AND BOARD OF HEALTH. __________ Total 1 Men Whites. > Women ) Children i Men Colored. > Women ) Children 1821. 1- - - to ca co to co January. o 18 4 7 12 12 17 February. o w to CH to co co March. V. CH 24 5 2 6 13 13 April. 00 tn 24 6 8 16 14 15 May. CO to co CO -4 O O -4 June. g 54 8 19 18 13 16 July. co w 60 7 10 20 18 18 August. to to 75 0 14 17 10 6 September. to o 74 10 89 12 7 15 October. 00 49 10 15 14 16 14 November. GT to h- *-»- co CA O' O Cn CH co December. ex 505 65 105 157 152 181 Total. History of Quarantine in Louisiana: Joseph Jones, M. D. CXLVII Governor Robertson, in January, 1822, congratulated the Legislature upon the good fortune of New Orleans as being "the healthiest city" in the Union; but at the close of August ihe yellow fever appeared ; it augmented throughout September, but it did not reach its culminating point until October; the month of greatest mortality having amounted to 665, exceeding that of the present month by 33. The following was the mortality for three months. August, 165; September, 532 ; October, 665; Total, 1,362. Total deaths from yellow fever in 1822, 808, or one in 53.28 of the population. The highest number of deaths any one day of yellow fever was 60; and of all causes, 80. During 1833 the largest mortality any one day of yellow fever was 53 ; 1841, highest number from yellow fever 43, and the greatest mortality 60.* Of the ten epidemics of yellow fever with which New Orleans has been visited since the cession of the American government, in 1803, up to the year 1842, the average loss per year has been estimated as not exceeding 800, and during that period the most fatal epi- demic was that of 1822, when the deaths numbered 808, or one in 53.28 of the entire population. The total mortality from yellow fever in 1841 was 1,641, distributed thus by cemeteries: Catholic Cemetery, 42; Cypress Grove Cemetery, 77; Protestant Ceme- tery, 63; St. Patrick's Cemetery, 78; Lafayette Cemetery, 241; Jewish Cemetery (in Lafayette), 16; Potter's Field, 1,124. Total, 1,641. Natives of the United States, 288; natives of foreign countries, 1,055; natives of countries unknown, 298. Total, 1,641. The population of New Orleans, including the parish of Orleans, in 1820, was 41,350, and in 1840, 102,191. In 1841 the population of New Orleans probably exceeded 103,000; ratio of deaths from yellow fever one in 62.7 of population. The value of the labors of the Board of Health in diminishing the rate of mortality and the prevention of yellow fever, by the so-called efficient and rigid quarantine, will be seen from the comparative mortality, from all diseases, during the three months of August, September and October of the years specified: Months. Years. 1817. 1819. 1820. 1822. 1833. 1837. 1839. 1841. August 489 292 289 165 410 483 619 562 September 304 594 402 532 783 1188 648 1115 October .. 172 513 177 665 565 568 297 659 Totals 965 1390 868 1362 2758 2239 1554 2231 Ratio to entire population 1 in. 37 02 1 in. 33.60 1 in. 37.63 1 in, 31.60 1 in. 27.72 1 in. 38.76 1 in. 61.73 1 in. 48.15 The message of Governor Robertson, after the epidemic of 1822,* breathed sorrow and despair, and he could no longer exult upon the good fortune of New Orleans, as being "the healthiest city in the Union," and his bitter experience might well be heeded, * It is worthy of note, as bearing upon the assertion that cold was capable of eradicating the cause of yellow fever, that the winter of 1821 and 1822. preceding the great epidemic of yellow fever of 1822, was one of the most severe ever experienced in Louisiana, as the following particulars recorded by a competent observer will show: "December 22. 1821, very cold, with hail; Sunday, December 23, ice one inch thick, and Fahrenheit's thermometor stood 20° above zero-on this day. cold as it was found in this climate, the volunteers had a parade and were reviewed by the Governor; December 24, cold ; December 25, snow one inch in depth. In summer the average heat is 83°, the highest 94°, all in.the shade. Mr. Peter Maspero, a maker of thermometers, and an old and respectable citizen of New Orleans, informed the observer in 1821, " that for seventeen years he had been in the habit of observing the thermometer, and never knew it to rise higher than 94°, which occurred last year; and two years previously to 93°; the instrument stood in the shade in his store." It was noted at an early day that New Orleans enjoyed the advantage of pleasant and refreshing breezes throughout the warm season. The extremely mild temperature of the summer climate of Louisiana, and the much greater severity of the cold of winter than could be expected below latitude 33° North, was a phenomenon which more than sixty years ago engaged the attention of a few thoughtful observers, without at that time receiving a satisfactory solution. As vegetable productions are the only decisive marks of climate, they offered to those earlier observers ample proof of how much more temperate the climate of Louisiana was than that of similar latitudes on the Eastern Continent. The orange tree flourishes in Europe above 38° N. Latitude, the sugar cane about the same height; neither of them have been cultivated with success in America as high as 32° N. The cotton and other tender plants have frequently been killed in Louisiana by frosts late in April or again in the latter days of September. In Louisiana the intervals between frosts may be called the months of May, June, July, August and September, though instances have occurred in Louisiana of frosts in September. The heat in summer seldom amounts to 90° F., and the medium tem- perature of well water is 52° F -Paxton's Directory of New Orleans, pp. 25-26. List of Governors of Louisiana from the first settlement to the administration of Governor Robertson : French-Sanvo'le, 1699; Bienville. 1700 ; Demonis (died on his passage), 1708; Tremouthe Cadiliac, 1713 ; L'Epinay, 1717; Bienville, 1718; Perrier, 1826; Bienville. 1733; Vandreuil, 1744; Kerlerec, 1753; D'Abadie, 1763; Aubrey, 1765 Spanish-Ulloa. 1766; O'Reilly, 1769; Unzegua, 1770; Galvez, 1777; Miro, 1783; Carondelet; 1700;Gayoso, 1796 ; Salcedo, 1800. AnwruM*-W. O. C. Claiborne; 1804; James VillerO; 1816; J. B. Robertson; 1820. CXLVIII History of Quarantine in Louisiana: Joseph Jones, M. D. when so-called sanitary reformers, attribute the absence of yellow fever from New Or- leans, wholly to their pretentious, but superficial, efforts. "It is," says Governor Robertson, "an idle waste of time for me to inquire into the causes, origin and nature of this dreadful malady." * * * * "The State resorted to quarantine, under the expectation that it would add to the chances of escape from this dreadful visitation. If this hope be fallacious, if no good effect has been pro- duced, if even a procrastination of its appearance has not resulted from the measure, then should it be abandoned, and our co 'iinerce relieved from the expense and incon- venience whicl>it occasions." In 1823, the Committee of the House of Representatives on Quarantine Laws reported that "during the last year (1822) notwithstanding the strictest compliance with these laws, our expectations were frustrated at the very moment when we thought we could indulge the hope of the most complete success. The season was far advanced, and in the month of September this metropolis enjoyed the most perfect health, when the yellow fever made its appearance." "Notwithstanding the signal and lamentable failure of quarantine in 1822, the com- mittee of the House of Representatives, of which F. Grima, Esq., was chairman, re- commended its continuance in the most rigid form, because it had not been tried sufficiently long, and because other States had similar regulations." The Board of Health upon this occasion', as well as upon many others, were not slow in finding an unfortunate vessel and some miserable individuals, to whom they attached the odium of having introduced the disease. The Board of Health of 1822 set a worthy example to succeeding boards, in expressing faith in the efficacy of quarantine to ex- clude yellow fever from New Orleans. Thus they held the following language : " The Board of Health believe it their duty to db away with the impression made by interested persons, to induce a belief in the inutility of the powers which you have so wisely conferred on the Board, for the establishment of quarantine, which these persons wish to see destroyed." * * * " This opinion is diametrically opposed to that of the Board of Health, who believe that the yellow fever is contagious, and that the establishment of quarantines is necessary to prevent its introduction." The citizens, however, were not convinced by the arguments of the contagionists, as to the value of their system to prevent yellow fever, and determined to petition the Legislature to abolish the quarantine laws. On the twenty-third of January, 1823, a large public meeting took place, in which it was moved and carried, "that the late epidemic had tested the total inefficiency of the quaran- tine laws and regulations ; we consider them not only useless, but in the highest degree oppressive and injurious to the commerce of this city ; and that application ought to be made to the Legislature for the purpose of having them annulled." A memorial was ad- dressed to the Legislature accordingly for that purpose. The Legislature, however, took no decisive action upon the matter. The quarantine continued in force. The health of the city continued good throughout 1823, only two cases of yellow fever having been recorded in the books of the Charity Hospital. The Governor, in his message of January. 1824, congratulated the Legislature on the health of New Orleans, and proclaimed the city free from "all contagious diseases," but ou the fifteen of November of the same year, the Governor in his message says : New Or- leans has been .again subjected to the dreadful scourge," and suggests the expediency of closing the business season in midsummer, and recommends a general flight to the un- acclimated. Mayor J. Roffignac in his message dated September 11, 1824, gives the following ex- position of the causes of yellow fever : "The opinion of professional men on the primary cause of the insalubrity of New Or- leans, tends only to confirm the idea which must occur to the mind of every attentive observer, on looking at the topographical situation of our city, to wit: that these causes are of two kinds; the one arising within and the other without the city itself, and that both ought to be counteracted. "The internal causes are: 1. The filth daily created in a populous city. 2. The low grounds and pools where stagnant water lies, the wooden gutters, constantly wet and fermenting under the rays of a torrid sun. 3. The want of privies in most of the popu- lous districts, which renders it necessary to recur to the disgusting and dangerous use of tubs. "The external causes are: 1. The marshes lying north and west of the city, uncovered but undrained, and deprived, by the cutting down of trees, of the shelter formerly afforded to them by the shade of a luxuriant vegetation, for which the very miasms that now spread death and desolation among us, were a source of life and vigor. 2. To the south and east, the Mississippi, which in its periodical retreat at the hottest season of the year, leaves on its banks a great portion of the filth which has been thrown into the current, but is brought back by eddies. 3. The winds, which at the moment we feel most secure, may, as was the case in 1822, convey to us the deadly effluvia of the dan- gerous spots, which they sweep in their course." History of Quarantine in Louisiana: Joseph Jones, M. D. CXLIX Mayor J. Roffignac does not allude to contagion, nor does he allude to the quarantine, which had afforded no protection, and proved a delusion against disease and a serious obstruction to commerce The quarantine had been tried for three years, and yet two epidemics had occurred; the centagionist began to waver, and, the joint committee of both houses of the Legis- lature disagreeing on quarantine, were discharged from the consideration of the same on the last day of November, 1824. Experience convinced the public that quarantine was not only useless, but absolutely injurious to a city so exclusively commercial; that a free untrammeled trade with free- dom of ingress, egress and progress, was a social necsssity involving the question of subsistance or starvation. On the nineteenth of February, 1835, the Legislature re- pealed the quarantine laws which it had enacted four years previouslv, and at the same time the quarantine grounds were directed to be sold. During the eight years which fol- lowed, yellow fever was never so destructive as in 1822, under a strict quarantine, when, according to some authorities, as the Reverend Timothy Smith, who visited New Orleans in 1823, 2000 died of that malady, although the records examined by Drs. Barton, Dowler and myself, show only 808, the whole mortality for the three months ending with October being 1362. The maximum mortality upon one day rose to 80, of yellow fever to 60. The ratio of mortality in the Charity Hospital was enormous, out of 337 admissions 239 deaths and only 98 cures took place. An ordinance for the establishment of another Board of Health in New Orleans, was again passed by the General Council in June, 1841. The Board consisted of nine mem- bers-three aidermen, three physicians and three private citizens. It was invested with ample powers to adopt and enforce such sanitary regulations as were thought conducive to the health of the city. This Board performed its functions during the first year of its existence ; but we have seen that a'fearful epidemic of yellow fever desolated New Orleans in 1841, destroying 1641 of her inhabitants, the mortality for the months of Au- gust, September and October reaching 2231, The second year there was a faliing off, but a dissolution did not take place till 1843. In 1844, the Board of Health having ceased to officiate, the General Council invited the Medico-Chirurgical Society to take charge of the sanitary interests of New Orleans. This proposition was accepted, and a committee of nine members appointed with full powers to act as a Board of Health. Acts were passed by the General Council fiteenth of August, 1846, twenty-third of June, 1847, and by the Legislature of Louisiana March 6, 1848, May 15, 1848, and June 13, 1855, relating to the Board of Health and quarantine. The present system of quaran- tine was established on June 13, 1855. 1833.-On the ninth of December, when the Legislature met, the State was just recov- ering from the terrors of the ravages produced during the preceding autumn by the yellow fever and cholera. Governor Derbigny informed them, that now "health pre- vailed throughout the whole of the State, and that the resources which her geographical position and inexhaustible fertility of her soil afforded her was so great that, after all these calamities, her situation was at present very prosperous."-History of Louisiana, American Domination, p. 655. An ordinance for the establishment of another Board of Health in New Orleans was again passed by the General Council, in June, 1841. The board performed its functions during the first year of its existence : but an epidemic of yellow fever afflicted New Or- leans in 1841, deseroying 1641 of her inhabitants. The second year there was a falling off in the interest of its members, but a dissolution of the board did not take place until 1843. In 1844, the Board of Health having ceased to officiate, the General Council invited the Medico-Chirurgical Society to take charge of the sanitary interests of New Orleans. The proposition was accepted, and a committee of nine members were ap- pointed, with full powers to act as a Board of Health. Acts were passed by the General Council, August 15, 1846, June 23, 1847, and by the Legislature of Louisiana, March 6, 1848, May 15, 1848, and June 13, 1855, relating to the Board of Health and quarantine. MAYORALTY OF NEW ORLEANS. GENERAL COUNCIL. MAIRIE DE LA NOUVELLE-ORLEANS. CONSEIL GENERAL, Sitting of Saturday, August 15, 1846. Be it ordained, etc,, That the Branch Pilots for the Port of New Orleans and the officers of the customs for said port and District be requested to notify all masters of ships or vessels bound for this port hav- ing on board the small-pox or any contagious dis- ease, that they are forbidden to come along aside of the levee in either of the municipalities until they have been visited by one or more members of the Board of Health and can produce a certificate of Seance du 15 Aotit 1846. Il est ordonne, etc., Que les Pilotes du Port de la Nouvelle Orleans, et les officers de douane du dit Port et District, soieut requis de notifier Atous Capi- taines de Na vires on Vaisseaux destin6s pour ce Port, et ayant A bord la Petite-V6role, ou tou te autre matadie contagieuse, qu'il leur estd6fendu d'aborder la Lev6e dans les limites des trois municipalit6s, h inoins qu'il s n'aient au pr6alalde requ la visite d'un ou plusieurs membres du Bureau de Sant6, et puissent CL History of Quarantine in Louisiana: Joseph Jones, M. D. convalescence from the said physician to the harbor- master to whom they may enter. The said ship or vessel shall come to anchor under Slaughter-House Point until they have received said visit from said physician under a penality of five hundred dollars, anil that the Navor be authorized to request the Collector of this port to notify the officers under his control to enforce the abovelordinance, and that two hundred copies thereof be printed and delivered to the pilots and officers of the customs. (Signed) W. H. WILDER. President. Approved August 17, 1846. A. D. CROSSMAN, Mayor. A true copy. A. MAZUREAU, Secretary. produire de la part du dit membre un certificat de convalesence qu'ils prfesenteront au Capitaine du dit Port charge de les placer. Les dits Navires ou Vaisseaux mettront & 1'ancre ilia Pointe de 1'Abat- toir, jusqu'b ce qu'ils aient recu la visite d'un des dits membres du Bureau de SantU, et ce sous piene d'une amende de cinq-cents piastres; Et de plus; Le Maire est et demeure autorisSa requ6rir du Collec- teur de la Douane de couloir bien notitier les ofticiers sous son controle d'avoir it veiller il I'exficution de la pr6sente ordonnance, et que deux cents copies en soient immediatement imprimees et distributes aux Pilotes et aux dits ofticiers de douane. (Sign6) W. H. WILDER, President. Approuvt le 17 Aotit 1846. A. D. CROSSMAN, Maire. Pour copie conforme. A. MAZUREAU. Secr6taire. MAYORALTY OF NEW ORLEANS. GENERAL COUNCIL. MAIRIE DE LA NOUVELLE-ORLEANS. CONSEIL GENERAL. Sitting of June 23, 1847. An ordinance relative to vessels arriving at this port from Sea. Article 1. Be it ordained by the General Council of the City of New Orleans, That all owners, captains, masters or commanders of vessels arriving at this port from sea, be and are hereby forbidden, when- ever ther e may be any infectious or contagious dis- eases on boar d of such vessel, to moor such vessel at any of the wharves of either of Ihe municipalities of this city, and it shall be the duty of said captains, masters and commanders of such vessels to anchor in the middle of the river below Slaughter-House Point, and there remain at anchor untill such infec- tious or contagious disease shall have entirely disap- peared from such vessel, and any master, captain or owner of any vessel, contravening, shall pay a fine of one hundred dollars. Art. 2. Be it further ordained, That it shall be the duty of the Mayor, w henever he may receive infor- mation of the arrival of any vessel having any in- fections or contagious disease on board, to order such vessel to come to an anchor in the middle of the river, below Slaughterhouse Point, and in case of the master or commander of such vessel refusing or neglecting so to do, the Mayor is hereby author- ized to cause such vessel to be immediately removed to and anchored at the place above designated, and the owner, master or commander of such vessel shall pay a fine of one hundred dollars for neglecting or refusing to remove such vessel as aforesaid, and shall also pay the expenses of such removal. Art. 3. Be It further ordained, That any owner, master or commander of a vessel who shall land or permit to land, within the limits of the city of New Orleans, any person or persons affected with any in- fectious or contagions disease, shall pay a fine of one hundred dollars for each and every person so affected they may land or permit to land. Art. 4. Be it further ordained, That it shall be the duty of all owners, masters or commanders of vessels arriving from sea, and having any infectious or contagious disease on board, to come to an anchor as required by the first article of this ordinance, and immediately notify the Mayor of this city there- of; and the Mayor shall immediately notify the Board of Health of the arrival of such vessel, whose duty it shall be to proceed on board of such vessel and examine the persons affected, and report the result of their examination to the Mayor; and any owner, master or commarder of a vessel refusing or neglecting to comply with the provisions of this article sh all pay a fine of $100. Art. 5. Be it further ordained, That whenever any vess< 1 having any infectious or contagious dis- ease on b tard, shall have been : nchored as directed by this ordinance, it shall not be lawful for any person m persons to remove su . h vessel from her anchorage until the ywuor; maeier or uummiuiUw of Seance du 23 Juin 1847. Ordonnance Relative aux Navires arrivant de la Mer en ce Port. Article 1. Il est ordonne par le Counseil General de la villa de Nouvelle Orleans, Qn'il sera d6fendu a proprietaires, capitaines, maitres ou commandants de navires, arrivant de la mer dans ce port ayant a bord des dits navires des maladies contagieuses on pes- tilentielles. de faire aborder lenrs navires A chacnn des wharfs d'aucnne des municipalites de cette ville; et il sera du devoir des dits capitaines, maitres ou commandants desdits navires, de les mettle a 1'ancre au milieu du tleuve, au-dessous de la pointe de 1'abattoir, et d'y mettre & 1'ancre jusqu'a ce que les maladies contagieuses ou pestilentielles aient com- pldtement disparu des dits navires, sous peine d'une amende de cent paistres pour chaque contra- vention. "Art. 2. Il est de plus ordonne, Qu'il sera du devoir du Maire, toutes les fois qu'il sera inform^ de 1'ar- riv6e d'aucun navire ayant a bord des maladies contagieuses ou pestilentielles, d'ordonner au dit navire de jeter 1'ancre au millieudu fieuve au-dessous de la pointe de 1'abattoir, et au cas oule capitaine ou commandant du dit navire refusernit ou neg- ligerait de se conformer it cet ordre, le Maire est autoris6 A faire Uonduire ledit navire et de lui faire jeter 1'ancre & 1'endroit ci-dessus design^ ; et le pio- priStaire, capitaine ou commandant dndit navire paiera tine amende de cent piastres pour avoir ne- glige ou refusU de conduire son navire comme il est dit. ci-dessus; et de plus, il paiera les frais de deplacement. Art. 3. Il est de plus ordonne, Que tout propri6- taire, capitaine ou commandant d'un navire qui debarquera ou laissera debarquer dans les linrites de la ville de la Nouvelle-Orleans. aucune personne affect6e d'aucnne maladie contagieuse on pestilen- tielle, paiera une amende de cent piastres par chaque person ne ainsi affectee, qu'il aura debarquUe on laisser debarquer. Art. 4. Il est de plus ordonne, Qu'il sera du devoir de tons proprietaires, capitaines, maitres ou com- mandants de navires arrivant de la mer et ayant a herd aucune maladie contagieuse ou pestilentielle. de jeter 1'ancre ainsi qu'il est pr6scrie dans le pre- mier article de la persent ordonnance, et de notifler immediatement le Maire de cette ville de ce fait; et le Maire notifiera immediatement le Bureau de ^ante de l'arriv6e d'aucun de ces n >vires; et il sera du de- voir des dits membres du dit Bureau de se rendre a bord de ce navire et d'examiner les personnes affect6es, et de faire au Maire un rapport du resultat de leur examen. Et tout proprietaire. capitaine ou commandant de navire refusant ou negligeant de se conformer aux dispositions du present article, paiera une amende de cert piastres. Art. 5. 11 est de plus ordonne, Que toutes les fois qu'un navire ayant il bord aucune maladie couta- gieuse ou pestilentielle. aura jet6 1'anchre comme il est present par la pi^sente ordonnance. il ne sera permis il aucune personne de d6plncer ledit navire, jusqu'a uto Que le propritouirej capitaine uu tom- History of Quarantine in Louisiana, Joseph Jones, M. D. CLI such vessel shall have first procured to that effect a written permit from the Mayor of this city ; and it shall be the duty of the Mayor, prior to granting such permit, to cause an examination of such vessel to be made by the Board of Health, and upon the Board of Health certifying in writing that all infec- tious or contagious disease has disappeared from such vessel, he shall grant permission to such vessel to remove from the anchorage and moorat any of the wharves ; and each and every person or persons re- moving or attempting to remove any vessel or ves- sels from the anchorage as aforesaid, shall pay a tine of one hundred dollars. Art. 6. Be it further ordained, That the fines and penalties imposed by this ordinance shall be recov- ered before any competent tribunal, for the benefit of the Board of Health of the city of New Orleans. Art. 7. Be it further ordained, That the printer of this Council shall print one thousand copies of this ordinance and deliver the same to the Mayor, and the Mayor is requested to forward two hundred copies.of the same to the branch pilots at the Balize and the Passes, with the request that they distribute the same to the captains and masters of vessels com- ing from sea. Art. 8. Be it further ordained, That all oidinauces contrary to the provisions of this or linance, be and the same are hereby repeal- d. (Signed) D. STICKNEY, President. Approved June 18, 1837. A. D. CROSMAN, Mayor. A true copy. A. MAZUREAU, Secretary. mandant du dit navire ait obtenu A cet effet, du Maire de cette ville, une permission 6crite. Et il sera du devoir du Maire, avant de d61iverer la sus- dite permission, de taire examiner le dit navire par le Bureau de Sante, et lorsque le Bureau certifiera par ecrit que toute maladie contagieuse ou pesti- lentielle a disparu dudit navire, alors il accordera la permission de deplacer ledit navire et de le faire aborder A 1'un des wharfs; et toute personne qui deplacera ou essaiera de dSplacer aucun navire ainsi qu'il est dit ci-dessus, paiera une amende de cent piastres. Art. 6. Il est de plus ordonne, Que les amendes im- posees par cette ordonnance serontrecouvrables par- devant tout tribunal competent au profit du Bureau de SantA . Art. 7. Il est de plu s ordonne, Que 1'imprimeur de de ce Conseil imprimera mille exemplaires de cette ordonnance et les delivrera au Maire, qui est requis d'en transmettre deux cents aux pilotes de la Balize et des Passes, avec prdire de les distribuer aux ca- pitaines ou commandants de navires arrivant de la mer. Art. 8. Il est plus ordonne, Que toutes ordon- nances contraires aux dispositions de la pr6sente soient et demeurent rappel6es. (Sign6) D. STICKNEY, President. Approuv6 le 28 juin 1847. A. D. CROSSMAN, Maire. Pour copie conforme. A. MAZUREAU Secr6taire. CUSTOMHOUSE. NEW ORLEANS, 1 Collector's Office, November 2, 1849. j Inspectors of the customs, acting as boarding officers, will deliver to the captain or officer in com- mand of every vessel entering the river from, which he may board, on board of which there may be any in- fectious or contagious disease, a copy of the above ordinances, and will promptly report to me all such cases, making a note on the manifest of the vessel thereof, noting the number of persons sick with such diseases, and the number that have died during the voyage, as may be reported to him by the captain or offi- cer in command, or as may be ascertained from other reliable sources. * SAMUEL J. PETERS, Collector. ESTABLISHMENT OF THE PRESENT SYSTEM OF QUARAN- TINE CHARGES ON JUNE 13, 1855. The memorial of the ship owners and ship agents of New Orleans, now before the General Assembly, would lead the uninformed to believe that the present bill to regulate the quarantine fees at the Mississippi Station is something new and wholly different from the organic act of the Legislature which had been in force during the past twenty- seven years. But this is not the case. 1853-54.-Louisiana had been in 1853 deprived of thousands of her citizens in the most frightful epidemic she had ever witnessed. It had not confined its ravages to New Orleans, but had spread to distant parishes in the country. lu 1855, on the fifteenth of February, the Legislature met in Baton Rouge, a few months after the yellow fever had for a second time, in 1854, desolated the State, "the general prevalence of that disease." said Governor Hebert, in his annual message, "during two successive years, in the most malignant form, seems to authorize the con- clusion that, supposing it to have been at any time of foreign origin, it has now annually a fixed habitation within our borders."-History of Louisiana, American Domination, Gayarr6, p. 677. AN ACT TO ESTABLISH QUARANTINE FOR THE PROTECTION OF THE STATE. Section 2. Be it enacted by the Senate and House of Representatives of the State of Louisiana, in General Assembly convened, That there shall be a quarantine established below the City of New Orleans, on the River Mississippi, at a distance of not less than seventy miles, by the river, from the city; that the Board of Health to be elected under this act is hereby authorized to' locate the quarantine ground, to receive the transfer of the necessary land in the name of the State, and to draw upon the Treasurer of the State for the necessary amount, out of the fund aupropriated under this act; provided, the consent of the Governor of the State is given to said purchase Sec. 2. Be it further enacted, etc., That there shall be a Board of Health composed of nine competent citi- zens of the State, to be elected as follows: Three bv the Council of New Orleans, on joint ballot, and six to be appointed by the Governor, by and with the advice and consent of the Senate; the said members shall be selected in reference to their known zeal in favor of a quarantine system. All the members of the Board shall be commissioned by the Governor for the term of one year, after having filed and subscribed in the CLII History of Quarantine in Louisiana, Joseph Jones, M, D. office of the Secretary of State, an oath well and truly to enforce and comply with the provisions of an act entitled "An act to establish quarantine for the protection of the State," and in case of neglecting or failing to comply with the above required oath within ten days after their appointment or election, their office shall be considered vacant. Sec. 3. Be it further enacted, etc., That the Board of Health shall meet once a month from the first of November to the first of June, and once a week from the first of June to the first of November, and as often as they may deem necessary. Sec. 4. Be it further enacted, etc,, That the Board of Health shall meet and organize on the third Mondav in April, and elect out of their own number a President, whose duty it shall be to reside in New Orleans and superintend the different quarantine stations of the State, and it shall be his dutv to visit them as often as the Board of Health shall deem necessary. He shall have the power to issue, during the adjournment, to constables or the sheriff, all orders and warrants provided by the provisions of this act, and shall report to the Attorney General all violations of the same. It shall be his duty to lay before the Board at each meeting the business to be transacted, and a book in which he shall enter copies of all letters written by him, orders and warrants issued, and a detail of all his acts. He shall present at each meeting all communications for- warded to him, and a report of the resident physicians amt treasurers, and perform such other duties as shall be assigned to him by the Board of Health. He shall only be removed by impeachment, and shall receive a salary of 42000 a year. Sec. 5. Be it further enacted, etc., That four members of said Board shall form a quorum ; provided, how- ever, that no contract for building shall be entered into without the consent of a majority of the Board. Sec. 6. Be it further enacted, etc, That the Board of Health shall authorize the Resident Physician to em- ploy, in case of need, an assistant physician at the Quarantine ground on the Mississippi River, w'iio shall act as his deputy, and whose salary shall not be more than two thousand dollars a year. The Board of Health shall have power to employ nurses and assistants to attend the sick, and such other persons as may be necessary to carry out proper cpiarantine regulations, and to fix their compensation; to fix the number of days of quarantine for vessels liable to it under sections ninth and thirteenth of this act, not to be less than ten dayg; to determine how said quarantine shall be performed, and to make out all legal regulations not provided by this act nor contrary to the same, and necessary to carry out a proper system of quarantine, and to enforce the same by a fine not exceeding five hundred dollars; to make rules and regulations for pre- serving good order and police within the limits of the quarantine ground, and to impose penalties for the breach thereof; to contract for the necessary buildings at the quarantine grounds; to appoint a Secretary who shall act as Treasurer, whose salary shall be fifteen hundred a year, ana who shall furnish security in a sum of ten thousand dollars. It shall'be his duty to keep a minute of the proceedings of the Board, and all vouchers and expenditures made by authority of said Board. The Board of Health shall have power to remove, or cause to oe removed, any substance which they may deem detrimental to the health of the city of New Olreans. and the commissioners of the streets shall execute their orders, whenever not in conflict with the ordinances of the city, or the laws of the State; to pass and enforce sanitary ordinances for the city, provided the same are approved by the Council and published as city ordinances; to define the duties of officers employed by them, and impose additional duties to officers appointed under this act; to issue w'ar- rants to any constable, police officer or sheriff in the State; to apprehend and remove such person or persons as cannot be otherwdse subjected to the provisions of this act, or who shall have violated the same, and whenever it shall be necessary so to do, to issue their warrant to the sheriff of the city or parish where any vessel may be, having violated the provisions of this act, commanding him to remove said vessel at the quarantine ground, and arrest Uie officers thereof, all which warrants shall be executed by the officer to whom the same shall be directed, who shall possess the like powers in the execution thereof, and be entitled to the same compensation as if the same had been duly issued out of any court of the State. The Gover- nor shall appoint a police officer to be designated as Marshal, who shall be under the control of said Board of Health, and reside at the Quarantine Station, on the Mississippi River, whose duties and powers shall correspond to those of a sheriff or constable, so far as regards the execution of warrants and arrests of persons for violation of said quarantine regulations, and for said services shall receive the annual allow- ance of one thousand dollars. Sec, 7. Be it further enacted, etc., That there shall be a Quarantine Station at some point on the Rigolets, and another on the Atchafalaya River, two miles below "Pilot Station," at the mouth of the Wax Bayou ; the Board of Health is hereby empowered, and it shall be their duty to locate them agreeably to the pro- visions of this section ; but the provisions of this act shall only apply to the station at the Rigolets from the day of the issuing of the proclamation of the Governor, as provided by section thirteenth, declaring any port on the lake-shore or on the Gulf of Mexico to be an infected place, and shall remain in full force until suspended by a vote of two-thirds of the members of the Board of Health. The provisions of this act shall apply to, and be enforced at the Quarantine Station on the Atchafalaya River, from the first of May to the first of November of each year; and also when the Governor shall have issued his proclamation, as provided by the thirteenth section, and in such a case shall remain in full force until suspended by a resolution voted for by two-thirds of the members of the Board of Health. There shall be no permanent building erected at Pilot's Station on the Atchafalaya River, but the Board of Health shall use as an hospital for the reception of the sick, hulls and cabins ot steamboats. The Board of Health shall employ an officer, whose duty it shall be, and who is hereby empowered, to require from captains of vessels, steamboats or crafts having passed the station at the Rigolets, or on the Atchafalaya River, the permit of the Resident Pdysician The Board of Health shall appoint a Resident Physician for each of the two Quarantine Stations oii the Rigolets, and on the Atchafalaya, and such other persons as may be necessary ; provided, their salary shall run only during such time as they shall thus be employed, and shall in no case exceed for the time they shall have been thus employed, the salary of the same officers at the Quarantine Station for the same space of time, on the Mississippi. Sec. 8. Be it further enacted, etc., That the Resident Physician of the quarantine ground shall receive a salary of five thousand dollars ($5000), and shall be appointed by the Governor of the State, by and with the advice and consent of the Senate, and removable at pleasure. It shall be his duty to visit every vessel comingfrom anyportand entering the mouth of the Mississippi River. He shall require the captain of every vessel thus inspected to pay the following fees: For every ship, bark or sea-going steamer, the sum of twenty dollars, and fifteen for all other vessels; provided, nothing contained in this section shall apply to any vessel or craft from New Orleans to sea and returning without having touched at any port, or at the quarantine, towboats excepted. To all vessels not coming from any infected district, as provided by section tnirteen, or not having on board patients affected with cholera, yellow fever, pestilential, contagious or in- fectious diseases, or not in a foul condition, a certificate to that effect shall be given. It shall be his duty to return to the Secretary of the Board of Health, a weekly list of vessels by him inspected, together with the amount collected for such inspections, which shall form a fund for the support of the quarantine. Sec. 9. Be it further enacted etc., That the Resident Physician shall have the power, and it shall be his duty, to detain at the quarantine ground, with their cargoes, crew and passengers, all vessels coming from an infected district, as provided by section thirteen, or in a foul condition, or having on board persons affected with cholera, yellow fever, pestilential, contagious or infectious diseases, during such time as he History of Quarantine in Louisiana: Joseph Jones, M. D. CLIII may deem necessary-not less than ten days-to compel the captain to land the sick at the Quarantine ground, to fumigate and cleanse such vessels", and to submit to such rules and regulations as will he here- after provided by the Board of Health, and that all costs incurred for vessels found in a foul condition, in- cluding the sum of five dollars for the support of each and every sick person landed at the Quarantine Station, shall be borne by the captain and owners, and shall be paid to the Resident Physician before a cer- tificate, as provided by section eighth, shall be given. Sec. 10. Be it further enacted, etc., That the Resident Physician shall have such other powers as may be delegated to him by the Board of Health, not contrary to the provisions of this act and necessary to carry them into effect. It shall be his duty to remain at the Quarantine ground, attend the sick, and perform all such other duties as may be required of him by the Board of Health. Sec. 11. Be it further enacted, etc., That the Board of Health shall appoint a treasurer for the Quarantine ground on the Mississippi River, with a salary of fifteen hundred dollars (J1500) per annum, and who shall furnish security in the sum of ten thousand dollars ($10,000). It shall be his duty to attend to the finances, collect all sums of money due by vessels in a foul condition, account and pay over to the Secretary of the Board of Health all monthly balances in his hands, and shall receive and deliver the freight of all vessels ordered to be unloaded, and perform such other duties as the Board of Health shall require of him. Sec. 12. Be it further enacted, etc., That the Secretary of the Board of Health shall deposit in bank all moneys paid over to him and shall keep a correct account of the same. He shall moreover present at each meeting of the Board a statement of its affairs, and cause his accounts to be approved by the Auditor of Public Accounts every three months, and shall act as commissary for the purchase of provisions and sup- plies, and shall deposit in bank all moneys paid over to him, ana perform such other duties as the Board of Health may assign to him. Sec 13. Be it further enacted, etc., That the Governor of the State shall issue his proclamation, upon the advice of the Board of Health, declaring any place where there shall be reason to believe a pestilential, con- tagious or infectious disease exists, to be an infected place, stating the number of days of quarantine to be performed. It shall be the duty of the Resident Physician to give timely notice to the Board of Health of the necessity of such proclamation. After such proclamation shall have been issued, all vessels arriving in the port of New Orleans, or at the Rigolets, or the Atchafalaya Station, from such infected place, shall be subject to quarantine, and shall, together with their officers, crews, passengers and cargoes, be subject to all regulations passed by the Board of Health, provided by this act. Every master of a vessel subject to a quarantine or a visitation, arriving in the port of New Orleans, who shall refuse or neglect either-first, to proceed with and anchor his vessel at the place designated for quarantine at the time of his arrival; second, to submit his vessel, cargo and passengers to the examination of the physician, and to furnish all necessary information to enable that officer to determine what quarantine shall be fixed for his vessel; third, to re- main with his vessel at the quarantine ground during the period assigned for her quarantine, and while there to comply with the directions and regulations prescribed by this act, or by the Board of Health, or with such directions prescribed for his vessel, crew and cargo and passengers, by the Resident Physician, shall be guilty of a misdemeanor, and be punished by a fine not exceeding two thousand dollars ($2000>, or by imprisonment not exceeding twelve months, or both, at the discretion of the court. Sec. 14. Be it further enacted, etc., That every person who shall violate the provisions of this act by re fusing or neglecting to obey or comply with any order, prohibition or regulation made by the Board of Health, in the exercise of the powers herein conferred, shall be guilty of a misdetoeanor, punishable by fine and imprisonment, at the discretion of the court by which the offender shall be tried. It shall be the duty of the captain of every towboat towing a vessel subject to quarantine or visitation, to leave such vessel at the quarantine ground and to inform the captain of the penalties attending a non compliancy with the pro- visions of this act. Sec. 15. Be it further enacted, etc., That the captain of any sea-going vessel, steamboat or towboat, vio- lating the provisions of this act, or the rules and regulations established or to be established by the Board of Health, shall be considered guilty of a misdemeanor, and sentenced to pay a fine not exceeding five hun- dred dollars and imprisonment not exceeding one year. Sec. 16. Be it further enacted, etc., That the Resident Physician shall report to the Attorney General all violations of this act; and it shall be his duty to prosecute all person or persons thus offending ; to collect the fines and remit the amount thereof to the Secretary of the Board of Health, whose duty it shall be to keep a separate book for fines collected, to be approved of every three months by the Attorney General, who shall receive such compensation as the board may fix for his services. Sec. 17. Be it further enacted, etc., That it shall be the duty ot the Harbor Masters in their respective districts to demand of the captain of every vessel arriving from sea to New Orleans, the permit of the Resident Physician, and to report to the Secretary of the Board of Health all vessels having entered the port without such permit. Sec. 18. Be it further enacted, etc., That from the first of May to the first of November, all towboats ply- ing from the month of the river to New Orleans shall be liable to inspection and quarantine, and it shall be the duty of the different Harbor Masters to require from the captains of said towboats the certificates of the Resident Physician, as provided by section eight, which certificate shall not be granted before a detention of at least five days ; provided, nothing therein contained shall be so construed as to apply to towboats plying between New Orleans and the quarantine ground, and no further. Sec. 19. Beit further enacted, etc., That the captain of any towboat or steamboat who shall receive on board of his boat, freight, goods or passengers from a vessel liable to inspection or quarantine, or who shall receive goods or passengers from the quarantine ground, without the permission of the Resident Physician, shall be punished by a fine not exceeding two thousand dollars ($2000), and by imprisonment at the discre- tion of the court; anil all violations of the provisions of this act at the Quarantine Station on the Mississippi River ami at the Rigolets shall be tried by the Criminal Court of New Orleans, and all violations of this act at the station on the Atchafalaya River shall be tried by the District Court of the parish of St. Mary, Sec. 20. Beit further enacted, etc., That the Board of Health shall cause such extracts of this act to be made as they may deem it necessary for the information of masters of vessels arriving in this State, and shall cause a sufficient number to be printed and delivered to the pilots, to be distributed to the masters of vessels as before provided. Sec. 21. Be it further enacted, etc., That every pilot, or any other person acting as such, shall deliver to the master of every vessel inward bound, one copy of the printed extract from this act. which shall be fur- nished him by the Board of Health ; and any pilot refusing or neglecting so to do. or aiding or landing any passenger or other person, contrary to this act, shall forfeit one hundred dollars for every offense. Sec. 22. Be it further enacted, etc., That every person who shall goonboardof any vessel while perform- ing quarantine, without the permission of the Resident Physician or his assistants, shall forfeit the sum of fifty dollars. Sec. 23. Be it further enacted, etc., That the Quarantine Station shall be known by that name, and its limits shall be designated by boards placed on the boundaries, on which shall be printed in large letters ; 'These are limits of the Quarantine Station." 19 CLIV History of Quarantine in Louisiana : Joseph Jones, M. D. Sec. 24. Be it further enacted, etc,, That the sum of fifty thousand dollarsj($50,000), be and ishereby appro- priated, out of any money in the treasury not otherwise appropriated, to be paid to the Secretary of the Board of Health, on a resolution of a majority of the board, payable by installments ; provided, that the second and third installments shall not be paid until the accounts of the Secretary of the Board of Health shall have been audited and approved by the Auditor of Public Accounts for former disbursements. Sec. 25. Be it further enacted, etc., That the buildings to be erected at the Quarantine Station shall consist of at the station on the Mississippi River, of two separate buildings, as hospitals for the sick, of a small house as a residence for the officers appointed under this act, and of a well ventilated store for the reception of the freight of such infected vessel as the Resident Physician may deem necessary to cause to be unloaded. The buildings at the Rigolets shall be constructed of wood, ami consist of a hospital for the sick and of a store for the freight of vessels or steamboats ordered to be unloaded. At the Atchafalaya Station a good shed shall be provided for the freight of vessels ordered to be unloaded. The Board of Health shall receive the transfer of such land as may be necessary at the Rigolets and on the Atchafalaya River, in the same manner and under the same conditions as are required by section one, and all plans, specifica- tions and contracts for the above buildings shall be submitted to and approved by the Governor of the State; provided, that the cost of said building shall in no case exceed the amount hereinbefore appropriated. Sec. 26. Be it further enacted, etc., That it shall be the duty of the Council of New Orleans, within ten days after the passage of this act, to elect three members of the Board of Health, as provided by section second of this act, and all acts, resolutions and ordinances passed by them after the expiration of the delav herein prescribed, and before the election of the members of the Board to be elected by them, shall be null and void. Sec, 27. Be it further enacted, etc., That the Board of Health, and their successors, are hereby created a body corporate, under the name of the Board of Health of the State of Louisiana, to sue and be sued under that title. Sec 28. Be it further enacted, etc., That all laws or parts of laws inconsistent with the provisions of this act be, and the same are hereby, repealed. Sec. 29. Be it further enacted, etc,, That this act shall take effect from and after its passage. JOHN M. SANDIGE, Speaker of the House of Representatives. ROBERT C. WICKLIFFE, President of the Senate. Approved March 15, 1855. P. 0. HEBERT, Governor of the State of Louisiana. A true copy: ANDREW S. HERRON, Secretary of State. The passage on the fifteenth of March, 1855, by the Senate and House of Representa- tives of Louisiana of "An act to establish quarantine for the protection of the State," marked a new era in the history of sanitation and quarantine in this State, and up to the present moment the great principles embodied in the twenty-nine sections of this act have not been withdrawn. Although some of its provisions have been modified, never- theless a critical examination will show that such modifications have in many respects impaired rather than strengthened the force of the original act. Thus it has been shown in the annual report of the Board of Health for 1881 (pp. 112-118) that the aban- donment of the minimum period of detention of ships from infected ports of ten full days, as ordained by the quarantine act of 1855, and the substitution therefor of the leg- islative act of 1876, was the direct means by which yellow fever was introduced in 1878. If the epidemic of 1878 was due to imported pestilence, then said importation was di- rectly and absolutely traceable to the abandonment of a definite period of detention of vessels at the Mississippi Quarantine Station. The tariff of inspection fees under the act of 1855 was as follows: "It shall be the duty of the Resident Physician at the Mississippi Quarantine Station to visit every ves- sel coming from any port and entering the mouth of the Mississippi River. He shall re- quire the captain of every vessel thus inspected to pay the following fees : For every ship, bark or seagoing steamer the sum of twenty dollars, and fifteen dollars for all other vessels." In the supplementary act passed March 18, 1858, the fees established in section eight of the act of 1855 were thus modified : "The Resident Physician shall require, for every certificate thus furnished, the follow- ing fees: Every sailing vessel of 1000 tons and over, shall pay thirty dollars ($30), every ship of 1000 tons or less, shall pay twenty dollars ($20); every bark shall pay fifteen dollars ($15(; every brig shallpay ten dollars ($10); every schooner seven dollars and fifty cents ($7 50); every steamboat, towboats excepted, shall pay five dollars ($5); every steamship from Florida, Alabama, Mississippi and Texas, ten dollars ($10); every steam- ship from other ports shall pay twenty dollars ($20)." The bill now before the General Assembly was designed to place all parties on a more equal footing and to remove certain objectionable terms relating to tonnage, and was the natural outgrowth of the complaints of the Maritime Association, which were laid before His Excellency Governor S. D. McEnery, at the extra session of the General Assembly. In the bill to fix and regulate quarantine fees at the Mississippi Quarantine Station, the fees have been modified so as to place ships and steamships on an equal footing, to restore the charges on barks to the original figure in the act of 1855, and also to permit of night inspection at the option of the master of the vessel and not upon that of the quarantine officer, upon the payment of double the amount charged for the day inspection. History of Quarantine in Louisiana : Joseph Jones, M. D. CLV The act of 1855 imposed a large tax on shipping for quarantine purposes, and under it a larger revenue was collected than has ever been received by the Board of Health since the American civil war, or than could be collected uuder the provisions of the present bill. This statement will be conclusively demonstrated by the following record of the fees collected at the Mississippi Quarantine Station during three years preceding and thirteen years following the American civil war. Fees collected by the Board of Health of the State of Louisiana at the various quaran- tine stations during a period of three years preceding the American civil war, 1869-81. Year. Quarantine Stations. Mississippi. Rigolets. Atchafalaya 1857 1858 .. $33,260 33,403 31,058 $445 707 1,365 $1,160 210 847 1859 Fees collected by the Board of Health of the State of Louisiana at the various quar- antine stations during a period of thirteen years following the American civil war 1865-78: A Mississippi. Kigolets. Atchafalaya 1869 •_ $23,960 $3,557 $1 027 1870 "21,012 ' 2,947 950 1871 23,704 255 1 160 1872 18'903 817 1,950 1873 18,336 1 635 1 989 1874 19'280 445 277 1875 13,801 1876 .... ... 19,347 674 40 1877 .. 15,109 301 60 1878 19,931 93 1879 . ... 18,114 178 22 1880 21',872 174 1881 18,052 503 From the preceding record of the receipts of the Board of Health from the various Quarantine Stations, it is evident that commerce was more heavily taxeil and yielded a heavier revenue for the support of quarantine before the recent civil war than at any period following this national calamity. During the years 1857, 1858 and 1859 the quarantine fees amounted to an annual aver- age of $34,000, and this sum was cheerfully borne by those engaged in mercantile and commercial and maritime pursuits, whilst in 1882, when the fees amounted to but little more than one-half the sum, and in the face of two years' exemption from yellow fever, the men representing the commerce of New Orleans threaten to institute measures to dafeat the collection of all quarantine fees. In view of the preceding facts, it is evident that the object of these representatives of the shipping interests of New Orleans is to practically destroy the quarantine system of Louisiana. The resistance to the quarantine system of Louisiana has been instigated and stimu- lated by the example of Charles Morgan, now represented by Charles A. Whitney & Co. If these men succeed in their efforts, and accomplish their designs, the port of New Orleans will be practically sealed during the six months of each year, unless the General Assembly of Louisiana shall assume the entire expense of the quarantine system of the State. In that event the absolute cost of maintaining the quarantine system would vary with the fluctuating value of State warrants. CLVI History of Quarantine in Louisiana, Joseph Jones, M. D. In the present depressed and deranged condition of the finances of the State of Louis- iana, it is difficult, if not impossible, to make any estimate of the probable cost to the taxpayers of Louisiana of maintaining an efficient quarantine. Another point worthy of note is that owing to the substitution of steam for sailing vessels and the progressive increase in the size of vessels coming to this port, the quar- antine fees will progressively diminish in number and the means of the board for the exclusion of foreign pestilence, etc., will consequently be curtailed. This point will be illustrated by the following table, giving the arrivals of sea-going vessels and steamboats at the port of New Orleans each year-1847 to 1859 : TABLE SHOWING ARRIVALS OF SEA-GOING VESSELS AT THE PORT OF NEW ORLEANS, EACH YEAR, 1847-1853-VESSELS FROM SEA. Year. Steam- ships. Ships, Barks. Brigs. Schrs. Steam- boats. 1847-48 206 1926 795 2977 1848-49 136 1597 456 2875 1849-50 147 1379 666 2784 1850-51 ... 190 1250 704 2918 1851-52 213 1465 673 2778 1852-53. .... 244 1524 596 3252 1853-54 204 1266 475 3076 1854-55 .. 225 1166 426 2763 1855-56 . 234 1510 399 2956 1856-57 212 1281 441 2795 1857-58 . 247 1250 388 3264 1858-59 300 1289 409 3259 • From this table there appears to have been a decrease in the arrivals of sea-going ves- sels of all classes, except steamships, in which a wholesome degree of progress was ex- hibited from 1857-1859. The decrease referred to, however, is only in number. The vessels coming to this port have been of a larger class from year to year, and the arrivals have exhibited a large increase in tonnage, as will be seen from the following table: NUMBER AND CLASS OF VESSELS PASSING THE MISSISSIPPI QUARANTINE STATION, 1880-1881. Steam- ships. Ships. Barks. Brigs. Schrs. Total. 1880 614 589 121 106 356 262 39 35 141 141 1271 1132 1881 We thus observe a progressive decrease in the number of small vessels entering the Mississippi River, whilst the actual tonnage increases within those limits determined by the depth of water, and the size of the cotton, grain and sugar crops of the Valley of the Mississippi. The actual number of vessels entered at the United States Customhouse, in 1880, was 1344, with a tonnage of 1,375,210; average tonnage 1023. In 1881, 1002 vessels, tonnage 1,123,873, average 1121 tons. Before the recent civil war the average tonnage of vessels entering the mouth of the Mississippi River ranged from 374 to 873 tons, whilst in 1880 the average tonnage was 1023. Small and insignificant as the quarantine fees now are, they will, from these causes, progressively decrease. We have, in the last place, to examine the charge that the exaction of quarantine fees for the protection of the State and Valley from the importation of foreign pestilence by the sastentation of a. proper system of quarantine, tends directly to cripple and destroy commerce. The following table presents a view of the importsand exports of New Orleans during the present century, 1850^-1880 : History of Quarantine in Louisiana, Joseph Jones, M. D. CLVII YEAR. Exports. Imports. 1805 $3 371 545 1806 3 887 323 1807 4 320 555 1808 1 261 101 1809 541 924 1810 1 890 652 1811 2 659 050 1812 1 060 471 1813 1345 153 1814 387 191 1815 5,102 610 1816 5 602 948 1817 9 024 812 1818 12,924 309 1819 9,768 753 1820 7 596 151 1821 7 272 172 $3 379 717 1822.... 7 978 645 3 817 238 1823 7,779 072 4 283 125 1824 7 928 820 4 539,769 1825 12 582 924 4 290 034 1826.... 10,284 380 8 165 521 1827 .... 11,728,997 4 531,645 1828 11 947 400 6 217,881 1829 .... 12 380 060 6 857 209 1830 15388392 7,599383 1831. . . 16761389 9 766,693 1832 16'530^930 8371353 1833 18341,373 9 950'505 1834. .... 26,527,554 13 781 809 1835. . 36.279,823 17319,814 1836 39,179318 15'117 649 1837 35,338,697 14 029,912 1838 31302,248 9'496'808 1839 23J84J67 12 864,942 1840 .. 35J36,936 10 677'190 1841 . 34387383 10 256,350 1842. 28304'149 8,033,591 ♦ 1850 38,105,350 10,760,499 1851. 54,413,963 12 800 000 1852 48,326,913 12,800,000 1853. 60 292360 13 654J13 1854 60 932J 30 14,402,050 1855 55300711 12323308 1856 80347'963 17 183327 1857 91,514,286 24,981,150 1858 88,382'438 19386313 1859 101'634 952 18,349316 1860 108393,567 20^920349 IMPORTS AND EXPORTS OF NEW ORLEANS, 1805-1860. From the preceding table it is evident that during the ten years extending from 1805 to 1815, inclusive, the increase of trade by no means corresponded with that of the popu- lation. On the contrary, a large falling oif was exhibited even before the commencement of the war of 1812-15. The close of the war, however, inaugurated a new era in the commercial history of New Orleans. The exports increased from $387,000 in 1814, to $12,918,000 in 1818. This wonderful advance, however, was checked, and a large falling off was exhibited during the next six or seven years, although the average largely exceeded that of any previous period of ten years. From 1820 up to the commencement of the civil war (1820 to 1860 inclusive J the increase of trade and population of New Orleans was remakable. It is worthy of note that when the quarantine was established in 1855, the total exports were $55,400,711, and the imports $12,923,608, while four years after, in 1860, the exports reached $101,634,952, and the imports $18,349,516. During the wonderful increase of the commerce of New Orleans, under the operations of the quarantine act of 1855, which embraced the essential conditions of the quarantine of this day, the revenue derived from quarantine was almost double that of any year following the American civil war. The following table will show still further that the quarantine system of Louisiana, so far from being a burden upon commerce, has fostered and promoted it: * From 1843 to 1849 inclusive, the exports of foreign and domestic merchaiidise avaia^xl about $40,000,00 0 the averaye of the imports from furu^u couutriue was barely $U^XJU,U0th CLVIII History of Quarantine in Louisiana : Joseph Jones, M. D. total Valve of commodities exported and imported at new Orleans for THE FOLLOWING PERIODS. Year. Exports. Imports. 1870 .$101,385,257 $17,705,659 1871 93,532,797 18,333,530 1872 95,950,942 30,000.377 1873. .. 100,930^307 18'285,527 1874. . . 87'974,797 13,472,483 1875 76'695,700 11'6373*8 1876 81'387'836 9,634,263 1877 70'270,593 11,340,751 1878 74,366,388 8,725,751 1879. 81.105'822 8^259'606 1880 102,528'366 li;800;977 From the preceding statistics it is evident that under the direction of the present Board of Health the foreign commerce of New Orleans has been greater than at any period since the close of the civil war-1861-1865; and that, with the exception of the year 1860, New Orleans actually enjoyed a larger commerce in 1880, during the action of the present quarantine law, than in any other year from her foundation in 1718. All the great sanitary and quarantine measures of the past twenty-seven years in Louisiana may be directly or indirectly traced to the act "to establish quarantine for the protection of the State," approved by P. O. Hebert, Governor of the State of Louisiana , on the fifteenth of March, 1855. During the preceding 156 years of the existence of the colony and State of Louisiana, the sanitary and quarantine efforts by the State and people were spasmodic, unsatisfac- tory and of short duration, and at frequent intervals the people were decimated by foreign pestilence imported by maritime men and immigrants. The exports of 1880 reached $102,528,376, and the imports $11,809,977; total exports and imports $114,338,353. The total amount collected from this vast sum for the pro- tection of the commerce and trade of New Orleans and the Mississippi Valley was $21,872.C an this paltry sum, barely sufficient to keep the quarantine establishments, guarding some 500 miles of the coast, be regarded as a tax on commerce-a burden de- structive to the growing comtnerce of New Orleans ? The internal or interstate trade of New Orleans now exceeds, annually, two hundred million dollars ; the preservation of the trade depends absolutely upon an efficient quarantine guarding the approaches to the Mississippi Valley from the Gulf of Mexico. New Orleans will become a great man- ufacturing centre for cotton, tobacco, jute and sugar, provided pestilence is kept away by a rigid system of quarantine and by an equally rigid system of domestic sanitation. If yellow fever is allowed to enter in May or June or July, the port will be hermeti- cally sealed until the disappearance of yellow fever. During this period, which may last as long as six months, there will be, practically, non-intercouse with surrounding States, and all manufactories will be closed, as there will be no possibility of shipping manufactured articles. No system of manufactures, however well ordered, can sustain such periods of inactivity. These facts relate solely to the mercantile and money view of this question. Truly, when we further consider that during the years 1853, 1854 and 1855, New Orleans lost 12,780 of her citizens by yellow fever, an imported pestilence, and that only' four years ago she lost 4056 souls, and about $15,000,000, by this same scourge, the necessity of the most thorough and stringent legislation with reference to quarantine fees is clearly per- ceived. The State of Louisiana has a right to demand that commerce, which benfits the entire Valley, and derives its richest rewards from the cotton, sugar and grain of these great Southern and Western States, shall pay a sufficient amount for such a system of inspec- tion and disinfection and quarantine as will prevent the introduction of foreign pesti- lence. With great respect, I have the honor to remain your obedient servant, JOSEPH JONES, M. D., President Board of Health, State of Louisiana. The preceding letter was illustrated by statistics, giving the main facts and figures re- lating to the commercial history and progress of population in Louisiana. GENERAL CONCLUSIONS. 1. The minimum length of quarantine detention should be definitely fixed by enact- ment of the General Assembly of the State of Louisiana. History of Quarantine in Louisiana: Joseph Jones, M. D. CLIX All nations and States, holding commercial relations with New Orleans, should have at all times a firm basis for calculation as to the minimum period of quarantine detention of ships from infected ports. The important subject of minimum period of quarantine detention should not be left to the accident of political changes, or to the varying powers and influence of commerce, or to the changing caprice of popular opinion, prejudice or fear. In the immediate presence of pestilence the people are timid, and prone to demand the unreasonable and even barbarous measures dictated by abject fear and absolute devotion to self-preservation, and it has been too often the case that the most liberal, enlightened and fearless of the medical prefession have been powerless either to control, direct or breast the storm of»popular terror, indignation, prejudice and abuse. 2. The minimum period of quarantine detention of vessels from infected ports, at the mouth of the Mississippi River, should not be less than ten (10) days. If under such a restriction commerce with ports infected with yellow fever is impos- sible, then let the commerce perish, in order that the health and lives of the people of Louisiana may be preserved and the safety of the surrounding States assured. 3. Quarantine in Louisiana has failed in excluding foreign pestilence on the one hand, and in establishing confidence in the health authorities of surrounding States on the other hand, because it has been uniformily opposed by the commercial interests, and condemned by members of the medical profession, who have generally been supposed to be competent to judge of such questions. The system of quarantine so wisely inaugurated in 1855 has been subject to violent and unreasonable changes, and has been made to suit the changing opinions of the so- called people, as developed in the fierce conflict between private gain and public health. No system of quarantine has been subjected to more violent and sudden changes or to more empirical treatment. Upon the experiments of a few years, those placed at the head of commercial and sanitary affairs jumped to unwarranted conclusions and .risked the lives of the people upon the results of crude and illy-devised experiments : These propositions will be sustained by the following facts: (a) The act of 1855, " To establish quarantine for the protection of the State," abso- lutely compelled the Board of Health to fix the number of days of quarantine for ves- sels liable to it, 11 not to be less than ten days." See sections 6, 9 and 13. The minimum period of quarantine detention of ten (10) days is again enunciated in section 3 of the supplementary act, approved March 18, 1858; but we find an important and, in the light of history, a fatal change in the entire system of quarantine detention, which rapidly developed the abundant harvest of disease and death. Section 3 of the act of 1858 provides : " That all vessels in a foul condition, or vessels whose crews or passengers are suffering or have suffered while on the voyage from con- tagious, pestilential or infectious diseases, shall be detained by the Resident Physician at the Quarantine Station such time, not less than ten days, as may be deemed by him necessary." Section four of the act of 1858 provides : 11 That in case of emergency the Board of Health shall have power to issue proclamation of quarantine without reference to the Governor, and to enact all needful regulations for the enforcement of the same." An important and, as the events of 1858 show, a fatal modification was made in sec- tion five, as follows : • " That vessels out ten days, presenting clean bills of health, not having, nor haviny had, sickness on board, and which are not in foul condition, shall be permitted to pass to the city after thorough fumigation by disinfecting agents ; to effect which purpose the Resident Physi- cian shall detain said vessel as long as he may deem necessary." In 1855, New Orleans lost 2670 of her citizens by yellow fever, while in 1856 she lost only 74, and in 1857 199, by the same disease. The short experience of two years (1856 and 1857) of comparative immunity from yel- low fever, appears to have given power to the opponents of quarantine, and served to obliterate the terrible scenes of 1853, 1854 and 1855, and led the Legislature of Louisiana to enact the important and fatal modification of counting the ten days of detention not at the quarantine stations, but from the point of departure to the port of New Orleans. It is well known that the period of comparative exemption from yellow fever in 1856 and 1857 was immediately followed by the epidemic of 1858, which, in the history of New Orleans, ranks second only to 1853 in severity, and claimed 4855 victims. A period of eight years followed of comparative exemption from yellow fever, the deaths being as foliows: 1859, 92; 1860, 15; 1861, 0; 1862, 2; 1863, 2 ; 1864, 6; 1865, 1; 1866, 185. During four of these years (1860-65) the city of New Orleans was excluded from active participation in foreign commerce by the existence and disastrous fortunes of the great American civil war Cholera, however, appeared in 1866, and continued through 1867, receding in its influence as the yellow fever advanced, and again exciting alarm by the number of its victims as the yellow fever subsided, 234 deaths from cholera being re- ported in November, and 210 deaths in December. CLX History of Quarantine in Louisiana, Joseph Jones, M. D. In 1867 yellow fever appeared in June, and before the end of the year destroyed 3107 of the citizens of New Orleans. The Quarantine act of 1870 was important, in that it conferred upon the Board of Health the "power to appoint Sanitary Inspectors" in the District of New Orleans and in the City and Parish of Jefferson, " in lieu of the four health officers now appointed by the Council of New Orleans;" and we find, also, that in accordance with sections nine and thirteen, of the act of 1855, the number of days of quarantine of vessels liable to it was fixed, "not to be less than ten days." It appears, however, that practically the period from port to port was counted in the ten days. b. The empirical use of carbolic acid for the arrest of the spread of yellow fever in New Orleans led to most important modifications in the quarantine system of Louisiana, and to such modifications may be traced the wide-spread and fatal epidemic of 1878, as well as the epidemics of 1873 in Memphis and Shreveport. Carbolic acid appears to have been first used for the "arrest of yellow fever " as a "disinfectant" during the memorable epidemic of 1867, under the direction of S. E. Smith, M. D,, President of the Board of Health. Yellow fever appeared in June. The first case died in the Charity Hospital on the tenth of this month. Dr. Smith states that " Every house where a case was reported as haviny occurred was, under the direction of the health officers, cleansed and fumigated with sulphurous acid gas and carbolic acid. The premises, likewise, were subjected to the provisions of the health ordinance, and the privies purified with the sulphate of iron." Dr. Smith held that " The slow development of the cause of the fever, its apparent temporary suspension in particular localities, the exceeding mild character of the dis- ease, leads to the hope that it may be kept in check, if not entirely eradicated, in the first cases, by the prompt application of disinfectants." At this time Professor E. S. Lewis, Health Officer of the Third District, expressed him- self as in favor of the carbolic acid disinfection for the arrest of yellow fever. Professor Lewis says: "The number of houses disinfected of yellow fever from the middle of August to November 1 was about 300. These houses were not only fumigated and disin- fected with sulphate of iron, in solution, but were pumped from top to bottom with car- bolic acid, which impregnated the atmosphere for some distance off. This was repeated as often as new cases occurred." Notwithstanding these measures the disease became epidemic. An immense number of cases occurred, and 3107 deaths were reported as directly caused by yellow fever, in addition to 990 deaths caused by the various forms of paroxysmal and continued fevers. With the overthrow ot the Democratic party by the action of the so-.called reconstruc- tion acts, and with the installment of the Republican party, the sanitary affairs came into the hands of Dr. C. B. White, late Sanitary Director of tjie New Orleans Auxil- iary Association. In 1869 only three deaths were recorded as due to yellow fever. During the summer and autumn of 1870 the deaths from yellow fever, as reported by the Board of Health, numbered 587 ; but it is worthy of note that other forms of fever, chiefly malarial fever, caused 591 deaths; total from fevers in 1870,1178; of this num- ber 211 were recorded as due to pernicious and congestive fevers. The lavish use ot car- bolic acid by the Board of Health for the "arrest of yellow fever" is well known, and the total sums of money expended have been before* recorded. According to the published statement of the President, all cases that came to the knowledge of the Board of Health were treated by the free use of such disinfectants as chlorine, sulphurous acid, carbolic acid and lime. The monthly mortality by yellow fever was as follows: August, 3; September, 231; October, 242; November, 106; December, 5; total, 587. In other words, yellow fever followed its usual course of rise and decline, and the heaviest mortality occurred in the month of October, after the thorough installation of the carbolic acid disinfection. In 1871 the cases of yellow fever reported were 114 and the deaths 54 ; the disease was chiefly confined to the Fourth District, but sporadic cases occurred in other portions of the city, as in numberless other years, in this and other Southern cities, in which neither carbolic acid nor any other disinfectants were used. In 1871 the disease was still more limited, only 83 cases and 39 deaths having been officially reported. In 1873 the first case of yellow fever occurred on board the Spanish bark Valparaiso. According to the statement of Dr. C. B. White, President of the Board of Health, "This bark left Havana June 15, in ballast, and arrived at quarantine, on the Mississippi River, June 14, and was detained there two days, after which she was released and per- mitted to come to the city, arriving June 26." The mate, Arua, was taken sick with yellow fever on the fourth of July. It is evident, therefore, that if this bark had been held at the Mississippi Quarantine Station for ten full days, according to the laws of Louisiana, not only would New Orleans have escaped the fever, but Memphis and Shreveport would have, in all probability, escaped the terrible epidemic of 1873. Of the 388 casesand 226 deaths the monthly record was as follows: July, 8 cases, 3 deaths ; August, 40 cases, 19 deaths ; October, 135 cases, 79 deaths; November, 22 cases, 17 History of Quarantine in Louisiana: Joseph Jones, M. D. CLXI deaths. Yellow fever followed its usual course, increasing up to a certain period, and then declining with the fall of temnerature, and ceasing with the appearance of frost. No connection between the decline and cessation of this disease and the vast amounts of carbolic acid used for purposes of "disinfection" could be traced. In 1874 Dr. Alfred Perry instituted what he called a new plan of disinfection at the Mississippi Quarantine Station, from Junel6 to October 31, and affirmed that "this disin- fection was more complete than has ever before been performed anywhere in the world." The essential portion of this system of disinfection consisted in forcing the sulphurous acid gas, resulting from the burning of sulphur in an iron furnace, down the hold of ships by means of a wind blast or blower. Dr. Perry held that whilst in 1871 yellow fever was imported into New Orleans through the quarantine by the brig Hope, and in 1872 by the steamship Havana, and in 1873 by the bark Valparaiso, that no yellow fever came through the quarantine during this period of service (June 23 to October 13), although it was brought in by the bark Queenstown, October 16, after his disinfection had ceased. The results of the experiments of Dr. Perry were received as conclusive by the Presi- dent of the Board of Health, by the Chamber of Commerce, and by a considerable por- tion of the Medical Profession, and the Legislature was petitioned to abolish the specific period of detention. The Hon. G. W. R. Bayley read an elaborate defense of the system of disinfection practiced by the Board of Health, and thus defines the theory upon which the Board of Health acted : "The theory that yellow fever is propagated by germs from infected centres, along surfaces in all direc- tions, and that it is not conveyed in the atmosphere otherwise, seems best to explain its phenomena. The disease is local and must be destroyed, and its spread prevented by local remedies. Carbolic or phenic acids • kill in loco parasites (or germs) of both systems-animal or vegetable-as announced by Professor Gritzier, of Paris, in 1874. " The New Orleans Board of Health have since, and including 1870, acted upon this knowledge-only recently discovered elsewhere-and applied carbolic acid to germ-infected surfaces, and to surfaces sur- rounding infected centres or surfaces, for the purpose of destroying and preventing the multiplication and dissemination of yellow fever disease germs, and knowing that it would ' kill in loco' all germs, whether animal or vegetable, with which it came in contact, and that none of them could cross such a disinfected surface," The President of the Board of Health, Dr C. B. White, in his Annual Report of 1875, says: • , "The paper of Hon. Mr. Bayley, of this Board, read before the Chamber of Commerce of this city, and the resolutions adopted by that body are of special interest, as both, based upon the supposed advances in theory, method and results of disinfection will be brought before the Legislature to essentially modify the definite time-detention feature of existing quarantine laws."-Annual Report, 1875, p. 15. RESOLUTIONS OF THE CHAMBER OF COMMERCE. "Resolved, by the Chamber of Commerce of New Orleans, That the system of disinfection to prevent the propagation and spread of in factious diseases in our city, practiced with so much apparent success since 1870, should be continued and encouraged by the State authorities; also, that the efforts of the Board of Health to prevent epidemics are approved and commended." ***»***♦*#» " Be it furthur Resolved, That this Chamber recommends to the present Legislature to grant authority to the Board of Health to permit, at its discretion, the passage of vessels from infected ports to the city, after the same have been satisfactorily and thoroughly fumigated and disinfected, in lieu of the prescribed time-detention called for by the existing quarantine law." The following petition to the Board of Health, in regard to quarantine, is a remark- able document, and was published in the New Orleans Medical and Surgical Journal (new series), vol. 2, 1874-5, pp. 960-964: NEW ORLEANS, April 26, 1875. To the President and Members of the Board of Health of the City of New Orleans : Gentlemen-The undersigned, practicing physicians of the city of New Orleans, beg leave to submit: 1. That after many years of experiment, it has been clearly proven that quarantine does not protect this city from yellow fever. 2. That the commerce of this city upon which her prosperity and the livelihood of more than half of her population, directly or indirectly depend, must continue to be most seriously damaged by the repetition of said quarantine. In view of these facts, we pray your honorable body not to recommend in future the imposition of any greater restriction upon vessels arrived from infected ports than to require them to be disinfected at the quarantine stations, and to remove to hospital at the same points any cases of yellow fever which may exist on board ; the detention for this purpose not to exceed twenty-four hours, and unaffected passengers, in the meantime, allowed to proceed to the city. (Signed) T. Alpuente, D. M. P., 142 Royal street. A. Foster Axson, M. D., 178 Annunciation street. E. B. Beach, M. D., 16 Claiborne street. C. Beard, M. D., 14 Dauphine street. S. M. Bemiss, M. D., 558 St. Charles street. Henry Bezou, M. D., 144 Dumaine street. C. J. Bickham, M. D , 710 Magazine street. W. P. Brown, M. D., 603 St. Charles street. J. Borde, D. M. P., 130 Customhouse street. D. Warren Brickell, M. D., 14 Dauphine street . J. N. Folwell, M. D., 221 Carondelet street. Edward Harrison, M. D., 112 Canal street. Alexander Hart. M. D., 19 Camp street. F. Hawthorn. M. D., University Building. D C. Holliday, M I) , 112 Camp street. A. C. Holt, M. 1)., 242 Felicity street. O. Howard, D. M. P., 117 Royal street. Wm. E. Kennedy, M. D., 168 Julia street. T. S. Kennedy, M. D., 168 Julia street. P. A. Lambert, D. M. P., 117 Koval street. CLXII History of Quarantine in Louisiana: Joseph Jones, M. I). A. Capdeville D. M. P., 449 St. Charles street. J. Carter, M. D., 694 Magazine street. John J. Castellanos, M, D., 72 Orleans street S. E. Chailld, M. D., University Building. Alc6e Chastant. M. D., 485 Magazine street. H. C. d'Aquin, D. M. P., 41 North Rampart street. John Dell 'Orto, D. M. P.,143 Julia street. J. P. Davidson, M. D., 242 Prytania street. D. H. Dennis, M D , 245 Baronne street. E. DeBlanc, M. D., 159 Dumaine street. C. Faget, D. M. P.. 159 Burgundy street. J. A. C. Fisher, M. D., 168 Felicity street. H. I). Schmidt, M D., 90 North Rampart street. B. Scratchley, D. M. P., 377 Dryades street. E. T. Shepard, M. D., 1140 Magazine street. E. Souchon, M. D., University Building. Benjamin Still6, M. D., 204 Prytania street. C. H. Tebault, M. D., 469 Baronne street. J. Trudeau, M. D , 132 South Rampart street. Charles Turpin, D. M. P., 41 North Rampart street. J. H. Wiendall, M. D., 304 Bayou road. S. S- Wood, M. D., 768 Magazine street. Thomas Layton, D. M. P., 702 Magazine street. J. Hampden Lewis, D. M. P., 289 Royal street. E. S. Lewis, M. D., 70 Frenchmen street. F. Loeber, M. D., 161 Baronne street. Samuel Logan, M. D., University Building. J. J. Lyons. M. D., 219 Carondelet street. Sabin Martin, D. M. P., 96 Burgundy' street. Armand Mercier, D. M. P., 220Girod street. W. S. Mitchell. M. D., 10 Carondelet street. T. J. Moreau, M. D., 118 Marais street T. G. Richardson, M. D., University Building. P. Yeiser, M. D., Louisiana avenue. M. Schuppert, M. E., 179 Carondelet street. J. F. Siguer, M. D., 82 Carondelet street. Howard Smith, M. D., 91 Prytania street. J. C. Stickney. M D., 168 Orange streei. F. L. Taney. M. D., 377 Dryades street. J. Touartre, D. M. P., 142 Dumaine stieeX. D Tureaud, M. D., 132 South Rampart street. W. D- Watkins, M. D., Rousseau street. W. B. Wood, M. D., 768 Magazine street. The New Orleans Medical and Surgical Journal, edited bj' S, M. Bemiss, M, D., Vol II. New Series, 1874-5. May, 1875, pp. 960-962. The editor of the New Orleans Medical and Surgical Journal not only published the petition to the Board of Health in regard to quarantine, "in order to exhibit the senti- ment of a large number of our leading physicians in respect to the true value of quaran- tine," but strongly indorsed the same by his signature and by a special editorial, from which we extract the following : " As an illustration of the drift of medical opinion, it is a movement which cannot be too highly estimated- Whatever of wisdom-whatever of actual benefit to man in a sanitary point of view may have been accorded to the practice of quarantine in former days, we are forced to admit its entire infeasibility and impractica- bility at the present time. The folly exhibited by attempts to blockade the great natural highway of com- merce, which the Mississippi river affords, and yet permitting unrestricted ingress of persons and families by the general railways which centre here, is too apparent to require discussion. * * * ' Recognizing these truths, the medical profession desire to do away with restrictions on commerce which render no compensation in the way of protection against disease. What other means of protection do we propose to substitute! Surely nothing promises such good results as those measures which are practiced under the term 'disinfection.' * * * * " The good results ascribable to the use of disinfectants point to this method as the proper substitute for quarantine. " The medical profession of this city includes a member whose experience, accurate chemical knowl- edge, great zeal and ingenuity in the application of means, qualify him most admirably for attaining the best results possible to be reached by disinfection. I refer to the gentleman who during the last year did himself so much credit in this kind of service. If an epidemic seems imminent on account of threatened approach of yellow fever, his employment, with a carte, blanche as to the means to be used, would afford a satisfactory test of the amount of benefit to be obtained by disinfection. " The quarantine laws of Louisiana demand revision and alteration. It is strikingly absurd to attempt to settle by legal enactments questions which are still sub judice at the bar of science, This absurdity must be charged against any statute which expressly provides that members constituting a scientific com- mission shall hold to one or another opinion in regard to unsettled questions connected with their duties. The explanation of this curious feature in the statute must be found in the fact that it was passed shortly after the great epidemic of 1858, when people were bewildered in regard to the best mode of securing exe-p. tion from such fearful plague. In the matter of fixing the duration of detention at quarantine they " (the members of the Board of Health) "possess some powers, but the law explicitly states the period shall not be less than ten days "-[New Orleans Medical and Surgical Journal, edited by S. M. Bemiss. M. D. Vol, II. N. S., pp- 960-962. 4. The combined efforts of the Board of Health, the Chamber of Commerce ami "a large number of our leading physicians," led to the enactment of the following law, in which the great scientific fact that the poisons of specific diseases act in accordance with definite laws, and after introduction into the system require a certain period (period of incubation) for the manifestation of their characteristic and recognizable phenomena was io-nored. Small-pox has its period of incubation as well as the vaccine virus, and yellow fever most generally manifests itself within from two to nine days after exposure to its cause. The framers of the Quarantine Act of 1855 were, therefore, wanting neither in science nor experience, but recognized a well-known law of disease, and wisely framed their or- dinance for the protection of the State of Louisiana and the Valley of the Mississippi from foreign pestilence, by including as an essential element of quarantine, a period of minimum detention of ten days at Quarantine Station. The advanced Sanitarians and Legislators of Louisiana, in 1876, condemned these "obsolete and absurd notions," developed by the careful observations of such men as Rush and Jenner, and upon the results of five years' experimentation with carbolic acid, and a little less than five months' trial with a "new process of disinfection" at the Missis- sippi Quarantine Station, substituted the following : AN ACT to authorize and empower the Board of Health of the State of Louisiana to detain and disinfect , and to pass after disinfection, vessels from infected ports, and from Quarantine Station, m lieu of a time of quarantine detention, in certain cases, and to repeal conflicting laws. Section 1. Be it enacted by the Senate and House of Representatives of the State of Louisiana, in General Assembly convened, That the Board of Health of the State of Louisiana be and is hereby authorized and History of Quarantine in Louisiana: Joseph Jones, M. D. CLXIII empowered, at its discretion at any time, to cause the detention at quarantine stations, for purposes of dis- infection and fumigation, and to disinfect, fumigate and purify any and all vessels from ports in which yel- low fever usually prevails, or from ports where other contagious or infectious diseases are reported to'ex- ist; and after such disinfection, fumigation and purification at quarantine, to permit the passage to the city of New Orleans of such vessel or vessels, without any prescribed time of detention, when it is satisfied that the same have been properly and sufficiently disinfected and purified, so that said vessel or vessels may safely be permitted topass without damage to the public health or risk of contagion. Sec. 3 Be it further enacted, etc., That all laws or parts of laws conflicting with this act, be and the same are so far as respects the operation of this act, hereby repealed, and that this act shall take effect from and after its passage. (Signed) E. D. ESTILETTE, Speaker of the House of Representatives (Signed) • C. C. ANTOINE, Lieutenant Governor and President of the Senate. Approved March 24, 1876. WILLIAM P. KELLOGG, A true copy: Governor of the State of Louisiana. P. G. Deslonde, Secretary of'State. Such measures prepared the way for the great epidemic of 1878. 5. The yellow fever epidemic of 1878 in New Orleans and in the Mississippi Valley was traceable to the introduction of the disease through the Mississippi Quarantine Station, in consequence of the substitution of so-called "disinfection" for the minimum period of detention of not less than ten days. The late Dr. Samuel Choppin, in his report to His Excellency, Frances T. Nicholls, Governor of the State of Louisiana, said : "The Board of Health accepts the theory that yellow fever is a zymotic disease, contagious in its nature by the multiplication of its germs, the infecting distance of which is at first short: that it travels on sur- faces, and, like the orange, the banana and the sugar cane, is exotic, its cradle being the Antilles. * * * " The experience of 1877 affords valuable teachings in the absence of our wonted scourge. First, it tes- tifies that yellow fever may be entirely destroyed here by the frost of an unusually vigorous winter, from which it follows that this is not an original habitat of the infection. Secondly, it testifies the utility of a suitable quarantine system. Thirdly, it testifies that, by the combined action of frost, quarantine and disinfection when required, we may reasonably hope to keep the mastery over this pestilence, which has made our city a dread to its inhabitants, and an abhorrence to strangers, at incalculable cost to its commer- cial prosperty. * * * " The advantage of a system of quarantine, with the omission of the objectionable feature of detention, and reliance on inspection and disinfection, was so strongly commended to the Legislature in 1876 as to obtain its legal sanction, and the experience of two years justifies our confidence in its efficiency. Vessels arriving from infected ports have been subjected to fumigation by sulphur and the disinfection of the bilges by carbolic acid, while the personal baggage and beds of their crews and passengers have been treated with dilute carbolic acid. This has been continued from the issuance of the Governar's proclamation at the Mississippi Quarantine from June 15 to November 15. 1877, and at the Rigolets and Atchafalaya from June 15 to November 15."-[Annual Report of the Board of Health of the State of Louisiana to the General Assembly for the year 1877, pp. 13-15. The origin of the fearful epidemic of 1878, which swept up the great Valley, embracing in its deadly coils a space of country extending from New Orleans, on the Gulf of Mex- ico, to Chattanooga on the East and St. Louis on the Northwest, was thus detailed by Dr. Choppin, in his Report to His Excellency, Francis T. Nicholls, Governor of the State of Louisiana, on January 1, 1879 Dr. Samuel Choppin says : "It would be well here to give the early history of the recent outbreak, and what we regard as the most probable explanation of its occurrence. "On the twenty-second of May the sanitary condition of New Orleans was as good as it generally is at that season of the year. Malarial fevers were not more prevalent than usual, and there was not a single case of yellow fever in New Orleans. On the morning of that day the steamship Emily B. Souder arrived and was moored at the foot of Calliope street. "The first eases of yellow fever at New Orleans in 1878, undoubtedly, were two of the officers of the above steamship, namely : Clark, the purser, and Elliott, one of the engineers. Clark was ill when the vessel reached the quarantine, but managed to pass inspection as suffering merely from neuralgia. Quite lately it has transpired, through the inquiries of the Yellow Fever Commission, that he boasted, after arrival in New Orleans, that he had 'beaten the quarantine doctor.' Be that as it may, he went ashore sick on the morning of May 23, and two days after he died, with symptoms which belong unmistakably to yellow fever, at a house on Claiborne street, near Conti. * * * "Elliott sickened after his arrival, and was attended by a private physician at his boarding house, corner of Front and Girod streets, until the evening before his death, without apparently a suspicion on the part of any one that he had yellow fever. Late in the evening of May 29 he was removed to Hotel Dieu, where he died within a few hours. A careful post mortem examination was made by two competent physicians, and the body was subsequently inspected by myself No one of us three doubted the nature of the disease. "Here it is proper to observe that the only case'of yellow fever in New Orleans in 1877 came through the quarantine by practicing deception on the Resident Physician. This man, a passenger on a British steamer, took passage at Havana and sickened before arrival at quarantine. However, he was able to go on deck, and passed inspection while sitting with a newspaper in his hand. Fortunately, on reaching the city, he fell into the hands of a physician who promptly reported his case as yellow fever to the Board of Health, and vigorous means were at once adopted to arrest the infection. No infection had survived the vigorous winter of 1877-8; no further harm resulted from the single case of 1877, and it is fair to presum'e that no trace of the fever existed here previous to May 22. S* ■ "In 1878 the cases from the Emily B Souder were unknown to the health authorities for a full week after the arrival of the ship at her wharf, at the head of Calliope street No further time was lost in making all of the usual means of disinfection, around the intersections of Front and Girod streets.^in and arour?d 'Hotel Dieu, where Elliott died, and in and around the house where Clark died, on Claiborne street . No mbrupases followed within the period of their apprehended occurrence, and it was supposed the danger was passed. About the middle Of July some cases of a strongly Suspicious character came to light bn COnStarCC street. CLXIV History of Quarantine in Louisiana : Joseph Jones, M. D. near its intersection with Terpsichore, and in a few days all doubt was removed as to their nature. About the seventh of July a young man by the name of Cohn came to the Touro Infirmary from Gasquet street, between Villere and Marais, presenting strong appearances of t ellow fever, but he recovered before atten- tion was drawn to Constance street, and his case was considered questionable." It is not material to the great principle which we wish to establish and enforce, namely: that quarantine based merely upon disinfection without a sufficient period of detention for observation is a delusion and a sham, that we should enter into the discussion of the relations of the epidemic of 1878, to the cases of Clark and Elliott, imported by the Emily B. Souder, in the month of May (I have elsewhere fully an d decidedly expressed my opinion upon this question), but I desire to bring further proof that if the Emily B. Souder did not import pestilence in May, she did import yellow £ever in the early part of Julj, 1878. The quarantine physicians at the Mississippi Quarantine Station during the events just recorded, and those now to be noted, were, in accordance with the appointment of His Excellency Francis T. Nicholls, Dr. P. S. Carrington, Resident Physician, and Dr. G. Farrar Patton, Assistant Resident Physician, at the Mississippi Quarantine Station. Dr P. S. Carrington and Dr. G. Farrar Patton served at the Mississippi Quarantine Station from about December 1. 1877, to May 21, 1880. This period embraces the great epidemic of 1878, during which the yellow fever was introduced through this station into the Mississippi Valley by the steamship Emily B. Souder. Whatever doubt may have existed as to the spread of yellow fever from the two cases imported by the Emily B. Souder in May, 1878, no doubt can be had as to the accuracy of the reports to the St. Louis Medical Society on the yellow fever of 1878, which shows that W. P. O'Bannon contracted yellow fever from cases concealed on this ship, about the fourth of July, 1878, and died with all the symptoms of yellow fever, in St. Louis, on the nineteenth of July, 1878. Dr. A. P. Lankford gives the following information with reference to the case of W. P. O'Bannon, very probably one of the first cases in the United States, and the first or second case in Missouri, and reared in St. Louis, left this city on the steamer Co mmon- wealth, for New Orleans, Capt. Shields, his uncle, in command, late in June, 1878 hold- ing the position of assistant second clerk: " O'Bannon lived on board the Commonwealth, and while at New Orleans, about the third or fourth of July, went on board the Emily B. Souder, then lying at the levee, notwithstanding the prohibition of his uncle against his going on board any such vessel. The Souder had lately arrived from the West Indies, with a cargo of sugar, and at the time of O'Bannon's visit had two cases of yellow fever on board, which had ap- parently escaped the vigilance of the authorities. " It is probable, however, that O'Bannon came into contact with these cases. The Commonwealth lay close to the Souder at the time, and transferred to her deck from the steamship 500 hogsheads of sugar for the Belcher Refining Company, iij St. Louis. It is not known that O'Bannon went into the hold of the Souder during the process of transfer, nor is it probable that he did so, as his duty as cierk required his presence on the deck of the Commonwealth. From the time of the transfer until the twelfth of July, involving the entire period of the return trip of the Commonwealth to St. Louis, young O'Bannon who was only 16 years of age, was romping and playing among the hogsheads of sugar, which were on the main deck of the Commonwealth, with his sistei' and cousin, neither of whom were subsequently affected. He arrived in St. Louis on the night of Thursday, July 11, 1878, and seemed perfectly well on the Sunday fol- lowing, being seen on that day by Dr. Langford, on a visit to the family. The next day (Monday) he com- plained of inappetence, and of slight ch'lly sensations. About 5 p. m.he was found by his mother, after a somewhat prolonged search, under the piano in the parlor., in high fever and profound sleep, from which it was very difficult to arouse him. Dr. Lankford being called, saw him at 1 p. m. on July 16. The stupor continued, and the fever did not abate; the tongu® was inclined to be dry, and the skin devoid of moisture. The bowels had been consti- pated, urine scanty and high colored. There was, as yet, no nervous irritability of the stomach, but much thirst. These symptoms increased in intensity, the patient became delirious during the night, and the fever was observed to be of a continuous character. Some irritability of the stomach had now appeared. At a con- sultation with Dr. J. R. Baudury next day (Thursday), the fever was noted as still continuous. There was frequent vomiting, and about 8 p. m. ejection of unmistakable black vomit, which had begun some four hours previously. The dejections also were very dark. There was no very marked icterus until the morn- ing after this, when suppression of urine was also determined. The patient died on Friday, the nineteenth of July, 1878, at about 1 p. m., the fifth day of his disease. "At this date there was no declared yellow fever in the United States, except the cases on board the Emily B. Souder ; none as yet reported in New Orleans or elsewhere. At the consultation on the eighteenth of July the case was declared to be one of yellow fever, and the diagnosis was thoroughly verified at the au- topsy. Drs. Lankford, Baudury and P. G. Robinson being present. (See statements of Drs. Baudury and Robinson). " Dr. Lankford has seen many cases of intermittent fever this past year. He regards these fevers as hav- ing been exceedingly obstinate, requiring the persistent administration of large and frequent doses of qui- nine and arsenic to overcome them and prevent recurrence. An unusually high temperature, and a disposi- tion to assume a remittent character was common. " Dr. J. k Baudury saw young O'Bannon, in consultation with Dr. A. P. Lankford, on the third day of the disease (seventeenth of July). The characteristic symptoms were stupor, almost simulating coma ; there were no convulsions until the morning of the day he died: there was much gastric irritability, with ejection of glairy matter at first, but the next day black vomit was thrown up ; the icterous was not marked during life, except on the last day. The patient complained of intolerable pain in the head, when the stupor remit- ted oeqasionallsy. .Towards the end the vomiting was very profuse; there was great jactitation and sub- sultus< and some Convulsions A blister which had been applied to the nape of the neck became gangrenous after a jew hours. The case, in Dr. Baudury s opinion, was indisputably one of typical yellow fever. Dr jBaudttry paw many cases of malarial fever this past year, and regards them as having been very unusuahy severe, difilbult to manage and strongly disposed toward recurrent®. History of Quarantine in Louisiana: Joseph Jones, M. D. CLXV "Dr. P. G. Robinson, 1523 Olive street, was present at the autopsy of the youth O'Bannon. The patient had all the characteristic symptoms of yellow fever, vomiting black vomit, which was found abundantly in the stomach and intestines after death. The skin was intensely yellow. This occurred a few days after the patient's return from New Orleans, where, as elsewhere detailed, he had gone on board an infected ves- sel. From the facts observed on autopsy Dr. Robinson affirmed positively that the case was one of yellow fever. This occurred early in the season, before there was any report of the prevalence of yellow fever in New Orleans. Reports to the St. Louis Medical Society on Yellow Fever, containing the Report of the Committee ap- pointed to Inquire into the Relations of the Epidemic of 1878 to the City of St. Louis, etc. St. Louis : Geo. O. Rumbold & Co., 1879. Pp. 16,17-34. 6. Tu. view of the preceding facts, it is but reasonable to conclude that if a definite period of detention for vessels from infected ports had been enforced by the Board of Health at the Mississippi Quarantine Station during the months of May, June and July, cases of yellow fever would not have passed that Quarantine Station unobserved. If the epidemic of 1878 was due to imported pestilence, then said importation is directly and absolutely traceable to the abandonment of a definite period of minimum detention at the Mississippi Quarantine Station. The abandonment of the minimum period of quarantine detention, and the substitu- tion instead thereof of "disinfection by the legislative acts of 1876, was the direct result of the recommendations of the Board of Health, the Chamber of Commerce and certain ' leading physicians of New Orleans.'" Immediately after the epidemic of 1878, in recording my experience, I said: "One great defect in the Mississippi quarantine system is that there are no arrangements for breaking the bulk of the cargo, and no thorough fumigation of vessels infected with yel- low fever can take place unless the bulk is broken. ' The mere burning of sulphur in pans, or the injection of the fumes, is nor sufficient to thoroughly disinfect the vessel. "Quarantine should not only command all the outlets and inlets to New Orleans, but all vessels from infected ports should either be excluded, or else the cargoes should be landed at the Quarantine Station, and should be thoroughly fumigated and then trans- ferred to lighters to be transmitted to the city. * * * Vessels trading with Southern ports liable to be affected with yellow fever should be constantly under sanitary police, A medical officer should accompany the vessel and superintend the crew in the infected ports, and disinfect the vessel in port and upon the voyage, and see that every prominent sanitary measure be instituted. An imperfect quarantine, such as now exisis at the inlets of the Mississippi, has been, and will be. a sham and a delusion. The question as to the foreign or domestic origin of yellow fever should be determined by an absolute quarantine"' Yellow fever Epidemic of 1878 in New' Orleans, by Joseph Jones, M. D. New Orleans Medical and Surgical Journal, February, 1879, p. 616.) 7. Holding the opinions just quoted with reference to the yellow fever epidemic of 1878, ami with reference to the necessity of a fixed period of quarantine detention, after my election as President in April, 1880, I urged upon the Board of Health and His Excel- lency Governor Louis A. Wiltz the importance of conforming to that portion of the Quarantine Act of 1855, that vessels coming from ports where pestilential, contagious or infectious diseases were prevailing, should be subjected to a detention at the Quarantine Stations of not less than ten (10) days. Thd exact language which I held was this: "All vessels from any place where disease subject to quarantine (pestilential, contagious or infectious diseases) existed at the time of their departure, or which shall have arrived at any such place and proceeded thence to New Orleans, or on board of which during the voyage any case of such disease shall have occurred, arriving between the first day of May and the first day of November, shall remain at quarantine not less than ten days, and shall perform such and further quarantine as the Quarantine Physician and the Board of Health may prescribe ; unless the Quarantine Physician with the approval of the Board of Health, shall sooner grant a permit for said vessel or cargo, or both to proceed." The Board of Health, however, declined to recommend any specific period of quaran- tine detention, and the Governor accordingly issued the following proclamation : STATE OF LOUISIANA, EXECUTIVE DEPARTMENT. Whereas. Section 3640 of the Revised Statutes of the State of Louisiana, approved March 14, 1870, pro- vides that the Governor shall issue his proclamation, upon the advice of the Board of Health, declaring any place where there shall be reason to believe a pestilential, contagious or infectious disease exists, to be an infected place, stating the number of days a quarantine is to be performed by the vessels, their passengers, officers and crews, coming from such place or places. Now, therefore, in pursuance of the provisions of the statute aforesaid and on the recommendation of the Board of Health, I, Louis A. Wiltz, Governor of Louisiana, have thought proper to issue this my procla- mation, declaring that vessels arriving from and after the tenth day of Mav. 1880, from the following ports known to be infected with yellow fever, viz : Vera Cruz and Rio de Janiero, and the officers, crews, pas- sengers and cargoes arriving from the above named places, or having touched or stopped at any of them, shall be subject to such detention and quarantine as the Board of Health may direct. 1 And I do hereby direct the proper officers at the Quarantine Station to rigidly enforce the execution of this proclamation, and any violation of the laws of this State on this subject matter to be vigorously prosecuted, CLXVI History of Quarantine in Louisiana : Joseph Jones, M. D. In testimony whereof I have hereunto set my hand and caused the seal of the State to be affixed, at the city of New Orleans, this fourth day of May, in the year of our Lord one thousand eight hundred and eighty, and of the hundred and fourth year of the independence of the United States of America. By the Governor: ' LOUIS A. WILTZ. Will. A. Strong, Secretary of State. The period of detention was left indefinite and dependent upon the action of the Board of Health, and in consequence this proclamation did not secure that measure of confidence in surrounding States which was to be desired. At the earliest practicable moment this subject was again urged upon the attention of the Board of Health, and a resolution on the twelfth of May, was unanimously adopted to the following effect: " Sec. 6. All vessels from ports in which yellow fever is prevailing, or from ports where other contagious or infectious diseases are reported to exist, shall be detained, for observation, disinfection, purification and fumigation, not less than seventy-two hours, or such length of time as the Board of Health may determine." Under this rule all vessels liable to its application were detained not less than three days, and in all cases in which the public safety appeared to demand it, they were held from ten to twenty days. The quarantine officers were directed never to release such vessels in less than three days, and in all cases where the public safety demanded it to hold them subject to the orders of the Board of Health. The occurrence of the cases of fevei on board the bark Excelsior in July led to the extension of the quarantine. In 1881 the Governor issued his'proclamation according to law and in accordance to the recommendations of the Board of Health, that the minimum detention should not be less than seventy-two hours. This proclamation was without doubt an improvement upon that of 1880; but in accord- ance with the prediction of the President, who had urged the establishment of the quarantine according to the original act of 1855, the Board was again forced by the de- mands of the agents of the surrounding States, and certain maritime and railroad in- terests, to make the period of quarantine detention not less than ten days. 8. In view of the preceding facts developed by a review of the history of quarantine in Louisiana from 1855 to the present time, I most respectfully urge the passage by the General Assembly of acts covering the following subjects : First-The re-enactment of that portion of the act of 1855 which requires that the period of detention shall be not less than ten days. Second-The modification of the quarantine fees, so as to conform strictly to the con- stitution of the United States, and thus place all parties upon an equal footing. AN ACT to fix and regulate quarantine charges at the Mississippi River Station, to establish a lien and privilege on vessels inspected, in favor of the Board of Health for the same, and to provide for their enforcement and collection by provisional seizure. Section 1. Be it enacted by the General Assembly of the State of Louisiana, That the resident physician at the Quarantine Station on the Mississippi River shall require for every inspection and granting certificate the following fees and charges: For every ship, thirty dollars ($30); for every bark, twenty dollars ($20); for every brig, ten dollars ($10); for every schooner, seven dollars and a half ($7 50); for every steamboat (towboats excepted), five dollars ($5): for every steamship, thirty dollars ($30) Sec. 2. Be it further enacted, etc., That the Board of Health shall have an especial lien and privilege on the vessels so inspected for the amount of said fees and charges, and may collect the same, if unpaid, by suit before any court of competent jurisdiction, and in aid thereof shall be entitled to the writ of provisional seizure on said vessels. Sec. 3. Be it further enacted, etc., That all laws and parts of laws in conflict with the provisions of this act are hereby repealed, and all laws and parts of laws on the same subject-matter, not in conflict and inconsistent herewith, are continued in full force and effect. R. N. OGDEN, Speaker of the House of Representatives. GEORGE L. WALTON, President pro tern, of the Senate. Approved, July 1, 1882. S. D. McENERY, A true copy: Governor1 of the State of Louisiana. Will A. Strong, Secretary of State. RESISTANCE OF QUARANTINE LAWS OF LOUISIANA BY MORGAN'S LOUISIANA A ND TEXAS STEAMSHIP AND RAIL ROAD COMPANY. The action of certain ship owners and maritime agents in resisting the collection of the quarantine fees established by the act of 1855 for the protection of the State against foreign pestilence, has been fully consid- ered by this board, ami a large portion of the report of 1882 has been nec- essanly consumed with a consideration of those questions which are vital to the protection of New Orleans and the Mississippi Valley. History of Quarantine in Louisiana : Joseph Jones, M. D. CLXVII The following communication was addressed to Attorney General J. C. Egan : Office Board of Health, State of Louisiana. ? New Orleans, November 13, 1882. 5 Hon. J. C. Egan, Attorney General, State of Louisiana : Sir-I have the honor to enclose a copy of a petition of the Morgan's Louisiana and Texas Railroad Company against this board, No. 7001 of the docket of the Civil District Court for the parish of Orleans, enjoining this board from collecting any fees under the quarantine laws of the State of Louisiana. This suit is one of several brought by different parties, and unless decided before next summer, will seriously embarrass this board in executing the law, by depriving them of the means of maintaining the ser- vice. The board designs pushing the matter as rapidly as possible, and their attorney has already filed an answer, and had the case summarily fixed for trial on Monday, November 20, 1882, at which time he hopes to try the case. Immediately on its decision in the lower court, it will be appealed to the Supreme Court of the State and placed on the summary docket; the board hopes for a decision in December or January. Should it be decided adversely to the plaintiffs, it will be taken by writ of error to the Supreme Court of the United States, and the attorney of the board will there endeavor to have its trial advanced, so as to have a final decision before that court adjourns. This can be done under rule 26 of the Supreme Court. The attorney of the board thinks that this can be most certainly done by the State of Louisiana making itself a party by intervention or otherwise, and refers us to 16 United States Stat, at Large, 176, 301,15 Wal., 390 ; 2 Wal., 159, and United States Act 1870. As the question in- volved concerns the nullity and non-execution of all the quarantine laws of the State, it seems that the State is immediately and directly a party in interest, as in the event of a final decision, ultimately decreeing the laws of the State to be unconstitutional, or even in case the suit should go over until next winter, and the injunction remain pendihg the Governor would have to convene the State Legislature in extra session to provide means for the maintenance of the quarantine, or else abandon the system entirely, and leave the State and the whole Mississippi Valley a prey to the ravages of infectious and contagious disease by importation. I, therefore, would respectfully request you to take proper steps to make the State a party to the suit, in order to effect the contemplated purpose. The attorney of the Board, Colonel F. C. Zacharie, who will hand you this, and more fully explain to you the details of the points at issue, will furnish you with a copy of his opinion thereon, and is prepared to fully attend to the matter, and consult with you, and the Board, as well and will be greatly obliged to you if you render what services you can in the premises. Hoping for an early reply, I am, respectfully, (Signed) * JOSEPH JONES, M. D., President Board of Health. From the following statistics, consolidated under the direction of the President, from the archives of the Board of Health, it is evident that the action of Charles Morgan & Co., in 1874, led to the great reduction ot the Quarantine receipts; and it is still further evident that at the present time the receipts from Quarantine are inadequate to its support, in accordance with the organic act of the General Assembly. There has been and will be a progressive decrease in the Quarantine re- ceipts on account of the increased depth of water at the month of the Mis- CLXVIII History of Quarantine in Louisiana : Joseph Jones, M. D. sissippi River, and the increase in size, capacity and tonnage of vessels and steamships, and the corresponding diminution in their number. Thus the number of vessels entering the Mississippi in 1860 exceeded 2000, whilst in 1881 there were but 1000 in round numbers. No more important question could possibly engage the attention of the Board of Health, the General Assembly of the State and the Congress of the United States, than the support and maintenance of the Mississippi Quarantine. For ten months. : YEAH. WBB&Ss ssssgasssasESS At Mississippi Quara mine Station. EXPENDITURES FOR QUARANTINE PURPOSES. K'Kih&Siiis 8S58588S8S"£^ At Rigolets Quara n t i n e Station. HBiesaiuiiW gggggggggggSgg At Atchafalaya Quara n t i n e Station. ^-5 oo o oc c>» «mm o?> a c> gSSsgggaJSSSag !±g£gS£58£g88:g£ At the Central Office. g!38g£Ki2ggggi§K8 Total Expendi- tures for Qua- rantine Pur- poses. gglggSSig^Esg ggggg&SggggSES Total Receipts from all Quar- antine Stat'ns Office Board of Health, State of Louisiana, ( New Orleans, January 3, 1882. f His Excellency, S. D. McEnery. Governor State of Louisiana, Baton Rouge, La. : Dear Sir-I have the honor to enclose, for the information of your Excel- lency, the outline of the decision of Judge Monroe, issuing an injunction against the Board of Health, and declaring the quarantine system of Lou- ana, established by the act of 1855, illegal. The immediate effect of this decision will be to stimulate all maritime men to resist the payment of quarantine fees. The power of this lower court is thus exerted to overthrow the quarantine system of Louisiana. 1 have directed the attorney of the board to take an immediate appeal to the Supreme Court of Louisiana. In the event that the decision of the lower court is sustained the quarantine system of Louisiana will be practically destroyed, and it will be incumbent upon your Excellency to devise the necessary measures, with the constituted and legal health authorities, for the effectual exclusion of foreign' pestilence. In the event that the Supreme Court reverses the decision of the lower court, the attorney of the plaintiff will be, most probably, instructed by C. A. Whitney & Co., to appeal the case for final decision to the United States Supreme Court. With great respect, I have the honor to remain, your obedient servant, JOSEPH JONES, M. D., President Board of Health, State of Louisiana. The case of Morgan's Louisiana and Texas Railroad and Steamship Com- pany, versus the Board of Health of the State of Louisiana. No. S755. was C. Mortuary Statistics of New Orleans, Louisiana, United States of America, During a Period of 34 Years, 1844-1880, Consolidated from Original Reports and Records by Joseph Jones, M. D., New Orleans, 156 Washington Street, Fourth District, January 1, 1882. 1 GENERAL DISEASES. Small-pox and Varioloid : 1844 10 1845 1847 3r 15 154 27 233 6 2,306 1 26 17 105 4 62 I 31 1 22 1848 105 61 119 " 372 1 223 6 808 14 13 116 67 1 646 66 32 "41 13 1849 | i 133 1850 37 1851 38 26 29 '228 103 1852 1853 17 123 126 103 146 "7,849 1855 1856 53 18 "22 ' ''115 74 1857 103 104 79 8 "118 "199 1853 1859 1 4ft 1860 22 60 200 4 10 "163 15 1861 1 35 198 102 20 1863 2 98 43 9 33 257 1864 605 34 200 ii 48 268 25 6 1865 613 31 161 26 154 17 1 7otaJ 19 Years 1,856 760 1,575 6 1,320 135 2,686 184 20,348 3 4541 503 2,871 8 2,338 9,678 508 1,128 1.201 520 225 27 159 211 108 568 210 1 1 12,368 1,826 4 169 1,519 16 9 37 4 1,694 67,236 1,603 812 940 1,513 307 359 11 32 8 315 1866 188 82 41 1867 47 24 1868 14 1 15 1869 141 217 13 1870 528 44 1871 2 12 1872 29 76 1873 1 509 69 6 5 57 226 3 16 40 246 1874 587 1875 1 342 1 144 1876 232 231 123 6 2 1 53 31 42 1877 1,099 15 10 1878 151 3 1 1879 1880 1 97 56 3 1 10 52 8 2 Votal 15 Years 3,870 829 491 15 102 237 1,034 223 8,393 16 467 796 3,466 185 1,409 2,169 381 1,280 724 506 181 177 235 217 252 1,392 127 61 207 11,703 2,765 34 13 365 1,035 31 10 26 6 94 45,524 2,076 508 1,243 1,480 109 49 76 354 35 111 54 493 8 1,112 13 173 3,101 54 706 2,837 297 10 416 85 7 850 16,257 123 84 72 272 58 187 2,057 242 40 .19 77 7 4 1 194; 3,437 Grand Total 34 Years. 5 726 1,589 2,066 21 1,422 372 3 720 407 2s, 739 19 921 1,299 6,337 93 3,747 11,847 889 2,408 1,925 1 02« 406 204 394 428 360 1 960 337 62 £08 24,071 4,591 38 13 534 2,554 47 19 63 10 1,788 112,760 3,679 1.320 2,183 2 993 416 408 76 365 67 116 62 808 8 2,175 16 191 5,906 70 3,202 6 016 605 25 1,887 146 8 2,837 35,579 239 89 91 282 58 1S7 3,238 337 49 64 109 7 14 2 451 5,217 19 2 670 '7I 1'3 79 121 1 Scarlatina 1 4 121 76 - - 11 769 21 199 "103 16 107 4 Dengue Typhus Fever Uerebro Spinal Fever Enteric or Typhoid Fever Simple Continued Fever Yellow Fever i Gastric Fever I 3 "44 148 456 20 189 4,845 7 "-214 8 91 12 43 116 192 59 368 23 52 119 22 3,107 1 51 110 533 24 58 109 3 26 63 "3 3 32 36 228 13 29 80 9 587 4 ^7 51 241 ■ 4 2 71 54 1 26 39 163 1 120 6 22 84 14 1 7 9 14 7 20 90 6 4 2 67 1 39 1 27 26 165 2 1 95 10 11 4 57 0 61 3 1 9 69 7 1 23 24 44 14 4,046 33 3 19 38 29 263 "90 585 35 75 7 14 119 18 12 15 78 14) 21J 8 14 11 50 6 71 61 189 13 4 34 68 188 55 15 8 12 15 3 46 36 15 26 172 37 62 254 13 122 6 11 80 102 16 19 21 20 11 17 87 14 30 36 187 14 116 4i 12! 100 69 58 11 33 49 162 14 151 50 56 151 90 62 30 128 355 23 241 15 35 90 7 62 19 50 151 23 93 Remittent Fever Malarial Fevers.. ..j Congestive Fever i 1 Typho-Malarial Fever : (Malaiial Fever (unclassified) Cholera, Malignant or Asiatic Cholera Mo. bus Cholera In taut um 62 4 9 22 1 49 3 176 109 40 27 13 85 128 206 1,448 69 73 8 58 35 430 10 55 17 121 23 43 18 116 101 30 24 6 91 20 369 "69 26 14 108 95 2- 15 28 223 45 27 10 88 253 31 26 5 16 21 6 50 15 26 250 58 30 13 108 145 75 19 4 10 25 6 58 3 66 316 " "32 57 80 337 39 26 4 11 18 11 66 21 63 274 24 9 42 79 104 13 20 18 1.6 57 21 1491 1,329 20 16 1,294 38 88 98 41 11 1 14 15 12 54 12 45 581 46 ICO 31 28 9 6 11 16 12 63 10 46 129 22 85 16 4 1 38 4 9 56 19 121 13 2 20 10 9 90 13 87 3 15 65 19 9 18 20 19 14 35 102 12 73 137 142 99 118 46 61 20 883 20 39 23 19 14 10 23 19 90 6 22 73 40 39 14 22 18 17 15 91 7 8 16 113 33 26 8 22 20 10 25 114 11 16 79 59 19 98 58 9 9 22 19 16 11 105 14 89 81 70 11 19 12 17 13 129 4 13 W hooping Cough Erysipelas. " 16 8 44 18 12 27 13 11 19 13 16 15 115 5 10 Puerperal Fever. 1 4 12 1 188 12 3 11 3 12 12 7 12 11 27 10 7 15 12 6 24 17 21 8 8 31 14 6 12 7 31 9 7 15 16 58 17 9 11 9 79 17 16 23 94 10 19 18 17 89 9 12 Rheumatism Syphilis 16 3' 7 17 Scrofula Tubercular Meningitis Tuberculosis . Phthisis Puhnonahs .... i1 10 13 1 1 834 181 32 757 182 76 780 178 4 1 29 83 2 58 784 258 1 2 28 88 1 2 1 41 850 238 6 1 26 73 1 4 3 1 8 3,227 201 45 120 114 15 360 576 50 727 45 592 1 674 19 411 31 787 755 21 652 615 181 624 125 779 201 1 12 101 4 1 3 876 176 3 9 141 654 173 761 200 839 194 664 213 600 204 "21 79 671 161 1 1 26 42 4 632 125 1 1 19 92 2 684 159 810 261 2 1 31 66 2 799 185 1 882 191 888 150 3 1 20 75 1 880 166 2 2 29 46 1 823 163 9 863 144 4 1 18 47 2 Diabetes Rickets Anaemia 3 14 J 13 96 1 1 4 104 1 1 5 7 64 1 14 66 1 3 1 40 1 1 1 '7 21 "io 91 "'5 152 -8 128 15 153 2 "23 148 2 35 116 2 2 1 1 18 95 6 1 1 1 10 70 7 29 71 28 59 33 49 2 3 1 1 12 1,746 95 17 67 122 1 General Dropsy 84 Gout '1 Scurvy 1 1 1 6 6 1 1 1.837 92 4 96 10 4 46 1 3 5 1 15 3,579 111 47 58 75 1 20 6 3 5 1 1 4 3,119 99 41 149 124 6 3 2 Leprosy 1 1 3 458 101 101 60 3 6 2.126 132 14 73 108 2 All other General Diseases not enumerated 1 3.869 66 17 47 71 6 22 » 4,666 115 102 49 119 24 22 ' i 3 2 5,603 118 117 65 ini 1,458 3.035 57 2 26 53 5 17 1 1 165 4,228 9 7.238 1 156 17 100 114 20 40 3 1,792 77 29 45 90 7 22 2,493 81 57 44 61 6 20 12 2,845 97 62 71 100 22 26 6 3 763 92 32 75 92 12 24 4 4 5 962 160 43 57 91 6 1 1,738 91 18 70 72 1 4 2,140 109 39 95 85 4 4 1,942 141 31 117 102 8 5 2,058 186 55 103 85 7 17 2,792 214 32 57 113 25 -I 2,510 2 2,658 6 3,169 106 69 56 85 9 11 26 36 3 16 11 23 2 58 182 6 69 132 14 6,574 155 18 73 112 2 14 10 35 3 11 6 32 2 4 2 4a 177 6 88 175 14 Total Deaths from General Diseases LOCAL DISEASES. Diseasesol the Nervous System. 508 26 16 27 16 628 10,475 111 134 61 133 21 24 4,224 1,608 101 63 44 103 12 34 "5 2,564 172 14 87 101 19 20 2,498 122 30 60 164 72 18 33 21 Meningitis. 80 95 4 7 x LUI on Hydrocephalus 6 23 2. 4 Diseases of the Cerebral Arteries Spinal Meningitis 7 7 2 2 9 1 3 4 43 8 11 1 8 5 30 2 44 2 4 1 25 1 54 2 7 2 39 3 29 6 8 3 41 2 2G 16 33 7 16 5 47 8 35 3 9 2 39 1 °5 58 208 3 5 172 19 Myelitis 1 5 'i 7 5 7 1 4 Haemeplegia 2 11 11 Paraplegia .... 1 37 10 4 34 41 ft< Paralysis (yinclasRified). . , 3 5 20 10 15 17 26 24 20 30 28 28 35 37 15 19 28 Locomotor' Ataxia j 26 f Unclassified ^Tetanus. < Idiopathic. - . (Traumatic Trismus Nasrentium Hydrophobia Convulsions 43 65 '7 1 61 109 78 6S 2 3 78 176 "'8 7 131 254 "16 1 98 3 29 3 70 193 66 188 450 49 144 C 465 36 "" 222 1 12 371 16 1 83 9 53 188 12 375 21 2 84 3 53 " 222 7 521 20 1 129 3 48 212 7 367 \ 138 5 132 99 4 26 409 22 14 280 27 300 10 74 "79 2 29 265 25 85 137 1 12 296 55 3 35 7 109 . .'. i" 125 "18 275 43 1 33 7 1.063 3 18 2,805 16 2,496 3.179 308 15 1,471 55 1 1,987 19,322 116 5 19 10 117 ;;;;;;;; 248 " '56 236 20 128 246 2 68 270 19 2 37 104 159 6 222 50 12 1 30 1 134 136 4 74 205 19 D9 "186 6 22 206 27 2 24 12 79 234 2 18 200 22 2 27 8 73 231 3 19 227 21 2 34 8 74 256 2 13 256 21 67 259 ii 203 25 6(1 2? 4 14 233 28 89 1 ""167 4 18 140 18 6 67 163 6 15 122 18 1 27 13 4 68 931 7 2 10 17; 31 11 83 5 163 351 143 Convulsions Infantile . Epilepsy Hysteiia 15 2 104 10 1 56 13 Delirium Tremens and Intemperance 73 85 123 175 4 81 4 30 9 33 3 13 7 39 4 28 3 IS 27 2 24 4 33 7 1 36 1,064 10 3 14 21 6 2 55 980 11 1 17 Insanity . Paralysis of the Insane 21 1 lit If All other Diseases of this System 2C 305 95 755 1 85 1,134 3 1 2 50 1 239 1 12 752 1,287 5 569 1,273 Is 1,317 19 44 1.174 2 34 1,145 7 30 1.457 8 48 1,276 11 90 1,457 7 74 1 068 7 20 837 5 23 1,006 4 14 1,047 6 45 1,098 6 11 7 49 1,216 5 3 42 907 4 42 1,015 5 7 73 1,156 4 5 67 1.121 14 14 54 1,189 9 9 2 35 72 1,337 3 5 86 1,213 11 9 4 45 71 1,072 8 4 58 979 17 8 37 979 9 3 18 Total Deaths from Diseases Nervous System Diseases of the (Ircnlatory System. Pericarditis 286 143 Dropsy of the Pericardium. Endo-Carditis 3 1 2 Heart Disease (valvular) 2 1 2 5 3 1 18 43 40 38 35 " Het rt Disease Aortic Heart Disease Mitral 15 60 105 18 33 148 20 IC 52 137 12 9 42 130 20 2 6 2 Heart Disease (ITiiclassifeil) 32 38 21 1 1 1 38 | 52 1 2 2 31 11 1 41 76 10 71 18 87 13 89 11 104 4 5 115 142 135 130 1,181 95 9 45 32 10 1 257 1,780 88 7 110 8 4 1 3 97 2 138 15 6 181 25 26 134 16 1 169 32 156 31 1 160 17 137 22 167 15 Heart, Enlargement of 6 Degeneration of Arteries A ueurism 3 C 2 5 1 11 2 "1 2 4 3 5 1 i 6 1 1 3 1 7 5 "2 1 10 3 1 J 2 2 1 2 Aneurism of the Aorta 4 5 2 4 5 6 4 8 9 10 9 Embolism of Heart Phlebitis 1 2 1 Phlegmasia Dolens . 1 6 10.- 1 23 235 All other Diseases of this System 2S 8 7fi 1? ? 1 63 82 11 109 117 0 132 24 13 1K1 27 169 2 135 8 145 8 116 C 20( 12 302 £2 •245 35 9QQ 31 274 12 268 6 5 9 249 Total Deaths from Diseases Circulatory System 45 R5* W GO 60 - 121 131 223 242 1 ' Diseases of the Respiratory System. Croup 3 3 1 2C 48 8 48 14 51 IS 33 11 4 54 88 126 87 79 3 32 3 1 97 64 90 46 0 887 92 3 1,419 14 184 3,351 25 49 3 49 2 46 1 28 6 21 10 19 8 13 8 26 10 2 116 49 18 2 131 55 22 40 22 1 30 !. 9 22 11 3 133 3 23 355 4 6 37 18 3 141 50 27 343 49 14 3 49 67 17 306 39 18 3 92 44 15 307 3 1 4 3 23 8 5 523 177 16 1,573 164 293 5,059 38 51 64 10 82 177 66 186 162 8,641 1,410 269 19 t 2,992 178 477 8,410 63 100 67 10 135 378 85 277 2,525 17 395 Laryngitis 6 Oedema of Glottis Bronchitis 110 95 11 2 145 1 3 5t 69 1 * 94 90 93 106 103 110 86 132 94 84 103 87 103 105 91 91 100 147 Bronchitis, Chronic Asthma • .. 1 25 14 122 1 97 7 184 9 189 3 1 14 232 3 5 11 276 3 7 14 306 6 12 19 329 1 21 240 1 4 13 282 18 417 3 1 28 287 1 20 281 3 1 20 317 1 6 15 241 1 23 384 3 2 28 370 6 5 4 16 306 2 8 7 20 388 18 398 5 21 323 3 6 3 13 339 3 3 5 2 1 • 17 j 401 1 6 9 1 1 Pneumonia Abscess < f Lungs Gangrene of Lungs Emphysema of Lungs 5 3^ 3 3 3 6 4 5 1 6 4 18 2 13 1 8 Atelectasis Hmmoptisis 1 17 2 15 1 7 21 i 4 10 14 9 12 16 13 16 53 201 19 91 2,363 8,754 19 12 22 18 6 Pleurisy Empyeama Haemorrhage of Lungs ! 17 10 18 4 9 1 17 561 2C 4 1 564 ! H \ | 573 14 18 13 448 11 13 7 13 11 10 13 3 17 13 an 15 19 26 9 28 " 21 13 586 12 13 16 K JU? 11 54 429 14 34 487 13 10 474 18 24 549 14 1 406 20 4 5Ra 20 12 5RR 24 6 401 All other Diseases of this System Of 5 247 40 i 15 844 1.043 1,187 1.187 42 378 S' 503 39 728 23 510 23 575 32 J G0( 682 8 557 1 566 Total Deaths from Diseases Itespiratory System - Diseases of the Digestive System. Haematemesis 2 f6 9 10; 137 1 93 2 355 1 " ' " 14. 37 230 270 " 267 12 4 3 214 71 1 164 33 21 15 2,173 228 12 9 1 14 484 25 3,786 4,891 130 71 10 6 5,618 47 4 692 129 95 9 14 130 8 369 143 1,184 20,318 } 59 I 38 !. 5 22 385 509 1 4 ; 88 2 2 1 . 4 ( 99 3 7 86 4 1 86 2 2 88 7 1 1 3! 2<>: 8C 5 144 11 55 1.' 4( i 16 32 1,257 38 8 9 2 3 259 45 3,129 2,206 72 56 74 15 2,671 90 10 723 179 419 41 21 80 2 484 31 887 12,859 488 397 I 166 13 38 279 1,381 37 47 3,430 266 20 18 ' 3 17 743 70 6,915 7,097 202 127 84 21 8,289 137 14 1,415 308 514 50 35 216 10 853 174 2,071 33,177 547 397 204 18 69 664 1,890 Stomatitis Teething Ulcerati\ e Sore '1 hroat '..... "24 " '90 10 ( 199 8 1 4 111 12 1 3 88 7 6: 78 1 151 2 189 13 202 ( 154 18 1 104 44 4 107 4 1 56 2 96 98 2 76 8C 2 80 1 Thrush Sloughing Sore Throat 7 1 1 1 7 Goitre 3 35 1 229 328 5 23 1 Tonsiiitis 1 1 46 2 31 i" 1 l 17 146 224 2 1 31 5 157 213 19 2 1 48 1 5 k 239 293 16 3 2 3 15 2 276 432 5 10 1 1 30 7 182 115 4 5 3 7 144 7 Gastritis 14 35 1 209 200 14 1 12 267 239 10 27 1 229 125 *2 1 24 27; 292 3 22 28 8 239 212 4 5 4 68 4 191 184 2 : 2 13 6 244 132 7 9 50 31 1 187 120 4 6 10 Dyspepsia 196 158 ? 1 2 183 155 4 3 3 1 249 123 14 5 9 2 276 153 6 241 156 ( 4 5 21$ 12C ( Enteritis 77 72 3 90 81 275 449 12 2 263 496 6 1 1 1 260 2 3'48 281 1 338 10 228 229 20 254 180 5 6 1 118 161 3 2 160 151 3 C 2 Dysentery Haemorrhage of the Bowels Intussuseption of the Bowels 2 1 297 3 2 6 4 16 Obstruction of the Bowels. ■ &4 2 1 260 2 Diarrhoea 21 2 1 28 56 192 1 290 2 167 1 224 4 295 5 352 6 229 4 1,126 5 913 5 1 47 8 13 425 3 2 40 10 16 269 4 205 2 112 12 195 7 2 46 10 12 j 165 4 2 185 4 195 ■ 56 11 44 209 5 18$ I 11 5d 175 170 4 Hernia ! f Fistula in Ano 2 Hepatitis 55 9 55 6 53 39 3 38 28 3 2 4 7 1 25 32 17 6 65 15 9 61 17 15 55 9 14 28 16 11 2 33 8 2 49 5 11 40 10 10 5 2 6 16 IC 13 2 56 13 26 4 63 34 61 1. 3. : 5f 3( 7C 14 23 11 £ 6$ 1' 3C 65 15 38 38 IC 41 1 3 4 Abscess of the Liver 7 20 7 7 3 Cirrhosis of the Liver 1 6 Atrophy of the Liver 3 Degeneration of the Liver 1 8 1 31 6 21 1 35 1 11 1 31 1 8 3 44 4$ 2$ 863 11 j 9$ 1 C J auu dice 2 7 2 1 18 26 32 1,310 * 15 3 4 11 16 6 7 8 2 11 6 Splenitis Peritonitis. 7 22 19 292 21 10 39 1.229 8 18 27 1,143 19 39 34 1,255 7 8 9 722 24 20 45 1.084 23 26 23 24 29 25 16 16 29 52 3f 3f 4 4' i 2£ 26 0 16 807 6 101 ' 2 11 19 14; 24 C c 744 1 3' It 11 799 Ascites All other Diseases of this System 322 677 70 1,051 42 987 L 27 1.210 61 1,243 70 1 1,265 89 92S 80 2,085 1 158 2,210 6 IS 60 1,402 1 32 1.00c 73 936 18 87 609 24 40 77C 5( 17 1 33 811 42 25 3 99 891 4S 27 2 101 95 54 101 l,00f 51 2(1 11 3l 94 51 14 1 9< 86' 6- 5C d_ 851 | i 50 Total Deaths from Diseases of the Degestive System Diseases of the Urinary and Generative Organs. Bright's Disease 227 Bright's Disease (Chronic) A Ibu min nria .... 1 "'•< '1 ) 1 1 • 1 2© 103] 97 Suppression of Urine ....... If 3 1 1 1 ]. IS 1 48 1 If ar 4 3! 4' 8 8 2 7 11 d 10 f A 11 other Diseases of this System. 2 io in 8t «r 2- sir 1< 2( 3.* 2 a- 25 44 21 30 34 55 18 42 12 84 10 80 17 95 25 R0 15 22 RR 21 21 mJ Total Deaths from Diseases Urinary System j : .. . -- ... _ - Affections Otnnected with Parturition. 4 1 1 1 1 £ 8 3 2 11 11 5 5 3 1 3 9 16 1 8 60 72 87 25 15 259 3 4 '73 2 78 ' 285 438 82 247 484 1,091 1,257 1,163 52 4,047 57 373 1 188 15 44 1,237 2,857 520 504 1 024 133 6!l 34 1811 154 14,724 141,960 5,182 3 10 24 42 11 23 18 7 18 5 9 1 in 170 1 243 3 257 512 1,015 180 523 1,376 2,242 3,295 2,746 95 9,754 173 794 1,985 57 328 1,963 5,127 921 1,030 1,951 160 184 303 401 363 16,374 242,426 11,808 2 11 13 16 8 8 21 32 25 19 91 30 79 8 12 22 4 16 21 26 69 8 18 37 7 27 50 39 75 4 10 25 10 28 43 3 13 10 12 27 5 15 76 40 5. 4f 7 30 40 2 12 90 Ofi 18 22 44 3 8 80 65 24 13 40 3 1 14 1 IP 52 60 91 54 8 2 34 2 8 63 6-. 128 17 18 13 73 16 19 113 73 108 29 6 329 50 59 20 20 51 6 23 110 83 137 52 2 384 6 27 69 6 19 25 14 15 52 86 90 161 2 26 51 12 i:- 64 91 87 163 ( 41 7I 41 61 13 31 44 13 38 92 119 140 8 14 40 7 13 26 81 126 112 2 347 18 3 9 8 7 25 22 aa 90 20 16 43 1 26 66 69 192 100 17 11 46 5 14 97 105 204 150 9 6 20 2 23 53 82 197 184 6 522 2!' 54 11 8 10 19 20 3 23 13 3 6 1 1 18i> 6' 309 | 3u 92 17 3 14 35 74 171 76 35 35 8: 227 34' ^77 Total Deaths irom Diseases Connected with Parturition Diseases of the Organs of Locomotion ' Diseases of the Cellular and Cutaneous System | Conditions not Necessarily Associated with General or Local Diseases. - -,- 23 11 1 si 1$ i 8 31) If '( 41 73| 4 13 15 150 35 101 3 61 3: 43 72 194 161 1 471 4 31 54 98 276 892 1,151 2,038 1,5831 43 5,707| iig| 421 797 42 284 726 2,270 401 526 927 27 123 269 220 £09 1,648 100,466 6,624 17 27 4 33 14 73 50 117 3 Old A^e. ~ 11 8 31 35 196 47 96 53 226 100 82 41 83 55 91 75| 69 65 60 1S! 18 209 11' Total If J 31 | 231 4 16 89 1 1 28 13.' 18 37 55 12 1 277 7 37 130 356 9 ->0 IC .1 18 51 96 379 4 18 105 ...J 219 1| c C 173 5 23 67 241 7I 37 86 239 4I 70 87 20 3, 211 1| 34 7f 344 292 4 16 71 27 111 257 e| 270 J 389 27 389 111 31 427 2 30 61 33 556 1 3 5 General Injuries. Burns and Scalds 21 61 24 67, Starvation Hnno'er Exposnre. ...... ...... ..... ■ 2 4 15 141 14 155 2 7 3 6 12 258 7,010 248 172,361 40.67 r 411 15: | 34 19 59 8 8 36 131 24 25 49 12 2 10 9 124 6 699 321 174,815 aR a-2 24 19 152 36 21 57 1 5 8 3 131 5,593 408 187,723 29.79 30 LI 137 20 66 86 2 18 13 11 144 6,942 449 191,418 36.26 5 3 19 34 46 80 1 0 12 14 14 35 5,595 464 193,412 28.92 36 77 218 32 45 77 2 8 18 65 6,122 466 I 196,406 31.17 31 10 149 32 24 56 4 61 27 82 7,505 490 198,900 37.73 34 16 182 83 36 119 47 16 41 2!) tl 4 11 18 n 6,117 418: 203,88.1 30.00 31 18 154 54 12 66 1 6 10 12 9 82 6,257 428 206,382 30.32 A 11 othei General Injuries. ...... 13 28 11 18 4 6 2 4 22 189 23 49 72 10 4 H'l 'Tir' 1 II IL 29 151 16 50 66 10 5 7« 2: 77 200 47 11 145 20 32 52 1 1 23 32 399 5,335 354 161,404 33.05 14 109 20 39 59 2 8 19 28 116 5,223 358 163,828 31.88 60| 183| 47 30 77 6 7 21 6 129 11,372 338 165,450 68.73 67 194 47 33 80 10 1 2-: 9' 6.49 353 166,500 39.00 23' 23 4 15 42 22 64 2 18 22 17u 5,099 350 169,907 30.10 13 13 126 126) 102 102 52 176 17 19 36 43 147 16 36 52 32 115 23 19 42 2 10 17 21 8 4! 128 13 30 43 1 11 24 20 4 Total ..••••• ....... 147 13 3^ Local Injuries. 13 _ 26 5 60 60 3 5 7 20 31 768 7,341 334 168 670 43.52 40 40 2 (1 10 6 273 7,342 412 178,042 41.23 31 31 9 11 16 173 9,586 510 181,269 52.88 72 72 2 9 19 17 470 4,838 505 184,496. 26.25 47 19 9 - 10 56 20 12 78 6,798 495 201,394 33.75 R 10 3 9 7 13 16 10 Congenital illalfnrinatioiis ...... ... 1 1 73' 8.88.' 305 115,503 76.92 ified. 0 Fehr Tanuar ber 1, a 10 7 1 634 7,275 14 e 213 8.56C 298 173 588 49.34 3,091 4,476 144 86.632 51.66 0 Dece Decern ccordii Janua 1,13' 2,60 176 89,261 29.20 mber 3 her 18, ig to di ry 1 to 581 7,303 i9e| 108,699 67.18 1, class 1847, t sease, Decern 6511 548 9,572| 7,531 291;! 288 122,511 129,747 78 13 ' 58 96 J_ uary 17, 1849. y to June; bal nd three week 340 8,379 284 147,441 56.82 icordin g Dece 1,235 15,287 346 154,132 99.18 5 to syt mber 2 3,139 7,50* 199 158,980 47.21 >tem. L. 6,708 451 208,870 32.11 10,318 399 211,371 48.81 5 12$ 379j 213,865 23.94 5,623 350 216,359 25.98 Population City of Now Orleans 138,599 52.48 ance at s endin Death Pate per 1 GOO per finnum .... . Mortality of 1844, only six months, July 1 Mortality of 1848 contains the deaths from Mortality of 1851 only partially classified, a Mortality of 1856 contains the deaths from .. TABLE BL Vital and Mortuary Statistics of New Orleans-Mortality of the White and Black Races in New Orleans, La., During Three Years, 1849, 1850 and 1853, Preceding the Civil War (1861-1865) and During the Period of Slavery. Also, Illustrating Weekly and Daily Mortality by Cholera and Yellow Fever for 1846, 1847, 1851, 1852, 1853, 1854, 1855, 1857, 1858, 1866, 1867, 1878. Also Mortality by Color, Sex, Ages, Nationality; by Zymotic Diseases (Yellow Fever, Typhus and Typhoid Fevers, Measles, Scarlatina, Diphtheria, Whooping Cough and Asiatic Cholera and Small-Pox), and Monthly and Annual Mortality During a Series of Years, 1849-1881 inclusive; Consolidated from Original Reports and Records Collected and Classified by Joseph Jones, M. D., New Orleans, 156 Washington Street, Corner of Camp, Fourth District, January 1, 1882. NAME OF DISEASE. 18 W. 49 B. 18 w. 50 B. 18 W. 53 B. Total 8 W. Years. B. Grand Total. W. &. B. VITAL AND MORTUARY STATISTICS OF NEW ORLEANS, ILLUSTRATING WEEKLY AND MONTHLY MORTALITY BY YELLOW FEVER, ASIATIC CHOLERA AND BY ALL CAUSES, 1846, 1847, 1851, 1852, 1853, 1854, 1855, 1857, 1858, 1866, 1867, 1878. VITAL AND MORTUARY STATISTICS OF NEW ORLEANS. Small-pox and Vai BENE KAL DISEASES. 78 9 16 55 1 6 25 46 18 2 191 90 12 107 12 11 3 14 96 103 3 27 23 117 151 137 0 448 376 21 8641 2 119 121 462 312 4302 148 139 67 35 2 32 21 14 33 24 1555 123 21 149 2 3 1 1 70 39 32 187 190 169 2 466 426 27 8682 2 129 132 517 351 5206 213 177 84 41 2 34 33 16 53 40 1 1921 141 21 214 2 3 1 1 2 330 352 186 341 109 68 4 3 3 8 32 174 5 479 6 1130 • 38 3 310 89 41 3! 8 1311 1 2 6| 7 19 118 36 221 3 19 0 6 7 48 97 2 382 5 2 97 1 829 933 13 2 3 801 4 126 8 7 21 51 77 106 2 12 29 20 100 9 55 42 181 579 154 1 18 294 78 149 84 120 47 21 24 3212 32736 924 1846, 1851. 1852. 1853. 1S54. 1857. 185S. 1S66. Week Ending. A 3 2^ A Week Ending. e co A § © 'o e co A Co g s 0 go co ZS e co A CO § Co O 1g A Week Ending. Co © A © © © AS Co © A Week Ending. CO © © A S A g s os 0 A Day Ending. Co © A © A g » Co 0 A Week Ending. © © A £> © •2^ Co © A Week Ending. © A 8 C«o I © © £ © © N Week Ending. © K Week Ending. © © A 8 © "© Day Ending. Co © © A § © © "© 0 CO a s Co K © C^ A © § A Scat latina* • • • * Dengue.•••••••••••• ••.•••••••••••••••• 159 158 9 766 2 41 17 108 50 2,623 74 29 22 12 5 20 2 3 8 13 4 98 128 5 17 18 50 6 41 DEATHS FROM ZYMOTIC AND EPIDEMIC DISEASES, (SMALL-POX, MEASLES, SCARLATINA, TYPHUS FEVER, TYPHOID FEVER, YELLOW FEVER, MALIGNANT OR ASIATIC CHOLERA, DIPHTHERIA, WHOOPING COUGH), AND FROM ALL DISEASES, WITH DEATH RATE PER 1000 INHABITANTS FROM EPIDEMIC AND ZYMOTIC DISEASES, FROM ENDEMIC DISEASES, AND FROM ALL CAUSES. Typhus Fever. • • • • J2/JLLLU11V VI AJpULV Simple Continued 7768 38 5 1 20 5 553 35 11 5 1 44 80 124 178 1197 49 64 7 9 2 12 6 5 11 8 528 19 14 46 1 3 1 1 5 4 28 251 20 9 6 1 34 24 230 84 482 25 46 38 14 4 5 31 6 100 10 18 6 4 10 1. 55 39 904 65 38 17 6 ■ i ) Remittent Malarial Fevers..-.. x congestive August... .30 September. 6 12 19 26 October.... 3 10 17 24 31 November. 7 14 68 70 74 93 68 94 88 107 98 91 84 82 i " 3 21 12 39 22 14 12 8 January ... 4 11 18 25 February.. 1 8 .. 15 22 March 1 8 15 22 29 April 5 12 19 27 May 3 10 17 9.4 136 131 132 141 132 142 144 132 135 138 148 157 127 140 162 180 180 157 171 167 137 155 140 130 "109 178 147 174 136 103 113 175 120 102 127 129 127 153 102 124 108 104 127 131 142 158 149 120 115 116 105 13 January ... 2 " 17 24 31 February .. 7 .. ' 14 21 28 March .... 6 13 20 27 April 3 10 17 24 May 1 15 22 ill 102 103 112 122 116 105 110 135 115 119 120 120 129 127 142 123 137 138 161 171 342 342 299 224 251 184 184 149 150 185 133 126 135 158 148 175 194 209 154 174 180 204 246 233 253 208 187 174 136 145 155 4 9 12 11 7 16 15 9 12 29 21 23 11 11 15 8 20 6 4 10 12 8 11 26 22 11 26 19 26 15 23 35 26 16 27 33 38 48 35 55 46 61 66 75 89 96 67 63 51 39 22 15 30 Ma v 9.Q 140 157 154 147 167 177 188 344 617 884 142 135 146 166 150 238 209 219 201 230 233 207 214 232 217 193 219 219 234 224 269 283 258 222 218 193 187 169 143 139 137 119 133 116 110 98 95 70 64 80 68 1 1 4 7 9 25 59 204 435 704 106 115 124 135 128 194 165 187 166 193 192 180 179 191 187 163 191 188 203 184 230 239 220 188 J 86 151 155 131 120 114 95 96 103 87 90 71 65 48 43 September. 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 October. 1 2 3 4 5 6 7 8 9 10 ... 11 12 13 14 15 16 17 18 19 20 21 22 Week End'g October.... 30 November . 6 13 20 27 December.. 4 11 18 25 January ... 1 47 45 52 51 47 47 34 49 38 34 28 34 35 42 33 33 26 32 32 31 24 28 21 27 16 16 29 10 15 15 12 Jul 329 191 129 159 122 212 207 258 386 293 484 530 504 423 358 272 January.... 4 11 18 .. 25 February.. 2 9 16 85 116 83 98 100 95 81 95 85 79 102 125 107 112 107 98 99 119 128 143 117 116 122 152 111 112 105 94 113 117 111 98 74 97 102 93 106 115 103 122 123 135 130 122 119 129 109 123 101 92 94 82 7 4 3 2 6 2 8 9 20 25 70 140 286 318 402 449 472 460 444 380 390 308 266 174 136 66 17 5 1 2 2 4,852 August.... 5 8 Day Ending August..-. 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 September. 1 2 3 4 " 6 8 . 9 10 11 12 13 14 15 16 17 18 19 20 21 22 " 23 24 25 26 1 2 9 September .2E 2C " 3C 8 October.... 1 4 2 7 .. 3 .. 4 .. 5 .. f .. 7 1 .. 8 .. 9 .. 10 .. 11 .. 12 .. 13 .. 14 .. 15 .. 16 .. 17 .. 18 .. 19 .. 20 .. 21 22 .. 23 .. 24 .. 25 .. 26 .. 27 .. 28 29 30 31 November. 1 2 .. 3 4 33 25 46 31 34 34 45 18 25 44 28 31 26 31 20 41 31 27 36 29 33 27 22 23 31 3 9 22 8 12 9 2 10 8 11 8 7 9 4 8 8 5 4 4 6 4 4 6 8 6 3 3 4 2 3 1,219 Fever. ••••••••••••••••• Q J y ' « Jul civat Zn n nl a aai fi AH 1 ------ 6 3 9 4 7 7 8 5 2 2 1 11 .. 15 22 29 August.... 6 13 20 27 September. 3 10 17 24 October.... 1 8 15 1 y 1 1 2 2 2 3 2 2 4 2 2 2 1 2 2 2 2 1 1 If T 1( 1. 2$ 1( If If 1( 21 r L If 2< 3$ 14 2$ If 2$ If If 1! 15 11 1$ 11 S Cholera, Malignant or Asi 18 25 " 1 2 August.... " 1 2' 2 September. 1' IS 2( October.... ! " If 2< 31 November . U 2 21 December.. 1$ 1< 2( Total 53 41 48 59 63 62 43 68 50 54 57 45 48 42 50 49 39 37 24 37 36 34 33 41 40 37 32 35 49 45 35 37 57 54 36 40 43- 42 48 21 42 39 31 25 37 22 24 41 36 Cholera Infantum Whooping Cough Erysipelas J uly 2 29 43 118 186 185 284 340 341 269 207 134 9 4 24 26 27 20 11 20 30 13 30 27 28 16 23 31 Day Ending August.... 1 2 3 4 " 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 September. 1 2 3 4 5 6 7 8 9 10 11 Marc 23 h 1 2 3 8 8 7 8 6 6 10 11 6 5 7 10 9 10 4 4 10 2 4 11 4 3 5 9 12 9 7 17 12 13 12 8 7 6 7 7 7 3 5 4 s © © © A 10 8 g| £ 8 5^ 8 Q 4 121 15 119 22 21 29 126 19 18 79 79 121 200 198 43 200 161 41 24 15 13 44 5 4 144 123 10 1 1 56 197 © © co © q 3 154 372 164 199 228 103 .© © Q 0 44 76 233 223 178 103 103 146 © © © § § SS © A 148 2 2306 808 769 107 456 7849 2670 74 199 4845 91 15 1 © ©'■^ ^ © © © < 8^ © © © A § © Ji ©^ 2$ s • ©.©A s £ 231 199 2797 3375 4479 1985 870 1785 8991 3572 380 662 5397 800 720 445 658 1505 1091 2064 3962 245 586 1306 169 282 1120 823 738 762 1254 4327 120 360 387 58447 S 4 qq © ©^ A° • Co -0 co ~ © © A 4245 2408 4506 5510 5093 5546 6405 6594 6296 3934 4955 4561 5975 5694 6621 4654 6352 7061 5608 5278 5624 4593 5007 5636 5426 5840 6385 5975 5379 5495 5454 5991 5002 5263 6019 190385 $ Ag C© © % if ns g £ © 4476 2607 7303 8885 9572 7531 7275 8379 15287 7506 5335 5223 11372 6494 7341 5099 7010 8566 6699 7342 9586 4838 5593 6942 5595 6122 7505 6798 6117 6257 6708 10318 5122 5623 6406 48832 JI ©* •2^2 -§ ■> © A 86632 89261 108699 115503 122511 129747 138599 147441 154132 158980 11,1404 163828 165450 166500 168670 169907 172361 173588 174815 178042 181269 184496 187723 191418 193412 196406 198900 201394 203888 206382 208876 211371 213865 216140 216140 5957750 O ©r-^c^ A © § ssS S « ® S 8.3 8 S-2A < . £ g A 2.66 2.22 25.73 29.22 36.56 15.29 6.42 12.10 58.33 22.46 2.35 4.04 32.62 4.80 4.26 2.62 3.81 8.67 6.24 11.59 21.85 1.32 3.12 6.84 0.87 1.43 5.58 4.08 3.61 3.69 6.00 20.47 0.54 1.66 1.79 9.81 2 g § As © Ms § §,8 A 49.00 26.98 41.45 47.70 41.57 43.67 46.06 44.72 40 85 24.75 30.70 27.84 36.11 34.20 39.26 27.48 36.86 40.67 32.08 29.64 31.03 25.07 26.67 29.42 28.05 29.74 32.15 29.67 26.39 26.63 26.11 28.34 23.38 24.32 27.85 31.95 i sg 0 e £ 1 , aS g 8 § § Ci Sa 8 51.66 29.20 67.18 76.92 78.13 58.96 52.48 56.82 99.18 47.21 33.05 31.88 68.73 39.00 43.52 30.10 40.67 49.34 38.32 41.23 52.88 26.25 29.79 36.26 28.92 31.17 37.73 33.75 30.00 30.32 32.11 48.81 23.94 25.98 29.64 41.76 6 4 3 9 6 445 1 7 . 42 1 1 10 2 7 5 1 146 14 11 6 13 10 582 103 61 1 1 12 29 16 1 366 18 65 Puerperal Fever. Rheumatism 1 15 22 29 April 5 12 19 26 May 3 10 24 Syphilis - - - 2 4 147 11 7 173 18 23 1 2 Scrofula Tubercular Menii Phthisis Pulmom Tabes Mesenteric Anaemia Total 1017 !37 23 19 35 31 39 26 28 20 23 18 4 9 17 36 178 179 129 73 76 40 29 28 37 19 9 5 13 18 14 30 35 28 9 12 11 11 26 28 68 39 23 20 13 19 16 1 2 3 22 20 26 31 26 33 19 23 29 29 19 32 30 24 13 19 17 27 15 19 23 22 26 14 27 17 193 . 79 115 110 261 372 255 153 91 118 13 8 7 11 8 4 10 11 4 10 4 5 8 2 9 5 4 4 5 9 2 10 2 26 9 5 8 3 1 Total 4,857 2,136 General Dropsy.. If If If If If 45 1 1 1 2 2 1 47 2' 10: 132 3" 3f 17 38 61 10 57 26 123 1 1646 3176 1448 430 1329 585 883 43 24 26 30 12 4 5 9 1294 581 129 4 3 6 142 6 4 2$ 41 2' 12 IC "44 "5: 28 31 75 14 55 39 13 41 28 4 121 9 1 23 61 16 58 39 26 9 70 1 1027 15 18 11 16 Scurvy 1 i 23 30 24 37 1 7 * 18 24 26 25 1 2 2 Ju 31 h* 7 Ji 29 1855. June 31 48 49 All other General Diseases not enumerated 2 • 67 73 67 92 3 11 2 14 12 14 50 95 87 41 64 19 16 83 77 34 82 67 19 2 1 1 1 11 50 4 114 "292 11 2 95 1 39 10 85 115 44 103 20 22 26 19 17 30 1 2 263 279 119 249 106 57 2 3 2 6 21 132 4 344 6 947 27 3 277 1 64 27 1 83 1 2 2 4 13 98 30 124 2 15 1 5 4 33 72 2 "310 1 2 72 1 635 838 10 2 3 718 2 101 6 6 20 41 69 82 0 9 22 11 72 9 41 80 78 490 116 1 17 249 49 116 71 99 35 15 22 2673 28168 21 28 July 5 12 19 26 August.... 2 9 16 23 30 September. 6 13 20 27 October.... 4 11 18 25 November. 1 8 15 22 29 December.. 6 13 20 27 19 26 July 3 10 17 24 31 August.... 7 14 21 28 September. 4 11 18 25 October.... '2 9 16 23 30 November. 6 13 20 27 December.. 4 11 18 Week Ending. August.... 4 11 18 25 October.... 3 10 17 24 31 November . 9 16 23 30 December.. 8 15 22 29 Total Co e © A S A 275 336 517 471 181 152 121 121 106 94 76 64 69 106 88 80 77 2,934 J© Co © ©£j © " A 173 222 394 357 70 46 24 15 11 6 7 2 3 3 2 1 22 29 July 5 12 19 26 August .... 2 9 16 23 30 September. 6 13 20 27 October .. 4 11 18 25 November 1 8 .. 15 22 29 December.. 6 13 20 27 1851 LOCAL DISEASES. Diseases of the Nervous System. Congestion of the Brain Inflammation of the Brain (Encephalitis) 1847. 43 34 16 43 20 12 5 7 2 36 19 18 19 10 14 13 32 24 22 25 25 21 35 21 22 14 14 14 18 18 20 14 13 14 10 10 1 If 16 16 16 16 16 16 IE 52 53 55 1 2 105 108 43 22 1 S 605 613 188 47 14 141 528 0 29 509 587 342 232 1099 151 53 104 7 13 60 35 98 34 31 82 2 1 217 23 12 76 69 i 231 15 3 22 8 20 7 10 9 11 12 23 5 13 4 4 2 1 23 1 115 118 189 214 163 102 257 268 154 116 119 58 63 80 71 67 57 95 57 53 69 44 33 52 66 3786 Week Ending. Co e A 3 1 s § ^8 CO Q> A 1 57 58 so 95 253 145 78 188 337 104 98 31 16 19 19 14 39 46 102 69 40 33 59 58 81 92 2017 4 2 2 1 1 2 2 2 Apoplexy Sun-Stroke Hydrocephalus 6 2 11 15 19 23 23 35 50 51 62 62 42 37 24 9 1 1 "1 1 1 60 1863 2 6 1 192 3107 3 3 587 54 39 226 11 61 42 1 4046 19 2 2 2 1 1 1 11 20 27 24 11 8 4 16 18 64 Myelitis 2 1 1 2 17 "'59 *63 3 "12 1 5 3 2 1 14 "'1 7 13 12 36 37 27 18' 17 14 6 2 2 2 2 65 1 2 11 42 1 135 "" 183 11 33 1 25 14 2 3 48 1866 Paraplegia Paralysis (unclassified) Tetanus (unclassified) • Tetanus traumatic Trismus Nascentium Hydrophobia Convulsions Epilepsy , Hysteria Delirium Tremens and Intemperance Insanity All other Diseases of this System Diseases of the circulatory System. Pericarditis Dropsy of the Pericardium "42 "113 ""251 7 1 71 " "if> 7 1 4 24 6 16 1 49 ""59 4 "'9 ..... 2 ""io 40 117 6 404 9 "iii "9 10 "5 9 '"27 ' "61 4 "'12 9 9 July 10 17 24 31 August.... 8 15 22 29 September. 5 12 19 26 October.... 3 10 18 Total 138 143 130 177 263 353 432 461 540 491 257 181 149 126 144 3985 6 16 17 118 1971 322 328 435 355 169 85 61 44 53 2241 1 1 2 1 1 1 1 2.094 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 67 68 69 70 71 72 73 74 75 76 77 78 79 1 80 81 1 5731 97 26 1615 43 Total 7,008 645 874 17 Tot 1 8.655 1,309 1.481 473 Total 13,152 7,930 1 336 Total 5,596 354 26 199 2263 1422 287391 11847 Endo-Carditis 1 34 1 2 1 2 18 "25 ' "16 1 8 6 7. 18 7 8. Heart, Enlargeme Degeneration of Aneurism of Heai Arteries •f. 1 4 12 41 16 37 3 1 2 4 17 25 2 ' "79 1 2 22 1 247 290 2 2 3 223 1 42 2 7 17 21 "5 6 8 20 6 8 2 16 153 48 1 5 76 19 31 19 56 14 3 3 6 9 3 21 1 3 4 15 '23 i 6 "ii 35 1 1 4 3 6 20 6 97 1 4 1 1 3 15 25 72 i 25 "194 95 3 Day Ending. June 1 2 3 4 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 0 0 © Co 5 3 1 Co © A 8 A 13 17 22 19 16 10 13 12 14 29 22 19 16 13 20 20 15 16 19 18 11 8 15 23 18 22 8 8 13 14 21 10 15 14 23 18 17 17 15 12 14 19 34 26 24 21 21 20 19 20 24 27 22 21 Day Ending. July 25 26 27 28 29 30 31 August.... 1 2 .. 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 September. 1 2 3 4 " 6 7 8 9 10 11 12 © O 2 2 2 ?> £ A 1 1 1 Co 2 2 2 3 6 7 8 6 6 6 8 2 6 2 7 14 9 6 12 12 13 20 16 14 11 12 29 16 20 21 19 26 32 24 20 31 33 31 52 36 46 51 56 46 75 70 48 45 62 56 78 Co $ A © 19 22 22 15 2t» 19 24 24 18 19 25 30 25 26 28 22 18 27 32 37 27 40 24 34 28 34 25 29 28 47 33 41 30 37 43 49 43 38 53 54 44 68 54 66 66 78 60 86 89 64 63 80 80 102 Day Ending. September 17 18 19 20 21 22 23 24 25 26 27 28 29 30 October.... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 November. 1 2 3 4 5 . .. 6 7 8 9 © © O 1 © © ^© K 46 66 64 69 77 82 68 57 77 67 61 64 63 54 56 75 59 60 58 50 64 56 49 46 CO © 49 71 72 84 90 99 83 62 86 78 69 70 74 68 66 81 70 73 67 59 72 70 61 37 36 46 35 37 39 40 40 39 19 32 25 20 16 14 23 15 14 17 11 13 8 9 12 13 9 7 © © A § 71 95 9 91 1R 115 131 10 8. 10' 10! 9< 9( 9' 95 9' 10' 9( 9' 9( 7( 9f 105 81 8f 6 5f 61 51 51 5£ 6' 6C 51 3i 5C 4' 3: 2E 31 3! 3' 35 31 • 2f 2! 3' 35 2' 2? 2' 3i 3f 2< Day Ending. November. 10 .. 11 12 .. 13 .. 14 .. 15 .. 16 .. 17 .. 18 .. 19 .. 20 .. 21 .. 22 .. 23 .. 24 .. 25 .. 26 .. 27 .. 28 .. 29 30 December.. 1 .. 2 3 .. 4 " 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 © © © 0 4 7 7 11 9 9 9 7 15 15 12 13 16 11 12 7 11 9 6 15 10 11 15 8 8 6 6 8 6 © £ © 3 8 £ 1 1 5 3 3 2 Co © © 7 8 11 3 2 S 8 7 7 1 3 2 2 3 6 3 2 Co © © A A 30 33 37 42 29 33 20 26 47 44 42 40 32 24 41 26 33 27 29 31 20 39 23 27 ' 16 21 33 24 26 18 25 26 28 51 28 22 19 19 14 19 33 20 25 15 21 14 11 23 15 15 15 Day Ending July 1 2 3 4 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 26 27 28 29 s © © -© co S < © "i 3 ' 2 3 3 3 1 6 8 6 1 7 6 5ft CO © © A IS A 12 16 12 19 9 13 24 24 17 25 21 18 8 8 13 31) 11 20 15 15 17 19 21 30 28 24 33 25 19 26 23 d 1 § s 9 8 8 8 8 8 9 9 9 9 9 8 8 9 9 9 9 81 81 95 9 9( 95 91 95 91 9 91 9C 8t 9( on © *© © Ib © 0 76 8 75 3 76 5 75 7 75 76 76 79 78 78 77 78 75 76 77 77 79 78 77 77 77 75 80 81 81 78 80 79 78 80 80 © © 14 13 7 10 12 11 15 13 13 13 14 11 13 15 16 15 11 10 12 15 14 15 12 12 11 13 12 12 15 8 10 © g c 8^ c*< 83.5 81.2 79.2 81.0 80.0 81.2 82 2 85.0 84.0 84.5 84.0 82.2 81 5 83.0 86.7 86.0 Si.5 84.0 84.2 86.0 82.0 82.2 84.7 86.2 87.7 85.0 85.0 85.2 85.2 84.0 85.7 s £ 67 74 78 81 80 80 73 74 65 67 74 73 70 67 59 64 70 69 72 66 72 76 68 67 70 70 71 74 71 74 63 © g 0 29.9 29.8 29.8 29.8 29.9 29 9 30.0 30.0 30.0 30.0 30.0 30.0 30.1 30.0 30 0 29.9 29.8 29.9 29.9 29.9 30.0 29.9 29.9 29.9 29.9 29.8 29.8 29 9 29.9 29.9 30.0 8 8 A .24 .24 "18 .08 .'ii .10 .34 .23 .39 2A4 "16 .04 .88 .03 "61 .05 Day Ending. August.... 21 22 23 24 25 26 27 28 29 30 31 © Co § rC © sg 59 47 51 40 27 59 51 49 66 57 71 GO © © A 83 85 65 67 55 88 79 70 100 84 103 © © ss g g § 93 94 91 91 90 89 89 89 86 86 88 s •£ if 7 7 7 7 7 7 7 7 7 7 © 7 16 8 16 8 13 8 13 7 13 6 13 3 16 6 13 4 12 4 12 4 14 © © g © si I s 86.2 86.2 85.2 84.2 84.7 80.7 82.2 83.5 78.7 79.5 80.7 -a g 71 65 68 65 63 71 67 66 80 77 73 © © £ ii 29.9 29.9 29.9 30.0 29.9 29.8 29.9 29.9 29.9 29.9 30.0 .8 § .01 .01 .01 2.05 .14 .03 Day Ending. October.... 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Total.... © © 11 Is A 48 54 44 38 32 33 37 29 31 33 25 42 33 23 21 19 27 18 15 18 10 6 11 1047 © © A £ 6 8 6 6 5 4 4 4 5 5 4 6 5 4 5 3 5 3 3 4 2 3 2 170 "© s S •s S3 7 79 8 78 5 81 4 79 6 81 3 82 3 79 8 84 8 78 4 71 9 67 0 69 8 76 7 70 9 67 7 72 0 75 0 77 4 74 9 66 2 70 70 66 3 77.3 © © h sSS n 72 69 68 71 64 69 69 69 70 61 50 53 60 57 49 53 59 63 59 50 59 62 53 64.5 © « A 7 9 13 18 17 14 10 15 8 10 17 16 16 13 18 19 16 14 15 16 11 8 13 13.4 *© g © g § " 75.5 73.5 74.5 74. 72.5 74. 74.C 74.5 74.C 66.0 58.5 62.5 62.0 Cl. 2 59.7 63.5 68.0 70.7 65.0 60.0 66.0 65.0 57.0 71.4 "© s 86 83 76 66 67 73 73 73 61 36 52 67 72 54 52 70 75 79 77 72 80 72 j 39 © © £ © g © 29.9 29.8 29.9 30.5 30.0 30.1 29.9 30.0 30.1 30.0 30.1 30.0 29.9 30.0 30.1 30.1 30.2 30.1 30.1 30.1 29.8 30.1 30.3 J? 8 8 A 2.05 .20 "66 "07 .01 1.48 5.07 Day Ending. November. 29 30 Total.... g § © * © ©>H A 90 co © © A 3 § 1' 1< 59f si £ s S § g 64 65 68.3 © © £ £ 41 49 52.7 © © A 23 15 15.5 £ © g ii 53.5 60.0 59.4 J© 1 65 75 68.8 5 Q $ C 1 30. 30. 30. l 1 A 2 .... 1 .... 1) 7.78 All other Diseases of this Diseases of the Sy at Am...... 1 29 8 29 2 7 3 Respiratory System. 4 3 40 1 2 1 28 6 58 7 Bronchitis Bronchitis, chronic 36 2 Abscess of Lungs Gangrene of Lungs 2 2 2 1 1 1 3 1 5 3 1 1 2 2 2 2 3 2 2 2 3 2 2 1 6 12 11 10 4 7 19 14 15 14 15 20 26 22 17 26 25 28 44 30 43 49 51 42 67 61 43 41 53 50 68 1 1 1 Hsemoptisis 8 12 '"109 4 1 ""23 "213 304 8 9 3 ""28 "9 ' " 68 34 2 8 35 122 27 175 244 2 7 "21 "16 "55 26 1 December.. 1 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Total.... 1 1 1 3 11 21 13 13 15 15 13 11 17 14 17 17 11 9 15 9 17 18 13 10 13 9 17 18 16 16 14 16 12 415 62 57 65 67 64 69 66 68 65 57 69 70 69 67 59 54 54 52 51 57 59 59 57 44 45 41 43 61 61 62 65 58.8 47 45 43 46 48 45 59 45 40 44 52 53 50 44 37 38 37 42 43 45 41 35 40 33 32 30 27 38 49 46 428 15 12 22 21 16 24 11 9 20 17 25 18 16 17 15 17 16 *9 14 14 18 22 17 11 13 11 16 23 13 9 6.0 52.5 50.2 59.5 58.0 54.0 J9.0 63 0 67.0 50.5 56 0 60.7 62.7 62.5 57.2 59.5 45.0 45.7 47.5 48.2 54.0 51.0 50.0 48.2 48.0 38.5 36.0 45.5 45.0 49.5 53.5 51.2 70.5 69 60 56 50 42 59 83 89 74 58 70 71 80 90 59 59 56 64 78 93 79 51 56 90 68 84 68 68 89 91 90 70.5 30. 30. 30. 30. 30. 30. 30. 29. 29. 29. < 30. 30.5 30.1 29. 30.( 30.$ 30.1 30.4 30.1 29. 30.1 30.1 30.$ 30.$ 30.$ 30. ( 30.3 30.3 30.1 30.2 30.1 30.15 ) .15 .... 1 .... .... .... '.53 .56 .30 .... .... 2 .... .10 1.24 .... ... .... .... .41 2.46 .17 .... .57 .04 .50 .69 .65 8.59 Pleurisy. All other Diseases of this System Diseases of the Digestive System. Hmmatemesis Stomatitis Teething Thrush . Sloughing Sore Throat Tonsilitis Gastritis Dyspepsia Enteritis Dysentery Ulceration of the Bowels Haemorrhage of the Bowels Obstruction of the Bowels i 1 2 2 2 1 2 1 1 1 3 1 2 1 1 4 1 3 2 2 3 2 2 2 5 1 2 2 3 4 6 4 2 1 1 1 1 4 2 3 71.6 29.9 4.90 1 2 .... 1 1 1 2 September 1 2 3 4 5 6 7 8 9 to 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 74 73 92 88 60 82 85 89 80 87 73 63 60 45 69 59 73 68 56 51 45 40 55 45 44 46 60 45 48 40 94 115 120 116 103 119 123 126 130 115 100 86 94 87 89 106 109 86 89 75 66 64 85 66 46 65 102 70 75 75 87 89 87 87 87 89 89 85 88 89 85 77 75 78 82 82 85 85 86 86 85 82 87 87 85 86 87 85 83 85 7 7 7 7 7 7 7 7 7 7 7 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 7 7 7 7 3 11 7 12 10 13 11 15 11 8 12 11 14 13 14 16 > 17 i 16 14 ! 12 15 14 14 9 14 1 14 14 15 13 11 11 2 13 80.7 83.7 80.2 79.2 81.7 82.7 82.5 81.5 84.0 84.2 74.2 70.7 70.2 72.5 75.5 76.5 78.7 79.0 78.5 77.2 78.7 77.7 79.7 78.5 78.5 80.7 80.2 79.2 77.5 78.5 72 68 77 82 74 72 72 84 68 65 59 46 45 48 59 71 78 69 73 74 81 83 80 79 76 70 76 70 66 66 30.0 30 0 30.0 29.9 29.9 29.9 29.9 29.9 29.8 29.8 29.9 29.9 30.0 30.1 30.1 30.1 30.1 30.1 30.0 29.9 30.0 30.0 30.0 30.0 30.0 30.1 30.0 30.0 29.9 29.9 .13 .01 .29 .97 "6i .03 .95 "17 .10 .01 1 1 1 1 2 3 3 2 1 1 2 2 3 3 6 21 1 11 i 1 1 6 2 4 6 255 1 26 6 "14 17 37 28 2 4 13 3 26 3 13 28 33 149 63 35 1 9 2 2 2 6 240 27 83 2 25 2 1 1 10 8 24 Hernia. 25 69.5130.07 33 6 4 17 15 33 5 7 12 1 1 1 1 1 2 1 1 1 1 32 33 39 28 31 34 35 35 31 13 18 19 17 12 10 16 11 9 13 9 3 11 7 7 7 4 8 5 Hepatitis Abscess of the Liver Cirrhosis of the Liver Jaundice Peritonitis Ascites All other Diseases of this System Diseases of the Urinary and Generative Organs. Albuminuria Cystitis All other Diseases of this System Affections Connected with Parturition. Haemorrhage, 27 28 29 30 July 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 i 1 1 1 1 2 1 5 3 1 1 8 4 1 1 November. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 .. 25 26 27 28 9 7 5 6 4 4 1 "3 2 5 6 1 6 1 2 i 5 3 1 3 2 3 2 2 2 2 2 2 2 1 2 2 2 1 2 1 1 1 1 J 1 1 2 1 2 1 1 1 60 67 69 70 71 75 74 76 71 75 75 ) 64 1 66 ) 67 72 64 64 8 66 68 5 71 8 65 64 71 2 76 75 67 57 2 61 42 46 49 54 53 60 61 61 58 57 62 57 50 50 61 55 56 56 57 53 55 47 48 55 58 48 43 42 18 21 20 16 18 15 13 15 13 18 13 7 16 17 12 9 8 10 11 18 10 17 23 21 17 19 14 19 52.2 58.7 21.7 63.2 62.7 67.7 67.2 70.7 62.5 66.5 68.5 59.5 57.7 63 0 65.7 60 0 60.0 60.2 61.5 60.7 58.7 54.7 60.2 66.5 66 7 53.2 49.5 57.0 48 63 54 61 84 86 72 50 83 56 61 70 83 80 81 81 70 63 54 53 68 76 88 89 63 59 30.3 30.2 30.2 30.2 30.1 30.0 30.1 30.1 30.1 30.0 29.9 30.0 30.0 30.0 29.9 30.0 30.0 29.8 29.8 29.9 30.0 30.0 .23 1.83 "61 1.77 .53 2 2 1 1 3 1 8 6 31 1 1 1 1 1 2 3 1 23 15 6 9 4 August.... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 .. 15 16 17 18 19 20 9 8 10 10 6 6 10 14 12 13 11 20 14 22 31 27 41 39 31 51 28 28 31 26 28 20 32 35 38 32 29 44 37 33 48 56 63 63 78 8< 91 8£ 9: 8S 8< 91 95 95 8< 9( 8< 9( 8< 91 8< 81 91 91 79 78 76 76 75 75 77 77 78 78 78 78 77 77 77 77 77 79 77 78 10 13 13 7 13 14 14 15 14 11 12 11 13 12 14 7 11 12 14 14 84.7 85.7 85.0 79.7 83.0 83.7 84.7 85 5 85.7 84.7 84.0 81.5 82 a 82.1 84.7 81.5 84.1 84.7 85. C 85.5 74 69 73 79 74 72 75 69 72 71 72 73 76 76 71 71 75 72 67 69 30.0 29.9 29.9 29.8 29.8 29.9 29.9 29.9 29.9 29.9 29.9 29.9 29.9 29.9 29.9 30 0 30.0 30.0 30.0 29.9 .05 .01 1.85 .09 .01 .25 .02 .21 .05 .01 1 6 5 3 i 3 7 9 28 1 1 1 4 2 1 1 1 2 3 1 9 7 5 4 1 2 4 1 3 1 3 1 1 13 26 9 mseases or me organs oi uocomo Diseases of the Cellular and C'utar non eons System 6 5 38 29 17 1 7 41 22 13 20 7 14 12 103 89 38 1 1 3 1 3 3 1 9.R94 R5 79. 19. ft 7S.7 70.4 30.0 Conditions not Necessarily Associated with General or Local Diseases. 1 3 3 2 3 3 6 5 3 4 2 1 2 1 1 October.... 1 0 " 3 4 5 6 7 8 65 51 57 41 65 39 48 41 88 84 79 63 87 60 72 57 14 14 13 1 13 17 15 15 2 14 79.0 79.0 79.4 79.4 78.4 78.3 78.5 79.0 1 2 86 86 86 87 86 85 86 7 7 7 7 7 7 7 76 73 56 74 76 73 85 29.9 29.9 29.9 30.0 30.0 30.0 30.0 .10 ".06 "oi 1 4 3 2 2 1 29 2 13 .68 Old Age 4 2 29.8 29.8 30.0 30.2 29 188 5 24 38 8 Debility Debility Infantile All others Poisoning 2 .. 14 15 16 Total 574 3058 3950 8078 16 11 12 2 14 4 2 8 77 19 25 12 43 6 3 9 504 6122 1 20 11 4 4 7 4 2 1 139 1409 4 96 11 60 40 9 7 17 7 1 45 29 33 13 21 12 6 0 539 4568 General Injuries. T)rnwni-n(r - . . ------ 1 NATIONALITIES- • Burns and Scalds All nthor fw-o.v.p.ml COLOR-VITAL AND MORTUARY STATISTICS OF NEW ORLEANS, LA., 1847-1881. Local Injuries. Wmmds . All other local inj Human Parasites Tumors, Non-Mali Suicide iries 15 7 13 1605 14292 4 2 1 207 1341 69 ^nant Unknown, or Not Total Deaths. Still-hmn Stated 564 7754 193 1818 Color. 1847 6274 1220 7499 1849 7974 1888 9862 1850 6319 1500 7819 1853 14392 1341 15633 1856 4274 926 5200 1857 4593 988 5581 1858 10592 1118 11710 1850 5781 1066 6847 1860 5884 1179 278 7341 1863 5015 1735 508 7258 1864 6032 2832 8864 1865 4688 2231 101 7020 Total 12 Years. 81718 18024 892 100634' 1866 4984 2392 378 ' '7754 1867 7866 1931 299 10096 1868 3503 1676 164 5343 1869 375' 209$ 15$ 600 1870 4602 2560 229 7391 1871 378$ 2115 16$ 605< 1872 3871 2143 108 6122 1873 4739 2684 82 7505 1874 4299 2395 104 6798 1875 386f 2151 9" 611' 1876 3847 2305 105 6257 1877 3976 2732 6708 1878 8062 2256 10318 1879 3267 1855 5122 1880 3637 1986 5623 1881 4127 2279 6406 Total 16 Years 72188 35552 1880 109620 Grand total, 28 Years. 153906 53576 2772 210254 ================ 1869 1870 1871 1872 1873 1874 1875 1876 1877 1878 1879 1880 1881 1 4 7 Total 20 Years. 1 145 405 16 214 168 165 95 171 22 4060 1 ' 5922 11484 26 68 13173 1523 21240 178 48 276 1 96 124 559 94 417 1 33 789 509 10 67401 31 861 18651 148978 Whit Black Not s T RS _ . - - - . ■ Vital and Mortuary Statistics of New Orleans, 1849-1881, Monthly Mortality. 1853 1857 1858 1859 1860 1867 1868 s ----- Australi A frir.n. fated- otal 12 7 8 29 6 15 4 17 1 19 12 44 2 10 11 52 I 22 3 193 "549 995 "'8 1133 144 2 6 IC 41 "191 27£ 47^ 45 । 1 1 1 1 1 397 3 81 LiOO 10 9 2 13 6 11 7 15 "'99 "352 518 1 g 551 199 7 2 14 12 10 32 9 31 1 ""2 44 6 9 2 1 11 ( 6 ""'9C 231 405 3 56S 52 12 IS 2( 21 "'l 21 11 7 13 24 4 9 19 14 8 1 82 '"290 534 2 2 597 52 12 1 15 1 6 15 3 28 2 49 21 13 11 1 4 6 11 7 8 "'56 "258 477 2 3 525 76 * 8 1 17 2 9 17 3 25 2 36 19 2 13 7 10 6 9 9 50 8 14 4 9 1 3 4 6 4 "519 1 193 363 1 4 t 47 3518 9 SEN-VITAL AND MORTUARY STATISTICS OF NEW ORLEANS, LOUISIANA, 1849-1881. Austria ••••••-_. 108 A +. Son 3 British America 25 76 10 2 10 13 16 6 "'8 5 11 '"70 "'212 411 1 3 537 43 4 3 8 7 "63 247 396 4 3 463 51 9 1 5 6 4 1 68 253 388 1 4 450 54 2 14 4 42 19 15 3 6 4 13 10 8 72 231 446 4 3 487 56 3897 9 5 10 3 6 " "49 '"267 302 2 0 439 33 11 1 6 1 4 36 3 10 i 29 YEARS. 1849 1850 1853 1855 1856 1857 1858 1859 1860 1861 Jan. 1182 582 581 ? 379 372 448 504 567 518 397 328 471 443 447 642 583 572 436 571 403 574 446 543 Feb. 600 425 463 ? 339 371 362 472 514 635 362 292 429 347 630 556 481 454 460 589 511 360 438 466 March. 1397 833 456 1 342 498 518 438 567 448 401 408 600 491 430 603 452 461 559 788 437 376 462 551 April. 968 491 532 1 334 530 482 479 633 411 350 555 545 440 418 600 609 522 447 555 475 369 461 529 May. 1007 601 671 851 390 504 576 621 646 510 316 602 621 411 713 930 548 403 601 738 535 509 581 683 June. 870 459 656 1316 797 497 531 525 730 657 561 525 673 535 572 562 517 551 653 633 427 402 573 733 July. 435 584 2216 1052 583 429 813 701 779 463 551 551 497 488 483 773 700 622 536 504 492 422 422 571 Aug. 485 916 6201 1747 569 482 1826 503 557 485 1039 421 480 551 569 498 708 447 469 516 1784 422 407 472 Sept. 666 653 1627 1454 497 417 3069 656 622 395 2498 422 858 451 425 624 440 675 503 439 2558 327 450 427 Oct. 910 620 674 502 481 510 1775 611 520 431 1942 474 681 441 432 713 636 473 477 417 1845 492 466 442 Nov. 712 899 712 321 489 602 834 788 535 496 <59 452 465 568 430 500 527 443 524 543 492 410 517 508 Dee 630 756 8-14 41. 369 476 519 631 720 563 512 429 473 504 597 494 592 415 359 459 460 481 Total. 9862 7819 15633 7691 5200 5581 11710 6847 7341 5449 10096 5593 6932 5595 6122 7505 6798 6117 6257 6708 10318 5122 5623 6406 neigium - - Sex. Males Females Not stated Total 1849 6458 3404 9862 1850 4802 3017 7819 1853 9765 5452 416 15633 1856 3108 2092 5200 1857 3245 2336 5581 1858 7675 4035 11710 1859 4193 2654 6847 1860 4193 2654 494 7341 1863 4405 2578 275 7258 1864 4S95 3739 230 8864 1865 3846 2963 211 7020 Total 11 Years. 56585 34924 1626 93135 1866 4372 3052 330 7754 1867 6239 3566 291 10096 1869 3275 2598 128 6001 1870 4466 2838 87 7391 1871 3530 •2481 48 6059 1872 3526 2568 28 6122 1873 4396 3070 39 7505 1874 3982 2798 18 6798 1875 3416 2666 35 6117 1876 3381 2623 253 6257 1877 3650 3058 6708 1878 6193 4125 10318 1879 2969 2153 5122 1880 3053 2570 5623 1881 3593 2813 6406 Total 16 Years 62785 45271 1564 109620 Grand total, 27 Years. 120370 80195 2190 202755 Chinn, 1 13 1 76 "'268 424 "566 24 14 1 5 5 101 219 443 "14 998 20 * 10 4 '"533 "'246 465 "2 t 64 3941 8 11 22 "'958 ""587 905 5 8 t 382 5354 11 8 5 '"'478 "'208 421 3 2 t 50 2873 9 JLOOy 2844 2292 207 5343 Denmark East Indies England Finland France Germany Greece Holland Ireland ""227 "392 1593 ""2867 4 7 63 166 308 ""686 20 * 11 1 15 3 3 28 0 17 4 13 23 16 4 214 ""677 1411 "1891 114 18 6 20 17 5 114 7 50 Ttalv AGES-VITAL AND MORTUARY STATISTICS OF NEW ORLEANS, LOUISIANA, 1849-1881. Louisian Mexico.. Madeira a. 1657 ""28 ""83 Ages. Under 1 year From l'to 2 years. From 2 to 5 years. From 5 to 10 years. From 10 to 15 years. From 15 to 20 years. From 20 to 25 years. 1875 1262 403 420 274 139 203 360 351 613 630 519 424 23C 78 21 11 178 1 1876 1193 494 504 273 138 200 287 346 644 637 536 420 261 99 29 24 172 B957 1877 1228 437 441 1878 1260 455 1523 693 ' 288 416 ^1549 1392 977 706 466 313 121 j 44 115 10318 1879 1115 261 227 132 97 127 j 520 588 594 426 439 313 105 j 46 32 5122 1880 1247 373 388 211 115 129 281 267 580 601 534 449 234 131 j 63 20 5623 1881 1231 304 390 240 150 188 334 341 684 705 638 576 337 131 42 20 6406 Total 16 Years 22224 6745 7550 4353 2364 3511 13896 12953 11253 8664 6342 3557 1355 699 4154 109620 Grand total, 27 Years. 38621 27348 8136 12175 j 30444 25586 19072 12999 8740 4827 1983 1037 11787 202755 1867 1869 1849 1232 j 903 342 530 ^1991 1603 833 382 192 101 4f 21 168$ | 986$ 1850 1323 j 937 249 126 279 ^1342 1224 615 321 191 101 44 IS 1041 781< 1853 1954 1296 ? 499 ^2085 ^4514 2093 901 448 206 83 40 18 1 1495 15633 1856 1608 434 337 155 71 87 298 431 730 483 253 131 80 55 20 2 25 5200 1857 1568 468 475 205 117 130 308 408 768 523 297 155 97 38 18 6 5581 1858 1944 603 1001 365 293 579 1539 1486 2001 1040 463 216 118 45 11 6 11710 1859 1609 538 505 326 153 231 445 549 1025 762 331 196 95 51 21 10 6847 1860 1467 668 581 322 115 175 400 602 956 701 378 216 99 47 23 3 587 7341 1863 952 694 643 279 140 271 782 725 595 367 236 155 84 37 14 1284 7258 1864 1365 806 962 1865 1375 578 624 446 194 189 650 728 649 495 301 159 66 34 12 520 Total 11 Years. 16397 13053 3783 6300 j 16548 12633 7819 4335 2398 1270 628 259 79 7633 1866 1524 518 510 360 172 244 j 1069 991 737 520 333 147 51 19 10 549 7754 1867 1863 529 566 491 253 466 942 1039 1441 946 604 344 163 70 12 10 357 10096 1868 1331 364 229 152 90 132 221 282 588 488 386 266 136 62 22 9 585 5343 1869 1385 472 493 201 105 146 24S 28C 581 57C 445 27( 135 45 3( 15 575 1870 1587 410 353 180 149 253 491 582 929 754 559 348 189 64 24 12 509 1871 1596 324 204 126 108 153 336 37C 753 66' 50S 32C 16( 74 If 1' 32C 1872 1367 405 337 162 114 170 327 368 750 675 529 365 220 62 34 18 219 1873 1539 507 516 299 153 188 519 514 880 775 603 404 215 77 38 16 262 7505 1874 1396 399 449 251 123 224 372 383 830 740 579 467 227 86 26 19 227 fiTftR 10 6 38 23 18 2 10 39 "40 "2 45 21 15 2 11 14 36 38 31 14 4 7 8 3 20 2 34 9 2 4616 1 44 74 6117 13 3 8 11 4 17 2 28 16 14 2 8 2 2 40 20 25 17 11 "'14 ' "3 44 44 7 1531 "59 200 10318 11 4 "2 2 28 26 6 7 7 i 27 22 14 1 4 4 14 i 43 20 1870 18 fl 1872 1873 1874 iNorway auu oweuen Persia Poland Portugal Prussia Russia , Scotland Sandwich Islands South America 17 3 171 20 66 1 3 53 46 1875 1876 1877 1878 O9O 255 280 803 780 170 272 916 66 76 42 28 1879 1880 1881 A. A Will A J UU DU From 30 to 40 crpsiiiTi __ .... Switzerland 1 4 8 38 rears. s 709 757 571 445 273 99 J 52 30 6708 a ui iwy United States (not Louisiana) 495 ""'23 8059 15633 3209 "'27 940 5581 5624 ""42 1278 11710 4073 "'47 1271 6847 3263 34 2010 7341 4990 34 1482 10096 333 4753 428. 4* 19 605 4474 2 68 97 » 6122 5517 2 63 109 7505 5041 2 65 93 6798 4517 3 38 338 6257 1066 51 202 6708 822 44 86 5122 799 2 27 34 5623 1017 1 36 3 6406 From 50 to 60 years. From 60 to 70 years. From 70 to 80 years. From 80 to 90 years. From 90 to 100' years 100 years and upward A ge unknown Total 600 358 183 110 38 21 991 Total Average Monthly Mortality From 1849 to 1 11989 521 867 inclu 10556 459 des Still 12456 541 born. 11735 510 14568 607 14955 623 15667 653 22554 940 21153 880 17065 711 13726 572 11801 513 178325 7430 w aies... West In Not stat Tota tin dies sd 32 787 5343 ! 54 577 1 7391 eluded unuer England. ■ 'xnciuuea under umxeu »taxes. History of Quarantine in Louisiana : Joseph Jones, M. D. CLXIX able argued by rhe attorney of the board, Col. F. C. Zacharie, and by Judge A. D. White, Assistant Counsel, before the Supreme Court of the State of Louisiana. The following able and learned decision of the Supreme Court of Louis- iana, sustaining the quarantine laws ol the State, and upholding and sanc- tioning the official acts of the Board of Health in maintaining quarantine, and collecting fees for the support of the same was delivered by Associate Justice Fenner, on the twenty-first of January, 1884, in the city of New Orleans. QUARANTINE FEES-THEY ARE LEGAL EXACTIONS OF THE STATE, IN PAYMENT FOR SPECIAL BENEFITS-THE QUAR- ANTINE LAWS DO NOT INFRINGE THE POWER OF CON GRESS TO REGULATE COMMERCE. THE MORGAN COMPANY REQUIRED TO PAY THE FEES OF THE BOARD OF HEALTH-HIGHLY IMPORTANT DECISION OF THE SUPREME COURT O" THE STATE OF LOUISIANA. New Orleans Picayune.] The following opinion was delivered by Associate Justice Fenner on Monday. January 21: No. 8755-Morgan's Louisiana and Texas Railroad and Steamship Company vs. The Board of Health of the State of Louisiana. Appeal from the Civil District Court, Parish of Orleans. The Act No. 69, of 1882, of the General Assembly of the State of Louisiana, provides that ''the Resident Physician at the Quarantine Station on the Mississippi River shall require, for every inspection and granting certificate, the following fees and charges: For every ship, $30; fot every bark, $20; for every brig, $10; for every schooner, $7 50; for every steamboat (towboats excepted), $5; for every steamship, $30." By virtue of other provisions of the quarantine laws of the State, it is made the duty of the resident physician, or his assistant, to visit and inspect every vessel entering the port of New' Orleans through the Mississippi River. If be finds the vessel free from dis- ease, not in a foul condition, and not from an infected district, he is required to furnish her with a " certificate of health " and allow her to proceed to the city. Vessels in a foul condition or having on board persons suffering or who have suffered during the voyage from contagions, pestilential or infectious diseases, he is required to detain for such time, not less than ten days, as he may deem neccessary, and to employ such means of purification of the vessels as may be directed by the Board of Health, and to require payment therefore from the vessel. Vessels out ten days from infected ports, presenting clean bills of health, not having nor having had sickness on board, and which are not in foul condition, shall be permitted to pass to the city after thorough fumigation by disinfecting agents. Revised Statutes, 3042-3-5. The practice under these laws is to visit and inspect every vessel, and to require, in every case, the fee prescribed therefor; and in cases where, under the law', the service of disinfection by fumigation is rendered, to require therefor an additional fee of twenty or twenty-five dollars as the estimated expenses thereof. Plaintiff is the owner of several vessels plying between the port of New Orleans and various other countries. The object of the present suit is to perpetually enjoin the col- lection of the fees and charges above mentioned, and to restrain the defendant from de- taining the plaintiff's vessels because of their non-payment, on the ground that the law's authorizing the same are null and void because they contravene : 1. Article one, section eight, paragraph three of the Constitution of the United States, which provides that " Congress shall have power * * * to regulate commerce with foreign nations, and among the several States, and with the Indian tribes." 2. Article one, section ten, paragraph three, which provides that "No State shall, without the consent of Congress, lay any duty upon tonnage," We shall at the outset disembarrass the case of several questions upon which we heard much learned argument, by laying down certain propositions which we consider clearly settled by the Supreme Court of the United States, to whose opinion on such subjects we yield our firm adherence. CLXX History of Quarantine in Louisiana : Joseph Jones, M. D. 1. The laws in controversy are in no sense "inspection laws," and can derive no sup- port rom that clause of the Constitution of the United States recognizing the right of the Spates to pass such laws, and to levy duties and imposts in execution thereof. The inspection, duties and imposts intended by that provision referred exclusivelv to articles of m< rchandise, and not to vessels. Gibbons vs. Ogden, 9 Wheat., 203; People vs. Com- pagnie, 13 Reporter, 326. 2. So far as the exclusive power of Congress to regulate commerce is concerned, that power is not infringed by the laws under consideration, unless the fees and charges imposed thereby are in the nature of a duty on tonnage, in which case they would doubtless violate both the general reservation to Congress of the exclusive power to regulate commerce, and also the special prohibition to the States to lay any duty on tonnage. In other respects, the rights of a State to provide for the healthx>f its people by establishing quarantine laws, and to subject vessels entering its ports to proper regulations as to inspection, detention, purification, etc., although necessarily affecting commerce, is, nevertheless, undisputed, subject, possibly, to the power of Congress to interfere and control it in its discretion. Gibbons vs. Ogden, 9 Wheat., 203; Passenger Cases, 7 How., 414; Peet vs. Morgan, 19 Wall, 581. 3. If the fees and charges complained of be of the n'ature of a duty on tonnage, the fact tjiat they are levied under quarantine laws would not save them from the prohibi- tion of the Federal Constitution. Such duties cannot be levied without the consent of Congress, and Congress has never consented, but on the contrary, in its acts of 1799, recognizing the existing quarantine laws of the States, it interposed the express proriso that nothing herein shall enable any State to collect a duty of tonnage or impost without the consent of the Congress of the United States thereto. 4. If the fees and charges be in the nature of a duty the fact that it is laid on the whole ship, and not at the rate of so much per ton, would not of itself exempt it from the Federal prohibition. Steamship Company vs. Poindexter, 3 Wall., 31; State tonnage tax cases, 12 Wall., 218. This elimination leaves open, on this branch of the case, the solitary question, whether the fees and charges here involved are duties in the sense of the constitution ? It is the well established jurisprudence that there are many forced contributions which gov- ernment may exact from persons and property which are not considered as taxes, duties or imposts, within the meaning or control of constitutional restrictions upon the power to levy the latter. Such are contributions provided for the constructions of public works for the advantage of particular districts, like levees, drainage, pavements, etc., levied on the property with reference to the supposed benefits derived by the property from the works; contributions provided to defray the expenses of building bridges, erecting causeways, or removing obstructions in a water-course, and like the light duty paid by all nations to the Danes, to be paid by such individuals only who enjoy the ad- vantage; and Jees or charges for services lawfully rendered, iike wharfage, pilotage and portwarden fees, to be paid by those who receive the services. States vs. Naviga- tion Company, 11 Mart. O. S., 324 ; Crowley vs. Copley, 2 Ann., 329 ; Lafayette vs. Or- phan Asylum, 1 Ann., 1, and etc. In the first of the cases above quoted, Chief Justice Martin said that the words, "im- post, tax on duty," as used in the consitution or laws, must be confined to the idea which they commonly and ordinarily present to the mind: exaction to fill the public coffers, for the payment of the debt and the promotion of the general welfare of the country- and not to contributions as the supposed equivalent of benefits conferred or services rendered, like those above indicated. It is apparent from the face of the laws here attacked that the fees and charges com- plained of are demanded as compensation for labor performed, expenses incurred and services rendered directly in connection with the vessels, the necessity for which arises solely from the fact that such vessels, in the exercise of an undoubted right, yet volun- tarily and in pursuit of their own interests, choose to seek the port of New Orleans, well knowing that they cannot enter said port without first being inspected, and, if neces- sary, purified in conformity wTith laws to that extent unquestionably valid. Can it be said that the rendition of these services, by virtue of which alone the vessel is enabled lawfully, to proceed to her destined port, is not a service to the vessel. It is said that it cannot be considered as a service, because the vessel does not regard it as such, but rather as a burden, and because she does not voluntarily seek or avail herself of it. As to the first point, the question would seem to be, not whether the vessel regards it as a service, but whether it is a service and whether she ought to regard it as such. It seems the plainest development of the primal duty, sic utere tuo ut alterum non laedere, that a vessel should seek and desire the performance of services the object of which is to prevent the chance of her spreading disease and pestilence amongst large populations. She is under the plain obligation, moral as well as legal, to do everything to avoid such risk, and the service which enables her to perform this obligation would seem so be a service to her. History of Quarantine in Louisiana: Joseph Jones, M. D. CLXXI As to the second point that the services are forced and not voluntary, the reliance placed upon the decisions of the Supreme Court of the United States in the wharfage and portwarden cases seems not well founded. In those cases there was no legal duty imposed on vessels to land at the wharves or to receive the services of the portwardens. They had the perfect right to decline these benefits and services and they properly held that a State law exacting contribution for them, whether used or not, was unconstitu- tional. But had it been the, legal duty of vessels to land at a particular place in the port of New Orleans, and had the city provided expensive wharves at such places, it is supposed that she would not have had the right to exact compensation for the facilities thus afforded, although vessels landing at the port would have had no option as to accept- ing the use of them. Finally, it is claimed that the services rendered under these quarantine regulations are for the benefit of the people of the city and State, and not for that of the vessel. No doubt that is true. It is equally true that the object of the city in building wharves was to benefit its own people, trade and commerce. We deem it unnecessary to con- sider more at length the objections which have been forcibly urged against the theory that the services in question are rendered to the vessel in such a manner as to justify the exaction of compensat ion therefor. What we have said sufficiently expresses our views on the subject, and while the question is not free from difficulty, even to our own mind, weare confirmed in our course by the reflection that it leaves the avenue open for correction of any error which we may commit by appeal to the Supreme Court of the United States, whereas if we should err in the opposite direction, the defendants would not be entitled to that remedy. The broad proposition of plaintiff, that in the exercise of the right to establish quar- antine systems, the States are bound to bear all the expenses thereof, and cannot throw the burden, in any manner, or to any extent, upon commerce, has certainly not yet received the indorsement of the Supreme Court of the United States. In the passenger cases, Mr. Justice Wayne, summing up, in his separate opinion, his view of what the entire court meant to decide, included, among other propositions, the following: " That the States may, in the exercise of their police power, pass quarantine and health laws, etc., and may, in the exercise of such police power, without violation of the power in Congress to regulate commerce, exact from the owner or consignee of a quarantined vessel, such fees as will pay to the State the cost of detention and purifica- tion of the vessel, cargo and apparel of the persons on board." Nothing iu any of the several opinions rendered in the case clashes with this statement or indicates any dissent therefrom. Passenger Cases, 7 How., 414. In the case of Peete vs. Morgan, strenuously relied on by plaintiff, the court, after recognizing the right of the States to pass quarantine laws, said : "It is evident that the power to establish quarantine regulations cannot be executed without the State possesses the means to raise a revenue for their enforcement, but it is equally evident that the means used for this purpose must be of such a character as the restrictions imposed by the Federal Constitution upon the taxing power of the State authorize." It cannot be doubted th kt the court meant to sanction the right of a State, iu its quar- antine laws, to raise a revenue for their enforcement, in some way connected with their execution. To suppose that the means to raise a revenue referred to as implied in the power to establish quarantine, meant only the ordinary powers of taxation of the State' own citizens and property, would be to accuse the court uttering a mere inanity, We can conceive of no other means which could have been in view, except just such exac- tions of compensation for services as are provided in these laws of Louisiana. As far as appears from the statement and opinion in Peete vs. Morgan, the charge there in question was a clear and simple duty on tonnage, levied by the State without any reference to services rendered, and we think it has no application to the instant case, except in the clause above quoted. We find nothing inconsistent with the foregoing views in the proviso inserted in the the act of Congress of 1799. That was an act empowering and directing the officers of the General Government to conform to and assist in the execution of the quart atine laws of the States. All or most of the seaboard States had such laws, the natur and mode of execution of which must have been known to Congress. Those laws conf lined provisions authorizing the exaction of fees and charges for inspection, disinfection etc., entirely similar to those in the laws of Louisiana. For instance the law of South Caro- lina, passed as early as 1759, forbade vessels bound for Charleston from infected iorts from passing Fort Johnson until visited, inspected and certified by one of certain n imed physicians, and obliged the owner or master to pay such physicians a fee of £7 10s cur- rent money, and. moreover, the expense of the boat and hands to carry down such physician to visit the said vessel and to bring him up again to Charleston. Nothing tn the acts of Congress reprobates such charges, and it must be supposed that the proviso forbiding the levy of any duty of tonnage did not refer to charges for services of this character, but was intended to shut out any implication of ft cbnhCfit by Congress to the imposition of tonnage duties proper. CLXXII History of Quarantine in Louisiana: Joseph Jones, M. D. There is nothing in the laws of this State or in their execution, as disclosed by the evidence, indicating the purpose of levying a forbidden tonnage duty under the guise of charges for service The services are shown to be actually rendered, and the charges are not excessive to a degree sufficient to authorize judicial interference It is proved that the revenue derived therefrom is devoted exclusively to quarantine purposes, and in no year has it been sufficient to defray the quarantine expenses. We therefore hold that the plaintiff is not entitled to the relief asked. As we maintain the validity of act 69 of 1882, the constitutional objection to the act of 1870 'Rev. Stat , sec. 3042), on the ground of discrimination between the ports of different States, does not arise, the law in this particular being repealed bv the act of 1882. The claim that the act contravenes article forty-eight or thirty of the Constitution of the State is without foundation. The act is neither local or special, but is of the more general character, intended for the benefit and protection of the entire people of the State. Neither does it revive or amend any prior law. It is an original and independent statute, repealing such portions of prior laws on the same subject matter as are incon- sistent with it. It is therefore ordered, adjudged and decreed that the judgment appealed from be annulled, avoided and reversed, and it is now adjudged and decreed that the injunction herein granted be now dissolved and that plaintiff's demand be rejected at his cost in both courts. After a continuous battle, of four years duration, in which the vast mari- time interests of the State, and the power and influence of the wealthiest railroad and steamship company in the Southwestern States, were mar- shalled against the legally constituted health authorities, the Board of Health of the State of Louisiana achieved a memorable and signal victory on the twenty-first of January 1884, in the complete and triumphant vin- dication of its efforts to exclude foreign pestilence from the Mississippi valley, by the highest legal tribunal of the State of Louisiana. If the decision of the Supreme Court had been adverse to the Board of Health, the quarantine laws of Louisiana would have been rendered pow- erless for the exclusion of foreign pestilence. Quarantine must be sustained either by an appropriation from the State government, or from the inspec- tion fees ; the General Assembly of Louisiana had made no appropriation for the maintenance of quarantine; therefore if the decision of the Lower Court had been sustained by the Supreme Court of Louisiana, an extra ses- sion of the Legislature would have been necessary for the appropriation for the support of the officers and employes, the supply'of disinfectants, the maintenance ot the hospitals, and the isolation and treatment of seamen and passengers, suffering with contagious and infectious diseases. Th§ actual expenses of an extra session of the Legislature of Louisiana, would have imposed an additional burden upon the taxpayers of the State which would have exceeded the amount now collected for the support of quaran- tine at least four times; in other words, the expenses of the extra session would have been sufficient to maintain the quarantine system, during a period of four years and longer. The records of the Board of Health show that the Morgan's Louisiana and Texas Railroad Company is indebted to the State of Louisiana, for quarantine fees, about $14,385; and the Cromwell Steamship Line $8,400; total amount due the State of Louisiana by the Morgan and Cromwell lines, about $22,865. The decision of the Supreme Court of Louisiana, in case No 8755, not merely relieved the citizens from the additional expense of an extra session of the General Assembly, but also affirmed the right of the State to over $22,000 dollars, due for unpaid quarantine fees, by the Morgan and Crom- well lines. The decision of the Supreme Court of Louisiana .has confirmed the view held and strenuously advocated by the President of the Board of Health that: History of Quarantine in Louisiana : Jose}}!! Jones, M. D. CLXXIII The fees collected by the State of Louisiana from vessels subjected to the quarantine laws are not in the nature of a tax or impost on commerce, but are a just and necessary compensation for the great service rendered commerce in the cleansing and disinfection, of the vessels and cargoes, in the care and treat- ment of the sick by the medical officers of the State, and by the exclusion of foreign pestilence, and the establishment of public confidence, and the mainten- ance of commerce, which, but for the said quarantine service would be greatly damaged. Were it not for the execution of the quarantine laws by the Board of Health of the State of Louisiana, the port of New Orleans would be her- metically sealed to commerce during from four to six months every year, and all intercourse with the surrounding States would be closed by the shotgun quarantine, controlling the river and railroads. The decision of the Supreme Court of Louisiana, is of interest and im- portance to every State and municipal government in the United States of America, for the doctrine is here clearly recognized, that: The establishment and enforcement of quarantine by individual States is not a regulation of commerce in violation of the provisions of the Federal constitu- tion, but is the legitimate exercise of the police powers, by the individual States which are inalienable, and which in a republic, cannot be surren- dered to the general GOVERNMENT, without transforming the sovereign States, into the dependent provinces of a centralized despotism. COMPARATIVE VIEW OF THE MORTALITY OF NEW ORLEANS DURING THE PERIOD OF FOUR YEARS; 1880, 1881, 1882 AND 1883. RELATIONS OF DISEASE AND DEATHS IN NEW ORLEANS TO RACE, TEM- PERATURE, RAINFALL AND MOISTURE-OUTLINE OF THE SANITARY WORK PERFORMED UNDER THE DIRECTION OF THE BOARD OF HEALTH * OF THE STATE OF LOUISIANA DURING 1880, 1881, 1882 AND 1883-COM- PARATIVE VIEW OF THE DISEASES AND MORTALITY OF THE VARIOUS DISTRICTS OF NEW ORLEANS. The following tables llustrate : 1. The population of the city of New Orleans, divided according to race and sex by the United States Census for the year 1880, and estimated increase for succeeding years, based upon the ratio of increase between the years 1870 and 1880. 2. Tabulated statement of the mortality of New Orleans, Louisiana, during the years 1880 to 1883, inclusive. These tables are of value in that they embody data capable of compari- sion with the vital and mortuary statistics of various European and Ameri- can cities. Aside from their scientific value in their relations to ethnological, medi- cal and sanitary science, they possess a material value in the light which they may throw upon the operations of the various f >reign and domestic life insurance companies. CLXXIV POPULATION OF THE CITY OF NEW ORLEANS, LOUISIANA. DIVIDED ACCORDING TO RACE AND SEX, BY UNITED STATES CENSUS FOR THE YEAR 1880, AND ESTIMATED INCREASE FOR SUCCEEDING YEARS, BASED UPON THE RATIO OF INCREASCE,BE- TWEEN THE YEARS 1870 AND 1880. History of Quarantine in Louisiana ; Joseph Jones, M. I). YEAK. White. Colored. White and Colored. 1 Males. Females. | [ ~ r । Totals. Males, Females, j Totals. Males. । | Females, j I Totals. 1880 75,693 82,702 158,395 25,247 32,501 57,748 100,940 115,203 216,143 Average 76.072 83,273 159,345 25,493 32,659 58,152 101,565 115.931 217,497 1881 76,450 83,844 160,295 25,740 32.816 58.556 102.190 116,660 218,851 Average 76,837 84,419 161.256 25,993 32,972 58.965 102.830 117,392 220,222 1882 ' 77,224 84,994 162,218 26,246 33,129 59.375 103.470 118,123 221,593 Average 77,605 86,586 163,191 26,501 33,289 59,790 104.106 118,876 222,982 1883 77,986 86,178 164,164 26,756 33,450 60.206 104.742 119,628 224.370 Average 78,369 86,775 165,144 27,017 33.610 60.627 105.386 120,385 225,771 1884 78,753 87,372 166.125 27.277 33,771 61,048 106.030 121,143 227.173 TABULATED STATEMENT OF MORTALITY OF NEW ORLEANS. LOUISIANA, DUBING THE YEARS 1880 TO 1883, INCLUSIVE. 1880 1881. 1882. 1883. <4 © 2050 2419 2104 2657 Males. Whites. 1587 1708 1478 1895 1'6103168. glgttg Totals. 1003 1178 1225 1634 Males. Colored. 9831986 11012279 1115 2340 11337 2971 Females. Totals 3053 3593 3329 14291 Males. White and Colored. 2570 2813 2593 3232 Females. qI co £ -totals, to to o io ■ OS to OS oo 26.87 31.47 27.11 35.18 Males. Whites 19.05 20 23 17.10 21.83 Females. 22.82 39.34 25.59 45.32 21.88 46.22 1 27.56 60.47 Totals. Males. | Colored. Death Kate per 1000 Popula 30.09 34.10 33.36 38.31 33.49 39.14 39.78 49 00 Females. Totals.' 30.03 34.94 31.97 40.71 Males. 22.16 : 23.96 21.81 1 26 84 Females. Total. o' B 25.85 25.85 29 08 29.06 26.60 24 69 I 33.32 27.71 Totals. Total Ex of Small elusive Pox. History of Quarantine in Louisiana: Joseph Jones, M. D. CLXXV [A,] r ABULATED EXHIBIT OF MORTALITY FROM SOME OF THE CHIEF FATAL DISEASES IN THE CITY OF NEW ORLEANS DURING THE FOUR YEARS 1880 TO 1883, INCLUSIVE, BY WEEKS. 1880. 1 Total w. and c...l F« - Dec. 4 8 s 3 o ◄ 5 e> f oto 8 £ H* I 2i2 4- > s re. -i co 1 IT o ? 55 ■Tune 5 5 00 24.... May 1 -J p I & to H- Mar. 7 8 w 2 nno 1 > 5 H* 4- WEEK ENDING. H* I35 Small-Pox. 1 ? ►-a Yellow Fever. 1 336 327 868 85 42 124 3( p »O W w *. W w Ox ex o O ® o wSoo Z-I o w W COtOtOWCxwexOxOseeCxlOtOtOOxCx tO CO IO 00 00 HHWWMA X-t t-1 1-1 Malarial Fevers. ' to w w co to to a'-c<5t®4!L«t?_-i w e» ox to w co w co w co 1 to: to co w to Ox w w : wl : w : : cow p Diarrhoeal Diseases. w ww to tow'. col tow tow co to'- 1010* WOxwtol cootowo-jeco: 1 oxtotoi '• to'- to A. to to- co to-J. too p ooSwcowoS® 5 5o-t-t w OOwOOOOOOtOOWOOOOO^xttS^teiWto^OWOOOOOxWxtCiKlOOCOxttoto Phithisis Pulmonalis. s towaxoowSgwwwioaoo-ioxwwMOotocotoosMwiowgwooMooo-nowooaaitoo-ooxcowocnwwioccoooo a s wwuio' wwa h- W to w to w w co to : HMMMM _ HA IO HA Hi to' to' Hi IO W Diphtheria. . • HA i . . HA '. < ; - M* • HA Hi Mi • co to co Hi IO to X-1 HA HA H* x_ H* 4- Croup. *• bO ■ H* * Hi « M* HA M H w be A W Hi • • Hi to HA HA hM to cotowescotowtocowox' co to co ■ www Ji p Bronchitis. a HA * * MM »-l Hi w to • M • ' Hl HA to co to 1 WW4XC0H*-' COWWtOCOCOCSOx: 10 I I-*: -4 Ox 10 tO Ox tO to CO Ox Ox to! to w ex to to to to: w! : tocowoxcococotocooswcsoxcococxoxococscxcxmtotooxwcn ■5 Pneumonia. )4 53 J 99 O CO CO Ox CO co to CO w : Wto-totowwwco' ex to to co to co o. co ex w OXCOOxlOlOlOtOCOCOOCOWCJOxlOOxOxlOWffilO P COW to co to toco ©MWMWM^HOi^W -!5: wco W W WOxCOCOlO w ■ W : MA to A CO to H* Congestion of Brain. 8 IO K) * HA • W H* • to ' HA HA : Mio to! HA * HA • • HA HA HA HA cowl * P W • WMWIOmm' to HA to Hi to to to w to to to to HA Xf) * UA X<J HA Scarlatina. -2 HA . ha HA Hi HA ' Hi HA P HA . t_a . • 3 Sunstroke. • HA P s Hitocnw^0>-iio^iO<xw^HAHAH* 3 Measels. £ tObOHAtObObOCCODCiWWlOtOHA* • Hi P CLXXVI History of Quarantine in Louisiana : Joseph Jones, M. D. IB.] TABULATED EXHIBIT OF MORTALITY FROM SOME OF THE CHIEF FATAL DISEASES IN THE CITY OF NEW ORLEANS DURING THE FOUR YEARS, 1880 TO 1883, INCLUSIVE, BY WEEKS. 1881. Total Total w. and c.. X o Dec, 3 10. 17. ©»-» 71 © © 4 5 Jt to © © o -T X 0 i * - © ■4 * © Z 0 X o to ■4 © a •* i to X © 3 3 T o X o -» 30 May 7 15 to X © * © > 5 2. to to © © 0 a Ji to © © 0 J B 5 J* ? 5 X WEEK ENDING 00 1 $ Small-Pox Ct to - •- • e 1 : • Yellow Fever. 1 • p X to © -i to to x JI X X O O OO -1 -I © 0 "r © - jc "t © Cl to to X © _<T to *-» *-* - 0 IO 53 Malarial Fever. © § 0 Jt CT to to w to T> tk X tO -U s. to - to to -* • o * CT ex to -1 © © CT CT © © - CT X O« © © n 4 IV Ct © - to © X X © X H4 to to © CT to Diarrhoeal Diseases. © © o j» CT © to X to •, X -4 CT * © X u x to to X 0 to to .U © IO ji CO 00 >-» X -4 X X t- X C' © © CT O © X JI © J X © © - © - © to J JX © J Phthisis Pnlmoralis. x o © O * J •, >1 © CT © 00 -4 CO u x © c» x- X to © Y) X 00 to X X X J to 0 k. to • to 1-4 to l_k 0 to to to to 0 X to CT *liU' ? Diptheria. © CT >-1 • to k_. p to g • co k_4 to L_ to Croup. U_k _k © to w w X •_4 to IO to to X i 2 । 9 2 ' 8 I 3 3 2 3 * Bronchitis. IQ Ct I-k -» to to CT to ke to to to to to to § C' 4- X to Ct >- to w 3 n to to X CT X. X -J J © >u c« © oc w w © to © cn S3 Pneumonia. -1 © IO - o Jf to to to 4- o w X u to © w x X © © x ex .J p Ct -» UI w to !-• to n X 0 I-1 ex to to to CT X l_k C' X to ? Congestion of Brain. - k-1 1-4 X to to to X p CO © I-k ■ ►- -r* ' _ . k- © to k. © X -4 X co © © X 00 © o» © er to >u c- == Scarlatina. 1-k f* H-k w X- to to 1- p r to 00 X ►t • s? Sun-Stroke. A. ' . . . . _ p -* CT X 51 Measles ■ © u* ■ to Z • • Z 1 z P Mortality and Sanitary History of New Orleans, 1880-1883. CLXXVII [C:] TABULATED EXHIBIT OF MORTALITY FROM SOME OF THE CHIEF FATAL DISEASES, IN THE CITY OF NEW ORLEANS, DURING THE FOUR YEARS, 1880 TO 1883 INCLUSIVE BY WEEKS. 1882. Total w. and c... Thtoi ' Ji © r b 21 Nov. 4 11 5 • £B£© i * 17 24 July 1 8 15 i " g|8 t> a 8 r 4.8 X 4 £ 88 Jan. 7 WEEK ENDING Ui a w 5 © m © - i 5 Ui u Ui © M o =>©©©© -ooo-oo»» 3 Small-Pox. •s 4^ - I-4 - W W4- 75 3 4 15-4. »to >» o L 4- 000-0©©©©©©o©c =>©©_© ©©»-»< 3 h-4 ©©«©©©©©©©©©<; =©©©©©©©©oc 0 © Yellow Fever. _ pp 2 o © < = ©© = < 3 = ' ?©©©©©©< acct =>c©oo©©©o©©©©c = ©< o .s m » 2to go ©.©SC 00m »»®juoi«wu*.na>Wa><o©1i*.i;f^o!Ki»8Kiwc-l-oci-t | Malarial Fevers. I6- . is a mu u, a (31 © M o^ w©- b m © »aioj-*.»uo^*wo.1o»(ow>-! ^0015-- IO - ©^O5t3t3 - p = »» 0-13 = MOOOO = = -UiK>C3*.tOIO: 00 ® © to t § - 2 I-4 i-4 rn t-» k 0 - -* 13 •kw © © -I M 4. to *. IO © C p Diarrhoeal Diseases. ? § coC-p-c o©©©5S©© oy mwa-tt»eS3 S©S2©© - S- ®2©^®oo©« •S cc cm® qo_p = -> -1 = P M < * © m to .too oo m. IM u. -> co co © >- © ® X - J00« 00- p Phthisis Pulmonalis. a tOCtOC 5-OWU 3 © © © C scootsuiou- ©0-5 Ot-i = > IO IO IO © © C 3 Diphtheria. K Oi MOC ?©o©oooooc 5© = © © © © o - ©^©© = ©©©©^©©-©c C c - o s .-Mcwocci-^cc^toc :~e©c :©^o©oc 5©©©«©C 5^©©r-C >K JH = - C Croup. ©©©==©= = ©©© = = ©©©©© = >o© = > = ' = = C © = © © © O © © © © © c c ©© p - - .io*.-iK>^oooiOHHO>-HHOHl-uio©e>!>oonoHi-Hc M Bronchitis. £ £ >0 - H w IO H O H M O H K -4 4-4 1- - 1- c - i- Mto^wot-m^ctoo © « toco to to to O K 1 p 2 OOT' IS © tO © 4. = w c © - » to o - c o i-i toj-i - to - to w c ^1 4 - 5 to to W 4- u *- tOM-M © ~ o © = © © to © i- IC © Kt to - to t- m a to to c w cc 44. 4x K © 0- jag ft 1 Pneumonia. 1- _1 O 4-4 15 _1 MM to © to _ 8 o -OK. ©©=©=© © © o - ©©©© © © © bD © © © ©© = 1- ©to w - ft 1 Congestion of Brain. £ ~ Oto -4 ©<C © ©©©© - © _o o - c I- 1-4 1-4 15 O - O - O (5 H c - © i-4 © ©o L-4 © - 03 tO -±5.^ ■- P=_© © ©CO-O© © © ©©©© 1- ©= = © -4 =-® = = OO_Pi±®_® 1-4 ooco ©. O © p - Scarlatina. © © © © © = © O O © © © © o - o o ©©© oc © 1-4 ©-to >-©©©©©© © o o©© © © © © 1 5? - oc © o© ©© © ©©©©©©©©©©©©©© o © ©°c©o© = © © ©© o O oc©c©©©©ooc ft Sun-Stroke. w o o © o 1-4 ©© o p© ©. = poo .©o© p 0^00 ©Ot- o ° poo c ©©©OO©OOOO 5 c © c © o © © © o © c © © © © O © © © © © © e © © © © © © © © © © © s © © © © 3 3 =>©©©©« 0) 3 © © =1 p Measles. CLXXVIII Mortality and Sanitary History of New Orleans, 1880-1883. IB.] TABULATED EXHIBIT OF MORTALITY FROM SOME OF THE CHIEF FATAL DISEASES IN THE CITY OF NEW ORLEANS DURING THE FOUR YEARS 1880 TO 1883, INCLUSIVE. BY WEEKS. 1 8 8 3. Total •••• 1266 8 . 15 22 29 31 Total w. and c... 24 Dec. 1 Nov. 3 10 17 29 •... Oct. 6 13 20 15 22 Sept. 1 8 Aug. 4 11 18 25 ,uly il: 21 • • • 16 23. ....... • 30 May 5 ' 12 19 26 June 2 to ts □0 1- > < X - - w n 24 Mar. 3 10 17 ... 20 27. Feb. 3 10 Jan. 6... | 13 WEEK ENDING $ V. 6 3 7 4 12 13 10 10 10 7 17 25 20 32 32 HI K 1 13 28 1 21 i 13 1 12 ' 17 i 9 9 10 11 10 11 12 1 Small-Pox. 45 28 . 28 20 17 24 20 2; 33 27 19 1 i; 1( I > I > 7 1 i j 2 I ! I I 2 1 I 1 1 ! 0. 5 10 'll 21 18 11! 30 17 17 39 40 49 54 -4 ' • 1 Yellow Fever. : • 1 ? | 481 1 Malarial Fever. Ul A.... .t. ■ n K J, . 1 - Xrl 1^ t2 M Jk >U 1-1 H 10 U O£ Io T* |301126 ! 11 . 1 i 4 1 6 1 3 ) 1 1 5 5 8 1 3 I 1 2 6 J 7 3 2 1 5 5 4 7 6 3 7 3 6 1 4 1 10 3 5 J 15 I 15 ! 7 ! 12 9 8 1 16 i 9 1 • • - »OW»O* lOW WaiO-l*AJ Diarrhceal Diseases. ; M: - « to'. 7 cato 2- | 859 g 14 1 11 Hi f 15 U 11 14 13 13 15 t? 5 6 12 9 11 : 9 ! 12 f I 12 1: l 1: J l 1( 3 i: 2 I 2 2 1 3 12 5 11 > IC 3 < I 11 I 12 ! 12 1 Phthisis Pulmonalis. ... ... . . . . -1! T - r - v-y M 1 . 99 1 y H-k-' - ' _ kk 2 (7) c Q C C ' 1 : : : : ; 3 cn ui .r1 0 c; 1 I i-ll-IM Ml-1 »O IO • • w . 1-4 ■ l-l k->* i-. w'. - to to - to w Diphtheria. to H J : '• H* • M ■ • • ?: • -H- : : 1 ? Croup. to o u-» t-4 • M4 ■ • Il i . 1 ; : P o co . 4 1 5 5 . 11 . 2 . 1 1 210( to 1 - - 1 10 k ■ - ■ 1- to - • l-4 to oc to * tout -to -w 1 • Bronchitis. sl • to to i - to to - - - I H* • tO i IO • H* H* -to^-ocj^LlL • _ , . • -4 oa to CO i_ ©WWWlOW^^-kACj;®*^ . Pneumonia. tc to | . . O 1 r KD I W W • 1 • 0 C3 Ui 1 00 | >c ■ ■ 1 r- • v-^ <w r- - ' = -a I tUlOCOChtOWWW4 * bOCO IO W H - to to - *- to - - • *-' - 7 - • 1- .to-, i Congestion of Brain. c to I : : . u- I to . k . • • 1-4 • H* * I**4 . >-* • • • - to 1 ' w 1 ■ : MM^H 7 - to . --1 k-4 • • 1-4 • to to ■ - 10 - : : io^- 1 * 1 0 Scarlatina. _ | : H - i J V- • »-4 ■ * • • - V i • ' to :: to : : 1 ? Sun-Stroke. • • 1 p a »-1 1 • • mi h* >-J to w : : M • » 1 • | Measles. Ji -J ' I • : to • • • • • -. J ■ Mortality and Sanitary History of New Orleans, 1880-1883. CLXXIX [E.] TABLE SHOWING TOTAL MORTALITY BY WEEKS DURING THE YEARS 1880 TO 18 3 IN- CLUSIVE. 1880. 1881. Week Ending. Mortality. Rate per 1000. Week Ending. Mortality. Rate per 1000. w. c. 1 Total w. c. Cot al w. c. Total! w. c. Cotai Jan. 4 76 34 110 25.49 32.14] 27.24 Jan. 8 89 41 129| 25.25 32.80 27 24 11 55 35 90 18.45 33.091 22.33 15 90 55 29.62 50 17 34'90 18 65 32 97 21 15 30.25] 24.04 22 .. 61 37 98 20.07 23*59 25 43 33 76 14.30 31.201 18.82 29 95 47 142 31.26 42 87 34'18 Feb. 1 61 32 93 20 46 30 25] 23.03 68 42 no 22-40 38.31 26'48 8 68 54 122 22 81 51 05 30.22 12 79 39 118 26 00 35 57 28'40 72 30 102 24.15 28.36 25.26 19 78 44 122 25 67 40.14 29'37 22 51 37 88 17 11 24.22 21.76 26 82 39 121 26.98 35.58 29-13 29 68 41 109 22 81 38 761 26 99 39 94 18 10 35 58 22-63 Mar. 6 46 36 82 15.43 23.27 20.30 12 93 47 140 30.60 42.87 33-70 13 45 33 78 15 09 31 20 19.31 19 80 41 121 26 33 37 40 29-13 21 54 31 85 18.28 29.30 21.04 26 87 6(0 147 28 63 54.73 35-39 28 65 44 10<) 21.15 41 60 26.99 60 49 109 19.74 44.70 26-24 April 3 77 35 112 25 66 33.09 28.00 9 86 45 131 28.30 41.05 31-53 10 72 28 100 24.15 26.47 24.76 16 71 42 113 23.36 38.31 27-20 17 81 33 114 27.17 31.20 28.22 23 81 32 113 26 65 29.19 27-20 24 69 33 102 22 98 31.20 25.25 30 89 47 136 29.29 42 73 32-74 May 1 76 35 111 25.49 33.09 27.50 May 7... 85 52 137 27.97 46.62 32-98 8 74 50 124 25.15 47 23 30.70 14 113 47 160 37.58 42.13 38.51 15 81 45 126 27.17 42 55 31.20 21 .... 102 55 157 33.56 50 17 37.79 22 86 55 141 28 85 52 00 34 92 28 no 165 36 20 50 17 39-72 29 88 50 138 23.52 47.23 34.17 105 63 168 34.55 40.44 97 53 150 32 54 50 10 37.14 11 . 119 51 170 40 12 45 72 39.16 12 118 48 166 39 58 45 34 41.10 18 135 54 189 44 32 48 61 45.47 19 70 44 114 23 48 41 60 28.22 25 136 50 186 45 01 44.74 26 71 44 115 23.65 41 60 28.48 79 127 25.93 43 21 July 3 73 39 112 24.98 26 11 27.73 " 9 92 51 142 30.20 45.01 34.16 10 66 33 99 21 32 31 2C 24 51 16 82 4: 125 26 92 38 71 30.07 17 68 32 100 22 81 30 25 24 76 23 75 34 109 24 22 30 60 26.22 24 60 33 93 20^63 31 20 23 02 30 97 41 138 31 84 36 91 33.20 31 74 29 76 25 15 27 42 18.28 53 40 93 17 40 36 01 22.37 41 48 89 13 96 45.34 21 04 13 73 28 101 23 96 25 20 24.29 14 47 25 72 15 60 23.63 17.33 20 80 43 123 26.27 38.71 20.59 21 71 36 107 23 65 33.27 25.75 27 73 38 111 23.96 34.20 26.77 28 37 102 21 15 34 22 24.55 67 45 112 21 9! 40 51 27.66 Sept. 4 62 40 109 20 80 38.30 24.55 10 53 41 94 17.40 36.91 22.61 11 57 33 90 18 64 30 10 21 66 17 55 38 93 18 05 34 20 22.37 18 76 51 127 24 85 30.57 24 58 41 99 19 04 36 91 23.81 25 72 32 104 23 54 29 19 25.03 56 43 99 18 38 38.7 1 23.81 71 32 103 23 22 29.19 24.79 8 66 35 101 21 67 31.50 24.30 9 65 42 107 21 25 38.31 25 75 15 64 26 90 21 01 23 40 21.65 16 68 28 96 22 23 25.54 23 11 22 77 31 108 25 28 27 91 25.98 23 73 31 104 23 87 28 28 25 03 29 66 45 111 21 67 40.51 26.70 30 8! j 26 115 29 10 23.71 27.68 Nov. 5 64 29 93 2L01 26.10 22.37 87 34 121 28.45 31.01 29.12 12 71 60 131 23 31 54.01 31.51 13 86 37 123 28 12 33.75 29.61 19.....'... 62 52 114 20.35 46.81 27.42 20 66 46 112 21.58 41.96 26.96 26 61 51 112 20.0; 45.91 26.90 27 84 47] 131 27 48 42.87 31.53 Dec. 3 84 52 136 27.58 46.81 32 72 71 27 98 23.22 24.6a 23.59 10 69 33 102 22.65 29.70 24.54 11 49 36 85 16.02 32.84 20.46 17 70 37 10' 22.98 33.31 25.74 18 79 28 107 25 83 25.54 25 75 24 6* 52 119 21 99 46.81 28.63 25 53 45 98 17.33 41.05 23.59 31 65 30 95 21.34 27.00 22.85 31 297? 25.71 38.95 29.31 Totals 3637 1986 5623 22.9€ 34.38 26.01 CLXXX Mortality and Sanitary History of New Orleans, 1880-1883. |E-Continued,! TABLE SHOWING TOTAL MORTALITY BY WEEKS DURING THE YEARS 1880 TO 1883. IN- ' CLUSIVE. 1882. 1883. Week Ending. Mortality. Fate per 1000. Week Ending. Mortality. Rate per 1000. w. c. Total w. c. Total w. c. Total w. c. Tolal Jan. 7 81 49 130 26.59 44.11 31.27 Jan. 6 116 47 163 37 26 41.27 38.25 14 60 36 36 99 19.69 32 41 23 09 13 81 39 120 25.74 33.82 27.91 21 61 38 20.02 34.21 23 81 20 101 57 158 49.44 36.75 32.10 28 57 50 107 18.71 45.01 25.76 27 63 53 116 20.02 45.97 26.98 Feb. 4....... 59 39 98 19.37 35.11 23.57 Feb. 3 102 69 171 32.42 59.85 39.77 11 60 28 88 19.69 25 20 21.12 10 93 57 150 29.56 49.44 34.89 18 67 49 116 21.99 44 11 27.98 17 96 51 147 30.51 44.24 34.19 Mar. "4''.'./ 70 31 101 22.32 27.90 24.30 24 77 67 144 24.47 58.12 33 49 64 42 106 21 .01 37.81 25.50 Mar. 3 71 53 124 22.57 45.97 28.84 11 59 37 96 19.37 33.31 23.11 10 71 74 145 22.56 64.18 33.72 18 60 54 114 20.02 47.71 27.42 17 80 92 172 25.42 78 80 42.56 of) 61 48 109 20.03 43-21 26.22 24 104 75 179 33.05 65.05 41.63 Apr. 1.... 50 53 103 16.41 47.71 24.78 31 95 93 188 30 19 80.67 43.73 8 69 .).) 124 22.65 40.51 29 83 Apr. 7 102 94 196 32.42 81.54 45.59 15 69 53 122 22 65 47.71 29.35 14 89 86 175 28.28 74.59 41.05 22 83 56 139 27.25 50.41 33.44 21 81 72 153 25 73 62.45 35.58 20 75 DO 130 24.62 49.51 31.27 28 ... 85 70 155 27.01 60.72 35.60 May 6 78 48 126 25.61 43 21 30.31 Mav 5.... 65 54 119 20.66 46.84 27.68 13 60 54 114 19.70 48.61 27.42 12 70 65 144 25.11 56.38 33 49 20 79 58 137 25.93 52.21 32.96 19 100 67 167 31.78 58.11 38.84 27 78 68 146 25 61 61 21 35.12 26 103 60 163 32.73 52.04 37.91 J line 3 ... 74 60 134 24.29 54.02 32.24 June 2.... 84 71 155 26.69 61.58 35.60 10 82 51 126 26.92 45 91 31 99 9 90 155 28.60 56.38 36.05 17 . 69 57 22.65 51.31 30 31 16 10i 69 176 34 00 59.85 45.41 24 92 57 149 30.26 51.31 35.84 23 104 54 158 33.05 46 84 36 75 J uly 1 76 43 119 24 95 38.71 28 63i 30 77 40 117 24 47 26.02 27.21 8 62 40 39 102 20.35 36 01 24.54'Jtilv 7 75 41 116 23.82 35 56 26.98 15 62 105 20.35 38.71 25.26 14 79 38 117 25.11 32 96 27.21 22 56 95 18.38 35.11 22.85 21 82 58 140 26.06 50.31 32.56 20 78 33 111 25.61 29.71 26 70 28 95 45 140 30.19 39.03 32.56 Aug. 5 59 37 96 19.37 33.31 23.09 Aug. 4 .. 11 83 55 48 138 125 26.38 24.47 47.71 32.09 29 07 12 49 45 94 16.08 40.51 22 66 41.63 10 68, 36 104 22.32 32 41 25 02 18 74 46 120 23.52 39.90 27 91 26.... 51 47 98 16.74 42.31 23.57 251.. 73 43 116 23 20 37.30 26.96 Sep. 2 74 39 113 27.18 24.29 35.11 Sept. 1 63 48 111 20.02 41.64 25.82 9 49 46 95 16.08 41.41 22.85 8 72 37 109 130 22.88 32.09 25 35 16 32 74 13 49 28.09 17.40 15 76 54 24.15 46.84 30 24 23 62 35 97 19 91 30.73 22 75 22 86 51 137 27 33 44.24 31 86 30 Oct. 7 66 64 30 31 96 95 137 21.20 20 56 26.34 27.22 22.51 22 28 32.13 29 Oct. 6 13.... 81 92 90 57 55 45 138 147 135 25 74 21.39 28.66 49.44 47.71 39 03 32.09 34.19 31.40 14 94 43 30.19 37.75 21.... 61 42 103 19.59 36.87 24.16 20 71 43 114 22.56 37.30 26.51 28 64 46 110 20.56 40.39 25.80 27 84 46 130 26 98 39 90 30 23 Nov. 4..... 59 47 106 18.98 41.00 24 87 Nov. 3 88 58 146 27 93 52.03 34.16 11 83 36 119 26.66 31.61 27.92 10 114 53 167 36.23 45 97 38.84 18 69 43 112 22.16 37.76 26 28 17 112 51 163 35.59 44.23 37.91 25 76 45 121 24.41 39.51 28.39 24 99 56 155 31.11 48.57 36 05 Dec. 2 85 51 136 27.31 44.77 31 91 Dec. 1 .. 97 50 147 30 83 43 37 34 19 9 84 47 131 26.98 41.27 30 74 8 91 50 141 28.92 43 37 32.79 16 88 38 126 28.27 33.37 29.57 15 96 49 145 30 51 42.50 33.72 23 ... 79 41 120 25 38 36.00 28.14 22 93 44 137 29.55 38.16 31.86 30 84 51 135 26.98 44.78 31.68 29 97 53 150 30.83 45.97 34.89 Total 3582 2340 5922 21.89 39.03 26.45 Total 4552 2971 7523 26.62 47.16 32.15 Note 1-The rate of mortality at bottom of table is calculated for the entire, year independently of the separate weekly reports. Note 2-The tabulation embraces the entire mortality for the years 1880 and 1881. In the year 1882, one day's mortality is omitted, and in 1883 two days. Note 3-The rate of mortality for the year 1883 is calculated upon the estimated population, based upon the ratio of increase between the years 1870 and 1880 by United States census Morlality and Sanitary History of New Orleans, 1880-1883. MORTALITY OF NEW ORLEANS, LOUISIANA, DURING 1880, 1881,1882 AND 1883, CLASSIFIED ACCORDING TO DISTRICTS, MONTHS, RACES AND PRINCIPAL DISEASES. CLXXXI TABLE ILLUSTRATING DEATHS IN THE FIRST DISTRICT CITY OF NEW ORLEANS. DURING THE YEAR 1880. DISEASES. | February. March. April. May. fl July.. 1 August. September. October. November. 1 December. Total. Yellow Fever 1 1 o Malarial Fevers 2 4 1 7 6 6 7 13 15 2 6 5 74 Typhoid Fever O 7 Scarlet Fever 1 1 4 3 7 3 1 1 2 19 Measles 2 8 20 Small-pox Diphtheria 1 1 I 3 27 64 1 ? 1 1.*) 2 4 1 13 Diarrhoeal Diseases Congestion of Brain 8 o 3 10 4 12 14 3 7 3 5 22 63 6 3 5 15 51 4 3 6 58 7 6 5 12 68 4 3 4 25 83 4 3 72 40 55 Phthisis Pulmonalis All other causes 21 94 87 22 77 21 86 17 76 19 62 900 869 Total Number Deaths. 129 114 107 119 149 134 116 88 89 119 133 96 1393 Number 1 White Deaths. J Colored 86 43 71 43 74 33 74 45 82 67 84 50 79 37 52 36 58 31 78 41 90 43 56 40 884 509 1 Yellow Fever 0.02 1.25 4 59 0.02 0.05 ta . Malarial Fever 0 41 0.62 5 64 0.83 4 59 1 46 1 25 1.46 2.71 1.25 3.13 1.25 1.04 1 28 1 n^rb1000 [ Phthisis Pulmonalis. ... 4.38 3.13 4 38 3.55 3.13 2.50 5 2^ 3 97 3 86 Inhabitants I p»। as J Total 23.84 36 52 26.94 19.66 36 52 23.81 20.49 28 03 22 35 20.49 38.22 24 85 22 71 56.91 31 12 23.26 42 47 27.99 22.16 31.43 24 23 14.40 30.58 18.38 16 10 26 33 18 59 21.60 34.83 24.85 24.93 26.32 27 78 15 51 33.98 20.05 20 40 36 10 24.24 Population-White, 57,945; Colored, 14,116. Total, 57,445. SANITARY CONDITION OF THE FIRST DISTRICT 1880. OFFICE SANITARY INSPECTOR, FIRST DISTRICT, ? New Orleans, July 21, 1880 $ Dr Joseph Jones, President Board of Health: Sir-Tn obedience to special instructions. I have the honor to present the following report: 1. The street gutters running from the river front, whenever in the range of the sanitary flushing main.- are kept well cleaned, and even those not so flushed have been washed almost daily by copious floods of rain, As a consequence, the general condition of street gutters has been far better than has usually been the case at this season of the year. * The gutters of streets in the rear of the Camp street canal, receiving none of the water from the flushing engine, are almost wholly dependent upon the rains and the exertions of the street-cleaning force employed by the city, and are therefore particnlarlv liable to become foul whenever the weather is dry. The gutters of the streets running parallel with the river require manual labor in cleaning, on account of the impracticability of flushing them. On this account it may be stated that all of the gutters parallel with and back of Rampart street would be intolerably filthy and offensive but for the rains. 2. The gutters flushed by the Auxiliary Sanitary Association's engine, carrying matter directly to the rear of the city, are those of Calliope. Delord, St. Joseph and Julia streets. Those streets between Felicity and Calliope, running from the river front, drain this water into the Camp street head of the Melpomene canal, rendering this formerly offensive sewer perfectly inodorous. 3. The. gutters immediately surrounding the Girod-street Cemetery are well flushed, while those on the opposite sides of the boundary streets are filthy. About the Charity Hospital and New Basin, particularly above the latter, the gutters become intensely foul as soon as the rains cease. 4. The total population of the First district, according to the census of 1879, taken by the sanitary offi- cers, is 54,344, and occupies an area divided by streets into 503 squares having an average front of 300 feet. This embraces the whole of the First and Second Wards and the Third Ward to Galvez street. Within this area are about 125 miles of street gutters, fully sixty-seven miles of which are unusually filthy and require manual force to clean them. The present scavenger force consists of 46 laborers, with 26 carts and drivers. There is per laborer a pro rata of about 1181 of population, and per cart about 2000. In considering the sanitary management of the First District, it is of importance to take into special ac count the great obstacle offered in the natural depressions of surface, involving in some instances an area of many squares. In these low spots drainage is so imperfect that street gutters are at all times in a stag- nant condition, and would require the constant exertion of a large number of laborers to prevent foul ac cumulations. 5. Accompanying this, T present a condensed statement of sanitary work accomplished by the sanitary officers of the Board of Health from April 15 to July 15, 1880. 6. To keep the district in good sanitary condition during the summer months would require a street clean- ing force of at least 100 men. 7. From the first to the fifteenth of July, there were but fo,rty deaths from all causes in the district. Four of these were from fevers-viz : one thypo-malarlal, and three congestion of brain. This does udt taku into acbfinnt thb dehth frttin ybUtlW fevtir of the A'anmu frbm Uib ExcUltfidr, at tht> Tdufd Infirmary. CLXXXII Mortality and Sanitary History of Neu: Orleans, 1880-1883. The rate of mortality is decidedly below the general average. In closing this report, allow me to state that every assistance has been rendered by the Department of Im - pfovments in the sanitary work of this office : and that, according to my observation, the utmost amount of work has been accomplished by the wholly insufficient force employed on the streets. Respectfully sub- mitted, JOSEPH HOLT, M, D., Sanitary Inspector First District. MORTALITY SECOND DISTRICT NEW ORLEANS 1880. The total number of deaths in the Second District during the year was 1115, making an annual ratio of 24.9 per thousand population. The annual ratio per thousand white population was 22.28. The annual ratio pe r thousand colored was 31.27. The greatest number of deaths occurred in the month of June 116 The least number of deaths occurred in the month of January 73 Mortality from January to June 555 Mortality from June to December 566 Total deaths from diseases of the respiratory organs 267 Of these, consumption ... .' 168 Total deaths from all fevers ••••.... 96 Total deaths from congestions ... 22 The greatest number of deaths occurred in the Fifth Ward. A suspicious case of yellow fever on Customhouse street, corner of Franklin, was reported, but on care- ful examination proved to be a case of haemorrhagic malarial fever. TABLE ILLUSTRATING DEATHS IN THE SECOND DISTRICT OF THE CITY OF NEW ORLEANS DURING THE YEAR 1880. ___ DISEASES. January, February. | March. [ April. May. I June. July. August. September. | October. I November, 1 1 December. i- Total. Malarial Fevers Typhoid Fever Scarlet Fever Measles Diphtheria Diarrhoeal Diseases Congestion of Brain Convulsions Phthisis Pulmonalis Deaths from all other causes 0 2 0 0 0 3 1 0 5 62 2 2 0 0 0 1 1 1 18 70 6 2 1 1 1 0 0 0 12 51 ? 1 0 0 4 1 14 48 8 0 1 7 2 4 9 4 14 65 2 4 1 3 2 18 73 2 1 4 2 1 1 2 2 10 54 4 1 1 1 0 2 6 4 8 57 18 2 0 0 1 10 4 16 55 2 0 0 4 3 4 18 51 3 1 1 0 4 25 0 20 76 4 0 2 0 1 0 10 2 15 53 62 16 12 20 14 22 21 168 715 Total number of Deaths 73 95 80 79 114 116 79 84 106 88 112 89 1115 Number ? White Deaths. J Colored 46 27 57 38 44 36 56 23 71 43 72 44 54 25 51 33 62 44 64 24 79 42 52 37 699 416 Death rate per 1000 Inhabtants per annum. Malarial Fevers Phthisis Pulmonalis... i 30 0.50 4.80 1.60 3.20 1.30 3.80 2.10 3.80 1 30 4 80 0.50 2 60 1.00 2.20 4 80 4.30 1.30 4.80 0.80 5.30 1.00 4.20 1 30 3 80 ■White Colored.... ..... 17.60'21 80116.51 24.35 34 28 33.47 21.43 20 75 27 16 27.54 38.79 39 69 20.40 22.55 19 51 23.69 29 77|39 69 24.4926 7419.89 21 65 27.8931.57 22 28 31.27 Total 19 61 25.52 21.49 21.22 30 6231 16,21 22 22.56128.47 23.64,30.0823 9o| 24.96 Still Born, 66. Population: White, 31,368 : Colored, 13,301; Total, 45,669. GUTTERS. For future reference, an exact and carefully prepared table of the number of miles of gutters in the Second District is here presented, which by streetsis as follows: Levee 1 1 Decatur 1 Chartres 2 Royal 2 Bourbon 2 Dauphine 2 Burgundy 2 Rampart 4 Basin 1 St. Claude 1 Franklin 1 Treme 2 Marais 2 Villere . 2 Robertson 2 Claiborne .. 4 Derbigny 2 Roman 2 Prieur 2 Johnson 2 Galvez 2| Miro 2 Tonti 2; Roehehlave 2 Dorgenois . ■.......... 'A Broad J W Total..... Canal 1J | Customhouse 3 Bienville 3 IConti 3 'St. Louis 3 Carondelet Walk 2 Toulouse 1J St. Peter 3 Orleans 3 St. Ann 3 Domain 3 St. Philip 3 Ursulines 3 Hospital. 3 Barracks 21 Esplanade 3 Total 434 Grand total of miles in the Second District 93J Mortality anti Sanitary History of New Orleans, 1880-1883. CLXXXIII REPORT OF W. R. MANDEVILLE. M. D„ SANITARY INSPECTOR SECOND DISTRICT. NEW ORLEANS, December 31, 1880. Dr. Joseph Jones, President of the Board of Health : Sir-I have the honor to present the following condensed report of the sanitary work accomplished in the Second District during the year ending with the above date: LOCATION. The second municipal district of the city of New Orleans is bounded on the north and northestby Esplanade street and Bayou St. John, and on the south and southwest by Canal street and the new canal. The district extends between these boundaries from the Mississippi River to Lake Pontchartrain, and com - prises three divisions, known as the fourth, fifth and sixth wards. TOPOGRAPHY AND DRAINAGE. The Second District is renowned for being the most historical part of the Crescent City, since that terri- tory bounded by the Mississippi River. Esplanade, Rampart and Canal streets constitutes the city of New Orleans as originally founded by Bienville. The streets are regularly cut in square blocks, giving to the map of that district the appearance of a chess board. Excepting most of the thoroughfares in the rear of Rampart street, the streets and banquettes of this district are narrower than those of more modern design. Many of the houses in this part of the city were built before an abundance of light and air and free ven- tilation were recognized as essentials to perfect health and comfort, but, thanks to their antiquity, are now rapidly falling to ruin and decay, and in their place new ones of more recent design and architectiial beauty are being erected with all the comforts now considered so necessary in this progressive age of sanitary science. The drainage system of this district is very imperfect. Storm and waste water is drained into Lake Pontchartrain, by a number of canals known as Hagan Avenue, Broad, Galvez, Claiborne and Orleans, but th -so canals are too small and rapidly till up with mud, and in summer almost completely dry up, mak- ing the air redolent with ther foul miasmatic odors. The drainage machine now iu use is far from having the requisite amount of power to carry off the surplus water after having rains, such as visited ns this year, and as a consequence the rear portion of the district after a rain resembles a miniature lake for several hours. It is earnestly urged that these canals be thoroughly deepened and cleaned before the warm season is upon us. WATER SUPPLY. Water from the Mississippi Riveris conveyed by pipes through the district only as far as Claiborne street. Its want is felt beyond this avenue to Broad street, an area of (130) one hundred and thirty square blocks, quite densely inhabited. This supply of water is freely used in all public buildings and private resi- dences, for cleaning purposes, bathing, etc., but its muddy condition renders it objectionable as drinking water. Rain water preserved in cisterns is generally used for drinking purposes. These cisterns, especially on premises where no hydrant exists, are in the majority of cases so limited in capacity that they are soon emptied when a drouth occurs. Some are in a miserable state of decay, and it would be beneficial to have them repaired or even destroyed. Wells are found in all parts of the district, and are used principally at dairies and stables for watering stock, and at nurseries for besprinkling plants. The water from these wells is universally considered un- healthy by the inhabitants, and is never used for drinking purposes, except in very rare instances, when no other water is obtainable. The scarcity of water in the rear of Claiborne street is a just cause of complaint in cases of conflagration, and it would be advisable for the protection of real estate against destruction by fire, to build fire-wells at different points of that section. The street hydrants in the more central part of the district should be allowed to flow tor a couple of hours morning and evening, during the summer months, so as to thoroughly clear the gutters of their filthy ac- cumulations. PUBLIC BUILDINGS. The Court-hou ■ Police Stations and Parish Prison are in a fair condition, and during the summer months were frequ m'iv inspected. The authorities in emtrge of the Parish Prison are doing their utmost to keep the building clean, and the police regulations in regard to cells and yard are excellent. The cells are large but poorly ventilated. The privy system of the prison is that known as the " Rochdale " or barrel system; they are emptied daily. Two wells 13 feet deep, formerly used as privy vaults, should be filled as soon as possible with river sand. At the time of last inspection the total number of prisoners was 252 ; number of white males 93 : number white females 29; number colored males 84 : number of colored females 46. TREME AND FRENCH MARKETS. The condition of these markets is tolerable. The principle cause of complaint lies in their vicinity, where banquettes are obstructed by the fruit and vegetable stand kept most by Sicilians. It is deplorable to verify the fact that this class of people, as a rule, seems to ignore the elements of hygiene. A glance in the interior of their abodes is sufficient to prove this assertion. The appearance of the vegetable markets could easily be improved. The washing of the banquettes on either side from Ursulines to St Philip would result in rendering them less slippery and dangerous to pedes- trians during damp weather. The prompt removal of all garbage should not be neglected. CEMETERIES. There are four large cemeteries in the Second District, which are the burial grounds of some of the oldest and most respectable families of this city. The walls and many of the vaults of these cemeteries are in a dilapidated state and require immediate repair. It is especially the case with the graveyard bounded by Customhouse, Claiborne, Bienville and Robertson streets, where also the least shower renders the alleys impracticable since the water, finding no outlet, remains stagnant until evaporated by the rays of the sun. The proper authorities should find a remedy for these defects at once. REMOVAL AND DISPOSITION OF GARBAGE. The removal and disposition of street garbage, as actually practiced, has proven to be superior to the old system of depositing the same on vacant lots in the rear of the district. CLXXXIV Mortality and Sanitary History of New Orleans, 1880-1883. Some complaints, however, arise about the non-hauling of garbage from the streets. This work should be attended to daily and with regularity, and consist not only in emptying of the receptacles containing the rubbish, but also in the removal of all decaying matter from the streets. Under this heading can be mentioned the neglected appearance of the gutters on some of the most fre- quented thoroughfares of the district, such as Royal, Chartres and Rampart streets. St. Philip and Ursu- lines streets in the neighborhood of the French market have a filthv and repulsive aspect. SANITATION. During the past year an immense amount of sanitary work has been accomplished in this district. Sev- eral thousand circulars have been distributed to the families residing in its boundaries, instructing them in domestic sanitation, and it is with no small amount of satisfaction that the statement can be made that the people were eager to receive all the knowledge possible in this line. Disinfectants to the amount of 333^ gallons of copperas and carbolic acid solution, and dry copperas (17,908 tbs), were gratuitously distributed to all those desiring it. This was accomplished by means of a cart conveying it from house to house, accompanied by one of the sanitary officers, thus leaving nothing un done to secure health and cleanliness to the inhabitants of this district. DAIRIES. A thorough inspection of all the dairies in this district was made during the summer mouths, and a de- tailed report presented to the Board. Could not some moans be adopted by which all milk in this city be first carefully tested as to its purity, etc. I The adulteration of milk is carried on to a much greater extent than one not thoroughly acquainted with the facts would suppose, and it certainly behooves us as sanitarians and as guardians of the public health, that this important matter receive our earnest attention. MORTALITY IN THE THIRD DISTRICT, NEW ORLEANS, FOR THE YEAR 1880. DISEASES. 1 January. February March. | April. May. I June. 1 July. 1 August. I September. 1 October. November. 1 December. Total. Malarial Fevers 3 1 4 4 2 1 12 9 2 12 3 11 o 2 9 2 12 1 1 6 1 1 8 2 4 1 6 82 16 15 32 1 20 36 18 45 135 758 Typhoid Fever 1 Scarlet F^ver .... Measles 17 1 6 Diphtheria 3 2 2 7 10 54 3 2 1 3 3 1 i 9 74 1 1 2 5 4 3 12 44 2 o 1 1 11 60 1 4 3 3 1 16 70 Diarrhceal Diseases 3 2 2 6 10 82 11 3 14 84 Congestion of Brain 2 2 15 54 Convulsions 5 11 3 14 51 1 55 Deaths from other causes Total Number of Deaths 82 91 92 95 132 135 80 88 87 85 59 26 83 111 1161 Number 1 White Deaths. ) Colored . / Whites 56 26 60 31 56 36 79 16 84 48 87 48 45 35 61 27 47 40 57 26 83 28 774 387 19 92 26.31 21.58 21.34 31 37 23.95 19 9228.10 36.4316.19 24.21,35.00 29.88 48.58 34.74 30.95 48.58 35.53 16 00 35.42 21.05 21.70ll 6.72 27.32140.48 23.16 22.90 20.99 26.31 52.37 20 27 29 82 26 3128.33 21.84 29.21 22.94 32.62 25.47 raw'"i er Colored VL'A Total 1000 J inhabitants ) Maiarial Fever8 .78 2.85 1.05 1.84 2.36 1.05 2.89 2 36 2.63 3.05 3.68 2.89 1.57 2.36 3.15 3.15 3.94 1.57 2 81 2.10 3.68 1.05 4 21 1.79 2.96 Pei Phthisis Pulmonis annum. Still-born Children... R 8 5 8 5 8 4 3 6 4 6 3 68 Population of District-White, 33.732; Colored. 11.856. Total, 45.588. DISEASES. । January. February. March. | April. 1 May. | June. i 1 July. | August. September. •joqojoo November. I December. Total. 3 2 1 6 4I 4 10 10 9 4 Typhoid Fever ] 0 li 1 1 0 1 ....2 9 Measles Diphtheria Diarrhmal Diseases 3 4 1 0 0 5 2 4 li 6 2 2 3 1 3 3 2 1 2 2 23 32 Congestion of Brain ConviiRinns 3 0 ] 1 9 1 4 2 2 1 6 2 8 69 4 22 Phthisis Pulmonalis... Deaths from all other causes 14 68 13 40 16 51 14 8 22 5, 61 13 56 10 40 7 46 19 48 5 65 132 64«» Total number of Deaths .... 96 56 74 74 79; 81 74 71 82 88 81 931 White 36 48 46 29 46 51i 50 46 47 56 62 26 56 609 Colored 31 20 26 28 28| 31 28 24 26 25 322 Still-born children 2 1 1 1 4 4 4 16 Population of district-White, 33,732 ; colored, 11,856; total, 45,588. Death rate per 1000 inhabitants per annum, census of 1880-white. 18.05 ; colored. 27.25 total. 20.42. MORTALITY IN THE THIRD DISTRICT DOR THE YEAR 1879. Mortality and Sanitary History of New Orleans, 1880-1883. CLXXXV REPORT OF W. II. WATKINS, M. D., SANITARY INSPECTOR, THIRD DISTRICT NEW ORLEANS, LA., December 31, 1880. Joseph. Jones, M. D., President Board of Health. State of Louisiana: Sir-I have the honor herewith to submit the annual report in regard to sanitation and sanitary regula. tions exercised in the Third District, for the year 1880. Having been elected Sanitary Inspector of this district, April 12, 1880, I at once assumed charge of the office vacated by my efficient predecessor, Dr. W. E. Schuppert The records for the preceding months have been carefully preserved by the sanitary officer, Mr C. F. Gon. zales, and from these, together with the reports of the former Sanitary Inspector, I have been able to fully complete the report for the year. On the fifteenth of April, Mr. T. C. Will was assigned as sanitary officer of the district. His remarkable energy and high qualifications admirably fitted him for the position, and the methodical exactness which he has exercised reflects great credit on him. LOCATION AND TOPOGRAPHY. The Third District of the city of New Orleans is embraced within the following boundaries: Esplanade street, United States Barracks,'the Mississippi river and Lake Pontchartrain. The District is -subdivided into the Seventh, Eighth and Ninth Wards. The inhabited portion is, however, embraced in a much more limited space, extending back from the river on an average of not more than three-quarters of a mile, and embraces about 800 square acres. Built on alluvial deposit, the whole district is almost level; highest at the river; the slope back to the lake is gradual, and, in the rear of the inhabited portion, swamps exist which are so low as to be continually covered with water. DRAINAGE. ' Surface drainage alone is the mode by which the district is cleared from storm water, and the facilities for carrying this off aie inadequate. The canals and gutters in the rear require deepening, and at least another or larger draining machine is required. The only draining machine is that one located on London avenue. The result is, that after a hard rain many of the streets are inundated, though the natural grade is such that the water does not remain long. PUBLIC BUILDINGS. A careful inspection of the Public Schools has been made. All were found in good sanitary condition, but the number of pupils in several is so large as not to allow air-space for each. The total number of pub- lic schools in the district is twelve, but one, the McDonogh school No. 12, is yet unfinished and will not be occupied before the latter part of January, 1881. The water supply and drainage of each is good. Privy* accommodations ample. a Total number of teachers 91 " " pupils-white . 3426 " colored , 772 " male ... 2226 " " female 1991 Average number of pupils to each teacher 49 The Orphan Asylums of the district are typical institutions of this kind. Care is exercised by those in charge to make each one clean and healthy. There has been little sickness in them, and no contagious disease has been reported. The Fifth Precinct Police Station, where the Sanitary Inspector's office is located, is in a dilapidated condition ; the doors have rotted away, and the plaster is falling from the ceiling. The privy vaults need rebuilding. There are five public markets in the district. Each is kept in good condition and regularly inspected by the sanitary officers. The private markets have been regularly inspected, and wherever nuisances have been found, they have been abated. This sanitary condition on the average is good. CEMETERIES. The three cemeteries located in the district are far removed from the thickly populated areas and present no feature especially objectionable STREETS AND GUTTERS The Third District with such an extent of river front, with imperfect drainage and sloping so gradually from the levee to the swamp, presents one of the problems as yet unsolved. How shall the gutters be kept clean ? At least forty miles of streets regularly laid out are now to be looked after, and the limited means of the city caused their total neglact during the latter part of the year, where owing to h- avy rains necessity demanded that they should receive attention. At the best season of the year careful inspection of street gutters was made by your orders, and in the report made at that time it was truly stated that of eighty miles of gutters quite'one-half could be classed as foul or obstructed. The Eighth Ward made the best exhibit, but this was in a great measure due to the fact that in compactness and grading, it is superior to the other wards, and therefore easier to clean with a limited force. Much can be done by the proper authorities, and such work should be commenced by alignment of the gutters, improving the grade and deepening the canals so that a rapid current shall be established A limit*! number of the streets in the district are paved with ballast from ships known as "cobble stones," and are in good repair. The streets not thus paved are in a fearful condition, and for months many of them are impassible to vehicles. The supply of water from the ' water works" of this city is so limited in the lower portion of the district as practically to be of no service in case of drouth or fires. DAIRIES AND STABLES. The number of dairies is large, but in many of them only two or three cows are kept. The extensive ones are located in the extreme rear of the Seventh Ward. They have been carefully inspected and all efforts made to have them kept in good sanitary state Ine milk has been frequently tested and its quality found to be excellent . The livery stables are kept clean, and the manure is frequently removed. PRIVY SYSTEM. This differs in no respect from that of other districts of the city, It is defective. An inspection revealed the fact that in numerous instances, they were not in conformity to law, and when cleaned soon fill up with sub-soil water, caus ing them to be always offensive and insanitary. The inspection of 7466 premises showed that only 5743 were found in good condition, 337 required repairing or rebuilding. CLXXXVI Mortality and Sanitary History of New Orleans, 1880-1883. The city ordinance in regard to the emptying of these vaults requires that vidangeurs shall perform this work froin six o'clock a. in. to six o'clock p. m., and for every vault to be emptied a permit shall be taken out at the office of the Board of Health. This is violated in many instances, and strict watch has been kept by the sanitary officer to prevent such an occurrence in this district. Another cause of complaint against the excavating companies, is that the barrels holding the faecal matter are not air-tight. A careful inspec- tion of such apparatus used by these companies convinces me that only that form of barrel having an iron top with rubber flanges is calculated to do away with all cause of complaint, on being carried to the ''nuisance boat," where such matter is deposited. The ''nuisance boat" is located ata wharf built by the city at the foot of Reynes street. It is well con- structed, holds about eighty loads, and since the adoption of the present system of dumping the fa?cal matter, no complaints have' reached this office. In the summer the boat is towed daily below the city, and its contents emptied into the middle of the Mississippi River. In the winter, owing to the small amount of work performed by the excavating companies, it is emptied but once a week. POPULATION. Adopting the United States census of 1880 as substantially correct, we find the Third District has a population as follows: WARDS. • White Males. 1 1 White Females. Black Males. j Bluck Females. Total Wards. 1 Total in 1 District. Seventh Ward 5.989 6.451 5.373 4.317 20.130 Eighth Ward 3 925 4 274 774 905 9 878 Ninth Ward 6 J 90 6.903 1 197 1.290 15.580 45.588 DISEASES. I January. 1 February. March. | April. June. July. '^snSny September. October. | November. December. Total. YaIIoW FAVAr. 1 al n r i n 1 Fa vats 2 1 8 2 3 13 7 3 2 42 Typhoid Fa vat . O 1 1 1 2 1 1 9 Scarlet Fever - - - ....... 1 1 1 1 4 1 2 1 3 5 1 13 f)jphthAria 2 1 2 4 8 6 18 Diarrhoeal DisAnsAs 5 1 6 17 13 8 6 8 3 4 2 73 Congestion of Brain 1 2 1 1 3 5 1 1 2 1 18 6 1 1 a 2 1 4 2 6 2 28 Phthisis Pulmonalis . 7 15 12 9 6 6 3 9 8 7 16 16 114 Deaths from all other causes 22 28 35 28 45 44 26 31 30 43 40 29 401 Total number of deaths 44 49 53 48 80 83 50 56 62 70 66 59 520 c Whites 25 32 32 35 62 62 38 32 46 50 50 42 506 Deaths, j Qojor34 19 17 21 13 18 21 12 24 16 20 16 17 214 Death Whites 9.79 12.53 12.53 13.71 24.29 24.29 14.88 12.53 18.02 19.59 19.59 16.45 16.52 rate per Colored 32.99 29.52 36.46 22.57 31.25 36.46 20.83 41.67 27.78 34.73 27.78 29.52 30.96 1000 Total 14.06 15.66|16 94 15.34 25.57 26.54 15.98 17.90 17.15 22.37 21.10 18.86 19.18 inhabitants pei* AT p lari al Fevers 0 311 0.63 0.31 2.55 0 63 0.95 4.15 2 25 0.95 0.63 1.11 annum. Phthisis Pulmonalis... 2.23' 4.791 3.83 2.87 1.65 1.65 0.95 2.87 2.55 2.23 5.11 5.11 3.37 Population-Whites, 30,625 ; colored, 6910; total, 37,535. MORTALITY FOURTH DISTRICT, NEW ORLEANS, 1880. REPORT OF R. A. BAYLEY, M. D., SANITARY INSPECTOR FOURTH DISTRICT OFFICE SANITARY INSPECTOR, FOURTH DISTRICT, ? New Orleans, January 1, >881. 5 Joseph Jones, M D., President Board of Health : gir The following report of sanitary work accomplished in the Fourth District, including health statis- tics, etc., during the year ending December 31, 1880. is herewith submitted. This district is composed of the Tenth and Eleventh Wards. The population of these wards amounts in the aggregate to 30,625 whites and 6910 blacks ; a sum total of 37,535 persons. The district is thickly settled from the river as far back as Dryades street. Only two of the streets are paved, viz : Tchoupitoiilas and Magazine streets. Washington street is paved, but only a short distance. HEALTH. There was considerable sickness in this district from the beginning of spring to the advent of cold weather, but the rate of mortality was small. The death rate per 1000 inhabitants for that time, from February to November, averaged only 20.11. For the whole year, the death rate was 19.18 ; the whites be- ing 16.52. and the blacks as high as 30.96. Mortality and Sanitary History of New Orleans, 1880-1883. CLXXXVII The deaths from all causes, commencing with January, gradually reached its maximum in May and June, and then ran up in September to a moderate figure, which was maintained with a slight increase during the last three months of the year. The majority of the deaths in the spring months was due mainly to diarrhoeal and malarial diseases, which are so common at this season. The rise of mortality in September was occasioned by many cases of congestive fever proving fatal. Isolated cases of diptheria and scarlet fever, usually of a malignant type, were reported throughout the year. There was no tendency to spread, except in a local manner, in the"cases coming under observation, Several foci of infection of scarlatina back on Jackson street were difficult of eradication. These diseases may extend to serious proportions the present winter, unless checked by energetic sanitation, fumigation of the rooms, and disinfection of the yards and vaults of infected houses, are done whenever a death or case is reported. The dengue fever, as a mild but yet extensive disorder, is classed among the remarkable diseases. The community groaned under this quasi serious visitation without any serious loss of life. This fever lasted about three months, and was only checked by frost in October. Nothing was attempted in the way of sani- tation to arrest its rapid progress. Like influenza it swept over the entire city in a very short time. The non-malarial character of this fever is amply proven by the failure of quinine' to abridge the average dura- tion of an attack Malarial fevers were very common, especially in the rear of St. Charles street, during the Spring and Fall months. The condition necessary for the generation of miasmata were never more strikingly present in this district, owing to the bad effects of continuous rainy weather on the unpaved mud streets and badly-constructed gutters. Two cases and a death from haemorrhagic malarial fever were reported in October, as having occurred in a family residing on Josephine street, between Liberty and Howard streets. These cases were declared of a purely malarial nature by competent authorities. Owing to the idea of yellow fever being associated in the minds of many persons with these cases and the bare possibility of danger, the sanitary measures in- stituted in the former diseases were immediately carried out. SANITARY CONDITION. The sanitary condition of this district may be said to be superior in some respects to that of previous years. This is improved by the constant inspection of the yards, drains and vaults of premises, which is not without good and permanent results. The people must be educated in the fundamental principles of sanitary science, as Herbert Spencer would say. before the real benefits of this work can be apparent to all. As for the streets and gutters, the less said about them the better. To condemn their present sanitary state in too severe language would be to cast odium on the heads of the innocent, perhaps. What could be expected, however, ot a street force of only eighteen or twenty men in a district having a superficial area of two and a half or three miles 1 A hundred men might be able to attend to the streets with credit to the city. The inspection of the gutters in summer elicited a few items of interest. The parallel or cross-street gut- ters were the foul ones at that time, in the front or middle sections of St. Charles street; the constant stream of river water in the perpendicular ones keeping the latter washed out. The rank growth of weeds in the parallel gutters in the tear of St. Charles street, acting as nature's purifiers, keeping those drains in a comparatively clean condition. The perpendicular gutters, not so good in front, are ditches, or canals, in the rear of the district. The drainage in these latter gutters was found to admit of a uniform flow of wa- ter. gradually slowing up from the river back, when the Auxiliary Association were working at the foot of Felicity street. Above Washington street, with the exception of Toledano street, there is little drainage noticeable back of St. Charles street. The water here has to And an exit by the gutters of the above men- tioned streets. The capacity of the perpendicular gutters for drainage purposes may be shown best in figures from estimates taken at the time. Eighth street in front: Flow of water 350 feet in 5j minutes. Eighth street in rear: Flow of water stationary. Second street in front: Flow of water 350 feet in 5j minutes. Second street in rear: Flow of water 350 feet in 6 minutes. St. Andrew street in front : Flow of water 350 feet in minutes. Josephine street in rear: Flow of water 350 feet in 5 minutes. There is not much difference, therefore, in the rapidity of the flow of water, between the extreme front and rear of the district, in the average gutters examined. There must be some difference, however, to prevent stagnation in front, but none worth mentioning. This flatness of grade in the gutters is not calculated to facilitate drainage ; it must be corrected before anything else need be attempted. If the sides and bottom of the drains were constructed of stone, the fric- tion of the water would be less, and a more rapid flow result as a consequence. The scavenger force in the two wards consists of ten or a dozen carts, with the accompanying drivers. This limited number of vehicles is expected (as required by law) to remove the trash, garbage, etc., from more than 7600 premises, between the hours of 7 and 10 a. m.; the undertaking is naturally a signal failure. After the streets became impassable from rains these car ts stopped going around. A matter of complaint with residents is the dumping of garbage by these drivers into the bad holes on some streets. Quagmires cannot be filled with sueh material without the erection of public nuisances. It is necessary in this report to recapitulate the sanitary evils not yet dwelt on, such as old privy vaults; low yards without drains ; tenement houses; low lots, etc. These nuisances come under the control of health ordinances, and are being rapidly abated with time and perseverance, SANITARY OPERATIONS. The limited outbreak of yellow fever in 1879 prompted and urged the completion of the inspections and abatement of nuisances at an early date the past year. Another regular officer was assigned to this district in May, and with his extra help the sanitary work was hastened considerably towaids completion. In the month of June, there were more than 5060 copies of the circular No. 9 distributed in this district. They were left at every house by the sanitary officers as far back as St. Denis street, when the supply allowed to this district gave out. This measure was followed not long afterwards by the free delivery of tfhe copperas in the dry state. The copperas disinfectant, in quantities varying from three pounds and up- wards (according to size and nature of vaults), was left at every public and private building from the river to St. Denis street• and around the markets in the rear of the district. Ample instruction was given to the . occupants of the houses visited, how to dissolve and use. the copperas in the vaults, sinks, drains, etc., on the premises. An examination of the privy vaults was included in the above work, and notices were served immediately to abate any nuisance discovered. A saturated solution of copperas, with a strong percentage of carbolic acid added, was kept on hand in the sanitary office during the summer, for the benefit and use of persons living in this portion of the city. These wise measures emanating from the Board of Health, were productive of incalculable good, in a sanitary point of view. The residents of the district showed their appreciation of them by a hearty and willing co-operation at all times. CLXXXVIII Reinspection of premises where yellow fever occurred in 1879 was repeatedly done through the summer The vaults and drains on them were snbjected:to thorough disinfection. The tanks, barrels, hose, etc., belonging to the excavating companies located in the District were made the objects of a special examination and test in August, There was nothing found, however, of an objection- able nature, as the companies use the odorless apparatus as specified in a health ordinance. It is worth mentioning here that, in consequence of the limited number of wagons in the employ of some of these vidangeurs, the emptying of privy vaults is not as rapidly attended to as the nature of the case demands. HOUSE TO HOUSE INSPECTION. The regular inspections were over some time in August, but the main portions of the district has been gone over as early as July. This work had been hurried on from the beginning of the year, but not as fast as after the reorganization of the Board of Health in April. Reinspection of premises was principally attended to during the months of July. August and September. This work is particularly necessary at this time of the year, and in the means of abating many nuisances lying over from a previous inspection Inspections and reinspections consist in the careful examination of the yards, drainage gutters, alleys and privy vaults connected with any premises visited by the sanitary ofiicer. Notices are served afterwards in the statement of nuisances, Much trouble is often experienced in forcing parties is to have their vaults cleaned. This is most likely to be the case when a notice is served within six or eight months subsequent to a previous one to the same effect, which is often necessary in badly constructed vaults. The average time for a vault to go uncleaned is ten months or a year, In the case of boarding-houses or asylums it is necessary at least three or four times a year, or even oftener in some instances. The vaults in this district are usuallv faulty in construction, and, on that account, soon fill with sub-soil water after being emptied. When a vault fills in this manner a careful disinfection is all that is'requisite. unless it overflows into the yard. There is a disparity then between bad and foul (water) vaults. Ordinances are necessary to enforce, with any hope of success, the filling of low lots and the construction of drains on premises. These evils are numerous in the district, but difficult of abatement. The two ponds on Tchoupitoulas street, just above Washington street, are happily now being filled The Board of Health, as in former years, ought to have the right to decide when a lot is properly' graded for building, DAIRIES. There are as many as 192 premises with cows on them in this district. The total number of animals is reckoned at 522. The dairies are distributed throughout the district, but principally in the front and rear portions. There are not over twenty large dairies in all, the average number of animals kept ranging from one to five. A personal inspection of the stables wras made in the Fall, when they were at their worst in consequence of bad weather. The good, indifferent and bad ones were examined in turn, and advice was given in one instance and an order in another, as the exigencies of any particular case demanded. I was surprised to see the evidences of improvement in many places, as well as a manifest endeavor on the part of the dairymen to comply with the requirements of health and decency. The better class of dairies had good or water-tight- flooring in the stalls and drainage gutters and receptacles for the excrementitious material of the cows. There were a limited number of what might be termed filthy dairies examined, where no disposition was shown by the owners of them to keep anything clean. It is for this class of stables that a Health Ordin- ance, properly worded, is requisite to enforce a strict compliance with law. This is but an instance of a retrograde metamorphosis of human nature, inasmuch as these slovenly people are ignorant of what consti- tutes cleanliness of either person or premises. In the absence of any law to limit the number of animals to be kept within thickly-settled neighborhoods, or to define the manner of construction of the stables, the sanitary officers are able only to act as in ordinary premises. The matter of the adulteration of milk, like the food on which the animals should be fed. is still beyond the immediate control of the Board of Health. SHIPPING, The shipping along the river front was regularly inspected in person every' day or so, from the middle of May to the end of September, The captain, or chief officer, of the vessel was interviewed, and a written statement required of him concerning the health of the crew, ports stopped at and sailed from, kind of cargo, etc. Th regular printed forms were used in every inspection. Some objections were raised in the beginning, called in question the legality of the examination, but they were easily set aside when fully ex- plaim d. No sickness was discovered on any steamship or sailing vessel visited in the, summer. The majority of the steamships had sailed from foreign ports between "West Indian and Mexican ports and this city came here usually with water-ballast or wine and other like simple car-goes. The crews of these latter vessels are almost invariably acclimated Spaniards or Italians. Number of steamships 36 Number of ships inspected • 15 Total 51 MARKETS. The principal markets in this district are not in perfect sanitary condition. Complaints have been re- ceived of late concerning three out of the whole number of five. The Saraparu Market has been reported in a dangerous state, the shed at the end towards Rousseau street being shaky and liable to fall down at any time. The roof of the Magazine Market leaks in several places. This has been so for the past six months. The Ninth Street Market is sadly in need of repair. The water-plug stationed here was reported outof orderabout a year ago. Keller and-Second Street Markets are in very good condition. BONE YARDS. These establishments for the purpose of rendering and cooking the flesh of dead animals, are situated in the rear of the Claiborne canal, on Washington street. They were reported early in the summer as nuis- ances in this city, so long as they remained on one of the principal streetsand drives in the district. A committee was appointed by the Board of Health to examine and report on them ; since which time the matter continues in statu quo. I succeeded, with some trouble, in having a lot of hogs removed from these yards. These hogs were being fed on the flesh of dead animals, and sold to butchers at every convenient oppor- tunity. The prop, ietors of two bone yards were setved with peremptory orders in September to cease further carrying on of their business, until such time as they might makeapplication for and receive permits for so doing. Mr. Barbach. owner of a bone-yard No 1, complied with the notice served on him, and is no longer to my knowledge pursuing his business. Mr. Kolwe. owner of bone yard No. 2, got an injunction out im- mediately in one of the courts and has continued working. The difference between the two establishments is tletad«l। and in favor of the one owned by Mr. Kolwt;. The latter party uses steam altogether to act on Mortality and Sanitary History of New Orleans, 1880-1883. Mortality and Sanitary History of New Orleans, 1880-1883. CLXXXIX the carcasses of the animals, which are placed in cisterns for that purpose ; the former party makes use of a plain iron boiler, in which the animals are imperfectly covered over during the boiling process. Mr. Bar- bach is willing to move off Washington street, and put up steam works in the extreme rear of the Sixth District. Mr. Koi we, having steam works already, is now testing in the courts the question of the eligi- bility of the location. These eases demand the early action of your honorable body. PUBLIC SCHOOLS. These institutions of learning were inspected just before the holidays. There are eleven of them in the district for the children of the white and colored residents separately. The schools were found about in the same condition as when reported on a detail a year ago. I thought proper, therefore, to omit the tables usually appended to this report. I would call attention, moreover to the general unsanitary condition of the new Dryades street school for colored children. The yard and bull- ing are not as good as the ones in use last year.' MORTALITY FIFTH DISTRICT NEW ORLEANS, 1880. DISEASES. inuary. ebruary. 9 & CD fl fl *fl ugust jptember. fl} o o fl} a o k o ecember. o ◄ <1 so o ft 0 - - - - - - - _ ■ Malarial Fevers 1 1 2 Measles 3 3 Diphtheria 1 4 1 1 Diarrhoeal Diseases 1 1 . .1 1 1 2 5 Convulsions 1 2 1 2 1 1 8 Phtbsis Pulmonalis 1 3 1 1 2 4 3 1 5 4 25 Deaths from all other causes. 7 6 8 6 16 10 11 3 7 6 6 5 91 - - - . - - Total number of Deaths 9 6 11 10 20 20 13 9 10 10 12 12 142 6 - ■ - - - - - Number (White 5 3 8 7 16 9 6 7 6 9 6 88 Deaths. 5 Colored 4 3 5 2 13 4 4 3 3 4 3 6 54 - ■ - - ■ - ■ - ) Malarial Fever. 1.04 1.04 0 22 Death rate 1 Phthisis Pulmonalis. 1.04 4.01 1.04 1.04 2 08 5.15 4.61 1.04 6.20 6.09 2.82 por1000 ( - - - - - Inhabitants ( Whites 12.01 7.03 14.05 19.03 16.09 38.04 21.01 14.05 16.09 14.05 21.01 14 05 17.52 pei' annum. Colored 10.07 9.00 15 08 6.05 40 75 12.07 12.07 9.06 9.06 12.07 9.06 18.02 14.00 J Total 16.10 Population-White, S021. Colored, 3856. Total, 8857. Death Rate per 1000 Inhabitants per Annum-White, 9.93; Colored, 14 00. Total, 16.00. TABLE SHOWING THE SANITARY CENSUS OF THE FIFTH DISTRICT (ALGIERS) DURING THE YEAR 1880. WHITE. Total population 5.021 Natives of New Orleans.... 2,603 Born in other States or foreign countries . 2,418 Male 2,993 Female 2,028 Adults 3,243 Children 1,778 Vaccinated •••< 3,904 Unvaccinated 1,117 BLACK AND COLORED. Total population 3,835 Natives of New Orleans 1,992 Born in other States or forcing countries 1,843 Male 1,631 Female 2,204 TOTAL POPULATION. White, black and colored 8,856 Table showing the number of inspections and reinspections made in the Fifth District (Algiers) during the year 1880: REPORT OF EUG. J. MIOTON, M. D., SANITARY INSPECTOR FIFTH DISTRICT. OFFICE SANITARY INSPECTOR FIFTH DISTRICT, ) New Orleans, La. January 1, 1881. 5 Joseph Jones, M. D., President Board of Health . Sir-The following report of sanitary operations performed in this district, including statistics, etc., dur ing the year ending December 31. 1880. is respectfully submitted. Having entered on duty April 11, 1880, I make use of the records preserved in the office, and particularly the monthly reports of my worthy and able predecessor, Doctor J. H. Magruder, to complete necessary ma- terial for a full statement of the year's sanitary work. ' TOPOGRAPHY. The Fifth District, which is composed of Algiers, Tunisbnrg, McDonoghville, Freetown and Gretna, Is situated on the right bank of Harvey's canal, opposite Carrolton. to the limits of Tunisbnrg opposite Chal- mette (battle grounds), and occupies an area of fourteen miles in length by half a mite in depth, AS is easily seen, the Fifth District is probably one of the largest of tire oity, although ite population is duly (14,IWO) foartxfen thoueaud inhabi tacts. CXC Mortality and Sanitary History of New Orleans, 1880-1883. HEALTH. It is most gratifying to state that the amount of sickness and the mortality that have occurred, when compared with the census of the district, will show the health of the community to have been excellent. Only one hundred and forty-two (142) deaths have occurred during the past year in Algiers out of a popula- tion of eight thousand eiglit hundred and fifty-six (8856) inhabitants. Not a single case of yellow fever nor small-jmx has been recorded in the district for the year 1880. The exanthemata were exceptionally mild; the malarial fevers and dengue, which prevailed throughout the summer months, were also of a mild type, there being only three deaths of malarial fevers and not a singJe one from dengue. SANITATION. The almost total immunity of the Fifth District from all contagious or infectious diseases during the year which has just elapsed, can, I believe, be fairly and justly attributed to the speedy and energetic man- ner with which the Board of Health's instructions concerning house to house inspections, the free distribu- tion of disinfectants (copperas and carbolic acid), the abatement of all nuisances, the special inspection of all the sea-faring vessels landing within the limits of the district, have been carried out. From April to the latter part of October, over 15 barrels of sulphate of iron and over 40 gallons of pure carbolic acid (Cal- vert's No. 5), have been freely and gratuitously distributed to the people of the district. All the premises were cleaned, fumigated and disinfected ; the bed-clothes and the patient's wardrobe were also treated in the same manner. PUBLIC SCHOOLS. The public schools, two in number, Mc.Donogh Nos. 4 and 5, were inspected several times during the past year, and their sanitary condition was made the object of careful note. Both buildings are compara- tively new, having been completed in 1875 ; the rooms are spacious, well ventilated and kept clean, borne of the rooms in these schools are quite crowded, and I presume are mroe so now. the number of pupils hav- ing increased since these particulars have been obtained. The privy accommodations and play-grounds are amply sufficient, and are kept in a very commendable manner. VACCINATION. Although Tuesday and Thursday in each week, from 11 to 1 p. m., were set apart for a gratuitous vac- cination, only three applicants were vaccinated in this office during the year, showing a very deplorable in- difference on the part of those who are most interested. INSPECTION OF SHIPS. In accordance with the sanitary rules, adopted and approved by the Board of Health of the State of Lou- isiana on April 22d, 1880, sixty-seven 167) ships were inspected by me from May to October. Of these vessels twenty-four (24) had sailed from Havana and Florida Keys, one (1) from Vera Cruz and forty-two (42) from healthy ports. The sanitary condition of the vessels, crews and passengers was in all instances found excellent. The most cordial thanks are here tendered to the officers of the Morgan line of steamers for their polite- ness and courtesy towards my sanitary police officers and myself. BABK EXCELSIOR. On the seventeenth of August, 1880. arrived from Quarantine Station the Swedish bark Excelsior. Cap- tain Bjorkgren. The bffik landed at "Wallace Wood's powder wharf." Tunisburg. Fifth District (opposite the abattoirs. I immediately repaired on board and officially took charge of her. According to the instruc- tions I had received from the Board of Health ; I placed permanently on board my detailed officer, Mr James Nowell, with the strict order of allowing no communication from land without a written permit from the President of the State Board of Health, This rule was rigidly carried out, and during all the stay of said bark in port, there were admitted on her those only who were employed in loading the vessel, and who had been previously examined by me and found to be acclimated. I made it my duty to visit the bark twice daily, morning and evening. Two (2) cases of dengue, both ending in recovery, occurre I on the bark,' which cases were reported at once. The honorable President of the Board of Health. Doctor Joseph Jones saw both patients and confirmed my diagnosis. A light purgative and a few grains of quinine were ad- ministered, and the fever readily subsided. t The bark "Excelsior" left for Bayonne. France, on the eleventh day of September, 1880, loaded with grain. The wise and prudent measures, rigidly enforced in this case by the State Board of Health, cannot be too highly praised, and all those who know and appreciate the delicate position of the board at that particular moment will acknowledge the wisdom of the course pursued on this occasion. DRAINAGE. The drainage of this district is very defective. The portion lying between the river and Market street is well drained, but back of that street there is no sewerage at all : as a natural consequence, the rear of tho district is overflowed after each heavy rain, and remains so for days until the water is absorbed or eva- porated. This complete lack of drainage could be remedied at very little expense by opening an outlet to the swamps. The above remarks will show that the streets must be. and are, in a'deplorable condition; although, injustice to the Street Commissioner, I must say that much has been done of late for their im. provement. NUISANCE BOAT. The most urgent and pressing want of the Fifth District for the present is, most assuredly, a nuisance boat. The ground used as a place of deposit for all kinds of garbage is situated in a thickly-settled part of the district, is a source of danger and annoyance for those living in the vicinity, and a disgrace to any com- munity. I have time and again complained of the state of affairs, hut vainlv so far. I earnestly hope that the Board of Health will take the necessary steps to secure a nuisance wharf and a garbage boat for the district. MARKETS. The markets of the district have been inspected regularlv every week throughout the year, and have always been found in a clean and irreprovable condition. Not a single complaint was ever made against them during the whole year nor has any objectionable article of food ever seen or offered for sale. DAIRIES. There are from twenty to twenty-live dairies iu the district, which have been regularly inspected during the-year, at intervals of one and two months, and cleanliness of the premises have been carefully enforced. The condition of the dairy buildings was especially examined, and with a few exceptions-which were made the object of special remonstrance-they were t ound to be kept clean; the cows looked be ilthy and in good condition. Quite a number of persons keep from one to three cows for family us6, but no complaint has ever been made against them. SANITARY POLICE. It is my pleasant duty to bear testimony to the perfect efficiency of Messrs. Henry Labarre and James Nowell. I must here state to their praise that they are well qualified for the position, attentive to duty, prompt in action, and that they neglect nothing that can promote the health of the district, POLICE STATION. The Eighth Precinct Police Station, in charge of Sergeant J. J. Pujol, is always kept clean and in the best sanitary condition. * Mortality and Sanitary History of New Orleans, 1880-1883, CXCI MORTALITY SIXTH DISTRICT, NEW ORLEANS, 1880. DISEASES. 1 January. February. March. April. May. 1 June. July. 1 August. ! September, October. November. December. Total. Yellow Fever ... .... Afalarial Fevers 1 1 1 3 1 3 10 Typhoid Fever 1 1 1 1 2 6 Scarlet Rever 1 1 1 3 4 1 1 6 Diphtheria Diarrhreal T 1 1 1 3 1 7 1 2 2 1 1 7 1 1 1 - 3 1 1 3 3 1 3 5 2 19 4 J 4 2 6 2 3 3 2 29 Deaths from other diseases. . . .... 25 16 9 20 22 20 20 23 21 22 19 22 230 Total Number of Deaths....» 30 22 14 25 40 28 25 29 32 30 26 28 329 ) White 21 9 4 19 29 21 18 18 22 16 12 17 196 Deaths. >pol„r„d 9 13 10 6 11 7 7 11 10 14 14 11 123 Death rate per 1000 Whites 21.08 9.03 4.01 19.16 29.11 21.08 18 07 18.07 22-09 16.06 12 04 17.06 16 40 Colored 26.48 38.08 29.42 17.65 32.36 20.59 20.59 32.36 29.42 41.19 40.19 32.30 30.16 Total .. 22.45 16.47 10 18 18.71 29.94 20.96 18.71 21.71 22.93 22.45 19.46 20.96 20.52 inhabitants Yellow Fever ... per Malarial Fevers 0.64 0.64 0.74 5.24 0.74 2.24 0.60 auu mu. Phthisis Pulmonalis... 2 99 2.24 2.90 1.49 4 49 1.49 2.24 2.24 1.49 1.80 Still-born, 13. Population-Whites, 11,951; colored, 4078 ; total, 16,029: REPORTS OF W. H. CARSON, M. D., SANITARY INSPECTOR SIXTH AND SEVENTH DISTRICTS-SIXTH DISTRICT. OFFICE OF SANITARY INSPECTOR, SIXTH DISTRICT, I New Orleans, December 31, 1880. $ To Joseph Jones, Al. D., President Board of Health, State of Louisiana ? Sir-I have the honor to submit the following summary report of the operations of this office, and other affairs of importance, as connected with the sanitary condition of the Sixth District, of this city, for the year 1880: HEALTH. Throughout the year this district has remained remarkably healthy. With the exception of a visit from the benign dengue fever in th>* later months of the year, and with but few cases of contagious diseases, the health of the district has been but slightly disturbed, the death-rate falling in the month of March as low as four per cent per thousand. The rate of mortality, with a population of over sixteen thousand, speaks unusually well for the general good health of the district. Not even a suspicious case of yellow fever during the year, and the one case occurring in September of last year (1879) the premises were repeatedly disinfected and cleansed, inside and out, painted, white- washed, water-closets emptied, and other sanitary measures incident to prevention duty attended to. In connection with my article on the health of the Sixth District, I have prepared a tableau of mortuary statistics, showing the number the cause of death, with the per centage per thousand in the district for the past year. I believe that the various forms of malarial fever, at times prevalent in this district, could be decidedly lessened, if not absolutely abolished, if the benefits of proper scientific drainage were in force. Many local! ties in the district have but little or no drainage, and it is scarcely to be wondered at that, after the rainy season, with the neighboring fields flooded with water at some localities, and saturated throughout, and with the aid of a semi-tropical sun, the powerful agents in the production of miasmatic fevers, if not of manv other more pernicious diseases, that the various types of malarial fever prevail. DRAINAGE. No efforts have been made during the past year as to improvement of drainage in the district. That the matter requires attention, and that at an early date, is indisputable. The continous and heavy rains for the past tour or five months have rendered the roads and highways im- passable, and large drifts from the roadway have, in many instances, clogged the drainage on either side of the roadbed, and in many instances resulting in the formation of quite extensive pools of water, stagnant and foul smelling. CXCII I cannot but again refer especially to the section between Toledano and Delachaise streets. This locality and its great drainage deficiency has been repeatedly laid before the authorities, but without avail: no reme- dial action has been attempted. In this section referred to, heavv rains will keep the rear of the district in overflow for many weeks, and even at times many months. WATER SUPPLY. If the district is sadly deficient in drainage requirements, the same may be said of its artificial water sup- ply. No extension of water-mains has as yet been made beyond Toledano street, and its absence is made manifest in many ways, as it refers to the furtherance of sanitary measures. Sunken wells still continue to be the main resource of the inhabitants of the district, and with the addi- tion of their wooden cisterns furnish sufficient grounds for suspicion as to the purity and properties of their water for drinking purposes. With not a hydrant in the district, and depending upon their supply of water from their cisterns and wells, it is almost impossible that the desired cleanliness and measures of a sanitary nature could be systematically attended to. PUBLIC BUILDINGS. The public buildings in the District number twenty-six (26); this includes public schools, churches, asy • lums, a police station and a market, All of these buildings have been the subject of inspection during the year. The public schools, according to the usual custom, have received a most thorough sanitary investigation, and it is my pleasure to state that, without exception, they piesented a most satisfactory condition. The Jefferson Market, located at the corner of Magazine and Berlin streets, is the principal and only market in the district. No complaint can be offered as to its sanitary condition. On the contrary, cleanliness is the rule, and on no one occasion have I had to take measures to prevent the sale of tainted meat. DAIRIES. Early in the month of September all the dairies of the Sixth District, numbering eighty-five (85) received a most thorough inspection, an inspection not only devoted to the dairy proper, stock, etc., but also the neighboring premises and outbuildings, and all was exceedingly satisfactory. This condition is in marked contrast to that noted in my annual report of the year previeus (1879), at which period but little time or attention was devoted by dairyman to many of the most simple, yet important hygenic requirements. The inspection of the stock proved them to be in the best possible condition of health; milk-pails, cansand the other attachments incident to the business were observed to be in an exceedingly clean condition. It is with much satisfaction that I embrace the opportunity to present such a deserving and industriou ' class in a more enviable light than that contained in my report on this subject for the previous year (1879 PRIVY SYSTEM. The pernicious privy system, with its leaky, ill-constructed and foul smelling vaults, yet continue to ex- ist and flourish ; no change, no improvement, but the same in character and build as used generations back of the present. In this district this unhealthy and obnoxious condition is probably not so prominent, or its unquestion- able deleterious effects, ti^any great degree, so noticeable, from the fact that the district occupies an ex- tensive area in proportion to its population. Yet in the more thickly settled and populated sections, the source of many of the so-called filth diseases, this privy system in vogue is not without just and almost positive suspicion. This is a subject of the utmost vital importance to every resident of this city, for the obnoxious system is not confined to any one district, and it is most sincerely predicted that ere another decade this most unciv- ilized and abhorent privy system, now in use, will have been abolished without even a vestige of its former residence. Mortality and Sanitary History of New Orleans, 1880-1883. DISEASES. January. [ February. | March. i I April. May. 1 | June. July.. | August. September. October. November. December. Total. Yellow Fever Malarial Fevers Typhoid Fever Scai'let Fever .... Measles ... 2 2 Diphtheria Diarrhreal Diseases Congestion of Brain.... 1 1 . ... • • 1 1 1 1 1 1 4 Convulsions Phthisis Pulmonalis Deaths from all other causes 8 14 3 4 3 1 12 "io 1 8 1 10 9 9 8 .... 3 4 1 1 8 9 104 Total Number Deaths 10 14 7 16 12 9 11 9 12 9 9 10 128 Number ( White Deaths. J Colored.... CP -r 6 8 2 * 8 8 7 4 5 4 3 6 6 6 8 1 5 3 7 62 66 Death rate per 1000 Whites Colored Total 23.13 15.36 19.27 23.13 30.72 26.93 19 13 .71 20 .47 30.84 26.99 30.72 19.20 36.78123.08 15.42 19.20 17.31 15.42 26 88 21.16 11.56 23.04 17.31 23.13 23.04 23.08 31.16 30.72 17.31 19.28 15.36 17.31 11.56 26 88 19.27 19 92 21.12 20.52 Inhabitants per annum. Yellow Fever Malarial Fevers Phthisis Pulmonalis. ... .77 1.94 3.84 5.77 1.94 0.32 1.44 Still-born, 5. Population-Whites, 3125; Colored, 3112. Total. 6237 MORTALITY SEVENTH DISTRICT, 'NEW ORLEANS, 1880. Mortality and Sanitary History of New Orleans, 1880-1883. CXCIII OFFICE OF SANITARY INSPECTOR, SEVENTH DISTRICT, * New Orleans, December 31, 1880. ? To Joseph Jones, M. D., President Board of Health State of Louisiana: Sir-I have the honor to submit the following summary report, with its accompanying comments, of the sanitary work performed throughout the year 1880 in the Seventh District of this city. HEALTH. The condition of health generally has not materially differed for the past few years. It is worthy of notice that in the population of the district, numbering in the total six thousand two hun- dred and thirty seven (62 «7>-U. S. census, 1880- the percentage of mortality attending the colored race is in excess of that of the whites. The two races are rather evenly div'ded in population, the whites numbering 3112 and the colored 3125. The deaths number in the former 62, and in the latter 66. Notwithstanding the heavy and persistent rains of the fall season, types of malarial fever did not present an increase, though diphtheria and intestinal diseases were prevalent. This district, in company with the neighboring and lower district, the Sixth, had each a case of yellow fever to record against them for 1879. No case or anything even suspicious appeared throughout the past year, 1880. The premises wherein the death occurred, and above referred to, received the same careful attention in the way of disinfection and other preventive measures that its fellow in the Sixth District received. In great part the good health of the district is to be attributed to the better drainage attending this district than that of many of the others, its mean elevation being about fourteen inches over and above that of the First and Second Districts. PUBLIC BUILDINGS. The public buildings in the Seventh District number in all twenty-one, sub-divided as follows : Twelve churches, two fire-engine houses, one court house, a jail building, police station, market and three public schools. These various buildings have been duly inspected during the year, and with the exception of the court house, jail and police station, were found to be in a satisfactory sauitarv condition ; the court house has been long in need of repair, and the neglect to attend to the same is sadly affecting the appearance and usefulness of the building. A comparative small outlay at the present time, would unquestionably save to the city a considerable outlay of money. If thie court house is in bad condition, what must be -aid of the jail and police station? The jail, a brick building of two stories, and without the slighest pretense to sanitary requirements in its architecture, is literally falling to pieces ; new joists are wanted, the floors are rotten and wan ing in many places, the stair-way rickety and unsafe, many of the prison cells have had to be abandoned, no longer be- ing inhabitable or secure for confinement of the prisoners, and in toto the building'is but a shell, and a most decidedly unhealthy one. even admitting that its use is confined only to the criminal classes. It is estimated that over one hundred barrels of bat manure were removed last September, the accumu- lation of years, leaving yet in great numbers the source of the annoyance. Various grand juries in their reports have called attention to the digraceful condition of this building and its present unfitness for the confinement of criminals, and surely it is about time that some attention was devoted to it. PRIVY SYSTEM. Though the privy system in vogue in the Seventh District, and I believe confined to this one district is rather simple in character and of primeval origin, it consisting of an excavation in the soil some four to six feet squard and over which is placed a light wooden enclosure easily movable, I earnestly believe that but little of the bad unhealthy effects are produced which are assigned and now generally accepted, to the brick, and cemented and stationary vaults of the other districts. For when this trench is no longer serviceable, the contents are disinfected, earth is thrown in covering the space in use completely, and the house is moved to another spot. The localities for erecting these tem- porary buildings are selected as far from the dwelling as possible, consequently the inmates are decidedly more free than those residing in the more densely populated districts of the city, where the closet is per- manently built, and in the majority of cases forming part of the main building. 1 do not desire to have it understood that this character of vault and the system described, applies to all of the residences in the district, for such is not the case, as there are localities in which it would be imprac- ticable and deleterious to the public health. MARKETS. One market centrally located, supplies the wants of the district in this respect; the meat sold is unusually good, and cleanliness is an ever present feature of the building. DAIRIES. The dairies are extremely numerous in this district, numbering over fifty, the majority of which are lo- cated on Carrollton avenue. They received a careful visit and inspection in the early part of September, and but small complaint can tee found against them; they are generally clean and out-buildings in good order. MORTALITY. The mortality of the district during the past year has not been great, the total number of deaths being one hundred arid twenty-eight (128), a death-rate of 20.52 per thousand. Since 1877 not a death from small-pox has occurred in the district. I have prepared a tabulated statement of the mortality of the district for the year, in which is shown all the deaths from the principal diseases, showing the per centage for each of the months of the year. 54 CXCIV Mortality and Sanitary History of New Orleans, 1880-1883. COMPARATIVE RATES OF MORTALITY IN NEW ORLEANS DURING THE YEAR 1880, AND IN THE PRECEDING YEARS -SANITARY MEASURES NECESSARY TO THE HEALTH OF NEW ORLEANS-MORTUARY STATISTICS. The total deaths from all causes iu the city of New Orleans during the year 1880, numbered 5623, and the death rate per 1000 inhabitants was 25.98. With the exception of two years (1827 and 1879) the death rate of 1880 was lower than that of any year since 1787, of which any records have been preserved. In 1827, the death rate was 24.56 per 1000 and in 1»79, 23.94 per 1000. It is of the highest importance that a general view of the mortuary statistics of New Orleans should be presented, in order that the effects of sanitary and quarantine measures should be clearly defined. It should be shown by the past and present mor- tuary records whether the death rate per 1000 inhabitants be decreasing or increasing ; whether certain diseases are increasing or diminishing in fatality, and whether differ- ences exist in the rates of mortality amongst the different races which compose the popu- lation of New Orleans. In order to throw light upon these important questions, the following comprehensive statement of the mortality statistics of New Orleans with the accompanying charts have been prepared: The tabular view of the mortuary statistics of New Orleans, contains the foilowing tables enumerated in regular order as they have been placed upon the chart: (a). Table illustrating the relations of the population of New Orleans, to the total mortality from all causes, during a period of ninety-four years. (b). Table illustrating deaths and death rate from all causes and from yelloiv fever in the city of New Orleans, during a period of sixty-four years. (c). Table illustrating the mortality from some of the principal diseases and total mortality, together with the death rate per IWO inhabitants of the different districts of New Orleans, for the year 1880. (d). Census of the State of Louisiana, from the tenth census of the United States, 1880. (e). Comparative tables of mortality by months, during the twelve years, 1869 to 1880, shoiv- ing deaths from some of the principal diseases ; total number of deaths according to race and color, and death rate per annum. (f). Table showing deaths diarrhoeal diseases, by months during the twelve years 1869-1880 inclusive. (g). Table showing deaths from phthisis pulmonalis, during twelve years 1869-1880 inclu- sive. (h). Table showing deaths from malarial fevers by months, during twelve years 1869-1880. (i). Deaths in the Charity Hospital, City of New Orleans, during the year 18'"0. From the preceding data, as well as from the vital statistics am. meteorlogical records of this city, the accompanying charts have been prepared, illustrating the increase of popu- lation in the city of New Orleans, during a period of ninety-four years, together with the total mortality for each year, and the death rate per 1000 inhabitants per annum, also deaths from yelloiv fever, mean maximum and minimum temperature and rain fall for a number of years. Without, at the present moment, entering into an exhaustive discussion of the data recorded in the accompanying tables and charts, the following points of general inter- est may be noted: 1. It will be observed that the maximum death rate per 1000 inhabitants was at- tained in the year 1832, 147.01 of every 1000 inhabitants of New Orleans died. In that year (1832) both cholera and yellow fever prevailed as epidemics. The next highest death-rate was in the memorable year 1853, when the mortality per 1000 inhabitants was 102.42, and the deaths from yellow fever alone caused nearly one- half of the total mortality-namely, 7849 out of 15,787 deaths from all causes, or 50.90 per 1000 inhabitants. The year 1878 will be distinguished by the diftusion ot yellow fever over a considera- ble area and by the wide spread alarm excited in the Valley of the Mississippi by the ravages of this pestilence. The rate of mortality, however, in 1878 was less than one- half that of 1853, being 50.70 per 1000 inhabitants from all causes, and 19.20 from yellow fever- and it was only a little more than one-third that of 1832 ; and it was exceeded by that of 1787, 1796, 1810, 1811, 1815, 1^17, 1819, 1820, 1822, 1825, 1829, 1832, 1833, 1834, 1835 1837 1839, 1841, 1844, 1847, 1848, 1850, 1851, 1852, 1853, 1854, 1855, 1858 and 1867. 2.'There has been an evident decline in the death-rate of New Orleans during the past twenty years 1860-1880. Of course we do not in this statement fail to note the high death-rate (55.57) of 1867, caused by cholera and yellow fever ; of 1873 (40.19) and of 1878 (50.70) embraced to the period 1860 -1880. The decline of the mortality rate during the period specified (1860-1880 is shown by the oscillations of the heavy black line on the chart which represents the death-rate per 1000 inhabitants per annum from all causes. Mortality and Sanitary History of New Orleans, 1880-1883. CXCV The same fact is also illustrated by the following statement of the years, presenting the lowest death-rate per 1000 inhabitants in New Orleans during the past ninety-four years : 1812, 32 50 , 1816, 27.93 ; 1821, 39.57 ; 1826, 30.61 ; 1827, 24.56 ; 1828, 32.89 : 1831, 36 71 ; 1S38, (36 77; 1840, 39.11; 1845, 31.17; 1856. 35.24; 1857, 34.07; 1861, 33.97; 1862, 36.10; 1868,28.96; 1869, 29.79; 1870, 36 26; 1871,31.24; 1872, 33.54; 1874, 35.71; 1875, 32.05; 1876, 32.39; 1877,34.32; 1879,23.94; 1880,25.98. This decline in the mortality rate may be referred to several causes: (a.) The sta- tionary condition of the population during the period specified (1860-1880), as shown by the line in the chart representing the increase of population in New Orleans during the past 94 years. It is clearly shown upon the chart that the periods characterized by the highest death-rates were precisely those periods in which the city increased most rapid- ly l>y additions from surrounding States and foreign countries; (b.) the relative prepon- derance during these latter years of a native-born and acclimated population; (c.) the diminution of the number of seamen entering this port, on account of the substitution of large iron steamships for wooden sailing vessels; (d.) the institution of more rigid quarantine regulations and measures ; (e.) increased drainage in the rear portions of the city ; (/.) certain sanitary measures, as the cleansing and disinfection of privies and the removal from the city limits of ni.ht soil and garbage. 3. As far as the statistics recorded in these tables extend, they tend to sustain the view that the establishment of quarantine at the mouth of tho Mississippi and at the Rigolets and on the Atchafalaya by the State of Louisiana, has tendered to diminish the frequency of yellow fever epidemics ; thus from the establishment of the quarantine in 1855 to the end of 1880 (25 years) there have been but three epidemics of yellow fever of any magnitude, namely : in 1858, 1867 and 1878; whilst in the preceding 39 years (1817- 1855) no less than 19 severe visitations of ye'low fever have been recorded. 4. During the past seven years (that is during the period in which we have data for the calculation)the death rate has almost invariably been higher amongst the colored population than amongst the whites. The result is at variance with the popular opinion that in tropical and semi-tropical cities the black race enjoy a greater immunity from diseases, and especiallv from the various forms of fever than the white race. The in- creased rate of mortality amongst the blacks may be referred to such causes as: (a.) im- providence in living; irregular habits ; poor diet; (b.) neglects of the sick; indifference to medical aid ; neglect of vaccination; (c.) crowding and imperfect ventilation; (d.) less vital power or capacity to resist the ravages of disease; (e.) ignorance of, and violation of physiological and sanitary laws. Many of these causes are capable of removal or amelioration. With advance of knowledge, and the acquisition of property by the colored race, there will be a corre- sponding diminution of the death rate. 5. Phthisis pulmonalis appears to destroy as many lives in New Orleans as yellow and malarial fevers combined. Thus during the past twelve years, 1869-1880 inclusive, phthisis pulmoual is caused 9,800 deaths, yellow fever 5,102 and malarial or paroysmal fevers 4,854 deaths 6. If the mortality of the past six years (1875-1880) be compareci with that of the pre- vious six years, 1869-1874, it will be found that the deaths of the first named period ex- ceed but to a slight degree those of the latter, notwithstanding the epidemic yellow fever of 1878. Thus : Total mortality for six years, 1869-1874 40,370 Total mortality for six years, 1875-1880 41,851 Excess of mortality during six years, 1875-1880 1,481 A portion of this difference is due to the increase of population. This period may be characterized in the sanitary history of New Orleans, as that of the experimental use of disinfectants, and more especially of carbolic acid." Under the direction of Dr. C. B. White, President of the Board of Health (1869--1875 inclusive), carbolic acid was more extensively used than in any ether city. From the data now at hand, we find that the city of New Orleans paid the following sums for dis- infectants of which carbolic acid formed the chief item. Amount paid bv the citv of New Orleans for disinfectants ordered by the Board of Health: 1870, $2,851.77; 1871, $2,448.21; 1872, not recorded; 1873, $16,069.83; 1874, $2,482.35; 1875, $12,376.35; total $35,128.51. The amount stated ($35,128.51) simply represents the amount actually paid by the city, and entered upon the records; outstanding claims are not included. The opinion prevailed that yellow fever could be controlled and even arrested by the free use of carbo ic acid ; but the result of the epidemic of the year 1878, when $12,207.22 were expended for disinfectants, and more especially carbolic acid, scattered to the winds that belief that certain disinfectants, and especially carbolic acid, possessed any specific control over epidemics of yelloiv fever. The signal failure of the experiments with carbolic acid disinfection, was followed by the wild panic and shot-gun quarantines of 1880. CXCVI Mortality and Sanitary History of New Orleans, 1880-1883. MORTALITY OF 1880. Hie accompanying charts illustrate the relations and changes of temperature-hu- midity and barometric pressure-to the death-rate per 1000 inhabitants during the year 1880. The charts illustrate so fuily and clearly the relations of the death-rate to meteorolo- gical conditions that any detailed explanation is unnecessary. The following points, however, are worthy of especial notice. 1. The highest mortality of 1880 occurred during the week ending the 12th of June. 2. During the six months ending June 30, 1880, the rain fall was 29.69 inches, the mean temperature 69,20°, mean barometer 30.07° ; total death-rate per 1000 population, 26.84 : whites 23.43, colored 36.35. During the six months ending December 31,1880. the rain fall was 37.68 inches ; mean temperature 69.80° ; mean barometer 30.09°; total death-rate 25.19; whites, 22.28; col- ored, 33.33. It is evident that the death-rate diminished during the last six months of the year in which yellow fever most generally7 prevails. 3. Throughout the year 1880, the death-rate of the colored race exceeded largely that of the whites. 4. If the deaths amongst the colored population be excluded from those amongst the white race, it will be seen that during 1880 the white inhabitants of New Orleans en- joyed a remarkable immunity from fatal diseases, and that this city was probably as ex- empt from fatal forms of disease amongst the white inhabitants as any other city of sim- ilar size in America or Europe. RELATIVE MORTALITY IN THE SEVERAL DISTRICTS OF NEW ORLEANS. From the table illustrating the mortality from some of the principal diseases and total mor- tality together with the death-rate per 1000 inhabitants of the different districts of New Orleans, for the year 1880, the following important results are established : (a). First District: Total deaths 1393; whites 884: colored 509; death rate per 1000 inhabitants : whites, 20.40; colored. 36.10 ; death rate white and colored 29.24. In this district the death rate amongst the whiteswill compare favorably with that of any city in the Western or Eastern Hemisphere, whilst the death rate of the colored popula- tion, although higher than that of the whites, will compare favorably with that of the descendants of the African race in any large city in the United States. It is believed and hoped that the humane efforts of the Board of Health of the State of Louisiana will still further reduce the death rate amongst the colored population. In the Second District total deaths, 1115 ; whites 699, colored 416. Death-rate per 1000 inhabitants, whites 22.28, colored 31.27. Total death-rate, whites and colored, 24 86. In the Second District, which lies below ('anal street and embraces the first settled por- tions of New Orleans, or the "city proper," of Bienville, the death-rate was only7 a frac- tion in excess of that of the First District. This difference may be referred to the fact that there are a larger number of tenement houses in which are congregated foreigners, and especially natives of Sicily and Italy. Repeated orders were issued by the Board of Health for the cleansing and disinfection of the crowded portions of the Second District. In the First District extending from Canal street to Felicity road, is located the new basin and canal connecting with the lake, and in the Second District extending from Canal to Esplanade street, is located the old basin and canal originally7 constructed by the Baron Carondelet, and commuicating with the lake by the Bayou St. John. Both the First and Second Districts, receive through the canals and basins, a consider- able amount of shipping and a corresponding number of seamen. The First District received a considerable amount of water by7 the flushing apparatus of the Auxiliary7 Sanitary7 Association, a portion of which found an exit on Camp street and Melpomene canal. No case of yellow fever was reported in the Second Dis- trict which had not the advantage of the flushing, whilst but three cases were reported in the First District, which have been fully7 detailed in the report. In the Third District total deaths 1,161; whites 774, colored 387; death-rate per 1000 in- habitants, whites 22.94, colored 32.62. Total death-rate 25.47. In the Third District, extending from Esplanade street to the lower limits of the parish of Orleans, a large portion towards the swamps and lake is ill drained and sub- jected to tlie action of malaria; and the statistics show that the deaths from the various forms of malaria] lever were relatively7 more numerous; thus deaths from malarial fever -First District, 74; Second District, 62; Third District, 82. Without doubt, a proper system of drainage and sewerage would reduce the deaths from malarial fever to the minimum. The cultivation of rice has been inaugurated in the rear of this district, and a portion of the sickness and mortality in this district must be referred to this the most pernicious of all forms of agriculture. The Legislature of Louisiana, the City Council of New Orleans and the Board of Health, should consider the subject of rice culture in its re- lations to the health of the City of New Orleans, and such ordinances should be con- sidered and passed as will protect the inhabitants from the effects of the destructive emanations of rice fields. In the Fourth District total mortality 720; whites 506, colored 214; death rate per 1000 uhabitants • whites 16.52, colored 30.96 Total death rate, whites and colored, 19.18. In the Fourth District the whites nredominate greatly over the colored, and a large proportion of the inhabitants of the garden district of New Orleans, amongst whom may be mentioned its successful merchants and business men, absent themselves from the city during the hot months of Summer and Autumn, seeking health and amusement at Amer- ican and European resorts of health and pleasure. The deaths from malarial fever in 1880 in the Fourth District number 42. It should also be noted that this district offers a far less front to the woods, the swamp and the lake than the First, Second and Third Districts. This district received the benefits of the flushing system. In the Fifth District the total mortality was 142 ; whites 91; colored 51; death rate net 1000 inhabitants : whites 18.12 ; colored 13.30 ; total death rate whites and colored 16.03. The Fifth District gave the lowest mortality in 1880 of any District within the bounds of the Parish of Orleans. This district, which occupies the opposite bank of the river and may be regarded as a separate city, received none of the benefits of the flushing sys- tem of the Auxiliary Sanitary Association of New Orleans. Such facts illustrate the na- ture of the claim that the running of water through the gutters of the Fourth District and through a portion of the gutters of the First District, preserved the City of New Orleans from yellow fever in 1880. The Board of Health has given its countenance and support to all rational efforts to improve the health of this city, and recognizes the la- bors of its officers in the cleansing and disinfection of privies, the prompt removal of garbage, the disinfection and cleansing of all premises in which cases of yellow fever, typhoid fever, scarlet fever, measles and small pox have occurred In the Sixth District, the total deaths numbered 329; whites, 196 ; colored, 123. Death rate per 1000 inhabitants: whites, 16.40; colored, 30.16. Total death-rate per 1000 in- habitants, 20.52. The colored population of the Sixth District, dominated in a measure the low death- rate of the whites 16.40, which would compare favorably with the death-rate of any similar congregation of white inhabitants in any portion of the civilized world. We have in this report recorded the relative population, white and colored, of the city of New Orleans. From this table it will be shown that the colored population is not uniformly distributed in the districts of New Orleans. In the Sixth District malarial fever caused ten deaths and in the Fifth District seven. In the Seventh District the total deaths numbered 128-whites 62, colored 66. Death- rate per 1000 inhabitants-whites 19.92; colored 21.12 ; total death rate per 1000 inhabi- tants 20.52. In this district the colored people, as in the Fifth District, are more com- fortably situated, owning more property and being less crowded, and being also at the same time less subjected to the excitement and vices of the thickly populated portions of New Orleans, and we find a proportionately lower death-rate. As the outcome of this investigation the Board of Health has the following important results . FIRST DISTRICT. Death-rate per 1000 inhabitants 24 24 ; whites 20,40, colored 36.10. . SECOND DISTRICT. Death-rate per 1000 inhabitants 24.96 ; whites 22.28, colored 31.27. THIRD DISTRICT. Death-rate per 1000 inhabitants 25.47 ; whites 22.94, colored 32.62. FOURTH DISTRICT. Death-rate per 1000 inhabitants 19.18; whites 16.52, colored 30.96. FIFTH DISTRICT. Death-rate per 1000 inhabitants 16.03; whites 18.12, colored 13.30. SIXTH DISTRICT. Death-rate per 1000 inhabitants 20.62 ; whites 16 40, colored 30.16. SEVENTH DISTRICT. Death-rate per 1000 inhabitants 20 52 ; whites 19.92, colored 21 12. From the preceding statistics it must be evident to every honest observer that this year ^1880; must be regarded as a period free from any pestilential and fatal influences Mortality and Sanitary History of New Orleans, 1880-1883. CXCVII CXCVIII Mortality and Sanitary History of New Orleans, 1880-1883. in New Orleans, and the earnest hope may be expressed that the Ruler of all things, will continue to vouchsafe to the people a similar exemption, in the future from epidemic diseases. The statistics of 1880, render it evident that there is nothing in the climatic and topo- graphical conditions of New Orleans, which precludes it from being the healthiest city iu America or Europe. With thorough sanitary regulations, with the prompt removal of all garbage ami fcecal matters and with the constant destruction of the poisons of all infectious and con- tagious diseases, by efficient and active sanitary officers, and with a rigid but enlightened quarantine, the Board of Health may siucerely hope for continued immunity from pes- tileutial diseases. The absence of pestilential diseases from New Orleans and from the valley of the Mis- sissippi, wid be followed by prosperity to all classes, and by a marked physical and moral development of all the various races congregated in the metropolis of the West. SANITARY MEASURES AND REFORMS. PROTECTION FROM OVERFLOW-DRAINAGE AND SEWERAGE The great sanitary problems of New Orleans are : 1. Protection of the city from overflow, by substantial levees elevated at least two feet above the line of the highest waters. 2. Thorough surface and subsoil drainage. Under this head should be included the reclamation of the swamps in the rear of the city, and perfection aud proper grading of gutters and surface drains, and the proper excavation, perfection, cleansing and flushing of the canals which receive the storm waters and those continually yielded by the gutters. 3. The immediate and continuous removal of all faecal matters- 4. The daily removal of garbage by an efficient scavenger force. 5. The constant repair and cleansing of the streets. 6. Paving the streets with the most substantial materials. Thus far the square block pavement has proved to be best adapted to the peculiar soil and location of New Orleans. The same form of gravel and small stones as those em- ployed at the jetties by Captain Eads might be used upon many of the dirt streets. This gravel may be obtained in large quantities from an island in the Mississippi river above Baton Rouge, and might be brought down in large quantities in flat-boats and landed on the river front in auy of the various districts of the city. The shells employed upon certain of the streets are, in the course of time, reduced to an impalpable powder, which forms a diffluent mud in winter, ami affords an irritating dust in dry weather. The gravel from Profit's Island on the Mississippi river, is composed chiefly of silex and silicates of the hardest description, which have resisted the action of the elements for unknown ages. 7. Abundant supplies of river water for the use of the inhabitants and for the clean- sing of private premises, and the purification of the markets, gutters and streets. The highest interests of the citizens of New Orleans, demand the institution of a rigid scientific investigation by the most skilled engineers of the United States and Europe, of the drainage aud sewerage of this city. A properly constituted commission of civil and military engineers might devise a plan of protection from overflow, and of surface aud subsoil drainage, and of sewerage, which may be capable of progressive execution aud expansion during indefinite periods in the future, aud iu accordance with the growth of the city. Every system of sewerage and sub-soil drainage must be adapted to the peculiar topo- graphy of the land occupied by the city. The following facts must be considered: (a). The land on which New Orleans is built is protected from overflow of the Missis- sippi River by a continuous levee from the beginning of its river front to the ending of it, a distance of about twelve miles. The levee has an elevation above the natural soil of from six to teu feet. The land upon whieh New Orleans is built falls from the river back to Claiborne street one mile, where it is twelve feet below the river. In high water the entire area occupied by the city of New Orleans is below the level of the Mississippi River. It is equally necessary to protect the rear of the city by a system of powerful levees, from overflow's from the lake. It frequently happens that the level of the lake is above that of a large portion of the laud occupied by the city. Mortality and Sanitary History of New Orleans, 1880-1883. CXCIX The basin occupied by New Orleans is further diversified by a ridge of land. On either side of the Metairie Ridge the land slopes in one direction towards the lowest depression towards the river, and in the other towards Lake Pontchartrain. From these natural conditions, the subsoil of a large area of the city of New Orleans is perpetually saturated with water. At the present time New Orleans is drained by large canals thirty-five miles long, which receive the surface water of over 300 miles of gutters. At the present time these canals are more than one-half full of the foul deposits washed down through the gutters of the city. (&). According to the city map of Mr. W. H. Bell, the inclosure within the protection levees measures 26,026 acres, which, if populated with forty persons to an acre, would give 1,041,040 persons. If the daily excrements of this population per head be estimated at three pounds, the entire amount would equal 569,970 tons in one year. But if with Civil Engineers, we consider the present city to lie on the slope between the river and Claiborne street, which contains between the upper and lower protection levees, 9,319 acres, and 30 persons to an acre, it will give a population of *372,760. The daily excrements of this population would be 1,118,280 pounds,'and would require to move it daily 1,118 carts, each taking half a ton at a load, or it would take 204 of the largest ships that come to New Orleans to carry a year's filth from the city, without cal- culating the refuse from cattle, horses and other animals. During the present year, it has been attempted to remove a portion of the excrements stored up in the privies of the city, by the so-called "air-tight" and "odorless" barrels and carts, to the nuisance boats, to be towed below the city limits and dumped into the Mis- sissippi river. If we estimate the present population of New Orleans at 220,000 inhabitants, and al- low live inhabitants to each house, we have 44,000 houses. It is possible that in many cases two or more dwellings are served by a single privy vault. If the total number of privies in the city of New Orleans number about 40,000; and if the cost of emptying each of those privies be about five dollars), then it is evident that the emptying of the privies of New Orleans, annually cost $200,000. In ten years the cost of emptying the privies of New Orleans only once annually would reach the enormous sum of $2,000,000 (two million dollars.) And at the end of this period there would be no permanent works of sewerage or drainage and no sub- stitute for the wretched privy system now used. To the above estimate must be added the cost of disinfectants to destroy the foul gasses, and more especially the poisonous snlphureted hydrogen and sulphuret of am- monia perpetually generated in these foul storehouses of tilth. With all the efforts of the sanitary officers it must be admitted that the garbage and nuisance boats and even the apparatus for emptying the privies are foulfand unbeara- ble nuisances (c.) The streets of New Orleans onen and requiring cleaning and repairing have been classified as follows: Square block pavement, 22 06 miles; cobblestone, 38.00 miles; baLast mads, 19.07 miles; shell roads, 26 54 miles; plank roads, 5.00 miles; dirt streets, 472.34 miles. We have, then, nearly 500 miles of dirt streets, not including those not in general use. There are also to be built and kept in repair 191 canal bridges, 5180 wooden street bridges, 459 stoue crossings, 580 iron street bridges, and 3301 wooden street crossings, together with the nine navigation bridges over the New Canal, the Carondelet Canal, and Bayou St. John. In wet weather the dirt streets become impassable quagmires, and from the failure of the garbage carts they become the receptacle of garbage and filth of every description; Added to this the rear portions of the city have been overflowed upon several occa- sions by the waters of the lake, and incalculable suffering and hardship have been in- flicted upon the inhabitants. A thorough system of protection from overflow, combined with an effective system of sewerage and underground drainage, will practically elevate the dirt streets into dry roads and highways suitable to the purpose of transportation and commercial inter- course. (d.] Without doubt a large number of the diseases of New Orleans are, to a certain extent, dependent upon the satuiation of the atmosphere with moisture, and, under certain circumstances, with foul exhalations from privies and gutters and ill-drained and ill-ventilated premises, and from the filthy drainage canals. The foul exhalations may, to a great extent, be removed by a prompt removal of all fiscal matter and garbage. The moisture may be greatly diminished by thorough sur- face and sub-soil drainage. lu this connection the following important facts should be ndted : CC Mortality and Sanitary History of New Orleans, 1880-1883. During the past twelve years, the average number of deaths caused by phthisis pul- monalis alone was 816, giving a grand total during this period 1869 to 1880, of 9,800 deaths. One in 248 of the inhabitants of New Orleans die annually of phthisis pulmonalis. It will be seen from the following table that the percentage of deaths from phthisis pulmonalis, varies in the different districts of New Orleans: TABLE SHOWING NUMBER OF DEATHS BY PHTHISIS PULMONALIS IN THE DIFFERENT DISTRICTS OF THE CITY OF NEW ORLEANS, AND DEATH RATE PER 1000 INHABI TANIS PER ANNUM. DISTRICTS | January. | February. | March, i I April, i May. | T I June. July. August. September. October. November. December. Total. Death Kate per 1090 per1 Annum. First District 21 15 27 22 21 17 22 15 6 12 25 19 222 3.86 Second District i) 18 12 14 14 18 10 8 16 18 20 15 168 3.76 Third District 10 7 9 11 10 14 6 12 15 11 14 16 135 2.96 Fourth District 7 15 12 9 6 6 3 9 8 7 16 16 114 3.37 Fifth District 3 1 1 2 4 3 1 5 1 25 2.82 Sixth District 4 3 4 O 6 2 3 3 4 29 1.80 3 1 1 3 9 Total 48 58 70 60 58 60 44 ' 48 48 52 83 73 702 3.25 The mortality is greater in the most crowded districts, being in the First 3.86 per 1000 inhabitants, Second District 3.76, Third 2,96, Fourth 3.37, Fifth 2.82, Sixth 1.80. Seventh 1*44. During the same period, 5,144 deaths were caused by diarrhoeal diseases, or on an aver- age 428 deaths each year, are caused by these diseases. Four thousand eight hundred and fifty-fo-ur deaths were caused during this period by malarial fevers, or 404 deaths per annum. This class of diseases appear to be directly related to defective drainage. During the peiiod of twelve years therefore, (1869-1880) phthisis pulmonalis, diarrhoeal diseases and malarial fevers, caused in the city of New Orleans, 19,798 deaths, whilst during the same period yellow fever caused only 5102 deaths as shown in the following table : DEATHS BY YELLOW FEVER IN NEW ORLEANS DURING THE TWELVE YEARS, 1869-80. Yeab. June. July. August, September. October. November. December. Total. 1869 .. 1 2 3 1870 i 3 231 242 106 588 1871 .. .. o 9 22 19 2 54 1872 .. 1 5 24 7 2 39 1873.. 3 19 108 79 17 226 1874 2 6 2 1 11 1875 5 24 20 9 3 61 1876.. 1 20 15 4 1 41 1877 . 1 1 1878 26 1025 1780 1065 147 3 4056 1879 .... 3 4 7 5 19 1'880 1 1 2 Total .. 1 34 1060 2186 1481 312 17 5102 The entire attention of the inhabitants of the Mississippi Valley is concentrated upon New Orleans, to the detriment of her commerce and fair name, on account of the occa- sional existence of yellow fever in the epidemic form ; and her people are prone to re- gard this disease of far greater importance than phthisis pulmonalis, diarroehal diseases and malarial fevers, which perpetually claim a far greater number of victims. It is possible by a proper system of drainage and sewerage to greatly reduce the mor- tality from phthisis pulmonalis, diarroehal diseases and malarial fevers. But any philosophical and successful system must be based upon the peculiar topo- graphy of New Orleans, situated below the high water lines of the river front and of the lakes in the rear. (e.) Every system of sewerage anti drainage adapted to New Orleans, must depend for its ultimate success upon the use of powerful pumps to lift up the liquids and project them into the Mississippi River below the limits of the city. CCI Qty The construction of a drainage and navigatien eanal circumscribing the city and connecting the waters of the Mississippi above Carrollton with those below the Barracks pr omises great hygienic and commercial advantages. T o render the canal available at once to the purposes of navigation, drainage and se werage, it should not be less than thirty feet below low-water in the river and should be not less than three hundred feet in width. Such a project could only be successfully executed by the combination of great capi- tal, and the co-operation of the General Government. The protection of the city from overflow, and thorough drainage and sewerage will, without doubt, render New Orleans one of the healthiest cities in the world, and do more to ward off destructive epidemics, and restore confidence in her own citizens and in those of surrounding States than even the most rigid and effective quarantine. PROTECTION OF THE CITIZENS OF LOUISIANA FROM UN- QUALIFIED PRACTITIONERS OF MEDICINE, AND THE EX TENSION OF THE REGISTRATION OF MARRIAGES, BIRTHS AND DEATHS, TO THE ENTIRE STATE. Article 178 of the Constitution of the State of Louisiana, adopted in 1879, ordains that : ''The General Assembly shall provide for the interest of State Medicine in all its de- partments; for the protection of the people from unqualified practitioners of medicine; for protecting confidential communications made to medical men by their patients while under professional treatment; for the establishment and maintenance of a State Board of Health." In order to diffuse a correct knowledge of all subjects relating to the important sub- jects, concerning the constitution and execution of quarantine, and the laws relating to sanitary and medical subjects, and to the protection of the people against the introduc- tion and spread of contagious diseases, and to the registration of marriages, births and deaths; the Board of Health of the State of Louisiana published in the month of Sep- tember, 1880, a large edition of the " Acts of the Legislation of Louisiana establishing and regulating quarantine for the protection of the State ; organizing and defining the powers of the Board of Health and regulating the practice of medicine, midwifery, dentistry and pharmacy ; also rules and regulations of the Board of Health of the State of Louisiana, and Health Or- dinances of the City of New Orlrens, quarantine and sanitary." These laws, ordinances and rules, collected and classified by the Presidentof the Board of Health, were distributed to the State officers, judges, city authorities and the prom- inent physicians and sanitarians of Louisiana. As the population of New Orleans numbers not more than one-fourth of that of the entire State, it is evident that great benefit would accrue to the entire State, by extend- ing many of their provisions, which now relate exclusively to the parish of Orleans, to every city, town and parish in the State. The sanitary and social advancement of the State would be especially promoted by the extension of the laws regulating the registrations of marriages, births and deaths, to every portion of the State. Such statistics would prove of marked value in all respects, but especially as estab- lishing a knowledge of the most fatal diseases and determining the death-rate, and pre- vailing diseases in different localities and amongst the different races. Such data would form the necessary foundation for sanitary reform and advancement. Mortality and Sanitary History of New Orleans, 1880-1883. CCII Mortality of Neto Orleans, Classified by Districts-1881. NAMES OF DISEASES. W. i- । January, 1 w. 4 5 = □ C R c. W. a - c. w. 1 c. w. a 3 c. W. © a 5 c. w. 3 C. w. 3 iC 3 < c. ^1 - । September. p w. 5 0 s a 1 w. D c D O 3 7 W. D © © c. To W. tai. C. Total. O Malarial Fevers 2 2 7 1 2 I 2 " 2 1 5 1 1 3 3 2 16 3 4 4 6 1 5 13 7 1 2 4 6 3 2 I 5 "2 1 1 67 9 41 5 31 5 10 0 98 14 51 5 Typhoid Fever. Scarlet Fever 3 1 8 14 2 2 3 2 1 2 Measles Small-Pox Diphtheria 8 2 2 .... 1 2 '2 1 3 3 2 2 7 5 1 4 2 2 14 69 ' ' 3 3 3 ' 2 3 1 5 11 33 1 3 3 3 2 2 6 7 "2 3 8 26 50 44 8 33 126 721 0 30 12 2 19 119 329 26 80 56 10 52 245 1050 Diarrhoeal Diseases 3 2 5 14 6 ii 91 8 1 1 1 3 30 3 7 6 2 Congestion of Brain 1 Sun-stroke Convulsions ... 2 15 21 3 9 52 2 5 25 3 16 65 2 13 35 10 9 61 1 14 39 4 12 78 2 8 30 2 6 32 1 6 56 2 6 41 1 28 5 8 47 1 11 24 3 8 45 15 32 ii 51 11 30 Phthisis Pulmonalis 16 65 Deaths from all other causes .... Total number of Deaths 104 40 77 2A 08 ss 105 5ft 145 4ft 101 70I AO AQ 40 ft9. 49 7ft ft9. 45 1020 5ftft 1618 White 28.80 33.97 21.30 30.58 27.10 45 02 29.03 49.27 32 13 42.47 40.16 40.77 27.97 44.17 20.22 51 81 19.11 41.62 22.71 35.67 21.60 46.72 22.71 38.22 23.77 41 62 27.81 Death rate Colored per 1000 Tnhabtants ■ Total White and Colored 30.08 23.60 31.54 34.05 34.71 40.31 31.96 27.78 24.64 25.90 27.78 26.52 per annum. Malarial Fevers*..... .62 6.47 1 1 A .62 2.95 1 I 0 41 6.05 1.04 4.80 .62 4.17 3.96 2.92 1.67 4 17 2.29 3.55 2 | 6 4.17 2.71 A 1 5 1.88 3 96 7 1 4 2.08 4.80 7 1 19 1.25 4.59 9 1 4 1.70 4.26 59 1 47 1.70 4.26 99 . Phthisis Pulmonalis •••• Number Still-born Children TABLE ILLUSTRATING DEATHS IN THE FIRST DISTRICT OF THE CITY OF NEW ORLEANS DURING THE YEAR 1881. Mortality of New Orleans, Classified by Dis trie ts-1881. CCIII NAMES OF DISEASES. January. February. March. P. May. | June. । July. August । September. 0 rO O O O nber. I > H- December. C. Total. Total. £ W. AV C. W. C. w. C. AV. C. AV. C. W. C. W. C. W. c. W. C. AV. C. C. W. C. W&C 2 1 1 3 2 5 5 3 1 3 1 6 4 7 4 6 3 ] 11 3 7 4 1 3 3 1 53 34 87 phoid l^CA'GT 3 3 1 1 1 1 1 1 3 2 2 2 1 15 11 26 Sciu'IgI I1 c\ gt - • •••• 2 3 3 3 4 5 3 5 2 1 1 18 14 32 10 2 1 1 1 2 O 1 6 4 1 3 1 2 1 1 3 1 1 1 1 2 11 7 18 Pi 'i-TTll CG3.1 HisAnsAQ. . . . 1 1 1 4 2 2 2 15 4 13 10 2 3 2 3 3 3 5 1 2 2 0 1 50 34 84 Con^Gstnou of Braiu 2 1 3 1 2 1 1 3 9 J 3 2 2 ] 1 1 1 27 8 35 <) SllUSt 1 olvO. ••••••••«•••• ••••• •••••• 6 2 1 7 0 Pqu vulsions ••••••• ••••••.. 1 2 5 3 2 3 3 1 1 1 2 15 13 28 P] । 4A1 si a Pul mon alia 10 4 13 5 6 8 15 9 11 7 7 6 10 6 4 6 2 9 6 6 5 10 4 99 75 174 pGatll® from nil nfliAr CfinsAS 40 28 34 23 33 30 34 13 41 0 50 28 35 17 35 18 27 15 31 19 35 39 42 24 - 437 284 721 Total number of Deaths 61 34 60 35 55 53 64 38 80 52 95 54 62 34 55 34 46 33 51 36 47 51 61 32 738 486 1224 Death rate ) White i Colored . ... ...... 23 33 30.57 22.95 31.57 21.04 47.81 24 45 34.28 30.60 46 91 36 48 34 91 24.10 30.67 21.04 30.67 11.22 29.77 19 32 53 47 17.98 46.01 23.33 28.87 23 5236.53 27 U6 per 1000 I $ Total white and colored.... 25.51 25.51 29.91 27 40 35.46 40.02 26 05 23.90 21.22 23.37 26.10 24.98 Inhabit.nits | 1 Malarial Fever. per annum, j Phthisis Pulmonalis 0.7[ 3.8: 0.0 3.6 0-3 4.9 0.9 4.5 1.1 2.2 4.5 7.2 1.9 2.7 8.1 6.3 4.2 2.7 6.3 2.2 2.6 2 9 5.4 2.61 3.8] 3.6 5.4 2.2 1.5 2.7 5.4 4.2 0.7 2.7 8.1 2.6, 1.9 3.6 5.4 0.3 2.2 2.7 4.5 1.1 3.8 0.9 3.6 1.6 3.1 2.5 5.6 1.9 3.8 Number Still-born 3 4 4 5 4 1 2 2 4 21 3) 2 4 4 6 4 6 2 5 2 1 11 47 24 71 Population-White, 31,368 ; colored, 13,301 total, 44,669 TABLE ILLUSTRATING DEATHS IN THE SECOND DISTRICT OF THE CITY OF NEW ORLEANS DURING THE YEAR 1881 CCIV Mortality of New Orleans, Classified by Districts-1881. NAME OF DISEASES. January. February. March. April. c? J une. July. 1 । August. September, ) October. November. December. Total. Total. * W. c. W. C. W. C. W. C. w. 0. W. C. W. C. W.| C. W. c. W. c. W.l C. W. c. W. C. W&C Malarial Fevers 3 1 11.... 2 ... | 1 4 il 9 Scarint Fever 6 & 9 1 9 1 1 10 ] 4 1 53 66 12 5 59 Tvnhoid Fever 1 1 1 1 ] 1 2 .... 1 1 1... 3 17 Measles . 3 x 1 .... Small-pox... Dinhtheria. 1 1 1 1 si.... 3 3 1 2 2 2 1 1 3 1 1 15 3' 18 Diarrhoeal Diseases 4 2 3 2 4 1 16; 6 18 5 22 Congestion of Brain. 1 2 2 1 1 1 4 1 21 1 3 1 23 Sunstroke .. 2l... 2 Convulsions 3 2 2 1 1 1 O 1 1 .... 9l 4 13 Phthisis Pulmonalis Pneumonia 10 10 6 7 10 2 38 2 0 7 6 4 3 8 1 4 5 4 7 3 5 1 5 11 6 8 2 8 3 4 2 7 3 3l 1 2 5 1 2 88 54 32 26 142 58 Deaths from all other causes . 45 22 24 52 19 39 26 71 29 75 40 69 32 41' 25 32 23 45 10 38 37 37 16 5811 314 895 83 43 33 82 29 69 38 91 37 99 52 87 40 62 33 72 38 62 16 49 43 48 19 859] 415 1274 Death l ate per Whites Colored 29 43 41 52 23 33 .12 .40 29 29 .41 .35 24 38 .27 .46 32 38 .37 40 35 .27 79 30 40 .94 .47 22.05 33.40 25.61 S3 22 16 .05 19 17 43 43 22 17 19 .43 23 25.46 35.17 1000 inhabitants' per Total 7 33 18 23.60 29.28 28 .16 33.67 39 .76 32 .54 25.03 29 .41 20 53 24.21 17 .63 27.94 Malarial Fevers 0.71 2.48 0.71 11.01 2.84(1.01 2 60 4 55 1 2.37 annum. Phthisis Pulmonalis 3.55 6.07)3.55 2.01 2.48)4.04 2 84 5.06 1.77'4.04 7.08 1 77)5.06 3.54 6.07 2.84 7.08 2 84 4.04 2.48 3.03 0.7111.01 3 11 Number stillborn 2 4 2 3 2 3 - 1 2 2 2 1 2 I1 2 0 1 5 5 el 3 8 4 36i 27 63 Population -Whites, 33,732; colored, 11,526 ; total, 43,588: TABLE ILLUSTRATING DEATHS IN THE THIRD DISTRICT OF THE CITY OF NEW ORLEANS DURING THE YEAR 1881. Mortality of New Orleans, Classified by Districts-1881. CCV NAA1ES OF DISEASES. 1 w. C. 1 p w D H c. *< w. C. W. c. - w. 1 c. w. c. AV. |d । : W. 0 3 3 4 c. < < 1 c/ av. u c. r c w. 5 5 c. av. c. av. p 5 J c. To AV. tai. C. 9 6 £ Malarial Fevers 2 1 1 1 2 1 13 2 2 3 3 6 2 2 4 4 1 3 2 1 2 29 4 28 4 Typhoid Fever Scarlet Fever 1 1 1 1 6 1 4 1 29 3 2 2 1 1 Measles Small-pox...... Diphtheria. 1 3 2 "i 1 5 1 4 1 1 "2 19 3 4 5 1 27 64 ' 8 2 1 1 10 22 "'9 2 1 3 6 31 55 2 1 •"7 3 1 6 1 3 2 1 3 3 1 "5 8 17 6 81 22 6 1? 67 280 478 1 19 6 7 100 28 6 28 97 407 656 Diarrhoeal Diseases .... Congestion of the Brain 1 2 1 3 1 "2 5 1 Sunstroke. Convulsions o 8 33 53 i 12 15 1 6 19 35 2 1 11 15 2 15 25 55 3 8 13 1 4 20 44 " 2 10 13 2 8 23 72 2 7 19 32 1 1 12 18 1 2 25 44 2 1 8 13 "4 19 34 1 1 7 16 3 15 29 1 3 10 19 1 4 25 39 10 30 127 178 Phthisis Pulmonalifl... Deaths from all other causes 6 18 31 4 12 18 Total number of Deaths Death rate 1 White 20.76 13.71 26.04 21 55 22.57 17.04 22.57 28.21 55.57 25.07 38.20 21.55 31.25 17.24 22.57 13.32 27.78 11.36 32.99 12.14 31.25 15.28 29 52 15 .60 17.40 1 Colored 26.04 25.75 per 1CCO 1 > Total 21.74 0.63 2 87 7 | 2 15.98 0 31 2.23 4| 1 21.74 0.63 5.76 6 | 2 18.22 0.31 1.65 2| ... 33.25 0 63 4.79 3| 1 27 49 0.95 0.63 ... | ... 23.34 0.95 2. as 18.22 2.55 0.95 15.98 1.65 1 34 15.34 2 23 1 65 15.66 0.63 3.19 17.90 0.31 17.40 1 01 2 58 40 | 14 Inhabitants Malarial Fevers 1.01 2.58 54 per annum. J Phthisis Pulmonalis Kumber Still-born 5 - 1 1 5 3 1 ... 3 2 3 2 TABLE ILLUSTRATING THE DEATHS IN THE FOURTH DISTRICT OF THE CITY OF NEW ORLEANS DURING THE YEAR 1881. CCVI Mortality of Sew Orleans, Classified by Districts NAMES OE DISEASES. January. February. March. April. •Abk June. July. , August. i । September. । October. 1 © a c © December. Total. Total. AV. C. AV. C. W. C. W. C. W. c. AV. C. W. c. W. j p W. C. AV. C w. c. 1 W. C. AV 1 C> W&C IMblarial Pev^rs 1 1 al.... 3 5 5l 7 12 J n vphnid Pever 1 3 4 1 1 .... ... 1 1^1 pssIp.q • «■ ■ . ....... 1 S'h ill Pox f) i p 11 t) i p ri h ...... ...... T uiirhrpal Diseases 2 2 1 1 1 2 8 1 9 C1 v visions ...... ...... 1 0 5 1 3 1 2 6 1 3 1 ... 1 1 2 3 J 25 5 12 40 9 12 65 btliisis Pnlmnnnlis ...... 1 1 3 "2 1 3 1 4 5 3 1 5 f sths from all other causes .. 1 4 3 1 3 1 "1 4 4 1 Total Number of Deaths 1 r 1 3 1 4 3 3 5 7 8 7 9 4 11 6 4l 5 5 5 48 65! 113 Death rate 1 White 3 85 19.20 3.85 11.36 3.85 7.69 11.57 19.20 11.57 19 20 19.28 26.89 30.32 19.30 26.99 I 34.56 ' 15.42 42 24 23 13 3 84 15.42 19.28 | 19.20 1 15.42 20 80 18.11 j Colored per 1000 | V Total White and Colored 19. 20 ! 31 ' 1 54 7.69 9 62 15.39 15.39 23.08 25.01 30.78 j 28.87 13.47 17 19.27 Inhabitants 1 1.94 1.94 3 84 3.88 15. 5. 20 .66 2.24, 1.94 1.94 1.94 per annum J Phthisis Pn Imon a.lis . 1.94 1.94 1.94 1.94 1.94 77 3.88 Population-Whites, 3,112; Colored, 8.125. Total. 0.237. TABLE ILLUSTRATING DEATHS IN THE SEVENTH DISTRICT OF THE CITY OF NEW ORLEANS DURING THE YEAR 1881. Mortality of New Orleans, Classified by Districts-1881. CCVII NAMES.OF DISEASES. 3 5 3 ■c February. 1 | March. | April. cd 3 June. July. August. r | September. 1 October. | November. 1 | December. Total. Total. w. c. W. C. W. C. W. C. W. c. W. c. W. C. W. C. W. C. W. C. W. C. W. C. W. C. W&C Malarial Fevers Typhoid Fever Scarlet Fever Measles Diphtheria Diarrhoeal Diseases Congestion of Brain Sunstroke Convulsions Phthisis Pulmonalis ... Dfeaths from other diseases Total Number of Deaths 1 6 2 3 1 3 .... 1 1 5 1 2 5 1 4 2 2 1 9 1 2 4 2 1 4 2 1 3 2 4 2 1 i 4 1 1 5 2 1 i 2 1 2 3 2 2 1 9 1 4 1 2 2 2 4 2 "i 1 1 1 6 2 4 1 2 3 6 7 62 8 1 6 1 4 6 35 12 1 2 4 12 1 11 13 97 7 2 7 2 6 8 5 2 12 7 7 6 6 8 7 6 6 10 9 5 11 3 9 2 92 61 153 Death rate per 1000 inhabitants' per annum. Whites Colored Total Malarial Fevers Phthisis Pulmonalis.... 16.72 6.25 16.72 6.25 14.33 25.03 11 6 94 25 28.67 21.90 16.72 18.77 14.33 25.03 16 18 .72 .77 14.33 31.29 21.50 15.64 26.28 9.38 21.50 6.25 18.31 15.90 17.27 12.19 12 19 18 96 9.48 25.74 17 .61 18.96 17.61 21 67 18.96 18.96 14 90 1 35 1 35 1 35 4 06 5.40 1.35 4.06 1.35 2.70 4.06 1.35 2.70 1 35 1.35 1.35 1.46 1 35 1.46 Stillborn Children 1 1 ... | i ••• 1 ■■■ ... ... 3 1 2 1 | ... | ... 6| 2 8 Population-White, 5022 ; Colored, 3845 Total, 8857 TABLE ILLUSTRATING DEATHS IN THE FIFTH DISTRICT OF THE CITY OF NEAV ORLEANS DURING THE YEAR 1881. CCVIII Mortality of New Orleans, Classified by Districts-1881. NAMES OF DISEASES. w. o. ! 'c £ w. > c. - w. f C. W. 1 4 c. £ w. c. W. c. T.. 5 c. W. fl 5 c. ^1 । September. * w. - J c. w. g 3 c. w. □ D g C. Total. W.l C. 13 W&C Malarial Fevers Typhoid Fever 1 1 1 1 1 3 1 2 7 1 5 12 1 Scarlet Fever . 2 2 1 1 1 8 1 10 Measles 1 - 1 1 Small-pox Diphtheria . 2 2 3 4 1 1 1 1 1 1 12 1 13 Diarrhoeal Diseases Congestion of the Brain 1 1 1 1 2 2 .... ;2 2 9 1 2 3 1 2 1 2 o 1 2 1 1 1 1 1 1 26 19 44 11 Sunstroke 2 2 2 1 1 .. 2 3 2 1 2 3 1 3 2 1 12 8 20 Phthisis Pulmonalis Deaths from all other causes 3 10 2 12 's 3 8 7 4 14 13 1 1 20 1 4 1 23 1 7 1 9 4 3 7 5 2 6 1 10 2 5 3 2 8 3 3 16 122 22 82 38 204 Total number of deaths 15 15 16 13 12 18 20 11 1 5 ! co 41 19 17 10 15 8 11 10 15 11 6 11 12 7 313 143 356 Death rate i White 1 Colored per 1000 z Total white and colored inhabitants | | Malarial Fevers per annum J Phthisis Pulmonalis 15 44 06 .13 16.06 38.08 12.04 52.96 20 32 .08 .36 34 26 .14 .48 41.16 55.91 17 06 29.42 15.06 23.54 11 29 04 .42 15 32 .06 .36 6 32 02 .16 12 20 .04 .59 18 35 .64 .06 22 .45 21.71 22.45 23 .20 32 12 44 91 20.21 17 22 15 .72 19 .46 12 79 14 .22 22.21 2.99 0 2 .74 .24 2.99 2.99 1.49 1 1 .49 .49 1 0 .49 .74 " 2 99 2 1 .24 49 2.99 , 2.24 " 0 .74 .99 0 59 1.33 1.22 5.39 0.74 2.37 Number Still-born 1| ... 4 ••• 2 2 1 ... 3 •• • ... I .. . I... •• • 2 1 2 • •• 1 12 7 19 Population-White, 11.951; colored, 4078; total, 16,029. TABLE ILLUSTRATING DEATHS IN THE SIXTH DISTRICT OF THE CITY OF NEW ORLEANS DURING THE YEAR 1881. Mortuary Records of New Orleans, by the Month and by the Year, for F^ur Years-1850, 1860, 1870, 1880-in which the United States Census was Taken, and in which Yellow Fever did not Prevail to any Extent. Consolidated from Original Reports and Records, Collected and Classified by Joseph Jones, M. D., New Orleans, Louisiana, United States of America, 156 Washington Street, corner Camp Street, Fourth District, January 1, 1882. JANUARY. FEBRUARY. MARCH. APRIL. MAY. JUNE. JULY. AUGUST. SEPTEMBER. OCTOBER. NOVEMBER. DECEMBER. TOTAL FOR EACH YEAR. TOTAL FOR 4 YEARS. 1850 1860 1870 1 880 1850 1860 1870 1880 18 50 1860 1870 1880 1850 1860 1870 1880 1850 1860 1870 1880 1850 1860 1870 1880 1850 1860 1870 1880 1850 1860 1870 1880 1850 I860 1870 1880 1850 1860 1870 1880 1850 1860 1870 1880 1850 1860 1870 1880 1850 I860 1870 1880 1850, 1860 1870, 1880 GENERAL DISEASES. 6 8 121 4 8 122 1 3 78 1 2 59 2 14 1 4 3 1 2 1 1 37 22 528 1 Small-pox and Varioloid 00 1 4 5 2 17 2 20 19 12 39 11 20 9 25 8 5 3 7 4 1 1 1 0 1 2 57 60 23 97 11 1 12 5 1 1 20 6 15 7 3 4 21 5 7 21 8 6 2 12 3 11 4 21 2 4 9 2 1 1 9 2 2 14 1 6 1 35 4 10 21 200 44 56 321 I 2 1 1 2 2 1 2' 4 3 Dengue - 1 ' 27 i 11 3 9 i 17 i 1 10 7 12 3 18 2 1 9 2 17 20 1 199! 10 13 1 Typhus I4 ever 35 4 3 1 7 1, 6 1 3 1 3 3 1 2 29 10 Cerebro Spinal I4 ever "Riitprip. nr Typhoid Trever- .... 8 17 4 6 12 21 4 ' ' 3 7 14 4 0 19 9 4 6 14 7 2 10 11 7 6 12 7 3 4 13 9 8 4 10 16 12 3 8 11 6 7 7 12 4 4 9 19 6 4 103 163 80 52 398 Simple Continued Dever 2 1 1 1 i 1 1 1 2 2 2 1 i; 6 1 2 2 4 2 1 16 9 8 33 1 4 3 J 62 3 33 , ) 231 242 1 1O6 5 107' 587 0 Yellow Dever 1 2 1 Gastric Fever "t 2 1 3 3 1 1 4 1 3 1 9 4 4 1 21 3 3 1 6 2 2 3 4 1 4 3 1 ■ 2 5 2 45 18 27 19 1 1 2 1 1 1 2 2 i 6 2 2 2 11 2 10 1 6 7 23 7 5 8 27 6 9 13 9 3 4 5 5 2 7 2 0 3 85 26 51 50 212 10 5 6 '' 2 7 13 11 2 6 11 7 4 17 20 15 23 24 19 14 36 23 9 51 42 24 12 30 53 34 31 9 23 30 16 2 14 19 12 4 17 8 9 128 250 241 151 770 1 4 2 ,) 2 0 | Typho-Malarial 1 ever [ Malarial Fever (unclassified) 5 2 2 3 1 4 4 402 3 10 4 3 9 71 3 2 4 3 4 64 7 2 1 1 2 38 5 3 3 1 '3 1 4 2 80 6 5 11 9 51 40 14 1 25 26 19 95 8 1 10 15 9 352 3 2 12 1 14 22 > 1 1 9 5 206 1,448 58 30 87 3 93 444 •Cholera, Malignant or Asiatic.* 13 0 4 2 1 2 3 4 2 3 3 4 3 2 2 2 1 1 2 5 3 1 6 3 1 15 1 11 1 ' 69 11 15 14 1 2 1 2 1 9 1 ...... 4 5 11 2 7 11 14 15 19 9 33 18 25 7 16 7 9 4 3 3 7 2 6 3 5 4 1 4 9 8 10 3 11 5 0 3 73 108 67 89 337 4 22 3 20 1 2 15 4 4 12 2 9 3 6 6 1 7 9 1 3 9 1 13 7 4 10 15 0 13 145 19 81 6 9 7 2 10 1 8 15 3 16 1 10 11 1 4 1 1 1 7 1 3 0 2 4 1 3 1 1 13 74 T 70 1 ' 1 1 3 1 1 1 2 2 2 1 1 4 2 3 2 1 2 2 1 2 1 2 1 2 1 2 1 1 2 1 2 1 10 19 18 11 1 1 2 1 2 2 1 2 2 1 2 1 2 o 2 2 3 2 2 4 20 '" \ • 1 1 3 1 2 1 3 9 1 1 1 2 2 1 2 1 1 2 3 4 1 1 1 1 4 1 1 13 10 19 Rheumatism 1 2 3 3 2 2 ' " ' '2 4 1 2 4 3 4 1 1 1 1 3 1 1 3 2 4 1 2 1 1 3 3 1 2 3 2 2 1 1 - 2 3 2 3 1 -1 1 16 25 14 17 72 Syphilis Cancer 1 3 4 2 8 4 15 6 4 4 1 6 : l2 2 9 13 4 5 6 17 12 12 9 3 9 11 2 3 7 7 7 1 4 10 13 2 5 17 14 3 3 8 8 1 7 1 9 6 18 58 35 102 13 129 61 307 Scrofula 1 1 1 1 1 1 3 2 1 1 1 2 2 1 1 1 2 2 1 1 1 1 2 1 1 13 3 12 4 32 Tuberculosis Phthisis Pnlmonalis* •••••••••••-••••• ••••••-... . ...... 54 67 59 1 52 69 "|!p5 "76 81 85 "46 78 ""74 '"68 66 76 53 69 43 50 64 80 44 52 66 57 56 54 48 54 43 55 71 65 62 78 55 60 72 72 53 94 78 96 84 95 674 834 32 757 863 33 3 128 Tabes Mesenterica Diabetes .... ......... _ 12 6 12 9 9 6 1 1 12 7 10 1 1 14 15 14 1 17 25 23 28 28 20 1 24 16 10 1 9 12 10 2 12 22 11 1 17 19 11 2 18 13 9 1 1 12 10 8 1 19 184 182 144 4 529 4 Rickets 1 1 2 "2 7 ■■ ■ '5 ■ ■ I ' "V ! / \ 11 ' J 3 ! 8 5 7 1 19 i 7 1 1 2 1 1 1 2 3 1 2 6 1 1 2 2 0 2 1 4 2 2 1 1 1 14 5 1 10 70 1 18 47 2 2 47 335 10 3 I 5 31 454 186 342 503 148 39 8 48 5 13 129 1 317 5 63 656 13 404 787 83 4 324 25 268 34 7 20 94 467 50 20 23 8 23 170 40 3 423 71 1,123 11 9 23 51 10 28 58 2 6 457 26 118 6 946 847 23 8 11 8 951 23 4 183 39 80 9 9 33 129 49 155 131 33 3 22 71 33 46 74 19 88 188 284 557 250 22 308 30 129 221 79 195 16 39 44 61 59 1,047 27,437 1 421 General Dropsy Gnut c 11 2 17 3 2 3 16 6 1 3 5 9 5 1 4 1 6 4 9 6 0 12 5 1 2 6 7 13 2 4 7 6 1 4 8 19 2 2 8 1 10 6 u 6 21 9 66 1 3 152 2 2 2 5 9 8 1 6 8 2 7 1 6 7 4 7 3 5 8 "2 2 3 "2 i 6 7 2 6 12 3 1 7 1 4 12 .... 7 1 i 3 6 6 4 4 3 9 6 12 4 i 1 1 1 1 5 99 41 149 124 i 3 3 1 6 2 " i 7 2 10 8 i 6 1 1 12 1 2 16 1 7 10 1 2 101 101 60 107 68 21 3 21 132 14 73 108 7 1 6 11 1 7 3 12 9 3 7 2 3 7 i 2 10 8 7 13 11 7 1 16 1 10 1 7 12 1 14 3 16 11 2 13 24 11 3 19 3 6 11 1 6 7 8 4 11 "2 9 3 122 30 60 164 72 18 LOCAL DISEASES. Diseases o. the Nervous System. Congestion of the Ppgin 13 6 11 5 8 "'4 1 i 1 ■ 6 3 6 10 2 12 3 7 3 2 2 3 "2 5 11 6 6 3 4 7 19 12 8 15 9 11 19 1 29 3 3 62 57 5 8 4 12 12 34 17 9 31 42 2 17 3 3 9 2 2 9 "3 10 15 11 4 8 2 2 8 3 6 18 8 5 6 4 4 3 13 2 4 2 8 7 12 3 13 10 8 8 1 5 8 2 7 2 6 26 T. । fl am m a t i on of tli c Brain . ...... "Meningitis.. 4 6 9 2 15 11 1 1 1 7 1 2 8 Apoplexy , 16 10 7 6 Sun-Stroke Hydrocephalus 1 1 2 1 1 1 2 6 2 Diseases of the Cerebral Arteries i 2 "2 1 4 9 1 2 6 1 2 3 1 1 1 1 2 1 8 35 3 9 2 39 1 58 208 3 5 172 19 Myelitis Hsemeplegia i 6 3 1 1 3 1 1 1 i 1 3 "'i 1 5 i 1 1 1 17 1 3 4 43 Paraplegia-••••• .. .... 1 2 4 1 2 2 ■ 1 1 9 "14 ""ic 3 "■4 6 ""io 3 2 c 26 ..... .... 10 2 "10 ""ii 1 .... 33 2 "5 "2 "3 28 4 "'8 3 17 1 5 2 4 3 4 3 2 3 3 2 2 1 1 1 2 1 1 2 2 5 3 4 2 2 3 4 30 7 6 5 5 3 12 8 ""e 2 12 "13 26 2 1 10 9 7 13 2 15 17 7 16 10 6 18 14 2 17 9 10 19 8 3 12 8 66 132 119 2 14 1 0 13 3 3 17 . J 1 2 "■4 16 i it 1 i ""2 2 18 1 .... 2 "21 6 14 ""ic 2 1 D ' ' ' 2f 1 1 10 19 ""18 1 1 7 9 io 1 1 1'7 "15 1 1 3 17 "13 1 Tetanus ..-.•••••••••}! diopathic. f ri'ainnatin 21 1 2 45 "'ii 1 ' "24 3 16 6 28 .... 15 3 0 13 "42 "'2 ' "9 "46 1 1 "ii 15 1 1 13 ""38 1 4 25 2 "ib 1 1 15 ' "23 5 163 "351 15 2 104 1 50 12 1 3 "52 1 j $ I 33 11 "99 4 26 409 22 ' 186 ( 22 206 27 2 24 12 73 4 5 43 181 25 16 10 6 12 IS 8 Trismus Nascentium Hydrophobia Convulsions Convulsions Infantile Epilepsy .. 10 ""20 15 1 24 1 16 4 20 3 17 "16 " "1 '"s 14 1 31 2 ""14 16 3 16 4 1 11 ""4 8 i 10 ""i 20 16 1 "6 44 1 21 19 1 2 16 "68 "1 1 34 1 25 1 2 11 2 21 " 47 2 45 3 23 1 2 18 2 12 "2 19 3 19 1 20 2 9 "i 33 4 20 '"24 21 Hy"tBua 9 2 23 "e 2 J 1 7 2 1* ; 2 1 2 4 20 2 ( 17 3 1 1-. 1 1 6 1 10 24 1 13 i2 4 1 J 4 1. 11 4 1 1 2 1 3 1 8 10 2 1 7 3 7, 1Q 2 1 3 6 7 2 7 1 3 1 4 1 7 5 2 4 6 1 1 3 14 1 0 175 4 90 7 21 8 55 11 1 17 51 130 20 2 6 2 9 39 18 3 136 15 307 3 1 23 8 Delirium Tremens and Intemperance •••••••«.. Insanity All other Diseases of this System Diseases of the Circulatory System. Pericard dis 1 I 3 5 5 3 3 1 11 1 4 1 1 1! 1 1 3 3 ""9 6 48 1 0 1 7 1 12 r 3 1 8 1 3 1 1 8 11 4 3 1 6 1 8 3 1 1 3 3 10 2 b 1 3 1 1 3 2 1 1 1 4 1 Endo-C . ditis. Heart Disease (valvular) - ■ * - 16 15 4 L i 1 2 16 1 5 9 3 18 3 1 i 4 15 f 1: 4 0 9 1 1 1 2 9 3 10 15 4 1 1 1 3 IS 3 2 1 8 2 1 2 t 12 4 17 1 104 4 Heart Disease (Unclassified) 8 2 8 i: 3 c 1 8 12 3 8 1 7 5 6 11 3 1 5 7 8 1 5 8 16 13 1 4 1 1 Degeneration of Arteries 1 2 1 1 1 1 1 1 "2 2 3 1 1 1 1 1 1 1 1 i 16 1 ..... 79 3 £ £ 1: 3' 1 5 7 .... 18 2 2 ] 18 1 22 1 5 1 3 9 1 1 3 1 3 1 1 4 3 1 1 15 Diseases of the Respiratory System. 1 "i( 51 1 1( "it 5" ""2' 4i 1 12 9 1 48 1 1 1 1 1 7 1 0 3 4 2 I 2 4 1 2 1 4 1 1 16 4 12 4 1 2 jaryn °'i tis. ••••••••••• it 3( 4 10 1 1 1 3 11 If 55 14 10 9 1 13 1 31 11 2 29 6 I i * 7 4 17 8 1 22 13 31 3 1 8 8 1 6 4 3 4 2 fl c 3 8 3 20 1 2 3 1 7 9 1 8 y 2 3- 8 1 20 7 8 J U 1 26 g 1 3 19 4 1 12 5 5 3 22 1 3 1 9 7 3 27 7 2 32 8 32 1 72 9 117 1 3 lit 19 329 1 105 28 370 6 9 49 3 3.' Pneumonia 12 41 26 18 IS 10 7 23 1 Abscess of Lungs •••••••• 1 1 1 1 0 1 1 3 £ "2 " i "2 4 3 1 2 " i 1 2 2 1 1 18 2 1 2 1 1 0 1 Pleurisy 1 1 3 3 1 3 1 1 2 1 "1 2 £ 1 2 3 1 1 1 2 1 17 15 5 8 5 11 1 i 1 1 4 2 3 1 1 1 1 1 11 "'2 1 1 1 1 1 6 1 4 1 3 4 i 4 1 20 16 All other Diseases of this System Diseases of the Digestive System. Haematemesis . 1 1 1 2 1 1 2 1 1 1 4 29 8 2 88 7 2 39 1 203 86 1 5 8 144 11 2 55 15 46 2 1 7 37 Stomatitis* ■•••■• •••■••••••* 1 fl 1 3 1 78 1 Teething Ulcerative Sore Throat Thrush 10 3 7 € < 1 10 t 6 3 1 6 2 8 13 3 7 12 17 2 17 16 40 1 11 20 25 1 8 17 11 2 2 1 C 12 12 4 ( 11 1 4 4 1 5 9 5 3 1 12 6 3 1 7 4 3 2 1 2 137 154 1c 1 11 267 23c 3 4 26 29 1 3 1 4 g j '2 4 1 1 3 1 "3 4 32 Gastritis Dyspepsia- 1 1 3 4 3 5 3 4 2 9 1 ( 3 1 1 14 6 • 3 30 26 4 1 35 16 2 4 1 30 31 9 1 3 7 i 26 17 3 3 30 4 195 184 2 3 Enteritis Dyson tory. v 19 35 8 20 8 12 9 12 18 12 5 29 10 2 8 4 19 24 ii 13 7 7 20 17 22 17 13 35 10 20 21 36 28 42 11 31 29 16 11 6 1 1 32 31 20 23 19 19 31 19 16 17 20 20 7 21 42 1* 17 10 14 16 9 32 31 20 16 14 19 15 3 1 23 ' 36 33 18 14 19 G 281 Ulceration of the Bowels 4 1 1 1 1 1 2 1 1 0 3 2 1 10 10 Intussuseption of the Bowels Obstruction of the Bowels Diarrhea - -- ..••••••••••••••••• •••••■••■ .... 29 2 32 10 2 16 25 14 6 1 9 21 17 6 1 1 5 2 4 1 8 "io 2 1 8 22 36 26 3 12 30 46 28 1 29 20 34 17 12 28 10 1 1 12 2 22 24 17 1 11 18 22 1 10 11 34 34 14 13 32 30 1 11 11 0 352 Hernia .. 3 2 1 1 6 2 1 6 2 2 1 2 1 1 5 3 1 6 2 1 1 1 4 1 2 2 2 c 4 2 38 7 20 7 7 3 29 Fistula in Ano 5 6 1 1 1 1 3 2 3 4 4 4 1 3 1 2 1 2 1 1 ( 1 2 2 1 4 4 3 4 7 4 2 3 '7 6 1 2 5 I 3 2 4 6 1 3 I 7 1 1 3 1 7 1 3 3 1 3 10 35 8 55 9 A bscess of the Liver* 1 9 1 1 CS rvlinui a nt til A U VPT 2 2 2 2 i 1 3 1 1 2 1 2 3 8 3 1 2 5 1 v>iiinobis <lug 1 1 1 Degeneration of the Liver Jaundice 1 5 1 1 1 1 1 1 3 1 1 "2 1 1 1 1 1 2 1 1 1 3 3 1 1 1 4 1 3 1 15 1 8 44 Peritonitis 4 2 2 3 ] 1 5 5 2 3 4 i i 1 1 i 4 3 6 1 1 4 2 2 1 1 2 9 1 2 3 1 4 1 6 4 6 1 2 6 1 2 6 1 2 1 3 2 1 1 5 0 3 4 3 2 6 1 6 2 1 5 1 3 2 8 2 1 19 AU other Diseases of this System Diseases of the Urinary and Generative Organs. Bright's Disease 4 1 2 3 10 1 5 1 4 3 2 2 1 8 7 2 1 4 1 11 4 3 3 1 8 6 1 3 1 9 2 8 4 3 2 5 4 3 3 1 6 9 1 2 1 1 13 1 6 1 4 1 1 6 2 3 6 1 1 2 8 2 1 8 1 1 2 3 1 17 35 2 73 6 33 17 25 14 107 Suppression of Urine .... 3 2 2 2 1 i 2 1 2 i 1 2 1 i 1 1 4 .... - 5 1 1 11 1 1 2 1 4 i 12 1 1 1 1 2 3 1 1 1 1 5 7 3 10 vtuLi A/tocaoco ul niis stem- ••••• Affections Connected with Parturition, lorrhage. 1 1 1 1 2 2 1 1 1 1 4 1 1 1 17 14 1 1 1 ""3 3 15 20 1 2 0 3 1 2 1 3 4 4 15 16 2 2 2 4 10 2 1 2 i 1 1 3 3 6 11 11 1 7 1 1 1 1 1 1 2 4 1 1 8 5 10 28 3 18 30 11 20 20 23 110 83 13' 6 69 30 27 41 20 66 0 13 11 24 99 6,942 449 9 16 9 7 33 43 194 161 4 54 others 1 1 4 1 4 1 2 I 3 1 1 3 1 1 3 6 3 1 2 2 3 3 1 1 2 3 1 3 2 3 2 2 9 3 2 2 1 4 1 2 6 3 1 1 0 10 1 9 4 2 5 2 1 17 or me ursransoi Dis jases f the Cellular and Cutaneous System Conditions not Necessarily Associated with General or Local Diseases. Premature Birth - 2 2 10 3 1 3 2 1 8 1 1 2 4 9 1 4 2 1 1 4 1 1 2 3 13 6 11 1 3 6 1 3 1 6 6 21 11 1 1 11 3 1 1 2 3 14 7 1 7 1 4 1 3 2 1 1 1 10 13 7 1 2 2 13 2 4 10 0 6 21 14 1 2 14 35 74 171 76 9 97 5 6 8 8 14 11 6 5 3 8 3 10 8 1 2 3 3 2 8 19 14 4 1 15 ii 3 11 2 4 15 21 6 14 8 6 11 9 1 8 4 12 8 8 14 6 4 6 31 6 10 19 2 9 8 1 7 7 6 2 5 3 5 3 3 2 6 12 6 1 7 4 7 24 9 3 3 7 11 6 1 6 11 28 16 1 4 16 16 7 4 8 10 1 4 55 55 91 3 88 V1U AAge- D ebility 9, 8 18 3 Si 1 ^1 I 18 11 16 14 18 15 5 It 21 16 1 8 2 8 1 7 D ebility Infantile' 4 1 4 11 1 1 1 3 2 1 1 6 3 1 12 1 9 1oisoniug ----- Gen ral Injuries. Drownmg 4 4 3 2 3 4 1 5 (1 4 I 1 2 1 - ^817 -J? - 16 " ".i 10 2 5 2 2 4 2 1 1 5 12 600 34 2 12 3 2 2 0 1 "9 8 8 6 4 19 6 3 6 15 8 14 5 7 3 1 1 0 3 8 5 3 Burns and Scalds • All other General Iniunes Local Injuries. 7 4 3 1 4 4 1 i 1 6 1 3 3 2 4 2 9 5 2 1 1 2 i 5 1 11 621 30 1 1 i 1 2 1 7 2 1 0 1 1 1 3 2 2 2 2 10 3 l 2 1 2 14 4 1 2 4 1 3 5 1 2 4 3 3 1 2 1 8 35 4 6 4 6 1 7 6 2 13 11 5 4 4 1 4 3 4 30 34 16 50 10 41 108 30 33 3 7 20 31 434 7,341 334 31 43 13 30 1 11 24 20 4 1 5,623 350 3 4 3 2 2 2 1 4 1 4 3 3 2 3 2 3 2 1 1 3 2 3 5 4 1 4 3 5 4 rI 3 3 3 3 4 1 Tutors NcAIalignant 1 1 1 2 1 2 1 1 2 1 438 25 ""1 1 1 15 537 ^~30 0 3 i 402 29 2 1 2 21 614 19 1 2 1 27 672 4o 1 4 1 9: 1 I 1 14 480 41 1 1 1 1 3 1 3 3 13 958 40 4 3 1 450 1 "2 2 54 627 44 1 4 3 C'on genital Malformations «... ""i 1 3 4 18 547 20 3 1 16 485 29 61 475 16 i 1 9 545 3 4 1 1 1 2 1 1 3 68 527 30 30 582 3« 1 1 3 28 488 32 1 1 1 17 791 47 3 1 1 1 "'52 729 27 1 1 1 8 512 58 Suicide Killed or Murdered 1 1 1 3 1 13 614 32 1 3 48 700 301 3 61 559 25 2 3 75 Ji!. 14* 4, 6i "'42 631 0 6 53 583 901 2 2 34 510 25 3 10 565 31 10 Unknown, or Not Stated 38 562 20 11 466 28 446 35 33 397 281 6 429 27, 461 25 62 579 22 581 2U 25 433 19 56 894 22 466 241 43 873 26' 460 38 533 7,531 29A 573 27 497 32 422 17 407 517 34f Still-born Mortality and Sanitary History of New Orleans, 1880-1883. CCIX MORTALITY OF 1881. MORTUARY STATISTICS OF NEW ORLEANS. MORTALITY OF 1881. Total deaths, whites, 4127 ; blacks, 2279: total, 6406. If the mortality of the year just closed (1881) be compared with that of the preceding four years we have the following figures, exclusive of still-born : 1880-Total deaths, whites, 3637; blacks, 1986 ; total, 5623. 1879-Total deaths, whites, 3267; blacks, 1855; total, 5122. 1878-Total deaths, whites, 8062; blacks, 2256; total, 10,318. 1877-Total deaths, whites, 3976 ; blacks, 2732; total, 6708, , It will be observed that the mortality of 1881 has exceeded that of 1880 by 783, that of 1879 by 1284, whilst it is 302 less than that of 1877. These years furnish the only data during the series following the recent civil war for the determination of the rela- tive mortality of the white and black races, and in the mortuary records of the Board of Health only three years cau be found before the recent civil war in which the tnor- tality of the two races is specified, namely, 1849, 1850 and 1853, and is as follows : 1849-Total deaths, whites, 7754 ; blacks, 1818 ; total, 9572. 1850-Total deaths, whites, 6122; blacks, 1409; total, 7531. 1853-Total deaths, whites, 14,292; blacks, 1341; total, 15,633. Total deaths, three years 1849-53 : whites, 28,168; blacks, 4568 ; total 32,736. Cholera prevailed in 1849-50, and yellow fever in 1853. The total deaths during the first series ot five years following the American civil war were : whites, 23,069 ; blacks, 11,108; total, 34,177. Yellow fever prevailed in 1878, and Asiatic cholera was absent throughout the entire period. It will be observed that the mortality of the three years, 1849, 1850 and 1853, reached 32,736, or Very nearly that of the five last years, 1881, 1880, 1879, 1878, 1877. The mortality of 1881 has not been materially influenced by exotic and zymotic diseases. Thus the deaths from this class of diseases were as follows: small-pox. 5 ; measles, 26; scarlatina, 197; typhoid fever, 66; diphtheria, 92; whooping cough, 1. Total deaths from zymotic and epidemic diseases, 387. [See Tables F. and G]. The deaths f om this class of diseases (zymotic and epidemic) were as follows, in the years specifier • 1844, 231 ; 1845, 199 : 1847, 2797 ; 1848, 3375 ; 1849, 4479 ; 1850, 1985 ; 1851, 870 ; ±85,., 1785 ; 1853, 8991 ; 1855, 3572 ; 1856, 380 ; 1857, 662 ; 1858, 5397 ; 1859, 800; 1860,720; 1861,445; 1863, 658; 1864, 1505; 1865,1091; 1866,2064; 1867,3962; 1868, 245 ; 186 586; 1870, 1306; 1871, 169 ; 1872, 282 ; 1873, 1120 ; 1874, 823 ; 1875, 738 ; 1876, 738; 187 1254 ; 1878, 4327 ; 1879, 120 ; 1880, 360 ; 1881, 387. We have ir 'ed under the head of the zymotic diseases, the following: the small- pox, meas1 j iet fever, enteric or typhoid fever, yellow fever, malignant or Asiatic- choler: diphtheria, and whooping- cough. It will thus be seen that the so-called con- tagious, infectious and epidemic diseases have been at various times the prime and sole causes of the high death-rate of New Orleans in the years in which they have prevailed. If this class of diseases be excluded we will arrive at the true rate of mortality in New Orleans, as determined by indigenous causes, namely, soil, climate, medical topo- graphy and hygienic condition. Thus the death-rate in New Orleans from all diseases during the years specified were as follows: 1844, 51.66; 1845, 29.20; 1847, 67.18; 1848, 76.92; 1849,78.13; 1850, 58.96; 1851, 52.48; 1852, 56.82; 1853, 99.18; 1855, 47.21; 1856, 33.05; 1857, 31.88; 1858, 68.73'; 1859, 39.00; 1860, 43.52; 1861, 30.10; 1863, 40.67; 1864, 49.34; 1865, 38.32; 1866, 41.23; 1867, 52.88; 1868, 26.25; 1869, 29.79; 1870, 36.26; 1871, 28.92; 1872, 31.17; 1873, 37.73; 1874, 33.75; 1875, 30.00; 1876, 30.32; 1877, 32.11; 1878, 48.81; 1879, 23,94; 1880, 25.98; 1881, 29.64, in 1000 population. In the series of years just recounted, we find that 1845, 1868, 1871, 1879 and 1880, ex- ceed the year 1881 in health as shown by the death-rate. If the zymotic and epidemic diseases be excluded, we have the following mortality per 1000 inhabitants for the years specified: 1844,19.00 ; 1845, 26.98; 1847, 41.45 ; 1848, 47.70 ; 1849, 41.57; 1850, 43.67; 1851, 46.06; 1852, 44.72; 1853, 40.85; 1855, 25.75; 1856, 30.70; 1857, 27 84; 1858, 36.11 ; 1859, 34.20; 1860, 39.26; 1861, 27.48; 1863, 36.86; 1864. 40.67; 1865, 32.08; 18bo, 29.69 ; 1867, 31.03; 1868, 25.07; 1869, 25.67; 1870, 29.42 ; 1871, 28.05; 1872, 28.05; 1873, 29.74 ; 1874, 32.15; 1875, 26.97 ; 1876, 26.39 ; 1877, 26.63; 1878, 28.34; 1879, 23.38; 1880, 24.32 ; 1881, 27.85. It will be observed that the years 1845, 1855, 1856,1860, 1868, 1869, 1875, 1876, 1877, 1879 and 1880, furnished a lower death rate than 1881, from epidemic or indigenous causes. Upon the whole the preceding statistics reveal a progressive advance in the health of New Orleans, and this must be attribtted to several causes-as the more stable condition of the population ; the diminution of immigtants; increased facilities for drainage; improved sanitary conditions, and more rigid execution of quarantine. CCX Mortality and Sanitary History of New Orleans, 1880-1883. We are also reminded by the preceding facts that it is unwise to draw dogmatic con- clusions from the records of a few years as to the absolute value and effects of any one measure; as, for instance, the flushing of the gutters with water. It is evident that, with greatly increased facilities for this work iu 1881, New Orleans, nevertheless, had a higher mortality than in 1880 and 1879. The mortality by months in 1881 was as follows; January, 543; Febuary, 466; March, 551 ; April, 529 , May, 683 ; June, 733; July, 571; August, 472 ; September, 427 ; October. 442; November, 508; December, 481. Total, 6406. The average monthly mortality of New Orleans during the past twenty-four years has been as follows : January, 521 ; February, 459; March, 541; April, 510; May, 607 ; June. 623 ; July, 653; August, 940; September, 880 ; October, 711 ; November, 572; December. 513. Annual average during twenty-four years, 7430. These statistics show that during 1881, contrary to the usual course of mortality in a series of years, including epidemic and non-epidemie, the lowest mortality occurred in August, September, and October. The highest mortality occurred in January, March, April, May and June. The increase of mortality during the winter and spring was due to the severity of the weather, the heavy rainfall, and the overflow of the rear portion of the city. The great mortality of June (733) was referable largely to the intense and prolonged heat. In May the maximum temperature ranged from 77° to 90°, and the deaths from congestion of the brain numbered fifteen, out of a total of 683 deaths from all causes. In J une the maximum temperature ranged from 82° to 97°, with a mean maximum temperature of 90.8; the deaths from sunstroke numbered twenty-seven, and from congestion of the brain forty, out of a total of 733 from all causes. In July the maximum temperature ranged from 82° to 95°, with a mean maximum temperature of 90.1 ; the deaths from sunstroke numbered five, and those from congestion of the brain twenty-one, out of a total of 571 deaths from all causes. In August the maximum temperature ranged from 81° to 94°, with a mean of 88.6; one case of sunstroke was reported in August, and only seven deaths from congestion of the brain. TOTAL DEATHS FROM SUNSTROKE, CONGESTION OF THE BRAIN AND FROM ALL CAUSES. WITH MAXIMUM TEMPERATURE RECORDED DAILY DURING THE HEATED TERM " (MAY. JURE, JULY, AND AUGUST), 1881, CONSOLIDATED FROM THE ORIGINAL RECORDS OF THE BOARD OF HEALTH. ■■■•85 ••"LS •••98 • ■t'S •••*85 •68 ••16 ••••06 ••61 ••SI "•11 ••••91 •"•91 •••n • 81 8.... 9.... 10.... 11.... 4 Oi UI k .w J 3 Date. Sunstroke. Ui t-* I ' ' ' to • to ■ -: -- to- H* Congestion of the Brain. MAY. o 00 03 xS O 03 Total Deaths. 1 83.6 22 2 Maximum Temperature. to : : wh-woo»u' »qj«m: Sunstroke. o : »O-tOW WIOJO - IOWWJO -WCO • • 1-^ • >-* Congestion of the Brain. JUNE. 1 w -iShhoo^S 19 35 15 35 Total Deaths. 1 90.8 58£33S£5E£j2Si3g£S82g3gS8533S23 Maximum Temperature. Ui Sunstroke. to M> ■ . ... - - - • JO «0 - - • -to' -to • >-* >- Congestion of the Brain JULY. UI h- S££££t5>SS^ - iO tO 0 H* - 03 to Total Deaths. | 90.1 8SSSS8g83838SSS3888SS8S8SSSS383J8 Maximum Temperature. t-i . . . . . . . . •. . . . . • • Sunstroke. . . . . . .- 1 . -; 1. Conge8"01: of tne Brain. AUG to -' -* oSwouaSStlSSExuSSo -1 5 5 Q» 2 -So o w .U -1 Total Deaths. a a: H 88.6 3$2££§g8{288288O88£283£S883gi3g;33S2 Maximum Temperature. Mortality and Sanitary History of New Orleans, 1880-1883. CCXI It is thus shown that the mortality of June was due to the prolonged and excessive heat. The effect of heat was especially manifest in the increased mortality of infants and children. It is worthy of note that the prolonged and intense heat of the summer of 1881 ivas unat- tended by the development of yellow fever. DEATHS REPORTED BY THE CORONER AND THOSE WHICH OCCURRED IN CHARITABLE AND PUBLIC INSTITUTIONS, INCLUDING THE CHARITY HOSPITAL, DURING THE YEAR 1881. The detailed statement of the causes of deaths reported by the Coroner and by the various public institutions of New Orleans, inclduing the Charity Hospital, will be found in Table H, of the Annual Report for 1881. From this table the following general results are obtained : The grand total of deaths reported by the Coroner during the year 1881 were 1018 ; in various public and charitable institutions, 292; in the Charity Hospital, 825, Total deaths reported by the Coroner and in charitable institutions, 2135. The races were re- presented as follows ; By Coroner-By disease and violence, whites 472, colored 546 ; still-born, whites 89, colored 101 ; public and charitable institutions, whites 240, colored 52 ; Charity Hospital, whites 517, colored 308. Total whites 1318, colered 1007 ; total blacks and whites, 2325. This last figure includes the still-born, which numbered 190. It is worthy of note that whilst the whites exceed the blacks in the proportion of about lour to one, at the same time the deaths among the white population, certified by the Coroner, actually exceeded those among the whites in the proportion of 472 to 546. The still-born reported by the Coroner among the colored race also exceeded, in the pro- portion of 101 to 89, those of the white race. THE MORTALITY AMONG THE COLORED RACE IN NEW ORLEANS AS CERTIFIED BY THE CORONER AND AS SHOWN BY THE STATISTICS OF THE CHARITY HOSPITAL, WAS AT LEAST FOUR FOLD GREATER THAN AMONG THE WHITES. As the deaths upon the Coroner's certificate and those recorded in the Charity Hospi- tal represent the amount of disease and deaths occurring among the destitute, homeless and friendless poor of New Orleans, these statistics would seem to lead to the conclusion that destitution and poverty were four-fold greater among the colored population than among the whites. Such a vast discrepancy in the ratio of deaths among those incapable of furnishing their own medicines and medical attendants must rest upon certain determinable causes. The excess of still-born recorded by the Coroner among the colored race, in the pro- portion of 101 colored to 89 whites, still further indicates the greater degree of poverty and destitution among the children of Africa. When we examine the total mortality for 1881, including the deaths from all causes, embracing the preceding statistics as occurring in charitable and public institutions, and as certified by the Coroner, we have the following: Total deaths, whites, 4127; total colored, 2279; total, whites and blacks, 1881, 6,406. The preceding number. 6,406, includes the deaths from all causes, and in all institutions, public and charitable, and those certified by the Coroner, within the limits of the City of New Orleans, exclusive of the still-born, which numbered whites, 217; colored, 136; total, 353 still-born. (See Table G, mortuary statistics of New Orleans, illustrating the mor- tality, by months, in the white and black races, during five years, 1877, 1878, 1879, 1880 and 1881.) The causes of the excess of mortality among the colored population oyer that of the white may be formulated thus: 1. Poverty, dependent upon imprudence, idleness and vice. 2. Poverty, dependent upon ignorance of mercantile and mechanical and professional pursuits. 3. Crowding and neglect of sanitary rules and imperfect food, enforced and fostered by destitution. 4. Want of skillful medical attention and proper medicines and diet for the sick col- ored poor. Without doubt the humane members of the medical profession, relieve a vast amount of disease and suffering amongst the 8ick poor Of both ractes; and the doors CCXII Mortality and Sanitary History of New Orleans, 1880-1883. of the Charity Hospital are wide open for the reception of the diseased, sick and suffer- ing destitute poor of both races, but the preceding statistics are sufficient to arouse the philanthropist to still greater and more noble exertions. In this great city at the mouth of this great river, all nations mingle, and it is not sur- prising that the miseries of the world should here find striking illustrations, and fur- nish a wide field for the labors of the philanthropist, and more especially for the medi- cal and sanitary philanthropist. If the still-born be excluded, the remarkable result is obtained, that out of the total deaths occurring in New Orleans during 1881 (6,406), almost precisely one-third (or 2,135) occurred in charitable or public institutions (asylums and prisons) or were diagnosed by the coroner. One-third of those dying in New Orleans die in poverty, and are buried at the public expense. One-sixth of those who die in New Orleans perish in silence and misery, with no kind com- panion, no efficient medicine, and no generous physician. In such a condition, the President of the Board of Health finds the greatest difficulty of, either discovering at the earliest practicable moment, or arresting by efficient sanitary measures, such contagions and infectious diseases as small-pox and typhus fever. 5. The various organizations of this city, as well as the Board of Health, cannot, by windy resolutions, exorcise the demon of poverty and stay the march of grim death, as he reaps his richest harvest among the destitute, the dissolute and the degraded ; but it may be possible by stern facts to realize our true condition, and to strike those chords in the hearts of the good and philanthropic, which, ih the progress of time, may even- tuate in the amelioration of much suffering and distress. That the heavy mortality among the colored race is to a large extent due to the pecu- liar conditions and vices of a large city was shown in the report of 1880. First District.-Total deaths, 1393; whites 884, colored 509; death-rate per 1000 in- habitants, whites 20.40, colored 36.10 ; death-rate, whites and colored, 24.24. Second District.-Total deaths, 1115 ; whites 699, colored 416 ; death-rate per 1000 in- habitants, whites 22.28, colored 31.27: total death-rate, whites and colored, 24.96. Third District.-Total deaths, 1161; whites 774, colored 387 ; death-rate per 1000 in- habitants, whites 22.94 colored 32.62 ; total death-rate, whites and colored, 25.47. Fourth District.-Total mortality, 720 ; whites 506, colored 214 ; death-rate per 1000 inhabitants, whites 16.52, colored 30.96 ; total death-rate, whites and colored, 19.81. Fifth District.-Total mortality, 142; whites 88, colored 54 ; death-rate per 1000 in habitants, whites 18.12, colored 13.30 ; total death-rate, whites and colored 16.03. The Fifth District gave the lowest mortality of any district within the bounds of the city of New Orleans. This district, which occupies the opposite side of the river, is, perhaps, the most sparsely settled. Sixth, District-Total deaths, 329; whites, 196, colored 123; death-rate per 1000 inhabi- tants, whites, 16.40, colored 30.16 ; total death-rate per 1000 inhabitants 20.52. Seventh District-Total deaths, 128; whites 62, colored 66; death-rate per 1000 inhabi- tants, whites 19.92, colored 21.12; total death-rate, whites and colored, 20.52. That the mortality among the colored race in 1880 corresponded, to a remarkable ex tent, with the density of population, is shown by a comparison of the mortality of the several districts just given with the population, as established by the United States cen- sus of 1880. Thus, the population of the districts of New Orleans in 1880, was as follows: First District-Whites 43,319 ; colored 14,126 ; total 57,445. Second District-Whites 31,368 ; colored 13,301 ; total 44.469. Third District-Whites 33,732 ; colored 11856 ; total 45,588. Fourth District-Whites 4,022; colored 3,034 ; total 8, 856. Fifth District-Whites 5,0022; colored 3,834 ; total 8 ,856. Sixth District-Whites 11, 951; colored 4,078 ; total 16, 029. Seventh District-Whites 3,112 ; colored 3,125; total 6,237. Without doubt, much of the poverty and unrelieved and unattended sufferingand disease in New Orleans, are dependent upon an excess of population, and more especially of the colored population, above the actual necessity of manual labor, marine and mercantile pursuits and manufacturing industries. Notwithstanding these causes, much good may be accomplished and many valuable lives saved, by the institution of free dispensaries, and the employment of one or more physi- cians in each ward at a just compensation, whose duty it shall be to attend the sick poor at all times and under all circumstances by night, as well as by day. • SMALL-POX. During the year 1881, only five deaths have occurred from this disease. It is worthy of note that this great city, holding communication withall parts of the civilized world, and with numerous foreign and domestic cities in which small-pox is prevailing, has up to the present time escaped an epidemic of this disease. The following figures represent the number of deaths from small-pox in New Orleans, during the years specified : 1847. Mortality and Sanitary History of New Orleans, 1880-1883. CCXIII 27 ; 1848, 105 ; 1849, 133; 1850, 37; 1851, 38; 1852, 0; 1853, 17; 1855, 0; 1856, 2; 1857, 103; 1858, 108; 1859, 43; 1860, 22; 1861, 1; 1863, 2; 1864, 605; 1865, 613; 1866, 188 1867, 47 ; 1868, 14 ; 1869, 141; 1870, 528 ; 1871. 2 ; 1872, 29 ; 1873, 509 ; 1874, 587 ; 1875 342 ; 1876, 232 ; 1877, 1099 ; 1878, 151; 1879, 0; 1880. 1; 1881, 5. Total deaths from small pox during tho past thirty-six years (1844-1881), 5731. TABLE SHOWING DEATHS IN THE FIRST DISTRICT, CITY OF NEW ORLEANS. DURING THE YEAR 1882. DISEASES. January. February. i March. April. May. June. July.. | August. 1 September. October. November. | December. Total. 1 1 2 jl ciLU w r uv ui ••••••• ••••••••••• alarial Fevers 3 3 11 20 12 6 11 10 21 18 114 Typhoid Fever 2 2 2 3 2 4 3 1 3 1 3 24 Scarlet fever 2 4 2 1 3 1 7 J 1 2 1 1 28 ^Measles*••••••■••*• 1 1 SmalVp^^ 7 6 6 8 2 1 3 5 7 15 60 1 2 1 2 1 2 1 10 JL71 pil lUUl 1« Diarrhoeal Diseases 6 9 3 35 24 17 14 6 11 24 29 178 2 3 2 7 3 1 1 1 2 1 2 25 Sunstroke* 3 1 1 5 Convulsions ••• 2 13 5 6 3 6 3 6 31 Phthisis Pulmonalis 21 24 32 25 32 28 19 17 16 27 34 288 Deaths from all other causes......... 154 117 141 99 106 95 88 183 117 144 112 127 1436 Total i^nmber Deaths 191 159 174 191 186 183 157 174 160 193 197 236 2201 dumber ) ^Yhites. 118 108 106 111 113 107 105 133 96 120 132 162 1381 Deaths. 5 Colored 73 51 68 80 73 76 52 71 64 73 65 74 820 1 Yellow Fever 0.20 0.20 0.03 Death rate 1 Afalarial fevers.. • • • • 0.62 0.41 2 30 4.18 2.50 1 25 2.30 2.10 4 38 3.75 1.94 per 1000 '.Phthisis pulmonalis • Inhabitants [ per annum. Whites J Colored...*.* ...... ... 4.38 5.02 2.71 6.68 5.22 6.68 5.84 3.97 3.55 3.55 5.6Z 7.09 5.01 32.68 62.01 29.91 43.32 29.36 57.76 30.74 67.95 31.32 52.01 29.64 64 56 29.09 44.17 28.54 60 31 26.59 54.36 33.24 62.01 36 56 55.21 44.87 62.86 31 85 58.05 To tai ........ |39.89 33.21 36.34 39 89138.85,38.22 32.79,36 34 33.42 4. .51 41.15 49.291 38.31 TOPOGRAPHY. The First, Second, and Third Wards are comprised in the First Municipal District. The First and Second Wards terminate at and a little beyond the Claiborne Canal; the Third Ward runs out to the lake. Felicity and Canal streets form the upper and lower limits in the city proper. The lands along the river for a half mile back, are much higher than the level of the lake ; those in the rear portions are lower. The section beyond Broad street, between the New Basin and Canal street, is not much better than swamp land. It is covered with a series of ponds after heavy rainstorms, which last for a long time afterwards. DRAINAGE. Although this district now constitutes the centre of the business and enterprise in this city, the system of drainage is as primitive as of old. Surface drainage still prevails, and very imperfect it is at its beet. After heavy rain storms, it is a common sight to see the rear of the district under water, which even extends as far front as Magazine street. The drainage machines have to labor days before this surplus of water is carried off. There is a fall in the surface slope of some fourteen br fifteen feet to the low lands, three miles distant from the river. The canals leading into the lake are on a higher level than the lands adjoining, from which the drainage machines are necessary to raise the rain water into these conduits. SANITARY CONDITION. The front of the district, as far back as Rampart street, is, generally speaking, in a fair sanitary condition the whole year. This is owing to the streets being paved, with some exceptions, and the gutters in conse- quence are capable of carrying off drainage waters. This is facilitated by the Camp street culvert and the Melpomene street canal. The rear of the district is given over to mud. The street railways, on Clio and Erato streets, have im- proved the streets by planking, which is vastly superior to mud. The extreme rear of the district being so low and so often ovei'flowed either by rain or lake waters, besides being traversed by the sewerage canals, is the least desirable for habitation. This is so of Canal street. This portion of the city, however, will never build up until an entirely new system of drainage is perfected and carried into operation. The city, in fact, will never build out to the lake, and become then the Southern Metropolis, so often prophe- sied, until this is done. The drainage into the lake is wrong in every way. The river and not the lake should receive the sewerage of the city. HEALTH. The past year was remarkably healthy for the entire city. The summer was cool, and the fall a late and pleasant ending of the warm season. The mortality was light in this distriet, with its aggregate population of fully sixty thousand persons. The deaths from all causes gave a ratio per 1000 per annum of 31.85 whites. 58.05 color ed, and 38.31 total. This embraces the mortality in the Charity Hospital, an institution that receives its patients from all parts of the State and country, which had a death list of 510 whites, 294 colored, and 804 total. If this was de- ducted frorp the death rate given above, the ratio would be as follows : Whitoff, 13.16 ; colored, 37.23; total, 19 ol^U reduction Of almost one half in the pbrtbutagb of deaths. CCXIV Mortality and Sanitary History of New Orleans, 1880-1883. The deaths were light for every month in the year, except April, May, June, November and December. The maximum was reached in December, and the minimum in August. The mortality from malarial fevers was greatest iu June and November. Typhoid fever, nev<r common in this city, was the cause of twenty-four deaths, most of which occurred in the Charity Hospital. The absence of this fever to a great extent in this city is in favor of surface drainage. The prevalence of contagious diseases was confined principally to scarlet fever and small-pox, but par- ticularly the latter. Small-pox was mostly in the lower districts last winter and spring, but bids lair to ex- tend on up through the upper ones this year. From present appearances, however, I would consider that its spread will be slow. This will be the case probably if the remainder of the winter should be mild and the spring an early one. The disease seems to be at a stand-still in this district at present, there being but four cases on hand. About seventy-five per cent of the cases occur among the colored race. The death rate in this disease is very high, fully fifty percent of the cases resulting fatally. There is a total disregard of the merits of vaccination on the part of both whites and blacks in the lower classes, Gratuitous vaccination is repeatedly proffered to persons in the infected localities, but very seldom accepted. The cause of this indifference appears to be as much due to prejudice as to carelessness. What costs nothing must not be good for much ! The two deaths from yellow fever, as shown in the mortality table, were of cases transferred from the Third District to the Charity Hospital. No case of this fever occurred in this district, setting aside a sus- picious case reported in September, back of Prieur street, near Gasquet street. Mortality and Sanitary History of Neiv Orleans, 1880-1883. CCXV NAMES OF DISEASES. January. 1 February. 1 March. April. May. June. August September. ' October. 1 j £ • Tol al. Total. W&C w. C. w. u. W. C. V. vv V. V. vv. V. vv . V. Malarial Fevers 4 2 1 5 1 1 3 1 2 1 1 2 2 5 6 4 1 1 1 3 1 1 0 91 7 1 2 2 2 4 37 6 10 24 2 61 8 10 Typhoid Fever .. 1 1 Scarlet Fever 1 Measles . Diphtheria 2 2 1 3 1 5 1 2 1 1 2 1 3 2 1 1 6 24 12 22 2 13 6 39 8 37 18 61 Diarrhoeal Diseases 1 2 1 2 2 2 5 28 37 14 i i ' i 5 4 5 1 2 14 2 1 2 3 "6 3 1 1 2 2 4 1 2 i 1 1 2 Congestion of Brain 1 5 'si Sunstroke Convulsions. ...T. Phthisis Pulmonalis 3 38 52 19 7 32 45 89 8 32 48 18 5 27 35 36 •10 26 39 15 4 29 45 17 4 32 43 .91 12 35 64 94 7 35 61 4ft 8 44 64 94 7 17 39 .4ft 8 32 51 IQ 8 20 38 51 9 31 •18 1ft 9 19 32 30 42 1H 24 33 OK 8 30 50 19 6 24 34 19 10 40 56 21 8 28 38 49 8 33 49 18 4 19 31 74 88 401 606 1Q 80 302 468 .31 168 703 1074 Deaths from all other causes Total number of Deaths Death rate ) White 1 Colored 40.52 26.06 31.57 22.29 35.18 20.41 38 79 23.64 55 03 . 35.18 33.58 97 67 34.28 23 68 28.87 21.49 29.77 20.14 30.67 25.66 34.28 25 25 27.96 21.49 35.18 per 1000 > Total white and colored.... 24.04 - 1 Malarial Fever per annum, ) Phthisis Pulmonalis Number Still-born 1.53 1.10 3 4.51 6.31 3 0.31 0.9 2.064.51 41.... 1'96 6 9'62 0.7 1.53 1 0.9 3.60 3 1 90 4 58 2 1.80 6.31 3 1.90 3.60 5 5 41 6.31 4 1.53 3.06 5 0.9 7.01 4 1.10 3.44 12 0.9 8.11 4 0.7 1.90 4 1 80 4.51 1 2.35 3.06 0.9 5.41 2 0.7 3.82 3 7'21 2 1 80 3.06 1 3.60 3.60 3 1.14 2.80 53 1.80 6.01 29 1.36 3.71 82 Pop ulati on- Whi te, 3 1,368 ; co lore< I, 1 3,301 ; to tai, 4 4,66< TABLE ILLUSTRATING DEATHS IN THE SECOND DISTRICT OF THE CITY OF NEW ORLEANS DURING THE YEAR 1882 CCXVI Mortality and Sanitary History of New Orleans, 1880-1883. NAME OF DISEASES. । January. February 3 3 3 34 c? - । June. । July. ! August. September 5 5 j November. | December. Total. Total. W. C. W. C. W.l c. C. W. c. W. c. ITT W&C 1 1 1 1 1 6 2 2 15 1 1 3 41 i 2 13 3 4 1 1! . 3 2 il 2 1 11 5 3 17 51 13 23 12 22 78 24 484 20 2 5 111 2 18 1 5 59 26 321 25 5 22 162 15 41 13 27 137 50 805 1 28 3 2|'". 12| 22 3 1 >1 2 2 1 1 Typhoid Fever 1 3 2 1 ....[ 3 16 8 1 3 6 .... 1 1 1 1 I 1 0 1 . 1 3 4 2 Small-pox. Diphtheria 1 1 1 6 43 3| 2 1 3 il el 3 .... 5 0 2 1 1 9 3 32 4 2 21 2 1 2 11 4 41 1 6 22 Congestion of Brain Convulsions .... "6 3 23 1 1 11 "41 8 2 21 3 2 5 1 33 2 " 1 1 2 2 43 6 3 2 43 2 2 6 5 4 1 39 43 1 6 4 34 5 3 21 1 41 K I 8 2 42 il 1 1 2 22 Phthisis Pulmonalis Pneumonia Deaths from all other causes 1 3 ' 1 1 291 40 3 1 16 3 "18 7 1 42 Total number of deaths 57 36 57 35 53 68 77 71| 69 77 69| 64 68 33| 53 29 56 32 57 40 49 34 67 51 732 570 1302 ,, Whites 20.27 36.43 20.27 35.42 18.85 67 98 27.09 24.54 71.86 78.01 24.54 64.77 24 19 ! 18.85 33.38 29 33 19.92 32 3R 20.27 40 4R 17 13 34 40 23.71 51.61 21.70 48.07 Colored rate per 1000 24.47 24.21 29.21 38.98 38 86 34.00 24.83 21.58 ' 23.16 25 52 21.84 31.06 28.34 inhabitants ' 1 " -P?,™ Malarial Fevers Phthisis Pulmonalis Number stillborn 2.13 3 6 07 3^90 6 1.01 8.09 1 1.77 7 2.02 5.06 2 1 06 5 1.01 6.07 1 1.77 6 6.07 0 351.... .... 1 .0612.000.35:2.02 3.20 4 1.01 5.06 3.90 6 11.13 8.09 0.15 2 31 63 1.68 4 97 23 0 55 3 01 1 77I3.12 9' 3 2 85 6 1 01 4 1.06|3.12'1.77|3.12,2 4915.06 1 41 41 9l 3l 11 5 Population-Whites, 33.732; colored, 11,856 ; total, 45.588: TABLE GIVING MORTALITY FOR THE YEAR 1882, THIRD DISTRICT. Mortality and Sanitary History of New Orleans, 1880-1883. CCXVII YELLOW FEVER IN THE THIRD DISTRICT NEW ORLEANS, 1882. [Extract from the report of Dr. Eug. J. Mioton, Sanitary Inspector Third District. | YELLOW FEVER. Three cases of yellow fever have occurred in the city of New Orleans during the last year, and all three cases have taken pLce in the Third District, at a distance of one or two blocks from each other. The fol- lowing is a brief history of the cases and of the several sanitary measures taken in connection therewith to abate the fever and prevent its spread. The first case was that of Henry Forbes ; took sick June 22, 1882, died June 27, 1882. The second, that * of Johannes Stroh, took sick July 28. 1882, died August 1, 1882. The third and last case, thatof Alexander Englund, took sick August 5, 1882, died August 8, 1882. I shall take up each case separately and in the order they have occurred. FIRST CASE-HENRY FORBES. Henry Forbes, English by birth, twenty years of age, residence in New Orleans about ten (10) days, was admitted in Ward 27 of the Charity Hospital on Sunday, twenty-fifth of June 1882, at 9 o'clock a. m. Forbes, it appears, sailed from Montevideo, in the Spanish brigantine Rita, for Havana, via Porto Rico. On board this ship was a passenger just recovering from "chills and fever" which he had contracted in Rio de Janeiro : the length of the voyage front Montevideo to Havana was fifty-four (54) days. Forbes remained five and a half days in Havana but did not pass a singe night ashore; from Havana he came to New Or- leans in eight days, including the detentions at quarantine station, on the steamship Marco Aurelio, Capt Morgan. The vessel landed in Algiers, but Forbes crossed over on this side of the city on Tuesday, June 20, and sought for lodging at No. 97 North Peter street, house kept by a Mrs. Viana, where he remained until Wednesday morning, when he went on board the steamer Commander, of Liverpool, and was set to work painting the ship, On Thursday, June22, at8 o'clock a, m., while working, he was seized by a violent chill, followed by high fever ; he then'returned to his boarding house, No. 97 North Peter street, and re- mained there without medical assistance until Sunday morning, June 25, when he was sent to the Charity Hospital. At the time of his admission to the Chiritv Hospital, he was very weak and jaundiced. Tuesday morning. August 1, the temperature in the axilla was 102° F.; pulse 99. Patient again vomited bilious matters flecked with brown specks and showed signs of jaundice, with red and injected eyes. The attending physieian then thought the case was so much like yellow fever, that soon in the afternoon he re- ported the matter to the President of the Board of Health. At two o'clock p. m.. Doctor Joseph Jones, President of the Board of Health, was at the patient's bed- side and found a temperature of 102° F. and a pulse of 116 ; patient was delirious kept his eyes and mouth tightly closed and exhibited much nervous agitation ; the surface of the body was jaundiced ; gums red and swollen ; by means of catheter the bladder was emptied of four ounces of a high-colored turbid urine, which, on being tested, exhibited the presence of albumen and showed a specific gravity of 1012. The" patient died at six o'clock the same evening. A post-mortem examination was held on Wednesday morning. August 2, at nine o'clock, at which were present Dre. Joseph Jones, G. K. Pratt, and C. Faget, Sr., of the Board of Health : Dr. S E. Chaillb of the National Board of Health, and Dr. V. C. Frogne, the attending physician. After due deliberation, and without hesitation, the case was pronounced to be one of yellow fever. The President of the Board of Health at once sentto Dr. Atkinson, President Boardof Health, Nashville, Tenn.; to Dr R. M. Swearingen, State Health Officer of Texas, at Austin; to Dr, W. D. Kelly, President of the Galveston Board of Health ; to Dr. Johnson, Secretary of the State Board of Health of Mississippi, at Jackson; to Dr. Fournier, Health Officer of Mobile; to Governor McEnery, at Baton Rouge, the following telegram : A case of yellow fever reported at No 25 Enghien street, Third District, yesterday at two p. m. Died during the night. The board has taken all necessary measures of disinfection, fumigation and isolation. No other case known in the city. City healthy and in good sanitary condition. Death rate per 1000 whites, 25.61. JOESPH JONES. M. D., President Board of Health At the same time the following instructions were issued to Dr. E. J. Mioton, the Sanitary Inspector of the Third District. 1. Disinfect and fumigate the house and yard and surroundings of No. 25 Enghien street. 2. Destroy by fire the bed, bedding, bed-clothes and every apparel of Johannes Stroh, who died of yellow- fever last night 3. Allow no gathering of people around No. 25 Enghien street. , 4. Cause the immediate burial of the body of Johannes Stroh. 5. Place your officers in charge of No. 25 Enghien street, and of the surrounding blocks, and carry for- ward systematic iuspection and disinfection, throughout this section of the city. 6. The Sanitary Inspector should attend to the execution of these measures in person and report all facts immediately to the Board of Health. I send man and cart, one barrel of carbolic acid, one half barrel of sulphur and four barrels of copperas. I have Ordered Sanitary Policemen Wiltz and Blanchard to report to you for duty. JOSEPH JONES, M. D., President Board of Health. All these instructions were rigidly enforced and carried out. The fumigation and disinfection of premises conducted in the manner described in Forbes'case. THIRD CASE-ALEXANDER ENGLUND. Alexander Englund, aged twenty-nine, born in Finland, carpenter by trade, arrived in this city from Cardiff, Wales, May 21. 1882, and had always resided at No. 85 North Peters street, in the block next to that where seaman Forbes was taken sick with \ ellow fever. The patient took sick at 8 o'clock on the eighth of August, and was given a hot foot-bath and a dose of castor oil by the people of the house; on the moruing of the ninth he was taken to the Charity Hospital, where his temperature was found to be 104° F. and pulse 90; at 3 p. m., temperature 104° F and pulse 80 ; atnight temperature 103° F. and pulse 59. Englund died on the fifteenth of August, in the evening, at about 4 o'clock. Il appears that Englund was working in repairing buildings in the same block of houses in which he lived; betook sick on the eighth, at night, was taken to the hospital on the ninth, in the morning, where his case was officially pronounced to be one of yellow fever of a mild type. For several days the patient was reported to be free from dangerous symptoms, and was believed to be doing well ; but in the last day or two his symptoms increased in severity, black vomit appeared and the patient succumbed to the attacks of the disease. . . In all three cases, all the necessary measures of sanitation, fumigation and disinfection were observed, not only in the premises where cases had occurred, but also in all the houses within six blocks right, six left, aud six back of that in which cases had taken place ; we were greatly aideil and assisted in the work by he able services of the sanitary police officers of the First, Second, and Fourth Districts ; the] Auxiliary 27 CCXVIII Mortality and Sanitary History of New Orleans, 1880-1883. Sanitary Association had kindly furnished us with the services of three men and a cart; the city authori- ties had sent us a large supply of copperas, lime, sulphur and carbolic acid, also two carts and eight men. I must here extend my most cordial thanks to Dr. K. A Bayley, Sanitary inspector of the First District, and to Dr. W. R. Mandeville, Sanitary Inspector of the Fourth District, for the most valuable services they have rendered me in sharing with me the supervision and responsibility of our work of disinfection ami sanitation of the infected portion of the district. The following is the list of the disinfectants used : Sulphate of iron (copperas) 50 barrels * Lime 30 barrels Carbolic acid (Calvert'sNo. 5) 10 barrels Sulphur 3 barrels Mortality and Sanitary History of New Orleans, 1880-1883. CCXIX NAMES OF DISEASES. aS £ reornary. March. 1 S' 3 a a s Julv. August o a K October. £ = 5 5 5 December Total. Total. W. W. c. W. C. W. c. w. c. W. C. W. C. W. C. w. C. W. C. w. c. W. c. W. C. W&C Malarial Fevers Typhoid Fever Scarlet Fever Small-pox Diphtheria Diarrhoeal Diseases Congestion of the Brain Sunstroke 3 3 3 2 1 3 1 1 3 1 2 11 4 3 1 4 1 3 7 1 2 3 2 3 3 5 1 6 3 1 3 2 1 1 4 1 3 2 1 3 2 4 4 2 1 2 2 3 1 3 5 9 2 2 1 1 4 1 1 1 1 3 2 3 o i n i 4 2 4 5 27 14 3 1 66 7 11 7 2 11 2 36 4 7 38 16 3 1 102 7 15 14 2 Convulsions Phthisis Pulmonalis Deaths from all other causes 2 1 28 12 1 24 3 c 27 1 4 3 1 31 2 10 2 32 3 9 7 3 26 1 17 20 10 1 1 18 1 14 5 2 12 1 5 1 1 28 i 13 5 30 11 4 2 37 i 12 30 12 313 11 3 126 41 15 439 Total number of Deaths 37 15 32 17 40 9 39 16 48 23 52 23 32 16 31 17 25 9 46 16 44 15 67 24 493 200 693 Death rate 1 White. 14 49 12 52 15 67 15.28 18 81 20 37 12.52 12.14 9 79 18 02 17 24 26 25 16 .09 per 1000 '.Colored Inhabitants per annum. J Total 26.05 29.52 15 63 27 78 39.94 39 94 27.78 29.52 15.63 27 78 26.05 41 67 28 .94 16.62 15 .66 15.66 17 58 22.59 23 97 15 34 15 34 11 13 19.82 18.86 29.09 18 .46 - Number Still-born . 11 1 i! 1 3| 3 3 1 3 41 1 1| 2 3| 3 3 1 3 4 1 3 4 1 3| 1 2 2 30 24 54 TABLE ILLUSTRATING THE DEATHS IN THE FOURTH DISTRICT OF THE CITY OF NEW ORLEANS DURING THE YEAR 1882. CCXX Mortality and Sanitary History of New Orleans, 1880-1883. EXTRACT FROM THE REPORT OF WM- R. MANDEVILLE, M. D., SANITARY INSPECTOR. FOURTH DISTRICT, NEW ORLEANS, 1882. OFFICE SANITARY INSPECTOR. FOURTH DISTRICT. ) New Orleans, La. January I, 1883. 5 Joseph Jones, M. D., President Board ot' Health, New Orleans, La. : Sir-I have the honor to transmit my annual report of the sanitary condition of the Fourth Municipal District and the work accomplished in connection therewith during the past year. This district ranks as third in the city, in the number of its population The distinction of the classes of this population is more marked than that of the Second Municipal District, in which I had the honor of serving under your board until the fifteenth of last April, when I was transferred to this field of labor. The large number of elegant residences, with their ornamental grounds, which, ranging through the middle portion of the district, from its upper to its lower limit, have won for it the title of the " garden district," give evidence of the culture and refinement of its wealthier inhabitants. The front portion, from the river to Magazine street, is occu- pied by a thrifty and enlightened class of laborers, men who work in cotton presses, and in handling the staple alongshore, and whose profitable labor, while it renders them vigorous and robust in constitution, furnishes them with the means of making their houses clean and comfortable abodes of health. With these advantages it would seem that we might look for a generally healthy condition in the district, even though we were unaided by the wise measures and expenditures of your honorable and efficient board. The ad- vance of know ledge has given to hygiene the place formally Occupied by the art of medicine: prevention has taken the place of cure; and it has been found cheaper for the community to ward off pestilence by the outlay of a few thousands of dollars, in the purchase of disinfectants, and the payment of proper sanitary officers, than fo lose thousands of lives and millions of money, by* neglecting to co operate with the proper- sanitary authorities of the State in providing measures for their safety. The year which has just been added to the past, ought to be considered a notable one for our community. With the dreaded scourge to the right and left of Its, and in front of us, baffling the skill of the National Board of Health, we have escaped ; and when the fever was imported and made its appear ance among us, is was instantly extirpated With pestilence all around on our circumference, we stood safe in a charmed centre. Surely confidence should be reposed in those who live by curing disease, and yet devote their time and attention to its prevention and the diffusion of the knowledge of physiology and hygiene among the masses. SMALL-POX, One of the best illustrations of the extent to which ignorance and carelessness nullify the utility of ad- vances in knowledge of methods for the prevention of disease, is found in the fact that small-pox still ap- pears as a local epidemic, and sometimes with great mortality. If anything is known in preventive medi- cine, it is that this loathsome disease may be easily ami certainly prevented in almost every case, and that it should never appear on the death register; yet to obtain snch an universal and satisfactory vaccination and revaccination of each individual as will give this security, there is necessary the decided and persistent interference of the government to an extent which has not yet been provided in this country. These re- marks are specially applicable at this moment, as this dread disease has suddenly acquired a strong hold in this district. There have occurred sixtv-one cases, of which thirty-four were white and twenty-seven colored. There were fourteen deaths. It is safe to say that, had vaccination been practiced in these cases at the proper time, nine-tenths of them might have escaped this loathsome disease. VACCINATION. The diminution in the death rate since Jenner's discovery robs small-pox of most of its terrors; and. instead of its being a scourge which frequently sweeps over thousands of miles within an incredibly short space of time, it has not far many years been beyond the control of intelligent medical efforts. Modern statistics show' that the modification of the disease by vaccination has been very decided. The proper management of the disease depends upon a perfect co-operation of the public, the general medical pro- fession and the sanitary authorities, and promptness in making known the existence of a case is the first necessity. The concealment of cases, and prejudice against vaccination, on the other hand, have much to do with the propagation ot the disease as well as with its fatality, and it is but just and proper, where medical men are negligent in reporting their connection with a case that a fine should be imposed upon them. In the year 1881. there were but 247 persons vaccinated at this office where for the year 1882 there were vaccinated 1010 persons, of whom 284 were white and 726 colored. This contrast is very encouraging, for it goes to show that the public at large are rapidly realizing the importance of vaccination. There were 682 of these primary and 323 secondary vaccinations. SHIPPING. All vessels in this district were boarded shortly after their arrival. No sickness of an infectious or con- tagious nature was discovered on any of them. These visits were made regularly' from May to October. But few vessels land on this side of the river, most of them being taken to Gretna, as wharfage is much less than on this side. CEMETERIES. All the cemeteries have been examined and a number of vaults repaired, especially in the Washington Street Cemetery, where complaint was made during the summer that a number of the vaults leaked and that the smell could be detected by the people living in the vicinity. LOCAL SANITATION. In July a suspicious case of yellow fever occurred at No. 1010 Tchoupitoulas street, a German, Louis Dischler by name. The man was a hard drinker, and had been sick ten days; he was removed to Charity Hospital, and died the day after. A post-mortem w'as held and the man was found to have died from in- tense jaundice. A minute microscopical examination of all the organs was made by myself, but nothing of a pathological nature could be found indicative ot yellow fever. A thorough disinfecting of the entire neighborhood was instituted, from Magazine to the'river front, Felicity to First, and from Washington to Toledano streets. The number of vaults disinfected was 2634 ; the number of gutters disinfected was 108; the number of yards cleaned was 25; twenty' barrels of copperas, and fifty gallons of carbolic acid were used. Sanitary measures, to be effectual, should be carried out at those times when most people see no special cause for anxiety, and often, therefore, appear to involve unnecessary labor and expense. During a greater portion of the month of August, I was assigned to duty in the Third District, with officer Allen, to assist Dr. Mioton in the fumigation and disinfection of the infected portion of his district, where had occurred two cases of yellow fever. During the entire month of September, I was assigned to duty as quarantine physician at Lookout Station, with officer Allen of the Fourth District, and Bohner of the First All trains from Mobile, and vessels entering Pearl river, were boarded and carefully inspected ; passengers and freight from Pensacola were detained or else sent back from where th< y came. There were, therefore, no inspections made in this district for the month of September and a portion of August. Mortality and Sanitary history of New Orleans, 1880-1883. CCXXI NAMES OF DISEASES. । January. 1 February. 1 j April. 1 May. 1 June July. 1 August. September. October. ' November, w. 3 I Total. | ■ 'IW W. c. W. C. w. C. W. C. W. C. W. C. W. c. W. C. W c. W. C. W. C. c. W. c. w&c Small-Pox 2 2 2 1 1 1 4 1 Il 1 1 9 8 17 Malarial Fevers .. 1 1 1 3 1 1 2 7 11 18 Typhoid Fever. 1 1 r 1 1 4 1 5 Scarlet Fever. .... 1 1 1 1 2 Measles.... .... Small-Pox . •••••■ 1 2 1 2 o 4 Diphtheria .... I 2 2 1 1 1 1 2 1 5 7 12 Diarrh<eal Diseases •...•••« •••••..... 1 1 2 1 2 3 4 7 Congestion of Brain 1 2 1 1 1 4 5 Sun-stroke 2 i 3 4 2 6 Convulsions .... 1 3 2 1 1 1 1 2 1 1 1 1 3 10 9 19 Phthisis Pnlmonalis.......... 1 1 1 1 1 1 1 1 1 5 5 10 Deaths from all other causes. ... 4 1 - 3 1 1 7 3 11 3 1 2 1 7 2 5 6 .... 1 4 4 4 36 35 71 Total number of Deaths 6 7 5 4 5 4 11 7 14 7 4 8 7 15 5 7 5 6 9 5 7 9 9 10 87 89 175 1 White .. . . 11 80 9 83 9.83 21 63 27 54 R7 1.1 77 9 83 9.83 17 70 13 77 17.70 14.26 Death rate 1 Colored 21 54 12.31 12.31 21 54 21.54 24.61 46.12 21 54 18.46 15 38 27.69 30.77 22 82 pei ivw । Inhabitants > Total White and Colored 15.60 10.80 10.80 21 60 25.20 14 40 26.40 14 40 13.20 16.80 19.20 22 .80 17 .60 per ftnnnni 1 Malarial Fevers. n. 10 0 10 o 10 0.40 0.40 n in o 30 n 30 I 90 1.80 ) Phthisis Pnlmonalis • ■ • • 0.40 0.20 0.20 0 10 0. 10 0.30 0.20 6 10 0.30 1 80 1.90 Number Still-born Children 2 3| 1 • 1 v 11 1 2| ... 2| 1 ... | ... .. | 2 .1 ... 3| .. . ...J 1 1| ... 10J 11 21 Population- -Whites, 6,100; Colored, 3,900. Total. 10,000. TABLE ILLUSTRATING DEATHS IN THE FIFTH DISTRICT OF THE CITY OF NEW ORLEANS DURING THE YEAR 1882. CCXXII Mortality and Sanitary History of Nev Orleans. 1^80-1883. EXTRACT FROM REPORT OF A. M. BERET, M. D., SANITARY INSPECTOR FIFTH DISTRICT, NEW ORLEANS, 1882. OFFICE SANITARY INSPECTOR. FIFTH DISTRICT. 7 Algiers, Louisiana. January I. 1883. $ Joseph Jones, M. D., President State Board of Health. New Orleans. La.: *********** THE OVERFLOW. The crevasse at the Oak Grove plantation, situated about fifteen miles down the river, and immediately in the rear of Algiers, (about seven miles in a straight line.) occuired in the month of April, and the back water from it soon encroached upon the populated portion of the district until it reached in the upper part, the levees on the Mississippi River, necessitating the throwing up of a protection levee, so as to at least keep the most thickly inhabited part irom being flooded. This was effectually consummated by the additional placing of a drainage machine at this levee at the intersection of Verret and Jackson streets, by which means all the drainage and sipeage waters were kept from accumulating. The crevasse was not closed, and the water covered the entire area until the falling of the river, when it gradually disappeared. It is quite natural to suppose that the health of the district after such an extensive overflow, lasting throughout the entire summer, would be seriously affected, and the mortality in the district be very heavy ; but. to my surprise, I am able to state that Algiers has been, and is now, the healthiest district of the city of New Orleans, the death-rate amounting to only 17.60 per 1000 inhabitants. (See table of mortality). Mortality and Sanitary History of New Orleans, 1880-1883. CCXXIII NAMES OF DISEASES. 1 January, < | February. ! 1 March. April. 1 .Tune. July. August. September. October. | Novembei. I December. 1 Total. w. C. W. C. W. C. W. c. W. c. W. c. W. C. W. c. W. c. W. c. W. C. W. C. W. C. Malarial Revel's . ... ........ Typhoid Fever 1 1 1 1 1 3 "i 3 1 2 1 4 2 1 1 12 5 6 1 Scarlet Fever "... Small-pox Diphtheria Diarrhoeal Diseases Congestion of Brain ... 1 1 1 1 1 1 5 1 3 I 4 4 1 1 1 2 1 1 2 3 1 1 1 2 1 2 3 1 'J 2 25 6 2 12 1 Convulsions Phthisis Pulmonalis Deaths from other diseases. . 1 9 2 4 2 5 3 1 ii "2 11 3 11 i 6 1 8 .... 4 I 2 17 1 1 7 16 1 1 6 6 7 1 1 9 1 7 i 6 3 14 "5 4 16 2 11 5 16 5 1 28 137 4 14 75 Total Number of Deaths 11 6 8 : 13 14 21 8 15 10 28 10 18 10 19 13 10 10 19 6 28 17 26 6 216 115 Death i-ate ( Whites per 1000 J Colored inhabitants') * per annum. ( Total 11 17 00 .65 8 14 00 .71 13 41 .00 .19 21 23 00 54 15 29 .00 .42 28 29 .00 .42 18 29 .00 .42 19.00 38.25 10 29 00 42 19 17 00 65 28 50 .00 02 26 17 .00 .65 21 60 28.20 12.08 9 70 23 54 21 .57 18.65 28 36 «0 89 23.88 14 96 18.65 33 68 23.88 20.65 ■ ■ --- - ■ -- DEATHS FROM ALL CAUSES IN THE SIXTH DISTRICT, CITY OF NEW ORLEANS, DURING 1882. CCXXIV Mortality and Sanitary History of New Orleans, 1880-1883. NAMES OF DISEASES. । January. ' I LI 1 ■ December. Total. Total. tar; a. st. nibi ubt । Febrt 3 5 A pril 5' 3 June. July. Augu Septe । Octol Nove W. C. W.| C. W c. W C. w C. W.| C. i w. c. | w. c. i w. c. • w. c W.I c. W. c. W. c. W&C * 1 1 1 J 1 1 1 3 1 1* 1 i 6 1 10 2 16 3 Typhoid Fever Scarlet Fever Small.Pox 1 .. 1 ... J 1 .... 1 1 4 4 Diphtheria 1 Diarrhoeal Diseases Congestion of the Brain Convulsions ... 1 ij 1 1 6 8 1 9 11 11... -iL1 i i _V 6| 7 2 .... 1 J 1 1 .. ■ 1 1 1 5 7 7 39 67 1 5 1 48 78 12 3 12 8 87 145 .... ... 1 5 :: 3 4 i 2 6 7 1 1 3 5 2 1 1 1 1 1 2 • .... A Phthisis Pulmonalis 1 I 4 4 • | TO L_J X । 00 6 7 ! 3 3 1 1 3 5 6 Total Number of Deaths 5 7 -7 9 6 6 Death rate | White ' 3.84 15.42 o 62 20 88 19.28 21 no 7.69 26 99 n.31 19 20 1 26.88 1 42.24 I 26 88 30.72 19 20 < 19.20 1 23.04 19.28 37.19 I 23.13 37.19 i 26.99 I 26 99 34.70 | 23.13 10 94 9ft SA i 19 71 Oft Hfi Oft ftli 91 09 ' 91 71 91 OO 91 44 per 1000 1 Colored Inhabitants j per annum. J Total White and Colored 23.13 17 *11 25 06 91 OS ____________ • . TABLE ILLUSTRATING DEATHS IN THE SEVENTH DISTRICT OF THE CITY OF NEW ORLEANS DURING THE YEAR 1882. Mortality and Sanitary History of New Orleans 1880-1883. CCXXV In addition to the data already recorded illustrating the mortality of 1882 we present the follow ing : MORTALITY OF NEW ORLEANS DURING 1882. DEATHS IN NEW ORLEANS DURING 1882, CLASSIFIED BY AGES, SEX AND COLOR. AGE. Whites. Colored. Total White and Colored. Grand Total. M 1 Males. Females Males. Females Males. Females Under one year . 398 293 230 186 628 479 1107 1 to 2 vears 88 81 51 58 139 139 278 2 to 5 veais 82 90 82 72 164 162 326 5 to 10 years 82 46 58 51 140 97 237 10 to 15 years 31 46 30 97 61 158 15 to 20 years 44 49 57 64 101 113 214 20 to 25 years. . . . 108 84 95 66 203 150 353 25 to 30 years 107 90 76 56 183 146 329 30 to 40 years 246 150 140 130 386 280 666 40 to 50 years. 274 142 117 88 391 230 621 50 to 60 vears 277 141 93 89 370 230 600 60 to 70 years. 219 133 91 87 310 220 530 70 to 80 years 106 101 50 82 183 339 80 to 90 years. 20 39 22 38 42 119 90 to 100 years 2 11 9 13 16 29 100 years and upwards.... 