AS TO YELLOW FEVER

By John P. Wall, M. D.

(Reprinted from the Florida Times Union)

Florida State Library

Pg. 1/Column 1

AS TO YELLOW FEVER

By John P. Wall, M. D.

(Reprinted from the Florida Times Union)

Since the appearance of the yellow fever in

Tampa, I have noticed much in the Times-

Union, more or less reflecting upon me,

for having advised the people of Tampa to

get away from the place and thus escape the

fever. The authors of these criticisms have

shown themselves such ignoramuses – and

among them are some of your editorial staff

that I would hardly deign to notice them

but for the hope that it may prove of some

benefit in the future.

Yellow fever is one of the few diseases of

which little is positively and definitely

known as to its cause, nature (in a patha-

logical sense) and exact mode of propagation.

For at least a century, all these points have

been discussed: and whether we know much

more about them now than did our progeny-

tors of the last century is extremely prob-

lematical, as the literature of the disease

abundantly proves. Medical opinion has

been divided as to its origin, transmissibil-

ity and contagiousness from its first inva-

sion of the shores of North America.

It is generally conceded now, however,

that it is a xymotic disease, and that if it

does not have its origin on our shores in

filth, at least the latter is an essential factor to

the generation and propagation of its infect-

ing germs, or morbitic agent – the poison

that produces the disease. Why it should

take on a comparatively mild type in certain

seasons and manifest no marked disposition

to spread at times is another of its problems

for which we cannot account at the present

day.

The few facts that we do know about yel-

low fever are that it is a disease attended

with a considerable mortality, ranging from

10 to 75 per cent.; and that the atmosphere

of the city where it is prevailing sooner or

later becomes infected – poisoned with its

morbific agent; and that those susceptible

to the disease, i.e., not being acclimated, or

protected by a previous attack, will in all

probability take the disease. Experience has

taught us this much, at least.

Yellow fever, then, being a xymotic dis-

ease – having its origin probably in the filth

of the slave ship – the necessity and import-

tance of sanitation – to keep air, water and

Column 2

soil clean and pure, become too obvious to

the ordinary mind to require any arguments

to demonstrate.

The Technical Commission of the Inter-

national Conference of Rome (1885) says:

“The measures recommended against

cholera are, in general, applicable to yellow

fever and to other diseases of this class are: the sani-

tary improvement of cities and of vessels

sailing from infected ports, isolation of the sic,

and disinfection of infected or suspect-

ed articles and localities.”

If, then, the same sanitary prophylaxis

for cholera is good for yellow fever, why is

not the doctrine and practice of England in

regard to cholera applicable here to yellow

fever? Instead of a quarantine of detention,

except as to the sick, the English pursue the

following enlightened and common sense

plan, as set forth in an editorial in the

London Lancet of the 20 th of last August:

“All sick of cholera or diarrhea are dealt

with and isolated at our ports; but the

healthy are not herded with the sick, as is

done under quarantine. They (the healthy

are allowed to go where they will, provided

they submit to proper supervision, by giving

the address of the destination to which

they are traveling. These precautions form,

however, only the fringe of our system of

prevention. Our population, knowing that

the Government will no longer pretend to’

guarantee any measure of safety by drawing

a quarantine around the country, have of

their own free will set themselves to remove

from their midst those conditions under

which imported cholera can alone spread;

and, according to Dr. Thorne, they have,

apart from all Government dictation, spent

during the past ten years, byway of loan or

in current expenditure, over eighty millions

sterling for purposes mainly of a sanitary

character. When quarantining countries

can give evidence of their alternative sys-

tem by submitting to any such expenditure,

then it will be time enough for them to urge

Page 4/Column 1

That their system merits further considera-

tion at our hands. Up to this present time,

and this even in the Red Sea, which is looked

upon as the gateway by which cholera may

at any time enter Europe, the quarantine

stations are not even provided with the

common decencies of life.

