Yellow fever epidemic of 1878 in New Orleans. Lecture III. Microscopical characters of the blood in yellow fever. Pulse, respiration and temperature in yellow fever.

              YELLOW FEVER EPIDEMIC OF 1878 IN NEW ORLEANS.
~y JOSEPH JONES, M.D.
942 Original Communications. [June
although you may have written a general letter of inquiry to
the same physician before without receiving any answer.
Failur-es, although by no means discreditable to the operators,
are often witheld from publication simply because the cases
have not the creditable mark of success.
It is difficult to account for the remarkable success in the
Cresarean cases of Louisiana, except in those operated upon
early; for exclude these, we still have a recovery of 61 7-13 per
cent. of the wemen after labors lasting from 24 hours to 10
days. In Mississippi, but 2 were saved out of 6, and Alabama,
3 out of 10, two of the three being white. In New Orleans, but
one woman and one child were saved, as the result of four late
operations. All of the other late operations (9), were upon
plantation slaves, and although but 2 children were saved, all
but two of the women recovered, or 77 per cent. In no other
section of the United States have late operations met with any­thing
like this degree of success, which exceeds even that of the
26 early operations of our country, except in the saving of
children.
713 LocuRt Street, Philadelphia, April 15th, 187!l.
Yellow Fever Epidemic of 1878 in New Orleans.
By JOSEPH JONES, M.D.,
Profe•oor of Chemistr.v and Clinical Medicine, Medical Department University of
Louisiana. Viaitlng Physician of Charity Hospital, New Orleans.
(Extracts from Clinical Leoture, Delivered in the .iJ.mphitheatre of the Cha1·ity
Hospital, January 22d, 1879. Reported for the New Orleans Medical and
Surgical Jo1wnal.)
LECTURE III.
MICROSCOPICAL CHARACTERS OF THE BLOOD IN YELLOW FEVER.
PULSE, RESPIRATION AND TEMPERATURE IN YELLOW
FEVER.
Gl!)NTLEMEN:
v;'ith reference to the various infectious fevers, pathologists
are accustomed to state that they have as their common and
1879] JONES-Yellow Fever .Epidmnic of 1878. 943
essential character an extraordiJ?ary development of contagious
chemical activity, or, as certain writers call it, fermentation or
zymosis, in the affected body. We may well ask whether there
is any exact knowledge behind these general terms, and
whether their authors have the remotest conception wherein the
chemical activity of small-pox difl'ers from that of scarlatina or
yellow fever¥ Under the head of the so-called dyscracies, syste­matic
writers have tabulated a large number of diseases, as gout,
scrofula and rheumatism, in which the chemical workings of the
body are at fault, but has any description of the peculiar physi­cal
and chemical changes been given which would be recognized
as intelligible by a chemist? What do we know of the chem­istry
of cancer, leprosy and rickets~ This defect of knowledge
not only leads to the use of undefined terms, but also lies at the
very roots of the imperfection in the practice of medicine_ It
is to be hoped that as medical science advances in the future, it
will be possible in respect to any morbid process, so far as it
concerns the chemistry of the body, to define it in precise
chemical language; to state accurately the precise bodily mate­rials
affected in any specific disease, the various stages of
transformation, and the physical and chemical results.
Just as the chemist expresses in exact chemical terms the
difference between the proces:-es and products of vinous and
butyric fermentatiOn, in like manner should the pathologist
define the different zymotic diseases. Such knowledge will
lead not only to rational systems of treatment, but may unfold
the true modes of prevention. It has been well said that for
future progress, the possibilities of medicine are but two; on
the one hand we have the choice, such as it is, that from time
to time new specific antidotes may accidentally be discovered ;
on the other band, there is the power of deliberate scientific
discovery and application_ During the past twenty three
years, I have endeavored to investigate in eivil and military
practice the chemical, physical, microscopical and pathological
changes of the solids and fluids in various diseases, and more
especially in yellow fever, typhoid fever, the various forms of
malarial, or paroxysmal fevers, and in cerebro-spiral menin­getis,
hospital gangrene, pyremia and traumatic tetanus. In
6
944 Original Oomrnunica.tions. rJ une
such investigations I have conce}ved it to be clearly the duty of
the investigator to record carefully and accurately the symp­toms
accompanyiug the microscopical and chemical changes of
the solids and fluids, and a similar course will be pursued in the
presentation upon this occasion of the results of the microscopi­cal
characters of the blood in yellow fever.
CASE. YELLOW FEVER- HIGH TEMPERATURE; JAUNDICE; URIN­ARY
SUPPRESSION; BLACK VOMIT ; BLOOD ABSTRACTED DUR
ING PROGRESS OF DISEASE CONTAINED CRENATED COLORED
CORPUSCLES .AND BAC'l'J.;RIA; POISONOUS QUALITIES OF
BLOOD DEMONSTRATED BY EXPERIMENTS.
J.D. Munson, age 29, native of Austria, bas resided in New
Orleans 2 years, black hair, black eyes, florid complexion,
stout, compact form, Jewi8b faith and features, cigar manufac­turer
and vendor, residencelOl St. Louisst.reet, but was taken ill
September 6th, in his tobacco factory, No. 17 Tolout~e street.
Attacked September 6th, 1878, about 7 o'clock, A. M., with
chill followed with intense pain in the bead and back and high
fever. I saw this patient at 2 o'clock, P. M.
September 6th, 2 P. M. Pulse 140, temperature of axilla
106, F., face greatly flushed and might well be describ d as
brilliant blazing red, eyes congested, tongue red at tip and
edges, with thick, cream-like fur, intense pain in head, back
and lower extremities: anxious and restless. Patient says til at
he felt greatly alarmed about the yellow fever, and had been
unwell for several days before he was attacked this morning.
The patient lies upon a small cot in his tobacco factor·y upon
the second :floor of house No. 17 'foulouse street, and is sur­rounded
by piles of leaf tobacco and cigars.
a. Hydrargyri Sllb-chloridi (mercurous chloride); quininre,
sulp)l. aa 3i. mix, administer at once, and follow with one :fluid
ouuce of castor oil in three hours. a. Tinct. veratri viridis f3ij,
four drops every two hours. Bay rum and sedative water to
head.
September 7th, 1878, 10 o'clock, A.M. Pulse 90, temperature
of axilla 104,0 F. Patient has bad four copious evaenations
from bowels and has urinated twice.
a. Snlpho-carbolate of sodium 3ij; divide into 12 powders,
one powder in oraoge leaf tea every 4 hourt~. a. Tinct. vera­tri
viridis, gtts. iiv, every 4 llours, in orange l~af tea. Apply
mustard foot bath. Iced Apollinaris water as a drink. Cold
cloths to head.
September 8th, 10 o'clock, A. l\1. Pulse 80, temperature of
axilla 1050. The pulse has fallen ten beats, whilst tue tempera-
1879] JoNES-Yellow Fever Epidemic of 1878. 945
tore has risen one degree Fahrenheit during the past 24 hours·
This change has been attended with a perceptible yellow tinge
of the surface, and without doubt the diminution in the
frequency of the heart's action must be referred to the acute
fatty degeneration of tllis o.rgan, as well as to the sedative
action of the constituents of the bile on the cardiac and spinal
ganglia. During the nights of the 7th and 8th the patient was
restless, and his friends called in the nearest physician, who
administered a large dose of Batley's sedative (a preparation
of opium, very popular with certain physicians of New Orleans
in the treatment of yellow fever). The patient had taken five
powders of the snlpho carbolate of sodium before the adminsi­tration
of the preparation of opium. Since the administration
of the preparation of opium he has become stupid, and his
kidneys have ceased to act. I attribute this "unfortunate turn.
in his case" to the action of the preparation of opium the so­called
"Batley's Sedative." I endeavored to re-establish the
secretion of the urine by sinapisms over the loins, and by the
free use of Apollinaris water.
4~ o'clock, P . M. Pulse 70, temperature of axilla 104.80.
Yellow hue of skin increasing in intensity. Great capillary
congestion, tongue red at tips and edges and heavily coated
witll fur in centre, gums red and spongy, suppression of urine,
Nausea, vomits thick mucus of a white appearance. Capillaries
greatly congested, the skin, however, and conjuntiva, present a
yellow tinge.
a. Qninire sulph. 3ij., liuamenti saponis f3iij., olei oli vre
f3iij . Mix: apply as a linament to trunk and extremities.
Applied cut cups over the epigastrium and loins. Blood
fiowed slowly, and rapidly assumed a brilliaut scarlet hue, like
the blood of those who have been poisoned with carbonic oxide
gas or cyanide of potas8ium. The blood was tested for hydro­cyanic
acid after its removal to the laboratory, but no trace ot
this poison could be detected. Tile patient expressed great
relief froJp tile .application of the cut cups.
Under the microscope the colored blood corpuscles presented
a crenated appearance, and minute oval bod1es with a central
nucleus, similar in size <UH.l appearance to those observed in the
yellow fever atmosphere, and previou:sl~' ues(,lilbell in the second
lecture, were discerned by the use of powers ranging from 4:.W
to 1800 diameters. 1 also observed ro<!-shapell bacteria and
delicate thi"ea<.l-like filameuts re~:>emlJling the mycelia of minute
fungi. The minute particles of matter posse8sing au active
vibratory motion observed iu this anu other specimens of IJlood
may have been examples of the Brunoniau movement. 'l'h~
vibratory motion of minute particles may be associated with
inorganic matter, as well as organic; but from the number of
these particles observed in the 1Jloo<1 of yellow fever patients
during the epidemic of 1878, l was inclined to refer theu exist-
946 Original Oomm1mications. I June
ence, in part at least, to the pathological processes of the
disease.
The blood was received carefully into a glass-stoppered
bottle, and examined microscopically at various intervals, and
there was a rapid and progressive growth of the bacteria, and
rotatoria, and minute vibratory particles. On the third day
after its abstraction and preservation in the~ glass-stoppered
bottle, the blood literally swarmed with the rod like bacteria
and rotatoria. When tlle blood thus undergoing change was,
22 hours after its abstraction, injected :subcutaneously into the
ear and back of a large, powerful buck rabbit, death ensued in
12 hours. Putrefaction was rapid, and the eoagul~ted ulood
which distended the cavities of the heart of the animal was
found, upon microscopical examination, to contain similar rod­shap~
d bacteria, and rotatoria, to those obst->rved in the blood
of the yellow fever subjects. The few urops of putrid yellow
fever blood injected subcutaneously. appear to have conveyed
to the living and healthy animal a deadly poison, and one of
the most marked effects of suclt putrid blood was the rapid
generation in the blood of bacteria.
At thP same time I injPcted subcutaneously into two healthy
rabbits, tresil ,yellow fever blood from another patient. This
blood was injected within two hours after its abstraction from
tile patient, wh9 was suffering with a violent fever which sub­sequently
termiuateti in black vomit and deatiJ. Oue of the
animals survived the operation, whilst tiJe other died ou the
fourth day after the operation.
September 9th, 10 o'clock, A. M. Pulse 52, slow and inter­mitting.
Temperature nuder the tongue 1030 F. The blazing
red scarlet face has changed to a yellow, sallow, jaundiced
hue; the litJS and tougue, however, are of a brilliant scarlet hue;
nausea and vomiting· still continue. ij,. Calcis carb. pr-ecip.
3ij., liq. fiori aura.ntii f3vj. Mix. Sig. Tablespoonf..tl every 4
hours. Has passed no uriue. Coudit;ion hopl:'less. 5 o'cloek,
P. M., pulse 60, temperature 103·20. Patient says that he is
better, that he derives great benefiL and comfort from rubbiug
with the quinine linament. A small quautity of urine was
passed this tlay, of a yellow color, turbid aspect, and loaded
with granular easts anti albumen.
September lOth, 10 o'clock A. M. Pulse 64, temperature 1020.
Restless and anxious; r;nrface of a golden color; great capil ­lary
congAstion; uausea and vomiting; vomit8 wheu liquids
are introduced into tile stomach ; vomited matters streaked
with tiark specks and flakes. SuppressiOn of uriue. Careful
examination revealed no urine in the bladder. Sinapisms to
the pit of tile stomach and loius, as well as cold ice-water in­jections
by the rectum, excited no verceptible effects upon
either the vomiting or the urinary suppression. Patient passed .
a restless night, and at the present moment is very restless,
187UJ JONES-Yellow J!'ever Epidemic of 1S78. 947
and his eyes move nervously and restlessly in their sockets.
5 o'clock P. M., pulse 70, temperature 102.50.
September 11th, 7 o'clock, A. M. At 5, A.M., this morning,
the patient threw up black vomit. Pulse 84, temperature 99.50.
With the ejection of the black vomit there has been a marked
fall in the temperature, whieh st-ands very nearly at the nor­mal
point. Intense jaundice. Patient very restless. his eyes
absolutely dance in their orbits, so incessant is the contraction
and expansion of the optic muscles. Delirium, twitching of
tendons. Has passed no uriue, the bla.dcler contains none.
Has passed two copious bloody dark stools. This occurrence,
as well as the black vomit, would indieate that profuse b::.emor­r
·hage had taken place into the alimentary eaual, and to this
cause most probabl.Y must be referred the abrupt descent of
the temperature.
The black vomit was carried immediately" from his sick
chamber (this specimen was vomited in my presence,) to my
laborator.v, and injected subcutaneously into two strong rab­bits.
Local irritation with the formation of pus in the neigh­borhood
of the injections, attended with moderate fever, ensued
in both animals, but they survived the opemtion. On the
other band, black vomit kept for some time (from 24 to 48
hours) which emitted a foul smell and swarmed with bacteria,
as well as the putrid black vomit taken from the ~Stomachs of
patients after death from yellow fever, destroyed the rabbits
(when injected subcutaneously) in from 12 to 18 hours.
Such experiments would indicate that fresh black vomit is
comparatively inocuous, whilst in the putrid state it rapidly
destro_ys life.
5 o'clock, P. M. Delirium, intense jaundice, hiccough, in
cessant twitching of the muscles, eyes dance incessantly in
their orbits. Died at 8 o'clock, P. M.
Commentary- It will be admitted that this was an example
of the gTavest form of yellow fever.
The blood after its abstraction, contained crenated blood
eorpuscles, Lacteria, and bodies resembling spores, and the
mycelia of fung·i. The fibrinous element was almost wlwlly
wanting in the blood.
The blood rapidly underwent pntrefaction after its abstrac­tion,
although preserved in an air-tight glass bottle, and con -
currently with this putrefaction there appeared innumerable
bacteria and micrococci. The putrid blood proved rapidly
fatal to living animals when injected subcutaneously, and the
blood of animals thus rlestroyed contained numerous bacteria,
similar to those observed in the yellow fever blood.
948 Original Communications. lJune
The fresh black vomit immediately after its ejection from
the stomach, acted as a local irritant when injected subcuta.
neously, but putrid black vomit acted as a violent poison and
in a manner similar to that of the putrid l;llood when intro­duced
into the blood.
CASE. YELLOW FEVER; HIGH TEMPERATURE; WILD DELIRIUM :
URINARY SUPPRESSION; BLOOD ABSTRACTED AT HEIGHT
OF DISEASE CONTAINED CRENATED CORPUSCLES AND BAC­TERIA;
DEATH ; EXPERIMENTS.
