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3/10/1883: Dr. Samuel A. Mudd's Guide to Health
Source: Baltimore Sun, March 10, 1883
This article was published a month after Dr. Mudd died. The Guide to Health treatise discussed in the article was never published and the original manuscript is now lost. Dr. Mudd’s views on the causes and treatment of yellow fever and other diseases were consistent with the medical knowledge of his time, but as we know now, were largely incorrect. It would be almost two decades after Dr. Mudd died that Dr. Walter Reed and his fellow researchers would show that yellow fever was transmitted by infected mosquitoes.
Dr. Samuel A. Mudd, of Bryantown, Charles County, Md., completed a short time before his death a treatise upon epidemic and endemic diseases, intended for the use of families and legislative bodies, State and municipal, entitled "The Family's and the Nation’s Guide to Health." The manuscript of the work is still in the hands of the widow of Dr. Mudd, and to her THE SUN is indebted for the privilege of its perusal and the publication of the following extract of its interesting contents. including his experience with the fearful yellow-fever epidemic that ravaged the Dry Tortugas in 1867, during the period of his unjust confinement there, from July 1865 to April 1869. Dr. Mudd's familiarity with the contagious diseases and the diseases of infection common in the United States extended over twenty years, and entitles him to speak with considerable authority upon the subject of which he treats. Writing for the public, he has freed his language from technical terms, intelligible only to physicians, and produced a brief work which merits publication, and is sure, if published, to prove to the general reader an agreeable and instructive work, although in some respects its conclusions may be disputed by the profession.
It gives what has been much wanted, an analysis which enables anyone to draw a distinct line between "the two forms of disease propagation known as epidemic contagion and epidemic infection" - terms which, like the things they designate, are generally confounded with each other.
The terms endemic and epidemic, so often used indiscriminately, are also placed in distinct contrast. As the intelligent application of sanitary precautions must depend upon a clear apprehension of the difference between germ-bearing diseases and non-germ-bearing diseases, and the modes in which they are originated, it may be fairly said that Dr. Mudd's work in elucidating these matters is of national interest, whether tending to controversy or not.
City councils and State Legislatures will find his suggestions, and particularly the body of quarantine regulations which he draws up, valuable for guidance or suggestion in legislation. In a private letter defining the scope and and object of his little book, Dr. Mudd says in this regard: "I have framed a quarantine law, the simple and the inexpensive provisions of which, if carried out, make it impossible for yellow fever, Asiatic cholera, typhus or any other of the epidemic diseases of contagion or infection to be introduced into any of our ports, or for them to occur even in climates where they are known to be indigenous." Farmers engaged in stock-raising and those interested in their transportation by rail or ship will find presented to them "the means by which they can distinguish a disease of contagion from one of infection, and the proper mode in which to prevent, with little cost and labor, the transmission of the malady from one animal to another."
Theory of Disease Germs
Physicians will note that in view of the fact that exhaustive experiments undertaken to prove the existence of disease-producing germs in the blood or viscera of persons suffering from yellow fever have failed to disclose the existence of germs of any kind, and in consonance with the large body of facts within his own experience, Dr. Mudd originates a theory of his own, novel to the profession and suggestive of experiment by microscopists. This theory, which underlies most that the doctor has to say in regard to diseases of infection, is briefly this - that yellow fever and certain other diseases result from the development of disease germs, not in the person, but in the concrete effluvia of the body such as perspiration and other exhalations of the skin, &c., which have for some time defiled the clothing, bedding and hair. Under suitable conditions of temperature and moisture, found in hot climates, the fermentation set up by these germs in the filth of clothing &c., renders it a poisonous substance, and this poison, being taken into the body, deranges its functions. But the germ itself finds no lodgment or development in the body, as in certain other diseases it undoubtedly does. It results that yellow fever cases may be isolated, provided only that the patient be well washed from head to toe and his clothing be scoured and steamed. In an environment of clean clothes yellow fever, typhus, Asiatic cholera and other diseases of that type are not infectious. Cleanliness may, therefore, with regard to them, be said to constitute the whole doctrine of health for persons brought into contact with the sick. "Diseases of infection of the epidemic form are caused by the action of specific germ upon human effluvia and such diseases do not propagate themselves, being effects incapable of self-propagation.”
Malarial Fevers
Dr. Mudd thinks malaria not due to germs: "Miasmata, arising from the swamps, &c., are in themselves innocuous. The fevers known as malarial fevers are developed only when the miasma (which I consider to be only moisture) in contact with volatile human effluvia under favorable conditions of heat and moisture, produces an action similar to fermentation, and from this, and this alone, the so-called malarial disease results."
Possibly there is a specific germ in the exhalations of swamps &c., but it finds its proper habitat and development in the filth of soiled clothes and bedding, not in the person. Hence malarial fever is not contagious, and is escaped by persons who know how to exclude the cold, damp air of the morning, sleeping within doors, and using clean linen. Fires morning and evening to warm the air of apartments and prevent chilling and the condensation of the so-called miasmatic poison (in reality the moisture) of the air, are important auxiliaries to health. The view that the free air over any infected area becomes poisoned, whether by typhoid fever, yellow fever, or malarial exhalations must be discarded in toto, since, if correct, it would necessarily follow that the mortuary report of any community after a season favorable to disease should embrace very nearly its whole population.
