Table of Contents
Title Page
Copyright Page
Epigraph
PART ONE - The American Plague
PART TWO - Memphis, 1878
CHAPTER 1 - Carnival
CHAPTER 2 - Bright Canary Yellow
CHAPTER 3 - The Doctors
CHAPTER 4 - A City of Corpses
CHAPTER 5 - The Destroying Angel
CHAPTER 6 - Greatly Exaggerated
CHAPTER 7 - The Havana Commission
CHAPTER 8 - Reparations
PART THREE - Cuba, 1900
CHAPTER 9 - A Splendid Little War
CHAPTER 10 - Siboney
CHAPTER 11 - An Unlikely Hero
CHAPTER 12 - A Meeting of Minds
CHAPTER 13 - The Yellow Fever Commission
CHAPTER 14 - Insects
CHAPTER 15 - Vivisection
CHAPTER 16 - Did the Mosquito Do It?
CHAPTER 17 - Guinea Pig No. 1
CHAPTER 18 - Camp Lazear
CHAPTER 19 - A New Century
CHAPTER 20 - Blood
CHAPTER 21 - The Etiology of Yellow Fever
CHAPTER 22 - Retribution
CHAPTER 23 - The Mosquito
PART FOUR - United States, Present Day
CHAPTER 24 - Epidemic
CHAPTER 25 - A Return to Africa
CHAPTER 26 - The Vaccine
CHAPTER 27 - History Repeats Itself
EPILOGUE
Acknowledgements
Notes
Selected Bibliography
“Engrossing . . . Crosby, a journalist, profiles the outbreak as it rips through Memphis, the city hardest hit. A first-rate medical detective drama . . . It is good to be reminded of the occasional nobility of the human spirit.” —The New York Times Book Review
“A fascinating book about yellow fever, its unspeakable horrors and the uncommon valor that four doctors displayed in their quest to solve a devastating medical mystery.” —The Tennessean
“A forceful narrative of a disease’s ravages and the quest to find its cause and cure. Crosby is particularly good at evoking the horrific conditions in Memphis, ‘a city of corpses’ and . . . also relates arresting tales of heroism.” —Publishers Weekly
“Seamlessly blends history and science to tell us how yellow fever haunted the nation—and why, if we’re not extremely vigilant, it will haunt us again.” —Hampton Sides, author of Blood and Thunder
“Masterful . . . Crosby uses rich detail and a stunning cast of characters to bring to vivid life the devastating yellow fever epidemic of 1878.” —Candice Millard, author of The River of Doubt
“Meticulous research and adroit storytelling . . . After a few chapters of The American Plague, I had to take an aspirin and lie down—and that is a tribute to the power of Molly Crosby’s memorable evocation of a terrible time.”
—Robert M. Poole, author of Explorers House
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PRINTING HISTORY
Berkley hardcover edition: November 2006
Berkley trade paperback edition: September 2007
Berkley trade paperback ISBN: 978-0-425-21775-7
The Library of Congress has catalogued the Berkley hardcover edition as follows:
Crosby, Molly Caldwell.
The American plague : the untold story of yellow fever, the epidemic that shaped our history /
Molly Caldwell Crosby.
p. cm.
Includes bibliographical references and index.
eISBN : 978-1-4406-2046-1
1. Yellow fever—History. 2. Yellow fever—Tennessee—Memphis—History. I. Title.
RC211.T3C76 2006
614.5’41—dc22
2006050497
PRINTED IN THE UNITED STATES OF AMERICA
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http://us.penguingroup.com
Author’s Note
This is a work of nonfiction: Any italicized or quoted statements are taken directly from letters, diaries, articles, books, or actual dialogue. The greatest challenge in writing this book was that the people involved, though truly heroic, were not famous. Even Walter Reed, best known of all the principal characters, has only a handful of biographies to his name, most of which are out of print. To write this story, I relied heavily on personal letters and diaries for character development; the rest was filled in with historical information from the time period and newspaper clippings. In Memphis, I pored through old photographs, newspapers and family papers to re-create the city in 1878. I visited numerous libraries for historical collections pertaining to this story, including the New York Academy of Medicine, which now houses Jesse Lazear’s original logbook—it was lost for fifty years before someone found it in a trash can and retrieved it. And I traveled to Havana, Cuba, to visit and photograph the original site of Walter Reed’s yellow fever experiments.
