Popular Science Monthly/Volume 14/December 1878/Fever-Factories
By F. L. OSWALD, M. D.
THE prediction of the New Orleans Medical Journal, that the vital and material losses of the Southern States by the last epidemic would exceed the costs of our Mexican War has been fully verified, but by its very magnitude the calamity may prove a less unqualified evil if it should help to open our eyes to the true nature and the origin of what has too long been considered a mysterious and unavoidable plague.
The hope of solving the riddle of the periodicity and topographical predilections of the fever-fiend suggested a careful comparison of the pathological statistics of our Spanish-American neighbors with those of our Southern lowlands; and these studies have revealed some curious facts, which the correspondents of our medical periodicals have corroborated rather than explained.
It appears that a disease which our ablest physicians have described as intensified malaria, has by no means confined itself to the malarious, i. e., swampy regions of the Atlantic slope, but in a great majority of cases may be traced to a city, or a well-drained but thickly-populated district, where the dietetic and domestic habits of the Caucasian race predominate over those of the American aborigines. Among many of the Indian tribes that inhabit the marshy lowlands and humid coast-forests of our continent, fevers are, on the other hand, wholly unknown; while Europeans who visit such regions, or natives who adopt European modes of life, become liable to a variety of enteric disorders.
Vera Cruz, la Ciudad de los Muertos, "the City of the Dead," as the Mexicans call it, on account of the frequency of its yellow-fever epidemics, is situated on a barren and extremely dry coast, remote from all swamps, and surrounded by arid sand-hills; while the natives of the peninsula of Yucatan, with its swamps and inundated virgin forests, are considered to be the healthiest and hardiest portion of the Mexican population. La Guayra, Caracas, and Santiago de Cuba, in spite of their mountainous environs, complain of the terrible regularity of their autumnal epidemics; but in the valley of the Amazon fevers were unknown before the arrival of the European colonists, and are still monopolized by the Creoles and negroes of the larger settlements. The forest tribes of the Madeira, says Bonpland, cautioned the missionaries against the use of animal food, and warned them that it would produce a disease which, like original sin, could only be cured by baptism, i. e., frequent shower-baths and invocations of the Great Spirit; and Bernal Diaz tells us that the subjects of Montezuma were afflicted with an eruptive disease, more painful though less incurable than leprosy, but that fevers made their first appearance with the Spaniards, and were long limited to the district of Toltepec (in the valley of Anahuac) and the Spanish quarter of the city of Tlascala.
In our cotton States, too. Baton Rouge, Vicksburg, and Memphis, on their high and dry bluffs, and Chattanooga, at an elevation of seven hundred feet above the level of the Gulf, have suffered more in proportion to their population than any place this side of Vera Cruz; while the swamps of the Red River and the Arkansas bottom-lands had not much to complain of besides their chronic "chills," and the ne-plus-ultra swamp, called Florida, has been entirely spared.
It is also known that the miasmatic virulence of alluvial districts is aggravated by excessive moisture and diminished by dry seasons, especially long, dry summers, which convert festering bogs into harmless steppes, and confine the swamp-belt of large rivers to a narrow strip along the lower shores. Now, if yellow fever, typhus, and cholera, were depending upon what physicians call telluric causes, i. e., the condition of the soil, in our more or less immediate neighborhood, wet years would be the most dangerous, whereas experience shows that, on the contrary, epidemics generally follow upon dry, hot summers, like the last and those of 1873 and 1868. These facts, which agree with the experience of the remotest countries and times, only confirm what dietetic reasons might indicate a priori, viz., that the so-called zymotic diseases have subjective rather than objective causes: they are produced by the unhealthy condition, not of the country so much as of the inhabitants, and originate in dry cities oftener than in swampy forests.
During the long centuries of the Juventus Mundi, forests and swamps were almost synonyms, as they still are in the lower latitudes of America and Eastern Asia. Animal life swarms and revels in such regions. Herbivorous and carnivorous animals, and our cousins the anthropoid apes, thrive in the moist woodlands of the torrid zone, and the Asiatic Malays, the natives of Soodan and Senegambia, and the aborigines of our own continent, have inhabited the swampiest districts of the tropical bottom-lands for ages with perfect impunity. They do not employ any of the antidotes by which the stranger hopes to secure himself against what he calls climatic influences, and that their immunity is not the inherited privilege of a special race is demonstrated by the diseases of the Mexican Indians, who have adopted the diet of their Spanish masters, and of the West African negroes, who have been carried to the far less swampy islands of the West Indian Archipelago. Dietetic differences alone can, therefore, furnish a logical explanation, and these differences may be comprised in a few words: the savages of the tropics avoid calorific food.
Like their next neighbors, the Hindoos, the natives of Siam and the Sunda-Islanders are mostly frugivorous. Rice, fruits, nuts, and milk, constitute their principal diet, and only famine can reduce them to the use of animal food; they eschew the sudorific drinks of their European masters, and their only stimulant is a cooling alkaloid, the coagulated juice of the betel-nut palm, which they chew with an admixture of shell-lime. The mountaineers of Abyssinia and the inhabitants of the chilly South African highlands are carnivorous; but the natives of Guinea and Soodan, like the Arabs of the Desert, keep cattle and sheep for the sake of their milk, and use their flesh only in times of scarcity or in war. Our Spanish neighbors divide the copper colored race into two well-defined classes, the Indios Mansos and the Indios Bravos, "the tame and ferocious Indians:" the first the frugal, Hindoo-like inhabitants of the coast-forests from Yucatan to Peru; the second the cruel hunters of men and beasts, who roam the wilds of the great West and the table-lands of Northern Mexico and Patagonia. The Indios Mansos of Yucatan, for instance, live on bananas, corn cakes, brown beans fried with a little butter or palm-oil, and the abundant berries and nuts of their native forests, and enjoy an exceptional longevity and freedom from all sicknesses whatever, in all of which respects they resemble the ancient Peruvians, who had no physicians, as Devega remarks, because their only sickness was an incurable one—old age.
Instinct teaches these savages what our science seems to have forgotten, viz., that we must not aggravate the effects of atmospheric heat by calorific artifices. Almost all the domestic habits which distinguish the weaving and house-building Caucasian from the naked savage were originally precautions against the inclemency of a frigid latitude; and it is perhaps the greatest mistake of modern civilization that these precautions have become permanent institutions, instead of being confined to the winter season and occasional cold nights in April and October. We counteract the effects of a low temperature by artificial supplements to our native skin, by weather-proof buildings and heat-producing food, and with such success that De Quincey could define comfort as a supper eaten at leisure in a chimney-corner during the fiercest storm of a November night; but, when the dog-star rules the season, these factitious comforts turn to a very positive misery, and the same contrivances that shelter us against the fury of the snowstorm exclude the breezes that would temper the glow of the summer sun.
All the conventional, anti-natural customs of our social life, and all the prejudices of our prudish morality, seem to conspire to make the sunny half of the year as uncomfortable as possible. In a temperature that makes us envy the external lungs of the zoöphytes, and seethes our veins till we would gladly part with our hereditary cuticle, custom obliges us to invest ourselves in double and threefold garments—air-tight if not water-proof, some of them—which intensify the effects of the atmospheric heat by the retained animal warmth of our own bodies, and confine, not perspiration, but the benefits of perspiration, to the small uncovered portion of our skin.
Our cities are atmospheric bake-ovens. They exclude the horizontal air-currents that sweep freely through the shady arcades of the forest, but they admit sunlight and retain their self-created heat, their dust, and their sudorific vapors. We have inherited, the antique passion for whitewashed houses and stone fences that reflect the sun's rays with a distressing glare, while we have abolished the intramural gardens and free public baths that alleviated the summer sufferings of the ancient Mediterranean cities; but our hyperborean diet is perhaps a still more prolific source of evil.