“Since our system of medical inspection

came into operation it has gone hand-in-

hand with a steady sanitary progress far ex-

ceeding anything to be met with in those

European countries where the inhabitants

are led to believe that quarantine restric-

tions will be imposed for their protection in

times of danger; it has been accom-

panied by a great diminution of mor-

tality, and it has spared the inhabitants

of this country from an untold amount of

misery and destitution, which ‘is the more

burdensome because it follows in the track

of preventable disease and death.’ That our

system is complete we do not for a moment

pretend, and we would make no boast of

the fact that imported cholera has on each

occasion, for many years past, been at once

checked in this country; but we do hold

that the experience of the past few years has

once again indicated the uselessness of

quarantine and the great advantages of the

system we have substitute for it. Quaran-

tine has a blighting effect on sanitary pro-

gress; it leaves the people unprepared to

face a disease which disregards the antiquat-

ed barriers which nations have opposed to

its extension, and so it prepares the way for

panic. On the other hand, the steady pro-

gress of true measures of prevention tell us

to impart that feeling of confidence which is

of such value in the face of an impending

epidemic, and at the same time it promotes

the healthiness and well-being of the popu-

lation.”

In the same article the editor points out

that Spain, France, Italy and Algeria, rely-

ing on quarantine for protection, have suf-

fered from the ravages of cholera during the

European epidemic of 1884-87.

In the New York medical Record of the 29 th

ult. we find the following editorial article:

“ England’s commercial interests have al-

ways led her to doubt the need and distrust

the efficacy of quarantine. She has held

what she is pleased to consider the ‘common

sense view,’ viz: that , though theoretically

quarantine may succeed in keeping out

disease, practically, in any large count-

try, it amounts simply to an irrational

derangement of commerce. England

has long since, says the British Medical

Journal, discarded quarantine as a means of

preventing cholera, and now places her

trust in the security afforded by purity of

local surroundings – of soil, air and water

on land’ and a system of watchful medical

inspection at her seaports. The success of

this policy, continues our contemporary, has

been complete, and there are not wanting

indications that this success is exercising a

beneficial effect on public opinion abroad.

It is added that at the recent International

Hygienic Congress, at Vienna, opinion seemed

to be turning against quarantine. Italy and

Austria, in particular, are wavering in their

allegiance to the older methods.”

Column 2

If, then, a quarantine of detention for

Cholera has proven to be useless, it is cer-

tainly much more senseless for the preven-

tion of yellow fever. And on this point –

the detention of persons – let us quote some

of our latest text books on the practice of

medicine.

Flint, in his edition of 1884, page 1026,

says:

“Measures for the prevention of yellow

fever relate, 1 st, to the removal of local con-

ditions which favor the multiplication of

the disease-germs, 2d, to quarantine regula-

tions, and 3d, to disinfection. The first of

these three divisions embrace all that per-

tains to public and private hygiene. The

local conditions especially important as

auxiliary causes are unknown, and, there-

fore it can only be hoped that they will be

reached by rendering sanitary measures as

complete as practicable. But, be these

measures never so complete, they do not

make superfluous those of quarantine and

disinfection. The object of quarantine reg-

ulations is that the disease-germs shall not

be imported. To effect this object, either

there must be non-intercourse with places in

which the disease prevails, or all articles of

merchandise, clothing, etc., brought there-

from must be thoroughly disinfected. To

be efficient, quarantine regulations must in-

clued, not only vessels from infected ports,

but inland transportation by railroads and

other conveyances. There is no danger of

the disease being carried by the living body

after disinfection of the wearing apparel,

nor by the bodies of the dead. Detention of

the well or the sick is, therefore, a needless pre-

caution, except to prevent groundless popu-

lar apprehension. (Italics mine.) If impor-

tation of germs have taken place, the houses

with their surroundings in which cases

occur, should be instantly and completely

disinfected. The object now is to ‘stamp

out’ the disease. There is ground for the

belief that this object may be effected if

measures of disinfection be promptly and

thoroughly carried out.

“During the prevalence of an epidemic,

unacclimated persons should avoid going

within the infected areas, except under a

sense of duty, and they who are already with-

in the areas should leave it, unless there are

motives fro remaining which render the

risk of life justifiable and praiseworthy.”

Bartholow in his work on practice, says:
“A germ or germs are introduced. Ac-

cumulated filth, decomposing animal or

vegetable matters, bad or no drainage,

crowding and other hygienic evils are in-

dispensable to impart the necessary vitality.