J. K., male, age 38 years, native of Germany, has resided
in New Orleans 20 years, residence 406 Second street. Vacant
lot in front of residence, covered with water, in which numer­ous
frogs disport themselves and render the nights hideous
by their incessant clamor. Occupation, clerk in stationary
store on Canal street.
Attacked with pain in the head and high fever, at 2 o'clock,
P. M., August 27, 1878. I was summoned at once and saw the
patient at 4~ o'clock, P. M., two and a halt hours after the on­set
of the fever. Pulse 160 per minute, temperature of axilla
105.20. .R. Hydrargyri subchloridi, quinire sulphatis aa
gmins x. mix: administer at once. :a,. Olei ricini f3j : in
three hours after the administration of the calomel and- qui­nine
powder.
August 28th, 9 o'clock, A. M., pulse 104, temperature 102.so.
There bas been a marked diminution of the beats of the pulse,
to the extent of 56 beats since 4~ o'clock, P. M., yesterday,
and the temperature has declined 2.4o F.
The bowels have been freely moved by the action of the
purgative. The patient, however, is very restless and dis­tressed,
and anxious about himself. He is said to have
dreaded the fever and to have taken various nostrums for its
prevention. I conceived that good might be accomplished in
this case, by the early and free use of quinine, and accord­ingly
or.l.ered the following: .a,. Qui nire sulph. grains xx :
divide into two powders, administer one powder immediately,
and the second in two hours. Hot mustard foot bath, cold
cloths to head. Orange leaf tea as a drink in moderate quan­tities.
8 o'clock, P.M. Pulse 102, temperature 106.20. The patient
has taken the 20 grains of quinine prescribed this morning and
they have been retained b.v the stomach; we fail however to
note any beneficial effects from the action of the medicine.
The quinine bas certainly produced no reduction of tempera
tnre, on the contrary the heat of the trunk has risen from
102.80 to 106.2°, that is 4° F., under the action of 20 grains of
this alkaloid.
1879] JoNES-Yellow Fever Epidemic of 1878. 949
It will also be observed that this rise of temperature bas
been attenderl with a diminution in the number of beats of the
pulse •
.August 29th, 9 o'clock, .A. M. Pulse 98, temperature 1050,
The patient was delirious and very restless during the night.
Tbis restlessness was not relieved by cold affusions, neither was
the heat reduced by the injection of considerable quantities of
ice cold water into the rectum. I had ordered during the
night, to secure if possible quiet sleep, the following: ij,.
potassii bromidi 3ij, tinct. gelsemium sempervirens (yellow
jassamine) f3j, liquor ammonire acetatis f3vj, mix tablespoon­ful
ever four hours; but no beneficial effects were observed from
this mixture. The entire body was also rubbed with fresh
olive oil. Stomach irritable, pressure upon epigastrium appears
to occasion much pain, complains of severe pain in head and
back and lower extremeties. Has a wild, restless, anxious
expression of countenance. When spoken to answered co
herently, but I am informed that as soon as I left his bedside
last night be raved and could not be quieted.
I determined to endeavor to relieve the cerebral symptoms, if
possible by the abstraction of blood locally, and accordingly
applied cut cups to back of head and epigastrium. I endeavored
also to reduce the temperature by the following: ij,. Salicylate
of sodium 3ij, divide into three (3) powders, dissolve in a half
pint of cold water and administer by enema every 4 hours.
Upon standing the blood abstracted presented a brilliant
scarlet hue, the clots were small and soft and rapidly dissolved.
The blood thus became entirely fluid a short time after its
abstraction by the dissolution of the fibrin. The serum at
first presented a bright golden color, but rapidly changed to a
scarlet hue from the liberation of the coloring matter of the
colored corpuscles. Many of the colored blood corpuscles
presented under low powers (400 to 600 diameters) a crenated
and granular appearance.
Under higher powers, l-18th of an inch, the peculiar cre­nated
appearance of the colored blood corpuscles was found to
be due to irregular elevations or exudations of the surface of
the corpuscles. Many of the colored autl colorless corpuscles
presented a distinctly granular appearance, wholly unlike the
conditions of these constituents in healthy blood. The blood
also contained minute vibrating particles, varying from one
ten-thousandth to one twenty-thousanth of an inch in d1ameter.
Injected the fresh blood from this patient subcutaneously into
rabbits. No perceptible ill effects were observed from such
injection of fresh blood.
August 29th, 8 o'clock, P. M. Pulse 98, temperature 104.20,
Ordered the continuance of the salicylate of sodium, and bro­mide
of potassium mixture, with cold sponging of the surface.
3
950 Original Communications. [June
Patient very restless; mutters to himself, but when aroused
appears to be rational. The tongue as upon the previous days
has preRented an intensely red color at the tip and edges, with
heavy coat of fur in the centre. Under the action of 120 grains
of the salicylate of sodium, administered by enema, the pulse
has remained unaltered, whilst the temperature has fallen 0.8o
F. This fall in the temperature is so inconsiderable that it
cannot with propriety be referred to the action of this agent.
August 30th, 8i o'clock, A. M. Pulse 90, temperature 104.20.
Countenance expressive of terror and great anxiety. Had a
great dread of yellow fever, and his friends represented him as
having been in a state of absolute alarm and fright for one
month before his attack. Delirious. Three drachms ( 180 grains)
of the salicylate of sodium have been administered by the rectum
in ice cold water with the design d obtaining its sedative,
antiseptic, antizymotic and antiperiodic effects, but no percep·
tible effects have been produced, unless we hold the ground
that it has at least prevented that great rise of temperature
which sometimes occurs in yellow fever, and which appeared
to be imminent in this stout, plethoric, :florid German.
8 o'clock, P. M. Pulse 102, temperature 104.50. Skin burn­ing
hot, patient restless and delirious, bowels have been moved
several times. Ordered 40 grains of the salicylate of sodium
in six :fluid ounces of beef tea every three hours. Continue cold
applications to head, also the fragments of ice in the mouth,
August 31st, 8 o'm. ck, A. M. Pulse 106, temperature 105.60,
wild delirium. The patient passed a fearful night, and it was
necessary to restrain him in bed. Up to the present time there
appears to have been no marked diminution of the urinary
secretion, and the complexion has been · comparatively free
from any appearance of jaundice; the full force of the disease
appears to have fallen on the cerebro-spinal system. The sali­cylate
of sodium, although freely and faithfully administered,
has failed to control the fever, the temperature having steadily
risen during the last 24 hours, from 104.30 to 105.60, and the
pulse from 98 to 106.
The urine presented a light yellow color, and contained a
small quantity of albumen, with a few granular ca.sts of the
tubuli uriniferi and epithelial cells of the urinary tubes, oil glo­bules
a•td bacteria, and granular matter. Immediately after
arriving at my laboratory, I injected two fluid drachms of this
fresh urine (urine passed in my presence) snbcutanr"•lsly into
the backs and thighs of healthy buck rabbits. After the injec­tion
of the urine, the lower extremities were temporarily para­lyzed
for a few moments, l>ut the animals were not to any per­ceptible
degree affected by the absorption of the urine, and
survived the operation.
1879] JoNEs-Yellow Fever Epidemic of 1878. 951
CASE. YELLOW FEVER; URINARY SUPPRESSION; BLACK VOMIT;
MICROSCOPICAL CHARACTERS OF BLOOD AND BLACK VOMIT ;
EXPERIMENTS ON ANIMALS.
William D., male. age 27, native of Ireland, resident of New
Orleans 5 months, red hair, blue eyes, florid complexion,
height 6 feet, weight about 185 lbs., sanguine nervous tempera­ment.
The full health, muscular development, red florid com­plexion,
indicated that this was a :fit subject for the manifesta­tion
of the most fearful ravages of yellow fever.
Residence 192 Felicity street. Attended the sister of this
man in the same house. through a severe attacd of yellow fever.
Although of a full and plethoric habit, she bad spent several
years in New Orleans,_and the successful issue of her case was
in a measure due to this fact.
William D., attacked with severe fever in hflad and back,
and high fever at 8 o'clock A. M., September 11th. Saw the
patient for the :first time at 6, P. M.; pulse 150, temperature
under tongue 106°, great congestion of capillaries of face; eyes
red and congested, tongue red at tip and edges. lj,. Hy­drargyri
sub-chloridi; quinre sulpb. aa grs. xx. Mix. Adminis­ter
at once. lj,. Olei ricini fjji. Administer in 3 hours. !),.
Tinct. veratri viridis m. iv., every two hours.
September 12th, 11 o'clock, A. M. Pulse 113, tflmperature
104.20. Retained the powder, but rejected the castor oil.
Bowels have not been moved.
B.. Hydrargyri sub-chloridi grs. x. Administer at once. Con­tinue
tincture of veratrum viride, 4 drops every 4 hours. Rub
the surface with fresh sweet oil.
8 o'clock, P. M. Pulse 112, temperature 104.5°.
September 13th, 11 o'clock, A. M. Pulse 100, temperature
103.70. Patient has had two copious actions from the bowels,
frecal matters of a dark greenish black color and most offen­sive
odor.
10 o'clock, P.M. Nausea and vomiting. Pulse 88, tempera­ture
102.1 o.
September 14th, 7 o'clock, A.M. Pulse ~~, temperature
100o. There has been a marked fall in the pulse and temper­ature,
but then there has been no improvement of the symp­toms.
Only one quart of urine bas been excreted during the
past 48 hours. Urine turbid from the presence of granular
yellow casts and epithelial cells. Chemical analysis showed it
to be loaded with albumen. Bacteria were developed in great
num hers and with great rapidity in the urine. Passed a rest­less
night, with incessant vomiting, skin of a mottled purplish
and yellow hue. Has passed no urine during the past twelve
hours, and upon careful examination, the bladder is found to
contain no urine. Threw up black vomit this morning for the
952 Original Oommunications. I June
first time. Throughout the attack there has been great
irritability of the stomach, even the introduction of the bulb of
the thermometer under the tongue, bas excited violent retch­ing
and vomiting. With the appearance of the black vomit
there has been a marked reduction of temprerature. Applied
four cut cups over epigastrium, and four over the small of the
back in the region of the kidneys. The blood upon exposure
to the atmosphere presented a brilliant scarlet color, and
flowed slowly, as if there was great torpor of the capillary cir­culation.
Thl~ cnt cups appeared to be productive of good, as
the vomiting was temporarily arrested, and the nervous ex­citement
and restlessness appeared to be at least temporarily
subdued. I hastened to my laboratory with the blood of the
patient which had been received into glass stoppered bottles,
chemically clean, and which bad 11ever been used before, and
subjected the blood to microscopical examination. The colored
blood corpuscles presented a stellate and granular appearance
as if minute globules were forming upon the surface of tlle
cell membrane. I also detected bacteria and Rmall globular
bodies with nuclei, and rotating and vibrating globules,
apparently surrounded by scil!iae, in the blood of this patient,
which were similar in all respects to those observed in the
yellow fever air, previously described.
Careful drawings were made and preservect of the blood of
this case, and the blood itflelf w::ts submitted to tile examina­tion
of three members of the Board of Health, and to Prof.
McCulloch, of Baton Rouge, Prot: Elliott, of tile Medical
Department of the University of Lonil:liaua., Mr. CI'uitnich,
Prnssian Uonsul, I)r. Davidson and other physicians, aud uo
difference existed amongst tilose observing tile fresh and dried
blood under the microscope, as to the iorm of t,he blood cor­puscles,
and the presence of the bacteria, and tile IJodies
resembling in all respects spores. Some of tlle bacteria bore a
striking resemblance to bacillus authracis, of splenic fever, others
to spirochaete obermeiri of relapsing fevu. The cdls resemble
those of micrococcus bombycis, and of mierococeus mae a11d
torulae. The delicate filaments appeared to be similar to those of
cladotnryx dichtoma. -
When the blood was allowed to stand in well stopped glass
vessels, it was fouud upou the sncceediug day, that the:se
organisms bad greatly multiplied.
Thb fresh blood injPcted subcutaneously into living animals
produced no ill effects, whilst the blood whicll was allowed to
putrefy for twenty-four hours, proved rapidly fatal
Portions of blood were placed in glass vessels, tlw mouths of
which were covered with cotton wooL The followiug experi­ments
were made:
1. Simple blood. At the end of one week all th'e colored
blood corpuscles had disappeared and an immense number of
1879] JoNES-Yellmr Fevm· Ep·id£-mic of 1t>78. 953
bacteria had been developed, many of which resembled the
spermatozoa, having a distinct cell with a tail-like prolnogation.
These appeared to be similar to the bacillus substilis, with
spores at one end. I also observed micrococci, vibrios, spiro­chaete
and spirillre.
2. Blood mixed with water, about one part of the former to
ten (10) parts of the latter. At the end of one week the colored
blood corpuscles have disappeared and numerous bacteria, re­semblingchiefly
bacillus anthracis, bacterium termo and spiril­lum
tenue and micrococci.
3. Blood mixed with a solution of crystalized (white) sugar.
At the end of a weell.: a distinct fungoid mass with a deep yellow
surface bad formed upon the free surface of the liquid. Under
the microscope this fungus resembled the aspergillus glaucus.
The spores varied in diameter from one four-thousandth to oue
three-thousandth of an inch in diameter. The sporiferons
stems, with spores, the sporangium, mycelium and zoospores
were well developed.
4. Blood mixed with lime water. At the end of one week
numerous bacteria and delicate elongated dichotoma threads
had formed.
September 14th, 7 o'clock, P. M. Pulse 90, temperature
1010. Has thrown up a small quautity of black vomit·. Ob­tained
a large, wide mouth glass jar, of one gallon capacity,
and ordered the nurse to collect all the black vomit as it was
discharged. All hope of relieving the patient appears to be
lost. Urinary suppression absolute; not a drop of urine has
been excreted during the day, and careful examination shows
the bladder to be completely empty.
September 15th, 10 o'clock, A. M. Pnlse 96, temperature
1010. Has thrown up and gulped up during the past twelve
hours about one gallon of black vomit. The patient gnlp10 up
tlle black vomit, which often resembles dark blood, apparently
without any special effort. Tbe reaction of the black vomit is
slightly acid. It emits a foul, putrid smell; th re is also com­bined
with the putrid odor, a uriuons smell. The breath and en­tire
body emit a strong urinous smell. Inten~e jaundice, intellect
clear. The patient appears to be wholly unconscious of his
impending destruction, and was reading a newspaper a~:~ I en­tered
his sick chamber. Says that be feels quite well. Even
as he gulps up large moutllfuls of almost pure blood, he appears
to be wholly unconscious ot the meaning of this dreadful
symptom.
The b~ack vomit wa~ conveyed_ immedi~tely to my laboratory
and subJected to chemwal and mwroscopwal examination.
At 2 o'clock, P.M., this patient was seized with uremic con­vul:;
ious ~ntl dieu at 4 o'clock, P. M.
