Molly Caldwell Crosby

The fever attacked each person in the Angevine family, one after the other, until none were well enough to help the others. It hit suddenly in the form of a piercing headache and painful sensitivity to light, like looking into a white sun. At that point, the patient could still hope that it was not yellow fever, maybe just a headache from the heat. But the pain worsened, crippling movement and burning the skin. The fever rose to 104, maybe 105 degrees, and bones felt as though they had been show more cracked. The kidneys stopped functioning, poisoning the body. Abdominal cramps began in the final days of illness as the patient vomited black blood brought on by internal hemorrhaging. The victim became a palate of hideous color: Red blood ran from the gums, eyes and nose. The tongue swelled, turning purple. Black vomit roiled. And the skin grew a deep gold, the whites of the eyes turning brilliant yellow.

During a trip to New Orleans for a medical conference last month I and several colleagues visited Lafayette Cemetery No. 1, the city's oldest public cemetery, which has been featured in several books and movies. It contained numerous tombs from the 19th century; the one that struck me the most was the Ferguson tomb, which listed the names of three children that died on consecutive days due to yellow fever in 1878: one day old Sercy and 22 month old Mary Love on August 30, and four year old Edwin Given, on August 31.

After I pointed out the Ferguson tomb to my friends we stood in front of it for a minute in quiet reflection and mourning for the deaths of three young siblings in such a short space of time, and how it must have affected their parents (assuming that they survived the epidemic). I read more about yellow fever in New Orleans after we returned home, and learned that the worst epidemic in the United States took place in 1878, which killed tens of thousands of people in New Orleans and Memphis. I remembered that I owned The American Plague, and I made plans to read it this month.

In The American Plague, Molly Caldwell Crosby focuses on two major topics: the 1878 yellow fever epidemic in her hometown of Memphis, Tennessee, and the efforts of Dr. Walter Reed and his fellow researchers to determine the cause of that dreaded disease, risking their own lives and health in doing so.

In 1878 Memphis was one of the major cities of the southern United States, as it was a transportation hub for steamboats from New Orleans to the south and the Ohio Valley to the north that arrived there via the Mississippi River, and trains that came from all over the country. It prided itself on its diversity and rich culture, and it served as the last major southern city between the developed eastern US and the largely untamed frontier that extended from Arkansas just across the river westward to California. However, the city was also in severe financial difficulty, due to corrupt local politicians and the national Panic of 1873, which hit the South especially hard. As a result, the city was filled with thousands of people who migrated there from small towns, and the city's sanitation and water supply were public health hazards to all Memphians.

Ships coming to southern cities like Memphis, New Orleans and Charleston from Cuba and other Caribbean countries were supposed to be kept in quarantine for 40 days some distance away from the cities' ports, so that the crews could be observed for signs of yellow fever, malaria, cholera and other transmissible diseases. However, local business and civic leaders put pressure on government and public health officials to relax these standards; that, in combination with a lack of understanding of epidemic disease by medical and public health professionals, climates that were hospitable to Aedes aegypti, the mosquito that served as the insect vector for transmission of yellow fever from one person to another, and the high susceptibility of Caucasians to serious and fatal disease in comparison to people of African descent, led to frequent epidemics during the later half of the 19th century.

The 1878 yellow fever epidemic in Memphis was the worst of all, due to a combination of hot weather, frequent rains that allowed mosquitoes to breed and survive in higher than usual numbers, and a worse than usual yellow fever outbreak in Cuba. As news of the extent of the epidemic spread Memphians who had the means to do so fled the city by the thousands, decreasing the city's population from 47,000 to 19,000 in a matter of weeks. Of those who remained, 17,000 contracted yellow fever, and over 5,000 of them died. The mortality rate for whites who contracted yellow fever was approximately 70%, versus 8% for blacks, many of whom were previously exposed to the virus in the Caribbean and Africa. Those four years of age and under were particularly hard hit, including the Ferguson children mentioned above.

The author uses archived letters, books and media to provide a vivid portrait of the "city of corpses", told by nurses and doctors who tended the ill, many of whom succumbed to the plague itself. After the epidemic was finally over in autumn 1878 the city, which was the second largest in the South after New Orleans at the beginning of the year, never recovered spiritually or financially, as many of the wealthiest Memphians moved elsewhere, and immigrants from other states and countries chose other places to live.

The second part of the book describes the tireless and heroic efforts by Major Walter Reed and his colleagues in the United States Army to determine the mode of transmission of yellow fever, through experiments conducted primarily in Cuba at the turn of the century. Although it would be many years until the yellow fever virus could be identified, their work conclusively determined that Aedes aegypti was the insect vector that permitted the disease to be passed from person to person. Several researchers and soldiers died of yellow fever or were left permanently disabled by it. As one doctor wrote, "I can think of no other disease who killed so many scientists studying it."

Crosby closes the book with a brief discussion of the yellow fever vaccine and the disease, which still exists in South America and Africa. Aedes aegypti is a common species in the southern US (and I can personally attest to its presence in Atlanta), so this country is at risk for yellow fever epidemics in the future, due to easy travel, a lack of knowledge of the symptoms of the illness in nearly all US medical professionals, who have never seen a case of the disease, and the preponderance of an unvaccinated and unprotected population.

The American Plague is a superb book about the 1878 yellow fever epidemic in Memphis and the work and personal sacrifice that led to the discovery of its mode of transmission and the development of an effective vaccine against the causative virus. Other topics are only lightly discussed, such as the epidemic of the same year in New Orleans and other cities in the Mississippi Valley, which killed a total of 20,000 people, the 1793 epidemic that decimated Philadelphia, and current efforts to control yellow fever in South America and Africa. It reads like a well written novel, making it a very enjoyable and enlightening book, and it is highly recommended to all readers. show less

only tangentally about the disease itself, this reads like an ad for US Exceptionalism: there's an awful lot of breathless prose about the brave, mustached US Military doctors who bravely combed their brave mustaches while bravely investigating the disease -- and they lacked the technology to see viruses (wee smols) so this "investigation" was done via experiment, involving a lot of soldiers who might or might not have been told the truth of what was going on ... but the soldiers were brave show more and the doctors were brave and they were all American, by gum, so it's alright.

there is no good reason for this to be so staunchy USAmerican-focused -- the disease was originally African, its effects are felt in three continents at least, and Walter Reed was not at all the only doctor desperate to solve the problem ... but rah-rah-USA is a hell of a drug, and a quick route to publication, i bet.

probably deserves two stars but i'm a sucker for a mosquito show less

The thing I like best about Crosby's writing is the way she is able to make well researched facts read like the twists of a detective novel. She gave me a glimpse of what 1913 London was like on the eve of World War I.

This interesting and beautifully written book covers the yellow fever epidemic in Memphis and the efforts to figure out what was causing the disease. This brings in Walter Reed and other historic figures and ties us to Cuba in around 1900. History here is compellingly written, so it almost reads like a novel - except it is all true. The author has Memphis connections and the book definitely reads as if it were written by someone who has an emotional connection to these characters and this show more setting. Crosby weaves in a range of related historical events, and includes a chapter at the end that speculates what might happen in a modern outbreak.

Perhaps my favorite part of the book was the section that I most commonly skip or skim. The notes on each chapter at the end of the book are a fascinating glimpse into the author's mind as she worked through the detective work needed to ferret out this story. Not only did I learn about the plague, I got a sense of the effort of the author to bring me this story. show less