In late July of 1976, a number of attendees at an American Legion convention at the Bellevue-Stratford Hotel in Philadelphia suddenly fell ill with a mysterious, pneumonia-like illness that would quickly kill 34 and require over 220 to receive medical treatment.
Public health officials scrambled to identify the disease and isolate its cause, and although the malady -- quickly labeled "Legionnaires' Disease" in popular parlance -- was ultimately determined to be a non-contagious infection caused by bacteria proliferating in the condenser coils of the hotel's air-conditioning system, for several tense days the public watched with apprehension, contemplating the prospect of an un-treatable killer contagion spreading unchecked across the country on an epidemic scale. Americans had not had to confront such a thing for a very long time.
A century before, they were commonplace.
Increasingly in the 18th and 19th centuries, as the country grew, trade flourished, and population density increased, periodic epidemics struck regions of the nation. Outbreaks of influenza, cholera, typhoid, smallpox, malaria, scarlet fever, and other diseases regularly plagued the population. In the south, one of the most prevalent was yellow fever.
Yellow fever is a hemorrhagic fever whose symptoms begin after a three to six day incubation period with a fever, nausea and pain. In acute cases, a brief remission is followed by a more intense stage in which vomiting of blood accompanied by liver and kidney damage develops, followed by the jaundice from which the disease gets its name, and then, frequently, death. The cause wasn't fully understood at the time -- the rudiments of modern germ theory were just being developed in the mid-19th century -- but theories abounded. And although the actual culprit, a virus transmitted by the bite of the female Aedes aegypti mosquito, would not be positively identified for decades, many of the prevalent theories of the day pointed to causes whose remedy would, quite coincidentally, reduce breeding opportunities for the mosquito. If only one had the will to tackle them.
The Caribbean islands, Central America, and the southern coast of the United States in summer presented favorable conditions for the spread of the yellow fever. There were outbreaks most summers somewhere in the region, the only variable being how far it would spread, which could be as far north as St. Louis, New York and Philadelphia. New Orleans, with its heavy trade traffic and bayou environs, fell victim to the disease many years, opening the door to spread up the Mississippi corridor.
Memphis in 1870.
An outbreak in 1873 had spread in just such a fashion, as unseasonably warm temperatures facilitated an epidemic that reached Memphis in August when ill members of barge tow were put off in Memphis, infected members of the family who attempted to care for them, and began to slowly creep outward from that locale, then gathered momentum and spread rapidly throughout the city. Twenty thousand of the city's population of 50,000 fled the city, and of the remaining 30,000 left behind, 1,500 died of the fever.
Landing at Memphis
(image: Penn State University)
The reputation Memphis bore in those days was not a complimentary one. It was regarded as the "filthiest and most foul-smelling" city in the country; the United States Surgeon General called it "shameful and a disgrace." Built on bluffs overlooking swampy bottomlands of the Mississippi, Memphis' streets were paved -- to the extent one could call it paving -- with creosoted cedar blocks that had a tendency to rot away and leave treacherous holes in their absence that both trapped water and animal waste, and broke the legs of unsuspecting horses that stepped in them. Bodies of maimed and euthanized animals sometimes littered the sides of the roadways for days before being carted off. The city lacked any kind of sewage removal system, relying on outhouses and private services to haul off human and animal waste, with varying levels of reliability. Travelers, it was said, could tell they were approaching the city by the smell they encountered miles out. Was it any wonder that disease thrived there?
The leadership of Memphis -- civic, cleric and business -- knew they had a problem, but no one could agree what to do about it. Even in regard to the threat of epidemic diseases, the disparate elements of the city could find no point of agreement. With no agreement on what caused yellow fever, for instance, even the medical community squared off into bickering factions.
