Yellow Fever and Malaria

Yellow Fever and Malaria

Sources

Dreaded Diseases . Yellow fever and malaria, two of the most feared diseases of the period, were often confused. Their symptoms—chills, aches, and high fever—are similar, and they tended to appear in hot weather. Neither is contagious—one person cannot catch it directly from another person—and both are transmitted by mosquitoes. In the late eighteenth century no one knew what caused these diseases; some thought there was a connection with swamp air or with summer heat. Yellow fever attacks the liver, producing the jaundice that makes the skin turn yellow, while with malaria, parasites build up rapidly in the liver, and the overworked spleen becomes enlarged as it tries to filter the parasites out. In severe cases blood vessels to the brain are blocked, causing delirium, coma, and death. The two diseases were apt to strike differently: yellow fever broke out in frightening epidemics, sometimes as far north as Philadelphia and New York City; malaria was a constant menace in hot, swampy areas of the Southeast, especially South Carolina and Georgia.

Philadelphia . The worst outbreak of yellow fever in America occurred in Philadelphia during the summer and fall of 1793. There were an estimated five thousand fatalities out of a population of forty-five thousand. A victim’s first symptoms were high fever and headache, followed a day or two later by severe vomiting of blood as the internal organs degenerated. Death often occurred within four days to a week after contracting the disease. People were so afraid of catching the disease that they avoided contact even with their friends and stopped shaking hands. Relatives were afraid to bury the victims, and a familiar sight was the death cart passing by and the cry of the grave diggers: “Bring out your dead!”

Causes. Even experienced doctors who recognized the symptoms were ignorant of the cause, although there were plenty of theories. The best-known physician of the day, Benjamin Rush, believed that the contagion may have resulted from a shipment of coffee that was rotting on a Philadelphia wharf. It was also thought possible that the air itself carried the disease. Crews on ships in the harbor were advised to burn tobacco in the hope that its smoke would cleanse the air somehow. Others, convinced it was God punishing a sinful population, noted with some satisfaction that many of the victims were from the poor sections of town, and of course the poor were more wicked than the rich. And while it was true that the poor were afflicted more than the wealthy, it was because of unsanitary conditions in their neighborhoods—stagnant water and open sewage that drew mosquitoes—and not the wrath of God. But the disease attacked the rich as well, especially those brave enough to stay in the city rather than flee to the countryside. As the rich fled, there were other kinds of victims: shops and businesses had to close, leaving thousands out of work.

Prevention and Cure . Once the epidemic had struck, health officials tried to keep the contagion from getting worse by burning tobacco to clean the air and by recommending public prayer and fasting. People tried mud baths or garlic to prevent the disease from striking. Doctors would try anything to save their patients. The most common “cure” was to administer mercury pills and extract large volumes of blood. Bleeding was the fashionable theory of the day: if enough blood were removed, it was believed, the disease would have nothing to attack. One can only imagine how many lives would have been saved if the patient had simply been left alone. Although emergency hospitals were set up, it was difficult to find people brave enough to staff them, and in any case victims had no desire to go to a hospital to die.

Government Shutdown . Philadelphia’s municipal government practically disintegrated during the epidemic. Only the work of an unofficial committee of public-spirited citizens, acting as a combined government and board of health, prevented total chaos. The U.S. capital was then at Philadelphia. It was common practice at the time to partially shut down the government during the hot summer months, so it was not unusual that President George Washington left for Mount Vernon. Secretary of State Thomas Jefferson, remaining calm in the midst of all the panic, tried to stay on, but found that his staff had evacuated the city, so he too went home to Virginia. Secretary of the Treasury Alexander Hamilton also went home, but not before contracting a mild case. As the time approached for the government officials to return, many feared for their lives. Washington decided to move the capital to Germantown, which became the temporary seat of government until November. By December the crisis had passed, and Congress was able to reconvene in Philadelphia.

Lessons Learned . Since there was no fundamental understanding of the cause of yellow fever, not many lessons emerged, although Benjamin Rush’s critics now had more examples of the ill effects of his practice of excessive bleeding. When the disease struck Philadelphia again, mildly in 1795 and 1796 and violently in 1797, the same inadequate measures were taken. Dr. Rush did, however, correctly point out that poor sanitation appeared to be a contributing factor, and his efforts to clean up Philadelphia finally resulted in the development of a public water system. It would be years before people trusted the public health conditions in Philadelphia, and more than a century before Walter Reed would prove that the female Aedes aegypti mosquito was the carrier.

Malaria . While yellow fever also reached epidemic levels in southern cities, it was malaria that was the most prevalent killer in the South. Malaria —the word comes from mala aria, an Italian phrase for “bad air”—had been a problem in the warm, wet Southeast coastal regions of America since early colonial days. Many early settlers from Europe, with no defenses against malaria, suffered and died from what they called “fever and ague.” South Carolinians were particularly susceptible to malaria because rice plants, for which large tracts of land had been cleared, grew best in shallow pools of standing water, which also formed breeding grounds for mosquitoes. Of course, at the time the mosquito was considered merely a pest, not a carrier of deadly disease.

Remedies . Although malaria’s cause was unknown, it was often treated differently from yellow fever. First of all, malaria was not always life threatening, so measures such as bleeding were not considered necessary. Fevers were intermittent, and chronic fatigue was often the most debilitating effect. Second, it had been recognized from early colonial times that cinchona bark (from a South American tree) was effective in reducing the symptoms of malaria. We now know that it worked because it contains a substance similar to quinine.

Rich Versus Poor . Unlike yellow fever, which was likely to strike in the crowded cities, malaria was prevalent in the low-lying countryside (it was often called “country fever”). The wealthy landowners simply left during the hot season; in fact, some of South Carolina’s richest families spent the summer in Newport, Rhode Island. That left the poor and slaves to labor in the intensely hot and mosquito-infested rice fields. It was generally believed that African slaves were not only better able than whites to endure the intense heat of southern summers, but were also resistant to malaria. Medical studies have since proved that black Africans were, in fact, partially immune, having come from areas where malaria was prevalent, and having built up antibodies, which were not genetic, but passed from mother to child during pregnancy. This immunity is curiously tied to sickle-cell anemia, a condition that causes blood circulation problems in black children, yet helps ward off malaria. The tragic social consequence was the belief in a “natural” law that blacks’ immunity to malaria justified their slavery to work the plantations of the South while the white owners spent the hot months in safer regions. Like yellow fever, malaria was eventually reduced through improved public sanitation, quarantine of ships coming from infected regions, and (after 1900) control of mosquitoes.

Sources

Dumas Malone, Jefferson and the Ordeal of Liberty (Boston: Little, Brown, 1962);

Page Smith, The Shaping of America (New York: McGraw-Hill, 1980);

Peter H. Wood, Black Majority (New York: Norton, 1974).