The supposed extensive vitiation of the atmosphere, if it occurs at all, has been taking place since the beginning of the world, and by this time should have made a breath of air as fatal as the rankest gas of the laboratory. The fact is that an exhalation from any given locality is, with the motion of the winds, speedily rendered innocuous by dilution and destroyed by contact with sunlight, seas and mountains. As long, however, as the opinion prevails that endemic and epidemic diseases of infection arise from a tainted atmosphere, no curative or preventive measures will be adopted, it being obviously impossible to combat a universal poison. There is no rational ground for sanitary precaution, and no proper measures can be fixed upon, until it is understood that epidemic and endemic diseases originate for the most part indoors, by the condensation and decomposition of the volatile emanations of animal and vegetable substances in conjunction with human effluvia which has found lodgment in clothing and bedding.
Sewer gas is hurtful or innocent according as it finds in inhabited apartments filth of person or clothing, rendered by some lapse of time suitable for the development of germs to which its virulence is attributed. Moisture, or dampness combined with sudden cold, is an important requisite to the condensation of the substances floating in the air, which produces disease. When the air is dry, and the temperature is equable between day and night, condensation is slow and scarcely perceptible. Such conditions obtain during parts of the year; those seasons are healthy. Localities also which are so favored by circumstances as to be dry and equable in temperature are exempt from chills and remittent fevers, although places not far distant, less favorably situated, are famous for their unhealthiness.
A Terrible Experience
Dr. Mudd thus graphically depicts his own terrible experience:
In July 1865 I was sent to the military prison at Fort Jefferson, better known as the Dry Tortugas, an island of coral formation in the Gulf of Mexico. Tried by a court-martial, an unlawful tribunal constituted for the purpose of conviction - the same that hanged an innocent woman - I was convicted in the testimony of paid and perjured witnesses of a crime the conception of which I never harbored or entertained. By such a tribunal, I was pronounced guilty of complicity in the assassination of President Lincoln, when all the world knew - and the members of that iniquitous and law-defying military commission knew it as well - that my only offense consisted of setting the leg of a man whom I did not at the time know to be a fugitive from justice, and with whose insane act I had not the slightest sympathy. I had done merely an act of charity, from which no true physician would shrink, no matter what the consequences might be. For this I was banished, under life sentence, from my wife and children, from home, friends and society; immured in the gloomiest and distant prison in the United States. For this I was bound in chains like some savage brute, denied for a long time healthy sustenance, and forced at the point of the bayonet to perform menial and offensive offices, which I will forbear mentioning. The iron entered my soul. Even now, though on restoration to my family and social circle I am brought back to life and to some portion of all that was lost by four years of banishment, yet the recollection of those years of mental and physical suffering, and the nature of what I endured on that barren coral reef, accursed and plague-smitten, rises before me at times like a horror of great darkness, and will never be effaced as long as memory remains.
Fort Jefferson is an irregular hexagon, containing within its walls about three acres - not of ordinary ground, but coral sand. It is distant from the Florida coast about ninety miles, and nearly as far from Key West and Cuba. The temperature is high there all the year round, advancing in the summer to an average a little above 90 degrees Farenheit in the shade, and in the winter rarely falling below 65 degrees. The surrounding water of the gulf exercises an equalizing influence upon the atmosphere. The drinking water in use is made from the sea water by distillation, which separates the salt and other impurities. Cistern water is more pleasant to drink, but the water so obtained is, I believe, healthy enough in that climate. The fort is surrounded by a moat, which in its turn is inclosed by a circular stone wall, called ‘the breakwater.’ The water in this moat is - or was in 1867 - about six feet deep. A portion of the moat, however, at that time remained to be dug out. When, on the 18th of August, 1867, the yellow fever broke out, there were stationed at the Dry Tortugas four companies of the Fifth United States Artillery, a few civilians employed in the Engineering Department, and about 200 'guard' prisoners. These last consisted of deserters from the Federal army, 'bounty-jumpers' &c. The roll of 'State prisoners' consisted of Messers. Arnold, Spangler, O'Loughlin and myself. There were also some Confederate prisoners, prominent among whom was Col. St. Leger Grenfel, sent there for life by sentence of a military tribunal for alleged complicity in the abortive attempt to release the Camp Douglas prisoners. It is generally supposed that he was drowned in the attempt to escape from the island.
Fighting the Fever
The first symptom of the appearance of the yellow fever was observed, as already stated, on the 18th of August. From that time until the 4th of September, when I took charge of the hospital, it was of a very malignant character and most frequently fatal. It was supposed, and I consider it highly probable, that the germ of the disease was brought in a boat that landed at the island, bringing government supplies. A member of Company K, engaged in unloading this vessel, was the first to take the disease. He died within a few days. Seventeen days after the occurrence of the first case of the epidemic Dr. J.S. Smith, the regular Army surgeon, a gentleman beloved and respected by the garrison, especially by the soldiers, on account of his having them relieved from unnecessary guard and other duty, was attacked with the yellow fever and died soon after, as did also his infant son. Dr. Smith was not under my care until a short time before his death, when, under the hallucination of the disease, he persistently refused to take any medicine or submit to any treatment. By the illness of Dr. Smith, the garrison was left without a government physician. I was the only person on the island possessed of any knowledge of medicine.