The medical intelligentsia of the time cared about the problem, but could not agree on the base cause of the outbreaks. There were a number of theories of the method by which Yellow Fever spread; was it contagious or non-contagious, or should the city take sanitary measures as opposed to quarantine. Even after the horrendous death toll of 1873 the city's leadership continued to waffle. Now, in 1878 there was a board of health with key politicians and celebrated physicians to take up the question. The two main factions of the board broke down along the existing lines. The faction led by Dr. Henry Erskine felt the disease was non-contagious. The other faction, led by Board president Robert Wood Mitchell, believing the disease was contagious, advocated quarantine and a stricter set of sanitary laws. Dr. Mitchell went before the Common Council to request funds for quarantines, but the Council rejected the request, due in part to a petition signed by 32 physicians opposing the measure. In early July Dr. Mitchell resigned from the council. Indeed Dr. Mitchell resigned as head of the Board when his suggestions regarding quarantines were ignored. In fact the quarantine would have been an effective short-term measure, but possibly onerous upon a city drained of finances by irresponsible bond issues and official corruption.
Memphis History.org: Yellow Fever
Now, in 1878, conditions ripe for the spread of yellow fever again presented themselves. With yellow fever cases prevalent throughout the Caribbean, a ten-year-long rebellion against the Spanish colonial government of Cuba culminated in the end of colonial rule in February. As a flood of refugees fleeing both the political turmoil and a yellow fever outbreak poured into, New Orleans, Congress, at the behest of the Rutherford Hayes administration, hastily enacted the National Quarantine Act of 1878, but it proved inadequate to keep yellow fever out of the city.
The Emily B. Souder arrived there in late May. One ill sailor, diagnosed with malaria, was removed from the ship. The ship was fumigated and cleared to dock in New Orleans. The night the ship docked, a crew member fell sick and died; another died four days later. When the Souder left to return to Havana, another ship, the Charles B. Woods arrived. Within six weeks every member of the families of the Woods' captain and engineer had contracted fever. They recovered, but a 4-year-old girl living in the same neighborhood died in July -- the first official fatality from yellow fever recorded that year in New Orleans.
The American Experience: The Great Fever
As the disease began to spread, a fifth of the Crescent City's population fled, leading the New Orleans Picayune, clueless to the irony, to report, "Only our mosquitoes keep up the hum of industry."
By the end of the July the fever reached Vicksburg, Mississippi and by August, Grenada, Mississippi, one-hundred miles south of Memphis, was reporting a hundred cases. As a preemptive measure, the mayor of Memphis ordered a quarantine, but the action brought objections from the city's merchants and businessmen. A lawsuit was threatened if an embargoed train of goods from New Orleans wasn't released to enter the city. The city government relented, and rail and river traffic again began to steam into the city, but train and boat crews were to remain aboard and forbidden to interact with the local population.
Memphis quarantine station on Presidents Island
In early August a steamboat crewman who had slipped the quarantine dined at a restaurant near the riverfront operated by Kate Bionda. The crewman shortly fell ill and died at a Memphis hospital, and within days Mrs. Bionda also developed symptoms and died of the disease. As news of the deaths became public, the panic set in and residents began to desert the city in droves. In short order, the population of Memphis was in flight -- at least two children were trampled to death at the railroad station in the chaos.
Memphis citizens began to flee the city in mass panic. Within about two weeks half the population of Memphis was gone or on their way. The chief route was by trains which were attaching extra cars as people stampeded one another in total surrender of civility. Schools and churches shut their doors as the city government geared up for the enforcement of quarantine measures. Quarantine facilities were set up in Germantown, Whitehaven and the main facility on President's Island. Passenger ships were blocked from the Memphis harbor, but right away passengers disembarking on the Arkansas side of the river began to ferry across despite the threat of a fifty dollar fine.
Memphis History.org: Yellow Fever
Safety patrols arresting yellow fever refugees
(Image: Tennessee State Library and Archives)
The refugees from Memphis were variously received in the places to which they escaped. Although they were taken in and cared for in many towns and cities, in others they were met with "shotgun quarantines", armed sentries -- official or vigilante -- determined that no potential yellow fever carriers would enter their cities. "Safety patrols" scoured the forests and fields looking for yellow fever refugees waiting for an opportunity to slip into town.