The experience of all tropical and sub-tropical nations has taught them to avoid animal food and fat, and to counteract the influence of a sultry climate by cooling, non-stimulating drinks and fruit, for a three or four years' neglect of these precautions is sure to undermine the soundest constitution, as demonstrated by the fate of countless employés of the East Indian administration, who left Great Britain as models of Saxon or Celtic vis virilis, and returned as tremulous invalids after a few hundred beefsteak-and-ale dinners in the atmosphere of the Lower Ganges Valley. The advent of our autumnal night frosts and bracing north winds saves most of us from the ultimate consequences of this East Indian malady, but not one man in a thousand escapes the pro tempore penalties of living through the tropical quarter of the solar year as if he were fighting the battle of life against an arctic snow-storm. Cold air is a tonic and antiseptic, and under its influence many substances which Nature never intended for our food become healthy or at least digestible, for a Kamtchatka fisherman can swallow as his daily ration a dose of blubber and brandy that would kill seven Hindoos. The pork-steaks and bitters that feed the fire of life in December smother it in August like so much incombustible rubbish, or evolve fumes that obscure its brightness, till we yearn for the equinoctial gale like a becalmed mariner in a fog, or take refuge from hypochondria in the summerless heights of a mountain-region; and, if starvation were not so often superadded to the cold and the darkness of the season of short days and long nights, it would be very doubtful if the bitterest winter sorrows of the children of Nature could compare with the self-inflicted summer martyrdom of a European or North American dyspeptic. For languor, dull headaches, nausea, and troubled dreams, though singly and momentarily no very serious evils, can aggregate in a sum of misery that has induced all northern nations to make a high temperature the chief characteristic of the pit of torment.
The antidotal resources of Nature counteract the evil for a while diarrhœa, retching, and intermittent fevers, discover her efforts to secrete an indigestible substance; the suicidal diet is modified, in quantity at least, by nausea and loss of appetite, and the periodical north winds that reduce the summer temperature of our Southern States by twenty or thirty degrees may help to postpone the crisis for weeks and months. But if that palliative fails, and the devotee of established customs pursues his course with intrepid fanaticism, the barriers of life yield at last, and Nature ends an evil which she cannot cure. The direct cause of yellow fever is the inability of the vital power to withstand the double influence of moist heat from within and without.
In all zymotic diseases the blood passes through the incipient stages of fermentation, incited, perhaps, by floating animal or vegetable germs but favored by and depending upon the enteric condition of each individual. The morbid humors begin to ferment, the progress of decomposition separates the red blood-globules from the serum; the first accumulate in the digestive apparatus and are discharged in that vomit of cruor which marks the advanced stages of yellow fever and cholera, while the absence of the coloring particles from the circulating blood tinges the skin with a yellowish hue. The convulsion of the bowels reacts on the brain, produces violent headaches, coma, perhaps, or delirium, and paroxysms of nausea, and ends by utter exhaustion and death. It is notorious that the bodies of the victims of yellow fever need immediate interment on account of the swiftness with which putrefaction begins, or rather ends, its work.
As its name implies, a fever epidemic is a contagious disease, and it cannot be denied that by prompt removal from the infected atmosphere innumerable candidates of the winding-sheet might be saved; but it is quite as certain that even persons of a frail constitution, but innocent of dietetic sins, may breathe with impunity the air in which thousands of their stricken fellow-citizens have recently expired. Everywhere the mortality lists show a great preponderance of males over females, of men of sedentary pursuits over open-air laborers, and of epicures over ascetics. Catholic seminarists, Sisters of Charity, vegetarians, and tramps, have enjoyed a remarkable immunity, owing to their voluntary or involuntary habits of abstinence. Worried physicians, spectral old spinsters, and smoke-dried presbyters, have generally survived, while corpulent beer-brewers, lusty landlords, and chubby butcher-boys, went down like grass under a sweeping scythe; and the local papers of New Orleans and Vicksburg have repeatedly called attention to the fact that the business-men who declined to close either their earthly career or their stores were mostly Italians and Jews.
