The American Plague

Nursing Book Club

The American Plague

The Untold Story of Yellow Fever, the Epidemic That Shaped Our History

By Molly Caldwell Crosby (Berkley Books, 2006)
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Reviewed By Christine Contillo, RN, BSN

My understanding of yellow fever had always been that it was caused by mosquitoes and existed mainly in the jungles of South America or Africa. Although we have mosquitoes in most areas of the U.S., it had never occurred to me that yellow fever was ever a major problem here. It turns out I was very wrong.

According to author Molly Caldwell Crosby, Memphis, Tenn., went from being the third largest city in the South in the mid-1870s to a city of corpses by the fall of 1878. Streets were white with disinfectant and piled with coffins. Prescriptions could not be filled, grocery stores were closed and Memphis was quarantined from the rest of the country, causing financial ruin.

The fact that yellow fever was a seasonal illness did not escape the medical experts of the time and all agreed that river travel from Cuba was involved. Political disagreements got in the way of finding the source of the problem, but in 1879, the Havana Yellow Fever Commission was established to travel to Cuba and investigate.

The commission’s international members hoped to discover whether it was mosquitoes that carried the disease or whether they were only the vector for moving “infected matter” from place to place. Viral particles were unknown then, so the method of transmission was a mystery the commission hoped to solve. In the process, despite meticulous care, several of the doctors died of the disease themselves, as did many of the patients they cared for and the volunteers involved.

Some of the names jumped out at me. One of the doctors, Walter Reed, later had the U.S. Army Medical Hospital in Washington, D.C., named after him. Reed was a member of the Havana Commission who volunteered to be bitten by mosquitoes and contract the disease, hoping that this would help him understand it better. His death won him the Congressional Gold Medal. One nurse, Clara Maas, later became the namesake of a hospital in New Jersey. She had volunteered to work in Havana, hoping that she would be bitten and develop immunity. (In fact, she was bitten four times, but it was the fifth bite that transmitted the disease and killed her.)

The commission’s methods of inquiry and standards of ethics would all be found wildly suspect today. In one experiment, volunteers had to quarantine themselves and wear the soiled clothing of deceased yellow fever victims to prove the disease was not spread through bedclothes or bandages. In other experiments, volunteers allowed themselves to be bitten repeatedly by specially bred and infected mosquitoes until the volunteers developed symptoms. It wasn’t until 1935 that it was discovered that jungle monkeys could harbor the disease and that mosquitoes could transmit it after biting the diseased animals. One doctor said that he knew of no other disease that killed so many of the scientists studying it.

The descriptions of Memphis during the yellow fever plague in 1878 sound very much like the descriptions of many American cities during the great influenza pandemic at the turn of the last century; the difference lay in how these diseases were spread.

Preventing the flu relies on good hygiene and can be advanced through the use of mass influenza vaccination programs. Preventing yellow fever, like preventing West Nile Virus (seen this summer in Texas) or Dengue Fever (seen in Florida), relies on eliminating the mosquitoes themselves.

Since the publication in the 1960s of Rachel Carson’s The Silent Spring, which described the disastrous secondary consequences of spraying pesticides to eliminate insects, many districts have stopped spraying altogether. However, just as the reluctance of British citizens to vaccinate against measles, mumps and rubella caused a huge resurgence in those infections, the reluctance to eliminate mosquitoes may leave us vulnerable to these tropical diseases.

Christine Contillo, RN, BSN, is a public health nurse who suggests joining a book club as a reason to put down trashy magazines and look smart on the subway.

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