For a time I hesitated what I should do in the novel and distressing situation in which we were placed. The sense of deep injury done me by the government and the voice of humanity were tugging at my will in opposing directions. My fellow 'State' prisoners urged me to have nothing to say or do in the matter, one of them remarking: "The yellow fever is a square deal in which the keepers take an equal chance at death with their prisoners, without regard to age, color or previous condition of servitude." In regard to myself, I could see that there was room for the exercise of discretion, as a cloud of suspicion rested upon me, and I apprehended that in case my treatment should not prove successful, the basest motives would be attributed to me. Putting aside, however, everything but what conscience and professional training taught me to regard as duty, I asked Mr. Arnold, my fellow prisoner, then employed as a clerk at headquarters, to inform Major Stone, who was in command of the post, that I was willing to devote all the skill and attention I was capable of to the terror-stricken garrison.
On his way to headquarters Mr. Arnold met Major Stone, who was then, as he informed Mr. Arnold, on his way to the casemate where I was confined, to ascertain whether I would take charge of the hospital until the services of another physician could be secured. He expressed himself as much gratified that I had already authorized a tender of my services. From the point of view of the scientist, the opportunities to which I was now introduced were valuable. On a small island where many people were congregated in small space, every facility being offered me and there being every desire on my part to watch the progress of the epidemic it will be admitted that for this purpose I could not have been more favorably situated.
The Fever's Deadly March
From very full notes on each case taken at the time, and from careful observation, I reached the same conclusion with regard to the mode of progress of yellow fever that I had reached some years before from observations of the spread of typhoid fever. I was enabled to follow step by step, from case to case, from bed to bed, from quarter to quarter, the development of the fever and track fully its sinuous course around the fort. As far as propagation is concerned, I found the disease innocuous when isolated from its cause. It is purely a disease of infection. From the evidence subjoined, it will be seen how the disease advanced, attacking one, then another, following the sleepers in their beds in a regular and unbroken order of succession, spreading as the flames of a conflagration is spread by sparks from house to house rapidly in the direction of the wind and slowly against it. Not, however, attacking one here and another there indiscriminately as it would have done had the poison been the atmosphere in and around the fort, but marching from bed to bed and from company to company in a line of unbroken continuity.
When the disease first broke out, the post surgeon, entertaining the not yet wholly exploded idea that it was caused by miasma which he supposed rose from stagnant water in the unfinished moat, had the portholes in the quarter where the disease broke out boarded up 'to keep out the malaria.' The effect, of course, was to prevent the free circulation of the air, and so to intensify the infection. Holding opposite views, I had everything thrown open, and acting upon my conception of the nature of the disease and the mode of its dissemination, I am happy to be able to say that during the time I had exclusive charge of the hospital, I did not lose a single case. On taking charge, I met with difficulties. One was to break up the practice instituted by my predecessor of sending the sick in open boats over a rough sea to Sand Key, a little island some two and a half miles distant, and the other was to induce the commander to send as many as possible of the soldiers not yet sick to some of the adjacent islands out of harm’s way.
The first case occurred on the 18th of August, the second on the 20th, the third and fourth on the 21st of August, all four men having occupied contiguous beds. Company K, to which they belonged, was then removed to new quarters to the windward of Company L and the prisoners' quarters. On the 24th, Company K furnished a new case, after which the disease spread rapidly (through a board partition) to Company L and the prisoners. The first two cases in Company L occurred in the beds next to the loosely boarded partition separating it from Company K. Those attacked during the night and following morning it was the custom to take immediately to the post hospital, and thence at 4 P.M. to Sand Key, as said above. Yet up to September 11 not one of the nurses who waited on the sick at the post hospital by day and slept in the same room with them by night was attacked by the fever.
After running through Company L and the prisoners' quarters, the disease next attacked Company I, quartered some sixty feet distant from Company L and worked its way regularly in series, not missing a single bed. Two days after some infected bedding was taken into the hospital the nurses there began to fall sick. Next the laundresses, occupying a building seventy yards distant were attacked simultaneously with the first issue to them of infected bedclothes brought into the hospital. Again, as soon as the nurses from the Sand Key Hospital who had hitherto escaped, were assigned duty at the post hospital, where the infected bedding had been admitted, they too fell sick. These various facts, with the order of their occurrence, convinced me beyond doubt that the yellow fever is not ‘infectious' not contagious, but is propagated primarily by germinal action in human effluvia contained in blankets, bedding, &c., and that in no case did the diseased person propagate the disease.
When a yellow fever patient, or one suffering from any other epidemic disease of infection, is placed in clean clothing, and clean bed and room, he is incapable of communicating the disease. Under these circumstances the germ may be carried along with the diseased person without danger of propagation, for if there is no effluvia, or filth, for the germ to react upon, it will die as does a fire from lack of fuel.
These conclusions were perfectly confirmed by the facts in the case of Company M and indeed by the whole subsequent history of the disease at Fort Jefferson.
