THE MEDICAL EXAMINER.
PHILADELPHIA, SEPTEMBER, 1853.
YELLOW LEVER IN PHILADELPHIA.
Since the August number of the Examiner went to press, our com-
munity has been startled by an unexpected visit from the yellow fever,
which for upwards of thirty years has been an entire stranger to our city,
so proverbial for its cleanliness and health.
Fortunately for Philadelphia, this dread enemy no sooner showed its
malignant foot-prints on our borders, than the Board of Health, in the
exercise of their prerogative, and with a commendable energy, instituted
a most rigid investigation in the neighborhood where the first case ap-
peared, and with the sanitary besom swept away, it is to be hoped, what-
ever nuisances were fruitful in concealing and propagating that poison-
ous maierieZ, be it malaria, unhealthy gases, animalcula, fungi, or what
not, which are ever so productive of epidemics.
To this prompt and energetic action, coupled with the efficient muni-
cipal arrangements for preserving the cleanliness of the city, in its
streets, gutters, and sewers, together with the abundant supply of water,
must be attributed in a great measure the present arrest of the disease,
and hence the preservation of the health of its 450,000 inhabitants,
from the inroads of a fearful pestilence.
Thus far the fever has been confined to a very limited district, em-
bracing an area of not more than 600 yards in length by 200 in breadth,
bounded by Union street on the north, Second street on the west,
Almond street on the south, and the Delaware front on the east, a
neighborhood by no means densely peopled; but in many places the
houses are confined and filthy, the Delaware avenue defective in surface
drainage, the cellars in the vicinity damp and subject to an overflow
during the flood and ebb of the tide waters of the Delaware, rendering
the neighborhood insalubrious from excessive moisture, and the exhala-
tion of noxious vapors, the product of animal and vegetable decom-
position.
The origin of this fever may be involved in some doubt and obscurity.
Whether from a specific germ imported in the barque Mandarin, or the
product of her putrid bilge water, or of spontaneous birth in that parti-
cular locality where the irruption first manifested itself, still remains a
perplexing question to solve. One circumstance connected with its his-
tory is clear, viz : that no yellow or malignant fever, or any epidemic, per-
vaded our city prior to the arrival of the barque Mandarin. This unfor-
tunate vessel arrived here, all well, from Cienfuegos, Cuba, after a
passage of seventeen days, on the 13th of July last, and hauled to at a
wharf between Lombard and South streets. Six days after, the first
outbreak of fever of a malignant type showed itself in that immediate
vicinity. From this point it spread itself in about one month over the
district above named.
It may be proper here to state that the Mandarin came from a port in
the West Indies, where “a few cases of small pox and fever” prevailed ;
that she lost two of her crew from “ fever” on the passage; that her
bilge water was in a very foul condition, and notwithstanding she
was detained at the Lazaretto, for cleansing purposes, yet, after opening
her hatches and discharging her cargo, consisting of sugar and molasses,
the bilge water was exceedingly offensive, and before she was removed
by the Board of Health, the stench became intolerable.
During the two weeks that this vessel remained in the vicinity of
South street wharf, the mean of the thermometer was 79
As already hinted, the first case of suspicious fever happened on the
19th of July, six days after the arrival of the Mandarin, in the person
of Joseph Sharp, a young and healthy carman, at South street ferry.
On the next day, the 20th, five cases were reported, on the 21st four
cases, on the 22d one case, on the 23d two, on the 25th three, on the
26th one, on the 27th one, on the 29th three, on the 30th two, on the
6th of August one, on the 9th two, on the 10th one, and so on up to
the 20th—all of them, with the exception of the 21st, being clearly and
distinctly traced as having their origin either by a residence in or a direct
communication with the infected district.
The following is a list of the cases, in the order of their occurrence,
up to the 20th of August:
Date of attack.	Died.
1.	Joseph Sharp .	. July 19th	. July 26th.
2.	Geo. Robinson .	“ 20th	.	“ 23d.
3.	Thos. D. Koehler	.	“	“	.	“	27th.
4.	G. W. Kerkeslager	.	“	“	.	“	25th.
5.	Mrs. Kerkeslager	.	“	“	.	“	26th.
6.	Charles Burrows	.	“	“	.	“	22d.
Date of attack. Died.
