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

Part II. Memphis, 1878

Chapter 6. Greatly Exaggerated

President Rutherford B. Hayes continued to receive word of death and loss at the White House. The 1878 epidemic had stretched from Brazil to Ohio. In the following months, the final death toll in the Mississippi Valley would prove to be 20,000 lives and the financial loss close to $200 million. Two hundred communities in eleven states had been hit by the fever. It was a bitter piece of news. Not only was the 1878 yellow fever epidemic one of the worst disasters to befall the country, but it happened under Hayes’s shaky command. “It is impossible to estimate with any approach to accuracy,” announced Hayes, “the loss to the country occasioned by this epidemic.”

Surely Hayes was also stirred by an unspoken sense of guilt when he thought of his dismissive letter in August; he had called the Memphis pleas for help “greatly exaggerated.” The toll on human life in Memphis alone surpassed the Chicago fire, San Franciscoearthquake and Johnstown flood combined. It was being called by some the worst urban disaster in American history. Over 5,000 lives were lost in Memphis, nearly a third of the population that remained in August of that year.

President Hayes contemplated his next course of action. Politically speaking, he knew he needed to act authoritatively and quickly. His recent election had been fraught with controversy between the North and South. He had taken office only by assistance from the National Guard and a promise to withdraw federal troops from the South. His liberal views on the rights of blacks further united his enemies in the South. His only allies in that region had been the businessmen and merchants looking to profit from reconstruction, and now, their economic viability would certainly be at stake. On the brink of the 1878 epidemic, the Memphis Appeal had published a column entitled, “Poor Hayes: The Republicans hate and mistrust him; and the Democrats, knowing he occupies a position to which another was chosen by the people, have no respect for him.” A country not at all secure with his leadership was looking to Hayes for healing.

With Congress out of session in August of 1878, H. Casey Young, the congressman representing Memphis, had appealed to Hayes on behalf of the stricken city not only for relief aid but for a committee of experts to investigate yellow fever once and for all. But the president, one historian wrote, “was not in a position to commit the recessed Forty-fifth Congress to financial sponsorship of an investigation.” It would not take long, however, for the epidemic to demand the attention of the U.S. government and launch it into a controversial, public debate over the national health system.

In November, Hayes called his cabinet together to assess the situation; federal response had been slow. In the south, the dead were still rotting unburied in cities and farmlands. Thousands of people had been displaced and collected in camps, waiting for food and supplies. The entire cotton market had been injured. The first action would be to declare a state of emergency in the Mississippi Valley. Charities and state governments could be depended upon to rally support, as well as deliver supplies and wooden coffins. Already, $1 million in aid had gone to Memphis from every state in the union and overseas. Towboats barreled down the Mississippi River carrying over 333,000 pounds of beef, 23,000 pounds of crackers, close to 33,000 pounds of coffee and 200 gallons of whiskey. Train cars full of wooden coffins pulled into the Poplar Street station.

What Hayes needed was a way to comfort the minds of the people, to offer some sense of protection against a tragedy like this in the future. He needed a united force of experts and physicians to not only reassure the people but also actively work to prevent and manage epidemics. The country needed a federal board of health.

In the weeks that followed, a battle would ensue between the American Public Health Association and the Marine Hospital Service, which would later become the Public Health Service. The two agencies, each under the helm of an ambitious, headstrong leader, would fight for dominant control of American health. It also became the familiar battle of federal versus state rights, an echo of pre-Civil War debates. This time, however, southern politicians argued vehemently for federal control of quarantines, while northern owners of those railroads and shipping lines shouted for state control. After all, on a local level, states would be unlikely to risk their own economy with quarantine, much less the financial stability of northern-owned transportation. That very problem had arisen during the 1878 epidemic: New Orleans officialslike Samuel Choppin believed strongly in a quarantine against infected ships arriving in New Orleans; but, once yellow fever was present, city officials refused to tell the rest of the country for fear of being quarantined themselves. A reporter for Harper’s wrote in December of that year, “No question in medicine, and scarcely any in theology, has been debated more learnedly and more ardently—I may say, indeed, more furiously— nor for a longer time, than this one.”

After weeks of investigation, no new medical information was available, and the country was no closer to solving the yellow fever mystery. Instead, the entire issue had been overshadowed by partisan politics and backbiting. Only one resolution seemed to please everyone, and that was the formation of a legislative committee, a joint committee represented by both the Senate and the House, to investigate the epidemic further. The Board of Experts would be led by Surgeon General John M. Woodworth, head of the Marine Hospital Service. Fifteen doctors were appointed to the board. Several came from New Orleans and other cities in the South, but also from New York, Philadelphia, Albany and Cincinnati. This was a disease, after all, that had at one time or another affected the whole of the country. Only one doctor had been chosen from Memphis, Tennessee: Dr. Robert Wood Mitchell.

Dear Sir:

I am authorized by the Committees of the Senate and House of Representatives on Epidemic Diseases to advise you that you have been elected a member of the Yellow Fever Commission of Experts, with compensation at the rate of “ten dollars per day and actual expenses while on duty.”

You are respectfully requested to attend a meeting of the Commission to be held in the city of Memphis, Tennessee, on Thursday morning the 26th instant.

Very respectfully, 
John M. Woodworth 
Washington City, Dec. 19th, 1878

It was December when Mitchell received his telegram, and he was undoubtedly aware of the quarantine debate in Washington, though in Memphis, politics seemed inconsequential to the shell-shocked city. With the dead buried barely a foot beneath the surface, the town still felt like a crypt. Families returned to find homes ransacked, city blocks burned and loved ones buried in the mass graves pockmarking the cemeteries. It seemed the smell of death would never leave Memphis.

