SPECIAL REPORTS OF ACTING ASSISTANT SURGEON JOSEPH Y. PORTER AND

ASSISTANT SURGEON HARVEY E. BROWN, U S. A.

POST HOSPITAL, FORT JEFFERSON, FLORIDA,
October 25, 1873.

To the Surgeon General of the Army:

GENERAL: I have the honor to submit for your information the following report on the epidemic of yellow fever at this post during the present year:

On the 28th of August, 1873, I officially informed the post-commander, Lieutenant James E. Bell, First Artillery, of the existence of yellow fever at this post, and advised the immediate removal of all unacclimated persons to Loggerhead Key, distant from this post about two miles and three quarters westward, that being the only available key where fresh water could be procured or shelter afforded. The advice was promptly acted upon, and orders issued to that effect; and as soon as possible, and with the least practicable delay, the laundresses and their children, together with such of the enlisted men as could be spared and were not absolutely required as nurses and burial party, were sent over under charge of the first sergeant; and as soon as the services of Acting Assistant-Surgeon Gould, United States Army, could well be spared here, he was ordered there also, to treat any minor cases of sickness that might arise. The light-keeper kindly accommodated the women and children in his own dwelling and as many of the enlisted men as there was room for. The rest lived in tents.

Before proceeding further, it is necessary that I retrace a little, and note a few instances of the previous two weeks, particularly as they have a certain bearing upon the progress of this epidemic, and which will hereafter be noticed. On the 6th of August the captain and crew of the British schooner Mai arrived at this post, and reported that their vessel was from New Orleans for Havana, and, springing a leak, they were unable to keep her afloat, and she sunk under them that morning thirty miles to the westward of Loggerhead light. They reached here by noon in open boats.

On the 11th of August Dr. Gould's son, who had the week before been visiting at Key West, was taken sick and remained quite ill for a few days. His father, who attended him, reported the case to me as biliousremittent fever, following exposure to the sun. The child was up and about within a week, but looked quite pale and languid for a week or ten days afterward.

On the night of the 24th, thirteen days from the date of the boy's seizure, his sister was taken with precisely the same symptoms (only the more exaggerated) as characterized her brother's attack, and was, indeed, very ill. I saw her, in consultation with her father, and thinking the case to be one of a bilious-remittent type, we directed the remedies accordingly. The case proved suceessful, although convalescence was slow and tedious. The same night my child was also taken, and had a fever, but, after three days, was up and about again. It is as well

here to mention that these children are all acclimated, having been born and raised in the southern climate.

On the morning of the 24th, Joseph Baumstark, a private of Company M, First Artillery, presented himself at sick call, complaining of headache and general feeling of malaise, and stating that the night before he had vomited, and slept very little. He was admitted to the hos pital and ordered to bed. At the time of admission his pulse and tem perature were very slighty above normal, his bowels very freely open, and his kidneys were acting naturally. He was further directed to have a febrifuge every two hours and a low diet. That night, a mustard footbath, carried well up to the knees, together with ten grains of Dover's powder, were administered, and the other treatment continued. The next morning, at my visit, he expressed himself as feeling much better, and said that he had passed a tolerably good night. The headache had left him, and he was then in a gentle perspiration. He was directed to have, in addition to the febrifuge, a tonic of compound tincture of cinchona and quinine, with a few drops of aromatic sulphuric acid, every three hours. During the day he was suddenly seized with singultus, and despite all exertions and application of remedies, it proved to be an uncontrollable and unrelenting complication, and continued, with but very slight remissions, to the time of his death, a day and a half afterward. From the commencement of the hiccough his stomach rejected everything, and although he appeared in good spirits and hopeful, he was evidently failing. Nourishment was then ordered to be adminis tered by enema. In the latter part of the second day, he experienced some difficulty in passing water, but that was afterward partly relieved. At 9 p. m., on the 27th, his condition was not materially changed; his pulse was 90, full and compressible, but he was still hiccoughing. At 2 a. m. of the same night I was sent for, and found him in articulo mortis. Stimulation was speedily resorted to, and finding that he was unable to swallow, it was given by enema. That, however, he failed to retain, and seeing any further attempt at medication useless and ineffective, all treatment was ordered to be stopped; and he died in three-quarters of an hour afterward. On examining the bedding in which he died, the next day, and noticing dark-colored spots over both mattress and linen, I questioned the steward, and learned that just before death took place he had vomited and passed some darkcolored liquid, but he (the steward) not thinking the matter of sufficient importance, had failed to report the fact to me until my own discovery led me to question him closely, and thus elicited the information.

I have been thus careful in detailing this case, as it was so obscure and complicated, being marked by other symptoms, and having none of the distinctive features of yellow fever at the time of admission, and only at the time of death and afterward was there anything tangible to be seized upon, or to arouse suspicion as to the true nature of the disease. Indeed, the case presented to me, at the beginning, more of the features of acute indigestion, and particularly so as I understood that the man was well known to be a great glutton, having, during the month, consumed, besides his rations and other eatables purchased from both commissary and sutler, a large amount of pies of various kinds.

