« ForrigeFortsett »
nutrition to feed upon the solids of the body also; and thus conduce to a healthy condition of the blood. In highly vitiated conditions of the fluids, we cannot expect healthy secretions. The improvement in the nature of the secretion will, as a general rule, increase as the blood is freed from its morbid elements, or as it approaches its healthy constitution. If it be admitted, as in the present state of our knowledge appears reasonable, that the cause of this fever is a poisoned or infected state of the atmosphere, primarily acting on the blood, and finally rendering it putrid in the fatal cases, or utterly inadequate to excite the healthy stimulation of any organ, the necessity of an early attempt to reorganize this fluid, or to arrest the farther process of vitiation, must be apparent to all who reflect on the subject. As a means promotive of this great object, blood-letting, in the epidemics of Opelousas, appeared to me most instrumental. Its other effects, however important, such as the relief from pain, the prevention of local congestions, &c., were consi. dered as of secondary utility. During the whole treatment, the avoid. ance of medicines where the effect was irritation or congestion of the in. testinal mucous membrane, was shown to be proper in all cases, for the results were always disastrous, if not fatal, even when the mildest purgative was followed, as frequently happened, by hypercatharsis.
The different modes of treatment recommended by different writers afford not only evidence that the disease presents itself in modified forms, but also that the true nature of its cause, and of the various de. rangements of tissues which ensue, are but little understood. By some its cause is considered native, and the disease regarded as endemic in its character; by others, it is thought to depend on a foreign cause, the introduction of which may be prevented by proper civil regulations. Some highly recommend mercurials in its treatment; others condemn them, without appeal. Blood-letting, advocated as the most important of all measures by one class, is very sparingly resorted to, or entirely condemned by the other class. In fact, the young physician, in his first intercourse with the disease, finds himself more embarrassed than if he had never heard of it. The conflicting opinions of its pathology and treatment place him in a position of incertitude, the horrors of which are by no means softened by the fatal results which too frequently attend his enthusiastic efforts to uphold the credit of his profession, and to rescue his friends and fellow-beings from an untimely grave.
In the epidemic of 1839, the mortality attributable to the disease was very inconsiderable. It is impossible to arrive at a perfectly accurate estimate, the difficulty being in ascertaining the exact number of cases. I am disposed to place it at about 4 per centum; and it should be observed, that amongst the fatal cases, there were many individuals far advanced in years, and whose recovery would have been doubtful from any kind of violent disease.
In 1837, the mortality, particularly in the commencement of the epi. demic, was much greater, in consequence, no doubt, of the nature of the disease being for a considerable time unknown both to the physicians and the people,- to the absence of early medical aid, and to the injuri. ous effects of frequently-repeated doses of calomel. In this year, the first fifteen cases, I believe, without an exception, resulted in death; but, happily, the subsequent mortality was not great.
It is one of the admitted facts, and, indeed, one of the proofs of this fever, that the chances of cure diminished in proportion to the length of time elapsing before proper aid is obtained; hence it is the duty of all to impress upen the people the indispensable necessity of early medical aid, and to discourage the use of quack medicines, so criminally scattered over the land by charlatans, huckstering pedlars, picayune storekeepers, and even by regular druggists.
It is to be presumed that the fevers of the country would differ in their type from those of the city; but there is no more reason to antici. pate the continuance of the same type or form in the one situation than in the other; and as in subsequent epidemics, a form of the disease differing from those which preceded may demand a different treatment, the importance of paying particular attention to the subject cannot too often be impressed on the attention of physicians.
The epidemics of Opelousas were preceded by fatal cases of fever with black vomit, in individuals who fell sick immediately on, or a short time after, their arrival from the city of New Orleans. From this circumstance, the belief is generally entertained, that the disease was imported from the city. Professor Carpenter, in his pamphlet in favor of quarantine laws, has mentioned an instance occurring many years ago, the authenticity of which is fully supported, of the importation of yellow fever into this village directly from New Orleans, through the medium of fomites. A keel-boat, with goods from the city, then afflicted with yellow fever, arrived at the nearest port to Opelousas, now the town of Washington. The goods belonged to two merchants of Opelousas, one of whom, at the instigation of the chairman of the town council, opened and ventilated his goods before bringing them to his store; but the other brought his goods directly to town, and of four individuals present at their opening, three soon fell sick and died, with all the symptoms of the fever, and the fourth narrowly escaped with his life. In consequence of the low stage of water in the interior bayous, the communication between this place and New Orleans during the summer and fall is frequently stopped ; and it is an exception to the general rule, if goods are ever imported at this season of the year from the city.
In 1837, the disease commenced at a particular spot, in a house adjoining the hotel, in which the subject, a Frenchman, from New Orleans, had died. Here seemed to be the focus of the infection, which did not appear to extend beyond well-defined limits. All residing within these limits, Creoles and foreigners, who had not previously had the disease, contracted it; and the instances were very few of any in the habit of frequenting this part of the town escaping the fever.
In 1839, the disease pervaded indiscriminately every part of town. No one portion - scarcely a family was exempt. People from the country either year incurred great risk in visiting town. Many most estimable individuals, after a visit to the place, both years, were, on their return home, stricken with the disease, and, with few exceptions, they died with black vomit.
In no instance am I aware of the disease being communicated by contagion in the country; and it must be observed, that among our creole inhabitants, more than common solicitude in the welfare of one's
neighbours is evinced, by crowds of visiters calling to inquire, and to offer aid in case of necessity. In many of the country cases of the fever, there had, to my knowledge, been no contact or personal communication with the sick in town. Aware of the danger, they re. mained but a short time, and visited no house in which there was or had been cases of the disease. Some of our citizens, to escape, retired to the country; but, having the seeds of the disease in their systems, some days after fell sick, and died with black vomit. In these cases, notwithstanding they left town after the breaking out of the fever, and carried with them what they required for a long stay with their friends, yet there was no communication of the disease. In 1837, I knew of some indi. viduals living with their families at a considerable distance from the infected limits of the town, who had contracted the disease, and died in the midst of their family, with its most aggravated symptoms, and yet there was no communication of it. This same year, a short time before the occurrence of the fatal case at the tavern, in the family of Judge King, senior, there was a well-marked case of yellow fever, in a relative who had left New Orleans after the disease had broken out there, and with the hope of escaping it. There was no extension of the disease in this instance, the entire family being exempt from it this year. The residence is situated on the outskirts of the town. In 1839, no member of this large family, black or white, escaped, save the judge and his venerable lady, both of whom had previously had the disease.
These facts certainly militate against the opinion of the contagiousness of yellow fever. But, again, it must not be forgotten, that every epidemic in this village, which, for many years past, has made no very noticeable progress in the path of civilization, is attributable to an in. fection contracted in or imported from New Orleans, or immediately preceded by such cases. The fact of the importation is as positive as any other in the history of the disease. Does it constitute an example of mere coincidence, a mere accidental circumstance, or is it to be regarded in the light of a cause ? Would the disease have broken out as an epidemic, in the years 1837, '39, and '42, had not, each year, a fatal case been imported from New Orleans? It cannot be objected, that these individuals may have contracted the disease in Opelousas; for, in 1837 and '39, the two first arrived sick, and it was some two weeks after before any disease whatever appeared in the town, and in 1842, the third fell sick in less than forty-eight hours after his return from the city.
In works written expressly on this subject, the number of facts re. corded in perfect accordance with those stated, 10 show that the disease in Opelousas was dependent on that of New Orleans, are very numerous. I simply state what was observed in this place; and the important question arises, Is it true, that the epidemics in question were the effects of an infection which would not have existed, had not individuals who contracted the disease elsewhere died in the town? An affirmative answer to this question, settles, for all practical purposes, that of the importation of the disease. Such an answer seems both natural and reasonable, when we consider that the town has, under other circumstances, ever enjoyed an immunity from the disease ; that, with the ex. ception of the four occasions mentioned, there never has been a case of
the fever; that, on each of those occasions, it appeared after it had pre. vailed in the city; that, in the first instance, the fever, which, in conse. quence of the absence of favoring circumstances, did not extend to any more than the cases which subsequently proved fatal in the country, was the direct consequence of imported infection; and that, in the three sub. sequent visitations, it was positively preceded by fatal cases of the disease contracted in the city. In the present state of our knowledge of the causes of diseases, it appears to me as easy to conceive a peculiar in. fected condition of the atmosphere, dependent on or produced by such a cause as the one in question, as to assign bilious fevers to marsh miasm, or to heat and moisture prevailing with easterly winds. The occurrence of this fever in Opelousas, resulting from the importation of woollen goods from New Orleans, without spreading beyond the individuals directly exposed to the imported poison, considered in connection with the subsequent epidemics, show that the simple introduction of the poi. son, without the aid of other concurrent circumstances, is not sufficient to produce a prevalence of the affection; and it is worthy of observation, that such concurrent circumstances are as unknown as is the poison of yellow fever itself; for, in the years of our great epidemics, there was a remarkable immunity, not only in the country, before and during the epidemic, from discase of all kinds, but in the town also, from all affections save the prevailing fever. For the production of every disease, there must exist adequate causes. Long.continued heat and moisture certainly merit the most serious consideration, as predisposing causes of our autumnal fevers. They are generally attributed to a miasmatic origin. Some years, both our country and town are almost entirely exempt from disease of all kinds ; as, for example, this present year, remarkable for excess of heat, and continued rains : other years, with. out apparent causes, the country is terribly afflicted with the common fevers. The causes of fevers are buried in obscurity.
Admitting, though, that there existed adequate causes, in the years of the epidemics, for the production of the worst forms of our country fevers, is it less to be wondered at, that, after the addition to these causes of the poison of yellow fever, this disease should result, than that without it the common bilious fever should have prevailed? What, under this supposition, caused the latter to be supplanted by the yellow fever? The only explanation, all three years, is the addition of the new element of disease, generating a new constitution of the atmosphere, which continued until frost, by purifying the air, rendered the new cause inert. But if these causes did not exist, then the conclusion a fortiori results, that the disease must have originated from a union of the poison with those general and local predisposing causes of fever which neces. sarily exist in the fall of the year in our southern States.
Yellow fever is now very generally acknowledged by all to be a spe, cific disease,- that is, a disease sui generis. Thus considered, the doctrine of importation has been objected to, on the ground that the disease presents itself, on different occasions, in different type. Now, it appears to me, that this fact rather strengthens than weakens this doctrine ; for, if the poison be importable, and in the absence of certain conditions, or of circumstances which favor its multiplication and extension, does not extend beyond the first attacked, it is
presumable that various results might ensue from its union with such condition or circumstances, according to their intensity or character, and that thus different cpidemics might rather be expected to present different than identical types. But it is right to observe, also, that the different forms of this fover, observed in different years in our Southern country, may be ascribed to modifications of constitution induced by the ever-changing predisposing causes of fever. It would certainly appear to me more surprising, should the fever, in New Orleans, resemble in type that which might prevail in the Harana, supposing it to be imported from that place, than that it should present a different form of the disease.
In the preceding pages, though it was my intention, at the outset, to record only some of the admitted facts of the epidemics of Opelousas, I have yet been led, almost unknowingly, into comments which, perhaps, had better been omitted. I will now close, disclaiming all pretensions to any thing original, and only hoping to stimulate others better qualified than myself
, to pursue the investigation of this very interesting, subject.
IV.-Obscrrations on the Stillingia Sylvatica, or "Queen's Delight'; with Cases. By A. Lopez, M. D., of Mobile, Ala.
“ Historia quoquo modo delectat.” It is remarkable that the therapeutic properties of a valuable remedial agent should have been permitted so long to sleep among the membra disjecta of the Materia Medica, and it is equally discreditable that its introduction should be committed to the ignoble though lucrative fate of a patent medidine.
The plant which leads this article has received no more than a passing notice from those who speak of it at all, and except its classi. fication and a few general hints as to the diseases in which it has been prescribed, few writers appear to deem it worthy of attention. * Pereira does not mention it at all. Dr. Barton who took much pains to accu. mulate a history of all southern plants for the completion of his “ Collection towards a Materia Medica of the United States," has permitted it to escape his attention. Elliott in his Botany-Nuttal's Genera, and Wood & Bache in their Dispensatory-insert it, but with by far too limited a notice. The amount of information derived from these last named authors may be summed up in what we find at page 637 of Wood & Bache, to wit: “The plant grows in pine barrens, from Virginia to Florida, flowering in May and June. When wounded it emits å milky juice. The root, which is the part used, is large, thick and
* The only monograph concerning this plant which I have ever seen was an inaugural thesis written by a graduate of the Charleston Medical college, and can be found among the bound manuscripts deposited in the library of the Medical society of that city. It evinced a careful research, and deserves publication. I think the author's name was Prioleau.