1 5 6 5 7 12 Unknown 1 3 1 3 4 Total ... 2104 1478 1225 1115 3329 2593 5922 Total deaths 1882 . Males, whites, 2104 ; colored, 1225. Total males, 3329. Females , whites, 1478; colored. 1115. Total females, 2593. Grand total, 5922. Total whites: 3582 ; total colored. 2340. Average daily mortality in New Orleans during the year 1882,' 16.22. Lowest daily mortality in first six months of 1882, January 19, when only six deaths occurred. Highest daily mortality in first six months of 1883, April 29, when thirty-four deaths occurred. Lowest daily mortality of last six months of 1882, on August 11, and October 1, when five deaths were recorded upon each of the days specified. Highest mortality during the last six months of 1882, October 14, when thirty deaths occurred. The highest daily mortality occurred on the twenty-ninth of April, and the next highest on October 14. The lowest daily mortality occurred on August 11, October 1 and January 19. The flushing of the gutters with Mississippi River water, under the auspices of the New Orleans Auxiliary Sanitary Association, sustained by the pecuniary assistance afforded by the honorable Common Council and by the voluntary contributions of the citizens, has without doubt, been the means of removing considerable quantities of filth toward the rear of the city, and into the drainage canals, by means of the gutters running perpendicularly to the river. It may be stated as a general proposition, that all gutters running parallel with the Mississippi River were and are, at the end of 1882, in bad sanitary condition. The absurd and unsanitary and expensive system of raking up the foul mud and stinking contents of the gutters into the streets, to await the action of the next rain, still prevails with the Department of Improvements, despite the protests of various Boards of Health. At the time of the change in the municipal government, the sanitary condition of New Orleans was an exact reflexion of the exhausted condition of her treasury, and corre- sponded with her unlighted streets and unpaid police. Whether a change in the form of government, without any material change in the rulers, will rectify monetary, legal and sanitary evils, must be determined by the great revealer of all things-Time. CCXXVI Mortality and Sanitary History of New Orleans, 1880-1883. It is worthy of note that a low death rate has been enjoyed by the white inhabitants of New Orleans, during a period in which there has been no system of underground sewerage. It is also evident that if the white population has enjoyed unexampled health during the past four years, the supply of water could have been neither very impure nor very deficient. RELATIONS OF THE RAINFALL OF 1882 TO THE MONTHLY MORTALITY. MONTH. Rainfall. Mortality. MONTH. Rainfall. M ortality. Cubic Inches. Total Deaths. Cubic Inches. Total Deaths January 4,59 465 July 6.84 460 1< ebruary 4.04 417 August 9.47 443 march 0.92 465 September 1.59 400 April 4.83 539 October 2.16 489 May 6.83 589 November 1.98 506 June 2-71 561 December. 4.27 585 It is evident from the following statistics : 1. That no fixed relation can be established between the rate of mortality and the rainfall. 2. The lowest mortality occurred in the month of September, when only 1.59 inches of rain fell. The highest mortality occurred in the months of May and December ; the rainfall in May being 6.83; and the total mortality 589. 3. The drouth occasioned by the small rain fall of the months of September, October and November, and the consequent exhaustion of the smaller cisterns, much to the dis- comfort of washer-women and the inhabitants of crowded tenements, was seized upon and exaggerated by interested parties, and by the enemies of the Board of Health, to inflame the popular mind with the idea that suffering, disease and death were being caused by the scarcity of water, and that the Board of Health of the State of Louisiana was responsible for the alleged sufferings, of the people. The Board of Health has, in its accurate statistics, the means of exposing this calumny. It is well known that this Board has advocated the supply of pure water in abundance, from various sources, of fresh and cheap meats, for the benefit of the citizens of the parish of Orleans, and that it has been inflexibly opposed to all monopolies, and has uniformity condemned all sensational statements from any and every quarter. DEATHS IN NEW ORLEANS DURING 1882, CLASSIFIED BY RACE AND GENERAL DIVISIONS OF DISEASES. CLASS OF DISEASES. White. Colored Grand Total. General diseases, including fevers, phthisis pulmonalis and small-pox 1448 1030 2478 Diseases of the nervous system 554 316 870 Diseases of the respiratory system 265 202 467 Diseases of the digestive system 253 830 Diseases of the circulatory system 177 150 327 Diseases of the urinary and generative organs . 92 73 165 Affections connected with parturition 18 10 28 Diseases of the organs of locomotion 5 11 16 Diseases of the cellular and cutaneous systems 8 10 Conditions not necessarily associated with general or local diseases 266 209 475 85 47 132 22 12 34 Tumors, non-malign ant • • 4 11 13 20 32 13 3 35 Killed or wounded : 11 Total....- 3582 2340 5922 Mortality and Sanitary History of Neu- Orleans, 1880-1883. CCXXVII DEATHS FROM SOME OF THE PRINCIPAL DISEASES IN NEW ORLEANS, DURING THE YEAR 1882. Disease (General Diesases.) White. Colored. Total. Disease (General Diseases.) White. Colored. Total. Small-pox 116 299 415 Puerperal fever 10 3 13 measles 3 0 3 Acute rheumatism 6 3 9 Scarlatina 41 5 46 Chronic rheumatism .... 6 3 9 Cerebro spinal fever 6 2 8 Syphilis 13 13 26 Enteric or typhoid tever 52 22 74 Syphilis congenital 4 4 8 Simple continued fever 3 2 5 Cancer of the breast 16 3 19 Yellow fever 4 0 4 Cancer of the liver 16 0 16 Intermittent fever 7 5 12 Cancer of the stomach 19 8 27 Remittent fever 32 25 57 Cancer of the womb 24 11 35 Congestive fever 111 48 159 Tubercular meningitis 7 6 13 Typho-malarial f ever Malarial fever not classified... 36 10 46 Phthisis Pulmonalis 507 350 857 85 60 145 Tabes mesenterica 113 57 170 Cholera infantum 66 20 86 General dropsy 10 21 31 Diphtheria Whoopingcough 37 5 5 I 6 Total General Diseases.... 1448 1030 2478 Leprosy 2 2 2 Under the class of general diseases, we propose to notice briefly, first the malaria fevers, scarlatina and diphtheria, reserving the consideration of phthisis, small-pox and yellow fever, for special record and discussion. MALARIAL FEVER OF 1882. During the first six months, of 1882, a marked increased in the mortality from th® various forms of malarial fever occurred in the month of June. Thus, during the six months ending the thirtieth of June, intermittent fever caused 4; remittent, 24; congestive, 70; typho-malariai, 24; malarial, not classified, 44 ; total from various forms of malarial fever, 160. Deaths in the month of June, intermittent fever, 1; remittent, 6; congestive, 25; typho-maiarial fever, 6 ; malarial fever, 15 ; total 53. Nearly one-third of the deaths from malarial fever occurred in June. During the last six months of 1882, there was an increase in the deaths from malarial fevers, thus: Intermittent fever Whites. 6 Colored. Total. 1 Whites. Colored. 2 8 Typho Malarial fever .17 5 Total- 22 Congestive fever 69 20 80 Malarial fever (unclassified).. 61 40 101 Total 153 67 220 It will be observed that the colored race suffered equally, if not to a greater extent? from the destructive effects of the various forms of malarial, paroxysmal, paludal, or marsh fevers. During the first six months of 1882, of the total deaths caused by the various forms of malarial fever, ninety-four occurred amongst the whites, and seventy-two amongst the colored. It is evident that, in relation of population, the malarial fevers were relatively more fatal amongst the colored population. This result is at variance with the opinions of many systematic writers. A portion of the mortality from malarial fevers amongst the colored population is un- doubtedly to be attributed to the fact that this class of the population occupies, to a large extent, the smallest houses in the rear of the city, towards the swamps and marshes. Improper diet, crowding and the occupation of low, malarial situations, and the want of proper medical attention in many instances, may account for the greater mortality from malarial fevers amongst the colored race. CCXXVIII Mortality and Sanitary History of New Orleans, 1880-1883. LOCAL DISEASES. Disease (Nervous System). White. | Colored. Total, Conposti^n nf thn brain 53 20 73 1 8 50 23 73 Softening of the brain 28 12 40 A of tho brain 4 1 5 Apoplexy C8 39 107 SunntrokR 6 6 Spinal Meningitis 10 8 18 Paralysis, unclassified 25 18 43 Hemiplegia 6 13 Total diseases of the np^ns system. Disease (Nervous System). White. Colored. Total. Paraplegia 2 I 3 Tetanus, traumatic 35 24 59 Tetanus, idiopathic 1 2 3 Trismus nascentium 90 82 172 Hydrophobia 4 4 3 10 Convulsions, infantile 67 39 106 . Epilepsy 19 1 27 28 14 42 | Mania 11 2 13 - ■ - - 554 316 87n Of the total number of deaths caused by diseases of the nervous system, it is worthy of note that the largest proportion was caused by acute affections of the cerebro-spinal system. Thus, the deaths caused by the diseases specified were as follows . Congestion of brain, 73; encephalitis, 8; meningitis, 73; apoplexy, 107; sunstroke, 6; spinal meningitis, 18; tetanus, 62; trismus nascentium, 172; hydrophobia, 4; convulsions, 13; infantile convulsions, 106; delirium tremens, 42. Total from these diseases, 684 ; total from all other diseases of the nervous system, 96. Trismus nascentium and infantile convulsions caused 278 deaths out of a total of 870; that is, about one-third of the deaths caused by diseases of the nervous system were occasioned by the convulsive dis- eases of children. Trismus nascentium was relatively much more fatal amongst the colored population. • Diseases (Respiratory System). White. Colored. Total. Diseases (Respiratory System). White. Colored- Total. Croup . ..39 1 31 Asthma ... 16 9 25 Laryngitis .... 6 3 9 Pneumonia ... 106 107 213 Bronchitis, acute .. . 47 36 ' 83 Pleuritic ... 5 5 10 Bronchitis chronic 29 Total diseases of respiratory • . 28 57 ... 265 202 467 Of the thirty-one deaths occasioned by croup, only one death occurred amongst the colored population. Acute bronchitis, pneumonia and pleuritis occasioned 306 deaths, out of a total of 467 deaths from diseases of the respiratory system. Diseases (Digestive system). Whites. Colored. Total. Diseases (Digestive system). Whites. Colord. Total. Teething ... 36 24 60 Hernia (Strangulated 4 4 8 Gastritis ... 21 7 28 Hepatitis .... 34 12 46 Gastro-enteritis ...21 0 21 Abscess of the liver ... 15 3 18 Enteritis ... 112 44 156 Cirrhosis of the liver ... 57 17 74 Dvsenterv .... ... 79 31 110 Jaundice ... 5 4 9 Obstruction of the bowels. ... 12 3 15 Peritonitis ... 17 11 28 Diarrhoea ... 124 75 199 Ascites ... 6 5 11 ---. Total diseases of the digestive system... ... 577 253 830 Sixty deaths are recorded as due to Teething. A more accurate delineation or division of those diseases characteristic of dentition is desirable. Inflammatory affections of the gastro-intestinal canal caused the following number of deaths: gastritis, 28; gastroenteritis 21; enteritis, 1.56; dysentery, 110: diarrhoea, 199; , total: 514, out of a grand total of 830 deaths from diseases of the digestive system. Abscess of the liver occasioned only eighteen deaths : fifteen whites and three colored. As abscess of the liver is comparatively frequent among Europeans in tropical climates, it has been attributed to the effects of heat, or of alternations of heat and cold. Being occasionally associated with malarious fever and frequently with dysentery, it is sup- posed that it may be induced by the same causes as those diseases. The opinion often advanced that abscess of the liver is always secondary to dysentery or to ulceration of the bowels has not been sustained by my experience in hospital and private practice. The proportion of cases in which liver abscess and dysentery .are as- sociated is extremely variable ; it is more frequent in one year than in another, and also at one period of the year than at another. Observation has also shown that there are many fatal cases of abscess of the liver, in which the bowels have been found perfectly healthy ; whilst on the other hand abscess of the liver can scarcely be consideied to be very frequent in dysentery The predisposing causes of abscess of the liver appear to be the abuse of alcoholic stimulants, irregular habits, exposure and the effects of prolonged heat. Mortality and Sanitary History of New Orleans, 1880-1883. CCXXIX Hepatitis caused forty-six deaths: whites 34, colored 12. It will be observed that acute inflammation of the liver (hepatitis) is by no means an uncommon affection in New Orleans, and its chief causes are, without doubt, exposure to heat and to changes of temperature in this sub-tropical climate, irregular habits of life, spirit drinking and the action of malaria. Cirrhosis of the liver caused seventy-four deaths ; whites 57, colored 17. Undoubtedly the most common cause of cirrhosis of the liver is abuse of spirituous liquors. Spirits unmixed with water seem to be more potent in causing cirrhosis than wine or malt liquors. A small proportion of cases may be referred to the prolonged and constitutional action of the syphilitic poison, and some cases have been referred to the immoderate use of spices and coffee, whilst, in rare instances, no cause has been apparent. From numerous clinical observations and post-mortem examinations, I am convinced jhat the prolonged action of the malarial poison may resmt in a cirrhotic condition of the liver of a peculiar nature, attended with the deposit of much pigmentary matter in the lobuli. Whitout doubt, a portion of the eleven deaths referred to ascites, and of the thirty- one deaths referred to general dropsy, were complicated by cirrhosis of the liver. 4 rrj Diseases (Circulatory System). © 'S Diseases (Circulatory System). © - £ "© o © s © O o H Pericarditis* 4 4 8 Angina pectoris . 4 2 6 Prepay of pericardium 3 1 4 2 4 6 Endocarditis 8 3 11 Rupture of heart .. 2 Valvular disease of heart. 38 47 85 12 6 18 TTypert.rnphy of heart 13 3 16 87 86 167 Dilatation of heart. 3 3 Total diseases of the circulatory system 177 150 327 rC CD Diseases ^Urinary and generative organs). -2 © © Diseases (Urinary an gen'tive organs) © H £ ■© o © Bright's di ease, acute Bright's disease, chronic Suppression of urine 14 7 21 Calculus 1 1 59 58 117 Preemie poisoning 2 2 1 ] Ovarian dropsy. 1 1 IC 2 2 Total diseases of urinary and generative svstem ... ........ 92 73 165 Bright's disease occasioned 138 deaths out of a total of 165, caused by diseases of the urinary and generative system, whilst only a single death was caused by calculus. The absence of calculous diseases in New Orleans is, without doubt, referable, chiefly, to the extensive use of cistern water: The large number of deaths occasioned annually by Brights disease should attract the attention of the sanitarian and physician. The term Bright's disease is now universally recognized as generic, and as including at least three different diseases of the kidney, namely: 1 The inflammatory affection, affect- ing the tubules, or the stroma, or both. 2. The waxy or amaloid affection, originating in the vessels. 3. cirrhotic or gouty affection, originating in the fibrous stroma. With reference to the aetiology of Bright's disease, the following facts are now generally accepted by those physicians and pathologists, who have carefully investi- gated this subject. 1. Of the Inflammatory Form of Bright's Disease.-Cold is the commonest cause in the adult; acting especially upon those who have been exposed to its influence whilst per- spiring. Various blood diseases, while they induce temporary albuminuria, along with their more ordinary symptoms, have renal inflammation as a common sequela. Among these, scarlatina occupies the first place ; diphtheria stands next in order, followed by erysipelas, measles, pyaemia, typhus, intermittent, remittent and congestive malarial fevers, acute rheumatism and pneumonia. Many of these maladies being most common in childhood, it follows that in the earlier years of life, they are the chief causes of in- flammatory Bright's disease. Pregnancy, heart disease, gout and malaria contribute towards its production in some cases, and the undue use of cantharides, turpentine or alcohol may also be reckoned as causes. That the malarial poison is capable of inducing active congestion, hsematuria, albu- minuria and structural alterations of the kidneys, has been established by numerous observations. That form of malarial fewer characterized by intense jaundice, obstinate vomiting, renal congestion and haemorrhage, uraemic poisoning and convulsions, is not so frequent in New Orleans as in St. John the Baptist and in St. James parish, and in and around Selma, Ala., and in certain sections of Georgia and Texas. CCXXX Mortality and Sanitary History of New Orleans, 1880-1883. Malarial hmmaturia illustrates the action of the malarial poison in the most intense degree upon the renal structures. Cases of albumnuria following and accompanying the various forms of malarial fever, were observed during the past three years, and in some instances the patients were brought directly from the swamps on the line of the railroads traversing Tennessee, Mississippi and Texas. It is well established that the urine of specific yellow' fever is characterized by albu- men and granular casts; how far this disease may be the cause of the inflammatory form of Bright's disease, has not yet been determined, but the subject is worthy of care- ful investigation. 2. Of the Waxy Form-Constitutional syphilis, phthisis and prolonged suppuration, caries or necrosis of bone, and other exhausting diseases, such as cancer or chronic rheu- matism, induce this degeneration. 3. Of the Cirrhotic Form-The commonest cause is the abuse of alcohol, particularly iu the form of ardent spirits. Gout and lead poisoning are far less frequent causes of the cirrhotic form of Bright's disease. This form of the disease is, however, met with in people who have neither indulged in alcohol, been exposed to lead, nor suffered from gout. Congestion from cardiac disease has been erroneously held by some authorities to be a cause of the cirrhotic form of Bright's disease. DISEASE. (Affections connected with parturition). White. | Colored. | Total. DISEASE. (Affections connected with parturition). 1 aiRAl Total. Difficult labor (cause stated) Haemorrhage Metroperitonitis ' Puerperal convulsions Total affections connected with preg 1 2 6 nam 1 2 3 4 y- -. 2 6 5 10 Puerperal septicaemia Exhaustion after delivery Vomiting in pregnancy . .... Inflammation of breast 2 2 1 1 18 10 2 1 1 1 28 DISEASE. (Conditions not necessarily associated with local or general diseases). White. Colored. [ Total. DISEASE. (Conditions not necessarily associated with local or general diseases). White. Colored. Total. Premature birth Difficult birth Umbilical hmmorrhage Old age General debility Infantile debility Senile debility.. Inanition Total conditionsnot necessarily com 28 1 5 33 1 51 107 37 ecte 14 1 2 31 2 58 86 14 d wi 42 2 4 64 3 109 192 51 tfi lo Accidental poisoning by- Opium ' Creosote Oxalic acid Laudanum .... Carbolic acid Chloral hydrate cal or general diseases 1 1 1 1 1 1 266 i 209 1 1 1 2 1 1 475 DISEASE. White. Colored. Total. General injuries Local injuries Total general and local injuries , 85 22 47 12 132 34 107 59 166 Of the general injuries, burns caused deaths, whites, 12, colored 14. total 26; scalds' whites 4, multiple injuries, whites 14, colored 4, total 18; shock from surgical operation' whites 1, colored 1, total 2; drowning, whites 39, colored 23, total 62. Of the local injuries, fracture of the skull caused deaths, whites?; concussion of brain, whites 2, colored 2, total 4 ; compression of brain, whites 2; gun-shot wound of heart, whites 1, colored 1, total 2; gun-shot wound of chest, whites 4 ; gun-shot wound of abdomen, wrhite 1, colored 1 , total 2; gun-shot wound of spine, colored 1 ; gun-shot wound of knee, colored 1; gun-shot wound of back, colored 1; incised wound of abdo- men, colored 1. Mortality and Sanitary History of New Orleans, 1880-1883. CCXXXI DISEASES (Suicide). White. Colored Total. By drowning 8 1 9 By hanging 1 1 By shooting 13 2 15 By cutting 1 1 By poison By laudanum 7 7 1 1 By fracture of skull 1 4 -- Total suicides 32 3 35 ■' 1 ■ 1. - Killed or murdered- Bv shooting 7 4 11 By stabbing 5 4 9 2 - By beating : 1 1 1 1 - - - Total killed or murdered'. .. 13 11 24 CCXXXII Mortality and Sanitary History of New Orleans, 1880-1883. TABLE SHOWING MORTALITY FROM SOME OF THE PRINCIPAL DISEASES IN THE FIRST DISTRICT OF THE CITY OF NEW ORLEANS DURING THE YEAR 1883. NAMES OF DISEASES. January. February. j March. April. June. J uly. , August September. । October. । November. December. Total. Grand Total. W. 0. W. C. W. C. W. C. w. C. w. C. W. C. W. C. W. C. W. C. W. C. W. C. c. W&C 10 1 3 4 4 6 0 4 7 £ 2 18 2 17 8 18 1 25 1 6 27 1 8 25 6 19 5 179 9 53 4 232 13 Typhoid Fever 2 1 1 1 1 1 o 1 1 1 1 1 1 2 1 1 1 1] 2 1 1 10 4 14 Vnllow Knvnr.... • 1 1 Small-pox .. 9 17 12 18 10 14 12 11 22 29 9 31 11 17 5 14 3 8 3 5 2 7 2 98 173 271 Diphtheria . 3 1 3 1 2 10 10 Diarrhfp.al Diseases . 15 11 7 4 10 6 9 3 2 • 17 7 16 11 6 7 3 1(1 17 8 34 12 35 5 188 39 76 264 Cnnvestinn of the Drain 2 1 2 3 3 2 3 2 1 4 1 9 5 1 4 4 5 3 10 49 24 10 8 24 8 23 13 10 13 10 12 16 10 16 $ 20 1 3 15 13 17 7 18 .... 14 23 5 11 201 12i 227 76 131 60 358 136 8 6 8 10 12 5 4 4 3 3 1 1 1 4 3 14 11 Measles 1^ 4 8 90 36 85 52 72 40 56 40 70 39 66 33 98 56 44 63 43 73 41 93 49 74 50 876 506 1382 163 81 143 98 138 89 110 79 141 94 137 81 148 82 107 132 83 142 81 190 86 170 86 1721 1017 2738 2 44 941 2 27 1 2 35 2 18 99.3 976 2 50 . 1 White. ......... 41 97 36.82 15 06 35 .53 .34 32 36 73 31 35 Oft 38 32 A3 94 27 .55 34 64 00 36 63 56 .11 48 67 92 43.80 67 m 36 .93 .03 Deatn rate 1 Colored 63 69 61 55 25 63 11 60 .00 .66 .01 66 per luuu S population. J Total white and colored 47.22 46.69 43 .77 35 58 45 48 42 19 42 .90 35 61 41 61 43 .16 53 42 49 .51 44.16 Estimated population-White, 46,600: colored, 15,400; total, 62,000. Note-Deducting from the total mortality of the district, the proportion according to population, of the deaths which occurred in the Charity Hospital, Hotel and Small-pox Hospital, not belonging to the district, reduces the total mortality of the district to 2064 : and the, death rate per 1000 population to 33.20. Dien Mortality and Sanitary History of New Orleans, 1880-18&3. CCXXXIII TABLE SHOWING MORTALITY FROM SOME OF THE PRINCIPAL DISEASES IN THE SECOND DISTRICT, CITY OF NEW ORLEANS, DURING THE YEAR 1882. NAME OF DISEASES. | । January. February ! April. 1 J j November. । December. Total. Grand Total. 1 £ a s l| ■ । July. । August. । September, 1 B 0 s W&C w. u. V. c. V. vv. u. \Y . u. w. u. XV . u. w . u. w. c. vv. u. w. U. W. C. Malarial Fevers 1 1 1 "2 4 1 10 5 1 3 5 2 3 4 1 21 1 2 ii 7 2 1 36 1 1 2 4 3 27 77 54 2 3 3 7 1 1 9 1 9 3 "20 4 1 '"7 1 7 2 6 1 3 2 7 1 5 6 1 3 3 4 1 1 1 7 4 3 1 3 1 4 1 2 45 7 5 107 17 81 11 99 41 2 305 810 29 10 171 5 31 8 65 27 2 271 619 74 17 5 278 22 112 19 164 68 4 666 X j piiuivi X U \ UI 1 28 "4 1 5 2 1 6 OlUiUUV A' U» vl • • • • Small pox Diphtheria«... • •••• 11 4 11 5 2 17 i 1 2 2 36 1 1 2 8 3 18 2 6 29 3 6 5 2 7 1 4 4 9 1 1 1 5 "9 1 7 2 1 1 2 7 3 1 25 44 )7 1 1 15 2 8 2 2 7 9 1 1 2 10 1 8 5 4 5 5 3 1 26 47 2 Diarrhoeal Diseases • • 6 2 12 2 1 29 62 1 1 2 9 1 1 8 9 5 10 4 31 74 IS 5 2 18 53 17 9 2 1 33 73 IS 4 Pljenninnift. Aleasles ...... Deaths fr<>n> n.ll ether causes 36 20 25 64 1 22 48 2 30 77 1 32 73 1 30 83 56 21 48 11 34 63 1 17 42 )5 18 30 58 ' 1 27 46 J4 37 63 1 44 20 43 10 34 Q^otai num her of* deaths 61 l( 48 )9 40 32 77 1 65 i 1429 Ulctuvi vwc*-t „ .. f Whites • ••- Death OnlerAd 21.72 39.72 22.79 39.72 27.42 63.72 25.97 68 69 26.35 43.86 25.99 39.72 22.42 34.75 22.08 33.10 20.65 38.19 22.40 36.41 27.42 37.24 23.14 38.96 24.03 42.69 rate per \ 1000 I Total 28 37 28 09 38 34 38 83 31 62 30 12 26 14 25 39 25 85 26 64 29 87 28 09 29.64 Estimated population for 1883-White, 33,700 ; । Note-Adding to the total mortality of this di Hotel Dieu increase ,oloi stric the ed, 1 ; the tota 4.50C pro 1 me ; to jort rtal tai, on, ty 0 18,20 ICCOI f the ). din^ dis to trict >opu to 1 at io 389, Q, Ot end the he <1 deal eath hs v rate 'hid per occ 1,00 urre poj I in rnlat ;he ion 5m al ,0 35 -pos 04. ant Che irity Hos pital s and Mortality and Sanitary History of New Orleans, 18*0-1883. CCXXXIV DISEASES. । January. February. March. April. May. June. July.. August. j September. । October. j November. । December. | Total. | Grand Total. W. C. W. C. W. C. W. C. W. C. W. C. W. c. W. c. W C. W. C. W. C W. 2 C. W. C. 69 8 3 425 23 104 17 120 57 2 724 Fevers- Malarial 2 2 5 1 3 1 2 1 1 2 1 6 2 1 3 5 5 1 1 3 4 4 1 6 3 6 6 3 1 1 1 1 2 1 4 3 1 1 "1 1 i 4 42 6 1 143 15 71 14 59 28 2 476 27 2 2 282 8 33 3 61 29 248 Typhoid Scarlet .... . .... Small-pox Diphtheria Diarrhoeal Diseases 9 a 1 3 13 19 36 26 86 39 2 5 1 1 2 40 92 26 25 1 9 I J 25 5 3 4 5 2 13 1 7 5 1 3 4 6 1 2 3 1 1 3 1 4 4 2 2 8 1 "3 9 1 3 0 2 3 9 1 1 5 12 1 '2 7 1 3 2 1 2 7 2 io 6 1 1 4 2 4 2 6 2 1 33 1 'S 3 24 1 5 Congestion of Hrain.... Consumption . 2 4 "18 7 1 1 41 6 2 Pneumonia Measles Other causes Totals 45 23 39 18 25 45 12 35 13 27 23 34 22 40 24 49 68 22 48 26 71 1 46 81 62 78 119 92 121 87 70 » 52 68 32 52 34 55 41 62 1 40 42 68 36 857 695 1552 17 47 143 197 213 157 127 100 86 96 92 1 10 104 17 26.77 57 23 34 80 28 54 109.84 47.95 30.41 111.09 51.84 28.76 64 61 38.21 24.79 47.23 30.91 22.48 29.54 24.34 19 18.18 37.84 23 36 20.49 36.92 24.82 22.48 38.77 26.77 22.48 33.23 25 31 23.61 53 46 10 00 population £ Colored ) Total 42.46 29.39 31.38 20.93 31.48 Estimated population for 1883-White, 36.300; colored, 13,000; total. 49,300. NOTE-Deducting from the total mortality of this district, the proportion, according to population, of the deaths which occurred in the Luzenberg Small pox Iios pital, and adding to the total, the proportion of the deaths belonging to the district, which occurred in the Charity Hospital, Hotel Dien and City Small-pox Hospital, incrases the total mortality to 1661. and the death rate per 1000 population to 33.69 TABLE SHOWING MORTALITY FROM SOME OF THE PRINCIPAL DISEASES IN THE THIRD DISTRICT, CITY OF NEW ORLEANS, DURING THE YEAR 1883. Mortality and Sanitary History of New Orleans, 1880-1883. CCXXXV TABLE SHOWING MORTALITY FROM SOME OF THE PRINCIPAL DISEASES IN THE FOURTH DISTRICT OF THE CITY OF NEW OR LEAN DURING THE YEAR 1883. NAMES OF DISEASES. January. February. March. [ April. 1 J June. j July. August ' September. October.! November. < 1 p > Tot al. Grand Total. [ W&C \v. u. w. u. \Y . u. u. u. vy. V. \v. V. u. \v. U. w. U. w. O. w. c. W. C. Malarial Fevers 1 1 2 4 2 3 "1 9 i 1 1 "1 3 2 1 1 6 4 1 0 3 2 1 2 9 2 2 2 5 1 2 1 1 1 2 27 7 9 56 9 60 6 66 27 2 328 10 1 1 39 37 8 10 95 9 76 9 111 39 0 453 Typhoid Fever Scarlet Fever. 2 7 1 7 1 1 Small-pox 4 1 7 4 12 1 3 7 5 5 2 5 1 "Diphtheria 2 8 5 2 2 1 10 1 3 3 4 2 1 32 1 4 1 9 Diarrhoeal Diseases. 1 2 2 11 5 16 1 1 6 2 1 1 5 13 1 6 "i 6 4 1 2 7 5 1 8 0 2 i 2 16 3 45 12 Congestion of Brain Consumption 4 9 i 2 4 2 4 3 3 8 0 3 2 "2 6 1 1 30 5 1 5 2 8 2 5 Pneumonia Measles Deaths Irom all other causes 34 10 25 12 15 25 11 23 11 16 27 5 22 12 39 7 32 8 23 9 125 Total 59 24 sol 94 46 27 54 24 43 18 63 29 45 17 43 22 59 14 55 14 43 24 597 252 849 Crrand total - 83 63 73 78 61 92 62 65 73 69 67 63 18.09 32.31 ) White 21.45 36.92 14.18 36.92 16.73 41 54 19.64 36.92 15.63 27.95 22.99 44.61 16.33 26.15 15.63 33.86 21.45 21.54 20.00 21.54 15.63 36.92 17.46 23.08 Ceath n™ e I Colored per 1000 population. | Total white and colored.... 24.41 ; 18.52 21.47 22.22 17.69 27.05 18.23 19.12 21.47 20.29 19.70 18 52 20.81 Estimated population for 1883-Whites, 33,000; Colored, 7,800. Total, 40,800. Note-Adding to the total mortality of this district the proportion, according to population, of the deaths which occurred in the Small-pox Hospital, the Charity Hospital and Hotel Dieu increases the total mortality of the district to 993, and the death rate per 1,000 population to 24.33. ' J CCXXXVI Mortality uitd Sanitary History of New Orleans, 1880-1883. TABLE SHOWING MORTALITY FROM SOME OF THE PRINCIPAL DISEASES, IN THE FIFTH DISTRICT OF THE CITY OF NEW ORLEANS DURING THE YEAR 1883. DISEASES. । January, B J A c. - | April. 5s | June. 1 July. August. September. October. November, December. Total. Grand Total. W. C. w w. C. W C. w. c. W. C. W. C. W. C. W C. W. C. W. C. W. C. W. C. Malarial Fevers Typhoid Fever. Scarlet Fever. Small-Pox Diphtheria 1 4 1 1 2 .... 3 1 9 1 I 1 i 1 1 2 1 9 2 1 56 10 3 12 2 13 1 81 3 16 3 22 3 1 137 1 1 3 1 4 3 6 7 18 15 1 14 12 8 9 11 1 4 11 6 3 1 4 Diarrhteal Dise, Congestion of B Consumption .. 1 3 1 2 1 1 1 2 1 2 1 13 3 28 1 2 1 1 1 1 2 1 1 2 1 1 1 1 2 1 3 .... 2 1 1 Pneumonia IVTaraIaa. Other causes - ... * 8 4 5 1 2 2 9 3 6 4 3 4 9 3 3 13 9 4 6 1 6 4 10 4 5 3 72 37 109 Tntn.l 10 1 4 4 7 2 9. 13 17 9 11 R 19 4 26 20 4 22 9 23 a 12 45 8 9 13 12 9 12 4 23 12 5 13 9 10 .3 167 154 321 Grand tota Rate per 1000 population 1 15 4.54 36.28 18.75 White 26.54 11.16 17.50 15.85 5.58 11.25 38.49 30.69 35,00 43 02 72.56 56.25 45.26 61.39 52.69 52.07 33.49 43.75 27.54 41.86 35.00 18.11 41.86 28.75 29.02 33.49 30.00 52.07 33.49 43.75 27.54 27.89 28.75 31.51 35.81 33.43 Total Estimated population-White, 5.300; colored. 4.300; total, 9,600. NOTE-Adding to the total mortality of the district, its proportion, according to population, of the deaths which occurred in the Charity Hospital, Hotel Dien and Small-pox Hospital, increases the total mortality to 374, and the death-rate per 1000 population to 38.95. CCXXXVII TABLE SHOAVING MORTALITY FROM SOME OF THE PRINCIPAL DISEASES IN THE SIXTH DISTRICT OF THE CITY OF NEW ORLEANS DURING THE YEAR 1883. Mortality and Sanitary History of New Orleans, 1880-1883. NAMES OF DISEASES. January. । February. March. April. June. July. August , September. October. । November. December. Total. Grand Total. W. o. W. c. W. c. W. c. W. c. W. c. W. c. W. C. W. c. W. c. W. C. W. C. w, C. w&c Malarial Fevers 1 1 2 1 1 5 3 2 2 2 2 14 4 27 3 29 7 35 22 168 8 22 Typhoid Fever Scarlet Fever 2 8 2 1 4 1 1 8 1 1 2 4 2 3 4 2 i 19 io 1 14 7 1 78 4 46 3 39 8 49 29 1 246 Small-pox 1 2 o 7 1 1 1 1 3 3 1 1 Diphtheria 1 2 "7 1 1 1 11 DiaiThmal Diseases . . A 5 2 1 2 1 1 1 7 3 1 2 "1 i 5 1 1 1 1 1 3 1 2 2 3 2 1 1 Congestion of the Brain . 1 1 3 2 Consumption. .... • ••••••.. 3 i 4 2 2 3 5 5 2 2 3 1 2 1 2 Pneumonia Measles Other causes. ...... 13 ' 5 8 2 9 7 11 3 10 7 15 14 4 12 8 16 7 19 11 20 21 8 11 Total 20 6 16 9 33 18 25 12 21 11 28 11 21 8 21 10 26 14 26 15 34 13 38 309 138 447 Grand total 26 •25 51 37 32 39 29 31 40 41 47 49 1 White 18.75 16.00 15.00 24.00 30.46 48.00 23.43 32 00 19.68 29.33 26.25 29 33 19.68 21.23 19.68 16.56 24.38 37.33 24.38 37.33 31.87 34.66 35 61 29.33 24.14 30.66 neatt} e Colored per 1000 S population. 1 rpnfoi white and onlnrod 1ft 0^ 17.34 35 97 95 00 99. 19 97 05 90 19 91 .50 97 74 97.74 39.60 33.98 25.84 Estimated population-White, 12,800; colored, 4,500; total, 17,300. NOTE-Adding to the total mortality of the district, the proportion according to population, of the deaths which occurred in the Charity Hospital, Hotel Dieu and Small-pox Hospital, increases the total mortality to 527 ; and the death rate per 1000 population to 30.46. CCXXXVIII Mortality and Sanitary History of Xew Orleans, 1880-1H83. TABLE SHOWING MORTALITY FROM SOME OF THE PRINCIPAL DISEASES IN THE SEVENTH DISTRICT. OF THE CITY OF NEW ORLEANS DURING THE YEAR 1883. DISEASES. s = I February. April. ■Ann S ■3 July- X 5 September. October. 5 3 o j December. Total. Grand Total. W. c. W. C. W. C. W. C. w. C. W. c. w. C. W. c. W. C. W. C. W. c. W. C. W. C. W&C • 1 3 1 1 2 1 2 3 1 3 12 2 10 90 Typhoid Fever 1 1 1 1 2 2 Small-pox ... 2 3 1 .... .... 1 2 1 1 1 1 1 6 8 14 Diarrhoeal Diseases 1 .... 1 1 1 3 1 i 1 1 1 1 1 1 1 1 10 4 5 15 4 Consumption 1 3 1 2 1 1 2 2 o 2 .... 1 3 1 1 1 1 2 1 .... 2 1 3 8 12 8 15 16 1 1 1 Other causes 4 1 2 4 3 6 2 7 2 1 3 4 3 5 6 8 n 6 4 2 8 4 5 4 44 52 96 Total 5 4 10 8 9 3 9 6 8 5 6 12 13 7 12 7 8 17 6 8 5 91 96 187 Grand total 1 White Rate per I Colored 1000 population ( J Total 1 32 17 24 73 14 70 1 14 34 24 54 28 70 17 29.09 30.86 30.00 1 10 30 21 2 .90 .86 .18 10 20 15 90' 57 88 15 29.09 24 00 26 47 11 10 90 20.57 19.41 25 43.63 44 57 - 44.11 19 25 45 41.14 - 33 53 1 25 27 26 45 42 47 2 61 20 40 1 82 .57 59 13 29.09 17.14 23.03 27.58 27.42 27.50 Estimated population for 1883-White. 3,300; colored, 3,500; total, 6,800. NOTE-Adding to the total mortality of the district, the proportion according to population, of the deaths which occurred in the Small pox Hospital, Hotel Dietl and Charity Hospital, would increase the total mortality to 210, and the death-rat* per 1000 population to 30.89. Mortality and Sanitary History of New Orleans, 1880-1883. CCXXXIX TABLE SHOWING- MORTALITY IN THE CITY OF NEW ORLEANS DURING THE YEAR 1883 BY MONTHS, ALSO THE RATE PER 1,000 POPULATION PER ANNUM. MONTHS. Mortality. Rate Per 1,000 Population, White. | Colored. । Total. White. Colored. Total. January . 393 214 607 27.57 40 76 30 80 February .... 354 253 607 24.89 48.19 30 89 March ...... .... .... 382 352 734 26.81 67 04 37 64 April 374 339 713 26.24 64 58 36.56 Mav .... 388 278 666 27.23 52.94 34 35 June 404 250 654 28.34 47.81 33 54 July 373 199 572 26.17 37 91 29 33 August 310 211 521 21.74 40.19 26'71 September 345 223 5<>8 24.20 42.48 29.07 October '. 367 214 581 25.75 40.56 29.78 November- .. 452 226 678 31 71 43.04 34 76 December 410 212 622 28.77 40.38 31.89 Total 4552 2971 7523 ' 26.62 47.16 32.15 Note-The foregoing rate of mortality is based upon an estimated population for the citv of New Or- leans, proportioned to the ratio of increase between the years 1870 and 1880- -White, 171.000, colored. 63,000: total, 234,000. CCXL Mortality and Sanitary History of New Orleans, 1880-1883. Months. Sonali-Fox. Scarlet Fev er Measles. Typhoid Fever. Yellow Fever Malarial Fevers. Phthisis Pulmonalis. Congestion of Brain. Diphtheria. Croup. W. C. Total W. C Total 1 3 C. Total W. C. Total W. C. Total W. C. Total W. c. Total W. C. Total W. c. Total W. C. Total J anuary February March 24 48 72 52 83 149 76 131 221 4 2 5 1 1 1 5 3 6 1 1 8 4 1 4 1 2 12 3 15 16 16 3 8 16 18 24 32 45 51 57 12 23 24 57 74 81 4 2 3 2 2 7 4 9 5 6 6 1 5 6 7 3 2 3 2 April May June July August September October November December 102 80 53 44 31 12 6 15 6 159 95 96 40 36 29 11 15 8 261 175 149 84 67 41 17 30 14 3 2 3 *5 1 1 5 1 2 i i 5 2 3 1 1 1 5 2 2 6 3 1 1 2 1 1 2 8 3 1 1 2 1 2 2 1 ' 1 2 2 4 5 1 3 i 2 1 3 2 2 2 4 1 3 4 8 1 I 11 18 31 28 33 45 46 39 30 9 10 14 20 11 21 19 11 8 20 28 45 48 44 66 65 50 38 32 37 38 40 39 37 37 47 41 31 25 20 26 31 41 36 44 31 63 62 58 66 70 78 73 91 72 6 6 5 9 14 7 9 8 7 5 3 1 2 3 2 1 1 1 11 9 6 11 17 9 10 9 8 3 2 3 6 1 4 3 6 9 1 1 1 2 3 3 1 4 3 3 3 7 6 7 9 2 1 1 1 2 2 1 3 1 i • 2 2 1 1 2 2 2 3 Total for the year 493 773 | 1266 32 7 39 14 4 18 33 18 51 1 1 328 150 478 501 344 845 84 26 110 54 13 67 18 2 20 TABLE SHOWING MORTALITY FROM SOME OF THE PRINCIPAL DISEASES OCCURING IN THE CITY OF NEW ORLEANS DURING THE YEAR 1883. Mortality and Sanitary History of New Orleans, 1880-1883. CCXLI MORTALITY OF NEW ORLEANS, LOUISIANA, DURING 1883. ACCORDING TO GENERAL CLASSES OF DISEASES, ARRANGED ACCORDING TO MONTHS AND RACES. January. । February. Arch. April. June. otal 6 mos. of 1883. | Total. ■ July. 1 August. September. ' October. November. December. Total last six mos. of 1883 | Total. Total 12 mos. . of 1883. | Total. W. c. W. C. W. C. W. C. W. C. w. c. W. C. W. C. W. C . C. W. C W. C. W. C. W. C. W. C. 133 84 143 132 181 205 179 220 191 164 187 151 1014 956 1970 161 Ill 152 103 139 109 138 94 179 94 123 70 892 581 1473 1906 1537 3443 Diseases ot the nervous system.. 6C 31 49 37 48 29 54 34 50 34 73 33 340 198 538 65 30 51 39 60 32 70 46 54 27 63 33 363 207 570 703 405 1108 Diseases of circulatory system.. 18 6 18 12 23 12 19 13 22 12 14 11 114 66 180 19 9 13 13 14 20 21 12 24 12 22 16 113 82 195 227 148 375 Diseases of the digestive system . 48 24 33 . 8 32 20 30 20 55 18 64 11 262 101 363 55 18 36 15 45 20 53 21 89 31 75 20 353 125 478 615 226 841 Diseases ot respiratory system . Diseases of the urinary and gen- 55 36 42 41 55 40 28 24 20 20 14 13 212 174 386 15 5 15 8 34 15 22 13 37 18 53 31 176 90 266 388 264 652 erative organs . Affection connected with parturi- 17 4 19 2 6 6 7 5 9 9 9 7 67 • 100 6 5 6 10 10 5 13 3 9 4 13 11 57 38 95 124 71 195 tion .... 2 1 3 1 1 2 1 4 1 2 13 18 5 1 4 3 2 1 1 2 2 4 1 19 7 26 32 12 44 Diseases of organs of locomotion . Diseases of the cellular and cu- I 2 2 3 1 4 9 1 3 1 1 1 1 1 1 4 6 10 9 10 19 taneous system Conditions not necessarily asso- ciated with local or general 1 1 •• 3 1 1 2 5 7 1 1 1 1 2 2 1 2 6 5 11 8 10 18 diseases 38 18 37 14 20 27 34 11 26 13 26 17 181 100 281 27 13 17 12 28 11 32 13 39 25 41 25 184 99 283 365 199 564 General Injuries 9 5 5 4 7 7 11 7 3 3 9 4 44 30 74 8 1 9 6 8 4 9 3 11 3 1 48 20 68 92 50 142 Local Injuries 4 1 2 1 1 2 2 1 2 12 4 16 2 2 1 1 4 2 i 2 1 9 7 16 21 11 32 Human Parasites 1 1 1 1 1 Tumors, non-malignant • .... Congenital malformations 1 1 1 1 2 1 1 1 1 2 2 3 5 8 4 • 6 10 2 2 j 2 2 1 7 3 10 5 1 2 2 2 2 1 1 1 2 14 5 19 21 8 29 Suicides 2 2 1 5 3 1 4 2 18 •2 20 1 J 2 3 2 6 3 9 24 5 29 Killed or murdered Total 393 60 214 7 354 6( 253 7 1 382 71 i 352 14 2 374 7 1 339 13 388 61 2 278 56 404 6 250 >4 3 2295 39 - 1686 81 7 1981 1 373 5' 1 199 ■2 31C| 211 521 1 345 51 223 58 2 367 5 i 214 =1 452 6' 226 18 6 410 6' 212 >2 10 2257 4 1285 14 1542 13 4552 8 2971 21 ^23 Mortality and Sanitary History of New Orleans, 1880-1883. CCXLII DISEASES. Under 1 year.| | 1 to 2 years. 1 1 2 to 5 years. i 1 | 5 to 10 years. 10 to 15 years. 15 to 20 years. 20 to 30 years. 30 to 40 years. 1 | 40 to 50 years. 1 | 50 to 60 years. 1 60 to 70 years. 1 70 to 80 years. 80 to 90 years. 1 | Above 90 yrs. 1 | Total. 1 I Grand Total, | Whites and Col'd W.| C. W. C. W. C. W. C. W. C. W. c. W. C. W. c. W. C. W. C. W. C- c, W. C. W. C. W. C. Yellow Fever 1 1 1 Malarial Fever .... Typhoid Fever 23 15 9 15 21 1 16 1 15 2 16 5 6 4 13 1 10 7 5 62 8 22 6 60 8 12 2 49 3 10 2 46 7 17 9 8 5 1 2 5 3 28 33 150 18 478 51 Scarlet Fever Measles Dyptheria 2.... 2 3 9 2 6 1 1 1 6 5 30 3 6 9 4 11 2 1 1 1 i 1 "i 1 1 1 2 2 1 1 1 .... 1 1 .... 32 14 54 7 4 13 39 18 67 Small Pox 43 44 27 46 67 121 75 127 30 50 41 72 81 155 53 77 43 41 21 24 8 9 3 3 2 1 2 493 773 1266 Diarrhoeal Diseases Congestion of Brain Phthisis Pnlmonalis 130 37 16 1 1 1 37 10 20 3 2 23 5 1 14 2 3 8 4 2 5 2 6 2 4 1 1 1 5 5 17 6 1 25 26 5 129 10 "94 36 9 139 12 4 86 39 7 92 28 "63 58 6 58 17 7 36 47 10 45 9 4 15 30 4 15 11 6 7 1 1 3 1 2 1 2 449 84 501 174 26 344 623 110 845 Pneumonia Bright's Disease Cancerous Diseases 31 26 11.... 22 2 14 2 10 1 .... 11 10 1 3 1 2 1 8 1 6 1 8 2 18 16 1 20 10 1 18 17 5 12 5 30 22 18 13 8 12 20 18 24 12 12 5 20 17 21 10 7 4 14 5 8 6 6 4 3 1 2 2 1 i 2 1 204 104 80 146 58 32 350 162 112 Suicide Sunstroke 1 4 3 2 5 2 6 1 2 3 24 5 29 1 2 2 •• Total .... 249 127 124 105 170 177 142 169 55 80 93 120 352 323 75; 218 311 179 258 121 188 67 90 42 17 15 3 8 2405 1751 4156 MORTALITY FROM SOME OF THE PRINCIPAL DISEASES IN NEW ORLEANS DURING THE YEAR 1883, CLASSIFIED ACCORDING TO AGE AND COLOR. Mortality and Sanitary History of New Orleans. 1880-1883 CCXLIII MORTALITY FROM SOME OF THE PRINCIPAL DISEASES IN THE CITY OF NEW ORLEANS DURING THE YEA# 1883, CLASSIFIED ACCORDING TO NATIVITY. NATIONALITIES. Yellow Fever. | Malarial Fevers, Typhoid Fever. Scarlet Fever. Measles. Dyptheria. | Small Poor. 1 Diarrhoeal Diseases. 1 Congestion of Brain. Phthisis Pulmonalis. 1 Pneumonia. | Bright's Disease. Cancerous Diseases. Suicides. 1 Sunstroke. Austria-Hungary Belgium.... British America China Denmark France Germany Great Britain (including Ireland).. 3 7 2 13 44 59 2 1 4 3 1 1 3 1 15 36 6 1 1 2 2 19 55 60 1 2 10 10 3 2 3 35 77 88 1 i 14 24 27 2 4 15 22 1 10 22 18 5 6 1 1 Holland Italy Louisiana Mexico Norway and Sweden Portugal Bussia South America Spain Switzerland United States (not Louisiana).... 1 3 14 254 1 3 3 6 1 62 3 35 3 35 3 17 1 65 1 3 1011 S 1 2 1 181 21 359 "a 4 1 90 69 2 "15 9 443 2 2 i 8 2 166 ' 6 217 2 4 1 51 "68 1 ' 1 1 1 46 2 23 2 2 30 "9 1 7 " i 4 . . . 1 West indies •• 3 .... 4 6 1 4 2 1 2 .... 2 Total 1 478 51 39 19 67 1266 623 11C 845 356 162 112 2S 1 5 CCXLIV Climate and Health of Louisiana : Joseph Jones, M. D. Observations on the Climate and Health of Louisiana. AND MORE ESPECIALLY UPON THE RELATIONS OE THE CLIMATE OF NEW ORLEANS TO EPIDEMIC AND ENDEMIC DISEASES. By climate we mean everything which relates to the physics and chemis- try of the air in which we live, which not only continually flows into our blood, but also alters the conditions of our existence, and the state of bodily health, by its variations of chemical constitution, of temperature, of moisture and of electrical ami chemical forces. The conditions of heat, rapidity of motion, weight and moisture in the atmosphere, are so important in their relations to agriculture, commerce and health, that institutions have been established all over the world for measuring the frequent variations. The discovery of oxygen by Priestley, laid the foundation for the estab- lishment upon a firm foundation of the chemistry of the earth's atmos- phere ; he believed that he had found the variations to be equal in amount to 6 per cent; Scheele found from 20 to 30 per cent, and others still greater variations; but Cavendish, who made 500 analysis, showed that the dif- ferences in the composition of the air of various localities were very small,and arrived at the conclusion that 20.833 per cent of oxygen is the mean amount, and that the composition is constant. Gay-Lussac and Humboldt after many experiments which gave from 20.9 to 21.2 per cent of oxygen, settled on a mean of 21.0; Gay-Lussac gave as a mean of the air from mountains and from Paris 21.49; DeSaussure examined the air at Chambeisy and found a mean of 21.05 ; Bertholet 21.05, Thom Thompson 21.0 ; Davy 21.0 ; Vogel on the Baltic 21.59 ; Hermbstadt on the Baltic 21.5; Dalton at Manchester from 20.7 to 21.15; Doyere found from 20.5 to 21.5; Regnault gave as the result of 100 analyses of the air of Paris, variations from 20.913 to 20.999, with a mean of 20.96 from Lyons from 20.918 to 20.966, from Berlin from 20.908 to 20.998, from Madrid 20.916 to 20.982, Geneva and Switzer- land, 20.909 to 20.982, Toulon and Mediterranean 20.912 to 20.982, Atlantic ocean 20.918 to 20.965, Ecuador 20.960, Pichincha, higher than Mount Blanc, 20.949 to 20.981; mean of all the analyses of Regnault 20.949 to 20.988 ; Bunsen in his numerous analyses of the air of Heidelberg, found the maximum to be 20.970, low'est 20.040; mean 20.924. Dr. Robert Angus Smith, from a careful examination of the analyses of the preceding and other chemists, as well as from his own extended observations, regards the average composition of the atmosphere in 100 volumes to be: oxygen 20.96, nitrogen 79.00, carbonic acid 0 04. Analyses of the air of impure places show deviations from the numbers found on analysing fresh air. Thus, according to Configliachi, the air of rice fields contains 20.08 per cent of oxygen, of crowded places 20.3; ac- cording to Regnault, air of Toulon Harbor 20.85, of Algiers20.42 to 20.395 of Bengal Bay, over bad water, 20.387 ; according to Robert Angus Smith, in the middle of Manchester, 20.179 to 20.868; air from closets or midden behind laboratory 20.70 ; London, mean of air from various places, 20.857 ; Glasgow 20.889 , marshy or confined places, Switzerland, 20.937 to 21.01. It is evident from the preceding facts, that the variations in the amounts of oxygen in the atmospheie under various circumstances, of elevation, and crowding, are not sufficient to establish any connection between them a fid the origin and spread of contagious diseases^ Climate and Health of Louisiana : Joseph Jones, M. D. CCXLV With reference to the relations of the active state of oxygen ('ozone), to the origin and spread and arrest of epidemics ; it must be admitted that: 1. The estimation of ozone, is in an unsatisfactory state, because other substances, besides ozone, act on the iodide of potassum, especially nitrous acid, which is lormed in some quantity during electrical storms ; the papers cannot be put under the same conditions from day to day; supposing that iodine is set free by ozone, a portion of it is at once changed by additional ozone into iodozone, which is extremely volatile at ordinary temperatures, and hence a portion of the iodine set free never acts on the starch; and finally, because the ozone may possibly act on the starch itself. 2. The substance giving the reaction of ozone is neither deficient in marshy districts, nor when ozone is conducted through marsh dew does it destroy the organic matter; and there are are no experimental proofs that it acts on the organic impurities of respiration. 3. There is no weight of evidence to prove that deficiency in ozone has assisted the spread of epidemics of any of the specific diseases, or that excess has checked them. The facts, however, that the reaction with SchOonbein's or Moffat's pa- pers is greater in pure than in impure air, at the seaside than in the interior, that ozone is often absent from hospital wards, though present in the air around them, that it is greatest when the barometer, the mean daily tem- perature, and the dew-point are all high, should lead to farther and more numerous experiments ; but they do not warrant the assertion made by some writers, that the cessation of epidemics of cholera, malarious fevers, and even yellow fever, has been due to currents of air bringing ozone with them; neither do they sustain the assertion that the accumalation of ma- laria at night is due to the non-production of ozone by the suns's rays, and that the effects of stagnant air in increasing epidemics is due to the absence of ozone. The effects of the variations of positive electricity on health, and on the origin, spread and intensity of diseases, are unknown ; and beyond the fact that free electricty appears to be less during the prevalence of certain epi- demics, as that of 1878, in New Orleans, all else is pure speculation. No theory of the causation of disease has yet embraced the considera- tion of the neutral gas, nitrogen ; but carbonic acid, sulphuretted hydrogen, carburetted and phosphuretted hydrogen, and various volatile substances which constitute odors and vapors, nitrogenized organic matter, organized and living matter, have been considered as active agents in the production of disease. The variations of carbonic acid and of sulphuretted hydrogen are, with- out doubt, most marked in crowded cities and in mines, and whilst both these gases are evolved from putrifying organic substances in increased amounts during the heat of summer, there are no facts to show that such increment is in any manner connected with the development and spread of such a disease as yellow fever. The effects of these gases are best studied in mines, in which when the quantity of oxygen falls under 13 per cent and is too small for the process of respiration, or when the carbonic acid amounts to 7 per cent, with sev- eral per cent of sulphuretted hydrogen and miasms of a peculiar kind, they communicate to the atmospheric air a property which is often very dan- gerous. As the venous blood possesses a greater affinity for the oxygen than the carbon of combustible substances, a man can replace the loss of oxygen by frequent breathing, and therefore can live when candles and mine lamps go out. As neither the combustible material nor the venous blood can remove all the oxygen from the air. but rather diminish it to 18 CCXLVI Climate and Health of Louisiana : Joseph Jones, M. D. and at most to 12 per cent, it follows that atmospheric air, the oxygen of which is to a certain degree diminished, acts towards men and candles like pure nitrogen. In an atmosphere poor in oxygen there is felt, not so much as a consequence of the presence of nitrogen as the absence of oxygen, constriction of the chest, tickling of the eyes, fatigue, weakness and anxiety; the breathing becomes more heavy and frequent, and the laborer is com- pelled to make more exertion at work, whilst perspiration and thirst ensue. If the laborer be continually subjected to such agencies for considerable periods of time, there will be induced, in addition to the rapid breathing, paleness, anaemia, debility, hardening of the glands, herpetic eruptions, loss of power in the extremities, and early asthma. We exclude, therefore, from the consideration of tlie causation of yellow fever, the variations of the amounts of oxygen, ozone, electricity, nitrogen, carbonic acid, carburetted and phosphuretted hydrogen in the atmosphere; for such variations are more marked and frequent in localities in which yellow fever is unknown. The organic, organized and living matters of the atmosphere, therefore, demand the first consideration ; and in the second place, the moisture and temperature of the atmosphere ; and in the third place, the force and direc- tion of the winds, and the amount and intensity of the electrical actions; and in the fourth place, the variations in the chemical constitution of the atmosphere, and the effects, the variations of ozone and of the established and extraneous, or what may be termed adventitious and abnormal consti- tutuents of the atmosphere. The thorough discussion of the preceding subjects, even if the proper data were at hand, would swell the present division into the magnitude of a volume; and we must delay to some future time the consideration of the minute history of the meteorological characters and differences of epidemic and non-epidemic years. The great problem of interest is : can climatic conditions in New Orleans cause or engender, de novo, certain infectious diseases, SL^yellow fever * If they cannot, then the protection of this city or valley from yellow fever lies in a rigid quarantine, supplemented by thorough disinfection and sanitation. CLIMATE AND HEALTH OF LOUISIANA. ASTRONOMICAL POSITION. Between latitudes 28° 55' and 33°, north, and longitudes 11° 38', and 17° 21' west, from Washington; and 88° 40z, and 94° 23', from Greenwich. DIMENSIONS. The extreme length of the State, east and west, is 290 miles ; area, 41,255 square miles. The longest line that can be drawn in Louisiana is from the mouth of the Mississippi to the northwest angle in Sabine, 380 miles. SURFACE. There is not, perhaps, on earth a continuous tract of equal extent pre- senting a greater diversity than Louisiana. Within its limits are included all the varieties, from the most recent and still periodically inundated alluvium, to hills approaching the magnitude of mountains ; every qualify of sMl, from the most productive to the most sterile, and from unwood* d plains to dense forests. UI the southern part of this State is an alluvial tract of low champlain co -! ry. extending from Lake Borgne to Sabine river, and from the Gulf ol Mexico to Baton Rouge and Bed River-about 250 miles long, and from 70 to 140 wide. This extensive tract is intersected by numerous rivers, Climate and Health of Louisiana : Joseph Jones, M. I). CCXLVII b^ys, creeks and lakes, dividing the country into a great number of islands. A large extent of country in Louisiana is liable to be overflowed by the Mississippi. According to Mr. Darby, the accurate and learned and ac- complished surveyor, the average width of overflown lauds above Red River, from latitude 31° to 33° north, may be assumed at twenty miles, equal to 2770 square miles. Below latitude 31° to the efflux of the La- fourche, about eighty miles in extent, the inundation is about forty miles in width, equal to 3200 square miles. All the country below the efflux of the Lafourche is liable to be inun- dated, equal to 2370 square miles. From this calculation, it appears that 8340 square miles are liable to be inundated by the pverflowing of the Mis sissippi; and if to this be added 2550 square miles for the inundated lands on Red River, the whole surface of the State liable to inundation will amount to 10,890 square miles. Of this extent, however, not one-half is actually covered annually with water; and every year, by the extension of levees and by the deepening of the mouths of the river, the area of culti- vated land is becoming greater, and that subject to overflow less. The immediate banks of the Mississippi River and its tributary streams are seldom, and many of them never, inundated, and they afford strips of arable land from one mile to two miles wide, of unsurpassed fertility, pro- ducing the great sugar and rice crops of Louisiana. The water of the lakes, as well as that of the Mississippi River, moderate the intense heat of summer and the severe cold of winter, and the residences of the planters on the banks of the streams are noted for their elegance, comfort, thorough ventilation and healthful climate. From its southern latitude, it might seem reasonable to expect in Louis- iana a very warm climate, and this has been reckoned upon to a greater extent than experience justifies. The winters are in fact more severe, and the mean temperature lower, than in higher latitudes, by 2° on the At- lantic. In reality, as far as vegetation can decide the question, the seasons may be considered milder at Charleston, South Carolina, latitude 32° 42', than at New Orleans, in latitude 30°. We will, however, consider this subject of the influence of the togograph- ical and geographical situation of Louisiana on her climate more fully here- after. Col. S. H. Lockett, for many years the able and accomplished Professor of Engineering in the Louisiana State University, who traveled over all the parishes of this State in search of data for his excellent topographical map of Louisiana (various journeyings amounting to more than 4000 miles within the limits of the State), thus classifies the surface of Louisiana : "Lands within the limits of Louisiana, including coast marshes, 40,700 square miles; inland water coast bays 2328 square miles; total, 43,028 square miles. There are two general divisions of the lands of the State, the hill and the level lands; hilly lands, 12,332,920 acres; level lands, 12,773,000 acres ; total, 26,105,600. These lands may be classed as follows : Good uplands, 5,298,000 acres ; pine hills, 5,497,600 ; bluff lands, 1,587,320; prairie region, 2,483,000; arable alluvial land, 3,615,00 ; wooded alluvial lands, 2,752,000 ; pine flats, 1,585,000 ; coast marsh, 3,338,000 ; inland water surface, 1,228,000 ; coast bays, 1,100,000. As it is situ- ated at the mouth of the greatest river on the continent, and con- tains within its limits the delta of this river, intersected by num- berless lesser rivers and bayous, and filled with lakes, most people conclude that Louisiana is, throughout its entire extent, a low, wet, swampy region. They imagine its surface to be a great plain of wonderful fertility, when at all arable, with an indefinable succession of deep jungles, CCXLVIII Climate and Health of Louisiana : Joseph Jones, M. D. tangled swamps, marshes, lakes, sloughs, cane and cypress brakes. But these misconceptions will be speedily dissipated by a journey into the in- terior, and it will be discovered that few States of the Union possess a greater diversity of surface, soil, climate, scenery and products than Lou- isiana, and no State has a more varied and interesting population, or a more eventful history." EFFECTS OF THE RIVERS, LAKES, BAYS, AND OF THE GULF OF MEXICO ON THE CLIMATE OF LOUISIANA. As the melting of a given quantity of ice requires as much heat as would be needed to raise the temperature of a sixty-three times greater mass of water one degree of Reaumur ; and as when boiling water assumes the form of vapor, there is required in this process and the formation of vapor of equal temperature, as much heat as would be required to raise the temper- ature of a 430 times greater mass of water one degree of Reaumur, it is evident that enormous quantities of heat must be absorbed at the base of the atmosphere in the process of the thawing of ice and the evaporation of water. When the water is reconverted from the higher to the lower form of aggregation, the heat so absorbed is again given out. And as the for- mation of clouds takes place principally in the higher parts of the atmos- phere, the latter resembles in some degree a steam engine, having its con- denser above. The decrease of temperature with increasing elevation is much lessened. At the same time, the clouds formed at a definite height intercept the sun's rays, and at such times the heat-which in clear weath- er is produced in far the largest amounts at the bottom of the atmosphere -is received instead in its higher portions. The reverberation from the ground as a second source of atmospheric heat, depends on the character of the surface; and the formation of dew teaches us what small differences are influenced in this respect. In regard to the warming of the air by contact with the earth, it is to be observed that a liquid surface is continually renewed, inasmuch as every depression of temperature causes the water at the surface, which by cooling has be- come denser and heavier, to sink down and make way for the warm water which rises from below to replace it; and this goes on until the density of the fluid makes it the same throughout its entire depth. It is thus that the depths of the sea are deprived of the temperature which they would have if they were as far beneath a liquid surface, be- cause the process of evaporation, or the conversion of parts of the water into vapors, employs heat, which if the surface were land would be given directly by contact to the adjacent air. The large masses of water in Louisiana, therefore, moderate the heat of summer and the cold of winter, and thus give to this State the advantages of an insular climate. The climate of Louisiana resembles in many respects that of the Missis- sippi valley. George Preston, in 1794, was the first who decidedly controverted the assumption that America was everywhere much colder than Europe under the same latitude. "It seems to us," he said, "as if there was some ex- aggeration in this sweeping assertion. The interior of North America, be- yond the Alleghanys, en joys a far milder climate than the east coast of the same latitude. The wild rice, which will not ripen on the south shore of Lake Superior, grows abundantly and brings its seed to maturity above Lake Winnepeg, nearly five degrees further to the North. Hearne and Mackenzie in their journeys to the interior, found the country clothed with forest to latitude 68°, and forests do not extend further North than this in Europe." Mortuary Records of New Orleans, by the Month and by the Year, for Four Years-1853, 1858, 1867, 1878-in which Yellow Fever Prevailed with the Greatest Severity in the Annals of this City. Consolidated from Original Reports and Records, Collected by Joseph Jones, I)., New Orleans, Louisiana, United States of America, No. 156 Washington Street, corner Camp Street, Fourth District, January 1, 1882. GENERAL DISEASES. Small-pox ami Varioloid Measles Scarlatina Typhus Fever Cerebro Spinal Fever Enter ic or Typhoid Fever Simple Continued Fever - - • Yellow Fever Gastric Fever f Intermittent Fever 1 Remittent Fever Malarial Fevers s Congestive Fever Typh o-Malarial Fever (Malarial Fever (unclassified) Cholera, Malignant or Asiatic. Cholera Morbus... Cholera Infantum Diphtheria - - - Whooping Cough Erysipelas Pyaemia Puerperal Fever Rheumatism Syphilis Cancer , Scrofula T11 bercul ar Menin giti Phthisis Pulmonalis Tabes Mesenterica Diabetes Pickets Anaemia General Dropsy Gout Influenza. Scurvy . All other General Diseases not enumerated LOCAL DISEASES. Diseases of the Nervous System. Congestion of the Brain ' Inflammation of the Brain (Encephalitis) Meningitis Apoplexy Sun-Stroke Hydrocephalus - Diseases of the Cerebral Arteries Spinal Meningitis Myelitis •••• Hamieplegia Paraplegia Paralysis (unclassified) Locomotor Ataxia ( Unclassified Tetanus < Idiopathic ( Traumatic Trismus Nascentium Hydrophobia Convulsions Convulsions Infantile Epilepsy Hysteiia Delirium Tremens and Intemperance Insanity - - Paralysis of the Insane All other Diseases of this System. Diseases of the Circulatory System. Pericarditis - - Dropsy of the Pericardium Endo-Carditis Heart Disease (valvular). , Heart Disease (Unclassified) Heart, Enlargement of. - Aneurism. Aneurism of the Aorta Embolism of Heart Phlebitis All other Diseases ot this System Diseases of the Respiratory System. Croup Laryngitis Oedema of Glottis - - - Bronchitis Asthma Pneumonia Abscess of Lungs • Gangrene of Lungs Emphysema of Lungs Haemop tisis Pleurisy Empyema Haemorrhage of Lungs All other Diseases of this System Diseases of the Digestive System. Haematemesis Stomatitis Teething Ulcerative Sore Throat Thrush Tonsilitis Gastritis Enteritis Dysentery Ulceration of the Bowels Haemorrhage of the Bowels Intussuseption of the Bowels Obstruction of the Bowels Diarrhoea Hernia (Class Stated) J 1853 2 1 20 15 13 i 2 1 9 *8 25 2 3 "i 6 " 73 9 7 5 10 3 10 22 9 3 2 8 1 7 3 3 4 11 21 23 4 2 2 4 ANW 1858 16 ' 13 4 9 1 "*4 1 5 2 1 1 58 7 io 1 4 1 2 12 1 4 1 24 28 3 12 16 14 18 1 3 1 3 4 14 10 1 1 1 1 4 VRY. 1867 9 i 3 8 3 3 3 1 2 2 2 "4 40 8 2 3 1 2 4 29 2 11 3 1 14 1 10 48 1 1 1 1 14 9 11 3 1 1 3 2 1 1878 13 2 1 3 4 3 3 1 3 11 1 65 5 3 11 2 '' 2 .... "'1 "'ii 4 2 2 2 1 2 5 3 8 4 14 33 2 2 3 1 4 1 6 4 2 12 1 7 3 7 I 1 1853 6 4 24 9 7 1 4 'b 3 1 2 1 1 1 1 70 3 ■ 9 3 3 4 11 2 1 9 16 1 5 4 5 2 3 1 11 25 1 2 3 11 16 11 ""4 ! 6 'EBRI 1858 14 7 12 4 '1 • 1 6 43 12 1 10 2 6 1 3 2 3 2 10 26 6 2 1 8 15 1 26 6 1 4 10 4 4 2 2 1 3 I ARY 1867 13 1 6 "4 1 1 3 2 1 1 4 4 4 3 3 ' "13 15 1 ii -yr 8 13 3 34 1 1 3 6 8 378 ___ 20 2 1 3 4 1 "4 1 1 3 3 11 1 2 4 1 6 4 i l3 1 4 3 1 3 -12 4 1 3 2 1 1 7 1 2 4 1 6 ' 1. 2 I 2 3 1 6 8 7 2 2 1 1 1 6 1853 MAR 1858 18 3 7 15 1 6 1 1 1 2 3 1 1 5 ' 16 1 9 2 2 6 1 10 12 4 4 3 17 1 2 7 4 1 10 12 CH. 1867 1 5 4 2 9 1 4 2 2 2 1 1 65 6 3 3 1 9 1 1 1 19 1 17 4 8 1 1 1878 52 1 1 0 1 3 7 4 2 3 3 2 2 6 77 14 1 4 12 1 i 2 3 1 i i 3 1 1 6 20 1 4 3 1853 2 20 17 7 17 2 1 9 ii 3 2 1 3 66 1 4 7 8 12 13 3 1 8 38 3 1 "io 1 API 1858 15 10 1 8 13 1 1 3 2 5 78 25 5 5 3 1 2 28 1 1 □ 14 IL. 1867 6 1 2 3 1 4 3 1 1 1 i si 1 4 3 3 9 1 4 15 8 2 4 1 1 1878 31 1 1 2 6 1 8 10 1 66 13 2 3 10 3 1 1 1 1 3 9 12 1 1 4 1 4 4 6 1 3 2 1 1 35 1 1 2 18 9 3 12 1 4 1 4 1 3 14 1853 3 53 25 12 13 15 2 2 1 4 4 14 8 8 5 3 4 8 8 42 1 1 8 3 2 15 1 3 24 18 26 43 4 1 3 MA 1858 11 11 1 13 1 3 18 1 3 2 74 19 1 6 1 15 10 1 1 1 '"13 34 1 10 5 1 7 13 8 1 18 3 1 1 1 23 3 27 19 4 1 8 2 1 3 4 uY. 1867 6 2 3 1 10 11 1 4 10 10 1 6 10 13 1 3 1 16 1 1 2 5 i 17 12 2 1 I 1878 12 7 4 3 4 1 4 4 20 3 1 1 1 6 68 16 1 7 4 1 1 6 5 0 1 1 15 1 3 1 1 1 1 4 5 19 1 3 1 1 1 25 17 14 6 1 1853 2 30 13 31 2 23 14 14 3 2 1 i 3 49 15 10 10 10 4 1 5 53 2 ""ii 2 1 6 11 'i 6 ""12 ^4 26 "*24 ! 1 4 10 JUJ 1858 6 1 2 1 7 12 1 2 29 1 3 1 3 3 46 26 1 8 10 4 c 9 4 "ji 46 3 g 4 1 i iii.'ii 9 1 1 1 iiiiii .31 35 23 1 31 1 i 4 4 IE. 1867 5 1 1 11 3 1 1 26 4 14 1 3 1 54 16 1 2 12 4 7 10 24 3 1 3 6 1 8 "17 1 3 " " io 1 2 40 23 1 '"4 "1 "1 3 1878 18 3 1 1 4 3 13 1 13 6 1 2 1 "11 108 1 5 2 11 1 1 4 8 12 3 13 1 3 1 1 17 I 1 3 8 8 28 1 i 1 1 5 1 20 1 18 4 1 1 4 12 1853 JUI 1858 7 11 15 132 1 2 36 17 3 12 6 3 2 3 8 1 17 2 4 1 1 13 1 15 13 11 5 9 18 37 2 4 0 1 13 1 1 6 7 13 1 1 24 1 4 28 33 1 1 37 8 1 4 Y. 1867 1 2 1 4 1 11 6 9 39 36 6 11 2 3 2 20 1 1 11 6 3 15 12 3 20 6 8 1 1 1 2 1 12 1 1 2 12 32 23 1 19 2 1 1 "i 1878 4 3 1853 1 1 1 13 21 AUG 1858 * 3 "'4 3 26 UST. 1867 1 1 1 255 9 17 4 12 25 102 6 39 12 6 4 3 1 9 53 17 3 3 21 12 6 11 3 6 19 20 3 38 5 2 14 1 4 2 1 10 1 16 1 25 29 1 3 1 1878 s 1853 1 1 24 EPTE 1858 2 2 31 MBEI 1867 1 4 9 16 20 10 1,637 ii 27 152 15 15 4 5 2 1 3 10 64 15 3 3 2 1 4 8 1 4 " 2i ■"24 29 27 4 4 1 12 1 1 4 *32 1 3 9 0 24 11 2 25 ' 4 "2 '8 1 1878 1853 OCTC 1858 4 -7 6 i7 )BER. 1867 1878 1853 NOVE 1858 2 1 20 MBEI 1867 ► 1878 1853 DECE 1858 8 1 3 1 16 3 7 1 3 1 12 1 1 2 6 69 8 1 7 1 2 10 3 8 2 3 6 22 1 22 1 15 2 4 1 12 *8 2 46 "2 1 1 9 3 10 20 1 24 1 4 2 MBEI 1867 1878 TOIL 1853 17 123 126 103 146 7,849 38 29 263 90 585 35 7j 44 18 15 12 6 24 17 755 121 84 111 134 61 133 21 24 15 49 144 6 465 13 123 is 19 9 41 41 35 6 "bi 7 184 10 42 143 '"37 231) 270 "'267 "38 6 4 "24 20 45 IL F EA 1858 108 7 79 20 "i89 4,855 22 20 369 69 26 14 108 95 28 15 7 15 16 58 17 779 201 1 12 101 4 1 3 11 156 17 100 114 20 40 24 "53 222 7 521 20 1 129 3 30 8 2 87 13 5 "2 126 106 11 276 3 7 9 1 17 189 13 48 228 229 20 2 1 297 3 65 15 9 6 21 1 35 IR CH A 1867 47 2 24 23 52 119 22 3,107 1 51 110 545 45 581 46 100 31 28 9 6 11 16 12 63 10 671 161 1 I 26 42 4 .3 4 160 43 91 6 i 37 ias 246 2 68 270 19 2 37 49 5 3 3 110 8 4 1 3 *8 46 1 103 20 317 1 6 ib "is 24 107 4 1 '"bi 254 180 5 6 1 205 2 40 10 10 2 6 25 LEAR. 1878 151 3 1 23 24 44 14 4,016 30 128 355 23 241 " ib 79 59 11 19 13 16 15 115 5 10 880 166 2 29 46 1 7 155 18 73 112 2 14 10 35 3 11 6 32 2 4 2 48 177 6 88 175 14 33 7 1 36 10 3 14 51 148 20 1 2 2 1 6 37 18 3 191 27 343 3 4 22 18 6 5 5 86 bi 187 120 4 6 10 170 4 65 15 38 i 6 26 9 17 107 Total FOR 4 YEARS. 1853 1867 1858 1878 323 135 230 169 76 498 36 19,857 1 141 287 1,532 23 445 1,192 111 362 185 100 53 25 46 59 49 260 49 10 3,085 649 4 3 67 273 9 1 6 22 582 212 291 450 49 78 10 35 3 11 7 108 2 234 2 48 789 14 628 966 66 3 322 10 1 133 42 6 14 65 386 41 4 2 19 2 3 55 244 25 3 494 65 1,120 7 17 5 22 50 7 35 76 5 7 525 17 1 1 137 899 799 29 12 13 1 939 9 208 40 63 5 9 37 1 110 29 141 125 11 20 11 3 1 6 2 1 1 2 ' 73 3 4 1 6 ...... 8 3 ::::: 4 4 1 7 1 19 10 1,521 6 43 12 5 8 6 1 3 1 15 12 8 7 21 7 3 14 44 4 14 1 1 1 3 2 11 3 20 30 34 1 3 4 1 '4 10 4 1 12 10 4 1,7-0 9 35 ' 103 2 80 1 3 1 1 1 6 89 25 3 6 2 29 13 2 2 2 1 16 19 30 4 3 1 1 14 1 1 1 1 10 26 2 1 2 12 3 15 11 1 1 14 1 4 1 * 1 2 6 1 7 4 26 3 1,072 8 31 140 12 37 3 3 1 2 1 3 4 3 60 17 3 2 35 7 9 23 28 3 53 1 1 6 1 4 2 13 34 1 14 2 31 17 1 25 4 1 1 3 6 6 1 1,065 2 22 87 1 2 1 1 1 11 59 14 3 4 27 1 6 1 4 2 3 20 13 16 1 4 1 2 1 19 1 4 1 10 10 2 1 4 3 10 8 ... iiiiii 8 8 3 2 1 1 2 1 4 8 i 4 u 4 103 4 11 38 1 234 8 22 3 1 1 1 2 1 7 1 72 28 3 4 17 1 1 8 18 io 6 29 3 6 8 1 1 3 " "ii 20 2 "is ''' io 28 3 22 2 2 "1 1 2 1 1 4 147 2 12 26 1 14 4 7 1 3 1 1 13 89 13 2 4 4 6 2 6 10 1 4 1 1 1 1 4 22 1 17 1 6 1 14 1 3 1 8 1 35 1 1 ii 5 17 8 1 15 6 i 1 1 2 6 "4 7 13 4 3 332 7 9 4 1 1 1 62 11 9 12 5 3 12 3 3 ib 2 26 1 9 4 4 2 6 2 12 1 1 15 "22 23 "24 0 2 2 8 26 1 1 18 1 210 10 14 4 1 i 4 1 3 57 11 1 3 9 2 6 7 6 28 3 17 3 1 4 1 10 1 4 *4 2 33 1 3 26 12 is "4 "2 1 1 2 i 3 3 3 2 i 6 6 2 1 9 47 9 1 2 4 "2 4 i 14 2 13 1 1 1 3 14 1 2 1 "b 2 26 1 1 2 8 2 1U 7 1 io 1 5 26 10 23 12 3 7 1 3 13 60 2 4 11 1 4 13 1 1 1 2 3 17 7 II 3 1 3 1 2 15 1 12 1 1 14 1 13 1 2 20 3 1 1 1 12 5,133 io 79 ib 1 8 1 2 1 4 1 60 12 10 21 35 10 17 i 1 3 is 1 107 1 13 4 2 1 10 1 15 "37 16 25 *4 1 4 2 1,140 1 57 16 6 8 13 3 1 3 2 3 54 11 8 27 2 11 13 8 4 J 7 20 1 65 2 11 2 8 1 :::::: 14 6 1 17 1 1 27 5 8 24 17 2 35 1 "i 1 1,025 8 31 89 8 41 2 10 4 1 3 1 9 '88 18 7 33 1 1 2 3 1 4 1 6 14 3 17 26 2 2 3 1 7 12 1 1 1 6 18 3 1 1 19 8 25 18 2 1 3 1 10 982 1 3 61 3 4 9 1 2 1 1 9 12 27 8 3 2 25 39 2 15 3 8 8 1 17 20 14 14 4 1 i 2 3 2,204 8 123 10 1 8 21 6 1 2 2 73 16 1 17 1 2 28 4 19 1 io 24 92 1 17 3 8 1 2 6 7 24 4 18 29 13 1 1 38 13 2 1 3 3 147 1 1 16 8 6 4 8 1 1 1 60 15 13 10 4 1 4 1 1 15 26 1 1 8 1 4 1 3 10 3 14 1 19 29 1 4 1,137 6 70 4 3 1 4 19 1 1 i 54 4 26 1 6 11 1 26 1 60 3 1 11 2 3 1 i 8 "5 '8 i 17 1 16 25 3 31 4 i 4 28 2 1 2 2 177 13 7 1 1 1 60 14 5 4 6 8 2 1 5 15 30 12 1 1 2 1 3 3 1 2 is 3 13 45 3 1 3 3 3 224 1 2 37 3 3 1 18 1 2 "i 1 2 80 21 3 9 11 1 4 4 4 4 22 1 31 3 13 1 1 13 2 1 9 11 1 36 1 2 1 1 10 2 4 13 34 3 35 \ 1 3 12 30 1 7 3 12 10 9 5 1 8 10 3 41 1 1 18 4 14 8 3 10 i 3 15 35 i 3 1 6 1 9 10 10 3 1 1 2 4 17 3 60 1 1 1 5 2 10 3 .12 6 4 1 1 2 15 16 1 31 1 ""id 8 15 14 18 1 10 1 20 1 1 1 is 1 3 19 13 1 17 1 1 1 10 3 26 1 2 4 1 4 ""ii 2 1 6 1 Hepatitis ... Abscess of the Liver Cirrhosis of the Liver .... Atrophy of the Liver Degeneration of the Liver Jaundice Splenitis Peritonitis 1 4 1 Ascites All other Diseases of this System Diseases of the Urinary and Generative System. Bright's Disease 1 3 1 3 3 0 8 1 1 3 2 3 5 27 52 18 Albuminuria 0 1 3 1 1 4 1 1 3 11 20 5 i 1 5 1 3 3 1 D 1 2 1 1 3 1 1 1 1 2 1 3 4 1 3 1 13 4 i 3 1 ■ i 2 1 1 1 1 1 1 1 5 2 3 4 2 21 1 2 6 11 1 i 2 "5 3 1 .1 3 2 2 "'20 22 2 3 i i 3 1 3 4 1 8 3 6 1 1 1 8 8 8 1 1 1 2 4 2 13 1 2 1 1 2 1 5 2 1 9 3 6 3 2 "4 26 11 8 18 9 27 50 77 39 75 7 1 86 37 4 34 10 3 ""b 1 19 52 60 91 45 6 80 36 9 14 19 18 " ii ii 5 14 97 105 204 150 1 59 3f 18 83 39 "28 70 15 87 199 295 560 283 18 330 127 9 9 190 124 83 30 32 25 67 0 71 ) 1,512 8 46,909 9 1.593 uysuus All other Diseases of this System Affections Connected with Parturition. Haemorrhage. Puerperal Mania... 1 1 3 1 4 9 4 ( 0 1 1 3 3 2 10 8 3 1 1 3 4 4 6 1 8 2 1 3 i 1 4 1 i 10 3 2 2 1 4 3 1) 12 4 1 1 30 2 1 3 3 8 7 4 2 1 1 4 6 11 0 7 6 2 1 4 9 6 11 1 3 2 Puerperal Convulsions Puerperal Septicaemia All others Diseases of the Organs of Locomotion Diseases of the Cellular and Cutaneous System Conditions not Necessarily Associated with General or Local Diseases. Premature Birth Old Age Debility Debility Infantile 1 1 6 8 0 2 2 3 8 6 6 1 '2 6 1 3 1 1 1 1 ( 3 8 5 3 4 1 i 4 8 2 7 5 1 2 1 1 11 13 15 8 1 1 22 6 ] 3 14 i 3 1 ■"2 4 8 1 13 1 1 1 8 1 2 3 26 1 10 i i"i.. 7 3 8 4 1 8 1 10 11 3 22 1 8 4 4 9 6 5 9 11 13 6 7 i 3 3 10 1 4 1 7 9 15 1 9 2 3 9 11 2 4 9 6 10 1 11 14 1 1 3 7 12 3 "1 4 17 16 ""35 27 53 226 13 4 105 18 1 3 1 1 1 6 2 17 ...!? 43 3 21 15 1 6 1 13 24 21 28 18 Poisoning General Injuries. C 1 2 7 3 7 f 8 5 1 2 4 10 6 6 1 8 2 13 2 3 17 b 1 Liii" ; £ 13 10 4 13 5 15 0 6 4 c 0 8 1 6 3 1 8 1 5 4 3 4 3 10 6 6 2 5 1 5 Inanition ( £ 1 2 4 1 1 I 0 6 10 1 1 2 7 3 6 ...... 3 4 "'8 3 0 0 7 2 1 1 2 3 17 4 3 1 4 " i 1 3 2 1 1 7 4? 1( 31 Starvation All other General Injuries Local Injuries. 8 ( 4 *. ( 3 0 2 6 4 1 4 10 8 5 4 1 1 4 0 0 3 0 2 C 7 1 1 1 2 ** 7 3 6 2 1 2 0 1! 1,88- 7 ... 4 1 1 7 1 2 If 2 1 77 4" 60 4' 31 2 12 11,37 i 33 IC 14 1' 1 11 9,58 8 51 All other local injuries 2 3 3 2 3 1 1 1 2 1 £ 4 2 1 1 1! Human Parasites 1 1 9 6 368 J 33 0 3 1 1 4 12 319 31 2 1 1 1 1 1 4 1 2 4 22 981 58 2 2 r 1,74! I1 21 1 90y 5 ... 1 1 1 3 10,31 0 39 Congenital Malformations It 41. 3 1 37 0 r 2 1 33 3 1 1 9 494 24 0 2 1 2 47. 24 1 "i 1,784 3£ 1 1 18 3,026 _ 41 1 4 1 2,558 3£ 1,65s 3 1 1 66 5 294 1 22 c 515 4! 2 2 1 ,1 781 32 0 10 515 1 30 ■1 If 65 £ 1' 1,23 1 15,63 34 2 Killed or Murdered Unknown, or Not Stated Total Deaths Still-born 121 55* % 40 81 43 2 • -.... 404 . 22 89 43C 2C ...... 544 39 21 51 2 ( 450 35 30 65: 10 It 556 ' 20 411 4 63 614 42 8 510 21 541 32 111 2,185 31 492 31 351 6,166 35 14 1,792 32 116 1,59' 3( 84 63( 4 8! 68! 2 80! 2. 68! 4; 6( 81f 21 45. 2 1 35 3 Climate and Health of Louisiana : Joseph Jones, M. D. CCXLIX In attempting to obtain any general results respecting the distribution of heat in the United States of North America, three regions should be distinguished: First, the regions of the Atlantic States, east of the Alle- ghanys; second, the Western States, in the wide basin between the Alle- ghanys and Rocky Mountains, watered by the Mississippi, the Ohio, the Arkansas and the Missouri; and third, the elevated plains between the Rocky Mountains and the coast range of New California, through which the Columbia, or Oregon river winds its course. Since the establishment by John C. Calhoun of uninterrupted observations of temperature made on a uniform plan, at the various military stations extending from the point of Florida and Thompson's Island (Key West), to the northern boundary of the United States, and embracing over forty degrees of latitude, we have obtained more correct climatic views than were generally held in the time of Jefferson, Barlow and Volney. The great characteristic feature of North America is its vast interior val-- ley, extending from the Gulf of Mexico to the Arctic Ocean, and presenting every variety of climate between the tropical and polar regions. This val- ley is cut off' from the general influences of the Pacific Ocean on the West, by the Rocky Mountains, and from those of the Atlantic Ocean in the East, but in a less degree by the Alleghanys. It is traversed by a deep winding longitudinal depression forming the trough of the Mississippi for more than two thousand miles. The hypsometrical character, or relation to the sea's level of the richly watered,, fruitful and thickly inhabited basin of the Mississippi, was first explained by the labors of the French astronomer Nicollet. The plain which encloses the valley of the Mississippi is identical with that of northern Canada, and forms part of one of the same depressed ba- sins extending from the Gulf of Mexico to the Arctic Sea. Wherever the low land falls into undulations, and slight elevations, which still retain the French appellations of coteaux des prairies, coteaux des bois, in connected rows between the parallels of 47° and 48° north latitude, these rows and gentle undulations of ground separate the waters between Hudson's Bay and the Gulf of Mexico. Such a line of separation between the waters is formed, north of Lake Superior; Kichi Gummi, by the Missabay Heights, ami further west by the elevations known as Hauteurs des Terres, in which are situated the true sources of the Mississippi, one of the largest rivers in n the world, and which were not discovered till the year 1832. The highest of these chains of hills hardly attains an elevation of from 1,500 to 1000 feet. From its month (the old French Balize) to St. Louis somewhat to the south of its confluence with the Missouri, the Mississippi has a fall of only 380 feet, notwithstanding that the itinerary distance be- tween these two points exceeds 1280 miles. The surface of Lake Superior lies at an elevation of 618 feet, and as its depth in the neighborhood of the island of Magdalena is fully 790 feet, its bottom must be 171 feet below the surface of the ocean. The broad valley of the Mississippi enjoys at its northern extremity, the warming influence ot the Canadian lakes, and at the southwest of the Mexican Gulf stream. These five lakes, (Lakes Superior, Michigan, Huron, Erie and Ontario), cover an area of 92,000 square miles. The climate is so much milder and more uniform in the vicinity of these* lakes than at Niagara, for instance, (in 43° 15' north lat.), the Mean annual winter temperature is only half a degree below the freezing point, while at a distance from the lakes in 44°, 53' north latitude at Fort Snelling, and nearthe confluence of the river St. Paul with the Mississippi, the mean winter temperature is 15.8°, Fahrenheit. 31 CCL CZiMate and Health of Louisiana : Joseph Jones, M. 1). At thia distance from the Canadian lakes,. -whose surface is from five to up- wards of six hundred feet above the sea's level, whilst the bottoms of Lakes Michigan and Huron is five hundred feet below it. Recent observa- tions have shown that the climate of that country possesses the actual continental character of colder summers and colder winters. The waters which enter the Gulf of Mexico between Cape Catoche, of Yucatan, and Cape San Antonio de Cuba, force their way back into the open ocean north of the Straits of Bahama, after they have been agitated by a great rotatory movement between VeraCruz, Tamiagua, the mouth of the Rio Bravo del Norte, and the Mississippi. Here they form a warm rapid current, known to mariners as the gulf stream, which deflects in a diagonal direction further and further from the shores of North America. The high temperature of the gulf stream, in all parts of its course, is one of its striking peculiarities. It is a current of warm water, so greatly above the average heat of the ocean, that the navigators may at once detect his entrance into it by the sudden rise of the thermometer. The difference often amounts to 9, 12 and 15 degrees Fahrenheit, and sometimes to much more. Near Cape Hatteras, on the coast of North Carolina the thermometer shows 81 degrees in summer, which is from 10^ to 11£ degrees above the water of the ocean, in the same latitude imme- diately contiguous to these streams. At Cuero, one of the Azores, its temperature is from 75£ to 77^ degrees, which is from 8 to 10 degrees above that of New Orleans. It is on the Mexican Gulf, which may be properly called a cauldron for heating water, that this high temperature is acquired, which is then in summer 4 degrees above that of the open ocean under the equator. From these physical conditions, the following influences are exerted in forming the peculiar character of the climate of Louisiana, which forms the southern extremity of the Mississippi Valley on the Gulf of Mexico : 1. The atmosphere of Louisiana is loaded with moisture, and upon this condition, as well as its warm temperature and the abundant uniform dis- tribution of rains in spring and summer, mainly depend its luxuriant forests ami splendid crops of sugar-cane and cotton. Whilst the rains which water the Atlantic slope are equally distributed, and those of the California coast are periodic, making a well-defined wet and dry season, those which water the Mississippi Valley are unequally dis- tributed ; those of spring and summer being greatly in excess. In winter, the mouths of the Mississippi and the region of Pensace la are in the area of greatest precipitation (18 inches) From this centre, the lines of equal precipitation on the west maintain a considerable parallelism; first, near northwest, along the Texas coast; then rapidly curving near northeast, then east; and, as they leave the continent, northeast. In autumn, the mouths of the Mississippi and the region of Pensacola are still within the area of greater precipitation. The lines of equal precipitation pursue a north-northeast direction. In summer, the average rainfall at New Orleans is about 17.28 inches ; in autumn, 9.62 inches; spring, 11.29; winter, 12.71. The abundant supplies of rain, and their relations to the seasons and agriculture1, will be most thoroughly and practically illustrated by the fol- lowing tables and facts, in which we have connected the monthly and annual rainfall expressed in inches and fractions of an inch in New Or- leans during a series of years, with the total mortality from yellow fever: Climate and Health of Louisiana : Joseph Jones, M. D. CCLI M )XTHLY AND ANNUAL RAINFALL, WITH DEATHS FROM YELLOW FEVER, IN NEW ORLEANS, LA., FOR A SERIES OF YEARS. CONSOLIDATED BY JOSEPH JONES, M. D. (Expressed in inches and fractions of an inch.) YEARS. Mean of 6 years ? : February. I 1 March. I April. 1 May. June. July. August. September. © e O 1.37 2.40 7.80 2.41 1.50 3 49 2 18 6.26 1.14 75 S 31 6.88 .96 3.70 2 83 5 17 4.84 2.10 2.29 5.01 4 13 2.17 5.66 3.95 1.03 1.67 2.22 ■ © © 0 3.18 3.92 5.55 .11 3.25 1.93 7.78 4.62 1.56 2.59 8.83 4 48 1.58 9 00 7.00 7.03 1.55 5.59 4 65 3.05 3.20 2 79 4.28 25 .36 .26 .77 © 0 © Q 2.87 4.40 2.22 9.44 1.70 6.02 1.35 6.20 1 55 7.73 1.86 2.52 3.46 2.69 5.30 4.57 1.16 8.23 4.75 5.10 3.42 5.09 2.74 .76 1 59 4.12 .46 Total inches. £ £ 0 Q 809 3 1325 211 187 148 2 160 2306 808 760 y)7 17 456 7849 2425 3670 74 199 4845 91 15 ' "2 2 6 1 3 587 54 39 226 11 61 42 1 4046 19 2 57.85 49.88 46.42 44.28 60 53 41.05 59.19 38.97 53.58 78 12 53.51 56.66 56.89 58.53 48.66 86.09 61.85 52.75 41.70 67.12 45.68 52.81 49 40 39.24 35.43 29.06 30.88 26.78 Mean of 3 v ears ( 1836 to 1838 ... S 1839 4.66 8 10 .11 19.50 4 21 4 00 4 41 6.24 9.20 7.71 5.42 3.55 7.40 3.82 .80 M.20 1 89 .86 8.90 2 68 3.71 6.40 .64 "3'79 2.11 3.42 3.97 9 46 13.52 5.22 5.61 2.30 9.17 2.25 3.40 2.01 5.10 3 51 3.80 .73 1.19 6.66 3.77 1.28 2.45 4.53 3.18 1.45 4.20 9.84 2.06 3.68 1 97 4.30 3.77 8.61 "2'76 3.56 .30 3.94 3^61 1.29 591 2.20 3.70 16.22 9.33 .85 3.50 2 13 4.62 5.80 4.04 1.56 3.91 2.59 2.19 1.09 6.90 2.71 5.51 3.90 5.16 7.88 3.40 1.97 2 83 2.27 1 20 4.24 7.38 4.18 .82 3.73 2.86 4.71 7.84 .76 2.83 3 73 3.05 5.30 13 90 2.85 6.11 9.73 5.49 7.31 13.73 11.65 5.31 4.63 1.36 6.66 2.75 0.92 5.01 4.84 6.21 2.10 3 10 5.10 5.20 2.67 .53 1.99 10 70 4 63 3.92 2.43 4.10 3 49 5.25 1.88 3.81 2 00 2 85 1.73 2.26 3.99 2.42 7.58 4.10 .31 .98 .24 4.47 9.22 2.75 6.73 1.73 18.44 10.44 8.20 4 51 1 51 9.56 6.88 3.92 4.83 14.21 4.68 2.95 2.02 4.80 1.70 1.12 .45 3.16 8.06 9 37 4.80 4.75 8.01 6.20 2.93 7.23 2.80 6.15 1.77 2.53 7.33 3.45 1.94 1.26 .01 .65 3.02 .68 6.10 3 11 7.10 3.10 1.13 14.57 2.75 3.20 7.98 3.43 9.36 3.79 8.92 2.21 1.64 1.86 4.08 1.75 5.79 2 90 4.89 7.12 5.07 4.41 .58 2 62 2.86 9.88 4.09 9.96 5.78 8.58 11 97 6 22 7.19 2.30 7.12 2.96 6.43 2.84 2.71 12.05 5.26 6.38 9.86 5 60 .89 4.52 6.33 8.80 1.88 8.86 5.06 7.79 11.09 6 31 2.13 7.44 11.71 2 94 7.24 8.63 5.86 7.72 .93 1.50 3.62 4.54 3.30 1.91 5.72 4.80 3 10 3.41 7.40 5.11 5.21 4 53 6.90 6.81 8.37 4.85 10.05 10.46 1 75 7.01 3.48 4.12 16.12 4.64 7.35 6.17 4.50 8.71 2.15 4.44 7.98 5.60 .12 1.80 2 87 4.80 5 51 1.08 4.30 6.32 2.83 .80 4 01 1.85 3.85 1.16 5 04 1.92 4 36 3.20 2.55 3 67 1.19 1.80 6 14 4 68 .174 2.15 1840 1841 1842 1843 1844 1845 1846 1847 1848 1849 1850 1851 1852 1853 1854 1856 1857 1858 1859 1860.... 1861 1862 1863 1864 1865 1869 1870 1.10 4. 11 5.72 3.97 21 50 .04 3.19 8.54 1.14 6.14 4.63 6.58 3.20 6.83 5.41 4.35 4.64 6.08 6.43 7.03 6.75 17.37 8.19 5.19 7.07 5.26 7.03 11.22 6.97 3.69 3.31 6.19 8.73 11.58 8.63 3.95 10.82 5.92 11.32 5.55 3.27 4.90 10.44 4 60 4.21 9 47 4.12 6.53 8.19 1.64 6.88 2.36 4.46 5.08 8.54 0.39 16.29 2.67 2.67 7.48 4.47 1.59 0.25 3.90 5.09 1 85 15.65 3.38 1 80 5.21 5.15 9.04 9.06 7.35 1.76 6 86 2.97 6.20 7.78 4.29 6.04 7.24 1.98 6.27 4.46 3 13 9.52 2.14 5.69 1.87 3.57 5 72 8.29 5.95 8.59 2.88 6.45 6.62 4.27 3.47 4.31 64.34 69.46 88.12 68.81 78 17 77.46 101.86 72 87 70.71 62 53 51.67 69 86 64.02 47.03 69.72 56.86 1871 1872 1873 1874 1875 1876 2.26 10 9.62 5.07 1.36 1 88 4.84 2.16 3.43 3.58 1877 1878 1879 8.20 5 36 2 34 1.02 11.16 4.54 10.63 5 49 1880 1881 1882 1883 4 1 Avr'ge of 42 y'rs, > 1839 to 1883 ... $ A careful examination of the preceding table establishes no absolute relationship between the amount of the rain-fall and the prevalence and fatality of yellowr fever. Thus yellow fever has been absent in some com- paratively dry years and has been present in others; and this disease has prevailed in some wet years and been absent in others. The rain-fall has been greater during the past two years 1880 and 1881, when yellow fever has been absent, than during 1841, when 1325 deaths were occasioned by yellow fever; 1847, 2306; 1848, 808; 1849', 760; 1853, 7849; 1854, 2425; 1855, 2670; 1858, 4845; 1878, 4046 deaths from yellow fever. On the other hand, the rain-fa'll and deaths frmn yellow ft ver, during the years yielding the highest rain-fall were as follows : 1846, rain-fall 78.12, deaths from yellow fever, 160; 1856, rain-tall 67.12, deaths from yellow fever 74; 187(1, rain-fall 69.46, deaths from yellow feVer 587 ; 18^1, rain-fall 88.12, deaths from yellow fever 54 ; 1872, rain-fall 68.81, deaths from yellow ' * r 39 ' 1873, rain-fall 78117, deaths from yellow fever 226; 1871, fain fall r<; Ji CCLII Climate and Health of Louisiana: Joseph Jones, M. D. deaths from yellow fever 11 ; 1875, rain-fall 101.86, with deaths from yellow fever 61; 1876, rain-fall 72.87, deaths from yellow fever 42; 1877, rain-fall 70.71 inches, deaths from yellow fever 1. From the preceding table we gather as a general result that whilst during the past fifty years there has been a gradual increase in the rain-fall, there has also been a marked decrease in the number and fatality of epidemics of yellow fever. The annual rain fall in New Orleans, during the period embraced in the table, embracing a period of forty years, may, in round numbers, be regarded as ranging from 26.78 to 101.86; average 56.79 inches. The general mean of the months may be stated thus: January 5.39; Feb- ruary 3.97 ; March 4 93 ; April 4.44 ; May 4.26 ; June 5.16; July 6.32; Au- gust 6.52; September 4.05 ; October 3.62 ; November 4.48; December 4.33 inches. If an average of a series of years be selected, it will be found that the heaviest rain-fall occurs in the summer and the least in the autumn. Thus if we select the statistics of the U. S. Barracks, for a period of fifteen years, 1839-1853 inclusive, the rain fall in inches were as follows: Spring, 11.29; summer, 17.28; autumn, 9.62; winter, 12.71 ; year, 50.99. The ex- treme quantities of rain in New Orleans, of a period of 17 years, according to the U. S. Military Register, and the observations of Dr. Barton, were: January, max. 10.5, min. 0,11 ; February, max. 9.84; min. 0.73; March, max. 7.88, min. 0.90 ; April, max. 10.70; min. 0 53; May, max. 8.06; min. 0.45; June, max. 14.07, min. 1.31; July, max. 14.74, min. 0.89; August, max. 8.39, min. 1.37 ; September, max. 8.92, min. 0.63; October, max. 6.45, min. 0.75; November, max. 8.83, min. 0.11; December, max. 9.44, min. 0.80; maximum for year, 62.64 (1853); minimum, 39.96 inches (1852). The rain-fall of 1841, when yellow fever destroyed a large number of citi- zens, was large, 60.53; it was also much above the average amount in 1847 and 1848, but it reached 67.12 inches in 1856, when yellow fever did not prevail as an epidemic. It is worthy of note that during the entire period embraced in the table, there is not a single month in any year without more or less rain-fall. At Fort Pike, Louisiana, latitude 31.10 N.; longitude 89.88; altitude 10 feet; meteorological observations conducted during four years, 1843-1846 inclusive, gave the rain fall as follows in inches: January, 5.62 ; February, 2.41 ; March, 7.13; April, 4.98 ; May. 4.59 ; June, 10.49; July, 8.46; August, 4.66; September, 8.43; October, 3.72; November, 6.81; December 4.62; spring, 16.70; summer, 23.61; autumn, 18.96; winter, 12.65; year 71.92 inches. Observations at Baton Rouge, north latitude 30° 26', longitude 91° 18' altitude41 feet, conducted during twelve years (1843-1854 inclusive), gave the following average rainfall in inches : January, 5.26; February, 4.91; March, 4.68; April, 5.22 ; May, 5.18; June, 5.52 ; July, 7.42 ; August, 6.20 ; Septem- ber, 3.91 ; October, 2.67 ; November, 5.90 ; December, 5.23; spring, 15.08 ; summer, 19.14 ; autumn, 12.48; winter, 15.40 ; year, 62.10 inches. Similar observations at Port Jesup, Louisiana, north latitude 31° 33z, longitude 93° 3V altitude 80 feet, continued during ten years (1836-1845), gave the following mean results : January, 4.70 ; February, 2.76; March, 5.02; April, 4.86 ; May, 3.80 ; June, 4.61; July, 3.36; August. 2.97 ; Septem- ber, 3.02 ; October, 3.80 ; November, 2.92 ; December, 4.03 ; spring, 13.68 ; summer, 10.94; autumn, 9.74; winter, 11.49; year, 45 85. The preceding observations upon the monthly and annual rainfall in dif- ferent portions of Louisiana, establish the important fact that the rains are. so distributed as to prevent disastrous drouths, and also to promote in the best possible manner the cultivation of the soil, and the rearing, Climate and Health of Louisiana : Joseph Jones, M. I). CCLIII watering and support of vast herds of cattle. In fact, the entomology of several of the regions of Louisiana indicate its adaptation to the raising of large herds of cattle. Thus, the word Ouachita is composed of two Choctaw words, namely, ouac, a buffalo, a cow, horned cattle in general; and chito, large (pronounced tchito, bearing lightly on the initial t). It means the country of large buffaloes, numerous herds of these animals having formerly covered the prairies of Ouachita. All the names, now translated into French, of Riviere aux Boeufs, Bayou Boeuf, have the same origin, from the numerous herds of buffalo which previous to the introduc- tion of the civilized races of Europe, formed the principal support of the Indian tribes. 2. The climate of Louisiana is rendered moist and suited^o the culture of the sugar cane, by the winds from the Gulf of Mexico. Owing to several causes, as the one just mentioned, the absence of pro- tracted drouths, the abundant rain-fall, and the presence of large bodies of water in the city and lakes surrounding New Orleans, the climate, as well as that of the gulf coast, comprising a large area in the Southern States, is very humid, containing a large quantity of vapor, though not in the sensible form of clouds or fogs. This condition of the atmosphere, combined with the tropical heat of summer, favors the rapid development of animal and vegetable organisms. Dr. Barton has accurately observed the humidity at New Orleans for many years, and the following results for 1853, when yellow fever pre- vailed in its most destructive form, will show nearly the general average then : Months. New Orleans. New Orleans. St. Louis. Greenwich. Humidity. Weight Vapor per cubic foot, grains. Humidity. Humidity. January 88 84 83 83 84 81 82 87 85 80 84 82 3.85 4.58 5.38 6.80 7.60 9 14 8.80 9.74 8.57 6.05 6.06 4.01 68 67 61 46 66 69 70 78 80 63 68 85 85 80 80 75 73 77 74 83 86 84 February.. ... March April May June July . August September October. November December Year 86_ 6.72 67 80 _ This shows a high measure of humidity for the whole year at New Or- leans, and an excess of vapor in the air in the warm months. That portion of the continent which embraces the United States, is sit- uated in the zone of southwest winds, and these winds are found to prevail with regularity on the Atlantic, north of the calms of Cancer; but in the region of the Caribbean Sea and the Gulf of Mexico, there are abnormal conditions which present a marked deviation from the tixedness and uni- formityobservable in the winds of the mid Atlantic and the north of Africa. Both southerly and northerly winds blow with violence across the parallel 30° (in the belt of the calms of Cancer), which, away from the American continent, acts as a great wall between the southwest and northwest winds. CCLIV Climate and Health of Louisiana : Joseph Jones. Af. D. In the summer season, the northeast trades, hot and moist from the equa- torial zone, as they enter the Caribbean Sea, are deflected by the lofty chains of the Andes which girts the coast, and pass into the Gulf of Mexico, where they become inland breezes on the coast of Texas; and as they pen etrate the interior, they are gradually deflected east, until they reach about latitude 39°, where they assume the direction of the great southwest aerial current. It is this deviation from the regular flow which gives to the Mis- sissippi Valley its moist tropical summer climate. Volney was the first to point out this deflection : "Mariners relate that from Cape Vela, a projecting point of the Gulf of Maracaibo, the winds vary, and swerve into a course parallel to the stream, which flows iuty the Caribbean Sea, and entering the Bay of Honduras it varies a little and blows from the southeast. The bank ot sand called Yu- catan is interposed between the two bays, but is so low and lex el that it is no obstacle to its progress. Bernard de Orto. who has published some care- ful information on the winds of Vera Cruz, tells us that southeast winds prevail in these parts." He further adds that the trade-winds are deflected by the table lands of Mexico, and become the south winds of the Mississippi Valley. Redfield admits that it is to this current that the Mississippi Valley owes its fertility, and Russell, in his work on "North America : Its Agriculture and Cli- mate," also sustains the same views, and calls attention to the remarkable generalizations of Volney, made at a time when no wind or rain charts were available. Blodget remarks that the southeast winds prevail almost exclusive from April to October, or during the whole period of warm months, when the Western plains receive their excess of moisture. Humphreys and Abbot, in their " Physics and Hydraulics of the Mississippi River," remark the great resemblance between the winds of Key West and those near the mouths of the Mississippi. " Both have, in part, the characteristics of the northeast trade-winds. Blowing chiefly between the northeast and south- east, they veer towards the south as summer approaches, and continue to blow from that quarter and from the east during the summer and early part of the autumn ; changing towards the north upon the approach of win- ter, they blow principally from that direction during the winter months." This course conforms, too, to the track usually pursued by the great hurri- canes which, originating in the West Indies, first blow southeast, then cease abruptly, and sweep the Atlantic coast in a northeast direction. 3. The presence of large masses of water within and around Louisiana, as well as the mass of cold water introduced from the northern regions, or from the Rocky Mountains, into the heart of the continent by the Missis- sippi River, render the climate of this State less liable to extremes of heat than positions far north and in the interior portion of the Mississippi Valley. Thus New Orleans, in the summer and fall months, is less liable to great and sudden elevation of temperature than Nashville, Tenn., or St. Louis, Mo. CLIMATE OF NEW ORLEANS-ITS RELATIONS TO MALARIAL AND YELLOW FEVERS-MONTHLY AND ANNUAL ELEVATIONS AND DEPRESSIONS, AND MEAN OF TEMPERTURES-SUMMARY OF METEOROLOGICAL OBSER- VATIONS. I have consolidated the following tables from the most reliable sources, and they constitute valuable records for present and future study of epi- demics in New Orlenns and the Mississippi Valley : ' Climate and Health of Louisiana: Joseph Jones, M. D. CCLV MONTHLY MEAN TEMPERATURES-ME AN TEMPERATURES: SPRING, SUMMER, AUTUMN AND WINTER-MEAN ANNUAL TEMPERATURE IN NEW ORLEANS, LA., LATITUDE 29° 57', LONGITUDE 90^ 50', ALTITUDE 10 EEET. CONSOLIDATED BY JOSEPH JONES, M. D. Mean 44 Years. । Mean of 42 Years. , Mean of 4 Years. • Mean of 38 Years. hi ii s®i fill 1® i 1820 1822 1825 1826 1827 1828 1832 1833 1834 1835 1838 1839 1840 1841 1842 1843 1844 1845 1846 1847 1848 1849 1850 1851 1852 1853 1854 1855 '856 1857 1858 1859 I860 1873 1874 1875 1877 1878 Year. BFSGKfr'M 67.7062.50 56.54 62.59 § § -F 8 8822 53^5 hi saagssagggsag^Egggg asasaaggs. 8 ' £8883 «: g^§"g:. January. g?32?525gSSi33t£$28: 81882822g: 33^3333333233883323: 38£33'2£gf a s S3b8 a 8 g. 88882: February. 8883 225 8§ 388252 3 S 8 §: 2 g 5 g 2 2 ££ g. 81.2 838 8: 8 23 ss £ 8 8 8 S828 sabs £ 3 8g232£8£3£g8S3232£22gg31£g8£8- §: 3£23£: March 3£5S3S$Sa5§§£8£3^88~aS3£5355: 8: £££§£: 3 22 3 3 3133 ssss 69.41 68.00 67.19 70.98 70.38 71 62 69.80 70.85 72 62 72.75 67.19 72.48 68.39 71.00 68.13 68.24 67.27 70 42 64 60 70.33 70.06 64.96 71.50 70 43 76.04 67 95 66 22 65 82 67.56 71.41 §:22822 :g:32888 April. 3 2 £ £ 1222 2 5 a 2 2 a g ? 22 a 2 2 2 2 5? 5 5 5 5 a 2 5 2 5 2 2 g g • : 2. 22222 May. §888 § £335^5853558538338888285/58^ : 3: §2388 s S3 £ 8 3 gggE §888 2 8 £23g£S3£3££S§382£$232223£28$£: ■ 2. S8&£8 June. 35$S3^Sg££Sggg£SS5£S;g88SS13g: :£:82288 38 8 8 ... 2S2o bbbi 8 2 8£83w3ww£$3SS£3%£o£3- £5338335: : 3 £ £ S' £ 3 July. 31S£3383.3S£833§£8fef2: 38838835: ■• 2. gg§g§ 3 3 S g 3 $£22 gg§3 8333333353£££S£38£3 : 3328E333: :3:38E38 August. ggX3g3g83338ggS5588. : §S83§^§: :3125885 ' 3 S 22 S3 g - -« b 833? 5888 2 £ 2223233232323338522 : 23223228: :3 oio2£ September. ?£SS8SS§5525 = 535S23: : 5§832g8g: : 8: 8£S8§ 2 b 33 S3 2 s 69.71 70.27 64.13 71.50 68.00 175 20 :..32888 October. SSS53S3§?- ; : 35S£§ 3 £ 83 S3 3 § 8 8 S8£8 3858 8 8S§£223£288382S§338S: 388233383. ' . 83333 £2t5£a3aS£85I3igf83£: : ' £8§§§ November. 8 8 32 S3 8 8 a gas? 8588 3 b 8838888288832^882338: 38888£338 . : 38£3§ December. 8^3£32335g3,i8$58§S8X: ^S5S8S5 .::§g§28 ' 3 8 S3 38 3 3 s 833 8 8383 3 8 23§88ag833S8$383g883$2338g888: . ■ ■ 2228: Spring. g£S3532S5£S85?gg88SS82gg32838: ■• - 8358: s g Si 23 8 g g 2222 ?3§b 3 8 3££3%g33S33S33££3SS : £$888335: : £:8£8S£ Summer. 5££388S8888?S85832g. M2S5S8838- : §:55388 2 2 21 33 3 s 2 Si?? S3b? 2 2 •: 22323 Autumn. 55§3?SS§£^5 88585Sg? : S82g§3§?- •:;28228 3 32 kj 4x § 2 8388 8883 8 2 3838883838223888888: : 88883382: :::2382: Winter. £8£8£S8388&3S8£^3?5: : 85^53835: :::8828: 3 k 70.79 71.17 b a 8883 3852 3 S£sg§S£i$S38Sg£55g8' : 2382333g: 5S38X882588g2Sg52S8. : 82825822: : : ' 2282: : . §3§g: Year. The preceding record has been constructed from the most reliable data extant, with reference to the climatology of New Orleans, namely: the meteorological records of the Military Post of New Orleans, extending over a period of twenty years, 1825-1853 ; the statistics published by Dr. Barton, embracing a period of nineteen years, extending from 1833 to 1853, and the manuscript of D. T. Lillie, Esq., and from reports of the Board of Health, and the records of the United States Signal Service. CCLVI Climate and Health of Louisiana: Joseph Jones, M. D. From the preceding record of forty-two years, extending (with some in- terruptions) from 1820 to 1881 inclusive, the mean annual temperature of New Orleans is 69.48°. According to the meteorological records of the Military Post of New Orleans, extending over a period of twenty-five years, the mean annual temperature is given a fraction higher, namely, 69.9° ; whilst, according to Dr. Barton, it is much less, or 67.6°. The statistics which I have presented in the preceding table must be re- garded as the fullest and most accurate expression of the temperature of New Orleans, and we must accept the mean annual temperature as 69.48°, with a range during the period specified of 72.50° maximum to 67.21° mini- mum annual temperature. The mean annual temperature of New Orleans is lower than that of Havana, Cuba, 75.9°; of Matanzas, Cuba, 78.3° ; Ubajay, Cuba^ 73.4°; of Nassau. Bahamas, 78.7°; of Rio Janeiro, South America, 73.7°; of Vera Cruz, Mexico, 77 to 79.8°; of Kingston, Jamaica, 78.7. The isothermal line of mean annual temperature of New Orleans passes through the north of Africa, through Morocco and Barbary, skirting the northern boundary of the Great Desert of Sahara, and crossing Egypt in a line with the Isthmus of Suez, and in the latitude of Alexandria, and passes on through the northern portion of Arabia, the middle of Persia, and Afghanistan, the north of India and the south of China. By its climatic relations, and especially by its mean annual temperature, New Or- leans is connected with those portions of Africa and Asia from whence have sprung in past ages some of the greatest plagues which have desolated the human race. The isothermal 70°, for the year, which is very nearly that of New Orleans, is nearly on the parallel of 30°-rising above it at the Gulf of California, and falling below in the interior and in Texas, it follows the northern coast of the Gulf of Mexico, and crosses the Atlantic and Africa nearly in a straight line. It bends north at the head of the Red Sea, and across the desert until it strikes the Himalayas, from which point it turns southward and is below the Tropic of Cancer. Off the west coast of California it falls nearly as low, its general course being in a right line along the thirtieth parallel, from which it is abruptly turned southward in approaching Canton from the west and in leaving the California coast. The last curvature is due to the now well-known masses of cold water off that coast, and at the east of Asia it is a pparently a mere continental effect, which would have been felt here if the continent had occupied the place of the Gulf of Mexico. • It is remarkable that the average position of this line is further north in the New than in the Old World. The average temperature of the spring in New Orleans is 69.58°, and very nearly 12|° below that of the winter, 57.04°. The average spring and winter temperatures of those places in which yellow fever is said by the contagionists and quarantinists to be indigenous are as follows: Havana, Cuba, spring 75.7°, winter 68.4°; Kingston, Jamaica, spring 78.1, winter 76.1; Matanzas, Cuba, spring 78.9°, winter 73.4°; Nassau, spring 77.7°, winter 70.7 Rio Janeiro, spring 74.7°, winter 79.1° ; Vera Cruz, Mexico, spring 77.8-78° ; winter 77-79.8°. The mean summer temperature of New Orleans is 82.53°, of Havana 84.2, of Vera Cruz 81.5°. The mean autumnal temperature of New Orleans is 69.48°, of Havana 75.9°, of Vera Cruz 77.0-79.8°. The most marked difference between the climate of New Orleans, and that of Havana, Cuba, is that the winter is colder by 11° F., and the spring colder by 6° F., in the former. The average temperature of the summer in New' Orleans is 1° higher than that of Vera Cruz, and 1.7° cooler than that of Havana: the average autumnal temperature of New Orleans is Climate and Health of Louisiana : Joseph Jones, M, D. CCLVII 4.8° lower than that of Havana, and between 7° and 8° lower than that of Vera Cruz. It is evident, therefore, from these results, that the differences of climate between New Orleans and Havana are not so great as to war- rant the dogmatic and oft-repeated assertion that yellow fever cannot originate de novo in New Orleans; neither do they sustain the lucubrations about the so-called hibernation of the yellow fever germ. If the curve of the monthly temperature of New Orleans be projected upon a chart, it will be found to rise in January from a mean temperature of 56.30° to 58.02° in February, 64.33 in March, 69.40° in April, 75° in May, 81.34° in June, 83.23° in July, and 83.06° in August; the mean temperature of June and July then descends to 79.58°in September, 70.25° in October, 62.20 in November, and 55.43° in December. The rise and pro- gress of the temperature during the summer corresponds to the rise and progress of yellow lever in New Orleans. The maximum temperature, 100° F., for the entire series of years 1817- 1881, was attained in 1841 and 1850; in the former year about 1800 deaths were occasioned by yellow fever, and in the latter the victims numbered only 107. The next highest temperatures with the annual mortality by yellow fever, were as follows: 1874, 99°, deaths from yellow fever, 11; 1838, 98°, no epidemic ; 1840, 98°- 3 deaths ; 1873, 98°, 226 deaths ; 1860, 97°, 15 deaths ; 1881, 79°, no deaths; 1877, 96.5°, 1 death; 1826, 96°, 5 deaths; 1839, 96°, 800 deaths; 1852, 96°, 456 deaths; 1843, 95°, 1000 deaths; 1855, 95°, 2615 deaths; 1875, 95°, 61 deaths; 1878, 95°, 4056 deaths; 1847,94°, 2600 deaths; 1848, 94°, 872 deaths; 1849, 94°, 769 deaths ; 1853, 94° 7849, deaths; 1862, 94°, 2 deaths; 1863, 93.5°, 2 deaths ; 1864, 93.5°, 6 deaths; 1879, 91°, 19 deaths; 1880, 92° 2 deaths. Such facts in- dicate that the prevalence of yellow fever in New Orleans is not necessarily associated with the prevalence during the hot months of fhc highest degree of heat. The minimum temperatures, were reached in the following years,with the accompanying mortality from yellow fever : 1870,16° F., 587 deaths ; 1852, 17°, 456 deaths; 1864, '18°, 6 deaths; 1872, 19°, 39 deaths; 1877. 21°, 1 death; 1838, 22°, no epidemic; 1878, 23°. 4056 deaths; 1876, 24°, 42 deaths; 1826, 25°, 5 deaths; 1845, 26°, 2 deaths; 1850, 26°, 107 deaths ; 1879, 20°, 19 deaths; 1880, 20°, 2 deaths; 1881, 31° no deaths. Such facts would seem to sustain the proposition, that extremes of cold were unfavorable to the generation of yellow fever. But a more critical exami- nation will show, that this proposition should not be unconditionally ac- cepted : for the effects of the extreme cold temperature of each year should be considered in the months of January, February and March, and of the months of December, November and October of the year immediately pre- ceding. The early supervention of cold weather and of frost without doubt, exerts a marked effect, in arresting the progress of epidemics of yellow fever, and it would also appear that an excessive degree of cold in the winter preceding, tended to remove or retard the operation of thecause or causes inducing yellow fever. It is worthy of note, that during the entire period covered by the following table, in almost every year, the tem- perature fell in New Orleans, during the winter months, to that point which insured the occurrence of frost, and the induction of that low point of temperature, which insured the arrest of the epidemic constitution ne- cessary to the generation and propagation of yellow fever. The connection of yellow fever with the rain-fall is worthy of study ; and as a scientific basis for this investigation we have consolidated from the most reliable sources the preceding table. Climate and Health of Louisiana : Joseph Jones, M. D. CCLVIII YEAR. January. February. March. April. May. June. July. August. Sept. October. Nov. Dec. Year 1 1 M a ri .fl * fl ri .fl s a ri * = 1 - s * a k s ri .5 * S s ' 3 1 a x I a £ 3 3 3 3 3 । 3 3 3 3 3 3 3 3 | 3 3 3 3 3 3 J 3 s 1 £ 3 j 1817 ... 92 92 .... 94 .... 94 .... 1819 70 41 74 48 79 45 82 i 50 84 71 89 74 88 73 85 ! 76 86 UO 83 44 77 1 53 70 37 89 37 1826 77 25 84 42 82 52 88 | 52 92 62 93 75 96 78 94 76 90 04 80 61 83 ■ 48 72 34 96 25 1838 77 29 80 26 90 40 91 : 50 91 52 98 64 98 72 90 1 76 87 45 1839 74 28 76 35 79 32 88 50 96 64 96 69 95 73 96 l 74 94 65 86 60 82 30 07 29 96 28 1840 78 28 84 36 88 52 90 54 94 57 94 70 98 80 100 74 93 64 90 42 80 32 78 32 98 28 1841 76 29 74 29 80 50 91 53 90 60 94 72 100 80 90 । 76 90 62 86 40 84 30 80 36 100 29 1842 82 35 78 32 86 50 82 55 85 58 87 72 88 73 87 72 89 72 82 4~ 79 1 31 89 31 1843 74 29 74 28 76 33 86 49 87 57 87 71 94 72 94 66 95 66 88 38 82 55 • 95 28 1844 76 37 80 38 82 42 89 67 89 69 92-5 73 92 51 69 91.5 61 85 5 46 80 55 75 33 92 5 33 1845 72 36 79 34 80 42 85 57 91 67 93 73 92 1 72 88 6'1 79 51 73.5 30 69 25 93 ~ 25 1846 70 32.5 68.5 40 73 50 87 ' 57 89.5 63 89 68 90 74 89.5 70 90 5 68 84 46 81 32 81 40 90 5 32 1847 78 27 79 35 80 41 84 52 87 62 94 71 90 71 91 71 91 66 87 51 83 29 76 31 94 27 1848 78 31 77 36 79 43 81 I 52 88 59 94 70 94 74 92 70 94 63 87 52 75 37 76 30 94 30 1849 76 37 77 35 88 41 85 42 92 65 92 70 92 73 92 70 94 63 87 52 75 37 76 30 94 30 1850 79 34 84 26 85 36 90 | 38 92 48 93 58 95 70 100 69 97 62 90 42 85 40 80 24 100 26 1851 81 30 82 34 84 37 90 48 90.5 54 94 71 94 76 95 76 92.5 62 89 | 17 83 43 81 26 95 25 1852 74 17 80 39 85 39 80 47 90 67 93 70 90 5 69 96 I 55 84 39 80 I 39 96 17 1853 74 32 77 38 77 44 86.5 48 91 58 92 73 93 71 94 72 92.5 60 86 1 48 80 45 74 34 94 32 1854 79 30 87 37 83 41 87.5 49 91 63 96 71 94 77 95 79 94 75 87 1 67 81 44 72 37 96 30 60.4 50 4 73 30 80 29 84 1 45 95 65 92 70 93 76 93 78 93 76 78 42 82 48 72 30 95 29 1856 59 30 70 27 78 47 80 1 63 89 68 89 78 90 79 90 78 87 62 74 1 53 82 45 90 27 1857 68 28 78 42 78 43 79 1 47 85 58 88 73 88 74 87 78 87 70 79 1 57 80 39 78 | 42 88 28 1858 73 50 70 40 77 42 82 : 56 84 65 86 72 90 78 90 73 87 70 84 1 64 73 43 76 1 43 90 40 1859 68 36 78 44 81 52 86 54 89 68 90 73 90 76 91 75 89 72 82 I 50 79 44 77 | 32 91 32 1860 72 35 75 38 80 54 93 65 89 65 94 77 97 83 95 77 93 65 86 1 54 79 40 74 34 97 34 1861 79 I 50 88 62 88 69 89 64 88.5 71 96 52 83 54 76 43 78 34 89 1862 77 38 77.5 35 84 38 81 1 44 87 64 93 65 93 70 94 1 72 89 70 86 34 70 32.5 94 32 5 1863 72 23 79 27 77 37 81.5 40 87 50 93 67 93 5 70 92 1 63 90 50 82 I 44 78 23 74 I 22 93 5 22 1864 74 18 76 23 73 30 84.5| 44 88 53 91 63 93.5 63 92 5' 74 90.5 62 83 42 83 5 24 79 1 21 93 5 18 1865 75 26 5 80 33 84 1 47 1867 90 70 92 70 92 79 87 75 92 1869 87 36 90 46 85 55 91 65 92 71 93 ! 70 89 56 82 40 79 38 70 31 93 1870 72 31 81 31 78 43 92 52 91 62 92 68 92 70 89 62 82 47 82 31 76 I 16 92 16 1871 72 27 78 41 78 42 84 50 86 52 92 69 92 72 92 73 89 55 84 41 79 26 92 26 1872 76 26 75 31 74 36 84 57 89 57 91 71 93 72 93 74 90 66 83 49 79 29 72 19 93 19 1873 66 25 81 43 81-5 38 86 45.5 98.5 57 92 72.5 98 70.5 92-5 71 91 70.5 88 38 77 37.5 78 32 98 25 1874 77 32 77.5 41.5 84 50.5 82 40 5 92 2 57 94 74 95 72 99 1 73 90.5 63.5 86 51 83.5 39.5 78.5 42.5 99 32 1875 77.5 29 80 31 81 36 5 82 51 90 62 94.5 67 95 74 92 69 94 60 82 I 51 5 83 46 79 35 5 95 29 1876 78.5 38.5 80 34 5 81 34.5 84 । 52 89 53 92 69 91 79 89 78 88 1 61 l 77 1 50 73 30 70 I 24 92 24 1877 76 21 72 42 77 39 80 55 92 56 94 67 96 73 I 96-5| 73 1 92 63 84 1 53 78 34 71 34 96 5 21 1878 73 31 73 32 82 42 87 41 90 55 93 66 95 70 94 | 68 I 99 1 57 1 87 | 44 82 i 35 77 23 95 23 1879 73 20 75 38 84 1 45 85 I 46 86 63 91 65 । 91 73 1 89 69 । 90 65 1 86 50 8-2 38 78 32 91 20 EXTREME (MAXIMUM AND MINIMUM) TEMPERATURE. MONTHLY AND ANNUALLY. IN NEW ORLEANS, LA., DURING A SERIES OF YEARS CONSOLIDATED BY JOSEPH JONES, M. D., NEW ORLEANS, LATITUDE 29° 57' N., LONGITUDE 90° 5 W. ALTITUDE 10 FEET. 1880 75 42 77 43 81 42 84 49 88 58 90 69 92 71 92 91 90 63 84 52 75 34 7'8 20 92 20 1881 73 31 78 42 84 38 90 66 97 71 96 73 93 74 91 63 88 57 80 31 77 40 97 31 1882 77 38 79 39 81.5 51 86 63 88 3 58.5 91.8 67 2 92 69.8 91 72.5 89 61.5 85 59.5 82 36.8 75.5 29.5 92 29.5 1883 77 33.5 80 39.5 80.3 44 84 51 88 56.5 91.8 68.4 94.1 74.5 92.5 73.9 90.5 63 88.7 58.9 81 36.8 75.7 27.8 94 1 27.8 Maximum and minimum i - - - - - - during 47 years, 1817- > ... 82 17 84 23 90 29 91 38 96 48 98 58] 100 63 ICO 63 99 50 96 34 84 23 81 16 100 16 1883 ) - - - - - Climate and Health of Louisiana : Joseph Jones, M. D. CCLIX CCLX Climate and Health of Louisiana : Joseph Jones, M. D, Whilst the summers are never excessively hot, and at the same time the thermometer during the winter season, in Louisiana, rarely falls below the freezing point, and even in the severest weather never reaches a point lower than 16 degrees below the melting of ice. The great valley, walled in on the east and west by two diverging moun- tain chains, and presentinng between the Gulf of Mexico and the Arctio Sea, no elevation much to exceed 2000 feet, there is no great barrier to arrest the flow of the hot, moist southerly winds of summer, or the cold, north- erly winds of winter. Along the Gulf coast, the climate assimilates in its features to that of the tropics-clear, blue skies in the morning, starlight nights, gentle showers at midday, and a luxuriant vegetation, with spread- ing leaves. But even here, the fluctuations occasioned by the change of air currents, are very great. The south winds sweeping over the Caribbean Sea and the Gulf of Mexico, are moist and warm, while the north winds, meeting with no barrier to arrest their progress, and being overland, are dry and cold; and hence the changes of temperature are abrupt. At New Orleans snow occasionally falls, and for a short time whitens the ground. The frosts which accompany the "northers' are of sufficient in- tensity to destroy the sugar cane and cotton plants, but at rhe same time, while they do not strip the trees of their leaves, they hardly admit of a perpetually verdant vegetation. The processes of fructification and exfo- liation are arrested, and the distinction between winter and summer are faithfully preserved. It results from the sudden cool changes in winter, that the human constitution in Louisiana is invigorated, and those causes which produce the various forms of malarial diseases are temporarily sus- pended. While, on the other hand, the warm, moist air of the Gulf has a singular, softening and beautifying effect upon the human form, and the golden climate of Louisiana produces the most beautiful and refined woman. The climate of Louisiana is still further varied in the salubrious and ele- vated good uplands of North Louisiana, which cover the greater part of the parishes of Caddo, DeSoto, Sabine, Bossier, Webster, Red River, Clai- borne, Bienville, Union, Jackson, Ouachita. Morehouse, and a small part of Caldwell. In the " Florida parishes," east of the Mississippi, a tract of country similar to the good uplands of North Louisiana is found in the eastern part of the two Feliciana's, and in the northeastern corner of East Baton Rouge. A great part of the good upland region is extremely hilly, some of the ridges being almost mountainous in elevation, reaching a height of at least 300 feet above the valley of the main streams, and from 400 tn 500 feet above the Gulf of Mexico. OBSERVATIONS OF THE ELEVATED TEMPERATURE AND SUNSTROKE OR HEAT APOPLEXY OF JUNE, 1881. EXTRACTS FROM THE PROCEEDINGS OF THE BOARD OF HEALTH, JUNE 23, 1881. The President, Dr. Joseph Jones, directed the attention of the board of the relations of sudden deaths to elevated and continuous solar heat: ELEVATED TEMPERATURE OF JUNE, 1881. During the week ending June 18, the maximum temperatures are as follows: June 12, 91c F.; 13th, 92° ; 14th, 95°; 15th, 94°; 16th, 96° ; 17th, 92° ; 18th, 91°. The mean of the maximum temperature during this period was 93°, and the mean of the minimum temperature 80.1°, giving an average range between the hottest period^of the day and the coolest period of the night of only 12.9°. The mean barometric pressure Climate and Health of Louisiana : Joseph Jones, M. D. CCLXI was high, being 30.01 inches, or that which the instrument maintains at the level of the sea. During this hot weather, which has continued unabated up to this day, June 23, there has been rain only on the eighteenth, when less than an inch of water (0.64 inch) fell, and the deleterious effects of the prolonged and excessive heat have been in a measure counterbalanced by the low mean humidity, which was 66°. While dry weather with elevated temperature may lead to sunstroke and fatal congestions of the internal •organs, at the same time the surface of the earth is dried, noxious vapors are dissipated, fermentation is in a measure arrested, and malarial fevers diminished in number and intensity. The effects of this excessive and prolonged heat were shown in the marked increase of deaths caused by sunstroke, congestion of the brain and apoplexy. Thus for the week ending June 11, 1881, the deaths from the causes just indicated were as fol- lows: Sunstroke, 2 ; congestion of the brain; 4; apoplexy, 2; total from these three •causes, 8. For the week ending June 18, 1881, sunstroke, 7; congestion of the brain, 15; apoplexy, 4 ; total, 26 deaths. The deaths from congestion of the brain and apoplexy were, without doubt, due largely to the causes inducing the deaths referred to as sunstroke, anil we observe that •during the last week they had increased more than three-fold. The total deaths of the week ending June 18, were 189, about one-seventh of which were undoubtedly caused by or traceable to the effects of the heat upon the human sys- tem ; but, in reality, a much larger number were due to heat, as we find that nearly one- half, or eighty-six deaths, occurred among children under ten years of age, and of this number 51 were under one year of age. Cholera infantum caused 17 deaths, tabes mesen- terica 9, enteritis 13, dysentery 10, diarrhoea 5, teething 9, phthisis pulmonalis 14. Total from these diseases 90 ; that is one-half the mortality was caused by these well- known diseases, recognized as existing in all cities and towns. If to these diseases be added the twenty.six sudden deaths most directly referable to elevated temperatures, we have a grand total of 116 deaths. A critical analysis of the remaining seventy-three deaths reveals the important fact that only six deaths were caused by the various forms of malarial fever, as follows: Remittent one, congestive one, malariel foul. It is a re» markable and encouraging fact that in a city containing 220,000 inhabitants, and situated below the level of the high water of the Mississippi River, only six deaths were caused by malarial fever during the seven days of intense heat. ELEVATED TEMPERATURE IN THE MONTH OF JUNE, IN THE CITY OF NEW ORLEANS DURING A SERIES OF YEARS-1817 TO 1881. Years. Maximum.0 Minimum.0 Years. Maximum.0 Minimum. 0 1817 92 1857 88 73 4819 ... 89 74 1858 86 72 1826 93 75 1859 90 73 1838 98 64 I860 94 77 -1839 96 69 1861 88 69 1840.. 94 70 1862 93 1841 94 72 1863 93 67 1842 87 72 1864 91 63 1843 87 71 1867 . 90 70 1844 . 89 69 1869 91 65 1845 . 91 67 1870 91 62 1846.... 89 68 1871 92 69 1847 94 71 1872 91 71 184a 94 70 1873 92 72 1849 92 70 1874 ' 94 74 1850 93 58 1875 94 67 1851 94 71 1876 92 69 1852.... 93 70 1877 94 67 1853 92 73 1878 93 66 1854 96 71 1879....' 1855 92 70 1880 1856 89 78 1881 96 78 It will be observed from the preceding observations that only in a sin- gle year (1838) was the heat greater than that of June, 1881, and in only two years was it equal, namely, 1839 and 1854. The mortuary records of New Orleans establish the fact that in past years sunstroke has not caused any great or unusual mortality. The fol- lowing table, giving the number of deaths from sunstroke in New Orleans during the periods specified, sustains the preceding proposition: CCLXII Climate and Health of Louisiana; Joseph Jones, M. D. DEATHS FROM SUNSTROKE IN NEW ORLEANS. Years. ^Deaths. Years. Deaths. Years. Deaths. 1849 20 1865 ... 22 1874 25 1850 18 1866 18 1875 4 1853 21 1867 7 1876 ... 7 1856.. . 12 | 1869 4 1877 9 1857 4 1870 6 1878 2 1858 20 1871 8 1879... 1 1863.... .... 6 1872 7 1880 2 1864 1 1873 15 1881 It should be observed that the preceding data relates to the total num- ber of deaths from sunstroke during the entire year, It is evident that New Orleans has never suffered from such devastating effects of solar heat Us h^ve upon several occasions occurred in New York, Philadelphia and St. Louis. The following table illustrates the relations of apoplexy^ sunstroke and congestion of the brain to the variations of temperature: DEATHS FROM SUNSTROKE, APOPLEXY, AND CONGESTION OF BRAIN DURING THE YEARS 1840 TO 1865. . Years. Cong, of Brain. Apoplexy. Sunstroke. Total. 1849 118 101 ' 20 239 1850 101 107 68 276 1853 111 133 21 265 1856... 97 92 12 201 1857 92 105 4 201 1858 156 114 20 240 1863.. 81 61 6 148 1864 111 75 1 187 1865 97 100 22 219 Climate and Health of Louisiana : Joseph Jones, M. D. CCLXIII TABLE ILLUSTRATING DEATHS FROM SUNSTROKE, APPOPLEXY AND CONGESTION OF THE BRAIN, TOGETHER WITH THE MONTHLY MEAN TEMPERATURE DURING THE YEARS 1866 TO 1881, INCLUSIVE. ♦Comprises only the first eighteen days in June, ; H H H h h i H Years. Sunstroke. ► * Apoplexy. 15 19 9 5 22 21 12 14 15 12 6 10 12 15 Congestion of Brain. ; ; : : : © oo w cn »o «: : .' : • • Mean Temperature. o - - • w • • • • : Sunstroke. June. oo-*o-iun£e*oi>Ewp» Apoplexy. Congestion of Brain. :::;: ©w©©-©©©. ©: : : : : : Mean Temperature. Sunstroke. July. * 14 5 S o> E 5 -> oo Apoplexy. 1 1 1 17 17 29 22 16 18 9 'S 10 Congestion of Brain. ■ . . . . . :S222S2SS2 . ®ooa>-iao-w©x.. ....... Mean Temperature. . ;-: isr • -: : w - >- w: « » «« Sunstroke. 12 6 7 11 5 11 6 11 5 6 11 7 4 10 Apoplexy. August. 12 22 7 14 21 26 14 76 3 22 33' 7 9 Congestion of Brain. : : : : : : vLoLv.-oL-: : • :j Mean Temperature. Sunstroke. 1 5 4 13 11 7 3 9 5 9 4 7 5 8 11 Apoplexy. • 8* 8 88 58888.8 m 8 w Congestion of Brain. : :3:ia!a!2!:3g2£: : : : : •' oic^k' Mean Temperature. October. 7 2 11 2 12 11 1 8 5 6 7 5 A poplex j-. 5 11 5 4 8 18 23 17 8 11 6 27 10 12 Congestion of Brain. ::::: . c 4! 41 - & <4 OD Mean Temperature. 18 7 I 7 15 25 4 7 9 2 1 2 Sunstroke. Total Six Months. Apoplexy. : Congestion of Brain. CCLXIV Climate and Health of Louisiana : Joseph Jones, M. D. The statistics of the great Charity Hospital still further demonstrate that the citizens of New7 Orleans are not liable to sun-stroke. I have examined carefully the records of the great Charity Hospital of this city during a period in which a population greater than that of New Orleans at this moment, and exceeding 300,000, were gathered within its walls. The following table presents the total number of cases and deaths from sun-stroke in the Charity Hospital for the years specified : SUN-STROKES. SUN-STROKES. Years. Cases. Deaths. Years. Cases. Deaths. 1842 4 2 1860 40 32 1843 1864 2 1 1844 . . • .... 1866 20 1845 27 17 1867 10 1 18.46 2 1 1868 4 1 1848 10 4 1849 3 2 1870 9 2 1850 o/ 32 1871 1851 26 26 1872 13 1852 29 16 1873. 11 7 1853 20 12 1874 1 1854 52 13 1875 2 2 1855 11 i) 1876 .. 1856. . 9 3 1877 2 1 1857 2 1 1878 6 1 1858 10 4 1879 1859 12 10 1880 From the preceding statistics it is established that during a period of t hirty-four years in the Charity Hospital, in -which the annual admissions from all diseases varied from 18,476 in 1850 to 4,277 in 1842, the total cases of suu-stroke entered upon the books of the Charity Hospital were 399, and the deaths 212. No relationship w hatever can be traced in the statistics of the Charity Hospital between sun-stroke and yellow fever. Thus, the largest numbers of cases and deaths from sun-stroke occurred in 1845, 1850, 1851, 1852, 1854 and 1860. The cases and deaths from yellow fever in the Charity Hos- pital during these years were as follows : 1845-No deaths, 1 case. 1852-496 cases, 339 deaths. 1850 - 6 cases, 4 deaths. 1854-2,743 cases, 1,233 deaths. 1851-7 cases, 2 deaths, 1860-2 cases, no deaths. On the other hand, in 1853, when there were 3,217 cases and 1,890 deaths from yellow fever, only 20 cases and 12 deaths from sun-stroke were recorded. In 1858, 2,727 cases and 1,382 deaths from yellow fever, 10 cases and 4 deaths from sun-stroke. In 1867, 1,493 cases and 672 deaths from yellow fever, 10 cases and 4 deaths from sun-stroke. In 1878, 817 cases and 4;1 deaths from yellow7 fever, 6 cases and 1 death from sun-stroke. It is evident, therefore, that the mere occurrence of prolonged and elevated solar heat forms no ground for the prognostication of evil with reference to the origin or spread of yellow fever and the various forms of malarial fever. There are three well-defined forms or varieties of sun-stroke, under the designation of sun-stroke, coup de soleil, isolation, heat apoplexy, heat asphyxia, thermic fever, ardent fever and sun fever. Careful observers have recognized certain essentially different pathological states, which are not (infrequently confounded. Thus excessive hear, whether projected in rays directed from the sun. or accumulated in close, ill-ventilated rooms, may cause : 1. Exhaustion, ending in simple syncope, during great fatigue or over-exertion, when there is depression of vital power during exposure to high temperature. The skin is pale, cold and moist, and the pulse feeble, indicating depression of nerve force and muscular power. Death may occur in this state from failure of the heart, but with proper care and treatment recovery frequently takes place. 2. The direct rays of a powerful sun often induce an effect upon the brain and spinal cord analagous to that known to surgeons and physicians as shock. During the expo- sure of the head and spine to the direct rays of a powerful sun, wheQ the atmosphere is much heated and the nervous energy is so depressed by over-fatigue, illness or dissipa- tion, asphyxia or aphncea (stoppage of breath) may come on, after premonitory symp- toms of depression and weakness. The brain and respiratory nerve centres are over- whelmed by the sudden rise of temperature, respiration and circulation fail, and death often results. Without doubt this sudden and fatal action of the rays of the sun is fre- Climate and Health of Louisiana: Joseph Jones, M. D. CCLXV quently aggravated by or consequent unon the improper and free use of alcoholic stimu lantsand to excess of various kinds which have impaired the tone and vigor of the ner vous system. Pre-existing disease of the heart or kidneys, brain and spinal cord, may in like manner give a peculiar susceptibility to the effects of heat. The susceptibility is also sometimes established by the effects of severe grades of fever. 3. The rapid elevation of the temperature of the blood, and of the entire body, above the normal standard, either from direct exposure of the sun's rays, or more frequently to a higher temperature of the surrounding medium. In the thermal fever caused by the action of heat whether artificially applied to the nerve centres, or directly received from the aun, thereis paralysis of the vaso-motor nerves, failure of the respiration and circulation, followedby asphyxia and death. Even when recovery takes place after this form of sun- strokeit is often tedious and imperfect, and sometimes ends in serious impairment to the in- tellect. The sudden rise of temperature from the normal standartl of health, 99c F. to from 108° to 111°, may, as is well known, occur independently altogether of the direct action of the sun's rays, during the night, in crowded, hot, badly ventilated rooms, in persons depressed by fatigue, foul air, overcrowding and alcoholic stimulants; As the normal temperature of the body is riiaintained at a certain standard, at the Poles and in the hot regions of the Tropics, by the relative activity of the respiratory and cutaneous funtions, and thetempeature and evaporation of the moisture from the skin and lungs, it is evident that incrersed chemical change due to overheating or to abuse of alcoholic stim- ulants, and the suppression of the functions of the skin and lungs by overcrowding, and hot and foul air, must be prolific of mischief during such a heated term as we are now experiencing. Alcoholic stimulants, when used to excess, may exert deleterious influ- ences, more especially during the hot weather, by overwhelming the nerve centres, para, lyzing the vaso-motor nerves, and inducing fatal congestions. Such instances have fre- quenty been observed by the experienced physicians of New Orleans. It is not the province of this Board to enter into the question of the treatment of dis- eases; and when its executive head has faithfully stated the nature and causes of the fatal and prevailing forms of disease, and placed the public in possession of the essential facts of sanitary and hygienic science, questions of remedial measures and agents may be left where they properly belong, namely : In the hands of the enlightened and faithful physicians of New Orleans, who have been noted for their skill, humanity and patriotism. It may be claimed that the physicians and surgeons of New Orleans have •contributed as much to the cause of suffering humanity as any body of scientific and learned men of equal numbers in the civilized world. During this century alone the medical profession of New Orleans have faithfully and gratuitously attended in the great Charity Hospital patients from every State in the Union, and from every country under the sun, to a number which reached over 450,000, or twice the present population of this city. CCLXVI Climate and Health of Louisiana: Joseph Jones, M. D. RELATIONS OF MALARIAL AND YELLOW FEVER TO CLIMATE. Malarial fevers prevail chiefly in the summer and autumn in New Or- leans, but they are never absent during any portion of the year. Yellow fever on the other hand prevails chiefly during the months of June, July, August, September and October, the heaviest mortality occurring as a general rule in August and September, as will be seen from the following tables: MONTHLY DEATHS BY YELLOW FEVER DURING A PERIOD OF 32 YEARS. 1847-1878. YEAK. May June. July. 1 August. September. 1 October. November. December. Total deaths by Yellow Fever.' Date of First Case. 1847 1848 1849 1850 1851 1852 1 4 74 33 1 4 2 965 200 17 62 8 8 1100 467 214 33 6 91 198 226 416 4 2 198 33 20 112 1 105 9 11 2306 808 769 107 17 456 July 6th. June 21st. July 28th. 1 death January, 2 March, 1 May. July 1853 1854. 1855 2 31 2 5 1521 29 382 5133 532 1286 982 1234 874 147 490 97 28 131 19 4 7 7849 2425 2670 May 22d. First death June 12th. June 19th. 1856 14 40 16 4 * 74 June 28th. 10 Years. 3 42 2046 8225 5041 1794 453 55 17481 1857 1858 1859 1860 1 2 1 132 3 1 1140 7 8 2204 1 5 98 1137 59 82 224 28 8 3 200 4845 91 15 1 death reported in Januaty. 1 death reported January ioth. June. 1861 1862 1863 1864 1865 1 1 1 2 4 1 1 2 2 6 1 About 100 cases in U. S. river fleet. About 200 cases and 57 deaths U. S. gun~ boats and river fleet. 1866 <> 56 89 31 4 192 1 death 10th August. 10 Years. 3 137 1154 2277 1387 366 21 5354 1867 1868 1869 1870 1871 1872 1873 1874 .... 1875 1876 3 1 11 1 3 255 3 2 1 19 5 1 1637 231 9 5 208 2 24 19 1072 5 2 242 22 24 79 6 20 17 103 106 19 7 17 2 9 4 26 5 2 2 1 3 1 "I 54 39 226 11 61 42 1 case died June 10th. October 5th, died in Charity Hospital. July 17th. May 26th. July 30th. August 28th. July 9th. August 19 th. August 8th. August 11th. 10 Years. 4 15 286 2135 1489 267 40 4136 1877 1878 2 50 974 1893 1044 1 90 3 1 4056 November. May 25d. 2 Years.. 2 50 974 1893 1044 91 3 4057 32 Years. 5 49 2248 10639 11346 5714 1177 119 3128 From the preceding table, it is evident that as a general rule the great epidemics, as those of 1847, 1849, 1853, 1854, 1855, 1858, 1867 and 1878, commenced early in the hot months (May, June and July) and attained their maximum intensity in August and September. Thus during the period of thirty-two years, the deaths from yellow fever in New Orleans were as follows: January, 6; February, 0; March, 2; April, 0; May. 5; June, 49; July, 2248; August, 10,639; September, 11,346; October, 5714 j November, 1177; December, 119. The curve of yellow fever, therefore, corresponds to a certain extent with the curve of temperature. Thus, from the records of thirty-eight CCLXVII Climate and Health of Louisiana : Joseph Jones, M. D. years, which I have consolidated'and calculated from the most reliable data> the mean temperature of New Orleans is as follows: January, 56.28; February, 58.03; March, 64.27; April, 69.41; May, 75.00; June, 81.35 % July, 183,21; August, 83.14; September, 79.64; October, 70.27 ; November;, 62.30; December, 56.43; spring, 69.56; summer, 82.53; autumn, 70.75; winter, 56.91; year, 69.51 F. The origin and spread of yellow fever, therefore, depends absolutely upon an elevated temperature, ranging from <0° to 85°, and its decline depends upon a mean temperature ranging from 65° to 56° F. These figures, of course, relate to the mean or average monthly temperature, the extremes being much higher or lower, ranging during the year, in New Orleans, as shown by meteorological observations extending from 1837 to 1878, from 17° to 100° F. On the other hand, the various forms of malarial fever are more uni- formly distributed throughout the months of the year, although this class of diseases, as well as yellow fever, show their maximum intensity in num- ber of cases and fatality in those months of the year in which the tem- perature is most favorable to the putrefaction of animal and vegetable mat- ters, and the development of the lower and most prolific forms of animal and vegetable life, and especially those forms which are active agents in putrefaction and fermentation. Thus, the deaths caused by the various forms of malarial fever were, in 1878, as follows : January, 6 ; February, 3; March, 9; April, 15; May, 12; June, 13; July, 25; August, 136; Sep- tember, 146; October, 111; November, 41; December, 6. The mortuary records, however, give but an imperfect and delusive view of the relative prevalence of the various forms of paroxysmal or malarial fever in New Orleans, from the well-known fact that these diseases rarely prove fatal. The favorable results obtained in the treatment of intermittent, remittent and congestive malarial fever, are, at the present day, mainly due to the free and prompt administratiion of quinine by the physicians of this city and of other parts of the Southern country. The relationship of the forms of malarial fever to the climate and sea- sons, and to other diseases as yellowT fever, are best established by the sta- tistics of fever hospitals situated in malarial districts, where also yellow fever is at times endemic and epidemic. The records of the Charity Hospital of Newr Orleans furnish the best field for such inquiries, as it has been justly regarded as one of the great fever hospitals of the world. The following statistics will serve as illus- trations of the numerical relations of malarial fevers to climate and yellow fever. It appears frsm the records of the Charity Hospital, that during a period of ten (50) years-January 1, 1841, to January 1, 1851-there were ad- mitted into this hospital, 91,892 patients; of which number there were ad- mitted, all the different forms of fever, 45,149; and among these last, for intermittent fevers, 25,183. It would thus appear that nearly one-half of all the patients admitted into this hospital w ere for the different forms or types of fever and that more than half of these were in termitten ts. It should be mentioned that this vast number of patients included a lunatic asylum, having from sixty to ninety inmates up to June 1848, when it was removed to Jackson. This, large number of fever patients included many that were imported by sea, and brought from neighboring States and foreign countries,, and furnished also by the army of Mexico, which twice passed, during this period, through New Orleans. The intermittent and paroxysmal form, of fevers mostly originate in the Mississippi Valley, whilst the continued fevers are mostly imported. CCLXVIII Climate and Health of Louisiana: Joseph Jones, M D. The following statement will show the prevalence of intermittent fevers at the different seasons of the year, for the time specified: TABLE OF ADMISSIONS OF CASES OF INTERMITTENT FEVER INCHARITY HOSPITAL OF NEW ORLEANS. IN THE DIFFERENT SEASONS OE THE YEAR-1841-1849. INCLUSIVE. YEAR. Spring. Summer. Autumn. Winter. All Fevers. Yellow Fever. 1841 112 403 177 92 1991 1113 1842 114 453 394 135 1758 410 1843. 85 208 413 137 2222 1053 1844 117 469 732 231 2207 152 1845 180 353 664 206 1763 1 1846 236 569 1045 218 2603 148 1847 391 508 691 602 6901 2811 1848 282 689 874 535 6361 1234 1849 420 1701 3738 1275 7575 1060 Total 1937 5353 8718 2431 33.381 7982 During the years specified, there was but one single year (1845) in which New Orleans was exempt from yellow fever, It is evident, from this table, that intermittent fever prevails in New Or- leans the year round, gradually increasing from the winter up to the autumn, when it begins to decline. Whilst variations appear in different seasons and years, and whilst the cases were most numerous when there was less yellow fever, still intermittents are never absent, even when yellow fever committed its greatest ravages, as in 1841, 1847, 1848 and 1849. If, during the nine years specified, the months be selected in which yellow fever prevailed to the greatest extent, the following relations to the cases of this disease and malarial fever will be established : •FEVER STATISTICS, CHARITY HOSPITAL, NEW ORLEANS, LA. TABLES SHOWING THE ANNUAL AND MONTHLY ADMISSIONS OF THE DIFFERENT FEVERS. 1 Year. | Total Admissions. FEVERS. January. February. March. April. 1 June. July. August. | September. | October. I November. 1 December. Total Fevers. U841 4*380 Intermittent 3 27 45 3? 28 65 187 151 18 66 93 72 794 Typhoid 1 6 12 Congestion Remittent .... 4 3, 1 7 3 3 1 2 24 3 2 9 9 6 31 3 13 5 1 81 Malignant Intermittent 3 .... 6 Yellow 174 642 252 37 8 1113 Bilious 3 3 Total 11 32 46 41 37 71 228 344 665 322 143 93 2033 1842 4404 Intermittent 45 29 35 39 45 1241 160 169 144 140 110 61 1101 Remittent 4 1 3 4 8 12 34 41 35 11 3 156 Typhoid ... Bilious 9 2 4 2 2 2 1 22 2 3 9 3 1 2 2 •» 23 ongestive 1 3 3 2 10 5 4 9 1 40 Gastric 1 2 6 1 1 11 Catarrhal . 1 1 1 3 Yellow 47 247 93 23 410 Nervous 1 1 Adynamic 1 1 .... Total 1842 59 31 39 47 52 142 197 259 439 284 150 6! 1768 5013 1 ntermittent .... 31 2 am as 31 19 4( 70 98 128 13t 14! 7( 1 843 Typhoid 2 4 Remittent 1 1 9 40 75 49 12 8 10 205 Catarrhal 1 1 2 Bilious 1 1 15 3 37 5 2 2 3 71 Tvphus 3 0 9 Congestive 3 17 4 24 Gastric 1 1 1 4 7 Continued 1 1 Yellow 3? 188 365 351 111 1:' 1062 Cephalic ... 3 Total 1843 30 30 _ 35 $ 34 60 20: 372 54' 1 501 - 1 271 10r 2231 Climate and Health of Louisiana : Joseph Jones, M. D. CCLXIX Year. Total Admissions. FEVERS. January. February. March. A S' s © a ►a 3 August. September. <0 eO O O o N ovember. December. Total Fevers. 1844 5846 intermittent 66 49 41 32 44 75 176 258 255 261 216 116 1589 Remittent 2 4 2 1 4 24 30 47 67 55 5 3 244 Yellow 2 2 1 1 1 68 52 25 152: Typhoid 6 1 3 3 10 12 11 8 6 20 80 Simple 3 6 3 12 Gastric 1 2 1 .3 2 11 Typhus .... 4 4 Bilious 2 4 2 1 3 1 13 Inflammatory 1 2 2 2 9 2 11 Congestive 1 7 11 17 14 13 15 3 81 Adynamic 2 o 4 Continued 2 3 Eruptive 1 1 Total 1844 80 65 50 41 59 117 239 333 423 401 254 145 2207 1845 61361 Intermittent 7 75 57 44 79 112 145 96 279 196 189 124 1403 Tvphoid 7 6 □ 2 10 8 11 14 18 20 15 23 139 Remittent 2 1 1 11 17 38 34 33 17 154 Congestive 3 i 1 2 1 4 5 4 21 Inflammatory 2 .... 1 1 4 Yellow 1 1 Continued 1 2 1 1 Nervous * 1 1 3 Bilious. 1 2 6 1 1 1 2 14 Simple. 1 4 1 1 1 1 9 Pernicious 2 2 .... 4 Other fevers 2 1 2 1 6 Total 1845 1 - 1 . 21 84 63 52 106 151 201 151 339 241 206 148 1763 1846 8044 Intermittent 79 58 75 76 85 138 214 227 359 376 310 81 2078 Typhoid 30 13 7 5 10 12 14 17 5 7 23 52 195 Remittent 3 3 5 6 2 9 09 36 7 3 103 Congestive 1 1 2 4 2 5 9 2 5 31 Yellow 29 83 3 2 4 148 Bilious 1 1 0 4 Pernicious 2 9 11 Catarrhal 1 1 Nervous 1 1 1 3 Scarlet 2 2 1 2 1 8 Malignant 2 2 Larvata 2 9 1 1 6 Pernicious intermittent 6 4 1 11 Gastric hepatic 1 1 Ataxic 1 1 1 Total 1846 117 75 90 83 104 161 236 255 433 522 381 147 2603 1847 111,896 Intermittent 144 117 | 98 153 14( 211 221 7-1 51 258 381 341 2192 Typhoid 4C 21 i 50 71 61 21 t 6( 111 457 Typhus 4 10' 16; 36£ 5' ■ 10( 23< 1045 Remittent - 1 4 1' 38 61 6- 2. IS 18 269 Congestive 1 1 S IS 11 ... 1 36 Yellow 1 148 161 77' 21! 4! 2811 Bilious J . . . - .. 42 Pernicious intermittent .. ... ... Other Fevers ... ... • ... 21 40 '■■■• ■ -■■■-- , - - - Total 1847 19. 145 15' 341 39( 66 52 1751 85' 51: 62: 73. 6897 1848 11,94; Intermittent-. 18' 11; 101 7: 11( 161 21! 31( ); 29 ) 33 4. 27 . 23 1 2411 Remittent 1' 1 2 5' 10 8' 7 6 1 6 ' 3 I 5 490 Typhus, Typhoid 521 588 26' 16< 11 28 21 111 • 5 6 6 1 3 0 1882 Yellow 3 465 59 7 10 5 3 1 1234 Catarrhal 11 )... L ... ... 1 • • • 13 Bilious 25 1' 11 1 1 35 2 1 6 3 173 Ephemeral 1( 1 9| ' 73 Congestive t... S 1 1. 1 2 11 4 Scarlet ... 7 Dengue 5> 1 1 ... 7 Puerperal . ... 1 .. . 1 Continued .. ... 1 .. 6 Total 1848 75 73 40( 28 ) 26 7| 28 42 92 100 4 57 61 42 0 27 7 6351 FEVER STATISTICS, CHARITY HOSPITAL-Continued. CCLXX Climate and Health of Louisiana : Joseph Jones. M. D. FEVER STATISTICS, CHARITY HOSPITAL-Continued. Total Admissions. FEVERS. January. February. - March. April. c? Juno-. July. August. | September. October. November, | December. Total Fevers. 11849 15,558 Intermittent ........ Typhus Typhoid Remittent Bilious Yellow .... Ephemeral Congestive. Puerperal 109 79 6 4 114 127 io 6 8 138 193 13 19 18 117 140 14 !» .... 18 69 128 30 6 6 1 155 65 49 10 "'2 4 1 368 43 70 39 592 44 166 20 28 8 6 2 763 49 223 11 374 7 8 720 21 116 3 520 1 8 1 360 ,23 76 1 130 2 684 58 "56 6 1 6 4189 891 79 824 130 1060 82 39 4 Scarlet 1 1 Cerebral 1 1 1 3 Continued 1 6 6 1 2 2 ■ 1 20 Total. 1849 205 265 381 298 241 292 539 867 1438 1392 598 806 7322 1850 18,676 Intermittent .... •- - - - - - 7891 Remittent 2278 80 Congestive .... 31 Congestive Intermittent 103 Typhus 1044 Congestive Remittent 4 Malignant Intermittent 34 Continued Ephemeral • 83 Malignant 1 Puerperal 4 Scarlet 3 Ataxic 4 Yellow 9 Dengue 1 Mesenterica 1 Total. 1850 1 11648 Tables 1841-1849, embrace those consolidated from records of Charity Hospital by Dr. Fenner. It is thus made evident that paroxysmal fevers prevail every year and in every month of the year in New Orleans, thus presenting a marked con- trast to the prevalence of yellow fever, which is shut up to much narrower limits. It appears that the cause of yellow fever, requires for its generation and propagation a higher degree of heat, and that the conditions of its exis- tence are more narrowly defined than those of malarial fever. The cause of the latter disease not only resists successfully a much lower tempera- ture than that of yellow fever, but when once engrafted on the human sys- tem, it is far more persistent and indefinite in its duration, and in fact in many cases produces such profound alterations in the constitution of the blood and in certain organs as the spleen and liver, as to constitute a con- dition of the system, which may underlie and modify supervening diseases. In this respect, therefore, the prolonged action of the malarial poison, re- sembles that of syphilis, in that it produces radical changes in the blood and arteries. Yellow fever, on the contrary, acts as a specific well defined disease, affecting as a general rule, the constitution but once, and in the vast ma- jority of cases leaving no recognizable traces of its action. The preceding proposition will be still further illustrated by the follow- ing table, showing the deaths caused by malarial fevers in each month in New Orleans during a period of twelve years, 1869 to 1880, inclusive: Climate and Health of Louisiana : Joseph Jones. M. D. CCLXXI TABLE SHOWING DEATHS FROM MALARIAL FEVERS BY MONTHS, DURING THE YEARS 1869 TO 1880, INCLUSIVE. •Average 0 £ 1880 1874 '1875 1876 1877 1878 -.. 1S79 . 1869 1870 1871 1872 S s 13 15 7 15 17 11 10 15 22 10 5 10 January. 05 w co 8 9 11 20 14 12 8 14 20 7 3 13 February. 115.3 £ 13 20 15 20 20 12 14 13 12 16 11 18 March. o 2 16 20 15 14 17 16 19 19 23 23 8 14 April. to I-* to g 22 31 11 31 30 24 15 20 18 16 13 26 May. g g 19 50 35 18 25 24 26 23 47 26 16 32 June. 144.5 Ui 2 47 43 40 34 62 67 39 55 41 47 33 26 July. ,66.2 w Ul 60 46 64 46 55 125 63 38 61 177 30 30 August. 00 bS co op 61 90 65 38 91 50 100 83 79 229 19 79 September. g c w 35 48 45 32 79 79 55 56 40 163 32 39 October. [30.5 § 27 46 26 11 25 36 18 41 29 55 20 32 November. • co g co 21 17 14 12 11 32 16 24 17 8 12 19 December. 4*. O £ 2 342 435 348 291 446 488 383 401 409 773 202 336 Total. CO CO 1.79 2.26 1.82 1.52 2.33 2.32 1.82 1.91 1.95 3.68 0 96 1.55 Death rate per 1000 per annum | 202.500 216.000 000012 j 000'161 | Population. During the entire 12 years, embracing 144 months, deaths occurred from ■malarial fever in every individual month. CCLXXII Climate nnd Health of Louisiana : Joseph Jones, M. D. STATISTICS OF YELLOW FEVER IN CHARITY HOSPTAL OF NEW ORLEANS. DURING A PERIOD OF 57 YEARS. YEAR. Admissions. Discharges. Deaths. Per cent of Mortality. Date of First Case. Date of Last Case. Yellow Fever. Yellow Fever. Yellow Fever. 1822 337 98 239 70.92 September 3. September 11. Angust4. June 23. December 21. 1823 1 1 100.00 1824 167 59 108 64.67 November 13 1825 99 40 59 December 19. November 18. 182G 24 19 5 20.83 May 18. Total 5 years. 628 216 412 65.63 1827 372 263 109 29.30 July 17. June 19. December 5. 1828 290 160 130 44.83 December 10. 1829 435 220 215 49.42 May 23. July 24. June 9. November 29. 1830 265 139 117 45.72 November 29. 1831 3 1 2 66.67 October 7. Total 5 years. 1356 783 573 42.23 1832 26 8 18 69.23 August 15. October 25. November 17. November 22. November 27. October 25. 1833 422 212 210 49.77 July 17. August 28. August 24. August 24 1834 150 95 63 33 1835 505 221 248 56.24 1836 6 1 83.33 Total 5 years. 1109 497 612 55.18 1837 998 556 442 19 44.29 77.25 July 13 August 25. July 23. July 9. August 2. November 28. November 1. November 17. November 17. December 8. 1838 24 1839 1086 634 452 3 41.62 100.00 53.14 1840 3 1841 1114 520 593 Total 5 years. 3225 1715 1510 43.72 1842 425 214 211 49.65 August 4. November 26. December 31. November 25. August 10. December 1. 1843 1096 609 487 44 44 July 10. September 4. August 10. August 29. 1844 169 86 83 46 11 1845 1 1 1846 146 50 96 65.82 Total 5 years. 1837 960 877 47.74 1847 2479 1584 895 46.11 June 29. December 11. 1848 1234 814 420 34.26 June 7. December 2. 1849 1062 517 545 4 51.66 40.00 28.57 July 28. August 23. August 1. December 4. November 16. October 9. 1850 10 6 1851 7 5 2 Total 5 years. 4792 2926 1866 39.06 1852 496 157 339 1890 68.74 58 71 August 20. May 21. July 2. June 3. August 10. November 29. 1853 3317 1327 1854 2743 1510 1233 44.91 December 1. 1855 2198 1099 1099 51 50.00 52 04 December 11. November 3. 1856 98 47 Total 5 years. 8752 4140 4612 52.69 1857 235 80 155 65.91 50.67 78.50 September 17. June 16. August 29. August 12. December 18. December 23. November 29. November 4. 1858 2727 1345 1382 1859 107 23 64 1860 2 1 1861 Total 5 years. 3071 1450 1621 52.78 1862 1 1864... 2 1 1 50.00 1 R65 . 1866 ... 130 95 35 28.92 November 14. Total 5 years. 132 96 36 27.27 Climate and Health of Louisiana : Joseph Jones, M. D. CCLXXIII YEAR. Admissions. Discharges. Deaths. Per cent of Mortality. Date of First Case. Date of Last Case. Yellow Fever. Yellow Fever. Yellow Fever. 1867 1493 8 4 518 29 821 3 3 256 9 672 5 1 262 20 45 01 62.50 33.33 50.75 68.96 June 9. October 5. October 22. October 22. 1868 IftfiO 1870 1871 Total 5 years. 2052 1092 960 46.36 1872 11 118 9 16 3 3 43 3 5 1 8 75 6 11 2 72.72 63.55 66.66 68.75 66.66 1873 1874 1875 1876 Total 5 years. 157 55 102 64.96 1R77 1878 817 406 411 50.44 ■July 18. November. 10 vears, 1822-1831 1984 999 985 49.64 10 years. 1832-1841 4334 2212 2122 48 75 10 years, 1842-1851 6629 3886 2743 41.47 10 years, 1852-1861 11823 5590 6233 52.71 10 years. 1862-1871 2184 1188 996 45.57 Total in 50 years. 26974 13875 13079 48.55 STATISTICS OF YELLOW FEVER IN CHARITY HOSPITAL-Continued. From the preceding table consolidated from the yearly reports of the Charity Hospital, it will be seen that during a period of fifty years, 1822-1871, 26,974 cases of yellow fever were treated in the Charity Hospital, with a mortality of 48.55 per cent., and if we include the five years, extending to 1876 inclusive, 27,130 cases of yellow fever were admitted, 13,181 of which proved fatal, giving a mortality of 48.65 per cent, for the entire period. During the entire period of fifty-five years, extending from 1822-1876 inclu- sive, only four years can be specified in which no case of yellow fever was entered upon the Hospital Register, namely, 1861,1862,1863 and 1865. In 1864, only two cases were entered. It is important to note that the period 1861- 1865, embraces the American Civil War, when the relations of New Orleans to commerce and emigration were altered, and the city was, to a great extent subject to a strict military government and rigid quarantine. A progressive increase in the number of cases of yellow fever, admitted into the Charity Hospital, is observed from 1822 to 1858. Thus, if periods of ten years be compared, the following results will be obtained : Admissions during ten years 1822-1831, 1984; 1832-1841,4334; 1842-1851, 6629; 1852-1861, 11,823. This increase should be referred not so much to a relative increase of the disease, as to the growth of New Orleans, and the progressive increase of emigration from European countries and Northeim and Northwestern States, during the forty years, extending from 1822-1861 inclusive. CCLXXIV Statistics of Charity Hospital: Joseph Jones, M. D. The truth of this proposition can be shown by the statistics of the Charity Hospital and the march of population: TOTAL ADMISSIONS AND DEATHS IN CHARITY HOSPITAL DURING 55 YEARS-1822-1877 INCLUSIVE. Year. Admis- sions . Dis- charged . Deaths. Remain- ing. Year. Admis- sions . Dis- charged. Deaths. Remain- ing. 1822.... 1,689 1,116 57.'. 82 1850 18,476 15,989 1.884 719 1823 1.266 983 283 78 1851 18,319 17,074 1,869 1824 .... 100 1852 18,031 15,057 2,098 1825. . . 1.267 989 218 70 1853 13,759 10,733 3 164 1826 1,408 1.212 196 125 1854 .... 13,192 9,976 2.702 1827 ... 1.853 1.519 304 90 1855 12,192 9.701 2,391 545 1828 2,390 1.989 401 94 1856 9.432 8,398 974 1829 .... 2,548 2,065 483 138 1857 8,903 7,913 1,017 1830. .. 2,790 2,366 424 148 1858 11,337 8,923 2.290 644 1831 ... 3,558 3.149 409 116 1859 12,775 11.257 1,321 730 1832.... 2,271 1,703 568 309 1860 .... 14,000 12.357 1,390 891 1833 .... 3,731 2,617 1.114 169 1861 8.665 7,918 798 1834 ... 5,797 4,745 1,052 262 1862 6,016 5,532 719 1835 6,225 4,999 1,226 265 1863 373 1836 4,748 4,163 585 222 1864 .... 4.861 3,999 812 423 1837.... 6,060 4,640 1,420 228 1865 .... 6,466 5,880 669 423 1838 4,573 3,890 683 271 1866 9,329 8,108 1,122 738 1839 4.566 3,611 955 239 1867 8,612 7.260 1.438 637 1840 4.989 4,370 619 267 1868 4,981 4.365 490 660 1841 4,249 3.093 1,156 314 1869 6,177 5,327 784 716 1842 ... 4,404 3.516 760 1870 7,837 6,764 1.118 672 1843 ... . 5,013 3,672 1,041 1871 6,651 5.730 891 700 1844 5,846 5,059 820 1872 5,541 4.846 825 570 1845 6,136 5.446 563 283 1873 .... 5,090 4,124 993 543 1846 8,044 7,074 855 401 1874 5,231 4,360 860 554 1847 11,406 9.369 2,037 427 1875 ... 4,845 4 121 753 525 1848 11,945 10,010 1,897 828 1876 5,690 4 780 742 693 1849 15.558 12,133 2,741 609 NATIONALITIES OF PATIENTS ADMITTED TO THE CHARITY HOSPITAL, NEW OR- LEANS FOR THE PERIODS SPECIFIED. YEAKS. Foreigners. Natives of the United States. Natives of Louisiana. Unknown. 12 Years. 1830-1841 37,543 16 247 512 1842 3,449 921 34 1843 3^921 1,033 59 1844 4'530 1.203 113 1845 4.786 1.231 119 1846 6,151 1 628 145 120 1847 10,171 53 157 1848 10,280 1 468 111 86 1849 - 13,634 1,635 147 142 1850 16 598 1 510 064 104 1851 16^503 1 485 241 191 1852 16,144 1 561 248 178 1853 12,333 1 078 •>28 120 1854 11'606 1 250 252 84 1855 10'861 960 328 43 1856 8,045 1 020 349 18 1857 7,326 1'183 394 1858 9,568 1,391 360 18 1859 10,753 1 637 377 £ 1864 2,966 1,167 624 4 1868 3,422 L014 524 21 1869 3,480 1'841 837 19 1870 4,907 2,163 723 44 1871 4.101 1,847 671 32 1872 3,255 1'622 631 33 1873 3,038 1,363 672 17 1874 3,013 1'437 764 17 1875 2,634 1,332 866 13 1876 2,991 1'669 1,015 15 Total 248,011 55,403 11,761 1,448 Total admissions oil Foreigners, Natives of the Unitad States and of Louisiana (18:10-1876 inclusi ve( 316,659. A.comparison of the. preceding tables will illustrate the relations of the foreign population to the disease, and especially to yellow fever, treated in the Charity Hospital of New Orleans. Practical Observations on Yellow Fever: Joseph Jones, M. D. CCLXXV During the period of forty years 1830-1876. 316,659 patients were ad- mitted to the Charity Hospital, and of this number 248,011 were foreigners ; 55,403 natives of the United States, outside of Louisiana, and 11,761 were natives of Louisiana. PRACTICAL OBSERVATIONS ON YELLOW FEVER IN NEW ORLEANS. LA. Sanitary measures and reforms must be based on facts and not on specu- lation. The first step is to view calmly and dispassionately the magnitude and true nature of the evils under which the people labor; and then when the public mind is sufficiently enlightened, those charged with the sanitary im- provement of the city, may be either aroused, or compelled to do their duty in the execution and perfection and maintenance of works absolutely essential to the comfort and health of the entire people. Rome in former times, before she had perfected her wonderful system of sewers, and drained the Pontine marshes, conquered surrounding nations with the sword and destroyed her citizens by fevers ; New Orleans on the other hand, has conquered her territory from the domain ot the Father of Waters, and by the progressive improvement of her system of drainage, she may hope, finally to banish those fevers which have destroyed her citizens. The statistics of our great Charity Hospital furnish data for the com- prehension of the magnitude of the sufferings, pecuniary expenses, and mortality inflicted upon the citizens of New Orleans by fevers. At great expense of time and labor I have been able to consolidate the recorcls of the Charity Hospital during a period extending from 1841 to the present time, and now present some of the more important results. (See Tables A and B). During eighteen years preceding the civil war, 1842-1860, the total ad- missions into the Charity Hospital of New Orleans 207,356 ; total deaths, 29,614; the per cent of deaths, 14.2. During sixteen years following the civil war, 1864-1881, total admis- sions, 96,857; total deaths, 14.104; per cent, 14,5. Total admissions during 34 years^ 304,213 ; total deaths, 43,718; per cent. 14.3. Yellow Fever-1842-1860 (18 years): cases, 16,073; deaths, 8,081. Per cent, of mortality in yellow fever, in the Charity Hospital, for the period specified, 50.2. 1864-1881 (16 years):'cases, 3,160; deaths, 1,560. Per cent, of mortality, 49.6. It is evident, therefore, that during the 34 years specified, that there were treated in the wards of the Charity Hospital 19,233 cases of yellow fever, with 9,667 deaths, giving a mortality of 50.2 per cent. It would appear from the preceding statement that yellow fever has greatly diminished during the past thirty-four years. This fact will be still more evident by extending the review over a longer period, from 1821 to 1881. CCLXXVI Practical Observations on Yellow Fever : Joseph Jones, M. I) CASES OF YELLOW FEVER FOR TEN YEARS, AS FOLLOWS : YEARS. CASES. DEATHS. PER CENT. 1822 to 1831 - 1,984 985 49.64 1832 to 1841 .. .. 4,334 2.122 48.75 1842 to 1851 6,614 2,743 41.47 1852 to 1861 11.823 6,233 52.71 1862 to 1871 2,183 996 45.57 1872 to 1881 817 411 50.44 Total cases of yellow fever treated in the Charity Hospital during the past sixty years, 26,958; deaths, 13,079. per cent of mortality, 48.55. During the last twenty years, 1862 to 1881, the cases numbered 3000, and the deaths 1407 ; during the middle series of years, 1842 to 1861, the cases numbered 18,437. and the deaths 8976 ; during the first series of twenty years, 1822 to 1841, the cases numbered 6318, and the deaths 3107. The remarkable decrease in the number of cases of yellow fever occurr- ing in the city of New Orleans, as evidenced by the statistics of the Charity Hospital, during the past twenty years, is rendered still more ap- parent when we reflect that during the period of the sixty years specified, the population of the city of New Orleans had increased from 41,351 (city 27,242, parish of Orleans 14,175) in 1820, to 216,359 in 1880. This marked diminution of yellow fever cases in New Orleans may be referred to several causes, as- 1. The progressive improvement of the sanitary condition of the city by the extension of the drainage system, the prompt removal of garbage and faecal matters, and the more general use of disinfectants. 2. The marked diminution in the rate of increase amongst the white popillation from the influx of emigrants from foreign countries. This proposition will command special consideration and amplification. 3. The substitution of iron steamships for wooden sailing vessels, and the displacement of smaller vessels by those of greater size and increased speed; the modern revolution in naval architecture, consequent upon the introduction of steam as the motor and iron as the material, has been at- tended with great gain, by rendering voyages much shorter, and by per- mitting of better ventilation and more perfect sanitary arrangement. The stay of ships in infected ports has, in like manner, been shortened. The mechanical appliances for loading and unloading ships are vastly improved,'and the number of seamen necessary to conduct the same amount of commerce greatly diminished ; although, from the increase of manufac- tures, and the increase of traffic, the total number of men now engaged in commercial pursuits is greater than at any former period in the world's history. 4. The improvement in the sanitary condition of ships, and the increased attention to the hygiene and comforts of seamen in the matter of sleeping quarters, clothing and food. Here is a field worthy of the labors of the wisest and best sanitarians and humanitarians. The interest awakened in our day amongst the masses with reference to public and private sanitation, has pervaded even the great mercantile and commercial world, and one of the grandest achievements of modern sani- tary science will be the development and perfection of such a sanitary system, including ventilation and disinfection, and personal cleanliness, that the importation of contagious and infectious diseases by ships from Practical Observations on Yellow Fever: Joseph Jones, M. D. CCLXXVII one country to another will be rendered impossible. As President of the Board of Health of Louisiana, I have endeavored to advance this impor- tant work by every means at my command. We have stated that the second proposition needed further consideration and amplification, and we shall now endeavor to throw light upon this important subject. During ten years inclusive, 1817-1826, the population of the city proper, of New Orleans increased from 24,196 to 40,766; actual increase 16,570 or 64 per cent. The deaths from all causes numbered 17,500, and the deaths from yellow fever 2734 : or one death from yellow fever in 6.7 deaths from all causes. During the ten years, 1827-1836, the population increased from 40,766 to 65,600 ; actual increase 24,834, or 69 per cent. Deaths from all causes, 32,- 382 ; deaths from yellow fever, 3042; one death from yellow fever in 10.6 deaths from all causes. During the ten years, 1837-1846, the population increased from 65,600 to 102,070; actual increase 36,470, or 55.6 per cent. Deaths from yellow fever 4453; one death from yellow fever in 8.4 deaths from all causes. During the ten years, 1847-1856, the population increased from 102.070 to 161,404; actual increase 59,334, or 58 per cent. Deaths from all cause 92,- 018; deaths from yellow fever 18,043 ; one death from yellow fever to 5.1 deaths from all causes. During the ten years 1857-1866, the population increased from 161,404 to 178,042 ; actual increase 16,638 or 10.3 per cent; total deaths from yellow fever 5367, or one death from yellow fever in 14.14 deaths from all causes. During the ten years 1867-1876, the population increased from 178,042 to 204,424; actual increase 26,3S2 or 14.8 percent; deaths from all causes 69,886; deaths from yellow fever 4133 or one death from yellow fever in 16.9 deaths from all causes. During the entire period extending from 1817 to 1878 inclusive, sixty-two years, the population of New Orleans increased from 24^196 to 210,000; actual increase in sixty-two years, 175,804 or 727 per cent. The total deaths during this period amounted to 342,480, and the total deaths from yellow fever 41,829; or one death from yellow fever in 8.2 deaths from all causes. If the increase of the population of New Orleans be estimated at the. regular intervals of the United States census, we obtain the following figures : In the ten years, 1820-1830 New Orleans gained 19,134 inhabitants or 70 per cent; in ten years 1830-1840, increase, 55,883, or 120 per cent ; in ten years 1840-1850 inclusive 14,192, or 13 per cent; in ten years 1850-1860, increase 52,295, or 46 per cent; in ten years 1860-1870, increase 22,748 or 13 per cent. There are no accurate statistics to show the actual population in 1878, but judging from the disturbed state of politics from 1870 to 1878, and the contraction of business, and the loss of commerce, the increase of taxes and public debts, the estimate of 210,000 as the population of New Orleans in 1878, appear to me very near the true figures. It is worthy of note that during the ten years 1860-1870, embracing the entire period of the civil war, and still more disastrous period of so-called u reconstruction," there was an actual decrease in the white population of New Orleans from 144'586, to 140,923, whilst there was an increase of colored population (negro race) from 27,074 to 50,456. Whilst therefore the whites actually decreased 3,673, t re colored popula- tion increased 23,382 or 85 per cent. Whilst the negro p< pulation of New Orleans had nearly doubled itself in ten years, 1860-1870; on the contrary during the ten years 1850-1860 CCLXXVIII Practical Observations on Yellow Fever : Joseph Jones, M. D. (according to the United States census), the white population had increased from 59,459 to 144,596, showing a gain of 55,137 ; and the negro popula- ion from 26,916 to 27,074, showing a gain of only 158. A complete revolution was therefore made in the population of New Orleans by the results of the civil war. The loss of 3673 white citizens during the period embracing the civil war (1860-1870) did not represent the actual destruction occasioned amongst the whites by the casualties ot the war, for it will be, admitted on all hands that a large immigration set in to New Orleans from all parts of the Southern States after the close of the war, and this city probably contained a larger white population in 1866 and 1867, than at any previous or subsequent time. The prevalence, as an epidimic, of yellow fever in 1867, was mainly due to two causes : 1. The absence of yellow fever, as an epidemic, since 1858, and conse- quently all children under eight years of age were liable to the disease; and, 2. To the influx of unacclimated strangers into the city. The immunity of New Orleans from yellow fever in 1863, 1864, ami 1865, can no more justly be referred to the sanitary measures of the United States government during that period, than to those of the city and State and Confederate governments in 1859, 1860, 1861 and 1862, when New Orleans enjoyed an almost equal immunity from yellow fever, the deaths from this disease being in these years respectively: 1859,92; 1860. 15; 1861, none; 1862,2. We have no data to show the actual number of deaths amongst the Federal troops on land and water in and around New Orleans, 1863 to 1865; but that yellow fever was present is well established. The comparison of the preceding facts with the statistics of yellow fever in the Charity Hospital, leads still more strongly to the conclusion that epidi- mics of yellow fever occur most frequently, and prevail to the greatest extent, in those seasons in which a large number ot passengers from foreign countries arrived in this city. Thus far, the following are the number of passengers from foreign coun- tries who have arrived in New Orleans and paid a specific tax to the Charity Hospital: 1842. 30,832 ; 1843, 24,930 ; 1844, 19,788 ; 1845, 29,97 ; 1846, 34, 540 ; 1847, 41,052 ; 1848, 40,962 ; 1849, 43,398; 1850, 38,423; 1851, 36,376; 1852, 45,335; 1853, 34,870. A progressive increase in the number of cases of yellow fever admitted into the Charity Hospital is observed from 1822 to 1858. Thus, if a period Vf ten years be compared, the following results will be obtained: Admis- sion in ten years, from 1822-1831, 1984; 1832-1841, 4334; 1842-1851, 6614; 1852-1861, 11,823. This increase should be referred not so much to a relative increase of the disease, as to the growth of New Orleans and the progressive increase of immigration from European countries, and Northern and Western States, during the forty years from 1822 to 1861, inclusive. Thus during a period of forty years, from 1830 to 1876, 317,286 patients were admitted to the Charity Hospital, and of this number 238,753 were foreigners; 44,119 natives of the United States, outside of Louisiana; and 11,760 were natives of Louisiana. During a period of thirty years, 1830- 1859 : total' admissions, 260,372 ; foreigners, 203,946 ; natives of the United States, 29,664 ; natives of Louis- isiana, 4334. During a period of ten years, 1864 -1868 -1876: total admissions, 56,914 ; foreigners, 34,807; natives of the United States, 14,455; natives of Louis- iana, 7426. Practical Observations on Yellow Fever: Joseph Jones, M. D. CCLXXIX It is clearly shown by these statistics that the effects of the American civil war, and the subsequent destructive and hostile legislation during the following ten years, were to diminish emigration from foreign countries and at the same time to impoverish the natives of Louisiana, who, in thirty years preceding the war, furnished only 4332 patients to the Charity Hospital, out of a total of 260,372 ; and who in ten years, including 1864, 1868, 1869, 1870, 1871, 1872, 1873, 1874, 1875 and 1876, furnished 7426 patients, out of a total of 56,914 admissions. From the preceding facts, we draw the following conclusions: 1. The increase in the number and extent of the epidemics of yellow fever in New Orleans has been intimately associated with the accumula- tion of unacclimated human beings in the city, and with the increase of commerce and in consequent crowding, and the accumulation of filth and crowd-poison in ships, and in badly constructed and badly drained and policed habitations. Yellow fever is not necessarily the outcome from the causes and condi- tions stated in Proposition No. 1, for it has been frequently absent as an epidemic even in the city, when all these conditions existed; and in like manner it is unknown in and around the Asiatic countries, where all the supposed factors for the generation of yellow fever exist. 3. Periods of great movements of population are periods of great danger to the maritime cities of the coast of the Gulf of Mexico; consequently, eternal vigilance should be exercised by those charged with the execution of sanitary and quarantine laws. 4. As the poison of yellow fever can be conveyed by ships and railroad cars, the vigilance of the health authorities of New Orleans should never be abated ; but it should be especially manifested at such time as the city becomes filled with unacclimated material. When the city is crowded with strangers and immigrants from regions in which yellow fever usually pre- vails, the introduction of the disease by ships may act as the match to the magazine. 5. The stationary condition of the population of New Orleans argues well for the future exemption of this city from sweeping epidemics. The population of the city is evidently sufficient for all the needs of com- merce, but it needs application and direction to the more useful branches of manufacture and labor, as ship building, cotton, jute, paper and other branches of manufacturing industry. The idle and dissolute might thus be utilized to the suppression of vice and crime, and the advancement of the city and State. 6. By its geographical position; by its peculiar topography; situated upon a low, alluvial, badly drained, swampy plain; surrounded by large bodies of water; by the exposure of an extensive river bank, putrid, stagnant canals and marshes; by defective drainage, sewerage and police, and by its hot and moist climate, New Orleans has been peculiarly exposed to the ravages of yellow fever. Whilst it is the wish of every true patriot to claim all excellencies of position and health for the land of his choice and love, at-the same time future advancement of sanitary science, and the highest interests of hu- manity, demand that all causes of disease, whether existing in the soil or climate, should be honestly stated and fully weighed. In sanitary science, as well as in disease and the science of medicine the proper remedies or preventives can only be fully appreciated after the.com- prehension of all dangers and difficulties. 7. It follows, from proposition No. 6, that one of the most essential meas- ures for the improvement of the sanitary condition of New Orleans, is the CCLXXX Practical Observations on Yellow Fever : Joseph Jones, M. D. thorough excavation and cleaning of the drainage canals. Provided the city continues in its present state of good health, the city authorities should commence the excavation and cleansing of the drainage canals of New Orleans before the end of October, and the work should be continued during the cold months of winter until completion. It is not just that the filth of the gutters in the front and of the more eleva- ted portions of the city should be perpetually pushed and washed back upon the citizens of the rear, or swamp portions of the city, to choke up the drainage canals with foul black mud. This pernicious practice has been persued for years, until the drainage canals are literally choked up with filth. I have agitated this question of the thorough excavation and cleansing of the drainage canals of New Orleans, and I shall continue to agitate itas long as they remain in their present condition; and whilst the hot summer months are unsuited for this work, it might have been undertaken last winter, and it should certainly be executed as soon as the weather becomes sufficiently cool. 8. Every system which would look exclusively to the defense of New Or- leans from pestilence by quarantine, is vicious and destructive at once to commerce and the best interests of the city, in that it leads to the neglect of those sanitary measures, which will best promote the removal and era- dication of the causes of disease, and the removal of those physical con- ditions which promote the rapid spread of destructive epidemics. Quarantine, to be effective, must be efficient and thorough. Justice to the commercial community demands that rigid rules as to the length of quarautiue should be fixed by legislative enactment. According to the existing laws of Louisiana, the funds derived from quarantine should legally be devoted to its maintenance, and should not be diverted to pay either the Sanitary Police or Sanitary Inspectors, the sala- ries of whom, according to the legislative acts of 1870 and 1877, are directly chargeable to the city of Newr Orleans. An advance in the quarantine system of Louisiana will be effected by the thorough equipment of the Kigolets and Atchafalaya stations, and the con- struction of a capacious and well-ventilated floating hospital for the harbor of New Orleans, to wffiich all contagious and infectious diseases occurring amongst the shipping could be immediately transferred. It is not right that cases of small-pox, typhus and yellow fever, should be carried from the shipping into the heart of a great city, as has been the case in former times. There is no remedy for this evil but the establishment and thorough equipment of a floating hospital, and the employment of a competent phy- sician at a liberal salary to take charge of it, and to be on duty at all times. This measure should be supplemented by the appointment or employ- ment of a competent, experienced physician, whose sole duty shall be the continuous inspection of the shipping and the prompt removal of all infect- ious diseases to the floating hospital. To the accomplishment of these important results, the Board of Health of the State of Louisiana should devote its energies and those resources which the State has allotted to the maintenance of quarantine and the protection of the State from foreign pestilence. 9. The results of the quarantine and sanitary operations of 1880 and 1881, demonstrate that it may be possible to institute at once a just and enlightened system of quarantine and hygienic rules among the agents and in the vehicles of commerce, and an enlarged and progressive system of sanitation, embracing thorough drainage, abundant water supply, rapid and efficient removal of all excrementitious matters, and the proper eleva- tion and construction of well ventilated and thoroughly policed houses. Relations of Fevers to Drainage : Joseph Jones, M. D. CCLXXXI RELATIONS OF FEVERS TO DRAINAGE-MALARIAL FEVERS. SANITARY MEASURES RECOMMENDED BY THE PRESIDENT OF THE BOARD OF HEALTH. The relations of fevers, and more especially of malarial fevers to drainage; the great injury inflicted upon New Orleans by the systematic neglect of the drainage, as well as the sanitary measures best adapted to overcome the difficulties and evils of soil and climate, will be illustrated by the following letters addressed to his honor the Mayor of New Orleans, November 14 and December 9, 1881. Office Board of Health, State of Louisiana, » State House, New Orleans, November 14, 1881. | His Honor Joseph A. Shakspeare, Mayor of the city of New Orleans : Dear Sir- In accordance with section 4 of Act No. 80, "An act to reor- ganize and render more efficient the Board of Health of the State of Lou- isiana," approved April 20, 1877 (a copy of which marked A is hereunto annexed), and in accordance with a resolution of Col. I. N. Marks, adopted unanimously by the Board of Health at the regular meeting held Novem- ber 10, 1881, as follows : "Resolved, That the estimate and statement of the President of the Board as to the receipts and expenditures of the Board of Health for 1881, and the sums necessary for the conduct of the sanitary affairs of the city of New Orleans for 1882, be accepted and endorsed, and that the President be requested to transmit the same to the honorable, the Mayor and Ad- ministrators of the city of New Orleans." I have the honor to transmit to his honor, the Mayor, and to the honora- ble the Administrators of the city of New Orleans, the following: 1. Statement of sums necessary for the maintenance of the quarantine and sanitary operations of the Board of Health during the year 1882. 2. Estimated and actual receipts and expenditures of the Board of Health for the year 1881. The said estimates in accordance with the requirements of section 4, Act 80, of the General Assembly of Louisiana, approved April 20, 1877, have been sworn to and subscribed before Oscar Drouet, Esq., notary public, on the twelfth day of November, 1881. The attention of your honor, and of the honorable the Administrators of the city of New Orleans, is most earnestly and respectfully' requested and directed to "the estimate of expenditures for the conduct of the sanitary affairs of the city of New Orleans for 1882, under the direction of the Board of Health." It will be seen that the sum which the Board of Health requires for the conduct of the sanitary affairs of the city of New Orleans, including the pay of Sanitary Inspectors, and the cost of disinfectants for the entire city is $16,422 50 (sixteen thousand four hundred and twenty-two dollars ami fifty cents). This would be at the average rate of about five cents (or more accurately 5.2) per inhabitant. The cost to the city of an epidemic of yellow fever has been estimated at not less than $15,000,000 (fifteen millions of dollars). The estimate which the board now submits for the conduct of the sanitary affairs of the city of New Orleans, is not more than the thousandth part of the cost of a single epidemic of yellow fever. In the conduct of the sanitary affairs of New Orleans, the organic acts of the Legislature of Louisiana (see sec. 1 of an act supplementary to an CCLXXXII Relations of Fevers to Drainage : Joseph Jones, M. I), act entitled "An act relative to quarantine," approved March 18, 1858; also, sec. 2 of an act to amend "An act to establish quarantine for the pro- tection of the State," approved March 16. 1870; also, sec. 5 of Act No. 80, "To reorganize and render more efficient the Board of Health of the State of Louisiana," approved April20,1877 ; all hereunto annexed, and marked respectively B. C. and D,) have made the honorable Mayor and Adminis- trators of the city of New Orleans responsible not merely for the prompt supply of the necessary funds for the payment of the Sanitary Inspectors, and for the purchase of the necessary disinfectants, but also for the detail of the necessary police for the proper and regular execution of the orders of the Board of Health. Accordingly, the Board of Health respectfully urge the honorable Mayor and Administrators of the city of New Orleans to detail, for the execution of the sanitary orders of the Board of Health for the preserva- tion of the city from pestilence and infectious diseases, the seventeen policemen and eight carts with their drivers and teams. Upon the action of the honorable the Mayor and Administrators of the city of New Orleans, in providing the necessary means for the payment < f the Sanitary Inspectors and in furnishing the necessary police, and the necessary disinfectants and the carts for their distribution, depends in a large measure the sanitary condition of New Orleans, and the health and commercial prosperity of her citizens. New Orleans has no system of sewers; the excrement from the 210,006 inhabitants, and from the strangers that constantly crowd her streets, must be removed by hard manual labor. It is horrible to contemplate the effects of hoarding up this vast accumu- lations of human filth in this damp, hot, semi-tropical climate. Tn the present condition of New Orleans, this only method of dealing with this gigantic evil, which is a constant menace to the health and com- fort of the people, is to clean the privies by mechanical means-by well devised odorless apparatus-and to keep them continually disinfected by cheap and reliable disinfectants, accessible to all at the lowest prices. The constant and systematic removal of the human and animal excre- ment, as well as the maintenance of a good sanitary condition of all private premises, must be based upon systematic house to house inspection. Thorough inspection and thorough attention to domestic sanitation requires intelligent, faithful and honest sanitary policemen, subject to rigid discip- line by the legal authorities. The prompt fulfilment of these important requisitions of the Board of Health by the honorable Mayor and City Council, will establish the fullest confidence in surrounding communities, and will promote the highest and best interests of the city and State, in protecting foreign and internal com- merce from unnecessary quarantine, and above all in protecting the lives and promoting the health of the people. With great respect and high esteem, I have the honor to remain, your obedient servant, (Signed) JOSEPH JONES, M. D., President Board of Health, State of Louisiana. RELATIONS OF FEVERS, AND ESPECIALLY MALARIAL LEVERS, TO DRAINAGE-CLEANLINESS AND DRAINAGE OF PARAMOUNT IMPORTANCE TO THE CITY OF NEW ORLEANS. Hou. Joseph A. Shakspeare, Mayor of the city of New Orleans : Dear Sir-The following facts, illustrating the importance of the imme- diate attention to the cleaning out of the drainage canals of this great Relations of Fevers to Drainage: Joseph Jones, M. D. CCLXXXIII city, which holds within its borders one quarter of a million of people, and represents a large portion of the wealth and intelligence of the State of Louisiana, and commercially occupies the gateway of the Mississippi Valley, are respectfully submitted. DRAINAGE CANALS OF NEW ORLEANS. From the following tabulated statement, it will be seen that the drainage canals within the populated portion of the city, bounded by Metairie Ridge, extend 118,915 feet, or 22.5 miles in length : FEET. NAME OF CANALS. Width. Length. FIRST DRAINAGE SECTION. Galvez, from New to Old Canals 25 5100 Broad from Now to Old Canals ..... 20 4500 Hawaii from Naw Canal to Draining Machine .... ... 60 4200 Claiborne, from Canal street, to Canal Carondelet. 6 1820 Carondelet. from *'laiborne street to Draining Machine 20 6750 Poydras from G-alvez to Broad street 20 25 2150 Tail race from Draining* Machine to Metairie Hoad 6100 SECOND DRAINAGE SECTION. Dublin, from Tenth street to New Canal 40 5815 Claiborne, from Dublin street to New Canal 40 15850 Tail race from Dublin street to Dpper Line Canal 25 4850 Tail race of Melpomene Draining Machine 25 10450 15 2600 15 2300 Melpomene' from Dryades street to Draining Machine 25 3800 THIRD DRAINING SECTION. Claiborne from Canal Carondelet to Elysian Fields 15 6400 Rrnad from Canal Carondelet to London Avenue 25 8480 London Avenue From Broad street to Draining Machine 40 2400 Orleans, from Claiborne street to Bayou St. John 25 6450 St Bernard from Claiborne to Broad street. 25 4300 Claiborne, from Elysian Fields to Poland street 8 8800 Total lengths of canals 118915 Or 22.52 miles. Outside of these limits, the length of the canals amounts to 12.5 miles more, making a total of about 35 miles. An inspection of the canals reveals the following important facts : 1. The various sections of the drainage canals of New Orleans are uni- form neither in breadth nor depth. Such variations induce marked devia- tions in the currents and in the deposits contained in these canals, and promote the accumulation of filth at the bottom and the constant existence of foul and stagnant water. A moment's consideration will show that the drainage canals should be uniform in depth; and without such uniformity the entire system is imper- fect, and a constant menace to the public health. The Claiborne canal, in the upper districts, which was originally seven feet in depth, is said to have been dug out several years ago to the depth of fourteen feet, and now acts as a reservoir ot the foul, stinking waters of the more shallow canals. 2. Examination and measurement shows that there is a mud deposit in all these canals, varying in depth from four to eight feet. Fermentation and the evolution of foul gases is constantly going on in this immense mass of filth, accumulated from the gutters and open sewers a id from the streets of this city. CCLXXXIV Relations of Fevers to Drainage : Joseph Jones, M. D. Every known or unknown combination and product of the putrefaction of vegetable and animal matter can be found in these foul reservoirs, which should more truly be termed "cloaca." 3. The drainage canals of New Orleans, unless thoroughly excavated and graded upon mechanical principles, and kept constantly flushed with fresh water, become nothing more nor less than receptacles of putrefying animal and vegetable matter of the most deleterious character to the health of the citizens of New Orleans. 4. The drainage machines do not fulfill their capacities, as there is a ne- cessity during the warm and hot months of spring, summer and autumn, to keep a layer of two or three inches of water upon the foul deposits cf the canals, to prevent the rapid evolution of the foul gases resulting from the direct action of the sun. 5. It is not just perpetually to wash the filth of the front and more ele- vated portion of the city back upon the unfortunate inhabitants of the rear or swamp portions of the city, who, in virtue of the declination of the plane upon which New Orleans is built toward the lake, are perpetually exposed to this nuisance* THE REMEDY. The immediate and thorough excavation of the drainage canals. The proper grading of the drainage canals. The constant supply of fresh water to the drainage canals after their thorough cleaning. THE TIME. Now is the time for the inauguration and rapid prosecution of this work. Work should be, if possible, commenced by large bodies of men upon all the canals under the direction and control of the constituted author- ities, namely the honorable Mayor and Administrators. The warm months of spring and the hot months of summer and autumn are manifestly improper for such excavations, but December, January and February are well adapted to this work. The offensive mud should be dis- infected if necessary with quick lime and copperas, and if practicable should be removed out of the habitable limits. If the funds of the city are inadequate let the plan of operations be fully explained, and the tax-payers of the city will without doubt countenance this most important of all sanitary works for the protection of their health, the improvement of their property and the enlargement of the commerce of New Orleans by establishing its reputation for health upon a firm basis. SHIP CANAL CIRCUMVALLATING THE CITY OF NEW ORLEANS. This scheme, originally advocated several years ago by Prof. Fontaine, has been revived by certain professional journalists, and is without doubt worthy of the consideration of the National Government, and sufficiently grave in its nature to require for its proper execution the national resources. Whatever may be done in the future, it is evident that the dangers and the needs of the present are absolute, and cannot with safety be neglected. The digging of a canal extending in the form of a bow entirely around the city of New Orleans, from above Carrollton to below the present limits of the parish of Orleans, sixteen miles in length, three hundred feet in width, and sixty feet in depth, will require years for its completion, and will demand millions for its execution. Whatever system of sewerage or of drainage may in the future be adopted, the storm-waters and surface drainage of New Orleans must be provided for, and the surrounding great canal will facilitate the speedy evacuation of the drainage canals on both sides, if the proper machinery Relations of Fevers to Drainage: Joseph Jones, M. D. CCLXXXV be used during the stages of high water ; but it can under no circumstances abolish the uniform operations of nature with regard to rainfall and the periodic elevations or depressions of the Mississippi river. The annual rainfall ot New Orleans varies from forty-two to seventy-two inches-that is, from three and a half to six feet. In a wet year, the drain- agecanals must remove from the tifty-ftve square miles of this city a vol- ume of water equal to that contained by a lake fifty-five square miles in extent and six feet in depth. This water is storm water, thrown from the heavens above, and does not include the vast quantities of water used by manufactories, for household purposes, for the extingishment of fires? for the watering of the streets, and for the flushing of the gutters. Under any system of drainage, these waters must have the fullest possible exit out of the limits of the city. In this hot, moist climate, stagnant water loaded with exuviae ot man and animal, means putrefication, disease and death. DIFFICULTY OF ESTABLISHING A CORRECT SYSTEM OF DRAINAGE IN THE AREA OCCUPIED BY THE CITY OF NEW ORLEANS. In the city of New Orleans, bounded by the Mississippi River, which has truly been compared to an inland sea, on the one side, and on the other by extended marshes, lakes, swamps and lagoons, and in high water lying far below the line of the surrounding waters, the question of drainage, sewage and sanitation have been of the most difficult and complicated character, and from her earliest history sanitary measures have engaged the earnest and intelligent care of her rulers and medical faculty. In the year 1727 the land on which New Orleans stands, not being pro- tected by an adequate levee, was subject to annual inundations, and was a fearful quagmire, presenting no better aspect than a vast sink or sewer, and Gov. Perrier announced his intention to cut a canal from New Orleans to Bayou St. John, in order to open a communication with the sea through the lakes. Gov, Perrier, in 1727, mentions the arrangements which he had made with the inhabitants, in relation to the negroes which were to execute this work, which was actually begun, but to which subsequent events put a stop. Thus it is to be seen that the plan of the canal which now bears the name of " Carondelet," did not originate with the Spanish government. On the ninth October, 1796, Baron de Carondelet completed the canal which carries off the waters of the city and its environs into one of the branches of Bayou St. John, which relieved the ditches surrounding the ramparts and the stagnant pools within and around the city, of the putrid waters which produced those epidemics which were so fatal to its prosper- ity . Thus "drainage," the great sanitary problem of New Orleans, engaged the attention of its governors for sixty years before the practical and val- uable experiment of Baron Carondelet. The, drainage of the city was still further improved by the labors of the " Canal and Banking Company," and subsequently to the civil war by the Mexican Gulf Company. That New Orleans has been rendered more salubrious by these labors will be demonstrated by the following statistics : CCLXXXVI Relations of Fevers to Drainage: Joseph Jones, M. D. TOTAL NUMBER OF CASES AND DEATHS OF THE VARIOUS FORMS OF FEVER TREATED IN THE CHARITY HOSPITAL DURING A PERIOD OF THIRTY-FOUR YEARS. DISEASES. Eighteen years pieced- Sixteen years follow- ing the civil war- 1864 to 1880 Total for thirty-four years-1842 to 1880. ing the civil 1846 to 1860. war- Cases. Deaths. Perct Cases. Deaths. Per ct Cases. Deaths. Per ct Yellow Kever 16,073 8,081 1,301 50.2 3,160 2 1,568 2 49.6 19.233 7,222 9,667 1 303 58.2 Typhus Fever . 7'220 18.0 100.0 18.0 Typhnid Ke ver 3,144 481 983 31.2 377 180 47.7 3,521 636 1,163 38 0 Dengue Kever 155 Nervous Ke ver 50 13 26.0 1 51 13 4 25.4 14.9 Adynamic, or Ataxic Fever Kphemeral Ke ver ....... 27 4 14.8 27 560 3 563 Continued Ke ver 1,020 97 75 7.3 70 13 16.4 1,099 111 88 8.0 0.8 2.7 2 0 Catarrhal Kever 0.0 19 1 5.2 Gastric Kever 111 3 2.7 113 3 Remittent Kever ... 13,157 53,789 952 266 2.0 2,204 20,881 266 145 65 15,361 75,670 1,218 478 311 128 Intermittent Kever 53 0.01 75 0.3 0.1 57 3 Congestive Kever 584 50 9 214 80.4 699 320 Pernicious Kever 346 221 63.0 132 99 75.0 66.9 10.1 11.6 8 4 Malarial Fever Malarial Poisoning 6,«51 431 636 10 1 6.251 431 95 636 50 11.6 Malarial Cachexia 5 1 20.0 90 7 7.7 8 Tvpho-malarial Kever . 117 66 56.4 117 66 20 47 8 14.8 Other Fevers 120 15 12.5 15 5 33 3 135 Total from all diseases . 207,356 29,614 14.2 96,857 14.104 14.5 304,213 43,718 14 3 It will be observed that during the period of thirty four years, 132,332 cases, with 15,480 deaths, of the various forms of fever, were treated in the Charity Hospital. If the cost of treatment of each case to the State be placed at the low figure of $20, then Louisiana expended during these thirty-four years, $2,- 646,700 tor the treatment of fevers alone-a sum sufficient to have thor oughly drained and sewered the whole territory. DEATHS FROM THE VARIOUS FORMS OF FEVER IN THE CITY OF NEW ORLEANS DURING A PERIOD OF THIRTY-FOUR YEARS. DISEASES. Nineteen years pre- ceding the civil war 1844 to 1865 Num- ber of deaths. Fifteen years follow- ing tlie civil war, 1866 to 1880. Num- ber of deaths. Total thirty-four years. 1844 to 1880. Small-pox and varioloid ... 1,856 3,870 5.726 Measles 760 829 1,589 Scarlatina 1,575 491 2,066 Dengue 6 15 21 Typhus fever 1,220 102 1,422 Cerebro-spinal fever 135 237 371 Enteric, or typhoid fever 2,686 1,034 3,720 Simple continued fever Yellow fever 189 223 407 20,348 8,393 28.739 Gastric fever 3 16 19 Malarial Fevers: Intermittent fever 454 467 921 Remittent fever 503 796 1,299 Congestive fever 2,871 3,466 6,337 Tvpho-malarial fevei Malarial (unclassified) 8 185 93 2.338 1,409 3,747 Total 56,478 Deaths from cholera, cholera morbus and cholera infantum in New Or- leans during a period of thirty-four years, 1844 to 1880: Cholera, 11,847; cholera morbus, 889; cholera infantum, 2408. Total, 15,144. Deaths from enteritis, diarrhoea and dysentery in New Orleans during a period of thirty-four years, lb44 to 1880 : Enteritis, 6915 ; diarrhoea, 8289; dysentery, 7097. Total, 22,301. Deaths from phthisis-pulmonalis in New Orleans during thirty-fjur years, 1844 to 1880, 24,071. Relations of Fevers to Drainage : Joseph Jones, M. D. CCLXXXVII Total deaths in New Orleans during thirty-four years, 1844 to 1880, from all causes, 242,426. From the preceding statistics we gather the following general (results) conclusions: 1. Fdvers appear to be decreasing in frequency and fatality in New Orleans, and such decrease should be referred chiefly to increased drainage and to improved sanitary methods. 2. While fevers of all varieties destroyed in the city of New Orleans 56,478 citizens in thirty-four years, yellow fever destroyed only one-half of this number, namely, 28,739; and nothwithstanding the fact that only about one-half of the mortality from fever in New Orleans during the period specified was due to yellow fever, the attention of the entire Missis si ppi Valley is directed to this disease, and it is sought to impose immense burdens upon the citizens of the United States for the support of a cum- brous and expensive system of railroad and steamboat inspection, whilst the equally destructive and far more prevalent forms of fevers are ignored. If these fevers be divided into separate groups, the mortality will stand thus : Total deaths from small-pox, measles and scarlet fever during thirty- four years _ 9,381 Total deaths from dengue, typhus fever, cerebro-spinal fever and simple continued fever 5,942 Total deaths from yellow fever 28,739 Total deaths from the various forms of malarial fever 12.416 The deaths from the various forms of malarial fever, indigenous to the soil and common to all parts of the great Valley of the Mississippi, were very nearly half as numerous as those caused by yellow fever; congestive fever alone caused 6337 deaths. It is well established by the records of medicine extending back over 2000 years, that drainage and agriculture are the great and only absolute and certain means of destroying the cause of malarial fever. If the value of a citizen to the State be rated at $1000, then the city of New Orleans has lost during thirty-four years 856,478,000 by fevers alone. Other diseases, however, whose existence and propagation are largely de- pendent upon defective drainage have been busy in the work of destruc- tion. Thus during the thirty-four years specified phthisis pulmonalis destroyed nearly as many citizens as yellow fever, namely : 24,071; enteritis, dysentery and diarrhoea 22,301; and cholera, cholera morbus and cholera infantum 15,144. Total from phthisis pulmonalis and bowel affections, 61,616. These diseases, which are common to the entire valley, count 61,616 deaths, exceeding those by fevers 5138. Without doubt, a large proportion ot the deaths from phthisispulmonalis and bowel diseases are preventable and directly referable to defective drainage. Fevers, bowel affections and phthisis pulmonalis alone caused in New Orleans 118,094 deaths in thirty-four years, out of a total of deaths from all causes of 242,426. We may therefore affirm that nearly one-half of the deaths in New Or- leans uuring the past thirty-four years (118,095) were caused by preventa- ble diseases, the remedy for the diminution of the same being effective drainage. From these diseases New Orleans has lost in thirty-four years, according to reliable data $118,094,000 (one hundred and eighteen million ninety- four thousand dollars). CCLXXXVIII Relations of Fevers to Drainage : Joseph Jones, M. D. In conclusion, extended and valuable experience has convinced your Honor, that no city in the world has suffered more obliquy than New Or- leans in relation to health, and more especially in regard to its epidemics of yellow fever, and however devoid of sanitary laws and hygienic regula- tions, and however filthy and neglected the towns and cities situated within the valley of the Mississippi and its tributaries have been in past times, they have ever sought to lay their own devastating epidemics at the'door of this great commercial centre. The rapidly advancing millions of the great valley look with increasing interest upon the sanitary condition and quarantine laws and regulations of New Orleans. It will not be beyond the bounds of truth to affirm that, but for the American scourge, New Orleans, even at this day, after the ravages of civil wAr and the ruthless plundering of her hostile rulers, would have exceeded every other city of America as well in the magnitude of her im- ports as her exports. The opening of the great state of Texas to railroad trade and traffic, and the vast movement of grain and cattle inaugurated, inspire all good and true citizens with renewed hopes of a brighter future, and solemnly warn those who are charged with the sanitary and quarantine interests of this great city and fertile State that the welfare of millions may be involved in their action. If, by the application of all the facts known to science, the sanitary con- dition of New Orleans can be so improved as to exclude yellow fever, it is not unreasonable to believe, when we consider the extent and extraordinary fertility of the basins of the Mississippi and Missouri, that New Orleans is destined to become the great emporium, not of America only, but of the world. Even at this present day she holds commercial relations with almost every maritime nation and large city of the globe; and, as the representative and port of this mighty valley, her health and prosperity are not merely national but cosmopolitan. With great respect, I have the honor to remain your obedient servant, JOSEPH JONES, M. D., President Board of Health, State of Lousisiana. The firstand most solemn duty of the State and Municipal governments is to secure the people from overflow, and to enlarge and perfect the drain- age of New Orleans. Such important works should be conducted upon a general and practical plau, and the highest engineering talents should be employed. During the past four years I have advocated the view that the protec- tion from overflow and the drainage of New Orleans should be confided to General G. T. Beauregard. It is well known that the distinguished engi- neering services of General Beauregard protected Charleston and Savannah from the powerful fleets and armies of the North, and that his defense of those and other Confederate towns, opened a new chapter in the history of defensive warfare. At my earnest request General Beauregard, permitted the reproduction in this connection of his valuable report on the drainage of the First Drainage District. New Orleans, March 2, 1884. Dr. Job. Joues, New Orleans. My Dear Doctor :-I have found at last, my report and estimate qd the "proposed system of drainage for the FirstDraiaage District of New Orleans," made in 1858, and which I had promised you; but 1 could not find it until this morning. As it is the only copy I have left, [beg you to be careful with it. I am. yours very truly, G. T.' BEAUREGARD. Report of General Beauregard on Drainage of New Orleans. CCLXXXIX RE POET ON PROPOSED SYSTEM OF DRAINAGE FOR FIRST DRAINAGE DISTRICT, NEW ORLEANS-BY MAJOR G. T. BEAUREGARD, CHIEF ENGINEER. NEW ORLEANS, DEC. 26, 1858. NEW ORLEANS, December 26, 1858. To the Board of Commissioners of the First Draining District, New Orleans: Gentlemen-I have the honor herewith, to submit for your approval the following report and estimate, relative to the best method of draining the First Draining District of this city, as defined by the Legislative Act of March 18, 1858. On this important subject a very elaborate treatise might be written, but I have thought it best to confine myself to the leading points embraced in the investigation, in order to make my report as concise as practicable. Two systems offer themselves to our consideration for attaining an object so desirable and important to the health and prosperity of our city. 1. The system of Colmates, adopted principally in Italy, which consists in successive overflows from the waters of any sedimentary stream contiguous to the land to be drained, by which operation its soil is gradually raised until sufficiently elevated to carry off naturally by means of surface ditches, the rain water which may fall upen it. 2. The system of Polders, adopted in Holland, or where no sediment bearing streams art at hand, and which consists in dividing into sections, by means of canals and levees, the land to be drained, and removing the waters therefrom artificially with "turbines," or screw pumps, water wheels or suction pumps, set in motion by the wind or by steam. It is evident that when circumstances will favor it, the first of these two systems is to be preferred, on account of its economy, and healthiness to the locality thus reclaimed, and is the one best adapted generally, to reclaim the swamp lands contiguous to the Mississippi River; but after mature consideration, I have concluded, that it cannot be applied to those in rear of the First Draining District, on account of the great cost and long time it would require to derive any material benefit from the deposit; hence we are constrained to the best application of the second or Holland system. By examining the topographical map of the envirous of this city, made by E. H. Spring- bett and L. Pilid, in 1839, it will be seen that Bayou St. John is the natural outlet to the lake, of the waters of the whole of the first part of the Third Draining Districts, said bayou occupying nearly the central line between the new canal on one side, and Espla- ade street, Bayou Sauvage or Gentilly-ridge and Pontchartrain railroad embankment on the other, the area thus enclosed draining naturally towards Bayou St. John ; he»ce it is a matter of great surprise, that when the charter of the Navigation Company was about expiring, advantage was not at once taken of this natural and economical method of draining perfectly the whole of said area, by reserving the Old Basin, canal and bayou, entirely for draining purposes, as by the establishment of a judicious system of flood or sluice-gates, and several large draining wheels at the mouth of the bayou; the water in the latter could always have been kept, even during the heaviest rains, several feet below the general surface of the contiguous swamps, which could then have been made to drain at once into this natural reservoir, merely by the construction of a few secondary canalscut perpendicular to the general direction of the bayou, intersected at right angels by smaller canals or ditches, so as to carry the waters of the intermediate areas into the larger canals, and from thence into the bayou or main reservoir. The average level of the swamp lands referred to, being about 2' 6" above ordinary low water, the bayou could generally be drained to that level, by the sluices of flood- gates at its mouth, and the additional quantity of water could be taken off by the drain- ing engines, thus obtaining a great economy of fuel whenever the tides in the lake would permit. By having a covered drain in Basin or Claiborne street, the waters of that part of the city lying between either of said streets and the river, could be drained at once into the Old Basin or canal, and would be thereby cut off from tbe lower levels, in the rear of said streets, without having as now to flow over one mile before reaching the draining engine, at the lower extremity of Hagan Avenue. Such a system of drainage would have been economical, perfect in itself, and easily carried into execution, so that what is now swamp-land of an impassable character, would have become in less than four or five years from the starting of the project, high lands, as available for cultivation and building purposes, as any to be found along the banks of the river. We would soon after have seen magnificient summer residences and gardens of all dimensions, wharves and landings, constructed along the lake shore, from thejNew Canal to the Pontchartrain railroad, and the whole area from the lake to the river intersected with shelled avenues and street railroads, and the active commerce of the city would soon have extended from the river to the lake. The health of the city would also have been materially improved, not only from the perfect drainage of its site, but by the lake breezes, which would have swept over it, unaccompanied by the miasmas, 35 CCXC Drainage of New Orleans : Gen. G. T. Beauregard. which are constantly generated in the swamps intervening between it and the lake; and to which may, no doubt, be greatly attributed, the yearly epidemics which decimate our population, and spread terror and dismay amongst our non-acclimated citizens. I would respectfully recommend that a strong effort should be made to carry into oper- ation this system of drainage, which I consider far superior in every respect to any other I could suggest. Accompanying this report, however, is a sketch showing the other plan proposed by me, and which I guarantee, if carried faithfully into practice, willalso drain thoroughly the whole of the First Draining District, which I have divided off into six separate sec- tions-each one provided with its requisite canals, ditches, and draining-engines-for it is evident that the latter can only perform a certain amount of work in a given time, to which must be proportioned, the area to be drained, and the canals and ditches required to conduct the water freely and continuously to the draining-wheel, the latter being situated in as central a position as circumstances will permit; and it is equally evident that two engines, of a certain power each, placed in one locallity, will not do the work as quickly, effectually and economically, as if the area to be drained was subdivided into two equal parts, and these engines placed in the most favorable position to drain each section separately ; for, in the first place, larger and more costly canals would be required to convey the waters to the engines, or the land contiguous to them would be drained almost immediately, and they would then have to be stopped or worked to disadvantage, while the lands inore remote would still remain for several hours under water. Again, our swamp-lands being almost on a dead level, they require to be cutup into as many small sections as practicable, by small ditches leading into larger ones, these into small canals, the latter into larger ones, and finally, these last, into the main canal or reser- voir, conducting the waters directly to the draining-engine. The whole area of the First Draining District is 5,518.3 acres, but the part actually to be drained will measure about 5,430^ acres, which have been divided into six polders or sections, as follows: 1. From the river to Galvez street Canal, about 833| acres. 2. " Galvez street Canal to the Metairie Bayou 1,385 " 3. " Metairie Bayou to half the distance to the lake, included between Bayou St. John and the discharge Canal, along Orleans street, about 803 " 4. " The latter to the New Canal, and corresponding to Section 3, about 5. " Section 4, to Lake Pontchartrain, and from the New Canal to the discharge Canal in Orleans street, about 803 6. " Section 3, to the lake, and from the discharge Canal on Orleans street, to Bayou St. John, about 803 " '80S " An important principle in draining is, that with a sufficiency of canals, the power of the engine and the proportions of the wheel should be such as to carry off the rain and filtration waters as fast as they fall or accumulate, under the most unfavorable circum- stances,upon the area to be drained. Thus when the soil is already saturated, and six inches of rain fall in twenty-four hours, (which occasionally occurs in this latitude), 945 pounds of water per acre from that source alone, or about 1,000 pounds (16 cubic feet, 120 gallons, about) from all sources, would have to be removed per minute : and if we take six feet as the ordinary lift to which that water has to be raised, we will then obtain the followings results for each of the sections to be drained : Total 5,430| " Ci Qi ■U I3 NO. OF SECTIONS. l_5.430.25 833.25 1.385.00 835.00 803.00 803.00 803.00 Area in Square Acres. j 651,630 ss^sSs w co co co io '© Ci Cl o ci o - o o o c o o No. of gallons of water to be drained p er minute. I 13.332 22 160 12.848 12.848 12 848 12.848 No. of cubic feet of water to be drained per minute. |5.430.250 w od go oc od w oo ccooxw CO CO CO CO CH CO OOOOC^ gggggg No. of pounds of water to be drained per minute. | 987.32 >- X X X -J Cl Ci Cl Cl gggggg No. of Horse power to raise the water six feet high. |1316.40 202.00 335.76 194.66 194.66 194.66 194.66 No. of Horse power of engine required. 19.65 25.32 19.30 19.30 19.30 19.30 Diameterof cylind r in inches. ' Cl • o Strokes per minute. ft. in. 2 23-5 Diameter of pinion. • t© Diameter of spur- wheel. : g Diameter of drain- ing wheel. '■ g Pressure of steam. o c S e5 5 Area of buckets of wheel. co • C3 Revolutions of draining wheel per minute, Drainage of New Orleans: Gen. G. T. Beauregard. CCXCI The above engine and wheels are calculated to raise 39,097,800 gallons of water, six feet high per hour, and should be so arranged as to drive out the water under ordinary circumstances, and to lift it over the height of the levees in severe and long, continued northerly storms, which backs up the waters of the lake several feet outside of those levees. The last four sections are not exactly of the same area as represented in the above di- vision, but the difference between them being slight, has been neglected without effect- ing the general results of this Report. Whenever the work comes to be executed, their precise ereas, etc., can be determined with acurracy. The first two sections comprise now, but one, and that very imperfectly drained by two wheels of different sizes, placed at the intersection of Bayou St. John and Hagan avenue, one of 35 feet 4 inches, diameter, 6 feet 2 inches wide, and the other 29 feet 3 inches, diameter, 4 feet 5 inches wide. The cubic contents of the draining canals at present in use in these two sections, ex- clusive of gutters and small ditches, are as follows : For the first Section, 473,400 cubic feet, or 568 1-7 cubic feet to one acre. For the second Section 2,907,000 cubic feet, or 2,099 cubic feet to one acre,which is indeed a very small proportion, altogether too small for perfect drainage ; then the two engines and wheels are placed together in one locality, which exposes them to destruction by an explosion of boilers or by fire, as has lately taken place. But as they are being repaired and put in good order, they can at present be allowed to remain where they are, for the sake of economy. Another great objection to the present system is, that a part of the area drained, having a fall from the river ridge to Rampart street of 5 feet 9 inches, and from thence to Claiborne street of 2 feet 8 inches, the rest being nearly level, it follows, that the waters of the higher lands are precipitated at once upon the lower levels, where they remain until removed by the above draining engines, which being very far ofi' (nearly mile) from the foot of the slope, and not provided with a sufficiency of "con- duits" or canals, perform their work very slowly ; indeed, I am informed, as should have been anticipated) that these lands remain sometimes thus submerged several days, to the injury of residents who live upon them, and to the detriment of the health of the city. (See note at bottom of page.) Whereas, if another draining engine of proper power had been erected near the intersection of Galvez street canal and Old Canal, as I now propose, increasing the dimensions of the former, so as to answer the purposes of a reservoir, and a discharge canal had been made along the old canal, falling into the head of Bayou St. John, near the site of the present draining engine, the waters of the higher lands would have been removed at once, or as fast as they would have accumu- lated into said reservoir, and the low lands below the latter, being separated from it by small levee or an elevated street, would have been drained at once of their own waters, by the engine at the head of Bayou St. John, particularly if section 2 had been better provided with small canals, leading into the existing ones, as marked in dotted lines on the accompanying sketch. We would then have had for each of these two sections the following cubical contents of canalling exclusive of gutters and small ditches. For first Section, 1,037,400 cubic feet, or 1,245 cubic feet to one acre. For second Section, 5,038,000 cubic feet or 3,6374 cubic feet to one acre. But I am informed that the present Carondelet Navigation Company objects to the city draining into Bayou St. John, because the waters thrown into it, containing a great deal of sedimentary matter, tend to obstruct the navigation by muddy deposits immedi- ately below the site of each engine. This is probably so, but it is an obstacle which can be easily removed at little cost to the city. This company, however, does not seem to he aware of the immense injury which would result to said bayou by excluding from it entirely all the waters of the first and third draining districts, which naturally flow into it and maintain its present depth; for it is a natural law of all streams in alluvial soils, that their regimen or cross-section is proportioned to the quantity of water which passes through them. If we divert or exclude from them any portion of said water, their depth and width will gradually accommodate themselves to this diminution. Thus, before the construction of the new canal, which cut off the head-waters of Bayou Metairie, the latter was several feet deeper than at present-being now nearly dry in many places. Bayou Gentilly is filling up gradually from a similar cause; Bayou Terre-aux-Boeufs was once navigable for skiffs and canoes to the river, whose waters then passed through it, but it is now nearly dry in many places for several miles from its source. The same fate, no doubt, awaits Bayou St. John, should the navigation company persists in its Note on Plantation Drainage.-From the above remarks it follows, that where practicable, when planta- tions composed of high and low lands have to be drained, the true system is to separate these by a canal and levee, allowing the waters of the high lands to run off along the side lines to the swamp, as to a grand reser- voir, and levee-in, the low lands to be drained separately and alone by the draining engine, otherwise all the waters of the high lands which ought to run off naturally, are precipitated upon the low lands, and must be got rid of artificially, while the low lands are kept much longer under water than they would otherwise remain. Moreover, the engine and wheel have in consequence to be made much stronger, and the canals much larger than are actually necessary. CCXCII Drainage of New Orleans: Gen. G. T. Beauregard. suicidal policy, and instead of only having a few deposits here and there to contend with, they will have to keep open the whole bayou from its source to its mouth, partic- ularly the latter. I would, on the contrary, advise them by all means to concentrate into that bayou all the waters they could conveniently, and at little expense, get to flow into it. By a map, in my possession, I find that the area of the other four sections has a slight inclination from the new canal to Bayou St. John, and from the Metairie ridge and lake shore, towards the centre of said area. Along the first of these lines, the ground aver- ages less than 2 feet below the high-water mark of the storm of 1831; along the second, it is about 4 feet 6 inches below it, and along the third it is above said mark, and along the fourth about 2 feet 6 inches below it. In the interior of this area, the ground is gen- erally about 4 feet 6 inches below said level, requiring to be protected from similar storms by levees along the lines referred to. from 1 foot to 18 inches above the highest waters of that storm. These are the considerations which have guided me in determin- ing the dimensions of the levees estimated for. The one along the lake shore being ex- posed moreover to the waves of the lake in northerly storms, requires in addition to be protected by a strong plank revetment. The details of these levees, ditches, canals and reservoirs, are given in the accompa- nying sketch, intended merely to illustrate my report, without regard to the plans of the city extending in that direction, which will, however, have to be followed in the execution of the work. Should it be found necessary hereafter, the surfaces of these sections can be subdivided still more by the construction of additional main and second- ary ditches. But it is probable that when the streets and gutters shall have been con- structed in that part of the city, none but the main canals or reservoirs will he required for the perfect drainage of each section. The canals and reservoirs are made gradually to increase in dimensions as their length increases, so as to produce the maximum effect at a minimum cost. I will also remark that, not designing to have any interior ditches or canals immediately next to the exte- rior levees, no filtration waters, which are generally so troublesome and expensive, need be apprehended, if said levees are kept in good condition. So soon as any of these levees are finished, I earnestlyrecommend that Bermuda grass seeds or cuttings should be sown on their crest and slopes to protect them from the effects of the sun, rain and high waters of the lake during northerly storms. This grass matting, when thick, as it will soon be- come, will even prevent weeds and bushes from growing on the levees. The planting of several rows of sun-flowers (helianthus) along the berms of every canal would, according to Lieut. Maury, U. S. Navy, cause the absorption of the miasmatic gases arising from these canals, when the latter are neglected or not cleaned out, and would remove, if successful, one of the greatest objections to their use in large cities. The secondary ditches (D) are 4 feet wide at top, 2 feet wide at bottom, and 3 feet deep. The main ditches (C) are 6 feet wide at top, 3 feet wide at bottom, and 4 feet deep. The secondary canals are as follows: At their beginning, 8 feet wide at top, 4 feet wide at bottom, 4 feet deep. At their lower end, 12 " " " 6 " 6 " " Averaging 10 " " " 5 " " " 5 " " The main canals or reservoirs are as follows: At their beginning, 26 ft. wide at top, 20 ft. wide at bottom, 6 ft. deep. At their lower end, 36 ft. wide at top, 30 ft. wide at bottom, 6 ft. deep. Averaging, 31 ft. wide at top, 25 ft. wide at bottom, 6 ft. deep. They present together, in each section an average cubical content of 2,987,037 cubic feet, or 3,718 cubic feet to an acre. In order to place the draining sections of the last four sections in the most favorable locality to do their work advantageously, by diminishing as much as practicable the distance the water has to pass over in getting to the draining wheel of each section, it becomes necessary to construct a central discharge canal along the middle of Orleans street (Nelson avenue), to carry off to the lake the discharged waters. Moreover it might be used hereafter for the same purpose for sections 1 and 2, if necessary. This canal would thus be situated about half-way between Bayou St. John, its dimen- sions should be such, also, as to furnish the earth required for the protection levees on each side of it, i. e., it should be 36 feet wide at top, 30 feet wide at bottom, and 6 feet deep, its length from the middle point of the line of separation of sections 3 and 4 to the lake would be about 10,250 feet. The foot of the outer slope of those levees must be at least 10 feet from the edges of the canal. The draining engines of sections 3 and 4 ought to be placed near the upper extremity of that canal, discharging their waters into it Those of sections 5 and 6 ought to be put, for the same reason, as near to it as practicable, at about the middle distance between the two first sections and the lake. The engines thus placed near each other, two in each locality, will require but one engineer to each set, and can be so arranged as to drain the contiguous sections in case of necessity. But they should be put far enough from each other to be beyond the reach of danger, should one of them be destroyed by fire or by an explosion of boilers. Drainage of New Orleans : Gen G, T, Beanregard. CCXCIII The entire separation from each other, or, more properly, isolation of these sections by their levees, enables us to complete the draining arrangements of any one of them inde- pendently of the others, and, according to the means at our command, leaving the drainage of the others to be commenced and completed as circumstances will permit. The Board of Commissioners must decide to which of the sections referred to in this Report the means at present available shall be applied, and the order in which the others shall be undertaken. By referring to the accompanying detailed estimate, it will be seen that the perfect drainage of the first district, comprising 5,430^ acres, will cost as follows: The 1st section, $42,961.16, or $51.56 per acre, or $5.16 per lot. " 2nd " 37,389.55, " 26.99 " " 2.70 " " 3d " 111,676.51, " 139.09 " " 13.91 " " 4th " 111,676.51, " 139.09 " " 13.91 " " 5th " 116,764.01, " 145.41 " " 14.54 " " 6th " 116,764.01, " 145.41 " " 14.54 " Total, " 537,231.75, " 98.93 " " 9.89 " Requiring 1,316 2-5 horse power, at a cost per horse power of $408 11, the horse power being taken at 33,000 lbs. raised one foot high in one minute. The above estimate may appear large at first sight, but when compared with the im- mense benefits to be derived from its proper and judicious expenditure, and with the large sums expended on some of the public and private buildings of this city (the St. Charles Hotel for instance, $500,000 ; the St. Louis Hotel, $1,000,000 ; the Municipal Hall, $356,000, etc.), it sinks into insignificance, particularly when it is considered that this sum is to be called for only during a series of years, and to be borne by a whole commu- nity who are directly interested in this vitally important improvement, which is to bring, in the opinion of the best informed, health and rapid prosperity to our metropolis, and entitle it, ere long, to the proud appellation of the first city in the Union, not only in commerce, but in population. Respectfully, your obedient servant, G. T BEAUREGARD, Brevet Major of Engineers and Chief Engineer of First Draining District. CCXCIV Drainage of New Orleans: Gen G. T. Beauregard. ESTIMATED COST OF DRAINING FIRST DRAINING DISTRK T. NEW ORLEANS. FIRST SECTION. DESIGNATION. Square Feet. 1 Length Bun- ning Feet. Cubic Yards Price per Yard Cost. Total. For re-excavation of Galvez street canal for purposes 104 4.900 1.700 18,874 2,015 40c. $7,549 60l 806 00 " re-excavation of Canal street •••• 32 " discharge canal and levee near old canal 90 4.500 15.000 50c. 7,500 00 $15,855 60 $9,000 00 1.200 00 " foundations 6,500 00 6,500 00 " building 23.200 00 Add for contingent and unforeseen expenses 10 per ct. 3.905 56 35.889 $42,961 56 That is $51 56 per acre, or $5 16 per lot, assuming ten lots per acre. Second Section. For re-excavation of old cansls 53.615 40c $21,446 00 " excavation of new canals. B 37J 10,000 13,889 50c. 6.944 50 " ditches, C 18 16,800 11,200 • • 5.600 00 33,990 50 12.500 00 1.400 00 8,500 00 7,500 00 " transportation and erection complete " foundations " building .... 20,900 00 63,890 50 Deduct draining engine already in use 29,900 00 33.990 50 Add for contingent and unforeseen expenses 10 per ct. 3,399 05 Total amount of estimate 78.704 $37.389 55 - - - That is $26 99 per acre, or $2 70 per lot. • Third Section. CANALS AND DUTCHES. 4,575 20,850 I or excavating main canal or reservoir A 168 37^ 28,467 28,958 50c. $14,233 50 14.479 00 secondary canals, B main ditches, C 18 27,300 27,800 6,950 18.200 9,266 25,740 9,100 00 4,633 00 12,870 00 secondarv ditches D 9 100 discharge canal $55,315 50 110.631 Levees. For Bayou St. John levee 115* 82J 82J 8,335 4,550 6,950 35.655 13,903 21,236 40c. 14.262 00 •5,561 20 3.185 40 " middle levee between sections 3 and 6 " separation between sections 3 and 4 15c. 23.008 60 " draining engine, building, etc., complete, as per 70.794 section 1.... 23,200 00 10,152 41 Add for contingent and unforeseen expenses 10 per ct. Total amount of estimate. 181,425 $111,676 51 That is $139 09 per acre, or $13 91 per lot. Fourth Section. The same as for section 3 181,425 $111,676 51 That is $139 09 per acre, or $13 91 per lot. Drainage of New Orleans : Gen. G. T. Beauregard. CCXCV Fifth Section. The same as sections 3 and 4 Add for revetment of Lake Shore levee, running feet.. " for contingent and unforeseen expenses 10 per ct Total amount of estimate That is $145 41 per acre, or $14 54 per lot. 4,625 181,425 $1 00 $4,625 00 462 50 $111,676 51 5,087 50 181,425 $116,764 01 181.425 * $116,764 01 Sixth Section. The same as for section 5 That is $145 41 per acre, or $14 54 per lot. ESTIMATED COST OF DRAINING FIRST DRAINING DISTRICT, NEW ORLEANS. RECAPITULATION. DESIGNATION. Cubic Yards. Cost. For First Section Second •* " Third " *• Fourth " ... " Fifth " Sixth " Total 35,889 78,704 181,425 181,425 181,425 181.425 $ 42,961 16 37,389 55 111.676 51 111,676 51 116 764 01 116,764 01 840,293 $537,231 75 That is, 5.430.25 acres will require for perfect drainage- 1 316.40 horse-power, at a total cost of Or 4.125 acres will require one horse-power, at cost of Or one acre at $98 93, or one lot at $537,231 75 408 11 9 89 G. T. BEAUREGARD, Chief Engineer First Draining District. CCXCVI Vital Statistics of New Orleans : Joseph Jones, M. D. VITAL STATISTICS OF NEW ORLEANS, LOUISIANA. TABLE ILLUSTRATING THE RELATIONS OF THE POPULATION OF NEW ORLEANS TO THE TOTAL MORTALITY FROM ALL CAUSES, DURING A PERIOD OF NINETY- FOUR YEARS. COMPILED BY PROF. JOSEPH JONES M. D. Year. Population. No. of Deaths Death Rate per ,1000 Inhabitants. Year. Population. No. of Deaths Death Rate per 1000 Inhabitants 1787 .. 5.284 338 63.98- 1844.... 86,632 4620 53.33 1796.... 8,756 638 72.86 1845 .. 89,261 2783 31.17 1808 ... 17,081 *773 45.25 1846 102,070 4220 41.34 1810 .. 17.242 963 55.85 1847.... 108,699 9043 83 19 1811.... 18.235 1239 67.94 1848.... 115,503 7407 64.12 1812 ... 19,229 624 32.50 1849 . 122,511 9862 80.49 1813 20,212 939 46.45 1850... 129,747 7819 60.26 1814.... 21,216 926 43.69 1851 ... 138,599 7275 52.48 1815.... 22,209 1252 56,36 1852 ... 147.441 8693 58 95 1816-... 23,303 651 27.93 1853 154,132 15,287 102.42 1817.... 24,196 1772 73.27 1854.... 156.556 11.347 72.47 1818.... 25,190 1106 43.90 1855... 158,980 10,096 63.50 1819-... 26,183 2138 81 65 1856 .. 161,404 5689 35.24 1820.... 27,176 1766 64.98 1857... 163,828 5581 34.07 1821 - 29,441 1165 39.57 1858.... 165.450 11,720 70.83 1822.... 31,706 2734 86.22 1859 .. 166,500 6849 41.13 1823.. 33,971 1662 48.92 I860.... 168.670 7341 43.52 1824... 36,236 1748 48.23 1861.... 169,907 5772 33.97 1825 ... 38,501 2177 56.54 1862 .. 171,134 6278 36.10 1826.... 40.766 1248 30.61 1863.... 172.361 7172 41 61 1827 43,031 1057 24.56 1864.... 173.588 8498 48.95 1828 . 45,296 1490 32-89 1865.... 174,815 7016 40.13 1829.... 47 561 2520 52.98 I860 ... 178.042 7754 43.55 1830 ... 49,826 2022 40.58 1867 .... 181.269 10,096 55.57 1831 52,455 1926 36.71 1868.... 184.496 5343 28.96 1832.... 55,084 8099 147.01 1869 . 187,723 5593 29.79 1833.... 57,713 4976 86.22 1870... 191,418 6942 36.26 1834.... 60,342 3687 61.10 1871 .. 193,412 6059 31.24 1835.... 62.971 3873 61.50 1872.... 196,406 6588 33.54 1836.... 65.600 2734 41 67 1873.... 198,900 7995 40.19 1837.... 68,229 4807 70.45 1874.... 201,394 7193 35.71 1838 . .. 70,858 2606 36.77 1875.... 203,888 6535 32 05 1839 ... 73,487 3934 53.53 1876.... 206,382 6585 32.39 1840.... 76.116 2977 39.11 1877.... 208,876 7169 34.32 1841 78,745 4549 57.76 1878.... 211,371 10.717 50.70 1842 ... 81.374 3375 41 47 1879. ... 213,865 5122 23.94 1843 ... 84,003 4050 48.21 1880 .. 216,359 5623 25.98 TABLE ILLUSTRATING DEATHS AND DEATH RATE FROM ALL CAUSES AND FROM YELLOW FEVER, IN THE CITY OF NEW ORLEANS DURING A PERIOD OF SIXTY-FOUR YEARS. COMPILED BY PROF. JOSEPH JONES. M. D. Year Deaths from all causes. Deaths from Yellow Fever. Death Rate per 100. Year. Deaths from all causes.. Deaths fromYellow Fever. Death rate per 1000. from all causes. from Yellow Fever. from all causes. fromYellow Fever. 1817.. 1772 823 73.27 3.40 1849... 9862 769 80.49 6.20 1818.. 1106 115 43 90 0 40 J850... 7819 107 60 26 0.80 1819.. 2138 425 81 65 1.60 1851... 7275 17 52.48 0 10 1820.. 1766 400 64 98 1 40 1852... 8693 456 58.95 3 09 1821.. 1165 39.57 1853... 15787 7849 102.42 50 90 1822.. 2734 808 86.22 2.50 1854... 11347 2425 72 47 15.40 1823.. 1662 1 48.92 0.01 1855.. 10096 267u 63..'>0 16 80 1824 1748 108 48.23 0.30 1856... 5689 81 35.24 0.50 1825.. 2177 49 56.54 0.10 1857... 5581 200 34.07 1.20 1826. 1248 5 30 61 0.01 1858 .. 11720 4855 70.83 29 30 1827.. 1057 109 24 56 0 20 1859... 6849 92 41 13 0 50 1828.. 1490 130 32.89 0.30 1860... 7341 15 43.52 0 09 1829.. 2520 900 52.98 1.90 1861... 5772 33.97 1830.. 2022 117 40.58 0.20 1862 .. 6278 2 36.10 0 01 1831.. 1926 2 36.71 0.01 1863... 7172 2 41.61 0.01 1832.. 8099 400 147 01 0.70 1864... 8498 6 48.95 0.03 1833. 4976 1000 86.22 17.30 1865. .. 7016 1 40.13 0.01 1834.. 3687 95 61.10 1.50 1866... 7754 185 43.55 1.00 1835.. 3873 284 61.50 4.50 1867... 10096 3107 55.57 17.10 1836.. 2734 5 41.67 0.08 1868... 5343 3 28.96 0.02 1837.. 4807 1300 70.45 19.00 1869 .. 5593 3 29.79 0.02 1838.. 2606 17 36.77 0.20 | 1870... 6942 588 36.26 3.10 1839. 3934 800 53.53 10.80 | 1871... 6059 | 54 31.24 0.20 1840 . 2977 3 39.11 0.04 1872... 6588 39 i 33.54 0.20 1841.. 4549 1325 57.76 16.80 1873... 7995 226 40.19 1.10 1842.. 3375 211 41.47 2.60 1874 . 7193 11 35 71 0.05 1843.. 4050 487 48.21 5.70 1875... 6535 61 32.05 0 30 1844.. 4620 148 53.33 1.70 1876... ■ 6585 42 32.39 0 20 1845.. 2783 2 31.17 0.01 1877 . 7193 1 34.32 0.01 1846.. 4220 160 41.34 1.50 .878... 10717 4056 50.70 19.20 1847.. 9043 2804 83.19 25.80 879... 5122 19 23 94 0.09 1848 .. 7407 872 64.12 7.50 | 1880... 5623 | 2 1 25.98 0.009 POPULATION AND MORTALITY OF NEW ORLEANS 1880-1883- VITAL STATISTICS OF NEW ORLEANS DURING FOUR YEARS, 1880-1883 INCLUSIVE. Vital Statistics of New Orleans r Joseph Jones, M. 1). CCXCVII POPULATION OF NEW ORLEANS. WHITE. COLORED. YEAR Males. •s.>pinakt{ Total. / YEAR. Mahs. ' Females Total. 1880 1S81 75693 76451 82702 83844 158395 16029.' 1880 . 1-81. 25247 25740 32501 32816 57748 58556 1882 77224 84994 162218 1882 26246 33129 59375 1883 ... 77986 86178 164164 1883 26756 33450 60206 1884 78753 87372 166125 1884. 27277 33771 61048 Total Whites and Colored. YEAR. •sap ft 1 emales Total. . 100991 115203 216143 218850 221593 1881 1882 102190 103471 118122 1883 . .. 104742 119628 224370 1884 1060301121143 227173 - - - - MORTALITY OF NEW ORLEANS. WHITE. COLORED. YEAR. Mules. 1 Females. 1 YEAR. Males. Females. Total. 1880. 1881 1882.... 1883 Total 2050 2419 2104 2657 1587 1708 1478 1895 2637 4127 3582 4552 1880 1881. i 1882 1883.. ; Tota' 1003 1178 1225 1634 983 1101 1115 1337 1986 2279 2310 2971 9230 6668 15898 5040 4536 9576 Total IV hi ten and Colored. YEAR. £ 2570 2813 2593 3232 Total. 1880 1881 1882 ... 1883 .. Total . - 3053 3593 3329 4291 5623 6406 5922 7523 14261 11208 25474 CCXCVIII DEATH-RATE OF NEW ORLEANS PER 1000 POPULATION. Vital Statistics of New Orleans: Joseph Jones, M. I). WHITE. COLORED. YEA W. | Males. Females. Total. YEAR. Females. ! Total. 1 3 S - o 1 1880 18-1 1882 1883 26 8 19 0 31 4 20 2 27.1 17 1 35 1 21 8 22 82 25 59 21.88 27 56 24 46 1880 1881 1882 1883 Mea; 39.34 45.32 46.22 60.47 30.09 33 36 33 49 49.78 Mean 30 1 19 5 47.84 34 18 40.14 Total Whites and Colored. YEAR. \ Males. 00 = 1 22.16 23 96 21.81 26.84 Total. 1880 1881 1882 1883 Mean - 30 03 34.94 31 97 40.71 25 85 29.08 26.60 33.32 34 41 23.67 28.71 DEATH-RATE OF NEW ORLEANS PER 1000 POPULATION EXCLUSIVE OF DEATHS FROM SMALL-POX. Year. Year - 1880 1881 . . '..1 25 85 29.06 1882. 1883 .... 24.69 27 71 YEARS. January. February. March. April. June. July. August. September. October. November. December. Total. 1849 1182 600 1307 968 1007 870 435 485 666 910 712 630 9862 1850 582 425 833 491 601 459 584 916 653 620 899 756 7819 1853 581 463 456 532 671 656 2216 6201 1627 674 712 844 15633 1855 1 ? ? ? 851 1316 1052 1747 1454 502 321 448 7691 1856 379 339 342 334 390 797 583 569 497 481 489 602 ? 5200 1857 372 371 498 530 504 497 429 482 417 510 369 5581 1858 448 362 518 482 576 531 813 1826 3069 1775 834 476 11710 1859 504 472 438 479 621 525 701 503 656 611 788 549 6847 1860 567 514 567 633 646 730 657 779 557 622 520 535 671 7341 1861 ... 518 397 635 448 401 411 510 316 463 551 485 1039 395 2498 431 1942 496 959 ? 5449 10096 1867 362 350 561 720 1869 328 292 408 555 602 525 551 421 422 474 452 563 5593 1870 471 429 60C 545 621 673 497 480 858 681 465 512 6932 1871 443 347 491 44t 411 535 488 551 451 441 568 429 5595 1872 , 447 630 430 418 712 572 483 569 425 432 430 473 6122 1873 642 556 603 600 93( 562 773 498 624 713 500 504 7505 1874 583 481 452 609 548 517 700 708 440 636 527 597 6798 1875 572 454 461 522 402 551 622 536 447 675 473 443 494 6117 1876 436 460 559 447 601 653 469 503 477 524 592 6257 1877 571 589 788 555 738 633 504 516 439 417 543 415 6708 1878 403 511 437 475 535 427 492 1784 2558 1845 492 359 10318 1879 574 360 376 369 509 402 422 422 327 492 410 459 5122 1880 '. 446 438 462 461 581 573 422 407 450 466 517 460 5623 1881 443 466 551 529 683 733 571 472 427 442 508 481 6406 Total 11989 10556 12456 11735 14568 14955 15667 22554 21153 17065 13726 11801 178325 A verage Monthly ( Mortality '. 5 "" 521 459 541 510 g07 623 653 940 880 711 572 513 7430 From 1849 to 1867 includes From 1869 to 1881 excludes Still: born. Still-born. VITAL AND MORTUARY STATISTICS OF NEW ORLEANS, 1849-1881, MONTHLY MORTALITY. Vital Statistics of New Orleans : Joseph Jones. M. D. CCXCIX COUNTRY. 1853 1857 1858 1859 1860 1867 1868 1869 1870 1871 1872 1873 1874 1875 1876 1877 1878 1879 1880 1881 Total 20 years 1 1 Australia 12 8 6 4 12 2 8 10 6 11 13 13 2 7 6 9 8 4 4 145 108 7 29 15 17 44 6 7 9 9 7 24 11 13 10 9 50 14 9 7 405 Austna * 1 2 3 2 2 4 1 1 16 At sea - • • • British America • * 25 10 10 16 19 10 3 4 13 1 6 9 4 3 1 14 42 15 3 6 214 76 2 13 11 5 4 6 1 6 5 5 4 19 3 4 4 168 52 10 10 11 11 8 19 11 8 6 6 13 165 1 1 1 3 1 • 7 6 5 14 7 7 5 4 11 8 4 10 95 4 16 13 5 22 6 3 15 6 11 8 8 5 4 5 22 5 - 5 8 171 Dcnmai It 7 4 1 5 3 1 1 22 England 227 63 214 76 101 193 49 49 99 90 70 82 56 63 68 533 958 478 . 519 72 4060 1 1 Finland 392 166 677 208 219 549 207 196 352 231 212 290 258 247 253 246 587 208 193 231 5922 F rance 1593 308 1411 424 443 995 302 279 518 1 405 411 534 477 396 388 465 421 363 446 11,484 26 Germany 2 -1 2 2 4 1 3 1 4 Greece • • • 14 8 2 2 5 3 3 2 3 3 4 2 8 2 4 3 68 nouanu Ii eland- - * 2867 686 1891 506 998 1133 439 474 551 569 537 597 525 463 450 t t t t 487 13,173 Tful v * . .. .. . 20 114 24 20 144 33 42 199 52 43 52 76 51 54 64 382 50 47 56 1,523 • • Louisiana .... 1657 % ★ * * * 3941 5354 2873 3518 3897 21,240 178 11 18 14 10 5 11 9 7 12 4 12 8 9 2 8 11 9 9 9 28 1 6 1 3 2 1 1 48 15 20 10 18 21 6 10 14 18 15 15 17 14 13 14 25 11 6 14 276 Norway and Sweden 1 1 Persia 3 17 6 2 17 1 2 12 4 2 1 '2 4 3 2 17 1 96 3 5 5 10 3 4 5 10 4 11 6 9 7 8 8 11 4 7 4 124* Poi tn gal 28 114 38 39 171 36 16 32 20 14 15 17 8 11 559 Prussia • • Russia - • • • 7 20 3 1 9 5 5 3 3 3 4 2 14 2 7 4 94 17 50 23 40 66 10 19 31 21 36 28 25 20 17 14 417 Scotland 1 1 Sandwich Islands.. •• 4 2 3 1 3 2 1 2 2 2 2 2 3 2 1 1 33 South America. 83 13 66 42 45 53 29 19 44 28 38 49 36 34 28 40 44 28 27 43 789 Switzerland • • • • 23 76 28 21 46 14 14 38 21 31 21 19 9 16 20 44 26 22 20 509 Turkey United States (not Louisiana) Wolaa . . ..... . 1 2 7 10 495 3209 5624 4073 3263 4990 5 3338 1 3971 1 4753 8 4285 3 4474 2 5517 2 5041 2 4616 1 4517 3 1066 1531 822 799 2 1017 1 67,401 31 vv aies • • • West Indies Not stated 23 8,059 27 940 42 1278 47 1271 • 34 2010 34 1482 32 787 33 812 54 577 40 199 68 97 63 109 65 93 44 74 38 338 51 202 59 200 44 86 27 34 36 3 861 18,651 Total 15,633 5,581 11,710 6,847 7,341 10,096 5.343 6.001 7,391 6,059 6,122 7,505 6,798 6.117 6,257 6,708 10,318 5,122 5,623 6,406 148,978 * Included under United States. t Included under England. NATIONALITIES. CCC Vital Statistics of New Orleans: Joseph Jones, M. D. VITAL AND MORTUARY STATISTICS OF NEW ORLEANS. DEATHS FROM ZYMOTIC AND EPIDEMIC DISEASES (SMALL-POX. MEASLES, SCARLA TIN A, TYPHUS FEVER, TYPHOID FEVER. YELLOW FEVER. MALIGNANT OR ASIATIC CHOLERA, DIPHTHERIA. WHOOPING COUGH), AND FROM ALL DISEASES. WITH DEATH RATE PER 1000 INHABITANTS, FROM EPIDEMIC AND ZYMOTIC DISEASES, FROM ENDEMIC DISEASES, AND FROM ALL CAUSES. T-c -g «.£ - -= = •£ = i gs-i 5 £ £ g £ = Z -E 2 2k® 2 2 3^ i r 2? 2s® Sg! r. = a x7- x^ x 7 x~ xii X SB ~ i as K as - s r £ j - z x : „ : ; _ ~ -c c •x s -.£s - . c l. - *" "tZ r.' Z* bii-- 13 13 b» cc -< PC X ■*"' ? 13 ® CL 13 © 13 c, *"3 * C K X 05 pH w , ex oj Z?? > co * K * s? 3. ♦"2 cS n & eS i ~ - T" ® q ® ® A ® t! H j g8 a ® ® _ 1844 10 4 3 44 148 .. . .... 22 231 4245 4476 86632 2.66 49.00 51.66 1845 121 ■. 76 2 199 2408 2607 89261 2 22 26.98 29.20 1847 27 38 15 154 233 2306 1 1 22 2797 4506 7303 108699 25.73 11.45 67.18 1848 105 61 119 372 223 808 1646... 41 3375 5510 8885 115503 29.22 47.70 76.92 1849 133 10 22 164 178 769 3176.... 27 4479 5093 9572 122511 36.56 41.57 78.13 1850. 37 57 21 199 103 107 1448.... 13 1985 5546 7531 129747 15.29 43.67 58.96 1831 38 26 29 228 103 430 16 870 6405 7275 138599 6.42 46 06 52.48 1852 .... 456 1329 1785 6594 8379 147441 12 10 44.72 56.82 1853. .. 17 123 126 103 146 7849 585.... 44 8991 6296 15287 154132 58.33 40.85 99.18 1855. 19 2670 883 2572 3934 7506 158980 22 4 6 24.75 47.21 1856 2 53 18 22 115 74 43 .... 53 380 4955 5335 161404 2.35 30.70 33.05 1857 103 104 79 8 118 199 24 .... 27 662 4561 5223 163828 4.04 27.84 31.88 1858 108 7 79 20 189 4845 26 95 28 5397 5975 11372 165450 32.62 36.11 68.73 1859. . ..43 13 121 7 214 91 27 253 31 800 5694 6494 166500 4.80 .34.20 39.00 1860. 22 60 200 10 163 15 30 145 75 720 6621 7341 168670 4 26 39 26 43 52 1861 1 35 198 5 102 12 78 14 445 4654 5099 169907 2.62 27 48 30 10 1863 2 98 43 9 257 2 4 188 55 658 6352 7010 172361 3.81 36 86 40.67 1864. .. 605 34 200 11 268 6 5 337 39 1505 7061 8566 173588 8 67 40 67 49.34 1865.... 613 31 161 5 154 1 9 104 13 1091 5608 66991174815 6.24 32 08 38.32 1866. 188 82 41 12 116 192 1294 98 41 2064 5278 8342 178042 11.59 29.64 41.23 1867 47 2 24 23 119 3107 581 31 28 3962 5624 9586 181269 21.85 31 03 52.88 1868 14 1 15 5 58 3 129 16 4 245 4593 4838 184496 1.32 25.07 26 25 I860 141 217 13 5 63 3 4 19 121 586 5007 5593 187723 3.12 29.67 29 79 1870 528 23 44 13 80 587 3 19 9 1306 5636 6942 191418 6 84 29.42 36.26 1871 2 12 5 4 71 54 6 14 1 169 5426 5595 163412 0.87 28.05 28.92 1872. 29 76 5 4 67 39 . 39 23 282 5840 6122 196406 1.43 29.74 31.17 1873 509 69 5 5 57 226 142 46 61 1120 6385 7505 198900 5.58 32.15 37.73 1874 .. 587.... 4 2 95 11 6 102 16 823 5975 6798 201394 4.08 29.67 33 75 1875. 342 1 144 2 57 61 4 69 58 738 5379 6117 203888 3.61 26.39 30 00 1879 232 231 123 2 53 42 40 39 762 5495 6257 206382 3 69 26.63 30.32 1877. 1099 15 10 1 69 1 33 26 1254 5454 6708 208876 6.00 26.11 32.11 1878 151 3 1 23 44 4046 59.... 4327 5991 10318 211371 20.47 28.34 48.81 1876 1. .. 33 19 58 9 120 5002 5122 213865 0.54 23 38 23 94 1880 1 97 56 1 52 2 ... 81 70 360 5263 5623 216140 1 66 24.32 25.98 1881 5 26 197 66 92 1 387 6019 6406 216140 1.79 27.85 29 64 5731 16152263 1422 3786 28739 11847 2017 102~ 58447190385248832 5957750 9.8£ 31.95 41 76 CONSUMPTION (PHTHISIS PULMONALIS). On examination, the mortuary records of New Orleans will show that phthisis pulmonalis, commonly called consumption, does not confine its ravages to more northern cities, but is the cause of an alarming mortality even amongst the natives (creoles of New Orleans). I have carefully exam- ined and consolidated the mortuary statistics of the Charity Hospital of New Orleans, with the following results : During a period of eighteen years preceding the civil war-1842 to 1860 -there were treated in the Charity Hospital of New Orleans, 5699 cases of phthisis pulmonalis, of which 3084 terminated fatally, giving 54.1 per cent mortality. During the sixteen years following the recent civil war, there were treated in the Charity Hospital 5251 cases of phthisis pulmo- nalis, in which 2525, or 40.8 per cent, died. During a period of thirty-four years-1842 to 1880-there were treated in the Charity Hospital of New Orleans, 10,950 cases of phthisis pulmonalis, 5669 or 51.2 per cent of which Phthisis Pulmonalis in New Orleans : Joseph Jones, M. D. CCCI terminated fatally. WTiile the statistics of the Charity Hospital refer chiefly to the laboring classes, and to those who have been reduced in cir- cumstances by misfortune and disease, at the same time the statistics of the city at large illustrate to an equal extent the destructive effects of this insidious disease. Thus, the deaths from phthisis pulmonalis were as follows in New Orleans for the respective years : 1859 1858 1857 9981 1853 1855.. . . 5981 1845 1848 1849 1850 Years. 360 576 592 674 787 755 652 568 624 779 876 Deaths from Phthisis Pnlmonalis. 11870 X X X 1865. 1866 X I860.. (1861 ,1862.. 11863 Years. 834 654 761 839 664 600 671 632 684 657 Deaths from Phthisis Pnlmonalis. X 00 o 00 co X X 1876 1877... .... X il871 1872 1873.. 11874 Years. I 780 784 850 810 799 882 888 880 823 863 Deaths from Phthisis Pnlmonalis. During a period of years extending from 1845 to 1881, the deaths from phthisis-pulmonalis have, with the exception of a single year, annually exceeded half a thousand, and in many years have been more than eight hundred. During ten years-1845-1858-the deaths from phthisis-pulmonalis, in New Orleans numbered 6367; during ten years, 1859-1869, 7251; during eleven years, 1870-1880, 9016. We have thus during a period of thirty-one years, 1845-1880, a grand total of 22,598 (twenty-two thousand five hundred and ninety-eight) deaths by phthisis-pulmonalis. Surely a disease which steadily and remorsely claims its victims each year, which in any long series of years has been as destructive as the dreaded yellow fever, should secure the earnest consideration of those charged with the sanitary affairs of this city. The epidemic of 1878, threw the profes- sional minds of a certain order, into a state of morbid excitability on the subject ot yellow fever, and the public have been served with numerous lucubrations on this subject, and quarantine. In comparison with phthisis-pulmonalis, which every year destroy^ its thousands in every State of this Union, yellow fever should be regarded only as a causal and minor disease, visiting only certain limited portions of the tropical and temperate regions at long intervals. We hear much of the cost of epidemics, but nothing as to the fearful cost of such diseases as phthisis, which holds its doomed victims in its deadly embrace for months and even years, and inflicting, in addition to indescribable tortures, vast and ruinous pecuniary expenses. I have given the stern facts with the design of arousing the attention of this people to the consideration of some of the prominent causes of this disease and some of the modes of prevention. This subject of personal and domestic sanitation should appeal to all alike. You may escape the yellow fever by leaving infected places; in other words when the disease appears the only sure remedy is flight, but you cannot es- cape those causes of disease which spring from your habits, modes of living and climate, and which are ever present with you, in your assem- CCCII Phthisis Pulmonalis in New Orleans: Joseph Jones, M. D. blies, in your counting-houses, in your dwellings, around your firesidesand in your beds devoted to quiet and rest. The chiet causes of the prevalence of phthisis-pulmonalis in New Orleans appear to be: 1. Imperfect drainage. 5. The saturation of the atmosphere with moisture. 3. Imperfect construction of houses. 4. Imperfect ventilation of houses. 5. Crowding. 6. The absence of regular exercise for diversion and recreation. 7. Imperfect nourishment. 8. Hereditary taint or predisposition. A volume might be written on the preceding divisions or causes, but our intention is clearly to present practical observations which may prove of benefit to those interested. Owing to the peculiar topographical and geographical situation of New Orleans, the soil is saturated with moisture, and the atmosphere is habit- ually near the dew point. Large portions of the city are compactly built with brick, and the sudden changes of the fall, winter and spring are fre- quently manifested by the precipitation of the moisture on the cold walls in the form of streams of water. Dampness'.checks the cutaneous perspiration : it abstracts the normal heat and electricity from the body; it holds the noxious exhalations from the human body, and from all sources and it promotes the devolopmeut of low.forms of disease, of which phthisis may be taken as a type. In many instances no attention has been paid to the proper filling in with sand and gravel of building lots, and stagnant water frequently stands under the houses, and is a potent source of disease. Whole blocksof build- ings can be pointed out in the heart of this great city in which there is no proper ventilation, and in which the lowest floor rests directly upon the damp earth. It is not to be wondered at that the floors of these damp, ill- ventilated rooms and stores rot continually, and must be almost annually renewed. Houses, churches, school-houses, stores, and all buildings inhabited or occupied by human beings, should be thoroughly ventilated-laterally and perpendicularly. The air should circulate freely under the lower floor. The air should be admitted by ventilators both in the front and rear of each room, and also, when practicable, laterally : and a system of ventilation should be so arranged as to allow of the escape of the foul air of the sleep- ing apartments directly up through the roof into the open air. If people would send for the carpenter and properly ventilate their houses, they would not so often need his services in the grave-yard. The effects of imperfect ventilation and close confinement and crowding, with insufficient food, is fully illustrated by the frequent occurrence of phthisis pulmonalis among females who are compelled to live by the needle alone, and who occupy small, unventilated houses, resting almost directly upon the ground. Begular exercise in the open air. nutritious food, and such thorough ventilation as shall at all times secure pure air in the store, workshop, sitting room and bedroom, are the great means of preventing the development of phthisis (consumption.) War destroys its thousand, but phthisis claims its tens of thousands ! The improvidence, ignorance and avarice of mankind, as manifested in the neglect of sanitary laws, in the construction and conduct of dwelling- houses, stores, factories, school-houses and churches, are more destructive to human life than yellow fever or all other pestilences. Diarrhoeal Diseases in New Orleans : Joseph Jones, M. D. CCCIII TABLE SHOWING DEATHS FROM PHTHISIS PULMONALIS BY MOE THS, DURING THE YEARS 1869 TO 1880, INCLUSIVE. Average -3 0 L 1880 1874 1875 1876 1877 1878 . . 1869 1870 1871 1872 ijwa o co CO 42 a6 55 56 90 81 80 76 74 65 76 67 January. o u» ►4 Ci<!-400CiO0®iCnCOCnCn4^ CWOlHO^O-CO-^iOW February. to CO 48 81 84 58 66 52 67 94 86 77 77 85 March. 165.5 s 72 74 56 49 68 79 65 58 57 66 74 68 April. ,65.9 O CT) *4 -) C C -J ►? Ol V V ®MOD-OiO^WO©W® May. to 62 64 74 66 58 58 59 64 92 108 37 70 June. to co - Ci 67 66 58 56 88 68 77 82 70 69 98 G7 July. 62.5 o 59 48 63 76 64 69 62 63 57 88 47 54 August. Ci 00 00 00 51 71 63 57 67 51 87 88 83 89 54 65 September. CO 60 55 66 79 89 81 58 66 63 59 101 60 October. co 3 c ci co cc cci o ci co ci c .U^CWlOKlO-lCDCDW-- November. 167.3 o 00 V Ci CO Ci yi-^0.CCi»fclOQO^O December. £ Ci 0086 684 757 780 784 850 810 799 882 888 880 823 863 Total. o 3.58 3.96 4 08 4.10 4.45 3.85 3.80 4.20 4-23 4.19 3.92 3.99 Death rate per 1000 per annum 1 202.500 216.000 210 000 1 000'161 । Population. DIARRHCEAL DISEASES The deaths from diarrhoeal diseases in New Orleans, appear, in a measure, to be related to the elevation of temperature, as they are most numerous in the months of May, June and July, as will be shown by the following- statistics : TABLE SHOWING DEATHS FROM DIARRHCEAL DISEASES, BY MONTHS, DURING THE YEARS 1869 to 1880, INCLUSIVE. Average. ■3 0 £ X) J © x o X X X -4 1875 1W7K 0 u 0 JO X ' O X ' - D A EARS. 24.5 g to © s -1 Ci O >- 4- 00 00 o to to to to to 4- o 4- Ci CO >- January. Ci © c< w ci © - 1-* r-* 4k. Ci 00 to cc ■4 Cl © c February, 00 © to to -* t-' CO tO •-* »-l >4 Cl I-' 1- *- to March. © 0 g £ <3 sc 108 24 18' 17 0 35 19 64 April. Cl Ci • 8 55 42 45 a 38 68 238 66 38 47 5i X May. ' 81 62 101 52 53 56 JI 55 81 67 41 June, 5 ^5 O -1 w -4 © © 46 30 71 . « 62 54 July. ft 57 21 26 x to to w w cc -4 M Cl to C © © ^4 03 August. |31_5 a 21 23 to w © to ^4 00 35 41 27 29 30 36 September. 0'63 ft 46 20 35 27 24 26 25 to to -j oo October. bO ft 27 22 21 U to to W 4k U^CODC'i - j< November. io JO to -- to to to to to to cc to CO >U © ci - c. 0 g 3? -0 JI December. co 00 £ 432 452 390 724 429 399 386 449 385 345 331 o Total. to r. 2.21 2.26 2.36 2.04 3.79 2.24 1.90 1.83 2.13 1.83 Death rate per 1000 per annum. '- o 202,500 to IO c c B o D pulation. RELATIONS OF MILK AND ITS ADULTERATIONS TO THE DIARRHOEAL DIEASES OF CHILDREN. From the fact that persons may be entirely sustained upon a diet of milk, for an indefinite period, it is evident that this fluid must contain all the ele- ments necessary for the growth and sustenance of the human body; and chemical research has shown that milk contains the three classes of prin- ciples which are required for human food, namely : the albuminous or nitro- genous, the oleagenous and the saccharine. Milk consists of water holding in solution casein or cheese, sugar of milk, various salts, and in suspension, fatty matters, in the form of myriads of semi-opaque globules, to which the color and opacity of milk is due. CCCIV As milk is the only article supplied by nature which combines all the ele- ments requisite to secure healthy nutrition in a form suited to the young animal; and as theentire human race after birth and for an indefinite period ranging from one to two years is dependent upon milk for its support and existence, it is evident that it should not be omitted from the category of the necessaries of life, to which the attention of those charged with the conduct of the sanitary affairs of this city and State should be earnestly and efficiently directed. The vast importance of regulating the milk supply of New Orleans, is clearly demonstrated by the great prevalence and frightfully destructive effects of such infantile diseases as cholera infantum, tabes mesenterica, convulsions, teething and infantile debility. The fearful mortality which occurs in this city amongst " teething " chil- dren and infants, is shown by the statistics of the following table : Diarrhoeal Diseases in New Orleans : Joseph Jones, M. D. TABLE GIVING THE DEATHS IN THE CITY OF NEW ORLEANS DURING A PERIOD OF TWENTY-SEVEN YEARS (1847-1880) FROM INFANTILE DISEASES (CHOLERA INFANTUM TABES MESENTERICA, CONVULSIONS, TEETHING AND DEBILITY). Tota 1878 1879 1880 X> OC 00 00 YEAR. 4 3? CH J to JI JI x o co -* O CO 00 J* w O <O GC >4 9SC& GO CO CO 00 88 100 85 56 65 84 52 118 80 100 73 113 ;os 89 801 5 o JC 75 115 01 U 00 5 - Cholera Infantum. 4311 166 163 144 178 258 238 261 185 191 1«w 204 161 125 159 1*9 184 200 194 213 -* 31 21 162 125 901 -a JI o Tabes Me«- enterica. 2133 >-* JI w X) X) o 3 26 29 12 18 50 68 999 465 10 12 7 £ 35 Cl Convul- sions. s o Jo 1 j< 345 375 521 367 409 265 296 275 236 270 50 215 206 200 227 256 203 233 140 Infantile Conv'lsions. 1 3102 63 78 88 90 98 70 80 80 99 86 86 88 154 104 214 164 88 107 56 137 143 189 151 189 909 o X Teething. 2429 52 161 163 140 112 120 102 100 150 184 161 §5 * 5? X) § 74 69 75 83 01 65 76 100 Infantile Debility. | 19901 Ci Ci CO 00 -1 £ § ** >4 "4 JO -4 X) 670 555 596 605 729 *00 £ 972 711 876 817 i ■* o » 00 <X O Ol w Total. During a period of twenty-seven years, cholera infantum, tabes mesen- terica, convulsions, teething, and infantile debility, diseases peculiar to children and infants, destroyed in the city of New Orleans, 19,901. On the other hand, during the same period, yellow fever occasioned the following deaths : 1847. 2804; 1849, 769; 1850, 107; 1853, 7849; 1856, 74; 1857, 199; 1858, 4855; 1859, 92; 1860, 15; 1863, 2; 1864, 6; 1865, 1; 1866 185 ; 1867, 3107 ; 1868, 3; 1869, 3; 1870, 587; 1871, 54; 1872. 39; 1873, 226 ; 1874, 11; 1875, 61; 1876, 42; 1877,1; 1878,4056; 1879, 19; 1880, 2; total deaths from yellow fever during the twenty-seven years specified, 25,172. The deaths from yellow fever during the twenty-seven years specified exceeded those caused by the diseases of infancy, 5271 ; or in other words were only a little less than one-fifth greater. By what process of reasoning, and for what ends does the medical profession at large, and the Board of Health of the State of Louisiana in particular, neglect the consideration Diarrhoeal Diseases in New Orleans: Joseph Jones, M. D. CCCV of 19,901 deaths from infantile diseases, and concentrate all available skill and knowledge upon a disease which commits its ravages only at comparatively long intervals ? All diseases and all causes of deaths should be equally considered, by those charged with the conduct of the sanitary affairs of the city and State. It is of course impossible to determine the exact proportion of the 19,901 infants who perished from improper nourishment and from adulterated milk, but that improper and insufficient food as well as crowding, imperfect ventilation, and exhalations from foul privies and filthy canals and gutters, enter as important factors in the production of the grand results, will not be denied. It is not our purpose at this time, to enter into a minute description of the methods of analyzing milk microscopically and chemically; and even if it be granted that nothing but water has been added to dilute the milk, this water may itself have been derived from a foul source, and in the out- breaks of diphtheria, scarlet fever and typhoid fever, the medical inspector should not neglect a single link in the chain of evidence as will be shown by the following example : Fever once appeared in a large public schools, and as no mode of the entrance of the poison could be discovered it was at first supposed to have arisen spontaneously. The water supply on anal- ysis proved to be pure. The milk was supplied from two or three sources, and was not complained of, but making an analysis of the milk it was found to have been manipulated with water. An analysis of the water from each of the farms, whence the milk was derived, was made, and one of these waters was discovered to be polluted with animal excrement, whilst the other two waters were undoubtedly pure. On visiting the dairy farm possessing the polluted water supply, it transpired that the closet and well were in affectionate proximity, and that the former bad recently received the specific poison of typhoid fever from one of the laborers. If milk under such circumstances, should not evince by chemical examina- tion, any decided departure from the usual state of the secretion, due re- gard being paid to its variation in composition, by reason of* the age and food of the cow, time after calving, weather, etc., it must not be concluded that the poison of the disease has not been communicated to the milk through the medium of water, for there is every reason to believe, that the smallest quantity of water containing the specific poison, such as may be introduced by merely rinsing the milk cans, is sufficient to infect a large quantity of milk. In outbreaks of scarlet fever, no ray of light should be neglected, how .ever feeble, in tracing the mode in which this disease is disseminated, and a most rigid and careful examination by means of the microscope should be instituted, between milk that has been exposed to infection-as for ex- ample, from being stored within a few yards of persons suffering or re- covering from this disease-and the milk of the same animal that has been thus endangered, with the object of discovering epithelial scales, for the poison of scarlet fever would seem to be mainly distributed through the air by the aid of the dust of the skin to which it attaches itself. It would be foreign to our purpose to enter fully into the history of this foreign pestilence, which has at various times reached the shores of Louis- iana from the cities of Europe, across the waters of the Atlantic Ocean and the Oulf of Mexico. Asiatic cholera has played no insignificant part in the grand carnival of disease and death. 37 MALIGNANT OR ASIATIC CHOLERA. CCCVI Asiatic Cholera in New Orleans : Joseph Jones, M. D. In 1832, Asiatic cholera, in conjunction with yellow fever, swelled the mortality of New Orleans to 8099, in a population Of 55,084 ; and marked this year as the most terrible in the annals of this city, the death rate reaching the enormous proportions of 147.10 per 1000 inhabitants. In 1832 the inhabitants of New Orleans were more than decimated, for more than one-seventh of their number was destroyed chiefly by Asiatic cholera and yellow fever, acting in addition to the usual endemic and epidemic diseases. The Charity Hospital affords the following statistics of Asiatic cholera: 1848, cases 662, deaths 396; 1849, cases 1813, deaths 1122; 1850, cases 724, deaths 530; 1851, cases 382, deaths 292; 1852, cases 485, deaths 358; 1853, cases 194, deaths 115; 1854, cases 478, deaths 352 ; 1855, cases 351, deaths 225 ; 1856, cases 32, deaths 11 ; 1857, case 1, death 1- total (1842-1860, eighteen years), cases 5122, deaths 3402; per cent of deaths. 66.4. Duringithe sixteen years following the American civil war, New Orleans has been comparatively exempt from Asiatic cholera, as shown by the stat- istics of the Charity Hospital; thus, in 1866, cases 300, deaths 237 ; 1867, cases, 94, deaths 70 ; 1868, cases 15, deaths 9 ; 1873, cases 34, deaths 2/- total during|sixteeu years (1864-1880), cases 443, deaths 343; percent of deaths, 77.4. , There were received into the Charity Hospital during thirty-four year's (1842-1880) 5565 cases of Asiatic cholera, of which 3745 terminated fatally, giving a rate of mortality of 67.3 per cent. The first authentic records which we have of the appearance of Asiatic cholera in New Orleans relate to the year 1832, when it occasioned 4340 deaths out of a total of 8090 deaths from all causes; yellow fever claimed only 400 deaths in this most pestilential year in the annals of this city. The disease lingered through 1833, when it claimed 1000 victims out of a total of 4976 deaths. In 1832 the population of New Orleans was 55,084, and of this number more than one-seventh perished, giving a mortality from all causes of 147 10 per thousand inhabitants, and from Asiatic cholera 78.78, and from yellow fever 7.20. Cholera appeared again in 1848 and destroyed 1646 inhabitants, and continued its ravages for several years, the deaths being: 1849,3176; 1850,1448; 1851, 430 ; 1852, 1329; 1853, 585; 1855, 883; 1856, 43; 1857, 24; 1858, 26 ; 1859, 27; 1860, 30; 1861, 12 ; 1863, 4; 1864, 5; 1865, 9 ; total deaths from Asiatic cholera during a period of nine- teen years (1844-1865) 9678. Cholera appeared again in 1866, and continued* its effects for three years. The deaths were as follows: 1866, 1294; 1867, 581; 1868, 129 ; 1869, 4; 1870, 3 ; 1871, 6; 1873, 142 ; 1864, 6; 1875, 4 ; total deaths during fifteen years (1866-1880) 2169. It is evident, from the preceding statistics, that during a period of thirty- four years (1844-1880) Asiatic cholera destroyed 11,847 of the citizens of New Orleans ; and, if we add to this number the deaths occasioned by this disease in 1832 and 1833, we have a grand total of 17,187 deaths. Those charged with the conduct of the sanitary affairs of the city and State should view these 17,187 dead citizens as victims to a foreign or exotic pestilence, imported from the shores of Europe in the cargoes and passengers of ships. The State of Louisiana can protect herself and the entire valley only by maintaining, at all times and under all circumstances, a vigilant quarantine at the mouth of the Mississippi river; and all parties who, under the guise of promoting commerce, endeavor to destroy an efficient quarantine, should be regarded as public enemies. It is probable that the mortality occasioned by Asiatic cholera was even far in excess of these figures, for we find upon careful examination of the Asiatic Cholera in New Orleans: Joseph Jones, M. D. CCCVII mortuary records of New Orleans, that during a period of thirty-four years (1844-1880), the deaths from bowel affections were as follows: Cholera Morbus, 889; cholera infantum, 2408; teething, 3430; gastritis, 743; enter- itis, 6915; dysentery, 7097 ; diarrhoea, 8289; total from these diseases, 29,771. During the same period of thirty-four years, yellow fever occasioned 28,739 deaths. It is evident, therefore, that the so-called ordinary bowel affections, diar- rhoea, dysentery, cholera morbus, enteritis, gastritis, and teething) actually caused a larger number of deaths in New Orleans than yellow fever. And if we add the 11,847 deaths caused by Asiatic cholera, we have a grand total of 41,618 deaths from those diseases in which derangements of the gas- tro-intestinal mucous membrane forms the most prominent symptom. The continuous and fearful mortality from this class of diseases, must be diminished by improved domestic and general sanitation. The great essen- tials of sanitary reform for the diminution of the number and fatality of the cases of bowel affections in New Orleans must be based upon- 1. Thorough drainage of the entire parish of Orleans, and especially that portion occupied by the city of New Orleans. 2. The prompt removal of all fcecal matters out of the limits of the city; 3. The daily removal of garbage ; 4. Systematic and thorough cleansing of private premises, public build- ings, factories, markets, streets and gutters ; 5. The filling up with sand and gravel of all low lots. SCARLATINA, MEASLES, WHOOPING COUGH AND DIPH THE RIA. During a period of thirty-four years (1844-1880); scarlatina occasioned .'066 deaths; measles, 1589; whooping cough, 1026 ; diphtheria, 1925 ; total Tom this class of diseases, 6606. Without doubt, much may be accomplished by certain hygienic meas- ires, and by disinfection, for the mitigation and limitation of this class of liseases. VENEREAL DISEASES-SYPHILIS, GONORRHCEA AND ORCHITIS. The mortuary records of New Orleans like those of most American cities, affords but imperfect data, for the determination of the effects of venereal diseases upon the general mortality of population. The shame and disgrace which attaches to the loathsome results of promiscuous inter- course, often leads to the concealment of the true cause of death, by those immediately concerned in the framing of the death certificate. In addi- tion to this fact, it is well known that the poison of syphilis, often induces profound constitutional derangements, which may not only be transmitted to the offspring to the third and fourth generations, but may also modify, and intensify various diseased processes. The only available statistics to show the prevalence of venereal diseases in New Orleans, are those afforded by the Charity Hospital. During a period of eighteen years (1842-1860), the number of cases of Syphilis in the Charity Hospital was 6767, of which 63 died, mortal'4' T9 per cent; sixteen years (1864-1880) cases 5761, deaths 96, per ct 6. Total cases sypihlis, 12,528, total deaths from this disease 159 per (v . 1.2 ■ n the Charily Hospital, during a period of thirty-four years, 18^.2 It30. What portion of the 11,721 cases of rheumatism, with 84 deaths, or of the CCCVIII Venereal Diseases in New Orleans : Joseph Jones, M. D. 10.950 cases of phthisis pulmonalis and 5609 deaths (51.2 per cent) were either directly or indirectly connected with constitutional syphilis, cannot be determined. During the same period (1842-1880) the cases of gonorrhoea numbered 2392 with four deaths, and of orchitis 794 cases and three deaths. It would appear from these statistics that venereal diseases have occa- sioned no marked mortality in New Orleans, but, nevertheless, they have furnished 15,714 cases to the Charity Hospital, which have been treated at the expense of the taxpayers of this city. We have no data by which to determine the actual cost of the treatment of venereal diseases in the Charity Hospital ; but if the actual expenses attending the treatment (food, clothing, medicine, etc,) of each case be tixed at the moderate sum of $10- (ten dollars), then we have a grand amount of $157,140, expended in thirty four years for venereal diseases alone. This estimate is below, rather than above the truth ; for we find that during the same period of thirty-four years that 10,513 cases of ulcers, with 48 deaths, were treated in the Charity Hospital. We know from experience that a large proportion of the ulcers treated in the Charity Hospital have been, either directly or indirectly, the result of syphilitic taint. A portion also of the 2794 cases of abscess, with 97 deaths, must also be referred to the action of venereal poisons. It is well known that chronic ulcers and constitutional syphilis are the most tedious of all diseases which fall to the lot of the hospital physician, and that, in proportion to their numbers, they consume far more of the public charity than such diseases as yellow fever, cholera, and the acute forms of malarious diseases. It would not be extravagant to assert that the treatment of venereal dis- eases in the Charity Hospital during the past thirty-four years has cost the taxpayers of the city and State between $300,000 and $400,000. These facts represent but a portion of the expense, mischief and suffer- ing caused by the venereal poison or poisons, for the statistics relate only to the poorer classes, who are without the means of obtaining proper medi- cal attendance or suitable medicines, food and accommodations. It would be just to estimate the number of cases of venereal disease which never enter a hospital as at least five times as numerous as those recorded upon the books of the Chaiity Hospital. Without doubt, vast numbers of visitors, strangers, mercantile and mari- time agents, and seamen from all parts of the globe, contract syphilis and gonorrhoea in New Orleans, as well as in all other large cities. The existence of venereal diseases in this and in all other cities in this and other countries, must be recognized by those charged with the conduct of the sanitary affairs. No form of quarantine has yet been devised which can prevent the spread of venereal diseases, but much good may be accomplished by the institution of a proper system of medical inspection and treatment, and police regulation, of the great sources of these diseases, namely, Pros- titutes. It would be foreign to our purpose to elaborate a plan for the proper reg- istration, restriction to certain prescribed limits, and medical inspection and treatment of prostitutes; but this subject is worthy of the careful con- sideration of His Excellency the Governor and the General Assembly, and the municipal authorities of the cities and towns of Louisiana. Prostitution has not yet been abolished by thefulminations of the pulpit, the denunciations of the press, and the stern enactments of the lawgiver. Typhus and Typhoid Fevers in Neu) Orleans : Joseph Jones, M. D. CCCIX That prostitution exists, is a fact to be recognized; and that the prostitute is one of the manifestations of humanity, even in this enlightened, advanced and civilized age, equally demands the recognition and earnest attention of the wise and humane legislator. Good will be accomplished by the enactment of such laws as will restrain vice within the smallest possible limits, and at the same time, by medical inspection, treatment and isolation, reduce the most loathsome diseases to the lowest practicable minimum. ' TYPHUS OR SHIP FEVER, AND TYPHOID OR ENTERIC FEVER. It is not our intention, upon the present occasion, to enter upon a minute history of continued fevers, and show how they have devastated at various times the fairest cities and most populous countries of Europe; and how, even in modern times, they have followed in the wake of great armies, and inflicted untold damage alike upon the victor and the vanquished. A volume might be written upon the birth of the fearful typhus in the mud hovels, and amongst the oppressed and starving poor of Ireland, and Hungary and Poland; but whatever may be our sympathies for these struggling people, our present duty and our present inquiry, relates to the great city of New Orleans, the commercial emporium of the Mississippi Valley. It has been asserted that typhus and typhoid fevers are unknown in New Orleans, and elaborate theories have been built upon this false premise; and learned arguments by learned and accomplished physicians have been launched against systems of underground sewerage, and even against the received theory that filth and excrements, when carefully hoarded in our yards and under our houses, may prove detrimental to human health. But to the facts. TYPHUS, OR SHIP OR FAMINE FEVER IN NEW ORLEANS. We find the following important data, after careful examination and con- solidation of the records of the Charity Hospital of New Orleans, during a period of eighteen years (1842 1860) preceding the recent civil war. There were treated in the Charity Hospital in New Orleans, 7220 cases of ship or typhus fever, of which 1301, or 18 per cent, proved fatal; while during the sixteen years succeeding the civil war (1864-1880) only two cases, both of which proved fatal, were treated in this hospital. Surely, this is a very remarkable fact. Truly, the prevalence of typhus fever during the eighteen years preceding our civil war, and its almost total absence in the sixteen years following the great civil convulsion, can be referred to well-known causes. First, typhus fever was imported to New Orleans by means of the emi- grant ships, which bore to these hospitable shores the fever and famine- stricken and oppressed inhabitants of Ireland. Previous to the year 1847, typhus fever does not appear to have made any serious lodgment in the city of New Orleans, although it had been com- mitting its ravages in Europe for centuries before. Thus, in 1841. no case of typhus fever was entered on the records of the Charity Hospital, nor in 1842. In 1843, we find 9: in 1844, 4; in 1845, no case; in 1846, no case; but in 1847, we find the record of 1045 cases; in 1848, 1883; in 1849, 891; and 1850, 1044. The disease introduced in 1847, both from Mexico (by the United States troops) and from Europe from the fever-stricken and starving districts of Ireland, raged as an epidemic in this city for several years. CCCX Typhus and Typhoid Fevers in Orleans : Joseph Jones, M. 1). We find the following mortality occasioned by typhus fever in New Orleans' for the respective years: 1847,154; 1848,164; 1850. IM); 1853, 103; 1856, 21^ 1857,8; 1858,20; 1859,7; 1860,10; 1861,5; 1863,9; 1864, 11;. 1865,5; 1866^ 12; 1867,23; 1868,5; 1869,5: 1870, 13; 1871,4; 1872,4; 18713,5; 1874, 2 ; 1875, 2; 1876, 2; 1877, 1; 1878, 23; 18?9, 0; 1880, 1. The following practical conclusions may be drawn from the preceding facts in the medical history of New Orleans : • 1. Typhus fever was imported into New Orleans in 1847, and prevailed for several years thereafter, causing the death of about 1500 of the inhab- itants of New Orleans. The disease was confined chiefly to the poor and. ill-fed, as the majority of the deaths occurred in the wards of the Charity Hospital. 2. Quarantine is essential to the protection of New Orleans fivw the introduction of typhus fever; and to be effective it must be perpetual. The public'mind has been so excited and manipulated upon the subject of yellow lever that, in the Mississippi Valley, it has become synonymous wittu quarantine. The quarantine against yellow fever may be practically limited to six months in the year, embracing that peculiar thermic condi- tion favorable to its lodgment and spread ; but typhus fever is not thus limited by climatic changes, but is often developed with most destructive effects in the dead of winter, and may at any time and any season be trans- ported across the ocean in ships. 3. As President of the Board of Health 1 have held that the quarantine of Louisiana, at the mouth of the Mississippi Kiver should be maintained in an effective condition at all times and under all conditions, and that the inspection of vessels by the quarantine physicians should at all seasons, both summer and winter, be thorough. It is natural that commercial and mercantile men should oppose and endeavor to defeat all measures which appear in any manner to diminish their business or put apparent obstruc- tionsin the way of the continuous and rapidaccumulation of money and capi- tal; but in the true light of public good and of substantial advancement, the exclusion of foreign pestilence, the preservation of the public health, is the only tru e road to permanent prosperity. 4. No mere s unitary measures within the limits of the city of New Or- leans, will in th e absence of an efficient system of inspection and quaran- tine, exclude sue h infectious and contagious diseases as typhus fever and small-pox. 5. Typhus fever in produced into New Orleans tends gradually to be- come extinct; this rest dt should be attributed to the better food, better living, or ventilation 01 ' the mass of the inhabitants of this city. 6. The establishment * of an extensive system of street railroads, during the past twenty-five yea. vs in New Orleans, has without doubt promoted the health as well as th© comfort of the people, by scattering the dwellings upon a far greater area a nd thus promoting ventilation, and preventing crowding. Typhoid, or enteric fev * h- 8 been present in New Orleans for an indefi- nite period, as will be <r k v tbe following statistics: The number of cases of typhoid fi>rAr "*n ' in the Charity Hospital in 1841 was 12; 1842, 22 ; 1843 1 787.r 139; 1846, 195; 1847, 457 ; 1849, 79. During a period of ei/i / \ 1842-1860, 3144 cases ot typhoid fever were treated in the Ph 7. *. ce''r Tears 983 or 31.2 per cent of which termi- nated fatally. hospital, During a period of sivfe > '-1880, following the civil war, only 377 cases, with ISO (le itl * "Aenrs' ^864 t of typhoid fever were entered TYPHOID FEVER. Prisons of New Orleans : Joseph Jones, M. D. CCCXI During thirty-four years, 1842-1880, 3521 cases and 1163 (33 per cent mortality) deaths were entered upon the records of the Charity Hospital as caused by typhoid fever. This disease in like manner with typhus fever has diminished since the cessation or great diminution of foreign immigration to New Orleans, which has characterized the close of the great civil convulsion of 1861-1865. These two diseases, typhus and typhoid fever, figure upon the records of the Charity Hospital during the past thirty-four years, with 10,743 cases, and 2466 deaths. The mortuary records of New Orleans show the following deaths from typhoid, or enteric fever, for the respective years: 1845, 70 deaths from typhoid fever; 1847, 233; 1849, 178; 1850, 103;' 1853, 146; 1856, 108; 1857, 148; 1858, 189: 1859, 214; I860, 163; 1861, 102; 1863, 257; 1864, 268; 1865. 159; 1866, 116; 1867, 119; 1868, 58; 1869. 63; 1870, 80; 1871, 71; 1872, 67; 1873,57; 1874,95; 1875,57; 1876, 53; 1877,69; 1878.74; 1879,33; 1880,52. It is evident from the preceding statistics that New Orleans has not been exempt from typhoid or enteric fever. It appears to be true, however, that New Orleans, and in fact the entire alluvial portion of Louisiana, suffers less from typhoid fever than more ele- vated portions of our country. This comparative exemption has been referred, by some writers, to the absence of underground sewers in New Orleans; but it would rather ap- pear to be due to those peculiar climatic conditions which do not favor the generation and propagation of the typhoid poison. From the preceding facts, we may draw the following PRACTICAL CONCLUSIONS. 1. Typhus, or ship fever, can be transferred from one country to another, and is capable of reproducing itself and spreading in populous towns or cities; more especially amongst the poorer classes in crowded houses. 2. Typhoid fever appears to be closely related to climate and soil, and in some instances has been traced to such local causes as the contamination of drinking water with fcecal matter; and whilst tacts exist to show that under certain circumstances it may become infectious, this disease is not possessed of contagious qualities to an equal degree with"typhus fever. 3. Both typhus and typhoid fever should be embraced in any system of maritime quarantine. 4. The chief means for preventing or arresting typhus or typhoid fever, are free ventilation, full supplies of pure drinking water, abundance of wholesome food, and the prompt removal of garbage and foecal matters. PRISONS, POLICE STATIONS AND CHARITABLE INSTITUTIONS AS SOURCES OF DISEASE. Shortly after my election as President of the Board of Health in April, 1880, I directed the earnest attention of this honorable body to the condi- tion of the prisons, police stations, Insane Asylum, Boys' House of Refuge and Charity Hospital. Again, in the early part of 1881, I agitated this question and brought the attention of the Grand Jury of the parish of Or- leans, prominently to the condition of the Parish Prison, police stations and Insane Asylum. Other matters, as the neglected and foul condition of the drainage canals were also urged upon the consideration of the Grand J ury. CCCXII Prisons of Neto Orleans : Joseph Jones, M. D. I have reason to believe that the agitation of important questions re- lating to the physical, mental and moral welfare of those accused and con- victed of crimes-the innocent as well as the guilty-resulted finally in the establishment of a Commission charged with the investigation of all matters relating to the conduct of prisons, houses of correction and asylums. It is confidently hoped that good will result from the labors of the philanthrophic gentlemen composing the honorable commission. POLICE STATIONS. The attention of the Board of Health, and of the administrators of police and public building, have been directed to the structure and conduct of the police stations; to the want of sanitation; to the foul practice of re- ceiving the discharges from the stomach and bowels of prisoners confined in these " dungeons" into open buckets, which are. allowed during the en- tire night to exhale their noxious gases in these confined, badly ventilated cells. The discussion of prison discipline and prison reform in New Orleans would cover far more ground than can be embraced in this report. It has engaged my earnest attention, and upon more than one occasion has the Parish Prison of Orleans been thoroughly and carefully investigated. PARISH PRISON. STATEMENT OF ADMISSIONS AND DEATHS IN PARISH PRISON, PER MONTH. FOR THE YEARS 1856-60. 1856. 1857. 1858. 1859. 1860. - - - - Totals Died of Died of Died of Died ot Died of | - - - - MONTHS. - Admitted. Stabbed. Not Stated. Total. Admitted. Fracture of > Not Stated. Total. Admitted. Yellow Feve Intern peranc Executed. Total. Admitted. Pneumonia. Diarrhoea. Phthisis. Intern peranc Jaundice. Executed. Total. Admitted. Pneumonia. Ty phoid Fey Inteinperanc Executed. A Admitted. Died. ' ■ -■ - - - - - - - - - - - - - - - - - - - - - - - - - ! January ... 49 225 653 580 1 1 673 2 2 2180 3 February 74 222 1 1 555 1 1 530 561 1942, 2 March 123 222 713 2 2 602 1 1 2 620 2280, 4 April - 239 172 558 i 1 2 503 519 1991' 2 May 131 228 416 359 1709 0 June 171 1 i 245 392 455 1 1 2 368 1 1 2 1631 5 July 239 231 1 1 513 2 2 463 849 1 3 4 2295 August 173 226 366 353 851 1 1 1969 1 September 210 207 1 i 449 2 i 3 457 , 789 2112 4 October 167 2 2 178 i 1 380 2 2 432 .. 894 2051 o November....» 162 341 445 1 1 620 2 1 3 1 950 2519 4 December 205 627 558 622 11079 1 30911 1 - - - -- - - - - - - - - - - - - - - Totals 1950 1 2 3 3124 1 3 4 5998 5 2 6 13 16186 1 1 1 3 1 1 8 18512 1 1 5 3 10 25770 38 STATEMENT OF ADMISSIONS AND DEATHS IN PARISH PRISON, PER MONTH, FOR THE YEARS 1866-70. Prisons of New Orleans: Joseph Jones, M. D. 1866. 1867. 1868. 1869. 1870. Totals. Died of Died of Died of I Died of Died of i ; i i MONTHS. i ® ! । | tted. ra. isis. tted. w Fe ipera sis. ra. itate< tted. monii tted. -pox tted. tated tted. 8 "o 5 3 a S 5 "3 3 a S3 2 3 s ® 3 s ni ^5 ja 0 ® a ja O 0 H c ns Q I o -e 0 0 x: .2 January .... 553 1 1 2 560 623 926 1 1 707 1 1 3 369 4 February 351 554 610.. . ... 903 678 1 1 3 069 1 March * ... 304 523 1 1 2 572 732 818 2 949 2 April 398 J 541 568.. 717 573 .... 2,797.... May . - 524 ... 499 527 653 756 1 1 2,959 1 JUne .... 461 653 475 731 1 1 353 .. 2,673 1 July 401 660 1 1 606 727 ... 467 .... . 2 861 1 August . 422 2 2 693 1 1 888 1 1 697 523 3.223 4 September . 380 8 .. .. 8 528 3 1 4 811 661 420 2,800 12 October .... ... 402 1 1 474 1.. ... 1 2 720 653 399 2,648 3 November 515 562 2 2 4 816 .. 622 368.... . 2 883 4 December... 527 ... 600 2 1 3 732 807 451 3417 3 Totals 5,238 12 1 13 6.847 5 3 2 3 4 17 7,948 11 1 8,829 2| 2 6.513 3 3 35,375 36 CCCXIII CCCXIV Sick and Destitute Poor of New Orleans: Joseph Jones, M. D. From the preceding statistics the following points are worthy of note: 1. During five years preceding the civil war. 1861-1865, namely: 1856, 1857, 1858, 1859 and 1860, 25,770 persons were admitted into the Parish Prison of Orleans, and that of this numbei thirty-eight died within the walls of the Bastiic. We have no means whatever to determine the num- ber of deaths in the Charity Hospital among the dangerously wounded (stabbed, shot and maimed), poisoned and sick. It' is, however, a fact of considerable importance in a sanitary point of view that in 1859 five of the prisoners died within the walls ot yellow fever. It has been affirmed that this disease has never invaded the Parish Prison, and that its exclusion was due to two causes, namely : the isolation (quar- antine) of the inmates, and the exhalation of ammonia from the excrements of the bats which inhabit the garret of the building in vast numbers, and also from the urine of the prisoners. 2. During five years following the civil war-1866, 1867, 1868, 1869 and 1870-35,375 prisoners were admitted within the walls of the Parish Prison, of which thitrty-six are said to have died. The five years following the war gave a richer harvest of prisoners, by the amount of nearly ten thousand. During the live years preceding the civil war we find ten deaths credited to the hangman (executed). During the five years following the civil war we find not a single death in accordance with the mandates of the law. Whilst the results of the civil war of 1861-1865 appeared to favor the increase of crime, they also appeared to relax the extreme rigors of the law, Cholera claimed twelve victims in 1866 ana three in 1867, and yellow fever occasioned five deaths in 1867, and even small-pox invaded " the sacred pre- cincts,'" and destroyed two of the unfortunate prisoners in 1869. The subject ot the physical, mental and moral treatment of prisoners, in every prison, workhouse and institution for correction and reform, in every parish throughout the State of Louisiana, is worthy of the most serious consideration and investigation on the part of his Excellency the Gover- nor,and the Senate and House of liepresentative of the State of Louisiana. THE SICK, DESTITUTE POOR OF NEW ORLEANS. Some estimate of the amount of unrelieved suffering endured by the destitute poor of New Orleans during sickness, may be formed by the re- view of the number of deaths occurring in the Charity Hospital and in the various other public and charitable institutions, and more especially from the number of deaths recorded upon the certificates of the coroner. Thus, during the months of January, February, March and April, 1881, the number of deaths occurring in charitable and public institutions were as follows: DEATHS IN THE CHARITY HOSPITAL DURING THE MONTHS OF JANUARY. FEBRUARY, MARCH AND APRIL, 1881. MONTHS. Whites. Colored. Total by Months. 37 35 72 47 22 69 March 42 28 70 April 30 24 54 Totals 156 109 265 Sick and Destitute Poor of Neic Orleans: Joseph Jones, M. D. CCCXV DEATHS IN PUBLIC AND CHARITABLE INSTITUTIONS DURING THE MONTHS OF JANU- ARY, FEBRUARY, MARCH AND APRIL, 1881. YEARS. Different Institutions. Number of Deaths. 1881 Small-Pox Hospital .... .... 1 1881 . . Hotel Dieu 20 1881 Touro Infirmary 8 1881 St. Vincent's Infant Infirmary 13 1881 Insane Asylum a.n<l "Louisiana* Ketreat 19 1881 Parish Prison.... 10 1881 Orphans' Asylum.... ..... 5 1881 Other Institutions 28 Totals 104 INQUESTS HELD BY THE CORONER DURING THE MONTHS OF JANUARY, FEBRUARY MARCH AND APRIL, 1881. MONTHS. Whites. Colored. Total by Months. January 44 62 1C6 February .... 28 44 72 March. .... 47 49 96 April.... 33 51 84 Totals 152 206 358 It is shown by the preceding table that the total deaths in New Orleans during the first quarter of 1881, in charitable and public institutions and upon Coroner's certificate numbered 727. If the same ratio of deaths to population should hold during the remainder of the year 1881, then the mortality for the entire year would be as follows: Charitable and Public Institutions 1107 Coroner's Certificates 1074 Total, as estimated for 1881. 2181 DEATHS IN THE CHARITY HOSPITAL DURING THE YEAR 1880. MONTHS. Whites. Colored. Total by Months. January. 44 23 67 February 33 18 51 March 26 13 39 April 43 22 May .. 23 23 46 June ... 31 16 47 July 27 19 46 August 29 19 48 September .... 32 15 47 October . .. 40 21 61 November . . 56 20 76 December 38 26 64 Totals 422 235 657 DEATHS IN PUBLIC AND CHARITABLE INSTITUTIONS DURING THE YEAR 1880- YEARS. Different Institutions. No. of Deaths. 1880. Small-Pox Hospital 1 1880 Hotel Dien 37 1880.. Tonro Infirmary. .. 10 1880 St. Vincent's Infant Infirmary 32 1880 Boys' House of Refuse 1 1880 City Insane Asylum and Louisiana Retreat . 23 1880.... Parish Prison 7 1880 Orphans' Asylum 14 1880.. Other Institutions . , 54 Totti Is...... ...... 179 CCCXVI Sick and Destitute Poor of New Orleans: Joseph Jones, M. D. INQUESTS HELD BY THE CORONER DURING THE YEAR 1880. MONTHS. Whites. Colored. Total by Months. January 28 49 77 February ... .... 35 38 73 March 27 42 69 April „ 40 39 79 May.. . 32 58 90 J une 29 85 July 47 37 84 August.. . _ .... 42 61 103 September 33 45 78 October 41 93 November .. 46 61 107 December 48 64 112 Total 448 602 1050 From the preceding tables we obtain the general results that, during the year 1880, the deaths in the Charity Hospital and other public and chari- table institutions numbered 836; of those recorded on coroner's certificate, 1050; total, 1886 deaths. Eighteen hundred and eighty-six deaths occurred among the poor and friendless of New Orleans, during the year 1880, out of a grand total of deaths from all causes of 5623. In other words, the deaths among those who availed themselves of public charity, or who were too poor to com- mand medical attention, constituted about one-third, or thirty-three per cent of the deaths from all causes. It is worthy of note that 1050 deaths were registered upon the Coroner's cer tificate ; that is, one in about five (5.35J of those icho died in New Orleans during 1880 perished without any known or recognized medical atten tion or service. It is also worthy of note that the deaths upon Coroner's certificates among the colored population greatly outnumber those among the whites, in the proportion of 602 among the former to 448 among the latter; that is, the number of Coroner's inquests were, relatively to the population, more than six times more numerous among the colored population. Such facts should arrest the attention and engage the action and earnest efforts of philanthropists. Upon mature deliberation the following measures appear to afford the best means of mitigating a portion, at least, of the suffering among the destituted sick poor of New Orleans: First-The employment, at a reasonable compensation, of one or more physicians in each ward, whose duty it shall be to attend to the sick poor. Second-The establishment of one or more depots of drugs in each ward, under the charge of competent druggists, to be dispensed upon the requi sition and certificate of licensed physicians. In the present condition of the public finances, both City ond State, it is not probable that any steps can be taken to accomplish these results by legislation; but it may be hoped that the good and philanthropic may be moved to assist in accordance with their means and benevolent impulses. INFLUENCE OF RACE UPON THE RATE OF MORTALITY IN NEW ORLEANS. In the consideration of the relations of endemic and epidemic diseases to the mortality of special cities and countries, it is essential that the death-rate of the distinct races should be determined. In New Orleans we have two great divisions into the white and black, or colored race. The latter terms are almost absolutely synonymous with the negro races. The mortality of New Orleans h$s not as yet been perceptibly affected by the copper-colored immigrants of Asia. From the following tables we gather that, during the series of thirty one years embraced in the period extending from 1845-1881, inclusive, the Vital Statistics of New Orleans: Joseph Jones, M. D. CCCXVII average annual death-rate, per 1000 inhabitants, amongst the whites of New Orleans was 39.69, and amongst the black or colored race 47.13; and the annual death-rate for both whites and blacks, 41.41. It is worthy of note that from 1845 to 1871, the still-born were included in the total deaths. Notwithstanding the greater liability of the white race to yellow fever, and the heavy mortality occasioned during epidemic years ; nevertheless the annual death-rate amongst the colored race for the entire series was 7.44 greater than that of the white race. The rate of mortality in New Orleans has been materially affected by its epidemics of yellow fever, and this movement has been due chiefly to the destructive effects of this disease upon the white race. Thus in 1847, the death-rate per annum, per 1009, was: whites 70.86, colored 37.08; 1853, whites 124.68, colored 48.98; 1867, white 56.79; colored 47.80 ; 1878, whites 52.08, colored 39.0. The year 1858, however was an exception to the rule, that in years of epidemics-yellow fever-the mortality is largely in excess of the whites, for we find the total death-rate to be 72.70, whites 69.64, colored 89.37, per 1000 inhabitants. If we exclude the year 1878, there has been a marked diminution of the death-rate amongst both whites and blacks in New Orleans since 1867, or during the past fourteen years, the mortality amongst the colored race, however, is far higher than in comportable with an improved mental, moral, physical and sanitary condition of this race. We have the relative mortality of the white and black races presented in the following table, embracing a series of years, from 1845 to 1881, in- clusive : Vital Statistics of New Orleans : Joseph Jones, M. D. CCCXVIII VITAL AND MORTUARY STATISTICS OF NEW ORLEANS, LA. TABLE ILLUSTRATING COMPARATIVE MORTALITY OF THE WHITE AND BLACK RACES IN NEW ORLEANS, DURING A SERIES OF YEARS. 1845-1881, INCLUSIVE CONSOLI- DATED FROM THE RECORDS OF THE BOARD OF HEALTH, UNDER THE DIRECTION OF JOSEPH JONES. M. D. YEARS. Population of New Orleans. No. of Deaths in New Orleans. Death-rate per 1000, per annum. Total. White. Colored. Total. White. Colored. Total. White. Colored 1845 114.442 79,698 34.744 2,783 2,001 782 24.32 25.10 22.50 1847 120,890 88,530 32.360 7,499 6.274 1,225 62.03 70.86; 37 08 1849 127,340 97,362 29,978 9,862 7,976 1.886 77.44 81.92 62.91 1850 130,565 101.778 28 787 7,819 6,319 1,500 59 88 62.08 52.10 1852 138 J 87 110.342 27,845 8^693 7J99 1,199 62 90 67.91 43.04 1853 141,988 114,624 27,374 15,633 14.292 1.341 110 09 124.68 48 98 1856 153,431 127.470 25'961 5'200 4.274 926 33.89 32.98 35.66 1857 157,242 131,753 25,489 5,581 4.593 988 35.49 34 86 38.07 185(5 161.053 136,036 25,017 11'710 9,474 2.236 72.70 69.64 89.37 1859 164,864 140.319 24,545 6,847 4.712 2.135 41.53 33.58 86.98 1860 168,675 144,601 24 074 7,341 6,070 1.271 43.51 41.99 52.79 18bl 170.949 144.233 26,716 5.449 4.456 993 31.87 31.58 37.16 1863 175.497 143.497 32.000 7.258 5,353 1,905 4135 37.30 59.53 1864 177,768 143.129 343139 8 864 6'032 2.832 49.86 42.14 81.75 1865 180,043 142.761 37,282 7.020 4,756 5.236 2.264 38.99 33.31 60 88 1866 182.318 142.393 39'925 7,754 2,518 42 52 36.77 65.56 1867 184.593 142.025 42,568 10.096 8.066 2.030 54.69 56.79 47.80 1868 186.068 141.657 44,411 5.343 3,612 1.731 28 60 25.49 38.97 1869 189,143 141.290 47.853 6.001 3.857 2,144 31.73 27.29 44 80 1870 191 418 140,923 50,495 7,391 4 755 2 636 38-61 33 74 52.20 1871 193,412 142.695 50.717 6,059 3 890 2,169 31.32 27.26 42.76 1872 196,406 144.437 51.969 6.122 3,943 2,179 31.17 27.29 41 93 1873 .... 198,900 146'179 52.721 7.505 4.794 2,711 37.73 32.79 51.42 1874 201 394 147 921 53 472 6.798 4 368 2 43C 33 75 29.53 45 44 1875 203^888 149.663 54,225 6,117 3.934 2,183 30.00 26.28 40.25 1876 206 382 151 406 54,976 6,257 3,917 2 340 30.31 25.87 42.56 1877 208.876 153.149 55'727 6.708 3-976 2,732 32.11 25.96 49.02 1878 . 211,371 154.892 56,479 10,3181 8.062 2,256 48.81 52.05 39.94 1879 213,865 156,635 57,230 5,1221 3,267 1,855 23 95 20.85 32 41 1880 216 14C 158 379 57,761 5,622 3,637 1,986 26.01 22 96 34.38 1881 218'500 160.000 58'500 6.406 4,127 2,279 29.31 25.79 38 95 Total 5,485.618 4.219,777 1.265.841 227.179 167,517 59,662 41 41 39.0f 47.13 The mortality from 1845 to 1871. inclusive, comprises '•Still-born. The mortality records from 1869 to 1876 give a certain number of deaths, 'Color not stated.' These have been divided in the above table by estimating two-thirds to be white, and one-third colored. The figures ot "Population" are taken from the United States census of 1840, 1850, 1860, 1870 and 1880, and those of the intermediate years have been derived from these by calculation Population of 1881 is estimated. Vital Statistics of New Orleans: Joseph Jones, M. D CCCXIX COLOR. 1847 1849 1850 1853 1856 1857 i 1858 1859 I860 1863 1864 1865 Total 12 Years. Whites 6274 1220 5 7974 1888 6319 1500 14292 1341 4274 926 4593 988 10592 1118 5781 1066 5884 1179 278 5015 1735 508 6032 2832 4688 2231 101 81718 18024 892 Not stated Total 7499 9862 7819 15633 5200 5581 11710 6847 7341 7258 8864 7020 100634 > COLOR. 1866 1867 1868 1869 1870 4602 2560 229 1871 1872 1873 1874 1875 1 1 1876 1877 1878 1879 1880 1881 Total 16 Years GrandTotal 28 Years. Whites ....... 4981 2392 378 7866 1931 299 3503 1676 164 3757 2092 152 6001 3782 2115 162 3871 2143 108 4739 2684 82 4299 2395 104 3869 2151 97 3847 2305 105 3976 2732 8062 2256 3267 1855 3637 1986 4127 2279 72188 35552 1880 154906 53576 2772 Not stated.... Total 7754 10096 5343 7391 6059 6122 7505 6798 6117 6257 670? 10318 5122 5623 6406 109620 210254 SEX. 1849 1850 1853 1856 1857 It 58 7675 1859 1860 1863 1 364 4895 1 865 3846 Total 11 Years. Males . Females 6458 3404 4802 3017 9765 5452 416 3108 2092 3245 2336 4193 2654 4193 2654 494 4405 2578 275 56585 34924 1626 4035 3739 230 2963 211 Not stated Total 9862 7819 15633 5200 5581 11710 6847 7341 7258 8864 7020 93135 SEX. 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 1876 1877 18' 18 1879 1880 1881 Total 16 years Grand total 27 years. Males 4372 6239 2844 3275 4466 1530 3526 4396 1982 3416 3381 3650 6193 2969 3053 3593 62785 i 120370 Females Not stated 3052 330 3566 291 2292 207 2598 128 2838 87 2481 48 2568 28 3070 39 2798 18 2666 35 2623 253 3058 4125 2153 2570 2813 45271 1564 80195 2190 Total 7754 10096 5343 6001 7391 6059 6122 7505 6798 6117 6257 6708 10318 5122 5623 6406 109620 202755 COLO&- VITAL AND MORTUARY STATISTICS OF NEW ORLEANS, LA., 1847-1881. SEX-VITAL MORTUARY STATISTICS OF NEW ORLEANS, LA.. 1849-1881. CCCXX Vital Statistics of New Orleans : Joseph Jones, M. D. AGES. - 1849 1232 j 903 342 | 530 < 1991 1603! 833 382, 192; 101 48| 20! 3 1682 1850 1323 £ 937 249 126 279 | 1342 1224 615 321 191 100 44 19 1 1048 1853 1954 | 1296 499 | 2085 | 4514 2093 901 448 206 84 40 '? 1495 1856 1857 1858 1944 603 1001 365 293 579 1539 1486 2001 1040 463 ! 216 118 1 45 i 11 6 1859 1609 538 505 326 I860 1467 668 581 322 1863 952 694 643 279 140 27 i 782 725 595 367 216 155 84 37 14 1284 1864 1365 806 962 595 255 280 | 803 780 1865 1375 578 624 446 194 189 J 650 728 Total 11 Years. 16397 [ 13053 3783 j 6300 | 16548 12633 7819 4335 2398 1270 628 259 79 7633 - 1608 434 337 155 71 87 1 298 5 431 730 483 253 131 80 20 2 1568 468 475 205 117 130 308 408 768 52: 297 155 97 38 18 6 Under 1 year From 1 to 2 j ears • From 2 t o 5 y ears ■ ■ ■ - From 5 to 10 years • IM 110 231 175 445 400 549 602 1025 956 762 701 331 378 196 216 95 99 51 47 21 23 101 3 From 10 to 15 years .,..•••••• I rom 15 to 20 5 ears From 20 to 25 years • From 30 to 40 years •••••• From 40 to 50 years. 600 495 358 301 From 60 to 70 years 110 38 21 991 66 34 12 520 From 80 to 90 years . From 90 to 100 years 100 years and upwards o87 Total " AGES. 1866 1867 1868 1869 9892; 1870 781 1871 9 15633 1872 1873 _5200 1874 5581 1875 11 1876 7101 1877 6847 1878 _ 7341 1879 7258 1880 | 1 881 8864 T 16 1 70 otal fears. 20 G _ 93135 rand Total, 27 Years. Under 1 year 1524 518 1863 529 566 491 253 46b 942 1039 1441 946 604 344 163 70 12 10 357 10096 1331 364 229 152 90 132 221 282 588 488 386 266 136 62 22 9 585 534:? 1388 472 493 201 105 i it; 249 280 581 570 445 276 133 45 30 15 575 6001 1587 410 353 180 149 25: 491 582 929 754 559 348 189 64 24 12 509 7391 1 1596 324 204 j 126 | 108 153 336 370 753 667 509 320 166 74 16 i 17 | 320 6059 1367 405 337 162 114 170 327 368 750 675 529 365 220 62 34 18 219 6122 1539 507 516 299 153 188 519 514 880 775 603 404 215 77 38 16 262 7505 1396 399 449 251 123 224 372 383 830 740 579 467 227 86 26 19 227 6798 1262 403 420| 274 139 203 360 351 613 630 519 424 230 78 21 11 178 6117 1193 494 504 273 138 200 287 346 644 637 536 420 261 99 29 24 172 6257 1228 437 441 208 170 272 £ 916 709 757 571 445 273 99 j a 30 6708 1260 455 1523 693 28 8 416 ^1549 1392 977 706 466 313 121 ' 44 115 10318 1115 261 227 132 97 127 ' 520 588 594 426 439 313 105 £ 46 32 5122 1247 373 388 211 115 129 281 267 580 601 534 449 234 131 * 63 20 .'>623 1231 394 390 240 150 188 334 341 684 705 638 576 337 131 42 6406 22224 6745 7550 4353 2364 3511 * 13896 12953 11253 8664 6342 3557 1355 * 699 4154 103620 5 '38621 27348 8136 12175 30444 25586 19072 12999 8740 4827 1983 1037 11787 202755 From 2 to 5 years. From 5 to 10 years From 10 to 15 years 510 360 172 244 £ 1069 991 737 520 333 147 51 19 10 549 7754 From 20 to 25 years • ■ From 25 to 30 years • • From 40 to 50 years From 50 to 60 years.... ••• From 60 to 70 years 100 years and upwards.... Age unknown Total. AGES-VITAL AXD MORTUARY STATISTICS OE NEW ORLEANS. LOUISIANA, 1849-1881. I ital Statistics of .New Orleans : Joseph Jones, M. D. NATIVITIES. ! Yello Fever. Malarial Fever. Typhoid Fever 1 1 Scarlet Fever. Measles. j Diphtheria. 1 Diarrhoeal Diseases. 1 1 Phthisis Pulmonalis. Pneumonia. I Congestion of : the Brain. । Sunstroke. 8 1 8 I ' 1 i Bright's Dif g « ' ® 5 a CC O Suicide. & Total. H ce £ & ! • Austi in and Hungary. • • • • • ... 1 1 i 2 1 8 5 1 .. '5 1 9 Belgium . - British America •••••••••••••• 1 1 1 11 6 4 109 ChiDd • ••••••••••• 1 1 17 23 Denmai k .. 1 10 36 . 2 F rance......... 3 3 1 2 17 35 73 46 63 84 4 21 29 6 5 5 5 10 i 60 1 7 21 24 1 2 42 1 5 6 2 1 German 2 . 917 Gicat Biit»iii and Iieland. ••••••• - ■ 52 1 103 Gi eece . • • W/tlloTltl .. .. ......... 1 "2 83 8 557 ' 7 455 2 3 1 2 209 1 1 2 73 I 1 5; 2 240 43 31 1989 7 7 1 4 1 24 11 517 13 • • • 188 24 5 10 1 1 1 1 1 Norway and Sweden Portugal Russia South Ameiica •• • 4 1 2 4 88 3 2| 3 1 6 9 5 203 6 3 1 1 28 1 1 io 2 1 Spain.... ••• • • • • •••••• Switzerland- • • • • • ............ United States (not Louisiana) 46, 1 6 6 1 54 1 30 29 8 3 Total 396 66 197 26 _92|_ 795 900 327 154 33 114 127 32 5 3264 CCCXXI VITAL AND MORTUARY STATISTICS OF NEW ORLEANS, 1881 DEATHS FROM THE PRINCIPAL CAUSES IN THE DIFFERENT NATIONALITIES, 1881-CONSOLIDATED FROM THE RECORDS OF THE BOARD OF HEALTH, UNDER THE DIRECTION OF JOSEPH JONES, M. D. CCCXXII Kitai Statistics of New Orleans : Joseph Jones, M. 1). INFLUENCE OF SEX UPON THE MORTALITY OF NEW ORLEANS. • In the following table, the relative mortality amongst the different sexes (males and females) in New Orleans, during a period of twenty-six years (1849-1881) is given. The per cent relates to the relations of deaths in the two sexes to the total deaths, and not to the population. We observe that the mortality during the entire series of years has been relatively greatest amongst the males. This is due to several causes : 1. The greater exposure of the male race to the changes of climate, and to violent deaths by accidents, by contagious and infectious diseases. 2. The large number of seamen and merchants frequenting New Orleans from all parts of the habitable globe. 3. The large number of paupers and sick laborers, transported from surrounding States to the Charity Hospital. VITAL AND MORTUARY STATISTICS OF NE WfORLEANS-TABLE ILLUSTRAT- ING THE NUMBER OF DEATHS, AND PERCENTAGE OF DEATHS, AMONG THE DIFFERENT SEXES (MALE AND FEMALE) IN NEW ORLEANS. Year Number of Deaths. Per cent of Deaths. Total. Male. Females. Male. Females. 1849 : 9862 6458 3404 65.5 34.5 1850 7819 4802 3017 61 4 38 6 1853.. 15633 9973 5660 63 8 36.2 1856 5200 3108 2092 59 7 40.3 1857... 5581 3245 2336 581 41.9 1858 . 11710 7675 4035 65 5 34 5 1859 6847 4193 2654 61.2 38.8 1860 7341 4440 2901 60.4 39 6 1863. 7258 4543 2715 62.6 37.4 1864 8864 5010 3854 56 5 43.5 1865 7020 3952 3068 56.3 43-7 1866...... 7754 4537 3217 58.5 41 5 1867 10096 6485 3611 64 2 35 8 1868 5343 2948 2395 55.2 44.8 1869 6001 3339 2662 55.6 43.4 1870 7391 4510 2881 61.0 • 39.0 1871 6059 3554 2505 58.6 41.4 1872 6122 3540 2582 57.8 42 2 1873 7505 4416 3089 58.8 41.2 1874 6798 3991 2807 58.7 41.3 1875 .... 6117 3434 2683 56.1 43 9 1876 6257 3508 2749 56.0 44.0 1877. 6708 3650 3058 54.4 45.6 1878 10318 6193 4125 60.0 40.0 1879 .....' 5122 2969 2153 57.9 42 1 1880 5623 3053 2570 54.4 45.6 1881 6406 3593 2813 INFLUENCE OF THE EPIDEMIC AND ENDEMIC CAUSES OF DISEASE AND DEATH UPON HUMAN LIFE AT THE DIFFERENT AGES OR PERIODS. In the following table the mortality at different periods of life in New Orleans, for a series of years, has been calculated with reference to the total mortality: Vital Statistics of New Orleans : Joseph Jones. M. D. CCCXXIII AGES. 1849 1850 1853 1856 1859 1860 1863 1864 1865 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 1876 1877 1878 1879 1880 1881 Average during 27 years. 1857 1858 Under 1 year. 12.5 16.9 12.5 30.9 28.1 16 5 23-5 20 0 13.1 15.4 19.6 19 6 18.4 24 9 23.7 21.5 26.3 22.3 20 5 20.5 20.6 19.1 18.3 12 2 21.7 22.2 19 1 20.0 From 1 to 2 years j 9.2 12.0 8.3 8.3 8 4 5.2 7-9 9.1 9.5 9.1 8.2 6.6 5.2 6 8 7.8 5.5 5.3 6 6 6 8 5 9 6.6 7.9 6.5 4.4 7 1 6.6 6 1 j 13.7 From 2 to 5 years 6 5 8.6 85 7.4 7.9 8.8 10.9 8.8 9 6 5.6 4 3 8.2 4.8 3 4 5.5 6.9 6.6 6.8 8 1 6.6 14.8 4.4 6.7 6.1 From 5 to 10 years 3 4 3.2 3.2 3.0 3.7 3.1 4.7 4.3 3.9 6.7 6.3 4 6 4.9 3.0 3.3 2.4 2.1 2.6 4.0 3.7 4.5 4 3 4.6 6.7 2.6 3.8 3.8 3 9 From 10 to 15 years | 5.3 1.6 jl3.3 1.4 2 1 2.5 2.3 I 6 1.9 2.9 2.7 2.2 2.5 1.6 1.7 2.0 1.8 1.9 2.0 1 8 2.3 2.2 2.5 2.8 1 9 2.1 2 3 £ 5 5 From 15 to 20 years 3.6 1.7 2 4 4 9 3.4 2.4 3.7 3.2 2.7 3.2 4.7 2 4 2.4 3.4 2.5 2 8 2.5 3.3 3.3 3.2 41 4.0 2.5 2.3 3 0 From 20 From 25 to to 25 30 years years ^20.2 17.1 28.9 5.7 8 3 5 5 7.3 13 1 12.7 6 5 8.0 5.4 8 2 jl0.7 9.1 9.3 13 8 9 3 10.3 4.1 5.2 4.1 4.6 6.6 7.9 5.6 6.1 5.3 6 0 6 9 6 8 5 5 5 6 5.9 5.8 4.6 5.5 |13.7 15.0 10 2 5.0 4.8 5.2 5 3 j 13.7 From 30 to 40 years.. • 16.2 15.6 13.4 14.0 13.7 17.2 15.0 13.3 10.0 8.9 10 3 12.8 14.3 11.0 9.7 12 6 12 4 12 2 11.8 12.2 10.0 10.3 10.6 13.5 11.5 10.3 10 7 12.4 Fiom 40 to 50 years 8.3 7.8 5 8 9.3 9.3 8.8 11 1 9 6 8 2 8.1 9.3 9.5 9 4 9 1 9.5 10.2 11 0 11.0 10.3 11.0 10.3 10 2 11.3 9.5 11.6 10.7 11 0 9.7 From 50 to 60 years 3.8 4 1 2.8 5.0 5.3 3.9 4.8 5 1 5.1 6.7 7.1 6.7 5 9 7.2 7.6 7.6 8.4 8 7 8.0 8 5 8.5 8.6 8 6 6.9 8.3 9.5 9.9 6.8 From 60 to 70 yaars 1.9 2.4 1 3 2 5 2.8 1.8 2.9 2 9 3.3 4.0 4.3 4 3 3.4 5 0 4.6 4.7 5.3 6.1 5.4 6.9 6.9 6.7 6.7 4.5 8 6 8 0 9 0 4 7 From 70 to 80 years ...... 1.0 1 2 .5 1.5 1.7 1.0 1.4 1.3 2.1 2.1 2.3 1.9 1.6 2.6 2.2 2.5 2.7 3.6 3.0 3.3 3 7 4.2 4 2 3.0 6 1 4.2 5.3 2 6 From 80 to 90 years .5 .3 1.1 .7 4 .7 .6 1 1 1.2 1.0 .7 .7 1.2 .8 .8 1.2 10 1.0 1.3 1.3 1.6 1.1 12 2.6 2 3 2 1 1.2 From 8C to 100 years .2 .2 1 4 .3 .1 .3 .3 .5 .4 .5 .3 .1 .4 5 .3 .3 .5 .5 .3 3 .4 £ '6 .4 .9 .7 j .3 100 years and upwards 1 .0 .0 .0 .1 1 .1 .0 2 2 2 .1 .1 .2 .3 .2 3 .3 .2 .3 .2 .4 .3 Unknown age ...... IT. 4 13.8 9.6 .4 8.0 17.9 11 1 7.4 7.1 3 6 11.0 9.0 7.0 5 3 3.6 3 4 3 3 3.0 2.7 .D l.l .6 4 .1 5 4 • VITAL AND MORTUARY STATISTICS OF NEW ORLEANS, LOUISIANA-1849 TO 1881. TABLE ILLUSTRATING THE RELATIVE MORTALITY IN THE DIFFERENT PERIODS OF LIFE, CONSOLIDATED FROM THE ORIGINAL RECORDS OF THE BOARD OF HEALTH, UNDER THE DIRECTION OF JOSEPH JONES, M. D. CCCXXIV Vital Statistics of New Orleans : Joseph Jones, M. D. VITAL AND MORTUARY STATISTICS OF NEW ORLEANS, 1881. MORTALITY FROM SOME OF THE PRINCIPAL ^DISEASES, CLASSIFIED ACCORDING- TO AGE AND COLOR, DURING THE YEAR^1881, CONSOLI- DATED FROM THE RECORDS OF THE BOARD OF HEALTH, UNDER THE DIRECTION OF JOSEPH JONES, M. D. DISEASES. Under 1 Year. 1 to 2 Years. 2 to 5 Years. 5 to 10 Years. 10 to 15 Years. 15 to 20 Years 20 to 30 Years. 30 to 40 Years. 40 to 50 Years. 50 to 60 Years. 60 to 70 Years. 70 to 80 Years. 80 to 90 Years. Above 90 Years Total of Colors. Total, both Colors. W. c. W, C. W. C. w. C W. C. W. c. W. C. W. C. W. 0. W. C. W. c. W. C. W C. W. C. W. C. Yellow Fever Malarial Fevers 19 5 IP 10 10 6 20 12 15 7 14 10 21 12 37 4 13 35 13 33 13 27 6 16 8 8 6 1 1 1 267 129 396 Scarlet Fever ........... 2 15 1 8 76 3 5 15 45 0 10 8 3 2 160 37 197 Tvphnid FV-vpr 1 4 2 o 0 6 10 4 4 5 3 1 45 21 66 Measles 2 2 3 1 1 21 26 Small-pox Diphtheria. ..... 1 1 1 1 1 3 2 15 5 196 IS 3 7 27 25 4 27 4 a 1 1 2 17 1-4 106 28 1 77 92 Diarrhoeal Diseases Congestion of the Brain 56 4 72 7 38 27 1 7 13 13 3 10 2 9 1 3 2 4 1 4 2 32 29 11 20 8 49 26 17 2 64 14 64 18 18 3 40 16 20 1 18 5 5 3 2 1 4 4 557 118 238 36 795 154 Consumption Pneumonia 2 31 2 37 1 17 2 13 2 H 1 5| 7 2 2 10 2 30 4 26 5 133 15 135 10 94 19 90 15 65 20 38 14 40 11 24 9 9 8 8 1 5 2 1 4 1 512 128 388 169 900 327 Bright's Diseases 1 1 1 4 1 4 14 6 11 10 14 10 13 7 2 4 1 1 1 69 45 114 Cancerous Diseases 1 1 3 8 18 12 27 14 19 8 9 4 3 42 1 127 2 u 5 1 31 32 Sunstroke ......... 1 1 8 10 1 6 o 1 28 5 33 Total 284 138 138 74 184 82 115 45 52 431 82 54 258 182 268 166 260 134 250 105 157 77 60 38 16 9 6 4 2131 1193 3264 Vital Statistics of New Orleans : Joseph Jones, M. D. CCCXXV It will be observed that in an average of twenty-seven years, 20 per cent of the deaths in New Orleans occur in infants under one year of age, and 13.7 per cent between one and five years, 3.9 per cent between five and ten years, and 5.5 per cent between ten and twenty years. Nearly one-half, or more exactly 43.1 per cent, of the deaths in New Or- leans occur between the period of birth and the age of twenty years. The relative mortality in New Orleans between twenty and forty years, and in the most vigorous and active period of life, is heavy (twenty to thirty years, 13.7 per cent; thirty to forty years, 12.4 per cent;, reaching 26.1 per cent of the entire mortality. Without doubt this large mortality, from twenty to forty years, is due to the influx of men in the prime of life, engaged in commercial and maritime pursuits, and the necessary exposure in this hot, moist climate. Yellow fever occasions a heavier mortality amongst men than women, and amongst men at that period of life, when their habits are most active, and their exposure to the vicissitudes of climate greatest. A just estimate of the progressive increase as well as the relative salu- brity of cities and countries might be based upon the number of marriages and births to the population. To reason upon such statistics, we must be assured of their accuracy. All the marriages and all the births should be recorded. In New Orleans, certain conditions exist, which render the statistics re- lating to the record of births and marriages valueless for purposes of scien- tific deduction, as the rate of increase or decrease of the population of New Orleans: 1. The Act of 1877, which transferred the duty of registering mar- riages and births to the Board of Health, is defective in that it inflicts no fine for failure; and provides no mode in which parties failing to report either marriages or births, shall be punished. 2. A large proportion of the population of New Orleans, is composed of colored people in the proportion, according to the United States census of 1880, of 57,748 colored to 158,395 white. It is not to be supposed that a race so recently emancipated from slavery, should appreciate the great ad- vantages afforded by the legal record in the public archives of marriages and births. 3. We have shown that over one third of the deaths recorded in New Orleans for 1881. either occurred in charitable institutions, or were certi- fied to by the coroner. If one-third of the inhabitants of New Orleans are too poor to provide either the means of medical attendance or proper shel- ter and food during sickness, it is not to be supposed that they should possess either the means or the intelligence to record marriages and deaths. 4. The legitimacy of a birth does not depend upon its public registration. 5. The legality of a marriage does not depend, in the United States of America, upon its mere registration in the public archives. The following statistics embrace the total number of births and marriages recorded at the office of the Board of Health of the State of Louisiana, during the year 1881: CCCXXVI Vital Statistics of New Orleans : Joseph Jones, M. D VITAL STATISTICS OF NEW ORLEANS, 1881-MARRIAGES AND BIRTHS BY MONTHS. CLAS- SIFIED ACCORDING TO COLOR AND NATIVITY IN NEW ORLEANS. DURING THE YEAB 1881. CONSOLIDATED FROM THE ORIGINAL RECORDS OF THE BOARD OF HEALTH UNDER THE DIRECTION OF JOSEPH JONES. M. D. Total 1? 1 - October November September Auffust 5^ > •T annary February ... March MONTH. 1070 115 98 82 74 68 87 59 80 95 89 101 122 Both whites. 39 34 18 15 11 17 9 H 26 21 Both colored. 9501 I Husband alone white. Husband alone colored. 114 106 78 69 61 85 54 74 84 88 100 113 Both United 1 States.; Ci b3 10 21 11 12 13 13 11 12 17 7 14 21 Both foreign. | 44 1 61 Husband alone United States, Husband alone foreign i I 1292 145 132 100 89 79 104 68 92 112 102 1 127 143 Total. VITAL STATISTICS OF NEW ORLEARNS. 1881-BIRTHS BY MONTHS. CLASSIFIED ACCORD ING TO COLOR. SEX AND NATIVITY OF PARENTS. IN NEW OBLEAS, DURING 1881. Color. Sex. Nativity of Parents. MONTH lutes, lored. des. males. th United States. th foreign ther alone Native. ther alone Foreign, tai births by months Lj 5 3 £ Be 1 Fa Fa To January 246 37 135 148 158 64 15 46 283 February 257 40 172 125 172 69 It 45 297 M arch 264 41 454 151 201 54 12 38 305 Ap ril 203 51 142 112 153 57 11 33 254 May 196 21 118 99 125 41 5 46 217 June 173 18 93 98 93 59 8 31 191 July .. . 232 32 117 147 133 52 14 65 264 August 225 26 125 126 157 39 3 52 251 September.... 193 26 101 118 123 53 8 35 219 October 158 18 87 89 103 41 12 21 176 November 193 20 107 106 109 38 17 49 213 December 137 27 77 87 84 41 7 32 164 - Total - 2477 357 1428 1406 1610 608 123 | 493 2834 It will be observed that only 129? marriages were recorded in 1881, of which 1070 were white and 223 colored ; during the same period. 2834 births, of which 2477 were w hite, and only 357 colored. The white children recorded were eight times as numerous as the colored ; although the popu- lation is in the ratio of about three whites to one colored. In 1880, the records were very similar in the general results to those of 1881: thus, the marriages recorded, whites 1040, colored 249; total 1298; births, whites 2442; colored 196; total 2738. According to the statistics the births in New Orleans in 1881 and 1880, did not equal one-half the mortality. Such results are evidently only partial and incapable of furnishing data for careful calculation, as to the rate of increase of New Orleans, by the inherent energies and multiplica- tion by birth of the inhabitants. How shall full accurate statistics of the birthsand marriages be at- tained I The law is defective, and although on the one hand the great advantages of a correct registration of births and marriages is appreciated by the in CCCXXVII Preventable Causes of Disease: Joseph Jones, M. D. telligent and virtuous citizens, and although as President of the Board of Health, I have endeavored toperfeet the registration, by using the sanitary police as mediumsof information, and by circulars to physicians, midwives, clergymen and recorders ; at the same time the results have not been satis- factory. The mere appendage of penalties to the law. as it stands, would not secure a full registration of marriages and births amongst the poor and ignorant; and the difficulty would be solved by an annual sanitary census of the entire population. The Board of Health is without the necessary funds for such an undertaking. PREVENTABLE CAUSES, OF DISEASE AND DEATH. INTRA- MURAL SEPULCHRE IN NEW ORLEANS, EFFECTS OF THE MODE AND PLACE OF BURIAL UPON THE HEALTH OF THE INHABITANTS, RESULTS OF INSPECTION OF THE VARIOUS CEMETERIES OF NEW ORLEANS. STATISTICS OF BURIALS IN THE CEMETERIES OF NEW ORLEANS. POISON SUICIDE, VIOLENCE, MURDER, ACCIDENTS, DROWNING, STARVATION, INTEMPERANCE, DELIRIUMTREMENS, MANIA A POTU, INSANITY, NUMBER OF CASES OF POI- SONING ACCIDENTAL OR INTENTIONAL IN NEW ORLEANS. INTRA-MURAL SEPULCHRE IN NEW ORLEANS, EFFECTS OF THE MODE AND PLACE OF BURIAL OF THE DEAD UPON THE HEALTH OF THE INHAB1 TANTS. The subject of the effects of Intra-Mural sepulchre, is of the greatest importance to the health and welfare of the citizens of New Orleans, not only from the deleterious effects of the products of purification in all places, under all circumstances, but more especially from the peculiar topo- graphical situation, the great commercial importance, and the warm, moist climate of the delta of the Mississippi. In order to obtain data for intelligent action upon this important subject by the General Assembly of Louisiana, and the Common Council of New Orleans, the President of the Board of Health, instituted a careful inspection of all cemeteries within the limits of the Parish of Orleans. The following public and private cemeteries and burial grounds are located on the east bank of the Mississippi river, within the parish of Orleans. IN NEW ORLEANS, LOUISIANA, PUBLIC AND PRIVATE CEMETERIES AND BURIAL GROUNDS. St. Louis No 1. Second District, bounded by North Basin, North Liberty, Conti and St. Louis streets, St. Louis No. 2, Second District, bounded by Customhouse, St. i.ouis, Claiborne and Robertson, St. Louis No. 3, Second District, bounded by North Basin, St. Louis, Conti and North Liberty. One square called American Cemetery. Lafayette No. 1, Fourth District, bounded by Washington, Prytania, Coliseum and Sixth. One square. Lafayette No. 2, Fourth District, bounded by Washington, South Basin, St. Denis and Sixth. One square ' valence Street Cemetery, Sixth District, bounded by Valence. Bordeaux, Rampart and Dryades. One square. Carrollton Cemetery, Seventh District, bounded by Adams, Lower Line and Seventh and Eighth streets. Four squares. CCCXXVIII 1 Preventable Causes of Disease : Joseph Jones, M. D. St. Joseph, Fourth District, bounded by Washington, St. David, South Liberty and Sixth. Two squares. St. Vincent, Sixtli District, bounded by St. David, Green and St. Patricks Three squares. Locust Grove Cemeteries Nos. 1 and 2, Fourth District, bounded by Locust, Freret and Sixth and Seventh streets. St. Vincent de Paul, Third District, bounded by* Louisa, Piety, Urquhart and Villere. One square. Girod Cemetery, First District, bounded by South Liberty, Periliiat, Cypress and Magnolia streets ; 250 leet wide and -100 feet deep. Holt's Cemetery, live to six acres, First District. Hebrew Cemetery, First District, bounded by Elysian Fields and Gentilly road ; one square. Hebrew Cemetery, called Dispersed of Israel;First District, on Canal street, between Anthony and Matairie Ridge, 250 feet square. Polish Hebrew, called also Jewish Rest; First District, on Canal street, opposite Dispersed of Israel. Hebrew, called Hebrew Place of prayer ; Sixth District, on Joseph street. German Lutheran, Sixth District on Canal, between Anthony and Bernadotte street, one square and four lots for burial rest. Odd Fellows, corner Canal and Metairie streets, 360 feet square. Charity Hospital No. 1, on Canal, between Anthony and Metiarie streets; 200 feet wide 1600 feet square exclusive for Hospital. Charity Hospital No. 2, Metairie Road, between Bienville and Canal streets, one square. Masonic, on Bienville, between Metairie and Anthony streets, three squares. St. Patricks No. 1, on Canal, between Anthony and Metairie streets, 400 feet wide and 1500 feet long. St. Patricks No 2, on Canal, between Anthony and Metairie streets, opposite No. 1. St. Patricks No. 3, on Metairie, between Canal and Bienville streets, two squares, opens from St. Patrick No. 2. Fireman's, Metairie Ridge and Canal street. Cypress Grove, Metairie Ridge and Canal street. Greewood Nos. 1 and 2, Metairie Ridge and New Canal. Chalmette National, one mile below Barracks on river, 108 acres for burial of Union Soldiers. Olivier, Sixth District, corner of Verrett and Market. St. Bartholemew Cemetery, Fifth District, De Armas and Lapeyrouse. William Tell, Franklin and Hancock, Gretna, Tenth street, between Laroesier and Noveta. The Hebrew Cemetary belonging to the Hebrew Association, opened in 1828, was closed in 1860. It is evident from the preceding table that there are thirty-five ceme- teries and burial grounds in New Orleans, many of which,'as St. Louis Nos. 1, 2 and 3, Lafayette, Nos. 1 and 2, St. Vincent de Paul and Girod Cemetery, are situated in the heart of populous districts. The removal, or rather establishment of a large number of cemeteries, as the Fireman's, Cypress Grove, Greenwood, Odd Fellows, Masonic, St. Patricks Nos. 1, 2 and 3, Metairie Ridge Cemetery, beyond the bounds of the thickly populated portion of the city has without doubt diminished the diseases referrable to the emanations from the putrefying corpses of the dead. Owing to the saturation of the soil of New Orleans and its environs with water, and the rapidity with which excavations fill with water, the custom was early introduced of interring bodies in brick or stone tombs constructed upon ground. At the present time, with the exception of the destitute burials at the public expense, only Israelites are buried under ground. Graves are dug from three to four feet deep, except at the cemeteries on Metairie Ridge, where, the ground being higher than in the other parts of the cemetery, it is possible to dig to a depth of seven feet. All other interments are made in vaults of brick stone or iron, which are built on the surface of the ground, the bodies after being introduced into the vaults are walled in by brick or mortar. There is no means of escape for the foul gasses arising from the decom position of the corpses, except through the pores of the brick and mortar. Gf course, whenever a vault, or a division of a vault, is opened, before putrefaction is completed, there is an immediate escape of noxious gases. Girod Street Protestant Cemetery, fronts on South Liberty, between Periliiat and Cy- press streets, and in the rear by the eity Work House, 600 feet in length by 260 feet in width, Sexton Mr. Peter Barr, since 1865. There are no records to show when the cemetary was started. The oldest tomb dates from 1817. Number of vaults and tombs : 5736 vaults and 1099 tombs. Drainage good. Drains into the street gutters. Sanitary condition good. The vaults and tombs are in general good condition, the walls are good, having been repaired two years ago. There have not been any interments in the ground since April 1835, being prohibited by law. MODE OF BURIAL. Preventable Causes of Disease: Joseph Jones, M. D. CCCXXIX St. Patricks Cemeteries are located, No. 1 in the First District, No. 2 in the Second Dis- trict, No. 3 in the Second District. St. Patricks' No. 1, is very much crowded and it is almost impossible to dig a new grave without coming in contact with an old grave. Sexton J. H. Healy. When opened : no records previous to September 1841. Number of vaults and tombs : 269 vaults and 163 tombs. Drainage fair, sanitary condition good. Total in- terments 31,375 ; died of yellow fever 4253, of small-pox 186, of cholera 1214, making a total of 5653. Cypress Grove No. 1 and 2, are located, No. 1, bounded by Canal street, Metairie Road and Charity Hospital cemeteries; No. 2 adjoins No. 1. Sexton J. B. Faget. When opened • Cypres Grove No. 1, no records previous to July 1841, No. 2, no records previous to June 1846. Cypress Grove No. 1, number intered in vaults and tombs 5591, in the ground 3783, total 9374. Whites 9327, colored 47. Deaths from yellow fever 820, small-pox 144, cholera 348, making a total of 1312. Cypress Grove No. 2, total interments, 34,412. Deaths from yellow fever, 5308; small-pox, 700; cholera, 2466; total, 8474. Drainage good sanitary condition good . Washington Cemeteries-The preceding table comprises five cemeteries, viz : Lafa- yette Nos. 1 and 2. Locust Grove, Valence and Carrollton, as near as the records show that the Carrollton interments were included from the year that Carrollton was annexed (1874) to New Orleans, up to January 1, 1883, Valence Cemetery, from 1874 to January 1, 1884, Locust Grove Cemetery from 1865 to 1879, when it was closed, Lafayette No. 2, from 1840 to 1884. Lafayette No. 1, the records of the cemetery previous to 1843 were destroyed, the oldest record is a receipt dated 1829. Lafayette No. 1-Located on Washington street, between Coliseum and Prytania, and bounded in the rear by Sixth street. Size 300 feet square, opened about the year 1829, contains 1778 lots and about 600 vaults. Drainage good, sanitary condition good, with the exception that the walls of the vaults fronting on Washington street are cracked ; these cracks must be refilled with cement each year. Lafayette No. 2, located on Washington street and bounded by St. Patrick street, St. David and Sixth streets, size 295 by 348 feet long, opened in 1840, contains 480 lots and 220 vaults. Drainage and sanitary condition good, tombs and walls in better condition than those of Lafayette No. 1. Valence Cemetery, located on Valence street, bounded by St. Denis, St. Patrick and Bordeaux streets, opened in 1872, size 300 feet square, contains 800 lots. Drainage and sanitary condition good. Total interments Washington Cemeteries, 44,366. Sextons: B. S. Quinman, from 1832 to 1844, H. G. Hicks, from 1844to 1861, Philip Harty 1861, Olivier Rice, 1862, D. F. Simpson, from 1862 to 1865, Jas. Hogan, 1865 to 1867, J. F. Callico, 1867 to 1869, Jim Tracey, 1869 to 1871, J. F. Callico, 1871 to 1874, Cornelins Dono- van, 1874 to 1876, Denis Irvin, 1876 to 1878, P. Gallagher, 1878 to 1879, J. F. Birchmier, 1879 to date. Charity Hospital cemeteries, Nos 1 and 2. Location-Charity Hospital Cemetery No. 1, bounded by St. Patrick's Cemetery No. 1, and Cypress Grove Cemetery No. 1, and fronts on Canal street. Charity Hospital Cemetery No. 2, bounded by St. Patrick's Cemetery No. 3 and Metairie road. Interments in Charity Hospital cemeteries com- menced May, 1850; previous to this date interments from Charity Hospital were made in Cypress Grove No. 2. Interments in Charity Hospital Cemetery No. 1 commenced May, 1850, and ended January, 1872. Interments in Charity Hospital Cemetery No. 2 com- menced January, 1872, and continue to date. Sexton, Charles Rolling. Interments, Charity Hospital No. 1, from May, 1850, to January, 1872: Whites, 21,418; colored, 1104; total, 22,522. Charity Hospital, No. 2, January, 1872, to date, interments, 6864; whites, 4128; colored, 2736. Grand total, 29,386. Total interments from yellow fever, 6939; small pox, 15; cholera, 1572; total, 8526. St. Vincent de Paul, Nos. 1 and 2, No. 1 bounded by Louisa, Villere, Piety, and Ur- quhart streets, No. 2 bounded by Villere, Piety, Desire, and Urquhart streets, No. 3 bounded by Louisa, Robertson, St. John Baptist, and Piety streets. These cemeteries were opened in 1840, but all records previsus to 1851 have been destroyed. Sexton, V. Suarez, 1851. Contains-No. 1, 1501 vaults, 211 tombs; No. 2, 1580 vaults. Total inter- ments: Whites, 26,053; colored, 6879; total, 33,832. Total interments from yellow fever, 3263; smallpox. 1127; cholera, 1261; total, 5651. St. Joseph's No. 1, located on Washington street, bounded by St. David, Liberty and Sixth streets, opened in 1855, size 300 by 250 feet, and contains 522 lots and 422 vaults. Drainage and sanitary condition good. St. Joseph's Cemetery No. 2, located on Sixth street, and bounded by St. David, Liber- ty and Seventh streets; same size as No. 1, contains 2 tombs, no vaults and 522 lots. Drainage and sanitary condition good ; Sexton : Wm. Maura, for both cemeteries ; total interments 14,912, died of yellow fever 1088, small-pox 191, cholera 105. Association Tememie Derich Cemetery, located on Canal street, opened in 1858; all in- terments in the ground ; total interments, white 378, died of yellow fever 69, small-pox 6, cholera 10, total 85. CCCXXX Preventable Causes of Disease : Joseph Jones, M. D. St. Loais Cemetery No. 1, bounded by St. Louis, Basin, Treme and Conti streets. Sextou, M. Rodrigue, records nrevious to 1855 has been lost, number vaults, 352 ; num- ber tombs, 836. Total interments, white, 6128; colored, 2950 ; total, 9078. Died of yellow fever, 388; small pox, 159; cholera, 121; total, 668. St. Louis Cemetery No. 2, (comprises three blocks) (a) bounded by St. Louis, Conti, Robertson and Claiborne streets, (b) bounded by Bienville, Conti, Claiborne and Robertson streets, (c} bounded by Bienville, Customhouse, Claiborne and Robertson streets. St. Louis Cemetery No. 2, opened about 1825 ; no records previous to 1843. Records from September 1, 1847, to January 1, 1865, were stolen, records from January 1, 1861, to February 28, 1869, lost or destroyed. Sexton, J, F. Calico, since 1881. Drain- age and sanitary condition, good. Number of tombs, 1794 ; number of vaults, 2347 ; total number of interments, 13,768. Died of yellow fever, 298; small-pox, 612; cholera, 248; total, 1158. New St. Louis Cemetery, or Potter's Field, bounded by Esplanade and Jockey Club Park, opened June, 1856. Sextou, Hypolite Bienvenue; number of tombs and vaults, 637; total number of interments in vaults and tombs, 634 ; in the ground, 8760; total, 9,394. Died of yellow fever, 656; small-pox, 199; cholera, 112; total, 967. Drainage and sanitary condition good. Greenwood Cemetery. Records from 1855 to date: Sexton, Daniel Merritt; drainage and sanitary condition good. Interments in tombs and vaults, 2190; graves, 4042 ; total, 6232. Died of yellow fever, 419; small-pox, 133; cholera, 42; total, 6826. Grand Lodge Masonic Cemetery, bounded by Bienville, Metairie, Anthony and Conti streets. Opened in 1867. Sextons, J. L. Lippe from 1867 to 1876, William Tell, from 1876 to date. Sanitary condition and drainage good. This location is very high, it is necessary to dig eight (8) feet before striking water. Number of vaults forty-eight, number of graves fifty ; total interments, 509 ; died of yellow fever, sixty- two ; died of small-pox, six; died of cholera, one. Odd Fellows Rest Cemetery, bounded by Canal, Matairie and St. Patricks Cemetery No. 2, opened in 1849, Sextons, D. Merritt, 1849 to 1868, D. Quin, 1868 to 1870, F. A. Bradley, 1870 to 1881. E. Barrett, 1881 to date, size 237 feet long by 340 feet wide. Drain- age and sanitary condition good ; number of vaults 640, tombs 44, graves 26, total num- ber interments 2563, died of yellow fever 236, small-pox 27, cholera 59. Congregation Dispersed of Judah Cemetery, bounded by Canal, St. Helena, Custom- house and Antonia streets, opened in 1846, size 180 feet front on Canal street, Sexton, Adam Eisenhauer. Drainage and sanitary condition good ; total number of interments all in the ground, 518 all whites. Diseases not stated. First German Evangelical Lutheran Cemetery of St. John's Church, bounded by Canal, Customhouse, Anthony, and Bernadotte streets, opened September, 1867. Sex- ton, Otto Burandt. Drainage and sanitary condition good; number of tombs, 8. Total interments, 171. Died of yellow fever, 11; smallpox, 1; cholera, none. Cemetery of the Congregation Gates of Prayer, Joseph street, Sixth district, opened in 1850. Records previous to 1867 were destroyed by fire. Sexton, L. Rosenbaum, Drainage and sanitary condition good; all interments in the ground. Total interments previous to 1867, ; total interments since 1867, 169; died of yellow fever, 18; small- pox, 4; cholera, 2. Cemetery Waters of Israel. Cemetery records from 1865: Sexton, H. Bonart. Drain- age and sanitary condition good. All interments in graves. Total interments, 33; died of yellow fever, 10; small-pox, 1; cholera, none. Hebrews' Rest Association Cemetery. The cemetery of this name, located on Jackson street, was opened in 1828 and closed in 1866. Hebrews Rest was then removed to Elys- ian Fields street. Records from 1866 to date are complete. Drainage and sanitary con- dition good. All interments in graves. Total interments, 917. Died of yellow fever. 118; small-pox, 5 ; cholera, 14. Metiairie Cemetery. Sexton, Win. H. Benson, cemetery opened in 1874. Drainage and sanitary condition good. Total interments, 603 ; died of yellow fever, 32 ; small-pox, none; cholera, none. Holts Cemetery opened May 1879. Drainage and sanitary condition good. Interments, white, 407; colored, 1617; total interments ^all grave), 2054 ; Died of yellow fever, none; small-pox, 422 ; cholera, 2. Of those intered as died from small-pox in 1883. 127 died at Luzenburg Hospital, seventy-one died at Beard's City Hospital, 111 died at their resi- dences, total 309 cases in 1883. Campo Santo Cemetery. Located on Washington Avenue between Prosper and SallidelI streets, Third District. Sexton, Father Trevis. This cemetery opened July 1, 1875. Drainage and sanitary condition good. Interments, whites 843, colored 1341, total 2331; died of yellow7 fever, fifty; died of small-pox, 124 ; died of cholera, none. Firemen's Cemetery (Algiers), right bank of the Mississippi River. Located in Algiers. Sexton, J Peterson. This cemetery opened in the latter part of 1878. The drainage and sanitary conditions are good. Interments, all white, sixty-seven ; died of yellow fever one, died of small-pox ten, died of cholera none , total eleven. Preventable Causes of Disease: Joseph Jones, M. D. CCCXXXI St. Bartholomew's, Catholic Cemetery, Algiers, right bank of Mississippi River. Sex- ton, Father Brady. Opened 1857. Drainage and Sanitary condition good. Total inter- ments, 2129. Sex, color, and diseasesnot stated. G.ctna Fireman's Cemetery, Gretna, parish of Jefferson, right bank of Mississippi River, opened 1866. Drainage and sanitary condition good. Total interments (all whites), 455. In 1878 there were 29 interments from yellow fever. This was the only year in which a record of diseases was kept. Great Samaritan Colored Society Cemetery ; located in Gretna, parish of Jefferson. Sexton, James Sparks. Cemetery opened in 1871. Drainage and sanitary condition good. Total interments, 50, all colored. Died of yellow fever, none ; small-pox, 9 ; cholera, none. Union Benevolent Colored Cemetery. Location, Gretna. Sexton, C. F. Brown. Cemetery opened in 1867. All records previous to 1874 are lost Drainage and sanitary condition good. Total interments (all colored), 45. No record of diseases. U. S. Government Camp Chalmette National Cemetery. Locatad on left bank of Mississippi river, Parish of St. Bernard. Drainage and sanitary condition good. Total interments, 12,461. Known, 6,844 ; unknown, 5617. No records of diseases, except that in 1878 there were 18 interments from yellow fever. The records of this cemetery extend from 1866 to 1884. In the execution of the inspection of the cemeteries of New Orleans, valuable service was rendered by the intelligent and faithful sanitary officers, Emanuel Bohner and Loring D. Allen, who acted immediately under the direction and supervision of the President of the Board of Health. CCCXXXII Preventable Causes of Dieease: Joseph Jones, M. D. INTERMENTS IN THE VARIOUS CEMETERIES OF NEW ORLEANS BY YEARS- TOTAL DEATHS AND DEATHS FROM CONTAGIOUS AND INFECTIOUS DIS- EASES, ACCORDING TO RECORDS. YEAR. Total Deaths. MaAOJ A\O[[3^ mojj sqijuaQ Deaths from Small-pox. Deaths from Cholera. Total Deaths from Contagi- ous and 1 fec-| tious Diseases. 1833.... 1834 ... 1835.... 1H16... 1837 1838 1839.... 90 1354 400 174 397 148 269 ; ... - - - . ...... ...... 2 103 .... 2 103 1840. 1841 182 485 1 141 o 1 143 1842.... ..... 360 23 3 26 1843 1844 1845.... 1846 .... 1254 1480 1506 2800 185 24 127 5 1 190 24 128 1847..... 5910 1858 3 1866 1848 4080 594 29 604 1227 1849 - - - 6475 620 55 2136 2811 1850 .... 5447 45 22 862 929 1851 5949 12 36 504 552 1852 ..... . .. 7160 411 35 957 1403 1853 . 12955 8037 38 469 8544 1854 . . . 9627 2419 21 979 3419 1855 8920 2412 56 1225 3693 1856 5036 76 1 34 111 1857. .. 5026 196 67 17 280 1858..... 10875 4646 68 12 4726 1859 6087 96 27 9 132 1860 7171 11 18 29 1861 . 5158 1 1 2 4 1862... . 1863 .. 5884 7259 1 1 3 3 4 1864.. 8011 6 512 42 560 1865 ... 7179 1 543 4 548 1866.... * 8417 216 182 1287 1685 1867- . - - . ...... 10363 3040 47 563 3650 1868 4798 6 9 100 115 1869.... - . - 6075 2 129 3 134 1870... .... . . 7281 574 498 13 1085 1871 5909 39 5 7 51 1872 6526 27 25 5 1873 7727 187 459 124 770 1874 6959 13 499 4 516 1875... 6527 51 313 5 369 1876 ... ...... . . . ... 6690 41 202 6 249 1877... 7122 1 1036 5 1042 1878.,.. 10635 3945 135 4 4084 1879. .. 1880 . 5407 5904 15 1 1 6 5 21 7 1881.... 6819 4 7 11 1882... 6174 3 386 2 391 1883.... 6208 1 931 932 Grand total 272649 31207 6406 10009 47622 The above recapitulation does not include the U. S. Government Cemetery, or the cemeteries on the right bank of the Mississippi, as their records are very imperfect. Preventable Causes of Disease: : Joseph Jones, M. D. CCCXXXIII The city of New Orleans embraces a vast extent of territory, extending from the slaughter house to the upper line of Carrollton, taking in Algiers on the right bank, reaching to Rigolets and connecting Lake Pontchartrain with Lake Borgne ; but the more densely populated portions lie along the course of the Mississippi river ; there is, therefore, ample room for the removal of the dead out of the inhabited portions of the city. It is important to note that there has been for many years, a progressive removal of the grave yards beyond the crowded limits of the city, to the Metairie Ridge; so that at the present time only nineteen cemeteries may be regarded as strictly intra-mural, viz : First District, one grave yard, American, on Basin street, near Girod; Second District, four grave yards, St. Louis No. 1, Basin, between Conti and St. Louis streets, St. Louis Nos. 2, 3 and 4, Claiborne, from Customhouse to St. Louis streets ; Third District, four grave yards, New St. Louis, Esplanade, near Bayou St. John. Hebrew. Gentilly Road, St. Vincent de Paul, Louisa and Urquhart, Campo Santo, Urquhart, near Girod street; Fourth District, Lafayette No. 1, Washington, near Prytania street, Lafayette No. 2, Washington and St. Patrick streets, St. Joseph No. 1, Washington, near St. Patrick streets, St, Joseph No. 2, Sixth, near St. Patrick street; Fifth District, two grave yards, St. Bartholemew, Algiers, Hughes, Algiers; Sixth District, two grave yards, Valence, Valence street, "St. Vincents," St. Denis street ; Seventh District, two grave yards. Catholic, Carrollton, City, Carrollton. The remainder of the cemeteries, including Holt. Metairie. Odd Fellows, Masonic, Lu- theran, Cypress Grove, Greenwood, Potter's Field, Hebrew and St. Patrick's, are situated at a considerable distance from the city proper, and are not strictly intra-mural. Without doubt the General Assembly of Louisiana should give the most careful con- sideration to the subject of intra-mural sepulture, and should frame such laws as would effectually close the cemeteries in the populous portions of New Orleans and confine the burials to localities removed ^s far as possible from the thickly populated portions. The question as to the influence of intra-mural sepulture upon the health of the citizens of New Orleans has never been fully or satisfactorily investigated, and unfor- tunately the medical history of the city is sadly deficient in past times in the monthly and yearly observations upon the relations of the soil, climate, commerce and epidemics npon the public health. A thorough investigation of the subject of the deleterious effects of cemeteries upon human beings, should embrace the following inquiries. 1. Mode of burial. 2. Number of burials. 3. Nature of diseases causing deaths. 4. When burials take place in the ground, the nature of the soil and the character, depth and origin, and periodic changes of the sub-soil water. 5. The effects of the different seasons, and of the degrees of heat and moisture upon the nature and rate of the purtrefactive process. 6. Chemical and physical properties of the gases exhaled. 7. The nature of the organisms developed during the putrefaction of the dead bodies. 8. The effects of the products of putrefaction in general upon the nature and com- position of the surrounding atmosphere. 9. Effects of the putrefaction of the bodies of those who have died of infectious and con- tagious diseases, as small-pox, scarlet fever, measles, asiatic, cholera and yellow fever. 10. To what distances can the deleterious gases and organized bodies developed during putrefaction penetrate to the detriment of living human beings? 11. In what manner is this deleterious product of putrefaction chiefly desseminated ? by diffusion and multiplication in the soil qnd subsoil waters? by progessive serial dif- fusion from the foci of infection in all directions, laterally as well as upwards ? by volitization upwards, in the atmosphere there by condensation in combination with water, at night or during the period of rain, forg or mist, thus contaminating our drinking water. HISTORICAL. After a careful examination of the mortuary nnd historical records of New Orleans, the earliest reference to the injurious effects of intra-mural sepulture was found in the manuscript records of the Old Cathedral, and relate to the year 1788. During a period of seventy years after the foundation of New Orleans, we have ho re- liable data by which to form an opinion of the effects of the mode and place of burial upon the health of the inhabitants. The great fire of 1788, which broke out on Good Friday in the month of March, in a chapel of a Spaniard on Chartres street, about three o'clock in the afternoon, and which being fanned by a high wind, desrroyed nine hundred houses before it was extinguished, was followed by pestilence. Through the courtesy of Mr. T. O. de Jaham, custodian of the records of the Cathe- dral, I have been furnished with the following extracts from the manuscript volumes. CCCXXXIV Preventable Causes of Disease: Joseph Jones, M. D. " I, brother Antonio de Sedella, Capuchin priest of the very holy Church Cathedral of the City of New Orleans, certify on the faith that I have : That because of the epi- demic that the inhabitants of the city and neighbourhood suffered after the great nre which took place the 21st of March of tiie year 1788, the governor of these colonies, who was then Don Esteban Miro, after consulting those empowered, and with the consent of the Administration (Agustamiento), gave the power to remove the cemetery or Holy Grounds in the rear of the Charity Hospital, farther than the other from that city, to which I consented because of the reasons that they gave me. and which related to the public health. I also certify that it was then said to me, and I never heard anybody say, that they intended taking from this church the ancient right of property and pos- session that they had, and have, on those grounds; and I also certify that in the above great fire perished, several books, and many parcels of documents concerning the same church, from its foundation or establishment; and to make this legal I, with superior orders, have giveu this in New Orleans, 9th of April, 1801. "(Signed), Fr. Antonio dk Sedf.lla." . " Your Highness,-The cemetery of this city is situated in the centre of the last block, which I have thought a long time since prejudicial to the public health, which was really shown this year, everybody having been sick in the colony, with putrid and deadly fevers, and specially dysentery, so that a large number of people died. I have myself experienced that loathsome smell emitted by t he cemetery." The remainder of this paper consists of a prayer to have the cemetery removed. The paper is in the handwriting of Father de Sedella. The petition was accompanied by the following plan, illustrating the position of the old cemetery. Preventable Causes of Disease : Joseph Jones, M. D. CCCXXXV CHARITY HOSPITAL. Toulouse -Street. Saint Peter Street. Old Cemetery of 90,000 Spanish square feet. Burgundy Street. Scale of 300 feet base, "Your Highness: The cemetery of this city is situated in the center of the last block, and has always been prejudicial to the public health. The deleterious effects of this cemetery has been visibly felt this year, which has been very unhealthy, for all the Province in general suffered from putrid and deadly fevers, and especially dysentery. Many people have died. Whilst passing the cemetery, having myself perceived a foetid smell, I sought information from the neighbors, and they affirmed that these foul odors have been very often perceived this year. Their complaints I have referred to the Cabildo, which I enclose under Nos. 1 and 2, with certificates from doctors and surgeons (Nos. 3 and 4), and my own observations (No. 5). The consequence is that we are look- ing for another burial ground, out of the city, where the dead will produce no deleteri- ous effects, and the corpses will begin to be buried three inside of eight days." This arrangement meets with the approbation of the people, and will consequently be agreeable to His Majesty. We pray your Excellency to authorize the City Administration (Cabildo) to provide bricks so that the new cemetery be permanent, and the old one be condemned, the bones in it to be removed to the new one, so that in about two years houses will be built where it now stands. The old cemetery comprehends twelve lots, of 70 feet front, 120 CCCXXXVI Preventable Causes of Disease : Joseph Jones, M. D. feet deep, which his Majesty might give away to citizens on condition to contribute to the City Treasury six dollars annually. So God help your Excellency many years. New Orleans, 12th November 1788." This is a copy, not signed, but the hahdwriting appears to be that of the Bishop's Sec- retary. The circumstances which caused the parish government to remove the cemetery grounds on three different occasions were probably the same as those which occasioned the removal on the 17th and 24th of October, 1788; said removal having been proposed in the spring, the number of corpses buried there being already so large that there was no more space to bury the dead. On opening the new graves underground, bodies were found, which occasioned the emission of foul smells, destructive to the health of the city, and more especially after the epidemic which the people suffered that summer, and were then suffering. These facts illustrate in the strongest manner the necessity of abolishing so danger- ous a proceeding, and at the same time of establishing a cemetery in another locality re- mote from the city." t The preceding extracts from the Spanish were translated by Mr. Carrouche, No. 39 Char- tres street. The preceding records are of great interest, not only in establishing the proposition that yellow fever and pestilential fevers have desolated New Orleans in past times be- fore the epidemic of 1796, which many writers have regarded as the first appearance of this disease in New Orleans, but also as affording incontestable proof that the custom of burying the dead within the limits of the city was prejudicial to the health of the citizens. Doctor M. Michel Halphen, in his " Memoire Sur Le Cholera-Morbus Complique d'une Epidemic de Fievre Janne qne, a Regn£ Bimultanement a la Nouvelle Orleans en 1832," (Paris, 1833), gives a dreadful description of the filthy condition of the city of New Orleans, and of the terrible ravages of the Asiatic cholera. In 1832 New Orleans received the cholera from St. Louis, by the arrival of the steam- boat Constitution on the 24th of October. With the accustomed ignorance, indifference and incompetence of the civil authorities of New Orleans, the cholera found this city in a filthy condition; gutters reeking in filth, the streets quagmires of mud and filth, the houses built upon low, ill-drained sites, the privies overflowing with urine and excrement; the drainage canals choked; the cemetery located in the heart of the city, badly constructed, badly drained, and crowded with corpses. The ignorant and credulous people seized with avidity upon petitions of every descrip- tion. The Mayor and Common Council resorted to such means as burning tar and the firing of cannon to disinfect the disease. Neverin any country had pestilence been more swift or fatal, and out of a population of 35,000, 6,000, or more than one-sixth perished in less than twenty days. The air was polluted by the unburied and putrifying corpses, which accumulated in piles in the cemeteries across the streets. Trenches could not be dug with sufficient rapidity to secure the putrifying and moulding corpses, and frequently putrid corpses were exposed in digging the graves. The stagnant water became con- taminated, and the ditches and gutters were reeking with the foul putrid drainings from the grave yard. PREVENTABLE CAUSES OF DISEASES AND DEATHS. POISON, SUICIDE, VIOLENCE, MURDER, ACCIDENTS, DROWNING, STARVA TION, INTEMPERANCE, DELIRIUM TREMENS, MANIA A POTU, INSANITY. A large portion of the annual report of the President of the Board of Health for 1880 was devoted to the consideration of those causes of dis- eases and deaths in Louisiana, and more especially in and around New Orleans, which, to a great extent, were under the control of human agency, and which might be to a large degree prevented, or diminished and controlled. In this connection, and with a view to arouse public interest and to lead to the institution of effective measures, such sanitary works and reforms were strenuously advocated as: protection from overflow, drainage, sewer- age, the abandonment of rice culture within and around the city. The great sanitary problems of New Orleans were held to be- TABLE G-_ Mortuary Statistics of New Orleans, Louisiana, United States of A. » ?rici, Illa^ratia* tlia Mortality by Months in the White and Black Baces, During Five Years, Subsequent to the American Civil War, na . ZS77, 1878, 1879, 1880 and 1881. Consolidated from Original Reports and Records Collected and Classified by Joseph Jones, M. D., New Orleans, 156 Washington Street, Corner of'Camp, Fourth District, January 1, 1882. > C NAME OF DISEASE. GENERAL DISEASES. Small-pox 187 W. 48 7. B. 78 187 W. 2 Jj 8. B. 11 ANU 187 W. AR" 9. B. Y 188 W. 0. B. 188 W. 1. i 187 B. ■ W. ~ 1 B. ! FE 1878. Vj B. 13 7 BRI 18 W. .... .... "2 " 4 "2 "2 2 6 1 43 "1 3 1 4 "5 14 1 "2 4 3 1 " 6 "2 3 "i 1 1 2 1 2 2 3 13 2 12 3 'i "3 ""b 3 " 9 3 "2 7 .... AR' 19. B. i "1 2 1 2 2 "30 "1 "i 2 4 1 2 1 '•"i 2 1 1 3 i 3 2 5 i "i 3 "ii .. 1 .... "'i 1 '2 4 i 1 1 i 1 6 r. 188 w. " i 1 " i "5 2 4 2 4 2 1 2 1 1 6 i 36 4 1 2 3 "i 5 2 5 7 "2 2 1 1 "2 "3 10 " i 3 1 " 2 3 "'2 3 i 7 2 "'8 5 3 24 "'i 1 2 "'2 "3 "e " 3 "3 ."i 7 "i 1 "2 !0. B. 3 1 "i 1 4 1 1 1 1 33 2 4 "i 2 1 1 ' 2 " 1 7 "'2 2 "i 2 1 "'i "12 1 18 1 "'2 1 1 2 "*2 "'2 2 "i 6 2 .... 1 "2 i 188 W. "3 15 "3 "1 1 3 1 2 "is "1 2 1 47 7 3 4 "9 8 "io 7 3 i 2 1 9 I 1 6 2 "2 i 3 1 .... 5 7 2 " 1 "2 3 1 9 1 3 15 1 ."i "1 " 1 "i 2 4 7 " i 1 1 6 3 1 1 5 "3 "i !1. B. "2 " i 1 "3 "3 2 3 .... 1 27 3 4 2 "i 1 1 i 2 "2 3 "8 1 "1 1 1 "9 i '"1 1 "'8 1 1 21 "i "i '2 i '3 1 "3 2 3 "i 18' W. 94 6 3 1 4 i 3 "5 2 2 1 3 1 1 1 11 1 49 9 2 3 ' 4 9 ' 2 1 5 i 3 3 10 3 8 1 2 2 2 1 "3 1 9 1 1 " 2 10 43 1 "3 "2 "'2 "'2 5 1 1 6 "'2 "'i "2 2 1 8 "2 11. B. 166 1 1 1 2 2 i 1 3 3 2 i 37 10 1 3 2 1 1 2 2 "i 14 "2 3 "2 "i 2 2 2 2 '12 " i 32 2 "'2 " i "3 5 5 3 2 5 "i 18' W. 22 i 1 1 ' 1 1 3 2 4 3 "2 3 2 2 2 4 2 ie 10 "i 3 10 4 5 1 2 i "1 " 2 10 1 2 4 1 i "3 "i "i 12 3 1 "i 6 3 "*8 1 1 33 " 1 i " i "2 "8 3 "7 "e 8 "i 1 1 18. B. 30 "i "1 "i 3 "i i "'2 si 4 "i 2 1 4 1 "2 "e 1 2 7 "1 4 1 8 1 "'7 1 2 27 1 1 "i 2 "'i "2 .... 5 '"i " i 2 7 "'2 1 1 5 6 6 4 1 3 "'3 1 2 2 221 1' JAR 18' W. "i "3 1 3 " 2 2 1 " 3 47 2 3 1 7 "'2 6 2 1 1 3 3 4 2 1 6 3 "'2 "1 3 3 2 1 ' 1 3 1 7 1 1 18 "i 1 2 "i 1 i 2 "'8 "i "6 i 5 1 CH. 9. B. "1 2 1 .... ' "i i 1 1 1 1 "30 4 "i 3 1 5 "2 9 1 i "'i 7 "i 1 i "3 "3 ii i "i "i 1 " i "i 2 5 i 3 i 1 188 W. 3 4 "*i "2 "io 3 "i 4 4 3 1 1 "3 2 11 "ie 2 1 1 1 1 6 1 3 7 i " 5 3 ' 2 • 9 1 4 2 1 6 4 "i "ii "i "i 2 1 "8 1 ' 21 ' 3 2 "i "i 3 .... 1 0 i i 8 4 .. "i 4 2 1 1 )0. B. "i 2 "3 "'i 1 1 i 1 6 "i "2 ' 39 8 i 1 1 i 5 2 "2 2 9 "e 1 i 1 2 7 1 i 1 1 "i2 "20 i " 1 "2 3 4 3 1 7 188 W. "1 30 "'2 "ii '2 .... 7 "2 2 1 "i 1 "59 9 1 1 1 3 "i 1 11 5 5 4 1 1 4 1 " 2 2 "1 8 2 "3 1 4 1 "i 2 6 10 1 "2 5 ' 9 5 1 30 1 '"2 "i "5 i 7 2 "3 1 6 " i 8 2 11. B. "i "3 "3 1 "2 " i 2 1 1 "i i2 2 18' W. 64 2 4 "*2 5 1 i "i "'8 6 3 1 "i "*2 3 36 12 7. B. 93 "i i 1 6 2 "2 2 "2 ' 3 2 21 1 i 2 5 1 2 1 1 2 i " 4 1 2 1 1 1 "9 1 "5 "ii "i .... 2 "'2 5 4 i 1 "i 1 1 "'2 6 1 "i 1 1 2 5 1 "i ..." 1 1 1 1 31$ IE 18' W. 13 1 " i 1 "i 3 " 3 6 10 1 1 6 "1 "ii 9 (8. B. 8 "i "2 2 3 1 5 ' 2 3 ' 1 3 "i 25 4 API 18' W. "2 1 .... 7 "3 8 3 2 'J "ii 9 1 in.. (9. B. 1 0 1 "1 1 25 1 18 • w. "ii 3 4 2 6 1 3 ' 1 6 2 6 2 1 1 "ii " 1 "ii 12 30. B. 5 "i 1 "i "i "3 1 "21 2 18 W. 1 9 41 " i "i 2 10 1 ...5 I 4 "'i 1 2 3 1 i '50 6 1 31. B. "i 10 " 1 "'i 3 "2 i 1 2 4 31 1 18 W. 43 11. B- 62 18 W. 4 78. B. 8 MA 18 W. lY. 79. B. 18 W. 1 19 5 "1 1 ' 3 1 10 3 1 "2 15 3 9 1 1 "'i ie 15 30. B. "20 "1 1 1 5 1 2 4 1 6 i 4 "ii 8 18 W. 1 6 26 1 "i 1 1 7 56 "i 1 2 i "ii 16 31. B. 13 2 1 3 2 " i ' 8 10 2 2 2 1 1 40 9 18 W. 53 1 1 1 4 2 3 15 2 7 6 30 3 1 2 "2 8 ii 14 77. B. 84 3 3 5 2 5 3 2 1 1 2 1 1 1 51 17 18 W. 12 2 " 3 3 5 1 11 6 1 2 "'9 1 62 17 78. B. 6 1 1 1 1 2 1 8 2 "1 " 2 2 46 8 JU 18 W. 3 "ii 3 " 1 1 i 7 16 15 3 NE. 79. B. "i 1 5 i "i 2 i 3 i 'ii 18 W. "ii 6 1 5 1 .... 2 17 3 6 2 14 8 4 " i 2 "'8 1 "49 16 80. B. 10 1 2 2 3 11 1 "'3 :::: - W. "'i 15 3 1 1 17 li 52 3 1 i 31 22 .... B. .... "'1 ...1 1 7 3 3 23 1 1 12 18 OC' . . - • 1 "7 6 3 1 3 27 77 3 3 77 4 23 18 W. 3 2 26 9 19 2 4 4 "1 8 2 2 "37 B. 2 "i 1 ' 1 4 3 3 1 .... 1 4 32 JU 18 W. "'i "i 1 4 12 1 6 "3 13 2 i 2 1 3 6 49 22 LY. 79. B. "i 4 3 2 1 "i 1 2 1 ' i 49 2 18 W. "i 9 2 1 4 5 2 2 8 6 1 2 1 6 1 i7 6 80. B- '"i 2 "i "1 3 4 'i "'i "i 1 ''1 "io 4 18 W. 5 '4 9 20 2 6 2 9 4 i 1 1 7 46 18 81. B. 1 3 "i "i 6 4 1 5 "i 9 2 "i 0 ii 4 If W. 15 4 '"b 4 20 12 "4 2 1 i "29 1 1 311 B. 7 "1 "i "5 8 2 1 'is 1 If W. 1 "■4 4 . 4 3 979 6 30 77 5 29 10 4 1 3 1 4 54 15 J 878 B. 1 6 1 46 2 1 12 3 12 "2 5 ii 3 AUG 1 W. 1 4 1 4 6 1 11 3 2 2 1 ' 7 1 "ii 3 UST 379 B. 1 1 4 1 7 2 1 1 21 4 1 W. 1 4 i 6 "4 1 5 6 1 1 7 25 6 380 B. 2 1 3 6 1 2 1 99 4 1 W. "'i "1 3 "1 9 14 1 8 3 7 3 1 2 10 1 35 15 381 B. 1 1 3 3 5 6 2 3 2 2 1 J 2 ii 9 1 W. 11 3 1 1 2 "i 8 15 27 "i 2 1 6 1 1 4 1 "43 i 377 B. 1 "3 4 14 3 i ' 6 1 "io 1 W. "1 "ii 7 4 1696 9 30 97 2 71 3 4 "3 1 1 5 2 "48 16 SE 378 B. 1 ' i "84 5 6 9 1 1 2 "i "i ii 9 PTE 1 W. 1 3 7 2 2 "2 3 1 2 1 2 1 5 "ii 5 MBI 379 B. 2 1 1 2 2 "2 3 1 1 1 "i 27 1 )R. 1 W. "1 " 1 2 "2 11 23 5 12 ' 5 3 "2 3 3 1 2 9 1 37 8 380 B. 1 ' i 4 1 2 8 "ii 1 "i 1 1 1 4 ' 2 28 3 1 w. " 1 " i 1 2 5 13 1 11 "i 4 i 2 7 27 7 3 381 B. "1 1 6 2 16 3 1 5 32 5 1 W. 6 1 2 10 3 13 1 1 1 1 1 10 2 30 6 377 7 1 1 2 i 6 1 "i "2 1 2 "ii 4 1 W. "i 6 1019 2 20 75 "ii i 7 2 i 1 "i 9 "ii 12 € 378 B. 1 46 '"i 12 "i i 1 2 23 2 )CTC 1 W. "i ' 5 1 2 10 "io 2 2 10 1 1 '9 2 55 15 1 )BEI 379 B. "i 6 1 1 "i 5 1 4i 4 1, 1 w. 2 1 i 4 1 3 3 13 io i 2 12 1 10 io 7 380 B. 1 1 3 1 2 3 5 2 1 4 1 20 4 1 W. ' i 4 1 11 4 16 2 4 6 "i 1 1 1 1 9 1 34 381 B. 3 ' 1 4 io 1 2 1 1 1 3 ii 4 1 w. 2 " 1 5 1 1 2 1 9 3 8 1 12 1 1 1 1 9 1 "45 13 377 B. 5 "i 0 4 1 0 0 1 "38 5 1 W. 1 1 4 140 1 6 19 1 11 i 7 i i li *ii 8 2 N 378 B. 7 1 6 7 3 i 1 1 0 37 5 OVE 1 W. 2 2 5 4 1 6 2 5 1 33 15 1 MB! 379 B. 1 i 1 2 1 1 1 1 1 4 21 10 SR. 1 W. i 1 3 1 1 11 1 7 2 10 i 2 i 1 6 1 63 1 380 B '"a "'1 1 •I 1 "'i 1 "i "ii • 4 1 w. i 4 1 4 9 6 9 3 4 1 6 3 36 7 1 881 B 1 3 4 2 7 1 3 1 1 1 1 7 1 37 6 1 w. 2 4 i 1 3 1 1 .... 6 1 "47 ; ;-; -;----- ; • oo :::::::: w 1 3 . . w Ji . . . Ol JJ.-.JJMIW.M. .M | • | 1 W. 3 "i 3 1 1 6 6 1 1 7 27 DI 878 B. 1 .... 1 1 1 1 1 2 "io 2 ECE 1 W. 1 2 1 4 1 4 3 6 3 1 1 10 35 8 MBE 879 B. 1 1 1 1 1 2 1 1 3 ii R. 1 W. "9 1 3 3 8 1 3 12 1 1 1 3 1 "58 6 880 B. 1 1 1 i 1 2 " 2 1 1 1 i 1 37 2 1 W. 1 2 11 1 1 1 6 3 3 1 1 1 7 3 40 11 381 B. 2 4 1 1 3 1 1 1 2 3 1 30 2 18 W. 437 13 10 52 6 1 27 33 111 59 47 11 86 24 17 16 10 3 15 87 2 8 513 94 3 77. B. 662 2 TOT. 18 W. 69 3 1 22 21 26 9 3863 19 107 309 16 184 7 66 55 10 14 9 10 10 89 2 9 507 115 2 2 16 24 1 4 127 16 61 87 1 12 22 3 9 3 23 1 4 1 36 100 4 62 113 27 6 1 32 8 2 9 8 19 91 8 1 1 1 8 32 17 2 42 30 18 178 0 2 ii 8 2 "i 4 55 ii 149 79 2 7 109 3 1 48 12 28 1 4 19 5 10 68 1 10 13 13 ""io 6 2 9 58 54 114 9E 4 1 41 22 4 ""29 8 16 7 9 14 10 8,062 242 AL FC 78. B. 82 )R TV 18 W. tELVI 79. B. 3 MOE IS W. 1 57 49 1 1 8 32 1 2 12 33 115 18 56 8 65 75 33 10 15 9 10 9 ui 2 5 517 97 3 1 13 24 3 98 11 53 75 2 9 6 25 2 1 24 1 32 118 3 4 98 10 19 4 2 38 8 1 9 3 22 74 10 i 1 1 "ii 35 15 3 47 29 12 163 2 i 2 9 5 2 i 1 1 59 4 2 1 1 27 1 148 48 4 5 83 8 1 1 48 14 36 2 1 6 io 10 68 TTHS. 80. B. 18 W. 3 21 160 81. B. 2 5 37 GR TO FIVE W. 510 94 221 1 25 45 179 22 3985 73 236 723 120 412 'ii 432 279 54 46 69 51 45 50 441 11 40 iiii 553 23 4 77 124 10 2 3 4 40 484 102 291 384 41 52 49 112 17 44 16 137 13 3 15 162 476 18 116 474 53 2 118 30 8 181 35 10 43 43 143 372 46 "4 14 4 2 1 55 145 60 10 265 144 66 855 8 8 19 8 60 25 14 'io 17 12 249 9 4 8 1 2 126 12 707 414 9 20 24 15 545 28 2 1 196 71 160 3 9 19 113 21 39 332 2 30 35 33 1 33 2 37 10 63 180 207 581 458 13 12 200 95 19 6 145 58 104 3 25 60 86 36 1 23.069 1.152 AND TAL YEARS. B. 746 47 44 2 5I 95 180! 491 187 481 140 44 52! 8 24 33 35 j 361 149 18 15 183i 259 1 1 45 127 1 1 GRAND TOTAL FIVE YEARS. W. & B. 1256 141 265 3 30 56 264 41 4168 125 331 903 169 599 40 7 0 Measles Scarlatina Dengue 1 1 19 ,±: "2 1 2 1 6 "2 17 3 4 1 3 1 1 2 3 1 1 43 16 3 3 2 "3 7 "i .... 1 2 1 i 1 28 4 2 4 1 1 3 15 3 "2 1 1 6 35 11 1 3 2 1 1 5 1 4 7 "1 ...? 3 4 "1 9 " 3 1 " 2 1 1 "i 4 "*2 1 4 7 i 1 1 "i "i "20 10 "i "i " i 3 1 3 1 1 2 1 1 3 6 5 3 3 i '2 3 4 1 " 3 1 5 "i '33 5 1 "3 .... 2 2 "2 "i 28 2 "1 2 1 "'i 1 41 20 1 ' i 1 2 2 1 "1 4 io 10 1 3 18 183 11 21 46 7 9 13 4 1 5 4 6 5 26 3 1 37i 51 1 i 2 24 2 19 7 26 68 6 44 ii 78 48 4 8 16 9 9 7 3 4 472 120 9 3 3 0 1 8 9 22 1 18 6 20 10 5 1 6 10 7 4 30 4 3 352 43 1 ■"i! * ... 1 2 17 1 23 23 40 31 15 27 9 1 6 10 7 10 27 3 3 375 56 i 5 43 1 1 31 17 22 21 3 3 10 1 3 4 5 "3 23 1 31 43 "2 6 4 1 27 45 7 1 "'i 11 2 1 13 150 1 2 1 5 7 3 5 50 1 15 "'140 49 1 1 ""ii 2 ""27 6 '"1 1 "is 3 7 48 2 2 7 7 1 10 30 37 93 30 16 12 18 'ii 4 2 6 3 1 2 1 2.732 175 Cerobro Spinal Fever • • • • Enteric or Typhoid Fever Simple Continued Fever Yellow Fever f Intermittent Fever | Remittent Fever Malarial Fevers < Congestive Fever Typho-Malarial [Malarial Fever (unclassified) Cholera Cholera Morbus Cholera Infantum Diphtheria 3 " 8 2 6 1 4 "i "2 4 1 3 3 1 3 3 "i 1 "i 1 "i 1 "2 1 1 5 1 "i "i "2 "4 1 1 "1 1 5 1 1 "2 14 43 10 " 2 1 3 3 "1 6 "i 1 1 1 *24 2 "2 3 i 5 .... 2 "i 1 4 1 "i '2 6 "i 3 3 "19 "'i 1 i i 5 "'i "e 1 1 4 1 1 "1 -2 "1 i "ii i| 31 ... 31 1 i 20 7 17 36 37 6 24 6 37 1 4 3 7 4 27 2 8 346 47 1 23 4 34 20 33 0 0 10 1 1 15 3 26 90 1 74 9 2 6 3 '"8 6 20 56 8 "i 1 "... 4 3 "'ii 15 3 144 1 1 1 1 14 3 3 1 4 29 3 '1 1 12 55 38 1 2 1 61 3 1 7 1 10 1 7 1 39 7 45 4 8 37 120 21 81 19 137 11 8 14 13 9 88 2 14 512 127 6 1 17 17 3 1 3 19 118 12 88 73 28 11 1 15 4 1 39 9 1 34 74 0 6 97 15 27 4 2 38 4 8 10 44 85 ..." "'ii "15 23 10 1 64 35 13 158 3 2 5 4 14 3 "10 4 5 44 2 1 17 5 164 103 1 3 7 6 139 6 36 22 32 24 6 7 69 1 21 3 25 36 5 60 ii 56 15 1 4 3 6 8 13 39 6 388 62 1I....L..I 1.... 1 ... 15 1 2 ••• 11 ... "3 "i 106 572 323 106 54 93 84 80 86 590 29 4355 812 24 5 122 251 10 3 4 4 59 642 134 377 528 47 67 64 163 63 28 202 15 10 23 279 896 23 183 769 89 2 140 33 12 212 48 18 73 74 273 690 76 "10 23 5 2 1 78 174 . 72 * 11 454 208 103 1638 13 13 28 11 99 47 32 io 22 18 444 13 4 9 2 3 179 16 1,046 608 13 26 32 20 849 37 3 1 268 91 202 3 11 28 161 41 55 537 3 45 54 42 1 60 2 56 22 117 302 395 1,065 736 18 15 274 168 42 10 212 91 130 6 45 82 92 44 34,177 1,932 VV hooping Cough Erysipelas Pyaemia Puerperal Fever Rheumatism Syphilis Cancer Scrofula Tubercular Meningitis Tubuculosis Phthisis Tabes Mesenterica Diabetes 1 3 ' "9 "ii 7 1 1 3 1 "23 1 3 3 10 1 "■40 3 i 25 2 1 2 2 1 3 2 1 53 6 1 3 1 1 ' 4 23 2 i 36' ..1 2 1 11 "1' 52 3 ... i| ... 3 2 2 2' 1 26 3 1 Rickets Anaemia General Dropsy Gout 2 4 " 1 2 2 3 4 "i 1 .... 3) 2 1 1 "i "2 1 2 "i 4 "1 9 6 1 i "2 1 i "3 8 1 "i "9 29 .... "'2 7 2 "2 1 2 "i 4 "i 1 1 1 1 "is 2 "i .... 3 1 "1 7 1 1 3 1 1 1 1 4 1 10 3 11 "2 2 "1 1 "i 11 1 3 14 "'i 2 1 "2 "'8 5 "i "ii 1 "2 2 1 " i "3 3 2 "1 5 1 L... 2 "'a 39' 1! 2 8 3 3 7 1 1 1 "2 6 1 5 1 ' 3 1 "i 1 " 2 1 2 2 2 2 2 "'2 1 1 18 " i "i "3 1 "i "ii 5 "2 '"s 1 1 "3 1 4 "i 9 1 2 4 1 9 4 4 1 £ 278 1' "3 2 3 2 "i 1 1 1 3 "i 7 "i "'2 "'i 4 i i "i 2 2 ii '2 1 "2 "i 1 4 4 "i "i " i " 5 1 3 1 10 3 8 6 4 1 2 1 • • . . 1 ! .... 19' IS 1 1 3 1 3 11 1 2 2 i 10 1 1 3 "i 1 4 .... 3 2 1 3 "ii i "5 "2 2 14 8 1 ."i 4 "2 8 1 1 3 1 6 4 5 £ "'£ 1 1 1 1 "i 1 0 3 9 " 1 4 "1 "'i '"i 3 "i "9 "'2 .... " i 2 "i ' "i 4 "i j 21 i 1 2 '"i 1 2 4 2 1 1 1 3 3 8 11 1 1 3 2 7 1 "i 1 2 1 4 1 14 1 "i "1 1 '' 3 " i 1 10 3 "'2 1 4 1 2 i r;i 1 1 7 "i " 2 2 1 2 6 6 1 "i "'4 2 4 326 13 1 "1 3 "2 2 1 3 6 2 1 " 1 "'i "3 1 i 8 ' 8 "2 "2 " i 3 '"i '2 .... 1 "1 2 "i 6 2 "3 "i 1 135 12 1 1 4 7 5 1 1 3 1 4 "13 "2 3 "'2 "4 3 1 i "i 3 1 "9 5 1 22 ' 1 i "'2 1 1 2 "'2 "i 1 "'i 1 "i 2 2 9 i 1 1 "1 3 2 12 7 i 1 3 2 1 6 1 343 18 1 2 4 3 4 ...! 1 "4 3 10 " 6 1 .... 1 "i 4 1 '"7 "i 18 "i ■"3 i 1 "i 1 1 4 2 "3 "'2 1 3 "i "1 " i 1 1 4 6 2 1 1 "'i "3 6 3 5 5 1 3 i i 7 4 4 1 1 3 1 1 "e "i i " i 18 "i i 1 3 "ii 10 '9 3 6 i 1 "2 2 3 2 13 7 2 1 "'i 2 4 1 2 6 4 2 ...i 1 6 i 3 1 i 0 "i 4 1 2 "i 3 12 "1 '2 9 "i i 2 i "3 1 3 .... .... 1 1 3 3 '"i 3 '' 3 "i i 234 4 2 1 1 1 1 1 2 1 " 6 1 3 "i 6 "i 12 1 "2 i "'i 7 .... "'i "i 3 2 "i 2 1 4 4 3 4 "'i 2 4 2 7 1 6 5 . ..9. "i "i 6 1 11 1 3 1 "i "i 1 5 1 "1 2 "i "ii "i "i "i "i 2 21 5 "i 1 1 8 "i .... .... 4 1 2 "i 1 3 "ii 12 6 2 "'3 1 1 2 268 24 1 1 3 3 "i ' i 1 "3 6 2 "9 1 "2 1 14 "i "i '"i 2 2 '2 3 2 4 1 5 10 3 1 1 2 1 136 15 2 1 1 "1 10 3 4 2 "2 1 .3 2 1 " i 4 8 ii "2 2 "1 "2 1 "1 i 1 "ii i " i "ii 1 i ' '25 i 6 "i 4 "i i 5 i "i 1 2 4 6 13 5 1 "'i 1 1 1 361 13 1 3 1 2 "i 1 1 "'i "1 6 15 1 3 3 3 3 i i ii "1 i " 6 "i io 4 "i 1 " i 1 2 4 6 1 "i 220 8 2 9 12 1 11 4 2 "i 1 "i 4 1 12 2 ' 2 " 3 2 3 12 1 "1 "i "3 2 "io 1 "i "2 "i " i 1 35 6 "i "ii "i 1 4 i 3 .... 2 .... 1 4 3 14 14 3 2 "i " i 1 2 2 450 12 1 1 3 1 4 3 1 2 i " 1 i 9 '7 1 i 1 1 "2 6 13 1 "1 "1 "1 12 "i "i 3 " i "i ' ' ' A 4 "i .... 1 1 1 4 1 1 2 "i 1 2 2 233 10 3 2 18 2 10 5 3 2 "i 2 11 "i 15 1 "i "1 1 1 1 1 "4 ' 9 "i "1 "ii "i "ii 16 i "ii 2 "i "i 5 2 "i "i 1 3 1 10 2 7 i "2 2 1 1 319 23 7 4 2 5 2 1 2 7 "9 6 i 1 "i "i "i "i 7 "i '"i 1 " i "9 7 "ii i "i 3 "i "i 5 4 5 2 . 2 "i i 2 1 1 268 11 1 3 6 2 8 7 1 1 0 '7 3 3 1 11 1 "i 1 "1 "3 11 " i 1 3 2 " i 2 "9 "i "i " i "ii 13 1 i "io "i 1 1 1 3 10 1 1 3 4 4 7 1 4 2 6 2 1 1 1 344 19 2 3 i 9 "i 9 2 2 1 "i 6 2 1 "4 1 1 19 i "i 1 "i 4 7 i "i " '1 " i 2 i 1 5 6 6 4 1 "i "i 205 13 i 5 "ii 4 1 2 2 i 1 "i 6 ii 1 i 3 i 1 "3 "2 5 1 " i "i 3 1 1 i 1 1 2 i '"i i 1 "io 9 1 "'i "io " i "i 5 "i i "i 3 10 7 "i 3 1 1 316 20 2 i 4 2 4 1 1 1 i 5 4 1 "i 3 6 "io "i "i '"i 7 "i 4 5 1 1 1 1 " 1 2 1 6 4 8 1 1 2 i ...4 14 14 8 1 1 1 4 "1 11 '"i "i 1 4 1 2 7 1 4 2 2 "5 1 "ii 1 "'i "i 13 0 35 8 i "io 1 "5 2 A 1 6 "i 1 1 4 2 10 12 3 2 "i "i 1 .... 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"i 2 3 "'i "9 '5 i 8 11 3 8 3 i i 1 1 1 "i 1 3 'i " 2 "i 1 "'2 2 "i "i 5 "'1 " i "i '"8 "i "'8 1 " 3 6 "6 " 2 1 1 1 "i 1 1 7 1 4 1 i 1 2 28 1 9 7 1 1 2 1 4 "i 5 5 3 14 20 2 "i 1 " 3 i 2 6 1 1 1 3 1 "'7 "'i "i "1 13 5 "ii 9 '"2 "is "'1 3 1 2 5 1 1 4 2 "i "2 1 5 5 "1 1 "1 9 3 6 "i 1 3 6 "2 "ii "i "i " 3 "6 9 "i "1 0 1 5 i "i "2 1 1 5 1 1 3 2 3 "1 ' 1 3 6 1 1 11 1 i 3 i 7 1 "2 1 4 1 i "4 i 1 12 9 ' 5 1 1 2 2 i 1 1 1 2 3 2 1 1 "i 4 i 3 1 "'i "1 6 "1 "5 i "6 1 1 1 1 2 2 "i 4 1 4 1 8 "i 7 1 "2 1 1 "i 6 11 1 1 ' i 4 3 "'4 1 5 1 "i 3 10 2 i 10 2 4 "'2 i 3 3 i 1 1 1 1 3 1 10 io 1 1 1 "i "1 1 3 i "i 3 1 " 2 1 i 1 3 i 1 1 2 2 3 8 2 1 " 1 158 19 2 2 1 3 6 6 2 1 1 i 1 9 2 "i 3 i 1 "i "'i 1 1 "4 "i "i "1 1 4 1 ii 4 "1 1 13 "4 4 3 ' 1 1 3 5 "i "i 1 i 16 9 2 6 2 " 2 1 1 2 3 2 300 10 3 2 i 1 ' 2 5 6 ii 1 1 1 3 3 1 "1 i "2 1 2 1 1 1 3 i 2 5 1 .... 12 5 1 3 1 " i 1 172 14 2 5 8 7 2 2 .... 2 0 "i 14 4 ' 7 1 "i "i "7 1 "4 "i 1 6 6 ii 13 "1 7 "5 1 4 "i 1 4 "ii 22 10 1 i 1 1 2 354 28 5 4 "i 2 2 ' 1 2 7 i 4 1 ""i "i "i 7 1 1 1 1 1 "5 ' i i 3 i 7 i 3 3 5 8 5 1 2 191 1 2 i 25 2 10 4 1 1 4 i 1 4 11 "ii 25 4 " 3 1 1 "i 10 "1 1 1 4 3 1 19 '*2 1 1 2 "9 3 ii 1 1 io "2 "1 1 6 "i i 1 2 8 6 12 18 i 3 1 1 4 1 2837 "16 1 1 4 " i 1 1 1 1 1 1 1 5 "3 5 1 1 "'i 4 1 i 1 1 7 i "3 1 2 4 4 2 2 1 i 1 1 2 8 4 1 1 1 314 16 2 2 "1 3 1 5 " 2 1 2 A 4 2 3 7 i 1 0 1 2 "i "3 "i 1 2 "1 3 1 1 " i 1 3 1 1 "i 5 2 1 1 1 2 1 1 1 1 2 2 4 2 5 "i i 1 187 16 2 "1 1 "i 3 1 "i "2 2 8 "1 4 i i 3 1 " i "3 i i 1 "i "i 2 "i 2 "i 1 1 3 3 10 7 2 3 i i 1 137 _19 1 2 14 2 3 8 2 1 .... i 12 1 10 2 ' 3 "1 "i 3 "2 7 1 1 "3 2 "ii i 1 "2 4 13 3 "1 8 2 2 2 1 1 8 3 1 1 4 4 12 11 1 1 7 1 i 2 3 2 265 24 1 5 1 3 3 1 1 "i 16 ■5 1 "'i 1 "1 1 3 1 "i 1 8 "i 1 2 1 1 1 4 3 1 1 ' i 5 i "i 7 2 2 3 1 1 1 ' ' '1 2 1 i 8 "i 3 3 "4 4 i "i "i i 3 7 2 2 9 12 1 .1 "11 1 3 "i 1 2 4 i "i 1 1 2 "i 1 ••'1 1 "i 8 "i 1 "'i 5 2 1 3 "i i "2 "1 3 10 "1 0 1 1 5 "'i 2 i i 5 .... 6 i 4 3 "i " 2 " 2 12 "5 5 1 1 "2 "i 4 i 1 "1 4 "i 1 2 2 10 8 6 i 2 3 4 1 '"i 5 "i 1 1 " 2 "i 4 9 1 2 3 1 1 "i "i 8 1 "i "i 8 i 5 3 3 i i i 2 4 "2 1 "i i 3 1 23 1 6 1 4 2 3 14 "io 13 4 1 2 " i "ii 1 4 1 "'7 1 2 5 " 2 1 3 " 2 "i 8 "7 "'i 3 2 i 2 7 "i 1 2 3 i 1 1 4 1 "i "3 3 1 "'7 "'i "5 1 1 4 1 i 1 2 "i 2 3 i 1 6 "5 5 " 1 2 "2 "i 8 2 9 1 1 1 i 1 "4 2 1 8 1 1 "3 i i 1 9 4 10 "'i 1 1 1 1 '' i "i 7 1 2 1 4 "i 1 1 '2 6 8 i 3 1 i "6 7 1 "i "2 1 "io "i "i i 7 1 2 2 ' 5 1 ' "i 1 1 2 i 10 "'i 3 ' 1 1 3 "i 14 9 1 " 3 " i "1 "i 2 "1 "2 3 3 "i "i 10 "'i 1 3 "12 6 7 "i "e "i 1 1 1 3 ' i 1 1 2 2 5 5 6 6 5 2 4 i 3 326 _12 1 2 "2 2 1 ' 2 1 3 3 " 6 "'i 1 1 "9 "i 2 4 3 "4 i i 3 1 1 1 5 2 1 140 12 2 i 13 i 8 "i 1 i 10 '9 3 "1 1 4 7 1 "1 " 1 1 "i 2 1 8 1 3 1 "i i 2 14 6 13 1 2 3 1 .... "i 6 i 1 1 2 2 3 9 7 2 " i 2 1 2 3 295 19 i 2 2 "i 1 "i "i .... 8 "i 1 3 8 i 2 ""i "i 1 1 '1 "i "i " 2 " i i 4 1 2 1 3 8 3 3 3 i 3 2 i 2 i ii 8 7 1 5 1 1 *2 6 1 ii "15 1 1 3 3 1 4 3 "'8 9 7 1 i 1 2 i 1 7 ' 2 2 2 i 2 1 1 2 1 1 "i 1 " i "i 6 "5 3 i "i 3 5 i "'5 1 9 i 3 '5 i 4 1 1 ' i 3 2 1 "■3 i 4 1 '2 3 1 4 1 8 "i "i i 1 1 "i 13 "i 8 1 "i "i 4 "3 7 3 1 '*8 19 "1 i i " 8 " 5 15 7 1 "ii 1 4 "i "i "■5 1 2 5 i 1 i 3 2 i 2 "i 0 9 1 3 9 "i i "'2 7 1 ' "ii "2 1 1 "i "2 1 i 2 1 1 1 2 5 3 4 4 1 "i "i 11 1 1 5 i "i 2 "3 4 6 3 2 "io "i "i " i "3 i ii 5 10 1 "i 1 3 4 1 3 "'1 3 i 2 "5 i 2 "i "i 2 " i " 4 3 1 "2 1 "ii "1 1 "1 1 i 2 1 "3 2 2 2 4 1 5 i "i 4 1 i 1 "1 "■5 8 4 1 6 • .... .... :i 6 .... i 1 "ii 2 2 .... "3 3 1 7 1 1 1 1 1 6 3 ' $ 12 "1 "i 4 1 "i 3 1 .... ""i " i 1 .... ::p "i 1 2 i 2 1 4 6 "i 6 1 6 1 "i 1 1 1 1 i 10 "i 4 2 i 1 "9 1 "1 " i "i 7 15 "i 14 1 "i 2 2 1 6 1 2 1 "'i 3 1 J 1 " 2 '1 " i " 3 " 3 13 " i i 1 3 1 ii " i 1 1 2 i '7 9 1 i i 3 1 1 1 5 8 7 1 1 2 1 21C 1! 3 2 1 4 1 1 6 i 1 1 1 " i 1 "'i 1 2 4 2 1 6 1 "1 2 1 10 1 "1 4 2 14 2 1 16 " 1 1 "i 1 ""i '"i 5 1 "io 1 2 1 i 2 i 1 1 . . . . :::: t 5 i i i 0 "'6 .... 3 i 1 1 6 "i i 1 11 .... i i i 4 "1 1 "'i "i 7 i 3 i u i "i "1 8 0 6 1 5 1 "1 1 "ii i 2 1 2 2 9 "1 1 4 i "io i 6 '1 1 "i 1 2 _2 i i i 6 7 i 3 "2 17 1 1 i i 4 i 4 i .... "i 1 1 1 2 2 3 10 .... i 1 1 1 1 12 i 4 1 1 6 1 1 ''1 2 3 2 11 ""s 1 2 23 2 i ""i "i 1 11 6 1 A 8 .... 3 1 "4 6 1 1 2 2 i "i i i "i 10 7 1 " 1 1 5 "'i ' 1 14 1 "i 2 " 2 i 1 "2 6 11 "i 8 1 2 11 io "2 i "2 2 3 1 i 9 i 3 1 19 1 i "i i 2 "'7 2 i *8 i 8 "i 1 10 3 5 1 1 2 1 2 i 1 6 3 1 "i 1 3 10 "i 1 1 i 1 ii "i "'2 '"4 3 "i ' i 7 2 2 9 "i 9 1 2 1 i 1 11 4 2 "3 i "2 1 3 8 4 1 "1 3 "io 3 2 15 "1 0 1 '"i "i " i "ii 12 i 1 1 12 i 3 1 4 1 1 1 1 1 2 8 2 3 ' 3 2 3 1 2 2 1 306 19 3 i 1 i 4 11 i 1 1 2 6 2 "i 1 22 "i "t i 3 "i "7 2 6 i 1 2 i 4 1 2 8 7 i 2 1 2 1 1 1 175 13 15 32 1 1 5 75 52 34 64 9 8 23 26 0 13 18 3 6 21 105 38 89 9 1 22 3 31 2 11 10 33 60 9 "i ' "i 4 11 9 3 78 2 10 205 3 3 ""ii 5 4 1 49 3 35 120 102 2 5 2 113 6 35 12 30 3 3 0 24 3 8 57 6 3 5 13 9 16 36 32 99 70 2 45 17 15 38 13 17 2 2 7 3,97C 27f 13 22 3 28 2 12 25 1 2 13 3 9 1 1 12 2 26 62 8 6 1 4 2 1 10 14 57 4 1 1 1 6 1 1 29 20 9 165 3 2 3 " 8 10 4 1 2 31 7 1 38 41 2 1 3 61 1 17 4 10 2 7 4 4 39 1 4 6 5 7 4 3 5 39 51 90 55 18 14 5 14 8 10 4 2 2,256 157 16 27 0 1 1 66 11 85 1 12 12 24 9 4 33 39 79 4 77 13 1 23 13 3 42 1 6 12 62 8 1 "'2 1 9 44 9 1 34 48 13 151 "i 4 2 9 2 "5 4 42 1 23 6 126 - 82 3 3 3 2 101 29 11 34 1 3 1 16 2 4 70 1 2 5 ■ 5 2 3 2 7 26 38 104 105 3 2 41 14 27 18 14 1 4 14 20 8 3,26* 221 17 22 1 29 6 12 37 2 4 9 1 1 14 1 28 84 0 9 45 4 1 6 ' "1 4 4 3 "i 1 ii 19 4 155 0 2 9 6 i 2 1 44 1 56 33 1 2 3 43 2 9 3 *8 4 2 34 17 6 36 4 20 28 6 3 9 1 3 22 1 1 28 92 71 9 8 3 9 4 5 6 42 85 8 ""6 "'i 4 1 "'ii 8 169 ' "2 ' i 2 2 "'7 41 1 12 50 33 1 1 12 9 1 2 8 7 2 45 Scurvy Leprosy All other General Diseases not enumerated LOCAL DISEASES. Diseases of the Nervous System. Congestion of the Brain - - Inflammation of the Brain (Encephalitis) Meningitis Apoplexy Sun-Stroke Hydrocephalus Diseases of the Cerebral Arteries spiun] Menin<r*iR.. _ •.. Hterripile ■•v, 1 ar al v sis (1 aeMS&inea Locomotor . - f Unclassified Tetanus... Idiopathic ( Tr- Trismiv Aasceutiuin ps. -ophobia - ^onvulsions Co«v visions Infantile Epilepsy Hysteria Delirium Tremens Insanity ---■ Paralysis of the Insane. All other Diseases of this System. Diseases of the Circulatory System. Pericarditis - • Dropsy of the Pericardium Endo-Carditis ; Valve Disease of Heart j ^^1. Heart Disease (unclassified) Heart, Enlargement of. - - Degeneration of Arteries Aneurism of Heart Aneurism of the Aorta - Embolism - Phlebitis Phlegmasia Dolens All other Diseases ot this System Diseases of the Respiratory System. Croup Laryngitis Oedema of Glottis Bronchitis, acute. Bronchitis, chronic - Asthma Pneumonia Abscess of Lungs Gangrene of Lungs Emphysema of Lungs Atelectasis Hsemoptisis Pleurisy Empyema Haemorrhage of Lungs All other Diseases of this System Diseases of the Digestive System. Haematemesis Stomatitis Teething Ulcerative Sore Throat Thrush Sloughing Sore Throat Goitre Tonsilitis Gastritis Dyspepsia Enteritis Dysentery Ulceration of the Bowels Haemorrhage of the Bowels Intususseption of the Bowels Obstruction of the Bowels Diarrhoea Hernia Fistula of Anus... Tuberculosis of Liver Hepatitis • .. Abscess of the Liver Cirrhosis of the Liver Atrophy of the Liver Degeneration of the Liver Jaundice - Splenitis Ascites All other Diseases of this System Diseases of the Urinary and Generative Organs. Bright's Disease-. Suppression of Urine Cystitis All other Diseases of this System Afteotlvns Connected with Parturition. Haemorrhage. Puerperal Mania Puerperal Convulsions Puerperal Septicaemia All others 6 3 8 3 2 2 2 4 "i 5 11 " 5 "'i 1 1 1 11 "i 1 1 "io " i 32 1 "'i 1 1 "i 4 3 "ii 1 ' "4 3 4 1 1 5 "1 1 i 4 2 1 4 i 5 1 "i "i 4 "i 3 "7 4 17 1 "1 "i "i 2 "i "i " i "i i 2 1 6 " 2 1 3 0 1 3 9 6 2 1 2 "i 1 2 2 ■"4 4 4 4 3 2 19 1 1 ' 2 1 "1 "1 "3 3 "1 "9 "4 "2 4 "i 1 "2 1 1 5 1 2 2 13 2 i "i " 3 1 1 "i 1 4 3 "ii "i 1 "i "i " 3 1 " i 3 1 3 3 1 1 1 i 1 11 2 5 7 2 3 1 2 4 1 1 8 5 4 1 1 6 2 "4 4 13 "1 "1 6 1 " 4 19 4 45 "i 3 " 2 'i "'2 " 2 3 5 " 9 2 1 2 5 1 1 7 "i 4 "5 .... .... .... 2 i 1 ii 1 2 5 1 "2 12 1 1 "9 1 33 1 "i "i 5 2 "1 "i 1 1 1 5 1 3 "5 5 2 1 2 2 9 1 1 9 2 "4 " 3 " 2 9 2 "i 5 3 1 3 4 1 18 1 6 " 3 8 7 i "io ' i 1 3 1 3 6 "i 1 3 ...: 1 2 6 1 •"i ■j .... "5 0 "2 7 9 3 1 "ii 11 27 1 4 1 1 1 "i 1 1 2 1 4 1 1 7 "i 1 3] 1 3 li 2i .... 1 9l 4l 1 .... 4 3 2 1 35 i .... "1 2 1 2 1 :::: "" 4 i i 1 3 12 5 1 5 4 ii 2 3 1 4 9 1 i 1 3 "2 28 "i 3 *8 2 3 1 .... 1 " 1 " 2 3 I *i ... 3! 3 ... 5 1 16 "1 .... "i 3 i 1 2 ii .... 3 "i i •••! 5 3i 5l- 10|. 3 3 3 i ll J 1 1 9 61 '"2 1 12 4 .... . j ..... 1 2 .... 4 1 1 "3 f 1 5 1 4 1 i 1 i 2 4 12 2 1 2 3 2 3 "'2 1 " i i 2 19 158 32 86 141 6 15 15 51 4 19 12 65 8 117 420 67 295 36 ~3 4 31 13 8 30; 31 130 818 30 6 9 1 29| 189 64 37 783 5 9 3 39 22 18 io it 195 4 1 1 1 53 4 339 194 4 6 8 5 304 9 1 72 20 42 2 ? 48 23 16 205 1 15 19 9 ii 12 54 122 188 484 27b 3 74 73 23 4 67 33 26 3 20 22 6 8 1 11,108 780 $ .... 2 7 3 6 3 8 1 13 1 4 18 31 43 107 98 1 2 38 23 28 r 25 1 7 19 19 3 3,637 193 4 3 1 6 11 2 5 3; 1 .... " i i 3 2 3 15 12 29 87 63 2 16 8 15 8 5 1 14 2 13 29 40 147 90 35 19 6 23 14 32 1 5 11 31 8 1 4,127 217 3 3 5 8 14 27 121 51 2 1 11 24 4 9 8 5 2 4 7 1 4 2', 279 136 diseases of the Cellular and Cutaneous System 'onditions not Necessarily Associated with General or Local Diseases. Premature Birth Old Age Debility Debility Infantile All others Poisoning General Injuries. Drowning Burns and Scalds Starvation and Hunger Inanition All other General Injuries Local Injuries. Wounds All other local injuries 1 1 5 8 2 1 1 1 "i 1 1 13 2 "4 1 "3 1 3 3 6 5 3 5 1 "s "'2 "8 14 "1 1 2 7 14 11 1 7 "'i 3 1 3 f 17 6 2 3 2 3 2 7 8 6 1 7 "i 1 3 1 6 3 '"2 3 3 4 9 10 "i 1 6 4 1 1 1 "3 2 1 "4 • 6 i"" i i 1 1 4 4 6 2 1 ... i 2 i 3 5 2 "2 .... .... 2 2 6 7 2 2 0 1 10 3 ... ... ... ... 1 7 8 6 2 2 '2 1 4 "i 11 8 1 3 2 "i 1 2 7 7 7 1 ...2 "i 2 1 1 3 11 2 1 1 1 1 1 2 166 10 1 4 li 2 2 1 "i '"i 1 3 339 35 1 "3 15 1 "'2 .... 300 25 6 7 9 4 9 3 1 "2 2 2 1 324 22 "3 13 3 1 2 3 2 . • • • 285 2( 1 5 9 4 1 "'i 1 1 1 1 171 IC 4 3 10 7 2 "'2 24 It 1 "3 4 1 2 1 1 .... 2 2 15 5 1 1 "i 1 1 8 5 1 9 i i .... 9 2 3 7 4 3 1 3 1 436 1 4 1 8 11 1 11 2 i 3 5 1 1 2 1 3 1 380 1 3 16 3 1 1 "i 1 1 8 7 " 6 4 6 "'i 1 12 5 13 8 1 3 1 "3 1 6 4 8 7 3 "i 1 1 4 2 3 "2 2 1 2 1 3 1 264 2 1 1 5 6 7 1 1 1 158 14 2 2 2 12 8 3 " i 1 2 1 1 1 249 14 1 2 "9 5 1 2 2 3 12 3 3 " i 1 2 2 " i 13 5 1 2 1 2 4 9 8 4 1 3 "i 1 1 1 251 17 1 4 3 2 3 i 2 i 1 166 13 2 9 5 16 1 1 1 1 2 1 1478 * 27 4 3 8 11 1 1 174 12 2 3 6 14 11 1 4 "i 3 1 1 2 238 20 2 4 6 7 "i 132 1 1 2 8 4 1 i 1 1 147 11 3 3 4 11 6 6 3 2 2 3 1 1 274 28 5 14 6 4 " i "i 177 16 3 5 20 15 4 1 1 2 1 447 33 0 3 8 3 '2 2 138 12 3 4 1 10 12 i 1 4 346 21 4 2 5 9 i 1 1 1 1 5 3 15 8 4 5 "i 2 1 8 13 8 1 3 i 1 1 1 7 22 7 1 2 2 i "i 1 7 4 7 3 2 "4 2 ' i 1 2 8 12 1 2 1 3 2 7 9 12 2 1 4 "i i 3 30; _ If 2 5 8 4 3 3 1 3 1 15' 3 8 10 15 2 3 3 "5 2 3 2 5 1 32C 2£ 2 2 7 9 "'5 " i 2 139 ' 11 3 1 1 8 8 1 1 4 1 2 2 1 3 3 291 1 21 4 1 5 13 6 1 1 i 1 2 1 169 17 16 27 44 93 79 3 13 15 "9 4 1 6 3 1 1 1,85? 158 Human Parasites Tumors, Non-Malignant .... 1 1 1 234 15 169 10 1 1 302 19 1 178 12 1 1 290 21 1 1 27 '1 1 i I... ... 1 2 1 271 IE 16' IC 1 1 300 17 .... 1 1 1 4 5 1 1 1,981 15' Suicide Killed or Murdered Unknown, or Not Stated Total Deaths Still-born 345 18 226 21 156 14 1 352 21 191 11 31b 30 ... 3 25£ 14 27 22 1, ; ... 14 .... 16 11 348 201 11 25 1 118 186 6 1 1 356 ' 15 252 L 26 1 161 15 191 □ 4 376 14 160 20 2 276 12 191 5 261 19 149 13 4 990 _ 22 201 10 165 h; 1 250 24 177 15 186 14 1 1 345 18 .... 172 16 7 1- | 292 L30 33( 2' 1 18' 11 Preventable Causes of Disease: Joseph Jones, D. CCCXXXVII 1 Protection of the city from overflow by substantial levees, elevated at .uSt four feet above the line of the highest waters. 2. Thorough surface and sub-soil drainage. Under this head should be included the reclamation of the swamps in the rear of the city, the per- fection and proper grading of gutters and surface drains, and the proper excavation, perfection, cleansing and flushing of the canals which receive the storm waters and those continually yielded by the gutters. 3. The immediate and continuous removal of all foecal matter. 4. The daily removal of garbage by an efficient scavenger force. 5. The constant repair and cleansing of the streets. 6. Paving the streets with the most substantial materials. 7. Abundant supply of river water for the use of the inhabitants and for the cleansing of private premises and the daily putrification of the markets, gutters and streets. 8. The protection of the citizens of Louisiana from unqualified druggists, midwives and practitioners of medicine, and the perfectionTand extension of the system of registration of marriages, births and deaths to the entire State. 9. The regulation and restriction of the sale of drugs, medicines and poisons. 10 The regulation and restriction of the sale of alcoholic and intoxicating stimulants. 11. The prevention of adulteration of food. 12. The proper elevation and construction and ventilation of all private dwellings and public buildings. Under this head, also, should be included the proper supply of pure air and pure water. 13. The proper construction, ventilation and conduct as regards all san- itary matters affecting the material, intellectual or moral nature'of all in- mates of prisons, jails, police, stations, schools, hospitals and asylums. INSPECTION OF DRUGS, MILK, ARTICLES OF FOOD, FERMENTED AND DIS TILLED DIQUORS, (WINES, MALT LIQUORS, DISTILLED LIQUORS, BRAN- DY, WHISKY, GIN, RUM, BITTTERS, ETC.) It is of great importance to the welfare of the citizens that the City Council and Board of Health, acting in concert, should appoint and com- mission one or more inspectors, of the highest moral and intellectual char acter, and of undoubted scientific attainments, and thoroughly skilled in chemical and microscopical science, and learned in the physiological, the- rapeutical and toxicological action of drugs, medicines and poisons, and of the substances usually employed for the adulteration of food^whose duty it shall be to inspect all drugs and medicines, and all articles of food (including milk and meat), and to determine, by careful microscopical and chemical analysis, all adulterations of drugs, medicines and articles of ood. It should also be the duty of said Inspector, or Inspectors, to examine the quality of the drinking waters, microscopically and chemically and not only point out impurities and draw up plans of relief, but also to determine, as far as practicable, the effects of drouth and of excessive rains, and of the changes of season upon the chemical constitution and properties of the waters of the Mississippi River, and of the cisters. Facts might be accumulated to show that far more victims perish from the adulteration of medicines and articles of food, than from the direct administration of poison, either accidentally or intentionally. CCCXXXVIII Preventable Causes of Disease : Joseph Jones, M. I). It is difficult to estimate the number of infants who perish annually in this and in other cities Irom the infamous practice ef adulterating and diluting milk. A small portion of the vast sums expended on amusements, spectacular shows, boat and horse races, lotteries, political campaigns, gambling- houses, and bar-rooms and clubs, would suffice to expose and prevent these adulterations of drugs, medicines and articles of food, which, directly or indirectly, destroy large numbers of useful and precious lives. DIFFICULTY OF CONTROLLING THE SALE OF POISONS. The difficulty of controlling the sale of poisons arises not only from im- perfections in the laws and their enforcement, and in the insufficient and inefficient character of the police regulations and forces, but also from the nature and uses of the substances designated as poisons. The term poison in popular language is applied only to those substances which destroy life in small doses; but this view of the nature of a poison is too restricted, for it obviously excludes numerous compounds, as the salts of copper, tin, zinc, lead and antimony, the poisonous properties of which cannot be disputed, but which, generally speaking, act as poisons only when administered in large doses. Ina medico-legal point of view, it is immaterial whether a man dies from one ounce of a comparatively inert poison or from two grains of such poisons as arsenic, strychnine or cyanide of potassium. When death is caused by the substance taken, the quantity required to destroy life cannot enable ns to distinguish a poisonous from a non-poison- ous substance. If we adopt the comprehensive definition, that "a poison is a substance which, when absorbed into the blood, is capable of seriously affecting the health or of destroying life," a large number of substances used in the treatment of disease, of both animal, vegetable and mineral origin, would be included, as well as a large number of compounds, as those of arsenic zinc, lead, copper, cyanogen and mercury, used in the arts and manufac- tures. If a substance be capable of destroying life or injuring health, it is of little importance so far as the responsibility of the prisoner is concerned, whether its action on the body is of a mechanical or chemical nature, and whether it operates fatally by absorption into the blood or not. Whether the administering to any person of any poison or other dele- terious thing be followed by any bodily injury or not, is a felony, provided the intent has been to commit murder. The difficulty of dealing efficiently with the subject of the sale of poisons is sill further shown by the large number of substances employed in medi cine and in the useful arts which possess poisonous properties. These poisons have been divided into several classes, according to their mode of action on the system, namely, irritant, nacrotics and narcotico-irritants. 1.-IRRITANT POISONS. Under this head may be included sulphuric acid (oil of vitriol), sulphate of indigo, nitric acid (aqua fortis), nitro-muratic acid (aqua regia), hydro- chloric acid (muratic acid), oxalic acid, acid oxalate of potash, tartaric acid, acetic acid, potash, soda, carbonates of soda and potash, ammonia and carbonate of ammonia, nitre (saltpetre), sulphate of potash, iodide of potassium, chloride of barium, carbonate of baryta, phosphorus, arsenic, arsenious acid, arsenite of potash (Fowler's solution,) asenite of copper, (Scheele's green, emerald green), arsenic acid and arsenates, sulphides of Preventable Causes of Disease: Joseph Jones, M. D. CCCXXXIX arsenic, (orpiment,) chloride of arsenic, arsen u retted hydrogen, corrosive sub- limate (perchloride of mercury), calomel (subchloride of mercury),ammoniated mercury (white precipitate), red oxide mercury (red precipitate), persul- phide of mercury (cinnibar, vermilion), cyanide of mercury, subsulphate of mereurx (Turpeth Mineral), nitrates of mercury, iodides of mercury, (red iodide and green iodide), acetate of lead (sugar of lead), subacetate of lead (Goulard's extract), carbonate of lead (white lead), oxides of lead (yellow oxide, massicot, litharge, and minium or red lead), copper, sulphate of copper (blue vitriol), subacetate of copper, (verdegris), antimony (tartar emetic), sulphate of zinc (white vitriol), chloride of tin (Dyer's spirits), nitrate of silver (lunar caustic, lapis infernalis), perchloride of gold, sul- phate of iron (copperas, green vitriol), muriate of iron (tincture of per- chloride of iron), subnitrate of bismuth, bichromate of potash, chromic acid, chromate of lead, thallium, iodine, aloes, colocynth, gamboge, jalap, scamony, savin, croton oil, castor seeds, colchicum, hellebore, oil of turpen- tine, oil of tar, mouldy bread, carib or locust bean, cantharides, poison- ous fish, mussels, cheese, sausage, poisonous, pork, bacon, trichiniasis, putrescent food. II.-NEUROTIC (NARCOTIC OR CEREBRAL) POISONS. Opium, poppies, Godfrey's cordial, Dalby's carminative, camphorated tincture of opium (paregoric elixir), powder of ipecac and opium (Dover's powders), black drop Battley's sedative solution, chlorodyne, nepenthe, tincture of opium (laudanum;, morphia and its salts, hydrocyanic or prussic acid, cyanide of potassium, essential oil of bitter almonds, narcotic liquids and vapors, sulphide of carbon, coal naptha, wood naptha, amy- lene. fusil oil, (amylic alcohol), benzole, nitrobenzole, aniline, oil of worm- wood, nitroglycerine or gleonoine, alcohol, ether, chloroform, camphor, tobacco, nicotina, cocculus indicus, picrotoxine, darnel seeds, calabar bean, fungi, henbane, lactucarium, solanum. m.-SPINAL POISONS. Strychnia, brucia. IV.-CEREBRO SPINAL POISONS. Conium maculatum (hemlock), conia, oenanthe crocata, aethusa cynap- ium, aconite (monksbane), aconitina, atropia belladonna (deadly night- shade), atropia, lobelia inflata (Indian tobacco), digitalis purpura (fox glove), datura stramonium (thorn apple), cristus laburnum (laburnum), taxus baccata (yew), ligustrum vulgare (birch). V.-GASEOUS POISONS. Carbonic acid, charcoal vapor, carbonic oxide, coal and coke vapor, sul- phurous acid, vapor of lime, cements and brick kilns, confined air, coal gas, carburetted hydrogen and water gas, sulphuretted hydrogen, effluvia of drains and sewers, mephitic vapors, exhalations from the dead. VI.-LiGHTNING, COLD, HEAT, STARVATION, DROWNING. Under the last head are included certain physical causes of death which cannot be strictly classed with poisons. It is evident from the preceding enumeration that, in a medico-lega! view, many substances must be regarded as poisons which are daily em- ployed as medicines and as valuable materials absolutely indispensable in the arts and manufactures. Thus arsenic, a violent poison, enters into the composition of many pig- ments, and of many preparations used in destroying insects and pests of all kinds, and for the preservation of stuffed birds and animals, and the CCCXL Preventable Causes of Disease: Joseph Jones, M. D. embalming of dead bodies. Cases of ill.health and actual poisoning have occurred from the extensive use of arsenic in the preparation of certain kinds of decorative wall paper. Paris green, extensively used for the des- I ruction of caterpillars in the cotton fields, has destroyed life upon various occasions, and pigments containing arsenic have actually been used in coloring candies, and have destroyed the lives of children. COPPER VESSELS AND COPPER IN ARTICLES OF FOOD. At the meeting of the Board of Health, on Friday evening, November 27, 1881, the following paper was submitted by the President : The extensive employment of copper vessels in cooking, as well as the use of certain salts of this metal as pigments for coloring wall papers, several articles of food-as pickles, fruits and candies-have been the oc- casion of accidental poisoning in this and other cities, and the attention of medical inspectors and of sanitarians should be directed to this source of disease. All the salts of copper are poisonous, only those more commonly known in commerce as Scheele's green (arsenite of copper), blue vitrol (sulphate of copper), and verdigris (subacetate of copper), will be considered. The sulphate of copper (blue vitriol) has been frequently taken and ad ministered in large doses for the purpose of suicide and in attempts at murder; in the latter case the strong metallic taste possessed by this salt would in general render it impossible that the poison should be taken un- knowingly. The arsenite of copper (Scheele's green/ owes its poisonous properties chiefly to arsenic. With the exception of these salts, poisoning by copper is usually an ac- cidental result of the common employment of the metal for culinary pur- poses. The sulphate of copper, it doses of half an ounce and upwards, acts as a powerful irritant on adrets, and a much smaller quantity would' suflice to destroy infants or children. It speedily causes vomiting of the most vio- lent kind, and the vomited matters are remarkable for being generally of a blue or green color. If the green color of the vomited liquids is owing to altered bile, it will not acquire a blue color when adding to a portion of the green liquid a sr tong solution of ammonia; but if it is caused by a salt of copper, the change of color will indicate the fact. The symptoms of poisoning by the sulphate of copper are headache, colicky pains in the abdomen, with purging and vomiting; and in aggravated cases, spasms of the extremities and convulsions have been noted. The medicinal dose of sulphate of copper, as an emetic, is from live to fifteen grains ; and as a tonic, from one or four grains. The subacetate of copper (verdigris) produces symptoms somewhat simi- lar to those caused by the sulphate, namely, a strong styptic, metalic taste; also, a sense of constriction in the throat, followed by some colicky pains, vomiting of a green colored liquid, and purging, with violent strain ing (tenesmus). In consequence of the uncertainty of its operation, subacetate of copper is not employed internally. The arsenite of copper (Scheele's green) is met with in commerce and the arts, and constitutes, wholly or in part, a great variety of green pigments, known as emerald green (aceto-arsenite of copper), employed for paper hangings, mineral green, Brunswick, Schweinfurt or Vienna green; in oil paint, in cakes, in boxes, ot water colors, in the green coloring matter Preventable Causes of Disease : Joseph Jones, M. D. CCCXLI spread over confectionery, in wafers, in adhesive envelopes, and in various kinds of green decorative papers used for covering the walls of sitting and bedrooms. Although the arsenite of copper is insoluble in water, it is sufficiently soluble in the acid mucous fluids of tie stomach to be taken up by the absorbents and carried as a poison into the blood. The symp- toms induced are similar to those caused by arsenic-violent irritation of the stomach, vomiting, purging, and intense burning sensation and colic. Toxicologists have recorded many cases of fatal poisoning in children from eating confectionery colored by the green arsenite of copper. Many of the colors used for confections are of a poisonous nature; the pink color given by cochineal or madder is the only one which can be regarded as innocent. Death has been caused by the employment of the arsenite of copper, to give a rich green color to blance mange, and it has thus been ignorantly employed for the coloring of materials served at public dinners, under the impression that emerald or mineral green was nothing more than an ex- tract of spinach. The use of this poison to impart a bright green color to the shelves of bakers and green grocers shops is dangerous and should be prohibited, as, the bread and meats resting upon these shelves may be contaminated. It is well known that wall papers covered with loosely adhering aceti- arsenite of copper are, from their cheapness as well as their brightness of color, extensively used in dwellings. This pigment consists of fifty-nine per cent of arsenic, and from these unglazed papers the poison may be easily scraped or removed by friction. It has been computed that a square toot of this paper may yield from twen- ty-eight to seventy grains of the arsenical compound, and iu rooms exposing five or six hundred square feet arsenic is thus liable to be dissolved in the state of a fine dust or powder in the air of the room. It has been observed by the physicians and toxicologists, in this and other countries, that work- men who hang these papers or who strip them from the walls suffer from symptoms referable only to the action of arsenic. The symptoms as described by careful observers are of a uniform char- acter, showing their origin from a common cause, namely: dryness and ir- irtation of the throat, with cough, irritation of the mucous membrane of the eyes and nostrils, dry cough, languor, headache, loss of appetite, nausea, colicky pains, numbness, cramp, irritability of the bowels, attended with mucous discharges, great prostration of strength, a feverish condition and wasting of the body. Medical writers have recorded various deaths among children from the use of the paper; and it is held by eminent toxicologists that many insidious cases of illness and chronic diseases may be referred to the noxious practice of covering the walls of sitting-rooms and bedrooms with arsenic. The manufacture, as well as the use, of paper thus colored with arsenite of copper, or any other poisonous compound, should be prohibited by leg- islative enactment. The sub-chloride and carbonates of copper are also irritant poisons, but ard not employed to any extent in the arts and medicine. The action of certain articles of food on copper, when it is; used for culinary purposes, is not an unfrequent cause of accidental poisoning. Metallic copper undergoes no change by contact with water, unless air is present, when a hydrated carbonate, mixed with oxide of copper is formed. If the water contain any acid, such as vinegar, or common salt, or if there is oily or fatty matter in contact with the metal, then the copper is more rapidly oxidized, and the liquor or fat acquires a green color. CCCXLII Preventable Causes of Disease: Joseph Jones, M. D. If the copper vessel is kept perfectly clean, and the food prepared in it is allowed to cool in other vessels, there is no great risk of its acquiring a poisonous impregnation. The sanitarian, however, should insist that no acid, saline, fatty or oily liquid should be prepared as an article of food in a copper vessel. The preparation of fruits, such as preserves, and the boiling of milk, coffee and tea in copper vessels, shold be discontinued. In this form of copper poisoning the symptoms rarerly appear until after the lapse of three or four hours, and are characterized by nausea, vomiting, colicky pains, and pinching cramps in the limbs. It should be further observed that all the ordinary copper employed in culinary vessels contaiins arsenic. It has been stated that an impure alloy used by some dentists has been so largely composed of copper as to affect the health of those who have used the plates. The acids and salts in the saliva facilitate the production of a poisonous salt of copper, and prob ably set free arsenic. In the making of preserved fruits and vegetable pickles, the salts of copper (blue vitriol) are sometimes used for the purpose of giving a rich green cojor. LEAD AND US COMPOUNDS Lead and its compounds occasion, perhaps, a greater number of cases of disease and death than any other poison, and. in fact, than all other poisons combined. In the use of lead pipes and lead cisterns it has been established that the purest forms of water, like that furnished by the clouds and stored in our cisterns, act most energetically upon lead, and most rapidly induce symptoms of lead poisoning-violent cramps (colica pictonum) and general paralysis. The use of lead pipes, lead gutters, or lead tanks, for conveying and storing water in this city, is fraught with danger to health and life. Some estimate of the effects of lead as a poison upon the citizens of New Orleans may be formed by examining the records of our great Hospital. CASES OF DEATHS FROM COLICA PLNCTONUM (LEAD COLIC) IN THE CHARITY HOSPITAL OF NEW ORLEANS DURING A PERIOD OF THIR- TY-FOUR YEARS. 1842-1880. During the 18 years preceding the civil war (1842-1860) the total admis- sions into the Charity Hospital from all causes numbered 207,356; total, deaths, 29,616, 14.2 per cent; and during this period 710 cases of colica pictonum were treated, with 15 deaths-per cent, 2.7. During the 16 years following the civil war (1864-1880) the total admissions numbered 96,857 ; deaths, 14,104; percent; 14.5; colica pictonum, 122; deaths, 4; per cent of deaths, 3.2. During 34 years (1842-1880) the total admissions numbered 304,214; total deaths, 43,710; 14.3 per cent deaths; total cases of colica pictonum during this period 840, with 19 deaths. We find upon careful analysis of the records that during this same period of 34 years, 684 cases of colic, with 5 deaths, were entered upon the books of the Charity Hospital, a large portion of which were, without doubt, due to the slow action of lead upon the human system. If to these statistics it were possible to add the large number of patients entered with paralysis caused by lead, it will show that not less than 2000 of the citizens of New Orleans have been compelled during the past 34 years to seek relief and treatment for the effects of lead within the walls of the Charity hospitol; of course a far greater number thus afflicted did not seek relief at the hands of charity. Various destructive and corrosive poisons, as sulphuric, nitric and hydro- chloric acids, are extensively used in the arts, manufactures and agricul- ture, and can at all times be purchased in any quantity desired. The same thing is true of oxalic acid, a potent vegetable poison, and used by shoemakers, and also by washwomen to remove ink stains, etc., from clothes. Preventable Causes of Disease: Joseph Jones, M. 1). CCCXLIII Cyanide of potassium is one of the most formidable poisons known to to the chemist; and the extensive use of this salt in certain arts, and especially in photography, has given rise to many accidents, and also afforded facilities for its easy procurement for suicide and poisoning. POISONOUS EFFECTS OF CYANIDE OF POTASSIUM GASEOUS POISONS. No subject is of greater importance to the sanitarian than the effects of impurities in the atmosphere upon the health and comfort of the peo- ple. The full discussion of the effect of aerial poisons upon the human race would embrace such questions as- 1. The variations of the constituents of the atmosphere under the con- ditions of climate and soil. 2. The variations in the normal amounts of carbonic acid aqaeous moisture, ammonia, nitric acid, sulphuretted hydrogen, carburetted hydro- gen, organic albumenoid matters, and living animal and vegetable cells. 3. The effects of terrestrial exhalations and emanations upon the atmos- phere. Under this head would be included the matters and gases ejected by volcanic eruptions, and the various products of the putrefaction of ani- mal and vegetable compounds, in swamps, cess pools, gutters and sewers. 4. The effects of variations in the composition of the atmosphere and in the matter, gases and germs resulting from putrefaction. In this re- port we propose to limit our researches to the following : POISONOUS EFFECTS OF ILLUMINATING AND HEATING GASES WATER GAS (HYDROGEN AND CARBONIC OXIDE), AND OF COAL GAS (CARBU- RETTED HYDROGEN AND CARBONIC OXIDE.) The reletive merits of water gas and coal gas, as well as their compara- tive poisonous effects, have recently engaged the attention of the civic authorities of this and other States, and the question, as far as it relates to the city of New Orleans, was referred by the Mayor and City Council to the ['resident of the Board of Health of the State of Louisiana. CONCLUSIONS. From the preceeding facts we conclude: 1. Water gas is superior to the ordinary coal gas in heating power. 2. Water gas can be furnished at less cost to the consumer than ordi- nary coal gas. 3. The products or effects of burning water gas are less objectionable and less injurious than those arising from the combustion of gas from coal gas. 4. All forms of illuminating gases, from whatever source Merived, are poisonous when inhaled in large quantities, or in small quantities during considerable periods of time. CCCXLIV 5. The public health should be secured from the accidents arising from imperfect apparatus for supplying illuminating gases, by the most stringent laws, and by repeated and thorough inspections. 