1847]

As it appeared at Boa Vista.

229

combination of circumstances that the contagionality of the fever with which her crew was affected is due. To me there is no proof that the fever in question was in any degree contagious before the vessel reached Boa Vista, and we have a right to look for proof both at Sierra Leone and the Gambia, where the evidence is against contagion. At Boa Vista the reverse is the case; for the whole history of the progress of the fever subsequent to the landing of the crew on the small island proves it to have then possessed highly infectious qualities. I would say, then, that the contagious properties which marked the 'Eclair' fever at Boa Vista were acquired or contingent, and not primarily or essentially belonging to it." P. 110.

Dr. Mc William, in drawing his observations to a close, alludes to what he considers the injudicious reluctance of Sir William Pym to permit the immediate removal of the sick from the Eclair, upon her arrival at the Motherbank, either on board a hulk of proper size, or to one of the wings of Haslar hospital, "to be appropriated exclusively for them," as was proposed at the time by Dr. (now Sir John) Richardson.

"This humane proposal might in my opinion have been acted upon, without any risk of the public health being endangered; for the history of yellow fever in ultratropical countries shows that a continued high temperature beyond that of the summer heat of England is necessary to keep its poison in a state of activity; and that when it has prevailed at Gibraltar, Cadiz, Malagar, and Leghorn, it has always been preceded by a certain duration of high temperature. The Superintendent-General of Quarantine objected most decidedly to the sick crew being landed at Haslar, on the ground of the disastrous consequences to the mercantile interest of this country, in the event of the Eclair' being admitted to pratique' for this reason alone, and without entering into a discussion relative to the public health,' did Sir William Pym oppose the removal of the sick crew to Haslar. One would have indeed hardly expected that the SuperintendentGeneral would have much dread of the danger of infection, from the crew of the 'Eclair' being landed in the month of October in the commodious, cool, and well-ventilated wards of the finest hospital in the world, after reading in his work that the contagious powers of yellow fever 'are destroyed by cold, or even by a free circulation of moderately cool air."" P. 111.

The general Conclusions of Dr. M.'s Report stand thus :

"First That the fever on board the Eclair' was primarily the remittent of the African coast, which is not a contagious disorder, but that the disease acquired contagious qualities in virtue of a series of causes.

"Second, That although there exists on the Island of Boa Vista a physical cause capable of producing remittent fever, yet it does not appear that that cause was in action when fever broke out in September 1845, and that the island was quite healthy when the Eclair' arrived there.

"Third, That the disease of which the Portuguese soldiers died at the Fort (Duke of Braganza) on the small island, was that which afterwards ravaged Boa Vista. and the same as that which prevailed among the crew of the Eclair.'

"Fourth. That the fever was propagated throughout the island almost exclusively by direct intercourse with the sick, there being only two cases in which there appears any probability of persons having been infected in any other way. "Fifth, That although those who had passed through the fever were much less liable to the disease than those who had not, yet it would appear that a person having had one attack, possesses no absolute protection against a second attack.

"Sixth. That connecting the whole of the circumstances attending the arrival and stay of the Eclair' at Boa Vista with those under which the disease appeared

on the small island, and afterwards on Boa Vista itself, leaves no doubt of its having been introduced by the 'Eclair.'

"Seventh, That in all probability the mortality from fever on the island was much increased by the want of proper nourishment for the people, as well as by the total absence of medical assistance for some months.

Eighth, That the disease had in no case spread to any of the other islands of the Cape de Verd archipelago." P. 112.

In taking leave of Dr. M'William's report, we cannot but express our surprise that Sir William Burnett, in transmitting it to the Admiralty, should still persist in asserting, now that the complete circumstances of the case have been ascertained and made public, that there was no case of the fever at Boa Vista for a month after the departure of the Eclair! Such hardihood of assertion surely savours more of pertinacity than of calm conviction. Sir William Burnett himself, in his former communication upon the subject, (vide the number of the Med. Chir. Rev. for July, 1846, p. 228,) candidly admitted that" if it can be fully and satisfactorily shewn that any person, who had visited the ship or tents where the sick were placed, contracted the fever in question and communicated it to others, and they to other persons in succession who had never visited the ship or sick, then there can be no reason to doubt the infectious nature of the disease; but if nothing of this kind has taken place, then the conclusion must be that the disease is not infectious, and is therefore incapable of being communicated; in either case settling this long-contested question." Can any unprejudiced reader of Dr. M'William's report hesitate for a moment as to his opinion? We cannot but suppose that Sir William Burnett allowed himself to prejudge the question at first, and that he was afterwards unwilling to recede from the position he had taken up. His stinted and ungracious recommendation of Dr. M.'s report must surely have proceeded from the same feeling of disappointed expectation.