Contrasts and Resemblances
After stating the present attitude of medical science with regard to the germ theory as applicable to epidemic diseases, Dr. Mudd gives for practical use a table in which the contrasts and resemblances of these diseases are clearly set forth. The substance of it is partly given here. By "diseases of contagion" are designated small-pox. measles, whooping cough, mumps, &c., by "diseases of infection", scarlet fever, diphtheria, typhus or typhoid fever, yellow fever, &c. Epidemic contagion proceeds from a specific germ, which primarily propagates itself only in the tissues of membranes of living animals; while epidemic infection proceeds from a specific germ which propagates itself only in the heavy and concrete emanations that have passed off from the bodies of living animals. The germ of epidemic contagion is sui generis, that is to say, the germ that produces disease in man does not propagate in other animals, and vice versa, and does not pass from one species of animal to another. The germ of epidemic infection likewise fails to pass from the effluvia of man to that of animals, and from the effluvia of one species of animal to that of another. The diseases of epidemic contagion are propagated by contact either with the disease or its emanations among the animals to which they specifically belong; those of infection on the contrary are not produced by contact with the disease or its emanations, but result indirectly from the peculiar gas or vapor produced by the reaction of germs on the heavy and concrete matters or emanations of animals, and this only among animals of the same species.
As the germ of epidemic contagion does not develop in dead matter, it may remain therein for an indefinite time with its virulence unimpaired; but the germ of infection, propagating only in dead matter, i.e., in effluvia of long standing, and not in living tissues and membranes, or in clean clothing, may be retained in unimpaired vigor indefinitely in clean clothing or in the hair, and be handled or even swallowed with impunity. The former produces disease only when it enters the body; the latter only when it meets with foul clothing which has remained too long unwashed. The germ of contagion gives immunity from a second attack of the disease which it causes; the germ of infection does not. The germ of contagion is inseparable from the disease, making it impossible to isolate it, while the germ of infection is separable, and may, therefore, be easily isolated. Diseases of epidemic contagion can be inoculated; those of infection cannot be so inoculated by matter taken from the diseased person, but only from matter undergoing germinal fermentation. Diseases of epidemic contagion are "contagious;" those of infections are not "infectious," i.e., their emanations have no effect upon either living or effete matter. The former class of diseases is never sporadic or accidental; the latter are. The former are confined to no particular climate, are governed by no atmospheric changes, except, so far as cold weather, by confining the disease to close rooms, renders it more virulent; the latter, on the contrary, are confined to particular climates and governed by atmospheric changes, and when found beyond a certain zone or latitude are traceable to importation.
The germ producing an epidemic disease of contagion is developed in the disease of the animal, be it man or beast; so that, in its case, we quarantine against the disease (that is the person having it) and its emanations retained mechanically in bedding and clothing. In epidemic diseases of infection, however, the primary cause of the disease is developed in the effluvia, so that, in their case, we quarantine against effluvial deposits, contained mostly in bedding and clothing. Endemic diseases possess no germ, and arise from the use of impure water, air or food, taken in connection with excessive heat, cold or anything tending to suppress the irrespirable transpiration or disorder of the stomach and bowels. Much importance is to be attached to adherence to proper definitions of the words contagious, infectious, endemic, and epidemic.
Quarantine Regulations
I. When a ship enters port, and after the landing of passengers, all bedclothing in use during the voyage shall be removed and washed, or steamed with soap and water, rinsed through clean water, ironed and dried without starching. The beds shall be also removed and washed, and the cabin walls, ceilings and bunks washed.
II. On leaving port the beds for both passengers and crew shall be furnished with duplicate bedclothing which has had ample time to be cleaned and dried.
III. No beds, bedclothing or wearing apparel shall be allowed aboard which does not bear evidence of recent purification.
IV. No one affected with a disease of epidemic contagion, or article of clothing that has been in contact with it, shall be permitted aboard.
V. Epidemic diseases of infection may with safety be permitted aboard by observing the following rules:
1st. All clothing must be taken off, the sick removed to a clean bed or chair, and clean clothing be put on. 2d. The hair and skin of the head must be thoroughly washed with soap and water and wiped dry with a clean towel. This having been done, the sick person may then be carried aboard wrapped in a clean blanket and placed in a clean bed.
VI. Sporadic cases of epidemic infection must be subjected to the treatment prescribed in the previous section before being admitted aboard.
VII. By observing the precautions specified in section III all accidental, scrofulous, tubercular and endemic diseases may be admitted aboard.
VIII. The passengers and crews of ships from infected ports shall be compelled before disembarking to don clean clothing and have their cast-off clothing disinfected. The hair and skin of the head should also have been washed thoroughly and wiped dry with a clean towel.
IX. Importers of dry goods shall keep a room above the ground or basement floor with spacious windows, in which to open and air boxes and bales of clothing before offering them for sale.
X. Manufacturers of textile fabrics shall not permit among their operatives a person living where a disease of epidemic infection or contagion exists.
XI. The commander of the ship shall be required to have a certificate, given by the health officer of the port from which it sailed, showing that the provisions of section 5 have been observed.
