Throughout the Nineteenth Century yellow fever continued prevalent in South America and the Antilles, and Bérenger-Féraud records only two years in which it was not epidemic. (1) During this period a vigorous trade between these countries and the United States was carried on, and since the cause of yellow fever was still a mystery it is not surprising to encounter repeated outbreaks of the disease in this country along the Atlantic seaboard. In the North, due probably to stricter quarantine, there were no real outbreaks after 1822. (2) In the far South there were serious epidemics. In Virginia there were no less than thirteen, confined chiefly to the cities on the seacoast, at whose wharves foreign vessels touched. There were nine epidemics in Norfolk, two in Portsmouth, one in Alexandria, and one in Winchester, with scares in Richmond, Williamsburg, Hampton, and City Point.
A severe epidemic visited Norfolk in July 1800, occasioned by the arrival of three infected ships from the West Indies. With great rapidity the disease spread from the neighborhood of the wharves to other parts of the city. Before its ravages were controlled 250 citizens of the town had succumbed. Two ob-
(1) Bérenger-Féraud : Traité Théorique et Clinique de la Fièvre Jaune.
(2) Packard: History of Medicine in the United States, v. 1, p. 15.
 servers of the epidemic, Drs. Selden and Whitehead, did not connect the outbreak of the epidemic with the arrival of the ships, (3) and Thomas Newton, Superintendent of Quarantine, was equally unsuspecting. In his report to the governor late in August he stated: "The fever prevailing here proves fatal to many strangers and those unused to this climate. I am fully convinced that it is not imported; the old Inhabitants are as healthy as common at this season of the year." (4)
Yellow fever in a milder form prevailed in Norfolk in 1801, and Newton, again observing its virulence for foreigners, reported: "The emigrants from Ireland suffer most, as they have no friends, and die for lack of good nursing." During these years Dr. James K. Read, health officer for Norfolk, was busily engaged in the inspection of ships in quarantine. (5)
Another epidemic in 1802 claimed several hundred victims. "We had the yellow fever raging very much among us this season," wrote William Couper, a recent arrival from Scotland, "where it cut off many one every day. . . But I have reason to thank my preserver for preserving me in the midst of 20 or 30 or 40 that died every day, for the matter of seven or eight weeks, and the country were no better. But all is well again, and hardly any complaints to be heard." (6)
In 1803 there was still another outbreak, which reappeared with great malignancy in 1805, according to notes kept by Dr. William B. Selden. (7) Not until 1821 did the fever again make its appearance. In that year on July 20 the George Armistead, a vessel from Point Peter, Guadaloupe, laden with sugar, molasses, and rum, anchored in the Norfolk harbor. During the night she secretly sent on shore the bodies of two of her crew, burying them at Sewell's Point; but when the health officer, Dr. Robert Archer, came on board next day her captain declared that the health of the crew had been and still was excellent. Eleven days later cases of yellow fever began to appear in Norfolk in the family of the harbor master in Woodside's Lane. Mr. Price, a warehouse clerk, and a negro cook in the same neighborhood came down with the disease and died. As cases of yellow fever began to appear all along Woodside's Lane, a crowded
(3) William B. Selden and Alexander Whitehead, Medical Repository, 1801, v. 4, p. 329; 1803, v. 6, p. 247.
(4) Calendar of Virginia State Papers, v. 9, p. 130.
(5) Calendar of Virginia State Papers, v. 9, pp. 215, 368, 376.
(6) Wertenbaker: Norfolk: Historic Southern Port, p. 208, quoting letters of Wm. Couper, October 11, 1802.
(7) Report of a Committee of Physicians on the Yellow Fever at Norfolk in 1855, p. 9. Members of this committee, whose report includes a survey of previous epidemics, were: William Selden. Robert B. Tunstall, William J. Moore, S. D. Campbell, Robert H. Gordon, A. B. Williman.
 narrow street given over to lewd occupants, and spread into Little Water Street, alarm became general. An exodus of citizens followed, and the mortality was kept to about 160. Contrary to the general belief negroes were affected as fatally as whites. (8) The disease "was confined to the part of the city south of Main Street, and west of Market Square, no case ever having been known to originate out of this, the infected district. . . persons living in that district had just to remove to the north of Main Street and they were as safe from the fever as they would have been a thousand miles off."(9) Dr. Archer observed that after the George Armistead had discharged her cargo, "her bilge water was pumped out in the dock between Southgate's and Warren's wharves, which was found to be so putrid and offensive as to render it expedient that the doors and windows on a neighboring house should be closed." (10) Believing as he did that yellow fever was the result of filth and some mysterious effluvia, Dr. Archer found this circumstance almost sufficient to explain the epidemic to his satisfaction, though it was hard to reconcile this theory with the vastly improved sanitary conditions which existed in the city, with its newly paved and drained streets.
In 1822 there were severe epidemics of yellow fever in New York and Pensacola, and the disease also appeared in New Orleans and in Ohio and Kentucky. At least three times during this year the fever knocked at Norfolk's door, but no epidemic occurred. In August the U. S. frigate Macedonia, returning from a cruise in the West Indies, put into Hampton Roads because of the outbreak of "a violent ship fever." Sixty-seven of the crew and ten officers, including Surgeon John Cadle, were dead. Fifty-two others were sick. The ship was promptly quarantined. The sickness continued, and by September 8 the number of deaths on board had swelled to one hundred. A court martial attributed the fever to the change from a cold to a hot climate following taking on water at "the sickly port" of Havana, and thought it was aggravated by allowing the men to sleep on deck. (11) In September the U. S. sloop Hornet, also recently returned from a cruise in the West Indies, was ordered to quarantine at Craney Island because of fourteen sick men. By September 13, nine were dead. (12) In November the Peacock, with thirty-seven of the crew sick and several dead,
(8) Wertenbaker: Norfolk: Historic Southern Port, p. 209, quoting the report of Dr. Robert Archer, in the Norfolk Herald, March 1, July 22, 1822.
(9) Armstrong: The Summer of the Pestilence, 1855, p. 23.
(10) Report of a Committee of Physicians, p. 10. Dr. Archer's account of this epidemic was reprinted in the Virginia Medical and Surgical Journal, 1855, v, 5, p. 324.
(11) Richmond Enquirer, August 13, 1822; November 26, 1822.
(12) Richmond Enquirer, September 6-13, 1822.
 including her medical officer, Dr. Trevett, had to be quarantined at Craney Island. (13)
Four years later, in 1826, another though less severe epidemic than that of 1821 occurred. Little is known of its origin except that residents attributed it to a vessel that had discharged a cargo of damaged coffee. (14) In 1848 three cases, all of officers from recently landed ships, made their appearance. So long had the city been exempt from the disease that not a single practitioner could be found who had ever treated a case. But doubtless the method was not very different from that employed in 1801, when Selden and Whitehead advised large doses of calomel, moderate bleeding, cupping, and cold baths three times a day. (15)
In 1852 there was another epidemic with several hundred cases and between fifty and a hundred deaths. Again the disease first manifested itself near the wharves. It appeared in a row of tenements known as Somers' Row and from there spread over the lower town. Only a few cases occurred north of Main Street. The physicians' committee, which included this epidemic in its 1855 report, was strongly inclined to the belief that the disease was introduced by the Tascio, a Spanish bark which arrived on the twentieth of July from Havana, where yellow fever was known to be prevalent. About six weeks later the disease appeared in Portsmouth, with fatal consequences in four cases. (16)
In 1854 there were three cases of the fever in Norfolk, all fatal, and others across the river in the country. At the time there were two merchantmen from New Orleans in quarantine. The ship's carpenter on one was taken with the fever, but recovered.
Virginia's most memorable epidemic occurred in 1855. On June 6 of that year the Ben Franklin in distress dropped anchor in the quarantine grounds just below Norfolk. The captain reported to Robert H. Gordon, the health officer, that with the exception of one death from heart disease and another from "exhaustion" the health of passengers and crew had been excellent throughout the voyage. Dr. Gordon's inspection disclosed nothing unusual, but in view of the yellow fever raging at St. Thomas's, from which the ship had sailed, she was ordered to remain in quarantine. Captain and crew were allowed on shore.
(13) Richmond Enquirer, November 12, 1822. During this year two deaths from yellow fever were reported in Brunswick County and five cases in Essex. Here the effluvia which pervaded a house after a long-closed cellar room had been opened was said to have been the cause. Richmond Enquirer, August 20 and October 15, 1822.
(14) Report of a Committee of Physicians, p. 13.
(15) Short history of the yellow fever which prevailed at Norfolk in the months of August, September, and October, 1801, by Selden and Whitehead, Medical Repository, 1803, v. 6, p. 247.
(16) Report of a Committee of Physicians, pp. 14, 15.
 On June 18 the captain had the health officer on board again to point out the serious condition of his ship and plead the urgent need for repairs. Inspection at this time showed her to be leaking badly, but clean and apparently free from sickness. Accordingly the quarantine was lifted, and on June 19 she entered the shipyards of Page & Allen at Gosport to be thoroughly overhauled.
On July 5th a boiler worker on the ship became suddenly ill and three days later died with unmistakable signs of yellow fever. Consternation prevailed in Portsmouth, and the ship was immediately ordered back to quarantine. (17)
From this time on events moved rapidly. Other workers on the Ben Franklin sickened and died—Francis Jones, James Courtright, and three others, besides two negroes, who had passed a night on board. The disease soon spread on shore. First Mrs. Fox, who lived near Portsmouth at the mouth of Scott's Creek just opposite the Ben Franklin during the ship's quarantine, was taken sick; then three residents of a tenement on Water Street immediately connected with the shipyards; and finally the whole of Gosport was attacked.