5. The subject of the influence of illuminating gases upon the health of cities and towns should receive the careful attention of the Board of Health. 7. One argument in favor of the electric light as contrasted with that furnished by illuminating gas is, that it is neither explosive nor poisonous, and produces little or no injurious contamination of the surrounding at- mosphere. Preventable Causes of Disease : Joseph Jones, M. D. Preventable Causes of Disease : Joseph Jones, M. D. CCCXLV ACTUAL NUMBER OF CASES OF POISONING, ACCIDENTAL OR INTENTIONAL, IN NEW ORLEANS. The great Charity Hospital of the city furnishes the most important field for this investigation, and I have examined, classified and consoli- dated its records with care, with the following results : TOTAL ADMISSIONS AND DEATHS FROM ALL CAUSES, AND TOTAL CASES AND DEATHS FROM POISON IN THE CHARITY HOSPITAL OF NEW OR- LEANS, DURING A PERIOD OF THIRTY-TWO YEARS-1842-1881, BY JOSEPH JONES, M. D. Years. Admissions Deaths. Poison. Remarks. Cases. Deaths. 1842 4404 704 2 1 1843 5013 1041 2 0 1844 5846 713 2 0 1845 1846 .. ....... 8044 855 0 0 1848 11945 1897 1 0 Laudanum. 1849 15558 2741 5 3 Laudanum. 1850.... 18476 1884 2 1 Laudanum. 1851 18319 1869 1 1 Laudanum. 1852 17957 2098 1 1 1853 13759 3164 1 1 Chloroform. 1854 13192 2702 0 0 1855 12192 2391 0 0 • 1856 9432 974 2 1 Laudanum. 1857 8897 1017 0 0 1858 11337 2299 0 0 1859 12775 1321 0 0 1860 14000 1390 0 0 Total for 17 years 19 9 Years. Admissions. Deaths. Poison. Remarks. Cases. Deaths. 1864 4861 812 2 o Arsenic 1. laudanum 1 1866 9329 1122 9 2 Belladonna 1, nitric acid 1, opium 1, camphor 1. Phosphorus 1. 1867 . 8612 1438 3 1 1868 4981 490 9 4 1869 6177 784 2 0 1870 7837 1118 7 0 1871 6651 891 6 2 1872 5541 825 7 3 Opium 3, arsenic 1, strych- nine 1. 1873 ......... 5090 993 6 2 Sulphate of zinc 1, opium 4. 1874 5231 860 2 0 Opium 2. Opium 2, strychnine 1. 1875 4845 753 1 1876 . 5690 742 7 1 Opium 4. 1877 6002 805 4 2 Opium 2, carbolic acid 1. Arsenic 2, opium 3. Phosphorus 2, opium 3, 1879 5246 693 8 4 1880 4884 658 8 1 chloral 1, poison oak. Total for 15 years. 85 25 CCCXLVI Preventable Causes of Disease: Joseph Jones, M. D. It will be observed that during a period of seventeen years-1842-1860 -nineteen cases of acute poisoning [exclusive of lead poisoning] were treated, about one-half [nine] of which proved fatal; while during a period of fifteen years [1864-1880] following the recent civil war eighty five cases of acute poisoning [excluding lead poisoning] were treated, less than one- third [twenty-five] proved fatal. These facts would iudicate that poisoning is becoming more frequent in New Orleans. At this time it is clearly shown that the disease and death arising from the administration of poison, either for purposes of suicide or malice, form but a very small fraction of the total diseases and deaths from all causes in New Orleans. The comparatively small effect of poison upon the death rate of New Orleans is still further illustrated by a consideration of the large number of patients treated iu the Charity Hospital for mechanical injuries, as shown by the following statistics : during 18 YEARS-1842-60. DURING 16 YEARS -1864-80. DURING 34 YEARS-1842-80. Causes. Cases. Deaths Causes. Cases. Deaths Causes. Cases. Death Burns 547 73 Burns 442 79 Burns 989 152 Scalds 274 33 Scalds 12 1 Scalds 286 34 Fractures.... 1962 227 Fractures. 1202 103 Fractures 3164 330 Contusions.. . 4417 29 Contusions ... 863 13 Contusions... 5280 42 Luxations .. 308 4 Luxations ... 209 2 Luxations... 517 6 Wounds 3319 189 Wounds 3415 134 Wounds 6464 323 Total L6700 887 Whilst, therefore, during a period of thirty-four years, 16,700 cases of wounds and mechanical injuries, with 887 deaths resulting therefrom, were treated iu the Charity Hospital, only 104 cases, with 34 deaths, by poison- ing were reported. Preventable Causes of Disease : Joseph Jones, M. D. CCCXLVII The deaths occasioned by accidental or intentional poisoning in New Orleans, generally, in like manner, form but a small proportion of the deaths, and are tar less than those occasioned by violence, as will be seen from the following table : DEATHS FROM POISONING, SUICIDE, KILLING AND MURDERING, AND FROM GENERAL AND LOCAL INJURIES IN NEW ORLEANS, DURING A PERIOD OF 23 YEARS. YEAR. Deaths from poison. Suicide. Killed or Murdered. Local Injuries. General Injuries. Total deaths from all Causes. 1849 5 0 91 165 9862 1850 9 10 66 156 7819 1853....... 4 14 47 200 15787 1856.. ... 1 20 26 51 127 5069 1857 .. . 5 19 18 59 109 5581 1858 7 21 6 77 183 11720 1860 3 20 31 60 237 7341 1865 4 10 9 49 123 7016 1866 11 7 6 40 133 7754 1867 6 16 55 31 126 10096 1868 8 19 17 72 102 5343 1869 0 8 3 57 152 5593 1870 6 11 5 86 137 6942 1871 19 14 14 80 190 6059 1872 7 26 18 77 218 6588 1873 11 9 27 56 149 7995 1874 18 20 12 119 182 7193 1875 11 18 12 70 161 6535 1876 10 12 9 66 154 6685 1877 2 3 9 36 182 7169 1878 i 16 10 52 147 10717 1879 2 21 8 42 119 5122 1880 4 20 4 43 128 5623 Total .... 154 334 309 1428 3580 168255 During a period of twenty-three years there perished in New Orleans by poison, 154; by suicide, 334; killed or murdered, 309 ; by local injuries 1328; by general injuries, 3580; out of a grand total ot deaths from all causes, of 168,255. SOCIETY FOR THE RECOVERY AND RESCUE OF DROWNED PEOPLE-DROWNED IN AND AROUND NEW ORLEANS. It is worthy of note, on the other hand, that the number drowned an- nually in the city of New Orleans exceeds those dying by poison and sui- cide. Thus in i860 the deaths by drowning numbered 88; 1861, 79; 1867, 80 ; 1868, 62 ; 1869, 59 ; 1870, 69; 1871, 74 ; 1872, 64 ; 1873, 77 ; 1874,93; 1875, 73 ; 1877, 61; 1878, 59 ; 1880, 54. During the fourteen years specified 1002 (one thousand and two) of the inhabitants of New Orleans perished by drowning. Without doubt, the majority of the unfortunate beings perished in the full vigor of manhood and womanhood. The value of each inhabitant to the State has been es- timated at $1000 (one thousand dollars), and if this estimate be accepted, New Orleans has lost, through this channel alone, one million of dollars during the past fourteen years. But this is a mercenary view, and leaves out of view the physical, mental and moral distress of the afflicted friends and families. CCCXLVIII Preventable Causes of Disease : Joseph Jones, M. D. Situated upon the banks of the most important river in the world, whose bosom is plowed by the ships of all nations, New Orleans, of all cities, should establish a society or association for the recovery and salvation of drowned and drowning people. POISONOUS EFFECTS OF ALCOHOL-DELIRIUM TREMENS AND MANIA A POTU. It can be clearly demonstrated, by facts, that alcohol is the most destruc- tive of all poisons to the human race, and to this general assertion the cit- izens ofNew Orleans form no exception. Thus in 1857, in the city of New Orleans, the deaths from intemperance and delirium tremens numbered 84; 1858. 139; 1859, 138; 1860, 175 ; and during the four years specified 526 in- dividuals perished in New Orleans from the direct effects of alcohol. A more direct demonstration of the effects of alcohol in producing di- sease and deaths can be derived by a careful examination and consolidation of the statistics of the Charity Hospital, which must be regarded as the great pathological thermometer or weather-gauge of the health of New Orleans. The records of the Charity Hospital of New Orleans show the following important facts: During a period of thirty-four years-1842-1862 ; 1864-1880-there were treated in the wards of this institution 4694 cases of delirium tremens and mania a potu, of which number 914 (19.4 per cent) died; during the same period 1873 cases of intemperance were treated, of which 97 (5.1 per cent) terminated fatally. That is, during a period of thirty-four years, in the city of New Orleans, an army of 6567 trembling, maddened, raving, drunken men and women, poisoned by alcohol, were conveyed to the wards of the Charity Hospital, and of which number more than one-seventh, or 1011 (one thousand and eleven), perished. To estimate fully the destructive effects of alcohol we must add the cases of death from the following diseases, treated in the Charity Hospital during the same period of thirty-four years, 1842-1880: Diseases. Cases. Deaths. Per Cent. Chirrhosis of Liver .. 390 240 61.5 Abscess of Liver . .. 131 88 67 1 Ascites 981 428 43 j6 Gastritis.. 1673 124 7 4 Anasarca 896 269 30.0 Hepatitis 806 221 27.4 From the diseases just specified, which, as are well known, are in a large measure dependent upon the use of distilled liquors in hot climates, there resulted 4877 cases and 1370 deaths. It would be fair to estimate that, during the last thirty-four years (allowing for the relative proportion of deaths and cases of sickness in the city and Charity Hospital), alcohol has directly caused at least 20,000 cases of sick- ness and occasioned over 5000 deaths in the city of New Orleans. It is impossible to form any correct estimate of the pecuniary loss to the city and State by the destructive effects of alcohol, for of all poisons it oc- casions the greatest physical, mental, moral and industrial loss. But the worst feature of the question of the influence of spirit drinking upon the population is its direct relation to crime. Preventable Causes of Disease : Joseph Jones, M. D. CCCXLIX New Orleans is not only the great seaport of the Mississippi Valley, and an important gateway for foreign immigrants to the Southern and South- western States; but its population is heterogenous, and its streets are thronged by the representatives of every country upon the globe. A large portion of its population have no interest, either personal or in- herited, in the institutions of the State and general governments. The emptyings of prisons, hospitals and almshouses, and the worst elements of the surrounding States and European society, are constantly fermenting and putrefying in this vast caldron. It is, therefore, not a matter of surprise that the government and proper policing of a city with such diverse elements should not only be difficult, but that rowdyism, crime, drunken rioting and "hoodlumism" should be common, and that officials dependent for their election upon such elements, and often sprouting like the foul fungus from its native soil, should not only fail in the execution of the laws, but should often furnish themost striking examples of their infraction. These difficulties are common to all great sea- port towns and cities in this country and Europe, and the term "modern Sodom" is no more applicable to New Orleans than to New York, Phila- delphia, Baltimore, Paris, Liverpool, Glasgow or London. On the other hand, it must be admitted that in New Orleans, as well as in the other great cities just named, those great monuments of the Chris- tian religion, churches, hospitals, public schools and benevolent societies, are mighty agencies for the preservation and advancement of the material and moral and intellectual welfare of the citizens. If the files of our daily papers and the records of our police courts, prisons, hospitals and asylums be examined, it will be found that the great cause of misery, want, insanity and crimes of all kinds, culminating in suicide and murder, originates in the unrestrained sale and the unres- tricted consumption of alcoholic stimulants, known to the public under the various names of whisky, brandy, gin, rum and absynthe. The vast proportion of street fights, stabbings and shootings occur within and around the liquor saloons, corner groceries and barrel-houses, found upon every square within the populous districts of this city; and six-sevenths ot the inmates of our prisons, work houses and insane asylums, were di- rectly or indirectly brought to their degradedand distressed state by whisky. In the drinking saloon, bar-room and barrel-house, the rank and file of voters congregate, and the candidates for place and power too often find such places a grand field for bargaining and bribing, and use whisky as a potent agent. It is the province of our wise, learned and incorruptible legislators to devise ways and means to regulate the unrestrained sale of distilled liquors, and to command the peace at all times and in all places. It is not our in- tention to inquire whether expostulation would be useless and entreaty despised, and legal proceedings utterly unavailing, through the intricacies of law processes and the failures of the officers of justice; but, as Presi- dent of the Board of Health, of the State of Louisiana, I desire by stern facts to arouse the public to a sense of the effects of the greatest and most destructive of all poisons. The poison, alcohol, which is accessible in all places and at all times to all the citizens of Louisiana, dethrones reason, undermines and gangrenes the moral and intellectual nature, dissipates credit, blasts the reputation, disrupts the tenderest and purest family and social ties, and destroys both body and soul. CCCL Preventable Causes of Disease : Joseph Jones, M. D. As President of the Board of Health 1 desire to arouse the attention of its members and of those charged with the sanitary and quarantine legis- lation of this great State to the importance of establishing efficient means to protect its citizens from the adulteration of food and medicine. At the meeting of the Board of Health held August 11,1881, I urged the establishment of the inspection of articles of food, milk, fermented and distilled liquors, and drugs, upon an equitable and thoroughly scientific basis. Not only was this subject amply illustrated by the sanitary and medico- legal history of New Orleans, butthe great truth was recognized that such labor should be confided only to men of the highest intellectual and moral character and scientific attainments. If any scheme looking to the protec- tion of the most vital interests of the citizens be adopted, either by the Board of Health and City Council, acting in conjunction, or by the Legis- lature of the State, acting in its sovereign capacity, it is important that intellectual, moral and scientific attainments alone should be recognized and employed. If such offices, demanding thorough microscopical and chemical training and knowledge of the most profound and varied character, be peddled out by political demagogues for the reward of some past political service, it would be best to stop at the threshold, and leave to wiser times the estab- lishment of a system of inspection and investigation by skilled chemists, pathologists and toxicologists-labors of the highest value to the common- wealth. Nepotism is not confined to Popes, Kings, Presidents and Generals; but it may sadly impair the influence and usefulness of sanitary boards and State and municipal governments. Since the great epidemic of 1878 the medical mind has been to a large extent deranged on the subject of yellow fever, and the professional and public mind has been concentrated upon this disease, which prevails only at long intervals of time, to the almost total neglect of the consideration of those causes of disease and death which are ever active and which are far more potent and destructive. The results of the agitation of 1880 and 1881 have, however, established the important fact that the President of the Board of Health of the State of Louisiana has enjoyed the confidence of the health authorities of Texas, Alabama, Kentucky and Missouri, to such an extent that any organized system of quarantine against healthy New Orleans has been impossible, de- spite the doubting, if not hostile, attitude of certain interested parties. ADULTERATION OF FOOD AND MEDICINE. FOOD RESOURCES OF LOUISIANA. The soil of this State, in virtue of its variations in composition and ele- vation, is adapted to the successful cultivation of sugar cane, rice, cotton, corn, wheat, rye, barley, oats and all the fruits common to the temperate and sub-tropical zones. Louisiana possesses, perhaps, the most fertile soil of any of the States of this Union, in virtue of the large proportions of the alluvium of the Mississippi Valley enclosed within her borders. As is well known, a wide belt of recent alluvium borders the Mississippi river from the mouth of the Ohio to the Gulf, seventy-five miles wide in the greatest expansion at Napoleon, and twenty-five miles in its greatest contraction at Natchez and Helena. The area of the alluvial tract above the delta is 19,450 square miles. The depth of the alluvial deposits, from Cairo to New Orleans, ranges between twenty-five and forty feet. Preventable Causes of Disease: Joseph Jones, M. D. CCCLI The area of the delta of the Mississippi river, which lies almost wholly within the borders of Louisiana, assuming that it begins where the river sends off its first branch to the sea, namely, at the month of Bayou At- chafalaya, is estimated at 12,300 square miles. This would be at the mouth of Red River, in latitude 31°, whilst the mouths of the Mississippi are in latitude 29°; so that the delta extends through two degrees of space. The entire delta is elevated but a few feet above the level of the Gulf of Mexico, and from its fertile soil, and proximity to the Mississippi river and bayous, is perhaps as fertile as any body of land in this or any other con- tinent, and is admirably adapted to the cultivation of rice and the sugar cane. RICE. The production of rice has been steadily increasing in Louisiana, and the quality of this invaluable grain will compare favorably with the famed rice of South Carolina and Georgia. It has been asserted that a larger number of the inhabitants of the globe live upon rice than upon any other grain, and here in Louisiana we have one of the most important articles of human food produced in the greatest abundance and in absolute purity. The very form and nature of the beau- tiful snow-white grain of the clean rice absolutely precludes the possibility of aduleration. PURITY OF THE SUGAR AND MOLASSES OF LOUISIANA. CHEMICAL EXAMINATION OF SEVERAL KINDS OF MOLASSES, OFFERED IN THE MARKETS OF NEW ORLEANS, LA. {By Joseph Jones, M. D., Professor of Chemistry in the Medical Department of the University ot Louisiana.] The method of manufacture of sugar pursued by the planters of Louisi- ana, as I have determined by actual investigation and analysis, insures not only good sugar, but also pure and wholesome molasses. In response to the request of sugar refiners and merchants, 1 made a careful chemical analysis of the most important varieties of molasses and syrup offered for sale in New Orleans, with the following results: Gentlemen-In accordance with your request, I have submitted the samples of molasses furnished, to careful chemical analysis, with the fol- lowing results: This examination has been executed with care, and has been extended so as to embrace the points of interest, in a sanitary as well as in a commercial point of view. The public, as well as the sugar manufacturer and refiner, is interested in the investigation of the quality and purity of a product which is daily consumed in large quantities as an article of food. This report also contains matter of special importance to the sugar planters of Louisiana. The value of one of the staple products of Louisiana is seriously threatened by the importation of inferior kinds of molasses from Northern manufactories. NO. I.-LOUISIANA MOLASSES. Physical Properties.-Clear, rich, brownish red color. No deposit. Free from all dark particles, specks or impurities. Sweet, pure saccharine taste. The Louisiana molasses leaves no unpleasant taste in the mouth, and it is well established that it never blackens the teeth. CCCLII Preventable Causes of Disease : Joseph Jones, M. D. Chemical Properties.-Ferrocyanide of potassium, ferricyanide of potas- sium, tincture of galls, and other tests ol iron, produced not the slightest discoloration. The absence of the salts of iron from the Louisiana molasses was ren- dered still further evident by the character of the ash obtained by careful incineration. Each gallon yields less than 350 grains of white ash, con- sisting almost entirely of the carbonate and sulphate of lime, and the chlorides and carbonates of soda and potassa, with only slight traces of iron. The characteristic tests for lead and other metals, in like manner gave no indications of metallic impurities. Solutions of nitrate of silver, chloride of barium and oxalate of ammonia, produced only that slight turbidness in solutions of Louisiana molasses which is characteristic of all products from the juices of such plants as the sugar cane. Specific gravity of Louisiana molasses, 1377.8. • The specific gravity in this case, as in all others recorded in this report, was accurately determined upon the balance, and not in the ordinary and less accurate method with the saccharometer. The following is the composition of 70,000 grains of Louisiana molasses as determined by chemical analysis. SEVENTY THOUSAND GRAINS OF LOUISIANA MOLASSES CONTAIN : Sugar. Sugar, including both varieties, Crystalizable ? Crystalizable sugar, grains 41,845.2 and Uncrystalizable, grains 53,845.20 $ Uncrystalizable " 12,000.0 Saline Constitutents. Carbonate and Glucate of Lime grains 86.39 Sulphate of Lime " 142.83 Chlorides of Sodium and Potassium " 156.15 Seventy thousand grains, yielded upon analysis, the individual components of the salts in the following quantities . Lime grains 107.18 Chlorine " 95.09 Sulphuric Acid " 89.03 In the determination of the amounts of crystalizable and uncrystalizable sugar, the method of M. Barreswill was employed in this case, as in all the other analyses recorded in this report. The method of Barreswill is founded upon the following facts : Grade sugar forms definite but unstable combinations with the alkaline bases; and their compounds, even at ordinary temperatures, gradually undergo change. Their solution, which is at first strongly alkaline, be- comes neutral, owing to the formation of a powerful, colorless but uncrys- talizable acid ((ilucic acid), which remains in combination with the base. Glucic acid, when boiled with water, absorbs oxygen and becomes brown. A new acid which is not crystallizable, termed by Mulder apoglucic acid, is formed. If an alkaline solution of grape sugar be heated, the sugar is rapidly destroyed, or converted into a dark brown acid body, termed melassic acid. This body has a powerful affinity for oxygen, and when boiled with an alkaline solution, to which a salt of black oxide of copper has been added, speedily reduces the black oxide of this metal to the con- dition of the red oxide. The amount of sugar which any mixture contains may be estimated by an alkaline solution of tartrate of copper and potash of known'strength. Fehling recommends for the preparation of the standard copper solution the following proportions, as reduced to English weights; 1 ounce of crys- Preventable Causes of Disease: Joseph Jones, M. D. CCCLIII tailized sulphate of copper; three ounces of cream of tartar; one and a half ounces of pure carbonate of potash ; fourteen or sixteen ounces of a solution of caustic soda (Sp. Gr., 1.12), and water, until the solution meas- ures 15,160 water grains. Two hundred measured grains of this solution contain a quantity of copper, which would be reduced by one grain of sugar reducing ten equivalents of the black oxide of copper to the state of suboxide. A given volume of this solution is placed in a porcelain capsule and heated nearly to its boiling point. The solution of sugar to be tested is then added by degrees from a burette, until the addition of the syrup ceases to produce any further precipitate. The proportion of sugar which is present in the liquid will be inversely as the volume of the saccharine solu- tion consumed. Cane sugar, however, does not reduce the alkaline solution of tartrate of copper ; consequently, no indication of the presence of cane sugar is af- forded by this re agent. Nevertheless, a qualitative determination, even of this variety of sugar, may be effected by means* of this method, provided that a given volume of the saccharine liquid, accidulated slightly with sulphuric acid, be diluted with water and boiled two or three hours. The cane sugar is thus converted into fruit sugar, and on diluting this liquid with water until it occupies a definite volume, the proportion of altered sugar which it contains may be ascertained. Supposing both kinds of sugars to be present, a preliminary experiment is made before boiling with acid, in order to estimate the amount of fruit or of grape sugar, and by deducting this from the quantity found after acidulating the liquid and boiling, the proportion of the cane sugar is as- certained. The results of the preceding analysis establishes not only the high com- mercial value of Louisiana molasses, but also its great purity and absolute freedom from all injurious ingredients. Louisiana molasses is therefore valuable, not only as a source of crystalli- zable sugar, but also as an article of food of the most nutritious and supe rior quality. NO. II-CUBA MOLASSES. Physical Properties.-Dark reddish brown color, with black fiakes and specks of carbonized organic matters. Upon standing, deposited a slight, dark colored, inclining to black sediment. Taste peculiar to Cuba molasses, and giving the impression of saline ingredients. CAmwaZProperties.-Ferrocyanide of potassium, ferricyanide of potas- sium and tincture of galls, revealed the presence of the oxides of iron in small amount. Upon chemical analysis of the molasses in solution, and of the saline ingredients upon incineration, no other metallic salts were de- tected. Solutions of chloride of silver, chloride of barium and oxalate of amo- nia produce bulky precipitates. Upon incineration, the saline residue amounted to 2100 grains in 70,000; and the saline constituents presented a reddish brown color, from the pres- ence of the oxide of iron. Specific gravity 1376.4. The following is the composition of 70,000 grains of Cuba molasses : CCCLIV Preventable Causes of Disease: Joseph Jones, M. D. 70,000 GRAINS OF CUBA MOLASSES CONTAIN : Sugar. Sugar, including both varieties, Crystalliza- Crystallizable sugar, grains 30,194 ble and Uncrystaliizable grains 46,666 $ Dncrystallizable " u 16,472 Saline Constituents. Carbonates of Soda, Potassa and Magnesia grains 350.94 Carbonate of Glucate of Lime " 634.10 Sulphate of Lime " 254 27 Chloride of Sodium and Potassium " 738.19 Sulphate, Carbonate and Glucate of Iron •* 122.50 Seventy thousand grains yielded, upon analysis, the individual components of the salts in the following quantities : Lime grains 459.27 Chlorine •_ " 439.90 Sulphuric Acid " 149,96 Salts of Iron " 122.50 NO. III.-LONG ISLAND FACTORY MOLASSES. Physical Properties.-Dark reddish brown, almost black color. Taste simi- lar to that of Cuba molasses. Contains black specks, as in the case of Cuba molasses. Specific gravity, 1391.7. Chemical Properties.-Ferrocyanide and ferricyanide of potassium and tincture of galls gave evidence of the presence of the salts of iron. The saline matters obtained by incineration gave evidence of the pres- ence of the oxide of iron in the brownish red color. The characteristic tests of such metels, as lead, tin and copper, failed to reveal their presence either in solutions of the crude molasses, or in solutions of thesaline ingre- dients. the saline ingredients obtained by incineration were even more abundant than in the Cuba molasses, being 2625 grains in 70,000 grains of Long Island Molasses. The following is the composition of 70,000 grains of Long Island factory molasses: 70,000 GRAINS OF LONG ISLAND FACTORY MOLASSES CONTAIN : Sugar. Sugar, including both varieties, Crystalli- 1 Crystallizable sugar, grains 20,222.88. zaule and Uncrystaliizable, 38,888.88grs. J Uncrystaliizable " " 18,666.00. Saline Constituents. Carbonates of Soda, and Magnesia grains 488.49 Carbonate and Glucate of lime " 779.69 Chlorides of Sodium and Potassium " 894.35 Sulphate of Lime... " 259.47 Sulphate Carbonate and Glucate of Tron " 203.00 Seventy thousand grains yielded the individual components of the salts in the follow- ing quantities : , Lime grains 543.05 Chlorine " 545.07 Sulphuric Acid " 152.63 Salts of Iron u 203.00 NO.^IV.-100 BARRELS NORTHERN MOLASSES. Physical Properties.-Dark, reddish brown color. Unpleasant taste, leav- ing the astringent, metallic taste of the salts of iron, and more especially of copperas, upon the tongue. This kind of molasses is said to blacken the teeth and derange thebowels. Ferrocyanide and ferricyanide of potassium and tincture of galls, and other characteristic tests of the salts of iron, gave decided precipitates with this metal. When a solution of ferrocyanide of potassium is added to a solution of this molasses it is changed to a deep blue color, from the forma- tion of prussian blue. Preventable Causes of Disease : Joseph Jones, M. D. CCCLV The ash obtained by incineration, which amounted to 1750 grains in 70,- 000, was colored of a deep reddish brown color, from the presence of the oxides of iron. Both the crude molasses in solution, and the ash obtained by incinera- tion, were carefully tested for various metallic salts, asthoseof lead, copper and tin, but no other metallic body besides iron was discovered. Secific gravity 1372.5. 70,000 GRAINS (100 BARRELS) OF NORTHERN MOLASSES CONTAIN : Sugar. Sugar, including both varieties, Crystallize- ( Crystallizable sugar, grains 20,000 ble and Uucrystallizable 40,000 grains ) Uncrystallizable " " 20,000 Saline Constituents. , Carbonates of Soda, Potassa and Magnesia .grains 169.05 Carbonate and Glucate of Lime .. " 250.77 Sulphate of Lime " 428.57 Chlorides of Sodium and Potassium " 551.61 Salts and Oxides of Iron " 350.00 Seventy thousand grains yielded the individual components of the salts in the follow- ing quantities : Lime grains 316.9 Chlorine " 311.4 Sulphuric Acid. " 252.1 Salts and Oxides of Iron " 350.0 PHYSICAL PROPERTIES-DARK BROWNISH, ALMOST BLACK COLOR, WHEN SEEN IN MASS. No. V. Seventy-nine barrels Northern Syrnp. Sour taste, but leaves a decided astringent and metallic taste in the mouth, similar to that of a solution of copperas. The characteristic tests for iron, as ferrocyanide'and ferricyanide of potassium and tincture of galls, gave heavy precipitates, and abundant evidences of the presence of the salts of iron in considerable amounts. The characteristic tests for lead, tin, copper and other metallic salts, applied to the molasses in solution, and to the saline constituents, revealed their absence. The salts of iron were the only metallic compounds present. The saline constituents, which amounted to 1750 grains in 70,000 grains of molasses, were discolored of a de«p brown color from the presence of the salts of iron. The prussian blue precipitated from this Northern molasses was collected upon a filter ; it made fully as striking an appearance as in the case of the preceding sample. The following is the composition of 70,000 grains of these seventy-five barrels Northern syrup. SEVENTY THOUSAND GRAINS (SEVENTY-NINE BARRELS) OF NORTHERN SYRUP CONTAIN. Sugar. Sugar, including both varieties. Crystaliza- ) Crystallizable sugar, grains 18,461.20 ble and Uucrystallizable, 40,000 grains ( Uncrystallizable " " 21,538.00 Saline Constituents. Carbonates and Glucates of Soda, Potassa and Magnesia grains 437.62 Carbonate and Glucate of Lime " 328.36 Sulphate of Lime " 56122 Chlorides of Sodium and Potassium " 709.80 Sulphate, Carbonate. Glucate and Oxide of Iron " 243.00 Seventy thousand grains yielded the iudividual components of the salts in the follow- ing quantities. Lime grains 415.00 CCCLVI Preventable, Causes of Disease: Joseph Jones, M. D, Chlorine " 430.50 Sulphuric Acid " 330.13 Salts of Iron " 343.00 The results of the preceding analyses have been calculated for a uniform quantity in each analysis of 70,060 grains, because this is precisely the weight of one gallon of dislilled water at 60°. Thus the weight of one gallon of these various samples of molasses is, respectively : Weight of one gallon of Louisiana molasses. grains 96,446 Weight of one gallon of Cuba molasses " 95,648 Weight of one gallon of Long Island molasses . " 97,419 Weight of one gallon (100 barrels) of Northern molasses " 96,075 Weight of one gallon (75 barrels) of Northern molasses " 96,419 If, therefore, the analyses be all calculated for 100,000 grains, the pro- portions would represent very nearly those of one gallon of each of the samples of molasses reduced to a uniform standard. The figures would be slightly in excess of the actual amounts contained in each gallon, but for practical and commercial purposes would be sufficiently accurate. The following table presents the actual amounts of the constituents entering into 100,000 grains, or very nearly one gallon of each of these varieties of molasses: TABLE GIVING THE COMPOSITION OF 100,000 GRAINS <VERY NEARLY ONE GALLON) OF EACH OF THE VARIETIES OF MOLASSES, ANALYZED IN THE PRESENT REPORT. CONSTITUENTS. Louisiana Molasses. No. 1. Grains. Cuba Molasses. No. 2. Grains. Long Island Factory Molasses. No. 3. Grains. One hundred Barr'ls Northern Molasses No. 4. Grains. Seventy-nine Barr'ls Northern Molasses No.5 . Grains. Both varieties of sugar, crystallizable and un- crystal]izable .... ..... 76927 57142 57142 Crystallizable sugar .. . 59778 43134 28889 28571 26373 Non-crystalilizablc sugar 16921 23521 20665 28571 30769 Saline Ingredients. Carbonates of soda, potassa. etc 501 697 241 625 Carbonate and glucate of lime. 123 905 1113 358 468 Sulphate of lime .... 204 363 370 612 801 Chloride of sodium and potassium 213 1054 1277 7S8 1012 Salts of iron 175 288 500 490 Total saline ingredients 550 3000 3750 2500 2500 The percentage of the different ingredients may readily be determined in the preceding table, simply by cutting off' the three last figures. The following conclusions have been drawn from the preceding analyses : 1. The Louisiana molasses is decidedly superior in appearance and taste to the other four samples of molasses. 2. The proportion of crystallizable sugar is greatest in Louisiana mo- lasses, whilst the proportion of uncrystallizable sugar is the least. Thus, the proportions of sugar in the different samples are as follows : In Louisiana molasses, 59 per cent of crystallizable sugar, and 16 per eent uncrystallizable sugar; in Cuba molasses, 43 per cent of crystallizable Preventable Causes of Disease: Joseph Jones, M. D. CCCLVII sugar, 23 per cent uncrystallizable sugar; in Long Island molasses, 28 per cent crystallizable sugar 26 per cent uncrystallizable sugar ; in 100 barrels Northern molasses, 28 per cent crystallizable sugar, and 28 per cent uncrystallizable sugar; in 79 barrels Northern syrup, 26 per cent crystallizable sugar, and 30 per cent uncrystallizable sugar, 3. The Louisiana molasses is, therefore, the best for the sugar refiner, because it contains the largest amount of crystallizable sugar. 4. Molasses consists of a concentrated solution of the products of the conversion of raw sugar into caramel and other products of decomposi- tion, which, however, compose the smallest portion of the entire mass. It contains, also, those salts which are not precipitated by lime, and which have accumulated ; also, certain soluble salts of lime and combinations with the sugar; also, compounds of sugar with the salts; and lastly, a kind of gum or mucus. The solution of all these substances is necessarily saturated with raw sugar. In a practical point of view, therefore, without reference to the foreign ingredients, molasses is a solution containing sugar in two modifi- cations, in the crystallizable and uncrystallizable condition. The sugar trade will only be established upon a sure footing when those interested in it are enabled, at any time, to obtain an accurate knowledge of the real intrinsic value of the raw material. The value of these goods consists, according to circumstances, either in the amount of saccharine matter generally, or in the amount of crystal- lizable cane sugar, or in the entire quantity of both which they contain. In other words, a test is very much required, or a means of accurately ascertaing this value readily, withoutany special experience or knowledge, and at in inconsiderable cost and trouble. A test of this kind would be invaluable to refiners, and for the collection of duties and imports . No part of the business of the refiner is of so great importance as the purchase of the raw material, since a knowledge of the quantity of raw sugar can only be attained by long practice and experience. A person posessing a sound knowlege of the markets with only a super- ficial knowledge of the technical processes of manufacture, will have a great advantage over the most able practical refiner, who is without ex- perience in the purchase of raw sugar. It will be also quite impossible to preserve the integrity of the principle upon which the. duty is levied, from frauds and the like, so long as the duty is levied upon the external forms and appearances of the produce, and from the want of an accurate test and the real value of the article. The loss of sugar in the process of abstraction from the cane, and sub- sequent boiling is very great. Only two-thirds of the juice are actually ob tained by the ordinary process, and these only contain 12 per cent of the sugar contained in the fresh cane, so that 6 per cent of the sugar is left in the bagasse or fibrous structures of this sugar cane. In the cane juice, as first expressed, the entire amount of sugar is of that crystallizable variety, and varies in amount from 18 to 22 per cent, the mineral matter varying from 0.14 to 0.21 per cent. It is, therefore, worthy of note, that by the present process of boiling, of the 18 or 20 per cent of crystallizable cane sugar which is contained in the sugar cane, not more than 7£, or between 6 and 10 per cent is actually obtained, or not quite one-half. Two causes are principally active in pro ducing this loss : First, the defective method of exposing the juice; second, the chemical changeability of the sugar, which, during the course of boil CCCLVIII Preventable Causes of Disease: Joseph Jones, M. D. ]ng, gives rise to tlie production of the well known secondary product, mo- lasses or uncrystallized sugar. The uncrystallizable sugar is capable of being substituted for cane sugar only in a very limited number of cases, and will by no means supply its place for sweetening tea or coffee, or other alimentary substances. For these purposes, it is, however, that a large amount of sugar consumed is employed. The causes for this arise from greater difficulty of crystallizing grape sugar, which is a guarantee to the public of its purity, and its lesser sustaining power and degree of solubility. Both kinds of sugar are soluble, in all proportions, in boiling water; but under similar circumstances, 100 parts of grape sugar require 133 parts, or according to others 103 parts of cold water; while 100 parts cane sugar only require 33 parts to be completely dissolved. In both eases, whether the water is hot or cold, the solution of the grape sugar takes place more slowly; and in order to produce an equal sustaining effect, two-and-a-half times as much grape sugar as cane sugar is required. Powdered grape sugar has a flowery taste, when placed upon the tongue, and very gradually becomes sweet as it dissolves, leaving a mucilaginous caste at the same time; cane sugar gives a perfectly sweet taste, in a much greater degree, and in a direct manner. In order to render the two kinds upon an equality, in an economical point of view, five pounds of grape sugar should only cost as much as two pounds of cane sugar. 5. The Louisiana molasses contains far less inorganic salts than the other varities of molasses. Thus a gallon of Louisiana syrup contains about 500 grains of salts, whilst two other varieties contain from 2500 to 3700 grains per gallon. This point is of great interest to the sugar manufacturer and refiner, because the presence of these salts explains not only the difficulty attend- ing the crystallization of molasses, but also its power of absorbing moisture from the air, which it communicates to the raw sugar. It is well known that many kinds of raw sugar melt into syrup when exposed to the atmosphere. These salts also account for the purging action of the molasses. The Louisiana molasses may be considered as almost entirely free from these impurities. 6. The Louisiana molasses is entirely free from iron salts, whilst in the samples of Northern molasses these salts of iron vary from 280 to 500 grains per gallon. Cuba molasses in like manner contains iron salts, but to a less degree. The salts of iron contained in the Northern molasses, are injurious to the health, and especially to children, and at the same time they blacken and injure the teeth. 7. In every respect the Louisiana molasses is superior to each of the other samples of molasses, and combines richness and purity of composi- tion with an elegant appearance and pure taste and wholesome action. As an article of food it is tar superior to the Northern molasses, and should, for this purpose, command at least four-fifths more than the price of the latter. COTTON SEED OIL. On submitting to strong pressure the oily seeds of the cotton plant (Gossypium barbadensej, a valuable and agreeable smelling and pleasant tasted oil is obtained, which, in a purified state, is now employed for the usual purposes in commerce and in the arts, and in pharmacy, for which other brauds of oils and fats are employed. Preventable Causes of Disease : Joseph Jones, M. D. CCCLIX The production of cotton seed oil has been steadily increasing, and large importations of the oil and cake are annually made from New Orleans to England, France and other European countries. As the cotton seed oil shipped to France, Spain and Italy is often re- turned to this country tabled "Olive Oil," it is of great importance to the citizens of the United States to ascertain whether cotton seed oil is a proper substitute for olive oil-whether, iu fact, it be wholesome. This inquiry is entirely pertinent, because it is well known that the root of the cotton plant is a powerful and even dangerous medicine. I have endeavored to examine this question with care, and have em- ployed the cotton seed oil as a local application, and as the basis of lini- ments in the treatment of various painful affections, as rheumatism, with marked benefit, and no instance has come to my knowledge iu which its use as a substitute for olive oil has produced any deleterious effect. The following facts, also established by a careful personal investigation of the nutritive value and chemical composition and agricultural uses of the cotton seed, have led me to believe that cottou seed oil may be substituted with impunity for olive oil, both as food and as a basis for liniments. Iu Europe the cotton seed cake is regarded with high favor, both on ac- count of its great nutritive value and as a superior manure. The value of cottou seed as an efficient fertilizer has long been recoguized by experi- enced planters in the Southern, Atlantic and Gulf States. REPORT ON THE NUTRITIVE AND AGRICULTURAL VALUE OF DECORTICATED COTTON SEED CAKE AND MEAL. JOSEPH JONES, M. D. In accordance with the request of the directors and officers of the Louisiana Oil Company, I have carefully inspected the works and subjected the cotton seed and its products to careful chemical examination, with the following results: On submitting to strong pressure the oily seeds of the cotton plant f Gos- sypium barbadense), a valuable and agreeable smelling and pleasant tasted oil is obtained, which in a purified state is now employed for the usual purposes, in commerce and in the arts, and in pharmacy, for which other- kinds of oils and fats are employed. The production of cotton seed oil has been steadily increasing, and large importations of the oil and cake are annually made from New Orleans to England, France and other European countries. In Europe the cotton seed cake is regarded with high favor, both on ac- count of its great nutritive value, and as a superior manure. The value of cottonseed asan efficient fertilizer, has long been recognized by experienced planters in the Southern, Atlantic and Gulf States. PHYSICAL PROPERTIES AND CHEMICAL CONSTITUTION OF COTTON SEED CAKE AND MEAL AS MANUFACTURED BY THE LOUISIANA OIL COMPANY The cotton seed cake and meal, prepared by the Louisiana Oil Company, is manufactured from the shelled or decorticated seed, and is far superior to that obtained from the whole seed, which contains less oil, and a much greater proportion of ligneous fibre. The decorticated cotton seed cake has a rich yellow color, isfreefromany strong or disagreeable smell, and has an agreeable taste; itisalmostentirely free from the dark brown, comparatively valueless seed shells; audit does not contain any large amount of mucilage, nor anything that produces on CCCLX Preventable Causes of Disease: Joseph Jones, M. D. mixing with water, a volatile, pungent or injurious essential oil. Cattle take to it at once, and rapidly improve in flesh and fat when fed upon it; and so valuable is this article regarded by the most experienced and intelligent European farmers, for the feeding of stock, that it readily commands from £6 to £8 per ton. Owing to its superior qualities as food, it offers considerable economic advantages to the feeders of stock in comparison not only with other varie- ties of cake, but also with corn and wheat. The chemical composition of the decorticated-cotton seed cake is presented in the following tables: CHEMICAL ANALYSIS BY JOSEPH JONES, M. D., OF DICORTICATED COTTON SEED CAKE AND MEAL, MANUFACTURED BY LOUISIANA OIL COMPANY. One hundred parts of decorticated cotton seed cake and meal contain : Water 8.65 Oil 18.75 Albuminous compounds, ( flesh forming principles), capable of yielding 6.5 per cent of Nitrogen; valuable as a fertilizer; in the soil undergoes rapid change and yields Ammonia, Carbonic Acid and Phosphates 38.5U Sugar, Starch, Gum, Mucilage, digestible fibre, &c. (Heat producing matter), valuable as food 26.6U Mineral matters; ash composed chiefly of phosphate of lime and potash 7.5 per cent capable of forming blood and bones in stock, valuable as a fertilizer : composed of Phosphate of Lime 3.04 Phosphate of Potassa 3.51 Chlorides, containing chlorine 0.18 0.30 Sulphates, containing sulphuric acid 0.19 0.43 Carbonates of lime and magnesia . 0.20 One hundred part of ash of seed, contain : Phosphate of lime 30.62 Phosphate of potassa. 46.87 Chlorides of sodium and potassium, containing chlorine 2.42 3.97 Sulphates of soda, potassa and magnesia, containing sulphuric acid, 2.59.. 5.65 Carbonates of lime and magnesia 2.85 NUTRITIVE AND AGRICULTURAL VALUE OF COTTON SEED CAKE AND MEAL. The nutritive and agricultural value of decorticated cotton seed cake will be readily seen from the following table giving the composition per tou: One ton of decorticated cotton seed cake contains: Oil lbs. 375.00 Albuminous compounds (flesh-forming principles ), capable of yielding 130 lbs. of nitrogen ...lbs. 770.00 Starch, sugar, gum, mucilage and digestible fiber (heat producing ele- ments) lbs 532.00 Mineral matters, composed chiefly of phosphates of lime and potash, . capable of forming blood and bones, and valuable as a fertilizer, especially to grain, 150 lbs. Phosphate of lime •. 60.80 Phosphate of potash 70.20 Chlorides 6.00 Sulphates 8.40 Carbonates of lime and magnesia 4.00 Each ton of decorticated cotton seed cake will yield 375 pounds of oil, 770 pounds of albuminous compounds (flesh-producing principles), 532 pounds of sugar, starch, gum, mucilage and wood fibre Cheatproducing agents), and 150 pounds of salts. Total nutritive elements in one ton, 1827 pounds. It is fair to estimate the value of this food, rich in oil, nitrogen- ized matters and phosphates, at two cents per pound. This estimate is under rather than above the nutritive value in the feeding and fattening of stock. Preventable Causes of Disease: Joseph Jones, M. D. CCCLXI Nutritive value of one ton of decorticated cottonseed cake and meal, manufactured by Louisiana Oil Company, $36.74. In computing the agricultural value, it should be observed that each ton is capable of yielding 130 pounds of nitrogen, which alone may be esti- mated as possessing an agricultural value of from $26 to $32.50, and the phosphate of lime and potash possess an agricultural value of $7. The agricultural value does not, therefore, differ materially from the nutritive value. RELATIVE VALUE OF COTTON SEED CAKE AND MEAL, AND PRACTICAL CONCLUSIONS. L The proportion of oil is higher than in the .best linseed cake, which rarely contains more than from 10 to 13 per cent of this ingredient which is so valuable for supplying fat to animals. 2. Decorticated cotton seed cake contains a very high and much higher percentage of nitrogenized flesh-producing matter than linseed cake, corn, wheat, oats, barley, beans and peas, and this renders it especially valuable as food for young stock and dairy cows. As a large proportion of the nitrogen of the food is not assimilated in the system, but passes away with the faeces and urine, the excrements produced by stock fed upon cotton seed cake will be found particularly valuable as manure. 3. The proportion of indigestible wood fibre in decorticated cottonseed cake is small, and not larger than in the best linseed cake. 4. The ash of cotton seed cake is rich in bone material; thus each ton is capable ot yielding sixty pounds of phosphate of lime and seventy pounds of phosphate of potassa. 5. The physical condition of the cotton seed cake and meal, is excellent, and eminently suited to the digestion and nutrition of animals. 6. At this late day no planter in the Southern, Atlantic and Gulf States is ignorant of the fact that cotton seed will compare favorably in its effects with the best commercial fertilizers. In the application of cotton seed as a manure the planter should act upon the principle that animal and vegetable manures should always be applied if possible in their natural condition, and should never be burned under the erroneous idea that the ash alone is valuable. The organic matters of the cotton seed will generate ammonia, and at the same time during their decomposition, the salts will be slowly given out and supplied to the plants continuously during their growth. The ashes of cotton seed, on the other hand, are readily washed by the rains, beldw where the roots of plants can penetrate. It will therefore greatly deteriorate if not completely destroy the value of cotton seed as a manure to burn the organic matter. 7. That cotton seed cake and meal is a potent fertilizer is evident not only from its acknowledged beneficial effects when applied to growing crops, but also from the following well established considerations: Plants require a large portion of vegetable and animal matter, to afford a supply of carbon, in the shape of carbonic acid, and of nitrogen in the form of ammonia, both of which are evolved during the decomposition of organic substances. Cotton seed cake is most valuable to grain crops, be- cause the seed of plants is, in all instances, the most highly azotized portion, and all plants require a supply of nitrogen to perfect their seed; which nitrogen cotton seed cake possesses in large proportion. Cotton seed cake is quick in its effects, because fermentation and putre- faction take place almost immediately after its application to the growing plants, and carbonic acid and ammonia are supplied to the roots of plants in large proportions. 44 CCCLXII Preventable Gauses of Disease: Joseph Jones, M. D. The plant in its infancy feeds upon or is developed out of the matter of the seed; but after it has developed certain fibres it begins to take up nourishment from the soil, while the green leaf or shoot which it has sent upwards extracts carbonic acid from the air; if the roots find no food, near they increase in number and length, and spread over a large surface ; and in poor soils, from this cause, plants have an immense number of fibrous roots and a poor stunted stem, the numerous roots having been formed at the expense of matters which should have assisted the growth of the stem. Cotton seed cake, from its rapid decomposition and the comparatively large amounts of carbonic acid and ammonia evolved, supplies the young plants with the best liquid and gaseous food at the most critical period, and con- sequently enables the plants to develop stouter stems and more perfect ami numerous leaves; for it appears to be well established that the sooner the plant escapes from the state of transition in which it derives its food from the seed, as well as from the soil and atmosphere, the sooner will its organs for extracting its food from the air and the soil be developed, the more vig orous will be their growth, and the more efficient their use in the process of vegetation. Cotton seedcake ensures also a better supply of moisture to the plant, because it possesses the power of absorbing from twice to ten times as much atmospheric moisture as the finest soils. 8. Cotton seed cake and meal are greatly superior to farm yard manure, in soluble organic matters, and are equal to it in phosphates; and one ton equals in agricultural value, at least from ten toeighteen tons of farm yard compost. 9. One ton of cotton seed cake contains 150 pounds of saline matters, chiefly phosphates. We have in this fact a strong argument for the use of cotton seed as a manure, in order that these salts should be returned, which are essential to the preservation of the fertility of tbe land. The great advantage resulting from the application of cotton seed as a manure for corn is referable to a high percentage of phosphoric acid and potash in corn. One thousand pounds of cotton seed are capable of yield- ing the necessary potash for about 7900 pounds of corn, and phosphoric acid for about 2200 pounds of the same grain. Each ton of decorticated cotton seed cake will yield 375 pounds of oil, 770 pounds of albuminous compounds {flesh producing principles}, 532 pounds of sugar, starch, gum, mucilage and woody fibre (heat producing agents, and 150 pounds of salts. Total nutritive elements in one ton, 1827 pounds. It is fair to estimate the value of this food, rich in oil, nitrogenized mat- ters and phosphates, at two cents per pound, or $36 74 per ton. In com- puting the agricultural value, it should be observed that each ton is capa- ble of yielding 130 pounds of nitrogen, which alone may be estimated as possessing an agricultural value of from $26 to $32 50, and the phosphate of lime and potash posesses an agricultural value of $7. The agricultural value does not, therefore, differ materially from the nu- tritive value. The decorticated cotton seed cake has a rich yellow color, is free from any strong or disagreeable smell and has an agreeable taste; it is almosten- terely free from the dark brown, comparatively valueless seed shells ; and it does not contain any large amount of mucilage, nor anything that pro- duces in mixing with water a volatile, pungent or injurious essential oil. Cattle take to it at once, and rapidly improve in flesh and fat when fed upon it; and so valuable is this article regarded by the most experienced Preventable Causes of Disease: Joseph Jones, M. D, CCCLXIII and intelligent European farmers, that it readily commands from £6 to £8 per ton. Owing to the superior qualities as food, it offers considerable economic advantages to feeders of stock in comparison not only with other varieties of cake, but also with corn and wheat. The preceding views have led me to the conclusion that cotton seed oil posesses valuable properties as a nutritive, oleangenous heat producing- food for man, and as a substitute for olive oil and butter. I am at present engaged in testing its relative value to cod liver oil, in the treatment of phthisis pulmonalis. LOUISIANA ROCK SALTS FROM PETITE ANSE ISLAND. Salt should be regarded not merely as a condiment, but as a most val- uable mineral constituent of our food and of the solids and fluids of the human body. Fortunately Louisiana produces her own salt of the purest quality and in vast and unknown quantities in Petite Anse or Avery's Island. CHEMICAL EXAMINATION OF LOUISIANA ROCK SALT AND OF TURK'S ISLAND SALT, WITH CRITICAL COMPARISONS WITH OTHER VARIETIES OF SALT FROM VARIOUS COUN- TRIES, BY JOSEPH JONES, M. D. LOUISIANA ROCK SALT. Louisiana rock salt presents the form, appearance and optical properties of pure chloride of sodium. The large crystalline masses are so perfectly transparent and free from all extraneous matter and are so uniform in their structure and density that they would be suited in all respects for the most delicate philosophical experiments upon the transmission of heat through different media. The entire mass of the samples selected was made up of crystals and fragments of crystals, derived from the cube, the primitive form of chloride of sodium. The crystals present a foliated texture and distinct cleavage; they feel when rubbed in the hand dry, and left no im- pression of moisture or of saline matter. The sample of Louisiane rock salt submitted to analysis, as well as the large solid masses, weighing several tons, are the purest and finest sam- ples of rock salt that have ever come under my observation. One hundred grains of Louisiana rock salt yield upon analysis: Chloride of Sodium (common salt). 99,617 Sulphate of Lime. r 0.318 Sulphate of Magnesia 0.062 Moisture (dried at 300°) 0.093 It will be observed from this analysis that the Louisiana rock salt con- tains less than one-half of one per cent (0.473y of those substances which may be considered as foreign, viz: moisture, and sulphates of lime and magnesia ; and which are found in greater or less quantities, according to their purity, in almost all samples of salt. CCCLXIV Preventable Causes of Disease: Joseph Jones, M'D. The absence of both chloride of calcium and chloride of magnesium is importantas these salts absorb moisture readily from the atmosphere, ami when existing to even a limited extent in salt impairs more or less its value, by rendering it more hygroscopic. Meats cured with salt abounding in the chloride of calcium are more prone to absorb moisture from the atmos- phere. TURK'S ISLAND SALT. The sample of Turk's Island salt submitted to my examination presented a less uniform appearance ; some of the crystals being semi-transparent, whilst others were opaque. The differences were due rather to physical than chemical properties. One hundred grains of Turk's Island salt was found upon analysis to contain: Chloride of Sodium 98.880 Sulphate of Lime 0.569 Sulphate of Magnesia .... 0.185 Moisture -. 0.341 Insoluble matters (sand' etc) ... 0.040 It will be seen from this analysis that the Turk's Island salt, although excellent in quality and yielding a large proportion of cloride of sodium, at the same time is somewhat inferior to the Louisiana rock salt. The Turk's Island salt yields a little over one per cent (1.12) of foreign matters, which add nothing to its antiseptic properties; whilst the Louisiana rock salt yields less than one half of one per cent. RESULT OF THE COMPARISON OF THE CHEMICAL COMPOSITION OF LOUI SIANA ROCK SALT WITH THAT OF TURK'S ISLAND. From this comparison we conclude: 1. The Louisiana rock salt may be considered as essentially pure chloride of sodium. 2. The Louisiana rock salt is superior in apperance and in physical pro- perties to the Turk's Island salt. 3. The Louisiana salt contains less moisture and less adventitious mat- ters than the Turk's Island. 4. The Louisiana salt contains nothing injurious whatever to meat, and is essentially and eminently adapted for all the uses to which this valuable mineral is applied in the preparation of food, or in the arts and agriculture. It remains that a comparison should be instituted between the Louisiana rock salt and that of various other localities. The tables on the following page present the composition of salt derived from different parts of the earth, and from the sea water and brine springs : ANALYSIS OF VARIETIES OF COMMON SALT FROM EUROPE AND AMERICA. Preventable Causes of Disease : Joseph Jones, Af. D. CCCLXV ORIGIN OF SALT-NAM E OF CHEMIST REMARKS. iloride of Sodium. iloride of Magnesium. iloride of Calcium. Iphate of I Soda. ilphate of Magnesia. ounq jo ay & Insol-! le ma'ters. ide of Iron. her Salts. Q 72 72 9 72 o 2 o O Louisiana Rock Salt-Joseph ( Moisture separatedat ? Joues, M. D 5 300° F 5 l urks' Island Salt-Joseph , Moisture separated at ? 99.62 - - 0.06 0.31 98.88 0.18 0.04 Sal-gem of Vic ' Amount of moisture 1 not stated in analysis I Amount of moisture | 99.30 0.005 0.02 99.80 0.002 Crushed Cheshire Salt 66.... not stated in analysis J Amount of moisture ? not stated in analysis J Amount of moisture ? not stated in analysis 5 Amount of moisture ( not stated in analysis J Amount of moisture ? not stated in analysis 5 Amount of moisture ( not stated in analysis 5 Amount of moisture ? not stated in analysis 5 Amount of moisture 1 not stated in analysis j Amount of moisture 1 not stated in analysis $ Amount of moisture? not stated in analysis J Amount of moisture ? not stated in analysis J Amount of moisture ( not stated in analysis j Amount of moisture ? not stated in analysis 5 Amount of moisture ? not stated in analysis > Amount of moisture < not stated in analysis 5 Dried at212c,moisture a not stated. On being \ 98.33 0.02 0.65 0.002 Salt Springs, Schonbeck, ( Westphalia 5 Salt Springs, Moutiers. des ? 93.90 0 30 no 0.80 97.17 0.25 2.00 0.58 Salt Springs, Moutiers,? boilers 5 Salt Springs. Chateau Salin's 93.59 0 61 0.25 97 82 96.88 99 45 2 12 Salt Springs. White of Sulz. 3.12 0.005 Salt Springs, Ludwigshall ? middle grained - • 5 Salt Springs, 'Kcenigsborn, ? Westphalia 5 Sea Salt, half white 0.28 95.90 0.27 1.10 97 20 0.004 1 12 0.07 Sea Salt of. Saint Malo Common Scottish Salt Lymington. common (Henry) 96.00 93 55 93.7 98.8 98.25 100.00 0.30 2.80 1.1 0.5 0.075 trace. 0.45 1.75 3.50 2.35 1.50 1.50 9 00 Lvmington, eat (Henry) 0.5 0.1 Cheshire, stoved 0.02 1.55 Rock Salt from Wieliczka. ] White variety (specimen ( selected for its purity by I Bischof.) J dr'dgave a littlewater ) Wieliczka (Hrdina) .. Dried at 212° 97.95 0.54 0.62 0 20 0.08 0.62 Rock Salt from Berchtesga- i den, fibrous variety > Dried at 212° 0.15 0.072 (Bischof) ) Rock Salt from Berchtesga- i den, yellow variety, > (Bischof) ) Dried at 212° 99 92 CCCLXVI Preventable Causes of Disease : Joseph Jones, M. D. ANALYSIS OF SALT FROM EUROPE AND AMERICA ORIGIN OF SALT- NAME OF CHEMIST. REM ARKS Chloride, of Sodium. Chloride of Magnesium. Chloride of Calcium. | Sulphate ot Soda. 1 Sulphate of Magnesia^ Sulphate of Lime. ('lav and Insol- uble Matter. Oxide of Iron I Carbonate ot Lime. Carbonate ot Magnesia I Aluminate and ; P< roxideof I ran | Water. Rock Salt from Hall, in ? in the Tyrell (Bischof). j Rock Salt-cracking salt 1 from Hallstadt, in Aus- > tria (Bischoff) ) Rock Suit from Schwa- ( bisch Hall (Bischof)... j Pure Rock Salt from Wil- i helmsgluck, at Schwa- S bisch Hall (Fehling) . ) Rock Salt from Wil- i helmsgluck, at Schwa- > bisch Hall (Fehling)... ) Rock Salt from Will helmsgluck. at Schwa- > bisch Hall (Fehling)... ) Rock salt from Vic (Ber- ( thier) J Rock Salt from Djehel, i Mel ah, in Algeria > (Fournet) ) Rock Salt from Ouled 1 Kebbah. in Algeria > (Fournet) ) Rock Salt from Ouled 1 Kebbah. in Algeria > (Fournet) ) Rock Salt from Ouled 1 Kebbah, in Algeria? (Fournet) ) Rock Salt from Holston. 1 in Virginia (C. B. Hay- > den) ... 1 Commercial Sea Salt, I Venice (Schrotter & > Pohl) ) Commercial Sea Salt ( Trepani, Sicily • • ■ • ) Salt deposited in the bot-1 tom of Elton Lake ? (Gobel) ' Sea Salt from St. Ubes, ( in Portugal (Berthier). > Sea Salt from St. Ubes, in ) Portugal (Berthier).... 1 Sea Salt from St. Ubes, in < Portugal (Berthier).... 5 Dried at 212°. Dried at 212° 99.430.12 0.25 . . 0 20 98.14 QQ RS 1.86 1 9R 0.09 99.97 .... .. 0.02 0 55 0 11 0.50 3 00 0 01 ... 0.53 .... 0.30' ... 0.20 .... 98 36 .... 98.81.... 99.301.... 0.02 .... 0 03 ...Jo.52 0.16 0.13 0.15 After deduction of 1 6 6 silica and 0.4 s water ) After deduction of ( silica and water $ 97.00 98.89 1.11 0.59 5.57 72.16 99.55 98 95 1.65 trace. 0.19 0.16 0.13 ■ . 0 0 1 6 7 06 51 35 69 20 27 10.72 ... 3 71 9 RQ1 oo 0.51 0.45 - 98 94 0.46 98 79 95 19 89.19 80.09 1 64 0.56 3 45 0 81 .... n 9(1 ■ 3.60 3 57 0.20 8.36 | It will be observed that in the vast majority of the preceding analyses the salt was first dried at 212°, and the amount of moisture is not stated. The neglect on the part of the various chemists to state the amount of moisture, of course, renders the analysis of the salt apparently somewhat better than it would otherwise4 have been. Notwithstanding that the most favorable conditions are on the side of the analyses of the salt from other countries, quoted in the tables, it will be found upon comparison that the Louisiana rock salt is of equa.1 purity with the best samples of rock salt in the world, and is far superior to the commercial salt obtained from sea water and brine springs. From the immense and inexhaustible deposits of Louisiana rock salt it must become a most important article of commerce and exchange through- out the Mississippi Valley. We conclude, therefore, from the preceding facts: 1. The Louisiana rock salt may be considered as essentially pure chlor- ide of sodium. 2. The Louisiana salt contains nothing injurious whatever to meat, and is essentially and eminently adapted to all the uses to which this valua le mineral is applied in the preparation of food or in the arts of agriculture. Preventable Causes of Disease : Joseph Jones, M. 1). CCCLXVII ABUNDANT SUPPLIES OF FRUIT, GAME AND FISH IN LOU- ISIANA. There is not perhaps on earth, a continuous tract of land of equal ex- tent, presenting a greater diversity than Louisiana. Within its limits are included all the varieties, from the most recent and periodically inun- dated alluvium to hills approaching the magnitude of mountains; every quality of soil from the most productive to the most sterile, and from un- wooded plains to dense forests. All the southern part of this State is an alluvial tract of low champlain country, extending from Lake Borgne to Sabine River, and from the Gulf of Mexico to Baton Rouge and Red River-about 250 miles long, and from 70 to 140 wide. This extensive tract is intersected by numerous rivers, bays, creeks and lakes, dividing this country into a great number of islands. The lower portions of the State extending up from the 28° 55z of N. lati- tude, is adapted to the orange, tig and banana, whilst in the more elevated regions, peaches, pears, apples and the vine flourish. The lakes, bayous and marshes abound with oysters, crabs, shrimp, fish of every variety and wild ducks and water fowl. Of the mammalia suitable for food, in addition to the domestic animals (cattle, sheep, goats and swine), the forests, swamps and marshes of Lou- isiana afford in considerable abundance, the black bear (ursus Americanus), raccoon (procyon lotor), otter (lutra canadensis), wild cat (lynx rufus), panther (lynx discolor), fox squirrel (sciurus capistratus), grey squirrel (sciurns Carolinensis), ground squirrel (tamias listeri), flying squirrel (pteromys volucella), woodchuck (arctomys monax), musk rat (fiber zib- ethicus), swamp rabbit (lepus palustris), common rabbit (lepus sylvaticus), deer (cervus Virginianus), porpoise (del phin us phocoena), opossum (didel- phis Virginianus), beaver (castor fiber). The elk (cervus stongyloceros), and the bison (bos Americanus), that formerly roamed over the plains of Louisiana, have disappeared before the advance of civilization. Of oviparous warm-blooded animals, fit for human consumption, Lou- isiana produces numerous species, some of which abound in the lakes and marshes, and contribute largely to the supply of human food. It will be sufficient to mention the following birds of Louisiana, which are consumed as food to a greater or less extent, accordiug to their number, and accord- ing to the taste of the people : hen hawk (buteo borealis), chicken hawk (buteo lineatus), bald eagle (haliaetus leucocephalusJ, fish hawk (pandion haliaetus), barn owl (strix Americana), hooting owl (syrnium nebulosum), horned owl (bubo Virginianus), screech owl (bubo asio), king bird (musci- capa tyrannus), sealingwax bird (bombycillia Carolinesis). blue bird (sia- lia sialis), cat-bird (orpheus Carolinesis ), thrush (orpheus rufus), robin (turdus migratorius), chuck-will-window (caprimulgus Carolinesis), whip- poorwill (caprimulgus vociferus), night-hawk (chordeiles Virginianus), non- pareil (spiza ciris), indigo-bird (spiza cyanea), maybird or goldfinch (car- duelis tristis), red-bird (petylus cardinalis), summer red-bird (pyranga aesti- va), rice-bird, (dolichonyx oryzivora), cow bird <molothru picoris), redwing blackbird <agelaius phaeniceus/ jackdaw <quiscalus major J, lark fstur- nella ludoviciana/ blue jay (garrulus cristatus/ivory billed woodpecker fpicus principalis), log-cock fpicus pileattis/yellow-bellied woodpecker (picus varius/red-headed woodpecker <picus erythroceph al us/rain-crow ^coccyzus Americanus/ ground dove (columba passerina/ wild pigeon fectopistes migratorius/ turtle dove (ectopistes Carolinensis,) wild turkey CCCLXVIII Preventable Causes of Disease: Joseph Jones, Al. 1) (meleagris gallopavoj, partridge fortyx Virgi.uja^, pheasant (tetrao uni bellusj, plover fcharadrius marmoratus^, kildeer fcharadrias vociferusy, whooping crane (grus Americana^, spoonbill ^Platalea AiaiaJ, qucw (ardea nycticorax^, poorjoe (ardea exilis), blue crane (ardea ludoviciana and hero- diasj, white crane (ardea candidissima;, stone curlew (totanussemipalma- tusj, snipe (scolopox wilsoni^, woodcock (microptera Americana,/, curlew (numenius longirostris , fresh water marsh hen (rallus elegans;, salt water marsh hen fra 11 us crepitans;, flamingo (phsenicopterus ruber) diver (podi ceps CarolinensisJ, ibis (tantalus loculatorj, white pelican fpelecanus Ame- ricanusj, brown pelican (pelicanus fuscus), cormorant (plotus anhinga> black duck (anses obscura), English or French duck, widgeon (anajs Ame- ricana), summerduck (amessponsa), green winged teal ( anaesCarolinensis), blue winged teal (anaes discors,), canvassback duck (fuligula valisneria), wild goose (anser canadensis), shagpoke (mergus merganser). Many other species of birds fit for food are found in Louisiana, and I have merely given examples of the different families to show the .great variety of game with which the markets of New Orleans at certain seasons abound. Of chelonians, Louisiana furnishes several varieties of great value as substantial articles of food, and even delicacies, suited to the most fasti- dious appetite, as follows: Gopher (testudo polyphemus), box cooter (cis- tuda Carolina), alligator cooter (chelonura serpentina), soft-shelled terra- pin, (trionyx terox), green turtle (chelonia mydas), loggerhead turtle (che- lonia carretta), leatherbacked turtle (sphargis coriacea). The Gulf of Mexico, the Mississippi river, the lakes and bayous, abound with fish of the greatest variety; and Louisiana produces not only the great- est abundance of delicious fish, but she has also sufficient to establish a large export trade. Amongst the important varieties of fish found in the waters of Louisiana, may be mentioned : Rockfish (labrax lineatus), grouper (serranus erythrogaster), blackfish (centropristis nigricans), trout (grystes salmoidesg maw-mouth (centrarchus gulosus,) perch and chub [centrarchus and pomotis], flying fish [dactylopterus volitans], yellowtail [leisotomus xanthurus], bass [corvina ocellata], whiting [umbrina alburnus], drum [po- gonias chromis], young drum [pogonais fasciatus], croker [micropognon undulatus], sheephead [sargus ovis], porgee |pagrus argyrops], anglefish |ephippus faber],Spanish mackerel (scomber colias). spring mackerel [scom- ber vernalis], pompano [tranchinotus pampanus and argentus], mullet [mugil albula|, salt water catfish |galeicthys marinus], fresh water cattish Ipimelodus catus], plaice and flounder |plateisa oblonga], saltwater eel [munena], fresh water eel [niaraenaj. Ln conclusion, the markets of New Orleans abound with oysters, crabs, crawfish and shrimp of the finest quality and the most delicate flavor. No city upon the habitable globe is better supplied with the most valu- able products of her soil, forests and waters than New Orleans, and her re- sources in the matter of food and fruits are enlarged to the greatest extent by the boundless resources of the tropical islands and continential regions lying to the south. The inhabitants of New Orleans, and Louisiana generally, have as abun- dant supplies of the great staples of human food, and of fruits and game, and of the actual luxuries of life, as the most famed people of the globe; and we can live with as much comfort and luxury in this city as in New York, London or Paris. The remarkable health and longevity of the natives, is referable at once to the mild climate and the abundant supplies and great variety of the agricultural products, fruits and game of the country. Preventable Causes of Disease: Joseph Jones, M. D. CCCLXIX If adulterations are practiced in articles of food, they are foreign to the people and soil, with the exception, perhaps, of milk. The extensive con- sumption in our day, of articles of food preserved in tin cans, is without doubt a source of danger and death from the accidental admixture of lead and other metallic salts; and the imported articles of food are no more free from adulterations than in other cities countries. EFFECT OF OVERFLOWS UPON THE HEALTH OF THE IN- HABITANTS OF THE DELTA OF THE MISSISSIPPI RIVER. OVERFLOW OF THE CITY OF NEW ORLEANS, ON THE RIGHT BANK OF THE MISSISSIPPI, BY THE WATERS OF THE LIVE OAK CREVASSE- RELATION OF OVERFLOWS TO DISEASE. [Extract from the Report of Dr. Joseph Jones, President Board of Health, State of Louisiana, delivered at the regular meeting of the Board, June 22,1882], Three breaks occurred iu the levee at Live Oak Grove Plantation, in the parish of Plaquemines, twenty-five miles below New Orleans, on the right bank of the river, March 17 and 18, 1882. This water would have, in low stages of the river and swamps, found a comparatively rapid and effectual outlet, through Barataria Bay and its several arms and bayous ; but the crevasses of the Bayou Lafourche, of January 29 and March 5, had filled the chain of lakes and the bayous and swamps connected with Bayou Barataria; thus on the west, Lake Cat- aouache, Lake Ouacha or Salvador, Little Lake, and Lake Villdiere and the surrounding swamps were filled with water, having very nearly the level of the Mississippi River; and although the water flowed continually through Barataria Bay into the Gulf, the volume rushing from above main- tained the level. The high ridges of Bayous Barataria and Dupont also aided as a barrier bounding the low lands on the west, and inclosing a well marked basin between the high leveed borders or the Mississippi. Although situated about twenty-five miles below New Orleans, the cre- vasse waters of Live Oak, gradually, from the causes mentioned, travelled up apparently against, or rather in a contrary direction of the natural flow and current of the Mississippi River, and filled the low lands lying between the banks of the Mississippi River and those above the above mentioned bayous, and before the end of March the waters had reached the rear of the various settlements on the right bank of the river, opposite New Or- leans, known as Algiers, Gretna, McDonoghville, Tunisburg, Freetown, (Gould sboro). During the past month, the lower portion of these towns have been sub- merged, and but for the constitution of a levee at the rear portion of Algiers, the water would cover all portions, up to within three blocks of the Mississippi River. This overflow has caused great inconvenience and exposure, and loss of time and money to the citizens of NewOrleans, residing on the west bank, as has been rendered evident by personal inspections, the most recent of which was made in company with Hon. Ed. Booth, of the board. The question of moment for this board to consider is what effect will the over- flow of New Orleans have upon the health of the citizens upon the west bank. This question takes a wider range, and should embrace the effects upon the health and the lives of the people, of overflows generally. During the CCCLXX Preventable Causes of Disease : Joseph Jones, M. D. remarkable Hood of 1882, a large portion of the richest and most highly cultivated and thickly populated lands of Louisiana have been overflowed by the crevasses of Airlie or Alsatia, Illawarra, Raleigh and Pecan Grove, of East Carroll; Noland-Omega, Backbone, Morancy, Upper Delta and Bayou Vidal, Madison Parish ; Ion and Woodbourn, Buckner's, Point Pleasant, Buck Ridge, Ship's Bayou, Upper Hardtimes, Lower Hard times. Ford-Field, Hardscrable, Bondurant, Kempe and Waterproof. Tensas Parish ; Lake Concordia, Fish Pond Bayou, head ot Atchafalaya, Merrick, Hagan, Torras, Smithland, Old River, Raccourc4, Pointe Coupee, Pointe Coupee Parish; Arizona, Iberville Parish; Landry, Ascension Parish Story, Poydras, St. Bernard Parish ; Like Oak Grove, Dobard, Guesnard, St. Sophie, Monsecour, Point-a la-Hache, O'Brien, Plaquemines Parish, and numerous others in Avoyelles, St. Landry and Lafourche parishes. In considering in a sanitary and hygienic point of view, the effects of this vast inundation of the Delta of the Mississippi River, the inquiry should commence with a consideration of : 1. The chemical constitution of the waters of the Mississippi River. 2. The physical and chemical properties and physiological relations of the sediment deposited from the waters of the Mississippi upon the sub- merged surfaces. 1. Chemical Constitution of the Waters of the Mississippi River, 1 have made the following examinations of the waters of the Mississippi River: (a). Mississippi River water from the inlet pipe. When first drawn the water presented a turbid appearance; upon stand- ing the suspended matters settled, forming a light grayish yellow deposit; and the supernatant water remained slighty turbid from a small remaining portion ot suspended matters. The insoluble suspended matters amounted to twenty-three and two- tenths (23.2) grains to the gallon of water, and under the microscope were found to consist chiefly of very finely divided sand (Silicic acid) and the silicates of alumina and contained but'few specimens of animalcules or vegetable structures. After the removal of the suspended matters the water yielded a specific gravity similar to that of distilled water, and the amount of saline matter was found to be only eleven and nine-tenths (11.9) grains per gallon. Upon analysis it was found that those saline matters contained only traces of the sulphate of potassa, soda and magnesia, and consisted almost entirely of the carbonates of lime and chloride of sodium. Each gallon contained 2.91 grains of lime (equivalent to 5.29 grains of carbonate of lime) and 3.378 grains of chlorine (equivalent to 5.53 grains of chloride of sodium, common salt). One gallon (79,000 grains) of Mississippi water contained : Specific gravity at 60° F.. ' 1000.00 Suspended matter deposited on standing 23.30 Fixed saline constituents 11.90 Carbonate of lime 5.29 Chloride of sodium 5.53 Carbonates and sulphates of soda, potassa and magnesia 1.08 From the results of the preceding analysis, and from those of many oth- ers which I have made, we conclude that the waters of the Mississippi, when freed from the suspended matters, are of great purity, and will com- pare favorable with the drinking water supplied to the largest and best Preventable Causes of Disease : -Joseph Jones, M. D. CCCLXXI regulated cities in the world, and the truth of this assertion has been es- tablished by a critical comparison with the analysis of the various springs and rivers used for the supply of cities in America and Europe. If the solid saline residue of one hundred thousand parts of the Missis- sippi River water be compared with the solid saline matters of the drink- ing waters of the noted springs and rivers of this and other countries, it will compare favorable with each, and is in fact far purer than the majority of drinking waters heretofore analyzed by chemists. In each glass of Mississippi River water, less than half a grain of saline constituents are present, and this small amount, absolutely inappreciable in its affects upon the animal system, is composed almost entirely of com- mon salt, and carbonate of lime. If these salts exert any effect upon the animal economy, it is beneficial, and not injurious. Thus, the lime salts are clearly related to the developement of the osseous and dental systems. We conclude, therefore, that the mere presence of the Mississippi "waters upon the overflowed lands will not necessarily cause sickness from any de- leterious property or substance inherent in them. 2 The physical and Chemical Properties and Physiological Relations of the Sediment Deposited from the Waters of the Mississippi upon the Subnerged. Surface. A point of considerable interest in a sanitary view, as established by the preceding and numerous other examinations, is that the suspended matters of the Mississippi River waters are, to a large degree, free from organic impurities, and consist almost entirely of finely divided silicic acid and silicates, The suspended matters, so far from rendering the waters of the Mississippi unfit for saijitary purposes, add to their disinfectant pro- perties. It is well known that clay, resembling in its general properties the sedi- ment of the Mississippi River, is disinfectant in. its properties, and sur- geons have long known that dried clay pulverized forms an admirable application and dressing to compound comminuted fractures and gunshot wounds. AMOUNT OF THE SEDIMENT CONTAINED IN THE WATERS OF THE MIS. SISSIPPI RIVER. The amount of the sediment deposited from fixed quantities of the Mis- sissippi River waters varies with the nature and extent of and sources of the overflows, but still certain results of a general and valuable character have been obtained from the careful collection and determination of the quantity of the sediment. Mr. Meade and Mr. Lidell, assistants of Captain Talcott in his survey of the mouths of the Mississippi in 1838, measured the amount of sedimentary matter contained in the water. The former, from observations made in April and May, considers the quantity to be 1 1250th part by weight. The latter adopts 1 1724th for the ratio. Professor Riddell's first experiments upon the amount of sediment con tained in Mississippi water were reported in a letter addressed to Sir Charles Lyell on March 5, 1846, and gave a ratio of dry sedimentary mat- ter to the weight of water and sediment of nearly one to 1245, and by volume of one to 3000. In his second series of experiments, in 1846 (extending from May 21 to August 31, 1846,) Professor Riddell estimated the ratio by weight of the sediment to the water as 1 to 1158.3. The observations of Mr. Brown, at Natchez, July 1, 1846, June 30, 1848, and of Lieutenant Marr, at Memphis, in 1849, placed the relative amount of sediment at a much higher figure. CCCLXXII Preventable Causes of Disease: Joseph Jones, M. D. Professor Forshey. in 1851, in his experiment at Carrollton, established that the Mississippi water is not charged to its maximum capacity with sediment, and that the amount of sediment varied during the different periods of the year within wide limits; the maximum amount being 1-681, and the minimum 1-6383, mean 1-1808 by weight. A comparison of the general results led Captain A. A Humphreys and Lieutenant H. L. Abbot to the belief that no material error will result from assuming that the sediment of the Mississippi is to the water, by weight, nearly as 1 to 1500, and by volume nearly as 1 to 2900, provided long periods of time be considered. If this be so, and if the mean annual discharge of the Mississippi proper be correctly assumed at 19.500,000,000,000 cubic feet, it follows that 812,- 500,000,000 pounds of sedimentary matter, constituting one square mile of deposit, 241 feet in depth, are yearly transported in a state of suspension to the Gulf; or, adding to the mean annual discharge of the Mississippi at Carrollton the mean annual discharge of the three outlet bayous, we have for the total discharge from the basin 21,300,000,000,000 cubic feet, containing 887,500,000,001) pounds of earth matter, which is yearly de- posited upon the delta proper. When the Mississippi swamp lands are securely protected against over- Hows, the earthy matter which in their usual condition was annually de- posited upon them, was carried to the Gulf. The discharge into any one of the great swamps during the mean annual Hood, may be taken as 100,000 cubic feet per second, during a period of one month and a half for the St. Francis, Yazoo and Tensas, and three months for the Atchafalaya bottom, or delta proper. Taking into con- sideration the fact, that during the great Hood year the breaks in the levees have been so numerous and so large, that the volume of water dis- charged through them has been nearly equaled to the volume discharged over the banks in their natural condition, we have for the additional amount of sedimentary matter that will be carried to the Gulf, 81,000,000,- 000 pounds, or about one-tenth of that transported to it before the con- struction of levees. The vast mass of sediment is spread over the overflowed districts, and leaves a brownish red deposit upon the surface of the earth, which whilst improving the fertility of the soil, at the same time in virtue of its fine di- vision, its chemical constitution, and the absence of organic matter, ca- pable of undergoing fermentation and change, exerts no deleterious effects upon the health of the inhabitants. It is possible, however, for overflows to occasion the prevalence of mal- arial and even of malignant fevers, from causes not necessarily dependent either upon the chemical composition of the water, or of the .sediment held in suspension. NOTES ON EARLY INVESTIGATIONS ON THE SEDIMENT OF THE MISSISSIPPI RIVER. At the meeting of " The American Association for the Advancement of Science," held at Philadelphia, September, 1848, Dr. Dickeson read an extended report on "The Sedi- ment of the Mississippi River," prepared by Andrew Brown, Esq., and Dr. M. W. Dicke- son^ from which we extract the following results: The committee composed of Andrew Brown, Esq., and Dr. M. W. Dickeson, charged with the duty of collecting and reporting to the association as many of the facts and characteristics respecting the condition and annual conduce of the Mississippi River, as might be practicable, submitted a series of facts and observations in connection there with, collected by virtue of the most favorable opportunities of daily observation for the last eighteen years, and continued without intermission with a view to this report, for the last two years of that term, beginning the first of July, 1846. and ending thirtieth of June, 1846, comprising a series of notations and calculations of the quant ity of water Preventable Causes of Disease: Joseph Jones, M. D. CCCLXXIII at the several stages of elevation and depression, during the river's annual oscillations, between its mean high water and low water lines, together with the quantity of detrital or sedimentary matter matter with which it is charged. The committee found the aggregate annual quantity of water discharged by the Mis- sissippi to be 14,882,360,639,880 cubic feet, or 551,235,579,143 cubic yards, equal to 101.1 cubic miles. As the Mississippi River is the only visible outlet for the surplus water of the vast valley, through which it passes on its way to the ocean, and as the Mississippi Valley has been found to contain an area very little, if any, shore of fourteen hundred thousand square miles, it is important to determine the relative difference between the quantity of rain water falling annually in this valley, and that discharged by the river. The committee found by examination of the meteorological register of the late Dr. H. Tooley, of Natchez, that the mean quantity of rain water, which falls annually at Nat chez, is between fifty-five and fifty-six inches; but, as such is the quantity for the Southern extremity of the valley, it may be regarded as over estimating, if taken for an average of the whole area, the mean quantity was, therefore, assumed to be fifty-two inches ; upon which basis it was calculated that the entire rainfall of the whole valley was 169,128,960.060,000 cubic feet, which is almost 11.36 times the quantity which is discharged by the river, i There can be but two ways by which this immense quantity of water can make its escape from the valley ; one is by the course of the river, and the other by evaporation. Hence there is but one relative portion of this quantity passing off by the river, for every lOf parts which are exhaled into the atmosphere; or 8-91 parts are carried off by the river, and 83-91 parts by evaporation. The result established an important fact to the planting interest (agriculturists) of Louisiana and Mississippi; for it will be perceived that the more exhalations are promot- ed, the less liable will the low or bottom lands of these two States be to the periodical inundations of the river. The best method of promoting the evaporating process, name- ly, the clearing of large portions of the valley of its forests for the promotion of agricul- ture, and the consequent exposure of the lands to the action of the sun and winds, has been in rapid and successful progress. The committee affirm: "So rapid is the progress of this increased exposure, and its consequent evaporating tendency, and so visible have been its effects on the Mississippi River, that we may hazard the assertion with safety that there is not now by twenty or twenty-five per cent as much water passing down the Mississippi as there was twenty- five years ago, for at and prior to that time, there were annual inundations of many feet and long periods of submergence of almost all the bottom lands, from the bluffs or highlands on one side of the river bottom to those on the other side. Such lauds were at that period in a great measure counted valueless ; and to such a degree that but little or no hopes were entertained of the practicability of their redemption by any artificial means, that is on any general scale; but such has been the diminution in the annual quantity of water discharged from the valley, that these lands have been progressively and rapidly redeemed from overflow, until very great portions of them are now in the very highest state of cultivation, and with but comparatively slight assistance from art in the way of embankments, and then such as could not have been at all available against the overwhelming effects of floods, and the length of time of their continuance ; for then there were annual inundations, both deep and expansive, of the waters, over almost all the bottom lands; but now the river seldom rises to the same elevation as formerly, and when it does, it is of much shorter duration, and the waters are almost exclusively confined to the channel of the river, in place of being spread over almost all the bottom lands the whole spring and early part of the summer." From the same cause the quantity of floating timber and drift wood passing annually down the river has diminished in a far greater ratio than that of the water, and the aggregate quantity cannot now be even fifty per cent of that which formerly passed down. It will not be difficult to perceive the yearly difference there must necessarily be in the evaporation from a surface of country exposed to such action, and that which is covered by the primitive forests and their almost impervious undergrowth, through which neither sun nor wind can penetrate but with difficulty. With reference to the amount of suspended matters ^sediment) contained in the Mis- sissippi River, we found that there was deposited from a column of water 19.36 feet, a column of sediment or solid matters of 464 inches. But as this sediment still seemed to evince some slight disposition to further settlement or contraction, the committee as- sumed forty-four inches to represent the solid sediment from a column of river water of 232.32 inches ; the mean proportion or quantity of sediment to the whole volume of river water being, according to these data, as 1 ts 528. As according to the determina- tion of Mr. Brown and Dr. Dickeson, the quantity of water annually discharged by the Mississippi River was 14,883.360,636,880 cubic feet, then must there be deposited from that quantity of water 28,188,053,893,1-6 cubic feet of solid matter. In this calculation CCCLXXIV Preventable Causes of Disease: Joseph Jones, M. D. no account is taken of the coarse sand and gravel, transported by the river current, which forms numerous shifting bars, subject to perpetual change of position, and con- sequent tendency of the matter to the river mouth. If, in common with Sir Charles Lyell, the delta of the Mississippi be regarded as com- prehending all that great alluvial plain which lies below or to the south of what, until recently, was the first branching off or highest arm of the river, called Atchafalaya, its superficial area may be computed at 13,600 square miles. If, in deciding the depth of the deposit laid down in the delta by the Mississippi, we assume the calculation of Pro- fessor Riddell and say that it is of an average depth of one-fifth ot a mile, or 1056 feet, which be infers from that being the average depth of the Gulf of Mexico, from the Balize to the point of Florida, by computation from the above data, it would require not less than 400,378,429.440,000 cubic feet, or 2720 cubic miles of solid matter to constitute this "delta." Having ascertained the quantity of solid matter annually brought down to the Mississippi River, to be 28,188,083,892 cubic feet, which would be equal to one square mile of the depth of 1056 feet in 381 1-5 days, or one cubic mile in five years, eighty-one days, it therefore follows that it would require a series of 14,203 4-5 years for the river to effect the final formation of the present "delta." "We are not disposed to consider the great alluvial plain, stretching with the river, from the above designated delta, as far up as Cape Girardeau, in Missouri, or any part of the delta proper, nor can it ever have been any continuation of the Gulf of Mexico, or arm of the oeean, as is usually supposed; the evidences are vastly against any such eon- clusions, inasmuch as to the diluvium which constitutes the highlands bordering on each side of this alluvia] plain by its general distribution, would have been equally deposited in such gulf or arm of the sea, which, in reality, could not have been the case, for the river has excavated through this diluvium, and exposed it in many places, resting on what is evidently of another formation ; and such is not only found to be the case at the base of the diluvial hills, but the same formation is found also to constitute the bed of the river at many other points, detatched for very considerable distances from any high lands. On-reference to the reported diagram, right hand side, will be perceived that the position of the formation and base of the diluvial bluffs, which are in depth, to high water line, at this point, 179| feet; and it w ill be seen that they extend almost as low as the bottom of the river, making their w hole depth about 220 feet." "There have been no excavationsor perforations through the alluvial matter in any parts of this vast plain, excepting those which have been affected by the river itself; but it would seem that it does not exceed, in any part, the depth of the river, whose high water line may be regarded as the average level of the plain, and from that to the bottom of the river is about 117 feet. This bed of the river is of entirely different character from the composition of any part of the diluvial bluffs. "In building a breakwater, your committee had occasion to quarry much of this sub- stance, and found it to possess all the characteristics of a well formed rock, which has to be acted on by wedges, crowbars and pickaxes to effet its reduction , but on exposure to the weather it gradually pulverizes and becomes an adhesive blackish clay, but very different from the tenaciousclay of the alluvium or diluvium, "From the above observations, should they truly represent the character of the plain, the inference is irresistable, that the Mississippi river has excavated the w hole of this valley, and denuded the upper tertiary of all its incumbent diluvium, from the high lands on one side to those on the other, of which every indication is confirmatory ; and there are evident traces of the river having occupied every part of the bottom, for its ancient beds are found at intervals ip the form of lakes and depressions throughout the whole extent of it. "The superficial area of this great valley has been found to be about 16,000 square miles, bounded by high lands on either side, ranging from fifty to 350 feet above the level of the plain. Should this space, therefore, have been reduced or excavated by the river, as we assume, it must have transported the diluvial matter, and caused it to form part or portion of its delta. Now assuming the average height of the high land above the plains to be 150 feet, we will therefore obtain 454| cubic miles, or 66,908,160,000,000 cubic feet of matter, as its proportional contribution, for the formation of the delta, the balance required being 333,451,269,440,000 cubic feet, to be derived from the reduction of other lands, the two sources being to each other as 1 to 5.98; or, by giving another ex- pression to the same quantities, there is, in the delta, 2720 cubic miles of matter ; 454^ of which would be derived from the diluvium on the excavation of this valley ; the other portion would consist of 2265| cubic miles to be derived from other sources or the reduction of other lands "We have now traced this great river through a period of 14.204 years, but how it was occupied before that time, or what was the condition of the country over which its waters passed, is more than we can safely venture to say ; but on particular examination of the bluffs, or cliff's, w hich bound its present plain, it will be very difficult to resist the conviction, that the river has had great agency in depositing the upper or loamy stratum which varies from a few feet to upwards of fifty feet in thickness, and in all of which Preventable Causes of Disease: Joseph Jones, M. D. CCCLXXV stratum there is abundance of land and fluvatile shells, such as those now found in the deposit from the river. On receding from the river bluffs, we find that the clay, or other diluvial matter, which underlies the loam-bed on the top of the bluff's, crops out, very clearly indicating an ancient valley, or depression in the diluvium, which constituted the more primitive bed of the river, on whose sloping flanks, and more particularly, in their depressions, this fluvatile matter or ancient alluvium, was deposited. "Any variation of its character, from that which is now deposited, may be very readi- ly accounted for by the varying conditions of the ground over which the waters have had to pass, for it may safely be inferred that they then had to make their way over the face of a country being different in character from the present; for they have gone on, progressing, to abrade the high lands of their lighter matter, and to cut deep channels in the valleys down through the more primitive rocks, whose detrital matter must neces- sarily assume a somewhat different character from that which it formerly had, particu- larly that on the top of the bluffs. We have found the age of that deposit to be not less than 14,204 years, through all of which time the waters have been actively engaged in changing the face of the country, and transporting 2720 cubic miles of its matter to a far distant location. * * * "Having early perceived that this report w ould exhibit a series of results varying very much from that obtained by Proffessor Riddell on the same subject, and reported to this association in 1846, we have on that account been the more careful that accuracy should attend all our proceedings with reference to it. "By this report, the mean annual discharge of water in the Mississippi is 14,883,360,- 636,880 cubic feet; the Riddell report gives 11,108,275,000,000 cubic feet. The difference maybe accounted for by the greater uncertainty there must be in obtaining any correct mean where conditions and velocities are so changeable ; at least, there cannot certainly be the same dependence placed in quantities got by such a method as there may be in that more mathematical one adopted by this report. But the difference in the two esti- mates, with respect to the solid matter held in suspension by the waters, may well seem the most extraordinary that can be conceived in any two estimates for the same thing. This report gives to the solid matter, in bulk, as compared with the bulk of water, as 1 to 528 ; the Riddell report gives it as 1 to 3000. Why there should be anything like this difference may seem difficult to determine, and is well calculated to abate the confidence to which either report may be entitled. "Agreeable to the Riddell report, it would require a column of water250 feet in height to deposit one inch of sediment. Were that so, it would have required that our tin tube should have been filled 1750 times in order to have produced the quantity of sediment herewith submitted; in which case we would have contented ourselves with obtaining a much smaller quantity. According to this report, there is one inch of solid matter deposited from a column of water of forty-four feet. Every one who has traveled on the Mississippi, and seen the turbid condition of its waters, will be able to decide between these two reported quantities. "We will here remark, so as to account for the discrepancy, that if the waters of this river are not continually agitated by the force and turbulence of the current, the sus- pended sediment very soon subsides considerable below the surface; and at or opposite the Mint, in New Orleans, is below almost all the wharves, and most of the shipping. When the waters are very still, and when deposition takes place to a very great extent, so as to make much land, after the water has so parted with a portion of its sediment, it passes down past the Mint without being but slightly agitated, the principal current being altogether on the other side of the river, and but very litrle on that side when Professor Riddell procured the test water for his experiments, according to his own state- ment. * * * "In a large excavation made for the gasworks, at New Orleans, eighteen feet deep, there were found imbedded innumerable stumps of trees, buried at various levels, in an erect position, with their roots attached, implying the former existence there of fresh water swamps, covered with trees, over which the sediment of the Mississippi River had been spread during inundations. The site of the excavation is only nine feet above the level of the sea; therefore, the lowest of the embedded stumps must be nine feet below this level. Now, this must not be at all surprising, when we reflect that the first growth of trees in ibis region must have taken root on the surface of new-made ground, de- posited from the Mississippi, and that ground, or deposit, of the depth of 1050 feet, with a continual tendency to settle into a more compact condition by incumbent pressure, molecular affinity and arrangement of particles, as we found it to be the case with the settling of our sediment. Every year's sinking down, in this case, would be fully com- pensated by every year's deposit, for the lower it at any time sunk the longer it would be subject to inundation by the subsequent overflows, so that the sinking and compen- satory process would go on together, and continue about equal, which will account for the circumstances of former forests being now found so far below the level of the sea. "Should this subsidiary process be now, in any measure, incomplete in that region where the city of New Orleans now stands, and which we indeed very much question, in CCCLXXVI Preventable Causes of Disease: Joseph Jones, M. D. that case, the compensatory equivalent being cut off by embankments, or the levying out of the waters, the time may, possibility, yet come, whers the ground on which the city of New Orleans now stands, may sink to a level with the ocean, or even below it; at least, should there be any further settlement at all, it must, in the same rate ap- proximate that level, for the final adjustment of particles in a deposit of 1056 feet deep, that may preclude any further settling, may be expected to take an immensity of time." "ANDREW BROWN, " M. W. DICKESON, Committee." TABLE OF THE CALCULATIONS MADE IN THE FOREGOING REPORT. 1. Quantity of water discharged by the Mississippi River, annually, 14,883,360,636,880 cubic feet. 2. Quantity of sediment discharged by the Mississippi River, annually, 28,188,083,892 cubic feet. 3. Area of the delta of the Mississippi, according to Mr. Lyell, 13,600 square miles. 4. Depth of the dMta, according to Professor Riddell, 1056 feet. 5. The delta, therefore, according to 3 and 4 contains 400,378,429,440,000 cubic feet, or 2720 cubic miles. 6. According to 2, it would require for the formation of one cubic mile of delta, 5 years and 81 days. 7. For the formation of oue square mile of the depth of 1056 feet, 1 year, 16 15 days. 8. For the formation of the delta, according to 2, 3, 4, 14,203, 4-5 years. 9. The valley of the Mississippi, from Cape Girardeau to the delta, is estimated to con- tainl 6,000 square miles, 150 feet deep ; it, therefore contains 66,908,160,000,000 cubic feet, or 454^ cubic miles.-Proceedings of the American Association for the Advancement of Sciences, May 1848, pp. 42-55. SEDIMENT OF THE MISSISSIPPI RIVER. At a meeting of the American Association for the Advancement of Science in 1847, a committee was appointed to report as to the practicability of reclaiming the drowned lands of the Missisippi Valley, and also as to the probable effect which the reclaiming of these lands would have on the navigation of the river. As those subjects were of vast national importance, Lieutenant Maury addressed a letter to Hon. J. Y. Mason, Secretary of the Navy, Washington, dated National Observatory, Washington, December 27, 1845, with a view of aiding the committee in its investigations, and requesting that the officers of the Memphis Navy Yard, be directed to conduct a series of observations, with a view to obtain answers to the following questions: 1. What is the average quantity of water taken up at Memphis by evaporation ? 2. What is the average volume of river water that daily passes by that place ? 3. What is the quantity of silt contained in the water ? 4. What is the daily rise and fall of the river? 5. What, at the different stages of the river, is the rate of the current at the surface, and successively at the depth of every ten feet ? 6. What the daily temperature of the water at the surface, and what the bottom of the main channel-way ? 7. And if not already the subject of observation, what is the quantity of rain that falls there f The Hon.. J. Y. Mason, Secretary of the Navy, Washington, promptly complied with the request of Lieutenant Maury, and the report of Robert A. Marr, Esq., of the United States Navy, was submitted to the American Association for the Advancement of Science, at their second meeting, held at Cambridge, August, 1849.-Proceedings of Association for the Advancement of Science, second meeting . held at Cambridge, August, 1848, pp. 334-435. From the report of observations made at the Navy Yard at Memphis during the months of April, May, June and a part of July, 1849, by Robert A. Marr, United States Navy, we extract the following: Evaporation-The average quantity of water evaporated was 13-lOOths of an inch daily. Rain-The average quantity of rain falling was ll-100ths of an inch daily. The weather was thought to be unusually wet. Quantity of Water passing Memphis-The average quantity of water passing during the observation was daily 57,165,356,160 cubic feet. "The river for the last few months has been unusually high, but considering this quantity as an average, the water passing by in one year would amount to 20,865.354,998,400 cubic feet, a quantity7 sufficient to cover an area of 100,000 square miles to the depth of 7| feet." Currents-Mr. Robert Marr found the velocity of the current near the bottom to be to that of the surface as 268 to 300. I believe that very near the bottom it is much less. It appears that the greatest velocity of current obtains when the river is rising most rapidly, and that the rapidity7 of the current at high water is to that at its lowest stage during the time of these observations, about 33 to 28. Preventable Causes of Disease : Joseph Jones, M. D. CCCLXXVII It is impossible to observe the current of this river, and notice its effects upon the banks, without being strongly impressed with the vital importance which the serpen- tine course of this river (at which travelers so inconsiderately complain) is to its naviga- bility. The winding course of this river, by diminishing the ratio of its fall to its length, greatly lessens the velocity of current; but the greatest restraint upon the fury of this current arises from the abrupt turns in the channel, which, by forcing the stream from a right course, constitutes a series of checks, without which this river would wash in with such impetuous violence as to render its navigation utterly impracticable. Temperature of the Water at the Bottom of the River.-" I have found the temperature of the water at the bottom of the river to be the same as that at the surface ; at least, the difference is not observable with the ordinary thermometer. * * * This equality of temperature is attributed to two causes: One is, that the sun does not in so short a time affect the water immediately beneath the surface to a degree observable with the common thermometer. This latter fact is evident, because whenever 1 have tried the experiment. I have found the river water as warm at midnight as at noon. Another cause may be that the bottom and surface water, owing to the greater agitation of the current, fre- quently change positions. The water is generally affected by the temperature of the air, but the effect is very gradual. The fact that the temperature of this river is so little affected by the casual and local variations of temperature of the atmosphere, suggests the idea that it may be regarded as the mean result of innumerable observations, taken in every portion of the country through which the river flows; and that if the temperature of all the large rivers and other large bodies of water should be carefully noted and combined, the result would indicate the average temperature of the whole country. If such observations were con- tinued for years, they would show whether the spring of any particular year was back- ward or in advance. " Telocity of Current as Influenced by Stage of Water.-The lowest stage of the river, since these observations were commenced, has been 20.2 feet above low water. At that point the average velocity of the central surface current was 2| miles per hour; at the height of 33.6 feet it was 3f. When the river is at 33.6 feet above low water, there is about one-half more water in the river than when at 20.2 feet. Now, I think it may be safely assumed that if all the overflow was confined to the river, the height of the river would not be increased more than fifteen feet, and this increase (reasoning from the above data), would not give a greater velocity of current than five miles. " Silt -The quantity of silt has been ascertained by daily placing a known quantity of river water in a box, drawing off the water as it becomes clear, and weighing (when dried) rhe earth thus deposited. The average quantity of earth contained in one hun- dred cubic feet of river water is twelve and seven-tenths pounds, which gives 26,580,008- 400 pounds, or 2,137,061,974 cubic feet of earth passing in one year-a quantity sufficient to make a bed of earth one mile square and seventy-six feet deep. " (Signed) ROBERT A. MARR, " Acting Master, U. S. N." PREVIOUS TO THE ERECTION OF LEVEES, THE DELTA OF THE MISSISSIPPI WAS ANNUALLY OVERFLOWED. The city of New Orleans was laid out in 1717, by Engineer Dumont de la Tour, on the left bank and in the concave bend of the Mississippi river, which approaches nearest to the Lake Ponchartrain, about five miles distant. The flood line of the river at that time was determined to be about three feet above the natural river bend, and de la Tour ordered a front levee to be constructed for the protection of the future city, four feet high, eight feet wide at top, and 5,400 feet long. In the rear on the present line of Rampart street, a levee six feet high was ordered, at the sides above and below, levees gradually increasing from four to six feet. These levees were constituted lines of fortification as well, and were pro- vided with stockades and ditches, bastions at the rear angles, and forts in front. They were not completed till 1726, and they were the first levees constructed in the valley of the Mississippi. The place d'Armes, now known as Jackson Square, and the Cathedral and public buildings were located opposite the middle of the river front. No perceptible change has occurred in the position of the river bank oppo- site the lower side of the public square, either by accretion or caving since CCCLXXVIII Preventable Causes of Disease : Joseph Jones, M D. 1717. Above, an extensive batture has been formed, below there has been very little if any change for some distance. On the opposite or right bank of the river, a little further down, where the Bellville foundry now stands, the river bank has also remained stationary since 1717. Before the era of levees, tin* points opposed to the river were kept, by deposits, nearly up to the highest flood line, while the bends, or natural banks around the bends, were generally from two to three feet or more below the flood line. Consequently, as the water flowed out over the banks in the bends, outlet channels existed in every bend. Soon after the settlement of New Orleans, plantations were established along the river bank above and below the city. Every proprietor had to construct and maintain his own levee, but as,the river deposits had kept the natural banks nearly up to the flood line, small levees answered the purpose. In 1723, there were small settlements in Ponte Coupee at Baton Rouge, near Bayou Manchac, below Bayou Lafourche, at Cannes Bruises, and at Tchoupitoulas. In 1728 the settlements extended for thirty miles above New Orleans, almost continuously. In 1735 the levees extended from English bend twelve miles below, to thirty miles above, and on both sides of the river. In 1742, an ordinance was promulgated requiring the inhabi- tants to complete the levees by January 1, 1744, under penalty of forfeiture of their lands to the crown. In 1752, the settlements were nearly con- tinuous for thirty miles below and thirty miles above New Orleans, and nearly the whole coast was in a high state of cultivation and securely pro- tected from floods. In 1763, France ceded Louisiana to Spain and the policy of the latter government was not such as to foster the growth of the Colony, and but little progress was made in levee construction until after the cession of Louisiana to the United States in 1803, by France; it hav- ing been ceded back to France by Spain in 1800. In 1812 when Louisiana was admitted into the Federal Union, levees ex- tended from the lowest settlements at Pointe Coupee on one side, and to the neighborhood of Baton Rouge on the other, except where the country remained unoccupied. In 1828 the levees were continuous from New Orleans nearly to Red River Landing, excepting above Baton Rouge, on the left bank, where the bluffs rendered them unnecessary. In 1844the leveeshad been made nearly continuous from New Orleans to Napoleon, Arkansas, on the right bank, and many isolated levees existed along the lower part of the Yazoo front. Above Napoleon few dr none had been attempted. Between the year 1856 and 1860, the levees of the right bank, from Cape Girardeau down to the mouth of the Arkansas River, were built piecemeal, but finally were nearly continuous, leaving intervals of less than forty miles, in the aggregate, when the war of 1862 ended all improvements. The process of levee construction began at New Orleans in about the year 1720, and it progressed gradually downwards for about seventy miles and upwards nearly one thousand miles during one hundred and fifty years. FLOODS OF THE MISSISSIPPI. In 1718, the year after the selection of the site of the city of New Or- leans, there was an extraordinary rise of the Mississippi, which greatly discouraged the new settlers. A great flood occurred in 1735, which in- undated the city. The flood of 1735 was continuous for an unusual length of time, from late in December to late in June, and the succeeding low Preventable Causes of Disease: Joseph Jones, M. D. CCCLXXIX water was remarkably low, giving a range from high to low water at New Orleans of fifteen feet, or about the same as to the highest flood lines of recent years, as in 1862, which was fourteen feet eight inches. The records of the flood years from 1735 to 1770 are wanting, but in the latter year a great flood occurred, with its usual inundations. In 1782 there was a flood which it was said exceeded any remembered by the oldest inhabitants. Great floods occurred in 1785, 1796 and 1799, and during each of these years New Orleans was inundated. The years 1869, 1811, 1813, 1815, 1816, 1823, 1824, 1828, 1840, 1849, 1850, 1851, 1858 and 1859 were marked as flood years. In 1865, 1867, 1874 and 1882 extensive inundations occurred. In 1862 the flood-line was everywhere below Cairo remarkably high, but although several crevasses 'occurred below Red River, their capacity was insufficient to cause any general inundation of the valley west of the Mis- sissippi, and south of Red River. The noted overflow of 1816 commenced on the sixth of May, and subsided in twenty-five days. The suburbs and rear portions of the city were sub- merged from three to five feet. One could travel in a skiff from the corner of Chartres and Canal streets to Dauphine, down Dauphine to Bienville, down Bienville to Burgundy, thus to St. Louis streeet, and from St. Louis to Rampart and throughout the rear suburbs. No increase of disease was referred to that overflow. In 1831 the waters of an inundation reached the line of Dauphine street -the fifth from the river front-the result of a violent storm in Lake Pontchartrain. A similar event occurred in 1837. In 1844 a storm backed the Lake waters up to Burgundy street, sixth from the river front, and the same disaster happened again in 1846. The overflow of 1849, following the Sauve crevasse, of the third of May, has been regarded as the most serious overflow with which New Orleans has ever suffered. The water reached its highest stage on the thirtieth of May. The line of the flood ran along Bacchus (Baronue) street, sometimes reached to C arondelet, from the upper limits of Lafayette to Canal street, covered that street, between Carondelet and St. Charles street, and thence to the Old Basin. About 220 inhabited squares were flooded, more than 2000 tenements surrounded by water, etc., a population of 12,000 souls either driven from their homes or leading a life of privation and suffering. The last inundation of the city, on the east bank, was in 1881. RELATIONS OF OVERFLOWS TO DISEASE AND DEATHS. We have but scanty and imperfect data concerning the floods and their effects upon the health of the inhabitants of Louisiana during the eight- eenth century, when the province was under the French and Spanish crowns, and the inquiry is necessarily limited to the nineteenth century. In estimating the effects of overflows upon the health of the people, it would be manifestly more accurate to consider the mortality not merely of the year in which the flood occurred, but of the succeeding year. No data, with the exception of that furnished by the United States census at interims of ten years, exists with reference to the mortality in the various parishes of this State; and hence it is impossible to estimate the effects of overflows upon the health of the inhabtants of Louisiana. In 1813, when the city w as inundated by a crevasse in the levee of Ken- ner's plantation, about two miles above Carrollton, the death rate per 1000 inhabitants was 46.45, and in the following year, 1814, 43.39. CCCLXXX Preventable Causes of Disease: : Joseph Jones, M. D. In 1816, when a large portion of the city of New Orleans was inundated for twonty-five days, during May and June, the mortality was remarkably small, reaching only 27.93 per 1000 inhabitants; but in the following year, 1817, yellow fever invaded the city, and the mortality rose to 73.27 per 1001) inhabitants. In 1831, when a large portion of the city was again inundated, the mor- tality was 36.71, and in 1832, when the city was desolated by cholera and yellow fever, the death rate rose to the extraordinary rate of 147.01 per 1000 inhabitants. 1837, death-rate per 1000 inhabitants, 70.45; yellow fever destroyed 1300 citizens ; 1838, death-rate, 36.77; 1844, death-rate, 53,33; 1845, death-rate, 31.17 ; .1846, death-rate, 41.34; 1847, death-rate, 83.19; 1849, death-rate, 80.48; 1850, death-rate, 60.26; 1867, death-rfite, 55.67; 1868, death-rate, 28.96; 1874, death-rate, 35.71 ; 1875, death-rate, 32.05. The mortality of 1881 does not appear to have been materially influenced by the overflow of the lower portions of the city by the lake waters, the death rate being 29.64 per 1000inhabitants; it is worthy of note, however, that the mortality of 1881 exceed that of 1880 by 783; that of 1879 by 1284, whilst it was 302 less than that of 1877. From the preceding facts, the following conclusions may be drawn : 1. No connection has been established between overflows and epidemics of yellow fever or Asiatic cholera. 2. In the history ot New Orleans inundations have often been accom- panied by, and followed by a high death-rate, whilst on the other hand, years may be selected in which no appreciable effect upon the rate of mor- tality has been observed. PROBABLE EFFECT OF THE OVERFLOW OF 1882 UPON THE HEALTH OF THE CITIZENS OF NEW ORLEANS ON THE RIGHT BANK OF THE RIVER. This question is of serious importance to near 10,000 citizens inhabiting the Fifth District and the Parish of Jefferson. According to the census of 1880, the fifteenth ward alone contained 8856 inhabitants, and this does not embrace the entire series of settlements immediately in front of the ancient city of New Orleans. The population of the righ bank has also augmented rapidly during the past two years, on account of the increase of manufac- turing, marine and railroad enterprises and the increased facilities afforded to shippers. The people are now confronted with a large mass of stagnant water, which in the lower portions of the chains of town, known as Algiers, Free- town (Gouldsborro), McDonoghville, Tunisburg and Gretna, has invaded their yards, and even their houses. Under the burning rays of the sun, the water which we have shown, by chemical analysis, is per se and in the fresh state pure and innocuous, now receives the drainage and a considerable portion of the offal of the habita- tions of ten thousand people. The lower forms of vegetable and animal life, fungi, aquatic plants of various genera and species, animalculae, frogs, serpents and fish, are multi- plying with great rapidity. Upon personal inspection I was informed that it was by no means uncommon to find reptiles of various kinds, as water mocassins, water-snakes and even rattle-snakes, under the houses and in the gardens. The nights are rendered hideous by the croaking of the frogs. Were it possible to maintain this mass of animal and vegtable life in a state of healthy activity, and to keep up continuous supplies of fresh Preventable Causes of Disease : Joseph Jones, Al. D. CCCLXXXI water, the damages from the overflow to health and life would be dimin- ished. It is evident, however, that if this water should subside during the hot months of June, July, August, September and October, the 10,000 cit- izens residing on the right bank of the Mississippi will be subjected to a terrible ordeal from the intolerable stench and the mephitic vapors arising from the putrefying vegetable and animal remains. The haemorrhagic malarial fever of 1880, which prevailed in the parish of Plaquemines, and more especially in and around Pointe Michel and Pointe & la Hache, was thought by local practitioners to have been aggra- vated, if not engendered, by the putrifaction of numerous small fish in the rice-fields after the water was drawn off. The history of medicine is not without numerous examples of the development of malignant malarial and haemorrhagic and typhoid fevers consequent upon the exposure of the sur- faces of marshes and ponds, and the consequent putrefaction of animal and vegtable matter. THE REMEDY. When the waters begin to recede from the low portions of the towns on the left bank of the Mississippi Biver, the Board of Health should be pre- pared to render the inhabitants prompt assistance with the necessary dis- infectants. Liberal supplies of quicklime, for covering the newly exposed earth, and of copperas and cloride of lime, for drains, privies, etc., should be supplied. The steam engines might be used to wash out the foul gutters and yards with streams of fresh Mississippi water. As a prophylactic, the citizens would do well to take from two to five grains of quinine, in black coffee, upon rising in the morning. I would respectfully suggest that the Committee on Drainage and Sew- age be empowered to solicit aid from the citizens for the purchase of the necessary disinfectants, and for the alleviation of the condition of our over- flowed and unfortunate fellow-citizens on the right bank of the Mississippi River, who, by the accidents of war and the Reconstruction Acts, have been annexed to the ancient municipalities, and have been compelled to share their burdens of taxation. This overflow has added another warning to the citizens of New Orleans as to the permanent necessity of protecting all inhabitable portions of both banks by substantial levees, elevated at least six feet above the highest flood-line. The inclosed areas should be kept thoroughly drained at all times by the best and most approved forms of pumps and draining machines. The first and highest duty of the City Administration is to protect the inhabitants from overflow, and thus prevent the increasing deterioration of property and the destruction of the lives of the people by these disas- trous occurrences. The people who pay the taxes have a right to demand that the money should be devoted to the protection of their property and the preservation of their health and lives. During the subsidence of the waters, heavy rains fell at intervals and inspections at intervals rendered it evident that the injurious effects of the overflow was greatly mitigated by the cleaning of surface by the falling waters. Many cases ot malarial fever were caused here and elsewhere in the over- flowed districts ; and during the autumn and winter of 1882,1 treated a large number of malarial fever patients in the wards of the Charity Hospital. Many of these cases were marked by yellow greenish swollen bloated countenances; extreme anaemias; general anasarca; ascites; hepatic de- rangements ; splenetic enlargement; and renal troubles with albumenuria. CCCLXXXII Preventable Causes of Disease: Joseph Jones, M. D. Albumen was found in the urine of the accute cases as well as in a cer- tain proportion of those suffering from chronic poisoning by malaria. WATER SUPPLY OF NEW ORLEANS. [Extract from the Report of Joseph Jones, M. D., President of the Board of Health of the State of Louisiana, on the waters of the Bogue Falaya, Tangipahoa and Mississippi Rivers]. [Correspondence]. New Orleans, June 10, 1882. Dr. Joseph Jones, President Board of Health. New Orleans, La. : My Dear Sir-I send you herewith a bottle of water sent by Judge Thompson, from the Bogue Falaya. Will you do me the favor to furnish an analysis of this water, in conjunc- tion with the report of Board of Health upon the advantages of an ample supply of clear pure water, etc. Yours, truly, D. B. PENN. I send resolutions of Chamber of Commerce. Board of Health, State of Louisiana, i New Orleans, June 13, 1882. f Honorable D. B. Penn. President of the St. Tammany Waterworks Company, New Orleans, La.: Dear Sir-I have the honor to acknowledge receipt of your letter of the tenth instant, conveying the request that I should furnish an analysis of samples of water sent by Judge Thompson, from the Bogue Falaya River, and respectfully submit the following as the result of the examination. * * * [As the analysis of this water did not differ materially from that of the sample subsequently furnished by the commission appointed by the Hon- orable Common Council, the report is omitted]. In conclusion, allow me to say that in accordance with your request, I shall take pleasure in bringing this subject to the notice of the Board of Health at the next regular meeting; but in the mean time, I shall call the attention of tho Conference Committee to your enterprise ; and it will thus be in your power, at any time, to consult with this committee, through its chairman, Colonel A. W. Bosworth. The Conference Committee of the Board of Health is thus constituted : Colonel A. W. Bosworth, (residence, 152 Washington street; office 22 Nat- chez street); Colonel I. N. Marks, residence, 163 Annunciation street; office, 33 Camp street); J. C. Faget, D. M. P., (residence and office, 281 North Rampart); Honorable Ed Booth, (residence, 505 Magazine street; office, corner Gravier and Magazine streets); Dr. George K. Pratt, resi- dence, 215 Camp street) ; office, corner of Carondelet and St. Charles streets). Respectfully, your obedient servant, JOSEPH JONES, M. D. REPORT OF CONFERENCE COMMITTEE OF BOARD OF HEALTH, STATE OF LOUISIANA. New Orleans, June 22, 1882. To the President and Members of the Board of Health. Your conference committee, to whom was referred the chemical analysis and papers concerning the properties of the water proposed to be furnished by the St. Tammany Water-works Company, having carefully considered the same, have come to the unanimous conclusion that a full supply of Preventable Causes of Disease: Joseph Jones, M. D. CCCLXXXIII such water, in manner and to extent and at rates contemplated, will be one of the greatest blessings this city has ever received. The scientific examination and analysis to which this water has been subjected by the President of this Board, whose report has been submitted to the committee, establishes confidence in these waters for the highest domestic uses, po- table, culinary and lavatory. If the company can overcome the engineering and financial obstacles, and furnish to New Orleans, as they propose, the pure streams filtered through the orange sand tormation described by Pro- fessor Jones in his analysis, they will have done for our city what ancient builders did for Babylon, Carthage and Koine, and moderns have endeavored for Boston. New York and Philadelphia. Viewed from a hygienic standpoint, we would not be understood as diminishing the just appreciation in which is held the ever-flowing, ever- free, fresh and superabundant waters of our Mississippi River, so valuable for so many purposes, but it has been long evident that there was, and is, needed a relief from the monopoly which our wooden, above-ground cisterns have enjoyod as our only resources of supply of clear, soft water for do- mestic use. It would be quite unnecessary to state, much less to argue, the detailed points involved in the above proposition, as against cisterns. Our present business is with the pure crystal floods awaiting us in Bogue Fai ay a, and to them we bid a hearty welcome, and say come, and come soon. The sooner, and the more the better; therefore, be it Resolved, by the Board of Health of the State of Louisiana that, guided by the chemical analysis made by Professor Joseph Jones of water pro- posed to be introduced to New Orleans by the St. Tammany Waterworks Company, this Board approves of the enterprise warmly, from a health point of view, and expresses the hope that the Legislature and City Council will give the necessary powers and facilities, by all proper and legal methods for the success of so valuable and important an undertaking. For the Conference Committee. [Signed] A. W. BOSWORTH, Chairman. THE BOGUE FALAYA-ENGINEER'S REPORT ON THE WATER SUPPLY- ENOUGH PURE SOFT WATER FOR 1,000,000 PEOPLE-CONSULTING ENGINEER COOK'S VIEWS. Below we present, a part of the report of the consulting engineer, made to the St Tammany Waterworks Company : In regard to the quality and quantity of water of the Bogue Falaya River, we have the following certificate of Mr. John Roy . "This is to certify that I have visited and inspected the proposed sight for forming a basin on the Big Bogue Falaya River, St. Tammany parish, in connection with a project for supplying the city of New Orleans with water, and found the same very advan- tageously situated for the purpose intended. The natural advantages are very great, leaving little for art to do to form a basin, ample, secure, and easily maintained. I also measured the flow of water and found it to be forty-nine millions wine gallons in twenty- four hours. This was in the month of Septemoer and a dry time. "JOHN ROY, Architect and.Engineer." Mr. J. D. Cook, consulting engineer, of Toledo, Ohio, makes the following report: Dear Sir-Knowing that your Water Supply Association are greatly anxious to know something as to the result of my investigation, and having been unexpectedly delayed in making such a report as I intended, and as the great importance of the enterprise amply merits, I send you this preliminary communication, which is intended to cor- rectly set forth the more important cbaracterists of the project, together with its esti- mated cost; and in the event that your further deliberations shall culminate in a per- manent organization, having for its object the actual construction of the works, I will at an early day prepare a more elaborate report, accompanied with such maps and draw- ings as may be necessary to represent in detail what I now merely give in aggregate. CCCLXXXIV Preventable Causes of Disease : Joseph Jones, M. D. The first, and indeed most important factor in the investigation, is as to an eligible source of supply of water sufficient in purity and quantity to meet the present and pros- pective demands of your city. In this connection, I deem it needless, in view of the thoroughly intelligent and ap- preciative readers whom I have the honwr to address, to more than merely advert to your great prospective growth and increased municipal importance, so easily foreseen as a resultant of the many new and important railroads which are being added to your former great facilities for transportation, or to your greatest of all rivers, which practically drains a continent and renders you easily accessible to the navigable waters of the world. In fact, with such an array and magnitude of natural and acquired facilities, your present population becomes the minimum factor in the comparison with other and even less naturally favored cities throughout the world. In other words owing to the intervention of several well.known and avoidable im- pediments, New Orleans, although taking respectable rank among the more important municipalities of the country, is nevertheless vastly below its legitimate prestige as a leading commercial city of North America. Guided by these reflections and the logical conclusions which they suggest, I should consider it demonstrably unwise in me to reccommend, or you to adopt, a system of water supply merely adequate to your present needs ; and although somewhat abbreviated in detail, the accompanying estimates and general description are intended to correctly reflect a design which will be found commensurate with the augmented municipal im- portance to which you are inevitably and speedily tending. In this connection, the proposition can scarcely be considered debatable that, a copious supply of water of almost unparalleled purity, delivered throughout the entire city, would be found directly and almost immeasurably instrumental in advancing your beautiful city to its legitimate standard of population, wealth and sanitary conditions. Here, again, you are manifestly fortunate beyond ordinary comparison. The territory north of Lake Pontchartrain, generally bounded on the west by the valley of the Tangi- pahoa and on the east by Bogue Chitto, extending beyond the northern boundary line of the State, and comprising a drainage area of more than two thousand square miles, is traversed by numerous navigable and living streams of proverbially clear, soft water. In my judgment, the territory drained by the Bogue Falaya and tributaries would furnish you an ample supply for many years to come, or until your consumption shall exceed 75,000,000 to 80,000,000 gallons per twenty-four hours. Its present drainage area may be taken at 200 square miles, which can, when desired, be enlarged to any needed extent by drawing from the watersheds of the Bogue Chitto, the Tchefuncta, the Chappapulla, etc. The area drained by Croton River supplying New York is taken at 300 square miles, with a minimum rainfall of 35 inches, maximum 63 and mean 43 inches. Taking that of Bogue Falaya at 200 square miles, minimum rainfall 42 inches, maximum 67 and mean 51, would give an average supply per annum of 176,639,543,000 gallons: deducting for loss by evaporation and other sources 85 per cent, which is considerably larger than is usually found necessary in actual practice, and taking the remaining 15 per cent, as available, would give an annual supply of 35,327,452,600 gallons, or 96.786,550 gallons per twenty- four hours, or 73,000,000 gallons water per day, on a basis of least recorded rainfall. In this instance the frequently troublous question of present purity or probable future pollution from dense population and dangerous manufactories are scarcely worthy of passing thought. With a watershed containing less than four persons to the square mile; with almost absolute freedom from stagnant pools or miasmatic swamps ; with a salubrious and even healthful climate, due to pure air and pure water, your immunity from solicitude in this regard, in contradiction to the experience of most other large cities, would be practically absolute and perpetual. The intervening distance, composed of land and water, which separates the city from this region, while tending somewhat to the complication of the problem and adding to its cost, should, therefore, not be regarded in the single light of a misfortune. With nearer proximity and no intervening obstacle to expanding settlement would come the usual source of pollution, involved from increasing population around and contiguous to the sources of water supply so common to the history of otiier cities. Unlike many of them, you would never be subjected to the expensive necessity ot revisions, reconstruc- tions, etc., incident to seeking a source of greater safety. Office Board of Health, State of Louisiana, ♦ New Orleans, August 7, 1882. i His Honor, Joseph A. Shakspeare, Mayor City of New Orleans : Dear Sir-I have the honor to acknowledge the following : Mayoralty of New Orleans, ) New Orleans, La., Aug., 1, 1882. I Joseph Jones, M D., President Board of Health, New Orleans, La. : Sir-His honor the Mayor requests you to analyse the water herewith sent at the earliest convenience and make report to him of the result of said analysis. The water sent is that taken by the committee appointed by the Council from the Bogue Falaya, to be tested for its purity for drinking purposes. Bv direction of the Mayor, E. L. BOWER, Chief Clerk. Office New Orleans Waterworks Company, 1 Corner St. Charles and Perdido Streets, > New Orleans, August 3, 1882. ) Dr. Joseph Jones. Dear Sir-In making analysis of the water sent to you, we would be obliged, if in your report, you would make a comparison with the waters of the Mississippi and our rain water, in such manner as to show their rela- tive merits, for the health of our inhabitants. Yours respectfully, JOS. A. SHAKSPEARE, Mayor. On the second of August I received samples of the soil and waters of the ''Bogue Falaya" basin and river, and in accordance with the request of your honor, present the following statement of the general results of the investigation : 1. Physical, Chemical aud Microscopical Properties of soil from the basin and banks of the Bogue Falaya river. (a) Surface Earth.-This sample embraced the surface soil with grass growing upon it, and extended to the depth of about 3J inches. Surface of a dark gray, inclining to dark blackish brown ; this color gradually shaded into grayish yellow earth, the darker coloring of the sur- face was due to small quantities of carbonized organic matter. Under the microscope the soil was found to consist of minute particles of silex and silicates, with slight evidence of organic matter. When moistened with water, the soil formed a soft yielding mass, with but little cohesion, and was entirely different in its physical properties, from the thick tenaciousclay of the Mississippi Valley, and more especially of the Delta. The porous sandy nature of this soil, as well as the absence of organic matters and lime salts, and those of the alkalie and alkaline earths, estab- lish the view that this soil should be regarded as unsuited to the purposes of agriculture, unless highly enriched by manure. This soil appears to be incapable of sustaining vegetation to any extent, and seems adapted only to the growth of the pine, and to the stunted forms of the more hardy grasses and plants. The mineral acids exerted little or no appreciable effect upon this silicious soil, and the solution thus obtained yielded only a mere trace of lime. The surface soil of the Bogue Falaya River, is thus shown to be silicious in its constitution, to a certain extent porous, and to be devoid of deleteri- ous organic and mineral constituents, and to be incapable of impairing the quality of the water collected from the basin or water shed. SAND FROM THE WATER LEVEL, TWENTY-FIVE FEET BELOW THE SUR- FACE OF THE PLATEAU, LIGHT CREAM COLORED, DRY FINE SAND. Under the microscope this sand was found to consist of numerous trans- parent and colored crystals of silicious acid and silicates. Preventable Causes of Disease : Joseph Jones, AI. D. CCCLXXXV CCCLXXXVI Preventable Causes of Disease : Joseph Jones, M D. The greatest portion of the sand consisted of transparent crystalline particles of silicic acid, varying in diameter from 1-50 to 1-100 of an inch in diameter. 1 discovered with the microscope no organic remains, vegita- bleor animal, recent or fossil in this sand. Concentrated chemically pure nitric and hydrochloric acids, appeared to produce no perceptable or recognizable effect upon the sand. (c) Sample, of soil taken from beneath the surface, at various depths ; two feet below the surface ; eight feet below the surface ; twelve feet below the sur- face ; water level twenty-five feet below the surface of Plateau. Aftercareful microscopical and chemical examination, these specimens were found io present essentially the same characteristics, and resemble closely the soil, differing chiefly in the degree of cohesion of the particles and density and solidity of the strata. Under the microscope all the specimens presented the same general char- acters, namely-collections of fine silicious particles ranging from 1-100 to 1-500 of an inch in diameter. This deposit, although presenting some of the appearances and proper- ties of a light-colored clay, more nearly resembled a soft, incoherent sand rock, composed chiefly of minute particles of silex and silicates; and the entire formation is more porous than the ordinary clays of South Carolina, Alabama, Mississippi and Tennessee. The concentrated nitric and muriatic acids caused no effervescence with any of these specimens, and exerted little effect, only traces of lime being obtained from the filtrates. As the entire thickness of the stratum (twenty-five feet), was of a porous, silici' us nature, devoid of soluble salts of lime and also of organic remains, recent and fossil, it forms a natural filter for the rain-water falling upon the water shed of the Bogue Falaya River. GEOLOGICAL SOURCE OF THE WATERS OF THE BOGUE FALAYA RIVER. This an other rivers of Louisiana and Mississippi, on the east of the delta, derive large portions of their waters from the great orange sand formation, which characterizes the greater part of the surface of Missis- sippi. The thickness of the orange sand formation is extremely variable ; as originally deposited, its strata appear to have been dependent on the degree of denundation, which the strata of the more ancient formations had pre- viously undergone. The greatest thickness observed by the learned and accomplished geologists, Professor Eugene W. Hilgard, was in a well dug at the University of Mississippi, to a depth somewhat more than two hun- dred feet. One hundred feet is no unusual thickness; but most commonly it varies between forty and sixty feet. As the name indicates, the prevaling materials composing this forma- tion, are silicious sands. They are usually colored, more or less, with hy- drated peroxide of iron, or orange yellow ochre. The color thus imparted givesan endless variety of tints, whilst deposit of white sand suitable for the manufacture of glass are not uncommon. The Orange Sand formation of Mississippi and Louisiana contains no fossils whatever characteristic of itself, and is without any appreciable or- ganic matter. The rounded shape of the grains of this great sand formation, and the relations of its materials, to those of the underlying formations, proves be- yond question, that its deposition took place in flowing water. Nor can there be any doubt that the general direction of the current was from north to south, although locally changed or directed by the pre-existing inequali- ities of the surface. Preventable Causes of Disease: Joseph Jones, M. D. CCCLXXXVII The waters percolating through the orange sand formation at the pre- sent time are remarkable for the small amount of the salts of lime and mag- nesia which they contain, and may, therefore, be uniformly characterized as free stone waters of excellent quality for drinking, bathing, cooking, washing and for various manufactories. RESULTS OF EXAMINATION OF SAMPLES OF WATER COL- LECTED FROM THE BOGUE FALAYA RIVER BY THE SPECIAL COMMITTEE APPOINTED BY THE MAYOR AND ADMINISTRATORS OF THE CITY OF NEW ORLEANS. The following samples of water from the Bogue Falaya River were sub- mitted for analysis: No. 1-Water from Bogue Falaya, taken at 8 a. m., July 28, 1882, from near bridge belowr Mulberry Grove. Heavy showers night before, and Bogue Falaya swollen one to two feet above ordinary. No. 2-Water taken from the surface flow from pine flats, running into Bogue Falaya on the west side, about three miles above Covington ; sample taken at 12 noon July 28, 1882, where running over edge of bank into Bogue Falaya. No. 3-Water taken from Bogue Falaya at 12:30 a. m., July 28, 1882, at site of Marty's old mill, four or five miles below Covington. No. 4-Water from "pond," or "slough," or "swamp," on west side of Bogue Falaya, not exceeding one acre in area. Has no present outlet to bayou. Not over six or eight inches deep. Goes dry in "dry times." Taken 1 o'clock p. m., July 28, 1882. No. 5-Water from Bogue Falaya, taken July 28, 1882, 5 p. m., near Mul- berry Grove. No. 6-Water from Little Bogue Falaya, taken from mill pond at Pane's Mill, 12 o'clock noon July 29, 1882. Stream swollen from heavy shower last night; Mr. Page says is five feet higher than ordinary stage. No. 7-Surface water from recent shower, taken from small branch run- ning into Bogue Falaya on east side, near Mulberry Grove Cottage, 2 o'clock p. m., July 29, 1882. PHYSICAL PROPERTIES. Color.-With the exception of the samples marked respectively Nos. 2 and 4, the water was perfectly colorless; in the specimens indicated, there was a very faint, scarcely perceptible tinge of yellow, ('hemical analysis revealed the fact that this color was due to vegetable coloring matter. The amount of organic matter, however, was a mere trace, and appeared to be derived from grasses and the leaves of trees. Nitrate of silver, oxalate of lime and the Baryta salt gave no deposit with any of those samples, show- ing that the coloration was due to a mere trace of the vegetable coloring matter. Specific Gravity.-The specific gravity of each and every specimen did not differ from that of distilled water, 1000° at 60° F. Deposit.-The specimens were free from any definite deposits; after standing for over twenty-four hours, a number of minute flocculi fell to the bottom. Under the microscope these light cloud-like flecks, were found to consist chiefly of the cells, spores and thalli of fresh water algae of green or brown colors, with a few small crystals of Silicic acid. Algae are found in all running streams, and without doubt their numbers are increased in the mass of the waters of a river by the aggitation of heavy and prolonged showers. CCCLXXXVIII Preventable Causes of Disease: : Joseph Jones, M. D. These green microscopical plants are characteristic of all collections of fresh water, and were, to a large extent, developed after the collection of the samples. 1 attribute no deleterious properties whatever to these microscopic plants, which are found in even greater abundance in the rain-water, col- lected in our cisterns. These samples of the Bogue Fai ay a water, therefore, may be described as clear, transparent and free from any distinct deposit or sediment; with a specific gravity similar to that of distilled water, and with the general characteristics of rain-water. CHEMICAL EXAMINATION. Careful testing with such reagents as the nitrate of silver, oxalate of ammonia, and Baryta salts, revealed the absence of the sulphates and chlorides, and the calcium compounds. No more effect was produced upon these reagents than would have been caused by pure rain-water, collected in the country where the atmosphere would have been free from the impurities characteristic of the atmosphere of large cities. Upon evaporation, in any small quantity, such as from two to four fluid ounces of the samples of water, no appreciable saline residue remained. GENERAL CONCLUSIONS. From the proceeding examination, 1 regard the water of the Bouge Fa- laya as pure, uncontaminated by saline or organic matters to any appre- ciable extent, and as suitable for drinking, washing and cooking, and also adapted to the use in boilers, and in all manufactures as those of paper and cloth, in which it is necessary to employ pure water, free from sedimentary matters. EFFECT OF ABUNDANT RAINS. It should be borne in mind, that these samples of water were taken after and during the presence of frequent rains, and that the Bogue Falaya, like the Mississippi and other streams, at this moment, is swollen to its greatest capacity. The sample of water submitted to me for analysis by Governor D. B. Penn, was taken at a somewhat lower stage of the river, and in this sam- ple nitrate of silver and oxalate of ammonia produced only a slight cloudi- ness, whilst cloride of barium produced no deposit. This sample was free from organic matter, but contained traces of the chlorides and the calcium compounds. From this comparative examination we gather that the chemical compo- sition of the Bogue Falaya water may vary within certain limits, in accord- ance with the greater or lesser rainfall. The same remark applies also to the waters of the Mississippi River. In the year 1869, at the request of General Braxton Bragg, I examined, microscopically and chemically, the waters of the Mississippi and of the Bogue Falaya and Tangipahoa River, from the iron wells and cisterns and natural wells of the city ; even the various forms of ice, natural and arti- ficial, consumed in New Orleans, were included in the extended analysis. Only a fragment of this report was published, and I have never been able to secure my original manuscript. I would, however, respectfully refer your Honor to the following extracts from this report, as embodying replies to one or more of your inquiries, and also relating to subjects of great san- itary importance to the citizens of New Orleans. At the time that this report was made, Colonel A. W, Bosworth (now of the Board of Health) was President of the City Waterworks, and General Braxton Bragg was Superinendent and Chief Engineer. EXTRACTS FROM REPORT OF SUPERINTENDENT AND CHIEF ENGINEER. Preventable Causes of Disease : Joseph Jones, M. D. CCCLXXXIX SUPERINTENDENT'S OFFICE, CITY WATER WORKS, ? New Orleans. January 15, 1870 . 5 To the Board of Commissioners, City Water Works: Gentlemen- ********** • WATER SUPPLY. CONSUMPTION AND WASTE. In seeking a source of water supply, we must examine, first, its quality ; second, its quantity; and third, the cost of introduction. Unless the quality is such as to recommend it as wholesome and suitable for domestic purposes, it is useless to look further ; for the more abundant the supply, and the cheaper it could be had, the greater the objection. The quantity to be obtained should be sufficient to meet all reasonable prospect for future increased consumption. And the cost must be within the available resources of the community. We are eminently blessed in having the three conditions fulfilled, in the immenee vol- ume which the Mississippi unceasingly pours by our very doors. ANALYSIS OF THE WATER SUPPLY. Some prejudices, in the absence of scientific analysis, have existed against the water of the Mississippi, predicated almost entirely on the apperance given by the matter held in suspension. We have been long taught, however, by the habits of our oldest settlers, and by the constant practice of our seafaring people, to regard this water as pure and wholesome. To place the matter at rest and beyond question, specimens of the water were submitted to the able Professor of Chemistry in the University of Louisiana, Dr. Joseph Jones, whose report is submitted herewith. It will be seen he pronounces the water of the Mississippi, obtained by our works, remarkably pure and wholesome. Even the few foreign substances found-principally common salt and carbonate of lime-are regarded by him as beneficial, in such small quantities. The great purity of the Mississippi water at this point is readily accounted for. The waters of all streams are originally derived from springs and surface drainage. The former bring from the bosom of the earth, in solution or suspension, large quantities of inorganic substances, and the latter add immense amounts of organic matter, swept from the surface. For several hundred miles above New Orleans, owing to the peculiar topo- graphy of the country, no streams enter the Mississippi, and all surface drainage is from the river. During the passage of the water over this distance, substances thus held and brought into contact with each other, and with the oxygen of the atmosphere, by the constant agitation and motion of the water, are decomposed, and the elements, reuniting, form new compounds, generally innoxious, the gases escaping into the atmosphere and the solids subsiding In this way nearly all deleterious substances brought with the Mississippi are disposed of before the waters reach this point. Doubtless the mere trace of organic matter found is added to the water after it reaches the settlements just above the works. The immense volume of water contained in the Mississippi, however, renders it almost impossible^for us to contaminate it. The sewerage of London, thrown into the Thames and that of Paris, into the Seine, have a decided effect on the waters of those streams for a short distance ; yet it is found to be rapidly changed, and almost disappears within a few' miles. These waters, too, used in London and Paris, receive the drainage of a thickiy populated country down to the point of supply. Considering the great volume of water discharged by the Mississippi, even were it not relieved of the surface drainage for so great a distance above us, the location of half the civilized population of the world on its banks would not contaminate its waters to the extent now produced in the Thames and Seine, whose waters are used in London and Paris. The water of the Tangipahoa River, taken from a point about forty miles from the city, was also analyzed. It is found both clear and pnre, and were it not for its distance, and the cost of introduction, it would be a better source of supply even than the Missis- sippi. EXTENSIONS Economy and health both demand an early and very large extension of the works. The saving on insurance alone would, in a few' years, pay the whole cost. If the city cannot accomplish the work on a scale commensurate with is importance, it maybe well to invite private enterprise and capital. No other city in this country of half the CCCXC Preventable Causes of Disease : Joseph Jones, M. D. population and commerce of New Orleans is without an adequate water supply, and all make annual additions in proportion to the progress of population. DAILY SUPPLY AND WASTE. The quantity of water delivered in the year was 1,915,963,251 gallons, or a daily aver- age of 5,249,214, being a reduction of 1,017,043 gallons on the daily average of last year, due to the use of the metre and partial suppression of waste. This gives a daily aver- age to each person for 1869, allowing ten persons to each hydrant in use, of ninety-five gallons. The highest average in any other city of the United States is in Boston, sixty gallons, and the general average does not exceed forty-five gallons. This excessive use and waste is sufficient reason why the water rates should be higher than in works where only half the quantity is taken, and were it not for the comparative economy with which the works are run, they could not be sustained. Consuming at least double the quantity of water, our people, under the present low tariff, are receiving it for about one-half what it costs in other cities of this country. The public consumption is enormous, owing principally to the habit of running the water in the street gutters to do the work of scavengers. The result is to cover the filth, or wash it back on the poor resident in the rear, there to reek, decompose, and pollute the atmosphere, at the expense of the public health. If this waste be considered necessary, it would be great economy to erect separate pumping works to deliver the supply. The water now used is raised on an average seventy feet above the river for the purpose of pouring it into the street gutters; ten feet would accomplish the same purpose, and six-sevenths of the expense might be saved. Being considered public property, no one seem to care how much water is wasted, and public hydrants are opened by everybody and permitted to run at all hours. The con- sumption a t the City Hall, for instance, is found by meter to be 6000gallons daily, enough for all domestic purposes in sixty families. A public horse trough on the levee is found to take 24,000 gallons daily. In the markets and other public places the same extrava- gance prevails. Having no control over these abuses, the water-works cannot be res- ponsible for the results. The effect is to render a higher water rate necessary, and the party guilty of the abuses is generally the first to complain. CHEMICAL EXAMINATION. CHEMICAL EXAMINATION OF THE WATERS OF NEW ORLEANS, LOUISIANA RY JOSEPH JONES, M. D,, PROFESSOR OF CHEMISTRY IN THE MEDICAL DEPARTMENT OF THE UNIVERSITY OF LOUISIANA. General Braxton Bragg, New Orleans, La: Dear Sir-The sample of the waters of the Mississippi River, and of various localities withig and around New Orleans, submitted to me for analysis, by you, as Superintendent of the City Water-works, have been subjected to careful chemical and miscroscopical examination, and the following results are respectfully submitted : No 1.-Mississippi River Water, from Inlet Pipe. When first drawn, the watar presented a turbid appearance ; upon standing, the sus- pended matter settled, forming a light grayish, yellow deposit ; and the supernatant water remained slightly turbid, from a small remaining portion of suspended matters. The insoluble suspended matters amounted to twenty-three and two-tenths (23.2) grains to the gallon of water, and, under the microscope, were found to consist chiefly of very finely divided sand (silicic acid), and the silicates of alumnia, and contained but few remains of animalcules or of vegetable structures. After the removal of the suspended matters, the water yielded a specific gravity simi- lar to that of distilled water-viz : 1000 at 60°-and the amount of saline matter, upon careful evaporation, was found to be only eleven and nine-tenths (11.9) grains per gallon. Upon analysis, it was found that these saline matters contained only traces of the sulphates of potassa, soda and magnesia, and consisted almost entirely of the carbonate of lime and chloride of sodium. Each gallon contained 2.91 grains of lime (equivalent to 5.29 grains of Carbonate of lime) and 3.378 grains of chlorine (equivalent to 5.53 grains of chloride of sodium, common salt.) No. 1.-One gallon (70,000 grains) of Mississippi River water contained: Specific gravity at 60° F 1000.00 Suspended matters deposited upon standing, grains 23 30 Fixed saline constituents, grains 11.90 Carbonate of lime, grains 5.29 Chloride of sodium, grains 5.53 Carbonates and sulphates of soda, potassa and magnesia, grains 1.08 Preventable Causes of Disease: Joseph Jones, M. D. CCCXCI No. 2.- Haters of Mississippi River (sample marked No. 3), from hydrants in office of City Water (Forks : The water was turbid, from sedimentary matters, when first drawn. Upon standing, the suspended earthy matters settled, leaving the water slightly turbid, from the pres- ence of the more finely divided silicate of alumina. The sedimentary matters were in slightly less amounts than in the preceding sample, being only eighteen and eight-tenths (18.8) grains to the gallon. On the other hand, the fixed saline constituents were, within a fraction of a grain, similar in amount to those of the first samples, being eleven and two-tenths (11.2) grains to the gallon. The reactions under different reagents were in like manner similar : chloride of barium producing a very slight, scarcely perceptible precipitate, whilst the nitrate of silver and oxalate of ammonia produced a more decided precipitate. The sedimentary matter, in like manner, was found, under the microscope, to consist of minute fragments of sand (silicic acid) and of mineral silicates, with very few articles of organic matter or animalcules. Each gallon contained 5.18 grains of chlorine and 1.45 grains of lime. No. 2.-One gallon (7,0000 grains) of Mississippi River water, from hydrant in office of City Water Works, contained: Specific gravity at 60° F 1000 00 Suspended matter (silicic acids, silicates, etc.), grains 18.80 Fixed saline constituents grains. .. 11.20 Chloride of sodium, grains 8 51 Carbonate of lime, grains 2.69 Sulphates and carbonates of alkalies, grains 0 05 From the preceding examination we conclude that the waters of the Mississippi, w hen freed from the suspended matters, are of great purity, and will compare favorably with the drinking water supplied to the largest and best regulated cities iu the world. The truth of this assertion is established by a comparison of the preceding results, with the results of the analyses of the various springs and rivers used in the supply of cities, us exhibited iu the following table. In order to render the comparison more sim- ple and conclusive, we have introduced into this table only the total amount of saline constituents. ****** (This elaborate table of details is omitted). ****** If the solid saline residue of one hundred thousand parts of the Missississippi River water be compared with the solid saline matters of the drinking waters of the noted rivers and springs recorded in the preceding table, it will be found that the drinking water supplied to the city of New Orleans compares favorably with each, audit is in fact far purer than the majority of the drinking waters heretofore analyzed by chemists. Iu each glass of Mississippi water less than half a grain of saline consti- tuents are present, and this small amount, almost absolutely inappreciable iu its effects upon the animal system, is composed almost entirely of common salt and carbonate of lime. If those salts exert any effect whatever upon the animal economy, it is beneficial and not deleterious. A point of considerable interest, in a sanitary point of view, is that the suspended matters of Mississippi river water are free from organic impurities, and consist almost entirely of finely divided silicic acid and silicicates. The suspended matters, so far from rendering the Mississippi river unfit for sanitary purposes, add to their disinfectant properties. The health of New' Orleans would be without doubt greatly promoted by flushing out the main drains and gutters continuously with full streams of Mississippi river water. The mud which would settle along the sides and bottoms of the drains would possess no noxious properties whatever of itself. The free use of coal tar and gas lime and quick lime, also iu gutters and drains, w'ould tend in a like manner to arrest noxious emanations, and so preserve the purity of the atmosphere of the city. No. 6 - (Cater from the Tangipahoa River (marked No. 6.) This specimen of water was clear, transparent, and crystaline in appearance. The specific gravity was similar to that of distilled water, viz: 1000. Nitrate of silver and oxalate of ammonia produced only a slight cloud, and chloride of barium produced no deposit. The fixed saline constituents amounted to only five and six-tenth (5.6) grains to the gallon, and consisted of chloride of sodium. 1.41 grains, and carbonate of lime, 2.51 One gallon, (70,000 graius) of Tangipahoa water contained : CCCXCII Preventable Causes of Disease : Joseph Jones, M. D. Specific gravity . 1000.0° Sedimentary matters ... _ _ non® Fixed saline constituents __ 5-^0 Chloride of sodium... 1.41 Carbonate of lime . 2^1 Carbonates, silicates and sulphates sf potassa, soda and magnesia 1 The preceding analysis establishes the great purity of the waters of the Taugipah03, river. This subject is of great importance in a sanitary point of view, and should be brought to the attention, not only of the proper authorities charged with the conduct of tb® sanitary police of the city, but should also be brought to the notice of the parties interested in the preservation of their lives and health, viz : to the citizens. The attention of the President of the City Waterworks is respectfully called, in counection to the numerous analyses of the waters of certain Southern towns, which 1 have executed and published in my report to the Cotton Planter's Convention, on th® "Agricultural Resources of Georgia," See pp. 245-305. With great respect and high esteem. I have the honor to be your obedient servant. JOSEPH JONES, M. D- UNIVERSITY OF LOUISIANA. New Orleans, November 12, 1869. The qualities of the cistern water of New Orleans vary under certai11 conditions, as: 1. The amount of rainfall. 2. The age and character of the cistern. 3. The nature of the root from whence the water is collected. 4. The position and surroundings of the cistern, whether in an open lot or in a small yard close to the privy, or overshadowed by trees. 5. The presence and effects of certain manufactories, -especially thos^ which evolve noxious gases and mineral acids. " , G. The amount and character of the dust and debris of all sorts wash°° from the atmosphere and from the roofs of the houses by the rains. / Owing to the continuous rains of the past four weeks, the cisterns0' New Orleans are, and have been continuously replenished, and upon cal'0' ful chemical examination I find that they afford water of great purity' yielding the specific gravity of distilled water, and giving similar reacti°11S with chemical reagents. Upon more extended examinations, however, at different seasons of tb° year, I have observed differences dependent upon the age of the cisteDb the amount of water received and discharged, the care with which th sediment has been removed at regular intervals, and the position of t^ cistern with reference to trees and privies, the character of the root8' whether wood, slate or metal. Without doubt the gaseous matters arising from privies and from certa1* manufactures, as well as the particles of dust which float in the air an( rest upon the roofs of houses are absorbed by the descending rains ai1 finally reach the receptacles called cisterns. j Dust is highly complex, and represents the contents of streets aR gutters. How far the poisons inducing yellow fever, scarlet fever, Asiatic cholet^ and malarial fever, may be dissolved by the descending showers, ah finally affect the population through the medium of the water collected 1 cisterns has not been determined, but this subject is worthy of carefid 10 vestigation. It has been asserted that certain parasites and their larvae may be iutr duced into the human system by the medium of drinking water. v It must, however, be admitted that as a rule the cistern water of Orleans will compare favorably with the water supplied to the majority 0 Preventable Causes of Disease : Joseph Jones, M. D. CCCXCIII the large cities of this and other countries, and that the remarkable ex- emption of her citizens from the various forms of calculous disorders is due to the freedom of the cistern water from calcium and magnesium salts. The abundant supplies of rain-water furnished by nature to the citizens of New Orleans is shown in the accompanying table, drawn up from authentic sources. In this valuable table we have recorded the daily rainfall in New Or- leans during a period of forty years. All estimates as to the capacity and value of cisterns, as well as to the number, length and capacity of gutters and canals for the proper drainage of New Orleans, must be based upon the data furnished by this and similar tables, which embrace the daily rainfall. The annual and monthly rainfall does not correctly illustrate the pro- blems involved in the questions of surface drainage and of water supply for drinking, cooking and washing. The periods of drouth, with the minimum water supply, as well as the periods of heaviest rainfall, must be carefully estimated. GENERAL CONCLUSIONS. 1. The Mississippi Ei ver water varies in chemical composition within certain limits, in accordance with the temperature and rainfall; but at all times when freed from the usual deposit it may be regarded as a whole- some drinking water. 2. For purposes of drinking, bathing and manufacturing the Mississippi water should be freed from the heavy deposit which varies in quantity at different seasons, and with different stages in the main river and its tribu- taries. . 3. As a rule, the waters derived from the soil of New Orleans by means of wells are wholly unfitted for drinking. 4. The cistern water of New Orleans is liable to contamination from many sources, and varies in composition with the seasons. 5. The waters of the Bogue Falaya are pure, of stable composition, are not liable to contamination, and are free from sediment, and require no fil- tration, and are, therefore, suitable for drinking, washing and manufactu- ring. With respect I have the honor to remain your obedient servant, JOSEPH JONES, M. D., President Board of Health, State of Louisiana. 2^1 7 .nKAPHICAL and DRatVa^ ,r rjor - - -of - ■1W PREPARED FOR ■JOSEPH JONES, M®. BT T. S< HA.SD1EJE, Civil jEngineev. FOFttLATION of the CITY OF NEW ORLEA.1TS, FIBS! DISTBIOT White Males White Females Black Males Black Females WARDS DISTRICT 1st Ward. ... 5,225 6,318 1,123 1,769 14,435 2d " 6,167 7,060 1,460 2,132 16,819 3d 11 9,310 9,239 3,372 4,270 26,191 57,445 SECOND DISTRICT 4th Ward 4,077 4,991 1,547 2,102 12,717 5th " 6,380 6,676 2,706 3,504 19,266 6th " 4,349 4,895 1,502 1,940 12,686 44,669 THIRD DISTRICT 7th Ward 5,989 6,451 3,373 4,317 20,130 8th " 3,925 4,274 774 905 9,878 9th " 6,190 6,903 1,197 1,290 15,580 45,588 FOURTH DISTRICT 10th Wari 6,878 9,047 1,332 1,934 19,192 11th " 6,793 7,906 1,497 2,147 18,343 37,535 SIXTH DISTRICT 12th Warl 3,202 3,407 806 890 8,305 13th " 1,647 2,004 781 973 5,405 14th " 790 901 300 328 2,319 16,029 FIFTH DISTRICT 15th War1 2,382 2,640 1,650 2,185 8,856 8,856 SEVENTH DISTRICT 16th War1 580 604 903 1,029 3,116 17th " 944 984 598 595 3,121 6,237 Tota^ • • • ■ 74,848 84,280 24,921 32,310 216,359 SCALE OUTLINE OF THE HISTORY, THEORY AND V PRACTICE OF QUARANTINE. RELATIONS OF QUARANTINE TO CONSTITUTIONAL AND INTERNATIONAL LAW AND TO COMMERCE. -BY- JOSEPH JONES M. D., PRESIDENT OF THE BOARD OF HEALTH, STATE OF LOUISIANA. Quarantine regulations established in Europe before the discovery of America ; the English colonies of North America adopted quarantine reg- ulations before their separation from Great Britain; all the essential ques- tions relating to quarantine and the relations oi the individual States to the General Government thoroughly discussed and settled shortly after the formation of the Federal Union. Quarantine regulations relate to the preservation of the health and lives of the people, and are based upon the inalienable rights of self preserva- tion. The power to establish and enforce quarantine by the individual States, not a regulation of commerce in violation of the provisions of the Federal Constitution, but the exercise of the inherent and inalienable police powers of the individual States, which were never surrendered to rhe Gen- eral Government. Quarantine recognized by international law for the common security of States against diseases regarded as importable. Quarantine protects the health of the people, and facilitates and fosters commerce by rendering services to ships and their cargoes, crews, passengers and owners. THE THEORY AND PRACTICE OF QUARANTINE, AND ITS RELATIONS TO CONSTITUTIONAL AND INTERNA TIONAL LAW AND TO COMMERCE. We propose to discuss and examine, in the light of history, and of estab- lished facts and principles in ,constitutional and international law, the following questions : 1. Has a sovereign State, as one of the integral parts of the United States of America, an inherent right to establish and maintain quarantine for the protection of her citizens from the introduction of foreign pestilence ? 2. Has a State an inherent and constitutional right to levy a tax upon indi. vidual vessels for the sanitation of ships, their crews and cargoes, and for the exclusion of pestilence ? 2 History of Quarantine. 3. Shall the inspection and fumigation and disinfection fees, imposed for the support of quarantine, be regarded as a ta.r on commerce, in violation of the provisions of the Constitution of the United States, without any compensation or service rendered the ships and ship owners, and men engagedin commerce? In reply to the above questions, we submit the following propositionsand facts: (a) Quarantine regulations were established in Europe before the discovery of the American Continent. The notion that the plague was imported from the East into Europe seems to have prevailed in all ages. But it would appear that the Venetians were the first who endeavored to guard against its introduction from abroad, by obliging ships and individuals from suspected places to perform quarantine. The term quarantine is derived from the Italian quaranta, forty ; it being generally supposed that if no infectious disease broke out within forty days, or six weeks, no damage need be apprehended from the free admis- sion of the individuals under quarantine. During the period of forty days, also, all the goods, clothes, etc., that might be supposed capable of retain- ing the infection, were subjeetto a process of purification, performed either on board the ship or on establishments denominated Lazarettos. The regulations for quarantine were issued by the Venetians as early as 1484. Since this date they have been gradually adopted by every other country. Various preventive regulations had been enacted in England for a long time, but in this country quarantine was not systematically enforced till after the alarm occasioned by the dreadful plague of Marseilles in 1720. The regulations then adopted were made conformably to the suggestions of the celebrated Dr. Mead, in his famous "Discourse Concerning Pestilential Contagion" (b) The English Colonies of America adopted quarantine regulations long before their separation from the mother country and the achievement of their independence. The following records from the history of the individual colonies illus- trate and sustain the preceding proposition : SOUTH CAROLINA. By act of October 8, 1698, "All vessels are forbidden to pass to the east of Sullivan's Island one mile, without permission of the Governor, under penalty of being fired on by the gunner and paying a fine. The pilot is required to ascertain from the captain before passingthat limit, if any contagious disorders are on board, under penalty of £50." By act of June 7, 1712, Gilbert Guttery was appointed health officer for the Province of South Carolina, to inquire "into the state of the health of all persons us shall arrive on shipboard." He was to go onboard all vessels as soon as they crossed the bar, and make these inquiries; also concerning the deaths on the passage ; search the ship and order all the men on deck for that purpose. He was empowered to administer oaths to captains and crew touching this law, and upon cause to send persons to the pesthouse on Sullivan's Island, to have the vessel fumigated, and to detain her for twenty days, with- out communication, except with Sullivan's Island. The diseases then specified were, "the plague, small-pox, spotted fever, Siam distemper, Guinea fever," etc. The penalty was £100. The pilot must wash himself and hisclothes before coming ashore, after being aboard of any vessel arriving from South of 30° N. Lat., under penalty of £20. No person shall visit such ship before the commissioner posted the public certificate, under penalty of £100, or being whipped through the public streets. Nor shall the cap- tain send a boat ashore before said certificate, under penalty of £50, together with a for- feiture of all negroes and other goods he may put ashore. No person should leave the pesthouse without permission, under penalty of £30. The commissioner must allow no one but himself to go aboard, and lie must cleause himself before his return. The commissioner has full charge of the pesthouse, furnish- Joseph Jones, M. I)., on Quarantine. 3 ing house, repairs, conveniencies to the value of £15 per annum. Persons in the pest- house must maintain themselves, the commissioner causing the provisions to be carried there at market prices. The commissioner's salary to be £40. Act of September 21. 1721: The same provisions as the act of 1712, except the pilot, "shall, wind and tide permitting, bring the said ship above Johnson's Fort, so that she may be under the command of the guns of the fort." That the captain or the doctor, or officer and sailor shall apply to the commandant of said fort, and answer whether "the place from whence he came is healthy; whether his ship's company is in health, and how long since." The commandant may permit him to pass, but he must then apply to the Governor, who being satisfied, the ship shall be "permitted to enter and trade." If the commandant or Governor is not satisfied, the ship shall be removed to a place, by them designated, for quarantine. The consignee may furnish provisions to his vessel under the direction of the Governor ; but no one shall go on board without his permission, or his boat shall be confiscated. In case of a hurricane, the quarantine ship may seek safety up the river. The provisions of this act extend to any other port in the province of South Carolina. Act of September, 1738: The Spanish in Havana and St. Augustine being about to in- vade the province, and there being fear of the spreading of the small-pox, no person having small-pox shall come within two miles of Charleston, or be inoculated within that limit, under penalty of £500. The justices of the peace shall remove infected per- wns outside of the limits and guard their houses. Persons refusing to assist the justice > be fined £20. All infected houses in the country shall be advertised on the public i id and at the church; and a white rag tied to the gate of the house or plantation, under penalty of £50. The justices are charged w ith cleansing infected places. Act of May 29, 1744: One thousand pounds appropriated for Sullivan's Island Pesthouse. No ship with negroes from Africa shall pass to town without the negroes staying ten days at the pest- house, or carried on shore five out of ten days for purification upon pain of confiscation. No one from shore shall go on board said ship ; and no one leave said ship under penalty of whipping. The captain, in passing Fort Johnson, shall swear conformity. Act of January 13, 1847 : The form of pilots' oath, when receiving his branch, that he will make inquiries for contagious diseases, is enacted. Pilot shall receive ten shillings per diem w hile at quar- antine, unless captain informed him before he went aboard. No one to leave the vessel without a pass. No vessel coming from any part of America where the commander at Fort Johnson has heard there is plague, malignant fever, small-pox or any other con- tagious distemper, shall be permitted topass Fort Johnson if the officer of the vessel refused to swear, unless w ith the consent of one of the doctors signing, date, Moultrie, Martin Caw and Rind. Their fee for visiting vessel, £7 10s and boat hire. The com- mandant at Fort Johnson shall signal for the doctor. Similar acts reaffirming the powers and provisions of the preceding acts were passed April 13, 1756; April 7, 1759; May 30, 1760 ; March 26, 1784 ; March 17, 1785. After the Revolution, and the confederation of the original colonies under the Repub- lic of the United States of America, the powers and provisions of these and similar acts relating to quarantine were reaffirmed and enforced by the State of South Carolina by the acts of December 19, 1796 ; December 16, 1797 ; December 19, 1809 ; December 20, 1832; December 21, 1-39 ; December 19, 1849; January 28,1861; September 26, 1868; March 9, 1869, 1872; February 7, 1875; December 23, 1878; December 23, 1879. The provisions of the act of December 19, 1809, are especially worthy of note : " The quarantine officers may board by force of arms any vessel, and detain crew and passen- gers who may violate quarantine; the penalty of the latter is from $100 to $2000 One. A pilot shall lose his branch for violating quarantine, as well as be fined. Any vessel vio- lating quarantine laws may be fired into." MASSACHUSETTS. Information having reached the Colony of Massachusetts-Bay that the "plague, or like grievous infectious disease," had "raged exceedingly in the Barbadoes and other islands of the West Indies," quarantine measures for the prevention of the introduction of a disease so fatal in its character were passed by the General Court in March, 1647 or 1648. The General Court legislated on the subject of quarantine, eleventh October, 1665; ninth October, 1667, and on the eighteenth of July, 1700, the Province of Massachusetts passed a stringent quarantine act, entitled "An Act for the better prevention of the spreading of infectious sickness." This act contains an important provision, compelling the parties bringing infectious disease within the limits of the Colony to pay all costs and damages. The power of the Colony to impose fines for violation of quarantine regulations, and to compel the infected vessel and crew to maintain themselves, and to pay all "the costs and charges arising therefrom," was clearly recognized and formulated in the act of 1700. 4 History of Quarantine. This is clearly set forth iu section 3 of the said act: Sec. 3. " That if any passenger or seamen arriving in any ship or vessel visited with the small-pox, or other pestilential or infectious sickness, upon her voyage, shall presume to come on shore before license had aforesaid, it shall and may be lawful to and for any justice of the peace to require or send such person or persons, with their clothing and bedding, on board such vessel again, or to coniine them to such other place or places as such justice shall judge most suitable for preventing of infection ; and all the costs and charges arising therefrom to be answered and paid by the passenger or seamen so offend- ing as aforesaid, who also shall forfeit the sum of £20 to the use aforesaid, and to be recovered in manner as aforesaid." Acts were passed relative to quarantine and contagious diseases in 1701, 1702, 1716, 1717, 1719, 1721-22, 1728-29, 1737, 1738, 1743-44, 1749-50, 1757, 1797. The acts passed by the Legislature of Massachusetts after the Revolutionary War greatly perfected the system of quarantine. The act of 1797 is specially worthy of note. It appears that the early jurisdiction over quarantine was exercised by the Governor and Council of the Colony of Massachusetts Bay. Later it was carried on by the same, with the assistance of the selectmen of the town of Boston. These selectmen hud the full power over quarantine conferred on them by an act passed in the year 1797. By the appointment of a Board of Health in 1799 all the powersof the selectmen over quarantine were delegated to this Board by an act passed June 20, 1799, and continued until the Board ceased to exist. Acts regulating quarantine were passed in 1816, 1821, and at various later dates. QUARANTINE LAWS OE RHODE ISLAND. The first law passed by the General Assembly of Her Majesty's Colony of Rhode Island and Providence Plantations, iu relation to quarantine, was during the session at Newport on the twenty-seventh day of February, 1711, entitled "An act to prevent the spreading of infectious sickness." The following are the main provisions of this act. "Whereas contagious destempers have been several times brought into the Colony, by the masters of ships and other vessels, coming into the several ports of this Colony from places that are-infected therewith; for the preventing whereof for the future, "Be it enacted by the General Assembly, and by authority of the same, that no master or commander of any ship or other vessel, that shall come into any port or harbor of this Colony, and shall in their passage hereto have any person or persons sick on shipboard with the small-pox, or any other contagious disease, or shall come from any port or place where any contagious distemper is brief or prevalent, shall not bring to anchor their ship or vessel, iu any of the ports of this government, within the dis- tance of one mile of any public ferry, pier or landing place; or if any vessel or vessels that are at anchor therein, shall land or suffer any person or persons on board such ship or vessel to be landed, or suffer any persons to come on board such ship or vessel with- out a license first had from the Governor of this Colony for the time being, if they shall anchor in the harbor of Newport, or in bis absence, from one or more justices of the peace of said town, and it they shall anchor in any other harbor of the Colony, a license shall be first had and obtained from some one or more justices of the peace of such town, under penalty of forfeiting one hundred pounds, good and lawful money of this Colony, to and for the use of the Colony, to be recovered by the General Treasurer of the Colony iu the general courts of trial of this Colony; by bill, plaint, or infor- mation, and where the offender or offenders herein shall have no essoin, protection or wages of law allowed." It was provided that passengers or mariners from infected vessels landing without a permit should be arrested by any justice of the peace, and either returned to the vessel or confined iu such place or places on shore as would prevent the spread of the infectious disease. Persons thus offending "shall answer, satisfy and pay all charges that shall arise thereon, and shall forfeit twenty pounds good and lawful money of said colony to and for the use of the colony, to be recovered as aforesaid." "And if the offender or offenders have not estate sufficient to satisfy and pay the same, that they shall be set to work, by the discretion and at the discretion of the judge of said court wh ere such cause shall be tried, until the same be fully satisfied and paid." It was further provided that, if any person or persons, passengers or mariners or slaves, notwithstanding the preceding precautions, "shall be landed from on board any ship or other vessel, aud shall, after being landed, be taken sick with the small-pox or any other infectious distemper, that then and in such case it shall and may be lawful for any one assistant or justice of the peace of any such town where such case shall happen, to remove such sick and distempered person and persons to such convenient place as shall o them appear to be necessary, to prevent the spreading thereof; and the person or per- tsons so removed, if free, to pay the charge thereof, and shall be recovered in any court of record within this colony, by the person or persons that shall disburse the same; and if Joseph Jones, D., on Quarantine. 5 the persons so removed be slaves, then the owners thereof shall pay the same; and if the slaves are eonsigued to any person within the Government, then such person to whom consigned shall pay the charge of the same, to be recovered as aforesaid." In the preceding provisions of the first Quarantine Laic passed by the General Assembly of the Colony of Rhode Island and Providence Plantations, one hundred ami seventy-two years ago, and sixty-four years before the commencement of the American Revolutionary War, the absolute control of the colonial government over vessels, masters, crew, passen- gers and slaves, with reference to all regulations for the exclusion of foreign pestilence, is announced, and the principle established that the ship, with its officers, mariners and passengers, whether free or slave, were liable for all expenses caused by sickness. In the following section the principle is established that masters of ships were respon- sible for all expenses incurred during the inspection of said ship by the authorized agent or agents of the colony. I3e it enacted by the authorities aforesaid, That the naval officer shall keep this act pub- licly set up in his office, for the view of all masters of ships and other vessels that shall enter with him ; and the said naval officer is hereby empowered, upon any information unto him given of any ship or vessel arriving in this harbor, that any infectious distem- per is aboard, to send on aboard of said ship or vessel a doctor to examine the same, as need shall require, and return thereof to the governor, or in his absence, to some of the assistants or justices of the peace of the town of Newport to make reports, that due care may be taken therein ; and the master of such ship or vessel shall pay all charges accruing therein ; and if he ref use to pay the same, it shall be recovered by the naval officer in any court of record within this colony." By the following act every vessel was required to anchor at Fort George, under heavy penalty : "June, 1731: An act passed by the General Assembly of Uhode Island at Newport, June, 1731. to prevent vessels coming into the government from places infected with the small- pox." " Every master of any ship or other vessel that shall come into the harbour of New- port, and shall not bring to his vessel (at the fort, Fort George), when the gunner shall fire a shot at him, shall for the first shot pay ten shillings, and for the second twenty shillings; and for every shot after the second, five pounds; and the naval officer shall, before he clear said vessel, receive the same, or shall have three shillings as a fee for the same. All which fines to be for the use of the colony." February, 1743.- " An act passed by the General Assembly of Uhode Island, in February, 1743, to prevent the spreading of small-pox and other contagious sickness in this colony." The following is the preamble: " Whereas, the small-pox and other contagious distempers have been several times brought into this colony by masters of ships and other vessels coming from infected places, which has proved of pernicious consequence to tiie trade, and greatly endangered the lives of many of the inhabitants of this colony, and occasioned a very great expense to the town of Newport in particular; " And whereas, the la ws to prevent the same, by reason of their great number, and the various occasions on which they were made, are become perplexed and intricate." The first section repeals all laws heretofore made relating thereto, and declares that "the following rules and orders for the future shall be kept and observed. The first and second enactments repeat, with but slight and unimportant differences, the portions of the law of 1711. The act of 1743 enjoins- "That the Governor, Deputy Governor, assistants, justices and wardens, as aforesaid, be and they are hereby empowered and directed to send a doctor or other suitable person to examine into and to make report to him or them, respecting, of the true state of such vessel and the people on board, at the charge of the master or commandant of said vessel; and the naval officer is hereby forbid to clear out such vessel till said charge (having been adjudged and settled by the Town Council of the town where such vessel shall ar- rive) is fully satisfied and paid. " That the Town Council ofNewport or other town as aforesaid, be and they are hereby empowered and directed to confine on board said vessel, or send to some pesthouse, all persons, mariners or passengers, or others, that came in said vessel, for a convenient time until such of them as have or are liable to have the small-pox, or other infectious dis- temper, are perfectly recovered and cleansed from said distemper, or have passed a suita- ble quarantine, and also all other persons that have gone on board such vessel without license, as aforesaid, at the charge and expense of such persons respectively, and also all other persons that came in said vessel, until they have been sufficiently aired and cleansed. "That, the Town Council of the town where such vessel arrives, be and they are hereby empowered and directed to appoint two persons to takeeffectual measures that all goods, wares, merchandise imported in such vessels, which they think liable to hold and com- 6 History of Quarantine. municate the infection, be landed on some of the islands in the Naragansett Bay, and exposed to the sun and air and cleansed, not exceeding ten days, norunder six days, before they are permitted to be brought into any house, shop or warehouse, other than where they are cleansed as aforesaid ; and when such goods are sufficiently aired and cleansed, said persons shall give the owners or possessors thereof a certificate; and the Town Council shall allow or order said goods to be delivered to the owner or owners thereof; and the charge and expense of landing, airing and cleansing such goods, wares and merchandise, shall be borne by the respective owner or owners; and all goods that shall be judged by the Town Council not liable to hold the infection shall be delivered to the owner or owners, without delay and expense of airing, so soon as may be con- sistent with the safety of the town in regard toparts of the cargo. And all goods, wares or merchandise imported into any town in this Colony by land from any place infected with the small-pox or other contagions distemper shall be aired, cleansed, at the dis- cretion of the Town Council of such town, and at the expense of the owner or owners thereof." 'That, all goods imported in such vessel as aforesaid,that shall be clandestinely landed or brought into any house, shop or warehouse-without certificate or allowance as afore- said, or that shall be imported by land as aforesaid, and not cleansed or aired by order of the Town Council as aforesaid, shall be forfeited ; one-third to and for the use of the Colony, and the other two-thirds to him or them that shall inform, and sue for the same in the inferior courts of Common Pleas, in the country where such offense shall be com- mitted. And all assistants, justices and wardens are hereby empowered and required, upon information given them, to seize and secure all such goods, wares and merchandise in their respective jurisdiction and legal trial. "That the Town Council of Newport, or other town as aforesaid, be, and they are hereby, empowered and directed to fix, settle, and adjust all wages and charges demanded by persons employed by them to secure such vessel or to air and cleanse such goods, or to attend upon and nurse such person, as aforesaid. And that if any owner, freighter, or mariner or passenger, as aforesaid, shall refuse to pay such wages and charges, so settled, adjusted and fixed by the Town Council, that then the Town Treasurer of such town is hereby empowered and required to sue for and secure such wages and charges, if above live pounds, in the Inferior Court of Common Pleas in the county where such charges shall be adjusted and settled; and if under that sum, then before any two justices or wardens, as in the case of other actions. "And the judges of such court where the action is brought are hereby empowered to lay double costs for the plaintiff, any law, custom or usage to the contrary notwith- standing. "That for the better security of the payment of what charges may arise for the nursing or attendance upon any sailor or mariner belonging to such vessel, as aforesaid, the mas- ter thereof is hereby required to stop payment of the wages due to such mariner until certified from the Town Council that such charges are fully satisfied and paid, on penalty of paying the same so far as the amount of the wages so paid by him; and no court in that Colony shall make up judgment for any such wages until satisfaction be made as aforesaid. And this act being pleaded in any court, when such wages, if sued for by such mariner, shall be a temporary bar of such action, any law, usage or custom to the con- trary notwithstanding. And the master or owner of any servants or slaves on board such vessels, or the persons to whom such slaves are consigned, shall pay all charges arising from them for their nursing or attendance. "That the master of any ship or other vessel coming into the harbor of Newport who shall refuse to bring to his vessel when the gunner of Fort George shall fire a shot at him, shall pay ten shillings for the first shot and twenty shillings for the second, and five pounds for every shot afterward, to and for the use of the colony, and three shillings to the Naval Officer, as his fee for receiving the same, who shall not clear out said vessel till the same be paid." The remainder of the act relates to the prevention of small-pox from the towns or colonies of New England, and to the isolation and control of this disease within the county and town of Newport. It will be observed that all the essential principles of the quarantine system of Louisi- ana, as established in 1855, had been established and enforced by the laws passed by the General Assemblj of His Majesty's Colony of Rhode Island and Providence Plantations, in relation to quarantine, in 1711, 1731 and 1743. The acts of 1747 and 1748 announced the same principles. The act of 1748 declared "that all the expenses incurred" in confining the sick with contagious diseases on board, or in sending them to the pesthouse, as well as all expenses of nursing and infection, "shall be at the charge of the owners." The most essential provisions of the act of 1748 are as follows : Joseph Jones, M. 1)., on Quarantine. 7 "Therefore be it enacted, That no infected vessel be anchored within one mile of any landing place, under the penalty of sixty pounds; that no person shall come on shore without a proper license; that a physician shall be sent on board to examine the vessel and crew, and make a true report of the same; that the Town Council of Newport, or other town, shall have power to put a suitable person on board to prevent communica- tion ; that the said Council shall have power to confine the people on board or send them to the pesihouses, and that all goods arriving in such vessels shall be properly aired and cleansed. "That all the expenses incurred in consequence of said vessels, shall be at the charge of the owners." May 1752, "An act to prevent the small-pox from being brought into the Colony by strangersand travellers coming from infected districts." In May, 1776, the General Assembly passed an act permitting inoculation for the small- pox in this Colony. An act was passed by the General Assembly in 1798, comfirming the sanitary laws en- acted in 1743 and 1748, and authorizing the Town Councils to make regulations for the preservation of the health of the inhabitants, and the Governor to appoint health officers in every port deemed by him necessary, in order to visit all vessels suspected of having contagion on board, and to carry into effect the provisions of this act. Acts were passed in 1806, 1816, 1822 and 1840, by the General Assembly, conferring from time to ti ne on the Town Councils, or the Board of Aidermen in the several towns, sufficient authority to guard the people against contagious diseases. With regard to the yellow fever and cholera, the Town Councils acted efficiently, deriving their authority from the ancient laws, given here, against small-pox and other contagious diseases. STATE OF NEW YORK. The first quarantine act seems to have been passed by the Colonial Legislature in 1755; previous to this date, however, there were many acts of the Council of New York, as those of September 17, 1702, April, 1714, January 31, 1716, April 1, 1742, designed to prevent the importation of small-pox or other malignant fevers of the West Indies, and their spread in the provinces. In 1755 the Colonial Legislature of New York passed the first quarantine law, entitled " Au act to prevent infectious distempers being brought into this Colony, and to hinder the spreading thereof." Sections 1 and 2 defined the place and mode of performing quarantine, and specified the duties of officers and pilots, and fixed the penalties for the violations of this act. The third section of this law provided for the appointment of " some surgeon or physi- cian to inspect all vessels," and fixed his compensation for this service, and was as follows: " Sec. 3. That in case any vessel shall come from any place visited with such contagious distemper, or have any person or persons on board actually infected with the small-pox, yellow fever, or other contagious distemper, and the commander of such vessel, upon demand made as aforesaid, shall not make a true discovery thereof, such commandant shall forfeit the sum of five (two) hundred dollars. And the Governor or Commuudant- in-Chief of this Colony is hereby authorized and empowered to appoint some surgeon or physician to inspect all vessels and persons suspected of having on board, or being vis- ited with any of the said infectious distempers, who is hereby required immediately logo on board of such vessel and make strict inquiry in the premises, and report the same accordingly, for which inquiry and examination such surgeon or physician shall be paid by the owner or master of the said vessel, the sum of twenty-eight shillings for each such examination." There is evidence to show that Dr. John Bard was the first physician (quarantine officer) appointed under the act of 1755, and that he continued in office until he left the city in 1773. A quarantine act, with similar provisions, was enacted on the ninth day of July, 1756, the only amendment being to raise the fee of the surgeon or physician appointed to visit or inspect vessels, from twenty shillings to one pound eight shillings. The law of 1756 having lapsed by expiration of time, a new law, with essentially the same provisions, and retaining the inspection fee of the quarantine surgeon or physician at twenty-eight shillings for each inspection, payable by the master or owner of the vessel, was enacted March 24, 1758, entitled "an act to prevent the bringing in and spread- ing of infectious distempers in the Colony." The law of 1758 was re-enated December 13, 1763, to continue in full force until Janu- ary 1, 1768; on the 24th of December, 1768, it was continued in full force until January 1, 1775; it then expired by limitation, and as the Revolutionary War came on, was not re-enacted. It was not until the seventh session of the State Legislature that the sub- ject of quarantine again attracted the attention of the government; and on the fourth of May, 1784, an act was passed, entitled "An act to prevent the bringing in and spread 8 History of Quarantine. ing of infectious distempers in this State," which was in intent, and nearly in terms, the same as the law of 1758. The title was the same as the law of 1758, except the substitu- tion of the word " State" for that of Colony. In the law of 1784 the term "ports and harbours of the State" are substituted for " ports and harbours of this city ; " in that of 1758 the health officer was appointed by "the Governor or Commander-in-Chief of the Colony, the person so appointed was " some surgeon or physician," and in 1784, "a physician," the fee of twenty-eight shillings was to bo paid the health officer for each visit and report, by the commander of such vessel; the fines and forfeitures under the act of 1758 were to be paid, one-third to the informant, and the remainder for the support of the government of the Colony, and under the act of 1784, they were to be applied to " the use and support of the light- house at Sandy Hook, for the security of commerce." This law remained in force unchanged for ten years. Meantime, with the renewal of commerce with the West Indies yellow fever again made its appearance in New York. In 1791 it broke out in the neighborhood of Peck Slip, and spread to other parts of the town, causing a large mortality. On the twenty- seventh of March, 1794, an act was passed " To amend the act of 1784, entitled an act to prevent the bringing in and spreading of infections distempers in this State." In the first section it provided that the act ''shall extend to all vessels coming from any port or place whatever." On the first of April, 1796, a new quarantine law was enacted, section 1 of which pro- vided, "That a person practicing physic shall be appointed health officer for the city of New York, and that seven persons shall be commissioners of the health office for said city, and by which several names of office the said persons shall be respectively known in the law." Section 2 specifies in regard to quarantinable vessels as follows : " All vessels arriving in the port of New York from ports beyond the sea, having on board forty passengers ; all vessels arriving in the said port having on board a person sick with a fever; all ves- sels arriving in the said port, on board of which a person may during the time such vessels were at the foreign port from which they last sailed, or during their passage thence to the port of New York, have died of a fever, and all vessels arriving in the said port from places where, at the time of their departure, an infectious disease prevailed, shall be subject to quarantine of course." The Governor was authorized to issue his proclamation declaring what other vessels to be described as coming from the countries, islands or ports therein to be mentioned, shall also be subject to quarantine; and to assign the limits to the places where all vessels subject to quarantine shall come to anchor, and remain until the health officer shall have examined them and reported "to some one of the commissioners to be free from infec- tion." The Governor was also empowered to prohibit or regulate the intercourse by land or water between the State of New York or any place or State in the United States where he is informed that an infectious disease prevails. The commissioners were empowered to remove to the quarantine grounds any vessel in the port of New York upon which a case of contagions disease appeared, or having on board articles which may be apprehended to contain infection ; and to cause all persons and articles which may have been landed to be arrested and seized and returned to the vessel, or removed to the lazarette; also to cause all persons coming into the State in violation ofthe proclamation to be arrested, or if well, to be conveyed to the place out of the State from whence they had come, or if sick to be removed to the lazarette. On the tenth of February, 1797, an act was passed to amend the act entitled, "An Act to prevent the bringing in and spreading of infections diseases in this State." It provided that there "shall be three persons appointed commissioners of the health office of the city of New York," who with the Health Officer, were invested with "all and singular the powers granted to the commissioners of the health office for the said city." "All coasting vessels coming from any place south of Cape May, although not subject to quarantine, of course, shall be liable to examination, if the health officer shall deem it expedient, by some fit person to be by him deputed, who shall ha ve such reasonable com- pensation for his services and paid by the commissioners as they shall deem right." Quar- antine was in all cases to continue as many days as the commissioners should deem ne- cessary. No vessel arriving in the port of New York, otherwise, and subject to quaran- tine of course, shall be exempt from such quarantine by reason of having previously touched or entered at any port within the United States unless such vessel shall have remained in such port for the space of ten days. The health officer was required to report all vessels subject to quarantine which he found free from infection, "to some one of the said commissioners, and he shall be en- titled to receive from the master of every vessel to be visited by him or coming from a foreign port, the sum of three pounds, and if coming from a port within the United Joseph Jones, M. I)., on Quarantine. 9 States, the sum of thirty-two shillingsfor his services therein he was empowered to put all necessary questions to the persons ou board any such vessel and to administer an oath. The person administering the government was authorized to cause the erection of a building suitable for a lazarette ou Nutten Island (Governor's Island), "or on any other land which may be deemed more eligible, which other land he is hereby authorized to purchase for the people of the State." The Health Officer was to be the physician to the lazarette, and the "Commissioners of the Health Office were to have the superintendence thereof, and employ nurses and attendants, and provide bedding, clothing and provisions, medicines, and other matters as shall be requisite therein." All persons removed to the lazarette were "liable to pay a reasonable sum for their board, medicine and attendance therein," and the Commissioners were to recover by suits in their own name, if pay was refused. The Health Officer was authorized to destroy infected bedding and clothing arriving in vessels subject to quarantine. It is not necessary, in our argument, to trace in full the growth of the quarantine system of New York, which has not only advanced with the growth of this mighty metropolis, located at the entrance of the great channels through which foreign com- merce and emigration enter the United States, but has kept pace with the progress of sanitary knowledge, until its equipments have been so perfected that they now meet the highest demands of science, and promote the highest interests of commerce. The preceding facts are sufficient, however, to establish that: 1. During her existence as an English Colony, New York exercised all the essential functions of quarantine, and, in common with the other American Colonies, established the principle that a service was rendered to commerce by quarantine, and that the masters and owners of vessels were liable and legally bound for the expenses involved in the medical inspec- tion, in the discharge of cargo, in the fumigation and cleansing of vessels, and in the removal and treatment of the sick crew and passengers. 2. New York, in common with the other original English Colonies of North America, did not surrender her rights to conduct quarantine and to levy quarantine fees after the establishment of independence and the forma- tion of the American Union, and the formal adoption of the Constitution of the United States. 3. New York and the other English Colonies have exercised without interruption, through their existence as parts of the British empire and as independent States of the American Union, up to the present moment, the inalienable right of establishing quarantine restrictions for the preservation of the health of the people, and of collecting fees from the masters and owners of vessels for the maintenance of quarantine. ( c) All the essential questions relating to quarantine, and the relations of the individual Mates to each other and the General Government, were thoroughly discussed shortly after the formation of the Federal Union of the independent Colonies. It is evident from the preceding facts that on the organization of the Federal Government, in 1789, several of the seaboard States had quaran- tine laws and regulations, adopted by the Colonial governments, and which had been in effect for nearly a century. South Carolina enacted a quarantine law as early as 1698, Pennsylvania in 1699, Rhode Island in 1711, New Hampshire in 1714, New York in 1758. Yellow fever had several times been epidemic in seaboard towns having commerce with the West Indies, as at Boston in 1693, Philadelphia in 1699, 1741, 1747. 1762, New York in 1702, 1793, Charleston in 1699. But it did not attract general attention, nor excite great public alarm, until the full establishment of commerce with the West Indies after the Revolutionary War. Yellow fever broke out in New York in 1791, and in Philadelphia in 1793, and in both places it was attributed to shipping from the West Indies. 10 Discussion of Quarantine in Congress, 1796. In the latter year the pestilence excited public alarm, especially in the neighboring States having personal and commercial intercourse with Phila- delphia. New York, Charleston, Baltimore and Annapolis took active measures, and finally established rigid land quarantine against Philadelphia. At the close of the last century, when yellow fever became widely epi- demic, the disease was regarded as contagious and infectious, and precau- tionary measures of the most rigid character were devised to prevent the contact of the sick with the well. Maritime and land quarantines were established, and the latter were enforced with the trusty shot-gun, as in the recent epidemic of 1878. All the scenes of abject tear and brutal cowardice of 1878 had their coun- terpart in 1793,1794 and 1795. City quarantined against city and State against State, and travelers were subjected to the most rude and brutal indignities. In December, 1795, the Fourth Congress met at Philadelphia at the close of one of the most alarming and wide-spread epidemics of yellow fever which up to that time had ever been known. The conflicting acts of different State and municipal authorities in the adoption and enforcement of measures for preventing the importation and spread of yellow fever had excited much comment; the fever was believed to be imported, and existing quarantines were regarded as inefficient, ow.ing to a want of power on the part of the States to enforce their regulations Two questions were raised in Congress: 1. Should not the establishment and management of quarantine be exclu- sively the duty of the General Government under the provision of the Constitution empowering Congress "to regulate commerce ?" 2. Is not quarantine a police regulation of the State or Municipality, and hence quite outside of the provisionsof the constitution ? From the annals of the Congress of the United States, it appears that on the twenty-eighth of April. 1796, Hon. Samuel Smith, of Maryland, proposed a resolution to the following effect, which was referred to the Committee of Commerce and Manufactures to report thereon : Resolved, "That the President of the United States be authorized to direct such quarantine to be performed on all vessels from foreign countries, arriving at the ports of the United States as he shall judge necessary." This measure proposed by the honorable representative from Maryland was designed to place the quarantine system of the United States under the direction of the President, who at that time was General George Washington. The Committee on Commerce and Manufactures consisted of the follow- ing members: Goodhue, of Massachusetts. Bourne, of Bhode Island. Livingston, of New York. Swanwick, of Pennsylvania. Smith, of Maryland. Parker, of Virginia. Smith, of South Carolina. May 7, 1796, the committee reported a bill to regulate quarantine, which was read twice and referred to the Committee of the Whole. It was as follows : "Be it enacted, etc. The President of the United States, be, and is hereby authorized to direct at what place or station, in the vicinity of the respective ports of entry within the United States, and for what duration and par- ticular periods of time, vessels arriving from foreign ports and places may be directed to perform quarantine. Joseph Jones, M. I)., on Quarantine. 11 "Be it enacted, etc, That the President of the United States bound is hereby authorized to direct the revenue officers, and the officers commanding ports, and revenue cutters, to aid in the execution of quarantine, and also the execution of the health laws of the States respectively, in such manner as may to him appear necessary." On May 11, 1796, on motion of Mr. S. Smith, of Maryland, the, Hon.se resolved itself into a Committee of the Whole on the bill regulating quarantine. Mr. Heister, of Pennsylvania, objected to the principle of the bill, as it proposed to take power from individual States to regulate what respected the health of theircitizens, and to place, it in the President of the United States. He thought the measure would be attended with very great inconvenience. Many States lay very distant from the seat of government, and before information could be given to the President of the apprehension of any pestilence being introduced, and his answer received, the disease might be intro- duced into the country and great havoc made among the citizens. It appeared to him that the Governor of each individual State was better calculated to regulate quarantine than the General Government, because upon the spot. And if the power was to be transferred from the President to the collectors at each port (that he conceived must be the case), it would put a vast deal too much power in their hands. Mr. Smith, of Maryland, said that each individual State might have its own health laws, but the performance of quarantine was in the direction of the General Government. The President of the United States ought to be empowered to designate the place where vessels should perform quarantine, to enforce the performance, and to determine at what time of the year it should commence and end. He denied that there was any authority in the State Governments to regulate quarantine. They could not command the officer of a port to use force to prevent a vessel entering their ports; the authority over him was in the General Government. Mr. Kittera, of Pennsylvania, understood that each independent State had a right to legislate on this subject for itself. He believed that each State understood its own con- cerns better than the General Government, and therefore the regulation might safely be left with them. Mr. Milledge, of Georgia, opposed the bill. He said that the State from which he came was in the habit of regulating quarantine, and that it would be attended with many inconveniences if the power was to be placed in the General Government. Mr. Giles, of Virginia, said that self-preservation justified every State in taking means to prevent the introduction of diseases among its citizens, and he thought the bill unnecessary. Mr. Smith, of South Carolina, said the Constitution did not give to the State Govern- ments the power of stopping vessels from coming into their ports. May 12, 1796: Mr. Heister, of Pennsylvania, moved to strike out the first section. It appeared to him as if it would be taking the power of regulating quarantine from the State Governments and placing it in the hands of the Collectors of the different ports ; and as he believed the Collectors were interested in proportion to the quantity of goods imported, the health of our citizens and the interest of the Collectors would be placed in opposition to each other. Mr. Swanwick, of Pennsylvania, said if the section were stricken out the bill would have every desirable effect. All that was complained of was, that the authority of any individual State could not compel vessels to perform quarantine; but if the President gave directions to the officers of the United States at every port to aid the State Govern- ments in this respect, every effect would be obtained. The first section of the bill was only to direct the time during which quarantine should be performed, and at what par- ticular place, which would certainly be best determined by the State Governments. Indeed, most of them having already fixed on places for the purpose, and erected suitable buildings for the sick, for purifying goods, etc., it would be attended with very great inconvenience if a different place were to be fixed upon by the United States. It was said that the right of regulating quarantine did not reside in the State Government. He believed it did, and that the individual Stateshad conceived so, was evident from the expense which some of them had been at in erecting buildings, etc., for the purpose. He particularly alluded to the provisions made for this purpose by Pennsylvania, on the Delaware. Mr. Bourne, of Rhode Island, opposed the motion; and Mr. Sitgreaves, of Pennsylva- nia, in like manner held that the strongest and best reason for a law such as the one pro- posed is that it is matter of very serious doubt whether, upon this subject, the Stateshad any authority at all, and whether all such power is not vested by the Constitution in the Congress, under their general authority to regulate commerce and navigation. 12 Discussion of Quarantine in Congress, 1T96. Mr. Milledge, of Georgia, favored the striking out of the first section, and advocated the view that the power of regulating quarantine rested with the State Governments. Savannah, in Georgia, he said, was one thousand miles from the seat of government, and from their situation in respect to the West Indies, they were very subject to the evil of vessels coming in from thence with diseases; and if they were to wait until information could be given to the President of their wish to have quarantine performed, and an answer received, the greatest ravages might in the meantime take place from pestilential diseases. The State of Georgia had a long law on the subject, and had always been in the habit of regulating quarantine without consulting the General Government. * * * Mr. W. Lyman, of Massachusetts, thought the individual States had the sole control over the regulation of quarantine. It was by no means a commercial regulation, but a regulation which respected the health of our fellow citizens. In the tow n of Boston the small-pox was considered a pestilential disease, and they certainly had a right to make their regulations accordingly. He knew' the United States could prohibit the importa- tion of goods, but he did not think it was in the power of the United States to prevent the landing of persons. He believed the bill was unnecessary; that individual States had a right to make such regulations as were necessary for the health of their citizens. * * * Mr. Gallatin, of Pennsylvania, said he did not agree in the least with the gentleman from Maryland (Mr. Smith), that the power of regulating quarantine was exclusively in the United States. He conceived the only clause in the Constitution which could at all countenance such an idea, wars the article relative to commerce, but, he said, the regula- tion of commerce had nothing to do with quarantine. It was a regulation of internal police. It was to preserve the health of a certain place, by preventing the introduction of pestilential diseases, by preventing persons coming from countries where they were prevalent, whether such person came by land or by water, whether for commerce or for pleasure, was of no importance-t hey were all matters of police. The individual States had thought themselves competent to prevent the introduction of slaves coming by sea, although that also might be called a commercial regulation, w hich they had no right to interfere with. And if a vessel belonging to the gentleman from Maryland was to come to the ports of Baltimore or Philadelphia, with a cargo of negroes, he believed that the government of either place would be equal to the preventing of him from landing and disposing of them, although he would say it was an article of commerce. The State Gov- ernments had also something to do with the internal regulations of their ports. That of Philadelphia was under the direction of wardens and of State laws. He had no ob- jection to the United States assisting the individual States in enforcing their quarantine regulations, but he had an objection to their insisting that they had the sole right of making regulations on that head, or of making health laws for the individual States. He knew' that where the Legislatures of the different States had legislated on the subject they had thought it an important branch of their duty. Mr. Lyman, of Massachusetts, observed that the gentleman from Maryland (Mr. Smith) did not make the proper distinction. Quarantine was not a commercial regula- tion ; it was a regulation for the preservation of health. If commerce was incidentally affected, it ought so to be, when the object was the preservation of health and life. The United States, it was true, could prevent the importation of any goods, whether infected or not, but it did not thence follow' that they could permit the lauding of infectious goods, contrary to the laws of any State. The several States possessed the sole power over this subject. They were the best judges of the due exercise of it. The right topreserve health and life was inalienable. The bill was not only unnecessary and improper, but it was injudicious interference with the internal police of the States; neither would the amendments, which had been offered by the gentleman from Connecticut (Mr. Hillhouse) ameliorate the bill; it would be interfering w ith State policy. If that gentleman had any panics about infectious dis- eases, he might find relief in the laws of the State. If the la ws there were not competent thereto at present, the gentleman might remonstrate to the Legislature, and no doubt could exist but be would be suitably listened to. As to the argument that States neglected to make regulations, it proved that they supposed them superfluous. Whilst they forbear to do anything, it was proof that nothing ought to be done. The States are the best judges and had the sole power to determine. Mr. Giles, of Virginia, said he did not know which States had legislated on this sub- ject, and w hich had not. He did not know that any of the States had not legislated upon it; but if they had not done it they could do it. The gentleman from Maryland (Mr. Smith) had said, to regulate quarantine was a commercial regulation. They were legislating not upon commerce, but upon preventing the introduction of pestilential dis- eases. Were these objects of commerce? If a State stops a ship she does not stop it on account of the goodsit contains, but because it contains an infectious disorder, which if it were considered as an article of commerce certainly ought, at least, to be a contraband article. * * Joseph Jones, M. D., on Quarantine. 13 Mr. Swanwick, of Pennsylvania, said: Commercial regulations were placed in the Gen- eral Government to prevent one State having advantages over another in respect to commerce; but with respect to health every State was certainly the best judge, and the claim was imperious; and if they were under the power of the General Government, and government was to neglect to take the necessary measures, the State would itself take them. * * * The governments of New York and Pennsylvania were in the constant habit of pre- venting ships from entering their ports until they had been examined with respect to their healthfulness. , The State of Pennsylvania had been at great expense in erecting necessary buildings for the reception of personsand goods infected with diseases. It was to be lamented that gentleman had not before found out that this was the business of the General Gov- ernment, for it had been a very expensive undertaking for the State of Pennsylvania to provide the necessary buildings for carrying their quarantine and health laws into exe- cution, and they would gladly have turned it over to the United States. He thought the utility of the business remaining in the State Government was evident. * * It was certainly of tirst consequence to guard the health of their citizens by every possible means. He said at this port they had laws respecting wardens; there were also in the different States inspection laws, which in some degree affected commerce, but were not the kind of regulations prohibited by the Constitution ; these did not interfere with the rights of Congress to regulate commerce. Mr. Holland, of North Carolina, said that in an inquiry into the subject whether the General Government or State Legislatures were the best judges of the measures necessary to be taken for the preservation of the health of the several States, it would occur that the extent of the country being so great it would be difficult to say what regulation would be best suited to all the parts of the Union, for what would be salutary and proper for one might be improper for another. From this circumstance it would seem that each State should have the power to pass its own laws on this head, and, if so, the first clause should be struck out; to preserve one's health was an article of self-defense. Every individual should take his own measures to preserve his own health, and each State should judge of the best way of doing it for its own districts. The Constitution being silent in respect to health laws, he supposed the passing of them was left to the States themselves. Those who yet have no laws on this subject will make them when neces- sary. The question, in his opinion, was by no means a commercial one. The gentleman from Maryland, being a commercial man, may be excused from considering it as one, as he readily converts most things into a commercial view. Mr. Brent, of Virginia, was in favor of striking out the first clause of the bill under consideration, not from any jealousy of the Executive, but because the Constitution did not authorize such an interference. If the doctrines of the gentleman from Maryland were true, they would swallow up all the authority of the State Governments. They had suggested that if the State Legislatures had the power they might use it so as to injure the General Government. He would ask whether this would prove that they did not possess the power? If they possessed the power and exercised it so as to injure the interests of the United States, the Constitution of the Union, he believed, would point out a remedy. The gentleman from South Carolina had said that if the State Govern- ments were possessed of this power they might impair the revenue of the United States, and that, therefore, being connected with commerce, the regulating of quarantine must be in the power of the General Government. He would ask whether the different States had not the power of regulating the inoculation for the small-pox ? Yet this might be so ordered as to affect the trade and commerce of this country, and yet no one would say that they had not the power of doing this. If the construction now contended for was carried to its extent, there would be no bounds to it. The States had always been con- sidered as possessing the power of regulating quarantine. Such was the opinion at the time of the adoption of the Constitution, and under that impression the States had passed laws on the subject; nor did he believe that necessity, expediency or policy required that the powei should be changed. If this was the case, the question could only be brought forward for the purpose of establishing a constitutional principle, and which he should certainly oppose. The question for striking out the first section was put and carried-46 to 23-and the bill was ordered to be engrossed for a third reading. Friday, May 23, 1796, the bill relative to quarantine was read a third time and passed. In the Senate, Tuesday, May 24, 1796, Mr. Rutherford, of New Jersey, from the com- mittee to whom was referred the bill sent from the House of Representatives for concur- rence, entitled "An act relative to quarantine," reported that the bill be amended by inserting after the word "that," "until general regulations relative to quarantine are made by law." And on the question to agree to the report, it was determined in the negative. Wednesday, May 25, the bill was read a third time and passed. Approved May 27, 1796. 14 Decision on Quarantine by U. S. Congress, 1796. It will thus be seen from the preceding record of the debate on quaran- tine in 1796, that the Members of Congress who took part in the first dis- cussion after the formation of the Federal Union, concerning the relations of the General and State Governments in the establishment and adminis- tration of maritime quarantine arrived at the following results: (a). Quarantine regulations related to the preservation of the health and lives of the people, and were based upon the evident and inalienable right of self preservation. The duty of each State to protect its citizens from the importation of foreign pestilence was clear and imperative. (b). The power to establish and enforce quarantine regulations had been exercised by the individual Colonies, and had never been surrendered to the General Government. (c). The establishment and enforcement of quarantine by the individual States, was not a regulation of commerce, in violation of the provisions of the Federal Constitution ; but it was simply the exercise of those police powers by the individual States, which were inalienable, and which had not and could not be surrendered to the General Government. (d.) The representatives who had themselves been active in the achieve- ment of the independence of the United States, and who were familiar with the exalted pariotism and great services of General George Washing- ton, were not willing to place the right of quarantine in the hands of the General Government, and invest the first President of the United States, "with authority to direct at what place or station in the vicinity of the respective ports of entry within the United States, and for what dura- tion and particular periods of time, vessels arriving from foreign ports and places may be directed to perform quarantine." (e). The outcome of the entire discussion, conducted by Smith, of Mary- land, Goodhue, of Massachusetts, Bourne, of Rhode Island, Livingston, of New York, Swanwick, of Pennsylvania, Parker, of Virginia, Smith, of South Carolina, Heister, of Pennsylvania, Kittera, of Pennsylvania, Milledge, of Georgia, Giles, of Virginia, Sitgreaves, of Pennsyl- vania, Williams, of New York, W. Lyman, of Massachusetts, Hill- house, of Connecticut, Gallatin of Pennsylvania, Page, of Virginia, Holland, of North Carolina, and Brent, of Virginia, was to affirm the right of the individual States to establish quarantine, and to direct the President of the United States to sustain and protect them in the exercise of said rights. This is clearly set forth in that portion of the original bill reported by the committee, which was passed by the House of Representatives and Senate, and approved May 27, 1796. " Be it enacted, etc., That the President of the United States be, and is hereby authorized to direct the revenue officers and the officers command- ing forts and revenue cutters, to aid in the execution of quarantine, and also the execution of the health laws of the States respectively, in such manner as may to him appear necessary." On the twenty-first of December, 1790, a committee composed of Messrs. Lawrence, of New York; Seney, of Maryland; Fitzsimmons, of Pennsyl- vania; Vining, of Delaware, and Goodhue, of Massachusetts, was ap- pointed to bring in a bill to establish health officers in the principal ports of the Union. This committee did not make a report, and the true nature and intention of the motion appears to have been suggested by the petition of the merchants and other inhabitants of Baltimore, presented on the six- Joseph Jones, M. ])., on Quarantine. 15 teen th of December, 1790, "praying that a health officer maybe established or other provision made by law, for protecting them from infectious and epidemical diseases brought by passengers and others arriving from for- eign countries." Congress, on the ninth of June, 1794, approved the act of the Legisla- ture of Maryland, levying a duty on vessels, to pay the expenses of its health officer and quarantine establishment. The action of Congress in regard to the port of Baltimore is as follaws: An act declaring the consent of Congress to an act of the Legislature of Mary- land passed December 28, 1793, and approved June 9, 1794. Be it enacted, etc., That the consent of Congress be, and is hereby granted and declared to the operation of an act of the General Assembly of Maryland, passed the twenty-eighth of December, 1793, entitled "An act to appoint a health officer for the port of Baltimore, in Baltimore county," so far as to enable the State to collect a duty of one cent per ton on all vessels coming into the district of Baltimore from a foreign voyage, for the purpose of the said act intended. Sec. 2. And be it further enacted, That this act shall continue in force to the end of the present session of Congress, and no longer. This act was subsequently repealed. Notwithstanding that yellow fever again prevailed during the summer of 1796 and 1797, and increased the public alarm by the extension of its area and the fatality of its attacks; and notwithstanding that during the sum- mer of 1798 yellow fever again appeared ami attained the proportions of a national scourge, prevailing in Portsmouth,N. II., Boston and Salem,Mass.; Westerly, R. I.; Hartford. Stonington, New London and Norwalk, Conn.; New York; Bridgeton and Worlbury, N. J.; Philadelphia, Marcus Hook and Chester, Pa.; Wilmington, Christina, Dark Creek and New Castle, Del.; Baltimore, Md.; Norfolk, Petersburg and City Point, Va.; Charleston, S. C.; nevertheless Congress reaffirmed the rights of the States toestablish and maintain local quarantines. President John Adams, in his address to the two houses at the opening of the Third Session of the Fifth Congress, December 8, 1798, thus refers to yellow fever, and the measures for its exclusion : "But when we reflect that this fated disorder has within a few years made repeated ravages in some of our principal seaports, and with in- creased malignity, and when we consider the magnitude of the evils aris- ing from the interruption of public and private business, whereby the na- tional interests are deeply affected, I think it my duty to invite the legis- lature of the Union to examine the expediency of establishing suitable regulations in aid of the health laws of the respective States, for, these being formed on the idea that contagious sickness may be communicated through the channels of commerce, there seems to be a necessity that, Con- gress, who alone can regulate trade, should frame a system which, while it may tend to preserve the general health, may be compatible with the in- terest of commerce and the safety of the Union." On Wednesday, January 23, 1799, Mr. Smith, of Maryland, Chairman of the Committee of Commerce, reported a bill respecting quarantine and health laws, which was read and committed. On Monday, January 28, 1799, on motion of Mr. Smith, of Maryland, the House went into a Committee of the Whole, on the bill respecting quarantine and health laws ; Mr. Rutledge in the chair. The bill was read as follows: 16 U. 8. Quarantine Laic of 1799. Section 1. Be it enacted, etc. That the quarantine and other restraints which shall be required and established by the health laws of any State or pursuant thereto, respecting any vessel arriving in, or bound to any port or district thereof, whether from a foreign port or place, or from another district of the United States, shall be duly observed by the Collec- tors and all other officers of revenue of the United States, appointed and employed for the several collection districts of such States respectively, ami by the masters and crews of the several revenue cutters, and by the military officers who shall command in any port or station upon the sea- coast; and all such officers of the United States shall be, and they are hereby authorized and required faithfully to aid in the execution of such quarantine and health laws, according to their respective powers and pre- cincts, and as they shall be directed from time to time by the Secretary of the Treasury. And the said Secretary shall be and is hereby' authorized, when a conformity to such quarantine and health laws shall require it, and in respect to vessels which shall be subjected thereto, to prolong the terms limited for the entry of the same, and the report and entry' of their car- goes, and to vary or dispense with any other regulations applicable to such reports or entries; provided, that nothing herein shall enable any' State to collect duty of tonnage or impost without the consent of the Congress of the United" States ; and provided, that no part of the cargo of any vessel shall, in any case, be taken out or unladen therefrom otherwise than as by' law is allowed, or according to regulations hereinafter established. Sec. 2. And be it further enacted, That when by' the health laws of any' State, or by' the regulations which shall be made pursuant thereto, any vessel arriving within a collection district of such State shall be prohibited from coming to the port of entry' or delivering by law established for such district, and it shall be required by such health laws that the cargo of such vessel shall, or may be, unladen at some other place within or near to such district, the Collector authorized therein, after due report to him of the whole of such cargo, may grant his special warrant or permit for the un- loading and discharge thereof under the care of the surgeon, or of one or more inspectors at some other place where such health laws shall permit, and upon the conditions and restrictions which shall be directed by the Secretary of the Treasury, or which such Collector may for the time reason- ably judge expedient for the security of the public revenue^ provided, that in every such case all of the articles of the cargo so to be unladen shall be deposited at the risk of the parties concerned therein in such public or other warehouses or enclosures as the Collectors shall designate, there to remain under the joint custody' of such Collector, or of the owner or owners, or master or other person having charge of such vessel, until the same shall be entirely7 unladen or discharged, and until the goods, wares or merchan- dise which shall be so deposited may' be safely' removed without contraven- in°' such health laws ; and when such removal may' be allowed, the Collector having charge of such goods, wares or merchandise may grant permits to the respective owners or consignees, their factors or agents, to receive all o0ods wares or merchandise which shall be entered, and whereof the duties accruing shall be paid or secured according to law upon the payment by them of'a reasonable rate of storage, which shall be fixed by the Secretary of the Treasury for all public warehouses and enclosures. "Sec. 3. And, be it further enacted, That there shall be purchased or erected, under the orders and with the approbation of the United States, suitable warehouses, with wharves and inclosures, where goods and merchandise may be unladen and deposited from any vessel which shall be subject to a Joseph Jones, M. D., on Quarantine. 17 quarantine or other restraint, pursuant to the health laws of any State, as aforesaid, at such convenient place or places therein as the safety of the public revenue and the observance of such health laws may require; pro- vided, that the sites of all such warehouses and wharves, with such other adjoining lands as may be necessary for the public uses hereby authorized, shall be ceded to the United States by the State wherein the same may be. "Sec. 4. And be it further enacted, That when, by prevalence of any con- tagious or epidemical disease in or near the place by law established as the port of entry for any collection district, it shall become dangerous or incon- venient for the Collector and other officers of the revenue employed therein to continue the discharge of their respective offices at such port, the Secre- tary, or in his absence the Comptroller of the Treasury of the United States, may direct and authorize the removal of the Collector and the other officers employed in his department from such port to any other more convenient place within, or as near as may be to, such collection district, where such Collector and officers may exercise the same authorities, and shall be liable to the same duties, according to existing circumstances, as in such lawful port or district; and of such removal public notice shall be given as soon as may be." t On motion of Mr. Sewall, of Massachusetts, the following section was added, repealing a law of the first session of the Fourth Congress respect- ing quarantine : "Sec. 5. And be it further enacted, That the act entitled 'An act relative to quarantine,' passed in the first session of the Fourth Congress of the United States, shall be, and the same is hereby, repealed." January 29, 1799, the bill was read a third time and passed. In the Senate an additional section was added, permitting the Chief Justice or the senior Associate Justice to adjourn the Supreme Court in the case of the prevalence of a contagious sickness in the District of Colum- bia. Similar power was conferred upon the judges of the District and Circuit Courts. This amendment was concurred in by the House, and the bill, as amended, was passed. The bill was approved February 25, 1799. From the preceding facts and records from the Journal of Congress, it is evident: 1. After the adoption of the Constitution, Congress held that the indi- vidual States had not divested themselves of the power to establish and enforce their own health, quarantine and police laws and regulations. 2. The acts of Congress passed in 1796 and 1799 not only recognized the power of the individual States to make their own health and quarantine laws, but they commanded the civil and military officers of the General Government to conform to and assist in the execution of the health and quar- antine laws of each and every State. 3. The men who were participants in the struggle for Colonial indepen- dence, and who framed the Constitution of the United States, assembled in ihe Federal Congress, solemnly declared, by their organic acts, that the health and quarantine laws of the individual States were constitutional. Until the present controversy in Louisiana and Texas, originated by Morgan & Co., the constitutionality of the health and quarantine laws of the individual States had never been denied by any court of justice in this State. 18 Decision of Judge Monroe, 1796. 4. Congress clearly indicated by the acts of 1796 and 1799 that health and quarantine laws were not in the nature of regulations of commerce, and did not violate the provisions of the constitution, but were essentially in their essence police regulations, based upon the indestructible and inalien- able right of self-preservation. (d) The fees collected, by the State of Louisiana from vessels subjected to'the quarantine lazes are not of the nature of a tax or impost on commerce, but are just and necessary compensation for the great services rendered to commerce in the cleansing and disinfecting of the ships and cargo, in the care and treat- ment of the side, by the medical officers of the State, and by the exclusion of for- eign, pestilence, and by the establishment of public confidence and the mainte- nance of commerce, which, but for said quarantine service, would be greatly damaged. This proposition is in direct antagonism with the recent decision of Judge F. A. Monroe, in the case of Morgan's Louisiana and Texas Railroad and Steamship Company vs. the Board of Health of the State of Louisiana, No. 7001, Civil District Court, Division C.; in fact the learned Judge appeared to hold that no service whatever has been rendered by the State of Louisi- ana in maintaining its quarantine system of inspection, disinfection, cleans- ing and medical care of vessels, during the past quarter of a century* Jud^e F. A. Monroe, reasoned and decided as follows: "It was also found upon the adoption of the Constitution that there was in force in every State a system for the regulation of pilotage which system was adopted by Con- gress by act of August 7, 1780, and given the same validity as if the provisions had been specially enacted by Congress. If, therefore, any duty of tonnage for pilotage or half pilotage is collected, such collection is made with the consent of Congress. Again, in many ports, wharves have been constructed either by private or municipal enterprise, and all vessels lauding at such wharves are charged a certain amount-either so much per ton, or a fixed sum for vessels of a particular description-for the use of the wharves and the peculiar artificial facilities afforded by t hem, upon precisely the same principle that charges are made by the proprietors of dry-docks for accommodations to vessels, except that the charge of wharfage upon the banks of navigable streams can- not exceed a reasonable compensation. So, in the case of port wardens, if the master of a vessel permits them to render a service to his vessel, the port warden is entitled to his compensation. But I think it the correct principle, as stated by the learned counsel for plantiff in his brief, that any charge imposed by the State upon a vessel engaged in commerce, for which no equiva- lent is given, is a duty of tonnage, whether such charge he measured for the tonnage of the vessel or imposed as a fixed sum upon all vessels of a particular character. And, be- yond this, I am satisfied that the States have no authority to impose upon vessels 'services which are neither needed, nor desired, and exact payment therefor of sums fixed by the States themselves. In the case at bar, for instance, it appears from the testimony that the fumigation of a vessel for the purposes of disinfection destroys more or less of the roaches and other vermin by which ships are sometimes infected and it may be said that the destruction of such vermin is advantageous to rhe ship, but it would be difficult to demonstrate upon what principle of law or common sense the State of Louisiana should be permitted, against the wishes of the owner, but at his expense, even to destroy vermin on his vessel, unless in furtherance of some police or health regulation ; but the very basis of the power which the States possess, to adopt and enforce such regulation is the inherent and inalienable rights of self protection. And the basis of the argument of the defence in this case is that the State has exercised the power to establish quarantine for the pro- tection of her citizens ; neither the power, therefore, nor the manner of the exercise in this case, affords the shadow of a pretext for the claim that vessels quarantined against the wishes of the owner, are hereby rendered a service for which a sum of money arbi- trarily fixed by the State, may be exacted. *The act under which the present and preceding Boards of Health have conducted a system of quarantine and collected fees for the liquidation of the expenses necessarily incurred in the discharge of duties and services, designed, on the one hand, to purge ships of infected diseases, and to render the crews and cargoes inocuous, and on the other to exclude foreign pestilence from the State, was enacted by the General Assem- bly in 1855 ; and it was not until 1874, nearly twenty years after the inauguration of the present system of quarantine, that Morgan and others enjoined the Board of Health from collecting quarantine fees. Joseph Jones, I)., on Quarantine. 19 The point upon which counsel for defendant appears to place most reliance, is that the charges which are here objected to are not duties of tonnage, because they are not proper tioned to the tonnage of the vessels taxed, but are fixed with reference to the class or character of the vessels. If, as we have seen, no service is rendered to the vessel, there exists no basis for the charge, whether it be a duty of tonnage or not; but the proposition that a steamship of 3000 tons can be forced to pay $30 toward the support of our health and quarantine sys- tem, provided the charge is imposed without the use of the word tonnage, and yet that nothing could be collected for so excellent a purpose if the charge is imposed at the rate of one cent per ton, it seems to me is disrespectful to the Constitution of the United States. The same point has, however, been suggested before, and was thus disposed of by Chief Justice Chase. "It was not only a pro rata tax which was prohibited, but any duty on the ship, whether a fixed sum upon its whole tonnage or a sum to be ascertained by comparing the amount of tonnage with the rate of duty:" 6 Wallace, 33. In this same case, in referring to the question of the right of the port warden to col- lect fees without the rendition of specific services, upon the theory that it was an advan- tage to commerce that'such officers should be at hand, the court said : "It may be true that the existence of such a body of men is beneficial to commerce, but the same is true of the government of the State, of the city government, of the courts, of the whole body of public functionaries. If the constitutionality of the charge for the benefit of the master and wardens can be maintained upon the ground that it secures compensation for services, it is difficult to perceive upon what ground the consti- tutionality of any State law imposing taxes for the benefit of the State government, upon vessels landing at its ports can be questioned-" 6 Wall, 33. See also 12 Wall, 218; 20 Wall, 580 ; 31 Ann., p. 65 ; 34 Ann., 703. An intervention was filed in this suit by the Attorney General, on behalf of the State, in which it is alleged that the plaintiff' is seeking to have annulled laws "whereby levenues are raised and provided for the maintenance and support of the quarantine system and service of said State for the prevention of the introduction of contagious and infectious diseases into the State of Louisiana," etc., all of which is undoubtedly true, and exhibits sufficient interest on the part of the State to justify the intervention. It also serves to illustrate more clearly the conflict between the laws referred to and the Constitution of the United States, since it is thus judicially admitted and averred by the State of Louisiana that she derives a revenue by the imposition of charges upon all vessels entering the mouth of the Mississippi river, wherewith she supports her quaran- tine system and service, while the laws themselves, and the evidence in this case, show that the damages are imposed with the sole purpose of raising this revenue and without rendering, or the intention to render, any service whatever to the ships charged. That the quarantine service is ably and intelligently conducted there can be no doubt, but this affords no reason for requiring that it should be supported by those who are under no legal obligations so to do. For these reasons, deeming it unnecessary to consider other points raised, I am of opinion that the injunction herein issued should be maintained and perpetuated at the cost of defendant and the intervention dismissed. Messrs. Leovy & Krutschnitt, counsel for plaintiff. Frank C. Zacharie fordefendant. In opposition to the above decision, we have the following well-estab- lished principles of the fundamental laws of quarantine, recognized by all civilized nations :* (a) Quarantine is established and recognized by international law, for the common security and protection of States against diseases which are supposed to be importable. (b) Although the chief source of the intercourse of States is the inter- change of commodities of natural or artificial production, and although such mutual exchange is, as a rule, reciprocally advantageous to both na- tions-and it may even be held that it is the moral duty of a nation not to refuse commerce with another nation-yet this duty always pre-supposes the safeguard that such commerce is not hurtful to the nation which im- ports. It belongs to each nation to judge for itself in this matter, and in a case of emergency a nation is not only not bound to sell its superfluities or goods to any other nation, but still less is it bound to purchase from it, or * "The Laws Relating to Quarantine of Her Majesty's Dominions, at Home and Abroad, and of the Principal Foreign States," by Sir Sheraton Baker, Bart. London: 1879. 20 Exercise of Forcible Protection Against Contagion. exchange with it, productions either of nature or of art. Neither is there any legal right in a State to compel another State to admit its inhabitants, or to receive its commodities, however great may be the inducements to maintain such intercourse or tralhc. But when such an intercourse or ex- change is permitted, the foreign State, in the disposal of the commodities allowed to be imported by law, is subject to such duties and restrictions as the government of the receiving State may judge necessary or expedient to impose for the benefit of its subjects. (c) Although it is contrary to sound policy for a nation to impose quar- antine merely for the purpose of providing a revenue to the country in which it is established, this is not to be understood of certain dues or duties which are imposed on ships entering the ports of a State for the legitimate purpose of maintaining the quarantine or sanitary establishments of a country.-Sir Sherston Baker. Quarantine restrictions prevent non-intercourse, and afford a form or gateway through which the commodities of all nations may pass after proper inspection, detention and disinfection ; therefore, a service is ren- dered to ships and to commerce, and, therefore, the dues or duties imposed on ships entering the ports of a State for the legitimate purpose of main- taining quarantine and sanitary establishments are just, and are recog- nized ai d sanctioned by international law. Numerous examples might be cited of the exercise of forcible protection against contagion, but the following will illustrate the mode in which States have dealt with infected ships and towns: In 1748 the Adam, a Dutch ship, carrying rice from Damietta to Mar- seilles, was cast on the shore of the island of Majorca by a tempest. The inhabitants (Spaniards) refused to permit the crew to land, as they feared the plague, from the fact of the ship sailing from the Levant. As the ship could not be removed, the Spaniards set her on fire, having previously fur- nished the crew with five boats, in which to save themselves and part of the cargo. In 1719 the captain of the Grand Saint Antoine,a French ship, returning to Marseilles from the Levant, and having lost some of his crew from the plague, fraudulently pretend^! that they had died of bad provisions, and neglected to go into quarantine. This cruel fraud was the cause of the death of half the inhabitants of the city. By order of the Minister, the vessel was burnt. When Valetta was attacked by the plague, in 1813, Sir Thomas Maitland ordered a cordon sanitaire to be drawn round the town, and every person who attempted to pass it to be shot. The 45 Geo. III., c. 10 (which repealed former acts of the same enact- ments), the 46 Geo. III., c. 98, the 50 Geo. III., c. 20, and the 51 Geo. III., c. 46, rendered all ships, including ships of war, which came from or ■which had touched at any place from whence the King, by order in council, had adjudged it probable that the plague or any other infectious disease might be brought, subject to quarantine. The penalty of felony, without benefit of clergy, was imposed on disobedience of persons under quarantine, and on those also who, although not infected, should, after entering the place of quarantine, escape therefrom. During the present century the British Government imposed duties upon ships for the support of quarantine. Thus, in the year 1800, the project of erecting a lazarette on Chetney Hill, in the county of Kent, was adopted, and by an act of Parliament (40 Geo. III., c. 80, and subsequent acts) large sums of money were granted for the purpose of carrying it into effect. Joseph Jones, M. I)., on Quarantine. 21 To meet the expense of the building at Chetney Hill, certain duties were formerly imposed upon all ships coming from the Mediterranean, and to the same ships various regulations, contained in the quarantine laws, were applied, with a power of extending by a special act of the government, the operations of it to vessels coming from any other part of the world. The right of States to impose quarantine charges for the support of quar- antine has been fully recognized by civilized nations; and was officially enunciated by international sanitary and quarantine conventions. Thus, in the convention made in Paris, February 3,1852, between France, Sardinia, Portugal, Turkey and Tuscany, the high contracting parties adopted the following, with reference to sanitary dues: " VII. To arrive, as far as possible, to a uniformity in the sanitary laws, and not to impose on the shipping ot the respective States, more than the charges required to cover the necessary expenses, the high contracting parties, under the limitation of the exceptions foreseen by the international sanitary regulations, decree in principle- 1. That all the ships in a port shall pay, without distinction of flag, cer- tain dues for sanitary purposes, in proportion to their tonnage. 2. That ships subject to quarantine shall pay besides daily dues for their berths. 3. That the persons who stay in the lazarette shall pay fixed dues for each day's residence in these establishments. 4. That merchandise placed ami disinfected in the lazarettes shall be subject to a tax according to weight or value. The dues and taxes mentioned in the present article shall be fixed by each government, and signified to the other contracting parties." The quarantine system of Louisiana, as it now exists, and with the quar- antine charges established in 1855, was, as far as the essential principles involved, the same as the systems of France, Sardinia, Portugal, Tur- key, Tuscany and other European powers. A vessel in quarantine is still theoretically in transitu, and there being no elements of voluntary sacrifice, her charter is not violated. According to international law, a vessel in quarantine is still theoreti- cally in transitu, and if the agent or consignee gives notice and claims the cargo during such period, there is sufficient stoppage of the goods to prevent the vesting in the assignees of the consignee, if he should become bankrupt, even although one of the assignees had already boarded the vessel and taken possession of, but not removed the cargo. If a ship be necessarily detained on her voyage by quarantine, there is no element of a voluntary sacrifice, and the weight of American authority is against any claim for contributions for wages and provisions, or other expenses caused by such detention. Quarantine facilitates commerce in that it furnishes the only legal certificate which grants to vessels, sulgect by international law to quarantine, " liberty to unload" "Pratique" is what a vessel receives when she has liberty to unload without impediment from laws of quarantine. Where such laws exist, vessels arriving from suspected countries must have a certificate to enable them to unload ; and this is called being ad- mitted to pratique. The word itself means " liberty to unload." The quarantine system of Louisiana furnishes pratique to all vessels con- forming to the organic acts of the Legislature, and to the laws, rules and regulations of the Board of Health. 22 Relations of Quarantine to Commerce. Were it not for the execution of the quarantine laws by the Board of Health of the State of Louisiana, the port of New Orleans would be heri- metically sealed during six months of every year (May-October), and prac- tically all intercourse with surrounding States would be closed, and the "shot-gun" quarantines lining the banks of the Mississippi River would nullify pratique, and effectually destroy both internal and external commerce. In virtue of its power to grant " Pratique" to vessels conforming to the quarantine laws, tho Board of Health of the State of Louisiana practically protects ami facilitates commerce; and justice demands that this beneficial system of protection should be supported by those who conduct commerce. The accompanying tables (K and table K continued) furnish accurate data by which to estimate the effects of quarantine as conducted by the Board of Health of the State of Louisiana on the commerce of New Orleans. The opponents of the quarantine system of Louisiana have continually used the press to arouse public indignation and hatred against the Board of Health, and especially against its President, by the cry that quarantine was destroying the commerce of New Orleans by the subjection of vessels from Mexican, West Indian and certain South American ports to quaran- tine detention during the months in which yellow fever prevails, namely: during May, June, July, August, September and October. We may from table K and table K continued, presenting a view of the commercial relations of New Orleans 1805-1882, establish the following facts illustrating the great service rendered by quarantine to the commerce of New Orleans. 1. During the ten years, extending from 1805 to 1815 inclusive, the in- crease of the trade of New Orleans by no means corresponded with that of its population ; on the contrary, a large falling off was exhibited even before the commencement of the war of 1812-1815; the close of this war, however, inaugurated a new era in the commercial history of New Orleans, the exports increasing from $387,000 in 1814 to $12,900,000 in 1818. This wonderful advance, however, was checked, and a large falling off was ex- hibited during the next six or seven years, although the average largely exceeded that of any previous period often years. 2. From 1820 up to the commencement of the American civil war (1820- 1800 inclusive) the increase of trade and population of New Orleans was remarkable. 3. It is worthy of note that when the quarantine system, which now exists, was established in 1855 the total exports were $55,400,711, and the imports $12,923,608, while four years after, in 1860, the exports reached $108,393,567 and the imports $20,920,849. From 1843 to 1849 inclusive, the exports of foreign and domestic merchandise averaged about $40,000,000; the average of the imports from foreign countries was barely $9,000,000 per annum. The following table will show that the quarantine system of Louisiana, so far from being a burden on commerce, has fostered and promoted it: Joseph Jones, M. It., on Quarantine 23 COMMERCIAL STATISTICS OF NEW ORLEANS, 1863-1882, INCLUDING THE PERIOD OF THE AMERICAN CIVIL WAR. YEAR. Exports. Imports. Domestic. Foreign. Total. 1862 t $3,397,521 882 919 000 1863 ... 3,600,958 $356,357 3,957,345 1 011 AR9 1864 7,310,022 1,848 657 1865.... 33,393.464 4,458 354 1867 77.815,906 863,638 78'679,574 1870 101,385'257 1871 93,532.797 18,333,580 1872.... 95,950.942 20,006'777 1873 100,960,307 18/285'527 1874 87,974'797 13,472 483 1875 75,695,700 155.993 75,851.693 11.637 1°8 1876 81.387.836 300,748 81,688,584 9,631 252 1877.. . 70,270,593 11 240 900 1878 74,366.388 123,608 74,489,991 8'725'751 1879........ 81.105,822 185^598 81'191^420 8,259^606 1880 102,528.336 221,031 102,749.367 11.800,977 1881 90,206,693 257,551 90,464,244 12,574'647 1882 80,759,022 305,731 81,064,753 11.076.833 It is evident, from the preceding statistics, that under the direction of the present Board of Health, 1S80 to 1883, the commerce of New Orleans has been as great as at any similar period since the close of the civil war, 1861 to 1865; and that with the exception of the year I860, New Orleans actually enjoyed a larger commerce in 1880, during the action of the present quar- antinelaw, than in any other year from her foundation in 1718. The quarantine was conducted upon the most liberal principles in 1875, 1876,1877 and 1878 ; and it is precisely in these years that we observe the greatest falling off in the commerce of this port. 4. All the great sanitary and quarantine measures of the past twenty- seven years in Louisiana, may be directly or indirectly traced to the act " to establish quarantine for the protection of the State ? approved by P. O. Hebert. Governor of the State of Louisiana, on the fifteenth of March, 1855. During the preceding 155 years of the existence of the Colony, prov- ince and State of Louisiana, the sanitary and quarantine efforts of the peo- ple were spasmodic, unsatisfactory and of short duration ; and as a conse- quence, at frequent and short intervals, the people were decimated by for- eign pestilence, imported by maritime men and immigrants. 5. The exports of 1880 reached $102,749,367, and the imports $11,800,977 ; total exports and imports $114,550,344. The total amounts collected from this vast sum, for the protection of the commerce and trade of New Orleans ami the Mississippi Valley, was 821,872. Can this paltry sum, barely sufficient to maintain the quarantine estab- lishments guarding the mouths of the Mississippi and over 500 miles of coast, be regarded as a tax on commerce-a burden destructive to the grow- ing commerce of New' Orleans ? 6. The internal or interstate trade of New' Orleans equals annually $200,- 000,000, exceeding by far the value of the foreign exports and imports. 24 Services Rendered Commerce by Quarantine. The preservation of this internal interstate trade depends absolutely upon an efficient quarantine guarding the approaches to the IMississippi Valley from the Gulf of Mexico. New Orleans will become a great manufacturing centre for cotton, tobacco, jute and sugar, provided that pestilence is kept away by a rigid system of quarantine, combined with an equally rigid system of domestic sanitation. If yellow fever is allowed to enter in May, June or July, this poit will be hermetically sealed until the disappearance of yellow fever. During this period of embargo, which may last as long as six months, there will be practically non-intercourse with surrounding States, and all manufactories will be closed, as there will be no possibility of shipping manufactured articles. No system of manufactures, however well ordered, can sustain such periods of inactivity. These facts relate solely to the mercantile and money view oi this ques- tion, but the vast suffering and destruction occasioned by the importation of foreign pestilence, through the channels of commerce, is realized when we consider that during the years 1853, 1854 and 1855 New Orleans lost 12,780 of her citizens by yellow fever (an imported pestilence), and still more recently in 1878, she lost 4056 souls, and about 815,000,000. The State of Louisiana has a right to demand that commerce, which benefits the entire Valley, and derives its richest rewards from the cotton, sugar and grain of these great Southern and Western States, shall pay a sufficient amount for such a system of inspection, disinfection, quarantine, and medical care of sick seamen and passengers, as will prevent the introduction of foreign pesti- lence. IMPORTANT SERVICES RENDERED BY DETENTION, CLEANS- ING AND FUMIGATION. It has been well established by the experience of the past four hundred years that vessels retain the contagion of yellow fever and other pestilen- tial diseases because- 1. From their structure it is difficult to introduce a sufficiency of fresh air to dilute and drive away the contagious or infectious particles. 2. From the manner of their construction it is exceedingly difficult to scrub, or cleanse the interior of vessels, so as effectually to remove all contagions or infections particles. 3. A ship is a human habitation, and the crew, especially when numer- ous, not only contaminate the stagnant air, but unless kept under the most stringent sanitary supervision, they are prone to become unclean in their persons, clothing and bedding. Upon long voyages, especially in tropical or semi-tropical climates, this uncleanliness of vessel and crew accumu- lates to a disgusting and dangerous degree, and engenders poisons of an infectious and destructive character. 4. A ship is not merely a human dwelling; she is a magazine or store- house ; within her sides, as in a common storehouse, are collected many sorts of things prone to perish and corrupt. Beef, fish, pork, hides and other animal substances frequently taint the hold that contains them with their deleterious vapors ; this tendency to putrify is increased by improper curing with inferior quality of salt, and also by the hot, moist climate of tropical and semi-tropical regions. The rotting of provisions on shipboard renders the berths and quarters of the men unhealthy, and the crew sickens under such mischievous agents. The evil is increased when the crew are Joseph Jones, M. I)., on Quarantine. 25 obliged to feed upon tainted or spoiled meat. Not only animal substances, but onions, coffee, Indian corn and various other vegetables which are car- ried in ships, contribute by their decay to render unhealthy the bottoms in which they are carried. From the corruption of their cargoes, the accumulation of foul bilge water and the uncleanliness of the crew, ships may be filled with a foul, infectious atmosphere, and the timbers, planks, bedding, and even the cargo, be dan- gerously impregnated. 5. Ships and vessels, though so prone to become foul and pestilential from their structure, tenants and cargoes, are seldom cleaned in a thorough manner; from the time they are launched to the day of their condemnation few or none of them are perfectly purified ; year after year the foulness increases, insomuch that old ships and vessels are usually the most nasty and loathsome of human habitations, and frequently carry pestilence to all parts of the world. The disastrous results have at all times been the same, whether the ship received the infection in an infected port, or engendered the infection within her bowels from the causes just enumerated. 6. The negligence of navigators and owners of vessels with reference to the health, comfort and cleanliness of the crew, and the condition of the vessels, render it imperative that the commerce of the country, as well as the happiness and security of her citizens, should be protected by such public State authority as will secure absolute cleanliness of crew, passen- gers, cargo and vessel. It is well known that bills of health are often valueless and deceitful, in that they fail to give a correct idea of the con- dition and history of the vessel. If a clean ship sails from a sickly place a foul bill of health will not really indicate an unfavorable state of health on board, nor prove the crew to be afflicted with the disorder that prevails in the port she left; nor will a clean bill indicate that the people in a foul and pestilential vessel are in good health, or that she is in a safe or fit condition to be admitted to port. 7. Quarantine consists riot in a mere detention of a certain number of days ; but to be efficient it should include a system of thorough cleaning, disinfection and fumigating of all foul vessels. The condition of a vessel can only be ascertained by inspection; and when the legal authority gives a certificate that a vessel is in good sanitary condition a great good is rendered said vessel, with its officers, crew*, pas- sengers and cargo. On the other hand, when the quarantine officers carefully and thoroughly cleanse, purify and fumigate a foul vessel, a service of the highest value is rendered to the vessel, with its officers, crew, passengers and cargo. Mere detention, without disinfection and purification, is valueless. SERVICES RENDERED TO COMMERCE BY THE REMOVAL OF THE SICK FROM THE VES- SELS, AND THEIR TREATMENT IN THE QUARANTINE HOSPITALS. The State of Louisiana has at various times appropriated moneys for the erection of suitable hospital buildings at the Mississippi Quarantine Sta- tion for the treatment of the sick, and the United States Government has facilitated the needs of commerce by erecting the necessary warehouse for the reception, disinfection and fumigation of cargoes. HISTORY OF THE ERECTION OF THE MISSISSIPPI QUARANTINE STATION. On the thirteenth of March, 1855, the Legislature of Louisiana appro- priated the sum of $50,000 for the erection at the quarantine station on the Mississippi Kiver of two separate buildings as hospitals for the sick, of a 26 Services Rendered Commerce by Quarantine. small house as residence for the officers appointed under the act, and of a well ventilated store for the reception of the freights of such infected ves- sels as the resident physician may deem necessary to cause to be unloaded. By the first section of an act of Congress entitled "An act making ap- propriation for certain civil expenses of the Government for the year ending the thirtieth of June, 1858," approved third of March, 1857, the sum of S50,00() was appropriated for the construction of warehouses at quarantine station on the Mississippi River below New Orleans. At the present time, the buildings erected by the State of Louisiana at the Mississippi Quarantine Station are as follows: 1. Fever Hospital.-The hospital devoted to the treatment of fevers, and especially yellow fever, is a two-story frame budding, 125 feet long, 33 feet wide ami 35 feet high, with upper galleries 9 feet wide and 125 feet long, running along the front of the hospital. This building contains nine rooms on the lower floor and four rooms on the upper-in all thirteen rooms. Halls divide the lower Hoor at right angles The upper floor is divided into four capacious, well ventilated wards. The rooms and halls are plastered, and the ventilation is excellent. The entire building is well adapted to the treatment of fever patients. The cubic capacity of the wards and rooms of the fever hospital is 55,030 cubic feet; of the halls and corridors, 8788 cubic feet-giving a total cubic capacity, exclusive of the galleries, of 63,818 cubic feet. If 1100 cubic feet of air be allowed to each patient, the hospital is capa- ble of accommodating about sixty patients. 2. Small pox Hospital-Is 80 feet in length, 30 feet wide, 24 feet in height; two stories, with galleries above and below 80 feet in length. 9 feet in width and 11 feet high. Total capacity of Small-pox Hospital, 34,760 cubic feet. If 1100 cubic feet of air be allowed to each patient, this hospital would accommodate about thirty patients. 3. United States Warehouse.-The Government warehouse is a substantial fire-proof brick building, two stories high, in each of which is a main hall and two wings. The two main halls, on the first and second floors, areeach 140 feet in length by 23 feet in width and 12 feet in height, giving a cubic capacity of 38,640 cubic feet; total, 77,280 cubic feet. The two wings are each 54 feet in length and 25 feet in width, and 12 feet in height, each floor giving a capacity of 17,200 cubic feet for each wing; total capacity of wings, 64,800 cubic feet; total capacity of general warehouse, 142,080cubic feet. Suitable wharves and warehouses have been constructed by the State of Louisiana and the United States. During the existence of the various Boards of Health from 1855 to the present time, the hospital service, with the necessary medicines and sup- plies, has been maintained at the Mississippi Quarantine Station. During the year 1880 the Board of Health expended at the Mississippi Quarantine Station $14,388 91; at the Atchafalaya, $833 83 ; at the Rigo- lets, $1720 17. During 1880 more than one thousand nine hundred dollars were paid for medicines, hospital furniture and disinfectants at the Mississippi Quaran- tine Station by the Board of Health. During the year 1881 the expenditures at the State Quarantine Stations were as follows : Mississippi Quarantine, $16,648 87; Atchafalaya Quar- antine Station, $690; Rigolettes Quarantine Station, $1536 93. Joseph JoneSy M. 1)., on Quarantine. 27 During the year 1881 the Board of Health expended upon the Mississippi Quarantine Station, for repairs and medical supplies and disinfectan's, 86186 62. During the years 1880, 1881, 1882 and 1883 every case of ser ious sickness has been removed to the hospital, and whenever necessary entire crews and passengers have been vaccinated, free of cost to the suffering. Are these not services of the highest value to commerce? GENERAL CONCLUSIONS RELATING TO THE THEORY AND PRACTICE OF QUARAN- TINE, AND ITS RELATIONS TO CONSTITUTIONAL AND INTERNATIONAL LAW AND TO COM- MERCE. 1. Quarantine regulations were established in Europe before the dis- covery of the American Continent, and received the support and recogni- tion of civilized nations, and became engrafted into international law. 2. The English colonies of North America adopted quarantine regula- tions long before their separation from the mother country and the achieve- ment ot their independence. 3. All the essential conditions < f the quarantine system of Louisiana wew? firmly established and fully recognized by the organic acts of the British North American Colonies long before the establishment of the American Union. 4. All the essential questions relating to quarantine, and the relations of the individual States to each other, and to the General Government, were thoroughly discussed shortly after the formation of the Federal Union of the Independent Colonies. 5. The outcome and final results of this discussion of the framers of the Constitution of the United States in the latter part of the last century, and the beginning of the present century, were as follows : (a) Quarantine regulations related to the preservation of the health and lives of the people, and were based upon the evident and inalienable right of self-preservation. (b) The power to establish quarantine regulations had been exer- cised by the individual colonies under the Government of England, and has never been surrendered to the General Government. (c) The establishment and enforcement of quarantine by the individual States was not a regulation of commerce in violation of the provisions of the Federal constitution, but it was simply the exercise of their police powers by the individual States, which were inalienable, and which had not and could not be surrendered to the General Government. (d) The outcome of the entire discussion in the Congress of the United States with reference to quarantine was to affirm the rights of these in- dividual States to establish quarantine for the exclusion of foreign pesti- lence, and to direct the President of the United States to sustain and pro- tect them in the exercise of said right. This is clearly set forth in that portion of the original bill reported by the committee, which was passed by the House and Senate of the United States and approved May 27, 1796, and which still remains to the present day as the law : 28 General Conclusions. "Be it enacted, etc., That the President of the United States be and is hereby authorized to direct the revenue officers and the officers commanding ports and revenue cutters to aid in the execution of quarantine, and also the execulion of the health laws of the States respectively, in such man ner as may to him appear necessary." 6. The fees collected by the State of Louisiana from vessels subjected to the quarantine laws are not in the nature of a tax or impost on commerce, but are a just and necessary compensation for the great service rendered commerce in the cleansing and disinfection of the vessels and cargoes in the care and treatment of the sick by the medical officers of the State, and by the exclusion of foreign pestilence, and by the establishment of public confidence and the maintenance of commerce, which, but for said quaran- tine services, would be greatly damaged. This proposition is in direct antagonism with the recent decision of Judge F. A. Monroe in the case of Morgan's Louisiana and Texas Kailroad and Steamship Company vs. the Board of Health of the State of Louis- iana, No. 7001, Civil District Court, Division C, and in fact, the learned Judge appears to hold that no service whatever has been rendered by the State of Louisiana in maintaining its quarantine system of inspection, dis- infection, cleansing and medical care of vessels with their cargoes, crews and passengers during the past quarter of a century. 7. Quarantine is established and recognized by international law for 1he common security and protection of States against diseases which are sup- posed to be importable. 8. Although it is contrary to sound policy for a nation to impose quaran- tine merely for the purpose of providing a revenue to the country in which it is established, this is not to be understood of certain dues or duties which are imposed ou ships entering the ports of a State for the legitimate pur- pose of maintaining quarantine or sanitary establishments of a country. 9. Quarantine restrictions prevent non-intercourse, and afford a form of gateway through which the commodities of all nations may pass after proper inspection, detention, purification and disinfection; therefore a service is rendered to ships and to commerce, and therefore the dues or duties imposed on ships entering the ports of a State for the legitimate purpose of maintaining quarantine and sanitary establishments are just, and are recognized and sanctioned by international law. In the International Quarantine Convention held at Paris, February 3, 1852, between France, Sardinia, Portugal, Turkey and Tuscany, the high contracting parties discussed and adopted in principle: 1. "That all ships in a port shall pay, without distinction of flag, certain dues for sanitary purposes, in proportion to their tonnage. 2. "That ships subject to quarantine shall pay besides, daily dues for their berths. 3. "That the persons who stay in the lazarets shall pay fixed dues for each day's residence in these establishments. 4. That merchandise placed and disinfected in the lazarets, shall be subject to a tax according to weight or value. "The dues and taxes mentioned in the present articles shall be fixed by each government and signified to the other contracting parties." 10. A vessel in quarantine is still theoretically in transitu, and there being no element of voluntary sacrifice, her charter is not violated. 11. Quarantine facilitates commerce in that it furnishes the only legal certificate which grants to vessels, subject by international law to quaran tine, liberty to unload. Joseph Jones, M. D., on Quarantine. 29 The quarantine system of Louisiana furnishes pratique (liberty to un- load) to all vessels conforming to the organic acts of the Legislature and to the rules and regulations of the Board of Health. Were it not for the execution of the quarantine laws by the Board of Health of the State of Louisiana, the port of New Orleans would be hermi- tically closed to commerce during from four to six months every year, and all intercourse with surrounding States would be closed by the shotgun quarantines controlling the river and railroads. In virtue of its power to grant "pratique" to all vessels conforming to the quarantine laws, the Board of Health of the State of Louisiana practically protects and facilitates commerce, and justice demands that this beneficial system of protection should be supported by those who conduct commerce. The quarantine established by the organic acts of the State of Louisiana in 1855, and as now administered by the Board of Health, has not injured or destroyed, but has protected the commerce of New Orleans. The accompanying tables, K and K continued, furnish accurate data by which to estimate the effects of quarantine as conducted by the Board of Health of the State of Louisiana on the commerce of New Orleans. The opponents of the quarantine system of Louisiana have continually used the press to arouse public indignation against the Board of Health, and especially against its President, by the cry that quarantine was destroying the commerce of New Orleans. When the press is used as the grand channel for the communication of facts and truth to the people, it becomes at once the highest and most powerful educator of the masses, and the strongest defender of right; when, on the contrary, it suppresses factsand perverts the truth, for the gratification of personal spite and malice, and for the advancement of mer- cenary interests, it becomes an enemy to the highest and best interests of Commonwealth. From the statistics embodied in Table K, extending back to the very dawn of the nineteenth century, we gather the following facts illustrating the great service rendered to the commerce of New Orleans by the execu- tion of the quarantine laws of 1855. (a) During the ten years, extending from 1805 to 1815, inclusive, the increase of the trade of New Orleans by no means corresponded with that of the population ; on the contrary, a large falling off was exhibited even before the commencement of the war of 1812 to 1815; the close of this war, however, inaugurated a new era in the commercial history of New Orleans; the exports increasing from $387,191 in 1814 to $12,924,309 in 1818. This wonderful advance, however, was checked, and a large falling off was exhibited during the next six or seven years, although the average largely exceeded that of any previous ten years. (b) From 1820 to the commencement of the American civil war-1820 to 1800, inclusive-the increase of trade and population of New Orleans was remarkable. (c) It is worthy of note that when the quarantine system, as it now ex- ists, was established in 1855 the total exports were $55,400,711 and the im- ports $12,923,608; while four years after, in 1860, the exports reached $108,393,567 and the imports $20,920,849. From 1843 to 1849, inclusive, the exports of foreign and domestic merchan Use averaged about $40,000,- 000 ; the average of the imports from foreign countries was b.urely $9,000,- 000 per annum. (d) It is evident from the statistics recorded in tables Kani K continued, that under the direction of the present Board of Health, 1880- 83, the com- 30 General Conclusions. merceof New Orleans has been as great as at any similar period since the close of the civil war, 1861-65; and that, with the exception of the year 1860. New Orleans actually enjoyed a larger commerce in 1880, during the action of the present quarantine law, than in any other year from her foun- dation. The quarantine was conducted upon the most liberal principles in 1875, 1876, 1877 and 1878 ; and it is precisely in these years that we observe the greatest falling off in the commerce of this port. (e) All the great sanitary and quarantine measures of the past twenty- eight years in Louisiana may be directly traced to the act to establish quar- antine for the protection of the State, approved by P. O. H^beit, Governor of the State of Louisiana, on the fifteenth of March, 1855. During the preceding 155 years of the existence of the colony, province and State of Louisiana, the sanitary and quarantine efforts of the State and people were spasmodic, unsatisfactory, and of short duration; and as a consequence, at frequent and short intervals the people were decimated by foreign pesti- lence imported by maritime men and immigrants. (f) The exports of 1880 reached $102,749,367 and the imports $11,800,- £77; total exports and imports $114,550,344. The total amount collected from this vast sum for the protection of the commerce and trade of New Orleans and the Mississippi Valiev was $21,872, Can this paltry sum, barely sufficient to maintain the quarantine estab- lishment guarding the mouths of the Mississippi Kiver and over five hundred miles of coast, be regarded as a tax on commerce, a burden de- structive to the growing commerce of New Orleans ? (g) The internal or interstate trade of New Orleans equals annually $200,000,000, exceeding greatly the value of the foreign imports and ex- ports. The preservation of this internal interstate trade, depends absolutely upon an efficient quarantine, guarding the approaches of the Mississippi Valley from the Gulf of Mexico. New Orleans will become a great manu- facturing centre for cotton, tobacco, jute and sugar, provided that pesti- lence is kept away by a rigid system of domestic sanitation. If yellow fever is allowed to enter, this port will be hermetically sealed ; during the embargo, which may last as long as six months, there will be practically non-intercourse with the surrounding States, and all manufactories will be closed, as there will be no possibility of shipping manufactured articles. No system of manufactories, however well ordered, can sustain such periods of inactivity. During three years. 1853, 1854 and 1855, New Orleans lost 12,780 of her citizens by yellow fever (an imported disease), and in 1878 she lost 4056 souls and about $15,000,000. (h) The State of Louisiana has a right to demand that commerce which benefits the entire valley and derives its richest rewards from the cotton, sugar and grain of the great Southern and Western States, shall pay a sufficient amount for such a system of inspection, disinfection, detention and medical care of vessels, seamen and passengers as will prevent the in- troduction of foreign pestilence at all times and under all circumstances. JOSEPH JONES, M. D., 156 Washington street, corner of Camp, Fourth District. New Orleans, La.. July 4, 1883. CONTAGIOUS and INFECTIOUS DISEASES. Measures for their Prevention and Arrest. SMALL-POX, SCARLATINA, DIPHTHERIA AND YELLOW FEVER. CIRCULAR NO. 1. PREPARED FOR THE GUIDANCE OF THE QUAR- ANTINE OFFICERS AND SANITARY INSPECTORS AND . POLICE OF THE BOARD OF HEALTH OF THE STATE OF LOUISIANA. BY JOSEPH JONES, M. D, PRESIDENT OF THE BOARD OF HEALTH OF THE STATE OF LOUISIANA. CONTAGIOUS AND INFECTIOUS DISEASES. MEASURES FOR THEIR PREVENTION AND ARREST. SMALL-POX, SCARLATINA, DIPHTHERIA AND YELLOW FEVER. CIRCULAR No. 1. PREPARED FOR THE GUIDANCE OF THE QUARANTINE OFFICERS AND SANITARY INSPECTORS AND POLICE OF THE BOARD OF HEALTH OF THE STATE OF LOUISIANA. BY JOSEPH JONES, M. D., PRESIDENT OF THE BOARD OF HEALTH, STATE OF LOUISIANA. The quarantine officers, sanitary inspectors and police officers of the Board of Health of the State of Louisiana, are instructed to enforce rigidly all laws and ordinances of the Board of Health relative to the exclusion, isolation, disinfection and report of all cases of infectious and contagious diseases. Much has been accomplished and much remains to be accomplished by the enforcement of existing laws. In virtue of the power conferred upon the Board of Health of the State of Louisiana, its officers should endeavor to throw a mantle of safety around the citizens; but extended sanitary improvement must depend largely upon the earnest and intelli- gent support of the people. Sanitary measures to be effectual in New Orleans and in all the parishes and towns of the State, must receive the warm support of the representa- tives of the people, assembled for deliberation, and clothed with certain powers in the Common Council, police jury and General Assembly. The power of the people depends essentially upon their health, and, hence, it becomes the duty of every officer and citizen to do all in his power to secure the most healthful conditions procurable. 36 Joseph Jones, Jf. J)., on Contagious Diseases. The situation of New Orleans at the mouth of the Mississippi river, and her extensive commercial relations with all parts of Louisiana, render it absolutely necessary that the construction, support and conduct of hospitals destined to the isolation and treatment of contagious and infectious diseases, as well as the supply of the necessary • amounts of money for the conduct of her sanitary7 affairs should depend not upon accident or the caprice of bodies perpetually changing with political revolutions. The strong arm of the organic law of the entire common- wealth should be exerted in behalf of the welfare of the entire people, and a specific sum for the exclusion of pestilence, and for its isolation and treatment, as well as for the conduct of the sanitary' affairs, should be appropriated from the moneys collected by' taxation. CONTAGIOUS OR INFECTIOUS DISEASES. The following facts represent the present state of our knowledge, and have been condensed not only from personal observation and experience, but from the writings of such eminent sanitarians and physicians as John Simon, Alexander Collie and E. C. Seaton, and are now placed on record, not merely for the guidance of the sanitary officers of the Board of Health of the State, but also for the information and guidance of citizens. Contagious or infectious diseases are spread by means of infectious par- ticles, and systematic means should be instituted to destroy the disease germs or particles, and to prevent their being carried from one person to another. Those parts of the body which are the breeding places of the contagious particles give off the poison in the greatest amount; for example : In scarlet fever, the mouth, throat, nasal passages, skin and urinary organs. In diphtheria, the mouth, throat and nasal passages. In small-pox, the pustules, chiefly of the skin. In measles, the skin and air passages. In whooping-cough, the air passages. In typhoid fever and cholera, the discharge from the bowels. The portions of the body thrown off and containing the contagium, may pass into the air, or find their way into water or food, and in this way be introduced by breathing, drinking or eating, or through broken surfaces of the bodv. Scarlet fever, diphtheria, small-pox, measles and whooping-cough are very readily communicable through the atmosphere. The contagium ot small-pox, scarlet fever and diphtheria remain virulent for a great length of time, and at great distances, and these diseases are most destructive in their effects. The number of contagious and infectious diseases is limited ; the mem- bers of this class of diseases have different periods of incubation ; the symptoms whenever developed have a regular course; some persons are more susceptible to the action of the poisonous particles which produce disease by contagion or infection, than others; as a general rule, one attack of a contagious disease is a cause of exemption from future attack; contagious diseases often assume an epidemic character, and the increase, spread and decline of some of these diseases are clearly related to climatic conditions and variations of heat and moisture. Contagious Diseases-Causes and Prevention Of. 37 However imperfect and unsatisfactory our knowledge may be as to the absolute nature of the poison or poisonous particles which produce disease by contagion or infection, it has, nevertheless, been demonstrated by sanitarians that some of these poisons are removable and destructible by physical and chemical agents, whilst certain contagious diseases, as chicken-pox, whooping-cough and mild measles, do not specially demand the attention of sanitary officers; on the other hand, yellow fever, scarlet fever, malignant measles, typhus or ship fever, typhoid fever, diphtheria, cholera, small-pox, Asiatic plague, and leprosy, should be combatted by such legal regulations and physical and chemical agencies as will prevent their spread. Thorough cleanliness of all human habitations, and of all buildings used by animals, and of all yards, privies, alleys, streets, gutters, sewers and canals ; the frequent cleansing and disinfection of all privies, and the daily removal of all garbage and filth, from the limits of the city; thorough drainage, the removal of all stagnant water around and under dwellings; thorough ventilation of all habitable and inhabited and occupied buildings and rooms ; thorough cleanliness of human bodies, clothing, beds, bedding, furniture and utensils of every description; sufficient supplies of whole- some nutritious food ; and abundant supplies of pure water, for drinking, cooking and washing, constitute the essential conditions of public health. Filth, crowding, bad ventilation, foul air, dampness, scanty or unwhole- some food, dirty bodies and dirty clothing and unwholesome and vicious habits of life, and especially the abuse of alcoholic liquors, at all times depress the vital powers, and lead to fatal forms of disease which largely increase the mortality; and epidemic diseases, as yellow fever, typhus fever, typhoid fever, small-pox and Asiatic cholera are increased by these conditions, in violence. Improvement, resulting from mental, moral and physical advancement, will be the chief agency in overcoming evils, vices and diseases engendered by the ignorance ami filth, almost necessarily associated .with poverty; and the health authorities may accomplish much good in preventing, controlling, limiting and resisting the spread of endemic and epidemic diseases by executing, efficiently and.continuously, all sanitary regulations and laws which promote the highest state of cleanliness of all private and public buildings, premises and thoroughfares. With reference to small-pox, disinfection and isolation, with vaccination, constitute the fundamental measures for its prevention and arrest; the object being to close up the channels through which the contagion is conveyed from the sick to the well; to destroy the contagious matter and to prevent the accumulatation of disease germs, and to produce in all human beings a mild, non-contagious disease, protective against small- pox. DEFINITION OF TERMS. CONTAGION AND CONTAGIOUS DISEASES. The word Contagion is applied in pathology to the property and process, by which in certain diseases the affected body, or part, causes a disease like its own to arise in other bodies or other parts. The Lati^ word Contagium is used to denote the specific material in which the infective material actually resides. 38 Joseph Jones, M. D., on Contagious Diseases. By Fomites, we understand substances capable of retaining contagium particles, and thus of being the means of propagating any infectious dis- ease. The most important fomites are clothing, bed clothes, bedding, woolen garments, carpets, curtains, letters, etc. Contagion attaches itself essentially to a material contact', it is not nec- essary, however, that when infection is spread from individual to individ- ual the contact of individuals must have been immediate; but in all cases there must have been such passage of material from the one to the other, as was in itself at least a mediate contact between them. The various specific matters which affect contagion in the living body, and induce specific diseases, seem all to have the characteristic of self mul- tiplication; now the faculty of self-multiplication is eminently one of the characteristics of vital action ; hence, when it is said that all contagia are self-multiplying things, this is being strongly to suggest that perhaps all contagia are endowed with life. CLASSIFICATION OF CONTAGIA. Contagia have been conveniently divided into two classes, namely, the true or Metabolic Contagia and Parasites. The True or Metabolic Contagia in their respective and specific ways operate transformingly on the live bodily material which they affect; on the contrary, the Parasite, however much it may grow or multiply in the body, produces no qualitative effects specific to itself, but only such effects as are of common kind to it and all other parasites, indicating its mechani- cal intrusivenesss in the parts which it occupies, and sometimes by the drain, which it makes on its hosts, of general nutritive resources. The identity of each true metabolic contagium is settled in experimen- tal and clinical observation, by the uniformity of the operation of each on any given animal body which it affects: each of the diseases propagates itself in its own form in an exact identity, as if it were a species in zoo- logy, or botany ; and in each such repetition of the disease there is a mul- tiplication of material which has the same infective property. METABOLIC CONTAGIA. One of the most important and characteristic facts in the physiology of metabolic contagia, is the preference (intimate connexion or chemical elec- tiveness'}. which particular contagia show for particular organs of the body; so that by the exercise of this preference, there is given to each of the diseases its own set of clinical and anatomical characters. In regard to some of these contagia, different persons, and particularly persons of different family stocks, show original differences of suscepti- bility. Many of the best known febrile contagia, run a course of definite duration, during which all present and in many cases all future susceptibility to the particular contagium is utterly exhausted from the patient ; so that re-intro- duction of the same contagium will no more renew that patient's disease, than yeast will excite a new alcoholic fermentation in any previously well fermented bread or wine. It has been inferred from this fact, that each such contagium, operates with a chemical distinctiveness of elective affinity on some special ingre- dient or ingredients of the body; and that exhausting this particular ma- terial in febrile process, which necessarily ends when the exhaustion is complete, is the bodily change which the contagium specifically performs. Contagious Diseases-Causes and, Prevention Of. 39 The transmission of various contagious diseases in communities is greatly influenced both in detail and in aggregate by differences of indivi- dual receptivity ; but there are conditions, not primarily of a personal kind, which operate on a very large scale, in determining the spread of some of the metabolic infections, giving to them respectively at certain times, a special increment of spreading poison, and also special malignity. The wider the survey of epidemiology, the more certain it becomes, that outside the conditions which are personal and local, there are great cosmical conditions, such as attach to the normal succession and occasional abnormality of seasons, in respect of the insolation of our planet, and of the temperature and humidity of air and earth. When any metabolic contagium enters the animal body, it requires an interval of time, and in most cases a considerable interval, before its meta- bolic effects can become manifest even to skilled observation. The period of latency or so-called incubation varies greatly in different diseases; in hydrophobia it is very rarely less than one month, and is certainly often of several months; in syphillis the infected spots remain generally for at least a fortnight, and may remain even as much as five weeks without any ostensible change; and the roseola of the general infection will not be seen till some weeks later, when, generally, at least three months will have elapsed since the first inoculation ; in Small-Pox the fever does not attrac- notice till about the twelfth day after infection, nor the eruption till two days later; and in measles the incubation time, though perhaps less uni- form, seems to be little, if any, shorter than small-pox. CONDITIONS WHICH FAVOR THE SPREAD OF CONTAGIOUS DISEASES. The social conditions through which the more fatal infectious diseases are enabled to acquire epidemic diffusion are chiefly the following: 1. Persons first sick in families and districts, instead of being isolated from the healthy and treated with special regard to their power of spread- ing infection, are left to take their chances. 2. Especially in poor neighborhoods, where houses are often occupied by several families, and where always there is much intermingling of popula- tion, a first case if not at once removed to a special establishment, will al- most of necessity give occasion to many, other cases. 3. Persons with infectious diseases, especially in cases of slight or inci- pient attack, and of incomplete recovery, mingle freely with others in work places and amusement places of common resort, churches and day schools. 4. Such persons travel freely with other persons from place to place in public conveyances. 5. Often where boarding-schools have infectious diseases, they are broken up for the time, and the scholars incubating or perhaps beginning to show infection, are sent away to their respective homes. 6. Keepers of hotels and lodging houses often receive lodgers into rooms and beds which have recently been occupied by persons with infectious diseases, and which have not been disinfected. 7. Persons in various branches of business, relating to dress and furni- ture, if they happen to have infectious diseases, such as scarlatina and small-pox on their premises, often spread infection to their customers by concealing the existence of their diseases, or by sending articles home to them. 8. Laundries disseminate infectious diseases by carelessness in regard to infected things and garments which they receive to wash. 40 Joseph Jones, Jf D., on Contagious Diseases. 9. Purveyors of certain sorts of food, if they happen to have infectious diseases on their premises, may by carelessness spread infection to their customers. 10. Streams, purveyors of public water supplies and wells with sewage and other filth escaping into them, are most dangerous means of infection, especially as regards enteric fever and cholera. 11. Ill-conditioned sewers and house drains, and cesspools receiving in- fectious matters, greatly contribute to disseminate contagion often into houses in the same system of drainage, and often by leakage into wells. MEASURES FOR THE PREVENTION AND ARREST OF CONTAGIOUS DISEASES. 1. Each case of infectious disease is a public danger, against which the public, as represented by its legally constituted health authorities is entitled to be warned by proper information. 2. Every man who, in his own person, or in that of any one under his charge, is the subject of such disease, or is in control of circumstances relating to it, is bound in common duty towards his neighbors, to take every care, which he can against the spreading of the infection ; in so far as he would not of his own accord do this duty, his neighbors ought to have ample and ready means of compelling him ; and that he should be respon- sible for giving to the health authorities proper notification of his case, in order that the authority may, as far as needful, satisfy itself as to the sufficiency of his precautions. 3. Persons sick with infectious diseases, or having them under their charge thus affected, so far as they may, from ignorance, not understand the scope of precautionary duties, cr may, from poverty or other circum- stances be unable to fulfill them, the civic authorities should give them liberally out of the common stock, such guidance, information and such efficient aid as may be needed. 4. So far as such persons are voluntarily in default of their duty, they should not only be punishable by penalty as for a nuisance, but should be liable to pay pecuniary damages for whatever harm they occasioned to others. 5. That the various commercial undertakings which, in certain contin- gencies, may be specially instrumental in spreading of infection-water companies, dairies, laundries, boarding schools, lodging houses, inns, etc., should respectively be subject to special rule and visitation in regard to the special dangers which they may occasion ; and that the persons in authority in them should be held to strict account for whatever injury may be caused through neglect of rule. 6. Every local sanitary authority should always have at command, for the use of its district, such hospital accommodations for the sick, such means for their conveyance, such mortuary, such disinfection, establish- ments, and, generally, such planned arrangements and skilled service, as may in case of need, suffice for all probable requirements of the district Joseph Jones, M. J)., on Yellow Fever. 41 YELLOW FEVER. DESTRUCTIVE EFFECTS OCCASIONED BY YELLOW FEVER, AND THE MORE FATAL DISEASES IN NEW ORLEANS, LOUISIANA. The relative position held by yellow fever, with reference to the impor- tance and fatality of various diseases, will be illustrated by the following tables: TOTAL NUMBER OF CASES AND DEATHS OF THE VARIOUS FORMS OF FEVER TREATED IN THE CHARITY HOSPITAL OF NEW ORLEANS, DURING A PERIOD OF THIRTY-FOUR YEARS, 1844 1880. TOTAL CASES AND DEATHS, DISEASES. IN 34 YEARS, 1842-1880. Cases. Deaths. Per Cent. Yellow Fever 19 233 9 667 50 2 Typhus Fev^r 7 222 1 303 18.0 Typhoid Fever 3 521 1 163 38.0 Dengue Fever 636 Nervous Fever 51 13 25.4 Adynamic or Ataxic Fever 27 4 14.9 Ephemeral Fever Continued Fever 1 099 88 8.0 Catarrhal Fever 111 1 0.8 Gastric Fever 113 3 2.7 Remittent Fever 15 361 311 2.0 128 0.1 Congestive Fever 1 218 699 57.3 Pernicious Fever 478 320 66.9 Malarial Fever 6 251 636 10 1 Malarial Poisonin 431 50 11.6 Malarial Cochexia 95 8 8.4 Typho Malarial Fever 111 66 47.8 Other levers 131 20 14.8 Total from all Diseases 304,211 43,718 14.3 During a period of thirty-four years, 1842-1880, 19,233 cases of yellow fever were treated in the Charity Hospital, of which 9,667, or 50.2 per cent, terminated fatally. During the same period, including yellow fever, 132,332 cases, with 15,480 deaths of the various forms of fever, were treated in the Charity Hospital. If the cost of treatment of each case to the State be placed at the low figure of $20, then Louisiana expended during these thirty-four years, $2,646,700 for the treatment of fever alone. Whilst yellow fever numbered only 19,233 cases out of a grand total of 304,213 cases of all diseases, it caused 9,667 deaths, out of a total of 43,718 deaths from all causes, during thirty-four years, in the Charity Hospilal of New Orleans. 42 Mortality Occasioned by Yellow Fever. DEATHS FROM THE VARIOUS FORMS OF FEVER IN THE CITY OF NEW ORLEANS, DURING A PERIOD OF THIRTY-FOUR YEARS, 1844-1880. Deaths during 34 Years, Diseases. 1844-1880. Small Pox and Varioloid 5,726 Measles 1,589 Scarlatina 2,066 Dengue 21 Typhus Fever 1,422 Cerebro-Spinal Fever 371 Enteric or Typhoid Fever 3,720 Simple Continued Fever 407 Yellow Fever 28,739 Gastric Fever 19 Malarial Fever ('Intermittent Fever 921 J Remittent Fever 1,299 ] Congestive Fever 6,337 ( Typho-Malarial Fever 93 Malarial (unclassified) 3,747 Total 56,478 During a period of thirty-four years (1844-1880) the following diseases caused the number of deaths specified in New Orleans : Deaths during 34 Years. Cholera 11,847 Cholera Morbus 889 Cholera Infantum 2,408 Total 15,144 Enteritis 6,915 Diarrhoea 8,289 Dysentery 7,097 Total *. 22,301 Deaths from phthisis pulmonalis in New Orleans, (luring thirty-four years, 1844-1880, 24,071. Total deaths in New Orleans, during thirty-four years, 1844-1880, from all causes, 242,420. While fevers of all varieties destroyed in the city of New Orleans 56,478 citizens in thirty-four years, yellow fever destroyed only one-half of this number, namely 28,739. If these fevers be divided into separate groups the mortality will stand thus: Total deaths from small-pox, measles and scarlet fever during thirty- four years 9,381 Total deaths from dengue, typhus fever, cerebro spinal fever and sim- ple continued fever .... 5,942 Total deaths from yellow fever 28,739 Total deaths from the various forms of malarial fever 12,413 The deaths from the various fevers and malarial fever, indigeneous to the soil or common to all parts of the great valley ot the Mississippi, were very nearly half as numerous as those caused by yellow fever; congestive fever alone caused 6337 deaths. It is well established by the records of medicine, extending back over 2000 years, that drainage and agriculture are the great and only absolute and certain means of destroying the cause of malarial fever. If the value of a citizen in the State be rated at $1000, then the city of New Orleans has lost during thirty-four years $56,478,000 by fevers alone; other diseases, however, whose existence and propagation are largely de- pendent upon defective drainage have been busy in their work of destruc- tion. Joseph Jones, M. D., on Yellow Fever. 43 Thus during the thirty-four years specified phthisis pulmonalis destroyed nearly as many citizens as yellow fever, namely 24,071; enteritis, dyssen tery and diarrhoea 22,301, and cholera, cholera morbus and cholera infan- tum 15,144; total from phthisis and bowel affections 61,616 deaths. Those diseases which are common to the entire valley caused 61,616 deaths, exceeding those by fevers 5138. Without doubt, a large proportion of the deaths from phthisis pulmon- alis and bowel affections are preventable and directly referable to detective drainage. Fevers, general affections and phthisis pulmonalis alone caused in New Orleans 118,094 deaths in thirty-four years, out of a total of deaths from all causes of 242,426. We may therefore affirm that nearly one-half the deaths in New Orleans during the past thirty-four years (118,095) were caused by preventable dis- eases, the important sanitary measure for the diminution of the same being effective drainage. From these diseases New Orleans has lost in thirty-four years $118,094,- 000. No city in the world has suffered more obliquy than New Orleans in reputation for health, and more especially in regard to its epidemics of yel- low fever. If by the application of all the facts known to science, the sanitary con- dition of New Orleans can be so improved as to exclude yellow fever, or to arrest it in its first beginnings it is not unreasonable to believe, when we consider the extent and extraordinary fertility of the basins of the Mis- sissippi and Missouri, that New Orleans is destined to become the greatest emporium, not of America only, but of the world. MEASURES FOR THE EXCLUSION, PREVENTION AND ARREST OF YELLOW FEVER. The measures for the exclusion, prevention and arrest of yellow fever may be divided into three divisions. 1. Local Sanitation. 2. Sanitation of all public conveyances, including ships and railroads. 3. Quarantine. The absence of yellow fever from New Orleans during 1880,1881 and 1882, would support the theory that this disease is not indigenous to this locality. If yellow fever be not indigenous to New Orleans, its exclusion depends upon a rigid quarantine. When introduced the health authorities should be provided with suffi- cent men and means to combat the disease and to thoroughly disinfect and cleanse every focus of disease as was done in 1882, successfully, by the Board of Health of the State of Louisiana, in the Third District, in the cases of Forbes, Stroh and Englund. The great difficulty rests in the prompt recognition and immediate report of the first case or cases. Correct diagnosis is of infinite importance. In order to present abases of discussion, and, if possible, agreement amongst the profession, I have drawn up the following statement embracing the result of my, original investigation during the past twenty-seven years. 44 Joseph Jones, M. D., on Yellow and Malarial Fevers. GENERAL OUTLINE OF THE SYMPTOMS AND PATHOLOGICAL ANATOMY OF YELLOW AND MALARIAL FEVERS. Yellow Fever Symptoms and Pathology. Yellow Fever. Definition-A pestilential fever of con- tinuous and specific type, originally de- veloped in tropical and insular America; confined to definite geographical limits and dependent in its origin and spread upon definite degrees of temperature, and capa- ble of transportation and propagation in ships and in towns and cities, in those por- tions of North and South America, which lie between 45° N. lat and 35c S. lat. ; the disease has been limited chiefly to the coast of tropical Africa, rather from the number and position of the commercial towns, than from any climatic causes adverse to its pro- pagation elsewhere ; it has been imported from the Antilles and from the shores of the Gulf of Mexico and from tropical Amer- ica, far in the interior of the Valley of the Mississippi, from New Orleans to St. Louis and alongthe Atlantic coast, from St. Augus- tine, Fla., to Portlaud, Maine,and even across the Atlautie ocean to Cadiz, Curthagena, Barcelona, Gibralta, Lisbon, St. Nazarre to Plymouth and Southampton, England. It presents two well-defined stages; the first characterized by intense pain in the head and back, injected eyes, rapid circulation, elevated temperature, which may extend from twenty-four to 160 hours, according to the severity of the disease; the second characterized by depression of the nervous and muscular forces, and of thegeneral and capillary circulation, capiiiary congestion, slow and intermittent pulse, jaundice, urinary suppression, passive haemorrhages from the stomach and bowels, nares, tongue, gums, uterus, vagina, gall bladder and anus, and in extreme cases from the eyes, earsand skin; black vomit; convulsions, delirium and coma. In Plate 5, figure 16, we have a representation of the countenance of a patient, in the first stage of yellow fever, of the sthenic form. The capillary congestion ■of the face and eyes is well shown, and upon first view the case might be mistaken for one of an eruptive disease as scarlet fever. We do not intend to convey the im- pression that the intense capillary conges- tion here depicted is present in every case of yellow fever; on the contrary, we have, especially in New Orleans, great varia- tions in the severity and duration of the febrile stage and corresponding variations in the degrees of congestion of the superficial capillaries. As a rule unacclimated indivi- duals who have recently come from elevated non-malarious and cold regions present the greatest degree of congestion of the super- Malarial Fever Symptoms and Pathology. Mala hi al Fever. The general division of malarial or par- oxysmal fevers into three types, namely in- termittent, remittent and perniciousor con- gestive fever, admits of several subdi- visions. Thus the forms of malignant intermittent are numerous, but all are attended with congestion of one or more vital organs, which may endanger the life of the patient, and which may pass into actual inflamma- tion attended with effusion of plastic lymph, serum or blood. In many cases in which no structural alterations have ensued dur- ing the congestive stage, there comes on at the conclusion of the paroxysm a perfect intermission of all the violent symptoms. The sudden disappearance of the most alarming symptoms may lead to a false prognosis, ami prevent' the institution of energetic measures. It is well known that in the malarious regions of the Southern and Western States, one of these violent paroxysms, whenever occurring, either at the onset of the disease or during the pro- gress of an ordinary mild intermittent, is the harbinger of others still more violent. If unheeded, the disease may prove fatal at the third, fourth or fifth paroxysm. The nature and effect of the malignant paroxysm will depend upon various causes, as the state of the constitution of the pa- tient, peculiar idiosyncracies, pre-existing diseases, the effects of diet and occupation, the composition of the blood, and the organ or organs chiefly involved. If the cerebro- spinal system is chiefly affected, the par- oxysm may be characterized by delirium, coma, convulsion and tetanic spasms, hence some writers have distinguished the coma- tose, the delirious, the convulsive and the tetanic varieties of the malignant intermit- tent. In many cases, in which the whole force of the disease appears to fall upon the cerebro-spinal system, these symptons indi- cating serious disturbances of the functions of animal life, as disorder of the mind, coma, apoplexy and paralysis, catalepsy, and various involuntary spasmodic move- ments, may disappear entirely as the par- oxysm abates, not even a trace of headache being left during the intermission ; in some cases, however, effusion may take place into the ventricles, or within and around the cerebro-spinal system, and lead to the establishment of permanent coma, with dilatation of the pupils, general paralysis and death. In some cases the effusion con- Symptoms and Pathology of Yellow and Malarial Fevers. 45 Yellow Fever. ficial capillaries ; whilst the natives present the slightest degree, and the faintest blush during the febrile stage. Deep rednessof the surface and great capillary congestion dur- ing the first stage of febrile excitement in. dicate great danger. In Plate 6, figure 17, we have a representation of the countenance of the same patient in the last stage of yellow fever,attended with haemorrhage and black vomit. In this stage the capillaries of the surface are still congested, but the movement of the peripheral circulation is sluggish, the blood has lost its brilliant hue. The presence of jaundice is also indicated. These illustrations are similar to those of Pariset and Mazet in the yellow fever of Cadiz in 1819. In its origin and propaga- tion, it is not dependenton those conditions and causes which generate malarial par- oxysmal fever, from which it differs essen- tially in symptoms and pathology. One of the prominent symptoms of the first stage, is the rapid increase of the pulse within the first few hours of the febrile excite- ment, and the progressive diminution of the beats of the heart, even whilst the temper- ature progressively rises: and in like man- ner the slow and feeble action of the heart constitutes a prominent and striking symp- tom of the second stage. Yellow fever, in common with such contagious diseases as small-pox, measles and scarlet fever, occurs as a general rule but once during life, and may be propagated by contagion; it differs, however, from the exanthematous disease, in that it has never been known to propa- gate beyond 48° North latitude, nor origi- nate below a temperature of 70° F. I will now briefly present the general conclusions as to the nature of yellow fever which I have drawn from my original in- vestigations during the past twenty-seven years. During this period I have at various times, and in different journals, published cases sustaining the various conclusions, and I have also in my possession, in manu- script, the detai Is of a large number of care- ful chemical and microscopical investiga- tions and numerous cases illustrating the symptoms and pathological anatomy of malarial and yellow fever. General Conclusions as to the Nature ot Yel- low Fever ; as Drawn from Original In- vestigation. 1. Yellow fever is a cont inued pestilential fever, presenting two well-defined stages ; the first characterized by active chemical change in the blood and organs, attended with elevation of temperature and aberra- tion of nervous action, which may consti- tute the entire malady, and prove fatal in a manner similar to the infectious form of small-pox; and the other, a stage of de- pression, induced both by the sedative ac- Malarial Fever. sists chiefly of serum, and in others of blood, with all the symptoms of haema- plegia, paraplegia, apoplexy and paralysis. A true inflammation of some portion of the cerebro-spinal substance may result from the congestion induced during the malig- nant paroxysm. Recovery is possible from such states, but convalescence is often tedi- ous, and accompanied with paralysis of one or more sets of voluntary muscles. In many cases of malarial coma, I have ob- served the temperature to be elevated to a degree varying from 102° to 106° F., and such elevation may be attended either with a hot, dry skin, or with a surface bathed in a hot, profuse perspiration. The action of the malarial poison is without doubt one of the causes of fatal and sudden apoplexy. It is probable that the result during the paroxysm is largely determined by preced- ing alterations of the arteries of the brain, and spinal cord, such as fatty and calcari- ous degeneration. If the lungs of the pleura be primarily and chiefly involved, difficulty of breathing, syncope, capilary obstruction, and excruci- ating pains in the pleura, lungs and dia- phragm, may characterize the paroxysm. In like manner these alarming and distress- ing symptoms may vanish, after the disap- pearance of the paroxysm, or structural alterations characterized chiefly by serous effusion into the air cells, bronchial tubes and pleural cavities, may ensue, and either destroy the patient suddenly or lead to painful and protracted pneumonitis and pleuritis. In some cases the effusion into the air cells consists chiefly of blood, and such pulmonic haemorrhage must be re- garded as similar to the haemorrhages from the stomach, small intestines and large in- testines, which characterize certain forms of malignant intermittent fever. In a third form, the heart appears to be chiefly affected, either directly or through the cerebro-spinal and sympathetic system. This, the so-called cardialgic variety, is marked by excruciating pain at the epigas- trium, either continuous or intermittent, intense suffering, great anxiety of counten- ance, vomiting, and sometimes general spasm of the muscles. In a fourth form, the abdominal viscera, the peritoneum, the stomach, the small in- testines, the large intestines, the liver and the kidneys, may one and all be involved, giving rise to the so-called peritonitic, gas- tric, choleraic, dysenteric, hepatic and ne- phritic forms of malignant intermittent. The tenderness of the peritoneum, the pro- fuse vomitings of biliary matters, and the choleraic and dysenteric and bilious dis- charges, may one and all disappear during the intermission. In a fifth form, known as algid fever, the cold stage is unusually protracted; there is 46 Joseph Jones, M. D., on Yellow and Malarial Fevers. Yellow Fever. tion of the febrile poison, and by profound changes excited in the blood, and in certain organs, viz., the heart, liver, and kidneys, and by the direct sedative and poisonous action of the excrementitious matter re- tained in the blood, in consequence of the failure, arrest, or perversion of the func- tions of the liver and kidneys, and by the arrestor perversion of the digestive func- tion, in consequence of the action of the yellow fever poison, in causing perverted nervous action, capillary congestion, and active desquamation of the secretory cells of the stomach, and in consequence of the elimination by the gastric mucous mem- brane of certain constituents of blood and urine, viz., urea and carbonate of ammonia. The various manifestations-as the in- tense capillary congestion, depression of the action of the heart, delirium, coma, convulsions, vomiting, headache, urinary suppression, uraemic poisoning, jaundice, and biliary poisoning-may all be referred to the action of the poison producing the disease, and should not form the basis for the erection of distinct types of the disease, The action of the yellow fever poison is the same in all cases, whether mild or severe ; the progress and termination of the case, as well as the manifestation of the various symptoms, depending upon the ex- tent of the action of the poison, the condi- tion of the system at the time of its intro- duction, the peculiarities of the constitu- tion, and the supervention of other diseased states. The action of the yellow fever poison is definite, and the disease is characterized by definite manifestations. Yellow fever is a self-limited disease. II. The changes of the blood appear to be continuous from the time of the intro- duction of the poison to the fatal termina- tion ; the intensity of the changes being increased, and their character being modified, as the disease advances, not only by the direct action, upon the constituents of the blood, of the poison, but also by the addition of certain noxious substances, as bile, urea, carbonate of ammonia, sulphates, phosphates, and extractive matters, in consequence of the profound lesions pro- duced in the liver and kidneys. Certain constituents of the blood, as the albumen and fibrin, are not only altered physically and chemically in the early stages of yellow fever, but, as the disease advances, from the causes just specified, certain excrementitious matters, which in a state of health are continuously elimi- nated, accumulate in the circulating fluid, and by their direct action upon the elements of the blood, and upon the nervous system, and by their disturbing action upon the processes of nutrition and digestion, still further alter the physical and chemical and vital properties of this fluid. Malarial Fever. great oppression at the chest and abdomen, restlessness, and prostration of nervous and muscular power. The attempt at the for- mation of the hot stage proves abortive, the skin becomes cold, pale and shrunken on the extremities, and covered with a cold clammy perspiration, while, on the con- trary, the central portion of the body and the internal organs are hot. In some cases of algid fever, I have observed the temper- ature of the extremities to be 80°, whilst that of the trunk has reached 104°., and higher. The patient complains of intense thirst, and when water is drank it is fre- quently rejected by vomiting; the pulse is small, frequent, and almost imperceptible at the wrist; the heart beats in a tumultu- ous, irregular manner, giving a thumping sound to the ear, the number of beats some- times reaching 180; the respiration is irreg- ular, often panting, and numbering 40 and over to the minute ; there is great restless- ness, jactitation, impatience of bed cover- ing, with continuous complaints of oppres- sive heat, uot only at the chest and abdo- men, but even on the cold extremities, so that the patient refuses to have them cov- ered. The intellect is generally undisturbed and the expression of the countenance may be qniet, even when the pulse cannot be felt, and when the disorder of the circulation and temperarure becomes so extreme that the heat of the trunk is reduced, and even the tongue and mouth become cold. This irregularity continues through the whole period of the paroxysm, and it is only at the end of it, in favorable cases, that the temperature and circulation are partially restored. In algid fever we have congestion of the internal organs, prostration of the nervous and muscular forces, and marked disturb- ances of the circulation and calorification. As the circulation and calorification depend mostly upon the cerebro-spinal and sympa- thetic nervous systems, as well as upon the physical and chemical changes of the blood and organs, the algid state must be referred at least to lesions of certain ganglionic cells or tracts of the cerebro-spinal and sympa- thetic nervous systems ; ana whilst similar phenomena, but less in degree and duration, are manifested in every true malarial chill, it is not entirely correct to regard the algid state as simply a prolonged chill, for in the algid state the chill is followed by imper- fect reaction, and the elevated temperature of true chill is rarely reached in the central organs, whilst there may be an actual diminution of heat. When from any cause, as bad diet, exces- sive exposure to cold and wet, the continu- ous use of salt meat, or the prolonged action of the malarial poison, the constitution of the blood is altered, haemorrhages take place during the congestive stage of malig- Symptoms and Pathology of Yellow and Malarial Fevers. 47 Yellow Fever. The blood of yellow fever patients under the microscope differs essentially from that of malarial fever patients; in the former disease, the blood corpuscles rapidly assume a crenated form, with minute transuda- tions upon the surfaces. In some cases of yellow fever the blood often contains small particles, possessing a vibratory motion. I have often observed bacteria, and the filaments of a delicate fungus in the blood of yellow fever patients. Blood from yellow fever patients has been allowed to stand, and the development of the micro- cocci, bacteria and fungi watched. I also diluted the blood, and added sugar and other materials, and observed the develop- ment of living organisms. If fresh blood from a yellow fever patient be injected into an animal, it will produce fever, which, as a general rule, is not fatal. If, however, the blood be abstracted from the dead sub- ject, or if, after abstraction from the living subject, it be allowed to stand for a short time, say two or three hours, it proves rapidly fatal to animals, even when injected under the skin. These experiments were performed in 1870, 1873 and 1878 and 1880 and 1882. Many of the animals, into whom small quantities of yellow fever blood and black vomit had been injected, died on the lirst, second, third, fourth or fifth days, in convulsions. A beautiful black and tan ter- rier into whom I injected a small quantity of the blood of John Forbes (1882), was seized with violent delirium, the animal rushing about, and barking and striking its head violently against obstacles. The animal died in tetanic convulsions on fifth day. Fresh black vomit introduced subcuta- neously acts as a local irritant and also produces fever. If black vomit be taken from the stomach of a dead man, or if that from a living person be allowed to undergo putrifactive change, it destroys in a few hours the life of an animal to which it may be administered under the skin. The black vomit a short time after ejection, in many cases, becomes filled with new forms of vegetable and animal life, such as the spores and thalli of torulae, the organized bodies found in yeast and other fermenting liquors, and also various forms of bacteria. I have noticed as characteristic of the secre- tions and excretions of yellow fever, an exceedingly delicate fungus which is evi- dently aspecies of the plant which produces fermentation in beer and sugars. The appearance presented by black vomit under the microscope, is represented in Plate 8, figure 24, Black Vomit of Yellow Fever, 1876; figure 26, Fungus developed on Surface of Black Vomit, 1876 ; figure 25, Fungus developed in Black Vomit, 1876; figure 27, Black Vomit of William Dwyer, died of yeBow fever, September 15th, 1878; figure 28, Black Vomit of James Kenney of Malarial Fever. nant intermittent fever, we may have a sixth variety, which has been indicated as haemorrhagic malarial fever. Without doubt, in this sixth form of in- termittent, haemorrhages from various or- gans, as the stomach, lungs, kidneys and bowels, are directly due to the prolonged and potent action of the malarial poison upon the fibrin and colored corpuscles of the blood, as well as to the various altera- tions in the spleen and liver, characteristic of all the forms of malarial fever. The haemorrhagic form of malarial fever may be attended with many of the promi- nent symptoms of the preceding varieties, as obstinate vomiting of biliary (grass green) acrid matters, intense thirst, rest- lessness, feeble rapid pulse, oscillations of temperature, oppression of breathing, coma, convulsions and apoplexy. In many cases of malarial haematuria, after the supervention of jaundice the pulse becomes slow, falling even below the stand- ard of health, even when the temperature of the trunk may be elevated to from 101° to 104° F. In this respect, as well as in the great irritation of the gastric mucous mem- brane, accompanied with incessant vomit- ing, the haemorrhagic form of malarial re- sembles yellow fever. The latter disease, however, differs from the former in the character of the vomited matters. Whilst in the first stages of yellow fever the vom- ited matters may consist of mucous and bile, in the latter stages the black vomit is essentially altered blood. In malarial haematuria the dark and in some cases black vomit consists almost always of dark green- ish black biliary matters, and rarely con- tains blood. The urine also differs essen- tially in the two diseases; in grave cases of yellow fever, the urine contains albumen and yellow granular casts, and detached cells of the tubular uriniferi. In well marked cases of yellow fever, albumen may appear as early as the first day of the dis- ease, but most generally it appears upon the second, third or fourth day. Blood may be present in the urine of yellow fever, but it is rarely a constituent; and even when present the granular casts of the tubuli uriniferi present a yellow color. In malarial hsematuriathe urine contains albu- men, but this constituent of the blood is invariably associated with blood corpuscles and haematin. The casts of the tubuli uriniferi in the urine of malarial haema- turia present a red or reddish brown color. Suppression of urine in yellow fever ap- pears to be due to the blocking up of the tubuli uriniferi with granular and oleagin- ous matter and detached cells ; the symp- toms in malarial haematuria appear to be due not merely to congestion of the kidney, but to the filling of the urinary tubes with coagulated blood. 48 Joseph Jones, M. D., on Yellow and Malarial Fevers. Yellow Fever. bark Excelsior, died in Touro Infirmary, with yellow fever, July 10, 1880. Plate 14, Fungus developed in Black Vomit, 1873; similar fungus developed in black vomit and in various portions of organs and excretions, in 1870, 1872, 1873, 1874, 1876, 1878, 1880 and 1882. In a case of yellow fever, attacked in New Orleans, September 8th, 1878, attended with high temperature, jaundice, urinary suppression and black vomit, the blood abstracted on September 8th, at 4| o'clock, p. m ., when the pulse was 70, and the temperature of the axilla 104.8°, presented the following characteristics: after ab- straction, the blood rapidly assumed a brilliant scarlet hue, like the blood of those who have been poisoned with carbonic oxide gas or cyanide of potassium. The blood was tested for hyrocyanic acid after its removal to the laboratory, but no trace of the poison could be detected. Under the microscope, the colored blood corpuscles presented a crenated appearance and minute oval bodies,with a central nucle- us similar in size and appearence to those observed in the yellow fever atmosphere. I also observed rod-shaped bacteria, and delicate thread-like filaments resembling the mycilia of minute fungi. The minute particles of matter possessing an active vibratory motion, observed in this and other specimens of blood of yellow fever patients during 1878. may have been examples of the Brunonian movement. The vibratory motion of minute particles may be associa- ted with inorganic matter as well as organic; but from the number of these particles observed in the blood of yellow fever patients, during the epidemic of 1878, I was inclined to refer their existence, in part, at least, to the pathological processes of the disease. The blood was received carefully into a glass-stoppered bottle, and examined mi- croscopically at varions intervals, and there was rapid and progressive growth of the bacteria, and rotatoria and minute vibra- tory particles. On the third day after its abstraction and preservation in the glass- stoppered bottle, the blood literally swarmed with the red-like bacteria and rotatoria. When the blood thus undergoing change was, twenty-two hours after its abstrac- tion, injected sub-cutaneously into the ear and back of a large, powerful buck rabbit, death ensued in twelve hours. Putrefac- tion was rapid, and the coagulated blood which distended the cavities of the heart of the animal was found, upon microscopical examination, to contain similar rod-shaped bacteria and rotatoria to those observed in the blood of yellow fever subjects. The few drops of putrid yellow fever blood in- jected sub-cutaneously appear to have Malarial Fever. The microscopical examination of the blood also reveals marked differences in the two diseases; in yellow fever the colored blood corpuscles frequently assume a cre- nated appearance, and in uncomplicated cases there is no accumulation of pigment particles and pigment cells, and the dark cells of an alg®, resembli.ig large colorless corpuscles filled with spores of a dark brownish red color. In malarial haematuria, it is rarely the case that the colored corpuscles present any other than the normal form of bicon- cave discs ; whilst pigment particles, dark granular masses, and cells of a dark reddish brown hue, some of which are similar in all respects to certain palmell®. are often present in considerable numbers. In malarial haematuria, after death, the intestines give the reaction of bile through- out their entire extent; in yellow fever we thus obtain no evidence of the presence of bile. Changes of the Blood in Malarial Fever. The malarial poison is capable of alter- ing the constitution of the solids and fluids, and of modifying and altering the type and progress and effects of various diseases, even when no symptoms of aberrated, phy- sical, chemical and nervous actions have been manifested sufficient to arrest the at- tention of the patient. The colored blood corpuscles are diminished during malarial fever; the extent and rapidity of the diminution of the colored corpuscles correspond to the severity and extent of the disease. The fixed saline constituents of the colored blood corpuscles are often diminished in malarial fever. The colored blood corpuscles are destroyed both in the liver and the spleen. The colored blood corpuscles are more uniformly and rapidly destroyed in severe cases of malarial fever, than in any other acute disease, with the exception, perhaps, of pyaemia. In the severe forms of malarial fever the serum presents a golden yellow color. I have shown by numerous analyses that this color in the various forms of malarial fever, and even in the so-called malaria] haema- turia, is due to the coloring matter of the bile, and not, as has been erroneously stated, upon superficial observations, to the escape of the hoematin of the colored blood corpuscles. The fibrin is diminished greatly in severe cases of malarial fever; the diminution of this element of the blood is characteristic, not only of malarial fever, but of all the fevers; while its increase, on the other hand, as characteristic of the phlegmasi®. As a general rule, the diminution of the fibrin in malarial fever, as in the pyrexi®, generally corresponds with the severity of the disease, provided there be no inflam Symptoms and Pathology of Yellow and Malarial Fevers. 49 Yellow Fever. conveyed to the living and healthy animal a deadly poison, and one of the most marked effects of such putrid blood was the rapid generation iu the blood of bacteria. At the same time, September 9, 1878, I injected sub-cutaneously into two healthy rabbits fresh yellow fever blood from an- other patient. This blood was injected within two hours after its abstraction from the patient, who was suffering with a vio- lent fever which subsequently terminated iu black vomit and death. One of the ani- mals survived the operation, while the other died on the fourth day after the oper- ation. September 11, 5 a. m., thirteen hours before death, this patient threw up black vomit and passed large quantities from the bowels. The black vomit was car- ried immediately from his sick chamber (this specimen was vomited in my presence) to my laboratory, and injected sub-cuta- neomdy into two strong rabbits. Local ir- ritation with the formation of pus in the neighborhood of this injection, attended with fever ensued in both animals, but they survived the operation. On the other hand, black vomit kept for some time (from twenty-four to forty-eight hours) which emitted a foul smell and swarmed with bac- teria, as well as the putrid black vomit taken from the stomachs of patients after- death from yellow fever, destroyed the rab- bits, when injected sub-cutaneously in from twelve to eighteen hours. In a case of yellow fever, J. K., male, age thirty-eight years, native of Germany, attacked in New Orleans with yellow fever at two o'clock p. m. August 27, 1878, at- tended with high temperature, 106°, wild del- irium, urinary suppression, the blood ab- stracted August 29, at 9 o'clock a. m. (when the pulse was 98°, and the temperature was 105°, having been the evening previous 106c) presented the following appearance: Upon standing the blood abstracted showed a brilliant scarlet hue, the clots were small and soft and rapidly dissolved. The blood then became entirely fluid a short time after its abstraction by the dis- solution of the fibrin. The serum at first presented a bright golden color that rapid- ly changed to a scarlet hue from the liber- ation of the coloring matter of the colored corpuscles. Many of the colored blood cor- puscles presented under low powers (400 to 000 diameters) a crenated and granular ap- pearance. Under higher powers, one-eighteenth of an inch, the peculiar crenated appearance of the colored corpuscles was found to be due to irregular elevations or exuda- tions on the surface of the corpuscles. Many of the colored and colorless corpuscles when magnified 1800 diameters presented a dis- tinctly granulated appearance wholly un- like the condition of these constituents in healthy blood. The blood also contained minute vibra- Malarial Fever. matory complication. The diminution and alteration of the physical properties of the fibrin in malarial fever to any great extent, was always accompanied by congestion of the spleen, liver and brain, and serious cerebral disturbances. The fibrin is not only diminished in malarial fever, but it is altered in its properties, and its relation to the other elements of the blood and to the blood-vessels, and in severe cases, heart clots, (fibrinous concretions') are frequently formed before death. The albumen is diminished during the active stages, but such diminution is not due to any loss of this constituent of the blood in the urine. As a general rule, alb- umen is absent from the urine in malarial fever, and when present, as in malarial luematuria, it is accompanied with blood corpuscles, and with casts of the tubuli uriniferi containing colored blood cor- puscles. The results of my microscopical investi- gations upon the blood of malarial fever, pursued during the past twenty-seven years, may be thus formulated : 1st. The malarial poison produces more rapid destruction of the colored blood corpuscles than any other known febrile agent. 2d. The destruction of the colored cor- puscles takes place chiefly in the spleen and liver. 3d. The black pigment resulting from the haematin of the blood corpuscles, is frequently observed in the blood as it cir- culates in the vessels and capillaries in masses of various sizes, and in the form of cellular elements. 4th. In the malarial blood we observe frequently black pigment or melanaemic corpuscles, varying from the one ten-thou- sandth to the one-thousandth of an inch and even less in diameter; conglomerations of these melanaemic particles, in masses of various sizes; colorless corpuscles or leu- cocytes which contained granular masses of black pigment; pigment cells containing ovoid bodies resembling sporules, and in all respects similar to the brownish red palmellae obtained by passing the air of malarial regions through melting ice. Many of the particles of melanaemic pig- ment are spherical, others irregular and angular, and some entirely free, others encased in a hyaline mass, others incorpo- rated with cellular elements, which are more or less related to the white corpuscles of the blood, and to certain forms of algae. Plate 13, figure 51, represents the appear- ■ ance of a drop of blood from a patient suffering with malarial haematuria, when i placed upon white bibulous paper. Figure 52 represents the microscopical • appearance of the blood in malarial fever i and malarial haematuria. The pigment particles and pigment corpuscles are shown in this figure. 50 Joseph Jones, M. I)., on Yellow and Malarial Fevers. Yellow Fever. tory particles, varying from one-ten thon- sandth to one-thirteenth thousandth ol an inch in diameter. It would appear that the bacteria are more numerous in the blood at a later stage. Subcutaneous injection of this blood into rabbits was not attended by fatal results. The fresh urine passed by this patient on the 31st of August, at 8 a. m., was of a light yellow color, and contained a. small quan- tity of albumen, with a few granular casts of the tubuli uriniferi, and epithelial cells of the urinary tubes, oil globules, bacteria and granular matter. Immediately after arriving at my laboratory, I injected two fluid drachms of this fresh urine (passed in my presence) subcutaneously into the backs and thighs of healthy buck rabbits. After the injection of the urine, the lower ex- tremities were paralyzed forafew moments, but the animals were not to any perceptible degree affected by the absorption of the urine and survived the operation. In a case of yellow fever, William Dwyer, age 27, native of Ireland, attacked with yellow fever in New Orleans, 8 o'clock, a. m., September 11th, 1878, attended with high temperature (106°), urinary suppres- sion and black vomit, the blood abstracted on the, 14th of September, 1878, presented the following appearance: The blood upon exposure to the atmos- phere presented a brilliant scarlet color. I hastened to my laboratory with the blood of this patient, which had been received into chemically clean glass-stoppered bot- tles, and which had never been used before, and subjected the blood to microscopic ex- amination, The colored blood corpuscles presented a stellate and granular appear- ance, as if minute globules were forming upon the surface of each cell membrane or outer coating. I also detected bacteria and small globular bodies with nuclei, and rotat- ing and vibrating globules, apparently sur- rounded with ciliae, in the blood of this patient, which were similar to those ob- served in the yellow-fever air. In Plate 7, Figure 19, 1 have reproduced the sketch which I made of the blood of this patient, AVilliam Dwyer. The blood here figured had not been abstracted two hours when the drawing was made. The blood itself was submitted to the examination of three members of the Board of Health, and to Professor McCulloch, of Ba ton Rouge, Professor Elliott, of the Medi- cal Department of the University of Louisi- ana, Mr. Krutschnitt. Prussian Consul, and other physicians, and no difference existed amongst those observing the fresh and dried blood under the microscope, as to the altered form of the blood corpuscles, of the presence of the bacteria, and the bodies resembling in all respects spores. Malarial Fever. The following is a brief outline of the case of malarial luematuria, from which the blood was abstracted, and furnished the illustrations, figure 51 and figure 52; Plate 13: J. E. Easterland; age twenty- one years; native of Carrolton, on Tom- higby river, Alabama; entered Charity Hospital, New Orleans, November 29th, 1876. Described Carrolton as a low, marshy, swampy locality ; informed by his parents that he suffered with chills and fever in infancy, and continued to suffer thus until he left the locality at the age of ten years. Spleen had been enlarged during this period. Between the ages of ten and nineteen years lived in Jasper County, Mississippi, a healthy locality ; enjoyed good health, but his spleen continued to be enlarged. From his nineteenth year, until a. short time before entering the Charity Hospital, was employed as carpenter, rear Greeflville, Washington County, Miss., in a malarious locality. Suffered with a severe attack of malarial fever in August, 1875, and was not fully restored to health until May, 1876. In the early part of June, 1876, attacked with severe chills and fever; on 1st of July had a congestive chill. Desiring to immigrate to Texas, he arrived in New Orleans on the 27th of November, but was compelled by illness to discontinue his journey. On the 28th was seized with a congestive chill, which lasted for two hours, and was followed by intense jaundice and high fever. Admitted to the Charity Hospital November 29th, 1876. At the time of admission presented the following symptoms: Intense jaundice; pulse, 144 ; respiration, 30; temperature of axilla, 102.5°; nausea, vomiting a large quantity of dark-green bilious matter. November 30th, 9 a. m. : Pulse, 32; respiration, • 16 ; temperature, 98.1°; vomits large quantities of dark-green bilious matter. Has passed no urine since entering the Hospital. Jaundice intense, even the saliva is a golden color. Anaemic appearance. Spleen and liver enlarged. Seven o'clock, p. m. ; pulse,134; respiration, 22; temperature, 99.5°. Kidneys have resumed their func- tions. The urine presents a dark brownish red color,and contains blood, and casts disclosed by the coloring matter of the blood. December 1, 8 a. m., pulse 122°, respira- tion 22°, temperature 100° F. Jaundice and bloody urine continue. Chemical and Microscopical Examination of Blood. Serum of the blood of a deep golden and yellow color. When the blood was dropped on white bibulous paper, the central car- mine spot containing the red corpuscles was surrounded by a deep orange yellow- colored border, due to the absorption of the Symptoms and Pathology of Yellow and Malarial Fevers. 51 Yellow Fever. Some of. the bacteria bore a striking re- semblance to bacillus anthracis of splenic fever; others to spirochacte oberm eiri of relapsing fever. The cells resembled those of micrococcus bombycis and of mi- croccus ureae and torulai. The delicate fil- aments appeared to be similar to those of eladothryx dichtoma. When the blood was allowed to stand in well stoppered glass bottles, it was found upon the succeeding day, that these organ- isms had greatly multiplied. The fresh blood injected into living animals produced no fatal eflects, whilst the blood at the end of twenty-four hours, injected in the same manner, proved rapidly fatal. Portions of the blood were placed in glass vessels, the mouths of which were carefully stoppered with cotton-wool. The follow ing experiments w ere made : 1. Simple blood. At the end of one week all the colored blood corpuscles had disappeared, and an immense number of bacteria had been de volped, many of which resembled in form human spermatozoa, having a distinct cell with a tail-like pro- longation. These appeared to be similar to the bacillus subtilis, with spores, atone end. I also observed micrococci, vibrios, spiro- chaete and spirillie. The appearance of the putrid blood of the man Wm. Dwyer, is represented in Plate 14, figure 57. The blood of John Forbes, who died of yellow- fever in 1882, in New- Orleans, presented the same organisms after standing for two or three days, the colored blood corpuscles having disappeared. The appearance of the putrid blood of John Forbes is repre- sented in Plate 14, figure 58. 2. Blood mixed w-ith water, about one part of the former to ten (10) parts of the iatter. At the end of a few days, the colored blood corpuscles disappeared, and numerous bacteria, resembling chiefly bacillus anthracis, bacterium termo and spirillum tenue and micrococci. The microscopical appearances of the blood thus treated are represented in Plate 14, figure 59. 3. Blood mixed with a solution of crystallized (white) sugar. At the end of a week, a distinct fungoid mass, with a deep yellow surface, had formed upon the free surface of the liquid. Under the micro- scope this fungus resembled the aspergillus glaucus. The spores varied in diameter from one-four thousandth to one-three thousandth of an inch in diameter. The sporiferous steins w ith spores, the sporangi- um,mycelium and zoospores were w ell devel- oped. The appearance of the fungus developed in the yellow fever blood of Wm. Dw-yer, treated with a solution of white sugar, is represented in Plate 11, figure 60. 4. Blood of yellow fever mixed with lime Malarial Fever. colored serum. This appearance is repre- sented in plate 13, figure 51. Careful tests revealed the presence in the serum of the coloring matters and acids of the bile. The deep golden hue of the serum was caused by the bile pigments, and imparted the golden hue to the skin and conjunctiva. Coagulum firm, separation between clot and serum perfect. The clot floated in golden colored serum. Under a magnifying power of 420 diameters, numerous dark granular masses and pigment cells were observed in the blood. Many of the colorless corpuscles contained numerous pigment particles. The appearance presented by the blood under the microscope is represented in plate 13, figure 52. One thousand parts of this blood con- tained : water 820.50 ; dried colored blood corpuscles 86.47; fibrin 4.50; saline and extractive matters 88.53; fixed saline con- stitutes 7.18. The extractive matters of the serum contained some of the coloring- matters and acids of the bile. The moist blood carpuscles in this case were 353.13 in the thousand parts of blood; and the liquor sanguinis, 616.86. In healthy blood the dried globules may vary in the thousand parts from 120.06 to 150.00, and the moist globules from 480.00 to 600.00; and the liquor sanguinis from 520.00 to 400.00. It is evident, therefore, that in this case of malarial hematuria, the blood contained, relatively, a much greater proportion of liquor sanguinis, and a less number of globules than in health. It is also worthy of note, that the fibrin was increased and reached 4.5 parts per thousand of blood. The blood also coagulated firmly, and there was no appearance of the destruction of the colored blood carpuscles in the serum. The formation of the dark, pigmentary particles in the blood is not peculiar to malarial haematuria, audit is probable that a large proportion of them was derived from the changes of the blood in the spleen and marrow of the bones. The increment of the fibrin in the blood in this case is of great interest, as indicating an inflamma- tory condition of the fluid, as well as of the organs most deeply involved, namely, the kidneys. Such results overthrow entirely the view that malarial haematuria is the result of the action of some sudden or potent agent upon the blood corpuscles, which causes their dissolution in the blood vessels, and the escape of the haematin through the ex- cretory structruesof the kidneys. 5th. The black pigment particles indi- cate the destruction or alteration of the plood corpuscles, and the escape of the ^sematin of the red globules. 6th. The black pigment is deposited in the capillaries of various organs and tissues, 52 Joseph Jones, M. D., on Yellow and Malarial Fevers. Yellow Fever. water. At the end of the week numerous bacteria and delicate, elongated dichotoma threads had formed. Figure 61 represents the microscopical appearance presented by the yellow fever blood treated with lime water. Figure 62 represents the appearance of the putrid blood of other cases of yellow fever observed during the epidemic of 1878. Figure 63, appearance presented under the microscope of putrid bile, from yellow fever subjects, 1878. Figure 64, organisms in putrid yellow fever liver, 1878. Figure 65, fungus developed in black vomit, and in various secretions, and upon the surface of organs, from vellow fever subjects, in 1870, 1871,1872,1873, 1874, 1876, 1878, 1880, 1882. III. The maximum elevation of tempera- ture is rapidly attained upon the first and second days of the disease, varying, accord- ing to the severity of the attack, from 102° to^llO0 Fahr., in the axilla, and, as a gen- eral rule, from the third to the fifth day, steadily falling and sinking down to the normal standard, and even below ; in some fatal cases it rises again toward the end, rarely, however, reaching or exceeding 106° Fahr., and only in certain rare instances attaining the high degree of temperature characteristic of the stage of active febrile excitement. In the preceding tables (see History of Epidemic of 1878 by author, published in N. O. M. and S. J.) we have recorded (case 94) a sudden rise upon the fifth day from 101.7° to 111°; (case 96) 106.8° on fourth day ; (case 97) 107.5° on sixth day ; (case 105) 105° on fourth day; (case 122) 107.2° on ninth (case 133) 107° on third day; (case 146) 109° on sixth day; (case 154) 111 1° on ninth day; (case 168) 108.2° on ninth day. The supervention of an inflammatory disease, or the occurrence of an abcess, or the access of paroxysmal malarial fever, may in like manner cause a progressive elevation of temperature, with slight even- ing exacerbations. The pulse at the com- mencement of the attack is often rapid and full ; the increase in the frequency of the pulse does not, however, as a general rule, continue to correspond with the elevations and oscillations of temperature, as in many other febrile diseases; and in many cases of yellow fever the remarkable phenomenon is witnessed of the pulse progressively de- creasing in frequency, and even descending below the normal standard, while the tem- perature is maintained at an elevated degree ; and, on the other hand, the pulse often increases in frequency, but diminishes in force near the fatal issue; the occurrence of copious hemorrhage from the stomach and bowels may be attended with sudden depression of temperature, and increase in Malarial Fever. as those of the liver, medulla of the bone, brain and subcutaneous tissue. 7th. The peculiar sallow, greenish-yellow and bronze hue, which characterizes those who have been for a length of time subjected to the prolonged action of the inalarial poison, or to its powerful action in perni- cious remittent fever, and in malarial htematuria, is due not merely to the hepatic and splenetic derangement, but also to the deposit of pigment particlesin the subcuta- neous capillaries. 8th. During the epidemic yellow fever of 1878, in New Orleans, I endeavored by the condensation of the organic and organ- ized and inorganic and particulate matters of the air in various portions of the city to determine whether the living particles found in the air, differed in accordance with the locality whether malarious or non- malarious. After a minute examination of the solid organic organized, living inorgan- ic and inanimate particles of the air in res- idences in which yellow fever was prevail- ing, it was observed : a. In the well paved and well drained non-malarious portions of New Orleans, the solid matters of the air examined not only during the prevalence of the yellow fever, but also at various intervals, during a pe- riod of six to eight months, I discovered no form which could be referred to such mi- croscopical plants, as the chloro-coccum, vulgare, proto-coccus, viridis. palmella, cruenta, coccochloris, brebinonii and other confervoidae, or unicclular algse capable of producing chlorophyl. Certain granular cells observed in the blood of malarial fever, resemble most nearly the resting spore of bulbochsete intermedia, and the granular cells of palmella cruenta ; but no such cells were observed in the atmosphere of the houses situated in well paved and well drained sections of the city. The forms of the non-malarial, sick-rooms (rooms containing yellow fever patients', were referable to those most nearly connect- ed with putrefaction and fermentation, as the bacteria and torulse, penicillus and micrococci and cryptococae. The absence of any of the known forms of algae in the air of yellow fever, collected in the non- malarious, well drained and well paved portions of the city of New Orleans, is im- portant, in that this class of plants is thus excluded from the consideration of the question relating to the origin and causa- tion of yellow fever. b. The water obtained by passing the air through ice and melting ice and ice cold water, was preserved, and portions added to solutions of sugar. The water from the rooms in which yellow fever patients lay caused the development in solution of sugar, of a delicate fungus, the spores of which were distributed in regular rows, within Symptoms and Pathology of Yellow and Malarial Fevers. 53 Yellow Fever. frequency, but diminution in the force and fullness of the pulse. The cause of the rapid rise and declen- sion of the temperature in yellow fever must be sought chiefly in the changes in- duced in the blood and in the organs upon which the circulation and integrity of the blood depend; neither the rapid rise nor the sudden declension of the temperature can be referred wholly to the effects of the yellow fever poison upon the nervous sys- tem. IV. The fever of the flrst stage of yellow fever, hike fever in general, however caused, consists essentially in elevation of temper- ature, arising from increased chemical change in the blood and tissues, and is at- tended with changes in the physical and chemical constituents of the blood, and aberrated nervous action. As long as the skin, kidneys, lungs, and gastro-intestinal canal, perform their func- tions, thisstage is characterized, as in other fevers, by an increase in the amount of solids excreted. But this increased elimination of the products of chemical change is not, in yellow fever, a constant concomitant of the increased temperature. Not only are large quantities of the pro- ducts of oxidation formed during the hot stage of yellow fever, but as we have shown, by numerous analyses of the blood, black vomit, urine, brain, heart, liver, spleen, ami kidneys, in this disease, lhe> are altered to a certain extent from their characteristic state of health ; the albumen of the blood, under the action of the poison, being transformed into nitrogenous and Don-nitrogenous compounds, a portion of which, as the fatty matter, and altered fibrin, being arrested or accumulated in certain organs, as the heart, liver, and kid- neys. The peculiar phenomena of yellow fever, like those of acute phosphorous poisoning, are due to the nature of the specific poison, and the character of these changes, which it is capable of exciting primarily in the blood, and secondarily in the nervous and vascular systems, and in the nutrition of the various organs. Neither the rapid rise nor the sudden de- clension of the temperature in yellow fever is necessarily referable solely to the effects of the poison upon the nervous system; because, in the first place, the changes of the blood are among the flrst manifestations of diseased action, and the progress and termination of each case are largely depen- dent upon the extent and character of the changes of the blood, and the degree of the elevation of the temperature; and, in the second place, the sudden fall of the tempera- ture during the succeeding stage ot calm may be referred to the peculiarity of the self-limited chemical changes excited by Malarial Fever. the thallus. This plant as well as that developed in the yellow fever blood, as- sumed a distinct yellow color. Both pen i- cillium and torulw were observed in these solutions. The microscopical objects ob- served in the air during the yellow fever epidemic of 1878 in New Orleans are rep- resented in plates 15 and 16, figures 66 to 75. First group of cases occurring in the brick house, on second floor, 363 Magazine street, within the areaOf the infected district including, the cases on Constance, and adjacent streets. The street in front of 363 Magazine, paved with square block pavement, and side street with cobble stones-dry, non-mala- rious situation. Plate 15, Figure 66. Microscopical ob- jects in urine of Miss C. H. The urine was carefully examined upon the three last days of illness, on t he 8th, 9th and 10th of Au- gust, 1878, and uniformly presented a clear light color. Under the microscope it contained a few granular casts with bac- teria, cells of torulae and penicillium, and very delicate thread-like bodies, most prob- ably a form of bacteria; also minute par- ticles resembling spores, possessing a rotary or vibratory motion. Figure 67. Microscopical objects in air of room of Joseph Oliver, 363 Magazine street. Air passed through ice and ice water. Attacked with yellow fever August 10th, 1878. Figure 68. Crystalline bodies and spores from evaporated water-from room of Jo- seph Oliver-August 11th, 1878. Figure 69. Microscopical objects from air of room of Miss Rhodes, 363 Magazine street, August 16ih, 1878. Attacked with yellow fever August 12th; died August 16th. Figure 71. Crystalline bodies, spores and bacteria in residue of evaporated water through which the air of the room of Miss Rhodes, 363 Magazine street, had been passed. Figure 70. Microscopical objects from air of room of F. Vonderburg, 363 Magazine street Attacked with yellow fever August 12th ; died August 21st, 1878. II and UI. Groups of cases. 46 and 41 S. Villere and 47 S. Robinson streets; low, unhealthy locality, 495 St. Charles street. Plate 16, Figure 72. Microscopical object8 in air of yellow fever, 495 St. Charles street- Figure 73. Microscopical objects in air of yellow fever, 44 S. Viller6 street, August 2d, 1878. Figure, 74. Microscopical objects in air of yellow fever, 44 S. Villerd street, Au- gust 6th, 1878. Figure 75. Microscopical objects in air of yard, 46 S. Viller6 street, during yellow fever epidemic of 1878, August 7th, 1878. 54 Joseph Jones, M. D., on Yellow and Malarial Fevers. Yellow Fever. the polso i, and to the structural alterations induced in the muscular tissue of the heart, and in the liver and kidneys, and the seda- tive action of the bile, urea, ami other ex- crementitions products retained in the blood, upon the nervous system : and finally, in the third place, the changes of the blood and of the heart, liver, and kidneys, are of a definite physical and chemical nature., and could never be induced by a mere exaltation or depression of nervous action, and must be referred to the introduction and action of some agent or material related in a defi- nite manner, in its constitutional and physi- cal properties, to the fluids and solids in- which it induces these profound physical and chemical changes. Without doubt, the action of the yellow fever poison upon the nervous system may be of the most direct and important charac- ter; but v ell-established facts do not justi- fy us in locating the origin of the disease wholly in the action of the poison upon the nervous system ; and, in fact, the earliest sensible manifestation of disordered ner- vous action, as evidenced by uneasiness, loss of appetite, and chilly sensations, may be entirely secondary to the changes in the blood, by which all parts of the nervous system are surrounded and supplied. V, While many of the most striking phenomena of yellow fever, as chillsand fever, and collapse, must necessarily beat- tended with disordered vascular innerva- tion, at the same time we must look to the blood as the seat of the operations of the fever poison ; and, as the nutrition of every organ and tissue depends upon the proper constitution of this fluid, its alterations must affect the entire organism, and the true commencement of yellow fever is in the alterations of the relations between the blood and tissues. The nervous system, both cerebro-spinal and sympathetic, suffers at first in common with the entire system ; but as the most im- portant offices are performed by the nervous system which relates the mind to the vari- ous parts of the body, and to the exterior world, and also regulates the actions of the circulatory and respiratory systems, and co-ordinates the actions of the component members of the system, in all the phenom- ena which succeed the invasion of fever the blood and nervous system becomejoint factors. VI. During the active stages of yellow fever, profound changes take place in the organs and tissues, especially in the kid- neys, heart, and liver; oil and granular al- buminoid or fibroid matter transude through the capillaries and fill up the cells and excretory ducts, and arrest the function of certain organs. The liver of yellow fever does not present the soft, friable condition characteristic of true fatty degeneration. The jaundice result ing from the suppression or alteration of the excretory function of Malarial Fever. Changes of the Circulation. Respiration and Temperature. Intermittent Fever. During the cold stage (chill), there is a rapid, feeble, pulse, rapid respiration, and hot trunk and cold extremities-the temperature of the ex- tremities is reduced far below that of the trunk, and even below the, standard of health, because the. circulation of the blood in the peripheral capillaries is to a great extent arrested, apparently by the contrac- tion of the unstriped muscular tissue of the walls of the ul timate arterioles. The dimi- nution of the capillary circulation and the reduction of the temperature of the extremities precede the aberated ner- vous and muscular phenomena de- nominated chill. This fact corresponds with the changes in the constituents of the blood, and indicates that the first phenom- ena of the cold stage are connected with derangements of the vaso-motor system of nerves. As a general rule, the higher the temperature of the, trunk during the cold stage, the more rapid will be the equaliza- tion of the circulation and temperature. The severity of the fever (animal tempera- ture), which often reaches in the hot stage 107° F., is by no means an index of the character and severity of the subsequent effects. As a general rule, the higher the temperature (within, of course, certain de- fined limits, not exceeding 102° and 107.5° F.,) the more readily does the attack yield to treatment. The changes of the tempera- ture in intermittent fever are characterized by abrupt elevations ami depressions, so that when the cases are projected upon a chart, they differ in the rapidity of the ele- vations and depressions from those fur- nished by yellow fever, typhus and typhoid fever and other diseases, the phlegmasia, phthisis, hospital gangrene and pyaemia. Remittent Fever.-The phneomena of the cold stage preceding the hot stage of remittent fever, are similar to those of in- termittent fever; the difference is one, of degree, and not of kind ; the phenomena of the cold stage of remittent fever are more protracted than those of intermittentfever; the sympathetic system does not so rapidly regain its normal action, and the circulation in the capillaries of the extremities is not so rapidly restored in remittent as in inter- mittent fever. The alterations of the blood are more profound in remit tent than in in- termittent fever, and therefore it results that the cold stage is more prolonged in remittent than in intermittent fever. The elevation of temperature corresponds more accurately with the increased action of the circulatory and respiratory system in inter- mittent than remittent fever. Remittent fever may be distinguished from typhoid fever by the greater and more sudden eleva- tions and depressions of temperature. Symptoms and Pathology of Yellow and Malarial Fevers. 55 Yellow Fever. the liver would appear to be due to the same causes which induce the suppression of the urine, viz., to the deposits of oil and fibrinous or albuminous matter in the ex- cretory structures of the kidney and liver. We do not mean to say that, in the case of the liver, its secretion ceases, or is even in many cases diminished ; on the contrary, it may even be increased, especially in the stage of active febrile excitement; but, from the cause indicated, obstruction takes place in the biliary tubes, and there is a rapid absorption of the biie directly into the blood-vessel system, and in this manner the delivery of the bile into the intestinal canal is impaired, and some times arrested. The heart in yellow fever appears to be as fully permeated with oil as the liver; in the latter organ, however, a large amount of the oil is enclosed within the cells; and in the former, in addition to the deposits ot oil, there is also a granular degeneration of the muscular structures. VIL While yellow fever is characterized in common with several other diseased states by an irritation of the gastric mucous membrane, the peculiar nature of the vomited matters does not rest entirely upon the congestion and irritation of the mucous membrane of the stomach, but is influenced to a greater or less extent by the changes of the blood, liver, kidneys and nervous system. The vomiting in yellow fever may, to a certain extent, be regarded as salutary, and as an effort for the elimination of cer- tain excrementitious materials from the blood. In some cases, the first effect of the black vomit may seem to be salutary ; the tongue improves in appearance, the febrile heat abates, and, if it were not for other profound changes in the blood, liver and kidneys, lying back, as it Were, of this almost universally fatal symptom, benefi- cial results of the most important character might flow from the relief afforded by the removal of a certain amount of excremen- titious matter, as urea, and ammonia, and bile, from the blood. Black vomit is to a certain extent an excrementitious product, containing urea and carbonate of ammonia, in addition to altered blood corpuscles, epithelial cells, broken capillaries, mucus, various matters received into the stomach, as food and medicine, serous exudations, and acetates, lactates, phosphates and chlorides. The microscopical appearances presented by the black vomit of yellow fever, as well as the various forms of fungi and bacteria observed, are represented in Plate 8, figure 24. Microscopical objects in black vomit of E. Griffin, who died in the Charity Hospital of yellow fever, November 2d, 1876. Upon standing a fungus was rapidly developed. Malarial Fevf.r. Congestive or Pernicious Fever.- The complete prostration of the muscular and nervous forces, the reduction of animal temperature, bothin the trunk and extremi- ties, the cold, clammy sweat, the rapid feeble pulse, the rapid, thumping action of the heart, and the sudden intervention of the most alarming cerebral symptoms, may occur gradually or suddenly, in either inter- mittent ot remittent fever, and may be in- duced by several distinct causes, acting singly or in conjunction. There is a want of co-ordination between the circulation, respiration and animal temperature in con- gestive fever. The respirations are full, accelerated, and often panting and heaving, varying from thirty to fifty per minute, the pulse beats from 120 to 160, and feels like a delicate thread, and is often so small that it cannot be counted ; the heart thumps irregularly and spasmodically and rapidly, against the walls of the chest as in some cases of narcotic poisoning; the circula- tion in the capillaries is feeble; the tem- perature of the trunk, notwithstanding the full, rapid respiration, sinks below the normal standard, and the surface is covered with cold, clammy sweat. Changes of the Urine in Malarial Fever. Intermittent Fever-The amount of urine excreted during the active stages, and during the earlest stage of the inter- mission, is lesstnau that of health, and this diminution relates to the water and not to the solid constituents. During convales- cence, and especially under the action of depurants, the amount of urine is increased. The color of the urine varies from light orange to deep red. During the active stages the free acid is increased, but dimin- ishes during convalescence. The urea is increased during the active stages above the standard of health, and especially dur- ing similar conditions of rest and starva- tion. The uricacid is diminished both with and without the action of the sulphate of quinia, during the active stages, when the pulse is full and rapid and the respiration full and acclerated, and the temperature elevated. As a general rule when the fever declines the uric acid increases above the standard of health both with and without the action of the sulphate of quinia. In some cases the uric acid is increased to four fold the normal amount during convales- cence. The urine of the intermission of malarial fever is characterized by heavy yellow deposits of urate of soda, and triple phosphates, the former, in the form of granular and acicular masses, and the latter as beautiful prismatic crystals. Phos- phoric acid is greatly diminished and may have entirely disappeared during the chill and first stage of the febrile excitement. The phosphates are more abundant in the stage of convalescence than during the 56 Joseph Jones, M. I)., on Yellow and Malarial Fevers. Yellow Fever. Figure 26 represents fungus developed on surface of black vomit in 1876. Figure 25 represents the fungus still fur- ther developed, showing the development of the spores, within the thalli, as well as upon their extremities. Figure 27 represents the microscopical appearance presented by the black vomit of Win. Dwyer, who died of yellow fever, on the 15th of September, 1878, in New Orleans. After the suppression of the function of the kidneys, this patient threw up ami gulped up in twelve hours almost one gallon of black vomit, resembling dark blood, with a putrid and urinous smell. The breath and body emitted a strong urinous smell. Under the microscope the black vomit contained colored blood cor- puscles and luematin ; and the whole mass literally swarmed with bacteria,micrococci, spirillium undulata, vibro-serpens, spiro- chaete plicatis, spirochaete obermeiri, spi- rillum tenne, ami delicate dichotoma threads, and the thallus of a delicate fungus, the diameter of which did not exceed one ten-thonsandth of an inch. When injected subcutaneously into animals, death occurred in twelve hours, ami the blood of animals thus destroyed, contained numerous bacteria. Some of the various forms of bacteria are represented in figure27. Figure 28. Microscopical appearances of black vomit of James Kenney, who was attacked with yellow fever on board the bark Excelsior, and died in the Touro Infirmary, July 10th, 1880. Black vomit contained colored blood corpuscles, haematin. conglomerations of colored blood corpuscles, mucous corpuscles, the spores of fungi and the cells of a fungus represented in figure 28. resembling tornla cervisiae. Plate 14, Figure 65. Fungus developed in black vomit of yellow fever, and upon the liver or other organs wdien kept. The draw- ing was made from a. specimen of dark black vomit in 1873 but similar fungus was observed in 1870, 1871, 1872, 1873, 1874, 1876, 1878, 1880 and 1882. I preserved large quantities, (nearly a gallon) of the black vomit ejected by Win. Dwyer, suffering with yellow fever, jaun- dice and urinary suppression, on the 15th of September. This black vomit in a large glass stopper- ed jar, was exposed in my laboratory, to the cold weather of November, December and January. In the early part of January, whilst the weather was cold, I performed the following experiments : 1. Eight ounces of the black vomit were introduced into a capacious glass retort, and distilled by heat. The distillate was collected; it was clear like distilled water, but emitted a foul, putrid odor. This distillate was injected subcutaneously Malarial Fever. active stage. The deposits (so-called criti- cal discharges), so common during convales, cence, consist chiefly of the urates of soda, and ammonia, and the phosphates, most generally in the form of triple phosphates. The chloride of sodium is abundant dur ing the cold and hot stages. The sulphuric acid, is increased during the height and de- cline of the hot stage. The urine excreted during the fever is generally deficient in uric, acid and the earthly salts, while its acidity and power of resisting decomposi- tion is greatly increased, and it will remain for a great time without undergoing decom- position. On the other hand, during con- valescence the urine rapidly undergoes change, ami deposits of the urates of soda and ammonia, and the precipitation of the triple phosphates, by the ammonia gen- erated during the decomposition of the urea., form the so-called critical discharges of malarial fever. Albumen is almost uni- versally absent from the urine of uncompli- cated malarial fever; it is present, how- ever, in that form called malarial hsema- turia, characterized by intense jaundice- and congestion of the kidneys, and passive hemorrhage. In such cases the urine con- tains blood corpuscles and casts of the tubuli uriniferi filled with granular matter detached uriniferous tubes and colored blood corpuscles. The changes of the urine in remittent fever, are the same in kind, but different in degree from those of intermittent fever. '1'he urine is higher colored, more concen- trated. and richer in urea, phosphoric acid and sulphuric acid. If the case be pro- tracted, the chloride of sodium diminishes as in typhoid fever. When the temperature falls below the normal standard in the early stage of convalescence, the urea, as in the similar stage of intermittent fever, decreases in amount. Dnriugthe period of remission and convalescence, the uric acid, which had suffered decrease in the active stages, in- creases above the normal standard. The formation of deposits of the urates of soda, and of ammonia, and of the triple phos- phates (critical discharges,) in the urine of remittent fever, is similar in all respects, takes place, at analogous periods, ami is due to the same causes as in the urine of remit- tent fever. Plate 11, Figure 46, represents the ap- pearance underthe miscrope of the deposits of nr«te of soda, ami triple phosphate often observed in the urine during the remission, of malarial fever and granular urates and lozenge-shaped crystals of uric acid are also represented in this figure. The deposit of uric acid in many cases of malarial fever is abundant; the lozenge-shaped crys- tals of uric acid being large, well formed ami highly colored. The color of the crystals of uric acid in Symptoms and Pathology ot Yellow and Malarial Fevers. 57 Yellow" Fever. into a healthy rabbit. No marked ill effects were observed, and the rabbit survived the operation. 2. Eight ounces of the black vomit were boiled in a glass vessel for two hours, and well filtered. The filtered liquid was then injected sub- cutaneously into the hind legs of a rabbit. Beyond slight febrile excitement, no ill effects were observed, and the animal sur- vived the operation. When the filtered liquid was set aside in carefully stoppered bottles, and removed to a warm place (my library) in which a fire was kept burning during the day, and examined at regular intervals, bacteria and micrococci were developed in consider- able numbersand the liquid assumed a turbid appearance from their presence. Amongst the forms of the bacteria, I recognized those which resembled most nearly bacillus anthracis, spirochtete obermeiri, spirochmte plicatis, spirillium undulata, spirillium ten- ue, bacillus subtilis, bacterium termo, micrococcus urem, and micrococcus bomby- cis. We have seen in this observatiou that the bacteria re-appeared m the tillered liquid although it had been subjected to a boiling temperature for the space of two hours. The re-appearance of the bacteria mnst be referred either to spontaneous genera- tion, or to the survival of the germs even after the continuance of the boiling heat of 212° F., for two hours. 