XII. Masters of vessels engaged in the transportation of cattle and other stock shall conform to the foregoing rules. and will, in addition, have the quarters set apart for stock thoroughly cleansed after each voyage.
XIII. No diseased cattle or other sick stock shall be admitted aboard ship.
XIV. Animals before being shipped shall have their skin and hair, by combing and washing, perfectly freed from all effete matter.
It may be added that Dr. Mudd's views as to the proper treatment of diseases of the class to which yellow fever belongs took definite shape during his professional experience before the war, at Bryantown, where he treated successfully a number of cases of typhoid fever during an epidemic of that disease. His opinions were formed in part some time before by observations ranging over a great variety of diseases of infection which came under his notice while a student residing, after graduating, at the hospital in charge of the University of Maryland, in this city.
It gives what has been much wanted, an analysis which enables anyone to draw a distinct line between "the two forms of disease propagation known as epidemic contagion and epidemic infection" - terms which, like the things they designate, are generally confounded with each other.
The terms endemic and epidemic, so often used indiscriminately, are also placed in distinct contrast. As the intelligent application of sanitary precautions must depend upon a clear apprehension of the difference between germ-bearing diseases and non-germ-bearing diseases, and the modes in which they are originated, it may be fairly said that Dr. Mudd's work in elucidating these matters is of national interest, whether tending to controversy or not.
City councils and State Legislatures will find his suggestions, and particularly the body of quarantine regulations which he draws up, valuable for guidance or suggestion in legislation. In a private letter defining the scope and and object of his little book, Dr. Mudd says in this regard: "I have framed a quarantine law, the simple and the inexpensive provisions of which, if carried out, make it impossible for yellow fever, Asiatic cholera, typhus or any other of the epidemic diseases of contagion or infection to be introduced into any of our ports, or for them to occur even in climates where they are known to be indigenous." Farmers engaged in stock-raising and those interested in their transportation by rail or ship will find presented to them "the means by which they can distinguish a disease of contagion from one of infection, and the proper mode in which to prevent, with little cost and labor, the transmission of the malady from one animal to another."
Theory of Disease Germs
Physicians will note that in view of the fact that exhaustive experiments undertaken to prove the existence of disease-producing germs in the blood or viscera of persons suffering from yellow fever have failed to disclose the existence of germs of any kind, and in consonance with the large body of facts within his own experience, Dr. Mudd originates a theory of his own, novel to the profession and suggestive of experiment by microscopists. This theory, which underlies most that the doctor has to say in regard to diseases of infection, is briefly this - that yellow fever and certain other diseases result from the development of disease germs, not in the person, but in the concrete effluvia of the body such as perspiration and other exhalations of the skin, &c., which have for some time defiled the clothing, bedding and hair. Under suitable conditions of temperature and moisture, found in hot climates, the fermentation set up by these germs in the filth of clothing &c., renders it a poisonous substance, and this poison, being taken into the body, deranges its functions. But the germ itself finds no lodgment or development in the body, as in certain other diseases it undoubtedly does. It results that yellow fever cases may be isolated, provided only that the patient be well washed from head to toe and his clothing be scoured and steamed. In an environment of clean clothes yellow fever, typhus, Asiatic cholera and other diseases of that type are not infectious. Cleanliness may, therefore, with regard to them, be said to constitute the whole doctrine of health for persons brought into contact with the sick. "Diseases of infection of the epidemic form are caused by the action of specific germ upon human effluvia and such diseases do not propagate themselves, being effects incapable of self-propagation.”
Malarial Fevers
Dr. Mudd thinks malaria not due to germs: "Miasmata, arising from the swamps, &c., are in themselves innocuous. The fevers known as malarial fevers are developed only when the miasma (which I consider to be only moisture) in contact with volatile human effluvia under favorable conditions of heat and moisture, produces an action similar to fermentation, and from this, and this alone, the so-called malarial disease results."
Possibly there is a specific germ in the exhalations of swamps &c., but it finds its proper habitat and development in the filth of soiled clothes and bedding, not in the person. Hence malarial fever is not contagious, and is escaped by persons who know how to exclude the cold, damp air of the morning, sleeping within doors, and using clean linen. Fires morning and evening to warm the air of apartments and prevent chilling and the condensation of the so-called miasmatic poison (in reality the moisture) of the air, are important auxiliaries to health. The view that the free air over any infected area becomes poisoned, whether by typhoid fever, yellow fever, or malarial exhalations must be discarded in toto, since, if correct, it would necessarily follow that the mortuary report of any community after a season favorable to disease should embrace very nearly its whole population.
The supposed extensive vitiation of the atmosphere, if it occurs at all, has been taking place since the beginning of the world, and by this time should have made a breath of air as fatal as the rankest gas of the laboratory. The fact is that an exhalation from any given locality is, with the motion of the winds, speedily rendered innocuous by dilution and destroyed by contact with sunlight, seas and mountains. As long, however, as the opinion prevails that endemic and epidemic diseases of infection arise from a tainted atmosphere, no curative or preventive measures will be adopted, it being obviously impossible to combat a universal poison. There is no rational ground for sanitary precaution, and no proper measures can be fixed upon, until it is understood that epidemic and endemic diseases originate for the most part indoors, by the condensation and decomposition of the volatile emanations of animal and vegetable substances in conjunction with human effluvia which has found lodgment in clothing and bedding.