Lodging thus in a suitable soil and with the

appropriate atmospherical conditions present

the disease grow and infect those in

the proper personal state to receive the

poison. * * * * * * * * * * * * * * * *

It is not by personal contact that the dis-

ease is communicated – in other words, it is

not a contagious, but an infectious disease,

and it is not against individuals that

quarantine restrictions should be enforced,

but against articles of clothing, bedding or

the like or against all fomites.”

Again, in the Lamb Prize Essay, for the

Page 5/Column 1

American Public Health Association, 1886,

on disinfection and individual prophylaxis

against infectious diseases, by Dr. Sternberg,

Surgeon United States Army, we find the

following on yellow fever.

“This disease, like cholera, is contracted

in infected localities, rather than by contact

with the sick. Indeed, it is rarely, if ever,

communicated directly by a sick person to

his attendants. In infected places the poison

seems to be given off from the soil, or from

collections of decomposing organic matter,

and we have no definite evidence that it is

communicated through the medium of food

or drinking water (as is the case with chol-

era.—W.) The history of epidemics of this

disease shows that when it obtains a lodg-

ment in a city or town which is an unsani-

tary condition, in southern latitudes and

during the summer months, it extends its

area and invades new localities similarly sit-

uated, until frost occurs, or at least until the

weather becomes comparatively cool in the

autumn. Those who remain in an infected

area, unless protected by a previous attack,

are almost certain to contract the disease,

and much less can be done in the way of in-

dividual prophylexis than in cholera. We

therefore advise all who can get out of the

way of this fatal disease to do so. * * * *

* * * This being the case, we repeat

our advice to all those whose duty does not

require them to stay on the field of batter,

to make an orderly retreat to some place of

safety.”

If such is the teaching of science, will

Medical men on county boards of health

please tell the public how much sense there

is in their fifteen days’ quarantine of indi-

viduals? Are they mere puppets of panic-

stricken communities, and by being thus,

prostitute science and professional propriety

to magnify their importance in the popular

estimation? Do they think it a light and

trivial thing to interrupt and prostrate all

business and bankrupt common carriers be-

cause these foolish measures of quarantine

are applauded by some scared editor who

has aroused by his ill-timed effusions on a

subject of which he knows but little, if any-

thing, a groundless popular apprehension?

Does it not occur to them that they are ex-

hibiting themselves to their professional

brethren who read and think, as being either

ignorant or dishonorable? Has it never oc-

curred to them that they are playing the role

of quacks and charlatans? Much would I

prefer to be shunned by the ignorant than

thus to sacrifice truth and science to the

clamor of a senseless scare, and forfeit my

own self-respect.

If, as is pretty well established, yellow

fever is not a contagious disease, and there

is no danger from the well, sick or dead,

from the infected locality – barring the

clothing and other effects – how is this thing

of confining a people to an infected locality

to be justified? Do they expect them to

remain and die like dumb brutes? If they

do, they are fools as well as inhuman mon-

sters. I told the people of Tampa that we

had yellow fever here, and advised them to

get out. I did this deliberately, and to pre-

vent reports being spread, I got the tele-

graph operators to refuse to receive any mes-

Page 5/Column 2

sages that would give the alarm to the out-

side world until I could give the people a

chance to get away. I know, Mr. editor,

that I was not endangering the lives of 250,-

000 people of the State as you charged, be-

cause I knew that the infection was only

here, and did not extend all over the State.

I was guided by the teachings of science,

and actuated by humanity and common

sense in my proceedings. The result has

vindicated my course and prevented an in-

crease of calamity that would, in all proba-

bility, have amounted to a holocaust in

sacrifice to life, to say nothing of the in-

creased suffering that would have naturally

resulted. I have nothing but the profound-

est contempt for the nincompoop M. Ds. and

pseudonymous liars of the “Viator” stripe

who write about fifteen days’ incubation and

a State Board of Health, and took occasion

to maliciously misrepresent me at a time

when I had neither time nor opportunity to

defend myself. The charge made by the
T imes-Union and “Viator” that I said I

would guarantee that “no yellow fever got

into Tampa,” is false in toto. When that

“M. D.” quoted Flint about the fifteen days’

incubation, why did he not quote him cor-

rectly? and why did he leave out what I have

quoted from the same author on quarantine?