3. Black vomit filtered through German filtering paper, and filtered liquid injected subcutaneously into rabbits, beneath skin of hind quarters. Both legs, as well as the testicles were swollen, and fever was ex- cited for some eight days. 4. The black vomit itself which emitted a foul stinking odor, and a strong urinous smell like the bloody urine of malarial hannaturia, was injected into the subcuta- neous tissue of the posterior extremities of an active buck rabbit. The putrid black vomit induced fierce fever and great swell- ing of the thighs and legs, and of the testicles. Both testicles became gangrenous and were entirely destroyed. The lower extremities became ulcerated and the hair fell of. The animal, however, survived these terrible effects, and was restored to its usual health, although the hind legs presented a bare and atrophied appear- ance. In the preceding case, chemical analysis showed the presence of urea in large amounts in the black vomit. The copious excretion of the black vomit was concomitant with, or rather consecutive to, the ablation of the functions of the kidneys, and to a certain extent must be regarded as salutary, in re- lieving the blood of an excess of urea and urinary constituents, and at the same time Malarial Fever. malarial fever varies from a light red to deep red and from light brown to deep brown. As a general rule albumen and urinary casts are absent in the ordinary varieties of malarial fever ; but in the severe grades they are frequently present. Albumen and casts have been observed in cases of malarial fever, both in the acute stage, and in the chronic form in the urine of laborers brought directly from the swamps of the Atchafalaya and other parts of the delta of the Mississippi river. I have also observed the occurrence of albumen and casts in the urine of inhabitants and natives of New Orleans, who in previous epidemics suffered with yellow fever, when they were subsequently attacked with malarial fever. This symptom is most likely to occur in the lowest and un- drained portions of the city, bordering on the swamp, and extending back to Lake Pontchartrain. Whilst yellow fever has almost invariably made its first appearance on the river front and around the new and old basins, these severe cases of malarial fever attended with renal congestion and albuminuria occur in the opposite direction. In Plate 13, figures 53 and 54, we have the microscopical appearance of the urine in malarial haematuria, showing the highly colored casts of the tubuli uriniferi and the presence of pigmentary matter and pigment cells. The following is an outline of the cases of malarial hmmaturia, from which the specimens of urine were taken : J. E. Easterland, age 21, native of Car- rolton, Alabama, has suffered with repeated attacks of malarial fever. Admitted to Charity Hospital November 29tn, 1876. Intense jaundice; incessant vomiting of dark green bilious matters ; pulse 144 ; res- piration 30; temperature of axilla 102.5°; urinary suppression. November 30th, 9 a. m.*-Pulse 132; respi- ration 16; temperature of axilla 98.5° ; con- tinues to- vomit large quantities of dark biliary matters; urinary suppression. 7 o'clock p. in.-Pulse 134; respiration 22; temperature 99.5°. The kidneys have re- sumed their functions, and the urine pre- sents a deep brownish red color and con- tains blood. The vomiting has ceased. December 1st, 8 a. m.-Pulse 122; respi- ration 22; temperature 100.5°. Chemical and microscopical examination of urine passed November 'Mth. 9 a. m., and De- cember 1st. 9 a. m., 1876: Amount of urine passed during twenty- four hours, 1560 cubic centimetres. Upto November 30th, 9 a. m., the urinary excre- tion had been almost entirely suspended. Heavy deposits of casts of urinary tubes, excretory cells, blood corpuscles and urates of ammonia, giving to the urine a muddy brownish red color. This deposit settled very slowly, and the clear urine then pre- sented a deep brown and greenish black 58 Joseph Jones, M. D., on Yellow and Malarial Fevers. Yellow Fever. relaxing the pressure within the blood ves- sels consequent upon the failure of the func- tion of the kidneys. Both the blood and the black vomit con- tained bacteria, of various species. The fresh bipod was incapable of produc- ing death when injected subcutaneously ; the putrid blood proved rapidly fatal. During the hot weather of summer, the black vomit swarming with bacteria, pro- duced death rapidly; during the cold weather of winter the same putrid black vomit excited fever and extensive gan- grene. We, have demonstrated by numerous chemical analyses the following chemical changes in the. blood of yellow fever : 1st. Marked diminution of fibrin : 2d. In- crease of fatty matters ; 3d. Accumulation of biliary and urinary constituents. Black vomit is consequent upon the first and third conditions of the blood in yellow fever. Black vomit in yellow fever is due to several causes, as- 1. 'I'o the direct irritation and structural alteration of the gastric, mucous membrane by the poison--the active agent which is probably first received into the blood, and acts in this manner or through this medium upon the, gastric mucous membrane, for we find contemporaneous changes taking place in the heart, liver and kidneys ; and these, changes would most probably succeed the, gastric, irrita tion, if the poison was received in food or drink primarily by the stomach. 2. 'I'o the structural alterations of the blood, and especially to the marked dimin- ution of the fibrinous element which appears to sink to a lower figure than in any other disease. 3. To suppression of the action of the kidneys, and the retention in the blood of urea and other excrementitious products, and the, elimination of urea as carbonate of ammonia by the gastro-intestinal mucous membrane. 4. To the direct irritant action of the ammonia and excrementitious materials, eliminated vicariously, upon the mucous membrane of the stomach and intestines. 5. To the irritant and nauseating effects of the bile in the blood. The bile retained in the blood, without doubt, produces its characteristic effects upon the nerves sup- plying the stomach, inducing nausea and vomiting. 6. To the degeneration of the cells of the gastric mucous membrane, attended with or characterized by the deposit of granular fibroid or albuminoid matter, and oil glob- ules in the secretory cells, and in the walls of the smaller blood vessels and capillaries. 7. To the capillary congestion of the gastro-intestinal mucous membrane, similar in all respecls to the intense capillary con- gestion which characterizes all the tissues Malarial Fever. color. 'Phe deposits contained blood, and stained bibulous paner of a red and yellow- ish red color. Small congnla of blood were visible. Chemical analysis revealed the presence of both biliary coloring matter and bile, and also blood and albnmen, blood corpuscles and casts. Under the mi- croscope, the casts of the tnbnli uriniferi were stained of a deep orange yellow and reddish brown color from the presence of the coloring- matter of the blood and bile ; instances of altered heamatin of dark brown and black color were also observed in the urine. The appearance presented by the urinary deposits is represented on Plate 13, figure 53. Reaction of urine, acid; sp. gr. 1044. 1560 cubic centimetres of urine passed during twenty-four hours contained urea, grains 528.5; nric acid, grains 18.7; phos- phoric acid, grains 120 1 ; sulphuric acid, grains 51.3: chloride of sodium, grains 24. Amount of blood not determined. As this patient was in a state of starva- tion, taking little or no nourishment, we observe a great increase, of the urea, uric acid, and especially of the phosphoric acid. 7 o'clock p. m-Pulse 110; respiration 21 : temperature 100°. December 2d. 8 a. m.-Intense jaundice ; surface of a bright golden color; conjunc- tiva of eyes of a, deep golden color; saliva and mucus from nose of a. deep golden color; pulse 80; respiration 20: tempera- ture of axilla. 99.5°. Urine abundant, red- dish, charged with heavy deposits of urates and casts. Amount of blood in urine di- minished. Urinary deposits similar to those in preceding sample, but casts and urinary tubes less abundant and not so highly col- ored. The microscopical apnearance of the deposits is represcneed in Plate 13, Figure 54. The urine contained bile pigments and biliary acids and blood. Upon standing, the deposits fell and left a brownish green- ish black color. Amount of urine passed during twenty-four hours (December 1st, 9 a. m., to December 2d. 9 a. m.), 1520 cubic centimetres; contained urea, grains 585.2 ; uric acid, grains 18.2; phosphoric acid, grains 87.7; sulphuric acid, grains 25.9; chloride of sodium, grains 23.2; blood not determined. This patient recovered and was discharged from the Charity Hospital. Comparison Between Malarial Hamatvria and Yellow Fever. Upon a careful comparison of the main features of malarial haematuria, with those of yellow fever, the following points may be noted : (a) In the last stages, after the superven- tion of jaundice and urinary suppression, many cases of malarial baematuria bear a striking resemblance to yellow fever in the Symptoms and Pathology of Yellow and Malarial Fevers. 59 Yellow Fever. in this disease, in consequence of the phys- ical and chemical alterations of the blood, and of the morbific action of the poison and its products upon the vaso-motor system of nerves. Black vomit, therefore, is an effect or re- sult of preceding changes or actions, and it is not a cause ; it is an error, therefore, to search by chemical reagents or by the micro- scope, for the cause of the disease solely in one of its products. VIII. The chief causes of death iu yellow fever appear to be: 1. The direct action of the febrile poison upon the blood and nervous system, de- pressing and deranging the actions of the one, ami rendering the other unfit for the proper nutrition of the tissues. 2. The suppression or alteration of the functions of certain organs, as the kidneys and liver, and the retention in the blood of the excrementitious mattersnormally elimi- nated by these organs. 3. The structural alterations of the heart and consequent loss of power in this organ' 4. Profuse haemorrhages from the stomach and bowels. IX. Yellow fever differs essentially in its symptoms and pathology from malarial fever. In the latter, the constituent of the bloo i, which appears to suffer to the great- est ami most essential degree, is the colored blood corpuscle; in the former, the consti- tuent of the blood which suffers to the greatest extent is the albumen. The changes of temperature in yellow fever follow a definite course, and are never repeated in uncomplicated cases; in malar- ial fever, on the other hand, they recur at regular intervals, and may be indefinitely reproduced. As a general rule, yellow fever attacks but once; malarial fever produces no ex- emption, but, on the contrary, establishes a disposition to frequent recurrence. Convalescence from yellow fever is com- paratively rapid, and the constitution of the blood is rapidly restored; in malarial fever, the changes of the blood and organs, and especially of the liver and spleen, may be profound and long continued. The liver in yellow fever presents various shades of yellow, and contains numerous oil globules; the liver of malarial fever is of a dark color, most generally slate upon the exterior and bronze within, and is loaded with dark pigment granules; the spleen is comparatively unaffected in yellow fever, while it is enlarged and softened in malarial fever; the heart and kidneys are softened and infiltrated with oil, and gran- ular albuminoid matter in yellow fever, while they are comparatively unaffected in malarial fever; the urine is almost always albuminous, and contains casts and bile in । yellow fever, while in malarial fever, albu- Malarial Fever. period of calm, depression of circulation and black vomit. The vomited matters, however, in malarial luematuria contain ■ bile, and the dark color is due to bile, rather than to blood. (&) Important differences are revealed by the microscope between the organic and organized elements in the urine of these diseases ; in yellow fever, the casts of the tubnli uriniferi are tilled with yellowgranu- lar matter and oil globules; in malarial haematuria, the tubnli uriniferi in many cases present a dark brownish-red color, and contain dark pigmentary matter, and altered colored corpuscles, in addition to the yeliow granular matter. (c) After death from malarial haematnria, the fibres of the heart present under the microscope a normal appearance, the trans- verse striae being distinct, and the oil globules and yellow granular matter char- acteristic of yellow fever, being in most cases absent. When no preceding lesions have existed, the heart of malarial fever, and of malarial haematnria, presents a firm structure, wholly different from the softened, altered and flabby yellow heart of yellow fever. (d) There is less congestion of themneous membrane of the stomach, and it is almost uniformly discolored by bile in malarial haematnria. Bile is absent from the con- tents of the stomach in yellow fever. Bile is universally present in the stomach of malarial luematuria. (e) The heart, liver and spleen in malarial luematuria present the same structure, and the same microscopical and chemical char- acteristics as in the various forms of paroxysmal malarial fever. In malarial fever, the spleen and liver aro loaded with dark pigmentary particles; in yellow fever the former organ is without any special in- crement of pigmentary particles, and the latter is of a yellow color, and loaded with oil globules and yellow granular matter. When yellow fever supervenes in malarial fever, both the dark pigment particles, and the oil globules and yellow granular matter are found in the liver, and this organ pre- sents a deeper color and more mottledap- pearance than in uncomplicated yellow fever. The gall bladder contains much more bile in malarial fever than in yellow fever, and this liquid is absent from the stomach and alimentary canal in yellow fever, but is universally present in malarial fever in all its forms. (J") When in malarial luematuria the con- gestion of the kidneys is so great, and the structural alterations so profound as to cause urinary suppression, then another dis- tinct train of phenomena is set up, which has much in common with the analogous condition in yellow fever when the function of the kidney is suspended. 60 Joseph Jones, M. I)., on Yellow and Malarial Fevers. Yellow Fever. men and casts are almost al ways absent, and the urine presents morbific periodic changes, corresponding with those of the paroxysm. X. Yellow fever is a self-limited disease, occurring, as a general rule, but once in a lifetime. The constitution of the blood, and even of the textures of the body, is altered; the most important organs, as the heart, kidneys and liver, as well as the most important nutritive fluids, are pro- foundly impressed. These changes of the blood, heart, kidneys and liver, as well as of the nervous system, may be compared to the profound changes induced in the blood and organs, and especially in the integu- ment, by small-pox. If this view is correct we cannot by drugs arrest or cure yellow fever any more than we can arrest or cure small-pox, measles or scarlet fever. If drugs accomplish the effect of promoting the free and regular action of those emuuc- tories through which the poison and the products of its action are eliminated, and if further, they tend to preserve the integrity of the blood, and to sustain the actions of the circulatory and nervous system, they will, without doubt, achieve much good, and, perhaps, all that we are justified in looking for in the present state of our knowl- edge. By judicious treatment, by proper ventilation, diet and rest, we place the patient in that condition which is best adapted to the successful elimination of the poison and its products; but we do not arrest or cure the disease, as we certainly may do in paroxysmal malarial fever, by the proper administration of quinine. Changes of the Urine in Yellow Fever. The reaction of the urine in yellow fever is acid. Even in the gravest cases, attended with suppression of the urinary excretion, jaundice and alkaline black vomit, the urine, however small the quantity excreted, main- tains an acid reaction. As a. general rule, the specific gravity of the urine in yellow fever does not vary from that of health, and ranges from 1009 to 1028. In those specimens which gave the highest specific gravity, the increasein den- sity was clearly referable to the increase of albumen; for when this constituent was co- agulated by heat, and removed by filtra- tion, the urine was of low specific gravity. In some of the gravest cases the specific gravity of the urine was only 1010, and presented a yellow color, and was turbid Malarial Fever. Symptoms and Pathology of Yellow and Malarial Fevers. 61 Yellow Fever. from the presence of cells and casts of the excretory tabes of the kidney and granular and fibrinous matters and colorless cor- puscles. Daring the early stages of the disease the urine is normal in color, clearness and quan- tity; its the disease proceeds, the urine be- comes of a deep yellow color, from the ad- mixture of bile, and at this stage, after the full establishment of the febrile excitement, about the third, fourth or fifth day, becomes turbid from the presence of the excretory cells, tube casts and yellow granular albu- minoid or fibroid matters. The color may deepen to orange red as the disease progresses ; er if the case termi- nates fatally from diminution and suppres- sion of the urinary excretion, it maintains a yellow color, sometimes presentingan oily appearance and motion, and consists of but little else than albumen, bile, excretory cells ami casts of the tubuli uriniferi, m a weak solution of the urinary constituents. In some cases of suppression, although the urea is greatly diminished in the small amount of urine excreied, it is rarely if ever entirely absent. If the case ends in convalescence, the urine is copious and the color progressively increases in depth, and may even appear black when viewed en manse. As far as my investigations extend, albu- men is an invariable constituent of the urine in grave cases of yellow fever, and may appear as early as the first day of the disease, but most generally it appears upon the second, third or fourth day. In yellow fever albumen may be found in the urine, as the only abnormal element, with or with- out other blood element, in company of abundant deposit of lithatos, with or with- out deposits of purpurine or other coloring matters in excess; in connection with bili- ary coloring matters, and in connection with apyrexial states The constituents of bile are almost uni- versally present in the urine, even in those cases which progress favorably and end in convalescence. When there is no suppression of the urin- ary excretion, the urea is increased above the standard of health during the active stages of the disease, and during the period of exhaustion or calm. I have obtained upon analysis as much as 1500 grains of urea during twenty-four hours in a case of yellow fever, and that, too, when no nour- ishment was taken. Of all known diseases, yellow fever is characterized by the earliest ami most uniform appearance of albumen and casts in the urine, and by the most marked tendency to urinary suppression; when, therefore, this occurs, owing to the chemical changes exhibited by the febrile poison, the blood is rapidly charged with urea, and coma and uremic convulsions are the result. Malabial Fever. 62 Joseph Jones, M. D., on Yellow and Malarial Fevers. YELLOW FEVER. In yellow fever the presence of albumen in the urine is attended by dequamation, fatty degeneration and disintegration of the excretory cells of the tubuli uriniferi. The granular casts so common in yellow fever are composed of excretory cells, oil globules, and granular fatty and albumin- oid granular matter, in some cases inti- mately mixed with urate of ammonia. Those who have failed to detect albumen and casts at some period of grave cases of yellow fever, are either ignorant of the ordinary chemical tests and microscopical appearances, or have been careless and superficial in their so-called researches and observations. When the kidneys are not seriously im- paired by structural alterations, the amount of urea excreted both during the stage of active febrile excitement and that ofcalm or depression, is at least five times more abundant than the amount of this constitu- ent which would be excreted by a patient in health, or even in Bright's disease simi- larly situated, lying perfectly quiet in bed, and taking little or no nourishment. This fact illustrates the absurdity of comparing • the effects of urinary suppression in yellow fever with the more tardy results in chronic Bright's disease. In yellow fever urinary suppression causes the retention of not only the greatly in- creased amount of urea, but also of the various products of the action of the poison, as sulphuric acid, phosphoric acid, extrac- tive, coloring and biliary matters. The fever of the first stage of yellow fever, like fever in general, however caused, con- sists essentially in elevation of temperature, arising from chemical changes in the blood and tissues, and is attended with changes in the physical and chemical constituents of the blood and aberrated nervous action. As long as the skin, kidneys and lungs and gastro-intestinal canal perform their func- tions, this stage is characterized, as in other fevers, by an increase in the amount of the solids excreted. But this increased elimi- nation of the products of chemical change is not, in yellow fever, a constant concomi- tant of the increased temperature, because, in virtue of the lesions of certain organs, as the kidneys and skin, the constituents of the urine and bile accumulate and are agents in the production of aberrated ner- vous and muscular action, and even of death itself. The appearance of the urinary deposits of yellow fever, are represented in Plate 10; figures No. 38, No. 39 and No. 40. These figures represent observations ex- tending from 1870 to 1882, a period of twelve years. Figure 38. granular casts in urine of yel- low fever, 1870. Figure 39, granular casts in urine of yel- low fever, 1876. MALARIAL FEVER. Symptoms and Pathology of Yellow and Malarial Fevers. 63 YELLOW FEVER. Figure 40, granular casts in urine of yel- low fever, 1880. The history of the case furnishing the sample in 1870, has already been published in the New Orleans Medical and Surgical Journal. The history of the case furnishing the sample of urine in 1876, is worthy of brief consideration, and is as follows : E. Griffin ; laborer; native of Ireland; admitted to Charity Hospital November 2d, 1876. Came to United States ten years ago, 1866, and resided in Kentucky until the month of May, 1876, when he moved to Louisiana., and commenced ditching in the swamps of the Atchafalaya river. Attacked with intermittent fever in July, and has been suffering with this disease at intervals up to the time of the present illness. Came to New Orleans on the 25th of October, and took lodgings in the fourth district, in the locality infected by yellow fever, on Jack- son street, near the river. After remaining Jive days in this section of New Orleans, entered the Charity Hospital November 2d, 1876, having had a chill, followed bv fever. November 3d, intermission. November 4th, return of chill. November 5t*h, has fever temperature, 104.0°. November 6th, pulse, 104; respiration, 24 ; temperature of axilla, 105.0°., a. m.; Evening, pulse, 101; respira- tion, 24; temperature, 104.5°. November7th, bowels constipated; severe pain in head and limbs; tongue red at tip and edges ; furred incentre; gums red and congested; con- gestion of capillaries of periphery ; jaun- dice,; conjunctiva of eyes, congested and yellow. Morning: Pulse, 80; respiration, 28; tempera tore, 103°. Evening: Pulse, 100; respiration, 20; temperature, 103 6°. Amount of urine passed during twenty- four hours (November 6rh, 9 a. m., to No- vember7th,9 a. in.: 1,600 cubic centimetres; sp. gr. 1,020; acid reaction; orange color. Heavy deposits of yellow, solid granular casts, filled with yellow, granular matter. Plate 10, figure 39. Heat and nitric acid revealed the presence of albumen, coloring matter and acids of bile. Chemical analysis showed that much of the granular matter outside the casts consisted of urate of ammonia, but the granular matter within the casts, consisted of albumenoid or fib- roid matters. 1,600 cubic centimetres of urine excreted during twenty-four hours, November 6th, 10 a. m., to November 7th, 10 a. m., contained urea, grains, 1034.88 ; uric acid, grains, 16; phosphoric acid,drains, 18.48; sulphuric acid, grains, 36.68; chloride of sodium, grains, 61.70; albumen, grains, 48. November 8th.-Jaundice increasing; tongue very red at tip and edges; gums red and swollen; conjunctiva congested; complains of some pain in back and limbs; morning pulse 100; respiration 24 ; temper- MALARIAL FEVER. 64 Joseph J ones, M. D., on Yellow and Malarial Fevers. Yellow Fever. ture 102° ; nausea and vomiting. 8 o'clock p. m.-Black vomit; very restless, tries to get out of bed; pulse 108; respiration 24; temperature 100.s°. Examination of blood, firm clot; Serum golden color, and contained coloring mat- ter and acids of bile, Colored corpuscles presented a normal appearance when ab- stracted, but rapidly assumed the crenate form after standing. This stellate and cre- nate condition appeared under high powers to be due to exudations upon and cor- rugation of the outer surface of the colored blood corpuscles. Numerous small globules about the one-seven thousandth of an inch in diameter were observed in the blood. Upon standing several days, the cells of a fungus were developed and the colored cor- puscles entirely disappeared. 1000 parts of blood contained: water, 788.5; colored blood corpuscles (dried), 140.5; fibrin, 1.47 ; albumen and extractive matters, 69.43; saline matters, 9.74. Amount of urine passed during twenty-four hours, November 7th to November 8th, 9 a. m., 1725 cc; sp. gr. 1017; acid reaction, heavy deposit of yellow cells and granular casts, granular matter, urate of ammonia, colorless corpuscles and cells of kidneys; colored matter and acids of bile present. 1725cc of urine contained: urea, grains 976.99; uric acid, grains 34.5; phosphoric acid, grains 22.0; sulphuric acid, grains 78-2; albumen, grains 80.1. November 9th.-Patient in extremis; dark yellow copper hue of surface, with congestion of capillary circulation ; threw up black vomit during night; pulse 120; respiration 40; temperature of axilla 97.5 F.; throws up black vomit; intellect clear. Amount of urine passed during twenty- four hours, November 8th, 10 a. m., to No- vember 9th, 10 a. m., 2225 cubic centi- metres ; of a deep orange golden color; biliary coloring matters and acids present; deposit less in quantity, but presents the same microscopical character; sp. gr. 1015; reaction acid. During this and the preced- ing day the urine has emitted a most foul and disgusting odor, resembling that of de- composing albumen. 2225 cc of urine con- tained: urea, grains 719.5; uric acid, 17.8; phosphoric acid, 25.6; sulphuric acid, grains 74.8; chloride of sodium, grains 84.5; albumen, grains 33.3. Patient died at 12| p. m.; intellect clear up to the time of death. No post-mortem rise of tem- perature Post-mortem three hours after death; golden yellow hue of skin, with deep pur- plish mottling of dependent portions. The weight of the different organs was as fol- lows: liver, 50 Troy ounces; spleen, 11 ounces; kidneys, 12 ounces; heart, 9 ounces. Lungs normal. Heart yellow and softened. Left ventricle dilated and hypertrophied. Malarial Fever. Symptoms and Pathology of Yellow and Malarial Fevers. 65 YELLOW FEVER. Appearance presented by heart shown in Plate, 7, Figure 20. 1000 parts of the heart contained: water, 786.4; solids, muscular fibres, etc., after removal of oil, 267.0; oil, 46.5. Under the microscope, transverse markings of muscular fibres ami heart indis- tinct, and much oil and granular matter de- posited within and around the muscular fibres. See Plate 7, Figure 21. Liver showed the previous action of malaria and presented a mottled appearance. See Plate 9, figure 30, figure 31, figure 33. Stomach, mucous membrane congested. Plate 8, figure 23. Stomach contained much black vomit; microscopical character represented in Plate 8, figure 24. MALARIAL FEVER. TABULAR VIEW OF THE PATHOLOGICAL ANATOMY OF YELLOW FEVER AND MALARIAL FEVER YELLOW FEVER. Exterior.-Generally full and not re- duced in flesh; features may even present a swollen, bloated aspect. Skin of face and upper portions of trunk of a golden yellow color. Dependent portions of body of a mottled, purplish and yellow ecchy- mosed appearance. Black vomit frequently oozes from corners of the mouth, and trickles down the face and neck. When the muscles are cut. a lar^e quantity of dark blood escapes, which, upon exposure to the atmosphere, changes to a bright scarlet hue. Putrefactive changes take place rapidly after death. In some cases of yellow fever, especially when the functions of the kidneys have been arrested for some time before death, the putrefactive changes take place with great rapidity and energy, and sometimes even appear to commence before death, the body exhaling a disagree- able odor. Cerebro-SptnalNervous System-Sym- pathetic Nervous System. -The post mortem examinations of the brain, spinal cord and sympathetic system have thus far revealed no characteristic lesions to which the aberrated nervous symptoms of yellow fever can be referred. Beyond congestion of the capillaries of the cerebro-spinal and sympathetic systems, which congestion appeared to be referable to the same cause as that producing capillary congestion in the internal organs, 1 have observed no structu- ral hemorrhagic, lesion,as fibrinous effusion, or softening of the cerebro-spinal and MALARIAL FEVER. Exterior.-The general appearance of those who die from the effects of malarial fever, will depend upon the nature and length of time ami the effects of the disease. When stout, healthy men are suddenly de- stroyed by pernicious malarial fever, the body may present the fulness of health ; and in such cases the superior portions of the body may, as in yellow fever, present a golden yellow color, whilst the dependent portions present a purplish and mottled appearance. The jaundice and mottling of the skin, however, as a general rule, present to a less degree than in yellow fever. Tn cases of protracted bilious fever, the body is frequently greatly emaciated. In chronic malaral poisoning, attended with enlarge- ment of the spleen and cirrhosis of tire liver, the belly and body and limbs gener- ally are distended with dropsical effusion. The cut surface of the muscles presents a purplish hue. and the change to the arterial hue, upon exposure to the atmosphere, is much slower and less perfect than in yellow fever. Cerebro-spinal Nervous System.- Sympathetic Nervous System.-As far as my observations have extended iii mala- rial fever, the dura mater was always normal ; the arachnoid membrane pearl- colored, opalescent in some cases, in others perfectly transparent and normal in appear- ance ; the blood vessels of the pia mater congested with blood, but most generally without marks of inflammation. Subarach- noid fluid in almost all cases clear, transparent, and in some cases of a golden color; the amount varied in different cases, sometimes exceeding, but most generally Joseph Jones, M. I)., on Yellow and Malarial Fevers. 66 YELLOW FEVER. sympathetic nervous structures. Chemical analysis revealed t he presence of urea, bile, and leucine in the brain, and to the effects of these substances, as well as to the direct action of the yellow fever poison, must be referred the aberration of intellect the restlessness, convulsions and coma. The. amount of the congestion of the blood vessels of the brain will to a certain extent vary with thestage andwith the conditions under which death takes place. Thus, when the functions of the kidneys are greatly impaired or wholly suppressed, owing to the retention of the watery element of the blood, the vessels through- out the entire system are tilled with blood to repletion, and the brain is especially, from its soft structure and the character of its circulation, the organ most affected. In such cases, the blood is seen issuing from numberless vessels when sections of the brain are made. Under the microscope, the thin sections of the brain reveal a state of great hyperaemia, the minute capillaries being filled with colored blood corpuscles. The golden hue of the brain substance and membranes, as well as that of the tis- sues generally, is due to the presence of the coloring matter of the bile, and not to the escape of hmmatin from the blood vessels. When death occurs after profuse haemorrhages from the stomach and bowels, the cerebral structures present less evi- dences of congestion than when these symptoms have been absent or present to a small degree. It is probable that the cerebral ganglia and commissures, as well as those of the spinal cord and sympathetic nervous system are affected with the same chain of chemi- cal reactions which result in the formation and accumulation of oil in the blood and in the heart, liver and kidneys. In this con- nection, the recent observation of Dr. H. D. Schmidt, during the yellow fever of 1878, in the Charity Hospital of New Orleans are of interest, in that they sustain the view that the accumulation of oil is not confined exclusively to the liver, heart and kidneys. Dr. Schmidt affirms that he has observed fatty degeneration of the nuclei in the walls of the minute vessels of the pia mater venules, as well as arterioles. In many vessels the nuclei have disappeared, leaving a number of fat globules in their places; others are met with in which an increase of the mere trace of protoplasm, surrounding the nucleus in the normal condition has taken place, causing a thick- ening of the wall of the vessels. " With reference to the brain, the most prominent observation thus far made is the existence of fatty degeneration of the blood vessels of the cortex-cerebri, similar to that ob- served in the vessels of the pia mater, MALARIAL FEVER. falling short of the usual amount. Blood vessels of the brain generally filled with blood. The structures of the brain appeared in acute cases, as a general rule, to lie un- altered either in structure or appearance; in chronic cases the nervous structures sometimes presented a deeper and more grayish color, from the presence of pigment granules. The structures of the brain and spinal cord, in malarial fever, were, therefore, as ageneral rule, altered neither in consistence or appearance, and the same is true also with reference to the sympathetic nervous system. The rapidity with which the symptoms of cerebr.il disturbance, such as coma and delirium vanish under appropriate treat- ment, in many cases, render it evident that the congestion of the cerebro spinal system is temporary and unattended with structural alterations. When death occurs in coma, the blood vessels of the brain, even to their minutest ramifications, are distended with blood, such congestion being not merely evident to the naked eye, but also more fully shown under the microscope, when thin sections are made of the brain struc- tures. The ventricles of the brain are also filled with serum, often of a golden color. The paralysis which sometimes results from a paroxysm of malarial fever, may be due to several causes, as the actual rupture of blood vessels and the effusion of blood, the detachment of a fibrinous clot, and the obstruction of some one of the arteries of the brain, and the impaction of some of the minute capillaries by pigment granules. Occasionally in cases of chronic malarial poisoning, attended with a watery condition of the blood, coma, with dilated pupils, sometimes supervenes suddenly, and in such cases, I have found the ventricles to be greatly distended with serous fluid,which by its pressure had caused the cerebral symptoms. Symptoms and Pathology of Yellow and Malarial Fevers. 67 YELLOW FEVER. together with degeneration of the gang- lionic bodies of the cortex." If these observations should be confirmed by farther research ami especially by chem- ical analysis, determining the exact pro- portion of oil in the brain in health and various diseased states, it will thus be shown that the nervous system both cerebro-spinal and sympathetic, is involved in a similar series of changes as the other organs. The universality of these changes point to the blood as the great medium and source of the chemical actions, ami we have a confirmation of this view in the fact which I have determined by chemical ana- lysis, that the oleaginous constituents are greatly increased iu the blood of yellow fever. That the mere presence of oil in increased amounts in certain organs, during yellow fever is not the cause of the gravest symp- toms, is evident from the rapidity of the convalescence in many cases; and also from the well known fact that in many cases the general health is greatly improved by an attack of yellow fever. The grave symptoms of this disease must be sought not merely in the structural alterations of certain organs, but in the initial chemical changes induced by the poison, which precede the final lesions discoverable after death. Heart.-Pale yellow and brownish yellow' as if undergoing fatty degeneration ; struc- tures of heart Ha bby and some A'hat softened; numerous oil globules deposited within and around the muscular fibrillae of the heart. The appearance of the heart in a case of yellow fever (Edward Griffin, who died in the Charity Hospital, of yellow fever, No- vember V, 1876, on the sixth day of the disease, after the ejection of large quanti- ties of black vomit, is represented in Plate 7, Figure 20. The following is the record of temperature, pulse and respiration iu this case: November 5, temperature, 104°; November 6, temperature, morning, 105° ; evening 104.5° ; pulse,morning 108; evening 104; respiration, morning 27; evening 24. November 7 : temperature, morning 103° ; evening 103°; pulse, morning 86; evening 100; respiration, morning 28; evening 20. November 8: temperature, morning 102°; evening 100.5°; pulse, morning 100; evening 108; respiration, morning 29; evening 24; profuse black vomit. November 9: morning, temperature 97.5 ; pulse, 120 ; resperation, 40; death. Heart yellow' and softened. Under the microscope, transverse mark- ings of muscular fibres indistinct and much oil and granular matter deposited within and around the muscular fibres. The appearance of the muscular fibres of this heart are represented in Plate 7, Figure 21, MALARIAL FEVER. Heart.-Normal in color, presents the deep purplish red muscular appearance of the healthy heart. Muscular fibres of the heart firm and of normal appearance under the microsope. No deposits of oil in the mus- cular structures. Cavities of the heart frequently distended with dark blood. Firm laminated fibrinous concretions very common; and iu some cases of pernicious fever, the formation of these heart-clots during the cold stage without doubt causes death, and renders unavailing the action of remedial agents. The fibrinous concretions are not only attached to the carme columnse and chordae tendinis and auriculo-ventricular valves, but they also frequently send forth long branches into the pulmonary arteries. The formation of these concretions is rare in yel- low' fever, and when formed they are much smaller and softer than in malarial fever. The blood of malarial fever contains more fibrin, few'er colored corpuscles, and changes more slowly to the arterial hue, upon exposure to the atmosphere, than the blood of yellow fever. In malarial fever the heart does not, as in yellow fever , undergo fatty degeneration. We do not by any means wish to be under- stood as affirming that fatty degeneration of the heart is characteristic of yellow fever in contradistinction to all other 68 Joseph Jones, M. D., on Yellow and Malarial Fevers. YELLOW FEVER. 1000 parts of the muscular structure of the heart, contained water, 786 44; solid mat- ter, muscular fibres, etc., exclusive of oil, 267.06; oil, 46.50. In this case the, left ventricle was dilated and hypertrophied, but this condition ap- peared not to have affected the health of the, patient before the advent of fever. In the case of Samuel Kinsley, aged 23, who entered the Charity Hospital November 14th, 1873, on the fourth day of yellow fever, the temperature, pulse and respira- tion were as follows: November 14th, tem- perature 104.8°, pulse 104, respiration 40. November 15th, temperature 105.6°, pulse 100, respiration 32; p. in, tempera- ture 106°; pulse 112. respiration 32. No- vember 16, temperatute exilla 105.6°, pulse 96, respiration 36; p. in., temperature 105 9°, pulse 102 respiration 30. November 17, a. m., temperature 102c andpulse 104; res- piration 32, threw up black vomit on six- teenth and seventeenth. Died 1 o'clock p. m.. November 17, on eighth day of disease. The autopsy was made eight hours after death. Weight of heart9Troy ounces. Great congestion of blood vessels of pericardium, resembling the appearance of the pericar- dium of a case of yellow fever which died on the sixth day of the disease August 5, 1871, represented in Plate 7, Figure 18. Blood vessels of the heart distended with dark-colored blood. Cavities of the heart contained almost three fluid ounces of blood, and golden yellow clots. Vena-cara and pulmonary veins filled with fluid blood. When washed the muscular structures of the heart, presented a distinct yellow color, similar to that of the heart delineated in Plate 7, Figure 20, and was readily mashed between the fingers ; under the microscope the muscular fibrillae presented indistinct transverse striae, and contained numerous oil globules and much yellow granular matter, resembling the fibres of the heart of a case of yellow fever depicted in Plate 7, Figure 21. One thousand parts of the mus- cular structure of the heart contained, water 736.65 ; solid matter.exclusive of oleaginous matters, 186.8 ; oil, (fat) 76.59. In the pre- ceding case, oil or fat in abnormal quanti- ties was present in the muscular structures of the heart, the fat being deposited within and around the muscular fibrillae in the form of minute globules of various sizes. Thereis also an obliteration or degeneration of the muscular fibrillae of the heart lead- ing to a disappearance of the muscular striae. The removal of the particles of oil, from the muscular structures of the heart by sulphuric ether, did not restore the obliterated striae, neither did this agent remove all the molecular particles, a portion at least being insoluble in ether, alcohol and chloroform, and having an analogous constitution to albumen and fibrin. It would without doubt be a matter of MALARIAL FEVER. diseases ; but only as distinguishing this disease from the various forms of malarial, paroxysmal or paludal fever. By quantitative analysis of microscopical examination. 1 have demonstrated : 1. Yellow fever is characterized by acute fatty degeneration of the muscular fibres the heart. 2. The fat or oil is far mere abundant in the yellow fever heart than in the healthy heart. 3. Fatty degeneration of the heart is not the sole state of this organ in yellow fever; a molecularchange has taken place in the sub- stance of the muscular fibres, and this change affects tbe albuminous or nitrogenous con- stituents and most probably represents one of the stages m the acute fatty degenera- tion. We do not by any means wish to be understood as affirming that fatty degener- ation of rhe heart is characteristic of yellow fever, in contradistinction to all other diseases: but only as distinguishing this disease from the various forms or malarial paroxysmal or. paludal fever. In the first cases of fever which occur in those seasons, and in those towns and cities in which yellow fever prevails, it is all important that the heart should be subjected to care- ful microscopical ami chemical examination, in order that a correct diagnosis should be formed and malarial fever clearly distin- guished from specific, yellow fever. Of course, all other phenomena and lesions upon which a correct diagnosis may be based should be carefully observed, and recorded in those cases by which it is sought to determine the true characters of an epidemic in its earliest manifestation. Softening of the substance of the heart has been observed to occur in certain asthenic states of the system, in which there is loss of power or tone in the entire muscular sys- tem ; this atony originating from a difflu- ent or otherwise depraved condition of the blood, itself one of the most important varieties of this morbid lesion, is that which so often occurs in typhus and other low fevers. I have shown by a number of observa tions recorded in the Medical Memoirs of the United States Sanitary Commission, that fatty degeneration of the heart character- ized the scorbutic state of the prisoners at Andersonville, Georgia,manifested by pete- chi;e, intermuscular haemorrhages, swollen ulcerated gums, uncontrolable diarrhoea, and dysentery and foul gangrenous ulcers. As far as my experience extends, it cor- responds with that of the learned P. M. Latham, M. D., contained in his valuable "Lectures on subjects connected with Clinical Medicine, comprising Diseases of the Heart ; " and I have been convinced by numerous facts, that the softened heart of yellow fever, as well as of scurvy and ty- phoid fever, is gradually but fully restored Symptoms and Pathology of Yellow and Malarial Fevers. 69 Yellow Fever. great interest to medical science, to estab- lish clearly the exact physical and chemi- cal changes which result in the final trans- formation ol the muscular structure of the heart, and the secretory and excretory structures of the liver and kidney into fat. The difficulties of such an investigation are very great, especially as the chemical re- search can be commenced only in fatal cases and after death. The complete investiga- tion of this subject should embrace the fol- lowin g inquires : 1. Is there an actual increase of the entire amount of fat in the blood, organs and textures in yellow fever ? 2. Is there any movement of the fatty mat- ters from the positions in which they are chiefly accumulated in health, as in the adipose tissue, the marrow of the bones, the brain, spinal cord, and nerves generally during the fibrile stage of yellow fever ? 3. Are the heart, liver and kidneys simply infiltrated with fat conveyed by the blood during the fever ? 4. Is there an actual conversion of the fibrin and albumen of the blood, and the albuminous elements of the heart ? 5. Does the accumulation of fat in certain organs in this disease, result from chemical changes directly excited by a specific poison, or from imperfect oxidization and per- verted nutrition ? 6. Has the perversion and arrest of the function of the liver, and the retention in the blood of the constituents of the bile any relationship to the deposit of fat in the various organs ? As the acute fatty degeneration of yellow fever is in no wise dependent upon the food of the patient during the fever, the change occurring with rapidly during absolute starvation, it is evident that the only possible sources of the oil or fat are those indicated in the preceding inquiries; namely the pre existing sources of fat or its transformation of the nitrogenous and albu- minous constituents of the blood and organs. Cavities of the heart in many cases filled with dark fluid blood; yellow fibrinous clots sometimes present. Blood contains abnormal amounts of urea and extractive matters and ammonia. Fibrin of blood greatly diminished in amount. I have determined, both by chemical an- alysis and microscopical examination, that the heart undergoes fatty degeneration in yellow fever. As far as my observations have extended, the heart undergoes more rapid and extensive degeneration in yellow fever than in any other acute disease. The acute fatty degeneration of the heart in yellow fever should not be confounded with similar changes observed in spirit drinkers and in certain chronic diseases, but is mo probably dependent upon the same or simi- lar chemical actions, as those leading to a similar result in phosphorus poisoning and M alarial Fever. to its normal condition, in the vast majority of cases which recover. It is true, however, that the softening (acute fatty degeneration) of the heart in yellow fever, is fraught with danger, and may be the cause of sudden death, both during the period of calm and during that of convalescence. Hence, we have deduced the important indication of treatment to preserve the yellow fever patient at rest and in the recumbent position. Imprudence in rising out of bed, and in attempting to move about, both during the active stages of the disease, and during convalescence, has been attended with rapid failure of the enfeebled heart, and sudden death. Whilst holding that this softening or acute fatty degeneration of the heart to be one of the most marked and special effects, of yellow fever, and while admitting with Dr. Stokes, that its diagnostic signs are the impulse of the ventricles becoming almost or altogether imperceptible, and the systolic sound at the same time almost or altogether inaudible; at the same time such are the lesions of the stomach, kidneys and liver in yellow fever, that in many cases it is difficult, if not impossible, to apply the precise and plain indications for the use of stimulants in fever, as deduced by Dr. Stokes from these ausculatory signs. After careful microscopical and chemical examination of the heart, in the various forms of intermittent, remittent, congestive or pernicious malarial fever, and malarial haematuria, I have never observed any increase in the normal amount of fat or any condition which could be designated as molecular change, or acute fatty degen- eration. If the heart be compared in malarial and yellow fever, it will be pos- sible to distinguish by the naked eye, the flabby, softened, yellowish and brownish- yellow hue of the latter, from the dense, firm, dark colored heart of the former disease. All doubts are immediately re- moved by the chemical and microscopical examination, the malarial heart presenting no accumulation of oil, and revealing a firm, normal, distinctly striated structure of the muscular fibrillae. If acute fatty degeneration of the heart was characteristic of malarial fever, from the almost universal prevalence of this disease in the Mississippi valley, and other portions of the Southern and Western States, and from the oft recurrence of the disease in the same indivdual, fatty degeneration of the heart would become one of the common diseases in malarial regions. Pericardium not spe- cially congested. In some cases pericardial fluid of clear straw color, in others, especial- ly when jaundice hasexisted, t he pericardial fluid is of a golden color. 70 Joseph Jones, M. D., on Yellow and Malarial Fevers. Malarial Fever. Lungs.-Dependent portions congested with blood ; otherwise healty. Owing to the effects of the malarial poison in decreasing the fibrinous element of the blood and the colored corpuscles, pneumo- nia engrafted upon an individual suffering with malarial fever, tends to spread by diffusive inflammation, and in the case of plcuritis as a supervening disease, the effu- sion into the pleural cavity is rapid and destructive in its effects. If pneumonia be complicated with malarial fever, the peri- ods of congestion of the lungs, attended with oppressed breathing and increase of pulmonic inflamation are periodic and may be to a certain extent controlled by qui- nine. Stomach.-Mucous membrane often pre- sents a normal appearance; sometimes ecchymosed ; rarely inflamed or softened ; sometimes discolored with bile; rarely contains black vomit (altered blood). Reaction of mucous membrane of stomach and intestines acid. The pathological alterations of the stomach, observed after death, do not correspond, as a general rule, with the severity of the symptoms, the vomiting and pain on pressure during the progress of the fever. The injection of the blood vessels, and the mottled, purplish- Yellow Fever. In yellow fever the fat is deposited within and around the muscular flbrilke of the heart, in the form of minute globules of va- rious sizes. There is also an alteration or degeneration of the muscular fibrillaj of the heart, leading to a disappearance of the striation. The removal of the particles of oil from the muscular structures of the heart by sulphuric ether does not restore the obliterated striae; neither does this agent remove all the molecular particles, a por- tion at least being insoluble in ether, alco- hol and chloroform, and having an analo- gous constitution to albumen and fibrin. Fatty degeneration of the heart, there- fore, is not the sole state of this organ m yellow fever ; a molecular change has taken place in the substance of the muscular fibres, and this change affects the albuminoid or nitrogenous constituents, and most prob- ably represents one of the stages of acute fatty degeneration. The pericardium in yellow fever presents a congested appearance. Under the micro- scope the minute blood-vessels appear to be injected with colored blood corpuscles. Pericardial fluid of deep yellow color. The appearance presented by the pericardium of the heart of a case of yellow fever which terminated fatally in New Orleans, August 5th, 1871, is represented in Plate 7, figure 18. The pericardium was put on glass slide and preserved in Canada balsam. The drawing represents the natural appear- ance as injected with blood. Lungs.-Dependent portions greatly con- gested ; otherwise normal. In some cases circumscribed effusions of blood in textures of Inngs. I have in a few instances observed pneu- monia as a supervening disease in yellow fever; in such cases the sputa consisted of almost pure blood. The supervention of pneumonia causes a continuation of the febrile phenomena beyond the usual period of the uncomplicated disease. Stomach.-Mucous membrane of stomach in many cases intensely congested, softened and eroded. Stomach often contains large quantities of black vomit. Reaction of black vomit often alkaline from the presence of ammonia, resulting from the decomposi- tion of urea, eliminated by the gastro- intestinal mucous membrane. Ammonia and urea present in the black vomit ejected during life and also when examined almost immediately after death. The presence of ammonia in the stomach and black vomit was not the result of post-mortem putrefac- Symptoms and Pathology of Yellow and Malarial Fevers. 71 Yellow Fever. 'five changes. In many cases ammonia was present iu such large amount, that when a rod, dipped in hydrochloric acid, was held over the mucous membrane of the stomach, or over the black vomit, dense fumes of chloride of ammonium were formed, as if the rod had been held over a bottle contain- ing liquor ammonia). Chemical analysis re- vealed the presence of ammonia and also of urea in the black vomit. Under the microscope the black vomit was seen to contain colored blood corpuscles, and cells of the mucous membrane of the stomach, and broken capillaries. In some cases vibrios and fungi were numerous in the black vomit; in others they were absent. That the stomach suffers, and suffers severely in yellow fever is evident from the fact, that in a great majority of cases the stomach is finely injected with blood, and exhibits even when examined immediately after death, abrasions of the tissue in pit- like holes and furrows. In some cases the whole surface of the stomach is affected, in others the effusion and injection is confined to the cardiac or pyloric portion, but in some rare instances the stomach, duodenum aud intestines have been said to present an almost entire absence of appreciable lesions. I have not myself in post-mortem examina- tions observed the absence of lesions in the gastro intestinal mucous membrane. The congestion of the stomach is to a certain extent due to the disturbance of the circu- lation in the liver, but not wholly to this cause ; we must from careful chemical and microscopical examinations, admit the exis- tence of irritation, desquamation and haemorrhage. The congested appearance of the mucous membrane of the stomach after death from yellow fever, is represented in Plate No. 8, figure 22, mucous membrane of stomach in yellow fever, Charity Hospital, October, 1871. Figure 23, mucous membrane of stomach in yellow fever, Griffin Charity Hospital, November, 1876. These illustrations must be regarded as exhibiting the extreme conditions of congestion in the mucous membrane of the stomach in yellow fever. In many cases, the stomach after death presents less con- gestion, and in some port ions of the mucous membrane shows different degrees of conges- tion ; the congestion being greater in some portions of the stomach than in others. Intestines.-As a general rule dack- colored and distended with gas. In some cases the reaction of the intestinal con- tents was strongly alkaline from the pres- ence of ammonia. Haemorrhage from the intestinal mucous membraue has been observed during life, aud in such cases, as well as in others in Malarial Fever. brownish red color, after death, appear to be indicative, not of inflammation, bnt rather of stagnation and accumulation of the blood in the capillaries, consequent upon the disturbance of the relations of the blood to the capillaries. The distress- ing vomiting, so often a troublesome symptom in malarial fever, appears to depend upon the contact of the altered bile and the irritation of the nervous centres which supply the stomach with nervous force, by the altered blood, and by the malarial poison. In cases where there has been chronic inflammation of the stomach before the ap- pearance of the fever, and m cases of long standing, where the solids and fluids were permanently altered, decided lesions of structure were found in the stomach. It may be asserted, however, that there is no constant or characteristic lesion of the stomach in malarial fever. The vomited matters in the various forms of malarial fever, unlike those of yellow fever, contain bile. Even in that form of malarial fever which most nearly resembles yellow fever, namely: in malarial haema- turia, the dark, almost black vomit, owes its color chiefly to altered bile. It is true that in some cases of malignant mala- rial fever, we may have- the vomiting of dark blood and bloody matter, resembling the vomito nigra of yellow fever, but as a general rule bile is present, even in these rare instances, whilst it is almost always absent from the black vomit of yellow fever. The presence of blood and its con- stituents, occasionally, in the vomit of ma- larial fever is due to the same causes, namely: desquamation rupture of capilla- ries, aud the transudation of the haemo- globin of the colored corpuscles. Intestines.-These remarks relating to the stomach apply also to the small intes- tines. The mucous membrane frequently • presented a purplish, irregularly injected, mottled appearance, especially after the administration of purgatives, and it was frequently observed that the injection of the blood-vessels was greatest in the de- 72 Joseph Jones, M. D., on Yellow and Malarial Fevers. YELLOW FEVER. which no blood has been discharged pre- vious to death, the intestines have been found upon post mortem examination dis- tended with blood, A remarkable feature in yellow fever is the frequent occurrence of intussusception of the small intestines. The late Professor John Harrison, M. D., states that intussusceptions of the small in- testines were exceedingly common in autop- sies made in 1839, in New Orleans. The quantity of intestines invaginated, some- times exceeded a yard. The large intes- tinesand the lower portion of the small, are not so often found congested, as the stomach and duodenum, yet such a condi- dition is by no means rare. The congestion of the veins, venules, and mucous mem- branes generally of the intestines in yellow fever, have been referred to the anatomical distribution of the veins, which like those of the stomach, are tributaries to the portal vein. But we have been inclined in many cases to regard the congestion as active and not passive. During life the rectum in yellow fever presents an intensely red, and congested appearance, and some cases of yellow fever in 1878, were followed by irri- tation and fissure of the rectum. Liver.-Yellow color and bloodless, re- sembling this orgau in fatty degeration, but firmer and denser in structure. Plate 9, figure 29, represent the general appear- ance of the yellow fever liver. The speci- ment was taken from a subject in the Charity Hospital in 1871. Plate 10, figure 35, illustrates the appearance of the liver in the case of cirrhosis, induced by spirit drinking,which died in the Savannah Hospi- tal in 1856. There was not only cirrhosis but also fatty degeneration in this case. Plate 9, figure 30, represents the appearauce of liver in yellow fever engrafted on malarial fever; figure 31, represent a portion of section of liver figured in 30, magnified, showing congestion of portal capillares, with pigment deposit, and the yellow, fatty and degenerated central portions of the lobuli of the liver. Figure 32, represents the appearance of the liver in yellow fever engrafted upon malarial fever. The black pigmentary iqat- ter alters the yellow color characteristic of the yellow fever liver. Figures 29, 30, 31 and 32, Plate 9, should be compared with figure 35, Plate 10, and with Plate 11, figure 41, liver in acute stage of malarial fever (bilious remittent). Figure42, appear- ance of liver in malarial fever of long standing; figure 43, appearance of malarial liver loaded with pigment particles. Under the microscope, textures of the liver infil- trated with oil; secretory cells of liver con- tain much oil. The liver of uncomplicated yellow fever, as far as my observations ex- tend, and according to the observations of MALARIAL FEVER. pendent portion of the intestines. In seve- ral cases, Brunner's glands in the duode- num were enlarged and distinct. Peyer's glands were uniformly free from any well-marked motbid alteration. In some- cases they were distinct and well defined in their outline, and presented a honey- comb surface, dotted with dark points; but they were always free from marks of inflam- mation and even of irritation, and in their pale, white color, contrasted strongly with the surrounding mucous membrane, dis- colored with bile and often irregularly in- jected with blood. As a general rule, bile is found in the in- testinal canal of malarial fever, and in some cases in large quantities, whilst it is absent from the entire alimentary tract in. fatal cases of yellow fever. Liver.-The weight of the liver is in- creased in malarial fever above the stand- ard of health. This increase of weight is due in part to the stagnation and accumu- lation of blood in the capillaries and blood- vessels, and to the deposit of pigment mat- ter in the structures of the liver. This ob- servation applies to the liver in the acute stages. In all the different forms of malarial fever, intermittent, remittent and conges- tive, which had continued longer than five days, and in which there had been no previous alterations of the structures, as in cirrhosis and fatty degeneration, I found the exterior of a slate color, and the in- terior of a bronze color. Plate 11, Figure 41, represents the appearance of the malarial liver, in the acute stage of remittent fever. Plate 42, represents the dark bronzed liver of malarial fever of longstanding. Figure 43, represents liver of malarial fever loaded with pigment particles, figure 44. repre- sents a magnified portion of a section of a malarial fever liver, showing the deposit of pigment chiefly in the portal capillaries, in the periphery of each lobule. Figure 45, represents the appearance of the liver cells and blood and bronzed pigmentary matter of the liver in malarial fever. This figure 45, should be compared with figure 33. Plate 9 showing cells of liver and oil globules in • yellow fever. In that form of cirrhosis of the liver which is directly induced by the prolonged action of the malarial poison, the liver is in like manner of a slate color upon the exterior, and olive green within,. Symptoms and Pathology of Yellow and Malarial Fevers. 73 YELLOW FEVER. (Louis and many others, is of a bright yel- Uow color. It is probable that this color, as in the case of the malarial liver, varies with the length of the attack and the ef- fects of previous diseases. Thus Dr. Samuel Jackson, of Philadelphia, found the livers of those who had died in the early stages engorged with blood. The decoction of the yellow fever liver is of a golden yellow color, whilst that of the malarial liver is of a brownish yellow color. The golden yellow ■color of the yellow fever liver can be ex- tracted both by alcohol and water. The yellow fever liver is firmer and harder than that of malarial fever, contains much less blood, and is much less readily acted upon by liquor potass® and acids. Liquor potass® readily dissolves the malarial fever liver, the decoction presents the appearance of venous blood, while no such effect is pro- duced by the action of this alkaline solu- tion upon the yellow fever liver. Chemical analysis reveals the presence of urea ami fat in abnormol amounts ; animal starch and grape sugar are also present in the yellow fever liver. As a general rule grape sugar is absent from the malarial liver. In some cases the deposit of oil is confined to certain portions of the lobuli and may even differ in amount in different portions of the liver, but in the majority of cases the fatty infiltra- tion, and fatty degeneration of the proto- plasm of tiie hepatic cells, extends through- out the whole organ. The oil is deposited both within and around the hepatic cells. Plate 9, Figure 33, gives the appearance of the hepatic cells and the oil globules in the liver of yellow fever case of Griffin, No- wember, 1876. This figure should be com- ipared with Fgure 45, Plate 11, representing the appearance of the hepatic cells and pig- ment particles in the liver of malarial fever The liver of Griffin, figured in Plate 9, Figure 30, Figure 31 and Figure 33 (a case -of yellow fever engrafted on malarial fever) upon a superficial examination presented a purplish, congested appearance. Thin sec- tions of this liver made with Valentin's knife, placed under the microscope, showed that each lobule consisted of an exterior portal peripheral border of deep red, with dark granular masses, illustrating the effects of preceding attacks of malarial fever, with the internal portions surround- ing the hepatic capillaries, and being com- posed of hepatic cells loaded with oil glo- bules, also granular matter and oil glo- bules within and around the cells and inter- cellular spaces. See Figure 30 and Figure 31, Plate 9. Upon analysis this liver con- tained in the 1000 parts: water, 747.88; solid matters, exclusive of oil, 162.95; oil (tatty matters), 89.17. In the case of Samuel Kinsly, who died of yellow fever in the Charity Hospital, MALARIAL FEVER. and loaded with dark pigment granules. The change in the color appears to be very persistent, and in several cases I have ob- served the liver to retain shades of light slate and light bronze several weeks, and even months, after the relief of the attack of malarial fever, the patients having been destroyed by other diseases or by violence. The liver, especially in the peripheral por- tions of the lobules, contains pigment granules, resulting from the alteration of the colored blood-corpuscles and the h®ma- tin. The pigment granules are frequently distributed uniformly through both the portal and hepatic systems of capillaries. There is no accumulation of oil globules, as in the yellow fever liver. If malarial fever precedes or succeeds yellow fever, the liver may contain both oil globules and pigment granules. The peculiar color of the malarial liver can to a certain extent be extracted by boiling water, and the filtered decoction presents a brownish mahogany color, from the presence of the dark coloring matters of the pigment granules ; the decoction of the yellow fever liver, on the other hand, presents a golden color. The blood issuing from the cut surface of the malarial liver presents a dark purplish hue, and does not change to a brilliant scarlet, as in the yel- low fever liver. Upon chemical examina- tion, the malarial liver contains animal starch, but no grape sugar; the yellow fever liver contains both substances. Whilst, by careful analysis (quantita- tive), I have shown that the oil may amount to over 40 per cent of the dried yellow fever liver, I have also clearly demonstrated that there is no increase of oil in the malarial liver. I speak of uncomplicated malarial fever; of course, when this disease is engrafted upon cirrhosis or fatty liver, the effects of the malarial poison upon this organ will be marked. 74 Joseph Jones, M. D., on Yellow and Malarial Fevers. Yellow Fever. November 17, 1873, the liver presented a mottled yellow and bronze color, as in Figure 32, Plate 9. Sections of this liver, washed with a stream of water, presented the yellow color of yellow fever. The liver cells were filled with oil globules ; oil glo- bules, in great numbers, were also found around the liver cells. The liver also con- tained much granular matter. Minute sec- tions of the liver, made by Valentin's double knife, exhibited the hepatic cells filled with globules of oil or fatty matter, the outline and hexagonal shape of the cells being altered and obscured, and the nuclei rendered invisible. When matter was scraped from the hepatic texture and spread upon a glass slide, the whole field of the microscope, and the intespaces between the cells were filled with granular, molecular and oily matter. 1000 parts of this liver con- tained: water, 677.20; golden yellow oil, 304.21; fibrous tissue, blood-vessels, etc., 18.59. We observed great increase of oil. Careful investigation of the relations of malaria to yellow fever, and an extended examination of the statements of various observers, have convinced me that the ap- parent contradictory statements made by various observers, as to the presence or ab- sence of the yellow color of the liver, which Louis regarded truthfully as the character- istic lesion of the disease, has arisen from two sources, namely, errors of diagnosis, and failure to detect the preceding and con- current, and subsequent action of malaria upon this organ. In uncomplicated yellow fever, the pigment particles so uniformly present in the malarial liver are entirely absent. When yellow fever has been en- grafted on malarial fever, the preceding changes wrought by the paludal poison alter and mask those developed by the yel- low fever. And hence a mingling of the yellow color of acute fatty degeneration with the dark bronze and slate of the mala- rial liver, may produce a color very closely resembling the Spanish brown of the healthy liver. Careful sections and examinations of the organs under the microscope will re- veal both the oil globules end the pigment particles. Gall Bladder.-The gall bladder in yel- low fever is, as a general rule, contracted, flaccid, small, and contains little or no bile. The amount of bile generally does not ex- ceed 100 grains. In malarial fever, on the other hand, the gall bladder is, as a general rule, distended with dark, greenish black bile. In yellow fever the vomiting is rarely bilious, unless in the commencement of the disease, and the black vomit contains little or no biliary matter. The small intestines are rarely, if ever, discolored by bile in yellow fever, whilst in malarial fever it is common to find the gastro-intestinal mucous membrane discol- ored by bile. Malarial Fever. Gall Bladder.-In most cases distended with more than 1000 grains of thick, green- ish black bile, having frequently a specific gravity ranging from 1.030 to 1.037. The bile is more abundant in malarial fever, and is of a deeper color than in yellow fever, and frequently contains concretions of epi- thelial cells, from the coats of the gall blad- der and biliary ducts, and casts of the bili- ary tubes. In thin layers, and when added to water, itpresents a deeper shade of green. The yellow fever bile presents a golden co.or in thin layers and when added to water. Whilst haemorrhage occasionally occurs in the gall bladder in yellow fever, I hava Malarial Fever. Symptoms and Pathology of Yellow and Malarial Fevers. 75 YELLOW FEVER. I have observed cases in which the gall bladder contained only a serous liquid co- agulable by heat. In two cases, a decided hEemorrhage had taken place into the gall bladder, which was distended with black blood. The bile in yellow fever contained numerous cells from the mucus membrane of the gall bladder, and casts of the hepatic ducts. Spleen.-As a general rule, but slightly enlarged. In many cases, normal in size and appearance. In many cases of yellow fever the spleen is neither enlarged nor softened, nor altered in appearance, either upon the exterior or within. There appears to be no special alteration or destruction of the colored corpuscles in the spleen of yellow- fever, as in that of malarial fever. The enlargement of the spleen in fevers, does not, from these observations, de- pend upon the diminution of the fibrin, because this element of the blood is dimin- ished to a much greater extent in yellow fever than in malarial fever, and at the same time the spleen is enlarged to a greater and more marked degree in the latter. Another fact worthy of con- sideration in this connection, is, that in yellow fever, the blood corpuscles are not specially diminished in amount, whilst in malarial fever they are rapidly destroyed, and this destruction appears to be greatest in the liver and spleen. In malarial fever both these organs are loaded with the altered blood corpuscles, and with the pigment granules resulting from the alter- ations of the colored corpuscles, whilst neither the spleen nor the liver in yellow- fever affords any evidence of alteration of the colored blood corpuscles. Supra-Renal Bodies.-These bodies ap- pear to be subjected to similar changes with the liver and heart, and oil is increased in amount in the cells of the cortical and medullary substance. Kidneys.-These organs, as a general rule, present a brownish-yellow color, much lighter than that of health. They, in com- mon with the heart and liver, contain much free fat. MALARIAL FEVER, never witnessed this remarkable condition in malarial fever; neither have I ever ob- served the entire absence of bile and th© replacement of this secretion by an albu- minous fluid in malarial fever. Spleen.-Enlarged, softened and loaded with altered blood corpuscles and pigment granules; of a dark slate color upon the exterior; the blood of the spleen does not change to the arterial hue upon exposure to the atmosphere. In many cases the spleen is so soft that it ruptures when the attempt is made to remove it from the cavity. When the splenic mud is subjected to> microscopical examination, it is found to contain numerous pigment granules of various sizes, and pigment cells, many of which resemble the colorless corpuscles in size, whilst others are much larger and contain oval nuclei and resemble certain palmellae. Plate 12, figure 48, represents the appear- ance of the spleen in malarial fever. The figure is only one-fourth the size of the spleen from which the drawing was made. Figure 47 represents the appearance of spleen (section) in a case of pyaemia, fol- lowing hospital gangrene. The deposits characteristic of pyaemia is well shown in the central yellow mass. The deposits were yellow and cheese-like, which, under the microscope, consisted of numerous cells, some of which were caudate and spindle shaped, also numerous granules and oil globules. (See Surgical Memoirs of the U. S. Sanitary Commission, p. 415, Plate 12, figure 49, represents the micro- scopical appearance of the splenic mud of malarial fever. Figure 50. Splenic mud of pernicious malarial fever. Plate 9, figure 34, represents the appear- ance of the splenic mud in a case of yellow- fever engrafted on malarial fever. E. Griffin, 1876. Supra-Renal Bodies.-Frequently dis- colored of a dark brownish hue, from the deposits of melanotic or pigment particles, around the cortical and medullary cells and capillaries. No accumulation of oil has been observed in these bodies in malarial fever. Kidneys.-Normal in appearance and structure, except in malarial hsematuria, when the textures are congested and dark colored in some cases. Occasionally slate colored spots appear upon portions of the kidneys. 76 Joseph Jones, M. D., on Yelloic and Malarial Fevers. Plate 10, figure 36, represents the appear- ance of the kidney in yellow fever; and figure 37 represents the appear- ance presented by a section of the same kidney. These figures may be regarded as repre- senting the, more decidedly marked kidneys in this disease; for in some cases they present greater degrees of congestion, and deeper coloration from the presence of blood in the capillaries. In the case of Grillln, who died of yellow fever in the Charity Hospital, November 17, 1876, sections of the kidneys, made with Valentin's knife, revealed, under the microscope, increase of oil globules and granular matter. Many of the tubnli urin- iferi presented a thickened and altered appearance, as if undergoing the changes characteristic of cirrhosis. One thousand parts of the kidney con- tained, water, 800.33 ; solid excretory Volicular and fibrinous matter, 158.39; oil or fat, 40.88. In the case of Samuel Kinsley, who died of yellow fever, in the Charity Hospital, on November 17. Sections of the kidneys under the microscope presented the appear- ance usual in yellow fever, namely : Mal- pighian corpuscles and tubnli uriniferi, filled with oil globules, yellow granular matter, and detached excretory cells. One thousand parts of those kidneys con- tained, water, 789,9; golden colored oil and fiat, 57.07; cellular tissue, blood vessels, excretory sturctures, etc., 142.99. When thin sections of the kidneys are examined under the microscope, the Mal- pighian corpuscles and tubnli uriniferi are found to be filled with granular albuminoid and fibroid matter, excretory cells detached and oil globules. As far as my observation ■extends, these structural alterations of the kidney have escaped the notice of preceding observers. The importance of these changes in the kidneys cannot be over-estimated, for upon them apparently depends the suppression of the urinary excretion, which is an almost universally fatal symptom. The changes in the kidneys may depend upon several causes, amongst which may be mentioned as of prime importance, the alterations induced in the albumen and fibrin of the blood by the febrile poison, and the congestion of the capillaries induced "by derangement of the vaso-motor system of nerves ami by the altered blood. This condition of the kidneys is preceded by capillary congestion, as has been shown by the results of post-mortem examinations at different periods of the disease. The same observation applies to the liver. The fatty degeneration and structural lesions are preceded by hyperaemia; but neither in the kidneys nor in the liver and other organs, can the mere stagnation of the blood in the capillaries be regarded as the YELLOW FEVER. MALARIAL FEVER. I have, by careful clinical studies, and by analysis of the urine, at different stages of malarial haematufia,. established the fact that many of the symptoms of this disease, as well as the fatal termination, are con- nected with the progressive failure of the kidneys to eliminate the constituents of the urine and of the bile. When sections were made of the kidneys of those who had died in the acute stages of malarial haematuria, the cortical and mendnllary portions presented a deep purplish red and bloody appearance. The color was deeper in some portions than others, resembling circumscribed effusions of dark blood. In many cases all portions of the kidneys were altered in appearance, and the tubnli uriniferi especially at the termination of the pyramids could be seen resembling dark red lines of coagulated blood. Microscopical examination of sec- tions with Valentin's knife, revealed the fact, that many of the tubnli uriniferi throughout their entire extent, were tilled with coagulated blood. The haemorrhage appears to have taken place through the malpighiau corpusches chiefly; little or no blood was effused around the tubnli urini- feri. It would appear that during the pro- longed cold stage, the kidneys become in this form of malarial fever, congested, in a manner similar to what occurs in the spleen. During this congestion, rupture of the blood-vessels and of the capsular mem- brane of the malpighian corpuscles occurs ; such rupture being mainly due to their anatomical structure, and the greater ten- sion of the blood in this portion of the renal capillary circulation. When from any cause the blood coagulates in the tubnli uriniferi, their function as excretory tubes is destroyed, and the extent of the imapir- ment of the execretory function of the kidneys, will depend upon the number of excretory tubes blocked up by coagulated blood. The grand cause of the severe, dan- gerous and often fatal character of malarial haematuria will be found chiefly in these structural alterations of the kidneys. Plate 13, figure 55, represents the appear- ance of a section of the kidney in malarial haematuria, figure 56, represents the ap- peraance of the extremity of a pyramid of a kidney of malarial haematuria viewed under one inch objective. The following is our outline of the case of malarial haematuria from which the il- lustrations, figures 55 and 56 were taken : George Price, native of Louisville, Ky., aged, 26 ; height, 6 feet 4 inch ; weight in health 170 pounds; occupation, laborer; during the months of August, September and October, 1877, visited my office several times, and appeared to be suffering from the prolonged effects of the malarial poison ; pale sallow, greenish yellow hue. As he was sick and destitute I furnished him .vith Symptoms and Pathology of Ydlozc and Malarial Fevers. 77 YELLOW FEVER. prime cause of the subsequent degeneration and disintegration of the textures, and more especially of the secretory cells. The chief cause is the action of the yellow fever poison on the blood and textures. The yellow fever poison excites a train of chem- ical changes, the final result of which is fatty degeneration. Thus in the case of the muscular fibres of the heart, there is fatty degeneration, although from the struc- ture and action of this organ, there could be no such passive congestions as we have in the liver and kidneys. It is probable that the fatty degeneration extends to all the unstriped muscular fibres, and may even disable the muscles of locomotion and animal life. The granules of the cells of the epithelium of the uriniferous tubes set free by the disintegration of the protop- lasm, oil globules, detached cells, and al- buminous matters and mucus, form opaque granular masses wrhich block up the tubtili uriniferi. We have in these structural alterations of the kidney, which vary in kind and degree according to the stage of the disease, an ex- planation of the frequent occurrence of albumen casts, detached cells of the epithe- lium of the uriniferous tubes, and oil globules and granular matter in the urine of yellow fever. MALARIAL FEVER. medicines, and such small assistance as lay in my power. On the thirty-first of Octo- ber, I was called to see the man, at the house of one who had allowed him shelter in a room over the stable. I found the patient jaundiced, surface of a deep golden color; incessant vomiting ; urine resembled blood in color and odor: Pulse rapid; patient very restless. On my recommendation the patient was sent to one of my wards in the Charity Hospital. The patient entered the Charity Hospital, Ward 13, November 1, 11 a. m. 1877. The patient stated that he had enjoyed good health, until he moved to Claiborne parish, Louisiana, in January 1876; and about a week after he was attacked with chills and fever. He remained in Northern Louisiana, where he continued to have chills and fever, at intervals of two or three weeks, when he arrived in New Orleans. After remain- ing a few days in the city, he went to work on a rice plantation, about seven miles below the city ; after remaining on the plantation a short time he be- came sick and was sent to the Charity Hospital, where he staid but one day. Continued to have chills and fever about once every two or three weeks. The pre- sent attack commenced with a chill on the night of the twenty-seventh of October, 1877 , had another chill on the night of the twenty-eighth; October 29, no chill. Had a chill on the night of the thirtieth, and in the morning observed blood on his clothing, and observed that his skin was of a yellow color. Vomited gray-green colored mattesr, and passed bloody urine during the thirty- first. I saw the patient at 8 o'clock p. m., directed his removal to the Charity Hos- pital. November 1st, 11 a. m. The patient has iust entered the Charity Hospital, suffering with head ache, intense thirst, nausea, and vomiting of large quantities of grass-green liquid. Tongue* swollen, coated, dry and very rough ; gums pale; great pain and tenderness over the entire abdomen ; respi- ration embarrassed, and the patient groans during respiration. Bowels moved twice this morning. Surface of a golden yellow color. Pulse weak and rapid, 102 per minute. Pulse, 102; respiration, 24; tem- perature of axilla, 102° F. ; acid urine of a deep blood red color, with the odor of blood. Amount of urine excreted during twelve hours, October 31st, six, p. m., and Novem- ber 1st, six, a. m.: 500 cc.; reaction strongly, acid, sp. gr. 1020; deep blood red color, upon standing, urine let fall heavy brown- ish red deposit. Under the microscope the deposit consisted of colored blood cor- puscles, variously altered in shape, yellow granular matter, and casts of the tubuli uriniferi, some of which were of a deep 78 Joseph Jones, M. D., on Yellow and Malarial Fevers. Yellow Fever. Malarial Fever. orange color, others of a deep red blood.' color, and contained colored blood corpus- cles. The deposits resembled closely those- illustrated by figures 53 and 54, Plate 13. Sp. gr. of the urine after the removal' of the albumen and blood by filtration, 1016. 500 cc. of urine, passed during twelve- Ijours, contained : urea grains, 205.6; chlo- ride of sodium, 38 5 ; albumen and consti- tuents of the blood coagulated by heat and' mineral acids, 119.75. November 1st, six o'clock, p. m. : Pulse,. 102; respiration, 24; temperature of axilla, 102.4° F. : continues to vomit green matter;- urine, bloody. November 2d, eight o'clock, a. m.: Pulse, 98 ; respiration, 20 ; temperature of axilla,. 99° F.; vomited eight times during the night and morning; urine of a deep blood rolor. Whilst the bed clothes were being changed, the patient was seated upon* a stool, he had a convulsion. Examination of Blood. Coagulum, small, but very firm ; serum, golden colored, and contained coloring matterand acids of bile, urea and extractive matters in greatly in- creased amounts. Under the microscope (420 diameters) some of the colored blood corpuscles presented a swollen and crenated appearance; the majority, however, pre- sented a normal appearance. A few pigment- particles were observed in the blood, and some of the colorless corpuscles contained the pigment granules characteristic of malarial fever. The blood also contained numerous vibrios and vibrating filaments: about one twenty-thousandth of an inch in diameter. One thousand parts of blood contained : water, 844.29; diied blood corpuscles, 47.55 (moist blood corpuscles, 190.2); fibrin, 14.51;- albumen, 57.27 ; extractive ma tters* salts, urea, coloring matters of bile, biliary acids and soluble salts, 23.80; fixed saline con-- stituents, 12.85. One thousand parts of the blood after complete coagulation contained clot, 348.19; serum. 651.83. We observe great diminution of the colored blood cor- puscles ; great increase of water; marked' increase of the fibrin. The fibrin has ac- tually risen to the high figure which we- regard as characteristic of tlie phlegmasise,. and especially of acute pneumonitis and pleuritis. Notwithstanding the increase of the fibrin, the body of the patient was covered during the past two days with small petechias of a deep purple and red color. We also observe marked increase in> the extractive and saline matters of the- blood. Examination of Urine. Amount of urine- excreted during twenty-four hours. No-. vember 1st, 11 o'clock, a. m., to November 2d, 11 o'clock, a. m. 880 cc, ; reaction strongly acid; sp. gr. 1016; color deep, blood red, odor like that of blood. Th& Symptoms and Pathology ot Yellow and Malarial Fevers. 79 Yellow Fever. Malarial Fever. microscope revealed the presence of casts of the tubnli uriniferi, some of which were composed of coagulated blood, and others of orange-yellow granular matter. Vibrios, were observed in this urine. Upon standing a heavy crop of deep red lozenge-shaped crystals of uric acid were precipitated. 880 cc. of urine passed during twenty- four hours, November 1st, 11 a. m., to, November 2d, 11 a. m., contained urea, grains, 271.04; chloride of sodium, grains, 13.55 ; albumen and matters coagulated by heat, grains, 142.24. November 2d, 6 o'clock, p. m. : vomiting continued; urine greatly diminished; passed urine only once during the night, and then in small quantity, and apparently uncon- sciously, in bed ; about three fluid ounces. Pulse, 112; respiration, 15; temperature of axilla, 98.8. Patient lies quiet in a stupor, and cannot be aroused. November 3d, a. m.: passed a quiet night; no vomiting; bowels not moved; suppresion of urine; died unconscious during the morning ; at five o'clock, a. m., had a slight convulsion, gasped three or four times, with an interval of a minute between each gasp, and then ceased to breathe. Autopsy. Four and one-half hours after death. Surface of a greenish-yellow color. When the skull-cap was removed, the dura mater, arachnoid, pia mater, and surface of the brain presented no marks of inflammation or structural alteration. No unusua^ amount of cerebro-spinal fluid was ob- served. When careful sections of the brain were made, so as to expose the ven- tricles, no unusual amount of fluid was. found in their cavities, and the gray and white textures of the brain, as well as its. membranes, presented a pale, anaemic and firm appearance. The medulla oblongata and spinal cord, presented a pale, anaemic appearance. Chemical analysis showed the, presence of ureaTn the cerebral structures in considerable amount. Thorax: lungs, normal in structure and appearance, but pale and anaemic. Heart : pale, and of a more decided yellow color than usual in malarial fever ; it was also softer than usual in this disease, and resembled in its yellow color and soft tex- tures more nearly the heart of yellow fever. Right side of heart distended with a fibrin- ous clot, attached to the carneae colamme, chordae tendineae, and edges of the tricuspid valve. Branches of the clot also extended into the pulmonary artery. Under the microscope, the muscular textures of the heart, presented a larger number of oil globules, and more granular matter than is usual in the natural heart, or in that of' malarial fever, uncomplicated by lesion of the kidneys, urinary suppression and jaun- dice. That there was an actual increase of oi^ 80 Joseph Jones, M. D., on Yellow and Malarial Fevers. Yellow Fever. Malarial Fever. in the heart, is shown by the following re- sults of chemical analysis: Weight of heart, 94 troy ounces; oil or fat in heart, 216.60, troy grains; oil or fat in 1000 parts of muscular tissue of heart, 47.5. The textures of the heart yielded urea in com- parative abundance. Stomach pale and anaemic; mucus membranes stained of a deep green; stomach contained eight fluid ounces of dark green fluid, sp. gr., 1012 ; 1000 parts contained, water, 952.0; solid residue, 48.0. Chemical analysis showed the presence of bile, acids and coloring matters and of urea, and the absence of albumen and all constituents of the blood. The microscope failed to reveal the presence of colored blood corpuscles. Liver enlarged; color lighter than in malarial fever, and of a deep Spanish brown. Under the micro- scope the liver cells contained more oil globules than usual in malarial fever, but less than in yellow fever. Oil in 1000 parts of liver, 40.1 ; gall bladder distended with 1600 grains dark green bile, sp. gr. 1038; 1000 parts contained, water, 868.88; solid residuum, 131.12; fixed saline constituents, 17.35. Intestinal canal empty, and con- tracted. Spleen enlarged; under micro- scope numerous p'gment particles. Kidneys. Capsule adherent; external sur- face of a deep purplish-red congested appearance. Weight of kidneys, nine ounces, and one drachm. When sections were made of the kidneys, the cortical and medullary portions presented a deep pur- plish-red and bloody appearance. The color was deeper in some portions than in others, resembling circumscribed effusions •of dark blood. All portions of the kidneys, however, were altered in appearance, and the tubuli uriniferi, especially at the term- ination of the pyramids, could be seen, like dark red lines of coagulated blood. The appearance of the section of the kidneys is represented in Plate 13, figure 55. Microscopical examination revealed the fact that many of the tubuli uriniferi, throughout their entire' extent, were filled with coagulated blood. The haemorrhage appears to have taken place through the Malpighian corpuscles chiefly, as little or no blood was effused around the tubuli uriniferi. It would appear from this observation, that during the prolonged cold stage the kidneys become congested in a manner similar to what occurs in the spleen. Dur- ing this congestion, rupture of the blood- vessels and of the capsular membrane of the Malpighian corpuscles occurred, such rup- ture being mainly due to their anatomical structure and the greater tension of the blood. When from any cause the blood coagulates in the tubuli uriferi, their func- tion, as excretory tubes, is destroyed, the extent of the impairment of the excretory Symptoms and Pathology of Yellow and Malarial Fevers. 81 YELLOW FEVER. \ Urinary Bladder.-As a general rule the bladder contains little or no urine in yellow fever. The urine is of a light yellow color, without any crystalline bodies, and loaded with albumen, granular fibroid matter, urate of ammonia, casts of the tu- buli uriniferi, and excretory cells of the kidney. In many cases the urine is entirely suppressed for as long a period as forty-eight hours before death. So long as the kidneys perform their functions freely and regularly the patient may recover even though black vomit may have appeared, but if the action of the kidneys has been arrested by struc- tural changes, death is inevitable. Mucous membrane of bladder often congested and in some cases ecchymosed. MALARIAL FEVER, function of the kidneys being dependent upon the number of excretory tubes blocked up by coagulated blood. The appearance presented by the tubuli uriniferi, as seen under low powers in sections of the kidneys, is seen in Figure 56, Plate 13. In this figure a view is given of the ter- mination of one of the pyramids of the. kidneys. We observe in these structural alterations, of the kidneys the grand cause of the dangerous and often fatal character of ma- larial haematuria. Urinary Bladder.-Often distended, with high-colored urine, free from albumen and casts. In malarial hsematnria the urine, contains casts and blood corpuscles, and desquamated cells of the tubuli uriniferi. Casts high colored, and often contain col- ored corpuscles. In some cases of bilious, remittent fever, and also in some cases of chronic malarial poisoning, the urine con-, tains albumen. 82 Joseph Jones, M. D., on Yellow Fever Atmosphere. CONSTITUTION OF THE ATMOSPHERE IN YELLOW FEVER. We have already alluded to this subject, but in order that the nature of the experi- ments may be more fully comprehended, we will enter more fully into detail. Seizing upon the fact that cold arrests yellow fever, I sought to condense, and render palpable to the eye and touch the poison, by passing large volumes of the yellow fever atmosphere through ice and ice-cold water by means of carefully constructed bellows. In this manner I threw from 100,000 to 600,000 cubic centimetres of air through ice and ice-cold water. The products of the condensation thus obtained were examined both chemically and microscopically. In this manner I have subjected the air of locali- ties and rooms which appeared to be infected with the yellow fever poison, to microscopi- cal and chemical examination, and I have discerned numbers of minute living organic particles, which might properly be termed sporules, having a diameter ranging from one-ten thousandth to one-thirtieth thousandth of an inch; and also numerous living animalculm, together with minute particles of fatty bodies, scales from the human body, and fibres from the bedding and clothing. The sporules resembled most nearly the mi- crococci and cryptococci of Hallier. I have observed similar particles in the blood of yellow fever patients, and have observed bacteria in the air and in the blood. liesuits of the examination of the air of the rooms in which yellow fever patients were confined, in the first group of cases in the brick house No. 363 Magazine street, corner of Thalia, August, 1878: No local cause of disease could be discovered in the brick building, nor in the paved streets immediately surrounding it. The premises were clean, and had been frequently cleansed and disinfected. Of five cases treated m this house from the 29th of July to the 21st of August, 1878, four terminated fatally. During the entire period of the continuance of these cases, the tem- perature. both within and without the house, was high, varying from 84° to 94°. The total mortality in New Orleans from the first to the twenty-fifth of August was: yellow fever, 616; all causes, 1190. Impartial judges will admit that this was a suitable location, in the heart of the infected district, and a suitable season, to condense ami examine microscopically and chemically the yellow fever atmosphere. The air of the rooms occupied respectively by Mr. H. as a sleeping apartment, and in which no case of fever or other illness had occurred, and by Miss R., Mr. D. and Mr. O., was passed through ice aud cold water on the 13th, 14th and 15th of August. About 600,000 cubic centimetres were passed through the ice and cold water in each room. It is worthy of note that two deaths had occurred in the room occupied by Miss R. The air was subjected to this treatment both at night and during the day. A marked difference was observed between the water of the melted ice from the large front room of Mi. H.'s house and the three small side rooms of the wing of the brick house facing Thalia street. The water from the front room was perfectly transparent, whilst that from the yellow fever rooms presented a turbid, milky appearance, and let fall a considerable deposit. When the water from the yellow fever rooms was subjected to microscopical examina- tion, the following extraneous matters were observed : 1. Numerous minute particles, many of which had a vibratory motion. Under a mag- nifying power of 420 diameters, with Beck's best l-5th of a inch (a superior glass of ex- cellent defining power) these appeared as minute oval specks. Under l-18th of an inch (1050 diameters) these particles were resolved into distinct oval cells with a central nucleus, resembling in all respects the spores of delicate fungi. 2. Bacteria and delicate thread-like filaments, similar to those observed in the urine aud in the blood of yellow fever. 3. Revolving minute animalcules and spores, with active rotatory movements. 4. Minute particles which could not be resolved into distinct structures by the highest powers. When magnified 1050 diameters, these resembled mere specks of matter, many of which have an active vibratory motion. 5. Epithelial cells, 6. Particles of dust evidently inorganic in their nature. 7. Oil globules. As the patients were well rubbed with olive oil, the oil globules may have in part been derived from this source; but as oil increases in the blood and in certain organs, as the liver, heart and kidneys, during the progress of yellow fever, I was disposed to refer a portion of the oil globules to the diseased bodies. It is possible that oil might be exhaled from the pulmonary surface in small quantities during the progress of the disease. 8. Hairs and particles of cotton and sheep wool from the clothing and bedding of the patients with numerous adherent spores. Experiments o i Organized Bodies in Yellow Fever Atmosphere. 83 When the liquid from the yellow fever rooms was evaporated, a distinct deposit was deft in the watch glasses and upon glass slides, which, in addition to the various organic substances specified, contained numerous stellate and acicular and prysmatic crystals and granular particles. The crystals appear to be those of the chloride and cerbonateof ammonia. Reaction of water slightly alkaline. The presence of organic matter was still further shown by the usual chemical tests, as charring by heat, blackening by sulphuric acid, and decoloration of the solution of the per-manganate of potassa. When glass slides were moistened with ice cold water and held so as to receive the breath of yellow fever patients in respiratiou, the microscopical examination yielded results similar to those recorded above. After the most minute examination of the individual specimens from the different rooms in Mr. Harrison's house, not only immediately after the experiments, but also during various periods, embracing nearly six months, I discovered no forms which could be referred to such microscopical plants as the Chlorococcum vulgare, Protococcus viridis, Palmella cruenta, Coccochloris brebinonii, and other confervoideae, or unicellular ■algae capable of producing chlorophyl. Certain granular cells observed in malarial fever (in the blood), resemble most nearly the resting spore of Bulbocluete intermedia, and the granular cells of Palmella cruenta; but no such cells were observed in the yellow fever atmosphere in the brick house 363 Magazine street. In fact it would be difficult to con- ceive how the algae of any description could thrive and multiply in this well paved and dry situation. The forms were referable to those most nearly connected with putrefac- tion and fermentation, as the Bacteria and Torulae, Penicillins and Micrococci and Cryp- tococceae. Kutzing includes his genera Cryptococcus. Ulvina and Sphaerotilus, amongst the families of algae, but they appear to be the conidia (reproduction cells, stylospores and spermatin) of the mycelia of mildew fungi. The absence of any of the known forms of the algae' in the air of yellow fever collected in this locality, which is as free from any source of swamp malaria as the best drained and paved portions of the city of New Or- leans, is important in that this class of plants is thus excluded from the consideration of the questions relating to rhe origin and causation of yeilow fever. Experiments upon living animals with the ivater through which the yellow fever atmosphere had been passed, in the brick residence, 363 Magazine Street. The liquid obtained by passing the air of the rooms in which the yellow fever patients lay through ice and ice-cold water, was conveyed immediately to my laboratory, and injected subcutaneously into eleven rabbits and two pigeons. In several of the rabbits the water was injected directly into the blood, through the large vessels of the ears. In the pigeons, the liquid was injected into the pectoral muscle. No rabbit was destroyed by these procedures, although abscesses formed in several places in different animals, in the neighborhood of the points of injection, and in such instances the animals manifested febrile phenomena. A pregnant female rabbit gave birth to four living rabbits several ■days after the experiment. The mother appeared to have no milk, and although we attempted to rear the young ■ones by artificial means, they perished; the mother, however, survived and is still living, and has since given birth to thirteen rabbits, seven at one time and six at another. One of the pigeons was killed by a cock in my yard, about ten days after the injection of the " yellow fever water" into the left pectoral muscle. Upon dissection, I found the left side to be atrophied and in a state of acute fatty degeneration. Upon microscopical ■examination, I found that some of the fibres of the blanket covering the yellow fever patient had been ejected along with the water into the pectoral muscle. Two views may be taken as to the effects produced upon this bird. 1st. The fibres of the blanket acted as a local irritant, and induced fatty degeneration and atrophy of the muscular tissue. 2d. The grannlar matter and spores of the yellow fever atmosphere induced chemical ■changes in the muscular structures, which were converted into oil. The latter supposition is at least worthy of consideration, as the yellow fever poison induces rapid fatty degeneration of the heart, liver and kidneys. It is also worthy of note, in this connection, that the granular matter possessing active motion, as well as the sporules, of the yellow fever atmosphere, are found in greatest abundance adhering to the fibres of cotton and wool condensed in the water. The other pigeon was killed at the end of two weeks, and found to be healthy. II. Second Group of Cases, 46 South Villere street, 44 South Villere street and 47 liobinson street. Low situation-mud streets, withfoul, ill drained gutters, reeking with filth, foul drain running through yard. Nine cases of yellow fever occurred in these three houses, between July 31st,, and August 15th, of which number two died. 84 Joseph Jones, AL D., on Yellow Fever Atmosphere. The air of the rooms in which the patients suffered with yellow fever, also that obtained from the neighborhood of a foul stinking gutter in the yard of 46 S. Viller^ street, which also acted as a surface drain to the surrounding houses, was subjected to the same treatment as in the residence 363 Magazine street, 400,000 cubic centimetres of air, in each of these sick rooms, containing four cases, were passed through crushed ice and ice-cold water, during the day and also at midnight; 600,000 cubic centimetres of air were at midnight treated in the same manner, the bellows being held over the foul drain in the yard. Total amount of air thus examined at the locality, 1,800,000 cubic centi- metres. The air from the sick room presented the same elements as were observed in the preceding experiments on Magazine street, with the addition of several hundred cells which evidently belonged to the plants, resembling the chloroccum vulgare, protococcus viridis and palmella cruenta. The true characters of these elements were fully shown by examinations of the water, at various periods extending over five months, during which time the cells increased considerably in size. The most numerous elements were as in the case of the water obtained from the sick rooms at 363 Magazine street, minute spores, minute thread-like bodies, bacteria, and minute granules which could not be resolved by the highest powers into any distinct animal or vegetable structure, epithelial cells, oil globules, several parasites from the skin, and fibres of wool and cotton, and particles of dust were also observed under the microscope. The crystalline bodies also appeared when the liquid was slowly evaporated. The water through which the air over the foul gutter was passed contained chiefly cells of the plants resembling the algae, as the resting spores of Bulbochaete intermedia chlorococcum vulgare protoccus viridis, and palmella cruenta. Bacteria and minute spores and minute particles were also abundant. When the waters obtained in the mannerstated from this locality were injected subcu- taneously into living animals, the results were similar to those previously detailed. Third Series of Cases: Examination of Air of Residence 495 St. Charles Street, corner St. Andrew, Surrounded by Low, Ill-drained Dirt Streets and Foul, Stinking Gutters-Mala- rial Fever not Infrequent in this Locality-New Orleans, 1878. Eight cases of yellow fever occurred in the house 495 St. Charles street, at which the author and his family resided during the yellow fever epidemic of 1878 ; of this number no one died, all recovered, Four cases recovered from September 16th to October 4th, and five cases subsequently. The experiments upon the atmosphere of this house were made before the occurrence of the first case attacked September 16th, and during the progress of the first four cases of yellow fever. About 1,900,000 cubic centimetres of air of the lower rooms (only occu- pied during the day) and of the sleeping apartments, both before and after the preva- lence of the fever were subjected to the influence of artificial cold. As in all the preced- ing and subsequent experiments, the purest ice was employed. Upon careful examina- tion and chemical analysis of the two varieties of ice used in New Orleans, the Boston ice and the Louisiana ice, the latter being manufactured by artificial cold in the city from distilled water, I found them to be free from organic impurities; and whilst the artificially preparedice was entirely free from all saline matters, the Northern or Boston ice contained only traces of the chlorides and sulphates. The experiments conducted at 495 St. Charles street yielded results essentially similar to those obtained at 363 Magazine and 46 South Viller^ streets. Thus the water, after the passage of the air of the lower rooms, which were used only as sitting and reading apartments, presented a clear and transparent and coiorless appearance, with only a few sporules : that obtained from the rooms during the prevalence of the fever presented a milky and turbid appearance, and contained numerous spores of various sizes, the most minute requiring the highest powers for their detection ; also minute particles of vibrating matter, which could not be resolved into specific shapes under the highest powers. As in the previous examinations, the particles of cotton woo', and of wool originally floating in the air and condensed in the cold water, contained vast numbers of these spores and minute particles, adhering to the fibres and entangled in the meshes. It is but just to conceive that the clothing and bedding of the patient become more or less permeated by these minute particles and spores. We have thus a practical demon- stration of the possibility of the contamination of the clothing of patients by matter in a minute state of subdivision, a portion of which, as the sporules, are capable of reproduction. After standing some time, I observed a few cells, chlorococcum, protococcus, and the resting-spores of several of the unicellular algae. This locality, as that at 46 South Villerd, may be regarded as favorable to the development of the algae, as the gutters are wide, deep and simply excavated in the earth at the sides of the street. Both St. Charles and St. Andrew streets are in this locality unpaved, and during periods of continuous rains, the streets become almost a quagmire of tenacious mud. Experiments on Organized Bodies in Yellow Fever Atmosphere. 85 In these deep " mud gutters " numerous algae flourish, and also numerous insects are developed, and the congo-snake (amphiuma means) find a congenial home and attains a large size. I will state that in the present examination, as well as in the preceding experiments at 363 Magazine street and 46 South Villerd street, and in the subsequent observations at the corner of Carondelet and Milan streets, drawings of the microscopical objects were executed and preserved for comparison. The microscopical objects themselves have also been carefully viewed in my laboratory by three members of the Board of Health of the State of Louisiana, and by my friend and colleague, Professor Elliott, and by Professor R. S. McCulloch, of Baton Rouge. No difference of opinion existed as to the nature of the objects obtained from the yellow fever atmosphere. It is to be hoped that in the future similar observations will be made, at various times and in various portions of our country; not merely during yellow fever epidemics, but also during periods of health and of epidemic visitation by divers diseases. IV. Group of Cases in the house at the corner of Milan and Carondelet streets ; malarious locality ; exposed to the direct winds of the low grounds and swamps. Seven cases of yellow fever occurred in this house, between September 22 and October 5, of which one case terminated fatally. The house in which this family dwelt was the only one on the entire square, and in fact there were no houses between it and the swamps towards the lake. The location was low and subject to overflow in high water. The rooms were small and ill ventilated. I caused the disposal of the patients through the various rooms. The family consisted of six : father, mother and four children, all of whom were attacked, the cases dating as follows: September 20th, September 22d, September 26 th, September 29th, October 4th, October 5th. One death occurred in the six cases. The air of the various rooms in which the sick lay was subjected to examination in the manner previously described, 1,100,000 cubic centimetres being thus operated on. Upon microscopical examination, in addition to the minute particles of matter possessing Vibratory motions, and minute sporules, bacteria and animalcules, the water contained numerous larger vegetable cells with nucleus and nucleolus, about the size of the color- less corpuscles of the blood, and of a distinct green color. These cells resembled most "nearly those of the chlorococcum vulgare and of the protococcus viridis and of the coccochloris brebiuonii and resting spore of Bulbocheete intermedia. We also observed colored granules and colored granular cells of a dark brown and reddish brown color, similar in all respects to the dark granular bodies and dark granular cells observed in the blood of malarial fever. These were probably a species of palmellm resembling the cells of palmella cruenta. Iodine imparted a distinct blue color to many of these cells. Upon evaporation, pris- matic crystals formed, which were rendered deep blue by a solution of the sulphate of 'copper. The water thus obtained from this sickroom of the small house (corner of Milan and Carondelet streets) was injected into 5 (five) rabbits, subcutaneously. In some instances it produced local irritation and abscesses attended with febrile symptoms; but no rabbit was destroyed by the liquid. The results were similar to those obtained by the injection of the water obtained in the residence 363 Magazine street; although the liquid obtained at the former locality con- tained organized elements, and more especially the algae, which were not preseut in the latter. The most marked change observed in the liquid obtained m the dwelling at the corner ■of Milan and Carondelet streets, by the lapse of some three and a half months, was the growth of the unicellular algae and the formation of fillaments by the fungi. Origin of Hospital Gangrene, Erysipelas and Puerperal Fever. We alluded to the conditions which appeared to be essential to the origin and spread of yellow fever, and cited the instance of the production of moist or hospital gangrene, de novo amongst the Confederate troops during the American Civil War. The origin of hospital gangrene as well as of erysipelas can be traced to the foul air of ill-kept hospitals, in which wounds, whether accidental or made by operative surgery, undergo certain characteristic marked changes, in which specific poisons orcon- tagions are developed. Traumatic erysipelas as well as hospital gangrene furnishes a specific-contagion from the affecied materials of the body, and may be regarded as a zymotic disease. Numerous facts establish that a physician goingfrom a case of erysipe- las to a puerperal woman, may convey the specific contagion to the uterine surface, and inay occasion death by that form of puerperal fever, which has justly been regarded by pathologists as intra abdominal erysipelas, 86 Joseph Jones, M. D., on Hospital Gangrene. Mr. John Simon,* has well observed, that to say that erysipelas is contagions, is not to say that no case of it can arise without contagion front a previous case. In this res- pect hospital gangrene, pyaemia and erysipelas appear to ho d a peculiar place among the zymotic diseases; and it isprobable that full aud careful research may show that this peculiarity is equally shared by yellow fever. Probably of the specific contagia, those of erysipelas and hospital gangrene, stand in nearest affinity to the ferments of common cadaveric decomposition, and are therefore most apt to arise de novo, whenever certain animal textures and juices fall into common putridity. Dr. Semelweiss believed that the immense mortality from puerperal fever in the division of the Vienna lying in, hospital, varying from about a fourth to about a ninth part of all the deliveries which took place there, to depend on an infection the real source which was to be forced in the hands of the medical men in attendance, contaminated with cadaveric poison. The other division of the hospital (reserved for the practical instruction of midwives, whose train- ing does not require them to be brought into contact with dead bodies) suffered only about the tenth part as much as the first; and this was the more noticeable as the second division was inferior to the first in the size and airiness of the wards. Dr, Semel- weiss, acting upon his supposition as to the cause of the disease, required that the male- attendants of the first division should, as much as possible, avoid contact with cadaveric matter; that after such contact they should never make a vaginal examination till the following day ; and that, besides very thoroughly cleaning their hands, they should sys- tematically disinfect them ivith a solution of chlorine. The latter precaution was not in-, troduced till some months after the more general precautions had been adopted. The result of these measures was that the mortality of the first division at once fell to the usual average of the second division. In 1846 the death rate per cent had been 13f ; .in, 1847 it was 5 1-5, and in 1848 it was If. This well known and often quoted instance clearly established the possibility of the- spontaneous generation of the erysipelas contagium, from unhealthy and gangrenous wounds, exposed surfaces of decaying animal matter undergoing similar putrefactive changes to those of the cadaver in the gissecting room : wherefore, if cadaveric decomposition can furnish the contagium of erysipelas and puerperal fever, it is evident that every surgical ward, in virtue of the natural processes of disease going on in it, maybe the birth-place of that contagium. The influence of the contagium thus engendered, fr.om a wound of such severity as to involve local mortification and its influence on the surrounding atmos- phere would be determined by circumstances; if the ward be well ventilated, dilution, and oxydation may render it inert in a short period, and before it had traveled far from its source; on the other hand, in an ill-ventilated ward crowded with ill-conditioned' surgical cases, the unclean atmosphere abounds with material which the contagium probably converts into its own likness, and thus all the wounded might be brought under its influence, and a so-called epidemic of erysipelas established. In addition to the danger that the contagium might thus, by commingling of atmosphere, spread from one patient to another, there is also the danger that the attendants in the successive operations and: wound dressings which they perform, may carry the specific poison from the part of a ward to another, and even to remote wards. If the preceding familiar illustration, drawn from surgical pathology, be applied to the- elucidation of the origin of yellow fever, no substantial or rational objection can be urged that this disease, in like manner with hospital gangrene, erysipeias and puerperal; fever, may arise under certain circumstances de novo, when the human constitution in a, peculiar state, is subjected to the conjoint operation of heat, moisture and the agents and products of the fermentation and putrefaction of animal and vegetable substances. The conditions of heat, moisture and crowding, together with the products of putre- faction of animal and vegetable filth, appear to be the most important factors in the spontaneous origin of the disease. When once the specific cause, the contagium of the disease is thus developed, as in the case of the spread of puerperal fever, erysipelas and gangrene, the spread of yellow fever will depend upon several causes, as continuous heat of a certain degree, a certain amount of moisture in the atmosphere, and the relative purity or impurity of the air of the ship or city in which the disease originates, and to which its victims and their effects are transported. The demonstration by the micro- scope of numerous living organisms (spores of plants, bacteria and animalculm), and of minute animal and vegetable particles in the yellow fever atmosphere, and the fact, also, that these minute bodies are found in greatest abundance, in the meshes of the particles of wool and cotton floating in the sick room, is important, as it illustrates the mode in which the contagium of the disease may be propagated aud wafted from house to house, and across cansiderable spaces. In this view it is not necessary to regard the micrococci and criptococci, bacteria and spores, and minute particles, as the essential causes of this disease, although in the countries and under the circumstances in which yellow fever prevails, they are necessary companions of the yellow fever contagion, and may take part in its elaboration, during certain putrefactive changes, and may be the vehicles of its propagation through the atmosphere, and of its preservation and concentration in spongy fabrics, as cotton and woolen clothing. * Sixth Annual Report of the Local Government Board, 1876. 1877, London 1878, p. 41, Joseph Jones, AL D., on Atmosphere of Yelloic Fever. 87 AGENCY OF THE ORGANISMS OBSERVED IN THE ATMOS- PHERE OF YELLOW FEVER AND IN THE BLOOD AND BLACK VOMIT. The following hypothesis may be framed as to the nature of yellow fever and the agency of these organisms in the spread of this disease: 1. Yellow fever may be regarded as a disease depending solely upon changes of heat, moisture and other climatic conditions, acting upon the human constitution in a certain state, or the absence of ozone or electricity from the atmosphere. But if this supposition was true the disease would appear in all quarters of the city simultaneously, and not ramify from a focus and along lines of travel. 2. Heat and moisture and other climatic conditions, affecting the human constitution when in a certain state, cause the development of a certain poison in the system thus acted upon, and in this pecular state become capable of propagation ; or, in plain language, the poison thus developed possesses contagious properties. 3. Yellow fever may be propagated by the direct emission or some poison from the person infected, either from the breath or the secretions. In this way the poison would be propagatered by contact, and would have no power of independent growth or self multiplication outside of the in- fected person. 4. The poison of yellow fever may be conveyed by minute forms of plant or animal life, the plant or animal finding a nidus for its growth in secre- tions, as black vomit and the dejecta from the bladder and intestines. The minute forms of plant and animal life thus rendered poisonous in virtue of their development and multiplication in black vomit and ti e secre- tion and excretions and corpses of yellow fever patients, are capable of con- veying the poison by attaching themselves to clothing, bedding, the sides of houses and ships, and to articles of merchandise or by being wafted about by currents of air. 5. Yellow fever may be due to special germs, indigenous to a limited por- tion of the world. It may be supposed that this germ exists independent of the human organism, and may be transported in ships, clothing and articles of merchandise; that it thrives in its native locality, and whilst it propagates outside of that locality, it will not exist for any great length of time, frost killing it. With this hypothesis may be coupled the supposition that these germs have potency only when in contact with disease matters. PRACTICAL APPLICATION OF THE RESULTS OBTAINED FROM THE EXPERIMENTS ILLUSTRATING THE NATURE OF THE AIR IN YELLOW .FEVER AND THE POIS- ONOUS PROPERTIES OF BLACK VOMIT AND PUTRID BLOOD. 1. The fact that putrid blood or black vomit of yellow fever develope im- mense numbers of bacteria and micrococci, and the still more important fact that the black vomit and blood of yellow fever destroy life when in- jected even in moderate quantities (sub cutaneously) explains why so many deaths have been traced to the exposure of putrid corpses 88 Agency of Organisms in Yellow Fever Atmosphere. 2. Even if the rapid putrefaction of the yellow fever corpses and secre- tions and excretions be due to the agency of low organisms which are not in themselves noxious, nevertheless they become poisonous in virtue of the nidus in which they are developed. 3. Yellow fever is to be combatted in the first cases by isolation, by dis- infection, fumigation, cleansing, and by the destruction of all infected articles _ 4. Intermural burials are, under all circumstances, dangerous, and should be discarded. The method of burial in structures above ground, practiced in New Orleans, is especially dangerous. 5. Cremation properly conducted furnishes the best and safest mode of disposing of the dead in all cases, but more especially in yellow fever, small-pox and asiatic cholera. QUARANTINE AND THE SANITATION OF SHIPS If yellow fever never originates in New Orleans, then the grand means for its exclusion rests in a rigid and efficient quarantine. By quarantine, we do not mean simply a definite period of detention, however essential this may be in semi-tropical climates; but we include under this head all those hygienic and sanitary measures of cleanliness, ventilation, purification, fumigation and disinfection whieh tend to pre- serve ships' crewsand passengers from infection, and which tend to destroy the contagium of yellow fever after its development. The sanitation of ships, including under this head the thorough fumiga- tion and cleansing of ships, and the proper attention to the physical, men- tal and moral welfare of seamen, is of the highest importance to the wel- fare and advancement, and uninterrupted intercourse and health of the great nations who control the destinies and make the history of the nine- teenth century. Upon assuming the duties of the President of the Board of Health of the State of Louisiana, in April, 1880, the necessity for collecting and pub- lishing all the laws of Louisiana bearing on quarantine and sanitation was ;at once realized, as the acts of the Legislature, the ordinances of the City Council, and the rules and regulations of the Board of Health, were scat- tered through various official documents, or existed only in manuscript, or in the archives of the City Hall and Board of Health. The quarantine laws of the State and the sanitary ordinances of the city and Board of Health were collected and published, and that order might flow from this confused mass, the following rules and regulations were elaborated, giving directions as to the inode of conducting quarantine, and as to the proper disinfection and cleansing of vessels. Guided by this quarantine code, Louisiana has been protected during three and a half years up to the moment of writing this, July 4th, 1883, from the introduction of yellow fever. Joseph Jones, M. D., on Quarantine Regulations. 89 RULES AND REGULATIONS OF THE BOARD OF HEALTH OF THE STATE OF LOUISIANA FOR THE GOVERNMENT OF QUARANTINE OFFICERS AND STATIONS, AND FOR THE EN- FORCEMENT OF THE ACTS OF THE LEGISLATURE OF LOUI- SIANA, "ESTABLISHING AND REGULATING QUARANTINE FOR THE PROTECTION OF THE STATE." At a meeting of the Board of Health of the State of Louisiana, held on May 24, 1880, in the State House, the President, Dr. Joseph Jones, submitted the following Rules and Regulations relative to Quarantine, which were unanimously adopted. The President was authorized to cause the publication and distribution of said rules: OFFICE BOARD OF. HEALTH, STATE OF LOUISIANA, / New Orleans, May 24, 1880. $ SANITARY RULES FOR SHIPPING. Hides and Regulations to be Observed by Vessels Duriny their Stay in the Port of New Orleans, and in Other Ports and at the Various Quarantine Stations of Louisiana, and on their Passage To and From New Orleans. SANITARY RULES. 1. Each ocean-going steamship or sailing vessel should be provided with a competent medical officer versed in the sanitation and hygiene of ships sailing in tropical or semi- tropical waters. 2. Physicians attached to ships, steamships or vessels of any description, should be considered as the Health Officers, and should be charged with the duty of watching their sanitary condition, and with the conduct of those operations which will promote in the highest degree the health of the officers, crew and passengers, and prevent as far as pos- sible the introduction of contagious and infectious diseases. 3. As far as possible, the commerce of New Orleans with insular, tropical and sub- tropical America, should be conducted by acclimated officers and crews. By the term acclimated, is understood those who have suffered at some period of their lives with yel- low fever. 4. The attention of the captain, master or medical officer, shall at all times and under all circumstances be directed to the personal cleanliness of the crew, and to their food and drinking water. 5. Neither the officers nor the crew should be allowed to sleep on shore at night, or on deck, unless protected by an awning. 6. When in tropical and semi-tropical ports, the officers and men should hold as little intercourse with the shore as possible. 7. Unless when engaged in the reception or discharge of cargo, vessels should lie in the harbor as far as practicable from the shore. 8. Earth, sand or soft porous rock should not be used as ballast. As far as practicable, the ballast should consist of hard rock, iron and other metals. 9. All vessels loading or unloading should pump out the bilgewater and wash out with fresh water until the bilge water shall be odorless. Then a solution of one part of carbolic acid (Calvert's No. V), to fifty parts of water, or the following compound should be introduced and allowed to remain: Sulphate of iron (Copperas).. fifty pounds. Carbolic Acid (Calvert's No. V) two gallons. Water - fifty gallons. Every five days oil the passage undiluted carbolic acid should be poured down the pump or sounding tube, and the entire hold and between decks sprinkled with one part carbolic acid (Calvert's No. V), to fifty parts of water. When practicable, it is especially recommended that the hold should be fumigated with sulphurous acid gas, or chlorine gas. As far as practicable the hatches should be kept open, both while in port or at sea, and the largest possible amount of fresh air be introduced between and below decks, by the use of wind sails and ventilators. White-washing of the unpainted wood-work below and between decks is recommended. 10. At the close of each day, while in tropical and sub-tropical ports, all the crew should wash their entire persons, leaving off all the clothing worn that day (for washing) and dress in clean flannels and clothing throughout. 90 Quarantine Regulations of Louisiana. Ah soon as the weather will permit after leaving port, all mattresses, bedding and similar material should be got up on deck, and sunned and aired for several hours, this to be repeated every two or live days during the passage, if the weather permits. 11. All baggage and clothing of passengers should be exposed to the air, and disin- fected or fumigated as soon as possible after coming on board, and again before arriving at Quarantine Station and the harbor of New Orleans. 12. Baggage-rooms, water-closets, dirty linen, lockers, cabins and berths, should be kept thoroughly clean and disinfected. 13. The quarters of the crew should be kept clean and disinfected. The Captain and Medical Officer should direct their especial attention to the general hygiene of the crew and passengers. ISITATION AND INSPECTION OF VESSELS BY QUARANTINE PHYSICIANS. Sec. 4. Vessels arriving at the Quarantine Station, shall immediately proceed to the Boarding Station, and shall be visited by the Quarantine Physician, between sun-rise and sun-set, as soon as possible after such arrival. The Quarantine officer shall inspect the ship, and require of the captain or master answers in duplicate to the following questions: • QUESTIONS To be propounded by the President, Quarantine Officers and Deputy Inspectors of the Board of Health of the State of Louisiana, to the Masters, Captains and Medical Officers of Vessels at the Port of New Orleans and Quarantine Stations of Louisiana. Port or Station Date of Inspection ; 188 1. Name of Vessel ? 2. Name of Captain or Master ? 3. Tonnage or Class of Vessel ? 4. From whence is the Vessel you command ? 5. How many days have you been on the passage ? 6. At what port or ports have you touched ? 7. Were any Contagious or Infectious Diseases prevailing at the port from whence your Vessel sailed ! 8. If so, name the Disease ? 9. Were any Contagious or infectious Diseases prevailing at the port or ports at which you touched? 10. If so, name the Disease ? 11. Was any freight or passengers received at the ports at which your vessel touched ? 12. If so, give particulars. 13. Have you any Bills of Health ? 14. If so, produce them. 15. During the course of your Cruise or Passage, what cases of Disease have occurred on board ? 16. At what dates ? 17. Have any deaths taken place on your Vessel since you left the last port ? 18. If so, at what dates and from what causes ? 19. Are there any sick on your Vessel at this time ? 20. Has Yellow Fever, Small-Pox, Cholera or Plague ever existed on this ship ? 21. If so, when ? 22. What is the number of Officers ? 23. What is the number of the Crew ? 24. What is the number of Passengers ? 25. What is your cargo ? 26. To whom is the cargo consigned ? 27. What is the present sanitary condition of your vessel, cargo, crew and passengers ? 28. Have you a Medical Officer ? 29. Give the name of the Medical Officer ? 30. Produce the Reports of the Medical Officer ? Signature of Master or Captain Subscribed to before me, Witness: The preceding questions and answers shall be signed in duplicate, one copy to be retained at the Quarantine Station and the other to be transmitted to the President of the Board of Health. Joseph Jones^ M. D., on Quarantine Regulations. 91 ■Disinfection, fumigation and Purification of Vessels from Ports in which Yellow Fever Usually Prevails. Sec. 5. All vessels from ports in which yellow fever usually prevails, or from ports where other conta- gious or infectious diseases are reported to exist, shall be detained at Quarantine Stations, for purpose of • disinfection, fumigation and purification, and shall be disinfected, fumigated and purified. Vessels from Infected Ports to be Detained at Quarantine Stations not less than Ten Days. Sec. 6. All vessels from ports in which yellow fever is prevailing, or from ports where other contagions or infectious diseases are reported to exist, shall be detained at Quarantine Stations, for observation, dis- infection, purification and fumigation, not less than ten days, or for such length of time as the Board of Health may determine. Sec. 7. In case yellow fever, cholera, or plague, or small-pox, or typhus fever, prevails in epidemic form at the port from which the vessel sailed, or at any port at which she has touched during the voyage, or on any vessel with which she has come in contact during the vovage, the detention shall not be less than sufficient to complete the full period of ten days from the date of exposure to such infection. Vaccination. Sec. 14. Every officer, seaman and passenger should be vaccinated by competent physicians,with pure and fresh vaccine matter, at the port of departure, unless the subject presents satisfactory proofs of successful vaccination, or a previous attack of small-pox. Sec. 15. The quarantine officers of Louisiana should examine the officers, seamen and passengers, with reference to his or her protection against small-pox, and in the event of failure to produce satisfactory evidence, should at once proceed to execute the necessary vaccination with pure and fresh matter. Infected Vessels-Rules and Regulations governing infected vessels at Quarantine Stations, Sec. 16. In case of yellow fever, cholera, small-pox, typhus fever, plague, or any other infectious or con- tagious disease, has attacked whilst in port, or during the voyage, or whilst lying at the Quarantine Station, one or more of the crew or passengers of the vessel, she shall be subject to'the following rules and regu- lations : Sec. 17. The crew and passengers shall be inspected by the Quarantine Physician, and if any are sick, thej» shall be removed to the proper hospital. Sec, 18. The clothing, baggage, bedding and equipage of the crew and passengers, both sick and well, shall be exposed to the air, and shall be ventilated, purified, disinfected and fumigated. The hatches shall be opened, and the vessel as far as possible ventilated ; the hold and cabin of the vessel and all closets and clothing, linen, carpets, curtains and fabrics of every description, shall be thoroughly fumigated with sulphurous acid gas; baggage-rooms, cabins, lockers, water-closets, and all parts of the vessel to be thoroughly ventilated, fumigated, disinfected and cleansed. The bilge-water shall be pumped out, and washed out with fresh water, tmtil the bilge-water shall be clear and odoiless. The following solution of sulphate of iron (copperas) and Calvert's Carbolic Acid No. 5, shall be introduced and allowed to remain. Disinfectant to replace 'bilge-water and also for cleansing water-closets and washing decayed or foul wood on ship board. Sulphate of iron (copperas) fifty (50) pounds ; Carbolic Acid (Calverts's No. 5) two (2) gallons ; Water fifty (50) gallons. This disinfectant is readily prepared by suspending 50 pounds of copperas in a straw basket, in the upper portion of a water-tight barrel or cask, and pouring water upon the copperas, until the barrel is nearly full, and then adding two (2) gallons of carbolic acid (Calvert's No. 5). The copperas will be dissolved during the filling of the barrel. This disinfecting, deodorizing, and antiseptic fluid may be extemporaneously pre- pared at any time on ship board in the course of half an hour. This solution should be used in the cleansing and purification of all unpainted wood-work, in the hold, between decks, in the forecastle, cabins, lockers and water-closets. Coal tar constitutes an excellent paint for the interior of infected vessels, and when practicable should be applied to all unpainted wood-work, including the bottom and sides of the hold, and the upper and lower portions of the deck. A mixture of solid asphalt, carbolic acid and turpentine is a valuable paint and disinfectant. Sec. 19. The amount of sulphur consumed during the fumigation of a vessel should be regulated by the size and capacity of the craft, nature of cargo, and general hygienic condition. When sulphur- is burned in iron pots, or pans, the fumigation should be continued until the sulphur is extinguished in the consumption of the oxygen of the air and the liberation of the sulphurous acid gas. At least two pounds of sulphur should be burned for every 1000 cubic feot of space in the vessel. The num- ber of fumigations will in like manner depend upon the condition of the vessel, crew, passengers and cargo. Sec, 20. If, in the judgment of the Board of Health, a vessel require it, the Quarantine Physician may order the following sanitary measures :-Baths, or other bodily care for the person; washing, or other disinfecting means for clothing; displacement of merchandise on board, or complete breakingout; subjection to high steam, incineration, or submersion at a distance below the surface of the water, for infected articles; the destruction of tainted or spoiled food, or beverages ; the complete ejection of water ; thorough cleansing of the hold, and the disinfection of the well. In short, the complete purification of the vessel in all her parts, by the use of steam, fumigation, force-pumps, wind-blasts, scrubbing or scraping, painting with coaltar, or a mixture of carbolic acid, turpentine and asphaltum, and finally detentention at quarantine anchorages until these means are perfected. Sec. 21. All articles which have been in contact with persons sick with contagious or infectious diseases, should be burned, or treated with a boiling hot solution of sulphate of zinc and common salt, dissolved to- gether in water, in the proportion of four ounces of sulphate of zinc and two ounces of salt to the gallon. Discharge of Cargo aud Purification on Infected Vessels. Sec. 22. Whenever it shall be deemed necessary by the Board of Health, the cargo of any vessel dan' gerously infected shall be discharged in lighters, or transferred to the ware-house especially prepared for its reception. After the discharge of cargo, the vessel shall be thoroughly cleansed, disinfected and ventilated ; the hold, the forecastle, or sleeping apartm >nts of the crew, and the cabins for passengers, as well as bunks, or por- table berths, shall be thoroughly cleansed, disinfected and ventilated 92 Quarantine Regulations of Louisiana. All decaying wood shall be scraped and disinfected with .strong solutions of sulphate of iron and carbolie acid. The decks and unpainted woodwork should be treated in like manner. Until the process of discharge of cargo and purification has been completed to the satisfaction of the Siarantine Physician, there shall be no communication between the vessel and the other vessels, except by e written permit of the Quarantine Physician. Every person who shall go on-board of any vessel while performing quarantine without the permission of the .Resident Physician, or his assistants, shall forfeit the sum of fifty dollars. Bules Governing the Sick at Quarantine Stations. Sec. 23. The sick shall be detained in hospital nntil recovery, and for such a time afterwards as will insure that they will not communicate or transport the cause of disease. Passengers under observation shall be detained at least ten days from the time of the last exposure, or during tho period of incubation of the disease or diseases for which the ship is detained. In case of the occurrence of other contagious or infectious diseases, they shall be detained until, in the judgment of the quarantine officer, they may be safely permitted to proceed to their destination In the case of small'pox occurring on board a ship arriving at any port, the sick shall be sent to the hospi- tal, and all not sick shall be immediately vaccinated, unless offering evidence of previous satisfactory vac- cination, or of a previous attack of small-pox. Sec. 24. Persons employed at Quarantine Stations, who have been brought in contact with infected ves- sels, shall not be permitted to leave such station until their clothing has been washed and disinfected, nor until an interval of ten days since their last exposure to infection. When Necessary, the Public Health to be Protected by Additional Measures. Sec. 25. It shall be the duty of the Quarantine Physician to take the responsibility of applying such ad- ditional means as may be deemed indispensable for the protection of the public health ; but in all such cases the Quarantine Physician shall report immediately and fully his action to the Board of Health. Classification of Merchandise at Quarantine Stations for Sanitary Measures. Sec. 26. For the purpose of sanitary measures, merchandise shall be arranged in three classes : 1. Merchandise to be submitted to an obligatory quarantine, and to purification. 2. Merchandise subject to an optional quarantine; and 3. Merchandise exempt from quarantine. • The first class comprises all clothing, personal baggage and dunnage, rags, paper-rags, hides, skins, feathers, hair, and all other remains of animals, cotton, hemp woolens and coffee in bags. The second class comprehends sugar, silks and linen, and cattle. The third class comprehends all merchandise not enumerated in the other two classes. With existing quarantinable disease on board, or if there be any such disease on board within the ten days last preceding, merchandise of the first class shall be landed at the quarantine warehouse. Merchandise of the second class may be admitted to pratique immediately, or transferred to the ware- house, according to circumstances, at the option of the quarantine officer, with due regard to the sanitary condition of the port. Merchandise of the third class shall be declared free, and admitted without un- necessary delay. Bules Begarding Foul Vessels. Sec. 27. If any vessel, though not having had during the voyage any case of quarantinable disease, yet be found in a condition which the Quarantine officer shall deem dangerous to the public health, the vessel and cargo shall be detained until the case shall have been considered ; the decision of the quarantine officer, however, in all such cases, shall be rendered within twenty-four hours. Vessels in an unhealthy and foul state, whether there has been sickness on board or not, shall not be allowed practique, until they shall have been duly cleansed and ventilated. Duties and Powers of the President of the Board of Health. Sec. 28. It shall be the duty of the President of the Board of Health to reside in New Orleans and superintend the different quarantine stations of the State, and it shall be his duty to visit them as often as the Board of Health may deem it necessary. He shall have the power to issue, during the adjournment of the Board of Health, to constables or the sheriff, all orders and warrants provided by the provisions of the "Acts of the Legislature of Louisiana, establishing end regulating Quarantine for the protection of the State, " and shall report to the Attorney General all violation of the same. Whenever it shall be necessary so to do, the President of the Board of Health shall have power to issue his warrant to the Sheriff of the city or parish where any vessel may be, having violated the provisions of'the "Acts establishing and regulating Quarantine for the protection of the State," commanding him to remove said vessel to the quarantine ground, and arrest the officers thereof, all which warrant shall be executed by the officer to- whom the same shall be. directed, who shall possess the like powers in the execution thereof, and be entitled to the same compensation as if the same had been duly issued out of any court of the State. Legislative Acts Establishing and Defining the Powers of the Board of Health, State of Louisiana, Belative to Quarantine. Sec. 29. The Board of Health of the State of Louisiana establishes the following rules and regulations relative to Quarantine in virtue of the powers conferred by the several Acts of the Legislature of Louis- iana, "establishing and regulating Quarantine for the protection of the State," viz : " An Act to establish Quarantine for the protection of the State." approved March 15. 1855. An Act supplementary to an Act entitled 'An Act relative to Quarantine,' approved March 18, 1858. "An Act to amend an Act entitled 'An Act to establish Quarantine for the protection of the State," approved March 16, 1870. "An Act to authorize and empower the Board of Health of the State of Louisiana to detain and disinfect, and to pass after disinfection, vessels from infected ports, at and from quarantine stations, in lieu of a time of quarantine detention in certain cases, and to repeal conflicting laws," approved March [24, 1876. "An Act to reorganize and render more efficient the Board of Health of the State of Louisiana ; to define its powers and prescribe its duties and those of Quarantine and other officers under its control; to provide for its expenses, and for the recording of births, deaths and marriages in the parish of Orleans ; and to provide penalties for the enforcement of this Act and for violation of the same,, and for the ordinances and orders made in pursuance thereof," approved April20, 1877. Joseph Jo ties, I)., on Quarantine Regulations. 93 Powers of Board of Health relative to Quarantine. Sec. 30. In accordance with the said acts of the Legislature of the State of Louisiana, the Board of* Health has power to fix the number of days of Quarantine for vessels liable to it; to determine how said, quarantine shall be performed, and to make any and all legal regulations not contrary to said acts, necessary to carry out a proper system of quarantine and to enforce the same; to make rules and. regulations for preserving good order and police within the limits of the quarantine grounds, and to impose penalties for the breach thereof; to contract for the necessary buildings at Quarantine grounds; to establish rules and regulations for the guidance of the Quarantine physicians, assistants and employees ; to employ nurses and assistants to attend the sick, and such other persons as may be necessary to carry out proper quarantine regulations and to fix their compensation. Power of Board of Health to issue Proclamation of Quarantine. Sec. 31. In case of emergency the Board of Health shall have power to issue proclamation of quarantine, without reference to the Governor, and to enact all needful regulations for the enforcement of the same. Power of Board of Health to issue their warrant to the Sheriff of the City or Parish where any vessel may he, having violated the quarantine laws. Sec. 32. The Board of Health shall have power to define the duties of officers employed by them, and impose additional duties to officers appointed under the Acts, entitled " An Act to establish Quarantine for the protection of the State," approved March 15th, 1855. and March 16th, 1870, to issue warrants to any constable, police officer, or sheriff, in the State ; to apprehend anti remove such person or persons as cannot otherwise be subjected to the provisions of this Act, or who shall violate the same ; and whenever it shall be necessary so to do, to issue their warrant to the sher iff of the city or parish where any vessel may be, having violated the provisions of the "Acts establishing and regulating Quarantine for the protection of the State," commanding him to remove said vessel to the quarantine ground, and arrest the officer thereof ; all of which warrant shall be executed by the officer to whom the same shall be directed, who shall possess the like power in the execution thereof, and be entitled to the same compensation as if the same had been, duly issued out of any court of the State. Duties of Besideni Quarantine Physicians. Sec. 33. It shall be the duty of the resident physicians of the quarantine stations, established by the Board of Health of the State of Louisiana, to faithfully carry out at all times and under all circumstances the provisions of the "Acts establishing and regulating Quarantine for the protection of the State," and, the rules and regulations of the Board of Health, founded upon said acts. Sec. 34. It shall be the duty of the resident physician of the Mississippi Quarantine Station, or his assistant, to visit and inspect every vessel coming from any port or entering the mouth of the Missis- sippi river. He shall require the captain of every vessel thus inspected to pay the fees fixed by the acts of the. Legislature : provided, nothing contained in this section shall apply to any vessel or craft going from New Orleans to sea and returning without having touched at any port, or at the Quarantine, tow boats, excepted. Vessels free from disease, not in a foul condition and not from an infected district (which shall be decided upon by the resident physician), shall be furnished with a certificate of health, and allowed to proceed to the city. The resident physician shall require for every inspection and certificate thus furnished, the following fees : every ship shall pay thirty dollars ($30; ; every bark shall pay twenty dollars ($20) ; every brig shall pay ten dollars ($10); every schooner shall pay seven dollars and fifty cents, ($7 50); every steamboat (tug boats excepted) shall pay five dollars ($5); every steamship shall pay thirty dollars ($30), The resident physician shall return to the secretary of the Board of Health a weekly list of all the vessels inspected by him, as well as all fees collected by him, which shall form a fund for the. support of quarantine. Sec. 35. The resident physician shall have the power, and it shall be his duty, to detain at the quaran- tine ground, with their cargoes, crews and passengers, all vessels coming from an infected district, or in a foul condition, or having on board persons affected with cholera, yellow fever, pestilential, contagious or infectious diseases, during such time Eis the Board of Health may deem necessary-to compel the cap- tain to land the sick at the quarantine ground, to fumigate and cleanse all such vessels, and to submit to such rules and regulations as may be hereafter provided by the Board of Health: and that all costs incurred for vessels found in a foul condition, including the sum of five dollars for the support of each and every sick person landed at the Quarantine station, shall be borne by the captain and owners, and shall be paid, to the Resident Physician, before a certificate shall be issued giving free pratique. Sec. 36. The resident physician shall have such other powers as may be delegated to him by the Board of Health, not contrary to the provisions of the acts of the Legislature of the State of Louisiana, necessary to carry them into effect. It shall be his duty to remain at the quarantine ground, attend the sick, and perform all such other duties as may be required of him by the Board of Health. Sec. 37. The Resident Physician shall have power, at his discretion, to grant permits to persons acclimated and healthy, to proceed to the city. He shall employ such means of purification, disinfection and fumigation of vessels as may be directed by the Board of Health, and shall require the captains, or owners of said vessels to defray the costs of inspection, purification, disinfection and fumigation, and the Resident Quarantine Physician shall not release the vessel from quarantine until said costs are paid. Sec. 38. Vessels out ten days from in fected ports,presenting clean bills of health, not having nor having had sickness on board, and which are not in foul condition, shall be permitted to pass to the city after thorough fumigation by disinfecting agents; to effect which purpose, the Resident Physician shall detain said vessels, as long as the Board of Health may deem necessary. The Resident Physician shall, in all such cases, re- quire evidence under oath; and he shall, by this act, be invested with the power to administer oaths when ever he may deem this necessary to attain the objects of quarantine. Sec. 39. It shall be the duty of the Quarantine Physicians, at their respective stations, to enter upon suitable books, furnished by the Board of Health, the following facts with referrence to the vessels in- spected : 1 Name of vessel. 2. Name of captain. 3. Tonnage or class of vessel, 4. Port from whence the vessel sailed. 5. Length of passage. 6. Date of sailing 94 Quarantine Regulations of Louisiana. 7. Date of arrival at Quarantine St; tion. 8, Number of days detained 9 Sanitary condition of vessel. 10 Numberof eases of disease occurring dining the voyage. 11. Numberof deaths occurring during the voyage. 12. Number of cases occurring at Quarantine Station. 13. Number of deaths occurring at Quarantine Station. 14. Number and characterof fumigations. 15. Sanitary measures instituted. 16, Number of officers. 17. Numberof Crew. 18. Number of passengers 19 Sanitary condition cf crew. 20 Sanitary condition of passengers. 21. Nature of cargo. 22. Name of consignee. Said books to be carefully preserved at the different quarantine stations. Sec. 40. It shall be the duty of the Resident Physicians at the different quarantine stations, to prepare for the use of the Board of Health an annual report, in which the statistics recorded in the books specified, shall be consolidated and arranged in accordance with the months of the year. By order of the Board of Health Penalties for Violation of Quarantine Acts, Pules and Pegulations. Sec. 41. Every master of a vessel subject to a quarantine or visitation, arriving at 1he poit of New Or leans> who shall refuse or neglect, either, fit st, to proceed with and anchor his vessel at the place designated for quarantine at the time of his arrival; second, to submit his vessel, cargo and passengers to the examina- tion of the physician, and to furnish all necessary information to enable that officer to determine what quar- antine shall be fixed for his veosel at the quarantine ground during the period assigned for her quarantine, and while there to comply with the directions prescribed by the acts of the Legislature of Louisiana, and the rulesandr gulations of the Board of Health founded thereon, or with such directions prescribed for his vessel, crew and cargo and passengers, by the Resident Physician, shall be guilty of a misdemeanor, and be punished by a fine nor exceeding two thousand dollars ($2000), or by imprisonment not exceeding twelve months, or by both, at the discretion of the couit. Duty of Quarantine Physician to Peport to the Attorney General all Violations of Quarantine Law. Sec. 42, The Resident Physician shall report to the Attorney General all violations of this act; and it shall be his duty to prosecute all persons thus offending; to collect the fines and remit the. amount thereof to the Secretary of the Board of Health, whose duty it shall be to keep a separate book for fines collected, to be approved of every three months by the Attorney General. Duty of Harbor-Masters to Demand Permits of Pcsident Quarantine Physicians. Sec. 43. It shall be the duty of the Harbor-Masters, in their respective districts, to demand of the captain of every vessel arriving from sea to New Orleans, the permit of the Resident Physician, and to report to the President of the Board of Health all vessels having entered this port without such permit, Pules and Pegulations Governing the Captains or Masters of Towboats. Sec. 44. From the first May to first November, all towboats plying from the mouth of the river to New Orleans shall be liable to inspection and quarantine, and it shall be the duty of the different harbor-masters to require from the captains of said towboats the certificate of the Resident Physician ; provided, nothing here contained shall be so construed as to apply to towboats plying between New Orleans and the quarantine ground and no further. Sec. 45. The captain of any towboat or steamboat who shall receive on board of his boat, freight, goods or passengers, from a vessel liable to inspection or quarantine, or who shall receive goods or passengers from the quarantine ground, without the permission of the, Resident Physician, shall be punished by a fine not exceeding two thousand dollars ($2000) and by imprisonment at the, discretion of the court; and all viola- tions of the quarantine laws at the Quarantine Station of the Mississippi River, and at the Rigolets, shall be tried by the Criminal Court of New Orleans, and all violations of tins act at the Station of the Atcha- falaya River shall be tried by the District Court of the Parish of St. Mary. Pules and Pegulations Governing Pilots. Sect. 46. The Board of Health shall cause a sufficient number of these Rules and Regulations to be printed and delivered to the pilots to be distributed to the masters of vessels, arriving as before provided. Sec. 47. Every pilot, or any other person acting as such shall deliver to the master of every vessel inward bound, one copy of the printed Rules and Regulations of the Board of Health of the State of Louisiana, relative to quarantine, which shall be furnished him by the Board of Health ; and any pilot refusing or neglecting so to do, or aiding or lauding any person or persons, contrary to the Quarantine Acts, ■ shall forftit one hundred dollars for every offence. SANITARY RULES OF THE BOARD OF HEALTH OF THE STATE OF LOUISIANA, REGULATING SHIPPING IN THE PORT OF NEW ORLEANS. At the regular meeting of the Board of Health. April 22d, 1880, the President Dr. Joseph Jones, submitted the preceding and following Sanitary Rules and Regulations, for the regulation of shipping at the quaran- tine stations and in the port of New Orleans, which were unanimously adopted. The President was authorized by the Board of Health to cause the publication and distribution of these 'rules: Joseph Jones, M. D., on Prevention of Yellow Fev.r. 95 OFFICE BOARD OF HEALTH, ) State House, t Comer of St. Louis and Royal sts , April 22, 1880. ) I. Resoh ed In the Board of Health of the State of Louisiana, in order to prevent the introduction and spread of contagious and infectious disease, that the President of the Board of Health is empowered to in- spect the shipping in the port of New Orleans, either in person or through the Sanitary Inspectors and to enforce the following rules and regulations : II. All captains, masteis or medical officers of any water-craft, are hereby required to report within twenty-four hours to the President of the Board of Health, all eases within their cognizance of Asiatic cholera, yellow fever, remittent and congestive malai ial fevers, typhus or ship fever, scarlet fever smallpox varioloid, measles, diphtheria, plague, leprosy, or any other case that may at anv time be specified by the hoard of Health, and in default or failure to so report such cases, such persons'fading or in default shall be liable to a tine not to exceed fifty dollars; provided, however, that the Board may declare it unnecessary to report further cases, when any disease shall have been pronounced epidemic. HL When it shall be deemed necessary to prevent the introduction and spread of contagious and infec- tious direases, every vessel or water-craft, arriving from a foreign port, shall be visited by the President of the Board of Health, or his Deputy Inspectors, between sun-rise and sun-set, as soon as possible after such arrival; and the President or his Deputy Inspectors shall examine the bill of health, and inspect the ship or Vessel and require of the captain or master, answers in duplicate to the following questions : Date of Inspection, New Orleans, 188 1. Name of Vessel ? 2. Name of Captain or Master ? 3. Tonnage or Class of Vessel 1 4. From whence is the vessel vou command ? 5. How many days have you been on the passage ? 6. At what port or ports have you touched I 7 Were any Contagious or Infectious Diseases prevailing at the port from whence vour vessel Bailed ? J 8. If so, name the Diseases. 9. Were any contagious or infectious diseases prevailing at the port or ports at which you touched ? 10. If so, name the diseases. 11. Was any freight or passengers received at the ports at which your vessel touched? 12. If so, give particulars. 13. Have you any bills of health ? 14. If so, produce them. 15. During the course of your cruise or passage, what cases of diseases have occurred on board ? 16. At what dates ? 17. Have any deaths taken place on board \ our vessel since you left the last port ? 18. If so, at what dates and from what causes ? ' 19. Are there any sick on your vessel at this time ? 20. Has yellow fever, small-pox, cholera or plague ever existed in this ship ? 21. If so, when ? 22. What is the number of officers ? 23. What is the number of the crew ? 24. What is the number of passengers ? 25. What is your cargo ? 26, To whom is the cargo consigned ? 27. What is the present sanitary condition of the vessel, cargo, crew and passengers? 28. Have you a medical officer ? 29. Give the name of the medical officer ? 30. Produce the reports of the medical officer. Signature of the Master or Captain Subscribed to before me, an officer, Witness : Official title. JOSEPH JONES, M. D., President Board of Health, State of Louisiana. PREVENTION AND ARREST OF YELLOW FEVER IN THE CITIES AND TOWNS OF THE VALLEY OF THE MISSISSIPPI, AND MORE ESPECIALLY IN THE CITY OF NEW ORLEANS. The sanitary measures essential to the health of cities situated on the ths water courses, and upon the shores of the Gulf and Atlantic States are: 1. Thorough drainage. 2. Daily removal, from all houses and yards, of garbage, and the disposal of this by composting, far beyond the limits of the city with quick lime, or by fire, or by dumping into large flowing rivers. 96 Joseph Jones, M. J)., on Small-Pox. 3. Systematic removal of deposits of the contents of privies. 4. Systematic disinfection, at regular intervals, of all privies with a solution of copperas and carbolic acid. 5. Abundant supplies of pure water for drinking, cooking and washing; 6. Systematic house-to-house inspection by intelligent medical officers. In attempting to combat and arrest yellow fever, it is essential that the first case or cases should be promptly reported to the health authorities. When the disease becomes scattered in separate foci, its progress is. greaty accelerated. The measures for its arrest are chiefly as follows : 1. Isolation of the sick. 2. Free ventilation. 3. Disinfection by means of copperas and carbolic acid solution or of zinc and iron solutions, as hereafter to be described. 4. Cleansing of all soiled articles in the zinc solution. 5. Daily disinfection of the privies, alleys and drains of the premises. 6. Immediately upon the announcement of the existence of a case of yellow fever, the infected locality, and all the surrounding section of the city, for at least four blocks each way around the focus, should be cleansed; gutters cleaned and limed: privies emptied, and disinfected' daily with solution of copperas and carbolic acid ; white-washing of all unpainted wood-work, and the ventilation and fumigation by means of sulphurous acid gas, of all crowded houses. 7. When practicable, people should move away from the foci of infection,, and even from the city itself, if they have never suffered with yellow fever. 8. In case of recovery, thorough ventilation and fumigation of the entire house. Cleansing of the furniture, floors and walls with soap and zinc solution ; disinfection of all bedding and clothing by sulphurous acid gas, followed by heat. The surest method is to destroy the bedding and soiled clothing by fire. 9. In the event of death, the funeral notice should state the cause of death, and there should be no gathering of persons at the funeral. The body should be washed with the zinc and carbolic acid solutions, and should be placed in a close coffin at as early a period as possible, the body being wrapped in sheets saturated with the zinc or lead and carbolic solution. The bedding and soiled clothing should be destroyed, and if the use of fire is impracticable, they should be disinfected and treated in the same manner as in small-pox. Thorough cleansing, disinfection and fumigation should be practiced throughout the entire building. The locality or localities where the first case or cases of yellow fever occur should be kept continuously under observation, and each new case subjected to the measures indicated. The custom of burying yellow fever corpses within the limits of cities is fraught with danger and is to be condemned. The proper mode of disposing of the corpses of those who have died of yellow fever is by burning in properly constructed furnaces (cremation). SMALL-POX. HISTORY OF SMALL-POX IN LOUISIANA. Previous to the introduction of vaccination, small-pox committed rava- ges amongst the early settlers of Louisiana. Small-Pox in Louisiana. 97 The ravages of small-pox are mentioned by historians thirty-five years ;after the foundation of the colony by Iberville. When Bienville returned to Louisiana, in 1733, after an absence of eight years, his companion, Diron •d'Artiguette, thus describes the situation of the colony in a dispatch of •the 23d of April, from Mobile : "I have found, on my arrival at this place, two contagious diseases; first, the small-pox, which has carried off and is still killiug every day a considerable number of persona of both sexes and of every age; and next, a general dearth of provisions, from which every- body is suffering, and which has been the result of the destruction of the late crop by a hurricane. The colony is on the eve of being depopulated." Navarro, in a dispatch of December 17, 1787, states that "in this year small-pox infested the whole province of Louisiana, and those whom fear prevented from being inoculated became the victims of their prejudices. All those who were attacked by the contagion either died or were danger- ously sick. The inoculation was fatal only to very few, but this was enough to confirm, in their systematic opposition, those who declaimed against this wise and human practice. This disease had struck such terror into the Acadian families that when one of their number was attacked by the dis- ease they used to abandon him to solitude and to his fate, leaving him to his own .resources, but supplying him with all the provisions and other ar- ticles they supposed he would need, although breaking off all communica- tion with him, and thereby depriving him of their assistance. Some of ■them, however, who were established in Feliciana, and who numbered eighty persons, of both sexes and of all ages, had the fortitude to have themselves inoculated, and not one of them had cause to repent having ■taken that determination. From the author of "Vue de la Colonie Espagnole du Mississippi, en des Provinces de la Louisiane et la Floride Occidentale, en l'Annce 1802," we gather, that, notwithstanding the opposition of the church and government to the practice of inoculation when first introduced into the province, the inhabitants observing the beneficial effects, practiced it extensively. Finally, the practice became obligatory by legislatue enactments, and even the bishop and clergy withdrew their opposition. We are not informed as to the date of the introduction of vaccination into Louisiana. The first edition of Edward Jewner's "inquiry into the causes and effects ■of the variola) vaccime," a desease discovered in some of the Western coun- tries of England, particularly Gloucestershire, and known by the name of the cowpox, was published in London in 1798; and as far as a careful examination of the earlier histories of Louisiana, and the accounts of the earlier voyages, extending through the period of the Spanish domination extends, the conclusion is reached that vaccination superceded inoculation at a later date than 1802. . SMALL-POX OF COMPARATIVELY RARE OCCURRENCE IN NEW ORLEANS FROM 1803 TO 1861. From the time of the transfer of Louisiana to the United States, up to the period of the American civil war (1861-1865), New Orleans, as well as the entire State of Louisiana, appears to have been exempt from wide-spread and destructive epidemics of small-pox. It is true that in 1849, the deaths from small-pox in New Orleans, num- bered 133; in 1857, 103; and in 1858, 108; but the total deaths from small- 98 Joseph Jones, M. D., on Small-Pox. pox in these three years before the civil war of 1861-1865, in which the disease committed the greatest destruction, did not exceed one-half the deaths of 1864, which numbered 605; of 1866, 613; of 1870, 528; of 1873 509 ; 1874, 587 ; of 1877, when they numbered 1099. The following record gives the number of deaths from small-pox, in New Orleans, for the years specified: YEAR. DEATHS FROM SMALL-POX. YEAR. DEATHS FRO>J SMALL-POX. 1844.. "27 105 133 37 38 "i7 "17 2 103 108 43 22 1 "'2 1864 605 613 188 47 14 141 528 2 29. 509 587 342 232 1099 151 "i 415 924 1845... 1865 1846 1866 1847 1867 1848 - 1868 1849. 1869 1850 1870 1851 1871 1852 - 1872.. 1853. 1873 1854 . - 1874 1875 1855.. 1856 1876 1857 1877 1858 1878 1859 1879 1860 1880... 1861 1881 1862 1882 1863 1883 June 1st Total Total 638 6432 Grand T otal, forty years ...7070. During a period of twenty years, 1844-1863, during which, time up to the occupation of New Orleans by the Federal forces, the institution of slavery existed in the Southern States, the deaths from small-pox numbered only 638; whilst in the twenty years, including from 1863 to 1883 (first twenty- three weeks) embracing the period of the abolition of the institution of slavery and the emancipation of the negro race, the deaths by small-pox numbered 6432, out of a grand total of deaths from this disease during forty years of 7070. Preceding the civil war the deaths from small-pox corresponded more nearly in the white and colored races to the relative numbers of the popu- lation. Thus, in 1849, the deaths from small-pox in NewOrleans were: whites, 78; colored, 55; total, 133; 1850, whites, 25; colored, 12; total, 36 ; 1853, whites,. 14 ; colored, 3 ; total, 17; total during three years, whites, 117; colored, 70 total, 187. During the period of slavery the deaths from small-pox among the whites largely exceeded those among the negro race. The reverse condition has existed and does now exist since the civil war of 1861-65. Thus, in 1877, the deaths from small-pox in New Orleans were-whites 437, colored 662; total 1099; 1878, whites 69, colored 82; total 151; 1880, whites 1; 1881, whites 3, colored 2 ; 1882, whites 116, colored 299; total 415; first twenty-three weeks 1883, whites 354, colored 580 ; total 924. During a period of about six and a half years-1877, June 9th, 1883- out of a grand total of deaths in New Orleans from small-pox of 2505, the whites numbered 970, and the colored 1625. Difficulty of Eradicating Small-Pox in New Orleans. 99 Whilst the colored population was in the relation of about 1 to 3 of whites, the deaths from small-pox were as very nearly 2 colored to 1 white. This leads us to consider one of the most important questions, not merely to the city of New Orleans, but also to every Southern city and State. The difficulty of eradicating small-pox from New Orleans greatly increased in consequence of the vast number of unvaccinated colored people inhabiting the States tributary to the Mississippi. This proposition will be illustrated by the following table: White and colored population of the State most nearly related to New Orleans by geographical position and commercial relations. Tenth Cen- sus U. S., 1880. POPULATION. STATES. TOTAL. WHITE. COLORED. Alabama .. ' 1.262,288 662,185 600,103 Arkansas . 802,197 1,648,630 591,531 210,666. Kentucky 1,377,179 271,451 Louisiana 938,609 454,954 483,655 Mississippi 1,129,689 479,398 650,291 Missouri 2,168,176 2,022,826 145,350 Tennessee 1,541,982 1,138,831 403,151 Texas 1,590,621 1,197,237 393,384 Total 11,082,192 7,914,141 3,158,051 Total population United States, including Territories, 1880 50,155,783 43,402,970 6,580,793 From the preceding statistics it is evident that : 1. In those States which are not nearly related to New Orleans by geo- graphical position and commercial relations, the white population numbers 10,086,741 out of a total population of the United States of 50,153,783, being about one-fifth; the colored population numbers 3,157,997, out of colored population, in the United States of 6,580,793, being about one- half. 2. Whilst only one-fifth of the total population of the United States inhabits the States of Alabama, Arkansas, Kentucky, Louisiana, Missis- sippi, Missouri, Tennessee and Texas, nearly one-half the entire negro population of this great country is gathered within the borders of these States, which are most directly connected with New Orleans by geographi- cal position and commercial relations. 3. The colored population of the States most nearly related to New Or- leans, constitutes more than one-third of the entire population, and is re- lated to the whole as 1 colored to 2.46 whites. 4. Before the civil war of 1861-65 small-pox was comparatively unknown upon the plantations of the South, because the negro was born in a.state of slavery, and compulsory vaccination and the isolation of the sick in special hospitals, under the direction of intelligent medical men, were almost uni- versally enforced by the white master. The result of the civil war, precipi- tated the dependent, uneducated and comparatively helpless colorod race into the enjoyments of the rights and privilages of freedom. It is not sur- prising that ignorance of sanitary laws, and neglect of vaccination, com- bined with unrestricted intercourse, should have found in the colored race of the South the most favorable condition for the lodgement, propagation spread and continuance of small-pox. 100 Joseph Jones, M. D., on Small-Pox. Small-pox holds firmly to New Orleans, and it is with difficulty van- quished on account of the large colored population gathered within her limits, as will be seen by a comparison of the statistics of race in the large ■cities of the United States. Population of the principal cities of the United States by race, accord- ing to Tenth Census, 1880 : POPULATION. STATE. CITY. TOTAL. WHITE. COLORED. ^New York . New York 1,206 299 1 185 843 19 663 New York Brooklyn 558 427 8 095 New York ........... Buffalo 155 134 154 268 857 New York _. Albany 90,758 89 694 1 056 New York _ _...... Rochester 89,366 88'859 497 New York Troy 56,747 56'185 557 'New York ...... Syracuse 51,792 51 199 590 Penns^ 1vania ........ Philadelphia 847,170 815 362 31 699 Pennsylvania Pittsburg 156,389 152,292 4'077 Illinois - Chicago 503 185 496.495 6 480 Massachusetts . _ .... Boston 362,839 356,826 5 873 Massachusetts ... Lowell 59,475 59 293 177 Missouri St. Louis 350,518 328'191 09 256 Maryland Baltimore 332,313 278*584 53 716 Ohio - - Cincinnati .... 255,139 246 912 8 179 Ohio Cleveland 160,146 158,084 2.038 California San Francisco 233'959 210,496 1,628 Louisiana ...... New Orelans. 216 090 158 307 57 617 Louisiana _ Baton Rouge. 7,197 2 915 4*282 . Louisiana ... o * ■ Shreveport .... 8,009 3,219 4,790 District of Columbia .... Washington _ 147,293 98,895 [48 377 Kentucky Louisville...... 123,758 102,847 20,905 Rhode Island Providence 104^857 101,211 3,582 Virginia .' ... Richmond 63^600 35*765 27,832 South Carolina Charleston 49,984 22*699 27,276 Tennessee Memphis . 33,592 18,677 14^896 Tennessee ... Nashville 433350 ' 27,005 16*337 Texas Galveston . 22,248 16,884 5,348 Georgia, Atlanta 37,409 21.079 16,330 Georgi a, - Savannah 1 30'709 15*041 15,654 It will be observed from the preceding statistics that New Orleans has a larger colored population than any other city on the North American Continent. The colored population of New Orleans actually exceeds the .united sum of the colored population of New York, Philadelphia and Boston. In virtue of this fact, New Orleans has the largest population of any city in the United States opposed to vaccination, and consequently the largest population liable to the ravages of small-pox. We have also shown that no city on this continent has as large a colored population tributary to it. A vast floating colored population continuously pours in and out of New Orleans. Large numbers of colored seamen (roustabouts.) man the steamboats which conduct the internal commerce of this great valley, and they are, and have been during the past ten months, introducing a stream of small-pox poison into New Orleans. Small-pox has been prevailing on the plantations along the Mississippi River during the past ten months, and small-pox cases have been continu- ously introduced into New Orleans by the inhabitants of the plantations. Difficulty in Eradicating Small Pox in New Orleans. 101 As long' as small-pox prevails among the colored population of the Mis- sissippi Valley just so long this disease will continue to find successive lodgments in New Orleans. In the month of September, 1882, I directed the attention of this honored Board to the fact that the State of Mississippi was dangerously infected with small-pox, and in proof thereof submitted the following communica- tion from the Secretary of the Mississippi State Board of Health. MISSISSIPPI STATE BOARD OF HEALTH, ) Office of Secretary, Jackson, Mississippi. > September 21, 1882. ) Joseph Jones, M. I)., President Board of Health, State of Louisiana: Dear Sir-"I have the honor to acknowledge the receipt of yours of yesterday, and in reply will state that reports received at this office show that twenty-three cases of small- pox have occurred in and near McComb city. We have been informed of only two cases having occurred in McComb city, the remainderbeing in a settlement called Algiers, about one mile southwest of the town. One case has also been reported near Chattawa in the same county (Pike). * * * * * * * ''One hundred and fifty-three cases of small-pox have occurred in Bolivar county on some plantations near Australia landing and Concordia, and twenty-five cases have oc- curred in De Soto county. Respectfully, WIRT JOHNSON, M. D., Secretary Mississippi State Boaid of Health. Small-pox has prevailed in Memphis, Tennessee, and Nashville, and in various other portions of Tennessee, but as Mississippi and Tennessee do not publish daily and weekly reports of mortality, this Board has had no accurate or reliable data by which to estimate the progress and location ot small-pox in these States during any specific period of time. The period during which the poison of small-pox lies dormant in the system, after contact with the disease is twelve days, followed by two days of fever which are followed by the appearance of the characteristic eruption, so that people infected with the poison of small-pox'may travel from Cincin- nati, Chicago, St. Louis, New York, or Philadelphia, before manifesting any signs of this dreadfid disease. The Board of Health has been powerless to prevent the constant influx of negroes and of all classes of citizens into New Orleans, and has offered the most effectual barrier in its power, namely free vaccination. • Immediate and universal house-to-house vaccination and re-vaccination are the only bulwarks of safety. Whenever a case of small-pox is reported the force of medical men em- ployed by the Board of Health should be sufficiently large to allow of an immediate detail of a vaccine physician to make the infected house a centre, and to vaccinate and re vaccinate all persons on the infected premises and all persons within a radius of two blocks of the case, north, south, east and west. The Board of Health has endeavored, with the limited force at its com- mand, to accomplish this result, but at least twenty vaccine physicians ad- ditional to the six sanitary inspectors should be employed for the space of such time as should meet the present emergency. It has been the experience of sanitarians here and elsewhere that in com- batting small-pox theexpenses have been and ever will be necessarily large, and should include: Pay of extra vaccine physicians Cost of vaccine virus. Removal of patients to small-pox hospital. 102 Joseph Jones, M. I)., on Small-Pox. Support of indigent patients in small-pox hospital. Burial of the dead. Disinfection of houses. Destruction of infected articles, beds and bedding. Purchase or hire of horses, wagons and supplies for sanitary inspectors. We may form some estimate of what a proper system of combatting small-pox in New Orleans should cost by a reference to the amount of money expended by Baltimore during the past year. From the report of George W. Benson, M. D., commissioner of health and registrar of the health department of the city and port of Baltimore, we gather that the whole number of cases reported in the year 1882 was 2825. During 1882, 90,000 vaccinations and re-vaccinations were performed in Baltimore by ten regular vaccine physicians and twenty extra physicians. From table twelve of the annual report of the Health Department of Baltimore for the year 1882 we gather that $51,003 72 were expended in combatring small-pox alone, the entire sum being promptly met by the city government, a sum far in excess of the receipts of the Board of Health of the State of Louisiana by which the entire quarantine system of this State is supported. The commissioner of health and registrar of the city of Baltimore thus estimates the expenses for 1883: General health $20,000 00 General health (indebtedness) 19.584 24 Nuisancesand sewers 6,000 00 Salaries 31,000 00 Post mortem 6,000 00 Quarantine hospital 25,000 00 Quarantine hospital (indebtedness) 854 07 Ten additional vaeccine physicians 3,000 00 Extra expenses of small-pox. 100,000 00 Total .$206,639 31 It appears from this report that the actual amount expended by the city of Baltimore for health purposes. exclusive of the assistance rendered by the regular police force during the year 1882, was as follows: Salary account, twelve months 1882 $14,500 00 General health account, including small-pox expenses 51,606 72 Nuisance and sewer account 14,000 00 Account of the Quarantine Hospital of the port of Baltimore. ... 23,01175 Total $103,118 47 The City Council of New Orleans appropriated $6000 (six thousand dol- lars) for sanitary purposes in 1883, and refuses to pay for the registration of its indigent dead. Baltimore appropriates more than one hundred thousand dollars,and yet she is not exposed to one-tenth of the danger that New Orleans is in from small-pox. It has been demonstrated by past experience that small-pox appears in large cities at intervals of eight or ten years, as the sequel of neglected general vaccination ; hence the prevention and.non-existence of small-pox in New Orleans can only be accomplished by general annual and success- ful vaccination and re-vaccination, conducted by a corps of competent phy- sicians, one or more of whom should be stationed in each ward and liberally supplied with fresh vaccine virus. Small-Pox in New Orleans. 103 RELATIONS OF SMALL-POX IN NEW ORLEANS TO TEMPERA- TURE AND SEASONS. The following tables illustrate the relations of the cases and deaths from small-pox to the individual months of the years specified. NUMBER OF CASES OF SMALL-POX Which Occurred in New Orleans During a Period of 11 Years, 1872-1882 (inclusive') by months. Months. 1872 1873 1874 1875 1876 1877 1878 1879 1880 1881 1882 Total. January 6 154 154 93 39 306 34 1 14 601 February 2 194 196 152 69 372 1 29, 1061 M arch - 7 220 203 240 44 502 82 a 151 1452 April 23 184 248 132 63 327 50 i 4 180 1212 M*ay 9 160 230 90 31 236 23 1 1 1 194 976 June 3 75 141 83 22 190 18 1 185 718 July 21 65 56 22 83 5 70 322 August., .... 8 12 39 8 46 1 48 162 September 1 15 13 7 8 32 1 32 109 October 1 14 8 7 31 28 45 134 November .... 10 106 23 19 82 10 4 41 297 December 36 146 45 17 167 11 1 12 104 539 Total 98 1299 1338 935 586 2143 259 9 1 22 1093 7783 DEATHS FROM SMALL-POX IN NEW ORLEANS During a Period of Sixteen Years-1867 to 1882, Inclusive. Months. 1867 1868 1869 1870 1871 1^72 1873 1874 1875 1876 1877 1878 1879 1880 1881 1882 Total January - - 9 3 69 2 64 82 32 8 126 13 (j 414 Fahrnary . 13 1 56 2 83 89 44 191 20 10 534 798 637 482 438 187 74 March 5 1 121 5 79 99 94 22 260 • 52 60 6 2 122 5 67 97 62 25 157 21 1 72 69 Mav 6 78 4 71 98 26 11 105 12 1 1 5 5 59 1 35 66 30 13 137 18 69 July . . 1 14 11 30 24 15 56 5 31 A ngnst •••••• 1 1 4 2 6 14 6 22 18 Septemb©1*. 1 1 3 7 6 4 3 16 15 56 58 October* ..... 5 1 8 3 4 8 13 16 W ovcm her. ...... ............. 33 1 27 12 1 24 7 11 116 302 Tlccemher. ..... ... 89 1 11 55 17 7 72 9 3 38 Total 47 14 141 528 2 29 509 605 342 232 1099 141 1 5 415 4110 CASES AND DEATHS OF SMALL-POX IN NEW ORLEANS IN 1882, Classified According to the District in which they Occurred, Color and Sex. Months. 1st Dist. 2d Dist, 3d Dist. 4th Dist, 5th Di it 6th Dist. 7th Dist. Total. Sex. No. of Deaths. vv C | pnoj w c | Total. w c 7s 6 16 70 79 102 98 23 22 19 25 13 21 494 w c | Total. w c | l«ioj. w c I w c : : Total. w c | Total. | Male. Female. w c | Total. 1 '7 - to 11 3 3 8 23 28 19 7 4 10 3 16 13 17 151 4.. 8 3 30 10 36 21 90 17 3 1 30 33 37 39 9 2 3 1 3 4 40 54 54 56 21 5 4 1 3 6 30 32 35 37 10 5 5 5 1 12 181 3 10 40 17 87 61 13 17 14 20 12 9 313 1 1 1 1 3 3 1 1 1 1 3 1 3 5 9 52 64 65 67 31 13 8 6 8 60 388 9 20 99 116 129 118 39 35 24 39 33 44 705 14 29 151 170 194 185 70 48 32 45 41 104 1093 9 19 90 107 89 87 40 25 13 20 16 50 565 5 10 61 73 105 98 30 23 19 25 25 54 528 1 3 11 21 17 22 13 6 1 1 3 14 116 5 7 49 48 52 17 18 12 14 15 8 24 299 6 10 60 72 69 69 31 18 15 16 11 38 415 February. .. March April 1 i 1 6 1 i 4 1 1 1 1 2 10 1 4 3 2 5 2 4 6 3 10 ( z 4 1 8 9 5 10 6 9 i 1 1 June 18 7 10 3 16 20 42 223 17 12 3 1 1 1 6 1 1 21 31 3 15 25 1 3 36 56 1 5 2 10 1 5 2 10 November ... December .... Total. .. 7 25 72 2 86 2 159 3 245 16 38 54 2 9 11 - 104 Joseph Jones, M. J)., on Small-Pox. If the year 1874 be selected during the years embraced in the preceding table for critical study, we observe the following relation between the num- ber of deaths from small-pox and the monthly mean temperature: Months. Deaths from Small-Pox. Mean Temperature Fahrenheit. Months. Deaths Small- FROM Pox. Mean Tempf.raturr Fahrenheit. January 82 56.70 July . 30 82 03 February 80 59.05 August. 6 85.05 March 99 67.08 September.... 6 80 04 April. 97 66.02 October 3 70 09 May 98 76.09 November... 12 61.01 J une. 66 82.06 | December 17 89.04 From the preceding facts it is evident that the poison of small-pox in New Orleans, and in all localities situated in the same latitude, appears to be intensified by cold and dissipated by heat. The intense heat of summer appears to cause the rapid alteration and destruction of the organic matters causing the disease. Small-pox in this latitude is least prevalent in those months in which the various form of malarial fever and yellow fever commmit their greatest ravages. MEASURES FOE THE PRESERVATION OF THE PUBLIC SAFETY. Those charged with tlie conduct of the sanitary affairs of New Orleans are compelled to recognize the following facts : (a) New Orleans has a population of about 00,000 colored people, a large proportion of whom are unprotected by vaccination. These people are a standing menace to their neighbors with reference to small-pox. (b) New Orleans is without a marine hospital for the treatment of the seamen of the United States afflicted with small-pox and other contagious and infectious diseases. The measures now imperatively demanded for the preservation of the publict safety are: 1. The selection of a proper site for a small-pox hospital in an isolated locality. 2. The erection of the necessary buildings adapted to the isolation and treatment of small-pox patients. 3. The proper equipment of the hospital buildings with beds, bedding, culinary utensils, and facilities for purification, washing, disinfection and isolation. 4. The supply of competent and reliable nurses. 5. The establishment of rigid police regulations. 6. The perfection and regulation of a definite mode of conveyance of small-pox patients to the hospital under the direction of competent sani- tary officers. The honorable City Council should take immediate steps for the erection of the necessary buildings for the isolation and treatment of small pox patients. These buildings need not be expensive, but on the contrary, should be light, well-ventilated, wooden frame and unsealed pavilions, quickly erected, and capable of easy cleansing, white-washing or disinfec- tion. The Board of Health will co-operate with the honorable City Council in any and every measure for the prevention and arrest of small-pox. Measures for the Arrest of Small-Pox. 105 7. New Orleans, and in fact the entire State of Louisiana is without any proper hospital accommodations for the isolation and treatment of small- pox, and other contagious and infectious diseases. The permanent small-pox hospital for New Orleans, should be located in a secluded, but readily accessible position, as nearly opposite the centre of the city as possible; it should be so arranged as to secure the fullest ventilation, the most healthful conditions to its inmates, and least possible danger of infection to the surrounding inhabitants. The hospital should be elevated at least four feet above the ground, so as to allow of free ven- tilation beneath; the ground upon which its supports rests, should be tilled with charcoal cinders and covered over with asphalt, to prevent, on the one hand, all exhalations from the soil, and on the other, the absorption of all noxious matters from the inmates ; the structure should be limited to one story, for in the light of existing medical and sanitary knowledge and experience, it is dangerous and unwise to construct a contagious disease hospital more than one story high. Ample room should be afforded for the construction of well veptilated detached buildings, and for the physician's office, drug room, provision housd, kitchen, wash house, laundry, dead house and cemetery. The dead should not be carried through the city, but should be buried or cremated upon the hospital grounds, or in their immediate vicinity. The detached hospital buildings should not be larger than to contain more than twelve patients each. The wards should be so arranged that each patient should have 2000 cubic feet of space, 144 square feet of floor space, ami 3000 cubic feet of fresh air per hour. Each of the wards should be ventilated by one or more iron pipes, at least twelve inches in diameter, running from the centre of the ceiling up through the roof, in the lower ends of which a flame of gas, or of some other inflammable material should be kept constantly burning, in order to burn up, oxydize and destroy all contagious matters in the atmos- phere. The ventilation thus secured should effect a frequent change of atmosphere in the ward, so as to give each patient 3,000 cubic feet of fresh air per hour. The means for the disinfection of clothing, beds and bedding, by means of sulphurous acid, chlorine, and super-heated steam should be ample. The ambulances for the transfer of patients from various portions of the city, should be conducted with the greatest care ; should be thoroughly disinfected and cleansed daily; and should, together with the horses and drivers, be kept upon the hospital grounds, subject to the call of the proper authorities for the removal of small-pox patients from any portion of the city, and at ary time, by night or by day. The entire grounds should be surrounded by a wall, with but two open- ings, one for entrance and the other for exit; and should at all times be under careful police superveillance, to prevent improper and unnecessary communication with the surrounding inhabitants. MEASURES FOR THE ARREST AND PREVENTION OF SMALL- POX IN LOUISIANA. 1. Compulsory Vaccination. This measure alone is effective. Small-pox will evade every barrier of quarantine in large commercial centres. Its poison may be brought in numberless forms of merchandise, and in the clothing of passengers. It will remain thus concealed for months, and there is no practicable means 106 Joseph Jones, M. I)., on Small-Pox. by winch the foul and deadly poison thus concealed can be detected by the sanitary inspector. The greed of commerce is so great, that it will be secreted in the holds and forecastles of ships. Officers will hide men away sick witli small-pox, and resort to subterfuge for their concealment, in order to avoid quarantine detention, and will for the sake of filthy lucre, jeopardize the lives of their fellow citizens. Another reason why vaccination should be compulsory is, that the incu- bation period of the small-pox poison may embrace from seven to fourteen days; and one having the poison in his system, might travel from Boston, New York, Philadelphia, Richmond, Cincinnati and Chicago to New Orleans, and jet transport or present upon his arrival no visible marks of the disease. As a rule small-pox manifests itself on the twelfth day, by fever severe pain in the head and back and nausea. Two days afterwards the eruption appears in red pimples, with a hard shot-like base, which in due time de- velope into vesicles, at first rounded, then depressed, or umbilicated, after- wards into pustules, which finally become scabs and fall off, leaving pock marks. Many pathologists regard small-pox as not contagious during the first two days of fever, headache, backache and nausea; and some even hold that the disease does not become contagious till the eruption passes into the umbilicated vesicular stage. The physician who has been warned by the primary fever and first popu- lar eruption, should lose no time in isolating the case, and in immediately vaccinating all in the house and in the neighborhood. For twelve days after exposure, patients, although having the small-pox poison in their bodies, will not communicate the disease, and they should be encouraged by the well known fact that vaccination promptly performed with fresh and reliable matter will in most cases arrest the disease, and in some cases, if the disease does appear, it will assume the comparatively mild and harm- less form of varioloid. Vaccination, well performed, with reliable virus will, in virtue of its shorter period of incubation, either wholly prevent small-pox by supplant- ing it, or at least modify it into varioloid when resorted to within three days after infection. At a meeting of the Board of Health of the State of Louisiana, held on November 8, 1877, Dr. Samuel Choppin in the chair, I offered the following resolutions: Resolved, That in consequence of the existence and destructive effects ot small-pox in the city of New Orleans during the past ten years, the attempt should be made to circumscribe and arrest this disease by the proper sani- tary regulations and legislative enactments. Resolved, That the representatives of the people are empowered to enact suitable laws lor the arrest and complete eradication of small-pox, and that it is as much the dufy of the government to protect its citizens from this disease as to exclude the introduction ot foreign pestilence by quarantine regulations. Resolved, That a committee of three physicians, members of the Board of Health of the State of Louisiana, be appointed to address a memorial to the Legislature of Louisiana, urging the necessity of compulsory vaccina- tion. Similar resolutions were also urged upon the State Medical Association, and the subject was brought before the General Assembly, and after dis- cussion, the bill embodying the resolutions was defeated, and compulsory vaccination wTas discarded, and the following adopted : Compulsory Vaccination. 107 "No. 80. An Act to reorganize and render more efficient the Board of Health of the State of Louisiana," etc.; approved April 20th, 1877. "Sec. 3. Be it further enacted, etc., A hat said Board shall have power and authority to make all needful rules, regulations and ordinances upon the subject of vaccination within the parish of Orleans; provided, that nothing in this Act shall be construed to render vaccination compulsory ; the said Board shall encourage vaccination, and shall furnish pure and fresh vaccine matter to the district sanitary inspectors and city physicians for the purpose of gratuitous vaccination, and the furnishing of such vaccine matter shall be paid by the said Board of Health." I then held, and still hold, that " each unprotected inhabitant who ne- glects, or willfully refuses vaccination, is a source of constant danger to himself, to his family, to his neighbors, and the whole community ; and the State has the power and the right to institute at the hands of competent medical men, compulsory vaccination." The true theory of a democratic form of government, is the equal pro- tection of the life, property, and happiness of all citizens, by wise and just laws, and the absolute subjection of all, both the governors ami the governed, to laic. Compulsory vaccination, in that it protects all alike from pestilence, suf- fering and death, is truly a democratic measure, designed to bestow' the greatest freedom, and the greatest happiness upon all alike, regardless of place or position or race. I advocated then and do now advocate: (a). The establishment of depots of reliable and fresh vaccine, at central points in the city of New Orleans, and throughout the entire State of Lou- isiana. (b). The appointment of one or more responsible physicians, in each Congressional District, by the Board of Health, to be commissioned by the General Assembly of the State, as Superintendents of Vaccination. Said superintendents of vaccination should be appointed by, and act under the direction and control of the State Board of Health. It should be the duty of each superintendent of vaccination to make an accurate census of his district, and record the number of vaccinated and unvaccinated inhabitants ; and also those who have suffered with small-pox in the natural wray. It should be the duty of superintendents of vaccina- tion to vaccinate all those wdio have not been vaccinated, or who have not suffered with the small-pox; an annual census of each district, together with the total number of cases of small-pox, varioloid and successful vaccinations, to be annually furnished the Board of Health of the State of Louisiana. The measures which have been instituted are as follows: 1. The quarantine officers have been ordered to conform to the rules and regulations of the Board of Health, and the acts of the Legislature, and bring vessels to anchor, and to put each captain or master upon his oath before mustering the men on deck. All cases of small-pox are removed to the Quarantine Hospital, and the entire vcrew accinated. The vessels thus infected are subjected to thorough fumigation and vaccination, and are not released until from fourteen to twenty-one days have elapsed without the occurrence of a case of small-pox. 2. Each case of small-pox in New Orleans, wdien reported, is visited by a Sanitary Inspector, and all persons w ithin a radius of three or four blocks are offered free vaccination. 108 Joseph Jones, M. D., on Small-Pox. 3. The law with reference to the vaccination of the children in the high schools is enforced. 4. The issuance of circulars to physicians, directing their attention to the law which requires the immediate report of each case of small-pox. 5. The institution of free vaccination at a stated hour each day at the offices of the Sanitary Inspectors in each district of the city. 6. The issuance of circulars to all railroad managers, etc., urging vaccin- ation with their Operators and employees. 7. Designation of all infected houses by the yellow flag with the word small-pox displayed. 8. The prevention, as far as practicable, of ingress and egress to houses infected with small pox. 9. Prevention of gatherings at funerals. 10. Disinfection, cleansing and fumigation. 11. Destruction of infected bedding and clothing. Vaccination is the only means of salvation from the small-pox at the command of all, and but for this beneficent gift of the medical profession, the United States would lose by the present epidemic at least 10,100,000 inhabitants. NATURAL HISTORY OF SMALL-POX-FACTS ESSENTIAL TO THE SANITARIAN. The following outline, drawn up not merely from personal experience, but from the writings and investigations of the most eminent medical men, are recorded for the information of the citizens under the immediate care of the sanitary officers of the Board of Health. SMALL-POX.-DEFINITION. Small-pox is the result of a specific morbid poison, which, after an incubative period of about thirteen days, produces an acute specific infec- tious disease, characterized by sudden and severe fever, which, after forty- eight hours, is followed by an eruption of pimples on the forehead, face and wrists, gradually passing over the body. This eruption is followed by a fall of temperature, and in from ten to fourteen days, it passes through the stages of vesicle, pustule and crust; it also appears on certain mucous membranes, and is sometimes complicated with haemorrhage into the skin, and from the mucous surfaces. The eruption is sometimes preceded by rashes of an erysipelatous, scarlet or measley character, chiefly seen on the lower abdomen, the groins and the upper and lower parts of the thighs, also the sides of the chest and about the axilla. They are distinguished from the haemorrhagic rashes by the absence of blue-black spots, and are usually associated with the milder cases. ^ETIOLOGY. The origin of small-pox is unknown ; but at the present time it is prop- agated by contagion and inoculation. No climate is free from its ravages; it affects all races of men, every age and both sexes It is exceptionally severe among negroes and the inhabitants of warm climates generally. Its subjects are unvaccinated or badly vaccinated persons. As a rule it attacks the same person once only, but there are exceptions to this rule. VARIETIES OF SMALL-POX. 1. Discrete. In this form the eruption is most abundant on the forehead, face and wrists, and least on the limbs and back. In the discrete form, fatal results are extremely rare, except in unvaccinated children under one year. Natural History of Small-Pox. 109 2. Confluent. In this form, the erupticn instead of showing distinct closely packed pustules, the whole face is swollen, presenting the appear- ance of a tense elastic mask. In the continent form more or less delirium is present in many cases, and it is sometimes maniacal or suicidal in character; the patient should not be left for one moment alone, otherwise he may have to be looked for wandering along some street, or drowned in the nearest body of water. In unfavorable cases, death usually takes place about the eleventh day. The mortality in this form is heavy ; half of the confluent cases die about the eleventh day. 3. Hcemorrhagic^ pustular or vesicular. This form is characterized by haemorrhage into the skin beneath the vesicles or pustules. There are generally petechiae, sometimes ink-spots, and often subcutaneous haemor- rhage. Death is almost always the result, and it may take place in the vesicular or the pustular stage. 4. Malignant. (Variola nigra; variola haemorrhagica; black small-pox ; purpura variola). This form is invariably fatal. Its distinguishing features are haemor- rhage into the skin, and irregularity in the form of the eruption. The illness commences with the ordinary symptoms, but accompanied by marked lumbar pain, precoidial anxiety and coolness of the extremities. This is followed about the third or fourth day by ecchymosis into the conjunctiva, and a purpuric or scarlatina form of rash, sometimes covering the whole body, but most marked over the lower abdominal region, and the upper and inner parts of the thighs, in which rash, large and small dark blue, deep violet, or black spots are seen. The ordinary eruption is sometimes entirely absent, or when present is very meagre ano much modified. There will also be found upon the skin hard tumors, of variable size, of the same color as the spots. Haemorrhages occur from the mouth, stomach, lungs, kidneys, uterus and vagina. Death sometimes takes place as early as the third day, most commonly on the fifth, rarely later than the seventh. 5. Inoculated. Small-pox induced by inoculation is comparatively mild, and it protects from the disease. The objections to inoculation are: 1st. That small-pox so induced is infectious, and the process propagates the disease to surrounding individuals. 2d. That it is sometimes fatal. 6. Small-pox after vaccination and re-vaccination. Good vaccination pro- tects from small-pox. and when it does not protect absolutely it renders the disease milder, the disfigurement less marked and reduces the mortality as the efficiency of vaccination and re vaccination. After successful re-vac- cination small-pox is practically unknown. PROGNOSIS. Small-pox is most fatal in unvaccinated children under five, and in adults over thirty. At those periods of life half or more die. The lowest mor- tality in the nnvaccinated occurs from ten to fifteen. The discrete form is rarely fatal in adults, the great majority of cases recover, but it is occa- sionally fatal when it occurs in unvaccinated children. Half of the confluent cases die about the eleventh day. The malignant cases invariably die. Nearly all children under one year of age die, what- ever form the disease may assume. In small-pox modified by vaccination, the course of the disease will depend upon the quantity and quality of the same, as shown by the marks. If these be of the best kind, three or four in number, and in a patient under fifteen, the disease is invariably mild. In some, however, who have past puberty, the best primary vaccination 110 Joseph Jones, M. D., on Vaccination. loses its power; but, nevertheless, it almost invariably modifies the disease, and when death occurs it is usually due to some accidental complications. As regards vaccination in prognosis, it may be stated generally that the unvaccinated will die at the rate of fifty per cent., the badly vaccinated at the rate of twenty-six per cent., and the well vaccinated at the rate of 2.3 per cent. TREATMENT. There is no specific for small-pox. The so-called specifics and prophylactics or preventives prove of no value, and their advocates and vendors mislead the public and cause fatal neglect. The treatment of small-pox must be conducted on general principles; and the public should rely upon the well educated practitioners of medi- cine. The following points of interest, however, should be impressed upon those who may meet this fatal disease in their own houses: 1. The patient should be isolated from the rest of the family and house- hold. He should be placed in a large, well-ventilated room. lie should be fed at intervals on easily digested food, such as milk, beef-tea, chicken broth, and eggs beaten up; and occasionally, according to habit, a little wine or spirit may be given. He should be permitted to drink cool water, or cool lemonade, as he pleases. There should be two soft beds in the room, so that the patient may be changed daily. 2. The hair should be cut short. Heat of skin may be relieved by cold water sponging, and the swelling of the eyelids and other painful parts by the constant application of cold compresses. To relieve itching, and at the same time to facilitate the removal of scabs and moderate the filling, the surface may be anointed with pure olive oil, cold cream, simple cerate, or better still, a mixture composed of equal parts of cosmoline (vaseline) and simple cerate. 3. Two competent nurses (unsusceptible by vaccination or by previous attacks of small-pox) should be obtained, one to attend the patient by day and one by night, and they should never for one moment lose sight of him. The medical treatment should be conducted by the physician. 4. The patient cannot safely be discharged until the crust and scabs have disappeared, and not less than six baths have been given at intervals of two days. VACCINATION. (Vacca-a Cow.) The object of inoculation with the material of vaccine or the cow-pox, as applied to the human subject, is the protection of the person vaccinated from an attack, and especially from a severe or fatal attack of small-pox. PHENOMENA OF VACCINATION. When lymph taken from a vaccine vesicle at that period of its course when the vesicle is fit for the purpose, is inserted into the skin by puncture, or applied to a small abraded surface of the skin of an unprotected person, no particular effect is noticeable till about the end of the second or earlier part of the third day, when a slight papular elevation becomes perceptible. The papular elevation of the fifth or sixth day becomes a distinct vesicle of a bluish white color, with raised edges, and central cup-like depression, By the eighth day (the day week from that on which the lymph was in- serted), it has attained its perfect growth; it is then plump, round, more decidedly pearl-colored, and distended with clear lymph; its margin is Vaccination and Re - Vaccination. 111 firm and central depression very marked. On this day, or sometimes even on the end of the seventh day, a ring of inflammation, called the areola, begins to form about its base, and the vesicle and areola together begin to spread for the next two days. The areola is circular, and when fully de- veloped has a diameter of from one to three inches, being then often at- tended with considerable hardness and swelling of the adjacent connective tissue. After the tenth day the areola begins to fade, and in two or three days more it has usually disappeared, with whatever of hardness or swell- ing may have existed. With the decline of the areola the vesicle begins to dry in the centre; the lymph remainingin it becomes opaque and gradu- ally concretes; and by the fourteenth or fifteenth day a hard brown scab is formed, which gradually contracts, dries and blackens, and from the twentieth to the twenty-fifth day, but usually about the twenty-first day, falls off. There is then left a cicatrice, which is circular, somewhat de- pressed, sometimes radiated, and with rare exceptions, permanent in after life. The constitutional symptoms attending these local phenomena are a rise of temperature, sometimes detectable by thermometer as early as the fourth day, more marked but still often very slight from the fifth to the seventh day ; more obvious feverishness, with restlessness and frequently derangement of the stomach and bowels, from the eighth to the tenth day, that is, during the stage of the areola, subsiding as that subsides. RE-VACCINATION. The regular phenomena of vaccination can in some persons be produced only once in a life time; but this is nor always the case, and vesicles may be produced by a second vaccination, not distinguishable in appearance from primary vesicles, though usually having a smaller and more transitory areola. Frequently the result of re-vaccination is the production of a spurious papular acuminated vesicle with hard, irregular areola, reaching its height about the fifth or sixth day, and having by the eighth day an imperfect scab, which soon falls. PERFORMANCE OF VACCINATION. Small-pox being a disease to which persons are liable from the moment of birth, and which is peculiarly fatal in infancy, it is of great importance that vaccination should be performed very soon after birth. Healthy children should be vaccinated within four or six weeks from birth. If the children be net robust, it may be deferred for three or four .weeks more. When small-pox occurs in the immediate locality, or invading the house- hold, all the inhabitants and inmates should be vaccinated and re-vaccinated irrespective of age or physical condition. Under such circumstances no age is too early for vaccination, and no state of health can be held to contraindicate it. Life, then, depends on the promptitude with which the vaccination is done. As the small-pox poison requires a period of about thirteen days, for its incubation, and as the vaccine disease manifests its phenomena in three days, and is fully formed on the eighth day after vaccination, the physician has the power of protecting from small-pox even after actual exposure to its poison, by prompt vaccination. SELECTION OF LYPMH. Lymph may be of two kinds, bovine or human. The advantage claimed for bovine lymph, are immunity from human disease and greater protection from small-pox. 112 Joseph Jones, M. D., on Vaccination. Iii the selection of lymph, whether bovine or human, the important point is to select healthy subjects, and it is probably as easy to select a healthy infant as a healthy calf. Human lymph should be taken from primary cases only, from perfectly healthy subjects, and from thorough characteris- tic vesicles. Babies selected for this purpose should not only be in good health themselves, but as far as can be ascertained, of healthy parents. Lymph should be taken on the day week from the vaccination, when the vesicle is perfectly formed, but before the stage of areola has set in. Any vesicle which at that date manifests areola must be discarded. This was Jenner's golden rule, and one which ought to be scrupulously observed. Good vaccine lymph is perfectly limpid, and has a certain degree of viscid- ity. A thin serous, too readily flowing lymph should not be used. METHOD OF COLLECTING LYMPH. Arm to Arm Vaccination. The collection of lymph from the human subject for vaccinating is effected by' opening the vesicle by numerous minute punctures on its surface, the utmost care being taken not to draw blood. Should any by accident be drawn, the vesicle must be discarded altogether. No lymph must be used which does not exsude spontaneously; there must be no pressure or squeezing of the vesicle. The lymph which stands on the surface of the opened vesicle is taken on the point of a lancet or other instrument em- ployed, and is inserted into the arm of the child to be vaccinated, invarions ways, as by puncture, byr scarefying, by scratching, or abrasions, or by tattooing. Vaccination should in all cases in which it is practicable be done direct from arm to arm, and insertions should be made in at least four, and preferably five, separate surfaces. Re-vaccination should be done with every precaution against failure, and therefore always, if possible, in cases of this kind direct from the arm. Re-vaccination at puberty is of great importance, but need not, except under circumstances of immediate exposure to small-pox, be recommended earlier. Re-vaccination should be performed in all cases where the cicatrices want the true vaccine character. When small-pox is of epidemic intensity, even the best vaccinated adults incur appreciable danger of attack ; but with them, if it do occur, is in the majority of cases mild and rarely' fatal. Amongst re-vaccinated adults attacks of small-pox are still more rare, and death is almost unknown. Whilst small-pox in the unvaccinated patients runs an unmodified course' in all but 2.6 per cent, its course in vaccinated patients is modified in 73 per cent; and while the death-rate of natural small-pox is from 35.55 to 50 per cent, that of vaccinal small-pox is but 6.56 per cent. FREE VACCINATION. (a) The Sanitary Inspectors of the Board of Health of the State of Lou- isiana are required by the rules of the Board to keep regular hours at the District Sanitary Office, and free vaccination should be performed daily' at specific hours. (b) The offer of vaccination to all inhabitants in each district, and the visitation in person by the Sanitary Inspector of all residences in the neigh- borhood of small-pox cases, and the earnest advocacy' of vaccination and re-vaccination. (c) Enforce the ordinance with reference to the thorough vaccination of the pupils of the public schools. The Sanitary inspectors are directed to Mortality of Neic Orleans During 1883. 113 make repeated inspections of the public schools in their districts, and whenever pupils are found without satisfactory marks of vaccination, they should be excluded until proofs of successful vaccination are furnished' Free vaccination should be offered to all children. By such measures small-pox may be banished from the public school of New Orleans. INVESTIGATION AS TO THE RESULTS ACCOMPLISHED BY VACCINATION IN THE CITY OF NEW ORLEANS DURING THE FIRST TWENTY-THREE WEEKS OF THE YEAR 1883. In the absence of exact data by which to determine the actual number of vaccinated and unvaccinated inhabitants and the cases of small-pox oc- curring amongst these two great classes, an inquiry was conducted, en- bracing the following subjects: 1. The mortality from all causes, and from small-pox, classified accord- ing to race, in the city of New Orleans, during the first twenty-three weeks of 1883. 2. The cases of small-pox, classified according to race. 3. The cases and deaths of small-pox occurring in the asylums, retreats, convents and prisons of New Orleans. 4 The cases and deaths of small-pox occurring amongst the children, white and colored, of the public schools. MORTALITY OF NEW ORLEANS DURING THE FIRST TWENTY- THREE WEEKS OF 1883, The total mortality of New Orleans during the first twenty-three weeks of 1883, has been : whites, 2,007 ; colored, 1,523; total, 3,530. It will be observed that, although the whites are three times as numerous as the colored, the number of deaths amongst the latter is only about one- fourth less. The highest death rate amongst the whites was reached during the week ending January 26th, namely 37.26 per thousand inhabitants per annum, and the lowest in the week ending May 5th, namely 20.26 per thousand ; death rate, whites, for the twenty-three weeks, 27.73 per thousand. The highest death rate amongst the colored population, occurred during the week ending April 7th, and reached the high rate of 81.54 per thousand inhabitants per annum. The lowest death rate amongst the colored population occurred in the week ending January 13th, namely 33.82 per thousand ; total death rate per thousand colored inhabitants for the first twenty-three weeks of 1883, 57.43 per thousand inhabitants. Death rate during twenty-three weeks of 1883 for white and colored, 35.70. The increase in the death rate amongst the colored population is clearly due to the prevalence of small-pox. In the following table will be found a detailed statement of the deaths,, death rate by color for each week, and total average from January 1st to> June 9th, 1883. 114 Joseph Jones, M. D., on Small-Pox and Vaccination. DEATHS, AND DEATH RATE BY COLOR FOR EACH WEEK, AND TOTAL AVERAGE FROM JANUARY 1 TO JUNE 9, 1883, Week Ending- No. of Deaths. Death Rate per 1000 per annum. White. Colored. Total. White- Colored. Total. January 6, [six days] 95 39 134 37.26 41.27 38,25 " 13 81 39 120 25 74 33 82 27 91 '' 20 101 57 158 32 10 49 44 36 75 " 27 63 53 116 20 02 45 97 26 98 1 02 69 171 32 42 59 85 39 77 '' *10 93 57 150 29 56 49 44 34 89 " 17 96 51 147 30 51 44 24 34 19 " 24 77 67 144 24 47 58 12 33 49 71 53 124 22 57 45 97 28 84 10 71 74 145 22 57 64 18 33 72 " 17 80 92 172 25*42 78 80 42 56 " 24 104 75 179 33 05 65 05 41 63 " 31 95 93 188 30 19 80 67 43 73 102 94 196 32 42 81 54 45 59 " 14 89 86 175 28 28 74 59 41 05 " 21 81 72 153 25 74 62 45 35.58 " 28 85 70 155 27 01 60 72 36 05 65 54 119 20 66 46 84 27.68 12 79 65 144 25 11 56.38 33.49 " 19 100 67 167 31 78 58 12 38 84 " 26 103 60 163 32 73 52 04 37 91 84 71 155 26 69 61 58 36 05 " 9 90 65 155 28.60 56.38 36.05 2,007 1 523 3,530 27.73 57.43 35.70 CASES OF DEATHS OF SMALL-POX IN NEW ORLEANS FIRST TWENTY-THREE WEEKS OF 1883. The increased death-rate both amongst whites and colored has been due to the presence of small-pox. Thus of the 2007 deaths amongst the whites, 344, or about one-sixth were caused by small-pox ; and of the 1523 deaths occurring amongst the colored populations, 580, or more than one-third, were caused by small-pox. If the total deaths caused by small-pox, numbering 924, be subtracted from the deaths from all causes, there will remain but 2606, as the mortality of New Orleans from all causes incident to the soil and climate. The total number of cases of small-pox reported upto twelfth of June, 1883, 2648: whites, 1169; colored, 1479; distributed as follows: First District, 572; Second, 637; Third, 791; Fourth, 232; Filth, 154; Sixth, 134; Seventh, 28. Full and minute details will be found in the following tables: Small-Pox in New Orleans, 1883. 115 DEATHS BY SMALL-POX BY WEEKS, JANUARY FIRST TO JUNE NINTH, 1883. Week ending (six days): White. Colored. Total. January 6 6 5 11 " ' 13 3 10 13 " 20 7 18 25 " 27. 4 9 13 February 3. .... 12 21 33 " ' 10 13 18 31 " 17 10 11 21 " 24 10 30 40 March 3 10 17 27 " 10 7 17 24 " 17 17 39 56 " 24 25 40 65 " 31 20 49 69 April 7 32 54 86 " 14 32 45 77 " 21 18 28 46 " 28 17 28 45 May 5.... 14 20 34 " 12 13 17 30 " 19 28 24 52 " 26 21 20 41 June 2 13 27 40 " 9 „ 12 33 45 Total 344 580 924 CASES OF SMALL-POX Reported to the Board of Health from January 1st to June V2th, 1883, inclusive. Month 1 Diet. 2 Diet, 3 Diet. 4 Diet. 5 Diet. 6 Dist. 7 Dist. Total w c w c Total w c Total w c Total w c Total w c Total w c Total w c Total January February March April May June 1 to 12. - 37 34 52 63 41 4 56 50 65 74 62 34 93 84 117 137 103 38 18 37 75 84 41 8 30 42 104 110 61 27 48 79 179 194 102 35 23 38 97 117 105 23 18 51 110 1-0 97 32 41 89 207 297 202 55 17 14 40 32 25 11 23 18 18 18 13 3 40 32 58 50 38 14 2 2 5 9 16 8 2 9 25 54 22 2 4 14 34 70 30 5 7 27 34 11 4 3 5 10 21 4 3 8 12 37 55 15 7 1 1 1 5 9 7 2 1 1 6 10 7 3 1 1 1C3 133 296 340 239 58 135 177 323 430 292 122 238 310 619 770 531 180 Total 231 341 572 263 374 637 403 488 791 139 93 232 42 112 154 88 46 134 3 25 28 1169 1479 2648 In order to place the Honorable Board of Health in possession of all the essential facte with reference to the presence of small-pox in New Or- leans, I have consolidated the results of recent inspections of the asylums, prisons and charitable institutions of New Orleans. This extended and careful inspection records the important fact, that all the great benevolent institutions of New Orleans have been free from small-pox. An extended inspection of the entire city, and an examination of the localities in which small-pox prevails has shown. 1. That small-pox has prevailed, in the more crowded and filthy portions of the city, and amongst the poorer classes both white and colored. 2. The prevalence of the disease is due to two causes: namely its con- stant introduction from without; and to the neglect of vaccination. 116 Joseph Jones, M. D., on Small-Pox and Vaccination. GENERAL RESULTS OF THE INSPECTION OF TWENTY-ONE ASYLUMS, HOUSES OF REFUGE, EDUCATIONAL INSTITU- TIONS, CONVENTS, AND THE PARISH PRISON, IN THE CITY OF NEW ORLEANS, LOUISIANA, DURING A PERIOD OF FOUR- TEEN DAYS, MAY 31st TO JUNE 14th, 18S3, BY JOSEPH JONES, M.D., PRESIDENT OF THE BOARD OF HEALTH OF THE STATE OF LOUISIANA, ESTABLISHING THE HEALTHY CONDITION OF THE INMATES AND THE TOTAL ABSENCE OF SMALL-POX ON ACCOUNT OF THOROUGH AND SUCCESSFUL VACCINA- TION BY EXPERIENCED PHYSICIANS. 1.-St. Elizabeth Asylum, Napoleon Avenue, corner of Pry tan ia street. In charge of Sister Superior Madeleine. Physician, Dr. E. T. Shepard. Fourteen (14) Sisters; one hundred and fifty-two (152) girls between the ages of 12 and 18 years ; three (3) employees. Total population at time of inspection, 168. All well, not a case of sickness. No case of fevers, nor of any infections or contagious disease, during 1883. Hygienic and sanitary condition excel- lent. The recent addition to the buildings has added much to the comfort of the inmates, and increased the efficiency and enlarged the field of use- fulness of this noble institution. 3-House of Good Shepherd, corner Bienville and Broad streets, in charge of Mother Superior St. Rose. Physicians: Drs. G. K. Pratt and William Martin. The population at the time of the inspection consisted of 33 Sisters and about 300 female inmates. Dr. C. Faget, Sanitary Inspector of the Second District, has vaccinated the inmates: No case of small-pox has occurred in tins convent during the years 1882 and 1883; the inmates have also been exempt from scarlet fever and measles. One death amongst the female inmates and two deaths amongst the Sisters have been caused by phthisis pulmonalis. With the exception of two cases of the preceding disease, the population was exempt from disease. Owing to its situation in the neighborhood of the naviga- tion and drainage canals, cases of chills and fevers sometimes occur. 3-Asylum for Destitute Orphan Hoys, St. Charles, between Valmont and Dufossat streets, in charge of Superin- tendent George Burns. Physician, Dr J. B. Henderson. At time of in- spection, 148 boys. No case of small-pox during 1882 and 1883; no death; 6 cases of scarlet fever, all recovered; at present 3 cases of mumps; in good sanitary condition. 4-German Protestant Asylum, State, between Cam]) and Chestnut streets. Superintendent, Mr. Gustave Pixburg. Physician, Dr. Joseph Schmittle. 54 boys and 54 girls; total, 108. Children have been vaccinated by attending physician ; no case of small-pox nor of measles, scarlet fever, or any contagious or infectious dis- ease in 1883; 1 death in 1882 from consumption, and no death from any cause in 1883; in good sanitary condition. Results of Inspection of Convents, Asylums and Prisons 117 5-Louisiana Retreat for the Insane, Henry Clay Avenue, Sixth District, in charge of Sister Superior Mary Jane Stokes. Physician, Dr. E. T. Shepard. Eighteen Sisters, 17 employes, nurses, etc.; 85 female patients; 31 male patients. Total patients at time of inspection, 116. No case of small-pox among the inmates during 1882 and 1883. One of the employes was attacked by this disease in April, 1883, but was imme- diately removed from the premises, and the necessary measures instituted for his isolation. No other case occurred. Dr. William Ryan, Sanitary In- spector of the Sixth and Seventh Districts, was charged by the Board of Health with the isolation and disinfection of this case 6-Poydras Female Orphan Asylum, corner Magazine street and Peters Avenue. Matron, Mrs. Sutherland.. Physician, Dr. G. N. Monette. Inmates, 89; employes, 9. One death in 1883, an infant brought in in a dying condition. One case of small-pox in 1883, girl, aged 14; case isolated; recovered. All inmates vaccinated ; no, other case occurred. Dr. William Ryan, Sanitary Inspector of Sixth and Seventh Districts, was directed by the President of the Board of Health to hold this case under careful observation and to institute the necessary- measures of isolation and disinfection. 7-Seventh Street Protestant Orphan Home, Matron, Mrs. A. Walker. Physician, Dr. E. A. Murphy. Boys in nursery, 17; large boys, 24; total boys, 41. Girls in nursery, 15; large girls, 43; total girls, 58. Total boys and girls, 99 ; attendants, 3. All well at date of inspection. No case of small-pox during 1883; one case in 1882. No measles nor diphtheria during 1883, and no deaths. All the children have been vaccinated. 8-St. Vincentis Infant Asylum, No. 74 Magazine street. Physician, Dr. W. E. Brickell. At time of in- spection 10 Sisters, 5 employes, and 200 children; 20 children at the Re- treat, near Carrollton. No case of small-pox during 1882 and 1883. Measles have been recently introduced into the institution by children brought from Greenville, Miss.; 12 of the children are now suffering with the disease, which will probably extend to all susceptible to this affection. In May, a Mrs. , from Greenville, Miss., applied to be admitted with her four children. The Sister Superior observing that two of the children were suffering with high fever and some eruptive disease, refused admis- sion, and the children were sent to the Charity Hospital. The mother subsequently returned about May 27, with an order from the Mayor to admit the mother and the two remaining children. After admission the measles developed, and is now spreading from these Mississippi cases to the other children. 9-Parish^Prison. At time of inspection 135 prisoners. During the months of January, February, March, April, May, there have been confined in the Parish Prison about 775 prisoners. Of this large number, only one prisoner, Victor Eloi, (convicted of wife murder), has been attacked by small-pox. In accordance with the instructions of the President of the Board of Health, Dr. C. Faget, Sanitary Inspector of the Second District, vaccinated all 118 Joseph Jones, M. I)., on Small-Pox and Vaccination. the prisoners, and the murderer, Victor Eloi, was transferred to the Small- Pox Hospital on March, 26, where he remained until April p. No cases of measles or scarlet fever or diphtheria have occurred in the Parish Prison during-1883. One death from chronic dysentery occurred on January 15. At the date of the inspection. (June 30, no case of sickness in Parish Parish. 10-Boys' House of Refurge, United States Marine Hospital Building, Common street. Thomas Bren- nan, Superintendent: ninty-seven boys, all well (June 3). No case of small-pox during 1883. The case of Jules A. Bone, (aged fifteen, com- mitted for vagrancy), supposed to have been small-pox and sent by the Coroner to Small-Pox Hospital, was pronounced by the physician in charge to have been one of measles; sent to Small-Pox Hospital April 4, and returned to Boys' House of Refuge, April 16; this boy is said to have had small-pox before entering the Boys' House of Refuge. 11-Fink Asylum for Widows and Children, corner Amelia and Camp streets. Matron, Mrs.Z. Henderson; Physician, Dr. Joseph Schmittle; thirty-two inmates all well; one death ; no cases of small-pox and no cases of measles or scarlet fever; death caused by diarrhoea, aged 63; one death in 1882 from same disease, aged 70 years. This institution is well adapted for the health and comfort of the in- mates- 12-The Association of Jewish Widows and Orphans' Home. Jackson street. Chief Superintendent, J. Brendzel ; Physician, Dr. Freder- ick Loeber ; boys, seventy-two; girls, fifty-two; widows, two: besides officers and attendants, seventeen-total, 143. One death in 1882, from dentition. No case of small-pox in 1882 and 1883. No deaths in 1883, and no cases of dipththeria, measles or scarlet fever at time of inspection, dune 5; all well. 13-Protestant Episcopal Children's Home, Jackson street, between Chippewa and St. Thomas streets. In charge of Sister Sarah. Physician, Dr. C. J. Bickham. Forty-eight girls, Sisters, six ; total, fifty-four. Only one death has occurred among the children of this excellent institution since its foundation; but two Sisters have died, one from yellow fever in 1878. No deaths in 1882 nor in 1883. No case of small-pox, measles or scarlet fever in 1882 or 1883. All the inmates vac- cinated. All well June 6, 1883. 14-St. Joseph Boys' and Girls' Orphan Asylum. •corner Laurel and Josephine streets. In charge of Mother Mary Jacobine. Physician, Dr. Thos. Layton. Two hundred orphans, boys and girls. All well. One death in 1883 from phthisis pnlmonalis. No case of small-pox, measles or scarlet fever during 1882 and 1883. This institution is con- ducted by Sisters. The day school has 400 girls and 250 boys. No case of small-pox has occurred among 650 children. 15-New Orleans Female Orphan Asylum. corner of Camp and Prytania streets. Sister Superior Eustolia; Physi- cian, Dr. Wm. E. Brickell; 140 girls, 12 Sisters, 5 employes, total 157. All well. During the past six years only one death, in 1878, amongst the children ; in 1881 one Sister died from dropsy. No case of small-pox, measles, scarlet fever or diptheria during 1882 and 1883. Results of Inspections of Convents, Asylums and Prisons. 119 16-Convent of the Sisters of the Holy Family, No. 17 Orleans street, Mother Madelaine; Physician, Br. J. C. Faget; 20 ■Sisters, 66 daily scholars and 14 resident scholars. All well. No case •of small-pox, or of measles, scarlet fever or diphtheria during 1882 and 1883. 17-Convent of the Sisters of the Holy Family, No. 140 Tonti street. Mother Theresa; 5 sisters, 68 children; no cases of small-pox during 1882 and 1883. 18-Asylum Sisters Holy Family, •St. Bernard, between Urquhart and Villere streets. 3 sisters, and 18 aged persons; have had no cases of small-pox in 1882 and 1883. 19-Convent of the Sacred Heart, No. 79 Dumaine street. Sister Superior Zeringue; physician, Dr. J. C, Faget; 31 sisters; 140 day scholars, 8 boarding scholars, total, 179; all vaccinated; all well. No case of small-pox or measles, scarlet fever or •diphtheria in 1882 and 1883. 20-Mount Carmel Convent, No. 200 Bayou Road. Mother Theresa; physician. Dr. Charles Turpin; 22 sisters ; 10 scholars, boarders; 75 white day scholars; 30 colored day scholars; all well; no case of small-pox in 1882 and 1883. 21-Mount Carmel Asylum, No. 53 Piety street. Sister Superior Justine ; 10 sisters, 129 children : all Well; no case of small-pox in 1882 and 1883., :2:;' ' 22-Mount Carmel Day School, Algiers, Fifth District. Sister Philomena ; physician, Dr. J. H. Magruder; 4 sisters, 83 children in school; no case of small-pox in 1882 and 1883. 23-Catholic St. Mary Boys'' Asylum, corner of Chartres and Mazant streets. Sister Superior Mary Desert; physician, Dr. E. Doumeing; 300 boys. There has been no small-pox in this institution during the past nine year$ and there is not a case at present. In 1874 there were 64 cases of small-pox, with four deaths. Dr. J. C. Faget was the physician at that time. No measles, scarlet fever or diph- theria in 1882; no scarlet fever or diphtheria in 1883. About May 20th, 1883, measles were introduced by a sick child brought to New Orleans from Natchez, Miss. Up to the date of the inspection, June 11, 1883, forty cases of measles have occurred, and I inspected about thirty •cases of this disease in the infirmary, all apparently progressing favorably. No other case of disease. 24-Asylum of the Little Sisters of the Poor, •corner of Johnson and Laharpe streets. Mother Superior, Joseph Theresa; physician, Dr. J. C. Faget; 230 inmates, 16 sisters. No case of fever, 120 Joseph Jones, M. D., on Small-Pox and Vaccinaiion. small-pox, measles or diphtheria during 1882 and 1883. Deaths incident to old age and chronic diseases. This most useful and benevolent institu- tion was in excellent sanitary condition, and presented the appearance of a comfortable, well ordered home for the aged and infirm. 25-Asylum of the French Benevolent Association, St. Ann street, between Roman and Derbigny streets ; 11 inmates and 1 nurse. No case of small-pox during 1882. One death from small-pox in 1883. 26-St. Anna Protestant Asylum for Widows and Children, corner Prytania and St. Mary streets. Matron, Mrs. E. E. Kip; physician, Dr. Joseph Holt; widows, 70; children, 36; total, 106. No case of measles, scarlet fever or diphtheria or small-pox in 1882 or 1833. No deaths in 1883. Two deaths in 1882 from old age. The sanitary arrangements of this admirable institution were found, as well as the rules governing it, to be excellent, Recapitulation : Total inmates 4,030 Total sisters 234 Total employes 62 Grand total 4,335 During the preceding inspection, not a single case of small-pox existed in any one of the twenty-six institutions specified ; and during the years 1882 and 1883, only two orphans, one prisoner and one employe were at- tacked by small-pox ; total, four cases of small-pox, each of which recovered. That is amongst 4,335 persons vaccinated, only one in 1,083 suffered with small-pox, and not one died. "'On the other hand, the total number of cases of small-pox reported in the city of New Orleans, from January 1st to June 12th, 1883, was, whites, 1269 ; colored, 1,497 : total, 2,648 ; with deaths, whites, 344; colored, 580 : total deaths by small-pox, 924. According to the United States Census of 1880, New Orleans, has a total population of 216,090 ; whites, 158,307 ; colored, 57,617. During the first twenty-three weeks of 1883, one in 81.6 of the entire population, one in 135.3 whites, and one in 39 of the colored population of New Orleans were attacked with smaibpox. Of the cases of small-pox, one in 2.87 died ; of whites attacked by small- pox, one in 3.39 died ; of colored attacked by small-pox, one in 2.55 died. I regard the public schools as affording another important field for the estimation of the power of vaccination to protect during the prevalence of an epidemic of small-pox, which had confined its ravages to no portion of this country, and, consequently, requested the learned, accomplished and efficient superintendent of the public schools, to make a thorough investi- gation as to the number of school children vaccinated; the number of cases attacked by small-pox, and the number of deaths occasioned. The following is the reply of Hon. Wm. O. Rogers, Superintendent Public Schools, New Orleans, Louisiana : Results of Inspection of Public Schools. 121 OFFICE OF SUPERINTENDENT OF PUBLIC SCHOOLS, I New Orleans, June 15, 1883. S Dr. Joseph Jones, President Board of Health: Dear Sir-Some time since I addressed a circular note to the principals of the public schools of this city, asking for information upon the following points: 1. How many pupils belonging to the schools, respectively, have had small-pox dur- ing the current session, beginning October 1, 1882 ? 2. How many pupils belonging to the school are reported to have died from small-pox during the present session ? Answers have been received from all the schools, except from two or three small schools in remote districts. I send, herewith, the results of the inquiry, ami add thereto the number of pupils en- rolled in the reporting schools May 31, 1883. Very respectfully, M. O. ROGERS, Chief Superintendent Public School, New Orleans. Names of Schools. Location of Schools. Number of Pupils Enrolled Number of Cases of Small-pox Number of Deaths Reported Girls' High School Boys' High School Clio street, between St. Charles and Prytania 39 Burgundy street..__ ISO 80 2 0 0 0 Total 260 2 0 HIGH SCHOOLS. FIRST MUNICIPAL DISTRICT. White Children. Names of Schools. Location of Schools. Number of Pupils Enrolled Number of Cases of Small-pox Number of Deaths Reported Jackson, Boys . . Magazine street 320 1 0 Jackson, Girls Magazine street 397 2 0 Paulding Constance and Gaiennie streets.. 382 0 0 Franklin . St. Charles street, near Girod... 734 3 0 Jefferson Dryades and Erato streets 434 4 0 Webster Dryades and Erato streets 535 3 1 McDonogh No. 13, Boys. Girod and Rampart streets 644 4 0 McDonogh No. 1, Girls. Prienr and Palmyra streets 732 8 3 Total white children. 4,178 25 4 Colored Children. Fisk, Bovs Franklin and Perdido streets.... 383 13 3 Fisk, Girls Franklin and Perdido streets.... 598 11 1 Total colored children. 981 24 4 SECOND MUNICIPAL DISTRICT, White Children. Names of Schools. Location of Schools. Number of pupils Enrolled. Number of cases of Small-pox Number of Deaths Reported. Bienville, Bovs Bienville and Robertson 422 0 0 Robertson, Girls Bienville and Robertson 246 4 1 St. Philip, Boys St. Philip, near Royal 768 3 0 St. Anne, Girls St. Ann, near Marais. . 356 4 1 McDonogh No. 15, Girls. Barracks and Dauphine 428 2 0 Total White Children 2220 13 2 122 Joseph Jones, M. D., on Small-Pox and Vaccination. Colored Children Bayou Road, Boys Bayou Road and Derbigny 306 14 3 Claiborne, Girls Claiborne and St. Peter 387 •20 4 Total colored children 693 34 7 THIRD MUNICIPAL DISTRICT, White Children. Names of Schools. Location of Schools. Number of Pupils Enrolled. Number of of Cases of Small-pox Number of Deaths. Reported, McDonogh No. 16, Boys and Girls Bagatelle street, near St. Claude 816 7 0 McDonogh No. 9, Boys and Girls Tonti and Onzaga streets 434 1 McDonogh No. 3, Boys Spain, near Rampart street Mandeville, near Rampart street McCarthy Square 6.13 6 0 •McDonogh No. 2, Girls 672 8 1 McDonogh No. 12, Boys 758 1 0 Washington, Girls Chartres and Piety streets 404 0 0 Hancock, Boys and Girls Near U. S. Barracks 201 3 0 Total White Children • 3898 34 2 Colored Children. Marigny, Boys and Girls McCarthy, Boys & Girls Marigny and Urquhart streets.. Pauline and Chartres streets. 432 214 15 2 6 0 Total Colored Children 636 17 6 FOURTH MUNICIPAL DISTRICT. White Children. Names of Schools. Location of Schools. Number of Pupils Enrolled Number of Cases of Small-pox Number of Deaths Keported Laurel, Bovs . Laurel and Philip streets 417 2 0 McDonogh No. 1, Girls.. Laurel street, near Philip 417 0 0 McDonogh No. 8, Boys.. Constance and Ninth streets. 441 2 0 Live Oak, Girls... Constance and Ninth streets.... 433 0 0 Magnolia, Girls. Carondelet street, near Jackson. 336 4 1 Chestnut, Boys and Girls Chestnut street, near Jackson .. 216 0 0 Keller, Boys and Girls.. Jackson and Freret streets..,. 387 10 3 McDonogh No. 10. Boys. Baronne and First streets 340 1 0 Total white children - 2,987 19 4 Fulton, Boys and Girls.. Fulton and Josephine streets....' 283 8 0 Dryades, Girls . Third street, near Baronne.. 295 & o St. Andrew, Boys St. Andrew and Magnolia 198 7 1 Total colored children 776 21 1 Colored Children. FIFTH MUNICIPAL DISTRICT, ALGIERS. White Children. Names of Schools. Location of Schools. Number of Pupils Enrolled Number of Cases of Small-pox Number of Deaths Reported McDonogh No. 4, Boys and Girls Algiers 578 8 2 Results of Inspection of Public Schools. 123 Colored Children. McDonogh No. 5, Boys and Girls Algiers 418 11 1 SIXTH MUNICIPAL DISTRICT. White Children. Names of Schools. Location of Schools. Number of Pupils Enrolled Number of Casesof Small-pox Number of Deaths Repor ted McDonogh No. 7, Boys.. Milan and Chestnut streets 330 1 0 McDonogh No. 7, Girls.. Milan and Chestnut streets. . 343 0 0 Lincoln, Boys and Girls. Carondelet and Dufossat streets. 102 0 0 Leontine, Boys and Girls Live Oak and Valmont streets .. 317 2 0 Total White Children 1,092 3 0 Colored Children. McDongh No. 6, Boys and Girls Magazine st. and Napoleon av... 414 5 0 SEVENTH MUNICIPAL DISTRICT, CARROLLTON. White Children. Names of Schools. Location of Schoolg. Number of Pupils Enrolled. Number of Cases of Small-pox Number of Deaths Reported. Jefferson No. 2, Boys. .. Jefferson street, Carrrollton 191 No Report No Report Washington No. 2, Girls Washington street, Carrollton.. 153 0 0 Total White Children 344 0 0 Colored Children. Short street Carrollton ....... 396 2 2 RECAPITULATION. White Children. Districts Number of • Schools. Number Pupils Enrolled Number Cases Small-Pox Number Deaths Reported White Colored White Colored White Colored White Colored Hio-li Schools 2 260 2 First District 8 2 4,178 981 25 24 4 4 Second District 5 2 2,220 693 13 34 2 7 Third District 7 2 3,898 636 34 17 2 6 Fourth District 8 3 2,987 776 19 21 4 1 Fifth District 1 1 578 418 8 11 2 1 Sixth District 4 1 1,092 414 3 5 0 0 Seventh District.... 2 1 344 396 0 2 0 2 Total 37 12 13,557 4,314 104 114 14 21 124 General Conclusions. The Board of Health has endeavored strictly to enforce the health ordinance passed May 18th, 1870, to the effect : " Section 29. No child shall be admitted as a pupil in any public school without a certificate from a practising physician, or proof of successful vaccination. The Board of Health will at all tim* s provide the means for gratuitous vaccination at the office of either of the sanitary inspectors." Whatever protection the children of the public schools of New Orleans have enjoyed from small-pox, beyond other inhabitants of the city, is entirely due to the efforts of the Board of Health to enforce the preceding ordinance. Thus, according to the statistics furnished by the superintendent of the public schools, of 13,557 white scholars, only 104 were attacked by small-pox; one case of small-pox occurred in 130.3 white scholars. Fourteen of the one hundred and four cases of small- pox terminated fatally, or one death in 7.42 cases ; and one death from small-pox in 968.3 white scholars. Of the entire white population of New Orleans, one in 135.3 were attacked by small- pox, a proportion not far different from that amongst the white scholars of the public schools, but the mortality was far greater, the deaths being in the ratio of one in 3.39 cases; and one in 460 of the entire white population died from small-pox during the first twenty-three weeks of 1883. Relatively the small-pox has been twice as fatal amongst the general white population of the city, than amongst the white pupils in the public schools. This result must be attributed to the protective effects of vaccination. Of 4,314 colored children attending the public schools of New Orleans, 114, or one in 37.8 were attacked by small-pox, of which number 21, or one in 205.4 scholars, and one in 5.42 cases proved fatal. Of the entire colored population of New Orleans, during the first twenty-three weeks of 1883, one in 39 were attacked by small-pox, and the mortality was one death in 2.55 cases; of the entire colored population of New Orleans during the same period, the proportion of deaths was one death to 99.7 colored population. The disease was more than twice as fatal amongst the general colored population. It is well known that the assemblage of large bodies of children, or of human beings of all ages, in rooms, as in schools and churches, is the most favorable of all conditions for the rapid propagation of contagious and infections diseases ; in addition to this, the assemblage of the children is daily, and they travel each day through considerable portions of the city. The conclusion is justified by the preceding facts, not only that vaccination has to a great extent protected the children of the public schools from the ravages and fatal effects of small-pox, but also that but for the protective influence of vaccination, every one of the 13,557 white children and 4,314 colored children, total, 17,871, children in the public schools of New Orleans would have been attacked by genuine, unmitigated small-pox, and the mortality would have been not .ess than one in three, or about 5,953. GENERAL CONCLUSIONS. RESULTS ACCOMPLISHED BY VACCINATION IN THE CITY OF NEW ORLEANS DURING THE FIRST TWENTY-THREE WEEKS OF 1883. In the absence of exact data in which to determine the actual number of vaccinated and unvaccinated inhabitants, and the cases of small-pox occurring among those two great classes, an inquiry was conducted embracing the following subjects: 1. The mortality, from all causes and from small-pox, in the city of New Orleans dur- ing 1883, classified according to race. Total mortality of New Orleans during the first twenty-three weeks of 1883: Whites 2007, colored 1523 ; total 3530. Deaths from small-pox, whites 344, or about one-sixth of the total deaths ; colored, 580, or more than one-third of the total deaths ; deaths from small-pox, colored and white, 924. If the total deaths caused by small-pox, numbering 924, be subtracted from the deaths from all causes, there will remain but 2606 as the mortality of New Orleans from all causes incident to our soil and climate. 2. Cases of small-pox classified according to race. The total number of cases of small-pox, reported up to 12th of June, 1883, were 2648; whites 1169, colored 1479. 3. Cases of deaths of small-pox occurring amongst the inmates of the asylums, re- treats, convents and prisons of New Orleans. An extended inspection of the entire city, and an examination of the localities in which small-pox prevails, has shown : (a) That small-pox has prevailed in the more crowded and filthy portions of the city and amongst the poorer classes, both white and colored. Joseph Jones, M. D., on Measures to Arrest Small-Pox. 125 (b) The prevalence of this disease is due to two causes, namely, its continual introduc tion from without and to the neglect of vaccination. 3. The cases and deaths of small-pox occurring in the asylums, retreats, and prisons of New Orleans. In an inspection of twenty-six asylums, houses of refuge, educational institutions, convents and prisons of New Orleans, it was found that not a case of small-pox existed at the time of examination, or during the years 1882 and 1883 ; only two orphans, one prisoner and one employe were attacked by small-pox. Total inmates.. 4,039 Total Sisters 234 Total employes 62 Grand total 4,335 That is amongst 4335 persons occupying these twenty-six institutions and who had been vaccinated only one in 1083-5, suffered with small-pox during the year 1882 and 1883, and not one died. On the contrary, during the first twenty-three weeks of 1883, 1 in 81.6 of the entire population ; 14n 135.3 whites and 1 in 39 of the colored population of New Orleans were attacked with small-pox. Of these cases of small-pox 1 in 2.87 died, of whites attacked by small-pox 1 in 3.39 died, of colored 1 in 2.55 died. 4. The cases and deaths by small-pox occurring amongst the children, white and colored, of the public schools. During 1883, of 13.557 white scholars only 104 were attacked by small-pox, of which fourteen (14) or 1 death in 7.42 cases, and one death from small-pox in 968.3 white scholars. On the contrary, during 1883, 1 in 460 of the entire white population died of small- pox. Small-pox .has been twice as fatal amongst the white population of New Orleans as amongst the white pupils of the public schools. Of 4314 colored children attending the public schools of New Orleans, 114, or 1 in 37.8 were attacked by small-pox, of which number 21 or 1 in 205.4 scholars, and 1 in 5.42 cases proved fatal. Of the entire colored population of New Orleans, during the same period, the propor- tion of deaths was 1 death to 99.7 colored population. The disease was more than twice as fatal amongst the general colored population. It is well known that the assemblage of large bodies of children, or of human beings of all ages, in rooms and in schools and churches, is the most favorable of all conditions for the rapid propagation of contagious and infectious diseases ; in addition to this the assemblage of the children is daily; and they travel each day through considerable por- tion of the city. The conclusion is justified by the preceding facts, that vaccination, as executetl in ac- cordance with the orders and regulations of the Board of Health, has been productive of good effects-; and but for this measure every one of those 17.871 children in the public schools might have been attacked by small-pox and at least 5953 would have died. SANITARY MEASURES FOR THE ARREST OF SMALL-POX. No sanitary measures or combination of sanitary measures will avail for the arrest of small-pox in the absence of vaccination and re-vaccination; nevertheless, much good may be accomplished by the following : (d.) Enforce rigidly the sanitary laws of the State and city, with reference to the prompt report of each and every case of small-pox and varioloid to the President of the Boarci of Health. Attention is especially directed to the following : (Jewell's Digest, 1882-Revised City Ordinances). XI.-Health. (Art. 54, p. 236.)-All practitioners of medicine, masters of any water craft, hotel, boarding or lodging house keepers, principals or masters of any boarding school or seminary, the chief officers or persons in charge of any public institution of charity or asylum, or otherwise, are hereby required to report within twenty-four hours, to the office of the Board of Health, all cases within their cognizance of Asiatic cholera, yellow fever, typhus or ship fever, malignant scarlet fever, small-pox, varioloid, trichin- iasis, or any other case that may at any time be specified by the Board of Health, and in default or failure to so report such cases, such person so failing or in default shall be liable to a fine not to exceed fifty dollars ; provided, however, the said Board may declare it unnecessary to report further cases, when any disease shall have been pronounced •epidemic. (e.) Isolation of cases of small-pox. 126 Measures for the Arrest of Small-Pox. When anybody, especially a child or growing person, has sore throat, bad health or fever, he should be kept separate from all other persons, except necessary attendants, until it be ascertained whether he has scarlet fever, diphtheria or some other communi- cable disease. When the Inspector observes neglect or refusal to use suitable precautions for the isola- tion of such cases, he should use his discretion in removing them to the pest-house, (f.) The prevention of gatherings at funerals. Particular attention is called to Section 2 of Ordinance 14, adopted April 14, 1870 : " Sec. 2. That the Board of Health shall have authority at its discretion to prevent access to, or egress from, or cause to be vacated any infected buildings, place or locality, whenever in the discretion of said Board such action should be deemed necessary to pre- vent the spread of small-pox." (g.) The heads of families, as well as practitioners of medicine, should be held responsible for the prompt report of each and every case of small-pox. Conduct of the Sick Room. (h.) The bed-room of a person sick with scarlet fever, diphtheria, small-pox or any other infectious disease, should be cleared of all needless clothing, carpets, drapery, or any material liable to harbor the poison of the disease. The room should have a liberal supply of fresh air, at least 2000 cubic feet per head per hour. In summer the supply should be unlimited, windows and doors thrown open, and kept open night and day. All discharges from throat, nose, bowels or kidneys should be received in vessels con- taining a pint or more of one or the other of the following solutions : Carbolic Acid and Copperas Solution. Dissolve 4 pounds of sulphate of iron (copperas) in two gallons of water and add one quart of Calvert's No. 5 carbolic acid. Store for daily use. Solution Chloride of Zinc. Sulphate of zinc (white vitriol) 4 ounces. Common salt 2 ounces, Water... 1 gallon. Solution of Chloride of Lead. Dissolve two drachms of nitrate of lead in a quart of water ; throw in a large vessel containing a gallon of water; dissolve two tablespoonfuls of common salt, mix the two Bolutions'together and store for daily use. Carbolic Acid Solution. Carbolic Acid 4 ounces. Water 1 gallon. This solution will be useful for clothing, scrubbing doors and washing of hands. Carbolate of lime and chloride of lime may also be sprinkled over the door, when necessary. When needed, the carbolic acid may be made to permeate the air by spray from air atomizer. Solution of ChlorimatedSoda.-Solution of Chlorimated Lime. The clothing or bedding used about the patient should be thoroughly purified by the following measures ; otherwise they should be destroyed by fire. Heat is a valuable and effective agent for the purification of clothing. The heat may be applied either by boiling water or in dry state, and should reach at least 212° F. When dry heat is desirable, an oven will answer that purpose, carefully removing the embers, and hanging on wires the clothing to be disinfected. Before using dry heat, the clothing should be thoroughly cleansed by washing. Clothing may be cleansed by adding to every ten gallons of boiling water, three- quarters of a gallon of commercial solution of chloride of lime ; or the clothing may be laid for twenty-four hours in a solution of sulphate of zinc, in the proportion of one to one hundred and twenty, or of chloride of zinc, in the proportion of one to two hundred and forty, or in the chloride of lead solution, previously described, and then be washed W'ith soap and water if they cannot be baked. Nurses and attendants should be required to keep themselves and their patients as clean as possible, disinfecting their hands frequently by chlorinated soda or other dis- infectants. Attendants should also wear cotton or liuen (not woolen) clothes or overalls, to which particles will not so readily adhere, and which may be more easily disinfected. Joseph Jones, M. D., on Disinfectants. 127 Disposal of the Dead of Small-Pox. Cremation would be the most effective and the most philosophical method of disposing of the bodies of those who die of small-pox. All gatherings around the body should be prohibited. After death the corpse should be wrapped in sheets saturated with pure carbolic acid ; the body thus treated should be enclosed in oil cloths and immediately placedin the coffin and covered with charcoal and chlorinated lime. The vehicle conveying the body should be unattended with any funeral cortege. The welfare of the living demands the utmost privacy and dispatch in the burial of the bodies of those w'ho have died of small-pox. Disinfection of Dwellings and Premises after Recovery or Death. In addition to thorough cleansing of all wood-work, with soft-soap and water to which carbolic acid has been added (one pint of carbolic acid to four gallons of water), and removing and washing all fabrics, which can be removed, in the manner already de- scribed, the walls should be carefully brushed, and whenever practicable, white- washed . In severe cases of small-pox, the clothing and bedding of the patient should be de- stroyed by fire. The rooms should be fumigated for a period varying from twelve to forty-eight hours. Fumigation. All doors and windows and the chimney being tightly closed, and all fabrics to be burneel or washed taken away, sulphur is put into a metallic dish, a little saltpetre put upon the top or mixed with it, and then ignited. The proportion shoukl be two pounds of sulphur to one thousand cubic feet of space. In large rooms two or more pans of sulphur may be used. Owing to the instant effects of the sulphurous acid upon the lungs, the person setting light to the saltpetre and sulphur mnst make a precipitate escape from the room the instant the sulphur is. burning. After the fumigation is completed, the doors and windows should be opened and kept open for several hours. All articles, such as beds and bedding or wearing apparel, must not be burned in the open air, until thoroughly disinfected. Bedding, beds, pillow-cases, which are not suffiiently infected to necessitate destruc- tion, should be cut open and subjected to the fumes of burning sulphur. DISINFECTION. The Board of Health of the State of Louisiana deem it important that the people should be instructed with regard to the value and importance of disinfection, for the. removal of foul gases and emanations, and for the destruction of the poisons of infec- tious and contagions diseases. To accomplish the greatest good for the preservation of the health of the people, dis- infection should be practiced at regular intervals throughout the entire year ; but more fully and frequently in the city of New Orleans during the months of May, June, July, August, September and October. By disinfection and household sanitation, the people should seek to avert or prevent pestilence, and should not delay the practice of these important measures until disease is actually developed, by the neglect and violation of sanitary laws. Each citizen, therefore, by obeying rigidly sanitary laws becomes the guardian of the health of his household. New Orleans is without sewers, and the privies necessarily contain at all times an im- mense amount of fcecal matter. Even under the most energetic system of removal of the contents of the privies, it is essential that disinfectants be used in this hot, moist climate, at regular intervals. It should be borne in mind, however, that disinfection cannot be substituted for want of cleanliness or of ventilation, but should be used for the prevention of those putrefactive processes, which result in the generation of com- pounds and agents deleterious to man. In the selection of disinfectants reliable agents should be secured, which can be procured in a state of purity, and at so small a cost that they can be used in adequate quantities and at stated intervals. DISINFECTANTS. Disinfection of Privies and Water Closets. For the disinfection of privies, cess-pools, water closets and vaults, use the fellowing ; Sulphate of Iron (green vitriol, or copperas) 8 pounds. Culvert's Carbolic Acid, No. 5 _.l pint. Water 4 gallons. 128 Joseph Jones, M. D., on Diphtheria. Dissolve the green vitriol in hot water, and when cool add the carbolic acid. Add one gallon of this mixture to the privy or water closet to be disinfected, and thereafter one quart every fifth day or oftener, if foul smell be evolved from the privy. Lime should not be used in the disinfection of privies, as it decomposes the salts of ammonia. This objection, however, does not apply to the sulphate of lime (plaster of Paris), which may be used with advantage in combination with carbolic acid and copperas. The walls of privies and all unpainted wood-work should be whitewashed. Foul Drains, Damp Foul Yards, Stables, Cow-Houses, Market and Slaughter- houses. Fresh-slaked lime, chloride of lime, plaster of Paris, and sulphate of iron should be sprinkled over damp and foul places, drains and yards. For disinfection of such places a simple solution of sulphate of iron or copperas, in porportion of one and a half pounds to the gallon, may be used. The copperas solution may be prepared in large quantities for markets, stables and slaughterhouses, foul yards, drains and gutters, by hanging a basket containing about seventy pounds of copperas in a barrel of water. DIPHTHERIA. HISTORY OF DIPHTHERIA IN NEW ORLEANS Of the total number of deaths caused by diphtheria in New Orleans during 1882, 37 oc- curred amongst the whites and only 5 among the colored population ; total, 42. Diphtheria first appeared upon the records of the Charity Hospital of New Orleans in the year 1859, when 5 cases were reported; 1860, 10 cases, 1 death; 1864, 7 cases, 6 deaths; 1867, 2 cases; 1868,1 case, 1 death; 1870, 6 cases. 2 deaths; 1871, 2 cases, 1 death; 1873, 1 case; 1874, 2 cases, 2 deaths; 1875, 1 case, 1 death ; 1876, 1 case, 1 death; 1877, 1 case, 1 death ; 1878, 1 case ; 1880. 1 case. Total cases and deaths in Charity Hospital during thirty-four years (1842-1880)-Cases, 43 ; deaths, 14 ; per cent of deaths, 32.5. Diphtheria first appeared in the list of diseases in the mortuary records of New Or- leans in the year 1847. During a period of nineteen years, preceding and including the American civil war, the deaths from diphtheria in New Orleans were as follows: 1847, 1; 1858, 95 ; 1859, 253 ; 1860, 145 ; 1861, 78 ; 1863, 188 ; 1864, 337 ; 1865, 104. Total, nineteen years, 1201. During the period following the American civil war, the deaths from diphtheria in New Orleans were as follows: 1866,98; 1867,31; 1868, 10:1869, 19; 1870, 19; 1871, 14; 1872, 39; 1873, 46 ; 1874, 102 ; 1875, 69; 1876, 40 ; 1877, 33 ; '1878, 59; 1879, 58; 1880, 81. Total during fifteen years, 724 ; total, thirty-four years, 1925. The deaths by races during the last six years were as follows: 1877, whites 24, colored 9; total 33; 1878, whites 55, colored 4; total 59, 1879, whites 48, colored 10; total 58; 1880, whites 75, colored 6 ; total 81; 1881, whites 77, colored 15; total 92; 1882, whites 37, colored 5 ; total 42 ; total during six years, 1877-1882, whites 316, colored 49 ; total 365. Total deaths from diphtheria in New Orleans during a period of thirty-six year, 1843- 1882, 2059. It is evident from the statistics furnished by the years 1877, 1878, 1879, 1880, 1881 and 1882, that diphtheria has prevailed to a greater extent amongst the whites than amongst the colored race. During the same period scarlatina caused deaths-whites 262, colored 49; total 311. Whilst it is true that the disease now known as diphtheria has been described under many names, without, however, an exact appreciation of its distinctive character by Hippocrates, Celsus, Sydenham and others from the dawn of medical history to the pres- ent. day, nevertheless, it was not until 1826 that Bretonneau, of Tours, created the name, and first pointed out the true pathology of the disease in his work entitled "Recherches, etc., sur la Diphtherite." Bretonneau, in his latest memoir, substituted the term diphtheric for diphtherite, having Arrived at the conclusion that the disease was not of an inflammatory character. Whilst diphtheria was almost unknown in English medical literature till 1859. when the Syden- ham Society published a volume of memoirs on the disease, translated by Dr. Simple, from the French, by Bretonneau and others, it is, nevertheless, established by the records of the Charity Hospital and by the mortuary records of New Orleans, that this disease Was recognized as early as 1847 by the physicians of New Orleans, and that 95 deaths Were attributed to it in 1858, and 253 deaths in 1859. During a period of thirty-four years, 1847-1880, diphtheria caused 1925 deaths, whilst the mortality occasioned by the diseases specified during the same time was as follows : Small-pox, 5726; measles, 1589; scarlatina, 2066; yellow fever, 28,739; Asiatic cholera, 11,847; cholera morbus, 889; cholera infantum, 2408; tuberculosis, 208; phthisis pulmo- Measures for the Arrest of Diphtheria. 129 nalis, 24,071; tabes mesenterica, 4591; general dropsy, 2554; trismus nascentium, 5906 ; hydrophobia, 70; convulsions, 3202; infantile convulsions. 6016; delirium tremens and intemperance, 1887 ; croup, 1410 ; laryngitis, 269 ; bronchitis, 2992 ; bronchitis, chronic, 178; pneumonia, 8410; teething, 3430; enteritis. 6915; dysentery, 7097; diarrhoea, 8289; hepatitis, 1415; total deaths during this period, 242,426. It is evident, from the preceding statement, that during a period of thirty-four years, the deaths from diphtheria were very nearly equal to those caused by scarlatina, and ex- ceed those occasioned by measles and those by croup. Out of a grand total of 242,426 deaths, diphtheria caused about the one-huudredth and twenty-sixth part of the whole. Whilst epidemics of diphtheria have occurred in many countries far apart from one an- other, and differing essentially in physical features and climate, it nevertheless appearsto be well established, that in recent years the geographical distribution of this disease has been greatly extended by the increasing intercommunications of people. Holding the view that diphtheria is contagious, and thatpoverty and its concomitants, unveniilated, filthy lodgings, scanty clothing and imperfect alimentation, impart to indi- viduals a reciptivity for its contagion, the sanitary inspectors and police of the Board of Health have been directed to institute measures of isolation and disinfection in this disease, as well as in scarlatina and small-pox. Diphtheria is a specific, contagious, asthenic, general disease, which sometimes prevails as an epidemic, and is endemic in certain places. It is characterized by the exudation in various situations, particularly of the mucous surface of the soft palate, uvula, tonsils, pharynx, larynx and trachea, of a peculiar cacoplastic lymph, which, together with' epithelial cells, generally forms a thick, tough and stratified pellicle or false membrane, -a stroma made up of mucous and epithelial cells, arranged in layers of the cacoplastic. exudation. Diphtheria presents the severest symptoms, when the diphtheritic inflammation of the fauces is accompanied by croupous inflammation of the larynx and trachea, for then the symptoms are complicated with hoarseness, loss of voice, great difficulty of breathing and other symptoms of croup, asphyxia and sudden death. Even when the disease apparently ends in recovery, it is often followed by paralysis. Diphtheric paralysis comes on from two to four weeks after the disease disappears. Natural course. Diphtheria has a tendency to run a specific course, as may be seen in cases of moderate severity. In cases termed benignant by authors, the disease runs its entire course in from eight to ten days. In this class of cases, complete and rapid recovery often takes place, not only without medical treatment, but also in spite of the most ob- jectionable measures having been adopted. In many benignant cases, the exudation is limited to the tonsils and pharynx, but sometimes it invades the larynx and trachea ; nevertheless, under both circumstances the false membrane begins to loosen sponta- neously, and to be got rid of between the fifth and seventh day. In cases of very malignant type-both in those which set in suddenly with intense symptoms, and in those which begin insidiously-the disease may run its course from health to death in less than one day, or according to the greater or less severity of the poisoning, the fatal issue or the dawn of recovery may not occur for several days. In many severe cases, the putrefaction of the false membrane causes a penetrating, foul breath ; and if the nasal mucous membrane is involved, a discolored, foetid fluid flows from the reddened and eroded nostrils. The swelling of the glands in the neck, become more marked ; the glands are hard but have no tendency to suppurate. Even after a few days, death may occur from general paralysis, while the intellect remains clear. In long cases there is prostration of strength, and some patients whose state had not excited any anxiety, may die suddenly with the symptoms of general collapse. Incubation. There is a great diversity of opinion as to the maximum period of incubation ;_but the general opinion is that it does not exceed a few days. VM * VI' There are facts and reasonings, however, which suggest the possibility of the diphthe- ritic poison remaining dormant in the system for weeks or months, till called into activity by favoring circumstances. Contagious Nature of Diphtheria. The disease is contagious. In recent years the geographical distribution of the disease seems to have become greatly'extended, a circumstance which is probably attributable to the increasing intercommunication of people. The contagium is contained in the false membrane and shreds of tissue detached from the fauces, and in the air breathed out by the patients. 130 Joseph Jones, M. D., on Diphtheria. Physicians are in great danger of being infected by the morbid products coughed out by the patients, during the performance of operations, or painting, cleansing and cauter- izing the t hroat. The medical profession has lost a number of excellent physicians and observers who have fallen victims to diphtheria whilst discharging their duties by t.he 'bed-side. The physician should as far as possible protect himself from contact of the false mem- brane and shreds of tissue that are coughed up, and warn the attendants on the patients of the danger of this contact. The well established cases of infection of persons who have been in the same room with diphtheritic persons, without coming in the immediate vicinity, prove that the air exhaled by the patient which does not contain shreds or exudation or tissue is a vehicle tor the contagion. Rules Governing Families Afflicted with Diphtheria. 1. As diphtheria is contagious, the patient should be isolated in an upper well ventil- ated room ; all persons who have nothing to do with the case of the. sick should be excluded. The sick should, as far as possible, be separated from the well. Pure air should be furnished by free ventilation, care being taken not to expose the patient to cold. The room selected for the sick should not only be the highest, but should if practi- cable be exposed to the sun. The room chosen for the sick should have no connection ■with the drains by water closet or wash basin. 2. Whenever practicable all well children should joe sent out of the house, imme- •diately after the occurrence of a case of diphtheria, and should not be allowed to return, unless the case has either recovered or died, and after the thorough cleansing and fumiga- tion of the sick room and of the house, and the disinfection and cleansing of the privies drains, gutters and yard. 3. Woolen clothes, carpets, upholstered furniture, curtains and all unnecessary bedding and bed clothes, should be removed from the sick room, and only such materials and clothing be used as can be readily washed. 4. All clothes, when removed from the person or bed of the patients, should be im- mediately placed in a disinfecting solution containing half a pound of sulphate of zinc and two ounces of carbolic acid dissolved in two gallons of water. After remaining in this solution for at least two hours, the clothing should be subjected to the action of boiling water. 5. Pieces of old soft linen or cotton cloth should be used about the patients instead of pocket-handkerchiefsand towels, and after serving their purpose should be burned. Solutions of copperas and carbolic acid, or of nitrate of lead and chloride of zinc should always be placed in the vessels containing the discharges from the throat, nose, kidneys and bowels. 6. As diphtheria presents the most malignant symptoms and is prone to become epi- demic, in the midst of filth, especially the filth of privies, cess-pools, foul sewers, earth sodden with buried excrement, unclean cow-stables, putrid garbage, foul hog pens and stagnant water, every measure of disinfection and cleaning should be instituted by the health authorities. During the prevalence of diphtheria in any house, the privies and water closets should be daily disinfected with a solution of copperas and carbolic acid. 7. After a death from diphtheria, the soiled clothing should be burned or subjected to the action of the sulphate of zinc solution and boiling water. The body should be cleansed with the zinc and carbolic acid solution, and wrapped in a sheet saturated with the same and placed as early as practicable in the coffin. The coffin should be tight and closed, and the funeral must not be held in a church or other public place. The cause of death should be specified in the funeral notice ; and no one should be allowed to ride in the same vehicle with the remains of the deceased person to the cemetery. In no case must the corpse be exposed at the funeral ; children should not be allowed to attend funerals in which a death from diphtheria has occurred; and the fewer the number of adults present the better ; and during the entire services the freest ventilation must be main- tained. 8. After the death or recovery of the patient, the. room should be thoroughly cleaned, disinfected and fumigated. The wood-work should be cleaned with the sulphate of zinc and carbolic acid solution, the walls white-washed and the room fumigated by burning sulphur. 9. During the prevalence of diphtheria in any household, the children should not be permitted to attend school, church or public gatherings. Joseph Jones, M. I)., on Scarlet Fever. 131 SCARLET FEVER Mortality occasioned by Scarlatina in New Orleans, Louisiana. The records of deaths by scarlet fever in New Orleans, do not extend back beyond the year 1844 ; and the deaths from this disease in the years specified were as follows :- 1844, 4 ; 1845, 121; 1847, 15 ; 1848, 119; 1849, 22; 1850, 21; 1851, 29; 1853, 126; 1856, 18 ; 1857, 79 ; 1860, 200; 1861, 198; 1863, 43; 1864, 200; 1865, 161 ; total for nineteen years, preceding the American Civil War and including this period, 1,575; 1866,41; 1867,24 ; 1868, 15; 1869, 13; 1870, 44 ; 1871, 5; 1872, 5; 1873, 5; 1874, 4; 1875, 144; 1876, 123; 1877, 10; 1878, 1: 1879, 1; 1880,56; 1881, 197; 1882,48; total, seventeen years following the American Civil War, 736; grand total during thirty-six years, 2,317 deaths from scarlet fever. The deaths from scarlet fever by races, during the last six years, were as follows : 1877, whites, 10 ; 1878, white, 1 ; 1879, white, 1 ; 1880, whites, 49, colored, 7; 1881, whites, 160, colored, 37; 1882, whites, 43, colored, 5; total, whites, 254, colored, 49; total, 303. It is worthy of note that during the past six years, out of a total deaths of 303, from scarlet fever, 254 were white and 49 colored, the deaths amongst the whites being five times as numerous, although this class of the population is only about three times as nu- merous as the colored. As some products of the sick, however conveyed to those hitherto unaffected, especially the young, always reproduce this infectious, specific fever, it would appear from the comparatively small number of deaths caused by scarlatina, during the past thirty-six .years, that the topography and climate of New Orleans are not favorable to the propa- gation of the infecting material of scarlet fever. Facts of Interest in the Natural History of Scarlet Fever for the Guidance of Sanitary Officers. All the forms of scarlet fever, however varying in degrees of severity, are capable of conveying the most severe types. It is held by sanitarians that scarlet fever is conveyed from one person to another by means of the epithetion of the surface of the body/by the exhalations from the outer or inner surfaces of the various parts of the body and from the excretions also. The contagious matter of scarlet fever is capable of retaining its power to carry the dis- ease for many days, and even for months; and it may infect and be stored up in any thing that may have come in contact with an infected person or object, as air, food, clothing, beds, bedding, curtains, carpets and furniture. The exhalations from the dead are dangerous, and there is evidence to show that funeralshave occasionally spread the disease. Whenever an individual has died of scarlet fever, or any other conta- gious or infectious disease, the funeral notice should specify the cause of death. The origin and nature of the scarlet fever poison is unknown ; it is impossible to say that it may not now and again be produced anew in the laboratory of nature ; but such a renewed production, is not required, for the explanation of its propagation and exis- tence at the present day ; for it is unquestionably contained in everything that proceeds from the body of a patient laboring under the disease. The poison of scarlet fever is contained in special energy in the skin, which peels off at the close of the attack, and is scattered to the winds in the form of tiny scales, or even as absolute powder; Such por- tions of dried skin may settle down in undusted corners, or may become entangled in clothing or bedding, in either case preserving their virulence for an unknown period of time and always liable to be disturbed from their resting place and sent forth to repro- duce the fever. The specific fever being established, the patient generates a poison which may be communicated directly, as shown by a few cases of successful inoculation, or which may contaminate the atmosphere. The disease is eminently communicable,so that no susceptible person can remain in the room, and hardly in the same house, without contracting it, unless special care be taken to isolate the sick. That scarlatina is capable of being directly communicated is shown by the fact that children have been inoculated with the serum found in the vesicles which sometimes accompany the rash, and have taken the disease ; but the inoculated disease not having proved milder than the natural, the practice has been abandoned. Another proof of the directly communicable nature of scarlatina is that it has often been propagated by fomites, as by the clothes and boxes of boys returning from school. Susceptible persons also sleeping in a room lately occupied by patients laboring under scarlatina, and before the furniture has been washed and the bedding and walls well ventilated, have often taken that disease. The virus is distructable by heat at the boiling point, or it may be disinfected arti- ficially by the fumes of nitric acid, chlorine gas, and sulphurous acid gas. The details vf disinfection have been given under the head of small-pox. 132 Measures for the Arrest of Scarlet Fever. Scarlatina in general affects the same individual only once during his life, and in this, respect obeys the general law of exanthematous fevers. Occasional exceptions have certainly been observed by practitioners, though, from the testimony of Dr. Willan, a second attack of scarlatina in the same individual is extremely rare ; he states that he had never seen such a repetition among two thousand patients whom he had visited In, scarlatina. It is by no means uncommon for those who have had the disease, to suffer from sore throat-Scarlatina faucium-whcu they are in attendance upcn one laboring under scarlatina. All ages are probably liable to the disease ; but it is most common to childhood-the febleness of this early period of life facilitating, perhaps, the reception of the poison ; the disease attacks most frequently between the second and fourth years of life ; the chances, of attack decline rapidly after the fifth year, and as children grow older, the less liable are they to be attacked. The period after invasion of exposure to sources of contagion is exceedingly various.. Some individuals are seized within a few hours ; others do not exhibit any of the pecu- liar symptoms for several days ; and in some more rare cases, five or six weeks have in- tervened between the period of exposure and the accession of the disease. The period of latency or incubation of scarlet fever may, as a general rule, be- estimated as lasting from eight to ten days. The action of the specific poison induces a disorder of the blood, which in the first instance is made manifest by a febrile state, and a disturbed condition of the great nervous centres ; the primary form having lasted for one, two or three days, does not entirely subside, and the further action of the poison is manifested by a peculiar scarlet eflorescence in the fauces and pharynx and on the neck and face, gradually spreading over the whole body, preceded, followed or accompanied by a sore throat, and also by intense hypersemia and catarrh of the uriniferous tubucles. The eruption runs a course of from six to eight days and terminates in desquamation, but the duration of the affection of the throat is more indefinite, and varies from eight to twenty or more days. The fever continues during the eruption, and as long as the sore throat exists ; but this being terminated, it subsides and convalescence ought to advance. In many instances, however, other results succeed, as dropsy or inflammation of the joints, pleura, or peri- cardium, of the ear or cornea, and of the kidneys. These lesions are quite as formidable as any which had preceded them, and each and all of them are localized expressions of the influence of the scarlet fever poison in the body. The scarlet fever poison affects individuals very differently; of a number of persons exposed to the same source of infection, some may escape altogether ; others have a mild form of the disease; in others there is fever and sore throat without a'distinct eruption, desquamation, however, may take place; in others the more malignant form of the disease may appear, as passive haemorrhages, albuminuria, uraemic poisoning and convulsions, extensive suppuration and abscesses. From the preceding facts, we deduce the following practical rules for the guidance of sanitary officers in dealing with scarlet fever. 1. Whilst the period during which the human body retains the power of communicat- ing, the specific poison ol scarlet fever which is reproduced during the progress of the disease, varies in different cases; children who have suffered with this disease should not be allowed to attend gatherings of healthy children and adults, as at school or church, or social entertainments, for at least two weeks after the establishment of convalescence. When Bright's disease supervenes, or painful abscesses form, the period of seclusion will of course depend upon the nature and progress of the supervening affections. 2. Cases of scarlet fever should be isolated, as far as practicable, in every house- hold and only the necessary nurses and attendants be allowed in the sick room. When the structure'of the residence will admit, the sick with scarlet fever shpuld be placed in an upper well ventilated room upon the highest floor, and should be secluded from all, except those who have charge of the case. 3. Children of families in which scarlet fever is prevailing should be prevented from mingling with other children and should be kept from meetings and schools. 4. To prevent the body of the patient from spreading contagion, the patient's body should be anointed at least twice a day with oil, lard or cosmoline, containing about ten grains, of carbolic acid or of thymol to the ounce. This process should be maintained until all bran-like scaling of the skin is at an end. After the establishment of convalescence the entire person should be thoroughly cleansed by means of warm baths and soap. Before the patient leaves the sick room, nurses and attendants upon scarlet fever cases, should not mingle with persons liable to take the fever, without thorough ablution of hands, head, and changing of all clothing. 5. Carpets, curtains, trunks, clothing and all stuffed furniture and bedding, should be removed from the room in which the sick or dead with scarlet fever are to be placed. Cleanliness and ventilation should be enforced night and day. Every cloth and cup and Joseph Jones, M. D., on Scarlet Fever. 133 all clothing and bedding, used in the sick room, must be cleansed and disinfected before being handled or used by other persons. Tne cloths and dishes used by the sick should be put into boiling hot water, as soon as removed, without being taken to another room. The soiled clothing from the sick and the bed, should be thrown into a disinfecting fluid, made by dissolving four table-spoonfuls of sulphate of zinc, and two table-spoonfuls of common salt, iu a gallon of boiling water. Soiled clothing from the sick should be thoroughly boiled before washing, and they should be cleansed and prepared separate from the rest of the family washing. To disinfect discharges from the sick, use a disinfecting solution composed of one pound of sulphate of zinc (white vitriol) and half a pound of common salt (chloride of sodium) in a gallon of water ; or two pounds of copperas and four ounces of carbolic acid (Calvert's No. 5} iu a gallon of water. The copperas and carbolic acid solution may be used for all excremeutal discharges, whilst the sulphate of zinc solution is best for all articles of clothing and furniture. The sulphate of iron will stain and injure clothing and bedding. Ad vessels used in the sick room should be disinfected with one or the other of these disinfecting fluids, unless immediately immersed in boiling water. All discharges and soiled clothing should be disinfected immediately. 6. After convalescence or death, the rooms occupied by the patients should be vacated. Close the rooms as tightly as possible; place sulphur in iron pots, set in wash buckets or iron pans containing a little water. Set the sulphur on tire by aid of hot coals or a spoonful of alcohol, and keep the rooms tightly closed twenty-four hours. For a room ten feet square, containing one hundred square feet of floor-space, at least two pounds of sulphur should be used ; for large rooms, proportionally increased quantities. Nitrous acid gas may also be used with benefit. This may be prepared by pouring nitric acid upon copper filings. In like manner, chlorine may be employed as a disinfectant; the gas may be evolved from a mixture of common silt, black oxide of manganese and sulphuric acid, or from hydrochloric (muriatic acid) and black oxide of manganese. Sulphurous acid, nitrous acid or chlorine gas should not be used simultaneously, but may be employed in succession. Successive fumigations with sulphurous acid, nitrous acid (or nitric oxide) and chlorine, together with the cleansing of the floors and wood work and walls with car- bolic acid and zinc solutions, would be sufficient to destroy the contagious matter of small-pox, scarlet fever, diphtheria, measles and yellow fever, when efficiently and thoroughly performed. 7. After death, the corpse should, be washed in the zinc and carbolic solution, and wrapped in a sheet saturated with the same, and placed at the earliest practicable moment iu the coffin and sealed up. When a death from this disease is announced in print, the notice should state the cause, as from " scarlet feoerf in order to prevent attendance at the funeral, or visits to the house. 8. As the liability to infect others continues as long as there is any desquamation, or peeling of the skin, and possibly even longer, the recently sick should not attend school, church or any public gathering, or ride iu a public conveyance while the skin is peeling, the throat and eyes sore, or any symptoms of dropsy are present. In all cases, a competent physician should decide and certify in writing, that the patient is safe to others, before any child recently suffering from scarlet fever is per- mitted to attend school. JOSEPH JONES, M. D. 158 Washington street, corner Camp, Fourth District. NEW ORLEANS, Louisiana, August 16, 1883. B£ 'ss '55 MO ILUSTIATINO THE TCPMEAPu? 0? NEW ORLEANS AND OF THB COAST OF itoni&tna ^Mississippi, JOSEPH JOSES, M. T. S. HAMn, Clril logisMr. VACCINATION: VARIOLA VACCINE (COW POX): VARIOLA, AND VARIOLOID: ACCIDENTS ATTENDING VAC- CINATION : SPURIOUS VACCINATION. CIRCULAR NO. 2-PREPARED FOR THE GUIDANCE OF THE QUARANTINE OFFICERS AND SANITARY INSPECTORS OF THE BOARD OF HEALTH OF THE STATE OF LOUISIANA, BY JOSEPH JONES, M. D., PRESIDENT OF THE BOARD OF HEALTH OF THE STATE OF LOUISIANA. The question of the arrest and eradication of small-pox has been re- garded and treated by the Executive Officer of the Board of Health of the State of Louisiana as of transcendent importance to the happiness and welfare of the people, and facts were recorded in Circular No. 1, issued on the sixteenth of August, 1883, which revealed the difficulties of deal- ing with this question in the delta of the Mississippi, and more especially in the city of New Orleans; and the measures of compulsory vaccination, isolation and disinfection which had been in past tynes urged upon the General Assembly and the municipal authorities were again strenuously advocated. No city upon the globe is more exposed to the introduction and spread of small-pox than New Orleans; and at the same time the greatest difficulties are experienced in the introduction of efficient measures for the exclusion and arrest of this pestilence. This proposition will be sustained by the following facts : 1. New Orleans has a larger colored population than any other city on the North-American Continent, the United States census of 1880 giving total population 216.090 ; whites, 158,307; colored, 57,617. A large pro- portion of the negro population not only neglect vaccination, but are opposed to this protective measure ; New Orleans, therefore, has the largest population unprotected and liable to the ravages of small-pox. 2. New Orleans has the largest negro population immediately tributary to it of any civilized city in the world. In those States which are most nearly related to New Orleans by geographical position and commercial relations, the white population numbers 11,082,192, out of a total popula- tion of the United States of 50,155,783, being almost one-fifth; the colored population numbers 3,158,051 out of a colored population in the United States of 6,580,793, being almost onb-half. Whilst only one-fifth of the total population of the United States in- habits the States of Alabama, Arkansas, Kentucky, Louisiana, Missis- sippi, Missouri, Tennessee and Texas, nearly one-half the entire negro 136 Joseph Jones, M. D., on Contagious Diseases. population of this great country is gathered within the bounds of these States which are most directly connected with New Orleans, by geogra- phical position and commercial relations. 3. The surrounding States tributary to New Orleans have neither estab- lished efficient quarantines against small-pox, nor have their health authori- ties reported the introduction and existence of this disease, to the Board of Health of the State of Louisiana. ^mall-pox has been prevailing in the Western cities and in the villages and plantations along the Mississippi river, and cases have during 1881, 1882 and 1883, been continuously introduced into New Orleans by the in- habitants of the plantations ; the settlements of which form almost a con- tinuous village for nearly one thousand miles along the banks of this mighty stream. It is not surprising that ignorance of sanitary laws, and neglect of vaccination, combined with unrestricted intercourse, should have found in the colored race along the banks of the Mississippi the most favorable condition for the lodgment, propagation, spread and continuance of small- pox. A vast floating colored population continuously pours in and out of New Orleans ; large numbers of colored seamen man the steamboats which conduct the internal commerce of this great valley, and they have during the years 1881, 1882 and 1883, been the medium of introducing a constant stream of small-pox poison into New Orleans. 4. As long as small-pox prevails amongst the white and colored popula- tion of the Mississippi Valley and of the States tributary to this com- mercial centre, just so long will this disease continue to find successive lodgment in New Orleans. The extent to which the population of New Orleans will suffer from each introduction of the small-pox poison will depend upon the number of citizens, unprotected by vaccination or by preceding attacks of small-pox. 5. The opposition to vaccination is not confined to the uneducated and comparatively helpless colored race, who by the results of the American Civil War of 1861-1865, have been precipitated into a state of freedom, de- nianding for its intelligent and successful enjoyment some knowledge of sanitary as well as of political science; bitter opponents to vaccination have been found amongst the white race, and in the ranks of the medical profession, and their efforts have up to the present moment defeated in the General Assembly of Louisiana, and in the Municipal Government of New Orleans, all efforts to eradicate small-pox, by the institution ot laws ren- dering vaccination compulsory. On the twenty-ninth of May, 1883, the following ordinance relative to vaccination was presented to the Common Council of New Orleans, read in full and referred to the Committee on Health ; on the twenty-sixth of June 1883, read and failed to pass ; August 14, read and ordered to be laid over, August 28, read and ordered to be laid over one week; September 4, 1883, lost: AN ORDINANCE BY THE CITY COUNCIL. "Section 1. That all children of the city of New Orleans shall be vac- cinated before same attain the age of two years, said vaccination shall be successful or repeated such a number of times as to make it evident that successful vaccination is impossible ; and such children and all other per- sons as is hereinafter provided, shall be re-vaccinated as often as the Board of Health or other legally authorized officers shall require, pro- vided that no person or child of full age shall be required to be success- fully vaccinated more than once during any period of live years. . Compulsory Vaccination. 137 "Sec. 2. Be it further ordained, that any resident of the city of New Or- leans over the age of fifteen years, who has not been successfully vaccinated after a lapse of five years, since successful vaccination, and who after twenty-four hours' notice to that effect given by officers legally authorized thereto, shall fail or refuse to be vaccinated, may be arrested and taken before the Recorder's Court, having jurisdiction, and on convic- tion, fined in a sum not exceeding twenty-five dollars or imprisonment not exceeding thirty days, the fines so imposed and collected to be turned over to the Board of Health, and any parent or guardian or person having con- trol of a child under fifteen years of age, and who on notice as herein stated, shall fail to vaccinate shall be subject to the penalties herein provided. "Sec. 3. Beit further ordained, that the Board of Health shall be and is hereby authorized to provide the means and facilities for vaccination which shall be free to all persons; and shall or may authorize the physi- cian in attendance in any case on application to give a certificate of the time when successful vaccination shall have been performed on any person. "Such certificate shall be evidence and proof of the fact therein stated, and a re-vaccination shall be necessary within a period of five years from the date of the vaccination stated therein." This subject was again urged upon the attention of the Board of Health of the State of Louisiana, as will be shown by the following extracts from the proceedings of that date : EXTRACT FROM THE PROCEEDINGS OF THE MEETING OF THE BOARD OF HEALTH, STATE OF LOUISIANA, SEP- TEMBER 6, 1883. The President, Dr. Joseph Jones, presented the following report: HEALTH OF NEW ORLEANS. Mortality of New Orleans, during the Months of July and August, 1883. WEEK ENDING Deaths. Total Deaths. Death Date. Total Death Rate. W. c. W. C. July 7........ 75 41 116 23 83 35.56 26 98 July 14 • • • • 79 38 117 25.11 32.96 27.21 J ill y 21 82 58 140 26 06 50.31 32.56 Ju Iy 28 95 45 140 30.19 39.03 32.56 Angust 4...............-...». 83 55 138 26 38 47.71 32.09 A11 wust 11 ---------- 77 48 125 24 47 41.63 29.07 Aiicmst 1R ....... . ............. 74 46 120 23'52 39.90 27.91 Aujrnst 25 73 43 116 23.20 37.30 26.96 September 1 63 48 111 20.02 41.64 28.82 Total deaths for the four weeks ending July 28, 513; total deaths for the four weeks ending September 25, 499 ; total deaths for the eight weeks July 1 to September 25, 1012; total deaths for the nine weeks July 1, Sep- tember 1, 1124; average number of deaths for the months of July and August, 562. An actual examination of the record shows that the total number of deaths in July were 572; and that the actual mortality of August was 531. 138 Joseph Jones, M. J)., on Arrest of Small-Pox. The mortality in New Orleans during the first eight months of 1883 has been as follows : Total Deaths. January 607 February 607 March 734 April 713 Total deaths six months 3981. Total Deaths. May . 666 June ... 654 July 572 August 531 Total deaths first eight months of 1883, 5084. We observe therefore that the lowest monthly mortality has occurred during the months of July and August, the hottest and dryest months of 1883, and the lowest mortality has been attained during the month of August, when the deaths numbered only 531. MORTALITY FROM SMALL-POX DURING THE FIRST EIGHT- MONTHS OF 1883. The progress of the small-pox of 1883, will be illustrated by the follow ing table: DEATHS FROM SMALL-POX IN THE CITY OE NEW ORLEANS, DURING THE FIRST EIGHT MONTHS OF 1883. MONTHS. Deaths from Small-pox. Total Deaths from Small-pox. White. Colored. White & Colored. January 24 52 February. 48 83 131 IVf arch 72 147 219 April 102 159 261 "May 80 95 175 June 53 96 149 July 44 40 84 A ngn.^t 31 36 67 Total deaths from small-pox during the first six months of 1883, whites 379; colored 634. Total whites and colored 1013. Average number of deaths from small-pox, during the first six months of 1883, 168.8. Total deaths from small-pox during the months of July and August 1883, whites, 75 ; colored 76. Total 151. Average number of deaths during the months of July and August from small-pox 75.15. Total deaths from small-pox during the first eight months of 1883, 1164. Average number of deaths per month during 1883, first eight mouths, 145.5. It is evident therefore that the small-pox has decreased one-half during the months of July and August. But this foul disease is still in onr city, and deihands the most earnest and careful consideration at the hands of the Board ot Health and the City Council. A sufficient corps of physicians, not less than one to each ten thousand inhabitants, should be at once appointed and properly paid to execute a careful house-to-house inspection and vaccination. Vaccination should be personally urged upon each inhabitant, by the experienced and trusted local practitioners of each division. Twenty physicians at $50 per month, $1000. Service of twenty physicians at $50 per month, for five mouths, October, November, December, January, February, $5000.' Joseph Jones, M. D., on Arrest of Small-Pox. 139 Vaccine matter $5 per month to each physician, twenty physicians, $100 per month. Total cost of vaccine matter $500. The most experienced and popular physicians should be appointed in the districts in which they reside, and they should be required to make a care- ful census of the district, giving the following' data : Inhabitants: Whites, colored. Total whites and colored. Number of inhabitants who have had small-pox : Whites, colored. Total number of inhabitants who have been vaccinated previous to census: Whites, colored. Total number of inhabitants unvaccinated : Whites, colored. Number vaccinated (primary) by inspector: Whites, males, females. Total-Colored, males, females. Total-. Re-vaccinations by inspector : Whites, males, females. Total-Colored, males, females. Total-. Number of those who refuse vaccination: Whites, males, females. Total-Colored, males, females. Total-. A careful list of all persons, with their exact residences and places of business, who refuse vaccination, should be kept. This list should be classified after the completion of the canvass in each district, and the homes, residence and occupations of all those refusing vaccination, should be published for the information and protection of the public. In this manner employes, heads of factories and heads of families would be warned as to the existence of dangerous and unprotected elements in their midst. Some laws should be enacted against all vessels or railroads bringing cases of small-pox into New Orleans. The entire police of this city should be instructed to arrest all persons found with small-pox on them wandering in the streets, and immediately send them to the small-pox hospital. If the proper funds were placed at the disposal of the Board of Health to execute the foregoing plan, much would be accomplished to eradicate this disease; the act of 1877 empowers the Board of Health to execute the necessary rulesand regulations with reference to vaccination, provided that it be not made compulsory. The preceding measures, proposed by the President, were discussed and warmly advocated by Col. I. N. Marks and Col. A. W. Bosworth, and Dr. Felix Formento introduced the following resolution, which was unani- mously adopted: Resolved, That a medical officer be appointed by this Board of Health for each ward of the city, whose duties shall be to visit personally every house in his ward, and to urge the necessity of immediate vaccination, and vaccination of any person liable to contract the disease living in it, and making distinct statements of the results of his investigation in accord- ance with the plan suggested by the President of the Board of Health. Resolved, That the city authorities be requested to appropriate sufficient funds in order to defray the necessary expense, such as salary of physicians, supply of vaccine matter, etc. In accordance with the preceding action of the Board of Health the following communication was addressed to His Honor Wm. J. Behan, Mayor of the city of New Orleans, on the tenth of September 1883. 140 Free Vaccination ; House-to-House Inspection. Office Board of Health, State of Louisiana, ) New Orleans, September 10, 1883. / Hon. W. J. Behan, Mayor of New Orleans, City Hall: Sir-I have the honor to enclose for the consideration of your Honor and the honorable the Common Council of New Orleans, extract from the minutes of the Board of Health, and resolutions unanimously adopted relative to the suppression of small pox. During the past eight months of 1883, one thousand one hundred and sixty-four citizens of New Orleans have perished from small-pox. The monthly deaths caused by small-pox are as follows: January 76, February 131, March 219, April 261, May 175, June 149, July 84, August 67. The total deaths from all causes including small-pox in New Orleans, during the same period, was 5084. Small-pox has therefore caused nearly one- fourth of all the deaths occurring in New Orleans in 1883. From the preceding statistics, it is evident that small-pox, has decreased to a marked extent during the months of July and August, and that the present is auspicious for the institution of measures for its arrest. The plan which I proposed, and which was endorsed by the Board of Health, was briefly to appoint one physician for each ten thousand inhabi- tants, who should visit every place of business or factory and each habi- tation, and urge vaccination upon each citizen. A careful census to be made, embracing number of inhabitants, number protected by preceding attacks of small-pox, by vaccination and re-vaccination, and therefore the number refusing to be vaccinated and liable to and unprotected from the disease. This work should be continued during the months of October, November, December, January, February and March, or until the thorough canvass of the city had been made, and the offer of free vaccination had been made to, and urged upon, every citizen. The cost of twenty physicians at $50 each per month would be $1000 per month or $6000 per six months. The extended and vital operations of quarantine as well as the important duties connected with the registration of births, deaths and marriages, together with the various sanitary opera- tions of importance, as inspection disinfection, and the promulgation by weekly and annual publications of the mortuary and sanitary operations, absorb the available resources of the Board of Health. It is therefore essential that the Municipal Government should make the necessary appropriation for the protection of its citizens from this destruc- tive pestilence. The matter of finance could be conducted in the same manner to that now employed in city sanitation by the Board of Health : each physician's name to be entered upon the pay roll, and said roll to be submitted to the Honorable Common Council and paid by special ordinance. In this manner the work could be stopped, and the expense closed as soon as the city had been in- spected, and the vaccination urged upon every citizen and inhabitant. If I am correctly informed, your honorable body has already expended during 1883, up to August 31, $14,094 for the support of Small-Pox Hospi- tals; how much more will be required to meet other expenses cannot be estimated. it would be difficult to estimate the cost, the loss of business, etc. If the value of each human life be rated at the moderate sum of one thousand dollars, then during the eight months of 1883, New Orleans has lost by small-pox (a preventable pestilence) $1,164,000. (Signed) JOSEPH JONES, M. D., President Board of Health, State of Louisiana^ Joseph Jones, Jf. D., on History of Vaccination. 141 The opposition to vaccination was referable to several causes such as: 1. Ignorance, superstition and prejudice. 2. Stupid and malicious opposition to all measures emanating from the Board of Health for the protection of the health and lives of the people. 3. Disbelief in the protective powers of vaccination. 4. A popular superstition that vaccination during the prevalence of small-pox tended to develope the disease in theperson vaccinated. 5. The belief held by many people and by some physicians that the vaccine virus has degenerated since its introduction bv Edward Jenner in 1798. 6. The frequent failure of the bovine virus furnished by the various vac- cine farms of the United States. 7. The dread of contracting syphilis, phthisis, erysipelas, scrofula and leprosy, through the medium of the vaccine virus. 8. The dread of contracting various diseases of animal origin, through the medium of the bovine virus. These statements, but more especially the 3d, 4th, 5th, 6th, 7th and 8th, propositions, demand careful investigation. The difficulty of procuring reliable vaccine matter during the recent civil war as well as the remarkable abnormal phenomena presented by the vccaine disease in some cases amongst the Confederate (Southern) Army, led the author to institute an extended investigation of all subjects bear- ing upon vaccination ; and it is believed to be of paramount importance that the results of these labors should now be fully recorded. Conceiving that the entire investigation could not be perfected without a full and careful persual of the original works of Edward Jenner; and, as after the most diligent search for many years in the book stores and libraries of the United States, the author was unable to procure or examine these immortal productions, he conducted a similar search amongst the book stores of Paris, London, Edinburgh, Oxford, Liverpool, and Canarvan, Wales, during a visit to Europe in 1870. After diligent personal search amongst the book stores of London, I succeeded in obtaining three copies of the works of Edward Jenner, namely : "Inquiry into the causes and effects of the variolse' vaccime, a disease dis* covered in some of the Western counties of England particularly Glouces- tershire, and known by the name of The Cow-Pox. By Edward Jenner, M. D. F. R. 8. etc.," published in London, June 1798. "Further observations on the variolae vaccinae," published in London in 1800, in connection with his "Inquiry into the cause and effects of the variolae vaccinae." "A continua- tion of facts and observations relative to the variolae vaccinae or cow-pox, by Edward Jenner, M. D. F. R. S. and L. S. etc., London 1800." Jenner published a third edition of his works in 1801; which was essen- tially the same as the second edition published in 1800, and contained three distinct papers, namely : "An inquiry into the causes and effects of the variolae vaccinae." "Further observation on the variolae vaccinae." "A continuation of facts and observations relative to the variolae vac- cinae." We have, aftercareful consideration of the grave situation, arrived at the firm conviction, that the public welfare demands, that at this time, when small-pox prevails in the Delta of the Mississippi, and in the commercial metropolis of the Valley, and when, at the same time, mistrust as to the efficacy of vaccination, is manifested by the people and by a portion of 142 Works of Edward Jenner. the medical profession, that the original worlds of Edward Jenner should be reproduced in Louisiana. We have selected the third edition of the works of Edward Jenner, published in London in 1801, because we find, upon careful comparison of the three editions, published respectively in 1798,1800 and 1801; that the latter appears to have received the most careful revision by the author. The second edition, published in 1800, has written upon the fly-leaves N. Prythorch, Surgeon Carmarthen 1800, December 16; liobert Marsh Wil- liams, seventeenth March, 1841. The corrections haye been written at the proper places, in the separate memoirs. The name of Richard Pearson is written across the title page of the third edition. I have selected the plates from "the first edition published in 1798, be- cause the impressions are better defined, and colored with more care, thau those of the second and third editions, the identical plates appearing to have been used in the printing of the three editions. Jenner gives four plates, all illustrative of, and included in, his orginal "inquiry into the causes and effects of the variohe vaccime." The first plate facing page thirty-two, showing the appearance of the hand of a dairy maid, (Sarah Nelmes, Case xvi,) infected with the cow-pox from her masters cows in May 1796, is given in full: the second, third and fourth plates (Case xviii p. 36; Case xx. p. 38; Case xxi. p . 40), have been placed upon a single plate, as it appeared to be a useless expense to reproduce the mere outlines of the arms, these portions showing nothing of note as far as the process and effects of vaccination were concerned. The following is the title and preface to the first edition of the inquiry of Dr. Edward Jenner. "An Inquiry into the causes and effects of the variolas vaccinae, a disease discovered in some of the western counties of England, particularly Glou- cestershire, and known by the name of The Cow-Pox. By Edward Jenner, M. D. F. R. S., &c. Quid Nobis Certius Ipsis Sensibus Esse Potest, Quo Vera ac Falsa Notemus. Lurcretius. London, printed for the author by Sampson Low, No. 7 Berwick street Soho. And sold by Law, Ave-Maria Lane; and Murray and Highley, Fleet street, 1798." TO C. H. PARRY, M. D., AT BATH. Jfy Dear Friend-In the present age of scientific investigation, it is re- markable that a disease of so peculiar a nature as the cow-pox, which has appeared in this and some of the neighboring counties for such a series of years, should so long have escaped particular attention. Finding the pre- vailing notions on the subject, both among men of our profession and others, extremely vague and indeterminate, and conceiving that facts might appear at once both curious and useful, I have instituted as strict an inquiry into the causes and effects of this singular malady as local circum- stances would admit. The following pages are the result, which, from motives of the most affec- tionate regard, are dedicated to you, bv Your sincere friend, " EDWARD JENNER. Berkley, Gloucestershire. June 21, 1798. AN INQUIRY * • INTO THE CUTTSES EFFECTS OF THE vmLAmcciM A DISEASE DISCOVERED IN SOME OF THE WESTERN COUNTIES OF ENGLAND PARTICULARLY GLOUCESTERSHIRE, AND KNOWN BY THE NAME OF THE COW EOX. -BY- EDWARD JENNER, M. D. F. R. S. &C QUID NOBIS CERTIUS IPSIS SENSIBUS ESSE POTEST, QUO VERA AC FALSA NOTEMUS LUCRETIUS. THE THIRD EDITION. LONDON: PRINTED FOR THE AUTHOR, By D. N. Shury, No. 7, Berwick street, Soho; And Sold by Hurst, Paternoster Row; Murray & Highley, Fleet Street; Carpenter Old Bond Street; and Callow, Crown Court. 1801. TO THE KING. Sir-When I first addressed the public on a physiological subject, which I conceived to be of the utmost importance to the future welfare of the human race, I could not presume, in that early stage of the investigation, to lay the result of my inquiries at your Majesty's feet. Subsequent inquiries instituted not only by myself but by men of the first rank in the medical profession have now confirmed the truth of the theory which I first made knowm to the world. Highly honored by the permission to dedicate the result of my inquiries to your Majesty, I am emboldened to solicit your gracious patronage of a discovery which reason fully authorizes me to suppose will prove peculiarly conducive to the preservation of the lives of mankind. To a Monarch no less justly than emphatically styled the Father of his people, this treatise is inscribed with perfect propriety; for, conspicuous as your Majesty's patronage has been of arts, of sciences and of commerce, yet the most distinguished feature of your character is your paternal care for the dearer interests of humanity. I am, sir, with the most profound respect, your Majesty's most devoted subject and servant, EDWARD JENNER. Berkeley, Gloucestershire, December 20, 1799. AN INQUIRY, &C., &C. The deviation of man from the state in which he was originally placed by nature, seems to have proved to him a prolific source of diseases. From the love of splendor, from the indulgences of luxury, and from his fondness for amusement, he has familiarized himself with a great number of animals which may not originally have been intended for his associates. The wolf, disarmed of ferocity, is now pillowed in the lady's lap* The cat, the little tiger of our island, whose natural home is the forest, is equally domesticated and caressed. The cow, the hog, the sheep, and the horse, are all, for a variety of purposes, brought under his care and dominion. ■ There is a disease to which the horse, from his state of domestication, is frequently subject. The farriers have termed it the Greafe. It is an inflam- mation and swelling in the heel, accompanied at its commencement with small cracks or fissures, from which issues a limpid fluid, possessing prop- erties of a very peculiar kind. This fluid seems capable of generating a disease in the human body, (after it has undergone the modification I shall presently speak of), which bears so strong a resemblance to small pox that I think it highly probable that it may be the source of that disease. In this dairy county a great number of cows are kept, and the office of milking is performed indiscriminately by men and maid servants. One of the former having been appointed to apply dressings to the heels of a horse affected with the malady I have mentioned, and not paying due attention to cleanliness, incautiously bears his part in milking the cows, with some particles of the infectious matter adhering to his fingers. When this is the case it frequently happens that a disease is communicated to the cows, and from the cows to the dairy maids, which spreads through the farm until most of the cattle and domestics feel its unpleasant conse- quences. This disease has obtained the name of cow pox. It appears on the nipples of the cows in the form of irregular pustules. At their first appearance they are commonly of a palish blue, or rather of a color some- what approaching to livid, and are surrounded by an inflammation. These pustules, unless a timely remedy be applied, frequently degenerate into phagedenic ulcers, which prove extremely troublesome.t The animals become indisposed, and the secretion of the milk is much lessened. In- flamed spots now begin to appear on different parts of the hands of the domestics employed in milking, and sometimes ou the wrists, which run on to suppuration, first assuming the appearance of the small vesications produced by a burn. Most commonly they appear about the joints of the fingers and at their extremities, but whatever parts are affected, if the situation will admit, these superficial suppurations put on a circular form, with their edges more elevated than their centre, and of a color distantly approaching to blue. Absorption takes place and tumors appear in each *The late Mr. John Hunter proved by experiments that the dog is the wolf in a degenerated state. tThey who attend sick cattle in this country find a speedy remedy for stopping the progress of this complaint in those applications which act chemically upon the morbid matter, such as the solutions of the vitiiolum zinci, the vitriolum cupri, etc. Variola Vaccina: Edward Jenner. 147 axilla. The system becomes affected, the pulse is quickened; shiverings, succeeded by heat, general lassitude and pains about the loins and limbs, with vomiting, come on. The head is painful, and the patient is now and then affected with delirium.* These symptoms, varying in their degrees of violence, generally continue from one day to three or four, leaving ulcer- ated sores about the hands, which, from the sensibility of the parts, are very troublesome and commonly heal slowly, frequently becoming phage- denic, like those from whence they sprung. During the progress of the disease, the lips, nostrils, eyelids, and other parts of the body, are some- times affected with sores; but these evidently arise from their being heed- lessly rubbed or scratched with the patient's infected fingers. No erup- tions on the skin have followed the decline of the feverish symptoms in any instance that has come under my inspection, one only excepted, and in this case a very few appeared on the arms. They were very minute, of a vivid red color, and soon died away, without advancing to maturation, so that I cannot determine whether they had any connection with the preced- ing symptoms. Thus the disease makes its progress from the horse, as I conceive, to the nipple of the cow, and from the cow to the human subject. Morbid matter of various kinds, when absorbed into the system, may produce effects in some degree similar; but what renders the cowpox virus so extremely singular is that the person who has been thus affected is for- ever after secure from the infection of the small pox ; neither exposure to the variolous effluvia nor the insertion of the matter into the skin produc- ing this distemper. In support of so extraordinary a fact, I shall lay before my reader a great number of instances. But first it is necessary to observe that pus- tulous sores frequently appear spontaneously on the nipples of the cows, and instances have occurred, though very rarely, of the hands of the ser- vants employed in milking being affected with sores in consequence, and even of their feeling an indisposition from absorption. These pustules are of a much milder nature than those which arise from that contagion which constitutes the true cow pox. They are always free from the bluish or livid tint so conspicuous in the pustules in that disease. No erysipelas attends them, nor do they show any phagedenic disposition, as in the other case, but quickly terminate in a scab, without creating any apparent dis- order in the cow. This complaint appears at various seasons of the year, but most commonly in the spring, when the cows are first taken from their winter food and fed with grass. It is very apt to appear also when they are suckling their young. But this disease is not to be considered as similar in any respect to that of which I am treating, as it is incapable of producing any specific effects on the human constitution. However, it is. of the greatest consequence to point it out here, lest the want of discrimi- nation should occasion an idea of security from the infection of the small pox, which might prove delusive. CASE I. Joseph Merrett. now an under gardener to the Earl of Berkeley, lived as a servant with a fanner near this place,in the year 1770, and occasionally assisted in milking his. master's cows. Several horses belonging to the farm began to have sore heels, which Merrett frequently attended. The cows soon became affected with the cow-pox, and soon after several sores appeared on his hands. Swellingsand stiffness in each axilla 'It will appear in the sequel that these symptoms arise principally from the irritation of the sores, and not from the primary action of the vaccine virus upon the constitution. 148 followed, and he was so much indisposed for several days as to be incapable of pursuing his ordinary employment. Previously to the appearance of the distemper among thd cows there was no fresh cow brought into the farm, nor any servant employed who was affected with the cow-pox. In April, 1795, a general inoculation taking place here, Merrett was inoculated with his family, so that a period of twenty-five years had elapsed from his having the cow- pox to this time. However, though the variolous matter was repeatedly inserted into his arm, I found it impracticable to infect him with it, an efiloresence only, taking on an erysipelatous look about the centre, appearing on the skin near the punctured parts. During the whole time that his family had the small-pox, one of whom had it very full, he remained in the house, with them, but received no injury from exposure to the con- tagion . It is necessary to observe that the utmost care was taken to ascertain, with the most scrupulous precision, that no one whose case is here adduced had gone through the small- pox previous to these attempts to produce that disease. Had these experiments been conducted in a large city, or in a populous neighbor- hood, some doubts might have been entertained ; but here, where population is thin, and where such an event as a person's having had the small-pox is always faithfully recorded, no risk of inaccuracy in this particular can arise. CASE IL Sarah Portlock, of this place, was infected with the cow-pox, when a servant at a farmer's in the neighborhood, twenty-seven years ago.* In the year 1792, conceiving herself, from this circumstance, secure from the infection of the small-pox, she nursed one of her own children, wrho had accidentally caught the disease, but no indisposition ensued. During the time she remained in the infected room, variolous matter was inserted into her arms, but without any further effect than in the preceding case. CASE III. John Phillips, a tradesman of this town, had the cow-pox at so early a period as nine years of age. At the age of sixty-two I inoculated him, and w'as very careful in select- ing matter in its most active state. It was taken from the arm of a boy just before the commencement of the eruptive fever, and instantly inserted. It very speedily pro- duced a sting-like feel in the part. An efflorescence appeared, which on the fourth day was rather extensive, and some degree of pain and stiffness was felt about the shoulder ; but on the fifth day these symptoms began to disappear, and in a day or two after went entirely off, without producing any effect on the system. CASE IV. Mary Barge, of Woodford, in.this parish, was inoculated with variolous matter in the year 1791. An efflorescence of a palish red color soon appeared about the parts where the matter was inserted, and spread itself rather extensively, but died away in a few' days without producing any variolous symptoms.t She has since been repeatedly employed, as a nurse to small-pox patients 'without experiencing any ill consequences. This woman had the cow-pox when she lived in the service of a farmer in this parish thirty-one years before. CASE V. Mrs. H , a respectable gentlewoman ot this town, had the cow-pox when very young. She received the infection in a manner that is not common. It was given by ♦I have purposely selected several cases in which the disease had appeared at a very distant period pre- vious to the experiments made with variolous matter, to show that the change produced in the constitu- tion is not affected by time. tit is remarkable that variolous matter, when the system is disposed to reject it, should excite inflamma- tion on the part to which it is applied more speedily than when it produces the small-pox. Indeed, it becomes almost a criterion by which we can determine whether the infection will be received or not. It seems as if a change, which endures through lite, had been produced in the action, or disposition to action, in the vessels of the skin ; and it is remarkable, too, that whether this change has been effected by the small-pox or the cow-pox that the disposition to sudden cuticular inflammation is the same on the application of variolona matter. Variolcv Vaceince: Edward Jenner. Varioke Vaccine: Jklward Jenner. 149 means of her handling some of the same utensils* which were in use among the servants of the family, who had the disease from milking infected cows. Her hands had many of the cow-pox sores upon them, and they were communicated to her nose, which became inflamed and very much swollen. Soon after this event Mrs. H was exposed to the • contagion of the small-pox, where it was scarcely possible for her to have escaped, had she been susceptible of it, as she regularly attended a relative who had the disease in so violent a degree that it proved fatal to him. In the year 1778 small-pox prevailed very much at Berkeley, and Mrs. H , not feeling perfectly satisfied respecting her safety (no indisposition having followed her exposure to the small-pox), I inoculated her with active variolous matter. The same appearance followed as in the preceding cases-an efflorescence on the arm, without any effect on the constitution. CASE VI. It is a fact so well known among our dairy farmers, that those who have had the small-pox either escape the cow-pox or are disposed to have it slightly, that as soon as the complaint shows itself among the cattle, assistants are procured, if possible, who are thus rendered less susceptible of it, otherwise the business of the farm could scarcely go forward. In the month of May, 1796, the cow-pox broke out at Mr. Baker's, a farmer who lives near this place. The. disease was communicated by means of a cow, which was pur- chased in an infected state at a neighboring fair, and not one of the farmer's cows, con- sisting of thirty, which were at that time milked, escaped the contagion. The family consisted of a man servant, two dairy maids and a servant boy, who, with the farmer himself, were twice a day employed in milking the cattle. The whole of this family, except Sarah Wynne, one of the dairymaids, had gone through the small-pox. The con- sequence was that the farmer and the servant boy escaped the infection of the cow-pox entirely, and the servant man and one of the maid servants had each of them nothing more than a sore on one of their fingers, which produced no disorder in the system. But the other dairy maid, Sarah Wynne, who never had the small-pox, did not escape in so easy a manner. She caught the complaint from the cows, and was affected with the symptoms described in the fifth page in so violent a degree that she was confined to her bed, and rendered incapable for several days of pursuing her ordinary vocations in the farm. March 28th, 1797, I inoculated this girl, and carefully rubbed the variolous matter into slight incisions made upon the left arm. A. little inflammation appeared in the usual manner around the parts where the matter was inserted, but so early as the fifth day it vanished entirely without producing any effect on the system. CASE VII. Although the preceding history pretty clearly evinces that the constitution is far less susceptible of the contagion of the cow-pox after it has felt that of the small-pox, and although in general, as 1 have observed, they who have had the small-pox, and are employed in milking cows which are infected with the cow-pox, either escape the dis- order, or have sores on the hands without feeling any general indisposition, yet the animal economy is subject to some variation in this respect, which the following rela- tion will point out: In the summer of the year 1796 the cow-pox appeared at the farm of Mr. Andrews, a considerable dairy adjoining to the town of Berkeley. It was communicated, as in the preceding instance, by an infected cow purchased at a fair in the neighborhood. The family consisted of the farmer, his wife, two sons, a man and a maid servant, all of whom, except the farmer, who was fearful of the consequences, bore a part m milking the cows. The whole of them, exclusive of the man servant, had regularly gone through the small-pox; but in this case no one who milked the cows escaped the contagion. All of them had sores upon their hands, and some degree of general indisposition, preceded by pains and tumors in the axilla; but there was no comparison in the severity of the disease as it was felt by the servant man, who had escaped the small-pox, and by those of the family who had not; for, while he was confined to his bed, they were able, with- out much inconvenience, to follow their ordinary business. "When the cow-pox hag prevailed in the dairy, it hag often been communicated to thoge who h ave not milked the cowg by the handle of the milk pail. 150 Variola Vaccince: Edward Jenner. February 13, 1797, I availed myself of an opportunity of inoculating William Rodway, the servant man above alluded to. Variolous matter was inserted into both his arms ; in the right by means of superficial incisions, and into the left by slight punctures into the cutis. Both were perceptibly inflamed on the third day. After this the inflamma- tion about the punctures soon died away, but a small appearance of erysipelas was manifest about the edges of the incisions till the eighth day, when a little uneasiness was felt for the space of half an hour in the right axilla. The inflammation then hastily disappeared, without producing the most distant mark of affection of the system. CASE VIII. Elizabeth Wynne, aged fifty-seven, lived as a servant with a neighboring farmer thirty-eight years ago. She was then a dairy maid, and the cow-pox broke out among the cows. She caught the disease with the rest of the fartiily, but, compared with them, had it in a very slight degree, one very small sore only breaking out on the little finger of her left hand, and scarcely any perceptible indisposition following it. As the malady had shown itself in so slight a manner, and as it had taken place at so distant a period of her life, I was happy with the opportunity of trying the effects of variolous matter upon her condition, and on the twenty-eighth of March, 1797, I inocu- lated her by making two superficial incisions on the left arm, on which the matter was cautiously rubbed. A little efflorescence soon appeared, and a tingling sensation was felt about the parts, where the matter was inserted, until the third day, when both began to fade, and so early as the fifth day it was evident that no indisposition would follow. CASE IX. Although the cow-pox shields the constitution from the small-pox, and the small-pox proves a protection against its own future poison, yet it appears that the human body is again and again susceptible of the infectious matter of the cow-pox, as the following history will demonstrate: William Smith, of Pyrton, in this parish, contracted this disease when he lived with a neighboring farmer in the year 1780. One of the horses belonging to the farm had sore heels, and it fell to his lot to attend him. By these means the infection was carried to the cows, and from the cows it was communicated to Smith. Ou one of his hands were several ulcerated sores, and he was affected with such symptoms as have been be- fore described. In the year 1791 the cow-pox broke out at another farm where he then lived as a ser- vant, and he became affected with it a second time ; and in the year 1794 he was so un- fortunate as to catch it again. The disease was equally as severe the second and third time as it was on the first.* In the spring of the year 1795 he was twice inoculated, but no affection of the system could be produced from the variolous matter; and he has since associated with those who had the small-pox in its most contagious state without feeling any effect from it. CASE X. Simon Nichols lived as a servant with Mr. Bromedge, a gentleman who resides on his own farm, in this parish, in the year 1782. He was employed in applying dressings to the sore heels of one of his master's horses, and at the same time assisted in milking the cows. The cows became affected in consequence, but the disease did not show itself on their nipples till several weeks after he had begun to dress the horse. He quitted Mr. Bromedge's service, and went to another farm, without any sores upon him ; but here his hands soon began to be affected in the common way, and he was much^indisposed, with the usual symptoms- Concealing the nature of the malady from Mr. Cole, his new master, and being there also employed in milking, the cow-pox was communicated to the cows. Some years afterwards Nichols was employed in a farm where the small-pox broke out, when I inoculated him with several other patients, with-whom he continued during the whole time of their confinement. His arm inflamed, but neither the inflammation nor his associating with the inoculated family produced the least effect upon his constitution. *T his is not the case in general-a second attack is commonly very slight, and so, I aminformed.it is among the cows. The reader will find further observations on this subject in the sequel. These re- peated indispositions must have arisen from the local irritation, and not from the specific action of the vaccine virus- Variola Vaccince: Edward Jenner. 151 CASE XL William Stinchcomb was a fellow servant with Nichols at Mr. Bromedge's farm, at the time the cattle had the cow-pox, and he was unfortunately infected by them. His left ■ hand was very severely affected with several corroding ulcers, and a tumor of consider- able size appeared in the axilla of that side. His right hand had only one small sore upon it, and no tumor discovered itself in the corresponding axilla. In the year 1792' Stinchcomb was inoculated with variolous matter, but no conse- quences ensued beyond a little inflammation in the arm for a few days. A large party were inoculated at the same time, some of whom had the disease in a more violent degree than is commonly seen from inoculation. He purposely associated with them, but could not receive the small-pox. During the sickening of some of his companions their symptoms so strongly recalled to his mind his own fate when sickening with the cow-pox, that he very pertinently remarked their striking similarity. CASE XII. The paupers of the village of Tortworth, in this county, were inoculated by Mr. Henry Jenner, surgeon, of Berkeley, in the year 1795. Among them eight patients pre- sented themselves who had at diflerent times in their lives had the cow-pox. One of them, Hester Walkley, 1 attended with that disease when he lived in the service of a farmer in the same village in the year 1782; but neither this woman, nor any other of tne patients who had gone through the cow-pox, received the variolous infection either from the arm or from mixing in the society of the other patients who were inoculated at the same time. This state of security proved a fortunate circumstance, as many of the poor w omen were at the same time in a state of pregnancy. CASE XIII. i One instance has occurred to me of the system being affected from the matter issuing from the heels of horses, and of its remaining afterwards unsusceptible of the variolous contagion ; another, w here the small-pox appeared obscurely ; and a third in which its complete existence w as positively ascertained. First, Thomas Pearce is the son of a smith and farrier near to this place. He never had the cow-pox, but in consequence of dressing horses with sore heels at his father's, when a lad, he had sores on his fingers, which suppurated, and which occasioned a pretty severe indisposition. Six years afterwards I inserted variolous matter into his arm repeatedly, without being able to produce anything more than a slight inflamma- tion, which appeared very soon after the matter was applied, and afterwards I exposed him to the contagion of the small-pox with as little effect* CASE XIV. Secondly, Mr. James Cole, a farmer in this parish, had a disease from the same source as related in the preceding case, and some years after wras inoculated with variolous matter. He had a little pain in the axilla, and felt a slight indisposition for three or four hours. A few eruptions showed themselves on the forehead, but they very soon disappeared without advancing to maturation. CASE XV. Although m the two foimer instances the system seemed to be secured, or nearly so, from variolous infection by the absorption of matter from sores produced by the diseased heels of horses, yet the following case renders it probable that this cannot be entirely relied upon until a disease has been generated by the morbid matter from the horse on the nipple of the cow, and passed through that medium to the human subject.! Mr. Abraham Kiddiford, a farmer at Stone, in this parish, in consequence of dressing a mare that had sore heels, was affected with very painful sores in both his hands, tumors in each axilla, and severe and general indisposition. A surgeon in the neighbor- *It is a remarkable fact, and well known to many, that we are frequently foiled in our endeavors to com- municate the small-pox by inoculation to blacksmiths, who in the country are farriers. They often, as in the above instance, either resist the contagion entirely, or have the disease anomalously. Shall we not be able now to account for this on a rational principle ? tThe succeeding part will give further explanations of this subject. Variola Vaccina: Edward Jenner. 152 hood attended him, who, knowing the similarity between the appearance of Ilie, sores upon his hands and those produced by the cow-pox, and being acquainted also with the effects of that disease on the human constitution, assured him that he never need to fear the infection of. the small-pox : but this assertion proved fallacious, for, on being exposed to the infection upwards of twenty years afterwards, he caught the disease, which took its regular course in a very mild way. There certainly was a difference per- ceptible, although it is not easy to describe it, in the general appearance of the pustules from that which we commonly see. Other practitioners, who visited the patient at my request, agreed with me in this point, though there was no room left for suspicion as to the reality of the disease, as I inoculated some of his family from the pustules, who had the small-pox, with its usual appearances, in consequence. CASE XVI. Sarah Nelmes, a dairy maid at a farmer's mar this place, was infected with the cow- pox from her master's cows, in May, 1796. She received the infection on a part of the hand which had been previously, in a slight degree, injured by a scratch from a thorn. A large, pustulous sore, and the usual symptoms accompanying the disease, were pro- duced in consequence. The pustule was so expressive of the true character of the cow- pox, as it commonly appears updn the hand, that I have given a representation of it in the annexed plate. The two small pustules on the wrists arose also from the applica- tion of the virus to some minute abrasions of the cuticle, but the livid tint, if they ever had any, was not conspicuous at the time I saw the patient. The pustule on the fore- finger shows the disease in an earlier stage. It did not actually appear on the hand of this young woman, but was taken from tlyit of another,*and is annexed for the purpose of representing the malady after it has newly appeared. CASE XVII. The more accurately to observe the progress of the. infection, I selected a healthy boy, about eight years old, for the purpose of iuoculation for the cow-pox. The matter was taken from a sore on the hand of a dairy maid*, who was infected by her master's cows, and it was inserted on the fourteenth of May, 1796, into the arm of the boy, by means of two superficial incisions, barely penetrating the cutis, each about half an inch long. On the seventh day he complained of uneasiness m the axilla, and on the ninth he became a little chilly, lost his appetite, and bad a slight headache. During the whole of this day he was perceptibly indisposed, and spent the night with some degree of restlessness, but on the following day he was perfectly well. The appearance of the incisions in their progress to a state of maturation were much the same as when produced in a similar manner by variolous matter.t The only differ- ence which 1 perceived was in the state of the limpid fluid arising from the action of virus, which assumed rather a darker hue, and in that of the afflorescence spreading round the incisions, which had more of an erysipelatous look than we commonly per- ceive when variolous matter has been made use of in the same manner; but the whole died away (leaving on the inoculated parts scabs and subsequent scars) without giving me or my patient the least trouble. In order to ascertain w hether the boy, after feeling so slight an affection of the sys- tem from the cow-pox virus, was secure from the contagion of the small-pox, he was in- oculated the first of July following with variolous matter, immediately taken from a pustule. Several slight punctures and incisions were made on both his arms, and the matter w as carefully inserted, but no disease followed. The same appearances were ob- servable on the arms as we commonly see when a patient lias had variolous matter applied, after having either the cow-pox or the small pox. Several months afterwards he was again inoculated with variolous matter, but no sensible effect w as produced on the constitution. Here my researches were interrupted till the spring of the year 1798, w hen, from the wetness of the early part of the season, many of the farmer's horses in this neighborhood were affected with sore heels, in consequence of which the cowr-pox broke out among several of our dairies, which afforded me an opportunity of making farther observations upon this curious disease. ♦From the sore on the hand of Sarah Nelmes.-See the preceding case a. the plate. tThis appearance was, in a great measure, new to me, and 1 ever shall recollect the pleasant sensations it excited ; as, from its similarity to the pustule produced by variolous inoculation, it iucontestibly pointed out the close connection between the two diseases, and almost anticipated the result of my future experi- ments. VARIOLA VACCINE. PLATE 17. Fig. 76/ Hand of Sarah Nelmes infected with the Cow Pox, May, 1796. Plate 1, Case. XVf of "An inquiry into the causes and effects of the Variola Vaccina." Edward fenner. TWi NEW ORLEANS ITO C? IO UNION ST. Variola; Vaccina : JEdward Jenner. A mare, the property of a person who keeps a dairy in a neighboring parish, began to have sore heels the latter end of the month of February, 1798, which were occasionally washed by the servant men of the farm. Thomas Virgoe, William Wherret and William Haynes, who, in consequence became affected with sores in their hands, followed by in- tiamed lymphatic glands in the arms and axilla., shiverings succeeded by heat, lassitude and general pains iu the limbs. A single paroxysm terminated the disease, for within twenty-four hours they were free from general indisposition, nothing remaining but the sores ou their hands. Haynes and Virgoe, who had gone through the small-pox from inoculation, described their feelings as very similar to those which affected them on sickening with that malady. Wherret never had had the small-pox. Haynes was daily employed as one of the milkers at the farm, and the disease began to show itself among the cows about ten days after he first assisted in washing the mare's heels. Their nip- ples became sore iu the usual way, with bluish pustules ; but as remedies were early applied they did not ulcerate to any extent. CASE XVIII, John Baker, a child of five years old, was inoculated March 16, 1798, with matter taken from a pustule on the hand of Thomas Virgoe, one of the servants who had been infected from the mare's heels. He became ill on the sixth day with symptoms similar to those excited by cow-pox matter. On the eighth day he was free from indisposition. There was some variation in the appearance of the pustule on the arm. Although it somewhat resembled a small-pox pustule, yet its similitude was not so conspicuous as when bxcited by matter from the nipple of the cow, or when the matter has passed from thence through the medium of the human subject. (See plate No. 2.) This experiment was made to ascertain the progress and subseqent effects of the dis- ease when thus propagated. We have seen that the virus from the horse, when it proves infectious to the human subject, is not to be relied upon as rendering the system secure from variolous infection, but that the matter produced by it on the nipple of the cow is perfectly so. Whether its passing from the horse through the human constitu- tion, as in the present instance, will produce a similar effect, remains to be decided. This would now have been effected, but the boy was rendered unfit for inoculation, from having felt the effects of a contagious fever in a work house, soon after this experiment was made. CASE XIX. William Summers, a child of five years and a half old, was inoculated the same day with Baker, with matter taken from the nipples of one of the infected cows, at the farm alluded to in wage 32, He became indisposed on the sixth day, vomited once, and felt the usual slight symptoms till the eighth day, when he appeared perfectly well. The progiess of the pustule, formed by the infection of the virus, was similar to tha t noticed in Case XVII, with this exception-its being free from the livid tint observed in that instance. CASE XX. From William Summers the disease was transferred to William Pead, a boy of eight years old, who was inoculated March 28. On the sixth day he complained of pain in the axilla, and on the seventh was affected with the common symptoms of a patient sickening with the small-pox from inoculation, which did not terminate till the third day after the seizure. So perfect was the similarity to the variolous fever, that I was induced to examine the skin, conceiving there might have been some eruptions, but none appeared. The efflorescent blush around the part punctured in the boy's arm was so truly characteristic of that which appears on variolous inoculation, that I have given a representation of it. The drawing was made when the pustule was beginning to die away, and the areola retiring from the centre. (See plate No. 3.) CASE XXI. April 5, several children and adults were inoculated from the arm of William Pead. The greater part of them sickened on the sixth day, and were well on the seventh, but in three of the number a secondary indisposition arose in consequence of an extensive erysipelatous inflammation which appeared on the inoculated arms. It seemed to arise from the state of the pustule, which spread out, accompanied with some degree of pain, to about half the diameter of a sixpence. One of these patients was an infant of half a 153 154 Variola; Vaccina;: Eduard Jenner. year old. By the application of mercurial ointment to the inflamed parts (a treatment recommended under similar circumstances in the inoculated small-pox) the complaint subsided without giving much trouble. Hannah Excell, a healthy girl of seven years old, and one of the patients above mentioned, received the infection from the insertion of the virus under the cuticle of the arm in three distinct points* The pustules which arose in consequence so much re- sembled, on the ninth day, those appearing from the insertion of variolous matter, that an experienced inoculator would scarcely have discovered a shade of difference at that period. Experience now tells me that almost the only variation which follows consists in the pustulous fluids remaining limpid nearly to the time of its total disappearance, and not, as in the direct small-pox, becoming purulent. (See plate No. 4.) CASE XXII. From the arm of this girl matter was taken and inserted April 12 into the arms of John Marklove, one year and a half old. Robert F. Jenner, eleven mouths old ; Mary Pead, five years old ; and Mary James, six years old. Among these, Robert F. Jenner did not receive the infection. The am s of the other three inflamed properly, and began to affect the system in the usual manner; but, being under some apprehension from the preceding cases ihat a troublesome erysipelas might arise, I determined on making an experiment, w ith the view of cutting oil'its source. Accordingly, on the eighth day after the patients had felt an indisposition that was just perceptible, of about twelve hours, I applied in tw o of these cases out of the three, on the vesicle formed by the virus, a little mild caustic, composed of equal parts of quicklime and soap, and suffered it to remain on the part six hours,! It seen ed to give the children but little uneasiness, and effectually answered my intention in pre- venting the appearance of erysipelas. Indeed, it seemed to do more, for in half an hour after its application, the indisposition of the children ceased.i These precautions were, perhaps, unnecessary, as the arm of the third child, Mary Pead, which w as suf- fered to take its common course, scabbed quickly, without any erysipelas.il CASE XXIII. From the child's arm matter was taken and transferred to that of J. Barge, a boy of seven years old. He sickened on the eight dayy went through the disease with the usual slight symptoms, and without any inflammation on the aim beypnd the common efflorescence surrounding the pustule, and appearance so often seen in inoculated small- pox. After the many fruitless attempts to give the small-pox to those who had had the cow-pox, it did not appear necessary, nor was it convenient to me, to inoculate the whole of those who had been the subject of these late trials ; yet I thought it right to see the effects of variolous matter on some of them, particularly William Summers, the first of these patients who had been infected w ith matter taken from the cow. He was therefore inoculated with variolous matter from a fresh pustule ; but, as in the preced- ing cases, the system did not feel the effects of it in the smallest degree. I had an opportunity, also, of having this boy (Barge) and William Pead inoculated by my nephew, Mr. Henry Jenner, whose report to me is as follow s : " I have inoculated Pead and Barge, two of the boys whom you lately infected with the cow-pox. On the second day the incisions were inflamed, and there was a pale, inflammatory stain around them. On the third day these appearances were still increasing, and their arms itched considerably. On the fourth day the inflammation was evidently subsiding, and on the sixth it w7as scarcely perceptible. No symptom of indisposition followed. " To convince myself that the variolous matter made use of was in a perfect state, I at the same time inoculated a patient with some of it who had never gone through the cow-pox, and it produced the small-pox in the usual regular manner." These experiments afforded me much satisfaction ; they proved that the matter, in passing from one human subject to another, through five gradations, lost none of its *This was not done intentionally, but from the accidental touch of the lancet, one puncture being always sufficient. tPerhaps a few touches with the lapis septicus would have proved equally efficacious. 'What effect would a similar treatment produce in inoculation for the small-pox I „The subsequent part of this treatise will sufficiently show the proper practice in cases of inflammation of the inoculated arm. VARIOLA VACCINJE. PLATE 18. Fig. 11: Arm of John Baker; Vaccinated March 16, 1798. Plate 2, Case XVIII. Inquiry, Edward Jenner. Fig. 78.' Arm of William Pead. CaseXX. Plate*. Inquiry, Edward 'Jenner ^19: Arm of Hannah Exceh Case XXL Plate No. 4. In quiry into Variola Vaccina Edward Jenner. TmMtW ONlfANS UTH €» 10 UNI Variola Vaccina : Edward Jenner. 155 original properties, J. Barge being the fifth who received the infection successively from William Summers, the boy to whom it was communicated from the cow. I shall now conclude this inquiry with some general observations on the subject, and on some others which are interwoven with it. Although, I presume, it may be unnecessary to produce further testimony in support of my assertion "that the cow-pox protects the human constitution from the infection of the small-pox," yet it affords me considerable satisfaction to say that Lord Somer- ville, the president of the Board of Agriculture, to whom this paper was shown by Sir Joseph Banks, has found, upon inquiry, that the statements were confirmed by the con- curring testimony of Mr. Dollan, a surgeon, who resides in a dairy country remote from this, in which these observations were made. With respect to the opinion adduced "that the source of the infection is a peculiar morbid matter arising in the horse," although I have not been able to prove it from actual experiments conducted immediately under my own eye, yet the evidence I have adduced appears sufficient to establish it. They who are not in the habit of conducting experiments may not be aware of the co- incidence of circumstances necessary for their being managed so as to prove perfectly decisive ; nor how often men engaged in professional pursuits are liable to interruptions which disappoint them almost at the instant of their being accomplished. However, I feel no room for hesitation respecting the common origin of the disease, being well con- vinced that it never appears among the cows (except it can be traced to a cow intro- duced among the general herd which has been previously infected, or to an infected servant), unless they have been milked by some one who, at the same time, has the care of a horse affected with diseased heels. The spring of the year 1797, which I intended particularly to have devoted to the completion of this investigation, proved, from its dryness, remarkably averse to my wishes ; for it frequently happens, while the farmer's horses are exposed to the cold rains which fall at that season, that their heels become diseased, and no cow-pox then appeared in the neighborhood. The active quality of the virus from the horse's heels is greatly increased after it has acted on the nipples of the cow, as it rarely happens that the horse affects his dresser with sores, and as rarely that a milk maid escapes the infection when she milks infected cows. It is most active at the commencement of the disease, even before it has acquired a pus-like appearance; indeed, I am not confident whether this property in the matter does not entirely cease as soon as it is secreted in the form of pus. I am induced to think it does cease*, and that it is the thin, darkish-looking fluid only, oozing from the newly formed cracks in the heels, similar to what sometimes appears from erysipelatous blisters, which gives the disease. Nor am I certain that the nipples of the cow are at all times in a state to receive the infection. The appearance of the disease in the spring and the early part of the summer, when they are disposed to be affected with spontane- ous eruptions, so much more frequently than at other seasons, induces me to think that the virus from the horse must be received upon them when they are in this state, in order to produce effects. Experiments, however, must determine these points. But it is clear that when the cow-pox virus is once generated that the cows cannot resist the contagion, in whatever state their nipples may chance to be, if they are milked with an infected hand. Whether the matter, either from the cow or the horse, will affect the sound skin of the human body, I cannot positively determine; probably it will not, unless on those parts where the cuticle is extremely thin, as on the lips, for example. I have known an instance of a poor girl who produced an ulceration on her lip by frequently holding her finger to her mouth to cool the raging of a cow-pox sore by blowing upon it. The hands of the farmer's servants here, from the nature of their employments, are con- stantly' exposed to those injuries which occasion abrasions of the cuticle, to punctures from thorns and such like accidents, so that they are always in a state to feel the conse- quences of exposure to infections matter. It is singular to observe that the cow-pox virus, although it renders the constitution unsusceptible of the variolous, should, nevertheless, leave it unchanged with respect to its own action. I have already produced an instance! to point this out, and shall now corroborate it with another. Elizabeth Wynne, who had the cow-pox in the year 1759, was inoculated with vario- lous matter, without effect, in the year 1797, and again caught the cow-pox in the year 1798. When I saw her, which was on the eighth day after she received the infection, I found her affected with general lassitude, shiverings, alternating with heat, coldness *It is very easy to procure pus from old sores on the heels of horses. This I have often inserted into scratches made with a lancet, on the sound uipples of cows, and have seen no other effects from it than simple inflammation. tSee case IX. 156 Variolcc Vaccince: Edward Jenner. of the extremities, and a quick and irregular pulse. These symptoms were preceded by a pain in the axilla. On her hand was one large, pustulous sore, which resembled that delineated in plate No. 1.* It is curious, also, to observe that the virus, which, with respect to its effects, is un- determined and uncertain previously to its passing from the horse through the medium of the cow,t should then not only become more active, but should invariably and com- pletely possess those specific properties which induce in the human constitution symp- toms similar to those of the variolous fever, and effect in it that peculiar change which forever renders it unsusceptible of the variolous contagion. May it not then be reasonably conjectured that the source of the small-pox is morbid matter of a peculiar kind, generated by a disease in the horse, and that accidental cir- cumstances may have again and again arisen, still working new changes upon it, until it has acquired the contagious and malignant form under which we now commonly see it making its devastations among us? And, from a consideration of the change which the infectious matter undergoes from producing a disease on the cow, may we not con- ceive that many contagious diseases now prevalent amongst us may owe their present appearance not to a simple, but to a compound, origin? For example, is it difficult to imagine that the measles, the scarlet fever, and the ulcerous sore throat with a spotted skin, have all sprung from the same source, assuming some variety in their forms according to the nature of their new combinations? The same question will apply re- specting the origin of many other contagious diseases which bear a strong analogy to each other. There are certainly more forms than one, without considering the common variation between the confluent and distinct, in which the small-pox appears in what is called the natural way. About seven years ago a species of small-pox spread through many of the towns and villages of this part of Gloucestershire. It was of so mild a nature that a fatal instance was scarcely ever heard of, and consequently so little dreaded by the lower orders of the community, that they scrupled not to hold the same intercourse with each other as if no infectious disease had been present among them. I never saw nor heard of an instance of its being confluent. The most accurate manner, perhaps, in which I can convey an idea of it is, by saying, that had fifty individuals been taken promiscuously and infected by exposure to this contagion, they would have had as mild and light a disease as if they had been inoculated with variolous matter in the usual way. The harmless manner in which it showed itself could not arise from any peculiar- ity either in the season or the weather, for I watched its progress upwards of a year without perceiving any variation in its general appearance. 1 consider it, then, as a variety of the small-pox.t In some of the preceding cases I have noticed the attention that was paid to the state of the variolous matter previous to the experiment of inserting it into the arms of those who had gone through the cow-pox. This I conceived to be of great importance in con- ducting these experiments and wrere it always properly attended to by those who inoc- ulate for the small-pox, it might prevent much subsequent mischief and confusion. With the view of enforcing so necessary a precaution, I shall take the liberty of digress- ing so far as to point out some unpleasant facts, relative to mismanagement in this par- ticular, which have fallen under my own observation. A medical gentleman (now no more), who, for many years, inoculated in this neighbor- hood, frequently preserved the variolous matter intended for use, on a piece of lint or cotton, which, in its fluid state, was put into a vial, corked and conveyed into a warm pocket, a situation certainly favorable for speedily producing putrefaction in it. In this state (not unfreqnently after it had been taken several days from the pustules), it was inserted into the arms of his patients, and brought on inflammation of the incised parts, swellings of the axillary glands, fever and sometimes eruptions. But what was this disease ? Certainly not the small-pox, for the matter having from putrefaction lost or suffered a derangement in its specific properties, was no longer capable of producing that malady, those who had been inoculated in this manner being as much subject to the contagion of the small-pox as if they had never been under the influence of this artificial disease; and many, unfortunately, fell victims to it who thought themselves in perfect security. The same unfortunate circumstance of giving a disease, supposed to be the small-pox, with inefficaceous variolous matter, having occurred under the direction of some other practitioners within my knowledge, and probably from the *As I have before observed, these symptoms probably arose from the irritation of the sore, which was very painful, fFurtlier explanation will be adduced on this subject. +My friend, Dr- Hicks, of Bristol, who, during the prevalence of this distemper, was resident at Glou- cester. and physician to the hospital there, where it was seen soon after its first appearance in this coun- try, had opportunities of making numerous observations upon it, which it is his intention to communicate to the public. Variolic Vaccine ; Edward Jenner. 157 same incautious method of securing the variolous matter, I avail myself of this oppor- tunity of mentioning what I conceive to be of great importance, and, as a further cau- tionary hint, 1 shall again digress so far as to add another observation on the subject of inoculation. Whether it be yet ascertained by experiment that the quantity of variolous matter inserted into the skin makes any difference with respect to the subsequent mildness or violence of the disease, I know not; but I have the strongest reason for supposing that if either the punctures or incisions be made so deep as to go through it, and wound the adipose membrane, that the risk of bringing on a violent disease is greatly increased. I have known an inoculator. whose practice was "to cut deep enough (to use his own expression) to see a bit of fat," and there to lodge the matter. The great number of had cases, independent of inflammations and abscesses on the arms, and the fatality which attended this practice was almost inconceivable, and I cannot account for it on any other principle than that of the matter being placed in this situation instead of the skin. It was the practice of another, whom I well remember, to pinch up a small portion of the skin on the arms of his patients, and to pass through it a needle, with a thread attached to it, previously dipped in variolous matter. The thread was lodged in the perforated parts, and consequently left in contact with the cellular membrane. This practice was attended with the same ill success as the former. Although it is very im- probable that any one would now inoculate in this rude way by design, yet these ob- servations may tend to place a double guard over the lancet, when infants, whose skins are comparatively so very thin, fall under the care of the inoculator. A very respectable friend of mine, Dr. Hardwicke, of Sodbury, in this county, inocu- lated great numbers of patients previous to the introduction of the more modern method by Sutton, and with such success that a fatal instance occurred as rarely assince that method has been adopted It was the doctor's practice to make as slight an incision as possible upon the skin, and there to lodge a thread saturated with the variolous matter- When his patients became indisposed, agreeably to the custom then prevailing, they were directed to go to bed, and were kept moderately warm. Is it not probable, then, that the success of the modern practice may depend more upon the method of invariably de- positing the virus in or upon theskin than on the subsequent treatment of the disease ? I do not mean to insinuate that exposure to cool air, and suffering the patient to drink cold water when hot and thirsty, may not moderate the eruptive symptoms and lessen the number of pustules ; yet, to repeat my former observation, I cannot account for the uninterrupted success, or nearly so, of one practitioner, and the wretched state of the patients under the care of another, where, in both instances, the general treatment did not differ essentially, without conceiving it to arise from the different modes of inserting the matter for the purpose of producing the disease. As it is not the identical matter inserted which is absorbed into the constitution, but that which is, by some peculiar process in the animal economy, generated by it, is it not probable that different parts of the human body may prepare or modify the virus differently? Although the shin, for example, adipose membrane, or mucous membranes, are all capable of producing the va- riolous virus by the stimulous given by the particles originally deposited upon them, yet I am induced to conceive that each of these parts is capable of producing some variation in the qualities of the matter previous to its affecting the constitution What else can constitute the difference between the small-pox when communicated casually, or in what has been termed the natural way, or when brought on artificially through the me- dium of the skin ? After all are the varioulous particles, possessing their true specific and contagious principles, ever taken up and conveyed by the lymphatics unchanged into the blood vessels? I imagine not. Were this the case, should we not find the blood sufficiently' loaded with them in some stages of the small-pox to communicate the disease by inserting it under the cuticle, or by spreading it on the surface in the shape of an ailcer ? Yet experiments have determined the impracticability of its being given in this way, although it has been proved that variolous matter, when much diluted with water, and applied to the skin in the usual manner, will produce the disease. But it would be digressing beyond a proper boundary to go minutely into this subject here. 4t what period the cow-pox was first noticed here is not upon record. Our oldest farmers were not unacquainted with it in their earliest days, when it appeared among their farms without any deviation from the phenomena which it now exhibits. Its con- nection with the small-pox seems to have been unknown to them. Probably the gen- eral introduction of inoculation first occasioned the discovery. Its rise in this country may not have been of very remote date, as the practice of milk- ing cows might formerly have been in the hands of women only, which, I believe, is the case now in some other dairy countries, and consequently that the cows might notin former times have been exposed to the contagious matter brought by the men servants from the heels of horses. Indeed, a knowledge of the source of the infection is new in 158 Variola; Vaccina': Edward Jenner. the minds of most of the farmers in this neighborhood, but has at length produced good consequences, and it seems probable from the precautions they are now disposed to adopt that the appearance of the cow-pox here may either be entirely extinguished or become extremely rare. Should it be asked whether this investigation be a matter of mere curiosity, or whether it tend to any benefical purpose, I should, answer that, notwithstanding the happy effects of inoculation, with all the improvements which the practice has received since its first introduction into this country, it not very unfrequently produces deformity of the skin, and sometimes, under the best management, proves fatal. These circumstances must naturally create in every instance, some degree of painful solicitude for its consequences. But as I have never known fatal effects arise from the cow- pox, even when impressed in the most unfavorable manner, producing extensive inflam- mations and suppurations on the hands, and as it clearly appears that this disease leaves the constitution in a state of perfect security from the infection of the small-pox, may we not infer that a mode of inoculation may be introduced preferable to that at present adopted, especially among those families, which, from previous circumstances, we may judge to be predisposed to have the disease unfavorably ? It is an excess in the number of pustules which we chiefly dread in the small-pox; but, in the cow-pox, no pustules appear, nor does it seem possible for the contagious matter to produce the disease from effluvia, or by other means than contact, and that probably not simply between the virus and the cuticle, so that a single individual in a family might at any time receive it without the risk of infecting the rest, or of spreading a distemper that fills a country with terror. Several instances have come under my observation which justify the assertion that the disease cannot be propagated by effluvia. The first boy whom I inocu- lated with the matter of cow-pox slept in a bed, while the experiment was going for- ward, with two children who never had gone either through that disease or the small- pox without infecting either of them. A young woman who had the cow-pox to a great extent, several sores which maturated having appeared on the hands and wrists, slept in the same bed with a fellow dairy maid who never had been infected with either the cow-pox or the small-pox, but no indisposi- tion followed. Another instance has occurred of a young woman on whose hands were several large suppurations from the cow-pox, who was at the same time a daily nurse to an infant, but the complaint was not communicated to thechild In some other points ot view the inoculation of this disease appears preferable to the variolous inoculation. In constitutions predisposed to scrofula how frequently we see the inoculated small-pox rouse into activity that distressful malady. This circumstance does not seem to depend on the manner in which the distemper has shown itself, for it has as frequently hap- pened among those who have had it mildly as when it appeared in the contrary way. There are many who, from some peculiarity iu the habit, resist the common effects of variolous matter inserted into the skin, and who are in consequence haunted through life with the distressing idea of being insecure from subsequent infection. A ready mode of dissipating anxiety originating from such a cause must now appear obvious. And, as we have seen that the constitution may at any time be made to feel the febrile attack of cow-pox, might it not, in many chronic diseases, be introduced into the sys- tem, with the probability of affording relief upon well known physiological principles ? * Although I say the system may at any time be made to feel the febrile attack of cow- pox, yet I have a single instance before me where the virus acted locally only, but it is not in the least probable that the same person would resist the action both of the cow- pox virus and the variolous. Elizabeth Sarsenet lived as a dairy maid at Newpark farm, in this parish. All the cows and the servants employed in milking had the cow-pox, but this woman, though she had several sores upon her fingers, felt no tumors in the axilla, nor any general in- disposition. On being afterwards casually exposed to variolous infection she had the small-pox in a mild way.t Hannah Pick, another of the dairy maids, who was a fellow servant with Elizabeth Sarsenet, when the distemper broke out at the farm, was at the same time infected, but this young woman had not only sores upon her hands, but felt herself also much indis- posed for a day or two. After this, I made several attempts to give her the small-pox by inoculation, but they all proved fruitless. From the former case, then, we see that the animal economy is subject to the same laws in one disease as the other. The following case, which has very lately occurred, renders it highly probable that not only the heels of the horse, but other parts of the body of that animal, are capable of generating the virus which produces the cow-pox. ♦Inoculation in a common way upon the arm will seldom produce this effect. When the disease takes place amon^ the dairy people, the virus comes in contact with preexisting sores, which doesnot fail to produce an irritation that affects the system generally. tThis will be more satisfactorily explained in the sequel. Variola? Vaccina?: Edward Jenner. 159 An extensive inflammation of the erysipelatous kind appeared without any apparent cause upon the upper part of the thigh of a sucking colt, the property of Mr. Millet, a farmer at Rockhampton, a village near Berkeley. The inflammation continued several weeks, and at length terminated in the formation of three or four small abscesses. The inflamed parts were fomented and dressings were applied by some of the same persons who were employed in milking the cows. The number of cows milked was twenty-four, and the whole of them had the cow-pox. The milkers, consisting of the farmer's wife, a man and a maid servant, were infected by the cows. The man servant had previously gone through the small-pox, and felt but little of the cow-pox. The servant maid had some years before been infected with the cow-pox, and she also felt it now in a slight degree. But the farmer's wife, who never had gone through either of these diseases, felt its effects very severely. That the disease produced upon the cows by the colt, and from thence conveyed to those who milked them, was the true and not the spurious cow-pox there can be scarcely any room for suspicion; yet it would have been completely satisfactory had the effects of variolous matter been ascertained on the farmer's wife, but there was a peculiarity in her situation which prevented my making the experiment. Thus far have 1 proceeded in an enquiry, founded, as it must appear, on the basis of experiment, in which, however, conjecture has been occasionally admitted, in order to present to persons well situated for such discussions, objects for a more minute investi- gation. In the meantime, I shall myself continue to prosecute this inquiry, encour- aged by the pleasing hope of its becoming essentially beneficial tomankind. FURTHER OBSERVATIONS ON THE VARIOLA ATtAOCIRTRA. AD VERTI SEN E NT. The foregoing pages contain the whole of my first treatise on the " Variolie Vaccime," published in June, 1798. The importance of the inquiry to the whole human race nat- urally excited universal attention. Ingenuity and industry were set in motion, but as physiological discussions are ever liable to error, from the complicated nature of their character, I soon clearly perceived that this theory, so beneficial to mankind, was liable to fall into disrepute, and to be wholly discredited by the hasty conclusions unfounded on experiment. To guard the public mind from prejudice, and to enforce the necessity of a scrupulous precaution in the conduct of inoculation with vaccine matter, I was induced to offer to the world " Further Observations" on the disease, which werepublished in the beginning of the year 1799. These treatises I have here combined, together with some additions which the continuance of the enquiry has enabled me to submit to the public. FURTHER OBSERVATIONS, &C., &C. Although it has not been in my power to extend the inquiry into thecauses and effects of the Variolas Vaccime much beyond its original limits, yet, perceiving that it is be- ginning to excite a general spirit of investigation, I think it of importance, without de- lay, to communicate such facts as have since occurred, and to point out the fallacious sources from whence a disease resembling the true variolae vaccime might arise, with the view of preventing those who may inoculate from producing a spurious disease; and, further, to enforce the precaution suggested in the former treatise on the subject, of sub- duing the inoculated pustule as soon as it has sufficiently produced its influence on the constitution. From a want of due tliscrimination of the real existence of the disease, either in the brute or in the human subject, and also of that stage of it in which it is capable of producing the change in the animal economy, which rendersit unsusceptible of the cantagion of the small-pox, unpleasant consequences might ensue, the source of which, perhaps, might not be suspected by one inexperienced in conducting such experi- ments. My late publication contains a relation of most of the facts which had come under my own inspection at the time it was written, interspersed with some conjectural observa- tions. Since then, Dr. G. Pearson has established an inquiry into the validity of my principal assertion, the result of which cannot but be highly flattering to my feelings. It contains not a single case which I think can be called an exception to the fact I was so firmly impressed with-that the cow-pox protects the human body from the small- pox. I have myself received some further confirmations, which shall be subjoined. I have lately also been favored with a letter from a gentleman of great respectability (Dr. Ingenhousz) informing me that, on making an inquiry into the subject in the county of Wilts, he discovered that a farmer near Caine had been infected with the small-pox after having had the cow-pox, and that the disease in each instance was so strongly characterized as to render the facts incontrovertible. The cow-pox, it seems, from the doctor's information, was communicated to the farmer from bis cows, at the time that they gave out an offensive stench from their udders. 164 Variola' Vaccina: Edward Jenner. .Some other instances have likewise been represented to me of the appearance of the disease, apparently marked with its characteristic symptoms, and yet that the patients have afterwards had the small-pox. On these cases I shall, for the present, suspend any particular remarks, but hope that the general observations I have to offer in the sequel will prove of sufficient weight to render the idea of their ever having had existence but as cases of spurious cow-pox extremely doubtful. Ere I proceed, let me be permitted to observe that truth, in this ami every other phy- siological inquiry that has occupied my attention, has ever been the object of my pur- suit; and should it appear in the present instance that 1 have been led into error, fond as I may appear of the offspring of my labors, I had rather see it perish at once than exist and do a public injury. 1 shall proceed to enumerate the sources, or what appear to me as such, of a spurious cow-pox : Firstly.-That arising from pustules on the nipples or udder of the cow, which pustules contain no specific virus. Secondly.-From matter, although originally possessing the specific virus, which has suffered a decomposition, either from putrefaction or from any other cause less obvious to the senses. Thirdly.-From matter taken from an ulcer in an advanced stage, which ulcer arose from a true cow-pock. Fourthly.-From matter produced on the human skin from contact with some peculiar morbid matter generated by a horse. On these subjects I shall offer some comments. First-To what length pustulous dis- eases of the udder and nipples of the cow may extend, it is not in my power to deter- mine ; but certain it is that these parts of the animal are subject to some variety of maladies of this nature; and as many of these eruptions, propably all of them, are capable of giving a disease to the human body, would it not be discreet for those en- gaged in this investigation to suspend controversy and cavil until they can ascertain with precision what is aud what is not the genuine cow pox ? For example, a farmer who is not conversant with any of these maladies, but who may have heard of the cow-pox in general terms, may acquaint a neighboring surgeon that the distemper appears at his farm. The surgeon, eager to make an experiment, takes away matter, inoculates, produces a sore, uneasiness in the axilla, and perhaps some affection of the system. This is a way in which a fallacious idea of security, both iu the mind of the inoculator and the patient, may arise, for a disease may thus have been propagated from a simple eruption only. One of the first objects, then, of this pursuit, as I have observed, should be to learn how to distinguish with accuracy between that peculiar pustule which is the true cow- pock, and that which is spurious. Until experience has determined this, we view our object through a mist. Let us, for instance, suppose that the small-pox and the chicken-pox were at the same time to spread among the inhabitants of a country which had never been visited by either of these distempers, and where they were quite un- known before. What confusion would arise! The resemblance between the symptoms of the eruptive fever, and between the pustules, in either case would be so striking that a patient who had gone through the chicken-pox to any extent would feel equally easy with regard to his future security from the small-pox, as the person who had actually passed through that disease. Time and future observation would draw the line of distinction. So, I presume, it will be with the cow-pox, until it is more generallj- understood. All cavilling, therefore, on the mere report of those who tell ns they have had this distem- per, and are afterwards found to be susceptible of the small-pox, should be suspended. To illustrate this, I beg leave to give the following history : Sarah Merlin, of the parish of Easington, in this county, when about thirteen or four- teen years of age, lived as a servant with farmer Clarke, who kept a dairy, consisting of about eighteen cows, at Stonehouse, a neighboring village.' The nipples and udders of three of the cows were extensively affected with large white blisters. These cows the girl milked daily, and, at the same time, she assisted, with two others, in milking 1 he rest of the herd. It soon appeared that the disease was communicated to the girl. The rest of the cows escaped the infection, although they were milked several days after the three above specified had these eruptions on their nipples and udders, and even after the girl's hand became sore. The two others who were engaged iu milking, although they milked the cows indiscriminately, received no injury. On the fingers of each of the girl's hands there appeared several large white blisters, she supposes about three or four on each finger. The hands and arms inflamed and swelled, but no constitutional indis- position followed. The sores were anointed with some domestic ointment, and got well without ulcerating. Variola; Vaccina;: Edward Jenner. 165 As this malady was called the cow-pox. aud recorded as such in the mind of the pa- tient, she became regardless of the small-pox; but, on being exposed to it some years afterwards, she was infected, and had a full burthen. Now, had any one conversant with the habits of the disease heard this history, they would have had no hesitation in pronouncing it a case of spurious cow-pox; considering its deviation in the numerous blisters which appeared on the girl's hands; their termina- tion without ulceration ; its not proving more generally contagious at the farm, either among the cattle or those employed in milking; and considering also that the patient felt no general indisposition, although there was so great a number of vessicles. This is perhaps the most deceptions form in which an eruptive disease can be commu- nicated from the cow, and it certainly requires some attention in discriminating it. The most perfect criterion by which the judgment may be guided, is, perhaps, that adopted by those who attend infected cattle. These white blisters on the nipples, they say, never eat into the tieshy parts like those which are commonly of a bluish cast, and which constitute the true cow-pox, but that they affect the skin only, quickly end in scabs, and are not nearly so infections. That which appeared to me as one cause of spurious eruptions, I have already re- marked in a former treatise, namely, the transition that the cow makes in the spring from a poor to a nutritious diet, and from the udders becoming at this time more vascu- lar thau usual for the supply of milk. But there is another source of inflammation and pustules, which I believe is not uncommon in all the dairy counties in the west of England. A cow intended to be exposed for sale, having naturally a small udder, is previously, for a day or two, neither milked artificially nor is her calf suffered to have access to her. Thus the milk is preternaturally accumulated, and the udder and nip- ples become greatly distended. The consequences frequently are inflammations and eruptions, which maturate. Whether a disease generated in this way has the power of affecting the constitution in any peculiar manner, I cannot presume positively to determine. It has been conjectured to have been a cause of the true cow-pox, though my inquiries have not led me to adopt this supposition in any one instance. On the contrary, I have known the milkers af- fected by it, but always found that an affection thus induced left the system as suscepti- ble of the small-pox as before. What is advanced in my second position, I consider also of very great importance, and I could wish it to be strongly impressed on the minds of all who may be disposed to con- clude hastily on my observations, whether engaged in their investigation by experi- ments or not. To place this in its clearest point of view (as the similarity between the action of the small-pox aud the cow-pox matter is so^obvious), it will be necessary to consider what we sometimes observe to take place in inoculation for the small-pox when imperfect variolous matter is made use of. The concise history on this subject that was brought forward respecting what I hail observed in this neighborhood,* 1 perceive by a reference since made to the Memoirs of the Medical Society of London, may he consid- ered as no more than a corroboration of the facts very clearly detailed by Mr. Kite.i To this copious evidence I have to add still more in the following communications from Mr. Earle, surgeon, of Frampton-upon-Severn, in this county, which I deem the more valuable, as he has, with much candor, permitted me to make them public: " Sir-I have read with satisfaction your late publication on the Variolae Vaccinae, and being, among many other curious circumstances, particularly struck with that re- lating to the inefficacy of small-pox matter in a particular state. I think it proper to lay before you the following facts, which came within my own knowledge, and which cer- tainly tend to strengthen the opinions advanced in pages 51 and 52 of your treatise. "In March, 17^4, a general inoculation took place at Allingham, in this county. I inoculated several patients with active variolous matter, all of whom had the disease in a favorable way; but my matter being all used, and not being able to procure any more in the state I wished, I was under the necessity of taking it from a pustule which, experience has since proved, was advanced too far to answer the purpose I intended. Of five persons inoculated with this last matter, four took the small-pox afterwards in the natural way ; one of whom died, three recovered, and the other, being cautioned by me to avoid as much as possible the chance of catching it, escaped from the disease through life. He died of another disorder about two years ago. "Although one of these cases ended unfortunate, yet I cannot suppose that any medi- cal man will think me careless or inattentive in their management; fori conceive the appearances were such as might have induced any one to suppose that the persons were perfectly safe from future infection. Inflammation in every case took place in the arm, and fever came on with a considerable degree of pain in the axilla. In some of their arms the inflammation and suppuration were more violent than is commonly observed *An inquiry into the causes and effects of the Variola) Vaccina). tSee an account of some anomalous appearances subsequent to the inoculation of the small-pox, by Charles Kite, surgeon, of Gravesend, in the memoirs of the Medical Society of London. Vol. IV., page 111. 