Although the disease continued to spread in Portsmouth, it did not appear in Norfolk, on the opposite shore, until the middle of July. Not until the thirtieth did the Board of Health become aware of its presence in Norfolk through Dr. George L. Upshur's report of sixteen cases in Barry's Row, a waterfront tenement, inhabited by the poorest people and extremely filthy. Acting on the assumption that contagion could be bottled up in this location, the streets leading to it were barricaded and all intercourse forbidden. Shortly afterwards all the inhabitants of that district, both sick and well, were removed to temporary quarters outside the city limits. (18) On the ninth of August some incendiary started a fire that wiped out the entire infected block. While condemning the act, the populace congratulated themselves that the disease was eradicated. Not so. From this time on its progress was steady and unchecked. "The epidemic wave, extending in a circle as the ripple from a stone thrown into the water, day by day invaded house after house and street after street." (19) It reached its height in the last days of August, continuing unabated until the middle of September. Then it gradually subsided, until frost on October 26 brought it to a close.
(17) Subsequent investigation showed that there had been eight or nine cases of yellow fever and several deaths on board the Ben Franklin before she left the docks at St. Thomas's. On the passage there were three cases and two deaths, one body being buried at sea and one after the vessel went into quarantine. The second mate was ill when the first quarantine was lifted and died a few days later of yellow fever. All told there were seven cases and four deaths among the crew after the ship left quarantine. These facts were carefully concealed from Dr. Gordon by the captain. (Report of Committee of Physicians, pp. 22-26.)
(18) Called Oak Grove Hospital.
(19) Report of a Committee of Physicians, p. 35.
 The ravages of the disease exceeded anything experienced in the state since the days of Jamestown. At the beginning of the epidemic Norfolk had a population of 16,000. Six thousand persons left the city. Practically the entire remaining 10,000 came down with the disease, only those who had had a previous attack being spared. Negroes proved as susceptible as whites and mulattoes, but with them the disease was seldom fatal. In all there were about 2,000 deaths, and one-third of the white population succumbed. (20) The Black Death of the Middle Ages did not exact such a heavy toll.
To the medical profession there were inexplicable features in this epidemic—the previous good health of the community, the cleanliness which generally characterized the city, the apparently favorable meteorological conditions, the fact that parts of the city inhabited by the wealthier classes were as susceptible as the crowded parts inhabited by the poor, and that dry, clean, well-ventilated, sparsely settled communities were not spared. None of these facts fitted in with contemporary conceptions of the disease. The committee of physicians appointed to study the epidemic reached the conclusion that the disease was imported by the Ben Franklin; that "the material cause of the disease was transported by the wind directly from Gosport" to Barry's Row in Norfolk—a distance of about a mile; and that it was "decidedly, not contagious." Their lengthy report ended with the hypothesis that the "material cause is some organic matter endued with the property of rapid reproduction, either in a soil or atmosphere congenial to it, but not capable of being reproduced in the human body. That this matter, whether of animalcular or vegetable character, is a production of tropical regions, and is only spread in temperate climates, when introduced into them by ships." (21)
The horrors of the epidemic were described by the editor of the Norfolk Herald: "The city was wrapped in gloom. All the stores, and the dwellings of the absentees, were closed; few were seen passing in the streets on foot, and these on some errand of mercy or necessity. . . Most of the inhabitants present were either confined at home by sickness, or in attendance on the sick. . . and though there was the perpetual din of carriages, continually passing, from early dawn till a late hour of the night—the physicians' carriages, and hacks conveying nurses and members of the Howard Association, and the hearses, and the ever-moving 'sick-wagon'—rattling and rumbling to and fro in every direction—there was no sign of wholesome animation." (22)
(20) Report of a Committee of Physicians, p. 38.
(21) Report of a Committee of Physicians, pp. 42, 43.
(22) Forrest: The Great Pestilence in Virginia, p. 87.
 A rigid quarantine was adopted, and many towns cut off all communication with the stricken area. "We have been treated," said the editor of the Argus, "with an inhospitality heretofore unknown in Virginia, in having almost every outlet from the place barricaded against us. Our citizens, who have gone to other retreats for safety (though free from disease themselves) have been, in many instances, inhumanly thrust back on our borders."
An invisible force had closed the harbor, and foreign and domestic commerce dared not enter the port. "Look along the water-front of the city," wrote the Reverend George D. Armstrong, an eyewitness. "Wharves and warehouses, with the names of occupants painted in large letters upon their fronts, all appear as usual, saving that their doors and windows are closed, and there is no living thing to be seen about them. The names painted there will, many of them, if they are to give true directions, soon have to be blotted out, and graven instead, upon the sign-stones in the 'city of the dead.' But look along the wharves, where at every season of the year there are many vessels lying, and in the winter and early spring they often line the wharf-heads five or six deep. There is not now one single vessel to be seen afloat, from the drawbridge to Town-Point. There are the two slender masts of a fishing-smack sunken in the county dock; and here, in this shipyard, there is a vessel drawn up as if for repairs; but there is no shipwright at work upon her. . . The only boat which enters our harbor now is the little steamer J. E. Coffee, run to meet the boats from Baltimore and Richmond in Hampton Roads. By her our mails are carried and all our commerce done. Yesterday she came in with her whole deck piled with empty coffins; and coffins for the dead are one main article of import now. . . Poor desolate Norfolk! The coming of a ship into her harbor today would cause almost as much surprise to the beholder as did the coming of the ship whose hull first rippled the surface of her waters to the Indian who then dwelt here." (23)
Mr. Armstrong labored through the epidemic, contracted the disease, and recovered only to see four of the seven members of his family swept away in the course of a few days. He has left a moving account of his daily rounds in the stricken city: "A widowed mother and two of her children, all victims of the fever, have been buried from this house within the last ten days, while the three remaining children of that family, all apparently convalescent, were on yesterday removed to the house of an uncle, in another part of the city. In the upper story, there is a maiden lady, with the three orphan children of a deceased
(23) Armstrong: The Summer of the Pestilence, pp. 101-103.
 sister, living—or rather, they were living yesterday, but all down with the fever . . . The children are all better, but the aunt is breathing her last. . . a sister has stolen away from her own sick son and daughter, that she may close her eyes." He describes another house, with two families living in it, "and all of both families have the fever . . . a few days ago, I stood at the door and begged a passing physician to come in and prescribe for the sick, but begged in vain; not that the physician was not willing to come, but because he had already more cases in hand than he could properly attend to. In another house all are apparently yielding to medical treatment except Mrs. J., who is now said to be near her end. . . She does not seem ill today, and yet her physician, who has come from New Orleans, and made this disease his study, tells me she will be dead before tomorrow morning." It is the Sabbath day. "Two of our churches are open today. . . A mere handful have come up to the Lord's House."
He visits the home of Mr. S.: "When last there, on Friday evening, there were five of the children down with the fever. . . The mother and another child were taken down yesterday. . . The eldest daughter has had the 'black vomit' for several hours. . . Passing around the corner of the street, here, in this house just before us, there were five sick with the fever yesterday. . . Those most ill have been placed in a room by themselves; that if they die . . . their death struggles may not excite . . . those who are recovering."
"We have burials, but no funerals now," he wrote on September 6. "It is the mother we are to bury; and the daughter is now so extremely ill that we dare not let her know that her mother lies dead in the very next room. . . Enough are present to carry the coffin to the hearse; and. . . we drive off. . . at the same rapid pace. . . The principal grave-digger opens the cemetery gate; but instead of silently pointing us to the grave, as in ordinary times. . . he now asks, in very much the style of the challenge given by a sentry on guard, 'Who's this?'. . . Arrived at the lot belonging to the family, we find no grave dug there as yet, so many graves have been ordered today. . . The hearse cannot wait; . . . all we can do is to deposit the coffin where the grave is to be dug, and, offering a short prayer, there leave it." (24)
Two effective relief agencies were organized to meet the desperate situation: the Portsmouth Relief Association and the Howard Association in Norfolk. The latter bore the brunt of the distress. Organized for the purpose of establishing hospitals, caring for the sick, and burying the dead, it expended $179,000 contributed by the citizens of Virginia, New York, Pennsylvania, Maryland, and
(24) Armstrong: The Summer of the Pestilence, pp. 76, 78, 79, 81, 82, 83, 84, 97.
 other states. Soon after the fever was discovered in Barry's Row a pest house was fitted up at Oak Grove just outside the city limits. A more salubrious site was soon chosen at the Julappi Race Course on Lambert's Point, distant some three miles by land and two miles by water. Here the sick were transferred by lighters and placed under the charge of William M. Wilson, a member of the Association and a young physician of skill and courage. Here about one hundred and fifty patients were treated. At the height of the epidemic the demand for additional and more accessible beds led to the organization of another hospital in the center of the town. The old "City Hotel" was cleaned, furnished, and converted into a hospital and called the Howard Infirmary. Here Drs. E. D. Fenner and C. Beard, volunteer physicians from New Orleans, were of great assistance. The Association also sponsored the Howard Orphan Asylum, first established in the lecture room of Christ Church and two years after the epidemic given a permanent home with extensive grounds in the northern part of the city. One hundred and twenty children, many of them infants at the breast, were thrust upon the Association. The Association also took over the responsibility for housing, feeding, and furnishing transportation to the large corps of volunteer physicians and nurses. By special arrangement these were all provided for at the National Hotel. With the cessation of the epidemic the Association did not end, for it found nearly 500 families dependent upon it and was forced to carry them until the succeeding spring. The final act of the Association was the striking of a gold medal, with appropriate designs of Faith, Hope and Charity on one side and the Good Samaritan on the other, to be bestowed upon Miss Annie M. Andrews and each of the volunteer physicians.
