The American Plague: The Untold Story of Yellow Fever, the Epidemic that Shaped Our History - Molly Caldwell Crosby (2006)

Part II. Memphis, 1878

Chapter 3. The Doctors

The sweet scents of honeysuckle, overripened fruit, and fresh-cut hay distracted from the fecund smell of the living body of water coursing beneath the bluffs of Memphis. Crape myrtle bloomed around the marble fountain in Court Square. Geraniums, roses and lilies bejeweled the park, and magnolia limbs bowed under the weight of the dark, glossy leaves. Throughout the park, the calls of the bootblacks offering shoeshines could be heard, and cicadas hummed from the treetops.

Early in the morning, before the haze of summer humidity settled over the town, the voice of the milkman resounded: “Wide awake,” “All alive, now!” The ice wagon rattled up Second Street, while the produce stands opened in front of the public offices and dry-goods stores on Main. Dust, mud and manure along the bustling thoroughfares necessitated that even the most well-bred lady wear rubber Wellingtons downtown. Nicholson wood-plank sidewalks, which had been rotting for ten years, were piled high with crates where newsboys sat shouting headlines.

When the summer heat arrived early, as it did in 1878, it was known as yellow fever weather. Memphians passed one another downtown with nervous glances, their eyes averted beneath cotton bonnets and straw hats. Few uttered the words “yellow fever,” but the fear of it suffused the still air nonetheless. In addition to the early arrival of summer, the high temperatures and little rainfall had produced a drought, draining the Mississippi River down to the hardpan. Green lawns lush from the surplus rain in months past turned as brown as prairie grass, and water wells dried up. The scant rain had left no natural way to wash sewage from the dusty Memphis streets, and bloated, dead animals rotted in the shallow pools of refuse; the city had no money to remove them. Finally, rumors of a yellow fever epidemic in New Orleans spread up the Mississippi Valley, and in Memphis, the talk of fever consumed conversation like brushfire.

Yellow fever answered to many different names, including yellow jack, coup de barre (blow of the rod), vomito negro (black vomit), the saffron scourge and the American plague. Regardless of what it was called, yellow fever, elusive and terrifying, remained a mystery to medical minds during the nineteenth century. Disease in general was an enigma, medicine still in its infancy. By the 1870s many doctors received no formal medical education, instead receiving their knowledge through a type of medical apprenticeship with local physicians or during the Civil War. The medical programs that did exist at places like Harvard and Yale had no admissions program, performed few autopsies, did not even own microscopes. While Europe excelled in its medical research, American institutions placed almost no value on evidence-based medicine. To them, the body was a balanced system, and their work focused on treating the occasional imbalancewith lancet bleeding, leeches, castor oil and even arsenic at times.

To make matters worse, a thin line existed between medicine and religion. Newspapers smacked of advertisements for medications like Tutt’s pills, which could cure everything from wind colic to low spirits, and were “Recommended by physicians. Indorsed by Clergy.” The physical body was the realm of the Almighty, so knowledge of its inner workings through autopsy or examination was like trespassing. From the pulpits people were often told that epidemics, plagues, resulted from wicked ways and intoxication. And, in reality, there might have been some common sense to it considering venereal disease was one of the largest health concerns of the day; a number of doctors even specialized in these private or secret diseases. Very little connection had been made between filth and disease, so amid this near witch-doctor approach to medicine, cities remained baffled by cholera epidemics as they drank from the same sources in which they dumped sewage. The germ theory would soon change all of that, but in Memphis in 1878, sanitation, like immoral behavior, was still just one in a number of guesses as to what caused and spread disease.

Doctors relied on two prevailing theories about yellow fever: One camp believed it was mysteriously spread by filthy conditions much like cholera and dysentery. Terms like fomites, effuvia, and noxious gases peppered medical literature in an attempt to explain what substance—whether animal matter, fungal or gaseous— spread the disease. The other side held that the fever was imported each summer into the city by railroads and river traffic. Not sure which would prove to be more effective, Memphis health officials decided to tackle both problems.

