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The Plagues Are Flying

Mosquito: A Natural History of Our Most Persistent and Deadly Foe

by Andrew Spielman and Michael D’Antonio
Hyperion, 247 pp., $22.95

No other disease—indeed, no other force of nature—did more to shape the evolution of American life than yellow fever. HIV-AIDS may, in a century or so, come to be regarded as an equal influence. But it was yellow fever that set the modern rules of engagement—emotional, political, scientific, and medical—in confrontations between disease and humankind. As is often the way with pathologies suppressed and illnesses prevented, the threat that yellow fever posed to society is now largely and happily forgotten. The apparent victory over a temporarily prevalent mosquito is part of the gilt-edged human history of the New World. Such are the repressions of memory, the distractions of the present.

The inquisitive reader is therefore forced to rely on primary sources to recover the sense of terror brought about by yellow fever in nineteenth-century proto-urban America. One example: Elizabeth Drinker, a Philadelphia Quaker born in 1734. She wrote a diary until six days before she died on November 24, 1807.1 Her chronicle of domestic living provides grisly insight into the drama of yellow fever in America’s then most significant city.

The fever first struck Philadelphia in 1699. In September 1762, Drinker noted its comeback: “A Sickley time at Philada. many Persons are taken down, with Something very like the Yallow-Feaver.” During the frequent epidemics of the 1790s, she called part of her diary the “Book of Mortality.” In 1793, for instance, she described “an unusual number of funerals,” the escape of families as the “fever prevails in the City,” and the burning of tar in the streets to ward off disease. Five thousand people died during that single outbreak, 10 percent of Philadelphia’s population. Drinker recounts stories of harrowing tragedy:

…G Hesser told a sad story, of Robt. Ross Broker that he died in the night of the Yallow fever, no Body with him but his wife who was taken in labour while he was dying, she opend the window and call’d for help, but obtain’d none, in the morning some one went in to see how they fair’d, found the man and his wife both dead, and a new born infant alive….

The number of dead exceeded all expectations. In September 1793, Drinker reported:

…it is said that many are bury’d after night, and taken in carts to their graves…. we have also heard to day that the dead are put in their Coffins just as they die without changing their cloths or laying out, are buried in an hour or two after their disease…. Coffins were keept ready made in piles.

The marks of these epidemics have been erased from the city’s public exterior. When I was there recently the only visible memorial—pointed out to me by an elderly man sitting beneath the Bicentennial Bell—was a U-shaped depression in the ground beside Carpenters’ Hall. An old sewer. And this for an epidemic about which, during fierce public petitioning for George Washington to declare war in support of the French Revolution, John Adams claimed that “nothing but the yellow fever…could have saved the United States from a total revolution of government.”

1.

Yellow fever is caused by a virus transmitted to human beings in villages and towns by a delicate-looking mosquito called Aedes aegypti, although the connection between mosquitoes and the fever wasn’t established until 1900. When the yellow fever–infected mosquito enters a human settlement, outbreaks of disease tend to be explosive—and mortal. An epidemic in Ethiopia between 1960 and 1962 killed as many as 30,000 people. The disease itself is particularly horrible. Illness begins abruptly with fever, headache, and muscle pain. The victim is extremely ill with bleeding and violent episodes of vomiting. Within a few days, the pulse slows, blood pressure falls, and the kidneys fail. Blood oozes from every tissue surface. When the infection is severe, half of those affected die.

Margaret Humphreys, a respected historian of science, has shown how the human slaughter brought about by yellow fever almost by itself precipitated the creation of important US public health institutions, including the US Public Health Service, which was set up, Humphreys argues, largely in response to yellow fever’s effects on American commerce.2 Each epidemic in the nineteenth century—and New Orleans took the brunt of the disease—“stopped trains and bottled up ports, keeping cotton from the mills and preventing the movement of basic merchandise from distribution points in cities to the countryside.” Boards of health were set up to combat yellow fever’s threat. Thus,

Yellow fever was crucial to the expansion of federal public health involvement in the late nineteenth century, largely because, unlike any other disease that steadily afflicted the country, it was fundamentally a national problem.

In her powerful and original analysis, Humphreys tried to lay down universal criteria that any new health threat must meet in order to command serious political attention. Her conclusions remain relevant today. The theory surrounding the disease, she writes, should be agreed upon by scientists; proposed intervention measures should be affordable; the rights of citizens should be disrupted only minimally by those measures; the risk of disease should hang over a substantial proportion of the population; and the actions to be taken must be understandable and acceptable to the public. A public health movement arose in response to yellow fever. The Public Health and Marine-Hospital Service—marine hospitals were responsible for the seamen’s well-being—was finally enacted into federal law in 1902. The disease was extinguished from North American shores by 1905.

Yellow fever also galvanized an unusually public debate about the epistemology of disease. The issue mattered because of a prevailing medical view that the yellow fever epidemic of 1793 had been imported from the West Indies. If correct, extensive quarantine measures at ports and in major cities would have been the only means of future protection. Such interventions would have seriously damaged expanding but fragile commercial networks. The dispute could not be left to sterile musings within the salons of academic medicine. Instead, Noah Webster, lawyer, journalist, lexicographer, and the first historian of epidemic diseases, took the debate out of doctors’ hands and made it a public issue. He pieced together information from medical and philosophical societies to construct a new theory to explain yellow fever as depending “wholly on the constitution of our own atmosphere,” and perhaps most of all on “the poisonous acids, extricated from every species of filth in hot weather.”