In Portsmouth the U. S. Naval Hospital, with Surgeon Lewis W. Minor in charge, was offered by the government and during the epidemic cared for 587 patients. The Portsmouth Relief Association spent over $85,000, received from all parts of the country. As in Norfolk, medical care, food, and burial services were provided, and orphans of the victims were cared for. The mortality in Portsmouth was about nine hundred. (25)
Naturally the burden fell heaviest upon the medical profession. There were thirty-five physicians in Norfolk and Portsmouth in 1855. (20) But with 10,000 cases of yellow fever in Norfolk and three or four thousand in Portsmouth, more doctors were needed. Volunteer physicians from far and wide, eighty-seven in all, hurried to the help of the stricken city. Twenty came from Philadelphia, ten from Baltimore, seven from New York, three from Washington—a re-
(25) Portsmouth Relief Association Report, pp. 11, 66.
(26) Forrest: The Great Pestilence in Virginia, pp. 231, 232, 248.
 markable response of Northern physicians who had little acquired or natural immunity. Georgia sent twelve, South Carolina eight, New Orleans six, Virginia ten. Of the ten volunteers from Virginia eight were from Richmond. The mortality among the physicians was extremely high, especially among the local doctors and those from the North. Of the twenty-five Norfolk physicians ten died, of the ten Portsmouth physicians four died. Twelve of the twenty volunteers from Washington, Baltimore, and New York succumbed, as well as five of the ten volunteers from Virginia. Of the thirty-two volunteers from the far South only three died. Altogether 122 physicians labored in Norfolk and Portsmouth during the epidemic. Forty of them succumbed to the disease. (27)
With the exception of William M. Wilson, who had had the disease, and J. J. Simpkins, who had to leave the city, the entire profession of Norfolk contracted yellow fever, and before the epidemic was over ten Norfolk physicians had fallen victims to it. George L. Upshur (1820-1855), a young man of thirty-five, was consulting physician to the U. S. Marine Hospital and was the first to recognize and treat cases of the disease. For a while the epidemic was spoken of as "Upshur's fever," as most of the cases were in his practice. Working indefatigably, keeping notes upon his cases for future publication, he survived almost to the end of the epidemic, seemingly invulnerable. Writing to a friend, August 22, 1855, he said: "Thanks to a merciful Providence, I remain well, but am pressed to the very earth by my professional duties. This is an epitome of my daily work: from 50 to 60 visits in private practice—a visit of 4 miles to the Fever Hospital (to which I am one of the Physicians) a visit of 2 miles to the Marine Hospital—making a daily ride of 12 miles—and office business enough to keep me from taking any rest from the time I get up until late at night—I am getting thin, but keep up my usual good spirits and remain well . . ." In the same letter he stated: "I am not prepared to say, that, under no circumstances can yellow fever be imported into a town, but I do know, that the epidemic now scourging our city originated in our midst." (28)
Dr. Upshur was born in Northampton County, January 14, 1820, the son of John E. Nottingham and Elizabeth P. Upshur Nottingham. (29) He graduated from William and Mary before taking up the study of medicine at the University of Pennsylvania, where he received his degree in 1843. In the twelve
(27) The names of all the physicians, resident and volunteer, may be found in The Great Pestilence in Virginia, by William S. Forrest, 1856, pp. 231-258. The list of the dead is given in the Virginia Medical and Surgical Journal, 1855, v. 5, p. 338.
(28) MS. letter in the possession of Mrs. M. R. Turnbull of Richmond.
(29) His maternal uncle, Judge Upshur, Secretary of the Navy and of State under President Tyler, in order to preserve the family name in Virginia induced young Nottingham to apply to the legislature of Virginia for change of his name.
 years prior to the epidemic he established a reputation for careful bedside observation and for medical authorship of more than average ability. In 1844 he married Sarah Andrews, daughter of Dr. Jacob G. Parker, of Northampton County. Dr. John N. Upshur of Richmond was his son.
The roll of martyrs continues with the names of a father and son. Richard W. Silvester (1801-1855), a native of Princess Anne County, had studied under Dr. Fernandez and Dr. Thomas F. Andrews of Norfolk, completing his medical education at the University of Pennsylvania. Worn out with the stiff demands of a country practice in Norfolk County, he moved to Norfolk City to recuperate his health and educate his children and in 1843 resumed the practice of medicine. He was the first physician to fall victim to the fever. His son, Richard J. Silvester (1828-1855), after attending the University of Virginia, graduated in medicine at the University of Pennsylvania in 1854. He had hardly begun practice before he was called to combat the epidemic in all its fury. A witness of his father's death and his brother's approaching dissolution, he, too, became an easy victim of the disease. (30)
Francis L. Higgins was about forty-five years of age when he succumbed to a recurrence of yellow fever in Philadelphia, where he had gone to recover his strength after an acute attack in Norfolk. He was a native of Norfolk, had studied under his uncle, the celebrated Dr. Thomas F. Andrews, and enjoyed considerable local reputation as a surgeon. (31)
Thomas F. Constable (1816-1855) was in the midst of a vacation in the mountains of Virginia when the news of the Norfolk epidemic reached him. As a member of the Board of Health of the city he felt it his duty at once to return to the stricken community, and it was not long before he, too, was seized with a fatal attack. He, also, had been a pupil of the worthy preceptor, Thomas F. Andrews, before graduating in Philadelphia. (32)
Henry Selden (1818-1855), son of William B. Selden, long a prominent practitioner of Norfolk, fought side by side with his older brother, William; but after two months of righting the epidemic, watching his only sister and his only daughter die of the fever, while his brother and his two remaining children were also attacked, he himself came down with the disease and died. He had studied medicine under Dr. W. W. Gerhard, taken his diploma from the University of Pennsylvania, and served an internship in the Blockley Hospital. The next three years he had spent industriously in Paris before returning to
(30) Forrest: The Great Pestilence in Virginia, pp. 232, 247.
(31) Forrest: The Great Pestilence in Virginia, p. 234.
(32) Forrest: The Great Pestilence in Virginia, p. 238.
 his native city, where he showed himself "clear and decided in diagnosis, firm and self-relying in practice." (33)
George I. Halson, aged thirty-seven, a close friend of Henry Selden, was one of the first physicians to succumb to the disease. He had had an excellent medical training under Dr. William B. Selden, followed by graduation at the University of Pennsylvania and service in the Blockley Hospital. He was esteemed by those who knew him as a man of character and parts.
Richard B. Tunstall was another young man cut off in the midst of a career of usefulness. A graduate of the University of Pennsylvania, his first experience was gained in the medical corps of the United States navy on the U. S. S. St. Mary. He had hardly resigned to take up practice in Norfolk before the epidemic broke and he suffered a fatal attack.
Junius A. Briggs, another victim, was a young man of promise and liberal education, secured not only in this country but in Europe. In the death of the final victim, Thomas Nash, Norfolk lost "a gentleman of much intelligence and experience."
Across the river in Portsmouth mortality among physicians was equally high. Death claimed John W. H. Trugien (1827-1855) a young man of unusual promise, who is remembered for his indefatigable labors. Richard H. Parker, Martin P. Lovett, and L. F. Nicholson also suffered fatal attacks.
The resident physicians who were attacked by the disease but recovered were William Selden, William J. Moore, Robert B. Tunstall, E. D. Granier, Herbert M. Nash, G. W. Cowdery, F. S. Campos, Thomas I. Hardy, Robert H. Gordon, David M. Wright, V. Friedeman, and D. W. Todd, of Norfolk; J. N. Schoolfield, C. Spratley, G. W. O. Maupin, James L. Hatton, and William J. Cocke, of Portsmouth. In Portsmouth V. B. Bilisoly, a homeopathic physician, and James G. Hodges were the only resident practitioners to escape the sickness. (34)
The Sisters of Charity connected with St. Patrick's Church, Norfolk, were among the first to volunteer as nurses, dividing their forces between the twin cities. They were immediately assigned to duty in the various hospitals, and every account of the epidemic describes their invaluable services.
Miss Annie M. Andrews of Louisiana, visiting relatives in Syracuse, New York, and hearing of the plight of Norfolk, hastened to the city and volunteered as a nurse. Assigned to duty in the hospital, she shrank from no danger or hardship, and it was her example that inspired the great company of other
(33) Virginia Medical and Surgical Journal, 1855, v. 5, p. 425.
(34) Forrest: The Great Pestilence in Virginia, 1856, pp. 230-249.
 nurses who shortly afterwards offered their services to the city. (35) All told, there were more than 150 volunteer nurses, many of whom were men. The noble Captain Boyd, performing the duties of the humblest servant to master and slave alike, gave without stint of his strength, as did many others from New York, Philadelphia, Baltimore, New Orleans, Mobile, Charleston, and other cities. Some of them were medical students, others were colored nurses brought from Charleston, New Orleans, and elsewhere.