I am greatly indebted to Philip S. Hench, a Nobel Prize-winning scientist, whose personal hobby was acquiring and interpreting massive amounts of information on Walter Reed and his Yellow Fever Commission for a book. Hench died before he was able to write that book, and his collection is now held at the University of Virginia; mine is but one of many other books that have sprouted from his years of research and insight.
The scope of this disease and its effect on this country is vast. It was a plague intrinsically tied to the worst and best in humanity, bro
ught on by the mistreatment of others and conquered only by self less sacrifice. In this book, I hoped to give a poignant portrayal of yellow fever by narrowing the focus to one town, a Southern city that would rise from the ashes, and a handful of doctors, one of whom would rise in the ranks of our country’s history. Yet their stories are the stories of dozens of other places and thousands of other people.
Nothing is an accident. Fever grows in the secret places of our hearts, planted there when one of us decided to sell one of us to another.
—JOHN EDGAR WIDEMAN,Fever
PROLOGUE
A House Boarded Shut
The flies had been swarming around the house for days. As he walked the exterior, he tried to peer into the boarded windows where flies crawled through starbursts of broken glass. Shielding his eyes with cupped hands, he could not see anything through the black splinters of darkness but a gray, dim light. He had no name, at least not one that survived in the family records; he was an old slave who continued to live with the Angevine family as a servant long after he had been legally freed. The family owned a 4,000-acre farm outside of Grenada, Mississippi, where Mrs. Angevine had been born and raised before marrying a New York attorney and moving to Memphis. A graduate of Harvard Law, Mr. Angevine worked in the Memphis offices of Harris, McKissick and Turley. When the Civil War broke out, he fought for the South against his brothers fighting for the North.
The family left Memphis and boarded themselves inside of the plantation house when the 1878 yellow fever epidemic struck. The measure may have seemed drastic to others, but Mr. Angevine understood the toll of yellow fever better than most; his wife had died of the fever the previous summer.
As far as the servant could see, the front door was locked, and the flies seemed to have the only access to the house. He pried open the shutters and broke the glass, letting loose a plume of repugnant air. In the stale, dark rooms he saw the corpses of the Angevine family, many in advanced stages of decomposition. Even in the darkness, he could see their yellow skin, the color of unpolished brass. Mary Louisa, the eldest, had been the first to go, and five others had followed. Mr. Angevine lay dead among his children.
No one can really imagine those final days in the fever-ridden house. 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 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.
The servant climbed through the window and made his way through the rooms where other servants and guests had died. Finally, he found a body not yet rotting; it was the youngest daughter, nine-year-old Lena. He knelt down, brushing away flies and maggots. Lifting her weightless frame, he carried her out of the family mansion that had now become a tomb, into the fresh air. He placed her body in a nearby house, resting a piece of raw bacon across her lips, and watched as Lena began to suck on the first bite of food she had had in days. It was then that Lena, more dead than alive, began to make her way back.
In the coming weeks, she would recover and tell of the horrors trapped inside of the house. Men from the countryside came into the city, robbing the dead and stepping over the bodies of the dying. “My own father, while ill with the fever, was choked, robbed and left alone to die: I was too ill to even cry out for help, but witnessed the entire affair.”
With no surviving family, Lena went to live with her grandparents in Memphis to attend St. Mary’s School. After graduation, and against the wishes of her grandparents, she enrolled in a nursing school at the Maury and Mitchell Infirmary, where she worked under the tutelage of Dr. Robert Wood Mitchell.
The remainder of Lena Angevine’s time in the South was a patchwork of nursing, ambition and marriage to a St. Louis man by the name of E. C. Warner. Warner, whose name Lena Angevine would take from that point forward, died of a heart attack just four months after the marriage. At least that was the generally accepted story; family rumors also alluded to a divorce. As it was far better to be a widow than a divorcée in the 1890s, Lena Warner would naturally opt for a dead husband over an estranged one.
