The American Plague

Yellow fever is something that many Americans seem to have forgotten, but it has played a huge role in the history of not just America, but also the world.  The American Plague, by Molly Caldwell Crosby provides an in depth look at yellow fever, and how it is intertwined with American history.

Image from The Elmwood Cemetery website

The book is sort of a biography of yellow fever in the United States.  This can make it a little difficult to follow in some parts, since we are more accustomed to following people through a story.  The fever jumps from one place to another, and is present at different times, so the it can be confusing which outbreak is going on.

There are portions of this book that are very difficult to read.  Graphic descriptions of the scourge that is yellow fever, and the effects it has on human beings.  This is especially heightened when the author introduces us to historical figures, lets us get to know them and a little of who they were, and then reveals that they were victims of the fever.  Especially poignant are the stories of nuns who devoted their time to nursing other yellow fever victims tirelessly until they themselves were infected, the reverend who read his own last rights, and the girl survived the fever and was found barely alive, and alone in her boarded up home with the rotting corpses of her entire family.

Later on in the book it follows yellow fever less closely and becomes more about Walter Reed and his work with the Yellow Fever Board.  I found this portion especially interesting because I have heard of Walter Reed Medical Center, but didn't know why the hospital had been named after him.  Although receiving credit within the medical community on his work leading the board that proved yellow fever's transmission was through the vector of mosquitoes (specifically Aedes aegypti). This book provides a great look at late 19th and early 20th century medical philosophy. Not only was the vector theory found by many to be preposterous despite the recent discovery of mosquitoes as malarial vectors, bacteriologists purported to have found the yellow fever germ.  Yellow fever is in fact caused by strains of virus that are transmitted through the blood, and thus is primarily spread by blood to blood contact or through vectors.

The most shocking part of the book is that despite continuing research, there has been little progress as far as yellow fever.  At the time of publication there was a vaccine available, but not widely used.  The yellow fever vaccine is a live vaccine which means that it is more difficult to produce, and more dangerous to take.  Yellow fever remains one of only three types of outbreaks that requires immediate notification to the World Health Organization (the other two being Bubonic Plague and Cholera.)  Yellow fever is so sever and has such a high mortality rate that even a single case is treated as an outbreak.

If it's such a threat, why have more people not heard of yellow fever?  Well, it's not really that interesting to a lot of people.  In fact plagues of different varieties have shaped world history through the ages, but we don't seem to like to talk about it.  Most people have read about the Bubonic Plague outbreaks of Middle Ages Europe, and quite a few know of the Cholera epidemics that affected American pioneers and early urban dwellers.  But how many are familiar with the epidemic that wiped out approximately 90% of the population of the North American continent just before the pilgrims arrived?  We kind of skip that one and go straight to the introduction of European small pox that wiped out a good number of those who survived the other.  Yellow fever was native to Africa and was transported across the ocean during the height of the slave trade. It was an unexpected cargo on slave ships that quickly gained a foothold in South America, and became a perennial problem.  If had a huge effect on the Spanish-American War, during which casualty rates from disease far out paced those of battle, and on the exodus of Napoleon from America and the resulting Louisiana Purchase.

James Gathany- CDC
from Science News July 14, 2012

While I obviously found this book incredibly interesting, I don't think many people will have the patience to wade through it.  The most important element seems to be that although sickness and plague are uncomfortable topics, they are important ones and pertinent not only to our survival, but also to our understanding of history.

But what does the future hold?  Are we doomed to a continual fear of the striped house mosquito and the virus it may carry?  The same mosquitoes that carry yellow fever, can also transmit malaria and dengue.  But let's not get too excited about this just yet.  It so happens that there hasn't been an outbreak of yellow fever in the United States in quite some time, though there have been isolated cases as recently as 2001.  Managing mosquito populations worldwide and use in high risk areas of mosquito bed nets have been long standing tools in the fight against these.  And in an exciting new article in Science News, Mosquitoes Remade, Susan Milius shares with us that science has not forgotten about this concern.  There has been work going on to actually rework mosquitoes to fight these diseases rather than transmit them.  It's not a long article and I would highly recommend it.