In March of 2014, an epidemic of the viral hemorrhagic disease Ebola began spreading in West Africa. By late summer and fall, Ebola had become pandemic in the region and became the focus of international concern. In the United States the concern at times bordered upon panic. Propelled by television, internet, and print news sources, the fear of Ebola spreading to the United States grew rapidly. Americans demanded that the countries where Ebola raged be isolated and that those who had visited or came from those countries be quarantined. Many Americans bought surgical face masks and other goods intended to protect themselves during a viral pandemic. Of course, Ebola never spread to the United States, but so far the disease has killed about 10,000 in West Africa.

In nineteenth-century America the dread viral hemorrhagic disease was yellow fever. Just as the unpredictability, the horrifying effects, and the high mortality of Ebola makes it particularly terrifying, the same was true for yellow fever. Yellow fever was also mysterious. It began with the same general symptoms as malaria, yet turned into something very different. The disease was not directly contagious: doctors knew from personal experience that contact with victims, their blood, or even the noxious black vomit did not transmit the disease. Yet, yellow fever was confined to limited and identifiable areas. It was a disease of place, and while doctors searched for the cause in water, in the earth, in the behavior of victims, no convincing source was found. Yellow fever literally seemed to be a miasma of the air located only in specific places. Of course, in a way, that was right.

Yellow fever is a hemorrhagic viral disease transmitted from person to person by the Aedes aegypti or other similar Aedes mosquitos. The virus needs concentrations of both human and insect hosts to complete its life cycle. Aedes aegypti reproduce well in small containers of water: flower pots, birdbaths, gutters. Able to fly at only about one mile per hour, Aedes do not naturally travel far from the place of their birth. Newly hatched females need to feed on an infected human within two to four days for the insect to catch the yellow fever virus. The virus then colonizes the mosquito’s gut, and within a week to ten days her bite can infect humans. The cycle can continue as long as there are mosquitoes and human hosts. Urban places or a tightly packed ship with open containers of water were conducive environments for yellow fever. The disease originated in Africa, and probably came to the Americas in the seventeenth and eighteenth centuries aboard slave trading ships. The disease was then spread throughout the Americas by the growing maritime commerce of the developing world economy.

Yellow fever began with shaking chills, fever, and aches; those famous “flu–like symptoms.” Often liver function failed, and the patient’s sclera and skin turned yellow with jaundice. Sufferers usually hemorrhaged from the gums, the nose, and the gastrointestinal tract. Sometimes the fever broke, and the patient began to recover. For others, vomit filled with half-digested blood spewed in horrible projectile-spasms, the victim racked by excruciating pain. If the hemorrhaging didn’t kill the victim, renal failure often did. Mortality for these victims was as high as 50 to 60 percent, and those who died lasted at most a week in horrible agony.

The only known prevention was flight. Once yellow fever was recognized, a panicked exodus followed. Yellow fever was an economic disaster, literally bringing entire communities to a halt. People abandoned their homes. Officials quarantined ships, business died, and stores closed. Virtually every year from 1793 on, newspapers reported yellow fever in some American city. Seaports as far north as Philadelphia, New York, and Boston experienced this plague, but most commonly it occurred in Southern cities, especially Savannah, Mobile, and New Orleans. These very busy ports had a native population of Aedes mosquitoes able to transmit the disease from infected new arrivals. The plagues were so common that the wealthy of those cities often left during the summer “sickly season.” The poor and the enslaved, of course, could not leave, and so suffered the brunt of the recurring epidemics.

One epidemic in Savannah, Georgia began quietly. Doctor William Waring first noticed the unusual fever on June 26, 1820. Many people in Savannah suffered each summer and fall from what physicians of the day called remittent fever: probably malaria. Waring had already seen plenty of remittent fever that year, but this case was different. The patient’s fever did not drop and rise in the regular cycle of remittent fever, and he died after just three days. Two weeks later another man “was attacked with Continuous fever,” the sclera of his eyes turned yellow, and he died bleeding profusely from his gums and anus. Then, Patrick Stanton was “seized by fever” and died after four days on July 16. Stanton’s death was accompanied by black vomit, the classic sign of the acute hemorrhagic effects of yellow fever. Waring knew then that disaster loomed. Within three months the city was an empty shell. Almost a thousand were dead, most of the population had fled, and only 1,500 or so people roamed the empty streets of the city. The commerce of Savannah had been destroyed, delaying the shipment of that year’s cotton crop to market, the effects echoing through the newly industrialized regions of Europe and the United States.

Yellow fever remained common in the United States throughout the nineteenth century. Savannah suffered additional great epidemics in 1854 and 1876, while other cities in the United States suffered repeated epidemics as well. In 1878 a yellow fever pandemic swept through the Mississippi Valley, killing more than 20,000 people, finally bringing the Federal government into the field of public health with the Quarantine Act of that year. Over the next thirty years state boards of health, the National Board of Health, and finally the discovery of the mosquito vector in 1900, all worked to suppress the deadly plague. The last true Yellow Fever epidemic in the United States occurred in New Orleans in 1905.

With an understanding of the vector, mosquito control and the isolation of yellow fever victims behind nets and screens quickly eradicated this hemorrhagic scourge from the United States. Gradually, the terror of the disease was forgotten. The terror of 2014’s Ebola scare also seems to be forgotten, but with airplanes playing the role of plague ships in our modern world, the threat of pandemic disease has not gone away.

You might also like Micah Schneider’s piece about the Aedes Aegypti mosquito and yellow fever.