166 Variola Vaccina:: Edward Jenner. when perfect matter is made use of; in one there was an nicer winch cast off several large sloughs About the ninth day eruptions appeared, which died away earlier than common without maturation. From these circumstances I should suppose that no med- ical practitioner would scarcely have entertained a doubt that these patients had been infected with a true small-pox; yet I must confess that some small degree of doubt pre- sented itself tome at the speedy disappearance of the eruptions; and in order, as far as I could, to ascertain their safety, I sent one of them to a much older practitioner than myself. This gentleman, on hearing the circumstance of the case, pronounced the pa- tient perfectly secure from future infection. " The following facts are also a striking proof of the truth of your observations on this subject: "In the year 1789 I inoculated three children of Mr. Coaley, of Hurst-farm, in this county. The arms inflamed properly, fever and pain in the axilla came on precisely the same as in the former cases, and in ten days eruptions appeared, which disappeared in the course of two days. I must observe that the matter here made use of was procured for me by a friend, but no doubt it was in an improper state ; for, from the similarity of these cases to those which happened at Arlingham five years before, I was somewhat alarmed for their safety, and desired to inoculate them again ; which being permitted, I was particularly careful to procure matter in its most perfect state. All the children took the small-pox from this second inoculation, and all had a very full burthen. These facts I conceive strikingly corroborate your opinion relative to the different states of matter; for in both the instances that I have mentioned it was capable of producing something Strongly resembling the true small-pox, although it afterwards proved not to be so "As I think the communication of these cases is a duty I owe to the public, you are at liberty to make what use you please of this letter. 1 remain, etc., JOHN EARLE." Frampton-upon-Severn, Gloucestershire, November 10, 1798. " P. S.-I think it necessary to observe, that lean pronounce with the greatest cer- tainty, that the matter wii h which the Arlingham patients were inoculated was taken from a true small-pox pustule. I took it myself from a subject that had a very full burthen." Certain then it is that variolous matter may undergo such a change from the putrefac- tive process, as well as from some of the more obscure and latent processes of nature, as will render it incapable of giving the small-pox in such a manner as to secure the human constitution from future infection, although we see at the same time it is capable of exciting a disease which bears so strong a resemblance to it as to produce inflammation and matter in the incised skin (frequently, indeed, more violent than when it produces its effects perfectly), swelling of the axillary glands, general indisposition and eruptions. So strongly persuaded was the gentleman, whose practice I have mentioned in page 51 of the late Treatise, that he could produce a mild small-pox by his mode of managing the matter, that he spoke of it as a useful discovery, until convinced of his error by the fatal consequence which ensued. After this ought we to be in the smallest degree surprised to find, among a great num- ber of individuals, who, by living in dairies, have been casually exposed to the cow-pox virus, when in a state analogous to that of the small-pox above described, some who may have had the disease so imperfectly as not to render them secure from variolous attacks? For the matter, when burst from the pustules on the nipples of the cow, by being exposed, from its lodgment there, to the heat of an inflamed surface, and from be- ing, at the same time, in a situation to be occasionally moistened with milk, is often likely to be in a state conducive to putrefaction; and thus, under some modification of decomposition, it must, of course, sometimes find access to the hand of the milker in such a way as to infect him. What confusion should we have were there no other mode of inoculating the small-pox than such as would happen from handling the diseased skin of a person laboring under that distemper in some of its advanced and loathsome stages! It must be observed that every case of small-pox in the human species, whether communicated by design or otherwise, is to be considered as a case of inoculation. And here I may be allowed to make an observation on the case of the farmer, communicated to me by Dr. Ingenhousz. That he was exposed to the matter when it had undergone the putrefactive change, it is highly probable, from the doctor's observing that the sick cows at the farm gave out an offensive stench from the udders. However, I must remark, that it is unusual for cattle to suffer to such an extent, when disordered with the cow-pox, so as to make a by-stander sensible of any ill smell. I have often stood among a herd which had the distemper, without being conscious of its presence from any particular effluvia. Indeed, in this neighborhood it commonly re- ceives an early check from escharotic applications of the cow leech. It has been con- ceived to be contagious among cows without contact; but this idea cannot be well- founded, because the cattle in one meadow do not affect those in another (although Variola; Vaccina : Edward Jenner. 167 there may be no other partition than a hedge), unless they be handled or milked by those who bring the infectious matter with them ; and, of course, the smallest particle imaginable, when applied to a part susceptible of its influence, may produce the effect. Among the human species it appears to be very clear that the disease is produced by contact only. All my attempts, at least, to communicate it by effluvia have hitherto proved ineffectual. As well as the perfect change from that state in which variolous matter is capable of producing full and decisive effects on the constitution, to that wherein its specific prop* erties are entirely lost, it may reasonably be supposed that it is capable of undergoing a variety of intermediate change s. The following singular occurrences in ten cases of in- oculation, obligingly communicated to me by Mr. Trye, senior surgeon to the infimary at Gloucester, seem to indicate that the variolous matter, previously to its being taken from the patient for the intended purpose, was beginning to part with some of its orig- inal properties; or, in other words, that it had suffered a partial decomposition. Mr. Trye says: " I inoculated ten children with matter taken at one time and from the same subject. I observed no peculiarity in any of them previously to their inoculation, nor did anything remarkable appear in their arms till after the decline of the disease. Two infants of three months old had erysipelas about the incisions, in one of them ex- tending from the shoulders to the finger's ends. Another infant had abscesses in the cellular substance in the neighborhood of the incisions, and five or six of the rest bail Axillary abscesses. The matter was taken from the distinct small-pox late in its pro- gress, and when some pustules had been dried. It was received upon glass, and slowly dried by the fire. All the children had pustules which maturated, so that I suppose them all secure from future infection; at least, as secure as any others whom I have ever inoculated. My practice never afforded a sore arm before." In regard to my former observation on the improper and dangerous mode of preserving variolous matter, I shall here remark that it seems not to have been clearly understood. Finding that it has been confounded with the more eligible modes of preservation. 1 will explain myself further. When the matter is taken from a fit pustule, and properly pre- pared for preservation, it may certainly be kept without losing its specific properties a. great length of time; for instance, when it is previously dried in the open air on some compact body, as a quill or a piece of glass, and afterwards secured in a small vial.* But when kept several days in a state of moisture, and during that time exposed to a warm temperature, I do not think it can be relied upon as capable of giving a perfect disease, although, as I have before observed, the progress of the symptoms arising from the action of the imperfect matter bear so strong a resemblance to the small-pox when excited completely. Thirdly-That the first formed virus, or what constitutes the true cow-pock pustule, invariably possesses the power I have ascribed to it, namely, that of affecting the con- stitution with a specific disease, is a truth that no subsequent occurrence has yet led me to doubt. But as I am now endeavoring to guard the public as much as possible against erroneous conclusions, I shall observe that when this pustule has degenerated into an ulcer (to which state it is sometimes disposed to pass, unless timely checked), I suspect that matter possessing very different properties may sooner or later be produced, and, although it may have passed that stage wherein the specific properties of the matter secreted are no longer present in it, yet, when applied to a sore (as in the casual way), it might dispose that sore to ulcerate, and from its irritation the system would prob- ably become affected; and thus, by assuming some of its strongest characters, it would imitate the genuine cow-pox From the preceding observations on the matter of small-pox when decomposed, it must. I conceive, be admitted that cow-pox matter m the state now described may produce a disease, the effects of which may be felt both locally and generally, yet that the disease thus induced may not be effectual in obviating the future effects of variolous contagion, lu the case of Mary Miller, related by Mr. Kite in the volume above alluded to, it ap- pears that the inflammation and suppuration of the inoculated arm were more than usually severe, although the system underwent no specific change from the action of the virus; which appears from the patient's sickening seven weeks afterwards with the natural small-pox, which went through its course. Some of the cases communicated by Mr. Earle tend further to confirm this fact, as the matter there manifestly produced ul- ceration on the inoculated part to a considerable extent. Fourthly.-Whether the cow-pox is a spontaneous disease in the cow, or is to be attrib- uted to matter conveyed to the animal, as I have conceived, from the horse, is a question which, thopgh I shall not attempt now fully to discuss, yet 1 shall digress so far as to adduce some further observations, and to give my reasons more at. large for taking up an opinion that to some has appeared fanciful. The aggregate of these observations, *Thns prepared the cow-pox virus was perfectly active, and possessing all its specific properties, at the end of three months, 168 Variola Vaccina': Edward Jenner. though not amounting to positive proof, forms presumptive evidence of so forcible a kind, that I imagine it might on any other person have made the same impression it did on me, without fixing the imputation of credulity. Firstly,-I conceived this was its source, from observing that where the cow-pox had appeared among the dairies here (unless it could be traced to the introduction of an in- fected cow or servant), it had been preceded at the farm by a horse diseased in the man- ner already described, which horse had been attended by some of the milkers. Secondly,-From its being a popular opinion throughout this great dairy country, and from its being insisted on by those who here attend sick cattle. Thirdly.-From the total absence of the disease in those countries where the men ser- vants are not employed in the dairies.* Fourthly.-From having observed that morbid matter generated by the horse fre- quently communicates, in a casual way, a disease to the human subject so like the cow- pox that m many cases it would be difficult to make the distinction between one and the other.t Fifthly.-From being induced to suppose from experiments that some of those who had been thus affected from the horse resisted the small-pox. Sixthly.-From the progress and general appearance of the pustule on the arm of the boy whom I inoculated with matter taken from the hand of a a man infected by a horse ; and from the similarity to the cow-pox of the general constitutional symptoms which followed.t I fear it would be trespassing too far to adduce the general testimony of our farmers in support of this opinion; yet I beg leave to introduce an extract from a letter on this subject from the Kev Mr. Moore, of Chaiford Hill, in this county : "In the month of November, 1797. my horse had diseased heels, which was certainly what is termed the grease; and at a short subsequent period my cow was also affected with what a neighboring farmer (who was conversant with the complaints of cattle), pronounced to be the cow-pox, which he, at the same time, observed my servant would be infected with; and this proved to be the case, for ho had eruptions on his hands, face and many parts of the body, the pustules appearing large, and not much unlike the small-pox, for which he had been inoculated a year and a half before, ard had then a very heavy burthen. The pustules on the face might arise from contact with his hands, as he had a habit of rubbing his forehead, where the sores were the largest ami t hickest. "The boy associated with the farmer's sons during the continuance of the disease, neither of whom had had the small-pox, but they felt no ill effects whatever. He was not much indisposed, as the disease did not prevent him from follow ing his occupations as usual. No other person attended the horse or milked the cow but the lad above men- tioned. I am firmly of opinion that the disease in the heels of the horse, which was a virulent grease, was the origin of the servant's and the cow's malady." But to return to the more immediate object of this proposition: From the similarity of symptoms, both constitutional and local, between the cow-pox and the disease received from morbid matter generated by a horse, the common people in this neighborhood, when infected with this disease, through a strange perversion of terms, frequently called the cow-pox. Let us suppose, then, such a malady to appear among some of the servants at the farm, and at the same time that the cow-pox were to break out among the cattle; and let us suppose, too, that some of the servants were in- fected in this way, and that others received the infection from the cows. It would be recorded at the farm, and among the servants themselves, wherever they might after- wards be dispersed, that they had all had the cow-pox. But it is clear that an individ- ual thus infected from the horse, would neither be for a certainty secure himself, nor would be impart security to others were they inoculated by virus thus generated. He still would be in danger of taking the small-pox. Yet were this to happen before the nature of the cow-pox be more maturely considered by the public, my evidence on the subject might be depreciated unjustly. For an exemplification of what is here advanced relative to the nature of the infection when received directly from the noise, see " In- quiry into the Causes and Effects of the Variola; Vaccinae," pages 25, 26, 27, 28 and page 33; and by way of further example, I beg leave to subjoin the following intelligence received from Mr. Fewster, surgeon, of Thornbury, in this county, a gentleman per- fectly wrell acquainted with the appearances of the cow-pox on the human subject. *This information was communicated to me from the first authorities. tThe sound skin does not appear to be susceptible of this virus when inserted into it, but when pre- viously diseased from little accidents its effects are often conspicuous. See plate No. 2. JThis case (on which I laid no inconsiderable stress in my late treatise, as piesumpiive evidence of th« fact adduced) seems'to have been either mistaken or overlooked by those who have commented upon th* subject,-See case XVIII, page 33. Ihe boy unfortunately died of a fever at a parish work house before 1 had an opportunity of observing what effects would have been ptoduced by the matter of small-pox. '1 tie experiments published by Mr. Simmons, of Manchester, and others, on the subject, with the view of retut Ing this theory, appear to hate but little weight, as even the cow-pox virus itself, when repeatedly intre- duced into the sound nipples of cotvs by means of a lancet, was found to produce no effect. Variolw Vaccina!: Edward Jenner. 169 William Morris, aged thirty-two, servant to Mr. Cox, of Almonsbury, in this comity, applied to me on the second of April, 1798. He told me that four days before he found a stiffness and swelling in both hands, which were so painful it was with difficulty he continued his work; that he had been seized with pain in his head, small of the back, and limbs, and with frequent chilly fits si cceeded'by fever. Ou examination I found him still affected with these symptoms, and that there was a great prostration of strength. Many parts of his hands on the inside were chapped, and on the middle joint of the thumb of the right hand there was a small phagedenic ulcer, about the size of a large pea, discharging an ichorous fluid. On the middle finger of the same hand there was another ulcer of a similar kind. These sores were of a circular form, and he de- scribed their first appearance as being somewhat like blisters arising from a burn. He complained of excessive pain, which extended up his arm into the axilla. These symp- toms and appearances of the sores were so exactly like the cow-pox, that I pronounced he had taken the distemper from milking cows. He assured me he had not milked a cow for more than half a year, and that his master's cows had nothing the matter with them. 1 then asked him if his master had a greasy horse ? which he answered in the affirma- tive, and further said that he had constantly dressed him twice a day for the last three weeks or more, and remarked that the smell of his bauds was much like that of the horse's heels. On the fifth of April 1 again saw him, and found him still complaining of pain in both his hands, nor were his febrile symptoms at all relieved. The ulcers had now spread to the size of a seven shilling gold coin, and another ulcer, which I had not noticed before, appeared on the first joint of the forefinger of the left hand, equally pain- ful with that on the right. I ordered him to bathe his hands in warm bran and waler, applied escharoties to the ulcers, and wrapped his hands up in a soft cataplasm. The next day he was much relieved, and in something more than a fortnight got well. He lost his nails from the thumb and fingers that were ulcerated." The sudden disappearance of the symptoms in this case, after the application of the escharotics to the sores, is worthy of observation. It seems to show that they were kept up by the irritation of the ulcers. The general symptoms which 1 have already described of the cow-pox, when commu- nicated in a casual way to any great extent, will, J am convinced, from the many cases I have seen, be found accurate; but from the very slight indisposition which ensues in cases of inoculation, where the pustule, after affecting the constitution, quickly runs into a scab spontaneously, or is artificially suppressed by some proper application, I am induced to believe that the violence of the spmptoms may be ascribed to the inflamma- tion and irritation of the ulcers (when ulceration takes place to any extent, as in the casual small-pox), and that the constitutional symptoms which appear (luring the presence of the sore, while it assumes the character of a pustule on y, are felt but in a very trifling degree. This mild affection of the system happens when the disease makes but a slight local impression on those w ho have been accidentally infected by cows; and, as far as I have seen, it has uniformly happened among those who have been inocu- lated, when a pustule only, and no great degree of inflammation or any ulceration, has taken place from the inoculation. The following cases will strengthen this opinion : The cow-pox appeared at a farm in the village of Stonehouse, in this county, about Michaelmas last, and continued gradually to pass from one cow to another till the end of November. On the twenty-sixth of that month some ichorous matter was taken from a cow, mid dried upon a quill. On the second of December some of it was inserted into a scratch, made so superficial that no blood appeared, on the arm of Susan Phipps, a child seven years old. The common inflammatory appearances took place in conse- quence, and advanced till the fifth day, when they had so much subsided that I did not conceive anything further would ensue. Sixth.-Appearances stationary. Seventh.-The inflammation began to advance. Eighth.-A vesication perceptible on the edges, forming, as in the inoculated small- pox, an appearance not unlike a grain of wheat, with the cleft or indention in the centre. Ninth.-Pain in the axilla. Tenth.-A little headache ; pulse 110; tongue not discolored; countenance in health. Eleventh.-No perceptible illness; pulse about 100. Thirteenth.-The pustule was now surrounded by an efflorescence, interspersed with very minute confluent pustules, to the extent of about an inch. Some of these pustules advanced in size and maturated. So exact was the tesemblance of the arm at this stage to the general appearance of the inoculated small-pox, that Mr. D., a neighboring sur- geon, who took some matter from it, and who had never seen the cow-pox before, de- clared he could not perceive any difference.* The child's arm now showed a disposition ♦That the cow pox was i lie supposed guardian of the constitution from the action of the small-pox has been a prevalent idea for a long time past, but the similarity in the constitutional effects between one dis- ease and the other could never have been so accurately observed had not the inoculation of the cow-pox placed it in a new and stronger point of view. This practice, too, has shown us what before lay concealed, the rise and progress of the pustule formed by the insertion of the virus, which places in a most conspicu- ous light its striking resemblance to the pustule from the inoculated small-pox. 170 Variola Vaccina: Edward Jenner. to scab, and remained stationary for two or three days, when it began to run into an ulcerous state; and then commenced a febrile disposition, accompanied with an increase of axillary tumor. The ulcer continued spreading near a week, during which time the child continued ill, when it increased to a size nearly as large as a shilling. It began now to discharge pus; granulations sprung up, and it healed. This child had before been of a remarkably sickly constitution, but is now in very high health. Mary Hearn, twelve years of age, was inoculated with matter taken from the arm of Susan Phipps. Sixth day.-A pustule beginning to appear, slight pain in the axilla. Seventh.-A distinct vesicie formed. Eighth.-The vesicle increasing; edges very red; no deviation at this time from the inoculated small-pox. Ninth.-No indisposition ; pustule advancing. Tenth.-The patient felt this evening a slight febrile attack. Eleventh.-Free from indisposition. . Twelfth-Thirteenth.-The same. Fourteenth.-An efflorescence of a faint red color, extending several inches around the arm. The pustule beginning to show a disposition to spread, was dressed with an oint- ment composed of hydrarg. nit. rub. ung ceroe. The efflorescence itself was covered with a plaster of ung hydr. fort. In six hours it was examined, when it was found that the efflorescence had totally disappeared. The application of the ointment with the hydr. nit. rub. was made use of for three days, when the state of the pustule remaining stationary, it was exchanged for the ung. hydr. nit; This appeared to have a more active effect than the former, and in two or three hours the virus seemed to be subdued, when a simple dressing was made use of; but the sore again showing a disposition to inflame, the ung. hydr. nit. was again applied, and soon answered the intended purpose effect- ually. The girl, after the tenth day, when, as has been observed, she became a little ill, showed not the least symptom of indisposition. She was afterwards exposed to the action of variolous matter, and completely resisted it. Susan Phipps also went through a similar trial. Conceiving these cases to be important, I have given them in detail; first, to urge the precaution of using such means as may stop the progress of the pustule; and secondly, to point out, what appears to be the fact, that the most material indisposition, or at least that which is felt most sensibly, does mot arise primarily from the first action of the virus on the constitution, but that it often comes on, if the pustule is left to chance, as a secondary disease. This leads me to conjecture, what experiment must finally determine, that they who have had the small-pox are not afterwards susceptible of the primary action of the cow-pox virus; for, seeing that the simple virus itself, when it has not passed beyond the boundary of a vesicle, excites in the system so little commotion, is it not probable the trifling illness thus induced may be lost in that which so quickly, and often times so severely, follows in the casual cow-pox from the presence of corroding ulcers? This consideration induces me to suppose that I may have been mistaken in my former observation on this subject. In this respect, as well as many others, a parallel may be drawn between this disease and the small-pox. In the latter, the patient first feels the effect of w'hat is called the absorption of the virus. The symptoms then often nearly retire, when a fresh attack commences, different from the first, and the illness keeps pace with the progress of the pustules through their different stages of maturation, ulceration, etc. Although the application I have mentioned in the case of Mary Hearn proved sufficient to check the progress of ulceration, and prevent any secondary symptoms, yet, after the pustule has duly exerted its influence, I should prefer the destroying it quickly and effectually to any other mode. The term caustic to a tender ear (and I conceive none will feel more interested in this inquiry than the anxious guardians of a nursery), may sound harsh and unpleasing, but every solicitude that may arise on this account will no longer exist, when it is understood that the pustule in a state fit to be acted upon is then quite superficial, and that it does not occupy the space of a silver penny.* As a proof of the efficacy of this practice, even before the virus had fully exerted itself on the system, I shall lay before my reader the following history : By a reference to the treatise on the Variola; Vaccina;, it will be seen that in the month of April, 1798, four children were inoculated with the matter of cow-pox; and that in two of these cases the virus on the arm was destroyed soon after it had produced a perceptible sickening. Mary James, aged seven years, one of the children alluded to, was inoculated in the month of December following with fresh variolous matter, and at the same time was exposed to the efflavia of a patient affected with the small-pox. The appearance and *1 mention escharotics for stopping the progress of the pustule, because I am acquainted with their efficacy. Probably more simple means might answer the purpose quite as well, such as might be found among the mineral and vegetable astringents. Variola Vaccina:: Edward Jennet. 171 progress of the infected arm was, in every respect, similar to that which we generally observe when variolous matter has been inserted into the skin of a person who has not previously undergone either the cow-pox or the small-pox. Ou the eighth day, conceiv- ing there was infection in it, she was removed from her residence among those who had not had the small-pox. I was now anxiously waiting the result .conceiving from the state of the girl's arm she would fall sick about this time. On visiting her on the even- ing of the following day (the ninth), all I could learn from the woman who attended her was that she felt somewhat hotter than usual during the night, but was not restless, and that in the morning there was the faint appearance of a rash around her wrists. This went off in a few hours, and was not at all perceptible to me on my visit in the evening. Not a single eruption appeared, the skin having been repeatedly and carefully examined. The inoculated arm continued to make the usual progress to the end, through all the stages of inflammation, maturation and scabbing. On the eighth day matter was taken from the arm of this girl (Mary Janies), and in- serted into the arms of her mother and brother, (neither of whom had had either the small-pox or the cow-pox), the former about fifty years of age, the latter six. On the eighth day after the insertion, the boy felt indisposed, and continued unwell two days, when a measles-like rash appeared on his hands ami wrists, and was thinly scattered over his arms. The day following his body was marbled over with an appear- ance somewhat similar, but he did not complain, nor did he appear indisposed. A few pustules now appeared, the greater part of which went away without maturating. On the ninth day the mother began to complain. She was a little chilly, and had a head-ache for two days, but no pustule appeared on the skin, nor had she any appearance of a rash. The family was attended by an elderly woman as a nurse, who, in her infancy had been exposed to the contagion of the small-pox, but had resisted it. This woman was now infected, but had the disease in the slightest manner, a very few eruptions appear- ing, t wo or three of which only maturated. From a solitary instance like that adduced of Mary James, whose constitution appears to have resisted the action of the variolous virus, after the influence of the cow-pox virus had been so soon arrested in its progress, no positive conclusion can be fairly drawn; nor from the history of the three other patients, who were subsequently infected ; but, nevertheless, the facts collectively may be deemed interesting. That one mild variety of the small-pox has appeared, I have already plainly shown ; and by the means now mentioned we probably may have it in our power to produce at will another. At the time when the pustule was destroyed in the arm of Mary James, I was informe'd she had been indisposed about twelve hours : but I am now assured by those who were with her that the space of time was much less. Be that as it may, in cases of cow-pox inoculation I would m t recommend any application to subdue the action of the pustule, until convincing proofs had appeared of the patient's having felt its effects at least twelve hours No harm, indeed, could ensue, were a longer period to elapse before the application was made use of. In short, it should be suffered to have as full effect as it could, consistently with the state of the arm. . As the cases of inoculation multiply, I am more and more convinced of the extreme mildness of the symptoms arising merely from the primary action of the virus on the constitution, and that those symptoms which (as in the accidental cow-pox), affect the p itient with severity, are entirely secondary, excited by the irritating processes of in- flammation and ulceration; and it appears to me that this singular virus possesses an irritating quality of a peculiar kind ; but as a single cow-pox pustule is a)l that is neces- sary to render the variolous virus ineffectual, and as we possess the means of allaying the irritation, should any arise, it becomes of little or no consequence. It appears, then, (as far as inference can be drawn from the present progress of cow-pox inoculation), that it is an accidental circumstance only, which can render this a violent disease, and a circumstance of that nature which, fortunately, it is in the power of almost every one to avoid. I allude to the communication of the disease from cows. In this case, should the hands of the milker be affected with little accidental sores to any extent, every sore would become the nidus of infection, and feel the influence of the virus; and the degree of violence in the constitutional symptoms would be in proportion to the number and to the state of these local affections. Hence it follows that a person, either by accident or design, might be so filled with these wounds from contact with the virus, that the constitution might sink u ider the pressure. Seeing that we possess the means of rendering the action of the sores mild, which, when left to chance, are capable of producing violent effects ; and seeing, too, that these sores bear a resemblance to the small-pox, especially the confluent, should it not encour- age the hope that some topical application might be used with advantage to counteract the fatal tendency of that disease, when it appears in this terrific form ? At what stage 172 Variola; Vaccina: Echcard Jenner. or stages of the disease this may be done with the most promising expectation of suc- cess, I will not pretend now to determine. 1 only throw out this idea as the basis of further reasoning and experiment I have often been foiled in my efforts to communicate the cow-pox by inoculation. Au inflammation will sometimes succeed the scratch or puncture, and in a few days disap- pear without producing any further effect. Sometimes it will even produce an ichorous fluid, and yet the system will not be affected.* The same thing, we know, happens witli the small-pox virus. Four or five servants were inoculated at a farm contiguous to this place, last summer, with matter just taken from an infected cow'. A little inflammation appeared on all their arms, but died away without producing a pustule ; yet all these servants caught the disease within a month afterwards from milking the infected cows, and some of them had it severely At present, no other mode than that commonly practiced for inoculat- ing the small-pox has been used for giving the cow-pox ; but it is probable this might be varied with advantage. We should imitate the casual communication more clearly, were we first, by making the smallest superficial incision or puncture on the skin, to produce a little scab, and then, removing it, to touch the abraded part with the virus. A small portion of a thread imbrued in the virus (as in the old method of inoculating the small-pox), and laid upon the slightly incised skin, might probably prove a success- ful way of giving the disease ; or the cutis might be exposed in a minute point by an atom of blistering plaster, and the virus brought in contact with it. In the eases just alluded to, where I did not succeed in giving the disease constitutionally, the experi- ment was made with matter- taken in a purulent state from a pustule on the nipple of a cow.t Is pure pus, though contained in a small-pox pustule, ever capable of producing the small-pox perfectly? I suspect it is not. Let us consider that it is always preceded by the limpid fluid, which, in constitutions susceptible of variolous contagion, is always infectious ; and though, on opening a pustule, its contents may appear perfectly puru- lent, yet a given quantity of the limpid fluid may at the same time be blended with it, though it would be imperceptible to the only test of our senses, the eye. The presence, then, of this fluid, or its mechanical diffusion through pus, may at all times render active what is apparently mere pus, while its total absence (as in stale pustules) may be attended with the imperfect effects we have seen. It wou d be digressing too widely to go far into the doctrine of secretion, but as it will not be quite extraneous, I shall just observe that I consider both the pus and the limpid fluid of the pustule as secretions, but that the organs established by nature to perform the office of secreting these fluids may differ essentially in their mechanical structure. What but a difference in the organization of glandular bodies constitutes the difference in the qualities of the fluids secreted ? From some peculiar derangement in the structure, or, in other words, some deviation in the natural action of a gland destined to secrete a mild, innoxious fluid, a poison of the most deadly nature may be created. For example: That gland, which in its sound state, secretes pure saliva, may, from be- ing thrown into diseased action, produce a poison of the most destructive quality. Nature appears to have no moie difficulty in forming minute glands among the vascular parts of the body, than she has in forming blood vessels, and millions of these can be called into existence, when inflammation is excited, in a few hours.! In the present early stage of the inquiry, (for early it certainly must be deemed), be- fore we know for an absolute certainty how soon the virus of the cow-pox may suffer a change in its specific properties, after it has quitted the limpid state it possessed when forming a pustule, it would be prudent for those who have been inoculated with it to submit to varidtous inoculation. No injury or inconvenience can accrue from this, and were the same method practiced among those, who, from inoculation, have felt the small-pox in an unsatisfactory manner at any period of their lives, it might appear that 1 had not been too officious in offering a cautionary hint, in recommending a second in- oculation with matter in its most perfect state. And here let me suppose, for argument's sake, (not from conviction), that one person in an hundred, after having had the cow-pox should be found susceptible of the small- pox, would this invalidate the utility of the practice? For, waving all other considera- tions, who will deny that the inoculated small-pox, though abstractedly it may be con- sidered as harmless, does not involve in itself something that in numberless instances proves baneful to the human frame. That in delicate constitutions it sometimes excites scrofula is a fact that must be gen- erally subscribed to, as it is so obvious to common observation. This consideration is important. *At thia period of the inquiry I had not discovered the importance of inoculating with virus newU formed in the pustule. The reader will find this explained as he proceeds. tThe cause of these disappointments will be explained. {Mr. Home, in his excellent dissertation on pus and mucus, justifies this assei tion. Var'olx Vaccince : Edward Jenner. 173 As the effects of the small-pox inoculation on those who have had the cow-pox, will be watched with the most scrupulous eye by those who prosecute this inquiry, it may be proper to bring to their recollection some facts relative to the small-pox, which I must consider here as of consequence, but which hitherto seem not to have made a due im- pression. It should be remembered that the constitution cannot by previous infection be ren- dered totally unsusceptible of the variolous poison ; neither the casual nor the inoculated small-pox, whether it produces the disease in a mild or in a violent way, can perfectly extinguish the susceptibility. The skin, we know, is ever ready to exhibit, though often in a very limited degree, the effects of the poison when inserted there: and how fre- quently do we see among nurses, when much exposed to the contagion, eruptions, and these sometimes preceded by sensible illness! Yet, should anything like an eruption appear, or the smallest degree of indisposition, upon the insertion of the variolous matter on those who have gone through the cow-pox, my assertions respecting the peculiarities of the disease might be unjustly discredited. I know a gentleman who, many years ago, was inoculated for the small-pox, but hav- ing no pustules or scarcely any constitutional affection that was perceptible, he was dis- satisfied, and has since been repeatedly inoculated. A vesicle has always been produced in the arm in consequence, with axillary swelling and a slight indisposition. This is by no means a rare occurrence. It is probable that the fluid thus excited upon the skin would always produce the small-pox. On the arm of a person who had gone through the cow-pox many years before, I once produced a vesication by the infection of variolous matter, and with a little of the fluid inoculated a young woman, who had a mild, but very efficacious, small-pox in con- sequence, although no constitutional effect was produced on the patient from whom the matter was taken. The following communication from Mr. Fewster affords a still clearer elucidation of this fact. Mr. Fewster says: " On the third of April, 1797, I inoculated Master H , aged fourteen months, for the small-pox. At the usual time he sickened, had a plentiful eruption, particularly on his face, and got well. His nursemaid, aged twenty-four, had many years before gone through the small-pox in the natural way, which was evident from her being much pitted with it. She had used the child to sleep on her left arm, with her left cheek in contact with his face, and during his inoculation had mostly slept in that manner About a week after the child got well she (the nurse) desired me to look at her face, which she said was very painful. There was a plentiful eruption on the left cheek, but not on any other part of the body, which went on to maturation. "On inquiry, I found that thiee days before the appearance of the eruption she was taken with slight chilly fits, pain in her head and limbs, and some fever. On the appear- ance of the eruption these pains went off, and now (the second day of the eruption) she complains of a little sore throat. Whether the above symptoms are the effects of the small-pox or a recent cold, I do not know. On the fifth day of the eruption, I charged a lancet from two of the pustules, and on the next day I inoculated two children-one two years, and the other four mouths old-with the matter. At the same time I inoculated the mother and eldest sister with variolous matter taken from Master H . On the fifth day of their inoculation all their arms were inflamed alike; and, on the eighth day, the eldest of those inoculated from the nurse sickened, and the youngest on the eleventh. They had both a plentiful eruption, from which I inoculated several others, who had the disease very favorably. The mother and the other child sickened about the same time, and likewise had a plentiful eruption. "Soon after a man in the village sickened with the small-pox, and had a confluent kind. To be convinced that the children had had the disease effectually, I took them to his house, and inoculated them in both arms with matter taken from him, but without effect." These are not brought forward as uncommon occurrences, but as exemplifications of the human system's susceptibility of the variolous contagion, although it has been pre- viously sensible of its action. Happy it is for mankind that the appearance of the small-pox a second time on the same person beyond a trivial extent, is so extremely rare that it is looked upon as a phe- nomenon. Indeed, since the publication of Dr. Heberden's paper on the Varicellae, or chicken-pox, the idea of such an occurrence, in deference to authority so truly respectable, has been generally relinquished This, I conceive, has been without just reason ; for, after we have seen, among many others, so strong a case as that recorded by Mr. Edward Withers, surgeon, of New bury, Berks, in the fourth volume of the memoirs of the Medi- cal Society of London (from which I take the following extractsone, I think, will again doubt the fact: 0 174 Variola Vaccina: Ed ward Jenner. " Mr. Richard Langford, a farmer of West Shefford, in this county (Berks), about fifty years of age, when about a month old, had the small-pox at a time when three others of the family had the same disease, one of whom-a servant man-died of it. Mr Lang- ford's countenance was strongly indicative of the malignity of the distemper, his face being so remarkably pitted and seamed, as to attract the notice of all who saw him, so that no one could entertain a doubt of his having had that disease in a most inveterate manner." Mr. Withers proceeds to state that Mr. Langford was seized a second time, had a bad confluent small-pox, and died on the twenty-first day from the seizure ; and that four of the family, as also a sister of the patient's, to whom the disease was conveyed by her son's visiting his uncle, falling down with the small-pox, fully satisfied the country with regard to the nature of the disease, which nothing short of this would have done. The sister died. " This case was thought so extraordinary a one as to induce the rector of the parish to record the particulars in the parish register." It is singular that in most cases of this kind the disease in the first instance has been confluent; so that the extent of the ulceration on the skin (as in the cow-pox) is not the process in nature which affords security to the constitution. As the subject of the small-pox is so interwoven with that which is the more immediate object of my present concern, it must plead my excuse for so often introducing it. At present it must be considered a distemper not well understood. The inquiry I have in- stituted into the nature of the cow-pox will probably promote its more perfect investi- gation. The inquiry of Dr. Pearson into the history of the cow-pox having produced so great a number of attestations in favor of my assertion that it proves a protection to the human body from the small-pox, I have not been assiduous in seeking for more ; but as some of my friends have been so good as to communicate the following, I shall conclude these observations with their insertion. Extract of a letter from Mr. Drake, surgeon, at Stroud, in this county, and late sur geon to the North Gloucester Regiment of Militia: "In the spring of the year 1796 I inoculated men, women and children, to the amount of about seventy. Many of the men did nor receive the infection, although inoculated at least three times, and kept in the same room with those who actually underwent the disease during the whole time occupied by them in passing through it. Being anxious they should in future be secure against it, I was very particular in my inquiries to find out whether they ever had previously had it, or at any time been in the neighborhood of people laboring under it. But, after all, the only satisfactory information I could obtain was that they had had the cow-pox. As I was then ignorant of such, a disease affecting the human subject, I flattered myself what they imagined to be the cow-pox was in reality the small-pox in a very slight degree. I mentioned the circumstance in the presence of several of the officers, at the same time expressing my doubts if it were not small-pox, and was not a little surprised when I was told by the colonel that he had frequently heard you mention the cow-pox as a disease endemial to Gloucestershire, and that if a person were ever affected by it, you supposed him afterwards secure from the small-pox. This excited my curiosity, and when I visited Gloucestershire I was very inquisitive concerning the subject; and from the information I have since received, both from your publication and from conversation with medical men of the greatest accuracy in their observations, I am folly convinced that what the men supposed to be the cow- pox, was actually so, and I can safely affirm that they effectually resisted the small-pox." Mr. Fry, surgeon, at Durfley, in this county, favors me with the following communi- cation : " During the spring of the year 1797, I inoculated fourteen hundred and seventy-five patients, of all ages, from a fortnight old to seventy yqars, amongst whom there were many who had previously gone through the cow-pox. The exact number I cannot state, but if I say they were near thirty, I am certainly within the number. There was not a single instance of the variolous matter producing any constitutional effect on these peo- ple, nor any greater degree of local inflammation than it would have done in the arm of a person who had before gone through the small-pox, notwithstanding it was invariably inserted four, five, and sometimes six different times, to satisfy the minds of the patients. In the common course of inoculation previous to the general one, scarcely a year passed without my meeting with one or two instances of persons who had gone through the cow-pox, resisting the action of the variolous contagion. I may fairly say that the number of people I have seen inoculated with the small-pox, who at former periods had gone through the cow-pox, are not less than forty;* and in no one instance have I *The greater part of these people must, of course, have had the cow-pox many years before this trial was made upon them witlr the matter of small-pox.-E. J. Variola Vaccina: Edward Jenner. 175 known a. patient receive the small-pox, notwithstanding they in variably continued to associate with other inoculated patients during the progress ot the disease, and many of them purposely exposed themselves to the contagion of the natural small-pox ; whence I am fully convinced that a person who had fairly had the cow-pox is no longer capable of being acted upon by the variolous matter " I also inoculated a very considerable number of those who had had a disease which ran through the neighborhood a few years ago, and was called by the common people the swine pox, not one of whom received the small-pox.* "There were about half a dozen instances of people who never had either the cow or swine pox, yet did not receive the small-pox, the system not being in the least deranged, or the arms inflamed, although they were repeatedly inoculated, and associated with others who were laboring under the disease. One of them was the son of a farrier." Mr. Tierny, assistant surgeon of tne South Gloucester Regiment of Militia, has obliged me with the following information: "That in the summer of the year 1798, he inoculated a great number of the men be- longing to the regiment, and that among them he found eleven, who, from having lived in dairies, had gone through the cow-pox. That all of them resisted the small-pox, ex- cept one ; but that, on making the most rigid and scrupulous^inquiry at the farm in Gloucestershire, where the man said he lived when he had the disease, and among those with whom at the same time he declared he had associated, and particularly of a person in the parish, whom he said had dressed his fingers, it most clearly appeared that he aimed at an imposition, and that he never had been affected with the cow-pox.t Mr. Tierney remarks, "that the arms of many who were inoculated, after having had the cow-pox, inflamed very quickly, and that in several a little ichorous fluid was formed." Mr. Cline, who in July last was so obliging, at my request, as to try the efficacy of the cow-pox virus, was kind enough to give me a letter on the result of it, from which the following is an extract: " My Dear Sir-The cow-pox experiment has succeeded admirably. The child sick- ened on the seventh day, and the fever, which was moderate, subsided on the eleventh. The inflammation arising from the infection of the virus extended to about four inches in diameter, and then gradually subsided, without having been attended with pain or other inconvenience. There were no eruptions. "I have since inoculated him with small-pox matter in three places, which were slightly inflamed on the third day, and then subsided. "Dr. Lister, who was formerly physician to the small-pox hospital, attended the child with me, and he is convinced that it is not possible to give him the small-pox, I think the substituting the cow-pox poison for the small-pox promises to be one of the greatest improvements that has ever been made in medicine; and the more I think on the subject, the more I am impressed with its importance. "With great esteem, I, am, etc., HENRY CLINE." Lincoln's Inn Fields, August 2, 1798. From communications, with which I have been favored from Dr. Pearson, who has occasionally reported to me the result of his private practice with the vaccine virus in London, and from Dr. Woodville, who has also favored me with an account of his more extensive inoculation with the same virus at the small-pox hospital, it appears that many of their patients have been affected with eruptions, and that these eruptions have matured in a manner very similar to the variolous. The matter they made use of was taken, in the first instance, from a cow belonging to one of the great milk farms in Lon- don. Having never seen maturated pustules produced either in my own practice among those who were casually infected by cows, or those to whom the disease had been com- municated by inoculation, I was desirous of seeing the effects of the matter generated in London, on subjects living in the country, A thread imbrued in some of this matter was sent to me, and with it two children were inoculated, whose cases I shall transcribe from my notes. Stephen Jenner, three years and a-half old. Third Day-The arm showed a proper and decisive inflammation. Sixth Day-A vesicle arising. Seventh Day-The pustule of a cherry color. Eighth Day-Increasing in elevation. A few spots now appear on each arm, near the iillertion of the inferior tendons of the biceps muscles. They are very small and of a *Thi8 was that mild variety of the small-pox which I have noticed in the late treatise on the cow-pox, page 49. tThe public cannot be too much on their guard respecting persons of thia description, 176 Variola' Vaccina: Edward Jenner. vivid red color. The pulse natural; tongue of its natural hue; no loss of appetite, or any symptom of indisposition. Ninth Day-Inoculated pustule on the arm this evening began to inflame, and gave the child uneasiness. He cried and pointed to the seat of it, and was immediately after- wards affected with febrile symptoms; at the expiration of two hours after the seizure, a plaster of ung. hydrarg. fort, was applied, andits effect was very quickly perceptible, for in ten minutes he assumed his usual looks and playfulness. On examining the arm about three hours after the application of the plaster, its effect in subduing the inflammation were very manifest. Tenth-The spots on the arms have disappeared, but there are three visible in the face. Eleventh-Two spots on the face are gone, the other barely perceptible. Thirteenth-The pustule delineated in the second plate in the treatise on Variolas Vac- cime is a correct representation of that on the child's arm as it appears at this time. Fourteenth-Two fresh spots appear on the face. The pustule on the arm nearly con- verted into a scab. As long as any fluid remained in it, it was limpid. James Hill, four years old, was inoculated on the same day, and with part of the same matter which infected Stephen Jenner. It did not appear to have taken effect till the fifth day. Seventh-A perceptible vesicle. This evening the patient became a little chilly ; no pain or tumor discoverable in the axilla. Eighth-Perfectly well. Ninth-The same. Tenth-The vesicle more elevated than I have been accustomed to see it, and assum- ing more perfectly the variolous character that is common with the cow-pox at this stage. Eleventh-Surrounded by an inflammatory redness about the size of a shilling, studded over with minute vesicles. The pustule contained a limpid fluid till the fourteenth day, after which it was encrusted over in the usual manner; but this incrustation or scab being accidentally rubbed off it was slow in healing. These children were afterwards fully exposed to the small-pox contagion without effect. Having been requested by my friend, Mr. Henry Hicks, of Eastington, in this county, to inoculate two of his children, and at the same time some of his servants and the peo- ple employed in his manufactry, matter was taken from the arm of this boy for the purpose. The number inoculated was eighteen. They ail took the infection ; and, either on the fifth or sixth day, a vesicle was perceptible on the punctured part. Some of them began to feel a little unwell on the eighth day, but the greater number on the ninth. Their illness, as in the former cases described, was of short duration, and not sufficient to interrupt, but at very short intervals, the children from their amusements, or the servants and manufacturers from following their ordinary business. Three of the children whose employment in the manufactory was in some degree laborious, had an inflammation on their arms beyond the common boundary about the eleventh or twelfth day, when the feverish symptoms, which before were nearly gone off, again returned, accompanied with increase of axillary tumors. In these cases (clearly perceiving the symptoms were governed by the state of the arms), I applied on the inoculated pustules, and renewed the application three or four times within an hour, a pledget of lint, previously soaked in aqua lythargyri acetati* and covered the hot efflor- escence surrounding them with cloths dipped in cold water. The next day I found that this simple mode of treatment had succeeded perfectly. The inflammation was nearly gone off, and with it the symptoms which it had produced. Some of these patients have since been inoculated with variolous matter without any effect beyond a little inflammation on the part where it was inserted. Why the arms of those inoculated with the vaccine matter in the country should be more disposed to inflame than those inoculated in London, it may be difficult to deter- mine. From comparing m^own cases with some transmitted to me by Dr. Pearson and Dr. Woodville, this appears to be the fact, and what strikes me as still more extraordi- nary with respect to those inoculated in London is the appearance of maturating erup- tions. In the two instances only which I have mentioned (the one from the inoculated, the other from the casual cow-pox) a few red spots appeared, which quickly went off without maturating. The case of the Rev. Mr. Moore's servant may indeed seem like a deviation from the common appearances in the country, but the nature of these erup- tions was not ascertained beyond their not possessing the property of communicatlig the disease by their effluvia. Perhaps the difference we perceive in the state of the arms may be owing to some variety in the mode of action of the virus from the skin of those who breathe the air of London and those who live in the country. That the ery- sipelas assumes a different form in London from what we see it put on in the country, is *Goulard's extract of Saturn. Variola; Vaccines : Edward Jenner. 177 a fact very generally acknowledged. In calling the inflammation that is excited by the cow-pox virus erysipelatous, perhaps I may not be critically exact, but it certainly ap- proaches near to it. Now, as the disease going forward in the part infected with the virus may undergo different modifications according to the peculiarities of the constitu- tion on which it is to produce its effect, may it not account for the variation which has been observed? To this it may probably be objected that some of the patients inoculated and who had pustules in consequence were newly come from the country, but I conceive that the changes wrought in the human body, through the medium of the lungs, may be extremely rapid ; yet, after all, further experiments made in London with vaccine virus generated in the country, must finally throw a light on what now certainly appears obscure and mysterious. The principal variation perceptible to me in the action of the vaccine virus generated in London from that produced in the country was its proving more certainly infectious, and giving a less disposition in the arm to inflame. There appears also a greater eleva- tion of the pustule above the surrounding skin. In my former cases the pustule pro- duced by the insertion of the virus was more like one of those which are so thickly spread over the body in a bad kind of confluent small-pox, except that I saw no instance of pus being formed in it, the matter remaining limpid till the period of scabbing Wishing to see the effects of the disease on an infant newly born, my nephew, Mr. Henry Jenner, at my request, inserted the vaccine virus into the arm of a child about twenty hours old. His report to me is that the child went through the disease without apparent illness, yet that it was found effectually to resist the action of variolous matter with which it was subsequently inoculated. I have had an opportunity of trying the effects of the cow-pox matter on a boy who, the day preceding its insertion, sickened with the measles. The eruption of the measles, attened with a cough, a little pain in the chest, and the usual symptoms accompanying that disease, appeared on the third day and spread all over him. The disease went through its course without any deviation from its usual habits; and, notwithstanding this, the cow-pox virus excited its common appearances, both on the arm and on the constitution without any sensible interruption; on the sixth there was a vesicle Eighth-Pain in the axilla, chilly and affected with headache. Ninth-Nearly well. Twelfth-The pustule spread to the size of a large split pea, but withoutany surround- ing eflioresence. It soon after scabbed and the boy recovered his general health rapidly. But it should be observed that before it scabbed, the efflorescence which had suffered a temporary suspension, advanced in the usual manner. Here we see a deviation from the ordinary habits of the small-pox, as it has been observed that the presence of the measles suspends the action of variolous matter, however the suspension of the efflor- escence is worthy of observation. The very general investigation that is now taking place chiefly through inoculation (and 1 again repeat my earnest hope that it may be conducted with that calmness and moderation which should ever accompany a philosophical research) must soon place the vaccine disease in its just point of view. The result of all my trials with the virus on the human subject has been uniform. In every instance the patient who has felt its in- fluence has completely lost the susceptibility for the variolous contagion, and as these instances are now become numerous, I conceive that, joined to the observations in the former part of this paper, they sufficiently preclude me from the necessity of entering into controversis with those who have circulated reports adverse to my assertion on no other evidence than what has been casually collected. A CONTINUATION OF ♦FACTS AND OBSERVATIONS* RELATIVE TO THE VARIOLBtOCCIN^, COW EDWARD JENNER, M.4). F. R. S. &C LONDON i PRINTED FOR THE AUTHOR. BY D N. SHURY, No. 7 BERWICK STREET, SOHO. 1801. A CONTINUATION OF FACTS AND OBSERVATIONS, &C., &C. Since my former publications on vaccine inoculation, I have had the satisfaction of seeing it extend very widely. Not only in this country is the subject pursued with ar- dor, but from my correspondence with many respectable medical gentlemen on the Con- tinent (among whom are Dr. De Carro, of Vienna, and Dr. Ballhorn, of Hanover), I find it is as warmly adopted abroad, where it has afforded the greatest satisfaction. 1 have the pleasure, too, of seeing that the feeble efforts of a few individuals to depreciate the new practice are sinking fast into contempt beneath the immense mass of evidence which has risen up in support of it. Upwards of 6000 persons have now been inoculated with the virus of cow-pox, and the far greater part of them have since been inoculated with that of small-pox, and exposed to its infection in every rational way that could be devised without effect. It was very improbable that the investigation of a disease so analogous to the small- pox should go forward without engaging the attention of the physician of the small- hox hospital in London. Accordingly, Dr. Woodville, who fills that department with so much respectability, took an early opportunity of instituting an inquiry into the nature of the cow-pox. This inquiry was begun in the early part of the present year, and in May Dr. Woodville pub- lished the result, which differs essentially from mine in a point of much importance. It appears that three-fifths of the patients inoculated were affected with eruptions for the most part so perfectly resembling the small-pox as not to be distinguished from them. On this subject it is necessary that I should make some comments. When I consider that out of the great number of cases of casual inoculation immedi- ately from cows which have from time to time presented themselves to my observation and the many similar instances which have been communicated to me by medical gentle men in this neighborhood; when I consider that the matter with which inoculations were conducted in the years 1797, 1798, 1799, was taken from different cows, and that in no instance anything like a variolous pustule appeared. I cannot feel disposed to imagine that eruptions similar to those described by Dr. Woodwille, have ever been produced by the pure, uncontaminated cow-pox virus', on the contrary, I do suppose that those which the doctor speaks of originated in the action of variolous matter, which crept into the constitution with the vaccine. And this I pre- sume happened from the inoculation of a great number of the patients with variolous matter, (some on the third, others on the fifth day), after the vaccine had been applied ; and it should be observed, that the matter thus propagated became the source of future inoculations in the hands of many medical gentlemen who appeared to have been pre- viously unacquainted with the nature of the cow-pox. Another circumstance strongly, in my opinion, supporting this supposition is the fol- lowing : The cow-pox has been known among our dairies time immemorial. If pustules then, like the variolous, were to follow the communication of it from the cow to the milker, would not such a fact have been known, and recorded at our farms? Yet neither our farmers nor the medical people of the neighborhood have noticed sueh occurence. A few scattered pimples, I have some timesthough very rarely, seen, the greater part of which have generally disappeared quickly, but some have remained long enough to sup- purate at their apex. The cuticular inflammation, whether springing up spontaneously or arising from the application of acrid substances, such, for instance as Cantharides, Fix Bur- gundica, Antimonium Tartavizatum, etc., will often produce cutaneous affections, not only near the seat of the inflammation,'but on some parts of the skin far beyond its boundary, is a well-known fact. It is, doubtless, on this principle that the inoculated cow-pox pustule and its concomitant efflorescence may in very irritable constitutions produce this affec- tion. The eruption I allude to has commonly appeared sometimes in the third week after inoculation, but this appearance is too trivial to excite the least regard. The change which took place in the general appearance during the progress of the vaccine inoculation at the small-pox hospital should likewise be considered. Although at first it took on so much of the variolous character, as to produce pus- tules in three csase out of five, yet in Dr. Woodville's last report, published in June, he says: " Since the publication of my reports of inoculations for the cow-pox, upwards of 300 cases have been under my care, and out of this number only thirty-nine had pustules 182 Variola Vaccince: Edward Jenner. that suppurated, namely, out of the first hundred, nineteen had pustules; out of the second thirteen; and out of the last hundred and ten, only seven had pustules. Thus it appears that the disease has been considerably milder, wnich I am inclined to attribute to a greater caution used in the choice of the matter with which the infection was communi- cated, for lately that which has been employed for this purpose has been taken only from those patients in whom the cow-pox proved very mild and well characterized.* The inference I am induced to draw from these premises is very different. The decline and finally the total extinction nearly of these pustules in my opinion are more fairly attributable to the cow-pox virus assimilating the variolous,! the former being the orig- inal, the latter the same disease under a peculiar and at present an unexplicable modifi- cation. One experiment tending to elucidate the point under discussion,! had myself an oppor- tunity of instituting. On the supposition of its being possible that the cow which ranges over the fertile meadows in the vale of Gloucester, might generate a virus differ- ent in some respects in its qualities from that produced by the animal artificially pam- pered for the production of milk for the metropolis, I procured during my residence there in the spring, some cow-pox virus from a cow at one of the Loudon milk farms.! It was immediately conveyed into Gloucestershire to Dr Marshall, who was then exten- sively engaged in the inoculation of the cow-pox, the general result of which, and of inoculation in particular, with this matter, I shall lay before my readers in the following communication from the doctor: " Dear Sir-My neighbor, Mr. Hicks, having mentioned your wish to be informed of the progress of inoculation here for the cow-pox, and he also having taken the trouble to transmit to you my minutes of the cases which have failen under my care, I hope you will pardon the trouble I now give you in stating the observations I have made uponthe subject. When first informed of it, having two children who had not had the small-pox I determined to inoculate them for the cow-pox whenever I should be so fortunate as to procure matter proper for the purpose. I was, therefore, particularly happy when I was informed that I could procure matter from some of those whom you had inoculated. In the first instance I had no intention of extending the disease further than myown family, but the very extensive influence which the conviction of its efficacy in resisting the small-pox has had upon the minds of the people iu general, has rendered that intention nugatory, as you will perceive by the continuation of my cases, inclosed iu this letter, || by which it will appear that since the twenty-second of March, I have inoculated an hundred and seven persons, which, considering the retired situation I reside in, is a very great number. There are also other considerations which, besides that of its influence in resisting the small-pox, appears to have had their weight, namely, the peculiar mild- ness of the disease, the known safety of it, and its not having in any instance prevented the patient from following his ordinary business. In all the cases under my care there have only occurred two or three which required any application, owing to erysipelatous inflammation on the arm, and they immediately yielded to it. In the remainder the con- stitutional illness has been slight, but sufficiently marked and considerably less than I ever observed in the same number inoculated with the small-pox. In only one or two of the cases have any other eruptions appeared than those around the spot where the matter was inserted, and those near the infected part. Neither does there appear in the cow-pox to be the least exciting cause to any other disease, w'hich in the small-pox has been frequently observed, the constitution remaining in as full health and vigor after the termination of the disease as before the infection. Another important consideration appears to be the impossibility of the disease being communicated except by actual con- tact of the matter of the pustule, and consequently the perfect safety of the remaining part of the family, supposing only one or two should wish to be inoculated at the same time. Upon the whole it appears evident to me that the cow-pox is a pleasanter, shorter and infinitely more safe disease than the inoculated small-pox, when conducted in the most careful and approved manner, neither is the local affection of the inoculated part or the constitutional illness near so violent. I speak with confidence on the subject, having had an opportunity of observing its effect upon a variety of constitutions, from three *In a few days after the cow-pox inoculation was introduced at the small-pox hospital I was favored with some virus from this stock. In the first instance it produced a few pustules, which did not maturate, hut ■n the subsequent cases none appeared. tin my first publication on this subject I expressed an opinion that the cow-pox and the small-pox were the same diseases under different modifications. In this opinion Dr. Woodville has concurred. The axiom of the immortal Hunter that "two diseased actions cannot take place at the same time in one and the same part," will not be injured by the admission of this theory. jit was taken by Mr. Tanner, then reeident student at the Veterinary College, from a cow at Mr. Clark's farm at Kentish town. I] Dr. Marshall has detailed these cases with great accuracy, but their publication would now be deemed superfluous.-E. J. Variola Vaccina : Edward Jenner. 183 months old to sixty years, and to which I have paid particular attention. In the cases alluded to here, you will observe that the removal from the original source of the matter has made no alteration or change in the nature or appearance ot the disease, and that it may be continued ad infinitum imagine) from one person to another (if care be observed in taking the matter at a proper period) without anynecessity of recurring to theonginal matter of the cow. . I should be happy if any endeavors of mine could tend further to elucidate the subject, and shall be much gratified in sending you any further observations I may be enabled to make. I have the pleasure to subscribe myself, dear sir, etc., JOSEPH H. MARSHALL. Eastington, Gloucestershire, April 26, 1799. The gentleman who has favored me with the above accounts, has continued to prose- cute his inguiries with unrelenting industry, and has communicated the result in another letter, which, at his request, I lay before the public without abbreviation. DR. MARSHALL'S SECOND LETTER. "Dear Sir-Since the date of my former letter, I have continued to inoculate with the cow-pox virus. Including the cases before enumerated, the number now amounts to four hundred and twenty-three. It would be tedious and useless to detail the progress of the disease in each individual-it is sufficient to observe, that I noticed no deviation in any respect from the cases I formerly adduced. The general appearances of the arm exactly correspond with the account given in your first publication. When they were disposed to become troublesome by erysipalatous inflammation, an application of equal parts of vinegar and water always answered the desired intention. 1 must not omit to inform you, that when the disease had duly acted upon the coustitution, I have frequently used the vitriolic acid. A portion of a drop applied with the head of a probe or any conven- ient utensil, upon the pustule, suffered to remain about forty seconds and afterwards washed off wtih sponge and water, never fail to stop its progress and expedite formation of a scab. " I have already subjected two hundred and eleven of my patients to the action of variolous matter, but every one resisted it. " The result of my experiments (which were made with every requisite caution) has fully convinced me that the true cow-pox is a safe and infalible preventive from the small-pox; that in no case which has fallen under my observation has it been in any con- siderabh? degree troublesome, much less have I seen anything like danger; for in no in- stance were the patients prevented from their ordinary employments. " In Dr. Woodville's publication on the cow-pox, I notice an ordinary fact. He says that the generality of his patients had pustules. It certainly appears extremelv extra- ordinary that in all my cases there never was but one pustule which appeared on a patient's elbow on the inoculated arm, and maturated. It appeared exactly like that on the incised part. "The whole of my observations, founded as it appears on extensive experience, leads me to these obvious conclusions; that those cases which have been or may be adduced against the preventive powers of the cow-pox, could not have been those of the true kind, since it must happeu to be absolutely impossible that I should have succeeded in such a number of cases without a single exception, if such a preventive power did not exist. I cannot entertain a doubt that the inoculated cow-pox must quickly supercede that of small-pox. If the many important advantages which must result from the new practice are considered, we may reasonably infer that public benefit, that sure test of the real merit of discoveries, will render it generally extensive. "To you, sir, as the discoverer of this highly-beneficial practice, mankind are under the highest obligations. As a private individual, I participate in the general feeling; more particularly as you have afforded me an opportunity of noticing the effects of a singular disease, and of viewing the progress of the most curious experiment that ever was recorded in the history of physiology. "I remain, dear sir, etc.. "JOSEPH H. MARSHALL. "P. S.-I should have observed that of the patients I inoculated and enumerated in my letter, one hundred and twenty-seven were infected with the matter you sent me from the London cow. I discovered no dissimilarity of symptoms in those cases, from those which I inoculated from matter procured in this county. No pustules have oc- curred, except in one or two cases, where a single one appeared on the inoculated arm. No difference was apparent in the local inflammation. There was no suspension of ordinary employment among the laboring people, nor was any medicine required. "I have frequently inoculated one or two in a family, and the remaining part of it some weeks afterwards. The uninfected have slept with the infected during the whole course of the disease without feeling it; so that I am fully convinced the disease cannot be taken but by actual contact with the matter. 184 Variola: Vaccines: Edward Jennet. ilA. curious fact has lately fallen under my observation, on which I leave you to com- ment: "I visited a patient with the confluent small-pox, and charged a lancet with some of the matter. Two days afterwards I was desired to inoculate a woman and four children with the cow-pox, and I inadvertently too*k the vaccine matter on the same lancet which was before charged with that of small-pox. In three days I discovered the mistake, and fully expected that my five patients would be infected with small-pox; but I was agree- ably surprised to find the disease to be the genuine cow-pox, which proceeded without deviating in any particular from my former cases, I afterwards inoculated these patients with variolous matter, but all of them resisted its action. " I omitted mentioning another great advantage that now occurs to me in the inocu- lated cow-pox ; I mean the safety with which pregnant women may have the disease ■communicated to them. I have inoculated a great many females in that situation, and never observed their cases to differ in any respect from those of my own patients. In- deed, the disease is so mild, that it seems as if it might at all times be communicated with the most perfect safety." I shall here take the opportunity of thanking Dr. Marshall and those other gentlemen who have obligingly presented me with the result of their inoculations ; but, as they all agree in the same point as that given in the aoove communication, namely, the security of the patient from the effects of the small-pox after the cow-pox, their perusal, I pre- sume, would afford us satisfaction that has not been amply given already. Particular occurrences I shall of course detail. Some of my correspondents have mentioned the appearance of small-pox-like eruptions at the commencement of their inoculations; but in these cases the matter was derived from the original stock at the small-pox hospital. I have myself inoculated a very considerable number from the matter produced by Dr. Marshall's patients, originating in the London cow, without observing pustules of any kind, and have dispersed it among others who have used it with a similar effect. From this source Mr. H. Jenner informs me, he has inoculated an hundred patients without observing eruption. Whether the nature of the virus will undergo any change from being farther removed from its original source, in passing successfully from one person to another time alone can determine. That which l^am now employinaghas been in use near eight months, and not the least change is perceptible in its mode of action, either locally or constitutionally. There is, therefore, every reason to expect that its effects will re- main unaltered, and that we shall not be under the necessity of seeking fresh supplies from the cow. The following observations were obligingly sent me by Mr. Tierny assistant surgeon to the South Gloucester Regiment of Militia, to whom I am indebted for a former report on this subject: "I inoculated with the cow-pox matter, from the eleventh to the latter part of April twenty-five persons including women and children. Some on the eleventh were inocu- lated with the matter, Mr. Shrapnell (surgeon to the regiment) had from you, the others with matter taken from these. The progress of the punchette was accurately observed, and its appearance seemed to differ from the small-pox in having less inflammation around its basis on the first days, that is, from the third to the seventh, but after this the in- flammation increased, extending on the tenth or eleventh day to a circle of an inch and a-half from its centre, and threatening very sore arms; but this, I am happy to say, was not the case for, by applying mercurial ointment to the inflamed part, which was repeated dailv until the inflammation went off, the arm got well without any further application or trouble. The constitutional symptoms which appeared on the eighth or ninth day after inoculation, scarcely deserved the name of disease, as they wrere so slight as to be barely perceptible, ecept that I could connect a slight headache and langour with a stiffness; and rather painful sensation in the axilla. This latter symptom was the most striking it remained from twelve to forty-eight hours. In no case did I observe the smallest pustule, or even discoloration of the skin like an incipient pustule, except about the part where the virus had been applied. After all these symptons had subsided and the arms -were well, I inoculated four of this number with variolous mattter taken from a patient in another regiment. In each of these it was inserted several times under the cuticle, producing slight inflammation on the second or third day, and always disappearing before the fifth or sixth; except in one who had the cow-pox in Gloucestershire before he joined us, and who also received it at this time by inoculation. In this man the puncture inflamed, and his arm was much sorer than from the infection of the cow-pox virus, but there was no pain in the axilla, nor could any constitutional affection be observed. "I have only to add that lam now fully satisfied of the efficacy of the cow-pox in preventing the appearance of the small-pox, and that it is a most happy and salutory substitute for it. "I remain, etc., "M. J. TIERNY, Variolas Vaccinas: Edward Jenner. 185 Although the susceptibility of the virus of the cow-pox is for the most part lost in those who have had the small-pox, yet in some constitutions it is only partially de- stroyed, and in others it does not appear to be in the least diminished. By far the greater number on whom trials were made resisted it entirely ; yet I found some on whose arms the pustule, from inoculation, was formed completely, but without producing the common efflorescent blush around it, or any constitutional illness, while others have had the disease in the most perfect manner. A case of the latter kind hav- ing been presented to me by Mr. Fewster, Surgeon, of Thornbury, I shall insert it: " Three children were inoculated with the vaccine matter you obligingly sent me. On calling to look at their arms three days after, I was told that John Hodges, one of the three, had been inoculated with tne small-pox when a year old, and that he had a full burthen, of which his face produced plentiful marks, a circumstance I was not before made acquainted with. On the sixth day the arm of this boy appeared as if inoculated with variolous matter, but the pustule was rather more elevated. On the ninth day he complained of violent pain in his head and back, accompanied with vomiting and much fever. The next day he was very well, and went to work as usual. The punctured part began to spread, and there was the areola around the inoculated part to a considerable extent. 11 As this is contrary to an assertion made in the Medical and Physicial Journal, No. 8,1 thought it right to give you this information, and remain, "Dear Sir, etc., "J. FEWSTER." It appears, then, that the animal economy, with regard to the action of this virus, is under the same laws as it is with respect to the variolous virus, after previously feel- ing its influence, as far as comparisons can be made between two diseases. Some striking instances of the power of the cow-pox in suspending the progress of the small-pox, after the patients had been several days casually exposed to the infection have been laid before me by Mr. Lyford, Surgeon, of Winchester, and my nephew, the Rev. G. C. Jenner. Mr. Lyford, after giving an account of his extensive and successful practice in the vaccine inoculation in Hampshire, writes as follows : " The following case occurred to me a short time since, and may probably be worth your notice. I was sent for to a patient with the small-pox, and on inquiry found that, five days previous to my seeing him, the eruption began to appear. During the whole of this time, two children, who had not had the small-pox, were constantly in the room with their father, and frequently on the bed with him. The mother consulted me on the propriety of inoculating them, but objected to my taking the matter from their father, as he was subject to erysipelas. I advised her by all means to have them inoculated at that time, as I could not procure any variolous matter elsewhere. However, they were inocu- lated with vaccine matter; but I cannot say 1 flattered myself with its proving success- ful, as they had previously been so long, and still continued to be, exposed to the vario- lous infection. Notwithstanding this, I was agreeably surprised to find the vaccine disease advance and go through its regular course ; and, if I may be allowed the expression to the total extinction of the small-pox. Mr. Jenner's cases were not less satisfactory. He writes as follows : "A son of Thomas Stinchcomb, of Woodford, near Berkeley, was infected with the natural small-pox at Bristol, and came to his father's cottage. Four days after the erup- tions had appeared upou the boy, the family (none of which had ever had the small-pox), consisting of the father, mother, and five children, were inoculated with vaccine virus. On the arm of the mother it failed to produce the least effect, and she of course had the small-pox ;* but the rest of the family had the cow-pox in the usual mild way, and were not affected with the small-pox, although they were in the same room, and the children slept in the same bed with their brother, who was confined to it with the natural small-pox; and subsequently with their mother. " I attended this family with my brother, Mr. H. Jenner." The following cases are of too singular a nature to remain unnoticed. Miss R , a young lady about five years old, was seized, on the evening of the eighth day after inoculation with vaccine virus, with such symptoms as commonly de- note the accession of violent fever. Her throat was also a little sore, and there were some uneasy sensations about the muscles of the neck. The day following a rash was perceptible on her face and neck, so much resembling the efflorescence of the Scarlatina Anginosa, that I was induced to ask whether Miss R had been exposed to the con- tagion of that disease. An answer in the affirmative, and the rapid spreading of the redness over the skin, at once relieved me from much anxiety respecting the nature of the malady, which went through its course in the ordinary way, but not without symp- toms which were alarming, both to myself and Mr. Lyford, who attended with me. *Under similar circumstances, I think it would be advisable to insert the matter into each arm, which would be more likely to insure the success of the matter.-E. J. 186 Variola' Vaccince: Edward Jenner. There was no apparent deviation in the ordinary progress of the pustnle to a state of maturity, from what we see in general; yet there was a total suspension of the Areola, or florid discoloration around it, until the Scarlatina had retired from the constitution. As soon as the patient was freed from this disease, this appearance advanced in the usual way.* The case of Miss H R is not less interesting than that of her sister above re- lated. She was exposed to the contagion of the Scarlatina at the same time, and sick- ened almost at the same hour. The symptoms continued severe about twelve hours, when the scarlatina rash showed itself faintly upon her face, and partly upon her neck. After remaining two or three hours it suddenly disappeared, and she became perfectly free from every complaint. My surprise at this sudden transition from extreme sickness to health in great measure ceased, when I observed that the inoculated pustule had occa- sioned in this case, the common efflorescent appearance around it, and that as it approached th^ centre, it was nearly in an erysipelatous state. But the remarkable part of this history is, that on the fourth day afterwards, as soon as the efflorescence began to die away upon the arm, and the pustule to dry up, the Scarlatina again appeared, her throat became sore, the rash spread all over her. She went fairly through the disease, with its common symptoms. That these were actually cases of scarlatina was rendered certain by two servants in the family falling ill at the same time with the distemper, who had been exposed to the infection with the young ladies. Some there are who suppose the security from the small-pox obtained through the cow- pox will be of a temporary nature only. This supposition is refuted, not only by analogy with respect to the habits of diseases of a similar nature, but by incontroventible facts, which appear in great numbers against it. To those already adduced in the former part of my first Treatise, many more might be added were it deemed necessary ; but among the cases I refer to, one will be found of a person who had the cow-pox fifty-three years before the offect of the small-pox was tried upon him. As he completely resisted it, the intervening period 1 conceive must necessarily satisfy any.reasonable mind. Should further evidence be thought necessary, I shall observe, that among the cases presented to me by Mr. Fry, Mr. Darke, Mr Tierny, Mr. H. Jenner, and others, there were many whom they inoculated ineffectually with variolous matter, who had gone through the cow-pox many years before this trial was made. It has been imagined that the cow-pox is capable of being communicated from one per- son to another by effluvia without the intervention of inoculation. My experiments made with the design of ascertaining this important point, all tend to establish my or- iginal position, that it is not infectious, except by contact. I have never hesitated to suffer those, on whose arms there were pustules exhaling the effluvia, from associating or even sleeping with others who never had experienced either the cow-pox or the small- pox, and further, I have repeatedly, among children, caused the uninfected to breathe over the inoculated vaccine pustules during their whole progress ; yet these experiments were tried without the least effect. However, to submit a matter so important to a still further scrutiny, I desired Mr. H. Jenner to make any further experiments which might strike him as most likely to establish or refute what had been advanced on this subject. He has since informed me, "that the inoculated children at the breast, whose mothers had not gonethrpugh either the small-pox or cow-pox, that he had inoculated mothers whose sucking infants had never undergone either of these diseases; that the effluvia from the inoculated pustules, in either case, had been inhaled from day to day during the whole progress of their maturation, and that there was not the least perceptible effect from these exposures. One woman he inoculated about a week previous to her accouchement, that her infant might be the more fully and conveniently exposed to the pustule; but as in the former instances, no infection was given, although the child fre- quently slept on the arm of its mother, with its nostrils and mouth exposed to the pus- tule in the fullest state of maturity, In a word, is it not impossible for the cow-pox, whose only manifestation appears to consist in the pustules created by contact, to produce itself by effluvia. In the course of a late inoculation, I observed an appearance which it may be proper here to relate. The punctured part on a boy's arm (who was inocculated with fresh lim- pid virus) on the sixth day, instead of showing a beginning vesicle, which is usual in the cow-pox at that period, was encrusted over with a rugged amber-colored scab. The scab continued to spread and increase in thickness for some days, when at its edges a vesicated ring appeared, and the disease went through its ordinary course, the boy having had soreness in the axilla, and some slight indisposition. With the fluid matter taken from his arm, five persons were inoculated. In one it took no effect. In another *1 witnessed a similar fact in a case of measles. The pustnle from the cow-pox virus advanced to ma- turity, while the measles existed in the constitution, but no efflorescence appeared around it until tho measles had ceased to exert its influence. Variolce Vaccince; Edward Jenner. 187 it produced a perfect pustule without any deviation from the common appearance ; but in the other three the progress of the inflammation was exactly similar to the instance which afforded the virus for their inoculation ; there was a creeping scab of a loose texture, and subsequently the formation of limpid fluid at its edges. As these people were all employed in laborious exercises, it is possible that these annomalous appearances might owe their origin to the friction of the clothes on the newly inflamed part of the arm. I have not yet had an opportunity of exposing them to small-pox. In the early part of this inquiry I felt far more anxious respecting the inflammation of the inoculated arm than at present, yet that this affection will go on to a greater extent than could be wished, is a circumstance sometimes to be expected. As this can be checked, or even entirely subdued by very simple means, I see no reason why the patient should feel an uneasy hour, because an application may not be absolutely necessary. About the tenth or eleventh day, if the pustule has proceeded regularly, the appearance of the arm will almost to a certainty indicate whether this is to be expected or not. Should it happen, nothing more need be done chan to apply a single drop of the aqua lythargyr acetati* upon the pustule, and having suffered it to remain two or three minutes, to cover the efflorescence surrounding the pustule with a piece of linen dipped in the aqua lythargyr compos.] The former may be repeated twice or thrice during the day; the latter as often as it may feel agreeable to the patient. When the scab is prematurely rubbed off (a circumstance not unfrequent among children and working people), the application of a little aqua lythargyri acet, to the part, immediately coagulates the surface which supplies its place, and prevents a sore. In my former Treatises on this subject, I have remarked that the human constitution frequently retains its susceptibility of the small-pox contagion (both from effluvia and contact) after previously feeling its influence. In further corroboration of this declara- tion, many facts have been communicated to me by various correspondents. I shall select one of them. " Dear Sir-Society at large must I think feel much indebted to you for your Inquiries and Observations on the Nature and Effects of the Variolae Vaccinae, etc., etc. As I con- ceive what I am now about to communicate to be of some importance, I imagine it can- not be uninteresting to you, especially as it will serve to corroborate your assertion of the susceptibility of the human system of the variolous contagion, although it has pre- viously been made sensible of its action. In November, 1793, I was desired to inoculate a person with the small-pox. I took the variolous matter from a child under the disease in the natural way, who had a large burden of distinct pustules. The mother of the child being desirous of seeing my method of communicating the disease by inoculation, after having opened a pustule, I introduced the point of my lancet in the usual way on the back part of my own hand, and thought no more of it until I felt a sensation in the part, which reminded me of the transaction. This happened upon the third day; on the fourth there were all the appearances common to inoculation, at which I was not at all sur- prised; nor did I feel myself uneasy, upon perceiving the inflammation continue to increase to the sixth and seventh day, accompanied with a small quantity of fluid, repeated ex- periments having taught me it might happen so with persons who had undergone the disease, and yet would escape any constitutional affection ; but I was not so fortunate; for on the eighth day I was seized with all the symptons of the eruptive fever, but in a much more violent degree than when I was before inoculated, which was about eighteen years previous to this, when I had a considerable number of pustules. I must confess I was now greatly alarmed, although I had been much engaged in the small-pox, having at different times inoculated not less than two thousand persons. I was convinced my present indisposition proceeded from the insertion of the variolous matter, and, there- fore, anxiously looked for an eruption. On the tenth day I felt a very unpleasant sensa- tion of stiffness, and heat on each side of my face near my ear, and the fever began to decline. The affection in my face soon terminated in three or four pustules attended with inflammation, but which did not maturate, and I was presently well. "I remain, dear sir, etc , "THOMAS MILES." This Inquiry is not now so much in its infancy as to restrain me from speaking more posi- tively than formerly on the important point of scrofula, as connected with the small-pox. Every practitioner in medicine, who has extensively inoculated with the small-pox, or has attended many of those who have had the distemper in the natural way, must ac- knowledge that he has frequently seen scrofulous affections, in some form or another, sometimes rather quickly showing themselves after the recovery of the patients. Con- ceiving this fact to be admitted, as I presume it must be by all who have carefully at- tended to the subject, may I noc ask whether it does not appear probable that the gen- ^Extract of Saturn, fG-oulard water. For further information on this subject see the first treatise on the Var. Vac., Dr. Mar shall's letters, etc. Variola Vaccina: Edward Jenner. 188 eral introduction of the small-pox into Europe has not been among the most conducive means in exciting that formidable foe to health ? Having attentively watched the effects of the cow-pox in this respect, I am happy in being able to declare, that the disease does not appear to have the least tendency to produce this destructive malady. The scepticism that appeared even among the most enlightened of medical men, when my sentiments on the important subject of the cow-pox were first promulgated, was highly laudable. To have admitted the truth of a doctrine, at once so novel and so un- like anything that had ever appeared in the annals of medicine, without the test of the most rigid scrutiny would have bordered upon temerity; but now, when that scrutiny has taken place, not only among ourselves, but in the first professional circles in Europe, and when it has been uniformly found in such abundant instances, that the human frame, when once it has felt the influence of the genuine cow-pox in the way that has been de- scribed, is never afterwards, at any period of its existence, assailable by the small-pox, may I not with perfect confidence congratulate my country and society at large on their beholding, in the mild form of the cow-pox, an antidote that is capable of extirpating from the earth a disease which is every hour devouring its victims; a disease that has ever been considered as the severest scourge of the human race! [ FINIS. ] DR. JENNER'S ACCOUNT OF THE ORIGIN OF THE VACCINE INOCULATION. "The most important discoveries, when familiarized to the mind, are contemplated with indifference. Who now wonders at the discovery of America, or the circulation of the blood ? There is, however, a period be- tween the conception of a discovery and its mature birth, fraught with more pangs than war or women know : and there is no light in which the human mind can be viewed more interesting than during this anxious period. Whenever, therefore, the author of any greatly useful invention details the progress of his own mind during the completion of his plan, the history is perused with avidity. On these grounds we conclude that our readers will be much gratified by the following narrative:" "T am induced to give the following concise history of the origin of vaccine inoculation, from my frequently observing that those who only consider the sub- ject cursorily, confound the casual cow-pox with the disease when excited by inoculation. Edward Jenner. "My inquiry into the nature of the cow-pox commenced upwards of twenty-five years ago. My attention to this singular disease was first excited by observing that, among those whom, in the country, I was fre- quently called upon to inoculate, many resisted every effort to give them small-pox. These patients, I found, had undergone a disease they called the cow-pox, contracted by milking cows affected with a peculiar eruption on their teats. On inquiry, it appeared that it had been known among the dairies time immemorial, and that a vague opinion prevailed of the small- pox. This opinion I found was, comparatively, new among them; for all the older farmers declared they had no such idea in their early days-a circumstance that seemed easily to be accounted for, from my knowing that the common people were very rarely inoculated for the small-pox, till that practice was rendered general by the improved method introduced by the Suttons; so that the working people in the dairies were seldom put to the test of the preventive powers of the cow-pox. "In the course of the investigation of this subject, which, like all others of a complex and intricate nature, presented many difficulties, I found that some of those ivho seemed to have undergone the cotc-pox, nevertheless, on inoculation with the small-pox, felt its influence just the same as if no disease had been communicated to them from the cow. This occurrence led me to inquire among the medical practitioners in the country around me, who all agreed in this sentiment, that the cow-pox was not to be relied upon as a certain preventive of the small-pox. This for a while damped, but did not extinguish my ardor; for, as I proceeded, I had the satisfac- tion to learn that the cow was subject to some varieties of spontaneous eruptions upon her teats: that they were all capable of communicating sores to the hands of the milkers; and that whatever sore was derived from the animal, was called in the dairy the cow-pox. Thus I surmounted a great obstacle, and, in consequence, was led to form a distinction be- 190 Dr. Jenner on the Origin of Vaccine Inoculation. tween these diseases, one of which only I have denominated the true, the others the spurious cow-pox, as they possess no specific power over the constitution. This impediment to my progress was not long removed, be- fore another, of far greater magnitude in its appearance, started up. There were not wanting instances toprove, that when the true cow-pox broke out among the cattle at a dairy, a person who had milked an infected animal, and had thereby apparently gone through the disease in common with others, was liable to receive the small-pox afterwards. This, like the former obstacle, gave a painful check to my fond and aspiring hopes; but, reflecting that the operations of nature are generally uniform, and that it was not probable the human constitution (having undergone the cow-pox) should in some instances be perfectly shielded from the small-pox, and in many others remain unprotected, I resumed my labors with redoubled ardor. The results was fortunate; for 1 now discovered that the virus of cow-pox was liable to undergo progressive changes, from the same causes precisely as that of small-pox ; and that, when it was applied to the human skin in its degenerated state, it would produce the ulcerative effects in as great a degree as when it was not decomposed, and sometimes far greater; but having lost its specific properties it was incapable of producing that change upon the human frame which is requisite to render it unsusceptible of the variolous contagion; so that it became evident a person might milk a cow one day, and having caught the disease, be for ever secure; while another person, milking the same cow the next day, might feel the influence of the virus in such a way as to produce a sore or sores, and, in consequence of this, might experience an indisposition to a considerable extent; yet, as has been observed, the specific quality being lost, the constitution would receive no peculiar impression. "Here the close analogy between the virus of small-pox and of cow-pox becomes remarkably conspicuous; since the former, when taken from a recent pustule, and immediately used, gives the perfect small-pox to the person on whom it is inoculated; but, when taken in a far advanced stage of the disease, or when (although taken early), previously to its insertion, it be exposed to such agents as, according to the established laws of nature, cause its decomposition, it can no longer be relied on as effectual. This observation will fully explain the source of those errors which have been committed by many inoculators of the cow-pox. Conceiving the whole process to be so extremely simple as not to admit of a mistake, they have been heedless about the state of the vaccine virus; and finding it limpid, as part of it will be, even in an advanced stage of the pustule, when the greater portion has been converted into a scab, they have felt an improper confidence, and sometimes mistaken a spurious pustule, which the vaccine fluid in this state is capable of exciting, for that which pos- sesses the perfect character. "During the investigation of the casual cow-pox, I was struck with the idea that it might be practicable to propagate the disease by inoculation, after the manner of the small-pox, first from the cow, and, finally, from one human being to another. I anxiously waited some time for an oppor- tunity of putting this theory to the test. At length the period arrived. The first experiment was made upon a lad of the name of Phipps, in whose arm a little vaccine virus was inserted, taken from the hand of a young woman who had been accidentally infected by a cow. Notwithstanding the resemblance which the pustule, thus excited on the boy's arm, bore to variolous inoculation, yet, as the indisposition attending it was barely perceptible, I could scarcely persuade myself the patient was secure from Dr. Jenner's Instructions for Vaccine Inoculation. 191 the small-pox. However, on his being inoculated some months afterwards, it proved that he was secure. This case inspired me with confidence; and as soon as I could again furnish myself with virus from the cow, I made an arrangement for a series of inoculations. A number of children were inoculated in succession, one from the other; and, after several months had elapsed, they were exposed to the infection of the small-pox-some by inoculation, others by variolous effluvia, and some in both ways; but they all resisted it. The result of these trials gradually led me into a wider field of experiment, which I went over not only with great attention, but with painful solicitude. This became universally known through a treatise published in June, 1798. The result of my further experience was also brought forward in subsequent publications, in the two succeeding years, 1799 and 1800. The distrust and scepticism which naturally arose in the minds of medical men, on my first announcing so unexpected a discovery, has now nearly disappeared. Many hundreds of them, from actual ex- perience, have given their attestations that the inoculated cow-pox proves a perfect security against the small-pox; and I shall probably be within compass if I say thousands are ready to follow their example; for the scope that this indentation has now taken is immense. An hundred thou- sand persons, upon the smallest computation, have been inoculated in these realms. The numbers who have partaken of its benefits throughout Eu- rope, and other parts of the globe, are incalculable; and it now becomes too manifest to admit of controversy, that the annihilation of the small- pox, the most dreadful scourge of the human species, must be the final result of this practice."-[The Medical Repository, vol. v., p. 239, New York, 1802.] DR. JENNER'S INSTRUCTIONS FOR VACCINE INOCULATION. Let the vaccine fluid be taken for the purpose of inoculation from a pus- tule that is making its progress regularly, and which possesses the true vaccine character, on any day from the fifth to the eighth, or even a day or two later, provided the efflorescence be not formed around it. When the efflorescence is formed, it is always most prudent to desist from taking any more of the virus from the pustule. To obtain the virus, let the edges of the pustule be gently punctured with a lancet in several points. It will gradually ooze out, and should be inserted upon the arm, about midway between the shoulder and the elbow, either by means of a very slight scratch, not exceeding the eighth part of an inch, or a very small oblique puncture. A little red spot will appear on the third day, if the operation succeed, which, on the fourth or fifth, becomes perceptibly vesicated. It goes on increasing till the tenth day, when it is generally surrounded by a rose co- lored efflorescence, which remains nearly stationary for a day or two. The efflorescence then fades away, and the pustule is gradually converted into a hard glossy scab, of a dark mahogany color. These progressive stages of the pustule are commonly completed in sixteen or seventeen days. A single pustule is sufficient to secure the constitution from the small- pox, but as we are not always certain the puncture may take effect, it will be prudent to inoculate in both arms, or to make two punctures in the same arm, about an inch and an half asunder, except in very early in- fancy, when there is a great susceptibility of local irritation. 192 Dr. Jenner's Instructions for Vaccine Inoculation. If the efflorescence surrounding the pustule should be extensive, and occasion much local heat upon the arm, it may be cooled by the repeated application of pieces of folded linen dipped in cold water, or still more expeditiously by a strong solution of the aqua lythargyri acetati* in water, an ounce, for example, of the former in five or six of the latter. If the scab should at any time be prematurely rubbed off, the party may be occasionally touched with undiluted aqua lythargyri acetati. Vaccine virus, taken from a pustule, and inserted immediately in its fluid state, is preferable to that which has been previously dried; but as it is not always practicable to obtain it in this state, we are compelled to seek for some mode of preserving it. Various means have been suggested, but from the test of long experience it may be asserted, that preserving it be' tween two plates of glass is the most eligible. Let a piece of common window glass be cut into squares of about an inch each, so that they shall lie smooth when placed upon each other. Let the collected vaccine fluid be confined to a small spot (about the size of a split pea) upon the centre of one of these glasses; which should be suffered to dry in the common heat of the atmosphere, without exposure to the heat of fire or the sun. When dry, it should be immediately secured by placing over it the other piece of glass. Nothing more is necessary for its preservation than wrap- ping it in clean writing paper. The virus thus preserved, when wanted for the purpose of inoculation, may easily be restored to its fluid state by dissolving it in a small portion of cold water, taken upon the point of a lancet. It may be used in the same manner as when just taken from a pustule. The vaccine fluid is liable, from causes apparently trifling, to undergo a decomposition. In this state it sometimes produces what has been denomi- nated the spurious pustule; that is, a pustule, or an appearance on the arm not possessing the characteristic marks of the genuine pustule. Anomalies, assuming different forms, may be excited, according to the qualities of the virus applied, or the state of the person inoculated; but by far the most frequent variety, or deviation from the perfect pustule, is that which arrives at maturity, and finishes its progress much within the time limited by the true. Its commencement is marked by a troublesome itch- ing ; and it throws out a premature efflorescence, sometimes extensive, but seldom circumscribed, or of so vivid a tint as that which surrounds the pustule completely organized; and (which is more characteristic of its de- generacy than the other symptoms) it appears more like a common fester- ing produced by a thorn, or any other small extraneous body sticking in the skin, than a pustule excited by the vaccine virus. It is generally of a straw color, and when punctured, instead of that colorless, transparent fluid of the perfect pustule, its coutents are found to be opaque. That de- viation from the common character of the pustule, arising from vaccine virus which has been previously exposed to a degree of heat capable of decomposing it, is very different. In this instance it begins with a creep- ing scab, of a pale brown or amber color, making a long and slow progress, and sometimes going through its course without any perceptible efflor- escence. Its edges are commonly elevated, and afford on being punctured, a liquid fluid. A little practice in vaccine inoculation, attentively conducted, impresses on the mind the perfect character of the vaccine pustule; therefore, when a deviation arises, of whatever kind it may be, common prudence points out the necessity of reinoculation; first with vaccine virus of the most *Goulard's Extract of Saturn. Dr. Jenners' Instructions for Vaccine Inoculation. 193 ■active kind ; and, secondly, should this be ineffectual, with variolous virus. But if the constitution shows an insusceptibility of one, it commonly does ■of the other. When any constitutional symptoms occur in inoculated cow-pox, they are •commonly first perceptible (especially in children) on the fourth or fifth ■day. They appear again, and sometimes in adults, not unlike a mild at- tack from inoculated small-pOx, on the eighth, ninth, or tenth day. The former arise from the general effects of the virus on the habit, the latter from the irritation of the pustule. If the effluvia of the small-pox have been received into the habit, pre- viously to the inoculation of the vaccine virus, the vaccine inoculation will not always be found to stop its progress, although the pustule may make its advances without interruption. The lancet used for the inoculation should always be perfectly clean. After each puncture, it is proper to dip it into water, and wipe it dry. The preservation of vaccine virus upon a lancet beyond the period of a few days, should never be attempted; as it is apt to produce rust, which will decompose it.-The Medical Repository, Vol. v ; Now Mork, 1802; page 483. EDWARD JENNER. Shortly after the discovery of Dr. Jenner had attracted public attention, Dr. George Pearson rendered service to the cause of vaccination by es- tablishing an extensive correspondence with medical men in different parts of England, by which he was enabled to prove that cow-pox was much more widely epizootic than had been at first believed; and that all the local traditions fully confirmed Dr. Jenner's positions. The early letters of Dr. Pearson indicated not less ardor in behalf of vaccination than respect and admiration for its author. Dr. Jenner amply repaid the good will of his correspondent by the most unreserved communication of all the knowledge which he possessed. On the eighth of November, 1798, and just on the eve of the publication of his pamphlet, Dr. George Pearson wrote a letter to Dr. Jenner which, among other matter, contained the following expression: "Your name will live in the memory of mankind as long as men possess gratitude for services and respect for benefactors; and if I can get matter I am much mistaken, if I do not make your live for ever." About the middle of November, 1798, Dr. Pearson published his inquiry ■concerning the history of the cow-pox, and thus announced its appearance to Dr. Jenner. DR. PEARSON TO DR. JENNER. My Dear Sir-Unexpectedly my pamphlet made its public appearance a day or two ago. I am sorry to trouble you to say by what conveyance I can send you a copy, and to what place ? If you have any commissions to execute in London, you may as well have a parcel made up, and I will see it forwarded. I observe several errors since print- ing, partly mine and partly those of the printer ; but I know other authors discover similar errors, and that readers do not perceive them. You can not imagine how fastidious the people are with regard to this business of the cow-pox ; one says it is very filthy and nasty to derive it from the sore heel of horses : another, O, my God, we shall introduce the diseases of animals among us, and we have too many already of our own! 194 Dr. Pearson's Letter to Dr. Jenner. A third sapient set say it is a strange, odd kind of business, and they know not what to think of it. All this I hear very quietly, and recollect that a still more unfavorable re- ception was experienced by the inoculation of the small-pox. I wish you could secure for me matter for inoculation, because, depend upon it, a thousand inaccurate, but imposing cases, will be published against the specific nature of the disease by persons who want to send their names abroad about any thing, and who will think yourself and me fair game. By way of Le defendendo we must inoculate. I have thought it right to publish the evidence as sent to me, and also my own reasoning, because I know you are too good a philosopher to be offended at the investigation of truth, although the conclusions may be different from your own. 1 think, too, your principal facts will be the better established than if it had happened that I had uni- formly acceded to all your doctrine. I am, with Mrs. P's best compliments to Mrs. Jenner and yourself, Your obedient servant, G. PEARSON, Leicester Square, November 13, 1798. During iny visit to Europe, in 1870, I succeeded, after a careful search, in obtaining in London, a single copy of the work of Dr. George Pearson, and also of the work of Dr. Woodville, and we conceive it of importance to the medical profession of America, that they should be reproduced iu connection with the works of Dr. Jenner, which are so fully sustained by the facts illustrating the history of the cow-pox. AN INQUIRY CONCERNING THE] H I S T O H T OF THE c o"W - fox3 PRINCIPALLY WITH A VIEW TO SUPERSEDE AWO EXTINGUISH THE SMALL - FOX, GEORGE PEARSON, M. D. F. R. S. PHYSICIAN TO ST. GEORGE'S HOSPITAL ; OF THE COLLEGE OF PHYSICIANS, Feliciores Inserit.-Hot. LONDON: Printed for J. Johnson, No. 72, St. Paul's Church Yard, 1798. TO SIR GEORGE BAKER, Bart. I'hyMfian to their Majesties, F. R. S. &c., &c.: Whose medical writing and pre-eminent learning reflect honor on the pro- fession of physic : This work is inscribed as an acknowledgment for promoting the present inquiry, and as a public testimony of personal regard, By his ever truly faithful and obedient servant, GEORGE PEARSON. Leicester Square, November, 17*J8. INQUIRIES CONCERNING THE COW-POX. The curiosity of the public has been lately gratified by the publication of the long-ex- pected treatise of Dr. Jenner,* on an epizootic disease, commonly known to dairy farmers by the name of the cow-pox. This distemper of cows has been noticed, time imme- morial, in many provincial situations, where it has been also observed to have been com- municated from these diseased animals to the persons who milk them. In the work just spoken of several facts are related, which seem to let new light into the nature of the animal economy, and to exhibit a near prospect of most important benefits in the prac- tice of physic. But as some of these facts do not accord, nay, as they are at variance in essential particulars with those to which they are nearest related, the truth of them is rather invalidated than confirmed by analogy; hence the testimony of a single observer, however experienced, and worthy to be credited, it is apprehended is insufficient for procuring such facts a general acceptance. But granting that the facts should be gen- erally admitted, without hesitation, to be true in the instances, which have fallen under the notice of the writer of the above work, the more judicious part of the medical pro fession will require the observations to be derived from much more extensive and varied experience, in order to appreciate, justly, the value of the practical conclusions. Hence there appears but little likelihood of improvements in practice being made, unless the subject be investigated by many inquirers, and the attention of the public at large be kept excited. I do not think that it is necessary for me to explain the various modes, and point out the situations in which inquiries may be prosecuted. These I suppose will without difficulty, be understood by perusing Dr. Jenner's treatise. I hope I shall not be considered as assuming too much in recommending, not only those of the profession of physic, but dairy farmers, and others whoreside in the country, to collect the facts on the subject, which have hitherto fallen under notice, only in a casual way. From such a procedure, it is reasonable to calculate that the acquisition of established truths will be greatly accelerated, or error will be exploded. Agreeably to the preceding representation, I go forward to examine the evidence of the principal facts, asserted in the publication on the cow-pox ; and to state what farther evidence I have derived from my own experience, and from the communications of a number of professional gentlemen, of unsuspected veracity, and undoubted accuracy. Perhaps it may be right to declare, that I entertain not the most distant expectation of participating the smallest share of honor, on the score of discovery of facts. The honor on this account, by the justest title, belongs exclusively to Dr. Jenner; and I wwuld not pluck a sprig of laurel from the wreath that decorates bis brow. This declaration I can prove to demonstrationt is utterly superfluous for this gentleman himself, but I am not confident that it is altogether without use, to exempt me from the suspicious which certain members of the profession (with whom I will have no fellow- ship) would be anxious to excite. The first fact in order which I shall examine, may be stated in the following terms: 1. Persons who have undergo ne the specific fever and local disease, occasioned by the cow-pox infection, communicated in the accidental way, (who had not undergone the small-pox,) are thereby rendered unsusceptible of the small-pox. To establish this important fact, Dr. Jenner has related (p. 9 to 26) about twenty in- stances of inoculation of the small-pox, of persons who were known to have gone through the cow-pox, but not one of them took the small-pox in this way; nor by associating afterwards, with patients laboring under this disease. The permanency of the inexcita- bility of the constitution to thesmall-pox, was manifested by some of the instances being persons who had been affected with the cow-pox twenty, thirty, forty, and even fifty-three years before. It must not be supposed that the fact unsupported by merely these twenty in- stances ; which were selected for illustiation ; for Dr. Jenner having resided in Glouces- tershire twenty years, in which county the cow-pox is frequently epizootic, several hundred instances must have fallen under his own observation, or that of his acquain- tance, of persons not taking the small-pox, who had gone through the cowTpox. Dr. * An Inquiry into the causes and effects of the variola: vaccines, etc., on the cow-pox. by Edward Jenner M. D. F. R. S. etc,, 4 to London, 1798. t On showing to Dr. Jenner the original paper which I read, as a lecture on the cow-pox; and which furnishes the principal materials of this dissertation, he seemed only anxious that I should not think it important enough for publication. 200 Cow-Pox ; George Pearson, M. IK Jenner appears to have been occupied for a long time in ascertaining this fact. And to prove that he has an extraordinary claim to credit on that account, I will mention the following occurrence. When I was in company with the late Mr. Jolin Hunter, about nine years ago, I heard him communicate the information he hail received from Dr. Jenner, that in Gloucestershire an infectious disorder frequently prevailed among the milch cows, named the cow-pox, in which there was an eruption on their teats -that those who milked such cows were liable to he affected with pustulous eruptions on their hands, which were also called the cow-pox-that such persons as had undergone this disease, could not be infected by the variolous poison, and that as no patient had been known to die of the cow-pox. the practice of inoculation, of the poison of this disease, to supersede the small-pox might be found, on experience, to be a great improvement in physic. I noted these observations, and constantly related them, when on the subject of the small-pox, in every course of lectures which I have given since that time. This fact has been mentioned in two publications: namely, by Mr. Adams,* in his book on morbid poison, etc., in 1795; and by Dr. Woodville, in his History of Inoculation, in 1796.1 On conversing with Sir George Baker, Baft, concerning the cow-pox, rendering people unsusceptible of the variolous disease, Sir George observed, he had been informed of the fact, in some papers, on the cow-pox, communicated to him many years ago ; but that as the statement did not then obtain credit, it was not published. After a fruitless search for these papers, Sir George, whose zeal for the improvement of physic did not forsake him on this occasion, authorized me to write to his relative, the Rev. Herman Drewe, of Abbotts. From this gentleman, who had availed himself of great opportunities of in- quiring into the nature of the cow-pox, when he resided in Dorsetshire, I immediately received answers in a very polite letter, to all the queries which I took the liberty of proposing. With regard to the fact under examination, the information received from this gentleman is in these terms : "Mr. Bragge.t who inoculated my parish, rejoiced at having an opportunity of ascertaining the fact. Three women had had the cow-pox, lie therefore charged them with a superabundance of matter, but to no purpose ; all his other patients, more than fifty, took the infection, but the three women were not in the least disordered, even though they associated constantly with those who were infected. Thirteen similar instances I at that time, in that neighborhood ascertained." Mr. Drewe observes, that the disorder "is epizootic in Devonshire, Dorsetshire, and Somer- setshire, and there is no doubt that it is to be met with elsewhere, under the name of cow- pox, or some other denomination. When I made inquiries about the cowr-pox I resided in Dorsetshire, and gained all my information from a Mr. Downe, Surgeon, of Bridport, a Mr. Bragge, Surgeon of Axminster, and a Mr. Barnes, of Colyton (since dead.) I have not thought of the matter since, and as my letters on the subject have es- caped Sir George Baker's search, so many particulars have my recollection." Dr. Pulteney|| of Blandford, who did me the honor to answer the question which I troubled him wdth, informs me "that the disease is well known in Hampshire, Dorset- shire, Somersetshire, and Devonshire. That it is not uncommon in Leicestershire, and other midland counties, but dairy-men keep it a secret as much as possible, as it is dis- reputable to the cleanliness of the produce. An intelligent and respectable inoculator in this country, informed me, that of several hundreds whom he had inoculated for the small-pox, who had previously had the cow-pox, very few took the infection ; and such as did he had great room to believe were themselves deceived, in regard to their having had the cow-pox." I am deeply indebted for several letters on the subject, to the Rev. Henry Jerome de Salis, D. D.§ "I have heard," says he, "a good deal of the cow-pox in this country. I have given a copy of your questions to Mr. Heurtley, and another to Sir William Lee, and I dare say, after a time this country will produce much information relative to the cow-pox. I have found that in this parish, (Wing) this disorder ragedin one farm, but did not get beyond it, three years ago. A man who now works with me, was employed with three others in milking the cows. None but himself had had the small-pox, all three had the cow-pox, but he quite escaped it. One of these three is now in the parish, * " The cow-pox is a disease well knowi*o the dairy farmers in Gloucestershire. 'What is extraor- dinary, as far as facts have hitherto been ascertained, the person who has been infected is rendered insen- sible to the variolous posion." Adamson Morbid Poisons, 8vo. 1795, p. 156. t "It has been conjectured that the small-pox might have been derived from some disease of brute ani- mals ; and if it be true that the manjje, affecting dogs, can communicate a species of itch to man ; or, that a person, having received a certain disorder from handling the seats of cows, is thereby rendered insensible to variolous infection ever afterwards, as some have asserted ; then indeed the conjecture is not improba- ble. Woodville, p. 7- $ Mr. Drewe's Letter, Abbotts, July 5, 1798. [j Dr. Pulteney's Letter, Blandford, July 14, 1798. § Dr. de Salia' Letters, Wing. Bucks, July 20th, 25th and29th, 1798. Cow-Pox; George Pearson, M. P. 201 and I will have him inoculated for the small-pox. He was much struck with the resem- blance of the symptoms to those lie had lately experienced in the small-pox. Mr. Thomas Rhodes, a respectable farmer and dairy-man at Abbots-Asron, (a parish adjoining to this) had the cow-pox when he was a boy, and was afterwards inoculated for the small- pox, without effect. As this is a case quite in point, and as I know the man perfectly well, and also know the inocnlator, I will have all the particulars drawn up in the man- ner you may direct, and authenticated in the course of a few days. I have the name of a servant of his father's who had the cow-pox at the same time that he had it. This man lives in the adjoining parish of Soulbury, and if he has not had the small-pox since, I will have him inoculated after harvest." In the dairy farm above mentioned, in which the cow-pox raged three years ago, it had not appeared for the preceding fourteen or fifteen years. Two men were then infected, one of whom lives now at Aylesbury, and the other at Bushy. For reasons which I will hereafter give you, I shall inquire after the man at Aylesbury." From Mr. Downe,* Surgeon of Bridport, I have received some important information. "The cow-pox is a disorder in Devonshire as well as Dorsetshire, but it so rarely occurs, that the sources of information are very scanty. A few years ago, when I inocu- lated a great number for the small-pox, I remarked that I could not, by any means, in- fect one or two of them, and on inquiry, I was informed they had previously been in- fected with the cow-pox. Some few families who had been infected with the cow-pox, were repeatedly inoculated with the matter of the small-pox, and without effect. I know that a medical man m this part of the country was injured in his practice, by a prejudice raised unjustly, that he intended to substitute the cow-pox for the small-pox. *So great an enemy to improvement are the prejudices of the public in the country, that I think experiments of importance can only be made in hospitals. "A farmer's! wife in this neighbourhood, her daughter, and two sons, were all em- ployed in milking the cows when this disorder prevailed among them. The mother had gone through the small-pox in the natural way, but the others had never had the small- pox. The latter, viz : the two sons and daughter, were infected from the cows, and the mother continued to milk them the whole time, without the least inconvenience. The daughter and two sons had a slight fever, and afterwards eruptions on the hands, by which they were much relieved of their fever. I had this account from one of the parties infected, and it may be depended upon. About three years since I inoculated between six and seven hundred, and I recollect one or two of the number who could not be infected. On inquiry I found they had previously had the cow-pox." The Rev. John Smith, of Wendover, to whom I owe many thanks for very willingly, at my request, taking upon himself the trouble of making inquiries in his neighbor- hood, informs met that the high land of his parish does not admit of dairying upon it, and the dairy farmers here know nothing of the cow-pox. But Mr. Henderson, the Surgeon in the parish, whose practice takes him a little into the vale, telis me, that he has met with the disease, and that a few years ago he three times endeavoured to inocu- late a lad, who had been used to milking, but could only excite inflammation upon the arm, without any pustulous appearance. And upon inquiry, he found the lad had pre- viously been affected with the cow-pox. Mr. Woodman, a Surgeon at Aylesbury, had met with the disease among the cow boys in the vale. Mr. Grey, a Surgeon of Bucking- ham, says the disorder is common among the milkers in his neighborhood. He had not been led to consider, particularly, the effects of the disease, but he remembers one boy possessed of the idea, that he could not take the small-pox by inoculation, because he had had the cow-pox, and that he could only excite redness upon the boy's arm. He thinks he recollects cases of boys having had the small-pox, after having had the cow- pox. The disease is not very notorious, for I passed some days last week with two intel- ligent farmers, one of them had kept seventy milk cows for many years past, but knew nothing of the cow-pox among his servants. The other knew as little.'' Mr. Giffard,|| Surgeon of Gillingham, near Shaftsbury, has been so good as to write to me on the subject of the cow-pox ; he informs me. "That it is a disease more known in Dorsetshire than in most other counties." "I last winter," says he, "inoculated three parishes, and some of the subjects told me they had had the cow-pox, and that they should not take the small-pox but I desired to inoculate them. I did so two or three times, but without effect. Persons never take the small-pox after they have had the cow-pox." Ou Thursday, June 14th last, happening, with Mr. Lucas, Apothecary, to be on pro- fessional business at Mr. Wilan's farm, adjoining to the New Road, Maybone ; which * Mr. Downe's Letter, Bridport, August 1, 1798. t Mr. Downe'a Second Letter, Bridport, August 25, 1798. J Mr. Smith's Letter, Vicarage, Wendover, August 5, 1798. || Mr. Giffard's Letter, Gillingham, August 9. 1798. 202 Coic-Pox; George Pearson, M. 1). farm is appropriated entirely for the support of from 800 to 1000 milk cows; I availed myself of that opportunity to make inquiry concerning the cow-pox. I was told it was a pretty frequent disease among the cows of that farm, especially in winter. That it was supposed to arise from sudden change from poor to rich food. It was also well known to the servants, some of whom had been affected with that malady, from milk- ing the diseased cows. On inquiry, I found three of the men servants, namely, Thomas Edinburgh, Thomas Grimshaw and John Clarke, had been affected with the cow-pox, but not with small-pox. I induced them to be inoculated for the small-pox : and, with the view of ascertaining the efficacy of the variolous infection employed, William Kent and Thomas East, neither of whom had either the cow-pox or the small-pox, were also inocu- lated. Three of these men, viz : Edinburgh, East and Kent, were inoculated in each arm with perhaps a larger incision, and more matter, than usual, on Sunday, June 17th, by Mr. Lucas; and Dr. Woodville and myself were present. The matter was taken from a boy present, who had been inoculated fourteen days before this time, and who was oblig- ingly provided by Dr. Woodville. CASE 1. Thomas Edinburgh, aged twenty-six years, had lived at the farm the last seven years. Had never had the small-pox, nor chicken pox, nor, any eruption resembling that of these diseases, but the cow-pox, which he was certainly affected with six years ago. He was so lame from the eruption on the palm of the hands- as to leave his employ, in order to be for some time in a public hospital ; and he testified that his fellow- servant, Grimshaw, was at the same time ill with the same disorder. A cicatrix was seen on the palm of the hands, but none on the other part. He said that for three days in the disease, he suffered from pain in the axill®, which were swollen and sore to the touch. According to the patient's description, the disease was uncommonly painful and of long continuance : whether on account of the unusual thickness of the skin, which was perceived by the lancet in inoculation, future observation may determine. THIRD DAY.-TUESDAY, JUNE 19. A slight elevation appeared on the parts inoculated. No disorder was perceived of the constitution, nor complaint made. FIFTH DAY-THURSDAY, 21. The appearance on the part inoculated, of the left arm, was like that of a gnat bite, and Mr. Wackfel, apothecary to the Small-Pox Hospital, observed that the inflammation seemed too rapid for that ol the variolous infection, when it produces the small-pox. On the other arm there had been a little scab, which was rubbed off, leaving only a just visible red mark. No complaint was made. EIGHTH DAY-SUNDAY, 24. The inflammation on the left arm had subsided, and there was in place of it, a little scab. The right arm as before. Has remained quite well. Sent the patient with Mr. Wackfel to the Small-Pox Hospital, where he was inoculated a second time, with matter from a person present, who then labored under the small-pox. FOURTH DAY AFTER SECOND INOCULATION, WEDNESDAY, 27. A little inflammation appeared on the part inoculated of one arm, but none of that of the other. Except some slight pains and headache on Monday last, had remained quite well. EIGHTH DAY AFTER SECOND INOCULATION, SUNDAY, JULY 1. A little dry scab was upon each part inoculated. No symptoms of disorder had appeared. CASE II. Thomas Grimshaw, aged about thirty years. Had lived in town, at the farm only seven weeks, but six years ago also lived at this place, when he was affected with the cow-pox ; and he testified that his fellow- servant, Edinburgh, was at the same time ill of the same disease Grimshaw said he had pains and sore- ness on touching the axillte during the illness, but he got much sooner well than Edinburgh. On Tuesday, the nineteenth June, Grimshaw was inoculated in both arms, at the Small-Pox Hospital, from a patient then ill of the small-pox. THIRD DAY-THURSDAY, 21. A little inflammation and fluid appeared under a lens in the parts inoculated, as if the infection had taken effect. Remained quite well. SIXTH DAY-SUNDAY, 24. Inflammation which had spread near the parts inoculated has disappeared ; and now nothing was seen but a dry scab on them. Had not been at all disordered. He was inoculated this day a second time, as be- fore, at the Small-Pox Hospital. FOURH DAY-SECOND INOCULATION, WEDNESDAY, JUNE 27. Not the least inflammation from the last inoculation, nor any complaint. Cow-Pox ; George Pearson, M. D. 203 EIGHTH DAY-SECOND INOCULATION, SUNDAY, JULY 1. Not the smallest inflammation from the inoculation. Had remained quite well. CASE III. John Clarke, twenty-six years of age, had the cow-pox ten years ago at Abingdon, where he was under the care of a medical practitioner of that place. He was inoculated by Mr. Wackfel, at the Small-Pox Hospital, on Tuesday, June 29th, from a patient affected with the small-pox. THIRD DAY-THURSDAY, JUNE 21. There was inflammation, and a fluid in the parts inoculated; but these appearances were judged to be premature, with respect to the small-pox. SIXTH DAY-SUNDAY, JUNE 24. The appearances of inflammation and fluid in the right arm, were such as to make it doubtful whether or not the variolous infection had taken effect; but there was no such appearance on the leit arm, the in- flammation being gone. He was this day inoculated a second time at the Small-Pox Hospital, from a patient. EIGHTH DAY AFTER SECOND INOCULATION, SUNDAY, JULY 1. No effect but inflammation, and afterwards festering, from the second inoculation. The inflammation on the right arm, from the first inoculation, went off in a day or two after the last report. He had remained quite well in all respects. CASE IV. William Kent, thirty years of age, had lived at Mr- Willan's farm about eight weeks. Had never la- bored under the small-pox, but said he had gone through the chicken-pox ; and he had been told that he had been affected with a disorder, which was supposed to be the cow-pox, when he was four years of age. He was inoculated under the same circumstances as Thomas Edinburgh, by Mr. Lucas/ on Sunday, June 17. THIRD DAY-TUESDAY, 19. The parts inoculated were scarcely red, yet their appearance was such, when viewed under a lens, as to render it probable the small-pox would take place. Remained quite well. FIFTH DAY-THURSDAY, 21. The inoculated part of the left arm appeared red ; and on viewing it with the magnifier, a little bladder was seen in the middle. The same was the state of the right arm, but less evidently. Continued free from illness. Pulse 94 after walking two miles in a very hot day. EIGHTH DAY-SUNDAY, 24. The left arm was more inflamed, and a small flat vesication appeared in the middle of the inflamed part. The right arm was affected in the same manner, but in a less degree. It was not doubted that he was in- fected with the variolous disease, especially as he complained of soreness of the arm pits, and he has been very much disordered the two last nights, having had pain of his bones in general, and headache, and had felt very hot, but not chilly. Pulse was only eighty, and his tongue had the healthy appearance, nor was he thirsty. ELEVENTH DAY-WEDNESDAY, 27. Variolous eruptions in number, perhaps twenty or thirty had made their appearance. FIFTEENTH DAY-SUNDAY, JULY 1. Eruptions are in a suppurated state. Had been quite well, and he has continued his employ during the present hot week. CASE V. Thomas East, aged twenty-one years, he believed he bad never been affected with the small-pox, and certainly not with the cow-pox. There were several cicatrices, however, on his arms, exactly like those from the small-pox, and if the inoculation had not succeeded, I should have been disposed to conclude that he had already gone through that disease. He was inoculated by Mr. Lucas on Sunday, seventeenth June, at the same time, and under the same circumstances, as Thomas Edinburgh and William Kent, THIRD DAY-TUESDAY, JUNE 19. Only a just visible scab on the parts inoculated, and it was thought the infection had not taken effect. Remained well. Went to the Small-Pox Hospital, and was inoculated a second time. FIFTH DAY-THURSDAY, JUNE 21. Redness appears now in the parts inoculated, as if both the first and second inoculation had taken effect. 204 Cow-Pox; Georye Pearson, M. I). EIGHTH DAY-SUNDAY, JUNE 24. All the four parts inoculated were so much inflamed, that it seemed now doubtful, whether the small pox would come on. Parts first inoculated, less inflamed than those of the second inoculation; and the right arm more inflamed than the left. I ains of the axillae were complained of, which were a little swelled, and sore to the touch. There were no symptoms of fever. ELEVENTH DAY-WEDNESDAY, JUNE 27. About a dozen variolous eruptions were now out. No complaints were made. FIFTEENTH DAY-SUNDAY, JULY 1. Variolous eruptions were in a state of suppuration, Therd was a suppuration of the parts inoculated pretty much alike, from both the first and second inoculation. It was thought the second inoculation had excited inflammation in the parts first inoculated, which other- wise might not have taken place so soon, or not at all. Notwithstanding the hot weather for the last fortnight, the temperature being generally 68o to 78° of Fahrenheit's thermometer, the patients who took the small pox were so little disordered, that they con- tinued their daily work. No treatment was prescribed previously to inoculation, all the men being in health ; but every other day after it. for a fortnight, they were purged with salts, and directed to abstain from strong liquors, and to eat very little animal food. I did not require any further evidence than what I have already procured, in my own practice, to satisfy me, that the quantity of variolous matter does not influence the disease ; but on account of some late asser- tions. that the disorder is rendered milder by using a smaller quantity of matter in the above cases, a larger quantity was purposely inserted : yet milder cases than the above could not be desired, It should also be noticed that the three patients above mentioned, who did not take the infection on inoc- ulation for the small-pox. had their children soon afterwards inoculated, who all took the small-pox. These men lived in the same apartments with their children during the illness of the small-pox ; but not one of them was infected. We have seen in the above cases, five persons inoculated for the small pox, under the. most favorable eir cumstances for the efficaciousness of the infection ; two of them took the disease from o 'ce inserting vario- lous matter, but the other three were uninfected, although the matter was twice inserted ; and although they were exposed to infection, by living with their children while they were suffering under the small- pox. The three patients who did not take the small-pox, gave strong circumstantial evidence that they had been affected with the cow-pox, but not with the small-pox. The other two patients, who were infected with the small-pox, there is no reason to doubt were as credible persons as the former, and they attested that they had not had the small-pox ; which attestation being verified by their taking the disease, it would be injustice to question the other part of their evidence, th it they had not labored under the cow pox. For, as to the mere traditionary story of William Kent having the cow-pox, no circumstance supported the truth of it against the extreme improbability of a boy of four years of age, or under, suffering a disease which is contracted by handling the teats of cows in milking, when they are so difficult to manage, that male, instead of female servants, must then, generally, be employed. In some places, it seems the eruptive disease, which is known to medical men by the name of the chicken, or swine-pox. is called by the lower orders of people, cowpox, Mr. Giffard takesnotice that "there are two kinds of cow-pox," the one is attended with eruptions of the' skin in general, and sometimes produces pits ; but the other is a disease confined to the hands It is most probable that Kent's eruptive disease, when a child, was the chicken-pox, if he really had an eruptive disease. One of three reasons may be assigned for the above three patients not taking the small-pox : viz, 1. That they had already suffered the small-pox. 2. That they had not had this disease, and that their constitutions were not excitable at the time they were inoculated ; for one can scarce suspect the failure to be from the mode of inserting the matter 3. That they were not capable of infection with the small-pox poison, because they had undergone the cow-pox. In respect of the first assignable reason, it must be allowed that a person may go through the small-pox, and the disease be so slight, that it is neither noticed by the patient, nor by his friends. But such unobserved cases are extremely rare, and they bear so very small a proportion to the others, that for threesuch cases to occur together on the present occasion, seems to be barely a possibility. With regard to the second assigned reason, probably about one out of fifty persons does not take the small-pox by inoculation of the same matter, and in the same manner; and perhaps not more than one out of fifty of those who are not infected by a first inoculation, fail to be infected on a second inoculation. Ac- cording to this representation, then it appears to be a mere possibility that the smad-pox poison should not take effect, for the second assignable reason, namely, a peculiar disposition : especially as the patients were subsequently under very favorable circumstances, for being infected with variolous effluvia. With regard to the third assignable reason, as in so many instances now recorded, itappears that persons, who have undergone the cow-pox, are not susceptible of the small-pox ; and as the failure of the inoculation cannot be imputed with justice to the two other causesabove mentioned, it seems most reasonable to impute the inefficacy of the variolous poison in the above three instances to a state of inexcitability, produced by the cow-pox poison On making inquiries at Mr. Kendal's farm, for milch cows, on the New Road, Marybone, a female servant informed me that she labored under the cow-pox many yearsago, when she lived in Suffolk, where this disease prevails. From her description I could not doubt that she had really been affected with the cow- pox. After this she took, what she believed to be the small-pox, from an infant, which was nourished by her breasts. A fever preceded the eruptions, which were only about fifty in number, and they disap - peared in a few days after they came out. If the latter part of this testimony is accurate, one cannot adroit this case to be an example of the small-pox, taking place in a constitution which had previously been af fected wtih the cow-pox. * At this farm, a cow was shown to me which was said to be affected with the cow-pox : on examination, the disorder appeared to be in its last stage of desiccation. However, eight persons, who had not undergone the small pox, were inoculated with the scabs of this disorder, but no disease ensued. Ou calling at Mr. Rhodes' milk farm on the Hampstead Road, where there is a very large stock of cows, I found the cow-pox had not fallen under his observation ; but two of the male servants were well acquainted with some parts of its history. It appeared also on inquiry, that one of the cows had really labored under the disease two months before, namely, in May last, but the milker was not infected, because he said thefe were no cuts on his hands, or abrasion of the cuticle. It was described very clearly to be a different disease from the common inflammations and eruptions which produce scabbed nipples. One of the male servants Cow-Pox ; George Pearson, M. D. 205 had often seen the disease in Wiltshire and Gloucestershire. The milkers, he said, were sometimes so ill, as to lie in bed lor several days, and there was a fever at the beginning, as in the small-pox. but that no one ever died of it. He had known many persons who had laboured under the cow-pox, but who had- never suffered the small-pox, although it prevailed in their own families ; except in one instance in which he was told that the person who took the small-pox, had gone through the cow-pox when a child. The same servant said it was a common opinion, that people who have been affected with the cow-pox, to use his own words, are "hard to take the small-pox." Mr. Francis, who keeps a farm for milch cows on the road to Somers'Town, had seen the disease several times in the autumn among his cattle, and he knew that it was very apt to produce painful sores on the milkers : but he had never heard, or observed, that it prevented persons from having the small-pox. He said that three years ago, in the spring, the disease prevailed at several farms on the New Road. A male servant of Mr Francis, who has a good understanding, and is a man of veracity, and had lived in dairy farms all his life, stated, "that he had seen the cow-pox thirty-five years ago at King's Wood, in Somersetshire, and frequently there, and in London since that time. The disease, he said was thenvul. garly called ths cow-pox ; it appeared on the teats and udders with fiery or flame like eruptions-was very infectious among the cows and the milkers; but never knew either human creature, or beast die of it. It affects the hands and arms of the milkers with painful sores, as large as a sixpence, which last for a month or more, so as to disable the sufferers from continuing their employment. The disease breaks out especially in the spring, but occasionally' at other times of the year. Most of the cows in his master's, Mr, Francis; farm, were infected three years ago in the spring at which times many of the milkers were also infected- A new cow is very liable to take the disease. He had always understood that a person who had had the cow' pox, could not take the small-pox, and never knew in the course of his life an instance of the small-pox in such persons. The following instances fell under his own observation : a fellow male and a female servant were affected with the cow-pox ; some time after this, the parish in which they lived were in general inoculated for the small-pox, but these two persons, who had never labored under the small pox, covld not be infected with this disease; nor did they take it, although they subsequently lived with their children while they were suffering the small-pox. Ho also believed, audit was a common opinion in many parts of the country, that persons who have undergone the small pox cannot take the cow pox. He himself labored under the inoculated small-pox when seventeen years of age, but never took the cow-pox, although he had milked a great number of cows laboring under the disease. He had never known either a human creature, or cow have the disease more than. once. He had the measles previously to the small-pox, as well as the hooping cough. At some other farms, near London, where milch cows are kept, I found the disorder was not known either to the masters, or servants, Dr; Haygarth very kindly wrote me a letter from Bath, on the 30th of August last, in which he says. "To none of your questions" concerning the cow-pox, can I give any answer from my own knowledge. Of such a distemper. I never heard among the Cheshire, or Welsh farmers. My first intelligence upon this subject came trom my friend, Dr. Worthington, of Ross, some time ago. He, as well as another friend, Dr. Percival, speak very favorably of Dr. Jenner, on whose testimony the extraordinary facts he has published at present principally depend." I feel most sensibly the great favor shown to me by Professor Wall, of Oxford. Although this gentle- man's zeal and ability in promoting useful inquiries are acknowledged, I cannot but attribute the great pains which he bestowed to procure answers to my queries in so short a time as I required, in part, to the friendship founded in the days of academical studies ; to use this amiable gentleman's own words-"those days of tree, manly, and liberal conversation which I reflect on with infinite pleasure. The information belonging to this place, from Professor Wall,* is the answer to the question, whether there is sntficient evidence that the small-pox cannot infect a person who lias once had the cow-pox, at- tended with fever: and if there has been a local affection without fever, is such person still capable of tak- ing the small-pox ? "I receive but one answer to the two different modes of the question, which is, that any person who has ever had the cow-pox. has never been known to have the small-pox." A servant who has kept the cows of a considerable dairy-farm in this neighborhood a great many years, told me that he had the cow-pox early in life. Yet about six or seven years ago he wished, for security, to be inoculated for the small-pox-the operation was performed three several times, but no disorder nor eruption ensued-the Surgeon, a gentleman of great eminence in this place, asked him if he had ever had the cow-pox ; upon his answering yes, the Surgeon replied. Then it is useless to make any farther trial. This servant, the next year, had several children inoculated by Sutton. He was with them all the time till their recovery, but din not receive the infection. A servant-girl at another considerable farm, told me she had the cow-pox early in life ; several years after she was inoculated, but nothing took place, except the appearance of red blush round the incision similar, I suppose, to what Dr. Jenner mentions . This red suffusion has been hastily, by some inoculators, regarded as a proof, that the system has been infected with the virus of the small-pox ■ but neither this appearance, nor even a much more considerable affection of the arm is always sufficient security against future infection, unless, there has been some erup- tion.-See Memoirs of the Medical Society." From Mr. Dolling, an Inoculator at Blandford. I have received important intelligence, for which I am under further obligations to the Rev. Herman Drewe.t "Mr. Dolling has inoculated for the small pox a great number of persons, who said they had been affected with the cow-pox, and very few of them took the infection, to produce the small-pox, and he is of opinion that those who took the small pox, were mistaken in supposing they had really labored under the cow-pox. In one family five out of seven children took the cow-pox, by handling the teats of a cow affected with the cow-pox ; these seven children were inoculated for the small-pox, but none took the infection, except the two who had not labored under the cow-pox. Dr. Croft tells me, that in Staffordshire, to his knowledge, the fact has been long known, of the cow. pox, which prevails in that county, affording an exemption of the human subject from the small-pox. This gen- tleman affords me an unequivocal proof of his conviction of the safety and efficacy of the inoculated cow- pox, by his application to me for matter, in order to inoculate one of his own children. My honorable friend. Mr. Edward Howard, has been assured on very good authority, that of a relation, who is an officer in the Oxfordshire Militia, that it is a received opinion among the soldiers, thatitisun- necessary to be inoculated for the small-pox, if they have already labored uider the cow-pox, as many of them have done. Dr. Redfearn of LynnJ informs me, that "the cow-pox is a common disease among the cattle in this part, and the fanners have made use of the appellation cow-pox for near thirty years, although totally ignorant of the disease existing in the West of England." But, *See Dr. Wall's Letter, Oxford, September 3, 1798. tThe Rev. H. Drewe's Second Letter, Septemder 17, 1798. jDr. Redfearn's Letter, September 15 1798. 206 Cow-Pox ; George Pearson, M. D. Dr. Alderson, of Norwich* acquaints me. that there is reason to believe the disease is not known in his neighborhood. My correspondents in the North and East Ridings of Yorkshire, in Durham, in Lincolnshire, and in the neighborhood of Windsor, acquaint me that the cow-pox is not known in those parts, but from the- saccess which I have had in discovering the disease, by making a strict inquiry in farms, where it was be lieved not to exist, I can scarce doubt that it breaks out occasionally in every part, where a number of cows are kept, and that the infection is widely disseminated Ido not find that the cow-pox is known in Lancashire. Dr. Currie, t of Liverpool, obligingly answers my letter; he says, 'I have made inquiries among the farmers, but I have not been able to find one who is acquainted with the disease. Of course I cannot answer any of your queries. My friend, Dr. Percival, of Manchester, who is now here, never heard of the cow-pox in this county, any more than myself." II. Person who have been affected with the specific fever, and peculiar local disease, by inoculation of the cow-pox infection, who had not previously, undergone the small- pox, are thereby rendered unsusceptible of the small-pox. The first set of evidences of this fact are those of Dr. Tenner, in the cases xvii, xix, xx, xxi, xxii, xxiii. They are insances of inoculation of the cow pox as in the small-pox, with matter taken from the teats of cows. A fever like that of the small-pox arose in six to nine days after the incision, but scarce of more than twenty-four hours, duration; attended with an inflammatory appearance, or erythematous efflores- cence around the parts inoculated, and pustulous sores of those parts ; which do not suppurate, but remain limpid till they disappear,; and there is no eruption of other parts of the skin, as in the small-pox. In the cases of inoculation under Dr. Jenner, the local affection was commonly as slight as in the inocu- lated small-pox, but sometimes there appeared a disposition to a more extensive inflammation of the skin around the parts in which the matter was inserted. "It seemed to arise from the state of the pustule, which spread out accompanied with some degree of pain, to about half the diameter of a sixpence. By the application of mercurial ointment to the inflamed parts, (as is practised in the inoculated small pox) the complaint soon subsided. To prevent inflammation of the skin, caustic was also applied to the vesicle of the inoculated part, to excite a different kind of inflammation ; but the precaution was perhaps unnecessary, as a third patient had nothing applied, and the arm scabbed quickly, without any erysipelas. One of these patients inoculated with the cow-pox was only six months old, and who took the disease. In none of the above eases, after the cow-pox; could the small-pox be excited, by repeated inoculation. The confidence of Dr Jenner, in the safety and efficacy of the inoculation of the cow-pox is unequivocally de- clared by the inooulation of his own son, R. F. Jenner, aged e.levenmou ths; although the poison did not take effect in this instance. The project of inoculation of the cow-pox occurred to other practioners, antecedently to Dr Jenner's experiments. Mr. Drewe, in his letter above cited, speaks of the practice. He says, "Mr. Bragge and I endeavored to try the experiment of inoculating with the matter of the cow-pox, but from the scarceness of the disease, and unwillingness of patients, we were disappointed." Mr, Pulteney informs me, that "a very respectable practioner acquainted him that of seven children whom he had inoculated for the small-pox, five had been previously infected with the cow-pox purposely, by being made to handle the teats and udders of infected cows; in consequence of which, they suffered the distemper. These live, after inoculation for the smallpox, did not sicken; the other two took the dis- temper." Farther. "A farmer in this country inoculated his wife and children with matter taken from the teat of a cow. At the end of a week the arms inflamed, and the patients were so far affected, as to alarm the farmer, although unnecessarily, and incline him to call in medical assistance. They all soon got well, and were afterwards inoculated for the small-pox, but no disease followed. I was not applied to in this case, but the fact is sufficiently ascertained." Mr. Downe furnishes me} with important information on the present fact. "R. F. rear Bridport, when about twenty years of age, was at a farm house when the dairy was infected with the cow-pox. It being suggested to him that it would be the means of preserving him from the small-pox, which he had never taken, if he would submit to be inoculated with the cow-pox; he gave his consent ; he was infected in two or three places in his hand with a needle. He felt no inconvenience till about a week, when the parts began to inflame, aud his hand to swell, his head to ach, and many other symptoms of fever came on. He was recommended to keep much in the open air, which he did, and iu four or five days the symptoms of fever went off, as the maturation of the hand advanced. The parts soon healed, leaving permanent scars. He was afterwards inoculated twice by my grand-father, and a considerable time after twice by my father, but without any other effect than a slight irritation of the part, such as is occasioned in the arms of' persons Who have already had the small-pox. It was not expected at the time, that the small-pox poison would be effectual, but it was inserted, partly by way of experiment, and partly by way of precaution, the small-pox being then in the family. The small-pox has been repeated since in his own family, and he never avoided it, being confident that it was not possible to infect him with this disease, The next case by Mr. Downe. although it affords defective evidence, is not useless. "I have lately conversed with a person who was in play, inoculated in the hand with the cow-pox matter. The wounds apparently healed for a time, and then inflamed. He had a swelling in the axilla, pain in the head, sickness, and slight fever. No eruption took place, but there was much maturation at the place of insertion, and considerable scars remain " Next hear what Piofesser Wall says in his answer to the question, "Whether the disease has been com- municated by inoculation, and whether it has produced a milder or more severe disease than in the casual way J" "I have|| not yet learnt that this disorder has, in this part of the country, ever been propagated by inocu- lation designedly. It has been communicated to persons who have had slight wounds from thorns, abra- sions of the skin from other causes, perhaps more readily than iu the common way ; but it has not ap- peared that the character or severity of the disorder has been altered by this circumstance." Mr. Dolling,§ of Blandford, communicates the following: "Mr. Justings of Axminster inoculated his wife and children With matter taken from the teats of a cow that had the cow pox; in about a week after inoculation, their arms were very much inflamed, and the patients were so ill, that the medical assistance of Mr. Meach, of Cerne, was called for. The patients did well. They were afterwards inoculated for the small-pox by Mr. Trobridge, without effect. *Dr Alderson's Letter, Norwich. September 16. 1798. !Dr. Currie's Letter, Liverpool, September 8, 1796» JSee Mr. Downe's Letter of August 25, 1798. llProlessor Wall's Letter, above cited. §Mr. Drewe's Second Letter, above cited. Cow-Pojc ; George Pearson, M. I). 207 III. The disease produced by inoculating with the nm-tter of the cow-pox. doesnot differ from the disease produced by inoculation with the matter from the human animal ; nor is any difference observed in the effects of the matter from the first human subject infected from the brute animal, or from the matter generated successively, in the second, third, fourth, or fifth human creature from its origin in the brute. This important fact, at present, is only supported by the instance related by Dr. Jenner, in the cases xix to xxiii, p. 37 to 14. Hence, according to these instances, the poison of the cow-pox has the same properties, as appears from its effects on the human constitution, whether it be generated by the cow, or by the human animal; and these properties are the same, however remote from the origin of the poison in tlie cow. But it has not been determined by inoculating the teats of cows with the matter taken from the cow, and with that taken from the human creature ; that the properties of the poison from this latter source are the same with regard to the brute, as those of the matter from the cow with regard to the same animal. I apprehend that the cow-pox is the only example at present known, of a permanent specific infectious disease in the human constitution, produced by matter from a different species of animal; but it has been often conjectured, that many of the infectious diseases of the human species are derived from brutes. IV. A person having been affected with the specific fever, and local disease, produced by the cow-pox poison, is liable to be again affected as before by the same poison ; and yet such person is not susceptible of the small-pox. I find that most part of professional men are extremely reluctant in yielding their assent to this fact. Some, indeed, reject it in the most unqualified terms. They are not averse from admitting the evidence, that the cow-pox may affect the same constitution repeatedly ; or even that a person having had this disease,' is unsusceptible of the small-pox ; but that the constitution having suffered the cow-pox, should still be susceptible of this disease, and not be susceptible of the small-pox, is an assertion with regard to which they demur to acquiesce. The unfavorable reception of the evidence for this fact does not seem to arise so much from the observations in support of it, being suspected to be inaccurate, or sufficiently full and com- plete, as from its appearing, as they say, absurd and inconceivable. On inquiring why the fact appears in this light, we find it is because there is no support from any other analogous fact. There is. in reality, no analogous fact. We have facts which show that a person having undergone certain diseases, occasioned by particular poisons, in some instances is, and iu others is not, again susceptible of the same disease, by the same poison ; but the instance before us is the first which has been observed of the corsitution being, rendered inexcitable to a disease, from a given morbid poison, by having suffered a different disease from another different poison, and yet it remains suspectible of this different disease by this given morbid poison. In the first instance of certain new facts, it is easy to conceive that there may be no analogous fact to the one discovered. When the small pox first broke out, on its being discovered that the same constitution could not undergo this disease a second time, no analogous fact was, I think, then known; and on that account it probably was not admitted without much hesitation. But on a subse- quent discovery that the same constitution could not be infected more than once with the measles, this, as well as the former fact, readily found acceptance. An evidence for a fact ought not to be rejected, because it is incomprehensible or inconsistent with what is already known ; but on the present occasion, if the subject be well considered, it does not seem to be difficult to conceive that a change may be effected in the human constitution, by a disease from a morbid poison, so as to render such constitution unsusceptible of a disease from a given different morbid poison, and yet such constitution shall remain susceptible of the former disease, from the former morbid poison. Hence, I apprehend, the only just ground of objection which may be taken, is that of the observations on the authority of which the fact is said to be established, Let us then state the evidence. Under Case ix. p. 21, Dr. Jenner relates the history of a person who was first affected with the cow-pox in the year 1780, a second time in 1791, and a third time in 1794. "The disease was equally severe the second and third time as it was the first," w'hich is, in general, other wise both in the brute and human kind. Inoc- ulation of the variolous poison was twice instituted in this patie. t, but without producing disease, nor could the patient be infected by association with persons laboring under the small-pox. Another patient (see Jenner, p 51.) suffered the cow-pox in 1759 ; in 1797 he was inoculated with the variolous poison, but without exciting the disease, In 1798 the cow pox again took place With respect to the information which I have gained by my inquiries, concerning this fact; some of my correspondents observed, that the cow-pox occurred so seldom among the human kind, that they had no observations to determine, whether a person could undergo the disease more than once ; the greater part of my correspondents ventured to say, that it had never been seen more then once in the same person ; but some testified that the cow-pox certainly does take place, repeatedly, in the same constitution. Mr. Woodman, of Aylesbury,* says, "the cow-pox does not supersede itself ou future occasions, for that cow-boys have it repeatedly." It may be worth while to notice, that none of the gentlemen of whom I made inquiries, knew an instance of the disease attacking the same cow more than once ; and it was said that it was the current opinion that this was a fact. The evidence for this fact, to my apprehension, only proves, sa-isfactorily, that the local affection of the cow-pox may occur in the same person more than once ; but whether the peculiar fever also occurs more than once iii the same person, from the cow-pox poison, does not appear certain; and must be determined by future observations, to be made with a particular view to this point. Future observations must likewise determine, whether, in those cases, (if such occur) in which a person, after having gone through the cow- pox, takes the small-pox the cow-pox was attended with the fever, or was merely a local affection. It seems pretty well ascertained, that the variolous poison may produce the small-pox only locally, or without any affection of the constitution ; and in such a case, the constitution is still susceptible of the small-pox, and yet. in both cases, viz: of the local affection only, and of the whole constitution, the matter of the eruptions is capable of infecting others, so as to produce the small pox : either locally only, or also in the whole con- stitution. Hence it seems probable, that similar local and general effects may be produced by the cow-pox poison, and not only in the human kind, but in cows. lacknowledge, however, that the case, p 51. in Jenner's book, militates against this supposition. * V. A person is susceptible of the cow-pox, who has antecedently been affected with the small-pox. *See Mr.'Smith's Letter, above cited. 208 Cow-Pox; George Pearson, M. D. Dr. Jenner, pp. 15-19, gives some instances of persons taking the cow-pox who had certainly gone through the small-pox. But lie says,* " It is a fact so well known among our dairy farmers, that those who have had the small-pox either escape the cow-pox or are disposed to have it slightly : that as soon as the complaint shows itself among the cattle, assistants are procured, if possible, who are thus rendered less susceptible of it, otherwise the business of the farm could scarcely go forward." I have not got much additional information on this fact. It seems, however, sufficiently authenticated that people may have the. cow-pox after they have had the small-pox, but it will require more nice attention to satisfy the query whether, in such cases, the cow pox affects the whole constitution or is only a local affection ? Mr. Downe*, in particular, speaks of a family who did not take the cow-pox when much exposed to the infliction, because they had all gone through the small-pox, except one who had been afflicted already with the coW-pox. I met with a servant at Mr. Rhodes' farm, on the Hampstead Road, who attested that he had Buffered the cow-pox fourteen years ago, but that long before that time he had gone through the small-pox. Professor Wallt says: " The answer to the question whether a person is capable of taking the cow-pox who has gone through the small-pox, is of some decidedly that such a person is not liable, to the infection of the cow-pox. Others of equal experience have answered this question with doubt." At Mr. Rhodes' farm, at Islington, I found that one of the male servants who had been long employed in taking care of milk cows in the environs of London, distinguished the cow-pox very clearly from common inflammation of the teats with scabs, with which several cows were at the time that I saw this man affected. He had never contracted the cow-pox, although he had been r epeatedly exposed to the infection, ami when others took it. He was deeply pitted with the small-pox, which he labored under when a young child. VI. The cow-pox is not communicated in the state of effluvia or gas, nor by adhering to the skin in an imperceptably small quantity, nor scarce, unless it be applied to di- visions of the skin by abrasions, punctures, wounds, etc. Some morbific poisons are communicated to animals only7 in the state of invisible effluvia or gas, e. g. the miasmata which produced intermittent fevers : the contagion which produces the ulcerous sore throat, that which occasions the whooping-cough, the measles, etc. Other morbific poisons are communicated both in the state of effluvia and in a palpable or visible quantity, e. g. the var iolous poison, the matter which pro- duces in oxen, the murrain or loose bovilla, etc. Others again are not propagated in the state of effluvia or gas, but in a palpable or visible quantity only, as the hydrophobic poison, the syphilitic, etc., and to these last must now be added the morbific poison of the cow-pox. It does not appear that the disease spreads from any infected cow among other cows which are fed in the same stable like a contagious disease. Persons wlio sleep in the same bed with one who is laboring with the cow pox are not in this way liable to be infected. (See Jenner, pp. 68, 69.) It is not even propa- gated from the cows to the milkers for the most par t, unless the skin of the part of the hands to which the matter is applied be divided. This property of the cow-pox infection not being propagated so as to pr oduce disease, but by contact- and then only when applied in a palpable or visible quantity, and also scarce unless the skin be divided, is the most important one. Yet a few instances I apprehend will suffice to show clearly under what circum- stances the cow-pox infliction produces disease. A boy who was inoculated for the cow-pox slept, while he was laboring under the disease, with two other boys, but neither of them by this exposure to the affliction got the cow-pox. A young woman who had the cow-pox, with several sores, which maturated to a great extent, slept in the same bed with a fellow dairy maid who never had been inflicted either with the cow-pox or small-pox, but the disease was no* communicated. A young woman, on whose hands were several large suppurations from the cow-pox, was a daily7 nurse to an infant, but the infant was uninfected. (See Jenner, pp. 68-69.) I am instructed uniformly by7 my correspondents that the cow-pox arises only from matter evidently ap- plied most frequently by friction of the diseased teats in milking, but sometimes from the matter lodging accidentally7 in some soft part, yet even under the circumstance it frequently fails to infect unless there be a cut, scratch, puncture, etc., of the hands. Mr. Drewe mentions the instance of a woman who lost her eyesight in consequence of the infectious matter being heedlessly applied to the eye, and that the cow-pox has been observed to take place from handling the milk pall on which the infectious matter has been incautiously allowed to remain. VII. The local affection in thecow-pox produced in the casual way is generally more severe and of longer duration than usually happens in the local afflictions in the inocu- lated small-pox, but in the cow-pox the fever is in no case attended with symptoms which denote danger, nor has it in any instance been known to prove mortal. The cow-pox in the incidental way, for sufficiently obvious reasons, most commonly affects the palms of the hands There is a wide difference in the degree of a local affection. I am instructed by my communi- cations that the extreme cases are, firstly, those in which the patients are inflicted with so much painful inflammation as to be confined to their beds for several days, and have painful phagedenic sores for several mouths. Secondly, those cases which are so slight that the patients are not confined at all, but get well in a week or ten days. In the more severe cases, in which the inflamed spots become vesicular with edges of the pustules more elevated than the cuticle, and of a bluish or a purple color ; there are pains of the axilla, fever and now and then a little delirium. These symptoms continue from one to three or four days, leaving ulcerated sores about the hands, which, from the sensibility of the parts, are very troublesome, and commonly heal slowly, frequently becoming phagedenic, like those from which they sprung. The lips, nostrils, eyelids and other parts of the body are sometimes affected with sores, but these evidently arise from their being heedlessly rubbed or scratched with the patient's inflicted fingers. Dr. Jeni.er considers the bluish or livid tint of the pustules to be characteristic of thecow-pox. P. 5. Mr Drewe's information on the fact is, " That the symptoms are similar to the small-pox, but less violent- The pustules are only about the hands, in the parts which have been in contact, with the infected teats.'' 'Mr. Downe's letter of August 30. Letter of Professor Wall, abovo citai Cow-Pox ; Ceorge Pearson, M. D. 209 But in answer to the question whether on the whole the cow-pox is a disease of less magnitude than the small-pox by inoculation, he says : " When I consider what a slight disorder the inoculated small pox is. it will not, in my humble opinion, admit of comparison," Mr. Dolling says : ' ' There is a swelling under the arm, chilly tits, etc.. not different from symptoms o f the breeding of the small-pox. After the usual time of sickening, namely, two or three days, there is a large ulcer, not unlike a carbuncle, which discharges matter." Dr. Pulteney's account of the symptoms is in these terms: "A soreness and swelling of the axillary glands as under inoculation for the small-pox, then chilliness and rigors and fevers as in the small-pox. Two or three days afterwards, abscesses, not unlik,- carbuncles, appear generally on the hands and arms, which ulcerate and discharge much matter." Mr. Downe, speaking to this point, says: " The symptoms, as far as could be ascertained in the cow' pox. were similar to those of the small-pox, but I never heard of any who had them in any degree alarm ing." Again. " the symptoms are exactly similar to those of the small-pox by inoculation, when of the most favorable kind. The disease generally disappears in about the same time that the small-pox does." Mr. Giffard tells me that " he never heard of either men or cows dying of the cow-pox." Mr. Woodman (see Mr. Smith's letter) testifies that he never observed symptoms worthy to be called fever; there was merely "feverish heat when the pain was considerable." Dr. Derails observes thatone of the persons affected with the cow-pox "was much struck with the re- semblance to the symptoms he had lately experienced in the small pox." Professor Wall's information is that "the milkers have the disorder only once, generally with preceding fever, sometimes very violent, sometimes more mild." "No human creature, or cow. has been known to be in danger , or to die of the cow-pox." After a strict inquiry at the milk farms adjoining to London, I could not find that any person had died of the cow-pox. With respect to the animals from which the human creature der ives the disease, it is known only to effect cows. They have, sometimes, but it is very seldom observed, a disorder of the whole constitution, "the secretion of milk being much lessened." The local affection appears with irregular pustules on the nip- ples. "At their first appearance they are commonly of a palish blue, or, rather, of a color somewhat ap- proaching livid, and are surrounded by an erysipelas inflammation. These pustules, unless a timely rem edy be applied, frequently degenerate into phagedenic ulcers, which prove extremely troublesome. (See Jenner, pp. 3 and 4.) Dr. Pujtenev acquaints us, that " the disease makes its appearance on the udder of the cow, and affects the teats principally, which inflame, then ulcerate, discharging a bloody matter; but it does not appear that the disease is more local, as the cows seem not to be out of health in other respects." From Dr. Drewe's testimony, however, it appears that the whole constitution of the cow is affected- Tnere being -'loss of appetite and of milk," as well as "ulcerated teats," so as to render the animal, in some cases, totally unfit for the dairy. " It is infectious in the herd, and the infection is probably con- veyed by the person's hands that milks them." Mr. Downe's information, relating to the present part of our inquiry, is that "the only symptoms were eruptions about the teats of the cow, exactly similar to the small-pox, which gradually become sore, and fall off; and the. infection was soon communicated to a whole dairy, as was supposed by the hand of the pei son who milked. The animals suffered much in the operation of milking." Professor Wall mentions that the symptoms are "blue or livid blotches on the teats and udder, painful and suppurating. The cows are seldom ill, so as to refuse their food. Others observe, that cows being naturally disposed to a lax habit of body, are not so much afflicted with feverish symptoms. Some say cows suffer no fever at all," The testimony of several other correspondents have been already stated, that a.cow has never been known to die of the cow-pox; to which I add in confirmation, that of the milk farmers near London. VIII. No consequential disease, which should be attributed to the cow-pox has been observed; nor has any disease been excited, to which there previously existed a disposi- tion ; nor has it been discovered to produce a predisposition to particular diseases. Although a considerable body of evidence might be stated in confirmation of these momentous facts, from the experience of Dr. Jenner, and the uniform testimony of my correspondent; and although we should be inclined to conclude in favor of these facts, from the consideration of the m ture of the cow-pox, as far as yet known, yet it does not. appear to my judgment that the observations and arguments warrant more than conclusions on the side of great probability. A number of persons, many hundreds, have gone through the inoculated small-pox; yet no one doubts that, in a certain proportion of instances, disease has been excited and disposition to disease been produced. We are led then to think that a greater number, and more accurate observations are wanting, to author- ize positive conclusions relating to the facts stated under this VIII head. IX. The cow-pox infection may produce the peculiar local disease belonging to it, but without the difference of the constitution ; in which case, the constitution is liable to be infected by the small-pox infection. This fact is not of small consequence either in respect of general pathology or practice. Dr. Jenner's work, n 71, furnishes us with an unequivocal example of this fact. A woman was affected with the local disease of the cow-pox in the ordinary way, but without any pains or swelling of the axilla, or any disorder of the whole constitution, this person was subsequently afflicted by the small-pox; but a fellow- servant who had suffered with the cow pox, (at the same time and from the same source of infectious matter,) in which there was fever as well as local disease, could not be infected by inserting the small-pox poison; even repeated trials for this purpose were successless. Hence, they who offer as evidence in- stances of persons taking the small pox after they have gone through the co-w-pox, will do well to assure themselves that the whole constitution was affected in the cow-pox, otherwise such evidence will be inad- missible. Analogous facts have been ascertained, on good authority in the small-pox, although the in-1 stances are too scarce to afford too scrupulous miuds full proof. It has been found that the usual loca 210 Cow-Pox; George Pearson, M, 1). disease of the inoculated small pox may occur, unattended by a disorder of the whole constitution ; but yet the matter of such local small pox will, in other persons, produce not only the local disease, but general eruption and fever; and that the person who had undergone this local small-pox only, will be infected at a future time, so as to have both the ordinary local disease and fever of the small-pox with eruptions. It appears from the observations of Dr. .Tenner, page 50, Mr. Drewe, Dr. Pulteney. and others, that during the cow-pox in the human subject, inflammation and sores are apt to be excited by the matter being lodged upon various parts, especially if the skin be, divided ; but no mention is made of fresh fever being excited, nor of the peculiar livid and bluish tint of the cow-pox pustulous sores. Enough has been said in a preced- ing part of this paper to direct observers in future to ascertain more accurately the effects of the agency of the cow-pox infection on the whole constitution, and on part of it only. It will be necessary also to caution inquirers against the errors of admitting facts to belong to the cow- pox, as understood in this paper, which, in lealitv, belong to thechicken-pox, or swine-pox, in some provincial situations, are designated by tire name of the cow-pox. Yet another caution is necessary in investigating the truth, namely, to distinguish from the cow-pox. " the pustulous sores which appear spontaneously on the nipples of the cows; ami instances have occurred, although very rarelv, of the hands of the servants employed in milking beihg affected with sores in conse- quence. ami even of their feeling an indisposition from absorption. These pustules are of a much milder nature than those which arise from that contagion, which constitutes the true cow-pox. They are always free from the bluish or livid tint so conspicuous in the pustules in that disease. No erysipelas attends them, nor do they show' any phagedenic disposition, as in the other case ; but quickly terminate in a scab, without creating any apparent disorder in the cow." Like the cow-pox, "this eruption appears most com- monly in the spring, when the cows are tirst taken from their winter food, and fed with grass. Jenner, p. 7. I observed during my visits to the cow stables near London, in August and September last, that a num- ber of cows were infected with eruptions, sores and scabs on their breasts, especially on their paps. None of the animals had any constitutional affection, nor could I learn that any of the milkers were infected The eruptions now spoken of break out, as I was told, especially in new comers. Fresh cows, it was said, were apt to be thus affected, on account of the much richer food which is given in London than in the country. The same kind of sores, eruptions and scabs (which must be distinguished from the cow pox), I apprehend are common in the country ; of which the following testimonials will be useful. Sir Isaac Pennington, who could not learn that the cow-pox was prevalent in Cambridgeshire, says, " I find cows are liable to inflammation of the. udders, but they do not affect the hands of the milkers." A number of milch cows are kept near Twickenham, and the Beauchamp* surgeon gave himself much trouble to oblige me. by making inquiries according to the direction of my queries. He instructs me, "that all the cow-keepers agree that warts, and small bladders, or pustules, appear frequently on the teats of the cow. but never observed the animal, or the milkers, to be affected, not even when these pustules were burst by the hands of milkers who had never suffered the small-pox. Dr. Beckwith, of York, who well merits my best thanks, bestowed great pains in making inquiries among the medical practitioners in bis neighborhood, and the farmers. His report is, "It am well satisfied that no such disease as the cow-pox has ever appeared here in the memory of man ; but soreness and chops of the paps are observed, from distension by milk in summer, never in winter, without affecting the hands of milkers." In the Pentex bovilla. or murrain, the breasts, and especially the. paps, are sometimes affected with pus- tules, or tubercles^; which, however, seem to be in that disease the least of the unfavourable symptoms. Dr. Belcombe, of Scarborough, in his obliging letter, observes, || "there is a disease of the paps, which renders them exceedingly sore and difficult to milk, but it is not infectious, and the same cow has it many t imes ; nor are the bands of the milkers ever sore from it. It commonly happens in hot and wet summers." On considering the facts of the preceding history, it appears that some useful conclusions ot a practical kind may be drawn from them. I. The body of evidence is numerous and respectable, declaring that a person who has labored under the cow-pox fever, and local eruption, is not susceptible to the small- pox. It does not appear that a single well authenticated contravening instance has fallen under observation. But I do not apprehend that accurate and able reasoners will consider the fact as completely established; though I doubt not they will allow that the testimonies now produced greatly confirm the probability; and that the cautious appro- priation of it, in practice, is warrantable. In the present inquiry the attestations have been obtained from so many persons, that it seems highly improbable, indeed, that the contrary instances should have been unob- served. or purposely kept out of sight. If the fact had been supported by the testimony of one observer only, the experience of the world would have justified us in demanding the account of the failures; after the example of the keen skeptic of old, who, on being shown the native tablets of those who had been preserved fiom shipwreck, instead of yielding his assent, replied, " Where are the tablets of those who have perished ?" § * Mr. Beauchamp's Letter, Trickenham, Sept. 18, 1798. t Dr. Beckwith's Letter, York, Sept. 19, 1798. J Illos duntaxat boves, and quidem admodum raros, mortem effugiffe quibns abscesaus ac decubitus informant tuberculorum, scabici. depilationis, vel rbagadnm, in ubenun papillis tieri contegerit.-Lancisi de bovilla peste, pag. 3, tom. 2, No. 134. || Dr. Belcome Letter. Scarborough, Sept. 22, 1798. § Intellectns humanus in iis qme semel placuerunt (aut quia recepta font et credita, ant quia delectant) alia etiam omnia trahit ad suffragationem et consensum cum illis. Et licet major sit instantiarum vis et copia quae occurrunt in contrarium ; tamen eas aut non observat aut contemnit, aut distinguendc summovit et re,jicit, non sine magno etperniciosopraejudicio quo prioribus illis syllepsibus authoritasmaneatinviolata. Itaque recto respondit, qui, cum suspensa tabula in templo ei manstraretur eorum, qui vota solverant, quod naufragii periculo elapsi sint, atque interrogando premeretur, anne turn quidem eorum numen agnosceret, quwsivit den no; At ubi hunt Uli depicti qui post vota nuncupata perierunt!-Verulamii Novum Organum, Aphor. XLVI. Coic-Pox ; George Pearson^ M. D. 211 Granting the truth of this fact, its usefulness in practice, in contemplation of it as a substitute of the small-pox, must depend upon the effects of the cow-pox, in comparison with the small-pox, especially in the particulars of the degree of danger to life; the kind of symptoms and their duration ; and the subsequent effects on the constitution. 1st. The evidences, showing that no one has ever died, or even been apparently in danger, are the same, as those for the fact itself; that a person is not susceptible of the small-pox after having suffered the cow-pox. But the conclusion, with respect to the point of danger, is far more equivocal. The comparison for this purpose should be made with not fewer than one, or even two thousand instances. For, though in several hundred examples of the cow-pox, which have been under observation, not one person has fallen a victim ; this might, and indeed has been, the fortunate issue of the inocu- lated small-pox, of which it will suffice to give two instances. Dr. William Heberden informs me, that at Hungerford, a fewyears ago, in the month of October, 800 poor persons were inoculated for the small-pox, without a single case of death. No exclusion was made on account of age, health, or any other circumstance, but preg- nancy ; one patient was 80 years of age; and many were at the breast, and in the state of toothing. Dr. Woodville acquaints me, that in the current year, from January to August inclu- sive, out of upwards of 1700 patients inoculated at the Inoculation Hospital, including the in and out patients, only two died, both of whom were of the latter description. Such instances of success can only be attributed to a certain favorable epidemic state of the human constitution itself, existing at particular times ; for the proportion of deaths is usually much greater ; indeed, sometimes it is very considerably greater, owing, probably, to certain unfavorable epidemic states. Of the various different estimates which have been made, the fairest seems to be that which states (under a choice of the most favorable known circumstances which can be commanded) one death out of two hundred inoculated persons. But when it is considered that we are not to make the comparison between the inoculated small-pox, and what may be called the natural cow- pox; when it is considered that the inoculated cow-pox, in respect of the local eruption and ulceration, is a much less painful and shorter disease than the natural, or casual cow-pox; when it is considered that the inoculated small-pox is especially dangerous from the number of eruptions, and that there is only a trifling local eruption of the part poisoned in the inoculated cow-pox ; when it is considered that the cow-pox infection is not propagated in the state of effluvia. I say, from such considerations, it seems to be most reasonable to conclude, that that there is great probability of the cow-pox either not proving fatal at all, or at most being much less f requently so than the inoculated small-pox. Further: the comparison of the two diseases should be instituted, with respect to danger, under the particular circumstances of Pregnancy; Age toothing; Peculiar morbid states; Peculiar healthy states, or Idiosyncracies; and certain seasons or epidemical states. Pregnancy. The inoculated small-pox is so commonly mortal to the unborn in every pe- riod of gestation ; and so frequently so likewise to the mother in advanced states of ges- tation; that no prudent practitioner would choose to inoculate under these circum- stances ; but to escape the taking the disease by effluvia, in the casual way.* The expo- sure to infection, being sometimes unavoidable, I confess T feel anxious to ascertain the effects of inoculating the cow-pox infection in such persons. And on the grounds of the slightness and short duration nf the cowpox eruptive fever and of the merely local erup- tion. I apprehend a practitioner would be justifiable in preferring the inoculation of the infection of this distemper to that of the small-pox. On another account, the practice of inoculating the cow-pox seems recommendable in pregnancy, namely, that of preventing the irritable state of the womb, which is produced by abortion, during the small-pox. From which irritable state, the female will be very liable, in future, to the misfortune of abortions. This is so notorious a fact in brutes, that a cow which has suffered abortion, while laboring under the Lues bovilla, or murrain, will seldom, in future, bring forth a live calf; and on this account such cow becomes greatly degraded in value. Whereas a cow, which has had the inoculated murrain when a calf, or at least before she was impregnated, is thereby greatly enhanced in value. It was the great Camper who recommended to his countrymen in Holland the general inoc- ulation of calves for the murrain. The matter is most advantageously inserted into the ear, tail or dewlap. Dr. Layard says, oxen may be inoculated, either with the pus of their eruptions, or with the mucus from the nose ; and that few, comparatively with the casual disease, die. Oxen were not infected by eating matter of the pustules with their corn; not by cover- ing their heads with a cloth, which had been impregnated with steam from the breathing of infected oxen. Whether the unborn animal will take the infection of the cow-pox from the mother, is a question for future observation to determine. * See my paper On the effects of the variolous infection on pregnant women.-Medical Annals, Vol. IX, Decade 2d, 1795. 212 Cow-Pox ; Ceorge Pearson, M. D. It, has been fully determined antecedently to the recent controversy between two emi- nent anatomists for the honor of the discovery, by pathological observations, and demon- strated by anatomical* experiment and artifices, that the blood of the mother does not. pass to the foetus, nor leturn from the foetus to the mother, for the unborn frequently escapes the disease of the smallpox, although the mother be affected with it; and when the foetus is infected, it is uniformly subsequent to the eruption, and even to suppura- tion of the pustules on the mother.! Further injections will pass from the umbilical arteries of the foetus into its body, and return by the umbilical vein, provided the pla- centa, or vicarious lungs ot the foetus be entire. The foetus then does not receive its blood from the mother, nor does the blood of the foetus circulate through the mother. Yet the infant, before birth, frequently does receive some kinds of infectious matter from the mother, viz: the syphilitic, variolous, etc., and of consequence it seems possi- ble that it may receive the cow-pox infection to its formation by the mother's constitu- tion. In this case we should expect no local disease, but merely the specific fever. Age. Whatever doubts may be entertained of very advanced or decrepit age being ad- verse to the success of the inoculated small-pox, I am sure that I shall be supported by the opinion and practice of a very decisive majority that infancy is the state in which the largest proportion die under inoculation. In medical families, and in large towns, where, to the reproach of our police, persons labouring under the small-pox are suffered to appear in the streets and public walks; even the most cautions practitioners deem in- oculation of infants warrantable, but not even then otherwise than to avoid the casual disease. Of the effects of inoculation of infants with the cow-pox infection, we have but one or two examples; however, these are in favor of the practice. Toothing. Though the tender, irritable state of a new-born child may be a more dan- gerous one with the small-pox, than even the state of actual great irritation during the cutting of teeth with this disease, yet the evidence in point of safety is against in- oculating the small-pox in the latter cases. This being the fact, we shall feel inclined, under the circumstances of dentition, to inoculate for the cow-pox, if exposure to the small-pox infection be unavoidable. Peculiar morbid states. Certain diseases have been found to have no influence in occa- sioning the inoculated small-pox to take place in a severe manner. On the contrary, it appears that some of these diseased slates render the small-pox milder. But of the in- fluence of such morbid conditions on the cow-pox, we possess no experience to author- ize an opinion. There are some states induced by particular diseases, namely, by the measles, whooping-cough, etc , which are considered to be the occasion of severe disease in the inoculated small-pox; and from this consideration, under the circumstance of un- avoidable exposure to the small-pox infection, it seems warrantable to prefer the inocu- lation of the cow-pox. Peculiar states of health, Idiosyncracies. The cases of certain families in which the small-pox is uncommonly severe, and of other families in which it is very mild, are so frequent as to have fallen under the notice of every physician of experience. Some families have been so unfortunate that all their children have died in the small-pox, either in the casual way or by inoculation. It is not a very great rarity to find a fam- ily in which several children have fallen victims to the small-pox, and in which a sin- gle surviving child remains ; in such case, the parents, and perhaps the child, are under constant apprehensions of the casual small-pox, for they are deterred from inoculation by what has happened. Surely, in such circumstances, one would be inclined to commend inoculation for tha cow-pox. * Succus nutritins et chylosus matris, ex poris et vasculis uterinis interventu membranao villoste tenuissimie quae chorio contigua est, non secus ac chylns a tunica intestinerum villosa recipitur, absorbetur, et per utubilicalem venam fertur, ex qua cum sanguine ad hepar infautis deducitur. Nutritur infans mediante succo temperato, gelatinoso matris. qui per spongiosam uteri substantiam transcolatur et a secundiua recipitur, per cqjus vasa ad infanteni defertur. Ipsa secundiua quatenus utero adhaeret ex ejus substantia porosa succum alibilem, non vero sangninem matris recipit-Credididerunt veteres, sauguinem matris nutrire infantem et vasa uteri cum vasis secundina; et foetus invicem connectised notabile est, liquorem siphone umbilicales arterias injectum per venam umbilicalem redire, mode placenta illaesa fuerit; ex quo apparet, nullus dari anostomoses vasorum uteri cum vasis secundinae et foetus, neque sanguiuem foetus rursus ad venas matris redire. Placenta uterina ex innumeris capillaribus minimis vasculis est con tecta, per quae dum transit sanguis atteritur, comminuitur inque mininias partes ac globulos dividitur, intima unione succi nutritii cum sanguine facta, ut hac ratione per tenues canaliculos embryonis commodius transire et nutritionem praestare possit: unde reyera secundiua in foetibus vice fungitur pulmonem, qui iu foetu a nuinere fuo vacant, quod identidem in intima sanguiris partium comminutione earumque unione cum chyloso succo consistit: qua de causa etiam vena umbilicalis id habet peculiare cum vena pulmonali ut sanguinem tluxilein floridum. et arterioso similem vehat quod omnibus aliis venis negatum est.-F. Hoffmann, t. 1 lib. 1 sect. 11. cap. XIII. t See the paper above cited on the effects of variolous matter in pregnant women. Cow-Pox ; George Pearson, M. D. 213 During certain seasons, or epidemical* states. At certain times, when the small-pox is ep- demical, it is mostly violent and very fatal, and at other times it is mostly neither vio- lent or very fatal. Such different sorts of small-pox seem to depend upon prevalent peculiar states of health of people, rather than on the properties of the atmosphere. When an unfavor- ble epidemical state is discovered, the judicious practitioner, will find the question worthy of his contemplation, whether it will not be justifiable to introduce the inocula- tion of the cow-pox to supercede the small-pox. 2. The kind of symptoms aud the duration of the two diseases must be compared to- gether. If an inoculator could, at his will, command an inoculation of the small-pox, a slight local affection, a trifling eruptive fever, and a very small number of eruptions, there would be no temptation held out on tlie foree of symptoms to inoculate for the cow-pox, because, in this disease, it appears that we are liable, even by inoculation, to produce a painful phlegmonic inflammation, extensive and very irritating inflammation of the skin around the part poisoned, and ulceration of the phagedenic kind. A sufficient number of cases of the inoculated cow-pox has not been attested to enable us to form an accurate judgment of the degree of the symptoms in comparison with those of the inoc- ulated small-pox. It does not appear that there is nearly so great a difference between the constitutional disorder, orfever, of the inoculated cow-pox, and of the casual cow- pox; as between the disorder of the constitution of the inoculated small-pox and the casual small-pox ; nor, of course, are the ad vantages of the inoculated cow-pox so eminently great, comparatively with those of the casual disease, as the advantages of the inoculated small-pox are superior to those of this disease in the casual way. On comparison of the symptoms of the inoculated chicken-pox, the inoculated murrain, and the inoculated measles, with these diseases, in the casual way, by effluvia, the differ- ence is not so great as to raise considerably our expectation of advantages from the practice of inoculation. Although Camper and Layard are advocates for inoculation for the murrain, Mons, de Berg gives a contrary opiuion, declaring, fQue Finocnlation n'offre aucuns a vantages reels; fur-tout dans les cas ou 1'epizootic est tres-meurtriere, circonstance qui d'ailleurs est laseule dans laquelle elle puisse etre de quelque utilite. 3. The subsequent effects on the constitution, from the cow-pox, must be compared with those from the inoculated small-pox. A disposition to certain diseases, and even diseases themselves, are not rarely brought on by the small-pox; but sometimes also dispositions to diseases, and diseases themselves of the most inveterate kind, are removed by the small-pox. In families wherever certain dispositions to diseases are hereditary, and which diseases are known to have been excited by the small-pox, inoculation for the cow-pox on this account may be a considerable benefit; but that is ou the supposition that no diseases, or morbid dispositions, are induced by it. As far as my inquiries have extended, I havePfound that no such morbid effects have ensued from the cow-pox; but I apprehend that many more observations than have hitherto been made, are requisite to ascertain this point satisfactorily. Although pits from the small-pox are not a disease, they are at least a deformity, which it is of the greatest moment for any person to preVent; but which, however, no one can certainly guard against, even by inoculation; and as in the cow-pox, no such conse- quences take place, an inducement is afforded to inoculate for this disease. II. As the small-pox infection is propagated in the state of effluvia, and by adhering in an unseen, and even invisibly small quantity, to cloths, furniture, etc.; but as the cow-pox infection is only propagated in a visible quantity, and for the most part only when applied to the divided cuticle, the means of avoiding the cow-pox are easy and obviously simple. On account of the extremely contagious nature of the variolous poison, the extensive dissemination of it by inoculation, and the practice of inoculating for the small-pox being only partial, it appears that the mortality by the small-pox has been in a greater proportion since than before the introduction of inoculation. And no sagacity is required to predict, that should the practice of inoculating for the cow-pox ever become very general amongst young persons, the variolous infection must be ex tinguished ; and, of consequence, that loathsome and destructive disease, the small-pox, be known only by name. And this benefit will accrue, without even the alloy of the in- troduction of a new disease, it being plain from the nature of the cow-pox poison that it will be easy to avoid and prevent its dissemination. III. The cow-pox poison appears to alter the human constitution, so as to render it unsusceptible of the agency of a different morbific poison, namely, of the variolous, in producing the small-pox. This fact is, I believe, quite a novelty in physiology and * A very mild and innocent endemial small-pox occurred in the practice of Dr. Hicks, of which a history is expected by the professional public. t Lettre a Mons. Linguet, p. 28, Appendix. 214 Cow-Pox ; George Pearson, M. D. pathology; it indicates a new principle in the mode of prophylatic practice. • And we now see upon what principle, diseases from various other morbific poisons may possibly be prevented from taking place, such as the measles, ulcerous sore throat, whooping- cough, syphilis, etc., viz. in consequence of destroying the excitability of the constitu- tion to such poisons by the agency of different and perhaps less hurtful ones. Whether the cow-pox preserves the constitution from other morbific poisons, besides the vario- lous, is an undecided question. This fact also suggests the idea that the economy of live beings may be liable to undergo permanent changes in the state of excitability of each, in respect of certain stimuli, both morbific and innocent ones, which observation has not hitherto discovered. And on account of the unobserved agency of such stimuli, some constitutions are utterly incapable, either permanently or for a limited time, of taking the small-pox, and perhaps other diseases. But if there are in nature means of rendering the human constitution unsusceptible, it must be allowed that it is probable there are also means of rendering it particularly disposed to certain diseases. And it is possible that the same constitution may, in the course of life, undeigo repeatedly a temporary state of inexcitability to certain stimuli ; but there is no reason to suppose that a state of inexcitability, which would otherwise be permanent, may be removed by certain morbific stimuli. In the veterinary branch of physic it is a matter of still greater importance to possess the means of rendering the constitution unsusceptible of the agency of the morbific poison which produces the murrain ; because, 1. This malady is more destructive when it is epizootic than the small-pox is among human creatures: 2. Because inoculation for it is not nearly so beneficial, a great pro- portion dying under inoculation. It seems of small consequence in practice, but it is very important on account of phys- iology to determine, whether the human economy is rendered unsusceptible of the cow- pox by having undergone the small-pox In the instances related, of people taking the cow-pox who had gone through the small-pox, the observation was not directed with a view to determine, satisfactorily, whether the local affection was certainly attended or preceded by a constitutional affection. IV. If it be true that the same constitution is liable to undergo repeatedly the cow- pox, to which distemper no one has fallen a victim, practitioners may avail themselves of this means of exciting an innocent fever as a remedy of various disorders, it being a truth, admitted by men of experience, that fevers are occasionally efficacious remedies, especially for inveterate chronic maladies, such as epilepsy, hysteria, insanity, St. Vitus' dance, tetanus, skin deformities and diseases, etc. V. Concerning the aetiology of the disease, which is the subject of our inquiry : The cow-pox in the human animal has, in every casual instance of the disease, been so clearly traced immediately to the cow's breasts, affected with the cow-pox, that it would be mispending time to relate, particularly the history of cases, to prove what is asserted. The inoculation with matter from the cow produces the same disease as the casual cow- pox. It appears also that the cow-pox matter of the human animal excites the same disease as the matter from the cow. It has not been determined by experiment, nor by any observation of incidental agency of cow-pox matter; that this matter geneiated in the human animal, will excite the same disease in the cow; but from the facts just spoken of, probably few persons will doubt that this must be the case. The cow-pox of the brute is either excited by the matter conveyed from a beast laboring under the dis- ease, (in an obvious way by the hands of milkers) to uninfected cows; in which manner one diseased beast may inf ct an unlimited number of beasts, or the disease is excited by aboriginal cow-pox matter ; that is, by matter compounded in the animal economy of the cow, without any matter of the same kind having been applied. The means by the agency of which the animal economy is put into such a state as to compound this pecu- liar matter are not yet found out. A connection is, however, observed between the dis- ease and the spring season, the autumn, and change from less nutritious to more nutritious food. It has been concluded by Dr. Jenner that the aboriginal matter is from the matter of the grease of horses, which gains admission through the milkers who handle such greased horses : but this conclusion lias no better support than the coinc deuce in some instances of the prevalence of the two diseases in the same farm, and in which the same servants are employed among the horses and cows. This assertion stands in need of support from other observations. The experimentum cruds seems to have been already instituted, but without success, namely, the inoculation with the grease matter of the cow's breast by Dr. Jenner. It is to excite further research, that I shall mention how successful my in- quiries have been to find the origin of the cow-pox to be in the grease. 1. I have found that in many farms the cow-pox breaks out, althoughno new-comer has been introduced into the herd ; although the milkers do not come in contact with horses; although there are no greased horses; and even although there are no horses kept on the farm. Cow-Pox ; George Pearson, M. D. 215 2. It appears that the cow-pox does not break out under the most favorable circum- stances for its production, if it be occasioned by the grease. Through the application of my inestimable colleague, Dr. Wm. Heberden, I have got much instruction relating to this head from Sir Isaac Pennington. "I* have had, "says Sir Isaac, " Dr. Jenner's hook some weeks, and the particulars stilted in it are really astonishing. I have made inquiries upon the subject at Cottenham and Willingham ; in which two parishes 3005 milch cows are kept, also a great many horses of the rough-legged cart kind, (much lia- ble to the scratches or grease,) half the parishes being under the plow, and the men be- ing much employed in milking. But I cannot find that any pustulous eruptions on the teats of the cow, or on the hands of the milkers, have ever been heard of, and what seems to prove the negative in this case, I understand inoculation succeeds just as well in these parishes as anywhere else. I cannot find from those concerned in inoculation that shoe- ing-smiths are less liable to the infection of the small-pox than other people." Dr. Parr is one of the few men of learning, and acknowledged ability, who has im- bibed an unfa vorable opinion of the whole of the facts and reasoning of Dr. Jenner. But as my Exeter friend merely opposes reasoning and gratuitous suppositions, to at least some well-attested facts, 1 do not think any tiling will be gained by stating, particularly, his sentiments on the subject, yet I-acquiesce to his judgment, "that the assertion that the cow-pox proceeds from the heels of horses is gratuitous." He reprobates the con- clusions on this part of the subject in somewhat opprobrious Serins, in which, however, the Doctor himself argues more on gratuitous suppositions than admitted truths. "Limpidt fluid is always more active than pus, for a wound no longer spreads when the matter becomes purulent. If a disease d^es proceed from the matter of the heel of the horse, it is no other than such as occurs in the human subject, namely, topical ulcers, from a putrid fomes; since it is probable, (p. 49, Jenner) on Dr. Jenner's own founda- tion, the eruptions must precede its influence. Men servants seldom milk cows in this country, and when they do, such insufferable dirtiness as to milk with hands streaming with the running of a sore heel, would not be tolerated in any milking court in this country. Indeed, I think this publication (Dr. Jenner's) is a libel on his own neighbor- hood." At the close of these adverse observations, it is but fair to represent that this opinion respecting the origin of the cow-pox, is not merely that of Dr. Jenner, for Mr. Smith (letter above cited) says, " Mr. Woodman had a notion of the cow-pox originating from the sore heels of horses." And several male servants at the milk farms near London said, "there was such a notion entertained in several parts in the country, whatever might be its foundation." The cow-pox poison, and the hydrophobic poison, are the only specific morbific matter to the human animal economy which are clearlv proved to be derived from brute ani- mals; for there is only small probability on the side of the opinion that the syphilitic poison is from the built, the small-pox from the camel|| and the itch from the dog. The economy then of the human kind, and of cows, resemble, in the particular of being ex- citable to a disease, the cow-pox. by a certain specific poison. Whether other animals, especially males of the bovine kind, can take the cow-pox has not been determined by experiment or accidental observation. Morbific poisons, which produce specific dis- eases, act in this way only on one species of animals, except in a few instances, such as the hydrophobic and cow-pox poisons. Camper, Ingenhousz and Woodville in vain at- tempted to produce the small-pox by inoculation in a number of different brute animals.§ J. Hunter failed in attempting to excite the syphilis in a djg by inoculating him with the poison of the gonorrhoe and of a syphilitic ulcer. Camper attests that in the most malignant epizootic murrain, which spread most rapidly among oxen, yet other an- imals, such as sheep, horses, asses, dogs, etc., were not infected by associating with the distempered oxen, nor even by feeding with them in the same compartments of a stable. In the eruptive contagious disease among sheep in France forty years ago, other spe- cies of animals which associated with them were not infected. The newly-observed disease, which prevailed among domestic cats in 1796, throughout great part of Europe, and even America, did not appear to affect other animals. * Sir Isaac Pennington's Letter, Cambridge, Sept. 14, 1798. t Dr. Parr's, M. D., Letter. Exeter, July 22, 1798. * Bulls so diseased are said to be stung.-Sir Isaac Pennington's Letter. || See Bruce's Travels and Dr. Woodville's History of Inoculation. § Berrier, of Chartres, asserts that monkeys, dogs, sheep, rabbits, oxen and other brute animals, are sus- ceptible of the small-pox : but his evidence lias not the weight of a feather against the contrary authorities. Swediaur asserts that monkeys are never affected with the syphilis. although in England they are subject to the scrofula, and that, other animals are equally unsusceptible of the syphilis, although Pauw affirms that in Peru dogs are affected with this disease. 216 Cow-Pox ; George Pearson, M. D. These observations may serve to remove the fears of those who apprehend, that in con- sequence of domesticating brute creatures, we are liable"lto render their diseases en- demial. VI. As it appears that the cow-pox poison,'after its admission into the human consti- tution, takes effect, or sensibly exerts its agency upon the whole economy, in seven or eight days, it seems probable that it will anticipate, in many instances, the agency of the small-pox poison, if the two poisons be introduced at the same time, or nearly so; in which case the patients should be in future incapable of the small-pox. If the morbific poison of the varicella, or chicken-pox, were to be inserted at the same time with the cow-pox poison, it is probable also that the cow-pox would suspend the chicken-pox, and perhaps render the constitution unsusceptible of its action in future. But if it be a truth that the rubeolous poison can be inserted by inoculation, and that it affects the constitution in six days, when this poison and that of the cow-pox are intro- duced at the same time, it is most likely the measles will suspend the cow-pox. So long as the constitution is under the,agency of the cow-pox poison, it is not proba- ble that it will be infected by those morbific poisons whose existence is only known by their effects, (for they operate in too minute a quantity to fall under the notice of our senses) namely, the poison which occasions the influenza, whooping-cough, ulcerous an - gina, that which occasions the typhus fever, the miasmata and the contagion of inter- mittent'fevers, etc. ♦ To give an instance of the application of facts to practice: if a woman be far ad- vanced in pregnancy, and exposure to small-pox infection has been, or is un.i voidable, in that case it will be of vast importance to avert the present, impending danger from the female. Under such a circumstance the temptation to inoculate for the cow-pox will be felt by the practitioner. And provided the inoculation be instituted in not more than six or seven days after exposure to the variolous infection, it should, according to prin- ciple, pretty certainly preserve the patient from small-pox; or if it be done witinn ten or twelve days, it should frequently answer the purpose. For the variolous poison lies within the human body, most frequently, fifteen days, and often four or five days later, before its general agency is perceived; whereas, the cow-pox poison acts upon the whole constitution in seven or eight days after its admission. VII. The cow-pox poison is, according to the present facts, totally different in its na- ture and effects from every oilier morbific poison, both of cattle and human creatures- it is not necessary to enter minutely into the distinguishing characters of it as it appears in cows, as these will be collected from the history of the disease. I think it right just to mention that care should be taken not to confound the cow-pox withthe common wart eruptions and inflammations ending in scabs, which affect the paps only, or at most th paps and the udders. It must also be recollected that the cow-pox is quite different from the diseases of cattle which are attended with eruptions of the skin in general, such as take fdace in the murrain, orpestis bovilla, already spoken of, on which eruptive diseases more has been written by the Italian, French and Dutch physicians than by the English*, On account of the notion which, by some, is entertained, that the cow-pox infection is of the same nature as the variolous, it may be useful to point out the great differences between them. 1. The cow-pox poison, introduced by inoculation, affects the whole constitution at the same time in the same degree and manner as when admitted in the casual way ; and if the local affection be more severe in che casual than in the inoculated way, it seems to be owing to the structure of the part, namely, the thick cuticle in the palms of the hands. 2. The cow-pox poison only affects the constitution through the intervention of the part poisoned. 3. This morbific poison produces no eruption or inflammation, but of and near the part to which the poison is applied. * Gli assistenzi a'bovi ammalati e molt' altri uomini degni di fede m'attestarono d'aver osservati, in alcuni tumori crudi in diverse parti del corpo con lingue aride, mre e tagliate, in altri aver veduti tumori matu- rate.-P. A. Michelloti, p. 12, 1711. La terza osservazione fu circa alcuni buovi, che dimorarano in ima stalla come alle pecore : due di essi cacciarono d' alia cute certi tubercolletti.-Padre Boromeo, p. 48. Annis 1713, 1714, in nostro Ferrariensi Ducatu lues contagiosa beum, &c. Correpti enim boves cibum respuebant; aures subito collapsro procidebant: pili erigebantns; tiemor pene universalis aderat: oculi lacrymabant: per nares multa lymph® copia exibat; alvus solvebatur - etin aliquibns pustuhe sub cute prodibant, ita ut crederent aliqui Variolis boves ipsos assici; tandemqne brevi septem dierum spatio mo- riebantur.-J. Lauzoni, t. 20, b. 202. Maculis denique et pustulis infecta cutis, adeo ut quibusdam, in mentem venerit cogitate boves non leu, ut nunc res est, sed ipsis pustulis quas Variolas vocant interire.- J. M. Lancisi de bovilla peste Scbreiben an die Generalstaaten betretfend die Einimpfung der Viehseuehe geschrieben den 16 Febr. 1770-Camper von Euumpfuu^ der Kuidviebseuche, ibren Vortheileu und Bedingungen -Campers Ber- liner Gesellschaft. Cow-Pox ; George Pear non, M. D. 217 4. The cow-pox poison from the human subject will, in all probability, infect the cow with the cow-pox, which the variolous poison will not. 5. It is asserted that a person may have the cow-pox who has had the small-pox. 6. The local pustulous eruptions in the cow-pox are rather in the nature of vesicles, or phylyctai » than purulent eruptions, and the ulceration is apt to be of the phage- denic kind. 7. The tow.pox infection is not propagated in the state of effluvia or gas. 8. Cow-pox matter applied to the eyes, lips and various other soft parts, or to any parts which are punctured, or wounded, in persons who already have had the cow-pox, or are then ill of the disease, will excite the peculiar local affection from this poison, and perhaps fever. VIII. There are some who are not certain whether or notthey have gone through the small-pox, yet they have such a dread of the disease as not to submit even to inoculation for it. To such persons the inoculation for the cow-pox as a substitute for the small-pox must prove a happy discovery. Some who have never gone through the small-pox have been repeatedly inoculated for the small-pox, and also been exposed much to the infection of it in the casual way, yet could not be infected. Persons so circumstanced to be more secure, may be inoculated for the cow-pox. Such is the'representation which I shall lay before the public of the benefits likely to accrue to human society from inoculation for the cow-pox. I shall be no better con- tented with those who will consider the facts to be already completely demonstrated, than with the opposite extreme opinion, that the whole of the prospects displayed are merely Eutopian. The fortunes of the new proposed practice cannot, with certainty, be told at present by the most discerning minds. More instances are required to estab- lish practical and pathological truths Without assuming pretensions which, I think, unwarrantable, the number of instances farther requisite can not be stated; but one may.safely assert that well directed observation in a thousand cases of inoculated cow- pox would not fail to produce such a valuable body of evidence as will enable us to ap- ply our knowledge with much usefulness in practice, and establish, or at least bring us nearer the establishment, of some truths. They who take a part in the present inquiry must not expect to escape detraction- But such a prospect will not divert him from his path who labors in the culture of physic for the satisfaction of his own mind, well knowing that it argues egregious ignor- ance of what is passing in the world, to do so from any other motive. COMMUNICATIONS RECEIVED AFTER THE PRECEDING SHEETS WERE PRINTED, AND ADDITIONAL OBSERVATIONS. Mr. Rolph, Surgeon in Peckham, practiced physic nine years at Thornbury in Glouces' tershire. During two of these years he was the colleague of the late Mr. Grove, who had been a medical practitioner at Thornbury for near forty years. The greater part of the facts above stated, relating to the cow-pox, are familiarly known to Mr. Rolph from his own observation, and from the experience of Mr. Grove. Mr. Rolph tells me, that in Gloucestershire the cow-pox is frequently epizootic in the dairy farms in the spring season. It especially breaks out in cows newly introduced into the herds. When a number of cows in a farm are at the same time affected, the infection seems generally to have originated in the constitution of soma one cow, and before the milker is aware of the existence of the disease, the infections matter is probably con- veyed by the hands to the teats and udders of other cows ; hence they are infected. For if the disease in the cow first affected he perceived in a certain state, and obvious pre- cautions be taken, the infection does not spread, but is confined to a single beast. Whether the morbific poison is generated in the cow first diseased in a given farm, de novo, from time to time, and disseminated among the rest of the herd ; or, like the small- pox poison, is onl> communicated from animals of the same species to one another, is not ascertained, j No cow has been known to die or be in danger from this disorder. A great number of instances of the cow-pox in milkers had fallen under Mr. Rolplfs observation, and many hundreds more under that of his late partner, Mr. Grove; but not a single mortal, or even dangerous, case had occurred. The patients were ordinarily ill of a slight fever for two i r three days, and the local affection was so slight t hat the assistance of medical practitioners was rarely required. He had no doubt that the inoc- ulated cow-pox was attended with as little pain and uneasiness as the ordinary cases of inoculated small-pox. 218 Cote-Pox; George Pearson, M. I). Mr. Rolph says, there is not a medical practitioner of even little experience in Glou- cestershire, or scarce a dairy farmer who does not know from his own experience, or that of others, that persons who have suffered the cow-pox are exempted from the agency of the variolous poison. The late Mr. Grove was a very extensive small-pox inoculator, frequently having 200 or 300 patients at one time, and the fact of exemption now asserted had been long before his death abundantly established by his experience of many scores of subjects who had previously labored under the cow-pox, being found unsusceptible to the small-pox, either by inoculation or by effluvia. While Mr. Rolph practiced at Thornbury, he thinks not fewer than three-scorce in- stances of failure in attempting to produce the small-pox by inoculation occurred in his own practice, all of which were persons who had been previously affected with the cow- pox. In almost a l of these cases the uninfected persons associated with those who took the small-pox, and many were repeatedly inoculated. Although Mr. Rolph has not, in his recollection, any instances of people taking the small-pox who ga ve admissible evi- dence of their having labored under the cow-pox, he thinks such cases may, and have indeed occurred to others, where the cow-pox had been only local, it being requisite that the whole constitution should be affected in order to destroy the excitability to the vari- olous poison. Mr. Rolph declared that his confidence in the efficacy and safety of inoculation for the cow-pox was such that be regretted he could not, at present, procure cow-pox matter to inoculate two of his own children who had not yet had the sma 1-pox. This measure is, however, determined upon. As a particular instance, Mr. Rolph related the following: A soldier's wife, while in the small-pox. was accidentally in the company of several farmers at an ale-house in Thornbury. Two of the company who had gone through the cow-pox. but not the small- pox, were not infected by the variolous infection ; but three others, who had not labored under the cow-pox, took the small-pox. Mr. Ralph's mind was not satisfied that a person could be constitutionally affected by the cow-pox poison more than once, but he had no doubt that the local affection might be produced repeatedly. Neither did he certainly know that a person was unsus- ceptible ot the small-pox who had been constitutionally affected by the cow-pox. Mr. Rolph, in a letter to Dr. Beddoes, dated June 10th, 1795, communicated thefollow- ing observations. Speaking of a man who could not be infected, although he was re- peatedly inoculated for the small-pox, and although he lived in the same room with an- other man who died of the small-pox, Mr. Rolph says, "it is worthy* of remark that this man had some years before a complaint incident to cows, and commonly called the cow- pox, a malady more unpleasant than dangerous. It is generally received by contact in milking. In the human species the complaint is sometimes local, at other times absorp- tion takes place, and the glands in the course of the absorbents become indurated and painful. When this is the case, I hare learned from my own observation, and the testimony of some old practitioners, that susceptibility to the small-pox is destroyed. Some advantage may probably, in time, be derived from this fact." Cheltenham, 27th September, 1798. My Dear Sir-The perusal of your proof sheets has afforded me great pleasure, both from the handsome manner in which you mention my name, and from the mass of evidence which has poured in upon ton from different countries in support of the fact which I so ardently wish to see established on a steady and dura- ble basis Your first query respecting the foetus in utero I can not resolve. With respect to your second, you may be assured that a person may be repeatedly affected, both locally and generally, by the cow-pox, two instances of which I have adduced, and have many more in my recollec- tion. But, nevertheless, on this important point, I have some reason to suspect that my discriminations have not been, till lately, sufficiently nice. I must observe to you. that what the constitution feels from the absorption of the virust, is of a mild and transient nature, but the sores (which sores, when casual, are often numerous, and attended with such soreness and inflammation) are sufficient of themselves to occasion much disorder in the system. Certain it is, that the skin is always subject to the ulcerative effects of th' virus, but whether the constitution can repeatedly feel the primary effects of it, I havl exptrimeuts in view to determine. Let me here call your attention to a similarity between the small pox and the cow-pox. The symptoms of absorption first disturb the system, and, secondly, the system feels the consequences of the local sores. Exactly so with the cow-pox; and as the cow-pox inflammation is always of the erysipelatous kind, when it spreads over the skin to any great extent, it produces symptoms not unlike the confluent small-pox It is painful to me to tell you, that I have not an atom of the matter that I can depend upon for continu- ing the experiments. Mr. - . when he inoculate d the hoy. did not ta e matter early enough from LETTER FROM DR. JENNER TO DR. PEARSON. * See the queries of Dr. Beddoes concerning it ovulation, subjoined to his translation of Gimbernet's method of operating for the femoral hernia.-London, Johnson. 1795. 11 use this expression as the common language of the day, without consenting to the truth"of it. Cow-Pox; George Pearson, M. D. 219 the pustule to secure its efficacy,-for after it has lost its limpid quality, and becomes pus, I fear its specific effects cease Much precaution is therefore necessary in the, progress of the inquiry ; and this is my grand fear, that the discovery may fall into discredit from a want of that attention, in conducting the experi- ments which the subject requires. For example, a person may conceive he has the cow-pox matter o his lancet , when, in fact, there may be only a little putrid pus-with this lie scratches the skiu and excites disease ;- the patient is afterwards subjected to the insertion of the variolous poison, and unquestionable will have the disease. Thus a delusive inference will be drawn, at once hurtful to the cause, and particularly injuri- ous to tne. However, truth must appear at last, and from your researches, its appearance will certainly be expedited. I remain, yours very truly, E. JENNER. Abstract of a Letter from Mr. Fewster, Surgeon in Tliornbury, dated October 11th, 1798, to Mr. Ralph, Surgeon in Peckham. In'the spring of the year 1768 I came to live at Thornbury, where I have resided* ever sinco. In that very year, from the following occurrence, I became well acquainted with the disease called cow-pox. The late Mr. Grove and myself formed a connection with Mr. Sutton, the celebrated inoculator; and to inocu- late for the small pox. we took a house at Buckover. We found in this practice that a great number of pa- tients could not be infected with the small-pox poison, notwithstanding repeated exposure under most favorable circumstances for taking the disease. At length the cause of the failure was discovered from the case of a farmer who was inoculated several times ineffectually, yet he assured us he had never suf- fered the small pox. but. says he. "I have had the cmv-pox lately to a violent degree, if that's any odds." We took the hint, and, on inquiry, found that all those who were uninfectable had undergone the cow-pox. I communicated this fact to a medical society, of which I was then a member, and ever afterwards paid par- ticular attention to determine the fact. I can now, with truth, affirm that I have not been able to produce the small-pox, in a single instance, among persons who have had the true cow.pox, except a doubtful case which you are acquainted with. I have, since that, inoculated near two thousand for the small-pox. amongst whom there were a great number who had gone through the cow-pox; the exact number of these I can not tell, but I know that they all resisted the infection of variolous matter. With regard to your questions : 1. As to danger from the cow-pox. In the course of thirty years I have known numberless instances of the disease, but never knew one mortal, or even dangerous, case. 2. Is a person susceptible of the cow-pox more than once? I can not answer this question. 3. Is the cow-pox. in the natural way, a more or less severe disease, than the inoculated cow pox ? I think it is a much more severe disease in general than the inoculated small pox. I do not see any great ad- vantage from inoculation for the cow pox. Inoculation for the small-pox seems to be so well understood, that there is very little need of a substitute. It is curious, however, and may lead to other improvements*. 4. Have you ever known any pregnant woman labor under the cow-pox ? Yes, many, but it never pro- duced abortion. The state of the foetus 1 can not speak of, 5. Are cows affected at certain times more than at others? They are especially effected from Febru- ary to May, when there is the greatest number of greased horses. I can not procure any cow-pox matter this season. From Mr. Bird to Dr. Pearson, October 16, 1798. Mr. G. G. Bird, of Hereford, who is now attending medical lectures in London, tells Dr. P. that he has very often seen the cow-pox in cows and human creatures near Gloucester; that it attacks the same person repeatedly, and once the third attack was obseived to be more severe than the preceding ones, but ordina- rily the reverse is the fact. It appears with red spots on the hands, which enlarge, become roundish and suppurate, tumors take place in the armpit, the pulse grows quick, the head aches, pains are felt in the back and limbs, with sometimes vomiting and deliiium. It is most common in a wet spring. No one dies of the disease. Dr. Currie, of Chester, informs Mr. Thomas that the disease called cow-pox is unknown to the medi- cal practitioners and farmers in Cheshire. Dr Richard Pearson, of Birmingham, in his obliging letter of the 26th September last, says, ''From this united evidence. ' that of medical persons and farmers) I think that it may be inferred that the disease, which Dr. Jenner calls variolae vaccina;, is not epizootic in the counties of Warwick, Worcester and Stafford." Dr. Woodville acquaints me, " that not being able to procure cow pox matter he is making trials with grease matter from which no doubt, some useful information will be obtained." Extracts of a letter from Mr. Thomas Wales, surgeon at Dowuham, Norfolk, dated October 18, 1798, to Dr. Pearson. I shall endeavor to give you satifactory answers to your queries. Previous to my conversation with Dr. Redfearn, Ihadno knowiedgeof the disease called cow-pox, norwas it known to any medical practioner in this district But on inquiring at the dairy farms, I have got much information concerning the disease. I this day saw two persons wao have had the cow-pox. One of them, a man above sixty years of ago. who has been a milker all his life, knows the disease very well by the name of pap pox, having himself experienced the disorder a great many years ago. He remembers that on that occasion he was sick at the stomach and otherwise ill for two or'three days. The eruption on his hands was considerable, and the fingers were swollen ; probably owing to improper applications the places healed slowly, and left scars, which are evident at this day; and when the hands are very cold, these scars are of a livid cast. He had not gone through the small-pox before he had the cow pox nor has he had the small-pox since this disease, although he has been repeatedly inoculated. The other cas ■ above mentioned, is that of a young woman, who had the cow-pox some time ago but never suffered the small-box although she has been seveial times inoculated. There are, I find, many other instances, of persons who have gone through the cow-pox, and who have not been able to take the small pox. either naturally, or by inoculation. Asthe public in this part are not at all aware of the advantages of inoculation for thecow-pox, there are no instances of this mode of producing it. * I have stated the writer's opinion of inoculation for the cow pox, in obedience to a law imposed on my- self, of not suppressing any part of the evidence communicated, however differently I might reason on the acts.-Note by the author of this inquiry. 220 Cow-Pox; George Pearson, M. D. I do not find that any person has had the cow-pox more than once, that is a fever with the local affection more than once; but the local affection without fever, has occurred in the same person repeatedly ; I have met with two cases, in which the matter of the cow.pox, by being applied to the eyes, destroyed the power of vision, from the opacity of the cornea so produced. No person has been known to die, or even to be in danger, with the cow pox, although the axillary glands have been much affected, and the sores on the hands have healed with difficulty. I have not met with a case of a woman who has gone through the disease during pregnancy. No instance has fallen under my observation, of a person who has gene through the cow-pox after hav- ing had the small-pox. With regard to cows they are subject to the cow-pox more than once. It comes on in the spring, when they first begin to taste luxuriant food, but not uniformly every year. One farmer informed mo that he thought it broke out especially when the cows were fed with turnips in autumn ; but I do not depend much on this observation REMARKS ON THE TERM VARIOLA VACCINE. For the sake of precision in language, and of consequence, Justness in thinking; and considering that there is no other way of disabusing ourselves from many of the errors in physic, but by the use of just terms ; it is not unworthy of our attention to guard against the admission of newly appropriated names which will mislead by their former accepted import. Variola is an assumed Latin word, and its meaning will be popularly understood in the English tongue, by saying that it is a name of a disease, better known by another name, the small-pox. Granting that the word variola is a derivative from varius and varus used by Pliny and Celsus to denote a disease, wi*h spots on the skin the etymological import of variola is any cutaneous spotted distemper; but one ot the most formid- able and distinct of the cutaneous order is what is called the small-pox, and therefore, as I apprehend the name variola has been used technically to signify this kind of spotted malady, and no other. Now as the cow-pox is a specially different distemper from the small-pox, in essential particulars, namely, in the nature of its morbific poison, and in its symptoms ; although the cow-pox may render the constitution not susceptible of thp small-pox; it is a palpable catachresis to designate what is called the cow-pox. by the denomination variola; vaccina;; for that is to say, in English, cow small-pox, and yet the cow is unsuscepti- ble of infection by the variolous poison. To the name cow-pox or better, perhaps cow-pocken* in our language, I think no reasonable objection can be urged. According to the more distinct and lucid arrangement of cutaneous distempers, by Dr. Wil- Ian.t thecow-pox belongs to the order entitled pustulas ; the word pock is known to signify pustule and the prefix cow denotes the only animal in which the morbific poison has its origin. Further; if here- after by the practice of universal inoculation, the human animal should be much more abundant, and better known source of this morbific matter than the brute animal, it is fit that the latter, to which obligations will be owing for an inestimable benefit, should live in the grateful memory of mankind, as ought also the name of Jenner who will be so great a public benefactor. QUERIES. It may save some persons the trouble of thinking, and time, if a set of questions be stated; which will serve to guide observation in the acquisition of facts belonging to the subject of inquiry. For this purpose the following queries are proposed : 1. If a distemper of cows has been noticed, called the cow-pox, or by any other name, in which the beasts, especially the paps, are affected with pustulous, and generally pur- ple, or livid eruptions and sores, by which the hands of milkers are infected ; what are the symptoms ? 2. Can any connection be traced betwixt this disease and the grease of horses' heels? between the disease and particular kinds of food and water ? between it and any par- ticular state of the athmosphere? between it and any particular season ? 3. Is the same liable to the disease more than once ? 4. Has any cow ever appeared to die of this disease? 5. Is the cow susceptible of the cow-pox by the inoculation of the breasts, with grease matter of horses ? 6. Are males of the ox kind, or other different kinds of brutes, susceptible of the disease by inoculation with cow-pox matter of cows? 7. Have cows in a state of pregnancy been observed to be affected with this distemper ? 8. Is the cow susceptible of the disease by inoculation of other parts beside the breasts ? 9. Is the cow-pox matter of human creatures capable of producing cow-pox in cows # WITH RESPECT TO BRUTES. WITH RESPECT TO HUMAN CREATURES 1. What parts are affected, and what are the symptoms of the distemper when con tracted in the casual way ? 'Instead of the modern orthography small-pox, etc , in which es and eks are denoted by ®, it will he, per- haps. thought preferable to follow the original orthography pock with its plural pocken, as the Germans still do ; from whose language we have received the words. tDescription and treatment of cutaneous disorders. Order 1. Pustulous eruptions on the skin, by Robert WiliamF. A. S. 4to. with plates, Johnson, 1798. Cotr Pox: George Pearson, M. 1). 221 2. Ilas any person been supposed to be in danger, or to have died of the disease? 3. Is the whole constitution disordered previously, or only at the same time the pustules breakout? Does the disorder of the constitution disappear on the appearance of the pustules? Does the same, or a different disorder of the constitution again appear; and under what circumstances in the course of the disease ? 4. It in the course of the disease, when there is no disorder of the whole constitution, the infectious matter of the cow or of the human patient already laboring under the cow-pox be applied to fresh parts, does a disorder of the whole constitution arise, as well asji local affection ; and of the same kind as those which have already taken place ? p. Is the same person susceptible of the cow-pox local affection, and fever, or disorder of the whole constitution more than once or only of the local affection more than once? In the instances in which the disorder of the whole constitution was said to have occurred more than once, is it not probable that in one case only the specific fever of the infection occurred, and in the others a different disorder of the whole constitu- tion, such as was merely from the irritation of the local affection ? 6. Is the local affection of the same nature on a second, or on farther attacks m the same as on the first ? 7. In the instances of cow-pox in persons who had gone through the small-pox, were the local affection and disorder of the constitution of the same nature as in persons who had not labored under the small-pox ? 8. Has it been observed that a person has ever taken the small-pox after having gone through the cow-pox ? In the instances in which the small-pox was said to have taken place, was it certain that the preceding cow-pox was attendant with its specific fever, or was there only a local affection, or at most, was there only disorder symtomatic of the local affection ? 9. Does the cow-pox render the human constitution unsusceptible of any other disease besides the small-pox; or on the contrary, increase its susceptibility to any particular disease ? 10. What are the effects of cow-pox on pregnant women? 11. In the inoculated cow-pox is the fever less considerable than in the casual way? 12. In the inoculated cow-pox is the local fever slighter and of shorter duration than in the casual cow-pox ? 13. How long after the insertion of the matter is it before the constitution is affected ? 14. If a person were to be inoculated at the same time with cow-pox and variolous matter, which disorder would appear first, or what other effects would be produced? 15. If the cow-pox morbific matter be applied to a secreting membrane, e. g. to the urethra, will it produce a gonorrhoea or pustulous sores ? 16. Does the disease appear to injure the constitution, by producing or exciting other diseases ? 17. Does the disease appear to eradicate any other disease already present ? 18. Does the mildness or severity of the inoculated cow-pox depend upon the quantity of the matter inserted, or on the wounds inflicted for inoculation ? 19. Does the cow-pox matter produce the disease as certainly in its dried as its fluid state ; and when old as when recent; and with equal mildness ? 20. Are there any particular states of the constitution in which cow-pox is particu- larly mild ; or on the contrary, severe ; as after the measles, whooping-cough, etc. ? 21. Are there particular idiosyncrasies in families or individuals, which influence the cow-pox, as is the case in the small-pox ? 22. Is the inoculation of the cow-pox equally successful in infancy, manhood, and de- crepit age ? Answers to the preceding questions will be principally obtained by inoculation for the cow-pox, of which there are many opportunities in provincial situations; which prac- tice it is one of the chief objects of this publication to encourage. 23. Do certain epidemic states appear to prevail, which influence this'disease ? P. S.-Extracts of a letter from Dr. Fowler to Dr. Pearson, dated Sarum, October, 24, 1798: My Dear Sir-The disease called cow-pox is known in this neighborhood only to a few farmers, but they understand that it is a preservative from the small pox. This morning, Anne Francis, a servant girl, aged 26 years, was brought to me ; she informs me, that some years ago bluish pustules arose on her hands, from milking cows diseased by the cow-pox. These pustules soon became scabs, which falling off, discovered ulcerating and very painful, which were treated bv a cow doctor, and were long in lualing. Some milk front one of the diseased*eows having spurted on the cheek of her sister, and on the breast of her mistress, produced ou these parts of both persons, pustules and sorek, similar to her oSvn ou hCr hands. Font of 222 CowfPox : George Peamon, M. 1). these three had suffered the small pox, nor have they gone through it since that time, although they have been mucn exposed to the infection ; and the sister above mentioned has been inoculated three times for the small-pox. The cew doctor who attended these three women said, he would forfeit his life if any of them should afterwards have the small-pox. With sincerest good wishes for the'success^of this and all your undertakings, I am, etc., ete. R. FOWLER, Note-Mr. Hughes' letter, dated'Stroud-Water, Gloucestershire, October 27, 1798, to Mr. Bliss, Surgeon, Hampstead, has been just sent to the author, in answer to his queries. Unfortunately this valuable lett r cannot now be published. It especially confirms, by a number of instances, the facts of the safety of the cew-pox, and of its producing unsusceptibility of the small pox. FINIS. Reports of a Series of Inoculations -FOR THE- VARIOLA VACCINE, or COW POX; -WITH- REMARKS AND OBSERVATIONS ON THIS DISEASE, CONSID- ERED AS A SUBSTITUTE -FOK- THE SMALL-EOX, " By WILLIAM WOOD VILLE, StD., Physician to the Small-Pox and Inoculation Hospitals. s LONDON: Printed and Sold by James Phillips & Sob, George Yard, Lombard street, 1799. TO THE KIGHT HONORABLE SIR JOSEPH BANKS, Bart.. • Knight of the Bath, President of the Royal Society, etc.: S/r-The great attention with which you honored some of the first cases described in the following sheets has induced me to hope, that on account of the whole, though not affording the satisfactory evidence upon the sub- ject that I expected, may still not be entirely unacceptable to you. I have the honor to be with the utmost regard, your obedient servant, W. WOODVILLE. Ely-Place, May 16, 1799. REPORTS, ETC. Last summer Dr. Jenner presented to the public* several curious and interesting facts, respecting a disease known to dairy farmers by the name of cow-pox. The most impor- tant of these is, that persons who have been effected with this distemper are thereby rendered as secure from the effects of the variolous infection as if they had actually un- dergone the small-pox. However extraordinary this circumstance may appear, it is supported by numerous experiments made under Dr. Jenner's inspection, and also by concurrent testimonies since collected by Dr. Pearson,! who with much laudable Zealand industry instituted a further inquiry into the subject. Dr. Jenner, who from his situation in Gloucestershire, had many opportunities of seeing the cow-pox, supposes it to originate from the grease in horses, and to take place in the following manner: " In this dairy country a great number of cows are kept, and the office of milking is performed indiscriminately by men and maid servants. One of the former having been appointed to apply dressings to the heels of a. horse affected with the grease, and not paying due attention to cleanliness, incautiously bears his part in milking the cows, with some particles of the infectious matter adhering to his fingers. When this is the case, it commonly happens that a disease is communicated to the cows, and from the cows to the dai ry-maids, which spreads through the farm, until most of the cattle and domestics feel its unpleasant consequences. This disease has obtained the name of cow- pox. It appears on the nipples of the cows, in the form of irregular pustules. At their first appearance they are commonly of a palish blue, or rather of a color somewhat approaching to livid, and surmounted by an erysipelatous inflammation. These pus- tules, unless a timely remedy be applied, frequently degenerate into phagedenic ulcers. The animals become indisposed, and the secreiion of milk is much lessened. Inflamed spots now begin to appear on different parts of the hands of the domestics employed in milking, and sometimes on the wrists, which quickly run on to suppuration, first assum- ing the appearance of small vesications, produced by a burn. Most commonly they ap- pear about the joints of the fingers, and at their extremities ; but whatever parts are af- fected, if the situation will admit, these superficial suppurations put on a circular form, with theiredges more elevated than their centre, and of a color distantly approaching to blue. Absorption takes place, and tumorsappear in each axilla. ■ The system becomes affected-the pulse is quickened; and shiverings, with general lassitude and pains about the loinsand limbs, with vomiting, come on. The head is painful, and the patient is now and then even affected with delirium. These symptoms, varying in their degree of violence generally, continue from one day to three or four, leaving ulcerated sores about the hands, which, from the sensibility of the parts, are very troublesome, and commonly heal slowly, frequently becoming phagedenic like those from whence they sprung. "Thus the disease makes its progress from the horse to the nipple of the cow, and from the cow to the human subject." Since no fatal effects have ever been known to arise from the cow-pox, even when im- pressed in the most unfavorable manner; and since this disease appears from numerous instances to leave the constitution in a state of perfect security from the infection of the small-pox, Dr. Jenner infers, that the employment of the matter of the cow-pox would be preferable to that of the small-pox, for the purpose of inoculation. In con- firmation of his opinion, it may be observed, that he relates the cases of seven or eight persons whom he successfullv inoculated with this new antidote to the variolous poison. Possessed of the above information I confess I became very anxious to try the effect of inoculating the matter of this singular disease, and as trials could be made not only with safety, but also with the prospect of advantage, I conceived it to be a duty that I owed to the public in my official situation at the Inoculating Hospital to embrace the tirstopportunity of carrying the plan into execution. *See an inquiry into the causes and effects of the variolas vaccinae, a disease discovered in some of the western counties of England, particularly Gloucestershire and known by the name of the cow-pox, ♦Sec in inquiry concerning the histbiy of cbw-p'ox. 228 Cow Pox : William Woodville, M. 1). Unfortunately, however, at the time Dr. Jenner's publication appeared, no cow-pox matter could be procured, for the disease had then become extinct; nor was it expected to return till the spring. the period at which it usually affected the cows. But conceiv- ing that the distemper might be produced bv inoculating the nipples of cows with the matter of grease of horses, in conformity with the opinion above stated I proceeded to try whether the cow-pox could be actually excited in this manner. Numerous experiments were accordingly made upon different cows, with the matter of grease, taken in the various stages of that disease, but without producing the desired effect; my friend, Mr. Coleman, the ingenious professor at the Veterinary College, like- wise made similar trials, which proved equally unsuccessful.* Neither were inocula- lations with this matter, nor with several other morbid secretions in the horse, produc- tive of any effects upon the Luman subject. I am aware, that the experiments I allude to, may, by some, not be deemed wholly conclusive from a supposition that the peculiar predisposition of the cows, necessary to render the inoculations efficient, might not exist at the time the matter was applied to their nipples. But I have also other reasons for believing that the cow-pox does not originate from any disease of the horse. In the first place, the affirmative opinion is confessedly gratu- itous. A horse, at a certain season of the year, becomes affected with the grease, and the cows at the same time are affected with cow-pox ; and from this coincidence the two dis- eases have been considered as cause and effect. Yet is it not equally probable that the same temporary causes which produce a certain disorder in one animal may so operate upon another animal of a different genus as to excite another disorder ? Therefore, though the cow-pox may break out among the cows at the time that the grease affects the horses kept on the same farm, yet the consecutive appearance of these diseases affords no proof of their connection ; while, on the other hand, I can adduce instances in which the former disease has broken out under such circumstances as render it highly improbable, if not impossible, that it should have been caused by the latter.t But, though Dr. Jenner seems to have been misled with respect to the origin of the cow-pox. still his facts and observations concerning its effects upon mankind are not the less valid and important ; nor did I feel the less desirous to try how far they would be invalidated or confirmed by a more enlarged experience than he had the opportunity of acquiring. Towards the latter end of January last I was informed that the cow-pox had appeared among several of the milch cows kept in Gray's Inn Lane, and upon examination of these, three or four were discovered to be affected with pustulous sores upon their teats and udders. These pustules corresponded in their appearance with the representation and description of the genuine cow-pox, as given by Dr. Jenner. I should not, however, call the surrounding inflammation erysipelatous; it was evidently an indurated tume- faction of the skin. The number of cows kept at this place was at this time about two hundred, and about four-fifths of them were eventually infected.! The hands of three or four persons became sore in consequence of milking the cows thus affected ; and one of them, Sarah Rice, exhibited so perfect a specimen of the dis- ease that I could entertain no donbt of its being the true, and not the spurious, cow- pox. Several gentlemen who I knew would be highly gratified by seeing the disease as it appeared upon the girl's arm, were invited to meet me at the cow-house on the following day, when Lord Summerville, Sir Joseph Banks, Sir Wm. Watson, Drs. Simmons, Pear- son, Willan, and others, attended. This was on the 24th of January last, and Sarah Rice had then been affected five days. The appearance of the disease upon the girl's hand and arm very much resembled the representation of it given in the first plate of Dr. Jenner's pamphlet At first a small tumor or circular vesication appeared between her fingers; next day she discovered three more like the first, namely, one upon her finger, another at the wrist, and also one upon the middle of her forearm. The two first never became larger, and exactly resembled the vesicle upon the finger in the plate alluded to: that at the wrist was now about one-third of an inch in diameter, and the other upon her arm was still larger; they were both of a circular form, not depressed at the centre, and had a simple inflammatory border; the pellicle of both these tumors, but more especially of the larger, had at this time acquired a blue color, which was deepest about the centre. This blueness had come on during the last twenty-four hours; for I had seen the tumors the preceding day, when this colored tinge could scarcely be perceived, * Mr. Coleman caused one of his cows to be inoculated ia its teats with cow-pox matter, and that taken from a variolous pustule, without effect: but the former matter, after being regenerated by the human sub- ject, produced the disease in the cow. t Those who wish for further information on this subject, may consult Mr, Simmons' Experiments and Dr. Pearson's Inquiry, pp. 83-84. J Tho's'e cows which v erC not in milk escaped the disease. Cow Pox : William Woodville, M. 1). 229 and that too only in the largest; at that time also it contained a colorless fluid, but now its contents appeared brownish. The girl now perceived an uneasiness at the axilla; and I afterwards learned that this symptom was followed by a slight headache. None of the tumors were painful, and they all gradually went oft' without producing ulceration. Sarah Rice had undergone the small-pox when a child; and the only reason why she was more affected by milking the diseased cows than the. other milkers were, was that her hands and arms were more red, swollen, and disposed to chap than theirs; though it does not appear that there were any abrasions of the cuticle of those parts of the skin which were infected by the cow-pox. Before relating the cases of inoculation with the matter of cow-pox, I have judged it proper in the first place briefly to state what are the local effects produced by inoculat- ing variolous matter, so that the progress of the infection in both cases may be compared, and the subject of inoculation at large, be better understood. In cases wherein inoculation of the small-pox proves effectual, a small particle of va- riolous matter being applied bj a superficial puncture of the skin, usually produces in the course of three or four days, or sooner, a little elevation of the punctured part, dis- coverable by the touch, and a red speck distinguishable by the eye. From this time the redness advances in a circular form, more or less rapidly, according to the constitutional circumstances of the patient; and the first effect of this superficial inflammation is the formation of a vesicle upon its centre, which usually appears between the fourth and seventh day after the inoculation. The extent of the vesicle is generally found to bear some proportion to the intensity of the inflammation; and contains a limpid fluid, by the absorption of which the small-pox is produced. The vesicle soon bursts, and the central part of the puncture becomes depressed, and often of a dark hue ; which appear- ances, together with the marginal inflammation, continue to increase till the eruptive symptoms subside, when the edges of the depressed part begin to swell with a purulent fluid, and the inflammation gradually recedes. Thus it appears that the variolous matter, first inserted by the puncture, like that of other morbid poisons, is not capable of being immediately absorbed, but lodges in the skip, and there excites an inflammatory process, by which a new matter, producing the disease is generated*. It would seem also that this process is carried to a greater or less extent in different persons before the matter enters the absorbents, owing probably to the greater or less aptitude in these vessels to receive it; hence we find the local inflam- mation, in some cases, considerably advanced before the system becomes affected, while in others the eruptive symptoms supervene when it appears to have made but very little progress; and, therefore, though the eighth day after the inoculation, proves the usual period at which the patient feels indisposed, yet this frequently happens much sooner or later, and the progress of the cow-pox infection will be found to take the same latitude. Monday, January 21, 1799, I took the matter of cow-pox in a purulent state upon the teats of a cow, with which I immediately inoculated seven persons by a single puncture in the arm of each, or rather by scratching the skin with the point of a lancet till the instrument became tinged with blood. FIRST CASE. Mary Payne, a child, two years and a-half old, of a strong, robust constitution. Third Day.-The in- oculated part was evidently ulcerated and slightly inflamed. Sixth Day.-The local tumor ex- tended to about one-third of an inch in diameter, and was nearly of a circular form, with its edges more elevated than the centre, and, with the surrounding inflammation, not greater than is usual in cases of inoculated small-pox. The vesicle, upon the middle of the tumor, was now very large, and distended with a limpid fluid, some of which I took upon a lancet and with it inoculated another person, John Talley. She appeared dull and drowsy, and her pulse was quicker than usual. She had no appetite for food, and had been very thirsty since yesterday. Eighth Day-The redness surround ing the tumor seems returning; and the thirst and other febrile symptoms are much abated: but she still appears lifeless and somewhat indisposed. Eleventh Day.-She is perfectly free from complaint; the inoculated part is scabbing, but surrounded with a hard tumefaction of a bright red color. She was this day inoculated with variolous matter. Fifteenth Day.-She has no ailment. The variolous inoculation pro- duced considerable inflammation, which gradually disappeared after the fifth day. Elizabeth Payne, aged four months, in appearance weak amd somewhat emaciated. The progress of th$ infection on this child's arm was very much like that of her sister's, just mentioned; but the vesication seemed rather more extensive, and the surrounding inflammation less. The sixth day after inoculation her mother informed me that the child had been very unwell the preceding night with wbat were called inward convulsions, and had vomited two or three times. On examination, the heat of her skin, and the fre- quency of her pulse, indicated the presence of some degree of fever. Eighth Day.-I learned that the SECOND CASE. *In the second volume of the History of Inoculation, now nearly ready for the press, I have endeavored to show that the general greater mildness of the inoculated than the casual small-pox depends upon this circumstance. 230 Com Pojc : William Woodville, M. D. febrile state had continued, more or less, till this morning; nor was it then wholly gone off. The inoculated part, I judged from its appearance, had not entirely ceased from disordering the, constitution. Eleventh Day,-The redness of the tumor is subsiding, and its general appearance resembles the effects of inocula- lation with variolous matter when the eruption is completed, and the maturation proceeding favorably. The patient's mother now thinks her as well as usual. She was this day inoculated with variolous matter. Thiiteenth Day.-She manifests no signs of indisposition. The redness about the tumor is gone off, and the n after is forming a scab. The second inoculation produces no effect. Fifteenth Day.-She is now very well; but her mother says she was seized with inward convulsions yesterday, and was extremely ill after- ward for two hours ; this, however, cannot be justly ascribed to inoculation, as the part in which the cow- pox matter was inserted is now covered with a dry scab, not attended with inflammation ; and the variolous matter produced no redness whatever. She was this day brought to a man laboring under the casual small- pox, and kissed by him, in order more fully to try if she was secure from the infection of the small-pox. Her' sister, Mary Payne, was also subjected to the same test, but neither of them have since taken the dis- ease. THIRD CASE. 'Ikomas Buckland, a strong child, four months old. The progress of the infection on the boy's arms was even more regular and produced appearances more analogous to those of the inoculated small-pox than in the case of Mary Payne. The vesicle on the inoculated part formed on the third day, and the surround- ing inflammation never became phlegmonous, nor was it attended with any hardness of the integuments. Seventh day.-In the evening he was discovered to be feverish and restless, when two pustules exactly re- sembling those of the small-pox appeared near to the inoculated part. The following day he still continued indisposed, and the cutaneous inflammation had that peculiar irritable or angry aspect which is observed on the accession of the eruptive symptoms in cases of inflammation with variolous matter. Tenth day.--The suppuration was more extended, and the efflorescence immediately encompassing it, had nearly disap- peared, leaving its border- more str< ugly marked than theinner; a circumstance of the most favorable im- portin inoculation The two pustub's upon his ar m were ntore advanced, and several other s were visible upon different parts of his body, his ankles and feet were beset with a rash like scarlatina. He is still feverish, artd his mother reports that last night he vomited Eleventh day. -The soreness of his atm, and the fever- had ceased. Nine distinct pustules were now discovered upon his body and limbs, somewhat smaller than variolous pustules ; from one of these I obtained an ichorous matter, and with it inoculated Sarah Price. Thirteenth day.-The febrile symptoms returned yesterday, nor is he wholly free front them to-day. Nine additional "pustules have appeared; no inflammation remains at the inoculated part, and the matter it con- tains begins to dry. Fifteenth day. He is free from disorder; six pustules have appeared making in the whole twenty-four, some of then? maturate at the apex, but they mostly oie away without proceeding to suppuration. He was this day exposed to the effluvia of casual small-pox. in the same manner as the two Paynes. FOURTH CASE. Bichard Payne, a healthy boy, ten years old. The inoculated part was not sensibly elevated nor in- flamed, till the fourth day. Seventh day.-The tumor had spread considerably ; and the vesication upon it was very evident. He felt a sensation of itchingin the part; and the next day complained of a pain m the axilla, which continued two days. Tenth day-The centre of the tumor became depressed, its edges elevated, and surrounded by a deep-color ed inflammatory border. The central part of the tumor was now assuming externally a brown color and in a few days afterwards it formed a dark scab. Though considerable tumefaction, with hardness artd redness, remained at the inoculated part sever al days yet no uloetation ensued. Fifteenth day.-l ive pustules remained resembling those irr Buckland. This boy was twice in- oculated with variolous matter during the progress of the cow-pox infection, and exposed to patients under the small-pox the whole time, without being infected by it; and the only complaint arising from the cow- pox was the pain in his arm-pit. FIFTH CASE. Matthew Bedding, sixteen years old. Third day.-The insertion of the matter did not appear to have produced any inflammation or hardness in the part; be was, therefore, inoculated with variolous matter, at the distance of two inches from the part in which the cow-pox matter was inserted Next day a little redness could be discovered at the first puncture, and from this time both inoculations proceeded very regularly, but slowly, so that on the seventh day they appeared to be inflamed in an equal degree, the ex- tent of the inflammation not exceeding the tenth of an inch in diameter. Eighth day.*-He has pain in the axilla. Tenth day.-Both tumors are approaching to suppuration. They are of the same form, and at tended with an equal degree of efflorescence. Eleventh (lay.-He complains of headache ; the red tinge now extends in a circular form, and includes both tumors. Thirteenth day.-There appears more tension and pain at the variolous tumor than at the other, but the latter tumor is more prominent. Fifteenth day. Both tumors began to dry, and no inconvenience followed. This boy made no other complaint, during the process of infection, than of uneasiness in the axilla, followed by a slight headache, of very short dura tion; however, on the seventeenth day, four small pustules appeared, viz : one upon bis nose, one upon his thigh, and two on his head : none of which suppurated. This case strikingly resembles that, ot Richard Payne, on which the pustules did not appear till the arm scabbed. SIXTH CASE. Jane Collingridge, a healthy, active girl, seventeen years of age. Third day.-The inoculated part began to be elevated and inflamed. ' Fifth day -It was vesicated, and attended with itching. She was inoculated with variolous matter in the right arm. the former inoculation having been in the left. Eighth day -The whole tumor is much increased in all dimensions; its form is perfectly circular, and it appears of a lemon- colored tint. She now complains of a stiffness across her arms, and of a pain in the axilla ; the puncture in the right arm begins to be elevated and inflamed. Eleventh day.-She complains of headache and pains about the loins ; the tumor produced by the cow pox matter is now more inflamed at the margin, which is beset with minute confluent pustules: tlie variolous tumor is also advanced to a state of vesication ; snd she reports, that last night both axillae were painful. Twelfth day.-She continues indisposed; the tumor is •'Here as well as in the subsequent cases, where the patient was twice inoculated on different days. I date he time from the first inoculation. CowPox: William Woodville, M. J). 231 surrounded by an extensive efflorescence; the variolous tumor is of a deeper rad color. Thirteenth day.- The cow-pox tumor is subsiding and forming a scab ; that of the small-pox is efflorescent; her headache continues ; pain in the right axilla; several pustules appear. Fifteenth day.-There are small pustules round the edges of the variolous tumor; more pustules appear scattered over the face, body, and limbs. Seventeenth day.-The scab over the cow-pox tumor is in a state of suppuration; she complains of a sore throat; the number of pustules is now from one to two hundred, in no respect differing from variolous pus- tules of the mild sort. From this time both the tumors gradually healed, and the pustules dried at the usual time. SEVENTH CASE. Ann Pink, a tall girl, of a brown sallow complexion, aged fifteen years. This girl was inoculated with variolous matter, on the fifth day, in the same manner as Colliugridge, and both tumors proceeded to ma- turation, though more slowly than in that case Neither of the tumors began to scab till the seventeenth day, when they resembled each other so perfectly that the one could not easily be distinguished from the other. She had no pain in either axilla, nor made any complaint during the whole progress of the infec- tion, neither did pustules appear upon her. The only other persons whom I first inoculated with the matter of cow-pox, and on the fifth day after- wards with variolous matter, were William Harris, William Bunker and James Crouch. EIGHTH CASE. William Harris, twenty-one years of age, of a tall and slender make, and of a delicate constitution, was inoculated January 24 with the"matter of cow-pox, taken from the arm of Sarah Rice, who received the dis ease by milking the cows. Third day.-The inoculated part was evidently elevated and inflamed. Fifth day.-It advanced to vesication, and a sensation of itching was perceived in the part; he was this day in- oculated with variolous matter. Ninth day.-The tumor of the first inoculation presents prominent callous edges with but very little redness ; its centre is depressed and contains a lymphatic fluid; he perceives a tenderness in the axilla; the variolous tumor is considerably inflamed and vesicated, and itches more than the other. Next day a pain was perceived in the axilla of the arm, in which the variolous matter was in- serted, as well as in the other. Twelfth day.-Redness of the cow-pox tumor is going off; but that of the variolous still spreads with an irregular margin. Fourteenth day.-Several pustules appear. The cow- pox tumor is now dry at the centre, but its surrounding edges appear of a blueish tinge, and still abound with ichorous matter. The variolous tumor is much inflamed, and beset with confluent pustules at its edges ; its centre is depressed and of a dark hue. Nineteenth day.-The cow-pox tumor has formed into a dry scab, with a finely polished surface, and of a mahogany brown color ; the variolous tumor is in a puru- lent state, with an extensive inflammation at the margin ; the pustules are about 300 in number, very large, and all in a state of maturation. From ihis time all the effects of inoculation went off gradually ; he never complained of headache, nor of any febrile symptom during the whole progress of the disease. NINTH CASE. William Bunker, a strong, healthy boy, fifteen years of age, was inoculated in his left arm, on the same day, and with matter from the same person as Harris. Third day.-The inoculated part was elevated and reddened Fitth day-The inflammation was much increased ; he was now inoculated in his right arm with variolous matter. Eighth day.-The tumor upon his left arm is much elevated, and the vesication consid- erable since the sixth day; he now complains of pain in the axilla and of headache. The pustule on the right arm advances very slowly. Tenth day The pain in the axilla and the headache continue. The tu- mor of the left arm begins to scab in the centre, and is surrounded with a red tinge of considerable extent. The tumor on the right arm now also presents a red tinge of a familiar appearance, but not of half the ex- tent. The tumor on the right arm now also presents a red tinge of a similar appearance, but not of half the extent; its center is in a state of vesication, and its edges studded with small pustules ; his headache is not entirely gone off. Twelfth day.-The red tinge surrounding the tumor on the left arm has disappeared, except a narrow ring at its outer border the tumor on the right arm is depressed at the centre, where it is also of a livid color ; its edges are hard and inflamed ; he now discovers two or three pustules upon his body. Seventeenth day.-The matter of both tumors is almost wholly formed into a dry incrustation ; no more pustules have appeared; one upon bis hip has maturated. Twentieth day -Both tumors are perfectly scabbed ; that upon his left arm appears browner and smoother than the other. TENTH CASE. James Crouch, seven years old, inoculated on the same day as the last patient with matter taken from the same girl, and with variolous matter five days afterward. Fifth day.-The inoculated part was considera- bly elevated and inflamed. Ninth day.-The c,ow-pox tumor is much advanced; the pellicle filled with ichor; the marginal inflammation not considerable ; the variolous puncture now displays a small red speck, which begins to spread. Eleventh day.-The cow-pox tumor exhibits an extensive efflorescence, or red stain, upon the surrounding skin, and its centre begins to dry; the variolous tumor is spreading a little, and in a state of vesication. Fourteenth day.-Pain in the axilla is now produced by the cow-pox tumor, which is drying at the centre; the variolous tumor is now efflorescent, but not to half the extent of the other. From this time the tumors quickly healed, no eruption took place, and no farther inconvenience was experi- enced. ELEVENTH AND TWELFTH CASES. Thomas Fox, aged twenty-five, and John Dennis, twenty-three years of age, both strong men, and accus tomed to hard labor, were inoculated on the 22d of January with variolous matter, and on the following day with cow pox matter, taken from the arm of Sarah Rice. In both these cases, the first inoculation was per- formed by two punctures at the distance of two inches from each other, and the latter by one puncture at the same distance from the two former. The local effects and appearances of the inoculation were very similar in both these men; the cow-pox turn >rs seemed to advance equally with those of the variolous, and bore a strong resemblance to them ; the former, however, were more elevated and circumscribed ; for about the ninth day the variolous tumors became angulated or ragged at the margin, which was not so conspicu- ous as the others, though both had small continent pustules at their margins. Those of the cow-pox also sooner healed, and formed a smoother scab. The eruptive fever came on about the eighth day with Dennis, but not till the tenth with Fox; the former had more than 300 pustules; and the latter about 100; allot' which were in every respect similar to variolous pustules. 232 Cow Pox: William Woodville, W J). THIRTEENTH AND FOURTEENTH CASES. John Talley, fourteen, and Thomas Brown, fifteen years old, were, Jaeuary 25th, inoculated with vario lous matter in the left arm, and the following day they were both inoculated in the right arm with the matter of cow-pox, taken from the arms of Mary and Elizabeth Payne, (see cases first and second). The progress of both the infections on the aims of these boys was perfectly regular ami equal throughout. On the sex - enth day all the tumors were considerably inflamed and in a state of vesication, attended with itching. Brown also at this time complained of a pain in eac h axilla; but witli Talley the pain was confined to the left till the next day, when both arm-pits were affected. Tenth day.-They both complained of headache and of pains about the loins; these, however, were very slight, and no further indisposition ensued. On the evening of the twelfth day some pustules appeared upon Brown, but upon Talley they did not appear till the fourteenth day; the former had in all about thirty, and the latter only six, all of which were ap- parently variolous. The cow-pox tumors were more elevated at the edges and less depressed at the centre after the ninth day than those of the variolous ; and they eventually formed a smoother and browner scab, as in the case of Fox and Dennis. January 30th.-William Mundy, Elizabeth George and Sarah Butcher weie inoculated by two punctures with the matter of cow-pox, taken from the arm of Collingridge, (Case6th.) FIFTEENTH CASE. William Mundy, a strong laboring man, aged twenty-five years, was inoculated as above described by two punctures in his left arm. The local infection of both punctures advanced, and the inflammation and its effects proceeded rapidly, so that on the eighth day he complained of uneasiness in his axilla, and of pain in the head and loins, which continued about two days; the tumors were considerably elevated, and their margins much inflamed. Thirteenth day.-They were surrounded with an extensive redness, in the form of an halo, and beginning to scab at the centre ; the edges continued circular, well defined, and elevated. Fourteenth day. Several pustules appeared upon his neck and back but disappeared in two or three days without suppurating. He was this day inoculated with variolous matter, but it produced no other effect than a little redness of two or three days duration. SIXTEENTH CASE. Elizabeth George, a strong woman, twenty-five years old, was inoculated in the same manner, and on the same day above mentioned, with cow-pox matter taken from the same person The punctures quickly rose, but the inflammation was inconsiderable till the sixth day, when vesication and itching commenced. Ninth day.-Has no pain in the axilla, but complains of headache and pain in the loins Eleventh day.- Her pains continue ; pulse quick ; the central pellicle of the tumors is extending, and replete with a watery humor ; the margins swollen and red. Thirteenth day -The same appearances continue Fifteenth day.- The symptoms are abated ; says she has no other complaint than a giddiness of the head ; the inflammation at the margin of the tumors is greatly abated; the matter in the centre is beginning to dry ; some pustules appear on tile face. Sixteenth day.-She makes no complaint; more pustules show themselves; the tumors appear circular, with the centre equally elevated as the edges, and exhibiting an uniform, smooth surface, which is becoming hard. Eighteenth day -More pustules have appeared; the tumors are scabbing, and the surrounding redness is almost wholly gone. Twentienth day.-Her face is swelled; the pustules aie very sore, and in a purulent state; their number is five hundred and thirty, and two in the throat are a little troublesome. Twenty-fifth day-The pustules in a state of desquamation. She was now inoculated with variolous matter, which produced no effect. The scabsat the inoculated parts were of that brown, smooth kind peculiar to the cow-pox. SEVENTEENTH CASE. Sarah Butcher, a healthy girl, thirteen years old. was inoculated with the matter ot cow-pox at the same time and in the same manner as above mentioned. Sixth day.-The tumors were much elevated, the inflamma- tion inconsiderable; the vesication fully formed, and attended with itching Ninth day-There was a slight efflorescence around the tumors, uneasiness in the axilla, headache, pain in the loins. Eleventh day.- Suppuration at the inner edges of the tumor, redness at the outer edge very extensive. Fourteenth day.- Tumors scabbing; no eruption ; complains of pain in her bowels and diarrhoea. Sixteenth day-No com- plaint, central part of tumor scabbed ; inflammation still surrounding the edges. She was inoculated this day with variolous matter. Eighteenth day.-The redness gone off, leaving a led tinge at its outer margin. The variolous matter produced a little redness, which disappeared in two days January 31st.-Thomas Wife, aged fourteen, and Sarah Price, aged thirteen years, were inoculated with the matter of cow-pox, taken from Mathew Bedding, and at the same time with variolous matter, but the latter inoculations were the following day prevented by applying the concentrated acid of vitrol to the punctures. EIGHTEENTH CASE. Thomas Wife, above mentioned. Fifth day.-The inoculated part was considerably inflamed and vesi- cated. Eighth day.-The tumor advances with much marginal redness, and a pain in the axilla is per- ceived. Twelfth day.-Pain in the axilla continued two days. He has no other complaint. The centre of the tumor is forming a scab, but is surrounded ■with an appearance like areola papillae. Two pustules were discovered upon his body this day, and two more appeared on the fifteenth day, but none of them became purulent. The tumor upon his arm had at the time formed a hard, smooth scab. NINETEENTH CASE. Sarah Price, inoculated, as above stated, in her left arm ; on the same day was inserted in her light arm cow-pox matter, taken from a pustule from Buckland. Fifth day.-There was a redness of elevation at the two punctures of each arm, but in consequence of the caustic effects of the vitriolic acid none at the vario- lous puncture. Eighth day.-Both tumors were advanced; vesication and a considerable degree of inflam- mation, especially in that on the left arm. She now complains of rigor and of pain in the left axilla. These symptoms, together with a headache, continues two days. Three pustules have appear* d upon her face and neck, and two days afterwards three others, none of which suppurated. This girl, as well as Thomas Wife, was constantly exposed to the small-pox during the progress of their inoculation. Cow Pox: William Woodville, M. D. 233 TWENTIETH CASE. Thomas Dorset, inoculated February 1st. with the matter of cow-pox, taken from the arm of Jane Col- lingridge (see case six). Seventh day.-The inoculated part was much elevated and in a state of vesication, attended with the usual degree of redness. Eleventh day.-Last night lie perceived an uneasiness in his axilla, and he now complains of pain about his loins; the tumor encircled bv an extensive efflorescence. Thirteenth day.-The tumor scabbing at the centre He was inoculated this day with variolous matter. The variolous inoculation, produced no effect. About the twelfth day. this man had four or five pustular appearances which he called pock, but they seemed to me more like common pimples than variolous pus- tules. TWENTY-FIRST CASE. John Keys, twenty-five years old, inoculated February 6, with matter of cow pox taken from the arm of James Crouch. On the fourth day the inoculated part was considerably inflamed, and affected with a sen- sation of itching; but from this time the redness gradually disappeared, and was entirely gone on the ninth day, when he was inoculated with variolous matter in both arms, but without effect. On the tenth day, however, he complained of pain in his head and loins, with which he was affected three days, but no eruption ensued. TWENTY-SECOND CASE. Edward Turner, a strong man. twenty-four years of age, inoculated by two punctures with the matter of cow pox taken from the arm of James Crouch (Case Tenth) February 5th. Seventh day.-The tumors were much advanced, in a state of open vesication, and attended with itching. Twelfth day.-They be- gan to dry in the centre, but the margins were of a dry red color, and studded with minute vesiculie; he now complains of pain in the axilla, stiffness of his neck and pain in the loins. Fourteenth day.- Headache and pains in the loins continue; the inner edges of the tumors are distended withan ichorous fluid. Sixteenth day.-Complaints of headache and sore throat; next day about 100 pustules appeared, many of which were very small. Nineteenth day.-He has no complaint; the number of the pustules now amounts to about 220; all of them afterwards suppurated. On the twenty-third day he was inoculated with the variolous matter, which produced no effect. TWENTY-THIRD CASE. Hannah Morgan, a strong child, one year old. was inoculated with the matter of cow-pox taken from the arm of James Crouch, February 5. Fifth day.-The inoculated part is much elevated and inflamed. Seventh day -The tumor contains ichor, and the redness and elevation are greatly increased; yesterday she became feverish, and last night was sick ami vomited; her skin at this time is hotter than usual. Fourteenth day -The febrile symptoms continued, and at times were very severe, till the tumor is now scabbing. She was afterwards inoculated with variolous matter, but it only produced a transient redness in the part. TWENTY-FOURTH CASE. fane West, twenty-one years of age, was inoculated on February 6th with the matter of cow-pox, taken from the arm of Sarah Butcher. Seventh day.-The inoculated part was considerably elevated and in- flam d : the vesication was also extensive and attended with itching. Ninth day.-She complained of head- ache, and next day of a pain in the axilla and upon her shoulder, attended with rigors and shivering; the border of the tumors appeared of a deep red, and its inner edges contained an ichorous matter. Thirteenth day.-Yesterday an efflorescense appeared around the tumor. She complains of a sore throat, and says she has a pain across her chest. Fifteenth day.-Two pustules have appeared upon her side; the tumor be- gins to dry. She makes'no complaint. Seventeenth day.-Twenty pustules appeared, all of which sup- purated. Twenty-third day.-The variolous inoculation produced no inflammation. TWENTY-FIFTH CASE. Ann Bumpus, aged twenty years, was inoculated February 6 with the matter of cow pox, taken from the arm of Sarah Butcher. The appearances of the inoculated part in this girl's arm corresponded in every respect with those stated in West's case. Eighth day.-She complained of headache Tenth day.-Pain of the head and loins; shivering. Eleventh day.-Two or three pustules appear upon her face. Thirteenth day. - Pains continue; more pustules appear. Fifteenth day.-No complaint; the pustules were counted and found to be 310, resembling those of the small-pox. Seventeenth day.-Complains of sore throat. Nineteenth day.-Pustules drying. Twenty-second day.-Inoculated with the matter of small-pox, but no inflammation was produced by it. TWENTY-SIXTH CASE. Thomas Slade, twenty years of age, was inoculated with the matter of cow-pox taken from the arm of William Mundy, February 6. On the eighth day the inoculated part was much elevated and in an advanced state of vesication. He complained of headache and pain in the axilla; and on the next day of a pain in the loins. Eleventh day.-Pains abated ; three or four pustules appear; the tumor is bordered with small •confluent vesicles. Fourteenth day.-No complaints; tumor beginning to scab. Nineteenth day.-The centre of the tumor formed a brown, hard scab. The pustules do not suppurate and are receding. Twenty- second day. - He was inoculated with the matter of small-pox, which produced a redness for two or three days, and afterwards gradually disappeared. TWENTY-SEVENTH CASE. Frances Jewel, a healthy young woman, twenty years of age, who had undergone the small-pox by inoc- ulation when a child, was inoculated with the matter of cow-pox taken from the arm of Sarah Butcher. February 5. The inoculated part advanced with a tumor equal in extent and duration to that in the case last mentioned ; on the ninth day headache and pains of the loins came on, and continued two or three days. The tumor began to scab on the thirteenth day, but no pustules appeared. She was afterwards inoculated with variolous matter, and also with that, of the cow-pox, neither of which produced any inflammation. 234 Cow Pox : William Woodville, M. J). TWENTY-EIGHTH CASE. Charlotte Fisk, four months old, was. on February the 13th, inoculated with the matter of cow-pox, taken from the arm of Frances Jewel. In this child the local disease proceeded very regularly. She had became indisposed on the eighth day, and continued feverish for three or four days, when about forty pustules ap- peared; but the greatest part of these pustules did not proceed to suppuration. The mother of the child labored under the natural small pox, and was covered with pustules in a purulent state at the time her child was inoculated; yet the infant was suckled by her during the whole course of the disease, and was fre- quently seen besmeared with variolous pus. Whence it would appear that the vaccine infection not only prevents but actually supersedes the casual small-pox. TWENTY-NINTH CASE. James Tarrent, nineteen years old, was, on the 16th day of February, inoculated with the matter of cow- pox. taken from a pustule upon Elizabeth George In this case the inflammation at the inoculated part pro- ceeded very rapidly, and was more extensive than usual on the sixth day; but from this time it began to re - cede, and was entirely gone on the tenth day, only a small dry scab at the punctire being left. He was now inoculated with variolous matter, which did not produce any inflammation whatever. I consider this man one of the few whose constitutions cannot be effected either by the virus of the cow-pox or the small- pox. It is true he complained of headache about the ninth day, but I should not be disposed to attribute this symptom to the inoculation. THIRTIETH CASE. William Hull, aged eleven years, was, on the 8th day of February, inoculated with the matter of cow pox taken from the arm of Sarah Butcher. Seventh dav.-The tumor at the inoculated part is advanced in the usual manner, and he this day complains of headache. Tenth day.-His headache and pains in the loins continue, and several pustules now appear upon him. Twelfth day.-The pains are gone off and more pustules appeared. Fifteenth day.-The pustules amount to about 200. They vary much in size, ami are proceeding to maturation. Eighteenth day. He was inoculated with variolous matter, which produced no effect. THIRTY-FIRST AND THIRTY-SECOND CASES. February 8th, Hannah Hull, aged thirteen years, and Sarah Hull, eight years old, were inoculated with the matter of cow pox taken from Sarah Butcher. These two sisters had the disease rather more favorably than their brother William Hull, for the inoculated part was in both surrounded by an efflorescence on the eleventh day, and the number of pustules upon the third was not equal to that of their brother's, nor were the eruptive symptoms of half the duration of his. On the twentieth day they were inoculated for the small-pox, but no disease ensued. THIRTY-THIRD CASE. George Reed, aged fifteen years, was inoculated with the matter of cow-pox taken from the arm of T Jeasel, February 14th. The inoculated part tumified in the usual manner; he complained of headache on the eighth day. and this symptom continued with occasional intermissions till the 13th day. Some pustules began to appear about the 11th, and the eruption was completed on the fourteenth day. They were in number about seventy some of which were very small, but they all maturated iu a favorable manner. He was aftewards inoculated with variolous matter, which formed a pustular appearance; but no disorder was produced, Frances Pedder, Amelia Hoole, George Hickland and Elizabeth Morton, were inoculated on February 13th and 14th with cox-pox matter taken from the arm of Sarah Price, who was inoculated from a pustule on Buckland (see case three). THIRTY-FOURTH CASE. Frances Pedder, a child, eleven months old. The inoculated part was gradually elevated and inflamed. Eigth day.-The eruptive symptons supervened and she continued feverilh till the thirteenth day, when sev- eral pustules appeared. The tumor began to scab and the number of pustules then upon her was forty, all of which inoculated without becoming purulent. She was afterwards inoculated for the small-pox without effect. THIRTY-FIFTH CASE. Amelia Hoole, five months old, was inoculated as above described . The local tumor advanced in the us- ual manner. Seventh day. She became feverish, and several small pustules appeared at the border of the tumor. Tenth day.-She continued slightly indisposed since the last report, and nine pustules are now visible upon her body and extremities. Fourteenth day -The pustules amount to 102 in number, and form yellowish scabs. Eighteenth day.-The inoculated part was perfectly healed; the pustules appeared in a state of desquamation. She was at this time inoculated with variolous matter, but without effect. ♦ THIRTY-SIXTH CASE. George Hickland, six months old, inoculated from the person above mentioned. The eruption symptoms in this child were less severe, and of shorter duration than in the last case. However the number of pus- tules which appeared amount to 300, but only about one-third of them suppurated. This patient also re- sisted the infection of the small-pox by inoculation. THIRTY-SEVENTH CASE. Elizabeth Morton, nine months old, was more severely disordered than any of the four children inocu- lated with the matter taken from Sarah Price. The fever continued with some degree of violence from the seventh to the fifteenth day, and the number of pustules amounted to 200. On the twentieth day she was inoculated with variolous matter without effect. Cow-Pox; William Woodville, M. I). 235 THIRTY-EIGHTH CASE. L. Davy, aged eleven weeks, was on February 19th inoculated with the matter of cow-pox taken from the arm of Charlotte Fisk. This child had the disease very favorably. On the tenth day the tumor was surrounded by efflorescence, and her skin was a little hotter'than usual during that dav only. Ou the thir- teenth day one pustule appeared near to the inoculated part, and two upon her forehead, which were all she had. She was afterwards inoculated for the small-pox without effect. THIRTY-NINTH CASE. Maria Murrell, aged four months, was inoculated with matter taken from the same person and on the same day as Davy. Fifth day.-The inoculated part was much elevated, and inflamed. On the evening of the eighth day she vomited. Tenth day.-Tne tumor was surrounded by" a very extensive efflorescence, and she became hot and restless. Twelfth day.-She seemed free from fever, and about twenty pustules appeared upon her. Fourteenth day.-The inflammation upon the arm was gone oft, and the pustules seemed to be scabbing. The subsequent inoculation of the small-pox as upon the otlfers, produced no effect upon this patient. A[cow kept by Professor Coleman, at the Veterinary College, was inoculated on its teat with the matter of cow-pox taken from the arm of James Crouch, which produced the disease in the cow (see case ten). A* man servant, by milking this cow, w as also affected with an extensive tumor upon his thumb ; this soon ac- quired a livid j>lne color, and was attended with a considerable degree of fever for several daxs, and with a rash upon his ankles and feet. With the matter'produced in the nipple of this cow were inoculated Martha Streeton. James Smith ami George Meacock. FORTIETH CASE. Martha Streeton. aged twenty-two years, was on the. 1Hth of February, inoculated with the matter above mentioned. The inoculated part tumified in the usuals manner, and on the ninth uay she complained of headache, and afterwards of a pain in the axilla. The headache and pain in the loins continded, but not with severity, for five or six days. Pustules began to appear on the twelfth, and the eruption was com- pleted on the sixteentli day, when the number was about 300, During the maturation of the pustules, which in no respect differed from those of the small-pox. she complained of her throat being sore. On the nine- teenth day this patient was perfectly well. She was afterwards inoculated for the small-pox without effect. FORTY-FIRST AND FORTY-SECOND CASES. James Smith, sixteen, ami George Meacock, thirty years of age, were, on the 19th of February, inocu- lated with the same matter as that mentioned in the preceding case. The latter of these patients had the disease nearly in the same manner as Streeton : but in a greater degree, for Meacock's pustules were more numerous and the inoculated part did not exhibit a tumor so well defined and elevated as Streeton's did. Smith's case differed widely from both; his arm tumified rapidly, and an erythema or blush extended from the puncture several inches up bis arm, and down to the elbow. The eruptive symptoms began on the seventh, and continued till the eleventh day. He had four or five pustules upon his face, and nearly a hundred upon his body and limbs, all of which matured favorably ami the erysipelatous appearance of the inoculated part soon went off. though no application was employed for that purpose. Both the above patients were inoculated with variolous matter, which produced noeffect upon Meacock, but in bmith it was followed by a cutaneous inflammation of several days continuance. Samuel Fairbrother, fifteen years old, Richard" Calloway, aged nineteen years. James Camplin, aged sev- enteen years, John Turner, eight months old, and Mary Welsh,',three months old, were all, on the 21st and 23d of February, inoculated with the matter of cow-pox taken from the arm of Edward Turner (see case twenty-two). FORTY-THIRD CASE. Samuel Fairbrother began to be indisposed on the ninth day. and had repeatedly slight feverish paroxysms with pain in the axilla till the fourteenth day, when four small pustules appeared, after which no further complaint ensued. FORTY-FOURTH CASE. In Richard Calloway the inoculated part tumified in the usual manner, and on the ninth day he first com- plained of a pain in the axilla and headache, which continued till the twelfth day, an extensive bright red blush then surrounded the tumor, and no farther complaint ensued. At this time also some pustules ap- peared, but their number never exceeded twenty. He had been inoculated in the hand as well as in the arm, in order to discover if the appearance of the tumor in a part constantly exposed to the air would be the same as in the arm covered by his dress. The difference was very evident, for the tumor upon his hand was much more extensive, of a more livid color, and'attended with more inflammation than the other. FORTY-FIFTH CASE. James Camplin suffered rather more from the eruptive complaints than Calloway, and they continued with him a day longer. However, the disease gave him very little uneasiness, and he had only thirty pus- tules. FORTY-SIXTH CASE. John Turner's arm was inflamed very extensively, and he became feverish on the eighth dav. The fol- lowing day many pustules appeared, and on the eleventh day he was almost covered with pustules, having about 1000, These, however, were perfectly distinct, and they all maturated favorably, so that about the seventeenth day he was completely well. 236 Cow-Pox ; William Woodville, M. 2). FORTY-SEVENTH AND FORTY-EIGHTH CASES. Joanna Bucklev' and Marv Welch had the disease in its mildest form. On the eighth day an efflorescence surrounded the inoculated part in both these children, and during this day only appeared a little indisposed. No pustules upon either of them All the six patients thus infected with vaccine disease from E. Turner, were subsequently inoculated with variolous matter, which did not produce any disorder. February 18th, William Walker, eleven months old; February 24th, Sarah Dixon, nineteen years old; Thomas Ellistone, aged fifteen months: Maria Dunn, aged twenty months; and James Cummins, aged- fourteen weeks, were all inoculated with the matter of cow-pox taken from the arm of Hannah Bumpus. F O R T Y - NIN T11 C A S E. ♦William Walker's arm tumitied in the usual manner, but he did not manifest the least indisposition dur- ing the course of the infection ; neither did any pustules appear, except one or two at the inoculated part. FIFTIETH CASE. Sarah Dixon's arm tumitied in the usual manner, and on the tenth day she began to complain of a pain in her head and loins: this was followed by shiverings ahd a pain in the axilla and across her shoulders. Thirteenth day -The pains were much abated, and some pustules appeared. Sixteenth day,-She makes no complaint, but ot a soreness of her throat : the eruption is now completed, and the number of the pus- tules is found to be 174 ; all of these afterwards maturated. FIFTY-FIRST CASE. Thomas Ellistone was feverish from the sixth to the eighth dav. when the tumor was surrounded with an extensive efflorescence. After this time he had no ailment. No pustules appeared. FIFTY-SECOND CASE. Maria Dunn was hot and restless from the sixth till the ninth day. She had no eruption. FIFTY-THIRD CASE. James Cummins did not seem the least disordered from #be inoculation, although the inoculated part tumi- tied very considerably, and several pustules appeared at the margin of the tumor on the eleventh day. All the above-mentioned persons, inoculated with the matter of the cow pox, taken from the arm of Bumpus, have been since inoculated with variolous matter, but without effect. John Giles, twenty years of age ; Win. Bigg, eighteen years old: Wm. Brian's, fifteen years old ; Sophia Dobinson, five years old ; Sarah Dobinson, three years old; and Hannah Dobinson, one year old; were inoculated with the matter of cow-pox, taken from the arm of Jane West, February 21. FIFTY-FOURTH CASE. John Giles complained of headache from the ninth to the eleventh day. A slight soreness of the throat came on. and continued several days. He had about thirty pustules. FIFTY-FIFTH CASE. William Bigg also complained of headache, and sore throat several days, and had about twelve pustules. FIFTY-SIXTH CASE. Wm. Brians first complained of indisposition on the seventh, and continued somewhat disordered till the eleventh day. Only two pustules appeared. FIFTY-SEVENTH OASE. Sophia Dobinson's arm tumitied extensively, but she made no complaint during the whole progress of the infection, and had no eruptions. FIFTY-EIGHTH CASE. Sarah Dobinson's case was in every respect similar to that of her sister Sophia. FIFTY-NINTH CASE. Hannah Dobinson suffered as littlefrom the disease as either of her sisters till the fourteenth day, when, according to her mother's report, she was seized with convulsions for two or three hours. She had no erup- tion . The above six patients have since been inoculated for the small-pox without effect. Mary Greeville, twenty years old ; Edward Honey wood, two years old; Thomas Rood, one and a half years old. Charlotte, Mile fifteen months old: Henry Barber, eleven months old; John Jenkins, one month old ; Thomas Dix, eleven mouths old ; Ann Walker, ten months old ; Samuel Francis Trough, ten months old ; Alexander Towser, eight months old; Wm. Knighton, eight months old: Sarah Price, eight mouths old ; Elizabeth Spilsbury, four months old ; Elizabeth May, four months old ; Mary Ann Sully, three months old ; Francis Terry, two months old ; Wm. Scott, two months old; Wm. Johnson, two months old, were inoculated with the matter of cow-pox, taken from the arm of Martha Streeton, on February 25th. * The father of this child is an ing nious engraver in Rosamond street, Clerkenwell, who having lost a child under the effects of inoculated small-pox, was induced to inoculate his only son for the cow-pox. The particulars of the case are related by Mr. Walker himself, in the Medical and Physical Journal for March, 1799. Cott' Pox : William Woodville, M. J). 237 SIXTIETH CASE. Mary Greenville, on the ninth day, began to complain of headache, which continued till the twelfth day when a sore throat came on, and gave her a little uneasiness for about two days. She had thirty-five pus- tules. SIXTY-FIRST CASE. Edward Honeywood was not perceptibly disordered from the inoculation, although his arm was much tumified ; and on the eleventh day it exhibited an efflorescence. No eruption appeared. SIXTY-SECOND CASE. Thomas Rood was feverish from the seventh till the tenth day, and at the commencement of the fever he had two or three short convulsive paroxysms ; but no eruption took place. SIXTY-THIRD CASE. Charlotte Mile. A little redness was observed at the inoculated part on this child's arm for two or three days ; but this had wholly disappeared on the seventh day, when she was inoculated with variolous matter, which produced the disease in a favorable manner. SIXTY-FOURTH CASE. John Jenkins became indisposed on the twelfth day, and was very restless for three days. He had about 300 pustules. SIXTY-SIXTH CASE. Henry Barber had a slight fever on the eighth day, when symptoms of dentition supervened, but the fever was of short duration. He had but one pustule and that was upon his upper lip. SIXTY-FIFTH CASE. Thomas Dix's arm exhibited an extensive efflorescence on the elveenth day. and some evanescent pustules appeared ; but he never manifested any indisposition during the progress of the infection. SIXTY-SEVENTH CASE. Ann Walker became indisposed on the ninth day, and continued fretful about twenty-four or thirty hours; the fever then ceased, and she has since been wholly free from disorder. No eruption appeared SIXTY-EIGHTH CASE. Samuel Francis Brough was taken ill on the ninth with spasmodic paroxysms, succeeded by fever; the former were of short duration, but the latter, with occasional intermissions, continued for three days. Eleventh day-Some pustules appeared; their number, however, when the eruption was completed, did not exceed twenty. SIXTY-NINTH CASE. Alexander Towser was restless and feverish about two days. Ten pustules appeared. SEVENTIETH CASE. William Knighton had no eruption. He was a little indisposed between the seventh and tenth days. SEVENTY-FIRST CASE. Sarah Price had some indisposition on the ninth day, which terminated in a diarrhoea. On the thirteenth day she was perfectly well; two pustules were now discovered upon her right foot, which were all she had. SEVENTY-SECOND CASE. Elizabeth Spisbury was somewhat indisposed on the tenth, and on the fifteenth day ; but the latter indis- osition was the effect of teething. She had no eruption. SEVENTY-THIRD CASE. Elizabeth May was a little feverish on the eighth day, and continued somewhat restless till the thirteenth pay ; five pustules appeared. SEVENTY-FOURTH CASE. Mary Ann Sully was feverish on the ninth day, and passed a restless night, but on the next morning she was better; she made no further complaint, and no pustules appeared. SEVENTY-FIFTH CASE. Francis Terry, became feverish on the ninth day; the next morning a rash appeared, when he seemed to be as well as usual. He had onlj- one pustule. SEVENTY-SIXTH CASE. William Scott was a little feverish on the eighth day only; no eruption ensued. 238 Cow-Pox ; William Woodville, M. J). SEVENTY-SEVENTH CASE. William Johnson's arm tumifled in the usual manner. He had no pustules, nor did heappear feverish dur- ing the course of the disease ; but on the evening of the thirteenth day, he was thought to be a little rest- less. SEVENTY-EIGHTH CASE. Mary Stewart, like Johnson, was not perceptibly indisposed during the whole progress of the infection neither had she any pustules. The above patients inoculated with the matter taken from Streeton, were subsequently inoculated for the small-pox, without affecting any but Charlotte Mile, in whom the inoculation for cow-pox took no effect, February 27th, Joseph Wrench, 24 years old ; Stephen Peters, 19 years old; Peter Peters, 18 years old; Elizabeth Brown, 5 years old ; Mary Shipley, 3 years old ; Margaret Crosby, 10 mouths old, and John Evans, 7 months old, were inoculated with the matter of cow-pox, taken from the arm of James Smith. SEVENTY-NINTH CASE. Joseph Wrench continued indisposed from the tenth till the thirteenth day. An efflorescence appeared at the inoculated part on the eleventh day. Fifteenth day-Several pustules appeared, and he now com- plained of a sore throat, which continued three days. The number of pustules was thirty. EIGHTIETH CASE. Stephen Peters began to complain on the eighth day, and continued tobe affected with the usual febrile symptoms till the thirteenth day. He had only one pustule. EIGHTY-FIRST CASE. Peter Peters' complaints were similar to those in the preceding case. The efflorescence did not appear, till the eleventh day. He had twenty-four pustules, all of which were very small. EIGHTY-SECOND CASE. Elizabeth Brown's tumor on the eighth day was surrounded by an efflorescence. She made no complaint, nor had she any eruption. EIGHTY-THIRD CASE. Mary Shipley's arm exhibited an efflorescence on the eighth day; but was not perceptibly indisposed, and had only one pustule. EIGHTY-FOURTII CASE. Margaret Crosby had no eruption, nor was she perceptibly ill during the progress of her inoculation. Her arm, however, tumifled in the usual manner, and displayed an efflorescence. EIGHTY-FIFTH CASE. On John Evan's arm there was an efflorescence on the sixth day, and the following day a slight fever commenced with a spasmodic paroxysm, but he was perfectly well on the ninth, and no eruption took place. The above five persons have been since inoculated with variolous matter without effect. Sarah Hat, twenty years old; and Elizabeth Platford, seventeen years old, were inoculated with matter of the cow-pox taken'from the arm of Maria Murrell. EIGHTY-SIXTH CASE. Sarah Hat began to complain on the sixth flay, and she continued much indisposed till the eleventh day, when the tumor was surrounded by an efflorescence, and she made no further complaint. The num- ber of the pustules which appeared was about forty. EIGHTY-SEVENTH CASE. Elizabeth Platford was taken ill on the ninth day, when she complained of pain in the head and loins, with chilliness, etc.; the inoculated part at this time was considerably inflamed; the tumor was circular, but flat, and not surrounded by any efflorescence. Eleventh day The pains and shiverings continue; pulse very frequent and weak; tongue white. Thirteenth day.-The symptoms still continue; she also complains of pain across the shoulders ; some pustules appear. Fifteenth day.-She complains of pain in the loins and of giddiness; the number of the pustules is much increased. Seventeenth day.-The pains continue; she is very weak and faint; her eyes and throat are inflamed and painful; the edges of the tumor are beset with confluent pustules; the pustules upon her face are about 200 or 300, and approach to conflu- ency. Nineteenth day.-Her face is considerably swelled, and the pustules are now maturating rapidly ; she makes no complaint, but of the soreness occasioned by the eruption. Twenty-first day.-Swelling of the face much subsided; the pustules in a state of desication Twenty-third day-She continues recover- ing. Twenty-sixth day-She complains of a sore throat, and a cough is troublesome to her Twenty- eighthday.-The sore throat is almost gone, but the cough' continues ; pulse 100. Thirtieth day.-The cough is still violent. Thirty-second day.-The cough is abated, and her appetite improves; from this time she gradually recovered. Both the above patients were afterwards inoculated with variolous matter, which produced no effect. Isaac Cowling, twenty-three years old ; Mary Webb, twelve years old; Sophia Mason, two years and a half old; and Elizabeth Goodluck, three months old, wer e, on the 2d of March, inoculated for the cow-pox with matter from the arm of G. Reed. EIGHTY-EIGHTH CASE. Isaac Cowling sickened on the ninth, and the eruptive complaints did not wholly go off till the fourteenth day. He had about fifty pustules. Cow-Pox; William Woodville, M. I). 239 EIGHTY-NINTH CASE. Mary Webb beffan to complain on the seventh day, and continued feverish for a week. On the tenth day a redness was diffused over the greatest part of her arm, between the elbow and shoulder, and did not wholly disappear till the fourteenth day. She had about twelve pustules. NINETIETH CASE. Sophia. Mason's arm tumifled in the usual way, and exhibited an e florescence on the tenth day. She had tour or five small evanescent pustules, but did not seem indisposed during the course of the infection. NINETY-FIRST CASE. Elizabeth Goodluck was taken ill on the eighth day, when she had a slight spasmodic fit: the tumor at this time exhibited an efflorescence. Eleventh day-Has had no in lisposition since yesterday. No eruption took place. None of the above three patients took the small-pox in consequence of inoculation with variolous matter. NINETY-SECOND AND NINETY-THIRD CASES. March 3-C. S. Cooke, four years old; and A. T. Cooke, two years old ; were inoculated with the matter of cow-pox, taken from the arm of George Meacock. An efflorescence at the inoculated part took place in both these children on the tenth day. but neither of them seemed indisposed from the inoculation, nor did any pustules appear upon them. They were also put to the test of inoculation with vatiolous matter, but no disease ensued. March 3.-A. K. Gunter, one year old ; Matthew Sears, nine months old: and Eliz. Giles, nine months old, were inoculated with the matter of cow-pox, taken from the arm of H. Dobinson. NINETY-FOURTH CASE. A. K. Gunter was a little feverish for two days. On the tenth day the tumor was surrounded by an efflorescence, which became very extensive. Only two or three imperfect pustules appeared. NINETY-FIFTH CASE. Matthew Sears was indisposed for about four or five days. The tumor was small and angular, nor was it ever surrounded with an efflorescence. He had about 200 pustules. NINETY-SIXTH CASE. Elizabeth Giles became indisposed on the tenth day. The tumor hal a dark red colored border without any efflorescence. She had from 70 to 100 pustules. The above patients have been inoculated with variolous matter without effect. Richard Scott, two years and a half old ; Sarah Bennett, one year old: Maria Black, one year old ; Mary Jenkins, nine months old; John Lawyer, eight months old ; Eliz. King, six months old; William Jones, six months old; Esther Phipps, six moutUs old; and Ann Harper, five months old, were inoculated with the matter of cow-pox, taken from the arm of Elizabeth Brown. NINETY-SEVENTH CASE. Richard Scott became feverish for a short time on the tenth day. He had about fourteen pustules. NINETY-EIGHTH CASE. Elizabeth King's tumor, on the ninth day, was surrounded with an efflorescence. She did not manifest any indisposition, nor had any eruption, NINETY-NINTH, ONE HUNDREDTH AND ONE HUNDRED AND FIRST CASES. The cases sf John Lawyer, William Jones and Sarah Bennett were similar to that of King. ONE HUNDRED AND SECOND CASE. Esther Phipps was a little restless and feverish from the tenth till the thirteenth day, but had no eruption. ONE HUNDRED AND THIRD CASE. Maria Black became feverish on the ninth day, and was indisposed for two or three days, during which time she had two slight convulsions. Some pustules appeared, but did not suppurate. ONE HUNDRED AND FOURTH CASE. Mary Jenkins was a little indisposed on the tenth day. She had no eruption ONE HUNDRED ^ND FIFTH CASE. Ann Harper was a little restless during the seventh and eighth night, but no eruption took place. ONE HUNDRED AND SIXTH CASE. Thomas Newman was feverish from the seventh till the twelfth day; but no pustules appeared March 4th, George Paul, 3years old : Ann Paul, 1 year old ; Martha Chandler, 5 months old ; Martha Hat, 1 vear old ; Eliz. Boardore, 7 months old ; Samuel Lampart, 2 years old ; Ann Page, one year and a half old ; Jane Carter. 5 weeks old ; William New, 18 months old ; Susan Sermon, 6 months old ; Alice Marshall, 2 years old ; Harriat Marshall. 4 months old. and Prances Henley, 5' years old, were inoculated with the mat- ter of cow-pox, taken from the arm of Elizabeth May. 240 Cow Pox : William Woodville, M. I). ONE HUNDRED AND SEVENTH CASE. George Paul was not perceptibly indisposed from the inoculation. He had two pustules. ONE HUNDRED AND EIGHTH CASE. Ann Paul was feverish for about three days, and had forty pustules, all of which were much smaller than those of the small-pox. ONE HUNDRED AND NINTH CASE. Martha Chandler's inoculation produced a very extensive efflorescence; but neither fever nor eruption ensued. ONE HUNDRED AND TENTH CASE. Martha Hat did not becomejndisposed till the thirteenth day, when a few small pustules appeared. ONE HUNDRED AND ELEVENTH CASE. Elizabeth Boardore's arm tumifled considerably; but neither efflorescence, fever, nor eruption, took place. ONE HUNDRED AND TWELFTH CASE. Samuel Lampart was somewhat disordered from the ninth till the twelfth day. and had three small imper- fect pustules. ONE HUNDRED AND THIRTEETH CASE. Ann Page was not sensibly indisposed from the inoculation, neither had she any eruption. The tumor was surrounded with an efflorescence on the twelfth day. ONE HUNDRED AND FOURTEENTH CASE. Jane Carter was slightly indisposed from the seventh till the tenth day, and had two or three pustules ONE HUNDRED AND FIFTEENTH CASE. William New was ill four days, and had about 100 pustules. ONE HUNDRED AND SIXTEETH CASE. Susan Sermon was taken ill on the ninth day, when she vomited. She continued feverish till the twelfth day. Only five pustules appeared. ONE HUNDRED AND SEVENTEENTH, ONE HUNDRED AND EIGHTEENTH AND ONE HUNDRED AND NINETEETH CASES. Alice Marshall, Frances Henley, and Harriet Marshall had no eruption, nor appeared to have any disorder from the inoculation. The local disease, however, was considerable in all these patients, and was attended with an efflorescence. AH the above patients who received the infection from Brown and May, have since been inoculated for the small-pox without effect. ONE HUNDRED AND TWENTIETH CASE. Mary Crouch, aged three years, was inoculated with matter taken from one of the pustules upon Joint Turner (see case forty-sixth). A tumor formed at the inoculated part in the usual manner, which was sur- rounded with an efflorescence; but neither fever nor eruption took place. ONE HUNDRED AND TWENTY-FIRST AND ONE HUNDRED TWENTY-SECOND CASES. Elizabeth "Wood, aged three years, and Wm. Clifford, two years and a half old, were inoculated with cow- pox matter, taken from the arm of Mary Stewart, March 4th. Both these children were slightly indisposed about the tenth day, but neither of them had any pustules. March 6 -The following persons were inoculated with the matter of cow-pox, taken from the aim of Ann Walker: , Amelia Restieux, 4 months old ; John Bates. 6 weeks old ; Martha Thompson, 2years old; William London, 6 months old ; Frances Wallace, 3 years old ; Joseph Rogers, 42 years old ; Thomas Thoroughgood, 14 years old; and Ann Thoroughgood, 17 years old. ONE HUNDRED AND TWENTY-THIRD AND ONE HUNDRED AND TWENTY- FOURTH CASES. Amelia Restieux and John Bates neither experienced any disorder from the inoculation, nor had any eruption ; but both their arms tumifled in the usual manner. ONE HUNDRED AND TWENTY-FIFTH CASE. Martha Thompson was feverish from the eight till the tenth day. She had only one pustule. ONE HUNDRED AND TWENTY-SIXTH CASE. William London was taken ill on the tenth day; and vomited ; but the following day was as well as usual. He had no eruption. ONE HUNDRED AND TWENTY-SEVENTH CASE. James London had no perceptible disorder; and no pustules appeared. On the tenth day the tumor was surrounded with an efflorescence. ONE HUNDRED AND TWENTY-EIGHTH CASE. Frances Wallace was feverish for two or three days; but no eruption ensued. Cow Pojc : William Woodville, M. 1). 241 ONE HUNDERD AND TWENTY-NINTH CASE. Joseph Rogers on the eighth day complained of pain in the axilla, and was affected with headache for two or three days ; but he had no eruption. ONE HUNDRED AND THIRTIETH CASE. Thomas Thoroughgood made the same complaints as Rogers. He had thirty-three pustules. ONE HUNDRED AND THIRTY-FIRST CASE. Ann Thoroughgood was indisposed for six or seven days, but she had only ten pustules. The preceding twelve patients have had variolous matter inserted in their arm without effect . The following persons were inoculated with the matter taken from the pustules of Martha Streeton, viz : Susan Reeve, 18 months old ; Ann Reeve, 5 weeks old; Susan Richardson, 13 years old, and Mary Adams, 6 mouths old. ONE HUNDRED AND THIRTY-SECOND AND ONE HUNDRED AND THIRTY- THIRD CASES. Susan Reeve and Ann Reeve were very little disordered by the inoculation ; the former, however, had twenty and the latter twelve pustules. ONE HUNDRED AND THIRTY-FOURTH CASE. Susan Richardson continued indisposed from the tenth till the fourteenth day, but she had only twelve pustules. • , ONE HUNDRED AND THIRTY-FIFTH CASE. Mary Adams had about two hundred pustules ; but the eruptive symptoms were not severe. The tumor in this case spread, and formed an irregular margin, which was studded with confluent pustules. March 7-The disease was transferred from the pustules upon Sarah Dixon to the following children, viz: Caroline Harriskind, 4 years old ; Wm. Harriskind, 2 years old; Daniel Harding, 14 weeks old; Eliza- beth Harding, 3 years old; James Waters, 12 years old, and Joseph Harding, 17 years old. ONE HUNDRED AND THIRTY-SIXTH AND ONE HUNDRED AND THIRTY- SEVENTH CASES. Caroline and Wm. Harriskind were feverish for two or three days. The former had 100, and the latter had twelve pustules. OND HUNDRED AND THIRTY-EI HTH AND ONE HUNDRED AND THIRTY- NINTH CASES. Daniel and Elizabeth Harding were but very slightly indisposed from 'the inoculation. Daniel had fifteen very small pustules: Elizabeth had only two. ONE HUNDRED AND FORTIETH CASE. James Waters complained of headache, pains of his limbs and sore throat, from the eighth till the four' teenth day. The tumor at the inoculated part was never much elevated above the skin, and had an angu' lated border. He had 120 pustules. ONE HUNDRED AND FORTY-FIRST CASE. Joseph Harding was very slightly disordered, and had no pustules. March 8.-William Shipton, 4 years old ; George Staits, 2 years old ; Elizabeth Youngman, 3 months old ; Mary Dudley, 2 years old; William Cade, 10 months old, and William Piper, 4 months old, were inoculated with the matter of cow-pox, taken from the arm of Esther Phipps. ONE HUNDRED AND FORTY-SECOND, ONE HUNDRED AND FORTY-THIRD, ONE HUNDRED AND FORTY-FOURTH AND ONE HUNDRED AND FORTY- FIFTH CASES. William Shipton, Elizabeth Youngman, William Cade and William Piper, had no pustules ; and none of them appeared to be disordered from the inoculation, except Piper, who was a little feverish on the eighth day. An efflorescence took place around the rumor in all of them. ONE HUNDRED AND FORTY-SIXTH CASE. George Staits was indisposed for two days, and had three or four small pustular eruptions. ONE HUNDRED AND FORTY-SEVENTH CASE. Mary Dudley was a little feverish on the ninth day, when a rash appeared which receded the following- day, and about fifty small pustules were discovered; these, however, disappeared in the course of twenty- four hours. March 11.-Hannah Timms, 19 years old ; Susan Timms. 17 years old ; Jane Franklin, 12 years old, and Henry Lee, 15 years old, were inoculated with the matter of cow-pox, taken from the arm of Mary Webb. , ONE HUNDRED AND FORTY-EIGHTH CASE. Hannah Timms was affected with the febrile symptoms from the eighth till the sixteenth day, and had 165 pustules, all of which suppurated. ONE HUNDRED AND FORTY-NINTH CASE. Sarah Timms was ill from the ninth till the fourteenth day. She had no eruption. 242 Cow Pox : William Woodville, M. J). ONE HUNDRED AND FIFTIETH CASE. Jane Franklin was very little indisposed from the inoculation, and had no eruption. ONE HUNDRED AND FIFTY-FIRST CASE. Henry Lee complained for two or three days, and had only one pustule. March 13--The following persons were inoculated witli the matter of cow-pox, taken from the arm of Sarah Hat, viz : Ann Spooner, twenty-one years old ; Matthew Wall, fourteen years old ; John Wall, ten years old; William Ockendon, twelve years old ; Joseph Ockendon, ten years old ; Willirm Jennings, seven years old ; George Jennings, six years old : John Pluckrose, seven years old ; Charlstte Webb, fourteen weeks old ; Charles Dibden. three months old ; Elizabeth Eaton, two years old ; Charlotte Eaton, ten months old ; and Joseph Pigg, tie ven years old. ONE HUNDRED AND FIFTY-SECOND CASE. Ann Spooner was indisposed for three or four days and had 150 pustules. ONE HUNDRED AND FIFTY-THIRD CASE. Matthew Wall was a little indisposed for three days. He had ten pustules. ONE HUNDRED AND FIFTY-FOURTH CASE. John Wall made no complaint, and had no eruption. ONE HUNDRED AND FIFTY-FIFTH CASE. William Ockendon was indisposed from the eighth till the tenth day. He had only one pus^tle. ONE HUNDRED AND FIFTY-SIXTH CASE. Joseph Ockendon was ill for three days. He had no eruption. [ONE HUNDRED AND FIFTY-SEVENTH CASE. William Jennings complained of headache two days. He had only one pustule. ONE HUNDRED AND FIFTY-EIGHTH CASE. George Jennings was disordered in the same manner as his brother William, but he had no eruption. ONE HUNDRED AND FIFTY-NINTH CASE. John Pluckrose made no complaint and had no eruption. ONE HUNDRED AND SIXTIETH AND ONE HUNDRED SIXTY-FIRST CASES. Charlotte Webb and Charles Dibden.-The former was perceptibly disordered by the inoculation, and had no pustules. The latter was a little feverish on the ninth day and vomited. He had three pustules at the inoculated part only. ONE HUNDRED AND SIXTY-SECOND AND ONE HUNDRED AND SIXTY-THIRD CASES. • Elizabeth Eaton and Charles Eaton were both slightly indisposed oh the eleventh and twelfth day, and each had about twenty pustules. ONE HUNDRED AND SIXTY-FOURTH CASE. Joseph Pigg complained of a pain in the axilla, and of a slight headache for four days. He had fourteen pustules only. March 13.-The following were inoculated with the matter of cow'-pox, taken from the arm of Samuel Lampart. viz.: Mary- Ockendon. sixteen years old : Sarah Ockendon, seven years old ; Sarah Stacey, twelve years old : Ann Stacey, seven years old ; Mary Fuller, eleven years old : Isabella Barrett, eleven years old ; Mary Perry, three years old ; Susan Vinicum, live months old; Elizabeth Rensden, eighteen months old; Mary Ward, ten months old: William Terry, two months old: Caroline Poorey, three years old; Ann Poorey, eleven months old; John Langstatf, four years and a half old ; Emma Lightfoot, thirteen months old; Daniel Sinclair, seven months old ; M. H. Hills, eighteen weeks old; and Catharine Donaldson, nine- teen months old. ONE HUNDRED AND SIXTY-FIFTH CASE. Mary Ockendon was indisposed from the ninth till the fourteenth day. She had only six pustules. ONE HUNDRED AND SIXTY-SIXTH CASE. Sarah Ockendon complained of headache, pain of her limbs, etc., from the tenth till the fourteenth day, but only four pustules appeared. ONE HUNDRED AND SIXTY-SEVENTH CASE. Sarah Stacey was indisposed from the tenth till the fifteenth day. No pustules appeared. ONE HUNDRED AND SIIXTY-EIGHTH CASE. Ann Stacey's case was similar to that of her sister Sarah. ONE HUNDRED AND SIXTY-NINTH AND ONE HUNDRED AND SEVENTIETH CASES. Mary Fuller and Isabella Barrett, both complained of the febrile symptoms from the ninth till the four- teenth day. The former had six. and the latter twenty pustules. ONE HUNDRED AND SEVENTY-FIRST. ONE HUNDRED AND SEVENTY-SECOND AND ONE HUNDRED AND SEVENTY-THIRD CASES. Mary Perry, Susan Vinicum and Elizabeth Brensden did not appear to be indisposed from the inocula lion, and had no eruption ; but the tumors io all were considerable, and surrounded by an efflorescence. ONE HUNDRED AND SEVENTY-FOURTH CASE. Mary Ward was a little feverish for two days; and a few small pustules appeared for one day only. Cow Pox: William Woodville, M. D. 243 ONE HUNDRED AND SEVENTY-FIFTH, ONE HUNDRED AND SEVENTY-SIXTH, ONE HUN- DRED AND SEVENTY-SEVENTH AND ONE HUNDRED AND SEVENTY-EIGHTH CASES. William Terry, Ann Poorey, Caroline Poorey and John Langstaff had no pustules, neither did any of them appear to be indisposed, except Ann Poorey, who was feverish for two days. ONE HUNDRED AND SEVENTY-NINTH AND ONE HUNDRED EIGHTIETH CASES. Emma Lightfoot and Daniel Sinclair were both a little disordered for two or three days, and the former had four or five small pustules, but the latter had no eruption. ONE HUNDRED AND EIGHTY-FIRST AND ONE HUNDRED AND EIGHTY-SECOND CASES. Ann Hills and Catharine Donaldson had neither fever nor eruption, ONE HUNDRED AND EIGHTY-THIRD CASE. Ann Clarke was inoculated with the matter of cow-pox, taken from the arm of Peter Peters, which pro- duced two or three small evanescent pustules; but no fever took place. March 15.-John Buckthorpe, twenty-two years old ; John Cater, fourteen years of age ; Susan Tomlins, nineteen years old; Maria Burgess, four years old ; and Sophia Burgess, three years old, were inoculated for the cow-pox, with matter taken from the arm of Joseph Wrench. ONE HUNDRED AND EIGHTY-FOURTH CASE, John Buckthorpe was indisposed from the ninth till the fourteenth day. He had nearly 100 pustules, ONE HUNDRED AND EIGHTY-FIFTH CASE. John Cater complained of headache, etc., from the eighth till the eleventh day. He had forty pustules. ONE HUNDRED AND EIGHTY-SIXTH CASE. Susan Tomlins continued ill for three days. She had twenty-four pustules. ONE HUNDRED AND EIGHTY-SEVENTH AND ONE HUNDRED AND EIGHTY-EIGHTH CASES Maria and Sophia Burgess were neither indisposed from the inoculation. Sophia had no pustules and Maria only three. March 18 -The following persons were inoculated with the matter of cow-pox, taken from the armof Elizabeth Platford : John Williams, seven months old ; James Runtsman, three months old ; Robert Lear seventeen months old; John Selby, five months old; Samuel Ariell, two years old ; James Ariell, five years old; Henry Servy, two years and a half old; Sarah Lovell, four years old; Heury Lovell, two years old; Rebecca Salmon,"nine months old; John Corwell, eight months old, and Francis Cundell, six months old. ONE HUNDRED AND EIGHTY-NINTH CASE, John Williams had no indisposition nor pustules. The tumor was surrounded with an efflorescence;)a the eleventh day, ONE HUNDRED AND NINETIETH CASE, James Runtsman was a little feverish on the evening of the tenth. He had no eruption. ONE HUNDRED AND NINETY-FIRST CASE. Robert Lear's case was similar to that of Runtsman. ONE HUNDRED AND NINETY-SECOND CASE. John Selby was feverish two days, and had forty pustules. ONE HUNDRED AND NINETY-THIRD AND ONE HUNDRED AND NINETY-FOURTH CASES Samuel Ariell and James Ariell were both feverish on the tenth and eleventh days, but neither had any eruption, ONE HUNDRED AND NINETY-FIFTH AND ONE HUNDRED AND NINETY-SIXTH CASES. Henry Servy and Sarah Lovell were disordered two days. The former had no pustules, the latter forty ONE HUNDRED AND NINETY-SEVENTH CASE. Henry Lorell was ill three days, and had 170 pustules. ONE HUNDRED AND NINETY-EIGHTH CASE. Rebecca Salmon was very slightly indisposed, but had about 200 pustules, which were very small. ONE HUNDRED AND NINETY-NINTH AND TWO HUNDREDTH CASES, John Corwell and Francis Cundell were both feverish for two or three days; the former had thirty six and the latter twelve pustules. All the above patients, inoculated since the 6th of March, have subsequently' had variolous matter in- serted in their arms, except the two Ariells, but it produced no disorder. Ill order that the progressive descent of the cow-pox infection from patient to patient, as well as the magnitude of the disease which was excited by the inoculation, may be comprehended at one view, I have subjoined the following tabular statement. It may be observed that the matter used for the preceding inoculations was not only derived immediately from the pustular eruptions upon the teats of the cow, but also from Sarah Rice, who contracted the disease by milking the infected cows. I begin with the former. In the first and second divisions opposite to the names the age in years or months is recorded; in the third the number of days during which the febrile symptoms continued ; and in the last, the number of pustules produced : 244 Cow Pox: William Woodville, M. D. TABLE. x ears 01 Age Months. 1 Rays of | Illness. i No. ot 1 Pustules. I Years of 1 Age. | Months. I Days of 1 Illness. I No. of 1 Pustules.' From the cow to- Pa vne •••••••••• 2 6 3 0 From Webb to- S. Timms 17 5 0 4 5 0 Franklin 12 1 0 4 4 24: Lee. 15 2 3 R. Payne .. 10 16 0 1 5 4 From Hatt to- 21 4 110 Cl nil in bridge 17 4 170 JtM. Wall 14 3 10 15 0 0 J. Wall 10 0 0 From M. and E. Payne to- I alley 14 J. Ockendon W. Ockendon 10 12 3 3 0 1 15 W. Jennings 2 1 From Collingride to- undy . ..•••■••. G »Tennin<rs 6 2 0 25 2 15 Plucfcrose....... 7 0 0 25 6 530 C. Webb 3 0 0 George ..................... 13 2 0 Dibden 3 1 0 19 1 0 E. Eaton 2 2 2 From Buckland's pustules to- 13 2 6 C. Eaton Pigg ii io 2 4 2 14 From Redding to- Wife . 14 0 4 From Hatford to-| Williams 0 0 From Mundy to- 3 1 0 21 4 Lear 1 1 0 DiiMie......•••••••••••••••• From George to- Selby 5 2 40 19 1 0 S. Ariell 2 2 0 From Butcher to- 5 2 0 20 2 0 Servy 2 6 2 0 20 6 310 S. Lovell 4 2 40 21 5 20 H. Lovell 2 3 170 W Hull 11 4 200 Salmon 9 1 200 w • nun H Hull 13 1 8 Corwell 8 3 36 S Hull 8 2 120 Cundell 6 2 12 From Jewel to- 4 4 40 From S. Rice to- Harris. 21 0 300 15 70 Bunker 15 3 3 From S. Price to- Redder. • ■ • 0 0 11 K 40 Fox 25 5 5 102 Rennis 23 Hickland ....••••••••••• •••••••• 6 3 300 From Crouch to- 9 200 25 1 0 From Fisk to- 24 220 3 1 3 Morgan - 1 5 0 AT 11 well 7 4 20 From Mr. Coleman's cow to- From Bumpus to- 22 6 300 19 4 174 16 4 105 "W Walker . • 11 0 0 Meacock 30 5 350 Cummins ..... ..... 3 0 0 From Turner to- Kllistone. •••••■•■ 3 2 0 Fairbrother 15 4 4 8 3 0 Calloway 19 3 20 From West to- So Robin son 17 4 30 5 0 0 J, Turner 8 2 1000 Sarah Robinson...... ........ 3 0 0 Buckley Welch 5 1 0 1 1 0 3 1 0 H • Robinson 20 30 30 From Streeton to- From West to- Bigg 20 3 35 18 5 12 Honey wood 2 0 0 Briaris From Reed to- 16 23 4 4 2 50 Rood •••• Mile. Jenkins 1 1 1 6 3 2 0 3 0 0 300 12 () 12 4 Barber ii 2 1 0 6 0 Dix 11 0 6 Goodluck ....... 3 2 0 A. Walker 10 2 0 From Murrell to- LT 10 3 20 20 4 40 Towser 8 2 10 17 8 1000 Knighton -... 8 2 0 x lavioru ....•••••*•••• From II. Dobinson to- Gunter . ....... 8 1 0 1 2 3 Spilsbury May 4 2 0 9 200 4 4 ,) 9 3 90 Sully 3 1 0 From Dixon's pustule to- 2 1 1 4 4 100 12 Scott 2 1 0 C • Hamskind 2 3 Johnston 2 0 0 3 1 1 15 2 0 0 E Harding.. 3 2 From Smith to- 30 12 6 1 20 Wrench 24 3 17 1 10 S. Peters 19 . . 4 1 From Webb to- H. Timms 18 4 24 19 7 165 Brown 5 0 0 Cow-Pox: William Woodville, Jf. D. 245 - •oS J° | Months Years of Age. Months. J Days of Hines | No of Pustules I I Days ol 1 Hines o® B § i Year.' From Smith to- From A. Walker to- - - Shipley 3 0 1 Wallace 3 2 Crosby 10 0 0 Rogers 42 3 Evans 2 0 T Thorough good 14 3 From Meacock to- A. Thoroughgood 17 33 1 n C. Cooke 4 0 0 From Streeton's pustules to- •• A. Cooke 2 0 0 S. Reeve 1 1 on From Brown to- A. Reeve 1 R. Scott 2 6 1 14 Richardson 13 1 3 12 Bennett 1 0 0 Adams 'a 3 Black 1 3 7 From Phipps to 6 200 M. Jenkins 9 1 0 Shipton 4 0 0 Lawyer b 0 0 St aits 2 0 3 0 From Brown to- Youngman 3 0 King 6 0 0 Dudley 2 1 Jones 6 0 0 io A 50 Phipps 6 3 0 Piper j 0 Newman 6 4 0 From Lampart to 4 0 Harper 5 2 0 M. Ockendon 16 4 o From May to- S. Ockendon 17 3 4 G. Paul 3 0 2 S. Stacey 12 4 a A. Paul 1 3 40 A. Stacey... 7 4 Chandler 5 0 0 Fuller 11 ,j 0 M. Hatt i 1 5 Barrett 11 4 6 Boardore 7 0 0 Perry 3 0 g Lampart 2 2 3 Vinicum 5 0 () Page 1 6 6 0 Bensden 1 g 0 Carter 1 2 3 Ward Sermon 6 3 5 Terry 10 i A. Marshall 2 o o 0 H. Marshall 4 0 0 A. Poorev 0 0 0 Henley 5 0 0 Lan <ystaft\ ... 4 New ' 1 6 4 100 Lightfoot 1 1 U 2 0 * 5 From Turner's pustules to- Sinclair 7 2 0 M. Crouch 3 0 0 Hills From Stewart to- Donaldson 1 7 u 0 0 0 Wood 3 1 0 From Wrench to- Clifford 2 6 1 0 Bn ch th orpe 99 From A. Walker to- Cater 14 4 3 100 .40 Restieux 4 0 0 Tomlin 19 Bates li 0 0 fl 3 24 Thompson 2 1 2! S. Hurless . 3 0 3 W. London o 0 u 0 J. London 6 0 O' Clarke ■ ■.. 5 0 3 The preceding table comprehends all the cases originally intended to have been given in the work, the publication of which, from a concurrence of circumstances, has been delayed much longer than the author expected, and has thereby afforded him an oppor- tunity of making the following additions : 1 Years of 1 Age. | Months. | Days of I Illness. I No. of 1 Pustules. Years of Age. Months, j Days of Illness, j No. of Pustules. | From Platford's pustues to- From A. Stacey to- Prince 1 0 30 Harriott 8 1 6 Chandler 1 9 0 40 M. Waite 10 2| 50 Jervoise 6 1 0 J. Waite Q 2 Palmer 3 3 100 O Henderson 10 4 300 H. Pie-lev.... 4 1 no Crawford 1 10 3 250 Dach t r • •» j j. Q From Dudley to- G. Piglev * o o A. Valentine 3 2 o Morson J- Valentine 2 3 0 Bradlev 19 2J 0 0 156 From S. Timms to Harrison 9 1 o S. Harris 21 6 Alorton Qi S. Clarke 9 2 0 Cooper 11 () M. Harris 23 6 60 E. Cooper 4 1 0 Ludgrove 11 2 0 Bl 1 ikins Q Q Q, Stringer 20 4 2 M. Hide 4 11 o o From Grenville to- D.Hide 1 5 o o B. Crane 2 3 200 Phillips . g q n T. Cranes 4 2 12 From Tomlin to- Garrett 14 4 62 C. Hopes 3 1 M, Crane 8 4 30 S. Hopes . ] q 0 From A. Stacey to- Oliphant 3 1 0 M. Stacey 38 3 5 Castin $ 3 0 R. Stacey 7 0 12 Hamm 0 0 J. Stacey 3 6 0 A. Smith 4 0 0 0 246 Cow Pox: Wiiliam Woodville, AL J). | Years of Age. | Months. | Days of Illness. No. of Pustules. | Years oil Age. | Afonths- I Days of | illness. | 1 No. of | Pustules-1 From Tomlin to- Reynolds 4 0 o From Wade to- Mays 1 1 2 500 From J. Wall to- G all way ...•••»••..• . •. ••• • • 3 . 1 0 From Mundy to- Matthews 4 2 0 Barneby 1 6 0 0 'From Brewster to- 2 8 0 3 M. Brewster 11 0 0 Dal kins 5| 1 0 From Lee's pustules to- Baker Bromley...... ••••.••••••••••••• 1 2 2 3 29 3 140 Ford 6 2 0 Caterer 15 0 5 8 From J. Valientine to- AtPUTin R. Featherstone 12 3 40 3 0 0 C. Featherstone 9 3 120 Tnsthis . 4 3 5 Porter 5 0 9 Ged f?R 3 0 0 From Lee's pustules to- J. Porter ' U ...... ..... Beasley 0 4 1 6 1 12 1 10 2 40 J. Jennings 5 1 30 From Spooner to- Stainer ••••••••• •••••• C. Jennings 3 1 30 16 3 34 W. Jennings .1 1 0 9 At Pepler - 4 0 0 Mansfield. 1 6 2 12 Swannell • 10 3 6 S. Wybrow 6 2 300 F. Pepler Brown .•••••••••• •••••••• •••• 2 0 0 S. Baker 1 1 3 25 19 4 35 J. Goss 2 8 1 0 1* Roberts 6 4 12 W. Goss 8 2 30 Al Roberts ...•••••• ..••••••••• 4 0 6 Odell 9 3 90 C • Roberts...... 1 fe 3 6 Afurpbield 6 2 0 Freeman 11 4 40 From Dalkins to- A • Palmer .••*.•«••••••«■ ••••• . 9 2 40 Sharp - . 4 o 0 "Wade.. 16 4 3 From Waite to- From Cooper to- Munden From H. Timm's pustules to- Stiles --- T. Jennings 1 6 0 0 7 1 50 Kitchen 5 1 o S. Pluckrose 4 2 0 6 500 T. Pluckrose 10 2 0 5 1 12 Rout 6 1 20 From M. Bartlett to- J. Mundy W. Houghton 2 6 1 0 6 3 100 From Swannell to- From Cowley to- Nash ..••••*.••••••••••• •••••.. 15 1 0 Mickland Ferguson 2 7 0 1 3 From Spooner's pustules to- Serjeant .. Cook ... Goddard i 2 0 16 4 35 11 Rob^ rts 9 1 0 15 2 Gran • . 6 1 0 From Stringer's pustules to- A rgan t ..•••••• . 8 2 0 17 7 19 Floaks 2 1 2 From I?. Timm's pustules to- 17 3 4 From M. Gilbert to- Welch 15 3 100 Ji, VX1J Uul V. •••••. ••••.. »g. •••••.- Brewster 11 4 6 Rowley 3 2 25 Trulock AN is gins •. • ••••••• ... ..... 6 2 250 A. AVaite • •., ... 17 4 10 5 0 Tarbotts 1 1 2 600 Tb • Turner 6 0 50 S. Tarbotts 3 3 4 300 Gilbert • *. 6 3 500 Bell 3 3 250 Downes................. 4 2 30 From S. Hopes to- Snell Ring. 2 2 4 17 2 200 Talbot .•.••••••••• ••••• 4 3 500 I. Houghton 32 3 200 From Corwell to- Graham ••••••....•• •••• •••••••• Stedman 6 2 60 4 0 0 M. Broad wood 6 2 200 Sellers From Barrett to- T• Rarrett 15 o o Sorrell 4 11 4 500 S. Sorrell 6 1 1 32 3 200 Underwood 9 2 105 Al. Barrett 5 0 0 From Ellikin to- J. Barrett..••••••• .... •••••.•• 2 3 7 1 0 G. Cooke 2 2 3 20 H. Barrett E. Wybrow Wybrow 2 30 Costin 5 2 0 9 3 3 200 150 From Reynolds to- Walford 6 2 600 J Wybrow ] 1 6 From Wade to- Harwood 2 3 1 6 Wen worth 1 8 3 500 At. Harwood..•••••• 4 o 12 Gibson 8 0 0 5 2 4 6 Lister 5 0 0 P. Harwood....•••• ............ 5 200 Wooden 1 4 4 0 3 0 o Smart 6 0 0 Higgins.. 2 6 0 5 Taylor 1 1 200 From Henderson to- yip stone ...... ........ Arnold 5 3 0 19 12 Turvey 3 2 12 I. Bumpus•■••■■.••••••••••••••• 16 20 Guilder 2 3 2 0 From S. Harris to- rp vler Gallap 2 2 0 13 18 0 0 Stanny 2 2 4 2 Av. ATeaco ck ..... .••••••••••••• 5 400 Moore 4 0 0 1t. Aleacock 1 29 3 6 AI. Aloore 2 6 1 0 At At eaeock 5 20 From Oliphant to- Absalom 3 6 0 2 7 1 0 E. Porch 2 0 0 From M. Ford to- J. Porch. •••■••••• ••••.••••••••• 4 3 350 Clark 2 4 3 0 Fermoy .••••• ••• •••••• ••••••.. 11 0 60 Cox 1 7 2 0 Gurney - 11 0 0 Sandaw 2 0 0 1 6 2 300 Cow-Pox : William Woodville, M. J). 247 95y | TO Months. 1 Da x s of Illness. I No. of 1 Pustules.] I Years of 1 Age. | | Months, j I Lays of | Illness. | No. of ] Pustules. I From J. Roberts to- From Kitchen to- T. "Roberts 3 3 0 Xettridan.... ...,. 16 1 From Kitchen to- Raymond 1 1 3 Q T. Foster 5 2 5 From I Harwood to J. Foster 1 1 2 A. Harris 26 4 M. Foster 1 1 24 M. Harris .... 1 4 1UU S. Gobby 27 • ) 20 S. H ar ri s 4 6 5 W. Gobby 5 0 2 W. Harris .. 5 6 2 DU J. Gobby 6 3 0 G Harris . 2 6 1 40 Putney 7 2 0 S. Boy ton 8 4 Bush 1 7 1 0 E. Bovton 6 3 E. Franklin 3 2 0 J. Boy ton 3 3 S. Franklin 8 0 0 From Talbot to- Neat 2 2 9 Lemare 6 3 Hicks 3 2 0 Williams 9 4 OU More 5 0 0 English ... 1 3 2 Barker 2 6 Churchman 3 4 North 2 3 0 Hunt ......... 1 2 4 Tnn Cowland 1 3 3 12 Whitburn 9 4 aqa Harrison & ] 5 Chartan ..................... 10 4 1 7 R. Lawyer. 36 ] 1 Callen 8 3 75 E. Lawyer 3 6 1 7 Russel 5 4 15 F. Lawyer . • 4 0 0 E. Russel 3 6 3 M. Lawver 1 0 0 Knight 8 3 500 E. Lunn... 5 0 0 Richardson 6 2 200 F. Lunn 2 *6 0 0 Johnston 1 7 3 150 T. Dunn 3 0 6 From J. Goss to- N. Coilop 9 1 0 Blinkinhorn 0 0 Q J. Collop 7 1 0 Mill ward 7 0 A. Collop • 3 1 0 Hay wood...... .... 1 8 4 E Collop 0 A Godden 1 2 300 T. Wiggins 7 0 0 AV. Godden 3 3 65n W. Wiggins 4 0 0 Jones 6 0 o P. Wiggins . . 1 & 0 0 Paradise 3 3 50 Ruffles.... 19 2 6 Kelly 2 0 100 Bridges 1 0 0 Hales • ...... 6 4 500 From J.'Barrett to- I. Mountain 4 6 2 300 I Mitchell 6 2 200 M. Mountain 2 2 150 P. Mitchell 2 2 50 A Mountain 1 1 75 T. Mitchell 2 2 26 From Brewster to- From Cook to- Barnett 1 1 0 0 E. Chapman 12 2 27 Balling. 9 2 6 M. Chapman 9 3 61 U pton 1 9 3 0 Good 13 4 40(; Finn 1 1 2 o From Styles to- Hilliard 6 0 o Edwards 18 3 0 White 1 4 1 o From Talbot to- From W. Meacock to- Brandrom 12 0 0 Westbrook 3 0 0 From Caterer to- From E. Chapman to- Stapler 22 4 300 Hider 2 1 o Mar sham • 17 4 43 Hughes 1 8 3 12 18 3 15 C. Hughes 5 2 4 Wall 8 3 200 From M Chapman to- R. Johnston 3 2 0 Sharp 18 0 3 30 6 3 500 Calbum 16 3 12 From Bradley's pustules to- Ledger 4 2 50 Vaughan 5 2 12 Vautin i 1 2 V e th all 4 3 200 McKennish 4 3 2 150 6 4 100 Wright. 7 3 10 5 2 20 Rance ... 2 0 o Green 2 4 3 30 From Ruffles to- 1 2 20 Thornton 17 1 0 3 4 50 Boreham 16 2 3 Starbuck 5 2 20 Fill 5 1 0 M. Phillips 2 2 3 500 Towler 1 3 1 0 S Phillips 3 11 3 5 French 11 6 0 4 3 36 Brestley .... 8 0 0 3 2 8 Thomas 4 1 0 Sheriff 7 3 34 Richardson 9 0 0 Steers 13 3 40 Morgan . 5 0 0 From I . Houghton to- From A. Waite to- S. Houghton. 19 0 0 W ood 22 4 6 58 (1 o "V onn g 16 2 o Jolly " 1 g o o Nnrman... .... 12 2 o From T\ Pluckrose to - M. Bartlett 11 1 20 12 3 3 A skew .. 3 0 15 W oodlard 2 0 J Clark _9 0 0 248 Cow-Pox: William Woodville, M. I). Those who are acquainted with the history of the cow-pox, will, no doubt, be surprised to find from the preceding cases that pustules have frequently been the consequence of the inoculation of this disease. Indeed, when T first observed a pustular eruption upon Buckland, (Case 3d) the occurrence being wholly unexpected, I was not without appre- hension that the lancet w'hich was employed in its inoculation might have had some par- ticles of variolous matter adhering to it. But this suspicion was soon removed, for, upon enquiry, I found that all the lancets which I had used on the twenty-first of Janu- ary were then made use of for the first time since they had been ground by the cutler. Among the patients inoculated for the cow-pox during the first week in which I ob- tained the matter of this disease, several were so circumstanced as to be afterw'ards con- stantly exposed to the infection of the cow-pox. Having then had no proof that the progress of the infection of the former w ould supersede that of the latter, I used the pre- caution to inoculate the patients with variolous matter on the fifth day after that taken from the cow had been inserted. This led some medical gentlemen to suppose that the matter locally formed in the arm from the first inoculation might be variolated by the progress of the second inoculation in the other arm, and that consequently the matter generated in the cow-pox tumor with which others were inoculated would produce a hy- brid disease and not the genuine small-pox. But as the matter employed in the cow-pox inoculations was always taken before the constitution could be effected by the variolous matter, and during the time that both inoculations were merely local diseases, I appre- hend its effects would be the same as if the variolous inoculation had not taken place. Nay, had this not been the case, but had several patients been inoculated with matter taken from the cow-pox tumor on the arm of Jane Collingridge, after both the inocula- tions xvere supposed to have affected the constitution for several days, neither facts nor analogy lead us to believe that the matter thus obtained would produce any other disease than that of its own species, or that its specific morbid quality would be changed by en- tering into combination with the virus of the small-pox. The general character of the tumor formed by the inoculation of the small-pox is very different from that of the cow- pox ; and though on the same day a person be inoculated in one arm with the matter of the cow-pox, and in the other with that of the small-pox, yet both tumors preserve their respective characteristic appearances throughout the whole course of the disease. This is certainly a strong proof that the two diseases, in respect to their local action, continue separate and distinct. Twenty-eight patients wrere on the same day inoculated with the matter of cow-pox and that of the small-pox, mixed together in equal quantities, in order to try which would prevail, or if it were possible to produce a hybrid disease by a union of both. The result was that in more than one-half of the patients thus inoculated, the local affec- tion distinctly assumed the characters of the cow-pox; in the others it more resembled the small-pox, but in none of them was there much indisposition or many pustules. At the request of Dr. Jenner, I transmitted to him, in Gloucestershire, some of the cow-pox matter from the patients then under my care, which he used for the purpose of inoculation ; after a trial of it he informed me that "the rise, progress and termination of the pustule created by this virus on the arm, was exactly that of the true unconi am- inated cow-pox." The matter sent was taken from the arm of Ann Bumpus, who had 310 pustules, all of which suppurated; yet with the matter of this stock Dr. Jenner in- oculated twenty, and another gentleman, in the same county, 140 persons, without pro- ducing any pustules w hich maturated. This fact wTould appear to confirm an opinion entertained by Dr. Jenner. In his second publication on the variola*, vaccinae he seems disposed to attribute the pusti les which so often attended this disease in London and its vicinity, to some peculiar influence of the town air. But of the cases which I have stated, several were those of patients who were inoculated eight miles distance from London ; yet these patients, in the proportion of about one in five, had an eruption. And at a small village, still farther from London, eighteen persons wrere inoculated with similar matter, in all of whom it produced pus- tules. The Twenty-seventh case also affords decisive evidence that the matter employed in it was that of the cow'-pox, for Jewel had undergone the small-pox when a child ; yet the inoculation excited febrile symptoms of tw o or three day's duration, and the tumor w'hich was produced upon her arm did not begin to scab till the thirteenth day. Having now, I presume, given sufficient reasons for establishing the point for 'which they have been adduced, I shall proceed to enquire howr far the effects of the cow-pox upon the human spbject seem to differ from or correspond with those of the small-pox when communicated by inoculation. The vaccine disease, as it has lately been called, affords a striking example, and per- haps the only one yet discovered, of a disorder which can be transferred from brute ani- mals to man, and carried back from him to the brute. A remarkable instance of this is related at page 62, which show's that the matter of the cow-pox, as reproduced by inoc- ulation in the human animal and inserted into the teat of a cowr, produced the disease. Cow-Pox: William Woodville, M. D. 249 Similar attempts were also made with variolous matter, which had no effect; hence, in this respect these two morbid poisons seem to differ. The cow-pox also differs from the small-pox in acting upon the constitutions of those who have undergone the latter dis- ease, as was fully exemplified in the case of Frances Jewel. However, I am disposed to think that the matter of the cow-pox is not so capable of affecting persons who have had the small-pox as has been represented. I made several trials to inoculate this disease in patients at the hospital who were recovering from a full eruption of the natural small- pox, but in no instance did any tumor appear on the arm ; neither does the insertion of the variolous matter, in such cases, excite the least inflammation in the skin. It is prob- able, therefore, that the matter of the cow-pox, like that of the small-pox, does not manifest any local action upon persons who have lately undergone the variolous disease. If a person has casually received the infection of the small-pox, and be inoculated with varioous matter three or four days before the eruptive symptoms supervene, the inocu- lated part does not tumify, as in other cases, but becomes a simple pustule ; on the con- trary, if a person has been inoculated, and the progress of the inoculation be so far ad- vanced that the patient is within one day of the approach of the eruptive fever, and be then inoculated a second time, the tumor produced from the second inoculation will be- come nearly as extensixe as the first, and be in a state of suppuration a few hours after the fever commences. Hence it appears that the process of variolation in the natural and in the inoculated small-pox is different. The cow-pox, in every case with which we are acquainted, has been introduced into the human constitution through the medium of external local inflammation, and is therefore to be considered as an inoculated disease ; the virus of it seems also to affect a similar mode of action, and to be governed by the same laws as that of th$ small-pox. Thus if a person be alternately inoculated with va- riolous matter and with that of the cow-pox every day till fever is excited, all the inoc- ulations make a progress; and as soon as the whole system becomes disordered, they ap- pear to be all equally advanced in maturation. However, the local tumor excited from the inoculation of the cow-pox is commonly of a different appearance from that which is the consequence of inoculation with variolous matter; for if the inoculation be per- formed by a simple puncture, the consequent tumor, in the proportion of three times out of four, or more, assumes a form completely circular, and it continues circumscribed, with its edges elevated and well defined, and its surface flat throughout every stage of the disease; while that which is produced from variolous matter, either preserves a pus- tular form or spreads along the skin, and becomes angulated and irregular, or disfigured by numerous vesicnlae. Another distinction, still more general and decisive, is to be drawn from the contents of the cow-pox tumor; for the fluid it forms, unless from some accidental circumstance, very rarely becomes purifonn, and the scab which succeeds is of a harder texture, exhib- its a smoother surface, and differs in its color from that which is formed by the concre- tion of pus. All the appearances here described, however, do not constantly attend the disease, but are some times so much changed they can in no respect be distinguished from those which arise from the inoculation of the small-pox. When the disease thus deviates from its usual appearance at the inoculated part, its effects upon the constitu- tion have commonly, though not always, been felt more severely than where the tumor was distinctly characterized. As I have now pointed out the principal circumstances in which the two diseases usually differ in their local effects, I shall proceed to examine them in a more important point of view, and to compare their general effect upon the constitution, in order, if possible, to ascertain, from the facts already adduced, whether or not the inoculation of the vaccine disease produces a milder distemper, and of less dangerous consequences to the patient, than that of the small-pox. For if it be an established fact, as I presume it is, that those who have undergone the former disease are thereby rendered secure against the effects of the latter, it only remains to be proved, in order to make the former be generally adopted, that the disorder which attends the cow-pox is also less severe and less fatal than the other. The number of cases of cow-pox inoculated under my direc- tion have amounted to about 600, but all these could not be included in the table, as at the time it was printed the disease, in many patients, was not far enough advanced to give the result; and to these may be added others who did not give proper attendance, and also some whose names I am not permitted to make public. The table, however, contains a sufficient number of cases to enable the medical reader to form a tolerably correct judgment respecting the disease; and from considering what would have probably been the effects of an equal number of cases of variolous inocula- tion, he may draw his own conclusions. But before this is done, I have to observe, that since the table was composed, an infant at the breast died on the eleventh day after the cow-pox matter had been inserted in its arm. In this solitary fatal case, the local tumor was very inconsiderable, and the eruptive symptoms took place on the seventh day, when the child was attacked with fits of the spasmodic kind, which recurred at short intervals with inci eased violence, and carried it off' at the time above mentioned, after an eruption of eighty or one hundred pustules. 250 Cow-Pox: William Woodville, M. I). It appears, therefore, that out of about five hundred cases of the inoculated cow-pox one proved fatal, and the preceding table shows that in some others the disease, from the number of the pustules, was of formidable severity ; while, on the other hand, a very large proportion of the patients were scarcely disordered from the inoculation, and had no pustules. . Were I enabled to state a number of cases of variolous inoculation, equal to those given above, and reduced to a similar tabular form, the comparative magnitude of the two diseases might be estimated with tolerable precision. It is evident, however, that the matter of the vaccine disease has generally produced much fewer pustules, and less indisposition than that of the small-pox; for it appears from the preceding statement that about two-fifths of all the persons inoculated for the variolas vaccinas, had no pus- tules, and that in not more than a fourth part of them was there experienced any percepti- ble disorders of the constitution. But it must be acknowledged, that in several in- stances, the cow-pox has proved a very severe disease. In three or four cases, out of five hundred, the patient has been in considerable danger, and one child, as I have already observed, actually died under the effects of the disease. Now, if it be admitted that at an average, one of five hundred will die of the inoculated cow-pox, I confess I should not be disposed to introduce this disease into the Inoculation Hospital, because, out of the last five thousand cases of variolous inoculation, the number of deaths has not exceeded the proportion of one in six hundred. But I am inclined to think, that if the matter of the cow-pox, used for the purpose of inoculation, were only taken from those in whom the disease appeared in a very mild form, the result would be more favor- able than in the statement here given. For though it has occasionally happened, that the matter taken from the arm of a patient, in whom the disorder neither produced fever nor eruption, has in others produced both ; yet still it has much more commonly had the effect of exciting a milder disease than the matter of the pustules, or than that which was obtained from a patient who had the disease in a severe manner, as may be seen by and examination of the table. Thus we find, that out of sixty-two persons, who were inoculated with the pustule matter, fifty-seven had an eruption ; and those who received the disease from any of these fifty-seven patients, appear also to have had pustules in nearly the same proportion I may also remark, that the disease, before noticed as proving fatal to a patient, was excited from matter of this description, and taken from Talbot. Whence it appears, that the cow-pox, from certain circumstances, is not only liable to lose the characters which distinguish it from the small-pox, but also to continue to propagate itself under this new and casual modification. The vaccine variolie, the human variola;, ought, therefore, to be considered as only varieties of the same disease, rather than as distinct species. One important advantage which the cow-pox is supposed to have over the small-pox is that the former is not a contagious disease, and not to be propagated by the effluvia of persons infected with it. This is certainly true when the disorder is confined to the in- oculated part, but where it produces numerous pustules upon the body, the exhalation they send forth are capable of infecting others in the same manner as the small-pox. Two instances of casual infection in this way have lately fallen under my observation ; in one the disease was severe, and the eruption confluent; in the other the disease was mild, and the pustules few. It has been asserted, that persons have had the small-pox after having been af- fected with the cow-pox; and some "facts havel been published with a view to show that instances of this kind have actually happened. But all these, as far as I have seen, have been very defective in not affording sufficient proof, that the affection supposed to have been the cow-pox, was in reality that disease. On the other hand, the instances which have been brought forward to prove that those who had under- gone the genuine cow-pox resisted the infection of the small-pox, are unquestionably decisive, and sufficiently numerous to establish the fact in the most satisfactory manner. This circumstance then appears to be as much a general law of the system, as that a person having had the small-pox is thereby rendered unsusceptible of receiving the dis- ease a second time. For of all the patients whom I inoculated with variolous matter, after they had passed through the cow-pox. amounting to upwards of four hundred, none were affected with the small-pox ; and it may be remarked, that nearly a fourth part of this number was so slightly affected with the cow-pox, that it neither produced any perceptible indisposition nor pustules. We have been told, that the cow-pox tumor has frequently produced erysipelatous inflammation, and phagedenic ulceration; but the inoculated part lias not ulcerated in any of the cases which have been under my care, nor have I observed inflammation to occasion any inconvenience, except in one instance, where it was soon subdued by the application of aqua lithargyri acetati. It should seem then, that the advantages to be derived from substituting the cow-pox for the small-pox, must be directly in proportion to the greater mildness of the former, than the latter disease. [End of Woodville on Cow-Pox.] THE ERRORS OF DRS. WOODVILLE AND PEARSON AROSE FROM THE PERFORMANCE OF COW-POX INOCULA- TION IN AN ATMOSPHERE POISONED BY THE CONTAGIOUS EMANATIONS OF SMALL-POX. CORRECTION OF THE ERRORS OF DR. WOODVILLE BY DR. JENNER. EXPERIMENTS OF DR. ROBERT WILL AN IN THE YEARS 1799 AND 1800, ON THE COMBINED INOCULATION OF THE VARIOLOUS AND VACCINE FLUIDS-REFERENCES ILLUS- TRATING THE EXTENSIVE NATURE OF THE CONTRIBU- TIONS BY VARIOUS OBSERVERS TO THE LITERATURE OF COW-POX INOCULATION, DURING THE FIRST FIVE YEARS AFTER JENNER'S ANNOUNCEMENT OF HIS DISCOV- ERY. It is evident from the preceding reports of Dr. Woodville, that he en- deavored to establish, that the substitution of vaccina in place of small- pox, would be of little or no advantage to mankind, as it was in many cases attended with eruptions not inferior in severity to those arising from variolous inoculation. The error into which the gentleman fell with regard to the eruptions be- ing an effect of cow pox in the inoculated form, was due to the performance of his experiments in a location and atmosphere poisoned by the emanations or contagium of. small-pox. Dr. Woodville performed the inoculation from whence these cases originated, in an hospital appropriated to variolous inoculation. In such a place the atmosphere would necessarily have been surcharged with small- pox infection, and the building with every article of furniture of such an establishment, must have been loaded with variolous effluvia; hence the eruptions are easily accounted for, as a person is susceptible of vaccine impression, notwithstanding he may, at the time of vaccination, have the infection of small-pox in his system, or even have passed through that dis- ease. Many of the patients experimented on by Dr. Woodville at the small-pox hospital in London, besides being exposed to variolous atmosphere, act- ually had small-pox matter inserted into the arm on the third and fifth days after vaccination. 252 Errors of Dr. Woodville, exposed by Jenner and Willan. Dr. Jenner had positively asserted that pustules do not belong to the cow-pox, as he had never seen them produced by genuine vaccine matter. Dr. Woodville, on the contrary, reported that three-fifths of the patients whom he had inoculated with vaccine matter had pustules not to be dis- tinguished from variolous ones. A statement of this kind,from such a quar- ter, so much at variance with what had been anticipated, excited the strong- est feelings of disappointment among the principal medical men of Lon- don, and for a season threw considerable doubt on Dr. Jenner's accuracy. From the commencement Dr. Jenner suspected the real cause of this de- viation ; but he was willing to give the gentlemen who began the experi- ments in London the benefit of every supposition that might tend to ac- quit them of the blunder which they had actually made. He thought it possible that there might be some peculiarity either in the constitution of the individual vaccinated, or something in the nature of the virus itself that might occasion the eruptions; but after admitting these suppositions he couldnot divest himself of the suspicion that the London cow-pox was somehow or other compounded with, small-pox. When Dr. Jenner became fully ac- quainted with the manner of conducting the practice in the small-pox hospital, this conviction amounted to certainty ; and at a latter period he declared to Dr. Woodville that the matter had absolutely been contaminated in the hospital. There are facts to show that this impure matter was really disseminated over many parts of England, and also on the continent, in place of that of the true variola? vaccime. Dr. Robert Willan,* in his valuable work on "Vaccine Inoculation," published in 1806, details in the first section some experiments made during the years 1799 and 1800, on the combined inoculation of the variolous and vaccine fluids. From these experiments it appears that: " The variolous and vaccine fluids inoculated about the same time, restrain the action of each other on the human body, so that in some cases the vaccine vesicle is smaller than us- ual, and has a very slow progress; in ocher cases the areola is scarcely perceptible; while in others it is large but premature ; and the variolous eruption consists of hard, distinct, shining pustules, which have but little inflammation round them, and which seldom maturate. Some of these pustules are tubuculated; and the small quantity of matter contained in them soon disappears, leaving the cuticle which confined it, horny and elevated for many days afterwards. The rest of the eruption is minute and papulous, not suppurat- ing but desquamating. I was fully satisfied that the pustules, produced under these cir- cumstances, were genuine variolous pustules, as many opportunities occurred to me of ascertaining, by inoculation from them, that they were capable of producing every variety of the small-pox, from the mild and distinct, to the confluent and more danger- ous form of the disease. Dr. Woodville, who considered them to be secondary vaccine pustules or vesicles, often inoculated from them and transmitted to several of Jiis friends ; we may, hence, perhaps, account for the appearance of pustules, in persons supposed to have been properly vaccinated, in different parts of the country. I may, however, ob- serve, that fluid, taken from the vaccine vesicle, in the arm of a person affected with the variolous fever and eruption, and inserted in the arm of another person by a clean lance, produced the vaccine disease alone." P. 56. Dr. Robert Willan, held that the chief nicety and difficulty of vaccina- tion is, in distinguishing from the genuine cow-pox, some irregular vesicles which have often been mistaken for it, and which do not wholly secure the constitution from the small-pox. Dr. Willan gives the following concise description of the irregular vac- cine vesicles: ★On Vaccine Inoculation. By Robert Willan, M. D. F. R. A. S. Physician Extraordinary to the Fever Institution, and to the Public Dispensary in London, quarto, 108 pages, with colored engravings, and an appendix of 54 pages. Philips, 1806. Errors of Dr. Woodville, exposed l>y Jenner and Willan 253 "I have observed three sorts of these irregular vesicles. The first is a single pearl- colored visicle, set in a hard dark red base, slightly elevated. It is larger and more globate than the spurious pustule above represented, but much less than the genuine ve- sicle; its top is flattened, or sometimes a little depressed; but the margin is not rounded or prominent. The second appears to be cellular, like the genuine vesicle, but is some- what smaller and more sessile and has a sharp angnlated edge. "In the first, the areolar is usually diffuse, and of a dark rose color; in the second, it is somewhat of a dilute scarlet color, radiated and very extensive, as from the sting of a wasp; at other times, it has the form and color exhibited in Plate 1, No. 7. The areola ap- pears round these vesicles on the seventh or eighth day after inoculation, and continues more or less vivid for three days, during which the scab is completely formed. The scab is smaller, and less regular than that which succeeds the genuine vesicle; it also falls off much sooner; and, when seperated, leaves a smaller cicatrix which is sometimes angu- lated. The third irregular appearance is a vesicle without an areola." On Vaccine In- noculation p. 39-40. as the degree of security afforded by these irregular vesicles is different in different persons, and, as the matter taken from them often produces the same imperfect form of the disease, it can scarcely be doubted that many mistakes and failures originated from this source. Dr. Willan therefore suggested the propriety of confining the practice of vaccination to those who had had a sufficiant education, and who had minutely attended to the subject. He also further recommended a strict examination of all persons inoculated between the first of January, 1799, and the first of January, 1802, and urged the necessity of re-inoculation in every doubtful case. With reference to the cutaneous and glandular affections imputed to vaccina- tion, Dr. Willan did not observe any new disease of the skin referable to the cow-pox. Dr. Willan endeavored to prove by a table, extracted from the register books of the public dispensary in London, that the number of cutaneous complaints was not increasing, their proportion to all other diseases having been the same before the publication of Dr. Jenner's inquiry as in the sixth and seventh year of vaccination. On Vaccine Inoculation, p. 82. The prime object of this division of our work on the prevention and arrest of contagious and infectious diseases, is to present those facts and original documents which illustrate the history and relations of small-pox and cow- pox, and which will furnish the sanitarians, physicians and legislators of Louisanna, and of all other States in the American Union the fundamental principles for the enactment of wise, just and efficacious regulations and laws for the absolute arrest of the most loathsome and destructive pesti- lence which has ever afflicted the human race. A minute analysis therefore of the various publications * relative to vac- ' * We append the following references in order to illustrate the rich and extensive nature of the contribu tions by various observers to the literature of cow-pox inoculation during the first five years after Jenner's announcement of his discovery : Dr. Pearson's Letter on the Effects of Inoculating the Vaccine Disease. The London Medical Review and Magazine, by a Society of Physicians and Surgeons, vol. 1, March to August, 1799, p. 201, p. 349. Dr. Woodville's Note on the Cow-pox, addressed to the Society of Physicians and Surgeons. London Med- Review and Magazine, vol. 1, p. 397. A communication from Dr. Hooper, respecting the Susceptibility of Persons Exposed to the Variolous Contagion after having had the Cow-pox. London Medical Review and Magazine, vol. 1, 1799, p. 505, Extracts of Letters from Mr. Cooke, Apothecary at Glocester. London Medical Review and Magazine, vol. 1, p. 591. Answers by Mr. Jacobs. Attorney-at-Law. Bristol, to Queries proposed by the Editor, respecting the Cow-pox. London Medical Review and Magazine, vol. 1, p. 599. A statement of the Progress in the Vaccine Inoculation, and Experiments to determine some important Facts belonging to the Vaccine Disease, by George Pearson, M. D., F. R. S. Physician to St. George's Hospital, etc. London Medical Review and Magazine, vol, 1. p. 612. Observations on Dr. Hooper's Cases of the Cow-pox, by the Rev. J. D. Fosbrooke, M. A., Curate of Horsley, Gloucestershire. London Medical Review and Magazine, vol. 1, p. 628. A communication concerning the Eruptions Resembling the Small-pox, which sometimes appear in the In- oculated Vaccine Disease, by George Pearson, M. D., F. R. S., Physician to St. George's Hospital. Lon- don Medical Review and Magazine, September, 1799-1800, vol. 2, p. 393, An Account of an Institution for Inoculating the Vaccine-pock, patronized by His Roval Highness the Duke of York, at No. 36 Warwick street, Golden Square. London Medical Review and Magazine, vol. 2, p. 475. 254 Errors of Dr. Woodville, enposel by Jenner and Willan. cination, would be a useless waste of time, for the essential facts will found in the works of the original observers which have been, or which will be, dissecated and recorded in the progress of the present vindication of vaccination. Remarks on Dr. Pearson's communication concerning the Eruptions resembling the Small-pox, which sometimes appear in the Inoculated Vaccine Disease. By the Kev. F. D. Fosbrooke, M. A. F, A. S., Cu- rate of Horsley, Gloucestershire. London Medical Review and Magazine, vol. 2, p. 481. Observations on the Cow-pox. By Mr. John Chapman, Surgeon at Ampthill, Bedfordshire; communi- cated by Dr. Pearson. M. D., F. R. S. London Medical Review and Magazine, March to June, 1800, vol. 3, p. 77. Translation of a letter from Mr. Stromeger to Mr. Hunneman. concerning the Vaccine Inoculation prac- ticed by him; dated Hanover, March 24, 1800. London Medical Review and Magazine, vol. 3, p. 174. Information relating to the Cow-pox; communicated by Mr, R. J. Taynton, Surgeon at Bromley, in Kent. London Medical Reviewand Magazine, vol. 3, p, 179. Casesand Observations tending to prove either the Infectious Nature of the Cow-pox, or the fallacy of some experiments made in London. By Mr. Blair, Surgeon of the Lock Hospital and Ferisbury Dispensary, etc. London Medical Review and Magazine, vol. 3, p. 188. Remarks on Mr. Blair's paper concerning the Infectious Nature of Cow-pox, and on that of Mr. Taynton relative to the same subject. By John Resig, Member of the Royal College of Surgeons in London. Lon- don Medical Review and Magazine, 1800, vol. 3, p. 312. Notice relating to the Cow-pox Institution. London Medical Review and Magazine, vol. 3, p. 316, Observations on Certain Peculiarities of the Cow-pox. By Mr. John Resig, Member of the Royal College of Surgeons; with Additional Remarks by the Editors. London Medical Reviewand Magazine, vol, 3, p. 417. Notice of a Testimonial in Favor of the Cow-pox ; signed by several Physicians and Surgeons in London, June, 1800. London Medical Review and Magazine, vol. 3, p. 420. Further Remarks on the Infectious Nature of the Cow-pox. By Mr. Blair, Surgeon of the York Hospital and Asylum, and of the Ferisbury Dispensary, etc. London Medical Review and Magazine, vol. 3, p. 421. Some further Observations and Experiments on the Vaccine Inoculation. By G. Pearson, M. D., F. R. S., London, Physician to St. George's Hospital, London ; in a letter to Dr, Duncan. London Medical Review and Magazine, vol. 3, p. 78. Reflections on the Cow pox, illustrated by cases to prove it an absolute security against the small-pox. Addressed to the public in a letter to Dr. Jenner, from William Fermor, Esq., octavo, 47 pages; Robson, London, 1800. The vaccine matter employed by Mr. Fermor was originally derived from the Rev. Mr. Jenner, of Berk- ley. The total number of his cow-pox patients amounted to 326, of which number. 173 were afterwards inoculated with the small-pox without taking the infection. In only two instances did any vaccine erup- tions appear, except on the inoculated part; a single pustule on the forehead of one, and likewise one on the arm of another. An Address to the Public on the Advantages of Vaccine Inoculation ; with the objections to it refuted. By Henry Jenner, Surgeon, F. L. S , etc., quarto, 19 pages ; Cadell & Davies, London. Some Observations on Vaccination, or the Inoculation of Cow-pox. By Richard Dunning, Surgeon. Plymouth Dock, and Member of the Medical Society of that Town and Plymouth, octavo, 122 pages; Cadell & Davies, London, 1800. Observations on the Cow-pox. By William Woodville, M. D., Physician to the Small-pox and Inocula- tion Hospitals, octavo, 43 pages ; Phillips, London, 1800. Copy of a Testimonial in favor of the Vaccine Inoculation, signed by thirty-six Physicians, and Sur geons in London. London Medical Review and Magazine, vol. 4. July to December, 1800, p. 60. Further infoimation respecting the case of Cow-pox which was lately communicated by Mr. Malim, with observations by the Editor. London Medical Review and Magazine, vol, 4, 1800, p. 208. Additional Observations on the Variform Eruptions which have occurred in the Cow-pox, with some fur- ther remarks on the origin of the disease. By Mr. Ring. Member of the Royal College of Surgeons in London. London Medical Review and Magazine, July to October, 1800, vol. 4. p. 91. On the Introduction of the Vaccine Inoculation at Paris (A. Monsieur Pearson. Medecin de I'Hopital de 1'Inoculation Vaccine a Londres). London Medical Review and Magazine, vol. 4, p. 204. Further Remarks on Variolated Vaccine Matter, and on Mr. Malim's case of Cow-pox. By Mr. Ring, Member of the Royal College of Surgeons in London. London Medical Review and Magazine, vol. 4. p. 307. Facts relating to the origin of the Cow-pox, communicated by Sir Christopher Pegge, Knight, M. D., and Reader of Anatomy, Oxford. London Medical Review and Magazine, November, 1800, to February, 1801, vol. 5, p. 76. Authentic information relative to some extraordinary cases of the Cow-pox at Clapham. By Mr. Pears. F. M. S., etc.; with a postscript by the Editors. London Medical Review and Magazine, vol. 5, p. 276. Facts concerning the Eruptions and Contagious Nature of the Cow-pox. By Mr. Harrup, of Cholsham. London Medical Review and Magazine, vol. 5, p. 289. Rapport sur la Vaccine ; ou Reponse aux Questions R6dig6es paries Commissaires de 1'Ecole de Mede- cine de Paris, sur la Pratique et les Resultats de cete Nouvelle Inoculation en Angleterre, et dans les Hos- pices des Londres, ou on PAdoptb. Par A Aubert, Docteur en Medecine ; Paris, An 9. Copy of a letter on the Cow-pox, from Dr. Marshall to Mr. Ring, dated Gibralter, August 23, 1800. London Medical Review and Magazine, vol. 5. p. 100. A Concise View of Circumstances and Proceedings respecting Vaccine Inoculation, etc., etc. London, 1800. A concise view of all the most important facts which have hitherto appeared concerning the Cow-pox. By C. R. Aikin, Member of the Royal College of Surgeons in London ; Phillips, London, 1800. A comparative statement of Facts and Observations relative to the Cow-pox ; published by Drs. Jenner and Woodville, London, 1800. Copy of a letter from Dr. Marshall to Mr. Ring, dated Mabon, Island of Miaorrca, September, 1800. London Medical Review and Magazine, vol. 5, p 198. Copy of a letter from Dr. Marshall to Mr. Ring, dated II. M. S. Fondrazars, Gibraltar Bay, October 16, 1800. London Medical Review and Magazine, vol. 5, p. 199. Additional Signatures to the Testimonial in favor of Vaccine Inoculation. London Medical Review and Magazine, vol. 5, p 315. lieports on Vaccination by British Physicians, 1807. 255 Tliat the labors of Dr. Jenner were recognized by the wisest and most able representatives of his own country, within ten years after the an- nouncement of his discovery, is shown by the following report of the Royal College ot Physicians of London, on vaccination in 1807. This report, with the accompanying opinions of the Royal College of Physicians of Edinburgh and Dublin, and of the Royal College of Sur- geons of London, of Dublin and of Edinburgh, made in accordance with an address from the House of Commons and in compliance with the com- mands of the King of England, should be regarded as one of the ablest and most impartial of the testimonials which have at different times and in different countries been received in favor of vaccination. REPORT OF THE ROYAL COLLEGE OF PHYSICIANS OF LON- DON, ON VACCINATION. WITH AN APPENDIX, CONTAIN- ING THE OPINIONS OF THE ROYAL COLLEGE OF PHYSI- CIANS OF EDINBURGH AND DUBLIN; AND OF THE ROYAL COLLEGES OF SURGEONS OF LONDON, OF DUBLIN, AND OF EDINBURGH. The Royal College of Physicians of London, having received his Majesty's commands, in compliance withan address from the House of Commons, "to inquire into the state of vaccine inoculation in the United Kingdom, to report their opinion and observations up- on that practice, upon the evidence which has been adduced in its support, and upon the causes which have hitherto retarded its general adoption ;" have applied themselves diligently to the business referred to them. Deeply impressed with the importance of an inquiry which equally involves the lives of individuals and the public prosperity, they have made every exertion to investigate the subject fully and impartially. In aid of the knowledge and experience of the mem- bers of their own body, they have applied separately to each of the Licentiates of the college; they have corresponded with the Colleges of Physicians of Dublin and Edin- burgh; with the Colleges of Surgeons of London Edinburgh and Dublin; they have called upon the societies established for vaccination, for an account of their practice, to what extent it has been carried on, and w^hat has been the result of their experience; and they have, by public notice, invited individuals to contribute whatever information they had severally collected. They have in consequence been furnished with a mass of evidence communicated with the greatest readiness and candor, which enables them to speak with confidence upon all the principal points referred to them.. I. During eight years which have elapsed since Dr. Jenner made his discovery public the progress of vaccination has been rapid, not only in all parts of the United Kingdom, but in every quarter of the civilized world. In the British Islands some hundred thous- ands have been vaccinated; in our possession in the East Indies upwards of 800,000, and among the nations of Europe the practice has become general. Professional men have submitted it to the fairest trials, and the public have, for the most part, received it with- out prejudice. A few indeed have stood forth the adversaries of vaccination, on the. same The Report of the Cow-pock Inoculation from the Practice at the Vaccine Pock Institution, during the years 1800. 