In the summer of 1878, the Board of Health secured $8,000 in city funds to clean up the foul city, investigating cisterns and outhouses.Wayward goats and hogs were impounded. Regulations for the disposal of animal carcasses were strictly enforced. Regardless of their efforts, over 70 percent of the city’s dwellings were wooden and prone to rotting. When it rained, basements flooded, holding several inches of water, while the walls wept polluted mud. The Nicholson paving continued to decay, and the city’s water, though routed through the pumping station, came from the Wolf River. Even milk, under no inspection, was diluted with river water, and it was reported that one person found a minnow in his milk jug. The biggest problem was that of raw sewage and privies. Like all other densely populated cities, there was no effective way to remove waste. Citizens in downtown Memphis carted and dumped their privies into the river, and over half of the city’s privies were located fifty feet or less from drinking wells. One authority would call privies the “most annoying problem connected with urbanization.”

Nonetheless, as yellow fever season loomed, one newspaper column read, “Memphis is about the healthiest city on the continent at present,” and another bragged, “We need not fear in Memphis. We were never in as good a condition from a sanitary point of view . . . Nothing in our atmosphere invites that dread disease.” In the greater scheme of things, from political neglect to public apathy, the city of Memphis was due a tragedy, though no one seemed ready to acknowledge it.

The war on disease was a two-front campaign. Despite all their efforts, the Board of Health had failed in their campaign to clean the filthy city. They turned now to the issue of quarantine.

Quarantine had been a regular measure for preventing disease as early as the biblical lepers, but it was most widely used beginningwith the bubonic plague in fourteenth-century Venice. Ships were forced to spend weeks anchored outside of a city until the crew showed no signs of disease among them. Vessels and their cargo were initially intended to spend thirty days—trentina—in the harbor, but that later changed to forty days—quarantina. Quarantines continued to rule maritime travel well into the nineteenth century, finding even greater cause with the trafficking of human cargo. European ships often spent weeks moored off the coast of Africa before crossing the Atlantic. Fever was so prevalent among the crews that one island, São Tomé, was known as the Dutchman’s graveyard. And the tale of the Flying Dutchman is thought to be the story of a yellow-fever-infected ship repeatedly denied port until all on board perished of the fever, and the ship was forced to sail endlessly, manned by a ghost crew, delivering detriment to other seafaring vessels.

Quarantines were not limited to maritime trade, however. In America, trains and paddleboats could also be quarantined to prevent smallpox, plague and fevers. Even returning soldiers were quarantined in camps. And once a city was known to harbor infectious disease, the town itself could become quarantined from the rest of the nation. Fleeing citizens were denied entry into healthy cities. Even Alexander Hamilton came down with yellow fever and was refused entry into New York City. He found refuge in the country until he recovered.

By the mid-nineteenth century, merchants and businessmen were becoming frustrated by the practice of quarantine, which proved more effective in preventing the delivery of goods than disease. Port towns in particular had become lax in their quarantine measures, yielding to commerce. On April 29, 1878, Congress had finally passed the Quarantine Act granting the Marine Hospital Service quarantine rights along port cities. If local governments could not be depended upon to enforce quarantine, the military could. The law, however, was a weak one and would take several months to go into effect. For the Mississippi Valley and beyond, the delay would prove to be disastrous.

In what would become known as the “war of the doctors,” the leading medical minds in Memphis debated quarantine. Dr. Robert Wood Mitchell was forty-seven years old, his white goatee brushing against a stiff, detachable collar and black bowtie. Mitchell had served as a division surgeon in the Confederate Army of Tennessee, and he wore the terror of that war in lines that feathered from his eyes and brow. Mitchell was described as “marvelously tender and sympathetic,” as well as “born to command . . . so great is his power and influence over men.” But it was an unassuming influence. If men followed him, it was because of his unclouded allegiance to serving—whether in battle, medicine or tragedy—rather than a charismatic personality. After the war, Mitchell returned to Memphis where he married an Irish woman and set up his practice Mitchell and Maury. He earned a reputation for excellence in his field, and in March of 1878, one week after the Mardi Gras festivities came to a close, Mitchell was appointed president of the Memphis Board of Health.

The board consisted of three doctors, the chief of police and Mayor John R. Flippin. In early July, the five men met to discuss how to deal with the 1878 epidemic season. As they opened windows to give way to the breeze and paced on plank-board floors, the hot season was upon them: Heat lightning cracked the nighttime sky, sermons were shorter on Sundays, and the picnic season had been declared officially over. Ice-cold buttermilk had become the fashionable drink. Watermelon, cantaloupe and peaches softened and seeped from crates at the fruit stands. Corn was on the silk, and advertisements for refrigerators, ice chests and coffins filled the pages of the newspapers. It was also noted in the paper that “Mosquitoes are increasing in numbers, and are becoming more vindictive and ferocious, if it were possible to do so.”

