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[From the Son-hern Medic*! Record-]
REMARKS ON THE CAUSE AND
T RE ATMEXT OF Y ELLO W
FEVER AND THE BEDFORD
(VA.) SPRINGS ALUM AN])
IRON MASS AS A REMEDIAL
AGENT.
By W. A. Greene, M.D., Macon, Ga., Ex-President
Georgia Medical Association ; formerly chief
Kurg. of Artillery, 3d Army Corps, A. N. Va.
The great pestilence of 1878, which
“walketh in darkness and destroyeth at
noon” may be stated in round numbers
to hive extended over live hundred miles
in length, on the Air-Line, and seventy
miles across at its widest part, sparing
neither city, town, village or hamlet,
clinging to the eastern side of the Mis
sissippi river—it greatest divergence be
ing at Chattanooga; Mobile, Charleston,
Savannah and Jacksonville, and other
places subject to its visits being free to
this time. It seems to prefer moving
Northward along the rich malarial pas
tures of the vast lowlands that stretch
out from the turbid Father of waters.
In contemplating this wide-spread
epidemic, and the terrible destruction of
human life, our minds linger—to think
of and admire the heroism and dauntless
courage of those noble volunteers and
martvrs, who, while others have Hed be
fore the approach of the pestilence, have
remained by the noisome couch, have
breathed the foul breath, and inoculated
themselves with the deadly secretions of
disease, to mitigate the sufferings or
save the livesof their fellow beings—and
wrest from the grasp of the poison some
salutary instruction.
For these two long, weary months,
they have watched by the gray dawn,
through the noontide heats, and all the
live-long night, at the bed side of the
sick, to catch the first ray of hope, to
seize upon the first favourable moment
in which to offer kindly aid and gain an
advantage over the deadly monster.
Such entire and unreserved immolation
of self, such devotion to the calls of duty
—are but the repetitions of the acts and
examples of thousands of our brethren,
who have thus, like Curtins leaped into
the gulf, and thrown away their own
lives for their fellows; and in every age,
and in every nation, are so numerous
that tLtdr biographies would fill another
Alexandrian Library. Like the Prome
theus of the Greek Poet, they seem
to struggle against late herself, and to
traverse with unbending resolution the
evil current of those who proceeded
them to the same destiny. It is ours to
stand ready to aid them with all our re
sources of study and investigation—that
they mav put limits to the sway of this
dread king of terrors.
It is now too late to discuss clean
streets and alleys, or correct sewerage or
any system of hygenic measures—but
rather, by experimental science and study
of the true pathology of the disease, seek
to cure it. This is our only hope. Our
oft scourged Southern cities have already
exhausted every resource, to prevent its
appearance, until it seems no human
foresight, or expenditure of time, talent
or money will ever avail anything. And
I regret to say, the frightful mortality
in the present epidemic proves how un
successful and uncertain are our thera
peutical means. Wc have in a measure
mastered other diseases of nearly equal
fatality as pulmonary consumption.
Typhoid fever, small-pox, now a disease
of the past. Rheumatism an oppo-
brium, now yields almost as certainly to
modern treatment as the intermittents
and remittents of malarial regions. In
the present epidemic of yellow fever the
oldest traditional theories have been de
molished, and it seems to me that we are
in greater ignorance of essential and spe
cific knowledge than ever before.
Yellow fever looms up before the
American people as a national peril and
calamity, the Leviathen of our pros
perity and the destroyer of the lives of
our people, and invokes at once the se
rious attention of the government. It
invades alike the palaces of the rich, and
the hovels of the poor ; in country as
well as city ; the inland cities and towns,
as well as the great marts of trade, the
water courses and thoroughfares of com
merce—sparing neither age nor sex; the
foetus in utero, the babe at the breast,
the youth, and the man alike are its vic
tims. Neither is it a respecter of na
tionalities, the hitherto exempted negro
is almost equally affected with liis“white
brother.” And it is a noticeable fact
in the present epidemic, that previous
attacks have proven less effective against
a recurrence than ever before, as is evi
denced from the numerous attacks and
deaths among the physicians, druggists
and nurses, who so nobly volunteered
their services to the afflicted cities. Fi
nally—although the flower and skill of
the profession, have, at the imminent
peril of health and life labored most
zealously, yet, no treatment has been
able to reduce the average mortality be
llow thirty-five per cent, of those attacked.
® I do not propose, in this paper, to dis
cuss the pathology of yellow fever, but
give simply a brief synopsis of my opin
ion of 'its direct cause and treatment.
I very much fear the space allotted in a
medical journal will be insufficient to
make myself understood, or convey the
probable benefit. 1 venture to hope for,
from a publication of my theory.
Yellow fever is a specific malignant
fever, usually of a continued type, and
propagated by minute germs, and has
appeared at elevations of 2,000, and even
4,000 feet above the level of the sea.
