The
American Plague: The Untold Story of Yellow Fever, The Epidemic That Shaped
Kyle Sondgeroth
March, 2010
Aedes aegypti: the striped house
mosquito. A nuisance? Yes. An annoyance at a summer picnic? Absolutely. The cause
for the Spanish-American War, Napoleon giving up his North American conquest
ideas, the near destruction of several American port cities, and the cause of
over 100,000 American deaths by the end of 1878? In Molly Caldwell Crosby’s The
American Plague: The Untold Story of Yellow Fever, The Epidemic That Shaped Our
History she argues that the mosquito is just one culprit in a horrifying
tale of disease, primitive medicine, economics, and politics in the late 19th
century. It is a tale of doctors who were both villainous and heroic in their
approaches to save lives. It is a tale of a disease that could have been
avoided through simple quarantine measures and sanitary systems. It is,
according to Crosby, a tragic tale of an epidemic that ultimately produced “losses
greater than the Chicago fire, San Francisco earthquake and Johnstown flood
combined.” (Crosby 13) This is the tale of the American Yellow Fever epidemic
of 1878.
Crosby’s
thesis in this book, like the book itself, is a tad disjointed. The book initially
centers on Crosby’s hometown of Memphis, TN. Crosby’s argument in this portion
of the book is fairly clear: The yellow fever outbreak of 1878 was an
underappreciated epidemic in our history that produced ripple effects for years
to come. Crosby also contends that the epidemic could have been contained with
some better political and economic choices made by the citizens of Memphis. Her
book then skips ahead 22 years to Cuba at the turn of the century. Crosby
details the work of Doctor Walter Reed, the man whose name currently titles the
Army’s flagship medical treatment center in Washington D.C. Reed, along with a
team of doctors in Cuba, theorized and proved that yellow fever was indeed
spread by mosquitoes. Finally, Crosby skips even further ahead to give us an
idea of what yellow fever holds for us in our present day. All of this skipping
forward leaves the reader feeling slightly disjointed with her argument. The
history of the epidemic in Memphis was well though-out and certainly the best
researched with the clearest thesis. Crosby contends that Memphis, along with
the rest of America, could have contained the disease by using better
sanitation, more advanced medical education/treatments, and quarantining river
towns such as New Orleans and Memphis. Her argument becomes less clear as she
moves on to her history of Reed’s work in Cuba and especially muddled when she
fast-forwards to today and discusses CDC work in Africa and vaccinations in the
21st century.
Crosby begins The American
Plague by briefly covering the history of yellow fever. Her background in
journalism lends itself to a nature of story-telling, rather than relying on
primary sources. The first chapter, for instance gives a very nice account of
yellow fever’s origins in West Africa. She discusses how the mosquitoes
carrying the virus made their way down the Niger Delta to the ports of West
African nations. Men selling the timber “might run a mild fever or feel
lethargic, but it was nothing compared to what the white Europeans would feel
in the coming weeks.” (Crosby, 9). What Crosby lacks here is any first-hand
account of how the men were feeling or what they saw and heard in that Niger
River Delta. She states:
“The
native Africans who worked the forests noticed an eerie silence in the trees.
Usually alive with the piercing sounds of birds, the hum of insects and the
calls of monkeys, tree canopies in some areas were still, a haunting contrast
to the living, breathing rain forest-a sign that something was not right in the
ecosystem. The monkeys had grown ill, their shrill chatter quieted. Unknown to
the men, the rain forest, teeming with smells, sounds, color, and life was also
home to something much smaller. Microscopic. A tiny, thriving life-form.”
(Crosby, 8)
The quote here gives the reader
a great detailed vision of the eerily quiet forest, but whose vision is it?
This description does not come from a local African worker. It is not from a
periodic diary or journal, but rather, it is Crosby’s account. Many portions of
this book, including the scene above, would have been better had they relied on
primary sources.
After introducing what yellow
fever is and how it spread to the Americas, Crosby then fast-forwards to 1878
and the Mississippi River town of Memphis, TN. According to Crosby, the eggs of
fever-ridden mosquitoes were laid into timber that was exported from West
Africa on ships across the ocean. These ships made stops at countries in the
Caribbean such as Cuba. They eventually made their way up the Gulf of Mexico to
American cities like New Orleans. As the weather turned warmer and ships were
resting in port cities such as Havana, Cuba and New Orleans, the eggs would
hatch and look to feed on human blood. The mosquitoes would latch onto an
unsuspecting human and the yellow fever virus soon went looking for a host in
the human body. Thus the yellow fever made its way from West Africa to North
America. As the ships steamed up the Mississippi River from New Orleans, men
contaminated with yellow fever accompanied.
Memphis at the time was a
bustling city with an economic foundation of two industries: cotton and
slavery. According to Crosby:
“Surrounded
by rural states and plantations, Memphis became a hub: the largest inland
cotton market, at its peak, handling 360,000 bales of cotton per year…But
cotton was not the only business booming. At the center of a vast web of
plantations, railroad lines, and port towns, Memphis profited from the slave
market as well.” (Crosby, 18)
This would ultimately play an
integral role in Memphis’ decisions to not quarantine itself during the spring
and summer of 1878. Crosby argues that some of the political decisions made
during this crucial period were done so in the interest of pure economics. They
were not made with the citizens of Memphis’ best interests in mind. Still
suffering from the Panic of 1873, city leaders, along with Mayor John Flippin,
realized that stopping the flow of ship traffic both in and out of Memphis was
economic suicide. They opted to keep the ports of Memphis open, fully aware
that doing so could potentially expose an invitation to yellow fever during the
warm months of the summer in 1878. Quarantining the city, Crosby argues, could
have prevented the death and degradation that accompanied the fever in the
following months.