1801 and 1802. Read at the General Meeting of the Governors February 7, 1803, at the Shaks- peare Tavern : written by the Physicians to the Institution ; to which are prefixed two painted engravings of Cow-pox and other Eruptions. London, 1803. Third Annual Report of the Vaccine Pock Institution for Inoculating the Poor, Supported by the Vol- untary Subscriptions, Benefactions and legacies of the Public ; From its Foundation, December 2, 1800, to December 31. 1802. _ . . , . A case showing the impropriety of taking the whole of the virus out of a vaccine vesicle; communicated by Dr. Frederick Dalcho, Secretary to; v Medical Society of South Carolina, to Dr. Michell, April 27,1805. The Medical Repository, etc., vol 3, p. 2t>4. The cases reported by Dr. Frederick Dalcho. occurred in May, 1802. " Remarks on the Cow-pox Inoculation, bv Mr. Charles Brandon Frye." From his own experience Mr. Frye asserted, first, that whatever has been said against the sufficiency of Cow-pox matter, as a security against variolous infection, may be also said with truth against Small pox mat- ter, as a similar security ; second, that the subsequent i'.l effects which have been said to follow Cow-pox, have, in a ten fold degree, followed Small pox ; third, that many instances of mortality have happened in Small-pox inoculation, while amongst all which has been said, not a single example appears of death from Cow-pox. 256 Reports on Vaccination by British Physicians, 1807. grounds as their predecessors who opposed the inoculation for the small-pox, falsely led by hypothetical reasoning in the investigation of a subject which must be supported, or rejected, upon facts and observation only. With these few exceptions, the testimony in favor of vaccination has been most strong and satisfactory, and the practice* of it, though it has received a check in some quarters, appears still to be upon the increase in most ports of the United Kingdom. II. The College of Physicians, in giving their observations and opinions on the prac- tice of vaccination, think it right to premise,-that they advance nothing but what is supported by the multiplied and unequivocal evidence which has been brought before them, and they have not considered any facts as proved, but what have been stated from actual observation. Vaccination appears to be in general perfectly safe; the instances to the contrary being extremely rare. The disease excited by it is slight, seldom preventing those under it from following their ordinary occupations. It has been communicated with safety to pregnant women, to children during dentition, and in their earliest infancy; in all which respects it possesses material advantages over inoculation for the small-pox; which, though pro- ductive of a disease generally mild, yet sometimes occasion alarming symptoms, and is in a few cases fatal. The security derived from vaccination against the small-pox, if not absolutely perfect is as nearly so as can perhaps be expected from any human discovery; for amonst several hundred thousand cases, with the results which the College have been made acquainted, the number or alleged failures have been surprisingly small, so much so, as to form cer- tainly no reasonable objection to the general adoption of vaccination, for it appears that there is not nearly so many failures in a given number ol vaccinated persons, as there are deaths in an equal number of persons inoculated for the small-pox. Nothing can more deary demonstrate the superiority of vaccination over the ^inoculation of the small-pox, than this consideration ; and it is a most important fact, which has been confirmed in the course of this inquiry, that in almost every case where the small-pox has succeeded vaccination, whether by inoculation or by causul infection, the disease has varied much from its ordinary course; it has neither been the same in violence, nor in the duration of its symptoms, but has, with very few exceptions been remarkably mild, as if the small-pox had been deprived, by the previous vaccine disease, of all its usual malignity. The testimonies before the College of Physicians are very decided in declaring, that vaccination does less mischief to the constitution and less frequently gives rise to other diseases, than small-pox, either natural or inoculated. The College feel themselves called upon to state this strongly, because it has been ob- jected to vaccination, that it produces new, unheard-of, and monstrous diseases. Of such assertions no proofs have been produced, and, after diligent inquiry, the, College believe them to have been either the inventions of designing, or the mistakes of ignorant men. In these respects then, in its mildness, its safety, and its consequences, the in- dividual may look for the peculiar advantages of vaccination. The benefits which flow from it to society are infinitely more considerable ; it spreads no infection, and can be communicated only by inoculation. It is from a consideration of the pernicious effects of the small-pox, that the real value of vaccination is to be estimated. The natural small-pox has been supposed to destroy a. sixth part of all whom it attacks : and that even by inoculation, where that has been general in parishes and towns, about one in 300 has usually died. It is not sufficiently known, or not adverted to, that nearly one- tenth, some years more than one-tenth of the whole mortality in London, is occasioned by the small-pox ; and however beneficial the inoculation of the small-pox may have been to individuals, it appears to have kept up a constant source of contagion, which has been the means of increasing the number of deaths by what is called the natural disease. It cannot be doubted that this mischief has been extended by the inconsiderate manner in which great numbers of persons, even since the introduction of vaccination, are still every year inoculated with the small-pox, and afterwards required to attend two or three times a week at the places of inoculation, through every stage of their illness. From this, then, the public are to expect the great and uncontroverted superiority of vaccination, that it communicates no casual infection, and, while it is a protection to the individual,it is not prejudicial to the public. III. The College of Physicians, in reporting their observations and opinions on the evidence adduced in support of vaccination, feel themselvos authorized to state that a body of evidence so large, so temperate, and so consistent, was perhaps never before col- lected upon any medical question. A discovery so novel, and to which there was noth- ing analogous known in nature, though resting on the experimental observations of rhe inventor, was at first received with diffidence ; it was not, however, difficult for others to repeat his experiments, by which the truth of his observations was confirmed, and the doubts of the cautions were gradually dispelled by extensive experience. At the com- mencement of the practice, almost all that were vaccinated were afterwards submitted to Reports on Vaccination by British Physicians, 1807. 257 the inoculation of the small-pox, many underwent this operation a second, and even a third time, and the uniform success of these trials quickly bred confidence in the new discovery. But the evidence of the security derived from vaccination against the small- pox does not rest alone upon those who afterwards underwent variolous inoculation, al- though amounting to many thousands ; for it appears, from numerous observations com- municated to the College, that those who have been vaccinated are equally secure sgainst the small-pox does not rest alone upon those who afterwards underwent variolous inocu- lation, although amounting to many thousands; for it appears, from numerous observa- tions communicated to the College, that those who have been vaccinated are equally se- cure against the contagion of epidemic small-pox. Towns, indeed, and districts of the country, in which vaccination had been general, have afterwards had the small-pox prevalent on all sides of them without suffering from the contagion. There are also in the evidence a few examples of epidemic small-pox having been subdued by a general vaccination. It will not, therefore, appear extraordinary that many who have commu- nicated their observations should state, that though at first they thought unfavorably of the practice, experience had now removed all their doubts. It has been already mentioned that the evidence is not universally favorable, although it is in truth nearly so, for there are a few who entertain sentiments differing widely from those of the great majority of their brethren. The College, therefore, deemed it their duty, in a particular manner, to inquire upon what grounds and evidence the op- posers of vaccination rested their opinions. From personal examination, as well as from their writings, they endeavored to learn the full extent and weight of their objections. They found them without experience in vaccination, supporting their opinions by hear- say information and hypothetical reasoning; and, upon investigating the facts which they advanced, they found them to be either misapprehended or misrepresented, or that they fell under the description of cases of imperfect small-pox before noticed, and which the College have endeavored fairly to appreciate. The practice of vaccination is but of eight years standing, and its promoters, as well as opponents, must keep in mind that a period so short is too limited to ascertain every point, or to bring the art to that perfection of which it may be capable. The truth of this will readily be admitted by those acquainted with the history of inoculation for the small-pox. Vaccination is now, however, well understood, and its character accurately described. Some deviations from the usual course have occasionally occurred, which the author of the practice has called spurious cow-pox, by which the public have been misled, as if there were a true and false cow-pox; but it appears that nothing more was meant than to express irregularity or difference from that common form and progress of the vaccine pustule from which its efficacy is inferred. Those who perform vaccination ought, therefore, to be well instructed, and should have watched with the greatest care the regular progress of the pustule, and learnt the most proper time for taking the mat- ter. There is little doubt that some of the failures are to be imputed to the inexperience of the early vaccinators, and it is not unreasonable to expect that further observations will yet suggest many improvements that will reduce the number of anamalous cases, and furnishing the means of determining with greater precision, when the vaccine dis- ease has been effectually received. Though the College of Physicians have confined themselves in estimating the evidence of such facts as have occurred in their own country, because the accuracy of them could best be ascertained, they cannot be insensible to the confirmation these receive from the reports of the successful introduction of vaccination, not only into every part of Europe, but throughout the vast continents of Asia and America. IV. Several causes have had a partial operation in retarding the general adoption of vaccination ; some writers have greatly underrated the security it affords, while others have considered it to be of a temporary nature only; but if any reliance is to be placed on the statements which have been laid before the College, its power of protecting the human body from the small-pox, though not perfect indeed, is abundantly sufficient to recommend it to the prudent and dispassionate, especially as the small-pox, in the few instances where it has subsequently occurred, has been generally mild and transient. The opinion that vaccination affords but a temporary security is supported by noanology in nature, nor by the facts which have hitherto occurred. Although the experience of vaccine inoculation be only of a few years, yet the same disease, contracted by the milkers of cows, in some districts, has been long enough known to ascertain that in them, at least, the unsusceptible of the cow-pox contagion does not wear out of time. Another cause is the charge against vaccination of producing various new diseases of frightful and monstrous appearance. Representations of some of these have been exhibited in print in a way to alarm the feelings of parents, and to infuse dread and apprehension into the minds of the unin- formed. Publications with such representations have been widely circulated, and though they originate either in gross ignorance, or willful misrepresentation, yet have they lessened the confidence of many, particularly of the lower classes, in vaccination ; 258 Reports on Vaccination by British Physicians, 1807. no permanent effects, however, in retarding the progress of vaccination need be appre- hended from such causes, for, as soon as the public shall view them coolly and without surprise, they will excite contempt, and not fear. Though the College of Physicians are of opinion that the progress of vaccination has been retarded in a few places by the above causes, yet they conceive that its general adoption has been prevented by causes far more powerful, and of a nature wholly differ- ent. The lower orders of society can hardly be induced to adopt precautions against evi s which may be at a distance ; nor can it be expected from them, if these precautions are attended with expense. Unless, therefore, from the immediate dread of epidemic small-pox, neither vaccination nor inoculation appear at any time to have been general, and when the cause of terror has passed by, the public have relapsed again into a state of indifference and apathy, and the satutary practice has come to a stand. It is not easy to suggest a remedy for an evil so deeply imprinted in human nature. To inform and instruct the public mind may do much, and it will probably be found that the progress of vaccination in different parts of the United Kingdom will be in proportion to that in- struction. Were encouragement given to vaccination, by offering it to the poorer classes without expense, there is little doubt that it would in time supersede the inoculation for the small-pox, and thereby various sources of variolous infection would be cut oft'; but till vaccination becomes general, it will be impossible to prevent the constant recurrence of the natural small-pox by the means of those who are inoculated, except it should ap- pear proper to the legislature to adopt, in its wisdom, some measure by which those who still, from terror or prejudice, prefer the small-pox to the vaccine disease, may, in thus consulting the gratification of their own feelings, be prevented from doing mischief to their neighbors. From the whole of the above considerations, the College of Physicians feel it their duty strongly to recommend the practice of vaccination. They have been Jed to this conclusion by no preconceived opinion, but by the most unbiased judgment, formed from an irresistable weight of evidence, which has been laid before them. For when the number, the respectability, the disinterestedness and the extensive experience of its ad- vocates is compared with the feeble and imperfect testimonies of its few opposers ; and when it is considered that many, who were once adverse to vaccination, have been con- vinced by further trials, and are now to be ranked among its warmest supporters, the truth seems to be established as firmly as the nature of such a question admits; so that the College of Physicians conceive that the public may reasonably look forward with some degree of hope to the time when all opposition shall cease, and the general con- currence of mankind shall at length be able to put an end to the ravages, at least, if not to the existence, of small-pox. LUCAS PEPYS, President, Royal College of Physicians, April 10, 1807. J A. HARVFY, Register. APPENDIX. NO. 1. To the Royal College of Physicians of London : Gentlemen-I am ordered by the King and Queen's College of Physicians, in Ireland, to thank the Royal College of Physicians, of London, for the communication they have had the honor to receive from them, of certain propositions relative to vaccination, whereon His Majesty has been pleased to direct an inquiry to be instituted, and in the prosecution of which the co-operation of the College in Ireland is requested. And I am directed to acquaint you that the said College having referred the investiga- tion of these propositions to a committee, have received from them a report, oLwhich the inclosed is a copy ; and that they desire the same may be considered as containing their opinion upon the subject. I have the honor to be, gentlemen, Your most obedient humble servant, HUGH FERGUSON, Register. By order of the King and Queen's College of Physicians in Ireland. Dublin, Nov. 11, 1806. " The practice of vaccination was introduced in this city about the beginning of the year 1801, and appears to have made inconsiderable progress at first. A variety of causes operated to retard its general adoption, amongst which the novelty of the prac- tice, and the extraordinary effects attributed to vaccination, would naturally take the lead. Reports on Vaccination by British Physicians, 1807. 259 "Variolous inoculation had been long, almost exclusively, in the hands of a particular branch of the profession, whose prejudices and interests were strongly opposed to the new practice; and by their being the usual medical attendants in families, and espec- ially employed in the diseases of children, their opinions had greater effect upon the minds of parents. The small-pox is rendered a much less formidable disease in this country by the frequency of inoculation for it, than it is in other parts of His Majesty's dominions, where prejudices against inoculation have prevailed ; hence, parents, not un- naturally, objected to the introduction of a new disease, rather than not recur to that, with the mildness and safety of which they were well acquainted. "In the beginning of the year 1804, the Cow-Pox Institution was established, under the patronage of the Earl of Hardwicke, and it is from this period that we may date the general introduction of vaccination into this city, and throughout all parts of Ireland. " The success of the institution, in forwarding the new practice, is to be attributed in a great measure to the respectability of the gentlemen who superintend it, and to the diligence, zeal and attention of Dr, Labatt, their secretary and inoculator. In order to show the progress which has been made in extending the vaccination, your committee refer to the report of the Cow-Pox Institution for the last two years, and to extracts from their Register for the present year : YEAR. Patients Inoculated. Packets Issued to Practitioners in General. Packets to Anny Surgeons. 1804 578 776 236 1805 .... 1032 1124 178 1806 Z" 1356 1340 220 Total 2966 3240 634 " In the above statement the numbers are averaged to the end of the present year, on the supposition of patients resorting to the institution as usual. The correspondence of the institution appears to be very general throughout every part of Ireland, and by ac- counts received, as well from medical practitioners as others, the success of vaccination seems to be uniform and effectual. At the present period, in the opinion of your com- mittee, there are few individuals in any branch of the profession who oppose the prac- tice of vaccination in this part of His Majesty's dominions. " It is the opinion of your committee that the practice of cow-pox inoculation is safe, and that it fully answers all the purposes that have been intended by its introduction. At the same time, your committee is willing to allow that doubtful cases have been re- ported to them as having occurred, of persons suffering from small-pox, who had been previously vaccinated. Upon minute investigation, however, it has been found that these supposed instances originated generally in error, misrepresentation, or the difficulty of discriminating between small-pox and other eruptions, no case having come to the knowledge of your committee, duly authenticated by respectable and competent judges, of genuine small-pox succeeding the regular vaccine disease. " The practice of vaccination becomes every day more extended ; and, when it is con- sidered that the period at which it came into general use in Ireland is to be reckoned from so late a date, your committee is of opinion that it has made as rapid a progress as could bo expected. [Signed] "JAMES CLEGHORN, " DANIEL MILLS, " HUGH FERGUSON." NO. II. Physician's Hall, Edinburgh, November 26, 1807. Gentlemen-The Royal College of Physicians of Edinburgh have but little opportunity themselves of making observations of vaccination, as that practice is entirely conducted by surgeon apothecaries and other medical practitioners out of this College, and as the etfects produced by it are so inconsiderable and slight that the aid of a physician is never required. The College know that in Edinburgh it is universally approved by the profession, and by the higher and middle ranks of the community, and that it has been much more gen- erally adopted by the lower orders of the people than even the inoculation of small-pox was, and they believe the same to obtain all over Scotland. With regard to any causes which have hitherto prevented its general adoption, they are acquainted with none, except the negligence or ignorance of parents among the com- mon people, or their mistaken ideas of the impropriety or criminality of being accessory to the production of any disease among their children, or the difficulty or impossibility, in some of our country districts, of producing vaccine matter, or a proper person to vac- cinate. 260 Reports on Vaccination by British Physicians, 1807. The evidence in favor of vaccination appeared to the Royal College of Physicians of Edinburgh so strong and decisive that in May last they spontaneously and unanimously elected Dr. Jenner an Honorary Fellow of their College-a mark of distinction which they rarely confer, and which they confine almost exclusively to foreign physicians of the first eminence. They did this with a view to publish their opinion with regard to vaccination, and in testimony of their conviction of the immense benefits which have been, and which will in future be derived to the world, from inoculation for the cow-pox, and as a mark of their sense of Dr. Jenner's very great merits and ability in introducing and promoting this invaluable practice. I have the honor to be, gentlemen, vour most obedient humble servant, TH. SPENS, C. R. M. Ed. Pr. To the Royal College of Physicians of London. NO. III. At a Special Court of Assistants of the Royal College of Surgeons, convened by order of the Master, and holden at the College on the seventeenth day of March, 1807; Mr. Governor Lucas in the chair; Mr. Long, as Chairman of the Board of Curators, re- ported: That the Board aje now ready to deliver their report on the subject of vaccina- tion. It was then moved, seconded, and resolved, that a report from the Board of Curators, on the subject of vaccinatiou, which was referred to their consideration by the Court of Assistants, on the twenty-first day of November last, be received. Mr. Long then delivered to Mr. Governor Lucas (presiding in the absence of the Mas- ter) a report from the Board of Curators. It was then moved, seconded, and resolved, that the report delivered by Mr. Long be read ; and it was read accordingly, as follows : TO THE COURT OF ASSISTANTS OF THE ROYAL COLLEGE OF SURGEONS IN LONDON: The Report of the Board of Curators, on the subject of Vaccination, referred to them by the Court, on the twenty-first day of November, 1806; made to the Court on the seventeenth of March, 1807. The Court of Assistants having received a letter from the Royal College of Physicians of London, addressed to this College, stating, that His Majesty had been graciously pleased, in compliance with an address from the Honorable House of Commons, to direct his Royal College of Physicians of London to inquire into the state of vaccination in the United Kingdom, to report their observations :ind opinion upon that practice, upon the evidence adduced in its support, and upon the causes which have hitherto retarded its general adoption; that the college -was then engaged in the investigation of the several propositions thus referred to them, and requesting the college to co-operate and com- municate with them, in order that the report thereupon might be made as complete as possible. And having, on the twenty-first day of November last, referred such letter to the con- sideration of the Board of Curators, with authority to take such steps respecting the contents thereof as they should judge proper, and report their proceedings thereon, from time to time, to the Court; the Board proceeded with all possible dispatch to the con- sideration of the subject. The Board being of the opinion that it would be proper to address circulars to mem- bers of the College, with a view of collecting evidence, they submitted to the considera- tion of the Court, holden on the fifteenth day of December last, the drafts of such letter as appeared to them best calculated to answer that end ; and the same having been ap- proved by the Court, they caused copies thereof to be sent to all the members of the College, in the United Kingdom, whose residence could be ascertained, in the following form, viz: "5ir-The Royal College of Surgeons being desirous to co-operate with the Royal Col- lege of Physicians of London, in obtaining information respecting vaccination, submit to you the following questions, to which the favor of your answer is requested. "By order of the Court of Assistants. OKEY BELFOUR, Secretary. " Lincoln's Inn Fields, December 15, 1806. " QUESTIONS. "First-How many persons have you vaccinated ? "Second-Have any of your patients had the small-pox after vaccination? In the case of every such occurrence, at what period was the vaccine matter taken from the vesicle ? How -was it preserved ? How long before it was inserted ? What was the ap- Reports on Vaccination by British Physicians, 1807. 261 pearance of the inflammation ? And what the interval between vaccination and vario- lous eruption ? "Third- Have any bad effects occurred ip your experience in consequence of vaccina- tion ? And, if so, what were they ? "Fourth-Is the practice of vaccination increasing or decreasing in your neighbor- hood; if decreasing, to what cause do you impute it? To such letters the Board have received 426 answers; and the following are the results of their investigation : The number of persons, stated in such letters to have been vaccinated, is 164,3'1. The number of cases in which small-pox had followed vaccination is fifty-six. The Board thinks it proper to remark, under this head, that in the enumeration of cases in which small-pox has succeeded vaccination, they have included none but those in which the subject was vaccinated by the surgeon reporting the facts. The bad consequences which have arisen from vaccination are, eruptions of the skin in sixty-six cases, and inflammation of the arm in twenty-four instances, of which three proved fatal. Vaccination, in the greater number of counties from which reports have been received, appears to be increasing; it may be proper, however, to remark, that, in the metropolis, it is on the decrease. The principal reasons assigned for decrease are : Imperfect vaccination; instances of small-pox after vaccination ; supposed bad consequences; publications against the prac- tice ; popular prejudices. And such report having been considered, it was moved, seconded, and resolved, that the report now read be adopted by this Court as the answer of the Court to the letter of the Royal College of Physicians, of the twenty-third of October last, on the subject of vaccination. Resolved, That a copy of these minutes and resolutions, signed by Mr. Governor Lucas (presiding at this Court in the absence of the Master), be transmitted by the Secretary to the Register of the Royal College of Physicians. [Signed] WM. LUCAS. NO. IV. Edinburgh, March 3, 1807. Sir-I mentioned in my former letter that I would take the earliest opportunity of lay- ing before the Royal College of Surgeons of Edinburgh the communication with which the Royal College of Physicians of Loudon had honored them, on the twenty-third of October last. I am now directed by the Royal College to send the following answer on that import- ant subject: The practice of vaccine inoculation, both in private and at the Vaccine Institution, established here in 1801, is increasing so rapidly that for two or three years past the small-pox has been reckoned rather a rare occurrence, even amongst the lower order of the inhabitunts of this city, unless in some particular quarters, about twelve months ago; and, among the higher ranks of the inhabitants, the disease is unknown. The members of the Royal College of Surgeons have much pleasure in reporting, That, as far as their experience goes, they have no doubt of the permanent security against the small-pox which is produced by the constiiutional affection of the cow-pox ; and that such has hitherto been their success in vaccination, as also to gain for it the confidence of the public, insomuch that they have not been required, for some years past, to inoculate any person with small-pox who had not previously undergone the in- oculation with the cow-pox. T he members of the Royal College have met with no occurrence in their practice of cow-pox inoculation which could operate in their minds to its disadvantage, and they beg leave particularly to notice that they have seen no instance of obstinate eruptions, or of new and dangerous diseases, which they could attribute to the introduction among mankind of this mild preventive of the small-pox. The Royal College of Surgeons know of no causes which have hitherto retarded the adoption of vaccine inoculation here ; on the contrary, the practice has become general within this city; and from many thousand packets of vaccine matter having been sent by the members of the Royal Col- lege, and the Vaccine Institution here, to all parts of the country, the Royal College have reason to believe that the practice has been as generally adopted throughout this part of the United Kingdom as could have been expected from proper medical assistance, and other circumstances of that nature. I have the honor to be, Sir, your obedient servant, WM. FARQUHARSON, President of the Royal College and Incorporation of Surgeons of Edinburgh. 262 Reports on Vaccination by British Physicians, 1807. NO. V. ROYAL COLLEGE OF SURGEONS IN IRELAND, ' Dublin, February 4, 1807. J Sir-I am directed to transmit to you the enclosed report of a committee of the Col- lege of Surgeons iu Ireland, to whom was referred a letter from the Royal College of Physicians iu London, relative to the present state of vaccination iu this part of the United Kingdom ; and to state, that the College of Surgeons will be highly gratified by more frequent opportunities of corresponding with the English College of Physicians on any subject which may conduce to the advancement of science and the welfare of the public. I have the honor to be, Sir, your most obedient humble servant, JAMES HENTHORN, Secretary, At a meeting of the Royal College of Surgeons in Ireland, holden at their Theatre, on Tuesday, the thirteenth day of January, 1807; Francis M'Evoy, Esq., President; Mr. Johnson reported from the committee, to whom was referred a letter from the College of Physicians, London, relative to the present state of vaccination in the United King- dom, etc. ; that they met and came to the following resolutions :] That it appears to this committee, That inoculation with vaccine infection is now very generally adopted by the surgical practitioners in this part of the Kingdom as a preven- tive for small-pox. That it appears to this committee, That from the twenty-fifth day of March, 1800, to the twenty-fifth of November, 1806, 11,504 persons have been inoculated with vaccine in- fection at the dispensary for infant poor, and 2,831 at the cow-pox institution, making a total of 14,335, exclusive of the number inoculated at hospitals and other places, where no registry is made and preserved. That it is the opinion of the committee, That the cow-pox has been found to be a mild disease, and rarely attended with danger, or any alarming symptom, and that the few' cases of small-pox which have occurred in this country, after supposed vaccination, have been satisfactorily proved to have arisen from accidental circumstances, and cannot be attributed to the want of efficacy in the genuine vaccine infection as a preventive of small-pox. That it is the opinion of this committee, that the causes which have hitherto retarded the more general adoption of vaccination in Irela nd, have, in a great measure, proceeded from the prejudices of the lower classes of the people, and the interest of some irregular practitioners. To which report the College agrees.* [Extract from the Minutes ] JAMES HENTHORN, Secretary. *In addition to the above highly satisfactory document, it may be proper to state, that the English House of Commons have just voted £20,000 additional to Dr. Jenner, as the discoverer of vaccination. Causes of Failures in Vaccination. 263 THE OCCASIONAL OCCURRENCE OF SMALL-POX AND MODI- FIED SMALL-POX (VARIOLOID), AFTER VACCINATION EX, CITED IN THE MINDS OF SOME DISTRUST AS TO THE PRO- TECTIVE POWER OF COW-POX INOCULATION, AND LEAD TO CAREFUL INVESTIGATION ON THE PART OF THE AD- VOCATES OF VACCINATION. THE YEAR 1804 FORMED AN ERA IN THE HISTORY OF VARIOLA VACCINJ3. DR. JEN- NER REFERRED THE REPUTED FAILURES OF VACCINA- TION TO SEVERAL CAUSES,AS: IGNORANCE AND CARE- LESSNESS ON THE PART OF MANY INOCULATORS, WHO FAILED TO DISCRIMINATE WITH DUE ACCURACY BE- TWEEN THE PERFECT AND IMPERFECT PUSTULE; SUCH MODIFICATION OF THE VACCINE PUSTULE DURING ITS PROGRESS AS TO DEPRIVE IT OF ITS EFFICACY; THE POWER OF THE HERPETIC AND OTHER IRRITABLE ERUP- TIONS TO RENDER THE VARIOLOUS AS WELL AS THE VACCINE INOCULATION IMPERFECT. The year 1804 formed an era in the history of variolm vaccime, for at this time the reports of failures in vaccination had began to multiply, and the fears of some of its supporters had been thereby excited to an immod- erate degree. Whilst Jenner deplored the ignorance that gave occasion to such minors, he felt no anxiety concerning his great and fundamental posi- tion. Writing to Lord Berkeley on this subject, he said : "I expect that cases of this kind will flow in upon me in no inconsiderable number; and for this plain reason-a great number, perhaps-the majority of those who inoculate are not sufficiently acquainted with the nature of the disease to enable them to discriminate with due accuracy bet ween the perfect and im- perfect pustule. This is a lesson not difficult to learn, but unless it is learned, to inoculate the cow-pox is folly and presumption." To another correspondent he said. " What I have said on this vaccine subject is true. If properly conducted, it secures the con- stitution as much as variolous inoculation possibly can. It is the small-pox in a purer form than that which has been current among us for twelve centuries past." Mr. Goldson, of Portsea, actuated by prejudice, joined Dr. Moseley in his conjectural arguments against vaccination. In 1804 the assertion was made that the cow-pox afforded only a temporary security. Had it been correct, it would have deprived the discovery of Dr. Jenner of nearly all its value. This assertion was very easily made, and in the infancy of the practice, could not be well disproved. To these circumstances it was owing that the crude and unsupported statements of Mr. Goldson acquired any influence. Dr. Jenner himself, from the commencement, perceived that in his cases of failure, cow pox had never properly taken place. The real merits of the question were also detected by Mr. Dunning, one of the first British surgeons who stood forward to recommend vaccina- tion, soon after the practice was promulgated, and to the day of his death upheld the accuracy and justness of Jenner's views. His little tract, pub- lished about this time, under the title of "A Short Detail of Some Circum- stances Connected with Vaccine Inoculation," etc., contains some of the soundest opinions with regard to the nature of variolas and variolce vac- 264 Causes of Failures in Vaccination. cinte that have ever appeared. It was by studying small-pox that be be- came thoroughly acquainted both with the benefits conferred by vaccination 'and those principles that ought to direct the practice. Some of the points which are even at the present time matters of dis- cussion, were fully explained at this early period of vaccination. It was then clearly ascertained, that there were deviations from the usual course of small-pox, which was quite as common, and infinitely more disastrous, than those which took place in vaccination. These deviations regarded two apparently different states of the constitution. In the one, the sus- ceptibility of small-pox was not taken away by previous infection; while on the other hand, some constitutions seem to be unsusceptible of small- pox infection altogether. It was found, that similar occurrences took place in the practice of vaccination ; but as the security which the latter afforded was more likely to be interfered with by slight cases than the former, it became absolutely necessary that good care should be shown in watching the progress and character of the pustule. Dr. Jenner had from the beginning felt the propriety of this watchful- ness; and had distinctly announced that it was possible to propagate an affection by inoculation conveying different degrees of security, ac- cording as that affection approached to, or receded from, the full and per- fect standard. Ue also clearly stated, that the course of the vaccine pus- tules might be so modified as to deprive it of its efficacy ; that inoculation from such a source might communicate an inefficient protection, and that all who were thus vaccinated were more or less liable to sub- sequent small-pox. His directions for obviating occurrences of this kind regarded, first, the character of the pustule itself, the time and quality of the lymph taken for inoculation,, and all other circumstances that might go to affect the completed progress of the disorder. He attached great importance to this last point; and in the course of 1801 published his tract " On the Varieties and Modifications of the Vaccine Pustule, Occa- sioned by an Herpetic State of the Skin." The following sentence in the introduction is worthy of note: " I shall here just observe, that the most ample testimonies now lie before me, sup- porting my opinion that the herpetic, and some other irritive eruptions, are capable of rendering variolous inoculation imperfect, as well as the vaccine." Besides the instructions which Dr. Jenner himself had published, for the purpose of securing perfection in the vaccine process, Mr. Dunning has themeritof establishing a canon, namely, that one pustule at least should remain undisturbed. Dr. Jenner candidly admitted the propriety of this rule of Mr. Dunning. In a letter to Dr. Willan, dated February 23, 1806, Dr. Jenner says : "It strikes me that the constitution loses its susceptibility of small-pox contagion, and the capability of producing the disease in its ordinary state, in proportion to the degree of perfection which the vaccine vesicle has put on in its progress; and that the small- pox, if taken subsequently, is modified accordingly; this opinion was first published by Mr.Dunning of Plymouth." In a letter to his friend Mr. Dunning, dated Berkeley, December 23, 1804, Dr. Jenner thus alludes to the work of Goldson: "You speak of King, and Goldson. Recollect then was the time to be cool. What came of vaccination-what man well acquainted with its nature, or that of the small-pox, could read Goldson's book, and lay it down cooly? Ring, the moment he read it, and that, indeed, which was infinitely worse than the book itself, the murderous harbinger- the advertisement, instantly charged his blunderbuss, and fired in the face of the author. I must freely confess, I do not feel so cooly about Mr. Goldson as you do. His book has sent many a. victim to a premature grave; and would have sent many more, but for the humanity and zeal of yourself and others who stepped forward to counteract its dread- Causes of Failures in Vaccination. 265 fill tendancy. Had Goldson but written to me, stating those occurances in his prac- tice which appeared extraordinary, I should with the greatest pleasure have told him where the mistake lay ; and made him a good vaccinest. * * * "But to return. There may be peculiarities of constitution favorable to this phe- nomenon. My opinion still is, that the grand interference is from the agency of this herpes, in some form or other; for I have discovered that it is a very Proteus, assuming as it thinks fit, the character of the greater part of the irritative eruptions that assail us. I shall have much to say on this disease one of these days." "The security given to the constitution by vaccine inoculation, is exactly equal to that given by the variolous. As failures in the latter are constantly presenting themselves, nearly from its commencement to the present, time, we must expect to find them in the former also. In my opinion, in either case, they occur from the same causes: one might name for example, among others, some peculiarities of constitution which prevent the virus from acting properly, even when properly applied ; from inattention or want of due knowledge in not being able to discriminate between the correct and incorrect pustule." * * * "Wonderful as it is, yet there are abundant facts to prove, that the insertion of variolous matter into the skin has produced a virus tit for the purpose of continuing the inoculation ; and yet the person who has borne it, and on whose skin it was generated, has subsequently been infected with the small-pox, on exposure to its influence. Just so with the vaccine." " Vaccine inoculation has certainly unveiled many of the mysterious facts attendant upon the small-pox and its inoculation. How often have we seen (apparently) the full effects of the arm from the insertion of variolous matter, indisposition and even erup- tions following it, and its termination in an extensive and deep cicatrix; and yet, on exposure, the person who underwent this, has caught the small-pox." In one ot his journals, Dr. Jenner has left the following notes upon the same subject: "The origin of the small-pox is the same as that of the cow-pox; and as the latter was probably coeval with the brute creation, the former was only a variety springing from it." "There are certainly more forms than one (without considering the common variation between the confluent and distinct) in which the small-pox appears in what is called the natural way." "It will be inquired (if the foregoing reasoning bea priori correct)'iu which way can the action of cow pox (or the equine pock) in preventing subsequently small-pox be re- concilable with the established laws of the animal economy ? My reply is, for the rea- sons which I have stated on the basis of facts, that they were not bona fide dissimilar in their nature; but, on the contrary, identical. On this ground I gave my first book of 'An Inquiry into the Causes and Effects of the Variola Vaccinal-a circumstance which has since been regarded by many as the happy foresight of a connection which was de- stined by further evidence to become more warranted."-The Life of Edward Jenner, M. 1)., LL. IL, F. II. 8., Etc., by John Baron, M. D., F, II. S., vol. 2rpp. 12-31. 266 Epidemic Small-Pox of 1818. THE EPIDEMIC SMALL-POX OF 1818-THE PREVALENCE OF SMALL-POX IN GREAT BRITAIN AND ON THE CONTINENT DEVELOPED INCREASED HOSTILITY TO THE PRACTICE OF VACCINATION-DR. JENNER BELIEVED IMPERFECT VACCINATION, OR SOME CAUSE WHICH INTERFERED WITH THE REGULAR AND COMPLETE PROGRESS OF THAT INFECTION TO BE THE MAIN SOURCE OF SUCH EVILS- SOM^ OF THE DIFFICULTIES WHICH PERPLEXED THE SUBJECT IN EDINBURGH; ALSO, FROM A DEGREE OF UNCERTAINTY THAT PREVAILED REGARDING THE CHAR- ACTER OF THE EPIDEMIC AT ITS FIRST APPEARANCE, DR. HENNEN AND OTHERS WERE INCLINED TO THINK THAT THE DISEASE WAS VARICELLA OR CHICKEN POX OF A MALIGNANT CHARACTER-ABANDONMENT OF THIS VIEW-INVESTIGATIONS OF DR. ALEXANDER MONRO, OF EDINBURGH, OF THE VARIETIES OF SMALL POX AND THE EFFICACY OF COWPOX INOCULATION-HIS EXPLANA- TION OF THE CAUSES OF THE PREVALENCE OF SMALL- POX IN 1817 AND 1818. Ill the course of the year 1818 a violent epidemic of small-pox prevailed in many parts of Great Britain, as well as on the continent; an increased hostility was evinced to the practice of vaccination ; and doubts of its effi- cacy, which had been artfully excited, soon propagated to other parts of the world. The small-pox was unusually fatal and malignant in Edinburgh and several other places in Scotland; it killed a very large proportion of those whom it attacked in the natural way; and it likewise spread to many who had previously had small-pox, as well as cow-pox. Dr. Jenner believed improper vaccination, or some cause which interfered with the regular and complete progress of that affection, to be the main source of such evils. lie admitted that small-pox might succeed perfect vaccination, just as small-pox does succeed small-pox; but the great num- ber of failures which were reported to have occurred, he thought, could only be accounted for by supposing that some circumstances interrupted the proper influence of vaccination in the system. One of them he con- ceived to be the existence of cutaneous disease. There can be no doubt of the truth of Jenner's main proposition, pub- lished in his circular letter, namely, that when vaccine failures were very frequent, there must have been some imperfections either in the virus or in the progress of the affection. This fact is rendered manifest by the differ- ent degrees of success which have attended the practice of different indi- viduals. After patient inquiry, Dr. John Baron, the learned and accom- plished author of the life of Dr. Jenner, did not know of more than six or eight cases of small-pox after cow-pox among all Dr. Jenner's patients. This proportion is probably no more than might have occurred had he in' oculated for the small-pox instead of the cow-pox. Some of the difficulties which perplexed the subject in Edinburgh, arose from a degree of uncertainty that prevailed regarding the character of the epidemic at its first appearance, Dr. Ilennen was inclined to think that Epidemic Small-Pox of 1818. 267 the disease was varicella or chicken-pox, of a malignant character. He was obliged, however, to abandon this notion. Dr. Thompson went further than Dr. Hennen; and in a very elaborate work endeavored to prove that the varicella, instead of being a distinct and peculiar disease, as had been generally supposed, was only a variety or modification of small-pox. Dr. Hennen in his paper on eruptive diseases, thus expressed his belief in the efficacy of vaccination : " So perfectly convinced ami of the pre- venting and modifying powers of the vaccine inoculation, that I should never hesitate about employing it, even though it were probable that my patient had imbibed the small-pox infection. N or should I be deterred from the practice by the idle supposition of the nurse that I was too late, or the learned objection of the doctor that the two diseases could not co- exist; experience very clearly demonstrating, that there is still something in the mutual relations of these diseases to each other that has not yet been satisfac- torily elucidated. " After the most mature deliberation, I most explicitly avow, that noth- ing has occurred in these cases which has in the smallest degree shaken my opinion of the great and pre-eminent importance of the practice of vaccination; whether we view it as a preventive of small-pox in a vast majority of. cases, or as a most effectual neutralizer of its malignity in the -comparatively few instances in which from some peculiarity of constitu- tion, or some anomaly in the process hitherto but fully developed, it has failed to afford this permanent security." There can be no doubt that during the first years of vaccine inoculation there had been great carelessness and inattention in conducting the practice. And in 1818, there were numerous complaints of the bad quality of the vaccine lymph. Dr. Jenner received hints of this kind from Italy, from America, and many parts of England. The greatly exaggerated statements on this subject of the vaccine fail- ures, and the hesitating manner in which many respectable physicians spoke on the subject, threatened to lead to a considerable abandonment of this practice. Under these circumstances Sir Gilbert Blane rendered distinguished services to the cause of vaccination, by proving by the most conclusive reasoning, and an appeal to the most authentic documents, that the importance of the vaccine discovery was not in the most essential points low- ered by the failures which were alleged to have taken place. In order to bring this matter to the test of calculation Sir Gilbert Blane, selected from periods, each of fifteen years, for the purpose of exhibiting the com- parative mortality of small-pox. The last series comprehended the time in which the vaccine inoculation had been so tar diffused as to produce a notable effect in the deaths from this disease. The result of the whole was, that even under the very imperfect practice of vaccinnation which had taken place in London, 23,134 lives had been saved in the fifteen years alluded to, that is from 1804 to 1818 inclusive. INVESTIGATIONS OF DR. ALEXANDER MONRO ON SMALL- POX AND VACCINATION. Dr. Alexander Monro, Professor of Anatomy and Surgery in the Uni- versity of Edinburg, in his " observations on the different kinds of small- pox, and especially on that which sometimes follows vaccination," pub- lished in 1818, states in the introduction, p. 24, with reference to the disease in Scotland: 268 Dr. Alexander Monro on Small-Pox and Vaccination. " All the cases of small-pox which have lately occurred have been imputed to the in- efficiency of the cow-pox; whereas I have ascertained upon grounds perfectly satisfac- tory to myself, that a few only have originated from that cause, as in a great majority of the instances of small-pox now to be observed among the lower orders of society, vac- cination had never been performed, and in others it had been imperfect. " It ought not to be forgotten, that in the first instance at least, Dr. Jenner's discovery appeared, in one important respect, to be rather incomplete; it did not furnish the inex- perienced eye, a certain means of distinguishing whether the disease be genuine or not, and also whether the constitution of the patient had been actually subjected to the in- fluence of the cow-pox-a great desideratum. That desideratum was still required, I mean a test for distinguishing whether or not the in fluence of the cow-pox has been constitutional or only local. This was supplied by the ingenuity of Mr. Bryce, who discovered, that by re-inoculating on the fifth day on the other arm, the pimples on both arms follow exactly the same course, and arrive at maturity at the same time if the disorder has been consti- tutional ; and this is what I understand by perfect vaccination. " But though it cannot be denied that vaccination has failed to give perfect security against the small-pox, yet in the cases where it has failed to do so it has modified and mitigated that loathsome and dangerous disorder in a most remarkable manner, so that the small-pox after cow-pox can scarcely be said to form one of the class of mortal dis- eases. P. 24 25. Dr. Alexander Monro communicates the following as the chief causes which had led to the failure of the vaccine inoculation. "1. The matter for inoculation has sometimes been taken from a spurious sore, which, though it occasioned a vesicle, and excited inflammation in the inoculated patient, did not communicate the genuine disease, or it has been taken from the true sore at too late a stage of its progress : and hence, though it occasioned accute inflammation, it did not communicate the true cow-pox. "2. If the lancet on which the matter of small-pox is present shall become rusty, the rust of the steel decomposes the poison. "3. If the vaccine vesicle has been repeatedly punctured or drained for two or three successive days, the inoculation generally fails; for the poison which, in the progress of the disease, is depositing in the cells of the vesicle, is thus exhausted, or may be so much diluted as to be incapable of producing the disease. "4. The matter taken from the genuine cow-pox vesicle may be injured by heat, ex- posure to the air, or moisture. "5. If the matter be taken from the cow-pox vesicle after the thirteenth day, it ' does not,'according to Willan, 'produce the genuine cellular vesicle, but is in some cases wholly inefficient, while in others it suddenly excites a pustule or ulceration ; in others a regular vesicle, and in others erysipelas.' •'6. If the crusts employed for cow-pox inoculation be kept in a high temperature, or in a damp place, they soon acquire, as Mr. Bryce has well observed, a peculiar smell, which marks their loss of power to reproduce the cow-pox. "7. The inoculation for cow-pox does not take effect when the child labors under other cutaneous disorders, as measles, scarlatina, itch, herpes, tenia capitis, or cruita lacta." "Imperfect vaccination," says Dr. Willan, " is not characterized by any uniform sign or criterion, but exhibits in different cases very different appearances, as pustules, ulcer- ations, or vesicles of an irregular form. The vaccine pustule is conoidal; it increases rapidly from the second to the fifth or sixth day, being raised on a hard, inflamed base, with diffuse redness, extending beyond it on the skin. It is usually broken before the end of the sixth day, and is soon after succeeded by an irregular yellowish-brown scab. The redness disappears within a day or two, and the tumor gradually subsides." According to Dr. Jenner, " the commencement is marked by a troublesome itching, and it throws out a premature efflorescence, sometimes extensive, but seldom circumscribed, or of so vivid a tint as that which surrounds the pustule (vesicle) completely organized, and (which is now characteristic of Its degeneracy than the other symptoms) it appears more like a common festering produced by a thorn, or any other small extraneous body sticking in the skin, than a pustule (visicle) excited by any vaccine virus. It is gener- ally of a straw color, oud when punctured, instead of the colorless transparent fluid of the perfect vesicle, its contents are found to be opaque." According to Dr. Alexander Monro, "when the vesicles are irregular or imperfect, there is commonly premature itching, w hich is so great as to promote scratching, in- flammation and the formation of matter. " The progress of the vesicle is too rapid, its texture is soft, and it is apt to be broken ; the border is not well defined, the middle is raised, and the contents discolored or puru- lent, and it is encircled by a premature efflorescence of a dirty purple hue, and the scab is of an ambre color. " It has been mentioned by Messrs. Dawson and Kate (Transactions of College of Phy- sicians, vol. 3) that the part into which the variolous poisou has been Inserted, inflames, Dr. Alexander Monro on Small-Pox and Vaccination. 269 and a pustule is produced, which is filled by an active variolous poison, capable of excit- ing the disease in others, without the person himself being constitutionally affected by small-pox, or being by this pustule on his body rendered unsusceptible of variolous conta- gion at a future period of his life. The same has been observed by several others, and this may undoubtedly happen in cow-pox as well as in the small-pox inoculation, and thus form a fruitful souice of disappointment in conducting vaccination. " All of these difficulties have been removed by the ingenuity of Mr. Bryce, who has supplied us with a certain test for determining these important points, which consist in reinoculating the child on the other arm on the fifth day after the first inoculation. If the constitution has been affected, the vesicles on both arms arrive equally soon at matu- rity, and also fade together. The arguments advanced in favor of Mr. Bryce's test are founded on the most vigorous investigation, and in my mind amount to a complete dem- onstration of its importance, and have been confirmed both by the testimony of experi- ence and of public opinion. My father, in his lectures, used always to express his utmost con^dence m Mr. Bryce's test as a mark that the constitution has been affected, and also his opinion that its ingenious author merited a public reward, he considered Dr. Jen- ner's discovery to be incomplete."-Observations on the Different Kinds of Small-pox, and especially on that which sometimes follows vaccination ; illustrated by a number of cases. By Alexander Monro, M. D., F. R. S. E., Professor of Anatomy and Surgery in the University of Edinburgh, Fellow of the Royal College of Physicians, Etc., Edin- burgh, 1818; pp. 108-113. The following account of the Test of Mr. Bryce,/or Successful Vaccin- ation, is given in the author's own words, and it is worthy of consideration, not merely on theoretical grounds in connection with the history of cow- pox inoculation, but more especially at the present time, when vaccination is too often performed in a careless manner, or when hostility to the meas- ure appears to have received a new impetus. MR. BRYCE'S TEST. " I am thoroughly convinced that some clear and well defined mark of a constitutional affection in cow-pox, different from what has hitherto been observed by those who have written on the subject, is still to be regarded as the grand desideratum in conducting this new inoculation; for, until this be established, our judgment of the efficacy of the cow-pox inoculation in preventing small-pox, must often be formed with doubt and anx- iety, and too frequently prove ultimately erroneous. The truth of these remarks will be best known to those mostly conversant with the cow-pox inoculation, and who are accustomed to observe the great variety of appearances which the affection at the part inoculated often assumes. " For some time after the introduction of the cow-pox inoculation into medical prac- tice, many cases were related in which an eruption of pustules, more or less numerous, was said to take place, similar to what happens in small-pox. While these reports were propagated, and certified by men who seemed worthy of credit, even although no in- stance of the period had come under my own observation, I entertained hopes of so con- ducting the new inoculation in every case as to obtain a certain and well-defined mark of a constitutional affection ; for, if an eruption of pustules belonged to cow-pox in any case, as a consequence of the peculiar fever or constitutional ailment thereby induced, I thought that one or two pustules might be made to appear in every case. It is well known that by irritating any part of the skin, by the application of heat, or a stimulat- ing plaster, or various other substances, we can produce a greater number of pustules of small-pox upon that particular part than would otherwise have appeared ; and judging from analogy, I expected that the same theory m ght have been affected on cow-pox. Such trials I have made ; and although they were conducted with as much anxiety and care to produce pustules as other persons seem to have taken to avoid producing them, yet they have constantly failed ; nay, these trials have now been made under such a va- riety of circumstances without effect as to confirm me in the opinion, that an eruption of pustules, as a consequence of a constitutional affection, doesnot belong to the cow-pox. " Foiled in my attempts so to conduct the inoculation of cow-pox as to produce pus- tules, I recollected some experiments which had been made with regard to the inocu- lation of small-pox. It was found that if the same person was inoculated every day until the fever induced by the first inoculation supervened, all the other punctures quickly advanced in their progress; and that, in the course of a day from the time the fever or general affection began, even that puncture which had been last made, perhaps only twenty-four hours beiore, and from which the fever had arisen. " In this case, it appears to me evident, and I think must be admitted by every per- son, that even had no other pustules appeared on the body than those occasioned by the 270 J)r. Alexander Monro on Small-Pox and Vaccination. repeated inoculations,.nay, had there even been no fever observed in consequence of the inoculation, yet as the pustule occasioned by the last puncture, had been suddenly ac- celerated in its progress to maturation, at the time the general or constitutional affectien should have appeared, this alone was a sufficient proof of the presence of the variolous action in the system. "Judging again from analogy, I expected that the same thing, which thus happened in the small-pox inoculation, might also take place in that for the cow-pox ; and the unexpected appearance of one or two vesicles upon children that I had inoculated, which vesicles were quite characteristic of the ailments, and the appearance of which 1 could only account for from a second and accidental inoculation during the course of the disease, strengthened my hopes. And certainly, if we tind in cow-pox, when the in- ilamed and hard areola does not take place, at least in the regular eourse of that affec- tion, until the end of the seventh or beginning of the eighth day from inoculation, per- formed for example at the end of the fifth or beginning of the sixth day, is so much ac- celerated in its progress, about the time the general affection of the system usually takes place, as to have an areola formed within a few hours, or very shortly after the first, and that this areola increases with the first,and again fades at nearly the same time, we must be struck with the similarity, and be forcibly led to draw the same conclusion in tins case as in the former, respecting the small-pox, viz : that although the inoculated affection had appealed very slight, and no fever had been observed, yet that a certain action had been excited in the constitution. That this was the true constitutional affection of cow- pox, may be judged by the acceleration of the second vesicle to a state of maturity, five days before this could have happened, had there been no consentaneous general action or change in the system. "The truth of this opinion was also soon put to the test of experience; and I have now much satisfaction in declaring that the result appears to answer my most sanguine expectations. "In short, my observations on this point lead me to conclude, that, in order to obtain the proposed criterion in the greatest perfection, the second inoculation should be per- formed between thirty-six and forty-eight hours before the areola of the fiist inoculation begins to appear. This is necessary, in order that the secondary affection may have pro- ceeded some length, and that a small vesicle containing virus may have been formed by it, before the constitutional action from the first inoculation begins, otherwise no areola but merely a slight degree of hardness will take place from the second puncture. "As, on the one hand, the acceleration of the second inoculation in the manner above mentioned is to be regarded as a certain mark of a constitutional affection in cow-pox, so, on the other, if it shall be found that no such acceleration takes place, but that the second inoculation proceeds by a slow progress through all the stages, and has the dura- tion of a primary affection, it is to be concluded that no constitutional action has taken place from the first insertion of the virus, and when this is the case, the second inocula- tion must be regarded as a primary affection, and a third puncture be made according to the plan laid down for conducting the second inoculation ; and thus we may go on until the proper tests be obtained, or until we be satisfied that the constitution completely resists the action of cow-pox." The directors of the cow-pox institution of Dublin, in their annual report for 1817, professed themselves utterly incredulous of danger from the small- pox, after vaccination, conducted with due attention, to Testing Accord- ing to Mr. Bryce's Plan (when practicable,) to the formation of the areola, and of the scabbing process from the twelfth to the thirteenth or fourteenth day on an average : they had reason to believe that many prac- titioners were not sufficiently attentive to the formation of the areola and scab. The test of Mr. Bryce had met with the approbation of Dr. Jenner as early as the year 1803. Thus in a letter to Mr. Bryce, dated April 5, 1803, Dr. Jenner says: . " I must admire your precaution in using a test of the certainty of infection ; and your ingenuity in the manner in which you employ it. Ou all young vaccinators it cannot be too strongly enjoined. The experienced will determine from the character of the pustule. The evidence before the House of Commons evinces the propriety of your observations. •T put your crust into the hands of my friend Ring, and he informed me yesterday that it had produced a good pustule. Experience now tells us this is a good mode of sending the vaccine virus to distant parts." Opinion of the Medical Profession in 1818. 271 OPINION OF THE MEDICAL PROFESSION IN 1818, AS TO THE PROTECTIVE POWER OF VACCINATION AGAINST THE SMALL-POX. The public and professional mind was much agitated by the appearance of an eruptive disease resembling small-pox, and apparently produced by small-pox infection, in many persons who had been formerly vaccinated, during the years 1817 and 1818, and the following questions were seriously propounded in less than a' quarter of a century after the promulgation of the Inquiry of Edward Jenner on the variolte vaccine: 1. In what proportion do failures occur in vaccination ? How many cases ot small-pox or varioloid occur in any given number of vaccinated persons exposed to the variolous poison ? 2. To what is it owing that vaccination proves a preventive against small- pox in some cases, and fails in others? Is it owing to the constitution of the individual? Is it owing to the vaccine virus with which they are in- oculated ? Is it owing to the manner of vaccination ? Is it owing to the progress and treatment of the cow-pox ? 3. Has the vaccine virus frequently deteriorated, from the employment of lymph in succession, from vesicles which had not gone through the stages with perfect regularity? Has the imperfect vaccine vesicle thus pro- duced the power of rendering the human frame susceptible of none but the mitigated form of small-pox? Is it true, that by improper^treatment, by accident, or by puncturing the vaccine vesicle too freely, enough of the virus to affect and secure the constitution will not be left to be absorbed? 4. How does the degree of protection differ? Is it absolute in any case "I Are there cases in which it is capable of resisting the most powerful ap- plication of the variolous virus, while others are susceptible of its slight- est application ? or, do the degrees of protection pass insensibly into each other, from the highest to the lowest? 5. Does the protection originally given gradually wear out as to suscep tibility of infection ? 6. Does the protection originally given, gradually wear out as to the power of modifying subsequent small-pox, or does it originally differ in de- gree? 7.* In what respect do the powers of vaccination, in modifying subse quent small-pox, differ from those of natural and of modified small-pox? The belief of the careful observers in the Medical Profession, in 1818, in reference to the preceding queries may be thus formulated. (^.^Vaccination seems to afford permanent protection against small- pox infection in a large proportion of cases. (&). In some instances'it only affords imperfect protection,- or there are instances in which from variolous infection a modified small-pox is pro- duced. (c). In somejnstances it seems to afford only temporary protection; or there'are persons, who, after having repeatedly been exposed to variolous infection, are at last inflicted by it, and pass through the disease in a mollified form. 272 Opinion of the Medical Profession in 1818. (d). In the small-pox modified by previous vaccination, the eruptive fever is often severe, the eruption sometimes numerous and general, in some cases even confluent, but the pustules are smaller, and dry up on the sixth and seventh days, without secondary fever. (e). This modified small-pox is capable of infecting others, both by inoc- ulation and naturally. It produces modified small-pox in persons previ- ously imperfectly protected by vaccination, and regular small-pox in those who have neither been vaccinated nor had the small-pox. (/). In some instances, persons who have previously had the small pox, whether from inoculation or infection, have had a second attack of small- pox, similarly modified, from exposure to variolous infection or from vario- lous inoculation. The constitutional disorder thus excited is generally more slight than a first attack of small-pox; but there have been recorded more instances of persons suffering severely, nay fatally, from what was considered to be a second attack of small-pox, after what has been considered perfect vacci- nation. (g). There is no evidence to conclude that the virus of cow-pox is dete- riorated by passing through, or being regenerated on a variety of human constitutions, provided it be taken from a regular vesicle at the period when most active. (/t). There is no evidence to conclude that the protecting influence im- parted to the human constitution by perfect vaccination, diminishes by tim e, and ultimately leaves the constitution as susceptible of small-pox as before vaccination was performed. In some very rare instances, in which persons are said to have died from the attack of small-pox after cow-pox, this occurrence may be fairly attributed to some error in conducting the previous vaccination : (i). The same general rule ought'to be applied to the small-pox and to the cow-pox, with regard to their powers of protecting the constitution of those who have undergone their influence, against a future attack of small- po'. (j). The advantages arising to society from propagating the cow-pox in place of the small-pox, are so many, and so conspicuous, as to admit of no hesitation in concluding that the former ought on every occasion to be en- couraged, and the latter repressed, with the most effective measures and active exertions. DR, THOMSON'S THEORY OF THE IDENTITY OF CHICKEN- POX, AND MODIFIED SMALL-POX. In 1809 Mr. Brown of Musselburgh, published the opinion that the pro phylactic virtue of the cow-pox diminished as the time from vaccination increased ; and this view was strengthened, by the occurrence of many cases of a mild form of variola, in vaccinated persons, duringthe epidemic of small- pox of 1818 and 1819; and at this time the term'modified small-pox was adopted. In addition to the work of Dr. Monro (published in 1818), on "the different kinds of small-pox, and especially on that which sometimes follows vaccination," an analysis of which has been presented, Dr. John Thomson, of Edinburgh, published "some observations on the varioloid disease which has lately prevailed in Edinburgh, and on the identity of chicken-pox and modified small pox," in a letter addressed to Dr. Duncan, Jr. dated fifteenth Er. Thomson''s Theory of Chicken-Pox and Modi fed Small-Pox. 273 September, 1818, (Edinburgh Medical, Surgical Journal No. L., 6). Dr Thomson reproduced this paper in his "Account of the Variolous Epidemic which has lately prevailed in Edinburgh and other parts of Scotland? etc., published in 1820. The following is a brief statement of the conclusions of Dr. John Thom- son of Edinburgh as detailed at length in the proceeding publication : 1st. The varieties which appeared in the epidemic of 1818 convinced Dr. Thomson, that the descriptions which had been given of the appearance and progress of the eruption in small-pox by the best systematic authors are in many respects imperfect; that the diagnostic marks which have been pointed out between small-pox and the disease that has been termed chick- pox, are not to be relied upon; and that no appreciable marks of distinc- tion between modified small pox and chicken-pox have hitherto been es- tablished. 2. It appears from the records of medicine, that the same person may have small-pox twice or oftener during life. 3. It has been incontrovertibly established by Dr. Jenner and his follow- ers, that cow pox has the property of rendering those who have passed through it much less susceptible of small-pox infection than they were be- fore; and besides this, that it possesses also the invaluable property of modifying the small-pox in those who receive them, and of converting them, from the most fatal of all diseases, to one scarcely, if at all, fatal. 4. By admitting that small-pox possesses this modifying property, it fol- lows, that, in the instances in which they exerted this influence, previously to the discovery of cow-pock, they must have produced a mild or less fatal species of small-pox, but a species which has not been recognized or pointed out as differing from natural small-pox. It seems, therefore, probable, that this secondary small-pox, must have formed a considerable portion of the varioloid eruptions that were formerly denominated the spurious small-pox, and afterwards by some the chicken-pox. 5. After Dr. Heberden had distinguished chicken-pox from small-pox, and had convinced himself and the medical world, that these diseases arose from two contagious poisons, specifically distinct from each other, it seems probable that the cases of modified secondary small-pox which may have occurred, must have been described as cases of chicken-pox, since we nowhere find any hint of the possible co-existence of these two diseases, or the danger in which medical practitioners are of confounding them to- gether. " Can it be that the hypothesis of the contagion of chicken-pox being specifically different from that of small-pox, has been had recourse to, in order to explain those cases of secondary small-pox which may have occurred after variolous inoculation, and in the benevolent wish of vindi- cating that practice from the suspicion of being inefficacious!" Dr. Thomson regarded the epidemical disease in Edinburgh as the same with those varioloid diseases which, since the introduction of cow-pox in- oculation, had been observed in England, Scotland and other countries, and which have been by some medical practitioners regarded as small-pox, and by others as chicken-pox. Appendix, pp. 1-11. ESTABLISHMENT OF REVAGINATION. Small pox was epidemic in France in 1826 and 1827, and in the northern part of Italy in 1827; and in consequence of the numbers of those vaccin- ated who had been attacked by small-pox more or less modified or unmod- 274 Establishment of lie- Vaccination. ified, the practice of Revaccination commenced in Prussia, and the Ger man States, and was subsequently encouraged by their governments. In 1832-4 small-pox prevailed epidemically in Ceylon, when a considera ble number of those vaccinated (lied; and it made great devastations in Hindoostan on several occasions, both prior and subsequently to this date, and many of those vaccinated were carried off with it. Dr. Gregory states that the admissions into the Small-pox Hospital in 1838, more than doubled the average number received annually, prior to the discovery of vaccina- tion, and that two-fifths of the admissions consisted of persons who had been vaccinated. Many of'them had the disease severely and more than twenty of the number died. Some of the earliest, and at the same time most conclusive testimony in favor of Revaccination, was furnished by its results in the Wurtemberg, Hanoverian, Bavarian, and especially in the Prussian armies. Revaccination was first commenced systematically in the Prussian armies in the year 1833, after having been practiced in the Wurtemberg army and among smaller bodies of men for several years previously, and recommended by several leading practitioners, and has been continued in that and several other armies, and also among large bodies of citizens. The following have been recorded as the results of revaccination : In Wurtemberg but one case of variohe occurred in five years among 14,384 revaccinated soldiers, and three only among 26,864 revaccinated civilians. Not a single case of small-pox occurred among those who had been re- vaccinated in the Prussian army in 1836, 1837, or 1839. But three deaths by this disease occurred in all the military hospitals of Prussia in 1841, and of these, one was in a person not vaccinated on enter- ing the army, because it had been done shortly before; a second in a recruit who had not been revaccinated; and the third in an officer who had been revaccinated some years before, but without success. In 1834 two deaths are recorded of those who had been revaccinated with effect in the Prussian army, and one in 1843. In 1849 but one case was fatal, and this was in a recruit vaccinated when a child, and who had not yet been revaccinated. During an epidemic of small-pox in Copenhagen, in 1828 to 1833, and another in 1835, but a single case of variolous or varioloid disease was ob- served'among any who had been revaccinated. In the Danish army, of those who were successfully revaccinated in 1838, not one was attacked with small-pox. In an epidemic of variola at Heidelburgh, in 1843 and 1844, described by Dr. Hoefle, of all those attacked not a single one had been previously revaccinated, while the vaccinations most successfully made did not pro- tect from the most severe varioloid those older than ten years. Steinbrenner, as the result of extensive investigation of the subject says, "Revaccination is the indispensable complement of the first vaccina- tion. not that it is always necessary, as some pretend who admit the loss of its protective power by time, but because it is necessary in very many cases, and because there is no other means of distinguishing such urgent cases from those in which revaccination is unnecessary." (Traits sur la Vaccine, p. 684.) Steinbrenner derives his arguments in favor of revaccination from its effects in the different European armies, as well as when performed by va- rious individuals on a small scale, of which he presents a long array; and says that in the absence of every other argument, those results are strongly Professional Views Held in 1839. 275 in its favor, because it is impossible that the process should be so often successful unless the success depended upon a predisposition which ex- posed the individuals to variola. IM. Bosquet says, after giving a long list of instances of protection by revaccination without a failure, even in the midst of epidemics, "There has not been an epidemic which has not proved at the same time the virtues both of vaccination and revaccination. The success of revaccination is at the same time the effect and the proof of the wants of the system. When it succeeds, it not only proves that the protective power of vaccination is diminished, but it supplies a remedy for this diminution." (Nouveau Traite A la Vaccine, Paris, 1848, p. 506.) The following are the conclusions on this subject of the Committee on Vaccination, of the French Academy, as contained in their report to this body in February, 1845: 1. Small-pox rarely attacks those who have been vaccinated before the age of ten or twelve, from which age, until thirty or thirty-five, they are particularly liable to small-pox. 2. Re-vaccination is the only known method of distinguishing those vac- cinated persons that remain protected from those that do not. 3. The success of re-vaccination is not a certain proof that the person in whom it succeeds was liable to contract small-pox; it merely establishes a tolerably strong presumption, that he was more or less liable to take it. 4. In ordinary periods, re vaccination should be practiced after fourteen years, but sooner during an epidemic. The following are among the conclusions of a report on the subject of vaccination made by a committee to the Belgian Academy of Medicine. As the immunity conferred by vaccination is not indefinitely absolute, re- vaccination, at least for a great number of individuals is rationally vindi- cated. Experience has proved that a recent re-vaccination preserves from va- riola and varioloid, and that practiced on a sufficient scale, conjointly with vaccination, it constitutes a sure means of arresting the progress of this malady when it appears epidemically. It succeeds but in proportion as it is most required, that is, the more re- mote the period since the individual had variola, or has been vaccinated. During the prevalence of an epidemic of variola or varioloid, it is pru- dent to re vaccinate all those whose first vaccination dates ten years back, and all those whose first vaccination gives rise to any doubts. (Brit & For, Md. Chir. Rev., January, 1851.) PROFESSIONAL VIEWS HELD IN 1839, AS TO CORRECT VAC- CINATION AND IMPEDIMENTS THERETO. Ill the able "Report of the section appointed to inquire into the present state of vaccination," read at the Anniversary Meeting of the Provincial Medical and Surgical Association, held at Liverpool, July 25, 1839; the Reporter observes on the discrepancy that obtains in the statements and ideas of medical men upon the protective influence of vaccination : 1. The only perfect test is the insertion of variolous lymph. This, how- ever, is obviously objectionable. 2. The regular progress of the vaccine vesicle. To determine this, the surgeon should note it at proper periods. The genuine disease can only be produced by pure lymph from a regular source. The time for taking this lymph, according to Dr. Jenner, is between the fifth and eighth days, 276 Professional Views Held in 1839. and before the formation of the areola. Others have recommended the use of the lymph taken at a much latter period, but this they believe to be a very questionable practice. 3. Jenner proposed that some fresh vaccine lymph should be inserted into the patient after the first vaccination. This practice was founded on the observation that the second vaccination proceeds with accelerated speed, provided the first has taken effect. It is a very simple and beautiful illustration of the constitutional effects of vaccination and deserves to be en- couraged. An experienced eye will for the most part be able to detect any deviation from the true vesicle. *4. The character of the lymph employed; it never ought to be taken from a vesicle which deviates in the least degree from the perfect standard, or from a patient laboring under any cutaneous disease. 5. A point which ought ever to be insisted upon, is the leaving one or more vesicles to run their course without being in any way disturbed. 6. The appearance of the cicatrix; the reporters think that this has been too much trusted, They are inclined to believe that though the presence of a perfect cicatrix is not a sure sign of protection, its absence must be held to speak strongly against the existence of vaccine influence. Yet the observation of Mr. Dodd would seem not to bear out this impression. Of flfty.seven cases that have been exposed to the contagion of small-pox and escaped, in six only was the cicatrix perfect; in fourteen it was slightly defective; in thirty it was very imperfect; and in seven it was totally wanting. Out of seventy-seven cases of small-pox after vaccination, one bore a perfect mark, fourteen had the cicatrix slightly defective, forty- seven were imperfect, and fifteen had none at all. Thus, to sum up the whole, out of one hundred and thirty-four cases of vaccinated persons who had been exposed to small pox, the cicatrices of seven were perfect, and one of these failed; twenty-eight slightly defective, of which fourteen failed; seventy-seven very imperfect, forty-seven of which failed; twenty- two had no mark at all, and of them fifteen had small-pox, while seven al- together escaped. 7. Vaccine lymph, though passed through a great number of subjects, and used for a great number of years, does not necessarily become deter- iorated. This, however, can only be said when unceasing attention is paid to every successive transmission ; for if a deviation commences, it may be perpetuated, and afford a gradually decreasing protection. There is no doubt that lymph of this kind have been often used. 8. The influence of cutaneous diseases on the vaccine vesicle has been insufficiently attended to. Dr. Jenner pointed out that the affection was very much modified in its progress by the scaly tetter, and those affections described by Dr. Willan under the term psoriasis, as well as those vesicu- lar eruptions commonly called herpetic. He observes that vaccination performed on a skin occupied by any of these diseases, "produces every gradation from that slight deviation from perfection, which is quite imma- terial, up to that point which affords no security at all." 9. Other constitutional peculiarities stand in the way both of human small-pox and cow-pox. Some resist these affections at one period of their lives and not at another; and there are examples of the very opposite con- dition, which show that the individual will receive either infection as often as it is presented to him These peculiarities frequently run in families. We know several children of the same parents who have had morbific small-pox after cow-pox; and not many months ago three brothers had small-pox after cwo-pox, one of these cases proving fatal. On this sub- History of Small-Pox by Inoculation. 277 ject we have illustrations from Mr. Dodd, who tells us that six brothers and sisters in one family having been vaccinated when children, had the small pox a few years afterwards. In another instance, two sisters vaccinated in infancy, were subsebuently inoculated and had the small-pox slightly, they both had it again in 1837, and one of them had it very severely. Their father caught the small-pox; their mother too, who was inoculated when young, had it again in the same year; their maternal grandfather, beholding from a window at night, the funeral of a friend who had died of small-pox, sickened of that disease and died. There are a few of the affinities and concordances between human small-pox and cow small-pox ; and we doubt not that every subsequent ob- servation will establish the analogies. In confirmation we further remark, that the great object of inoculation with human small-pox, was to produce an affection as much like that of cow-pox as possible, and by great care in selecting the virus to be employed this was sometimes accomplished in a very remarkable degree. On the other hand, it is known that the disease, when casually caught from the horse or cow, is often a severe one-as severe, it was said by an experienced observer, as for the most part was in- oculated small pox. We ourselves have seen it, when caught from the horses, exhibiting great intensity, the hands and arms being covered with the eruption."-Transactions of the Provincial Medical and Surgical Associa- tion Instituted 1832, Vol. 8.,p. 39. Medico Chirurgical Review, Oct., Vol.Al, 1840. ON THE COMPARATIVE ADVANTAGES OF THE INOCULATED SMALL-POX AND OF THE COW-POX-HISTORY OF SMALL. POX INOCULATION-MORTALITY OCCASIONED BY NATU- RAL SMALL-POX, INOCULATED SMALL AND COW-POX- STATISTICS ILLUSTRATING THE GREAT BENEFITS CON- FERRED ON THE HUMAN RACE BY VACCINATION. HISTORY OF SMALL-POX BY INOCULATION. The Roman Empire was finally overturned by the Northern Barbarians in the sixth century of the Christian era; from that event literature and art lay for many centuries afterward buried in the ashes of Rome. The crash of this immense colossus was soon succeeded by another memorable catastrophe; the Arabians, in G22, under Mahomet, sallied forth from the East, sword in hand, to propagate his religion, and with rapidity sub- dued several great kingdoms and princes in the West. Three new diseases, the small-pox, the measles, and the spina ventosa, were first described by the Arabians. The two former diseases had never before been seen in any part of the globe frequented by Europeans; at least no history of them has been found in any ancient medical author, poet or historian of either Greece or Rome. Mahomet's followers are said to have exported these two specific poisons from the deserts of Arabia. Variolous poison was soon spread by the Mahomedans through Palestine, Syria, Egypt, Persia, Spain, and wherever they carried their victorious arms. Many centuries after, the Crusades, or Holy Wars, were instrumen- tal in diffusing this exotic venom more widely over Europe. 278 History of Small-Pox by Inoculation. The small-pox and measles, thus introduced by the Mahomedans, un- peopled more of Europe than all the fiercest wars or bloody exploits with which its annals are stained. The exact time and place of the origin of the small-pox is shrouded in mystery; for it must be considered as a most extraordinary circumstance so contagious a disease, the poison of which adheres to clothes, linen, woolen, cotton and porous materials, during a long time, and has in this way been conveyed to very distant kingdoms, could have been circum- scribed, and its ravages confined for several thousand years to a small corner of the globe, not divided by sea, from the rest of Asia. Dr. Mead thinks that the small-pox was first generatedin the hot climate of Ethiopia, and together with the plague, transported from thence across the narrow channel of the Bed Sea into the opposite continent, Arabia; but if small-pox had been a disease anciently known in Ethiopia (which no one has proved) there were various opportunities for the infection being car- ried down the Nile into Nubia and the heart of Egypt, countries bor- dering on Ethiopia and of the remotest antiquity in arts and civilization, holding at various times commercial and military relations with the nations of Africa, Europe and Asia. The Romans in the height of their glory and after the conquest of Egypt, carried on a considerable trade with Arabia and India; one hundred and twenty vessels sailed annually down the Red Sea, traversed the Arabian coast, and arriving at the Malabar shores in India, and the Island of Ceylon, returned from thence loaded with cin- namon, pepper, ginger, silk, pearls and diamonds. Mecca, the birth place of the Mahomedan prophet, stands on the borders of the Red Sea. Throughout all this intercourse of great nations, variolous infection, seems not to have been dispersed amongst the great kingdoms, bordering on the Mediterranean, Red Sea, and Indian Ocean. Mr. Holwell, who resided a great part of his life in India, published about the middle of the eighteenth century, a treatise on the practice of Inoculation, and the treatment of Inoculated Small-Pox, in Hindos- tan. Mr. Holwell states that it is believed in India, that Small-pox raged there time immemorial, and that the Brahmins or priests, time out of mind, have practiced Inoculation. The Turks ascribe the origin of the prac- tice to Circassia, formerly one of the Asiatic provinces of Turkey. It has been conjectured, therefore, that it is to India, that Europe is originally indebted for this important discovery through the medium of the Circas- sians. Neither Rhazes, Avicenna, nor any of the Arabian physicians, who wrote in the ninth or tenth centuries, make the least mention of Inocula- tion ; had variolous poison been transported from India to Arabia, the physicians of the latter nation could not have remained ignorant of a practice, according to Indian tradition, so universal and ancient, and at- tended with such happy consequences. Inoculation in India is performed by a particular tribe of Brahmins, who were delegated annually for that purpose, and who made a tour or sep- arate circuits in traveling parties to inoculate the distant provinces ; arriv- ing at the place of destination a few weeks before the return of the natural disease. The inhabitants who intend to have themselves or children in- oculated, know the time of the Brahmin's arrival, and abstain according to established rules universally known, for one month before the inoculators' periodical visitation, from fish, milk, and a kind of butter made of Buffa- lo's milk; this is the invariable and only preparatoy regimen. history of Small-Pox by Inoculation.. 279 The Brahmins inoculate generally on the outside of the arm, the male about the middle, between the wrist and the elbow; the female between the elbow and shoulder. The operator first rubs the parts with a dry cloth, during eight or ten minutes; then with a small instrument made like a crow-quill, and sharp at the point, he makes in a small space, which might be covered with a silver six-pence, several slight scratches, so that the smallest appearence of blood may be perceptible; a pledget impregnated with variolous matter is then applied, after being wetted with a little water from the Ganges; over all a bandage is rolled ; six hours after the bandage is removed, and the cotton left to fall off of its own accord. Variolous matter, taken from Inoculated small pox, of the preced- ing year is generally used for inoculation ; but is never received or preferred from natural small-pox, however mild and distinct. There are many instances, says Mrs. Hol well, of the variolous matter entangled with cotton, and kept close stopped from the air in a bottle during five or six years, at the end of this period proving active. The same careful regimen in diet is continued through the disease, as before inoculation. Every morning before sunrise, or every evening after sunset, the patients, from the first day after inoculation, are stripped naked, and sluiced over the head and body with buckets of cold water; in this manner the diurnal cold bathing is continued until the eruptive fever comes on, which by such means is rather hastened, and commences about the close of the sixth day. Then during a few days of the eruptive fever, they desist from cold bathing; but on the pustular eruption appearing on the surface, which is generally a process of three days, they again resume the cold water, and continue it to the end of the disease. The variolous pustules when ripe are all opened with a pointed thorn. Every pustule is considered as a small abscess, or boil, that has reached maturation, and whose matter should be drained off by an external opening. About a dozen pustules are opened with great gentleness at one time, then the matter is absorbed with a linen or cotton rag dipped in warm water and milk; in this way they proceed gradually over the whole body, face and extremities. A cooling regimen is prescribed through the disease; the inoculated are forbidden to confine themselves to the houses, and are exposed very freely to the air and wind ; all the fruits of the climate are permitted such as plantain, sugar cane and watermelons; and cold water, or rice gruel used for common drink. The number of pustules from inocu- lation in India, are generally fifty to one hundred. Mr. Holwell affirmed that the process was mild and that almost all the inoculated recovered. This same authority has observed a malignant form of small-pox in India, which .killed numbers so early as the second or third day, and which attacked turkeys, capons, fowls, poultry, parrots and other species of the feathered tribe. From the testimony of the Missionary Jesuits, it appears that inocula- tion was practiced in Pekin, China, only from about the middle of the seventeenth century. The Chinese Method of Small-Pox Inoculation, was to roll up in cotton a few of the dried scabs, which had fallen off from the variolous pustules, and which were kept ready for use in a bottle close stopped with wax ; small pledgets of these were put up the nostrils ; or the dried scabs were powdered and sniffed up the nose; and in this way the vascular mu- cous membrane of the nose the artificial disease was communicated. In 1724, when a virulent small-pox was raging in Tartary, the Emperor of China dispatched the physicians of his court to inoculate the Tartars. 280 History of Small-Pox by Inoculation. There appears to be no such similarity in the Chinese or East Indian modes of inoculation, as to induce one to refer them to the same origin. The earliest information in Britain of inoculation, and of its utility in diminishing the mortality ot small-pox,was from Emanuel Timoni, a Greek physician, in a letter to Dr. Woodward, dated Constantinople, 1713. In 1715, in another letter of Doctor Emanuel Timoni, to the Royal Soci- ety of London, he says that forty years before the above date, inoculation had been introduced into the capital of Turkey from two of the Asiatic provinces bordering on the Caspian Sea-Circassia and Georgia. An ac- count of the Circassian practice may be found in Motraye's Travels to that country in 1712. Kennedy, another eye-witness of inoculation (Surgeon in the English Army), published in the same year with Timoni observations on-the subject. Pylarini's account of Inoculation at Constantinople, where he then prac- ticed medicine, was published at Venice, 1715; in which year several thou- sand were inoculated in the Turkish capital. The Turks themselves, as Mahomedans and fatalists, rejected inoculation, and it was adopted only amongst the Greeks, Armenians and Christians. In Greece and the adja- cent island of Candia it had been a practice during one or two centuries earlier. In Egypt, Tripoli, Tunis, Algiers, and other provinces of Africa subject to Turkey, inoculation had likewise been long known, and had ex tended so far south on the African Continent as the River Senegal. It is stated that the Circassians and Georgians were induced to the prac- tice of Inoculation by an ' additional and powerful motive to the security against small-pox, namely,-avarice, in order to preserve the beauty of rheir female children and to sell them at higher prices to the rich Turks and Persians as mistresses. The variolous matter they transferred by a small scratch made in different parts of the body, previously dipping the point of the needle into a ripe pustule, or in a nut shell full of variolous infection. Many young women of Constantinople exercised the function of inocula- tors. Timoni says that they were indifferent whether the variolous infec- tion was engrafted from natural or artificial pustules. In 1717, the elegant and accomplished Lady Mary Wortley Montague, wife of the English Ambassador at Constantinople, had her son inoculated in that capital by Maitland, an English surgeon. In 1725, Dr. Mead and Mr. Maitland made the experiment of Chinese inoculation upon one of seven condemned criminals in Newgate, ^id of the Turkish practice upon the other six ; all of w hom by that means ob- tained a pardon from the King, and recovered ; but in the first case the brain was seriously affected, and a prejudice was engendered against the Chinese method. In 1722, on Lady Montague's return to England, her young daughter was inoculated by a slight incision on each arm, and was the first person of any rank inoculated in that country. A few months after the Princess Royal and some other members of the Royal Family were inoculated. 1722. In this year inoculation was carried to Boston, Massachusetts, in North America, and was attended with the same favorable results as in London, in the handful who had the resolution to entrust their lives to that protection. Dr. Jurin, from 1723 to 1727, published several detached papers in the Philosophical Transactions comparing the mortality of natural small-pox and the numbers lost by inoculation. From a great mass of materials, and many thousands of sick in different parts of Europe, he found that one of jwe, or six, at a medium, died by the natural disease; for, in its malignity, History of Small'Pox by Inoculation. 281 there is everywhere in different years various gradations, for in Turkey, in the northern parts of Europe, and in Africa, and throughout the whole ex- tent of the Mediterranean coast, small-pox was still more fatal, and it has been in many outbreaks so violent as to kill nearly one-half of the infected. Of those then inoculated, one in fifty died ; but amongst them were in- cluded young infants, many of whom were cut off by convulsions, which was laid to inoculation, and some aged persons, pregnant women and valet- udinarians. Jurin's list of all the inoculated in London and other parts of England, from 1721 to 1727, amounts to only seven hundred and sixty-four. It is important to note in this connection, that in Wales a custom pre- vailed before the introduction of inoculation from Turkey, of engrafting the small-pox. A small wound or scratch was made on the hand or arm with a pin or a knife, and the variolous matter rubbed in ; now and then the pocky scabs were merely rubbed in the hollow of the hands. A simi- lar custom prevailed in some parts of Denmark in the fifteenth century, and is related by Bartholine. Inoculation from 1727 languished in England and America until 1738, but two (2) died ; in the same year, of one thousand inoculated at all ayes in one province of North America, namely. South Carolina, and in the most un- favorable season, during the sultry heat of June, July and August, but eight (8) died. Inoculation was first advocated in Ncrth America by the Be verend Cot- ton Mather, and was first practiced at his suggestion by Dr. Z. Boylston, on the twenty-seventh of June, 1721, in Boston, upon his only son, about thirteen years of age, and two negro servants, and was successful. Dur- ing that year, or the early part of 1722, Dr. Boylston performed inocula- tion upon 247 persons-Thacher's American Medical Biography, Boston, 1828, p. 28. The havoc then made by small-pox, drove the inhabitants of Charleston, South Carolina, to adopt the only remaining remedy from destruction. Middleton, in England, inoculated eight hundred and lost but one. Other inoculators lost one out of three and four hundred. In the West Indian Island, St. Kitts, of three hundred negroes inoculated, only one died. Ban by inoculated a thousand in England and without a single death. In 1746 a small charitable hospitable was erected at Pancras, in the environs of London, for the double purpose of inoculation, and to receive during the sickness, persons of indigent circumstances who had been siezed with nat- urM small-pox; of eighteen hundred and ninety-six inoculated in this hospital in the course of several years, but eight died. At another period, of four hundred and ninety-six inoculated at this asylum, but one died. In the year lr/59, the number inoculated at Pancras were, five hundred. and ninety three (593), and many of these adults, yet but one died. The Suttons in the seventeenth century, by their own computation, inocu- lated throughout London, and many parts of England, about forty thou- sand, and they assert they did not lose one hundred. In Pennsylvania and other provinces of North America, of 8000 inocu- lated, only 19 died, or one in 467. In 1748, inoculation was introduced into Amsterdam by Dr. Tronchin, who began experiments upon his own son, and before 1759, inoculation had spread into several other towns of Holland. In 1774, a malignant small-pox was committing severe ravages in the ecclesiastical state of Italy, and several mothers dreading the destruction of their whole families, inoculated their children, when sleeping, with the desired success. 282 Mortality Occasioned by the Inoculated SmalbPojr. The efforts of a few physicians and patriots of France to introduce the inoculation failed, from the ignorant and bigoted opposition of the clergy ; and from 1724 to 1752, no person in the medical profession of France wrote upon inoculation ; in 1754, the public attention in this country was awak- ened by Mr. Condamine's papers read before the Academy of Sciences, in vindication of inoculation, and in 1755 and 1756, a few of the principal nobility were inoculated at Paris. In 1755, Mr. Shultz returned to Stockholm from London, where he had been sent, by order of the Swedish Court, to inquire into the success and mode of inoculation, particularly at the London Inoculating Hospital ; and in that year a small building for a similar purpose was erected at Stockholm. Of 1200 inoculated in Sweden before the year 1764, not one died. Den- mark adopted the practice about the same time with Sweden. MORTALITY OCCASIONED BY THE INOCULATED SMALL-POX. According to the immature calculations of Turin, of those inoculated, one of fifty, and of Dr. Mead, one of every hundred died ; but by the ac- counts of later date, collected by practical inoculators and physicians, on an average only one of every jive hundred inoculated die, and it would seem from Mr. Holevill's statements, that this last rate of mortality would also apply to this practice in India. In the London Small-Pox Hospital, of the last five thousand that were inoculated, only one in six hundred died. THE PRACTICE OF INOCULATION FOR THE SMALL-POX, SUB- STITUTED A COMPARATIVELY MILD FORM OF THE DIS- EASE, ATTENDED WITH BUT SMALL MORTALITY; BUT THE TOTAL NUMBER OF DEATHS BY SMALL-POX WAS THEREBY INCREASED, AND THE PERPETUATION AND SPREAD OF THIS LOATHSOME PESTILENCE ON THE SUR- FACE OF THE EARTH, WAS PROMOTED BY INOCULATION. Inoculation seldom or never fails to convey the disease ; the pustules are in general few, and although only one or two should appear, the person is protected against the small-pox. Exclusive of the immediate havoc by small-pox in the natural way, num- bers who survive are disfigured for life; in multitudes of others, the natural disease is followed by phthisis and scrofula, and a considerable number are deprived of eye-sight. Dr. W. Black* writing in 1781, says: " Others surmised, that infectious *Observatious, Medical and Political, on the Small-pox, etc.: London, 1781, p. 41 . Mortality Occasioned by the Inoculated Small-Pox. 283 and hereditary diseases might be instituted together with variolous infec- tion. Universal experience proves there to be chimerical conjectures, and in the natural disease there is greater danger of such imaginary combination of infections; for in chosing variolous matter it is easy to select it from healthy constitutions. Experiments have been made with variolous matter taken from persons laboring at the same time under the venereal disease, yet the latter affection was not engrafted with inoculated small-pox. The true scurvy, however virulent, every common seaman knows, is neither conta- gious nor infectious, neither is the scrofula." The London bills of mortality show that within one hundred years pre- ceding 1780, in this city alone upwards of two hundred thousand people had been cut off by one single disease-small-pox. An examination of the London bills of mortality as far back as 1629, when the different diseases of those who died were first inserted, show that in all the interval extend- ing to 1780, the deaths from small-pox in any one year did not exceed four thousand ; in 1772, which yielded the heaviest mortality from this disease, they numbered 3992; and it was calculated that about two thousand inhabi- tants were annually destroyed in London by the small-pox. If in the eighteenth century, during the practice of inoculation and before the intro- duction of vaccination, the six hundred thousand inhabitants of London lost two thousand annually by small-pox, then throughout the nine millions in Britain and Ireland, thirty thousand annual deaths should be attributed to small-pox. In the hundred years preceding the introduction of vaccination, during at least sixty of which inoculation was practiced, Britain and Ireland alone lost three millions of inhabitants by small-pox. Baron Dimsdale, who was sent from England to inoculate the Czarina of Russia, in his treatise on small-pox, says that " this single disease destroys more than the eighth part of the inhabitants. " If, therefore, in London, which enjoys the many advantages already re- cited, more than two thousand persons die annually of small-pox, we may surely suppose that the loss which Russia in its whole extent sustains in the same space of time, amounts to tico millions of souls." P. 16. The learned Dr. W. Black, however, on more careful calculation, founded upon the best data accessible at that time (1780), estimating the total pop- ulation of Europe at 120,000,000, taking Britain and Ireland as a body, "the annual deaths by smallpox, throughout all the kingdoms of Europe, will amount to only four hundred thousand."* During the practice of inoculation a question of great importance to mankind was agitated, namely, whether by inoculation in London and other great cities, at the private houses of the inhabitants, contagion is not more likely to be dispersed, and, upon the whole, the community at large more injured than benefited by the practice ? The arguments urged chiefly by Baron Dimsdale and other English writers, during the latter part of the eighteenth century, may thus be con- densed. Though the loss under inoculation is very inconsiderable, almost the whole of those that are inoculated recovering, yet by spreading the disease, a 'Observations Medical and Political on the Small-pox, etc., 1781, p. 50. 284 Mortality Occasioned by the Inoculated Small-Pox. greater portion take it in the natural way; more lives are now (1725-1780) lost in London than before inoculation commenced, and the community at large sustains a greater loss; the practice, therefore, is more detrimental than beneficial to society. In the four years preceding 1776, the number of bills from small-pox were at a medium to 2,444, an alarming increase. The disease, by general inoculation throughout London, spreads by visit- ors, strangers, servants, washerwomen, doctors and inoculators; by means of hackney coaches, in which the sick are sent out to take the air, or by sound persons communicating with the sick in the streets. The poor in London are miserably lodged; their habitations are in close alleys, courts, lanes and old dirty houses; they are often in want of medi- cines, even of bedding. The fathers and mothers are employed constantly in laborious occupations abroad, and cannot attend the inoculated sick; should they neglect their occupations, food and necessaries would be defic- ient, and the medicines and diet ordered by the physicians could not be regularly complied with. The air in their houses is impure, they have neither areas, gardens, or carriages for the convenience of ventilation and taking fresh air. Sailors and sea faring people, many of whose lodgings are miserable in the little houses on the river, are liable to catch the distemper, and either to fall sick there without friends or assistants; or, perhaps, being infected on shore, to carry it to sea in their contaminated clothes, and afterwards falling sick without care or attendance spread the disease in foreign cli- mates. Country people coming to town for markets, visits, or pleasure, all are subject to the danger of the infection. Persons going from the sick to the General Inoculating Hospital, or Dis- pensories, for medicines or advice, scattered the disease in their infected clothing in the streets and whole neighborhood. The gossiping disposition of the poor, the flocking of persons to funerals of those dead with the small-pox. and the sick sallying forth in the public ways in their dirty garments loaded with small-pox infection, scattered the disease broadcast. The children who were able to run about, immediately upon their recovery, still farther scattered the seeds of the fatal disease by intermingling in the streets and in the schools with their play-fellows. The success, therefore, derived from general inoculation was beneficial to a comparatively few only; whilst it misled a great number of others in danger to which they would otherwise have been less exposed. THE MORTUARY STATISTICS OF LONDON DEMONSTRATE THAT INOCULATION ACTUALLY INCREASED THE MOR- TALITY FROM SMALL-POX. On the continent registers were instituted fifty or a hundred years before their introduction in England ; but general annual registers of births, dis- eases and deaths are modern establishments, and were unknown to the ancients. In 1538, exact records of weddings, christenings and burials, were first ordered by the King and Council to be kept in every parish and church in England by either the vicar or the curate. This order was very negli- gently obey eel in many parishes, until 1759, in Queen Elizabeth's reign, Mortuary Statistics of London. 285 when to prevent registers from rotting in damp churches, they were di- rected to be written on parchment. At first, they seem, both in Germany and in England, to have been designed to prove the birth, death and de- scent of private persons, and the rights of inheritance in property or lands. In 1592, a year of pestilence, bills of mortality for London were instituted ; but were discontinued till 1603, another year of desolating pes- tilence, which was the only distemper then taken notice of in the printed reports. In 1629, the different diseases, casualties of those who died, to- gether with the distinction of sexes were added and published; and in 1728, and not sooner, the different ages of the dead were ordered to be specified in the London bills. Upon first establishing the distinction of diseases and casualties in the bills of the metropolis of England, the prim- ary intention appears to have been to discern the numbers destroyed by the plague, and to detect concealed murders. Since the days of Moses, however, existence has been circumscribed within the same narrow bounds. In the London bills of mortality, during a period of thirty years, that is, from 1728 to 1758, the total deaths amounted to 750,422, and of this number 242 only reached beyond 100 years of age; one of whom arrived at the age of 138. Dr. W. Black* has recorded the following statistics illustrating the annual average births and burials recorded in London bills from 1671 to 1781: YEARS. Christenings. Burials. From 1671 to 1681 12,325 19,144 14 439 22 763 From 1691 to 1700 : 14,938 20470 From 1700 to 1705 15 750 21 091 From 1706 to 1710 15 489 21 832 16 204 22 178 From 1716 to 1720 18 019 25-641 From 1721 to 1725 18,828 26 513 From 1726 to 1730 17 578 28 472 From 1731 to 1735 17 517 25 491 From 1736 to 1740 16445 27'494 Irom 1741 to 1745 14.419 25,351 From 1746 to 1750 14.490 25,351 15,119 21 080 15 710 22 956 From 1770 to 1780 17,218 21000 LONDON BILLS AT A MEDIUM ANNUALLY. From the preceding table it appears that the mortality in London -was great from 1617 to 1750, and comparatively low, considering the increase of population, from 1751 to 1780. That this apparent improvement in the health and diminution in the mortality of London was not due to inoculation is conclusively shown by the following statistics: Deaths from small-pox in London during fifteen years beginning from 1701 and ending with 1716, before the introduction of inocu- lation 22,219 Deaths from small-pox in London during fifteen years, 1717 to 1731, during and after the introduction of inoculation 34,418 Deaths from small-pox in London, fifteen years, 1732 to 1746, dur- ing inoculation 29,462 Deaths from small-pox in London, fifteen years, 1747 to 1761, dur- ing inoculation * 29,165 Deaths from small-pox in London during fifteen years, 1762 to 1776, during inoculation 36,276 ♦Observations, etc., on Small-pox, p. 158, p. 196. 286 Statistics of Small-Pox and Vaccination. During the preceding fifteen years before the introduction of inoculation' the deaths from small-pox reached only 22,216, whilst after its introduction in similar periods of time they ranged from 29,169 to 36,276, the highest number occurring in the last series of fifteen years. THE ADVANTAGES OF COW-POX INOCULATION (VACCINA TION) DEMONSTRATED BY OFFICIAL RECORDS AND STA- TISTICS. In order to place this subject in a clear and impregnable position, we quote from official reports and records. We extract the following from the valuable Report of the House of Com- mons rpon Dr. Jenner's Claim. "As a comparison between this new practice and the inoculated small- pox, forms a principal consideration in the present inquiry, some facts with regard to the latter engaged the attention of your committee; and they have inserted in the appendix statements of the mortality occasioned by the small-pox in forty-two years before inoculation was practiced in Eng- land, and from the forty-two years, from 1731 to 1772, the result of which appears to be an increase of deaths, amounting to seventeen in every 1,000, the genei al average giving seventy-two in every 1000 during the first forty- two years, and eighty-seven in the forty-two years ending with 1772, so as to make l he whole excess of deaths in that latter period 1742. The increase of mortality is stated by another witness to be as ninety-five to seventy, comparing the concluding thirty years with the first thirty years of the last century, and the average annual mortality from small-pox to have been latterly about 2000; for although individual lives are certainly preserved, i nd it is true that a smaller loss happens in equal numbers who undergo th3 small-pox now than there was formerly, yet it must be admitted, that the general prevalence of inoculation tends to spread and multiply the di- sease itself; of which, though the violence be much abated by the modern mode of treatment, the contagious quality remains in full force. It de- serves also to be noticed, that the deaths under the inoculated sort of small-pox, with all the improvements of modern experience, are not incon- siderable. It is stated by one of the witnesses at about one in every 300 throughout England ; by another as about one in every 100 in London ; while the loss in the natural small-pox is probably uot less than one in six." The following statement was subjoined to the Report of the House of Commons, illustrating the beneficial effects of vaccination. "For this purpose we shall state the uuiuber of deaths by small-pox from the bills of mortality of parish clerks of London, during the twelve years since vaccination was in- troduced, viz., from January 1799, to January 1, 1811, and also during the twelve years immediately preceding the vaccine practice, viz., from January 1, 1787 to January 1, 1799. But in order to judge more accurately, we shall arrange the two periods of twelve years under three heads, each comprehending four years. This distribution atfords the underwritten tables: 1. Deaths by Small-pox preceding vac- cination in the first four years: 2. Deaths from Small-pox, during the Vaccine Practice in the first four years: 1 2 3 4 In 1787 2418 1101 2077 1617 7213 1 9 3 4 In 1799 1111 2409 1401 1579 6500 In 1788 In 1800 In 1789 In 1801 In 1790 . Total In 1802 Total Statistics of Small-Pox and Vaccination. 287 Deaths from Small-pox in the second four Deaths from Small-pox in the second four- years preceding Vaccination: years after the institution of the Vaccine practice: ] In 1791 .... 1747 1 A In 1803 . 1202 2 In 1792 1568 2 In 1804 622 3 In 1793 . 2382 3 In 1805.... . .... 1685 4 In 1794 1913 4 In 1806 1158 Total 7610 Total 1667 In the third four years: In the third tour years : 1 In 1795 1040 1 In 1807 .. 1297 2 3 In 1796 3548 2 In 1808 2257 In 1797 522 3 In 1809 1163 4 In 1798 2237 4 In 1810 1198 Total 7347 Total 5915 The total number of deaths by Small-pox in 12 years previous to inoculation 22,170 Ditto, subsequent to vaccination .... 17,142 Decrease 5,028 From the preceding statistics it appears that the number of deaths from small-pox in the first twelve years exceed the number in the twelve suc- ceeding years during vaccination by 5,028: or 419 persons per annum fewer for twelve years died since than before vaccination. The progressive increase of the population during the period under obser vation should also be taken into the calculation. The absolute increase of the population of England from 1801 to 1811 was one million, nix thousand and fifty-four, or about eleven in 100; or setting aside the increase of the army and navy, the population of England increased 14£ per cent, Wales and Scotland 13 per cent. The following statistics, derived from authentic sources, illustrate in the clearest manner the power of vaccination and re-vaccination to prevent small-pox and to diminish the sum of disease, suffering, and death, and to promote the longevity of the human race TABLE SHOWING THE COMPARATIVE MORTALITY FROM SMALL-POX IN LON- IN DECENNIAL PERIODS BEFORE THE DISCOVERY OF INOCULATION DUR- ING THE PRACTICE OF INOCULATION, AND UNDER VACCINATION. PERIODS. Mean Annual Small-pox deaths. Per 1000. Comparative Numbers. 1650-1660 48 1 1660 1670 36 1670-1680 71 S 56 No protection. 16^0-1690 74 1690 1700 51 1750-1760 100 1760 1770 108 1770 1780 98 96 Inoculation. 1780-1790 87 1790 1800 88 1810-1820 42 ) 1820-1830 ... 32 1830-1840 23 > 25 Vaccination. 1840 1850 18 1850-1860 12 J ♦Parliamentary Return, 26th April, 1853. Vaccination, its Value and Alleged Dangers, etc., by Edward Ballard ; London, 1868, pp. 273 to 301. 288 TABLE SHOWING THE ANNUAL DEATHS FROM ALL CAUSES AND FROM SMALL-POX IN LONDON FOR DECENNIAL PERIODS, FROM 1751 TO 1860. (1). Statistics of Small-Pox and Vaccination. PERIODS. Average All Causes. Annual Deaths Small-Pox. Small-Pox Deaths per 1000 Deaths From All Causes. 1751-60 20 872 2 061 100 1761 60 23,202 2A45 108 1771 70 22304 2 204 98 1781-90 19;516 1,705 £7 1791 1800 20,213 1.780 88 1801 10 19'582 1 253 64 1811 20 . . 18 604 793 42 1821 30 .... 21,645 699 32 1831 40 24.585 573 23 1841 50 52'217 841 16 1851-60 61^047 715 11 TABLE SHOWING THE PROPOR HON OF DEATHS FROM SMALL-POX IN PRAGUE, DURING SEVEN YEARS PRIOR TO THE INTRODUCTION OF VACCINATION, AND TWENTY-FOUR YEARS SUBSEQUENT TO THE INTRODUCTION OF VACCINATION. (2). Years 1792-1806, 7 Years Prior to Introduction of Vaccination- Years 1832-1855, 24 years Subsequent to the In- troduction of Vaccination Proportion to Population of death generally Death from Small-pox to population Deaths from Small-pox to total number of deaths 1 to 32 1 to 396J 1 to 13J 1 to 32| 1 to 14,7414 1 to 457j TABLE* SHOWING THE NUMBER OF DEATHS IN ENGLAND FROM EACH OF CERTAIN ZYMOTIC DISEASES IN EACH OF THE TWENTY-THREE YEARS FOR WHICH THE RECORD HAS BEEN MADE. YEARS. Scarlatina. Diphtheria. Measles. Whooping Cough Small-Pox Fever. Diarrhoea, Dysentery and Cholera. 1838 5802 6514 9107 16268 18775 3440 1839 10325 10937 8165 9131 15666 3493 1840 19816 9326 6132 10434 17177 4799 1841 14161 6894 8099 6368 14846 4198 1842 12807 8742 8091 2715 16201 7622 1847 14697 8690 9260 4227 30994 15630 1848 20502 6867 6862 6903 22037 15604 1849 13111 5464 9615 4645 18347 74155 1850 13370 7080 7770 4666 15375 14400 1851 13594 40 9370 7905 6997 17930 18045 1852 18813 74 5846 8022 7320 18641 21754 1853 15653 46 4894 11200 3151 18554 20502 1854 18325 203 9277 9770 2808 18893 42092 1855 17128 186 7354 10185 2525 16470 15044 1856 13931 229 7124 9225 2277 16182 15912 1857 13919 310 5969 10138 3936 19016 24037 1858 25481 4836 9271 11648 6460 17882 16004 1859 19907 9587 9548 8976 3848 15877 20597 1860 9681 5212 9557 8555 2749 13012 11185 1861 9077 4517 9055 12309 1320 15440 20999 1862 14834 4903 9800 12272 1628 18721 12667 1863 30475 6507 11349 11275 5964 18017 16801 1864 29700 5404 8323 8570 7684 20106 18368 Note (1).-Report of the Small-pox and Vaccination Committee of the Epidemiological Society, p. 41. Handbook of Vaccination, by Edward C. Seaton, M. D., Medical Inspector to the Privy Council, London, 1868. pp 422-424. Noto (2).-Mr. Simon's Report and Papers relating to the History and Practice of Vaccination, 1857 p. 162. Vaccination, etc., Edward Ballard, p. 378. 'Eighth Report of the Medical Officer of the Privy Council, 1865; presented pursuant to Act of Parlia- ment; Loudon, 136; p. 38. Statistics of Small-Pox and Vaccination. 289 TABLE SHOWING THE ANNUAL MORTALITY FROM SMALL-POX IN ENGLAND, WITH THE PROPORTION OF DEATHS TO POPULATION AND TOTAL MOR- TALITY, FROM 1838 TO 1865, INCLUSIVE.* YEAR. Population. Deaths From .All Causes. Deaths From Small-pox. Deaths from Small-pox per One Million of Population, Deaths from Small- pox per 1000 Deaths from all Causes. Place Occupied by Small-pox in the Order of Mortal- ity in the Causes of Deaths in Eng- land. 1838 15,312,256 342,529 16,268 1,101 47.96 5th 1839 15,515,296 338,979 9,131 604 26.93 10th 1840 15,721,029 339,561 10,434 679 29.00 9th 1841 15.929,492 343,849 6.368 408 18.51 14 th 1842 (1) 16,123,793 349,519 2,715 172 7.76 25th 1847 (1) 17,131,512 420,304 4,227 246 10,05 22d 1848 17,340.492 398,521 6,903 398 17.32 16th 1849 17,552,020 440,839 4,644 264 10.53 20th 1850 17.766,129 368,995 4,665 263 12 90 19th 1851 17.982.849 395,396 6,997 396 18.00 15th 1852 18.205.627 407,135 7,320 409 18.28 17th 1853 18,403,313 421.097 3,151 174 7.60 26th 1854 18,618,760 437.905 2,808 153 6 49 29th 1855 18,786,914 425,703 2,525 136 6.01 34 th 1856 19,045,187 390,506 2,277 121 5.90 35th 1857 19.304,897 419,815 3,936 206 9.48 24 th 1858 19.523,103 449,656 6,460 335 14 54 18th 1859 19,746,000 440,781 3,848 197 8.84 26th 1860 19,902,713 422,721 2,749 140 6 59 35th 1861 20 119,314 435,114 1,320 66 3.06 46: h 1862 20,336.467 .436.566 1,628 81 3.77 39th 1863 20,554,237 473,837 5,964 293 12.70 21 st 1864 20,772,308 495.531 7,684 373 15.64 18th 1865 20,990.946 490,909 6,411 309 13.20 21st Table showing the annual mortality from small-pox in England and in London at three periods, viz : I. Before the enactment of any vaccination laws. 2. After vaccination was provided gratuitously. 3. Since vaccination has been made obligatory by statute.! DEATHS FROM SMALL-POX IN ENGLAND. 1. Before the Enactment of any Vaccination Laws. 2. Vaccination Provided Gratui tiously but not made Obligatory. 3. Vaccination to a Certain Extent made Obligatory. Years. Deaths. Years. Deaths. Years. Deaths. 1838 1839 1840 Average annual deaths from Small-pox 16,268 9,131 10,434 1841 1842 (1) 1847 (2) 1848 1849 1850 1851 1852 1853 6,368 2,715 4,226 6,903 6,645 6.666 6,897 7,320 3,151 1854 1855 1856 1857 1858 1859 1860 •. 1861 1862 It 63 2,808 2,525 2,277 3,936 6.460 3.808 2,749 1,320 1,628 5,964 11,944 5,221 3,351 * From Reports of Registrar General of England. (1). From 1843 to 1846, inclusive, the causes of deaths were not analyzed by the Registrar General.-Hand" book of Vaccination; Edward C. Seaton, M. D.; p. 422. t Registrar General's Report. Analysis of Deaths from 1843 to 1846, inclusive, not given in Registrar Report on Vaccination ; by Edward Ballard ; p. 379. 290 Statistics of Small-Pox and Vaccination. DEATHS FROM SMaLL-POX IN LONDON 1. Before the Enactment of any Vaccination Laws. 2. Vaccination Provided Gratui- tously, but not made Obligatory. 3. Vaccination to a Certain Extent made Obligatory. Years. Deaths. Years. Deaths. Years. Deaths. 1838 3,817 634 1,235 1841 1842 1,053 360 438 1,804 909 257 955 1,617 518 498 1,066 1.159 211 1854 1855 1856 1857 694 1,033 531 156 242 1,158 898 217 345 2.012 537 646 1,388 1839 1840 1843 1844 1845 1858 .. 1846 1847 1848 1859 1860 1861 1862 1863 1849 .. 1850 1851 1864 1H65 1852 1753 1866 A verage annual deaths . 1.859 826 758 The diminution of the deaths from small-pox in London, during the pe- riod specified (1838-1866, 29 years) took place in a constantly and rapidly increasing population. In the years 1840-41, the annual deaths from small-pox in the metropolis was 016, out of every million persons living, at all ages; from 1841 to 1850 there were in the mean population 389 per mil- lion ; from 1851 to 1861, 272 per million. Table Showing the Difference between the Mortality from SmaU-Pojc in Eng land and Ireland, during a Period in which there was no Law Com- pelling Vaccination, and that in Countries where Vaccination is More or Less Compulsory * Mortality in Various Places in England, Scotland and Ireland from Small-pox, as Compared with the Total Mortality for ten years, 1850-1851. Mortality from Small-pox, in Various Countries in Which Vaccination is Directly or Indirectly Com- pelled. as Compared with the Total Mortality. PLACES. Deaths from Small-pox per 1000. Deaths from All Causes. 1 PLACES. Deaths from Small-pox per 1000 Deaths from All Cause, s London Birmingham Leeds Paisley Edinburgh Liverpool ..... .... Dundee Perth Greenock Glasgow Dublin Cork Galway Limerick Connaught ten years, ending 1841... All Ireland, ditto England and Wales (eight years).... 16.0 16 6 17.5 18 0 19.4 21.0 24.2 25.0 34.6 36.0 25.66 39.5 35 0 41 0 60.0 49.0 21.9 Westphalia Saxony Renish Provinces ' Prussian Silesia Pomerania All Prussia ....< Lower Austria Trieste Bohemia Lonj hardy Venice Sweden Bavaria 6.0 8 33 3.75 5.25 7.75 7.5 * 6.0 5.15 2.0 2.0 2.2 2.7 4.0 ♦From Parliamentary Return. April 25,1853. Mortality of Small-Pox in Copenhagen for a Period of 100 Years before Inoculation, during Inoculation, and during Vaccination, 1750-1850. Statistics of Small-Pox and Vaccination. 291 Died of Died of YEAR. Remarks and Population. YEAR. Remarks and Population. Small-Pox. Small-Pox 1750 60000 1457 1803 Commission recognize pro- 1751 80 tective power of vacci- 1752 113 nation 1753 53 1804 13 1754 Inoculation introduced 9 1805 5 1755 Inoculation Hospital founded 1117 1806 1756 125 1807 2 1757 13 1808 46 1758 13 1809 5 1759 1079 1810 1 Decree ordering vaccination 1760. .. Inoculation Hospital closed. 118 1811 ; promulgated 4 1761 4 1812 100975 1762 7 1813 0 1763. 167 1814 0 1764 480 1815 0 1765 138 1816 0 1766 42 1817 0 1767 6 1818 0 1768 70495 27 1819 0 1769 1219 1820 0 1770 j Inoculation Establishment in trod need 22 1821 1822 0 0 1771 8 1823 0 1772 22 1824 41 1773 190 1825 $ Vaccination placed under 1774 116 control Board of Health. 12 1775 276 1826 29 1776 86 1827 4 1777 7 1828 1 1778 270 1829 29 1779 283 1830 3 1780 98 1831 0 1781 174 1832 3 1782 Inoculation Establishment closed 332 1833 Revaccination general. ... 19 1783 £ 123 1834 1835 119292 26 434 1784 77 1836 119591 81 1785 1786 427 193 1837 £ Revaccination ordered for the army 1 1787 136 1838 2 1788 185 1839 0 1789 323 1840 2 1790 140 1841 0 1791 297 1842 35 1792 155 1843 111 1793 1794 139 452 1844 j Revaccination ordered for the navy 83 1795 248 1845 126787 7 1796 .. .. 83604 357 1846 0 1797 423 1847 0 1798 386 •1848 2 1799 45 1849 7 1800 35 1850 129695 0 1801 j Vaccination first introduced 91631 2 486 1802 Vaccination Establishment erected 73 Mr. Simon's Report (Papers Relating to the History and Practice of Vaccination, p. 171. Vaccination, Edward Ballard, M. D., p. 375). 292 Statistics of Small-Pox and Vf ((j i Ct n. Table Showing for Several Centuries the Death Rate from Small-Pox during a Period prior to the Introduction of Vaccination and since the Introduction of Vaccination* Sums of Years Res pecting Which Par- ticulars are Given. TERRITORY. Approximate Average Annual Death Rate per Million of Living Population. Befoie Intro duction of Vaccination. After Intio- d u c t i o n of V accination. 1777-1806 and 1807-1856 Lower Austria 2.484 340 1777-1806 and 1807-1850 Upper Austria and Saltzberg 1,421 501 1777-1807 and 1806-1856 Styria 1,052 446 1777-1806 and 1807-1851 Illyria 518 244 1777-1806 and 1807-1850 Trieste 14.046 182 1777-1806 and 1807-1850 Tyrol and Voralberg 911 170 1777-1806 and 1807-1850 Bohemia t 2,174 215 1777-1806 and 1807-1850 Moravia 5 402 255 1777-1806 and 1807-1850 Gallicia.... 1,194 676 1777-1806 and 1807-1850 Austrian Silesia 5,812 198 1787-1806 and 1807-1850 Bulkorania ■ 3,527 516 1817-1850 Dalmatia 86 1817-1850 Lombardy 87 1817-1850 Venice 70 1831-1850 Military Frontiers 288 1776-1780 and 1810-1850 Prussia (Eastern Provinces) 3.321 556 1780 and 1816-1850 Prussia (Western Provinces) 2,272 356 1780 and 1816-1850 Posen 1,911 743 1776-1780 and 1810-1850 Brandenburgh. 2.181 181 1776-1780 and 1816-1850 Westphalia 2,613 114 1776-1780 and 1816-1850 Rhenish Provinces 908 90 1781-1805 and 1810-1850 Berlin 3,422 176 1776-1780 and 1816-1850 Prussian Saxony 719 170 1780 and 1810-1850 Pomerania 1,774 130 and 1810-1850 Prussian Silesia 310 1774-1801 1810-1850 Sweden 2,050 158 1751.1800 and 1801-1850 Copenhagen 3,128 286 Table Showing the Relative Fatality of Small-Pox When it Affects the Un- , vacinated and Vaccinated f Places and Times of Observation. Total Number of Cases Ob- served, Death Rate per 100 Cases. Among Unvac- cinated. Among the Vaccinated. France, 1816-41 16,397 16$ 1 Quebec, 1819-20 2 27 Philadelphia, 1825 Canton Vaud, 1828-9 140 60 0 5,838 24 2 1-6 Durkehmen, 1828-9 134 18 4-5 0 Verona, 1828 39 909 46 J 5$ Milan, 1830-51 10,240 38$ 7$ Boston, 1831-33 220 53 4-5 2 1-9 Wirtemberg, 1831$-5$ 1,442 27$ 7 1-10 Carniola, 1834-5 412 16$ 4 2-5 Vienna Hospital, 1834 360 51$ 12$ Carinthia. 1834-5 1,626 14$ i 2 4-5 Adriatic, 1835 1,002 15 1-5 Lower Austria, 1835 2,287 25 4-6 11$ Bohemia, 1835-1855 15.640 29 4-5 5' Gallicia, 1836 Dalmatia, 1836 1,059 723 23$ 19 j 5 1-7 8$ London Small-pox Hospital, 1836-56 9,000 35 7 Vienna Hospital, 1837-66 6,213 30 5 Kiel. 1852-3 218 32 6 Wirtemberg, no date 6,258 38 9-10 3$ Malta, no date 7,570 21 7-100 4 2-10 Epidemiological Society returns 4,624 19 7-10 2 9-10 'Mr. Simon's Report; Papers relating to the History and Practice of Vaccination, 1857, p. 23. t Papers relating to the History and Practice of Vaccination, p. 27. Statistics of Small-Pox and Vaccination. 293 The statistics relating to the effects of vaccination in reducing in a mark- ed manner the mortality from small-pox in various countries, will be still farther extended and enlarged, under the subsequent division of this inquiry, relative to the history of the cow-pox, and the introduction of vaccination in- to the various states of the American Union. The following conclusions and general results may be deduced from the preceding statistics. 1. In, every country in which the practice of vaccination has been adopted there has been a marked reduction of the mortality from small-pox. In times preceding the introduction of vaccination, small-pox was the terror of princes and the fierce unconquerable slayer of the people; and although its nature has lost none of its cruel and destructive attributes, it has been so effectually guarded that none need fear its attack, but those who neglect vaccination. It is estimated that prior to the commencement of this century, out of every million of the population of England, 3000 persons annually fell vic- tims to small-pox ; during the ten years 1851, to I860, the mean population of England and Wales was 18,996,916 persons; during the ten years, 42,071 individuals died of small-pox, which is in a ratio of 2214 per million of population for this whole period, or only 221. 4 on the average annually ; therefore small-pox has been more than ten times less fatal to the people of England, than it was when vaccination was not known. 2. The practice of inoculation promoted the spread of small-pox and increas- ed the mortality from this aisease. In London, during the latter halt of the seventeenth century, when in- oculation was not practiced, the death-rate from small-pox ranged from thirty-six to seventy-four per 1000 of all the deaths that took place, the mean being fifty-six ; during the second or inoculation epoch, it ranged from eighty-seven to 108 per 1000, the mean being ninety-six; and during the third or vacciation epoch, it has ranged from twelve to forty-two per 1000, the mean being twenty-five. In Copenhagen in 1750, with a population of 60,000, 1457 deaths occurred from small-pox; in 1755, 1117 deaths; in 1759, 1079 deaths; in 1769, with a population of 70,000, small-pox occcasioned 1219 deaths. Vaccination was introduced into Denmark, in the year 1801; and during the ten years preceding there occurred in Copenhagen alone 2546 deaths from small-pox, which becoming more prevalent in 1801, carried off in that year 486 of the inhabitants of tlie city. From 1802 to 1810 inclusive, in the course of the nine years succeeding the introduction of vaccination, small- pox occasioned only 158 deaths; and from this latter year until 1824, al- though the population had risen to above 100,000 not a single death from small-pox was recorded. Vaccination appears to have been introduced in Prussia in 1801, and in 1803, inociilation for small-pox, was prohibited ; before the introduction of vaccination, 40,000 persons were said to die annually of stnall pox within the Prussian domains; in 1817, notwithstanding an extension of teriitory, out of 306, 728 deaths only 2940, were occasioned by small-pox ; and this result was clearly due to the extensive practice of vaccination, the number of vaccinations far exceeding the number of births. In the department of Breslau, in 1818, out of a population of 510,617 per- sons, 17,629 were successfully vaccinated; arid although during this year small-pox was introduced at nine different places, only twenty-eight per- sons took the disease, and only six persons died of it. Vaccination was introduced in the principality of Ansprach, in Bavaria, in 1801, and in 1807 regulations for public vaccination and the suppression 294 Statistics of Small-Pox and Vaccination. of small-pox was promulgated by the Government, which were rendered still more stringent in 1808. In this principality, with a population of 260,406 individuals, three perished from small-pox during the years 1797-98-99, on an average an annual number of 500 persons, and in the single year 1800, no less than 1609 persons. In the year 1807, 500 cases and fifty deaths from small-pox occurred. In this year under the new regulations, 3«,880 persons were vaccinated, and during this and the subsequent years, al- together 141,755, persons underwent the operation. In the year 1808, only eight cases of small-pox, and one death occurred; in the year 1809, only eleven cases and four deaths; and from this time to 1818, only four cases, every one of which recovered. And yet din ing these three years small-pox was prevailing epidemically in the adjoining kingdoms of Wurtemburg, where vaccination was not enjoined until 1818. According to Mr. Hendricks:* in Sweden, from the year 1749 to 1801, the proportion of small-pox varied from 1.2 per cent in 1786, to 25.16 per cent in 1779 ; in three years prior to the practice of vaccination, the small-pox deaths was under 1 per cent of all deaths in no one year; from 5 and under 10 per cent of all deaths in twenty-two years ; 10 to 20 per cent in seventeenyears; and 20 per cent in two years. During-the vac- cination period, from 1802 to 1855, the proportion of deaths from small- pox varied from no deaths in 1846, to 31J per cent of the deaths from all causes is 1881. During this the vaccination period, the small-pox deaths were under 1 per cent, of all deaths in thirty-three years, from 1 and un- der 2 per cent in nine years 2 per cent and under 3 per cent in ten years; 3 per cent and under 4 per cent in two years, over 4 per cent in no one year. It is also shown by the statistics of a large number of European States, collected by Dr. Seaton from the statistics of the Epidemiological Society (recalculated by Mr. Simon), that the mortality from small-pox per million of population has been vastly reduced since the introduction of vaccination. Thus the small pox mortality in Trieste dining the vaccination period has been seventy-five times less than it has been before, in Moravia twenty-one times less, in Silesia twenty-nine times less, in Westphalia, twenty-five times less, in Berlin nineteen times less, in Sweden thirteen times less, in Lower Austria seven times less, and, in Copenhagen eleven times less. 3. The mortality /rein small-pox has been least in those States, and places where the most complete arrangements have been in force for bringing the entire population under the protective influence of the vaccine disease ; and when in the same county or localities the regulations for the enforcement of public vaccination have been more strict at one period than at another, and when this has been more actively carried out at one time than at another, the mortality of the pop- ulation from small-pox has receded as the vaccination of the masses has been more p rfectly ensured. 4. The evidence is conclusive that the vast majority of mankind may, by a sin- gle properly perfected vaccination, be rendered wholly unsusceptible of any sub- sequent action of the variolous poison ; and that in the minority, where suscepti- bility to small-pox infection has not been entirely exhausted by the vaccine pro- cess, the disease will with rare exceptions be so modified as to be but rarely at- tended with severe or fatal effects. Vaccination, without endangering the life of the individual submitted to it, and without diffusing any infection, entirely and permanently exhausts the susceptibility to small-pox in the vast majority of those in whom it has been properly performed ; but leaves an undetermimed proportion still * Vital Statistics ot' Sweden fro u 1749 to 1856,- Statistical Journal, 1862, Vol. 25, p. 142. Statistics of Small-Pox and Vaccination. 295 subject in a greater or less degree to the action of the variolous poison. In those where susceptibility has been only partially destroyed, the action of the variolous infection may be manifested at any period, from a few weeks or months to any number of years, after the performance of the vaccination ; but it is most frequently not manifested till after puberty, and when man- ifested before puberty is generally inconsiderable in degree and only quite exceptionally fatal. The degree of severity which post vaccinal small-pox may manifest after purbety is chiefly determined by the perfection of character and sufficiency of amount of the vaccination that has been per- formed; even when the vaccination has been the most imperfect, leaving but a single mark of indifferent character, the disease is still in most in- stances modified in its course, and is not fatal in one third the proportion of cases in which natural small-pox is fatal ; but when the vacua nation has been done in the best manner, the modification is so great and so general that the proportion of deathstoattacks is scarcely more than the seventieth part of that which occurs in the natural disease. It is therefore a matter of vital importance that the vaccination should always be done in the best known manner. * 5. Revaccination should be performed on all persons after puberty and in all cases irrespective of the age (before or after puberty), udmo the vaccination has been imperfect in character, spurious, irregular, or disturbed in its normal course. After successful revaccination, small-pox, even of the most slight or mod- ified form, is rarely met with. Thomas Heim found that in five years there occurred among 14,384 revaccinated soldiers in Wurtemberg not one in- stance of varioloid, and among 30,0(H) revaccinated persons in civil practice only two cases of varioloid occurred, although during three years small-pox had prevailed in 344 localities, producing 1,673 cases of modified and un- modified small pox among the not revaccinated and in part not vaccinated population of 363,298 persons in those places in which it had prevailed. In the Prussian Army, since the introduction of systematic revaccination in 1839, the cases reported as " varioloid," and, still more, those called u variola," ha ve been nearly all of them among that portion of recruits whose turn for revaccination had never come, on whom revaccination had not been successful, or who were incubating small-pox when they were re- vaccinated; in the twenty years which immediately succeeded the adoption of this system there occurred altogether but forty deaths from small-pox in this large army-or an average of two deaths per annum-only four of the entire forty being in persons said to have been successfully revaccin- ated. In the Bavarian Army, in which there had been compulsory revaccina- tion since 1843, there had not from that date up to the time of a report made to the Minister of War, in 1855, been a single case of unmodified small-pox, and only a very few cases of modified small-pox without any deaths-Simon's Papers Relating to Vaccination, pp. 35-36. Seaton's Hand- Booh of Vaccination, pp. 268-273. Mr. Marson has recorded the fact, that during the period of his connec- tion with the Small-pox Hospital, not on^ of the nurses or servants had taken the small-pox during her residence there, each one of them who had not already had small-pox having been carefully re-vaccinated before being allowed to enter on her duties (Medica Chirurgical Trans, vol. 36). Mr. Marson had been connected with the Small-pox Hospital above * The work of Dr. Edward 0 Seaton Medical Inspector to the Privy Connell (Hand book of Vaccina- tion), will prove of value to every sanitarian and practitioner of medicine as it contains all the necessary de- tails. 296 History of Cow-Pox Inoculation in England. seventeen years when he made the preceding statement, which, according to Dr. Edward C. Seaton, " holds equally good now after a connection of more than thirty-two years." From the preceding considerations the important practical rule has been chosen : That every person should be re-vaccinated about the age of puberty, for the age of most danger from post vaccinal small pox is from fifteen to twenty five; on the other hand, when there is any unusual risk of small-pox, as in localities in which the disease is prevailing re vaccina- tion may be and should be performed at any period of life after birth. G. During the nineteenth century the application of steam to the rapid trans- portation of human beings and merchandise, has furnished the most important and essential condition for the rapid and continuous spread of small-pox over the entire face of the habitable globe ; and but for the discovery of vaccination by Edward Jenner, this pestilence would have reigned without intermission in all commercial centres and been perpetually propagated along all the lines of human travel and intercourse. Fortunately for mankind, the application of steam to the wants of mankind was preceded by the discovery and diffusion of the process of vaccination. OUTLINE OF THE INTRODUCTION OF COW-POX INOCULA- TION INTO VARIOUS COUNTRIES, AND ESPECIALLY THE NEW ENGLAND, MIDDLE AND SOUTHERN STATES OF THE UNITED STATES OF NORTH AMERICA. The following observations, facts and statistics will show that the most powerful and impregnable argument in behalf of vaccination is furnished by the simple historical narrative of the Introduction of Cow-Pox In- oculation in Various Countries. The labor necessarily endured in the tedious search through the- records of medical science, and the still greater labor of analysis, comparison and synthesis, has received the great and inestimable reward of establishing, by numberless facts, the value of vaccination in preventing and modifying small-pox, and in vastly diminish- ing the sufferings and mortality of the human race. It does not appear that the anti-variolous power of cow-pock was gen- erally taken notice of in England until after the introduction of sin all-pox inoculation ; before that time a knowledge of it was chiefly confined to cow doctors, farmers, etc., who did all in their power to keep its existence a profound secret, lest it should hurt the character of their milk. When inoculation for small-pox was first practiced in England, most of the prac- titioners engaged in it frequently experienced disappointment in communi- cating that disease by inoculation or otherwise, and they constantly found that those who thus resisted the infection had previously had the cow-pock. About one hundred and twenty four years ago, three surgeons, Messrs. Fewster, Grove and the celebrated Sutton, formed a connection for the purpose of inoculating for the small-pox. In their practice, which became very extensive, they found that a great number of patients could not be infected, notwithstanding repeated expos- ure under the most favorable circumstances. At length the cause of the HISTORY OF COW-POX INOCULATION IN ENGLAND. History of Cow-Pox Inoculation in England. 297 failure was discovered, by the case of a farmer whom they could not infect with the small-pox, though he assured them he never had the disease, but told them he had had the cow-pox. This fact incited the gentlemen to in- quire into the particulars of these cases in which they could not communi- cate the small-pox, and they found that all the patients who resisted the infection of the disease had labored under the cow-pox at some period or other of their lives. The result of their observations on this head, in an ample experience, during many subsequent years, was invariably the same. And many other gentlemen, extensively engaged in variolous inoculation, have since discovered that their want of success in infecting patients with small-pox proceeded from the same cause. In the year 1780, a young womam who some years before had taken thecow- pox while milking cows, being desirous to know whether this circumstance would secure her from the small pox, went to the Small-pox Hospital in Lon- don, where she was inoculated and exposed in all possible ways to the conta- gion, yet did not take the disease. A man who had had the cow-pox sev- eral years before, went to the Hospital, and was inoculated for small-pox; he remained there in the very midst of contagion for several weeks, but did not take that disease. About one hundred and thirty-two years ago, a farmer who lived in Wiltshire, when he was going to London, being asked whether he was not afraid of the small-pox, replied-no-for he had had the cow-pox. In a letter dated Axminster, April 12, 1802, from Mr. Nicholas Bragge to Sir William Elford, Baronet, we find the following communication : " It is now more than thirty years ago that I first made experiments, and proved that the vaccine disase was a preventive against the small-pox, and it is, I believe, more than twenty years ago, that, through the Rev. Hermen Drew, I acquainted Sir George Baker, Baronet, with the observations and experiments I had made. It is twenty years ago that Mrs. Rendall, the wife of a vegetable farmer in the parish of Whitechurch, near Lyme, in Dorsetshire, inoculated herself ai d three or four children for it; and these children, who have long since arrived at manhood, have inoculated their friends and neighbors whenever an opportunity has offered.v Many communications of a similar nature may be found in the Report of the Committee of the House of Commons on Dr. Jenner's Claims. In the year 1767, a butcher, near Bridgeport, aged twenty, being informed that if he would allow himself to be inoculated with cow-pock, it would preserve him ever after from taking the small-pox, with which he had not been previously affected, was accordingly inoculated by a needle in two or three places on the hand. In eight days the parts inflamed, the hand swelled, headache and other symptoms of fever came on. He was after wards inoculated for small pox several times, and exposed in every way to it, but did not take the disease. Mr. Benjamin Jesty, farmer of Downshay, in the Isle of Purbeck, ap- peared at the Vaccine Pock Institution, London, in August 1805, when he afforded satisfactory evidence of his having vaccinated his wife and two sons, Robert and Benjamin, in the year 1774, who were thereby rendered unsusceptible of small-pox, as appeared by the exposure of all the three parties to that disorder frequently during thirty-one years, and from the inoculation of the two sons for small-pox nineteen years before. He was led to undertake this novel practice in 1774, from knowing the common opinion of the country ever since be was a boy, that persons who had gone through the cow-pock were unsusceptible of small pox, from himself being rendered incapable of taking that disease, having gone through the cow-pox many years before; and from having known many individuals, who, after 298 Jlistory of Coic-Pox Inoculation in England. the cow-pock, could not be infected with small-pox. During their visit to London, Mr. Jesty and son willingly submitted publicly to inoculation-the former with cow-pock, and the latter with small-pox-in the most rigorous manner, but neither could be infected. Mr. White, of Bath, in a letter to Mr. Greaser, of that city, mentions the case of a laboring man who, about the year 1780,being then a farmer's boy, had the disease communicated to him in a frolic, upon a small scratch in his hand, by one of his fellow servants, who had gotten it by milking a cow. He has since been repeatedly inoculated without effect; his family has had the inoculated small pox around him, and he has more than once been exposed to the most malignant species of that disease without any sort of effect being produced upon him. About the year 1782, when Dr. Archer was physician to the Hospital for Small-pox Inoculation, Catherine Wilkins, from Crichlade, Wiltshire, who had had the cow-pock, in consequence of milking cows, (tame to her brother in London, who, being desirous of ascertaining whether this circumstance could be depended upon as preventive of the small-pox, sent her to the hospital for inoculation, where she was inoculated with variolous matter by the doctor, against which, however, she was proof. In the year 1787, when there was a general inoculation for the small-pox in Wincaunton, in Somersetshire, a young woman was twice inoculated without effect. The failure was attributed to having had the cow-pox some years before. The failure so often remarked of communicating small pox to blacksmiths by inoculation, must have arisen from them previously having been in- fected with the equine pock, in dressing the horses' heels laboring under that complaint. The first allusion to cow-pock on record is noticed by Dr. Jenner, in a letter to Mr. King, " When the Duchess of Cleveland." said he, " was taunted by some of her companions, that she might have to deplore the loss of that beauty which was then her boast, (the small-pox at that time was raging in London) she made a reply to this effect, that she had no fear about the matter, for she had had a disoider, which would prevent her from ever catching the small pox." The author from whence this intelli- gence was derived, could not be recollected, but Dr. Jenner was disposed to believe that it alludes to cow-pock. Jenner, in his first treatise, besides referring to cases in which the dis- ease had been accidentally transferred to various persons at different pe- riods long past, mentions it as having been specially noted in the Glouces- tershire dairies in 1770, 1780, 1782, 1791 and 1794. Jenner's first vaccination was performed in 1796, from a casual vesicle on the hands of a milker, but this source was not gone on with. In 1798 he met with the disease again, then raised his first stock of lymph. After the publication of Jenner's discovery, accounts were obtained of cow pox having occurred in at least eighteen counties besides Gloucestershire, the county in which his own observation were made. In January, 1799, Wood- ville met with the cow-pox in the London dairies, and propagated the dis- ease to the human subject. In the spring of the same year cow-pox was seen in North Nibley, in Gloucestershire, and another stock obtained from it for Jenner's use, and soon after he also obtained a new supply from the Kentish Town. In 1836, Mr. Leese, one of the vaccinators of the National Vaccination Establishment, obtained a stock from the eow, and propagated it. In 1838, the disease was met with in Gloucestershire by Mr. Estlin; in 1838 or 1839, iu Dorsetshire, by Mr. Fox, of Cune Abbas; in 1839, also in History of Cow-Pox Inoculation in England. 299 Dorsetshire, by Mr. Sweeting, of Abbotsbruy; in 1838, 1840 and 1841, in the Vale of Aylesbury, by Mr. Ceely; from all these sources lymph was transferred to the.human subject. No doubt the disease might nave been found much more frequently if it had been only thought worth while to look for it, and it is probable, also, that cases had been found, and used for raising lymph, which have passed unrecorded. When the Epidemiological Society made inquiries in 1851, several in- stances in which practitioners had met with cow pox, and had vaccinated with the lymph obtained from it, were brought to light; as by Donald Dalrymple of Norwich, by Mr. Beresford of Narborough, in Leicestershire; by Mr. Gorham of Aldeburgh, by Mr. Alison of Great Retford, by Mr. Coles of Leckhampton, by Mr. Rudge of Leominster, and one or two others. Mr. Sweeting met with the disease in two instances, and dissemi- nated lymph obtained by the vaccination of persons from each source. In Ireland cow-pox was early reported as having been known, and anti- variolous powers attributed to it. It is also worthy of note that Dr. Gregory experimented with a renewed lymph at the Small-Pox Hospital* in 1836. The source of the new lymph is not mentioned, but the difference in re- sults from the lymph in use at the hospital, may be given in Dr. Gregory's own words: "the lymph in use at this hospital has been preserved in un- interrupted descent for a very long period of time; but for three or four years past I have noticed that its intensity was diminished, and that eight or ten incisions produced no more irritation than the three to which Pwas accustomed fifteen years ago. In March last (1836) Mr. Marson, the resi- dent surgeon,employed lymph obtained from a different source. This lymph was found to be more intense and active than the old lymph. Three or four incisions were now found amply sufficient; and so satisfied was I of the superior quality of the new lymph that, after a careful trial of about two months, the old lymph, was suffered to die out, and for the last six months we have vaccinated from the newstock. The facts have convinced me that vaccine lymph in passing through the bodies of many persons loses in process of time some essential portion of its activity. It follows from this that an occasional resort to primary lymph from the cow becomes a matter of great importance, perhaps even of indispensable necessity." HISTORY OF THE COW-POX IN IRELAND. According to Dr. Samuel B. Labattt, in some parts of Ireland, particu- larly in the County of Cork, the cow-pock, under the name of the shinach^ has for ages been esteemed a perfect preventive of the small-pox, so much so that old women have been in the habit of bringing children to the neigh- boring dairies to have them affected with it. Dr. Barry, of Cork, gives many instances of persons having had the cow-pox more than fifty years before; and informed Dr. Labatt, that one woman, aged eighty years, as- serted that as long as she could remember, an opinion prevailed, that those who had the cow-pock cannot take the small-pox, and that people pur- posely exposed themselves to the former under that persuasion. Dr. Huston, of Colerain, an eminent practitioner of long standing, and one of the earliest and most zealous promoters of vaccination in Ireland, communicated to Dr. Labatt the following facts: •Medical Gazette, vol. xxi, p. 861. tA.n Aildress to the Medical Practitioners of Ireland, oil the Subject of Vaccination. Second Edition. By Samuel B. Labatt, M. D., etc., Dublin, 1840. 300 History of Cow-Pox in Ireland. " Before Dr. Jenner's discovery of cow-pock, I met with two mothers of families who had not had small-pox, and when inoculating their children, I inoculated the mother also. All the children passed through the disease regularly and safely, but nothing took place in the mother's but a trifling local affection ; and since the discovery of cow-pock I have met with many females who never had small-pox, and I inoculated some of them with small-pox infection, and in every one of them only local affection was produced; and I was, in several instances, able to trace this unsusceptibil- ity-to their having, several years before, contracted infection from the cow, in their hands in milking. 1 believe that almost all the female cases here mentioned were owing to cow-pox in milking, for few men escaped small- pox." A gentleman from the County of Wexford, in 1804, informed Dr. Labatt of three women, who, the year before, in consequence of milking cows affected with sore nipples, were attacked with considerable inflammation of their hands, attended with much pain; they were then very young, and never had the small-pox, and although they were repeatedly since exposed to the contagion, they <lid not take the disease. Before the publication of Jenner's discovery, cow-pox had long been known in Wexford and the ad- joining counties, where it was called punthans or punclhane, and was esteemed a certain preventive of small-pox; it had also been observed among the cows in the neighborhood of Dublin.-An Address to the Medical Practitioners of Ireland, on the Subject of Vaccination; Second Edition, pp. 27-28. HISTORY OF COW-POX IN THE DUCHIES OF SCHLESWIG AND HOLSTEIN. The knowledge of the circumstances of the origin of cow-pox in different countries and at various times, is of great importance ; for to this source must the medical profession, in all time to come, look for fresh uncontamin- ated supplies of vaccine matter, wherewith to protect mankind from the inroads of small-pox. The history of cow-pox in England has up to the time of the publication of the work of Dr. Woodville, been fully recorded in the works of Jenner, Pearson and Woodville ; and it has been shown that the disease was known in Peru and Mexico before the introduction of vaccination in those coun- tries. The most important addition to the history of cowr-pox in the early part of the eighteenth century, was made on the third of December, 1802, by the Medical Faculty of Kiel, in their report to the Royal German Chan eery of Copenhagen, relative to the cow-pox in the Duchies of Schleswig and Holstein. The report of the Medical Faculty of Kiel was signed by Drs. Acker- man, Weber, Heusler, Fischer and Pfaff, and was based upon the replies to the memorial sent by them to all the districts, and other physicians of duchies and neighboring provinces, especially the Circle of Eaton, and cir- culated still more generally by the care of the chancery. The second section of this report related to the observations which had been made on cow-pox as affecting the cow, as well as the facts known in Holstein prior to the Jennerian discovery; the effects of cow-pock on the human body, and especially its power ot preventing small-pox. In arranging the facts contained in the report, the Faculty of Kiel fol- lowed the order in which the questions were addressed to the physicians of both duchies: history of Cow-Pox in Schleswig-Holstein. 301 1. How long has the cow-pox been known in either duchy, according to indisputable evidence The reports unanimously agreed in stating that, where it occurs, it has been known for several generations. Dr. Heinze referred to an epidemic cow-pock among the herds at Ohlen- rade as far back as 1746, and named his authorities, who were then living. A countryman, Daniels, of Halendort, remarks, that before the time of his mother, who is now eighty years of age, the cow-pox was known ; and, in the family of Inspector Carstens, at Monch Neversdorf, the knowledge of it goes as far back as when his grandfather was a boy. According to the reports, the cow-pock was known in the greater part of Holstein, especially on the noble estates in the Probstey and their neighborhood ; in the contiguous county of Oldenburgh ; in the county of Eutin; in Oldesloe, Legeberg; and in the tract of country from thereto Rendsburg; in short, in the Eastern parts in general, while it is totally unknown in the Western, as in Pennebury; in Gluckstadt; and especially in the parishes, as those of Norder and Siiderdithmarschen; in Wilster- marsch ; in the marshes of Schleswig, Eiderstadt, and in the neighborhood of Tondeln. It prevails especially among the numerous herds of the great dairies; commonly spreads, when it appears, very quickly through the whole herd; and often returns to the same herd, like the epidemics of small-pox among men, after longer or shorter intervals of fifteen, twelve, ten, or even a few years. On the contrary, there are cases where, in the course of thirty or forty years, it has only appeared once in the herds of the same dairy. In the very country where it has once raged among the large herds of the dairies, it has not affected the single cows of the peasantry. In Wulfdorf, the cow-pox was epidemic in 1762, while the cows were still in their stables; and again in 1764, after they' were out at grass. As no vaccinations were taken, it affected the whole of them. The farmer whose name was Stuhr, did not regard it, as he knew a remedy' which alleviated it much, and rendered it very' short. It consisted of green euphorbium in powder, mixed up, to the state of a thick salve, with frbsh butter. The size of a pea of this rubbed into every pustule, destroyed the poison ; and a hard crust was quickly formed; the inflammation of the teats disappeared; the crust fell off in a few days ; and, in a few days more the teats were well. He applied the same remedy to the hands of the milkers who were infected, and often prevented, by means of it, the painful inflammation of the arm. In June, 1787, the cow-pox appeared in a herd of 400 cows at Fulter- kamp, and became general. They were, in general, successfully treated, by the application of a compound linament; but some, to which it was not soon enough applied, lost their teats. Dr. Heinze quoted thirteen other •cow-pox epidemics, which prevailed in different herds, in different years, and at different seasons ; and by which individuals were infected, who re- sisted the small-pox during life. 2 and 3. " What different hinds of cow-pox are known m your district f How are they distinguished from each other, by color or other character The reports furnished less conclusive information on these subjects. In general, they agreed that there are several kinds of pOx which affect the cow, but the character of these are, in part, so imperfectly given, that an accurate diagnosis of them is still a deficiency. Several reports distin- guished the cow-pox. (a). In regard to it sin tensity, into mild and malignant. They7, however, were said to resemble each other in their essential external characters, such 302 History of Cow-Pox in Schleswig-Holstein. as color and form ; and to be distinguishable from each other by the fol- lowing circumstances: The mild are more distinct (tariol dincutm), and somewhat larger, be- ing as large, or larger, than a pea; all the symptoms connected with them, as the swelling of the teat and udder, the pain, etc., are milder; and the subsequent ulcers are not so deep, and heal without any further bad con- sequences. . The malignant, on the contrary, are more frequently contiguous, and, as it were, confluent (variolconduentes), and smaller, not being larger than a lentel; and, in the sequel, form a confluent ulcer, covered with a single crust, accompanied with much swelling and pain, and even sometimes caus- ing rhe loss of the whole teat or udder. According to some reports, however, the malignity of the cow-pox ap- pears to be connected with other more specific differences : (i). From the reports it appeared that there are various species, differing in their color, appearance, form, relation to the small-pox, etc.; but in most of the reports the characters were too vague to admit of the enumeration of the different species with certainty. Dr. Nissen, by transmitting to the Medical Faculty of Kiel, colored drawings of the different kinds of cow-pox seen by himself, threw the great- est light on this subject. By comparing these drawings with the other re- ports, the Medical Faculty enumerates the following kinds of cow-pox. 1. The Blue genuine cow-pox, which is also described by some as blue- grey, pearl-colored, and even white. Accordingto Dr. Nissen, they are the smallest which he has observed, and the most benign ; they discharge much matter, and the ulcers eat somewhat deep, but they form a crust much sooner than the other kinds. 2. The yellow cow-pox, which was stated in the greatest number of the re- ports to be smaller than the former, and are described to be yellow from their first appearance, and to continue so, containing a yellow matter, are also contagious, *but according to one account, at least, do not afford se- curity against the small-pox. As observed by Dr. Nissen, the yellow, or brownish-yellow cow-pox, were larger than the blue, and almost transpar- ent, emtited an extremely unpleasant and almost putrid smell; and soon degenerated into itchy, eating sores, from which matter and blood fell in drops. In cows with reddish stripes, they had more of a brownish color. They were infectious, and the boils and ulcers arising from them had the same unpleasant effect on those who milked them. Those who were infect ed by them were often confined several days in bed, suffered some pain in the pustules, and were in danger of losing some of their fingers. To this species belong the red or yellowish-red variety, to which Mr. Henckel, surgeon in Lehnsahn, gave the title of malignant, and which, when together, acquiring the appearance of yellow wax, and stinking abominably. 3. The Black Cow-pox. Dr. Nessin alone described them minutely. They were larger than the blue species observed by him; had completely the ap- pearance of scrofula ; also, degenerated into bad ulcers, like the yellow kind ; and, in the manner of their drying up, resembled them exactly. On the hands of the dairy-maids who were infected by them, they were equally large and black ; and when they changed into ulcers are particularly deep, 4. Wind Cow-pox, which resemble blisters, and contain a watery fluid only; they are said to be less infectious than the yellow cow-pox, and to afford no security against small-pox. History of Cow-Pox in Schleswig-Holstein. 303 5. Red Cow-pox. Dr. Heinze remarked them in about twenty cows in the country meadow in Pretz. The red vesicles stood like pearls, and con- tained thin matter. 4. What influence is the cow-pox said to have on the cow, and, perhaps, also, on other animals? All the reports agree that the cow-pox, considered as a general disease, is slight, and that the constitution never suffers obviously, since during its continuance the cows eat, chew the cud, stale, and sleep as before; and, considered as a local disease, the degree of violence varies much ; but even in the most violent degree, the general health does not suffer obviously. It was always treated as a local disease, and the application of appropri- ate remedies, which individual farmers and cow doctors have long em- ployed, and which, according to valuable observations communicated with regard to them by Dr. Heinze, are slight caustics, are attended with speedy effect. Even the secretion of milk in many cases is not obviously affected, and in the worst cases not entirely suppressed. The influence of cow-pox in other animals is not mentioned in any of these reports, and one of these distinctly states, that other animals, as horses and sheep, which pasture on the same meadow with the diseased herd are not affected by it. Also all these reports mention only the cow- pox of milk cows, and never hint at its being communicated to calves, bulls, or oxen. 5. " What proofs can be deduced from the accounts in your dictrict, with any certainty, that cow-pox is a preventive oj small-pox The greatest number of reports, from the districts where cow-pox is known, agreed that its powers of preventing small-pox have been known as long as the disease itself. About fifty cases were recorded in these reports, illustrating the security afforded against small-pox by cow-pox, with the names, age, and sex of the individuals when alive, and of the authorities, when dead, specified. The most remarkable was that of a woman, still alive in 1802, who had the cow-pox when a year and a half old, and who remained secure against small-pox infection for sixty years; another fifty-six years, some about forty, several thirty, and some twenty, almost all alive in 1802. The daughter of a farmer of the name of Priehm, when fourteen years of age, was affected with the cow-pox in 1746, when it was epidemic in the herd at Ohlensade. She married M. Martens; lost eight children in the malignant small-pox, whom she attended without being infected ; and in 1802, being above seventy years of agerlived with her son; and four years before nursed her grand-child who had the small-pox from inoculation. In 1742, when the cow-pox was epidemic in Legalendorf, Mrs. Volker, then only a year and a half old, was infected by her mother, who was at that time obliged to assist in milking the cows. On returning to her house, her mother took her out of the cradle to wash her, probably with- out having previously washed her own hands; and a pustule, which had a bluish appearance, and had a large areola, appeared on one of the labia pudendi. In 1749 the small-pox came into the country, and she slept in the same room with her infected brethren; she also nursed her own children when ill with the small-pox; and at other times was frequently exposed to infection. In lb02, she was sixty-three years of age, and lived with her son-in-law, Daniels, in Legalendorf, and was still proof against small-pox infection. Most of the fif y cases mentioned in the reports of having the cow-pox, were repeatedly exposed under the most favorable circumstances to the 304 History of Cow-Pox in Schleswig-Holstein. small-pox infection, and five of them allowed themselves to be inoculated for the small-pox along with their children, without any effect, although the latter took the disease. There was rarely in the reports any specification of the kind of cow-pox which afforded security against the small-pox, but when there was, it is re- ported as genuine blue cow-pox. Four observations of an opposite character were recorded, where small- pox occurred after cow-pox, in these reports. The wife of Abraham, steward at Behrensbrock, according to the information given to M. Mehring, Surgeon at Emkendorf, by her neighbor Lerch, who himself had had the cow-pox several times, had the cow-pox very severely; and, if Lerch remembered accurately, even several times, and yet she died of small-pox nine years be- fore 1802. What kind of cow-pox she is said to have had is not mentioned. The second case was mentioned by Kofal, the dairy-woman on the estate of Cadcn, to the steward. Her son was infected pretty severely by the cow- pox in the hands and arms, in consequence of milking the cows; and, almost a year afterwards, he took the small-pox along with the rest of the children. This was a case of infection by the spurious yellow cow-pox, as was fully proved by the accurate description of it, and by other circumstances, as the want of any constitutional affection, except the pain, and the absolute similarity of symptoms in those affected, whether they had previously had the small pox or not, etc. Mr. Henckel, of Bensahn, Surgeon, relates two cases, but which on the one hand were not sufficiently attended, as the sub- jects were not alive, and on the other it was uncertain whether the cow-pox which failed to give them protection, was genuine or spurious. Dr. Weber, more than twenty-five years before 1802, had his attention directed to the cow-pox by landed proprietors and dairymen, and made his pupils acquainted with the subject. Among the great numbers whom he inoculated with small-pox, he always met several from the country, of whom it was said, that the inoculation would not succeed, because they had had the cow-pox; and this was most commonly the case. A few of them only took the small-pox from inoculation. Even at that time he was in- formed that occasionally country people inoculated themselves by simply scratching the hand, and rubbing in fresh cow-pox matter, to prevent them from taking the small-pox. Two girls, effectually inoculated thus with the real blue cow-pox, the one three and the other five years, afterwards took the small-pox in a severe and confluent form. These two instances Dr. Weber knew from personal observation; and he had heard of two others from a farmer well acquainted with the eruption, one of which was bis own daughter. 6. "Has any unpleasant consequences been observed from the action of the cow-pox in the human body ?" All the reports agreed that the cow-pox was followed by no consequences prejudicial to health. This was proved by instances of persons who had the cow-pox in their youth, were preserved from small-pox all their lives, and lived to the age of sixty, seventy and even eighty. The cow-pox received by infection in most of these reports, is described as very mild, so far as respects the general affection, and also as a local disease. A single case only is mentioned, in which a pretty smart fever with delirium, arose from infection ; and several cases were quoted where the local affection was considerable, consisting of & great swelling of the whole arm, with violent inflamnation and pain, but without being followed by any local con- sequences. History of Cow-Pox in Schleswig-Holstein. 305 7. u What effect has the cow-pox on those who have already had the small-pox, especially on the dairy-maids V Most of the reports agree that those girls who have had the small-pox are still susceptible to the cow-pox; but at the same time the local affection is much slighter, and the disease was then, in the strictest sense of the term, local. 8. "We are assurred that, in small places of the duchies, there are families of country people in which either the real inoculation of the cow-pox, or at least intentional infection, by milking, has for several generations been practiced, partly as a secret for preserving themselves from the smallpox. Are there any proofs of this assertion in your neighborhood Although the reports contained no direct answer in the affirmative, it may be concluded, from several accounts, that particular families had long availed themselves of the advantages resulting from vaccination. Several instances are related in which they intentionally exposed themselves to in- fection from pustules in the cow, or even practiced inoculation coarsely, and recommended it to others. It is further remarkable, in this point of view, that all the members of the family of the Inspector Carstens, from the grand-father downwards, viz., he and all his brethren, the father of Mr. Carstens and his mother, also his father-in-law and all his children, including Mrs. Carstens, were preserved from the small-pox by having the cow-pox in their youth. Dr. Heinze relates u remarkable instance which fell under his own observation, of a schoolmaster, Plett, in Laboc, who, in 1792, inoc- culated three children of a farmer called Martini, at Lammers- hagen, by introducing fluid matter, taken from the cow, into a wound made with a pen-knife in the skin between the fingers, and with success, as they resisted the small-pox, when epidemic there, and who was only deterred from continuing the practice, by the great swelling in the arm of the youngest child. 9. " Is there any positive proof, that persons having the cow-pox hav' infected others One instance is particularly mentioned by the Rev. Mr. Holst, of Riel, and Dr. Heinze, with the names of all the parties, some of whom were still alive, of a person who was infected with the cow-pox by milking a cow, com- municated the disease to her sister's hand by rubbing it with her infected hand, by which means her sister was secured against the small-pox. A second case was mentioned of a child infected by its maid ; and a third, of a child by its mother, who had previously milked a cow without either of them having the cow-pox themselves. The propagation of the infection amongst the cows, was chiefly occa- sioned by the hands of the milkers, even when these were only soiled with the matter from the cow, and not themselves affected with the disease. With reference to the question as to the origin of the coic-pox from the grease (Manke) in horses, all the reports with the exception of one answered in the negative. Mr. Fries, surgeon in Pratz, was informed by a veterinary surge m of the name of Brasch, who lived upon the estate of Rixdorf, that the dairy-man atTresdorf, below Rixdorf, had a newly foaled mare, so very ill with the grease, that at last the udder was affected to such a degree, that the foal could not suck her any longer. He therefore, ordered one of his maid servants to milk the mare daily, and every day after milking her, to rub her hands with some ointment. This girl also milked the cows; and, in a short time, the whole of them were affected with cow-pox, of which there did not previously exist among them the slightest appearance. »If this statement is accepted as correect, it is an evidence that the disease was not confined to the heel or the horn but affected the entire system, and it is now reasonable to regard this as an instance of horse-pox. 306 Cow-Pox in Germany. This view is sustained by the observations of Mr. Kolen, a veterinary surgeon, to the effect that persons who dressed the horses' heels afflicted with the grease (Manke) and then milked the cows, failed to communicate the cow-pox; and of the Privy Counsellor, Von Thienen, that on his estates, which were very wet, the grease was very frequent, while the cow-pox, in a period of forty years, has appeared in some of them only once, and others not at all; these marshes, and some other situations, where the grease is very common, being free from the cow-pox; the frequency of cow-pox in Holstein, where the milk-maids have no connection whatever with the horses. COW-POX IN GERMANY. in Germany, after the promulgation of Jenner's discovery, inquiries showed that cow pox had been recognized in various places, especially in Mecklenburg, Holstein, Brandenburg, Silesia, in the country about Greis- sen and Erlargen, and also in Switzerland. A statement was found in a Gottingen newspaper, of the date of 1769, that this disease had been often seen about this place, and milkers affected by it were thereby protected against the small-pox. An instance of cow-pox occurred in Wirtemberg in 1802. In 1812, the disease was seen in Berlin and its environs, by Bremer; near Luneburg, by Fischer, and in Greifswalde by Mende; in 1816, at Leggerde in Bruns- wick, by Giesker. In the eleven years preceding 1824, Luders saw several epizootics of the disease in Holstein, and in 1824, 1825, 1829, 1830 and 1832, Ritter made some successful vaccinations from cows which he found suffering from it in various parts of Schleswig-Holstein. Ritter says that in some parts of Schleswig-Holstein the disease is very common ; he had himself seen it on many previous occasions, but not in the stage admitting lymph to be taken,nor till the pustules on the milkers' handshad become sores. Probable examples of the disease were then met with in 1829 by Riss at New Breisach, and by Albers, near Stralsound, in 1834. The history of the discovery of cow-pox in Wirtemberg is interesting as showing how much these discoveries depend on the zeal with which the disease is looked for. In as much as the tendency of all herd-keepers and their servants is to keep secret the existence of any disease among their cattle, the Government offered premiums for the discovery of natural cow-pox in the cow ; and in 1825 it was determined that a prize should be given for each case of cow-pox reported, which should be found in such a state that the character of the disease could be well ascertained, and the case used for vaccinating from. Cases were met with every year, and in eleven years (1827-37) the genuine cow-pox was found (in a state that suc- cessful vaccination could be performed from it) in sixty-nine different places, the cows affected by it amounting to eighty-four; besides which there were reports from 152 places, regarding 208 cows, in which the dis- ease probably was cow-pox, though vaccinations were either not performed at all from them, or were unsuccessful. In Holland, according to Numann, cow-pox was seen in 1805, in 1811, and in 1824. In Russia, in 1838, an epizootic of cow-pox is said to have occurred among the cows in a village in the neighborhood of St. Petersburg. In Italy, cow-pox was discovered in 1800, on the plains of Lombardy by Saceo, and again in 1808 and 1809, by the same successful vaccinator; in 1830 it was seen in Peidmont. In 1812 it was discovered at Naples. In 1832 and 1834, it was found at Rome on cows of Swiss breed, by Dr. Macer- oni, and in 1834, a lymph stock was established. Coic-Pox in France. 307 In France, cow-pox is said to have been found in 1810 in the department of La Meurthe ; and in 1822, at Clairveaux. In 1836, it was discovered at Passy, Amiens and Rambouillet; in 1839 it was discovered at Rouen; in 1841, at Saint Illide, at Saint Seine, at Pertlhac; in 1842, at Pagnac; in 1843, at Veux Junieaux; in 1844 in a cow belonging to M. Magendie; in 1846 in three departments ; in 1852 at Rheims, and also in the department of Eure-Et-Loire ; in 1854, in the arondisement of Sancerre and at Bezieres ; in 1863, at Guzonville; in 1864, on farms in three villages near Nogent, at Petit Quevilly, near Rouen. In 1866, cow-pox was discovered at Beau- gency. COW-POX IN FRANCE. OBSERVATIONS OF M. J. B. BOSQUET* ON THE COWPOX (PETITE-VEROLE DES VACHES), DISCOVERED AT PASSY NEAR PARIS, ON THE TWENTY-SECOND OF MARCH, 1836. On the twenty-first of March, 1836, a woman residing at Passy, a milker, applied to a medical man in the neighborhood on account of an eruption upon her hand. He recognized the affection as the cow-pox, and the same day sent the woman toM. Bosquet. Bosquet states that there were vaccine pustules on the right hand and one upon the upper lip, and he was struck by the unusual bluish tint they exhibited, such as Jenner had mentioned as a characteristic of the cow- pox. From a pustule on the hand he vaccinated nine children. The lymph was taken late in the course of the disease; it was thick, white and puru- lent. Bosquet, however, vaccinated the children with it by three punctures on the left arm, and used the ordinary humanized lymph in three places upon the right arm. In one of these nine children no effect followed in either arm; in the others the old lymph took, and from twenty-four punct- ures there were obtained twenty-two pocks. But in only three of these eight children did the new lymph take upon the left arm, and in each of them it took only in one place. Only one of these three children returned for examination on the eighth day-a weakly, puny infant, three months of age; three punctures on the right arm with the old lymph and one upon the left arm with the new, had given rise to pocks as miserable and lan- guishing as the child itself. M. Bosquet took lymph from the pock on the left arm resulting from the vaccination with the cow-pox matter, and vac- cinated four other children on the left arm, again making a comparative vaccination with the old lympt upon the right arm. All the punctures took-the three with new virus on the left arms and the three with old virus on the right-on all the four children. The vesicles ran a completely parallel course upto the seventh day, when a difference became perceptible in favor of the new virus. The vesicles were better formed, flattened and more depressed in the centre on the eighth day than those from the old virus, more brilliant in appearance and firmer, and the lymph they contained was as clear as crystal. On the twelfth day the difference was still more marked; the new vesicles were flat and nearly four lines broad, firm at the border, prominent and full of force and vital- ity ; the old ones, on the other hand, were already beginning to dry up. *Snr le Cow-pox (Petite-Verole des Vaches) D6couvert a Passy (Pr6s Paris), le 22 Mars, 1736. Notic epar J. B Bosquet, Secretaire du Conseil et Membre de I'AcadGmie Royale M6decin6, Charg6 des Vaccinations Gratnites, Chevalier de laL6gion-d'Honncur, etc. Ave une Blanche Cilri6e. A Paris, 1836. 308 Cow-Pox in France. M. Bosquet presented in his valuable memoir on the cow-pox discovered at Passy, in 1836, the following comparative view of the effects of the old humanized and the new lymph : ANCIEN VACCIN. 1°. Les deux premiers jours aprds 1'opera- tion, les piqflres ne prdsentent rien d'appa- rent. 2.° Du troisidme au quatridme, on aper- yoit un petit point rose, plus sensible au doigt (pi'il 1'oeil. 3.° Dds le cinquidme la pustule vaccin- ale commence a se dessiner avec tons see caractdres; ddjft plate ft son soumet, Idgdre- ment ddprimde au centre ; les jours suivans ces caractdres ne font que se marquer da- vantage. Au septidme jour la pustule tout entiere reflate cet dclat argentd qui la caractdrise, et commence ft s'eutourer d'une petite ard- ole rouge. La consistance en est si molle, que pour pen qu'on y touche avec la lancette, elle se vide, etle virus qui en soit est ddjft un pen louche. 4°. Au huitidme jour l'ardole grandit; au qeuvieme elle s'efface; la pustule plus large et plus haute, se ramollit encore. Le centre se courinne d'un point brun, signe certain d'un commencement de dessiccation. Le virus se trouble de plus en plus. 5°. Du dixidme au douzidme jour la des- siccation fait des progrds rapides Lf bou- ton tout entier se couvre d'une crohte jaun- fttre encore molle, laquelle brunit de plus en plus, et se rapetisse en prenant plus de soliditd. 6°. A partir du trezidme jour, la croftte rdduite au volume d'une grosse lentille, se sdche toujours davantage, et en sdchant elle diminue encore. Elle tombe commune- ment du quinzidme aux dix-huitidme jour. Les cicatrices, en gdndral trds superfici- elles, se font plutdt reconnaitre ft leurteinte rougefttre qu'ala depression qu'elles laisseut ft la peau. Mais au bout de quelque mois, la peau revient ft son ton naturel, et 1'oeil apeine ft retrouvde les trace de la vaccine. NOUVEAU VACCIN. 1°. Des le 1'endemaih de 1'operation, on distingue ordinairement un point rouge qui indique un commencement de travail. 2°. Ce point d'un rouge pins vif, est aus- si sensible ft 1'oeil qu'au toucher. 3°. Monies caractdres, except/ qu'ils sont mienx dessinds; la depression est plus mar- quee, 1'dclat plus brillant, la consistance beaucoup plus ferine. Le virus est parfaitement lempide. Il n'y a pas encore vestige d'ardole. 4°. Le bouton n'est jamais plus beau, plus ferme, plus brillant. L'ardole commence a se prononcde. Le virus conserve sa transparance et sa puretd. 5°. La pustule se ddvelloppe en tons sens, sans changer de caractdre. L'ardole est large et vive, le tissu sons- pacent profondement engorge. Les glandes de l'aisselle sou vent doulon reuses, tumifids, principalement chez les adultes. Ndanmoins il n'y a pas toujours de fidvre, s'il y en a, c'est principalement ft ce mo- ment qu'elle est sensible. Le virus commerce ft se troubler ; mais il n'en est pas moins bon ft transmettre. (j°. Les pustules d'un diamdtre de trois ft quatres lignes, desdchees an centre, prd- sentent un bounelet circulaire sailiant dle- vd, et dont la transparence indique assez 1'dtat du vaccin qu'il contient. Cet dtat dure jnsqu'au quinzieme jour, et quelquefois davantage. L'ardole est encore tres vive et trds eten- due, coinme on peut voir par la graveur. 7°. Du quinzidme an dix-huitidme jour la dessiccation s'dtend ft toute la surface de la pustule. La croftte est plate, large, brune et comme terrdfide. Pour la couleur je ne saurais mieux la comparer qu'ft une amande grille. En meme temps l'ardole pftlit et se retire insensiblement jusqu'a ce que enfin elle s'efface compldtement. La chute des crodtes se fait commence- ment du vingt-cinquidme au trentidme jour. Aux crofttes succddent des cicatrices larges, profondes et traversdes par une foule de petites brides qui leur donnent Cow-Pox in France. 309 ANCIEN VACCIN. NOUVEAU VACCIN. l'aspect reticula. En y posant le doigt, on sent une cavit6 comine s'il y avait en perte de substance. Il n'est pas rare que les crobtes laissent aprbs elles un plaie suppurante, un ulcure dont il faut attendre la cicatrisation. J'ai vu des pustules creusu si profond^. ment la peau qu'elles y faissaient de ver6- tabies trous. pp. 18-19; We may thus briefly sum up the results obtained by M. Bosquet from the use of the old and new lymphs in the numerous comparative vaccina- tions which he performed. The new vaccine proceeds in its course at once more quickly and more slowly than the old-more quickly in that it sooner gives signs of life, more slowly in that its career is more prolonged. The resemblance between the two sources of virus is at no time greater than an the seventh or eighth day. From that period the vesicles are quite distinguishable the one from the other, and the more they advance the more pronounced becomes the separation. As to the size, those of the new vaccine often acquire a size almost double that of the others ; they are also flattened, more brilliant, more umbilicated, better defined, and firmer. When looked at closely, they present to the eye a grained surface, something like that of the rind of an orange; they appear to be more closely and firmly attached to the skin, and as they become more developed they raise and drag upon it; while the old vesicles are slighter, more superficial to the eye, and more raised, and look as if separate from the skin, more after the manner of a " vesicle." Cor- responding to this is the areola; in the one it is active, extended and phlegmonous; in the other, slight, fugitive and erysipelatious. Bosquet describes the cicatrix in the old and new virus: Old.-The scars are in general very superficial, and make themselves evident when the crust has fallen, rather, by their reddish tint than by any depression left in the skin. At the end of some months, however, the eye can, with difficulty, if at all, discern any cicatrical trace whatever. New.-The crusts are succeeded by large cicatrices, traversed by a mul- titude of little bands or bridles, which give them a reticulated appearance. Laying the finger in one of these a cavity is easily perceived, as if there had been a decided loss of substance. It is not uncommon for the crust to leave after them suppurating wounds or ulcers, the cicatrization of which may be considerably delayed. M. Bruchir, of Versailles, also made comparative re-vaccination upon twelve persons, using the new lymph upon one arm and the old upon the other; he found that the new produced well developed and perfect pustules, equal in numbers to the punctures, while the old, if it took at all, gave only modified or false pustules. Several medical men experimented sub- sequently with the new lymph, and their observations confirmed those of M. Bosquet. Similar results were obtained by Mr. Estlin, by ttie use of cow-pox mat- ter, which he obtained on August 18, 1838, on a farm in Gloucestershire, where several of the cows were affected and where the farm servants had received the contagion. (Medical Gazette, vol. 22, p. 977, "Accounts of a Supply of fresh Vaccine Virus from the Cow." Medical Gazette, vol. 24, p. 2075. Steinbrenner's observations with Mrs. Pass's lymph in 1840, and with new lymph obtained from other sources 1841 and 1845, confirmed the accu- racy of the results announced by Bosquet in 1836. 310 Discovery of Cow-Pox in America. DISCOVERY OF COW-POX IN AMERICA. Don F. Xavier Balmes, Director of the Spanish Vaccine Expedition, dis- covered cow-pock in the cows of the valley of Allixico, near the city of Puebla de los Angelos, in the neighborhood ot Volladolid, in Mechvachan, and in the districts of Calaboza, in the province of Caraccas, and in the Peruvian Andes. Dr. Waterhouse informed Dr. Jenner of the existence of cow-pock in sev- eral parts of America, where its anti-variolous power was not unknown. "As one of our periodical inoculations," says Dr. Waterhouse, "which occur in New England once in eight or nine years, some people drive their cows to an hospital, near to a populous village, in order that their families might have the daily benefit of their milk. These cows were milked by persons in all stages of small-pox, the consequence of which was, the cows had an eruptive disorder on their teats and udders, so like small-pox that every one in the hospital, as w'ell as the physician who told me, declared the cows had the small pox." Thus according to Dr. Waterhouse the human small-pox was conveyed to the cow, in the same manner as the cow-pock was communicated from the cows to the milkers in dairy countries, and the statement was strongly confirmative of the doctrine of the identity of small-pox and cow-pox. The important services rendered the citizens of the United States of America by Dr. Waterhouse and President Jefferson, in the introduction of vaccination into the United States will receive due consideration ; we re- gard it of importance to place in the following facts in chronological rela- tion with the discovery of cow-pox on the American continent. Professor Waterhouse wrote thus to Dr. Samuel Mitchell, of New York, editor of "The Medical Repository and Review of American Publications," in a letter dated Cambridge, Massachusetts, September 26, 1801. "President Jefferson informs me that the kine-pox has pervaded or is pervading his family at Monticello, more than twenty having gone through the genuine disease-at least I presume so from the virus sent him, and the description he has given me of its effects. It is progressing in this quar- ter with undeviating success, very few spurious cases having occurred this season. " Yesterday 1 received a letter from Doctor Jenner, one paragraph of which I must transcribe, because it contains the golden rule of vacccination. " I don't care what British laws the Americans discard, so that they stick to this-Never take the virus from a vaccine pustule, for the purpose of inoculation after the efflorescence is formed around it. I wish this efflores- cence to be considered as the sacred boundary over w hich the lancet should never pass."-Medical Repository, vol. 5, p. 235. In the history of cow -pox inoculation in the United States, it was felt at an early date, that a necessity existed of establishing a point of time for taking the vaccine virus for the purpose of inoculation, as a popular criterion. It was difficult if not impossible correctly to apply Jenner's golden rule in the practice of cow-pox inoculation amongst the African Negro slaves of the United States, owing to the color and structure of the skin of their bodies. In a letter from 5 to Dr. Waterhouse, dated Washington, De- cember 25, 1801, the following inquiry was made: "Knowing how little capable the people in general are of judging be- tween genuine and spurious matter from their appearance or that of the pustule, I endeavored, in the course of my inoculations at M , to find Discovery of Coic-Pox in America. 311 some other criterion for their guide. With this view, I was very attentive to discover whether there was a point of time, counting from vaccination when the matter is genuine in all cases. I thought that eight times twenty- four hours furnished such a point. I governed myself by it, and it has been followed here successfully by Dr. Gantt; but your experience, so much greater, can inform us whether this rule is a sure one, or whether any other point of time would be still more certain. To the eye of experi- ence this is not necessary, but for popular use it would be all-important; for otherwise the disease degenerates as soon as it gets into their hands, and may produce a fatal security. I think some popular criterion necessary to crown this valuable discovery." The following is the answer of Dr. Waterhouse: » " I was forcibly impressed with the necessity of fixing on some point of time, by way of popular guide, when to take the vaccine fluid for the pur- pose of inoculation, in order to prevent the evils you suggest. " I know that the perfection of the virus differs somewhat in different subjects; but in the formation of a general rule it is necessary to impose a limitation. Dr. Jenner says, 41 prefer the fifth day, or the sixth, or the seventh, eighth, or (if the efflorescence is not far advanced beyond the mar- gin of the pustule) the ninth day.' But I conceive this is impossible to be discovered with requisite precision on the skin of the African. The crite- rion of lympid matter is fallacious; for, in the rising of a vesicle from almost any cause, the scarf-skin separates from the true, and a portion of the superfluous water of the blood, and sometimes of the coagulable lymph is found under it. 1 have known this limpid fluid exude in considerable quantity from the vaccine pustule that has been too much irritated by pricking, and exhausted of its virus. It gives a shining, glazy appearance to the thread. I know of no writer or practitioner who has made this dis- tinction. "Were i then to fix on a point of time, of all others, as a general and popular rule, I should say eight times twenty-four hours, this being the re- sult of my own experience. "BENJAMIN WATERHOUSE. "Cambridge, Jan. 28, 1802."-Medical Repository, vol. 5., p. 347. Dr. Samuel T. Mitchell and Dr. Edward Miller, of New York, editors of The Medical Repository and Review of American Publications, at an early day in the history of vaccination, suggested to the physicians of the United States, to inquire for the vaccine disease among the cows of this country. -See Medical Repository, vol. 4, p. 322. Dr. William Buel of Sheffield, in the State of Massachusetts, in a letter to Dr. Edward Miller, dated twentieth May, 1801, describes the case of a lad in his neighborhood affected with an eruption on the face and hands, greatly resembling vaccine pustules, to whom he was called on the tenth of the preceding month. With matter taken from these pustules, he inoculated several persons, and observed the disease to pursue a similar course and to exhibit similar phenomena to a case of actual vaccine pox under his care. And after the termination of this new disease, he tested it, as usual, by variolous inoculation, with the same happy results as, in other cases of vaccine pox. Upon inquiry he found that he had sometimes milked cows, that these cows had been observed to have sore teats, and that the hands and face of the lad had been prepared for the reception of the disease by having been previously scratched in play with liis companions. Dr. Elisha North, of Goshen, in the State of Connecticut, who had bestowed much attention on the vaccine disease, found it among the cows of that neighborhood, and inoculated it with success. 312 Introduction of Vaccination into the United States. In a letter of the twenty-fifth of May, 1801, to Dr. Edward Miller, he an non need the discovery of cow-pox and stated that the inoculation of the disease had been tried in a number of instances with complete success. Dr. Joseph Trowbridge of Danbury, in the State of Connecticut, in a let- ter to Dr. Samuel L. Mitchell, dated the sixth of July, 1801, communicated a similar discovery which he had made among the cows of that place. At that time he had inoculated three persons of his own family, and the disease produced by the inoculation exhibited all the appearences of the genuine vaccine pox. Medical Repository, vol. 5, New York, 1802, p. 92. INTRODUCTION OF VACCINATION INTO THE UNITED STATES OF AMERICA. Since the spreading of the small-pox on the earth, by the increased in- tercourse of mankind, its violence had been seriously felt by most civilized nations, frequently by the uncivilized people who traded with them. Dreadful were its ravages in Europe before the Asiatic method of lessen- ing its fury by inoculation was introduced; and even after that time, and the adoption of this artificial and safe method of infecting the constitution with the venom, the benefits by inoculation were only partially experienced for it tended to keep alive the disease; the introduction of small-pox, even in the inoculated form, had been prohibited in some States by laws; and in others where no such prohibition existed, the expense and trouble of undergoing the disease, debarred many from submitting to its operation. It seemed politic and proper to the governments of those parts of feder- ated America, called the New England States, to prevent, by various legis- lative provisions, the introduction and spread of small-pox among their citizens in the natural way, and, in some, by inoculation. In consequence of such statutes, it was many years customary for persons in New England who wished to have the small-pox, to come to New York for the purpose of being inoculated, and, after their recovery, to return home. There was an inconvenience in this, but this was thought a mere trifle compared with the evil of its indiscriminate introduction. In sea-port towns, possessing a large share of foreign commerce, it had been found impossible to exclude this malady altogether.; and in spite of all possible precautions, the con- tagion would, at certain times, be secretly introduced. To relieve them- selves, in some degree, from the perpetual anxiety of having the small-pox spread among them in the natural way, the inhabitants of the town of Bos- ton underwent a general inoculation, by common consent. Dr. Benjamin Waterhouse, of Boston, who had previously published an instructive account of the various regulations concerning small-pox inocu- lation, was the first to describe to and urge upon his fellow citizens ot New England, the great discovery of Edward Jenner. INTRODUCTION OF VACCINATION INTO THE NEW-ENGLAND STATES, M*6rE ESPECIALLY INTO BOSTON, MASSACHU- SETTS BY DR. WATERHOUSE. Early in the year 1799, Dr. Jenner's work on the variola vaccine reached the shores of North America. Dr. Lettsom transmitted a copy of it to Dr. Waterhouse, Professor of the Theory and practice of Physic in the University of Cambridge, Massa- chusetts. Dr. Waterhouse was not slow to estimate the advantage of the Introduction of Vaccination into the New England States. 313 discovery, aud he published in the Columbian Sentinel of March 12, 1799, a short account of cow-pox. The article was headed "Something Curious in the Medical Line." Not long afterwards he brought the subject be- fore the American Academy of Arts and Sciences. Jolin Adams, President of the United States, who was likewise President of the Academy, was at the meeting and received the communication in a manner worthy of his exalted position as the head of a great and free people, and the patron of every useful art and science. After several unsuccessful attempts to obtain cow-pox matter from Eng- land, Dr. Waterhouse at length succeeded in getting some from Dr. Hay- garth, of Bath, who forwarded it from Bristol. It was procured from Dr. Jenner's stock by Mr. Creaser. With this matter Dr. Waterhouse inocu- lated seven of his children, six of whom went through the disease in the usual manner. In order to confirm the doctrine of the prophylactic powers of the vaccine virus, he resolved to have his children inoculated with small- pox matter in the most public manner. With this intention, lie wrote to Dr. Aspinwall, Physician to the Small-pox Hospital in the neighborhood of Boston, requesting him to inoculate the children. This gentleman assented to the proposal. Three of the children were sent to the Small-pox Hos- pital. One of them, twelve years old, was selected for the trial. Active small-pox matter was inserted by two punctures; an infected thread was likewise drawn through the skin, and the patient then left in the hospital. On the fourth day there was some slight appearance of infection; but it died away and left no traces of its action. The successful vaccinations in the family of Dr. Waterhouse soon turned the tide of popular feeling in favor of cow-pox. A vessel arrived from London at Marblehead. A common sailor on board was supposed to have the cow-pox. Matter was accordingly taken from him, and was used extensively. It was soon discovered that small-pox matter had been employed, and that disease spread rapidly through the neighborhood. The occurrence at Marblehead led Dr. Waterhouse to believe that the vaccine virus had degenerated. He therefore sent a very urgent request to Dr. Lettsom, begging him to apply to Dr. Jenner for a fresh supply. Dr. Jenner complied with his request, and the matter which he sent out arrived early in the spring of 1801. Dr. Waterhouse forwarded some of the mat- ter to President Thomas Jefferson, in whose hands it completely succeeded. Thomas Jefferson did not think it beneath him to set an example to his fellow-citizens. In the course of July and August, Jefferson, with his son- in-law, vaccinated, in their own families aud in those of their neighbors, nearly two hundred persons. • The estimate in which Mr. Jefferson held the discovery of Dr. Jenner, is shown by the following letter: MR. JEFFERSON TO DR. JENNER Monticello, Virginia, May 14, 1806. Sir-1 have received the copy of the evidence at large, respecting the discovery of the vaccine inoculation, which yon have beeli pleased to send me, and for which 1 return you my thanks. Having been among the early converts of this part of the globe to its efficacy, I took an early part in recommending it to my countrymen. 1 avail myself of this occasion to render you my portion of the tribute and gratitude due to you from the whole human family. Medicine has never before produced any single im- provement of such utility. Harvey's discovery of the circulation of the blood was a beautiful addition to our knowdedge of the ancient economy; 314 Introduction of Vaccinnation into the New England States. but ou a review of the practice of medicine before and since that epoch, I do not see any great amelioration which has been derived from that dis- covery. You have erased from the calendar of human afflictions one of its greatest. Yours is the comfortable reflection that mankind can never forget that you have lived; future nations will know by history only that the loathsome small-pox has existed, and by you has been extirpated. Accept the most fervent wishes for your health and happiness, and assur- ances of the greatest respect and consideration. TH. JEFFERSON. The following extract from a letter of Jefferson addressed to Dr. Water- house, illustrates the careful manner in which he studied the progress and varieties of the cow-pox. "Washington, January 14, 1802. " I have waited till I could inform you that some variolous, after vac- cine, inoculations have proved that I had preserved the matter of the kine-pox in its genuine form. Dr. Coxe, of Philadelphia, has ascertained this, having received his matter from hence. To this is added your in- formation that the matter 1 sent you produced the genuine disease, and consequently those in Virginia who received the matter from me are in se- curity. " Knowing how little capable the people in general are of judging be* tween genuine and spurious matter from their appearance, or that of the sore, I endeavored in the course of inoculations at Monticello to find some other criterion for their guide. With this view, I was very attentive to discern whether there be not a point of time, counting from vaccination, when the matter is genuine in all cases; 1 thought the eight times twenty- four hours furnished such a point; I governed myself by it, and it has been followed here successfully by Dr. Gant; but your experience is so much greater, can inform us whether this rule is a sure one, or whether any other point of time would be still more certain. To the eye of experience this is not necessary; but for popular use it would be all important; for other- wise the disease degenerates as soon as it gets into their hands, and may produce a fatal security. I think some popular criterion necessary to crown this discovery." In answer Dr. Waterhouse quoted to Jefferson, the opinion of Dr. Jen- ner, and fixed the time at " Eighth Times Twenty-four Hours." JOHN QUINCY ADAMS TO DR. JENNER. Boston, July 13,1802. The following is the letter of Mr. Adams announcing the election of Dr. Jenner as a member of the American Academy of Arts and Sciences. Sir-I have the honor of enclosing herewith a certificate of your election, by an unanimous vote, as a member of the American Academy of Arts and Sciences, and, in transmitting this testimonial of respect from my country- men, I am sure of expressing their sentiments when I add that never since the institution of this society have its members enjoyed a more genuine and universal satisfaction), by the accession of a new associate, than when they acquired the privilege of reckoning among their number the name of Dr. Jenner. I am, very respectfully, sir, your very humble and obedient servant, JOHN QUINCY ADAMS. Corresponding Secretary to the Academy of Arts and Sciences. Introduction oi Vaccination into the Southern States. 315 Dr. Benjamin Waterhouse* is justly regarded as the first person in Amer- ica who successfully imported aud inoculated the vaccine disease; and his exertions to introduce, disseminate and vindicate this inestimable substi- tute for the small-pox, have given him a just and elevated distinction among those who have signalized their zeal in the cause of humanity. INTRODUCTION OF VACCINATION INTO THE SOUTHERN STATES, BY THOMAS JEFFERSON, OF VIRGINIA. In the preceding observations upon the history of vaccination in the New England States, we have presented the outline of the efforts of Water- house and Jefferson to establish the value and promote the practice of vac- cination amongst the citizens of the American Union. The subject, however, is of such importance to sanitarians, physicians and legislators, that we record the following original documents, as given to the medical profession by Dr. Henry A. Martin, in his valuable memoir, entitled, "Jefferson as a Vaccinator^] The first American vaccination was made July 8, 1800. By the first of September Waterhouse had vaccinated "about fifty persons of different ages, sexes and conditions," and "public attention was thoroughly excited." From "all parts of New England" he received "very numerous letters requesting further information, as well as a supply of matter for carrying on rhe inoculation." With Waterhouse's announcement of the successful vaccination of his family, and the thorough and triumphant test and proof of its value as a perfect prophylactic of variola, hia labors and troubles began ; labors and troubles to be continued through many years, utterly thankless and unrewarded, but performed and overcome with wonderful energy, enthusiasm and wisdom. Innumerable were the inquiries and demands for vaccine virus, and, although he was untiring in his efforts, innumerable the complaints, because all were not answered and every demand not immediately gratified. In the secmar press, in the rarely appearing issues of medical journals, in every avail- able way he ceaselessly cautioned the profession to be careful to follow exactly the pre- cise and admirable rules laid down by Jenner, not one of which has failed to withstand the test of time, or to survive the antagonistic doctrines of innumerable theorists. Over and over again, he repeated, and enforced the repetition with much ability and eloquence that inestimable "Golden Rule" of Jenner already referred to; adhering to which, ex- actly, one can hardly go amiss, and departing whence has been the fertile source of an incalculable amount of evil. It is not too much to say, that, with a precise and accurate knowledge of the develop- ment, from day to day, of the vesicle of true vaccina, not only from its first appearance to the formation of the areola, but from the decliue of that efflorescence until the spon- taneous fall of the scab, and of the true characteristics of the latter as well as of the scar which its fall reveals, and an inflexible determination to observe the "Golden Rule," the practitioner possesses all the knowledge and principle necessary to make a successful and intelligent vaccinator. Waterhouse's cautions and labors were unheeded, misjudged and futile. In his words: " But these repeated cautions were disregarded by the young and san- guine practitioner, who saw nothing but regular cases, little trouble and great profits. If those whom it concerns will not attend to what is written expressly for their inform- ation, they must alone be answerable for the consequences. There are cases where igno- rance is converted into a crime. * A Prospect of Exterminating the Small-pox, being the History ot the Variolic Vaccina; or Kine-pox, commonly called the Cow-pox, as it has appeared in England ; with an account of a series of Inoculations performed for the Kine-pox in Massachusetts By Benjamin Waterhouse, M D., Fellow of the American Philosophical Society, Academy of Arts and Sciences, etc., etc. Cambridge, Hilliard; 8 vo , p. 40. 1800. A Prospect of Exterminating the Small-pox. Eart 2. Being a Continuation of a Narrative of Facts con- cerning the Progress of the New Inoculation in America; together with Practical Observations on the Local Appearance, Symptoms, and Mode of Treating the Variola; Vaccinte, or Kine-pock, etc. By Benjamin Wa- terhouse, M. D., Professor of the Theory and Practice of Medicine in the University of Cambridge. 8 vo., pp. 139; Cambridge, Hilliard; 1800. tNorth Carolina Medical Journal. Thomae D. Wood, M. D., Editor, Wilmington, January, 1881, vol. 7, No. 1, pp. 1-34. The medical profession is indebted to the learned editor of the North Carolina Medical Journal for the preservation and publication of valuable articles relating to vaccination. 316 Introduction of Vaccination into the Southern States. " Perceiving that my reiterated warnings were misconceived and misrepresented, and finding some professional gentlemen in the country so wrapt np in ideas of extreme sim- plicity, that they encouraged women and children to inoculate each other, I ceased from further expressions of that kind, and endeavored to content rayself with predicting the consequences. " During this period, viz : the autumn of 1800, a singular traffic was carried on in the article of kine-pock matter, by persons not in the least connected with the medical pro- fession ; such as stage-drivers, peddlers, and in one instance the sexton of a church. I have known the shirt sleeve of a patient, stiff with the purulent discharge from a foul ulcer, made so by unskillful management, and full three weeks after vaccination, and in which there could have been none of the specific virus ; I have known this cut up into small strips, and sold about the country as genuine kine-pock matter, coming directly from me. Several hundred people were inoculated with this caustic morbid poison, which produced great inflammation, sickness, fever, and in several cases eruptions, with a greater disturbance of the system than what occurs in the true disease. It is worthy of remark that I could not influence these people to believe that they had not passed through the true disease, and that they were not secure from the small-pox. So true it is, that a man need not despair of making the common people believe anything but truth ! That vagrant quacks should stroll about the country, inoculating for half a dollar a head, ami some for less, is not quite so surprising as that they should, in such a country as ours, find people weak enough to receive it from such hands! This impru- dence ought not, however, to be attributed to the common people alone. Many young practitioners in country villages come in for a share of it. Not a few first inoculated themselves, and then others, without having read more than the newspaper publications, and some not even those, and were looking out for eruptions, and foretelling appearances and symptoms that are never attached to the disease ; and if any very disagreeable oc- currence arose, in the course of this imprudent practice, the odium reverted to me." Following this is given a narrative of the terrible catastrophe resulting from all this reckless, ignorant, presumptuous tampering with a new and as yet a very imperfectly known practice, at Marblehead, a large Massachusetts town, an event which had a par- tial parallel at Norfolk and Portsmouth, in Virginia, and in other parts of the country. The result of all this malpractice and of an imperfect knowledge of the best methods of preserving "stored" vaccine virus was extreme aud rapid deterioiation, and, at last, en- tire loss of the first supply of true vaccine lymph in America. "Very early in the spring of 1801" Waterhouse received "a fresh supply of virus from England from Drs. Lettsoiu and Jenner, and as soon after, more from Dr. Pearson, Dr. Woodville, Mr. Ring, Mr. Wachsel, Mr. Kerre, Sir Granville Temple and the Vaccine In- stitution of London, and also from Dr. Haygarth and Mr. Creaser, of Bath, and Mr. Dun- ning, of Plymouth Dock."* " Previous to this second importation," he writes, "I had reason to believe that the true virus had become extinct in America. The inoculation was, however, carried on here and there, in the country, with such matter as they had.*'] Those ample supplies were used immediately with prompt and perfect success, the nar- rative of which is given with a very admirable commentary 011 the contrast between the regularity and mildness of the development of the true and protective disease in contrast with the irregularity and violence of the phenomena and symptoms of that totally un- protective spurious disease, apt io result from the use of lymph taken from the vesicle after the formation of the areola and sure to follow the inoculation of decomposed or de- composing pus, but which many of Waterhouse's contemporaries, who misjudged his motives and disregarded h s repeated cantions, had pronounced perfect and admirable developments of vaccina, £ II this is extremely interesting and might be republished and pondered even now with profit. The disasters and innumerable annoyances accompany the use and great abuse of the first importation of efficient virus determined Waterhouse to exercise the greatest caution in selecting those to whom he should distribute, what he calls the "second importation" of virus. Vaccination had not yet been introduced into the Southern States, but, in his own words: About this time (the spring of 1801) I received a number o f letters from a variety of people in the Southern States, especially from Virginia, expressing a strong wish to be better acquainted with the kine-pock, and a desire to introduce this benign remedy into *1 have given Waterhouse's long list of English physicians and institutions supplying this "second im- portation" of virus, merely to illustrate the great extent of his European correspondence, as affording, too, slight indication of the arduous nature of his labors, as a missionary of vaccination, by those who were, above all others, competent to criticise and judge. tThe italics are mine. The employment of dubious vaccine virus, in the absence of any State or public institution whence perfectly reliable and gratuitous supplies might be always obtained, on a sort of theory ( any false, in vaccination at any rate, that a poor remedy, or rather pretence of remedy, is better than none at all, has always been one of the great evils of America, and the cause directly of a vast amount of imper- fect or quite illusory protection " protection," and indirectly, both by failure to afford immunity from small- pox and by the production of "bad arms" (the "loathsome hideous eating ulcers." "running"sores," "dis- gusting eruptions," etc., of the anti-vaccinists) very serious injury to the cause and reputation of vaccina- tion in this country.-H. A. M. Introduction of Vaccination into the Southern States. 317 that extensive region. As most of the writers were entirely unknown to me, I was at a loss how to act. I might deny a physician of character, and I might entrust it to a per- son who had none. Some untoward occurre tees in the past year rendered me cautious; for I had unknowingly encouraged mere speculators. I use that word in its modern and degenerate sense. While doubting what course to take, the right road opened to my view. " I had heard that President Jefferson was favorably impressed by my first annuncia- tion of the Jennerian discovery aud practice. Indeed, the following letter, written in consequence of transmitting him a copy of my pamphlet on this subject, sufficiently tes- tifies it: Washington, December 25, 1800. " Sir-I received last night, aud have read with great satisfaction, your pamphlet on the subject of the kine-pock, and pray you to accept my thanks for the communication of it. " I had before attended to your publications on the subject in the newspapers, and cook much interest in the result of the experiment you were making. Every friend of hu- manity must look with pleasure on this discovery, by which one evil more is withdrawn from the condition of man ; and must contemplate the possibility, that future improve- ments and discoveries may still more and more lessen the catalogue of evils. In this line of proceeding you deserve well of your country ; aud I pray yon accept my portion of the tribute due to you, and assurances of high consideration and respect, with which I am sir, your most obedient, humble servant, ' "THOMAS JEFFEKSON.'" [Copy.] Dr. Waterhouse, Cambridge.* " Hearing by some gentlemen direct from the seat of government that the President wished for still more information and that he was desirous to see the practice introduced into Virginia and the other Southern States," Waterhouse "sent him the vaccine virus and painted representations of the pustnlet in all its stages on the white man and on the African." This precious package was accompanied by a long (seven pages in Water- house's book) letter, excellently written and giving a masterly resume of the whole sub- ject of vaccination. A foot note informs ns that this letter was repeated in many manu7 script copies which were widely circulated "at the southward" and it doubtless con- tained the first reliable information on that subject received by many a Southern practi- tioner. Although this letter could hardly fail to interest Southern physicians, it would occupy too much space in a paper which has already far exceeded limits originally in- tended. The following is Jeffer-on's answer. At the bottom, a note intimating that Jefferson's first letter had been considered a precious and grateful tribute to Jenner and, as such bad been transmitted co him, is in the writing of Waterhouse : Washington, June 26, 1801. Your favor of the eighth instant came safely to hand with the several matters accom- panying it; as the longer the vaccine matter should be unemployed, I knew the chance of its success would be the less. I thought it would be more likely to answer your benevo- ♦This is the letter which, as a note on the margin of the second letter (the first facsimile in the hand writing of Waterhouse informs us was sent to Jenner, and, of course, it is not to be found in series of fac- similes. t" Pustule"-Waterhouse, here and elsewhere, uses the word "pustule" in describing the induced erup- tion of vaccina, rather than to appear, with what might be called, captiousness, to differ from Jenner and other English writers. The eruption of vaccina is not a pustule at any stage of its development. When the disease pursues a regular normal typical course, pus is never discoverable in the vesicle. After the formation of the areola pus exists in the tissues outside the vesicle as an accompaniment of the processes by which the cutaneous slough of which the crust is (with the desicated lymph) composed is cast off and the characteristic indellible scar is produced. Waterhouse knew this perfectly, as is evident from the following foot note to page 6, of the second part of his "Prospect of Exterminating the Small-Pox: "By the pustule, the British writers mean the circular sore, or vesicle made in the arm by inoculation; and not those erup- tions, that have, in a few instances, appeared in places remote from the inoculated part This difference in our phraseology has misled some among us. It ought not. strictly speaking, to be called pustule, until its contents have become purulent. The eruptions on the udder of the cow are more of phylctine than of the purulent kind." It may be usefully added that pus may appear in the vesicle, when it does it is as a result of injury or other causes and resulting inflammation and deterioration but this is not the regular normal or usual course, such a contaminated fluid is not tit to use for vaccination, but this fluid, a mixture of vaccine virus and pus, has been used times without number and even pus, quite unmixed with virus. We can well see how easily, by men, who regarded the vesicle as a pustule, a something normally secreting pus, and those who adopted the views of Coxe and others and collected material for their inoculations (they could not properly be called vaccinations) from the site of the vesicle so long as that site yielded or could be compelled to yield a fluid of almost any kind. The fact, for it is a fact, that a normal perfect vaccine scab is very sure to afford material for perfect vaccination was thought by Coxe and his school (whose name was and is Legion) to triumphantly demonstrate the position that the above practice is quite free from otqection. It would be extremely easy to exhibit the fallacy of this supposed proof and show that while.a perfect typic a vaccine crust, from a healthy vaccinifer, generally affords excellent material for vaccination fluid taken from any vaccine vesicle after the decline, even after the full formation of the areola is extremely apt to be the verv worst and although such fluid may and often does induce perfect vaccina, it should be always declined. H. A.M. 318 Introduction of Vaccination into the Southern States. lent views by having it employed here rather than by risking it by a further mission to Virginia. I, therefore, put it immediately iuto the hands ol Doctor Gantt, a long estab- lished, judicious and successful physician of this place, together with your letter and the pamphlets and papers accompanying it. It turns out that it had still been too long unemployed ; for of numbers inoculated with it from the thirteenth to this time, no one appears to have taken the infection. In the meantime a great anxiety is pro- duced here to obtain a successful inoculation. I know not, however, how it will be ob- tained, unless you could continue your goodness so far as to inclose by post new matter two or three times successively until we can inform you that it has at length taken. You need not be at the trouble of writing a word, for it is making it troublesome enough to you to put the matter under cover and into the postoffice. The benevolence which has dictated the measures for which we are indebted to yon, will, I hope, plead my excuse on this new request. I pray you to accept assurances of mv high consideration and re- spect. ' TH. JEFFERSON. N. B.-The first letter I received from Mr. Jefferson was dated December 29, 1800. It is printed m my Treatise, p. 2. I sent the original a present to Dr. Jenner, thinking, that coming from the Chief Magistrate of the Americans, it would not be unpleasing to the originator of vaccination. Doctor Benjamin Warehouse. The next letter informs Dr. Waterhouse that not only the first, but also a second sup- ply of virus had failed, but expresses hope that the third will be more successful. This liope was to prove fallacious. The letter contains an original and excellent suggestion of Mr. Jefferson's for the preservation of virus in hot weather. It may be worth while to state that the present writer thought he had invented the same plan which he found very useful in the summer of 1872. He procured the manufacture of several hundred sets of glass vessels, similar to test-tubes, for distribution to his correspondents. Each set consisted of one vessel to contain the charged points and a larger one containing water in which the smaller vessel was enclosed. He spoke with considerable compla- cency of his invention for a month or two, onlv, at the end of time, to find that Mr. Jef- ferson was the inventor. This experience of the method convinced him that it is a good one and worthy of the recollection of practitionerswishing to keep virus from deterio- ration under certain circumstances, as lor instance, on the office table during hot weather. It will be perceived that a small bit of this letter has been lost. There is no doubt the letters "tie" formed part of the word treatise, or that the reference is to a now quite rare pamphlet by Dr. J. C. Lettsom, entitled, "Observations on the Cow- Pock, London, 1801," a work principally noticeable for the portraits it contains of the four men then fully recognized as the leaders in the great innovation of vaccination, viz: Jenner, Pearson, Woodville and Waterhouse. The author believes the portrait of the latter and a poor reproduction of the same in the Boston Polyanthos, for May, 1806, to be the only engraved likenesses ever produced of a man, of whom, if men saw fit to thus honor their benefactorsand saviors, rather than their disturbers and destroyers, the features would be perpetuated in "everlasting bronze" in every city of America. A marginal note in the handwriting of Waterhouse and signed with his initials will be noticed. Washington, July 25, 1801. Dear Sir-Your favor of the seventeenth arrived last night, together with the new vac- cine matter, which was immediately sent to Doctor Gantt. The second as well as the first supply of matter had failed. We hope the third will be more successful. How might it answer to put the matter into a phial of the smallest size, well corked, and im- mersed in a larger one filled with wrater and well corked. It would be effectually preserved against the air, and I doubt whether the water would prevent so great a de- gree of heat to penetrate to the inner vessel as does w'hen it is in the open air. It would get cool every night, and shaded every day under the cover of the stage, it might per- haps succeed. 1 leave this place on the thirtieth instant for Monticello, being unwilling to risk myself on the tidewaters during the months of August and September. The sit- uations which generate bilious complaints are most dangerous; my own is entirely ex- empt from thal danger. Should you be so good as to continue forwarding matter till it succeeds, it will now be best to address the packages to Dr. Gantt, from whom, so soon as he succeeds, I shall ask a transmission of fresh matter to Monticello*, where I shall endeavor to introduce it. it will be a great service, indeed, rendered to human nature to strike off from the catalogue of its evils so great a one as the small-pox. I know' of no one discovery in medicine equally valuable. Accept assurances of my great esteem and respect. THOMAS JEFFERSON. P. S. I re-endorse Doctor Letsom's treatise. Doctor Benjamin Waterhouse. * The matter sent agreeably to this direction was the first that succeeded. Introduction of Vaccination into the Southern States. 319 The fourth letter acknowledges receipt of a further supply of virus, and refers to the terror with which small-pox was regarded in Virginia: Monticello, August 3, 1801, Dear Sir-I had the pleasure of writing you on the twenty-fifth of July, acknowledging the receipt of yours of July 17, with the vaccine matter, which I immediately de- livered to Doctor Gantt. Your favors of the twenty-fourth and twenty-fifth, sent to me at this place on the sixth instant, and the matter accompanying them was, by a skillful physician of the neighborhood, Dr. Wardlow, immediately inserted into six persons of my own family. We shall thus stand a chance of planting the disease here, where I im- agine it will be as salutary as anywhere in the Union. Our laws indeed have permitted inoculation of the small-pox, but under such conditions of consent of the neighborhood as h ive admitted of not much use of the permission. That disease, therefore, is almost a stranger here and extremely dreaded. Will take car eto inform you of the result of our operation Accept my esteem ami respect. THOMAS JEFFERSON. Doctor Benjamin Waterhouse. The fifth ietter refers to still further receipts of virus and the use that was made oj them, and also to two vaccinations made on the seventh of August which exhibited symptoms leading the writer to hope that success had been, at last, achieved. Monticello, August 14, 1801. Dear sir-I wrote you on the eighth instant that your favors of July 24 and 26 had come to me here. Dr. Wardlow on the seventh inoculated two persons withMshe matter of the twenty-fourth and four with that of the twenty-sixth, the latter has no effect, but the. two former show inflammation and matter. Some of them complain of pain under the arm-pit, and yesterday was a little feverish ; the matter is of this size and form *; the inflammation about an inch all round from the pustule. We have considerable hopes he has the true infection. Yesterday I received your favor of the first instant; Dr. Ward- low immediately inoculated five of the former subjects with it, and one other; he also in- oculated one from the pustule above described. Yon shall be regularly informed of the progress and success of this business. 1 learn from Washington, indirectly, that Dr Gantt's cases have all failed; should ours succeed, he shad be supplied hence. I am very anxious to obtain the disease here. Accept my best esteem and respectful salutations. TH. JEFFERSON. Dr. Benjamin Waterhouse. The next letter announces the undoubted success with which all three different lots of virus, transmitted hy Mr. Jefferson's method, had been employed. Monticello, August 21, 1801. Dear Sir-I had the pleasure of informing you on the fourteenth instant, that I sup- posed the inoculation of the kine-pox to have taken effect in two subjects, these were from the matter you were kind enough to send July 24; that of July 26 succeeded with two others; that of August 1, with four. On the fifteenth instant, we inoculated from the two first subjects, fifteen others; fourteen of whom very evidently have the infection, so that we have twenty of my family on whom the disease has taken, besides some recent inoculations; some of them have slight fevers, headache, kernels under the arms, and one only has a very sore arm ; most, however, experience no inconvenience, and have nothing but the inoculated pustule, well defined, moderately filled with matter and hol- low in the centre. I have this day impregnated some thread and half a dozen toothpicks, which I forward to Dr. Gantt, who writes me that his inoculations all failed Dr. Ward- low, of this neighborhood, has so much other business, that he has been able to be with us only twice, however, I expect that the extent of my experiments will encourage the neighborhood generally. Engage him to introduce it in their families. To you they will be indebted for it, and I am sure they will be sensible of the obligation. Accept assur- ances of my great esteem and respect. TH. JEFFERSON. Dr. Benjamin Waterhouse. Number seven announces the successful use in Washington, of virus sent there by Jefferson, the transmission of supplies to Richmond, Petersburg and other parts of Vir- ginia, refers slightly to certain futile and disastrous previous attempts to introduce vac- cination in Norfolk and Richmond which were followed by results similar to thsoe ob- served at Marblehead and had done much to impede the introduction and progress of true vaccination in the South, also to a proposed, out probably never executed publica- tion of Dr. Waterhouse's long letter of instructions before alluded to. Monticello, September 17, 1801. Sir-I received by the last post your favor of August 28, and by the same a letter from Dr. Gantt, informing me that the matter I first sent him from hence had taken on three of the subjects into whom it had been inserted; that from these he had inoculated others, 320 Introduction of Vaccination into the Southern States. so that they are now in full possession of the disease at Washington. I have also sent matter to Richmond, Petersburg and several other parts of this State, so that I have no doubt, it will be generally spread through it, notwithstanding the incredulity which had been produced by the ineffectual experiments of Richmond and Norfolk. The first letter you were so kind as to write to me on the subject, and which contained a great deal of useful information, I put into the hands of Dr Gantt, and we concluded it would be use- ful to publish it as soon as the public should be possessed of the disease ;4t is still in his hands, and as you have been so kind as to permit ns to make any use of it which the general good may require, I shall propose to him to have it published immediately on my return to Washington, which will be within a week from this time. It is just our coun- trymen should know to whose philanthropic attentions they will be indebted for relief from a disease which has always been the terror of this country. Accept my particular thanks fox' the great good, and assurances of mv high esteem and respect TH. JEFFERSON. Dr. Waterhouse: The eighth letter is a very interesting one, and affords a good idea of the care and wis' dom with which Jefferson proceeded in this whole matter. It refers to the supply of virus, from his own Virginia vaccinations sent (through Mr. John Vaughn) to Dr. J. R. Coxe, of Philadelphia, by means of which vaccination was first introduced into that city. After the/ac-simile«, a letter from Jefferson, which accompanied this supply of virus, is inserted, reprinted from Dr. Coxe's volume on the cow-pox. Washington, December 25, 1801. Dear Sir-I am indebted to you for several favors unacknowledged. I have waited ti'l I could inform you that some variolous after vaccine inoculation had proved that I had preserved the matter of the cow-pox in its genuine form. Dr. Coxe, of Philadelphia, lias ascertained this, having received his vaccine matter from hence. To this is added your information that the matter I sent you produces the genuine disease, and conse- quently those in Virginia who received the matter from me are now in security. Know- ing how little capable the people in general are of judging between genuine and spuri- ous matter from their appearance, or that of the sore, I endeavored, in the course of my inoculations at home, to find some other criterion for their guide. With this view, I was very attentive to discover whether there be not a point of time counted from the vaccina- tion, when the matter is genuine in all cases. I thought the eight times twenty-four hours furnished such a point; I governed myself by it, audit has been followed here successfully by Dr. Gantt, but your experience, so much greater, can inform us whether this rule is a sure one, and whether any other point of time would be still more certain. To the eye of experience this is not necessary, but for popular use it would be all-im- portant, for otherwise the disease degenerates as soon as it gets into their hands, and may produce a. fatal security. I think some popular criterion necessary to crown this in- valuable discovery. Accept assurances of mj great esteem and respect. TH JEFFERSON. Dr. Benjamin Waterhouse: The ninth and last of the series in which any reference is made to vaccination, is dated fourteen years after its nearest predecessor. It is a long and admirable letter, and is in- troduced here because it contains an eloquent and consoling tribute to Waterhouse amid the sad harvest of vindictive, malignant persecution and ingratitude he was reaping for so much enthusiastic, untiring, sagacious labor for the benefit of humanity ; the only harvest he ever gathered, the only one that has ever yet been garnered by the very highest and noblest benefactors of mankind. How long the list! How sad the thoughts its consideration must awaken ! But, thank God, there have always been men to whom the lives of Galileo, Spinoza, Luther, Pare. Vesalius, Servetus, Harvey, Jenner, Bell, Waterhouse, and a very large and shining company of such men seem more, attractive, with all their wrongs, poverties, disappoint- ments, persecutions and chagrins, than those of the sleek, well-fed orthodox, conserva- tive, successful and honored mediocrities who always have been, who are and must be, their triumphant rivals, opponents, persecutors. It is one of the best and surest anchors and hopes of humanity that there always have been, and probably always will be, men to whom a consciousness of the honest and fearless expression of important truth, how- ever unpopular or unappreciated, will always be more fascinating than the success and wealth which is too apt to soften and sweeten the lives ol the docile apostles of routine and error. A brief extract from a letter from Waterhouse to his old friend Lettsom is here appro- priate. It is dated May 8, 1810: "For the honor of my country, I am ashamed to tell Dr. Jenner how I have been treated by our Legislature" (that of the State of Massachu- setts) "respecting remuneration. I have received nothing but abuse, nay. more, I have been intrigued out of my place as Physician to the United States Marine Hospital, with 500 sterling a year, and given me by Mr. Jefferson as a reward for my labors in vaccina- Introduction of Vaccination into the Southern States. 321 tion, and this merely in consequence of his going out and others coming in, so that, at fifty-six years of age, I have now to contrive and execute some new plan to supply this deficiency. * * * * Were I a single man and without children I would go to England ; if not to live there, at least to die there. You do not knock a man on the head in Britain because he exerts himself more than his neighbors do. * * * Sometimes one man influences and impels the sentimentsand conduct of the public. I am not calculated by nature or habit to control intrigue "* Monticello, October 13. Dear Sir-I was highly gratified with receipt of your letter of September first, by General and Mrs. Dearborne, and by the evidence it furnished me of your bearing up with firmness and perseverance against the persecutions of your enemies-religious, polit- ical and professional. These last I suppose have not yet forgiven you the introduction of vaccination and annihilation of the great variolous field of profit to them; and none of them pardon the proof you have established that the condition of man may be ameli- orated, if not infinitely, as enthusiasm alone pretends, yet indefinitely, as bigots alone can doubt. In lieu of these enmities, you have the blessings of all the friends of human happiness for this great peril from which they are rescued. I have read with pleasure the orations of Mr. Holmes and Mr. Austin. From the former we always expect what is good; and the latter has by this specimen taught us to expect the same in future from him. Both have set the valuable example of quitting the beaten grounds of the Revolutionary War and making the present state of things the subject of annual animadversion and instruction. A copious one it will be, and highly useful if properly improved. Cobbet's address would of itself have mortified and humbled the Cossack priests; but Brother Jonathan has pointed his arrow to the hearts of the worst of them. These reverend leaders of the Hartford Convention nation it seems then are now falling out together about religion, of which they have not one real principle in their hearts. Like bawds, religion becomes to them a refuge from the despair of their loathsome vices. They seek in it only an oblivion of the disgrace with which they have loaded themselves by their political ravings, and of their mortification at the ridiculous issue of the Hartford Convention. No event more than this has shown the placid char- acter of our Constitution ; under any othe'r their treason would have been punished by the halter. We let them live as laughing stocks of the world, and punish them by the torment of eternal contempt. The emigrations you mention from the Eastern States are what I have long counted on. The religious and political tyranny of those in power with you cannot fail to drive the oppressed to milder associations of men whose free dom of mind is allowed in fact as well as in pretence. The subject of their personal, clawings and caterwanlings is not without its interest to rational men. The priests have so disfigured the simple religion of Jesus that no one who reads the sophistications they have engrafted on it, from the jargon of Plato, of Aristotle, and other mystics,would conceive these could have been fathered on the sublime preacher of the Sermon on the Mount. Yet knowing the importance of names, they have assumed that of Christians, while they are mere theorists, or anything rather than disciples of Jesus. Sone of them are beginning now to sling off these meritorious trappings; their followers may take courage to make thorough work, and restore to us the figure on its original simplicity and beauty. The efforts of this squabble, therefore, whether religious or political, cannot fail to do good in some way. The visit to Monticello, of which you hold up an idea, would be a favor indeed of the first order; I know, however, the obstacles of age and distance, and should therefore set due value on its vicarious execution. Should business or curiosity lead a son of yours to visit this Sodom and Gomorrah of persons, Osgood and Gardener. Accept my wishes for yoi r health and happiness and the assurance of my great esteem and respect THOMAS JEFFERSON. The following is the letter with which Jefferson transmitted that supply of virus to Dr. Coxe, of Philadelphia, which, as before intimated, inaugurated vaccination in that city. It is printed from Waterhouse's book into which it was copied from Dr. Coxe's " Practical Observations on Vaccination, or inoculation for the Cow-Pock, Philadel- phia, 1802. Page 120, et seq." Washington, November 5, 1801, " Dear Sir-I received on the twenty-fourth ult., your favor of the twenty-second, but it is not till this day that I am enabled to comply with your request of forwarding some of the vaccine matter of Dr. Coxe. On my arrival at Monticello in July, I received from Dr. Waterhouse, of Cambridge, some vaccine matter taken by himself, and some which he at the same time received from Dr. Jenner, of London. Both of them succeeded, and exhibited precisely the same aspect and affection. In the course of July and August. I 'Life and Letters of John Coakley Lettsom, London, 1817. 322 Introduction of Vaccination into the Southern States. inoculated about seventy or eighty of my own family ; my sons-in-law about as many in theirs, and including our neighbors who wished to avail themselves of the opportunity, our whole experiment extended to about two hundred persons. One on y case was at- tended with much fever and some delirium ; And two or three with sore arms which re- quired common dressings. All these were from accidents too palpable to be ascribed to the simple disease. About one in five or six hid slight feverish dispositions, and more perhaps had a little headache, and more of them had swelling of the axillary glands, which in the case of adults, disabled them from labor one, two or three days. Two or three only had from two to half a dozen pustules on the inoculated arm, and nowhere else, and all the rest only the single pustule where the matter was inserted, something less than a coffee-bean, depressed in the middle, fuller at the edge, ami well defined. As far as my observation went, the most premature cases presented a pellucid liquor the sixth day, which continued in that form the sixth, seventh, and eighth days, when it be- gan to thicken, appear yellowish, and to be environed with inflammation. The most tardy cases offered matter on the eighth day, which continued limpid the eighth, ninth, and tenth days. Perceiving, therefore, that the most premature as well as the tardiest cases embraced the eighth day, I made that the constant day for taking matter for inocu- lation, say, eight times twenty-four hours from the hour of its previous insertion . In this way it failed to infect in not more I think than three or four out of the two hundred cases. I have great confidence, therefore, that I preserved the matter genuine, and in that state brought it to Dr. Gantt, of this place, on my return, from whom I obtained the matter I now send you, taken yesterday, from a patient of the eighth day. He has observed this rule as well as myself. In my neighborhood we had no opportunity of ob- taining variolous matter, to try by that test the genuineness of our vaccine matter; nor can any be had, or Dr. Gantt would have tried it on some of those on whom the vaccina- tion has been performed. Weare very anxious to try this experiment for the satisfac- tion of those here, and also those in the neighborhood of Monticello, from whom the mat- ter having been transferred, the establishment of its genuineness here will satisfy them. I am. therefore, induced to ask the favor of you to send me in exchange, some fresh vari- olous matter, so carefully taken and done up, as that we may rely on it ; you are sensible ot the dangerous security which a trial with effete matter might induce. I should add that we never changed the regimen nor occupations of those inoculated ; a smither at the anvil continued in his place without a moment's intermission, or indisposition. Gener- ally it gives no more of disease than a blister as large as a coffee-bean produced by burn- ing would occasion. Sucking children did not take the disease from the inoculated mother. These I think are the most material of the observations I made in the limited experiment of my own family. In Aikin's book, which I have, you will find a great deal more. I pray you to accept assurances of my esteem and respect. (Signed) ' "THOS. JEFFERSON. " Mr. John Vaughan." In conclusion, it is worthy of remark how very completely the mission of Waterhouse was accomplished. Through his direct means vaccination was introduced not only in Boston but in a very large proportion of the other cities and towns of America. Those not directly supplied with their first efficient virus by Waterhouse obtained it through the agency of Jefferson. It is by no means too much to say that Waterhouse and Jefferson were the two men to whom the introduction of vaccination in America was wholly due. However actively many, as Coxe, Seaman, Scofield, and others labored, none even ever nearly approached these two in the success with which they propagated perfect vaccine virus and, directly or indirectly, supplied every considerable city and town of North America, not only with their first efficient lymph but, over and over again, with fresh supplies when, as repeatedly happened through ignorance, neglect, or, more frequently, malprac- tice (mainly the result of following Coxe's teachings, and collecting virus after the appear ance, even after the decline of the areola) the precious contagium was lost. It is, of course, not possible here to detail the facts on which this broad assertion is based. Enough that it is not rashly made, but as the result and outcome of careful study of data quite suffi- ciently full, although not accessible without difficulty. Let the assertion stand as one. When possibly it may come to be disputed it shall be proven. This remarkable and unique success was due to Waterhouse, and from him Jeffer- son, being the sole recipient of supplies of virus from England. To very many others, societies as well as individuals, ample supplies from Jenner and many of his earliest En- glish disciples were repeatedly sent, but no record of any authenticity has been discov- erable that any but Waterhouse and Jefferson succeeded in perpetuating vaccina of a perfectly normal type such as alone could afford virus fit to be used in vaccination. The simple solution of this remarkable and quite exceptional success is to be found in the fact that Waterhouse was a true and faithful disciple of Jenner, that Jefferson was equally loyal to the Master and that both religiously observed his "golden rule;" while the prac- tice of a very large proportion of American physicians was unfortunately influenced by teachings which criticised and even ridiculed that rule; teachings which have not, even yet, fulfilled all their mission of evil and injury to the cause of vaccination in America."-Martin. Introduction of Vaccinnation into New York. 323 INTRODUCTION OF VACCINATION INTO NEW YORK, UNITED STATES OF AMERICA. The value of the labor of Dr. Jenner and Dr. Waterhouse,were acknow- ledge by the physicians of New York, and more especially by Dr. Val- entine Seaman, Edward Miller, Wright Post, Samuel Borrowe, Samuel Scofield, Samuel L. Mitchell, were appreciated in the first years of the nineteenth century; and they induced a number of the prominent citizens of New York, impressed with the importance of substituting the inocula- tion of the vaccine disease for that of the small-pox, to form an association, and to contribute to the establishment of a public institution, to extend the advantage of vaccine inoculation to the poor ;-to maintain a permanent supply of genuine matter for the use of that community, and to disseminate a knowl- edge of vaccine inoculation among the physicians of the adjacent country. After public meetings, held by the contributors for the purpose, they formed and adopted a constitution suited to their design; and then proceded in pursuance of the constitution, to elect the officers of the institution, when the following gentleman were elected Directors: James Watson, Samuel Browne, John Reese, Robert Browne, Samuel L. Mitchell, Isaac Hicks, Gilbert Aspinwall, William Moore, Thomas Buckley, Samuel Miller, Willet Seaman, Andrew Cock, James Robertson; Thomas Franklin, Treas- urer; Adrian Hegeman, Secretary. The directors made choice of the following gentlemen to perform the various duties assigned to their office by the constitution : James Watson, President; Gilbert Aspinwall, Vice President. * Medical Board.-Valentine Seaman, Edward Miller, Wright Post, Samuel Browne; Samuel Scofield, Resident Surgeon- A suitable apartment was obtained and the Medical Board commenced vaccine inoculation. At a meeting of the contributors the following resolution, moved by Mr. Samuel Browne, was unanimously adopted, viz: "Resolved, That in testimony of the high estimation in which this meet- ing of contributors hold the philanthropic and able exertions of Edward Jen- ner, M. D., F. R. S., etc., of London, and Benjamin Waterhouse, M. D., professor of practice in the University of Crambridge, in Massachusetts, relative to the inoculation of the Kine-Pock, they are hereby appointed perpetual honorary directors of this Institution."-Medical Repository, vol. 5, New York, 1802, p. 346-7. The Medical Profession of the United States were deeply indebted to the learned and eloquent editors of the Medical Repository, for the first full and scientific reviews of the discoveries of Jenner, and the works of Pear- son, Woodville and others. Drs. Samuel Latham, Mitchell, Edward Miller, and Elihu H. Smith, pub- lished an account of Dr. Jenner's " Inquiry into rhe causes and effects of the variola; vaccinae," in the second volume of the Medical Repository, p. 244, third edition. Letters from Dr. Pearson, as well as accounts of his work and that of Dr. Woodville, were published in the Medical Repository, volume third, pp. 70, 315, etc. In the same (third) volume of the Medical Repository, p. 310, it is stated that Dr. George Pearson, of London, had transmitted in a letter to Dr. Edward Miller a thread impregnated with the matter of the vaccine dis- ease, for the purpose of inoculation in North America, with a view to its use as a substitute for the small-pox. < 324 Introduction of Vaccination into New York. The readers of this valuable medical journal are informed as to the progress of vaccine inoculation in Europe and America. (See vol. 4, pp. 88, 176, 204, 321, 322, vol. 5, vol. 4, pp. 410, p. 205, etc.) The vaccine matter received in New York during 1800, did not succeed according to the expectations of Dr. Edward Miller, and he expressed the Opinion that the matter employed was not genuine. (Medical Repository, vol 4 p. 321.) I^or the introduction of vaccination into New York, the people were in- debted to the persevering and philanthropic exertions of Doctor Valentine Seaman, who, on the twenty-second of May, 1801, procured virus from the arm of Governor Sargent's domestic, who was vaccinated in Boston by Doctor Benjamin Waterhouse, and fortunately arrived in New York, at the proper period for procuring the virus. With this infection Dr. Seaman in- oculated several, and succeeding in communicating the genuine variolae vaccinae' There had been virus received in New York, during the preceding winter, but unfortunately it gave rise to a spurious disease. In January, 1802, an institution was established in New York for the purpose of vaccinating the poor gratis, and of keeping up a constant sup- ply of the genuine matter. In this establishment Samuel Scofield,* M. D. was appointed resident surgeon. This institution was subsequently con- nected with the New York City Dispensary, and a physician appointed for the express purpose of vaccinating such as applied for that purpose. Dr. V. Seaman, Physician of the Kine-Pock Dispensary, reported to the trustees on the third of January, 1807: "That the practice of vaccination has been regularly attended to, and that by means of this establishment, nearly eleven hundred have been inoculated; not one of whom has been known since to have taken the small-pox. "During the fifteen years immediately preceding the introduction of the vaccine disease into this city, it appears, by a regular record preserved by the sextons, 5,756 persons were interred in the cemeteries of St. Paul's and Trinity, of which 610, which is upwards of the tenth part of the whole number, had died under the immediate operation of the small-pox. From the public obituary, since established by the corporation, we find that in the years 1805 and 1806, 4,595 persons have died in this city ; 110 only, which is less than one-fortieth part, was by the small-pox; where it may be fairly inferred, that during the last two years, the practice of vaccina- tion has preserved 276 of our fellow citizens from falling victims to that most loathsome of all human maladies, while it does not form a single item on the bills of mortality. If individuals would attend reasonably to partake of the means now offered for their protection, it is more than probable, that in a little time the small pox would only be heard of in his- iory, and our country be freed from one of the most dreadful scourges."- The Medical Repository, vol. 4, New York, 1807, p. 430. In order to determine the value of vaccination in New York, which from its geographical position, its extended commercial connections, and the vast multitudes of foreign emigrants passing through this great gate-way of the North American Continent, was th* most exposed of all cities to the ravages of this pestilence, I consolidated from the official reports of this city the mortality during the period of half a century, immediately follow- ing the introduction of vaccination. *"A Practical Treatise on Vaccine or Cowpock' by Samuel Scofield, M. D., one of the physicians of the New York Citv Dispensary, and first Resident Surgeon of the New York Institution for the' Inoculation of the Cowpock.Embellished with a colored engraving representing a view of the local affection in its differ- ent stages. New York: Printed by Southerick & Pelsue, for Collins & Perkins, 1810. Introduction of Vaccination into Nero York. 325 Total Deaths from all Causes, and from Small-Pox, Measles, Scarlet Fever and Phthisis- Pulmonalis in the City of New York during a Period of Fifty Years, 1804-1853. YEAR. Total Deaths FROM All Causes. DEATHS FROM Small-Pox. Measles. Scarlet Fever. Phthisis Pulmonalis. 180-1 2125 164 2 14 499 1805 2344 62 0 4 462 1806 2225 48 0 4 354 1807 2312 29 1 2 464 1808 2014 62 64 4 429 1809 2108 66 2 9 413 1810 2167 4 2 1 562 1811 2524 117 2 0 595 1812 2553 21 9 0 669 1813 2283 2 35 1 562 1814 1974 2 15 1 572 1815 2507 94 18 0 618 1816 2739 179 19 0 678 1817 2527 14 20 3 574 1818 3265 19 18 0 591 1819 3176 o 10 3 577 1820 3515 0 74 5 625 1821 3542 0 109 3 715 1822 3231 0 1 1 624 1823 3444 18 117 2 683 1824 .... 4341 394 100 3 730 1825 5018 40 53 10 843 1826 4973 58 31 24 820 1827 5181 149 172 4 829 1828 5181 93 28 11 906 1829 5094 16 91 188 880 1830 5537 176 12 246 974 1831 6363 224 39 258 1033 1832 10389 89 290 221 1514 1833 5746 25 38 179 1251 1834 9082 233 212 418 1471 1835 7082 351 82 174 1437 1836 8009 173 442 202 1514 1837 3732 164 288 579 1458 1838 5053 91 79 257 1225 1839 7953 68 133 158 1318 1840 8474 332 185 391 1296 1841 9115 200 113 360 1470 1842 9176 181 60 416 1339 1843 8693 117 118 223 1503 1844 8875 21 51 224 1428 1845 10483 125 136 63 1659 1846 11318 141 17 114 1690 1847 15788 53 275 142 1626 1848 15919 544 77 93 1869 1849 23773 326 125 266 2086 1850 16978 231 324 311 1922 1851 21924 562 320 627 2374 1852 21601 407 246 613 2487 1853 22702 656 134 454 2739 Total 364698 7131 4749 8398 55265 From the preceding statistics we gather that out of a total of 304,698 deaths from all causes (males, 198,432; females, 166,266; excess of males 32,166 or 19.35 percent), occurring in New York during 50 years, 1804- 1853 inclusive, small-pox occasioned only 7131 deaths. During the same period measles occasioned 4749 deaths and scarlet fever 8398; these two diseases occasioned 13,147 deaths, or nearly twice the number caused by the more fatal pestilence small-pox. Phthisis pulmonalis caused 55,265 deaths or about eight times the num- ber credited to small-pox. We must attribute this result, that is the comparatively small mortality from small-pox to vaccination Some estimate of the number of emigrants pouring in from Europe may be formed from the fact that from.May 5,1847, to the end of 1853, there arrived at New York, 1,627,174 white emigrants. 326 Introduction of Vaccination into Philadelphia. INTRODUCTION OF VACCINATION INTO PHILADELPHIA,PENN- SYLVANIA. In Philadelphia, Dr. John Redman Coxe made most laudable efforts to introduce the inoculation of the cow-pox into Philadelphia, Penn., and in 1802, he published his "Practical Observations on Vaccination or Inoculation for the cowpock." in which he duly appreciated the value of the discovery of Edward Jenner, and endeavored with a zealous and benevolent warmth, to recomemnd this safe and easy substitute for the small-pox. Most of the leading facts and principles concerning the cow-pock, known and ascertained at the time, are noticed in this publication. Much discussion and difference of opinion having arisen on the question how late in the disease it may be allowed to take matter for the purpose of inoculation, Dr. Coxe could not entirely agree with Dr. Edward Jenner, who enjoined it upon inoculators to consider the appearance of the efflores- cence, as a sacred boundary which might not be trangressed. Dr. Coxe was inclined to believe, that while the fluid in the vesicle continues limpid, and the scab is not too far advanced, no inconvenience will arise from the use of the matter; and the point of time beyond which the matter is not ordin- arily to betaken he supposes may properly be eight times twenty-four hours. Dr. Coxe records his belief in the efficacy of vaccination in correcting the scrofulous diathesis, in removing certain cutaneous diseases, and curing whooping-cough and deafness. Dr. John Redman Coxe published farther observations on vaccination in 1804. (See the Medical Repository, Second Hixade, vol. 1; New York, 1804; p. 122.) Mr. Bryce, of Edinburgh, in his Observations on the Cow-pox, published in 1802, advocated the use of the crust of the vesicle after it falls from the arm ; and also proposed a mode of ascertaining whether the constitution had been affected by the vaccine virus, by a double inoculation, the second be- ing performed some days after the first. Wm. Farquharson, James Bryce, A. Gillespie and J. Abercrombie, of the Vaccine Institution of Edinburgh, after recording 7140 vaccinations from February, 1801, to February, 1807, state that "by using the crust, the cow-pox has frequently been renewed at this institution, when the fluid virus had been lost, from the non-attendance of the children at the proper period of taking it." From a report of Mr. Shoolbred, of Calcutta, it is shown that " by this mode of using the crust, the cow-pox had been renewed at the different out-stations in the Province of Bengal, at Prince of Wales Island, and at Port Marlborough, when the virus had been lost, and every means of transmitting it from Calcutta had proved ineffectual."-Edinburgh Medical and Surgical Journal, 1807 ; vol. 3, p. 253. The following tables, consolidated from official sources, will present in a clear light the relations of small-pox to other diseases in Philadelphia; and will also clearly demonstrate the protective power of vaccination. These figures are of special value and force, when compared with those of London, England, previously recorded, illustrating the mortality occa- sioned by small-pox in that city during the seventeenth and eighteenth centuries, before the introduction of vaccination, when the population ap- proximated to that of Philadelphia, during the period under observation : Small-Pox and Vaccination in Philadelphia. 327 Deaths in Philadelphia, Penn., from Small-Pox, each year, from 1807 to 1882, inclusive, with the Average Population of each year and Deaths to every 1000 Persons Living. Years. Population. Deaths from Small-Pox. Deaths from Small-P o x in 1000 Liv- ing Persons Years. Population. Deaths from Small-Pox. Deaths from Small-P o x in 1000 Liv- ing Persons 1807 32 0.27 1845 ,. 190 0.73 1808 145 1 28 1846 251 0.61 1809 101 0.90 1847 9 0.02 1810 111.210 34 0.30 1848 100 0.24 1811 117 1.04 1849 408,762 152 0.37 1812 1850 40 0.09 1813 1851 216 0.52 1814 1852 427 1.04 1815 1853 57 0.13 1816 97 0.77 1«54 40 0.09 1817 52 0.30 1855 275 0.67 1818 8 0.05 1356 390 0.68 1819 1 1857 65 0.11 1820 1858 7 0.01 1821 137,097 1859 2 0.003 1822 1860 565,529 57 0.10 1823 160 1.16 1861 758 1.34 1824 325 2.37 1862 264 0.46 1825 ... 6 0.04 1863 171 0.30 1826 3 0.01 1864 260 0.45 1827 100 0.52 1565 524 0.92 1828 107 0.56 1866 144 0.21 1829 188,797 81 0.42 1867 48 0.07 1830 86 0 45 1868.... 48 0.07 1831 14 0.07 1869 6 0.008 1832 37 0.19 1^70 674,622 9 0.01 1833 150 0.82 1871 1,879 2.78 1834 195 1.03 1872 1 2,585 3.83 1835 101 0.53 1873 39 0.05 1836 76 0.33 1874 15 0.02 1837 79 0.34 1875 54 0.08 1838 r 42 0.16 1876 407 0.45 1839 5 0.01 1877 155 0.17 1840 < 268,034 63 0.24 1878 0.006 1841 259 1.00 1879 846,980 6 1842 156 0.60 1880 429 0.05 1843 36 0.13 1881 1,336 1.57 1844 17 0.06 1882 314 0.03 Total deaths from Small-pox for 76 ears 13,813 From the preceding table it is established that during the past seventy six years small-pox has occasioned deaths in Philadelphia in sixty-eight years, and that in only eight years was the disease entirely absent; and that, notwithstanding its almost constant presence, it occasioned only 13,- 812 deaths during the entire series of years embraced in the table. Dur- ing the first thirty-nine years, 1807-1845 inclusive, small-pox occasioned 2281 deaths, and in the last thirty-seven years, 1846-1882 inclusive, 11,532 deaths; total seventy-six years, 13,813. The apparent, increase of deaths during the last seven years from small- pox must be referred chiefly to the increase of population ; during the first thirty-nine years (1807-1845) the population of Philadelphia ranged from 111,210 to 268,034. and during the last thirty-seven years (1846-1882) from 408,762 to 846,980. That small-pox has played but a secondary part in the mortality of Phil- adelphia, will be evident from a comparison with the following statistics:* *Health Officer's Annual Report, City of Philadelphia, 1882. Philadelphia, 1883; p. 201, p. 3. 328 Small-Pox and Vaccination in Philadelphia. Table showing the ratio of deaths, with population in Philadelphia, Pennsylvania, during the past twenty-two years. YEARS. Populat ion. Deaths from all causes. Deaths to 1000 persons. Persons living to one death. 1861 576 408 13,540 23 49 42 57 1862 587 287 13.864 23.60 42 36 1863 598,166 14,220 23.73 42.06 1864 608 045 15 875 26.10 38.30 ] 865 618 924 15,633 25.25 39.59 1866 620,803 15,362 22.80 40.99 1867 640.682 12'660 19.76 50.60 1868 651 561 13 391 20.39 48.65 1869 662 440 13 428 20.27 49.33 1870 1674 022 15.317 22.72 44.00 1871 700 000 15,485 22.12 45 20 1872 725,000 15 238 26.19 38.18 1873 750.000 15,224 20.29 49.26 1874 775,000 15^987 19.66 50.86 1875 800 000 17,805 22.25 44.93 1876 825.594 18,892 22.88 43 69 1877 850,856 16.004 18.81 53 16 1878 876'118 15.743 17.97 55.65 1879 901,380 15,473 17.17 58.25 1880 1846 980 17 711 20.91 47.82 1881 868.000 19.515 22.48 44.47 1882 •••• 886,539 20,059 22.62 44 19 Note-tUnited States census, the intervening years, population estimated. Total Deaths from Diphtheria and Scarlet Fever in Philadelphia, Pennsylvania, during the past Fifteen Years-1868-1882. YEARS. Total Deaths Diphtheria. Total Deaths Scarlet Eever. YEARS. Total Deaths Diphtheria. Total Deaths Scarlet Fever. 1868 119 224 1876 708 328 1869 182 799 1877 458 379 1870 172 953 1878 464 554 1871 145 262 1879 321 336 1872 150 174 1880 323 291 1873 110 319 1881 457 486 1874 170 461 1882 933 310 1875 652 1.032 'Health Officer's Annual Report, 1882, p. 4. Total Deaths from Consumption, Typhoid Fever, Scarlet Fever and Small-pox in Philadelphia, Pennsylvania, during Twenty-one Years-1862-1882. K t* DEATHS FROM YEAR. DEATHS FROM Consump- tion. Typhoid fever. Scarlet fever. Small-Pox. Consump- tion. Typhoid Fever. . Scarlet Fever. Small-Pox. 1862. 1949 654 461 264 1873.. 2291 364 319 39 1863. 1953 486 275 171 1874.. 2304 491 461 15 1864. 2089 648 349 260 1875.. 2359 419 1032 54 1865. 2026 773 624 524 1876.. 2776 761 328 407 1866. 1944 381 491 144 1877.. 2349 542 379 155 1867. 1947 367 367 48 1878.. 2491 404 554 1868. 1995 395 224 48 1879.. 2481 344 336 6 1869. 1975 373 799 6 1880.. 2692 498 291 429 1870. 2308 409 953 9 1881 2768 645 486 1336 1871 . 2337 313 262 1879 1882.. 2809 650 310 314 1872. 2330 369 174 2585 .. The deaths from typhoid fever alone numbered, in twenty-one years, 10,256. Small-Pox and Vaccination in South Carolina. 329 The remarkable exemption of the citizens of Philadelphia, from the ra- vages of small-pox during the nineteenth century, may be justly attributed to the faithful advocacy and efficient practice of vaccination, by her learn- ed and philanthropic physicians. SMALL-POX, AND THE INTRODUCTION OF VACCINATION INTO SOUTH CAROLINA. Small-pox committed fearful ravages amongst the North American In- dians who were protected neither by inoculation nor subsequently by vac- cination. Entire nations and tribes disappeared-swept away by small- pox, without leaving any record of their sufferings. This fearful scourge first introduced into Mexico by the Spaniards in 1520, and at various sub- sequent periods by the French and English colonists, has been the chief agent in the destruction of the aboriginal inhabitants of North America. The powerful nation of the Katahbas, which, in the early history of South Carolina, numbered several thousand warriors, in 1743 could muster scarcely 400 men. In 1738, small-pox destroyed one half of the Cherokee nation ; and the Muskohgees, Uchees, Shawnese, Choctaws, Chickasaws, Natchez, and many other tribes have suffered to an equal extent. In describing the Sewees of South Carolina, John Lawson says : "These Sewees have been formerly a large nation, though now very much de- creased, since the English hath seated on their land, and all other nations of Indians are observed to partake of the same fate where the Europeans come, the Indians being a people very apt to catch any distemper they are afflicted withal; the small-pox has destroyed many thousands of these nations, who, no sooner than they are attacked with the violent fevers and the burning which attends that distemper, fling themselves overhead in the water in the very extremity of the disease ; which, shutting the pores, hin- ders a kindly evacuation of the pestilential matter and drives it back, by which means death most commonly ensues-not but in other distempers, which are epidemical, you may find among them practitioners that have extraordinary skill and success m removing those morbific qualities which afflict them." John Lawson visited Carolina in 1700. A New Voyage to Carolina, containing the exact description of that country, together with the present state thereof, and a Journal of a Thousand Miles, traveled through several Nations of Indians, giving a particular account of their customs, manners, etc. By John Lawson, Gent, Surveyor General of North Carolina. London: Printed in the year 1709 ; p. 10, p. 224. In another portion of his "New Voyage to Carolina," John Lawson says with reference to the Indians of North Carolina: " The small-pox has been fatal to them ; they do not often escape when they are seized with that distemper, which is a contrary fever to which they ever knew. Most certain, it had never visited America before the discovery thereof by the Christians. Their running into the water, in the extremity of this disease, strikes it in and kills all that use it. Now they are becoming a little wiser, but formerly it destroyed whole towns without leaving one Indian alive in the village." p. 223 224. '"A letter from the Governor and Lord's Proprietors, dated March 12, 1697-8, states: " We have had the small-pox amongst us nine or ten months, which hath been very infectious and mortal; we have lost by the distemper 200 or 300 persons. Ami on the twenty-fourth of February last,a fire broke out in the night in Charlestown, which hath burnt the dwellings, storesand oiit-houses 330 Small-Pox and Vaccination in South Carolina. of at least fifty families,and hath consumed (it is generally believed) in houses and goods the value of £30,000 sterling.*" In a subsequent letter, dated April 23, 1698, they state that the small-pox still continued, but was not so fatal as in the cold weather, and that a great number of Indians had fell victims to the disease.* Dr. David Ramsay is evidently in error when he states that the years 1700 and 1717 were the dates of the two first attacks of small-pox in Charleston ; it is qvident from the preceding facts that the small-pox pre- vailed in 1697 and 1698. Dr. Ramsay also appears to be in doubtabout the date of the first appear- ance of yellow-fever in Charleston, for, in his Medical History of South Carolina from 1670 to 1808, he says that " in the year 1699 or 1700, in addi- tion to the calamities resulting from a desolating fire and a fatal epidemic small-pox, a distemper broke out in Charleston which carried off an incred- ible number of people, among whom were Chief Justice Bohun, Samuell Marshall, the Episcopal clergyman; John Ely, the Receiver General; Edward Rawlins, the Provost Marshal; and almost one-half of the members of the Assembly. Never had the colony been visited with such general distress and mortality. Some whole families were carried off, and few escaped a share of the public calamities. Almost all were lamentingthe loss either of their habitations by the devouring flames, or their friends and relatives by this disease, or the small-pox. Anxiety and distress were visible on every countenance. Many of the survivors seriously thought of abandoning a country on which the judgment of heaven seemed to fall sb heavy. Dr. Hewatt, from whom the preceding account is taken, designates this malady by the general appellation of 'an infectious distemper.' It was generally called the plague by the inhabitants. From tradition and other circum- stances, particularly from the contemporaneous existence of yellow-fever in Philadelphia, there is reason to believe that this malady was the yellow- fever; and, if so, was the first appearance of that disorder in Charles- town, and took place in the nineteenth or twentieth year after it began to be built.+" Dr. Frederick Dalcho has definitely fixed the date of this outbreak of yellow fever in Charlestown in the year 1699. Thus this historian says: " The Rev. Mr. Marshall died in 1699, of a malignant disease which swept off many of the principal inhabitants of Charlestown. This disease was probably the yellow fever which raged at the same time in Philadelphia. In a letter from the Governor and Council to the Lord's Proprietors, dated Charlestown, in South Carolina, January 17, 1699-1700, they state that they had nothing to communicate, but that a most infectious, pestilential ami mortal distemper (the same which hath always been in one or more of His Majesty's American plantations for eight or nine years last past), which from Barbadoes or Providence was brought in among us into Charlestown about the twenty-eighth or twenty-ninth of August last past, and the decay of trade and the mutations of your Lordship's public officers occasioned thereby. This distemper, from the time of its beginning afore- said to the first day of November, killed in Charlestown at least 160 per- sons, among whom were Mr. Ely, Receiver General; Mr. Amory, Receiver for the Public Treasury; Edward Rawlins, Marshal; Edmund Bohun, Chief Justice. Amongst a great many other good and capital merchants *An Historical Account of tho l*fotestnnt Episcopal Cliurcli in South Carolina from the first s< ttlen ent of the Province to the War of the Kevolntiou, etc.; by Frederick Dalcho, M. D., Assistant Minister of st. Michael's Church ; Charleston, p. 32. tThe Histbry ot South Carolina, from its first settlement in 1G70 to the year 1808, in two volumes j by Da- vid Kamsay, 11. D.; Cluulestou, 1800 ; vol. 2, p. 82. Small-Pox and Vaccination in South Carolina. 331 and housekeepers in Charlestown the Rev. Mr. Marshall, our minister, was taken away by the said distemper. Besides those that have died of this distemper in Charlestown, ten or eleven have died in the country, all which got the distemper and were infected in Charlestown, went home to their families and died; and what is notable, not one of all their families was infected by them. This afflictive dispensation of Providence is likewise mentioned in a letter from Isaac Norris, dated November 18, 1699, O. S. It states that 4150 persons had died in Charlestown in a few days; that the survivors fled into the country, and that the town was thinned to a very few people.'* Small-pox appeared again in 1717, and returned in 1732, but in this latter year effectual care was taken to prevent its spreading. In the year 1738, small-pox was imported in a Guinea Ship, and spread so extensively that there was not a sufficency of persons in health to attend the sick; and many persons perished from neglect and want. Th^re was scarcely an hour in which there had not been one or more deaths. From a manuscript in the hand-writing and found among the papers of the venerable Thomas Lamboil, who died in 1775, the following particulars are collected relative to this disease. "It first attracted public notice in May, 1738. In the next month a fast day was appointed by proclamation. Soon after the disease commenced, a report was circulated that tar water was not only a good preparation for recovering, but a preventive of the small-pox. Many barrels of tar were sold and used for that purpose; but the author soon after took the infection and died, and his empirism died with him. "By an account dated September 30, of the same year, it appears that the whole number of deaths was 411 ; and the whole number who had taken the small-pox was 2112, of which 833 were whites and 1279 blacks. Of the former, 647 took the disease in the natural way and of them 157 died. Of 188 whites who took the disease by inoculation, nine died. Of the 1279 blacks who took the disease 1028 had it in the natural way, and of them 138 died, the remainder; 253, were inoculated, and of them seven died." From these facts, as stated by Mr. Lamboil, it appears that of the white persons who took the small-pox in the natural way, nearly one in every four died ; but of such as took it by inoculation, the deaths were only one in twenty. Of the negroes who took the disease in the natural way, nearly one in every seven died, but of such as took it by inoculation, the deaths were only one in thirty six. Dr. David Ramsay, writing in 1808, says, in reference to the preceding facts, that, "It is well known that negroes have the small-pox as bad, if not worse, than white people when the treatment of both is the same. That they fared better than their owneis on this occasion must be referred to their being under less restraint with regard to cold air. In treating the small-pox, an excess of care and confinement is much worse than no care or confinment whatever."! From the same manuscripts of Thomas Lamboil, it appears that on the twenty-first of September, an act of assembly was passed at Ashley ferry against inoculation for the small-pox in Charleston, or within two miles of it after the tenth of October,§ 1738. Dr. David Ramsay, gives the following account of the introduction of the practice of inoculation into the province of South Carolina during the pre- valence of small-pox in Charleston in 1738. *An Historical Account of the Protestant Episcopal Church in South Carolina etc. by Frederick Dalcho, M. D. p. 35. t History of South Carolina, p. 77. • §History of South Carolina, p. 77-78. 332 Small-Pox and Vaccination in South Carolina. Dr. Moybray, a surgeon of a British man of war then in the harbor, pro- posed inoculation ; but the physicians opposed it at first. With the excep- tion of Dr. Martin, they afterwards came into it. Mr. Philip Priolean was the first person in Charleston who submitted to the operation. The suc- cess which attended this first experiment encouraged several others to fol- low the example. The disease soon after abated. Small-pox appeared again in 1760. Dr. Frederick Dalcho, records the facts, that; "the twelfth annual meet ing of the clergy was held April 16, 1760. Five clergymen were present and eleven were absent. The small-pox raging in town, prevented those who were subject to its influence from attending the meeting. No sermon was preached." Dr. David Ramsay states, that "about thebeginning of the year 1760, the. small-pox was discovered in the house of a pilot on White Point; guards were placed round the house, and every precaution taken to prevent the spreading of the disease; but in vain. When the persons first infected at White Point were either dead or well, the house in which they had lain was ordered to be cleaned. In doing this a great smoke was made which, being carried by an easterly wind, propagated the disease extensively to the westward in the line of the smoke. Inoculation was resolved upon and became general.* "When this practice was first introduced, and for several years after, the inoculators loaded their patients with mercury and tortured them with deep crucial incissions, in which extraneous substances impregnated with the va- riolous matter was buried. There were then able physicians in Charleston ; but they were so mistaken with the proper method of treating the disease that it was no uncommon practice to nail blankets, over the shut windows of closed rooms, to exelude every particle of cool fresh air from their va- riolous patients, whose comfort and safety depended on its free admission. The consequences were fatal. Charleston was a scene of the deepest afflic- tion. Almost every family was in distress for the loss of some of its mem- bers, but so occupied with the attentions to the sick that they could neith- er indulge the pomp nor the luxury of grief. The deaths from the small- pox was nearly eleven-twelfths of the whole mortality in Charleston. Only eighty-seven died of other diseases, while the deaths from the small-pox amounted to nine-hundred and forty. Of these only ninety-two died under inoculation. Fifteen hundred persons are said to have been inoculated in one day; and it is certain from the bills of mortality that 848 persons died of the di- sease who were not inoculated. If we allow that only one in four died, as in the year 1738, the whole number who took the disease in the natural way must have been 3392. Precision in numbers is not attainable; but enough is known and remembered by several persons still alive to prove that the year 1760 was one of the mort melancholy and distressing that ever took place in Charleston. In the year 1763 the small-pox returned; but as there were few to have it, and inoculation was generally adopted ; its ravages were not extensive. For seventeen years after, the small-pox was seldom or never heard of. During the siege of Charleston it was introduced, and immediately after the surrender of the town,on the twelfth of May, 1780, a general inoculation took place. As the cool regimen was then universally adopted, the disease passed on without any considerable loss or inconvenience. *Au Historical account of the Protestant Episcopal Church p. 134. Small-Pox and Vaccination in South Carolina. 333 " Since the Revolution, all the laws which interdicted the introduction and spreading of the small-pox have been repealed. There have been, of course, some cases of small-pox almost every year, but nothing very gen- eral or alarming in any one. A small proportion of those inoculated died or suffered inconveniences from it; but to nineteen of twenty, it was a trifling disorder. This was a great triumph of suffering humanity, but it was short of what followed. In the yeer 1802, vaccination was introduced into Charleston within four years after Doctor Jenner had published its efficacy in preventing the small-pox, though eighteen years had elapsed between the first inoculation in England for the small-pox and the adoption of that practice in Carolina. . This substitute for small-pox (vaccination) was introduced into Charles- ton by Dr. David Ramsay, who after many trials succeeded in February, 1802, in communicating the disease to his son Nathaniel. From him, originally or remotely, some thousands have received the disease. No case has yet occurred in which a clearly marked case of small-pox has followed a clearly marked case of vaccination. Mistakes have been made with re-, spect to both diseases, and the one has in some instances been communi- cated to persons who had previously used the seed of the other. From these causes, added to the ignorance and carelessness of some vaccinators, the confidence of a few in the Jennerian discovery has been weakened. But that the real vaccine is a preventive of the real small-pox is as cer- tain, from the testimony and experience of thousands, as that the inocu- lated small-pox secures against the natural. Thus in the short space of seventy years, the small-pox has been moderated in Carolina from the natural to the artificial. The latter so alleviated by mild treatment, and particularly by the cool regimen, as to become for the most part a trifling disease; and finally an opportunity has been given to avoid the danger and inconvenience of both, by a safe and easy substitute. The future ravages of the small-pox may be fairly put to the ac- count of the carelessness, the ignorance, or the prejudices of the people. [The History of South Carolina from its first settlement, in 1670, to the year 1808; in two volumes. By David Ramsey, M. D.; Charleston, 1809 ; pp. 78-81.] Small-pox prevailed epidemically in Charleston during the seventeenth century, in 1698 and 1699; during the eighteenth century, in 1717, 1738, 2112 persons were attacked, of whom 411, or 20 per cent, died; of these 833 were whites, 1669 of whom, or 20 per cent died; among the blacks, 1279 cases occurred, of which 145, or 12.5 per cent were fatal; in 1760 deaths from small-pox 940, only 87 deaths being recorded from all other causes during that year, the deaths from small-pox bearing the frightful proportion of 91.52 per cent to the deaths from all other causes; small-pox again prevailed epidemically in 1763 and 1780. During the nineteenth century after the introduction of vaccination no ex- tensive epidemics are recorded, up to the time of the great American civil war, 1861-1865. The absence of small-pox from Charleston during the first sixty years of the nineteenth century during which period vaccination was systematically and intelligently urged and practiced by its learned and accomplished phy- sicians and surgeons, has been acknowledged by the medical profession and also demonstrated by official records. The truth of the preceding proposition will be illustrated by the follow- ing statistics: 334 Small-Pox and Vaccination in South Carolina. Statement of the Deaths in Charleston, South Carolina, from all Causes and from Small-Por for Thirty-six Years, from 1822 to 1848, Inclusive. YEARS. Population. Deaths. Proportion of Deaths to Population. Deaths from Small Pox. 1 | Males. 1 F'inales Total. 1 One in. In 100. White. Black. Total. 1822 24,780 537 388 925 26.78 3.72 o o o 1823 26'301 432 382 814 32.21 3.10 0 () o 1824 27,822 403 1 059 26.27 3.80 o 1 1 1825 28 233 481 359 840 33.60 2.97 18 34 52 1826 28 644 420 344 764 37.48 2 66 15 14 29 1827 29,055 474 329 803 36.68 2 67 0 0 () 1828 29'466 454 339 793 37.15 2.69 0 0 0 1829 29,877 388 374 762 39.20 2.55 o o 0 1830 30/289 408 355 763 39.68 2.50 0 16 16 • 472 364 836 33.82 2.95 33 65 98 1831 30,187 382 351 733 41.17 2 42 6 36 42 1832 30,085 303 257 560 53 72 1.86 0 0 0 1833 29,982 281 261 542 55 31 1.80 o o o 1834 29 879 350 342 692 43.03 2.32 o o o 1835 29'776 365 299 664 44.50 2.23 0 0 o 1836 29,673 639 533 1,172 25 31 3.95 0 0 o 1837 29,570 352 278 630 48.52 2.06 0 0 '0 1838 29,467 828 381 1,209 24.36 4.10 0 0 0 1839 29,364 502 354 856 34.30 2 91 o o o 1840 29,261 361 244 605 46.36 2.18 1 1 2 433 330 766 38.80 2.57 7 37 44 1841 28,910 336 258 594 50.35 1.98 0 1 1 1842 28'559 307 243 550 51.83 1.92 0 0 0 1843 28,208 368 329 697 40.47 2.47 4 46 50 1844 27,857 282 271 533 50.37 1.98 0 0 0 1845 27,596 272 298 570 48.40 2.06 0 0 0 1846 27,155 326 281 607 44.72 2.23 0 o o 1847 26,803 272 276 548 48 89 2.04 o o o 1848 26,451 322 292 614 43.05 2.32 1 0 1 Mean 310 281 592 46.77 2.13 5 47 52 Swine-Pox occasioned amongst the whites one death in 1824 and one death in 1825; amongst the blacks, one death in 1827 and one death in 1837 ; total deaths from Swine-Pox in Charleston, South Carolina, during twenty-six years (1822 to 1848 inclusive), four. During the same period vaccination caused one death amongst the whites in 1844, and one death amongst the blacks in 1842 and one death in 1844; total deaths from vaccination in Charleston, South Carolina, during twen ty-six years (1822 to 1848 inclusive), three. On the other hand Small-Pox caused deaths-whites 45, blacks 149; total, 194. Small-Pox and Vaccination in Charleston, S. C. 335 From all the data which we have been able to obtain relative to the mor- tality of Charleston, South Carolina, subsequent to 1840, we extract the following concerning small-pox and vaccination. YEARS. Population. Total Deaths. Proportion of Deaths to Population. V accination. Deaths from Small-Pox. 1844 29,963 553 54.13 2 0 1845 29,963 570 52.18* 0 0 1846 607 47.71 0 0 1847 543 54.74 0 0 1848 617 43.11 0 0 1849 798 36.34 0 0 1850 No report. 1851 922 44.46 0 4 1852 No report. 1,582 27.81 0 0 1853 1854 1.876 23.49 0 59 1855 No report. 1,088 45.94 0 0 1856 1857 1.237 42.37 0 1 1858 1.922 26.14 0 0 1859 1,033 48.40 0 0 1860 1,472 37.38 0 0 1861 No reports. 1.380 35.09 0 0 1862, 1863, 1864 1865 2.068 9.70 0 138 * Of the 138 deaths occasioned by small-pox in 1865, eleven were whites and 137 colored. That small-pox continued to prevail is indicated from the report of the Health Officer for 1866. We have in our possession the report of the Registrar of Charleston, South Carolina, for only three months of 1876, April, May and June; during these months the deaths from small-pox were, whites thirteen, colored eighty-three ; total ninety-six. During the Federal occupation, after the fall of Charleston, near the close of the Confederate struggle for independence, the colored people congregated in the city, and small-pox introduced, by the Federal forces, prevailed to a great extent, but the exact data is not in our posesssion to show the ac- tual mortality occasioned by this disease: Some conception of the condition of affairs in Charleston may be gather- ed from the following extracts from the journals of 1867. SANITARY STATISTICS OF SOUTH CAROLINA. Through the kindness of the Medical Director of the Freedmen's Bureau for South Carolina, Brevet Colonel and Surgeon M. K. Hogan, we have been permitted to examine the Sanitary Reports of Refugees and Freedmen, who have been receiving medical treat- ment from the officers of the Bureau. We procured these statistics in order to examine, from the most reliable data within reach, into the general condition of health prevailing throughout the State, as well as in this city. We did this because there has been within the past few weeks what we believed to be exaggerated rumors regarding the amount of sickness and mortality in the State. As we have before stated, " refugees" here means indigent whites. These reports include the Health Department of the City of Charleston. The following posts are represented; Charleston, Beaufort, Port Royal Island, James' Island, Wadmalaw, Georgetown, Hamburg, St. James' Santee, Edisto Island, Mount Pleasant, Summerville, Columbia, Hopkins' Turnout, Hilton Head, St. Paul's Parish, Legareville, St. Thomas' Parish, Monk's Corner, and Darlington. Some of these posts have lately been discontinued. The reports of the "Refugees," we believe, are princi- pally confined to the white poor of this city, and the freedmen, for the most part, are of Charleston and the sea islands. The reports before us would be of great interest and scientific value if there were any possibility of determining what proportion the number of sick here reported bears to the whole population, from among whom these sick are taken. But this from the nature of the case, it is impossible to ascertain. The numbers purporting to give this informa- tion, therefore, are necessarily only of proximate accuracy. We have thought, how- ever, that a comparison of the sanitary condition of the present summer, with that of last year, and of the white with the colored population, may not be without interest to the profession, or even to the public. 336 Small-Pox and Vaccination in Charleston, S. C. The consolidated reports of the several posts in South Carolina, under the char ;c of the Freedmen's Bureau (including the poor white and black of Charleston), present ns with the following statistics: REFUGEES. < 1866. 1867. May. June. July. May. June. July. Total under charge of Bureau... 2,825 2,825 2,925 4'184 4,4:19 4,437 Total number treated during month... 585 546 601 889 626 98-' Died during the month 12 17 8 13 7 8 Small-pox and Varioloid 26 9 1 Deaths from same 1 Typhoid fever 2 3 1 3 2 Deaths from same Malarial fevers.... 81 112 169 132 173 300 Deaths from same... 3 2 Consumption 6 9 13 12 7i 5 Deaths from same 2 1 2 2 Scrofula. 1 6 1 2| 4 Deaths from same 1 1866. 1867. May. June. .July. | May. June. । July. Total number under charge of Bureau 39,099 3,9096 33,285 116,135 116,135 116,974 Total number treated during month.. 5,356 5,536 4.522 5,716 5,641 7,883 Died during the month 87 67 70 66 113 Small-pox and Varioloid 176 271 226 Deaths from same 20 10 1. ■ ■ Typhoid fever 41 69 89 10 5 3 21 Deaths from same 6 3 2 6 Malarial fever 603 1,190 8 1,840 686 1,228 7 3,390 23 Deaths from same 5 5 2 Consumption 27 28 3 33 31 37 33 Deaths from same. 5 4 14 7 8 Scrofula 40 35 32 53 64 63 Deaths from same 1 1 2 FREEDMEN. Upon an examination of the foregoing tables it will be seen that the amount of sick* ness this year has been greater, both among black and white, in May, June and July, than during the corresponding months of last year; and this difterence, we have every reason to believe, is due to the greater preponderance this year of the different forms of maleria fever. Small-pox, it is known, was epidemic here during the winter months of 1866-'67, and the period embraced in the above reports bring us to the close of the epidemic cycle. The disease was very fatal, but during the summer months, as usual, its virulence abated, and we hence find that but few whites died from it. The number of deaths among the freed- men was greater-11 per cent, in May ; 6 per cent, in June, and about 4 in July; while among the whites, during the three months, the deathsform only 3 percent, of the cases. There is now not a single case of small-pox in the State of South Carolina that we know of, norjhasjthere been for months. Typhoid fever did not prevail to any alarming degree either last year or this. We have only sixteen cases reported among whites, two of which, or twelve and one-half per cent. died. Among the freedmen, we note 179 cases last year, with fourteen deaths, and only forty cases, with eleven deaths, this year. The percentage of mortality last year from this disease was about eight per cent , and this year twenty-seven per cent, of the cases resulted fatally, a very large mortality, if the statistics may be relied upon. Small-Pox and Vaccination in Charleston, S. C. 337 The numbers of cases of the different forms of malarial fevers reported are not greatly in excess this year over last. It is true the aggregate of cases is much larger, but it should be observed that, both among white and black, the number of those enjoying the benefit of medical care from the Bureau is larger this year than it was last. The per- centage of malarious diseases this year and last, calculated from the whole number of cases treated, is as follows : FREEDMEN. REFUGEES. 1866. 1867. 1866. 1867. May .10 .12 May .14 .15 June .21 .21 June .20 .27 July .33 .43 July. .28 .30 We find here, with all the uncertainty and accidents to which statistics are subject, a striking coincidence, in the similarity of the proportion these malarious diseases hold to the entire number oi diseases reported, in the two years under consideration. Consumption and scrofula, we believe, are not common diseases in this climate. During the three months under consideration, in 1866 and 1867, we have 52 cases of consumption reported among whites, with 7 deaths, or 13 per cent. Among the freedmen, during the same period, we have 189 cases and 41 deaths or 12 per cent. The percentage of cases of consumption among whites, calculated on the number of persons under the charge of the Bureau, was .014, or nearly one and a half per cent., and among the freedmen .002, only one-fifth of one per cent., a very small fraction. Of scrofula only 15 cases are reported among whites, and 287 among the freedmen. On the whole, as far as we are able to judge from these reports, we should say that the sanitary condition of South Carolina is good-much better than is supposed by those who have not examined the subject. Perhaps, in conclusion, it may be well to state that there has not been this year a single case reported of any epidemic disease within the limits of this State. There has been no small-pox, not a single case of yellow-fever, cholera, or even breakbone-fever, reported this year; and considering the lateness of the season, we think our people may enjoy a reasonable hope of immunity from epidemic during the remainder of the year. The following statistics of deaths by small-pox, in Charleston, South Carolina, during the fifteen years immediately following the American Civil War, have been furnished by the Registrar.* Deaths from Small-Pox in Charleston, South Carolina, during the Fifteen Years 1865 to 1879 1865 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 1 1876 1«77 1878 187»| Total Whites. Total Colored. Total White and Colored. Whites 11 37 0 0 o 1 8 3 0 0 0 0 0 60 Colored 127 239 4 0 0 ' 0 0 6 98 32 0 6 0] 0 o| 512 Total.. 138 276 4 _ 9 0 Ol 0 7 106 35 0 6! jol 0 q 60 512 _ 572 The marked increase of small pox amongst the colored people after the Civil War was referable to the sudden liberation from slavery, and the con- sequent freedom of action, as well as to the neglect of vaccination. From the preceding facts, it is evident that Charleston, South Carolina, was protected from the ravages of small pox by the introduction of vaccina- tion in 1802 by Dr. David Ramsey, and tha(t the immunity of this city from this loathsome pestilence during the first sixty-four years of the nineteenth century must be attributed to the earnest and philanthropic labors of her accomplished physicians and surgeons in the earnest advocacy and skillful practice of vaccination. 338 Small-Pox and Vaccination in Georgia. The early medical history of Georgia, during the eighteenth century, em- bracing a period of almost sixty-seven years, has never been written ; but we are convinced after careful research that this province and State has ever enjoyed the benefits of the professional skill and labors of educated, accomplished and philanthropic medical men. During the nineteenth cen- tury, no State of equal white population in the American Union can pro- duce a more distinguished array of learned and skillful surgeons and phy- sicians, amongst whom may be named Drs. Waring, Richardson, Kollock, Bullock, Arnold, West and Harris, of Savannah; Dr. Harden, of Liberty county; Dr. Anthony, Dr. Paul F. Eve, L. A. Dugas, Lewis D. Foard, Jo- seph Eve, and Henry F. Campbell, of Augusta, Georgia; and Dr. Long, the discoverer of the Anaesthetic effect of Sulphuric Ether, of Athens, Georgia. The first authentic notice of the presence of small-pox in Georgia which has been recorded (although the disease was undoubtedly present at other times), was in the year 1779. The failure of the allied arms to capture Savannah, ami the mutual de- feat ami withdrawal of the French and American troops, left Georgia in a worse condition than ever ; and it seemed almost as if her political existence was at an end. The royal government was re-established and Sir James Wright issued his proclamation, dated Savannah, the twentieth of October, 1779. The first care of Sir James Wright was to put Savannah into a proper condition ; for it had been so shattered by the destructive fire of the French and Americans, and by the wanton use of the troops, as well as by the necessary demands of the siege, that it was in a deplorable state. The churches and public buildings had been used for depots, and hospitals and barracks ; private dwellings had been converted into mess-halls and officers' quarters; tire had laid waste some squares of buildings; others had been pulled down, to use the materials in different parts of the fortifications; others had been rendered tenantless by the battering balls; and there was scarcely a house in town which had not been made to suffer, outside or in, in consequence of crowding together so many of the inhabitants, with sol- diers, seamen, and negroes, within the narrow limits of the entrenchments. Scarcely had the town put on the aspect of order and cleanliness, before the small-pox, broke out and produced great consternation amongst the inhabitants and soldiers. Inoculation was at that time but little practiced, and only then after an order obtained for that purpose from the Governor's Council, who generally refused to grant the order, except the disease had already broken out in the houshold desiring this preventive treatment. The exact date at which vaccination was introduced into Georgia is not known, but it was probably about the same time (1802) that it was practic- ed by Dr. David Ramsey in Charleston, South Carolina. Many of the older citizens, who were known to me in my boyhood had been inoculated for the small pox before the introduction of Dr. Jenner's method. The following records of the mortality occasioned by small pox, in Sa- vannah and Augusta, Georgia, which I have consolidated from the original records, will show that the small pox was almost wholly absent from the two largest and most important cities of Georgia, during the first sixty years of the nineteenth century; and that its appearance and prevalence was re- ferable to the assemblage of large bodies of troops during the American civil war, and the liberation of the negro slaves : SMALL-POX AND VACCINATION IN GEORGIA. Small-Pox and Vaccination in Georgia. 339 Deaths from all Causes and from Small-pox amongst the White Population of Savannah, Ga., during a period of fifty years, 1804-1853, inclusive. Year. Deaths from All Causes. Deaths from Suiall- Pox. Year. Deaths from All Causes. Deaths from Small Pox. Year. Deaths from All Causes. Deaths from Small- Pox. 1804 207 1 i 1824 ... 136 0 1844 247 0 1805 238 0 1825 .... 126 0 1845 229 0 1806 159 0 1826 235 0 1846 240 0 1807 ... 230 o 1 1827 221 0 1847 210 0 1808 ... 219 0 1828 146 0 1848 298 0 1809 183 0 1829 209 0 1849 357 0 1810 163 0 1830 159 0 1850 384 0 1811 312 0 1831 149 0 1851 414 0 1812 226 0 1832 216 0 1852 642 0 1813.... 214 0 1833 202 0 1853 470 0 1814 300 0 1834 197 1 1815 233 0 1835 228 1 1'otal 10 years 1844-1853.. 0 1816 272 0 1836 249 0 Total 20 years, 1824-1843.. 2 1817 461 2 1837 358 0 Total 20 vears 1804-1823.. 3 1818 211 0 1838 331 0 1819 510 0 1839 .... 367 0 Total deaths from Small- 1820 817 0 1840 380 0 pox in Savannah. Ga.. 1821 384 0 1841 .. .. 305 0 during fifty years, 1804- 5 1822 291 0 1842 ... 272 0 1853 .1823 Total 20 288 0 1843 .... 256 0 years.. 3 2 During a period of fifty years, 1804-1843, inclusive, in Savannah, Ga., the total deaths from all causes numbered 14,322, and of this number small- pox occasioned five. The white population in 1804 was 2799, in 1808, 3010; 1840, 5888; 1843, 7250; 1850, 8395. Total Deaths from All Causes, and from Small-Pox, in the White and Colored Population of Savannah, Georgia, during a Period of Sixteen (16) Years, 1854 to 1869, inclusive. YEARS. WHITES. BLACKS AND COLORED. WHITES, BLACKS AND COLORED. Total Deaths from All Causes. Total Deaths from Small-Pox. Total Deaths from All Causes. Total Deaths from Small-Pox. Total Deaths Total Deaths from All Causes. from Small-Pox. 1854 1,221 0 308 0 1,529 0 1855 433 0 292 0 725 0 1856 466 0 297 0 765 0 1357 376 0 264 0 640 0 1858 592 0 262 0 854 0 1859 430 0 273 0 703 0 I860 474 0 282 0 756 0 1861 563 0 269 0 832 0 1862.... 555 0 372 , 0 927 0 1863 459 0 389 0 848 0 1864 747 4 446 0 1,193 4 1865 1,202 13 819 1 2,021 14 1866 530 9 912 8 1,442 17 1867 476 0 594 1 1,070 1 1868 498 1 581 0 1,079 1 1869 423 0 429 0 852 0 Total deaths from small pox during sixteen vears in Savannah, _GaL, 1854 to 1869 27 10 37 Total deaths from all causes, whites and colored, 1854 to 1869, 16,231. A careful examination of the mortuary records of Savannah shows that it is difficult to determine the exact number of deaths from yellow fever, during many of the years embraced in the preceding table, containing the deaths amongst the whites from all causes, and the deaths from small-pox, during a period of sixty-six years, and amongst the blacks and colored during a period of sixteen years. 340 Small-Pox and Vaccination in Savannah, Ga. 1804-One death is recorded as due to yellow fever in the month of Octo ber, whilst inflammatory and putrid fevers caused ten deaths, and remittent fever sixty five, intermittent one; total seventy-seven; natives fourteen, foreigners sixty-three. 1805-No classification of fevers; 110 deaths being recorded simply as fever, two deaths nervous fever; total 112; natives twenty-two, foreigners seventy-eight. 1806-Kernitting fever forty-one, fever and ague eleven, total fifty-two; natives nine, foreigners forty-three. 1807-Fever seventy-two, intermittent five, nervous three; total eighty ; natives nine, foreigners seventy-one. 1808-Fever remittent seventy, intermittent seven; total seventy-seven ; natives eight, foreigners sixty-nine. 1809-Fever remittent sixty, intermittent one, malignant one, nervous one; total sixty-three; natives nine, foreigners fifty-two, unknown two. 1810-Fever remittent forty-four; inflammatory one; intermittent one; natives eight, foreigners thirty-eight. 1811-Remittent seventy four, bilious malignant four, intermittent two, inflammatory one, putrid one, typhus five; total eighty-seven; natives thirteen, foreigners seventy-three, unknown one. 1812-Fever ninety-three, bilious fourteen, inflammatory six, endemical one, putrid two, nervous one, malignant fever one, black vomit two; total 120 ; natives twenty-four, foreigners ninety-two, unknown four. We observe that two cases are recorded as black vomit; and also that fever caused a mortality of 102 in a city of only about 5,300 inhabitants. The distribution of these deaths by months are as follows, May two, June four, July ten, August eleven, September twenty nine, October fifty, November five, December five; the rise and decline of the mortality from fevers in 1812 resembled the ordinary progress of yellow fever. 1813-Fever fifty-five, bilious two, intermittent three, inflammatory three, nervous one; total sixty-four; natives nineteen, foreigners forty-five. 1814-Fever 125, bilious putrid four, inflammatory one, typhus one, spotted one, intermittent two; total 166; natives twenty-three, foreigners 138, unknown five. In this year again the course of mortality from fever resembled that of yellow fever, being January one, March one, May one, June eight, July fifteen, August twenty-five, September fifty-five, October forty-six, Novem- ber fourteen. 1815-Fever 129, inflammatory two, nervous two ; total 130 ; natives eighteen, foreigners 104, unknown eight. 1816-Fever 134, bilious three, putrid one, intermittent six, typhus one, yellow one; total 146; natives thirty-eight, foreigners ninety-one. 1817-Fever 304, bilious four, inflammatory one, yellow two, typhus two; total 311; natives fifty-seven, foreigners 236, unknown twenty. Amongst this large number of deaths from fever, only two were indicated as yellow; the deaths by months from fever, were as follows : January four, February five, March two, June eight, July forty-five, August thirty- seven, September forty-six, October 104, November forty-seven, December thirteen. 1818-Fever seventy-four, nervous two; total seventy-six ; natives thir- teen, foreigners sixty, unknown three. 1819-Fever 322, black vomit one; total 323; natives thirty-three, for- eigners 285, unknown five. The monthly mortality from fever was as follows: Small-Pox and Vaccination in Savannah, Ga. 341 March one, April three, June four, July twenty-four, August twenty- eight, September, sixty-six, October 147, November forty, December nine, total 323. The first acknowledged and undoubted epidemic of yellow fever in Savannah, Georgia, during the first twenty years of the nineteenth century occurred in 1820. 1820-Fever 626, yellow fever two, black vomit ten, intermittent one; total deaths from fever 649; natives 116, foreigners 502, unknown thirty- one. The deaths from fever were distributed as follows: January four, Feb- ruary four, March one, May three, June fourteen, July thirty-nine, August 110, September 214, October 197, November fifty-three, December ten. It is remarkable that upon the mortality record, only two cases were recorded as due to yellow fever. The following table presents the total deaths from fever and other causes in Savannah, Georgia, during a period of fifty years, 1804-1853, inclusive, amongst the white inhabitants : YEARS. Total Deaths from Fevers. Total Deaths from All Other Causes. YEARS. Total Deaths from Fevers. Total Deaths from All Other Causes. 1804 77 130 1829 32 177 1805 112 126 1830 28 139 1806 .... 107 1831 17 139 1807 80 150 1832 57 159 1808 77 142 1833 36 166 1809 63 120 1834 34 163 1810 117 1835 57 171 1811 87 125 1836 38 211 1812 120 106 1837 100 258 1813 64 150 1838 108 163 1814 166 134 1839 154 213 1815 130 103 1840 .... 124 256 1816 146 126 1841 83 222 1817 313 148 1842 62 210 1818 76 135 1843 91 165 1819 .... .... 323 187 1844 51 196 1820 649 168 1845 57 172 1821 183 202 1846 60 180 1822 .. 133 158 1847 28 182 1823 109 159 1848 50 148 1824 42 94 1849 71 286 1825 23 103 1850 63 321 1826 62 173 1851 75 339 1827 96 225 1852 202 440 1828 23 123 1853 76 394 4 888 9,444 Total deaths from all causes, 14,332. Table-Deaths from Malarial Dever and from Yellow Fever in Savannah, Georgia, During a Period of Sixteen Years, 1854-1869 ; Whites. 1854 1855 1856 1857 1858 1859 TEAR. ■u 115 60 86 76 Malarial Fever. DEA 625 0 0 0 112 0 Yellow Fever. THS. CO Ci 1860 1861 1862 1863 1864 YEAR. 59 80 53 35 97 , 103 Malarial Fever. DEA u o o o Yellow Fever. THS. 1 Total 11866 1867 11868 1869 YEAR. 1,071 48 67 52 36 Malarial Fever. DEA c? w H- © OX Yellow Fever. THS. 342 Small-Pox and Vaccination in Savannah, Ga. Table-Deaths from Malarial Fever and from Yellow Fever in Savannah, Georgia, During Sixteen Years, 1854-1869 ; /Hacks and Colored. 00 Ct © K a T XT Ci Q» C.T in X> -4 © CH 4^ H H YEAR. © 23 9 40 5 Malarial Fever. DEA © to © © © ** Yellow Fever. THS. S98ll 1860 1861 1862 1863 YEAR. 3 3 14 19 20 120 Malarial Fever. DEA © to © © © © Y ellow Fever. THS. | Total 1866 1867 1868 1869 YEAR. 8 © «S fR El OS Malarial Fever. DEA 00 o o o o Yellow Fever. THS. The total deaths amongst the whites during the period specified (1856- 1869) were 9,445; amongst the blacks and colored, 6,789; grand total whites and blacks, 16,234. In 1827 sixteen deaths from yellow-fever were recorded, and seventeen deaths from malignant fever; total from yellow and malignant fever, 33. The deaths from these causes were distributed as follows: September, ten; October, nineteen ; November, four. Fever was credited with fifty deaths- intermittent, six; nervous, four; typhus, three; total, ninety-six; natives, sixteen ; foreigners, seventy-eight; unknown, two. In 1839, when the yellow-fever prevailed in a fatal form in Augusta, Georgia, yellow-fever does not appear amongst the list of fatal fevers. The deaths from fevers were classified as follows: Fever, 139; intermit- tent, three; malignant, eleven; nervous, one; total deaths from fevers, 154 ; natives, fifteen; foreigners, 137; unknown, two. It is probable that a portion of the deaths (154) recorded as fever and malignant fever, etc., were yellow-fever. In 1876, during the months of August, September, October and Novem- ber, yellow-fever caused 896 deaths, and other diseases 455; total, 1,351. The following is the official record as prepared by Dr. William Duncan, and embodied in the annual report of Hou. Edward C. Anderson, Mayor of the city of Savannah for the year 1877. Deaths from Yellow Fever and other diseases in Savannah, Georgia, dnring the months of August, September, October and November. 1876. WHITES. COLORED. TOTAL. Months. Yellow Fever. Other Dis- eases. Total. Yellow Fever. Other Dis- eases . Total. Whites and Colored. August 35 25 59 2 19 21 80 483 66 549 66 137 201 752 212 54 266 52 109 161 427 November.; 41 16 57 5 30 35 92 Total 771 160 981 125 295 420 1,351 Total yellow fever, 896; other diseases, 455 ; grand total, 1351. If the deaths from fevers occurring in the months of June, July, August, September, October and November and December in 1820, be regarded as yellow fever (an estimate above rather than below the true number of deaths occasioned by this disease), then we have 637, as the yellow fever mortality of that year; and if we add the deaths from yellow fever in 1854, 639 ; 1858, 114, and 1876, 896, the total deaths from yellow fever in Savannah, Georgia, during a period of seventy-three years, 1804-1876, would number: Small-Pox and Vaccination in Augusta, Ga. 343 1820 637 1854 639 Total ... 1,276 1858 114 1876 896 Grand total 2,286 Before the introduction of vaccination a large proportion of the deaths was caused by small-pox, and yet the official mortuary records of the city of Savannah show that, during a period of sixty-six years, 1804 to 1869, the deaths from small-pox reached only forty-two out of a total of deaths from all causes: Whites, 1804 to 1853, 14,332; whites and colored, 1854 to 1869, 16,234; total, 30,566. Whilst the various forms of fevers destroyed amongst the whites during fifty years, 1804 to 1853, 4.888; whites and blacks, sixteen years, 1854 to 1869, 2,626; total, 7,514. The statistics of Savannah show that the colored race are far less liable to the various forms of miasmatic fevers and yellow-fever. This immunity does not extend to small-pox, which, ou the other hand, proves very de- structive to the colored race. We must attribute the remarkable immunity of the white and black races of Savannah, Georgia, during the nineteenth century, from the rav- ages of small-pox to the faithful performance of vaccination and revaccin- ation by the medical profession; and the results of their labors in this respect have been placed in bold relief by the record of the preceding mor- tuary statistics, illustrating the ravages committed by yellow-fever and malarial fever, during the period taken under consideration. SMALL-POX AND VACCINATION IN AUGUSTA, GEORGIA. Deaths from All Causes and from Small-Pox, Whites and Blacks, in Augusta, Georgia, during Forty-eight Years, 1818 to 1866. YEARS. Total Deaths from All Causes. Deaths from Small-Pox. YEARS. Total Deaths from All Causes. Deaths from Small-Pox. 1818 90 o 1842 71 o 1819 118 o 1843 80 o 1820 126 o 1844 4 105 o 1821 127 o 1845 139 o 1822 145 o 1846 185 o 1823 109 0 1847 .. 168 0 1824 90 o 1848 236 o 1825 127 o 1849 243 o 1826 117 0 1850 328 1 1827 134 0 1851 363 7 1828 91 o 1852 410 o 1829 94 o 1853 .... 372 0 1830 71 o 1854 538 1 1831 152 0 1855 364 o 1832 104 o 1856 367 o 1833 129 0 1857 421 o 1834 75 o 1858 333 o 1835 105 o 1859 349 o 1836 107 o I860 395 o 1837 150 0 1861 432 o 1838 95 o 1862 638 o 1839 340 0 1863 687 5 1840 93 0 1864 827 0 1841 55 0 1865 1,490 82 In 1865 the deaths from small-pox amongst the whites was eight, and amongst the colored people seventy-four. The disease continued to prevail in August, during 1866; we have the record for only the first six months of this year (1866, January, February, March, April, May and June), and duriug this period the deaths numbered, whites, 37 ; blacks, 260 ; total, 297. 344 Introduction of Vaccination into Spanish America. The negroes, suddenly set free by the results of the civil war, flocked into the cities to receive Federal aid ; and in their destitute, filthy and crowded condition, fell easy victims to small-pox^ During a period of forty-six years, 1817-1864, inclusive, the deaths from small-pox in Augusta, Georgia, numbered only fourteen, notwithstanding that the disease was introduced in 1850-1851, 1854 and 1863. Its suppres- sion must be referred to the untiring efforts of the skillful physicians, in protecting the people by vaccination. During the year 1865 and the first six months of 1866, forty-five whites and 334 colored people perished by the disease; total, 379. Since its foundation up to the present date, January, 1884, Augusta has suffered with two epidemics of yellow fever ; namely, in 1839 and 1854. The mortuary records show the following mortality occasioned by yellow fever in Augusta, Georgia: Deaths by Yellow Fever in Augusta, Ga., 1839. Deaths by Yellow Fever in Augusta, Ga., 1854. MONTHS. Deaths. MONTHS. Whites. Colored. Total. •Tilly 1 September. 4 49 August, 27 52 7 59 September 148 November 12 2 14 October. 52 December 0 • 0 0 16 IWpnihAt .... 1 Total 109 13 122 Total A.- 245 Total deaths from yellow fever in 1839 and 1854, 367. The small-pox ot 1865-1866 (first six months), destroyed 379 lives, or twelve more than the mortality of the yellow fever epidemics of 1839 and 1854, which struck terror into the hearts of the people. Yellow fever strikes down the most prominent and useful citizens, and concentrates its ravages upon the white race ; small-pox since the introduc- tion of vaccination confines its attacks almost exclusively to the unvaccin- nated, and to the poor and filthy in crowded houses. Hence the former disease excites more terror and alarm than the latter. • • -- INTRODUCTION OF VACCINATION INTO THE POSSESSIONS OF SPAIN IN NORTH AND SOUTH AMERICA. Father Torribio says, that the small-pox, introduced by a negro slave of Navarez attached to the Spanish forces, in 1520, carried off half the inhabi- tants of Mexico. Torquemada states, that the Matlazahuatl carried off 800,000 Indians in 1545, and 2,000,000 in 1576; but Alexander Humboldt, justly observes that these numbers must be in a great measure conjectural. He also remarks, that there is an interesting problem to be solved. Was the plague, which is said to have ravaged the Atlantic regions of the United States, prior to the arrival of the Europeans, and which Dr. Rush and his followers consider as the origin of the yellow fever, the same with the Matlazahuatl of the Mexicans ? According to Humboldt,* small-pox, introduced into Mexico in 1520? commits its ravages only every seventeen or eighteen years. In equinoctial countries, like the black vomit and several other diseases, it seems to have regular periods of recurrence; for, although frequently introduced by ship- ping from Europe, it does not become epidemic but at well-marked inter- 'Voyage d'Alexaudre de Humboldt, et Aime Bonpland. Esai Statisque sur la Nouvelle Espagne, 4 to. Paris, 1808. Introduction of Vaccination into Spanish America. 345 vals. It committed terrible ravages in 1763, and especially in 1779. In that year it carried off more than 9,000 in the City of Mexico alone. The epidemic of 1797 was less fatal, chiefly on account of the attention and zeal with which inoculation was propagated. In the city of Valladolid, the capital of Mechoacan, of 6,800 inoculated, only 170 died, and many of these had probably been previously infected. In the whole kingdom 60,000 were inoculated.* Vaccination was unknown at Lima, Peru, till the month of November, 1802. At that period the small-pox prevailed on the coast of the South Sea. A merchant vessel, Santo Domingo de la Calzada, put into Lima, on the pas- sage from Spain to Manilla. An individual had had the good sense to send by this vessel vaccine matter to the Philipine Islands. They availed them- selves of this opportunity at Lima; and M. Unanue,t professor of anatomy and author of a work on the climate and diseases of Peru, vaccinated several individuals by matter brought by the merchant vessel. No pustule appeared, and the virus appeared either altered or too weak. However, M. Unanue having observed that all the vaccinated individuals had a very mild small-pox, employed this variolous matter to render, if possible, by the ordinary inoculation the disease less fatal. He thus per- ceived in an indirect way the effects of a vaccination supposed to have failed. It is also stated by M. Humboldt that in 1802 it was discovered that the cow-pox was known to the peasantry in the Peruvian Andes. A negro slave in the family of the Marquis Valleumbroso was inoculated with small-pox, but ineffectually. They were going to repeat the inoculation, when the young man declared that he was very certain he would never take the small-pox, because in milking the cows of the Cordilleras of the Andes he had had a sort of cutaneous eruption, caused, as the old Indian herdsmen said, by certain tubercles which are sometimes found on the teats of the cow. "Those who have had this eruption," said the negro, " never take the small-pox." The Africans, and especially the Indians, evince great sagacity in observing the characters, manners and diseases of their domes- tic animals. It is not, therefore, astonishing that after the introduction of diseased cattle into America, the common people should have remarked that the pustules upon the cow's teats should communicate a sort of mild small-pox, and that those who had it should escape the general contagion during epidemics. In the month of January, 1804, the vaccine inoculation was introduced at Mexico through the activity of Don Thomas Murphy, who brought the virus from North America. This introduction found few obstacles; the cow-pox appeared under the aspect of a very mild malady; and the small- pox inoculation had already accustomed the Indians to the idea that it might be useful to submit to a temporary evil for the sake of evading a greater evil. Alexander Humboldt affirms, that if the vaccine inoculation, or even the ordinary inoculation, had been known in the New World in the sixteenth century, several millions of Indians would not have perished victims to the small-pox, and particularly to the absurd treatment by which the disease was rendered so fatal. To this disease the fearful diminution of the number of Indians in Cali- fornia is to be ascribed. 'Fifteen in the hundred, died of individuals of all ages, who, without being inoculated, were victims of the natural small pox. tObservaciones sobre el clima de Lima, y bus influencias en los seres organizados en especial, el hombre- por el Doctor Don Hipolito Unanue, Catedratico de Prima de Medecina, en la Real Universidad de San Marcos, Director del Colegio de Medecina y Cirurgia de San Fernando, Medico Honorario de Camara de -S. M., Socio de la Real Academia Medico Matritense, Proto Medico del Peru, secunda edicion, Madrid, 1815. 346 Introduction of Vaccination into Spanish America. The ships of war commissioned to carry the vaccine matter into America and Asia arrived at Vera Cruz shortly after the arrival of Alexander Hum- boldt. Dou Antonio Valmis, Physician General of this expedition, visited Porto Rico, Cuba, Mexico and the Philippine Islands; and his stay at Mexico, where, nevertheless, the cow-pox was known before his arrival, contributed singularly to facilitate the propagation of this notable prevent ive of the small-pox. In the principal cities of the kingdom, Vaccin- Committies were formed, who by vaccinating monthly, preserved the virus from being lost. M. Valmis discovered cow-pox in the environs of Valladolid, and in the village of Atlisco, near Puebla, in the udder of the Mexican cows. This fact renders the story of the presence of cow-pox in the Peruvian Andes less improbable, for the IIindostan relation of a similar kind was a mere fabrication to impose a belief of their great sagacity. The persons attached to the expedition of Dr. FrancisX. de Valmis, honor- ary surgeon of the Royal Chamber, were several physicians, with assistants, and twenty-two children, who had not bad the small-pox, and were destined to preserve the valuable fluid by a successive vaccination from arm to aim, or one after another in the course of the voyage. They sailed from the port of Corunna, under the direction of Dr. Valmis on the twentieth of November, 1803. They first touched at the Canaries, then at Porto Rico, and from thence proceeded toCarracas. On leaving the port of Laguaira in that pro- vince, they separated into two parties, the one sailing for South America, under the care of the sub-director. Dr. Francis Salvani; the other under Dr. Valmis for the Havannahs, and from thence to Yucatan. In this pro- vince they again made a division. Dr. Francis Pastor proceeded from the port of Sisal to that of Villahexmosa in the province of Tabasco, to propa- gate vaccination in the royal city of Chiapa, and as far as Guatemala, pas- sing through a tedious and rough country for 400 leagues to Oaxaca ; whilst the other party arriving safely, at Vera Cruz, not only passed through the whole viceroyship of New Spain but the interior provinces, from whence they were to return to Mexico, which was the point of reunion. Having profusely disseminated this preventive from the natural small- pox, through the northern parts of Spanish America, to the coasts of Sonora and Sinaloa ; and having established in each capital a central society composed of the highest authorities and most zealous medical characters, to presreve it as a sacred deposit, for which they were answerable to the King of Spain and posterity, the Director determined that this part of the expedition, which had been crowned with success, should carry to Asia the vaccine virus, and having overcome some difficulties, Dr. Valmis embarked at Acapitlco for the Philippine Islands. Dr. Valmis accomplished this passage in little more than two months, taking with him from New Spain twenty-six children to be successively vaccinated; and, as many of them were very small, they were placed un- der the charge of a matron from the orphan house of Corunna; and in this, as in former voyages, the greatest attention was paid to their cleanliness and comfort. The expedition having arrived at the Philippine Islands, propagated the variola? vaccina? through the islands subject to his Spanish Majesty. Dr. Valmis, having thus closed his philanthropic missibn, resolved, with the consent of the Captain General, to extend the beneficieuce of his King and the glory of his august name to the utmost coniines of Asia. Introduction of Vaccination into Spanish America. 347 In consequence vaccination was introduced through the vast Archipelago of the Visayas Islands. When Valmis arrived at Macao and Canton, he succeeded in introducing fresh and active vaccine matter into the Chinese Empire, by the means already pointed out. After having extended vaccination in Canton as much as possible, under the political regulations of that empire, and leaving its propagation to the English factory in that place, Valmis returned to Macao, and embarked for Lisbon, where he arrived on the fifteenth of August, 1806. That part of the expedition which was destined for Peru, under the di- rection of Salvani, was wrecked in one of the mouths of the River Made- lai ne; but being quickly succored by the natives, the magistrates of the neighborhood and the government of Carthagena, they saved the sub- director, three physicians who accompanied him, and the children, with the fluid in a proper state, which they successfully spread in that port and province. From thence they transmitted it to the Isthmus of Panama, and undertaking the troublesome navigation of the River Madelaine, they passed the time necessary on its respective banks; they penetrated repeat- edly into the country to fulfill their commission in the towns of Teneriffe, etc., etc., in the valley of Cucuta, and in the city of Pampelona and other populous places, until they rejoined each other at St. Fee. They gave full information to the medical men wherever they went, and laid down regula- tions agreeably to the instructions of the director, in order to preserve the vaccine virus, which, from the account of the Viceroy, they communicated to 50,000 persons without one unpleasant accident. Towards the end of March, 1805, they prepared to continue their journey, taking different and separate routes, to pass with more expedition and facility through the other towns of the Viceroyship, situated on the road to Popayan, Cuenca and Quito, and so onto Lima; and in the following- August they arrived at Guayaquil. This expedition not only succeeded in propagating vaccination throughout countries adverse as well as friendly, but, in the dominions of the King of Spain, they assured the perpetuity of the blessing by the establishment of the central societies, and also by the discovery of Dr. Valmis of the existence of the cow-pox in the Valley of Atlixco, near the city of Puebla of the Angels, and in the neighborhood of the city of Valladolid de Meehoacan, where it was discovered by the Assist- ant, Dr. Antonio de Gutierrez, and in the district of Calabozo in the prov- ince of Carracas, where it was found by Dr. Carlos de Pozo, a physician established there.* The voyage of M. Valmis, will thus remain forever memorable in the an- nals of history. The Indies saw for the first time three vessels, which were formerly freighted only with the instruments of carnage and destruction, bearing about the germs of relief and consolation to distressed and suffering hu- manity. The arrival of the armed frigates in which M. Valmis made the circuit of the Atlantic and Pacific Oceans, gave rise on several coasts to one of the most simple and affecting ceremonies. The bishops, military governors, and persons of greatest distinction repaired to the shore, where they took in their arms the children who were to carry the cow-pox to the indigenous Ameri- cans and the Malays of the Philippine Islands, and followed with public acclamations, they laid at the foot of the altar those precious preservative deposits, returning thanks to the Supreme Being for having been the wit- nesses of so happy an event. We must have some knowledge of the ravages ♦Supplement to the Madrid Gazette, October 14, 1806, Phila. Medical Museum ; vol. 3 ; 1807; p. 237. 348 Relations of Grease to Cow-Pox. occasioned by the small-pox in the torrid zone, and especially among a race of men whose physical constitution seems adverse to cutaneous eruptions, in order to feel all the importance of Dr. Edward Jenner's discovery. It appeared to be a much greater blessing for the equinoctial part of the New Continent than for the temperate climate of the Old.* THE RELATIONS OF GREASE IN THE HORSES' HEELS TO COW-POX. Horse-Pox.-The facts concerning the origin of the cow-pox were inves- tigated by Edward Jenner before the publication of his " Inquiry." His nephew, George Jenner, in the year 1787, went into the stable with him to look at a horse with diseased heels. " Tb' said he, pointing to the horse's heels, " is the source of small-pox. i have much to say on that subject, which I hope in due time to give to the world." Writing to a friend in 1794, Jenner observes: " Our friends at our last meeting treated my discovery of the origin of the cow-pox as chimerical. Further investigation has convinced me of the truth of my assertion beyond the possibility of a denial. Domestication of animals has certainly proved a prolific source of disease among men. But I must not anticipate ; you shall have a paper." Subsequently to this letter, and before the publication of his " Inquiry," in 1798, Jenner made many experiments in order to determine the connec- tion between the grease and the cow-poxj but difficulties of a nature not easily overcome interfered with his success. On the fourteenth of May, 1796' he made his first experiment, which demonstrated the possibility of propagating the cow-pox from one human being to another. From this period till the spring of 1798, Dr. Jenner's researches were interrupted by the disappearance of the cow-pox from the dairies. It again showed itself, and he had an opportunity of repeating his inquiries. Before bringing out his Inquiry on the Variola Vaccina, he was desirous of proving by direct experiment the truth of his opinion as to the origin of cow-pox, which at that time rested only on circumstantial evidence. Being foiled in his hopes of seeing more of that disease in its usual form in the dairies, he made many efforts, in 1797, to generate it from the heel of the horse. In refer- ence to these experiments ho wrote on the second of August, 1797, to a friend in the following terms : "The simple experiment of applying the matter from the heel of the horse, in its proper state, to the nipples of the cows when they are in a proper state to be infected by it, is not so easily made as at first sight may be imagined. After waiting with impa- tience for mouths in my own neighborhood, without effect, I sent a messenger to Bristol in vain to procure the true virus. I even procured a young horse, kept him constantly in the stable, and fed him with beans in order to make his heels swell, but to no purpose. By the time the pamphlet goes to a second edition, I hope to be able to give some decisive experiments." At the time of the publication of the " Inquiry," with regard to the opinion that the source of the infection of cow-pox "is a peculiar morbid matter arising from the heel of the horse," Jenner believed that, though it had not been completely proved by actual experiments made under his own eye, it nevertheless was supported by evidence sufficiently strong to estab- lish it. When the inquiry was presented he imagined that the matter excreted in the heel of the horse required to be modified by passing through the sys- tem of the cow, in order to afford it the peculiar protecting power which it "Political Essay on the Kingdom of New Spain, by Alexander De Humboldt; London. 1811; vol. 2. pp. 111-118. Variolce Equince (Horse Pox), 349 evinced when it appeared in the shape of what is vulgarly called cow-pox on the hands of the milkers. In the infancy of the investigation this was a most natural conclusion; but subsequent trials found that the equine matter, which had never undergone any change from passing through the constitution of the cow, exhibits all the characters of, and affords all the security which can be obtained from vaccine matter strictly so called. The following remarks of Dr. Jenner will illustrate this statement: "The skin of the horse is subject to an eruptive disease of a vesicular character, which vesicle contains a limpid fluid, showing itself most commonly in the heels. The legs first become ocdematous, and then fissures are observed. The skin contiguous to these fissures, when accutely examined, is seen studded with small vesicles surrounded by an areola. These vesicles contain the specific fluid." "It is the ill management of the horse in the stable that occasions the malady to ap- pear more frequently in the heel than in other parts. I have detected it connected with a sore on the heels of the horse, and on the thigh of a colt." It lias been established by unquestionable evidence that matter from the horse does produce a pustule similar in appearance to the vaccine; and likewise possessing the same protective power; and that, without having- passed through the constitution of the cow. This fact, though it tends to prove the close relationship, if not the absolute identity of the diseases, does not prove that they both originated in the horse; but it strongly con- firms the views of the simultaneous origin of the affections in question. It seems certain that there are, at least, four animals, namely, the horse, the sheep and the goat, which are affected with a disorder communicable to man; and capable of securing him from what appears to be a malignant form of the disease. It has, moreover, been proved by direct experiment, that other animals are capable of receiving the vaccine disease by inocula- tion ; and that matter taken from pustules so produced affords the genuine cow-pox in man. These animals on which these experiments have been tried are the dog, the goat, the she-ass, and the sheep. The fact with re- gards to the dog was ascertained by Dr. Jenner; with respects to the other animals, the facts rest on the authority of Valentine, of Nancy, who made his experiments in 1801-2, in communicating the human small-pox to dogs, asses and swine; he asserted also, that it had been proved by experiments at the Royal Veterinary College at Berlin, that the cow likewise receives the small-pox by inoculation.* It is perhaps to be regretted that Jenner employed the word grease, in- stead of the Variolas Equina. The grease has no necessary connection with the horse-pox ( Variola Equinaf though the disorders frequently co-exist. This circumstance at first misled Dr. Jenner, and caused much misappre- hension ahd confusion. The mistake in considering the disease, vulgarly called the grease, as the source of the cow-pox was subsequently corrected by Dr. Jenner himself; and he recognized the fact that the horse, as well as the cow', is liable to an eruptive disease of a variolous character, and that this disease of the horse, when communicated to man, is capable of affording protection against small-pox, even though it had never passed through the cow. For the most part, however, the equine affection was seldom recognized in the dairies, except in connection with a similar dis- ease in the cow. According to Dr. John Baronf, the last observation of Dr. Jenner on the Variola} Equinae was in 1817. Dr. Baron copies the following mem- orandum from a manuscript written by Dr. Jenner on the first of April, 1817: ♦Medical and Physical Journal, September, 1802, p. 271. tThe Life of Edward Jenner, M. 1)., F. B. S., etc. London, 1838. Vol. 2, p. 220. 350 Variola) Equina) (Horse Pox J, "Rise and progress of the equine matter from the farm of Allen of Wan- sell-From a horse to Allen ; from Allen to two or three of the milch cows; from the cows to James Cole, a young man who milked at the farm ; from James Cole to John Powell, by inoculation from a vesicle on the hand of Cole; and to Anne Powell, an infant; from Powell to Samuel Rudder; from Rudder to Sophia Orpin and to Henry Martin; from Henry Martin to Eliz- abeth Martin. All this went on with perfect regularity for eight months, when it became intermixed with other matter, so that no journal was kept afterwards. Proof was obtained of the patients being duly protected." Another entry on the seventeenth of May runs thus: Took matter from Jane King (equine direct), for the National Vaccine Establishment. The pustule beautifully correct." The matter from this source is said to have been extensively diffused in England and Scotland. Some years before 1817, Mr. Melon, of Litchfield, had found the equine virus in his neighborhood, and sent a portion of it to Dr. Jenner. In 1818, Dr. John Baron sent Dr. Jenner some equine matter, which he obtained from the hands of a boy who had been infected directly from the horse. In this case the disease assumed a pustular form, and extended over both arms. Dr, Jenner thus acknowledges the reception of this matter: "April 25, 1818. ".Yesterday H. Sharpneil brought me the equine virus and your drawing, which con- veys so good an idea of the disease, that no one who has seen it can doubt that the ves- icles'contain the true and genuine primative fluid. I have inserted some of it into a child's arm ; but I shall be vexed if you and some ot your young men at the Infirmary have not done the same with the fluid fresh from the hand. * * * " With best affections, yours, my dear doctor, very truly, "EDWARD JENNER." We have thus given the facts which referred to Dr. Jenner's experi- ments, and conclusions as to the relations of cow-pox to the grease and horse-pox; it should be noted that valuable observations were made by others upon this subject at an early date in the history of vaccination. As early as 18U0, Mr. Tanner, a veterinary surgeon at Rockhampton, raised a perfect vaccine vesicle on the teat of a cow, by first removing a scab from the surface of an accidental sore, and then rubbing over the sore the limped matter taken from the heels of a horse afflicted with what he re- garded as the grease. Lymph taken from the vesicle thus raised was success- fully transferred to the human subject, and a stock of vaccine thus ob- tained, some of which was sent to Jenner, and through him to the Small- pox Hospital. {Ring's Treatise on the Cowpox, p. 336.) Mr. Lupton, of Thame, m Oxfordshire, in 1800, correctly pointed out that the disease of the horse, which was analogous to cow-pox, and was communicable to the cow, was notli the grease" nor any form of grease, but a disease, regarded by the farmers of the neighborhood, as widely dif- ferent from it, and to which they gave the name of the " scratchy heel," Medical and Physical Journal, vol. 4, November, 1800.) In 1801, Loy, after many unsuccessful attempts, succeeded in infecting four cows, by inoculation with lymph from a "greasey" horse which with con- siderable indisposition had a generalized eruption. Loy observed that the horses " that did not communicate the disease had a local affection only." He was led by his experiments to distinguished two forms of grease, the acute and the chronic, the former of which alone he regarded as capable of imparting the cow-pox to the cow or to man, and then only when the mat- ter was taken at the proper period of the vesicle. {Loy, Experiments on the Origin of the Cow-pox, vol. 8, Whitley, I801.J Variolas Equines (Horse Pox). 351 In 1803, Dr. La Font, a French physician at Salonica, was successful in producing the perfect vaccine vesicle in two young children with lymph, taken direct from a horse suffering from a disease which was known to the Macedonian farmers as "grease," but which they distinguished from ordi- nary grease by the epithet, " the variolous." The preservation of this fact was due to the great and zealous advocate of vaccination, Dr. De Carro. DR. De CARRO TO DR. JENNER. Vienna, June 21, 1803. My Dear Sir-My friend, Dr. Marcet, wrote to me lately that the account I have sent you of Dr. Sacco's experiments have afforded you great satisfaction. The motive which induces me to write to you to-day is another confirmation of your theory, which has taken place in a country where you scarcely expect it from, the more so that it is accom- panied with veterinary observations which appear to me very nice and curious. Monsieur La Font, a French physician established at Salonica, in Macedonia, has been one of the most active vaccinators I know on the Continent; his last letter, of the third of June, mentions that he has since last autumn vaccinated 1130 persons. He first heard of your discovery on the occasion of Lord Elgin traveling in Greece with Dr. Scott, dur- ing which journey his lordship and the doctor took a particular care of propagating vaccination. The English Consul at Salonica went to Athens to meet Lord Elgin ; there he saw a large number of young Athenians with vaccine pustules. Not a word had yet been heard at Salonica of your discovery, and he desired Dr. Scott to give him vaccine matter to put into the bands of Dr. La Font, and Lady Elgin was so kind as to give to the Consul a copy of my work for the instruction of his physician. The first Athenian matter did not succeed, but seeing its failure Dr. La Font applied directly to me, and my ivory lancets produced their effect at the first trial. Since that time I have been in regular correspondence with that physician, who appears to me to be possessed of much learning, prudence and activity. Some time afterwards I sent him a translation of Dr. Loy's experiments, and desired him to make as many veterinary observations and experiments as he could. He has some reasons to suppose that the cow-pox reigns in that country, according to the reports of several Albanian peasants. As to the'grease (which he calls javart), he says that the farmers at Salonica know it well. Dr. La Font began his experiments with the kind of grease which the Macedonian farriers call variolous. He found a horse which had been attacked with feverish symptoms, that ceased as soon as the eruption appeared. The fore legs were much swelled ; the left had four ulcers, one upon the heel, a second some inches higher, a third on the articulation, a fourth near the breast. The eruption on the legs was, he says, very like the small-pox, but none was to be seen on the other parts of the body. He took matter from the upper ulcer which was of twelve days standing. The matter was limpid, but a 1 tttle yellowish and filamentous (three only); first, a cow was submitted to this inoculation, but without success ; secondly, a girl twelve years old, without effect; but this girl had been vaccinated some months before without success, and was suspected to have had the small-pox ; thirdly, two boys, one six, the othei' five years old, were inoculated with the same equine matter, and in both a pustule appeared, which followed the regular course of a vaccine pustule. The color was less white and more purple than usual. These two children had a pretty strong fever, for which some cooling medicines were administered. Those inoculated w ith matter from them under- went the disease in the usual mild way. These particulars, I hope, will silence all those who still doubt of the method of your doctrine. These observations enhance the merits of your discovery. The means of mak- ing it were everywhere, yet nobody before you had the least idea of that singular con- nection between the grease, the cow-pox and the small-pox." (Life of Edward Jenner by John Baron ; vol. 1, p. 431.) Coleman, whose early attempts had failed, at a subsequent period suc- ceeded in infecting a cow with matter taken direct from the heels of a horse, and in propagating vaccine from the vesicles thus induced. Direct inoculalions were made by Viborg and by Kahlert on cows, and by Steinbeck, both on cows and children; and Sacco and several others suc- ceeded in producing on human subjects perfect vaccine vesicles with lymph taken from sores (vesicles) on the hands of individuals, which sores they were quite satisfied had been derived from the horse. In France, from the general negative results of repeated inoculations from horses' heels, doubts of the existence of an equine-pox seemed to have been largely entertained up to a very recent period; and Bosquet, re- 352 Artificial Production of Horse-Pox. viewing, in 1848, the whole of the experiments and observations up to that time, declared himself unsatisfied as to whether cow-pox had ever been de- rived from the horse or not. (Nouveau Truitt de la Vaccine, p. 436.) But within the last twenty-three years, the doubts of this connection of variola? vaccina? with variolte equinee, have been set at rest amongst the French physicians. Two outbreaks of the disease among horses-one near Toulouse in 1860, and one at Alfort, in 1863-gave rise to inoculations, the results of which were acknowledged to be entirely unequivocal. These outbreaks were care- fully observed and the phenomena of horse-pox well described. M. Bresley, in 1863, induced the horse pox, by inoculation in the horse and other animals-the equine lymph being transferred from horse to horse. Dr. Edward C. Seaton has given the following observations upon the horse-pox in his valuable " Handbook of Vaccination," which we have classified and condensed: ARTIFICIAL PRODUCTION OF HORSE POX BY INOCULATION. The horse-pox has been designedly induced in the horse and other ani- mals of the horse tribe by inoculation; (a) with equine lymph directly transferred from horse to horse; this was done on numerous occasions, and with great success, in 1863, by M. Bonley (Bulletin de 1'AcadOnie, tome 29, p. 236) (b) with equine lymph that had been passed successfully through a cow, producing in that animal all of the phenomenon of the genuine in- oculated cow-pox; this was done both in 1866 at Toulouse by M. Lafosse (Rapport de 1'Academic Imp6rialc de Medecine sur les Vaccinations pen- dant l'Annee, 1861), and in 1863 at Alfort by M. Bonley, and at the Jardin d'Acclimatisation at Paris (Bulletin de l'Academie, tome 29, pp. 131, 133 and 199); (c) with lymph, supposed to be unhumanized cow-lymph, not pri- mary, but the product of a series of transmissions of primary lymph through animals of the ox tribe; this was done by M. Chauveau and his col- leagues (Vaccine et Variola?, etc., of Cit,) ; and (d) with ordinary human ized vaccine lymph ; an experiment thus made, in 1862, by MM. Bayer and De Paul, at Alfort, resulted in the production of eight well-characterized vesicles, perfectly circular, with central depression and induration of the whole surrounding thickness of the dermis. In the horse-pox induced by the ordinary process of inoculation, erup- tion is limited, with rare, if any, exceptions, to the points of inoculation. The local phenomenon are less active than in the natural disease, but the course of the disease is essentially the same. ARTIFICIAL PRODUCTION OF HORSE-POX BY INJECTION OF LYMPH. A variety of inoculation, viz., that of injecting the liquid vaccine lymph into the blood vessels or lymphatics of horses has been attempted by M. Chauveau, with the design of producing, if possible, by this method, the more extended or generalized eruption, which in this tribe of animals fre- quently attends the natural, or, as it is called, spontaneous disease. M. Chauveau inoculated from old horses by injecting some vaccine lymph into a blood vessel, and four more by injecting into a lymphatic vessel, just before its entrance into a ganglion. The first series of experiments failed ; but of the animals in the second series (those inoculated through the lymphatics) the inoculation succeeded in three out of the four, producing a fine eruption of vaccine, which had all the characters of the spontaneous Character and Course of Horse-Pox 353 horse pox. One, a horse, had a full eruption, commencing at the end of eleven days, and completely developed in three or four days' more, on the nostrils and lips, as well as on the hind heels; the second, a mare, infected from the preceding, had isolated vesicles disseminated over the body, ex- cept the neck and posteriors, but chiefly in the mammary region and on the lips, the eruption commencing on the eighth day, and continuing to appear up to the fourteenth; and the third, a man, had, on the twelfth day, an eruption chiefly on the genital organs and the inner surface of the thighs. Seed virus, taken from the eruption on each of these animals, produced, it is said, regular vaccine both on the cow and on children. Subsequently M. Chauveau succeeded in inoculating a young colt by two injections of vaccine lymph, at intervals of two days, direct into the sanguinenous system through the jugular vein ; vesicles beginning to appear, principally in the naso-labial region, in twelve days, and continuing to appear for four days more, the lymph of which was found to produce regular vaccine both on a child and on animals of the ox tribe. Following out still further the same idea, M. Chauveau, by injecting vac- cine into a pouch formed in the subcutaneous cellular tissue on the left side of the neck of a colt, but with great care that the lymph should not touch the wounded skin, obtained no local vesicle, but an eruption, commencing on the tenth day, of a few vesicles on the naso-labial region. From these results, in connection with the fact that nearly thirty successful inocula- tions of horses with the vaccine lymph in the ordinary way, no general eruption followed, M. Chauveau concludes that one essential condition of a generalized eruption to be that the virus should not pass through the mem- brane which is the anatomical seat of the vaccine eruption. M. Le Blanc,^however, states that he has seen general eruptiofa to occur in a case in which inoculation had been done in the ordinary way, and that he proved the vaccinal character of the vesicles secondarily developed by equinating successfully from them, both horses and ruminants. (Chauveau, Des Conditions qui president an Developpement de la Vaccine di te Primitive; Bulletin del'Acad. Imp. de Med.; tome 31 ; also, Comptes Rendus del'Acad. des Sciences, tome 62, p. 1118, and tome 63, p. 573.)-A Hand-Book of Vac- cination, by Edward C. Seaton, M. D., Medical Inspector of the Privy Council, pp. 29-33. CHARACTER AND COURSE OF HORSE POX. It is evident from the preceding facts, that the Horse, like the Cow', is subject to a specific eruptive fever, resulting in the development of a pock, the material of which has the same property as the fluid of cow-pox, pro- tecting the human system, when inoculated with it, from small-pox. This pock has the outward appearance and the anatomical structure which dis- tinguish the vesicles of cow-pox. The chief point in which the diseases as seen in the horse, differ from that in the cow are, (1) the locality of the eruption-which is chiefly on the heels, and on the naso labial mucous membrane; (2) the tendency of the eruption in some cases to become gen- eralized over the body; and (3) its appearance in the male as well as in the female, horses being subject to it as well as mares. The disease differs so little in its course from the cow-pox in the cow, that very minute description is not necessary. The chief distinction is as to the part of the body affected, which in the horse is principally the hind legs; the eruption being generally more copious there than anywhere else, and seldom extending beyond the hocks, except as the result of auto- inoculation. It is, no doubt, from its great exposure to this kind of inocu- 354 Natural History of Cow-Pox. lation that, after the heels, the naso labial mucous membrane is the chief seat of eruption. In some cases the vesicles seen in this membrane may be primary; and there are said to have been cases in which this membrane was the sole seat of the disease. Occassionally, especially in certain epi- zootics, the eruption has been seen extending over the body, in greater or less abundance, from the heels to the belly, and from the head to the tail. This general eruption, when it occurs, may come on in the course of the disease, and after the usual local symptoms have manifested themselves; or the generalization may be noticed from the very outset. The course of the disease is this : There is a period of invasion, some- times accompanied with fever, which, if it occur at all, is, in the great ma- jority of instances, very trifling; then, on the posteriors and other parts about to develop the eruption, points are felt, or seen, which soon acquire prominence and take the form of pimples, becoming rapidly flattened and umbilicated at the centre. These, by the eighth or ninth day, are fully de- veloped, mostly circular, and of the size of a big lentil, notably elevated above the skin, resisting pressure, and having a well-marked surrounding induration. They have absolutely the same structure as the vaccine or va- riolous vesicle, and yield, although generally in small quantity, a viscid, slightly yellowish lymph. By the ninth, tenth, or eleventh day many of them burst, exuding, often copiously, a viscid, serous, or sero-purulent fluid ; incrustation going on progressively and forming scabs or crusts, which, from the fifteenth to the twenty-fifth day, detach themselves, leaving whitish superficial vesicles. Varieties are observed, as in cow-pox, some of the vesicles being smaller and later than others, some less markedly umbilicated, some not umbilicated at all. They are most developed on the parts that are naked or have little hair, or where the skin is fine. If the hair be long and close, they are smaller and less regular, and attentive ob- servation is often necessary to make out their existence; little pencils of hair will be seen standing up here and there, and if the finger be lightly moved over these spots, slight indurations will be felt, corresponding to pimples or vesicles, which may be brought to light by cutting the hair away. The horse-pox, like the cow-pox, is communicated from animal to animal by casual inoculations, immediate or mediate, and these inocula- tions are the main cause of the spread of the disease. Horse-pox should be distinguished from grease on the one hand and Aphtha epizotica on the other.-A Hand-Book of Vaccination, by Edward C. Seaton, M. I)., Medical Inspector of the Privy Council, pp. 27-29. GENERAL DESCRIPTION OF COW-POX-OBSERVATIONS ON COW-POX BY ROBERT CEELY-ILLUSTRATION OF THE APPEARANCE OF THE HABITUAL COW-POX. The cow-pox was thoroughly investigated by Edward Jenner, and he is also said to have exhibited drawings of the appearance of the disease in the cow. The natural history of vaccinia in the cow has been studied more or less by various other observers, but by none so accurately or so comprehen- sively as by Robert Ceely, of Aylesbury, who, in 1839, showed in a satis- factory manner that by operating upon the mucous surfaces, instead of the more insensible corion, the cow' can be made with facility to receive the variolous poison, which the constitution of that animal converts into vac- cine. These important experiments were instituted under the auspices and supervision of the Provincial Medical and Surgical Association, in whose transactions (vols. 8 and 9) they are detailed at great length. COW POX. PLATE 19. Fig. 80- The Casual Cow-Pox in the teats and udder of a black and white milch cow. After Mr. Ceely, of Aylesbury. T»tNEW ORLEANS LITKC* IO UNION ST Natural History of Cow-Pox. 355 To facilitate the labors of the medical profession with reference to the recognition and propagation of the cow-pox, we have reproduced the accompanying plate of the vaccine disease, as it appears in the cow, from the illustrations of this affection by Mr. Ceely, of Aylesbury, England. The plate illustrates the appearance of the casual cow-pox in the teats and udder of a black and white milch cow. Plate 19, Figure 80. The disease is at its acme ; and the skin being fair a slight areola is visible around some of the vesicles, many of which have a bluish central tint. It exhibits papular vesicles with central crusts, unacuminated and acuminated vesicles; imperfectly developed and also broken vesicles, both solitary and interfluent. The vesicles on the extremities of the teats are nearly of the color of the skin on which they are placed, a circumstance of itself sufficient to distinguish them from spurious or sub-epidemic vesicles. GENERAL DESCRIPTION OF COW-POX-COURSE OF LOCAL PHENOMENA-DURATION' OF THE VARIOUS STAGES OF COW-POX-CONSTITUTIONAL SYMPTOMS-SPURIOUS COW POX-DIAGNOSIS OF TRUE COW-POX. Cow-pox is a specific eruptive disease, of the vesicular order, the erup- tion not being general over the body, but limited, to the udder and teats of the cow, the only exceptions being the results of accidental or casual in- oculation. Cow-pox is met with from time to time, in various countries, either sporadically or as an epizootic, attacking particularly milch cows ; young cows and milch heifers appearing to be more subject to it than older cows. In its earlier stages it is attended with so little general or obvious local disturbance that, in the animals first attacked in a dairy, these stages seldom come under skilled observation; and, as the fluid of the vesicles is very infective, and the disease is thus readily conveyed from animal to ani- mal by the milkers, it is difficult to distinguish, in animals subsequently attacked, between those exhibiting the natural disease and those who have been infected casually by inoculation. There is first a period of incuba- tion ; but, from the extreme slightness of the earliest symptoms, it is very difficult to say how soon after infection has been received these may mani- fest themselves. In the natural disease the incubative period is probably three or four days, though in some cases it may be prolonged to from five to eight days. The earliest symptoms noted are heat, swelling and tender- ness of the udder, soon followed by irregularity of surface and develop- ment of hard papules, about the size of a vetch or pea, especially on that part of the udder which adjoins the basis of the teats, and on the basis of the teats themselves. There is not generally at this stage, any loss of appetite, manifestation of fever, or other sign of constitutional disturb- ance. In the casual disease, or that which arises from infection by the un- intentional inoculation of the milkers, it is very rare for any indications of contagion to manifest themselves till the sixth or seventh, sometimes they do not appear till the eighth or ninth day after undoubted exposure ; but in thin-skinned animals with cracks or chaps in the teats, small red tender papules may often be found by vigilant observation as early as the fifth day. The papules increase in size as the disease goes on, and in three or four days from their first appearance, many of them will be found to have acquired a distinct vesicular character, with more or less central depression. The first change from papule to vesicle is indicated by the appearance of a dull or dusty yellowish point at the apex of the pimple, the circumference then increases in substance and extent, and the centre becomes wider and 356 Natural History of Cow-Pox. deeper, till at last the flattened vesicle with depressed centre is formed As with the papules, so with the vesicles, there is gradual increase of size, until in three or four days more their full development is attained, the number, size, shape and color of the vesicles, differ much in different ani- mals, as well as in different parts of the same animal. There may be only one or two of them, but much more frequently there are ten, twenty or more; they are more common on the base, neck and body of the teats. The amount of eruption, and consequently the severity of the disease, depends greatly on the state of the teats ami udder. With a short, compact, hairy udder, and thick, smooth, terse, unchapped, or scarcely cracked teats, the affection is often very mild, and sometimes there is only a single vesicle. An animal with a voluminous, flabby, cracked, pendulous udder, and loose, long teats, the skin of which is thin, fissured, rough and unequal, scarcely ever escapes a copious eruption. The size of the vesicles varies from that of a large pin head to that of a sixpence, or bigger, but is most ordinarily that of a vetch, pea, or horse-bean; in gen- eral, the more numerous the vesicles are, the smaller they are. Their shape is determined chiefly by their position. Around the base or neck of the teats they are almost invariably circular; on the body of the teats, generally oval, but oval vesicles may be seen also on the udder; and the vesicles on the teats are often interfluent. The color of the vesicles varies according to the period of their progress, and according to the color and texture of the animal's skin; but they have always a metallic-glistening aspect. By the time that the vesicle is completely formed, it is frequently seven or eight lines wide; but a solid, uniform, terse, and shining margin, a glistening white, pinky, or silvery hue, and a bluish or slate-colored centre; it contains a clear, viscid lymph, which, however, is even at this period generally in small quantity and often difficult to obtain; and around its base there is a narrow, pale-rose, or light-damask areola, not more than a line or two wide, and sometimes scarcely so much, though subsequently extending with circumscribed induration of the adjacent skin and subjacent connective tissue. The color of the areola, like that of the vesicles, is greatly influenced by the hue and texture of the skin, and in some skins- as in dark, thick ones-the areola is scarcely to be seen, or is entirely ab- sent; but the induration is always palpable. Between the tenth and elev- enth days the disease has generally reached its acme; the areola has ex tended, though seldom to more than a width of from four to five lines, and there is deep induration of the underlying integument. The vesicles, such as have not been broken, are at their fullest development; lymph, which two days before was hard to get from them, is now so copious that it raises the cuticle, destroying the central depression and forming a globular or conoidal vesicle, or it bursts the cuticle and flows .freely out; it has already acquired, or soon acquires, a pale, straw-colored, or light-amber hue, and speedily becomes mere scum, turbid and opaque. While this is taking place in some vesicles, in others the process of incrustation will already have begun at the centre, and in others it may have even extended to the circumference. On and after the twelfth day nearly all is passive; the in- incrustation process continues steadily to advance, and by the thirteenth or fourteenth day the crusts have usually acquired their greatest magni- tude, are of a brownish-black color, adhering more or less tenaciously to the epidermis or skin beneath, the marginal induration and intumescence at the same time subsiding. The crusts after this go on drying and shrink- ing, and they fall off* usually from the twentieth to the twenty-third day, by which time the induration has nearly, but seldom wholly, disappeared. The cicatrices left after the falling of the crusts are shallow, smooth, oval Natural History of Cow-Pox. 357 or circular, and of pale-rose, white or whitish color, according to the con- trast of the surrounding pigment. The vesicles on the teats are attended generally with less areola and less induration of circumference than those on the udders, but in other respects, in so far as they are undisturbed, and out of the way of the milkers, they exhibit exactly the same phenomenon ami undergo precisely similar changes. Such is the course of the undisturbed eruption, but from the tractions of the milkers it seldom happens that the vesicles, where they are most num- erous, as on the base, neck and bodies of the teats, escape disturbance. By the eighth or ninth day, when the uninjured vesicles are the most perfect, injured ones will be found exuding lymph from their centres, the cuticle being loose or partially detached. Raw surfaces, and brown and black crusts will be intermingled, and here and there will be seen a conoidal vesicle, often with slightly depressed apex, distended with pellucid lymph. Two or three days later the appearance on the teats will exhibit crusts, large, black and solid, often more than an inch or two in length, some firmly adherent to a raw and elevated base, others partially detached from a raw, red and bleeding surface; many florid red, ulcerated surfaces secreting pus and exuding blood; the teats excessively tender, hot and swollen, not un- frequently one or more forming a tumid mass of black crusts and naked red sores, the discharge from which imparts to the finger an odor very closely resembling that of the last stage of small-pox. In some animals this state will continue for a week or two, but in others the process of heal- ing will go regularly on, crusts being continually formed and renewed, till at last they fall off and leave cicatrices generally regular, smooth, circular or oval, but occasionally deep and irregular. With reference to the duration of the various stages of cow-pox, it appears that the normal course of the disease occupies from twenty to twenty-three days, which may be divided into four stages, namely: (a) About four days of early symptoms, during which papulation takes place. (b) Six or seven days to the full development and perfect maturation of the vesicle. (c) Five or six of decline of the vesicle and formation of the crusts. (d) Five or six more from the completion of incrustation to the sponta- neous separation of the crusts. Stages (a) and (b) are often materially abridged in the natural disease, while in the casual disease (a) is sometimes prolonged, (b) being propor- tionately abridged or (a) is prolonged, (b) and all subsequent stages occu- pying the normal duration. These variations, however, in the early stages of the disease are often more supposed than real, the earliest symptoms being so extremely slight in many cases that they are overlooked. Both in the natural and casual cow-pox (c) is sometimes prolonged, often abridged. The whole of the cow-pox eruption is not by any means always simultaneously developed. Papules, depressed vesicles, acuminated or globular vesicles, and vesicles more or less desiccated, ranging in size from a pin's head to a diameter of eight or ten lines, may be seen on the same subject at the same time; but all, whatever their date of appearance, ter- minating together. No doubt these apparent anomalies are due either to self-vaccination of the cow from pressure, as in the act of lying down, or still more frequently to the manipulation of the milker. Structure of the Cow-pox Vesicle.-If we examine the anatomical struc- ture of the cow-pox vesicle, when completely formed, we find it consist of a number of cells, which appear to be arranged in two concentric rows, and are separated from each other by whitish radiating partitions united 358 Natural History of Coic-Pox. at their converging extremeties by a central membraneous band. In these cells is secreted and contained a clear viscid lymph. The dusky central spot, which marked the first change of the pimple into the vesicle, and which has now become darker and more distinct, seems to be caused by a greater or less degree of separation of the epidemics stretched over a crypt-like recess, which contains a small quantity of semi-concrete lymyh- like matter and occassionally a turbid opaque fluid. This cellular con- formation of the vesicle is essential and diagnostic. It is by the bursting and breaking up of the cells and their connecting band, as the lympli be- comes more abundant and less viscid, and by separation of the epidermis from its attachment to the subjacent adventitious membrane', that the vesicle in its further progress loses its distinctive central depression, and acquires the acuminate or convidal form, which has been described. Constitutional Symptoms.-The local symptoms of cow-pox in the cow are seldom accompanied by any material constitutional disturbance; in the great majority of animals, feeding and grazing go on as usual. The secre- tion of milk is sometimes diminished; and, in most instances, the amount artificially obtained is greatly lessened from the trouble and difficulty of milking. In some cases the cow exhibits in the course of vaccinia a peculiar vesicular eruption very like vesicular varicella. It occurs gen- erally about the ninth or tenth day, commencing with erythemato-papular elevations, which in twenty-four hours have become vesicles full of pellu- cid serous fluid. Next day this fluid is straw-colored, and it becomes speedily turbid, the cuticle collapses or bursts, turns yellowish-brown, and before the fifth day from their origin, the vesicles desiccate with brown or black thin flimsy crusts, which soon fall off. Spurious Pocks.-The cow is liable to other diseases, which more or less resemble cow-pox, and from which it is important to distinguish it-a dis- tinction all the more necessary that some of these diseases may, and in fact not uncommonly do, either co-exist with it, or immediately precede or follow it. Besides certain cutaneous, sub-cutaneous and follicular inflam- mations and suppurations on the udder and teats, which are liable to affect occasionally the hands of the milkers, warty growths and even warty vesi- cles, and eczema, or other superficial vesicular eruptions, three kinds of spurious cow-pox have been described by Geely. The Yellow Pock, a pustular eruption, resembling ecthyma on the teats and udders, succeeded by thin dirty-brown, or black irregular crusts. The Bluish or Black Pock.-Bluish or black or livid vesications on the teats and udders, followed by thin dirty-brown or black irregular crusts, and some degree of impetigo on the interstics, near the base of the teats. The White Pock.-A highly contagious disease among milch cows and to the milkers, quickly causing vesications and deep ulcerations, often or al- ways confounded by them with the true vaccine, and certainly not readily distinguishable in all its stages by better informed persons than milkers. Diagnosis of True Cow-pox.-Although broad and palpable grounds of distinction may be found between vaccinia and white pock, in the character of the genuine vaccine eruption, its cellular structure, its hard and knotty feel, its glistening aspect, its tardy and progressive changes to the vesicu- lar form, its central depression and its late acumination, the necessity for caution and accuracy of diagnosis must be borne in mind. Edward Jenner pointed out that milkers were very liable to contract infection from spurious pocks, and to acquire in consequence false and delusive ideas as to their having immunity from small-pox; and Ceely states that he has in several instances known milkers who undoubtedly had made this mistake suffer afterwards from small-pox, while in other instances he has discovered the Relations of Cow-Pox to Small-Pox. 359 mistake he had made in time to save the subjects of it from small-pox, by performing successful vaccination in the ordinary way. The white or blister-pock in the human subject exhibits sometimes, in fact, an appearance exceedingly like that of real cow-pox, so that, as in the case with the two diseases in the cow, some care may be necessary to distinguish them. It is communicable by inoculation from one human subject to another, and may be communicated repeatedly to the same subject. Mr. Ceely success- fully inoculated himself three or four times, with the virus of white or blister-pock. Other diseases of the cow besides white-pox may be con- tracted by milkers and communicated from them to other human subjects. Mr. Ceely relates a case in which a whole family (a wife and five children) labored under a pustular disease of the character of ecthyma, from infec- tion by the father, who had himself caught the disease from a cow, de- scribed as being in a terrible condition.-Robert Ceely, Transactions Provinc- ial Medical and Surgical Association, vol. 8, vol. 10. A Hand-Rook of Vac- cination, by Edward C. Seaton, M.D., Medical Inspector to the Privy Council; London ; Macmillan & Co., 1868; pp. 1-11. COW-POX-RELATIONS OF COW-POW TO NATURAL AND IN- OCULATED SMALL-POX. COMPARATIVE VIEW OF THE NATURAL SMALL-POX, INOCULATED SMALL- POX AND COW-POX-MICROSCOPICAL CHARACTER OF THE COW-POX, (VACCINE) LYMPH, AND OF THE CONTAGIOUS MATTER FROM THE PUS- TULES OF SMALL-POX-COMPARATIVE PHENOMENA OF INOCULATED SMALL-POX AND COW-POX-COMPARATIVE PHENOMENA AND RELATIONS OF VARIOLA AND VARIOLOID-DETAILED DESCRIPTION OF THE ILLUS- TRATIONS OF COW POX, VACCINE DISEASE, CONFLUENT SMALL-POX DISTINCT SMALL-POX AND VARIOLOID-DEVELOPMENT AND STRUCTURE OF THE SMALL-POX PUSTULES-CHANGES OF THE TEMPERATURE AND URINE IN VARIOLA (SMALL-POX) AND IN VARIOLOID (MODIFIED SMALL. POX). COMPARATIVE VIEW OF THE NATURAL SMALL-POX, INOCU- LATED SMALL-POX AND COW-POX. The relation of Inoculated Cow-Poy (Vaccina), to the natural and inoculated small-pox, were formulated in terse and unequivocal terms, shortly after the discovery of Jenner had resulted in the foundation .of the Royal Jennerian Society. The views held and propagated by the advocates of vaccination, were condensed and forcibly expressed in the following comparative view of the natuaral small-pox, inoculated small-pox and inoculated cow-pox, drawn up by John Addington* and published by order of the Medical Council of the Royal Jennerian Society, for the extermination of the small-pox. ^Medical Repository, etc., Second Hexaude, vol. 1, New York, 1904, p. 313. 360 Relations of Cow-Pot to Small-Pox. A COMPARATIVE VIEW OF THE NATURAL SMALL-POX, IN- OCULATED SMALLPOX AND COW-POX. NATURAL SMALL-POX- HISTORY, GENERAL CHARACTER, MOR- TALITY. Circumstances, independent of contagion and mor tality, viz : Danger, eruptions, confinement, loss of time, expense, requisite precautions, medical treat- ment, deformity and subsequent diseases. For twelve centuries the disease has been known to continue its ravages, destroying in every year an immense proportion of the whole population of the world. 1. One in three has the natural small-pox in a dangerous form. 2. It produces eruptions, numerous, painful and disgusting. 3. Occasions confinement. 4. Loss of time ; and 5. Expense more or less considerable, affecting in- dividuals, families, parishes, etc. 6. Renders precautions for the most part unavail- ing. 7. Medical treatment necessary both during treat- ment and afterwards. 8. Leaves pits, scars, seams, etc., disfiguring the skin, especially the face ; and, is followed by scrofula in every form, diseases of the skin, glands, joints, etc., blindness, deafness, etc., etc. A contagious disease. in some instances mild, but for the most part vio- lent, painful, loathsome and dangerous to life. One in six who have the disease dies At least half of mankind have it; consequently one in twelve of the human race perish by one disease. In London. 3000 annually; in the United Kingdom. 40,000 A contagious disease, for most part mild, but in some instances violent, painful, loathsome, and dangerous to life. INOCULATED One in three hundred in- oculated dies. In London, probably one in one hundred. 1. One in thirty or forty has had inoculated small pox in a dangerous form. 2. It produces eruptions in greater or less numbers. 3. Occasions confinement. 4 Loss of time; and 5. Expense, sometimes considerable. 6. Requires preparation by diet and medicine; care to avoid certain seasons,as extremes of heat and cold; certain periods of life, as early infancy and old age; and certain states of constitution, as general ill- health. teething, pregnancy, etc., etc. 7. Renders medical treatment usually necessary. 8. Is liable to produce deformities whenever the disease proves severe ; and to be 9. Followed by the diseases as above enumerated. | but less frequently. SMALL POX. The inoculation of the small pox having been but partially adopted, has become the means of spread- ing the infection, and has thus increased its general mortality. In London this increase has been in the proportion of seventeen in every thousand. INOCULATED COW-POX. Not contagious ; and when properly conducted uniformly mild, inoffen- sive. free from pain or danger, and an infallible preventive of the small- pox. XU VFK J 1 1 v FATA L. J 1. The inoculated cow-pox is attended by no danger. 2. Produces a pustule in the inoculated part only. 3. Occassions neither confinement, 4. Loss of time, nor, 5. Expense; 6. Demands no other precautions than such as respect the conduct of the inoculated ; 7. Requires no medicine; 8. Leaves no deformity nor disfiguration ; 9. Excites no subsequent diseases. During a long series of years the cow-pox accidently received, has been considered as apreservative against any future attack of the small-pox. Many persons in the dairy countries, who have had the former in their youths, have remained to old age unsusceptible of ihe latter. NATURE OF THE VIRUS OR CONTAGIUM OF COW-POX AND SMALL-POX. The virus of cow-pox is not known to be communcaible otherwise than by direct contact or inoculation. In this respect, therefore, it differs from its congeners, the contagia of small-pox and variola? ovium, both of which are believed to be readily com- municable through the air. Considering the very close analogies which Nature of the Virus of Cow-Pox and Small-Pox. 361 subsist between these three diseases, it has been held with reason that this contrast may be due not so much to any intrinsic difference between con- tagious particles by which they are respectively propagated, as to differ- ences in the amount of virulent matter generated in the infected organism, and in the facilities afforded for the distribution of this matter through the surrounding medium. Inasmuch as not one of the three contagia is vola- tile, infection at a distance can only take place by the transfer of particles derived from the diseased individual to some absorbent surface in the healthy one. Such absorbent surfaces are to be found in the mucous mem- branes lining the air passages and the alimentary canal. That the virulent matter is capable of being absorbed from the intestinal surface, and caus- ing all the phenomena of constitutional infection, has been experimentally proved in the case of ovine variola; and the result may reasonably be extended to the two allied disorders. Experiments with reference to the introduction of small-pox virus into the system through the channel of the alimentary canal appear to have been made as early as 1792 (six years before Dr. Jenner published his In- quiry on the Variolce Vaccince), as will be seen from the following statement: SMALL-POX COMMUNICATED TO MAN AND ANIMALS BY EAT- ING THE SMALL-POX MATTER, IN 1792. John Maisill® gives the following facts, in the Bulletin de la Societe Philomatique, for October and November, 1792: "A peasant of the County of Essex having a great many children carried off by the natural small-pox, was desirous of inoculating his two boys-one nine and the other twelve years old. Not being able to employ a surgeon, he collected the scabs of a child then sick of the disease, powdered them, and sprinkled the powder upon slices of bread and butter. The two sons eat them, and gave a bit to the housedog. They had a mild small-pox, and got well without any remarkable accident. The dog remained sick for two or three days, drinking a great deal and refusing to eat; on the fourth he had a very decided variolous eruption ; on the ninth the pustules were full ripe and dried up, and fell off like those of the two children. An English author says he has observed the same epidemic in a flock of sheep, the greater part of which were affected, and communicated it to two cows, one of which died. The symptoms that manifested themselves in these animals, in the course of the disease, were in every respect the same as are observed in the human species."-The Medical Repository, vol. 1, Third Edition ; Netv York, 1804 ; p. 247. When we consider the number of distinct foci, each yielding a large amount of infective matter, distributed over the skin of a man affected with small-pox, or of a sheep suffering from the severe form of ovine vari- ola; when we recollect further, that similar infective foci exist elsewhere in the body, as in the mouth, fauces and throat of man, and in the lungs of the sheep, while secondary nodules full of virulent particles are often de- veloped, in situations which enable their products to be discharged into the surrounding medium by respiration and by coughing; we cannot but be struck with the contrast between these two diseases and cow-pox as it oc- curs after inoculation in the human subject. The quantity of infective material generated in cow-pox, though very considerable in relation to the amount introduced, falls very far short of the common supply yielded by a single case of ovine or human variola ; and what there is, is generated in a situation which absolutely precludes its distribution throughout the envir- onment, at least during the period when the infection of the contagion is at its highest. Since the difference between the communicability of vaccinia on the one hand and of small-pox on the other, admits of being thus easily 362 Nature of the Virus of Cow-Pox and Small-Pox. explained ; it appears that the difference is one of degree only, and that deductions from experiments performed with the contagia of cow-pox may be extended to variola.* Cow-pox and small-pox, whether inoculated or arising in the natural way, are attended during the active stage of the development and increment of the specific contagion, by febrile pyrexia. The recognized characteristics of fever, are those which relate either to the disintegration of the living substance of the body, or to the increase and diminished constancy of the bodily temperature; but it is essential to the correct definition of fever that it should comprehend particulars relating to its origin, progress and termination ; in other words fever is not merely a state but a process. Fever has its beginning in the entrance into or action on the organism of some affecting or infecting cause. After this event fol- lows the period of latency; and it is not until it is passed that the first indications within the affected organism begin to manifest themselves. The state of fever once established, it may vary in its course, in its duration, and in the local inflammation which accompany it; but in all cases it has its onset, accession, and declension, each of which is characterized by more or less distinctive phenomena. Two hypothesis have been framed as to the nature of fever, however ex- cited. One is that fever originates in disorder of the nervous centres, that by means of the influence of the nervous system on the systemic functions, the liberation of heat at the surface of the body is controlled or restrained, so that by retention the temperature rises, and finally that the increased temperature so produced acts on the living substance of the body so as to disorder its nutrition. The other is, that fever originates in the living tissues, that it is from first to last a. disorder of protoplasm, and that all the systemic disturb- ances are secondary. In both hypotheses it is tacitly admitted that fever is the product ot a natural fever-producing cause contained in the blood or tissue juice, the mor- bific action of which in the organization is antecedent to all functional dis- turbances whatever. The first hypothesis must be rejected, because, on the one hand, no dis- order of the systemic functions, or of the nervous centres which preside over them, is capable of inducing a state which can be identified with febrile pyrexia; and on the other, that it is possible for such a state to orig- inate and persist in the organism after the influence of the central nervous system has been withdrawn from the tissues by the severance of the spinal cord. It appears to be more rational to adopt the hypothesis of the tissue or- igin of fevert. Dr. J. Burdon Sanderson (2) has shown by experimental investigations that whatever may be the nature of the poisonous agent, which produces septic fever and infective inflammations, it admits of complete removal by mechanical filtration. It is therefore material and particulate. ■♦Dr. Baxter's Report on an Experimental Study of Certain Disinfectants. Reports of the Medical Offi cer of the Privy Council and Local Government Board. New Series, vol. 6 ; London, 1876, p. 216. tDr. J, Burdon Sanderson on the Process of Fever. Public Health Reports of the Medical Officer of the Privy Council and Local Government Board; New Series, vol, 1, London, 1875, pp. 9, 40, 42, 47; vol. 2,1876. Microscopical Characters of Vaccine and Small-Pox Matter. 