Examination of Black Vomit.- Uuder the microscope the
954 Origina.l Communications. [June
black vomit contained colored blood corpuscles, dark granular
masst'.s of altered blood corpuscles and h!Bmatin; and the whole
mass literally swarmed with bacteria, micrococci, spirillum
undula, vibro serpens spirochaete plicatitis, spirochaete ober­meii
spirillum tenue, micrococci, and delicate dichotoma threads,
and the thallus of a delicate fungus, the diameter of which did
not exceed one ten-thousanuth of an inch.
When injected subcutaneously into animals, death occurred
in 12 hours, and the -blood of animals thus destroyed contained
numerous bacteria.
I preserved a large portion of this black vomit in my labora­tory,
where it was exposed freely 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:
1st. Eight ounces of the black vomit were introduced into a
capacious glass retort and distilled by heat. The distilate
was collected; it was clea,r like distilled water, but emitted a
foul, putrid odor. This distillate was injected subcutaneously
into a ·healthy rabbit. No marked ill effects were observed and
the rabbit. survived the operation.
2d. Eight ounces of the black vomit were boiled in a glass
vessel for two hours, aud well filtered.
The filtered liquid was theu injeeted subcutaueausly into the
hind legs of a rabb!t. Beyond slight febrile excitement, no ill
effects wer~ observed, and -the animal survived the operation.
When the filtered liquid was set aside in carefully stoppered
bottles an1l removed to a warm room (m.) library) in which a
fire was kept burning during the day, and examined at regular
intervals, bacteria and micrococci were developed in consider­able
number, aud the liquid assumed a turbid appearauce from
their presence. Amongst the forms of the bacteria I recog­nized
those which resembled most nearly bacillus anthracis,
spirochaete obermeiri, spirochaete plicatis, spirillum undulate,
spirillum tenue, bacillus subtilis, bacterium termo, microccus
ure!B, and micrococus bombycis. We have seeu in this observa­tion
that the bacteria reappeared ill the filtered liquid although
it had been subjected to a boiling temperature for the space of
two hours. The reappearauce of the bacteria must be referred
either to spontaneous generation, or to the survival of the
germs even after the contiuuauce of the boilng heat, 2120 F., for
two hours.
3d. 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 excited for some eight days.
4th. The black vomit itself which emitted a foul stinking
odor and a strong urinous smell like the bloody urine of rna-
e
e
1879J JoNES-Yellow Fever .Epidemic of 1878. 955
larial hrematuria, was injected into the subcutaneous tissue of
the posterior extremities of an active buck rabbit. 'rhe putrid
black vomit induced fever aud gTeat swelling of the legs and
thighs and of_ the testicles. Both testicles becam~ ~augrenous
and were entirely destroyed. Tbe lower extremitJes became
ulcerated and most of the hair fell off Tbe animal, however,
survived these terrible effects and is now restored to its usual
health, although the hind legs preseut a bare and a atrophied
appearance.
Oommentary.-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 con·
comitant with or rather consecutive to the ablation of the func­tion
of the kidneys, and to a certain extent must be regarded
as salutary in relieving the blood of an excess of urea and urin­ary
constituents, and at the same time relaxing the pressure
within the blood-vessels consequent upon the failure of the
function of the kidneys.
Both the blood and black vomit contained bacteria of various
species.
The fresh blood was inocuous when injected subcutaneously;
the putrid blood proved rapidly fatal.
During the hot weather of summer, the black vomit swarm.
ing with bacteria produced death rapidl,v; during the cold
weather of winter, the same putrid black vomit excited fever
and extensive gangrene.
We reserve the consideration of the significance of the bac­teria
in the blood and black vomit in yellow fever, to another
occasion.
CHEMICAL CHANGES OF THE BLOOD IN YELLOW FEVER.
I have observed by accurate chemical analysis the following
changes in the blood in this disease :
1st. Marked diminution of the fibrin.
211. Increase of fatty matters.
3d. Accumulation of biliary and urinary constituents.
fThe preceding changes were illustrated by numerous cases
and analyses, which are necessarily omitted from the report of
this lecture.]
We will consider in the next place the changes of the tem­perature,
pulse and respiration iu yellow fever.
956 Original Communica.tions. rJune
CHANGES OP THE TEMPERATURE, PULSE AND RESPIRATION
IN YELLOW FEVER EPIDEMIC 1878.
I desire, gentlemen, in the first place, to present to your
careful consideration the actual observations which I have con·
solidated and recorded in two tables. The first table, embrac­ing
· ninety·three cases, has been consolidated from my own
records at the bedside of my patients, in private practice dur­ing
the epidemic of 1878.
The second table embraces the records of ninety-five cases,
recorded chiefly at my request and direction in the wards of
the Charity Hospital by the resident students.
The third table embraces the records of the respirations per
minute in the various cases.
The letter N, under the head of Results, indicates that the
patient was born in New Orleans; all others thus indicated were
born in foreign countries or in other States than Louisiana,
Tabulated Cases illustrating the changes of the 'fempemture and Pulse in the Yellow Feve1· of 1~78 in New Orleans, by ;roset)ll Tones. -M.l).
let DAY OF DIS.lliA:::!.I!<. 2dDat , 3·~d· D-A-Y-. 4·t--·h DAY. 5..~..1. 1 D__A Y, 6....th. D__A__Y_. -7t·J·i DAY- S~ t- li DAY. 9~L·J i DAY. .l.O....t.h _ _________, ______,_ __ _ ___,_ ______. , _ _ _ ___ ··------·--·- - - 1-- · ---·------·--- -D-U-. -
~~~~~~~~J:~-.~ - _._ E _ _ -.~ I- _.E _ _.M _ ~. -~.- _I__.: _E_ ~.: _· _.E _ _n I:_ _..:: _ _ ~. _'!- ..! :.__I_~J_~ __ i~_l~- ,; I.;, ~ a:. 'D Cl.1 Q.J ¢1 ctl ctl ctl QJ a:> o:t; (tl I ., ':1 ~ ~ h .. .... '"' ;... .... '"' J ... 1-< ~ """ '-
~ ~ ~ ~ ~ ~ ~ ~ p ~ ' ~ p 0 ~ d
I ~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ eo:S l c: o::: ~ = c1 c'! c3 ~~ ~ ca 1
1
~ ~ ~ .... ;... .... h ~ .... ~ '"' ~ ~ '"' h h '"' h
~ ~ ~ ~ ~ ~ § ~ ~ ~ s ~ ~ ~ ~ ~ ~ ~ ~ ~ § ~ § ~ ~ ~ ~ ~ : ~
::1
~
'"" !I Q. s
E"-<
1%) ~ ¢) j I . I REMARKS
tl ... ...
~ 3 E
CD ~ CD Pol CD s::li ID ~S.!2S~S.!E s"' !"l
P CD =' CD ~ CD o::i
~~~a:>~ (tl~ tV~¢~ :t)~ cP~ lP~ <D~ a.:~ (ti~ I Q)~ a)~ Q;)~
H ~ H ~ H ~ H ~ ~ ~ H ~ H ~ H ~ H ~ H ~ H ~ H ~ H ~ H ~ ~ H
16M- · -- l03. i4o lOI. 96 98' sii 98' 8B Y9:'51o2 98.5 7ii 98.s 76 !18.5 so-·-.--- ·- - -- ~- - ·---~--~ - - I I I li{ecovered.
2 30 F 103 105 l l13 106 102 96 IU3 96 101 2
1
~0 102 9U 99.E 82 99.o 68 99.8 ~2 99.8 82 98 76 qg_5 7•l 98.~~70 98.o 66 98.5 60
1
98.5 66
346M 103 99.5 711 99 64 99 6•1 99.5 76 98 67 98 52 60 I 46 I
I~ . ~ ~ .
., I ~ H ~ H ~ E-< ~ H "-0< -- -- -- ·- -- -- -· -- -----·- - -----
I
168
1 9 M 103.1132102 110 102 100 101 1081110 P.•l 9d 80 !IS PO 'I
522F 103 104103 100 !04 104104 96 104.2
1
1061045 98104 . 2100 I O:J.~ 92 100 t6 99 8~ 99.5 78 99.5 80 99 1 80 9R 6~~ £9 64
6 19 F I 102 96 I 735M I l[Jj 110106 IOO I U> 84104 84 103.2 104 104 120104
819 F 105.5 140103.5110 102 100 102 82 102 no
9 36 M JOI-5 to4 101.5 1oo -99.5 78 99.5 12 97 66 98.sl 70 9B.o 1n I I I
IO 17 M 99 82 100 88 !01 80 99 70 99 70 !19 66 U~.4 62 99 66 66 I
11 25F 103 160 100 120
1
100.2 111011rl. 5 100 1110 ~1110 1 102100 l00\01 IOU100 100 102 104101 101 99.8106100 l<'o i100 100101 88
1
100 o8
12 ~0 M 103.5150 102.5130 102 98102 80102 86 100 86 ~9.5 88100 >12100 5 92 101 96 lOi '4 100.5l 92 100.1 ~~ 107 I 94
44
I 98.5 66
101 88
100.4 92
13 ~0 M 102 104! 99 74 99 64 99 72 9~ 72 99 70 H9 60 99 60 91!.5 o81 50 5
144-1 M 101 68 !Ill 811 101 7G lUO 74 102 80 103.2 72 100.8 5• ___ _
15 G M !OJ 146 'tOO 120 101 120 100 116 91 \0? 99 94 ! 9.51
1
108 I II I I N }{ecovere<l.
99,2166
fil
1100.5 60
16 19 M 102 138 • 9H 88 90 72 I 98.5 74 9S.!i 60 I 1
N Recovered,
17 6 F I 102 158 ll ·O.!i, l20 I Reco,ere<i .
18 3u F 1104 !26 103 1\<0 99 94 9Y 86 , ' N Recovered.
19 22 F 11u2 158 101 100 99 94 100 5 84101 88 99 I F8 09 5 96 99 .2 76 99.o 70 99.8 70 74 741 99.21 6'i N Recovered.
20 6 M lO.l 120 112 110 108 108 92 90 84 82 N Rt•cov•-red.
" I 8 M 102 164 100 148 101 112 103 120 I 10.J.2 104 102.5 1112 103.2104 102.5 102 101.8100 N Recooered.
22 t tl Ml 101 5140 99.!i 74 ~19.5 70 99 5 54 9e-2 52 I I N ){ticot·ered.
23 II F 103 156 1101 2 108 101 102 N Recovered,
24 8 F 103 2142!03 9150 103 134 104.2132 103 513•1 104 /l oO I 1 I N D, a1h 4th day.
25 6 M 102.5 1:l8 102.2110 103 120 101.2 102 99.8 84 9S.a 74
1
, N Rec,verH•l,
26 28 F 104.5 112 1 104.2 88 103 80 too 74 I I , d) Deal b 6th day.
2723 Ml 102-2 96102 94 100 68 IOO.o 68 1101.6 72 102 70 101.8 7~ 98 51 581 98.8 64 i Kecov•·Jed.
~8 25M 104 96 104 90 101 92 Ill! H4 101 82 102.~ 82 102.8 9:! i102.6 86 RlltO'I"CJ"eu .
29 ts Mlt o4 1341u4 t34 103.9 1 011o~.2I02,1 0 t.51 g;; to2.2/1o4too.4 86 1oo.3 84
1
u9 6 i~ 99 6 98 99.2 861 99.5 78 9a 12 99 701 1 R•'coven11l.
:JO 13M 103.2128 10:1.2 128 102 108 1112 841 102 P·l ,102.8 10-l'l 103.5 98 104.5 102 ! Death 10~h day.
:n 25 F 104 12U 10 1.2 90 10\!.4 94 100.4 7~ IOO.e 90 100.81 02 U9.5 76 99.3 9G , / Hecovemd.
32 30M 103.5124 10 1.5 92102.8 So 103.9 88 104 .6 92103.3 8810:1.5 92 103 2 90 101.4 90 103.8 90,101.8 88 D, al.b. lOth •lay.
33 20 F , 10'!.3 l3U 104 104105 130'105-5 102 IO!i 'I 96 103.5 84103.8 HOI I I' >el Death 5tll day.
34 9 Ml 103 128 103 128 100.5 106100 106 99.8 72 on 5 80 ~g_;; ~~ I N Reco'l"ered.
35 18 F 102.5148 100 80 9.18 76 I I Recovered.
:16 38M 10.) SO 103.E 70101 68 IOU 5 6o i
1
Recoveree\.
37 15 F 10·1 120 101 72 .11•0 70 99 hO , 'I Rer.m·ered.
38 ll F! IOfJ 130 106 140103 110103 411211 10; 211261i00 2 11611!1 5 102101 I 100 99 8 881 99.4 84 "" oul
J9 I~ F · 1 104 11 lO 105 13b 104 144105 1461 I I I
40 29 M1 104 108101.2 88 100.5 98 Jfll 9B 101 8 88 102 2 81
1
101 ~ 8s!1o2 leo 101 8 82 ~~ 5 121 99.8 68 100 2 66
4117F l 102.8116100.8 96 99.4 76 99 88 I 9921 74 ' I I 42138 111 105,21.60 1!12.8 104 106.2 102 JU5 98 104 2, ~8 104 2 9ol t04 5102 105 6106 I 1
433~ M 102.5118, 103 961 04.6 U6 104210211052 88 1048 86105.2 86
14136 Mlll1.5 10~101 96 99.8 104 99.8102 101 10010251 84 101 9111 110 1 51 94 0!2 921026 94ll03 86 102.5 881 02.2 ~<' 10\.S 881
4528M 101 1 02.5 10~1028104 1 02 76 102 76 10;)8 6~1 02 . 2 72 103.2 1 81 1026 72 1UI2 661
1
102 7, 101 60 100 nO
4629 M 106. 14U 104 90 ,
1
10;; 811 104 Rl 70 103 5~ 10.1 ~ 60102.1 64102 5 ~~ 99 5 84 _ "-. •• I I
47:12 ll IOt.o ltl6 lOt.~ 80 101 2 72 IPO .. 64 I 1004 6c 99.o 60 . ---- -- ____ _
-- -·-- - +-- --- --------- ------ -
'al Black vomit 4th day. (b) Black vomit 5th dJLy. (e) Black vomit nth rl"'Y· (d) Black vomi t 5th day. (r) Bl:tck Yomit 7th li:t.f. lfl B l acl< vomit 3d day. (g) Urinary suppression, black vom!L.
f h ) Urinary snppression, hlack -.-emit. (il Black vomit 5th da_1 N . ~~rrtiYP. ofNe'~ Orlen.ns.
1l'able of 'l'empemture and Pulse of Yellon Fever of 1S7S-Colltin·u.ed.
1st DAY OF DISI!ABII. 2d DAY. I 3d DAY. 4t h UA-Y.-- I 5 h lJAY, I Utb UAY. 7tLlJAY. - 8thlJAY. 9Lh OAY. lOth DAY.
---~~~~~~~~~-.!':.--:-!:-=-~~ -~- ~--~ _M_ -_E _I :u _l~! i-_M I .E _M-, __ E= .M=-~E ___ M ____ E __ -_M __ E-=
.. e f e e ~ ~ ~ rz. ;:::1 =' 1::1 ~ ~ ~ e1::1 !f::: ! fp : e;:::: ~~ ~ c~ ~ p~: ep 1 ~~ ~~ E~ E~ ~;::::; ec ~~ 1 1 RE•M AUKS.