One such man who advocated for
the quarantine of Memphis was Dr. Robert Wood Mitchell. Appointed as the
President of the Memphis Board of Health in March 1878, Mitchell was an ardent
supporter of closing off Memphis to the rest of the country during “epidemic
season.” Crosby recounts the events as the following:
“The
board consisted of three doctors, the chief of police and mayor John R.
Flippin. In early July, the five men met to discuss how to deal with the 1878
epidemic season….advertisements for refrigerators, ice chests, and coffins
filled the pages of the newspapers. It was also noted in the paper that
‘Mosquitoes are increasing in numbers and are becoming more vindictive and
ferocious, if it were possible to do so.” (Crosby 42)
Again, the author relies to
heavily on painting a picture of the meeting rather than relying on primary
sources of the time such as board minutes, newspaper accounts, or personal
diary/journal entries from the men attending the meeting. In any case, the
board voted 3-2 to actually quarantine Memphis. Another doctor on the board was
John H. Erskine, who opposed the quarantine of Memphis. Relying mostly on
economic scare tactics, Erskine took to the streets and found thousands of
people, including several prominent physicians to sign a petition asking the
Board of Health to overturn the quarantine. Realizing the economic interests of
the city were triumphing the potential health risks, Mitchell resigned from the
Board of Health and was replaced by a man “who saw no need to quarantine the
city and choke the river traffic” (Crosby 43).
As vehemently as Crosby argues
that economic interests ruled public health decisions, she is also firm in her
contention that better sanitation could have also staved off the spread of the yellow
fever epidemic once it arrived in Memphis. Crosby states:
“Two
yellow fever epidemics, cholera and malaria had given Memphis a reputation as a
sickly city and a filthy one. It was unheard of for a city with a population as
large as the one in Memphis to have no waterworks-the city still relied
entirely on the river and rain cisterns to collect water, and there was no way
to remove sewage. There was no money or organized method of removing refuse
from the bustling city center, so people carted their own garbage to the Gayoso
(bayou) and dumped it. Horse manure and dead animals floated through the pale
green scum. Corrupt politics kept the city funds depleted, and anything as
bland as sanitation or water management was the last thing on the minds of the
civic leaders. (Crosby, 21)
Crosby contends here that once
again, the city leaders chose to stuff their own corrupt economic pockets
rather than assist the public health needs. The lack of sanitation and
waterworks in Memphis is one reason that the fever spread so quickly once it
reached the city. In her 4th chapter, entitled “City of Corpses”
Crosby outlines a haunting portrait of a city that, could not only empty their
own garbage or refuse, they could not rid themselves of the disease-ridden dead
that cluttered the streets of Memphis. She tragically supports this as she
states:
“Only six months after the
lavish Mardi Gras celebration, Memphis was a city of corpses. Streets, white
with disinfectant, were deserted. Once lined with cotton bales and parade
bleachers, Main Street now held piles of coffins, stacked one on top another,
so that the walking thorough-fare felt like entering a tomb.” (Crosby, 49.)
By not taking preventative measures
and installing a sewer and garbage system, the city leaders of Memphis laid the
seeds for an epidemic. Crosby gives reason to believe that the corruption and
economic selfishness of city leaders took precedence over public health. Her
argument here is a relevant one. The city of Memphis let down its citizens by
both not planning ahead (lack of sewer, waterworks, and garbage removal) and
not having good leadership at the time of crisis (opting to keep the city and
river traffic open in favor of a quarantine). At the end of the chapter, Crosby
states a startling fact: “In July of that year, the city boasted a population
of 47,000. By September, 19,000 remained and 17,000 of them had yellow fever.”
According to Crosby’s arguments, better leadership and planning could have
prevented a majority of these deaths from occurring.
As I have said, the rest of the
book becomes a tad disjointed and Crosby’s arguments become more unclear. It is
as if she had a great “beginning” to a book, but could not sell it to her
publisher without lengthening it. The remainder of the book discusses Dr.
Walter Reed’s work in Cuba and his discovery that yellow fever was in fact
carried by mosquitoes. It touches upon Reed’s group and their work on human
subjects, which would lead to stricter regulations on human testing. Finally,
Crosby brings it back to today’s world by discussing present work being done in
Africa by the World Health Organization and our own Center for Disease Control.
Overall, I found this portion of the book to be lacking any clear thesis and
very dissimilar to her historical approach to the portion on the 1878 Memphis
yellow fever epidemic.
Crosby’s book serves as an
interesting jumping off point when discussing governmental involvement in
public health. Her assertion in the book is clear: the city leaders, and to a
lesser extent the Federal presidency of Rutherford B. Hayes, failed the
citizens of Memphis. They chose to not stifle the economy of Memphis by closing
down the Mississippi River therefore allowing the disease to infiltrate the
city. They did not want to quarantine the city due to fears that the cotton and
slave trade industries would suffer. Instead the citizens of their city paid
the ultimate price. The city leaders were also not proactive in their approach
to the sanitary conditions of Memphis prior to the arrival of yellow fever.
According to Crosby, this led to the near destruction of an entire city and,
more tragically, to the death of over half the citizens living in Memphis.
Crosby’s work is a jumping off
point because it relies to heavily on her “painting a picture” rather than
allowing the primary sources of the time to do so. There are too many instances
where she gives a haunting description or an eerie scene only to not back it up
with true documentation from that time. There are no footnotes for any of her
quotes and some of her writing can go a whole chapter without using a primary
source. If one is looking for an interesting starting point, this book would
serve the purpose well. If, however, one is looking for an historic account of
the yellow fever in Memphis, it may be beneficial to take a look at a few other
books. The subtitle of Crosby’s book is “The Untold Story of Yellow Fever” yet
I feel like that “story” is still waiting to be told.