Mitchell found little comfort in knowing that he had been right, that an early and efficient quarantine might have prevented over 5,000 deaths. His own Board of Health in Memphis, the one from which he resigned, had been hit severely. Two of its members had been stricken with fever, including the mayor, another board member buried his son, and Dr. John Erskine, Mitchell’s nemesis in the struggle, had himself perished of yellow fever. As an army surgeon, Mitchell was precise and objective; he applied his skill to repairing tattered bodies. As the leading obstetrician in Memphis, his work had turned toward delivering new lives. Mitchell’s experiences had done nothing to prepare him to watch, unable to help, as so many of the children he delivered, in addition to women and men, friends and colleagues, died.

The first proceedings of the Board of Experts would take place in December 1878, in Memphis, Tennessee. It was a pitifully appropriate setting. The board met on the day after Christmas at the Peabody Hotel at 3:00 p.m. and was there past 7:00 that night. It was resolved that board members would visit the towns most severely hit during the 1878 epidemic, collect blood and tissue samples, investigate weather phenomena and conduct a chemical analysis of the air. Just the idea of testing the air demonstrated the pervasive fear of this disease. In the minds of nineteenth-century scientists, it was as though some unknown, unseen entity traveled through air, climbing, claws extended, into a healthy human to leave a corpse behind.

Mitchell served on the committee to interrogate local doctors and specific cases, as well as quarantine measures. His committee would also keep accurate record of the number of yellow fever cases in 1878, dividing them among whites, blacks and mulattos. The entire Board of Health would meet in Washington, D.C., in January to make presentations.

The findings of these boards have been written into the pages of history in staggering statistics: “Yellow fever should be dealt with as an enemy which imperils life and cripples commerce and industry. To no other great nation of the earth is yellow fever so calamitous as to the United States of America. In a single season more than a hundred thousand of our people were stricken in their homes, and twenty thousand lives sacrificed by this preventable disease.”

The board declared that yellow fever made its first appearance in this hemisphere after the discovery of America by Columbus, and it had appeared in a long list of states: Massachusetts, Rhode Island, New Hampshire, Connecticut, New Jersey, Pennsylvania, New York, Delaware, Maryland, Illinois, Missouri, Ohio, Kentucky, Virginia, North Carolina, South Carolina, Georgia, Alabama, Tennessee, Mississippi, Arkansas, Louisiana, Florida and Texas.

Racially, yellow fever decimated members of the white population.While blacks did contract the fever, more so in 1878 than in any other year, the number of deaths was drastically different based on skin color. During the 1878 epidemic in Memphis, the mortality among whites was 70 percent and among blacks 8 percent. In actual numbers, out of 14,000 blacks, 946 died; among 6,000 whites, over 4,000 perished. White Irish immigrants in particular suffered the most. Another unusual aspect of the 1878 epidemic surfaced in New Orleans. In the past, yellow fever had been kinder to children than to adults, often leading to a mild case and a lifelong immunity. That year, New Orleans statistics showed that nearly two-thirds of the deaths were children, the great majority under the age of five.

Most likely, the slave trade had provided a small measure of genetic immunity against the disease for blacks. Living in the South and surviving childhood bouts with the fever also offered immunity. Many of their encounters with yellow fever whether on plantations, in rural areas or in the poor sections of cities most likely went unreported. Whatever the cause of immunity, it had been fuel for racism for decades. White slave owners had argued for keeping slaves as a labor force since they seldom fell to the fevers that so plagued whites in the South.

In the months that followed the Board of Expert’s presentation, the argument over public health escalated, and distinct lines were drawn between the two public health giants, the North and the South and theories of how yellow fever spread. Every issue, on all sides, seemed driven by self-interest.

John Shaw Billings, with the U.S. Army Medical Corps, wanted control of the national board, so his American Public Health Association argued that yellow fever was a matter of sanitation, which of course, fell under their jurisdiction. Northern politicians who did not want to see quarantines impede commerce aligned themselves with Billings. If yellow fever was a sanitary matter, why would quarantines be necessary?

On the other side, John Woodworth, surgeon general of the Marine Hospital Service, also vied for control. He wanted strong quarantine powers, which would be controlled by his Marine Hospital Service. It was not the first time, and it would not be the last, that the Army Medical Corps and the Marine Hospital Service found themselves on opposing sides of a yellow fever argument.

The only ones making an honest case in this mire of politics, public insults and self-interest seemed to be the South. They just wanted the yellow fever epidemics to stop, and most southern health officials believed that Woodworth’s strong, federal quarantine—whatever the cost to commerce—was the way to do that. Memphis’s Casey Young who survived his case of yellow fever that fall argued that he “had fought for four years in trying to make the states greater than the Federal Government, and that effort had cost millions of lives, and this effort made . . . to establish the superiority of the state, if it resulted in defeat of the bill, would result in the loss of many more lives.”

Woodworth and his southern supporters lost the debate, and their bill was defeated. John Shaw Billings won the day, and in spite of the ruthlessness of this argument, his place in history remains a great one. Billings was instrumental in opening Johns Hopkins University, and he started the Surgeon General’s Library, which would one day become the National Library of Medicine.

Eleven days after the very public debate and humiliating loss, John Woodworth died; his death was rumored to be a suicide. In the wake of this brawl and a divided nation, the National Board of Health was formed.