Do you think that was either gentlemanly or

honest?

It is just such nincompoops as he who

impose false ideas upon the people, and ex-

cite groundless apprehensions of danger.

As for railroad quarantine, it is an absurd-

ity, and the disinfection practiced with sul-

phur at the quarantine station, was bout as

efficient as so much ordinary smoke. Yet, it

met the approval, according to their report,

of two or three of your Jacksonville physic-

cians, who reported that the fumigation at

Dr. Caldwell’s camp was satisfactory, and

was of two or four hours’ duration, I am not

certain which. Now, in the article on Dis-

infection, in Vol. 2, Reference handbook of

the Medical Sciences, by Dr. Sternberg (pre-

viously quoted), page 480, can be found this:

“Fumigation with sulphur dioxide has

been largely relied on for the disinfection of

clothing. To be effectual, the articles to be

disinfected must be freely exposed to its ac-

tion, in a well closed chamber, for a period

of at least twelve hours. Burn three pounds

of sulphur for each thousand cubic feet of

air space in the room.”

And, besides, it is only efficient for micro-

organisms in the absence of spores, being

quite impotent for the destruction of these

reproductive elements. Now, do they know

anything about the micro-organisms and

spores of yellow fever? and whether or not

these spores—the reproductive elements—

pertain to the yellow fever poison? And as

for the closeness of the fumigating chamber,

if it was the one I saw, it was wholly lacking,

and failed to confine the fumes of the sul-

phur, which were escaping in a manner to

remind one very much of a country smoke-

house in the bacon-curing season. And yet

this was satisfactory to the sanitarians and

hygienists of Duval county!

In the North Carolina Medical Journal of

November, 1878, Dr. R. A., Kinloch, of Charles-

Page 6/Column 1

ton, S. C., published an able article on “In-

land Quarantine,” from which I make the

following extracts:
“Can it be claimed that any ‘cordon sani-

taire’ has ever kept out cholera or yellow

fever when these diseases appear in an epi-

demic form? Has it ever prevented the ex-

tension of yellow fever from our seaport

towns into the interior? In years gone by,

and before we were as proud as we are now

of our scientific knowledge, we never enter-

tained the hope of land quarantine prevent-

ing the spread of the disease. And its dif-

fusion, or march into the interior, with rare

exceptions, never took place. In recent

times the boasted sanitarians have so im-

pressed the people with their importance

that much is now expected. Hence incon-

veniences, privations and sufferings have

followed, in a most alarming degree, the

futile attempt to carry out a supposed prin-

ciple in hygienic law. Upon a mere as-

sumption of the knowledge of the laws of a

disease (a knowledge possessed, as we said

above, no more now than it was a hundred

years ago), the most arbitrary regulations

have been attempted. People flying from a

stricken city have been driven back to die.

Refugees from a pestilence have been hunt-

ed down, and, upon the possibility of their

introducing disease (after they had already

been the carriers of the poison, if such thing

were possible,) have been shipped to the

nearest sister city, who in turn was expected

to protect herself. This selfish, arbitrary

and unreasonable action was practiced by

cities hundreds of miles away from the in-

fected regions, and in Northern as well as

Southern latitudes. The law of self-preser-

vation, as interpreted in other times, con-

tained no provision for a brother’s welfare.

We regret to say that in but few instances

has even a protest against this rule of con-

duct gone forth from the profession. The

people naturally cling to their superstitions.

They possessed but small capability of dis-

tinguishing between a real and an imaginary

danger. They were without that enlighten-

ment which should have reached them

through the profession, and they were ready

to reject the lessons of facts. Thus it was

that the futile scheme most generally con-

sisted in the attempted exclusion of persons.

While this action for the most part pertained

to municipalities, or improperly constituted

health boards, it at times received the sanc-

tion and support of regular health officers in

good repute.”

The late Dr. J. M. Wood worth, Supervis-

ing Surgeon-General of the Marine Hospital

Bureau, expressed the belief that absolute

quarantine by land is impracticable.