Sewer gas is hurtful or innocent according as it finds in inhabited apartments filth of person or clothing, rendered by some lapse of time suitable for the development of germs to which its virulence is attributed. Moisture, or dampness combined with sudden cold, is an important requisite to the condensation of the substances floating in the air, which produces disease. When the air is dry, and the temperature is equable between day and night, condensation is slow and scarcely perceptible. Such conditions obtain during parts of the year; those seasons are healthy. Localities also which are so favored by circumstances as to be dry and equable in temperature are exempt from chills and remittent fevers, although places not far distant, less favorably situated, are famous for their unhealthiness.
A Terrible Experience
Dr. Mudd thus graphically depicts his own terrible experience:
In July 1865 I was sent to the military prison at Fort Jefferson, better known as the Dry Tortugas, an island of coral formation in the Gulf of Mexico. Tried by a court-martial, an unlawful tribunal constituted for the purpose of conviction - the same that hanged an innocent woman - I was convicted in the testimony of paid and perjured witnesses of a crime the conception of which I never harbored or entertained. By such a tribunal, I was pronounced guilty of complicity in the assassination of President Lincoln, when all the world knew - and the members of that iniquitous and law-defying military commission knew it as well - that my only offense consisted of setting the leg of a man whom I did not at the time know to be a fugitive from justice, and with whose insane act I had not the slightest sympathy. I had done merely an act of charity, from which no true physician would shrink, no matter what the consequences might be. For this I was banished, under life sentence, from my wife and children, from home, friends and society; immured in the gloomiest and distant prison in the United States. For this I was bound in chains like some savage brute, denied for a long time healthy sustenance, and forced at the point of the bayonet to perform menial and offensive offices, which I will forbear mentioning. The iron entered my soul. Even now, though on restoration to my family and social circle I am brought back to life and to some portion of all that was lost by four years of banishment, yet the recollection of those years of mental and physical suffering, and the nature of what I endured on that barren coral reef, accursed and plague-smitten, rises before me at times like a horror of great darkness, and will never be effaced as long as memory remains.
Fort Jefferson is an irregular hexagon, containing within its walls about three acres - not of ordinary ground, but coral sand. It is distant from the Florida coast about ninety miles, and nearly as far from Key West and Cuba. The temperature is high there all the year round, advancing in the summer to an average a little above 90 degrees Farenheit in the shade, and in the winter rarely falling below 65 degrees. The surrounding water of the gulf exercises an equalizing influence upon the atmosphere. The drinking water in use is made from the sea water by distillation, which separates the salt and other impurities. Cistern water is more pleasant to drink, but the water so obtained is, I believe, healthy enough in that climate. The fort is surrounded by a moat, which in its turn is inclosed by a circular stone wall, called ‘the breakwater.’ The water in this moat is - or was in 1867 - about six feet deep. A portion of the moat, however, at that time remained to be dug out. When, on the 18th of August, 1867, the yellow fever broke out, there were stationed at the Dry Tortugas four companies of the Fifth United States Artillery, a few civilians employed in the Engineering Department, and about 200 'guard' prisoners. These last consisted of deserters from the Federal army, 'bounty-jumpers' &c. The roll of 'State prisoners' consisted of Messers. Arnold, Spangler, O'Loughlin and myself. There were also some Confederate prisoners, prominent among whom was Col. St. Leger Grenfel, sent there for life by sentence of a military tribunal for alleged complicity in the abortive attempt to release the Camp Douglas prisoners. It is generally supposed that he was drowned in the attempt to escape from the island.
Fighting the Fever
The first symptom of the appearance of the yellow fever was observed, as already stated, on the 18th of August. From that time until the 4th of September, when I took charge of the hospital, it was of a very malignant character and most frequently fatal. It was supposed, and I consider it highly probable, that the germ of the disease was brought in a boat that landed at the island, bringing government supplies. A member of Company K, engaged in unloading this vessel, was the first to take the disease. He died within a few days. Seventeen days after the occurrence of the first case of the epidemic Dr. J.S. Smith, the regular Army surgeon, a gentleman beloved and respected by the garrison, especially by the soldiers, on account of his having them relieved from unnecessary guard and other duty, was attacked with the yellow fever and died soon after, as did also his infant son. Dr. Smith was not under my care until a short time before his death, when, under the hallucination of the disease, he persistently refused to take any medicine or submit to any treatment. By the illness of Dr. Smith, the garrison was left without a government physician. I was the only person on the island possessed of any knowledge of medicine.
For a time I hesitated what I should do in the novel and distressing situation in which we were placed. The sense of deep injury done me by the government and the voice of humanity were tugging at my will in opposing directions. My fellow 'State' prisoners urged me to have nothing to say or do in the matter, one of them remarking: "The yellow fever is a square deal in which the keepers take an equal chance at death with their prisoners, without regard to age, color or previous condition of servitude." In regard to myself, I could see that there was room for the exercise of discretion, as a cloud of suspicion rested upon me, and I apprehended that in case my treatment should not prove successful, the basest motives would be attributed to me. Putting aside, however, everything but what conscience and professional training taught me to regard as duty, I asked Mr. Arnold, my fellow prisoner, then employed as a clerk at headquarters, to inform Major Stone, who was in command of the post, that I was willing to devote all the skill and attention I was capable of to the terror-stricken garrison.