Mitchell called his meeting to order. He was a quiet man, a listener who rarely spoke unless he had something important to add to the argument. He had already appeared before the local council in June to formally request additional money for sanitation and quarantine as the epidemic season approached. His request was denied. A staunch believer in annual quarantine during the summer months, Mitchell then appealed to his own board for quarantine. The majority voted yes; but the two other physicians on the board voted no.

Dr. John H. Erskine listened to Mitchell’s pleas. Erskine was a commanding presence, standing at an unusual six feet tall. His close-set, pale eyes and fair skin glowed against black-blue waves of hair and a long, dark goatee. Erskine’s height coupled with his striking appearance gave him an air of leadership; he was used to people not only taking notice of him but listening to him. A highly educated and ambitious surgeon, he excelled during the war and later as the health officer of the Memphis Board of Health during the 1873 yellow fever epidemic. During that epidemic, Erskine had even noticed an unusual occurrence: The prison where he often worked reported only two cases of the fever. The fifteen-foot-high prison wall, Erskine noticed, had somehow barred the fever from entering.

Still, as Erskine listened to Mitchell’s pertinacious pleas, he did not believe the rumors from New Orleans warranted such drastic measures. Quarantine, after all, would create panic, stifling river traffic and delaying cotton shipments. It was not even a proven method of protection against the scourge. Erskine spear-headed a petition, signed by several prominent physicians and published in the newspaper, overturning the vote for quarantine.

It brought the battle to the public. Angry letters to the Memphis Appeal asked, “Is it not better to expend a few thousand as a safeguard than to lose millions by the disastrous effects of yellow fever, besides the thousands of valued lives that will have passed away?” The paper followed with an editorial: “Should an epidemic reach Memphis this year those who opposed the establishment of a quarantine will be held responsible.”

It is impossible to know what went through Mitchell’s mind at that moment, frustrated by his own board and fed up with city officials. On July 11, Mitchell resigned from the Board of Health, and in spite of a 400-person petition in support of him, Mitchell would not change his mind. To replace him, the mayor instated Dr. Dudley Saunders, who saw no need to quarantine the city and choke river traffic.

The Memphis Appeal published a letter from Mitchell in which he explained his resignation to the people of Memphis: “I may add that at present I see no cause of danger from yellow fever; but we saw none in 1873 . . . It is my earnest and honest conviction that should we ever have yellow fever again, it will be our own fault in not taking the known necessary precautions against it.”

In the coming weeks, both Mitchell and Erskine would think back to their initial actions and that fateful vote—one would survive and one would perish in the consuming epidemic. The “war of the doctors” had been a futile skirmish, waged too late to be effective. Unknown to any of them, the fever had already taken its first victim in Memphis.

The Appeal also published an editorial in favor of Saunders: “The public will hail his appointment with satisfaction and feel assured that with him and Dr. John Erskine . . . all will be done that can be done to keep our city free from epidemic disease.” On that very day, national news of yellow fever in New Orleans finally prompted the Memphis Board of Health to reconsider their long-argued decision and establish quarantine. Mayor Flippin assigned a physician, one who had signed the petition against quarantine, to the quarantine post on President’s Island in the Mississippi River. It was July 27.

Police with shotguns stood along the train tracks of the Mississippi and Tennessee railroads at Whitehaven Station, eight miles outside of the city. The Charleston railroad at Germantown, a good twelve miles away, was quarantined. Cotton, sugar and coffee shipments were held, and all river ports closed with posted shotguns, citizens, believing as they did, that firearms and willpower might be enough to barricade disease.

The board resolved to meet every Monday night at 8:00 during the yellow fever excitement, and Dr. Erskine would purchase barrels of Calvert’s No. 5 carbolic acid to use as disinfectant. Nonetheless, the quarantine did little to ease the minds of the people. Restless in the quiet before the storm, Memphians seemed to feel the epidemic long before any confirmed cases of disease surfaced. Bank accounts were cashed out, letters were written to relatives in other cities announcing plans to visit, businesses kept shorter hours. The heat always made it difficult to sleep, but now worry added to the collective insomnia. Even the animals furthered the subtle sense of hysteria. Throughout the town, people noted that pets and farm animals had been running away; the birds had stopped chirping. The only life-forms unfazed were the unusually high number of striped house mosquitoes.