“It may be argued,” continues Dr. Kin-

loch, “that it is necessary to calm the public

mind, and that upon this ground quarantine

serves a useful purpose. We question if

public quietude is not thus often obtained

at too high a cost, and if the reaction, that

sooner or later must follow with the realiza-

tion of the truth, is not the evil the more to

be dreaded? We cannot, however, now dis-

cuss this point, but will parenthetically ex-

press our earnest conviction that truth is

ever the best policy, and should be diffused

Page 6 / Column 2

Everywhere under an enlightened and pro-

gressive medicine.

“With the vulgar, the question of exclud-

ing disease from communities is a simple

one, and their faith in the potency of human

power and scientific application of means is

stronger than it can be with our enlightened

profession. Quarantine and sanitation are

now, with the people, veritable supersti-

tions. They are worshipped and implicitly

relied upon. There are many, too, in the

profession equally credulous in this regard,

and some, though sufficiently informed,

culpable enough to encourage the vulgar

delusion, with the view, perhaps, of magni-

fying their own office.”

Much more might be adduced to show the

absurdity of inland quarantine if time and

space permitted, but I shall wait till after

frost to prove its futility in the present epi-

demic, when probably some more M. Ds.

will feel cheap as they may be surprised.

This is the first season that I have had any

experience with a County Health Board, and

I am so disgusted with its workings that it

will be my last. I have no hesitancy in de-

nouncing them as a curse to the State, and

trust that among the first acts of the next

Legislature will be the repeal of the statute

creating them. For funds they are made de-

pendent on the County Commissioners, and

are expected, without remuneration, except

in the way of abuse, to protect the public

health. Nor do I have any faith in a State

Board of health being able to accomplish

any more in preventing the introduction and

spread of epidemic diseases; and am fully

convinced that, as a member of the Constitu-

tional Convention of 1865, I made a mistake

in using my efforts to get a provision in the

Constitution providing for a State Board of

Health. Capable medical men cannot be

Expected to use their knowledge and give

their time to the public for nothing, while

incapable men would prove a blight and curse

to the commercial and industrial prosperity

of the State. So the best thing for the State

is to let her population know that they must

protect themselves after the English fashion

by removing from their midst those causes

which would give epidemic diseases a foot-

hold if introduced. Provision for medical

inspection at seaports, and the detention

and isolation of the sick with infectious and

contagious diseases, is all the quarantine

that a State law should provide for or per-

mit on the part of any seaport city or town.

Of course this should include disinfection

where necessary. Beyond this neither

State, county nor municipal law should ex-

tend; for, as already pointed out, reliance

on quarantine has a blighting effect on sani-

tary progress, which is our only hope for

the future health and prosperity of the
State.

In conclusion I may say that the fever did

not get in here through the Plant Line of

steamers, but was evidently smuggled in by

a small boat engage in contraband trade,

which, it seems, eluded the Custom house

officials as well as the quarantine authorit-

ties. The first cases occurred during my

absence from the State, and were among

Italians and fruit dealers, who were

Page 7/Column 1

doubtless the confederates of the smugglers

and receivers of the goods. This was evi-

dently the avenue by which the fever was

introduced in the character of fomites, as I

expect to be able to conclusively prove at

the proper time. The sanitary condition of

the city afforded a suitable soil for the lodge-

ment and propagation of the infectious

poison, and the result the world knows. It

is true that the city authorities disregarded

my warnings as to the neglected sanitary

condition of the city, and seemed to be in-

spired with a spirit of antagonism to me per-

sonally. Why this was so I leave to them to

explain if they can; and if the result has

been pleasing to them and the people of

Tampa, they are welcome to all the enjoy-

ment it affords.

I was absent from Tampa from the 2d to

the 25 th of September, and, from what has

since come to my knowledge. I presume

the first cases must have made their appear-

ance about the middle of September – in res-

idents and not in persons who had come

from either Key West or Havana. How-

ever, I was home but a few days before my

suspicions were aroused as to the presence of

yellow fever in the city, but these were not

confirmed till the first of the following

week, October 3d and 4 th. On the 22 nd of

September a case was reported, but the

physicians who saw it denied its being yel-

low fever. This was three days before my

return. I know now that if I had seen cer-

tain cases to which my attention was called

on the day I announced its presence to

the public, I should have been able to de-

clare its presence at least six days earlier

than I did.