In November 1855 an editorial in the Virginia Medical and Surgical Journal gave some reflections on the recent disaster: "It is a mournful fact that with regard to the cause of the origin of epidemics, we still remain in great ignorance . . . It is now held by the best minds in our ranks, that two elements are required to create the epidemic, the specific poison of the disease, and an appropriate local matrix." As for the local factor the writer believed that could be taken care of by energetic action in enforcing cleanliness, proper drainage, etc. The search for the "specific poison," however, was a harder matter. "It is a vast undertaking. . . . Individuals therefore cannot complete it. . . Dr. Fenner suggests a government commission and his proposition is worthy of the most serious consideration of the whole nation."
Yellow fever epidemics in other parts of the state were never equal to those which so fatally descended upon the cities of Norfolk and Portsmouth. But the terror of the disease was everywhere, and the occurrence of a few cases in one of the inland cities, even though imported, was sufficient to create consternation.
Outbreaks of yellow fever occurred in Alexandria, in 1800, 1802, 1803, 1804, (36) and 1821. The epidemic of 1803 was described by Dr. Elisha Cullen Dick in the Medical Repository. Upwards of one-half of the 6,000 inhabitants left the city. In spite of the fact that "it was singularly limited in its operations" the epidemic continued throughout the summer and was responsible for the death of more than two hundred persons. Dr. Dick attributed it to a very large mass of oyster shells, many of them containing oysters which were found to be in a state of putrefaction, emitting a nauseous effluvia which could be detected from afar. (37) Dr. B. H. Hall also gave an account of this 1803 epidemic, agreeing that it was not imported. (38) The outbreak in 1821 was less severe. Beginning near the wharf in summer it continued to spread until frost. More than fifty persons died of it. (39)
(35) The names of most of these nurses may be found in the Report of the Howard Association of Norfolk. Virginia, 1857, p. 94.
(36) Article by B. H. Hall of Alexandria. Medical Repository, 1805, v. 8, p. 18.
(37) Medical Repository, 1804, v. 7, p. 190.
(38) Medical Repository, 1805, v. 8, p. 18.
(39) Jordan MS., p. 590.
 In 1800 Richmond became alarmed over yellow fever in Norfolk, and the Common Council petitioned the Governor to establish an infirmary in which to isolate refugees from Norfolk should they be taken with the fever. No epidemic developed in Richmond. (40) An outbreak of what was said to be yellow fever occurred in the state penitentiary in the summer of 1806, limited to six or seven convicts, with only one death. Pain in the head, red eyes, yellow skin, and black vomit were the outstanding symptoms. Rocketts, the only depot of foreign trade, was unaffected, and the rest of the city remained in a healthy state. Only the convicts, who suffered from "a long train of inconveniences"—damp sur-roundings, want of exercise, and "a desponding mind"—were affected. Consequently this epidemic was held to support the theory that the disease was of domestic origin and could appear independently of ships from the West Indies. The next appearance of yellow fever in Richmond was in 1855, when many citizens of Norfolk fled from the pestilence there and came down with the disease after their arrival. The cases at this time must have been numerous, for there were no less than twenty deaths among the fugitives alone. (41)
Instances of the inland appearance of yellow fever were reported in Winchester in 1802 and again in 1804. Robert Dunbar of Winchester described the epidemic of 1804, which spread through the Valley of Virginia during the summer and autumn with a high mortality. (42) He considered the first cause of the epidemic to be "marsh miasma, aided by the effluvia emitted from so much vegetable putrefaction, brought powerfully into action by an excessive hot sun."
In 1800, 1802, and 1803 Fredericksburg adopted quarantine measures against yellow fever. Cases occurred in the practice of Drs. French and Carmichael. In every instance the patient had recently been in some infected seaport. (43)
City Point in 1800, fearing the epidemic then raging in Norfolk, asked the Governor for a quarantine officer and urged the establishment of an isolation hospital at Jordan's Point. Petersburg in 1801 became similarly alarmed over the discovery of yellow fever on a vessel from Norfolk. Quarantine measures were immediately instituted and the disease did not spread. (44)
A local outbreak in the Soldiers' Home in Hampton occurred in 1899, with forty cases and eleven deaths. (43) A double line of quarantine was maintained. Old Point and Hampton were quarantined against the Home, and Phoebus,
(40) Calendar of Virginia State Papers, v. 9, p. 132.
(41) Armstrong: The Summer of the Pestilence, p. 187.
(42) Medical Repository, 1805, v. 8, p. 252.
(43) Calendar of Virginia State Papers, v, 9, pp, 129, 137, 322, 325, 366.
(44) Calendar of Virginia State Papers, v, 9, pp. 129, 137, v. 10, p, 501.
(45) Virginia Medical Semi-Monthly, v. 4, 1899-1900, p. 290.
 Norfolk, and Newport News took steps against the spread of the disease from Hampton and Old Point. Several Northern cities—Baltimore, Philadelphia and Boston—quarantined against the Virginia seaports. The efficient work of Health Officer Howe of Hampton, Surgeon Pettus of Old Point, S. W. Hobson of Newport News, and Dr. Hope, quarantine officer of the Elizabeth River district, was applauded. (46)
(46) Hazen, Charles M.: Yellow Fever in Virginia, Medical Register, 1899, v. 3, p. 138.
Article II. An Account of the Yellow Fever Epidemic in Norfolk
During the Summer of 1855.
By A. B. Williman, M. D.
On the evening of August 27th, 1855, I reached Norfolk in company with two young medical gentlemen and a few nurses who had left Charleston for the purpose of rendering aid during the Yellow Fever epidemic. Accounts of the most gloomy description had already been published in many Southern papers. These, together with such statements as reached us on our journey, gave anticipations sufficiently alarming, yet they were not fully realized until we had entered into the thoroughfares of the town. The silence of profound grief seemed to reign on all around us. Houses were left tenantless or closed; the market-place was deserted; shops stood dark and desolate; while dismay marked the features of those few individuals who passed along the streets. A short walk soon conducted us to the office of the Howard Association, and I there, for the first time, observed how serious was the calamity which had invaded the public welfare. The Mayor of Norfolk had just died, and from the rapid increase of sickness, and distress, no efficient system of City Government was possible. Numbers were hourly falling from the ranks of those who remained at their posts of duty, and great confusion seemed near at hand.
A like condition of things to the above, was well calculated to arouse public alarm; nor is it surprising that such an evil soon manifested itself under the form of general panic. In further examination for the reasons of disturbance just noticed, some facts of importance deserve mention. 1st. The little community of Norfolk had enjoyed peculiar exemption from fatal epidemics during a period of more than twenty years. It is true, that in the Summer of 1852 there had been some prevalence of Yellow Fever, but it was then confined to a small portion of the town, and passed away with the loss of few lives. Careful records, kept by the old and distinguished Dr. Selden, prove that the last visitation of epidemic Yellow Fever extending over the town of Norfolk, happened in 1826. Since this date, the inhabitants had been living in that profound repose which always accompanies an uninterrupted continuance of health. Under circumstances such as these, disquiet and apprehension would seem like natural results, when a disease of violence began to appear. It was commonly believed, that the Fever was some new and dreadful pestilence, which, being brought from Africa, was destined to sweep away all life before it.
In addition to the above evil, another, appertaining to the medical profession, must next be mentioned. At the period of the last great epidemic in 1826, the present medical generation had not commenced its studies; and owing to the limited extent of disease in 1852, few practitioners obtained opportunity for correct observation. This circumstance produced a natural degree of distrust, when the progress and violence of the Fever in 1855 had been remarked. Youth and intelligence, however, among the Norfolk physicians, largely compensated for a want of practical experience, and they continued to perform their duties with judgment and fortitude. Unhappily, death had removed from the ranks of our profession, many men of activity and usefulness; thus leaving an increased burthen of labor upon the few who remained in health. When infection and disease had made still deeper inroads, that small number of physicians who continued to labor, were exhausted by fatigues too strong for human endurance. In their actions, no marks of excitement appeared; but the grave looks, the solemn voice, and silent tears, often betrayed a state of mind bereft of hope. Those consolations, ordinarily bestowed by the medical attendant, were thus in a great degree impaired, and the sick chamber wore the saddened aspect of a place of mourning.
Contrary to the course of things in former times, the present epidemic was seen taking its rise in the neighborhood of Gosport; thence extending to the adjoining population of Portsmouth; and finally invading across a wide river, the dwelling of Irish inhabitants who were situated nearest to the water side in Norfolk. From this gradual mode of approach, people living at a distance, and in comfort, were lulled into fancied security; and it was supposed that the disease would be confined, as formerly, to one portion only of the town. Attempts were made, by means of barricade, to prevent intercourse with that locality where the fever first appeared. This effort, however, proved unavailing. The sickness rapidly over passed its original limit, and soon began to spread like a general epidemic. In a moment of frenzied excitement, the Irish habitations (known as Barry's Row, and comprising a small square of building) was intentionally destroyed by fire. This act, while it clearly indicated a state of great popular alarm, in nowise served to abate the dreaded evil. Removals from one quarter of the town to others more distant west appeared as likely means for security in health, and accordingly many inhabitants transported themselves to remote situations. This early change of residence, whatever it may claim as postponement to illness, was not effected without fresh calamities. Fatigue, uneasiness, and discomfort were its necessary attendants; and these, too, in a hot season when every kind of tranquility was eminently demanded. Nervous agitation of body soon showed its effects under various forms of mental anxiety. The example, in persons who attempted flight, next began to work its pernicious consequences, until a general sense of disquiet, and alarm pervaded the entire population. Safety seemed to exist nowhere, and the panic grew daily worse, evacuation of the town was at length determined upon. It is computed that during one week in August, 10,000 persons left their homes amidst a scene of indescribable confusion, an increase which, news came from the surrounding country, refusing to admit refugees within healthy districts. A fresh source of disturbance thus arose; but fortunately the evil was short in duration, and sufferers from Norfolk found a safe asylum in other places.