The lessons of the last epidemic find numerous precedents in the history of former times. The black-death that ravaged Asia and Southern Europe in the fourteenth century spared the Mohammedan countries—Persia, Turkistan, Morocco, and Southern Spain—whose inhabitants generally abstained from pork and intoxicating drinks. In the Byzantine Empire, Russia, Germany, France, Northern Spain (inhabited by the Christian Visigoths), and Italy, 4,000,000 died between 1373 and 1375, but the monasteries of the stricter orders and the frugal peasants of Calabria and Sicily enjoyed their usual health (which they of course, ascribed to the favor of their tutelar saints); but among the cities which suffered most were Barcelona, Lyons, Florence, and Moscow, the first three situated on rocky mountain-slopes, with no lack of drainage and pure water, while the steppes of the Upper Volga are generally dry and salubrious.
The pestilence of 1720 swept away 52,000, or more than two-thirds of the 75 000 inhabitants of Marseilles, in less than five weeks; but of the 6,000 abstemious Spaniards that inhabited the "Suburb of the Catalans" only 200 died, or less than four per cent. The most destructive epidemic recorded in authentic history was the four years’ plague that commenced in a. d. 542 and raged through the dominions of Chosroes the Great, the Byzantine Empire, Northern Africa, and Southwestern Europe. It commenced in Egypt, spread to the east over Syria, Persia, and the Indies, and penetrated to the west along the coast of Africa and over the Continent of Europe. Asia Minor, with its plethoric cities, Constantinople, Northern Italy, and France suffered fearfully; entire provinces were abandoned, cities died out and remained vacant for many years, and during three months 5 000 and at last 10,000 persons died at Constantinople each day! (Gibbon's "History" vol. iii., chap, xliii.); and the total number of victims in the three continents is variously estimated from 75,000,000 to 120,000,000 (Procopius, "Anecdot.," cap. xviii.; Cousin's "Hist.," tome ii., p. 178). But in Sicily, Morocco, and Albania, the disease was confined to a few seaport towns, and the Caucasus and Arabia escaped entirely.
This dreadful plague made its first appearance in Alexandria, Egypt, then a luxurious city of 800,000 inhabitants, and Paulus Diaconus a contemporary historian, speaks of the "reckless gluttony by which the inhabitants of the great capital incurred yearly fevers and dangerous indigestions; and at last brought this terrible judgment upon themselves and their innocent neighbors" (lib. ii., cap. iv.). Alexandria lost half a million of her inhabitants in 542, and 80,000 in the following year, and for miles around the city the fields were covered with unburied corpses; but the monks of the Nitrian Desert (3,000 of them had devoted themselves to the task of collecting and burying the dead) lost only fifty of their fraternity, who with few exceptions confessed that they had secretly violated the ascetic rules of their order.
If the thirteen centuries since that year of judgment had been employed in the study of physiology and hygiene rather than in Trinitarian and Monophysite disputes and transubstantiation controversies, we might know by this time that the repetition of the excesses of the Egyptian capital in an Egyptian climate will always provoke an Egyptian plague, and that the observance of some simple dietetic rules would insure our health against the most malignant climatic influences. Southern cities like New Orleans, Memphis, and Galveston, that consume from 500 to 5,000 barrels of pork and four times as many kegs of lager-beer and gallons of whiskey each summer day, while they confine forty or fifty per cent, of their population in stifling tenement-houses, schoolrooms, and workshops, and, instead of providing free public baths, legislate against river-bathing within their corporate limits—such cities, whether situated in the swamps, like New Orleans, or on dry hills, like Memphis, are fever-factories, and produce epidemic diseases by the use of calorific food in a sweltering climate, as systematically as the New Orleans ice-factory evolves cubes of congealed water by the evaporation of ether in and around its copper water tanks.