~f ~ f s e e e e E ~ e ~ e~ "E ~ ~ ~ ~ ~ ~ f f ~ ~ Q;) • ~ • Q;l ' • 001 . , Q;l • a,) Q;l QJ q;> ~ Q; • 0 Ctl ~ Cl,} • Q) • Q,) • Ill • Q;l • l; •
""' ~ ¢ ~ 4:1 p.. I ~ ~ ~ P1 4,. p. <:.' ~ i :0. 4) I=.. i ::;... a) l ~ (1. ~ i s::. a.) ~ i p.. <tl p. ct p.. 4. A 0 p.. Q,.. ;::l,. Q;)
~lP-a !:a ~S · ~a :!S ~a ~S 2:-S .!!::.5 !:8 .!E.E ,!!..9 ,!:;S! .!!!.E ..!!:!S .!!:.2 ..!.8 .!!:.::; ~8 ,!!:.::; .! z ~] ~ ~ H If H ; t. H If H t, ~ ~ H ~ A ~ H ~ ~ ~! H ~ ~ ~ -H ~ H ;E H &: I ,:; t. ~ t. H t. H ~ H £
48 3ij ---- t04. :ii7a--·,- - ~.3-l:io-----~-123 ___ i(iQ.:ill2 ____ iOI. i1ii'--io2.1 1;4 ---~ yg::~IQ;--- ·----·---------- ------ Heconrerl. ---
~u :lo :\1 102.5 112 101.5 92 100.2' 8~ 107 71 100 9l 80 100 86 101 90 101 95100.9 82 1101.2 go·
1 ·
101.5 90 100 82 100.8 BO 100 2 tO too 76 99.5 70 Reco• •·reel.
50 26M 114.2 140 101.5 80 I 99.5 72 9~ 70 I I ;.r Ke• ·on·rPd.
51 6~ M 10~ 1120 ,lv2 1 ~6 102 100 102 94 102.8 104 1102.2 gr., 102 96 100.2 82 101 5 64 99.3 68 N lle<·overerl,
52~~ F 102.5 114 10'i.4101> 105 120 103.J 9~ 101.8 84 102-2 ~1- IIIII 861 IOU.8 76 99.5 i6 (a) Re•·o,·erecl.
53 4;, :\1 10~.2 9~ l102.o[ 74 I 10~ tifi 102 6~ 102.2 62 !0~.8 G6 102.4 6G 101.5 !'>8
1
103 56 H8.5 521 99 5~ t00.8 64 Recov•·•·ed.
54'HF lU~ 110:101.8106 , IOUI08101.510~ ltL6.2!50: ib)NDie<l~thday.
55
1
20 M I 04 JG2 98 621 • , I 1 I Recovered.
56 26 F 104 1~- 99 90 UU . ~ 98 JOa. dl t24 I 99 9J 99 94 .103.6 124 99.5 100 98.5 96 Recovered.
57~7 M lOG 150104.2113104.5 112,!03.7110o 109.t l 88 tu0 82101 91J1101 >16 1 I 14 (c) Died 5th day.
58 oO :\1 1 10:1.8 90 92.2 6<' 100 74 l{ecovered.
59 "6 F 101.5 158 10l.515a 1101.~ LU2 I 98.r. 76 fl8 82 9E-2 76 98.2tOO Reco.-ercrl.
60 4:'> F 102 130 t0~.5ll ~ 10~.2 72 I 15 D1c<l 4th day-
6!3:1 M 102 106 lOt 96102.4 94 103.5 % 101 88 101.5 78 99.8 72 99 . ~ 72 99.8 7~ 99 2 60 99.2 611 99.6 58 99 ·5 5? 99 !\4 Recovered.
62:16 ,\J t0~- -8 114 10l.~ll4 10~ IO~·JOl.JI 96103 9H t(l2 102100 .. 1 86 9>1.:1 76100 5 76 99.5 fi8 99 76 U".4' ;ol 9~.5 6ti 1 62 56 54 Reco..-ererl.
6357F 101 144102 112102 1 t0<1 l\13.51 221 10~ i02 1U2 1102LU05 HoiOO . ~tU2100 110100 102 >)9 88 99 i~ Recovered.
Gl ~2 F ! 104 2 130 . 100.5 1021 99 100 Recoverurl.
6530:1{ - \lO:t .r.J361100.J 96103.5 9G 103.21
1
96102.2 92JOL 88!01 78 f\9.4 76 99.3 82 98.3 71 98.5 74 99 741 1 98.5 75 R.,covererl.
66 15M 101.51 96 9<'.8 56 99 40 99 46 99 H I 1 103 138 103 13B Recuvered.
ti7 !9 .'<! ' 100.4 8l 99.9 80 I tOO 76 99 76 99 76 93.8 ~6 98 .8 60 100 lCO 9R.4, 90 Rerovrre<l.
68 5~ MILO! l2ll 10l.8t20 101 '1~-1 lllo 1114 1 roo.e 1U4 10 1.2 go 101.~190 100 6 g:; U9 92 98B 84
1
98 1 82 9o.6 e6 j N Recovered.
69 2< M. lOt 98 100 90
1
66 1 56 :;~ 58 60 1 N Rero-rered.
70I5F 102.d124 102.51ll8 L02.2 116L03.8
1
ll,810:l.8108 tO;,G 8:! 101.6 941002
1
9 .. !00 82 99 .; 8~ I ' Recovere<l.
71 1U .'<!; 10J.4 1:1~ 100.21109100.8 1111 99.~ 94 99.6 7U 9Y.B 7!• 98.4 75 9~ . 8 75 Recnvered.
72 8 J;' , lU3 143 t05.5t>v 101 10> 102 5 100 101 96104 104 <d) N Diorl7th day.
7319 .1{1 104 !28104.8 llol02. 8118 LOUI120 104.5110~ 102.R 10~ t02.5 96 106.5171 101 6rl 9 •. 9 64 98.8 60 9U 641 99.2 G5 9B 2 62 99.!> 6:! 98 4e 98 58198.7 !>~ ·96 52 N Recoverer!. ·
74 6 F 104.5 IJ2 104 . ~ 12.1 101 100 100 90 I N Rero.-ered.
752:! F !tm.t !~3101.6 126100.8 66100.2 so 99 8~ ; 99 2 so Y9.b BR u9 o >e 99.8 96 98.8 76 9d.4 ~0 Re<~overed.
76 8 F ' 102.515<101 4 t20 100.6 !22103 99 1 gg 06 U9 90 '1 N Recovered.
77 6 F 104-510210l.81•4 100.8 12~1 102.8 130 ~6.o 10~ f\9 10 1 N Reco,·ered.
78 37 MI10J.51061012l04 100.8 9~ IOU 98 99.8 71; 100 gr, LUO.:;I 76. !00.4 70 "9o.6 tiS 98.4 68 98 , 6ij Recovered.
;g ~ F 1 103.5152101 -4 1~0 100,6122 9Y.i! 102 99 9v Recovered.
80 9 l!fl t04.11281U4.312<l 102.2130 t03.5 !12 t00.2 14g tOO.~ US 99.91 gr, 100.2 ,o 99 8·1 99 e6 99 861 N Recovered.
81 72 .'<II 101.8114 100.5 83 99 98101 1113 1015122 99.6'112 Recovered.
8< LS F 109.5 t34 100.2 92 t07.5 96 101:2lld 101.2'115 10' .1102100 108 100.2 104 N Recovered.
83 9 .l! jL01.6132 103.5130100.5 92100.5 98 99.5 98 99.2 99 98.4 80 98 04 9d 176 N Recu'l'cred.
84 39 M: 102.5 tOO 99 60 99.8 58
1
, 98.5 60 100-5 56 99.2 60 Kecovct od .
~5 3 F I 105 160 103 t52102 !40 102 140 104 t60 tel D oell 5tll day.
86 23 F . 103.~ 134 101 roo 99 80 • N Recovered.
87 Ill Ml 101 174 99.5 92 100 H8 'I Recovered.
88 28 F 1101.8 l t2 98.4 78 99.2 7~ I I :-< ltecovercrl.
89 2 F 103 18U 102.2 !60 LOU.8 138 100.2 !40 :-.' Recovered.
90135 F 102 5 156 100.9 104 100.1 LOU 101.2 96 I :-; Recovered.
91 18 M 101.4 144 103.5 LOO 101 90 Reco.-ercd.
92 II }1 102 156 Reco\·erotl.
93 45 M 104 120103.2115 104.5 Ll5 103.5 108 103 100 164.51100 I l{ecovci·et!.
(a) Black V"()mit. (b) Sudden rise of temperature. (c) Black vomit 4th day. (d) Blaci< vomit 5th day. (e) Black vomit 4tllday. N. Native of N~_W. Q.£lru:tns.
Tabulated CasCJJ_illn.,tl'fttiuy the Clwnycs of the Teut~>e••rrtul'e <t'lld Pu.lse ·i•• YeUow Feve•• of 1878 in New 01·leans, eo11soli<Iatert fi'OIIb Ctinlcttl Ch<n·ts of Ch<tl'lty
I / I J [ ,._w, c <cu.
·----- • ~-"· '"' ouuuen rJse of temperatm·e. (c) Black v~mit 4th day. (d) Black vomit 5th day. {e) Black vomit 4th day. ~- Native of Newl OrLans.
Tabltlrtted Cases illnst1'ltUn(J the Chanyes of the Ternpe'J•atu1·e ltnd P.nlse ·in Yellow Feve,. of 1878 in New 01·leans, cou;oli~latect f, ;;;:-CU.niclr.l Clu.r•J•ts of Oha·•·ity
HOSJ>'ital, by Joseph Jones, III.D.
~~~~~rm.~-~ -WDA~--/--3dnAv. _ _ ,. 4th n_~/ · 5t.h n~v, I 6th DAv._,~h~A:::._-1 8t~ DAY._=-1 9t~ DAv._,~thoAv. __ Morni'giEveni'g M I E I M E M I E ---- ,_ ___ , ___ , _____ ,_ ______ I M I E M I E M I E M I E M I E M I E , ___ , ___ , ___ , ___ , ___ , ___ , ____ , ___ , ___ , ___ , ___ , ____ , ___ , ---
(tJ ~ (J) ! ~ li e e ,;
ci tr. ~ 3 z I ~ E .& ;:; W M -+01 .j..;l -+'"' +=o
('j ~ cfl c6 CIS ~ ~ 0 (1,) ;... ~ ~ t-o "' "' .. ;., ~;:.-. 8. cr~ d)~ l <t)~ il ~ ~ ~ d ~ ,; " ~<P-e .!a ~s ~s .:?) i3 s :E a ~ i"3" Z~£~ ~~ ~~ ~~ = Q) ;::: <P -; il< " il< H il< H"
,; ,; ,; ~ li .; ,; I e
;., ;., ... i ,; ,; ,; " ... ;., ... 3 ."., " E " B B " ~ a I RE>IAllKS.
"'
..,
1;l
""
.., "' " " "' :: "' " 1;l ;., ... ... ... ., ~
... ~ ... ... fO ;., .;/ ~
.,
,; ~
~ " ~ " ,; . ~ " ,; "' ,; " I~ ,; "" ,
"" " "' A p. .~ ~ .; A A p. i p.
:E e "' s "' a s ro " a "' s "· 8 ro 8 w 13 .!E s
p:: ~ = " -; " p:; " "5 0 ~ " -; " -; ~ -; ~ = ~ il< H il< H H il< H H il< H il< H il< 8 p.. H
1U3
~=1~ ~- - --· ------ --· - - --- --·-- ~ I ~ ~~~
~~ ~~ i 98.8 96 rot 100 102 81J:·I]~~~ ~~no }~J J-}~~ 7,9; :g ~~--~--~-~--~-1 ·-:-1 -·1-1-· 1-- -·-l--l·-l--•-··--··--··--··-·--·--------
97 37 F IO•I 1oo 101.21 ~110311oo111o2 88tU4 1 92 1o4 3 96 to;; 5 96 105.5110 106.5 136
101.5 99.5 99.5 101.3 1~1.8 ;103 100 5 1102.4 101
Died 5th dav, 111o.
(a.) Died I F.th day.
tb) Died 4th da.y .
98 5;, F I 104 94 lfl3 80101 74 102 6 78100 2 74 100 80 99.8 90 IU3 108 104 116106.5 156
99 22 F 101 106104 1011100.61 80 101 I 62 100 fiO 100 52 99 .5 60 98.8 52 99 56 99 60 I
100 28 F 103.5 120 103 112 102.4 94 104 100 104.4·100 104 1100 10:1.5 o811l2.8 92 101 88102. .5 9t 99 SO 99.5 80 99 SO 100 S0/99.3 80 99.2 B2
101 19 F 105 104.8 104.8 10151 10~ lOO.R 10 1..4 101.6 101.6 1011 .3 100.7 99 .4 100.2 98.5
102 26 F 102.4 104 102.4 96 104.5 90 10~1.5 82 101 64 102 7G 99.5 72 100 80 100 74 99 72 97.8 72 99.3 92
8•1100
99.5 98 8 98.5 98.5
103 38 F I 1102 5 92 103 90104 108 10~. 5 96100 93100 100 98.8 90 99 ~8 99 90 99 88
104 24 l!' I 105.5130 104 llO 105 108104 11Uf 104 11~ 104.5 128103.8 I 1o:; 34 F 104.7112105 108'1o4 92 1112.6 s.> 100.7104105
I061RF 1Q:J510UI125 961 102~10L 1 102 92101!\ 94100 100 995 90 98.8 90 99.3184 995 80 98.7 84 99 !' rl6 995 80' 99
IU712 F 102.!\ 120 1015120100.5 120
1
100 21108 101 51112101 98 100 100 99 o 100100 4 100 100 4 82 101 6 100 101.6 100 101 0 112199 S 9U 100
108 17 :F 101 120'100 5•104 IIIU 104 100 94 101 S6101 3 S4101 3 86 100 7 SO 101 80 101 ~0 101 SO 1UO 5 70 99
J093tF t02510iiOI2100,9931 92 995 9o 99.2 90 996 94 99.2 e410o so 99.8 s6 1oos go1006 AOJOO 8oroo5IOOI99.3
11!1 ~4 F I 103.5IOS 104 4110104-7 104 103 71104 1115 ~ 80 10~. 5 80 10 1.4 101
111261r 1 11~711~105 1056 10:\8 96IO:J2 88100.n 80
Ir2:JOFJ 1 0~.a1 uo1 oo.r. B8;oo8 80LO J.6 75101 suroo8 78tuo Eotoo 89 99 9210o 90 99.o 98 99.o
JI324F 105 104 BSIO:l 100102.5 96102 88 10l.E1201U2.61114
1141BF 103.81:J2LOI 124103.S 1241U4 120104 10~102.41121102.4104102.41201028110101.2104100.5 S8 I I II Jt517F I 104.5tOOI028. 94101.0 80 99.2 80 99 80 I J./62Es]!' 102 120102 96 99.5 681 99.8 64
ll715F I 1102 LOU 101 9Sl01.4 06 98.8 88 ~)9.7 S6
1 18 37 F 1 o~ 4 84 rg. 7 ss 1 oo.6 S6 99.5 78 98 5 72 f8 68 98.5! 68
\1943F 995100101 IOiilOI 96101 9<100 9~100 88 99.e So 99.5 gS l 9.5 88 99 106 99 84 99 . 92
1202711 lOU.6100100.7 102~ 76101.7 fi2LOI.5 64
121 45 F 99.5 99.2 94 9S.8 90 101 100 99 94 99 lUO 98.8 90100 98 99 o ~8 99
12<!48M10:l lll3 1015 86
1
100.2 96100.918·11.02 00101 91102.6100100.9 101 99 99 90 98.S 81 98 98.5 107.2
12328 M 104 6 1104 10~-410510J.fi10•llU1.8105102 104101.5102101 S2 99.7 84100.5 99.5 100.5 100.5 100.41 100.8\ 101 1100.4
124 30M I 102.5 66 102.5 70101.5 82 IOU S41U0.2 84 1.00.8 80 99.7 7S 99.5 79101 72 !GO -,,. 98.8
12516M 1025113103 124105 122103.3112102.7103 99.5 99.5 86 98.5 99.4 80 9S.5 7c I 126 25M 104.5 lOS 104.211JO 104.2 86 102,5 \01.5 86 \00.5 80
127 25 ~I 10.4.5 Gil 103 75 103 8 66102-4 57101.7 68 99.8 70101.2 88 1110.5 102.5
so 99 811 99.4 76 95.7
IOU 95.8 e2 9S.5 80 94
68 98.7 cs 986 60198
80 99.2 ES 99.7 88 99.2
I
SS\ 9B.6/10 4IIOI 11081
I
130 ~~ M 103.4 IU5 1 111!i.6 112 104 103 7 102.8 90 J 03.5
8726 19998..74
5o 9a .. ;
84 100
Died 6th <lay.