While admitting the benefits attendant upon flight from an infected city, it cannot be denied that such a practice, during the Norfolk disaster was productive of ill consequences. A population, suddenly deprived of its intelligent and influential members, is always in danger from sources of alarm; but when desertion happens in a trying emergency; when the class forsaken is poor and ignorant, their state of mind reaches almost to the pitch of despair. Such is a truthful picture of the Norfolk populace during last summer's epidemic. While engaged in my duties to the sick, a most serous obstacle in the form of mental disquiet was invariably present; and I deemed those cased peculiarly fortunate where attendance from surrounding friends contributed it share in allaying fears already excited to the verge of madness from the prevailing panic.
Other sources of alarm may next be traced to some peculiar features in the Fever itself. Always remarkable as a scourge to human lives in Southern latitudes, the appearance of the disease during late years, had assumed an aspect of settled and increased malignity. Tracing its course from the city of New Orleans in 1853, Yellow Fever was seen making fresh strides in its progress Northward throughout all the seaport towns of the United States. Mobile, the coast of Florida, Savannah, and lastly Charleston, had each, in turn, suffered great mortality. It was well known that from the circumstance of long exemption, Norfolk presented a population whose liability to Yellow Fever scarcely differed from that of utter strangers; and hence the well founded dread which arose in the minds of such a people. One short month of trial only served to confirm those suspicious which had been early entertained. During the brief space of time, a wide-spread pestilence, reducing all classes and ages under illness, was abroad. Cries of distress were daily increasing, as yet the most fatal season had not arrived. When August had produced such rapid mortality, it was tremblingly inquired, who shall ever live to see the month of October?
No history of disease, perhaps, was ever marked by greater fatality to physicians than the epidemic in Norfolk. Those numerous losses which had been early sustained by the profession, necessitated a call from other parts of the Union, and the demand was met with promptness. At the time of my own arrival a large body of medical gentlemen had reached the town, but these were chiefly Northerners, who fell easy victims to the Fever. The deaths of such, besides its reduction in the number of practitioners, served only to increase an existing state of ills. It produced general dismay, at the same time that it weakened the degree of safety from disease, which physicians usually consider as their peculiar protection. Rightly to estimate the influence which I am here attempting to describe, would demand that the reader had been an eye-witness of the actual scene. There, in the anxious faces, the haggard eyes, the faltering and troubled speech, were too plainly set those marks of alarm which had seized upon each stranger's mind. Then, too, arose the grave doubts and gloomy forebodings which forced themselves upon the thoughts of unclimated men, and even old veterans from a fever climate. More than half of our medical brethren had already perished, while the pressing calamity threatened to under mine every remaining security of body and mind.
In none of the febrile disorders which I have ever witnessed, was there such complete liability to attack amongst the African race, as during the recent epidemic. At first, a confident belief prevailed that the black population of Norfolk would pass through the approaching disorder with comparative immunity; but very brief experience served to dispel such an error: they were stricken with disease almost at the same moment with the white inhabitants, from whom, it was supposed, some infection had been derived. Great consternation arose from such a belief, and it even proceeded so far, as often to impair the service due from servant to master. I can offer no better explanation for this unfortunate alarm, than the fact of an aggravated disease being present in white subjects, most of whom sunk under loathsome hæmorrhages and black vomit. When these symptoms made their appearance, they seemed as if instinctively to warn the slave attendants against a dangerous contagion; and I witnessed many examples where preparations for burial were obliged to be performed by physicians and the surviving relatives of deceased persons.
During the whole course of the epidemic, great dread manifested itself in the minds of all classes, towards sick persons. The bedside was regarded with apprehension; and wherever one entered, the dwellings contained vessels of disinfecting material. Newly washed walls, streets covered with chloride of lime, fumigation of tar, and destruction of bedding, all gave clear evidence of some direful evil.
The Hospital (it had recently been destroyed by fire, after repeated incendiary attempts, doubtless excited by popular horror of the building.) was regarded as the place of worst infection, and instances occurred where the poor perished sooner than suffer removal to a situation which seemed to exclude all hope of life. I could instance more than one example where desertion occurred to infected households; and those who, under ordinary circumstances, possessed friends, were now forsaken by them on account of bewildering fears.
The malignity of the disease which assailed Norfolk must ever remain as a memorable feature in its history, and no doubt produced a large share of the general panic. Almost at the first invasion, all ages and conditions seemed to be the destined victims of suffering. Those accounts which had heretofore been given of the Fever, offered reasonable hope that some degree of exemption would be enjoyed by aged person, delicate females, and such as led regular and temperate lives. On the present occasion, however, these rules were set at defiance, and a virulent poison seemed to penetrate every station in society. Invalids, both in Norfolk and Portsmouth, who had been long confined to the house, and almost excluded from intercourse with others, are cited as among the early cases of disease; while great mortality occurred amongst persons in all stages of life. (In my own practice, a new-born infant died with well marked symptoms of the prevailing disease.) It would be natural to expect that, under a state of things such as I have been just describing, human emotions would be wrought to a pitch of dangerous agitation. This state of disturbed feeling was only increased by something peculiar in the attack of the sickness. Generally speaking, a household in close proximity to some infected locality, would remain with all its members well, until the first individual began to complain; this appeared to be the signal for general seizure; and very soon few were left to perform duty towards their adjacent sufferers. Many of those menial services which the poor are accustomed to receive from their immediate family, were thus cut off; medical prescriptions rarely reached the sick in due time; and the possession of common nutriment became a serious difficulty. Added to these heart-rending troubles, was another of even worse import. The rapid onset of disease produced almost promiscuous assemblage of the sick, the well, and the dying; nor could the best directed efforts avail in preventing restlessness and mental despondency. These daily pictures of distress; the repeated cries of death, from door to door; the difficulty in burial caused by the destructive pestilence; all contributed to swell the tide of popular dismay—one hitherto unknown in the history of Norfolk, and which has not yet passed from the recollection of her people. (Many persons are still resolute in their determination to quit the town at all events towards the approaching summer.)
Another cause of great disturbance, is connected with inexperience in management of the late disease. Among the early arrivals at Norfolk were several physicians of ability and reputation, who had long been familiar with Yellow Fever in the city of New Orleans. The advice and remedies proposed by these gentlemen, were immediately adopted in the hope of better success than that which had been experienced by the resident practitioners of Norfolk. The former, amongst other measures, advocated the plan of gentle and uniform perspiration during the whole course of a febrile paroxysm; careful admittance of currents of air by day, and exclusion of such during the night. This system, at once rational and simple, became rapidly marked by grievous errors. The poor and ignorant, deprived of medical advice, and with minds ever susceptible to alarm, began to conceive an unnatural horror against the hurtful influence of infected atmosphere. Every caution was taken to avoid it. Out door exercise was abandoned, while the inmates remained closely shut up within their crowded and suffocating apartments. The first plain effect of these evils, manifested itself upon the persons who were not yet laboring under disease. Anxious and hurried respiration, nervous tremor, agitated movements, exaggerated sensibility to slight impressions, were everywhere observable. To the sick, who were often in immediate contact with these hurtful influences, a very disastrous state of mind resulted. Subjected to the distracted looks of those around, and oppressed by stifling heat (The two first cases of Yellow Fever witnessed by me, with others of our Charleston friends, were truly suffocated by bed clothing. We found them in the last stage of illness, under three blankets, and with closed windows, which had been the treatment for several days consecutively.) and impure atmosphere, the unfortunate sufferer might often be found, panting with fears like those of approaching and painful death.
Lastly, the early appearance of the Fever at Norfolk, was a circumstance of peculiar and unfortunate omen. No severe degree of heat had marked the months of May and June; but on the contrary, these were more pleasant in temperature and general salubrity, than the usual average of seasons. Great activity and enterprise had been lately manifested in all departments of business, while peace and security spread their blessings throughout the entire community. Suddenly, a sad change came over these bright prospects. Disease of fatal nature was announced; and the busy avenues to trade and travel were immediately closed. Persons who were on their journey North or South, became alarmed, choosing rather to go many miles in a circuitous route, than approach the infected city. Steamers, plying constantly to and from New York, Philadelphia, and Baltimore, and supplying very many necessaries of life, refused to bring such goods within reach of a landing. From these deprivations, the inhabitants of Norfolk soon began to suffer many inconveniences in their domestic affairs. As disease became more prevalent, separation from friends and the pleasures of society, produced additional discomfort; while the remembrance of recent case and enjoyment, only formed a more painful contrast with the idea of coming illness and increasing want. This dismal train of evils, daily lengthened by fresh news of an outward panic, was rendered more dark and cheerless from the following consideration:
The invasion of Yellow Fever in Norfolk had happened in the full tide of summer. None of the recent epidemics which prevailed throughout our Southern cities, had commenced until the hot season was far advanced. Charleston was appealed to as an instance of great mortality produced in the brief space of eight weeks; yet Charleston did not begin to suffer before the 1st of September. At this date, in 1855, Norfolk was already reduced to such an extremity of distress, that assistance from abroad became necessary; and still the worst period remained in gloomy anticipation. Two long months of endurance seemed to be the dismal prospect. At the thought of its approach, every heart sunk with dismay; and what at first appeared as a state of distracted and confused alarm, now assumed the character of torpor, and silent resignation to impending death.
In the foregoing brief remarks, I have endeavored to point out some prominent causes of panic observed by me, at Norfolk, during the epidemic of 1855. The subject required notice, as a necessary part of the history of the disease, and it has been given in the hope of allaying rumors already exaggerated in relation to the disaster.
ORIGIN OF THE FEVER
The Norfolk epidemic can be regarded in no other light than an extension of the same disease which began in June, 1855, at the town of Gosport. The neighborhood of the places; the character of the disorder and its almost simultaneous appearance in both situations, seem sufficient evidence to settle this disputed question. As it is one, however, of much importance, a more minute examination upon the subject will be held hereafter.
In declaring my opinion as to the distinct importation of Yellow Fever into Gosport, I will state both the positive and negative evidence upon this enquiry, which has received from me a careful and impartial consideration. All the proofs thus far furnished, are strongly in favor of the health condition of Gosport, and its neighborhood, previous to the epidemic. It is extremely doubtful, from the testimony given by the people, as well as by medical men who have practiced upon the spot for twenty years, whether Yellow Fever ever prevailed there. Up to the date when the steamer Ben Franklin landed on the 19th of June, 1i55, this small place, together with the adjoining United States Navy Yard, was in the enjoyment of health. After special enquiries, I am assured that even the ordinary complaints of early summer, were unknown. This fact is alike true for the towns of Portsmouth and Norfolk, nor is there any evidence of a single case of Fever (In spite of assertions to the contrary, my own and repeated investigations testify as to the accuracy of this fact.) prior to the arrival of the above mentioned vessel. The first report of Fever, and its details, are thus recorded by the late Dr. Upshur, Surgeon of the Marine Hospital: "Entered the wards June 21st, a man, who is last from St. Thomas in steamer Ben Franklin. He was seized with Fever on 15th inst. Attack commenced in a chill, and the disease was marked by vomiting and purging. Came into the Hospital at 8 o'clock, P. M., and was visited half an hour afterwards. Decubitus on the back; countenance distressed; breathing panting and oppressed; eyes heavy and somewhat injected; head and limbs ache intensely; nausea and vomiting; thirst; skin natural; pulse soft, full, 96.
"June 22nd.—Died at 2 A. M., having vomited a large quantity of black fluid (black vomit.)"
The case here detailed was removed from the steamer two days after her arrival at the wharf next to Gosport. Its date (since the 15th inst.) is worthy of remembrance, as denoting evidence of an infected vessel, which had been detained at quarantine on account of suspicions regarding her healthy condition.
The two cases immediately subsequent to the above, and whose occurrence happened one week afterwards, are found in persons who were employed at work in the hold of the steamer; one was a man engaged upon repairs to the boiler, and the other a mechanic who had been stepping a mast. The Fever next appears in individuals who were daily on board the vessel, but living at the time near by. One of these was landlord of an Irish boarding house. Thus far we have details of four cases of Fever where the sufferers had been in direct contact with a supposed cause of infection, viz: the steamer Franklin. She lay at a dock distant about two hundred yards from the main street in Gosport, which is inhabited by mechanics and Irish laborers. Of this latter class, we find the three next well authenticated cases of disease. They are marked thirtieth June upon the note book of Dr. Trugien, a late physician of Portsmouth. Whether these cases were ever on board the steamer, is uncertain; but having examined the locality, I can state that very little space (probably fifteen or twenty yards) separated them from those apartments where all the previously named sick persons were lying.
I have thus mentioned seven instances of Fever which arose within ten days after an alleged cause; four as immediately exposed to its influence; and the remaining three in close proximity. Between the 1st and 10th July, a rapid increase of sickness occurred, and the Irish dwellings became largely infected. These houses form a long tenement, called Lee's Row (Lee's Row is not above 150 yards in direct line from the wharf where the steamer was moored.) and are situated opposite to the ship yard where the Ben Franklin steamer was undergoing repairs. From this spot, in various radiating lines, the progress of the epidemic can be traced, on one hand towards the Navy Yard and on the other towards Portsmouth and Norfolk. Between Portsmouth and Gosport there is a communication by a long wooden bridge, over which hundreds of persons are daily passing. This fact will serve to explain the quick succession of disease in both the paces just named. (In a week or ten days there was spread of Fever from Gosport to Portsmouth.) It must be added, also, that the wind from one locality to the other, was favorable for transporting a poisonous miasma. From Portsmouth to Norfolk, a steam ferry boat plies every fifteen minutes. At the present time, crowds of Irish laborers are incessantly moving by this conveyance; and the same was true during the festival of last 4th of July. "Barry's Row," in Norfolk, and the chief resort of this class of foreign people, was thus placed in constant intercourse with the original seat of infection at Gosport. In addition to this circumstance, another fact deserves remembrance. Popular excitement (The alarm became soon so general that the vessel was remanded to her quarantine station July 8th.) against the steamer Franklin, began towards the end of June, and persons soon commenced to fly from the neighborhood. That the seeds of disease were directly planted in Norfolk by the foreign population, and the manner above detailed, is to me very probably, after close examination of persons who were familiar with the Irish quarter and the character of its inhabitants. One fact is at least clear—that the earliest cases of Fever discovered in Norfolk, were in Barry's Row and its immediate vicinity. (Popular opinion, as well as that of Norfolk physicians, prove this statement.)
The condition of the vessel under notice, must now receive a short consideration. She was last from the Island of St. Thomas, where the Yellow Fever had been prevailing in March and April, 1855. The disease had reached vessels lying next in dock to the Ben Franklin steamer, and the two in nearest station to her, suffered great mortality. (Purser Dunn, of the Navy, gives me this information.) Facts hitherto do not reveal more in regard to the Franklin, than that she left St. Thomas, and lost two men during the voyage to Norfolk. Neither of these deaths have been thus far satisfactorily accounted for. After entering port, the steamer was suspected, and detained at quarantine for twelve days. The reports given by the Health Officer of Norfolk afford no indication of disease while the vessel remained at anchor in the roadstead. The Captain asserted the loss of a large portion of his crew from desertion (A statement was made that the loss happened from several deaths amongst the men who were secretly buried on the neighboring shore. I cannot verify the matter, as it came from a sailor, now gone away.) and in ten days after his arrival at quarantine he received on board a fresh crew. As there was no written list of the latter, all chances were afforded for eluding the examination of the Health Officer. He paid two visits to the steamer while she was in the roads; the first, on the day of her arrival, June 7th; and another on the 18th. The case of Dr. Upshur, already detailed, sickened June 15th, and therefore escaped detection. This circumstance can be readily accounted for, either by some deceptive appearance in the Fever, or actual concealment of the ill person from the inspecting physician.
The foregoing view clearly denies the origin of Yellow Fever at Gosport from endemic or local causes. (The neighborhood of Gosport and Portsmouth is one of a large salt marsh, bordered by small buildings and vacant lots, all indicating an eminently neglected sanitary condition. These, no doubt, aided in spreading the pestilence when once it had arisen; and also served to render the character of disease both malignant and fatal. While making this assertion, however, as the extreme warrant of probability, a few facts already mentioned, point clearly to the steamer Ben Franklin as the primary source of one and the same disease which desolated Gosport, Portsmouth and Norfolk during the summer of 1855.
NATURE OF THE FEVER
The great mortality caused by yellow fever within late years, has produced a supposition of some new and more malignant character acquired by this disease. I have already mentioned that, at an early period of the epidemic, popular opinion at Norfolk regarded the disorder as of African origin, and hence peculiarly fatal in its nature. Such a belief, however, rests on no reliable foundation. The steamer Ben Franklin, to which I have traced the earliest cases, had been for two months previous to her arrival at Gosport, lying at the port of St. Thomas. The passage from thence to the United States occupied only a few days, and was performed in direct course, without approach towards the African coast.
In its general character, the Norfolk fever bore a close resemblance to those late epidemics which have prevailed throughout the Southern cities of the United States. An account already published by Dr. Fenner, of New Orleans, likens the disease to that fatal scourge which produced such fearful mortality in the summer of 1853; and my own observations would confirm the statement in reference to the fever witnessed in Charleston in 1854. A short period of bodily discomfort, but oftener without harm. Amongst the medical gentlemen from Charleston and New Orleans who were employed in Norfolk, almost entire escape from sickness occurred. The two cases of death which happened in the persons of nurses from Charleston, appear without any strong protective influence of acclimation in Southern climates, and both were aggravated instances of yellow fever.
After a careful summary of my observations, the following propositions seem to be still tenable, viz: That long and continued residence in cities situated throughout our Southern sea coast, constituted a main element of safety during the Norfolk epidemic; that inhabitants from the West Indies, the Gulf ports, or other places subject to hot seasons, were peculiarly exempt from fever; and that any recurrence of disease, after its previous manifestation by black vomit or hemorrhage, was extremely doubtful.
The poison which is productive of yellow fever, whatever be its nature, seems to be so powerful in kind, as to overrule all other maladies existing at the same time with it. During eight weeks in Norfolk, little else than one prevailing form of disease was observable; and even those persons who suffered no worse indisposition, gave distinct evidence from time to time of jaundiced complexion, discolored eyes, and certain slight pains in the head and limbs. In a few instances amongst the country people, I had an opportunity to observe the supervention of yellow fever upon the common form of intermittent disease. Several persons of the class just alluded to, had recently settled on the extreme outskirts of Norfolk, and in the first attack suffered from distinct chills which recurred every two days. Soon, however, the rigors disappeared, and a continued febrile excitement of severe form changed the character of complaints which now assumed all the most malignant features of yellow fever with fatal termination.
That the disease under consideration manifested clear marks of a contagious property, is evident from all reflection upon its origin and subsequent progress. I have already mentioned a few cases which may be regarded as the first traces of poison introduced into the town of Gosport towards the end of June 1855. In close proximity, if not in actual contact with these earliest examples, other instances of yellow fever quickly showed themselves, throughout the immediate neighborhood. Here the disease lingered sufficiently long to give warning to persons living at a distance, and an attempt was actually made to barricade the bridge which connects the towns of Gosport and Portsmouth. The authorities, also, of the the United States Navy Yard, acting under a belief that non-communication with the infected locality would protect their large body of workmen, compelled them to pass by a distant way around this spot. The result was favorable and although the design had been put into execution too late, it afforded fair exemption from sickness to a thousand laborers during two or three weeks in the months of July. It was not until after fearful mortality had existed without the Navy Yard walls that isolated cases of yellow fever began to show themselves amongst those who were employed within this enclosure.
The earliest indications of disease in Norfolk, I have before said, appeared in the Irish dwellings known as Barry's Row. A communication between this spot and the original seat of fever, has been already described, and the transportation of disease seems to have occurred through the direct agency of human bodies. This supposition is the most probable indication of facts, and even supersedes a belief in contaminate atmosphere, which, in the beginning of an epidemic, may not possess any far reaching influence. (Norfolk is separated from Portsmouth by a river nearly one mile in width.) The first case of fever discovered amongst the respectable residences in Norfolk, I have recently traced to an individual who was fresh from the original seat of disease at Gosport, and who actually left there with symptoms of an approaching attack. In following the successive steps of the epidemic throughout this city, difficulty of insuperable kind arise, yet the following statements may be made with certainty, viz: That the progress of disease was in a pretty regular northerly direction, away from the wharves and shipping, and along the course of prevailing summer winds; that the main tides of human intercourse in Norfolk were the chief seats of fever during its early commencement; while deviations from the principal streets appear to have happened at a later stage of the epidemic, and seemed rather like exceptions to a general rule.
The contagious nature of the Norfolk fever is a warrantable inference who from its peculiar mode of invasion into many households which were under my immediate observation. While the course of disease throughout the general bulk of population continued somewhat erratic, is spread amongst members of the same family amounted almost to a certain anticipation after the first individual sickened. (After careful inquiry I found that my first cases came from some quarter where the fever was already very malignant. In most instances there had been close approach towards the sick.) Second and third cases I found very constantly in the persons of those who were in immediate attendance at the bedside, and who had remained in their apartments during the panic for a long time previous to attack. Such individuals also had been nearly excluded from any supposed hurtful influence in the external atmosphere and were peculiarly subjected to the poisonous air within doors. Those persons who were a little removed from the sick chamber and who visited it only occasionally, taking moderate exercise with their accustomed employments, received infection last. It was a subject of common remark amongst the practitioners in Norfolk that one fatal case of fever in a family was sure to be followed by others of malignant form, and this statement seemed to be true according to my personal experience. All my observations upon the communicability of the disease may be reduced to the following conclusions: 1st. That whatever be the nature of the poison, nearness of contact with its influence and subjection thereto for a length of time were minly necessary for the reproduction. 2d. Two grades of yellow fever were present at Norfolk, the mild form of which exhibited its power of propagation faintly if at all. 3d. The malignant variety showed it contagious property at a period corresponding with the appearance of jaundiced sweat, black vomit, and hemorrhages. 4th. That these morbid products cast off by the blood, were received and retained with ltenacity by articles of bedding, blankets, and woolen clothing which also possessed infecting qualities. This last remark has been a subject of such frequent comment by previous writers, that little of practical import can be here added in relation to it. The suggestion of immediate and free exposure under a hot sun, of all articles, where formites were suspected, forced itself upon the minds of even ignorant persons during the Norfolk epidemic. A procedure less common, destruction by fire, was also resorted to, but no indications of practical value can be deduced from it, since the seeds of disease were already widely disseminated over the town. If future observation should confirm the third statement above given, it seems likely to reconcile some of the disputes which have long been held respecting the contagious nature of yellow fever. A definite period for the evolution of its poisonous virus being once established, and that happening at a late stage of disease, it is presumable that before such time, no power of reproduction exists. While awaiting the revelation of new discoveries hereafter, it is of extreme importance that our medical police in Southern sea ports should continue a system of constant vigilance. If after due observance of quarantine regulations, a case of yellow fever may be discovered in any town, its instant removal to air isolated and distant quarter is strongly indicated. Where the disease has already invaded a single family, or particular residence, absolute non-intercourse with such except by the physician is proved by the Norfolk epidemic to be our last but determined resort.
The nature of my employments at Norfolk, completely forbid any attempt at post mortem examinations which may have thrown light on the pathology of the late fever, and I did not enjoy a single opportunity to observe any changes which the blood may undergo in this disease. In some experiments instituted upon black vomit under the microscope, Dr. Ravenal found constantly the oval granular cells which fill the stomach tubes, known as the peptic cells of Kölliker. This is a confirmation of the views given by Dr. F. T. Miles in our Charleston fever of 1854, and has recently been repeated in an elaborate and interesting report from British Guiana, by Surgeon-General Blair, published in the British and Foreign Medical Review for January, 1856. I may state that in all the examples which came under my notice, the different and progressive stages in black vomit were very regular and well defined. In one instance only did it seem to come on fully formed, copious, and dark, unattended by previous bilious discharges from the stomach, and this happened in the case of an Irishman newly arrived in Norfolk. The snuff-colored specks, floating, and sometimes sinking in the bluish-white fluid, generally appeared first, and as the progress of disease advanced, a more decided brown tinge affected the particles, until at length an evident coffee-grounds sediment showed itself. To the naked eye, both the discharges from the nose and bowels gave evidence of marked changes which had been wrought in the hæmatin of the blood, and they underwent rapid putrefaction after short exposure to the air. In females almost without exception, a recurrence of the menstrual flow happened about the third day of fever, while men, at the same period of time began to suffer from partial or complete suppression of urine. One case only presented the last named characteristic before the accession of fever, and it ran rapidly into a convulsive and fatal termination. The progressive steps towards the urinary suppression were commonly well marked, presenting often on the first day a saffron-colored fluid, thin and abundant, which changes afterwards to an orange hue with copious albuminous deposit. In rare instances, pure blood was voided through the urinary organs, but more commonly, and in the late state of fever, a dark grumous hemorrhage occurred from the bowels.
TREATMENT OF THE FEVER.
It is a subject of mournful reflection that only very small success appears to have attended those medical efforts which were directed against the Norfolk epidemic in 1855. Such a consideration, however, is not without many extenuating circumstances. I have before observed that a long period of health previously enjoyed by this population, had placed them in the position of actual strangers, and hence without any defenses against the encroaching disease. The violence of attack, and the small chance of success from medical treatment, will be readily understood after the statement just made. But still greater obstacles to the interference of art arose from multiplied troubles amongst the panic-stricken population, and their destitute and wretched situation. The class which became chief sufferers were eminently poor, and they, under an existing state of evils, could find aid only in those services which were rendered by the physician. Regular attentions to the sick, or any system of nursing was not at hand; and often the medical assistant performed these duties and administered his own remedies. I have made repeated attempts to ascertain the total number of cases which received medical treatment in Norfolk, but hitherto without a definite result. The population, at the close of the epidemic, was stated by the Mayor of this place at 6,000 persons; and since nearly all suffered from an attack, while the ascertained mortality reaches to 2,000, a loss of one-third must have happened. During the month of September, my inquiries amongst on Southern practitioners, and also from resident physicians, afforded much more favorable returns than the above, and the loss varied from one-fourth to one-sixth upon a large number of patients of all classes.
Those remedies which were employed in the Norfolk fever appear to have been designed either for the purpose of cutting short the disease in its incipient stage, or on the other hand with a view towards combating symptoms as they successively arose. A candid opinion in regard to both these procedures must pronounce the latter most safe, since it is now generally conceded that we possess no heroic or specific remedies against yellow fever. The practice of salivation was indeed still relied on; but its advocates are now few, and I think that the experience of 1855 tends altogether against the future administration of calomel, except for its simple cathartic effects; employed otherwise in Norfolk, the results were generally bad, and increased tendency to hemorrhage, local and general, constantly followed mercurial ptyalism.
Combinations of calomel and quinine in large doses, was a remedy in constant use by those who believed some similarity of nature to exist between yellow fever and the intermittent variety. The testimony upon its efficacy seemed to me very variable; and the few instances recorded of success, happened in persons of strong constitutions, who were not afflicted with disease in its worst form. Quinine alone, given after the febrile paroxysm had passes, or was nearly reduced, afforded perhaps more favorable indications. I knew of its decided benefit when administered as an injection, to a patient much exhausted by restlessness and continued vomiting. Physicians from New Orleans, who have had more acquaintance with the whole routine of quinine practice, used this drug but sparingly in Norfolk; and my own experience satisfies me in stating, that moderate doses at a late stage of the fever were alone advisable.