363 MICROSCOPICAL CHARACTERS OF VACCINE (COW-POX) LYMPH AND THE CONTAGIOUS MATTER FROM THE PUSTULES OF SMALL-POX. There are a few contagious diseases in respect of which the presence in the contagious liquids of forms of vegetation differing from those met with either after death in the normal tissue or liquids of the body, or dur- ing life in the products of primary or secondary inflammations, has been established. These are small-pox, sheep-pox, splenic-fever and relapsing fever. The first statements as to the existence of organisms in the lymph of cowpox was made by Dr. Keber,* of Dantzic, in 1868, who regarded them as the carriers, if not the generators, of the active virulent principle. In 1869, Dr. Burdon Sandersonf began a series of most valuable .etiologi- cal researches in a new direction, and in his first paper on the pathology of contagion, published in 1870, he gave an account, accompanied by a wood cut of certain bodies to which he assigned the name of microzymes, the presence of which he found it was usually possible to demonstrate in vac- cine liquid. Dr. Sanderson was not able, however, to assert that their pres- ence was or was not essential to the infective activity of the virus. In 1863, Dr. Lionel Beale described in a paper which appeared in the "Microscopical Journal," for April, 1864, the existence of transparent hya- line particles, of extreme minuteness, in vaccine lymph. These particles he regarded as masses of living matter, or germinal matter. In a subse- quent research on the same subject, an account of which appeared in the Report of the Royal Commission on Cattle Plague, his previous results were confirmed. Both papers contain drawings of the particles. Since that time, vaccine lymph has been examined by many other skillful cbservers, all of whom agree that the liquid, notwithstanding its apparent limpidity, contains minute particles. In the papers referred to, Dr. Beale expressed his opinion that the contagious principle resided in the granules, but he did not offer any experimental proof of its being so. At this point the investigation was taken up by Dr. Chauveau, of Lyons, who, without knowing of the observations of Dr. Lionel Beale, had also found that vaccine lymph contains particles. Using the large field at his disposal, as professor in the Government Veterinary School at Lyons, he has carried out a number of experiments as to the physical character of infective liquids in the communicable diseases of animals. His earliest researches weredirected to the relation between cow-pox and small-pox, and are contained in well known reports on these diseases published at Lyons in 1865$. Subsequently, M. Chauveau directed his attention to the question of the nature of the contagious process in general, taking as his basis an inquiry into the physical characters of vaccine. Mature vaccine lymph contains in suspension two kinds of particles. In the first place, bodies'are generally met with analogous to pus corpuscles. They do not differ from the corpuscles which occur in pus in an early stage of formation, as in the liquid of a blister when first becoming op descent. But besides those particles vaccine contains particles far inferior to them in size, not exceeding indeed 1-20,000 of an inch in diameter. *Keber. Heber die microscopischen Bestandtheile der Pocken-Lymphe, Virchows Archir, vol. 42, p. 112 Reports on recent researches on the Pathology of tho Infective Processes, by J. Burdon Sanderson. Public Health Reports of the Medical Officer of the Privy Council and Local Government Board; New Series, vol. 3, London, 1874, pp. 11-48. tlntroductory Report, by Dr. Burdon Sanderson, on the intimate Pathology of Contagion. Public Health. Twelfth Report of the Medical Officer of the Privy Council, 1869 ; London, 1870, pp. 229-256. {Vaccine et jVariola, etude experimentale sur la question de 1'identite de ces deux affections, Paris, 1865. 364 Microscopical Characters of Vaccine and Small-Pox Matter. Starting from these facts, M Chauveau proceeded to inquire by experi- ment, in which of those three elements of which vaccine consists (viz., the leucocytes, the minute particles, and the clear liquid in which they float) the activity of the vaccine resides. By careful experiments M. Chauveau (1) has proved that the leucocytes contain nothing essential to the activity of vaccine lymph; and also that the fluid portion freed from the minute particles although containing all the soluble constituents of vaccine, is wanting in those upon which its activity depends. The experiments of Chauveau were perfected and repeated by Dr. Burdon Sanderson in 1869, and their accurancy was confirmed and the result estab- lished that the infective property of vaccine lymph, resides in the minute particles; although the proposition was not announced by Dr. Sanderson and Chauveau. About the same time Professor Klebs, (2) described the minute particles of vaccine in his handbook of Pathology(3). Two years afterwards, Professor Ferdinand Cohn, (4) of Breslau treated of this subject. His observations relate both to vaccine and variolous lymph, and led to the interesting discovery that the organisms (minute par- ticles) discovered in vaccine lymph by Lionel Beale, Chauveau, Klebs and Burdon Sanderson, are also found in the variolous lymph, and present characters so entirely similar, that it is not possible to draw any distinc- tion between them, either as regards form or development. According to Professor Ferdinand Cohn, vaccine and varimous lymph is always to be found filled with spheroidal particles or corpuscles, which, although they exhibit molecular motion, have no motion of their own. They are extremely small, and in their reaction on light differ little from the serum in which they are suspended, on which account they are uasily overlooked. It is difficult to determine the diameter of the spheroids mi- crometrically, but Professor Cohn estimates it about three-quarters of a micromillimeter. In addition to these, numerous larger and more refrac- tive bodies are found in the lymph, as regards which it is difficult to say whether they are fat globules or result from further development of the others. It seems most probable that they are cells, each of which consists of a dark central part, surrounded by a membrane indicated by a clearer ring, an appearance often seen in stages of division. In perfectly fresh preparations most of the corpuscles are simple, others being joined together in a form resembling the figure 8. After the preparation has been kept, the number ot these'double cells increases, and soon chains of four begin to be distinguishable. These chains are usually curved or in zigzag; their attachment one to another is evidently very slight, as they can readily be displaced. After one or two hours, numerous necklaces present themselves, usually of eight joints, which are even more readily broken up than the others. In this displacement the groups are to be attributed; of these, some resemble sarcinm, but it is to be observed that no true sarcime showing crucial divi- sion present themselves. Obviously the very rapid and uninterrupted multiplication of the spheroids takes place by a process of repeated trans- verse division,in which the septa are parallel, so that the resulting daughter cells are arranged in necklaces like the spores of a penicillium. In conse- quence of their very slight attachment to each other, it is only at the be- ginning that the original grouping, due to their mode of development, is 1 Determination experimentale des 616ments qui constituent le principe actif de la serosite vaccinate virulente. Comptes Kendus, LXV1II. 1868, p. 289. 2 Twelfth report of the medical officer of the Privy Council, London, 1870, p. 233. 3 Klebs, Handbuch des Pathologie, vol. 1, p. 40. 4 Cohn, Orgauismen in des Pockenlymphe Virchows Archir, vol. 55, p. 229. Phenomena of Inoculated Small-Pox and Cow-Pox. 365 traceable. After a few hours' observation they are sure to be all aggre- gated into irregular colonies or clumps, each consisting of sixteen, thirty- two, or more, corpuscles. The multiplication of cells lasts for several days, the aggregations becoming larger and larger. In* capillary glass tubes the multiplication of colonies sometimes lasts a long time, so that they ac- quire considerable size, and present themselves as flocculi. By the forma- tion of mucous-like interstitial substance the corpuscles become intimately united with each other, the mass being converted into zoogloea. When this is the case, the size of the individual cells increases, their contents be- coming more refractive, so as to resemble oil drops. As these agglomerations arc apt to be encrusted with other bodies derived from the lymph, the char- acters which indicate their origin become indistinct. It often happens that the changes described are associated with the appearance of acicular crys- tals resembling raphides. Some months before the appearance of the paper of Professor Cohn, containing the preceding facts with reference to the organisms of vaccine and variolous lymph, etc., Weigert,* of Breslau, published a short commu- nication founded on the microscopical examination of the skin in patients who had died of small-pox, in which he stated that he had found the lymph- atics plugged with a granular mass which exhibited all the characters of micrococci. , The fact that organisms of a particular form exist in the lymph of small- pox, taken in connection with the occurrence of similar organisms in the channels of absorption leading from the pustules, suggest the probability of their having to do with the morbid process. During the small-pox of New Orleans of 1881, 1882 and 1883, I have repeated the observations of Kohn and obtained similar results with re- ference to the spheroidal particles or corpuscles of vaccine and variolous lymph. COMPARATIVE PHENOMENA OF INOCULATED SMALL-POX AND COW-POX. INOCULATED SMALL-POX. Inoculation is performed by introducing into the arm, at the insertion of the deltoid, by means of a lancet, a minute portion of variolous matter. The thin lymph of a fifth day vesicle is to be preferred to the well-con- cocted purulent matter of the eighth day, but both are efficient. One incis ion only is to be made. A minute, orange-colored spot is perceptible by the aid of the microscope on the second day; on the third or fourth day, a sensation of pricking is experienced in the part. The punctured point is hard* and a minute vesicle, whose centre is depressed, may be observed sur- mounting an inflamed base. On the fifth day the vesicle is well developed and the areola commences. On the sixth day the patient feels stiffness in the axilla, with pain. The inoculated part has become a hard and inflamed phlegmon. The subjacent cellular membrane has become involved in the inflammatory action. On the evening of the seventh, or early on the eighth day, rigors, headache, a fit of syncope, vomiting, an offensive state of the breath, alternate heats and chills, langor, lassitude, or, in the child, an epi- leptic paroxysm, announce the setting in of fever. The constitution has been invaded by the operation of the contagium from the local disorder. ♦Weigert uhn Baltineu in der Pockenhuut; Contralblatt, 1871, p. 609. 366 Phenomena of Vaccination. On the appearance of febrile symptoms, the inflammation of the arm spreads rapidly. An areola ot irregular shape is soon completed, which displays within it minute confluent vesicles. On the tenth day tile arm is hard, terse, shining and very red. The pus- tule discharges copiously, and ulceration has evidently penetrated the whole depth of the corion. On the eighth day spots of variolous eruptions show themselves in various and often in the most distant parts of the body. In a very large proportion of cases, the eruption is distinct and moderate. Sometimes not more than two or three papules can be discovered, which, perhaps, shrivel and dry up without going through the regular process of maturation. At other times the eruption is full and semi-confluent, passing through all the stages of maturation, and scabbing, and cicatrization, with as much per- fection as the casual disease can display. Between these extremes every possible variety may be observed. The truly confluent eruption with af- fection of the mucous membrane is very rare, and that implication of the fluids and solids and of the nervous system, which together constitute the extreme of variolous malignity is nearly, if not entirely, unknown. Secondary fever of any great intensity is not common.* INOCULATED COW-POX-VACCINATION. The symptoms which cow-pox manifests in the human subject resemble very closely those observed in the cow. If vaccine lymph on the point of a lancet be inserted by puncture on the arm of an individual who has not been before vaccinated, nor has suffered with the small-pox, no particular local effect is noticed for the first two da\s; but at the end of the second or by the third day, a slight papular ele- vation is perceptible, which by the fifth or sixth day, has become a distinct vesicle of a bluish-white color with a raised edge, and a peculiar central, up-like depression. By the eighth day (the day week from the insertion of the lymph) this vesicle has attained its highest perfection, is plump, round, and more decidedly pearl-colored; the elevation of its margin ami the depression of its centre, are more marked. At this date or a few hours earlier a ring ot inflammation termed the areola, begins to form about its base, and for the next two days continues to spread. It is circular and, when fully developed, has a diameter of from one to three inches, and is often attended with considerable hardness and swelling of the subjacent connective tissue. The establishment of this areola, is the anatomical evi- dence that the cow-pox has produced its specific effects on the constitution. Other proofs of the constitutional influence of the vaccination are, its course, generally manifested in restlessness, heat of skin, with derange- ment of the stomach and bowels, and with, in some cases, swelling of the axillary glands. • These general symptoms, though seldom altogether absent, are often ex- ceedingly slight. After the tenth day the areola begins to fade, the vesicle begins to dry in the centre, the lymph remaining in it becomes opaque and concretes, and by the fourteenth or fifteenth day a hard, brown scab is formed, which contracts, dries, blackens, and from the twentieth to the twenty-fifth days falls off, leaving a cicatrix commonly permanent, and which in character is circular, somewhat depressed, foveated or indented with minute pits, and sometimes radiated, *Lectures on the Eruptive Fever, by George Gregory, M. D., New York, 1851, pp. 108-110. Relations of Variola and Varioloid. 367 Occasionally certain constitutional symptoms beyond those already de- scribed are observed in young children of full habit, especially in hot weather, about the ninth or tenth day, when the areola is at its height, an eruption of roseola will sometimes take place, chiefly on the extremities ; sometimes the eruption has a papular form (vaccine lichen), and sometimes it is vesicular. These eruptions are generally very transitory; their ordi- nary duration does not extend beyond a week, and they very seldom last beyond the falling of the scab. When lymph is employed that is derived directly, or say recently, as either three or four removes from the cow, the course of the disease is gen- erally retarded at various stages. Papulation is sometimes deferred till the seventh, eighth, ninth or even the tenth day, and the areola is not com- pleted till from the eleventh to the fourteenth, or even the sixteenth day. The areola, when at its height, is more indurated than is observed in vac- cination with ordinary humanized lymph, and is said to decline and revive, continuing to exhibit a brick-red or purplish hue while the hardness re- mains.* The papular and vesicular eruptions which occasionally attend vaccination with humanized lymph, at this stage of its course, are more frequently seen. The vesicles themselves are commonly more devel- oped than those produced by ordinary lymph. Desication is generally prolonged, and the crust is often retained till the fourth or fifth week. Such are the ordinary phenomena induced by primary vaccination, in the human subject. The course however, is sometimes modified ; and may be simply retarded, simply accelerated, or altogether irregular and spurious.! The anatomical changes in the skin after the first vaccination clearly resemble those of variola. While fever never occurs at the commencement of vaccinia, the stage of maturation is always accompanied by a secondary fever. In incomplete, modified vaccina, the inflammation of the skin some- times causes insupportable itching, sometimes tense or burning pain From humerous measurements of temperature, Dr. Felix Von Wiemeyer,} has satisfied himself that the patient has a fever which is not at all in pro- portion to the intensity ami extent of the dermatitis. Where the local symp- toms were very slight, Dr. Niemeyer has noticed a temperature of 104°. But from the less extent of the dermatitis, the fever never becomes so high as in variola; it can only prove dangerous to very weakly children, and only in rare cases. It is rare also for dangerous erysipelas or pseudo-erysi- pelatous inflammation of the arm to occur during the stage of maturation. PHENOMENA AND RELATIONS OF VARIOLA AND VARIO- LOID-PHENOMENA OF VARIOLA (SMALL-POX), It is not necessary to the present inquiry, that a minute description should be given of the varieties of small-pox, such as the unmodified; confluent (pustules running together over the greater part of the body; semi-con- fluent; distinct or discrete (all the pustules separate); Petechial Haemor- rhagic (blood effused into the vesicle or pustules, with a tendency to haemor- rhage from the mucous surfaces); malignant, variola nigra, black small-pox, variola purpura ; variola corymbosa. It is important that such facts should be recorded as illustrate the difference between cow-pox and small-pox on the one hand, and vari- cella (chicken-pox) on the other ; and also to determine, whether the modified * Geely; Observations on the Variolas Vaccin®. Transactions of Prov. Med. and Surg. Association. Vol. 8, p. 346. tVaccination by Edward Gator Seaton, M. D. +A Text book of Practical Medicine, New York, 1869, vol. 2, p. 559. 368 Phenomena and Relations of Variola and Varioloid. small-pox {varioloidJ, in tbhich the pustules are cut short in their development by vaccination or previous attacks of small-pox, presents decided differences in its thermometry and chemical pathology. We have endeavored to present a comparative view of the appearances of the cow-pox in the human being and in the cow, and also of the discrete and confluent small-pox and of the modified small-pox {varioHoidf Plate 17, Figure 76, represents the variola, vaccime. This drawing represents the hand of Sarah Nelmes, infected with the cow-pox from her master's cow, in May, 1796. Dr. Jenner states that the pustule was so expressive of the true cow-pox, as it commonly appears upon the hand, that he had given a representation of it in Plate 1, of his ^In- quiry into the Causes and Effects of the Variolas Vaccina," Case 16, p. 31. Plate 18, "Variola Vaccinal-Figure 77, arm of John Baker, vaccinated March 16, 1798 (Plate 2, case 18. Inquiry, Edward Jenner, p. 35); Figure 78, arm of William Pead (Plate 3, case 20, Inquiry, Edward Jenner, p. 38); Figure 79, arm of Hannah Excell, (Plate 4, case 21, Inanity intoVariohe Vaccina,, Edward Jenner, p. 39). Plate 19. Cow-Pox.-The casual cow-pox on the teat and udder of a black and white milch cow, after Dr. Ceely, of Aylesbury. Plate 20, Small-Pox (Variola).-Figure 81, confluent small-pox ; Figure 82, confluent small-pox ; Figures 83, 84 ami 85, small-pox pustules (discrete small-pox). Piate 21, Varioloid and Variola.-Figure 86, varioloid (modified small-pox); Figure 87 and 88 small-pox eruption; Figure 89, varioloid eruption; Figure 90, varioloid eruption. It is important that the cases furnishing the Figures in Plates 20 and 21, should be examined somewhat in detail. Plate 20, figure 81: portrait delineation of the confluent small-pox eruption* as it ap- peared on the tenth day after it broke out on the face and hand of a female patient, who was at the time of the disease in the small-pox ward of La Petit, Hospital of Paris. She was twenty-live years of age, and had never been protected either by the cow-pox or the variolous disease. She experienced all the common symptoms which generally attend this form of variola, and during the day on which the painting was executed she exhibited, in her features, the appearance of great anxiety and distress; the general swelling of the face, however, was not so great as often takes place in cases of the distinct variola, and the disease was one of moderate severity. Some of the pustules about the nose, mouth and chin had begun to dry up and look scaly. After the tenth day' desiccation continued to progress, and on the fourteenth day' the eruption on the nose and the other parts of the face presented the appearance repre- sented in figure 82, plate 20.t From this date the disease pursued its usual course, and the patient, after five weeks of illness, was able to leave the ward, but her features were much deformed by the ex- tensive ulceration caused by the eruption. Figures 83, 84 and 85 represent the discrete and confluent small-pox eruption as it ap- peared at different periods on the face and hand of a girl aged fourteen. Figure 83, fifth day ; figure 84, seventh day ; figure 85, on the eleventh day of the eruption.! Plate 21, figure 86, represents a case of varioloid or modified variolous eruption of the distinct kind, as it appeared on the fourth day of its development. The female who wa8 the subject of this eruption had been vaccinated when young, and the marks of the vac cination were visible on her arm. The scars were deep and smooth, and were supposed from their general appearance to be the results of a spurious disease. On the ninth of May, 1826, she experienced some unpleasant chills, which were accompanied with slight nausea. These were soon followed by flushes of heat, pains in the bead, back and limbs, and by considerab'e, though moderate, fever. On the twelfth, and after three days of illness, a few pimples were discovered on her face and body. The pocks were in moderate number, and amounted, perhaps, to two or three hundred. They were more *The paintings from which plates 20 and 21, figures 81 to 90, were engraved, were made in the Hospitals of Paris during the years 1825 and 1826, a period at which the variolous disease prevailed epidemically in that city. They were executed by a French artist, under the immediate direction of Dr. John D. Fisher, of Boston, Massachusetts, and were all begun and finished at the bedside of the patients from whom they were taken. In making the drawings Dr. Fisher was careful to attend to a circumstance of some import- ance, in attempting an accurate and intelligible representation of the diseases intended to be illustrated by them ; neither the severest nor the mildest cases were selected, but those of moderate severity, as it was thought that delineations of the maladies equally removed from the two extremes would be the best calcu- lated to guide the inexperienced practitioner to a correct diagnosis. Dr. Fisher regarded the small-pox and the varioloid as one and the same disease, and that the chicken-pox is a separate ami independent malady. Description of the Distinct Confluent and Inoculated Small-Pox, Varioloid Disease, Cow-Pox and Chicken- Pox. Illustrated by thirteen plates. By John I). Fisher, M. D. Second Edition. Boston : 1837. t Description of the Discrete, Confluent and Inoculated Small-Pox, Varioloid Disease, Cow Pox and Chicken-Pox. By John D. Fisher, M. D. Plate 5. ^Small-pox, etc., J. D. Fisher, M. D , pp. 3-4. SMALL POX (Variola.) PLATE Fig. 81.' Confluent Small-Pox, Fig. 82.- Co fluent Small-Pox. Figs. 83, 84, and 8 Small-Pox Pustules. Figure 81. Figure 82. Figure 83. Figure 84. $ Figure Phenomena and Relations of Variola and Varioloid. 369 numerous on the face than on the trunk and extremities. The pimples were papular at first, were hard to the touch and rather painful on pressure, and before the termiua tiou of the second day the tops of them became vesicular. As they were converted into ves- icles they increased in diameter and became more globular, but did noi project far above the common surface. On the third day the pocks were all converted into vesicles, and were filled with a yellowish kind of serum. On the fourth day they had attained to the full size, an^ the eruption exhibited all the appearances represented in the portrait in plate 21, figure 86. The bases of the pocks were still surrounded by bright-red areola, and were hard and tubucular to the finger The fluid contents of the eruption had grown yellowish and more consistent, anti the flattened surfaces of some of the pocks had be- come slightly discolored. From the fourth day the pocks decreased a little in diameter, but diminished proportionately in elevation, and in a few instances they united and ran together. The matter in them continued to grow thicker and more purulent in its char- acter, and their tops, in consequence of the gradual coagulation or congretion of the virus, assumed by degrees a dry and discolored appearance ; and on the sixth day the pocks had flattened considerably, and the inflamed areola surrounding them had dimin- ished in redness and breadth. From the seventh day desiccation proceeded rapidly, and by the eighth the virus had concreted into a solid mass. In drying, the pocks were formed into reddish-brown crusts or scabs, and during this process they gradually became shriv- elled and the scabs or crusts began to scale or crumble on the eighth or ninth day ; and on the tenth day most of the scabs had separated and fallen off, and left brown-colored depressions in the skin. These discolored depressions remained for some time, and were distinguished by a tubucular hardness. They finally, however, disappeared, and left no traces of the existence of the malady. The patient, through the whole course of tire disease, suffered but little, and was not, for a single day, confined to her bed. The febrile symptoms subsided on the breaking out of the eruption, and did not afterwards reap- pear. A swelling of the face and hands took place during maturation, but this went off as soon as desiccation commenced.* Figures 89 and 90, Plate 21, represents varioloid pock, which appeared on a little girl six years of age. Figure 89, second day of eruption. Figure 90, fourth day of eruption. This little girl had been vaccinated when an infant, and the vaccine scab was strongly marked on her left arm. She had been confined to the sick ward in the Hopital des Eufans Malades of Paris in the summer of 1826, and whilst she was recovering from a slight fever, a girl fourteen years of age who occupied a bed near to the one she lay iu, was taken sick and broke out with the confluent small-pox. Just sixteen days from the exposure of the little patient to this case of confluent small pox, about twenty pimples were discovered on different parts of her body. The eruption broke out without any or very little previous illness, which would not have been noticed had it not been succeeded by the eruption. A slight degree of langour, and a little dizziness and pain in the head, attended with a partial loss of appetite was all the symptoms that were observed. The eruption first showed itself on the upper and inner part of the thigh, and was vesicular when discovered. A few pimples were next seen on the face, trunk and hands, and were papular on their arrival at the surface, but before the termination of the first day their tops were converted into regular vesicles, containing a light straw-colored serum. On the fourth (Figure 90), they had gained their full size, and the matter which they.contained began to concrete ami dry up. On the sixth day the virus had completely dried up, and the surfaces of the pocks were covered with dry, light brown scabs. On the eighth day these scales or scabshad become harder and of a darker color and began to crumble off. During the march of the erup- tion the patient suffered but little and experienced no secondary fever, and was as play- ful and lively as usual. She remained during all this time in the ward in which she was taken sick, and continued to sleep in the same, notwithstanding the one next to it was occupied by the girl who was sick with confluent variola. After the scabs had separated and fallen, purplish depressions or marks remained in the skin for some days, but then disappeared by degrees and in three weeks every vestige of the pocks had disappeared.t Figure 87 and Figure 88, contain an accurate copy of an eruption of the natural small- pox, as it appeared on the hand and round the eye of a laborer on the seventh day after it broke out. The pustules were very numerous and were coherent and were piled upon each other, but were not confluent, and had passed into a state of suppuration. They were perfectly round an<;l varied in sizein the different regions on which they existed. They were much larger and more globular on the hand than round the eye, as represented in the figures. On the hands and feet the pustules were of the tubucular or warty kind, and differed from those of the face and trunk, and from the more common eruption, in being more compact, harder and less prone to suppuration. Every part of the body of this pa- tient was nearly as thickly studded with the pustules, as the regions here represented, and the eyes even were invaded by the eruption, and the sight of one of them, as shown in Figure 87, was destroyed by a pustule which appeared over the pupil.J *Small-pox, etc., John D. Fisher, M. P., p. 35. ♦Small-pox. Fisher p 37. {Small-pox, etc., by John D. Fisher, M. D., Boston, 1834, p. 42. 370 Ma lignant Small- Pox. This fatal variety of small-pox was called by the early writers Variohe Nigrse. The blood appears to be poisoned from the first by the disease, being rendered florid and watery. When drawn from a vein a large part of it will be found to be serum, and what ought to be the prasamentum remains almost fluid ; it is principally coloring matter ; the fibrin seems to have disappeared. The countenance of the patient is sunken, the breath- ing anxious, and in some instances death takes place before the eruption has been developed, leaving it doubtful whether the disease was small-pox, scarlet-fever, or some other form of idiopathic malignant fever. The erup- tion is rather slowly developed. There is hemorrhage from some, and occasionally from all, or nearly all, of the mucous surfaces; from the nose, from the mouth, from the air passages, from the bowels, from the uterus and vagina, in the female there is invariably hemorrhage from the uterus and abortion in cases of pregnancy, and the foetus is usually born dead. Hemorrhage frequently occurs from the kidneys, and the urine is loaded with blood. Albumen with granular casts may appear in non-malignant cases of small-pox. but the presence of blood in the urine of this disease must be regarded as a symptom of the most serious import. A patch of effused blood under the conjunctiva, appearing early in the attack, should always be looked upon as a most dangerous symptom. In some instances blood oozes from the ears and eyes. Livid patches from effused blood are formed on the surface of the body, and blood is mixed with the Huid formed in the small-pox vesicles which can scarcely be said to become pustules. There is great depression, but the intellect usually remains clear to the last without delirium. A confluent eruption generally accompanies the malignant form of small-pox, and death commonly takes place on the fifth day of the eruption. Petechial small-pox presents very nearly the same characters as malig- nant small-pox; the condition of the blood is very much the same in these two varieties of the disease. In Petechial small-pox numerous little dark spots, resembling flea-bites, especially about the arm-pits and groins, are observable, and the skin in these parts has a greenish-yellow hue, very like what is seen around a severe bruise. VARIOLA MALIGNA-VARIOLA HEMORRHAGICA. DEVELOPMENT AND STRUCTURE OF THE SMALL-POX PUS. TULE. The eruption or formation of the small-pox pustule has certain definite stages in its development; it runs a given course of about eleven days, and its progress undergoes many mutations; it is at first a papule, then a vesicle, then a pustule, and lastly it forms a scab or crust. The various changes form so many stadia of unequal duration. The first or stage of papule, lasts from twenty-four to twenty-eight hours. The second or vesicular stage lasts four days. The last stage, or that of scabbing, lasts three days more, making the whole duration of the normal pustule ten or eleven days. There are varieties, however, of small-pox, in which the formation of the pustule is irregular, as in the Hemorrhagic, confluent and home small- pox. In the home small-pox the two last stages are singularly shortened or absent altogether. When the eruption of small-pox is of the distinct variety, its first appear- ance consists of a number of small red papules, about the size of a pin's head, more or less numerous, but separate and distinct from one another, VARIOLOID AND VARIOLA. rJUAir. Figure 86. Fig. 86/ Varioloid. Fig. 87/ Small-Pox erup- tion. Fig. 88.- Small-Pox eruption. Fig. 89/ Varioloid eruption. Fig. 90 - Varioloid eruption. Figure 87. Figure 88. Figure 89. Figure 90. Structure of Small-Pox Pustule. 371 and'scarcely salient. They commence with a circumscribed hyperaemia of the true skin, extending into the subcutaneous tissue. The cells of the Rete Malpighii swell up the papillae elongate, and the red spot of skin be- comes a sharply defined nodule, perfectly solid, and having a flattened top. On the second or third day of the eruption, the second stage towards the development of pustules commences. A small vesicle, which gradually enlarges, bound down and depressed in the centre, or umbiUcated, forms on the apex of each pimple, by elevation of the outer layer of the epidermis, and contains a clear whey-colored fluid. This vesicular stage lasts almost four days, when the vesicle maturates or " ripens " into a pustule. This process is so gradual, that if the pustule be examined closely about the fifth or sixth day, a central whitish disc of lymph may be seen, set in or surrounded by a circle of yehowish, puriform matter. According to the testimony of Watson and others, there is in the centre a vesicle, which is distinct from the pus, so that you may puncture the vesicular portion and empty the contents without letting out any of the pus ; or you may punc- ture the part containing the pus, and let that out without evacuating the contents of the vesicle. The vesicles have even, by careful dissection, been taken out entire. The pus cells form from the young cells of the Rete Mal- pighii. The adherence of the altered cuticle to the cutis at some points, and its separation at others, produces the little compartments or dissepi- ments spoken of by some writers. These cavities are usually irregular in shape, and contain a white substance of the consistence of pulp or thick mucous, which at first was supposed to be the specific exudation of small- pox. It is now ascertained that it is no pseudo-membrane, but is composed of the deeper and softened layers of the epidermis. This " disc "ot soft- ened epidermis covers the interior of the pustule, and extends from the centre to the raised circumference of the pustule in diverging rays, form- ing part of six or eight fan-like chambers of nearly equal size. In the structure of this disc the following elements are distinguishable from without inwards : (1), large flat cells ; (2), large cells not so flat,but more globular and mucous ; (3), nearest the cutis are the cells and tissue of the rete mucosum. (Gruby, Gluge, Bayer, Gustav Simon, and other observers and systematic writers, as William Aitken.) The variolous pock has been carefully examined with a view of describ- ing its structure, by John Hunter, Dr. Adams, Petzholdt, Erasmus Wil- son, Dr. Gustav Simon, Sir Thomas Watson, Dr. Heming, and others; but it would be foreign to our purpose to present an extended view of the opinions of these various writers, and the above concise statements of the condition of our knowledge on this subject will be still further illustrated by the following description, by Carl Wedl, in his Rudiments of Pathologi- cal Histology.* "External integuments-exudations in this situation, are particularly fitted for study, being accessible to observation, even during life. The most frequent are those which take place in the cutaneous papilla, in which they are either confined to small limited districts, in which the exudation takes place around isolated groups of papilla?, or are more extensive. An instance of the former kind, or of a limited exudation, is afforded in small-pox, in which the spots are at first filled with a limpid fluid, containing nothing but molecules, and do not become pustules till afterwards, when pus-corpuscles are de- veloped in the hyaline exudation. The transudation takes place from the capillary sys- tem of the papilla, the exudation as it is poured out gradually accumulating between the under surface of the epidermis and the upper surface of the corium. But since the pro- cess is confined to limited groups of papilla, the epidermis covering the latter is raised in the form of a transparent vesicle, while the spot at which the hair escapes from its sheath, together with the excretory duct of the sebaceous follicle, remains depressed, and con- stitutes the central pit of the vesicle. In those parts of the skin where no hair or seba- ♦Translated by George Busk, F. K. S.; Sydenham Society, p. 206. 372 Changes of Temperature in Small-Pox. ceous follicles exist, as in the palm of the hand and sole of the foot, the exudation de- posited around a point where several of the deeper grooves in the corium, meet, may cause a similar pit,since in a situation of this kind the epidermis constitutes a stronger layer and is of closer texture. When the puriform fluid iu the pustules begin to dry up, the pit becomes shallower and wider, owing to the subsidence of the swelling. In the integu- ments of a subject dead of small-pox, it is easy to perceive that the vessels of the papilla are more or less injected, when the skin has been macerated long enough to allow of the removal of the epidermis, beneath which the isolated patches of vascular injection are immediately apparent. Perpendicular sections show that the papilla are the con- stant and principal seat of the injection, and it is from these vessels Xhat the hemor- rhage takes place, in cases of petechial small-pox." The poison of small pox is believed to be most active just at the period when the clear contents of the vesicles begin to turn cloudy. While the maturation of the vesicle, into a pustule is going on, a damask red areola forms around each pustule; and as the vesicle fills, the whole face swells, and often to so great a degree that the eyelids are closed. When the erup- tion is completed the "bridle" which bound down the centre of the vesicle, ruptures, and the pustule now becomes spheroidal or acuminated. About the eighth day of the eruption a dark spot is seen on the top of each pustule. At that spot the cuticle ruptures, allowing matter to exude, which conceretes into a scab orcrust; and during this process the-pustule shrivels and dries up. The crust is detached between the eleventh and fourteenth days, leav- the cutis beneath of a dark reddish brown hue, a discoloration which lasts many days, or even weeks. On the face, however, the pustule often pene- trates or burrows, so as to cause ulceration of the rete mucosum, leaving a permanent cicatrix in the form of a depression or "pit." The cicatrix thus formed, though at first of a dark reddish brown, ultimately becomes of a dead white color. The small-pox eruption does not appear on the whole body at once, but appears in three successive crops. The first crop covers the face, neck and upper extremities; the second the trunk, while rhe third appears on the lower extremities. There is usually an interval of several hours between each crop; and the later the papules are in appearing on the trunk and lower extremities than on the face and neck, by so much the later they are in maturing and disappearing from these parts. When the eruption on the face is declining, that upon the extremities has scarcely yet arrived at its height, so that the hands and feet are then considerably swollen. This is to be regarded as a favorable sign, in so far as it indicates a certain sign of constitution. The number of pustules sometimes does not exceed five or six over the whole body ; more commonly they number from one to 300, and occasion- ally amount to several thousands. It has been calculated that if 10,000 pustules be counted on the body that 2000, at least, will be found on the face; ami accordingly the number of the pustules on the face being in proportion, those on the other parts of the body furnish a fair estimate of the extent of the disease and of the danger of the patient.* CHANGES OF THE TEMPERATUBE AND URINE IN SMALL- POX (VARIOLA) AND IN MODIFIED SMALL-POX VARIO- LOID. The following observations and chemical researches were made by the author, chiefly during the recent Civil War (1861-1865), when the camp life permitted isolation and continuous labor, without the interruptions attending private practice. * The Science and Practice of Medicine. Bv William Aitken, M. D., Edinb., Prof, of Pathology in the Army Medical School, Philadelphia, 1872. Vol. 1, pp. 376-378. Changes of Temperature in Small-Pox. 373 CHANGES OF TEMPERATURE IN SMALL-POX. The fever of this disease, as well as that of measles, scarlatina, typhus and typhoid fevers, in like manner with those of hospital gangrene and surgical fever, is due to the contamination of the blood by a specific organic poison. The matinal producing small-pox being definitely related chemically and physiologically to the organic constituents of the living body, the development of the disease is traceable through well marked stages. During the period of incubation (the duration of which varies within narrow limits, according as the poison has been introduced by the mucous or cutaneous tissues, in the former case, or natural small-pox, the period of latency varying from ten to fifteen days, and in the small-pox produced by inoculation, from seven to nine days), the specific poison absorbed gradually infects the blood, rendering it contagious in its properties, and excitant and irritant to the nervous system and circulatory apparatus. The infection and alteration of the blood during the period of inocula tion in small-pox gives rise to the secondary stage of primary fever, last-- ing from two to six days, till the eruption appears, when, in most cases, it remits. This stage is characterized by fever, the temperature of the axilla rising to 106° F. and even higher; severe muscular pains, especially in the small of the back; nausea and in some cases obstinate vomiting, oppres- sion of the brain, drowsiness, stupor and even coma, and occasionally con- vulsions. During the fever and prior to the appearance of the eruption, the in- tense pain in the back is a symptom of great importance as giving a warn- ing as to the character of the disease. The pain in the back is a peculiar and striking symptom, and is more intense than in any other form of fever. It is distinguished from lumbago by its position; that in lumbago affects the muscles on each side of the spine, and is greatly aggravated by move- ment ; while the pain of the back in small-pox is in the central part of the sacrum and the lumbar region, and is not influenced by movement. During a series of investigations and post-mortems on small-pox in 1864, I suffered with all the symptoms of the first stages of this disease, and experienced the most intense pain in the back; this pain was even greater than that which I suffered subsequently in 1873 from daugue, and in 1878 from yellow fever. Three views have been advanced, as to the source of this characteristic pain in small-pox. (1.) Hyperaemia of the spinal medulla. (2.) Pressure on spinal nerves as they emerge from the lumbar and sacral regions by the distended venous plexus surrounding them in the bony out- lets. (3.) Excessive hyperaemia of the kidney, or incipient nephritis in the connective tissues of the kidney. In severe cases of small-pox I have detected albumen and urinary casts in the urine, and the pain may, in some degree, be due to hyperaemia of these organs, but is most probably referable to congestion of the spinaj cord. On the evening of third or morning of the fourth day, after the com- mencing of chill, the fever is usually at its height; and on the fourth day, sometimes sooner and but seldom later, the eruption appears, and the third stage commences, the phenomena of the third stage are as a calm succeeding to a storm ; for on the appearance of the eruption, the fever re- mits, the heat abates, the affection of the head subsides, the vomiting 374 Changes of Temperature in Small-Pox. ceases, and the pulse returns to its natural standard. The febrile phe' nomena seem to have altogether disappeared for the time, and the patient may think himself well. A temporary defervescence is thus well marked, the temperature falling from, perhaps, 106° F. progressively downward to 100° F. On the first or second day of the disease the temperature may attain a considerable height, seldom below 40°c (104°F.), and more often above it; and this rise may occur in an unbroken line and with extreme rapidity, or it may occur more slowly and reach the elevation on the second evening. On the second day the temperature may have already attained its maxi- mum, or may still exhibit a moderate increase on the third or on the fourth day, with which only very slight remissions occur in the morning hours. According to Dr. C. A. Wunderlich :* " The maximum temperature of the initial stage or prodromal fever is only exceptionally less than 40°e (104°F.), generally somewhat above that, sometimes even 41°c (105.8°F.), or indeed a few tenths more. "When the maximum has been reached a slight fall immediately ensues, which gen- erally lasts only one day. At this time we may commonly notice the first traces of the eruption in the form of spots. This stage lasts from two to five days, and it is not pos- sible at this time, from the course of the temperature, to discriminate small-pox from exanthematus typhus, relapsing fever, or from a pneumonia which as yet affords no local evidence of its presence; and even when the other symptoms are taken in conjunction, it is seldom that we can speak with complete certainty. Yet, on the one hand, every day that the fever lasts, without the lung symptoms render pneumonia less probable; and, on the other hand, if the fifth day of the disease pass over without any eruption making its appearance, the presence of small-pox must be considered very doubtful. " Soon after the first development of the variolous papules, the temperature falls more or less rapidly. In rare cases of the disease this defervescence occurs as early as the second or third day of the disease, but generally from the fourth to the seventh day. The downfall lasts only twenty-four hours or less, in which case it is continuous ; or two, or, indeed, even three days, when it is generally not continuous, or, in other words, it is interrupted by a moderate evening exacubation. * * * "The falling temperature after the prodromal stage either never gets down to normal, sometimes remaining sub-febrile, but generally at decided febrile degrees, and continuing in this fashion for several days, with or without daily fluctuations; or the normal tem- perature is reached, if at all, tediously, and deffervescence is by lysis." About the fourth day of the eruption, and about the eighth day of the disease, inclusive, from the first attack of the primary fever, when the eruption is fully out, and the most advanced pustules commence to matur- ate, the commencement of suppuration is announced by the swelling of the integument, and especially of the whole face, head and neck. During this period of intumescence (generally lasting three days), simultaneously with the renewed hyperamia of the skin, and introductory to the change taking place in the cavity of the pustules, the fever, which had remitted, returns, and the last stage, or that of secondary or suppurative fever, commences. In rare cases of extraordinary interest, this stage is marked by a rise of tem- perature to a considerable height (104°, 105°, and even in the case of Colonel Nat. Offut, my hospital student, to lll°c,) by acceleration of the circula- tion, and by slight delirium and rigors. In cases of greater intensity, severe delirium, a harsh, dry, cough, and hemorrhages from the kidneys and lungs and bowels may be added to the other symptoms. In many cases the secondary fever, and the swelling and redness of the face, having lasted from three to five days, subside, and the now fully ripe pustules burst and discharge a thin, yellow matter, which concreting into a crust, falls off on the fourteenth or fifteenth day, and the disease terminates. During these changes the secondary fever of small-pox disappears, and the temperature sinks gradually to the normal standard. *0n the Temperature in Disease; Sydenham Society; London, 1871; p. 339. Changes of Temperature in Small-Pox. 375 The secondary fever of small-pox is clearly related to the suppurative process, and without doubt has much the same origin as uncomplicated inflammatory fever accompanying mechanical injury or amputation, or suppurative inflam- mation of some important organ. It is mainly due to the absorption of the serum of the pus, and of the products of the inflammatory exudations. In many cases the secondary (suppurating) fever is of indefinite dura- tion, varying in accordance with the intensity of the disease; and at the same time its course and the height of the temperature differ according to the danger and severity of the disease. In small pox of moderate severity the temperature in this stage scarcely reaches 39°c (102.2° F.) in general, and very rarely 40°c 104°F.) or more; there are morning remissions, and the duration is usually only a few days. In some cases the temperature is considerably higher; the course is sometimes remittent, with very marked exacerbations.and sometimes continuous with occasional isolated elevations of temperature. Irregular fluctuations very often mark its course. If, during the fever of suppuration, the temperature several times exceeds 40°c (104°F.), it is a sign of great danger. In cases not fatal the duration of the secondary fever is seldom less than a week. In favorable cases the fever depresses by lysis, in a very gradual man- ner, and sometimes at the time of scabbing, there is an occasional preju- dicial but brief rise of temperature, or the fever may even continue till desiccation, and it may even be longer. In fatal cases, the temperature may rise rather quickly from mod- erate heights to very considerable degrees, and death may occur at 42° c. (107.6° F.), or even more, although during this stage the patient may die with only moderate elevation of temperature. Simon (Charite Annative, 13, Bd. 5 J has published cases in which the temperature (which was, how- ever, measured after death) was 43.75° and 44.5° c., respectively, (110.75° and 112.1°). Serious complications may cause intercurrent attacks and irregularities in the temperature, which, however, presents nothing specially character- istic of small-pox.* CHANGES OF THE TEMPERATURE IN VARIOLOID OR MODI- FIED SMALL POX (SMALL-POX AFTER VACCINATION). Small-pox as modified by vaccination, received the name of Varioloid, first suggested for it by Dr. John Thompson, of Edinburgh, who wrote a work on the subject in 1820; and this word has been adopted generally in Europe and America by writers on small-pox. Small-pox after vaccination presents various degrees of severity, aud modification, from the slightest form of which there is none, or hardly any eruption at all, to the most confluent cases, closely, often exactly resembling the disease in the unvaccinated; and it also assumes the petechial and malignant types after vaccination just as in the unvac- cinated state. This depends in a large measure upon : ♦Investigations upon the Nature, Causes, and Treatment of Hospital Gangrene, as it prevailed in the Confederate Armies, IbGl-1865 ; by Joseph Jones, M D. Surgical Memoirs United States Sanitary Com- mission ; New York. 1871, pp, 355-361. G. A. Wunderlich; Archiv fur physiol, Heilk unde. N. F. 2, 18, 1858. Leo; Archiv der Heilkunde, 4, 481, 1864 ; Frohlich, ibid, 1867, v. 8, 420; Korber, Petersb Zeitschrift, 13, 303. On the Temperature in Dis- eases ; a Manual of Medical Thermometry, by Dr. C. A. Wunderlich, New Sydenham Society; 1871,. pp 337-341, table 4. The Science and Practice of Medicine, by William Aitkin; Philadelphia, 1872, vol, 1, pp. 376-398. 376 Changes of Temperature in Varioloid or Modified Small-Pox. 1. The matter with which the patient Jias been vaccinated. 2. The mode in which the vaccination has been performed. 3. The length of time which has elapsed since the performance of the vaccination. 4. The state of the constitution of the patient at the time of the erup- tion of the variolous poison. Dr. J. F. Marson, Resident Surgeon to the London Small-Pox Hospital, has published the following valuable table, illustrating the effects of the mode of vaccination upon the subsequent attacks of small-pox (varioloid): TABLE. Analysis' of all the Cases of Small-pox after Vaccination, admitted at the Small-pox and Vaccination Hospital, London, for a period of twenty years, viz: from 1836 to 1855, in- clusive, showing, from a careful examination of the Cicatrices, the relative amount of secu- rity given by the number of Vesicles produced at Vaccination ; and, judging from the char- acter of the Cicatrices, the probable state of activity and efficiency of Lymph used after Vaccination. PATIENTS ADMITTED WITH SMALL-POX. Number of Patients Character of Cicatrices. Cases. RESULTS. Discharged. Died. Died Affected by Super added Diseases. Ratio per cent of Mortality from Small- Pox.after de- ducting en- tirely Cases affected by Sup er a ddeil Diseases. 1. Having one vaccine cicatrix 2. Having two vaccine cicatrices | 3. Having three or more vaccine cicatrices.... 4. Having four or more vaccine cicatrices 5. Stated to have been vaccinated but hav-( ingno cicatrix .. ... j 5. Stated to ha,ve been vaccinated but par-( ticulars of cicatrix not recorded } Total 2,001 1,446 518 544 370 17 Good. Indifferent. Good. Indifferent. Good. Indifferent. Good. Indifferent. 1,032 969 873 573 307 211 358 180 370 17 978 835 841 516 300 202 356 183 269 14 w 2 wkxomSSBe 15 21 12 10 4 2 0 2 18 3.83 11.91 2 32 8.34 0.99 3.34 0.55 0.54 7.73 4.70 1.95 0.55 23.57 6.66 4,896 4,896 4.494 402 86 6.56 Dr. Marson describes a good vaccine cicatrix as distinct, foveated, dotted, or indented, in some instances radiated, and having a well, or toler- ably well-defined edge; an indifferent cicatrix is indistinct, smooth, with- out indentation, and with an irregular, well-defined edge. According to the preceding statistics, and in accordance with the valua- ble experience of Dr. Marson, the aggregate mortality with good vaccine cicatrices, from small-pox alone, uninfluenced by other diseases, is 2.25 per cent.; with indifferent vaccine cicatrices, from small-pox alone, uninfluenced by other diseases, 8.82 per cent. There is found to be a mortality of about two per cent, in vaccinated as well as unvaccinated patients from small-pox, being complicated with ante- cedent or superadded diseases. Three-fourths of the cases had taken the vaccination in but one or two places, and among these, by far the largest proportionate mortality from small-pox has fallen. By vaccinating so as to take effect in four or more places, we not only save life, but prevent a great deal of suffering and sub- sequent damage to the appearance of the person, which, in females at least, is of great consequence, and not always quite a matter of indifference to males. Changes of Temperature in Varioloid or Modified Small-Pox. 377 Of 544 cases having four or more vaccine cicatrices, not one-half of one per cent, died of small-pox, or one in 200; whereas of 969 cases, with only one indifferent vaccine cicatrix, almost twelve per cent. died. Of <70 persons who believed themselves vaccinated, but who had no cic- atrix to show for having been vaccinated, but who trusted to it for their protection, died of small-pox at the rate of twenty-three and one-half per cent. The security of vaccinated persons gradually rises, not only from the number of cicatrices produced at vaccination, but also according to the quality of the cicatrices. Active vaccine lymph, such as leaves clear, per- manent cicatrices, is evidently indicated as the most desirable to select for use in vaccination. According to Dr. J. F. Marson, "In the course of years vaccine lymph becomes humanized, by passing many times through the subject, and can only be kept in a great state of efficiency by having many subjects con- stantly to select from for its continuance, and even then the cicatrices it leaves, after many years' use, are not so good as they were formerly. "Out of large numbers ot cases of small-pox after vaccination, viz., 1,958, admitted into the Small-pox Hospital during the years 1863 and '64- small-pox having been epidemic in London throughout these entire years- the mortality shows a considerable increase, by from 6.56 per cent, for twenty years-1836 to 1855-to a mortality of 9.2 per cent, out of 1,958 cases for the years 1863 and '64; all patients manifesting antecedent or supervening diseases having been deducted from the calculation. "It is a question that may be fairly and properly entertained, and de- serves very mature deliberation, whether we ought not to resort more fre- quently than has hitherto been done to supplies of lymph from the cow."* Modified small-pox, or varioloid, is characterized by the comparative mildness of the symptoms, the pustules being cut short in their develop- ment by vaccination or a primary attack of small-pox. The principal varieties of modified small-pox (varioloid) have been thus classified by systematic nosologists: 1. A fever of three days, without eruption, affecting people during va. riolous epidemics (variolae sine variolis vel eruptione). 2. A high and severe fever, followed by a very mild eruption, sometimes only a single pock; the slight proportion which the amount of eruption bears to the severity of the preceding fever is perhaps the most marked characteristic of varioloid. 3. The occasional appearance of a scarlet efflorescence, like that of scarlatina or roseola, preceding the appearance of the proper pimples, which occur as a very scanty crop. 4. In some rare instances the eruption is confluent, but does not advance beyond the development of a pimple or vesicle, and begins to dry on the fourth or fifth day of the eruption, forming a small, hard tubercle, which soon disappears. 5. Sometimes the eruption is pimple, vesicle and pustule at one time in the same case. 6. Sometimes the eruption runs its regular course, but stops sooner, sometimes on the sixth or seventh day, instead of the eighth or ninth. In general, it may be stated that the severity and fully developed state of the disease is in proportion to the length of time which elapses from vaccination. ♦Small pox, J . F .Marson ; System of Medicine, by J. Russell Reynolds; Philadelphia, 1879; vol, 1, pp. 152 and 154. 378 Changes of Temperature in Varioloid or Modified Small-Pox. 7. The varioloid eruption wants the peculiar odor of natural small-pox, and secondary fever is very rare.* It may be stated in general terms that in varioloid, after an intense con- tinuous fever, lasting a few days, a final exacerbation terminates the fever suddenly and simultaneously, with the development of the small-pox pim- ples. A rapid and perfect defervescence then ensues, the temperature decreasing seven or more degrees, Fahr., within thirty-six hours. From this event the patient remains entirely free from fever-provided there exists no serious complication-in spite of the continuous and progressive develop- ment of the small-pox pimples into pustules, and even in spite of the suc- cessive eruption of new pimples. It is evident, therefore, that the fever in small-pox exhibits two distinct types, which closely correspond at their commencement. i These two types correspond to the two chief modifications of small-pox; one a brief continuous form, belonging to modified small-pox or varioloid, occurring chiefly, although not exclusively, in vaccinated or inoculated persons; the other a relapsing type,which characterizes the unmodified small- pox (variola, vera), which runs its course with fever in the suppurating stage. The course of the temperature in the initial stage will not suffice to dis- tinguish between true variola and varioloid, but as soon as the exanthem develops itself the course of the temperature is not only the most certain, but the only certain, criterion by which true small-pox may be distin- guished from the modified form. Not only in the occurrence of a more or less developed secondary or suppurative fever the most trustworthy means of diagnosis between the two fevers, butthemode of defervescence of the eruptive fever gives an almost infallible indication as to the kind of further course of the disease. The initial period is common to both types (variola and varioloid). In the first or second days of the disease the temperature attains a considera- ble height, seldom below and often above 104° F.; the maximum tempera- ture of the initial stage or prodromial fever reaching in many cases, and even exceeding, 106° F. Soon after the first development of the variolous papules the temperature falls more or less rapidly. In cases of uncomplicated varioloid the temperature quickly reaches by this defervescence, or falls down a trifle below it, and thenceforth remains normal or pretty nearly so, unless the occurrence of some complication causes a fresh rise, which is but seldom the case. When the eruption in modified small-pox (varioloid) is very copious there may sometimes occur a slight (scarcely febrile) and seldom febrile elevation of temperature at the time when the pustules are desiccating, but this does not last long in any case. This fall of temperature is the best characteristic of varioloid, especially when regard is had to the fact that the defervesence is not simultaneous with the full development of the eruption, but occurs soon after that begins, even at the time the spots begin to be papular, or to be distinctly felt as elevations. CONSTITUTION AND CHANGES OF THE HEINE IN VAR 10- LOID (MODIFIED SMALL-POX), AND IN VARIOLA VERA (SMALL-POX). The urine of small-pox presents changes corresponding, to a certain ex- tent, with the four well marked stages of the disease. 'Science and Practice of Medicine, by William Aitken. M, D.; Edinburgh; Philadelphia. 1872; vol 1, p. 388. Constitution and Changes of the Urine in Varioloid. 379 In this disease, the urinary excretion presents uniform characteristics; namely, great concentration, increase of the urea and uric acid, phosphoric acid, and sulphuric acids, and diminution and even total disappearance of the chloride of sodium. The urine of modified small-pox (varioloid ), slso presents marked differ- ences from that of true uncomplicated small pox. The table contains a consolidated statement of the results of the author's labors upon the changes of the urine in varioloid and variola during the civil war (1861-1862J. 380 Observations upon the Constitution of Urine in Small-Pox. TABLE OF OBSERVATIONS UPON THE PHYSICAL AND CHEMICAL PROPERTIES, AND CONSTITUTION OF THE URINE IN SMALL-POX-BY JOSEPH JONES, M. D., SURGEON PROVISIONAL ARMY OF THE CONFEDERATE STATES. Physical Properties and Chemical Constituenss of Urine . Name of Patient, History of Disease, etc. Date. Urine aring 24 ins. £ c ® r- Grains, Grains. Acid, 2 Grains. • • Amount of collected d Hours, Gra Specific Gr Color. Urea excret during 24 i Grains. Uric Acid, Free Acid Grains, Phosphoric Grains. Sulphuric A Chlorides, Varioloid-Light Case.- J. J. Cobb, private, C. S A. Age 31. Oct. 31, 1864. Variolons eruption very slight; pustules small and few, and the patient walks about; appetite pretty good. The first symptoms made their appearance about five days ago. Pain in head, limbs, and back, with fever. Eruption first noticed Oct. 30. Nov.l. Pustules Oct. 31, 1 P. M. ) to Nov. 1, 1 > P. M. ) 5,865 1,029 Deep orange red 227.89 7.22 16.77 15.51 41.63 Trace Nov. 5 13,424 1,015-5 Orange yellow 239.93 8.00 14.22 15.57 48.74 38.80 increasing somewhat in size, but still small; patient dressed and walking about; eruption so slight that the character of the disease might escape observation ; heavy deposit of urates in urine. Nov. 4. Pustules disappearing ; they aborted. Case of Well-Marked Varioloid.-Severer than the preceding, and approaching more nearly to distinct small-pox. Pustules large, well- formed, but scattering. W. B. Aiken, Company A, 30th Regiment, Georgia Vols. Age, 30. Had headache, and pain in back and limbs, Oct. 24. 1864. Two days after on the 26th, the eruption made its appearance. Oct. 31. Pustules sparsely scattered over the face, but large and well filled. Patient up and about; appetite rather poor; complains of sore throat. Nov. 1. Pustules still in process of forma- tion ; heavy deposit of urates in urine. Nov. 4, eight and a half A. M. Pustules large and distinct, fully formed, and drying. Patient, as before, up and dressed and walking about; has taken a dose of Nov. 1 4 7,325.7 8,146.9 1,028.5 1,036.5 Orange red Light orange 222.33 260.53 10.85 10.80 28.30 38.01 26.98 27.79 24.73 88.52 14.14 10.32 Epsom salts. Case of Small-Pox.-Austin, negro man. Oct. 25, 1864. Eruption Oct. 29 6,495 1,031 Deep orange red 434.56 6.80 25.24 22 54 19.93 Trace appearing. Oct. 28. Eruption three days out; patient has cough; pulse but little above healthy standard, 88 per minute. Tongue very 30 9,322 1,024.5 Deep orange red 407.61 12.00 32 42 32.60 23.95 4.63 31 16,967 1,016 Deep orange red 376.52 11 66 24.68 30.70 56.24 48.97 slightly coated; appears to be doing well; confined to bed. Oct. 29. Progresses favorably; pulse, 88; pustules distinct, and comparatively Nov. 1 26,999 1,015 Orange 443.58 16.90 39.14 32 51 24 11 84.94 4 23,866 1,016 Orange 555.84 18.60 46.32 46.32 31.38 63.84 few; urine high-colored and concentrated, with heavy deposit of urates. Oct. 31. Patient doing well; tongue only slightly coated ; voice hoarse ; pustules forming well; heavy deposit of urates and uric acid. Nov. 1. Pustules filled and drying ; continues to improve ; appetite good. Nov. 4- Continues to improve; pustules drying, large and distinct; appetite good ; urine clear. Observations upon the Constitution of Urine in Small-Pox. Small-pox.-Charles, negro man. Age, 38, Stout, black negro. Taken Oct. 29 9,593 1,024 Deep orange red 450.14 7.18 29.83 33.06 30.81 Trace with fever anil headache, Oct. 23, 1864. Eruption made its appearance 30 9,243 1,027 Deep orange red 415.02 10.41 25.93 29.39 31.30 Trace three and a-half ays after, on the 27th of Oct., 1864. Pulse full and 31 7,927 1,029.5 Deep orange red 400 97 9.31 28.37 32.60 26.98 Trace good. 82 per minute; eruption quite full, but not confluent; has what Nov. 1 7,457 1,030 Deep orange red 348.05 15.30 28.36 33.28 24 94 2.13 appears to be a vaccine scar, and says that he was vaccinated when a 2 10.280 1,028 Deep orange red 422 36 12.16 29.59 37.54 29.94 24.60 youth ; urine deep red and cone ntrated ; lets fall heavy deposits of urates. Oct. 30. Eruption coming on fully in face and scattering on breast, but fuller on thighs ; tongue slightly coated, and red at tip and edges ; heavy yellow deposit in urine 31st. Heavy deposit in urine. 11,770 1 023.5 Deep orange red 355.04 9.49 28.17 29.30 26 44 33.81 Nov. 1. Pustules tilled; patient doing well; still confined to bed. Nov. 2. Continues to improve ; pustules drying; appetite improving. Nov. 4. Pustules drying; patient continues to improve. Nov. 5. Continues to improve. Small-pox.-January, negro man. Age, 24 Light case of distinct Nov. 1 6.444.9 1.023 Orange 240.86 6.40 23.16 27.79 15 64 1.85 small-pox. Had pain in head and back on the 25th of Oct., 1864. Erup- tion made its appearance on the 27th of Oct. Nov. 1. Patient doing well; urine deep-colored. Nov. 4. Pustules out in large numbers, fully formed, just beginning to dry upon surface; appetite good. 4 19,544 1,018.5 Oiange 602.79 9.27 65 90 55.95 46.86 3.65 Case of Confluent Small-pox.-Jamns Graves, 2d Regiment Georgia Reserves Was taken with a chill, folio wild by high fever, Oct. 26, 1864. Has had high fever up to the present time, Nov. 1. The erup- Nov 2 9,713 1,022.5 Bright red Red 351.29 11.11 45.62 68.43 24.27 Trace 5 4,807 1,023 176.01 4.50 21.84 15.74 19.66 Trace tion attracted notice first on the night of the 27th, three days ago. At the present time, Nov. 1, face covered with eruption, and much swollen ; eyes irritated and discharging matter; pustules confluent; heavy deposit in urine. Nov. 4. Confluent eruption encrusts theen- * tire face, like a tilthy mask. Nov. 5. Continues to improve; pustules drying. Confluent Small-pox.-Sawney, negro man. Age, 22. Was taken with characteristic symptoms'of small-pox, Oct. 25, 1864. Nov. 2. Pustules not well tilled; confluent; patient delirious. Nov. 4, Pus- Nov 4 12,264 1,022 Red 469.37 10.64 49.87 46.93 33.36 Trace ■w tules filled ; confluent; mind clear ; urine high-colored, concentrated, with heavy deposits of uric acid and urates. 381 382 Constitution and Changes of the Urine in Varioloid and Small-Pox. When it is considered that these patients partook of but little food, and were in a state of almost absolute rest, it is evident that the urea is con- siderably increased in the urine of small-pox, amountingin one case to over six hundred grains during the twenty-four hours. As a general rule, the increments of this constituent corresponded with the severity of the dis- ease, being but little above the normal standard in mild cases of varioloid, and increasing to double and even treble the usual amount in cases of con- fluent small pox. In like manner, the uric acid and the phosphoric and sulphuric acids were increased. The excretion of these constituents furn- ishes a measure of the destructive metamorphosis of the blood and muscu- lar and nervous systems during the progress of the disease. The uric acid and urates exist in such large amounts in the concentrated and scant urine of small-pox as to form heavy deposits upon cooling. Uric acid is in like manner largely increased in hospital gangrene; and this increase, as in the case of small-pox, must be referred to the derangement of the nutrition, and oxidization of the nitrogenized elements and constituents and tissues. The great concentration of the urine in small pox may be due to several causes, as the congestion of the kidneys, the peculiar constitution of the blood, in virtue of which the water is held more tenaciously in combination with the nitrogenized elements and constituents, and the large abstraction of this constituent of the blood during the morbid changes in the integument. The rapid diminution and complete disappearance of the chlorides during the exudative and suppurative stages of small-pox is important, as illus- trating the offices of these metallic salts in the animal economy. The chlor- ides disappear so completely from the urine of severe cases of small-pox, that nitrate of silver gives scarcely a perceptible turbidness, when added to the urine acidulated with nitric acid. The wide diffusion of the chloride of sodium through the solid and fluid portion of the earth's surface, and its similar diffusion throughout all animal substances in deflnite proportions, as well as the craving of men and animals for this substance, and its estab- lished beneficial effects when used as an article of food, point to the im- portance of this substance in the metamorphosis of animal tissues. It is now well established that this salt is constantly associated with certain animal matters, and essentially influences their chemical and physical properties, rendering albumen, casein, and fibrin more soluble, and modifying their coagulating properties. The influence which this salt exercises on these protean compounds, and upon the physical properties of the blood cor- puscles, as well as its relations to urea and glucose, renders this view prob- able that it is capable of forming definite chemical compounds with certain organic bodies which are most active in the changes characteristic of in- flammation. Recent investigations upon the composition of inflammatory exudations, pus and muces, indicate that this salt discharges an important office in the metamorphosis of the inflammatory materials of various diseases, as pneumonia and small-pox. And it is not unreasonable to refer the absence of this salt in the urine in small-pox, not merely to the diminution of the amount ingested with the food, but to its abstraction by the exudation, and the part which it plays in the metamorphosis of the organic constituents into organized cells and fibres. We have thus established by the preceding observations that- 1. Cow-pox (vaccination) produces a profound change in the chemical constitution of the human body. 2. When the small-pox poison induces fever after vaccination, and the disease appears in a modified form, known as varioloid, the course of the Spurious Vaccination. 383 temperature differs in a marked degree from that of true small-pox ; in the former the fever is continuous and forms but one paroxysm ; in the latter the fever is intermittent or remittent. In varioloid the fever subsides and disappears with the appearance of the eruption. In small-pox, the fever often subsiding after the appearance of the erup- tion, reappears during the filling of the vesicles or eruption with pus. 3. In varioloid the increment of urea, uric acid, free acid, phosphoric acid and sulphuric acid in the urine is comparatively slight. 4. In small-pox there is a marked increment in the urea, uric acid, free acid, phosphoric acid and sulphuric acid. 5. The action of the vaccine virus tends to prevent secondary fever and rapid oxidation of the nitrogenesed and phosphorized constituents of the blood, muscles and nervous tissue. 6. It is evident that the cow-pox virus protects from small-pox, by pro- ducing profound changes in the chemical constitution of the solids and fluids of the human body. SPURIOUS VACCINATION OR THE ABNORMAL PHENOMENA ACCOMPANYING AND FOLLOWING VACCINATION. (AUSES OF THE VARIOUS DEVIATIONS OF VACCINE DISEASE FROM ITS NORMAL COURSE-DANGER OF THE INTRODUCTION OF OTHER DISEASES INTO THE ORGANISM BY VACCINATION, VACCINO-SYPHIILTIC INOCULA- TION-POST-VACCINAL SYPHILIS. No question is of greater importance to the citizens of the United States of America, than the arrest, prevention and exclusion of small-pox. This loathsome disease has in past times after its introduction by Europeans depopulated the native races of the North American continent; and but for the practice of vaccination by the Medical Profession of the Ignited States, smallpox would find a permanent home in this great and growing country; and the facilities of travel by steamboat and railroad are so great that scarcely a citizen of this mighty republic would escape this foul pestilence. The question of the arrest and exclusion of small-pox is of especial interest to the citizens of Louisana, who in virtue of the geographical position of their State, hold the key to the Missisippi valley. We have established by original investigation and by statistics derived from official sonrces, and consolidated especially for this inquiry, the great protection afforded by vaccination to the citizens of the Eastern, Middle and Southern States, whose settlement and history antedated by periods ranging from seventy to two hundred and more years, the announcement of the discovery of Edward Jenner. It remains that the value of vaccination should be impartially considered in all its varied respects, and that all sources of accident, error and danger arising from this operation should be fairly discussed. 384 Spurious Vaccination. The experience gathered by the medical officers of the Southern (Con- federate) Army during the great American Civil War of 1801-1865 was of great value, and opened an entirely new chapter in the history of vac- cination. At the present time the enemies of vaccination appear to be gathering renewed strength, from the apparent failures and accidents occasionally attending this operation. Like all other great discoveries, vaccination has been atone time extolled for powers which it does not possess, and at others blamed for accidents fbr which it was not justly chargeable. IN THE EARLY HISTORY OF VACCINATION, PROTECTIVE POWERS AGAINST CERTAIN DISEASES WERE ERRONE- OUSLY ATTRIBUTED TO COW-POX INOCULATION. Soon after the world was informed that the vaccine poison was preven- tative of the small-pox, a disposition was shown by physicians and specu- lative men to extend its influence and prophylastic powers to other diseases. The idea was advanced, that the morbid action excited by the virus from the cow, could as well prevent other contagious distempers, as that one for which it was particularly employed; and if it was capable of doing such good in the human constitution it would be no less operative in the bodies of brutes. Accordingly it was said that the plague of Syria, could be prevented by previous vaccination ; but M. Valli who made the experiment on himself was seized afterwards by the plague. This alleged power of vaccination in controlling the plague, attracted at an early period a considerable degree of attention, and Dr. Jenner received letters on this subject from many quarters. The circumstances having been made known to the Spanish Consul at Morocco, a communication was transmitted to Sir Joseph Banks on that subject, and from him to Jenner. The opinion of Jenner on this point was thus expressed. "I never was so sanguine in my hopes of seeing the plague extinguished by vaccine inoculation as some of my friends were, as you may have seen by the few introductory lines which accompanied Dr. Cairo's letters in the public papers." "I will just drop a hint; the vaccine disease, in my opinion, is not a preventive of the small-pox, but the small-pox itself; that is to say,the horrible form under which it appears in its contagious state is (as I conceive) a malignant variety. Now if it should ever be discovered that the plague is a variety of some milder disease generated originally in a way that may even elude our researches, and the source should be discovered from whence it sprang, this may be applied to a great and grand purpose. The phenomena of the cow-pox open many paths for speculation, every one of which I hope may be explained." The prophetic hope of Jenner, breathed more than half a century ago, has and is being realized in our day by the investigations of Pasteur, Koch and others. M. Valentine of Marseilles, in a letter to Dr. Samuel Mitchell of New York presented the following : " I think it may be agreeable to you to become acquainted with a letter written by the Hospodar of Wallachia, to my friend, Dr. Carro, of Vienna. It was published a few months ago, in the Bibliotheque Britanique, a French journal published at Geneva. That Prince is well known to be one of the most learned, polite and liberal men of the present day. What he says on the plague seems to be worth a volume. ' ' Sir-Ihave received the letter you have done me the honor to write me, dated April the seventh, together with the work which accompanied it. I have perused the whole, with the lively interest which talents and intrepidity engaged in the cause of humanity, never Spurious Vaccination. 385 fail to inspire. After having given so striking an instance of your confidence in the cow-pox, it was well worthy of the extent of your ideas, to seek a preventive against one of the greatest scourges of the earth. But you know, Sir, that I belong to a country where it is but too easy to make observations on the plague. I have seen this capricious disease assume all forms, and exhibit the most opposite symptoms. It has frequently appeared under the guise of an inflammatory fever, and then suddenly disclosing all the peculiar symptoms, so that most inexperienced physicians have been strongly deceived in prescribing blood-letting, which has produced the most fatal effects. Sometimes it commences its career by an inflammation of the stomach, accompanied by signs of a septic ferment, which infects the whole alimentary canal, attacks the nervous system, and assumes the character of a deadly malignity. Other persons seized by the disease, have had no other symptoms than those of uneasiness and surprising weakness in all the joints, so that the physicians could consider it only as a slow fever, invading the rvhole nervous sys- tem. From this proteiform variety of symptoms, we are to suppose that the pestilential miasmata, introduced into the mass of humours incorporated with them, and excite symptoms corresponding to the peculiarity of constitutions in the sick ; and that we are to respect a remedy which promises uniformity either to prevent this distemper, or to cure it. " Mr. Valli, on his passage through Bucharest, owned to me that his experiments with cow-pox had taught him nothing. [Dr. Valli returned from Constantinople to Italy. This is the man who inoculated himself for the plague, and who shut himself up in a pestiferous hospital at Constantinople. All the hopes he once entertained of preventing the plague by vaccination are vanished.] And the notion of guarding against the plague by inoculating with its own poison promises still less success, because it is very common to see people who have been cured of it ten times die on the eleventh. " Shall I give you, sir, an instance of the whimsicalness of this disease? The Imans practice charity with the most religious zeal. We observe some of them who, after hav- ing washed, rubbed and buried thousands of those whom the plague has killed, without experiencing the smallest inconvenience, are attacked and overwhelmed at times when they are least exposed to the supposed exciting cause. My opinion, therefore, is that in the present state of our knowledge, the best thing we can do in this respect is to estab- lish hospitals, over which men of your merit cannot be too vigilant for the purpose of recommending proper discipline to governments.* " I have the honor to be, etc., CONSTANTIN YPSILANDY." Dr. Jenner proposed vaccination in hydrophobia. Thus in a letter to Rev. Dr. Worthington, dated London, Flading's Hotel, Oxford street, June 26, 1811, he says: "Yesterday I dined with Professor Davy. I wish you had been with us. His mind is all in a blaze. He seems to be one of those rare productions which nature allows us to see in a score of centuries. We touched on hydrophobia. He started an ingenius idea, that of counteracting the effect of one morbid poison with another. What think you of a viper? "Not its broth, but its fang, as soon as the first symptom of disease appears from Canination. If this should succeed we must domiciliate vipers as we have leeches. But from this hint I should be disposed to try, under such an event, vaccination; as it can almost always be made to act quickly on the system, whether a person has previously felt its influence or not, or that of the small-pox." John Archer, M. D., of Hartford county, Maryland, recommended vacci. nation as a remedy for pertussis, in a letter addressed to Dr. Samuel Latham Mitchell, of New York, dated November 15, 1808. Dr. Archer stated that he had " vaccinated six or eight patients that had the whooping-cough, and in every case it succeeded in curing this most troublesome disease." " The whooping-cough does not come to its height in less than six weeks from its com- mencement, and then, when a favorable termination is expected, the declension of the disease is gradual and it does not terminate in less than six weeks more. To arrest this afflicting disorder in its progress, I would recommend vaccination in the second or third week of the whooping-cough. The termination of the vaccine disease will be the termi- nation of the whooping-cough ; that is, as soon as the vaccinated part loses the efflores- cence, and the scab begins to dry and becomes of a blueish or brownish color, there will then be an evident change in the whooping-cough for the better, and the severe symp- toms will cease.-Medical Repository. Vol. 4. New York, 1809; p. 182. * The Medical Repository and Review of American Publications on Medicine, Surgery and the Auxiliary Branches of Science. Conducted by Samuel Latham Mitchell, M. D., and Edward Miller, M. D. Vol. 3. New York. 1806 ; pp. 427-429. 386 Spurious Vaccination. " It was eveu reported that vaccination was an effectual bar against the syphilis. With reference to this supposed power of the vaccine virus, a writer in the Medical Re- pository. in the year 1805 (vol. 2, p. 76), remarks: 'Of this power we nave heard no proof, and as far as our observations extend, the old enemy of the gentlemen of gallantry liarasses them as sorely as ever. Should they be able to take shelter behind the vaccine, it would be a protection to which they might gladly betake themselves.'" It was also claimed in the early part of the nineteenth century,* even before 1805, that the rot in sheep could likewise be prevented by vaccina- tion. Experiments, however, demonstrated that the cow-pox was power- less to preserve these animals from that distemper. Dr. De Cairo testified that this operation, which was called clavelization, was quite fashionable in some parts of Germany, but that there weie no facts to prove that the ex- periments had prevented rot in sheep. The expectations entertained of vaccination preventing hydrophobia in dogs were equally fallacious. SPURIOUS vaccination, or the abnormal phenomena ACCOMPANYING AND FOLLOWING VACCINATION, EX- CITED THE ATTENTION OF THE MEDICAL PROFESSION OF ENGLAND IN THE EARLIEST PERIOD OF THE HISTORY OF VACCINATION. It has been shown by the preceding works of Edward Jenner, Pearson and Woodville that the phenomena of cow-pox and vaccination were crit- ically studied, and the causes of deviation in the progress and effects of the disease carefully noted. The enemies of vaccination seized with avidity upon all facts which tended to weaken the confidence of the profession and public, and to excite prejudice against the measure proposed by Dr. Jenner for the eradication of small pox. Drs. Win. Rowley, B. Moseley and R. Squirrel (John Gale Jones) not only published works against vaccination, but circulated prints represent- ing the human visage in the act of transformation and assuming that of a cow. Dr. William Rowley exhibited in all the touching simplicity of graphic delineation a Master Jowles, the cow-poxed, ox-cheeked young gentle- man, and the Miss Mary Ann Lewis the cow-poxed and cow-manged young lady. The articles of this celebrated triumvonate-Moseley, Rowley and Squir- rel-appeared in the columns of the Independent Whig and of the Medical Observer, and also as separate treaties. I have in my possession a translation in French of the books of Rowley, Moseley and Squirrel, entitled as follows: La vaccine combattue dans le Fays on elle a pris naissance, on traduction de Trois ouvrages Anglais; Savori. 1. De Vinefficacite et des dangers de la vaccine ; ouvrage, dans lequel sont, rapportes plus de cinq cents accidents ; suivi d'un Mode de Traitement pour les Maladies causees par la vaccine, Traduit sur la troisiOne edition de docteur Wil- iam Roivley, auteur de la Medecine Universelle, Membre de V Universitive d'Ox- ford, du College Royal de Medicine, et professeur, etc. 2. Discussion Historique et critique sur la vaccine, par le Docteur Moseley, Medicin de 1'Hdspital Militaire de Chelsea, membre de College de Medecine de Londres, auteur d' un traits sur les Maladies tropiques des *Rapports faits au comite de laChambredes Communes, par plusieurs Mede- cins et Chirurgiens, concernant la vaccine. *The Medical Repository, vol. 2; New York, 1805; pp, 75-76. Spurious Vaccination. 387 3. Observations sur 1'Inoculation variolique tendant, & prouver qu'elle est plus salutaire pour le genre liumain que la vaccination; par R. Squirrel, docteur en Medecin, aucien pharmacien a 1'Hdspital de la petite verole et d'inoculation. Aux Deux Gravures Colorices. A Paris, Chez Gignet et Michaud, Im- prim. ; Libraires, Rue des Bons-Enfants, No. 34, 1807. The work of Dr. William Rowley is illustrated by 504 examples or cases of " the accidents occasioned by vaccination." Dr. Moseley, physician to Chelsea Hospital, first made his attack upon the cow-pox in a treatise on sugar ; and his bitterness and prejudice claimed to see in distant prospects, an awful aggravation of human ills, from an admixture of bestial humours, which the cow mania as he elegantly termed it threatened to inflict upon the human race. He even predicted an altera- tion in u the human form divine," and that another brood of minotuars would overspread the land " Semibovemque virum Semiviriemque borum." This attack of Dr. Moseley on vaccination brought out many champions, on the side of Dr. Jenner, prominent amongst whom was Mr. John Ring. At first Mr. Ring's opinion on vaccination had been somewhat modified by the publications of Drs. Pearson and Woodville; but when Dr. Jenner's accurate details were confirmed and illustrated by his own experience, he devoted a great part of his professional life to the cause of vaccination. Mr. Ring investigated every adverse case that he heard of in London ; he offered gratuitous vaccination to all who would accept of it; and he marshalled the chief medical men in London, who had satisfied themselves of its efficacy, by procuring their signatures to the following testimony. "Many unfounded reports have been circulated, which have a tendency to prejudice the public against inoculation for the cow-pox. We, the undersigned, physicians and surgeons, think it our duty to declare an opinion that those persons who have had the cow-pox are perfectly secure from the future infection of the small-pox. We also de- clare that the inoculated cow-p?x is a much milder and safer disease than the inoculated small-pox." This document bears the signature of thirty-three of the most eminent physicians, and of forty distinguished surgeons of the London College of Surgery, amongst whom are the well-known names of Bailie Vaughn (afterwards Sir Henry Halford), Cline, Cooper, Abernethy, Lettsom, Willan, Garthshere, Maton, Lynn, Blair, Dundas, Good, John Pearson, James Moore, Saunders, Croft, Garnett, etc., etc. Dr. Jenner, in a letter to R. Dunning. Esq., dated Berkley, February 10, 1805, thus alludes to the subsequent publication of Dr. Moseley: " Have you seen Moseley's infamous pamphlet ? You ask for fatal cases of the vaccine. This gentlemen, in one single paragraph, furnishes you with some of the most terrible deaths that were ever heard of from this cause, One would suppose he was speaking of the small-pox, as he tells us the children did not lose their torments even in the article of death! Luckily, he takes away every thing like truth that can attach to this history by omitting every kind of reference. What punishment does a man of this description merit?" In a letter addressed to R. Dunning, Esq., dated Cheltenham, February 21, 1806, he thus characterizes the injurious effects of the statements of Rowley, Moseley and Squirrel: " What havoc the anti-vaccinationists have made in town by the reiutroduction of va- riolous inoculation! It is computed that since April last, not less than 6,000 persons in the metropolis, and the villages immediately in contact, have fallen victims to the small- pox. One would scarcely conceive it possible ; but these murders are, for the most part, to be attributed to the absurd productions of Moseley, Rowley, and that pert little Squirrel, to say nothing of Goldson. It is about London that the venom of these deadly serpents chiefly flows. So little have the people around me (though only 100 miles from it) felt it, that since August last I have vaccinated within a few of 1500; and I must certainly deenrit a piece of extreme good fortune that out of the many thousands I have vaccinated, no failure or accident 388 Spurious Vaccination. of any sort has arisen to my knowledge." "Did you see a paper in the last Journal from a Dr. Wood ? I think it capable of doing great mischief, as it will tend to make practi- tioners careless about a point of great consequence, namely, an herpetic state of the skin, coincident with vaccination, which you as well as myself, have not only observed, but publicly and very properly noticed. My communications from various parts of the world are very cheering-800,000 cases from India." Dr. Jenner, in connection with the subject of the interference of herpes with the vaccine pustules, again refers to Dr. Moseley, in a letter to K. Dunning, Esq., dated Berkley, April 22, 1806 : " The impertinent interference of herpes with our vaccine pustules, I thought of so much consequence to be generally known, as to induce me to reprint my paper on the subject for distribution. With this you will receive two copies ; one of which I must beg your acceptance of; and the other you will have the kindness to present to the Dock Jennerian Society, with my grateful respects to the members. You will do much public good by enforcing attention to the progress of the vaccine pustule. If it be torn to । pieces, either by the nails or the lancet, before the business for which it was placed upon the arm was accomplished, it is unreasonable to suppose that perfect security can follow. But to what purpose shall you or I address the public on these subjects, while such un- principled characters as Moseley, and those who enlist under his banner, still continue to instil, or rather to push by violence, into the minds of the British nation their doc- trines ? Have you seen Moseley's last pamphlet, the one just published f It is far more violent than any of the preceding. In this be has brought forward a string of cases to point out my failures in vaccination-cases of small-pox after cow-pox. But mark bis audacity. They are of children I never saw in my life, and whose names 1 never heard of till they were placed before me in the murderous publication. Mr. H. Jenner, whose name he brings forward with a list of failures annexed, assures me that the whole is a most impudent forgery. What can be done with such a man as this ? A general mani- festo with the signatures of men of eminence in the profession (and I really think we should now embrace nearly, if not quite, the whole,), in favor of vaccination, would, if anything could, crush the hissing heads of such serpents at once ; and I fear nothing short of it, unless Parliament had a mind again to take the matter up." Front the preceding extracts it is evident that Dr. Jenner has made a careful study of the effect of skin diseases upon the progress of the vac- cine vesicles; and we find him thus alluding to the same subject in a letter dated Berkley, February the tenth, 1805. "In the cicatrix of those children on whose arms, through the intervention of herpes, the pustule has proceeded irregularly, I find in general a singular deviation, which it will be difficult to describe by words and I draw most wretchedly. Instead of the fiat, correct indentation, the cicatrix exhibits a preceptible elevation of a conical shape, though very slightly so. I have a fine specimen in a child lately inoculated, with recent tinea capiles, and shall endeavor to take a cast in wax or Paris plaster. Indeed a series of pustules might be done in this way, and afterwards colored." The important suggestion of Dr. Jenner, with reference to casts, andillus- trations of the vaccine cicatrix was fulfilled in an able manner by J. E. B. Denarp Decauteleu in his Monographic des cicatrices de la vaccine, pub- lished at Paris in 1851. Dr. Denarp Decauteleu published a large lithographic drawing, copied from a collection of casts in stucco, taken from the arms of a large number of subjects, this collection of casts of vaccine scars, colored after nature, the author refers to in the single number of his unfinished Monograph, and offered them for the inspection of his readers as corroborativeof the accuracy of his drawing*. Dr. Jenner held that the herpetic affections affected the progress of variolous inoculation, as well as that of the cow-pox. His views are thus stated in a letter to James Moore, Esq., dated Berkley, February 26,1810: "Do you not intend mentioning cases of small-pox after supposed security from small- pox inoculation ? Such cases are innumerable. I think there are thirteen on record among the families of the nobility. Blair, 1 believe, has collected the greatest number *Dr. Henry Austin Martin of Boston purchased, from the publisher, Balliere of Paris, all that remained of the edition ot this work ; and I am indebted to the courtesy and generosity of Dr. Martin for a copy of this valuable contribution to the history of vaccination. Spurious Vaccination. 389 of them. You know my old opinion of the matter ; that they occur, for the most part, through the interference of herpetic affections at the time of inoculation. One decisive proof you will find in Willan's Vaccine Book, given by me. From facts I go to hypo- thesis; and conceive that the appearance of the small-pox twice in the same individual arises from the same cause ! "On this subject I could write a long chapter; hut as it would necessarily be theoretical yon would not thank me for it. I must just touch upon it. We see that variolous matter may be generated by inoculation on the arms of one person in that degree of perfection as to communicate the small-pox by transferring it to those of another; yet the person whose constitution shall in the first instance have been exposed to it, shall remain unpro- tected from future infection, although the system has been deranged during its presence on the skin. Where, then, is the difference, whether the morbid poison was confined or limited to a point or two, or spread universally in the form of pustules. If the change required to give security could not take place in this one instance, why should it in an- other under the same existing circumstances! The peculiarity of the action (I do not like to call it morbid, because it is generally salutary), is often too strong to be overcome, yet I am ready to conclude that this is not a frequent occurrence. " The more I reason upon it, the more I am convinced that the idea I broached in my first publication on the cow-pox, namely : that poisonous animal fluids are not absorbed and carried into the blood vessels is correct." In the same letter to Mr. Moore, Dr. Jenner thus exposes and disposes of his enemy, the notorious "Squirrel: " "John Gale Jones, I see, has at; length succeeded in obtaining the situation for which he has long been a candidate. This fellow had once the impudence to desire a man to call on me in Bedford Place, to say, that he, Jones, would advise me immediately to quit London, for there was no knowing what an outraged populace might do. He was the writer of Squirrel's book, the long anti-vaccine columns in the Independent Whiy, and many of the most violent papers in the Medical Observer. I was held up in his Forum for several nights as an object of derison ; but I silenced him by the same weapon as I had many others-contempt." RESEARCHES UPON "SPURIOUS VACCINATION," OR THE AB- NORMAL PHENOMENA ACCOMPANYING AND FOLLOWING VACCINATION IN THE CONFEDERATE ARMY, DURING THE RECENT AMERICAN CIVIL WAR, 1861-1865. SECTION 1. PRELIMINARY OBSERVATIONS-ACCIDENTS ATTENDING VACCL NATION AMONGST THE * ITIZENS AND SOLDIERS OF THE CONFEDERATE STATES-NECESSITY FOR THE INVESTIGATION-METHOD, EXTENT AND OBJECT OF THE INQUIRY-THE INJURIOUS EFFECTS OF VACCINATION REFERRED TO SIX CAUSES-CIRCULAR LETTER ADDRESSED TO THE MEDICAL OFFICERS OF THE LATE CONFEDERATE ARMY-FACTS ILLUS- TRATING THE VALUE OF VACCINATION AND THE FATALITY OF SMALL POX-DESCRIPTION OF SMALL-POX BY SIR MATTHEW HALE-DR. JEN- NER POINTED OUT SOME CAUSES OF THE ACCIDENTS ATTENDING VAC- CINATION AND GAVE RULES FOR THEIR AVOIDANCE. During the recent civil war, untoward results followed vaccination, and a number of deaths both amongst the troops and citizens were directly re- ferable to the effects of vaccination. So great was the evil in the army, that it was made a special subject of investigation, and a number of inter- esting reports were prepared by several of the medical officers, upon what was most generally called in the army, " spurious vaccination." Our friend, Surgeon Jackson Chambliss, in charge of Div. No. 1, Camp Winder Hospital, Richmond, had examined and recorded a large number of cases of " spurious vaccination," illustrated with drawings of the various local diseases and skin affections. As far as our information extends,this valu- able mass of matter, relating to one of the most important subjects in its bearings upon the welfare of the human race, was destroyed during the evacuation of Richmond. So common had accidents become after vaccination, and so strong was the prejudice growing, both in the army and amongst citizens against its employment, that we instituted a series of experiments upon the inocula- tion of cows with small-pox matter, in order to produce, if possible, cow- pox, from whence a supply of fresh and reliable vaccine matter might be obtained. It was our design to carry out an extensive series of investiga- tions upon the various secondary affections following vaccination, and to determine, if possible, what contagious principles could be associated with the lymph of the vaccine vesicle. These labors were brought to a sudden and unexpected close, by the disastrous termination of the civil war. As far, however, as our labors amongst the Confederate troops extended, we were led io attribute the injurious effects of vaccination to the following causes: 1st.-Depressed forces, consequent upon fatigue and exposure and poor diet; impoverished, vitiated and scorbutic condition of the blood of the patients vac- cinated, or yielding vaccine matter. 392 Spurious Vaccination: Joseph Jones, M. D. 2d.-The, employment of matter from pustules or ulcers which had deviated from the regular and usual course of development of the vaccine vesicle; such deviation or imperfection in the vaccine disease or pustule being due mainly to previous vaccination, and the existence of some eruptive disease at the time of vaccination. Or, in other words, the employment of matter from patients who had been previously vaccinated, and who were effected with some skin disease at the time of the insertion of the vaccine virus. 3d.-Dried Vaccine, Lymph or Scabs, in which decomposition has been ex- cited by carrying the matter about the person for a length of time, and thus sub- jecting it to a warm, moist atmosphere. 4th-The mingling of the Vaccine Virus with that of the Small-Pox-matter taken from those who were vaccinated while they were laboring under the action of the poison of Small-Pox, was capable of producing a modified Variola, and comparatively mild disease in the inoculated, and was capable of communicating by effluvia Small-Pox in its worst character to the unprotected. • 5th.-Dried Vaccine, Lymyh or Scabs, from patients who have suffered with Erysipelas during the progress of the Vaccine Disease, or whose systems were in a, depressed state from improper diet, bad ventilation, and the exhalations from Typhoid Fever, Erysipelas, Hospital Gangrene. Pyaemia, and offensive suppur- ating wounds. 6th-Fresh and dried Vaccine Lymph and Scabs, from patients suffering from Syphilis, at the time, and during the progress of vaccination and the vac- cine disease. I addressed a large number of communications relating to "Spurious vac- cination," to Southern physicians formerly connected with the Confederate Army, and the replies to t hese inquiries will be found in the following pages. The following is the general form of circular employed : - 18- , M. D. Dear Sir- In the circumscribed and distressed condition of the Southern States, cut off from the surrounding world, with the necessity of Vaccinating the entire male population capable of bearing arms, and without any means of obtaining fresh and reliable matter outside of the Confederate States, the experience of the Medical Officers of the Confederate Army possesses a high and peculiar value. I shall be glad to receive from you a communication, setting forth your views at length upon the nature and value of Modified Inoculation, and upon the Nature and Causes of the Accidents resulting from Vaccination ("Spurious Vaccination ") in the Confederate Army. The subject of the transmission of Syphilis through the medium of the Vaccine Virus, should be carefully discussed, and all conclusions should be supported by carefully re- corded facts and cases. One well reported case, proving the transmission of Constitutional Syphilis, or any other disease, as Erysipelas, by vaccination, is worth large volumes of mere opinions and assertions. We should exercise the utmost caution in discussing the value of vaccination, and the causes of the accidents, which have tended of late, to bring it into disrepute with the public; for all conscientious physicians and lovers of mankind will agree that this question is interesting, not only to the physiologist and medical practitioner, but that it concerns every community on the earth, and comes home to every individual of the hu- man race. It has been well said, by a writer who was not a medical man, "It is difficult to con- ceive that there should be one being who would not be affected by its decision, either in his own person, or by those of his nearest connexions. To the bulk of mankind wars and revolutions are things of infinitely less importance; and even to those who busy themselves in the tumult of public affairs, it may be doubted whether anything can oc- cur that will command so powerful and permanent an interest, since there are few to whom fame or freedom can be so intimately and constantly precious as personal safety and domestic affection." Spurious Vaccination: Joseph Jones, M. D. 393 It is important that we should carefully distinguish the accidents which result from the carelessness in the selection of the matter, and from ignorance of the true character and progress of the vaccine disease. You will oblige me by answering at an early day, and also by forwarding the address of any physicians who have made this subject a special study, and who have recorded trustworthy observations. Very respectfully yours, JOSEPH JONES. This circular letter was not as widely distributed as desired; as it has been difficult to ascertain the address of many of the medical officers of the Southern Army, on account of the sudden manner in which the struggle terminated, and the utter and sudden loss of all organization and records, and on account of the imperfect mail facilities of the Southern States. The replies which have been received in response to my letters, will be found under the different divisions of the inquiry; and we have preferred presenting each paper entire, when using it for the illustration of some particular branch of the subject, although it might contain some matter irrelevant to the subject under immediate consideration. In this manner we hoped to do justice to those contributing facts and observations; and whilst we have freely expressed the results of our investigation, and given our judgment without reserve, we have endeavored, on the other hand, to avoid all personal criticism. Before proceeding to the discussion of the subjects under consideration, it is but just that I should disclaim all designs of decrying vaccination when properly performed. Nothing is farther from my intention, than even in the remotest manner, to detract from the value of the greatest phys- ical boon ever bestowed by a mortal upon the human race. From authentic documents and accurate calculations, it has been ascer- tained that one in fourteen, of all that were born, died of the small-pox, even after inoculation had been introduced ; and of persons of all ages taken ill of the small-pox in the natural way, one in five or six died ; and in addition to this frightful mortality, alike observable in all the different regions of the globe, many of those who recovered were permanently dis- figured, or deprived of eyesight, or left with shattered constitutions the prey to pulmonary consumption, chronic opthalmia, and scrofula. According to the researches of Black, Liissmileh and Frank, eight or nine per cent, of the human race were carried off by small-pox : and Duvil- lard endeavored to show that of 100 persons, only four reached the age of thirty years without having it; that one in seven or eight, who were affected, died^and that of those who were attacked in infancy only two-thirds escaped. Before the introduction of vaccination, small-pox was infinitely more destructive to human life than the plague itself; it has swept away whole tribes of savage and half civilized people, and its miserable victims have been abandoned by their nearest relatives and friends, as persons doomed by divine wrath to irrevocable death ; it was calculated that 210,000 fell victims to it annually in Europe, and Bernouilli believed that not less than fifteen millions of human beings were destroyed by small-pox every twenty-five years, that is six hundred thousand annually ;^ind this loath- some disease was not only universal in its ravages, but was so subtle in its influence and insidious in its attack, that all efforts to stay its violence or to prevent its approach, were utterly futile. Even inoculation whilst it was far less fatal than the natural small-pox and thus benefited the indi- vidual, tended nevertheless to increase the spread of the disease, and its extensive adoption was attended with a most marked increase of mortality of the disease in the human race. Sir Matthew Hale, in a letter of advice and admonition to one of his grand- sons, has given an excellent picture of this disease, which well illustrates 394 Spurious Vaccination: Joseph Jones, M. D. its odious characters, and exhibits the impression which it makes on the world at large, in a stronger light than if the description had been drawn np by a strictly professional hand. ? therefore, touching your late sickness (small-pox) I would have you remember these particulars : 1st. 1 he disease itself in its own nature is now become ordinarily very mortal, especially to those of your age. Look upon even the last year's general bill of mortality, you will And near two thousand dead of that disease; and, had God not been merciful to you, you might have been one of that number with as great likelihood as any of them who died ot that disease. 2d. It was a contagious disease that se- cluded the access of your nearest relations. 3d. Your sickness surprised you upon a sudden, when you seemed to be in your full strength. 4th. Your sickness rendered you noisome to yourself and all that were about you : and a spectacle full of deformity, by the excess of your disease, beyond most that are sick thereof. 5th. It was a fierce and violent sickness : it did not only take away the common supplies of na- ture.. as digestion, sleep, strength, but it took away your memory, your understanding and the very sense of your condition, or of what might be coudncible to your good. All that you could do was only to make your condition more desperate, in case they that were about you had not prevented it and taken more care for you than you did or could for yourself. 6th. Your sickness was desperate, in so much that your symptoms and the Violence of your distemper were without example; and you were in the very next degree to ab- solute rottenness, putrefaction and death itself." By the unaided efforts of a man, emulous not of distinction but desirous of advancing truth, and promoting the happiness and well being of his fel- low creatures, and distinguished as much for his humility, long suffering and perseverance, as for his unsurpassed powers of practical observation, the world has been furnished with the means of completely eradicating this terrible scourge, by substituting the same disease in a mild, modified form non-communicable by effluvia and capable of affording complete immunity from the natural small-pox. So far, therefore, from charging the accidents which we are about to describe, to the process of vaccination, as established and advocated by E.lward Jenner, we are persuaded that a very large part, if not the whole, of these distressing accidents and failures, are to be ascribed directly or indirectly to the ignorance, and inattention of those who practice vaccina- tion. We have no more sympathy with the modern opponents of vaccina- tion, than we have with those English physicians who attempted to decry the labors and to steal the honest dues of their immortal countryman, and who condescended to such low expedients as to caricature the process of vaccination, by representing the human vissage under its effects, in the act of transformation into that of the lower animals, the cow and the horse. And we would heartily endorse any public enactment which would guard in a proper manner the process of vaccination ; and at the present time, some of the older European edicts upon the subject of vaccination, as those ot the Emperor of Russia in 1811, and of the King of Wirtemburgh in 1818, might be reenacted, by the General and State Governments, with great benefit to the people. If the profession had uniformly adhered to the advice and the rules estab- lished by the illustrious founder of vaccination, we would have been spared the vast majority of the unfortunate accidents which tend to bring this the only safeguard against the small pox, into disrepute. Dr. Jenner gave the most minute attention to every deviation from the correct progress of the vaccine vesicle, to the state of the virus to be insert- ed, to the condition of the skin of the person about to be vaccinated, and to the character ot the vesicle itself; and so early as the year 1799, had ascertained by the clearest evidence, some of the causes of accident and failure, which had been confirmed by later observations. He showed that in some cases the system was not rendered totally un- susceptible to the variolous contagion, either by the cow-pox vaccination or the smallpox; but that vaccination, when properly performed with genuine matter, afforded as complete protection as the small-pox itself. He proved that by inoculating a person wlio had gone through the cow pox, with variolous matter, it was possible to excite a local vesication, the virus from which was capable of producing a mild but efficacious small-pox. He Spurious Vaccination: Joseph J ones, M. D. 395 farther maintained that modifications and varieties might arise in the vac- cine pustide, and that these varieties were such as to produce " every gra- dation in the state of the pustule, from that slight deviation from perfec- tion, which is quite immaterial, up to that point which affords no security at all." He held that fluid taken from a spurious vaccine pustule can pro- pagate and perpetuate its like, and even if it be taken from a genuine pus- tule in its far-advanced stages, it is capable of producing varieties which will be permanent if we continue to employ it. Jenner laid great stress upon the herpetic state of the skin, in inducing deviation in the normal progress of the vaccine disease ; but every devia- tion, from whatever cause it may have arisen, was considered by him of the greatest moment ; and in all his published works, as well as in his private communications and letters, he never failed to urge the importance of the most scrupulous attention to the mode of propagation and to the whole progress of the vaccine disease. Thus in his paper on the "Varieties and Modifications of the Vaccine Pustule," he thus urges upon the pr< fession the necessity of the most careful attention to this important subject: "I shall conclude this paper by observing that although vaccine inoculation does not inflict a severe dis- ease, but. on the contrary, produces a mild affection, scarcely meriting the term disease, yet, nevertheless, the inoculator should be extremely careful to obtain a just and clear conception of this important branch of medical science. He should not only be acquainted with the laws and agencies of the vaccine virus on the constitution, but with those of the variolous also, as they often interfere with each other. " A general knowledge of the subject is not sufficient to enable us to warrant a person to practice vaccine inoculation: he should possess a peculiar knowledge ; and that which I would wish strongly to inculcate, as the great foundation of the whole, is an intimate acquaintance with the character of the true and genuine pustule. The spurious pustule would then be readily detected, whatever form it might assume ; and errors known no more.'' Dr. Jenner, in a letter written to Sir Gilbert, near the close of his life, reiterates these precautions, and observes : "Withregardtothemitigateddisea.se which sometimes follows vaccination, I can positively say, and shall be borne out in my assertion by those who are in future davs to follow me, that it is the offspring en- tirely of incaution in those who conduct the vaccine process. On what does the inexplicable change which guards the constitution from the fang of the small-pox depend ? On nothing but a correct state of the pus- tule on the arm excited by the insertion of the virus ; and why are these pustules sometimes incorrect, los ing their characteristic shape, and performing their offices partially ? "-Life of Edward Jenner, Jf. D.' etc., by John Baron, M. D.; vol. 2, p. 241. Jenner even went so far as to maintain that the process of vaccination might be rendered ineffective by mechanically disturbing the vesicle, during the collection and transmission of the virus, and he insisted upon the ne- cessity of allowing one vesicle at least to run its course undisturbed. So far, therefore, from desiring to injure the cause of vaccination by the record of distressing failures and accidents, it will be our endeavor, rather in the spirit of Jenner, to guard the process, by so exposing the cause of these accidents as to lead to their avoidance in future. "Ere I proceed, let me be permitted to observe, that truth in this, and every other physiological inquiry that has occupied my attention, has ever been the first object of my pursuit; and should it appear in the present in- stance that I have been led into error, fond as 1 may appear of the off- spring of my labors, I had rather see it perish at once than exist and do a public injury." 396 Spurious Vaccination: Joseph Jones, J). SECTION II.-MODIFICATION, ALTERATION AND DEGENERA- TION OF THE VACCINE VESICLE, DEPENDENT UPON DE- PRESSED AND DERANGED FORCES, RESULTING FROM FATIGUE, EXPOSURE AND POOR DIET; AND UPON AN IMPOVERISHED, VITIATED AND SCORBUTIC CONDITION OF THE BLOOD OF THE PATIENTS VACCINATED AND YIELDING VACCINE MATTER. IN SCORBUTIC PATIENTS ALL INJURIES OF THE SKIN TEND TO FORM ULCERS OF AN UNHEALTHY CHARACTER. EFFECTS OF SCURVY UPON THE CHARACTER AND PROGRESS OF THE VAC- CINE VESICLE.-INVESTIGATIONS UPON THE EFFECTS OF VACCINATION AMONGST THE FEDERAL PRISONERS CONFINED IN CAMP SUMPTER, ANDERSONVILLE, GA. EXAMINATION OF THE CHARGE URGED BY THE UNITED STATES MILITARY COMMISSION, THAT THE CONFEDERATE SURGEONS DELIBERATELY POISONED OR DESTROYED THE FEDERAL PRISONERS AT ANDERSONVILLE WITH POISONOUS VACCINE MATTER. DR. HAMILTON ON SPUR- IOUS VACCINATION IN THE U. S. ARMY. DR. L. GUILD • ON THE MEDICAL RECORDS OF THE ARMY OF NORTH- ERN VIRGINIA. REPORTS ON SPURIOUS VACCINATION IN THE CONFEDERATE ARMY, BY S. E. HABERSHAM, M. D., OF AUGUSTA, GEORGIA, AND OTHER CONFEDERATE OFFICERS. Large numbers of the Confederate soldiers manifested slight scorbutic symptoms, which were not sufficient to attract attention, or to induce treatment, and as far as we could learn, no attention was paid to this con- dition either in vaccination or in the selection of the vaccine lymph. In scorbutic patients, all injuries tended to form ulcers of an unhealthy character, and the vaccine vesicles even when they appeared at the proper time, and manifested many of the usual symptoms of the vaccine disease, were nevertheless larger and more slow in healing, and the scabs presented an enlarged, scaly, dark, unhealthy appearance. In many cases a large ulcer, covered with a thick laminated crust, from one-quarter to one inch in diameter, followed the introduction of the vaccine matter into scorbutic patients. Matter from these scabs and sores was frequently used in vacci- nation, and this decomposing pus and blood acted as an animal poison in some cases, and especially in constitutions debilitated by exposure, fatigue and salt diet. During the prosecution of the investigations which we instituted upon the diseases of the Federal prisoners confined at Andersonville, the oppor- tunity was embraced of investigating the remarkable effects which followed the attempts of the Confederate medical officers to arrest the spread of small-pox by vaccination. In a number.of cases large gangrenous ulcers appeared at the points where the vaccine lymph had been inserted, caus- ing extensive destruction of tissues, exposing arteries, nerves and bones, Spurious Vaccination: Joseph Jones, M. D. 397 and necessitating amputation in more than one instance. These accidents led to the belief amongst some of the prisoners that the surgeons had in- tentionally introduced poisonous matter into their arms during vaccination- After careful inquiry we were led to the conclusion that these accidents were, in the case of these Federal prisoners, referable wholly to the scor- butic condition of their blood, and to the crowded condition of the stockade and hospital. The smallest accidental injuries and abrasions of the sur- face, as from splinters, or bites of insects, were in a number of instances followed by such extensive gangrene as to necessitate amputation. The gangrene following vaccination appeared to be due essentially to the same cause; and in th*e condition of the blood of these patients, would most probably have attacked any puncture made by a lancet, without any vac- cine matter or any other extraneous material. It appeared also that the dried scab, resulting from the vaccination of these scorbutic patients, was also capable of producing effects wholly different from the vaccine lymph of healthy individuals; and in some cases these effects were of a most po- tent and injurious character. The cause of Justice and Truth demands, at my hands, something more than this simple record, with reference to the accidents following vac- cination amongst the Federal prisoners confined in Camp Sumpter. In the specification of the first charge against Henry Wirz, formerly Commandant of the interior of the Confederate States Military Prison, dur- ing his Trial before a Special Military Commission, convened in accordance with Special Orders No. 453, War Department, Adjutant General's Office, Washington, August 23, 1865, the following is written: "And the said Wirz, still pursuing his wicked purpose, aud still aiding in carrying out said conspiracy, did use and cause to be used, for the pretended purpose of vaccination, impure, and poisonous matter, which said impure and poisonous matter was then and there, by the direction and order of said Wirz, maliciously, cruelly, and wickedly depos- ited in the arms of said prisoners, by reason of which large numbers of them, to-wit, one hundred, lost the use of their arms, and many of them, about the number of two hun- dred, w-ere so injured that they soon thereafter died: All of which he, the said Henry Wirz, well knew and maliciously intended, and in aid of the then existing.rebellion against the United States, with the view to assist in weakening and impairing the armies of the United States, and in furtherance of said conspiracy, and with full knowledge, consent and connivance of his co-conspirators aforesaid, he, the said Wirz, then and there did." Amongst the co-conspirators specified iu the charges, were the Surgeon of the Post, Dr. White, and the Surgeon in charge of the Military Prison Hospital, R. R. Stevenson. As ths vaccinations were made by their orders, and by the medical officers of the Confederate Army, acting under their command, the charge of deliberately poisoning the Federal prisoners with vaccine matter was a sweeping one, and whether intended so or not, affects every medical officer stationed at that post; and it appears to have been designed to go farther and affect the reputation of every one who held a commission in the Medical Department of the Confederate Army. The acts of those who once composed the Medical Department of the Confederate Army, from the efficient and laborious Surgeon General to the Regimental officers, need no defence at my hands; time, with its unerring lines of historic truth, will embalm their heroic labors in the cause of suf- fering humanity, and will acknowledge their untiring efforts to ameliorate the most gigantic mass of suffering, that ever fell to the lot of a be- leaguered and distressed people. I desire at the present time, simply to place on record, the results of labors which concern this country, no more than any other; and the results when properly received without prejudice or malicious hatred, will be seen 398 Spurious Vaccination : Joseph Jones, M. J). to relate to the hygiene and to the diseases of prisoners, however confined, and wherever incarcerated, in civil or military prisons throughout the world. In accordance with the direction of Dr. Samuel Preston Moore, formerly Surgeon General C. S. A., I instituted during the months of August and September. 1864, a series of investigations upon the diseases of Federal prisoners confined in Camp Sumpter, Andersonville, Georgia. The field was of great extent and of extraordinary importance. There were more than five thousand seriously sick in the hospitai and stockade, and the deaths ranged from ninety, to one hundred and thirty, each day. From the establishment of the prison, on the twenty-fourth day of Feb ruary, 1864, to the first of October over ten thousand Federal prisoners died ; that is, near one-third of the entire number perished in less than seven moi ths. I instituted careful investigations into the condition of the sick ami well, and performed numerous post-mortem examinations, and exe- cuted drawings of the diseased structures. The medical topography of Andersonville and of the surrounding country was examined, and the waters of the streams, springs and wells, around and within the stockade and hospital candidly analyzed. The report which I drew up for the use of the Medical Department of the Confederate Army, contained a truthful representation of the sufferings of these prisoners, and at the same time gave an equally truthful view of the difficulties under which the medical officers labored, and of the dis- tressed and beleaguered and desolated condition of the Southern States. Shortly after the close of the civil war, this report, which had never been delivered, on account of the destruction of all railroad communication with Richmond, Virginia, was suddenly seized by the agents of the United States government, conducting the trial to which we have alluded.* It was with extreme pain that I contemplated the diversion of my labors in the cause of medical science, from their true and legitimate object, and I addressed an earest appeal, which accompanied the report, to the Judge Advocate, Colonel N. P. Chipman, in which I used the following language : Injustice to myself, as well as to those most nearly connected with this investigation, I would respectfully call the attention of Colonel Chipman, Judge Advocate U.S.A., to the fact that the matter which is surrendered in obedience to the demands of a power from which there is no appeal, was prepared solely for the consideration of the Surgeon General, C. S. A., and was designed to promote the cause of humanity, and to advance the interests of the medical profession. This being granted, I feel assurred that the Judge Advocate will appreciate the deep pain which the anticipation gives me that these labors may be diverted from the original mission, and applied to the prosecution of crim- inal cases. The same principle which led me to endeavor to deal humanely and justly by these suffering prisoners, and to make a truthful representaiou of their condition to the Medical Department of the Confederate Army, now actuates me in recording my be- lief that as far as my knowledge extends, there was no deliberate or willful design on the part of the Chief Executive, Jefferson Davis, and the highest authorities of the Confed- erate Government to injure the health and destroy the lives of these Federal prisoners. On the twenty-first of May, 1861, it was enacted by the " Congress of the Confederate States of America," "That all prisoners of war taken, whether on land or at sea, during the pending hostilities with the United States, should be transferred by the captors, from time to time, as often as convenient, to the Department of War ; and it shall be the duty of the Secretary ol War, with the approval of the President, to issue such instruc- tions to the Quartermaster General and his subordinates, as shall provide for the safe custody and sustenance of prisoners of war ; and the rations furnished prisoners of war shall be the same in quantity and quality as those furnished enlisted men in the army of the Confederacy." By act of February 17, 1864, the Quartermaster General was relieved of this duty, and the Commissary General of Subsistence was ordered to provide for the sustenance of prisoners of war. *1 have since learned that the United States authorities gained knowledge of the fact that I had inspected Andersonville through information furnished by a distinguished member of the medical profession of the North, who, after the close of the war, had shared the hospitality of my own home. Spurious Vaccination: Joseph Jones, M. D. 399 According to General Orders No. 159, Adjutant and Inspector's General's Office, " hos- pitals for prisoners of war are placed on the same footing as other Confederate States hospitals, in all respects, and will be managed accordingly." The Federal prisoners were removed to Southwestern Georgia in the early part of 1864, not only to secure a confinement more remote than Richmond and other large towns, from the operations of the United States forces, but also to secure a more abundant and easy supply of food. As far as my experience extends, no person who had been reared upon wheat bread, and who was held in captivity for any length of time, could retain his health and escape either scurvy or diarrhoea, if confined to the Confederate ration (issued to the soldier in the field and hospital) of unbolted corn meal and bacon. The large armies of the Con- federacy suffered more than once from scurvy, and as the war progressed, secondary hemorrhage and hospital gangrene became fearfully prevalent, from the deteriorated con- dition of the systems of the troops, dependent upon the prolonged use of salt meat. And but for the extra supplies received from home %nd from the various benevolent institu- tions, scurvy and diarrhoea anol dysentery would have been still farther prevalent." It was believed by the citizens of the Southern States, that the Confederate authorities desired to effect a continuous and speedy exchange of prisoners of war in their hands, on the ground that the retention of these soldiers in captivity was a great calamity, not only entailing heavy expenditure of the scanity means of subsistence, already insuffi- cient to support their suffering, half-starved, half-clad and unpaid armies, struggling in the field with overwhelming numbers, and embarrassing their imperfect and dilapidated lines of communication ; but also as depriving them of the services of a veteran army fully equal to one-third the numbers actively engagedin the field; and the history of subsequent events have shown that the retention in captivity of the Confederate prison- ers was one of the efficient causes of the final and complete overthrown of the Confeder- ate Government. * * * It is my honest belief that if the exhausted condition of the Confederate Government, with its bankrupt currency, with its retreating and constantly dimishing armies, with the apparent impossibility of filling up the vacancies by death and desertion and sick- ness, and of gathering a guard of reserve of sufficient strength to allow of the proper enlargement of the Military Prison, and with a country torn and bleeding along all its borders with its starving women and children and old men fleeing from the desolating march of contending armies, crowding the dilapidated and over-burdened railroad lines, and adding to the distress and consuming the poor charities of those in the interior, who were harrassed by the loss of sons and brothers and husbands, and by the fearful visons of starvation and undefined misery, could be fully realized, much of the suffering of the Federal prisoners would be attributed to causes connected with the distressed condition of the Southern States. The grand object of the trial and conviction of Henry Wirz was the con- viction and execution of President Davis, Gen. Robert E. Lee and other prominent men of the Confederacy, in order that " treason might be RENDERED FOREVER ODIOUS AND INFAMOUS." The Judge Advocate, N. P. Chipman, Colonel U. S. A., was not only deaf to this appeal, but in his final argument before "The Military Com- mission,v or so-called 11 Court," whilst excluding all portions of my testi- mony which related to the distressed condition of the Southern States, and the efforts of the medical officers and Confederate authorities to relieve the sufferings of the prisoners of war, deliberately endeavored to arouse the hatred of the entire North against the author of the report and the medical officers- of the Confederate army. This statement will be sustained by the following quotation, which I extract from the "argument" of the Judge Advocate before the Court:" " He had called into his counsels an eminent medical gentleman, of high attainments in his profession, and of loyalty to the rebel Government unquestioned. Amid all the details in this terrible tragedy, there seems to me none more heartless, wanton and void of humanity than that revealed by the Surgeon General, to which I am about to refer. I quote now from the report of this same Dr. Joseph Jones, which he says (Record, p. 4384,) was made in the interest of the Confederate Government, for the use of the Medi- cal Department, in the view that no eye would ever see it but that of the Surgeon General. " After a brief introduction to his report, and to show under what authority it was made, he quotes a letter from the Surgeon General, dated 'Surgeon General's Office, Richmond, Virginia, August 6, 1864.' The letter is addressed to Surgeon J. H. White, in charge of the hospital for Federal prisoners, Andersonville, Georgia, and is as follows: 400 Spurious Vaccination: Joseph Jones, M. 1). "Sir-The field of pathological investigation, afforded by the large collection of Fed- eral prisoners in Georgia, is of great extent and importance, and it is believed that re- sults of value to the profession may be obtained by careful examination of the effects of disease upon a large body of men, subjected to a decided change of climate, and the cir- cumstances peculiar to prison life. The surgeon in charge of the hospital for Federal prisoners, together with his assistants, will afford every facility to Surgeon .Joseph Jones in the prosecution of the labors ordered by the Surgeon General. The medical officers will assist in such post moriems as Dr. Joseph Jones may indicate, in order that this great field for pathological investigation may be explored for the benefit of the Medical Department of the Confederate States. S. P. MOORE, Surgeon General. "Pursuant to his orders Dr. Jones, as he tells us, proceeded to Andersonville, and on September 17 received the following pass: 'Andersonville, September 17, 1864. • To Captain II. Wire, Commanding Prison : ' Captain-Yon will perm t Surgeon Joseph Jones, who has orders from the Surgeon General, to visit the sick within the stockade that are under medical treatment. Sur- geon Jones is ordered to make certain investigations, which may prove useful to his profession. Very respectfully, ' By order of Gen. Winder : W. S. WINDER, A. A. G.' " When we remember that the Surgeon General had been apprised of the wants of that prison, and that he had overlooked the real necessities of the prison, shifting the respon- sibility upon Dr. White, whom he must have known was totally incompetent, it is hard to conceive with what devilish malice, or criminal devotion to his profession, or reckless disregard of the high duties imposed upon him-I scarcely know which-be could sit down and deliberately pen such a letter of instructions as that given Dr Jones. "Was it not enough to have cruelly starved and murdered our soldiers? Was it not enough to have sought to wipe out their very memories by burying them in nameless graves? Was it not enough to have instituted a system of medical treatment the very embodiment of charlatism ? Was it not enough without adding to the many other dia- bolical motives, which must have governed the perpetrators of these acts, this scientific object, as deliberate and cold-blooded as one can conceive ? The Surgeon General could quiet his conscience, when the, matter was laid before him by Colonel Chandler, by in- dorsing that it was impossible to send medical officers to take the place of the contract physicians on duty at Andersonville, yet could select at the'same time a distinguished gentleman of the medical profession and send him to Andersonville, directing the whole force of surgeons there to render him every assistance, lea ving their multiplied duties for that purpose. Why? Not to alleviate the sufferings of the prisoners; not to convey to them one ounce more of nutritious food ; to make no suggestions for the improvement of their sanitary condition-for no purpose of this kind, butas the letter of instruction itself shows, for no other purpose than that this great field of pathological investigation may be explored for the benefit of the Medical Department of the Confederate Armies." The denunciations of the Judge Advocate were leveled, not merely against a defenseless prisoner of war, whose papers had been seized, and himself dragged as a witness to this crucifixion of his native land, but they were sweeping in their character, ami were designed to arraign the hu- manity, honesty and intelligence of the Surgeon General and the entire corps of the medical officers of the Confederate Army. The charge had the desired effect, and was reiterated even by eminent medical men of the North. Thus the son of the Vice President of the United States, Dr. Augustus C. Hamlin, late Medical Inspector U. S. A., Royal Antiquarian, etc., etc., in his Martyria or Andersonville Prison, says : " Here came a medical officer of the highest rank in the rebel army, and one of the most eminent savans of the South, to study the philosophy and physiology of starvation. "The notes of that fearful clinic are preserved, and may, some future day, startle the scientific world with their clearness, their candor, their positive evidence of the cause of death. Thus the scalpel silences the argumentsand reasonings of sophistry." A similar statement has been made by Dr. Austin Flint, Jr., in his recen work on the Physiology of Man. It was clearly demonstrated in my report that diarrhoea, dysentery, scurvy, and hospital gangrene were the diseases which caused the extraordinary mortality of Andersonville. And it was still further shown that this mor- tality was referable, in no appreciable degree, to either the character of the soil, or waters, or the conditions of climate. Spurious Vaccination: Joseph Jones, M. D. 401 The effects of salt meat and farinaceous food, without fresh vegetables, were manifest in the great prevalence of scurvy. The scorbutic condition thus induced modified the course of every disease, poisoned every wound, however slight, and lay at the foundation of those obstinate and exhaust- ing diarrhoeas and dysenteries, which swept off thousands of these unfor- tunate men. By a long and painful investigation of the diseases of these prisoners, supported by numerous post-mortem examinations, I demon- strated conclusively that scurvy induced nine-tenths of the deaths. Not only were the deaths registered as due to unknown causes, to apoplexy, to anasarca, and to debility, directly traceable to scurvy and its effects, and not only was the mortality in small-pox, and pneumonia and typhoid fever, and in all acute diseases more than doubled by the scorbutic taint, but even those all but universal and deadly bowel affections, arose from the same causes, and derived their fatal characters from the same conditions which produced the scurvy. Scurvy and hospital gangrene frequently exist in the same individual. In such cases, vegetable diet, with vegetable acids, would remove the scor- butic condition without curing the hospital gangrene. It has been well established by the observations of Blane, Trotter and others, that the scor- butic condition of the system, especially in crowded camps, ships, hospitals and beleaguered cities, is most favorable to the origin and spread of foul ulcers and hospital gangrene. In many cases occurring amongst the Fed- eral prisoners at Andersonville, it was difficult to decide at first whether the ulcer was a simple result of the scorbutic state, or of the action of the poison of hospital gangrene. So commonly have these two diseases been combined, that the description of scorbutic ulcers by many authorities, ev- idently, includes also many of the prominent characteristics of hospital gangrene, as will be seen by a reference to the descriptions of Lind, Trotter, Blane and others. More than two hundred and fifty years ago, Pare described a condition of things similar to that of Andersonville; at the siege of Rouen, the air was so noxious that no wounds would heal, and the besieged finding that all their wounds became gangrenous,'reported that the besiegers had poisoned the balls; the besiegers also seeing none but putrid sores in the camp, believed that the wounds were poisoned, and both within and with- out the city such was the state of the air, and so putrid were all the wounds, that the surgeons could scarcely look upon the sores, or endure the smell ; ami if they neglected them for a single day, they found them filled with worms Woodall, in his Chirurgeons Mate, or Military and Domestic Surgery, pub- lished in 1639, not only carefully describes acrobatic ulcers, but also lay* down rules for their treatment; and Gideon Harvey, twenty-four years later, in his " Venus Unmasked," mentions superficial, profound, simple, inflamed, callous, dry. sanious, purulent, phagedenick, and gangrenous ulcers, as characteristic of scurvy. This last named author derives the name scurvy from "Scorbeck, and that from Scornobocca, or Fowl mouth, (from Scorno a Fowl or shameful thing, and bocca the month), for a stinking breath and fowl rotten gums, may still be termed a foul or shameful mouth ; they call it also La marcia di bocca, or putrefaction of the mouth."-p.24. The British seamen, in Lord Anson's voyage, and in fact in all long voy- ages, before the mode of preventing scurvy was practiced, suffered terribly from scorbutic ulc< rs. John Huxham in his Essay on Fevers, in a chapter in which he discourses on the "disordered and putrid state of the blood," observes that the 402 Spurious Vaccination: Joseph Jones, M. J). " Salt and half-rotten provisions of sailors in long voyages, cause such a sharpness and corruption of the humors that they are rendered almost unfit for the common uses of life, producing great weakness, langour, wanderingpains and aches, stinking breath, corroded, spongy gums, black, blue, and sallow spots, sordid, dark, livid fungous ulcers, gangrene, etc., etc. Such scorbutics frequently fall into patecheal fevers, bloody dysenteries, hem- orrhages, etc. What is mentioned by the Rev. Mr. Walter in Lord Anson's voyage, is very surprising, viz. ; that the blood burst from the wounds of some of the scorbutics after they had been cicatrified for twenty or thirty years. I have known many a ship's com- pany set out on a cruise in high health, and yet in two or three months, return vastly sickly, and eaten out with the scurvy, a third part of them half rotten, and utterly unfit for service. About four or five weeks after they had been out, they begin to drop down, one after another, and at length by dozens, till at least scarce half the compliment can stand to their duty; particularly I remember some years since, from a squadron under Admiral Martin, we had near 1200 men put on the shore sick at one time, though they went out very healthy and returned in about twelve or thirteen weeks-"-p. 47. Dr. John Hunter, Surgeon of the English Army, in his "Observations on the Diseases of the Anny in Jamaica," states that " Sores and ulcers in the lower extremities, were frequent at all seasons of the year, and in all the different quarters were the soldiers were stationed. They, together with fevers and fluxes, amounted to nineteen-twentieths of the sick received into the hospitals, all other complaints nor being more than one-twentieth, if particular times be excepted, when the dry-belly-ache or small-pox were prevalent. The proportion of sores in the hospitals, though always considerable, admitted of great variation. At Spanish Town and Kingston they were often one third ; at Fort Augusta, one-half, at Stony Hill, two-thirds of the whole number in hospital. They arise from the most trifling causes ; a scratch, or hmt, or bruise in the lower extremities, are sufficient to produce a sore, which is always fiitfieult to heal, and sometimes impossible. Old sores often break out anew, and prove Equally obstinate." Dr. Lind, in his valuable work ou scurvy, has recorded the fact that the slightest bruises and wounds of scorbutic persons may degenerate into offensive bloody and fungous ulcers, which are prone to spread with great rapidity, which are cured with the greatest difficulty. The distinguishing characteristics of scorbutic ulcers, as given by Dr. Lind, are as follows : "They do not afford a good digestion, but a thin foetid matter, mixed with blood* which at length has the appearance of coagulated blood, and is with great difficulty wiped off or separated from the parts below. The flesh underneath these sloughs feels to the probe soft and spongy. No irritating applications are here of any service for though such sloughs be with great paius taken away, they are found again at next dressing, when the same bloody appearance always presents itself. Their edges are generally of a livid color and puffed up with excrescences of luxuriant flesh arising under the skin. When too tight a compression is made, in order to keep these excrescences from arising; they are apt to have a gangrenous disposition ; and the member never fails to become swelled, painful and for the most part spotted. As the disease increases, they come at length to shoot out a soft bloody fungus, which the sailors express by the name of Bul- lock's liver; and indeed it has a near resemblance, in consistence and color, to that sub- stance when boiled. It often rises in a night's time to a monstrous size, and although de- stroyed by caustics, or the knife (in which last case a plentiful bleeding generally en- sues, is found at next dressing as large as ever. They continue, however, in this condi- tion a considerable time without tainting the bone. The slightest bruises and wounds of scorbutic persons degenerate sometimes into such ulcers. Their appearances on what- ever part of the body, is singular and uniform ; and they are easily distinguished from all others, by being so remarkably offensive, bloody and fungous, that we cannot here but take notice of the impropriety of refering many inveterate and obstinate ulcers on the legs, with very different appearances, to scurvy ; which are generally best cured by giv- ing mercurial medicines; whereas that medicine in a truly scorbutic ulcer is the most dangerous and pernicious that can be administered." In like manner Dr. David Macbride in his " Methodical Introduction to the Theory and Practice of Physic," London, 1772, p. 618, affirms that: " The slightest wounds and bruises in scorbutic people degenerate into foul and un- toward ulcers. And the appearance of these ulcers is so singular and uniform that they are easily distinguished from all others. Scorbutic ulcers afford no good digestion, but a thin and foetid ichor mixed with blood, which at length has the appearance of coagulated gore lying caked on the surface of the sore, and is with great difficulty wiped oil or sep- arated from the parts below. The flesh underneath these sloughs feels to the probe soft Spurious Vaccination: Joseph Jones, M. D. 403 and spongy, and is very putrid. No detergents nor eseharotics are here of any service > forthough such sloughs be with great pain taken away, they are found again at the next dressing, where the same sanguinous putrid appearance always presents itself. Their edges are generally of a livid color, and puffed up with excrescences of putrid flesh aris' ing from below the skin. As the violence of the disease increases, the ulcers shoot out a soft bloody fungus, which often rises in a night's time to a monstrous size, and although destroyed by caustics, actual or partial, or cut away with the knife, is found at next dressing as large as ever. It is a good while, however, before these ulcers, bad as they are, come to affect the bone with rottenness." Sir Gibert Blane, in his "Observations on the Diseases of Seamen," af- firms that there is no complaint more hurtful to the public service, by sea and laud, and more afflicting to.the individual than ulcers. " It is found, says Dr. Blane, in the work just referred to fi from direful and multiplied experience, that not only those who are affected with natural symptoms of scurvy, but those who are exposed to the causes of it, and whose constitutions are in such a train as to fall into it, are particularly susceptible of ulcers of the most malignant ki <1, from the smallest injury which breaks the skin. This might naturally be expected, from what has been said from the great debility of the fibres, and deficiency of the powers of renova- tion and nutrition in this disease. The characteristic symptoms of such ulcers, are, a thin, fetid discharge, commonly mixed with blood, which sometimes coagulates on the surface. The ulcerated surface is soft and spongy, generally elevated above the level of the surrounding skin, particularly about the edges, where there are excrescences of luxu- riant flesh, which in the more advanced state of the ulcer, shoots into a soft bloody fungus, called by the sailors bullock's liver.-Third £d., London, 1799-p. 502. Dr. Blane records a number of important observations showing the ten- dency to foul gangrenous ulcers amongst seamen. On board the Ganges, of seventy-four guns and six hundred men, during the year 1798, the tend- ency to the complaint was such that the smallest sore, whether from a hurt or a pimple, fell into the state of an ulcer. Blistered parts were also affected in the same manner. Sores which seemed to be in a healing state would suddenly become gangrenous. A black speck in the middle was the constant precursor of this. In the most severe cases the ulcers began with violent inflammation, which suddenly terminated in mortification; destroy- ing in a short time the fleshy parts, so as to expose the bone, which soon became carious. The crew of the Triumph, of seventy-four guns and six hundred men, suffered severely from malignant ulcers during the summer and autumn of 1798. Not only wounds and blisters fell into the ulcerated state, but a scartch or boils and the orifice of the arm after bleeding, were subject to the same accident. Sores which seemed to be in a healing state, would suddenly and without any visible cause, spread again, and become foul and bloody, extremely painful, and would resist every means of cure. This unfavorable change always began, as in the Ganges, with a black spot in the middle of the ulcer. Ulcers of the same kind prevailed to the most dreadful degree, in the ships serving at the Cape of Good Hope, and in the Naval Hospital there, in the years 1796 and 1797. These foul ulcers produced the most severe and protracted sufferings, terminating frequently in the loss of limbs or life, or both. Nor were they confined to the lower extremities, for the ossa-ilium, the scapula and cranium would sometimes become carious. It became frequently necessary to amputate at the hos- pital, and it was observed that if the patients who underwent the opera- tion, remained in the wards, with the ulcers, few survived, owing to the gangrenous and ulcerous states of the stumps; but when they were carried into a separate apartment, the large majority recovered. It was also observed, both in the ships and at the hospitals, where this species of ulcer prevailed, that the hands of those who dressed them, where the skin was broken, were attacked by the same sort of ulcer.-Observa- tions on the Diseases of Seamen, by Gdbert Blane, M. D.-pp. 506-512. 404 Spurious Vaccination; Joseph Jones, M. I). Dr. Thomas Trotter, in his Medicina Nautica^ has, in like manner, re- corded a large number of instances where malignant gangrenous ulcers have arisen spontaneously in various ships, and attacked with violence, not only external injuries, but in a number of cases, where neither wound, puncture, scab, or contusion could be said to have first taken place, a cir- cumscribed red spot would at first be perceived, scarcely to be felt, but in a few hours rising to a pimple, becoming black in the centre and inflamed around the edges, till it increased in size, swelled and assumed every char- acteristic symptom of malignant ulcer, with constant fever and subsequent ulceration, slough and fetid discharge. This malignant ulcer or gangrenous ulcer attacked also the flesh wounds made with the lancet in bleeding, for different inflammatory diseases, as catarrhs and sore throats. Contused spots, even where the cuticle was not broken, were not exempted from the general tendency to ulceration. But parts that had been scalded or burnt, above all accidents, most quickly assumed the nature of this horrid sore, spread and inflamed more rapidly, amt in the end put on the most formid- able appearance; deeper and larger sloughs were the consequence, and symptomatic fever violent in proportion. Even in the early stage, some- times before the cuticle had burst so as to expose the naked surface, buboes appeared in the groin and axilla, not to be touched without much pain, and always attended with fever. These, however, seldom suppurated ; but where they did, they constantly exhibited the complexion of the parent sore. (Medicina Nautica, an Essay on the Diseases of Seamen, by Thomas Trotter, M. D., Sec. Ed., 1804, vol. 2. pp. 169-230; vol. 3d, pp. 497-504). Dr. Trotter, in the third volume states that in the summer of 1799 the malig- nant ulcer made its appearance on board the Temeraire, with all the char- acteristic symptoms and violence which marked it in other ships. Every wound, abrasion of the cuticle, blistered part, scald orburn, passed rapidly through the various stages of inflammation, gangrene and sphacelus; in a few days leaving the bones almost bare, from the separation of immense sloughs. The tendency of the bones to caries after inflammation in this disease, was more frequent than any other species of ulcer, and in many cases ren- dered the cure very tedious and painful; and many cases sank under the long confinement necessary to the separation of the dead bones. Dr. George H. B. Macloed, in his " Notes on the Surgery of the War in the Crimea," states that " The French suffered most dreadfully from hospital gangrene in its worst form. The system they persued, of removing their wounded and operated cases from the camp to Constantinople at an early date, the pernicious character of the disease, tended to render it fatal when produced. Many of their cases commenced in camp, but the majority arose in the hospitals on the Bosphorus, where the disease raged rampant In the hospitals of France it also prevailed, and, from what M. Lallour, Surgeon to the Euphrate trans-, port, tells us in his paper on the subject, it must have committed great ravages in their ships, from one of which he says, sixty bodies were thrown over during the short passage of thirty-eight hours to the Bosphorus. With them the disease was the true gangrene, and attacked not only open wounds but cicatrices, and almost every stump in the hospitals." By the official reports of the Medical officers of both the English and French Armies, during the Crimean war, it was conclusively shown that, nothwithstanding the extraordinary exertions of these powerful nations, holding undisputed sway of both sea and land, scurvy and a scorbutic condition of the blood, increased to a fearful degree the mortality, not only of gun-shot wounds, but of all diseases, and especially of pneumonia, diarrhoea and dysentery. We might add many other facts from various authors establishing the spontaneous origin of malignant spreading gangrenous ulcers, in many navies and armies, as the result of scurvy and crowding ; but the facts just recorded are sufficient to show that the foul scorbutic ulcers, and hospital gangrene, and the accidents from vaccination, arising at Andersonville, were by no means new, in the history of medicine, and that the causes which induced these distressing affections have been active in all wars and sieges, and amongst all armies and navies. In truth these men at Andersonville were in the condition of a crew at sea, confined upon a foul ship, upon salt meat and unvarying food, and without fresh vegetables. Not only so, but these unfortunate prisoners were like men forcibly confined and crowded upon a ship, tossed about on a stormy ocean, without a rudder, without a compass, without a guiding star, and without any apparent boundary or end to the voyage; and they reflected in their steadily increasing miseries, the distressed condition and waning fortunes of a devasted and bleeding country, which was compelled, in justice to her own unfortunate sons, to hold these men in this most dis- tressing captivity. The Federal prisoners received the same rations in kind, quality and amount, issued to the Confederate soldiers in the field. These rations were, during the last eighteen months insufficient, and without that variety of fresh meat and vegetables, which would ward off scurvy from soldiers, as well as prisoners. As far as my experience extended, no body of troops could be confined exclusively to the Confederate rations of 1864 and '65 without manifesting symptoms of the scurvy. The Confederate ration grew worse and worse as the war progressed, and as portion after portion of the most fertile regions of the Confederate States were overrun and desolated by the Federal Armies. In the straight- ened condition of the Confederate States, the support of any army of fifty thousand prisoners, forced upon their hands by a relentless policy, was a great and distressing burden, which consumed their scant resources, bur- dened their rotten lines of railroad, and exhausted the over-taxed ener- gies of the entire country, crowded with refugees from their desolated homes. The Confederate authorities charged with the exchange of prison- ers, used every effort in their power consistent with their views of national honor and rectitude, to effect an exchange of all prisoners in their hands, and to establish and maintain definite rules by which all prisoners of war might be continuously exchanged as soon as possible after capture. Whatever the feelings of resentment on the part of the Confederates may have been against those who were invading and desolating their native land, which had been purchased by the blood of their ancestors from the Indians and English, the desire for the speedy exchange and re- turn of the great army of veterans, held captives in Northern prisons, was earnest and universal; and this desire for speedy and continuous exchange on the part of the government, as well as on the part of the people, sprang not merely from motives of compassion for their unfortunate kindred and fellow-soldiers, but also from the dictates of that policy, which would ex- change on the part of a weak and struggling people, a large army of pris- oners (consumers and non-combatautsj, requiring an army for their safe- keeping), for an army of tried veterans. Apart from the real facts of the case, it is impossible to conceive that any government in the distressed and struggling state of the Confederate States, could deliberately advocate any policy which would deprive it of a large army of veterans, and compel it to waste its scant supplies, already insufficient for the support of its struggling and retreating armies. And the result has shown that the destruction of the Confederate Gov- ernment was accomplished as much by the persistent retention in captivity Spurious Vaccination: Joseph Jones, M. D. 405 406 Spurious Vaccination: Joseph Jones, M. J). of the Confederate soldiers, as by the emancipation and arming of the Southern slaves, and the employment of European recruits. And still farther to show that these accidents attending vaccination at Andersonville were active in Northern prisons, we quote the testimony of a medical officer who occupied during the war a distinguished position in the Medical Department of the United States Army. Dr. Frank Hastings Hamilton, late Lieutenant-Colonel, Medical Inspec- tor, U. S. A., in his " Treatise on Military Surgery," records the follow ing facts, which have an important bearing upon the subject under consideration: " In still further confirmation of the correctness of onr views, we will mention that in many of the regiments stationed in Kentucky and Tennessee during the summer of 1863, all slight wounds, such as scratches, slight burns, etc., took on an ulcerative action, and often became ugly and intractable sores. Vaccination almost constantly produced the same results, and was in many cases followed by abscesses in the axillary, cervical and other glands. " Upon the evacuation of Murfreesboro by the Confederate Army, on the first of Janu- ary, 1^63, 1673 sick and wounded soldiers were left on our hands ; of these 250 were sick, and 1423 were wounded. The whole number were placed in charge of Dr. Avent, the intelligent Medical Director of General Bragg's army, assisted by several other Confed- erate surgeons, and were allowed to remain in the buildings which they had originally taken as hospitals, and which were the best the place afforded. On the twentieth of May, 1863, nearly five months after the battle of Stone's River (Murfreesboro), Dr. Avent reported to us that 640 of these men had died, and 55 remained in the hospital, the re- mainder having been sent off for exchange. The ratio of deaths, continues Dr. Avent, allowing the same percentage for the 55 now on band, is about 38£ per cent. I have not separated the sick in this calculation from the wounded, from the fact that the hospitals were common to both ; consequently I have no positive data on which to make an esti- mate of the relative mortality. I am satisfied, however, that the mortality amongst the sick has been much less than of the wounded. An estimate, placing the percentage of the wounded at about 40, I think would not be far wrong; which loss, you will discover, is unprecedented in any previous battle between the present belligerents. "In explanation of this great mortality after wounds, Dr. Avent proceeds to offer sev- eral facts, namely: overcrowding of the patients in the hospital buildings, mental de- pression, the fact that only the most severely wounded were left behind ; but he gives especial prominence to the physical condition of the men, in consequence of a prolonged absence in their food of anti-scorbutic articles, both before and since their capture." We have here a far heavier mortality amongst these Confederate prison- ers than amongst the Andersonville prisoners ; and according to the pub- lished statements of the United States Government, the majority of deaths during the war was largely on the side of the Confederate soldiers confined in Northern prisons. And after careful inquiries amongst returned Con- federate prisoners, I am convinced that the accidents attending vaccination were quite as numerous and severe in Northern prisons as in Southern ; and the causes of death amongst prisoners in both sections were not ma- terially different, with this exception, that the heat of the Southern States was balanced by the effects of severe cold upon teeble scorbutic men with insufficient clothing. We have dwelt thus long upon this subject, because we have considered its discussion of paramount interest in the history of vaccination, and of the medical profession in America. In many cases, occurring in the Confederate Army, the deleterious effects of vaccination were clearly referable to the condition of the forces, and the constitution of the blood of the patients, for it was observed in a number of instances that the same lymph from a healthy infant, inoculated upon different individuals, produced results corresponding to the state of the system ; in those who were well-fed and robust, producing no ill effects, whilst in the soldiers who had been subjected to incessant fatigue, expos- ure and poor diet, the gravest results followed. HOSPITAL GANGRENE. PLATE 22. Fig. 91/ Arm of Federal Pris- oner, Hospital Gangrene. At- tacked, small abrasion near elbow. Amputation-Death. Ander- sonville, Georgia, September 20, 1864. From Nature by JOSEPH JONES, M. D. TMt NEW ORLEANS UTH C' 10 UNION 3 Spurious Vaccination: Joseph J ones, M. D. 407 As this subject is of vast importance in its relations to the theory and practice of vaccination, and in its bearing upon the fair name and honor of the American Medical Profession, we have substantiated the statements by the following illustrations, drawn from nature : Plate 22, Figure 91-Arm of Federal prisoner, attacked by hospital grangeue, in the military prison, and transferred to the military prison hospital. The gangrene at- tacked a small abrasion or scratch near elbow joint. The arm was amputated about midway between the elbow and shoulder joints. Hospital gangrene attacked the ampu- tation, and death resulted from exhaustion and septic poisoning. The following is the official report of my testimony, with reference to vaccination of Federal prisoners at Andersonville, delivered in the Military Court at the "Trial of Henry Wirz " By counsel-Q. Did you say anything about vaccination in your report? "A. I saw some cases of injury from vaccination. I do not recollect exactly what 1 stated in my report on that subject, but I can tell you what I did by referring to it. There were a number of instances, I think some dozens of instances, that I was informed of; I did not see more than one or two instances myself; they occurred previous to my going there. The case which I examined more particularly was a case of amputation of the arm from vaccination, and upon carefully examining it, I was led to believe that it was in consequence of the condition of the system of the man, rather than from the mat- ter introduced, from the fact that severe injuries were frequently attended with gan- grene in that foul atmosphere. "From the crowded condition, filthy habits, bad diet, and dejected, depressed condi- tion of the prisoners, their systems had become so disordered that the smallest abrasion of the skin, from the rubbing of a shoe, or from the prick of a splinter, or from scratch- ing, or a musquito bite, in some cases, took on rapid and frightful ulceration and gan- grene." (Fortieth Congress, Second Session, House of Bepr esent atives. Ex. Doc. No. 23, Trial of Henry Wirz. Letter from the Secretary of War ad interim, in answer to the resolution of the House, April, 16, 1866, transmitting a trial of Henry Wirz, December?, 1867. Referred to the Committee on the Judiciary and ordered to be printed. P. 642, p. 625.) The following is the record which I made on the Confederate Military Prison Hospital at Andersonville: The dra wing, Plate 22, Figure 91, was made by myself from the arm of a Federal pris- oner, who had scratched and abraded the skin around the bite of some insect, most prob- ably that of a mosquito, inflicted in the stockade. The abrasion did not heal, but giadually assumed a dark, unhealthy hue; and the irri- tation commenced to spread. In two weeks it had reached the size of a silver half-dol- lar. This patient was then transferred to the Confederate States Military Prison Hos- pital, and in the course of six days it reached the size and presented the appearance represented in the drawing (Plate 22, Figure 91). When I examined this patient the con- stitutional symptoms were well marked-hot, dry skin; small, rapid, feeble pulse; leaden, sallow, unhealthy hue of complexion; dejected, distressed countenance; coated and tremulous tongue. The stench emitted from this gangrenous mass presented a ragged, pulpy, putrescent mass, without pus, and with ragged, everted edges, elevated above the surrounding tissues. It was also surrounded by a livid blue and deep purple border on the skin. The deep blue and purple areola is a sure index of the spread of hospital gangrene. The patient was most urgent in his entreaties for the removal of the arm, and it was decided, upon consultation with the attendant medical officers, that his condition could not be rendered worse by an amputation, which would substitute a smaller flesh wound for this most extensive and foul ulcer, invading the joint and excit- ing intense pain. Notwithstanding the probability that in the condition of the system of the patient, in this foul atmosphere, the gangrene would return agaiu in the stump, it was, neverthe- less, considered proper to amputate, on account of the reasons just given. Numerous amputations had been performed in the Confederate States Military Prison for gangrene supervening upon slight injuries, and attacking scorbutic ulcers. I en- deavored to collect all the cases with the results, but the records were imperfect and in- complete. Upon the incomplete reports, 266 cases of hospital gangrene were recorded ; out of sixty-six amputations in consequence of the disease with twenty-five deaths ; one hundred and two cases are given as supervening upon gun-shot wounds, and the remain- der were reported as gangrenous ulcers arising from the scorbutic and deranged condi- tion of the system. Twelve cases of gangrenous ulcers were recorded as following vaccination. These figures are far below the truth. Many cases of gangrenous ulceration which were in the hospitals, were originally en- tered upon the hospital registers under the head of scurvy, diarrhcea, dysentery, or some other disease. 408 Spurious Vaccination: Joseph Jones, M. D. Hospital gangrene returned almost invariably after amputation in these scorbutic and enfeebled patients, and in this infected atmosphere; and in some cases the disease reap- peared in the stump within thirty-six hours after the operation. I extract the following from a report on hospital grangrene at Andersonville Prison, drawn up by Assistant Surgeon A. Thornburgh, of the Confederate Army, in response to my official request: " Early in the spring (1864) small-pox made its appearance in the prison, and as a pro- phylactic measure, we were ordered to vaccinate all who could not show the proper vac- cine scar; consequently we went to work, and in a week or ten days two or three thou- sand were vaccinated. Out of this number, nearly every prisoner who happened to be affected with scurvy was attacked with ulceration of the pustule. These small ulcers soon began to slough, and extend over a large extent of surface; when the superficial sloughs were separated, the parts beneath were found to be in an unhealthy, sloughing condition; finally these ulcers would become phagedenic, and destroy every structure .in their track for a considerable extent. In this condition gangrene would set in, ami if the disease was not speedily arrested by powerful escharotics, emollient poultices, and the pro" ;r vegetable diet, amputation became necessary, or the poor sufferer sank under this irritation. Diarrhoea and dysentery frequently supervened, and speedily destroyed the patient."* That exposure, hardship, improper and scant and salt food had pro- puced a similar condition in the Confederate troops is conclusively shown, by Plate 23, Figure 92. Leg of J. S. Cole, private Third Regiment, Georgia, Reserves; guarding Federal prisoners at Andersonville, Georgia, Septem- ber 22, 18G4, while guarding the stockade, hospital grangrene attacked some abrasions of the skin on the right foot and leg. The following is the detailed statement of this case : "Case 54.-General Hospital for Confederate soldiers, Andersonville, Goorgia, Septem" her 22, 1864. Thomas Cole, private 3d Regiment, Georgia Reserves, Company H. Age- sixteen years ; height, five feet nine inches ; weight in health, 150 pounds. Arrived at Andersonville on the twentieth of July. Was engaged in guarding prisoners at the stockade. Performed guard duty every third day ; two hours on and four hours off, during the twenty-tour hours. Before leaving home, received a slight scratch on the side of the left foot, a little below the ankle. This boy did not usually wear shoes at home, and on the way to Andersonville the shoes bruised and enlarged the small injury. This small abrasion did not heal after the commencement of his duties as a soldier at Andersonville. It did not, however, give him any special trouble, or appear inflamed, until about the first of September, forty-two days after his arrival at this post. Up to this time this young recruit had never been inside the stockade, and had never stood guard around or within the hospital. On the fourth of September, the patient was compelled to quit duty, and on the twelfth instant he was transferred to the Con- federate General Hospital. At the time of his entrance into the hospital, the gangrenous spot was not larger than a silver half dollar, and presented an inflamed areola on the sound skin, elevated, everted edges, and elevated pulpy, ragged greenish central mass. Up to the date of making the drawing, the gangrene has spread rapidly, presenting the appearance represented in Plate 23, Figure 92. Hemorrhage was constantly taking place from the numerous small eroded vessels, and hence the red and mattiered appearance of certain portions of the gangrenous mass. Several smaller gangrenous spots were visible upon the leg and are represented in the figure. These are said to have arisen spontaneously; that is without any preceding abrasian or injury. The black mass in the centre of the large ulcer upon the ankle joint, appeared to be the surface of the necrosed bone. The constitutional symptoms were well marked in this case. At night when I exam- ined the patient he had hot fever, with rapid pulse, pale aneamic, sallow, unhealthy complexion. This morning has less heat of surface, and the pulse is less frequent, but still there is febrile excitement, and he is very nervous and weak ; cries like a child when his wound is touched, even in the gentlest manner. Bowels loose; had a large, loose, yellow, very offensive evacuation whilst I was engaged in executing the sketch. Plate No. 24, Figure 93: Hand of W. J. Black, Confederate soldier, poisoned in dress- ing, hospital gangrene, October 3, 1864. The following record of this case was made by myself during the investigations on hospital gangrene, instituted in the Empire Hospital, Vineville, Georgia: 'Surgical Memoirs of the United States Sanitary Commission. Investigations upon Hospital Gangrene as it prevailed in the Confederate Armies. 1861-1865, by Joseph Jones. M. D., formerly Surgeon in the Pro- visional Army of the Confederate States. New York. 1871: p. 528. HOSPITAL GANirKK/ST Fig. 92/ Leg of T. S. Cole, Private Zd Regiment Georgia Reserves; guarding Federal Prisoners at Andersonville, Georgia, September VS,, 1864. While guarding the Stockade, Hospital Gangrene attacked some abrasions of the skin on the right foot and leg. From Nature by JOSEPH JONES, M. D. Spurious Vaccination; Joseph Jones, M. D. 409 Case 7, Empire Hospital, Vineville, Georgia. W. J. Black, Company " G," Lee's In- valid Battalion ; aged forty-six years Native of Troup county, Georgia. Farmer by occupation. Height, 5 feet 9 inches; weight, in health, 160 pounds; black hair and eyes; florid complextion. Has been in Confederate service .three years and three months. Served two years with "Stonewall" Jackson. Was wounded about one year ago in Maryland ; lost the first joint of the second finger, and has not been in field service since. Has been acting as a nurse in this hospital for the past two months, since the conversion of this hospital into a gangrene hospital. During this time has been inoculated with hospital gangrene twice. The first attack was caused by a prick of a pin on the side of the hand, received in dressing a gangrenous wound. The prick of the pin became painful almost immediately, and in the course of two days the injury commenced to inflame, and the surface around assumed a purplish and bluish color. The disease spread from the centre of infection, and the slough pre- sented a grayish and greenish color. The inflamed and gangrenous parts were freely cauterized with strong nitric acid. By this means the gangrene was arrested before the ulcer had exceeded one-quarter of an inch in diameter. This occurred in the beginning of September, about one'month before the drawing was made. The constitution did not appear to suffer, the wound healed readily, and the patient resumed his labors as a nurs- to the gangrene patients. Had not been engaged in dressing the gangrenous wounds more than two or three days before a small blister appeared on the third finger of his right hand, which gave much pain, and in the language of the patient "throbbed as if a bone was breaking loose." The blistered surface assumed a gray and greenish color, and was surrounded with a purplish and blue halo in the skin. The gangrene commenced to spread rapidly. Con- centrated nitric acid was immediately applied three times a day, but it did not arrest the gangrene. It appears that in the first inoculation, the system was not specially involved, and the local treatment arrested the disease. But the continued residence in this infected at- mosphere, and the constant attention upon the gangrenous wounds, gradually poisoned the system of this faithful nurse to such an extent, that in the second attack the local treatment did not arrest the disease. On the third of October, 1864, just twelve days after the commencement of .this second attack of hospital gangrene, I executed the drawing (Plate 24, Figure 93). The gangrene is progressing along the upper border, under the bluish discolored skin of the third finger of the right hand. The color of the skin in this portion of the wound, where the gangrene is progressing most rapidly, was of a most remarkable deep blue. The lower portion of the ulcer appears to be improving somewhat, and now discharges a little pus. The constitutional disturbances, notwithstanding the comparatively small surface in- volved, are well marked, pulse accelerated and feebler than in health. Face flushed. During the execution of the sketch of his right hand, suffered much pain from the con- fined position of the hand ; was very restless and nervous, and was much nauseated, and attempted several times to vomit. Hands tremble from the nervousexhaustion. No ap- petite. Tongue of a purplish, bluish, leaden color. Has fever in the morning, which declines toward the evening. Feels weak, nervous, feverish and depressed. Urine brownish red and scant. On the seventh of October, gangrene still spreading. Patient sent out of Hospital into the country. The history of vaccination in the Anny of Virginia, under General Lee, was of great interest, in the light which it threw upon these questions, and it is with deep regret that we learn that all the most valuable field reports were destroyed. The following letter from Dr. L. Guild, formerly Medical Director of the Army of Northern Virginia (General Lee's Army), was received in reply to my request, for the experience upon this subject, of this surgeon, who had held one of the most responsible and distinguished positions in the Medical Department of the Confederate Army. Mobile, Ala., Decembe 12, 1866. Professor Joseph Jones : Dear Sir-Your letfer of the fifth inst., has been received. It would afford me great pleasure to contribute to your contemplated monograph on "Spurious Vaccination," but in the retreat of tne Army of Northern Virginia from Petersburg io Appomattox Court-House, all of the retained papers, professional notes, reports, etc., of my office were either destroyed by the enemy or burned, with other baggage, byour own people for the purpose of lightening our trains, and facilitating the movement of our retreating 410 Spurious Vaccination: Joseph Jones, M.D. columns. When the boxes were burned their contents were? of course, unknown to those entrusted with the execution of the order. On account of this unfortunate occurrence, 1 have nothing with which to refresh my memory accurately, in a single case, out of a vast number that came under my observation. The subject of transmission of syphilis through the vaccine virus is a most interesting and important one to the profession-admitting great diversity of opinion, and, as>ou truthfully remark, "one well-reported case is worth volumes of mere opinions and asser- tions " 1 know of no one who could report such a case, but much Useful information on the subject can be furnished by Dr. R. J. Breckinrigde-now of Houston, Texas-formerly of Louisville, Ky. He was one of the Medical Inspectors of the Army of Northern Virginia, and it was his duty, on several occasions, to collect all interesting facts and opinions on the subject, such as the nature and character of the ulcers following vaccination, anterior history of patients, effects of treatment constitutional and local; etc., etc. I regret my inability to furnish something worthy of your consideration Respectfully, yours, etc., L. GUILD. The testimony of Dr. S. E. Habersham, upon this cause of the abnor- mal phenomena accompanying and following vaccination, is dear and im- portant. The following report was placed in my hands by its author, and was ac- companied with the following answer to my request and inquiries: Summerville, April 28, 1866. Dr. Joseph Jones: Dear Sir-The accompanying report of an anomalous disease or the result of vac- cination, was written shortly after its first appearance in the Army of Northern Virginia, and after a careful study of the cases especially assigned to the hospital under my charge for "treatment and report" At the time there was much discus- sion among the medical staff, both in held and hospital, as to the aetiology and pathology of the manifestation which by some, and, indeed, most of the observers, was attributed to impure virus, and especially syphilitic inoculation. This latter opinion was ingeni- ously advocated by Surgeon Breckinridge, and no doubt many cases may have resulted from such an accident. In none of the cases, however, assigned to my division of Chim- borazo Hospital, could 1 discover a sufficient number of symptoms to lead me to suppose that such might have been the cause, either in its prodoma or development, hence I could not attribute the cause of the eruption to any other than that assigned in the report. This view as to its aetiology was subsequently very ably maintained by Surgeon Frank A. Ramsey, in a report referred to me by Surgeon-General Moore, and which was pre- served among my papers, but lost at the time of the evacuation of Richmond, together with the history of all the cases, and diagrams intended to illustrate the above report. In consequence of the loss of these papers, this report is not as perfect as it should be; but I hope the general description and history of the disease is sufficiently clear and com- prehensive to embrace everything of practical importance concerning this horribly dis- gusting and filthy accident, or result of vaccination, as seen in our army. Since the termination of the war, I have had several opportunities of conversing with a few intelligent surgeons of the Federal Army, and ascertained from them that such a disease had appeared among their soldiers in regions of country where the scorbutic dia- thesis manifested itself among the troops, and to which the disease was generally attrib- uted by them, though there were also surgeons of that army who attributed it to syphil- itic inoculation. I find the same view7 as advanced in the accompanying report held by most of the Surgeons of the Federal Army, as stated in Circular No. 6, Surgeon-General's Office, United States Army, November 1, 1865. If you think my report of sufficient importance to appear upon the pages of your journal, or if it can in any way advance the cause of medical knowledge, you are at per- fect liberty to make use of it for that purpose. With much respect, I remain very truly, your obedient servant, S. E. HABERSHAM. lieport on Spurious Vaccination in the Confederate Anny. By S. E. Habersham, M. D., Surgeon in the Provisional Army of the Confederate States: Chimborazo Hospital, Division No. 2, November, 1863. To Surgeon W. A. Carrington, Medical Director: Sir-I have the honor to inform you that, in accordance with your order of the twenty- ninth June, 1863,1 have received ail the patients sent into this Division, with a " peculiar eruptive disease," supposed to be the consequence of vaccination, and herewith forward you the results of my investigation in this anomalous affection. In compliance with an order issued from the Surgeon General's office, in the month of November, 1862, general vaccination w as practiced upon all soldiers as soon as they were admitted in this Division, and in order to insure the full protective influence of vaccina- HOSPITAL GANGRENE. PLATE 24. Fig. 93/ Hand of Confederate Soldier, pois- oned by prick of pin-in dressing Hospital Gan- ' grene. IV. J. Black, C. S. A., October "id, 1864. From Nature by w«NCW ORLEANS UTH.C*10 UNION 8T JOSEPH JONES, M, D. Spurious Vaccination: Joseph Jones, M. I). 411 tion (not anticipating any evil consequences therefrom), the order was strictly obeyed, and all the patients, even those having recent scars upon them, were re-vaccinated. A few days after the insertion of the virus, and, in many cases, within twenty-four hours, the seat of puncture became very much inflamed, with a deep inflammatory blush around it, which gradually implicated, in the severe cases, nearly the whole of the affected limb. A pustule rapidly formed, instead of a vesicle, which very soon discharged an ich- orous fluid. This fluid was, in the course of forty-eight hours, converted into a dark, mahogany-colored irregularly-shaped scab, prominent, and firmly attached at its base. A dark-red areola of several lines in diameter, measuring from the edge of the scab, was then developed, which, in turn, seemed to exude an ichorous serum. This was soon con- verted into a scab surrounding in juxtaposition the first, and presented the appearance of a single scab. This process continued for several days, and there was often formed a scab, one inch or two and a-half in diameter. "Pari passu" with the increase of this scab, the erysipelatous blush on the limb diminished, and when the blush had disap- peared, this scab ceased to enlarge. As this inflammatory process subsided, the dis- charge lost its serous character, and seemed to be converted into pus, which exuded from under the scab, loosening its firm attachment at its base, and thus rendering it liable to be removed prematurely by the patient in his sleep, or even by the friction of his cloth- ing. When this occurred, a foul bleeding, irregularly-shaped phagadenic ulcer was re vealed, with everted edges, and presenting the appearance of a syphilitic phagedenic- ulcer, involving the subcutaneous areola tissue, exposing, in many cases, the muscuiar tissue below. The process of destruction of parts did not end here, for the ulcer contin- ued to increase, and from the loosened edges an ichorous discharge continued to pour out from under the skin which seemed to destroy the edges of the ulcer, thus increasing its dimensions. Wherever the ichorous pus fipm this ulcer touched the sound skin, an- other pustule of a similar character was formed, in some cases reaching the size of the primary sore This, however, was seldom the case, but a smaller ulcer generally re- sulted, which often healed and cicatrized before the first. The axillary glands, when the arm was affected, and the inguinal glands, when the leg was the seat of the disease, sometimes became inflamed and discharged pus, pre- senting the microscopic character of healthy pus. This enlargement of the glands, however, did not occur in a sufficient number of cases to make it a natural sequence of the disease. Attending the early stages of the formation of the ulcer, before pus was discharged, there was always more or less pyrexia, with furred tongue and loss of appe- tite ; these symptoms disappearing as soon as ulceration was established. In these highly aggravated cases, successive crops of pustules made their appearance on the af- fected limb, often developing themselves also upon the lower limbs of the affected side, but seldom crossing the mesian line, and never developing themselves ubou the trunk or head. The less malignant form of the disease resembled the first in character, but not in de- gree. For a few days after the insertion of the virus, merely a small inflamed spot was discerned, which seemed to be more the result of the injury done to the skin, by the prick of the lancet, than any inflammatory action resulting from a specific cause. About the fifth or sixth day a minute pustule was discerned upou a scarcely larger inflamed base. This pustule and areola gradually increased, but the diameter of the areola was not as great, and there was no deep inflammatory blush upon the arm, merely a diffused redness of several inches in diameter. The same process, however, took place-an exudation of serum from the areola-which, in turn, became a crust, and which gradually increased in size, but it never reached the diameter of the more malignant type ; and when it was de- tached by the process of ulceration, which occurred at an early period, the revealed ulcer was neither as deep nor as malignant in its appearance. The edges were not everted, and there was no discharge of pus from under the edges of the ulcer; it only presented the appearance of an ordinary ulcer, showing no tendency to increase, and but little to heal. Pyrexia very seldom attended this form, nor was the appetite impaired. The third and mildest form of the disease made its appearance as a small pimple, in from two to ten days after the introduction of the virus, and which gradually formed a pustule ; a dark brown scab succeeded in from three to four days, which remainedattached sometimes as long as two weeks, and when it become detached, a livid or brown spot was revealed, the size of which w'as equal to the scab. This scar, however, was very sensi- tive to the touch, and liable to bleed from the least friction of clothing, and when this occurred, it would exude serum or blood, and another scab would surely form. If the system became suddenly depressed from any cause, it would almost always assume the ulcerative process, and become a sloughing ulcer, which only healed with the general improvement of the system. As thus described, this disease has prevailed in the Army of Virginia, both in field and hospital. The surgeons of the Army of the Southwest report its prevalence there. It was developed, in the early part of the year, in a cavalry regiment in the mountains of Virginia, the Colonel commanding suffering severely from the disease. In every case its origin has been traced to the introduction of vaccine virus into the system. How far an 412 Spurious Vaccination: Joseph Jones, M. D. epidemic cause may have exerted its influence in its early development it is impossible even to surmise ; we know, however, that it originated in Virginia, at a time when our Army was upon very short rations, and that many of the soldiers sent from the field at that time presented a decidedly scorbutic appearance. Many had been reduced and were broken down by exposure to the inclemency of a cold winter, and the depressing influ- ences of low diet, want of clothing, and many other prolific causes of disease, calculated to deprive the blood of its healthy constituents, particularly of its fatty matter. Hence this may have produced a predisposition. In verification of this fact, I will state, that when it was found how frequently the disease in consideration supervened upon vaccina- tion in this hospital in broken-down and depraved constitutions, it was deemed prudent to postpone the introduction of the virus until the patient was restored to a healthy con- dition by improved diet and medical treatment. At the first appearance of the evil con- sequences of vaccination I was inclined, with other surgeons, to believe that the virus was impure, and, because of this suspicion, I threw away the matter we then had, and obtained a vaccine scab from Dr Knox, a practitioner on Church Hill, who assured me he had used it in several cases with a perfect result. The introduction of this virus into the arms of some ten patients resulted in the devel- opment of the disease in question in three of them, while in the remainder it produced apparently a true pustule. From this fact, and the immunity which healthy looking men enjoyed, I was led to believe that the predisposing cause existed in a vitiated ami impoverished condition of the blood, and so reported in my first report, and that the in- troduction of pure virus iuto the system was the exciting cause of a latent disease. This view, I see, is also held by Surgeon Frank A. Ramsey, of the Department of East Ten- nessee, in a communication on file in office of Surgeon General. This view I have never had reason to change, though I am aware that many men, apparently in health, have suffered from the effects of vaccination. In one case, which I here quote, the influence of a good condition of the general system seems to have exerted a wonderfully modifying influence. Case No. 29.-J. L. Turner, a private, Company G, Fifth Virginia Cavalry, aged 27, married, parents healthy-he himself enjoying good health-never had any venereal dis- ease. Entered the service, April, 1861-has been in service ever since, was vaccinated about a month ago, when in hospital at Farmville. This patient, Turner, was vaccinated last winter by Assistant Surgeon Vaiden, of this division. It not having any effect upon his system, and feeling assured from this and previous vaccinations that he was proof against the effect of it, he insisted upon being vaccinated by Assistant Surgeon Moses, from the effects of which he has suffered since, and for which he was ou the eighth of September admitted to this hospital, presenting the following appearance: A number of pustules, resembling impetigo, on left arm and leg, which were developed in successive crops, appearing as soon as the original pustule began to heal. This was a remarkably mild form of the disease, and was improving on coil liver oil, when he was furloughed on the twentieth of September, being a paroled prisoner. This patient was young, vigorous and comparatively healthy when he received this vaccine into his system. The search, for parasitic or cryptogamic vegetation, with a good microscope, revealed none. The pustule was seldom developed where parasites make their habitation, namely, in the bulbs, or at the roots of the hair. The pus presented microscopic characteristics of pus globules floating in a homogenous fluid. These globules were not as abundant as in laudable pus, and not so distinctly nucleated, and were irregular in outline in some of the cases examined. This appearance of globules, however, often exists in healthy or laudable pus, when it has been exposed to air any length of time. In the many cases I have examined, I have yet to find a patient who will acknowledge that he has had any syphilitic disease at any period of his life, though many of them have had gonorrhoea. This exemption from syphilis, however, is not strange, since it is a very uncommon dis- ease in the rural parts of our country, the inhabitants of which comprise the very large majority of our army. We also know that the tendency of the secondary form of syph- ilis is to develop itself in the forehead, chest, back, and trunk, generally, and yet no cases, developed upon these parts of the body, have presented themselves to my observa- tion. Many of the patients, also, have suffered long enough to have had the tertiary form of syphilis, developed nodes, etc., and yet no such symptoms have been seen by me. From what I can learn, the Army of the United States has so far escaped these evil re- sults of vaccination. A few cases, however, originated among the Federal officers in the hospital of Libby Prison, who were vaccinated in the prison by one of their surgeons from his own arm, some weeks after their confinement, which presented all the character- istics of the disease as it has appeared in our army. I was assured bv these officers that they had neither seen or heard of such a result of vaccination in their army. Does not this fact alone lead us to infer that its cause of origin may be traced to some abnormal condition of the blood, in these cases, induced by confinement in a vitiated atmosphere, without the means of eliminating the materies morin from the system by exercise and care to the function of the skin. Spurious Vaccination : Joseph Jones, AL D. 413 The classification of this disease is difficult and unsatisfactory, since it commences as a pustule, and assumes often the outward form of rupia, which, by all dermatologists, is classified among the bullae. If we classify it among the pustulie, we find no disease there describing it accurately, some cases resembling ecthyma, others impetigo. Inas- much, however, as it oftener assumes the characteristics of chronic etchyma, either in a mild or aggravated form, according to the healthy or unhealthy condition of the pati- ent, I propose to name it vaccine ecthyma. Like all chronic cutaneous diseases, it shows a decided tendency to return whenever the system becomes reduced from any cause, or when the patient is exposed to causes which produce an undue action in the circulation of the capillary system. An undue amount of exercise in warm weather seems to excite its appearance. This was illustrated in those soldiers supposed to be thoroughly cured, and who were about to be ordered to their regiments for duty, when a raid was threat- ened, in the month of July, upon the city of Richmond. These men were among the volunteers from the hospital to defend the city, and were marched through a hot sun some four miles to the lines at the extreme limits of the western end of the town. They returned with a new crop of pustules, which, however, healed by resolution in a short time. Treatment-There is every reason to believe that the disease results from a blood dis- ease, only to be eliminated from the system by enriching the blood and supplying its deficiency of fatty matter with rich nutritious food, and by the judicious use of altera- tives. It is in vain to treat the ulcers locally, for without alterative treatment with nutritious diet, all the local applications which were tried seemed to aggravate rather than improve them; but as soon as the general condition began to improve, so did the ulcers. The milder cases began to improve a few weeks after admission without any treatment, except dietetic, in conjunction with the iodide of potash, syrup iod. ferri, and sarsaparilla; in others, merely applying simple dressing to the ulcers, was found sufficient to subdue it. Under this treatment all the cases gradually but slowly im- proved. In the early part of August we received a large supply of cod liver oil, and I was thus enabled to test fully the treatment which the supposed cause of the disease naturally suggested. Some few of the patients could not digest the oil, but those who could began rapidly to improve, and many were able to return to their regiments, whilst others were thought well enough to be transferred to their respective State hospitals, in compliance with an order issued at that time. Those who were unable to digest the oil continued the syrup iod. ferri, which was thought the best alterative indicated in their cases. Their improvement was scarcely perceptible. In the early part of September, however, another effort was made by them to take the cod liver oil, which they were enabled to do in a little whisky; their improvement soon became very evident to them- selves, and, though not entirely well, the ulcers are rapidly granulating. No new pus- tules are being developed, and the patients are in a fair way to recover. I have nodoubc that the best remedy has been found in the cod liver oil; and this, locally applied and internally administered, with an entire change of air and nutritious diet, will remove and eventually eradicate this obnoxious and filthy disease from the system. From the above mentioned facts I am led to draw the following conclusions : That the disease is pustular at its first appearance ; that it resembles ecthyma in its general character; that it is but a local manifestation of a general disorder, or vitiated condition of the blood ; that this vitiated condition resulted from improper and spare diet, together with inattention to cleanliness, thus impairing the eliminating functions of the skin ; that syphilitic virus has had no influence in producing the disease ; that the morbid effects have in most of the cases resulted from deficiency in condition, independent of any imperfection in the vaccine virus ; that the disease can only be removed by those means calculated to improve the general condition and restore the healthy play of all the functions. Dr. James Bolton, of Richmond, Virginia, who enjoyed opportunities for the investigation of the abnormal phenomena manifested by vaccination in the Confederate Army, of the most extended and valuable character, attri- buted the so-called u spurious vaccination" to several causes. We present in this connection that portion'of his reply which relates to the influence of diet, hardship, exposure and corroding upon the progress of the vaccine disease, reserving the facts which he adduces to establish the existence of syphilo-vaccination, to section 7, of this Inquiry. Richmond, Va., February 25, 1867. Joseph Jones, M, D.: Dear Doctor-After various delays I send you my paper on Spurious Vaccination as it occurred in the Confederate Armies, only regretting that they were not forwarded at an earlier date. In addition to these, I am engaged upon some practical suggestions on Vaccination, and also upon the subject of Syphilo-Vaccination; but know not when I shall be able to furnish the papers. Very truly yours, JAMES BOLTON, M. D. 414 Spurious Vaccination: Joseph Jones, M. D. During the years 1863-4, a wide-spread epidemic of small-pox broke out in the South- ern States. It was impossible to supply the demand for vaccine virus. Especially was this the case in the Confederate army, which was panic-stricken by the spread of the disease. An order for virus was sent to England through the blockade. It either was never sent, or was captured. A supply was sent through the lines by the Federal authorities; but this was totally insufficient for the wants of the prisoners alone. Under orders from the Surgeon-General in Richmond, the writer was engaged in propagating virus among healthy children, and vaccinating the employes of the various departments of the Gov- ernment. The reports of these vaccinations* showed that more than thirteen hundred persons, chiefly adults, had availed themselves of the powerful influence of the prophy- lactic agent, and that of these, only one failed to obtain perfect protection. In that single instance, the varioloid eruption appearing two or three hours after the insertion of the vaccine virus, proved that the system had already become infected and that it was too late for the vaccine virus to have exercised the least protective or modifying in- fluence. Nearly all of these persons had been previously vaccinated. It was observed that the susceptibility of the system to the virus was remarkably great. The presence of the variolous poison in the atmosphere seemed to increase the susceptibility of the system to the influence of its antitode.t By a rough estimate, the writer thinks that two-thirds of the persons operated on exhibited phenomena of vaccinia, or of some grade of vaccination.t The same samples of virus were used upon nearly the whole of these without an unfavorable result in a single instance. Some of this virus, thus tested, was given to a Senator from Tennessee, whose physician reported, that having used the virus upon five members of the Senator's family, it produced no result in four cases, and those of a spurious character in the fifth. The youth's arm was almost cov- ered with scabs of different thickness at different points, healing here and there, and breaking out again, and this succession presenting for many weeks subsequent to the vaccination. How can this be explained? This same sample of virus had been culti- vated and extensively propagated by the writer for more than seven years, with none but normal results in any case. The fault was, therefore, clearly not the virus as origi- nally furnished. But how had this virus been preserved ? It may have been kept for some time about the person, exposed to heat and moist exhalations from the surface. These circumstances, most favorable to decomposition, may have caused a putrescent state in the vaccine crust.|| This crust would of course produce a putrescent zymosis in the pa- tient, or an eliminative action, or it would be successfully resisted, and then its effects would be ml. § Or it may be explained in another way. There may have been some occult influence, atmospheric or some other, so affecting the constitution of these per- sons at the time that true,vaccine zymosis was prevented or perverted. At this exigency the writer offered to supply the Medical Department with an abundance of pure vaccine virus. Having received instructions from Surgeon-General S. P. Moore,H he traveled for four weeks among the plantations in the interior of Virginia, vaccinating whites and negroes, and retracing his steps for the purpose of gathering the crusts. The result of this expedition was about eight hundred crusts, mostly from healthy negro children. This was distributed extensively through the army, and no further reports reached the writer of abnormal results. Among all the children vaccinated during this tour, one only presented abnormal phenomena, viz : its face and the vaccinated arm were covered with impetigo. This child was a mulatto, of a strumous appearance. Dr. Ramsey, Medical Director at Knoxvillle, Tenn., reported that many cases of spuriou s vaccination having occurred at that post, a civil physician, of high repute, was employed to obtain a supply of reliable vaccine virus from healthy infants in that city and its environs. Notwithstanding the greatest care was taken, the virus thus obtained produced no effect in some instances, and in others it was followed by erysipelas and other cutaneous eruptions. Dr. Ramsey reports unpleasant abnormal exhibits recently observed to suc- ceed the insertion of real or presumed vaccine virus. "These exhibits are not alone ery- sipelatous, but are in many instances a nondescript furfnrraceous condition of the skin, presenting in flakes from the size of meal particles to that of a fish scale, and a much larger number of instances of rupia-sores of irregular shape and size, penetrating deep in the tissues, and thickening black scales occurring at points remote from, as well as at * It is much to be regretted that the reports of Vaccinations in the Confederate Army, including those of Spurious Vaccination, were destroyed by the fire which occurred in Richmond, Va , on the night of its evacuation by the Confederate troops, and that an elaborate paper on Spurious Vaccination, by the writer, was wantonly destroyed by Federal soldiers. 11 have observed this on other occasions. t Of these, two persons had been inoculated with genuine variolous matter in childhood. || The vaccine crust being used almost exclusively at the South, in consequence of its retaining its proper- ties for a longer period than the died lymph, and furnishing a more abundant supply of virus, will be always understood as the only form of virus alluded to, unless otherwise stated. § This I acknowledged to be entirely theoretical, as I have no facts to prove such a deterioration, and consequent zymosis ever to have taken place. IT The labors of this gentleman in the cause of suffering humanity, whether in the form of friend or foe, entitle him to high rank in the roll of philanthropists. Spurious Vaccination: Joseph J ones, M. D. 415 the point of which the real or presumed vaccine virus had been inserted. In many cases of the erysipelatous exhibits sloughing of the tissues occurred to an enormous extent, even to the destruction of the part for use. * * * These exhibits have been observed in every State of the Confederacy, in every Department from the Potomac to the Mis- sisisppi. They have been observed to follow the insertion of virus, which when inserted into other persons was followed progressively by pimple, vesicle, cellular pustule, drying, small in diameter with dark-brown or deep mahogany, but semi-opaque, color ; the whole complete in from sixteen to twenty-one days, and regarded by me as regular vac- cine disease." * * * * These abnormal exhibits "do not depend on, or proceed from, any quality essentially pertaining to the virus which was used, but result from an epi- demical cause, the impress of which is made efficient or active by the co-operation with a virus. The old doctrine of predisposing and exciting causes." When the Army of Northern Virginia lay around Fredericksburg, after the first battle at that place, a large number of spurious vaccinations occurred among the soldiers. These appeared to be abnormal results of true vaccinations. Large numbers were sent to the hospital, and many remained in a disabled condition for several weeks, the ulcers show- ing no disposition to heal. The army was ordered to move northward, and most of the men quitted their beds and joined the ranks. All these cases got well on the march. In this instance it was evident that the abnormal results were due to the condition of the sys- tems of the men. S. E. Habersham, Surgeon in charge of the Second Division of Chimborazo Hospital, reported that many cases of spurious vaccination occurred at that institution. In con- sequence of the prevalence of small-pox, orders were given by Surgeon-General Moore, to vaccinate the patients whenever the condition of their systems, impaired by disease or wounds, would admit of it. Observing that the virus, with which the hospital was supplied, produced abnormal results, a physician of high respectebility residing in the neighborhood, was employed to procure genuine virus from the arms of healthy infants, for the use of the hospital. The virus thus procurred perfectly normal results in some instances, and abnormal results in others Surgeon Habersham remarks : "The character of all the cases which have come under my observation approximate more impetigo sparsa of an aggravated character than any other disease. The disease is evidently constitutional, as a pustule may be produced in many cases simply by the scratch of a pin in other parts of the person. I am by no means satisfied that the disease has originated by the use of impure virus, inasmuch as three cases were developed in this hospital as early as December. 1862. in patients who had been vaccinated with virus which in other, subjects produced a perfect vaccination with no ulterior evil consequences. It will be seen that many of the foregoing cases were developed in men who stated that they were perfectly healthy up to the time of their vaccination. My experience, however, is that in the cases developed in the hospital the pa- tients were in bad health, and of broken-down constitutions, with a very impoverished condition of blood. Under this impression, vaccination was withheld from such patients until their general health had been restored, when vaccination was practic'd without any evil results. "A close inquiry into the cause and origin of the disease will reveal facts, I am inclined to believe, which will show that the predisposing cause exists in some peculiarly vitiated condition of the vital fluid, and that the exciting cause is the insertion of vaccine virus." As a strong corroborative evidence of the truth of these opinions,Dr. Habersham states that about this time a considerable supply of cod liver oil was brought in through the blockade, that a liberal supply was sent to Chimborazo Hospital, that he placed the pa- tients suffering from spurious vaccinia upon the use of this valuable assimilative mate- rial. and that they all rapidly recovered. The following reports illustrate some forms of the disease upon which these remarks were ba sed : "Case X-Private W. J. Smith, Company A, Sixtieth Georgia Infantry, aged twenty-two; by occupa- tion a farmer ; has suffered from an eruption of the skin for about two months ; was never healthy, having sufibred from debility for a long time ; born of healthy parents ; was vaccinated about the middle of Janu- ary. 1863, in General Hospital, at Danville, bv surgeon in charge. Vaccination performed in both arms, on the left first, and about ten days afterwards on the right Both punctures produced pustules, which healed in about two months, leaving dark cicatrices. He was then returned to duty. About two months after- wards a pustule formed on the upper edge of the cicatrix on the left arm. Eight pustules formed success- ively around the first secondary pustule (which gradually coalesced into one scab), similar to the eruption of variola confluense. "Patient admitted into hospital May 27, 1863. presenting an eruption of five pustules on the right arm, and one near the wrist, one two inches below the bend of the elbow, ard three above the elbow, which were covered with thick, elevated scabs, from beneath which a saneous and ichorous pus was discharged, similar in character to impetigo sparsa. General health bad. System emaciated and anemic. Treatment- iodide of potassium internally. General health and character of pustules improving." In other cases the eruption made its appearance on the lower extremities. The following report illustra'es a class of cases unaccompanied by eruption or evi- dence of zymosis extending to other parts of the system. "Case 1.-June, 1863; Henry H. Burnett, private, Company A, Sixth Georgia Infantry, admitted May 2,1863, with ulcer on left arm, about two inches long by one inch wide. It was very much elevated above the general surface, and upon it there was a hard, black scab, which was loosely attached at the base, and from all points issued a thin, ichorous discharge. The patient's general health'was bad, and he was very anaemic. He states that he was vaccinated in camp on the fifteenth of April, by the Assistant Surgeon (does not remember name) of the Sixth Georgia Regiment, with virus supposed to be good; that his health was bad at the time, just convalescing from an attack of dysentery: that the third day after the operation the arm became very much inflamed from the elbow to the shditlder, which lasted about a week; during 416 Spurious Vaccination: Joseph Jones, M. J). which time, or soon thereafter, the ulcer extended and assumed the size and shape that it presented when admitted to hospital. The patient was put upon the iodide of potassum. gr, x, three times per day, with the syrup of sarsaparilla and generous diet. The arm was poulticed until the scah came away. It presented a cupped appearance, corresponding to the elevated and fungoid base, and has all the characteristics of an in dofent and chronic ulcer, which being freely cauterized, improved, and the patient is now convalescent. "The patient states that he was born of healthy parents, but lost a brother with consumption; that he entered the service on the eighteenth of February, 1862: did not enter the service at the commencement of hostilities because of bad health, which has improved since." During the latter part of the year 1862, and the early part of 1864, up to the fall of Richmond, the citizens suffered for the want of provisions, from the destruction of sup- plies by raiding parties, difficulty of transportation, and depreciation of currency. In- stances of scurvy occurred among the citizens. At this time cases of spurious vaccinia occurred, of which the following is an illustration: "Cask 1*.-January, 1863; vaccinated a white woman, who resided on Third street, near the cemetery, and on the same day her adopted child, a girl about six years old. Both were primary vaccinationsand from the same virus, the vaccine disease, which appeared on the child about the fifth day, went regularly through its stages. It was, in fact, a perfect vaccination, but in the woman it was quite different. When I examined her arm four days after the operation there was an excrescence, a spongy sore. I told her as it had failed to take, 1 would vaccinate her from the child at the proper time. About ten days after this I was sent for to treat her arm, which presented an ulcer of an inch in diameter, with incrustations, from which was discharged some healthy pus. She accused me at once of having used impure virus, but the case of the child protected me. Considering the ulcer the result of some vice of system (though I could obtain no evidence from her of this), I treated the case with five-grain doses of iodide of potassium and stimulants, and applied the ointment of the nitrate of mercury dilute to the part, after it had been cleansed by a flax- seed poultice. The sore proved of a very indolent character until the treatment had been used for two weeks, when it began to improve, and finally healed. From her character I inferred she had had syphilis. I vaccinated from the scab of the child without success." It appears from the foregoing reports that in some cases the pure vaccine virus was absorbed by a system in an unhealthy condition, and produced the normal phenomena of vaccinia; but the sequelae were abnormal. In some instances latent disease appears to have been developed, in others the system had not sufficient recuperative power to restore the injured part to its former condition, and hence ill-conditioned ulcers showing no disposition to heal were left by the falling scab. In all these cases there was no abnormal contagious disease propagated by or originating in vaccine virus. The resulting vaccinia was perfectly protective ; only the sequelae were abnormal. When the virus was used from these cases, of which the records are not numerous or clear, it produced spurious results. These phenomena appeared to be only the conse- quence of the resisting or eliminating efforts of the part, in order to guard the system against the introduction of an animal poison. In one instance there may have been an evanescent inflammation, and in another a true zymotic action not producing vaccinia, but an ulcer difficult to heal. In the former case the vital powers were more energetic, or the blood was in a more healthy condition ; in the latter these powers were more feeble and the blood was less healthy. Both of these states were due to circumstances of nutri- tion, exposure, fatigue, moral condition, etc. Beside these cases others occurred of a far more formidable character. After the trial of Wirz I published a small volume, entitled : " Re' searches upon Spurious Vaccination, or the Abnormal Phenomena, acconr panying and following Vaccination iit the Confederate Army, during the recent Civil War, 1861-1865," in which I examined the charge that the medical officers of the Confederate Army had deliberately w poisoned the Federal prisoners with poisonous vaccine matter. Copies of this work were sent to several of the most prominent Generals and medical officers of the Confederate Army, with the request that they would communicate such facts as were in their possession with reference to the sufferings of the Federal and Confederate prisoners. The universal testimony was to the effect that the sufferings of the Fed- eral prisoners were due to causes over which the Confederate Government had little or no control, and that the sufferings and mortality amongst the Confederate prisoners confined in Northern prisons were equally great and deplorable. From this correspondence I select the following letters from Gen. Robert E. Lee and other eminent citizens of the Southern States: Lexington, Virginia, April 15, 1867. Dr. Joseph Jones: Dear Sir-I am much obliged to you for the copy of your "Researches on Spurious Vaccination," which I will place in the library of the Lexington College. *Reported by Dr. W. H. Davis, of Richmond, Virginia, Spurious Vaccination: Joseph Jones, M. D. 417 I have read with attention your examination of the charge made by the United States Military Commission, that the Confederate surgeons poisoned the Federal prisoners at Andersonville with vaccine matter. I believe every one who has investigated the afflictions of the Federal prisoners is of the opinion that they were incident to their condition as prisoners of war, and to the distressed state of the whole Southern country ; and I fear they were fully shared by the Confederate piisoners in Federal prisons. Very respectfully, your obedient servant, R. E. LEE. T ***** * Crawfordsville, Georgia, April 9, 1867. Professor Joseph Jones, M. D.: Mil Dear Sir-Your esteemed favor of the third instant was received to-day. The pam- phlet came to hand two or three days ago. I am truly obliged to you for both. I have been very much interested indeed with the pamphlet, especially with the matter on pages 13 and 27, inclusive. With renewed thanks and kindest regards, I remain yours truly. ALEXANDER H. STEPHENS. Mr. Alexander H. Stephens, formerly Vice President of the Southern Confederacy, thus alludes to this subject in his great work, " A Constitu- tional View of the Late War Between the States f "The condition of those at Andersonville at the time was, indeed, most pitiable and deplorable. A very correct idea of itis given in the report of Dr. Joseph Jones, the very learned and eminent, as well as philanthropic surgeon, who voluntarily devoted months of his time to the alleviation of their maladies and miseries. In speaking of their gen- eral condition he says : " ' Surrounded by these depressing agencies, the postponement of the general exchange of prisoners, and the constantly receding hopes of deliverance through the action of their own government, depressed the already desponding spirits, and destroyed those mental and moral energies so necessary for a successful struggle against disease and its agents. Home sickness and disappointment, mental depression and distress attending the daily longings for an apparently hopeless release, appeared to be as potent agencies in the destruction of these prisoners as the physical causes of actual disease.' " Savannah, Georgia, August 21, 1869. Joseph Jones, M. D., Secretary Southern Historical Society: Dear Sir-I have had the honor to receive your letter of the second instant, and thank you cordially for the compliment you pay me, by "submitting" for my criticism your valuable paper on the losses of the Confederate armies in the recent war. Even if my means of obtaining information on the subject of that paper, so interesting to us, were equal to yours, I could not venture to criticise your work; still less, as the fact is, that I am without knowledge of the subject, or have so little as to justify the above expression-too little to make suggestions to you, or to pretend to offer you information. Most respectfully, yours truly, J. E. JOHNSTON. New Orleans, Louisiana, April 11, 1867. Dr. Joseph Jones: Dear Sir-Your letter of the third instant has been received-also the accompanying pamphlet, "On Spurious Vaccination in the Confederate Army," which I will read with pleasure, and for which please receive my thanks. The charge relative to poisoning Federal prisoners by our surgeons, at Andersonville, I never gave a second thought to, as I believed it to be too absurd and ridiculous; but it is well to have refuted it. I remain yours, very truly, G. T. BEAUREGARD. Charleston, April ?2. Joseph Jones, M. D.: My Dear Sir-Your letter, incorrectly addressed to meat Columbia, reached me only yesterday in Charleston Your pamphlet came several days ago, and I am very grateful for it, but as I gave my copy to a professional medico, I will thank you for another. I retained the first copy long enough, however, to peruse it, and you will find from the enclosed printed notice, w'hich I prepared editorially for the Charleston Courier, that I had, in some degree, recognized your object in one very important portion of the work. Let us hope that the notice, however inadequate to the merits of vour essay, will not bp found ungenial. Yours, truly, W.'GILMORE SIMMS. SPURIOUS VACCINATION. We are indebted to the author, Dr. Joseph Jones, M D., Professor of Physiology and Pathology in the Medical Department of the University of Nashville, Tennessee; for a copy of an elaborate pamphlet, de- voted to this most interesting subject of " Spurious Vaccination," a subject which, during the late war in 418 Spurious Vaccination: Joseph Jones, M. D. this country, grew to be one of enormous proportions, as being one of vital interest to the statistics of hu- manity and mortality in every section. The curious and complicated history of the abnormal phenomena accompanying and following vaccination in the Confederate Army, during the war, and governed-as doubtless it was-by the melancholy condition of the army, under exposure, privation, cold or heat, bad food, crowded hospitals, and the use of salt meat without vegetables ; this is the general topic of this valu- able pamphlet, which displays a great deal of earnest inquiry, scrupulous thought, and a speculation which seems to be built upon just and plausible premises, and which is enforced by a great body and variety of testimony from eminent medical men of equal leading and experience. But in regard to the medical and surgical value of this work we prefer to have the opinion of medical men, and we have accordingly confided the publication-which covers 136 pages of closely printed octavo-to the hands of an able friend and corre- spondent, who will probably afford us a just and complete opinion of its facts and theories at a future day. But there is another point of view in which this pamphlet is to be regarded, and for which we gladly welcome its publication, viz : The Historical. It will tie found, in its uniform statement of facts, in its statistics of mortality, relatively among the Federal soldiers and our own, in its very full report of the con- ditions under which our soldiers were treated-in their sufferings from want, equally of food and medicine- a sufficient answer to those atrocious slanders, by which it was sought to make the Confederate Government and people odious for their misfortunes, as if for crimes, and to place to their account those evils which accrued wholly from the cruel and brutal policy of the Federal Government itself, throughout the progress of the war. In this point of view, as a contribution to the history of the country, this pamphlet merits to be read by every citizen, and to find circulation in every region where it is thought necessary, or proper, that a lie'should be knocked on the head as soon as possible. We thank Dr. Jones for our copy of this valuable pamphlet, and counsel its general circulation. Charleston, South Carolina, 37 Tradd Street, April, 1867. Professor Joseph Jones, M. D.: My Dear Doctor-Thanks for the copy of your "Researches upon Spurious Vaccina- tion." Your labors in the department of pathology and hygiene during the war were fa- miliar to us all in Richmond, and the profession at large must be glad to find them in print. I trust your entire labors were not lost among the Surgeon-Generals' documents? Mine were lost, but I still have notes and material which I may make public. Hoping to hear from you shortly, I am, with brotherly and friendly feelings, Your obedient servant, MIDDLETON MICHEL. Richmond, Virginia, April 5, 1867. Professor Joseph Jones: Dear Sir-I beg to acknowledge, with many thanks, the receipt of two numbers of the " Nashville Journal of Medicine and Surgery " and your pamphlet upon " Spurious Vac- cination." The last especially was read with great interest, and the profession owes you a debt of gratitude for the careful and masterly investigation you have given the subject. . I received your letter in regard to spurious vaccination, last November, and was anx- ious to answer it, because I had seen in the army a great many cases, and was one of a committee of investigation ordered by Dr. Guild, and referred to by Dr. in the letter you publish from him ; but soon after your letter came, I left the city to be mar- ried, and did not get back until it was too late, I supposed, for an answer to reach you in time for your article. My letter, however, would have served only to corroborate what you received from Dr. B. Yours, very respectfully, HUNTER McGUIRE. First Military District, Richmond, Virginia, April 3, 1867. Dear Doctor-Your monograph on spurious vaccination is just received. I have looked over the articles seriatim as they appeared in your journal, with very great interest. At the same time, I am compelled to say, that you have failed to convince me of the correctness of your conclusions. I am prepared to show, and, I think, by clear, convincing evidence, that vaccine virus never conveys any other disease or morbific virus, that it refuses to associate with any other. I am very anxious to complete my paper on this subject, but have been so constantly interrupted that 1 can only look occasionally, and wistfully, at ray unfinished manuscript. If you had done nothing more than to have written the second section of your mono- graph, you would be entitled to the everlasting gratitude of every Southerner. There is no vile slander so extensively circulated, and pertinaciously insisted upon by our ene- mies as that which declares that we starved or otherwise maltreated the prisoners in our hands. This you have ably refuted in the second section. I will feel greatly indebted to you if you will send copies of your monograph to the following gentlemen : Dr. Edward C. Bolton, Poughkeepsie, New York ; Dr. Abram Dubois, No. 13 West Eleventh Street, New York; Dr. Elisha Harris, No. 21 West Twelfth Street, New York ; Dr. I. M. Minor, No. 7 Upper Gloucester Street, Dorset Square, London. The last is a native Virginian, and true as steel. I am sure he will be glad to be furn- ished with the means of refuting the foul slanders where there will be a chance of hav- ing an impartial hearing. Sometime since I forwarded to you my paper on spurious vaccination as it occurred in the Confederate Armies, and also abstracts from reports of Confederate surgeons upon the same subject, but have received no acknowledgment from you, and fear my letter may have miscarried. I would regret this very deeply, as I have kept no copy. You will, therefore, oblige me greatly by replying at your earliest convenience and re- lieving my anxieties, If the letter has not come to hand, you will please use all endeav- ors to recover it. Very trujy, yours, JAME8 BOLTON, M. D. Spurious Vaccination: Joseph Jones, M. D. 419 Dr. Joseph Jones, University of Nashville. P. S. You need not trouble yourself to send a copy of your paper to Dr. Minor, of London. If you will send me a copy, I will forward it. * Wilmington, N. C., July 21, 1867. Joseph Jones, M. D.: My Dear Sir-I am under obligations to you for your "Researches upon Spurious Vac- cination," which I will make a subject of report with other committee matter at the next annual meeting of our State Society in April. I am very much pleased with the extensive research which your work exhibits, and think I can see that many spurious vaccinations observed by me, are referable to rational causes, and not much to the method of vaccination. Spontaneous vaccinia, I am inclined to believe, occurs in this section of North Carolina and we are making every endeavor to collect everything for a complete report. I am now testing some vaccine sent by Dr. Wilson, from a spontaneous vaccine pustule from one of his cattle ; Dr. Bolton is engaged in a similar investigation. If I am not trespassing on your valuable time, I would like to learn your process of inducing spontaneous vaccinia. Allow me again to express my obligations to you, and believe me, Very truly, yours, THOMAS F. WOOD. Our transactions will be completed by the first of August. THE TENNESSEE MEDICAL SOCIETY-THIRTY-FOURTH AN- NUAL MEETING. IN THE BOARD OF HEALTH ROOMS, ? Nashville, April 10, 1867. 5 The Society met pursuant to adjournment. Dr. Robert Martin, President, in the chair. AFTERNOON SESSION. The Society was called to order by the presiding officer, and the various standing and special committees appointed as follows : On Publication-Drs. J. H. Callendar, Joseph Jones, of Davidson, and D. F. Wright, of Montgomery. On History of the Society-Drs. J. E. Manlove, W. K. Bowling, of Davidson, and J. W. Richardson, of Rutherford. On Registration of Births, Deaths, etc., etc.-Drs. J. R. Buist, of Davidson ; E, B. Has- kins, of Montgomery; Daniel German, of Williamson ; B. W. Avent, of Shelby ; A. Jack- son, of Madison; B. Frazier, of Knox, and S. P. Crawford, of Greene. On Amendment to Charter-Drs. R. Martin, C. K. Winston and W. A. Cheatham, of Davidson. Dr. Buist moved that a committee of three be appointed by the Chair to select and recommend as many as eight subjects, assigned to as many suitable writers, who will be requested to prepare a paper on each, to be presented at the next regular meeting ; that this committee repopt at an early day, to the President of the Society, the results of their labors, so that he may be able to notify each appointee. Adopted, and Drs. Buist, Eve and Du Pr6 appointed as such committee. The Secretary read a letter from Dr. Lipscomb, of Shelbyville, the President elect, regretting his inability to attend the meeting of the Society, and submitting the follow- ing resolutions for its consideration : Resolved, That although the elaborate researches of Prof. Joseph Jones may have failed to define conclusively the origin of spurious vaccination, they have not failed to eluci- date the points of vital importance intimately connected with vaccination. Resolved, That Prof. Jones has succeeded in collecting a sufficient number of facts to overthrow the long-accredited dogma, that secondary syphilis is incommunicable by in oculation. Resolved, That the facts collected forcibly illustrate the importance of using no vac- cine virus, except that obtained from perfectly healthy subjects, as well as manifest the propriety of omitting the vaccination of the unhealthy. Resolved, That for the zeal, industry and learning devoted to this subject, by which so many important facts have been presented, and various points elucidated, the author is entitled to the thanks of the profession. The resolutions were unanimously adopted. 420 Spurious Vaccination: Joseph Jones, M. D. SECTION III-THE EMPLOYMENT OF MATTER FROM PUSTULES OR ULCERS WHICH HAD DEVIATED FROM THE REGU- LAR AND NORMAL COURSE OF DEVELOP MENT IN THE VACCINE VESICLE ; SUCH DEVIATION OR IMPERFECTION IN THE VACCINE DIS- EASE AND PUSTULE BEI&G DUE MAINLY TO PREVIOUS VACCINATION, AND THE EXISTENCE OF SOME ERUPTIVE DISEASE AT THE TIME OF VACCINATION. OR, IN OTHER WORDS, THE EMPLOYMENT OF MATTER FROM PATIENTS WHO HAD BEEN PREVIOUSLY VACCINATED, AND WHO WERE PARTIALLY PROTECTED, OR WHO WERE AFFECTED WITH SOME SKIN DISEASE AT THE TIME OF THE INSER- TION OF THE VACCINE VIRUS. PROF. PAUL F. EVE, M. D., ON SPURIOUS VACCINATION-DR. R. D. HAMILTON, OF CHATTANOOGA, ON SPURIOUS VACCINATION AMONGST THE CONFED- ERATE FORCES SERVING IN EAST TENNESSEE-INVESTIGATIONS OF DR. EDWARD JENNER, ON THE VARIETIES AND MODIFICATIONS OF THE VAC- CINE DISEASE-ANSWER TO DR. JENNER'S INQUIRIES, BY THE RECTOR OF LACKHAMSTEAD-OBSERVATIONS OF DR. JAMES DAVIS, OF COLUM- BIA, SOUTH CAROLINA, ON THE VACCINE AND VARIOLOID DISEASE-EX- AMINATION OF THE DOCTRINE OF JOHN HUNTER, ON DISEASED ACTIONS AS BEING INCOMPATIBLE WITH EACH OTHER-RELATIONS OF THE VAC- CINE DISEASE TO MEASLES AND OTHER DISEASES, WITH THE OBSERVA- TIONS OF NUMEROUS AUTHORS-RELATIONS OF CHICKEN-POX TO SMALL- POX-HISTORY AND PHENOMENA OF CHICKEN-POX (VARICELLA)-DIF- FERENTIAL DIAGNOSIS BETWEEN VARIOLOID AND VARICELLA. Whilst it might admit of debate, whether pure vaccine virus, obtained from persons never before vaccinated, and who manifested all the phe- nomena of the disease, and especially the characteristic febrile phenomena ever becomes deteriorated or possessed of deleterious properties in its passage through numerous human bodies, not suffering with such a conta- gious disease as syphilis; on the other hand, it cannot be denied that the power of vaccination has been impaired to a lamentable and almost incal- culable extent by a succession of imperfect vaccinations ; and especially by the employment of matter from those who have been previously vaccinated, or who have suffered from small-pox previous to vaccination. Vaccination may be rendered imperfect by the development of febrile and other diseased states after the introduction of the virus into the sys- tem, arising from the action of cold, or some cause producing constitutional disturbances differing essentially from the febrile phenomena which mark the progress and perfection of the vaccine disease, as well as by its im- perfect and altered course in those who are partially protected by previous vaccination. In the isolated condition of the Southern Confederacy, cut off from the surrounding world, and denied even vaccine matter, as 11 contraband of war; " with the necessity of turning out the entire fighting population to repel invasion, and with the necessity of employing all the available med- Spurious Vaccination: Joseph Jones, M. D. 421 ical aid, good, bad and indifferent ; and with the progressive increase of small-pox, it is not strange that the process of vaccination was not as care- fully watched and tested as it should have been; and that consequently much imperfect material circulated as vaccine matter, which not only afforded little or no protection against small-pox, but also proved positively dele- terious. My friend, Professor Paul F. Eve, M. D., has recorded in his discussion of certain questions relative to the health of the late Southern Army, in- teresting observations upon spurious vaccination ; and it will be seen, from the following extracts, that this distinguished surgeon inclines to the belief that the abnormal manifestations of the vaccine disease may be due, in a great measure, to the alteration of the matter in consequence of its pass- ing through a long succession of human subjects, and in consequence of the co-existence of various diseases: "The scab used in Atlanta, which did so much mischief, was soft, porous and spongy, of a yellowish-brown color, resembling concrete, impissated pus. It was not a small, hard, compact, translucent substance, like dried compressed glue, of dark-mahogany color, requiring, as the genuine scab does, considerable effort to break it; neither did it present the clear, even, vitreous aspect when fractured, but was bulky, irregular and crumbling. In every instance, wherein vaccination was attempted with it, premature effects were developed. No proper period of incubation, nor papular or vesicular erup- tion was observed, but in a few days, even as early as the second, inflammation had set up, and by the fourth or fifth day, sores were produced, covered by a thick, dirty crust, with an ichorous discharge. Soon an ill-constituted ulcer, with perpendicular edges, en- sued, extending through the dermoid to the cellular and muscular tissues, and involving the neighboring lymphatics. The cutaneous surface suffered chiefly, presenting large, irritable, very dark-colored and scabby ulcers. Sometimes there was one, in other cases several, not on the extremity only into which the matter had been inserted, but on the others, and sometimes on the body. These cases were greatly aggravated by complica- tions with erysipelas, scorbutis, syphilis, itch, etc. I believe we had no death from un- complicated case of spurious vaccination, though forty to fifty patients were treated in thishospital. * * While every deviation from the regular development of the vaccine disease may be considered spurious, we yet understand now by that term, a pretty well defined, certainly a peculiar, if not a specific affection, which we have al- ready attempted to describe. * * Intimately connected with the nature of spurious vaccination, is involved the question of its being simply a local affection, or constitutional disease. To what are its symp- toms due; to a virus, or do they arise from cachexia? I am free to confess that the in- vestigation of this subject has caused me to reverse the opinion that the effects of impure vaccination are alone to be attributed to the bad condition of the patient's system, and did not depend upon anything special or specific. From repeated experiments, it is well ascertained that laudable pus when inserted into a healthy person is inocuous, and should it be used in even a decomposing or concrete state, will not excite certain uniform and peculiar results. Impure blood, peculiarity of constitution, indulgencies, epidemic influence, etc., etc., will account, I know, for many local disturbances, but not for the origin of spurious vaccination. In every case it is the result of vaccination with impure virus, by careless or inexperienced persons. In reference to the nature of this impurity, there is good reason to believe that it results from a perversion or modification in the vaccine vesicle. We know heat destroys vaccine, as well as variolous virus, and it may be that excessive inflammatory action changes the genuine vaccine matter into the spurious. Or it may be this virus affected by another disease, or the bad state of the system, or becoming nearly effete itself, by passing through numerous systems produces a disease only resembling the true vaccine. The difficulty of developing genuine vac- cination in one once impressed by the spurious, shows plainly the connection between the two."-The Nashville Journal of Medicine and Surgery, New Series; vol. 1, 1866, pp. 21-28 It will be seen from the following interesting communication that Dr. Hamilton, of Chattanooga, who enjoyed ample opportunities for the inves- tigation of the accidents following vaccination in the Confederate Army, attributes much of the spurious vaccination to the careless use of matter from imperfect vesicles or sores. 422 Spurious Vaccination : Joseph Jones, M. D. Chattanooga, January 15, 1866. Prof. Joseph Jones : Dear Sir-Yonr note of the fifth was received some time since. Sickness, absence from home, and professional duties have prevented an earlier reply, which I much regret, but cannot remedy. In regard to the subjects named, I fear I can afford but little information worthy of your consideration. Of what is termed as " spurious vaccination," I saw many instances during my ser- vices as Surgeon in the army ; and while in charge of the General Hospital at Strawberry Plains, East Tennessee, I was directed from the Surgeon General's Office, to make a sta- tistical report of all cases which had come to my knowledge. In obedience to this order, I bad collected notes of many cases, but shortly after came the evacuation of East Ten- nessee, and my engagement in a different field of labor, so that the report was not made, and most of the notes which I had accumulated were " lost or destroyed by unavoidable accident." From the few notes I have on hand, and from such facts as I can recall to memory, I give you herewith the general results. All the cases, with a few exceptions, of " spurious vaccination," which came under my observation during the war, were reducible to one of the three following named classes: 1. A single suppurating ulcer at the point of vaccination, 2. General eruptions, sometimes single, sometimes in patches involving a considerable extent of surface, appearing during the existence of the original ulcer, or after it had healed. 3. General eruptions attended by suppuration of the lymphatic glands. To what extent these different forms may be regarded as separate stages of the same development, I am not prepared to say, and I believe that no connection exists between them iu such a sense. There certainly was no discoverable progression through the dif- ferent conditions, such as is seen in some diseases. It is evident that the result of any vaccination or inoculatiou must depend upon one or both of the following causes : 1. Upon the kind of virus used. 2. Upon the condition of the patient. If vaccine virus is not used in any particular instance the result will be useless and perhaps hurtful to the patient. I am forced to the conclusion that a large majority of the cases of " spurious vaccination," which came under my observation during the war, were such because of the spuriousness of the virus used. If, by supposed vaccination, a " sore" was produced ou the arm, the virus was supposed to be ''taking," and straight- way the matter was put into other arms, and other " sores" produced, when, on examina- tion it would be found not one of the arms gave evidence of vaccination. The pustules did not possess the characteristics of true vaccine, either iu their progress or in their results. The proper scar was not left by them, nor the usual protection from variola afforred. A portion of liquid or encrusted pus, or of epithelium, was inserted in the arm, and the patient was presumed to be vaccinated. In some instances true vaccine virus was used on persons whose systems were protected by previous vaccination, and the matter from the resulting pustules when used by others, became a source of evil. Soldiers practiced upon themselves from the arm of one of their number, whence came a long train of evil results. But there were instances where portions of the same scab produced in some persons the true vaccine pustule, and in others only the spurious eruption, and the explanation must be found in the condition of the patient. Just what this peculiar condition is, or what its causes are, we know not. The questions concerning the influence of army life on the physical, mental and moral condition of men recently taken from the walks of civil life, are many and various, and as yet, I believe most of us are only "guessing" at answers. Every medical officer remembers how fatal among soldiers, at times, were com- plaints which are ordinarily remediable, and that, too, when, at the time of the appear- ance of the disease, the soldiers were apparently in robust health. It will also be remem- bered how very few instances occurred of what would be regarded as types of any one disease, while at the same time a large number of cases would be found. Nearly all were more or less modified, and some so completely as almost to lose their identity. But this subject is too extensive for discussion at this time. In regard to the transmission of syphilitic poison through the process of vaccination, I can recall to mind a few instances, where I feel positively certain that secondary syph- ilitic, eruptions existed, and the patients were equally in their expressed belief that the symptoms came from vaccination. Such cases were always diagnosticated as s\ philitic, and treated and relieved as such. My experience leads me to put so little faith in the assertions of persons affected with any venereal disease, ou this subject, that 1 have ar- rived at no rersonable conclusion, and I can only say with the poet-begging pardon for so unpoetic a connection-"Though I cauna see, I guess and fear." Spurious Vaccination: Joseph Jones, M. D. 423 To sum up then, in a few words. First-It is my belief that most of the cases of so- called spurious vaccinacion resulted from the fact that vaccine virus was not used, and therefore no vaccination, in the proper sense of the term took, place. Secondly-The condition of the system, affected by atmospheric influence, or the kind of life led by sol- diers, or by what you will, so modified the action of the virus as to produce morbid results. I regret that circumstances prevent a more extended consideration of the subject touched on in this letter, such as their importance demands, and I rejoice to learn that you are preparing a Monograph on the same, and I shall look forward with much interest for its appearance in print. Very truly, yours, R. D. HAMILTON. Dr Jenner, in the beginning of his inquiries, felt the propriety of watchfulness ; and at an early day he distinctly announced that it was pos- sible to propagate an affection by vaccination conveying different degrees of security, according as that affection approached to, or re- ceded from, the full and perfect standard; he also clearly stated that the course of the vaccine pustule might be so modified as to deprive it of its efficacy, and that inoculation from such a source might communicate an in- efficient protection, and that all who were thus vaccinated were more or less liable to subsequent small-pox. He still further maintained that fluid taken from a genuine pustule in its far advanced stages, is capable of pro- ducing varieties which will be permanent if we continue to employ it. Dr. Jenner attached great importance to the condition of the skin at the time of the insertion of the virus. In his tract "On the Varieties and Modifications, of the Vaccine Pustule occasioned by an herpetic state of the skin," he says, '' I shall here just observe that the most careful testimonies now lie before me supporting my opinion that the herpetic, and some other irritative eruptions, are capable of rendering variolous inoculation imperfect, as well as the vaccine." One of the entries in his Journal is to the following effect: " Inoculated Lady C. F. a second time. It is evident that that affection of the skin called red-gum. deadens the effects of the vaccine virus. This infane was covered withit when inoculated four days ago. The same thing happened to Mrs. D's. infant." In a letter to Mr. Dunning, dated Berkely, December 23, 1804, Dr. Jen- ner says: " There may be peculiarities of constitution favorable to this phenomenon. My opinion still is, that the grand interference is from the agency of the herpes, in some form or another ; for I have discovered that it is very Proteus, assuming, as it thinks fit. the character of the greater part of the irritative eruptions that assail us. I shall have much to say on this disease one of these days." The reported failures of vaccination, and the occurrence of several vio- lent variolous epidemics in different parts of the country, induced him to endeavor to rouse the attention of professional men to those points, in the practice of vaccination, which he deemed essential to its success. With such intentions he printed a circular letter early in 1821, which was sent to most of the respectable medical men in England ; in it he directed their observation to the three following questions: "First. Whether the vaccine vesicle goes through its course with the same regularity when the skin is under the influence of any herpetic or eruptive disease, as when it is free from such affections ; secondly, whether the existence of such eruptive diseases causes any resistance to the due action of vaccine lymph, when inserted into the grms; thirdly, whether cases of small-pox, after vaccination had occurred to the observer, and if so. whether such occurrences could be ascribed to any deviation in the progress of the vac- cine pustule, in consequence of the existence of herpetic or other eruptions at the time of vaccination."- The Life of Edward Jenner, Jf. D,'L.L. D., F. R. £., etc., by John Baron, If. D., vol. 2, p. 272. The answer to these inquiries, by the rector of Leckhamstead, contains facts of such value in their bearing upon this portion of the subject, that we are induced to reproduce it entire: Lkckhamstead, Near Buckingham, June 29,1820. Edward Jenner, M. D.: Dear Sir-Your letter did not reach Buckingham till June 23, though dated the twelfth. The object of inquiry appears to be the extent to which cutaneous diseases reject or modify the vaccine virus, so as to render the efficacy and security doubtful. I have looked over a number of copies of communications to Pr. Harvev. and will with great pleasure send you the transcripts of the interference of variolous and vaccine infection and the superceding power of the latter if applied in time, six of which took place at Old Strat- ford. in 1816. among the elffldren of one family, being the whole time under the same loot. I he distiess and alarm at the tuu« wbsu ewtmely grt&v, tike inhabitant* werb rtbVrbupg libiu UA utosltk when Utb 424 Spurious Vaccination: Joseph Jones, M. D. small pox broke out. The anxiety of the parents was such that I was induced, contrary to my own opinion, to vaccinate several where the fever of measles had not completely subsided ; the consequence of which was nothing more than that the vaccine virus lay dormant in its cell till the field was clear, and came into action two or three days later ; but afterwards proceeded in as regular and decided a manner as in constitu- tions which were not previously engaged. I discovered at a very early period that the itch was not an impediment: as to the shingles. I cannot speak. The grand rejecting agent in children is the tooth-rash, or. as it is here commonly called, the red- gum, especially while it continues bright and active. Dr. William Cleaver (when Bishop of Chester) pro- moted an extensive variolous inoculation in his diocese. Some years after he asked me if I could account for the very frequent failure of communicating the affection to young children. I told him that it applied equally to the vaccine; though frequently, if the virus was fresh and active, it would be suspended in its career for a time only, but push forward with success at last. I beg to assure you, sir, that nothing I have met with has, in the slightest degree, shaken my faith in the vaccine. I have several children, the eldest sixteen, all vaccinated by myself ; and of 14,305, all within a few miles of this place, I have never heard of a single fatal disappointment; and of only two or three cases of modified, or what I should feel inclined to call superficial or cutaneous small-pox. As to remote or deriative diseases, I know ot no such thing fairly to be ascribed to the cow-pox ; I have ample means of knowing if such a thing had taken place, as the people of my two parishes, and many in the neighborhood, are, somehow or other, continually coming under my consideration for medical assistance. My communi- cations of late years have been to Dr. Harvey, according to the directions of the National Establishment; but I have met with no demand for inoculation since February, 1820, simply from the absence of any stimu- lating alarm. 1 am, dear sir, with the highest respect, your most obedient, humble servant, T. T. A. REED, Rector of Leckhamstead. Mr. Reed had, in 1806, printed and distributed a tract for the encourage- ment of those who entertained any doubt respecting the efficacy of vaccine inoculation; and distinguished himself as an ardent and successfid pro- moter of vaccination. His testimony, therefore, is of great value. Dr. Jenner maintained to the last hour of his life, that any cutaneous disease, however slight in appearance, was capable of interfering with the regular course of the cow-pox, and of preventing it from exercising its full protecting influence; and his directions for obviating any deterioration of the virus, regarded first, the character of the pustule itself, the time and quality of the lymph taken for inoculation, and all other circumstances that might go to affect the complete progress of the disorder. Thus he maintained that the vaccine fluid should be taken, for the purpose of inoc- ulation, at an early period of the formation of the vesicle, and before the appearance of the areola; and he insisted that the pustule, when excited, should be permitted to go through all its stages in an uninterrupted man- ner, and if any deviations appeared in its progress, he always forbade the employment of virus from such a pustule for further vaccinations. Dr. Waterhouse, in a letter to Dr. Mitchell, dated Cambridge, Septem' ber 26, 1801, says: " Yesterday I received a letter from Dr. Jenner, one paragraph of which I must transcribe, because it contains the golden rule of vaccination, viz : 11 don't care what British laws the Americans dis- card, so that they stick to this-never to take the virus from a vaccine pustule for the purpose of inoculation, after the efflorescence is formed around it. I wish this efflorescence to be considered as a sacred boundary, over which the lancet should never pass." Med. Repository, N. Y., vol. 5, p. 236. Every deviation, from whatever cause it may have* arisen, was consid- ered by Jenner of the greatest moment; and as has been fully shown by the learned author of his life, in all his published works, as well as in every private communication, he never failed to express his deep sense of the importance of the most scrupulous attention to that part of the sub- ject; and to the last he felt that, had his admonitions been received as they ought, had the phenomena connected with vaccine inoculation, been studied by all who conducted the practice, a large proportion of the failures would have been avoided. The following important and interesting communication, published about forty-five years ago, confirms, in a striking manner, the correctness and great value of the laws laid down by Jenner, with reference to the rela- tions of the vaccine disease to cutaneous affections': Spurious Vaccination : Joseph Jones. M. D. 425 OBSERVATIONS ON THE VACCINE AND VARIOLOID DISEASES. COMMUNICATED BY JAMES DAVIS, M. D., OF SOUTH CAROLINA. I offer you the following communication, not only because it seems to corroborate the observations of Dr. Jenner and others, that the simultaneous existence of cutaneous dis- eases. with the vaccine-pox, has a tendency to vitiate the virus of the latter disease, and render it unfit for communicating the true kine-pock; but, moreover, because it would appear that the vaccine matter is liable, from this circumstance, to be converted into a virus of a totally different character. * * * I extract the following case from my notebook : On the twenty-ninth of June, 1814, I vaccinated Master James D, Montgomery, aet. eighteen months, son of Dr. B. R. Montgomery, Professor of Moral Philosophy, etc., in the South Carolina College, together with six other healthy children. I had obtained the matter that I made use of from Dr. Smith, of Baltimore. James D. Montgomery had been laboring under a cutaneous disease (the strophulus interlictus of Willan) ^or about three months. It had resisted every remedy which I had prescribed for it, and by this time had literally spread over the whole surface; so as to render it difficult to find a sound spot on the arm large enough for making the insertion. I should have been de- terred from vaccinating in such a case, but for a remark of Dr. Jenner, viz.: "That vaccination, although not very certain to take in cases of cutaneous eruption, yet, when it did take, it was durative of the cutaneous disorder." Upon this information I recom- mended it to Dr. Montgomery, who readily acceded to the experiment. The vaccine failed to take effect in every one of the cases, except in that of J. D. Montgomery ; and in his case it was really gratifying and delightful to observe the effect of it on the cuta- neous disease. As the vaccine pock advanced, the affection of the skin disappeared, and that in a very exact proportion to each other ; so that, by the time the pock was mature, the cutaneous disorder had entirely gone off. From fifteen to twenty-five days after the kine-pock had been in its full course, he was afflicted with two abscesses, one on his back and one on his breast, which discharged from half an ounce to an ounce of laudable pus; since which time he has remained in sound and perfect health. His pock proved to be anomalous, and whether it were sufficient to protect his system against the small-pox has not since been tested. But from the constitutional symptoms which I attentively observed, I am very much inclined to believe that as to himself it was effectual. The virus manifested no signs of having taken effect until the eighth day, when the small inflamed point at the puncture first appeared. The areola did not progress from day to day with regularity, nor was it at any time sufficiently circumscribed, having some radii considerably longer than others. Its color was a coarse red, instead of that beautiful fine blush which the genuine vaccine gener- ally exhibits. The pock, although of ordinary size, and of a concave surface, was destitute of that cordon of bead-like vesicles, which form around the corona of the true kine-pock It was peculiarly dry, insomuch that it was difficult to obtain from it as much lymph as would serve for further vaccination. Four healthy children (white and black), of the family of Dr. E. D Smith, Professor of Chemistry, etc., were vaccinated from this pustule. I had expressed an opinion, that although I believed the constitution of little Master Montgomery was secured against the small-pox, that, nevertheless, I doubted of the efficacy of the matter of his pustule to communicate the true disease. As matter, however, was hard to be obtained, and as it was conceived no danger could result from it, the doctor determined on making the trial. It failed to produce any effect whatever on all, except on one of the doctor's own children. In this case the puncture began to inflame within the first fourteen hours. The inflammation spread rapidly, accompanied with innumerable papulous eruptions over the inflamed surface, exuding a profuse quantity of gelatinous matter. It continued to spread for about thirty hours, assuming in its progress rather a formidable appear- ance, and exciting a good deal of alarm, until it occupied a space longer than five or six areolas of true pock ; extending over the one more longitudinally than laterally. Aperi- ents were administered, and the topical affection fomented with a decoction of chamomile flowers, and in about forty-eight hours it bad totally disappeared, having exhibited no sign whatever of anything like a pock. There was no constitutional disturbance accom- panying the affection. The child remained in perfect health, and has undergone the kine-pock by a subsequent vaccination. This case evinces two facts in a clear and decided manner, to-wit: that the vaccine disease is capable of effecting the cure of certain inveterate diseases of the skin ; and that certain diseases of the skin may exert an influence ovor the vaccine matter, as not only to Vitiate and fender it unfit for cbminunicating the true kind-pock, Hut also abso- 426 Spurious Vaccination : Joseph Jones, M. D. lately to change and convert it into a poison of a new and unknown character Two facts of great practical importance, and which, perhaps, deserves more investigation and scrutiny, than they have hitherto received. The influence of kine-pock over cutaneous disorders is an old remark; and the influ- ence of diseases of the skin in vitiating t he matter of the kine-pock, and rendering it unfit for communicating the true pock, is equally old. But its liability to be converted into a poison of a different nature, productive of singular and anomalous affections, in conse- quence of being blended with certain cutaneous disorders, is a subject which has not hitherto attracted as much attention as it merits. In this instance, the cutaneous disease of Master Montgomery obviously occasioned a conversion of the vaccine matter into a new kind of virus, producing a new and singular affection. It is true it proved to be a mere topical affection, and terminated without any serious consequences; but, as the vaccine matter is liable to be changed by one form of cutaneous disease, is it not reason- able to conclude that it may also be changed by others? And, although, in this particu- lar case, it was changed into comparatively an inocuous virus, have we any evidence, that in blending with some others of the multifarious affections of the skin, incident to mankind, it may not become converted into a virus of deleterious and destructive oper- ation ? All this, however, indicates nothing against the utility and importance of genuine vac- cination, but only shows how important it is that it should be practiced with a care, cir- cumspection, and skill, with which the prevailing custom of our country at present is utterly incompatible ; and until there shall be a reform effected in this respect, it will be in vain to look for the full extent of those beneficial results to mankind which the kine- pock is unquestionably calculated to afford. The attainment of these results in strict conformity with the laws of our condition in the attainment of every other great and important good, is beset with difficulties; nev- ertheless, we have no reason to suppose that these difficulties are insuperable. Every year brings to light some new facts, which enable us to approach nearer and nearer to the attainment of the desired object. And as one principal obstacle to the improvement of our knowledge of this subject has been the apathy, indifference, and even levity, with which it has been received by a great majority of the community; so, when, per- haps, from severe afflictions and scourges, or from any other cause, this supineness and indifference shall be removed ; then the march of improvement will be rapidly acceler- ated, and great and permanent advantages will be the happy result. Would it not be a wise precaution, and worthy of legislative provisions, to impose a penalty on any one who should communicate the vaccine disease from an unhealthy sub- ject ?-The American Medical Recorder of Original Papers and Intelligence in Medicine and Surgery, conducted by John Eberle, M. D., Philadelphia, and II. W. Ducachet, M. D., New York, vol. 5, 1822-pp. 208-272. The power of the vaccine virus to relieve diseases of the skin, can only depend upon its absorption into the blood, and its effects upon the entire system; and facts are now wanting to show by actual manifestations of the local disease in other parts of the system not inoculated with the virus, that the entire system as well as the skin is brought under the action of this poison. Dr. Denby reported the case of Henry Freeman, a lad of twelve years of age, who was vaccinated in the left arm by the usual mode. The vesi- cle was marked by the appropriate progressive character of successful in- oculation. It happened that on the same day on which he was vaccinated (five hours subsequent to that process,) an incised wound was accidently inflicted on his right knee; which wound, for two or three days promised union by the first intention. On the fourth or fifth day, however, an in- crease of pain was felt in the knee, with throbbing and heat about the edges of the wound ; and, on inspection, some slight papulae, to the num- ber of ten or thirteen, were observed surrounding it. These appearances were yet referred to a common cause. On the eighth day, their peculiar and regular form imparted a conviction that they were true vaccine vesicles, which they proved to be by their progress and maturation.-London Med. Press, April, 1825. As far as our knowledge extends, the records of Medicine, are singularly barren of critical observations upon the phenomena manifested by man, when p-Cted upon* by* twu or .inure diseases at the same time. This iinper- Spurious Vaccination: Joseph Jones, M. D. 427 fection of knowledge results not only from the complexity of the phe- nomena, and the difficulties of the investigation, but also from the com- paratively infrequent occurrence of two or more contagious diseases, at the same time, in the same household, and in the same individual. Every fact illustrating the relations of the vaccine disease, to other dis- eases arising simultaneously in thesamei ndividual, is of importance in the light which it throws upon the modifications of the vaccine disease, and upon the question of the possibility of transmitting vario us contagious diseases through the medium of vaccine virus. The following tacts and observations by various writers, bearing upon these questions, which we have gathered up alter some research, are pre- sented under this division of our subject, to which they naturally belong, rather for the purpose of exciting and aiding farther investigation, than as full and complete investigations upon which definite and uncontrovertible principles may be founded. I have myself conducted extended investiga- tions upon the mutual relations, of various concurrent diseases, as malarial fever, typhoid fever, pneumonia, cerebro-spinal meningitis, hospital gan- grene and pyaemia, the results of which it would be impossible to present at the present time, although related to the subject now under discussion ; and I shall present those facts which relate chiefly to the relations of small- pox and the vaccine disease to several of the Exanthemata. If we accept without reserve the doctrine of John Hunter, that "No two actions can take place in the same constitution or in the same part, at one and the same time; no two different fevers can exist in the same constitu- tion, no two local diseases in the same part, at the same time;" ( Works of John Hunter, edited by James F. Palmer, London, 1837, vol. 2, Treatise on the Venereal Disease, p. 132); the question of the modification of the vaccine dis- ease by concurrent diseases, as well as the possibility of the transmission of contagious diseases through the medium of the vaccine virus is definitely set- tled in the negetive. The unreserved assent to such a doctrine as this, is wholly incompatible with the admission of the possibility of transmitting such a disease as syphilis through the medium of the matter produced by a distinct disease, different in its mode of origin, constitutional action, symptoms and progress. . Even the renowned author of this doctrin, appears to have experienced difficulties, when he attempted to apply it universally. The engrafting of other diseases upon the systems of those who were laboring under constitu- tional syphilis, and scurvy, as well as the occasional occurrence of these two diseased states in the same individual, presented'at the outstep diffi- culties to the mind of John Hunter, which he attempted to remove by argu ment. The mode, as well as the facts, by which Hunter supported his doc- trine are worthy of full consideration, in this connection, as gathered from various portions of his works. "0/ diseased actions, as being incompatible with each other.-As I reckon every opera- tion in the body an action, whether universal or partial, it appears to me beyond a doubt that no two actions can take place in the same constitution, nor in the same part, at one and the same time ; the operations of the body are similar in this respect to actions or motions in common matter. It naturally results from this principle that no two different fevers can exist in the same constitution, nor two local disease in the same part. There are many local diseases which have dispositions totally different, but, having very similar appearances, have been supposed by some to be one sort of disease, by others to be of a different kind, and by others again a compound of two diseases. Thus the venereal disease, when it attacks the skin, is very similar to those diseases which are vulgarly called scorbutic and vice versa. These, therefore, are often supposed to be mixed, and to exist in the same part. Thus we hear of a pocky-scurvy, a pocky-itch, rheumatic- gout, etc., which names, according to my principle, imply a union that cannot possibly exist. 428 Spurious Vaccination: Joseph Jones, M. 1). •'It has been considered as contradictory to this opinion that a patient might have scrofula, scurvy, venereal disease, small-pox, etc., at the same time. All of this is in- deed possible ; but then no two of them can exist in the same part of the body at the same time ; but before one of them can occupy the places of another, that other must be first destroyed, or it may be superseded for a time, and may afterwards return. "When a constitution is susceptible of any one disease, this does not hinder it from being also susceptible of others. 1 can conceive it possible that a man may be very sus- ceptible of every disease incident to the human body, although it is not probable ; for I should believe that one susceptibility is in some degree incompatible with another, in a manner similar to the incompatibility between different actions, though not of so strict a kind. "A man may have the lues and the small-pox at the same time ; that is, parts of his body may be contaminated by the venereal poison, the small-pox may at the same time take place, and both diseases may appear together, but still not in the same part. "In two eruptive diseases, when both are necessarily the consequence of fevers, and where both naturally appear after the fever nearly at the same distance of time, it would be impossible for the two to have their respective eruptions, even in different parts, be- cause it is impossible that the two preceding fevers should be coexistent. •'From this principle I think I may fairly put the following queries: Do not the failure of inoculation, and the power of resisting many infections, arise from the existence of some other disease at that time in the body, which is therefore incapable of another action ? " Does not the great difference in the time, from the application of the cause to the appearance of the disease, in many cases, depend upon the same principle? For in- stance, a person is inoculated, and the puncture does not inflame for fourteen days, cases of which I have seen. Is not this deviation from the natural progress of the disease to be attributed to another disease in the constitution at the time of inoculation ? Does not the cure of some diseases depend upon the same principle?-as, e. g , the suspension or cure of a gonorrhoea by a fever. " Let me illustrate this principle still further by one of many cases which have come under my own observation. On Thursday, the sixteenth of May, 1775, I inoculated a gentleman's child, and it was observed that I made pretty large punctures. On the Sun- day following, viz., the nineteenth, he appeared to have received the infection, a small inflammation or redness appearing around each puncture and a small tumor. On the twentieth and twenty-first the child was feverish; but I declared it was not the variolous fever, as the inflammation had not at all advanced since the nineteenth. On the twenty - second a considerable eruption appeared, which was evidently the measles, and the sores on the arms appeared to go back, becoming less inflamed. " Ou the twenty-third he was very full of the measles ; but the punctures on the arms wrere in the same state as on the preceding day. On the twenty-fifth the measles began to disappear. On the twenty-sixth and twenty-seventh the punctures began again to look a little red. On the twenty-ninth the inflammation increased, and there was a little matter'formed. On the thirtieth he was seized with fever. The small-pox ap- peared at the regular time, went through its usual course and terminated favorably." (Vol. 3, Treatise on the Blood, Inflammation and Gunshot Wounds-pp. 3-5. "All diseased actions are simple.-A disposition of one kind may and shall exist in a part or whole, while an action of another kind is going on; and when the action ceases, the disposition, or dormant action, if we may be allowed to call it so, shall then come into action. * * " Two children were inoculated for the small-pox. Their arms inflamed, but about the third or fourth day from the inoculation symptoms of fever arose, and the measles ap- peared, and went through their progress as usual. During this time the inflammation in the arm was arrested; but when the measles were completely gone, the small-pox took place, aud went through its progress. " Here a disposition for the measles had taken hold of the body, but although it ha'^ done that previously to the small-pox, yet it was not in such a way as stopped the pro- gress of the small-pox. The small-pox matter was capable of contaminating, and pro- duced inflammation, which went to a certain length, but the moment the measles changed their disposition into action, as the two actions could not go together, the actiou of the small-pox was suspended till the measles had gone through its action, aud the moment the constitution got free of this, the small-pox began to act again. "A lady of rank was inoculated by Mr. Sutton. A few days after a fever came on, of the languid or putrid kind, but without any eruption, except a few petechiae on the breast; she went through the process of a low fever, and afterwards the small-pox com- menced ; yet when the pustules matured they spread and were very large; also a differ- ent set of eruptions succeeded so that thirty days passed before the skin was clear of the eruptions. Spurious Vaccination: Joseph Jones, M. D. 429 " These cases show that but one mode of action can take place at the same time; yet I could conceive that two actions might produce a third one, which might have been a new poison, as the last case in some measure seems to show." (Vol. 1, Principles of Sur- gery, pp. 312-313.) Dr. Joseph Adams, in his valuable Observations on Morbid Poisons, Chronic and Acute (London, 2d Ed., 1807,), advocated the doctrine of Hunter, that " Two actions cannot be carried on at the same time, or in the same constitution. And recorded in his work the following observations to sustain this proposition: "Though the law was entirely overlooked till Mr. Hunter's time, yet it is now as well ascertained as any other in pathology. It is worth remarking, that in all the epidemics described by Sydenham, in which small-pox and measles raged at the same season, he gives no hint of there ever appearing at the same time in the same person Dierembroek, indeed, mentions a solitary instance in which the two diseases took place at the same time. His son remarks on the passage, that he never met with a similar instance more than twice in his own practice. Dierembroek's account is somewhat confused. It should be remarked, too, that measles was at that period not so distinctly marked as in later times, and that with the small-pox and other exanthemata, an unusual efflorescence, which may be mistaken for measles is not uncommon We have, however, two cases given us by that close observer, Dr. Russell (Medical and Chirurgicat Transactions, vol. 2, p. 90), which from the reputation of the author, deserves particular notice. The series and order of symptoms are traced with such accuracy, as not only to place the fact be- yond a doubt, but to enable us to make remarks without conjectures, or with only such as every reader will see are admissible. " We shall first observe, that when in the ill-built and crowded city of Aleppo, small- pox and measles were at the same time epidemic for three months together, only two such cases occurred. In both these cases, the measles were of a formidable kind. It is now established, that if measles do not produce their full action, they sometimes occur a second time. (See Dr. Willan's Diseases of London, p. 207.) It would be a curious inquiry, if there were chance that it could be satisfied, to iearn whether, on a future epidemic, these children took the measles again. However, those who know how few laws in pathology are without any exception, will only be surprised that this should so rarely occur. " Dr. Settsom (Mem. of Med. Society, vol. 4, p. 288), relates the history of a family, consisting of the parents, eight children, and three servants, among whom scarlatina and measles appeared about the same time. Some had measles first, others scarlatina. All the latter, and as many as had gone through them before, had measles. In conse- quence of 1 his succession, adds the Doctor, the disease continued in the family for two months, which probably might have terminated in as many weeks; but no person had the two diseases at the same time, so far, at least, as could be ascertained by the symp- toms !" The industrious De Haen, wishing to discover a common original cause for all the exanthemata remarks that small-pox and measles usually become epidemic about the same time. Referring to his notes, he observes, that in the year 1752, scarce afamilj' but was visited by other diseases at the same time, yet each individual had the two diseases in succession-Videas successive iisdem in aedibus occupare infantes quorum alii mor- billis, variolis alii laborere demum incipiant.- Hat. Med., vol. i., page 102. "Dr. Winterbottom, in a general vaccination, describes the retardation of that process, by the occurrence of measles, as an event too common to excite any particular attention. (Med. Trans., vol. xiv., p. 25). The same retardation was remarked by Dr. King, from the same cause. (Med. Trans., vol. xiii., p. 167). The same occurred to Mr. Wachsell, at a general inoculation in Walthamstow. "Dr. Willan observes, that it is generally found the small-pox, measles, scarlet fever, and whooping-cough, become epidemic about the same time, and continue their progress, though not with equal violence. (Diseases of London p. 105), Yet of the three former he gives no instance in which two of them appeared at the same time in the same person. It is evident that this was not from any inadvertency, because we find the same accurate writer, on another occasion, observing that whooping-cough and small-pox had occa- sionally occurred in the same person and at the same time. On this I would remark, that after the febrile paroxysm of whooping cough has subsided, the disease loses its specific character, and if the lungs have materially suffered, the cough may be exas- perated by the variolous paroxysm. But Dr. Willan, in another place (Diseases of London, pp. 38-39) asserts, that in some instances whooping cough commenced during the small- pox eruption. If this fact had been furnished by a less accurate observer, I wonld have objected, that whenever whooping cough is epidemic, we have usually other severe coughs at the same time, which in children, are not easily distinguishable from whooping cough. But admitting the accuracy of the statement, it only proves, as Dr. Willan observes, 430 Spurious Vaccination: Joseph Jones, D. that the law, though very general, is not without any exception. We have also his own authority, that in some instances the whooping cough was instantly superceded by small- pox, and after the decline of the latter, returned with the same violence as before. Mr. Oakes (Medical Journal, vol. 8., p. 426) relates the case of a child whom he was under the necessity of inoculating with small-pox whilst under the whooping cough. The con- sequence was that as soon as the eruption appeared, the cough ceased and never re- turned. The same has frequently happened after vaccination, and I have reason to be- lieve, permanently, as the cough has not returned at least ten days after the process of vaccination has been completed. This is now so generally understood, that many mothers have brought their children to the hospital for vaccination, under an expecta- tion of curing them of whooping cough, and I do not recollect that any of them have been disappointed. However, I would never recommend it till the acute symptoms of the cough are passed, for, as till that time the full action of the disease is not over, it is reasonable to expect its return when the process of vaccination is completed. "To those who are fond of tracing the operation of nature under disease, it will be curious to mark the exact regularity of the succession of these morbid poisons when they occur in the same subject. Mr. Hunter, (Introduction to Treatise on the Venereal Disease, and also to the Treatise on the Blood, etc)., found the variolous insertion in his patient interrupted on the fourth day after the puncture was made, till which time it had proceeded regularly. On the day following, themorbillous fever commenced, and on the fourth day after that, the measles appeared. Four days afterwards, the measles began to disappear. During,these eight days, the variolous insertion had made no progress; but on the following day it recommenced its process, and in five days afterwards the variolous fever commenced. Here the constitutional disposition was interrupted on the fourth day. On its recommencement, five days more were necessary before the action could take place, nine days being the medium between the insertion of small-pox and the commencement of the variolous fever. "Mr. Cruickshank's case (Treatise on the Absorbent Vessels, p. 126,) appears to have been interrupted ab initio : for he found his patient with all the symptoms of morbillous fever on the ninth day after inoculation. The punctures of the arms, therefore, con- tinued invisible till the constitution began to recover from the measles, after which time the punctures inflamed and required their full period of eight days for the appearance of small pox. " In a general vaccination at Walthamstow, two children were seized with the morbil- lous eruption on the eighth day after vaccination. In these the areola from that virus was suspended for four days. In a third, on the tenth day ; and here the interruption to the process was only three days. " But a most elegant experiment, in illustration of this subject, is contained in Dr. Willan's last number of Cutaneous Diseases. ' I inoculated,' says Dr. Willan, 'about the same time, three children with the fluid contained in these (lymphatic or miliary vesicles in measles), but no effect was produced by the inoculation. A similar trial, at the inoculation hospital, proved more successful. Richard Brooks, aged eighteen, was inoculated by Mr. Waschsel with fluid from the miliary vesicles in the measles, and with vaccine virus, January 6, 1800. On the tenth there was some redness and ulceration in both the inoculated places. January 15, the redness round the part where the lymph of the measles was inserted had disappeared, while the vaccine pock was vivid. January 18, the vaccine disease was over. January 22, he has a severe cough, sneezing and watery eyes, with cold shiverings and fainting. January 28, the measles appeared; his eyes were inflamed and the lids swollen. January 29, the efflorescence was diffused all over the surface of the body; frequent cough and violent fever. February 1, efflores- cence disappeared ; cough and fever much abated. From that time he gradually recov- ered, and was dismissed in health on the twelfth of February.' "This interesting passage, besides containing an account of the successful inoculation of the measles, affords also a striking illustration of the protraction of a disease, after the disposition of it had taken place, and its regular return to complete all its periods, as soon as the cause which interrupted them ceased. This subject was, at the same time, susceptible of the two contagions ; and as long as the diseased actions were local, both went on at the same time in different parts. But as soon as the constitutional disposi- tion commenced in one (the vaccine), the local action from the other was suspended. When the vaccine disposition and action were completed, the rubeolous disposition com- menced. Four days afterwards the constitutional symptoms showed themselves, with cough, sneezing and watery eyes.* In six days more the eruptive symptoms began, and were completed on the following day. On the fourth day afterwards, the efflorescence disappeared and the symptoms abated, making, in the whole, about twenty-seven days, a fair allowance for the two diseases. *Dr. Willan considers the common period, after infection by effluvia, before these symptoms appear to be from six to ten days. The anticipation in this case, by inoculation, is nearly analogous to the mean differ- ence between inoculated and casual small-pox. Spurious Vaccination: Joseph Jones, M. D. 431 " The following laws, then, are to be admitted with as few exceptions as any others that are received in pathology : " 1. All persons are susceptible of the impression from a morbid poison, in proportion as they are unaccustomed to it. "2. That susceptibility and disposition are necessary in a constitution or part before the action excited by a morbid poison can take place. "3. That after the constitutional disposition has taken place from a local diseased action, the destruction of that local action will prevent the future appearance of the constitutional disease. " 4. That no two actions from two different morbid poisons can be carried on at the same time in the same part, or in the same constitution. "5. If a constitutional disposition to one morbid poison exists, whilst the action of another is going on in the constitution, we ought to expect the action of the first to ap- pear after the action of the second is completed, or has ceased. " 6. Though nothing can prevent an action from following after a disposition has taken place, yet a disposition may be prevented by preventing a susceptibility in the constitu- tion or part. "7. The susceptibility may be prevented by rendering the constitution familiar with the morbid poison, or, as long as the constitution is exposed to it, by keeping up a con- stitutional action previously excited by another morbid poison, or any other cause."- Adams on Morbid Poisons, pp. 21-23. Dr. Lundford, a native of Jamaica, who made Yaws the subject of his inaugural dissertation, states that "those who are under the Yaws are liable to the other exanthemata, such as measles and small-pox. The lat- ter may be induced by exposure or inoculation, which last is better attempted when yaws is in the decline, for then the small-pox will either entirely take away yaws, or at least will check it for some time; nor will the funguses continue long, even if they should happen to appear again on the surface." Upon this observation Mr. Adams, in his work on Morbid Poisons, remarks: " All this is perfectly analagous to what has been traced in other morbid poisons. It is probable that the irritation from small-pox and measles, being greater than from yaws, may interrupt the latter at any time. But the laws of that poison, requiring a certain course to be pursued, if the new irritation is induced before that course is completed, the disease must return as that new irritation ceases. If, on the contrary, the irritation has not been induced till the course of yaws is completed, and nothing remains of it but an habitual ulceration, the new irritation will not only supercede the old action, but by breaking the habit very much expedite the cure." "Dr. Dancer, in confirmation of the above, gives the following quotation from Dr. Membhard : ' During the universal prevalence of small-pox in this Island, in the year 1784, it was remarked, that several negroes afflicted with yaws, who had the yawy pus- tules on the surface of the body, and had been a considerable time under all the afflicting circumstances of the disease, were inoculated promiscuously among many other negroes. The result was that upon the decline of small-pox, and dying away of the pustules, the yaws also gradually clisappeared; as if both might be considered in the light of one congenial disease. (Adams on Morbid Poisons, pp. 212-213.) Dr. Delgrade relates several cases of the simultaneous occurrence of small-pox and measles, which ran their course together. A child was in- oculated with the matter; on the eighth day, this infant, after a slight indis- position, took the measles. " On the fifteenth, after having completely recovered from the measles she became very feverish. Between this and the twentieth, she had several convulsions. On that day small-pox appeared. The infant not having been near any other child with that disorder, it was thus proved not only that the eruption was variolous, but that the fever was in- fectious. "Still the difficulty remained of accounting for its origin, since no small-pox was known to prevail in the neighborhood. The parents and neighbors could give no clue. Soon afterwards I heard that a child had recently died of combined small-pox and measles. Unable to trace this report, I concluded it was merely an erroneous account of the present case. Calling, hewever, with Mr. Daniell, on a female, one of his dispensary patients, she informed me that the child was her own. Of this case I can give no accu- rate narrative. The mother herself was dying, and the child had been visited by no medical attendant. Judging from the statement, I imagine the two disorders occurred 432 Spurious Vaccination: Joseph Jones, 21. D. in succession, not simultaneously. The child was taken ill some days before Brookes' and certainly died of small-pox. Yet even this was unsatisfactory since the families lived at a distance from each other. No communication of the children was known, un- til I discovered they had attended the same school, a circumstance of which their friends were mutually unconscious." {Medical Chirurgical Transcript, of London, vol. 1, Part I.) Dr. Russell, in noticing the reciprocal influence of small-pox and measles, states that he carefully watched above three hundred cases in which these diseases succeeded each other, at a time when they were both epidemic at Aleppo (1765). He noticed that the measles rarely succeeded small-pox in less than twenty days from the first appearance of the eruption. Several cases occurred where small-pox succeeded measles before the total disap- pearance of rubeolous rash from the extremities, that is on the eleventh or twelfth day of the eruption. He adds, 11 so little did the quality of the first disease influence that of the second, that a mild, distinct small-pox was often observed to follow the worst kind of measles, and vice versa." Willan relates the case of a young man, aged eighteen, inoculated for measles and cow-pox on the same day; the cow-pox took the lead, measles following at the end of sixteen days; and Dr. Gregory has described a case very analogous, but there measles had the start, and after sixteen days cow-pox had its turn. Dr. Gregory calls attention to the fact, that in each case sixteen days was the period of suspension, and expresses his belief that this was, not accidental. (Lectures on the Eruptive Fevers.) Dr. Moreland reported to the Boston Society for Medical Improvement the following interesting case: On the thirteenth of February, 1856, he vaccinated a healthy male infant, six months old. On the seventeenth of the same month, a faint but suffic- iently distinct eruption of measles was observed about the neck and shoul- ders. The usual symptoms of rubeola had declared themselves on the next morning after the vaccination, and the disease, consequently, must have commenced only a few hours previously to that operation, if four days be adopted as the period elapsing between the attack and the appearance of the eruption. The vaccine vesicle matured very slowly for several days, ami the rubeolous eruption continued with varying distinctness, but al- ways comparatively slight, until the nineteenth of February, when it dis- appeared. The vaccine vesicle then took a start, and went on rapidly to perfection. There seemed to be a retarding action reciprocally maintained for a time by the two affections, thus accidentally crncurrent; vaccine finally prevailing. The circumstantial record made at the time reads thus: "February 17, vaccination apparently taking effect, measles appeared; will the vesicles be retarded ? 18, vesicles advancing very slowly, measels retrograding; ordered a warm bath. 19, vesicles going on, but more slowly than is common; less redness around it; eruption of measles gone ; will it recur ? 20th, vaccine vesicle much larger ; child fever- ish ; warm bath. 21, at 7:15 o'clock in the morning, the child was seized with a severe general convulsion. He was seen by Dr. M. in about twenty minutes; a warm bath had been used. Wine of ipecac, and enemata, with cold lotions to the head, were at once resorted to, and subsequently, three grains of calomel with five of rhubarb were given. Aspect of the little patient pale and confused. At 1:45 o'clock p. m., he had another convulsive attack of rather greater severity. By previous direction, he was immediately placed in a warm bath, the body and limbs were well rubbed with the hands, and sinap- isms were applied to the abdomen and to the feet; the face being colored and the scalp showing many turgid vessels, a large leech was applied to the left temple, and the wound was allowed to bleed for half an hour after the animal fell off. No more convulsions through the day. At 7:30 o'clock p. m., mustard was applied to the back of the neck. The night of the twenty-first was passed by the patient in quiet sleep. 25, very bright and well to all appearance, until about 9:30 o'clock, a. m., when he had another very severe convulsion, lasting several minutes longer than the two previous ones. He was seen fifteen minutes after the access of the fit; was found stupid, with an occasional wild look in the eyes ; had been placed again in the warm bath. Mustard-water frictions to the extremities were continued; the head being rather hot, cold applications were cautiously made to it; one drachm of castor oil was given; discontinued the breast milk. Spurious Vaccination : Joseph Jones, M. D. 433 Dr. Storer saw the patient at this time, and recommended Dovers powder, one eight of a grain of the former to one half of a grain of the latter, every three hours A contin- uance of the mustard-water frictions were also advised. Dr. 8. believed that another leech might be needed. Dr. James Jackson, who had been sent for at Dr. M.'s request, visited the child shortly after, and gave a favorable prognosis. It was thought best by him to restrict the child's nursing to one minute's time every two hours; and, in the inter- vals, to allow sugar and water. Dr. J. thought that although another leech might pos- sibly, be required, he should be 1 slow to apply it.' The remainder of the management was concurred in. The powders above mentioned were commenced, and the other means continued. There seemed a degree of amendment iu the afternoon of this day, and there had been some good sleep. The night of the twenty-second was quietly passed ; there was only one dejection ; a little colicky pain from flatulence ; no convulsive action. 23, Quite well, seemingly; pulse 118, rather sharp (yesterday, 128 to 130); skin moist: one powder was taken at bedtime last evening, and another this morning. The vesicle of vaccination has broken and dried into quite a large scab ; it was full, yesterday. In the afternoon of this day the child seemed dull and stupid, possibly from fatigue ; the lips and tongue somewhat swollen ; suspended the regular use of the powders ; renewed the mustard frictions, etc. He was now allowed to draw the breast during three minutes, not having nursed for three hours previously. Flatulence troublesome ; relieved by mint-water. 24, night quiet; had one dejection ; got one powder about midnight; the eyes somewhat red ; no signs of returning rubeolous eruptiou ; tongue white; occasional colic. 25, nearly as well as ever. 26, same record. 27, a cervical gland, on the left side (that of vaccination), much enlarged ; otherwise very well and lively. Discontinued visits. From the last date to the present time, there has been no untoward occurrence, the child seeming better even than before its illness. "The supervention of measles upon vaccination, by the doctrine of chances, must be rare ; a purely accidental occurrence. The points of interest in this case are the evident mu- tually retarding influence of the two affections thus coexisting ; the modification of the vaccine vesicle and of the eruption of rubeola by this action-not uncommonly witnessed under such, or similar, circumstances of complication-and, especially, the convulsions, as to their cause. Dr. M was at first inclined to ascribe these to the retrocession of the measles; but it will be noted that they were manifested upon the eighth day after vac- cination, when the vesicle should be perfect and the primary febrile action is usually ob- served-and consequently they may be more reasonably referred to the latter. This was Dr. Jackson's opinion. How much influence the conjunction of the two affections may have had, however, can hardly be determined. In his recently-published volume, Dr. Jackson gives an instance where convulsions took place in a child on the eighth day after vaccination. Some time previous to this the patient had had pneumonia, which was ushered in by convulsions, and the same had occurred, also, during dentition. Dr J. had apprehended they might take place after the vaccination, and had forewarned the mother on the subject. He refers to other cases in which convulsions were observed in children at the commencement of bronchitis and scarlatina, but mentions only one after vaccination. Iu the case detailed above, there had not been any convulsions, pre- viously, nor any threatening of them; there was, therefore, no reason to expect them. "In this connection, the remark of Sydenham may appropriately be referred to 'that an epileptic fit, in infants, is so sure a sign of small-pox, that if, after teething, they have one, you may predict variola-so much so that a fit over night will be followed by the eruption next morning. This, however, will be generally mild, and in no wise con- fluent.' (Works, Syd., Soc. edit., v. 2, p. 252.) Dr. Jackson also remarked 'that he be- lieved convulsions are not rare in children, when the symptoms, so-called, of small-pox, first appear-corresponding to the eighth day of vaccination.' It would seem that the accident must be frequent after simple vaccination."-Boston Medical and Surgical Journal, June 19, 1856. Joler has described an epidemic of measles that took place in the Retzat Circle, in Bavaria, in the district where he himself resided. He says that the disease was much milder among the vaccinated than among the unvac- cinated. Fifteen in fifty-two died among the non-vaccinated, while barely one in three hundred died among the vaccinated, showing that measles was eighty-six times more fatal among the former than the latter. As far as our knowledge extends, there are but few facts bearing upon the question of the possibility of the transmission of the poison of measles along with the vaccine virus. The experiments of several authors have shown that measles may be transmitted by inoculating a sound person, either with the blood, with the fluid of the accidental vesicles which sometimes complicate the eruption, or with the secretions of those affected with the disease. 434 Spurious Vaccination : Joseph Jones, M. D. Dr. Home, of Edinburgh, in 1758, appears to have been the first Euro- pean physician who proposed and performed the inoculation of measles. His method of inoculation was to apply cotton dipped in the blood of a measly patient to a wound in the arm of the well patient. He describes the febrile symptoms as appearing on the sixth day, and of a mild char- acter, with no secondary complications. (Clinical Facts and Experiments, 1858.) Mr. Wachsel, of the Small-pox Hospital, in the early part of this cen- tury, inoculated successfully a lad with fluid taken from the measly vesi- cles. In 1822, Dr. Speranza, an Italian physician, in the territory of Man- tua, repeated the experiments of Dr. Home, Professor of Meteria Medica in the University of Edinburgh. He inoculated six cases and afterwards himself, with the blood taken from a slight scratch in a vivid papula. In a few days the measles appeared, and went through their course mildly and regularly. This encouraged him to make further experiments, and he says they were all successful. Dr. Von Katona, ot Borsoder, in Hungary, conducted an extensive series of experiments upon the inoculation of measles in 1842. He inoculated 1,122 persons, by taking the blood and fluid from the vesicles, or a drop of the teats from a patient laboring with the disease. The operation is said to have been performed in the same manner as the inoculation for small- pox ; the infecting blood was drawn from the vesicles most effloresced. The puncture was immediately surrounded by a red areola, which soon dis- appeared. On the seventh day the fever set in with the usual premonitory symptoms of measles, as rigors and catarrhal symptoms; on the ninth and tenth day the eruption appeared; on the fourteenth desquamation commenced with decrease of fever and eruption; and on the seventeenth day from inoculation (seventh and sometimes eighth from eruption) the patients were in general convalescent and apparently well. Dr. Katona failed only in seventy-eight cases out of 1.112 (seven percent.); and he affirmed that the resulting disorder was mild, contrasting favorably with the severity of the reigning epidemic. No deaths occurred among the in- oculated. The fruitless and unsatisfactory experiments which have been performed at different periods for the purpose of testing the possibility of inoculating measles, cannot be adduced as evidence against these well- established facts, for a single successful inoculation is sufficient to over- throw any number of unsuccessful attempts. Dr. George Gregory, in his valuable Lectures on the Eruptive Fevers, even goes so far as to express his belief that the child whose case he had de- tailed as having undergone cow-pox after measles, " received the germ of measles and of cow-pox at the same time; in other words, that unknown to me the child that furnished the lymph was incubating the measles, with the zuma or poison of which the vaccine matter had been impregnated." The following is the case as recorded by Dr. Gregory: Eliza Finch, aged four months, residing at Pentonville, was vaccinated by me at the Smalt Pox Hospital, May 15, 1835. May 17 the child began to droop. Bilious vomiting, very severe, with drowsiness, succeeded. Much blood passed by stool. The head was very hot. Vomiting continued all that and the four following days. It ceased on the twenty-second. On the twenty-fourth the other febrile symptoms yielded a little. On the twenty-fifth (nine days from the invasion of symptoms, and eleven from the probable reception of the germ,) measles appeared and went through its course regularly. Whilst the preceding facts, in the main, support the doctrine of Hunter, and show that where two poisons, representing two distinct contagious ex- Spurious Vaccination: Joseph Jones, M. D. 435 anthematic diseases, act simultaneously upon the human being, the most obvious pathological phenomena excited by the poisons will not occur sim- ultaneously, but in succession, the one poison retardiug the action of the other, the one producing its cycle of changes, whilst the other remains dormant, as it were, during the action of the other, and immediately after the changes induced by the first cease, inducing its own distinct effects ; at the same time it must be admitted that the character and course of these specinc eruptive diseases are greatly modified by such altered states of the constitution as exist in scurvy, scrofula and secondary syphilis. In that class of diseases represented by constitutional syphilis and scurvy, the whole mass of blood is at fault, and the nutrition is perverted, and the course and products of diseased actions are comparatively modified. As all the nutritive processes are more or less deranged in scurvy and secondary syphilis, and as it is now established that the blood in the latter disease is capable of reproducing syphilis when inoculated in healthy bodies, and as we have shown that in scurvy the blood is so deteriorated and the forces so depressed, that the smallest injuries tend to degenerate into foul gangrenous ulcers, it is but reasonable to conclude, apart from well-established facts, that the vaccine lymph would partake of the quali- ties and properties of the blood from which it is formed, ami the parts by which it is secreted. And even if the doctrine be maintained that the vaccine matter, as well as all other special morbid poisons, have an unvary- ing chemical and physical constitution, the difficulty is not removed, as in the practice of vaccination we are unable to separate the active agent of the virus, from much extraneous matter, as lymph and blood. And we contend that it is impossible to open a living vaccine vesicle and draw matter for vaccination, without injuring to a greater or less extent, the delicate blood-vessels, within and around the vesicle. With reference to the concurrent action of the poisons of two contagious exanthemata, upon the same system, we know nothing whatever of the state and mode of the existence of that poison which lies dormant whilst the other is acting. Does it remain in the part where it has been inserted, or does it exist as well in the blood, and effect those organs and tissues which are not implicated in the action of the first ? Until the relations and effect of each exanthematous poison has been carefully studied, and its effects determined upon the constitution of the blood, upon the process of nutrition, upon the action of the nervous system, and upon the chemical and physical phenomena of the body, as manifested more especially in the disturbances of circulation, respiration and calorifi- cation, and excretion, it will be difficult if not impossible to settle such questions. RELATIONS OF CHICKEN-POX TO SMALL-POX-HISTORY AND PHENOMENA OF CHICKEN-POX (VARICELLA) - DIFFER- ENTIAL DIAGNOSIS BETWEEN VARICELLA AND VARIO- LOID. CHICKEN-POX (VARICELLA) CRYSTALLED - VARIOLA SPURIA - VARIOLA LYMPHATICA-VARICELLA VOLATICA-VARIOLA PUSILLA-EXANTHEMA VARICELLA. Definition.-An eruption over the body, of semi-transparent glabrous vesi- cles, with red margins accompanying a slight attack of fever, seldom passing into suppuration; but on the third day, bursting at their tips, concreting 436 Spurious Vaccination: Joseph Jones, M. I). into small puckered scabs, and leaving no cicatrices. The disease consists of a specific eruption, in a series of new crops usually appearing for several days in succession ; so that dried and fresh vesicles are often along- side of each other, on the breast, back, face, and extremities, preceded by fever. The disease may be portracted for a fortnight or longer. Changes of Temperature.-According to Thomas and other observers,* sometimes in the incubation stage of varicella, there are slight elevations of temperature, and at the time of the eruption in many cases the rise of tem- perature is very trifling. In the majority of cases, however, sometimes at the beginning of the exanthematic period and sometimes after a copious eruption had been developed, there is a sudden and relatively considerable elevation of temperature, sometimes indeed only a few tenths over 38° c., or about 101° F.; in rather severe cases 38.5° c. (101.5° F.) to 40° c. (104° F.); but seldom more. The high stage lasts from two to five days, and the fever is remittent, and as regards the height of the temperature cor- responds pretty accurately with the copiousness of the eruption. The maximum temperature occurs sometimes in the first, but more often in the second half of the fastigium, and the morning remissions after the maxi- mum were somewhat more considerable than they had been before. De- fervescence was rapid and commonly over in half a day. Under the name of chicken-pox, or varicella, have generally been com- prised certain eruptions which closely agree in many features with each other, and which in some respects resemble small-pox. It is from this lat- ter circumstance that they deserve a particular notice, as they are gener- ally of so slight a nature as to require but little medical treatment. They were formerly very generally confounded with small-pox; but the differ- ence between them was remarked as early asthe beginning of the sixteenth century, by Vidus Vidius and Ingrassis. Sennery and Riveri, professors at Wurtemburg and Montpellier, at the commencement of the seventeenth century, and Diemerbrock, state that the distinction was well known in Germany, France and Italy, to the vulgar, who had a separate appellation for this eruption. Morton was the first in England to mark the differ- ence, and to describe this disease under the name of 11 chicken-pox." Since then it has been noticed by Fuller, and accurately described by Heberden. Heberden, however, continued to designate it by the term variola pusilia ; whilst his cotemporaries, Vogel, Burserius and Sauvages, also applied to it the generic term, variola, with the specific designation of volatica, spuria and lymphatica. Dr. Heberden must be regarded as the principal writer on varicella, who, in 1767, published in the first volume, page 427, of the Transactions of the Royal College of Physicians, a description of the disease, professing to give a full and accurate account, not only of its symptoms, but of its pa thological relations; and for a long series of years this paper was looked upon as a standard authority on this disease. In 1805, Dr. Frank, of Vienna, carefully distinguished the several kinds of spurious small-pox, and by way of distinction applied to them tlie names of pemphigus varioloides, vesicularis and solidescens. His description of the former disease corresponds accurately with the complaint hitherto called chrystal-pock, water-pock and chicken-pock. In 1809 a detailed account of varicella was published by Dr. Heim, of Berlin, but much confusion is occasioned by his applying the same term to designate three kinds of spurious small-pox-the water-pock, the horn- * Archiv der Keilkunde, 8, 376 ; Archiv fur Dermatologie and Syphilis. 1. 309. Temperature in Diseases, Dr. C. A. Wunderlich, New Sydenham Society, 1871, p. 311. Spurious Vaccination: Joseph Jones, M. 1). 437 pock and the swine-pock. Dr. Heim affirmed that matter taken from a subject who has chicken-pox will only produce chicken-pox, and afford no protection from small-pox. He also states that the cicatrices left by vari- cella were different from those of variola, and that a careful inspection of them is alone sufficient to designate the one disorder from the other. We find, upon careful examination, a similar statement as to the inoc- ulability of chicken pox, in il The Report on the Cow-pox Inoculation, from, the practice at the Vaccine-Pock Institution, during the years 1800, 1801 -and 1802, read at the general meeting of the Governors, February 7, 1803, at the Shakespeare Tavern ; written by the Physician of the Institution ; to which are affixed two painted engravings of cow-pox and other eruptions." London, 1803; p. 41. The following is the detailed statements of the Physicians of the Cow-pox Institution, Drs. George Pearson, Lawrence Niholl and Thomas Nelson in the above mentioned report: Chicken-pox occurring during vaccina, at any period, as well AS AFTER THE VACCINA. 2. Chicken-pox-Intervening cases have, occurred of chicken-pox not only at all times curing the cow-pock, but immediately after the scabbing process; as well as subsequently at a much later period. In this last re- spect of the chicken-pox after the formation of the scab, or at a later period of the cow-pock, there is a difference between the chicken-pox and small pox. No differences was observed in the stages of the cow-pock, or of the chicken-pox, when the two diseases went on together; except that the cow-pock was sometimes a little retarded in scabbing. In these instances there may be a constitutional affection for each of the diseases on different days, or they may occur together. In one case, the chicken-pox and the vaccine pock were inoculated on the same subject, and both went on as usually distinctly." Dr. Willan, in 1806, advanced somewhat our knowledge of varicella, by some observations published in the seventh and eighth edition of his work, (On Vaccine Inoculation, qt., p. 86). He therein describes with great minuteness, the appearance of varicellous eruption, which he subdivides into three varieties. In 1820, Dr. Thomson, of Edinburgh, published his views on the identity of the chicken-pox of Morton and Haberden with small-pox, in his account of the varioloid epidemic of Scotland during the years 1818 and 1819. This opinion of Dr. Thomson, which we have already presented in detail in a former portion of this inquiry, was nothing more than the revival of an old doctrine. The learned Dr. John Thomson and Mr. Berard urged, in favor of this opinion, the circumstance of variola and varicella appearing from the same exciting cause, whether those affected have been vaccinated or not; and affirmed that persons exposed to the infection of chicken-pox have caught small-pox, and that the former appears only in those whose constitutions have been modified by the influence of either small-pox or cow-pox. On this subject M. M. Schedel and Cazenave remark, that in those epidemics which they have had opportunities of noticing in Paris, the several erup- tions might be classed under three heads: 1, variola properly so-called; 2, the malady termed varioloid or variola modified; 3, an eruption purely vesicular, offering every appearance of varicella. The same cause, namely, variolous infection, seemed to develop these several eruptions, which were observed in the same quarters, in the same streets, in the same houses. When the disease made its appearance among 438 Spurious Vaccination: Joseph Jones, M. D. a numerous family, some had small-pox, some modified small-pox, and others chicken-pox. One circumstance was striking to every one, namely, the mildness of the disease in those persons who had been vaccinated, and in the majority of those who had already had variola. Whilst these facts appear to favor the old view, revived by Dr. Thom- son, many cogent arguments have been urged against it by Abercrombie, Bryce, Luders, Fisher and others. 1.. It is very difficult to determine, during a small-pox epidemic, whether the occurrence of that disease among individuals coming in contact with persons infected with the chicken-pox is rather the result of this communi- cation than of the variolous infection, which, at that moment, develops on all sides. 2. Vesicular varicella, so-called, is not transmitted by inoculation, and never produces variola. 3. Those persons who consider chicken-pox as contagious have con- founded it with modified small-pox. 4. Varicella appears in persons who have not been vaccinated, and who have never had the variola ; consequently, in such cases, it cannot be re- garded as a variola modified by the prior existence, either of the disease or of vaccination. 5. Vaccination practiced shortly after the disappearance of varicella, pursues its course in the most regular manner, which never happens when vaccination follows variola. 6. The progress of varicella is uniformly the same whether it occurs be- fore or after vaccination, or after variola. 7. Variola sometimes reigns epidemically, without being accompanied by varicella; and on the other hand, the latter may become epidemic without being attended by the former. In fact, the characters of the eruption, and the symptoms of varicella, differ essentially from those of variola. Dr. John D. Fisher, of Boston, in his valuable work on small-pox, vario- loid disease, cow-pox and chicken-pox, the first edition of which was pub- lished in 1829, gives an elaborate description of chicken-pox. Dr. Fisher strongly advocated the doctrine that " the small-pox and the varioloid are one and the same disease, the latter being only a modification of the former, and that the chicken-pox is a separate and independent malady. * * All the observations that I have been able to make go to confirm the truth of this opinion. Indeed, the fact that the small- pox and the varioloid are capable of engendering each other, and that the chicken-pox has, year after year, prevailed epidemically in many of our towns in which the small-pox never appeared, and consequently without giving rise to it, settle the question concerning their identity." Dr. John Hughes Bennett(l) held with Dr. Thomson, the opinion that chicken-pox was a modified form of small-pox; and this view has been more recently revived by Dr. Hamernjk, of Prague, and Professor Hebra. On the other hand many systematic writers of this day, as George Gregory,(2J James Copeland,(3) Felix Von Niemeyer,(4) J. F. Marson,(5) Edward Ballard (6) and William Aitken(7) regard the disease as wholly distinct from small-pox and varioloid. (1.) Clinical Lectures on the Principles and Practice of Medicine, third ed., p. 976. (2.) Cyclopaedia of Practical Medecine ; Philadelphia, 1859, vol. 4, pp. 636-639. (3.) A Dictionary of Practical Medicine ; New York, 1855, vol. 1, pp. 369-371. (4.) A Text Book of Practical Medicine: New York, 1869, vol. 2, pp. 560-562. (5.) A System of Medicine, Renolds; Philadelphia, 1879, vol. 1, pp. 124-127. (6.) Vaccination, its Value and Alleged Dangers; a prize essay ; London, 1868, p. 6. (7.) The Science and Practice of Medicine; Philadelphia, 1872, pp. 421-424. Spurious Vaccination: Joseph Jones, M. D. 439 DESCRIPTION OF VARICELLA. Under the name chicken-pox are included different varieties of eruption, generally characterized by very slight and brief antecedent fever, consist- ing of vesicles or very imperfect pustules, which maturate and decline in three, four and five days, occurring chiefly during infancy and childhood, but also at adult age, and occasionally prevailing epidemically. The gen- eric term, chicken-pox, comprises three species, or, rather, varieties, which have been distinguished from each other for very many years in America, and in different parts of England, by the names of chicken-pox, swine-pox and hives. These Willan and Bateman distinguished, according to the form of their vesicles, into: First, Varicella Lentiformis ; second, Varicella Coniformis ; and, third, Varicella Glohularis. Dr. Good adopted these names and dis- tinctions, but added & fourth-the Varicella Corymbosa-the clustering or confluent chicken-pox, which, if considered at all as a distinct variety, is not of frequent occurrence, but has occasionally been observed by Bate- man, Ring and Copeland. Anatomical Appearances.-The exanthema begins as small, red, distinct spots, which, after a few hours, are changed to liquid vesicles of the size of a pea or lentil, by a copious serous effusion between the cutis and epi- dermis. These vesicles have neither a central depression nor a cellular forma- tion. After a time these contents become whey-like, but never purulent, Thin crusts form from the dried vesicles, which fall off after a few days, without leaving a cicatrix. From the form of the vesicles, the different vareities, varicellae globulosa, ovalies, lenticulares, coniformes, and acu- minatae, are distinguished. We often see, especially when the eruption is very extensive, that, besides numerous varicella vesicles running the usual course, a few filled with pus (varicellae pustulosae) acquire the ap- pearance of variola pustules, and even leave cicatrices. Since the form of variola pustules is not specific, but exactly resembles that of some erythma pustules, we should not attach too much importance to the external resem- blance of some of the efflorescences in varicella to those in variola, and consequently consider the two diseases as identical. Symptoms.-There are no symptoms to be noticed before the eruption, they are absent or slight; headache and feverishness precede the eruption by a few hours; cough is sometimes observed. Eruption Period.-The eruption appears within the first twenty-four hours of indisposition, in the form of small sore spots, slightly accuminated; from ten to fifteen come out on the first day; they appear on any part of the body. The vesicle is preceded by a red spot or papule, due to hyper- aemia of the cutis vera, and not to an exudation into it, for tension of the skin causes the varicellous papule to disappear. On the second day there may be a hundred or a hundred and fifty fresh spots; those of the previous day have the epidermis raised in the form of a bleb, sometimes perfectly round, containing serosity as clear as water; there is no inflammatory areola. The vesicles from the first have the size of split peas, and that size is soon attained or exceeded. The patient has the ap- pearance of having been subjected to a shower of boiling water. The vesicle is unicellular, not umbilicated, has a very delicate cuticle, aid when picked collapses perfectly. The eruption occupies all parts of the body, the hairy scalp not excepted. The shape ol the vesicles on the trunk is often oval, the long axis being athwart that of the body. Itchiness is common and impels the children to rupture the vesicles. 440 Spurious Vaccination: Joseph Jones, M. D. The next morning a hundred or a hundred and fifty new spots will have appeared during the night, the eruption of the preceding day having be- come vesicular. The contents of vesicles which have lasted twenty-four hours become slightly milky ; the turbidity however is uniform. A slight inflammatory areola appears. This nocturnal outburst of spots, which be- come vesicular within ten hours, is repeated for four of five succeeding nights from the beginning of the disease. Many vesicles, as soon as they have attained their full size, get broken and so encrust at once. Those that remain unbroken present on the third, fourth or fifth day of their existence a small central scab, which quickly attains to the size of the vesicle in a day or two. The scab is thin and granular; it falls in fragments, and leaves no en- during redness and no cicatrix. If the vesicles have been subjected to unwonted irritation, the scab may be thick, coherent, and may leave when it falls a permanent pit. The following table presents a comparative view of the phenomena of small-pox and chicken-pox: Table, Giving a Comparative View of the Phenomena of Small-Pox and Chicken-Pox. SMALL-POX. 1. The fever is ushered in by a cold stage, is severe and continues three or four days, and after declining or ceasing in the eruptive process, it commonly re- appears during the suppurative stage, or between the fifth or eighth day of the eruption. 2. The eruption is often preceded or accompanied by an erysipelatous efflorescence. 3. The eruption does not break out until the third or fourth day of the fever; it appears first on the face, then on the neck, chest, trunk and extremities, and is completed in the course of two days, 4. The eruption presents itself in the form of small red circular points or papulae ; these are hard, resist- ing and moveable, and communicate to the finger a shot-like sensation. They scarcely project above the surface, but are easily and distinctly felt by drawing the finger over them. 5. The eruption seldom becomes vesicular before the end of the second or the commencement of the third day, and the vesicles are confined to the sum- mits of the pocks. 6. The pustules at first haveaccuminated summits; they aftewards become rounded, and at an early period present slight depressions in the centre of their surfaces. 7. Eruption is situated in the substance of the cutis. 8. The pustules after they have become vesicular are distinguished by hard, unyielding bases. 9. The pustules are composed of little cells, all of which communicate with each other; and the cuticu- lar coverings of the pocks are opaque, tough and not easily broke n. 10.'The pustules are at an early stage filled with a serous secretion ; this after a time becomes con- verted into purulent matter that exhales a very un- pleasant and peculiar odor. 11. The pustules remain whole until they are six or seven days old, when some of them commonly be- come ruptured, and permit a little of the virus to ooze out upon their surface,- but they still retain their form and prominence. CHICKEN-POX. 1. The fever is not often preceded by a cold stage, is uniformly light and is frequently insensible; it seldom continues more than two days, and never re- appears after it has once ceased. When, however, the vesicles appear in successive crops, the fever lasts longer and continues until the eruption is com- pleted. 2. This efflorescence does not take place. 3. The eruption breaks out by the termination of the first or on the second, and almost invariably before the end of the third day of the fever; it usu- ally appears about the breast and shoulders first, afterwards on the face and extremities. It fre- quently appears in successive crops for four or five days. 4. The eruption likewise breaks out in small in- flamed spots, out these are not papular in their origin and are not exactly circular, but tend to an oblong figure. They may be distinctly felt by the finger, but they are yielding under it, and are destitute of the tubercular hardness and rolling motion which characterize the variolous eruption at the same period. 5. The eruption is vesicular from the beginning or from the early part of the first day, and by the sec- ond day the whole surface of the pocks are converted into vesicles which resemble little bladders of trans- parent fluid. 6. The vesicles are usually lenticular in form, but are sometimes conoidal or globate, and present one shape through their course, or until they become ruptured. 7. Not formed in the true skin, but upon its sur- face, not in the cellular tissue between the skin and cutis. 8. The vesicles are destitute of tuberculous bases, are yielding, and easily give way underpressure, and communicate to the finger a soft, elastic sensation, or a feeling similar t» that which a minute globule of fine sponge softened with water would give rise to when pressed. 9. Tne vesicles are composed of a single cavity, and the coverings are extremely thin and fragile, are di- apthanous and very easily broken. 10. The vesicles contain, when fully matured, only a whitish transparent, serous fluid ; this never, ex- cept through accident, becomes pus, and is destitute of any unpleasant odor. 11. The vesicles often become broken in two or three days after their appearance, and pennit the whole of their contents to escape; their coverings then sink down and collapse, and the vesicles become flattened, or lose their Original form. Spurious Vaccination: Joseph Jones, M. D. 441 SMALL-POX. 12. The pustules break out simultaneously, pur- sue a regular march and arrive at maturity about the same time. Desiccation does not commence un- til about the eighth day of the eruption. The pro- cess of eruption of suppuration and of desiccation constitute three successive periods, rendered distinct from each other by their duration ; the first occupies about three days, and the other two about five days each. 13. A general swelling of the cutaneous surface takes place just before jthe pustules begin to desic- cate. 14. The scabs fall off in a single piece. The sur- faces of those who have had the disease remains spot- ted for a long time. The scars which remain per- manently in the skin are irregular in figure and pre- sent uneven surfaces, 15, The small-pox, even when distinct and of mod- erate mildness, is a disease of fifteen or twenty days in duration, and often proves fatal. 16. Communicated by contagion and inoculation, In varioloid or modified small pox, the eruptions, for a considerable time after the scabs have fallen, leave little kernels or tuberculous elevations in the skin. 17. The poison of small-pox,varioloid and cow-pox, in a majority of cases, preserve the system from sec- ond attacks of the same disease. 18. Children have been attacked by varicella who have been vaccinated, or had variola only a few weeks before, CHICKEN-POX. 12. The vesicles generally break out in successive crops for a number of days, in which case a great variety may be observed among them ; some are ap- pearing, whilst others are fully formed, shriveled or crusted. Desiccation commences on the fifth day, or as soon as the vesicles are ruptured, and some- times on the second, third or fourth days. The three periods of eruption, suppuration and desiccation seem to be confounded in consequence of the pocks in successive crops, the time ef their duration sel- dom exceeding eight days. 13. Desiccation is never perceived by any exten- sive swelling of the cutaneous surface. 14. The scabs do not usually fall off in a single piece, but in small fragments of different forms and sizes. The marks remaining in the skin after des- quamation are but slightly colored, and the redness if apparent soon disappears When scars are left in the skin by the vesicles they are regular and figure in present smooth sur- faces . 15. Chicken-pox runs its course and is completed in five or six days, or in eight or ten at the most, and it never of itself proves fatal. 16. Not communicable by inoculation, as shown by Dr. Bryce. The chicken-pox never gives rise to true small-pox or varioloid, neither is it ever com- municable by variola or varioloid 17. The chicken-pox when it prevails epidemically, attacks individuals who have never had the variolous and the cow-pox diseases, with equal readiness as it does those who have had neither. 18. Varicella frequently occurs in children that have never been vaccinated, and its occurrence does not prevent them taking small-pox, nor prevent successful vaccination . Varicella must, therefore, be regarded as a specific disease. SECTION IV.-DRIED VACCINE LYMPH, OR SCABS, IN WHICH DECOMPOSITION HAS BEEN EXCITED BY CARRYING THE MATTER ABOUT THE PERSON FOR A LENGTH OF TIME, AND THUS SUBJECTING IT TO A WARM MOIST ATMOS- PHERE. The effects of such decomposing matter, resemble those of the putrid matter received in dissecting wounds. The practice of some physicians to mix a considerable portion of powdered vaccine scab, with water on a glass slide, and to use this in a number of vaccinations, from house to house, is not unattended with danger, especi ally during warm weather. The danger of this filthy procedure, is three- fold. First, when the dried scab is used, the chances of communicating the vaccine disease by inoculation are lessened, and there is greater danger of communicating other diseases through the medium of this dried mass of pus, blood, lymph and cellular tissue. Second, when animal matter is finely divided and mixed with water, and subjected to a temperature of near summer heat, all the conditions are supplied for those active chemical changes, which in nitrogenized matters, frequently lead to the formation of poisons, capable of exciting rapid and destructive changes in the living organism. Third, in using matter from a common store, fresh blood is fre- quently conveyed from the patient vaccinated, upon the instrument or lan- cet, to the vaccine mixture. The liability to putrefactive change is not only increased by this mixture, but also the danger of communicating sec- ondary syphilis, Or any other disease capable of being transmitted by vac- cination is augmented. When a score, or more, cases are vaccinated from 442 Spurious Vaccination: Joseph Jones, M. D. the same supply, and with the same instrument, if the greatest precaution is not employed, more or less blood from different individuals becomes mixed with the virus. The method so common in America, of vaccinating with the dried scab, should be performed with great care. In the warm climate of the Southern States, it is especially difficult to preserve vaccine matter for any length of time, without more or less change and even putrefaction. The length of time which the vaccine virus will retain its active properties, will depend upon the temperature and moisture of the climate. The true mode of preserving and propagating the vaccine virus, is that recommended by Jenner, viz.; the inoculation of the lymph directly from the arm at a period not later than the eighth day. By a succession of such vaccinations upon a number of children, transported for this purpose, Dr. Francis Xavier Balm is, Surgeon-Extraordinary to the King of Spain, im- parted vaccination to many nations during his voyage round the world (1803-1806) executed for the sole purpose of carrying to all the possesions of the King of Spain beyond the seas, and to those of other nations, the inestimable gift of vaccine inoculation. At an early day in the history of vaccination, Dr. Jenner made numerous attempts to send the vaccine virus to the most distant possessions of the English in the East. After the failure of the virus sent by ships to India twenty recruits, or men of any description who had not had the small-pox, should be selected; and a surgeon appointed to attend the successive vac- cinations. Dr. Jenner thus engaged that the vaccine disease should be carried in its most perfect state to any English Settlements. Upon the re- jection of this proposition by the government, he formed the plan of equip- ping and sending out a vessel to India with such arrangements and such a number of men as to ensure the continuous transmission of the vaccine virus, by private subscriptions, and put down his own name, for one thousand guineas. Before his design could be carried into execution, tidings arrived from the east, that Dr. De Carro had succeeded in forward- ing vaccine matter from Vienna to Constantinople, and from thence to Bombay. The manner in which Dr. De Carro, (by whose unwearied labors the vaccine disease was first disseminated over Germany, Venice, Lom- bardy and other parts of Europe), transmitted the vaccine virus to India, possesses great interest at the present time, when so much carelessness is manifested by the profession both in the selection and in the preservation of the virus. Many disappointments having arisen from the difficulty of transmitting it in an active state to distant countries, Dr. De Carro employed every ex- pedient that ingenuity or experience could suggest to obviate them. Vari- ous methods had been tried. Impregnated lint, or threads enclosed between plates, or in bottles and in tubes closed up with wax. The prac- tice of imbuing the points of common steel lancets was soon abandoned. To these succeeded lancets of silver, silver gilt, gold and ivory. After a series of trials Dr. De Carro gave the preference to ivory, which he con- sidered to be, in all respects, the most secure vehicle for transporting the virus. On lancets of this material it was sent from Breslau to Moscow, where, under the patronage and actual inspection of the Russian Empress, it completely succeeded. As that which was destined for Bagdad would be exposed to the accidents of a long journey, in a climate heated by a scorching sun, he took special care to protect it as much as possible from external influence. He sent some on lancets of silver, silver-gilt and ivory; he also impregnated some English lint with the vaccine fluid, and enclosed it between glasses; and when be had properly secured them he dipped Spurious Vaccination : Joseph Jones, M. D. 443 them at a wax-chandler's till they formed a solid ball, which he enclosed in a box filled with shreds of paper. In this state the packet was safely con- veyed across the Bosphorus, and passed over the whole line of deserts; and he had the satisfaction of hearing that, on its arrival on the banks of the Tigris, its contents were still liquid and succeeded on the first trial. It was received on the thirty-first of March, 1802, upon the banks of the Tigris, and before the end of June it had reached Bombay. Dr. De Carro, in a letter to Dr. Jenner, dated Vienna, April 22, 1803, thus describes the method which he had employed for the preservation of the vaccine virus: " I do not know whether yon are well informed of the great improvement which MM. Ballhorn and Stro meyer have made to the glasses invented by you. They have taught us a simple and easy manner to pre serve the vaccine lymph fluid during an indefinite term. The Hanoverian vaccinators take a small bit of English charpie, which you call, I believe, dry lint. The quantity must be, of course, equal to the concavity of the glass. The pustule then is punctured by a circular or half-circular incision with the lancet, so as to open a greater number of the cells forming the vaccine pustule covered with the same pellicle. The lint is applied upon the pustule on the most wooly side, so as to act better as a syphon. It pumps in a very short time a sufficient quantity of vaccine fluid to saturate it as completely as if it had been dipped in a glass of water, particularly if the lint is now and then gently pressed with the point or back of the lancet. When it is quite full you take it with the lancet and place it carefully in the cavity of the glass; you put a drop of oil, or a little mucilage, upon the internal surface of the glasses ; you make the flat bit of glass slide upon the charpie, so as to exclude the air as much as possible ; you tie the two bits with thread, and seal the edges. To prevent the access of light I commonly fold it in a black paper, and when I was desired to send it to Bagdad, I took the precaution of going to a wax-chandler's, and surrounded the sealed-up glasses with so much wax as to make balls. With this careful manner it arrived still fluid on the banks of the Tigris." (Life of Edward Jenner, vol. 1, pp. 420, 430.) The method so extensively employed in America, of preserving the entire scab after it separates from the arm, by enclosing it in wax, is not only less reliable than the method practiced by Drs. Jenner and De Carro and others, but it is attended with greater danger, from the changes induced by heat and moisture. Shortly after the introduction of vaccination into the United States, by Dr. Waterhouse, ignorant persons, in New England, not of the medical profession, who were stimulated by avarice to carry on a traffic in vaccine matter, obtained the shirt-sleeves of patients which had been stiffened by the purulent discharge from an ulcer consequent on vaccination. These they cut into strips, and sold about the country as impregnated with the true vaccine virus. Several hundred persons are said to have been inocu- lated with this poison, which in some cases produced great constitutional disturbance. SECTION V-THE MINGLING OF THE VACCINE VIRUS WITH THAT OF THE SMALL-POX-MATTER TAKEN FROM THOSE WHO WERE VACCINATED WHILE THEY WERE LABORING URDER THE ACTION OF THE POISON OF SMALL-POX, WAS CAPABLE OF PRODUCING A MODIFIED VARIOLA, AND COMPARATIVELY MILD DISEASE IN THE INOCULATED, AND WAS CAPABLE OF COMMUNICATING BY EFFLUVIA SMALL-POX IN ITS WORST CHARACTER TO THE UNPRO- TECTED- OBVERVATIONS OF DRS. JENNER, WOODVILLE, ADAMS, WILLAN, GREGORIE, HENNEN, FOWLER AND BOUSQUET, UPON THE RELATIONS OF THE VACCINE DISEASE AND SMALL-POX. In more than one instance small-pox was disseminated, by vaccination with what was considered as vaccine virus. In all such cases the virus was obtained from patients who were laboring under 444 Spurious Vaccination: Joseph Jones, M. D. the action of the poison of small-pox, at the time of the insertion of the vaccine matter. Some cases of small-pox were said to have originated from the employment of small-pox scabs, which had been sent through the lines by the enemy as good genuine vaccine matter. As far as my knowledge extends, such accidents did not arise from the willful and malicious dissemina- tion of small-pox matter, as was charged publicly through the newspapers; but they were referable to the careless employment of vaccine matter de- rived from patients in small-pox hospitals, or from members of households vaccinated after small-pox had appeared in their midst, and consequently after the introduction of poison into their systems. Such accidents are by no means new to the profession, for, more that half a century ago, they had well nigh proved fatal to the infant cause of vac- cination. Many of the patients experimented upon, by Dr. Woodville, at the Small-Pox Hospital in London, were not only exposed to a variolous atmosphere, but they actually had small-pox matter inserted into their arms on the third and fifth days after vaccination. Dr. Jenner had positively asserted that pustules do not belong to the cow-pox: Dr. Wood- ville, on the contrary, affirmed that three-fifths of the patients whom he had inoculated with vaccine matter, had pustules not to be distinguished from variolous ones. Dr. Wood vile, in an interview which he held with Dr. Jenner on the twenty-third of March, 1798, mentioned that the cow-pox had been communicated by effluvia, and that the patient had it in the con- fluent way. Dr. Jenner is said to have remarked on this marvellous occur- rence, "Might not the disease have been the confluent small-pox commu- nicated by Dr. Woodville, as he is always full of the infection?" Such careless experiments as those of Dr. Woodville, conducted in a small-pox hospital! excited the strongest feelings of disappointment among the principal medical men of London, and for a season threw doubt upon the accuracy of Dr. Jenner's statement. And it was only after careful in- vestigation that Dr. Jenner was able to demonstrate that the London coto- pox was somehow or other compounded with small-pox. This contaminated matter from the London small-pox hospital, was dis- tributed to different parts of the country by Dr. Pearson, and caused most unpleasant accidents. Some of this contaminated matter fell into the hands of Mr. Andre, Surgeon at Petworth, and fourteen persons who were inocu- lated with it had variolous eruptions and in some cases suffered severely. Lord Egremont wrote along letter on this occasion to Dr. Jenner, detailing the occurrence at Petworth. The reply of Dr. Jenner to this letter is worthy of careful consideration, in the light which it throws upon similar accidents occuring during the recent war. My Lord-I am extremely obliged to your Lordship for your kindness in giving me so fully the account of the late inoculation at Petworth; a subject which, before, I did not clearly understand; and which, of course, had given me much vexation. I will just briefly lay before you part of the history of the cow-pox inoculation since my experiments were first publicly made known, which may tend in some measure to ex- plain in what manner pustules may be produced. About a twelvemonth ago, Dr. Woodville, Physician to the Small-pox Hospital, procured some virus from a cow at one of the London milk farms, and inoculated with it several patients at the Small-pox Hospital. Fearful that the infection was not advancing properly in some of their arms, he inoculated them (some on the third, others on the fifth day afterwards j with small-pox matter. Both inoculations took effect; and thus, in my opinion, a foundation was laid for much subsequent error and confusion ; for the virus thus generated became the source of future inoculations, not only in the hospital, but in London, and many parts of the country. Hearing a murmur among medical people that the cow pox was not the simple disease I had described, but that in many instances it produced as many eruptions and was attended with us much severity as the small-pox, I went to town with the view of inquiring into the cause of this deviation. Dr. Woodville at once invited me to the Small-pox Hospital, and very mgenously told me the whole of his proceedings. The inoculated patients were shown te me, and though some were;without eruptions and exhibited the appearance of the true cow-pox, others were very full of them, and I could not discern any differences be- tween them and the perfect small-pox. I therefore did not hesitate to tell the Doctor that it clearly appeared to me that the small-pox had crept into the constitution with the cow-pox; that I did not consider them as two DR. JENNER TO LORD EGREMONT. Spurious Vaccination: Joseph Jones, M. D. 445 distinct diseases, but as varieties only of the same disease ; and therefor# they might co-exist in the same constitution, and that thus a mixed disease had been produced. I communicated also the same sentiment to Dr. Pearson, who was then, and had been, busily employed not only in inoculating from this source, but in dispensing threads embued in the virus to various places in our own country, and to many parts of the continent. Forseeing what was likely to ensue from these hasty measures, I remonstrated against them, but was not listened to. In many places where the threads were sent a disease like a mild small-pox frequently appeared; yet, curious to relate, the matter, after it had been used six or seven months, gave up the vario- lous character entirely, and assumed the vaccine ; the pustules declined more and more, and at length be- came extinct. I made some experiments myself with this matter, and saw a few pustules on my first pa- tients ; but in my subsequent inoculations there were none. From what I once saw at the hospital, I had rea- son to think that some of these threads sent out were not only stained with small-pox matter from the con- tamination spoken of, butthat they had sometimes a dip in a real small-pox arm; as the patients were all mingled together at the hospital, and stood with their arms bare, ready to afford matter one among another. Without making any further trials with matter from the cowmanagedin another way, Dr. W. published a vol- ume containing the result of his practice, which certainly dampened the spirits of many who had from my represention taken up a high opinion of the cow-pock inoculation A thought now struck me that, if pos- sible, it would be proper to procure matter from a London cow, and compare its effects with that generated in the country. Unwilling to determine in a hurry, I procured matter from a London cow, conceiving it possible that th* animal in this situation might generate matter possessing qualities differing in some measure from that which is more in a state of nature in our meadows here ; but the result convinced me that the virus was the same, as 500 psople were inoculated from this source without the appearance of any pustules. But this his- tory, my lord, does not tell you by what means the pustules appeared at Petwortli ; but it informs you how errors may arise, and how they may be persisted in, There is another source which I fear will be too com- mon. Laacets are often carried in the pocket of a surgeon with small-pox dried upon them, for the purpose of inoculation. A gentleman some time ago sent a lancet here to have it charged, as it is called, with cow- pox matter; perceiving it stained at the point with some dried fluid, it was sent back, when he immediately recollected that his lancet was prepared with the matter of the small-pox. What confusion might have happened from this ; and how narrowly we escaped it! For it was but an equal chance, probably, that had the lancet been used a direct small-pox might have been produced, for the chances Were equal 'whether it produced one disease or the other. It may be necessary to observe, it is improbable that a mixture of the two matters used in this way would have produced a mixed disease, as two different diseased actions cannot go forward in one and the same part at the same time, so that the disease would have been either the perfect cow-pox or the perfect small-pox. The matter which was made use of, I hear, came from Dr. Pearson ; and doubtless Mr. Keate will have candor, and, I hope, industry enough to trace the error to its source. That there was error somewhere, of which Mr. Keate became the innocent cause, is a fact that I think will not admit of controversy. I have sometimes seen, perhaps in one case in a hundred, a few scattered pimples about the body and some- times rashes; but these have arisen from the inflammation and irritation of the arm, for it is very well known that many acrid substances, applied to the skin, so as to produce local inflammation, will frequently occasion a similar appearance. This letter, in which Dr. Jenner announces the doctrine held and taught by his triend John Hunter, (viz., two diseased actions, cannot go forward in one and the same part, at the same time), is important not only in the demonstration which it affords of the transmission of both small-pox and cow-pox, at the same time, through the same mass of matter, but it also contains a strong argument for the view held by Jenner that these were not distinct disease, but only varieties of the same disease. Dr. Adams, in his work on Morbid Poisons, gives the following interest- ing and important observations, which confirm the correctness of the views of Dr. Jenner. "It is to be hoped that a very correct attention to the processes of variolation and vaccination will enable us to ascertain the exact analogy which exists between the two morbid poisons evidently distinct, yet not entirely separated by those laws which we have to trace in others. The correspondence in the laws of each-the peculiarities in which they differ-the manner in which they interrupt each other's action, and the man- ner in which they may be made to act in concert, are all equally interesting, and the daily subjects of experiment and observation. At present the following may be consid- ered as established facts: " Each, when inserted, requires about the same time to produce its local effects. "A subject, that has regularly passed through either, is insensible to the future consti- tional effects to the variolous poison. "Each will produce secondary eruptions, having the same property of infecting as the primary; but the secondary eruptions appear more than ninety-nine times in a hun- dred in small-pox, and not once in three hundred, if the skin is otherwise entire, in the cow-pox. " In the small-pox, secondary pustules appear whilst the primary is advancing, and maturate two or three days after them. In cow-pox, when secondary vesicles appear, it is not till the primary has begun to scab. " The small-pox may infect by the effluvia, the cow-pox can only be communicated by the scretion from the local infection. " When these poisons are inserted at the same time in the same part of the same sub- ject, by mixing the secretion of each, only one will produce its effect. 446 Spurious Vaccination: Joseph Jones, M. D. " When inserted separately in different parts of the same subject, each will produce its local effect, and at the same time. "If cow-pox is inserted at the same time that the subject is exposed to a vitiated at- mosphere, the former will supersede the effects of the latter. If inserted four days later, the effect will be less certain, but as far as can be ascertained, not more uncertain than the variolous insertion," (Adams on Morbid Poisons, pp 10-16.) Dr. Adams gives sev- eral instances to show that the vaccine and variolous diseases may be confounded in cer- tain cases, that is, that the laws peculiar to one may occasionally influence the other. (See pp. 16-20.) " The invaluable Jennerian discovery has introduced us to a morbid poison, the prop- erties of which are different from all others that we are acquainted with in superseding the constitutional susceptibility to another. As such a law as this is unknown in any other two morbid poisons, we might suspect the analogy between these two would be clearer than between any other two. We might even expect that the characters of the two might be altered by applying both at the same time, and also that the phenom- ena of one might imitate the other in such a manner as to render the distinction between the two often doubtful. It is, therefore, rather a matter of surprise that the distinction should be so regularly reserved, aud the laws which separate other morbid poisons so rarely infringed. "The next thing I would remark is that small-pox and cow-pox, contrary to the law of all morbid poisons, which are different in their action, will proceed together in the same person without the smallest interruption of each other's course. If inserted nearly at the same time, in the same person, each proceeds in the same course as if it were in two different subjects ; if inserted nearly in the same spot, the two form one common areola, but the vesications are distinct, and each preserves its own character, till that of small-pox becomes purulent from suppuration for the separation of the slough. If secon- dary pustules follow from the small-pox, and they should continue coming out till the cow pox has completed its progress, its vesicle, like any other inflamed part, will become the seat of a small-pox pustule, or the whole vesicle will become purulent, contrary to its legitimate character. In the first case, you may take small-pox matter from the pus- tule, which, by the adhesive inflammation, will remain distinct from, though seated in part of the vaccine vesicle ; and from the other parts of the vesicle you may take the vac- cine matter, and each will perpetuate its respective morbid poison. If the whole vesicle becomes purulent it is a variolous pustule, and will inoculate small-pox. "It was remarked by Dr. Woodville that if a person is inoculated with small-pox to- day, and three or four days after is reinoculated with the same morbid poison, though the last insertion may remain a smaller pustule than the first, yet both inoculations will arrive at their height at the same time. The same takes place in cow-pox; and also, if a person is inoculated to-day with cow-pox, and three or four days after with small-pox, or to-day with small-pox and three or four days after with cow-pox, the two insertions, though the last may remain smaller than the first, will maturate and scab at the same time. "By these facts it appears, first, that a marked kind of small-pox may be perpetuated. If, therefore, the cow-pox is a marked kind of small-pox, there can be no reason why it should not have been perpetuated with its true character; and that the cow-pox is such, appears, secondly, by its not being interrupted by, and not interrupting the progress of small-pox, and by both retaining their respective laws and characters at the same time, whether inoculated separately in different subjects, or the same; or if each has been in- oculated in the same subject at different times, the consequence is similar to the inocu- tion of either one, at different times. " These experiments have been repeated so often, as to leave no question concerning the law. The same experiments have been repeatedly tried with small-pox and measles, and also with cow-pox and each of the others, yet these interruptions have always fol- lowed, which have been remarked in the early part of the work. " As, therefore, a marked variety of small-pox is capable of preserving its distinct character under inoculation, there seems no reason why the cow-pox should not be among such varieties; and as any of the known varieties will destroy the susceptibility to the disease in all other forms, so there is no reason why cow-pox, if among the varie- ties, should not do the same; and there is the more reason to expect this, because, contrary to any morbid poisons, the action of small-pox aud cow-pox are maintained at the same time in different parts of the constitution, subject respectively to similar laws, whether only one or both of them are applied in any variety of forms. " It may be said that small-pox is an eruptive disease, whilst cow-pox, though affecting the constitution, is only confined in its local action to a single part. But small-pox is sometimes, we have seen, equally confined in its local action, and principally in those cases in which its appearance most resembles cow-pox. It is not less certain that cow- pox, on some occasions, produces secondary eruptions. Besides the cases I have seen myself, the Rev. Mr. Holt {Med. and Phys. Journal) gives an account of full eruption Spurious Vaccination : Joseph Jones, M. D. 447 of vesicles, which had the same properties of contagion as the inoculated part. The Rev. Mr. Fermn saw a few scattered in different parts." (Adams on Morbid Poison, pp. 398-401.) Dr. Will an found "that when a person is inoculated with vaccine and variolous matter about the same time, (that is, not exceeding a week,) both inoculations proved effective, for the vaccine vesicle proceeded to its acme in its usual number of days, and the maturation of the variolous pustule was attended by a variolous eruption on the skin." (On vaccine Inocula- tion, p. 1.) When cow-pox is inserted during the incubative stage of the casual small-pox, while the small-pox is still latent, the vaccine vesicle for the most part does not advance, or advances tardily and imperfectly. There are exceptions, however, to this rule, and cow-pox and casual small-pox may sometimes be seen running their full course at the same time. In no case, however, does the cow-pox so inserted alter or modify the course of the small-pox. When the variolous and vaccine fluids are inserted into the arms on the same day, each disease occasionally proceeds, preserving its original character. At other times, however, they mutually restrain and modify each other. The vaccine vesicle is smaller than usual, and irregu- lar in its progress, while the variolous pustules which follow are of the kind denominated vanolae verrucosae, vulgarly swine-pock, stone-pock, or horn pock (Willan on Vaccine Inoculation, p.5); that is to say, they are hard and shining, surrounded with little inflammation and they suppurate imperfectly. The small quantity of matter they contain is absorbed, leav- ing the cuticle horny and elevated for many days afterwards. Upon the extremities the eruption does not pustulate at all, but is minute and papu- lous, and terminates by desquamation. It will be found in most cases that even though the eruption be modified in its character, there is, neverthe- less, considerable disturbance of the general system under the joint influ- ence of the variolous and vaccine poisons. Dr. Woodville has said that if the cow-pox matter and the small-pox matter be both inserted in the same arm of a patient, even within an inch of each other, so that on the ninth day the same efflorescence becomes com- mon to both the local affections, nevertheless inoculating from the cow-pox tumor the genuine vaccine disease will be produced (Observations on the Cowpox, p. 12); but if the inoculation be performed with a mixture of the two matters, then the chance is equal that small pox or cow-pox will be the result, or the varioloid disease. When the insertion of the vaccine lymph precedes that of the variolous by a period not exceeding four days, both diseases advance locally. Some- times an eruption of small-pox papulae follows. At other times the vario- lous fever is slight and unaccompanied by eruption. Under these circum- stances matter taken from the primary vesicles shall sometimes communi cate cow-pox and small-pox respectively, but more commonly the variolous poison predominates, and contaminates the lymph of the vaccine vesicle. It was ignorance of this phenomenon, in the mutual action of the vaccine and variolous poisons, which occasioned Dr. Woodville's mistakes at the small-pox hospital in 1799. Variolous matter inserted into the arm at any period not exceeding a week from the date ot vaccination will take effect and be followed by a pustule. After that time no effect is produced. When small-pox inoculation precedes by three or four days theinsertion of vaccine lymph, the vaccination advances, but after the tenth day the fluid in the vaccine vesicle becomes purulent j and in that state will communi- 448 Spurious Vaccination: Joseph Jones, M.D. cate small-pox. (Willan on Vaccine Inoculation, p. 8; also Dr. George Gregorie's valuable article on Vaccination in the Cyclopaedia of Practical Medicine.) Dr. Denby, whilst admitting that the period of incubation of variola may be somewhat undefined, as in the case of other animal poisons, con- cludes that, nevertheless, from experiments, a fair conclusion may be formed as to the usual period of this incubation, when prophylaxis may be in- duced. Anri from these Dr. Denby judged that, if on the third day, before the onset of erethism, rigor, and headache, perfect lymph be inserted, prophylaxis is almost certain, assuming three or four days for the premoni- tory symptoms before the variolous point or papula appears. The vaccine vesicle will then be eight or nine days old, the areola will be becoming indurated, and erethism will exist. Dr. Denby considers that in this fever against fever, the essence of prophylaxis really exists. If under this influence the variolous papula proceeds, it will resemble umbilicated vari- cella or horn-pock. If the vaccine be used two days later, especially if there be bronchial or pulmonary symptoms present, it will be useless. The papula may be just apparent, but it will be blighted. There are, of course, exceptions to this rule. A woman was delivered, says Dr. Hennen, while suffering from confluent variola; the infant was vaccinated a few hours after birth. The mother died on the eleventh day ; the infant had true vaccine and lived. Med. Times, October 25, 1851.J In an analagous case, reported by Mr. T. C. Beatty, of Durham, the child delivered from a mother in whom the variolous pustules made their ap- pearance during labor, was not vaccinated until the morning of the fourth day after its birth. True vaccine was the result; and yet, on the eighth day after she was vaccinated, when the vesicles were fully matured, the little patient was very ill, and showed signs of eruption under the skin, which proved to be confluent small-pox, of which the little creature died four days after. (London Lancet, 1852.) Dr. Robert Fowler, of the Loughborough Dispensary, and Mr. Robert Tod, of Gilmore Place, Edinburgh, (London Lancet, 1852); MM. Herard and Bousquet, (L'Union Medicale, Nos. 108, 109, 110, Bulletin de Th6ra- peutique, tome 35, pp. 342-52), and others, have recorded cases proving the possibility of the simultaneous existence of small-pox and the vaccine dis- ease, and confirming the correctness of the conclusions of Jenner and the older observers. M. Bousquet goes so far as to deny that the two eruptions, variola and vaccinia, exert any reciprocal reaction, and the nearer they appear to- gether, the more independent are they of each other. Suppose for example, that they could appear at the same hour, then each would pursue its or- dinary course, just as if the other were not present. But supposing the one eruption appears after the other, all will depend upon the space of time separating them. If this be only some hours, or even two. or three days, all passes on as just stated. The case is different when one of these eruptions is greatly in advance of the other. If this is not to such an extent as to exclude, the eruptions progress together, but not in parallel. The most advanced always keeps its advantage, and finishes at its ordinary epoch, without having undergone any change in form or duration. The other follow s it at a distance, but after the variolous capacity of the sub- ject has become exhausted by the first, the second dies away. In these influences, M. Bousquet considers that there is nothing direct, active or special; they are the consequences of the faculty possessed by the eruptions of supplying or substituting each other. The vaccinia does not Spurious Vaccination: Joseph Jones, M. T). 449 arrest the variola, but it is the variola that stops short in the face of the vaccinia : and, conversely, variola does not cut short the course of vac- cinia, but this last interrupts its own course in presence of the variola. It is the right of precedence, and the more widely the two eruptions are separated, the more readily do they exclude each other, while the nearer they are together, the more independently do they proceed. Considered in themselves, the vaccine and variolous virus are so little capable of des- troying each other's energy, that if they are mixed together, and inocula- tion performed with the mixture, M. Bousquet affirms that two perfectly distinct eruptions may be produced. Considered as regards their effects, therefore, according to this view, it cannot be said that vaccinia cures variola, or even, rigorously speaking, prevents it. It takes its place, stands in its stead, and is neither more nor less than a substitution. Thus, so far from explaining the operation of vaccinia by the supposed opposition it offers to variola, we would rather do so by the analogy and reciprocal action of the two diseases. (Bulletin de Thferapeutique, tome 35, pp. 342-52; also, the British and Foreign Medico- Chirurgical Review, April, 1849.) From the facts recorded in this section, we deduce the practical conclu- sions : First-That vaccine matter derived from the patients of small-pox hos- pitals, or from those in civil or military practice who have been exposed to the contagion of small-pox, should never be used for the propagation of the vaccine disease. Second-The vaccine disease is not a distinct disease from small-pox, but a variety or modified form of the variolous affection. SECTION VI.-DRIED VACCINE LYMPH OR SCaBS, FROM PA- TIENTS WHO HAD SUFFERED WITH ERYSIPELAS DURING THE PROGRESS OF THE VACCINE DISEASE, OR WHOSE SYSTEMS WERE IN A DEPRESSED STATE FROM IMPROPER DIET, BAD VENTILATION, AND THE EXHALATIONS FROM TYPHOID FEVER, ERYSIPELAS, HOSPITAL GANGRENE, P Y^EMIA, AND OFFENSIVE SUPPURATING WOUNDS-DR WM. GERDNER, OF GREENE COUNTY, TENN., ON THE RE- LATIONS OF ERYSIPELAS TO VACCINATION-CASES OF ERYSIPELAS FOLLOWING VACCINATION-VIEWS OF DR. PAUL F. EVE, ON THE POSSIBILITY OF INOCULATING ERY- SIPELAS BY VACCINATION-DR. J. C. NOTT, OF MOBILE, ALA., ON ERYSIPELAS-REPORT OF DR. J. F. BELL, OF VIR- GINIA-REPORTS OF SURGEON HUNTER McGUIRE OF VIR- GINIA, AND OF OTHER PHYSICIANS. In several instances during the revolution death resulted from phleg- monous erysipelas following vaccination in apparently healthy patients, in both civil and military practice. It was believed that in some cases the poison of erysipelas was con- veyed along with the vaccine virufii 450 Spurious Vaccination: Joseph Jones, M. D. Ill one instance which came to my knowledge, the lives of several negro women and children were destroyed by erysipelas excited by vaccine matter taken from the same scab, and a stout healthy white man who was vaccinated with the same matter, and by the same physician who vac- cinnaated the negro (on a neighboring plantation), was extremely ill from the effects of the poisonous matter, and barely escaped with the loss of a large portion of the muscles of the arm. I was informed upon good authority that the matter caused the death of a preguant negro woman, and of another negress and her young infant, of some week or ten days of age, at the time of the inoculation of the vaccine virus. The following observations relating to erysipelas following vaccina- tion, were placed in my hands, by Dr. Frank A. Ramsay, of Memphis, Tennessee: COMMUNICABILITY OF SYPHILIS BY VACCINATION. BY WILLIAM GERDNER, M. D., OF GREEN COUNTY, TENNESSEE. I notice in the Medical and Surgical Monthly, June, 1866, an article taken from the Richmond Medical Journal, June, 1866, by William Fuqua, M. D., Appomatox County, Virginia, on the communicability of syphilis by vaccination. About the same time referred to by Dr. Fuqua, I had numerous cases of vaccination, in the district of my practice, presenting abnormal features. The people believed it to re- sult from syphilis, and called the exhibitions by that name. I made close scrutiny of the cases occurring under my observation, and concluded that they were not syphilitic in origin or manifestation. I regarded them as erysipelas, presenting the form called phleg- monous, for which opinion I thought I had reasons. Many cases assumed the form of common erysipelas, invading limited portions of the arm, and in some few cases the whole surface of the vaccinated limb was affected. The proper distinction for the practical physician of erysipelas, is superficial and deep- seated-ordinary or common erysipelas affecting the cuticle proper-deep seated or phleg- monous erysipelas involving the tissues, particularly the cellular. At present the cause of the difference is inexplicable-why in one case serum, and in the other lymph is poured out, remains a question, while the fact exists. Each distinct inflammation has its habits. As far as iny knowledge extends, the records of medicine do not afford any very large collection of cases of erysipelas supervening upon vaccina- tion. The following are the most important cases of the apparent excitation of erysipelas by vaccination, which were noted in the works and journals consulted during these researches : Diffuse Cellular Inflammation following Vaccination.-The first was that of.a female child, aged five years, who had been vaccinatefl by a respectable practitioner in Dublin. This child was brought to the physician who reports these cases, about three weeks after it had been inoculated. The arm was then greatly swollen, the swelling extending to the hand ; the integuments of the upper arm were of a dusky leaden hue, and a large black slough occupied the situation of the usual crust of the vaccine vesicle. The child's pulse was weak and slow, not exceeding sixty-four. The extremities were cold, tongue dry and coated. There were extensive sloughing and hemorrhage from the mucus membrane of the mouth. The integuments of the cheeks adjoining the commissure of the lips were of a livid hue. The respiration was very much hurried, but no physical sigu of disease could be detected in the chest. The child's parents stated that these formidable symptoms first presented themselves, between the ninth and twelfth day from that on which it had been vaccinated. The practitioner who inoculated the child affirmed that up to that period, the vaccine vesicle ran a healthy course and that he had vaccinated other children with the same lymph in whom the course of the vesicle was perfectly regular. This child was of a delicate con- stitution, having suffered with attacks of scrofulous ophthalmia, pneumonia, and bron- chitis. Its health was said to be good, at the time it was inoculated. Complete recovery, though very slow, was effected in this case by the use of mild tonics and stimulants. The second case"was that of a male child, aged eighteen months, who was also vac- cinated by atphysician of Dublin. About the twelfth day from the period on which it was vaccinated, the arm was attacked with severe inflammation of the erysipelatous character, the vaccine vesicle having, up to that day, according to the statements of the parents, run a regular course. On the sixteenth day, a dark slough, as large as a shilling occupied the situation of the vesicle J the entire extremity was immensely swollen ; the Spurious Vaccination: Joseph Jones, M. D. 451 integuments of the upper arm were of erysipelatous redness, and such of them as were in the immediate neighborhood of the slough were quite livid. The attending fever was of the inflammatory type, the skin being hot, tongue furred, pulse rapid and full, and the thirst great. Until the fever was subdued by cooling and alterative medicine, and the local inflammation relieved by the application of poultices and fermentations, the sloughing spread with the most alarming rapidity. After the sloughs had separated, and the progress of the gangrene arrested, a large and deep ulcer remained with undermined edges, at the bottom of which the muscles of the arm could be distinctly observed ; so extensive was this ulcer, that it was not healed for three months, though the case pro- gressed most favorably in every respect."-Dublin Journal of Medical Sciences, 1844. Dr. Greene reported to the Boston Society for Medical Improvement, a fatal case of erysipelas, following re-vaccination, which occurred in January, 1846. The patient, a gentleman sixty-four years of age, had been vaccinated twenty years before, and re-vaccinated, though without success, two or three times since. On Friday, the day after the re-vaccination by Dr. Greene, he was seized with chills, nausea, and a sense of general uneasiness; and, at the same time, inflammation commenced in the arm, attended by heat, redness, and pain. He slept none on the following night, and on the next night was attacked with vomiting and purging. The symptoms from this time did not become materially worse, however, till the following Wednesday, when he complained of pain just below the elbow ; and on Thursday, a small patch of erysipelas was discov- ered at this point, which gradually extended over the arm and chest of the affected side, the infiltration of the cellular tissue, keeping about two inches ahead of the redness. He died at ten on Friday evening, a little more than eight days from the time of re-vaccina- tion, the erysipelas having extended to within two inches of the sternum. In regard to the quality of the matter introduced, Dr. Greene remarked that it was taken on the eighth day from a perfectly formed vesicle, on the arm of a perfectly healthy infant, born of healthy parents ; that one of his own children had been vaccinated with the same matter, and also another person, in both which cases, the symptoms and appearances were slight. It is said that in 1849 and 1850, erysipelas so frequently followed vac- cination in Boston, and the result was so often fatal, that many physicians refused to vaccinate, except when it was absolutely necessary, and almost entirely abandoned re-vaccination. Cases were reported to the Boston Society for Medical Improvement, by Drs. J. B. S. Jackson, Cabot, Bige- low, Homans, Putnam and Channing-. From the transactions of this so- ciety we select the following cases : Case Reported by Dr. Cabot.-This being a case rather of diffuse cellular inflammation than common erysipelas. The patient was a gentleman, sixty-nine years of age, who having been exposed to varioloid, was re-vaccinated in two places on the third of April. On the second day, two vesicles had formed about the size of a small pin's head, and there was pain iu the axilla, with pain and soreness under the pectoral muscles. In about two weeks the inflammation had extended to the hand, and in the course of the third week an opening was made about the elbow, from which a considerable quantity of sero-purulent fluid was discharged ; the back of the hand being opened down to the fascia a few days afterwards. From the shoulder the erysipelas extended over the whole back, down the right arm to the elbow, and somewhat over the abdomen from each side ; also across the front of the chest, nearly to the right shoulder. The whole duration of the erysipelas in an active form was about seven or eight weeks; neither the hand nor lower extremities were affected; the areola about the vaccine points subsided, but sub- sequently the surface was attacked with the disease. The suppuration about the left shoulder and down the upper extremity had been very extensive; the pectoial muscle was separated from the parietes of the chest, «nd the skiu of the forearm was so de- tached from the subjacent parts that fluids thrown in at the elbow would pass out at the back of the hand; very numerous openings have been made about the elbow and shoulder for the discharge of pus. For about two months the patient was confined to his bed, and convalescence was tedious. The prostration was not so great as would have been expected in such a case ; the pulse not rising above ninety during the active stage of tbe inflammation ; there was, however, some delirium, with chills, headaches and pain in the back. No suppuration occurred, except in the parts above alluded to. Case Reported by Dr. J. Bigelow.-This patient was a gentleman, about thirty years of age, and having been exposed to small-pox, was re-vaccinated with several others, from the same virus. Two days afterwards, an erysipelatous spot, of the size of a dollar, was discovered around the point of vaccination. This spread rapidly in every direction, and at the end of five days, had occupied the whole arm from the shoulder to the elbow. At 452 Spurious Vaccination: Joseph Jones, M. D. this time, several dark spots appeared upon the inside the arm, which in two days were perfectly gangrenous, so that an incision was made five inches in length, without pain. The slough was apparently confined to the skin and cellular substance, inasmuch as the muscular power was at no time lost. Meanwhile the pulse was quick, and the skin hot, with prostration, headache and delirum. In another week, the erysipelas had extended to the whole trunk, half way down the thigh, and to the wrist of the affected arm ; the patient being much of the time delirious, or somnolent, and with a pulse of 120. During the third week, the symptoms were greatly aggravated, and the cerebral affection in- creased ; there was also a retention of urine, and the catheter was required for a fort- night. During this time, however, the slough gradually separated, leaving a large, deep ulcer. The patient became convalescent at the end of a month, and slowly recovered ; the ulcer requiring another mouth or more to cicatrize. No other person, who was vac- cinated with the same virus, had any unusual symptoms; but a lady of the family, about seven weeks after the vaccination, was attacked with inflammation of the fauces and tonsils, followed by protration and delirum, and died in a week ; during her sickness a livid spot, about two inches in diameter, appeared over the upper part of the sternum, but this disappeared before death. In another case reported by Dr, Bigelow ; a healthy child about five months old, was vaccinated, and the vesicle went on well until the ninth day, when the arm became erysipelatous, the inflammation rapidly spreading over the whole trunk; and the child died in a few days. Ou the eighth day of the vesicle, the day before the appearance of the erysipelas, matter was taken with which three others were vaccinated, and these patients had perfect vesicles without any anomalous symptoms Case Reported by Dr. Homans.-The patient was a healthy infant, about three weeks old. On the eighth day, the vesicle appeared well, and matter was taken with which other children were vaccinated, the result being in every case successful. On the tenth day, erysipelas appeared below the elbow, and extended into the axilla; the swelling and redness very defined, and the inflammation spread rather more rapidly than is usual in the adult. Vomiting and diarrhoea came on, and lasted some days ; the pulse'was too quick to be counted. The head and abdomen then became affected, andyon the ninth day from the invasion of the disease, the scrotum and penis were greatly swollen ; these last were punctured with much relief, but a deep sloughing of the scrotum took place, one and a half inches in diameter, and nearly exposing the testicles. The extremities were next affected, but in the mean time the child began to improve, and the pulse had fallen to 120. On the subsidence of the disease, abcesses formed upon the body and limbs beneath the surface, and about the left hip, one that was quite large and deep. This last, is the only one that remains open, and the child is fairly convalescent, after a sickness ol about three months. Dr. Channing mentioned a case of erysipelas after vaccination in which the shoulder, axilla and pectoral muscles were involved. (The American Journal of Medical Sciences, October, 1850-pp. 318-321.) Dr. Charles E. Buckingham, Physician to the Boston House of Industry, has also published an interesting case of "Constitutional Irritation follow- ing Vaccination," from which we make the following abstract: B , a farmer, twenty-five years of age, of previous robust health, vaccinated on Thursday, August 28, 1849. September first, he took an emetic, and on the second a cathartic dose. > Both operated freely. Dr. Buckingham was first called to him at nine P. M., September 3. At this time the patient presented the following conditions : Complete anorexia ; great thirst; headache ; sleeplessness; pain in back ; eyes and hearing normal; urine free ; pulse 150, full and strong; decubitus dorsal. His late vaccination was not known at this time. Got a saline mixture, consisting principally of bicarbonate of soda and chlorate of potassa. Fourth.-Febrile action less; has pain in calf of right leg; no tenderness, redness, swelling or heat. Ninth.-Pulse, 84 ; appetite good. No sleep last night on account of the pain in the calf, and in the sole of the right foot; has had a sinapism to the foot, with partial relief; no dejections for twenty-four hours; whole of right calf swollen; a circum- scribed red spot one and a half inches below head of right fibula, covering about two inches. Tenth.-Patient was seen, in consultation, by Dr. H. G. Clark. Redness more diffused; leg much swollen, and cedematous from knee to heel; pain confined to spot of yesterday, which is, for the first time, tender ; no headache or thirst; eyes and hearing normal ; neither delirum nor sighing ; no appetite ; tongue red at its top, and in other parts cov- ered with a thick creamy paste ; pharynx the same ; pulse, 88, full. Spurious Vaccination : Joseph Jones, M. D. 453 Thirteenth, 9 a. m.-Pulse, 100, full and soft; dejection. Attention was called to a hard, red, circumscribed swelling on the left forearm, similar to the others ; in examining which, found the remains of an irregular vaccination, of which Dr. Buckingham first learned the date as given above. Sixteenth.-Swelling of right leg decidedly less; that of the left leg hard, red, and ex- cessively tender. The right elbow was red and swollen. The right eye red, swollen and painful about the orbit; no conjunctival redness; tears trickling over face; pulse 120, full, soft, dicrotic ; respiration slow and distinct, with occasional sighing; no delirium; tongue perfectly steady, when protruded; face somewhat livid; no dejection for two days, except from enemata. Eighteenth.-Had a good night; pulse 112; respiration 16; nose much swollen, dusky, red and painful; about a dozen papules, hard, red and shot-like, scattered over forehead, face, back and legs; no glandular enlargement. 12 M., a few more papules on abdomen ; the others are becoming pustular, and a few are umbilicated. Nineteenth, 8:30 a.m.-Two dejections, with urine; tongue dry, black and cracked; redness and swelling of whole upper face ; papules increasing in number, and pustules in size; a few of them umbilicated; no glandular enlargement. Twentieth, 10 a. M.-Pulse 120, more firm, but not so full; respiration 32, labored, no rales ; numerous black, pasty dejections; took dose of brandy in the night; restless, and occasionally wandering; easily aroused, and speaks sensibly, but soon falls asleep again; pustules increasing in size and number, some of them as large as good-sized peas; knuckles of right hand swollen; both sides of face red, swollen and cedematous; right leg of normal size, and appears well; left leg the same, with the exception of slight tender- ness ; swelling of left forearm soft and fluctuating; no glandular enlargement, nor mark of absorbents. 9 P. M., constantly delirius; unable to drink; frequent involuntary de- jections and urine; hands tremble, pulse 134, feeble; respiration 36, noisy and husky; sounds and impulse of heart normal; many of the pustules drying ; scab of vaccination came off arm ; erythema and oedema of scalp. Twenty-first, 10 a. M.-Delirious all night; takes nothing ; insensible; no dejections ; pulse, 134, soft, and moderately full; respiration varies from 30 to 40, occasionally like that in hydrophobic paroxysm ; heart's impulse strong; first sound loud, second sound scarcely perceptible. 5:30 p. M.-Died. The body was removed early next day. No autopsy allowed." As far as Dr. Buckingham could learn, there had been no sick animal on his farm, and so far as known, the patient had had no communication with any such, nor had he any occasion to handle hides.