Died 8th <lay.
Recovered.
Reco-vered.
Recovered.
Recovered.
Recovered.
Died 5th day.
Died 4th day.
84/(cJ Recovered.
84 Recovered.
471Recovered.
84>Recovered.
Death 4th day.
(cl Died 5th day .
Died 9th day.
Died 4th day.
Died 6t.h d>y.
Recovered.
Recovered.
Recovered.
Recovered.
Recovered.
Recovered.
Recovered.
Died 9th day.
100.81 /Recovered.
70\ 9U 72 Recovered.
Recovered .
r d) Died 7th day.
Died 6th day.
Recovered.
Died 5th day.
12s 4t M I04 J03.5 10:!.7 101 1 102 99 6 too ~·a.8 99.2 98.s 99.4 99 99 1oo.5 99.5 I 129 38M 103.5 \18 102.;, 102.;; 102.5' 101.6 90 1114.6 I .
131 24 M 104 101 I 02.5 92104 S9 103.tl 96103.5 Btl 101.-5 96 I 02
132 46 ~~ I I 10:1 ~Sl01.7 8~ 103.H 94100 90 1110 I S6 99.5 80 99.5 g;, 99 4 84 99•8 92 98.4 8G 99.3 84 98.3 H6, 98.7/ 84\ 98.2 m~~ :~ 103.2 104.'' 1 33l~t~ 106 ~~~.4~ l~mn 89
135 4;, Ml 102.5100 IOI.e 102 105 112 103 IU8!113.g 104 !12104 2117104 131 IO!i 140 ,
Died 6th day.
Died 5th day.
Sol Recove1 od.
Died 3d day.
Died 4th day.
1:l623M l022 102 82104 77104.2 Sf \04.2 ~2102,3 SB I022 l02.S ~8103 92102.5 801102.31 9911021921>04.6182 Died 5th day.
137 47 M 101 103.21 101 74 100 71198 70 H8.5 79 I
13826 M IO:l.5 S2l04 103.2 74 104 S6 SO 101 7d 100 72100.5 100 64100 66 99 60 98 5 60 97.6 56
139 30M 105.5 98 103.5 8:! 104 102.5 80 102 74 100.9 74 101 94 ·
14020 M 104.8 108103.8102104.3 90 103 92102.7 .10 99 82100 82101 90
14129 M 102.2 s~ I00.411SI\02 87 to~ 86 103.3 8ti 102.s 90 101 12101 I Ha 76100 66 98.31 6Sit00.61 76 1100.6\ 791102 1 /101.5: 801101.81 861102.21 82[12v.•' 90 102
58\ 90.5\ 51 \ 98-o 99 98.5
(a.) Black vomit 5th day. (b) Suppression of urine. (c) Black vomit. (d) Black vomit 5th day.
Died 7th day.
IIDie<l 6th <lay.
Recovered.
Died 6th day.
Died (ith day.
901102 .2 90 Died 12th day.
'l'ttf)n/trff'tl t)m"''"' illttRI'rtffin.tJ flu· (.'Jutnfftlll of the ':J'etttJJe1'ltt ru·e fuUt Fubut. ·in Yeltow .l!'cvt!-1' uf l~j1S in NeuJ Ot•ltatt•, consuUdat4ul fJ'o'ln Clinical Cllat•t_. of Oha1•ity
Hosp-ital, by Joseph Jones, JII.D.-Oontinutd.
-is:~AY OF lJlOllAS!t. i!dDAY.- --1 -::fol D~Y- -- ~ -~~~~~--5-t~~2_ ~~~-~~~A::_ _ _ 8_l~ DAY._~~ DAY. _ ___:()_tb DAY:__ lltfo ~~~.::__
1 ~~rni~ ~~~~ :-:r.:_-~-~--'-:-r.:_-:-~-- ~-~ ~- ~- __ _!"_ ~~ ~E- ~M- --~ _ ~-~__;_ ~- -~-- ___;:_ _ __;__ ~ -: E
~0 e f: ' f je ~ e f f e ~ ~ !: f f /e ~ f e ct) f f
!l .; ~ " " I " " " • ~ e e e 1 c " " " " c " " " " " " " " !3 " " I I REMARKS. I E ~· E E ~ ~ f f f ~ ~ e ~ f ~ ~ ~ ~ 0 » G I ~ • Q: ! . IV . , QJ • C) • ct) • cp aJ Q,l ~ • Q.) Q,) • 0 • ~ • Q;) • Q) • Q;) • Q;. Q;) • a) cD
~ p,. ~ &:i cD PI< Q;) 1=01 Q;) ~ cD ~ Q;) ~ Q;) ~ ~ ~ i ~ !l5 0.. ... ~ Q;) ~ cD ~ Q;) p., Q;) p. cD ~ ~ ~ cD p., .... ~ Q.) p. ~ p.. l.;
~"-~ "'S !iS !!S .!:6 .!':6 .!8 !!6 .!iS !:6 .EE .!!.S .!iS .!:E .!iS.$ E .!8 ..!'S.! 6 .."'8.! 13 ..!' 8!!
0 ~l )oC CP "2 cD : ~OJ t: cp ~ Q.1 F Q,} 0 ¢1 t:' Q;) :::1 Q.l : OJ = IOU :: a:> : Q;l ~ Q.1 ;:: ~ :::: ~ t:' «< 0 Q;l t= Q;l t= Q.1 = 1.: «:~ ::::1 z -'1 ~ H P-o H P-o i:-i , ~ H P-< H . P-< - . P-< H P-< H P-< H P.. H P-< H il. H il. E-< P-</ E-< P.. E-< a.. I E-< P.. E-< P.. i'-< A. E-< P.. E-< il. E-< t_ E-< il. -----· ---- ------ - -· -- --- --~---- - 1-·------· ---·--·-·---· -,---------·---· -- ·--- --·-- --·----·---- ---
14235M104 114!05 10210:1 I 104 80i03 96104180
1
102.4 901 10~.6 8011J1 9• 1025 ~11111 • 1.5 92-10l.2 90101 H 1110.5 7~ 98.5 70 99 71 99 69 99.5 67100 6>'1004 681(0.8 641J110 / 621<ecov•red.
!43 1:1 M 120 104 1(}0 ~9 9G 100.2 84 100.4 87 9U.8/ !l51LO-~ 98 101.5 96 IO~.o 881L0.5 84 1 10~.2 67 100.9 84 101.5 99101 8 106102 99 101.5 12Ulll3.6114 102 118103 '108 D. 21Rt. clay
144 33 M I 03.51 R8 103.5 ~0 lu~ iS' JO;J 78 104 I j . D. 5th clay.
1453i'M [ 110 •. 2 84 103-4 90104 91103.5100103.41071038125103.712~102.11151042132 I D.9. h,lay.
146 4f• M I I I JOJ 2 7fi 101 6 JIL•7 5 1U9 105 I D. 6th d~y.
147 28M 101.3 103.6 104.6 lfl~ 102.2 103 J10J.5 101 10:3 D. 5th <lav.
!48 28 y 103.8 88103.5 84 10:1.8• f8 100.5 881 1 I 1 tal D.4tb d.
149 M 10:; 105 5 92 104.5 80 104.9 88 101..'> : 801101.4 6e 101.5 7;; 104 [ D. 5th clay.
15•154 y l01.5115:!1J2 ooJ02.5 961ll3.4 961102 soto2.7l 7oiJUl.2 881111.6 8·1101 78, I02.2Jo.-.tuo 921•'05115 ! 1 (b)D.7thil.
151128 M 104 96103 s 9~~1o2 8 72104.;; 90101.8 90/102.71 G4 99.8 60 9Y.B 70 !lo 8 .'>6 9cl 54/98.5 78 9o.5 5o 98 54 98.5 54 1/ 60/ 56 U••·nverHd.
1105o3 1:l~MM I 101.5 llii lU4 6 IU2 10J.6 IOO.o ~d.:i D. 5fb <lay. 10:1 JJ4104:iJ20IIl:' .d lOOII04 104110J.511oOtO.!.OlOPI027 92olO:l.:il04l:ot.4 90102.9 9~tro.G ~8101 90 996 72 9~.9 7i! 99.3 72 99.8 7Pif10 72100.o 72100 78101 fiG Ti e•·n,·er•il .
JS·I3RM [to2 102.8 961011 90101 80102 7olli1 1.8i ~4102.2 66100.8 7AI01.7 66100 s•IOl 7dl025 104 105.2 104.5 84103.6 7~105.5 9tlll lOti D.9thil"Y-
155~GM 1 10~ lO:J5JG6lll4 104.2,8H IOJ5! 94101 99 j I I (c•D.4tbil.
1;,6 M 1 100 72 too.5 100 go :02 80 9~.5 eo 101 78 100 12 100.4 . 97 100 98.7 7~ 101 79'1ou 80 n. 10 11 •l'v
15725 M 104 104102 96102 IO•IflU1.6 96 103.5100102.5 8-1102.8 84 101.5 8-1 10 1.5 Y2 102.:; ll011u1 ~ 101 1061"2 D. lith d'v
158 18M! I I 104 100 100.51100 lu1.8[ c6 IO:J 9210~ 96 101.3 U6 99 I 94 100 lsi 100 54 9~.o o7 99 44199 5{) 99.6 40 97.5 44 99 481 9o 4~ 101.41 4~ 99.:! 40\ !18-4 4111Kecovuod.
159 Mi 10:1 104 124 104 • 101.3 8G 102 84 102.l 103 6 100.5 ,;o 101 98 11 •0 f>2 98.5 fi9 !19.4 70 9!1 100.3 711: 99.:i 72 9d 6 7-J 9~.4 6li/ 99.8 i~ R1 co..-ore<l.
160 40 M; j 102A J03.9l• 101 ao 102 1o2.5 70[ 1o1 6610t.5 101 l 102.1 1110.8 111o I 6o 100 / 98.< 97.o 54 Y9 44lll•o /5o na .. ; 54 96 au too ,;o Reco'"'"'l.
161 Ml 101.5 sa 111~ 101 99 101.5l 10:1 102 100.5 97 101 I rd1 ll .• th <1.
16~ 29 Mi 104.3 94 103 90 103 1110 10l.9 100 I 1 1 (el D .5•h <1.
163 M I 104.5 105.~ 90 103 10110:1 100103 107.2 ' I lj)DGIJtol.
16420M 105 80i04.5 104-5,76 10:1.7 RO IO:J 80102.4 761025 lg)ll.5h•l.
165 Ml I 1U2 i 102.5 76 104 102 58 103 103.5 104 50100.5, 52 101 5• IOO.t; 60 100.4 58 99 I 100 08 100.6 · •/11 ,t,IOth ol
166 IBM IO!l 104.5 ~ 105.51·10 103.5 11:3 101 110 98 128 98 5 •it D. 5th d.
167 M 104 10~ 101.5 103 101.5 ' IOO.f>1 IO'! IG!.31 Il.91hday.
IG8 :!3\oll 104 100104.510410!i 1120105 10d107i 1os;o2.2 961036 9G I02 ~R I03.5IOO IOO.!ll0011'0.4 80 9<:<.o 80101 103.7 10:; 8·10o.2 8~1&3.·' I, D.911tot,.,._
169 11 ll : _ lm.5 1211 106 120 105.8 120 102 116 102 5 10o 101 116100.5 1 0~ 10.1.5 108 101 1118 U3 .5 108 100.5120 IOU 128 IOI.:-1 l:lr< D. 9th <lny.
!7035Mi 104.ol22102.81108IIU3 [too 10l.5 88 10l.5 92 98 8o P9 84 9R 78 9R.5 81J 98 ne1 98.5 64 98 64 9~ oO 98 1 68 78 fi4 98.5 64 100.!'. 08 99.2 68 99.41 ~4100.5 99.2 72Rccovererl.
171 Ml 101 101.5 102 102 2 102 99 I IHrcovo·t <'d.
17~ 19 \I 102 9& llt3 101103 100104.8 11·0 lQ4.ti 1011104.5 92 101 !IGIOI.5 9·1101 G8
1
10l I 72101.1 64 99 5 56 9d.5 .56 98.5 64 99.5
1
- iO Re...ov<•red.
173~1:\1 101 12810:1 10t1!0:1.6Ll6 103.6 98104 101102,i 9~102810~101.4 92 J\. 6thda.y. n• :!3M 104.2\15 105 tt5 10• 104104 96 1113.5 93 103 94 LtH 78100.~ 6o/ 99 4 701110.9 101.3 n. 7th cl":v-
175 21 \l 103 10~ 103.5 104 102 •
1
. 96 I 03 lOO I 03 9fi 1113 5 9:1 100 8 n2111 0 l.H 9Q 99.2 68 99.6 80 98 76 98 72 99.4 72 94.4 88 99 -4 72 99.5 7~ 101 li4 101.2 80 I 00 64 99 76 Recovered.
176 :!0 ~{ 103 8 Sl 101-7 72 103 n 101.2 72 Lfl2.5 76 101.4 76 101.8 72 ~9.5 6" 99.2 72 Recov~red.
1n 32:11:104 100104.2104 JC4.2 9~ 103.8 Bl 103 92 102.5 1u1 103 I n. 5th day.
178 :)3 ~I l114 .8 II:! 104.8116 103.5 10~ IOI.r 104 I D. 3rl day.<
17928:11: 103.811610.5 110101 I 92104 94103 921031 91100 n D. 5th day.
180 14 ~1 IOJ.5 104 1U4 710~ 10!.2 109 1114.1 96 101.3 102103.7 98 l~l :1 92 101. 8. 100 92 100 104 1111 88 101 120 D. 7th day.