However, the diagnosis of yellow fever is

not the easy thing that some suppose, nor

does a post mortem always demonstrate

the true character of the disease, as some doc-

tors believe. In 1870 the disease prevailed

on Governor’s Island a month before it was

recognized even by the Health Board of
New York who stated that “post mortem

examinations upon the bodies gave satisfac-

tory evidence that the disease was not yellow

fever.” But it was proved to be yellow fever

when seen by a medical man familiar with the

disease. There were 159 cases with 52 deaths.

But yet a whole month passed before the

true character of the disease was recognized

on an island in New York Harbor within

rifle shot of Castle Garden. Strange to say

there were a few cases in the city, but the

epidemic on the island did not extend to the

city. (N.Y. Medical Record for 1870 and

1871.) “The late Dr. Warren Stone, of New

Orleans, very justly remarked that when he

had seen one epidemic of yellow fever he

thought he knew all about it, but after see-

ing twenty epidemics he discovered that he

knew nothing about it.” Such was the lan-

guage of the late Dr. J.C. Nott, who gave it

as an illustration of how little really was

known of the disease by those who had had a

life-time opportunity, as it were, to study it.

The mortality here has been about 17 per

cent , among the whites, and hardly one per

cent, amount the blacks. There have been

up to date, 26 th of November, 72 deaths from

the fever, only 2 o which were colored –

one mulatto and one full blooded African.

Page 7/Column 2

The exact number of cases in Tampa and

vicinity is not known, as all were not re-

ported, and some were so mild as not to re-

quire the services of a physician; but I

should estimate the number at about 400

whites and possibly 200 negroes. Among

the latter the cases were, as a rule, of mild

type. Not an old resident who had had the

fever in previous epidemic in Tampa, had

it this time; nor did any one suffer from a

second attack during the epidemic. The

whole adult Cuban population was acclimate-

ed and escaped. Nor does this immunity

conferred by one attack of the disease, de-

pend on the severity of the attack – a mild

attack being as protective as a severe one.

With children it is generally mild – the

younger the child the milder the fever – so

that is a great mistake to remove small

children beyond the infection if it is expect-

ed the place where it is epidemic or any oth-

er Southern city, is to be their homes, i.e.,

provided the parents are acclimated so as to

run no risk themselves.

There is another prevalent idea, enter-

tained, too, by some very competent men,

the erroneousness of which I desire to point

out; and that is in case of an epidemic appear-

ing in a city, all that is necessary is to re-

move the unacclimated into camps some dis-

tance in the country. This is impracticable

in the first place, because of the lack of con-

veniences in the shape of houses or even

tents for the protection of the people from

the inclemencies of the weather, and in the

second place, even if such camp was estab-

lished, communication with the infected

place for some time at least, would from the

very nature of things, be kept up, so that

the infection would be sure to invade the

camp before arrangements for getting sup-

plies and other necessaries from uninfected

places could be made. In this way the fever

was carried out into families several miles

from here into the country during the pres-

ent epidemic. According to Dr. J. C. Nott,

who moved his family from Mobile into the

piney woods seven miles from the city, in

1856, even before the fever reached Mobile

from New Orleans, the fever followed his

family out of the city and he lost four of his

children. (N. Y. Medical Record, 1871.)

But there are other things which render

this camp business wholly impractical:

1 st, getting the people to leave their homes

when there are so many medical ignora-

muses and wiseacres who will sear to the

last that it is not yellow fever; and 2d, the

impossibility of keeping hem there if they

should feel disposed to have communication

with the infected area. It is very easy for

theorists and inexperienced people to say

what ought or should be done, but carry-

ing out their suggestions is altogether a very

different thing, unless one was an autocrat

with a standing army toe execute his orders.

It is one thing to preach, and another to

practice. And it is for this reason that a

State Board of Health would be as literally

helpless in controlling the spread of an epi-

demic as any other authority now existing.

The success of the National Board in 1879

was not encouraging and proved a failure.

John P. Wall, M.D.

November 28th.