-The American Journal of the. Medical Science, July, 1850, pp. 96-99% Many of such unfortunate accidents attending vaccination, may be re- ferred to the peculiarities of individual constitution, upon some condition of ill-health at the time of vaccination, upon the mode of life pursued dur- ing the progress of the vaccine disease, or upon some circumstance such as is known to impart a severe character or a fatal tendency to other affec- tions. Thus, it was said, that in the case of Sir Culling Eardley, who died from the effects of vaccination, his health at the time of the operation was not in completely satisfactory condition ; and in another case recorded by Mr. Wells, where death followed re-vaccination, that, on a previous vaccination, an unusual idiosyncrasy was manifested by the occurrence of a prostration almost bordering on death. At certain times the development of erysipelas after vaccination may be traced to the operation of the same cause which occasions this affection after surgical operations of any kind. Thus in October, 1859, erysipelas followed vaccination in a few cases at Parkhurst on the Isle of Wight; and in one of these cases sloughing occurred to such an extent as to render necessary amputation at the shoulder joints. At that time, however, there was a general cause of ill-health in operation, for both typhoid fever and erysipelas were prevailing at Newport, and several cases had occurred at the Barracks. It is well known to every surgeon, that at such times all surgical operations, even the most trifling, are dangerous. A similar event on a large scale occurred in the French army in 1858 (Rapport sur les Vaccination en France, pour 1860 p. 21 J. On the twenty- ninth of June, 1858, several men were admitted into the hospital with en- gorgement of the axillary glands, phlegmonous erysipelas of the arm, etc., 454 Spurious Vaccination : Joseph Jones, M. D. as the result of a vaccination effected on the twenty-first. Sixty men were vaccinated with every precaution and unexceptionable lymph. The next day one of them was attacked with phlegmonous inflammation of the arm, complicated with typhoid fever, the origin of which was without doubt prior to the vaccination. Three days later another soldier was similarly attacked, and the fourth day seven more, but without the typhoid fever. M. Larrey, who was sent to inquire into the affair, noted amongst its causes, first of all a very high atmospheric temperature, and, secondly, an unfavorable medical constitution. Erysipelas was prevalent in the town of Florence, where this accident happened, as well as in the hospital, and the men had, moreover, undergone an unusual amount of fatigue on ac- count of an approaching inspection of the troops. It is evident that the mere vaccination was not in fault, since, during four years, more than 12,- 000 soldiers from the garrison of Paris had been re-vaccinated without any serious accident occurring. Dr. Tymann has collected into a table a large number of instances in which erysipelas or troublesome ulcerations, have followed vaccination in the practice of several British and American surgeons. (American Medi- cal Series, v. 4, p. 134.) The greater number were in children ; but then it is to be recollected that vaccination is mostly performed upon children. Of the six adults, two were between sixty and seventy years of age, one was thirty, one was twenty-five, and the seventh eighteen years old. Seven of the cases proved fatal, being attacked with erysipelas on the ninth day in three instances; on the tenth in one; on the eighth in one; on the sev- enth in one, and in one case the time of attack was not specified. In some of the other cases it occurred on the second, third or fourth days. The season of the year in which these cases occurred is deserving of notice. Excluding some cases of tendency to troublesome ulceration during the prevalence of a cold northeast wind in the month of May, only three ot the whole twelve cases or groups of cases collected were observed during the warmer months of the year. With regard to the cases in the month of May, it is stated that the same tendency to troublesome ulceration declared itself also in persons who were at the same time inoculated for small-pox. In one case of erysipelas followed by sloughing and necessitating ampu- tation, related by Mr. Chartres, it is noted again that an epidemic tendency to unhealthy inflammation was observed in all cases then in the hospital, so that it became necessary to avoid every surgical operation; and even the punishment of the soldiers by flogging was suspended on account of the erysipelatous inflammation, which occurred whenever the cutaneous surface was injured. In some cases, however, the occurrence of erysipelas may be clearly the fault of the operator, who uses lymph takeu from a pock too far advauned, or lymph which has been present in the fluid state so long as to permit of its decomposition, or who may have taken it from ^subject recently blistered. An instance is recorded of nine persons vaccinated in the year 1800 with virus of a purulent appearance, taken from a vesicle at a very late period of its course ; extensive erysipelas resulted, followed by ulceration, and in some of the instances by a tendency to gangrene. Of a large number of persons vaccinated at the same time but with different lymph, none suffered (London Medical and Physical Journal, vol. 4, p. 488). Mr. Wakley mentions the case of two infants, aged respectively two and six months, vaccinated with good lymph (originally), preserved in a bot- tle for thirty or forty hours, and which at that time had undergone decom- position. In both infants the arm became greatly inflamed; one of the Spurious Vaccination: Joseph Jones, M. D. 455 children died with sloughing of the wound, and the other had abscesses form in the joints and elsewhere, but recovered. (Lancet, July 10, 1852.) Dr. Tymann also mentions an instance where fifty persons were vacci- nated with a fluid produced by dissolving otherwise good scabs in water, the phial having been carried about in the pocket of the operator. (American Medical Times, vol. 4, p. 107.) All these persons had very severe erysipe- latous and gangrenous inflammation supervene, and three of them died. With respect to the danger of taking lymph from persons recently blistered with cantharides, Mr. Ceely states that he has known erythema and ery- sipelas propagated from irritable, late ruptured or exhausted vesicles, or from apparently healthy ones on a child who had a blister behind the ear. (Papers, etc., p. 125.) Dr. Huder relates an instance of five children, all vaccinated from the same child, in whom very quickly the arms became swollen and oedem- atous, one child suffering from convulsions and two from abscesses, no vac- cine vesicle being on any of them. The child from whom the lymph was taken had, the evening before, a blister applied behind the ear. Four of these children were vaccinated with clean lancets, and the fifth, being at a distance from the others, with points. (Medical Gazette, v. 13, p. 440.) Husson relates also the case of two persons in whom sloughing ulcers resulted from the application of vaccine lymph to a surface blistered with cantharides. (Dec. des Siences Med., tome 56, p. 423.) Doctors Seaton and Buchanan mention three public vaccinators who made use of a moist lymph, preserved in a bottle, after it had been kept for a week; and one vaccinator expressed his opinion that the lymph being ammonical and putrid, was no obstacle to its success, nor to the regular course of the vaccine disease that was produced by its insertion. (Sixth Report of the Medical Officers of the Privy Council, p. 102. On Vaccina- tion, by Edward Ballard, M. D., pp. 84-89.) Doctor Paul F. Eve does not admit the possibility of the inoculation of erysipelas by vaccination, as will be seen from the following extract from his article on the health of the Southern Army : " Erysipelas by Vaccination. In regard to the inoculation of erysipelas by vaccina- tion, independant of a peculiar atmospheric influence, and irrespective of some adventi- tious circumstances connected with a wound, I am not prepared to admit. Weare all familiar with the idiopathic variety of this affection attacking the cutaneous and mucous surfaces, at times, too, becoming epidemic, and apparently in affinity with puerperal per- itonitis, and we know the traumatic type, but surely this disease does not originate from a specific virus. It is evidently infectious, but not, I believe, contagious. A dis- tinguished surgical writer, admitting that it is inocuable, states expressly that it would be impossible for it ever to appear in a sound individual. There, then, must be a predis- position in the general system, it would seem in every instance, usually induced by ma- laria, before it is developed. And if this be true, namely, that the attack depends for its origin upon a peculiar state and condition of the patient's health, is it not then unwise, not to say erroneous, to suppose that erysipelas occurring after vaccination is due to a poison escorted by vaccine matter into the system ? I do not, therefore, believe it inucu- lable by this little operation." The view maintained by Hippocrates and his followers, that erysipelas was a disease originating from some intestine commotion of the humors, and that the offending matter was thrown off or eliminated by means of the skin, has been held by a large number of writers, with various modifica- tions and slight additions up to the present time. The French especially advocate this view, and as a general rule deny the contagiousness of ery- sipelas. The English writers, on the other hand, are almost unanimous in considering the disease as capable of propagating itself by contagion under certain circumstances. Dr. Cullen admitted a species of erysipelas capa- ble of throwing off' contagious emanations. He says, " This disease is not 456 Spurious Vaccination : Joseph Jones, M. D. commonly contagious, but as it may arise from an acrid matter externally applied, so it is possible that the disease may sometimes be communicated from one person to another." The first well-authenticated facts militating against the old notions, and proving the contagious nature of erysipelas, were published by Dr. Wells in 1798; for although Sauvages, in his uNosologia Methodica," published thirty years before, admits an erysipelas contagiosum, his views are obscure and his authority doubtful, as the epidemic of Toulouse in 1715, to which he refers in support of his opinion, appears to have been scarlatina, and not erysipelas. The examples brought together by Dr. Wells, in which this complaint appeared to be unequivocally propagated by contagion, have been sustained by similar cases, described by Pitcairn, Stevenson, Gibson, Lawrence, Gregory, Elliotson, Arnott, Watson, Rogers, Goodfellew, and other English physicians. The question of the possibility of communicating the poison of erysipelas along with the virus of the vaccine disease, is intimately associated with that of the contagiousness of erysipelas. FACTS ILLUSTRATING THE PROPAGATION ON ERYSIPELAS BY CONTAGION. In the brief discussion it was freely admitted that erysipelas at times prevails as an epidemic, and appears to be produced by some general epidemic influence, and that in many cases the disease may be most plausibly accounted for by sudden changes of atmos- pheric temperature, along with considerable moisture, together with derangement of the bowels, and the effects of particular articles of food, ardent spirits and vicious habits ; and that isolated cases frequently occur in private families, and even in hospitals, in which the disease, as is often the case with typhus fever, typhoid fever, hospital gan- grene, pyaemia and Asiatic cholera, spreads no farther. The rapid propagation of erysipelas, both in the sick room and in the wards of the hos- pital, has been so frequently observed that no doubt can exist of this disease being under certain circumstances communicated by emanations, by fomities, or by some palpable virus. The adoption of this proposition does not at all overthrow the belief which we also hold, that the origin and spread of erysipelas in hospitals, and in private families, will depend upon the hygenic condition of the wards and rooms, and upon the state of the constitution of the patients. It is the intention of this brief note to detail facts, rather than to enter into any hypo- thetical discussion. In the summer of 1760, a person laboring under erysipelas of the face was brought into St. Thomas Hospital, in London, where he died. Another patient, having a different disease, was put into the same bed before it was duly purified. This patient was shortly after seized with erysipelas of the face. Several other persons in the hospital were then attacked, among whom was an upper nurse, or sister, and she died. A rumor hence arose that the plague had got into the hos- pital; and so widely did this opinion spread that an advertisement was inserted into the newspapers of the day, contradicting the rumor. Dr. Bailie described it as spreading also in St. George Hospital, London, and Dr. Cullen in the hospital at Edinburgh. Dr. Wells has brought together several examples in which the complaint appeared to be une- quivocally propagated by contagion. "I visited," says Dr. Wells, on the eight of August, 1796, in Vine street, Clerkenwell, an elderly man' named Skelton, who had been attacked several days before with erysipelas of the face.. In about a week af' terwards he died. On the nineteenth of the following month, I saw Mrs. Dyke, of about seventy years of age, the landlady of the house in which Skelton had been a lodger, and found her laboring under an erysipelas of her face. I inquired whether any other person in her house had been ill of the same disease since the death of Skelton, and was told that his wite had been seized with it a few days after his decease, and had died with it in about a week. During my attendance upon Mrs. Dyke, an old woman, her nurse, was at- tacked with the same disorder, and was sent to the puish workhouse, where she died. Mrs. Dyke has since informed me that a young man, the nephew of Skelton, w'as taken with the disease of which his uncle died, shortly after visiting him, and survived the attack only a few days. That she herself had been several times with Skelton, and his wife during their sickness, and after death had removed some furniture from the room they occupied to her own apartment."-Transactions of a Society for the Improvement of Medical and Chirurgical Knowledge. Dr. Wells relates other histories of the same kind, which in like manner occurred when there was no epidemic of erysipelas prevailing. Spurious Vaccination ; Joseph Jones, M. D. 457 Dr. Pitcairn attended, in February, 1797, a lady with child-bed fever, who had erysip- elatous inflammation in her skin. Her new-born babe had erysipelas of the pudendum, and both mother and child died after a few days' illness. Eight days after the death of the child, the lady's mother and a servant maid, both of whom had attended the child in its illness, were attacked with erysipelas faciei, trom which both recovered. Dr. Stevenson details briefly the results of twenty-one caess of erysipelas which oc- curred in his practice in 1821-2: '•It spread, in many instances, through the members of the same family ; in some it appeared soon after visiting friends, or relatives, during the period of the disease. A person who was attacked while in attendance on an erysipelatous patient, went home to her parents, who resided at some distance, as soon as she was taken ill; they were soon successively seized, and the mother died in a few days." (Transac- tions of the Medico Chirurgical Society of Edinburgh, v. 2.) Dr. Gibson has recorded similar cases which came under his observation in 1822. (Transactions Medical Chirurgical Society of Edinburgh, v. 3.) "A young man with erysipelas of the face, was brought to his father's house at the distance of some miles. He ultimately recovered. His master had died a few days before of a febrile disease. The father of this young man was attacked with erysipelas in both hads and arms, which spread to the face. He died in a few days. The infant son of a gentleman was seized with erysipelas on one foot. The mother was afterwards with erysipelas of the scalp. The nurse, who suckled the child, was seized with symptoms of pneumonia, and was removed to her father's house, four miles off. Her father, who had some (lays before her arrival, received a wound of the scalp, was seized with erysipelas of the face and scalp, and died soon afterwards. A sister, living in the same cottage, had fever with sore throat, from which she slowly recovered. Two children in the same house were cut off with what appeared to be the croup. The disease in the sister and children was supposed to be erysipelatous inflammation of the fauces and trachea. A woman was admitted into the infirmary of Montrose, with suppuration of the baud, which had followed an attack of erysipelas. Some days after her admission, the patients in the two beds next to her were seized with erysipelas. It was afterwards found that, notwithstanding all the patients were removed from that ward, and the process of cleaning, whitewashing and fumigating adopted, the disease again reappeared when fresh patients were placed in this ward, so that it became at length necessary to shut up the infirmary for a time.-Cyclopaedia of Practical Medicine, Art. Erysipelas. Mr. Lawrence also mentions similar cases. (Medico Chirurgical Transactions of Lon- don, vol. 14.) Dr. George Gregory in his valuable lectures on the Eruptive Fevers, has expressed his belief in the contagious nature of erysipelas in no unequivocal terms, and his views are worthy of careful consideration in this connection. "A connection of more than twenty years with the small-pox hospital, has given me abundant opportunities, not only of confirming the truth of these propositions, but of showing that we may carry our views much further. I feel persuaded, first that erysipelas may commence in an hospital without the suspicion of impor- tation. 2. That being so generated, from bed to bed, it may spread by contagion. 3. That the miasm gen- erating erysipelas is identical with that which in lying in hospitals generates puerperal peritonitis, which in foundling hospitals and workhouse nurseries gives rise to pudendal gangrene and umbilical ulceration- which in army hospitals generates hospital gangrene-which in hospitals differently circumstanced is found to occasion a malignant form of cynanche, both mucus and cellular, with otitis, glossitis, an asthenic form of laryngitis, the most aggravated type of typhus gravior. " The origin of scurvy in crowded and ill-regulated ships is obviously a branch of the same general doc- trine. A destructive miasm is there generated which is far more injurious to the human frame than the use of salt provisions. Whatever be the exact nature (or essence) of the miasm which thus generates erysipe- las, peritonitis, gangrenous ulceration or scorbutic blotches, it is something depressing to the vital power. " The dependence of erysipelas on a miasm sui generis is no new doctrine. It has been stated over and over again by individual writers, but it has never, I think, been urged by systematic authors with the im- portance which it merits; nor has the doctrine been received as one of ihe avowed axioms of pathology. Dr. Rollo, in a treatise entitled, ' A Short Account of a Morbid Poison Acting on Sores,' and published very early in this century, distinctly announces the principle, and illustrates the intimate connection between erysipelas and hospital gangrene. The circumstances which lead to the development of ochletic miasm have never been investigated with all the accuracy which is desirable, and of which the subject is certainly susceptible. The first in im- portance is undoubtedly overcrowding the wards of an hospital. When the French academicians (I think it was early in the French Revolution) were laboring diligently to reform the abuses m the Hotel Dieu, some of them were at the pains to calculate in how many hours, supposing the ward to have been her- metically sealed, all the patients in it must necessarily have died, presuming that each adult requires for his support a gallon of air per minute. The time was wonderfully short. 2. But it is not numbers alone which are to be con sidered. A ward might safely hold fifty cases of simple fracture, which would not with safety contain twenty cases of compound fracture. Something, therefore, depends on the nature of the disorder. All disorders which throw out diseased secretions are more apt to taint and vitiate the air than those where no secreting process goes forward. It is on this account that the wards of the Small-pox Hospital are so peculiarly liable to generate ochletic miasm. 3. Another element of great importance in determining the sources of ochletic miasm is the degree of attention bestowed on cleanliness. If the bed linen, mattresses, palliasses, sheets, and blankets, be fre- quently changed, the floors well cleaned, and the walls frequently whitewashed; if the nurses be careful to carry away all foul secretions, and to purify the patient's body by an abundance of soap and water ; in short, if the internal regulations of the hospital be good, miasm would, I suppose, be rarely engendered, even though the ward be crowded. 4. A fourth element must enter into the calculation, and that is a good supply of fresh air. This by some is considered all in all; but it is not so, and all the ventilation in the world, conducted on the most scientific principles, and superintended by Dr. Reid himself, would fail in preventing ochletic miasm, if feather beds or bolsters, soaked in unhealthy discharges, are permitted to remain in the ward. 5. Dr. Rollo has advanced a step further in the analysis of ochletic miasm, and maintains that the dis- position to erysipelas and its correlative diseases (puerperal peritonitis, and hospital gangrene) depends partly on a peculiar, but hitherto undetected condition of the atmosphere. He is led to this opinion by observing that erysipelas sometimes shows itself in the airiest, least crowded, and best regulated hospitals. Without stopping to inquire how much is due this circumstance, we are fully warranted in saying that the 458 Spurious Vaccination: Joseph Jones, M. D. state of the atmosphere must not be lost sight of in such an investigation. We known on the authority of Dr. Lind, that in Batavia and other localities notorious for malaria, hospital gangrene and erysipelas, and every sort of associated disorder, prevail with intensity at certain seasons. Assuming it as proved, that erysipelas is liable, from one or more of the five causes now detailed (viz: accumulation of persons, character of the discharges, want of cleanliness, want of ventilation, constitution, of the atmosphere), to spread epidemically, it is still to be shown that this disease throws off contagious emanations, which can, per se, independent of any such influences, propagate the like complaint. " Dr. Wells has met this question fairly by detailing a variety of cases where erysipelas spread by con- tagion in private houses, and under circumstances calculated to exclude all agency save that of simple con- tagion." Dr. Gregory supports his views by a reference to the cases of Dra. Wells, Pitcairn and others, and also by his own individual experience. Dr. Elliotson, in his "Principles and Practice of Medicine," gives the following ac- count of the mode in which he contracted the disease in his own person : " I recollect once having had it, five days after stooping down over a patient, who had ths disease in so violent a form that hb died of it. Iwas looking into the state of his skin, and his breath came into my face. I turned away with a feeling of disgust, and said, ' I hope I have not caught it,' but, five days after- wards, having forgotten the circumstance, I was seized with erysipelas. I felt chilly, and my head was sore; and I had the disease violently." Professor Arnott also has given striking examples of the propagation of erysipelas from one person to another, not only under the same roof, and in the same locality, but also when the parties lived at a distance from each other, and the intercourse had been but for short periods of time. Dr. Thomas Watson, who advocated the view that erysipelas is contagious gives the following incident in his " Lectures on the Principles and Practice of Physic," which had been told him upon good authority: " A man living somewhere in Westminster fell ill of idopathic erysipelas. In that state for some reason or other, he was removed thence; and his brother, who was a servant in or near Portland Place, received him clandestinely into his master's house, and allowed him (for two nights I believe) to share his bed. That brother was soon attacked with erysipelas; and in the course of his illness was visited by his master. The master was also attacked ; and it is worthy of remark, that in both master and servant, the disease showed itself just seven days after they had respectively come near another who was affected with it." Dr. Rogers has related a case, which closely resembles that of Dr. Elliotson: " A medical student went into the country, and was requested by his brother, a medical man, to visit an erysipelas patient. While leaning over her he became conscious of a nauseous odor, which almost caused him to be sick. A few days after, he was suddenly seized with shivering, followed by fever; erysipelas shortly came on in the head and face, and he died after a week's illness." In the following instance, communicated to Dr. Campbell De Morgan, Surgeon of the Middlesex Hospital, by Dr. Goodfellow, it is evident that the disease spread from bed to bed: "In the epidemic of typhus that prevailed in the autumn of 1838, more or less of erysipelas was con' stantly to be found in the wards ; and, as a general rule, it spread from bed to bed. On one occasion, how ever, this was more than usually striking. It occurred in the large fever ward, containing thirteen beds, and well ventilated. Erysipelas attacked a patient on that side on which were seven beds. She was in the bed next but one to the end; the patient lying in the next bed, the third from the end, was next attacked, and then the patient at the end. The disease successively attacked all the patients in the order in which the beds were placed, until it reached the lower end of the ward. It then attacked the patient lying at the same end of the ward, but on the opposite side, and spread from bed to bed until it reached the last on this side, the patient lying in which was the only one who escaped. "-A System of Surgery by Vari- ous Authors, Edited by Holmes, pp. 247-8. Dr. Steele, iu his Annual Report on Guy's Hospital for 1863, writes, that for some years past it has been customary to place patients suffering from erysipelatous wounds in these (the medical) wards, in order to diminish as much as possible the risk of extending in- fection in surgical wards, as well as to promote recovery in the patients themselves. It happened, however, that in one of the wards of the new hospital into which a patient suffering from erysipelas was placed, in the course of the past year five persons suffering from other complaints were attacked with the disease; and although none of the casoe were attended with fatal consequences, the occurrence is sufficient to point out the danger which mush be occasionally apprehended." Erysipelas has appeared extensively, and for long periods, in the Birmingham, Edin- burg, Glasgow, and London hospitals and it has been frequently necessary to empty and whitewash the wards and thus rid them of the disease. Many of the surgeons of the English navy believe in the contagiousness of erysipelas; and it has been debated, whether scrubbing the decks, or dry rubbing them is the best mode of cieasing a ship and preventing the spread ot the disease. The old Dreadnought, hospital of the Thames is said to have been so impregnated with the contagious matter of erysipelas that she had ultimately to bo taken up, and a new vessel substituted. There was a diversity of opinion amongst the Confederate surgeons with regard to the contagiousness of erysipelas. This diversity of opinion was clearly referable in some cases to dogmas embraced during education, and Spurious Vaccination : Joseph Jones. M. D. 459 to a want of careful and extended observation, and investigation of the origin, and mode of propagation, of the diseases incident to camp life. The reliability and value of the testimony of men upon such questions, clearly depends, not merely upon the extent of the field of observation, but also upon the mode in which, and the intelligence with which, the phenomena are investigated. Many cases occurred during the progress of the war, in which erysipelas was clearly referable in its origin and spread to the crowding together of large numbers of sick and wounded, in ill ventilated hospitals. The following communication from Dr. J. G. Nott, of Mobile, Alabama, illustrates, not only the dependence of erysipelas upon crowding, but also shows that in such cases, in like manner with hospital gangrene, the disease is best eradicated by scattering the patients and giving them free ventila- tion. It would be surely unwise and unphilosophic to refer the origin of erysipelas in such cases to an atmospherical influence, for the disease was most prevalent and most fatal in the most crowded hospitals, and was most speedily and effectually destroyed by breaking up those sources of contagion. No light whatever is thrown upon the subject by declaring the disease infectious and not contagious in crowded hospitals. We can only refer the propagation of infectious diseases to the exhalations from the sick, or from the excretions of their bodies, which act upon the extended surface of the lungs and skin of those immersed in the infected atmosphere; and we know that in the case of the two most contagious and infectious diseases- small-pox and measles-the diseased actions may be propagated in both ways by the inhalation of the exhalations of the sick, as well as by direct contact with the morbific matters. Mobile, November 21, 1866. Professor Joseph Jones, M. D. : Dear Sir-Your letter came to hand yesterday, together with two numbers of your journal. I am sorry that I have no notes or statistics relating to hospital gangrene. My connection with the army was in the command of General Bragg, commencing about six weeks before the battle of Shiloh. I had, it is true, been the Medical Director in Mobile for some time previously, but we had no wounds to deal with. Very soon after we got to Corinth all sorts of camp diseases prevailed among the troops-diarrhoea, ty- phoid fever, etc., and erysipelas. The colonel of a regiment came to me and begged me to visit a small brick church in the vicinity of Corinth, in which his men were dying at a fearful rate with erysipelas. On visiting the church, I found some seventy or eighty sick or wounded men crowded together in a small church, and about one-half of them with erysipelas. There had been daily skirmishing going on. and about one-fourth of the men had been wounded. The disease attacked those wounded, as well as others, in- discriminately. Many of them were dying with erysipelas of face and scalp, who haclnot been wounded, and I never saw a more revolting scene than this hospital presented. I ordered it to be evacuated at once, and the patients to be removed to tents, at some dis- tance off in the open field. The effect was immediate and salutary. The erysipelas ceased to attack others, and the health of the command improved rapidly. At the same time above alluded to, we had some cases of hospital gangrene among the wounded in different hospitals, up to the time of the battle of Shiloh. Being occupied very busily in office as Director of the Post, I had no time for visiting hospitals, and the battle of Shiloh coming off soon, and there being very little hospital accommodation, we were compelled to send off in every direction 10,000 wounded and as many sick. So 1 saw very little of what occurred among our wounded. I afterwards went into Kentucky; was at the battle of Perryville, and other smaller battles ; but here we had to leave our wounded behind, after every battle. So really my experience has not been extensive or satisfactory in hospital gangrene. I have seen a good many scattering cases during the war, and have found them best treated by the application of nitric acid, iron, tonics, stimulants and good diet. On the whole, then, my observations and information are too indefinite to be worth much, and I write more to state the simple fact that we did have cases of hospital gan- grene before and after the battle of Shiloh, and I looked npon it as close akin to ery- sipelas. Very respectfully, yours, etc,, J. C. NOTT. 460 Spurious Vaccination: Joseph Jones, M. D. It will be seen from the following statistical information and sanitary report of the Moore Hospital, Manassas Junction, Virginia, for the month of January, 1862, that in this hospital, which received th^ worst cases of typhoid fever and pneumonia, and was liable to sudden and unavoidable crowding of the sick, erysipelas attacked almost universally the patients operated on, only two escaping. " Mooke Hospital," Manassas Junction, Va,, February 7, 1862. Thos. Williams, Surgeon, C. S. A., Medical Director Army of Potomac : Sir-I have the honor to forward the report of the "Sick and Wounded " of the Moore Hospital, for the month of January. The face of it shows only 235 patients admitted, while 77 of these have died-a fearful mortality, I confess-and did it extend to all dis- eases would soon decimate our army. But when it is recollected that the 235 men kept here were picked out of over 2900 that have passed through and were sent further back, and that those kept are the sickest-in fact a number came in moribund, others dying from six to twenty-four hours after their arrival-the mortality doesnot appear so appal- ling. At the beginning of January there were remaining 114 sick and convalescents ; of these 25 died during the past month, making the mortality 102. The report shows 37 cases of febris typhoides, with 17 deaths, which is, strictly speaking, not true, as there have been but four or five cases of well-developed typhoid fever in the wards, and those so diagnosed are, in the majority of cases, simple continued fever, taking on a typhoid form, but wanting in all the particulars of typhoid fever proper; and, I feel confident, was there an opportunity afforded for post-mortem examinations, they would be found wanting in the pathological changes peculiar to the disease. There were 128 cases of pneumonia treated, with a loss of 45, almost 36 per cent, though not large when the condition of the patients at the time of entering the hospital is taken into consideration ; a large majority of the cases are sick from three to ten days in camp before they are brought to the hospital. Such cases presenting bad symptoms, but still not necessarily of a fatal character, after a ride in an ambulance or" wagon of three or five miles over a rough road, are placed beyond redemption. Stimulantsand carb, ammonia may revive the vital spark, and the man live for several days, and occa- sionally, I am happy to say, has elasticity enough about his constitution to get well. As an evidence of the fatality caused by surrounding disadvantages, I have simply to refer to some ten or twelve cases of pneumonia in my nurses where every case has re- coveied, each one of them showing the good effects of antimony in the early stage of the disease. Those sent from this place to general hospital, have been convalescents sent further back to make room for the sick. They have been South Carolinians and Mississippians, and were sent to Charlottsville and Warrenton. The number of furloughs (47) is large for the number of patients ; but when it is con- sidered that all of the wounded-at least 60-from the battle of Drainesville, were here, that will be accounted for. I may add, that the two cases of erysipelas were purely idiopathic, and in the ward where all the worst wounded were, there was quite a number of other cases there, arising from any little operations performed, such as removing a bullet or spicula of bone, but two patients operated on escaping. On one of those I ligated the carotid artery ; in the other, amputation of the thigh was performed. The latter operation was performed three weeks since, and the same day a bullet was extracted from the shoulder, which immediately took on erysipelatous inflammation, whilst there has never been theslighest symptoms of it about the amputation. In several of these cases, and especially the idi- opathic, the inflammation was not confined to the skin, but extended to the subcutane- ous areolar tissue, forming what Dr. Stone, of New Orleans, says is different from ery- sipelas, and what he calls "subcutaneous areolar inflammation," never running its course without suppuration, and occasionally to an enormous extent, invariably presenting typhoid (low) symptoms. I am., sir, your obedient servant, J. F. BELL, P. A. C. S., Surgeon in Charge. These examples might be multiplied, but these are believed to be suffi- cient to illustrate the experience of many Confederate surgeons upon the intimate relations of erysipelas, in its origin and spread to such diseases as hospital gangrene, which were known to be contagious. On the other hand the armies were never so healthy, and the wounded were never so free from erysipelas as during the most active campaigns. The army of Gen. T. J. Jackson (Stonewall) during its active campaign in the Valley of Virginia was remarkably healthy, and the wounded, as I Spurious Vaccination: Joseph Jones, M. D. 461 ascertained by a personal inspection and examination of the records of sev- eral of the largest hospitals connected with the department commanded by this distinguished soldier, were exempt to a great degree from both erysipelas and hospital gangrene. This immunity was due to several causes, but chiefly to the active habits and good morale of his soldiers, to the comparatively abundant supplies of this rich country, and to the large and commodious hospitals established at Staunton and other eligible points in this elevated and healthy region. The truth of this assertion will be sustained in the following sanitary report of his Medical Director, Surgeon Hunter McGuire: New Market, Virginia, April 15, 1862. S. P. Moore, Surgeon General, C. S. A.: Sir-I have the honor to forward the consolidated report of sick and wounded, and the return of the medical officers serving in the Army of the Valley of Virginia for the month of March, 1862, (Major General Jackson's Command). Though subjected to long and sometimes forced marches, the health of this army was better during the month of March than during any other since its organization. It is a fact well known to regimental surgeons and commanders, that the numbers reported sick during marches, even when they are long and fatiguing, provided the weather is clear and dry, is less than that which occurs when troops are stationary and subjected to the ordinary duties of camp. Towards the end of the month recruits and drafted men were added to the regiments, and the amount of sickness increased; indeed, the large proportion of those reported sick belong to the men recently attached to the regiments, who are not yet inured to the hardships of a soldier's life. I enclose also a list of the killed and wounded of this army, in the engagement near Winchester, March 23, 1863. It numbers sixty-one killed and three hundred and sixty-one wounded. Some of the latter were mortally wounded, and have since died, which increases the number of dead, as far as known, to eighty-eight, and proportionately reduces the number of wounded. One hundred and fifty-seven of the wounded were removed from the field, the rest fell into the hands of the enemy. It is gratifying to know that our dead were decently buried by the citizens of Winchester, and that our wounded have received every attention from the physicians and ladies of that place. Very respectfully, your obedient servant, HUNTER McGUIRE, Medical Director Army Valley of Virginia. While we do not at all deny, that erysipelas at times prevails as an epi demic, and appears to be produced by some general epidemic influence, and that in many cases the disease may be most plausibly accounted for, by sudden changes of atmospheric temperature, along with considerable moisture, together with derangement of the bowels, and the eifects of par- ticular articles of food ; at the same time there are facts to show that this disease is at times, if not al ways, contagious. Neither would we be understood as insinuating, that instances of its transmission by contagion, are common in private practice, for isolated cases frequently occur in private families in which no member of the family and no nurse contracts the disease. The origin and spread of erysipelas in hospitals, will depend upon the hygienic condition of the wards, and upon the state of the constitution of the patients. Many of the Confederate surgeons appeared to be aware of the dangers attending the indiscriminate use of sponges, dressings, and uncleansed wash bowls, when erysipelas was present in their wards. When wounds were cleansed with sponges or rags which had been used on erysipelatous, patients, it was frequently observed that the disease appeared; and such propagation appeared to be clearly referable to the transference of the con- tagious matter. It can be shown therefore that the evidence of contagion in erysipelas rests npon nearly the same grounds as in the well known contagious diseases, scarlet fever, measles, and typhus fever. 462 Spurious Vaccination : Joseph Jones, M. D. Many of the British physicians and surgeons entertain but little doubt of the connection, if not the identity of erysipelas with puerperal fever. Without entering into an extended examination of the facts upon which this view rests, it will be sufficient to recall the well known fact, that in- oculation with the fluid of a female who had died of puerperal fever, is a most fatal source of diffuse cellular inflammation to the dissector. Dr. George Gregory, in his Lectures on the Eruptive Fevers, says that he had heard of a case where vaccine matter taken from the arm of a child laboring under erysipelas, had communicated both diseases. And finally, Dr. Willan has testified that if a person be inoculated with the fluid contained in the phlyctinae or vesicles of a genuine erysipelas, a red, painful, diffused swelling and inflammation analogous to erysipelas is produced. This experiment has not, as far as we are aware, been repeated; and, with such a direct demonstration of the possibility of communicating ery- sipelas by inoculation, we are at a loss to know upon what principles of reasoning, authors, who have never performed a single experiment them- selves, assume the right of setting aside the assertion of Dr. Willan. By these facts, therefore, as well as by those which occurred during the recent war amongst the soldiers and citizens of the Confederate States, we are justified in drawing the conclusion that it is possible to communicate the poison of erysipelas through the medium of the vaccine matter The practical conclusion which we draw from this discussion, is that: As far as possible soldiers, especially during long and fatiguing campaigns, and when crowded in hospitals and barracks, should be vaccinated with the lymph or vaccine virus from young healthy children. It is best, both in civil and in military practice, not to use the vaccine virus from the arms of soldiers, because their mode of life is an artificial one, to a great extent; a stereo- typed life of restraint and hardship, and of great sameness of diet, and consequently a life liable to great excesses and irregularities of habits, and to great and sudden variations of health, as well as to slow and impercep- tible deterioration of nutritive fluids. The quality of the vaccine virus will depend, in great measure, upon the manner in which the nutrition of the body is performed. We use the word nutrition in its largest sense. Vaccine matter obtained from the arms of the feeble and often scorbutic convalescents of crowded civil and military hospitals, is wholly unfit for the propagation of the vaccine disease. Of all places, civil and military hospitals are the very last, to which the pro- fession should look for supplies of vaccine matter; and yet, during the re- cent war, it was in the crowded hospitals that vaccination was most dilli- gently, perpetually and indiscriminately performed. In these most destruc- tive centres of contagious diseases of typhoid-fever, erysipelas, hospital gangrene, and pyaemia, the so-called vaccine matter passed from soldier to soldier in an endless round. Is there any marvel that under such a system, enforced by military law, the matter should have progressively deteriorated, and the accidents of vaccination (spurious vaccination) have become both common and serious? Spurious Vaccination: Joseph Jones, M. D. 463 SECTION VII.-FRESH AND DRIED VACCINE LYMPH AND SCABS FROM PATIENTS SUFFERING WITH SECONDARY OR CONSTITUTIONAL SYPHILIS AT THE TIME AND DUR- ING THE PROGRESS OF VACCINATION AND THE VACCINE DISEASE - PROFESSOR EVE, DOCTORS KRATZ, FUQUA, RAMSEY, CRAWFORD, PERCIVAL, STOUT, WOODWARD, HUBBARD, BOLTON AND OTHERS ON THE RELATIONS OF SYPHILIS TO SPURIOUS VACCINATION-DISCUSSION OF THE RELATIONS OF SECONDARY OR CONSTITUTIONAL SYPHILIS TO VACCINATION-THE POSSIBILITY OF COM- MUNICATING TUBERCULOSIS AND CANCER BY INOCULA- TION-THE POSSIBILITY OF COMMUNICATING SECONDARY OR CONSTITUTIONAL SYPHILIS BY INOCULATION-TES- TIMONY OF TORELLO, 1498; WILLIAM CLOWES, 1637; GID- EON HARVEY, 1665; DANIEL TURNER, 1717; JOHN HUNTER, 1776; AND OF DOCTORS DUNCAN, WATSON, HAMERTON, EGAN, PRICE, RIZZI, WALLER AND OTHERS, ON THE CON- TAGIOUSNESS OF SECONDARY SYPHILIS. THE POSSIBILITY OF COMMUNICATING CONSTITUTIONAL SYPHILIS THROUGH THE MEDIUM OF VACCINE VIRUS-TESTIMONY OF M. VIENNOIS, DRS. PAC- CHIOTTI, MARONE, POGUE, DEPAUL AND OTHERS-SMALL-POX EPIDEMIC IN MOBILE DURING WINTER OF 1865-6-SYPHILITIC VACCINE AND THE MEANS OF PREVENTING IT-IN0CULABIL1TY OF TUBERCLE-MORTALITY OCCASIONED IN NEW ORLEANS AND THE MISSISSIPPI VALLEY-POSSIBIL- ITY OF TRANSMITTING SCROFULA BY VACCINATION-1NOCULABIL1TY OF CANCER-CONTAGIOUS NATURE OF CONSTITUTIONAL SYPHILIS-COM- MUNICATION OF SYPHILIS BY VACCINATION-MODIFIED OR LACTO-VARIO- LOUS INOCULATION-VARIOLATION OF THE COW-ANIMAL VACCINATION. We examined at different times, during the progress of the recent war, and also had under treatment, various skin affections, which presented the characters of the cutaneous diseases, characteristic of secondary syphilis, which were directly traceable to impure vaccine virus. I saw several cases in which enlarged buboes in the axilla and groin accompanied the peculiar skin affection induced by impure vaccine matter. No such results followed vaccination as performed by myself or immediately under my direction du- ring the war; these accidents were avoided in my civil and military prac- tice, by adhering rigidly to the rule of using lymph from the arms of healthy children and infants; the opportunity therefore did not present itself of ob- serving and carefully noting the disease in its first stages. The cases re- sembling consfitutional syphilis and which were said to have resulted di- rectly from vaccination, which came under my observation and treatment, were as a general rule of long standing, and had been collected from differ- ent hospitals, and from various regiments, serving in widely separated districts. 464 Spurious Vaccination: Joseph Jones, M. D. In the summer of 1863, I examined a large number, and if my memory is correct, over two hundred cases of severe skin affections and general constitutional derangement resulting from vaccination, in the large hospi- tals in and around Richmond, Virginia. In these cases, as well as in those examined in other parts of Virginia, South Carolina, and Georgia, great difficulty was experienced in tracing the impure matter to a definite source, that is to the point at which it became contaminated or deteriorated. I do not wish to be understood as asserting or insinuating that this large num- ber of cases presented the symptoms of secondary syphilis; so far from this it appeared to me that those cases which presented the most complete resemblance with constitutional syphilis were not as numerous as those which were clearly referable to scorbutic and other deranged conditions of the system induced by fatigue, exposure and bad diet. During the progress of the war, the subject of the relation of vaccina- tion to constitutional syphilis, engaged my most anxious thought and I had determined to make it a special subject of investigation in the field and general hospitals, immediately upon the completion of my investiga- tions upon typhoid fever, malarial fever, small-pox, hospital gangrene, and pyaemia, believing that a correct solution of this difficult and important question was to be obtained only by a personal examination of the cases as they arose in the regiments serving in the field, and a careful collection and examination of the testimony of the regimental surgeons and assistant surgeons. From experience gained in other investigations in the field and general hospitals, I was well aware that such labors required much time and were beset with many difficulties. From the terrible drain upon the Confederate States for men, the hospitals and convalescent camps were subjected to the most rigid scrutiny, and all men not absolutely disabled from every kind of duty, were at the earliest possible moment transferred to clerical and light duty in the quartermaster, commissary, medical and purveying departments. From the great disparity of numbers, and from the immense extent of country in which the operations were conducted, the Confederate troops were in perpetual motion. The same soldiers, in the course of a few months, conducted fatiguing campaigns which extended over entire States, and fought bloody and desperate battles with superior forces in localities separ- ated by hundreds of miles. Whole armies that had been victorious at some remote portion of the border, or of the Atlantic and Gulf coasts, were sud- denly transported by railroad, across the entire Confederacy, to take their immediate part, without rest, in the bloody battles of the mountains of Tennessee and in the valleys of Virginia. These difficulties were experi- enced to a greater or less degree by every medical officer who undertook the investigation of this subject; and it has been rendered still more obscure by the sudden manner in which the struggle terminated, and by the loss of the most extensive and valuable reports on file in the Surgeon General's office at Richmond. I have sought to remedy, in a small degree, these defects, by addressing inquiries to a large number of those who formerly occupied positions in the medical service favorable for the investigation of the causes of the acci- dents following vaccination. It must be confessed that, up to the present time, the replies received to these inquiries have been wanting in that full and accurate detail of individual cases, which is so necessary to the proper solution of the question, whether the lymph or scab of a vaccine vesicle its peculiar virus, contain another infections principle, as that of syphilis. The affirmative of this question was held by many, both in civil and military practice; and a number of the Confederate surgeons boldly took Spurious Vaccination; Joseph Jones, M. I). 465 the ground that secondary syphilis could be communicated along with the vaccine virus, and especially when the dried scabs were employed. In the records upon this subject, which we examined in the Surgeon General's office in the Confederate Capital, this view was clearly announced. Several of these reports had been prepared in accordance with a direct order issued by the Surgeon General, directing a careful investigation into the origin and causes of spurious vaccination. The history and results of a portion of the investigations ordered by Dr. Moore are given in the tollowing extracts from an official letter : Professor Joseph Jones, M. D.: During the month of March, 1863, Medical Director Guild was so impressed with the importance of this affection that he ordered a committee of investigation into the extent of its prevalence, its causes and nature. The committee limited their inspection to those regiments only whose medical officers had re- ported the presence of this "spurious vaccination." The committee consisted of Surgeons R. G. Breck- inridge, now of Houston, Texas; Herndon, of Fredericksburg, Virginia, and , of North Carolina. The eases of spurious vaccination was most numerous in the Twelfth and Sixteenth Georgia Regiments. In one of those regiments we found over one hundred cases of ulcerated arms and hands, and in many instances extending to the body and lower extremities. In one of these regiments the historical connection with syphilis was most conclusive. They had all been vaccinated from the arm of a comrade of very disso- lute habits, who had just returned from a leave of absence. This soldier was at this time in camp, and presented unmistakable evidences of syphilis. I do not think I err when I state that there was no chancre on the penis, but we rested our opinion of the existence of syphilis upon the characteristic sore throat and eruption, and his confessions as to the recent existence of chancre. He had just returned from some little village in Georgia, and informed us that a physician practicing there hail taken matter from his arm and inserted it into the arms of a large number of young persons in his neighborhood. The "vaccination" in all these cases was done by the soldiers themselves, and not by their medical officers; consequently, acting upon the popular idea that the larger the sore the more complete is the pretection, they selected the worst sores for the propagation of the virus. The committee agreed, with regard to the worst of these ulcers, that their appearance and progress were so analogous to syphilides that they did not hesitate to class them as such. The usual treatment for syphilis did not cure or benefit these cases with any marked uniformity. We find a ready explanation of this observation in the condition of constitution and circumstances under which the treatment was instituted-poor diet, scurvy, and camp life. * * * The testimony of Dr. J. F. Gilmore is decided as to the syphilitic origin of a portion at least of the cases of spuriotts vaccination in the Confederate Army of Northern Virginia, as will be seen from the following communi cation, kindly placed in my hands by the late Professor Paul F. Eve, M. D.: [Copy,] Mobile, Ala , May 27, 1867. Prof. Paul F. Eve, Nashville, Tenn. : Dear Doctor-I promised Dr. Nott, before he left us for Baltimore, to write Professor Jones, relative to spurious vaccination, of which I saw a great deal in the army in Vir- ginia, and as I am in your debt a letter, I trust you will pardon me for doing so through yourself. The small-pox broke out in the army in Virginia, shortly after the battle of Sharps- burg, whilst we were in camp, in the valley, in the vicinity of Winchester, reorganizing and watching the movements of McLellan. The first case occurred in the brigade of Gen. G. T. Anderson, of Georgia. At that time, I was the Chief Surgeon of McLaw's Division. The disease did not show itself in my command until the latter days of October. The first case occurred in a private of the Thirteenth Mississippi Regiment, who contracted it while hauling sup- plies from Staunton for the army. It, however, did not make much headway until after the battle of Fredericksburg, the thirteenth and fourteenth of December, I believe. The act of Congress reorganizing the army after the expiration of the twelve months' volunteers, provided that each man who re-enlisted, should receive, in addition to the bounty, a furlough for thirty days, and Gen. Lee, in order to carry out the provisions of this act, without materially weakening the army, issued a general order granting fur- loughs to two (2) men to every hundred on duty. This order, I think, was issued whilst we were in the valley. Shortly after the battle of Fredericksburg, a private in Semmes' Georgia Brigade returned to his command, who had received! a furlough under the order. He came back to his regiment, with what he supposed was an ample supply of virus for all of his friends, a large number of whom he vaccinated, not only in his own brigade, but also in Cobb's. In this way the impure virus obtained a stronghold in these two brigades. McLaw's Division was composed of four brigades: Kershaw's, South Carolina; Barks- dale's, Mississippi ; Semmes' and Cobb's, Georgia brigades. I don't recollect that I saw a single case in either Kershaw's or Barksdale's commands, but in the other two com- mands we had about three hundred cases. By the direction of Surgeon and Medical Director L. Guild, I had two hospitals estab- lished, one for Semmes' and the other Cobb's brigades; Semmes' under the charge of Sur- 466 Spurious Vaccination: Joseph Jones, M. D. geon Todd, and Cobb's under the charge of Surgeon Eldridge. For some cause which I don't recollect, Dr. Guild thought it better that these cases should uot be sent to general hospital ; and it being impossible to obtain suitable buildings, tents were used. The cases presented the appearances that are familiar to those of us who were con- nected with the Confederate army-large rupia-looking sores, sometimes only one, gen- erally several on the arm in which the virus was inserted. In a number of cases, these sores extended, or rather appeared, on the forearm ; and in twro cases that I saw, they appeared on the lower extremities. These men suffered severely from nocturnal rheuma- tism. Several cases had, to all appearances, syphilitic roseola. I saw enough of the trouble to convince me thoroughly that the virus owed its impu- rity to a syphilitic contamination The cases all improved under the administration of the iodide of potassium and vegeta- ble diet. In some of the cases, Grau's combination of the iodide of potassium and corro- sive sublimate was employed. In many of them there was a marked scorbutic tendency, which may in part account for the bad effects of the virus; but there were in the great majority of the cases unmis- takable evidences of syphilis. When the hospitals were broken up, just a few days .before the battle of Chancellors- ville, there remained under treatment about twenty cases, that were sent to general hos- pital at Richmond. To Surgeon Todd, we are indebted for the follow ing facts, that wrere embodied in a report made by myself to Surgeon Robert J. Breckinridge, Medical Inspector of the army. To the man above alluded to, who returned to his command shortly after the battle of Fredericksburg, was traced the origin of the vacciue virus that had wrought so much mischief in the two Georgia brigades. He stated that on his way back to the army, that he was detained in Augusta, Ga., and whilst there visited a house of ill-fame, and was vaccinated by one of the female inmates. This man denied ever having had syphilis pre- vious to his vaccination. The rupia looking sore on his arm, and roseolous eruption of the skin of a coppery hue, added to the fact that others vaccinated from the sore pre- sented many of the characteristic features of constitutional syphilis, are to my mind un- mistakable evidences that syphilis may be communicated, I will not say by vaccine lymph, but certainly by vaccination ; possibly by getting a small quantity of blood on the point of the lancet in performing the operation. I am unable to say whether the woman by whom this man was vaccinated had syphilis or not. In thinking of this subject, the thought suggests itself to my mind, that if the blood can convey a poison, that the vaccine lymph would be equally as capable; for if there is anything in our theories about cells, and especially if the cells have an individual exist- ance, certainly it is fair to presume, that any cell that has its existance from a person suffering from a constitutional disease, might have imparted to it the disease of the parent. In no other way can w'e account for the transmission of disease from father to child; and then again the query arises, if the blood can be poisoned by a disease of the cells, why may not, the other fluids be also ? But this is theorizing and we are after facts, and I think that my experience will sustain me, in the assertion, that syphilis may be commu- nicated by vaccination. I am not prepared to say that its transmissibility is not due to a small quantity of blood that happens to get on the point of the instrument, when the operation is performed, by inserting the virus directly from the arm of another, or by a small quantity that happens to get on the crust when removed ; but I am forced to con- clude that I can see no reason why vaccine lymph cannot as well be the vehicle of conta- sion as blood itself. The testimony of a distinguished member of our profession is strong in proof, that syph- ilis may be communicated by the blood, wrho affirms that he had constitutional syphilis from a poisoned wound got from operating after the battle of Shiloh. * * * Yours, truly, J. T. GILMORE, Dr. James Bolton, in the report from which we have already introduced valuable facts relative to the history and origin of " spurious vaccination," in the Confederate army, held that besides these cases which were referable to the imperfect nature of the vaccine matter and to the unhealthy condition of the system, and to the development of latent diseases, others occurred of a far more formidable character. Dr. James Bolton testified : So great was the dread of the small-pox in the army, that the men became impatient of the slow process of vaccination by medical officers with carefully selected virus. Com • mon soldiers and even officers became zealous operators. The more powerful the local action the more effectual wTas the protection supposed to be, and "large sores were in great request." In a short time the most terrible consequences ensued. Large numbers Spurious Vaccination : Joseph Jones, M. D. 467 of men were unfit for duty. The attention of medical officers was called to a wide spread truly contagious disease. On careful inspection the ulcers presented the various appear- ance of genuine chancre. In some instances there was the elevated, cartilaginous, well cut edge surrounding the indolent, greenish ulcer; in others there was a burrowing ulcer, with ragged edge; in others there was the terrible destructive sloughing process devas- tating the integuments of the arm. Many of these cases were so situated that their his- tory could be preserved, and iu these secondary symptoms appeared, followed in due time by tertiary symptoms, The chancre was followed successively by axillary bubo, sore throat, and various forms of eruption, (syphilo ■ dermata), while the system fell into a state of cachexia. Finally, previous vaccination did not protect against this disease. In short, the disease was genuine syphilis. Whence its origin ? So far as was ascertained by strict inquiry it had in no case been propagated by a medical officer. In these instances there was no case of true vaccinia followed by syphilis. When first seen it was true syphilis, and it never presented any other phenomena than those of this foul disease. This was true of all cases; the phe- nomena were those of true syphilis from its inoculation to its development, on to its termination. There was, therefore, no evidence of the contamination of vaccine virus by that of syphilis. The results of treatment also corresponded with this view of the disease. The mercu- rial treatment was the only one which could be relied upon. On account of the scor- butic condition of many of the patients it was necessary to use mercury with great cau- tion, and the alterative use of the bi-chloride of mercury was best adapted to the gener- ality of these cases. The question remains. Whence the origin of this disease in the army ? It prevailed most extensively among the troops from The State of Georgia, and it was thought to have been traced to a soldier from that State, who had returned home on furlough, and who was said to have vaccinated himself from his wife. It was also reported that there were many cases of this form of disease in the neighborhood of his home. Another source of this disease was said to have been traced to the person of a highly respectable lady residing in the neighborhood of Danville, Virginia. Finally, a third source was thought to have been traced to Culpeper comity, Virginia. All these accounts of the disease, however, are exceedingly indefinite and unreliable. In fact, they may have been given by some of the men iu order to conceal the really im- pure origin of the disease. The following propositions may then be fairly deduced as a resum6 of the foregoing facts and remarks: 1. That in some instances pure vaccine virus being introduced into a scorbutic system, or one deranged by some other cause, e. g., epidemic influence, an aberration of the phenomena of vaccinia was produced, but the patient was protected from variolous con- tagion. 2. It is highly probable that concrete pus, or some other morbid animal product was used, and that it produced local, eliminative inflammation, with some degree of consti- tutional disturbance. In these instances there was of course no consequent protection. , 3. In very many caSes there was true syphilitic inoculation. In these cases the virus was unmixed with that of vaccinia. Its source was purely syphilitic. Here again there was no protection. From these propositions there result the following corollaries: 1. Vaccinations should only be performed by educated physicians, except in case of necessity, and then by carefully instructed persons, under their observation. Vaccina- tions of themselves and of each other, by soldiers should be strictly prohibitted. 2. Vaccine virus should be carefully selected from healthy persons in whom the disease was known to have run a normal course. 3. Except in case of necessity, vaccination should not be performed when the system of the subject is in an unhealthy condition. 4. Except in case of absolute necessity, vaccination ought not to be performed when there is an epidemic influence prevailing which predisposes to erysipelas or other con- generic diseases. APPENDIX TO DR. BOLTON'S PAPER ON SPURIOUS VACCINA- TION AS IT APPEARED IN THE LATE CONFEDERATE ARMY. In a paper on spurious vaccination, as it occurred in the late Confederate Armies, I stated that my original paper, and the original sources of information, having been destroyed, I was compelled to write from memory, and was unable to verify my remarks by quotations. Since then I have discovered some fragments of the rough draft of my original paper, containing several abstracts of army reports. I therefore respectfully present these by way of appendix to the paper recently read before the Academy, only regretting that these abstracts are so meager. 468 Spurious Vaccination : Joseph Jones, M. D. Surgeon Habersham, in charge of the second division of Chimborazo Hospital, presented an elaborate report upon a large number of cases of spurious vaccinia which came under his care. He states that in obedience to an order from the Surgeon-General, he vaccina- ted all the soldiers as they were admitted. Instead of the usual phenomena of vaccinia, a spurious form of disease appeared, which he thus describes: "A few days after the insertion of the virus, and in many cases within twenty-four hours, the seat of the puncture became very much inflamed, with a deep red inflamma- tory blush around it, which gradually implicated, in the severe cases, nearly the whole of the affected limb." A pustule rapidly formed instead of a vesicle, which soon dis- charged an ichorous fluid. This fluid was, in the course of forty-eight hours, converted into a dark mahogany-colored, irregularly-shaped phagadenic ulcer, with everted edges, presenting the appearance of a syphilitic ulcer. There was also more or less pyrexia and loss of appetite. In these highly aggravated cases, successive crops of pustules appeared upon the upper and lower limbs, but never upon the head and trunk. He observed three grades of the disease differing in degrees of malignancy. Thinking these results may have been due to the impurity of the virus, he cast it aside, and ob- tained some of a highly respectable civil practitioner, accompanied with the assurance that it had been "used in several cases with a perfect result. The introduction of this virus into the arms of some ten patients, resulted in development of the disease in ques- tion in three of them, while in the remainder it produced apparently a time pustule. From this fact, and the immunity which healthy-looking men enjoyed, I was led to be- lieve that the predisposing cause existed in a vitiated and impoverished condition of the blood. There was no evidence to show that its origin was syphilitic." Surgeon H. regarded the disease as a consequence of " an impoverished condition of blood, being deficient in fatty matter." Accordingly he treated his cases by supplying a rich nutritious food, by the judicious use of alteratives, and by the administration of cod-liver oil. He states that a large supply of this oil was received in the early part of August, and that by the nineteenth of the same month many were well enough to rejoin their commands. The oil was used internally and locally. He arrives at the following conclusions: 1. That the disease is pustular and resembles ecthyma. 2. That it is a local manifestation of a general disorder or vitiated condition of the blood. 3. That this vitiated condition resulted from impure and spare diet, together with in- attention to cleanliness. 4. That syphilitic virus had no influence in producing the disease. 5. That the effects were not produced by any impurity in the vaccine virus. fl. That the disease can be removed by those means only which are calculated to improve the general condition and restore the healthy play of all the functions. W. S. Mitchell. Chief Surgeon of Rodes' Division, thus reports a spurious vaccinia which appeared in January, 1863. Inflammation occurred within twenty-four hours after inoculation. In two or three days a vesicle was formed which was soon followed by pustulation. Some observers state that the eruption was pustular from the very be- ginning. The ulcers w ere covered with thick scabs having a tendency to renewal. The ulcers were dry and many had indurated edges with little disposition to granulate and presented a tawney grey color resembling the Hunterian chancre. The hundred and twenty-seven cases which occurred in the Forty-Fourth Georgia Regiment, were derived from one mrfh who was inoculated from his wife, in Georgia. Many similar cases were reported as having, occurred in that State. Some cases yielded to, and some resisted treatment. Some were treated with mercury, and some with iodide of potash, with little advantage. The best treatment consisted in keeping the ulcers clean and applying nitrate of silver. Many cured in this way showed a tendency to return. The disease could not have been due to canstitutional vice, as the subjects were all previously healthy. It was evident that the constitution was subsequently involved, as all recovered during the Maryland and Pennsylvania campaigns. Two hundred and forty cases left Fredericksburg, all of which recovered on the march. It was evidently not followed by constitutional symp- toms. Many similar reports were made by surgeons of other divisions. Surgeon Read, in charge of the Officers' Hospital, Richmond, Virginia, states that a number of cases came under his care which resisted treatment while at hospital, butthat all recovered on being sent to their homes. The reports of Surgeons Habersham and Read evidently refer to a class of cases not of syphilitic character. Some of Surgeon Mitchell's cases, which were not fully traced out by him, may have proved syphilitic when fully developed. All those which continued to be under his observation seem not to have been syphilitic. Even this, however, is not perfectly clear. The history of the disease is certainly very suspicions. The patients were previously healthy, and the local results resembled strongly those of syphilitic in- oculation. The constitution was evidently involved, but neither secondary nor tertiary symptoms were devloped so long as they were under his observation, and the patients re- Spurions Vaccination : Joseph Jones, M. D. 469 covered without the use of what is commonly understood by anti-syphilitic treatment. These facts, however, will not be regarded by every one as conclusive, for it will not be denied that syphilis may be cured without mercury We are not informed how long these cases continued under Surgeon Mitchell's observation, and secondary symptoms may have subsequently appeared in some of them. Without his knowledge, Surgeon Breckinridge investigated the disease as it came under his observation, and carefully ex- amined the reports of surgeons transmitted to him in compliance with orders. He con- cludes " that the disease was essentially syphiloid, and in respect as a whole resembled in its incipiency, progress or termination, the genuine vaccine disease. The army was generally in good health. There was some tendency to scurvy, but no connection could be traced between the disease and this condition. In many cases there were no evidences of a scorbutic condition. The subjects were generally in robust and vigorous health. There was no case in which I had reason to be- lieve that any antecedent constitutional vice, either inherited or acquired, exercised the slightest influence in developing or modifying the disease. Previous vaccination failed to afford any protection against it " Surgeon A. H. Powell's report: A driver vaccinated a soldier from his own arm on the eighth day from the date of his own vaccination. Two or three days after there appeared at the place of the insertion of the virus a suppurating ulcer, fol- lowed by large unhealthy ulcers on the arm which did not heal for six months. These ulcers were accom- panied by an enlarged gland in the axilla. The soldier had two ulcers, a large one at the point of vaccina- tion and another on the back of the hand. Several others were inoculated with the same virus and with like results. Nothing was known of its origin. Abstract of the report of Surgeon J. A. Etheridge: Three hundred and thirty-two occurred in Dale's Brigade, beginning as early as January. Inflammation commenced twenty-four hours after inoculation. A vesicle appeared in two or three days, but in some in- stances the eruption was pustular from the first. These were followed by ulcers covered with thick scabs. The ulcer closely resembled the Hunterian chancre. Two hundred and twenty-seven cases occurred in the Forty-fourth Georgia Regiment, and the virus in all these cases was derived from one man. He stated that he was vaccinated from his wife's arm while at home on furlough, and that there were other cases in the same neighborhood. All the eases in the Twelfth Georgia Regiment were inoculated with virus derived from the Forty-fourth Georgia Regiment. All cases in the Twenty-first Georgia Regiment, with few excep- tions, were derived from the same source. The cases in the Fourth Georgia Regiment were derived from a scab obtained from the chief surgeon of the division. Treatment.-Some were cured by the topical application of nitrate of silver, some stimulating lotions and others by ointments. Some w»re treated by the internal use of mercury and iodide of potash,but with little benefit. The best remedies seemed to be nitrate of silver locally applied, and cleanliness. In many cases there was a tendency to return. Cause.-The disease could not have been due to an impoverished condition of the blood, as it occurred in some who had just returned from furlough, and were in high health. Although the.disease was not caused by constitutional vice, yet some vice must have existed at the time, protracting the disease and interfering with the cure, since all recovered during the Pennsylvania and Maryland campaign. Two hundred ana forty cases existed when the army left Fredericksburg, and all recovered on the march. Although he, at first, suspected it to be syphilitic, he was afterwards satisfied that it was not. No secondary symptoms oc- curred, and all recovered on the march. At the same time there must have been some constitutional vice, from the disease breaking out after being apparently cured. Abstract of Report of Surgeon Hicks: Perfectly pure virus was mixed with some whose history was unknown. This mixture produced vesi- cles which soon became pustular; in no other instances it produced pustules from the beginning. The suppuration was so profuse that no scab was formed for two or three weeks. After several successive scabs, the ulcer healed, leaving a purple cicatrix. These sores were frequently accompanied by others upon the extremities only. There were no constitutional symptoms. In a few cases there was debility. Treatment.-Some were treated with mercury, some with iodide of potash internally, and nitrate of silver locally ; some were treated with cold water locally and generally. The cold water treatment succeeded best. Anti-syphilitic treatment failed entirely. The worst cases were sent to General Hospital, and the others went with the army. All of the latter recovered speedily. With a few exceptions, all sent to the hospital recovered, but required two or three months' longer treatment . In one case a sore above the ankle healed under the local application of braised stramonium leaves. Cause.-It was not scorbutic, because scurvy cannot be inoculated. The officers and men, whether they had been at home or had remained in camp, whether they used scorbutic or anti-scorbutic diet, were equally obnoxious to it. Scorbutic diet will prolong it. It does not protect the system against small-pox. It may be reproduced any number of times on the same individual, no matter how far advanced the sore may be. A hospital nurse, insusceptible of vaccinia, was readily inoculated with this virus. It was not syphilitic, because it did not present the appearance of syphilis and did not yield to anti-syphilitic treatment, which served rather to prolong the disease. No secondary symptoms were observed. It resembles rupia, but this cannot be inoculated. Abstract of Surgeon Haighill's report: A soldier was vaccinated on the fifth of April. His arm was healed by the first of May, when a large ulcer appeared on one of his ankles. On the seventh of May, he complained of sore throat, and appeared to have secondary syphilis. Treatment .-Iodide of potash internally and lunar caustic locally. A general improvement took place under this treatment, but the ulcers had not healed on the ninth of September, more than four months after the first appearance of the disease. Abstract of Surgeon Rutherford's report: In nineteen out of twenty cases the virus (lymph ?) was taken from the arm of a comrade by some soldie r or officer, and not by a surgeon, without reference to the period after vaccination. Matter was often taken 470 Spurious Vaccination: Joseph Jones, M. D. from beneath a scab. Of course this was true pus and not lymph. The only case following the use of a scab resulting in malignant ulcer occurred in Jeffrey's Battery. The scab appeared to be derived from a secondary vaccination. From a limited experience, he concluded that the disease was due to the introduc' tion of pus into the system. Professor Paul F. Eve, M. D., of the Medical Department of the Univer- sity of Nashville, as will be seen in the following quotation from his article " On the Health of the Southern Army," believes that syphilis may be trans- mitted by vaccination. " Syphilis in Connection with Vaccination.-From all I have heard and read on the trans- missibility of syphilis by vaccination, the question, from the evidence already accumu- lated, would appear decided in the affirmative. While I have seen nothing confirming this opinion, yet I do know that cases did occur in Richmond, Va., said to be corrobora- tive of it, and that medical officers in the Southern service were specially cautioned as to the Bourse whence vaccine matter was derived. Since my return to Nashville, I find that in some instances syphilitic diseases have been definitely traced to the insertion of vac- cine matter. My colleague, Dr. Briggs, called my attention recently to a case of this kind, the source of which he entertains no doubt. I failed to see it, as the patient had left for the Hot Springs of Arkansas. When told that he had secondary symptoms of syphilis, he replied that it was impossible, as he had never contracted the primary, though confessing that he was almost daily exposed to it. Two other physicians were consulted as to the affection, and from this history of the case were inclined to the belief of the patient, but stated it looked like venereal. It was subsequently ascertained that this person had been vaccinated from a girl of the town who labored under constitutional syphilis. Not only was the arm very sore, but buboes formed in the axilia, followed by ulcerations in the throat, copper blotches in the skin, nodes, etc. "The possibility of communicating syphilis by vaccination, was agitated in Italy as far back as 1846 ; and the transmissibility of this unfortunate contamination was there de- finitely admitted in 1861, by a committee elected at a Medical Congress at Acqui in Piedmont, at which it was believed that numerous cases had occurred in both children and adults, who had been vaccinated. The names of Pacchiotti, Parola, Ponza, Tassani, of Milan, who I met there in charge of a large hospital after the battle of Magenta and Solferino, in 1859, De Kalt, Hubner, etc., vouch for the accuracy of this report. The transmission of (syphilitic) disease has also been maintained by Leeoq, Rollet of Lyons, and particularly by Vennois in the Archives G6n6rales de Paris, 1860; and on this point, the admission of Dr. D. F. Condie, long known to occupy the front rank in the profes- sion, and who has done so much for its literature, deserves serious consideration ; and he publishes these words in a recent number of the American Journal of Medical Sciences : " 'Let it be strongly impressed upon the mind of every physician, lest in his attempt to guard the system against one formidable malady, he inoculate with another, more in- sidious iu its operations, but not less destructive.' "As to the consentaneous presence of two constitutional diseases in the same patient, and the contagiousness of secondary symptoms of syphilis, it is sufficient for us to state that at a recent meeting of the Academy of Medicine in Paris, the report from a com- mittee, on which MM. Velpeau and Ricord served, (than whom it may be safely asserted two better names for this very purpose never existed in the annals of the profession), decided both these questions in the affirmative." Dr. O. Kratz, iu the following report to the Surgeon General on vaccina- tion, originally published in the July number of the Confederate States Medical and Surgical Journal (vol. 1, 1864, p. 104), supported the view that secondary syphilis could be communicated through the medium of vaccine virus. ON VACCINATION AND VARIOLOUS DISEASES. BY O. KRATZ, SURGEON, P. A. C. S. The following remarks on vaccination and variolous diseases have been suggested to me from my own experience. Spurious vaccine and its deleterious influence on vaccin- ation, seen?to me worthy of further investigation as a subject hitherto not sufficiently appreciated. In order to define my stand-point, let me state, at the outset, that Liebig's Theory of Fermentation is, till now, the best to explain the phenomena of vaccination, and that all the anomalies occurring may be best elucidated by this hypothesis. At the same time I do not feel warranted in subscribing blindly to it; but I think we have not any better as yet, and I simply adopt it in the same manner as I would have to conform to the atomic theory iu treating about chemistry. Spurious Vaccination: Joseph Jones, M. D. 471 In vaccinating a subject, we introduce, then, the yeast-the virus-into the circula- tion, to produce the fermentation and its result, the scab. ]f thereisa cerrain substance in the system for the virus to react upon, the scab will be formed, and the subject is vac- cinated. If, on the contrary, this substance is entirely deficient or modified in some way or other, no scab, or an imperfect one, will be'the result. With very few exceptions the good vaccine matter will produce a normal scab on the subject never vaccinated before. The reacting matter in the system is eliminated, and by this process the liability to the infection of small-pox rendered impossible or greatly diminished. Possibly, in a long interval of time, this matter may be reorganized in the body, but never to its original state. I say never, because such a subject may be at- tacked by varioloides, but never by variola. If this reacting matter is reorganized as nearly as possible to its original state, the sec- ond vaccination will produce a scab also, but never a perfect one. It may be perfect for the protection of the individual on whom it appears, but it offers no guarantee for revac- cination on other subjects. I call this a pseudo-scab. This scab may yet retain much of the original fermenting property, but not the same as the genuine. If this virus is used again for revaccination of an individual, its product will offer again less guarantees of being protective. Continuing in this manner the scab will finally contain nothing but common suppurative matter-pus-as if taken from any other suppurating place in the body. The germ of the scab itself willgbe more or less ^modified and deviating from its normal structure. As I have no book of reference on the subject, I quote the following from memory : Some years ago, the Academy of Science in Paris investigated very closely the fact if syphilis could be transferred by vaccination. The result obtained by repeated and most direct experiments was, that it could not be communicated by transmission of genuine vaccine virus, from one individual to another, affected with syphilis m any of its stages. Liebig's explanatory theory of fermentation holds good here. The vacoine virus will re- act only on certain substances in the system and ignore others entirely. We know, at the same time, that matter from asyphilitic suppurating surface will reproduce syphilitic symptoms on another subject. I have had occasion to observe several well defined cases of Rupia Syphilitica produced solely by vaccination. Other respectable surgeons, worthy of implicit belief, from their scientific attainment, have noticed the same and similar facts repeatedly. These subjects had never syphilis before, otherwise the inference would have been doubtful or worthless altogether. Therefore, instead of having had vaccine virus in- serted, they have been inoculated with syphilis. I have seen one case, where the product of the vaccination was serpetigo rodehs, a frightful disease of, I believe, cancerous character. Some cases had herpes excedens as the result of vaccination on their arm. The syphilitic cases had been treated for other cutaneous diseases without any mate- rial amelioration. The mercurial treatment removed the symptoms at once. I have never seen anomalous results from vaccination, if the following precaution was strictly adhered to: The vaccine matter used was taken from a healthy infant, never vaccinated before. The indiscriminate vaccination and re-vaccination from arm to arm has been, in my opinion, the principal cause of the deterioration of the vaccine virus, and of producing cutaneous diseases from vaccination. A second cause may be found in the fact that the virus used is old and too rarely regenerated by passing it through the cow. Cow virus will fail only 1 in 100; good common virus will fail 3 in 100, if I remember right.-Con- federate States Medical and Surgical Journal, July, 1864. The testimony of Dr. Wm. F. Fuqua, of Virginia, formerly surgeon of the Seventh Florida Regiment, C. S. A., is clear and decided. Fifty-two Confederate soldiers, who had been inoculated with virus from the arm of a sailor who was laboring under syphilis, presented the characteristic symptoms of constitutional syphilis, as abscesses in the axillary glands, pain in the limbs and joints, sensation of dryness and ulceration in the throats, buboes, coppery colored spots, and loss of hair, and they were only relieved by syphilitic treatment. If these results of vaccination had been due to a depressed and scorbutic state of the blood, the syphilitic mercurial treatment would have greatly aggravated the diseased condition. 472 Spurious Vaccination : Joseph Jones, M. D. ON THE COMMUNICABILITY OF SYPHILIS BY VACCINATION. BY WM. M. FUQUA., M. D., APPOMATOX COUNTY, VA. On assuming charge of the Seventh Florida Regiment, late C. S. A., as medical officer, I found fifty-two men, who had been recently vaccinated, suffering from severe ulcers on their arms at the site of vaccination. Some of these ulcers bad scabbed, and to all ap- pearances seemed to promise a speedy " return to duty." There were others varying in size from that of a quarter of a dollar to that of a Mexican dollar. Their edges were hard, shining and everted ; in some few cases they were undermined. An ashy-colored slough covered their base, which was from time to time cast off. This, however, was not always a genuine slough, but a tenacious gray and partially organized exudation. These ulcers were offensive, and discharged pus freely. The redness circumscribing them was limited, the limb but little swollen, and the pain of a burning, stinging character. In many instances the lymphatic vessels were much inflamed, and the axillary glands in each case w'cre more or less affected. Many of these patients complained of pain in their limbs; there was some febrile excitement, and their appetites had been much impaired. Having thus briefly described these ulcers, it may not be improper to remark upon the hygienic condition of the regiment. At this time, it was doing duty at Knoxville, in the department of East Tennessee, and was quartered a mile from town, upon soil which had been previously occupied by troops, who had left the encampment in no praiseworthy condition. To the south, southwest and west, passed the Holston river. The general health of the command was bad-the sick list comprising one-seventh of the command. The prevailing diseases were the malarial fevers and acute diarrhoea. The first part of the treatment of these cases, consisted in their removal to a more cleanly and healthful locality; cleanliness of person and clothing was enjoined also, General directions were given ns regards diet, and of maintaining their bowels in proper condition. The second part of the treatment was the local application of astringents in the milder cases, and eschoratics, varying from the mildest kind to that of the most potential, in conjunction .with the astringent lotions in the severe ones. Under this re- gimen, some few improved ; none, however, recovered; by far the greater number grew worse. Abcesses now began to form in the axillary glands ; pain in the limbs and joints increased in severity ; there was a sensation of dryness in the throats of many, which -was speedily followed by ulceration. Our apprehensions were now fully awakened ; each day we inquired more and more diligently for some new symptom which might be diagnostic. Coppery-colored spots now appeared upon two ; the hair began to fall off in a third, audit was nota week before a syphilitic bubo, in its incipient stage, appeared in another. Heretofore, these eases had been denominated "spurious vaccination." Spurious they were in one sense; but specific in another, in the strictest acceptation of the term. It is hardly requisite for me to state, that these cases were placed upon a syphilitic treatment, and we had the satisfaction, in a comparatively short time, of seeing a great number of them returned to duty. A few were sent to the General Hospital, one of whom died. In conclusion, let me remark, that having mentioned to Dr. Frank Ramsey, then Medi- cal Director of the Department, the nature of these cases, he requested me to make a re- port in detail concerning them, which was done, and in all probability found its way to the late Surgeon General's office. Upon inquiry, it was definitely ascertained that the virus for inoculating these patients was obtained from a sailor, on the coast of Florida, who labored under primary syphilis at the time of vaccination.-Richmond Journal of Medicine and Surgery, June, 1866. The following article by Dr. Frank A. Ramsey, of Memphis, Tenn., con- tains an argument for the possibility of the transmission ol syphilis by vaccination, although its author does not feel justified in supporting this opinion in 11 a strictly professional disquisition." In a letter from Dr. Ram- sey to myself, accompanying this paper, dated Memphis, November 15, 1866, he says: " The subject has occasioned me much thought, and inci- dentally some research, being on the watch for anything, however remote, at all applicable to the question. But I cannot say that I have formed any definite views regarding the question involved.* Spurious Vaccination : Joseph Jones, M. JD. 473 ABNORMALITIES OF VACCINATION. BY FRANK A. RAMSEY, M. D., MEDICAL DIRECTOR OF THE (Quondam) C. S. A. It is, after conference, regarded as proper for the following letter to be published. The subject-matter of which it treats, was one of exceeding importance and interest, almost from the incipiency of the intestine strife, in the Southern States, but has not yet had, in the professional periodicals, any exhibition of the attention it elicited, or any declara- tions of results of observation or of investigation. I do not deem it necessary to defend now the course of thought taken in the letter, written under the peculiar circumstances connected with the period at which it bears date. It has, however, a reference to a particular opinion, which I would not, at any time, or under any circumstances, support in a strictly professional disquisition ; that opinion had been hastily expressed in the midst of official business, and for the purpose of producing a particular effect, which I honestly judged to be proper and best in the exigency. Effects, very nearly resembling rupia, followed vaccination, with presumptively pure virus, in so many instances, as induced the Surgeon General to appoint medical officer8 connected with the Southern army to the duty of tracing, if any, the connection between syphilis and vaccinia; and the prosecution of this duty gave occasion to the letter, now presented in the hope that it will lead others to record their observations, experiences and reflections on the same subject; and with the intention on the part of the writer himself, under other and more favorable conditions, to give the subject further consid- eration : MEDICAL DIRECTOR'S OFFICE, ? Abingdon, Virginia, March 20, 1864. $ Doctor:-Your note, of March the eleventh, informing me, that you had been ap- pointed "chairman of a committee on the relation of vaccination to syphilis," and making references to my "report of last year," and asking me for "any further informa- tion relative to spurious vaccination," has been received; and I take the first oppor- tunity, offered in the performance of official duties, to reply. I have no facts, which have occurred within the field of my observation, directly re- lating to the sunject, as stated by you; but, with your permission, will continue writing, until I have given you something of the operation of my mind, occasioned by your note. I thank you for the honor you have done me, in preferring the request, aud in the re- ference you have made to, I presume, a letter written by me, to a surgeon at Chattanooga, a copy of w'hich I deemed proper to forward to the Surgeon General. That letter was written, as I now write to you, currente calamo, and though 1 preserved a copy, it was left at Knoxville, and has doubtless fallen into the possession of the enemy. I am, therefore, prevented from making reference to it, as I am debarred from any ability to consult authority, or to refresh my memory, as I should, and would do, if differently situated. But, if I correctly remember, the latter was not of such a character as to convey an idea, that the observations were of cases of spurious vaccination Indeed, the basis of the letter was furnished by observations of results, or effects following the introduction, or inoculation of vaccine virus undoubtedly pure. Aud though the result or exhibits were in their course, certainly not such as ordinarily present from vaccina- tion, or as are usually recognized as essentially cow-pox ; yet observations were not suffi- ciently numerous, or continued for a time long enough, to determine whether any, or the same degree of immunity fiom small-pox was occasioned in subjects thus affected, as in those who presented the ordinary course of the cow-pox disease. There were, however, practitioners of medicine who were esteemed, in communities in which they labored, as capable observers, who affirmed that these subjects were as free from liability to small-pox as those in whose economies the vaccine disease had exhibited nothing unusual in deviation from its regular course. If, then, the scab was undoubt- edly a pure vaccine scab, and the effect was perfect, or relatively perfect, immunity from small-pox, notwithstanding there was nothing observed from the application of the virus, until the production of the ultimate effect, at all like vaccine disease in progress, the disease, I think, cannot properly be termed spurious. To be spurious, the vaccine virus must not be in the scab, or the effect must be an absence of any protective energy having been impressed on the economy into which the scab had been introduced. Vario- loid consists of exhibits iu course, differing from variola in course; yet no one, I pre- sume, would feel himself justified in terming it spurious small-pox, because it is known to proceed from small-pox virus, will communicate small-pox, and leaves the economy it has effected impressed with immunity from a future attack of small-pox. Varioloid is, then, not spurious small-pox, but small-pox modified in its exhibits in progress through an economy previously impressed by the operation of the virus of cow-pox. Here the modifying cause is known. 474 Spurious Vaccination: Joseph Jones, M. D. So by analogy, the cases which gave occasion to my letter of last year were, each, an instance of modified cow-pox. The matter was obtained from Nashville, Tennessee, from Atlanta, Georgia, and from Richmond, Virginia, from surgeons of reliability, and the same results were observed to follow upon the introduction of the several matters, in some instances regular vaccinia, in others abnormal exhibitions; indeed, in many an ap- proximation to the regular exhibition of the original poison from cow matter could not be discovered. And professional men, who were not destitute of reputation for capacity, affirmed, on the strength of observations sufficient to satisfy them, that the economies thus effected were impressed with immunity from small-pox as though they had passed through cow-pox in its regular exhibitions. True, to make complete the analogy I have instituted, it remains to establish by experi- ment, that true vaccine in its regular exhibitions, in one instance, or more, can be pro- duced by the inoculation of matter from one of these economies. Which experiment, however, I will leave to some one with more curiosity and temerity than I have, feeling satisfied myself, that they were modified cow-pox. But in these instances, the modify- ing cause is unknown. It must, however, have obtained an union with cow-pox matter, in its passage through an economy peculiarly affected, and, therefore, resided in the scab, not altered from its ordinary physical appearance, because, as yet, not sufficiently imbued with the acquired and modifying contagion. Or, it must have been a peculiar condition of the individual economies, into which the vaccine virus was introduced. Or, it must have been telluric or celestial relationships sustained by the particular persons affected ; or, as Sydenham's comprehensive term is applicable in giving expression to such relation- ships- "the epidemic constitution." In my previous letter, I believe, I advanced this last as sufficient to account for the abnormalities which have been observed. It is the more easily assumed, and probably the more easily sustained position. I will, however, not undertake to defend it here, for, notwithstanding my great respect to the "epidemic constitution," when I am at the bedside of a patient, 1 can, when I am reflecting, readily comprehend, that either one or all the positions may be defended, as the source of cause in its influence modifying cow- pox. Will vaccine virus become possessed of capacity acquired in its passage through an econ- omy peculiarly diseased, to propagate such disease in other economies ? The question thus stated, will in some degree, embrace the relation of vaccinnation to syphilis. Whether there is truth in the doctrine which has been promulgated, that two distinct contagious diseases cannot exist at the same time, in the same economy, it is not amiss to make reference to it here ; for if it is not true, the fact does not justify the assumption that two poisonous causes cannot be introduced into an economy at the same moment, one having the office of vehicle for the other-does not justify an assumption that two poisonous causes in the same economy, at the same time, can occasion no modification, each of the other, or the one of the other-and if it is true, the fact or modification is at once established. More, directly assertive of the virus acquiring a modifying capacity, even to the complete destruction of original physical appearances, and exhibitions of effects, is the idea suggested during the year 1800, by Richard Dunning, Surgeon, Plymouth Dock, that " the vaccine disease, united with some other virus, may have afforded the more active affection of variola." Dunning's reviewer, from whom I received my' infor- mation, says " the hint deserves some attention, as a point of speculation, which cannot be subjected to the test of experiment." I only make reference to it as an assertion made long ago, that one virus may be mod- ified by another : for I do not regard the poisons of variola and vaccinia as being at all identical. This, I think, is evident, if there is truth in the following statement: Small- pox and varioloid will produce small-pox. but never cow-pox. Cow-pox will produce cow-pox, but never small-pox or varioloid. Cow-pox will prevent the occurrence of small-pox, or mitigate its severity, and lessen its mortality in the human economy. Small-pox having occurred in the human economy, is not preventive of cow-pox, if its poison be introduced by inoculation. Cow-pox, reproduced in the human system, in- serted into the teat of the cow, will produce cow-pox. Small-pox, similarly introduced into brute animals, will not produce small-pox. This last assertion is made by Wm. Woodville, M. D., London, 1800, and by others, perhaps before, and several times re- peated since ; and w ithin the past two years medical officers in the service have attempt- ed, at Greenville, Tenn., to occasion small-pox in a cow, in one instance, and iu a calf in another instance, using matter taken from a case of confluent small pox then under treat- ment, and inserting it under the cuticle, and introducing it into the stomachs, mixed with lood, and without any bad effects w hatever, or any disturbance of the health of the animals. lam aware that observations have been published, seemingly different from this, but there is a want of explicitness in connection with their relation which justices a doubt of authenticity. But this, if you please, by way of parenthesis. The most insidious of contagious poisons affecting the human economy is, probably, the syphilitic It has, doubtless, occurred to almost every practitioner to observe cases in •which the subjects were known to have been treated lor syphilis; and afterwards to have Spurious Vaccination: Joseph Jones, M. D. 475 exhibited for many, very many years, entire health, when occasion, known or unknown, presented, and they offered themselves for treatment, affected with disease which the physician pronounced to be syphilitic, and which could not be cured, except by the ad- ministration of anti-syphilitic agents. The poison had remained latent or dormant for these many years, only awaiting circumstances or conditions favorable to the exercise of its capacity to effect. I had under my charge, for twenty years, a family, the children of which were generally healthy, whose father was treated for syphilis from the age of nineteen to twenty-four, since which he has enjoyed good health, seemingly, in every particular. His children, how ever, were frequently attacked with illness deemed suffic- ient to require my professional attention. No odds how simple the attack, even though when I first called, the evidences were nothing more than those of slight catarrh, I have never known them yield or mitigate until one dose, or more, of a mercurial-generally calomel-had been administered. This I have ascribed to the presence in their economies of the syphilitic poison derived from their father, and exerting an influence retarding healthy developments, or preventing the disappearance of symptoms of diseased action not in themselves syphilitic. The cases cited in " Montgomery on Pregnancy" bear well on this point. A woman married a man with latent constitutional syphilis. She became infected, which was first exhibited at conception, or in miscarriage, followed by secondary symptoms of syphilis. A woman contracted syphilis, was treated and recovered. A con- siderable time afterward she married. One, two, or three children were born, all affected with syphilis. The husband died, and the woman married again, a healthy man; and to this husband children were born, and all died, except one, affected with syphilis ; the exception had mercury and recovered. One of the children communicated syphilis to the w'oman by whom it was nursed. But the insidiousness of this contagion is more strongly exhibited in another case, cited by Montgomery. A woman, whose husband had constitutional syphilis, gave birth to a child; which died with syphilis in two months, the mother remaining wholly free from any exhibits of the affection. This husband died, and she married again, a healthy man. Four years after the former birth, she was delivered of a child, which, in a few months, presented the same syphilitic appearance manifested by the child of the first husband. If these instances are, as observers affirm them to be, true, how little effort does it re- quire for the mind to conceive the probabiity of a vaccine scab, having acquired the capacity from an economy, affected with syphilis, to propagate that disease ? If a woman can remain in health, after sexual congress with a man affected with latent constitutional syphilis, and yet, years afterward, give birth to syphilitic children, begotten by a healthy man, it is within the bounds of legitimate assumption, to affirm that syphilitic exhibits may be manifested in an economy, by the introduction of vaccine matter, taken from an economy tainted with syphilis, even though it is in that system in latency, and had never been developed. Two of the cases which gave occasion to my letter of last year, were ladies whose husbands occupied prominent and responsible positions in society. Neither the husbands or wives were at all under suspicion of immoral taint. The wives were vaccinated, aud for many months were affeeted with ulcerations, which under other circumstances, would have beep, without hesitation, pronounced to be syphilitic rupia. They came under the care of Acting Assistant Surgeon Meadows, then, as now, in charge of small-pox hospitals in this department. He put them on the use of bi-chloride of mercury, and they both recovered in ten' or fifteen days. Permit me to summarize. Two contagions may be introduced into thehuman economy at the same moment of time, and connected with the same vehicle ; or, one contagion may be the vehicle of another, and each may exert its own ultimate effects, the interme- diate effects being the exhibitions of but one or the other of the contagions having made impression ; or the intermediate effects may be the exhibitions of one poison, which, hav- ing passed their course, the intermediate effects exhibiting the presence of the other poi- son, supervene and pass their course. Syphilis and vaccine. Two contagions may respectively modify each other. An illustration does not occur to me. One contagion may modify another, and while it is itself not subjected to a modifying influence, exerted by the one it has modified, it may be modified by another contagion. Cow-pox and small-pox, cow-pox and syphilis. The introduction of one contagion into an economy may arouse another which has remained dormant, or latent, and unsuspected. Cow-pox and syphilis. An item relative to the treatment of small-pox: Acting Assistant Surgeon Meadows, in two cases of small-pox occurring in children, employed croton oil, applying it on the third and fourth day of the active fever to the breast, producing full and confluent pus- tulation. The immediate effect was certainly unpleasant-very considerable cerebral disturbance, evidently, in its intensity, ascribable to the croton oil pustulation ; but he is convinced that the course of the disease was shortened two-thirds, desquamation be- ginning on the seventh day instead of during the second week, and that the eruption was one-half less than it would have been under other circumstances. He has also prac- 476 Spurious Vaccination: Joseph Jones, M. D. ticed opening each pimple just as it assumed the vesicular character, with the effect, he believes, of expediting the process, desquamation occurring one-third the time sooner than usual. I have written, Doctor, hurriedly, but I hope, that I have not been so rapid as to have failed wholly of interesting you, at least for the moment. Very respectfully, your obedient servant, FRANK A. RAMSEY, Surgeon and Medical Director, P. A. C. S. To James Bolton, M. D,, Chairman Committee on the Relation of Vaccina to Syphilis, Richmond, Va. (The Medical and Surgical Monthly, May, 1866, p. 140-147.) Dr. Crawford, of Greenville, Tenn., was able to trace the impure virus which produced indurated ulcers ami constitutional symptoms, to a single individual, and the disease thus disseminated by inoculation, yielded to the remedies best adapted to the treatment of syphilis: Greenville, Tenn., January 27, 1867. Professor Joseph Jones, M. D. : Dear Sir-Having seen in the January Number of the Nashville Journal of Medicine and Surgery, a circular letter addressed by you to the surgeons of the late Confederate Army, instituting inquiries upon "Spurious Vaccination/' 1 desire to respond to your inquiries, and to communicate those facts in my possession which may throw light upon this sub- ject, which is fraught with so much interest to humanity and science. During the winter of 1862 and 1863, I was "Surgeon in Charge" of the "Madison Hos- pital" (Confederate) at this place, during which time over 1000 patients came under my charge. Small-pox made its appearance in the hospital fifteenth November, 1862. In anticipation of the appearance of the disease, I had some time previous procured a fresh supply of genuine vaccine virus by vaccinating some healthy children. In this way I had kept a fresh supply on hand since 1856-that is, by vaccinating some healthy child every few mouths. I immediately ordered all patients then in hospital (350) co be vac- cinated-both those that had been, as well as those that had not previously been vac- cinated The matter took well upon all who had not been vaccinated, and imperfectly in some cases that had been vaccinated. A "pest-house " was established, and the infected, as soon as the nature of the disease was manifested, removed at once to it. The disease did not extend to the patients in hospital; but from time to time patients were admitted, many of whom proved to be suffering with variola. But in no single instance was the disease communicated to those that had been recently vaccinated or re-vacci- nated, and but six cases of varioloid occurred out of the 350 patients, all of whom had been exposed to the contagion of small-pox. There was great alarm, both among citizens and soldiers ; for the small-pox cases were exceedingly fatal, owing to the want of proper comforts and attention. Out of ninety cases, forty proved fatal. Neither the citizen nor soldier was satisfied of his immunity from danger, unless he could make a " sore" of some sort upon his arm. Consequently vaccination was perseveringly sought from the ugliest and foulest looking ulcers. The idea being with the masses, that vaccination loses its effects after a few years, and must be renewed ; if a sore was not produced by matter from one arm, another was sought. This state of things continued without any mischievous effects until about the first of January, 1863, when Col. Clayton, then Commander of the Post at this place, who had been on leave of absence some weeks in North Carolina, returned with an ugly looking ulcer upon his right arm which was reported to be genuine matter. The cry of eureka w as raised, and it was not long until dozens, both citizens and soldiers had this matter inserted into their arms. From this dates the history of " Spurious Vaccination." Co). Clayton had been successfully vaccinated some years before; but so soon as it was known that we were in the midst of the most loathsome of all diseases, I re-vaccinated him twice with genuine virus, but without effect. What the history of the case was from which he received the infectious matter, I never learned, for the Colonel could not find out. Col. Clayton was about twenty-one years of age, sanguine temperament, and in excellent health at the time he received the infectious matter into his arm. The ulcers I regarded at the time, and still regard, as caused by inoculation with syphilitic virus. The cases ran an indefinite course of from three weeks to six months, and yielded only to Blue Mass, Iodide Potassium, internally, and Sul. Cupri. externally. Some cases taken in their incipi- ency, yielded in a few days to the external treatment alone. It is proper to state that there was no tendency to scorbutic disease among either sol- diers or citizens, and the infectious matter was equally as severe among the citizens as soldiers. The hospital was well provided with everything calculated to promote com- fort and health. The patients were in good houses, had plenty of clothing, and rations in abundance, such as fresh meats, fruits, potatoes, cabbage, etc. There was no scarcity of these things in this country at that time, and what the Government did not provide the citizens supplied with a liberal hand. ' • Spurious Vaccination : Joseph Jones. M. D. 477 This " spurious vaccination " yielded no protection whatever from variola. I have seen more than a dozen cases of variola occur where there were large ulcers from this spurious virus, the patients thinking they were protected from the disease by such sores. The spurious matter would take effect in all cases and all sorts of constitutions. About this time orders were issued from Surgeon General Moore to procure fresh vac- cine virus through the cow I tried the experiment three times without succeeding. First on a cow seven years old, with a calf six months old. Then a young heifer two years old, and finally the calf. I inserted the matter in the teats, nose, ears and various parts of the skin, but never succeeded in getting a crust. Finally I fed the calf on the dried scabs mixed with its food, but it died without yielding me the much sought for treasure. In August, 1863, the Confederate Army evacuated East Tennessee, and in September, 1863, the Federal Army took possession and held for a time. That army, under Gen. Burnside, was composed of new recruits, made up mostly of six mouths volunteers, many of whom had not been in the service three months. This same disease was among them. This army was abundantly supplied with anti-scorbutics, and fed with a liberal hand, and had never been exposed to hardships. My best wishes for your success in your undertaking. Yours sincerely, S. P. CRAWFORD. If such accidents had been confined entirely to the Confederate Army, or to the period of the war, when the citizens were to a greater or less extent subjected to unusual privations, and to the action of the most depressing causes, the views of those who denied emphatically the possibility of trans- mitting the poison of constitutional syphilis by the process of vaccination, would receive at least a show of support from the apparent dependence of the abnormal phenomena accompanying the vaccine disease, upon the de- pressed and deranged states of the system, induced by improper nutrition and physical causes. It happened, however, that a large number of cases, which were referred by both citizens and physicians to the contamination of the vaccine virus with the syphilitic poison, occurred in the quiet manufacturing community of Graniteville, after the close of the war. Under the kind, liberal and efficient management of the intelligent head ot the Graniteville Manufacturing Company, the operatives enjoyed com- fortable dwellings and abundant supplies of nutritious and wholesome food. This class of the population of South Carolina were, perhaps, more favora- bly situated as to subsistence and support, than the great majority of the citizens of South Carolina, whose dwellings and barns had been laid in ashes, and whose social and agricultural system, the growth of centuries, had been so completely overturned as to convert, without warning, the richest into the poorest. The following report of Dr. W. F. Percival, of Aiken, South Carolina, is important, as being the most clear and intelligent statement which I was able to obtain, after considerable inquiry: EEPORT ON THE COMMUNICATION OF SYPHILIS THROUGH THE MEDIUM OF VACCINE VIRUS AMONGST THE INHABI- TANTS OF GRANITEVILLE AND VICINITY, 1806. BY W. F. PERCIVAL, M. D., OF AIKEN, S. C. Aiken. November 15, 1866. Professor Joseph Jones, M. D.: Dear Sir-I received your letter yesterday, and inclose a copy of my report on spurious vaccination with pleasure. I intended sending it to one of the medical journals, but have never had time to revise and prepare it for publication ; the fads, however, are all stated. I am, with high esteem, yours very respectfully, W. F. PERCIVAL. Spurious Vaccination.-The Epidemical Society of London prepared four questions on the subject of vaccination, to be addressed to the most eminent medical men in Europe. The third was as follows : 478 Spurious Vaccination ; Joseph Jones, M. D. Have you any reason to believe, or suspect, that lymph from a true Jennerian vesicle has ever been a vehicle for syphilitic or other constitutional infection T Among the number who responded (over 400), but three asserted their belief, twenty-seven in doubt and nine had no experience The rest asserted that it could not be done. In a report from the College of Faculty of Medicine, at Prague, the following language is used : "The possibility of inoculation with syphilis by means of vaccination, (al- though not a single completely attested fact is known in this country,) is not to be excluded, for the conveyance of syphilis, by means of inoculation, has been placed beyond a doubt" In the face of so much testimony against the possibillity of such an occurrence, the fol- lowing report will perhaps throw some light on the subject. About the last of April, 1866, 1 was requested to take charge of some cases of spurious vaccination, at the manufacturing village of Graniteville, One hundred and fifty cases were presented for examination, men, women, and children, of all ages, from fifty years to twelve months. The larger proportion were operatives in the factory, the others en- gaged in out-door w ork. There w as every variety of constitution, from the pale attenu- ated girl, to the hardy and robust laborer. Of the one hundred and fifty cases, ninety- three had been previously vaccinated. The appearance of the sore was identical in every case, viz; an excavated ulcer, of circular form, with raised and hardened edges and base. They varied in size, from one half to two inches in diameter, covered with grey or dark sloughy matter, and secreting unhealthy pus. There was no appearance of granulation. In some cases ulcers of a similar character, appeared on the arms affected; others on the opposite arm, and in a few on the lower limbs.* In some, abscesses formed on the inside of the arm, and in nearly all the axillary glands w'ere inflamed, and many suppurated. A thick and unhealthy crust would form, to be soon separated by the pus which accumu- lated beneath. In one case, there was a copper-colored eruption on the body and limbs; in two or three the hair dropped off. None of these cases were in the primary stage. The disease had existed from three to eight weeks. Most of them pursued their ordinary avocations, as far as possible, and complained of no constitutional symptoms, or any loss of appetite. The history of these cases, as given to me by the individuals first vaccinated, was, that they had obtained the virus from a man w hom they afterward discovered to have had primary syphilis. One was vaccinated from another, and so it spread. None of the ulcers had evidenced any tendency to heal. One of the worst cases was a man who, two years previously, had small-pox. The usual treatment, both constitutional and local, for venereal ulcers, effected a cure in from three to six weeks. It might be supposed that the predisposing cause of the ulcers existed in a vitiated condition of the blood, dependent on local causes, but I had twelve or fifteen cases in other localities, some of them ten miles distant. All of these had obtained the virus with which they were vaccinated at Graniteville. All of these were strong and healthy indi- viduals. Again, most of the cases reported had been vaccinated a sho^t time previously, and had progressed in the usual manner without any trouble, showing that no local cause had produced any derangement of their system. As I did not see the individual from whom the virus was first obtaiued, I am unable to say that he really had primary syphilis. I cannot, therefore, draw positive conclusions from the above cases, and only present the report as information. On the other hand, many of the Confederate surgeons entertained views similar to those announced by Dr. Habersham, and denied that any of the cases of spurious vaccination were syphilitic in their origin or relations. Thus, Dr. S. F. Stout, of Pulaski, Tenn., formerly Medical Director of the general hospitals attached to the Army of Tennessee, in his reply (dated near Pulaski, November 19, 1866) to my inquiries, says: I am uot satisfied that there occurred a well-authenticated instance of the propagation of secondary syphilis by means of the so-called spurious vaccine matter. I think that the injurious effects were chiefly produced upon persons already diseased syphilitic, scor- butic, or while living in an atmosphere infected by the causes of gangrene and erysipelas. A vast majority of these cases were those of individuals who had been previously vac- cinated, and in very many instances the virus used was taken from the arms of re-vac- cinated individuals. Thus, common pus, and even ichor, was no doubt inoculated, which produced effects similar to those that are caused by a wound received while dissecting a dead body, modified in many instances, no doubt, by the condition of the patient's health and the morbific influences to which he was exposed. Prior to my assumption of authority to take steps to stop the evil, I am satisfied that there were several errors iu practice among our troops. First, the order requiring all soldiers to be vaccinated, whether they had been previously effectually vaccinated or Spurious Vaccination: Joseph Jones, M. D. 479 not. This order was literally interpreted and acted on by the superintendents of vacci- nation appointed by the Surgeon General. Secondly, many soldiers, ignorant of the characteristics of genuine vaccinia, vaccinated themselves, or each other, without con- sulting a surgeon. Thus, no doubt, common pus, and even ichorous matter, were often inserted. Thirdly, when variola first appeared in our army, so great was the fear of the disease, and the consequent anxiety to vaccinate everybody in the army, or in its vicin- ity, that the temptation to the surgeon to use any virus within his reach was very great. Thus, much matter was used which ought to have been rejected by surgeons. In my investigations I could not learn of a single well authenticated instance in which due care had been taken in the selection of the virus, whether in the form of lymph, or of the dried scab, that was accompauied by the evils of so-called spurious vaccination, in a perfectly healthy individual, in an atmosphere uninfected by erysipelas or gan- grene. Believing these conclusions to be correct, when as Medical Director of the hospitals I undertook to relieve the army of the evil, I made provisions to supply it with virus taken only from the arms of healthy children, who had never before been effectually vac- cinated, By the zeal and energy of medical officers designated at every hospital post, from supplies of virus obtained from the Surgeon General, S. P. Moore, and Surgeon J. C. Mullins, superintendent of vaccination of my department, appointed by me, the army in the field and the hospitals in the rear were amply furnished with virus from healthy children. No soldier was vaccinated with matter taken from another soldier. The supply was so abundant that there was not temptation to use any other part of the dried crust than the vitreous, mahogany-colored portion. I recommended that no soldier who had been vaccinated within a few years past, and who had the characteristic mark, should be revaccinated, unless positively known to have been exposed to variolous contagion ; and especially, if he were laboring under any form of syphilis, or was scorbu- tic, or was living in an atmosphere infected with gangrene or erysipelas. Under this practice the so-called spurious vaccination disappeared from our army, and before the close of the war it might be said to have ceased to exist iu Georgia. Having thus far entered into a statement of the impressions I have, and of facts bear- ing upon the subject, it may not be amiss to say to you that my observations and experi- ence during the war has confirmed my faith in the prophylactic powers of the Jennerian virus. I use the term Jennerian to designate that vaccine virus which has been propa- gated from that originally supplied by Jenuer. The immunity of so many thousands of soldiers and officers witnessed during the war, and the comparatively small number of the vaccinated who were attacked with variola or varioloid, enhance my estimate of the protective power of vaccinia, rather than diminishes it, as has been the case with many whose field of observation has been comparatively smaller than mine. The testimony of Dr. E. A. Flewellen before the United States Military Court, in the trial of Henry Wirz, is of interest in this connection, in so far as it relates to the prevalence and nature of spurious vaccination in the Western Army of the Confederate States. MEDICAL TESTIMONY-THE CONDITION OF THE PRISONERS IN THE HOSPITAL. September 28, 1865. Dr. E. A. Flewellen for the prosecution. * * # # # VACCINATION. Q.-Can you tell us what effect vaccination had upon your own soldiers and citizens? The Witness-Do you mean spurious vaccination, as it is called ? Mr. Baker-Yes. sir. A. -The first I ever heard or knew of spurious vaccination- The Judge Advocate-State only what you saw or knew at Andersonville. Witness-I know nothing about the vaccination at Andersonville. Q.-Go on and state all you know about spurious vaccination anywhere throughout the Southern Confederacy. The Judge Advocate objected to the question, on the ground that even if it could be proved that persons throughout the South were poisoned by means of vaccination, it would furnish no proof that prisoners of war at Andersonville were not so poisoned, and could not in any way exculpate any one who was inculpated by the evidence already brought before the court. Mr. Baker argued that the question was proper. The defence proposed to show that the same effects experienced from vaccination at Andersonville had been experienced throughout the whole South ; that the same matter used at Andersonville, was so far as could be ascertained, used in various places throughout the South, and had similar effects bn soldiers and private citizens! 480 Spurious Vaccination: Joseph Jones, M. D. If the defense could show that this vaccine matter was used upon Confederate soldiers, and produced the same results as those testified to in the case of Federal prisoners, it would tend to rebut or disprove oue of the elements of the alleged conspiracy. The court, after deliberation, sustained the objection. Witness.-I know of the effects of vaccination on the troops in Georgia. Q.-State to the court what their effects were on your troops. Objected to by the Judge Advocate, unless it could be shown that the vaccine matter used for the Confederate troops was obtained from the same source as that used on the Union prisoners. After deliberation the objection was overruled. A.-While the army of Gen. Bragg was at Tullahoma I was medical director, and 1 know that very great complaint was made to me as to the character of the vaccination practiced in the army. A large number of men were represented as unfit for duty. I think that one division represented nearly a thousand men as unfit for duty on account of spurious vaccination. 1 saw a number of cases in the early progress of the vaccina- tion, but they presented nothing abnormal that I could detect. But, as it advanced, the cases seemed to have the appearance very nearly of syphilitic rupia. It diffused itself more or less over the whole surface. A large number of surgeons regarded it as a com- plication of vaccinia and syphilis. Finally they settled into the opinion that it was not syphilitic. There never was, I may say, any settled opinion among the surgeons of the Confederate Army as to what was the true character of this impure virus. (40th Con- gress, second session, House of Representatives, Ex. Doc. 23 ; trial of Henry Wirz, pp. 472-473.) SMALL-POX EPIDEMIC IN MOBILE DURING THE WINTER OF 1865-6. BY J. C. NOTT, M. D., OF MOBILE, ALABAMA. Mobile, December 12, 1866. Joseph Jones, M. D.,: My Dear Sir-Your letter of the fifth reached me yesterday, and I regret to have to plead ignorance again on the subject in hand. I have had to treat a good many cases of spurious vaccination, but have no clear facts as to their origin. Many of them look syph- ilitic-rupial sores, etc.-they are more properly syphiloid. I am not sure but the ugly sores we saw in the army are as anomalous as many other forms of disease which seemed to result from crowded camps and hospitals, foul air, bad diet, etc. Dr. J. T. Gilmore, who was a medical director in the Virginia Army, saw a great deal of this spurious vaccine, and has promised me to write you about it. We have in Mobile a medical society, and it is the duty of each member in turn to read a paper once a month. Some six or eight months ago, in the performance of this duty, I threw together some rough and hasty notes on vaccination, etc., which I send you iu their rude state. If you can find any useful idea or suggestion, you are at liberty to use it as you like. Very respectfully and truly yours, J. C. NOTT. The extraordinary prevalence of small-pox in Mobile during the winter just passed, presenting all the characters of a true epidemic, deserves to be placed on record as a matter of history, and deserves much fuller detail than I propose at present to give it The reason for this extraordinary prevalence of small-pox not only in Mobile, but more or less throughout the whole of our Southern States, is very obvious. It is now about ten months since the close of our civil war, which has thrown our population into great confusion ; and the negroes having been suddenly liber- ated, have from various causes been congregated in towns, and freed from their accustomed restraint and the fostering care of former masters. A large portion of them had never been vaccinated, scarcely any vaccinated, and they therefore afforded an unprecedented amount of material for the disease. Fully nine out of ten of the deaths from small-pox have been among the freedmen. The disease having been scattered by this class, through all parts of the city and surrounding country, the whole atmosphere became infected, and a true epidemic constitution established. A great many of the old citizens, both white and black, have been attacked by varioloid. The cases, however, among the better class, who have been in the habit of paying proper attention to revaccination, have been few and mild. With regard to the proteection afforded by vaccination, I must say that it is difficult to imagine a more perfect triumph than that of the immortal Jenner. My own experience leads me to declare that I have not seen more than three or four cases of varioloid amongst those I have been in the habit of attending and re- vaccinating; but I must add that I have paid no attention to age-, I have i evaccinated young children as indiscriminately as the adults and aged, and have seen no appreciable difference in their susceptibilities either to vacciee or to varioloid. It has been evident, from the intense epidemic constitution of the atmosphere, that we should, had it not been for vaccination, had at least three- fourths of our population attacked by small-pox. There have been treated in the pest house alone, up to the present date, March 20, 1866, about six hundred cases. One hun- dred and eighty cases are now under treatment in that establishment, and there seems to be no abatement in the progress of the disease. I think it would be within the mark to say that at least three thousand cases of small-pox of all grades had occurred in Mobile during the past five months. The panic produced has caused almost all of our old citizens of all ages to seek revaccination, which have given some interesting results. Many adults, vaccinated in early life and exhibiting pood cicatrices, have received the vaccine in a spurious form, though their systems had refused it several times previously since the first vaccination, thus showing that when an epidemic influence is prevailing, the vaccine is much more apt to take effect in some form. This fact has been noticed by writers on the subject, and has been very striking in the prevailing epidemic. In not a few, also, bearing good marks from childhood, who had Spurious Vaccination ; Joseph Jones, M. I). 481 repeated revaccinations in former years, the vaccine this year has taken perfectly and run its course regu- larly as in those newly vaccinated. Such patients, doubtless, were in danger of taking genuine small-pox How long does vaccination, when done in childhood, protect against small-pox ? Boes it really wear out in a 8*veu tune, or at all ? Were I to judge by my own experience, it never wears out, arid time has little influence on it. It the system is once fully affected, it is good for the life-time; in order, however, to be sure that the system is fully affected, it is proper to repeat the vaccination several times till the system fairly refuses good virus. It should be remembered that when the population of a town is exposed to the influence of small-pox, or any other epidemic disease, a considerable per centage of them are not susceptible to the disease at that time and will escape it. Members of the same family will not communicate it to those around ; even chil- dren sleeping in the same bed with others sick ot small-pox will not take it. Why these immunities we know not, but yet the facts are indisputable. So with the vaccine. Suppose you are called upon to vaccinate half-a-dozen children, and it is performed on them all at the same time and with the same virus. What happens ? One may not receive it at all; in all the others it may take, showing its characteristic vesicle, but affecting the individuals in various de- grees, thus showing difl'erent grades of susceptibility. In one a good vesicle will appear without constitu- tional symptoms, in another the vesicle may be accompanied by high fever, glandular swellings, etc., and the others will present intermediate grades of effect. Now the one which did not respond at all to the vaccine virus, if exposed to small-pox, might not at that time take the disease, on account of a temporary insusceptibility, but at some future day under similar ex- posure might be attacked by confluent small-pox. The one which took the vaccine so fully as to develop severe local and general symptoms would probably be protected for life, against either vaccine or variola. The other children which had mild local symptoms, ami little or no fever, if exposed to small-pox in after life would be attacked by varioloid in various degrees, according to the degree of susceptibility left in the system. If vaccinated after one or more years, the vaccine would again show to a greater or less extent its characteristic effects on some of the cases, thus proving that the system had not been fully affected by the first vaccination, and consequently not fully protected against the poison of small-pox. Now in the case of these six children, it must be remembered that when they were vaccinated the first time, the morbid poison was/orced upon the system without any regard to its present susceptibility. The system might be disposed to reject it entirely, or to receive it in various degrees, just as when exposed to contagious diseases in the natural way. Some children during the present epidemic, could not be brought under the influence, and in one ease of a healthy child of three months old, it did not take until the ninth trial. We have no criterion, by which we can tell before hand -what is to be the effect of any disease on individ- uals. Suppose small-pox, diphtheria, or scarlet fever appears in a boarding-school, what happens? Some escape entirely, and the others are affected in all possible grades. Here you may say that the disease is again forced upon the subjects, and they receive or reject the poison in whole or in part, according to the condition of each individual. There is this great difference in the two cases. In the boarding-school ex- ample, the children take the disease in the natural way, and each one may receive or reject it as the system chooses ; but in the case of vaccination the poison is thrust into the blood of the subject by the physician without any regard to the present susceptibility, and the system is compelled to fight the enemy as it best can. Under these circumstances it is rational to conclude, that in the case of vaccination, the system being forced, resists the influence of the virus to a certain extent in many instances, and thus leaves the system jjUt partially protected, against the poison of small-pox. Another important question arises as to the duration of the protecting influence of vaccine. Does it " wear out" in a given time, or at anytime during our three-score-and-ten ? I confess that I have never seen any facts to prove that it does wear out, where the system has been once fully affected. How many hundreds of individuals does every physician see in whom one vaccination in childhood protects perfectly against both small-pox and vaccination through life ? There are ten thousand of such cases to prove that vaccine does not wear out. My own experience, which corresponds with that of the other physicians of Mobile during the present epidemic, goes to prove that in vaccination the virus just as often takes effect in children of all ages, from one year upwards, as in those vaccinated half a century previously. I have, dur- ing the past few months, seen scores of children bearing good marks, from the ages of one to eight or ten years, in whom the revaccinations have taken, or who have been attacked by varioloid. I have also seen scores of all ages who were insusceptible to both forms of this virus. I have seen no evidence whatever that time has had anything to do with the protecting influence of vac- cine ; but much that it depends almost entirely upon the efficiency of the first vaccination. It is, however, proper to vaccinate again and again, as we have no criterion to go by but the repeated refusal of the system to receive it. It has been curious to see how the epidemic constitution of the atmosphere has gradually deepened. It seems now to be breaking through all barriers. Some few have been attacked twice within three months by varioloid-many have had varioloid who have been vaccinated again and again-the vaccine has taken either well, or in spurious form, in some who had rejected re-vaccinations repeatedly before. In those who had never been vaccinated the vaccine has taken mildly and well, and the same matter has made very sore arms in those previously vaccinated. Another interesting fact has been witnessed in attacks of small-pox in individuals while under the influ- ence of vaccination. Instances have been seen by our physicians in which the small-pox has broken out in subjects in all stages of vaccination, and within two or three weeks after vaccination has run its course through. There has been no fixed rule in the conduct of the small-pox under these circumstances, and no conclusion aprirori could be formed as to the violence of the attack. Most of the attacks of small-pox, while undergoing the influence of vaccine, assumed the form of varioloid, but some have been genuine and fatal small-pox. It has been curious, too, to witness the infinite grades of those vaccinated. I have seen cases of vario- loid with a single pustule-some five, ten or twenty, and so on, until the disease was lost in true small-pox. Gen. Withers had all the premonitory fever and other symptoms for four days, when a single well marked vesicle appeared on the forearm, and ran its course with all the characteristic marks of var iola. In connection with one of the points above alluded to, viz: the power of the system to resist morbid poisons when forced upon it, as is the case of vaccination, I will quote a very interesting paragraph from the Annuaire Encyclopedique, for 1864 : . Until recently, it has been believed that the vaccine virus formed a char icteristic vesicle. No matter what the diathesis or condition of the subject producing it might be, the virus was always the same, and could be n ed for propagation in others with impunity. In other words, that the vaccine virus in passing through a body could not be contaminated by any constitutional taint, and th is engender any other disease, such as syphilis, scrofula, etc. . . " Such was the generally-received opinion, •' says the extract, "when it was 8scertained at Rivalta, m Italy, in tlito first series of 46 children vaccinated tho twenty-third May, 1801, with matter furnisbdd by the vaccine 482 Spurious Vaccination : Joseph Jones, J). pustules of an infant named Chiabrera, who seemed healthy, and in a second series of 17 children vaccinated with the pus taken from one of the children of the first, there had occurred symptoms of syphilis in 37 chil- dren of the first series, and in seven of the second series; then propagation of the infection to the mothers and to the nurses. Several of these infants died ; several were fortunately cured. It was Dr. Cerise who first made these facts known in France."-Union Medicale, t. xii. " This caused equal surprise in France and Italy. The first impulse was to doubt. It was also the sub' ject of very serious investigation, which left no doubt either as to ihe reality of this sad experience, or as to the origin of the syphilis itself. Was it then necessary to admit that two poisons so unlike could combine? On the other hand, why had a certain number of the children, both of the first and second series, escaped the infection-why had it been more powerful in some than in others? Several physicians supposed that the in- fection had been transmitted by the blood, which is so often mingled with the' vaccine, especially when the pustules are drained to the extent which had been necessary, in order to perform such a large"number of vaccinations. The discussion was long and earnest. The result a resume of all the previous forgotten or unappreciated facts of the part touching the transmission of syphilis by vaccination, or by blood. Dr. Vennois was the principal promoter of the opinion, which, in the case of vaccination, attributed to the blood alone the faculty of transmission. He called to mind that previously to the facts of Bivalta he had pub- lished a memoir on this subject. Still, the doubt remained, the observations were not sufficiently precise, the facts could be explained in another way. It remained to make direct experiments as to the possibility of syphilitic infection by a minute quantity of the sanguine fluid. This direct experiment was made at Florence by Dr. I'ellizari on medical students who volunteered for the purpose. He proved that a few drops of blood are sufficient to transmit, syphilis. Thus it has been demonstrated that, to explain the facts, it is necessary to admit the mixture or composition of the two poisons, which upset all previous no- tions. It is also demonstrated that the fresh sanguine particles borne on the vaccinating lancet, at the same time with the vaccine, may transmit the syphilitic infection. From these facts it results that in future we should inquire with great care into the previous history of those children from whom we select our protecting virus." Now, gentlemen, these facts are set forth with a fullness of detail and a weight of authority that chal- lenge belief, and if borne out by future investigations are of immense practical value. In the present stage of the question it is our duty to take the benefit, of every doubt and use the utmost precaution in selecting the virus we employ, and in removing it from the arm from which it is selected without its being contami- nated by a pari icle of blood. There is. I think, another important point to be attended to. and it is this. When we vaccinate, the lancet always draws more or less blood, Not only should the lancet be thoroughly cleansed before it is used on another subject, but the identical matter should not be used on a second sub- ject. We ordinarily mix the dry scab in this country with water on a piece of glass, and in the process of vaccinating a child the lancet is dipped several times into the mixture, thus necessarily adding to it some particles of blood. In this state another piece of glass is ordinarily placed over the one on which a part of the virus just used remains, and is carried about in the pocket for a day or two, or more, to be remoistened and used again on others. Now, to my mind, there are two strong objections to this method. 1. The virus is thus contaminated with blood. 2. From being kept in this moist state it becomes putrid, and not only fails to produce a good vesicle in succeeding subjects, but may hazard, from its putridity, the production of spurious vaccine, followed by bad sores and even symptoms not unlike dissection wounds. I throw these hints out for further investigation. I beg leave to add to the above an extract translated from the " Annuaire de Medecine et de Chirurgic," 1864, which will be found interesting in connection with the above at this time: " The contagion mess of the blood plasma being demonstrated to his satisfaction, as to the congenital con' tamination of Ihe infant by the mother. M. Laroyenne admits in like manner the contagiousness of the serum that transudes under the vaccine pustule, and mingles with the vaccine without the possibility of being dis- tinguished. Hence a new danger outside of the blood, and the vaccinal chancre, which cannot be avoided, except by most scrupulous examination of the subject from which it is taken, and of the mother if it is not too old. The subject vaccinated itself should not be overlooked, for it may also be a source of infection, according to the same author, tn a collection of children to be vaccinated, if there be one infected, a com- mon lancet impregnated with his blood may communicate syphilis to all those vaccinated after him, and to the subject from which the vaccine is taken. (Gaz. de Lyon, No. 12.) All this is possible, without doubt, but is not demonstrable, and is not even probable; for if the syphilis had so many chances of being commu- nicated by vaccination, would it not be more frequent? Without deciding on this accessory question, M. Dupaul. in making this important subject, the principal object of his annual report on vaccine to the Academy of Medicine, lias recognized the reality of the trans- mission of syphilis bv vaccination. Doubtless a discussion will clear up the points in dispute." " Vaccine-bearing Heifers.-There exists in Naples, says M. Palasciano, besides the official vaccine insti- tute for vaccinating from arm to arm, an establishment of Dr Galbiate, where the cow-pox is propagated through heifers, in sufficient number to supply many vaccinations. When it is wished to have a child vac- cinated, one of these heifers is driven to the door, the conductor cuts out a pustule entire with a pair of scissors and hands it with a pair of forceps to the physician who executes the vaccination. Ihe whole costs one dollar. This plan is also used in the army and colleges, and vaccination from arm to aim is prac- ticed little except among the poor. "-('rongrGs de Lyon. It is desirable that similar establishments should tie founded in France, as it would be the surest means of escaping syphilitic vaccine.-Union Med. de la Seine Inf. p. 193. M. Lanoix, who went to Naples to study this mode of animal vaccination, has tested it successfully and publicly at Lyons. He vaccinated a heifer of nine months old, in the iliac region and at the proper time transferred the matter to the arms of children. But we must not pass over another curious extract, which is as follows: The milk of cows, submitted to this inoculation, would, according to Dr. Sonbie, of Leghorn, have another advantage, By drinking the milk during the course of the inoculation, all the benefits of vaccina- tion are obtained. He inserted the vaccine into the teat of a cow, and two fine pustules being developed, he made two children drink the milk. One, six months old. nourished by the bottle, took 600 grammes in two days, the fifth and sixth of the vaccine: the other, aged fourteen months, weaned, drank only half this quantity on the eighth day of the vaccine. A month after, having attempted to vaccinate them from an arm, they refused it, while the same matter succeeded perfectly in another inoculated at the same time." These statements, to say the least, are interesting, and, coming from sources of high lespectability, de- mand examination. I have no data, by which to form an opinion, as to the relative frequency and nature of the foul gangrenous ulcers attendant upon vaccination in " SYPHILITIC VACCINE AND THE MEANS OF PREVENTING IT." Spurious Vaccination: Joseph Jones, HL D. 483 the United States forces. In the second section of the present inquiry, we have quoted the testimony of Dr. Hamilton to show that they were, to a great extent, as in the Confederate Army, referable to the depressed and scorbutic condition of the soldiers. Dr. Woodward, in Circular No. 6. War Department, Surgeon-General's Office, p. 127, affirms that the accidents attendant upon vaccination in the United States Army, were generally regarded by the Medical officers, as " the expression of scorbutic or other cachectic conditions of the patients, and not due to any poisonous admixture with the vaccine virus ; and it was frequently observed that the same scab which had produced a number of successful vaccinations, would, in other men vaccinated at the same time, produce the ulcers referred too." It appears, however, that some of the United States Medical officers held that a portion at least of these abnormal affections following vaccination, were due to the admixture with the syphilitic poison, as will be seen by the following extracts from an article on Spurious Vaccination, by Geo. H. Hubbard, M. D., late Brevet Lieut.-CoL, and Surgeon U. S. Vols., published in the Philadelphia Medical and Surgical Reporter, February 10,1866, p. 103. On the last day of November, 1863, I reached Fort Smith, Arkansas, under an assign- ment to duty as Medical Director of the Army of the Frontier. My attention was immediately called to several hundred men disabled in consequence of spurious vaccination, and a board of medical officers was soon after organized, by com- mand of Major General Schofield, to investigate its origin, etc. This Board made a detailed report, from which, from reports of other medical officers, and from personal observation, 1 was enabled to arrive at the following facts and conclu- sions. It was definitely ascertained that the virus which caused all these cases came from per- sons who had been vaccinated in the rebel army, or by rebel surgeons. This virus was used by ignorant medical officers and by self-inoculation among the men, till more than five hundred were infected. The Board reported that-" Soon after the operation was performed, the points at which the matter was inserted commenced to itch and inflame, and by the second or third day, pustules were formed, of a yellowish color, which rapidly increased in size, and in a few days burst. In some a scab formed, but in all, open ulcers were formed by the tenth day and which furnished a thin ichorous discharge. "At the time we examined the patients, some had well marked Hunterian chancre; some had large excavated ulcers, with edges elevated above the raw and surrounding induration ; the centres, when not recently cauterized, were of a brownish hue-some, whose primary ulcers were about healed, had secondary symptoms, such as swelling and ulceration of the glands in different parts of the body; while others had pain and stiffen- ing of the joints. "The disease was brought to the First Arkansas Infantry by deserters from the Confed- erate army, and in our opinion is syphilis." The following is from my official report to the Surgeon General:-"I have no reason to believe that in any one case did this virus produce a true vaccine pustule, or had any one of the protecting powers of vaccination. " The ulcers all possessed, in a greater or less degree, the well established peculiarities of venereal chancre, being of a specific and progressive nature, spreading in some cases to the size of a dollar, but usually about half that size ; commonly round in shape, but often irregular, and usually of the depth of the true skin. "All had ragged, elevated, indurated, and overhanging edges, little sensitive to the touch or even to caustics; while the bottom of the ulcer, (especially under these indurated edges), was excessively sensitive. "All discharged dark ill-conditioned pus, which in many cases caused painful excoria- tion of the surrounding skin, and when transferred to other parts of the body, reproduced ulcers like the original; in this way, chancres were produced on the penis in several cases. "Cases precisely similar occurred in the Indian Brigade, stationed at Fort Gibson, in the Cherokee nation. "Acting Assistant Surgeon Miller, on duty at that post, reported as follows: " Besides the cases occurring among the troops, it has spread among the people to an alarming extent by self-inoculation. "In a large proportion of the cases, consecutive symptoms have appeared; suppuration of the lympathic glands in the axilla, sore throat, exanthematous eruptions, etc. 484 Spurious Vaccination: Joseph Jones, M. D. "The cases occurring among the troops have received the ordinary treatment for syphilis, and in most cases with excellent results. "The mischief was wide spread before the true character of the disease was recognized, so that few cases have had prompt abortive treatment, and many are, in consequence, permanently disabled. "Nearly every case has required constitutional treatment, in addition to local treat- ment of the chancre. * "The milder caustic applications proving insufficient, in many cases, acid nitrate of mercury was used to clear away the indurated edges, when the ulcer usually healed rap- idly under mildly stimulating applications." " Six cases of well marked small-pox occurred in men who had suffered severely from this venereal inoculation.-Med and Surg. Reporter,-February, 19, 1866,-p. 103. Up to the commencement of the recent civil war, the belief was almost universal that secondary syphilis could not thus be commuuicated by vac- cination. In the papers relating to the history and practice of vaccination, con- tained in the report of the General Board of Health, presented to both Houses of Parliament, by command of Her Majesty-London, 1857-Mr. Simon called for the opinion of the profession at home and abroad on the general question. " Have you any reason to believe or suspect (a) that lymph from a true Jennerian vesicle has ever been a vehicle of syphilitic, scrofulous or other constitutional infection to the vaccinated person ; (b) or that unintentional inoculation with some other disease, instead of the proposed vaccination, has occurred in the hands of a duly educated medical practioner In answer to this question a writer in the British and Foreign Medico- Chirurgical Review (October, 1857, Review 3, Small pox and Vaccination), quotes the opinion of Hebra, which maybe taken as expressing in a logical and lucid manner, the belief of the majority of the medical profession at that time. This widely-grasping question (says Hebra) requires several separate answers, because queries are made- " 1. Whether the lymph of a vaccine vesicle may, besides its peculiar virus, contain another infectious principle-e. g., that of syphilis ? "2. Whether constitutional non-infecting diseases, as, for instance, scrofula, may be trans- mitted by the inoculation of cow-pox matter ? "3. Whether a vaccine vesicle possesses such characters that it may easily be distinguished from other similar vesicles, blebs or pustules ? "(I) The transmissible infectious principles which have hitherto been recognized, by means of inoculation, are the syphilitic virus contained in the pus of a chancre ; and the virus contained in the cow-pox vesicle and the small-pox pustule. The question, there- fore, simply is, whether these morbid poisons have ever been mixed ? Whether inocula- tion has ever taken place with such a mixture ? And what results were obtained by such an operation? It is well known that compendious answers have, for some time past, been offered to these questions, chiefly the result of Sigmund's experiments. These answers agree in the following respects: "Inoculation with secretions of this kind, viz: containing, as it were, several special poisons, either produced no effect at all, or only generated a chancre, by inoculating a mixture of piis from the chancre and vaccine lymph; and only cow-pox, by inoculating a combination of vaccine lymph and blenorrhagic matter. Hence, one morbid state only was produced, either cow-pox or syphilis ; the latter circumstance being a proof that both poisons are not simultaneously transmissible. This opinion is supported by the experience of Heim, Ricord, Bousquet, Taupin, Landouzy, Friedeuger, etc. "(II). It is maintained in many quarters that the blood of persons suffering from sec- ondary syphilis may serve as a vehicle to the infectious principle; but were even this theory found correct, it would have no prejudicial effect on the practice of vaccination, because we know from experiments made lor the purpose (Heim), and from accidental inoculation, that regardless of the quality of vaccine lymph, the latter may be inoculated from syphilitic upon sound individuals; and on the other hand, from sound subjects upon such as are under the influence of systemic syphilis, without propagating syphilis along with the cow-pox. "What has here been proved of syphilis, must, a fortiori, hold good as regards other constitutional morbid states, as direct inoculations with the secretions peculiar to these diseases have always yielded a negative result. Spurious Vaccination: Joseph Jones, M. D. 485 "But, although it is abundantly proved that scrofula, tubercular affections, rickets, cancer and other blood diseases cannot be transmitted by means of their own secretions, or along with the vaccine lymph, we should nevertheless, if possible, avoid vaccinating diseased persons, because experience has taught us, as regards adults and children, that the phenomena of vaccinatian may awake-i. e., render worse-dormant affections; and that, moreover, the cow-pox vesicle easily degenerates upon such individuals. These latter vesicles are, nevertheless, adapted for further propagation, even when they take an imperfect development, because a positive result, a regular development of the ves- icle, and sufficient protection against small-pox, have been observed in cases where vac- cine lymph was transferred from weakly, scrofulous and rickety subjects upon perfectly sound individuals. " (III.) Every morbid appearance on the cutaneous envelope has its own peculiar characters, by which it may be distinguished from all other similar phenomena ; the vac- cine vesicle presents, in the like manner, sufficiently striking peculiarities as to form, size, number, locality and peculiarity as regards its course, to enable the observer easily to establish a distinction between the same and other vesicular, bullar or pustular eruptions." In 1856 Mr. Simon, the medical officer of the Board of Health, addressed a circular to members of the medical profession in England and other coun- tries, as well as to the foreign governments, inquiring, among other things, " whether they had any reason to believe or suspect that lymph from a true Jennerian vesicle has ever been the vehicle of syphilitic infection." From the very large number of replies which Mr. Simon obtained, we select or condense the following : Mr. Acton-" I unhesitatingly affirm that I have never witnessed a single case that will bear out the supposition. Although I have for a long time been convinced that infec- tion cannot be thus introduced into the system, I have never felt myself justified in directly vaccinating healthy children from the virus of vesicles obtained from syphilitic infants." Dr. Addison-" To both these propositions my own experience would return a negative." Dr. Alderson-"No; but as a commissioner of the Vaccine Board, I am aware of a single instance, some years ago, of bad results following vaccination with a lancet ascer- tained to have been foul and accidently used in ignorance." Dr. Balfour-" In no instance (in army vaccination during eight years) did any symp- toms ever occur, or any appearance present itself, which could lead to the suspicion that the lymph had been the vehicle of syphilitic, scrofulous or other constitutional affec- tion." Dr. Barlow-"I have no certain proof that it is even the vesicle of such infection, though I have suspectedit in the case of syphilis." Dr. Beatty-" I do not think such a thing possible." Dr. Bright-" I have never seen such a case." Dr. Brinton-"No." Sir. B. Brodie-"I have no reason to believe that vaccination was ever the means of introducing syphilis, or scrofula, or any other constitutional disease into the system." Dr. George Burrows-" I have no reason to believe or suspect that the true vaccine lymph has ever been a vehicle of syphilitic, scrofulous or other constitutional infection to the vaccinated person ; but I do fear and suspect that unintentional inoculation with some other matter than the true vaccine lymph has occurred in the hands of legally qualified medical practitioners." Mr. George Busk-" I have never witnessed any circumstance which could lead to such a belief or suspicion." Mr. Ceely--" Although I have heard of such events, I have never witnessed anything of the kind in my own practice of more than thirty-five years." Sir James Clark--1' I see no reason to believe the occurrence of either circumstance." Sir Philip Crampton--" I have no reason to believe that lymph from a true Jennerian vesicle has ever been the vehicle of any other disease." Mr. Theodore Davis-"I have never seen (andmy observation extends over some thou- sand cases) the slightest reason to suspect that any other disease has been communicated by vaccination." Mr. Erichsen-"I do not believe that any constitutional disease can be communicated through the medium of vaccine," Dr. Arthur Farr, Dr. Robert Ferguson, Dr. Greenhill, and Mr. Thomas Hunt answered in the negative. 486 Spurious Vaccination: Joseph Jones, M. J). Sir William Jenner-"In the discharge of my duties as Physician to University Col- lege Hospital and the Hospital for Sick Children, I must have had, during the last six years, more than thirteen thousand sick adults and children under observation ; and in no case have I reason to believe, or even suspect, that any constitutional taint had been conveyed from one person to another by vaccination, or that any other disease had been unintentionally inoculated." Mr. Jones, of Chesterfield-" During the past six years, I find I have vaccinated almost 1,052 children. The result of my experience leads me positively to state that in no in- stance have I seen a true Jennerian vesicle-the vehicle of syphilitic, scrofulous or other disease." Dr. P. M. Latham-" I have never met with the slightest proof of it; and the sugges- tion of its being possible amazes me." Sir Charles Locock and Mr. Lord answered in a like negative manner. Mr. Marson-" I have no reason to believe or suspect that lymph from a true Jenuerian vesicle has ever been a vehicle of syphilitic, scrofulous or other constitutional infection to the vaccinated person. I answer on this point from the experience of having vaccin- ated upwards of 40,000 persons. Dr. Noble, of Manchester; Dr. Robertson, of Manchester; and Dr. Stokes, of Dublin ; replied decidedly in the negative. Mr. Tompkins-"After an experience of twenty-one years as a vaccinating snr* geon, and having vaccinated upwards of 40,000 children, I have never known syphilitic, scrofulous or other constitutional affection, to be communicated by the operation." Mr. B. Travers-" My experience has not furnished me with reason to believe that the true Jennerian vesicle has ever been a vehicle of syphilitic, scrofulous or other consti- tutional infection." Sir Thomas Watson-" I have never had any reason to believe or suspect that lymph from a true Jennerian vesicle has ever been a vehicle of syphilitic, scrofulous or other constitutional affection." Dr. West-"None whatever." Dr. C. J. B. Williams-" I do not recollect an instance in my own experience in which such untoward results have followed vaccination, but I have heard of such, and I cannot but think that they were not the necessary consequences of vaccination, but of its indis- criminate and careless performance, as in taking the virus from the diseased subjects." Mr. Erasmus Wilson-"No. I went frequently with parents who believed an erup- tion under which their child suffered to have originated in vaccination, but the origin w as in reality traceable to a different source." On the other hand, the following surgeons and physicians testified to their belief that syphilis might be communicated by vaccination : Mr. Ackerly, of Liverpool-"I have no doubt that syphilis has been communicated from a diseased to a healthy child by means of vaccination." Dr. J. R. Bennett-"I have suspected that syphilitic disease may be communicated by vaccination, and 1 would not willingly sanction vaccination from an unhealthy child, however perfect might be the Jennerian vesicle whence the lymph was derived." Dr. Fleming, of Glasgow-"I have a suspicion that I have once seen syphilitic disease communicated in this way, but it is a very difficult point to ascertain with perfect accuracy." Mr. J. Hutchinson-" I believe that I have seen four or five instances in which local syphilitic affections were induced by vaccination, performed under ordinary circum- stances, and by duly qualified men. In one or two of these the constitution suffered also, as seen by the appearance of disease in several parts, but mothers it was perceptibly af- fected." Dr. Laycock-" I think that this may be reasonably believed or suspected, and think a duly educated practitioner may be a negligent, careless or thoughtless practitioner, and may inoculate unintentionally with some other disease. Our knowledge of morbid poisons is too imperfect to speak positively as to what may happen or what may be suspected, reasonably or not." Dr. Lever-" I must say yes. I have known syphilis communicated to a child by the hands of a supposed but legally educated medical practitioner." Mr. Martin, of Bristol-"I believe it is sometimes the vehicle of communicating the syphilitic taints to children previously perfectly free from it. * * * I nave on many occasions, been called to cases of eruption markedly syphilitic, occurring after vaccination, and in which I have failed to detect the slightest taint in either parent or in the other children of the same marriage." Mr. Morley, of Sunderland-"I have had one case where the lymph, sent me by a medical friend who is a public vaccinator, did produce a syphilitic taint-" Mr. Startin-■" This is a difficult question to answer satisfactorily, as the reply must rest upon what is regarded as a 'true Jennerian vesicle,'as this vesicle, in a subject suffering under constitutional or acquired syphilis, or from purigo, or even scabbies, Spurious Vaccination: Joseph Jones, M. D. 487 might be still a ' true Jennerian vesicle,' though not a pure one, and these maladies I have many times seen transferred from such a vesicle. I have also seen the same mala- dies inoculated by public vaccinators from unintentional vaccination " Dr. Whitehead, of Manchester-" I have seen several instances of the transference of the syphilitic taint through the medium of vaccination, the lymph having been taken from a true Jennerian vesicle, or presumed to be so at least in a tainted infant." The opinions of the Continental physicians on this subject were equally divided. Mr. Simon's own opinion at the time he wrote (1857) was that in the cases then on record, in which persons pretending to vaccinate did really effect a syphilitic inoculation, it is almost certain that the matter of syphilis was used by the vaccinator instead of vaccine lymph. Since the publication of the Rivalta outbreak, however, Mr. Simon ap- pears to have modified his opinion, and is disposed to believe that cases of reported vaccine-syphilitic inoculation have arisen from the admixture of syphilitic matter with the vaccine in such manner as might readily be com- prehended to occur amongst careless and dirty people. We shall examine these doctrines and conclude these Researches on Spu- rious Vaccination, with an examination of the following questions : 1. The possibility of communicating tuberculosis and cancer by inoculation. 2. The possibility of communicating secondary or constitutional syphilis by inoculation. 3. The possibility of communicating the poison of syphilis through the medium of vaccine virus. INOCULABILITY OF TUBERCLE. 1. True tubercle is organized; that is, it is composed of living cells, and during its growth it resembles, to a certain extent, fresh granulations. These soft fragile cells and nuclei, resembling the gland cells of the lymphatic glands, are to be regarded as the characteristic living element of tubercle. According to this view, tubercle resembles malignant growths. M. Villemin's researches appear to have settled the question of the in- oculability of tubercle. This observer affirms that he had succeeded in reproducing tubercle by inoculation, again and again, in rabbits, not only when taken from the human subject, but also when derived from the cow; and further, that the tubercular matter thus produced in one rabbit, could be in like manner transmitted to another. (Gazette Hebdomadaire, 1866.J Dr. Lebert, professor at Breslau, has succeeded in introducing tubercle into the system by subcutaneous injection, and thus confirmed M. Ville- min's experiments. Dr. Lebert's experiments were made with Guinea pigs and rabbits, and both grey and yellow matter were employed, as well as liquid from the cavity ; the nape of the neck was the spot chosen for in- jection, and the amount introduced varied from fifty centigrammes to a gramme, diluted and triturated with distilled water. The result of his ex- periments was the finding of tubercles not only in the lungs, but in other organs, as the liver,spleen, plurae and pericardium. In some experiments, the tubercles were found in large portions of the lymphatic system. Mi- croscopic examination revealed the identity of the tubercles thus formedin animals by inoculation, with those of man. Tubercle still further resembles malignant growths, in that the original growth causes the formation of new tubercles in its neighborhood and thus gradually infects large tracts of living and previously healthy tissue. It is possible in many cases, by carefully comparing the symptoms during life, with the results of post-mortem examination, to trace the gradual propagation, of tubercle from a well defined centre. 488 Spurious Vaccination : Joseph Jones, M. D. The question of the contagious or non-contagious nature of tubercles is one of vast importance, as will be shown by the following statistics and facts: MORTALITY OCCASIONED IN NEW ORLEANS, LOUISIANA, AND THE VALLEY OE THE MISSISSIPPI BY PHTHISIS (TUBER- CULOSIS, PHTHISIS-PULMONALIS, CONSUMPTION). During the first six months of 1882 phthisis-pulmonalis caused the fol- lowing mortality: MONTH. White. Colored. Total. MONTH. White. Colored. Total. January .. 38 34 72 April 34 29 63 February • 53 35 88 May 45 28 73 M arch .... 50 33 73 J tine 44 23 67 Total 254 182 436 During the last Six months of 1882 phthisis-pulmonalis caused the fol- lowing mortality: MONTH. White, Colored. Total. MONTH. White. Colored. Total. 42 24 66 October 44 24 88 A11 gn st 37 34 71 November 43 29 72 September 32 23 55 December • 55 34 89 Total 253 168 421 Total, twelve months 507 350 857 During the first six months of 1882 tabes-mesenterica caused 97 deaths- whites, 58; colored, 39; syphilis, 17 deaths-7 whites and 10 colored. During the last six months of 1882 tabes mesenterica caused 63 deaths- whites, 55; colored, 18; syphilis, 17 deaths-whites, 10; colored, 7. Lep- rosy occasioned two deaths, amongst only whites, during 1882. It will be observed from a critical examination of the mortuary records ot 1882, that phthisis-pulmonalis heads the list of diseases in its fatal effects, occasioning a total mortality of 857-whites, 507; colored, 355. Tabes-mesenterica caused deaths: whites, 113; colored, 57; total, 170. These two diseases, phthisis-pulmonalis and tabes-mesenterica, caused 1,027 deaths, or more than one sixth of the total mortality of 1882. Relative to population, phthisis was most fatal in the colored race. During a period of thirty-four years, 1846-1880, 10,950 cases of phthisis- pulmonalis were treated in the Charity Hospital of New Orleans, with a mortality of 5,600: 51.2 per cent. During thirty-six years, 1846-1882, phthisis-pulmonalis occasioned in New Orleans 25,828 deaths; during the same period tabes-mesenterica occasioned, 4,950 deaths. Total deaths by these two diseases during the period specified, 30,778. During the same period, 1844-1882, yellow-fever occasioned 28,745 deaths. These statistics show that phthisis-pulmonalis demands the first and highest consideration at the hands of the sanitarians and physicians of New Orleans. It is also worthy of note that the mortality occasioned by phthisis-pul- monalis is quite uniform throughout the great Valley of the Mississippi, with its 20,000,000 of inhabitants; and if the mortality be placed annually at 500 deaths in every 200,000 inhabitants (an estimate below the real mor- tality from phthisis), then not less than 50,000 inhabitants of the Missis- sippi Valley annually fall victims to phthisis-pulmonalis. Spurious Vaccination : Joseph Jones, M. D. 489 Yellow-fever has only at long intervals extended its ravages beyond the cities located near the Gulf of Mexico, and the most extravagant and wild calculation cannot claim a mortality in 1878, when it is supposed to have been most widely diffused through the Valley, of over 20,000 victims. After careful examination of the statistics of 1878, I am inclined to place the mortality from yellow fever at not more than 15,000. Phthisis pulmonalis visits annually every hamlet, village, town or city of the great Valley, and its causes and prevention should be of daily con- sideration ; and State and national legislation should not be invoked alone for the prevention of yellew fever, small-pox and cholera; neither should the truth be obscured, and national and State legislation perverted by a constant appeal to popular prejudice, ignorance and fear with reference to yellow fever. The relations of phthisis to moisture and to faulty construction of dwell- ings and to the low and badly drained localities of New Orleans, were con- sidered in the Annual Report of the Board of Health of the State of Lou- isiana for 1881; see pp. 188-190. It is however of importance that we should briefly consider the condi- tions which give rise to phthisis, and also examine the important question as to the contagious or non-contagious nature of tuberculosis. AETIOLOGY OF PHTHISIS. The conditions which give rise to phthisis are varied and diverse, but may be arranged into general and local causes; in the former, the constitu- tion of the individual and the functions of nutrition and assimilation appear to be first involved ; in the latter the lungs are the primary seat of the disease, and changes in their epithelia and parenchyma lead to pro- ducts of a retrograde kind, through which the lymphatic and vascular sys- tems and the constitution generally become affected. The general have been called constitutional and the local inflammatory. Dr. C. Theodore Williams and other systematic medical writers, have assigned the following as the most important causes of phthisis ? 1. Family predisposition. The influence of heredity as a cause of phthisis cannot be doubted. 2. Local infection.- Chronic inflammatory affections of organs and textures leading to the formation of caseous centres. 3. Acute febrile diseases.-Continued fevers, measles and scarlatina, act partly by exhausting the system, and partly by bequeathing to the indivi- dual the legacy of caseous matter, either in the lungs or glands, which form the centres of subsequent tuberculisation. Syphilis.-Syphilis by its debilitating influence predisposes to phthisis ; but it also appears to act as a cause capable of developing a limited con- solidation, and a form of a laryngeal phthisis, characterized by ulcers in the larynx and pharynx. 5. Debilitating conditions.-Miscarriages, unfavorable confinements, over- lactation, insufficient food and alcoholism are recognized causes of phthisis. 6, Bad Ventilation.-Consumption is more rife among persons of indoor occupations than among those employed out of doors. Of nearly 6000 cases of phthisis admitted into the Brompton Hospital during ten years, two- thirds had indoor occupations." Among them milliners, seamstresses and tailors'furnish the largest quota,^who all live in close rooms to which they are almost entirely confined. Phthisis frequently attacks printers, com- positors, tailors and tradesmen who live in hot gas-lit shops, and often sleep in miserably ventilated bed-rooms. 490 Spurious Vaccination : Joseph Jones, M. I). 7. Climatic Influence.-A moist atmosphere is more favorable to the de- velopment of consumption than a dry one. Dr. Gurlbert has shown that a combination of heat and moisture, as exemplified in the litoral of Peru, in the West Indies, etc., produces an acute form of consumption, largely prevalent in these districts, attacking the abdominal organ in addition to the lungs. 8. Dampness of Soil-The researches of Dr. Buchanan have demonstrated that the death rate from phthisis in the Districts of Surrey, Kent and Sussex depend, to a great extent, on the geological formation of the soil; for while in the light and sandy strata deaths from phthisis are rare, in the heavy impentrabK ones, in which clay predominates, the mortality from this cause is high. The conclusion that wetness of soil is a cause of phthisis to those living on it, has been confirmed by the Registrar General of Scotland, and Dr. Bowditch, of the United States; the latter testifying that the law holds good, not only as regards villages and towns, but even as regards individual houses-the houses on clay becoming the foci of consumption, whilst others, but slightly removed from them, but on a dry soil, wholly escape. The pine regions, with their dry, sandy, porous soil, of Louisiana, Ala- bama, Florida, Georgia and Mississippi are noted for their freedom from phthisis, and are famed as health resorts for those suffering with this dis- ease. The difference in the relative salubrity with reference to phthisis between New Orleans and the neighboring pine hills is due, not to variations of temperature, but to the absence of moisture in the atmosphere and of water in the soil of the latter. 9. Inoculation-From the time of Laennec until the present, experiments have been carried on by numerous observers to ascertain whether tubercle is, oris not inoculable; and the results of these experiments prove that in guinea-pigs and rabbits tubercle can be produced artificially by the in- sertion under the skin, not only of tubercle, but of various other materials, such as pus, putrid muscle and diseased liver taken from non-tuberculous subjects. There was nothing specific in the results of the inoculations, for the materials most efficient in producing artificial tubercle were taken from low pneumonia, pysemic abscess, etc.; while human tubercle, phthisical sputa, pus and putrid muscle were less successful. It was found by Dr. Bur- den Sanderson that tuberculosis might be induced in the guinea-pig by the insertion of a cotton thread under the skin, but if the seton was steeped in carbolic acid, no tubercle was produced. To ascertain the results of me- chanical injury without exposure to air, the scapulae of guinea-pigs were fractured subcutaneously. No tuberculosis resulted. It is evident, from these experiments, that tubercle is not so effective for infective purposes as many other materials, and especially those of a septic nature, as pyaemic pus and putrid muscle. These facts warrant the conclusion that tubercu- losis is closely associated with pyaemia, and among animals the difference between these two diseases would appear to be one merely of degree. 10. Infection-The idea of infection being the cause of phthisis has been received^ and extended in England and Germany. The evidence of the Brompton Hospital negatives the idea of a contagion such as is present in small-pox or scarlet fever; for it has been demonstrated that the percentage of acquired pththisis occurring amongst the resident staff of the institu- tion is less than that of most general hospitals. Virchow and most English physicians strongly maintain that phthisis may be communicated from husband to wife, and Dr. Herman Weber has lately indicated, by some striking cases, the danger of pregnancy to the wife of a consumptive. Spurious Vaccination: Joseph Jones, M. D. 491 Cohnheim, who appears to have confirmed by his own experiments the doctrine of specific infection, holds, in opposition to the above views, that the test of tubercle is its iuoculability, and prefers this to any structural test. He considers that tubercular particles are conveyed by means of organisms to the lungs, thus affecting the pleura and bronchial glands, later the larger bronchi. The infection of the intestinal canal arises, ac- cording to Cohnheim, from swallowing the sputum.* Dr. Koch, an eminent German mycologist, distinguished for his classical work on anthrax and infectious surgical diseases, has advanced the view that phthisis is of parasitic origin, and claims that he has proven by direct experiments on animals that a certain bacillus, which he calls bacillus tuber- culosis, is the cause of this disease. The recent appointment of Dr. Koch as Imperial Councillor and Chief of the Laboratories of the National Board of Health of the German Empire, has given great weight to his statements, and his conclusions as to the aetiology of phthisis have been indorsed by some distinguished microscop- ists and physicians in Germany, England and America. The news of this great discovery of Koch have been spread by the newspapers throughout all civilized nations. Recently the low organism which is alleged to be the cause of general tuberculosis and phthisis "was exhibited to the pathologists and physicians of Philadelphia by Professor Whittaker, of Cleveland, O., by invitation of the College of Physicians. Dr. H. D. Formad, lecturer on experimental pathology and demonstrator of morbid anatomy in the University of Pennsylvania, has also publicly demonstrated, before the Philadelphia County Medical Society, the exist- ence of this organism in the sputum of patients suffering with this disease in the Philadelphia Hospital. The discovery of Koch and his theory, which corresponds with the pre- vailing opinion that there must be a specific poison of some kind character- istic of phthisis transmissible from person to person and from animal to animal, and from animal to man, through food, water, air and cohabitation, followed to its logical conclusion leads to most important results. It is said that in Germany, by imperial order, in military hospitals phthisical patients are separated from other cases, as carefully as small- pox patients ; and even in this country the people begin to regard consump- tion as eminently contagious. The adoption of the views of the contagionists will, without doubt, lead to much mental and physical suffering. The wife will look with suspicion, if not with abhorrence, upon her sick husband; the hale and hearty husband will abandon his feeble wife; and the sick child will be isolated and pass the remaining days of suffering in solitude. During the experience of more than twenty-five years spent mainly in the sick-room and in the wards of civil and military hospitals, the opinion has grown into a strong conviction that tuberculosis (consumption) phthisis pulmonalis is not contagious in the same manner as small-pox, measles or scarlatina. The following conclusions and propositions recently enunciated by H. D. Formad. M. D., of the Medical Department of the University of Penn- sylvania, are worthy of consideration, in connection with the foregoing facts : (a) The predisposition to tuberculosis in some men and animals, the so called scrofulous habit, lies in the anatomy of the connective tissue of the * "A Dictionary of Medicine, Including General Pathology, General Therapeutics. Hygiene, and the diseases Peculiar to Women and Children by Various Writers.'' Edited by Richard Quain, M. D., F. R. S. London : Longmans, Green & Co., 1882. Pp. 1166-1168. 492 Spurious Vaccination: Joseph Jones, M. D. individual, the peculiarity being a narrowness of the lymphatics, and their entire obliteration by cellular elements. (b) Only beings with such anomalous structure of connective tissue can have primary tuberculosis, and such animals invariably do become tuber- culous from any injury resulting in inflammation, although it may remain local and harmless. (c) Scrofulous beings can have no other than a tuberculous inflammation, although it may remain local and harmless. (d) Non-scrofulous men or animals may acquire the predisposition to tu- berculosis through mal-nutrition and confinement, the latter bringing on the above mentioned peculiarities in the connective tissue. (e) No external etiological influences are necessary to cause tubercular disease other than those which ordinarily produce inflammation, and even scrofulous beings will not become tuberculous unless local inflammation is set up. No inflammation, no tuberculosis. (f) Non-scrofulous animals, so far as can be established now, may acquire tubercular disease through injuries of serous membranes, viz: peritoneum, pleura, etc. And even here, without any special virus whatsoever, clinical observations on the post mortem table show similar conditions, and prove the same in men. (g) The bacilli, which is the merit of Koch to have first proved to infest tissues affected by tubercular disease, are not necessary for its causation, even if a special organism exist and be really possessed of such property. The presence of bacilli is secondary, ami appears to condition the com- plete destruction of the tissue already diseased and infected by them, and this destruction is in direct proportion to the quantity of the organism. The tuberculous tissue seems to serve merely as a nidus for the growth of the bacillus. (h) An analysis of Koch's experiment shows that he has not proved the parasitic nature of phthisis, or that there exists a special bacillus tubercu- losis; so that the infectiousness of tubercular disease is still sub judice. (i) From the result of microscopical and post mortem observations, and clinical investigations, the conclusion seems to be justified that phthisis is not a specific infectious disease; but that the individuals suffering from tubercular disease are specific themselves, originally, and form a specific variety of mankind, the scrofulous. 11. Local Causes-The local causes of phthisis are those which injuriously affect the bronchi and air passages, causing large epithelial proliferations and various inflammatory lesions, followed by thickening and induration of the alveolar walls, and in time caseation or fibrosis. Bronchitis and pneu- monia arte fruitful sources of phthisis. 12. Trades and Occupations Giving Rise to a Dusty or Gritty Atmosphere.- The constant inhalation of particles of flint, iron, coal, hard clay, and even of cotton, flax and straw, as is the case in certain trades-such as stone- masons, fork and needle grinders, colliers, potters, cotton carders, chaff cutters, and others-has been shown by Dr. Greenhow to induce phthisis. The various irritating particles have been defected, microscopically and chemically, in the lungs, where they appear to cause great irritation, fol- lowed by thickening of the bronchi and subsequent induration of the lung tissue, with increase of pigment. Intermingled in the consolidations are found gray and yellow tubercle, and also extensive cavities, proving the identity ot this disease with phthisis. (A Dictionary of Medicine, etc., edited by Richard Quain, M. D.; London, 1882; p. 1168.) Spurious Vaccination: Joseph Jones, M. D. 493 It is not my design to discuss, at this time, the cause and mode of origin of tubercle, or its relations to inflammation, and to defective nutrition; my design has been simply to show that there are facts and experiments prov- ing the possibility of transmitting the disease from one animal to another by inoculation. And whilst we are unacquainted with a single fact which illustrates in any manner the relations of vaccination to tuberculosis, at the same time it must be admitted that we need farther experiments and light upon this subject; and we know just enough to create a prejudice against the indiscriminate use of vaccine matter from scrofulous and tuber- culous subjects. POSSIBILITY OF TRANSMITTING SCROFULA BY VACCINATION. Dr. Edward Ballard, in his valuable Prize Essay on Vaccination, pro- posed the following question: "Is there any reason to believe that scrofulous affections or cutaneous diseases are ever com- municated by means of vaccination ?" " In replying to this question we may freely admit that sometimes scrofulous manifesta- tions do succeed the vaccine disease, and, moreover, that it is not a rare event for cer- tain eruptions on the skin, such as eczema or the 'crusta lactea' of authors, to appear shortly after vaccination. But it does not follow from this that the lymph which has been over it, as mothers are very apt to fancy, the cause of the attack, or that it has been derived from an unhealthy child. The quality of vaccine virus as we shall see presently, is not regulated by any special healthiness or unhealthiness of the child who furnishes it, in the sense that it partakes in any way of that child's peculiar constitution. It is the same from a scrofulous or ricketty infant as from a robust one; it is vaccine virus weak- ened and deteriorated somewhat, perhaps in its energy, but nothing more. Besides, if it were contaminated-if, it did partake of the constitution of the vaccinifer-what then ? Is scrofula a disease capable of being communicated by inoculation of a secretion from one subject to another ? or the skin diseases, so commonly laid to the charge of bad lymph, capable of a similar mode of transmission? Nothing of the sort. Neither of them are contageous, neither of them inoculable-although the very secretions and material itself be used to make the attempt with. These maladies arise in a very different manner. How scrofulous affections generally arise I have already had occasion to point out; and I have only to add that skin affections, such as eczema, strophalus, etc., are very common diseases in infants constitutionally predisposed to them, and especially during dentition, or when children are supplied with food of an improper character, or when cleanliness is neglected. Glandular swellings, also, about the neck are often associated, as a result of the local irritation, with eczema of the head and face, if at all extensive. And these things happen just the same in unvaccinated children as in vaccinated children, and was observed just as often in the days when vaccination was unknown as they are now ; and they originated then from just the same causes as they originate in now. The most that can be said about their relation to vaccination is that the disturbance of the system in the vaccine disease may sometimes, like any other constitutional disturbance, or like small-pox itself, promote or arrest in the manifestation of a scrofulous taint if pre-exis. tent, or may arrest other causes which alone have been insufficient for the appearance of an eruption on the skin. I cannot express the relation borne by vaccination to such outbreaks of cutaneous disease better than it has been statedby Mr. Paget: "When eczema, impetigo, etc., occur, as in any sense, a consequence of vaccination, the explanation is to be found in the fact that vaccination produces a certain amount of fever- ishness, and is followed by a few days loss of strength-states which, though they are quite insignificant in moderately healthy children, are favorable to the evolution of any constitutional disease or blood disease to which a sickly child may be liable. In children and adults alike it is certain that a tendency to the external manifestations of eczema and the other diseases above named may exist for many weeks or months, and yet not take effect till some accident disturbs the health, and wakens, as one may say, the form of retention or repression of the morbid tendency in the blood. There is, indeed, scarcely a blood-disease of which evolution may not thus be determined or hastened by an acci- dental injury, or by casual loss of health. When, therefore, eczema, or any such disease, so appears after vaccination that the one may with any reason be regarded as the conse- quence of the other, the vaccination may be considered to have done no more than any accidental injury would have done. Indeed, even among ignorant persons, the blame of these diseases is not nearly so often laid on vaccination as it is on accidental blows, falls, frights, colds, surfeits, and other such things. Perhaps the most common expression of all is that a child cannot even get so much as the scratch of a pin but what it brings out 494 Spurious Vaccination: Joseph Jones, M. D. an eruption, or 'is followed by an abscess.' Now vaccination may do, though I believe it very rarely does, what these small accidents may do, namely, by disturbing the gen- eral health it may give an opportunity for the external manifestation and complete evo- lution of some constitutinal affection, which, but for it, might have remained rather longer latant." But so deeply rooted is the belief in some minds that, because these maladies sometimes succeed the vaccine disease, therefore they are caussd by it directly and solely ; that rather than run a remote risk of what mostly is by no means a serious ailment, of what may occur in a predisposed child even if vaccination be not performed, mothers will pre- fer to accept for their offspring the chances of small-pox and all its dangers."-Vaccina- tion : Edward Ballard, pp. 272-275. INOCUL ABILITY OF CANCER. Dr. George Budd, of London, in his valuable work on diseases of the liver, has recorded a large number of facts to show, not only that cancer may be disseminated by inoculation, or by the mere contact of a sound part with a part affected with cancer, without any direct vascular connection between them; and by cancerous matter conveyed by lymphatics and veins to other parts of the body; but that cancer may even be propagated by inoculation, or by injection of cancerous matter into veins from one animal to another. The facts recorded by Dr. Budd illustrate in the clearest manner the first two modes of the dissemination of cancer, in the human being; and to support the third proposition he cites the following experiments: Professor Langenbeck injected into the veins of a dog some pulp taken from a cancer which had just been removed from a living body. At the end of some weeks the dog began to waste rapidly. It was then killed, and several cancerous tumors were found in its lungs. Another instance to the same effect, taken from a German periodical, is related in the Provincial Medical Journal for September 23, 1843. Some cells were collected from a black liquid in the orbit of a mare affected with melanosis, and were inoculated into the conjunctiva and lachrymal gland of an old horse. These merely caused a black spot on the conjunctiva, which extended very slowly; but about the sixteenth week after inocula- tion, melanosis of the lachrymal gland was very decided; it had invaded the whole organ, and pushed the globe of the eye forward. Some of the melanotic matter, taken from the same mare, was injected into the veins of the neck of a dog, who died suddenly whilst hunting, three weeks after the operation. There was found in the left lung a melanotic tumor, which was ruptured, and which contained a brown, coffee-colored fluid, abounding in cells. So many instances have occurred of cancer of the penis in men whose wives had cancer of the womb, that many physicians have been led to be- lieve that the disease in these instances was propagated by contagion. (On the disease of the liver by George Budd, M.D., Third Edition, London, 1857, chapter 4., pp. 388-416). It would in like manner, be foreign to our purpose to enter into any speculation astto thecause of cancer, or into an examination of the question, whether the germ of the disease be a true parasite, introduced from with- out ; or whether cancer is generated within the body, or of the materials of the body, under the influences of certain agencies. We will have accomplished our purpose in recording these facts, if we succeed in directing the attention of the profession in this country, to the necessity of greater attention to the condition of the subjects selected for the propagation of the vaccine disease. Spurious Vaccination: Joseph Jones, HL I). 495 II. CONTAGIOUS NATURE OF CONSTITUTIONAL SYPHILIS. We proceed now to the consideration of the second and more important question, which relates to the propagation of one of the most destructive poisons in its action upon the human race. The formal and persevering denial by eminent surgeons, that secondary syphilitic disease could be communicated by contact, and the adoption of this theory by a large and influential school, has inflicted much domestic misery and led to most unwarrantable and destructive carelessness in the process of vaccination. The question of the communication, by contact and inoculation of secon- dary syphilis, is of vast importance in its bearing upon the human race, and should not be settled dogmatically-in fact it is not in any manner a ques- tion of belief, but of facts. As early as 1498, Gaspard Torella affirmed that he had often seen the unweaned child infected by the sore breasts of its mother, and then bestow upon its nurse, who fondled and kissed it, the same unfortunate endow- ments. Many of the older writers appear to have entertained no doubt with re- ference to the possibility of communicating constitutional syphilis. The following testimony is from William Clowes, who wrote more than two centuries and a half ago: I have also knowne divers persons infected, who have had in all other parts of the bodie manifest signes thereof, as dolors, tumors, ulcers, and venemous pustules, etc. And yet in the parts aforesaid, no paine, or any signes thereof; so that their opinion is not to be observed, which afiirme, that this disease is ingendred onely, by the company of un- cleane persons ; for I have knowne not many years past, three good and honest midwives infected with this disease, called Lues Venerea, by bringing abed three infected women, of three infected children, which infection was chiefly fixed upon the midwives, fingers and hands, etc. What should I speake of young sucking children, whereof divers have been grievously vexed with this disease, and some of them a moneth, two, three or foure moneths old, and some of them a year old, some foure or five yeares old, and some of them sixe or seaven yeares old, amongst which sort, I thought it good here to note a certaine wench, the daughter of one Sare of twelve yeares of age, the which I cured, in the yeare oure Lord 1567, who was greatly infected with this sicknesse in many parts of her body, having thereon painfnll nodes or hard swellings and nJcers, with corruption of the bones, and yet no signe in the most suspected parts, neither by reason of debilitie was able to have committed any such act, but it is not to be doubted, but that she received the infec- tion, either from the parents, the which cure of some is supposed uncertaine, whether children bagotten by infected parent may bee cured or not; or else she was infected, as children begotten by infected parents, may bee cured or not, or else she was infected, as divers are, by sucking the corrupt milke of some infected nurse, of whom I have cured many, for such milke is engendred of infected blond, and I may not here in conscience overpasse, to forwarne the geod Reader, of such lewde and filthie nurses; for that in the yeare 1583, it chanced that three young children, all borne in this citie of London, all of one parish, or very neere together, and being of honest parentage, were put to nurse, the one in the countrie, and the other two were nursed in the citie of London ; but within lesse than halfe a yeare, they were all three brought home to their parents and friends, grievously infected with this great and odious disease, by their wicked and filthy nurses ; Then their parents seeing them thus miserably spoiled and consumed by extreme paines, and great breaking out upon their bodies, and being so young, sick and weake, impossi- ble to be weaned, were forced, as nature doth binde, to seeke by all meanes possible to preserve these poore silly infants, which else had died most pitifully. To be briefe, ere ever those children could be cured, they had infected five sundry good and honest nurses; I cured one of the children, and the nurse which gave it sucke, the other two children and their nurses were also cured by others, but one of the children lived not long after, as I was given to understand. Also, friendly reader, I read of late in a certaine hisjory, w.itten by Ambrose Pare, in his 2. book, intreating of the causes of Lues Venerea which history indeed is worthy the rehearsall: "An honest citizen saith he, granted his most chaste wife, that she should nurse the childe which she was lately delivered of, if she would keepe a nurse to be partaker of the travel! and pains; the nurse that she tooke by chance, was infected with Lues Venerea, therefore she did presently infect the foster childe, and he the mother, and she the husband, and he two children which ho had daily at his taublo and bed^ not knowing of that poison which he did nourish in bis own body and 496 Spurious Vaccination: Joseph Jones, M. D. intrals. But when the mother considered and perceived, that her childe did not prosper or1 profit by the nourishment, but continually cried and wexed wayward, desired me to tell her the cause of that disease, neither was it any hard matter to doe, for bis body was full of the small-pocks, whelkes, and venerous pustules: and the brests of the nurses and mother being looked on, were eroded with virulent ulcers; and the body of the father and his two sonnes, the one about three yeares, and the other foure yeares of age, were infected with the like pustules and swellings that the childe had; therefore I shewed them that they were infected with the Lues Verenea, whose beginnings, and as it were provocations, were spred abroad by the nurse that was hired, by her maligne infection. I cured them all, and by the helpe of God, brought them to health, except the sucking childe, which died in the cure ; and the nurse being called before the magistrates, was punished in prison and whipped closely, and had been publikely whipped through all the streets of the citie, if it had not been for the honors of that unfortunate family." Thus we see children infected by filthy nurses, and sometimes nurses be infected by giving sucke to such infected children. And now to returne to my former purpose, the disease, as saith Nicholas Masa, whose councell and direction in the cure of this disease I have greatly observed. The disease because it hath a flowing matter, being once entered into any part of the body, proceedeth on from part to part, never resting until it hath cor- rupted the liver, with the ill disposition of this infection especially. When it toucheth any such part, as hath in it an apt disposition to admit such infection, as when the action or force of the agent is wrought and imprinted in the patient, fitly affected to receive the same forme, and so it disperseth itselfe through the whole bodie: likewise this sick- nesse is many times bred in the mouth, by eating and drinking with infected persons, and sometimes onely by breathings ; and Almanor a learned physition setteth downefor truth, that this disease may be taken by kissing, and sometimes by lying in the bed with them, or by lying in the sheets after them ; also it is said to come by sitting on the same stoole of easement, where some infected person frequenteth, and sometimes such as have been cured of this disease, fall into it againe by wearing their old infected apparell: all which causes of this disease I rather set downe, for that I would thereby admonish as many, as shall read this treatise, to be carefull of themselves in this behalfe, and to shun as much as may be, all such as may be, all such occasions.-A Profitable and Necessarie Booke of Observations for all those that are burned with the flame of gun-powder, etc, By William Clowes, London; M. Dawson, 1637. pp. 151-2-3. Gideon Harvey, in his "Venus Unmasked," published two hundred years ago, expresses similar views : 4. Probl. How many various ways the pox exert its contagion ? No external part is impowered to transmit its infection immediately, except where it's suscepted ; so we ob- serve the venereal parts to be infectory immediately upon the susception of virulency, but not through kissing, sucking of the breast, by sweat, or through any.other parts but themselves. So the mouth that's *infectod by kissing, or sucking a thorow pockified whore's tet, is capable of immediately infecting another's lips by kissing, or any other part by sucking it, because the pocky miasms are neer ; but not by copulation, or sweat, etc., because the contagion cannot be crept so far. Experience verifies this dictate, Is it not an ordinary trick of wenchers (as Musa relates) to suck whore'stongues, andtets of their breast and yet those whom they know have been pockified many years about their lower parts, and for that reason though their appetites are furious, yet dare not be dabbling, but the other they reiterate a thousand times over without the least hazzard ? Au instance for the other part of the dictate, which I had from my first master in physick, that wonder of physicians, Prof. Job. Antonid, vander Linden, p. m., the profoundest com- mentator on Hippocrates and Celsus that ever any age presented, whom I heard that most famous Professor Hegins Guido Patin intitulate the Dutch Hippocrates. He during his luculent practice at Amsterdam, had a merchant's prentice in cure of an genorrhe, and a blistered, or cankered like mouth ; both symptoms he contest to have started upon him at the same time. The excellent Professor being curious and admiring at the rarity of such distant symptoms emerging at once, extorted an ingenuous confession from his patient, upon pretence that it would facilitate and abreviate the cure : the other without any longer suspense impudently told him his tongue was as unfortunate as his tayl; a sort of diabolick satyrism, outvying Aretius flagello de Principi and very like a Dutch invention. What insued ? this bastard at a Besoeck (an invitation that's usually made to young folks, preliminary to all weddings) accosted himself to two pretty damsels, and being planted between them, oft flanckt to the right, and in a kiss pledged his right hand man, and so to the left, and performed the like duty there. But the tragick event may imprint a dread upon al! young women. A short time after their lips felt hot, inflamed, grew sore and ulcered, one named it the thrush, another a sore mouth ; vulgar applications rather pro- moted than checkt the evil, wherein they persisted so long that accessory accidents, as sordid ulcers of the palat and tonsils, nocturnal pains, etc., moved a jealousie of the fowl disease. Here you may remark, how innocently the poor lasses pessundated their fortunes. The reflexion of this relation upon the latter part of the dictate I commit to your own thoughts. Spurious Vaccination: Joseph Jones, M. D. 497 2. A wench or monsieur by that time they are thorow pockitied, are infections in any part where ever the pox bursts out, because the virulent seminaries are propagated quite through the body, which exhaling at the places affected, transport the contagion. What the thorow-pox is expect below ; so that when the malady is tumefyed to so high a flood, its time for nurses, physicians, and all visitors to stand off; upon such occasions a person may be infected by drinking out of the same vessel (provided the spittle adhering be warm still), as we have heard of many ; (Leonardus Botallus adduceth an observation of a patient of his, of a chast and religious converse, who was stigmatized by a peculiar pledging of his familiar, then under a sore affliction of thorow-pox. His lips iuflamed, afterwards ulcered, his jaw bone grew carious, and was miserably rackt with nocturnal arthritick, pains). By trying of a warm pocky glove ; by succeeding a virulent patient on a close stool; by shifting of him, or making his bed whilst the sheets continue warm ; as Nicol. Massa's friend and patient, who incurred this evil, by touching the sheets, one lay in, that was lame of a Neapolitan ulcer in his legg ; and that old woman in Horst's observ. aged fifty-six, tending a pocky fellow in his lying in, was seized of the same disease in as furious a degree as her master: and by kissing, witness Faventinus, who knew a young man, that contracted this evil by oft kissing a fowl slut. The initial symptoms appeared about his mouth ; his privities, which otherwise might have bin suspected, appearing free from all contagion. To thisl'l parallel another; one Mrs. &c., then a pocky inhabi- tant of the Hague, having run the gantlop of several cures, hydrotick and mercurial, at last proved with child; her reckoning being expired, she was brought to bed of a monster, in all particulars resembling a living child ; saving the skin, which was abomi- nally ciphered with spots and botches, This object of mercy upon us was committed to the care of a nurse, the infant aspiring to higher things, had bade world adieu. But the unhappy nurse had cause to curse her late foster child, her breasts and head ulcered, a caries got into the cranium, the pox took possession of the poor woman's carcase, for want of a purse to release her. The pocky original Mistris, &c., was proclaimed barbarous by a whole jury of matrons, for refusing relief to the disastered woman. In all these trans- actions the Pater Familias stood it out vigorously with a fresh countenance, no sign con- tradicting his pancratick health. Just such auother mischance Musa Brasavous tells us, befell a nurse that suckled one Sr. Orobo's child, thorowly conspurcated with the pox. The observation hereupon infers this a thorow-pox, and consequently must prove infec- tious in all partsof the body. Physicans in this case run a great risk in feeling pulses and approaching such patients in their sweats.-Venus Unmasked, or a More Exact Discovery of the Venereal Evil, or French Disease : By Gideon Harvey, London ; T. Grismond, 1665, pp. 94-5-6-7-8-9. In like manner Daniel Turner in his work on syphilis, published in 1717, maintains the contagious nature of constitutional syphilis : And this I intend shall suffice for its chronology or time, the topology or place, and the histriography or account of the disease in general; which, with some other writers there- on, we shall now define, a venomous or contagions distemper, for the most contracted by im- pure coition, at least some connect of the genitels of both sexes, or some other leived and filthy dalliance between each other that way tending. I said for the most part, because it is beyond controversy, the infection is communicated by other ways, as from pocky parents by inheritance ; by sucking an infected nurse, to the child; suckling a diseased child, to the nurse; lying also in bed with the diseased, without any carnal familiarity ; by which, though it may be possible for strong and vig- orous bodies to escape, ^yet are the tender ones, especially of little infants, very likely to be contaminated, as I liave more reason to believe than by bare imagination. There are several other more uncommon ways of giving as well as receiving the vener- eal venom ; some of which I have already imparted to the world in short remarks upon a quack libel, printed several years past. But the thought of such vile monsters, and their execrable practices, is too shocking (unless to the dregs of human nature) to bear a repetition of circumstances, and fit only for a detestable gonologium or collection of smutt and obscenity, in which I am told, they have been inserted, as some of the author's own observittions. As for those fancied ways of catching it by common conversation, drinking after one, sitting on the same close-stool, drawing on a glove, wiping on the napkin or towel, after the infected person, with a hundred the like stories, I believe in our time (whatever may have happened formerly) there is no great danger. Yet we find in one of our late chron- icles, that these and such like imaginations were so strongly riveted in men's minds at that time, even those of the better and more learned sort, that it was one of the articles against a noted cardinal that he had breathed on the king, when he, the said cardinal, had this disease upon him, which you will find in Baker's Chronicle, aud of which pas- sage Dr. Harvey has also taken notice. Hildanus likewise tells us of a young gentlewoman, who contracted the same, by only patting on the apparel of a gentleman (that it seems was pox'd) at a masquer ide, of w aich, through modesty concealing her illness (which first of ali had seized the Pudenda') 498 Spurious Vaccination: Joseph Jones, M. D. till she was past recovery, she deceased. The good man's credulity, at least his charity, might however be abus'd in this relation, as the young lady perhaps was also after the masque, otherwise than by simply putting on the habit. But were it so as the case is stated, there is nothing therein much more admirable than what the same great man re- cites of a whole family he knew infected, viz: the wife with three children and a fourth in the womb, as also a maid servant, by the husband, who had got the distemper in their absence only by sleeping in the same bed with his man servant, whom he after under stood was broke out with this distemper. The relation of Horst and Hornung are yet more strange, of several people infected in the bagnio, by having the same scarificator apply'd after cupping, as had been used to a venereal patient, which seems alike credible with that of the priest poxed at his ear, in the time of confessing a wanton nun; the venomous breath from her mouth defiling the holy father. But enough of this.-Syphilis; A Prartical Dissertation on the Venereal Dis- eases By Daniel Turner, London : R. Bonwicke & Co., 17J7, pp. 10, 11, 12. John Hunter, in his ''Treatise on the Venereal Disease," gives a number of instances of the communication of secondary syphilis, from which we select the following: A lady was delivered of a child on the thirtieth of September, 1776. The infant being weakly, and the quantity of milk in the mother's breasts abundant, it was judged proper to procure the child of a person in the neighborhood to assist in keeping the breasts in a proper state. It is worthy of remark that the lady kept her own child to the right breast, the stranger to the left. In about six weeks the nipple of the left breast began to inflame, and the glands of the axilla to swell. A few days after several small ulcers were formed about the nipple, which, spreading rapidly, soon communicated and became one ulcer, and at last the whole nipple was destroyed. The tumor in the axilla subsided, and the ulcer in the breast healed in about three months from its first appearance. On inquiry, about this time, the child of the stranger was found to be short-breathed, had the thrush, and died tabid, with many sores on different parts of the body. The patient now com- plained of shooting pains in different parts of the body, which were succeeded by an eruption on the arms, legs and thigh, many of which became ulcers. She was now put under a mercurial course, with a decoction of sarsaparilla. Mercury was tried in a variety of forms: in solution, in pills internally, and externally in the form of ointment. It could not be continued above a few days at a time, as it always brought on fever or purging, with extreme pain in the bowels. In this state she remained fill March 16, 1779, when she w as delivered of another child in a diseased state. The child was committed to the care of a wet nurse, and lived about nine weeks; the cuticle peel- ing off in various parts, and a scabby eruption covering the whole body. The child died. Soon after the death of the child, the nurse complained of headache and sore throat, together with ulceration of the breasts. Various remedies were given to her, but she determined to go into a public hospital, where she wras salivated, and after some months she was discharged, but not cured of the disease. The bones of the nose and palate ex- foliated, and in a few months she also died tabid. Of the various remedies tried by the lady herself, none succeeded so well as sea-bath- ing. About the end of May she began a course of the Lisbon diet-drink, and continued it with regularity about a mouth, dressing the sores with laudanum, by which treatment the sores liealed up ; and in Septtmber she was delivered of another child, free from ex- ternal marks of disease, but very sickly, and it died in the course of the mouth. About, twelve months after the sores broke out again, and, although mercurial dress- ings and internal medicines were given, remained for a twelve-month, w hen they began again to heal up. * * ' * * The third case was of a gentleman, where the transplanted tooth remained, without giving the least disturbance, for about a month, when the edge of the gum began to ulcerate, and the ulceration went on until the tooth dropped out, Some time after spots appeared almost everywhere on the skin ; they had not the truly venereal appearance, but wrere redder or more transparent, and more circumscribed. He also had a tendency to a hectic fever, such as restlessness, want of sleep, loss of appetite and headache. After trying several things, and not finding relief, he was put under a course of mercury, and all disease disappeared according to the common course of the cure of the venereal disease, and we thought him well ; but some time after the same appearances returned, with the addition of swelling in the bones of the metacarpus. He w'as now put under another course of mercury, more severe than the former, and in the usual time all the symptoms again disappeared. Several months after the same eruption came out again, but in not so great a degree as before, and without any other attendant symptoms. He a third time took mercury, but it was only ten grains of corrosive sublimate in the whole, and he got quite well, The time between his first taking mercury and his being cured was a space of three years.-The Works of John Hunter, with Notes, edited by James F. Palmer. VoL 2, pp. 470, 476, 484. Spurious Vaccination: Joseph Jones, M. D. 499 In an extract from a letter to Dr. Duncan, published in the " Medical Commentaries for the years 1783-84-85," it is said that a new disease has lately been discovered in London, occasioned by the transplanting of teeth from the head of one person to that of another. The mortality from it is computed at nearly two deaths to ten diseases; and about one in every hundred who receive teeth by transplantation are affected with the disease. Ulcerations of the throat and gums, and eruptions on the skin, are the chief marks of the disease. When death takes place it is from the occur- rence of sphacelus. For five or six weeks after transplanting, the teeth look well, and are as firm as the others. Pp. 490-491. In the third volume of the London Medical Transactions, Dr. William Watson, Vice President of the Royal Society, recorded an interesting case, illustrating the terrible effects of transplanting teeth, from which we ex- tract the following particulars : । An unmarried lady, in the twenty-first year of her age, of a delicate habit, but in other respects in perfect health, observing one of the incisors of her upper jaw to become black and carious, determined on having it replaced by a sound tooth. This was accordingly done by an able dentist; the tooth which was introduced being taken from the mouth of a person apparently healthy in every particular. At the end of a month, her mouth, which had continued all that time a little tender, became very painful. Her upper gums were at first inflamed and enlarged; afterwards they were discolored and ulcerated. This ulceration spread very fast, insomuch that the gums of the upper jaw were corroded away, and the alveoli left bare. Before another month was at an end, the ulceration occupied the whole space under the upper lip between the teeth and nose; it extended likewise to the cheeks and throat, which were corroded by large, deep and fetid ulcers. Soon after this, part of the alveoli of the upper jaw became carious, one of her teeth dropped out; and in a few days a second tooth, together with the transplanted tooth, which hitherto had remained firm in its place. About this time blotches appeared on her face, neck and various parts of her body; and several of these became ulcerated sores. The fetid dis- charges from her mouth and throat had for a considerable time deprived her of sleep; and the soreness of the parts had prevented her from taking nourishment. And, in addition to these, the soreness from the external ulcers induced such a degree of fever that her death was soon expected. When Dr. Watson was consulted, concluding that all her fluids were in a most putrid and acrimonious state, he directed peruvian bark combined with gum-myrrh in large doses. No benefit resulted trom this plan, and the patient was placed upon alterative doses of mercury. The improvement was marked, the ulceration was arrested and the blotches began to dis- appear. The internal administration of mercury was abandoned, on ac- count of its irritant effect upon the bowels, and the impression was kept up by rubbing mercurial ointment into her legs and thighs ; this practice in like manner was attended with beneficial effects. In about ten or twelve days, the blotches had entirely disappeared and the ulcers of the mouth almost completely healed. The griping and purging, however, returned with such violence that Dr. Watson was compelled to abandon the mercury altogether. Small portions of the carious alveoli continued to exfoliate, the ulceration began again to spread, the patient labored under great weak- ness, with frequent returns of feverish heat, and was every night oppressed with colliquative sweats. Her strength gradually lessened, till death put an end to her sufferings. As the progress of the disease was not impeded by the most powerful antiseptics in liberal doses, and as it gave way to mercurials even in small 500 Spurious Vaccination : Joseph Jones, M. J). doses, there appeared to be good ground for believing that the taint was truly venereal; but Dr. Watson, although aware of the great subtility of the venereal poison, was perplexed by the statement that the person from whom the tooth was taken was perfectly well, and never had any venereal taint. Mr. Clement Hamerton, Surgeon to the Castletown Dispensary, has re- corded in the Dublin .Journal (March, 1841) cases illustrating the introduc- tion of syphilis into the system, through other channels than sexual inter- course, from which he draws the following conclusions : A healthy child is applied to the breast of a venereal nurse; in a couple of weeks syphilis shows itself in the child. A venereal child is applied to the breast of a healthy woman; soon afterwards she gets a syphilitic sore of the breast, which contaminates her system. A servant girl sucks a venereal sore breast, she gets a venereal ulcer of the mouth, which taints her system. The midwife has a slight scratch on the palm of the hand, and in delivering a putrid venereal child, she gets a sore on the hand which in- fects her system ; and lastly the husband of the widwife is diseased at the time the ulcer exists upon his wife's hand. Dr. Egan has recorded (Dublin Quarterly Journal, May, 1846) several cases illustrating the contagiousness of secondary syphilis. In the first case the child was born apparently healthy; eight weeks afterward syphi- lis appeared. An ulcer then presented itself upon the breast of the nurse, and secondary syphilis occurred. In the second case the child was born apparently healthy; about ten weeks afterward a suspicious rash appeared, succeeded by blisters and fissures about the mouth ; ulcers occurred on the nurse's breasts, and then a scaly eruption and other secondary symptoms. Both cases were cured by anti-syphilitics. In the third case the woman was a dry nurse, being disqualified by age from suckling. The child was unhealthy, and affected with sores, of a brownish color, about the nates and mouth, and a constant flow of saliva. A scratch appeared on the neck of the nurse, whether produced by a pin or torn by the nails of the child was uncertain; but being in the habit of bringing the child's mouth in contact with the affected part, in order to induce sleep, the disease was be- lieved to be communicated through the abrasion, and the local effect was succeeded by an eruption, cured by anti-syphilitics. In a trial which took place at Cork, Dr. O'Connor and Dr. Bull gave evi- dence to show that a child affected with syphilitic eruption may convey the contagion to the nurse. (Lancet, July 4,1846.) Dr. Hector Gavin has given the history of a case where a man and his wife, purporting never to have had syphilis, had a first child born perfectly free from any traces of the disease, subsequently to which the diseased child of a woman known to have had syphilis, but supposed to be cured, was placed to the wife's breast, the nipple being " cracked " at the time, and the disease was communicated. (Lancet, July 18, 1846-Rankin's Abstract.) Mr. Price, of Margate, has recorded the case of a woman who had syph- ilis, which commenced in the nipple, from nursing an infected child. She gave birth to one child affected with the disease, and to another dead child. The child from whom this woman derived the disease had a very sore mouth and smelt very badly, and its father was known to have secondary syphilis of an aggravated character. Another respectable married woman, six weeks afterwards, applied to Mr. Price, having syphilis, with a large sore on one of the nipples, and it,turned out that this woman was nursing the same child which had affected the former nurse. This woman's own child also had the disease. This woman affected her husband. Two years and Spurious Vaccination : Joseph Jones, M. D. 501 five months subsequently she gave birth to another child ; this was affected with syphilis; twelve months subsequently another child was born simi- larly affected, and after this the mother was cured with iodide of potas- sium. Several very remarkable cases by Lallemand, Dr. King and Dr. Maenick, will also be found in the twelfth volume of the Medical Times- pp. 81, 176, 422-Rankin's Abstract, v. 10, p. 336. According to M. Rizzi, who had au ample field for recording facts relat- ing to congenital syphilis, in a large hospital under his charge in the city of Milan, if a woman contracts specific ulcerations on the breast by suck- ling an infected infant, mucous tubucles very frequently develop them- selves on the vulva and about the anus; and the syphilis, although second- ary, is transmissible by contact, so that a perfectly innocent woman may communicate the disease to her husband; and it behooves the medical at- tendant to be well apprised of this fact, as upon his knowledge of it not only the health, but the peace of mind and honor of the individuals must rest. Of one hundred individuals with chancres on the breast from impure lac- tation, or on the mouth or throat, derived from contact with an infected infant, thirty-four have tubercles of the vulva, nineteen syphilitic angina, three iritis, fourteen tubercles of the vulva and angina simultaneously, five tubercles of the vulva, and others disseminated over other parts of the body of divers complicated symptoms, six tubercles of the vulva, angina, tubercles on the skin and iritis, and nineteen no secondary symptoms. In nurses, as well as in men infected with them, M. Rizzi has remarked that tubercles are the most common form of secondary symptoms, and angina is frequently superadded. A discharge, vegetations, and exostoses, are very rare, and buboes, when they occur, consist only of swelling and tension of the sub-maxillary or axillary glands. In fifty-three infants, the disease manifested itself one month after birth in thirty-three ; at the expiration of two months in eleven ; of three months in four; and in one only after the expiration of eight months. These statistics show how easily parties may be deceived as to the condition of infants that have been subject to the syphilitic poison, from infants taken by them to nurse, without the slightest apprehension, whose parents even might not have a suspicion of the existence of the disease.-Rankin's Abstract, vol. v. p. 219, from Gaz. Med. di Milano, and Gaz. Med. de Paris, Oct. 25, 1846). On the twenty-fifth of October, 1858, a letter was addressed to the Im- perial Academy of Medicine at Paris, by the Minister of Commerce, Agri- culture and Public Works, requesting an authoritative answer upon two question; first, whether consiitutirnal syphilis was contagious; and secondly, whether, as regards contagion, there was a difference between constitutional syphilis as seen in infants at the breast and in adults. This letter led to the appointment of a commission consisting of MM. Velpeau, Ricord. Devergie, Depaul, and Gilbert, and these commissioners reported and their report was adopted by the Academy,-first, that some of the manifestations of secondary syphilis, especially condylomata, are undoubt- edly contagious; and secondly, that there is no reason to suppose that the case is different in infants at the bi east and in adults. The commissioners arrived at this conclusion after examining the clinical facts and experimental researches already on record, and after four experi- ments of their own, which was taken with great reluctance on their part. The persons experimented upon were all suffering from lupus, but free from any syphilitic taint, and these were chosen from the notion that the treatment for syphilis, if the inoculation took effect, might possibly be of service in remedying the lupus. 502 Spurious Vaccination; Joseph Jones, M. D. The following case will serve as an example of the four experiments: On a man whose face had been affected with lupus from childhood, a raw surface was made on the left arm by strong ammonia, and to this was ap- plied a piece of lint soaked in purulent matter obtained from a condyloma near the anus of a person who had had a chancre fifteen months previously. The condyloma was of fifteen days standing. Fourteen days afterwards there was slight redness at the sear of inoculation. Four days later still, a prominent coppery-colored papule made its appearance in the same part. On the twenty-second day this papule was much larger, and there was a slight oozing from the surface. During the week following, the oozing, after being purulent, dried up into a thin scab. On the twenty-ninth day a gland in the corresponding axilla became enlarged. On the fifty-fifth day, the papule on the arm had become a real tubercle, with some slight ulcera- tion in the centre, and several blotches and coppery papules had made their appearance on the trunk. During the week following, these papules became multiplied on the body, and they spread also to the extremities; many of them also changed into pusties of acne. Two or three days later the pa tient was put under the treatment for syphilis, and in six weeks, at the date of the report, there was still much to be done in the way of a cure. In addition to asserting the contagiousness of secondary syphilis, the commission arrived at the conclusion that there are characteristic grounds of distinction between the primary and secondary affection, and that the period of incubation in the secondary affection is from eighteen to twenty days, or even longer;; and that the result is first a papule, and then a tuber- cle, which is finally converted into an ulcer covered with a crust.-Rankin's Abstract, No. 30, p. 272, from Comptes Rendus, May 24 and 31, 1849. We might greatly multiply such facts from various authors, but this ap- pears to be unnecessary, as the experience of the authors just quoted covers three centuries; and we are justified in affirming that it is now clearly established that constitutional syphilis can be transmitted by direct inocu- lation with the secretions of secondary sores. And recent experiments have shown that the blood of persons affected with constitutional syphilis is capable when inoculated on healthy subjects of giving rise to syphilitic disease. Waller succeeded in inoculating a healthy boy fifteen years old, with this disease, by applying the blood of an individual affected with secondary syphilis to incisions made by a scarificator on the body of the boy. Well marked and unmistakable symptoms of secondary syphilis followed this experiment. In Gibert's case, the blood was taken from a large squamous papule on the forehead. "The point of the lancet was thrust into the circumference of the papule, and charged with a blood which was somewhat serous." It may be objected that the blood in this experiment was mixed with some of the diseased secretions within the papule itself. The secretary of the Society of Medicine of the Palatinate communicated the general results^ of the inoculations performed by an individual. "Of those men inoculated with the same blood, three were successful, and there were cases where a large absorbing surface had been rubbed."-Archives G^n^rale, secs. 10,11, p. 603. Whatever objections may have been urged to these experiments, no fault can be found with the well-conducted experiments performed by Prof. Pelizzari,* of Italy, in 1862. As this subject is of great interest, we present the account of these ex- periments: ♦Lectures on Syphilis, by Henry Lee, 1863; p. 198. Spurious Vaccination: Joseph Jones, M. D. 503 This physician inoculated two medical students with the blood of a syphilitic patient with a negative result. On the sixth of February, 1862, he resumed his experiments, three physicians, Drs. Bargioni, Rosi, and Passagli submitting themselves to his investi- gations. The blood of a female patient, aged twenty-five, affected with constitutional syphilis, and who had undergone no treatment, was used for the purpose. The blood was drawn, with a new lancet, from the cephalic vein. The patient was at the time affected with mucous papules on the left labium, at the place where the chancre had ex- isted ; mucous tubercles surrounded the anus, and the inguinal glands were indurated and enlarged, and there were'pustules on the head. At the point on the arm from which the blood was drawn there was no sign of any eruption, the skin of the part was well washed, and the surgeon washed his own hands. The bandage was new, as was also the vessel in which the blood was received. As the blood escaped from the cephalic vein, some of it was received on a piece of lint, which was placed on the upper part of Dr. Bargioni's arm, where the epidermis had previously been removed, and three tranverse incisions made. A similar operation was performed on the other two gentlemen, but in the case of one the, blood was cold, and in that of the other it had coagulated. After twenty-fonr hours the dressings were removed, and nothing wras observed but the crusts formed by the effused blood. Four days afterwards all traces of the inocula- tions had disappeared. On the morning of the third of March, Dr. Bargioni informed Prof. Pelizzari that in the center of the inoculated surface he had noticed a slight elevation, which produced a little itching The arm was examined, and at the point indicated Prof. Pelizzari found a small papule of a roundish form, ami of a dull-red color. On the eighth day the papule had augmented to the size of a twenty-centime piece. On the eleventh day it was cov- ered with a very thin adherent scale, which became denser, and on the second day com- menced to crack in its ct ntral part. On the fourteenth day two axillary glands became enlarged to the size of nuts. The papule remained indolent, and there was no induration at its base. On the twenty-first, the scale was transferred into a true crust, and the part beneath was ulcerating. Slight induration was more evident. On the twenty-sec- ond the crust was detached, leaving a funnel-shaped ulcer, with elastic and resistant borders, forming an annular induration. There was but a small amount of secretion from the sore, and the pain was trifling. On the twenty-sixth the ulcer had become as large as a fifty-centime piece, and the surrounding induration was considerably increased. Up to the fourth of April the ulcer remained stationary, but at that date its base appeared to be granulating. The axillary glands remained swollen, hard, and indolent. Slight noctural pains occurred in the head about this time, and the posterior cervical glands became somewhat enlarged. On the twelfth of April spots of an irregular form and of rose color appeared on the surface of the body. The eruption extended itself, and dur- ing the succeeding days became more confluent. No constitutional disturbance, heat of skin, or pruritus accompanied it. On the twentieth the cervical glands had increased in size and were harder. The chancre mantained its specific character and exhibited no tendency to cicatrization. On the twenty-second the color of the eruption was decidedly coppery. Small lenticular papules were now perceived to be mixed with the erythema. The edges of the chancre had begun to granulate. Mercury was now administered. This case isjof itself sufficient to prove the inoculability of syphilis through the blood of an infected person. No objection can bo urged against this inoculation, that any precaution against a fallacious result had been neglected. The following may be accepted as the generally received doctrines with reference to the inoculation of syphilis: > 1. There are two kinds of primary venereal sores, namely: The simple contagious ulcers of the genitals ; the " soft " or "chancroid" ulcer; and the true chancre-the u indurated " or u Hunterian " chancre. The soft or chancroid ulcer is a purely local disease, accompanied by sup- purating enlargement of the lymphatic glands of the region in anatomical relation to the seat of the sore; it is non-infecting, the general constitution not being affected or infected by the virus which produces it. The poison of soft chancre can be transferred or transplanted by conta- gion, or by inoculation from one part of the body to another, and thus the person who is the subject of it may come to exhibit second sores of a simi- lar character on more parts than one; it is, therefore, said to be auto- inoculable. The general system not being infected, an attack of the pri- mary disease is not succeeded at any future time by general symptoms ; and the primary attack affords no immunity against a future euntagion.. 504 Spurious Vaccination : Joseph Jones, M. D. The true indurated or Hunterian chancre, although at first apparently a local disease, does not remain long a purely local disease ; it is accompanied by indolent, non-suppurating multiple enlargements of the related lymphatic glands, and its virus infects or contaminates the whole system, which is thus protected against a second miasm of the primary disease. The gen- eral infection of the system exhibits itself in various ways, or by certain general symptoms, called secondary, or tertiary, or constitutional syphilis. It does not follow necessarily that the two forms of venereal ulcer are due to two specifically different kinds of virus. Thus some surgeons of eminence hold with Dr. Boeck, of Christiana, that the soft chancre is produced by the same virus as the indurated chan- cre; the two forms arise from the intensity of their virus being different. Soft chancres are held to be the product of the most energetic virus, which by its intensity develops in its circumference an inflammation which puts an obstacle in the way of absorption ; indurated chancres are the product of a virus of less intensity, which does not develop an inflammation suffi- ciently strong to impede absorption. When the matter is very intense we get a definite soft chancre; if it is of little intensity we get a definite indu- rated chancre. It is with matter of an intensity different from these that we obtain intermediate forms of chancre, to which, with all our experience, we are uncertain whether or not the primary affection will be succeeded by constitutional syphilis. Syphilis, in its manifestations as a general or constitutional disease, has a period of incubation, short sometimes, but at other times prolonged. Con- stitutional symptoms rarely occur before the third week following the ap- pearance of the primary symptoms, and more rarely still after the sixth month. The interval is one marked by no characteristic disturbance of the general health. The infection may not manifest itself until some disturb- ance of the constitution is brought about. For instance, Bamburger, of Wurzburg, mentions two cases where secondary manifestations did not ap- pear until the occurrence of small-pox. In like manner, vaccination may cause such a disturbance in the system infected with the syphilitic poison, as to excite the manifestation of secondary or constitutional symptoms. 2. Constituti nal syphilis is transmissible to offspring; it is an hereditary disease, and like the constitutional malady in the parent, it exhibits its manifestations generally in their system. The symptoms of hereditary or congenital syphilis are secondary and constitutional symptoms. Hered- itary syphilis exhibits itself in the offspring of syphilitic parents, not in the primary form of a chancre, but in some of its secondary constitutional forms. 3. Syphilis is contagious and inoculable, both in its primary form and in its secondary or constitutional stage; and when it is thus transmitted to the healthy it always appears first in the primary form. Not only can the disease be propagated from the original chancre, and from the syphilitic eruptions, but by inoculations as shown by the experiments of Wallace in 1835, by Vidal in 1849, by Waller in 1850, and by Bincker in 1852. All theg observers assert that where the inoculation was performed with the morbid secretions of constitutional syphilis, the result was a primary lesion, having all the characters of an infecting chancre. A remarkable character of these inoculations was the period of incubation of the disease, which never ap- peared before the expiration of the second week, but in general not till after the expiration of the fourth week. The interval between the introduction of the virus and the appearance of the local disease, was much longer than when inoculation was practiced from a primary sore. The first alteration was always observed at the spot Spurious Vaccination: Joseph Jones. M. D. 505 where the inoculation had been practiced ; the disease produced had a pro' gress essentially chronic, so much so indeed, that the 1 >cal affection was still present when the generel symptoms appeared if not subjected to treatment. The general symptoms only appeared at the end of a month, and often much later, after the first manifestation of the local lesion. 4. Whether syphilis be really derived from a primary, or from a secondary affection, the disease which appears upon the recipient is always the primary form of syphilis, always a chancre, or the induration which only requires the most trifling modification to become a sore. A chancre appears at the place where the matter of contagion from the secon- dary lesion has been applied. The imparted disease never appears first in the form of a constitutional mal- ady, at the due time secondary symptoms become manifested. There intervenes an incubation of about three weeks. This is, then a mark, a test by which we can distinguish between an im- parted syphilis and one which is merely aroused from latency in an individ- ual already tainted. In the former case, the first thing observed is a chan- cre ; in the latter there occurs no chancre, but the disease appears at once in its secondary or constitutional form. When therefore syphilis occurs after vaccination, first in one of its consti- tutional manifestations, it is a proof that it was not imparted by contagion, but is the result of an inherent constitutional taint. 5. Syphilis may be communicated by inoculation of the blood of a person, whose constitution is infected with syphilis; and from whatever source, the disease which first results is a chancre, the primary form of syphilis.* III. COMMUNICATION OF SYPHILIS BY VACCINATION: POST VACCINAL SYPHILIS-VACCINO SYPHILITIC INOCULATION. III. As we have before said, in the third section of this inquiry, the acceptance without reserve cf the doctrine of John Hunter, expressing the impossibility of the coexistence of two actions, or two local diseases, or two different fevers, in the same part, or in the same constitution, at one and the same time, would necessarily lead to the denia of the possibility of transmitting syphilis, through the medium of the matter produced by a distinct disease as cow-pox. What are called pathological laws, are nothing more than expressions of the fixed modes in which the phenomena of disease are manifested, and they conform to truth, only when they conform to, or formulate, the estab- lished course of nature. It is evident that a law may correctly express the relations of a certain class of facts and phenomena, without necessarily embracing other facts and phenomena, which upon a superficial view are related to those undoubtedly embraced by the law. Whilst the law of Hunter may express the relations of the actions of the special poisons of the exanthemata (and we have shown in the third section, that it was from this very class of diseases, that the law was formulated), it does not at all necessarily follow, that it is applicable to the actions of poisons differing wholly in their nature, mode of origin, and pathological processes. The poison of syphilis, after its introduction into the system, induces profound alterations in the blood, and in the processes of secretio i and nutrition, ami, in fact, produces derangement through all the solids and ♦BulUixl ou Vucciuotjuii iW2' 506 Spurious Vaccination: Joseph Jones, M. D. fluids. The economy under the action of constitutional syphilis, is to be looked upon as entirely deranged. When, therefore, another disease is engrafted upon this state, the product of that diseased action must par- take, more or less, of the diseased condition of the blood and tissues. Does anyone deny this, with reference to the products of inflammation excited in the syphilitic subject? Where is there sufficient proof to show, that syphilitic blood and lymph, furnishing materials for the elaboration of the vaccine matter, loses, altogether during this new process, its contagious and poisonous properties in the vaccine vesicle ? Is not the vaccine vesicle but the manifestation of a general disease affecting the entire system, just as the eruptive skin affection of syphilis is the manifestation of a disease pervading the entire system? In addition to the facts recorded in this inquiry, is it not well known that the fetus in ultero is affected by the vac- cination of the mother? And it is probable, though experiments are as yet wanting, that the blood of one suffering with the vaccine disease may propagate the disease by inoculation. If then it be possible to produce a protective vaccine pustule in an in- dividual suffering from secondary syphilis, then it is established that two local and two constitutional diseases may exist at the same time and in the same constitution, and the law of Hunter falls to the ground, as far as the action of these two animal poisonsis concerned. If the law of Hunter be universally applicable, we should have no vac- cine disease produced at all, upon individuals suffering with constitutional syphilis. But even admitting that the special contagious matter of cow-pox, formed from the blood of one suffering with constitutional syphilis, is free from the poison of syphilis, how can we practically, in the process of vac- cination, separate this from all admixture with the diseased epithelial cells, cellular tissue, and syphilitic products of the skin and blood. If the dried scab be used, does not this cover, and in fact has it not been formed from a circumscribed portion of structure which had been originally tainted with syphilis, and are not its borders encrusted and mixed up with the products of the secondary diseased skin ? The truth is, that we have much yet to learn about the phenomena manr fested by the living organisni when acted upon simultaneously by two or more poisons. Much of our established treatment consists in the use of certain poisons, often related to those under which the system is laboring. In this inquiry we do not need pathological formula and generalizations, so much as well authenticated facts. We cannot subscribe to the doctrine, that practically all danger may be avoided, by proper caution, as "every morbid appearance on the cutaneous envelope has its own peculiar character, by which it may be distinguished from other similar phenomena, and thus the observer may easily establish a distinction between the vaccine vesicle and other vesicular, bullar, or pus- tular eruptions." Is it not well known that syphilis may lurk for years in one individual, never occasioning so much inconvenience as to arouse sus- picion, until it is unmasked by the unexpected appearance of an infected offspring? On the other hand how fearful and destructive is the progress of the disease in others, in which from the first apperance of the chancre, symptom follows symptom, sore throat, swelled testicle, iritis, eruptions, nodes, ulcerations, and caries, until the entire body has become apparently a mass of nlth and rottenness. We are utterly and profoundly ignorant of the variations of the vaccine vesicle under these different states of the constitution j and we are utterly Spurious Vaccination: Joseph Jones, M. D. 507 and profoundly ignorant of those conditions which are essential to the trans- mission of the syphilitic poison through the medium of the vaccine vesicle. But to the facts : About twenty-nine years ago a medical man was condemned to two years imprisonment for having vaccinated several children from a child exhibit- ing a syphilitic eruption on its face and body. The witnesses asserted that the vaccine pustules had not been properly developed, and were fol- lowed by tedious ulcerations. Moreover, nine grown-up persons were asser- ted to have been re-infected by the children tainted through the vaccine pustule. The judgment was commuted, in consequence of the opinions expressed by Messrs. Heyfelder and Pauli, two distinguished medical men of Rhenish Bavaria, whose judgment had been supported by that of Ricord and Culler - ier, who utterly denied the possibility of communicating the syphilitic poison by the agency of vaccine lymph.-(B. and F. Med. Chirurg. Rev., Oct., 1855, from Bull. Gen. de Th^rap, July, 1855). Dr. Whitehead has made the following statement in the "Third Report of the Clinical Hospital, of Manchester," p. 52: "The occasional presence of eruptions on the skin and other forms of disease, as an entailment apparent or actual of vaccination in a family not previously subject to such affections, undoubtedly operates in the minds of many very much to the depreciation of the procedure as a preventive and healthful measure; and certainly in not a few in- stances there would seem to be just and sufficient reason for such prejudice. But the cause of this is not to be found in the vaccine virus in its pure state ; it is due to a mor- bid material superadded, and its nature peculiar and extraneous. The noxious matter commonly conveyed by vaccination is the syphilitic poison. A child of naturally vigorous con- stitution, whose blood is tainted with the poison of syphilis, may retain the outward appearance of health up to three, six or twelve months, or even two or three years longer before a characteristic outbreak shows itself. The parents of such a child may also have the semblance, to superficial observation, of faultless health, although still possessing the seeds of the malady in a degree sufficient for its transmission to their offspring. It is from such sources that mischief is often derived and disseminated, by vaccination, and other modes of implication; and it is true that the efficacy of this great sanitary measure has been in many instances rendered questionable." Dr. Whitehead furnishes a table of sixty-three cases of infantile syphilis, treated in the course of twenty-two months at the Clinical Hospital, of Manchester, and out of these cases he attributes no less than fourteen, or twenty two per cent., to vaccination. This proportion appears to be almost incredibly large; and the state- ment of Dr. Whitehead is singularly at variance with that of such men as Acton, Erasmus, Wilson, Watson, Jenner, Simon, De Merie, Henry, Lee and other distinguished surgeons and physicians. Another case is recorded by Dr. Whitehead in his work, "On the trans- mission from parents to offspring of some forms of disease, and the morbid taints and tendencies," 1851, p. 17. Cerioli, of Lucca, relates two instances illustrating the transmission of syphilis by vaccination. In one forty-six children were vaccinated from an apparently healthy child, and of the entire number only six escaped syphilitic contagion ; in the other several children received syphilis at the period of vaccination from a child apparently healthy, but whose father was syphilitic, the child herself presenting what were believed to be syphilitic symptoms at a subsequent period. Similar cases have been recorded by Hubner. Eight children vaccinated from a child apparently healthy, but as subsequent investigation showed contaminated by its mother with syphilis, presented ulcerations at the vac- cine punctures and manifested constitutional symptoms. Five other chil- dren vaccinated at the same time from the same child escaped. 508 Spuri jus Vaccination : Joseph Jones, M. J). M. Viennois* has collected many cases of the transmission of syphilis by vaccination, and has summed up his conclusions from the data on hand. From his observations and researches it would appear that syphilis cannot be communicated by vaccine virus taken from a subject affected with the disease unless a portion of the blood of the individual is also inoculated. Thus he says: "When the vaccine virus of a syphilitic subject, pure and unmixed with blood, is inoculated on a healthy individual, a simple vaccine pustule is obtained, without any near or remote syphilitic complications being- produced. "On the contrary, if, with the vaccine virus of a syphilitic individual who either has or has not at the time constitutional accidents, a healthy person is vaccinated, and the point of the lancet be charged with a little blood at the same time as with the vaccine virus, both diseases may be transmitted by the one operation-the vaccine disease with the vaccine virus, and syphilis with the syphilitic disease.'' M. Viennois also concludes that in such cases the vaccine vesicle is de- veloped first, and that after undergoing its incubatory period the syphilitic ulcer, with all the characteristics of a true chancre appears. The, following are the conclusions of M. Viennois. 1. Syphilis has in many instances been observed to follow vaccination, ever since the introduction of that operation, and by authors worthy of credit, French, English, German, Italian, etc. 2. When a syphilitic subject is vaccinated, in whom the disease is in a latent state, syphilitic symptoms may be developed by the vaccine in- fluence; these symptoms often consist in general eruptions of a papular, vesicular character, but a chancre never forms at the seat of the vaccinal puncture. 3. On the contrary, if a healthy subject be vaccinated with vaccine virus taken from a syphilitic subject, and the lancet be charged at the same time with a little blood, as well as vaccine matter, the two diseases maybe conveyed by the same puncture-the vaccine with the vaccine matter, and syphilis with the syphilitic blood. 4. In these cases, of which a number are on record, vaccination is first developed because its period of incubation is shortest, and its evolution more rapid than that of syphilis. The latter appears subsequently, and manifests itself by its characteristic lesion at the inoculated spot. 5. The initial lesion, then, by which syphilis, following the vaccinal pus- tule, manifestsitself, s an indurated ulcer, with adenitis; in a word, all the phenomena of primitive syphilitic chancre. The great law announced by M. Rollet, that syphilis always commences by a chancre, even when it result sfrom secondary symptoms, or even from syphilitic blood, is thus fully confirmed. 6. After the primary chancre is developed at the inoculated spot, and in the usual period, secondary syphilis occurs, and runs the usual course, as if transmitted in any other way. 7. When the mixture of virus does not take place accidentally, but is affected intentionally, (as practiced by MM. Spereno and Daumts, by mixing the vaccine matter with the pus of chancre), the result is the same; one virus does not destroy the other, but each runs its separate course. 8. The vaccine matter thus acts as a simple vehicle for the virus con- tained in the syphilitic blood, which it divides and dilutes, as a drop of watei would do, withe nt at all modifying its properties or its effects. * De 11 Transmiasiou de la S. philis par la Vaccination. Archiv. Gen. de Med., Juin, Juiliet, et Sep tembre, 1860. Spurious Vaccination: Joseph Jones, M. I). 509 9. It is important, then, never to take the vaccine virus from a suspected person, or from an infant whose parents are unknown before the age at which hereditary syphilis usually manifests itself, 10. If circumstances make this last necessary, great care should bo taken to collect only the vaccine matter, free from blood or any syphilitic humor. 11. In no case should a healthy subject be vaccinated with matter taken from a syphilitic subject, for in spite of all precautions, there can be no certainty as to the purity of the vaccine matter. 12. These precautions are the more important, because, with the matter from one syphilitic subject a number of persons may be vaccinated, and syphilis conveyed to many (as seen by Ceriale, of Cremona). 13. It is sufficient to point out these precautions, to avoid new evils, and to remove the cavils of the enemies of vaccination ; for in these cases, the propagation of syphilis is not the fault of vaccination, but of the vac- cinator.-Gaz. Med. de Paris, Jan. 26,1861. American Journal of Medical Sciences, April, 1861. These views of M. Viennois have received the most ample confirmation from the tragedy which occurred at Kivalta, in Italy, by which forty-six children and twenty nurses had syphilis communicated to them through vaccination, and of which several of the children died. The full details of this remarkable event are given in a memoir by Dr. Pacchiotti,* of Turin. On the twenty-first of May, 1861, Sig. Cagiola vaccinated Giovanni Chiabrera with lymph contained in a tube sent from Acqiu. Tht operation was performed in the usual manner and with a perfectly clean lancet. The child was eleven months old, and in good health at the time. Forty-six other children were, ten days subsequently, vac- cinated with the lymph taken from the vesicle of this child; and ten days after this, seventeen children were vaccinated with lymph taken from the arm of Lugia Manzone, one of the forty-six first vaccinated. Of these sixty-three children, forty-six-thirty-nine of the first lot and seven of the last-were within two months attacked with syphilis. On the seventh of October seven of them, including the little Manzone, were dead, three were yet in danger of dying, fourteen were recovering under the use of mercury and iodine, and one was well. A medical commission was now appointed to inquire into all the circumstances con- nected with this fatal event, and they proceeded to the execution of the duty assigned them. Twenty-three children were examined in full ; the others were not so accurately noticed, as their parents had neglected to avail themselves of medical aid in time. In the forty-six children who were affected, syphilis appeared at periods varying from ten days to two months after vaccination, the average time being twelve days. The initia- tory symptoms were variable. Sometimes just as the vaccine vesicle had healed, it be- came surrounded with a red, livid, and copper-colored areola, and ulcerated again. In other instances an ulcer would form on the cicatrix, and become covered with a scab, which in a few days would fall off to make room for another, and so on. In others the vaccine vesicles had an unhealthy appearance from the first, and were accompanied by a general eruption. The principal symptoms observed by the commission were mucous tubercles in the vicinity of the anus and on the genitals, ulcerations of the mucous membrane of the lips and fauces, engorgement of the lymphatic glands in the groin and neck, syphilitic skin diseases, alopecia, deep tubercles, gummy tumors, etc. In two subsequent papers, Dr. Pacchiotti* continues the detail of his investigations. On the eighth of February, twenty of the mothers or nurses of the forty-six children had become affected with symptoms of syphilis. He ascertained, too, from a revaccination of five of the children, that the occurrence of syphilis had not destroyed the efficacy of the first vaccination. But he also discovered the source of the infection. It appeared that a year and a. half previously a young unmarried woman had syphilis, and that she was syphilitic at the time Chiabrera was vaccinated. The woman was the mother of a child which had died syphilitic three months after its birth. After the death of the child she was in the habit of having her breasts drawn by the little Chiabrera, and gave * Sifilide trasmissaper Mezzo della Vaccinazione in Kivalta, presso Acqui. Gazetta della Associazone Med., Octobre 20, 1861. 510 Spurious Vaccination: Joseph Jones, M. D. him the clothes which her own child had wore. Another child nursed by this woman, but who was not vaccinated, also became syphilitic, and this child infected its mother just as little Chiabrera did his mother. It is therefore shown that the vaccine virus used on Chiabrera was not at fault, but that all tne other forty-five children were infected through the lymph taken from his arm. It is also shown that blood was on the lancet when several of the children were vaccinated. Dr. Pacchiotti, as the results of his investigations and those of the commission gives the following rules to be observed in vaccinating :- 2. Inquire into the state of the parent's health. 3. Take the lymph in preference from those children who havepassed the fourth or fifth month, as hereditary syphilis appears in general before that time. 4. Do not use lymph taken from a vesicle which has passed its eighth day, because on the ninth and tenth days the lymph becomes mixed with pus, which latter may be of an infectious character. 5. In taking the lymph, avoid hemorrhage, as there is less danger with lymph free from blood. 6. Do not vaccinate too many children with the same lymph. In consequence of the publication of the details of the lamentable affair at Rivalta, Dr. Marone concluded to relate the particulars of a similar event which occurred to him, and in regard to which he had thought it advisable to maintain a discreet silence. The particulars are given with sufficient fullness by Mr. Lee, whose excellent work I have already referred to se veral times. It seems that in November, 1856, Dr. Marone obtained some vaccine lymph, with which he vaccinated a number of children at Lupara. The lymph was contained in glass tubes, and Dr Marone noticed that it was mixed with a little blood, which affected its trans- parency. Of the number of children vaccinated with this lymph, notes were preserved in twenty-three cases. All these were affected with syphilis, and the disease likewise manifested itself among the mothers, nurses, and even the servants who were brought in contact with them. The symptoms with which the children were affected consisted chiefly of a syphilitic character, and subsequently of mucous tubercles at the angles of lips, around the anus, and on the vulva. The post-cervical and inguinal glands were enlarged, and there was emaciation, in degree varying with the severity of the syphilitic symptoms. Besides these cases, eleven nurses of the number who suckled these children gave the disease to eleven other children who were not vaccinated. In some of the cases the syphilitic phenomena continued till April, 1859. Dr. Marone draws the following conclusions from his experience : " That the syphilitic virus was really transmitted in the above recorded cases by means of vaccination. " That the children vaccinated suffered first, and became the means of transmitting the disease to others. " That the lymph used for the purpose of vaccination was impure, being mixed with blood, and that the result shows how necessary it is to abstain from using lymph of that description." In the sad tragedy enacted at Rivalta, a child named Chiabrera was vac- cinated; from him another child named Manzone was revaccinated, with forty-five other children. Syphilis was conveyed from Chiabrera to thirty- nine children, and communicated to his mother. The same disease was conveyed from Manzone to seven children and his wet nurse. Both vaccin- ifers were very ill, and one died three months after vaccination. Twenty nurses or mothers were known to have been similarly affected; in three cases the same disease was again communicated from the mothers to their husbands, and in three other cases the disease was communicated to other healthy children. The annexed diagram furnishes a view of the progress of this terrible disease previously unknown at Rivalta, a village containing not more than two thousand inhabitants: L'Uuion Medicate, Fer. Seme et Avril 3eme, 1862. Spurious Vaccination : Joseph Jones. M. 1). 511 GENEALOGICAL SCHEME OF THE RIVALTA SERIES OF VAC- CINO-SYPHILITIC INOCULATIONS. Tube of lymph from Acqui. Giovanni Chiabrera, First syphilitic vaccinifer; lymph bloody. Communicated the disease to I Louisa Meuzone, second vaccinifer, commu- nicated the disease to His mother infected by contagion. His wet nurse by contagion. To seven other children by vaccination. Thirty-nine other children vaccinated. • Communicated I the disease to Eighteen other mothers or nurses by contagion. Three other children, not vaccinated, by contagion. Three husbands from their wives by contagion. A series of cases similar to those which occurred at Rivalta, is related by Dr. Marone to have happened at Lupara. Dr. Marone ascribed the cause of the inoculation to the admixture of some blood with the vaccine lymph. Spurious Vaccination: Joseph Jones, M. D. 512 THE LUPARA SERIES OF VACCINO SYPHILITIC INOCULA- TIONS. This series occurred in 1856, but was kept secret until the Rivalta series had been made public, and the subject was undergoing discussion in medi- cal circles. M. Marone, in whose practice it occurred, and who published his account of it in 1862, (Impraziale de Florence, No. 5, 1862), states that he had not dared to make it known before, partly because of his own reputation, and partly because he feared that he should injure the cause of vaccination. Prior to 1856, syphilis had not been observed among the peasants of Lupara. The following is the summary furnished M. Depaul (De la Syphilis Vac- cinale, etc., p. 108): " M. Marone obtained some lymph in tubes from Campobasso; it was transparent, but tinged with blood. A large number of infants were vaccinated, and twenty three of them were infected with syphilis. He gives the names and ages, which last varied from live to ten months. All the children, as well as their parents, were healthy at the time of the vac- cination. The vaccinal eruption proceeded regularly up to the period of desiccation ; but then the dry crust began to soften anew, and when it fell off an ulcer with indurated base was found to occupy its seat. In other cases the dry crust remained adherent for an unusual length of time, and then fell off. At the expiration of a few days the cicatrix reopened and a sore was produced, having all the characters of an indurated chancre, and lasted a month or six weeks. In all the subjects indolent, non-suppurating, en- larged glands in the axilla were observed. In all of them also, toward the middle of January, the general symptoms of syphilis appeared-roseola, papules, pemphigus, mucous patches on the lips, mouth, anus and genitals, with inguinal and cervical glands engorged. The nurses were infected in their turn with indurated chancres on the breast; and at a latter period, that is, after five or eight weeks, they had also general symptoms, roseola, psoriasis, impetigo, mucous patches, etc. In their turn, also, the mothers imparted the disease to the fathers. M. Marone has since learned that the vaccine sent from Campobasso had been furnished by a little girl who died some time after vaccination from an eruptive affection, the character of which, however, has not been thor- oughly determined, Filomena Littorti, one of the twenty-three infected, served for new vac- cinations. Eleven infants were contaminated. First they had the charac- teristic primary affection, and then the consecutive phenomena. Mothers were again contaminated and they infected others. The disease having been at last recognized, a specific treatment was instituted ; but neverthe- less several of the children died. Eleven nurses, infected by the vacci- nated children, infected in their turn other children who were not vacci- nated, but who had been suckled by them. Several of the contaminated women, too, having fallen pregnant, were confined either prematurely or at full term of children, dead or living, but in every case bearing the marls of congenital syphilis. Spurious Vaccination : Joseph Jones, M. D. 513 GENEALOGICAL SCHEME OF VACCINO SYPHILITIC INOCULA- TIONS-LUP ARA SERIES. Tube of lymph taken from Campo basso, bloody, vaccinifer syphilitic. Filomena Littorti Vaccinated, infected. Twenty-two other children Vaccinated, infected. Nurses and mothers infected by contagion. Husbands infected by contagion. » Eleven children vaccinated, infected. Eleven Nurses infected by contagion. Several bore children infected with syphilis. Nurse, children infected by contagion. 514 Spurious Vaccination : Joseph Jones, M. I). THE BERGAME OR TORRE DE BUSI SERIES OF VACCINO- SYPHILITIC INOCULATIONS. This series was reported to the Conseil de Saute of Bergame, in 1862, by Dr. Adelasio, and is included in a paper read to the Congress of Lyons by M. Viennois. (De la Syphilis Vaccniale, etc., p. 303. Vaccination, Ed- ward Ballard, p, 337.) In the autumn of 1861, M. Quarenghi, a physician at Terre de Busi, vac- cinated Pierre Ferrari with lymph which had been preserved from the last season six months previously. The pustules were well developed, and pre- sented all their normal characteristics; so good were they that they were selected for the vaccination of the following season. In none of the sub- jects vaccinated at this time did the vaccination produce any morbid com- plications. It is to be observed that Ferrari died a year afterwards, it is said, of severe cough. The parents, when examined, in April, 1863, were found perfectly healthy, and they had a reputation of being moral. On May 8, 1862, Girolama Carenini, born of parents young and in perfect health, was vaccinated with the lymph of Ferrari, preserved in tubes. It does not appear in the statement that other children were vaccinated with the same lymph. It is stated by the mother of the children who were vac- cinated from Girolama that, although she was plump and of a good color, they noticed here and there upon her an eruption which, by the description given, was something like chicken-pox. The pustules from whicn the lymph was taken were fine, and the operation itself was performed with a needle, without any blood being drawn. When the child was examined subse- quently, live natural cicatrices were found, and there was nothing observed upon the body of the child. The parents were also carefully examined, and no traces of syphilitic affection was found upon them. All that they would admit was that the child had got an eruption from exposure to the sun. From this child, Girolama, six other children were vaccinated on the fifteenth of May (eighth day), and out of the six, five were infected with syphilis; but the vaccinator could not recollect whether the one which escaped infection was vaccinated first or last. In the case of the five in- fected, it is stated that the fall of the crusts was delayed, and that indur- ated ulcers, replaced them, which were followed by secondary symptoms, which were in no case typical, but left copper-colored stains. About the same time mucous patches appeared, and the mothers and nurses were in- fected, and imparted the disease to their husbands. The disease spread also by contagion to bi others, sisters, aunts and cousins. Altogether there is a record of twenty-three persons whom these children infected. One of the infected children, Joseph Valsecchi, aged five months, who infected altogether five other persons, was selected on May 23, for supplying lymph for the vaccination of five other children. It took upon all. In four of the five the healing of the pustules is said to have been rather tardy, and there was some alteration in the form of the cica- trices, and in two, there had occurred a cutaneous eruption, which got well of itself and did not affect the general health. One of these five, Charles Perruchini, served for the vaccination of three more children, who remained perfectly healthy, only one of them presenting the cicatrices a little elevated in the middle! These cases render it; evident that the two viruses, that of vaccinia and that of syphilis, at the same spot, may both, one after another be devel- oped there. Spurious Vaccinativn; Joseph Jones, M. D. 515 GENEALOGICAL SCHEME OF VACCINO-SYPHILITIC INOCU- TIONS-BERGAME OR TORRE DE BUSI SERIES. Preserved lymph from previous season. Pierre Ferrari (healthy). Girolama Carenini (doubtfully syphilitic). Joseph Valseechi vaccinated, infected. Four other children vaccinated, infected. Other children, mothers and nurses infected by contagion„ Husbands and children infected by contagion. Charles Perruchini vaccinated and remained healthy. Three other children vaccinated and remained healthy. M. Adelasio records an additional instance of infection that happened at Alm^, in the same province as Bergame, in September, 1863 . The account of this series is given by M. De Paul. (Bulletin de FAca- demic Imp. de Med., t. 32, No. 9, p. 201.) The first intimation of the occurrence was received by M. De Paul from Drs. Closmadeno and Denis, ot Auray, who accompanied M. De Paul in his visit to the place three months afterwards, and some additional facts were obtained by a member of the Academy, M. De Kergaradec. It appears that a mid wife, named Madame Frangoise Lemouel, an experienced vac- cinator, was the vaccinator of the series. She received, on May 20, 1866, some dry lymph from the Prefecture at Vannes, with which, on the next day, she vaccinated two children, in excellent health, named Mah6 and De Norcy. Mah^, when visited by M. De Paul, in August, was aged fifteen months, and had two ordinary cicatrices on the right arm and three on the left. A little indolent axillary adenitis existed on both sides. According to the account given by the family, he had been very ill during the five weeks succeeding the vaccination, and the pustules had suppurated during seven weeks. At the time of the visit, however, he was very well in health, although he had not undergone any specific treatment, and his mother had not suffered in any way. Jean Maire De Norcy, aged ten months, had, like the preceding child, been suckled by his mother. He was a large and fat child, and appeared in good health. He had on each arm two normal scars, only still a little VACCINO-SYPHILITIC INOCULATIONS-AURAY SERIES. 516 Spurious Vaccination : Joseph Jones, M. D. red. He also had, on both sides, a little indolent axillary adenitis, cervical adenitis, but no eruption or other affection of the skin. The mother had not suffered in health; but, according to her and her husband, the child had been very ill for at least two weeks after the vaccination, the pustules suppurating during all that time. An eruption, which they called "measles," had appeared three weeks after vaccination. DeNorcy was used as vaccinifer on the eighth day for the vaccination of Marie Frangoise Rosnaro. She presented on August 20, on each arm, six cicatrices, perfectly normal both in size and color: no trace of adenitis, cervical or axillary, and no eruption upon the skin. In a word this child was completely healthy, and in excellent general condition. Her mother, at the time of the visit,was in bed with rheumatismal pains,but M. DePaul could find nothing suspicious about her, and her nipples were free from dis ease. The father of the child also was found free from all syphilitic in- fection. This child Rosnaro, was selected as vaccinifer for the next batch of vac- cinations, of which more than eighty were made on the third, fourth and fifth of June. A list of forty-two children who suffered from syphilis, hav- ing been vaccinated from Rosnaro is given by M. DePaul; they suffered as usual, from primary ulcers at the seat of the vesicles, followed by various secondary affections. Two of them were used as vaccinifers, and their history is as follows : Boulaire, a girl aged seventeen months, when seen in August, had fallen away a great deal, and had ail the aspects of the syphilitic cachixia. There were two violet-colored cicatrices on the left arm, one upon a very manifestly indurated base, and three similar on the other arm; indolent axillary adenitis on both sides, a little posterior cervical adenitis and general ro- seola. The other, Anna Andran, aged nineteen months, was still suckled by her mother. There were three cicatrices of a violet tint, and reposing upon a somewhat indurated base on the left arm, and three on the right; axillary indolent adenitis on both sides, considerable on the right; axillary adenitis on both sides, considerable on the right, but less on the left; pos- terior cervical adenitis and general roseola. From these children, Boulaire and Andran, a large number of vaccina- tions were done, certainly less, however, than from Rosnaro. M. Depaul, however, only succeeded in seeing and examining seventeen of them, and three of these seem to have had nothing amiss with them after the vaccin- tion, but the rest exhibited phenomena similar to those observed in Bou- laire and Andran. Spurious Vaccination: Joseph Jones, 1). 517 GENEALOGICAL SCHEME OF VACCINO-SYPHILITIC INOCULA- TIONS-A URAY SERIES. Dry lymph from prefecture at Vannes Mahd vaccinated, infected. De Noicy vaccinated, infected. Marie F. Rosnaro, remained healthy. Boulaire vaccinated, infected. 40 other children vaccinated, infected. Anna Andran vaccinated, infected. 17 other children at least vaccinated, infected. In a western department of France (Morbihan), some villages have been the theatre of severe syphilitic symptoms in more than thirty children, who had all been vaccinated from a little girl with six punctures on each arm, the child herself having been operated upon from another who had been vaccinated from lymph preserved between two plates of glass ob- tained from the authorities. This misfortune created so much sensation, that the Academy of Medicine of Paris sent down two commissioners. Messrs. Henry Rogu and Depaul. These gentlemen presented their report to the Academy, and this important document ends with the following- considerations : 1. Several of the children whom we have examined were undoubtedly suffering from secondary syphilis. 2. We see no way of explaining this contamination but by vaccination, and we are confident that the cases we have seen were really syphilis en- gendered by vaccination. 3. As to the origin of the virus, it is very probable that the poison is traceable to the lymph, preserved between two pieces of glass, supplied by the authorities. As primary symptoms were also observed among the children M. Ricord begged the commissioners to insert that fact in their report, which these gentlemen agreed to do. Here we unfortunately have again repeated the sad occurrences which took place at Rivalta (Italy), a short time ago.- (Medical News and Library, 1867-from London Lancet, December 15, 1866.) The experience of the Confederate surgeons, establishing the possibility of communicating constitutional syphilis by vaccination ; the experiments of Waller, Pelpizzari and others, establishing the possibility of communi- cating secondary syphilis by inoculation of the blood from patients suffer- ing with the constitutional symptoms of this disease into healthy indivi- duals ; the cases collected by M. Viennois illustrating the transmission of syphilis by vaccination; and the unfortunate tragedy of Rivalta in the 518 Spurious Vaccination: Joseph Jones, M. D. district of Piedmont, Italy, where syphilis was previously unknown, (forty- six children ot various ages being simultaneously attacked with well- marked syphilis, proceeding in all cases which could be properly examined from the action of vaccine virus which produced chancre on the arms, fol- lowed by buboes in the axilla, and ail these children had been vaccinated directly or indirectly from a single child, who was subsequently proved to have contracted syphilis from a wet nurse, and these children transmitted the disease to a number of women, their wet nurses and mothers, and even to children who played and nursed with them, and the women so infected, in turn infected their husbands, and finally the disease yielded in all cases to the usual remedies for syphilis); these, and other similar facts, as the infection of the infant at the breast with secondary syphilis, and the com- munication of syphilis from the infant inheriting the disease from its mother or father, to a healthy nurse, all demonstrate the possibility of transmitting constitutional syphilis by inoculation of syphilitic blood, or vaccine virus, from patients poisoned with syphilis; and each such fact, of itself is sufficient to overthrow the dogma, that "primary syphilis alone is capable of being inoculated, and that secondary affections and the consti- tutional disease cannot be communicated from one individual to another, by any such means as vaccination, or the direct inoculation of syphilitic blood." Mr. Jonathan Hutchinson, narrates no less then four series of cases in which syphilis was communicated by vaccination, in volumes 54 and 56 of the Medico Chirurgical Transactions. Such is the importance of this sub- ject that we reproduce the observations of this distinguished surgeon, together with the report of the committee. REPORT ON VACCINO SYPHILIS, BY MR. JONATHAN HUTCH- INSON. INTRODUCTION. The following report contains the narrative of two separate series of cases. At the time of my first report (which was read before the society on April 25) only one of these had come under my notice, and at that time none of the patients in it had passed further than the primary stage. The discussion of this paper was adjourned for a fortnight, and during this interval the second series of cases had been brought under my notice. At the adjourned meeting I presented a report upon them, with also some further particulars regarding the first. A second appendix was presented to the society at its last meeting (June 27), bringing the narrative of both series up to that date. At that time many of the subjects of the second serieshad presented all the symptoms of constitutional syphilis in its most typical form of evolution, while none of those in the first had shown any constitutional phenomena which could be pronounced beyond dispute. This difference 1 was inclined to explain by reference to the fact that all in the first series had taken mercury, while none of those in the second had had any treatment. That this sugges- tion was correct has since been proved by the occurrence, in four of the first group, of secondary lesions of the most unmistakable kind. At the request of the Council, I have remodelled my original paper, with its two ap- pendices, and endeavored to bring all the facts of both series into a continuous narrative up to the present date. As regards the main points, the cases will, I believe, be found amply sufficient, but I am well aware that respecting some individual ones there is less detail than could have been wished. The peculiar conditions under which the inquiry has been conducted, the necessity for avoiding any steps likely to excite the alarm of the patients, and other circumstances to which I need not avert, have prevented me from keeping all the cases under such close observation as might for some purposes have been desirable. Spurious Vaccination ; Joseph Jones, M. J). 519 FIRST SERIES OF CASES. Synopsis.-Twelve Persons, mostly Young Adults, Vaccinated FROM A HEALTHY-LOOKING CHILD-SATISFACTORY PROGRESS OF the Vaccination in All-Indurated Chancres on the Arms of Ten of the Vaccinated in the Eighth Week-Treatment by Mercury in All-Rapid Disappearance of the Primary Sores-Constitutional Symptoms in Four of the Patients Five Months after the Vaccination-The Vaccinifer Show- ing Condylomata at the Age of Six Months. These patients came under my observation in the seventh week after vaccination. The suspicions of the vaccinator had been excited about a fortnight earlier, and he had ap- plied to the medical officers of the Privy Council on the subject. It was on the advice of Dr. Seaton that I was requested to see the patients and investigate the matter. It was with the permission, and, indeed, the suggestion, of the surgeon in whose practice it occurred (the father of the vaccinator) that the facts were made known to the pro- fession, and I cannot help expressing here my admiration of the moral courage with which this gentleman met a calamity which caused him the keenest distress, and of the anxiety which he displayed that the fullest use should be made of it for the public good. On February 7, 1871, a young surgeon in the neighborhood of London applied at a public vaccine station for a supply of lymph. He was offered a healthy-looking infant of four months old, then on the eighth day, and with five good vesicles. As he wished to vaccinate a considerable number of persons in the same house, he preferred to borrow the child rather than, as first proposed, to charge points, and an arrangement having bee n made with the mother, the child was at once taken to a private house where eleven young adults (shopmen and servants) were vaccinated from its arm. Four only of the five -vesicles were used, and the testimony, both of the operator and the child's mother, is that more than one, and possibly all, of them bled somewhat. Finally, a tube was charged, and with the lymph thus obtained, which is reported to have looked quite clear, two persons, a father and son, residing in another house, were immediately after- wards vaccinated. Thus we have a total of thirteen persons vaccinated. In all, ex- cepting one doubtful case, the vaccination was second to successful performance of the same in childhood. In the doubtful case both arms were done ; in all the others, only one arm. In all, excepting one instance, the vaccination took, and the vesicles are be- lieved to have gone through their usual stages. The patients were not under any close medical inspection afterwards, as none of them needed it, but it seems certain from their testimony that at the end of three weeks in all cases the scabs had fallen and small round cicatrices alone remained. At the end of a mouth, or from a month to five weeks, sev- eral of them applied for advice because the scars were again becoming sore, and at the expiration of two months it was quite certain that ten out of the twelve had indurated chancres on their arms. Many of them had more than one chancre, and about half had enlarged axillary glands, whilst two or three suffered from febrile disturbance with roseo- lous rash. I will append to this paper some brief notes of each of the cases, but it will be convenient for the present to restrict our attention to the general facts as to the group, and to turn next to the vaccinifer. FACTS AS TO THE VACCINIFER. The infant had been seen by the public vaccinator, whose patient she was, and by the surgeon who borrowed her, and to them, to her own mother, and to those who were vac- cinated arm to arm from her, she bore the aspect of general health. She was remarkably well grown, not in the least fretful, and had gone through the stages of her own vaccin- ation perfectly well. On April 5, two months after the vaccination, she was brought to my house for exami- nation. Her mother ridiculed the idea that she ailed anything. My attention was, however, at once attracted to a slight peculiarity in the tint of her skin and to the look of her face ; and although it was strongly denied that she had ever "snuffled," yet when she was made to cry I noticed a nasal twang which was Very suspicious. On having her stripped not a single spot of rash could be seen on the skin, but on inspecting the buttocks five small circular condylomata were discovered close to the anus, about which there could not be the slightest doubt. Her mother now admitted that she had been aware for a week of the existence of these sores, and had consulted a chemist about them, who had attributed them to teething. She said they had not been present more than a week, and repeated her assurance that the infant had rot seemed in the least ill. I could not find in the mother herself any indications of syphilitic tain^ nor obtain any 520 Spurious Vaccination: Joseph Jones, M. D. history of suspicious symptoms. She looked pale and cachectic, as if underfed. She had been married about eighteen months, and this was her first-born child. Her husband was a Frenchman and one of the Paris National Guard. 1 prescribed for the child some mercurial ointment, and was very desirous to keep it regularly under observation, but the mother would not bring it. A fortnight later (on April 19), I sought it out at home. The child then looked more ill than when I first saw it; the condylomata were in the same condition. It had no rash. Its head was enlarging, and its mother complained that it was wasting away. She had not used the ointment, alleging that its father would not allow her to do so. I was never able to see the father of the child, although I used every endeavor; he was evidently unwilling to be seen, and his wife positively refused to give me his address. About the existence of constitutional syphilis in the infant at the date of my examina- tion (two months after the vaccination) there could not be any doubt, and scarcely any as to the taint having been an inherited one. The vaccination spots presented perfectly healthy scars, and there was not the slightest reason for thinking that the disease was introduced into the child's system at the time of its vaccination. Had such been the case it is almost certain that it would now present symptoms similar to those in the patients vaccinated from it, i. e., primary sores on the arm. There could be only a week's difference in the stage of the disease in itself and in those vaccinated from it. Instead of this we find the child presenting the ordinary symptoms of hereditary syphilis,- condylomata, commencing marasmus, and hydrocephalus. That a syphilitic infant should appear to be in perfect health, as far as external appearance is concerned, is by no means unusual. "It is a mistake to suppose that syphilitic infants always present a withered 'old-man-like' aspect ; in many instances, although manifesting specific local symptoms, they may grow well and remain plump and fat." This occurs, I believe, with especial frequency when the child does not suffer from a skin eruption, and under such circumstances condylomata are not unfrequently the only symptom by which the exis- tence of the tint is proved. There can, I think, be little doubt that in this instance it was the blood, and not the vaccine lymph, which was the source of contamination. Two of those vaccinated wholly escaped, and as they were two of the youngest on the list, and mere boys, it is very improbable that their immunity was consequent upon their having had syphilis before. In those in whom chancres occurred, nearly half of the vac- cination punctures escaped. Now, I can see no other explanation of this immunity of some persons whilst others suffered, and immunity of some vaccination punctures in the same person in whom others were infected, than by supposing that the vaccine virus and the syphilitic virus were present in different fluids, and that it was possible to convey the one in all its vigor without necessarily conveying the other. It is important in ref- erence to this point to note that the two individuals who have escaped were the two who were first vaccinated, since it is not improbable that the lymph which first flowed was unmixed with blood. I may add also that the third person vaccinated was the only one in whom both arms were done, and that one of his arms escaped whilst the second suf- fered. The conjecture may be permitted that it was when obtaining lymph for this pa- tient's second arm that the operator first drew blood. The success or non-success of the vaccination, as vaccination, seems to have had noth- ing to do with the induration of the scars. Some scars in which the vaccination vesicle had not "taken " became indurated, whilst many punctures which did "take" escaped Owing to the patients not having been constantly under observation after the vaccina- tion, there is a little uncertainty as to which vesicles were well-developed and which failed, since we are obliged to rely to a considerable extent on the statements of the pa- tients themselves. There seems reason to believe that the vaccination failed in all the spots in only one individual, and he subsequently had several indurated chancres at the sites of puncture. The period of incubation seems to have been very nearly the same in all the cases. Two of the patients, a father and son, noticed that their scars were becoming irritable on the same day, the eighteenth of March, a little more than five weeks after the vaccination and between two and three weeks from the cicatrization of the vaccine vesicles. In all the patients the spots were characteristically indurated when I saw them on April 4th, exactly two months from the date of the vaccination. It would have been of great inter- est to science to have allowed half of this group of patients to abstain from any specific treatment, but, on the other hand, it appeared a paramount duty to adopt at once the very best means for their recovery. On the fourth of April, they all commenced, with one exception, the use of mercury in small doses, and the application of black-wash. In all the effect of the remedy upon the local sore was most definite. Many of them, at the date of my first paper, had become (after eleven days' treatment) quite soft; in the course of a week none of them displayed a degree of induration which would have been considered characteristic, and several which had been ulcerated were healed. One important feature in this group of cases is the remarkably close similarity which they bear to each other. In no single case was there any unusual degree of inflammation Spurious Vaccination: Joseph Jones, M. D. 521 of the vaccine vesicle. In all, as far as the patient's impressions go, the vesicles went through a usual course, and in all a period intervened, before the development of indu- ration, during which the cicatrix was quite healthy. As the patients were not at the time under medical inspection it is impossible to be accurate as to the precise day on which induration of too cicatrices began, but so far as can be ascertained there is reason to believe that nine out of the eleven began to complain of inflammation of the scar towards the end of the sixth week. At the end of the eighth week these nine patients had all reached the same stage. In the other two cases the progress was about a fort- night behind hand. The characters assumed by the sores were, with some minor differences as to size, etc., remarkably similar. Ulceration occurred in all excepting two patients, and in one of these two, out of three chancres, one did for a day or two ulcerate slightly. In one patient, a healthy, florid girl of seventeen, three glossy buttons of induration formed, but never passed into the ulcerative stage. It is not improbable, however, that they were arrested by the influence of mercury. Of those which ulcerated all took the circu- lar form, and in all, in the first instance, the discharge was stated to have been " glutin- ous." They had all been dressed with water dressing for several days before I saw them, and had much improved in appearance ; some of them were secreting healthy pus, but most of them still showed deficiency of secretion. None of the patients were out of health at the time of the occurrence, but they varied a good deal as to temperament and degree of vigor. There is no reason to think that any of them had suffered from syphilis before. About half of them complained that they had headache and felt more or less un- well during the time that the sores were indurating. One young man was confined to his bed with severe aching in the back, vomiting, and general febrile disturbance, all of which passed off in a few days. Most of them had more or less enlargement of the glands in the axilla, but none did it occasion any material pain or inconvenience. In all but one mercurial treatment was commenced on the fourth of April, two months after the vaccination, and about a fortnight after the scars had begun to indurate, and the uniformity with which all the sores altered in character under its exhibition was most re- markable. In the two cases in which ulceration had not occurred, the sores never passed beyond the stage of induration. The sores which were ulcerated when mercury was be- gun, in the course of about a week after its commencement, began to discharge healthy pus and to show florid granulations. Most of them, as already stated, were healed within a fortnight, and after three weeks the majority were quite sound and almost free from induration in all. In all cases the mercurial treatment consisted in two grains of gray powder given night and morning, with the application of black-wash under gutta- percha tissue. About half the patients showed slightly the influence of mercury on the mouth, but none were particularly inconvenienced. In one case the patient did not come under treatment till ten days after the others, having, indeed, in the first instance, consulted a homoeopath. In him the chancre attained a size twice that of the largest of the others. The following paragraphs are extracted without modification from my first report (April 25th), as I have special reasons for wishing to preserve their original form : "As already stated, none of the patients have as yet displayed any of the persistent forms of skin rash, nor have any shown positive ulceration of the tonsils. Several of them have had transitory, but definite, eruptions of roseola, and in several the skin of the abdomen and chest is slightly mottled. Three of them to-day display about the neck, face and shoulders, a few lichenoid spots of doubtful character. " It is to be feared that before long we shall have yet more definite evidences of consti- tutional contamination in some of these patients; but in the present stage I think we are quite justified in deducing the following conclusions from them : "1st. That the blood of a child suffering from inherited syphilis can, if inoculated, transmit the disease with great certainty. "2d. That the result of such inoculation of blood will he an indurated chancre- "3d. That if multiple inoculations be practiced, multiple chancres may be produced. "4th. That a period of incubation between the inoculation and the first occurrence of induration about the prick will occur, during which the part may appear perfectly healthy. "5th. That the period of incubation prior to the first specific induration will usually be about five weeks. "6th. That it is quite possible for vaccine lymph and blood to be transferred at the same time, and for each to produce its specific results, the effects of the syphilitic inocu- lation occurring subsequently to those of vaccination. "7th. That it is quite possible to vaccinate successfully from a syphilitic infant in the stage of utmost potency as regards its blood, without communicating syphilis." Tae following are some particulars respecting all the persons vaccinated in this series. The canes are arranged according to the order in which vaccination was performed; 522 Spurious Vaccination: Joseph Jones, M. D. No. 1. Master W , a youth of 14. He was'vaccinated in three places, all of which took, and went through their usual course. No ill consequences followed. On April 8, I examined his scars, and found them pale and quite normal. No. 2. W. N , set. 16. Only one of three spots took. No ill consequences followed. On the eighth of April. 1 found the scar of the vesicle which succeeded pale and healthy. No. 3. Mr. T. B , set. 20, a young man of fair complexion and somewhat delicate ap- pearance. As he had no scars of a former vaccination, it was thought best to vaccinate him on both arms. This was accordingly done in three places on each; in two or three on each arm the vaccination took and scabs resulted. He left the establishment shortly afterwards, and at the time of my first visit I did not see him. Having obtained his ad- dress, he was subsequently induced to come to my house. This was at the end of two months after vaccination. He had then one large ulceration with indurated edges and prominent granulations in the middle. This chancre, which was as large as a florin, had resulted from the confluence of two vaccination sores. He stated, as regards the vacci- nation, that the scabs fell within three weeks, and that the sores then seemed quite well. During the sixth week two of the spots on his left arm inflamed and became hard, and during the following week he had a good deal of febrile disturbance. He had an enlarged but softish gland in the left axilla. Mercurial treatment* was commenced in the end of the ninth week, and continued for two months. The chancre was quite healed in about a month, but the scar remained hard and dusky. He had a few suspicious lichen spots in the thirteenth week, but nothing characteristic. He never had any sore throat, and his general health remained throughout good. No. 4. Mary Jane L-, ait. 18. Three spots took and went through their stages. About six wrecks after the vaccination all three became inflamed, and they subsequently in- durated. On April 4, they were all indurated and superficially ulcerated (see sketch). There was an enlarged gland in the axilla, movable, but not very hard. During the pre- ceding week she had had some febrile disturbance. Mercurial treatment was commenced at the end of the eighth wreek, and was pushed to slightptyallism. She subsequently had some diarrhoea, and could not continue the mercury regularly. The chancres soon healed. In the thirteenth week she reported that she had a rash, which came and went, but I never saw anything positive. She was of strumous diathesis, and a large glandular mass in the neck, which had shown itself in the eighth week, persisted ever afterwards. In the middle of July, all specific treatment having been suspended for more than two months, she had a rash on the neck, fronts of arms, etc. It consisted of small, slightly scaly papules, of dusky color. She bad also symmetrical ulcers in thetonsils. Mercurial treatment was at once recommenced, and the rash soon began to fade. She was seen a few dayslater by the Society's Committee. On August 1, all traces of the rash had dis- appeared, but the ulcers in the tonsils persisted. On September 4 she was seen by Mr. Smith, secretary of the committee. At this date she had no rash, but the ulcers in the tonsils were still characteristic. No. 5. Caroline R , act. 24, stout and florid, was vaccinated in three spots, two of which took slightly and one well. After they had been for some time soundly healed, they relapsed about the twentieth of March and became red and irritable. She had at this time backache and flying pains. There was no swelling in the axilla. Mer- curial treatment was commenced at the end of the eighth week, and was pushed to de- cided salivation at the end of ten days, after which she took only one pill daily. At the end of a month the sores were all healed and the scars soft. She had on several occa- sions shown a few suspicious spots about the neck, but characteristic, and she had bad no sore throat Throughout she had complained a good deal of rheumatoid, etc., but she kept at her work. In the middle of July, at the same time as in the preceding case, a Characteristic rash attended with ulcers in the tonsils showed itself. Mercury, which had been suspended for two months, was resumed, and the rash soon disappeared. On the first of August she was quite well, with the exception of two or three spots which persisted on her neck. In the beginning of September, she had a relapse of ulce ration in one tonsil, but it was very slight. Her general health at this time was good. No. 6. Annie W , a florid, robust girl, aet. 17. The three vaccination spots took well, went through their normal stages, and healed. On April 4 (eighth week) the outer one showed slight induration, but was not in any degree ulcerated. The other two were reddened, but not at all hard. She said they were redder than they had been a week before, and that they were be- ginning to itch. She felt perfectly well. Three days later all three spots bad beco me slightly harder. None of them ever passed into open ulcers, and under mercurial treat- ment all induration disappeared in the course of three weeks. I believe she took the mercury afterwards very irregularly. No constitutional symptoms of any kind ever showed themselves. *By "mercurial treatment" throughout this paper may he understood the careful use of black-wash applied to the sore three times daily, ami protected with oil-silk, and the administration internally of two grains of gray powder twice or throe' times a day( according to circumstances. Spurious Vaccination: Joseph Jones, M. I). 523 No. 7. Lucy L , aet. 20. All the four vaccination punctures took well, and healed in due course. Nothing followed until the last days of March (beginning of eighth week), when the two inner spots became red, hard, and irritable. Ou April 4, the two outer scars still showed no sign of irritation, but the two inner ones were of a dusky red, somewhat raised, hard, and covered with thin epidermit scale. She complained that they felt sore. She had no other symptoms. No axillary bubo. In this case the chancres never ulcerated. Under the influence of mercury the induration disappeared. For a short time in the tenth week her tonsils were suspiciously inflamed, but she never had any rash. Cod liver oil was given most of the time, as she was in delicate health, and had a cough. No. 8. Mr. T , set. 20. Three vaccination places took, and the fourth did not. These scars remained quite sound until April 1, (eighth week). I saw him on April 8, and found one ot the scars inflamed, slightly hard at the base, and covered with a scab. The other three were quiet. He said that he felt well. There were some hard glands in the axilla. Mercury was at once commenced, and the sore, which had ulcerated, soon healed, The mercury never produced any ptyalism, and, excepting alittle headache, he felt quite well throughout. On the fifth of May the scar was sound, but still hard, and the glands in the axilla could still be felt. My notes mention "some small spots on neck and shoulders, fairly characteristic." The spots alluded to had disappeared at my next visit. He subsequently remained quite well until the middle of July, when he had a general roseolous eruption, which, however, disappeared in a week, when mercury was resumed* No. 9. Mr. H , set. 22, of fair complexion and delicate. Lymph was inserted at three places, and good vesicles developed at two. They all healed well, but about March 20 the inner one began to inflame. On April 4, when I saw him, he complained of hav- ing felt dull and heavy during the last week. The spot, which had inflamed, was raised and hard. On each tonsil there was a slightly marked patch of suspicious appearance, but not actually ulcerated. Mercury was commenced at this date. The chancre soon healed. The throat was slightly sore for about a week, and after this, excepting some complaint of frontal headache, he had no symptoms. On May 5, the chancre, which had been healed for more than a week, scarcely showed any induration. He felt quite well, and had no rash. Mercury was continued once a day for a month longer, and then disused. No. 10. Mr. W , set. 18, a rather delicate young man of dark complexion. He was vaccinated in three places, but none of them took. The inner one inflamed a little, but soon healed. On the twenty-second of March the inner one had again inflamed, and was becoming hard. On April 1 he felt ill, had backache, thirst and headache; and on the second a succession of slight rigors, with frequent sickness, came on. When I saw him, on April 4, he was in bed, on account of his backache and feverishness. There was an enlarged gland in his axilla, and the skin of his abdomen was a little mottled. Only one of the vaccination spots was affected, and it was exactly like those in the other cases-raised, hard and inflamed. Nothing could be seen on his tonsils. On April 8 he was much better, having lost his backache. He stated that on the seventh his body and face were covered with a blotchy rash, but, with the exception of a very slight mottling of the abdomen, this had disappeared on the eighth. On the fifth of May he had conges- tion of the right eye and circumorbital pain, but no positive irritis resulted. At the same time he had a lichenoid eruption on shoulders, arms and face, but as it was mixed with acne, to which he had been previously liable, it was not easy to be confident as to its character. On account of diarrhoea, the mercury had been omitted. No. 11. Mr. W , aged 45, a married gentleman, the father of a healthy family, and who had never, at any time, suffered from syphilis. He was vaccinated in three places, two of which took, went through their stages and cicatrized. The middle one of the three did not take. On or about March 18, all three inflamed, and when I saw them, on April 4, they were all indurated and ulcerated. He had no enlarged glands, nor any other symptom. On April 8, bis condition was much the same; he was taking mercury twice a day; the thermometer had been used regularly, and had not shown any elevation of temperature. On the 11th, the mercurial was omitted, as he was decidedly salivated. On the 14th, two of the sores were quite healed, and the other showed healthy granula- tions. After this he continued the liberal use of black-wash, but took no more mercury internally. From the 10th to the 24th, his mouth was slightly sore, and the mercurial odor was perceptible in his breath. Subsequently, he remained quite well as regards syphilitic symptoms until the latter end of June. We had sent him to the seaside, as he had not regained quite his ordinary strength. Whilst there he rapidly improved, but a copious eruption came out on his scrotum, thighs and scalp. He thought it had been excited by bathing. He returned to town three weeks later, and I saw him in the mid- dle of July. His scrotum, penis, and the inner sides of his thighs, were covered with flat- topped papules and patches of psoriasis of the most characteristic kind. He had no rash worth mention on other parts of his body, but bis scalp, which was bald, was covered with small patches of porrigo. Under the use of mercurial ointment and small doses of mercury internally, both the scrotum and scalp rapidly healed. 524 Spurious Vaccination: Joseph Jones, M. J). No. 12. Mr. W , Jr., set. 18, son of the subject of Case 11. He was of brown com- plexion and in tolerable health, but had been for years the subject of enlarged tonsils. Three out of four of his vaccination spots took, went through their usual stages, and healed. On the eighteenth of March, two of the three spots which had taken became a little inflamed and irritable, and during the next week they gradually indurated. He consulted his surgeon about them on the 24th, and on April 4 I saw him. The outermost of the three spots then showed a healthy cicatrix, but the inner and middle ones were inflamed, slightly raised, superficially ulcerated, and decidedly indurated at the base. He had no other symptoms. No definite glandular swelling. Mercury was prescribed, and under its influence the sores softened and healed. He was never positively salivated, but the occurrence of slight diarrhoea several times interrupted the mercurial course. Up to the present date he has not had any secondary symptoms, with the exception of a doubtful roseolous rash in the beginning of May. He took mercury in all tor about a month. SECOND SERIES OF CASES. Synopsis-Unquestionable Symptoms of Constitutional Syphilis in Nine Children who had been Vaccinated from the same Patient-Suspicious Symptoms in Six Others, and Entire Es- cape of a Certain Number-Vaccinifer a Fine Healthy Look- ing Child, but with Slight Local Symptoms Indicative of In- herited Syphilis. On May 5, 1871, two children were brought under the care of my friend and colleague, Mr. Warren Tay, on account of syphilitic eruptions. They were a brother and sister, aged respectively four years and sixteen months, and in both the syphilitic rash was very definite. In searching for its cause Mr. Tay found that about seven weeks pre- viously they had been vaccinated, and that the vaccination spots were at the present time unhealed, and with very decided induration at their bases. Mr. Tay now brought the cases to me, and I am indebted to his courtesy for permission to investigate the facts respecting them, and also for much help in doing so. We obtained from the mother of the children the name of the vaccinator, and on application to him were at once supplied with his vaccination register, and allowed to copy out the names and addresses of twen- ty-four other patients who had been vaccinated at the same time from the same vaccini- fer. Nothing had occurred to excite the vaccinator's suspicions, not a single one of this series having been taken back to him on account of the unhealthy condition of the arm. On making inquiries at the houses of the patients, however, we found that no fewer than nine had chancres on their arms, and that six were suffering from well-marked and copious syphilitic rash. Two of them had been under medical care for these symptoms, but not in a single case had the real nature of the disease been suspected. 1 will state teriatim the chief facts respecting these cases in this series, but it will be convenient first to mention those which concern the vaccinifer. HISTORY OF THE VACCINIFER. I visited the child at its home, the parents having no knowledge of the object of my visit. I found it a stout, well-grown male infant, of seven months old. Thus, he would be four months old at the date of vaccination. His mother stated that he was selected as a vaccinifer from amongst several others, as being the most healthy present, and that his vaccination spots were very good ones. They healed afterwards quite well, and the scars remained sound. He still looked healthy, and was well grown and cheerful, Ex- cepting a little transitory " tooth-rash," probably lichen, on the face, he had had no eruption. His head was decidedly large, and the fontanelles widely open. This had, his mother said, only been noticed for a few weeks. Latterly, several neighbors had 1old her that he had " water on the brain." I inquired as to snuffles, and she replied at once and emphatically, "Yes, he has snuffled a great deal." There was no trace of rash in the child's skin at the time of my visit, but at the anus was a single small condylomatous patch just healing. This had never attracted his mother's attention. He was said to have had thrush. His mother was a young and healihy-lookiug woman, who had been married two years. I did not, of course, ask her any direct questions. Immediately afterwards I called on the father of the child, and in answer to a direct question, he denied very positively having ever been the subject of venereal disease. On a subsequent occasion he submitted to a personal examination at my house, and we Spurious Vaccination : Joseph Jones, M. D. 525 failed to detect anything of a nature to cast suspicion on his denial. I saw the infant two or three times during the next six weeks, but no symptoms of a more definite char- acter showed themselves. The condyloma soon healed, and,with the exception of a slight tendency to hydrocephalus, the infant at the time I last saw it might have been regarded as a specimen of excellent health. As regards its condition at the date of vaccination, I may state that the parents of several of those vaccinated from it subsequently men- tioned to me its very healthy appearance. No trustworthy evidence could be obtaineil as to whether blood was or was not trans- ferred in the act of vaccination. The vaccinator, who is a very able and careful sur- geon, assured me that it was his custom to avoid blood-stained lymph, and several of the women who witnessed the proceedings told me that they did not observe any bleeding. In addition to the number of children vaccinated directly from its arms, some tubes were also charged with its lymph. These tubes, having been mixed with others, could not bo traced. The following are the particulars of all the patients vaccinated from this vaccinifer: No. 1. Arthur Edward T , set. 16 months, one of those first seen by Mr. Tay. He had been vaccinated for the first time on February 13, and five of the punctures were successful. The spots healed, but subsequently became hard. When he applied to Mr. Tay, in May, the scars were decidedly indurated, but not ulcerated; there were enlarged glands in the axilla; he had symmetrical ulcers on the tonsils, and a moderately copious rash of mixed roseola and psoriasis on the trunk and limbs. He was treated by mer- cury, and his symptoms slowly disappeared. No. 2. Elizabeth T , set. 4 years, sister of the above patient, She was vaccin- ated for the first time at the same date, and five of the punctures took well. They went their usual stages and healed. Afterwards the scars inflamed and ulcerated. When she was seen by Mr. Tay on May 5, she presented superficial sores with slightly indurated bases, and covered with a good deal of scab on the seat of the vaccination scars. The glands in the armpit were enlarged. She showed deep symmetrical ulcers on the tonsils nearly healed, and she had a copious rash of papules and small scaly patches on the body, the color, arrangement, and general appearances of which were most characteris- tic. This eruption was most symmetrical, and occurred especially on the back of the neck, the bend of each elbow, and the thighs and hips. Under mercurial treatment the chancres healed and the rash disappeared. No. 3. William C , set. 10 years. His was a second vaccination, but three of the punctures were followed by good vesicles. The vaccination spots were healed. He be- came the subject of rheumatoid pains, and had a copious rash over the whole body. When seen by me at the end of thirteenth week he had already been for several weeks under medical treatment. The vaccination chancres were just healed, but were still in- flamed, indurated, of a dusky red color, and covered with a dry papery scab. There was a gland as large as a walnut in the axilla. Each tonsil showed a well-marked gray-based ulceration. The rash, although evidently fading, was still abundant. It occurred sym- metrically on the neck, arras, trunk, and thighs. It was copious both on the backs and fronts of the arms, especially so on the outsides of the thighs. No. 4. Eliza T , rat. 14. a re-vaccination ; four or five of the punctures took ; the crusts fell in about a fortnight, and the scars remained sound for three weeks after- wards. Five weeks after vaccination they inflamed and became hard, and " a white skin came over them," but they never reulcerated. She had a painful lump in the armpit during the first week after vaccination, but it subsequently disappeared. During the twelfth week she first noticed an eruption on the chest, and at this time she had some cough and felt ill. as if she had taken cold. She was now placed under the care of a surgeon. I first saw heron May 17, the first day of the fourteenth week. At that date her vaccination spots were soundly healed, but the scars were dusky and covered with a papery scale ; none of them were indurated There was a slightly enlarged movable gland in tne armpit. She had symmetrical ulcers in the tonsils, with white borders. There was a sparing eruption of dusky lichen spots on her chest, chiefly below the nip- ples. There were a very few spots also on the chest and upper part of the neck, but none on the arms. Up to this date the patient had taken no mercury. No. 5. Maria H , rat. 3; a first vaccination; four punctures took. When visited in the fourteenth week she was found to have symmetrical ulcers in the tonsils, a slightly enlarged gland in the axilla, and an eruption of dusky psoriasis on the back and outer sides of the thighs. One of the vaccination scars was slightly indurated and dusky, with a thin papery scale ; the others were sound. The rash had only been noticed for a few days. The child had been for some time under the care of a surgeon for "inflamma- tion of the lungs." Up to this date the child had taken no mercury, and the treatment afterwards was conducted with extreme irregularity. On September 6, after an interval of two months, during which the child was lost sight of, it again came under care on account of condylomata at the anus. No. 6. Eliza M , rat. 17; revaccination, four places took. On May 16, end of the thirteenth week, the sores had only just healed, and their scars were slightly indurated, 526 Spurious Vaccination: Joseph. Jones, M. D. dusky, and covered with a dry scale. There was a slightly enlarged gland in the axilla, and she had a few scaly papules of dusky red color on the upper parts of the legs, but none elsewhere. She was florid and in good health. No. 7. This patient, Hannah S , was not found. No. 8. Elias W , set. 1 year; a first vaccination ; four punctures took. At the end of the twelfth week the sores were not healed, but were covered with porrigo scab. There was, however, no evidence of syphilis, and the child had been the subject of porrigo before vaccination. No. 9. Mary Anne O , aet. 11; a re-vaccination; five places took. The sores healed very slowly, and had only just closed at the end of the thirteenth week. Their scars were then dusky and red, with a thin dry scale and slight induration. There were a few dusky papules on the back of her neck, and one in front of the right elbow. The patches were either smooth and glossy, or covered with a thin scale. There was a large indolent swelling in the axilla. The child had not been out of health, and no treatment had been adopted. No. 10. Amelia O , set. 5 years; first vaccination; five places took. The sores healed in about five weeks, and the scars, when examined, at the end of the thirteenth week, were scaly and somewhat congested, but not indurated. The axillary glands were slightly enlarged. She had no eruption excepting some patches of dry eczema on the face. It is probable that she was not syphilitic. No. 11. Frances C , set. 4 years. I do not know more respecting this child than that the vaccination sores healed slowly, and that during the eighth week she had a rash of red pimples. She was not seen. No. 12. Alice C , set. years, sister of the above. Facts as to vaccination very similar. No. 13. Henry C , set. 8 years, brother of the above. Ou May 8, end of twelfth week, two or three of his vaccination spots were still unhealed and covered with porrigo scab. He was reported to have had a rash like his sisters, but neither in him nor them was there anything positively syphilitic. No. 14. Emily JuliaJ , set. 6; first vaccination; five places took. The places healed up at the end of the third week, but subsequently inflamed and reopened. 0*6 May 17, fourteenth week, the four lower spots were healed, but hard, glossy and dusky. The upper one was covered with a dry pus-scab, and its base, as large as a shilling, consid- erably indurated. She had an enlarged gland on the border of the axilla. The lower part of the chest, the whole of the abdomen and the back were covered with a lichenoid rash, and there were a few spots on the front of the elbows and on the thighs. The rash had probably been out about a fortnight. There were symmetrical ulcers in the tonsils, and she had been low-spirited and ailing. Mercurial treatment, one grain of gray pow- der twice a day, was commenced on the seventeenth. On the thirtieth, all traces of the rash and of the ulcers in the throat had disappeared, and she was in good health. The vaccination scars were still dusky and somewhat indurated. No. 15, Alfred J , tet. 9, and brother of the above. A first vaccination; five places took, and all healed during the third week. They afterwards inflamed and re- opened. In the beginning of the fourteenth week the scars were dusky, and there was an enlarged gland in the axilla. He had no rash of a positive character, but a suspicious mottling of the skin of the abdomen. No. 26 Annie J , tet. 3 years, sister of the above. All the four vaccination punc- tures healed well in the usual time, but subsequently reopened. An abscess formed in the armpit and broke. It was said that she had scarlet-fever soon after the vaccination. At the beginning of the fourteenth week all the sores were well healed, but the scars were slightly dusky. She had no rash. A young woman who was vaccinated from this child suffered no ill consequences. No. 17. Herbert D , aet. 5 years. In this case nothing unusual occurred. No. 18. Alfred George H--, set. 1 year. In this, as in the preceding, the vaccination was successful and without any, untoward remit. Both of them were first vaccinations, and in each some places took. No. 19. Eliza C , tet. 16 months In this instance the vaccination, first, was not successful, but nothing followed it. No. 20. Rose Jane B . tet. 3 months. I did not succeed in obtaining any informa- tion about the child, and the same remark applies to the three following cases. No. 21. Rosina T . No. 22. Daniel C . No. 23. John C . No 24. Caroline W-, set. 13 years; a revaccination; three places took. The sores never quite healed. About the fifth week they inflamed considerably. An abundant eruption appeared in the eighth week, and at the same time she failed in health, lost her appetite, and had pains in her limbs. When seen in the beginning of the fourteenth week she had a large open sore on her arm, with indurated edges, and prominent florid granulations in the center. This sore was formed by the coalescence of two ; a third was Spurious Vaccination: Joseph Jones, M. D. 527 healed, but indurated. She had symmetrical excavated ulcers in the tonsils, and en- larged glands in the axilla and back of the neck. She had a copious eruption of dusky flat-topped papules, occurring on almost all parts, excepting the face, and there was also a single, round, condylomatous patch on her tongue. A sketch of her arm was taken on May 19, and on the same date she was seen by many surgeons. Mercurial treatment was commenced on May 17. On May 31, she was rapidly getting well, the rash having almost disappeared and the sore being nearly healed. On June 21, the sore on the arm was healed, but its scar was dusky and covered with scales ; the only constitutional symptoms which remained were a few spots on the neck and the condyloma on the tongue. Subsequently this child got quite well, but she had to take mercury for more than two months. Towards the eud of July she was again under care for a small condyloma at the anus, but it soon disappeared under treatment. No. 25. Harriet W-, set, 15 years ; revaccination ; successful; no ill consequences. No. 29. John R-, set, 8 years. A successful first vaccination. No ill consequences. REPORT OF A SUB-COMMITTEE OF THE ROYAL MEDICAL AND CHIRURGICAL SOCIETY ON SOME OF THE CASES RELATED BY MR. HUTCHINSON IN THE PAPERS READ AT THE MEETINGS OF THE SOCIETY ON APRIL 25 AND MAY 9, 1871. Ou May 16, 1871, we saw, in company with Mr. Hutchinson, the following cases: The vaccinifer of the first series »f cases reported on April 25, and three persons (Cases 1, 2 and 3) who were vaccinated from this child. Vaccinifer (No. 1), female, set. 7 months. Had been used on February 7 for vaccinating the series of cases reported by Mr. Hutchinson on April 25. . This child is hydrocephalic; its head is much elongated and widened posteriorly ; the fontanelle is some- what more open than usual. It is pallid, but not unhealthy looking. There are five marks on the left arm from vaccination, which are quite healed. No eruption can be seen anywhere; the anus and genitals are quite clear, but the mother states that theHs were sores on the latter after vaccination. The glands in both groins are large, and can be very distinctly felt. The mother is rather pale, but looks healthy, and declares she has always been so. This is her first child. The following persons were vaccinated from the preceding case on February 7, and presented on May 16 the following features: Case 1.-Female, set. 17, No. 6 in Mr. Hutchinson's first series; a hearty, robust, plump girl, with bright color. Has, in a horizontal line, three vaccination marks on the left arm, the outer of which is not yet healed: the base of this sore is very slightly thickened. Mr. Hutchinson states that this girl has been living at home with her friends, and taking her medicine very irregularly. Case 2.-Male, set. 18, No. 10 in Mr.Hutchinson's first series. A. dark-complexioned, strumous-looking lad. Has three cicatrices on his left arm, which present nothing different from recent vaccination marks. There are a few scattered spots of acne on the shoulders and upper part of chest. Case 3.-Male, fet. 19. A healthy-looking lad. Has an unhealed ulcer, larger than a shilling piece, on the right arm, resulting from vaccination. The sore is covered by a crust, which is disposed to scale* slightly, and its base is leathery. Nothing else can be detected. Mr. Hutchinson states that this is the last case of the series which had been traced, and therefore treat- ment was commenced later than in the others. He also informs us that in the above three cases the vaccin- ation sores all healed, and subsequently ulceration set in at some of them, which continued to spread slowly until mercury was given, when in about ten days they commenced to heel. Black wash was applied locally. The same sequence of events had occurred in all the other cases of this group that we had seen. From the foregoing account, it will be seen that neither the vaccinifer, nor any of the three cases vaccin- ated from it, presented any symptoms of constitutional syphilis at the time of our examination. But, whilst in Case 2 the vaccination sores were healed, leaving nothing but the ordinary scars, in Cases 1 and 3 there were still open ulcers at the site of the vaccination fourteen weeks after its .performance. These ulcers were of a suspicious but not of a conclusive character. Of the second series of cases reported by Mr. Hutchinson we have seen the vaccinifer (No. 2), and three children (cases 4, 5, 6), who were vaccinated from it. Vaccinifer (No. 2), male, mt. 7 months. Had been used on February 13 for vaccinating the series of bases reported by Mr. Hutchinson on May 9, and brought under his observation by Mr. Warren Tay. This child is hydrocephalic; its head is universally enlarged ; the fontanelles are perhaps more open than usual. It is a pallid delicate-looking child, and has a slight herpetic eruption on the forehead, but is very lively. It breathes hard through the nose ; the mother says it has a cold and is teething. There is a small white scar at the anus, as if from an ulceration. The glands in both groins arc large and separate. On the right are five vaccination marks, which are healed. The mother is a bright-complexioned, healthy-looking woman and has never suffered from illness. This is her first child. She has never had a miscarriage, or discharge, or sore nipples. She says the child has been occasionally nursed by the landlady and her children She knows that one of these was ill, and was sent into the country for its health, and the mother had attended a hospital, but she never heard what was the matter with either of them. The father, set. 36, cabinet-maker, is a spare pale man, but apparently in health ; he has worked thirteen years in the same situation. He denies having had venereal disease of any kind, and readily submitted to examination without previous preparation: nothing could be found except some enlarged separate glands in the left groin, and a slight white scar on rhe inside of the cheek, opposite the left molar tooth. The only illnesses he has ever had are measles and whooping-cough. The following cases, which had been vaccinated from this vaccinifer on February 13, presented the ap- pearances detailed below on May 16, thirteen weeks afterwards : Case 4 -E. T.- , a girl, set. 4|, No. 2 in Mr. Hutchinson's second series of cases, a pallid, thin, strumous-looking child. On the right arm are two sores covered by crusts; the larger of these has a cir- cumscribed thickened base, which is superficial, and has a leathery feel when compressed; the surface of 528 Spurious Vaccination: Joseph Jones, M. D. this is disposed to scale. The glands in the corresponding axilla are enlarged. There is a seal}' eruption, consisting of small, circumscribed, for the most part circular, spots of a coffee-color at the back of the neck, the lower part of the abdomen, and the upper and outer part of the thighs, with a general scattered mottling of the trunk, on its anterior surface especially. The inguinal and post-cervical glands are large and indistinct, Both the tonsils are excavated, but not now ulcerated. Case 5.-A. E. T -, a bov, set. 18 months, male, No. 1 in Mr. Hutchinson's series, a fat, well-grown, hearty-looking child. On the left arm are two dusky-colored marks of vaccination, which are scaling on the surface, but not ulcerated; these have a thickened base, precisely similar to the preceding case. There is a general mottling of the trunk, which is fading, and a few small scaly spots, resembling those in the foregoing patient, scattered over the abdomen. The glands in each groin are very distinct. There is well-marked ulceration of both tonsils. The mother of these children is a healthy-looking woman; she has never suffered from illness ; a rigid cross-examination failed to elicit any history of previous syphilis in herself or either of her children. Cask 6.-W. C , set 10, a boy, No. 3 in Mr. Hutchinson's second series. This case was not reported at the Medical and Chirurgicai Society. A spare lad, but not unhealthy in appearance; his mother says he has lost much flesh lately. On the left arm the cicatrices of vaccination in infancy show plainly, and below these are two large sores covered with crusts with well-defiued, thickened, circumscribed bases', surrounded by a dusky areola. The glands in the corresponding axilla are enlarged. The inguinal and post-cervical glands are very perceptible to touch. There is a scaly eruption, for the most part in small annular patches, over the trunk and limbs, which is fading. On each tonsil is a deep, vertical ulcer, with a gray, unhealthy surface. The mother is a tall, healthy-looking woman ; she has never had any serious illness, and no history of previous syphilis in herself or her boy can be obtained. These three cases were vaccinated on the same day, and the ulcers resulting have never healed, but have slowly increased in size. There has been no treatment in any of them. In our opinion, these three cases present unequivocal evidence of constitutional syphilis, and we see no reason to doubt, from the appearances presented by the arms and from the history of the cases, that the disease had been conveyed by vaccination. As to the method in which vaccination was performed in these cases, and the character of the fluid inocu- lated, whether lymph, bloed, or both, we could obtain no satisfactory evidence; and with regard to this question, we may refer to the remarks made by Mr, Hutchinson in his paper, where such facts as could be elicited are recorded. [Signed] SAMUEL WILKS, WM. S. SAVORY. GEO. G. GASCOYEN, THOMAS SMITH. The following case was shown to Dr. Wilks by Mr. Hutchinson, on May 19, being one of the same series Case 4.-Female, set. 14. No. 4 in Mr. Hutchinson's second series. There was a round red sore on the arm, raised and granulating. Over the body and arms was a well-marked eruption of bronze-colored, scaly, raised, spots. The tonsils were swollen and slightly ulcerated. [Signed] SAMUEL WILKS. SECOND REPORT ON CASES OF VACCINO-SYPH1LIS. The following cases-belonging to the first series reported by Mr. Hutchinson on April 25-were seen by us on August 1, 1871, with Mr. Hutchinson and the medical attendant. They were vaccinated February 7 from vaccinifer No. 1; all have been, and still are, taking mercury; in one or two of them the gums are slightly reddened. They belong to the group first described in the previous report, so that eight of that series have been seen by the committee. Cask 1.-C. R , female, aet. 26. No. 5 in Mr. Hutchinson's first series. A plump, robust woman, with fresh color, is apparently in perfect health. On the left arm are the cicatrices of three vaccination marks, which are quite healed ; they are of a dusky brown color, but opinions differ as to whether they are darker than usual. There are three or four scattered spots of acne on the chest and back. The throat is sound. Mr. Hutchinson states that this patient has never had a characteristic rash. Case 2.-M. J. L--. female, a;t. 18, No. 4 in Mr. Hutchinson's first series. A pale, delicate-looking girl, but does not appear to be out of health. There are three cicatrices from vaccination in a horizontal line on the right arm, which are quite healed and somewhat dusky in color. The glands beneath and be- hind the angle of the left lower jaw are enlarged, forming a mass which extends over the parotid region and downward into the neck. There is one enlarged gland at the back of the neck on the right side. In eacli tonsil is a vertical, excavated, unhealthy-looking ulcer. At the bend of the right elbow is one red spot which is scaling, and another less distinct on the left arm at the same situation. Case 3.-C. T , male set. 20, No. 8 in Mr. Hutchinson's first series. A short but rather thick-set man of fair complexion ; looks, and says he is, quite well. On the left arm is one dusky-colored cicatrix of vac- cination, quite healed. A few small spots of acne are scattered over the upper part of the chest. The fauces are slightly congested, but there is no ulceration. Case 4.-H. H , male. a"t. 22.-No. 9 in Mr. Hutchinson's first series. A very fair man, with a par' ticularly clear, white skin and bright color, appears to be in perfect health. On the left arm is one dark- colored cicatrix from vaccination quite healed. The tonsils are large and red, but not ulcerated. In the centre of the back, below the scapula?, is a superficial patch somewhat coppery in color, desquamating slightly and fading off. Case 5.-W. W - , male, act. 18, No. 10 in Mr. Hutchinson's first series. A dark-complexioned man. spare and short; looks to be in general health. On the left arm is a deep-colored vaccination scar, not raised and quite healed. A few spots of acne are scattered over the shoulders. The fauces are a little congested, but not ulcerated. WM. S. SAVORY, GEORGE G GASCOYEN. On July 25, 1871, in company with Mr. Hutchinson and the gentleman who vaccinated the cases reported in the first series, I visited a large business establishment in order to examine several of the persons who had been vaccinated from vaccinifer No. 1, already reported on. No. 1.-J. L , a girl, a?t. 18, No. 4 in Mr. Hutchinson's first series. She showed three vaccine marks on one arm of a brownish color. On her body and arms there were a few, small, copper-colored, sealv blotches. I counted about a dozen in all. Her throat showed a deep excavated ulcer on the right tonsil, and Spurious Vaccination: Joseph Jones, M. D. 529 on the left two or three smaller and more superficial ulcers. The posterior cervical glands were enlarged, andon the left side under the jaw there was a circumscribed lymphatic gland much enlarged. No. 2.-C. K . acook, set. 24, No. 5 in Mr. Hutchinson's first series. On her arm there were two vac- cination marks ; these presented no remarkable appearance. On examining the neck and body there were seen a few very faint blotches. These would have been scarcely observed had they not been pointed out as the traces of what was said to have been a very evident eruption a few days before. There was nothing worthy of notice in this case. No. 3.-C T , a young man, set. 20, No. 8 in Mr. Hutchinson's first series. On one arm was the cica- trix of the vaccination, only one place having taken. This was of a red color, not |very dark, and felt hard when pinched from side to side. On the body and arms, and more especially on the abdomen, there was seen a general mottling or staining of the skin. The rash was slightly darker than the surrounding healthy surface, but was not raised. This was said to be the remains of a rash which was well marked a few days previously. No other symptoms. No. 4.-W. W , a young man, set. 18, No. 10 in Mr. Hutchinson's first series. He had a rash similar to that seen in the preceding case, but more defined. All over the body and shoulders there were distinctly defined blotches of a brownish color. These were evidently the remains of a fading rash, which was said to have been very distinct. The remains of a nearly healed ulcer in the throat were to be seen. No. 5 H. H , a young man, ast. 22, No. 9 in Mr. Hutchinson's first series. Covered with a rash re- sembling that seen in the preceding case, but still more marked. On passing the hand over the surface it felt somewhat raised as if disposed to be lichenous. The tonsils were much enlarged, red, and injected. This enlargement is probably of old standing. In the last three cases the eruption might be styled erythematous, while in this case it was disposed to be also papular. SAMUEL WILKS. These cases were seen by members of the committee on three separate occasions, which accounts for the/* differences in the several reports. When, however, the history of the patients is taken into consideration, and the symptoms presented by them at different periods of time, we can entertain but little doubt that they have been the subjects of con- stititutional syphilis. " SAMUEL WILKS, WM. S. SAVORY, GEO. G. GASCOYEN. On September 4, 1871, I saw a female, aet. 18, No. 4 of Mr. Hutchinson's first series. She had a large and tender swelling on the left side of the neck, beneath the angle of the jaw. There was a large excavated ul- cer on the right tonsil; there were a few faintly marked scaly copper-colored spots about the bend of the elbow. On the right arm wete three marks of vaccination of a light capper color. The patient complained of pains in her forehead. She seemed to be in good general health. THOMAS SMITH. I entirely agree with the above report, so far as it applies to this case, which was the only one of this group that I had an opportunity of examining. THOMAS SMITH. It will be observed that in the series of vaccinations reported by Mr. Hutchinson, not all those vaccination from the same children contracted syphilis. Mr. Hutchinson asks whether the practice followed by some vaccinators of allowing the vesicle to drain after its first contents have been exhausted, and using the weepings, necessarily mixed with the consti- tuents of the blood, for vaccination, may not account for the fact that those first vaccinated in the series escapad the contagion of syphilis. Evidence has been recorded to show that direct inoculation of blood from a syphilitic patient, may propagate primary syphilis. In order to avoid the catastrophe of communicating syphilis by vaccina- tion the following precautions have been recommended : 1. A clean lancet should be used. 2. In selecting lymph avoid first children, and those where family history is not well known to the physician. 3. Exercise the most scrupulous care in the performance of vaccination 4. The lymph should be taken from the vesicle not later than the eighth day. 5. The lymph only should be taken, and it should be free from the ad- mixture of blood or other secretions. 6. The lymph should be always taken from a healthy subject. 7. Whenever the surgeon is not fully and thoroughly satisfied of the humanized virus at his command, he should use virus derived directly from the cow. A graver question is involved than even the possibility of syphilitic in- fection, and one which threatens the safety of the entire community, namely the avoidance and even forcible resistance of all vaccination and the 530 Spurious Vaccina tion: Joseph Jones, M. D. defeat of all laws devised to protect the people from the ravages of small- pox, on account of the occurrence of such isolated cases, as those of the outbreak at Rivalta, and those reported by Mr. Hutchinson. The object of vaccination is to produce a real and absolute disease; and no precaution should be regarded as too minute and trifling which is cal- culated to insure the perfect attainment of this end ; the vaccine disease is not natural to man, it is planted on a soil foreign to its existence ; and there- fore it requires constant watchfulness and judicious cultivation to restrain all conditions or tendencies to deterioration. If under the best possible selection, and with the utmost care in cultiva- tion, the vaccine virus loses energy as its human transmissions become more and more numerous, it follows logically that, from time to time, new sources of primary supply should be sought for and opened. We have recorded the essential facts in the history of the cow-pox in various countries, and the medical profession should be always on the alert to discover spontaneous cow-pox, and should ever be ready to introduce new supplies of cow-pox matter. MODIFIED, OB LACTO-VARIOLOUS INOCULATION. Docter Basil Thiele, conceived the idea of mixing the virus of small-pox with milk; and in 1839 thus described this process. Small-pox matter was preserved for ten days between glasses, closed with wax; then after having diluted the matter with warm cow's milk, in- oculation was practiced as with ordinary vaccine. Dr. Thiele stated that the pustules obtained by means of this mixture are much better marked than in ordinary cases, but after about ten trans- missions, they end by presenting the characteristics of true vaccine when, however, care has been taken at each transmission to mix the virus of va- riola with a small quantity of milk taken directly from the cow. M. Bracuet, at Lyons, and Robert, at Marseilles, claimed to have per- formed similar experiments about the same time. The theory which underlies this practice appears to be, that variola has passed from man to the cow, and that during this passage it has undergone that modification which makes of it vaccine; the changes which takes place in the virus of variola can also be produced by a drop of milk in the open air. Dr. Descieux of Monfort l'Amanry, was attending a woman attacked with variola; three of her children were around her; two had not been vaccinated ; having at the time no vaccine matter, he made a mixture of milk and variolous matter, with which he inoculated the children making four incisions in each arm. The sores at the points of insertion occurred as usual and followed the course customarily observed ; but on the eighth day one of these children was taken with fever, and three days later from twenty-five to thirty elevations appeared over its body. The other child showed only the sores of insertion, besides which on the eleventh day, five or six supernumary points not far removed from the spots where the virus had been inserted made their appearance. Notwithstanding this second eruption, M. Descieux still remained un- decided ; on the eighth day he again took virus from the last child and transmitted it to three others. This inoculation cleared up all his doubts ; the newly inoculated being all three seized withtwell defined although mild attacks of variola. In one, the general eruption made its appearance on the seventh day, and in the two others on the eleventh. A midwife inoculated five infants with lacto-variolous matter; one of those three had a complete, though rather mild attack of variola, and the Spurious Vaccination: Joseph Jones, AL D. 531 two others who were barely two months old, had confluent small-pox, and their lives were in danger. A final proof pf the small efficacy which milk has in modifying variola, was afforded by the fact that these experiments gave rise to an epidemic of small-pox, which affected six vaccinated persons. The epidemic was not at an end, at the time when M. Descieux, wrote the preceding interesting details. M. Lanfranchi, sanitary officer at Guitera (Canton of Licaro District of Ajaccio), and physician to the Canton, had to contend, in 1854, with an epi- demic of confluent Variola, and conceived the idea of testing on his son a mixture of variolous matter and cream from cow's milk. The inoculation of this variolous matter and cream, resulted in the formation of a small scab which fell off or became indolent on the third or fourth day; when on the sixteenth or seventeenth day a well pronounced inflammation mani- fested itself at the incision; fever was kindled, and variolous pimples exhibi- ted themselves in divers places on the body, to the number of seven or eight. The fever was mild in character and the child recovered, six other children of the parish in which the fatal form of confluent variola was pre- vailing, were subjected to the same mode of inoculation, and like the son of M. Lanfranchi* had a benign type of varioloid. If the disease produced was varioloid, it was of course contagious, and no special advance was made on the old method of inoculation, which we have shown, was a comparative mild and harmless operation, often attended with but slight fever and few pustules, and causing death when properly treated in a proportion of not more than one in 600 cases.! Dr. C. H. Tebault, practiced "Modified Inoculation," or the engrafting of "equal parts of cow's milk and variolous matter taken from the pock in the vesicular stage," in October, 1864, upon some thirty Confederate soldiers in the Ocmulge Hospital, at Macon, Georgia. Dr. Tebault states that he "engrafted one soldier after another with the modified lymph, until thirty-odd had swelled the list of my experiments. Of thirty-five persons thus successfully inoculated, there only exhibited a few additional pocks, in no case more than six in addition to the seat of puncture." "Additional pocks" are not characteristic of the vaccine disease; but they are characteristic of inoculated small-pox. By the stringent orders of Surgeon General S. P. Moore, universal vac- cination had been and was practiced by the medical officers of the Con- federate Army ; and a military hospital subject to this rigid rule was not the most favorable position to test the contagious or non-contagious char- acter of the disease induced by "modified inoculation." The question was rendered still more complicated by the prevalence of small-pox in Macon, and the transferring of small-pox cases occurring amongst the Confererate troops to the small-pox encampment or tent hos- pital three miles from Vineville, under the direction of Assistant Surgeon L. Carter (at that time in the service of the Confederacy). Dr. Tebault states that " at the encampment above mentioned, this modi- fied inoculation was in general use, vaccination being entirely ignored. It was practiced, I believe, previous to the date of my own experiments, though unknown to me at the time. To this station all casee of variola or varioloid occurring at any of the post hospitals, were immediately sent for treatment." 'Revue Medico-Chirurgicale, No, 13, p. 543. tModified Inoculation by C. H. Tebault M. D. New Orleans Medical and Surgical Journal, July, 1866 532 Spurious Vaccination: Joseph Jones, M. D. Dr. Tebault, writing in 1866, expressed the hope that "Dr. Carter will find an early occasion to make known his very extended experience in the premises." , During my investigate ns upon hospital gangrene in the Confederate Army at the Empire Hospital, in 1864, I frequently visited the small-pox tent hospital on the outskirts of Vineville, and witnessed the devotion of Dr. Carter to the small-pox patients. I also conducted investigations upon the changes of the urine in variola and varioloid, and performed post mor- tem examinations. I also corresponded with Dr. Carter on the subject ot inoculation, after the war, and his testimony was to the effect, that he did not mix milk with the variolous matter, but employed the clear lymph from the pocks before the formation of pus. He appeared to attribute the mildness of the resulting variola to the employment of the variolous lymph before the formation of pus. As therefore there are facts to show that the»disease excited by inocu- lating the mixture of milk and variolous matter is essentially varioloid and capable of producing small-pox in the unprotected, we must therefore discard lacto-variolous, (modified) inoculation, for the same reasons that the profession has abandoned small-pox inoculation. Inoculation whether performed with pure small-pox matter, or with a mixture of variolous matter with cream or milk, induces a comparatively mild, and harmless disease to the individual; but it keeps alive the con- tagium of small-pox, and involves the health and lives of all unprotected persons in contact. RETRO-VACCINATION. Retro-vaccination, or the inoculation of cows with vaccine lymph that has been passed through the human body has been performed inumerable times by various observers, with very variable success. Ceely made various discriminative experiments, and found that whatever the source of the lymph, and whatever its age, if it were only good lymph, it succeeded equally often, and excited equally perfect and productive vesi- cles. The most conflicting statements, however, have been made, as to the facility with which cows may be infected with humanized lymph. Accord- ing to Heim, Hering and Hausmann, the experiment is only rarely suc- cessful, perhaps once out of ten or a dozen trials; Fiard met with but six or seven very doubtful successes in seventy experiments; Viborg and Retta were unable to succeed; on the other hand, Caque, at Rheims, Husson and Tenier, at Paris and Versailles, Sacco, at Milan, aud Hill wag, at Eutin, in the early days of vaccination, and more lately, Neumann, at Utrecht, Billing, at Stockholm fin 1832), Lentin, in Weimare in 1835), Prinz, at Dre sden (in 1838), Messrs. Ceely, Chauveau and others have succeeded. Dr. Edward C. Seaton in his valuable hand book of vaccination (p. 96) states that "when active lymph, such as passes from arm to arm with the greatest facility, is passed through the cow, and at once vaccinated back, it yet retains so much of its humanization that it is not able to fail like primary cow-lymph, but will be found also to have lost so much of its humanization that on its return to the human subject, it takes effect less kindly; papulation is usually retarded, and though the vaccination may obtain maturity at the ordinary average period, the completion of the maturation is often postponed. The vesicles are often smaller and the disease not really so well developed as the stock from which the lymph was derived. Two, three, four, or several removes are necessary to give it the same activity as it had before it was transferred. Spurious Vaccination : Joseph Jones, M. D. 533 VARIOLATION OF THE COW; OR PRODUCTION OF VACCINE BY INOCULATION WITH THE LYMPH OF HUMAN VA- RIOLA. The records of medicine establish beyond the shadow of a doubt that it is possible to produce vaccine in the cow by small-pox inoculation; but the operation is one of very considerable difficulty ; for one case in which the inoculation succeeds, it will fail in at least a dozen. The earliest efforts at the inoculation of the cow with small-pox failed ; Jenner himself did not perform any inoculations of cattle with the lymph of human variola; but as early as 1801, Gasner, of Gunsbury, by inocula- ting eleven cows with small-pox matter produced on one of them vesicles from which he was able to inoculate four children ; these children developed the ordinary phenomena of vaccination, and, with lymph from them, sev- enteen other children were similarly infected. In the same year (1801) Loy demonstrated the production of the vaccine disease in the cow from horse-pox (variolae equinae) Dr. McMichael stated to the Royal College of Physicians in 1828, that in Egypt it had been discovered by some medical men that fine, active vaccine virus might be produced by inoculating the cow with small-pox from the human body, and that several children had been vaccinated with complete success with the lymph thus generated. (Report of the Vaccination Sec- tion of Prov. Med. and Surg. Assoc.. 1839f p. 24.) Dr. Sunderland, of Barmen, in 1830, infected cows with the contagion of variola, by enveloping them in blankets taken from the bed of a. patient who had died of small-pox, and by hanging such blankets around the head ot the animal, so that they might breathe the effluvia arising from them. The result, according to the statement of Dr. Sunderland, was that in a few days the cows manifested the symptoms of cow-pox, and lymph taken from them produced genuine vaccine vesicles in the human subject. (Hufe- land's Journal, January, 1831.) Similar attempts to infect cows directly by the repetition of Sunder- land's experiments, as those of Mr. Geely, (1) in England, Mr. Macpherson, in India, and by Mr. Lamb, (2) at the veterinary school at Alfor, at Ber- lin, Weimar, Bugen Dresden. Kason, Ut retch and Stockholm, were unsuc- cessful. In 1836, Dr. Thiele, of Kasan, after similar fruitless attempts to infect the cow by inoculation of the variolous virus, succeeded in producing the genuine vaccine disease. From this Dr. Thiele raised a stock of lymph for human vaccinations, which at the time his account was published, had gone through seventy-five transmissions, and been employed in the vac- cination of more than 3000 subjects, many of whom had had their security against small-pox, tested by inoculation, and by the closest exposure to the infection of that disease. Dr. Thiele on various occasions afterwards succeeded in producing cow- pox in cows by variolous inoculation, and he attributes much of his latter success after so many early failures, to the precaution he takes in selecting the animals and in the mode of conducting the experiments. Dr. Thiele directs that the cows should be selected from four to six years old, which have recently calved, and if possible which have white or fair teats; they should be kept at a uniform temperature (15° R.); the inocula- tions should be performed at the base of the udder, out of the way of lick- ing, the udder being first shaven; and the variolous lymph should be in a clear limpid state. (1.) Trans. Prov. Med. and Surg. Assoc, vol, 8, p. 380. (2.) Trans. Med. and Phys. Society of Calcutta, vol. 6 and vol. 8. 534 Spurious Vaccination : Joseph Jones, M. D. Mr. Ceely, of Aylesburz, succeeded in February, 1839, in producing vaccine vesicles in two sturks, by inoculation with variolous lymph, and in thus establishing lymph-stocks which passed at once into extensive use, so that, in a few months, more than 2000 children had been vaccinated from them. In many of these subjects the protective value of the variola- vaccine lymph was tested by variolous inoculation by Mr. Ceely himself at various periods after the vaccination ; no constitutional affection was pro- duced thereby in any case and the local results resembled in every respect those recorded by Willan as having attended the test inoculations practiced in the early days of vaccinatien. The experiments were made on this oc- casion on three animals, and succeeded on two ; but he states that he had many times failed to variolate the cow at different seasons and under vary- ing circumstances by precisely, or pretty nearly the same modes of opera- ting as were successful in these instances. (Trans. Prov. Med. and Surg. Assoc, vol. 8, pp. 379-402.) Mr. Ceely draws especial attention to the fact, that the transmission of the disease, thus originated, from the cow to the human subject was a matter of some difficulty. Out of twenty punctures made from his first cow, only six vesicles were obtained, and they appeared tardily; he de- scribes the vaccine as fine and "pearl like." Out of sixteen punctures, again made from his second cow, only seven vesicles were obtained. The areola did not appear until from the tenth to the twelfth day. In this difficulty of transmission Mr. Ceftly recognises phenomena similar to those observable in vaccinating from primary or natural cow-pox. Subsequent human generations were effected more readily ; but-in some instances the difficulties were not completely overcome, even in the second removes. In the subsequent removes a marked experiment was observed in the develop- ment of the vesicles, and the active manifestation of the primary and sec- ondary symptoms were not less apparent than in the use of natural lymph under corresponding circumstances. Mr. Badcock, in December, 1840, "succeded in variolating a cow at Brighton, and deriving thereform a stock of genuine vaccine lymph. (A Detail of Experiments Confirming the Power of Cow-pox, etc). Mr. Badcock, from 1840 to 1867, has by inoculation of cows with the lymph of human variola raised stocks of vaccine lymph for use on no fewer than thirty-seven separate occasions. Every one of these thirty-seven suc- cessful experiments was the result of the direct inoculation of the animal with lymph taken from a human subject affected with variola; that no case is included in which lymph taken from a cow that had been variolated was used to inoculate other cows. Dr. Edward C. Seaton states that the lymph thus obtained by Mr. Bad- cock, is now (1868) largely employed; it has been supplied to many hundreds of practitioners, and very many thousands of children have been vaccinated with it. It is worthy of note, however, as illustrating the difficulty attendant on the production of vaccinia in the cow by variolous inoculation, that these thirty-seven successes represent but seven per cent of the experiments undertaken by Mr. Badcock ; to obtain them, he had to perform between five and six hundred variolous inoculations. There is a large amount of medical testimony to show that the lymph obtained by Mr. Badcock, is equal in activity and protective power to that of the early human generations from natural cow-pox. In 1852, Mr. Ceely's experiment were repeated in America by Dr. Adams, of Waltham, and Dr. Putnam, of Boston, who were able in consequence to "furnish the city and neighborhood of Boston with the vaccine matter used there since that period." Spurious Vaccination : Joseph Jones, M. D. 535 Dr. Leonhard Voight.* superintendent of vaccination at Hamburg, has recently succeded in inoculating cows with human small-pox matter ; his results, however, do not possess the value which attaches to those obtained by Thiel, Geely and Badcock, inasmuch as he performed vaccination sim- ultanous with the variolous inoculation. We cannot admit that the experiments at Lyons and those of M. Chau- veau, show "that it is a delusion to suppose that the inoculation of cows with variola has ever produced in that animal real cow pox ; for in fact it produces in the cow real small-pox and nothing else." The experiments have been too few to warrant this wide inference; at the same time it may be admitted that the local sores prodimed by the small-pox matter may have been capable of propagating small-pox when inoculated into the human being. We cannot admit that the hundreds of practitioners who in England have been using Geely's and Badcock's lymph, during the past forty-four years have not been vaccinating as they supposed, but actually uncon- sciously variolating their patients-that they have in fact been making their patients so many foci of variolous infection. ANIMAL VACCINATION. By the term "Animal Vaccination" is meant the employment for the vaccination of the human subject of the virus of cow-pox, as propagated upon a succession of calves or heifers, the original virus having been de- rived from pocks upon the cow spontaneously affected with the natural disease. The practice of animal vaccination, as now followed in Europe and vari- ous parts of America, originated with M. Negri, in Naples, who was the first to propagate natural cow-pox by successive vaccinations upon the heifer. Shortly after the introduction of vaccination into Italy, Troja, of Naples, conceived the idea of taking the vaccine virus from the vaccinated cow for the purpose of human vaccination, and the practice was preserved by him and his successors during many years for the benefit of the upper classes of society. On tiie death of Troja, Galbiati continued it, and, although in >810 these vaccinations were prescribed, yet, in the same year, several dis- tinguished statesmen availed themselves of this method for their own children. Galbiati was followed by M. Negri, who has had to bear the brunt of official opposition similar to that offered to his predecessors. It is to M. Negri that the world owes the practice of animal vaccination. Troja and Galbiati had both propagated in the heifers a vaccine disease implanted upon them originally from a human source. In fact, they practiced retro- vaccination, the result of which was propagated through a series of animals. At first, M Negri followed in their steps, and after a time ceased to prop- agate the virus thus obtained. During the thirty-four years preceding 1868, that he has presided over the animal vaccination in Naples, he has three times obtained a new supply of virus from cases of natural cow-pox, on each occasion maintaining the supply by an uninterrupted succession of inoculations from animal to animal. It is said that on two occasions M. Negri availed himself of natural cow- pox matter obtained in Italy, but that on a third occasion, in 1858, in which he renewed his supply, it was derived from London. * Vaccine and variola by Dr. Leonhard Voight, superintendent of vaccination at Hamburg. North Caro- lina Medical Journal, October, 1882 No. 10, p, 383-412.] 536 Spurious Vaccination : Joseph Jones, M. D. So thoroughly have all the prejudices against animal vaccination been cleared away, that M. Negri vaccinated from the heifer in the course of a year from 3,000 to 4,000 persons, a number nearly equal to the annual births that take place at Naples, and for several years past, M. Bima, of the Italian Army, has used the animal vaccine alone for his regimental vaccinations and for the pupils of- the military colleges. In 1864. M. Lanoix, a young French physician, visited Naples in order to study the practice of animal vaccination as pursued there, and on his re- turn brought back with him to Paris a calf, and in concert with M. Cham- bon, set up a private establishment for the propagation of the virus from calf to calf, and for the supply of animal vaccination in Paris. In his report on vaccination in France during 1864, M. Depaul, in the name of the Academie de M^decine, gave an account of the observations made in Paris upon this subject, and in February, 1866, the French Gov- ernment placed the sum of 6,000 francs at the disposal of the Academy for the purpose of experiment in the matter. A commission was appointed, the report of which was drawn up by M. Depaul, the Director of Vaccine. This report was favorable to the practice of animal vaccination. The commission, however, were much divided in opinion, and the Academy did not recommend that the practice should be adopted. At first, the virus used by the commission was that in use by MM. Lanoix and Chambon, and which they had previously obtained from Naples. But, after four trans missions of the virus had been made, a new source of virus from natural cow-pox was discovered at Baugency (Loiret), and then the use of the Neapolitan virus was abandoned, and this new and undoubted cow-pox virus alone employed. MM. Lanoix and Chambon also adopted the use of this virus to the ex- clusion of that they had before employed, and having in the autumn of the same year (1866) met with another case of natural small-pox at St. Mande, near Paris, they introduced this lymph also into their practice of animal vaccination. They saw no advantage in keeping these two lymphs dis- tinct, and the virus they have employed since 1866 to the present time is a mixture of the two natural sources discovered at Baugency and St. Mand^. Whatever the origin of the Neapolitan virus may have been, therefore, there can be no question that the inoculations made by the commission (after the first four) and that still made in Paris by MM. Lanoix and Chambon, were transmissions of the virus of a cow-pox of spontanous origin. • The establishment of these latter gentlemen, situated in the centre of Paris (Rue Marsillen), is a private one. They bear the entire expense of it and make a charge to practitioners and others to whom they supply virus. It is carried on like that of M. Negri, at Naples, as a private speculation. M. Lanoix, however, has, since the summer of 1865, held an appointment from M. Hassen, the Director de 1'Assistance Publique, for the weekly per- formance of vaccinations in the hospitals of Paris, from the calves which he inoculates week by week, and by far the larger part of the vaccinations and re-vaccinations performed in these establishments is done hi this way. From Paris the practice of animal vaccination has extended in many children. In February 1865, it was introduced into Brussels, by Dr. Warlomont. Animal vaccination has been inaugerated in Prussia by M. Prosoroff. The practice was introduced into Berlin, by M. Pissin, in June, 1865, and is still carried on there as a private speculation. It is also practiced in the same way in Vienna. Spurious Vaccinativn: Joseph Jones, M. D. 537 The practice of animal vaccination has been established in most of the capitols of Europe. Animal vaccination was inaugurated in the United States of America, in September, 1870, by Dr. Henry Austin Martin, M. D., of Boston, Massa- chusetts. (Boston Medical and Surgical Journal, October, 20, 1870). Dr. Manin received virus by letter from Professor Depaul, of Paris, and also directly through his agent, who returned from Paris, to Boston, on the twenty-third of September, 1870. The virus brought to America, by Dr. Martin was, from the 258th, 259th, and 2(>0th, animal of Depaul's series, beginning with the heifer at Beaugency. During the Franco-Prussian War and the siege of Paris, animal vaccination ceased. In November, 1873, Professor Depaul assures Dr. H. A. Martin, of Boston, that the virus car- ried from Paris by his agent in 1870, was'the last to have left the city, and that during the siege the " stock" was lost. The animal virus employed in Paris, since the Franco-Prussian War, is from other stock discovered since that of Beaugency. (Report on Animal Vaccination by Henry Austin Mar- tin. M. D. Reprint from the Transactions of the Amerioan Medical Asso- ciation, Boston, 1877, p. 17.) There are two principal grounds on which the practice of vaccination from the heifer has been advocated. 1. The opinion is widely though not universally held, that the results of vaccination from arm to arm are not such as they used to be during the earlier years of the practice of vaccination ; in fact, that by repeated human transmissions the virus has become weakened, and that the pocks produced by the introduction of lymph which has passed through a large number of human beings are not so fine or so perfect as those which result from the use of lymph derived recently from the cow. 2. The opinion that certain human diseases may be propagated together with the vaccine when vaccinations are performed from arm to arm. Galbiati adduced this belief as his reason for practicing vaccination from the cow ; arguing that on vaccinating the cow from the human subject, the vaccine disease alone would be communicated to her, the other morbid germs which might be introduced with it remaining without effect. He considered apparently that in practicing retro-vaccination he as it were filtered human vaccine from all human contamination. The publication within the last few years of alleged outbreaks of syphilis after and, as is stated, as the result of vaccination from diseased subjects, has greatly assisted to popularize the practice of animal vac- cination. They not only made a deep impression upon the public mind, but determined the adoption of the practice by some distinguished physi- cians. One of the highest living authorities on vaccination, M. Depaul, in a report to the Academie de Medecine, which attracted much attention and gave rise to much angry discussion, expressed his views upon this subject so decidedly that nothing was logically left him but to recommend the entire discontinuance of arm to arm vaccination and the use of animal vaccination as the only safe method of propagating the disease. Dr. Edward C. Seaton,* in his elaborate report on "so called animal vaccination, in France, Belgium and Holland, not only embodies the results of the careful investigation of Dr. Edward Ballard, upon the history and practice of animal vaccination in various parts of Europe, but also presents his own extended and elaborate personal observations upon European animal vaccine establishments. * Twelfth Report of the Medical Officer of the Privy Council, London, 1870 p. 171-191. 538 Spurious Vaccination : Joseph Jones, M. D. Dr. Seaton thus states his general conclusions. "So far, then, as evidence at present goes, it appears quite clear. (1). That the present degree of success attending the practice of animal vaccination is, in comparison with the success attending on vaccination from arm to arm, very low, and such as to constitute a most serious drawback to its use, supposing that other reasons were deemed sufficiently strong to render the introduction as an alternative proceeding desirable. (2). That much training and experience are indispensable to the attainment of even that degree of success which at present attends it. If practicted and most scrupulously careful vaccinatiors, anxiously endeavoring to niake the experiment successful and neglecting no known precaution for the purpose, find after two years experience that in vaccinating direct from the heifer to the arm, they are obliged in one eighth of these cases to vaccinate a second iime before they can produce any effect, and that in the end very nearly one fourth of the children who are infected in this way are sent out with that imperfect degree of protection against small- pox which is afforded by only one or two vaccine vesicles, it must I think be obvious that by the adoption of such a practice we should be greatly weakening our defense against small-pox. The chance to each individual of a full protection would be very largely diminished, and the danger to the community of spreading small-pox greatly increased by the num- ber of half protected persons thrown upon it. We should be going back in fact to the state of things which from other causes, existed a few years ago, and from which of late years so much has been done to rescue us. The large quantity of lymph which would be available at short notice in case of epi- demic outbreaks of small-pox, and of want of sufficient supply of ordinary lymph, has been nut forward as one of the great advantages which would attend the use of animal vaccination. Under the arrangement, however, now in force, in England, deficiency of lymph supply in any such emergency is a contingency which need not be thought of. And if there be a time when it is important that the lymph employed should be such as can be depended on for success, that it should strike home without failing, it is surely when persons brought for vaccination are in immediate danger of contracting small-pox." My experience with tire so called "bovine matter," used in New Orleans during the past four years, corresponds with the preceding statement of Dr. Seaton. The vaccine matter on points and quills and crusts furnished by the various vaccine farms of the United States, has not given universal sat- isfaction with the profession on account of the vast number of failures which have attended its use. These failures appear to have been referable to several causes, amongst which we may mention. 1. The abstraction of too much lymph from each vesicle in the cow. In other words the effort to supply a large demand and secure large pecu- niary profits with a limited supply of cow-pox matter. A careful examination of many of the points, revealed the fact that the '■''dried lymph" was largely composed of the constituents of the blood- many colored and colorless blood corpuscles-albumen and fibrin. This result was in many cases due totheusejof the bloody serum flowing from the injured pocks. 2. Carelessness in the selection of the animals vaccinated, and the failure to reject all in perfect pocks. 3. Changes in the infective powers of the cow-pox matter, consequent upon tune, heat and moisture. In the emergency of the small-pox of 1882 and 1883 in New Orleans, the sanitary officers of the Board of Health, of the State of Louisiana, have not been able to meet the issue by the employment of bovine matter alone. Out of over 12,000 (twelve thousand) gratuitous vaccinations performed by the president and sanitary officers of the Board of Health, of the State of Louisiana, during the past four years, no case of vaccinal syphilis, or of serious accident has been reported. The vast proportion of these vaccina- tions were perfor ned with humanized virus; and in all cases care was taken to select the matter from healthy subjects. Spurious Vaccination : Joseph Jones. M. I). 539 GENERAL CONCLUSIONS. From the vast mass of matter relating to vaccination, including the valuable works of Jenner, Pearson, and Woodville, recorded in the preced- ing pages, we may draw the fallowing practical conclusions : 1. The practice of vaccination carefully performed in accordance with the rules and regulations laid down by Edward Jenner, is as complete a protection from small-pox at the present time as in the early part of the nineteenth century. Millions of human beings have been preserved from the most loathsome and destructive of modern pestelinces during the past eighty-tour years by vaccination. 2. Without vaccination, the application of steam and navigation and land travel would have, during the past fifty years, scattered the seeds of small-pox in every part of the habitable globe. Fortunately for mankind, the great discovery of Jenner was announced before the application of steam, and the revolution of commercial and mili- tary operations. 3. The practice of vaccination has not impaired the strength and vigor of the human race, but on the contrary has added vastly to the sum of hu- man life, happiness and health. 4. Variolous inoculation which preceded vaccination, induced a compara- tively mild disease, and served as a protection against subsequent casual contagion ; but it multiplied the foci of contagion, kept perpetually alive the contagion of small-pox, and increased the fatal ravages of this disease amongst mankind. 5. Asa general rule, vaccination in itself is a harmless operation ; and whilst lessening the ravages of small-pox it has not had the effect of pro- moting the occurrence of other fatal maladies. 6. Whilst the protection afforded by vaccination against small-pox is neither unconstitutional nor unlimited, nevertheless many of the conditions upon which it depends are under the control of mankind For the majority of persons vaccinated in infancy and not unusually exposed to the conta- gion of variola, vaccination serves as a life-long protection against attacks of this disease. Experience however demonstrates that vaccination in in- fancy is not an absolute protection to all persons, against a future attack of small pox, and in a few persons, small-pox has happened within a very short period of time after vaccination. Neither is small-pox an absolute pro- tection to all persons against a recurrence of the disease, still the recurrence of small pox is a much more rare event than small-pox after vaccination. Post-vaccinal small-pox is most commonly met with in epidemic seasons, or under circumstances of unusual or prolonged exposure to contagion. 7. When vaccination fails to impart absolute protection against small- pox contagion, it nevertheless modifies, in the majority of instances, the course of the disease and renders it less fatal. The protection against the contagion of small-pox commences from the time that the areola is formed around the vaccine vesicle. 8. A large number of persons, vaccinated in infancy, reacquire, in the progress of years, the power of developing the virus of small-pox in their systems; the breaking of the protective power of infant vaccination is pro- gressive, and occurs most rapidly during the period of most active bodily growth from infancy to puberty; therefore, revaccination should be per- formed about the age of fifteen, or at any time when small-pox becomes prevalent. 9. The production of a perfect or imperfect vaccine disease, and the amount of protection imparted in vaccination, depends,-to a considerable extent, upon the adoption or neglect of certain precautions, having ref- 540 Spurious Vaccination : Joseph Jones, M. J). erence to the source from which the lymph is derived, to the subject vac- cinated, and circumstances and mode in which the operation is performed. The opinion is held by many that the vaccine disease is a less perfect and harmless protection against small-pox when produced by the inoculation of virus which has already undergone a large number of transmissions. Hence, it kn been concluded that post-vaccinal small-pox would occur more rareb, a lymph directly from the cow, or only a few removes, is em- ployed. Without doubt, the profession should, at all times, seek to discover cases of cow-pox, and recurrence to the original source of vaccine lymph should be had whenever practicable. 10. It is the duty of municipal, state and general governments to regu- late and foster a correct system of vaccination, and to institute ami sustain the necessary establishments for the supply to all citizens, regardless of condition or race, supplies of pure vaccine matter, derived from healthy hu- human beings, or from animals suffering with the natural cow-pox, or from a system of inoculation of cow-pox from heifer to heifer, or repeated and continuous successions: such general, municipal and state regulations should embrace the revaccination of all persons at the age of sixteen years, and such persons so vaccinated may be regarded as permanently protected. 11. Vaccination should be performed by experienced physicians, and with every attention and precaution as to the cleanliness of the operator and his instruments, and the freshness and purity of the vaccine matter. 12. The experience of the Confederate medical officers during the recent American civil war, 1861-1865, was most extensive and valuable, and tended to establish the necessity of the greatest care in the selection and mode of propagation of the vaccine disease. The Confederate struggle of 1861-1865 opened a new field in the history of vaccination, and the experience thus obtained led to greater care in the performance of the operation ; but the results of this war in liberating the African slaves of the Southern States, necessarily promoted the spread of small-pox amongst an ignorant and comparatively helpless class sud- denly elevated to the rights, responsibilities and license of almost absolute freedom. When the colored people of the South were under the direction and con- trol of their intelligent white masters, small-pox was almost unknown. It is apparent from the results of the prevalence of small-pox since the war, amongst the colored people, that the municipal police and state, govern- ments should take immediate steps to adopt all the necessary statutes, rules and regulations for the protection of the colored people and all other citizens, who neglect vaccination, from the ravages of small-pox. 13. When properly conducted, vaccination is never the medium of pro- pagating small-pox; nor is there any reason to believe that scrofula or tuberculosis has been transmitted by this process. At the same time virus should not be used from unhealty individuals. 14. In children hereditarily infected with syphilis, vaccination hastens the manifestation of the already existent, but latent, constitutional taint ; and many cases of so-called post-vaccinal syphilis are traceable to the excitation of the latent disease into such active manifestations as will render the vaccine matter capable of transmitting syphilis. When vaccination excites symptoms of constitutional syphilis, in one already infected with the poison of this disease, either by inheritance or preceding contagion-there is no chancre formed at the place ot the inser- tion of the vaccine virus. But when syphilis is communicated by the operation of vaccination, a chancre forms at the point where the vaccine Spurious Vaccination : Joseph Jones, M. D. 541 virus was introduced. This is a consideration of importance in tracing vaccine syphilis to its origin in any given series of cases. 15. The numerous cases recorded demonstrate that constitutional syphilis may be transmitted by contagion, by the abnormal secretions, by the blood and by the vaccine lymph. The vaccine virus and the syphilitic virus may both be inoculated at the same spot and by the same puncture of the vaccine lancet, and in such instance both viruses may take effect, the vaccine vesicle running naturaly through its several stages, and being succeeded by a chancre on the tall of the crusts. In the case of a vaccinifer constitutionally infected with syphilis, the danger of imparting syphilis with the vaccine is greatest when some of the blood of the vaccinifer has been accidentally mingled with the lymph obtained in puncturing the vesicle. At the same time in vaccinating, syphilis is not necessarily imparted to the person vaccinated. 16. Whilst the danger of syphilitic inoculation exists, when vaccination is carelessly performed; the practical bearing of this fact, however, has been greatly exaggerated; for in the hands of the most experienced physi- cians and surgeons in Europe and America, it is a danger practically so in- significant as not to detract materially from the va|ue of arm to arm vac- cination as a popuiar practice of general applicability. It is small-pox and not syphilis which threatens our people with destruc- tion, and which is perpetually knocking at their gates. In the Mississippi Valley especially with its teeming millions of rapidly increasing colored people-the danger from syphilitic inoculation under a properly conducted system of vaccination is almost inappreciable, whilst the danger of small- pox contagion is perpetual. Good physicians and wise legislators should guard the public welfare from the disastrous and murderous effects of the silly reasoning of illogical detractors, the exaggerated fears of the timid, or the subtle insinuations of selfish quackery. 17. Even if the danger of syphilitic contamination by vaccination was greater than it realty is, the adoption of the following precautions on the part of the vaccinator, the inoculation of syphilis in vaccination would be almost an impossible event. / (a). Lymph for vaccination should; as a rule, not be taken from an adult person. The chances are greater of meeting with a syphilitic vaccin- ifer in adults than in children. As a rule, lymph should not be taken from an infant under three months of age, since, if any syphilitic taint exists, it will, most probably, have de- clared itself during this period. (&). Before taking- lymph, a careful examination should be made of the surface of the body of the vaccinifer, of the mouth, genitals and anus, and every infant should be rejected which is manifestly out of health or presents an eruptive or morbid appearance anywhere. Inquiry should be made into the health of the parents and nurse and the least suspicion of syphilis in either or in the child itself should lead to the rejection of the vaccinifer. (c.) The hands and person and the lancet of the vaccinator should be scrupulously clean; the lancet should be strictly used for vaccination alone, and should never be employed for opening abscesses or other surgical operations; and the lancet should be cleansed and wiped perfectly clean after each vaccination. The use of an unwiped lancet, with the blood of the vaccinated child or person upon it, is not merely careless and un- 542 Spurious Vaccination; Joseph Jones, M. I). cleanly, but if syphilis exists in any one of the vaccinated, it may be transmitted through the blood on the point of the lancet. (d). In taking lymph, great caution should be observed in opening the vesicle, so as not to draw any blood ; should blood be accidently drawn, the vesicle should be abandoned, the lancet cleaned, and a new vesicle opened. Itisbest to abstain from vaccinating more children from one vesicle than can be conveniently done with the lymph supplied from the first punctures made into the surface. Lymph should not be taken from a vesicle after the areola is established, or from one irritated or damaged. Parents and nurses should be warned against moistening the punctured spots or vesi- cles, when they arise with saliva, and also against applying old linen to the spots unless previously well washed. (e). No child should be vaccinated whose parents or nurse are known at the time to be the subject of any primary or secondary manifestations of syphilitic disease, unless removed temporarily from the influence of con- tagion. The vaccinator should, at all times and under all circumstances, retain a due sense of the responsibility which attaches to the act of vaccination, as well as to all others of a professional character. JOSEPH JONES, M. D., 156 Washington street, Fourth District. New Orleans, La., March 4, 1884.