On his way to headquarters Mr. Arnold met Major Stone, who was then, as he informed Mr. Arnold, on his way to the casemate where I was confined, to ascertain whether I would take charge of the hospital until the services of another physician could be secured. He expressed himself as much gratified that I had already authorized a tender of my services. From the point of view of the scientist, the opportunities to which I was now introduced were valuable. On a small island where many people were congregated in small space, every facility being offered me and there being every desire on my part to watch the progress of the epidemic it will be admitted that for this purpose I could not have been more favorably situated.
The Fever's Deadly March
From very full notes on each case taken at the time, and from careful observation, I reached the same conclusion with regard to the mode of progress of yellow fever that I had reached some years before from observations of the spread of typhoid fever. I was enabled to follow step by step, from case to case, from bed to bed, from quarter to quarter, the development of the fever and track fully its sinuous course around the fort. As far as propagation is concerned, I found the disease innocuous when isolated from its cause. It is purely a disease of infection. From the evidence subjoined, it will be seen how the disease advanced, attacking one, then another, following the sleepers in their beds in a regular and unbroken order of succession, spreading as the flames of a conflagration is spread by sparks from house to house rapidly in the direction of the wind and slowly against it. Not, however, attacking one here and another there indiscriminately as it would have done had the poison been the atmosphere in and around the fort, but marching from bed to bed and from company to company in a line of unbroken continuity.
When the disease first broke out, the post surgeon, entertaining the not yet wholly exploded idea that it was caused by miasma which he supposed rose from stagnant water in the unfinished moat, had the portholes in the quarter where the disease broke out boarded up 'to keep out the malaria.' The effect, of course, was to prevent the free circulation of the air, and so to intensify the infection. Holding opposite views, I had everything thrown open, and acting upon my conception of the nature of the disease and the mode of its dissemination, I am happy to be able to say that during the time I had exclusive charge of the hospital, I did not lose a single case. On taking charge, I met with difficulties. One was to break up the practice instituted by my predecessor of sending the sick in open boats over a rough sea to Sand Key, a little island some two and a half miles distant, and the other was to induce the commander to send as many as possible of the soldiers not yet sick to some of the adjacent islands out of harm’s way.
The first case occurred on the 18th of August, the second on the 20th, the third and fourth on the 21st of August, all four men having occupied contiguous beds. Company K, to which they belonged, was then removed to new quarters to the windward of Company L and the prisoners' quarters. On the 24th, Company K furnished a new case, after which the disease spread rapidly (through a board partition) to Company L and the prisoners. The first two cases in Company L occurred in the beds next to the loosely boarded partition separating it from Company K. Those attacked during the night and following morning it was the custom to take immediately to the post hospital, and thence at 4 P.M. to Sand Key, as said above. Yet up to September 11 not one of the nurses who waited on the sick at the post hospital by day and slept in the same room with them by night was attacked by the fever.
After running through Company L and the prisoners' quarters, the disease next attacked Company I, quartered some sixty feet distant from Company L and worked its way regularly in series, not missing a single bed. Two days after some infected bedding was taken into the hospital the nurses there began to fall sick. Next the laundresses, occupying a building seventy yards distant were attacked simultaneously with the first issue to them of infected bedclothes brought into the hospital. Again, as soon as the nurses from the Sand Key Hospital who had hitherto escaped, were assigned duty at the post hospital, where the infected bedding had been admitted, they too fell sick. These various facts, with the order of their occurrence, convinced me beyond doubt that the yellow fever is not ‘infectious' not contagious, but is propagated primarily by germinal action in human effluvia contained in blankets, bedding, &c., and that in no case did the diseased person propagate the disease.
When a yellow fever patient, or one suffering from any other epidemic disease of infection, is placed in clean clothing, and clean bed and room, he is incapable of communicating the disease. Under these circumstances the germ may be carried along with the diseased person without danger of propagation, for if there is no effluvia, or filth, for the germ to react upon, it will die as does a fire from lack of fuel.
These conclusions were perfectly confirmed by the facts in the case of Company M and indeed by the whole subsequent history of the disease at Fort Jefferson.
Contrasts and Resemblances
After stating the present attitude of medical science with regard to the germ theory as applicable to epidemic diseases, Dr. Mudd gives for practical use a table in which the contrasts and resemblances of these diseases are clearly set forth. The substance of it is partly given here. By "diseases of contagion" are designated small-pox. measles, whooping cough, mumps, &c., by "diseases of infection", scarlet fever, diphtheria, typhus or typhoid fever, yellow fever, &c. Epidemic contagion proceeds from a specific germ, which primarily propagates itself only in the tissues of membranes of living animals; while epidemic infection proceeds from a specific germ which propagates itself only in the heavy and concrete emanations that have passed off from the bodies of living animals. The germ of epidemic contagion is sui generis, that is to say, the germ that produces disease in man does not propagate in other animals, and vice versa, and does not pass from one species of animal to another. The germ of epidemic infection likewise fails to pass from the effluvia of man to that of animals, and from the effluvia of one species of animal to that of another. The diseases of epidemic contagion are propagated by contact either with the disease or its emanations among the animals to which they specifically belong; those of infection on the contrary are not produced by contact with the disease or its emanations, but result indirectly from the peculiar gas or vapor produced by the reaction of germs on the heavy and concrete matters or emanations of animals, and this only among animals of the same species.
