Yellow fever: the American plague

The fever hit suddenly in the form of a piercing headache and painful sensitivity to light, like looking into a white sun. At that point, the patient could still hope that it was not yellow fever, maybe just a headache from the heat. But the pain worsened, crippling movement and burning the skin. The fever rose to 104, maybe 105 degrees, and bones felt as though they had been cracked. The kidneys stopped functioning, poisoning the body. Abdominal cramps began in the final days of illness as the patient vomited black blood brought on by internal hemorrhaging. The victim became a palate of hideous color: red blood ran from the gums, eyes and nose. The tongue swelled, turning purple. Black vomit roiled. And the skin grew a deep gold, the whites of the eyes turning brilliant yellow.

These symptoms played themselves out over and over again in Memphis, Tennessee, during the summer of 1878. Memphis in the 1870s was a mess. It was a city of contrasts: high society and formal dinners co-existing with extreme poverty. The city itself was filthy, swampy and overrun with mosquitoes during the warm months. Disease was rampant, and yellow fever was one of the deadliest. Molly Caldwell Crosby chronicles the 1878 Memphis outbreak, and the effect this outbreak had in history in The American Plague. More after the jump...

Yellow fever is caused by a RNA virus in the flavivirus family, related to the viruses that cause West Nile and dengue. We know today it's transmitted by mosquitoes, and especially by that scourge to mankind, Aedes aegypti. However, in Victorian Memphis, it wasn't known if yellow fever was directly contagious, caused by a "miasma", or some other route of infection. When yellow fever pounded Memphis in the 1870s, some fled--while others remained and tried to hide from the plague. Most were unsuccessful.

Memphis inhabitants were looking to rebuild following the chaos of the Civil War. However, yellow ever delayed that goal. An 1873 outbreak of the virus sickened 5000 and killed 2000 (of an estimated population of around 40,000). The virus returned 5 years later, taking a huge toll on the city. Close to 18,000 became ill, and over 5000 died. A third epidemic closed out the decade, killing 600 out of 2000 cases. The city was in such poor shape by this time that the state repealed their city charter, jump-starting a major sanitation overhaul.

"The American Plague" uses Memphis' experiences with yellow fever as a jumping-off point to discuss the history of the disease: the identification of the virus, the determination of its mode of transmission, and the development of the yellow fever vaccine, as well as the role outbreaks of the virus have played in American political and cultural history. Along the way, she brings to life the personalities of the people who dedicated their lives--and in several cases, lost them--to learn about the cause of yellow fever, and to find ways to control or prevent the disease. She describes, among others, Cuban physician Carlos Finlay, who was the first to theorize, and then test, that yellow fever was transmitted by mosquitoes; Walter Reed's work as the head of the Yellow Fever Commission; and the short life of Jesse Lazear, one of several scientists who volunteered to be infected in order to advance their hypothesis. The book shines when describing these scientists and their experiments. Crosby writes in her notes that she searched through piles of archives and old diaries (including Lazear's, which had at one point been rescued from the trash), and her preparation and research is evident in both the storytelling and the science.

However, it's not quite the book I had been expecting. I already knew much of the basic story about the history of yellow fever; what I was looking to get was more of a focus on the history of Memphis, and the U.S. in general, examined through the lens of the virus and the disease. While Crosby gives some of that, it's not as much as I'd thought given the introduction and blurbs about the book.I think it was a missed opportunity to do more examination in this area, which would have made the book more unique, rather than just another biography of yellow fever and its discoverers. Still, Crosby does an excellent job of telling this tale, so the book is an excellent choice for readers unfamiliar with this history.

Unfortunately, despite the heroic efforts of the early scientists and physicians working on yellow fever, and the availability of an effective vaccine against the virus, the disease continues to plague humanity. It may no longer be a scourge in the United States due to good sanitation, mosquito control programs, and surveillance, but the WHO estimates that worldwide, approximately 200,000 are infected each year, with 30,000 deaths. A current outbreak in Paraguay, free of yellow fever for the past 34 years, as well as recent cases in Brazil highlight the importance of the work Crosby describes in "The American Plague," but also how much more still needs to be done--not necessarily with the science (although there is no treatment or cure), but also with the politics and public health issues: controlling mosquitoes and assuring access to vaccination. The 20th century brought an understanding of the epidemiology of the disease, but understanding can only go so far without policy and means to help those at risk of infection.