JA I 2<' M I 104.E 111 4.~ 101 104.2 103.81 105.8 102 103.~ 101.3 llJO I D. 13t,h d'y
l8~4oY 99 10~.2 101.5 10:;7 103.8 104.5 103 102 1.:05 I D.6thdav.
1E3il5 M 103 100105 90 10.'.2 88 105 82 101 72102.;! 72101.2 60 10n 99.:; 5~ 90 .2 49 46 40 43 51 4b 46 42 R<·covered.
184!311 M 104 104 104 ' 103 101.5 81102 71~ tOO.S 7G 101.8 80 100.6 80 101.3 80 D. 7th <lay. 1B~iso M 10; 102.5 66J02.:l 104 21 68 10:1 66 103 n:, 101.8 62101 5 Gli 1017 70100.8 66100 99.6 99.6 99-;; 100.1 100.3 109 98.7 99.61 99.81 99.8 Recoveren.
1861~6 M 104 115lt)L7 90 104-~/ 100 lOt.:i 1U4 104.7106 101 84 104 110 li13.G 1041•·2--l 90 10< R811:2.3 ~210l 881011.2 901111.2 ~0 99 7fi 98.5 99.5 1 Ret·ovot·ed.
187126 M 102 168l03.5llsll02 1108105 120 100.41
1
! 04103.5\80 100 3~ 100 I 90 H 9~.5\4:. 98.5 80 98.!\ 6j 98.5 72 9B.1l 70 98.5 H 98.6 68 98.5 94 98.5 74 98.7,100) 98.8100199.41JOORo•co,er<d.
188'22 M I tu:l.2 105 107-ij 101 10~! .5 101.6 102 100 100 99 1 1 I llt•ro,·~rcd.
(a) Black vomTt- (b) Black vomit 6th day. (c) Black vomit. (d) Convulsions. (e) Black vomit. (f) Black vomit 4Lh day. (g) Block vomit.. (h) :Rln.ck vomit 9th day. (iJ Black vomit 4th dav.
187~) J JoNES- Yello'W Fever Epidemic of 1878. 961
ReSJ)iratiou per minute iu Cases ot' Yellow Fever, Epidemic 1878.
.;
C.th day.,6th
.,
ol lst da, .. 2d day. 3rl day. 4th da~· da.y . 7th day. 8th day .
D
'+-< - - ---- 0
M I E. M. \ E -,- c M.z l E. M I E. M I E. M.\ E . M. l E. M.I E.
94 .. .. .. . . . . .. .. 42 .. .. .. . . -· .. I ..
06 .. .. '20 26 36 36 26 :30 .. .. . . . . .. .. I ..
97 .. .. 1S 2S 24 20 60 30 2R 26 36 36 36 .. .. ..
98 .. .. . . .. 30 :36 36 :36 20 30 34 40 24 56 .. ..
99 .. .. 20 24 16 28 1S 24 ~0 20 24 28 24 .. I ..
100 28 24 20 28 22 lt:l 20 24 20 20 24 1S lS 1S IS I 15
102 .. .. 32 14 24 34 1S 14 24 16 28 24 26 24 ..
126
103 .. .. .. 24 30 26 22 23 20 18 22 24 20 ..
104 .. :36 ;j6 42 36 38 32 4S .. .. .. . . .. .. ..
105 .. 2S 30 22 26 :30 .. .. .. . . .. ..
10o . . .. :32 32 2S 26 26 2S 26 24 26 18 1S 20 2S
107 .. :36 29 2S 28 ~s l!S 27 2S 26 26 26 32 26 32 1 24
10S .. 26 26 38 4H 32 :32 32 28 28 24 26 ~4 2S 1 26
109 .. 24 24 27 ~u 20 20 22 ~0 1S 20 16 18 24 · 2o
llO 34 32 40 36 :36 40 36 .. .. . . . . .. .. '
112 .. .. . . .. 2S 16 20 20 27 28 25 22 25 1S 25 26
11~ .. 32 36 36 36 34 28 .. .. .. .. . . .. .. ..
114 4S 42 46 42 40 3S 34 2S 32 30 28 .. .. .. ..
115 40 2S 26 24 24 .. .. . . .. .. .. .. .. ..
116 42 26 20 22 .. .. .. .. .. .. .. . . .. .. .. ..
117 .. .. . . 2tl 22 20 20 22 .. .. .. .. .. .. ..
118 .. . . . . .. .. . . 27 22 22 20 24 24 22 ..
119 32 2S 2S 30 32 2tl ~4 24 22 zo 36 26 .. .. .. ..
120 . . 16 18 22 20 22 .. .. .. .. .. .. .. -- .. ..
121 .. .. 24 24 28 ~4 22 24 22 .. .. . . .. .. .. ..
122 .. .. 26 32 24 t4 22 32 .. .. .. .. .. -- ..
123 .. .. .. .. 26 23 24 36 26 23 . . .. .. .. ..
124 .. .. .. .. .. .. .. 30 2H 29 30 28 2S 25 29 2:{
127 .. .. .. 22 21 .. 21 .. . . 50 .. . . -· .. .. ..
129 .. 26 . . . . 37 .. . . .. .. .. .. . . .. .. .. ..
130 .. .. . . :;() .. .. 56 .. . . .. -- .. .. ..
131 .. 34 2S 30 36 ;j4 30 .. .. .. .. .. .. ..
132 .. .. .. . . ill 1S 20 26 2S 24 26 24 :!6 24
133 .. :36 38 . . .. .. . . .. .. -- .. ..
134 .. . . 38 .. :{0 40 . . .. .. .. .. -- .. .. ..
135 .. 29 2S 32 24 29 35 47 59 .. .. .. ..
136 .. .. 25 24 28 3U 26 27 30 31 ~fl 3(1 45 .. ..
137 .. .. .. .. .. . . 26 22 26 39 .. .. .. ..
138 .. .. 31 34 41 31 30 2S .. 2l 30 24 22 i/4 26 2U
1:39 .. .. 29 21 . . 29 24 36 40 . . .. .. .. .. ..
140 .. .. .. 26 26 21:> 32 30 31 31 32 .. .. .. .. ..
141 33 40 30 32 28 ,• 28 .. 23 26 26 26 27 .. 32 40
142 42 40 32 3u 1[) 30 :37 35 :l6 31 30 32 31 28 2S
143 36 36 .. 50 48 30 35 29 46 44 43 30 32 39 28 44
144 .. . . .. . . 24 30 30 34 36 .. .. .. .. .. ..
l45 .. .. . . 48 40 44 44 :16 40 40 37 42
146 .. .. . . .. . . 24 .. 36 .. .. .. ..
147 .. .. 44 45 50 5·~ .. .. .. . . .. .. .. .. ..
149 .. 38 :{8 32 :1S 42 .. .. .. .. .. .. .. .. .. ..
150 24 30 35 24 2~ 18 24 22 18 2S 24 2il .. .. .. ..
151 32 40 24 24 28 30 24 22 24 26 IS 24 18 22 22 18
15:3 .. .. 38 42 36 33 42 42 34 :14 30 28 30 26 24 24
154 24 30 30 30 24 30 24 24 24 24 32 .. .. 24 24
1fi5 .. .. 30 .. 20 34 .. .. . . . . .. -- .. ..
156 .. .. .. .. .. .. 30 .. 22 . . 22 .. -- -- 27
157 . . .. 1S 24 16 18 29 IS .. 1S 2S ·- 1S 24 24
962 Original Communications. !June
Respiration per minute in Cases of Yellow Fever, Epidemic 1878-Continned.
oi
"01' 1st day. 2d dayfd d•Y· 4th day. 5th day. 6th day. 7th day. Rth day. .0.. . 0
M.l E. M. I E M.l E. M.l E. ~ M I E. M. l E. 0 M.l E. :;-.
158 -- -- -- 30 34 22 20 36 34 33 25 18 20 24 ~4 lti
159 -- -- -- -- 24 28 -- -- -- -- -- 30 32
161 -- -- -- -- -- 32 15 42 38 -- -- 42 -- 42 -- --
16~ .. -- -- -- 32 25 42 38 -- -- -- -- -- -- --
163 -- -- -- -- -- -- 32 -- 30 -- -- -- -- --
164 34 -- 36 4R 50 42 -- -- -- -- -- -- -- --
165 -- -- -- 26 -- -- 30 -- 27 28 -- 36 --
161-3 24 18 28 16 28 28 30 32 24 20 20 16 -- 30 32
169 -- -- -- 28 29 24 :30 24 24 28 32 :32 32 40 34 28
170 26 24 2R 22 22 24 24 12 20 18 20 20 24 24 24
172 36 32 28 36 32 28 24 34 24 32 28 24 24 24 -- -- 175 -- -- 24 32 28 24 32 32 26 28 28 24 24 24 24 28
182 -- -- 24 22 30 22 30 18 -- -- -- -- -- -- --
185 -- -- 23 -- 22 21 20 20 22 24 2!:3 -- -- -- --
186 -- 40 34 30 45 30 36 :-16 32 32 30 40 3~ 32
187 3! 24 32 20 28 32 16 -- -- 20 20 22 29 18 18 18
CHANGES OF TEMPERATURE IN YELLOW FEVER-FATAL CASES·
In the first table, including 93 cases occurring in my pri­vate
practice: and selected from the total number 256 treated
during the epidemic of 1878, 35 were natives of New Orleans,
and of this number 6 terminated fatally ; the ages being
respectively 3, 8, 8, 13, 18 and 21 years. In the first fatal case
amongst the natives recorded in the t.able (No. 24), the maxi­mum
temperature 104.20, was reached in the evening of the
first day, and also in the evening of the second day. The
lowest temperature 103°, was observed upon the morning of
the second day. Tbrougbout the disease, the temperature!'\ con­tinued
at an elevated point, and was 104o a few hom·s before
death on the morning of the fourth day, the pulse also was
rapid, varyiug from 132 to 150.
Tbis case (female, age 8 years,) occurred during intensely hot
weather in August, the thermometer ranging above and rarely
below 90° F., iu the shade, and pre::>ented a continuous parox­ysm
of a little over three days duration, aud was character­ized
throughout by grave cerebral symptoms.
In the second fatal case (No. 30, male, age 13), the initial
temperature was 103.2°, which continued for two days and fell
to 1020 on the 3d, 4th and 5th days, but rose to 104;50 on the
morning of the 8th day. Death took place on the lOth day.
Quinine freely administered produced no reduction of temper­ature.
The pulse fell from U8 on the 1sG day to 84 on the 4th
and 5th days.
This case may be regarded as a continued fever of 10 days
Juration, with a rise of temperature during tb.e last days
above the initial temperature. In its general progress this
1879] JONES-Yellow F'erJer Epidemic of 1878. 963
case resembled typhoid fever, with thiR difference, that the
pulse was slower than in cases of typhoid fever occurring
on patients of similar ages.
The third fatal case (No. 39), was that of a female, aged 18
years, which I saw for the first time on the 4th day, when the
temperature was 104° and the pulse 130; the patient was in a
state of intense mental excitement and agitation, which was fol­lowed
shortly by delirium. On the 5th day, the temperature
reached 1l!5°, and remained at this point upon the day of
death. This patient preRented a rapid pulse (130 to 146) and
elevated temperature throughout the disease. The paroxysm
of fever in this ease continued six days, and was wholly unin­fluenced
by quinine.
The fourth case (No. 54, female, age 21) had suffered with
chills and fever contracted out of the city on the Mississippi
rif"er, for several months before the attack of fever. The tem­perature
which was 103° upon the evening of the second day,
fell to 101.5o, 101.80 upon the 3d, 4th and 5th days, but sud­denly
rose to 106.1:!0, with a pulse of 130 upon the morning of
the 6th day. Urinary suppression was complete, speedily fol­lowed
by convulsions, coma and death.
The fifth case (case 72, female, aged 8 years), was character­ized
by high temperature and slow sighing respiration, which
at times was not more than 4 per minute. On the morning of
the 4th day, the temperature was 103°, and the pulse 145. On
the morning· of the 5th day, temperature 105.5°, pulse 150.
On the morning of the 7th day, the pulse was only 96, and the
temp11rature had fallen to 101°, but it rose in the evening to
104,0, and the pulse to 104. In this case there was a decided
remission of the fever on the 6th day. Black vomit app~ared
on the 5th day, aud death took place on the 7th day, the slow
respiration was attended with disturbance of vision, ending in
total blindness.
The sixth fatal case (No. 85, child, female, 3 years of age),
presented a temperature of 105°, and a pulse of HiO beats per
minute, at the onset of the disease. The temperature tell to
102° on the 2u and 3d dayR, but rose again to 104o (pulse 160),
on the morning of the 4th day. Black vomit, bremorrhage
from the bowels and urinary suppression occurred on ti.Hl
4th day, and the child died on the morning of the 5th day in
convulsions.
Iu the 29 cases of natives which recovered the maximum
temperatures and course of the disease were a:,; follows: case
13, male, age 20, 102°, single paroxysm of fever, of 36 hours
duration, uo Recondary rise; case 15, 1030 1st day, paroxysm
48 hours, secondary fever 101° ou 3d day ; case 16, 1020
paroxysm 36 hours, no secondary ris~; case 17, 10~o, 4i; hours,
no secondary rise; case 18, 1040 48 hours, no secondary rise of
temperature; case 19, 1020 72 hours; ca:,;e 20, 103o 6 days;
case 21, 103.2°, fever lasted 11 days; case 22, 103.5o, 48 hours
no secondary rise; case 23, 103°, 5 days; case 34, 103°, 72
964 Original Omnmunicatinn.~. r.T nne
hours, no secondary rise; case 37, 104o, 72 hours, no secondary
rise; case 50, 104.2°, 48 hours, no secondary rise; case 51,
1020, 9 days; case 68, 101.80, 6 days; case 69, 1010, 48 hours;
case 73, 104.50, 5 days; case 74, 104.5o, 5 days; case 76, 103°, 3
days; case 80, 104.3°, 4 days; case 83, 104.5°, 7 days; case H3,
103.5o, 48 hours; case 86, 103.2o, 48 hours; case 87, 1010. 48
hours; case 88, 101.H0, 48 hours; case 89, 103°, 72 hours ; case
90, 102.50, 4 days. Of the 57 (fifty-seven) cast>s of yellow fever
recorderl in the table as occurring amoug·st those not native to
Louisiana (foreigners and natives of nortbern and western
States), eleven terminated fa.ta.Jiy, making a total mortality in
the93 cases recorded in the table of seventeen. The entire mor­tality
of the 256 cases treated by the author during the
epidemic, was 18. It is evident therefore that the preceding
table embraces all the fatal cases, with one except-ion, which
occurred in my practice, and is on this account especia.Jiy
valuable as illustrating the changes of the temperature and
pulse in yellow fever. I have excluued of course, from thPse
statistics, the cases in which I was called in eonsultatiou by
other physicians, for manifold reasons, but chil'.fl.y because
such cases were in almost every instance horeless, aud no real
value for comparison could be obtained from one or two
observations.
CHANGES OF TEMPERATUR.E IN FATAL CASES OF FOREIGNERS.
In the 11 fatal cases of yellow fever amongst foreigners,
and natives of other States, tbe maximum tt>mperatnrrs and
course of the disease were as follows: case 6, temperature 1020
and pulse 96 on the 6th day, black Yomit IJaving appeared on
the 5th day and death on tile 7tb day; case 7, maximum
temperature 106° on 4tb day, temperature on day of death,
7th day, 104°, fever continuous for seven days; ease 8, IWLXi­mum
temperature 105.5°, black \'omit 6th tla.v, death 7tll <lay,
temperature 102°, pulse 170 a short time before death; case
26, 104.50 continuous fever up to occurrence of black vomit on
5th day, death on 6th day ; case 02, 104.60 3d day, continuous
fever 9 days, death on lOth day; case 33. 1.05.50 3d day, con­tinuous
fever rluriug 4 days, until occurrence of death on 5th
day; case 39, case 42, 105.6° on 5th day, uriuar.v suppression
and black vomit, death 5th day ; case 4;), 105.20 on 5tb aULl
6th days, black vomit and death 6tll day; case 46, 1060 lst
day, continued fever 5 days, black vomit 5th d<1j', death 6th
day; case 57, 106° l!<t da.v, continuous fever- 4 days, blaek
vomit 4th day, death 5th day; case 60, 103.50 2d day, con­tinuous
fever, died 4th day.
CHANGES OF TEMPERATURE IN CASES THAT RECOVERED OF
FOREIGNERS.
Amongst the 46 cases whic~ recovered, the followiug facts
may be briefl..r noted ; In the 5th case the fever continued five
1 R7!l) .JONES- Yellow Fet·er Epidernio of 187.13. 965
days, the maximum temperature 104.50, occurred upon the
evening of the 3!1 day, and notwithstanding the supervention
of blaek vomit this case recovered.
In the 11th case the temperature oscillated between 100° and
1030 during a period of 10 days. In the 12th case, the maximum
tempernture was reflched (103.5°) on the morning· of the first
dHy. There was a complete remission on the 4tlt day, and a
distinct increment of temperature on the 6th day. In the 28th
case, the temperature stood at 1040 on the third and 4th days,
fell to 101 o on the 6th and 7th days, and rose to 102.20 to 102.80
on the 8th, 9tb and lOtll days. In the 29th case the maximum
temperature, 104°, was reached upon the morning of the first
day, and the tebrile excitement continued for 4 days, and there
was no secondary rise of temperature. In tbe 40th case the
maximum temperature, 104°, was reached on the 1st day, the
temperature declined to 102.2° on the 2cl day, rose to 1020 on
the 5th da.y, and remitted on the 6th and 7th days. The 44th
case furnished an example of what might be called the typhoid
type of yellow fever; the maximum temperature, 103°; was not
reached until the fith <lay, and the fever continued with but
slight variation for 12 !lays, and was attended with abso­lute
prostration of the muscular and nervous forces, obstinate
constipation, and distressing and dangerous tympanitis, In
the 45th case the fever continued 7 days, and the highest tem­perature,
103.2o, was reacl1ed on the 5th day. In the 47th
case the maximum temperature, 104.5°, occurred upon the 1st
day, aud there was uot a distinct remission, or rather intermis­sion,
of tile fever until the 7th day. In the 48th case the
maximum temperature, 104.5°, occurred on the 1st day, the
febrile lJeat declined on the 3<1 and 4til d<tys and rose again on
the 6th day, and intermitted on tle 7th day. In the 49th case
there was a remission oo the 5th day, and an increment of
fever on the 6th day. In the 50th case the maximum tempera­ture,
103.!::lO, occurred on the secouu day, and there was no
remis~:;ion until the 18th day. In the 55th case the initial tem­perature
was 104o, and tbe fever continued only about 36
hours. In tile 56th case we note thr-ee distinct elevations of
temperature: on the 1t>t day 1040, 3d Jay 103.2o, on the5tb day
103.60; on tile :ld, 4th and 6th days tue temperature ranged
frem 98.50 to 99.20.
Without prosecuting the analysis farther, the preceding
facts are sufficieut to show tl1at the yel low fever or 1878, in
New Orleans, was in many cases characterized by exacerba­tiom;
and remissions, anll tbat the febrile excitement frequently
continued from five to ten days; and also that as a general
rule, tile severity of the disease anll the frequency of the fatal
results were io direct proportiou to the heigllt of the initial
temperature.
lu the second table, cou:;;olidated from the observations
recorded in the Charity Hospital, th(l changes of the tempera­ture
and pulse are given in ninety-five cases of yellow ieve1·,
966 Origina.l Communications. fJnne
of which 58 terminated fatally, and 37 recovered, and of the
entire number only two were reported as natives of New
Orleans.
RAPID RISE OF TEMPERATURE BEFORE DEATH.
We will first comlider briP:fl.v the cases in which the tempera.
ture rose abruptly before death.
In the 94th case, the temperature rose on th~ 5th day,
abruptly from 101.750 to 1110 F.
From the clinical notes of the resident student P. B. 1\'Ic.
Cutchon, Jr.,• we gather th at the patient, a female, agRd 30,
native of Germany, was transferred from the Commercial Hotel,
corner of Girod and Peters streets, on the morning of August
2d. She was seized with fever July 29th, and vomited 'Jiack
matter on the 1st of August. August 2d, 91, A. M., restless
and nervous, turning from side to side of bed ; some ht>adache,
great thirst, hot dry skin, e,yes congested, urine loaded with
albumen , third wonth of pn'gnancy, respiration 42, pulse 98,
temperature of axilla 101.75°. 12.30, delirious and speechless.
2, P.M., respiration stertorous. The thermometer was pl ace<l in
the axilla, and in 5 minutes recorded 110.750, aud in .5 minutes
more recorded 111 o, no pulse could be felt at the wrist. 'l'he
temperature in the axilla remained at 1110, until the moment
of death at 2.40o'clock, P.M. Five hours after death the tem­perature
of the axilla was 105.50, and iu the epigastric region,
the bulb of the thermometer being introduced tbr·ougll an
incision, 109°. It is worthy of note that in this case the pulse
at the commencPment of the rise of temperature was only 98,
and at the heigth of the increase of beat, the pulse could not
be felt. At the commencement of the sudden rise of tempera­ture,
the respiration on the other hand numbered 42 per min­ute.
These facts would tend to indicate that the rapid rise of
temperature was not ouly the cause of cleath, preceded by
coma and followed by arrest of the actiou of the heart, but
also that the rapid rise of the bodily heat was due to two
causes: 1st. To the action of the febrile poison upon the blood
exciting rapid che.mical cha ug-e aud increased heat; and 2d, to
tile action of the febrile puison upon those portions of the ner­vous
system which preside over those chauges of nutrition and
secretion and chemical action, which result in the development
of animal heat. In the 96th case we observe a similar rise of
temper~:~ture towards the close ot life, but to a less degree, viz:
106.80 on the 4th day. The 97th case manifested a marked rise
of temperature (1050), ou tile 5th, and (106.50) on ths sixth day
upon which the patient died. Case 98 manifested a marked rise
of temperature on the 6th and 7th days, the temperature in the
evening- of the 7th day being 106.4°. and the pulse 156 shortly
before death. In the 105th case, the temperature rose from
_____.__
*Now M. D.
1879} JONES-Yellow Fever Epidemic of 1878. 967
100.70 in the morning, to 105° in the evening of the 4th day,
and the patient died, the prominent symptoms in addition to
the rise of temperature being black vomit and suppession of
urine. The J lOth case manifested high temperatures, with slight
variations up to the time of death.
In thf> 122d case, there was a sudden and remarkable rise of
temperature on the 9th day of the disease. Between the 1st
and 5th clays, the temperature oscillated betwt>en 100.80 aud
103o; on the 8th day it fell to 98.50, and on the 9th day rose to
107.2°. This last temperature was taken by Mr. F. W. Parham,*
resident student of Cllarity Hospital, during the death agony,
forty-five minutes before death. In the 133d case, the patient
entered the Charity Hospital on the 2d day of the disease, with
a temperature of 104.4°, pulse 106, re~;piration 36. On the
third day the temperature of tile axilla stood at 105.3° in the
morning, and in the evening 107.60, Black vomit preceded
death on the 3tl day. In the !35th ca~e death took place on
the 5th day, the last observations preceding· death being tem­perature
105°, pulse 140, respiration 59.
In the 136th case the temperature on the 4th, 5th and 6th days
ranged between 102° aud 103°, aud on the 7th day, upon which
the patient threw up black vomit and died, reached 104.60. In
the 141st case the temperature was 103.8° on the twelfth day,
upon which death too place. In the 144.th case the patient died on
the 4th day with a temperature of 104°. In the 145th case the
patient ejected black vomit on the 6th day, und died on the 9th
day with a temperature of 104.30. In the 146th case the pa­tient
entered the Charity hospital on the 5th day of the diRease
with a temperature of 101.20, whieh, upou the 6th day in the
morning, rose to 107.50, and in the evemng to 1090. This last
temverature was taken by the resident student, Mr. F. W.
Parham, during the death agony.
In the 15ith case the patient (wale, age 38, native of Ireland),
entered tl.te Charity Hospital I~ hours after the onsf't of J'ellow
fever, with a temperature of 102.80, Pulse 96, respiration 30.
On the 2ll, 3d, 4th aud 5th days the temperature ranged be­tween
100 and 102.2o, pulse 66 to 90, respiration 24 to 30. On
the 6th day temperature rose to 1040 iu the evening; on the
morning of the 7th day it reached 105.20; on tile 8th morning
102.6°, evening 103.60. On the 9t hday the tempe.mture in the
morning was 1U5.5o, in the aftemoon 1070 ; one hour before
lleath 1100; ten minutes after death 111.10 F. Acording to
the resident student, lVlr. G. L. Duulap,t who recorded the tern·
perature in this case, this patient bled from the eyes and nose.
In the 163d case, the patient entered the Charity Hospital
with a temperature of 104.50, the next day it rose to 105.3°,
and the following day fell to 102o, and in the evening of the 4th
day rose rapidly to 107.2o, reaching this point half an hour
*Now M.D.
UJowM.. D.
I
968 Orig·inal Cowmun:ications. [June
before death. Death in this case, was preceded by delirium,
black vomit and coma.
In the 167th case, the patient entered the Charity Hospital
with a temperature of 104° ; between the 2d aud 3d days, tlw
temperature ranged from 100.6 to 103°, and on the eveuing of
the 4th dfty rose to 105.2°. In this case ur~uric poisoning, con­vulsions
an<l delirium preceded death.
In the 168th case, the patirnt, agefl 33 years, uative of Ger­many,
pntered the ChariLy HoRpital on tl.H\ evening of the 1st
d11y, with a temperature of 104°; on the 2tl aud 3d days the
temperature reached 105°. On the 4tb, 5th, 6th and 7tll days,
the temperature de;;cended from 103.7 to 98.2°. Ou the even­ing
of the 8th day, rose to 105°. Ou the morning ot the 9th
day, stood at 10f•.3o. At 3:25 o'clock, P.M., 5 minutes before
death 1010, and at 3:3;) o'cloek, P. M., 5 minutes after
death, the temperature of the axilla, as registered by my hos­pital
student, Mr. (), A. Bourgeois, was 108.20 F. In a case of
yelbw fever, complicated witil pneumonia, not recorded in the
preceding table, the temperature duriug the 8th, 9th, lOth and
11th (last days of the disease), ranged between 102 and 1050.
As a general rulr, the cases attended with high temperature,
that is above 1050, were fatal, but notable exceptions occurred,
as in the case 188, of the table, in which the temperature rose
from 103.20 in the evening of the 4th day, to 107.60 in the
evening of the 5th (lay. By cold sponging, the temperature
was reduced on the 6th day to 101°. In the evening it rose
again to 103.5o, but upon the 'ith, 8th, 9th and lOth days,
gradually dt:scended to the normal standard and the patient
recovered.
It is evident from a careful examination of the pre­ceding
facts, that the rapid rise of temperature, in
the pro-agonistic state, as well as in the death
agony itself, occurred in patients who had before shown high
febrile degrees of warmth, and also in those whose illness had
previously furnished no remarkable f'leva.tions of temperature.
In this respect, yellow fever does not differ materially from
malignant febrile a:fl'ectious, of an infectious character, as
abdominal typhus, exauthemic or true typhus, scarlatina,
variola., pyremia, septicoomia.. Iu sun stroke, which is clearly
in its origin, not of an infectious character, we observe a simi­lar
rise of temperature to extraordinary heights, in the pro­agonistic
state, and in the death agony itself, and for some
moments following death,
In fatal cases of small-pox, in common with Simon, I have
seen the temperature in tlte last hours of life, rise quickly
from moderate heights to 1110 F., and even to 112.50 F.
A rapid rise of temperature in the death agony is sometimes
observed, though less commonly iu measles, pneumonia, acute
miliary tuben.:ulosis, endo-carditis, malignant IWritouitis, facial
erysipelas, and rheumatic fever. The investigations of Wun­derlich
and others, have shown that in all these cases very
1879] JONES-Yellow Fevw Epidernic of 1878.
severe cerebral disturbances are often met with, but are by uo .,
means essential, in order to induce the excessive temperature
in the death agony; and it would rather seem that extensive
chemical processes of a zymotic nature are the causes.
On the other band it has been shown, chiefly by Wunder­lich,
that there are diseasrs in which the affection of the ner­vous
eentres appears to determiue the rssenti.al, or one of the
essential, disturbancrs, as meningitis of the convexity, soften­ing
of the brain, tetanus, epilepsy, hysteria, and other s:o-etLlled
centml neuroses; diseases in which the tempflfature generally
begins to rise for the first time in the last da.ys of life, and
very rapidly reaches enormous heights. It may he qnestiont~d
in these cases, whether the fatal rise of temperature is a symp­tom
and effect of the death agony a.nJ the procr>sses that g·o
along with it, or whether this rise and the proceRses which form
its basis, be the origin:Ll cause of the agony that is the fa,tal ter­mination.
Thus Sentor, holding the latter view, concludes
that the agony and death occur because from some cause or
other the temperature rises to a height incompatible witb life.
Wunderlich, on the contrar.v, regarils the phenomena as not
so simple. The high temperattUP.S of the agc.ny, must be
differently estimated, according as they take t.heir points of
departure from an immerliately preceding high febrile process,
or on the other band attain suddenly to enormous heigllts,
after prer.erliug moderate temperatures. However, it must. be
conceded that a fresh state of r~ffairs is inaugurated, a final
process, which is very frequently and thus early aud tllus
undonbteclly prejudicial from HO other cause so mnch as from
the enormous elevation of tempernture.
POST MORTEM RISE OF TEMPERATURE.
In the majority of cases of yellow fever, as in other c;liseases,
after death tbe temperature begins to fall, and the decrease is
slow at first, then more or less quickened in accordance with
the depression or elevation of the surrounding temperature.
In some cases, however, a.s in No. 94, 154 and 168, the temper­ature
not only rose rapidly during the death agony, but also
continuerl to rise for some time after death.
This post rnortem rise of temperature, which appears to
have bern first nbserved in yellow fever, by the late Dr. Ben­net
Dowler, of New Orleans, was again observed during tbe
epidemic ot 1878 in New Orleans.
