The American Plague

by Molly Caldwell Crosby

  It was spring, and in West Africa, the wet season was under way. As the rivers and coastal areas were inundated with falling rain, mosquitoes proliferated. The mosquito found a perfect environment on board the oceangoing steamers: shelter, fresh rainwater, rotting fruit and an ample supply of warm bodies. The males, focused mainly on food and sex, fed off of the fruit and sought out their female shipmates. The impregnated females fed on the blood of human passengers in order to lay eggs. This transatlantic romance could repeat itself as many as three times during the journey.

  In the water-dappled hollows of empty casks, the striped female mosquito deposited her eggs. Each time rain filled up the casks during the six-week sail across the Atlantic, the eggs hatched. When they did so, a virus born in the wilds of West African forests coursed through the new generation of Aedes aegypti mosquitoes.

  Aedes aegypti, the striped house mosquito, looks like any other mosquito to the naked eye. Its elegant, gossamer wings flicker above a black body bright with white scratch marks. A silver lyre mark decorates its back. Its long, wiry legs are crooked high above, giving it the chilling appearance of impending attack. It is, however, heartier than many of its relatives. The striped house mosquito thrives indoors, feeding at any time of the day, and the females, who bite, outnumber the males five to one. The mosquito also has a peculiar adaptability to travel, prospering among the habitations of man, whether dwelling or boat. Some have been known to live for days in the damp clothes enclosed in a trunk. Aedes aegypti were native to Africa but established residence in the western hemisphere after centuries of ship trade provided the insect stowaway with repeated opportunity to colonize in the New World. The mosquito flourished.

  When African ships dropped anchor in the Havana harbor, the new generation of female mosquitoes hunted warm-blooded mammals. The bright colors, movements, accents and sounds of the bustling harbor were lost on these insect immigrants; they were attracted to the ephemeral scent of exhaled carbon dioxide and lactic acid mingling in the humid air. Some moved unnoticed onto the shores of Cuba, where blood meals were in large supply. Others settled onto the decks of neighboring steamboats like the Souder where shipments of tobacco and sugar would soon depart for New Orleans. As the female mosquito departed her ship, she was attracted to the flailing arms and swatting that usually precipitate a swarm of mosquitoes. Her vision sensors locked onto the frenzied movement and its resulting heat. She landed on the flesh of an arm, easing in her proboscis, and injected a chemical that would prevent the human blood from clotting too quickly. As she did so, a sphere-shaped virus slipped into the bloodstream like oil entering water, and yellow fever replicated in the lifeline of an unsuspecting donor. The loaded mosquito simply moved onto the next warm body, where once again, she would exchange fever for blood. The infected person harbored the virus, unknowingly for a few days, while local Aedes aegypti mosquitoes then fed on the carrier human. This blood meal would pass the yellow fever virus into the gut and bloodstream of new mosquitoes, and the cycle, about one to two weeks long, would be complete. Within weeks, this rotation of the virus from mosquito to human to mosquito would create an insect population of virulent mosquitoes that would feed on the human population through all of the summer and fall. And so another yellow fever epidemic made its start in Cuba.

  Though it was almost a yearly occurrence on the busy Caribbean island, this year’s epidemic would prove to be unusually virulent, as though after two centuries it had finally perfected its genius for killing.

  Yellow fever had been endemic in Cuba since the mid-1600s when the slave trade had established a sturdy colony of Aedes aegypti mosquitoes and a steady influx of the virus on cargo and slave ships. Small, sporadic cases would surface yearly. Exposure to these mild infections, especially during childhood, produced a type of immunity among the locals. Throughout the Caribbean and American South, it was almost a rite of passage to become “acclimated” to the fevers, and yellow fever quickly earned its reputation as a “stranger’s disease” for its ability to hone in on new blood. In 1878, however, it was as though a new virus entered the circulation; the death toll mounted and those previously thought immune succumbed.

  On May 19, 1878, the Souder set her course for Key West, where she would dock two days for supplies. This also provided the crew with some time for entertainment, mostly in the form of rum. Four days later, hungover and tired, the crew arrived at the Mississippi quarantine station outside of New Orleans and awaited inspection.

