The American Plague
Author: Molly Caldwell Crosby

Overview

The plague at the heart of this book is one which the author said ‘created a panic and fear few other diseases, ancient and contemporary, can elicit’. As the book traces the mysterious origins and murky history of yellow fever, a disease it said is ‘intrinsically tied to the worst and best in humanity’, it also unravels its deadly modus operandi and devastating impact. And as it forensically maps its deadly footsteps in one American town, the book highlights why yellow fever is a pestilence that is ‘brought on by the mistreatment of others and conquered only by selfless sacrifice‘. Accompanying its gripping historical portrait of the epidemic, the author also charted the scientific advances that demystified yellow fever, from the inspiring heroic efforts of the ‘handful of doctors‘ who delineated the disease’s life cycle, to the eventual development of effective control strategies. And as a reflection of its broad perspective, the book also provides an enlightening academic and political account of yellow fever, from the biological mechanisms that it to hijack the human cells which ‘give it refuge’, to the environmental factors that favour its spread (pages viii, 11-12 and 37).

Synopsis

Whilst the author admitted that ‘no one knows for sure how the yellow fever virus first came into existence‘, she nevertheless painstakingly traced the history of the malign virus in a story that goes back to the slave trade. Arguing that yellow fever originated from West Africa, she said it ‘journeyed’ down the Niger and Benue rivers and onto the slave ships which took it to the ‘the ports of the new World‘ and into the blood of Europeans‘. It is there, she added, that ‘yellow fever made a giant evolutionary leap‘ by adapting and spreading to become ‘the most dreaded disease in North America for two hundred years’. Indeed she said that the 1878 epidemic in the American South, where slavery was ‘deeply entrenched’, was ‘the worst in history‘. Such was its ruinous impact that the author asserted that it paralysed the United States government and necessitated the move of its capital from Philadelphia to Washington. The narrative also gave a vivid portrayal of the virology and life cycle of yellow fever, particularly noting that, unlike similar flaviviruses, it uses Aedes aegypti as a vector – a mosquito that ‘hunted warm blooded mammals’ to ‘exchange fever for blood‘. The book described this pernicious insect in detail, pointing out that it is ‘attracted by the ephemeral scent of exhaled carbon dioxide and lactic acid’, and noting that its ‘long wiry legs‘, which are ‘crooked high above’, give it the chilling appearance of impending attack‘ (pages 8-14 and 33-37).

Memphis was one of the American cities at the centre of the dramatic yellow fever epidemic that this book explores. Referring to the city as ‘a hub‘ and ‘a fault line carved between the past and the future’, the author described it as a place that had earned ‘a reputation as a sickly city and a filthy one’ because of its ‘deplorable sanitary conditions and disease’. Further noting that Memphis had ‘swelled with the underclasses‘, she explained that it had attracted ‘all classes of society, all colors of skin, all manner of accents‘. This depiction set the tone for the narrative that revolved around the 1878 Mardi Gras, what the author characterised as a veritable superspreader event, attended by over 10,000 tourists. It was into this cauldron that the ship, The Emily B. Souder, arrived from Cuba laden with ‘hundreds of mosquito eggs…ready to hatch’. The author described how the ship journeyed up the Mississippi River with its cargo that harboured ‘death in its bloodstream’, and how it spread ‘the worst yellow fever epidemic in American history’. And as the plague spread, the book also captured the typical instinctive human response to epidemics – the rich escaping in a ‘mass exodus‘, leaving the poor and the sick behind. Portraying the gory outcome, the author said ‘a morbid calmness‘ and ‘the pallor of death‘ fell on the city which ‘collapsed, hemorrhaging its population, its income, its viability‘. Indeed the author maintained that 6 months after, Memphis remained ‘a city of corpses‘ with ‘piles of coffins, stacked one on top of another’ (pages 20-37, 41, 54-57).

 

The horrific clinical manifestations of yellow fever formed a key theme of the book which the author captured in vividly gruesome detail. In depicting the unique ‘mysterious horror‘ of yellow fever, the author described its typical onset as ‘acute and quick‘, and its clinical course as ‘painful‘. She illustrated this with how yellow fever ‘hit suddenly in the form of a piercing headache and painful sensitivity to light‘, and how the condition progresses with a high fever, kidney impairment, and abdominal cramps. And as ‘black vomit roiled’ and ‘red blood ran from the gums, eyes and nose’, the author added that ‘the victim became a palate of hideous colours‘ – the skin becoming ‘a deep gold’ and the eyes turning ‘brilliant yellow‘. The author also explored the distinctive diagnostic markers of the disease, for example Faget’s sign – the combination of a high fever and a low pulse rate, and ‘its cruel tendency to return after a period of brief recovery’ (pages 2, 38, 72 and 80).

By far the central character in the book’s retelling of the yellow fever saga was Walter Reed, the physician who the author said ‘would survive amongst the greatest names in medical history’. In narrating his detailed and revealing biography, the book noted the personal qualities which enabled his success, and these included his humility, his honesty, his ‘gracious and well-mannered nature’, and his ‘look of steadfast concern‘. She also referred to his ‘lofty principles‘, his ‘swelling determination‘, and his ‘rare ability to be simultaneously amicable and commanding‘. The text also narrated his early life, his medical training, and his qualification as the youngest graduate of his school. It also documented his early work as a ‘district physician to the poorest district in New York’, and his commissioning as an assistant surgeon in the Army. But particularly relevant to his future career was studying pathology with William Welch at Johns Hopkins, joining the faculty of the new Army Medical School in Washington, and heading the Typhoid Commission during the Spanish-American War (pages 125-140 and 163).

The journey towards understanding the life cycle of yellow fever started when Walter Reed was commissioned to take charge of the medical board set up to investigate the disease at Camp Columbia in Cuba. In narrating the board’s activities, the striking feature was undoubtedly the self-experimentation that its members carried out to determine the transmission of yellow fever. In this regard, the author particularly highlighted the critical role played by Jesse Lazear, the bacteriologist who she said was the ‘visionary of the group’, ‘gifted with perception, a sort of insight for the way things worked’. Remarking rather poignantly that his ‘obsession with accuracy…would prove to be the haunting mystery left in Cuba’, the author described how Lazear contracted the infection from his self-experiment, and subsequently died from it as ‘a martyr for science‘. The book also documented how the experiments conclusively showed that yellow fever could only be transmitted by infected mosquitoes and not by filthy clothing or by inhalation from the air, and that it was not caused by a bacterium as claimed by physician Giuseppe Sanarelli. Other prominent members of Reed’s team which the book profiled were James Carroll – a ‘tragically conflicted man’ who was ‘by far the most eccentric of the group’ but whose ‘skill in the laboratory was undisputed’, and Carlos Finlay, the physician who the Spanish government assigned to work with the Commission, and whose theory and research on Aedes aegypti proved crucial (pages 96-101, 145-146, 154-157, 161, 164, 174, 180-195, 203-227 and 235).

Opinion

Yellow fever is one of the most dreaded plagues of mankind, and this book brings its devastation to life with striking relief. With a dramatic depiction of its human and economic costs, and of its historical legacy, the author succeeded in highlighting its deadly past and the sources of its staying power. The book’s portrayal of the work of a small group of dedicated scientists which solved the transmission of yellow fever is also a lesson in the selfless and conscientious commitment to a task that bears fruits in all scientific endeavours. The picture of yellow fever the book paints is as vivid as the portraits of the inspiring scientists who charted its life cycle.

Overall assessment

The story of yellow fever is relevant for health care because it continues to plague many areas of the world. By documenting its morbid history, the book stressed the almost uniquely devious nature of the virus. By highlighting the work of Walter Reed and his group, the book serves as an inspiration for all healthcare providers in the values of collaboration and sacrifice in the service of both science and humanity. I therefore recommend the book to all doctors.

Book details

Publisher, Place, Year:  Berkley Books, New York, 2006
Number of chapters: 27
Number of pages: 368
ISBN: 978-0-425-21775-7
Star rating: 4
Price: £11.16