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.
CHAPTER 7
The Havana Commission
While Memphis struggled to rebuild itself, the nation continued to grapple o
ver the question of what to do about yellow fever. Hayes’s Board of Experts had failed to do anything more than provide statistics for past epidemics and the dismal results of the most recent one. What Hayes needed now was a group of experts to go to the source of the problem: Cuba. After all, Cuba had proven to be the hub for all major epidemics of the American plague over the last two centuries. The country could not afford to wait for yellow fever to strike another severe blow. It had to go to the source of the problem and seek out the virus. The National Board of Health organized a group of yellow fever experts to travel to Cuba and study the disease—they were the Havana Yellow Fever Commission.
Dr. Carlos Finlay had an air of madness about him. He was not mad, quite the opposite; he was brilliant. But he had trouble expressing himself, in part because his mind seemed to work faster than words could accommodate, but mostly because a childhood bout with a nervous system disorder had left him with a distinct stutter.
Juan Carlos Finlay was born in Cuba in 1833. The Finlay family moved to Havana when Carlos, as he would choose to be called, was only one year old. His father was a Scottish physician who was on a British expeditionary force when his ship wrecked near Trinidad, and he met Finlay’s mother. In Cuba, Finlay’s father practiced medicine and owned a coffee plantation, where Carlos was homeschooled as a child. Finlay’s father also loved to travel, and he took Carlos with him on trips throughout the West Indies, South America, and later, Europe.
Finlay’s education was multinational as well. He was sent to school in France, but eventually returned after a bout of typhoid. Like his father, Carlos Finlay wanted to practice medicine, but he needed a bachelor of arts degree to do so in Havana. Finlay moved to the United States where medical education was still substandard, and he would not need a degree to enter medical school. He graduated from Jefferson Medical College in Philadelphia.
What Finlay really wanted, however, was to return home to Havana; but, before he could practice medicine there, he would need to pass the oral board examination. Finlay’s stutter—paired with Havana’s low opinion of American medicine—caused him to fail at his first attempt, but persistence was a hallmark of Finlay’s personality. After a year of traveling with his father, Finlay settled back in Havana for good, finally passing his oral boards, and beginning his practice.
Dr. Carlos Finlay was a true intellectual of the Victorian age. He spoke fluent English, French, German and Spanish, and could read Latin; he liked to have breakfast in one language, lunch in a second and dinner in a third. He excelled at chess. Finlay was a member of Havana’s Royal Academy of Medical, Physical and Natural Sciences. He was also charitable, often taking on patients who could not afford care. Finlay published articles on subjects varying from cholera to leprosy, gravity to plant diseases, but his most prolific writing involved yellow fever. During his life, he published forty articles on the subject. He was particularly interested in the atmospheric conditions surrounding yellow fever— especially after the 1878 epidemic in the United States. In direct opposition to the prevailing contagionists versus noncontagionists view, Finlay believed that an intermediary host was responsible for the spread of the fever.
In 1879, just after the devastating yellow fever epidemic in the Mississippi Valley and beyond, the group of American yellow fever experts arrived in Havana. The Havana Yellow Fever Commission consisted of several members, including the chairman, Dr. Stanley E. Chaillé of New Orleans, Dr. George M. Sternberg of the U.S. Army Medical Corps and Dr. Juan Guitéras of the Marine Hospital Service. The Spanish government assigned counterparts in Havana to work with the commission, and Dr. Carlos Finlay was a natural choice. Finlay’s international background, his congenial nature and his knowledge of tropical diseases made him a perfect fit. One member of the commission would later describe Finlay as “an original, penetrating, tenacious, untiring investigator . . . a mentor worthy of imitation by anyone with a dedicated vocation to science and humanity.”
The commission moved into Havana’s Hotel San Carlos during their three-month stay. Chaillé was assigned to work on the prevalence of yellow fever in Cuba. Guitéras, a Cuban-born, American-educated professor of tropical medicine, looked for microorganisms and pathologic changes in the tissue of yellow fever cadavers. And Sternberg searched for a pathogen in the blood samples. Carlos Finlay, Juan Guitéras and George Sternberg would form a lasting friendship during the work—all three would spend the next twenty-five years fighting this disease.