  For three months the quarantine officers had been fielding cases of yellow fever coming from the Caribbean, in addition to four infected steamships from Rio de Janeiro. Two years before, in 1876, pressure from the New Orleans Chamber of Commerce, as well as a number of prominent physicians, had persuaded the Louisiana Legislature to weaken its laws on quarantine. Once required to spend ten days in detention to assure no cases of fever, vessels were now at the personal discretion of the board. To make matters worse, New Orleans officials were threatened with law-suits if they detained a ship carrying perishable fruits. Many of those ships in 1878 came from Cuba, where the Ten Years’ War for independence was coming to an end and an epidemic of yellow fever had been raging since March. Refugees landed in New Orleans by the hundreds.

  The very day that the Souder arrived, another ship coming from Havana had declared five cases of fever on board. It was promptly taken into custody and would be held for nearly two weeks while it was thoroughly worked over with sulfur and carbolic acid. The harbor was filling with vessels bobbing in the water, the Yellow Jack flying high over their decks.

  The captain of the Souder wasn’t going to take any chances for delay; the last thing he needed was to be detained for a week or two at a quarantine outpost. A few of his men looked to be suffering from more than the average hangover, even complaining of fever. The captain met the quarantine physician on the gangway and offered up one feverish crewmember. The physician examined him, diagnosed it as malarial fever and sent him to the quarantine infirmary before examining the remaining crew. He recorded no other cases of fever. The physician did take notice of one other sailor looking sickly though; it was the ship’s purser John Clark. The men blamed his condition on a rum hangover and “neuralgia,” but Clark would later boast he “had beaten the quarantine officer.” The Emily B. Souder was detained for only a few hours before she was given a clean bill of health and steamed her way into New Orleans, mooring in a berth off Calliope Street.

  That night, John Clark’s health worsened. Feeling feverish and agitated with an intolerable headache, he took a room at a nearby boardinghouse on Claiborne where a mulatto nurse looked after him. As his temperature climbed, his pulse slowed, known as Faget’s sign. He felt intense heat all over his skin, but was unable to perspire. The fever attacked his organs, and his kidneys and intestines stopped functioning; high concentrations of uric acid collected in his kidneys, while he writhed from abdominal cramping.

  His entire body ached from dehydration, and he suffered from severe hypoglycemia.

  By Friday afternoon, Clark suddenly began to feel better and asked for food. A doctor who later described the scene wrote that the “fancy of food” always proved fatal. With the approach of evening, Clark again grew restless and his condition spiraled; the fever returned. He awoke twice in the night convulsing before finally slipping into delirium, his eyes glassy and empty. With the third convulsion, he died. It was shortly after 2:00 a.m. His dying liver had released a surge of bile, tinting the whites of his eyes and his skin saffron yellow. Upon later investigation, Clark was found to have been given treatments for yellow fever, though his death was officially recorded as malarial fever by the Board of Health.

  Clark’s body was removed, and he was quietly buried by 10:00 a.m. with no funeral and no public announcement of his death. Nearby streets were disinfected with carbolic acid, the smell lingering in the air well into the evening.

  On the same day that Clark was buried, the Souder’s engineer, Thomas Elliott, fell feveri
sh in a boarding room on Front and Girod streets; he died five days later in a nearby hotel. Rumor of another dead crewmember from the Souder caught the attention of two city physicians, and the body was sent to the dead house where an autopsy could be performed. The physicians described Elliott’s body as “bright canary color” and his stomach filled with dark, blood-like matter. Dr. Samuel Choppin, president of the Board of Health of Louisiana, visited the dead house to examine Elliott’s body. Choppin would later write: “These are all the usual appearances observed in the examination of a person dead of yellow fever, and we had no doubt that the man had been the subject of this disease.”

