The American Plague: The Untold Story of Yellow Fever

Nursing Book Club

The American Plague: The Untold Story of Yellow Fever

A disease more deadly for soldiers than the battlefield

By Elizabeth Hanink, RN, BSN, PHN
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Book ReviewWhen Lena Angevine Warner was nine years old, she survived the yellow fever epidemic in Memphis, but barely. More dead than alive when a servant found her, she was surrounded by the rotting corpses of five family members, all struck down by the “American Plague.” Her family had sought refuge in their plantation house to avoid contagion, and they cared for one another until each died and no one was left to care for the youngest.

Eventually, Lena recovered and grew up to be a nurse. As a nurse she participated in one of America’s most famous medical research efforts, the Yellow Fever Board of 1900. Her hard-won immunity made her the ideal participant. Like Ebola today, yellow fever once struck fear in the heart of everyone. Panicked communities everywhere imposed quarantines without understanding the origin or method of transmission. It was a yellow fever outbreak that caused the nation’s leaders to move the capitol from Philadelphia to Washington. After having killed 23,000 French troops, it precipitated Napoleon’s sale of the Louisiana Purchase. During the Spanish American War, more American soldiers died from yellow fever than died from their wounds.

Conquering this “saffron scourge” was not without a struggle. In the book, The American Plague: The Untold Story of Yellow Fever, author Molly Caldwell Crosby describes in detail an effort that was fraught with setbacks, rivalries and, for some, death. The effort also brought honor to a singular medical doctor, Walter Reed. When he began to lead the Yellow Fever Board, he brought with him experience from his work on another horror, typhoid fever. His diligence, persistence, and clear leadership were pivotal.

It was not Reed’s idea that mosquitoes carried the disease; that was the theory of a Cuban doctor, Carlos Finlay. But it was Reed’s vision that designed the conclusive experiment to prove it. Innovations he insisted on, including bilingual consents and control groups, remain with us today. Nor did Reed work alone. Several doctors, among them John Carroll, supervised key aspects of the research. Indeed, Carroll isolated the causative agent long before the category “virus” was known. Not surprisingly, a group of nurses were at their sides, Lena Warner among them. Clara Maass was another. Tragically, she allowed herself to be fatally inoculated in a follow up experiment that proved the disease had more than one strain.

Solving the mystery of etiology tamed the yellow fever threat in this country; but as the author points out, total victory has been elusive. Yellow fever is still endemic in Africa and Latin America, a frequent illness in jungle workers. Globalization and rapid air travel bring renewed danger. The Aedes aegypti mosquito remains common in the United States. All it would take is for one such mosquito to bite someone with the fever and then transmit its cargo, the yellow fever flavivirus, to a new victim. Unlike Ebola, which kills fast enough to be self limiting, yellow fever allows its victims to linger, giving ample time for more mosquitoes to wreak havoc. Bam!—an epidemic. Yes, the World Health Organization considers even one case in an urban area to be just that, an epidemic.

Written By Elizabeth Hanink, RN, PHN, BSN is a freelance writer in Los Angeles. She has 30 years of nursing experience.

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