To our dietetic abuses and the deficient ventilation of our buildings and bodies, we can ascribe the fact that the average mortality of the half-year from June to November exceeds that of the remaining six months by twenty per cent, on the table-lands and by more than thirty per cent, along the sea-coasts of the two Caucasian continents; but this increase of the death-rate is only a small part of the sum total of our self-caused summer martyrdom. If we could weigh the nameless discomforts, the weariness, the physical and moral nausea, and the unsatisfied hunger after the life-air and freedom of the wilderness, endured by millions of factory-children, shopkeepers, and counting-house drudges, if we could weigh all their misery against the hardships of the savages and half-savage nomads, we might agree with the Benthamites, that, measured by the criterion of the greatest happiness of the greatest number, modern civilization is a very indifferent success. "There is something pathetic in every suicide," says Montesquieu, "for the fact that life had become insupportable to a human being could not be more conclusively proved." But the same fact is proved by every premature death, for the destructive agencies of Nature never assert themselves till the evils of life outweigh its blessings. When Vishnu resigns his power to Shiva we may be sure that annihilation is the more merciful alternative.
A privileged small minority, some happy few among the upper ten per cent, of our city population, can celebrate the holidays of their luxurious year, when rising thermometers, dust-clouds, kitchen-fumes, woolen garments, and peppered ragouts, kindle the fires of Moloch in our veins; but what shall we do to be saved if poverty or duty prevent us to save ourselves by flight to the White Mountains? A century may pass before chemists invent the art of cooling our houses by an artificial process as cheaply and effectually as we warm them by fire, but in the mean time we might restrict our calorific efforts to the eight coolest months of the year.
In the first place we might curtail the number of our warm meals, or cook them on the coöperative plan in a separate building, where ten or twelve families could use a common stove and a joint stock of fuel and certain groceries, and thus save our sitting-rooms and studies from the effects which even a basement-kitchen fire exerts on the domestic atmosphere. Heat-producing food, too, might very well be dispensed with. The vegetarian school has demonstrated beyond the possibility of a doubt that farinaceous dishes, sweet milk, and fruit are sufficient to maintain a hard-working man in perfect health, and such a diet might certainly be substituted for our greasy steaks and ragouts during the hottest weeks of the sultry season. Whether or not such mild stimulants as tea and coffee are preferable to pure water, it is certain that they are sudorific drinks, and that even their moderate use increases the temperature of our blood by several degrees during their passage through the digestive apparatus. Smoking-hot dishes and such spices as pepper, mustard, onions, and ginger, are liable to the same objection and we should not forget that sultry weather retards the digestion of all fatty substances by several hours.
Cooling and non-stimulating drinks of a temperature of not less than 5° above the freezing-point might, on the contrary, be freely used in any enjoyable quantity, for the prevailing notions in regard to the danger of "cold drinks in the heat" prove nothing but the marvelous tenacity of popular superstitions. Like the prejudice against raw fruit, night air, and "draught" (i. e., the passage of a current of pure air through the vitiated air of a human dwelling), this notion has furnished a pretext for the strangest sanitary aberrations, and has been defended with the same ingenious sophistry that supplies the advertisers of patent nostrums with their specious arguments. To prevent cold water from "chilling our stomachs," we are advised to mix it with a few drops of brandy, to wash our wrists and let our faces cool off or to chew a preliminary bread-crust; and parents solemnly warn their children not to endanger their health by gratifying an imprudent appetite.
But the craving of our heated system for a refrigerating beverage is a natural instinct which we share with all warm-blooded animals and which manifests itself in children and savages as well as in adult and civilized men. We see horses, hounds, and stags, walk bodily into a cool river after a hot chase, or quench their thirst at a cold spring with perfect impunity, and the idea that Nature should thus tempt us to anything positively injurious implies a deplorable ignorance of the language of our physical conscience. Injurious things, as poisons, excessive heat, or excessive cold, are disagreeable; and whatever is agreeable is beneficial, unless instinct has been supplanted by artificial habits. It might, for instance, be said that the appetite of a drunkard tempts him to indulge in a body and soul destroying poison, but that appetite has been artificially and painfully acquired, and in spite of the earnest protests of Nature, which teach a child by the unmistakable testimony of its senses that alcohol and all fermented drinks are disgusting, and consequently injurious. But cold water, cold sweet milk, lemonade, and cider fresh from the press, are agreeable to every palate, and of these and similar beverages we might drink our fill on the hottest day, without any fear of having to repent the gratification of a natural appetite. Persons, like Baron Brisse, who frankly admit that their only object in life is to diminish its tedium, act at least consistently if they adopt the most effectual means to shorten its duration, but housekeepers who, from motives of economy, grudge their children a handful of apples or an excursion to a shady picnic-ground, should not boast of their annual savings before they have deducted the doctor's bill.