As a layman with extraordinary forensic skills, Webster challenged physicians of the time—in particular, Dr. William Currie of Philadelphia, a man described by Dr. Benjamin Rush as “the oracle of our city upon the subject of yellow fever.” Webster set out his contrary ideas in twenty-five letters published in the New York Commercial Advertiser in 1797.3 It is one of the earliest and most important examples of investigative journalism provoking discussion about a subject of crucial civic and public health significance.

One freakish modern branch of this history concerns American enthusiasm for yellow fever as a biological weapon. In now declassified government documents, a glimpse can be had of the US biological warfare program between 1945 and 1960.4 Yellow fever, together with its urban mosquito vector Aedes aegypti, was a great military hope. Work began on offensive mosquito strategies in 1953 at Camp Detrick. The advantages of a mosquito attack were plain—the virus is injected into the human body directly; as long as the mosquito is alive, the release area is dangerous; there is no known cure for yellow fever; the population of the USSR would be highly susceptible; and vaccination programs would be impossible to organize quickly enough. In 1956, field trials using uninfected mosquitos began in Georgia and Florida. These insects were good carriers: mosquitos spread over several square miles. Fort Detrick could produce up to half a million mosquitos each month.

Part of this early work was completed by Dr. Lewis Gebhardt, a scientist at the University of Utah. Together with colleagues elsewhere, Gebhardt defined the requirements for a successful urban yellow fever attack. His team studied the advantages and drawbacks of several mosquito species, the complexities of Eurasian meteorological conditions (notably around Moscow, Stalingrad, and Vladivostok), and the defensive capacities of these regions, and they appraised plans for mosquito attack. Their analyses were followed by Project Bellwether and Operations Big Buzz and Magic Sword. Bellwether, conducted in 1959 and 1960, centered on studying the biting potential of starved female mosquitos at various distances, wind speeds, temperatures, and humidities, together with experiments in several simulated urban settings. Big Buzz set out to assess the feasibility of mass production of mosquitos and their use in munitions. (In these documents, China crops up as another US target.) Magic Sword took Bellwether a step further by detailing precise attack rates per thousand mosquitos released. President Nixon eventually terminated US research into offensive biological warfare in 1969.

In Mosquito, Andrew Spielman, a distinguished Harvard investigator into mosquito-borne diseases and a professor of tropical public health, summarizes the history of yellow fever’s discovery and the complex interplay of Cuban and American scientific rivalry that tied the infection to the Aedes species. After twenty years of research and debate between scientists in Havana and Washington, D.C., it fell to Walter Reed in 1900 to announce yellow fever’s true source of transmission. (The virus was eventually isolated in 1927.) A century later, as Spielman notes ruefully, “after a person is infected, there is little even today that physicians can do.” Indeed, as the Ethiopia epidemic underlines, there was a fatal slackening of interest in yellow fever during the twentieth century, so much so that only in 1983 did the World Health Organization gather yellow fever experts together in Dakar, Senegal, to reach a consensus on how to deal with this emerging global menace.5

Since 1983, yellow fever has ignored the efforts of these scientists. In Africa, almost five hundred million people live at risk for the disease. The virus is endemic in nine South American nations, including much of Brazil, Venezuela, Colombia, Peru, and Bolivia. And the threat is spreading. Yellow fever epidemics are occurring more frequently and the numbers of mosquitos are increasing. A yellow fever outbreak occurred in Kenya for the first time in 1992.6 The worst outbreak in Brazil during the past twenty years took place in 1993. Yellow fever reemerged in Senegal in 1995. And the first instance of urban yellow fever in the Americas for half a century was described in 1999.7 WHO again convened its expert forces in 1998 to examine why the disease was reemerging.

The reasons are twofold. First, the relation between human settlements and the forests from which yellow fever emerges is changing fast. In the Kerio Valley, where the Kenyan epidemic began, a road had recently been cut through the bush. Opportunities for mosquitos to be transported out of the valley, or for humans to come into the region at risk, have widened significantly. With high birth rates in many of these regions, forests have been destroyed to make way for human habitation, thereby opening up new contact points between susceptible humans and virus-loaded mosquitos.

  1. 1

    See The Diary of Elizabeth Drinker, edited and abridged by Elaine Forman Crane (Northeastern University Press, 1994).

  2. 2

    See Margaret Humphreys, Yellow Fever and the South (Rutgers, 1992). In Malaria: Poverty, Race, and Public Health in the United States (forthcoming in September from Johns Hopkins University Press), Humphreys traces the influence of malaria, another mosquito-borne disease, on American life.

  3. 3

    See Noah Webster, Letters on Yellow Fever Addressed to Dr. William Currie (Johns Hopkins University Press, 1947).

  4. 4

    See Alastair Hay, “A Magic Sword or a Big Itch: An Historical Look at the United States Biological Weapons Programme,” Medicine, Conflict and Survival, Vol. 15 (1999), pp. 215–234.

  5. 5

    See Prevention and Control of Yellow Fever in Africa (World Health Organization, 1986).

  6. 6

    See Eduard J. Sanders et al., “First Recorded Outbreak of Yellow Fever in Kenya, 1992–1993,” American Journal of Tropical Medicine and Hygiene, Vol. 459 (1998), pp. 644–649.

  7. 7

    See P. van der Stuyft et al., “Urbanisation of Yellow Fever in Santa Cruz, Bolivia,” The Lancet, Vol. 353 (1999), pp. 1558–1562.

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