Dr. Sternberg was an expert at photomicroscopy. Using oil immersion objectives and a Tolles amplifier, he produced 105 photographs of blood smears during his months in Cuba. Sternberg, America’s “pioneer bacteriologist,” also had an impressive résumé. He was captured by Confederates during the Battle of Bull Run, escaped and made his way back to Washington. After the Civil War, he served on the western frontier. During service at Fort Barranacas, Florida, Sternberg contracted yellow fever. He survived the fever, but it launched a twenty-year grudge against the disease he searched tirelessly for beneath the microscope. Like Finlay, Sternberg would publish roughly forty articles on the subject of yellow fever; but Sternberg’s expertise was not limited to yellow fever alone. He discovered, the same year as Louis Pasteur, the pathogen responsible for pneumonia, and he was the first in this country to show the malarial parasite and tuberculosis germ. But Sternberg was anxious for his own fame. He was ambitious, and it would take him far. Two decades later, Sternberg and Finlay would again battle yellow fever, one as the most powerful medical mind in America, the other as the most ridiculed scientist in Cuba.
The commission admired and worked well with Finlay, but ultimately were uninterested in his theory about atmospheric conditions, instead focusing on the ever-popular germ theory. They failed to discover any new groundbreaking information on the disease and soon returned to the United States. Finlay’s interest in the disease, however, was roused, and he began extensive studies building on the work of the commission. For his part, Finlay was more interested in the hemorrhaging so common to the disease. He believed the “germ” or agent of infection must be spread through the blood. What could pass blood from one person to another? What independent agent could take the blood of one sick person and spread disease to a second one?
There had been some very recent studies on insects as vectors by Patrick Manson, who would later make the connection between mosquitoes and malaria. There was also a French scientist named Louis-Daniel Beauperthuy who had suggested twenty years before that a mosquito—a striped one—had an intrinsic relationship to yellow fever. The fewer mosquitoes, the fewer incidences of fever. Where Beauperthuy missed the mark was in believing that the mosquito just carried filth or decomposing matter, spreading the disease through its bite. Around the same time as Beauperthuy, an American physician, Josiah C. Nott, had also suggested a sort of insect theory, wondering if the yellow fever germ could travel through air much like insects. Beauperthuy saw the mosquito as a vehicle for infected matter; Nott saw infected matter as taking flight like the insect. Both were wrong, but their theories circled the truth nonetheless and broadened thought for future scientists.
To Finlay, the insect theory would also explain why yellow fever epidemics were so sporadic, striking different cities during different years, in spite of quarantines. Finlay was particularly interested in a common striped mosquito, known later as Aedes aegypti, which proliferated in areas where yellow fever was present. That particular mosquito had a few peculiar habits that would make it an ideal vector of disease. As soon as it had digested a blood meal, Aedes aegypti went in search of another, which would enable it to carry and spread disease easily. The mosquito is also benumbed when the temperature drops below sixty degrees, which correlated with Finlay’s atmospheric studies on areas where epidemics are common and at what times of year they begin and end in places like New Orleans and Memphis. For the first time, it seemed there was a connection between the pest and the pestilence.
It was with a bitter sense of irony that Me
mphians would one day learn the yellow fever epidemics that nearly destroyed their city, a city named for Memphis, Egypt, would be spread by Aedes aeygpti: the Egyptian mosquito.
In 1881, Finlay began studies on Aedes aegypti and blood inoculations. His experiments were partially successful, producing a few mild cases. He presented his theory on August 14, 1881, to the Royal Academy under the title The Mosquito Hypothetically Considered as the Agent of Transmission of Yellow Fever. To Finlay, the theory made perfect sense, in spite of some inconclusive experiments. But to a medical age wholly dedicated to the germ theory and the idea of contagion, his ideas seemed bizarre. His experiments had also been riddled with problems, leaving more questions than answers. Finlay stood at the lectern and stuttered his way through his presentation, trying to explain his strange theory through fits and starts in his voice. When he finished reading his paper, he looked up and awaited questions from the audience. Instead, he was met with complete silence. The combination of his speech impediment and outlandish theories about mosquitoes left him ridiculed and rejected by the medical community. He was dubbed “Mosquito Man” by the U.S. press and became known as a “crank” and a “crazy old man” in Havana.
The American Plague Page 9
