World; the other that it was imported to the West Indies from the African coast, probably by vessels engaged in the slave trade, soon after the occupation of the country by the Spaniards. It seems necessary to look for an original endemic focus of the disease elsewhere than in the West Indies, for the reason that, in the few places where it is now endemic, there is historical evidence to show that the disease was originally imported, and that prior to such importation it was unknown.
In Brazil, according to the best medical authorities in that country, yellow fever was not endemic at any of the seaport cities prior to the year 1849. From Brazilian ports the disease has occasionally been introduced to the cities at the mouth of the Bio de la Plata, and has there caused great loss of life.
According to Hinemann, yellow fever was unknown at Vera Cruz prior to the year 1699, a year in which it was widely prevalent in the West Indies. This city is now recognized as one of the endemic foci of the disease, and epidemics at other towns on the Mexican coast have usually been traced to importation from Vera Cruz. The Gulf coast of South America, and especially the Trench and English settlements in Guiana, have been frequently visited by epidemics of yellow fever. In Venezuela the disease has occasionally prevailed at Caracas and at the neighboring seaport, La Guayra. In Central America epidemics have occurred at all the principal seaports. Upon the Pacific coast of South America the disease was imported to Callao in 1854, and extended from this port to the Peruvian capital and to the principal towns on or near the seacoast. It continued to prevail to some extent until 1869.
The history of yellow fever in the United States shows that the disease is an exotic which has not found the conditions favorable for its continued development at any of our seaport cities. It is true that for many years it prevailed almost annually at New Orleans, but since efficient quarantine regulations have been enforced the disease has been excluded, and no epidemic has occurred in this city since 1878, a period of eighteen years, until the present year. The epidemics in this city attended with the largest mortality occurred in 1819 (mortality, 2,190), in 1847 (2,259), 1853 (7,970), 1854 (2,423), 1855 (2,670), 1858 (3,889), 1867 (3,093).
At Galveston, Mobile, and Pensacola on the Gulf coast, and at Charleston and Savannah on the Atlantic, epidemics were formerly of frequent occurrence, but these cities have also learned to protect themselves by suitable quarantine regulations. The last epidemic occurred in Galveston in 1867 (mortality, 1,150), in Mobile in 1878, in Pensacola in 1882, in Savannah in 1876, in Charleston in 1871.
During the latter part of the eighteenth and the early part of the