As the germ of epidemic contagion does not develop in dead matter, it may remain therein for an indefinite time with its virulence unimpaired; but the germ of infection, propagating only in dead matter, i.e., in effluvia of long standing, and not in living tissues and membranes, or in clean clothing, may be retained in unimpaired vigor indefinitely in clean clothing or in the hair, and be handled or even swallowed with impunity. The former produces disease only when it enters the body; the latter only when it meets with foul clothing which has remained too long unwashed. The germ of contagion gives immunity from a second attack of the disease which it causes; the germ of infection does not. The germ of contagion is inseparable from the disease, making it impossible to isolate it, while the germ of infection is separable, and may, therefore, be easily isolated. Diseases of epidemic contagion can be inoculated; those of infection cannot be so inoculated by matter taken from the diseased person, but only from matter undergoing germinal fermentation. Diseases of epidemic contagion are "contagious;" those of infections are not "infectious," i.e., their emanations have no effect upon either living or effete matter. The former class of diseases is never sporadic or accidental; the latter are. The former are confined to no particular climate, are governed by no atmospheric changes, except, so far as cold weather, by confining the disease to close rooms, renders it more virulent; the latter, on the contrary, are confined to particular climates and governed by atmospheric changes, and when found beyond a certain zone or latitude are traceable to importation.
The germ producing an epidemic disease of contagion is developed in the disease of the animal, be it man or beast; so that, in its case, we quarantine against the disease (that is the person having it) and its emanations retained mechanically in bedding and clothing. In epidemic diseases of infection, however, the primary cause of the disease is developed in the effluvia, so that, in their case, we quarantine against effluvial deposits, contained mostly in bedding and clothing. Endemic diseases possess no germ, and arise from the use of impure water, air or food, taken in connection with excessive heat, cold or anything tending to suppress the irrespirable transpiration or disorder of the stomach and bowels. Much importance is to be attached to adherence to proper definitions of the words contagious, infectious, endemic, and epidemic.
Quarantine Regulations
I. When a ship enters port, and after the landing of passengers, all bedclothing in use during the voyage shall be removed and washed, or steamed with soap and water, rinsed through clean water, ironed and dried without starching. The beds shall be also removed and washed, and the cabin walls, ceilings and bunks washed.
II. On leaving port the beds for both passengers and crew shall be furnished with duplicate bedclothing which has had ample time to be cleaned and dried.
III. No beds, bedclothing or wearing apparel shall be allowed aboard which does not bear evidence of recent purification.
IV. No one affected with a disease of epidemic contagion, or article of clothing that has been in contact with it, shall be permitted aboard.
V. Epidemic diseases of infection may with safety be permitted aboard by observing the following rules:
1st. All clothing must be taken off, the sick removed to a clean bed or chair, and clean clothing be put on. 2d. The hair and skin of the head must be thoroughly washed with soap and water and wiped dry with a clean towel. This having been done, the sick person may then be carried aboard wrapped in a clean blanket and placed in a clean bed.
VI. Sporadic cases of epidemic infection must be subjected to the treatment prescribed in the previous section before being admitted aboard.
VII. By observing the precautions specified in section III all accidental, scrofulous, tubercular and endemic diseases may be admitted aboard.
VIII. The passengers and crews of ships from infected ports shall be compelled before disembarking to don clean clothing and have their cast-off clothing disinfected. The hair and skin of the head should also have been washed thoroughly and wiped dry with a clean towel.
IX. Importers of dry goods shall keep a room above the ground or basement floor with spacious windows, in which to open and air boxes and bales of clothing before offering them for sale.
X. Manufacturers of textile fabrics shall not permit among their operatives a person living where a disease of epidemic infection or contagion exists.
XI. The commander of the ship shall be required to have a certificate, given by the health officer of the port from which it sailed, showing that the provisions of section 5 have been observed.
XII. Masters of vessels engaged in the transportation of cattle and other stock shall conform to the foregoing rules. and will, in addition, have the quarters set apart for stock thoroughly cleansed after each voyage.
XIII. No diseased cattle or other sick stock shall be admitted aboard ship.
XIV. Animals before being shipped shall have their skin and hair, by combing and washing, perfectly freed from all effete matter.
It may be added that Dr. Mudd's views as to the proper treatment of diseases of the class to which yellow fever belongs took definite shape during his professional experience before the war, at Bryantown, where he treated successfully a number of cases of typhoid fever during an epidemic of that disease. His opinions were formed in part some time before by observations ranging over a great variety of diseases of infection which came under his notice while a student residing, after graduating, at the hospital in charge of the University of Maryland, in this city.
Copyright © 2012 Robert Summers. All rights reserved.