From one Sir William we pass on to another Sir William. He of the Quarantine board is, as might be expected, much more complimentary to Dr. M William than the chef of the Navy Medical Department. The Report is declared by the former to be "a most valuable document," displaying "great judgment, perseverance and impartiality," and its author is said to "deserve well of his country for the manner in which he has executed his mission." Strange !—is it creditable?—that the very same act and work should be so differently regarded by men equally professing the same regard for truth and candour.

As a matter of course, Sir William Pym points to the cases of Georgio the store-keeper, of Luis Pathi, and of the two Portuguese soldiers at the Fort as affording incontrovertible evidence of the introduction of the fever by the Eclair,' and of its spreading by infection. We quite agree with him in this respect the facts are too strong to be gainsaid, and too conclusive to be explained away. But we cannot see how the evidence, brought forward by Dr. M., can anyhow be said to finally settle the question as to malignant Remittent and Yellow Fever being essentially distinct diseases. Dr. McWilliam evidently thinks quite otherwise, as we have already seen. Sir William then enumerates what he deems to be the distinguishing features between the two diseases. He makes the presence of the black vomit to be the characteristic or discriminating symptom of the true pesti

231

18471 His Observations on Dr. M'William's Report. lence, and this symptom he (unguardedly, it must be presumed) says "only shews itself in the persons of natives of a cold climate." He does not hesitate to declare that it is "a native of and peculiar to the West Coast of Africa," and that it "has been at various times imported into different islands and countries; viz. to the different West India islands, the island of Ascension, and the different ports of Spain and North America, as in the year 1845 into the island of Boa Vista." With respect to the assertion that "it has a singular and peculiar character; viz., that, like Small-pox, it attacks the human frame but once," we shall only now say, in addition to what has been suggested in a former page, that the character or attribute in question is by no means so singular or peculiar as Sir William and some other writers imagine. All fevers of a continued type, (whether originally or only secondarily so,) and more especially when they have once occurred in a severe form, leave a greater or less degree of insusceptibility to a relapse or recurrence. Second attacks of true Typhus are comparatively of very rare occurrence. We have already seen that the same holds true of the Ardent fever, and, we doubt not, of malignant Remittent also.

The general assertion, too, of Sir William that the endemic fevers of intertropical countries are not infectious has been shown to be, when taken in an unqualified sense, not strictly correct: they are unquestionably liable, now and then, to become so under circumstances of crowding, want of cleanliness, imperfect ventilation, &c.

With respect to the statement that "it appears evident from the history of the 'Eclair,' that she had both diseases on board at different and distinct periods; viz., the marsh or mild during the months of April, May and June, and the yellow or Bulam fever with black vomit, from the 23rd of July to the time of her arrival in England," we can only say that it is very far from being evident. Dr. Mc William, as we have seen, interprets the matter very differently, and, as it seems to us, in the right way. Sir Wm. indeed, fixes the exact day when the first case in which there was black vomit occurred, viz., on the 27th of July, the fourth day after the steamer left Sierra Leone. But not only is there an utter want of evidence to warrant this statement,* but there is a very strong presumption that this symptom had been observed, in a partial degree at least, at a much earlier period; for (as quoted in our previous article) we read, in the account of three post-mortem examinations in the month of April, the following entries made by Dr. Maconchy :-" the stomach contained some reddish glairy matter"" the stomach was distended with dark serous fluid, mixed with black flakes." What, pray, were those appearances but evidences of black vomit having, either actually or all but, taken place? and when it is mentioned in addition that, “not a clot was seen in the body, but fluid

It is amusing to notice how Dr. Copland, in his narrative of the fever on board, seeks to reconcile Sir William's statement on this point with the lack of any evidence to prove it. While he admits that "no description or details are given in the official papers," he nevertheless tells us that "on this point it is impossible for Sir William to have been mistaken; seeing that his experience of this distemper in the West Indies and in the South of Spain has been greater than that of any other physician whatever." What has his experience to do with

the matter?

blood exsuded from the nostrils and blistered back," can we resist the conclusion that already the fever on board the Eclair' had begun to exhibit symptoms of incipient malignancy? Moreover, it is left utterly unexplained by Sir William Pym, where his true yellow or Bulam fever was caught. It was not prevailing at Sierra Leone at the time of the departure of the Eclair; and all the other ships of the squadron were healthy at the time, and remained so. Both of these considerations appear to us to render it very much more probable that the already existing fever on board of the steamer became, from a variety of circumstances all tending to the deterioration of the health of the crew, infectious and fatally malignant, than that an entirely new disease, nova pestis, was introduced on board immediately before the vessel left Sierra Leone.

