“Nature had found the perfect place to hide the yellow fever virus. It seeded itself in the blood, blooming yellow and running red.”
Long before the idea that mosquitoes could spread disease was scientifically proven and medically accepted, diseases like malaria and yellow fever were wreaking havoc, spreading from West Africa to the Caribbean and up the Mississippi River Valley on the gossamer wings of aedes aegypti. People who had never been in contact with anyone who was ill mysteriously succumbed, as if the disease was in the very air. In The American Plague, journalist Molly Caldwell Crosby chronicles how yellow fever arrived in North America, the devastating effects of an outbreak, the efforts to uncover how the disease was spread, and finally the journey to a vaccine.
The American Plague has two main subjects; the 1878 yellow fever outbreak in Memphis, Tennessee, and the work of Walter Reed, James Carroll, Jesse Lazear, and Aristides Agramonte on the Yellow Fever Board in Havana during the Spanish-American War. A Memphian herself, Crosby begins with the Memphis outbreak, a devastating event that killed at least 5000 people, in a city with a population of only 40, 000—half of whom fled at the onset of the epidemic. There were not enough doctors and nurses to care for the sick, and medical volunteers arriving in Memphis were often stricken by yellow fever within days of arrival, adding to the burden. With deep access to the local history, Crosby pulls out fascinating details, such as the caretaker’s daughter who kept the cemetery’s record book, writing down each name and ringing the bell for the dead, until she succumbed to yellow fever herself.
Economic imperatives and subsequent devastation surround this narrative, beginning with the slave trade, which was the vehicle that brought yellow fever from West Africa to the Americas, satisfying the thirst for free labour at the cost of human life. Crosby recounts how yellow fever would typically arrive in New Orleans via the Caribbean, and then make its way up the Mississippi River Valley. Port cities were caught between the desire to prevent disease and the economic benefits of not quarantining incoming ships. Cargoes such as fruit from the Caribbean could be destroyed by a quarantine. The Memphis Board of Health voted against a quarantine in 1878, only to have the city economically destroyed anyway; the outbreak was so severe that the city was bankrupted, and its charter revoked. I found this particularly striking in the midst of the fraught economic debates currently surrounding COVID-19 containment measures.
After illustrating the devastating effects of yellow fever on both human life and the American economy, Crosby shifts her attention to the efforts to discover the cause of yellow fever, and create a vaccine against it. When the Yellow Fever Board was assembled in Havana in 1900, they were building on the work of Dr. Juan Carlos Finlay, a Cuban doctor who had proposed the mosquito as the vector for yellow fever two decades earlier, to much ridicule. What is most interesting here, however, is the various controversies surrounding the work. Members of the board experimented upon themselves, and on army volunteers, but also carefully recruited and groomed new Spanish immigrants to Cuba, using large financial incentives to get them to consent to participating in the experiments. Army doctor Jesse Lazear, who was the head of the mosquito work, died of yellow fever which is now suspected to have been self-inflicted, but was covered up at the time. James Carroll eventually died in 1907 of the lasting complications of yellow fever contracted in the course of his work in Havana. From there Crosby goes on to the work of Max Theiler, who invented a vaccine for yellow fever, infecting thousands of American soldiers with hepatitis in the process—although to be fair to Theiler, he expressed his concerns about the widespread use of this vaccine and was overruled in favour of ensuring that American soldiers deploying for World War II were inoculated.
Although Crosby dedicates a significant amount of the book to medical investigations, I would describe this account of yellow fever as more cultural than epidemiological. She doesn’t delve deeply into any of the virology or the nitty gritty scientific details. Although she briefly mentions that the difficulty in proving the mosquito hypothesis was a matter of the timing of the reproductive cycle of the virus, she never does get around to fully explaining the viremic window for infection between mosquitoes and humans, or a more than cursory exploration of the zoonotic origins of the disease. Nevertheless, The American Plague is an interesting look at how one tiny virus significantly shaped the course of American history, and I would recommend it for those more interested in the human impacts of pandemic than the science surrounding it.
More pandemic reads:
Spillover by David Quammen
Pale Rider by Laura Spinney
China Syndrome by Karl Taro Greenfeld