  It was the end of May, and yellow jack had gained its foothold in New Orleans. To a city on the bluffs, 400 miles to the north, this would have been urgent news. Since the two cities were first linked by railroads and steamboats in the 1850s, disease had been making its way into Memphis in fits and starts. By the mid-1850s the first railroad cars rolled between Memphis and New Orleans, and 200 yellow fever deaths soon followed. As Robert Desowitz, a professor of tropical medicine, wrote, “The railroads were viewed not as a channel of commerce but as a channel of contagion.” Memphis experienced another epidemic in 1867 and a terrible one in 1873. At first, Memphians denied that the dreaded fever could have made its way into their promising city; the city was considered too high above sea level and too far inland for this plague of the port towns. To an extent, they were right. But once the railroads and steamships connected Memphis to the Gulf, the Aedes aegypti mosquito found its opportunity to move north. The insects settled near the river, finding refuge in the stagnant pools of water, private cisterns and the waxing and waning of the Mississippi riverbeds. The area at the mouth of the Wolf River was so hospitable to mosquitoes, one Memphian recalled, that a man could thrust his arm into the swarms of mosquitoes and leave a momentary vacuum when he withdrew it. Within ten years, there were enough striped mosquitoes in place to infect thousands of people in Memphis.

  On the very day the Souder passed quarantine, a member of the Tennessee Board of Health wrote to the Louisiana health board in New Orleans asking for news of any yellow fever cases. Dr. Samuel Choppin, the doctor who examined the Souder’s dead crewmembers, assured the Memphians that they would receive regular reports and that nothing would be concealed from them. They did receive the reports; no mention of yellow fever cases ever appeared. Not until two months later, July 26, would Memphians read about an epidemic in New Orleans in the national papers. By then, it was too late. For all of June and July, New Orleans would routinely pass ships, including eighteen from Havana and fifteen from South American ports. In that time, the Emily B. Souder would make three more trips delivering sugar to New Orleans, escaping authorities and landing feverish crewmembers again in early July, sparking another wave of yellow fever cases. As the Souder unloaded cargo, other boats waited in nearby berths to sail north. One such towboat, the John D. Porter, left New Orleans on July 18 and entered the massive transportation waterway of the Mississippi River, where it would make its way north toward Memphis.

  In the summer of 1878, the Mississippi River, the great artery of North America, would carry death in its bloodstream, spreading the worst yellow fever epidemic in American history.

  CHAPTER 3

  The Doctors

  The sweet scents of honeysuckle, overripened fruit, and fresh-cut hay distracted from the fecund smell of the living body of water coursing beneath the bluffs of Memphis. Crape myrtle bloomed around the marble fountain in Court Square. Geraniums, roses and lilies bejeweled the park, and magnolia limbs bowed under the weight of the dark, glossy leaves. Throughout the park, the calls of the bootblacks offering shoeshines could be heard, and cicadas hummed from the treetops.

  Early in the morning, before the haze of summer humidity settled over the town, the voice of the milkman resounded: “Wide awake,” “All alive, now!” The ice wagon rattled up Second Street, while the produce stands opened in front of the public offices and dry-goods stores on Main. Dust, mud and manure along the bustling thoroughfares necessitated that even the most well-bred lady wear rubber Wellingtons downtown. Nicholson wood-plank sidewalks, which had been rotting for ten years, were piled high with crates where newsboys sat shouting headlines.

  When the summer heat arrived early, as it did in 1878, it was known as yellow fever weather. Memphians passed one another downtown with nervous glances, their eyes averted beneath cotton bonnets and straw hats. Few uttered the words “yellow fever,” but the fear of it suffused the still air nonetheless. In addition to the early arrival of summer, the high temperatures and little rainfall had produced a drought, draining the Mississippi River down to the hardpan. Green lawns lush from the surplus rain in months past turned as brown as prairie grass, and water wells dried up. The scant rain had left no natural way to wash sewage from the dusty Memphis streets, and bloated, dead animals rotted in the shallow pools of refuse; the city had no money to remove them. Finally, rumors of a yellow fever epidemic in New Orleans spread up the Mississippi Valley, and in Memphis, the talk of fever consumed conversation like brushfire.