If any particular method of treatment deserves notice for its success, it was one eminently mild. Free but gentle movement of the bowels soon after the accession of fever, was generally produced by a few grains of calomel, either alone or in combination with blue mass. The form of pills was perhaps most employed from its ready passage into the stomach, and greater freedom from nauseating effects. Where the stomach showed no marked signs or irritability, castor oil was very commonly given, and amongst the blacks it constituted almost the only medicine during the early stages of fever. Its action, in all cases which fell under my immediate treatment, was prompt and efficacious, as well as safe when administered before the first 12 hours of illness had elapsed. In cases where vomiting persisted, there was free resort to saline cathartics, especially such as possessed effervescing qualities. After the administration of mercurials, and where necessity appeared to demand it, free purgation was often produced by amy of the neutral salts. For my own purposes, I commonly employed sulphate of magnesia in a pleasant draught of lemonade, to which a few drops of nitric acid had been added in order to disguise any unpleasant taste. This old and apparently trifling remedy, from its easy administration in small doses, and active property, seemed to answer every purpose in keeping up a continued revulsive action upon the bowels. As the poison of yellow fever makes its first attack apparently upon the brain and great nervous centres, these parts should be the objects of early medication. With this view, it was my intention after reaching Norfolk, to test fairly the use of the cold bath upon the entire body. The want of means, and the class of my patients, however, prevented almost entirely any full employment of this remedy, and I was forced to a trial of cold effusions upon the head and upper parts of the body. Results of the most encouraging and beneficial kind attended the application, which was easy, and without much inconvenience to the patient. I frequently employed, with my own hand, some vessel containing two or three gallons of water, and poured it from a height of two feet upon the exposed parts. Relief to the agonizing headache and parched surface of the chest and limbs was prompt, while frequently an increased moisture began to appear over the whole surface, attended by greater repose and diminished fever. So far as my knowledge extends, all attempts at internal local medication upon the stomach invariably failed. The muriated tinct of iron, once vaunted for its peculiar styptic virtues in arresting black vomit, was in our practice at Norfolk only productive of increase nausea; nor can I mention a single one of the large class of antacid remedies which gives more than momentary relief. Counter-irritation at an early stage of fever was generally made over the epigastrium, and with such results as gave to this remedy considerable value in controlling excessive vomiting. Frictions along the whole course of the spine with powerful stimulants as turpentine, chloroform, &c., together with cupping upon the back of the neck, were also resorted to when there was apparent tendency towards the black matter formation. But at most, these means only delayed the dreaded symptom; and when any arrest occurred in the progress of black vomit, it seemed to be rather attributable to the direct powers of nature. In a few cases, where I employed strong opiate enemata, more repose was induced than by any other method of treatment which had been adopted. Local, and not general blood-letting, was the plan pursued at Norfolk; and it is probably that in the early stages of fever, depletion direct from the circulation, together with emetics, might have been employed oftener with benefit. As rapid prostration, in the late epidemic, very generally happened towards the period of crisis, there seemed obvious indication for supporting the system against fatal debility, and hence stimulants were added to some light nutritious fluid. Nothing seemed to me so easily borne as thin chicken water containing a little salt, and frequently the sick partook of it when fatigued with cold or acidulated drinks. During the actual stages of black vomit, a variety of means were used for some supposed stimulant and tonic virtues which they seem to possess; but I am not aware that the administration of brandy, champagne, or porter added at all to our knowledge previously entertained respecting alcoholic medicines in yellow fever.
On reference to my case book I find that during the epidemic one hundred and twenty persons came under my personal treatment. Of this number eighty were whites, and forty blacks and mulattoes. The white cases show a loss of eighteen, the colored races only two. One of the latter was a woman of 60, of nearly pure African blood, whose case presented a fever lasting between three and four days, accompanied with nausea and vomiting. No other peculiarity was seen in the discharges from the stomach except their thin and watery appearance, but free from discolored particles. The tongue remained soft and only slightly furred, while the jaundice in the eyes was quite distinct; skin was relaxed and cold three days before death; and the urine, although of a jaundiced colour, was considerable in quantity. The other case was in the person of a mulatto female, aged 50, of nervous temperament. Fever in the most violent, rapid pulse, with excessive restlessness and anxiety. Jaundice was perceptible on the third day, and in the progress of disease extended itself over the whole body. Urine of dark orange color on the fourth day, together with black vomit. Delirium supervened, and death and convulsions ensued between the seventh and eighth day.
The following instances are recoveries from different stages of black vomit:
Mrs. N____, a lady of 70 years of age, was attacked by fever of insidious form, but accompanied by constant nausea and vomiting. On the fourth and fifth day discoloration of skin quite distinct, and widely spread; delirium, with great prostration; discharges from the stomach thin, bluish-white, and covered with gloating brown particles. She was treated by opiate injections, and although the fever assumed a typhoid form, recovery came about slowly.
Child of Mr. B____, aged 8 years, dark florid complexion. Fever was intense, attended with deep suffusion of face and peistaxis on the third day; delirium constant, and alternations of great stupor, except at moments of vomiting. The matter vomited from fourth to sixth day was distinctly thin, colorless, and contained floating brown particles in abundance. Seventh day discharges from the bowels set in, and were almost entirely of grumous blood. The presence of bile increased as the intestinal hemorrhage diminished, and by degrees fecal matter could be perceived. This case was accompanied by extensive jaundice and marked changes in the urinary secretion, but convalescence went on regularly to a perfect restoration of health.
W. J____, a youth of 14 years old. Violent fever, and much cerebral torpor, together with epistaxis in the beginning. On the fifth day extensive jaundice appears, and hemorrhage from the gums sets in. Nausea and vomiting had been constant; the discharges from the stomach were thin, without a trace of bile, and slightly specked by brown matter. Convalescence was slow, and the jaundice disappeared very gradually.
Daughter of Mrs. S____, aged 7 years. Attack of fever was violent, with deep red suffusion over the cheeks and breast; parched surface and vomiting came on with the febrile movement. On the third day, when the evacuations from the stomach were thin and free from bile, characteristic brown particles appeared, while jaundice extended itself fully over the body. Recovery was regular, after subsidence of fever, which was complete on the fourth day. The peculiar character of the vomit in three cases above mentioned was sufficiently distinct to attract immediate attention on the part of those who acted as nurses, and was at once removed by them from the sight of each patient.
Suppression of urine was observed by me in a large proportion of my male patients. Although a symptom most commonly found in persons of advanced life, it was often present in childhood, but at late stages of illness. In those cases where I observed early diminution in the discharge of urine, or its complete cessation, fever of the most intense grade, with great heat and redness over the upper extremities, was always present. The tongue was, in the beginning of such cases, covered by a heavy brown fur, which soon became dry, rough, and stained, as if by tobacco juice, particularly at the root. The cases of suppressed urine were also indicated by an early and most obstinate torpor of the bowels, which yielded to none, even of the most powerful cathartic medicines.
I find upon my list four cases in which the reappearance of a menstrual flow was discovered. In three instances the discharge occurred respectively on the third, fifth and seventh days, where a return to health happened. In the fourth, which terminated fatally, black vomit was already present before the catamenia returned, and the restoration of the uterine function seemed like a critical hemorrhage which often supervenes in the advanced stages of yellow fever. So far as I could discover, the urinary secretion went on in my female patients far more regularly, and with less danger from suppression, than amongst the male class. A black girl, who was severely attacked by the prevailing fever at a period immediately before the menstrual return, continued with partial suppression of urine for two days, which resisted every local application. At length the stomach appeared to take on some sympathetic action, and a most alarming hemorrhage ensued. The quantity of blood discharged in vomiting amounted to several quarts, and it was followed by prompt reduction of fever, and complete restoration to health.
In the instances of five or six sufferers from intermittent fever, I saw a formidable character of the prevalent disease strongly resembling the worst features of typhus gravior. The hemorrhage from the nose, gums, and tongue came on very soon after each attack, and was so offensive that it was difficult to remain near the sick person. Black vomit, in the present cases, took on its coffee-ground appearance, without running through gradual changes, and putrefied rapidly after exposure to the atmosphere. Jaundice was constant in all the individuals, and I found it quite impossible to rouse them from a profound coma which supervened upon the other symptoms.
The following details regarding three cases of pregnancy, contain some points of interest:
Mrs. B____, the mother of two children, and in very great destitution, was in her eighth month of pregnancy when I attended her for an attack of yellow fever. Abortion was much threatened, but passed off in the course of disease, leaving behind it, however, a very serious disturbance in the functions of the stomach. Vomiting of blood, to great excess, continued daily during a month, and when labor came on it was attended by severe bleeding, but without harm to the child or mother, both of them are now doing well.
Mrs. C____, a young Irish woman, a stranger, and pregnant with her first child. She was visited by me, and found to be suffering from severe fever, with excessive irritability of stomach, and bilious vomiting. Towards the third day labor pains began to show themselves during the period of jaundice before strength was far reduced. Hemorrhage of almost alarming kind seized upon the stomach, and delivery of a dead child (?) months old took place. The uterine flooding was out of all proportion to the discharge from the stomach, and the case rapidly assumed the darkest shade of orange color, which continued until death. Patches as deeply stained as mahogany appeared over the forehead and cheeks before and after dissolution.
Mrs. S____, of delicate form, and the mother of several children, was attacked by fever when in the last stage or pregnancy. I was present at the time of labor, and the skin was beginning to assume a yellow color. Delivery came about in the natural way, and a fine, healthy infant was born. The condition of the mother continued to improve, but the child, in 48 hours after birth, and during the night, grew ill, and died with every evidence of yellow fever upon the body.
Gold Cups Awarded Charleston Volunteers
Courtesy of the Waring Historical Library
MUSC, Charleston, SC
(One cup's inscription)
The City of Charleston
Alex Baron Williman, M.D.
For Meritorious Services
to suffering Humanity