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YELLOW FEVER

Yellow Fever in the United States

Before the twentieth century the acute viral disease yellow fever was one of the most feared diseases in the United States, especially in the Southeast. Victims suffered high body temperatures, headaches, liver damage and resulting jaundice, and internal bleeding that caused discharge from the nose and mouth, bloody stool, and black vomit. Death could follow in one day or two weeks, and reported mortality rates often reached 50 percent of known cases. Between the mid 1600s and 1905 yellow fever epidemics ravaged many cities along the coastal and lower Mississippi Valley regions of North America. During those years more than 230 major epidemics were recorded. The country's earliest outbreaks appeared in Spanish Florida and the Northeast; as populations grew in the lower Atlantic and Gulf Coast states, yellow fever followed. Transmitted by the bite of the female Aedes aegypti mosquito, the disease typically developed in the summer and early fall and spread rapidly. By November or December yellow fever would disappear. By the mid 1820s quarantine measures and improvements in sewerage and water drainage effectively eliminated yellow fever from the cooler northern states. Warmer cities from South Carolina to Louisiana continued to endure epidemics until 1905, when the final outbreak in the United States hit New Orleans.

Response to Yellow Fever

Yellow fever caused more panic on a national scale than any other disease except Asiatic cholera, which threatened many areas untouched by the fever. Outbreaks of the fever were swift and unpredictable: a community free from yellow fever for a few years might be struck several years in a row. In efforts to respond to the epidemics, many communities formed temporary boards of health with powers to quarantine the sick. These boards were among the few cooperative health efforts undertaken by American governments in the nineteenth century and became a model for the permanent public health institutions that were established in the 1900s and 1910s.

Attempts to Find a Cause

Before the Civil War yellow fever was widely believed to develop spontaneously from filthy conditions. During the 1850s some southern physicians began to suspect that the disease arose from a transportable agent. By the 1870s most American doctors accepted the idea that a microscopic agent was involved. In that decade the search began for a microbe in the blood of yellow fever victims. In the 1880s researchers in Brazil and Mexico announced that they had found the agent, but investigation proved these reports to be false.

The Cause Is Found

In 1881 Dr. Carlos Finlay published his idea that a mosquito was the carrier agent for yellow fever. But like Dr. Josiah Nott, who had suggested a similar theory in 1848, Finlay was not able to develop irrefutable proof. In June 1900 Finlay began advising the U.S. Army Yellow Fever Commission, which had been formed in response to noncombat deaths among military personnel during the Spanish-American War and the subsequent U.S. Army occupation of Cuba. Dr. Walter Reed, chairman of the four-man team, was at first skeptical of Finlay's mosquito theory. After two members of his group were bitten by mosquitoes and contracted yellow fever, however, Reed was convinced. He established a quarantined camp and quickly confirmed Finlay's idea.

Controlling the Fever

By early 1901 Dr. William Gorgas, chief U.S. Army sanitation officer, began to rid Cuba of the mosquito and thus of yellow fever. While more than one hundred thousand people are estimated to have died in the United States alone through the New Orleans outbreak in 1905, by the end of the first decade of the twentieth century yellow fever had been eradicated from most parts of the world. In their continuing attempts to control mosquito and other insect pest populations, officials would employ increasingly toxic chemicals, including DDT, which would create environmental hazards that were exposed by Rachel Carson in the 1960s.