It is curious to observe how apt a person, who has taken up strongly any favourite hypothesis, is to assimilate, and as it were incorporate, all facts that present themselves with that hypothesis. Sir William Pym, in his zeal to prove the great fatality of the real Yellow fever, and consequently the danger of its being imported into this country, actually quotes from an anonymous newspaper a list of ships on the African coast, with their mortality, during a period of eight months in the year 1837-38. Out of 650 men, no fewer than 308 perished; a truly frightful loss! But how, may we ask, does Sir William know that every one of these fatal cases was his genuine yellow or Bulam fever? Is it not much more probable that a very large proportion arose from that very fever, viz. the endemic remittent, which he so emphatically declares to be essentially distinct from the former, and which we know to be abundantly fatal ?

Sir William still adheres to the propriety of the advice he gave upon the arrival of the Eclair' in England not to land the sick, as was proposed by Sir J. Richardson, at Haslar Hospital, upon the ground that the landing of them at Boa Vista was the cause of the introduction of the disease into that island :-not a very valid reason, it must be confessed. His allusion too to the disease being arrested at Moradinha, in the beginning of June, by the measures recommended by Dr. Mc William, is surely straining a more than doubtful point to the very uttermost: the fever was all but extinct upon the island at the time!

In concluding our notice of the "Eclair fever," we may remind our readers that although four of the officers of the Growler," who went on board of the former steamer at Boa Vista, were attacked very soon after, there is no evidence to show that the disease spread to any other of the Growler's crew. But what is very remarkable is that, while this vessel lay at Woolwich, two of her men, engaged in clearing out her hold (which, it is stated, gave out a very offensive smell), were taken ill on the 10th of October-a month after leaving Boa Vista-and both died in hospital with all the characteristic cases of yellow fever: no other case occurred subse quently, either on board the Growler or among any of the attendants in the hospital on shore. Here, therefore, is another instance of the disease appearing to be connected with a foul and unwholesome state of the vessel's hold, and of the danger of men being exposed to the effluvia thence proceeding. It is much to be regretted that Mr. Carter, the surgeon of the Growler, has not given the public any particulars respecting the health of her crew, notwithstanding the appeal that has been made to him.

1847)

Quarantine and other Preventive Measures.

233

Already so large an amount of space has been occupied with the preceding details, that we have left ourselves only a few lines to allude to the principles which should guide a medical man in his endeavours to prevent the introduction and arrest the diffusion of the Yellow fever. And here, to prevent all mistake, let it be understood that we are alluding to a fever of hot climates, which, in whatever manner it may have originated, is accompanied with symptoms of a dissolved and putrescent state of the fluids, as indicated by the occurrence of black vomit, sanguineous discharges from the bowels and other passages, and by a luridly-yellow discolouration of the surface. That such a disease is liable, under certain favouring circumstances, to exhibit highly infectious properties cannot, we think, be fairly disputed; and is not this just what we might have a priori expected from its very analogy, we might rather say its close alliance, with other forms of malignant putrid fever? Cullen was quite right, we are convinced, in making it one of the several varieties or modifications of Typhus; its peculiar characters being the result of climatorial and other appreciable influences.

It would be easy to point out many features that are common to them all; and we verily believe that it has been from a neglect of this very fact that there has been so much discrepancy of opinion amongst medical men in reference to the one we have been treating of. That petechial typhus is apt to spread by infection will not be denied: and the same thing seems to hold good of malignant yellow fever.* The virulence of the infection, and consequently the risk of propagation, in both are proportionate to the degree of the dissolution and putrescency of the fluids, and the corresponding malignancy and fatality of the disease.

There is but little occasion to entangle ourselves in controversies as to there being any essential difference between one intertropical fever and another, or as to the alleged original habitat of a particular species in this part of the world or in that. It is sufficient for the practical physician to recognise the simple and intelligible principle that, whenever a fever in a hot climate begins to exhibit symptoms which clearly indicate that the blood is "touched corruptibly," it is high time for him to have recourse to precautionary measures to mitigate or arrest its diffusion from the sick to the healthy. And what are these measures?—the very same that every prudent man would resort to, in this country, in the case of Typhus. Do not crowd the sick together, but keep them as much apart as possible; maintain the greatest cleanliness and freedom of ventilation in their chambers and abodes; separate the healthy, and prevent all unnecessary intercourse between them and the sick; remove all causes, as far as may be practicable, of existing insalubrity; be of good courage, be not afraid. It is always useful to have the healthy well-fed and actively occupied. Wherever the sick have been located, the cabin, room, or ward should not be occupied by persons in health until it has undergone a thorough cleansing and purification; and here we cannot but express our opinion that the use of disin

* Much of what has been said on the Typhoid form of Dysentery, in a previous page of our present number, is strictly applicable to the history of the Yellow fever, and supersedes the necessity of further remark in this place.