Lena Angevine Warner’s experience with yellow fever would continue to sear her, and in 1898, with the outbreak of the Spanish-American War, she answered an ad in the newspaper. The surgeon general of the United States Army was looking for nurses immune to yellow fever. Warner would receive fifty dollars per month, and in 1900, she was stationed in Cuba as chief nurse under a doctor of some distinction, Major Walter Reed.
PART ONE
The American Plague
Plague: A widespread affliction or calamity, especially one seen as divine retribution.
—The American Heritage Dictionary
The rain came in West Africa. A massive wind blew in from the Atlantic coast bringing the deluge of water known as the southwest monsoon. It swelled the Niger and Benue rivers; it spilled into the braided streams of the Niger Delta; it filled the flood-plains and swamplands of southeastern Nigeria. It purpled the sky and saturated the country.
Towering oil palms dripped water from their feathered branches, and the brush-marked trunks of rubber trees were streaked with rain. The broad, bush-topped cocoa trees moistened. And the forests of Nigeria grew heavy and humid. Water is nourishing, and it enriched the plant life emerging from West Africa’s dry season. It also nourished something else—dry, oval-shaped eggs clinging to life inside the hollows of trees. Once the rain fell, those eggs grew, and soon, mosquitoes hatched. In the natural world, a string of events had been set into motion.
The rains falling in Africa did not deter men from entering the forest and felling trees for timber. As the trees fell, their canopy of dense green fell with them, often bringing a swarm of gnats and mosquitoes with it. Some of those mosquitoes would bite.
The native Africans who worked the forests noticed an eerie silence in the trees. Usually alive with the piercing sound of birds, the hum of insects and the calls of monkeys, tree canopies in some areas were still, a haunting contrast to the living, breathing rain forest—a sign that something was not right in the ecosystem. The monkeys had grown ill, their shrill chatter quieted. Unknown to the men, the rain forest, teeming with smells, sounds, color and life, was also home to something much smaller. Microscopic. A tiny, thriving life-form.
No one knows for sure how the yellow fever virus first came into existence. No records of it in early history exist, nor is it among the biblical plagues. But then, how does any new life emerge? There is a creation and a birth and eventually a discovery in the dark forests of Africa.
A virus is one of the smallest beings in evolution’s survival of the fittest, mutating and coalescing in order to thrive, its ultimate goal being epidemic. Viruses affect nearly every life-form on earth from flora to fauna, but a virus in its own right is not actually alive—it only becomes alive by possessing something living. The virus seeks out a healthy cell, overtakes it, impregnating it, forcing the body’s cells to produce thousands of the new offspring. This rapacious battle will eventually allow the virus, something as small as one-ten-thousandth of a millimeter, to conquer something the size of a human.
It is uncertain whether viruses evolved from a single cell, becoming more complex, or whether they devolved into something simpler, more efficient, gracefully infectious. Either way, a virus is an evolutionary masterpiece; since it does not have the ability to have sex or reproduce o
n its own, it must constantly change, adapting to other life-forms—from something as small as bacteria to something as large as mammals. Taking it a step further, once the virus has mastered something like a mosquito in the case of yellow fever or a bird in the case of influenza, it may spread to other species. There, it adapts again and again until there is a seamless transition between certain species—perhaps a monkey to a mosquito to a man.
Once inside the bloodstream, a virus is programmed with elegantly simple genetic material, its DNA or RNA, to produce certain symptoms that will spread it further. In the common cold, sneezing and a runny nose spread the virus. In smallpox, open sores on the skin act as the vehicle for infection. With influenza, coughing expels the virus into the air. In the case of HIV, the virus uses one of the most basic functions in human life— reproduction—to spread through the population of men, women and children.
Yellow fever is what is known as a flavivirus, a group of viruses spread by mosquitoes that includes West Nile, dengue and Japanese encephalitis. As a virus, yellow fever is not one of the stronger ones. It cannot live outside of the body for more than a few hours. It does not spread through the air or by touch. It does not mutate as easily as some viruses. In fact, its most telling symptom—fever—is really just the body’s own attempt to kill the virus. What makes yellow fever unique is its choice of vector. What the virus lacks in evolutionary prowess, the mosquito makes up for.
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