The cases that were taken sick and admitted on the 25th were regarded with suspicion, and although not reported, for sufficiently good reasons, the treatment was nevertheless pursued and directed as for yellow fever. One of these cases died at 12 m. on the 28th, vomiting at the time of death unmistakable black vomit. From the 28th to the

31st, there were seven cases and four deaths, and from the 1st of September to the 10th inclusive, fourteen cases and three deaths. These also include civilians who were taken sick. From the 10th to the 20th of September I shall pass over, as a report on the progress of the disease for that interval of time devolves upon Assistant Surgeon Harvey E. Brown, U. S. A., who was in charge of the hospital during that period. I may, however, remark that, from the 11th to the 26th, there were five cases and six deaths. There was no one taken sick after I re-assumed charge of the hospital on the 26th of September. The patient admitted on the 20th was the last case, and he then bid fair to recover, but, being unfortunate enough to take a relapse, and not having sufficient strength to rally, he fell into a typhoid state, in which he gradually sank, and finally died on the, 6th of October.

The mode of attack of the fever in this epidemic was not the same in each case, and the type of the disease differed according to the habits and temperament of the individual; and although the invasion of the disease was generally marked by the symptoms usually described, yet in not a few cases was the chill and universal tired, aching feeling, together with torpidity of the bowels, totally absent. Patients have presented themselves who, on admission, complained only of debility and a general feeling of languor, and whose cases pointed to no especial symptom denoting yellow fever, save the wild expression of the eye. and perhaps a little frontal headache, yet within an hour the fever would be raging, the pulse strong and bounding, beating from 110 to 120 iu a minute, the skin hot and dry, and the thermometer placed under the tongue denoting a temperature over 103° Fahr. To illustrate: On the 11th of September, a corporal walked into the office of the hospital and, saluting, said very composedly, "Yellow fever, sir; I've got it." That man complained of nothing in particular. "I don't know how I do feel, doctor, except generally good for nothing," was his reply to my question; yet in a few hours he had the well-marked and distinctive features of the disease. A few were suddenly attacked, the poison of the disease appearing to burst forth in them with overwhelming violence, and a very good example of this mode of invasion was the case of Hospital Steward Horner. At 10 o'clock of the morning of the 28th of August to all outward appearances he was perfectly well, and was as usual attending to his duties in the hospital. In half an hour he presented himself, and reported that while walking across the parade he was suddenly overpowered, and not ten minutes afterward he had an intense headache, both frontal and occipital, violent throbbing carotids, great pain in back and limbs, with high fever.

The pulse I found to be, at the commencement of an attack, an uncertain guide in the discrimination of the disease, and often the temperature of the skin was not appreciably increased to the touch, for in certain cases, while the pulse was not above 90 and still soft and compressible, the mercury would show a temperature of over 102° and 103° Fahr., either in the axilla or under the tongue.

The wild and injected appearance of the eye was never absent in any of the cases; neither the anxious expression of the countenance nor the indescribable feeling of uneasiness. In the majority of the fatal cases there was no stage of calm, the patient passing directly from the stage of high febrile excitement to that of collapse; neither was the black vomit a constant symptom, but in those cases in which it did occur, it was ejected with that involuntary ease and readiness so characteristic of yellow fever, and in one instance the patient died immediately afterward.

Suppression of urine occurred in all of the fatal cases during some portion of the disease, commencing often as early as the second day, the patient rarely surviving over twenty-four hours after total suppression had set in. Uræmia was well marked in a few cases. Vomiting was a constant and uncontrollable symptom in a few cases only, and in others there was no nausea or uneasiness of the stomach prior to the ejection of black vomit. The range of temperature was generally between 100° and 105° Fahr., the latter being the highest point the mercury reached that was noticed. I regret that the observations in this line could not have been more extensive, but owing to the absence of any clinical thermometers at this post, no observations could be taken until the arrival of a set of my own, and that unfortunately only toward the close of the epidemic. I must not neglect to mention the odor given off from the person of the patient during the epidemic, and more markedly from those whose cases ended fatally. Of course this feature of the disease is not new, and I have noticed it in other epidemics, but I do not remember to have appreciated it as strongly as in this.

Such was the general course pursued by the fever, and which I trust has been mentioned sufficiently in detail.*

In tracing a history of this epidemic, and in order to arrive at a definite and satisfactory conclusion in regard to the origin or probable cause of the fever, it is necessary that several circumstances be taken into consideration; and first, the arrival of the crew of the schooner Mai, at this port, on the 5th of August; second, the visit of Dr. Gould's son to Key West, and his subsequent illness on his return; third, the atmospheric changes and influences which had prevailed during the previous six weeks or two months; fourth, the unacclimated condi tion of the command; and, finally, the sanitary condition of the post itself.

Concerning the first of these considerations, and to which I have al ready alluded in the beginning of this report, I would remark that the Mai was reported to be bound from New Orleans to Havana, and at the time of the disaster occurring to her she had been at sea over a week. Yellow fever was known to have existed at New Orleans at that time. but was not reported epidemic, nor had the port been declared an infected one. An easterly gale was prevailing at that time, and the captain and crew barely saved their lives, reaching this port with only the clothes they had on, and they thoroughly wet through. They were a hardy set of men, and at the time of arrival were in good health and condition, and so continued during their stay here, which was only until the Matchless could arrive and return with them to Key West, about five days. Possibly their clothing having been infected at New Or leans, some germs of the fever might have still remained about them, and in this way have been imported into this port. Although infection of the post from this source is possible, I consider it extremely doubtful. As to the second point noticed, I would merely state that had yellow fever existed at Key West when Charles Gould visited there in August, or had he in any way been exposed to its morbific influence, I could clearly and very properly trace the importation of the disease through him. But, on the contrary, I am assured by the health-officer at Key West, and other reliable parties there, that there was no fever in that place during the year prior to the month of September, and that the past summer has been an unusually healthy one. I may also add that the boy is well acclimated, having lived all his life in Southern Florida, and for the past two years in Key West.