To take plenty of rest after meals is another health rule which we might adopt on the authority of our instinct-guided fellow-creatures, if not of our sensible ancestors, who surpassed us in physical vigor and hygienic insight as much as we exceed them in mechanical or astronomical knowledge. In obedience to an urgent instinct, wild animals retire to their hiding-places after a hearty feed, and digest in peace; and the ancient Greeks, as well as the Romans of the ante-Cæsarean era, contented themselves with one daily meal, which they ate leisurely in the cool of the afternoon after completing their day's work. The rest of the evening they devoted to music, conversation, dances, and light gymnastics, and had thus all night, besides the larger part of the following day, for digestion, could assimilate their food, and probably derived more enjoyment from that one meal than we do from our hurried dinners, late suppers, luncheons, and "Christian breakfasts"—true déjeuners dinatoires, that dull our brains and limbs during the first three or four post-prandial business-hours.
For a quarter of a year, at least, we might get along with two daily meals, one at noon, after finishing the larger and harder half of our day's work, on an "empty stomach" (which custom would soon make a resigned and very comfortable stomach), then a siesta of three or four hours; work till sunset, and then a bath, followed by a leisurely symposium and such domestic amusements as our tastes and opportunities might suggest; and since it is probably true that sleep should not follow too close upon a large meal, we might prolong our amusements or dolce far nientes through the first third of the night, on Saturdays even till after midnight, without fear of thereby violating any law of Nature. The habits of our next relations among the children of the wilderness, the mammals, and vertebrate reptiles, become semi-nocturnal during the warm season: deer, buffaloes, antelopes, and kangaroos, graze in moonshine; bears and foxes leave their dens after dark and rest through the warmer part of the day; alligators wander about on terra firma in warm nights, and frogs continue their serenades till the morning wind chills them into silence and somnolence. The drowsy heat of the afternoon invites to slumber as the cool hours before the noon of night invite to music, reverie, or sentimental conversation, and our midsummer-night dreams would be no worse for a moonlight ramble on the mountains or in the garden-suburbs of a large city.
But "the best of all things is water, after all," was Pindar's motto, and should be our motto in summer-time, in regard to pure cold water, externally applied. In the crowded cities of the Atlantic seaboard and the Lower Mississippi Valley, whose summer temperature equals that of southernmost Europe, the lot of the hard-working classes would be exceedingly improved by the institution of free public baths. The citizens of the Roman Empire regarded their thermæ and their balnea publica as the chief criterion of a civilized town; and it is strangely characteristic of the metaphysical and anti-natural tendency of our ethical system that not one of our wealthy philanthropists ever thought of promoting the welfare of his native city by an establishment which an enlightened community should value as a common necessity rather than as a luxurious privilege.
The baths of Caracalla, which furnished the means of physical purification to tens of thousands, were certainly as useful—practically and morally—as the Serapion or the temple of Jupiter Capitolinus; and one per cent, of the wealth that has been expended on churches, Sunday-schools, foreign missions, and other attempts to secure the post-mortem felicity of the masses, would suffice to make their terrestrial existence far more endurable.
- The territorial acquisitions of the United States in 1848 were achieved at a cost of 15,350 human lives, and a direct and indirect expense of $123,000,000—a sum which was more than repaid by the California revenues of the next ten years. Total deaths by yellow fever from August 5 to October 5, 1878, 17,012. Direct and indirect losses (without any prospective compensation) of the city of New Orleans alone, $16,000,000—about one-tenth of the loss total to the Mississippi Valley from Memphis to the Delta.
- That the blood-changes in zymotic diseases are catalytic is sufficiently proved by the prophylactic power of cold and of the same antiseptics that would arrest an inchoate process of fermentation.