7.	Fred. H. Kellog	.	July 21st	.	July	23d.
8.	Fanny Martin .	.	“	21st	.	“	26th.
9.	J. M. G. Koehler	.	“	“	.	Recovered.
10.	Paulina Koehler	.	“	“	.	“
11.	Honora Stanton	.	a	22d	.	July	27th.
12.	Silas Green .	.	“	23d	.	Recovered.
13.	R. N. Campbell	.	“	“	.	“
14.	John Shellcott	.	a	25th	.	July 30th.
15.	Rosanna McKean .	“ u	“
16.	John White	.	“	“	.	Recovered.
17.	David Murray	.	u	26th	.	“
18.	James Markley	.	“	27th	.	“
19.	James Clements	.	“	29th	.	Aug.	1st.
20.	Mrs. Mullen	.	.	“	“	.	“	5th.
21.	John Haslett	.	.	“29	.	“	2d.
22.	Mary Bulger	.	.	“	30th	.	“	3d.
23.	Ann Jane Stewart	.	«	«	.	“	13th.
24.	Mary Williams	.	Aug.	6th	.	“	12th.
25.	John S. Williams	.	“	9th	.	“	“
26.	Betsey Stephens	.	“	“	.	“	13th.
27.	Ellen Boland .	.	“	10th	.	“	15th.
28.	James Riley .	.	“	13th	.	“	15th.
29.	Bridget Tibley	.	“	14th	.	“	22d.
30.	Oliver Pitcher	.	“	15th	.	<f	18th.
31.	James Genton	.	“	15th	.	u	27th.
32.	Mary Carrigan	.	“	17th	.	“	19th.
33.	“	“ (daughter) “	“	.	“	20th.
34.	Mary Turner .	“ 18th .	“	“
35.	John Brennock	.	«	«	.	«	19th.
36.	John Carrigan	.	“	20th	.	“	22d.
37.	Catharine Handson	.	“	.	11	22d.
38.	Edward Carrigan
Of the above 38 cases, 31 of them died, 24 of which were accompa-
nied with black vomit.
The 21st case, of John Haslett, the drayman, cannot be traced to any
portion of the infected district, although he stood on Chesnut street wharf,
and was engaged daily in hauling goods along the eastern front of the
city, and may perchance have been within the range of infection.
In enumerating all the facts in connexion with the appearance of this
fever, it must not be overlooked, that at the dock fronting South street
there is the open mouth of one of the sewers of the city, belching forth
at all times its decomposing compounds of filth, which, when the tide is
low, being exposed, must contaminate the immediate atmosphere with
foul and unwholesome exhalations.
The question may be agitated by some one who has not witnessed a
single case of this disease, “Is it yellow fever?” In answer, we would
reply, that the most reliable evidence has been furnished of its being
genuine yellow fever. Prof. Samuel Jackson saw two of Dr. Gegan’s
cases, and had one of his own; in all of them he recognized the same
enemy that visited our city in 1820. Other gentlemen, who had seen
the disease in the South, and in the West Indies, at once regarded the
fever to be similar in all its features.
It was ushered in by intense headache, pains in the loins and extre-
mities, distress at the epigastrium, nausea and vomiting, tongue soft and
white, with red edges, eyes of a pink or yellow color, skin assuming a
yellow tinge, in some instances petechiae; the fever lasting for three and
sometimes four days, and then remitting ; the patient feeling better,and
in some cases says he is well; but in a few hours, prostration comes on
rapidly, with vomiting of black matter, in which, under the microscope,
blood corpuscles have been discovered ; the ejections from the bowels
are thin, watery and dark in their appearance, with hemorrhages. In
the fatal cases, no reaction of the system comes on, and the patient
dies on the third, fourth or fifth day, and almost invariably the whole
surface of the body becomes of a deep jaundice color.
A post mortem, where it has been made, reveals the usual appearances
found after death, in those who have died of yellow fever, viz.—soften-
ing of the mucous membrane of stomach with patches of inflammation,
the liver contracted and invariably of a light yellow or box wood color.
In several instances the peculiar black fluid, called black vomit, was
found in the stomach or intestines.
Where reaction follows the remission of the fever, the recovery has
generally been rapid. In Dr. Jackson’s case, the 22d, there was no steady
reaction after the third day of attack, and no black vomit, while the
patient lingered until the fourteenth day and then died. The yellow
skin and pink eye, with oppression and great distress over the epigas-
trium and heart, were prominent symptoms in this case.
Besides the cases above numerated, there have been several deaths
from fever, in the immediate vicinity of the infected district, which bore
some slight resemblance to those cases classed undSr the head of Yellow
Fever; but as the disease has not as yet assumed an epidemic form, it
js presumed they were no more than ordinary instances of bilious fever,
which usually makes its appearance about this period of the year.
We have endeavored to obtain a list of all the well authenticated cases
which have occurred, and we believe we have succeeded in securing the
most reliable information on this interesting topic. If there have been
other cases, they were kept from the public, and therefore we had no
access to them.
Since the above was in type, a few more cases have occurred, all of
which, with a few exceptions, may be traced to that section of the city
where the disease first made its appearance.
We may congratulate ourselves that no epidemic is at this time prev-
alent in our city The cases of fever that are to be found, arc few in
number, and are beginning to assume the ordinary bilious character of
our Autumnal diseases.
Indeed our city is healthy; comparing the weekly statement of deaths
with those of last year, they will be found rather under, than above
the mortality of the same season in 1852.
[We are indebted for the above very interesting account of the recent
cases of yellow fever in this city, to our esteemed correspondent, Dr.
Wilson Jewell. A more detailed notice of the earlier of these cases
was read by Dr. Jewell before the August meeting of the College of
Physicians, and will appear in the Transactions of that body.—Eds.
Examiner.]
It will be seen, from the list of Books received, prefixed to the present
number, that an unusual amount of new publications has been, within
a short period, placed upon our table. Our limits prevent an immediate
notice of all, but we hope to be able to do them justice in the October
number.