July had also been a month of exciting, if not strange, occurrences. First a well-known citizen had been crushed beneath a streetcar amid all the celebration and festivities on July 4; another had been struck by lightning just a week later. Streetlamps explodedand caught fire, while mules fell dead of heat stroke in the fields. Citizens gathered downtown to listen to a technological breakthrough, the Edison speaking phonograph. Then, it was reported that a five-and-a-half-foot rattlesnake had been killed in Memphis. The strangest of all, however, was the approaching solar eclipse. In a fit of brevity, there had even been two new cocktails created that July—one was called the Quarantine, the other the Eclipse. The Quarantine, it was said, would isolate and insulate from all other drinks; the Eclipse would shut out what your neighbors are taking in theirs.

For those who followed the stars, the solar eclipse would occur during the constellation Ophiuchus, the serpent carrier, and the little-known thirteenth zodiac. Ophiuchus is the only constellation based on a real man, a doctor who lived in ancient Memphis, Egypt, and a solar eclipse under his sign was said to bring disease and struggles between life and death. Another solar eclipse happened under his watch in Philadelphia in 1793 just before an outbreak of yellow fever. That epidemic, one historian wrote, “ushered in the longest and deadliest string of yellow fever years yet known in North America.”

On the afternoon of July 29, Memphians braved the ninety-degree heat to stand in the streets and along the bluffs at 4:28 in the afternoon. They held opera glasses and smoked glass heavenward and watched the moon cross the sun. An onyx sphere crept partway across the bright light, and to the spectators on the bluffs of Memphis, there seemed little question as to which was stronger as the dark eclipsed the light. It was like dusk had suddenly descended upon the city.

When yellow fever first arrived on the streets of Memphis, it did so silently. On July 21, a man arrived off of a riverboat to visit his wife who worked as a cook at 279 Second Street. The Victorian home was the downtown residence of Attorney General G.P.M. Turner. The man fell feverish, but soon recovered. Ten days later, Turner’s two children burned with fever. One survived, the other died.

July 25, Willie Darby, an employee of Farrell Oysterdealers who lived at 277 Second Street was taken with a fever and soon recovered. Though no doctor confirmed it, Darby’s was the second known case of yellow fever in July of 1878.

Other unconfirmed cases along Second Street surfaced, and Memphis police learned that travelers had evaded quarantine in South Memphis, a suburb that had recently been incorporated, slipping by night into the unguarded yard of the gas works.

Then, the plague-stricken steamboat John D. Porter passed upriver with her tow at the end of July. Crowds of Memphians, who had heard that the John Porter carried yellow fever from New Orleans, gathered along the river to watch it approach their city. Dr. John Erskine was called in under the laws of quarantine. He rode a tugboat across the river and boarded the ship. The captain, denying any cases of yellow fever, reported that four men had died and one crewmember was sickly from sunstroke. It is unknown whether or not Erskine saw any of the dead crewmembers, nor if he saw any obvious signs of yellow fever on board. What is known is that the suffocating confines of the cabin made it easier to blame the deaths on overheating. The John Porter was asked to bypass Memphis, and the towboat would continue up the Mississippi River, spreading yellow fever all the way to Ohio, where its crew finally abandoned the cursed boat.

On August 1, the steamer Golden Crown landed three feverish ladies on the banks of Memphis. The same week, the newspaper reported, “The city is quiet and yellow fever rumors appear to have abated . . . This should effectively dispose of the tale circulated by sensationalists about the presence of yellow fever here.”

In hindsight, it seems negligent that the board and the press would be so quick to dismiss the possibility of another epidemic. Epidemics hit in 1867 and again in 1873, the latter taking 2,000 lives in Memphis. But it also proves true of the time period, one in which men began to see themselves as governing over nature itself. Hubris abounded. And as was the case with most American cities, civic and business leaders alike looked more at commerce and industry, new roads and railroad tracks, than at sanitation or poverty-ridden districts. A New York Times columnist writing of the devastating epidemic in the South editorialized, “It would have been only necessary for the deadly germs to get abroad in one of our filthy tenement house districts to spread terror and dismay and defy all human efforts to exterminate it.” In a struggling city like Memphis that depended heavily on river traffic, another epidemic, or even word of one would be costly. The board unanimously promised, however, that should symptoms of yellow fever arise, they would make no attempt at concealment.