As harsh and inhospitable as these actions may have been, the fears of the townsfolk were not unfounded. The fleeing throngs, many already ill or exposed, spread yellow fever throughout the area to towns along the rail lines and major roads as far away as Chattanooga, and into neighboring states, spreading the disease into Kentucky, Indiana, Illinois, and Ohio. But nowhere in the nation would the effects of the epidemic hit harder than in Memphis.
Yellow fever internment camp
(Image: Dominican Sisters of St. Cecilia, Nashville)
The remaining residents -- as always, predominantly the poor without the means to flee -- were about to live their own nightmare. The fever spread inexorably through the 19,000 of Memphis' 47,000 residents who stayed behind. An estimated 14,000 of those who remained were African-American.; the whites remaining were principally Irish and German immigrants. Health officials set up tent camps designed to house a few hundred inhabitants each in an effort to "disperse" the population in an attempt to make it more difficult for the disease to spread. Some 5,000 were interred -- many willingly -- in these concentration camps, so desperate were those remaining to do anything that might aid their survival. While many doctors and nurses fled the city, a few stayed behind to treat the afflicted, and still others from around the country rushed to the city to offer assistance. Clergy, too -- those who remained -- ministered to the ill. And city officials struggled to provide needed services as the situation deteriorated.
During the first week of September the city government and Board of Health ceased to function. Among the officials stricken were Mayor Flippin and Chief of Police Philip Athey. Of the 41 police remaining in the city, only seven were fit for duty, and the Fire Department's number was cut to 13.
"One by one they fell, dying at their posts," reported Keating.
Memphis History.org: Yellow Fever
For others trying to tend to the desperately ill, the situation was not much better.
Half the population of Memphis had fled by then and rigid quarantines were imposed, but the death rates mounted. The Board of Health shot off cannons and burned pine tar (thought then to disinfect the malevolent air). At the time, it was believed that Yellow Fever was passed from person to person by contact or breath, and by contaminated apparel and bed clothing, and open privies. The streets were covered with powdered lime and sheets soaked in carbolic acid were hung around sick rooms.
The Sisters immediately noticed that this 1878 version of the epidemic was far more virulent than that of 1873. Towards the end of August the death rate was running to 70 a day. In house after house the Sisters found victims—often abandoned, alone, unconscious, and without medical care. It was impossible to find formally trained nurses. Many doctors had fled the city—as had most clergymen. Sometimes it took a police order even to get an undertaker’s services.
The Martyrs of Memphis, 1873 – 1878 (Excerpted from Stars in a Dark World: Stories of the Saints and Holy Days of the Liturgy by Fr. John-Julian, OJN (pdf)
Howard Association physician attending yellow
(Image: Tennessee State Library and Archives)
The toll taken by the yellow fever climbed to staggering proportions. Of the approximately 19,000 unable or unwilling to escape the city, eighty percent are estimated to have contracted the illness. According to one account, the epidemic killed 4,204 of 6,000 whites and 946 of 14,000 African-Americans who remained in Memphis, the latter's lower death rate owing to a greater genetic tolerance of the disease. Victims were carted to the cemetery in wagonloads to be buried, many in mass graves -- if enough able-bodied laborers could be found to dig the graves. The morbid tasks fell largely to the African-American community, so few of the white residents were unaffected by the disease.
The people who stayed behind or came to Memphis to care for those in need were not spared from the ravages of the fever. J. M. Keating's 1879 study of the epidemic for the Howard Association lists 28 physicians, volunteers affiliated with the association who came to Memphis to lend aid, who fell victim to the epidemic. An untold number of nurses, both female and male, white and black, died as well. Twelve Catholic nuns, nine priests, four Episcopalian nuns and ten Protestant ministers as well as numerous volunteer helpers succumbed to the fever.
Finally, in October, the frosts of approaching winter came, and with them -- in a well-documented, but not-yet-understood phenomenon -- the end of the epidemic.
Next week we'll conclude our look at the 1878 Memphis yellow fever epidemic with grim statistics, a response to the crisis that might make one think more of 2011 Michigan than 19th century Tennessee, innovations that are today as common as the flush of the toilet, and reforms at federal, state, and local levels that benefit us all today. Hope you'll join us next Sunday for part two.
Previous installments of How Regulation came to be: