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move himself, or to be moved ; in which state I had left him on the 5th day. I heard soon after, that he had run into the streets after knocking down his nurse. This man had a carbuncle on the fore arm, which bled profusely just before death, he also had petechial and miliary eruptions.—A great soreness to the touch was not uncommon in some cases, which rendered the weight of the bed-clothes oppressive, and was so severe as to produce violent screaming. stipation of the bowels was common, requiring powerful purges, which in all the cases I saw, produced black and fætid stools, that became, by persevering in these,green, and then light coloured. Partial diaphoresis was seldom favourable, and connected with cold extremities, was fatal, a continued hot skin was always so. I had one case which seemed to affect the bowels; but by the remedies employed, it was elicited in its more usual form,--sudden deaths were common, in 24 and 36 hours; I saw some apoplectic cases in habitual drunkards.
Great pain existed in many to the last, but the usual terminations were with low delirium, hemorrhages, diarrhæa, biccough, inability to swallow or speak, cold extremities, laborious breathing-death. Scars on the head were very painful to several who had not the fever, as also to a patient of mine who had it.
In August the mortality was great; on the 13th the number of funerals in a day amounted to 16, and on the 29th, to 25; but in Sept. they increased greatly, so as to make 36 on the 5th, as I was informed by the old grave-digger, who was at work in the mud and water, in the grave-yard. He said, the usual number a day this month, was from 22 to 25. I have said in my letter before referred to, that there had been 54 on the second, but this was from misinformation. I judged from the proportion of Catholic funerals, that the mortality was as great among the natives, as among the strangers, this month. Though there appeared to be diffe
rent degrees of susceptibility to an attack in different persons,—those from the eastern section of the union had it most violently.
Secondary attacks. The number of these that I knew of, was large, both of such as had the fever in this city and elsewhere. A young physician from Ireland, who told me he had it in Havana, died from a second attack. The first patient I had, had recovered from it in the East Indies; several others came under my observation, and the writer of this had an attack several years since in Philadelphia. I did not escape it at New Orleans,-an immunity from it does not seem to be purchased by former suffering.
Of its Contagiousness. In order to ascertain this quality of an epidemic, the first cases which occur are the most important, and require more particular attention.
When the disease has become wide spreading, extending its ravages to distant points, the advocates of either question have their resource, as it is difficult to fix the limits of the assimilatory process; or to say how far the infectious miasms may be wafted.
Even after a few cases have occurred, the previous exposure, both of those who are taken down, and those who escape, to the causes to which the origin is ascribed by both parties, is so common, that it is impossible, perhaps, to ascertain to a certainty, whether the former have sickened from attendance on their sick friends, or from exposure to the same causes; and why the latter
Sporadic cases, those which are the first well ascertained, and those which sicken at very distant points, after leaving the places where the disease is raging, must be regarded as the best evidence on the contested subject.
I did not find that the case I have mentioned, as occurring in March, could be traced to any foreign source whatever; and as the common bilious fevers were prevalent at this time, it may be considered as supporting the views of Doctor Bancroft respecting the yellow fever. The friends of this patient, though with him to the last, and sleeping in the same apartment, retained their health there, though they suffered with the epidemic afterward. A few cases again occurred in May, but could not be attributed to any foreign source that I could learn; and there had been several cases at the Army Hospital of the United States previous to my arrival in June, but none at that time. Three cases terminated fatally, but were not considered as arising from a foreign or contagious source, as I was informed by the surgeon, Dr. Mercer, a gentleman of great respectability, and much experience in this disease.
The first case which came into my hands, was the master of the vessel in which I arrived at that place. He had not been exposed to any possible source of contagion, there being none in fact, as I was credibly informed, then existing in the city; and bad he been so exposed, I could not but have known it: he was attacked on board the vessel, at the levée, on the 5th day after arriving. The second case I saw, occurred the same day in the vessel alongside the other, and had not been exposed to any cause of foreign origin,—both vessels were recently from the eastern states. Both these persons recovered, but died afterward of the disease late in the season.
The quarantine laws had been, and were during the season, vigorously enforced on all vessels arriving from those places where the fever usually rages. This was the case in relation to a vessel which arrived from the Havana : while this fever was committing its ravages at New-Orleans, she was detained twenty days, at the quarantine ground, in the most disagreeable situation, sufficient to produce sickness, if coming from the north pole. The next cases that came under my notice, were six persons, in the same Hotel with myself, who were taken down the first week in July. They were persons who had arrived in the city before me, but I could not learn that they had been exposed to any personal infection. The Hotel was on the levée, exactly opposite the two vessels, on board which my two first patients sickened. It was along this levée that most of the cases occurred after this, and as I was told, usually occur in other seasons. Among the shipping, it was peculiarly fatal, yet in the onset seemed al. most confined to the seafaring class of people. Not a vessel escaped without some loss, and some with the loss of all on board. The upper part of the levée, where the boats from up the river lay, seemed to be as much affected by the disease as the lower. A steam-boat (the Vesuvius) lost her captain, crew, and three passengers,—she was then ordered to the other side of the river. The French crews did not escape; all the French vessels lost more or less. All on board the Frederic Adolphe died, excepting the captain and mate, who had the disease, but recovered; many other natives of France were sick, and died. The cases that occurred were now so numerous, and the devastation so great, that it became impossible to trace them :-indeed so much confusion is liable to exist at such periods, that it were use. less to attempt it, as cases may be attributed to contagion, which have originated from the same sources as those, that are said to have communicated it, viz. the infectious ex. halations; which being constantly generated, and not dispersed by strong breezes, extend until the circle of their influence includes remote parts, which from their situation may be perfectly salubrious, before contaminated by these noxious vapours,
Many are in the habit of leaving the city, and retiring to the shore on the Bay of St. Louis, in Alabama, during the summer season; but some are not, from circumstances, enabled to leave the city until late, when the disease has become epidemic. Many of these fall sick at the shore, which is a perfectly healthy situation; but in no instance communicate the fever to those about them, who have resided there the whole season or longer. Facts of this kind are numerous, and have occurred during this epidemic in many places.
Instead of endeavouring to trace an uncertain connexion between remote effects and distant agents, which method is too often pursued in investigating the subject of contagion; it should be our endeavour to follow the regular gradation of phenomena, from which they derive an existence, in order to arrive at correct conclusions in this system of causation.
It is well known, that intermittent and remittent bilious fevers are endemic at New-Orleans, at all times of the year in common seasons; and its character for insalubrity is but too well established on the ruins of the hopes of many in this part of the union. The topographical account of the place, therefore, will not be irrelative to our subject, any more than meteorological observations, at the time of the prevalence of the epidemic under consideration ; which was said to have exceeded, this season, any former ones since the place participated with us our happy form of government.
The city is situated between the river and swampy ground; and beyond the latter are thick woods: these swamps extend both above and below the city, which is situated 128 miles from the mouth of the river; the banks of which are of alluvial formation, and lower than the water, when that is at its height. The soil is composed of a rich loam well cultivated near the city, but less so as you approach the mouth, where it is little else than a marsh; under water much of the time; the Levée being discontinued. This is a mound of earth, raised to prevent the overflowing of the river, which is from four to six feet above the soil when at its height, but on a level, or even below it, when it has fallen to its lowest, which is during the summer months. The river rises higher, and falls lower, some years than others. The Levée is sometimes carried away by the force of the current, which at the city runs from three to five miles an hour, and the country is consequently overflowed, and much damage is done. There is no tide at the city; the water is fresh, and used for all do.