It is well known that the post mortem rise of temperature
sometimes occurs in cholera, but more especiftlly iu cases of
disease which ha.ve terminated, as in yellow fe\rer, small-pox
a.ud sunstroke, with byperpyretic temperatures, and most espe­eially
in those in whicil the rise of temperature has co11tiuued
to the very momeut of death.
Tile remarkable phenomenou of post-mortem rise of temper;l-
5
970 Original Oomm~tnications. [June
hue has been referred to two causes: when death occurs, the
cooling which goes on by t.he introduction of air in respiration,
and by perspiration, comes to an end, whilst the warmth­producing
processes of the economy are not so immediately
terminated. And new sources of warmth are opened after
death, by changes in the substance of the muscles and by post­mm
·tem decomposition, two sources which are foreign to the
living body, and which are sufficient to maintain the corpse for
a short time at an equilibrium of temperature against the losses
of heat it suffers, and sometimes even to raise the temperature
one or two degrees. lt is possible that in yellow fever the
suppression of the function of the kidneys, as well as the rapid
progTess of the disease, and the presence of bacteria, and living
animalenlm or spores in the blood, together with the chemical
alterations of the circulating fluid, may furnish the necessary
conditions for rapid chemical change, and consequent elevation
of post-mortem temperature.
DEATH OCCURRING WITH LOW TEMPERATURE.
The preceding data, embodied in the tables, also illustrate
the fact that in yellow fever, as in other febrile diseases, death
occurs with a low temperature; and that in the former this
fall of the temperature is frequently preceded and accompanied
by hmmorrhage from the stomach, bowels and uterus. 1'he
fall in the temperature was frequently, but not always accom­panied
by increased frequency of the pulse and respiration.
These propositions are full.Y sustained by the records of cases
104,111,112,113,114,127,137,139,140,141,143,150,152,155,
161, 162, 165, 166, 173, 174, 178,179, 180, 181 and 184.
MAXIMUM TEMPERATURES IN CASES WHICH RECOVERED.
In these cases l'ecorde.d in the second table, which recovered,
the maximum temperatures were reached upon the days
indicated.
Case 99, 3d day 104°; case 100, 3d day 104.50; case 101, 1st
day 1050; case 102, 3d day 104.50; case 103, 4th day 1040;
case 106, 2d day 103.5°; case 107, 1st clay 102.50; case 108, 5th
day 101.3°; case 109, 2d day 102.5°; case 115, 2d day 104.50;
case 116, 1st day 102°; case 119, 1st and 2cl days 101 o; case
120, 2d day 102.3°: case 121, 2d clay 1010; case 123, 2d day
104.60 ; case 125, 3d da,y 105°; case 127, 2cl da.v 104.50 ; case
128, 1st day, 104°; case 132, 4th clay 1030; case 138, 2cl and
3d days 1040; case 139, 2d day 105.50; case 140, 2d day 104.80;
case 142, 1st clay 1050; case 151, 1st clay 104°; case 1;13, 3d
day 1040; case 158, 2<1 day 104°; case 159, 3<1 tlay 1040; case
1'70, 3d claJ' 102.20; case 171, 3d day 102,2; case 172, 3d day
104.8°; case 185, 1st day 105°; case 186, 4th clay 104.70; case
187, 2ct day 1050; in the 188th case, 4th clay 107.60.
It will be observed in reference to the cases observed at the
Charity Hospital, in like manner with those treated in private
1879] GoDFREY-A Case of Lithotomy. 971
practice, that the fever varied in length from 48 hours to ten
and even 12 days, and in many cases distruct remissions and
intermissions were noted during the progress of . the disease,
no definite rule could be deduced as to the exact recurrence of
the intermissions and remissions, and we were inclined to refer
the secondary form in many cases to the effects of the lesions
induced by and during the febrile process upon certain organs
as the cerebro-spinal system, heart, liver, stomach and kidneys.
The occurrence of abscesses and carbuncles often produced
seconday elevations of temperature. One of the most fruit­ful
sources of secondary fever (so-called relapses) was the ex­ertion
too soon of the enfeebled muscular and nervous struc­tures,
in getting out of bed and in endeavoring· to walk about
and attend to business. As the disease progressed, the pulse
which was greatly accelerated at the onset, became slower,
and often continued not far above, and even below, the normal
standard with elevated temperature.
A Case of Lithotomy.
By JOHN GODFREY, M. D.
Assistant Surgeon Marine Hospital Service, Mobile, Ala.
The following case is reported principally as a contribution
to the statistics oi operations of this class, and as an addi­tiomtl
argument to cut without delay whenever the accident
which necessitated the operation should occur, forasmuch as
such accidents have probably not happened for the last time.
For, notwithstanding the patient was finally brought out of
his difficulty, an immediate extraction in the way it was clone
would have saved him many months of extreme anxiety and
suffering:
. On the 25th of September, 1878, I took charge of ·the
Marine Hospital in Mobile, and found among those on th,, sick
list seaman Thomas, suffering from cystic irritation. He had
been cut for stricture with the Maisonneuve instrument about
six months previously, at which time, unfortunately, the fili­form
was incised and a part of it left in the bladder.
Repeated attempts were made immediatel.Y after and at
various subsequent intervals to remove the body, but without
avail. Irritation of the bladder soon set in, giving rise to the
usual symptoms of vesical calculus. Not long before I saw
-1
Orig·hwl Comm·uu·ications. [Juue
the patieut he bad lJugun to pass small ualculous coneretions,
about half the size of a rice grain, and E~ oon tllereafter a num­ber
of piel.:el:\ with a bole in the eeutre, :;llowiug that they had
beeu moulded about the foreigu body anJ had lJecome detached.
At this time micturition was uonstaut, difficult, and attended
by a great deal of pa.iu, <Lnd altogether his conditiou was quite
clistre:;siug.
Soutl(.l exploratiou r evealed ualculous forma.tiou, but follow ­iug
the examvle of wy predeces.sor, I al.so made an effort to
extnwt per uretlwcwn; a .s was expeute<l, failure eusuecl. I now
determiued to perform lithotomy. Meautime J·ellow fever began
to spread; aud vartly on account of the eugrossiug nature of
that Ui.sea:;e, aml the suspiciou that 8Ucll surgery as could wait
sllouh.l be uefeneLl uutil its subsideuee, autl particubrJy Oll
aceouut of the debilitated ami. irritable eouditiou of the
patieut, tlle operatiuu was po:;tpouell till tile 25tll of Novem­ber,
at which tilllt-l he was thuugl.tt to be uu ilt up s ufticieutly
to stauu it.
W itlt tile l:L88istauce or.' Dr<J. GuuLle <lllLl Fuuruier, Surgeon
Hut,tuu, Mariue Ho:>vit;tl 0enice, giving tl.te cllloroforw, aml
Dr. Scale.s coutrolliu6 tll0 8ta1f, I ovezwd LlJ0 llhtLlder by tile
h~teral wethod aud succeeded iu briugiu g a >my after many
tedious attemlJts, tue filiform, to wilicll wen>. u tLacht~d tltirLeeu
caleuli-or rather tw e h-e~olte cowiug otf iu the wo1tull aud
rewovetl by the ham!.
.d.s iutimaletl, tl.te OlJeratiun lc,sted louger th<lu usua l ; O\\'ing
iu part to tl.te p eculiar shape of tile body, 1ritl.tin tho blathler,
w llil.:il I 1ouml uue.:.vectetl lr to be curled upo11 itsdf, and
tJliglt tly agglu t.iu ;LLeJ IJy <L SJ..l ceies uf J'cthe 1Ue1ubmuo, qui te
thiu aud \·ery slipverj·; iu part to ill -ltd;: ur lack of enuni11g
ia gettiug tlte ever-shittiug .::mustaaee within the lJlaJ~:s of tile
fort;ups. 'l'lte IJLttld er was tl.teu cart.:full.y anll ctlt.:ct ually syr·
iuged b.Y wy lrieull Dr. Guotle, tl.te patie ut, jJllt to !Jed, <trtu a
::.killed atteutlaut set to watcll him.
'.l'he furtl.ter hi~Story of the case cuutaius littl'3 of iuteretl t.
Fur tile tir::;t half ua,y t l1cre was a good deal of nausea. Tl.tree
iluurs after the O[Jemtiou Lwo slight rigors came 011 lasting
ouly a fell minutes eaeh,. followed b_y- im:ousillerable rise of
klllpcmture. The ~ccoud da.y the p<~ti e nt had tlia rrl1ma which
1879] Correspondence. 973
yielded to treatment the day following. Up to the fifth day
the temperature ranged from three-fourths to one and a half
degrees above normal; pulse from eighty to ninety-five.
From that time every thing went smoothly. The wound
healed kindly, and in three weeks the patient was going about
the ward.
The concretions are remarkably light, and appear to be of
the ammonia-magnesia-phosphatic variety. The accompany­ing
figure gives a correct outline-natural size-of the calculi
as they appear strung upon the guide.
CORRESPONDENCE.
lffessrs. Eclitors :
In a former letter I made brief mention of the Massachusetts
law which about ten years :tgo abolished the ancient, wretched
coroner system, and substituted medical examiners who are
thoroughly acquainted with their duties. Formerly the coroner
might be a shopkeepee, a lawyer, a regular physician, a quack,
974 Correspondence. [June
an undertaker, or whosoever might have sufficient influence
· among pett.v warn politicians to secure recommendation and an
appointment. While London, with its enormous population,
had four coroners, New York four, Brooklyn,Philadelpbht, New
New Orleans and Chicago two each, and San Francisco, Wash­ington,
Baltimore and Cincinnati but one each, our Suffolk
County, consisting chiefly 9f Boston, had forty-seven coroners, of
whom Boston proper had forty-three. Of .these the majority
were called doctors, many of them being irregulars and quacks,
with a fair sprinkling of regular physicians; there were lawyers,
etc.,-anybody could be made a coroner_ Among these men
were two in particular who made themselves notorious by their
very peculiar official mismauag·emen t. One of them was obliged
to run away because of his extreme sharpness. The other will
be mentioned again. In these days-shortly before the aboli­tion
of the old system-post-mortem examination~ were rare,
except iu striking cases. In Boston the traditional coroner
system was in full force with an overweening share of its abuses,
which, principally, arose from competition among so many
coroners, and their struggles to mauuia.cture cases and occa­sions
for work. The jury elemt3nt was always imperfect, always
unsatisfactory. Half a dozen men would be picked up on the
street just as it happened. Court House Square swarmed with
candidates ap.d, moreover, as is usual in such cases, the scamps
were the most favored, while decent men among the coroners
rarely secured any cases. So that in the last fifteen years the
larger portion of the coroner business was done by three or four
men who bad the ear of the police. And while the others did
but little, there nevertheless was a great deal of scrambling·, and
the whole system was a disgrace and a scandal. The tempta­tions
which were offered to protect or make criminals, to shield
the guilty.and involve the innocent, will suggest themselves.
At intervals for the previous twelve years the matter was made
a subject of comment by our Medical Journal, but in the fall of
1875 it began to be agitated in serious earnest. The appoint­ment
of self.styled Dr. Newton as coroner, and the management
of the celebrated Clara Fisher case were especially influential
in bringing about the cllange for which our medical men had
been so long maturing. The appointment o~ a man so out-
1879] Correspondence. 975
rageously inefficient as was this Newton led a number of our
most distinguished medical men to petition the Governor for his
removal, and the Boston Medical and Surgical Journal came down
upon him in such scorching terms that he sued the publishers for
$20,000, and was ingloriously defeated by his own inability to
make out a case. His name stands in the Directory of Physi­cians
and Surgeons of the United States. The statements therein
made, though written by himself, were proven to be wholly un­true,
but he backed clown in such a hurry that the proofs were
not exhibited to the court. Meanwhile, an able lawyer, Mr.
Thepdore H. Tyndale, read a paper before the American Social
Science Association, showing that the coroner system, as then
existing, was an anachronism, and a very dangerous one.
He showed that by existing laws .a coroner, though appointed
by the Governor and Council, could be removed only by an
address of both Houses of the Legislature to the Governor ;
that if the six jurors who are summoned did not appear, the
coroner could fill the number from the by-standers, and there­fore,
that he could manipulate them as he chose ; that by the
consent of the majority of this jury, he could make the inquest
a secret one; that he could take charge of all the property
upon or near the person of the deceased, and yet give bonds
for only $500; and that there was no law limiting the number
of coroners. He then showed how a timid or corrupt coroner
could shield a criminal and thus endanger public safety, and how,
by malice or vindictiveness he could work n;lllch harm. The
paper created a profound impression. Mr. Tyndale also as­serted
t)lat two coroners were enough for Boston; that juries
were mere figureheads, and claimed that the office of coroner
should be divided into two, a medical and a legal. He like­wise
showed that in one year, inquests under the old system,
cost the city $10,769 74. The salaries of the two medical ex·
aminers, now acting for the whole of Suffolk county, amount
to only ~6000 . The Social Science Association took up the
matr.er in eamest, but the first formal step was taken by the
councilors of the Massachusetts Medical Society. At their Octo·
ber meeting in 1876, the matter was thoroughly dis·
cussed, and a committee was appointed to report on the sub"
ject at the February meeting in 1877. Thus all these influ-
976 Correspondence. !June
ences, viz: the disgraceful appointment of Newton as coroner,
Tyndale's paper, the activity of the Social Science Associa­tion
and the action of the Massachusetts Medical Society
moved together. The councilors appointed a commit­tee
of five and gave them fall powers to cooperate with
committees of other societies and persons engaged in obtain­ing
a reform of the coroner laws. A bill was next presented
to the State Legislature. The latter placed it in the hands of
a special committee of whom one was Dr. Cogswell, who at the
time was President of the Massachusetts Medic~l Society, and
one of the Governor's council. He gave great assistance in
working the bill through both Houses. The petition of some
leauing medical men for the removal of Newton was also on
the carpet, and acted as a strong lever in favor of atolishing
the whole rotten coroner system. Of course, much opposition
was oftered by friends of the coroners, and great endeavors
were made to have more than two examiners. Especially ac­tive
in this was a physician, who was also a coroner. He
defended the old system and then applied for a position under
the new one. The bill went through most triumphantly. The
old system was rooted out, much to the satisfaction of all well­disposed
persons, especially the physicians.
Coroner Newton, in the interim, had sent in his r,;signation,
upon which the Governor and Council very properly declined
to take action until the evidence of his gross qnfitness was
made public. This course )Vas upheld by the Legislature, by a
motion which in a decided manner est<1blished the doctrine,
that in Massachusetts a public officer is not allowed to
escape the results of an iuq uiry into his lllit>conduct
by a resignation. In June Newton was dishonorably
di~:>missed by the Governor. On the first of July
the coroner system disappeared from Massachusetts,
and the new plan went into operation. Wllat this plan is I
can best show by a synopsis of the law, which purged the most
coroner-ridden community ill the world of a burden~ome dis­grace.
Section first did tile business.
1. " The offices of coroner and special coroner are hereby abol­ished."
2. The la,W then 0.111>uwecs tue GUI'er-uor ~wd Council to