On August 1, a man named William Warren, a deckhand from the Golden Crown, landed in Memphis and visited an Italian snack shop in the Pinch District. Named for the “pinch-gut” appearance of its hungry Irish immigrants, the Pinch was the closest neighborhood to the river, wedged between the Wolf River and the Gayoso Bayou. Here, the river traffic congregated, and it was not uncommon to hear drunken laughter and the roll of bone dice. Gambling, prostitution and drunkenness flourished. The next morning, William Warren grew feverish. Dr. Erskine was notified once again and admitted the man to a quarantine hospital on President’s Island where he died three days later of fever. Though yellow fever proved hard to distinguish from other tropical diseases at its onset, it was unmistakable at the time of death. The deep yellow skin appeared like tarnished brass, marred by violet-colored spots. Still, Warren’s case never went on record.

The first case to go on record for the public was not for twelve more days when Mrs. Kate Bionda, owner of the Italian snack house Warren had visited, died of the fever on August 13. Hers was officially reported by the Board of Health, on August 14, as the first case of yellow fever in the city. Bionda’s shop, a clapboard shack reeking of fish and catering to the river traffic in the Pinch, was fenced in, blockaded. All adjacent buildings were disinfected. The body of Mrs. Bionda was burned within five hours of death. On that day, the Appeal published a warning: “The sad case of Mrs. Bionda, who left two little children and a grief-stricken husband, does not prove necessarily that others will follow. There is no need of a panic or stampede.” Only two cases of yellow fever went on record that day; at least twenty-two cases existed.

YELLOW FEVER IN MEMPHIS flashed across telegraph wires nationwide. It would chill residents from New York City to Philadelphia to Charleston and every town, small or large that fed from the Mississippi River.

The same trains and steamboats that brought thousands into Memphis for Mardi Gras that spring now carried away over 25,000 Memphians, more than half of the population, in a span of five days. In mass exodus, the rich fled by train, carriage, or boat, leaving dinner tables still set with silver and doors wide open. Traffic clogged the roads, and dust sprayed in the wake of carriage wheels. At the depot, ticket sales in one line alone exceeded $35,000. Platforms were piled high with trunks, suitcases and furniture. In an age of honor and Victorian manners, people trampledover one another. As one man commented, “For the sake of humanity, men became inhuman.”

The city collapsed, hemorrhaging its population, its income, its viability. Trains pulled away, leaving people weeping beside the tracks, their last chance at escape gone as the final train cars rolled to a start. A morbid calmness fell over Memphis, so still and quiet as to be serene if one didn’t know it was simply the pallor of death. In July of that year, the city boasted a population of 47,000. By September, 19,000 remained and 17,000 of them had yellow fever.

Once free of the city, Memphians did not fare much better. Nearby farmers locked their gates and doors, with shotguns ready. Public roads were wrecked and bridges burned to prevent travel. Many cities and towns refused admittance in fear of the dreaded fever. People were crowded into train cars with no food or water, the smell of sulfur still fresh on their shoes. A man jumped off a train to fill a bucket with fresh water at one stop. He sold the precious commodity to passengers for one dollar a cup at a time when a dollar was considered a decent day’s wage.

One train sent a message to the nearby town of Milan for food and water. The townsfolk set up tables of food and tubs of water along the river bottom, four miles outside of town limits. The people gathered on a hilltop a mile away and watched as the men, women and children released from the train cars ran toward the provisions. Then, guards with shotguns herded the Memphians back into the suffocating train cars. Those were the lucky ones. Left behind in the ruined city were the poor, the sick and the dead.

Immediately, a Citizen’s Relief Committee, headed by Charles G. Fisher, convened in the Memphis opera house. Since most wealthy city officials had fled, ordinary citizens took up the call. Their first priority: to get the poor out of the city and organized in refugee camps. Already, families sought out chicken shacks and abandoned slave quarters throughout the countryside. The committee turned every stall and booth of the county fairgrounds into shelters. It was said that the flutter of canvas could be seen on every grove in Memphis.

The Howard Association, formed specifically for yellow fever epidemics in New Orleans and Memphis, organized nurses and doctors. They asked Dr. Robert Mitchell, newly resigned from the Board of Health, to be medical director. He accepted the position in what must have been a state of despair. Mitchell had known this would happen; he had seen it coming and could do nothing to stop it. His fate, it seemed, would be fixed to this fever.

Amid shimmering light and supple breezes on August 23, the Board of Health finally declared a yellow fever epidemic in Memphis. It was two months after Mitchell’s ill-fated battle for quarantine; one month after the fever’s first victim.