No physician who has studied the inves
tigations of Yellow and Malarial fever,
made by men of ability—or themselves
made the invstigations, but have been
struck with the identity of the two dis
eases in material respects, and I hold
that any general treatment adapted to
one will be found valuable in the other.
The most recent investigations agree
with all previous ones, that yellow fever
prevails exclusively in malarial regions,
and is produced by spores of fungi float-
in the air, and in which often, especially
in mild types, remissions and intermis
sions of the fever are observable. Dr.
Lei lardy, of Savannah, who has given
the subject perhaps more thought than
any recent investigator, and fully com
petent, states tha f • has observed this
(the remissions :.nd intermissions) often
among the n<"rues in the last Savannah
epidemic, a <1 in a majority of those
cases quinine controlled the febrile
symptoms. On this important point we
have the valuable testimony of Dr.
Robert Lawson, inspector general of
hospitals, who has seen yellow fever on
the West coast of Africa and in the West
Indies, as well as the United States, and
given special attention to the featuies
which characterize it, and serve to dis
tinguish it from other kinds of fever. He
says, “the train of urinary symptoms
and other characteristic features of yellow
fever were as fairly developed in the
periodical as in the continued form of
the disease; the definition of yellow
fever which represents it as being always
of the continued form, is altogether erro
neous.”
While the yellow fever plant may not
be identical with the malarial plant,
(neither having been sufficiently isolated
and explained); yet, the conditions for
their development are strikingly similar,
even to a casual observer. Neither are
contageous by personal contact. Mala
rial fevers of more or less severe type
invariably follow as a consequence,
when there has been slight frosts, few
freezes, unusual quantities of rain, satu
rating the earth and filling the ponds and
low places, resulting in stagnant water
and much decayed vegetable matter.
These are the conditions which propa
gate yellow fever, and in which it luxu
riates and delights to dwell, leaving
wretchedness and death in its wake.
For these reasons and others, gathered
from a residence and practice of nearly
thirty vears in an intensely malarial
region, with close observation and pati
ent investigation of the diseases peculiar
thereto, and an experience with yellow
fever sufficient for practical purposes. I
am forced to the conclusion that it is the
combined influence of the spores of the
yellow fever and malarial plants, acting
together, and upon each other, under fa
vorable conditions for their mutual devel
opment, which produce and propa
gate yellow fever. It will be noticed
that the identical surroundings or con
ditions are always required for the ger
mination, growth and development of
yellow fever; and in closely studying
and observing the types of different epi
demics, 1 have noticed that it is con
trolled by the predominating presence of
the one or the other cause, being milder
if the malarial is in excess, and severer
if the yellow fever has supremacy, and
will yield to a lower degree of tempera
ture or spread and be susceptible of more
rapid multiplication when it is higher,
for the same reasons.
And ao-ain, the treatment that has
been found successful in one epidemic
failed perhaps in the next, in the same
locality, which can be explained by the
same theory. A notable instance being
the epidemic of 184i in Xc\\ Orleans,
in which the cases were controlled most
satisfactorily by quinine; but the advo
cates of quinine treatment were doomed
to a most unexpected disappointment in
the severer epidemic of 1853.
In the former epidemic, in all proba
bility the malarial cause was in excess,
and accounting for the good results of
quinine, upon which the physicians
mainly depended. The epidemic of
1853, as all will remember, was unsually
severe, and I have no doubt the yellow
fever poison predominated to such a de
gree as to render the malarial antidote
almost inert as a remedy. There seems
to be a mutual intensification of these
subtle poisons by their commingling in
the atmosphere, and entering the animal
system.
The striking similarity which yellow
fever so often presents to the malignant
or pernicious forms of malarial fever, has
always perplexed etymologists in the in-
the investigation of the former—and
this theory may open up the way for a
more satisfactory elucidation of the sub
ject. In fact so difficult is the deffereu- |
tial diagnosis, that the first cases in all
epidemics are diagnosed and treated for
some form of malarial fever, even by ex
perts—those who have had considerable
experience with yellow fever. It is
fresh in the minds of many of us, who
were residing in the Southern portion of
Georgia at the time, concerning the
doubts as to the character of the fever
which proved so fatal in Bainbridge,
Georgia, a few years since. For several
weeks it was pronounced and treated for
the haemorrhagic malarial fever which
had been prevailing in that section pre
viously—until the rapid multiplication
of cases and alarming fatality excited and
aroused the entire State, and consulting
physicians were summoned from the yel
low fever cities, and pronounced it gen
uine yellow fever. There are those,
even to this day, and intelligent physi
cians, too, who are not satisfied with this
diagnosis. Bainbridge is a small in
land town, with some 1500 inhabitants
where yellow fever had never before ap
peared—neither was it at the time
prevailing at other points in the
vicinity, so far as I remember, nor did
it extend beyond the town. There was
also considerable speculation concerning
the fever when it first appeared in Mem
phis in the epidemic before this one. In
neither of these instances did the fever
yield as promptly to the first frosts as
has been its custom on the coast hereto
fore. We can here again explain these
irregularities on my theory of the two
poisons operating together, and the mala
rial predominating—for we know the
latter does not yield decidedly to low
temperatures—but is decidedly mitigated.
In the fever called “Typho-malariai”
we have another instance of two separate
and distinct poisons operating at the
same time, in the same patient—the
typhoid and malarial fungi. We have a
knoweldge of the typhoid fever fungus,
which is distinct from the malarial plant.
According to the predominance of the
one or the other of these causes, will the
fever assume the typhoid or the malarial
characters in excess, and to be treated
accordingly.
The haemorrhagic malarial fever, so
similar to yellow fever, requiring nearly
the same treatment, I believe to be caus-
by the spores of a plant resembling the
yellow fever plant, which, combining
with the malarial Allant, intensify each
other, and poison the blood of those com
ing within its influence, producing this
, characteristic fever, which, of recent
years, lias prevailed so extensively and
fatally in the malarial regions of the
South.
Since this fever made its appearance
in Georgia during the years 1808 and
1869, I have carefully an 1 patiently
watched and studied it, with a view of
ascertaining its true cause, pathology and
treatment. I have given the profession
the benefit (if any) of what little 1 have
discovered in previous papers, contribu
ted to the “Richmond and Louisville
Medical Journal,” in 1870, and more
recently in “The St. Louis Medical and
Surgical Journal” (June number, 1878),
and the “Cincinnatti Medical News,”
October, 1878. In those papers I
strongly advocated the use of the “Alum
and Iron Mass”* as a chief remedy, sus
tained by giving a few eases. It was in
pursuing those investigations 1 arrived
at the theory of the cause of yellow fever
as expressed in this paper, and from the
strong resemblance of the two diseases,
based my theory of the treatment ofyel-
low fever. I regret my limited oppor
tunities for more thoroughly testing my
views of this treatment of yellow fever
with the iron and alum mass, before ap
pearing before the profession in an arti
cle so strongly recommending it; and
would not do so, but for the reason that
the disease is prevailing so alarmingly
and fatally in our Western cities, and it
there is any good in it, the physicians
there could* use it, test it as thoroughly
and perfectly as I could, and more so;
and if my sanguine expectations should be
realized, even a tithe of them, I will feel
that I have done some good, though not
present to share with them the dangers
and hardships of administering directly to
the afflicted ones. I caasay, truthfully ;
I never had more confidence in a remedy,
and have good reasons for it, from my
experience with it, and success in treating
haemorrhagic malarial fever, and the few
cases of yellow fever that came ^ under
my notice and attention in 1876, from
Savannah. I earnestly insist that the
physicians who now have ample oppoi-
tuuities for testing the remedy, will do
so at once, and communicate directly
with me for any further information on
the subject. But for my peculiar sur
roundings, I would at once go to some
portion of the yellow fever district, and
use this theory of treatment, and make
further investigations of the causes.
I invite a careful examination of the
analysis of the mass as procured from
the waters of the BeJford, (Va.,) springs,
which, taken in consideration with my
theory of the cause of yellow fever, ?md
its similarity to the form of malarial
fever I have considered, the adaptability
of the treatment at once becomes appa
rent. The usual pieliminary treatment
of putting the patient to bed, covering
him up, closing the apartment, foot
baths, with strong mustard and pepper,
friction of limbs, elder-leaf and other
teas to produce perspiration, assist
ed by hot bricks, bottles of hot water,
and boiled corn, about patient’s body
and extremities, or mustard plasters ail
infinitum, may sometimes be proper in a
guarded manner. But this hot, fiery,
pungent treatment, should be carefully
administered, as every case may not re
quire this stereotyped proceeding.
In all specific diseases there is some
specific remedy on which we build our
main hope of reliance as the alkaloids of
Cinchona bark in intermittents and re
mittents, mercury in Syphilis, lod Potass
and Salacylic Acid in Rheumatism, etc.
In yellow fever, I should build my hope
of cure chiefly on the Iron and Alum
Mass of the Bedford (Va.,) Springs, as
it is condensed from the water by pure
and simple evaporation. It is now well-
known to all physicians and needs no
special mention. The medical properties
of the several constituents as shown by
the analysis of eminent chemists will
readily suggest their effects on the sys
tem.
ATLAUTA
The Twenty-First. Annual Course of Lectures will com
mence Oct. 15tli, J878, and close March 4th, 1879.
FACULTY.
A. W. Griggs, M,D.. Emeritus Professor of Practice.
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Wm. Abram Love, M.D., Professor of Physiology.
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