  Yellow fever answered to many different names, including yellow jack, coup de barre (blow of the rod), vomito negro (black vomit), the saffron scourge and the American plague. Regardless of what it was called, yellow fever, elusive and terrifying, remained a mystery to medical minds during the nineteenth century. Disease in general was an enigma, medicine still in its infancy. By the 1870s many doctors received no formal medical education, instead receiving their knowledge through a type of medical apprenticeship with local physicians or during the Civil War. The medical programs that did exist at places like Harvard and Yale had no admissions program, performed few autopsies, did not even own microscopes. While Europe excelled in its medical research, American institutions placed almost no value on evidence-based medicine. To them, the body was a balanced system, and their work focused on treating the occasional imbalancewith lancet bleeding, leeches, castor oil and even arsenic at times.

  To make matters worse, a thin line existed between medicine and religion. Newspapers smacked of advertisements for medications like Tutt’s pills, which could cure everything from wind colic to low spirits, and were “Recommended by physicians. Indorsed by Clergy.” The physical body was the realm of the Almighty, so knowledge of its inner workings through autopsy or examination was like trespassing. From the pulpits people were often told that epidemics, plagues, resulted from wicked ways and intoxication. And, in reality, there might have been some common sense to it considering venereal disease was one of the largest health concerns of the day; a number of doctors even specialized in these private or secret diseases. Very little connection had been made between filth and disease, so amid this near witch-doctor approach to medicine, cities remained baffled by cholera epidemics as they drank from the same sources in which they dumped sewage. The germ theory would soon change all of that, but in Memphis in 1878, sanitation, like immoral behavior, was still just one in a number of guesses as to what caused and spread disease.

  Doctors relied on two prevailing theories about yellow fever: One camp believed it was mysteriously spread by filthy conditions much like cholera and dysentery. Terms like fomites, effuvia, and noxious gases peppered medical literature in an attempt to explain what substance—whether animal matter, fungal or gaseous— spread the disease. The other side held that the fever was imported each summer into the city by railroads and river traffic. Not sure which would prove to be more effective, Memphis health officials decided to tackle both problems.

  In the summer of 1878, the Board of Health secured $8,000 in city funds to clean up the foul city, investigating cisterns and outhouses.Wayward goats and hogs were impounded. Regulations for the disposal of animal carcasses were strictly enforced. Regardless of their efforts, over 70 percent of the city’s dwellings were wooden and prone to rotting. When it rained, basements flooded, holding several inches of water, while the walls wept polluted mud. The Nicholson pav
ing continued to decay, and the city’s water, though routed through the pumping station, came from the Wolf River. Even milk, under no inspection, was diluted with river water, and it was reported that one person found a minnow in his milk jug. The biggest problem was that of raw sewage and privies. Like all other densely populated cities, there was no effective way to remove waste. Citizens in downtown Memphis carted and dumped their privies into the river, and over half of the city’s privies were located fifty feet or less from drinking wells. One authority would call privies the “most annoying problem connected with urbanization.”

  Nonetheless, as yellow fever season loomed, one newspaper column read, “Memphis is about the healthiest city on the continent at present,” and another bragged, “We need not fear in Memphis. We were never in as good a condition from a sanitary point of view . . . Nothing in our atmosphere invites that dread disease.” In the greater scheme of things, from political neglect to public apathy, the city of Memphis was due a tragedy, though no one seemed ready to acknowledge it.

  The war on disease was a two-front campaign. Despite all their efforts, the Board of Health had failed in their campaign to clean the filthy city. They turned now to the issue of quarantine.

  Quarantine had been a regular measure for preventing disease as early as the biblical lepers, but it was most widely used beginningwith the bubonic plague in fourteenth-century Venice. Ships were forced to spend weeks anchored outside of a city until the crew showed no signs of disease among them. Vessels and their cargo were initially intended to spend thirty days—trentina—in the harbor, but that later changed to forty days—quarantina. Quarantines continued to rule maritime travel well into the nineteenth century, finding even greater cause with the trafficking of human cargo. European ships often spent weeks moored off the coast of Africa before crossing the Atlantic. Fever was so prevalent among the crews that one island, São Tomé, was known as the Dutchman’s graveyard. And the tale of the Flying Dutchman is thought to be the story of a yellow-fever-infected ship repeatedly denied port until all on board perished of the fever, and the ship was forced to sail endlessly, manned by a ghost crew, delivering detriment to other seafaring vessels.